Journal of Lumbini Medical College (JLMC)
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PAP Smear versus Colposcopy in the Absence of HPV-DNA Testing for the Screening of Pre-malignant and Malignant Cervical Lesions
Get PDFIntroduction: The incidence of cervical cancer is very high in developing countries. The extensive use of cervical screening with PAP smear and colposcopy has considerably increased the detection of premalignant and malignant cervical lesions. Methods: This was a hospital-based study conducted over a period of three months. All the patients underwent gynecological examination, PAP smear and colposcopy. In case of abnormal findings in colposcopy or follow-up cytology, patients were advised for cervical biopsy. With reference to the histopathological reports, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PAP smear and colposcopy were evaluated. Results: The most common cytological result was Negative for Intraepithelial Lesion or Malignancy (NILM, 60%) followed by Atypical Squamous Cells of Undetermined Significance (ASCUS, 10%), Atypical Squamous Cells- cannot exclude High grade lesion (ASC-H, 6%), Low grade Squamous Intraepithelial Lesion (LSIL,10%) and High grade Squamous Intraepithelial Lesion (HSIL, 11%). In colposcopy, 60% of the patients were normal and 40% showed atypical transition zone. Histo-pathological findings among 53 patients were NILM (13.2%), cervicitis (13.2%), Cervical Intraepithelial Neoplasia I (CIN I, 28.3%), CIN II and CIN III (39.6%) and invasive carcinoma (5.66%). The sensitivity, specificity, PPV and NPV of PAP smear were 63.6%, 66.6%, 33.3%, and 87.5% respectively. Similarly sensitivity, specificity, PPV, NPV of colposcopy for abnormal cervical lesions were 87.56%, 15.38%, 76.09% and 28.57% respectively. Conclusion: In the absence of HPV-DNA testing, the combined use of PAP smear and colposcopy to detect premalignant and malignant cervical lesions increases early detection and treatment
Clinical Profile and Short-term Outcome of Heart Failure Patients in a Tertiary Hospital in Kaski, Nepal: A Cross-sectional Study
Get PDFIntroduction: Heart failure is one of the leading causes of hospitalization. The aim of this study was to evaluate the epidemio-clinical profile and short-term outcome of hospitalized heart failure patients in a tertiary care hospital. Methods: This descriptive cross-sectional study was conducted at Pokhara Academy of Health Sciences, Kaski, Nepal from October 1, 2021 to January 31, 2022. All the hospitalized heart failure patients aged 18 years or above were included. Relevant history, examination, laboratory, and pertinent findings were noted. Descriptive statistics were used for qualitative and quantitative data. Paired t-test was used for the comparison of pre-and post-hospitalization data. A p-value <0.05 was taken for statistical significance. Results: There were a total of 116 patients (65.5% females) with a mean age of 64.20 ± 16.35 years. Most of them had shortness of breath (97.4%) and orthopnea (72.4%) and presented with pedal/sacral edema (81.9%) and bilateral basal crepitations (69.8%) in the chest. Heart failure with preserved ejection fraction was the most prevalent (61.2%) type and dilated cardiomyopathy (27.6%) was the commonest etiology of heart failure. The median duration of hospitalization was five days and the in-hospital mortality was 2.6%. Loop diuretics and vasodilators (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker) were the most commonly used medications. Conclusions: Dilated cardiomyopathy was the most common etiology and heart failure with preserved ejection fraction was the predominant type of heart failure. With a short length of stay and low in-hospital mortality, the short-term outcome was good
Antimicrobial Susceptibility Pattern of Enterococcus Species Isolated From Various Clinical Specimens in a Tertiary Care Center in Western Nepal
No full textIntroduction: Enterococcus species are Gram-positive oval cocci arranged in pairs or short chains. They are found as gut microbiota of adults, but from the last decade, they are emerging as causative agents of various nosocomial infections throughout the world. High level aminoglycoside resistance and vancomycin resistance are being increasingly reported from different parts of the world thus limiting the therapeutic options for the treatment of enterococcal infections. The objective of our study was to determine the antimicrobial susceptibility pattern of Enterococcus species isolated from various clinical specimens in Lumbini Medical College and Teaching Hospital, Palpa. Methods: All the clinical samples were cultured and enterococci isolates were tested for antibiotic sensitivity, high level gentamicin resistance and vancomycin resistance by Kirby Bauer disc diffusion method.Results: Among the 90 isolated Enterococcus spp.maximum isolates were obtained from the age group 21-40 years, most from in-patient department with urine as sample (n=53, 58.89%). The highest antimicrobial susceptibility was recorded for linezolid (90.48%) followed by chloramphenicol (79.71%), nitrofurantoin (76.83%) and then high-level gentamicin (70%). The overall prevalence of high level gentamicin resistance and vancomycin resistant enterococci were 30% and 35.55% respectively. Conclusion: The present findings show a high rate of high-level gentamicin and vancomycin resistant enterococci. Thus, routine surveillance of such resistance pattern should be done every year. Linezolid can be considered as a drug of choice to treat serious enterococcal infections
