Journal of Lumbini Medical College (JLMC)
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Management of Dysgeusia related to Cancer: A Systematic Review
Get PDFIntroduction: Taste change due to cancer is a notorious side effect, adversely affecting appetite and weight. Even though taste change or dysgeusia is one of the major causes of poor nutritional status in cancer survivors, it is not addressed as a significant problem and is often left untreated. The main purpose of this review is to explore current knowledge of pharmacological and behavioral interventions for the treatment of cancer related taste change.
Methods: This systematic review was conducted in accordance with PRISMA guidelines to identify original articles on taste change. Multiple databases including; Scopus, Medline, EMBASE, CINAHL, and all databases via Pro quest were searched for original articles or studies related to taste change caused by cancer or its treatment. Relevant articles were subjected to a full text evaluation and assessed by Critical appraisal skills program (CASP) guidelines and the Effective public health practice project (EPHPP) instrument.
Results: The search revealed 12 eligible studies, six of which were randomized controlled trials. Most of the studies used a standardized validated tool to measure taste change. Dysgeusia is common in cancer, 14 to 100% cancer patient report it. Pharmacological management with zinc remains inconclusive as one study reports it as beneficial and two other studies reported null effect. Few studies suggested dietary modifications such as use of sugary, salty foods that are helpful to reduce the effect of dysgeusia.
Conclusion: Dietary counseling and informing the patient well about self-care strategies before treatment has consistently shown positive results on taste change, with strong statistical power. Other potential treatments for dysgeusia such as zinc, amifostine, and megestrol acetate gave inconsistent results
Essential Palatal Myoclonus: A Case Report
Get PDFIntroduction: Palatal myoclonus is a rare condition presenting with clicking sound in ear or muscle tremor in pharynx. There are two varieties: essential and symptomatic. Various treatment options exists ranging from watchful observation to botulinum toxin injection. We have not found any reported case of palatal myoclonus from our country. Here we present a case of essential palatal myoclonus managed with clonazepam.
Case report: A young female presented in Ear Nose and Throat clinic with complain of auditory click and spontaneous rhythmic movement of throat muscles for eight months. On examination, there was involuntary, rhythmic contraction of bilateral soft-palate, uvula, and base of tongue. Neurological, eye, and peripheral examination were normal. A diagnosis of essential palatal myoclonus was made. It was managed successfully with clonazepam; patient was still on low dose clonazepam at the time of making this report.
Conclusion: Essential palatal myoclonus can be clinically diagnosed and managed even in settings where MRI is not available or affordable
Adverse Effects of Oral Hypoglycemic Agents and Adherence to them among Patients with Type 2 Diabetes Mellitus in Nepal
Get PDFIntroduction: Oral hypoglycemic agents (OHAs) are the most common drugs used in Type 2 Diabetes Mellitus. There are various established adverse effects related to their use including hypoglycemia, weight gain, gastrointestinal disturbance, lactic acidosis, and fluid retention. However, the pattern of adverse effects related to OHAs in Nepalese patients still needs to be explored. Our study aims to determine the pattern of adverse effects resulting from the use of OHAs among Type 2 Diabetes mellitus patients and their adherence to the medication.
Methods: All diabetic patients who met the inclusion criteria were enrolled in the study. After informed consent, patients were interviewed and evaluated as per the designed proforma. They were mainly studied for common drug used, adverse effects of the drugs, occurrence of hypoglycemia, and adherence to treatment.
Results: The study comprised of 183 patients with mean age of 58.73 years (SD = 12.95). Fifty-six (30.6%) patients said that they developed adverse effects of drugs but only 21 (11.5%) of them reported to their treating physician. Most common adverse effect were related to central nervous system such as tingling sensation of hands and feet, dizziness, drowsiness, etc. Though 91 (49.7%) patients had developed symptoms suggestive of hypoglycemia, only 31 (16.9%) knew that it was due to hypoglycemia. Majority of the patients (n = 143, 78.1%) administered the drugs as prescribed by the physician. Among the defaulters, the most important reasons for failure to properly administer the drugs was forgetfulness in 82.5% (n = 33, N = 40) of cases. Among the study variables family history of chronic illness (p = 0.046) and information about adverse effects from physician (p = 0.001) had a significant relationship with incidence of adverse effects. Whereas none of them had a significant relationship with adherence to hypoglycemic medication.
