Journal of Lumbini Medical College

Anatomical Variations of Renal Artery in Patients Undergoing Computed Tomography of Abdomen: A Hospital-based Cross-sectional Study

Pramod Kumar Chhetri — 2021-08-29

Introduction: Renal vasculature is known for presenting a wide range of variations. Knowledge of different anatomical variations helps the surgeon prevent possible intraoperative complications. Computed Tomography (CT) is an excellent imaging modality providing detailed anatomy of the renal artery. This study aimed to evaluate renal arterial variations in individuals undergoing abdominal CT examination.

Methods: This was a hospital based cross-sectional study on 400 consecutive patients who underwent abdominal CT examination in a medical college in Nepal. The number of patients with normal and any arterial variations was noted. Accessory renal artery (hilar and polar artery) and any pre-hilar branching were evaluated.

Results: Among 400 patients, 271 (67.75%) individuals had normal renal artery supply and 129 (32.25%) had variations. Among 129 individuals (79 males and 50 females) with artery variations, 93 (72.09%) had unilateral and 36 (27.91%) had bilateral variations. The most common unilateral variation was a single polar artery in 66 (70.97%) cases, pre-hilar branching in 18 (19.35%), accessory hilar artery in 7 (7.53%) and dual polar arteries in 2 (2.15%). In those with bilateral arterial variations, the right and left kidneys showed polar artery in 25 (69%) and 30 (83%), pre-hilar branching in 6 (17%) and 2 (6%), and accessory hilar in 5 (14%) and 4 (11%) cases respectively.

Conclusion: Renal artery variation was observed in approximately one-third of individuals. Unilateral variation was more common than bilateral and polar artery was the most common arterial variant.

Anatomical Variants of Portal Vein Branching in CECT Scan of Abdomen: A Descriptive Study

Subindra Karki — 2021-10-04

Introduction: Various anatomical variants are encountered in portal venous system which are quite important while undergoing hepatobiliary surgeries and percutaneous radiological interventions. Contrast enhanced computed tomography (CECT) of the abdomen is considered a better imaging modality to identify these variations.

Methods: A descriptive prospective study was conducted in 1000 individuals undergoing CECT of abdomen. Triple phase CECT scan of the abdomen was done and the portal vein anatomy was reconstructed and analyzed.

Results: Normal branching pattern of the portal vein was seen in 786 (78.6%) patients. Variations were seen in rest of the 214 (21.40%) patients. The most common variant was trifurcation of the portal vein seen in 113 (11.3%) patients. Right posterior portal vein as the first branch of main portal portal vein was found in 72 (7.2%) patients. Right anterior portal vein arising from left portal vein was seen in 29 (2.9%). Sixty nine of the 567 males had trifurcation accounting for 12.1% incidence of this variation amongst males. Trifurcation was seen in 44 of the 433 females resulting in an incidence of 10.1%. Forty-four (7.7%) males and 28 (6.4%) females had right posterior portal vein as the first branch of main portal vein. Right anterior portal vein was noted to arise from the left portal vein in 20 (3.5%) males and nine (2.07%) females.

Conclusion: The most common variation in portal venous system was trifurcation of portal vein followed by right posterior as first branch and right anterior branch arising from left portal vein respectively

Fatigue and Sleep Quality Among Staff Nurses Working in A Tertiary Care Hospital During COVID-19 Pandemic

Sunita Rana — 2021-10-11

Introduction: Fatigue, a universal phenomenon, is a suboptimal psychophysiological condition caused by physical and/or mental exertion. Insufficient recovery between work shifts causes accumulated acute fatigue to progress into chronic. As fatigue and sleep quality are related, adequate sleep and inter shift recovery are thus vital to the overall health. The current COVID-19 pandemic has caused added burden to the nursing workforce worldwide. This study aimed to assess fatigue and sleep quality among staff nurses of a tertiary care hospital during the pandemic.

