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Vision Loss following Small Incision Cataract Surgery: A Case Report 小切口白内障术后视力丧失1例报告
Pub Date : 2021-05-15 DOI: 10.22502/JLMC.V9I1.390
Sushma Chaudhary, Sharad Gupta, S. Singh, H. Sharma, R. Yadav, V. Kamble
Introduction: Retro-bulbar block is still safe and widely employed anesthetic technique in large volume routine cataract surgery. Nevertheless, the procedure is not free of complication. Case report: A 48 years old man who had small incision cataract surgery of left eye under retro-bulbar block, had vision of hand movement close to face on his first postoperative day. He was given intracameral cefuroxime and subconjunctival gentamycin at the end of the surgery. Fundoscopy of the operated eye showed marked retinal whitening with cherry-red spot in the posterior pole suggestive of cilio-retinal artery occlusion. Optical coherence tomography and optical coherence tomography angiography were done to support and confirm the diagnosis. Conclusion: Retinal artery occlusion secondary to retro-bulbar block or drug induced toxicity following routine cataract surgery is unusual and sometimes dreadful vision threatening complication can occur.
引言:球后阻滞在大容量白内障常规手术中仍然是安全且广泛应用的麻醉技术。然而,该手术并非没有并发症。病例报告:一名48岁的男子在球后阻滞下接受了左眼小切口白内障手术,术后第一天就看到了手靠近面部的运动。手术结束时,他接受了前房内注射头孢呋辛和结膜下注射庆大霉素。手术眼的眼底镜检查显示视网膜明显变白,后极有樱桃红斑点,提示纤毛视网膜动脉闭塞。进行了光学相干断层扫描和光学相干断层成像血管造影术来支持和确认诊断。结论:常规白内障手术后继发于球后阻滞或药物毒性的视网膜动脉闭塞是不常见的,有时会出现严重的视力威胁并发症。
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引用次数: 0
COVID-19: Intranasal and Oral Routes of Vaccination COVID-19:鼻内和口服疫苗接种途径
Pub Date : 2021-05-10 DOI: 10.22502/JLMC.V9I1.427
J. Robinson, Alexandra Leclézio, I. Banerjee
The mainstay protocol exercised by global health leaders to control the spread of severe acute respiratory syndrome corona virus (SARS-CoV-2) has been screening, the identification of cases, isolation thereof, contact tracing and nation-wide lockdowns. The development of vaccinations against the SARS-CoV-2 virus has marked a new dawn for the war against corona virus disease (COVID-19).
全球卫生领导人控制严重急性呼吸综合征冠状病毒(SARS-CoV-2)传播的主要方案是筛查、发现病例、隔离病例、追踪接触者和全国范围内的封锁。针对SARS-CoV-2病毒的疫苗的开发标志着对抗冠状病毒病(COVID-19)的战争出现了新的曙光。
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引用次数: 1
Nursing Students’ Perception of Online Learning Amidst COVID-19 Pandemic 新冠肺炎大流行期间护生对在线学习的认知
Pub Date : 2021-05-08 DOI: 10.22502/JLMC.V9I1.408
Sunita Rana, C. K. Garbuja, G. Rai
Introduction: The declaration of COVID-19 pandemic on 11th March 2020 by World Health Organization forced many countries including Nepal to choose online mode of nursing education. Hence, it is essential for the educators to find out students’ perception that ensures their readiness to learn in this new environment. This study sought to examine the perception of online learning among nursing students. Methods: After obtaining ethical clearance, a cross-sectional descriptive study was conducted among 211 nursing students using enumerative sampling method. Self-administered structured online questionnaire was used. Calculated Cronbach's alpha value was 0.828. Descriptive (frequency, percentage, mean etc.) and inferential statistics (Chi-square test) were used to analyze data. Results: The mean age of the participants was 19.80±1.87 years. All (100%) had mobile phone. Most (93.8%) had internet facility at home. More than half (59.7%) strongly agreed that face-to-face learning was more effective. Less than half (44.6%) strongly agreed that interrupted internet connection was an obstacle. More than half (56.9%) participants had positive perception of online learning. Age, enrolled nursing program and device used were statistically significant with perception of online learning. Conclusion: The perception of nursing students towards online learning is positive. Students are satisfied with their learning opportunities amidst COVID-19 through online education. However, interrupted internet connection, unfeasible practical natured courses, load-shedding etc. were perceived as obstacles to online learning. Age, enrolled nursing program, academic year, and devices used had an impact on positive perception.
