Journal of Lumbini Medical College (JLMC)
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Complications of Percutaneous Nephrolithotomy and their Management: Experience from a Single Centre
Get PDFIntroduction: Increasing global prevalence of nephrolithiasis has resulted in the development of new minimally invasive techniques and has also led to the resurgence of established methods such as percutaneous nephrolithotomy (PCNL). This procedure is now recommended as the first option for the treatment of single large or multiple renal stones and those in the inferior calyx. This study was done to assess the complications of PCNL and their management, in our centre.
Methods: Medical records of 144 patients who underwent PCNL at Lumbini Medical College Teaching Hospital, during the last one year were reviewed. The demographic data, size, tract number and location of the calculi, and intraoperative and postoperative complications were evaluated. The various parameters of the calculi were evaluated. Descriptive analysis with frequencies was done.
Results: Complications occurred in 13 (9.02%) patients. Post operative bleeding occurred in seven (4.8%) patients, out of which one patient developed pseudoaneurysms and the other developed arteriovenous fistula. One patient developed hypovolemic shock immediately after surgery. Frequent blockage of urine, excessive drainage of urine from the drain site, hemothorax and colonic perforation was seen in one patient each. One patient had mortality due to post operative bleeding. Complications increased with the number and size of stones and number and site of the tracts.
Conclusion: Percutaneous nephrolithotomy has low complication rate in experienced hands and complications depend upon stone size, history of open stone surgery, tract number, and tract location
Bacterial Translocation as a Cause of Postoperative Sepsis in Surgical Patients Undergoing Laparotomy
Get PDFIntroduction: Bacterial translocation is the invasion of indigenous intestinal bacteria through the gut mucosa to normally sterile tissues and the internal organs. Objective of the study is to examine the spectrum of bacteria involved in translocation in surgical patients undergoing laparotomy and to determine the relation between nodal migration of bacteria and the development of postoperative septic complications.
Methods: Mesenteric lymph nodes (MLN)culture was done in patients undergoing elective and emergency surgeries fulfilling the inclusion criteria.
Results:Bacterial translocation was identified in 22 (44.8%) patients. The most common organism identified was Escherichia coli (n=11, 50%). Both enteric bacteria, typical of indigenous intestinal flora, and non-enteric bacteria were isolated. Postoperative septic complications developed in four (11%) patients. Septic morbidity was more frequent when a greater diversity of bacteria resided within the mesenteric lymph nodes.
Conclusion: Bacterial translocation is associated with an increase in the development of postoperative sepsis in surgical patients. The organisms responsible for septic morbidity are similar in spectrum to those observed in the mesenteric lymph nodes. These data strongly support the gut origin hypothesis of sepsis in humans. Besides, there is increased bacterial translocation in patients undergoing emergency procedures.
Keywords: bacteria • laparotomy • postoperative • sepsis • translocatio
Clinical Results of Surgically Treated Medial Humeral Epicondylar Apophyseal Avulsion Injury in Children and Adolescent.
Get PDFIntroduction: Fractures of the medial humeral epicondyle represent approximately 10% of all paediatric elbow fractures. Objective of our study was to assess treatment outcomes of children and adolescent with medial epicondylar fracture of the elbow using standard operative protocols.
Methods: 20 surgically treated fractures of the medial humeral epicondyle were analysed & reviewed for their epidemiological, clinical and surgical parameters. A valgus stress test was performed under general anesthesia or sedation. All patients underwent open reduction internal fixation using a similar technique. The medial epicondylar fragment was anatomically reduced and fixed in all cases with screws, Kirshner wires or tension band wiring. At final evaluation, union (radiologically) and elbow function [MAYO elbow performance score (MEPS)] was assessed.
Results: An evaluation of all of our patients after a mean follow-up of 8.75 months (SD=4.76) after initial surgery was possible. The mean age of patients at the time of injury was 10.8years (SD=2.3). Fifteen (75%) dominant elbows were injured in our study and 12(60%) elbows had an associated elbow dislocation. On examination in operating room post anaesthesia, all of the elbow injuries revealed some degree of valgus instability. All of our patients(n=20) showed good to excellent results in the MAYO elbow performance score (MEPS). Radiographically, union was achieved in all cases. Three patients developed postoperative ulnar nerve neuropraxia, all recovered at time of final follow up. One patient developed mild lateral heterotrophic ossification but did not require any additional surgical intervention.
