Journal of Lumbini Medical College (JLMC)
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Supernumerary Nipples, Congenital Scoliosis, Spina Bifida, Diastematomyelia, and Crossed Renal Ectopia in a child: Case Report of a Rare Combination
Get PDFIntroduction: Supernumerary nipples are common anomalies which may be associated with several systemic disorders, particularly urinary tract abnormalities.
Case report: Here we report a case of a 4½ year old male presenting to the pediatric out patient clinic with fever for three days and recurrent sinopulmonary infections. The child had supernumerary nipples over the right side with deformed thoracic cage, congenital scoliosis, diastematomyelia, crossed renal ectopia, and spina bifida. All the conditions present together did not match any syndrome reported till date.
Conclusion: This was a rare syndrome and did not match fully with any known syndromes till date. This case warranted further investigation for its definite diagnosis but we do not have resources to that extent
Adolescent Pregnancy among Ethnic Variants at Lumbini Medical College
Get PDFIntroduction: Adolescent pregnancy is a common social phenomenon that results to both maternal and fetal related health consequences globally. Important factors affecting this high risk group of pregnancies are social, cultural, ethnic and racial disparities which may limit the care during pregnancy thereby affecting the perinatal outcome. The main objective of this study was to estimate the maternal and fetal outcome of adolescent pregnancies visiting Lumbini Medical college among ethnic variants of mid-western region.
Methods: A retrospective observational study was conducted in Lumbini Medical College and Teaching Hospital for one year duration. Data was retrieved from the medical records of the admitted adolescent pregnant mothers with hospital delivery after 20 weeks’ gestation. Variables of interest were the selective demographic characteristics like place of residence and ethnicity of women, parity, and obstetrical &fetal outcomes.
Results: The total numbers of admission for deliveries during the study period were 1905, out of which 462 (24.3%) were adolescent pregnancy. A total of 184 (39%) adolescent mothers were at the age of 19 and 334 (72.2%) of them were from Palpa district. The highest number of teenagers were from Janajati group i.e. 240 (52%). Among all, 38 (10%) had preterm delivery and 7 (1.5%) had intrauterine fetal death. While 407 (88.3%) adolescent pregnancies had vaginal deliveries, 54 (11.7%)of them had lower segment cesarean section (LSCS). Fifty-one (11.4%) neonates had low birth weight (below 2500 gm)and 11 (2.4%) had stillbirths. Among the low birth weight, 32 (51%) newborns were admitted to neonatal intensive care unit (NICU).
Conclusions: Adolescent pregnancy is higher common in Palpa district of Nepal. Janajati adolescent girls are becoming pregnant early after marriage. Higher numbers of teenagers are 19 years of age and are primigravida. On reaching the tertiary center, obstetrical outcome is better with less maternal morbidity and no mortality and better neonatal survival
Endoscopic Management of Epistaxis in Lumbini Medical College
Get PDFIntroduction: Epistaxis is one of the commonest Ear Nose Throat (ENT) emergency. Proper guidelines for its management are lacking; on the other hand, the management is mostly done by the junior health service providers which has invited non-standardized practice of epistaxis management. Thereby this study was much inclined towards assessment of the effectiveness of endoscopic management of epistaxis.
Methods: This prospective study included patients above 16 years who were diagnosed with idiopathic epistaxis visiting Out Patient of ENT Department or in the Emergency Department of Lumbini Medical College from 1st of July 2014 to 30th of June 2015. ENT examination was done to find the cause and site of bleeding. Thereafter different epistaxis management interventions were done depending on the bleeding condition. The data were collected, entered and then analyzed using SPSS version 21. The descriptive statistics were applied.
Results: Of the total 116 patients, 53 (45.69%) were male and 63 (54.31%) were female showing no gender preponderance with epistaxis in our study. Majority (49%) of the patients were managed with cauterization with silver nitrate or electrocautery in out-patient clinic. Second most common (18%) procedure was endoscopic sphenopalatine artery cauterization. Nasal packing was done only in three cases with zero posterior pack.
Conclusion: Endoscopic intervention of epistaxis seems to be safe, simple, fast, and effective for the management of epistaxis with low rates of morbidity and complications. Thereby it can be preferred over the conservative nasal packing and considered as immediate second-line management
The Efficacy of Ketamine Gargle in Attenuating Postoperative Sore Throat: A Randomized Control Trial
Get PDFIntroduction: Postoperative sore throat (POST) is a common complication of general anesthesia with endotracheal intubation that affects the patient satisfaction after surgery. The aim of the study was to compare the effectiveness of ketamine gargle with placebo in preventing POST after endotracheal intubation.
Methods: Sixty eight patients scheduled for elective surgery under general anesthesia were enrolled in this study. Patients were randomly allocated into two groups, 33 in study group and 35 in control group. Study group patients were asked to gargle with ketamine (50 mg in 1 ml mixed with 29 ml of drinking water) 10 minutes before induction for 30 seconds. Controls were made to do so with 30 ml of drinking water. POST was graded at one, two, four, and 24 hrs after operation on a four-point scale (0-3). The outcome measures were compared between two groups in terms of occurrence of POST and severity of POST at one, two, four, and 24 hr to determine the efficacy of ketamine.
