Journal of Lumbini Medical College (JLMC)
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Study of Association Between Glycated Hemoglobin and Lipid Profile in Type 2 Diabetes Mellitus in Tertiary Care Center
Get PDFIntroduction: Diabetes is one of the major burdens of non-communicable disease causing morbidity and mortality. Glycated hemoglobin (HbA1c) has been used as a tool to monitor glycemic control in patients with type 2 diabetes mellitus and elevated HbA1c value is considered an independent risk factor for dyslipidemia. Methods: A total of 120 patients with type 2 diabetes mellitus were enrolled in this cross-sectional study. Means with standard deviation were used for age, height, weight and fasting blood sugar and Pearson correlation test was applied to identify correlation between Glycated hemoglobin (HbA1c) and lipid profile. Comparison of means was done by Student \u27t\u27 test in parametric data within the two groups. P value less than 0.05 was considered significant. Results: The mean HbA1c of male and female patients were 8.35±1.77 and 8.65±1.95 respectively. Among patients with good glycemic control, mean total cholesterol and mean high density lipoprotein were higher than poor glycemic control patients. Patients with poor glycemic control had higher mean triglyceride and low density lipoprotein than good glycemic control patients. Correlation coefficient for various components of lipid profile and HbA1c were: total cholesterol (r=0.189, p=0.038, n=120), triglyceride (r=0.418, p<0.01, n=120), low density lipoprotein (r=0.673,p<0.01,n=120) and high density lipoprotein ( r=-0.683, p<0.01, n=120). Conclusion: There was a significant moderate correlation between HbA1c and lipid profile. Lipid profile values were significantly higher in poor glycemic control than good glycemic control patients. Hence, HbA1c can be considered as a surrogate marker for dyslipidemia in type 2 DM patients
Gynecological Oncology Surgery During COVID-19 Pandemic: What We Should Know
Get PDFSevere Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) that causes Corona Virus Disease -19 (COVID-19) is a novel virus and hence humans do not have any prior immunity to it. Every human being is susceptible to this viral infection and rapid spread worldwide made WHO declare it as a global pandemic. Cancer patients are even more vulnerable not only because they are immunocompromised by the disease process itself, but also due to potential effect of chemotherapy, radiotherapy along with substantial effect on their timing of treatment. Patients older than 65 years, and those with preexisting co-morbidities are considered more atrisk. Considering the increased chances of intensive care unit admission, need of mechanical ventilation and possible mortality, all cancer patients should be educated about preventive measures, personal protection, social distancing and isolation. Another possible impact of COVID-19 could be delays in initial evaluation, diagnosis and initiation of actual treatment which are independent risk factors for cancer related mortality. This is due to limited services provided at the health care facilities, lockdown effects, fear of being infectedand economic crisis
Reproductive Health Issues and Use of Family Planning Methods among Married Adolescent Mothers
Get PDFIntroduction: Adolescent pregnancy is a major public health concern in low- and middle-income countries. Nepal ranks among the twenty countries with the highest child marriage rates in the world. Adolescent mothers are at higher risk for poorer maternal and neonatal outcomes. This study intended to find the reproductive health issues and use of family planning methods among married adolescent mothers at a tertiary care center in a western part of Nepal. Methods: This was a cross-sectional study conducted among adolescent mothers who attended the family planning counseling session at Community Medicine Out-patient Department at a tertiary care center. Pre-tested semi-structured questionnaire was used for data collection and variables were entered in SPSSTM version 16. Descriptive statistics were presented in terms of mean and percentage. Results: Among 235 adolescent mothers, the mean age of adolescent mothers was 18.02 years (SD = 1.13). Almost 93.2% had not used any kind of contraceptive methods previously. Limited knowledge, uncomfortable talking about contraception and spousal denial were common reasons for not using contraception. Obstetric related complications were observed in 13.6% and one in ten neonates required neonatal intensive care unit admission during the study period. After the counseling session, six out of ten expressed current choice of long-acting reversible contraceptives method in which Jadelle implant was preferred. Conclusion: Our study among the adolescent mothers showed that use of family planning methods before pregnancy had been very low. Policies need to focus on meeting the unmet need for family planning among married adolescent girls
Vascular Surgery in COVID-19 Period and Beyond: Acknowledging the New Normal
Get PDFThe first infected case of Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCoV-2) in Nepal was diagnosed on 23 January, 2020 which was also the first recorded case in South Asia, but after confirmation of subsequent cases on March 23 and 24, the entire nation was put under lock down. Between January and March, the government took preventive measures by upgrading health infrastructure, setting up health desks atimportant public spaces like airports, spreading public awareness through various means, sealing off of international borders. Initially, our optimism stemmed from the slow rise in cases compared to our neighbors which delivered hope that things will be back on track soon. But with consistently escalating infection rates it was clear that we are as vulnerable to this as any other nation. For us, it reflected in thinning out of emergency and urgent cases. This was sure to have a significant impact on patients’ lives. On one hand, owing to confinement measures, to avail specialty services was becoming a challenge for them, especially those from remote, rural areas where transportation even if desired is accessible on select occasions. On the other, phobiaof coronavirus led patients to defer going to distant tertiary hospital as far as possible
Virtual Learning during COVID-19 Pandemic: Pros and Cons
Get PDFThe current outbreak of corona virus disease (COVID-19), declared as public health emergency of national and international concern by World Health Organization (WHO), led to unprecedented public health responses in Nepal and many countries around the world including travel restriction, closure of educational institutions, curfews in some places and quarantines. This pandemic has affected lives of millions in different ways in different geographic locations worldwide. Beyond the immediate threat to health, unemployment, insecurity, etc., education is one of the sensitive areas which has been affected tremendously, students in Nepal not being an exception.
