Journal of Lumbini Medical College <p>Journal of Lumbini Medical College (JLMC) is a biannually, peer reviewed, open access, Scientific Medical Journal published in English by Lumbini Medical College in Palpa, Nepal. The journal is also available on its own website at <a title="JLMC" href="" target="_blank" rel="noopener"></a></p> Lumbini Medical College en-US Journal of Lumbini Medical College 2392-4632 The <strong>Journal of Lumbini Medical College</strong> (JLMC) publishes open access articles under the terms of the <a href="" target="_blank">Creative Commons Attribution</a>(CC BY) License which permits use, distribution and reproduction in any medium, provided the original work is properly cited.<p>JLMC requires an exclusive licence allowing to publish the article in print and online.</p><p>The corresponding author should read and agree to the following statement before submission of the manuscript for publication,</p><p><strong>License agreement</strong><br />In submitting an article to Journal of Lumbini Medical College (JLMC) I certify that:</p><ol start="1"><li>I am authorized by my co-authors to enter into these arrangements.</li><li>I warrant, on behalf of myself and my co-authors, that:</li><ul><li>the article is original, has not been formally published in any other peer-reviewed journal, is not under consideration by any other journal and does not infringe any existing copyright or any other third party rights;</li><li>I am/we are the sole author(s) of the article and have full authority to enter into this agreement and in granting rights to JLMC are not in breach of any other obligation;</li><li>the article contains nothing that is unlawful, libellous, or which would, if published, constitute a breach of contract or of confidence or of commitment given to secrecy;</li><li>I/we have taken due care to ensure the integrity of the article. 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For the avoidance of doubt it is stated that sections 1 and 2 of this license agreement shall apply and prevail regardless of whether the article is published under <a href="" target="_blank">Creative Commons Attribution License 4.0</a> or the <a href="" target="_blank">Creative Commons 1.0 Public Domain Dedication waiver.</a></li><li>I, and all co-authors, agree that, if the article is editorially accepted for publication in JLMC<em>,</em> data included in the article shall be made available under the <a href="" target="_blank">Creative Commons 1.0 Public Domain Dedication waiver</a>, unless otherwise stated. For the avoidance of doubt it is stated that sections 1, 2, and 3 of this license agreement shall apply and prevail.</li></ol><p>Please visit <a href="">Creative Commons</a> web page for details of the terms.</p> Minimal Local Analgesic Dose of Intrathecal Bupivacaine and Ropivacaine in Patients Undergoing Cesarean Section: A Comparative Study <p><strong>Introduction: </strong>Spinal anesthesia is considered a reasonable option for cesarean section. Bupivacaine and ropivacaine have been used as intrathecal drugs alone or in combination with various opioids. Ropivacaine is considered a valid and safe alternative to bupivacaine for intrathecal anesthesia. This study aims to determine the median effective dose (ED50) of intrathecal bupivacaine and ropivacaine for cesarean section and defines this as the minimum local anesthetic dose (MLAD).</p> <p><strong>Methods: </strong>Forty pregnant women undergoing elective cesarean section were allocated and randomized into two groups. The initial dose was 13mg for both ropivacaine and bupivacaine groups and was increased or decreased of 0.3mg, using the up-down sequential allocation technique. Efficacy was accepted if adequate sensory dermatomal anesthesia to pinprick to T6 was attained within 20 minutes after intrathecal injection and required no supplemental epidural injection for procedure until at least 50 minutes after the intrathecal injection of test drugs. The MLAD for both bupivacaine and ropivacaine was calculated with 95% confidence interval using the formula of Dixon and Massey. Comparison of different variables between the groups was done using t-test with significant p value at &lt; 0.05.