Journal of Lumbini Medical College (JLMC)
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Penetrating brain injury
Get PDFIn the past 20 years, there has been an increase in the incidence of head injuries caused by gunshot wounds.  Penetrating brain injury is a traumatic brain injury caused by high-velocity projectiles or low-velocity sharp objects. A wound in which the projectile breaches the cranium but does not exit is referred as a penetrating wound, and an injury in which the projectile passes entirely through the head, leaving both entrance  and exit wounds, is referred to as a perforating wound. A large number of these patients who survive their initial wounding will nevertheless expire shortly after admission to the hospital. Until the introduction of aseptic surgery in the last quarter of the nineteenth century, penetrating missile injuries of the brain were almost universally fatal. We have learned a great deal about gunshot wounds and their management from military experience gained during times of war, when a large number of firearm-related casualties are treated in a short period of time. Newly designed protective body armor has reduced the incidence of penetrating brain injuries significantly. Many of the victims in the vicinity of a cased explosive or an improvised explosive device will incur injuries by fragments. Blast injury is a common mechanism of traumatic brain injury among soldiers serving in war zone. Each war has had different lessons to teach. World War I for example, proved the efficacy of vigorous surgical intervention. During World War II, the importance of initial dural repair and antibiotic medication was first, debated, then acknowledged, and finally, universally accepted. The incidence of blast-induced traumatic brain injury has increased substantially in recent military conflicts. Blast-induced neurotrauma is the term given to describe an injury to the brain that occurs after exposure to a blast. Resent conflict has exposed military personnel to sophisticated explosive devices generating blast overpressure that results in secondary cellular and molecular insults to the brain parenchyma akin to diffuse brain injury. In soldiers with varying amounts of body armor, the pattern is quite different. What had previously been fatal penetrating brain injuries now become treatable brain injuries as a consequence of secondary damping of energy by the helmet. Traumatic brain injury is not prevented by a protective helmet. High- and low-frequency blast waves disrupt the blood-brain barrier and produce massive brain swelling in a very short time, thereby necessitating urgent decompressive craniectomy, and when low in energy, such blast waves may result in cytoskeletal and diffuse axonal injury that leads to neurodegeneration. Penetrating traumatic brain injury is typically identified and treated immediately mild traumatic brain injury may be missed, particularly in the presence of other more obvious injuries. In recent years there has been an apparent paradigm shift of scientific interest in long-term effects of mild traumatic brain injury and its contribution to posttraumatic stress disorder. The introduction of Guidelines for the Management of Penetrating Brain Injury has revolutionized the medical and surgical management of penetrating brain injury during the last decade. There has been a paradigm shift toward a less aggressive debridement of deep seated fragments and a more aggressive antibiotics prophylaxis in an effort to improve outcomes.Â
Why a Medical Career and What are Pros and Cons of medical profession? Beliefs of Students at Lumbini Medical College
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Introduction: Medicine is one of the noblest of all professions and is one of the rapidly expanding fields with increasing number of private medical colleges in the past few years. Several international studies over the years have explored perceptions and preferences of students in choosing a career in medicine. This study was done with the objective to assess students\u27 views regarding selection of medicine as a career.
Methods: A survey study was conducted at Lumbini Medical College Teaching Hospital (LMCTH) where 300 students of both sexes were asked to fill a structured questionnaire.
Results: All medical students mentioned that they selected the medical profession because of personal interest. Of them, 285 (95%) students believed this profession offers services to humanity. However, 240 (80%) students felt that their family had an influence in their career selection. Among discouraging factors, 234 (78%) students mentioned that medical training is difficult and prolonged, 210 (70%) students said that the course is too expensive, 225 (75%) students felt that there is too much competition while 186 (62%) students expressed that doctors have excessive working hours and lack social life. Major factors in choosing LMCTH as study destination were compulsion because of failure to enroll at other colleges 180(60%), easy access to admission 120 (40%), cheaper than other medical colleges 165 (55%) and location near to hometown 24 (8%). Some of the discouraging factors were limited facilities 210 (70%), insufficient faculty members 270 (90%), newly established college and uncertain future 90 (30%).
Conclusion: Study concluded that reasons for joining medical profession are primarily based on personal interest, respect and honor, family influence and service to humanity; however, long working hours, prolonged training, expensive study, discourages many students
Comparative Evaluation of 25µg and 50µg of travaginal Misoprostol for Induction of Labor
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Introduction: To compare the efficacy and safety of 25g vs. 50g of intravaginal (Posterior fornix) misoprostol for induction of labor in 100 patient from Jan 2012 to Dec 2012 at Lumbini Medical College.
Methods: One hundred pregnant lady requiring induction were randomly assigned to receive either 25 g (group A=50) or 50 g (group B=50) of intra vaginal misoprostol every 4 hrs till adequate contractions were achieved or maximum dose of 150 g was used.