导语:2020年3月11日,世界卫生组织宣布COVID-19大流行,迫使包括尼泊尔在内的许多国家选择在线护理教育模式。因此,对于教育者来说,找出学生的感知是至关重要的,以确保他们准备好在这个新环境中学习。本研究旨在探讨护理学生对网上学习的看法。方法:在获得伦理许可后,采用抽样方法对211名护生进行横断面描述性研究。采用自我管理的结构化在线问卷。计算的Cronbach’s alpha值为0.828。采用描述性统计(频率、百分比、平均值等)和推断性统计(卡方检验)对数据进行分析。结果:参与者平均年龄为19.80±1.87岁。所有人(100%)都有手机。大多数(93.8%)家庭有互联网设备。超过一半(59.7%)的人强烈同意面对面学习更有效。不到一半(44.6%)的人强烈同意网络连接中断是一个障碍。超过一半(56.9%)的受访者对在线学习持积极态度。年龄、注册护理计划和使用的设备与在线学习的感知有统计学意义。结论:护生对网络学习的态度是积极的。学生们对新冠肺炎期间通过在线教育获得的学习机会感到满意。然而,网络连接中断、不可行的实用课程、负荷减少等被认为是在线学习的障碍。年龄、注册护理课程、学年和使用的设备对积极感知有影响。
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引用次数: 16
Comparative Study on Effects of 2% Lidocaine Hydrochloride with Adrenaline (1:200000) on Blood Pressure Among Controlled Hypertensive and Non-hypertensive Patients During Dental Anesthesia 2%盐酸利多卡因和肾上腺素(1:200000)对控制性高血压和非高血压患者牙科麻醉期间血压影响的比较研究
Pub Date : 2021-05-02 DOI: 10.22502/JLMC.V9I1.415
L. Tuladhar, Meen Bahadur Budhathoki, A. Bhattarai, K. Bimb, N. Acharya, E. Tuladhar
Introduction: Local anesthetic used for dental extraction is 2% lidocaine hydrochloride with adrenaline (1:200000). Lidocaine is cardiac depressant and adrenaline is cardiac stimulant; it decreases or increases blood pressure respectively. Methods: A total of 100 patients (50 controlled hypertensive and 50 non-hypertensive) were selected. The study was conducted over a period of 14 months from January 2020 to February 2021. Blood pressure was measured for patients who were planned for dental extraction by auscultatory method. Following that, 1.5-3 ml (depending upon the nerve block) 2% lidocaine with adrenaline (1:200000) was injected using a 3ml syringe (26 Gauge). Blood pressure was re-recorded after 10 minutes from the time of injection. Visual analog scale pain score was obtained during administration of local anesthesia. Paired t-test was applied to compare blood pressure change before and after administration of local anesthesia in controlled hypertensive and non-hypertensive patients. Results: There was a statistically significant increase in both systolic and diastolic blood pressure in non-hypertensive patients (p = 0.008, p = 0.017). This, however, was not the case with controlled hypertensive patients. There was statistically significant increase in systolic blood pressure (p < 0.001). Pain on injection (50% in non-hypertensive and 48% in controlled hypertensive patients) was the only adverse drug reaction that was reported in both groups. Conclusion: 2% lidocaine hydrochloride with adrenaline (1:200000) increased systolic but not diastolic blood pressure in controlled hypertensive patients
简介:用于拔牙的局部麻醉剂是2%盐酸利多卡因和肾上腺素(1:200000)。利多卡因是心脏抑制剂,肾上腺素是心脏兴奋剂;它分别降低或升高血压。方法:选择100例患者,其中50例为高血压对照组,50例为非高血压对照组。这项研究从2020年1月到2021年2月,历时14个月。通过听诊法测量计划拔牙的患者的血压。随后,使用3ml注射器(26号)注射1.5-3ml(取决于神经阻滞)2%利多卡因和肾上腺素(1:200000)。在注射后10分钟后重新记录血压。在局部麻醉期间获得视觉模拟量表疼痛评分。应用配对t检验比较高血压对照组和非高血压对照组局部麻醉前后的血压变化。结果:非高血压患者的收缩压和舒张压均有统计学意义的升高(p=0.008,p=0.017)。然而,对照高血压患者的情况并非如此。收缩压有统计学意义的升高(p<0.001)。注射疼痛(非高血压患者为50%,对照高血压患者为48%)是两组中唯一报告的药物不良反应。结论:2%盐酸利多卡因和肾上腺素(1:200000)可提高高血压患者的收缩压,但不能提高舒张压
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引用次数: 0
