Journal of Lumbini Medical College (JLMC)
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Childhood Tuberculosis and its Relation with Nutrition: A five Year Retrospective Study
Get PDFIntroduction: Tuberculosis is the sixth leading cause of mortality in Nepal. Childhood tuberculosis consisted 5.54% of newly registered 32,056 cases in 2016-17. Malnutrition is a predictor of tuberculosis and is associated with poorer outcomes. This study evaluates the clinico-epidemiologic profile of childhood tuberculosis and its relation to nutritional status.
Methods: This was a retrospective review of 60 cases of tuberculosis admitted over a period of five years. Details regarding demographics, anthropometry, symptomatology and examination findings were retrieved. Diagnosis was categorized as pulmonary, extra-pulmonary and disseminated tuberculosis. Findings of various investigations were noted. Nutritional status of the patients was assessed using the WHO standard charts. Association of malnutrition and anemia with types and severity of tuberculosis was assessed.
Results: A total of 60 patients were included in the study. Mean age was 7.9 years (SD = 4.6). The commonest presenting symptom was fever (83.3%) followed by decreased appetite (33.3%) and weight loss (26.7%). Cough was the predominant symptom in pulmonary tuberculosis (45%). Only eight cases were bacteriologically confirmed. Underweight, wasting and stunting were observed in 68.4%, 63.3% and 53.3% of cases respectively. Wasting was significantly associated with severe forms of tuberculosis (p = 0.03). Anemia was present in 89.5% of under five children (p = 0.02).
Conclusion: Malnutrition often co-exists in a significant proportion of children with tuberculosis. Diagnosis in resource limited settings heavily relies on clinical suspicion and supporting investigations. Anemia is significantly associated with childhood TB, especially under five children
Placental Thickness and Its Correlation with Gestational Age: A Cross-sectional Ultrasonographic Study
Get PDFIntroduction: Placenta grows in size with the advancement of gestational age (GA) and plays an important role for delivery of nutrients from mother to fetus. Ultrasonography (USG) is implicated for the estimation of GA by using fetal growth parameters like Femur Length (FL), Bi-parietal Diameter (BPD), Head Circumference (HC), and Abdominal Circumference (AC). This study intends to observe the correlation between Placental Thickness (PT) and GA. Methods: It was an observational, cross-sectional, and analytical study conducted over a period of six months from November 2017 to April 2018. Fetal growth parameters i.e. FL, BPD, HC, and AC were measured to estimate GA. PT was also measured at the same time. Results: There was a positive correlation between PT and GA (r = 0.89, n=249, p < 0.001). Pearson correlation coefficient between the two variables at second and third trimesters were 0.81 and 0.49 respectively. Fisher r-to-z transformation was used to analyze the difference between those two coefficients and was found to be statistically significant (z = 4.6, p < 0.001). This indicates that there was a significant overall relationship between PT and GA. As GA increases, PT also increases. Conclusion: Our study observed a positive correlation between the PT and GA in second and third trimesters. Thickness of placenta can thus be used as a reliable parameter for the estimation of GA during the second and third trimesters, and can be used as a supplementary USG parameter along with FL, BPD, HC and AC
Hereditary Spherocytosis: A case report
Get PDFIntroduction: Hereditary spherocytosis is a red cell membrane disorder that causes hemolytic anemia. Due to defective cell membrane, red cells are spherical shaped and result in their early lysis. Osmotic fragility of spherocytic red cell is increased.
Case report: A 22 year old female presented with chief complain of abdominal pain. Initially she was diagnosed as cholelithiasis. Under laboratory evaluation she was found to be anemic with reticulocytosis. In peripheral blood smear, spherocytes were moderately distributed. Antihuman globulin test was negative but osmotic fragility was high. Hence, she was confirmed as case of hereditary spherocytosis.
Conclusion: Hereditary spherocytosis is a rare red cell disorder and its diagnosis can be made by osmotic fragility test
Prevalence of pterygium and outcome of pterygium surgery in hilly western Nepal: A hospital based study
Get PDFIntroduction: Surgical removal is the treatment of choice for pterygium; however, prevention of recurrence is a challenge. Several techniques have been tried to reduce the ï¬bro-vascular activity aiming to reduce rate of recurrence such as B-irradiation, conjunctival and limbal auto-grafting, anti-mitotic drugs, and amniotic membrane transplantation. This study reports the magnitude of the disease in a hilly region of western Nepal and outcome of excision and conjunctival autografting for pterygium surgery.