Methods: A descriptive cross-sectional study was conducted among 151 staff nurses of Lumbini Medical College and Teaching Hospital (LMCTH) using enumerative sampling method. Valid and reliable instruments i.e., Occupational Fatigue Exhaustion Recovery (OFER) and Pittsburgh Sleep Quality Index (PSQI) were used. Analysis was done using descriptive and inferential statistics.

Results: The mean ±SD age of the participants was 26.54±6.93 years. Less than half (39.1%) of them had moderate to high acute fatigue. Nearly half (41.2%) had high chronic fatigue and most (61.6%) had low to moderate inter shift recovery. Poor sleep was found among 60.9% of the participants with mean global PSQI score of 6.74. Sleep quality had moderate positive correlation with chronic (r=0.4, p<0.001) and acute (r=0.39, p<0.001) fatigue whereas had moderate negative correlation with inter shift recovery (r=- 0.41, p<0.001) which were statistically significant.

Conclusion: The staff nurses had fatigue and poor sleep during COVID-19 pandemic. Nursing administration should take appropriate measures timely to decrease fatigue and improve sleep to prevent serious consequences.

Effect of Anemia in Pregnancy and its Perinatal Outcome: A Prospective Cohort Study

Noora Pradhan — 2021-11-17

Introduction: Anemia is a major risk factor for poor maternal health status. Anemia during pregnancy leads to poor birth outcomes such as fetal anemia, low birth weight, preterm birth, stillbirth, and neonatal mortality. This study aimed to assess the effect of anemia in pregnancy and its perinatal outcome.

Methods: A prospective study was conducted among 370 pregnant women in Dhulikhel Hospital, Kavre from June 2017 to December 2017. Descriptive statistics were used to represent the socio-clinical characteristics. Bivariate analysis was performed to analyze the effect of anemia.

Results: The study found that all the participants were anemic out of which mild anemia was observed in 352 (95.4%), moderate anemia in 17 (4.6%), and severe anemia in one (0.3%) participants respectively. Women aged 17 to 24 years and multiparous women had higher odds of having moderate anemia (Hb 7.0-8.9 g/dL). Women with moderate anemia had more odds of having neonates with less Apgar scores. Women with moderate anemia had nine times higher odds of having newborn mortality.

Conclusion: Anemia during pregnancy not only affects the health status of the mother but also impacts the birth outcomes. This study highlighted the emphasis on the active participation of governmental and non-governmental organizations to prevent adverse effects of anemia during pregnancy and birth outcomes.

The Cost of Menstrual Cycle in Young Nepali Women: A Cross-Sectional Study

Surya Bahadur Parajuli — 2021-12-02

Introduction: Every woman must have safe access to clean water and menstrual products. They have to spend more or less money to buy menstrual products or to alleviate menstrual symptoms. Cost of a menstrual cycle is often associated with period poverty. We found a research gap on this issue. The objective of this study was to find the cost of menstrual cycle and their perceptions on menstrual cost among young Nepali women.

Methods: We conducted a cross sectional study from 15 August 2019 to 15 February 2020. Total enumeration sampling technique was used to enroll 157 female medical students. Ethical clearance was obtained from institutional review committee of Birat Medical College Teaching Hospital. Open data kit (ODK) collect software was used for data collection. The collected data was extracted in Microsoft Excel 2016 and analyzed by SPSS version 23.

Results: Majority (33.8%) had menarche at 13 years and 47.8% had regular menstrual cycle. Total average cost of items used in last menstrual period was NPR 480.41 (NPR 40-1850) and lifetime cost was NPR 219066.96. Sanitary pads/ tampons/menstrual cups etc. should cost less money (85.4%) and tax currently put on it should be removed by government (91.1%) were the perceptions of the participants.

Conclusion: Menstrual cycle added additional cost in women's life. Participants perceived that cost is high and it should be tax free. Nepal constitution already passed sanitation as basic fundamental right. So, the cost of sanitary items needs to be minimized by removing the government tax.