Results: The onset of contraction was earlier in group B in 34 cases as compared to group A, where only 25 cases had earlier contraction ( P> 0.05). 38 cases (76%) in Group B and 35 cases (70%) in Group A delivered vaginally. Induction to delivery interval was shorter(<12hrs) in group B in 15 cases and in 10 cases in group A. Mean dose of Misoprostol (94micrograms) for successful induction in group B was high compared to Group A (75.5 microgram). Requirement for oxytocin infusion was higher in group A, 26% vs. 15%. Abnormal contractility pattern was seen in B group 24% cases compared to 14% cases in Group A. APGAR score < 7 at 1 min was seen in 26% neonates in Group B and in only 10% neonates in Group A. Ruptured uterus did not occur in any group.
Conclusion: 50 g dose of misoprostol is more efficacious than 25 g dose as seen in our study. However it appears to be less safe both for mother and baby due to the high incidence of tachysystole, hyperstimulation and intrauterine passage of meconium
Case Report of Peritoneal Hydatidosis Diagnosed as Ovarian Cyst
Get PDFPrimary peritoneal hydatidosis is a rare condition and it was mistiaken for ovarian cyst. Hydatid disease is caused by dog tape worm, Echinococcus granulosus, and is the commonest one having worldwide distribution. Human hydatid disease results from infection with larval form of Echinococcus granulosus. The disseminated intra-peritoneal hydatid disease is a rare finding. A case of disseminated intra-abdominal hydatid disease is presented along with a review of literature and various therapeutic modalities
Practices and Problems during Menarche among Adolescent Girls in Sultanpur, Uttarpradesh, India
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Introduction: Menarche is a highly emotional experience for the young pubescent. The intensity of experience for the young pubescent is maximum at the time of menarche and depends on how well she is informed about menstruation and the type of support system around her. The subject of menstruation revolves around notion of dirt, taboos and restrictions in various spheres of a woman’s life. The objective of this study is to ascertain and compare practices and problems during menarche among adolescent girls in Sultanpur, Uttarpradesh (UP), India.
Methods: The comparative study was conducted in both urban (Civil Lines) and rural (Wallipur Village) areas in Sultanpur district of UP, India. A cross-sectional study was followed from August to November 2011. Two hundred adolescence girls were selected through simple random procedure. Interview schedule was used to collect information from respondents.
Results: The mean age of menarche among adolescence girls was 12.16 years. There was no statistical difference between rural and urban population with regard to knowledge about menstruation. Menstruation was taken as a disease by 20.6% and 23.7%. in each population. Use of sanitary pads was more in urban girls. Unhygienic practices like using no means of menstrual absorbent were more prevalent among rural girls.
Conclusion: Unhygienic practices during menstruation among adolescent girls was common in adolescent girls in rural population
Experience of Laparoscopic Cholecystectomy at Lumbini Medical College Teaching Hospital
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Introduction: The difficult gallbladder is the most common difficult laparoscopy being performed by generalsurgeons all over the world and the potential one that places the patient at significant risk. The present study aimed to study all the cases of laparoscopic cholecystectomy conducted in current setup at Lumbini Medical College and Teaching Hospital, to compare the results with the published literature and also analyze the complications and ways to decrease the incidence of conversion to open procedure.
Methods: Five hundred twenty five patients age 10-90 years, male:female ratio of 1:3.86 with body weight 45-65 kilogram, who had undergone laparoscopic cholecystectomy for symptomatic cholelithiasis without choledocholithiasis from April 2011 to April 2013 were studied.
Results: All the laparoscopic cholecystectomy (LC) were without major complications. Only nineteen out of five hundred twentyfive (3.6%) required conversion to open cholecystectomy (OC). Reasons for conversion included: dense omental or visceral adhesions; two (0.38%), unclear anatomy; 16 (3.04%), common bile duct injury; one (0.19%). There were 20 cases of shrunken gallbladder suspicious of malignancy but didn’t required conversion.