Screen Time in Children of Central Nepal: A Parent Reported Cross-sectional Study during COVID-19 Pandemic
Get PDFIntroduction: The insurgence of COVID-19 has affected many aspects of human life and its repercussions on the life of children cannot be undermined. In addition to the serious impact on health and food insecurity, lack of recreational activities, school closure and switch to online learning have pushed children to excessive screen exposure. This study aimed to assess the duration of screen time and parental perspective towards screen viewing in children during the pandemic. Methods: A community-based descriptive cross-sectional study was carried out in Bharatpur Metropolitan City. A total of 384 parents were included purposively. A semi-structured questionnaire was used to interview the parents during the pandemic for one month. During the data collection, appropriate universal precautions for COVID-19 were taken. Results: The median duration of screen exposure was two hours (30 minutes to 9 hours). Most (65%) of the parents stated that their children spent more time on screen compared to pre-COVID-19 times. The majority (82%) of the parents were worried about the possible consequences of excessive screen time. More than two-thirds (72%) of parents thought that screen exposure also has various benefits for children. Conclusion: Most of the children exceeded the duration of screen time recommended by the World Health Organization. Most of the parents were worried about the harmful effects on the health and behavior of children
Prevalence of Absence of Palmaris Longus in Students of a Medical College in Nepal
Get PDFIntroduction: Palmaris longus is one of the most variable muscles present in the superficial layer of the anterior compartment of forearm and is phylo-genetically categorized as retrogressive muscle. It arises from the medial epicondyle of humerus and forms a long slender tendon which becomes flattened in palm to form palmar aponeurosis and helps in the flexion of hand at wrist. This muscle can be used in plastic surgery or reconstructive surgeries. The present study was carried out to find the prevalence of presence or absence of palmaris longus tendon in Nepalese population so that it would be helpful to provide a baseline data for surgeons to perform surgical procedures. Methods: This was a cross-sectional descriptive study conducted among 200 medical students after the approval from Institutional Review Committee. The presence or absence of tendon of palmaris longus was observed and confirmed on the flexor aspect of wrist by using Schaffer’s test and Thompson’s test. Results: The overall absence of palmaris longus was observed in 55 students (27.5%) with the prevalence of bilateral absence in 27 students (13.5%) and unilateral absence in 28 students (14.0%).The overall absence of palmaris longus was reported in 20 males (23.2%) and in 35 females (30.7%). Conclusion: Absence of palmaris longus (either unilateral or bilateral) was observed in about one fourth of the participants
A Ten-year Retrospective Study of Nasal Bone Fractures at a Tertiary Care Hospital of Nepal
Get PDF Introduction: Nasal bone fracture occurs due to its vulnerable position and reduced biomechanical resistance to traumas. If not timely treated, it can result in permanent functional and esthetic damage. Methods: A retrospective and cross-sectional study conducted on 91 patients above 17 years of age with nasal bone fractures in the Department of Otorhinolaryngology and Head and Neck surgery of a tertiary care hospital in Kavre. Results: Road traffic accident was the most common cause of fracture (45.1%) followed by fall (36.3%), violence (13.2%), sports-related accidents (4.4%) and occupational accidents (1.1%). Class I fracture was seen in 70 (76.9%), Class II in 17 (18.7%), and Class III in 4 (4.4%). A closed reduction procedure was performed in 74 (81.30%) of the cases, closed reduction with septoplasty was done in 10 (11%), closed reduction with augmentation rhinoplasty was performed for 3 (3.3%), closed reduction with inferior turbinoplasty was required in 3 (3.3%) whereas closed reduction with debridement was done in 1(1.1%). Conclusion: Nasal bone fracture is a complex clinical issue which needs to be addressed early. Violence prevention programs along with drinking and driving campaigns need to be more strengthened to decrease the alarmingly high frequency of nasal bone fracture in the current scenario
In-hospital Outcomes in Patients Undergoing Percutaneous Coronary Intervention in Peri-urban Area Hospital Without Cardiac Surgery Backup