External Ophthalmomyiasis by Oestrus Ovis: Two Case Reports from Nepal 由雌卵引起的外眼病:尼泊尔2例报告
Pub Date : 2021-03-24 DOI: 10.22502/JLMC.V9I1.407
Nabina Maharjan, Ashish Jamarkattel, B. Nepal
Introduction: Ophthalmomyiasis is an infestation of eye with larvae of dipteran flies most commonlyby Oestrus ovis (Sheep nasal botfly). External ophthalmomyiasis in humans is a rare condition seen inpeople residing in rural areas and also living close to livestock. Case Report: We report two cases ofexternal ophthalmomyiasis in 22 years old male and 38 years old female both having history of suddenonset of foreign body sensation and redness in left and right eyes respectively. Conclusion: This externalophthalmomyiasis presenting nonspecific symptoms similar to acute conjunctivitis is the first case reportedin Nepal to the best of our knowledge. This report may aware all ophthalmologists about larval conjunctivitispreventing misdiagnosis.
简介:眼蝇病是一种常见于绵羊鼻蝇幼虫的眼睛感染。人类外眼蝇蛆病是一种罕见的疾病,见于居住在农村地区和牲畜附近的人。病例报告:我们报告了两例外眼蝇蛆病,男22岁,女38岁,均有异物感和左右眼发红史。结论:据我们所知,这种表现出类似于急性结膜炎的非特异性症状的外部性眼球炎是尼泊尔首例报告的病例。这份报告可能会让所有眼科医生意识到幼虫结膜炎会导致误诊。
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引用次数: 0
Pre-operative Hypoglycemia in Patients Presenting for Surgery: A Hospital Based Cross-sectional Study 手术患者的术前低血糖:一项基于医院的横断面研究
Pub Date : 2021-03-16 DOI: 10.22502/JLMC.V9I1.373
A. Thapa, R. Yadav, R. Basnet, B. Pradhan, R. Maharjan, Samreta Chaudhary
Introduction: Peri-operative glycemic control is an important factor for post-operative recovery and is well protocoled for diabetic patients in every setup. It is not always so with non-diabetic patients. This study aimed to observe the pre-operative glucose level and prevalence of hypoglycemia in patients presenting for surgery and its association with the duration of nil per oral period (NPO), age and intravenous fluids used in the pre-operative period. Methods: A cross-sectional study was conducted in the Department of Anesthesiology in a Nepalese medical college including all the patients posted for elective surgery over a period of three months. Socio-demographic and clinical details of the participants were collected in the operating theatre. Duration of  NPO period and intravenous fluid prescribed in the pre-operative fasting period were recorded. A glucose strip test was performed on all the participants. Results: Participants were found to have fasted for an unnecessarily longer duration (12.84±2.27 hours). The incidence of hypoglycemia in patients posted for elective surgery was very high (43.3%). Ringer lactate and normal saline were equally prescribed (38.4%) and dextrose-normal saline was prescribed in the rest of the participants. Gender and type of intravenous fluids were positively correlated whereas NPO period was negatively correlated in overall participants though statistically insignificant. In hypoglycemic participants, we observed that lower glucose was influenced by pre-operative fluids, age and NPO duration. Conclusion: Pre-operative use of glucose-containing fluids during NPO period is an important step to prevent hypoglycemia and related consequences.
