Journal of Lumbini Medical College (JLMC)
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First Line Treatment of Meniere’s Disease: A Randomized Controlled Trial
Get PDFIntroduction: There is no consensus on the first line medical treatment of Meniere disease to produce symptomatic improvement and slow the disease progress. Dietary salt restriction, diuretics, and vasodilators like betahistine are among the first line drugs that have been used for long. There is lack of evidence due to paucity of quality studies to support their effectiveness and advocate their use. This study is done to evaluate the effectiveness of three first line treatment of Meniere disease i.e. salt restriction, oral diuretics, and betahistine.
Methods: Double blind randomized controlled trial was carried out in out-patient clinic of Ear Nose and Throat department of Lumbini Medical College Teaching Hospital. Cases were randomized into three groups; dietary salt restriction, diuretics as amiloride and furosemide, and vasodilator as betahistine. Pre and post treatment evaluation was done in terms of number and severity of vertigo, tinnitus, and hearing outcome.
Results: There were a total of 97 cases with F:M ratio of 1.1:1. Mean age of patients was 47.86 yr (SD=12.7). Twenty-nine (30%) were treated with dietary sodium restriction alone (Group A), 35 (36%) were treated with diuretics (Group B) and the rest 33 (34%) were treated with vasodilator (betahistine, Group C). There was no significant difference in hearing outcome in any group. Tinnitus was significantly improved in Group B. Number of vertigo attack was significantly decreased in Group B and Group C. Severity of vertigo was significantly decreased in Group B.
Conclusion: Dietary salt restriction alone was not effective in controlling any aspect of the disease whereas diuretics were effective in reducing tinnitus and number and severity of vertigo. Betahistine was effective in reducing the number of vertigo attacks but not effective on other aspects of the disease
Aerobic Bacteria Associated with Symptomatic Gallstone Disease and their Antimicrobial Susceptibility in Western Nepal
Get PDFIntroduction: Gallstone disease is one of the most common disease affecting the gastrointestinal tract. Biliary tract infection results from bile stasis due to chronic obstruction, mainly (80%) gallstones. Biliary obstruction increases ductal pressure, resulting in bacterial proliferation and dissemination. Proper guidelines for appropriate use of antibiotics in managing uncomplicated and complicated gallstone disease are lacking; on the other hand, the antibiotic usage for its management cover a broad spectrum of organism which may not be required most of the times. This study aims to determine the microbiology of the bile culture and antimicrobial susceptibility in patients with symptomatic gallstone disease in our setup.
Methods: This prospective study included patients admitted in surgery department with a diagnosis of symptomatic gallstone disease and subjected for laparoscopic or open cholecystectomy from 1st of Oct 2015 to 30th Sep 2016. The intraoperative bile of patients subjected for cholecystectomy were cultured aerobically in Blood agar and MacConkey agar. The isolates were identified and tested for their sensitivity pattern. The data were collected, entered and then analyzed using SPSS version 23. The descriptive statistics were calculated.
Results: Of the total 259 patients, bile culture was negative in 183 patients (70.7%) and was positive in only 76 patients (29.3%). Pseudomonas was the most common cultured organism in 52 (68.4%) patients. Other isolated organisms included E. coli, Staphylococcus, Klebsiella, Enterococci, and Acinetobacter. Imipenem and amikacin were the most effective prophylactic antibiotics.
Conclusion: Bile culture was negative in majority of patients with symptomatic gallstone disease. Few patients are positive in culture with predominantly Pseudomonal growth, mostly sensitive to amikacin or imipenem
Pattern of Acute Poisoning Attending a Tertiary Care Hospital of Western Nepal
Get PDFIntroduction: Poisoning with various substances is a major public health problem and a reason for significant morbidity and mortality throughout the globe. It is one of the most common presentation in an emergency department. This study was conducted to determine the sociodemographic, poisoning types, and mode of poisoning in cases attending a tertiary hospital of Western Nepal.
Methods: A retrospective observational study of two years was conducted from July 2014 to June 2016. Demography details, name of poisonous substance, and reasons for poisoning were reviewed and analyzed using descriptive statistics.