Readiness for Self-directed Learning among Nursing Students of Lumbini Medical College and Teaching Hospital: A Cross-sectional Study

Parbati Nepal — 2021-12-25

Introduction: Self-directed learning is an independent learning approach and especially appropriate for adult learners where control over the learning is exerted by the learners than by teachers.

Methods: A descriptive cross-sectional study was conducted among 147 nursing students. All the students of 2nd and 3rd years Proficiency Certificate Level (PCL) and 2nd, 3rd, and 4th-year bachelor in science (B.Sc) nursing were selected purposefully. The level of readiness was assessed through internationally validated “Self-Directed Learning Readiness Scale (SDLR)”. Data were analyzed using descriptive and inferential statistics. The p-value was set at <0.05.

Results: The mean age of participants was 20.10±1.73 years and 55.1% of participants were from PCL nursing and 51.7% were from Brahmin/Chhetri ethnicity. Nearly three quarter (72.3%) were hosteller. A majority (83.7%) of participants had a high level of readiness for self-directed learning with an overall mean score of 158.78±14.27. The mean score (60.42±6.99) of self-control subscale was higher than the mean score of self-management (49.82±5.01) and desire for learning (48.53±5.47). The year of study (p<0.001), level of study (p<0.001), age (p<0.001), and grade obtained in previous level education (p<0.001) were statistically significant with the readiness level for self-directed learning.

Conclusion: Nursing students had a higher level of readiness for self-directed learning, so the teachers need to adopt those learning strategies that help and encourage nursing students for independent learning which enhance student’s learning with better retention, good decision making, and confidence.

Menopausal Symptoms in Premenopausal Women Among the Cohort of Gynecological Patients Attending Outpatient Department of Dhulikhel Hospital

A. Dongol — 2021-12-30

Introduction: Perimenopause is the time when ovaries gradually produce less estrogen. The menopausal symptoms in perimenopausal women cause severe disturbance in the women’s life. This study aimed to identify menopausal symptoms in perimenopausal women.

Methods: This was a hospital-based descriptive, cross-sectional study conducted among 243 women aged between 45 to 55 years. The categorical variables were presented as frequency and percentage. The associations between categorical variables were tested using Chi square or Fisher exact test.

Result: The total prevalence of menopausal symptoms was 91.8%. Physical symptoms were identified to be prevailing symptom (n=184, 75.7%) followed by psychological (n=167, 69.5%). There were 136 (55.5%) women experiencing poor memory and 148 (60.9%) women having genitourinary symptoms. Stress urinary incontinence (n=73, 30.04%) was predominant over urge (n=58, 23.8%), mixed (n=43, 17.6%) and prolapse (n=49, 20.1%) symptoms. Vasomotor symptoms were experienced by123 (50.6%). Excessive sweating (n=114, 46.9%) was leading over hot flush (n=113, 46.5%), night sweat (n=107, 44.03%) and palpitation (n=96, 39.5%). A total of 114 (46.9%) women were facing sexual symptoms. The common sexual symptom was dyspareunia 68 (27.9%). The Menopausal Rating Scale (MRS) rating of overall symptoms showed women mostly suffer from mild symptoms during the perimenopausal period.

Conclusion: Physical symptoms were identified to be predominating followed by psychological, genitourinary, vasomotor and sexual. However rating of symptoms using MRS showed majority of symptoms were mild. This study signifies the need to use the tool for assessment of severity of menopausal symptoms from the perimenopausal group. findings are noted in most of the cases of chronic LBP, degenerative changes being the most common and ranging from congenital to malignant lesions.

Pharmacovigilance: Knowledge, Attitude and Practice among Medical Professionals at a Tertiary Care Hospital in Nepal

Kamal Kandal — 2021-12-30

Introduction: Awareness regarding pharmacovigilance and adverse drug reaction reporting by medical professionals significantly contribute to the safer use of medicine. Therefore, the objective of this study was to assess the knowledge, attitude, and practices regarding pharmacovigilance among the medical professionals at a tertiary care hospital in Nepal.