Conclusion: The incidence of adverse effects was high with hypoglycemia occurring in 49.7% of the cases, though only one-third of them recognized it to be due to hypoglycemia, in the patients with Type 2 Diabetes Mellitus. Family history of chronic illness and information about adverse effects from the physician had significant relationship with the incidence of adverse effects of hypoglycemic treatment
Coronary Calcium Scoring and Modifiable Coronary Risk Factors
Get PDFIntroduction: Non-invasive coronary calcium scoring predicts earliest atherosclerotic changes in the coronary arteries on the basis of amount of calcium deposited in the coronary arteries. This study was done to analyze calcium scores in patients with different risk factors for coronary artery disease (CAD).
Methods: This was a cross sectional study conducted from 1st November 2015 to 30th April 2016 at Kathmandu Medical College Teaching Hospital. Patient with cardiovascular risk factors were included in the study. These patients underwent coronary calcium scoring. Calcium scores were then compared with the presence of risk factors.
Results: Total 467 participants were included in the study. There were 309 (62.2%) males and 158 (33.8%) females. Mean age of patient was 56.6 year (SD = 12.7). The difference in the scores observed with presence or absence of risk factors were statistically significant for gender, smoking, and hypertriglyceridemia (p<0.05) but not significant for impaired fasting glucose, hypertension, and body mass index.
Conclusion: This study suggested that presence of traditional risk factors does not necessarily indicate high coronary calcium level
Effectiveness of Same-Day Human Ear Wax Removal as an Office Procedure and Factors Associated with its Successful Removal
Get PDFIntroduction: There are various methods of ear wax extraction and there are no specific guidelines on this subject. Many times we ask patients to instil some wax softening product for a few days and revisit for wax removal. These revisits result in increased cost, discomfort and loss of time. We conducted this study to determine the effectiveness of same-day ear wax removal as an office procedure with one or more techniques. Our secondary objective was to find the association between various factors and successful wax removal.
Methods: During the study period, all patients with ear wax managed by a single ENT surgeon were included. History and examination were done and findings noted. One or more methods including probe, forceps, hooks, curette, suction, wax softening with wax softening agents, syringing were applied for wax removal. Complete wax removal was noted as success.
Results: There were a total of 63 cases of ear wax among 34 participants. Wax was successfully removed in 52 (82.5%) cases in the same day. Presence of ear ache, narrow canal, complete obstruction and hard dry wax were adversely associated with successful wax removal. Presence of ear fullness, ear discharge, or use of ear drops in home was not significantly associated with successful ear wax removal.
Conclusion: We were able to extract wax from a large proportion of patients on the same day of visit, thereby reducing their cost of revisit, however there were 17.5% of cases who could not be treated successfully on the same day
Single dose Intraoperative Antibiotics versus Postoperative Antibiotics for Patient Undergoing Laparoscopic Cholecystectomy for Symptomatic Cholelithiasis: A Randomized Clinical Trial
Get PDFIntroduction: Surgical site infection is a common complication shown in literature following cholecystectomies. Smaller incision and use of trocars in laparoscopic cholecystectomy lessen the contamination resulting in less chances of surgical site infection. However, in fear of postoperative infection, many opt for the prolonged postoperative use of antibiotic and there is growing consensus against it. Antibiotics not only increases the cost and hospital stay duration but it aids in emergence of multidrug resistance. Because of the controversies, we conducted this clinical trial to see whether a single prophylactic dose of antibiotic at the time of induction of anesthesia for laparoscopic cholecystectomy was equally effective in controlling post-operative infection as multi-dose antibiotics during and post-operative period.
Methods: The study was conducted at the department of general surgery, Lumbini Medical College Teaching Hospital, from November 2015 to October 2016. All cases with symptomatic cholelithiasis subjected for laparoscopic cholecystectomy were enrolled. Patients were randomized into two groups; Group SD received single dose of an intravenous dose of amikacin 500 mg, at induction of anesthesia and Group MD received multiple intravenous dose of amikacin, during and postoperatively for two days. Complications, hospital stay, and treatment cost in two groups were compared and analyzed.
Results: There were a total of 240 patients in the study, 118 in Group SD and 122 in Group MD. Post-operative infection rate was 4.2% (n= 5, N=118) in Group SD and 3.3% (n=4, N=122) in Group MD; the difference was not significant (p=0.75). Hospital stay was prolonged and cost was higher significantly in Group MD.
