Journal of Lumbini Medical College (JLMC)
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Microscopic Antegrade Parotidectomy for Different Types of Parotid Tumor
Get PDFIntroduction: Salivary gland tumor accounts for about 5% of all the neoplasms of the head and neck. 75% of such tumors occur in the parotid glands. Pleomorphic adenoma is the most common type of benign salivary gland tumor. It tends to recur after inappropriate treatment. Surgery of parotid tumor includes enucleation, superficial parotidectomy and total parotidectomy. Identification and preservation of facial nerve trunk and its branches are very important in parotid surgery. Advancement of microsurgical technique has helped in better visualization, identification and preservation of the facial nerve. Methods: This prospective study included twenty-seven patients. Preoperative ultrasonography and fine needle aspiration cytology were done for all cases. Computed tomography/magnetic resonance imaging were performed in some cases when needed. Standard microsurgical technique with the help of microscope was performed for antegrade parotidectomy. Data analysis was done using SPSS version 26.0. Results: The patients\u27 age ranged from 12 to 78 years. Fifteen (55.6%) patients were female and 12 (44. 4%) were males. Sixteen (59.3%) tumors were located on the right side whereas 11 (40.7%) were on the left side. Most of the tumors (n=18, 66.7%) were pleomorphic adenoma. Two (7.4%) of the patients had temporary facial paralysis which improved with time. Two (7.4%) patients had developed hematoma. Frey’s syndrome was not found in follow-up. Conclusion: This study showed low morbidity in parotidectomy using microsurgical techniques. No permanent injury to the facial nerve was found
Limitations of COVID-19 Fever Clinic as the First Point of Contact: Are We Relying Too Much? An Experience from a Tertiary Center
Get PDFIn Nepal, after the first case was diagnosed with Corona Virus Disease -19 (COVID -19) in a 32-year-old returnee from Wuhan, China on 13 January 2020, it took more than four months to reach a figure of 500 infected cases. Seventy of them have already recovered and returned home. However, the curve has been taking a steeper slope after the first 50 cases were documented. With the first mortality from COVID-19 confirmed on 16thMay, 2020, the fact that this pandemic is tightening its grip in the country is more evident now. And witheach passing day, more cases are being diagnosed. In such a situation, strategies of screening the infected/suspects are of paramount importance and those already in place should be strengthened. On March 19, the Nepal Medical Council asked all hospitals, both private and public, with over 100 beds to operate a separate fever clinics and postpone elective surgeries to conserve resources for an outbreak. Such fever clinicsaim at separating and filtering out the suspected/ diagnosed COVID-19 patients. Arguably started firstin Kathmandu Medical College, fever clinics now have been established and run in almost every largehealth care centers. United Nations International Children’s Emergency Fund (UNICEF) has been pivotal in supporting some of these centers. Rising up to the task, Lumbini Medical College and Teaching Hospital started its fever clinic from 22 March 2020 in a separate makeshift place which later moved to a more organized structure. The fever clinic is set up in a separate area in order to keep off suspected patients from the main hospital
COVID-19 And Lockdown: Be Logical in Relaxing It
Get PDFCambridge Dictionary defines ‘lockdown’ as a situation in which people are not allowed to enter or leave a building or area freely because of an emergency. Merriam-Webster outlines three definitions of lockdown: a) the confinement of prisoners to their cell for all or most of the day as a temporary security measure, b) an emergency condition in which people are temporarily prevented from entering or leaving a restricted area during a threat of danger and c) a temporary condition imposed by governmental authorities as during theoutbreak of an epidemic disease in which people are required to stay at their homes and refrain from orlimit activities outside the home involving public contact. Our focus, here, is on lockdown strategy adopted to contain corona virus disease 2019 (COVID-19) pandemic
Unilateral Phthiriasis Palpebrarum Infestation: A Rare Presentation
Get PDFIntroduction: Phthiriasis palpebrarum is an uncommon eyelid infestation mainly caused by Phthirus pubis also known as crab lice. Case report: A 16 years male presented with redness, itching and watering of the right eye for one week. On slit-lamp biomicroscopic examination lice and nits anchored to the eyelashes along with seborrheic material accumulation was noted. Lice, partial nits along with matted eyelashes were removed and sent to laboratory for microscopic examination. On follow up visit remaining nits were expunged. Conclusion: Meticulous slit lamp biomicroscopic examination should be done in all patients presenting with itching of the eyelids in conjunction with clinical findings resembling seborrhea and evidence for Phthiriasis palpebrarum should be looked for