Get PDFIntroduction: In centers without cardiac surgery backup, current guidelines recommend to conduct emergency percutaneous coronary intervention and discourage elective percutaneous coronary intervention. The objective of the study was to evaluate the feasibility and safety of percutaneous coronary intervention in patients with stable coronary artery disease, acute coronary syndrome, and ST segment elevation myocardial infarction in periurban area of Nepal without on-site cardiac surgical facilities. Methods: This retrospective single-centered study was done at College of Medical Sciences, Bharatpur, Nepal. The study included 600 patients who underwent percutaneous coronary intervention in the cardiology department cath lab from January 2014 to March 2020. Patients were evaluated for in-hospital outcomes, procedural success and post percutaneous coronary intervention complications within seven days of hospital stay. Results: Seventy percent (n=420) of percutaneous coronary intervention was emergency percutaneous coronary intervention for acute coronary syndrome and 30% (n=180) of percutaneous coronary intervention was done as an elective percutaneous coronary intervention for stable angina. Procedural success was 98% (n=176) for elective percutaneous coronary intervention and 93% (n=390) for emergency percutaneous coronary intervention. Sixteen percent (n=96) patients developed acute kidney injury, six percent (n=36) of patients developed pulmonary edema and cardiogenic shock respectively, 2% (n=12) patients developed post percutaneous coronary intervention myocardial infarction, 3% (n=18) patients developed bleeding complications, 0.5% (n=3) patients developed stroke and death rate was 3% (n=18). Conclusion: Percutaneous coronary intervention can be done with comparable and acceptable safety in peri-urban area hospital of Nepal without cardiac surgery backup with dedicated and experienced team
Vision Loss following Small Incision Cataract Surgery: A Case Report
Get PDFIntroduction: Retro-bulbar block is still safe and widely employed anesthetic technique in large volume routine cataract surgery. Nevertheless, the procedure is not free of complication. Case report: A 48 years old man who had small incision cataract surgery of left eye under retro-bulbar block, had vision of hand movement close to face on his first postoperative day. He was given intracameral cefuroxime and subconjunctival gentamycin at the end of the surgery. Fundoscopy of the operated eye showed marked retinal whitening with cherry-red spot in the posterior pole suggestive of cilio-retinal artery occlusion. Optical coherence tomography and optical coherence tomography angiography were done to support and confirm the diagnosis. Conclusion: Retinal artery occlusion secondary to retro-bulbar block or drug induced toxicity following routine cataract surgery is unusual and sometimes dreadful vision threatening complication can occur
Prevalence of Refractive Error and Associated Risk Factors in School-Age Children in Nepal: A Cross-sectional Study
Get PDFIntroduction: The most common visual disorder in school age children is refractive error globally. The present study aimed to know the prevalence of refractive errors and explore the factors associated with the refractive error in school-age children in Palpa district of western part of Nepal. Methods: All the school children were selected between age groups 5 to 18 years from four schools of Palpa by multistage sampling method. After the preliminary examination on visual acuity, the children were referred to the Department of Ophthalmology, Lumbini Medical College, Palpa for confirmation of the refractive errors. Results: In school-age children the prevalence of refractive error was 9% of which myopia was the most common (4.05%). Females (about 12%) were more likely to have refractive errors than males (about 7%). The refractive error of males was 0.106 (right eye) and 0.564 (left eye) times more likely than females. The refractive errors were statistically found more common in Dalit students (14.6%) than Brahmin/Chhetri (about 12%) and Janajati (7.6%). The prevalence of refractive errors among students using smart phone/ laptop (about 12%) was higher than those not using (8.36%). Conclusion: Sex, ethnicity, and near-work activity like using the smart device were the covariates of developing refractive error on the eye. Myopia was more among those students who were using smartphones/laptops. Near activities stress on eyes of the children and might be one of the causes of developing myopia
Anatomical Variations of Renal Artery in Patients Undergoing Computed Tomography of Abdomen: A Hospital-based Cross-sectional Study
Get PDFIntroduction: Renal vasculature is known for presenting a wide range of variations. Knowledge of different anatomical variations helps the surgeon prevent possible intraoperative complications. Computed Tomography (CT) is an excellent imaging modality providing detailed anatomy of the renal artery. This study aimed to evaluate renal arterial variations in individuals undergoing abdominal CT examination. Methods: This was a hospital-based cross-sectional study on 400 consecutive patients who underwent abdominal CT examination in a medical college in Nepal. The number of patients with normal and any arterial variations was noted. Accessory renal artery (hilar and polar artery) and any pre-hilar branching were evaluated. Results: Among 400 patients, 271 (67.75%) individuals had normal renal artery supply and 129 (32.25%) had variations. Among 129 individuals (79 males and 50 females) with artery variations, 93 (72.09%) had unilateral and 36 (27.91%) had bilateral variations. The most common unilateral variation was a single polar artery in 66 (70.97%) cases, pre-hilar branching in 18 (19.35%), accessory hilar artery in 7 (7.53%) and dual polar arteries in 2 (2.15%). In those with bilateral arterial variations, the right and left kidneys showed polar artery in 25 (69%) and 30 (83%), pre-hilar branching in 6 (17%) and 2 (6%), and accessory hilar in 5 (14%) and 4 (11%) cases respectively. Conclusion: Renal artery variation was observed in approximately one-third of individuals. Unilateral variation was more common than bilateral and polar artery was the most common arterial variant