The closure of all educational institutions effective from 18th March, 2020 followed by the nationwide lockdown from 24th March, 2020 till date enforced by Government of Nepal (GoN) as an effort to limit the spread of COVID-19 has shed a light on numerous issues affecting the access to education. As per the United NationsEducational, Scientific and Cultural Organization (UNESCO) report 2020, a total of 1,190,287,189learners are currently affected constituting 68% of the total enrolled learners worldwide because of temporary or indefinite country wide school closures implemented by the respective governments in an attempt to slow the spread of COVID-19. In Nepal alone 8,796,624 students have reportedly been affected
Nairobi Eye: A Clinico-epidemiological Study from A Tertiary Care Center of Central Nepal
Get PDFIntroduction: Periocular paederus dermatitis (Nairobi eye) is characterized by erythematous vesiculobullouslinear plaque with stinging sensation. It commonly occurs during rainy season. It has been describedin people living near agricultural fields due to the potential toxin pederin. This study aims to evaluate thedemographic profile and clinical presentation of patients with periocular paederus dermatitis in a tertiary carecenter. Methods: This was a descriptive, cross-sectional study evaluating patients attending dermatologyand/or ophthalmology department with features consistent with paederus dermatitis involving perioculararea from June to August, 2019. Relevant demographic and clinical data were obtained; clinical photographswere taken and histopathology performed among selected patients. Results: A total of 24 (14.8%) patients hadfeatures of Nairobi eye among 162 patients of paederus dermatitis. Majority of the patients were males (1.4:1)with mean age 29.08±13.38 years. The peak time of presentation was the first week of July (37.5%). Meantime period between onset of symptoms and presentation was 3.41±2.01 days. The lesions were unilateral inall cases, with predominant involvement of the right eye (62%). Burning sensation (80%) and itching (60%)were the predominant symptoms while conjunctival hyperemia (41.6%), seropurulent discharge (20.8%)and chemosis (16.6%) were the ocular findings. Most of the patients (n=17, 70.8%) noticed the lesion whilewaking up in the morning. Conclusion: The finding of the present study has shown that Nairobi eye isa common presentation during rainy season. Periocular findings with significant intraocular signs weredocumented to be presenting features among patients with periocular paederus dermatitis
COVID-19, Pregnant Women and Their Hard- Wired Worry
Get PDFIn our day to day obstetric practice, we face a number of concerns raised by the pregnant women regarding their health. Some of the frequently asked queries include: if they would develop health problems like high blood pressure and/or diabetes; if they would have a normal delivery or would require an intervention in the form of cesarean section or instrumentation, if they would have the birth experience as they envision and if the stress is harmful during the ongoing pregnancy. Every pregnant woman strives her best to give birth to a healthy child. As every pregnancy is a period of uncertainties and risks, pregnant women are anxious about their well-being and that of their baby. The list of concerns is endless with the addition of corona virus disease (COVID-19).