Conclusion: Laparoscopic cholecystectomy is the preferred method in our setup even in difficult cases
Clinical Profile of Patients Presenting to the Psychiatry Outpatient Department of A Tertiary Care Hospital In A Hilly District of Nepal
No full textOBJECTIVES: To determine the various diagnostic categories of psychiatric disorders as per the DSM IV in patients of hilly area of this region who presented to the psychiatry outpatient department for the first time. This observational study has also attempted to highlight the multiple presenting symptoms of patients initially attending other departments of the hospital, but were eventually diagnosed with a psychiatric disorder without any comorbid medical or surgical illness. METHODS: 200 patients who either presented directly or were referred by various departments of the hospital over a 2 month period (September to November 2013) were assessed by standard semi- structured interview and diagnosed according to the DSM- IV-TR (Diagnostic and Statistical Manual of Mental Disorders, IV, Text Revision). Their sociodemographic data was also recorded during interview. Data analysis was done using SPSS version 21.0. RESULTS: Patients had a mean age of 36.5. Out of the 200 patients there were 115 adult females (57.5%), 84 adult males (42%) and a single 10 yr-old female child (0.5 %). Anxiety disorders were the most common diagnosis (47%, n=94), followed by mood disorders (27.5%, n=55). Pain symptoms in the form of headache, chest pain, and abdominal pain were the most common presenting complaints leading to a large percentage of referrals from the medicine and emergency departments. Patients presenting with psychological symptoms of anxiety and mood disorder directly, were less than those presenting with the physiological symptoms. CONCLUSION: Anxiety and mood disorders are the common psychiatric disorders in this region with female preponderance. Patient’s awareness and need for relief of their physical symptoms makes them seek help initially from various other departments before being eventually treated by psychiatrists
Study on nutritional status of children under 5 years in palpa district, nepal: speacial reference to baal vita
Get PDFBackground: Malnutrition is a pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients. Malnutrition is a major underlying cause of the child morbidity and mortality in Nepal. Adequate nutrition is a fundamental right for every human being. Malnourished child is depriving from physical and mental development. Objectives: To assess the nutritional status of children under 5 years and to find out the knowledge and practice regarding micronutrient powder “Baal vita†Materials and Methods: Descriptive cross sectional community based study was conducted in Palpa district, total of 390 respondents at the age of 6-59 months were selected with the help of multistage sampling. Through anthropometry, prevalence of underweight, stunting and wasting was determined. Results: Prevalence of underweight, stunting and wasting was 25.9%, 27.2% and 7.3% respectively. The association between age of the mother at the birth of the children and nutritional status of children is not statistically significant. Majority of the children (80.5%) used to take junk foods sometimes, followed by 16.7% very often, 2.8% children never used to take. Majority of the children (52.6%) were taken the micronutrient powder (first course) but the coverage of second course of micronutrient powder was 29.5% and followed by third course coverage was only 18.9%. Conclusion: The nutritional status of children in this study were found to be satisfactory because compared to the Millennium Development Goals (MDGs) target but the coverage of micronutrient powder is low
Fractures of the proximal humerus in children and adolescents
Get PDFBackground: In most children proximal humeral fractures are treated non-operatively with generally good results. The aim of the study was to evaluate the clinical outcome of closed/open reduction in children with severely displaced proximal humeral fractures. Materials and Methods: The charts of 15 patients (8 girls and 7 boys; mean age: 9.4 years) with proximal humeral fractures who were managed at our institution were reviewed from October 2011 to December 2013. Results: There were 7 metaphyseal fractures and 8 physeal injuries which were angulated according to Neer-Horowitz score as grade II (n=2), grade III(n=4) and grade IV(n=9). Associated lesions comprised open fracture with head trauma in a 2 year old female child which was operated on primarily and the 14 others by secondary intention. All patients were treated surgically with either closed (n = 5) or open (n=10) reduction and internal fixation with Kirschner wire or titanium elastic nails (TENs). They were assessed for clinical and radiological healing at a mean follow up of 1.25 years ranging from 0.5 to 2.0 years. Conclusion: Surgical option is indicated for severely displaced and unstable fractures in older children and adolescents. In addition to the periosteum , long head of the biceps, deltoid muscle, and bone fragments in combination can prevent fracture reduction. Key words: Proximal humerus fracture, Children, Open reduction, Operative
Characteristics of Patients with Tuberculous Pleural Effusion in Rural Nepal
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Introduction: Tuberculosis (TB) is a major cause of mortality and morbidity in developing countries. TubercularPleural effusion is the second most common form of extra pulmonary tuberculosis (EPTB), superseded in Prevalence only by lymph node tuberculosis. Pleural effusion occurs in approximately 5% of patients with TB. The purpose of this study was to assess the demographic characteristics of patients presenting with pleural effusion in rural Nepal.
Methods: A retrospective study was conducted with all the cases diagnosed and admitted with pleural effusion at Lumbini Medical College And Teaching Hospital from April 2011 to March 2013 of all the cases diagnosed andadmitted with pleural effusion were included in the study. Hundred cases diagnosed with pleural effusion by clinical Examination or chest X-ray or ultrasonography’s (USG) of the chest were included in the studied. The following parameters patients demographic profile, causes of pleural effusion, location (unilateral/bilateral), hemoglobin and complete blood count, sputum stain and culture sensitivity, Monteux test, chest X-ray and USG findings and Pleural fluid analysis (biochemical, hematological, microbiological and cytological) were analyzed by using SPSS 21.
Results: Out of 100 cases, the cause of pleural effusion in 59 patients was tuberculosis, 14 by malignancy, next 14 by Para pneumonic Effusion, 12 by congestive cardiac failure and three cases by alcoholic liver disease. Patients with tuberculous pleural effusion were younger, predominantly males, had unilateral effusion, lower blood hemoglobin, lower Pleural fluid neutrophils, higher pleural fluid Adenosine Deaminase (ADA) levels and higher level of pleural fluid to serum protein ratio as compared to the patients with non-tuberculous effusion.
Conclusion: Tuberculosis is the most common cause of pleural effusion in patients of rural Nepal