Lumbini Medical College Teaching Hospital Research Articles

Study of Electrocardiographic Changes and Spirometry Findings in Chronic Obstructive Lung Disease

Introduction: Chronic Obstructive Pulmonary Disease is one of the top three causes of death worldwide and patients have to do pulmonary function test by spirometry to diagnose and to evaluate the severity. Electrocardiogram abnormalities have been found uniformly increasing with the severity by Global Initiative for Obstructive Lung Disease stages.
 Aims: To know the role of Electrocardiogram in the evaluation of severity of Chronic Obstructive Lung Disease.
 Methods: This was conducted in the department of Internal Medicine of Lumbini Medical College Teaching hospital from December 2021 to June 2022. The Chronic Obstructive Pulmonary Lung Disease was established with history, examination and spirometry along with Electrocardiogram.
 Results: Among 72 patients included 40 (55.56%) were in mild to moderate stage and 32 (44.44%) were in severe stage. The mean Force Expiratory Volume in one Second/Force Vital Capacity of severe stage was 38.59± 6.9 and 66.32±7.37 in mild to moderate stages. The electrocardiographic abnormalities like right atrial enlargement (P –pulmonale), right ventricular hypertrophy, complete right bundle branch block, low voltage in limbs, right axis deviation, sinus tachycardia and supraventricular tachycardia were seen in severe stage with statistical significance (p<0.05). Whereas left axis deviation and premature atrial contraction were found in mild to moderate disease and was statistically not significant.Increased percentage of normal electrocardiogram was found in mild or moderate than severe stage with statistical significance. So it is inversely related with the severity of disease.
 Conclusion: The relationship between Electrocardiogram findings and degree of airway obstruction was found to be highly significant. So, Electrocardiogram can be used as a surrogate investigation to evaluate the severity of Chronic Obstructive Pulmonary Disease.

Assessment of fear, anxiety, obsession and functional impairment due to COVID-19 amongst health-care workers and trainees: A cross-sectional study in Nepal.

The emergence of the COVID-19 epidemic threw the world into turmoil. The medical community bore the brunt of the pandemic's toll. Long work hours, and a lack of personal protective equipment (PPE) and social support all had an influence on mental health. This cross-sectional study was conducted among Lumbini Medical College Teaching Hospital students and employees in Palpa, Nepal. Data entailing their demographic details, pre-existing comorbidities, or death in the family due to COVID-19 was collected using a self-administered survey.In addition, the level of fear, anxiety, obsession, and functional impairment due to COVID-19 was recorded using previously validated respective scales. In total, 403 health-care workers and trainees participated in our study. The mean age of the study participants was 23±4 years, and more than half of them (n=262, 65%) were females. A significant association was found between fear score with age (p-value=0.04), gender (p-value <0.01) and occupation (p-value<0.001). The participants suffering from chronic diseases (p-value=0.36), were not found to be significantly obsessed with COVID-19. Age (p-value=0.34), was not found to be significantly associated with higher anxiety levels. Nursing students suffered from a significantly greater functional impairment than other health-care professionals (mean rank score=269.15, p-value < 0.001). A moderately positive correlation was observed between fear, anxiety, obsession, and functional impairment scales. This study revealed various socio-demographic characteristics as risk factors for psychological stress in the people related to the health-care profession of Nepal during the COVID-19 pandemic. A viable answer to this quandary might be adequate psychosocial intervention by health-care authorities, increased social support, and the introduction of better mental health management measures for the front-line health-care workers.

Assessment of fear, anxiety, obsession and functional impairment of COVID-19 amongst health-care workers and trainees: A cross-sectional study in Nepal

