Journal of Lumbini Medical College (JLMC)
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Clinical Profile and Outcome of Asphyxiated Newborn in a Medical College Teaching Hospital
Get PDFIntroduction: Perinatal asphyxia, a major topic in neonatology, is a severe condition which has a high impact on neonatal mortality and morbidity and neurological and intellectual development of the infant. It is defined by WHO as \u27failure to initiate and sustain breathing at birth\u27. It is estimated that around four million babies are born asphyxiated and among those one million die and an equal number of babies develop serious neurological consequences ranging from cerebral palsy and mental retardation to epilepsy. This study was done to identify the occurrence, clinical profile and, immediate outcome of perinatal asphyxia in Lumbini Medical College Teaching Hospital.
Methods: It was a retrospective study where 82 cases who fulfilled the inclusion criteria were included between December 2014 to November 2015. Inclusion criteria included newborns with: a) Apgar score equal to or less than six at five minutes, b) requirement of more than one minute of positive pressure ventilation, c) signs of fetal distress (heart rate of less than 100 beats per minute, late decelerations).
Results: Out of total 425 neonatal intensive care unit (NICU) admissions, 82 (19.3%) cases were of asphyxia among which 56 were inborn and 26 were referred from outside. Of those 82 cases, 47 (57.3%) cases developed hypoxic ischemic encephalopathy (HIE); HIE stage I had good outcome with survival rate of 95% and HIE stage III had poor outcome with survival rate of only 25%.
Conclusion: Despite advances in management of neonates, perinatal asphyxia is still the leading cause of neonatal intensive care unit admission and mortality and morbidity in neonates
Comparison of Perinatal Outcome of Breech Presentation between Vaginal Delivery and Cesarean Section
Get PDFIntroduction: Many times, parturient opt for labour and vaginal breech delivery even after informing increased perinatal risks. Vaginal breech deliveries are undertaken with the reasons like avoidance of cesarean section in next pregnancy, null risk of operative and anesthetic hazards, ability to resume early all household works after vaginal birth, etc. The purpose of this study is to compare the perinatal outcome of breech deliveries in singleton breech presentation between vaginal breech delivery and cesarean section.
Methods: A retrospective study was done in Lumbini Medical College Teaching Hospital for the duration of one year (December 2014 to November 2015). Data of perinatal outcome of breech deliveries were collected from the hospital records. The records of neonatal examination were also collected. The primary outcomes included were neonatal morbidity and mortality.
Results: Out of 80 selected women with breech presentation, 42 of them had vaginal deliveries and 38 women had undergone caesarean section. The perinatal mortality was 4.8% and morbidity was 2% in vaginal breech deliveries. There was no significant difference of APGAR score in the two groups at any time. Similarly, there was no significant difference in perinatal morbidity and mortality in the two groups. Nulliparous women were more likely to deliver by Cesarean section.
Conclusion: In places where planned vaginal delivery is a common practice and when strict criteria are met before and during labour, planned vaginal breech delivery of singleton fetus in breech presentation remains a safe option that can be offered to women
Clinico-radiological Profile of Stroke in Western Nepal: A Computed Tomography Study
Get PDFIntroduction: Stroke is a major public health burden worldwide and is responsible for a large proportion of disability. It ranks third in the causation of morbidity and mortality. This study was carried out to establish the pattern of various types of cerebrovascular accident (CVA) in western Nepal, to correlate the clinical data and radiological findings in cases of stroke, and to identify the common risk factors associated with stroke.
Methods: A total of 200 patients presented at the department of Radiodiagnosis from emergency or ward within six months of study period from 18th of September 2015 to 17th of March 2016 with clinical diagnosis of stroke. Brain CT scan was done within 14 days of onset.
Results: There were 200 patients with stroke (124 males and 76 females), aged 19 to 92 years in which infarction was more common than hemorrhage (57% Vs 41.5%) clinically. Hypertension was the commonest risk factor noted in 59% cases followed by Diabetes Mellitus in 39%. Middle cerebral artery (MCA) territory infarction was the most common site of infarction. Clinical and CT localization of hemorrhage and infarct was correct in 153 cases (75%) which was statistically significant.
Conclusion: Infarction is more common than hemorrhage as the type of stroke. Hypertension is the commonest risk factor followed by diabetes mellitus.  
Outcomes of Pediatric Supracondylar Fractures of Humerus Treated by Posterior Triceps Splitting Approach
Get PDFIntroduction: Close reductions and percutaneous pinning is the gold standard treatment for supracondylar fracture of humerus. Open reduction and internal fixation is indicated in patients with unacceptable closed reduction, neurovascular compromise, and open fractures. Open reduction can be performed through various approaches. Every approach has their advantages and limitations. The aim of this study was to assess the functional outcome of pediatric supracondylar fracture of humerus treated by posterior triceps splitting approach.