Methods: This study was a descriptive cross-sectional study conducted at Lumbini Medical College and Teaching Hospital. Printed questionnaires were distributed to all the medical professionals and collected data were analyzed to find the knowledge, attitude, and practices of the medical professionals regarding pharmacovigilance.

Results: A total of 107 medical professionals, 77 (71.96%) males and 30 (28.04%) females, participated in the study. The overall response rate was 98.16%. In this study,70.1% of medical professionals knew the definition of pharmacovigilance, and more than half of the participants(63.6%) did not know the existence of the national pharmacovigilance center. Regarding attitude, 52.3% of the medical professionals strongly agreed that adverse drug reaction reporting and monitoring systems were beneficial to patients or improved patient care. Half of the medical professionals would sometimes counsel the patients about adverse drug reactions. Almost half of medical professionals mentioned that the major factor behind underreporting was insufficient knowledge of where to report adverse drug reactions. Training on pharmacovigilance was the main recommendation from the participants (52.3%) to improve the pharmacovigilance program.

Conclusion: There is room for improvement in the knowledge, attitude and practice of the participants. Most medical professionals suggested training or continuing medical education as a way to improve pharmacovigilance programs.

In-hospital Outcomes in Patients Undergoing Percutaneous Coronary Intervention in Peri-urban Area Hospital Without Cardiac Surgery Backup

Manoj Shrestha — 2021-12-30

Introduction: In centers without cardiac surgery backup, current guidelines recommend to conduct emergency percutaneous coronary intervention and discourage elective percutaneous coronary intervention. The objective of the study was to evaluate the feasibility and safety of percutaneous coronary intervention in patients with stable coronary artery disease, acute coronary syndrome, and ST segment elevation myocardial infarction in periurban area of Nepal without on-site cardiac surgical facilities.

Methods: This retrospective single-centered study was done at College of Medical Sciences, Bharatpur, Nepal. The study included 600 patients who underwent percutaneous coronary intervention in the cardiology department cath lab from January 2014 to March 2020. Patients were evaluated for in-hospital outcomes, procedural success and post percutaneous coronary intervention complications within seven days of hospital stay.

Results: Seventy percent (n=420) of percutaneous coronary intervention was emergency percutaneous coronary intervention for acute coronary syndrome and 30% (n=180) of percutaneous coronary intervention was done as an elective percutaneous coronary intervention for stable angina. Procedural success was 98% (n=176) for elective percutaneous coronary intervention and 93% (n=390) for emergency percutaneous coronary intervention. Sixteen percent (n=96) patients developed acute kidney injury, six percent (n=36) of patients developed pulmonary edema and cardiogenic shock respectively, 2% (n=12) patients developed post percutaneous coronary intervention myocardial infarction, 3% (n=18) patients developed bleeding complications, 0.5% (n=3) patients developed stroke and death rate was 3% (n=18).

Conclusion: Percutaneous coronary intervention can be done with comparable and acceptable safety in peri-urban area hospital of Nepal without cardiac surgery backup with dedicated and experienced team.

Antimicrobial Susceptibility Pattern of Enterococcus Species Isolated From Various Clinical Specimens in a Tertiary Care Center in Western Nepal

Anjila Pal — 2021-12-30

Introduction: Enterococcus species are Gram-positive oval cocci arranged in pairs or short chains. They are found as gut microbiota of adults, but from the last decade, they are emerging as causative agents of various nosocomial infections throughout the world. High level aminoglycoside resistance and vancomycin resistance are being increasingly reported from different parts of the world thus limiting the therapeutic options for the treatment of enterococcal infections. The objective of our study was to determine the antimicrobial susceptibility pattern of Enterococcus species isolated from various clinical specimens in Lumbini Medical College and Teaching Hospital, Palpa.

Methods: All the clinical samples were cultured and enterococci isolates were tested for antibiotic sensitivity, high level gentamicin resistance and vancomycin resistance by Kirby Bauer disc diffusion method.