Background: The emergence of the COVID-19 epidemic threw the world into turmoil. The medical community bore the brunt of the pandemic's toll. Long work hours, and a lack of personal protective equipment (PPE) and social support all had an influence on mental health. Methods: This cross-sectional study was conducted among Lumbini Medical College Teaching Hospital students and employees in Palpa, Nepal. Data entailing their demographic details, pre-existing comorbidities, or death in the family due to COVID-19 was collected using a self-administered survey. In addition, the level of fear, anxiety, obsession, and functional impairment due to COVID-19 was recorded using previously validated respective scales. Results: In total, 403 health-care workers and trainees participated in our study. The average age of the study participants was 23±4 years, and more than half of them (n=262, 65%) were females. A significant association was found between fear score with age (p-value=0.04), gender (p-value <0.01) and occupation (p-value<0.001). The participants suffering from chronic diseases (p-value=0.36), and those who had experienced a COVID-19 death in the family (p-value=0.18), were not found to be significantly obsessed with COVID-19. However, for those who had experienced a COVID-19 death in the family (p-value=0.51) and age (p-value=0.34), these factors were not found to be significantly associated with higher anxiety levels. Nursing students suffered from a significantly greater functional impairment than other medical professionals (mean score=269.15, p-value < 0.001). A moderately positive correlation was observed between fear, anxiety, obsession, and functional impairment scales. Conclusion: This study revealed various socio-demographic characteristics as risk factors for psychological stress in the people related to the health-care profession of Nepal during the COVID-19 pandemic. A viable answer to this quandary might be adequate psychosocial intervention by health-care authorities, increased social support, and the introduction of better mental health management measures for the front-line medical workers.

Assessment of fear, anxiety, obsession and functional impairment of COVID-19 amongst health-care workers and trainees: A cross-sectional study in Nepal.

The emergence of the COVID-19 epidemic threw the world into turmoil. The medical community bore the brunt of the pandemic's toll. Long work hours, and a lack of personal protective equipment (PPE) and social support all had an influence on mental health. This cross-sectional study was conducted among Lumbini Medical College Teaching Hospital students and employees in Palpa, Nepal. Data entailing their demographic details, pre-existing comorbidities, or death in the family due to COVID-19 was collected using a self-administered survey.In addition, the level of fear, anxiety, obsession, and functional impairment due to COVID-19 was recorded using previously validated respective scales. In total, 403 health-care workers and trainees participated in our study. The average age of the study participants was 23±4 years, and more than half of them (n=262, 65%) were females. A significant association was found between fear score with age (p-value=0.04), gender (p-value <0.01) and occupation (p-value<0.001). The participants suffering from chronic diseases (p-value=0.36), and those who had experienced a COVID-19 death in the family (p-value=0.18), were not found to be significantly obsessed with COVID-19. However, for those who had experienced a COVID-19 death in the family (p-value=0.51) and age (p-value=0.34), these factors were not found to be significantly associated with higher anxiety levels. Nursing students suffered from a significantly greater functional impairment than other medical professionals (mean score=269.15, p-value < 0.001). A moderately positive correlation was observed between fear, anxiety, obsession, and functional impairment scales. This study revealed various socio-demographic characteristics as risk factors for psychological stress in the people related to the health-care profession of Nepal during the COVID-19 pandemic. A viable answer to this quandary might be adequate psychosocial intervention by health-care authorities, increased social support, and the introduction of better mental health management measures for the front-line medical workers.

Distant virtual medical education during COVID-19: Half a loaf of bread.

The Clinical TeacherVolume 17, Issue 4 p. 418-419 Covid-19 Insights Distant virtual medical education during COVID-19: Half a loaf of bread Alok Atreya, Corresponding Author Alok Atreya alokraj67@hotmail.com orcid.org/0000-0001-6657-7871 Department of Forensic Medicine, Lumbini Medical College Teaching Hospital, Palpa, NepalCorresponding author's contact details: Alok Atreya, Department of Forensic Medicine, Lumbini Medical College Teaching Hospital, Palpa, Nepal. E-mail: alokraj67@hotmail.comSearch for more papers by this authorJenash Acharya, Jenash Acharya Department of Forensic Medicine, Kathmandu Medical College Teaching Hospital, Kathmandu, NepalSearch for more papers by this author Alok Atreya, Corresponding Author Alok Atreya alokraj67@hotmail.com orcid.org/0000-0001-6657-7871 Department of Forensic Medicine, Lumbini Medical College Teaching Hospital, Palpa, NepalCorresponding author's contact details: Alok Atreya, Department of Forensic Medicine, Lumbini Medical College Teaching Hospital, Palpa, Nepal. E-mail: alokraj67@hotmail.comSearch for more papers by this authorJenash Acharya, Jenash Acharya Department of Forensic Medicine, Kathmandu Medical College Teaching Hospital, Kathmandu, NepalSearch for more papers by this author First published: 18 June 2020 https://doi.org/10.1111/tct.13185Citations: 20 Funding: None. Conflict of interests: None. Acknowledgements: None. Ethical approval: Not required. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume17, Issue4August 2020Pages 418-419 RelatedInformation

Pattern of Head Injuries in Western Hilly Region of Nepal: A Hospital-based Cross-sectional Study

Introduction: 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.