</p> <p><strong>Results: </strong>The two groups were comparable in terms of demographic profile and clinical characteristics. The MLAD of ropivacaine and bupivacaine were 11.63 mg (95% CI, 11.5-12.92) and 10.459 mg (95% CI, 10.12-10.87) respectively. The potency ratio between spinal ropivacaine and bupivacaine was 0.89.</p> <p><strong>Conclusion: </strong>Ropivacaine provided clinically surgical anaesthesia of shorter duration without compromising neonatal outcome and can be used as a safe alternative to bupivacaine.</p> <p>DOI: <a href=""></a></p> Jeevan Singh Ashish Shrestha Kalpana Kharbuja Alex Tandukar Abha Shrestha ##submission.copyrightStatement## 2019-02-13 2019-02-13 7 1 Trend of breastfeeding and its impact on morbidity in children in a tertiary care hospital in Kathmandu <p class="Default"><span class="A6"><strong><span style="font-size: 10.5pt;">Introduction: </span></strong></span><span class="A6"><span style="font-size: 10.5pt;">WHO advocates for exclusive breastfeeding in infants till 6 months of age. Exclusive breastfeeding has been estimated to reduce 70% of infection related mortality in children. This study aims to elaborate the current trend of breastfeeding and its impact on common infectious morbidities in children. </span></span></p> <p class="Default"><span class="A6"><strong><span style="font-size: 10.5pt;">Method: </span></strong></span><span class="A6"><span style="font-size: 10.5pt;">This study was a prospective longitudinal study done at Kathmandu Medical College Teaching Hospital with a sample size of 103 infants. Detailed proforma including sociodemographic data, breastfeeding related data and morbidities were collected at one and half months of life. The patients were followed up at 6 months of age again and the same proforma was again filled up. Statistical analysis was done with SPSS 20.0 and various associations were elucidated. </span></span></p> <p class="Default"><span class="A6"><strong><span style="font-size: 10.5pt;">Results: </span></strong></span><span class="A6"><span style="font-size: 10.5pt;">A total of 103 infants were analyzed. Males were 58 in numbers with mean birth weight of the infants being 3048±537 grams. Breast feeding was initiated within an hour in around 37%. At one and half months of age, 63% reported of exclusive breastfeeding which decreased to 23% at 6 months of age. Breastfeeding for at least 45 days decreased the incidence of Acute Respiratory Infections (ARI), Acute Otitis Media (AOM) and diarrheal diseases although statistically significant difference was found with only ARIs. </span></span></p> <p class="Default"><span class="A6"><strong><span style="font-size: 10.5pt;">Conclusion: </span></strong></span><span class="A6"><span style="font-size: 10.5pt;">Prevalence of exclusive breastfeeding is low in the study. The study has also shown that breastfeeding significantly reduces incidence of common infectious morbidities in infants.</span></span></p> <p class="Default"><span class="A6">DOI: <a href="" target="_blank" rel="noopener"></a></span></p> Anwesh Bhatta Rydam Basnet ##submission.copyrightStatement## 2019-04-24 2019-04-24 7 1 Hand Index - A Forensic Tool for Sexual Dimorphism <p>DOI: <a href="" target="_blank" rel="noopener"></a></p> <p><strong>Introduction: </strong>Amongst the various parameters of identification, sex is one of the most important elements. Figuring out hand index from measurement of hand dimensions is a convenient way to determine sexual dimorphism. This study aims to find out sexual dimorphism from hand dimensions, obtain cut off points for male and female and check percentage accuracy of sex determination from hand dimensions in Nepalese population.</p> <p><strong>Methods: </strong>The data was collected from 400 asymptomatic, healthy working staff (229 males and 171 females) above 23 years in the department of Forensic Medicine and Toxicology of a tertiary care center of Western Nepal. Measurements of hand length and hand breadth were taken using standard instruments and hand index was calculated therefrom.