Journal of Lumbini Medical College (JLMC)
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Hand Index- A Forensic Tool for Sexual Dimorphism
Get PDFIntroduction: Amongst the various parameters of identification, sex is one of the most important elements. Figuring out hand index from measurement of hand dimensions is a convenient way to determine sexual dimorphism. This study aims to find out sexual dimorphism from hand dimensions, obtain cut off points for male and female and check percentage accuracy of sex determination from hand dimensions in Nepalese population. Methods: The data was collected from 400 asymptomatic, healthy working staffs (229 males & 171 females) above 23 years in the department of Forensic Medicine and Toxicology of a tertiary care center of Western Nepal. Measurements of hand length and hand breadth were taken using standard instruments and hand index was calculated therefrom.
Results: The mean (+SD) right hand lengths for male and female were found to be 17.87 cm (+0.87) and 16.93cm (+0.58) respectively. The mean (+SD) left hand lengths for male and female were 17.85 cm (+0.86)and 16.97 cm (+0.56)respectively. The average hand breadth for male was 1.00 cm greater for right hand and 0.96 cm greater for left hand as compared to female hand breadth. Differences in length and breadth of hands for both sexes were statistically significant (p<0.001) with no statistically significant difference of hand dimensions in the same sex. Cut off point for right hand index was found to be 42.32 cm and for left hand, 42.30 cm.
Conclusion: Hand dimensions and hand index can be reliably used to determine sex in medicolegal cases, especially where isolated hand is obtained
Paradigm Shift in Gynecological Surgeries Over Eight Years in Dhulikhel Hospital.
Get PDFIntroduction: One of the greatest achievements in the surgical field is the paradigm shift from opensurgery to minimal invasive surgery. Hysteroscopy, laparoscopy, laparoscopy-assisted vaginal hysterectomyand total laparoscopic hysterectomy are frequently performed minimal invasive gynecological surgeries.These surgeries are being regularly performed in Dhulikhel hospital. This study aims to review thechanges in surgical approaches in the field of gynecological surgeries in this institute. Methods: This was aretrospective study of changes in surgical approaches from conventional to minimal invasive surgery in thefield of gynecological surgeries from 2010 to 2018. Demographic characteristics of patients and indicationfor various minimal invasive surgeries were compared over this time period. Results: There were significantchanges in surgical approaches from conventional open surgeries to minimally invasive approach throughthe years. There was no obvious difference in demographic characteristics of the cases and the indications forhysterectomy and endometrial sampling were comparable. Conclusion: There was definitely paradigm shiftin conventional method to minimal invasive methods for major gynecological surgeries like hysterectomy,ovarian cystectomy, salpingectomy for ectopic pregnancy and endometrial samplings
Predictive Factors for Post-Operative Bleeding in Percutaneous Nephrolithotomy.
Get PDFIntroduction: Post-operative bleeding is a serious complication necessitating prompt attention inPercutaneous Nephrolithotomy (PCNL). A number of factors dictate the severity of post-PCNL bleeding.Identification of these risk factors helps prevent bleeding complications. Methods: In this observationalcross-sectional study, a total of 126 patients with renal stones >10mm or stag-horn stones underwent PCNL.All the relevant pre- and intra-operative factors were noted and analyzed. Hemoglobin differences betweenpre- and post-operative levels were considered for the evaluation of blood loss. Univariate and multivariablelogistic regression analysis was done. The strength of association was examined using Odds Ratio and95% confidence intervals derived from the logistic regression. A p value <0.05 was considered statisticallysignificant. Results: The mean age of the patients was 31.9 ±4.47 years. The mean drop in hemoglobinwas 1.83 ±0.98 gm/dl. Age, stone size, number of tracts, size of Amplatz sheath and number of stonessignificantly affected the blood loss in univariate analysis. Among the variables mentioned above only, thenumber of stones could maintain the significance in multivariable analysis (p<0.05). The number of stonesincrease the risk of bleeding post PCNL by 4.4 times. Conclusion: Stone size, number of tracts, size ofAmplatz sheath and the number of stones significantly affect the blood loss post PCNL. Identification ofthese risk factors should be considered for minimizing bleeding in PCNL