Psychiatric Co-morbidities Among Patients of Globus Pharyngeus Attending Psychiatry Clinic of a Teaching Hospital

Introduction: Globus sensation is described as a constant feeling of a lump, something stuck or foreign body in the throat associated with an uncomfortable experience of dysphagia or choking. It is a common complaint in Ear, Nose and Throat clinics. The symptom is considered functional when no apparent organic cause is detected. In that case the symptoms must be positively identified as psychologically related to some underlying mental conflict or need. The objective of this study is to evaluate the occurrence of psychiatric Co-morbidities in patients complaining of globus sensation in throat coming to psychiatric clinic.&#x0D; Material and Method: A case-control study was done. Patients coming to Outpatient of psychiatry OPD which were referred from Ear, Nose and Throat Department of Lumbini Medical College Teaching Hospital with complain of globus and not having an organic explanation of the condition were included. Age, sex and socio-economic condition matched control group was selected from healthy visitors (1st degree relatives). Mini International Neuropsychiatric Interview, English version; 5.0.0.,HAM-D/HAM-A, were applied to rule out depression, anxiety and assess psychiatric co-morbidities. Final ICD-10 Criteria were done for diagnosis which were made from two psychiatrists.&#x0D; Results: About 64.28 % (n=45) of globus patients had psychiatric co-morbidities which was significantly higher (p&lt;0.0151, odds ratio 0.46) than their relatives attending with the patients. Major depressive disorder was found in 25.71% (n=18), Anxiety disorder in 22.85% (n=16), Undifferentiated somatoform disorder in 7.14 % (n=5), Dysthymia each in 7.14% (n=5), Psychosis in 1.4% (n=1), Personality Disorder in 1.4 % (n=1).&#x0D; Conclusion: Burden of psychiatric co-morbidities among the patients of globus is quiet high. So, the patient who present with Globus should undergo psychiatric evaluation after organic causes have been ruled out. They should be regularly screened for psychiatric illness and an integrated treatment approach can be taken for them.

Profile of new Patients attending Psychiatry Out-patient Department at Lumbini Medical College-Teaching Hospital, Palpa

Introduction: Study on prevalence of psychiatric disorders in Palpa and nearby districts which lie in western Nepal, is not much studied till date. We therefore conducted this study aiming to see the pattern of psychiatric illness in an Outpatient Department of Lumbini Medical College which is a tertiary care centre located in Palpa district.Material And Method: : This is a retrospective study where outpatient record of all new cases attending the Psychiatry OPD from 29th Oct 2014 to 29th Dec 2014 were studied and statistical analysis were done. The number of new patients were 107.Results: Out of 107 patients, 60.74 % (65)) were females and 39.26 %( 42) were males. Patients of age group 31-40yrs showed the largest proportion (27.49%) followed by age group 41-50yrs (24.29%). Majority cases were illiterate (69.15%) followed by primary level of education (14.95%). The occupation of most of the cases were household work (35.51%) followed by farming (31.77%). Anxiety disorder (27.10%) was the most frequent diagnosis ahead of “Others” (18.69%) followed by depressive disorder (15.88%).Conclusion: Most of the new patients attending the psychiatry OPD of Lumbini Medical College were females, of 31-40 age group and most of the patients suffered from anxiety disorders. J Psychiatrists’ Association of Nepal Vol. 6, No. 2, 2017, Page: 42-44