</p> <p><strong>Results: </strong>The mean (±SD) right hand lengths for male and female were found to be 17.87 cm (±0.87) and 16.93cm (±0.58) respectively. The mean (±SD) left hand lengths for male and female were 17.85 cm (±0.86) and 16.97 cm (±0.56) respectively. The average hand breadth for male was 1.00 cm greater for right hand and 0.96 cm greater for left hand as compared to female hand breadth. Differences in length and breadth of hands for both sexes were statistically significant (p&lt;0.001) with no statistically significant difference of hand dimensions in the same sex. Cut off point for right hand index was found to be 42.32 cm and for left hand, 42.30 cm.</p> <p><strong>Conclusion: </strong>Hand dimensions and hand index can be reliably used to determine sex in medicolegal cases, especially where isolated hand is obtained.</p> Sanjay Kumar Sah Bashir Ahmed Jeelani ##submission.copyrightStatement## 2019-06-05 2019-06-05 7 1 Drug Utilization Pattern by Using WHO Core Prescribing Indicators in Orthopedics and Obstetrics / Gynecology Departments of a Tertiary Care Hospital <p>DOI: <a href="" target="_blank" rel="noopener"></a></p> <p><strong>Introduction: </strong>Drug utilization research is an important tool to provide facility of rational use of drugs. In low income countries irrational use of drugs is a common problem like overuse of drugs and inappropriate use of antibiotics, leading to poor treatment outcome and increased burden of treatment. This study was conducted to provide understanding of drug utilization pattern by using WHO Core Prescribing Indicator.</p> <p><strong>Methods: </strong>This study was conducted in Orthopedics and Obstetrics / Gynecology departments. Patients visiting these Out Patient Departments with at least one drug on prescription form were included in the study. Further, information related to WHO Core Prescribing Indicators were collected in pre-designed proforma.</p> <p><strong>Results: </strong>Average number of drugs prescribed per prescription was 2.6. Means of number of drugs prescribed in Orthopedics and Obstetrics / Gynecology departments were 2.9 and 2.3 respectively (p &lt; 0.001). Drugs prescribed in generic name and from essential drug list was 41.4% and 34.3% respectively. Prescription forms with generic name in Orthopedics department were significantly more compared to Obstetrics / Gynecology department (p = 0.00002). However, there was an increased tendency to prescribe drugs from essential drug list in Obstetrics / Gynecology department compared to Orthopedics department (p &lt; 0.001).</p> <p><strong>Conclusion: </strong>Drugs were prescribed by generic name and from essential drug list, but this was not sufficient to meet the ideal values of WHO Core Prescribing Indicator. Therefore, prioritization on prescribing drugs by generic name and from essential drug list by respective departments to achieve the standards of WHO needs to be encouraged.</p> Naresh Karki Pravin Prasad Ruban Raj Joshi Buddhi Kumar Shrestha ##submission.copyrightStatement## 2019-06-21 2019-06-21 7 1 Depression and its Associated Risk Factors among Residents of a Geriatric Home in Western Nepal <p class="Default"><span class="A6"><span style="font-size: 10.5pt;">DOI: <a href="" target="_blank" rel="noopener"></a></span></span></p> <p class="Default"><span class="A6"><strong><span style="font-size: 10.5pt;">Introduction: </span></strong></span><span class="A6"><span style="font-size: 10.5pt;">Elderly people suffer from many acute and chronic illnesses and also show higher prevalence of depression. The trend of old age homes is rising in Nepal. The aim of this study was to assess depression in the residents of a geriatric home and compare it to that in the elderly population living in their own homes. </span></span></p> <p class="Default"><span class="A6"><strong><span style="font-size: 10.5pt;">Methods: </span></strong></span><span class="A6"><span style="font-size: 10.5pt;">This was an observational cross-sectional study in which residents of a geriatric home above 60 years of age were selected as cases, and those living in their own homes were selected from the local community as a comparison group. Depression was measured with Geriatric Depression Scale comprising 30 questions. Chi-square (or Fisher Exact) test was used to compare categorical variables. </span></span></p> <p class="Default"><span class="A6"><strong><span style="font-size: 10.5pt;">Results: </span></strong></span><span class="A6"><span style="font-size: 10.5pt;">There were 52 participants in both groups. Thirty-six (69.2%) participants from the study group had depression whereas only 10 (19.2%) from the comparison group had depression. This difference was statistically significant, the odds ratio being 9.45. </span></span></p> <p class="Default"><span class="A6"><strong><span style="font-size: 10.5pt;">Conclusion: </span></strong></span><span class="A6"><span style="font-size: 10.5pt;">Depression is significantly high in elderly population living in a geriatric home as compared to those living in their own homes.