Results: Among the 90 isolated Enterococcus spp.maximum isolates were obtained from the age group 21-40 years, most from in-patient department with urine as sample (n=53, 58.89%). The highest antimicrobial susceptibility was recorded for linezolid (90.48%) followed by chloramphenicol (79.71%), nitrofurantoin (76.83%) and then high-level gentamicin (70%). The overall prevalence of high level gentamicin resistance and vancomycin resistant enterococci were 30% and 35.55% respectively.

Conclusion: The present findings show a high rate of high-level gentamicin and vancomycin resistant enterococci. Thus, routine surveillance of such resistance pattern should be done every year. Linezolid can be considered as a drug of choice to treat serious enterococcal infections.

Prevalence of Absence of Palmaris Longus in Students of a Medical College in Nepal

Prabina Manandhar — 2021-12-30

Introduction: Palmaris longus is one of the most variable muscles present in the superficial layer of the anterior compartment of forearm and is phylo-genetically categorized as retrogressive muscle. It arises from the medial epicondyle of humerus and forms a long slender tendon which becomes flattened in palm to form palmar aponeurosis and helps in the flexion of hand at wrist. This muscle can be used in plastic surgery or reconstructive surgeries. The present study was carried out to find the prevalence of presence or absence of palmaris longus tendon in Nepalese population so that it would be helpful to provide a baseline data for surgeons to perform surgical procedures.

Methods: This was a cross-sectional descriptive study conducted among 200 medical students after the approval from Institutional Review Committee. The presence or absence of tendon of palmaris longus was observed and confirmed on the flexor aspect of wrist by using Schaffer’s test and Thompson’s test.

Results: The overall absence of palmaris longus was observed in 55 students (27.5%) with the prevalence of bilateral absence in 27 students (13.5%) and unilateral absence in 28 students (14.0%).The overall absence of palmaris longus was reported in 20 males (23.2%) and in 35 females (30.7%).

Conclusion: Absence of palmaris longus (either unilateral or bilateral) was observed in about one fourth of the participants.

Impact of Lockdown of COVID 19 Pandemic in Pregnancy Outcomes in a Tertiary Care Centre: What to Expect?

Anjali Subedi — 2021-12-31

Introduction: Corona Virus Disease 19 (COVID-19) was declared a "pandemic" in March 2020 by WHO and advocated lockdown measures with the use of mask, frequent hand washing and social distancing for decreasing the transmission of disease. In Nepal where antenatal coverage is just 50% and institutional deliveries 54%, this lockdown has further reduced the regular antenatal visits, institutional deliveries posing an increased adverse effect in pregnancy outcome. This study aimed to reveal the impact of lockdown of COVID 19 pandemic in pregnancy outcomes in a tertiary care center.

Methods: It was a cross-sectional, analytical study done in the Department of Obstetrics and Gynecology, Manipal Teaching Hospital for three months lockdown period (March 2020 to June 2020) and total deliveries along with maternal and perinatal complications were studied in the lockdown period and compared with those in non-lockdown period.

Results: During the lockdown period, there were total 1070 deliveries and maternal complication was seen in 17.38% of deliveries. In the non-lockdown period, there were total of 982 deliveries and maternal complication was present in 18.43% of deliveries (p= 0.53). In the study, more cases of early pregnancy complications were seen in lockdown period than in non-lockdown period. Regarding obstetric complications, hypertensive disorder was the most common one observed during lockdown period whereas preterm labor was common in non-lockdown period. There was no increase in perinatal complications during lockdown period on comparing to non-lockdown period.

Conclusion: There was no increase in adverse pregnancy outcomes during lockdown of COVID 19 pandemic in a tertiary care center.