A study on malaria cases in hilly areas and Terai belt of Nepal

Introduction: Malaria is a well-known disease and it continues to be a major public health problem at the start of new millennium. The problem is persistent not only amongst the city dwellers but also amongst the rural population.Objective: To identify the magnitude of malaria cases and to compare the malaria cases between hilly area and Terai belts.Methods: This cross-sectional study was carried out in Terai belt of Morang District Nepal at Nobel Medical College &amp; Research Center Biratnagar from March to Oct 2007 and hilly area around Lumbini Medical College Teaching Hospital &amp; Research Center Pravas, Tansen, Palpa of Nepal between March to December 2008. Blood samples were collected from all the cases and malaria parasites were examined by Peripheral Blood Smear Examination and Rapid Card Method Screening.Results: Thirty-five cases were malaria positive from hilly area of whom 80% had Plasmodium vivax infection. Whereas in Terai belt 231 positive cases ware recorded. Out of them (62.8%) cases were affected by Plasmodium vivax infection. That most vulnerable age group was 15 years and above. Males were more affected than females.Conclusion: It was observed that in hilly areas the numbers of positive cases are less than the Terai belt. The magnitude of malaria cases are found high in July. A steady decline has been observed till September to October Health Renaissance 2015;13 (1): 4-12

Gender-based Violence in Women attending Gynecology Outpatient Department in a Hospital of Western Nepal: An Issue of Endurance and Invisibility

ABSTRACTIntroductionGender-based violence (GBV) is faced by many women in Nepal but health-seeking behavior is rare. A reproductive health facility may be the only place where a woman comes for a health visit. So, health care providers, especially gynecologists, play an important role to identify women suffering from GBV as they see clients suffering from the reproductive health effects of GBV on a daily basis. The purpose of this study was to find the prevalence and severity of GBV in women attending the outpatient department (OPD) and to compare their clinical diagnosis with those not facing GBV.Materials and methodsThis is a prospective study conducted at Lumbini Medical College Teaching Hospital for a period of 3 months enrolling 741 nonpregnant women attending the OPD. A structured questionnaire was used for interview to identify women facing abuse and to assess their gynecological problems.ResultsOut of 741 women, 172 faced GBV, so the prevalence was 23.21%. Emotional and physical abuse was the most common type of abuse faced by 56 (32.56%), but the severity was reported more in sexual abuse [8 (57.14%)]. Pain abdomen was the most common symptom [69 (40.12%)], and chronic pelvic pain (CPP) [60 (34.89%)] was the commonest clinical diagnosis made in these women. Chronic pelvic pain was diagnosed more in women facing abuse (p &lt; 0.001).ConclusionIn this study, about one in four women in reproductive age group had experienced GBV. Gynecology OPD of a tertiary hospital could be used as a screening setting that can assist in early detection and prevention of GBV in Nepal.How to cite this articleAryal S, Pant SB, Baniya S. Gender-based Violence in Women attending Gynecology Outpatient Department in a Hospital of Western Nepal: An Issue of Endurance and Invisibility. J South Asian Feder Obst Gynae 2017;9(3):225-229.

Thyroid Function Abnormalities among Hospital Patients of Hilly Nepal

Introduction: Thyroid dysfunction stands as the second most common endocrine disease after diabetes mellitus. National reports on its prevalence are meagre. Hence, the study was conducted with the objective of exploring the prevalence of thyroid dysfunction among hospital patients of hilly region of Nepal.&#x0D; Methods: A hospital based, retrospective, analytical study was conducted in the department of biochemistry, Lumbini Medical College Teaching Hospital (LMCTH) from 15th February 2017 to 30th April 2017. The hospital records of patients from March 2014 to mid-February 2017 with suspected thyroid dysfunction and presented from different departments of hospital were reviewed. Data was entered in Excel 2007 and analysis was done with Statistical Package for Social Sciences (SPSS-21). Necessary descriptive and inferential statistical analysis was done. P value less than 0.05 was regarded as statistically significant.&#x0D; Results: Out of 3136 subjects, 601 (19.2%) were male and 2535 (80.8%) were female with F:M ratio of 4.2:1. Female were more likely to be suspected of thyroid dysfunction. Mean age of male was 39.28 years (SD = 19.01) and that of female was 39.60 years (SD = 14.63). Prevalence of thyroid dysfunction was 23.31%. Correlation of log10 TSH with age showed a significant relation (r = -0.05, p = 0.003). Age group and thyroid function category among female patients was found to be statistically significant (p = 0.01).&#x0D; Conclusion: The prevalence of thyroid dysfunction was high in Tansen region, a hilly mid-west Nepal. Female above 40 yrs (post reproductive age) and male above 60 yrs (elderly group) were more prone to thyroid disorders. Also, the study revealed that younger people are more likely to be euthyroid whereas as age advances, people are likely to be either hypothyroid or hyperthyroid. These findings can be a guide for elaborative research in thyroid disorder in future.