If we look back into the past, viral infections such as influenza, H1N1, and Severe Acute Respiratory Syndrome (SARS) caused immense maternal and fetal complications during pregnancy. Due to compromised, pregnant women are more vulnerable to being infected. SARS-CoV-2 is a new strain of corona virus that is similar to Middle East Respiratory Syndrome corona virus (MERS-CoV) and Severe Acute Respiratory Syndrome coronavirus (SARS-CoV). These viruses spread primarily by coughing and sneezing or direct contact. Most patients infected with any one of these three strains of corona virus may remain asymptomatic or may develop relatively mild symptoms such as fever, cough and fatigue. However, some may develop severe forms of the disease leading to pneumonia and respiratory failure; requiring oxygen or other respiratory support. Pregnant women infected with MERS-CoV or SARS-CoV were at high risk of developing severe pneumonia; heart failure and other complications which could be life-threatening leading to death in many cases
Perceived Barriers to Adherence to Standard Precautions among Healthcare Personnel Working in a Teaching Hospital of Palpa District, Nepal
Get PDFIntroduction: The present study aimed to find out the perceived barriers to adherence to standard precautions among healthcare personnel working in a teaching hospital of Palpa district. Methods: A descriptive cross-sectional study was conducted among 191 healthcare personnel in April 2019. Barriers to standard precautions adherence were evaluated using ‘Factors Influencing Adherence to Standard Precautions Scale’. Mann Whitney U test and Kruskal Wallis H test were applied to examine the association of selected demographic variables: age, educational background, duration of employment, working areas and having attended trainings related to standard precautions with the perceived barriers to standard precautions adherence. Results: The mean age of participants was 24.87±6.05 years. Most (85.3%) of participants were nurses. 19.9% and 52.4% of participants always performed hand hygiene before and after using personal protective equipment respectively. The subscale scores in leadership and culture of the institute were 14.86±4.21 (possible range 0-24) and 14.59±2.60 (possible range 0-20) respectively. Subscale scores in judgement and contextual cues were 17.49±3.46 (possible range 0-20) and 18.02±5 (possible range 0-24) respectively. Score in justification was 7.52±5.12 (possible range 0-28). Age, educational background and duration of employment had a statistically significant association with subscale scores on justification and perceived culture of the institution. Conclusion: The present study revealed that only 19.9% of the participants would perform hand hygiene before using gloves and 52.4% of participants would do it afterwards. Personal judgement, dependence on contextual cues and inadequate leadership skills were found to be the major barriers to adherence to standard precautions
Evaluation of Mode and Psychiatric Co-morbidity of Intentional Self Harm: A Hospital Based Study.
Get PDFIntroduction: Intentional self harm is a potentially self injurious action with a non-fatal outcome for which there is evidence, either explicit or implicit, that the individual intended to kill himself or herself. Suicide is a fatal act of self-injury (self harm) undertaken with more or less conscious self destructive intent. There has been an increase in the number of patients presenting with attempted suicide in the emergency settings of hospitals. This study aimed to explore socio-demographic characteristics, pattern of attempts, psychiatric diagnosis, psychosocial and personality factors among survivors of suicide attempt presenting to a tertiary care hospital. Methods: The study included 100 survivors of intentional self harm registered over a period of six months visiting a tertiary care hospital. The cases directly presented to Psychiatry department and were referred from medical and other departments for psychiatric evaluation. They underwent evaluation by consultant psychiatrist and received appropriate interventions. Results: Majority of the victims were female (73%), belonging to the age group of 20-40 years. The most common method of attempt was self poisoning with pesticides (65%) followed by hanging (16%) and overdose of drugs (7%). Most of the attempts (68%) were impulsive in nature. Mental illness was diagnosed in (65%) of the cases, mainly depressive disorder (51%), and personality disorder (10 %). Most of the attempts (67%) were triggered by psycho-social factors. Conclusion: The pattern shows predominance of female gender, young age group, a role of mental illness, impulsivity and psychosocial factors in intentional self harm
Self-rating on Self-directed Learning: A Cross- Sectional Survey on a Cohort of Medical Undergraduates from Nepal.
Get PDFIntroduction: As medicine is an ever-changing field, it necessitates medical students to develop independent learning skills for continuous learning process. Self-directed learning (SDL) is a learning strategy where students take the initiative to learn on their own. It is basically an independent study where the students use available resources and learn independently of the subject. Methods: This self-administered questionnaire study assessed five domains of SDL consisting of 60 items. The responses were made on a five-point Likert scale: from 5 = always to 1 = never. The level of self-directed learning was categorized as high, moderate and low if the scoring range was between 221-300, 141-220 or 60-140 respectively. Any student scoring in the range between 221 and 300 was considered an effective self- directed learner. Results: The present study found three out of four the students (74.7%, n=56) were active self-directed learners. However, one out of four students were half-way in becoming self-directed learners. Conclusion: SDL skill is crucial not only for the students but also for the clinicians in a complex learning process for continuous advancement of knowledge in medical profession. The findings of the present study showed that majority of the students were effective self-directed learners. The effectiveness of SDL process can be accomplished if the students are encouraged and motivated during Problem Based Learning (PBL) sessions. Identifying the factors that spark interest amongst the students to learn on their own can be achieved by active feedback sessions