Conclusion: Our results suggest that open reduction internal fixation of displaced medial epicondyle fractures leads to satisfactory motion and function. A valgus stress test in operating room can reveal the true nature of joint instability that can warrant operative stabilization of medial epicondylar injuries
Psychological Distress in Patients having Globus Pharyngeus: A Case-Control Study
Get PDFIntroduction: Globus sensation is described as a constant feeling of a lump or foreign body in the throat in absence of pain and dysphagia. It is a common complaint in Ear Nose and Throat clinics. Etiology of this condition remains multifactorial and unclear. Psychiatric disorder has been described as one of the cause of globus. The objective of this study is to evaluate the occurrence of psychological distress in patients complaining of globus sensation in throat coming to our centre.
Methods: A case-control study was done. Patients coming to Outpatient of Ear Nose and Throat Department of Lumbini Medical College Teaching Hospital with complain of globus and not having an organic explanation of the condition were included. Age, sex and socio-economic condition matched control group was selected from healthy visitors (patient parties). Validated Nepali version of GHQ-12 was used to assess the psychological distress.
Results: Psychological distress was present in 72.69% of the cases and 39.91% in the control group. The difference was statistically significant.
Conclusion: Psychological distress was significantly higher in the patients with globus pharyngeus compared to the control group. It was also present in a larger fraction of the controlgroup. The patient who present with Globus should undergo psychiatric evaluation after organic causes have been ruled out. We recommend a national policy to evaluate the population for their psychiatric health
Clinical Study of Ectopic Pregnancy in a Tertiary Care Hospital in Nepal
Get PDFIntroduction: Ectopic pregnancy is a cause of pregnancy related mortality and its incidence is on the rise. The aim of modern management of ectopic pregnancy should be to diagnose ectopic pregnancy accurately, so that women can seek prompt diagnosis and treatment and optimize their future fertility.
Methods: This prospective study was done for a period of one year in patients suspected clinically to have ectopic pregnancies which were subsequently confirmed by pregnancy test and ultrasonography (n=17). The following parameters: age and parity of the patient, relevant past medical and surgical history, significant clinical findings at presentation, management done and outcome of the management were noted.
Results: Most patients 13 (76.47%) were in the age group of 20-25 years and 16 (94.11%) of them presented with acute pain abdomen. In all cases, emergency laparotomy was performed. There were 16 cases of tubal ectopic and one of ovarian pregnancy. Right side was affected in 14 (82.35%) cases including one right sided ovarian ectopic. Tubal rupture was found in 10 (58.82%) patients. The most common 12 (75%) site of tubal pregnancy was ampullary. Salpingectomy was performed in 14 (82.35%) cases. All patients were discharged byseventh postoperative day.
Conclusion: Ectopic pregnancy can be suspected clinically by history and associated risk factors. Women presenting with acute pain abdomen with a positive urine β-hCG test should be promptly diagnosed and treated without undue delay to reduce maternal morbidity and mortality
Knowledge on Perimenopausal Symptoms among Women Attending Lumbini Medical College Teaching Hospital
Get PDFIntroduction: Perimenopause is an unavoidable stage of a woman\u27s reproductive life that starts several years before menopause. Due to declining estrogen level, women experience physiological and psychological changes during perimenopausal period and sometimes symptoms are very distressing that affect the women’s quality of life negatively. This study was done to assess the knowledge of women about perimenopausal symptoms.
Methods: A cross-sectional analytical study was done at Lumbini Medical college (LMC) throughout the months of November and December, 2013. Women of age 40-60 years, attending various clinics in LMC and ready to take part in the study were included. A total of 142 women were selected purposefully. The data was collected using the semi structured interview schedule.
Results: The study revealed that half of respondents were between age group 40-44 years, 141 (99.3%) were married and 82 (57.7%) were literate. Three quarter of respondents (74.6%) were menstruating women. The main source of information on perimenopausal symptoms was friends and relatives (81.2%). Majority of respondents (n=90, 63.4%) had poor, 52 (33.8%) had fair and only 2.8% had good level of knowledge on perimenopausal symptoms. The respondents’ level of knowledge on perimenopausal symptoms was statistically significant with educational status (p<0.001), level of education (p=0.048) and economic status (p=0.02).
Conclusion: Many women have poor knowledge on perimenopausal symptoms. The role of health care provider is that they should seriously discuss about mid-life women’s health problems including perimenopausal symptoms and treatment modality including hormonal replacement therapy so the quality of life of women can be improved
Clinical and Epidemiological Features of Psoriasis in Patients Visiting Lumbini Medical College
Get PDFBackground: Psoriasis is a worldwide disease and varies in its clinical profile and epidemiology in different regions of the world. The disease is common and few epidemiological data are available in our country. Objective: The purpose of this study was to evaluate the epidemiologic and clinical features of Psoriasis in Lumbini Medical College.