Single dose Intraoperative Antibiotics versus Postoperative Antibiotics for Patient Undergoing Laparoscopic Cholecystectomy for Symptomatic Cholelithiasis

Introduction: Surgical site infection is a common complication shown in literature following cholecystectomies. Smaller incision and use of trocars in laparoscopic cholecystectomy lessen the contamination resulting in less chances of surgical site infection. However, in fear of postoperative infection, many opt for the prolonged postoperative use of antibiotic and there is growing consensus against it. Antibiotics not only increases the cost and hospital stay duration but it aids in emergence of multidrug resistance. Because of the controversies, we conducted this clinical trial to see whether a single prophylactic dose of antibiotic at the time of induction of anesthesia for laparoscopic cholecystectomy was equally effective in controlling post-operative infection as multi-dose antibiotics during and post-operative period.&#x0D; Methods: The study was conducted at the department of general surgery, Lumbini Medical College Teaching Hospital, from November 2015 to October 2016. All cases with symptomatic cholelithiasis subjected for laparoscopic cholecystectomy were enrolled. Patients were randomized into two groups; Group SD received single dose of an intravenous dose of amikacin 500 mg, at induction of anesthesia and Group MD received multiple intravenous dose of amikacin, during and postoperatively for two days. Complications, hospital stay, and treatment cost in two groups were compared and analyzed.&#x0D; Results: There were a total of 240 patients in the study, 118 in Group SD and 122 in Group MD. Post-operative infection rate was 4.2% (n= 5, N=118) in Group SD and 3.3% (n=4, N=122) in Group MD; the difference was not significant (p=0.75). Hospital stay was prolonged and cost was higher significantly in Group MD.&#x0D; Conclusion: Single dose of prophylactic antibiotic, administered at induction of anesthesia, is equally effective as multiple doses of post surgical antibiotics to prevent post-operative infection in patients undergoing elective laparoscopic cholecystectomy for uncomplicated cholelithiasis.

Single dose Intraoperative Antibiotics versus Postoperative Antibiotics for Patient Undergoing Laparoscopic Cholecystectomy for Symptomatic Cholelithiasis

&#x0D; Introduction: Surgical site infection is a common complication shown in literature following cholecystectomies. Smaller incision and use of trocars in laparoscopic cholecystectomy lessen the contamination resulting in less chances of surgical site infection. However, in fear of postoperative infection, many opt for the prolonged postoperative use of antibiotic and there is growing consensus against it. Antibiotics not only increases the cost and hospital stay duration but it aids in emergence of multidrug resistance. Because of the controversies, we conducted this clinical trial to see whether a single prophylactic dose of antibiotic at the time of induction of anesthesia for laparoscopic cholecystectomy was equally effective in controlling post-operative infection as multi-dose antibiotics during and post-operative period.&#x0D; &#x0D; Methods: The study was conducted at the department of general surgery, Lumbini Medical College Teaching Hospital, from November 2015 to October 2016. All cases with symptomatic cholelithiasis subjected for laparoscopic cholecystectomy were enrolled. Patients were randomized into two groups; Group SD received single dose of an intravenous dose of amikacin 500 mg, at induction of anesthesia and Group MD received multiple intravenous dose of amikacin, during and postoperatively for two days. Complications, hospital stay, and treatment cost in two groups were compared and analyzed.&#x0D; &#x0D; Results: There were a total of 240 patients in the study, 118 in Group SD and 122 in Group MD. Post-operative infection rate was 4.2% (n= 5, N=118) in Group SD and 3.3% (n=4, N=122) in Group MD; the difference was not significant (p=0.75). Hospital stay was prolonged and cost was higher significantly in Group MD.&#x0D; &#x0D; Conclusion: Single dose of prophylactic antibiotic, administered at induction of anesthesia, is equally effective as multiple doses of post surgical antibiotics to prevent post-operative infection in patients undergoing elective laparoscopic cholecystectomy for uncomplicated cholelithiasis.

