Journal of Lumbini Medical College (JLMC)
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COVID-19 in the UK- Experience from The Frontline
Get PDFStart of the pandemicAt the end of February, I was undertaking a mini fellowship on Trans-anal Total Meso-rectal Excision (TaTME) in Switzerland. The number of cases infected with corona virus disease (COVID-19) and deaths were rising exponentially in Italy. As the virus hit the UK, I was still able to complete ‘Non-Technical Skills for Surgeons (NOTSS) for trainees’ course at the deanery office at Fulbourn, Cambridge on the 13th of March 2020.
Effect on personal life - self isolationI had operating list on the 17th of March where an 81-year-old male having laparoscopic right hemicolectomy for cancer was listed. This patient was readmitted a week after being discharged from the hospital with collapse and it had become apparent that he acquired COVID-19 in the surgical ward. Fortunately, he recovered from this and remains well till date. The same day, my son had fever with some cough. I needed to self- isolate according to UK government guideline for two weeks as there was no facility for testing whether my son had contracted coronavirus or not. There were a lot of problems in getting food from the supermarket on the way back home as the shelves were empty, online food order was impossible but somehow, we managed with ourfriends delivering food for us at our front door
Medication Adherence Pattern for Benign Prostatic Hyperplasia: A Cross-Sectional Study
Get PDFIntroduction: Benign prostate hyperplasia is one of the most common diseases and a common cause of lower urinary tract symptoms in aging men. Various disease management approaches to optimize the patient’s long life and efficient status where patient adherence to the prescribed treatment plays a vital role. This study evaluated the medication adherence pattern of the patients to obtain successful treatment outcomes. Methods: A cross-sectional study was conducted in out-patient department of urology in a tertiary care hospital. Patients diagnosed with benign prostate hyperplasia were interviewed using a structured questionnaire. Results: The high expenses of medicine, fear of medication, lack of symptomatic relief were factors that showed statistically significant (p < 0.05) difference between adherent and non-adherent group. Similarly, the duration of diagnosis of the adherent group was significantly less than the non-adherent group including the pattern of physical activities (p < 0.05). Adherent group also had more participants working in business and services occupation compared to the non-adherent group. Conclusion: The general attitude (such as fear of medication and lack of symptomatic relief) is seen as major factors that affect adherent pattern in benign prostate hyperplasia patients. These issues can be solved using proper guidance. However, the cost of medicines also posts an immense issue for the non-adherent group
Pattern of Head Injuries in Western Hilly Region of Nepal: A Hospital-based Cross-sectional Study
Get PDFIntroduction: Subtle or gross structural changes of scalp, skull and its contents due to application of direct or indirect external force are known as head injuries. Head being the most vulnerable and prominent part of body, injuries to it cause major mortality and morbidity globally. This study focussed to find the pattern of traumatic head injuries in patients presented to Lumbini Medical College Teaching Hospital, Palpa, Nepal. Methods: The data was collected from 252 patients (164 males and 88 females) with head injuries attending Emergency or out-patient department of Neurosurgery of the institute. All patients with traumatic head injuries (scalp injury, skull fracture, intracranial haemorrhage and brain injury) were included in the study and brought dead patients and patients with non-traumatic brain lesions were excluded. Results: Among the various modes of head injuries, the most frequent was road traffic accidents accounting 125 (49.60%) cases and fall from height 108 (42.86%) cases was second to it followed by physical assault 12 (4.76%) and others 7(2.78%). Manner of injuries were unintentional in 238 (94.44%) of cases. Among males, intentional injuries were present in 5 (2.98%) cases and among females, 9 (10.72%) cases presented with intentional injuries. In 105 (41.67%) of the cases, head injuries were associated with injuries to the other body parts as well. Conclusion: The most common cause of head injury was found to be road traffic accident followed by fall from height. Intentional injuries were more common in females when compared to males
Pregnancy Outcome Among Primigravidae Aged 35 Years and Above: A Comparative Study