Methods: A retrospective investigation of a total of 240 patients visiting Out Patient Department (OPD) of Dermatology and Venereology of Lumbini Medical College with Psoriasis was done. The parameters included were age at onset of disease, age at first treatment, current age, sex, type of disease and distribution of lesions. Data and statistical analysis was done with SPSS 17.0.
Results: The mean age of patients at onset of disease was 26.4 (SD = 14.3) years. M:F ratio was 1.16. Psoriasis vulgaris (PV) was the most common variety of the disease. Extensor surface of the body was most commonly involved.
Conclusion: Psoriasis is a common dermatological disease accounting 2.9% of all dermatology patients in our center. PV is the most common clinical subtype. The disease is more frequent in the third decade of life and has a male predominance in our region. Treatment compliance has been found to be poor
Induction of Labour in Prelabour Rupture of Membranes with or without Cervical Ripening with Prostaglandin E2: A Randomized Controlled Trial
Get PDFObjective: To compare the outcome of induction of labour with titrated dose of oxytocin with or without pre induction cervical ripening using prostaglandin E2.
Methods: This is a prospective study. Sixty women with prelabour rupture of membranes (PROM) and Bishops score of less than six were randomly assigned to either immediate induction with intravenous oxytocin drip or induction with intravenous oxytocin drip preceded by cervical priming with prostaglandin E2 (PGE2) gel 0.5mg instilled intracervically. These two groups were compared regarding the mode of delivery, induction to delivery interval and maternal and neonatal morbidities.
Results: Cervical priming with PGE2 resulted in lesser number of caesarean section (5 Vs. 12) and lower incidence of meconium stained liquor (n=6 Vs. n=2). Induction to vaginal delivery interval was shorter when cervical priming was done (5.4 hrs Vs 7.9 hrs). The maternal morbidity was negligible (<1%) in both the groups. The number of neonates with birth asphyxia (n=2) and the need for their resuscitation (n=2) was more in the oxytocin group but the need of antibiotics for the neonates was more in PGE2 group (5% Vs. 3%).
Conclusion: Induction of labor with oxytocin, with or without cervical priming with vaginal PGE2 gel, are both reasonable options in cases of PROM, since they result in statistically non significant rates of maternal and neonatal morbidities and caesarean section. Cervical priming with prostaglandin results in higher rate of vaginal delivery and shorter induction to vaginal delivery interval and this is viewed as an advantage to the mother
Perceived Social Support among Mentally Ill Patients
Get PDFIntroduction: Social support is the perception that one is cared for, has assistance available from significant others and its benefit is by buffering stress by influencing the ability to adjust and live with illness. Social support can uplift the quality and subjective wellbeing of people. The objective of this study was to examine the perceived social support and factors influencing it among mentally ill patients.
Methods: A descriptive cross-sectional study was carried out. Ninety cases aged more than 18 years visiting outpatient of psychiatric department and diagnosed as a case of mental illness for at least a year were included. Instruments used were self-developed proforma and Multidimensional Scale of Perceived Social Support. Interview technique was used to collect the data.
Results: Majority (60%) of the patients perceive social support from family, 28% of the patients perceive social support from significant others. Regression analysis showed that the perceived social support is influenced by employment status, type of family one lives in and physical illness. It is not influenced by gender, subjective financial status and frequency of hospitalization.
Conclusion: Perceived social support is influenced by employment status, type of family one lives in and physical illness. Majority (60%) of the patients perceive social support from family
Menarche and Its Determinants in Adolescent Girls
Get PDFIntroduction: Biological, psychosocial, cognitive, emotional and social changes begin during puberty and continue throughout adolescence. The age at which a female reaches sexual maturity is critical in determining her future reproductive health and success. The aim of the study was to assess the average age of sexual feeling and menarche among the adolescent girls and its determinants.
Methods: Three hundred fifty five respondents were selected through simple random sampling from three secondary schools (namely Sunrise Boarding School, Swaraswati Secondary School and Gyanjyoti Samudayak Bidhyalaya) in Palpa for the cross-sectional study. Structured interview schedule was used to collect information. Data was tabulated in Microsoft Excel spreadsheet and analyzed with SPSS-16.
Results: Most of the girls (44.8%) attained menarche at 12 years (M = 12.4, SD = 1.11). Age at menarche was more likely before 13 years of age when the age of onset of sexual feeling was earlier than 12 years of age, in students than in domestic workers and if they are living with parents than in those not living with parents.
Conclusion: The average age of menarche among the adolescent girls was 12.40 years and it could be influenced by age of sexual feeling, occupation and living status of girls