Histopathological Study of Endometrial Biopsy Specimens for Abnormal Uterine Bleeding

Introduction: Endometrial specimen for abnormal uterine bleeding (AUB) is the one of the commonest specimens received in histopathology laboratory. Histopathological characteristics of endometrial tissues, as assessed by light microscopy, remains the diagnostic standard for the management of AUB. The objective of study is to find out the histopathological pattern of endometrium in AUB in the light of clinical details.&#x0D; &#x0D; Methods: This was a prospective observational study carried out in the department of Pathology, Lumbini Medical College Teaching Hospital for a period of two years from June 2014 to May 2016. Formalin fixed endometrial specimens were processed, paraffin embedded, sectioned at 3-4 µm, stained with hematoxylin and eosin, and studied under light microscopy along with their demographics. Data were collected, entered and analyzed using SPSS version 20.&#x0D; &#x0D; Results: The study included 100 cases of endometrial biopsy specimens with clinical diagnosis of AUB. Menstrual disturbances was found in wide age range between 17-75 years with the mean age of 45 (SD=13.36) years. Menorrhagia was the commonest (n=60, 60%) clinical presentation. Most (n=85; 85 %) endometrium had non-neoplastic lesions. Among them, normal endometrial patterns were commonest (n=50, 50 %). Neoplastic lesions (n=15, 15%) were distributed in all menstruation status with majority in postmenopause (n=7, 7%) and included malignant cases (n=5, 5%) among others.&#x0D; &#x0D; Conclusion: Post-menopausal bleeding was common presentation among women with malignant and premalignant disease which was present in 15% of the cases together. Timely evaluation of AUB by histopathology can be life saving with early tissue diagnosis and management.

Vacuum Assisted Vaginal Delivery in Singleton Term Pregnancies: Short Term Maternal and Neonatal Outcome in a Tertiary Hospital of Nepal

Introduction: Other than cesarean delivery, assisted vaginal delivery is an alternative procedure for delivery in emergency obstetrics. Presently, vacuum delivery has gained more popularity than forceps for operative/ assisted vaginal delivery, when and where indicated, with success as well as lesser neonatal and maternal complications. This study was done to estimate the short term maternal and fetal morbidity/mortality due to vacuum assisted vaginal delivery.&#x0D; &#x0D; Methods: A prospective observational study was conducted at Lumbini Medical College Teaching Hospital from January 2015 to May 2016. One hundred and four pregnant women who had successful vacuum assisted vaginal deliveries were enrolled. Fetal and maternal outcome were assessed.&#x0D; &#x0D; Results: One hundred and four successful vacuum deliveries (2.9%) were conducted among 3457 deliveries during our study period. Sixty seven (64.4%) were primigravida and most (n=59, 56.7%) parturients were of age group 20-30 years. The commonest (n=65, 62.5%) indication for vacuum application was prolonged second stage of labor. The maternal morbidity variables were: 6.7% (n=7) had genital tract injury, 3.8% (n=4) had primary post-partum hemorrhage, 3.8% (n=4) had urinary retention, 2.8% (n=3) needed blood transfusion. Among neonatal morbidity indicators, 19.2% (n=20) neonates had birth asphyxia, 4.8% (n=5) neonates had cephalohematoma, 0.96% (n=1) had brachial plexus injury. There was one early neonatal death due to meconium aspiration syndrome.&#x0D; &#x0D; Conclusion: A successful vacuum assisted delivery can be achieved with lesser maternal and neonatal morbidity with timely assessment of labor, skilled operator, and availability of neonatal team.

