Journal of Lumbini Medical College (JLMC)
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Echocardiographic profile of patients with cardiomyopathy
Get PDFIntroduction: Cardiomyopathies represent a heterogeneous group of diseases that often lead to progressive heart failure with significant morbidity and mortality. Exact epidemiological data on cardiomyopathy in Nepal are lacking. This study was done to observe the demographic and echocardiographic profile of patients with cardiomyopathy attending a medical college teaching hospital.
Methods: Trans-thoracic two-dimensional echocardiographic study was performed by first author on all patients with cardiomyopathy over a period of six months. Patients’ demographic and echocardiographic data were collected and analyzed using SPSS version 20 software. Student t-test and Chi-square test were applied where appropriate.
Results: A total of 60 patients were studied from October 2017 to March 2018. Mean age of all participants was 56.38 years (SD = 13.86). Mean age of males was significantly higher than that of females (60.96 yrs, SD = 13.61 versus 51.62 yrs, SD = 13.47) in dilated cardiomyopathy subgroup (p < 0.05). Of all patients, 32 (53.33%) had dilated cardiomyopathy (idiopathic) and 13 (21.66%) had ischemic cardiomyopathy.
Conclusion: Our study highlighted significant burden of dilated cardiomyopathy. Dilated cardiomyopathy appeared in females at earlier age compared to males. Potentially reversible cardiomyopathies like alcoholic and peripartum cardiomyopathies were also present which have a probability of cure if treated properly
Psychiatric Comorbidities in Patients with Alcohol Dependence Syndrome in a Tertiary Care Center: A Cross-Sectional Study
Get PDFIntroduction: The co-occurence of substance abuse and mental illness is well known. Alcoholics are reported to be three times more likely to suffer from another psychiatric disorder. This study aims to observe the prevalence of psychiatric comorbidity in alcohol dependent patients in our setup. Methods: This was a hospital based cross-sectional observational study conducted over a period of three months. Consecutive patients presenting to the out-patient section of Psychiatric department who met the DSM-IV-TR criteria for alcohol dependence were included in the study. They were interviewed using Structured Clinical Interview for DSM-IV-TR (SCID I&II) to assess for comorbidity. Data was analyzed using Statistical Package for Social Sciences (SPSS TM) software. Mann Whitney U test and Chi square or Fisher\u27s Exact tests were used for statistical analysis. Results: Out of 31 patients enrolled, 14 (45.16%) had psychiatric comorbid conditions all of which were Axis I disorders. Anxiety disorder (35.71%) was the most frequent associated disorder followed by depressive disorder (28.57%). The alcohol dependent patients with comorbidity was significantly younger (mean age=35.71±13.60 years) in comparison to those without comorbidity (mean age=42.59±11.15 years). Other socio-demographic parameters were comparable between the two groups. Patients with history of past psychiatric illness and medication were less likely to have comorbidity, which was statistically significant. Conclusion: Psychiatric comorbidity is common in alcohol dependent people. Anxiety disorder and depression were more prevalent entities. Those with past illness and medications were less likely to have comorbidities
Hypovitaminosis D in Healthy Health Care Professionals: A Real Deficiency or Necessity of New Reference Value for Specific Population?
Get PDFIntroduction:
Vitamin D, a steroid vitamin, has attracted noticeable interest of clinicians and researchers for decades because of its diverse array of biological functions. Various studies have shown that the level of vitamin D is low in significant proportion of healthy individuals. However, indoor workers especially health care professionals are not focused, particularly in Nepal. We aimed to measure level of vitamin D in apparently healthy health care professionals.
Methods:
A descriptive cross-sectional study was carried out in apparently healthy health care professionals working at Kathmandu University Hospital in Dhulikhel, Nepal. Structured questionnaire including socioÂdemographics, dietary habits, and anthropometric measurements was filled in by the participants. Total serum 25-hydroxy vitamin D was measured by Chemiluminescence Immunoassay (CLIA) technique. Results were analyzed with t-test, Chi-square test, and Pearson correlation test.
Results:
Data from 64 female and 47 male were analyzed, mean 25-hydroxy vitamin D level was 8.81 ng/dl (SD = 4). Almost all (98.2%, n = 109) participants had vitamin D lower than normal where 72.7% (n = 92) were deficient, 24.5% (n = 17) were insufficient, and only 2.7% (n = 2) were having adequate level. Non-specific body pain was the only factor among all we studied that was significantly associated with vitamin D levels (p = 0.002).
