Journal of Lumbini Medical College (JLMC)
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A Comparative Study Between Pneumatic and Laser Lithotripsy for Proximal Ureteric Calculus
Get PDFIntroduction: There are various modalities of breaking urinary tract calculus. The aim of this study was to compare outcome between laser and pneumatic lithotripsy in patients with upper ureteric calculus in terms of stone free rate, proximal migration and complication. Methods: This was a prospective comparative study done in 210 patients with upper ureteric calculus. The patients were randomized into two groups (Laser Lithotripsy and Pneumatic Lithotripsy) from April 2018 to June 2019. The main objective of both the procedures was to break stone into particles less than 3 mm which was confirmed by X-ray KUB and ultrasonography of abdomen and pelvis after six weeks and to compare effectiveness in terms of immediate stone free rate, proximal migration, operative duration and post-operative complication. Results: There was no difference in age, gender and stone size in both groups. Immediate stone free rate was 99.05% in Laser Lithotripsy and 76.19% in Pneumatic Lithotripsy (p value<0.001). Proximal migration in Laser Lithotripsy was 0.95% and 23.81% in Pneumatic Lithotripsy (p<0.001). There was significantly prolonged operative duration in Pneumatic Lithotripsy (14.7±4.77 min vs 13.31±3.24 in Laser Lithotripsy, p=0.014). Complications were more in Pneumatic Lithotripsy group, which was statistically significant (p=0.017). Conclusion: Both pneumatic and laser lithotripsy are effective and safe modalities for treating upper ureteric calculus, however laser has less chances of proximal migration and higher immediate stone free rate with less complicatio
The Relationship of The Mandibular Canal to The Roots of Impacted Third Molars- The Root Factor: A Panoramic Radiographic Study.
Get PDFIntroduction: Third molar extractions are one of the most common reasons of injury to mandibular nerve and postoperative complications. Pre-operative assessment of pending doom is a must. In order to study the relations between change in Inferior Alveolar Canal (IAC) and Type, Class, and Level of impaction with radiographic root change of impacted third mandibular molar, we designed a study to assess the relationship of the mandibular canal to the roots of impacted third molar in reference to changes in roots and factors affecting it. Methods: This was a retrospective cross-sectional study wherein the panoramic radiographic records of subjects with impacted third molar were assessed for change in root and its correlation with change in IAC, Type, Class and Level of impacted mandibular third molar. Results: Roots of impacted third molar when in contact with IAC presented most often in our study subjects with the Darkening of roots in both sides {right side (16.79%) and left side (11.29%)} and both genders {males (right-14.29%, left-8.75%) and females (right-19.39%, left-13.94%)}. They were statistically significantly associated with interruption of white line of IAC, vertically impacted third molars and Pell and Gregory Class II, Level A of impaction. Conclusion: There is a need to properly identify radiographic risk predictor signs to avoid any surprises at the time of extraction and post operation complications following it
Online Medical Education in Nepal: Barking a Wrong Tree
Get PDFTo combat the global pandemic of Covid-19, the Government of Nepal declared a country wide lockdown on 24 March, 2020. The lockdown affected all the institutions, medical schools being no exception.
To keep in pace with the academic calendar, most of the universities instructed their affiliated medical schools to start online classes for medical undergraduates. Kathmandu University which affiliates ten medical schools under its umbrella circulated a notice to start online classes. To facilitate this, the most important requisite is internet connection. A working device in the form of a laptop, desktop, or smartphone is needed to log in through the internet. After the lockdown, when all the medical schools closed, the students went home. We should not forget the fact that many students are from rural locality with no access to the internet at their home. The mobile internet data is costly and more data is consumed during video conferencing in online classes. The geographical remoteness further hinders the network coverage across the country
Jugaad Culture Amidst COVID-19: A Time to Step Up for Innovation in Low-Income Countries.
Get PDFMore than four months have already elapsed after the world first encountered Coronavirus claimed to originate from Wuhan, China. Scientifically, termed sudden acute respiratory syndrome corona virus (SARS-CoV-2), that causes Coronavirus disease of 2019 (COVID-19), this deadly pathogen has already claimed about 2.83 lakhs casualties with four million infected and 1.5 million recovered as of 11 May 2020. Different preventive measures like hand washing, social distancing, nation-wide lock down from March 23 have been practised inNepal which has definitely dwindled the number of positive cases. they have helped flatten the curve and procure time for preparation for forthcoming disaster. Total documented positive cases have been 120 till date (11 May 2020) with zero mortality in Nepal. However, the scenario might be out of control in coming days where claims of inadequate testing due to lack of diagnostic kits have been a major issue. Whatever be the outcome in upcoming days, for an economically poor country like Nepal, preparation seems satisfactory despite challenges to outsourcing the necessary kits like Personal Protective Equipment (PPE) and diagnostic Polymerase Chain Reaction (PCR) machines etc
Planning, Preparedness and Challenges During COVID-19 Pandemic: Experiences from Emergency Department
Get PDFTwo months have already passed since the declaration of countrywide lockdown on last week of March 2020. The number of corona virus disease (COVID-19) infected cases are gradually increasing in Nepal till date. With a steady increase of COVID-19 cases the burden of planning and preparedness is also getting bigger. Outpatientdepartments (OPDs) were closed for the first few weeks and all patients visiting the hospital were screened at fever clinic established at the hospital entry point. Suspected COVID-19 cases were then quarantined at special COVID-19 isolation ward using a different route. Those patients whose history excluded the suspicion of COVID-19 were then allowed to proceed to Emergency Department (ED)