First Line Treatment of Meniere’s Disease

Introduction: There is no consensus on the first line medical treatment of Meniere disease to produce symptomatic improvement and slow the disease progress. Dietary salt restriction, diuretics, and vasodilators like betahistine are among the first line drugs that have been used for long. There is lack of evidence due to paucity of quality studies to support their effectiveness and advocate their use. This study is done to evaluate the effectiveness of three first line treatment of Meniere disease i.e. salt restriction, oral diuretics, and betahistine.&#x0D; &#x0D; Methods: Double blind randomized controlled trial was carried out in out-patient clinic of Ear Nose and Throat department of Lumbini Medical College Teaching Hospital. Cases were randomized into three groups; dietary salt restriction, diuretics as amiloride and furosemide, and vasodilator as betahistine. Pre and post treatment evaluation was done in terms of number and severity of vertigo, tinnitus, and hearing outcome.&#x0D; &#x0D; Results: There were a total of 97 cases with F:M ratio of 1.1:1. Mean age of patients was 47.86 yr (SD=12.7). Twenty-nine (30%) were treated with dietary sodium restriction alone (Group A), 35 (36%) were treated with diuretics (Group B) and the rest 33 (34%) were treated with vasodilator (betahistine, Group C). There was no significant difference in hearing outcome in any group. Tinnitus was significantly improved in Group B. Number of vertigo attack was significantly decreased in Group B and Group C. Severity of vertigo was significantly decreased in Group B.&#x0D; &#x0D; Conclusion: Dietary salt restriction alone was not effective in controlling any aspect of the disease whereas diuretics were effective in reducing tinnitus and number and severity of vertigo. Betahistine was effective in reducing the number of vertigo attacks but not effective on other aspects of the disease.

Complications of Percutaneous Nephrolithotomy and their Management

Introduction: Increasing global prevalence of nephrolithiasis has resulted in the development of new minimally invasive techniques and has also led to the resurgence of established methods such as percutaneous nephrolithotomy (PCNL). This procedure is now recommended as the first option for the treatment of single large or multiple renal stones and those in the inferior calyx. This study was done to assess the complications of PCNL and their management, in our centre.&#x0D; &#x0D; Methods: Medical records of 144 patients who underwent PCNL at Lumbini Medical College Teaching Hospital, during the last one year were reviewed. The demographic data, size, tract number and location of the calculi, and intraoperative and postoperative complications were evaluated. The various parameters of the calculi were evaluated. Descriptive analysis with frequencies was done.&#x0D; &#x0D; Results: Complications occurred in 13 (9.02%) patients. Post operative bleeding occurred in seven (4.8%) patients, out of which one patient developed pseudoaneurysms and the other developed arteriovenous fistula. One patient developed hypovolemic shock immediately after surgery. Frequent blockage of urine, excessive drainage of urine from the drain site, hemothorax and colonic perforation was seen in one patient each. One patient had mortality due to post operative bleeding. Complications increased with the number and size of stones and number and site of the tracts.&#x0D; &#x0D; Conclusion: Percutaneous nephrolithotomy has low complication rate in experienced hands and complications depend upon stone size, history of open stone surgery, tract number, and tract location.

Pattern of Severe Acute Maternal Morbidity in a Tertiary Care Institute

Introduction: Maternal mortality traditionally has been the indicator of maternal health all over the world. More recently review of the cases of severe acute maternal morbidity (SAMM), also termed as "near miss obstetrics events", has been found to be a useful supplementary indicator to investigate maternal health care. Cases of near miss are those in which women present with potentially fatal complication during pregnancy, delivery, or the puerperium and survive merely by chance or by good hospital care. This study was done with the objective to analyze cases of SAMM at Lumbini Medical College Teaching Hospital (LMCTH), Nepal.&#x0D; &#x0D; Methods: A retrospective study of all cases meeting the WHO criteria for SAMM, during May 2015, was done. Cases meeting the WHO eligibility criteria for near miss cases were included in the study. Medical record of such cases in past one year was reviewed. Their socio-demographic variables, parity, gestational age, associated organ dysfunction, ICU and hospital stay, management, and fetal and maternal outcome were noted.&#x0D; &#x0D; Results: During the study period, there were total of 28 cases of SAMM and two maternal mortality out of 2735 live births. Thus rate of SAMM was 1.02%, and maternal mortality rate was 0.07%. Majority of patients were unbooked (n=18, 64.28%) and 10 (35.71%) were illiterate. Commonest causes for admission to ICU was hemorrhage (n=10, 35.71%) followed by hypertensive disorders (n=9, 32.06%), sepsis (n=2, 7.14%), and obstructed labour (n=2, 7.14%). Laparotomy was performed in six (21.42%) women, obstetric hysterectomy in four (14.28%), and pelvic devascularization in two (10.71%).&#x0D; &#x0D; Conclusion: SAMM is a useful adjunct to maternal mortality to assess maternal health care. Improving facility based care and prompt referral, education of primary health care (PHC) staff can be a short term measure to quickly reduce the number of maternal deaths. Facility based monitoring and reporting of SAMM outcome is an important step for scaling up such efforts.