Otomycosis and its Predisposing Factors in Out-Patient Department of Otorhinolaryngology in a Tertiary Care Center
Get PDFIntroduction: Otomycosis is a fungal infection of external auditory canal frequently encountered by
otorhinolaryngologists. It causes discomfort to patients with varied symptoms of pruritus, otorrhea, aural
fullness and earache. People with a habit of using unnecessary ear drops, cleaning ear with unsterilized
objects and those who use mustard oil are all prone to otomycosis. This study aims to find out the association
between otomycosis and its predisposing factors. Methods: This study was undertaken in the Department of
Otorhinolaryngology of a tertiary hospital from March 2018 to February 2019 and a total of 300 clinically
diagnosed cases of otomycosis were enrolled for the study. Results: The mean age ±SD of the patients was
37.7 ± 18.8 years. Females (n=172, 57.3%) were more prone to otomycosis than males (n=128, 42.7%). The most common presenting symptom was pruritus only (n=95, 31.7%) with unilateral involvement being more common. The most common predisposing factor was mustard oil instillation (n=124, 41.3%). Aspergillus niger was the most common fungus causing otomycosis in this study (n=104, 34.7%). Positive fungal cultures were observed in 285 specimens (95%). The fungal growth (n=285) was high in patients with the history of instilling mustard oil (42.8%) into the ear, 34.0% in topical steroid containing ear drops and 23.2% in self-cleaning group. Conclusion: Otomycosis is common in people using unnecessary steroid containing ear drops, cleaning ear with unsterilized objects and instillation of mustard oil
Nasal Parameters and Facial Index in Medical Undergraduates: A Cross Sectional Study
Get PDFIntroduction: Face has priority in identification of an individual. Nose occupying the middle of face is animportant sense organ that helps in respiration. Nose and face can be classified into different types accordingto nasal index and facial index. The aim of this study was to analyze nose and face type and find out itsdominance in different sex of Nepalese and Indian population. Methods: This was a quantitative observationalstudy conducted on 156 medical students using simple sampling method. Data were collected then nasalindex and facial index were calculated. Descriptive statistical data i.e. mean, standard deviation, togetherwith the independent-samples t-test results for anthropometric variables of nasal and facial parameters insex and Nationality (Nepalese and Indian) were analyzed. Results: All the measurement values were morein males compared to females, but the sexual dimorphism in nasal index (male 76.25 ± 7.75, female 75.70± 8.05) and facial index (male 85.77 ± 8.1, female 82.97 ± 7.63) is not statistically significant. Chi-squaretest revealed significant difference in face type among Nepalese and Indian population. Mesorrhine wasthe most common type of nose in both the population. Nepalese had commonly euryprosopic type of facewhile Indians had hypereuryprosopic type of face. Conclusion: Sexual dimorphism was not significant inboth nasal and facial parameters while type of face was helpful in differentiation of Nepalese and Indianpopulation
Cardio-respiratory Fitness in Medical Students by Queen’s College Step Test: A Cross-sectional Study
Get PDFIntroduction: Cardio-respiratory fitness indicates the ability of circulatory system to supply oxygen toworking muscles during continuous physical activity. Maximum oxygen uptake (VO2max) is a single bestmeasure of cardio-respiratory fitness and is considered gold standard to quantify aerobic capacity. Methods:Eighty students of age group 18-25 years were taken by simple random sampling. VO2max was estimatedindirectly by following the protocol of Queen’s College Step Test (QCST) method. Results: Mean value ofVO2max for male (51.61±6.26 ml/Kg/min) and female (36.02±3.71 ml/Kg/min) was compared, which wasfound significantly higher in males than in females (p<0.001). There was negative correlation of gender(r = -0.838), body mass index (BMI) (r = -0.339), obesity category (r = -0.275), obese vs non-obese (r =-0.264) and basal pulse rate (r = -0.456) with VO2max and positive correlation of height (r = 0.592) and hoursof study(r = 0.309) with VO2max. Conclusion: This study showed that increased BMI is associated withdecreased level of VO2max in young adults. One can improve VO2max by maintaining BMI within normallimits
Clinico-epidemiology of Hymenoptera Stings in and around Kaski District, Nepal.