Conclusion: Single dose of prophylactic antibiotic, administered at induction of anesthesia, is equally effective as multiple doses of post surgical antibiotics to prevent post-operative infection in patients undergoing elective laparoscopic cholecystectomy for uncomplicated cholelithiasis
Cardiovascular Risk Factors among First Year Medical Students
Get PDFIntroduction: Detection of cardiovascular risk in young age is important to motivate them to modify life styles and seek health care early to lower the chances of acquiring cardiovascular disease in later age. This study was done to assess cardiovascular risk factors among first year medical students.
Methods: A cross-sectional study was conducted throughout September and October 2017 in which all first year medical students from a medical college were assessed for the presence of cardiovascular risk factors. Participants’ demography, family history of illness, anthropometric measurements, and blood reports of lipid profile and fasting glucose were acquired. Data were analyzed with Statistical Package for Social Sciences (SPSS-21).
Result: There were 99 participants; 55 males and 44 females. One or more risk factors were present in 87 (87.9%) participants. Moreover, 67.7% (n = 67) participants had more than one risk factors. Low HDL-cholesterol was the most common (n = 55, 55.6%) risk factor followed by elevated triacylglycerol (n = 47, 47.5%) and family history of hypertension (n = 45, 45.5%). There was no significant difference in presence of various risk factors between genders.
Conclusion: There was higher prevalence of cardiovascular risk factors among first year medical students. Majority of them had more than one risk factors. Low HDL-cholesterol was the most common risk factor. The risk factors were comparable in males and females
Ectopic Pregnancy Following Interval Tubal Sterilization: Lessons Learnt
Get PDFIntroduction: Tubal sterilization is a highly effective method of permanent contraception. However, pregnancy can still occur following a successful procedure. Published literatures report a failure rate of 0.13-1.3% and 15-33% of such pregnancies are likely to be ectopic.
Case report: A 33 years para three lady with prior history of tubal ligation presented with generalized abdominal pain and several episodes of vomiting. Bimanual examination revealed a soft and mobile mass of 2 x 3 cm in right adnexa. Urine pregnancy test was positive and ultrasonogram showed a heterogeneous mass of 3.4 x 3.3 cm in right adnexa with empty uterine cavity. Culdocentesis resulted in aspiration of frank non-clotting blood. She then underwent emergency laparotomy with bilateral salpingectomy for ruptured ectopic pregnancy.
Conclusion: Ectopic pregnancy after tubal sterilization though rare is not entirely impossible. All women who are offered this procedure should always be educated about its failure rate. And in women presenting with acute abdomen, a prior history of tubal sterilization doesn\u27t preclude the possibility of ectopic pregnancy
Thyroid Function Abnormalities among Hospital Patients of Hilly Nepal
Get PDFIntroduction: Thyroid dysfunction stands as the second most common endocrine disease after diabetes mellitus. National reports on its prevalence are meagre. Hence, the study was conducted with the objective of exploring the prevalence of thyroid dysfunction among hospital patients of hilly region of Nepal.
Methods: A hospital based, retrospective, analytical study was conducted in the department of biochemistry, Lumbini Medical College Teaching Hospital (LMCTH) from 15th February 2017 to 30th April 2017. The hospital records of patients from March 2014 to mid-February 2017 with suspected thyroid dysfunction and presented from different departments of hospital were reviewed. Data was entered in Excel 2007 and analysis was done with Statistical Package for Social Sciences (SPSS-21). Necessary descriptive and inferential statistical analysis was done. P value less than 0.05 was regarded as statistically significant.
Results: Out of 3136 subjects, 601 (19.2%) were male and 2535 (80.8%) were female with F:M ratio of 4.2:1. Female were more likely to be suspected of thyroid dysfunction. Mean age of male was 39.28 years (SD = 19.01) and that of female was 39.60 years (SD = 14.63). Prevalence of thyroid dysfunction was 23.31%. Correlation of log10 TSH with age showed a significant relation (r = -0.05, p = 0.003). Age group and thyroid function category among female patients was found to be statistically significant (p = 0.01).
Conclusion: The prevalence of thyroid dysfunction was high in Tansen region, a hilly mid-west Nepal. Female above 40 yrs (post reproductive age) and male above 60 yrs (elderly group) were more prone to thyroid disorders. Also, the study revealed that younger people are more likely to be euthyroid whereas as age advances, people are likely to be either hypothyroid or hyperthyroid. These findings can be a guide for elaborative research in thyroid disorder in future