Methods: A prospective study was done from 1st July 2015 to 31st December 2016 in which all patients with primary pterygium presented to Palpa Lions Lacoul Eye Hospital from 1st July 2015 to 30th June 2016 were treated and followed up for next six months. Patients were treated medically or surgically as indicated. Data on age, sex, visual acuity, extent of disease, treatment modality, complications, and outcome were collected and analyzed by descriptive statistics, Chi-square test, t-test, and Anova tests. P value less than 0.05 was considered significant.
Results: There were 18,960 patients in total attending hospital for various conditions among which 290 (1.5%) had pterygium. There were 186 (64.1%) female and 104 (35.9%) male and this difference was significant (p<0.001). The mean age was 47.42 yrs (SD=14.23) with age ranging from 20 to 80 years. Right eye was affected more (43.1%) than left eye (33.1%); remaining 23.8% had bilateral disease. Grade-1 disease occurred in younger age compared to Grade-2 and Grade-3 disease. All grade-1 patients were managed medically; grade-2 and grade-3 patients were equally likely to be managed medically or surgically. There were no major intra or post-operative complications. Minor post-operative complications noted were subconjunctival hemorrhage, corneal scarring, suture gaping, and conjunctival cyst among others.
Conclusion: Despite much advanced techniques in pterygium surgery, pterygium excision combined with conjunctival autograft is found to be a safe and effective method for treating pterygium in developing world
Maternal Mortality and Associated Factors in a Tertiary Care Center of Western Nepal
Get PDFIntroduction: Identifying the cause of maternal death is important. The aim of this study was to determine the causes of maternal deaths and the factors associated with it.
Methods: This was an observational, cross-sectional, analytical study conducted at Department of Obstetrics and Gynecology, Manipal Teaching Hospital from July 2013 to June 2017. Women who died during pregnancy, delivery, or puerperium were included in the study. Demographic factors, clinical profile, cause and type of maternal deaths were noted by taking history and by inquiring with the medical personnel involved in managing patients. Data analysis was done using SPSS version 16.
Results: There were 15 maternal deaths and 9923 livebirths. The maternal mortality ratio was 151 per 100,000 live births. Mean age of mothers was 28 years (SD = 7.5). Most of them were from rural areas, had low educational status. The mean gestational age at time of death was 33 weeks (SD = 7.5). Most of deaths (73%, n = 11) occurred in the postnatal period and 60% (n = 9) were critical at presentation. Direct obstetric causes like eclampsia was the most common (26.7%, n = 4) direct obstetric cause and cardiac disease was one of the important indirect cause (13.3%, n = 2). Delay in seeking health care and delay in reaching health center was the major reason for maternal deaths.
Conclusion: Maternal mortality were mostly associated with direct obstetric causes, eclampsia being the most common. Most of the deaths were associated with delay in seeking health care and reaching health care centers
Submandibular gland sialolith of unusual size: A Case Report
Get PDFIntroduction: Sialolithiasis is the most common disease of the salivary glands. Majority of sialoliths occur in the submandibular gland and is a common cause of acute and chronic infections of the gland. The size varies from one mm to one cm. Size greater than 15 mm are considered unusual or giant sialolith.
Case report: We present a case of an unusual size sialolith of 16 mm in submandibular gland duct which was removed via transoral incision. The aim of presenting this case report is to understand etio-pathogenesis, clinical presentation and management of submandibular sialolithiasis.
Conclusion: Submandicular sialolithiasis of more than 15 mm in size though rare are not uncommon. They can be managed intraorally if situated at or near the orifice
Nutritional Assessment of Under Five Children Attending Pediatric Clinic in a Tertiary Care Hospital in the Capital of Nepal
Get PDFIntroduction: There has been a decreasing trend in malnutrition (stunting, wasting, and under-weight) in Nepal from 2001 till 2016 according to Nepal demographic health survey 2016. We tried to study whether these national survey data equally reflect the nutritional status of children visiting hospitals in the capital city of our country. The objective of the study was to evaluate the nutritional status of children less than five years of age brought to a hospital in Kathmandu.