Contributing Factors for Perceived Satisfaction with Nursing Care among Inpatients in General Wards

Introduction: Patients' perceived satisfaction with quality of care may affects health outcomes. Patients who are satisfied with their nursing care are more likely to follow treatment and consequently to have better health outcomes. It encourages them to behave in a healthy way after discharge, and positive rating of service quality seems to be correlated with no hesitation about revisiting the same hospital ward in time of need. This study was done to identify the contributing factors for perceived satisfaction with nursing care among inpatients in general wards in Lumbini Medical College.&#x0D; &#x0D; Methods: A descriptive cross sectional study was conducted in Lumbini Medical College Teaching Hospital throughout the month of August, 2015. A total of 60 heterogeneous study population from three different wards (Medical, Surgical, and Orthopedics), who gave consent for participation, were included using non-probability convenient sampling technique. Nepalese version of Newcastle Satisfaction with Nursing Scale (NSNS) was used to measure the satisfaction score.&#x0D; &#x0D; Results: There were a total of 60 respondents with mean age of 30.08 years (SD= 9.72). Male, duration of hospital stay, and number of hospital stay had a significant relation with the satisfaction score when calculated individually. However, the relationship was not significant when adjusted for other variables by linear regression.&#x0D; &#x0D; Conclusion: Majority of respondents were satisfied with the quality of nursing care. Male, duration of hospital stay, and number of hospital stay had a significant relation with the satisfaction score when calculated individually. The nurses should know the factors influencing patients' satisfaction and work on those to improve the quality of nursing care.

Presentation and Management of Soft-Tissue Foreign Bodies in a Teaching Hospital of Western Nepal

Introduction: Accidental penetrating injuries with foreign bodies are a common presentation in hospital's emergency rooms. If missed, these bodies can remain dormant or result in a wide range of complications. This study evaluated the characteristics of patients, presentation and management who suffered foreign body embedded in soft tissue at a teaching hospital of Western Nepal.&#x0D; &#x0D; Methods: The study was conducted at Department of Orthopaedics, Lumbini Medical College Teaching Hospital from September 2013 to August 2015. All cases confirmed to have a foreign body in soft tissue were enrolled. Surgical exploration with removal of foreign body was carried in operating room under tourniquet control. The patient demographics, cause of injury, nature of foreign body, occupation of the patient, diagnostic yield of radioimaging, procedures undertaken for retrieval of foreign body, and complications were recorded. All patients were followed-up up to five months.&#x0D; &#x0D; Results: Total 28 patients, nine (32.1%) males and 19 females (67.9%) were observed. The mean age was 35.6 yr (SD=11.1). Housewives (n=14, 50%) were the common sufferers. Most of our patients (n=17, 60.7%) presented two weeks after injury. Accidental prick while cutting grass or tree was the common mode (n=13, 46.3%) of injury and among foreign bodies, wooden or vegetative were the commonest (n=19, 67.9%) observed. Among the extremities, hand (n=10, 35.7%) and foot (n=5, 17.9%) were commonly affected. All patients had successful surgical exploration and retrieval of the foreign bodies under anesthesia and tourniquet control in operating room. Image intensifier was employed in seven cases to locate the foreign bodies per-operatively. Wound infection developed in 14.2% (n=4) of patients, all of whom were managed successfully with oral antibiotics. None of the patients required re-hospitalization. All patients were fine at final five months follow up.&#x0D; &#x0D; Conclusion: Managing foreign body embedded in the soft tissue are challenging. Surgical exploration under tourniquet control suffice a definitive management. At times, image intensifier is required to locate the foreign body.