Conclusion:
Hypovitaminosis of 25-hydroxy vitamin D was found to be very common (98.2%) in apparently healthy health care subjects of Dhulikhel Hospital. This may necessitate further research to redefine the biological reference value for our population
Estimation of Height from Foot Dimensions
Get PDFIntroduction: Height determination by measuring various body parts is of value in medicolegal investigations as well as in anthropology. The current study was conducted to analyze interrelation between foot dimensions and stature, and to predict stature from foot dimensions.
Methods: The study was done in medical students where stature, foot length, and foot breadth were quantified using standard instruments. We calculated correlations between variables with correlation test and predicted stature from foot length and foot breadth using linear regression.
Results: The correlation between foot length and stature, and foot breadth and stature were statistically significant in both gender (p < 0.05). Greater correlation coefficient between foot length and stature than that for foot breadth and stature indicated stronger correlation between foot length and stature. Separate formulae were drawn for calculation of stature from foot breadth and foot length by regression analysis.
Conclusion: Both foot breadth and foot length were correlated with stature. Foot length was found to be a better predictor of stature
Kluver-Bucy Syndrome in a Patient with Bipolar Affective Disorder: A Case Report
Get PDFIntroduction: Kluver and Bucy described a behavioral syndrome in rhesus monkeys following bilateral temporal lobectomy which included psychic blindness, hyperorality, hypermetamorphosis, hypersexuality, and emotional unresponsiveness.
Case report: A 44 years old right handed male of Indo-aryan origin, blacksmith by profession, had presented in manic phase of bipolar illness. He had hypersexuality, hypermetamorphosis, hyperorality, and altered dietary habits along with amnesia and fleeting misrecognition of even his close relatives. MRI of the patient showed mild cerebral atrophy with right temporal lobe atrophy. The patient was treated with lithium and olanzapine along with benzodiazepines. The symptoms resolved gradually with resolution of the manic phase. Patient had similar features in the previous manic episode as well that resolved with resolution of mania.
Conclusion: The symptoms of Kluver-Bucy syndrome like increased libido, increased activity might be confused with that of mania. Other features of Kluver-Bucy syndrome and the overt hypersexuality could help identify it even during manic phase of bipolar illness
Insomnia, its Prevalence, Associated Factors and Effects on Old Age: A Cross-Sectional Study
Get PDFIntroduction: Insomnia is a common problem among old age population. Almost half of all old age adults report difficulty in initiating and maintaining sleep. The objective of this study was to assess the prevalence of insomnia, its associated factors and effects in old age adults. Methods: This was an observational analytical study where adults above 60 years of age from a ward of a village development committee were included. Data were collected for a period of four months. Insomnia was measured by Athens Insomnia Scale and structured questionnaires were used to assess the effects of insomnia. Descriptive statistics were presented as frequency and percentages. Association between variables was assessed with Chi-square test or Fisher\u27s Exact test as appropriate. Results: There were a total of 55 participants in the study. Insomnia was prevalent in 56.4% (n=31) of the study population. Among the studied socio-demographic variables, presence of medical illness was significantly associated with insomnia. Insomnia was significantly associated with morning headache, irritability, unhappiness, fatigue, lack of concentration, day time sleepiness, avoiding interaction with people, and need of sedative for sleep. Conclusion: Majority of the old age adults suffer from insomnia with night awakenings as the most common symptom. Insomnia significantly affects various aspects of life at an old age
Bicondylar Angle and its Relation with Length and Neck Length of Human Femur
Get PDFIntroduction: Femoral bicondylar angle has immense importance from anatomical and clinical (forensic and anthropometric) point of view and is the characteristic feature of bipedal gait in humans. It is the angle between axis of femoral shaft and a line perpendicular to its transcondylar axis. The study was carried out to assess bicondylar angle and its relationship with femur length and neck length.
Methods: Bicondylar angle, length, and neck length of available dry human femurs of unknown sex and age were measured using osteometric board and vernier caliper. Bicondylar angle between two sides were compared. Similarly, relation between the angle and femoral length and length of femoral neck was studied.
Result: Bicondylar angle on right side was 8.65° (SD = 2.03) and on left side was 9.35° (SD = 2.05) and the different was not statistically significant (p = 0.08). On both sides, no significant correlation was found between bicondylar angle with femoral length and length of femoral neck.