Methods: Anthropometric measurements (height/length and weight), other demographic details, and morbidity of all children, six months to five years of age, visiting the hospital over the period of three months were collected from the out-patient register. Height-for-age, weight-for-height, and weight-for-age were calculated and expressed as standard deviation units as compared to the median of reference data taken from WHO Multicentre Growth Reference Study Group (2007). Association between morbidity and various anthropometric values were calculated.
Results: A total of 424 children were included in the study. There were 2.1% severely stunted, 8% stunted, 2.8% tall, and 1.7% very tall children. Similarly, 6.4% were severely wasted, 14.4% wasted, 4.7% severely under-weight, and 12.3% under-weight. The anthropometric values were significantly associated with morbidity (acute Vs chronic) but not associated with whether they were from within Kathmandu or form outside, and individual morbidity.
Conclusion: Wasting and severe wasting in under five children from and nearby Kathmandu of Nepal is higher while stunting and severe stunting is lower as compared to previous National reports
Prevalence of Helicobacter Pylori among Patients undergoing Gastrodudenoscopy in a Hospital in Western Nepal
Get PDFIntroduction: Helicobacter pylori (H. pylori) related chronic gastritis is a major health problem worldwide, specially in the developing countries. The prevalence of H. pylori infection has been reported to vary between and even within countries. There are limited data on this infection in Western Nepal. Our objective was to study the prevalence of H. pylori infection and its association with presenting complains and upper gastrointestinal diseases.
Methods: Medical records of patients undergoing gastrodudenoscopy and biopsy for various upper gastrointestinal symptoms from 1st of January 2015 to 30th of June 2017 were reviewed for presence of H. pylori infection, demographics, indications for gastrodudenoscopy, and histopathology findings. T-test, Chi-square test, and Fisher exact test were applied.
Results: Two hundred fifty six patients (135 male and 121 female) with a mean age of 47 (SD = 16.5) underwent gastroscopic biopsy and had an overall H. pylori prevalence of 24.6%. H. pylori infection was most commonly noted between 41 to 60 years of age. Gender did not seem to be significantly associated (p = 0.82) but gastrointestinal bleed was significantly associated with H. pylori infection (p = 0.006). The most common histopathological diagnosis was gastritis followed by gastrodudenitis; however, none of the diagnosis were found to be significantly associated with H. pylori infection.
Conclusion: The overall prevalence of H. pylori infection was 24.6% and was most common between 40 to 60 years of age. Heart burn was the most common symptom and gastrointestinal bleed was the only significantly associated symptom with H. pylori infection
Functional Outcome of Intramedullary Nailing with Rush Pin for Pediatric Both Bone Fractures of Forearm in Western Hilly Nepal
Get PDFIntroduction: Both bone diaphysis fracture of forearm is common in children of hilly area in Nepal because the children climbs tree and cliff for playing and cutting grass. Close reduction and casting is the preferred method of treatment these fractures but the chances of re-displacement is very high. Intramedullary nailing with titanium elastic nails or rush pins is widely accepted these days with good outcome. Titanium nails are popular in western world but is costly whereas rush pins are cheap and are preferred in developing world. The aim of this study was to evaluate the functional outcome of intramedullary rush pin for pediatric both bone fracture of forearm.
Methods: In this retrospective, observational study done from 1st of February 2017 to 31st of March 2017, a total of sixty patients with both bone fractures of forearm were treated with intramedullary rush pin and followed up for six months for evaluation of functional outcome. T-test and Chi-square tests were done.
Results: Closed reduction and internal fixation was done in 48 (80%) patients. Mean age of the patients was 9.23 year (SD=2.77). Fifty-six (93.3%) patients were male with a significant difference (p<0.001). With price et al. grading system, 49 (81.7%) patients had excellent results, nine (15%) had good and two (3.3%) patients had fair results. There was no major complication. Mean time to implant removal was 24.16 weeks (SD=1.62) from the time of surgery with range of 20 to 28 weeks. Among transverse and oblique fractures, patients with transverse fracture were likely to have better outcome (p=0.04).
Conclusion: Intramedullary nailing with rush pin gives excellent to good functional outcome in majority of the cases without major complications at low cost for management of both bone fractures of forearm in children