Results: Occurrence of POST was significantly less in study group at four hours. Severity of POST was significantly low in study group at one, two and four hours as compared to that in controls. It was comparable at 24 hours.
Conclusion: Ketamine gargle significantly reduced the occurrence and severity of POST
Pattern of Severe Acute Maternal Morbidity in a Tertiary Care Institute
Get PDFIntroduction: Maternal mortality traditionally has been the indicator of maternal health all over the world. More recently review of the cases of severe acute maternal morbidity (SAMM), also termed as \u27near miss obstetrics events\u27, has been found to be a useful supplementary indicator to investigate maternal health care. Cases of near miss are those in which women present with potentially fatal complication during pregnancy, delivery, or the puerperium and survive merely by chance or by good hospital care. This study was done with the objective to analyze cases of SAMM at Lumbini Medical College Teaching Hospital (LMCTH), Nepal.
Research Methods: A retrospective study of all cases meeting the WHO criteria for SAMM, during May 2015, was done. Cases meeting the WHO eligibility criteria for near miss cases were included in the study. Medical record of such cases in past one year was reviewed. Their socio-demographic variables, parity, gestational age, associated organ dysfunction, ICU and hospital stay, management, and fetal and maternal outcome were noted.
Results: During the study period, there were total of 28 cases of SAMM and two maternal mortality out of 2735 live births. Thus rate of SAMM was 1.02%, and maternal mortality rate was 0.07%. Majority of patients were unbooked (n=18, 64.28%) and 10 (35.71%) were illiterate. Commonest causes for admission to ICU was hemorrhage (n=10, 35.71%) followed by hypertensive disorders (n=9, 32.06%), sepsis (n=2, 7.14%), and obstructed labour (n=2, 7.14%). Laparotomy was performed in six (21.42%) women, obstetric hysterectomy in four (14.28%), and pelvic devascularization in two (10.71%).
Conclusion: SAMM is a useful adjunct to maternal mortality to assess maternal health care. Improving facility based care and prompt referral, education of primary health care (PHC) staff can be a short term measure to quickly reduce the number of maternal deaths. Facility based monitoring and reporting of SAMM outcome is an important step for scaling up such efforts
Pattern of Dermatological Disease and its Relation to Gender in Lumbini Medical College Teaching Hospital
Get PDFIntroduction: The pattern of skin disease differs in different countries, and within various region of a country depending on socio-economic, racial and environmental factors. Many researchers have reported various patterns of skin disease in different countries. This type of study has not been done in this part of country. So, we decided to study, assess and compare the different pattern of dermatological disease in patients visiting our centre.
Methods: This was retrospective study done from the hospital record of Lumbini Medical College Teaching Hospital (LMCTH). The study was carried out from September 2014 to December 2014 while the data were accessed from the records of respondents from September 2013 to August 2014. The diagnosis was categorized into 10 groups. The diagnosis which did not fit any category was kept in \u27Others\u27. The 10 categories include acne, bacterial infection, dermatophytes, eczema, leprosy, pigmentory diseases, psoriasis, scabies, urticaria and viral infection. Data was collected based on gender and categorized according to the diagnosis. Microsoft Excel was used for data entry while all the analysis both descriptive and inferential statistics was done using SPSS version 21.
Results: There were a total of 7967 patients visiting Dermatology OPD. Out of the total patient, there were 52.10% female and 47.89% male and this difference was statistically significant. In both gender eczema was the most common skin disease. Eczema was significantly more common in male whereas acne was significantly common in female. Most of the patients were from age group of 15-30 yrs with eczema being commonest in this age group.
Conclusion: Eczema and dermatophytes are the most common dermatological diseases. Eczema is significantly more common in male. Acne is significantly more common in female
Asymptomatic Bacteriuria in Diabetic Adults
Get PDFIntroduction: Urinary Tract Infection (UTI) is a well- known complication of Diabetes Mellitus (DM). Its spectrum ranges from Asymptomatic Bacteriuria (ABU) to acute pyelonephritis. Many studies have delineated an increased prevalence of ABU in DM whereas to the same degree other studies have come to naught showing insignificant association. Hence, this study was drafted to evaluate the presence of ABU among diabetics and assess various risk factors.
Methods: Total of 116 diabetic adults without symptoms of UTI attending medical out-patient department, Manipal Teaching Hospital were enrolled by detailed clinical history, examination and laboratorial examination as per standard set of questionnaire from February 2013 to May 2014. Data were analyzed by SPSS (17.0).
Results: The rate of ABU in diabetic adults was 10.3% and was significantly associated with duration of DM, fasting blood glucose level and poor glycaemic control. Escherichia coli was the most frequently isolated pathogen which was sensitive to Nitrofurantoin and Imipenem.