Methods: This was a prospective evaluation of 20 consecutive patients with displaced pediatric supracondylar humeral fractures operated by triceps spitting posterior approach in our institution for two years. At initial presentation, 19 cases were Gartland III and one was flexion variant of injury. Complications such as reduction loss, pin migration, infection, osteonecrosis of any part of the elbow, bone healing, and functional results were evaluated. Flynn criteria were used to evaluate the final results.
Results: Twenty patients underwent open reduction and internal fixation by triceps splitting approach. Thirteen patients were male and seven were female with M:F ratio of 1.86:1. The mean age was 6.8 yr (SD=2.74, range 2-14). All the fractures united by six weeks; mean time for union was 4.5 wk (SD=0.94). All patients were assessed at six months using Flynn clinical and radiological criteria. Results were satisfactory in all patients.
Conclusion: Posterior triceps splitting approach is simple, safe and has good functional and radiological outcome. We recommend this approach for open reduction and internal fixation in pediatric supracondylar fracture
Incidence of Carcinoma Prostate in Transurethral Resection Specimen in a Teaching Hospital of Nepal
Get PDFIntroduction: As suggested through several autopsy studies there is a high prevalence of latent prostate cancer in the population. A much smaller proportion of prostate cancer is detected because of clinical symptoms. This study was done to identify the rates of incidentally detected prostate cancer in patients undergoing surgical management of Benign Prostatic Hyperplasia (BPH) in our centre.
Methods: A retrospective review was done on all transurethral resections of the prostate (TURP) cases from May 2014 to May 2015 at a single tertiary care institution. One hundred and three men, aged 40 to 88 year, underwent TURP and their specimens were sent for the histopathological analysis.
Results: Five (4.85%) patients were diagnosed with the prostate cancer. All the five patients had Gleason score of seven or more. Two patients had moderately differentiated adenocarcinoma with Gleason score of seven. Three patients had poorly differentiated adenocarcinoma with Gleason score of eight or above. The Prostate cancer was seen only in the age group above 65 years but it was not statistically significant.
Conclusion: Our series demonstrated that 4.85% of patients had latent prostate cancer. It occurs mainly in men above 65 years of age though this was not statistically significant
Measurement of Fertility Benefits with Low Dose Thyroxine in Sub-fertile women
Get PDFIntroduction: High prevalence rate of thyroid dysfunction associated infertility is identified by a number of studies in Nepal. Thyroid dysfunction not only affects fertility but is also associated with miscarriage and fetal death. The objective of this study was to measure the fertility rate after low dose Thyroxine, 12.5 microgram, in women with subfertility.
Methods: This was a descriptive and observational study done among women visiting infertility and in-vitro fertilization (IVF) center at Nepalgunj Medical College, Nepal. After undergoing baseline investigations for infertility, all women diagnosed with primary or secondary infertility were enrolled in the study. Male factor and tubal factor infertility was excluded. All 136 women who were enrolled in the study received 12.5 microgram of thyroxine supplementation for a period of three months and subsequently followed up until the same time period.
Results: Out of 136 women, 83 (61.02%) women achieved pregnancy within three months of supplementation with low dose thyroxine. Among them, 34 (40.9%) women with primary infertility achieved pregnancy within three months. Similarly 14 (16.8%) women with previous miscarriage, 20 (24.09%) women with previous caesarean section within past five years back, and 15 (18.07%) with previous IUFD achieved pregnancy within three months.
Conclusion: Low dose thyroxine supplementation would be beneficial and recommended to subfertile women of reproductive age group in the endemic regions of hypothyroidism. Dose adjustment would give extended benefits as soon as pregnancy is achieved
Lifestyle Modification after Diagnosis of Hypertension in Patients Visiting Lumbini Medical College Teaching Hospital
Get PDFIntroduction: Lifestyle modifications is an important aspect of hypertension therapy. However, studies on this nonpharmacological approach of hypertension management and its impact is very limited in a developing country like Nepal. The objective of the present study was to determine the life style of patients after diagnosis of hypertension.
Methods: A descriptive cross sectional study design was conducted in Lumbini Medical College Teaching Hospital (LMCTH). A total of 63 patients attending Medical outpatient clinic of Lumbini Medical College who were diagnosed as hypertensive at least two months before the interview were included. Data were collected from 22nd February 2015 to 21st March 2015 by interview method using a questionnaire consisting of a combination of structured and semistructured questions.