导言:围手术期血糖控制是术后恢复的重要因素,在每一种情况下都对糖尿病患者进行了很好的控制。非糖尿病患者并不总是如此。本研究旨在观察手术患者的术前血糖水平和低血糖患病率,以及其与术前无口服时间(NPO)、年龄和静脉输液的关系。方法:在尼泊尔一所医学院麻醉科进行横断面研究,包括所有在三个月内接受择期手术的患者。在手术室收集参与者的社会人口学和临床细节。记录NPO期持续时间和术前禁食期静脉输液时间。所有参与者都进行了葡萄糖试纸。结果:参与者的禁食时间延长了(12.84±2.27小时)。择期手术患者的低血糖发生率非常高(43.3%)。38.4%的受试者服用乳酸林格盐和生理盐水,其余受试者服用葡萄糖-生理盐水。性别和静脉输液类型呈正相关,而NPO期在所有参与者中呈负相关,但统计学上不显著。在低血糖患者中,我们观察到术前液体、年龄和NPO持续时间对低血糖的影响。结论:NPO期术前使用含糖液体是预防低血糖及相关后果的重要步骤。
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引用次数: 0
Prevalence and Risk Factors of Hypertensive Retinopathy in Hypertensive Patients in a Tertiary Hospital of Gandaki Province of Nepal 尼泊尔甘达基省一家三级医院高血压患者高血压视网膜病变的患病率和危险因素
Pub Date : 2020-12-30 DOI: 10.22502/JLMC.V8I2.374
S. T. Godar, K. Kaini
Introduction: Hypertensive retinopathy is one of the major complications of hypertension. The presence of hypertensive retinopathy may be an indicator of the presence of other complications too. This study aimed to determine the prevalence and risk factors of hypertensive retinopathy in hypertensive patients in a tertiary care hospital in Nepal. Methods: This was a hospital-based cross-sectional study conducted among 95 hypertensive patients aged 30 years and above. Standard proforma was used to collect socio-demographic and clinical variables of the patients. Detailed eye examination including fundus evaluation under mydriasis was done on all patients and hypertensive retinopathy was graded according to Keith-Wagener-Barker classification. Statistical analysis was carried out using Epi-info 7. Results: The mean age of the study sample was 59.74±15.11 years. The prevalence of hypertensive retinopathy was 38.95%. Among the patients with hypertensive retinopathy, the prevalence of grade I, II, III, and IV retinopathies were 7.36%, 17.89%, 10.52%, and 3.15% respectively. There was a statistically significant association between hypertensive retinopathy and controlled blood pressure and treatment of hypertension. However, there was no statistically significant association between hypertensive retinopathy and gender, duration of hypertension, residence, family history, history of smoking, and diet. Conclusion: Uncontrolled blood pressure and untreated patients of hypertension were the significant risk factors for hypertensive retinopathy. Early diagnosis and treatment of hypertension are essential to prevent loss of vision.