Conclusion: Being asymptomatic, diabetics fail to recognise ABU, however, ABU is preponderant in DM and is linked mainly with duration of DM and poor glycaemic control. Hence screening for ABU is imperative in diabetic adults if above mentioned risk factors are present
Intraperitoneal Hydrocortisone plus Bupivacaine versus Bupivacaine alone for Pain Relief after Laparoscopic Cholecystectomy: A Randomized Controlled Trial
Get PDFIntroduction: Laparoscopic cholecystectomy has been the gold standard in the treatment of gallstones since last decades. Beside several benefits of laparoscopic cholecystectomy compared with open surgery, postoperative pain is still a frequent melancholy. Hence, pain management is utmost regarding patients\u27 comfort. The main objective of the study was to compare the effect of intraperitoneal hydrocortisone plus bupivacaine with bupivacaine alone on pain relief following laparoscopic cholecystectomy.
Methods: A randomized study was conducted from December 2015 to August 2015 that included 100 patients aged 20 to 60 years of both genders who were found to have symptomatic gallstones and were scheduled for elective laparoscopic cholecystectomy at Lumbini Medical College. Patients randomly received 100 mg hydrocortisone plus 100 mg bupivacaine in 200 ml normal saline (group A) or 100 mg bupivacaine in 200 ml normal saline (group B) into the peritoneum. Post-operative abdominal and shoulder pain were evaluated using Visual Analog Score (VAS). The patients were also followed up for postoperative analgesic requirements, and recovery variables. Data were collected, tabulated and analyzed statistically using SPSS version 19.
Results: Total number of patients in this study were 100. Age and gender among both groups were comparable. VAS scores for pain was significantly lower for group A as compared to group B at 0, 2, 4, 6, 12, and 24 hours. Time of oral intake in hrs for liquids and solids was statistically significant in Group A compared to Group B. Rescue analgesic requirement was also significantly low in Group A compared to Group B. Hospital stay in both group were comparable.
Conclusion: Combination of hydrocortisone plus bupivacaine can relieve pain after laparoscopic cholecystectomy better compared to bupivacaine alone when administered intraperitoneally
Contributing Factors for Perceived Satisfaction with Nursing Care among Inpatients in General Wards
Get PDFIntroduction: Patients\u27 perceived satisfaction with quality of care may affects health outcomes. Patients who are satisfied with their nursing care are more likely to follow treatment and consequently to have better health outcomes. It encourages them to behave in a healthy way after discharge, and positive rating of service quality seems to be correlated with no hesitation about revisiting the same hospital ward in time of need. This study was done to identify the contributing factors for perceived satisfaction with nursing care among inpatients in general wards in Lumbini Medical College.
Methods: A descriptive cross sectional study was conducted in Lumbini Medical College Teaching Hospital throughout the month of August, 2015. A total of 60 heterogeneous study population from three different wards (Medical, Surgical, and Orthopedics), who gave consent for participation, were included using non-probability convenient sampling technique. Nepalese version of Newcastle Satisfaction with Nursing Scale (NSNS) was used to measure the satisfaction score.
Results: There were a total of 60 respondents with mean age of 30.08 years (SD= 9.72). Male, duration of hospital stay, and number of hospital stay had a significant relation with the satisfaction score when calculated individually. However, the relationship was not significant when adjusted for other variables by linear regression.
Conclusion: Majority of respondents were satisfied with the quality of nursing care. Male, duration of hospital stay, and number of hospital stay had a significant relation with the satisfaction score when calculated individually. The nurses should know the factors influencing patients\u27 satisfaction and work on those to improve the quality of nursing care
Perinatal Outcome of Deliveries after One Previous Caesarean Section: A Prospective Study from Mid-west hilly Nepal
Get PDFIntroduction: Contrary to the WHO recommended caesarean section (CS) rate of 15%, there is an alarming trend of increasing caesarean section rates. An important reason for this is repeat caesarean section (RCS). Vaginal birth after caesarean (VBAC) is one of the methods of reducing CS rates in women with history of previous CS. This study was done with the aim to see the maternal and fetal outcome among parturient with history of single previous caesarean section and to determine the rate of VBAC at Lumbini Medical College, Nepal.
Methods: This is a prospective study done for a period of ten months. Seventy parturient fulfilling inclusion criteria of term pregnancy with single live fetus and history of one Lower Segment Caesarean Section (LSCS) were enrolled in the study. Patients meeting the criteria for VBAC were given trial of labour and others were taken for elective repeat CS. This cohort was analyzed further, with respect to age, parity, period of gestation, mode of delivery, indication for CS, maternal and fetal complications and outcomes.
Results: VBAC was successful in 27.14% of patients (n=19) while the rest 51 (72.85%) underwent RCS . Indications for RCS was mainly scar tenderness 7 (13.7%), fetal distress 6 (11.7%), non progress of labour 6 (11.7%), meconium stained liquor 6 (11.7%) and post-dated pregnancy 6 (11.7%). Maternal morbidity was comparable in women undergoing RCS or VBAC. There was one still birth and one early neonatal death in each group due to complications of meconium aspiration.
Conclusion: Patients with previous CS are at high risk of RCS. If trial of labor is allowed under careful patient selection and supervision, the rate of vaginal delivery after caesarean section can be increased safely. As there is no added perinatal morbidity and mortality in cases of VBAC as compared to RCS, VBAC shows the right way forward to decrease the rate of caesarean section