</span></span></p> Bandana Pokharel Bhaskkar Sharma ##submission.copyrightStatement## 2019-06-26 2019-06-26 7 1 Cardio-respiratory Fitness in Medical Students by Queen’s College Step Test: A Cross-sectional Study <p>DOI: <a href="" target="_blank" rel="noopener"></a></p> <p class="Default">&nbsp;<strong>I</strong><span style="color: windowtext;"><strong>ntroduction:</strong> Cardio-respiratory fitness indicates the ability of circulatory system to supply oxygen to working muscles during continuous physical activity. Maximum oxygen uptake (VO<sub>2max</sub>) is a single best measure of cardio-respiratory fitness and is considered gold standard to quantify aerobic capacity. </span></p> <p class="Default"><span style="color: windowtext;"><strong>Methods:</strong> Eighty students of age group 18-25 years were taken by simple random sampling. VO<sub>2max</sub> was estimated indirectly by following the protocol of Queen’s College Step Test (QCST) method. </span></p> <p class="Default"><span style="color: windowtext;"><strong>Results:</strong> Mean value of VO<sub>2max</sub> for male (51.61±6.26 ml/Kg/min) and female (36.02±3.71 ml/Kg/min) was compared, which was found significantly higher in males than in females (p&lt;0.001). There was negative correlation of gender (r = -0.838), body mass index (BMI) (r = -0.339), obesity category (r = -0.275), obese vs non-obese (r = -0.264) and basal pulse rate (r = -0.456) with VO<sub>2max</sub> and positive correlation of height (r = 0.592) and hours of study (r = 0.309) with VO<sub>2max</sub>. </span></p> <p class="Default"><span style="color: windowtext;"><strong>Conclusion:</strong> This study showed that increased BMI is associated with decreased level of VO<sub>2max</sub> in young adults. One can improve VO<sub>2max</sub> by maintaining BMI within normal limits.</span></p> Bibek Koju Shaligram Chaudhary Lok Raj Joshi Anupama Shrestha ##submission.copyrightStatement## 2019-06-28 2019-06-28 7 1 Central Retinal Artery Occlusion Associated with Atrial Septal Defect: A Case Report <p>DOI: <a href=""></a></p> <p><strong>Introduction:</strong> Central retinal artery occlusion (CRAO) is characterized by sudden obstruction of the arterial blood flow in the retinal circulation with consequent ischemic damage to the retina resulting in vision loss. An interesting case of unilateral CRAO associated with atrial septal defect (ASD) in a young female is reported here.</p> <p><strong>Case:</strong> A young female presented to emergency department with history of sudden and painless loss of vision in her right eye for one day. Her visual acuity at the time of presentation was perception of light in right eye and 6/6 in left eye. On examination, anterior segments of both the eyes were normal. However, relative afferent pupillary defect was positive in her right eye. On fundus examination, right eye showed pale retina and cherry red spot whereas left eye was unremarkable. Findings were suggestive of right eye CRAO. Ocular massage was done and oral carbonic anhydrase inhibitor was given. Patient was referred to a cardiologist for further evaluation and establishment of the etiology. All tests were within reference limit except a large ASD (secundum type with left to right shunt) with a diameter of 28 mm was revealed on transthoracic echocardiogram.</p> <p><strong>Conclusion:</strong> The association between ASD and CRAO is rare. Intracardiac shunts through defect may predispose the disease. Detailed cardiac evaluation is mandatory to rule out possible causes to prevent ocular or systemic embolic events and associated morbidity.</p> Sharad Gupta Manoj Aryal Yogita Rajbhandari Ajay Adhikari Vinit Kumar Kamble Binod Aryal ##submission.copyrightStatement## 2019-06-25 2019-06-25 7 1