Get PDFIntroduction: Maternal age is an important determinant of pregnancy outcome. Women aged 35 years ormore at their first pregnancy are considered high risk as they are associated with increased adverse maternaland perinatal outcomes. Methods: A retrospective, comparative study was carried out over a period of two years in a tertiary center. Each elderly primigravida was matched with two primigravidwomen aged 20-34 years who delivered during the same period. Secondary data on obstetric outcomes (diabetes, oligohydramnios, polyhydramnios, hypothyroidism), postpartum complications (post-partum hemorrhage, postpartum eclampsia) and perinatal outcome (intra-uterine growth restriction, prematurity, congenital anomalies, and neonatal death)of 82 elderly primigravidae (study group) was compared to 164 younger primigravida (control group) delivered during the period of study. The Chi Square test and Fisher’s Exact test were used for statistical analysis and p value of <0.05 was taken as level of significance. Results: During the study period, there were 15,012 deliveries and 82 of these were elderly primigravidae giving an incidence of 0.55%. The mean age of the elderly primigravidae was 36.8±2.16 years. The study group had more antepartum complications with preterm labor, diabetes in pregnancy, hypertensive disorders in pregnancy, multiple pregnancy and polyhydramnios (p<0.05). Seventy-one elderly primigravidae were delivered by caesarean section, the commonest indication being maternal request. The study group had higher incidence of post-partum hemorrhage but no perinatal mortality of significant proportion. Conclusion: Maternal age at the first pregnancy influences pregnancy and neonatal outcomes. Hence, elderly primigravidae should be considered as high risk and followed up accordingly
COVID-19 Pandemic: A Neurological Perspective
Get PDFEven though severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects the respiratory system, the nervous system is not spared either. SARS-CoV-2 has been isolated from the brain, olfactory bulb and cerebrospinal fluid. During the SARS (SARS-CoV-1) outbreak in 2002 to 2003, neurons had been found to be highly susceptible for infection and the virus could cause extensive neuronal damage. Similar to SARS-CoV-1,SARS-CoV-2 exploits the angiotensin-converting enzyme 2 (ACE-2) receptor to gain entry and infect both glial and neuronal cells which express ACE-2 receptors.[1] SARS-CoV-2 affects the central as well as peripheral nervous system presenting with diverse manifestations like myelitis, cerebrovascular events (CVE) and encephalitis to mention a few.[2,3] Indepth understanding of neurotropic potential of this virus will be helpful to individualize the treatment protocol from a neurological perspective
“Solidarity Trialâ€: A Feeling of Trust Towards COVID-19 Treatments
No full textCorona Virus Disease (COVID-19) drugs are not being developed at the pace in which the disease is spreading throughout the world. WHO and its partners have announced the worldwide clinical trial on 18th March 2020, known as “Solidarity Trial†for greater co-ordination of developments of drugs. “Solidarity Trialis an international clinical trial to help find an effective treatment for COVID-19â€. The trial is randomized, open-label and adaptive. This trial will analyze four treatment options against standard of care, after recruiting patients from various countries, and then will approach to their relative effectiveness against the disease. The aim of this trial is to rapidly explore if any of the administered drugs will slow progression of disease or improve survival.
The rationale of conducting “Solidarity Trial†is to reduce time taken by the trials. Randomized clinical trials generally take years to conduct, while, “Solidarity Trial†will reduce the duration by 80%. By enrolling patients from around the world, this trial might be able to provide result more rapidly than multiple small trials. Moreover, those small multiple trials will not be able to gather solid evidence required to determine the relative effectiveness of given unproven drugs. 
Perspectives on the COVID-19 Pandemic: Truth and Trust
Get PDFWhen one examines life in various countries of the world regardless of type of government, health system, or even culture, one sees the great diversity of the world but also large areas of commonality among all people and all places. The twentieth century’s history is one of almost constant war, two of those wars having affected the majority of the global population, but only one event parallels today’s pandemic in impact on almost every individual on planet Earth: the great pandemic of 1918, which by various accounts took between 20 to 100 million lives over a three-year period
Disruption of Anatomy Dissection Practical in COVID-19 Pandemic: Challenges, Problems and Solutions
Get PDFWe are undergoing crisis for humanity with corona virus disease (COVID-19) causing extensive damage to life and its aspects. Moreover we do not know how this will unfold in near future. All the academic classes are suspended during nationwide lockdown to alleviate the propagation. It is high time to rethink ways to deliver quality medical education under restriction of social isolation and absenteeism in real time teachings and discussions. We propose, based upon our experiences, replacement of didactic gross anatomy dissection with handmade dissection videos and its implications. It has its own challenges which could be overcome with planned directives based upon current experience.