Perception of Educational Environment among Nursing Students of Different Colleges: A Cross- Sectional Study
Get PDFIntroduction: Learners are key figures for whom the provision and perception of positive, progressive and encouraging interactive educational environment at any educational institution is very crucial. The study aimed to find the perception of nursing students of two different medical colleges regarding their educational environment. Methods: A cross-sectional descriptive study was conducted among 190 students through the use of internationally validated, non-culturally specific questionnaire. The responses were made on five points Likert scale scored from 0 to 4. The overall score was interpreted as very poor, plenty of problems, more positive than negative and excellent based on obtained score of 0-50, 51-100, 101-150 and 151-200 respectively. Descriptive statistics and one way analysis of variance test was used to analyze the collected data. Results: There were 98 (51.6%) participants from College of Medical Sciences and 92 (48.4%) from Lumbini Medical College and Teaching Hospital. The overall score of perception of educational environment were 142.13±14.90 (74.64%) and 144.34±15.59 (76.14%) in the two centers respectively which means more positive than negative perceptions. Only nature of accommodation was found statistically significant with students’ perception of teachers (p = 0.014). Conclusion: Majority opined a more positive than negative perception towards educational environment. Good communication skills of teachers, knowledgeable teachers, teaching to develop their competence level were some positive perceptions. Whereas, teachers being authoritarian, focus on short term and factual learning, lack of support system were the areas which could be improved
Hemispheric Brain Preference and Academic Parameters in Medical Students: A Cross-sectional Study
Get PDFIntroduction: Hemispheric brain preference means using one side of the brain over the other to learn. Hemispheric brain preference may influence one’s learning style. This study aimed to investigate hemispheric brain preference and its relation with academic parameters in medical students. Methods: Four hundred participants were included in the study by cluster random sampling. Using self-administered questionnaires, data on personal profile (name, age, sex, handedness, academic score, study method, study hours per day and study pattern) and hemispheric brain dominance was collected. Open Hemispheric Brain Dominance Scale 1.0 (2015) was used to determine the hemispheric brain dominance. Result: Participants having no clear hemispheric brain preference (46.75%) were in majority followed by those with left hemispheric brain preference (29.25%) and then those with right hemispheric brain preference (24%). There was a statistically significant difference in academic score of students with different hemispheric brain preference (p=0.021). Students with left brain preference had the highest academic score (63.85±11.78) and those with no clear preference had the lowest (59.96±11.64). Also, students with left hemispheric brain preference would study more regularly and would spend more time in study per day. Conclusion: In our sample, participants with left hemispheric brain preference were found to have the highest mean academic score but they also spent more time in study and also studied regularly throughout the semester. As this study shows diversity in brain preference among medical students, we recommend a good mix of various teaching learning methods for better learning of the entire class
Effectiveness of Structured Teaching Program on Menstrual Hygiene among Adolescent School Girls
Get PDFIntroduction: Adolescent girls face different physical conversions, sexual changes and psychological pressures associated with growth and maturity, menstruation being one of them. Menstruation is still clouded by taboos and socio-cultural restrictions resulting in ignorance of scientific facts and hygienic health practices. Since response to menstruation depends upon awareness and knowledge about issues, menstrual hygiene education has shown to be effective in improving health by developing good knowledge, attitude and practice among adolescent girls. Methods: An analytical study with one group pretest – posttest design was carried out to assess the effectiveness of structured teaching program on menstrual hygiene among 100 adolescent school girls studying in a public school in Palpa. Pretested semi structured questionnaire was used to assess knowledge and practice whereas valid MAQ (Menstrual Attitude Questionnaire) was used for attitude. This was followed by structured teaching program consisting of information on menstruation, myths and hygiene. Then a posttest was conducted after a week to the same respondents. Results: The study resulted in statistically significant improvements (P<0.001) in total knowledge (63% to 66%), attitude (47% to 63%) and practice (43% to 49%) after implementation of the structured teaching program. There was positive correlation between knowledge and attitude scores (r=0.023), attitude and practice scores (r=0.026) and knowledge and practice scores (r=0.183). Conclusion: The structured teaching program is effective in improving knowledge, attitude and practice on menstrual hygiene among adolescent school girls. Thus, adding menstrual hygiene as part of curriculum may break the culture of silence