高血压视网膜病变是高血压的主要并发症之一。高血压视网膜病变的存在也可能是其他并发症存在的一个指标。本研究旨在确定尼泊尔三级医院高血压患者高血压视网膜病变的患病率和危险因素。方法:这是一项以医院为基础的横断面研究,对95名30岁及以上的高血压患者进行了研究。采用标准形式收集患者的社会人口学和临床变量。对所有患者进行详细的眼科检查,包括眼底评估,并根据keith - wagner - barker分级对高血压视网膜病变进行分级。采用Epi-info 7进行统计分析。结果:研究样本平均年龄为59.74±15.11岁。高血压性视网膜病变患病率为38.95%。高血压视网膜病变患者中,1级、2级、3级、4级视网膜病变患病率分别为7.36%、17.89%、10.52%、3.15%。高血压视网膜病变与血压控制和高血压治疗之间有统计学意义的关联。然而,高血压视网膜病变与性别、高血压病程、居住地、家族史、吸烟史和饮食没有统计学上的显著相关性。结论:高血压患者血压不受控制和未经治疗是高血压视网膜病变的重要危险因素。早期诊断和治疗高血压对于防止视力丧失至关重要。
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引用次数: 1
Sexual Dimorphism of Maxillary Sinus: A Morphometric Analysis using Computed Tomography 上颌窦两性畸形的计算机断层扫描形态学分析
Pub Date : 2020-12-29 DOI: 10.22502/JLMC.V8I2.382
S. Kandel, R. Shrestha, Rupesh Sharma, S. Sah
Introduction: Gender determination is the important aspect of forensic science. Most of the bones used for sex determination are badly disfigured and found in incomplete state, thus bones recovered intact are used. Maxillary sinus being recovered intact can be used for gender determination by measuring maxillary sinus dimension through computed tomography (CT). The aim of this study was to assess sexual dimorphism using morphometric maxillary sinus measurements through CT scan. Methods: This analytical cross-sectional study included CT scan images of 80 patients (40 males and 40 females). Maxillary sinus mediolateral (ML), superoinferior (SI), anteroposterior (AP) linear dimensions and volume were measured. All the measured parameters were then subjected to Student’s t-test to determine mean difference between males and females and discriminative statistical analysis to determine gender. Results: The mean value of maxillary sinus length, width, height and volume in males on both right and left sides were (3.80±0.175, 3.74±0.209) cm, (2.57±0.317, 2.51±0.295) cm, (3.55±0.338, 3.5±0.286) cm and (17.49±3.909, 16.54±3.274) cm3 respectively and in females (3.67±0.250, 3.64±0.256) cm, (2.37±0.297, 2.34±0.3222) cm, (3.29±0.280, 3.23±0.254) cm and (14.42±2.935, 13.81±2.779) cm3 respectively. The discriminative analysis showed that the accuracy of maxillary sinus measurements was 72.5% in females and 75% ofmales (overall accuracy = 73.8%). Conclusion: The maxillary sinus measurements are valuable guide for sex determination with relatively good accuracy rate.
引言:性别鉴定是法医学的一个重要方面。大多数用于性别鉴定的骨骼都严重毁容,并且处于不完整状态,因此使用了完好无损的骨骼。完整恢复的上颌窦可用于通过计算机断层扫描(CT)测量上颌窦尺寸来确定性别。本研究的目的是通过CT扫描,使用形态计量上颌窦测量来评估两性异形。方法:这项横断面分析研究包括80名患者(40名男性和40名女性)的CT扫描图像。测量上颌窦内侧(ML)、上下(SI)、前后(AP)的线性尺寸和体积。然后对所有测量的参数进行Student t检验,以确定男性和女性之间的平均差异,并进行判别统计分析,以确定性别。结果:男性上颌窦长、宽、高、体积分别为(3.80±0.175、3.74±0.209)cm、(2.57±0.317、2.51±0.295)cm、,分别为(3.29±0.280、3.23±0.254)cm和(14.42±2.935、13.81±2.779)cm3。判别分析表明,上颌窦测量的准确率女性为72.5%,男性为75%(总准确率为73.8%)。
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引用次数: 1
Unilateral Phthiriasis Palpebrarum Infestation: A Rare Presentation 单侧帕氏邻苯二甲酸感染:罕见表现
Pub Date : 2020-12-29 DOI: 10.22502/JLMC.V8I2.398
V. Kamble, Sharad Gupta, R. Yadav, S. Singh, Bipin Bista, Nirajan Shah
Introduction: Phthiriasis palpebrarum is an uncommon eyelid infestation mainly caused by Phthirus pubis also known as crab lice. Case report: A 16 years male presented with redness, itching and watering of the right eye for one week. On slit-lamp biomicroscopic examination lice and nits anchored to the eyelashes along with seborrheic material accumulation was noted. Lice, partial nits along with matted eyelashes were removed and sent to laboratory for microscopic examination. On follow up visit remaining nits were expunged. Conclusion: Meticulous slit lamp biomicroscopic examination should be done in all patients presenting with itching of the eyelids in conjunction with clinical findings resembling seborrhea and evidence for Phthiriasis palpebrarum should be looked for.