Conclusion: Mean bicondylar angle of right femur was 8.65° and that of left was 9.35° and the difference was not statistically significant. There was no significant relation between the angle and other two parameters
Evaluation of Clinical Characteristics and Outcomes of Obstetric Patients Admitted to Intensive Care Unit: A Case Control Study
Get PDFIntroduction: The need for critical care support and admission to intensive care unit (ICU) in obstetric population is infrequent. The proportion ranges from 0.1 to 8.5%. Yet, obstetric admissions to ICU and mortality continue to have a significant impact on overall maternal health care. The study of epidemiology and predictors of obstetric admissions to ICU will prove a useful proxy for better understanding maternal near miss events and mortality.
Methods: This was a case control study reviewing all the obstetric cases admitted to ICU over a study period of five years. The individual files were recovered from the record section and data pertaining to referral status, demographics, clinical profile and ICU information were retrieved. The ICU data comprised of the length of ICU stay, indications for admission, interventions required, and outcomes. The data were then compared to historical controls.
Results: A total of 80 patients were admitted to ICU accounting for 0.84% of total deliveries and 4.6% of total ICU admissions. Mean age was 24.84 years, mean gestational age was 32.33 weeks, and mean blood loss was 707.27 ml. Hypertensive disorder of pregnancy followed by obstetric hemorrhage were the most common indications. Lower gestational age, increased blood loss, emergency cesarean sections, and surgical interventions were noteworthy risk factors for ICU admissions. There was a mortality rate of 5%.
Conclusion: Hypertensive disorders account for the most number of admissions to ICU followed by obstetric hemorrhage. Lower gestational age, increased blood loss and emergency cesarean section are notable risk factors for ICU admission
Outcome of Percutaneous Nephrolithotomy in Horseshoe Kidneys
Get PDFIntroduction: The horseshoe kidney is extremely rare, the incidence being one in every 400 - 800 patients. In a recent review of more than 15000 radiographic imaging studies, the incidence was one in every 666 patients. The renal stone formation in horseshoe kidney is around 20-80%. Percutaneous nephrolithotomy is the most accepted modality of treatment . This study was carried out to find the outcome of percutaneous nephrolithotomy in horseshoe kidneys.
Methods: Between May 2013 and November 2017, 11 adult patients (12 renal units) with stones in horseshoe kidneys underwent percutaneous nephrolithotomy in the department of urosurgery, Kathmandu Medical College and Teaching Hospital and were evaluated for the operating time, stone free rate , complications and hospital stay. Data analysis was done using Statistical Package for the Social sciences (SPSS) Version 20. Categorical data were analysed by using Fisher exact test.
Results: The mean age of the patients was 30.9 years (SD = 10.3) and the mean stone burden was 385.83 mm2 (SD = 331.3). The overall stone free rate was 83.33%. The two patients with residual stones when counselled for Extracorporeal shock wave lithotripsy, refused for it and decided to be on follow up. No auxiliary procedure was done. The complications noted were of Clavien-Dindo grade I and II. No pleural or bowel injury was seen. One patient needed blood transfusion.
Conclusions: Percutaneous nephrolithotomy is safe and effective in the management of stones in horseshoe kidneys. It does not carry increased risk than reported in normal kidneys
Comparative Evaluation of Effectiveness of Intravenous Paracetamol and Intravenous Diclofenac as Post-operative Analgesia in Laparoscopic Cholecystectomy
Get PDFIntroduction: Though the development of minimally invasive surgery has revolutionized the field of surgery, post-operative pain is still a significant issue. Unlike in the past, concerns about adverse effects have limited the role of opioids in post-operative pain management. This study aims to compare the effectiveness of intravenous paracetamol and diclofenac as postoperative analgesia in laparoscopic cholecystectomy.
Methods:One hundred and twenty eight patients of American Society of Anesthesiologists (ASA) categories I and II included in this study were divided into two groups. Anesthesia induction and maintenance were standardized. The first group received 15mg/kg (maximum 1gm) intravenous paracetamol and the second group received 2mg/kg (maximum 75mg) intravenous diclofenac 30 minutes prior to ending of surgery. A questionnaire was responded by patients and chart was maintained by visual analogue scale. Mann Whitney U test was used to analyze quantitative data and Chi-square test for categorical data. P value <0.05 was considered statistically significant.
Results: Profiles of hemodynamic changes were almost similar in both groups with respect to heart rate and blood pressure. However, paracetamol infusion provided hemodynamic stability in post-operative period. We observed statistically significant differences in visual analogue scale between the two groups. Most of the patients in paracetamol group had low mean pain scores in post-operative period and provided an extended analgesia compared to diclofenac. No serious postoperative complication was observed in paracetamol group.
Conclusion: Administration of intravenous paracetamol has better and prolonged analgesic effect with low mean pain score and less requirement for rescue analgesia compared to diclofenac