“Overcoming the Defectâ€:A Perinatal Review of Congenital Anomalies in 6984 Consecutive Deliveries in a Tertiary Care Center in Western Nepal
No full textIntroduction: Neonatal congenital anomalies are the 17th leading cause of global disease burden. Congenital anomalies in low-income countries are high due to prevalence of nutritional deficiencies, intrauterine infections, teratogenic exposure and unsupervised self medication. This study aimed to find various antenatal risk factors for birth defects and the delays in health seeking behaviors in cases of still births with birth defects. Methods: In this retrospective study the records of mothers and neonates born with congenital anomalies during the period of 30 months were reviewed. Consanguinity, intrauterine infections, presence of anemia, and history of drug intake were noted. In cases of stillborns with anomalies, mode of delivery, labor complications and the three delays leading to morbidities were also noted. Results: There were 65 congenital anomalies during the study period with an incidence of 9.3 per 1000 births. Out of them, 43 were live births and 22 were still births. The commonest anomaly amongst live births was of musculoskeletal system (n=11, 25.5%) and amongst still births was of nervous system (n=10, 45.4%). Consanguineous marriage was present in 30 (46.1%) parents and folic acid was taken by only 26(40%) of the mothers. In cases of still births with anomalies, most deliveries were vaginal (97%) without any maternal complications. Among the three delays, delay in deciding to seek care was observed in most cases (n=14, 63.6%).Conclusion: Factors like consanguinity and intake of folic acid are modifiable factors useful in preventing congenital anomalies. Encouraging early antenatal visits might help in early detection of anomalies
Morphometric Study of Lumbar Intervertebral Spaces (discs) by Using MRI.
Get PDFIntroduction: The radiological space between two vertebrae is known as intervertebral space (height) which corresponds to the thickness of the intervertebral disc. Lumbar intervertebral disc is the most important structure which maintains the spinal function. An early diagnosis of pathological changes in disc has clinical significance. Hence the study aimed to determine normal height of the intervertebral disc space and effect of aging. Methods: It was a cross-sectional analytical study performed on 106 images of MRI scans of lumbar region. Dimensions of lumbar intervertebral spaces (discs) such as the anterior, middle, posterior intervertebral space height were measured in millimeter. Results: The mean anterior intervertebral space height was gradually increased from L1-L2 level (6.91 mm) to L5-S1 level (13.55 mm). The middle intervertebral space height increased from L1-L2 level (7.89 mm) to L4-L5 level (11.96 mm) whereas at L5-S1 level, there was a decrease (11.10 mm). Similarly, the posterior intervertebral space height showed an increment from L1-L2 level (5.52 mm) to L4-L5 level (8.09 mm) except at L5-S1 level, where it was decreased (6.94 mm). All mean values were found to be higher in males than in females except posterior intervertebral space height. The height of disc was increased up to third or fourth decade followed by a decrease. Conclusion: Knowing the normal lumbar intervertebral space height could be helpful for clinicians to diagnose and plan for proper treatment. It may also help to generate baseline data and to produce proper devices for Nepalese population
Hypertriglyceridemia Induced Acute Pancreatitis in Pregnancy: A Case Report
Get PDFIntroduction: Acute pancreatitis is a rare event in pregnancy. Hypertriglyceridemia induced acute pancreatitis accounts for the second most common cause in pregnancy. This rare event has a high maternal and fetal mortality of 20% and 50% respectively. Case report: A 21-year-old woman, G2P0+1 at 26 weeks period of gestation presented to OBGYN emergency in a state of shock with history of sudden onset of severe epigastric pain and multiple episodes of vomiting for one day and absent fetal movement for six hours. Immediate fluid resuscitation was done. Her reports showed increased hematocrit, leukocytosis, serum lipase and amylase elevated to > 200U/L. Ultrasonography showed bulky pancreas with intrauterine fetal death. With the diagnosis of acute pancreatitis with fetal demise, she was managed conservatively in intensive care unit by fasting, nasogastric aspiration, intravenous fluids, antibiotics, analgesics and heparin. She was intubated on the third day for increasing tachypnea. Her lipid profile showed elevated triglyceride> 1000 mg/dl and was started on oral hypolipidemic drugs. Pregnancy was terminated vaginally by misoprostol and was discharged on 19th day. Conclusion: Hypertriglyceridemia induced acute pancreatitis in pregnancy has an increased maternal and fetal complication