What is the magnitude of the problem?In this gloomy environment of forced absenteeism, reluctance in study plans and procrastination requirescounseling for emphasizing the importance of tight declining schedule and benefits of timely curriculumfor covering huge syllabus. Traditional methods of face-to-face educational didactics, lectures and chalk talks has been compromised like no other time in past. Use of education technology at a mass scale for economically deprived countries, limited availability of techno friendly medical educators and adaptation of student to newer teaching techniques was already restrained in pre-pandemic time. Also, the alignment of new teaching format with amount of content and duration of topic coverage, necessary and safe enough to train for effective practice of problem-based learning warrants reorganizing available resources. From student’s perspective,accommodation and fooding concerns in lockdown, poor internet access with intermittent disconnection,lack of high-end laptops and absenteeism are major concerns, which precluded us from live streaming ofgross anatomy dissection. Also, it is to be ensured that changes in teaching style have positive impacton amount and depth of concerned knowledge
Motherhood in Nepal during COVID-19 Pandemic: Are We Heading from Safe to Unsafe?
Get PDFSafe Motherhood Program (SMP) has been one of the successful ongoing maternal health programs in Nepal. It is the major reason for Nepal being able to reduce its Maternal Mortality Ratio (MMR) significantly falling from 539 to 281 deaths per 100000 live births over the decades. SMP has nine components out of which three components mainly deal with pregnancy and puerperium; birth preparedness plan, rural ultrasound program and the “Aama and New born Programâ€. The latter one is one of the key components of SMP which includes incentives, free delivery services and free sick newborn care. Financial incentives are provided for transport and completion of four antenatal visits, and for health care workers attending deliveries. However, with the corona virus disease (COVID-19) pandemic, this program might not be enough to ascertain a safe motherhood for Nepalese women. This program aims to reduce the three delays leading to maternal morbidity and mortality namely, delay in reaching care, seeking care and receiving care. But with a nationwide lockdown, the chances of these delays have increased even more
Preparedness of Community Hospital Against COVID-19
Get PDFGovernment of Nepal (GoN) imposed a nationwide lockdown on 24th March, 2020 with an effort to limit the spread of novel corona virus which is responsible for corona virus disease (COVID-19). COVID-19 Nepal: Preparedness and Response Plan (NPRP) was implicated on April 2020 which stated Sukraraj Infectious and Tropical Disease Hospital (STIDH) in the capital, Kathmandu has been designated by the GoN as the primary hospital along with Patan Hospital and the Armed Police Forces Hospital in the Kathmandu Valley. The Ministry of Health and Population (MoHP) had requested the 25 hub and satellite hospital networks across the country; designated for managing mass casualty events; to be ready with infection prevention and control measures, and critical care beds where available.
Hospitals with less than 50 beds viz community-based municipality hospitals were left feeble against the surge of the pandemic. Waiting for the aid and support from government was the only option for some hospitals that lacked resources to combat this invisible culprit of global pandemic. However, Nepal Korea Friendship Municipality Hospital (NKFMH) located in Thimi, Bhaktapur determined itself to fight against this pandemic withlimited resources. This hospital not only serves the local community but also patients coming from all over Province 3 due to government insurance facilities provided by this hospital. With interaction and support from the Hospital Director, Mayor of the municipality, Korea International Cooperation Agency (KOICA), Bhaktapur Red Cross, Hospital board, Hospital Staffs, Medical Team, Adminstration, Interpid and locals in the community prompt preparedness action plan was formulated through various meeting at different levels and acted upon