Results: A total of 65 cases of poisoning were recorded. The occurrence was more common in female (n=44, 67.7%) than in male (n=21, 32.3%) with a F:M ratio of 2.1:1. Poisoning was most common in the age group of 11-20 years (32.3%). Most of the cases were students (37%) followed by farmers (26%). The most commonly abused poisoning substance were organophosphorous compounds, zinc-phosphate, and kerosene in adults, adolescents, and children respectively. Oral route was the most common (99%) route of administration. Suicidal attempt, as a mode of poisoning, accounted for 70.8% of total poisoning cases.
Conclusion: Female and young people are at greater risk of acute poisoning. Insecticide was the most common agent and self administer poisoning was the most common mode of poisoning. The occurrence of poisoning and its morbidity and mortality can be reduced by developing and implementation of effective prevention strategies like restricting easy poison sales, establishing drug and poison information centers, and community awareness programs
Initial Experiences of Laparoscopic Surgery at Nobel Medical College Teaching Hospital: A Learning Curve
Get PDFIntroduction: The field of minimal invasive surgery has flowered explosively in the recent past. Modern endoscopy has changed the approach to diagnosis as well as the operative procedure. This study was done with the aim of sharing the experiences of gynecological laparoscopic procedures done at Nobel Medical College and Teaching Hospital, Nepal.
Methods: A descriptive study was done in the department of Obstetrics and Gynecology, Nobel Medical College from 1st April 2015 to 30th March 2016. All the patients undergoing laparoscopic procedures were analyzed for the indication, type of procedures and their complications.
Results: During the study period, 100 patients underwent laparoscopic procedures including 25 cases of diagnostic and 75 cases of therapeutic procedures. Fiftythree patients with an ovarian mass underwent laparoscopic cystectomy. Laparoscopic salpingectomy was done in 11 patients with ectopic pregnancy. Laparoscopy assisted vaginal hysterectomy (LAVH) was done in eight cases and laparoscopic sterilization in two cases. One patient underwent successful myomectomy. One patient undergoing laparoscopic cystectomy and one case of LAVH had conversion to laparotomy because of dense adhesion and vault bleeding respectively. No other major complication noted apart from port side bleeding, infection and vault hematoma.
Conclusion: Laparoscopy is a safe and feasible alternative to open gynecological surgeries though it has a longlearning curve and a lot of expertise is necessary
Simultaneous Ipsilateral Pediatric Fractures of the Elbow and Forearm Attending a Tertiary Care Hospital
Get PDFIntroduction: Ipsilateral supracondylar humerus and forearm fractures in the pediatric population are an uncommon injury associated with high-energy trauma. The incidence varies between 3% and 13%. Our aim was to conduct a descriptive analysis on seventeen cases of children with floating elbow injuries who attended our institution and to review the literature relating to this topic.
Methods: Between April 2013 to March 2016, data were obtained through the medical records. Children who had completely displaced supracondylar fractures of the humerus associated with ipsilateral forearm fracture were reviewed. All patients underwent operative reduction and percutaneous K-wire stabilization. At mean follow up of 12.9 months, all patients were assessed clinically and radiologically. The following variables were used: age, gender, side, mechanism, type of fracture, classification, treatment and complications.
Results: Seventeen pediatric \u27floating elbow\u27 cases that had operative management were identified. Twelve (70.5%%) were male and five (29.4%) female. The mean age was 9.5 (SD = 2.1) years, ranging from six to 14 years. The left side was predominantly affected (70.5%). The commonest injury mechanism was fall from a height (76.47%). All the supracondylar fractures were Gartland type III. Majority of forearm fractures (76.4%) were at distal meta diaphyseal region. Distal radius physeal fractures were diagnosed in three patients. Open fractures occurred in three cases (17.6%). All supracondylar fractures were reduced and fixed using K-wires. There was one radial nerve, and three median nerve injury. Five patients had pin tract related complications. Fifteen (88.2%) patients had good to excellent, two had fair in terms of modified Flynn criteria in last month follow up. All patients went on to radiographic union without secondary procedures.