Adverse Pregnancy Outcomes in Overweight and Obese Pregnant Women Visiting a Tertiary Care Center in Western Nepal: A Prospective Cohort Study

Deepak Shrestha — 2021-12-31

Introduction: Maternal obesity is an established risk factor for various adverse pregnancy outcomes. For instance, increased chances of labour induction, prolonged labour, instrumental and cesarean deliveries, medical disorders of pregnancy, post partum haemorrhage, preterm deliveries, macrosomia, and low Apgar score are well recognised risks of maternal obesity. This study aimed to evaluate these maternal and fetal outcomes in relation to the maternal body mass index (BMI).

Methods: A prospective cohort study involving 115 overweight and obese women was conducted. Various maternal and fetal outcomes were studied and compared with those of 115 postpartum women with normal BMI. Statistical analysis was done using student's t-test and Chi square test. Binomial logistic regression analysis was carried out to examine the magnitude and significance of the independent effect of BMI.

Results: The three groups were comparable in terms of maternal age and gestational age at delivery. The total blood loss was significantly higher in the obese group as compared to the normal BMI (p=0.001) or overweight groups (p=0.005). Vaginal delivery was 69% less common in the obese group in comparison to the normal BMI group. The prevalence of meconium-stained liquor, labour induction, preterm labour, and neonatal intensive care unit admission were not significantly different across the three groups.

Conclusion: This study highlighted the increased risk of total blood loss and birth weight >3500 grams with increasing BMI of pregnant women. A multicentric prospective study with larger sample size would shed further light on the strength of association between maternal BMI and various outcomes.

Evaluation of Alcazar Scoring System to Differentiate Between Benign and Malignant Ovarian Masses- A Nepalese Perspective

Rupesh Sharma — 2021-12-31

Introduction: Ovarian cancer is the fifth most common cancer in Nepalese females and the tenth overall, accounting for 5% of the total new cases of cancer in females in 2020. Ultrasonography (USG) remains the primary tool for diagnosis and characterization of ovarian masses in which many grey-scale and Doppler characteristics are evaluated. Various scoring systems have been described incorporating different USG parameters to differentiate benign and malignant nature of the ovarian masses. Alcazar scoring system includes both grey-scale as well as Doppler characteristics of the ovarian masses and is one of the more widely used systems worldwide.

Methods: This was an observational cross-sectional study based on 52 consecutive patients who were clinically suspected to have ovarian mass and referred for USG evaluation and who subsequently underwent surgery.

Results: As confirmed by histopathology, 37 cases were benign and 15 were malignant masses. Alcazar system of scoring identified 34 out of 37 benign cases and 15 out of 15 malignant cases with sensitivity and specificity for diagnosing malignant cases of 83.3% and 91.1% respectively.

Conclusion: Alcazar system of scoring is a highly effective tool to differentiate between benign and malignant ovarian masses and can be of great help in diagnosis, characterization and effective preoperative planning

Satisfaction of Online Learning among Nursing Students during COVID-19 Pandemic in Pokhara

Man Maya Rana — 2021-12-31

Introduction: The outbreak of COVID-19 pandemic across the world has profoundly altered almost all aspects of life, including education. Conducting online learning was necessary to continue academic activities across all schools worldwide. The objective of this study was to assess satisfaction of online learning among nursing students.

Methods: A descriptive cross-sectional study was carried out among 191 nursing students of PCL and B.Sc nursing programme. An enumerative sampling technique was used to select the sample. The self-administered web based questionnaire was used to collect data. The collected data was analysed by using descriptive and inferential statistics.

Results: More than half (56%) of students were satisfied with online learning. A majority (95.8%) agreed that they need to be updated with the latest technology, 93.2% agreed on self-discipline is necessary during online class, 78% students agreed that they feel practical/clinical simulation exercises through online class is difficult, and 73.3% agreed the instructors organization and preparation for class provides comfortable online learning environment. However, only 23.56% of them agreed that they feel lazy and disinterested during online classes. There was significant association between level of satisfaction and type of residence, monthly family income, and academic level.

Conclusion: More than half students are satisfied in online learning. Students' satisfaction is one of important factors for effective outcome from online learning. So, E-learning is a good opportunity to continue education in future.