Phytobezoar: A Rare Cause of Small Bowel Obstruction
Get PDFIntroduction: Small bowel obstruction is a common condition encountered in surgical practice. However, obstruction due to phytobezoars is a rarity. Until recently, phytobezoars were incidental findings during surgery however advances in imaging have eased the diagnosis by precisely identifying and locating the etiology. Case: An 86-year-old lady presented to the emergency room with abdominal pain, distension, and inability to pass stool and flatus. Workup showed she had features of small bowel obstruction with features of sepsis with worsening of preexisting respiratory co-morbidity. Exploration showed a phytobezoar causing the bowel obstruction. Conclusion: Phytobezoar though uncommon should always be thought of while treating a case of intestinal obstruction in the elderly age group. Surgery is the mainstay of treatment. However preexisting co-morbid condition plays a vital role in the outcome
Bacteriological Profile of Wound Infection and Antibiotic Susceptibility Pattern of Various Isolates in a Tertiary Care Center
Get PDFIntroduction: Wound infection due to various pathogenic microorganisms and the development of resistance to antibiotics is one of the major problems in medical sector. This study aimed to identify the etiological agents of wound infection along with their antibiotic susceptibility. Methods: A total of 400 wound swab specimens were collected from the patients visiting a tertiary center in western Nepal over a period of six months. Thus, collected specimens were processed in Microbiology laboratory for isolation of causative agents. Antibiotic susceptibility test was performed for entire isolates by Kirby Baur disc diffusion method. Methicillin-Resistant Staphylococcus aureus was detected by cefoxitin disc diffusion test and Extended- Spectrum Beta-Lactamases producing Enterobacteriaeae by Phenotypic confirmatory disc diffusion test as recommended by Clinical and Laboratory Standards Institute. Results: Two hundred and fifty-nine (64.7%) of specimens were infected, giving rise to 269 different isolates. Among these, 166 (61.7%) were gram positive and 101 (37.6%) were gram negative bacteria. Staphylococcus aureus (n = 130, 48.3%) was the most predominant bacteria followed by Escherichia coli (n=44, 16.3%), and Klebsiella pneumoniae (n=23, 8.5%). Gentamicin followed by co-trimoxazole was the most effective among the tested antibiotics for Staphylococcus aureus. Gentamicin and ciprofloxacin were shown effective for isolated gram-negative bacteria. Conclusion: Fifty-eight (44.6%) of total Staphylococcus aureus were Methicillin-Resistant Staphylococcus aureus positive and 16 (20.7%) of total Enterobacteriaceae were Extended-Spectrum Beta-Lactamases producers. The increased prevalence of Methicillin-Resistant Staphylococcus aureus and Extended-Spectrum Beta-Lactamase suggest rational use of antibiotics on the basis of antibiotic sensitivity results
Covid-19 Pandemic and Mental Health Issues
Get PDFIn January 2020, the World Health Organization (WHO) declared the outbreak of novel coronavirus disease (COVID-19), a Public Health Emergency of international concern. WHO stated that there is a high risk of COVID-19 spreading to countries around the world. In March 2020, WHO declared COVID-19 as a global pandemic. From December 2019 till today (18 June 2020) the total cases have approached to 8,242,999 with the death of 445,535 and the incidence is increasing day by day. From the first case seen in Wuhan, China the virus has been rapidly spreading to most of the countries of Asia, Europe and America with almost all the world population affected directly by the disease or its consequences. The physical, social, economic, psychological, and mental wellbeing of the world population have been affected with this pandemic in its peak. To control this pandemic, most of the resources and manpower are dedicated to the patients with COVID-19 and the health care workers and volunteers who work in frontline. Governments have implemented lockdown modalities with a hope to reduce the burden of transmission in their countries, which has surpassed more than 2-3 months in most countries. The effect of pandemic, lockdown and social isolation approach have risen concern regarding their consequences to the mental health of the general population
‘Publish or Perish’ Trend: Fueling the Predatory Journals
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In the past, journals were published only in the print, and the only way to access them was through the library. However, today we can easily access journals and articles with a click. There are more online journals which have made it possible and feasible for authors to submit their work.
As an editor of a journal, I am often approached by younger aspiring authors for accelerated publication of their manuscripts. The journal is biannual and undergoes double-blind peer review process which in itself is time consuming. The authors also fear the reviewer’s comment about major corrections or even rejection of their article. The criteria of mandatory publication for academic promotion has compelled medical professionals to write and publish research articles. To get their articles published quick and easy, they sometimes fall prey to predatory journals. The ‘Publish or Perish’ trend should be discouraged and young researchers should be mentored and encouraged to publish in good impact journals
Apical Hypertrophic Cardiomyopathy: A Special Entity.
Get PDFIntroduction: Apical Hypertrophic Cardiomyopathy (AHCM) is a unique variant with distinct clinical presentation, genetics, treatment, complications and outcome. Case: A 52 year non-hypertensive Asian male presented with exertional shortness of breath for two years without chest pain, palpitation or syncope. The apex beat was heaving. Electrocardiogram revealed non q wave deep symmetrical T wave inversion in anterolateral leads and echocardiography demonstrated hypertrophied apical septum. Coronary angiogram showed normal coronaries with typical “Ace of Spade†configuration during ventriculography. Conclusion: Characterization of various forms of hypertrophic cardiomyopathy is essential for management purpose as apical hypertrophic cardiomyopathy usually have benign course