Conclusion: This, uncommon injury in most cases, results from high-energy trauma. Early surgical treatment for both fractures is required in the form simultaneous closed reduction of the displaced forearm fracture followed by supracondylar fixation with K-wires. This provides not only stable fixation but also allows close observation for early sign and symptom of development of compartment syndrome
Computed Tomography Findings in Patients with Seizure Disorder
Get PDFIntroduction: Seizure occurs in up to 10% of the population, whereas epilepsy is a chronic disease characterized by recurrent seizures that may affect up to 2% of the population. Modern neuroimaging is useful in diagnosis of abnormalities underlying the epilepsies, but the information provided by imaging techniques can also contribute to proper classification of certain epileptic disorders and can delineate the genetics of some underlying syndromes. Neuroimaging is even more important for those patients who have medically intractable seizures. This study was carried out to establish different etiologies of seizures, to correlate the clinical data and radiological findings in cases of seizure, and to identify the common etiologies in different types of seizures.
Methods: This was a retrospective hospital-based study conducted in the Department of Radiodiagnosis of Lumbini Medical College Teaching Hospital. Records of patients of past two years, admitted in any department of the hospital with history of seizure disorder and underwent a Computed Tomography (CT) of brain were included. The CT patterns were assessed and the data were tabulated and statistically analyzed.
Results: There were a total of 480 cases out of which 263 (55%) were male and 217 (45%) were female with M:F ratio of 1.2:1. Generalized seizure was more frequent than partial seizure in both gender. In 274 cases of generalized seizures, CT scan findings were abnormal in 151 cases and normal finding observed in 123 cases. In 206 cases of partial seizures, 125 cases were abnormal and 81 having normal CT scan findings. Age wise distribution showed highest number (n=218) of cases in young group (<20 yr) and least number (n=45) in eldest group (>60 yr). The most common cause of seizure was calcified granuloma (n=79, 16.5%) followed by neurocysticercosis (NCC, n=64, 13%). Diffuse cerebral edema, sub-arachnoid hemorrhage, and hydrocephalus was seen only in lower age group particularly among 1-20 years. Infarct and diffuse cortical atrophy were most common cause of seizure in older age group. NCC and tuberculoma are the most common cause of partial seizure whereas cerebral infarcts, hemorrhage, malignancy, diffuse cortical atrophy are the most common cause of complex seizure. Few rare diseases like Fahr disease and tuberous sclerosis were also found in CT scan of seizure patients.
Conclusion: NCC and tuberculoma are the most common cause of partial seizure whereas cerebral infarcts, hemorrhage, malignancy, and diffuse cortical atrophy are the most common cause of complex seizure. CT scan plays an important role as a preliminary tool in radiological assessment of patients presenting with seizures
A Segmental Fracture of Humerus with Ipsilateral Forearm Fracture: A Rare Variant of Pediatric Floating Elbow Injury
Get PDFIntroduction: Simultaneous segmental humerus fracture with ipsilateral forearm is an uncommon injury and scarcely mentioned in the literature.
Case report: We present a case report on such a complex injury in a 9-year old child after falling down from the first floor of his house while playing. The injury pattern consist of ipsilateral supracondylar fracture humerus with distal humerus and ipsilateral distal forearm fracture. Open reduction and pinning of the both injuries was obtained.
Conclusion: Ipsilateral multiple fractures in children often result from high energy trauma and are associated with complications. Immediate reduction and fixation is required. If satisfactory reduction cannot be achieved by closed technique, open reduction should be considered to avert additional soft tissue injury and forthcoming complications
Seasonal Variation of Pediatric Dermatoses: A Hospital Based Study in Western Hilly Nepal
Get PDFIntroduction: Skin diseases are common in children; however they differ depending in age, region, socioeconomic status and climate. Many studies have been done to study pattern of dermatological disease in pediatric age group but only few studies have been done in its seasonal variation. So we decided to study seasonal variation of pediatric dermatoses.
Methods: This was retrospective study done from hospital record of Lumbini Medical College Teaching Hospital (LMCTH). All children 14 years and below attending the Dermatology out-patient clinic with skin diseases between the period of March 2015 to February 2016 were included. Demographic, clinical and laboratory details were recorded. Data were collected and categorized according to four seasons. Microsoft Excel was used for data entry while all analysis, both descriptive and inferential, was done using SPSS version 22.