简介:睑板虱是一种不常见的眼睑感染,主要由阴虱引起,也被称为蟹虱。病例报告:一名16岁男性,右眼出现红肿、瘙痒和流泪症状一周。在裂隙灯生物显微镜检查中,发现了固定在睫毛上的虱子和nits,以及脂溢物质的积聚。切除虱子、部分虱子和缠结的睫毛,并将其送往实验室进行显微镜检查。在后续访问中,剩余的尼特被删除。结论:所有表现为眼睑瘙痒并伴有类似脂溢的临床表现的患者都应进行细致的裂隙灯生物显微镜检查,并应寻找眼睑邻苯二甲酸的证据。
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引用次数: 0
Intensive Physiotherapy Interventions in Speedy Recovery of Sub-acute Stroke: A Case Series 强化理疗干预在亚急性脑卒中快速康复中的应用:一系列病例
Pub Date : 2020-12-25 DOI: 10.22502/JLMC.V8I2.375
S. Adhikari, R. Maharjan, Redisha Jakibanjar, Anushree Balla, M. Shrestha, Narendra Shalike, G. Nepal
Introduction: Intensive physiotherapy interventions have shown good recovery in stroke if applied to stable patients who can tolerate it. Influence of enriched environment on intensive physiotherapy interventions after acute care has not been studied in low-resource contexts, and therefore, we reported outcome of the interventions in multiple cases with stroke in Nepalese context and cultural background. Case reports: Three patients in sub-acute stage of stroke were admitted in intensive physiotherapy treatment unit where the environment was therapeutically enriched. The therapist-administered interventions were intensive for each domain of impairment and activity limitations, every day for six days a week. Patients were trained to carry out caregiver-assisted practice or self-practice in enriched environment. Training demonstrated visible and measurable outcome in all cases. Conclusion: Intensive physiotherapy interventions in an enriched environment promoted good recovery in short period in stroke. The interventions applied, and the principles adopted were based on the established evidence, and therefore findings of this study may support for its feasibility and applicability.
引言:如果将强化物理治疗干预措施应用于能够耐受的稳定患者,则中风患者的康复情况良好。在资源匮乏的情况下,尚未研究丰富的环境对急性护理后强化物理治疗措施的影响,因此,我们报道了在尼泊尔背景和文化背景下对多例中风患者进行干预的结果。病例报告:三名处于中风亚急性期的患者被送入环境丰富的强化理疗治疗室。治疗师对每一个损伤和活动限制领域进行强化干预,每周六天,每天进行。对患者进行了培训,使其能够在丰富的环境中进行护理人员辅助实践或自我实践。培训在所有情况下都显示出明显和可衡量的结果。结论:在丰富的环境中进行强化物理治疗有助于脑卒中患者在短时间内恢复良好。所采用的干预措施和所采用的原则都是基于既定证据,因此本研究的结果可能支持其可行性和适用性。
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引用次数: 1
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Journal of Lumbini Medical College
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