Get PDFIntroduction: In Nepal, morbidity and mortality from Hymenoptera stings is mainly from three commonly encountered insects: hornets (local: aringal), wasps (local: barulo) and honey bees (local: mahuri). The present study documents the incidence of hymenoptera sting in Western Region of Nepal and explores the cause behind such unprovoked attack upon human subjects. Methods: This hospital-based study included all the patients with history of insect sting attending the Emergency Department of Manipal Teaching Hospital, Pokhara from May 2015 till November 2015. Results: Of total 16 cases during the study period three were brought dead cases. The alleged insect happened to be bee in two cases, hornet in two cases, and wasp in eight cases with a case of unidentified insect sting. Severe burning pain with swelling, redness and itching were the common presenting symptom in all the admitted patients (n=13). Conclusion: Agricultural activity during the day was the cause of most unprovoked stings followed by deliberate destruction of the insect hive. Immediate medical attention in the nearby health care facility to the victims will save mortality. The health care facility also needs to have surplus lifesaving medication to counteract the life-threatening anaphylaxis reactions from such stings
Efficacy of Tranexamic Acid in Reducing Blood Loss in Cesarean Section: A Comparative Study.
Get PDFIntroduction: Obstetric hemorrhage is one of the major causes of maternal morbidity and mortality. Blood loss during cesarean section is almost twice than that in vaginal delivery. The aim of this study was to evaluate the efficacy of tranexamic acid to reduce blood loss in cesarean section and its side effects. Methods: A comparative study was done in 100 women undergoing cesarean section between December 2015 to January 2017. The study group of 50 women received one gram intravenous tranexamic acid and the control group of 50 women did not receive tranexamic acid. Primary outcome measure was blood loss during cesarean section. Secondary outcome measures were drop in post-operative hemoglobin and hematocrit, change in pulse rate and blood pressure, need of additional uterotonics, auxiliary procedures to stop bleeding, blood transfusion rate and maternal and neonatal side effects of the drug. Results: Mean intraoperative blood loss in the study group was 443.62± 86.73ml; and in control group, 667.40±131.01ml (p<0.001). Mean postoperative drop in hemoglobin (g/dl) in the two groups were 0.82±0.27 and 1.86±0.64 respectively (p<0.001). Mean postoperative drop in hematocrit in the two groups were 2.60±0.91 and 5.49±1.97 respectively (p<0.001). Fourteen patients in the control group required additional uterotonics while none in the study group (p<0.001). There was no significant difference in the transfusion requirement (p=0.079). None of the mothers and the newborns had major side effects of drug. Conclusion: Tranexamic acid is a safe and effective drug to reduce blood loss in cesarean section
Axial Torsion and Meckel’s Diverticulitis: A Diagnostic Conundrum
Get PDFIntroduction: Meckel’s diverticulum is one the most common congenital anomalies of gastrointestinal tract that mimics acute appendicitis, gastroenteritis, peptic ulcer disease. Complications related to it can be haemorrhage, intestinal obstruction, perforation while axial torsion is one of the rarest complications. So, this paper objectifies a rare clinical scenario that we encountered in our practice and highlights on the possible management strategies. Case : An 11 year boy presented with a history of pain at peri-umbilical region for four days with 2-3 episodes of vomiting. Abdominal examination revealed tenderness at suprapubic area with a mass around 5x3 cm along hypogastrium. Ultrasonography abdomen revealed an avascular structure in central area with clumping of bowel and omentum over the lesion while computed tomography scan of abdomen revealed blind ended gas filled structure at hypogastrium with thickened enhancing irregular wall associated with adjacent mesenteric fat plane stranding and prominent adjacent axial vessels supplying inflammatory lesion. Exploratory laparotomy showed axial twisting of diverticulum about 10x5 cm arising from anti-mesenteric border around 50 cm proximal to ileo-caecal junction with a fibrous band attached to the fundus and ileum leading to gangrenous diverticulum with clumping of bowel loops along with omental covering. De-twisting and adhesiolysis along with excision of the diverticulum was done with two layered closure of the defect. Conclusion: Axial torsion is the rarest of the complication of MD and should be managed with utmost caution. Excision of the twisted diverticulum with or without wedge resection of the involved ileum is the procedure of choice