Results: There were a total of 987 children visiting Dermatology clinic during the study period. Of those, 520 (52.7%) were male and the remaining 467 (47.3%) were female with M:F ratio of 1.1:1. Most of the disorders were seen between 10-14 years of age. Majority of visits was in summer (n=403, 40.8%) followed by spring, autumn and winter. Most common dermatosis seen among children during summer was fungal infection (n=91, 9.2%) and during winter was eczema (n=49, 5%).
Conclusion: In the present setting there is seasonal variation of dermatological diseases in pediatric age group
Outcome of Eclamptic Mothers Attending Tertiary Care Centre from Home and those Referred from Primary Heath Care Site: A Comparative study
Get PDFIntroduction: Magnesium sulphate (MgSO4) is an effective and safe drug which stabilizes the patient within few hours of eclampsia and terminates subsequent seizures if it is given on time. The aim of this study was to compare maternal and fetal outcome between a group of eclamptic mothers who came to the tertiary care hospital directly without receiving MgSO4 (Group 1) and those referred from primary care centers after receiving loading dose of MgSO4 (Group 2).
Methods: This is a retrospective cohort study of eclamptic mothers who were admitted and managed from the period of 1st January 2012 to 31st March 2016 at Nepalgunj Medical College Teaching Hospital, Nepal. Sociodemographic characters and maternal and fetal outcome was compared between the two groups.
Results: Among 92 cases, 57 (62%) were from Group 1 and 35 (38%) were from Group 2. Most of the mothers attended from Banke district (n=52, 56.5%) followed by Bardia district (n=17, 18.5%). Brahmin and Chhetri were 20 (35%) and 10 (29%); Muslim 16 (28%) and 4(11%); Janajati from Terai 16 (28%) and 8 (23%); Janajati from hilly region 4 (7%) and 5 (14%); and Chaudhari 1 (2%) and 8 (23%) in Group 1 and Group 2 respectively. More (n=26, 74%) mothers had baby with good Apgar score in Group 2 than in Group 1 (n=33, 58%). There were 14 (15.2%) still births; 9 (16%) in Group 1 and 5 (14%) in Group 2. Complication rate was observed more in Group 1 (n=16, 28%) than in Group 2 (n=7, 20%) and the most common complication in both groups was wound infection. The mean days of hospital stay was 5.96 (SD=3.32) and 5.91 (SD=3.38) in Group 1 and Group 2 respectively.
Conclusion: The group receiving magnesium sulphate in primary care centre have good fetal outcome and less maternal complications compared to those who were admitted directly in tertiary care centre and receive the treatment there
Antibiotic Sensitivity in Post Cesarean Surgical Site Infection at a Tertiary Care Centre in Eastern Nepal
Get PDFIntroduction: Post cesarean surgical site infection (SSI) is one of the common complications diagnosed in 2.5%-16% of the cases and is associated with significant increase in maternal morbidity, hospital stay, costs, and psychological stress to the new parents. This study was designed to study the incidence of SSI and the antimicrobial resistance pattern in our hospital.
Methods: This was a prospective observational study conducted from July 2015 to December 2015, in which all patients who were admitted with post cesarean SSI or developed SSI during their stay were included. Wound specimens were collected and susceptibility testing was carried out using disc diffusion technique.
Results: The incidence of post cesarean SSI was 6.07% (47/774). Out of the 47 patients who had SSI, 35 (74.75%) had positive swab culture. The most important organism isolated was Staphylococcus aureus (82.85%) out of which 17 (58.62%) were MRSA strain. The resistance of Staphylococcus to penicillin was 84.6% whereas amikacin was found to be highly sensitive (>96%). Among the MRSA strain, resistance to ciprofloxacin, which is the currently used drug for prophylaxis, was 94%. Resistance to penicillins, cephalosporins, and clavulanate was also high. Resistance to vancomycin was also high (53%). Amikacin and chloramphenicol were found to be highly sensitive (94% and 90% respectively) in the MRSA group.
Conclusion: MRSA is the leading cause of post cesarean SSI and is a matter of great concern. Amikacin and chloramphenicol were found to be highly sensitive in this group but unlike other studies, resistance of vancomycin was showing an increasing trend