Results: This study revealed that non-vegetarian decreased from 95.2% to 74.6% after diagnosis. Lifestyle modification criteria like amount of salt intake, smoking, and alcohol consumption were significantly reduced whereas physical exercise and stress reduction activity were significant increased.
Conclusion: Majority of respondents has changed their lifestyle after diagnosis of hypertension
Education Status of Husband and Wife and its Influence on Acceptance of Contraception
Get PDFIntroduction: Acceptance of family planning is influenced by a variety of interrelated factors such as age at marriage, education, economic status, religion, number of living children etc. This study is an endeavor to assess the relation between education status of husband and wife and acceptance of contraception among postpartum women at Lumbini Medical College Teaching Hospital.
Methods: A prospective, observational analytical study was conducted in Obstetrics and Gynecology department of Lumbini Medical College. The information on socio-demographic data, educational status of husband and wife and willingness to accept any form of contraception within the next three months was obtained by an interview, utilizing a questionnaire.
Results: There were 615 postpartum ladies accompanied by their husbands who were included in the study. Mean age of wives was 25.11 years (SD=5.36, range 17-45) and husbands was 27.89 years (SD=5.55, range 20-47). Contraceptive acceptance was shown to increase significantly with literacy status. Illiterate husbands and wives refused to accept the contraception which was statistically significant (p<0.001).
Conclusion: Contraceptive acceptance was significantly poor in illiterate wives and husbands whereas it was significantly higher in educated wives and husbands of all education levels. We feel the need of more education programs and education friendly socio-economic conditions which increases the acceptance of contraception thereby assisting family planning and population control
Bier\u27s block: A Case Report
No full textIntroduction: Intravenous Regional Anesthesia (IVRA) has been first described in 1908 by the German surgeon August KG Bier. Although the technique was convenient to perform and effective in giving surgical anesthesia, the recent plexus block techniques have largely replaced the Bier’s block instantly because of time limitations and safety considerations of IVRA. Throughout the years, modifications in procedure and new pharmacologic adjuvants have shown to prevent toxic reactions to anesthetics and mitigate limitations of IVRA, still IVRA can be preferred as choice of anesthesia for short procedures.
Case Report: We present a case of 86 yr old male who was operated for radius fracture after a fall injury under Bier\u27s Block or IVRA technique. Conclusion: IVRA can be the choice of anesthesia for short procedures because of rapid onset of anesthesia, easy administration and cheaper cost with special considerations on its side effects, complications which can be the outcome of technical errors
Presentation and Management of Soft-Tissue Foreign Bodies in a Teaching Hospital of Western Nepal
Get PDFIntroduction: Accidental penetrating injuries with foreign bodies are a common presentation in hospital\u27s emergency rooms. If missed, these bodies can remain dormant or result in a wide range of complications. This study evaluated the characteristics of patients, presentation and management who suffered foreign body embedded in soft tissue at a teaching hospital of Western Nepal.
Methods: The study was conducted at Department of Orthopaedics, Lumbini Medical College Teaching Hospital from September 2013 to August 2015. All cases confirmed to have a foreign body in soft tissue were enrolled. Surgical exploration with removal of foreign body was carried in operating room under tourniquet control. The patient demographics, cause of injury, nature of foreign body, occupation of the patient, diagnostic yield of radioimaging, procedures undertaken for retrieval of foreign body, and complications were recorded. All patients were followed-up up to five months.
Results: Total 28 patients, nine (32.1%) males and 19 females (67.9%) were observed. The mean age was 35.6 yr (SD=11.1). Housewives (n=14, 50%) were the common sufferers. Most of our patients (n=17, 60.7%) presented two weeks after injury. Accidental prick while cutting grass or tree was the common mode (n=13, 46.3%) of injury and among foreign bodies, wooden or vegetative were the commonest (n=19, 67.9%) observed. Among the extremities, hand (n=10, 35.7%) and foot (n=5, 17.9%) were commonly affected. All patients had successful surgical exploration and retrieval of the foreign bodies under anesthesia and tourniquet control in operating room. Image intensifier was employed in seven cases to locate the foreign bodies per-operatively. Wound infection developed in 14.2% (n=4) of patients, all of whom were managed successfully with oral antibiotics. None of the patients required re-hospitalization. All patients were fine at final five months follow up.
Conclusion: Managing foreign body embedded in the soft tissue are challenging. Surgical exploration under tourniquet control suffice a definitive management. At times, image intensifier is required to locate the foreign body