There was a time when epidemics were of interest only to historians. In spite of the knowledge of the risks of emergent infectious diseases, Coronavirus disease of 2019 (COVID-19) managed to disrupt the entire world. This new virus has the capacity to evade, adapt, diversify and persist. Human factors such as global travel, human-animal contact, urban crowding and ecological changes have helped favor the rapid spread. Epidemics are known to eventually resolve, whether succumbing to societal action or having exhausted the supplyof susceptible victims. COVID-19 too will be contained but it will leave a trail of devastating health consequences for low- and middle-income countries (LMIC) including Nepal.When governments responded in the hopes of slowing the course of the pandemic and reducing the total mortality, stringent controls were implemented, including school closures, bans on public gatherings, and other forms of isolation or quarantine. In Nepal, a nationwide complete lockdown commenced on the 24th March, 2020. This brought about a drastic decrease in demand for hospital services, mainly due to inaccessibility orthe health care seekers’ apprehension of contracting the virus during a hospital visit. Elective surgeries and procedures were temporarily discontinued and preventive care such as antenatal and well-baby visits came to a complete halt in majority of the institutions nationwide. Although mortality rates for COVID-19 appeared to be low in children and in women in the reproductive age, these groups might be disproportionately affected by thedisruption of routine health services, particularly in LMICs.
{"title":"The The Impact of COVID-19 on Immunization Services","authors":"S. Mathema","doi":"10.22502/JLMC.V8I1.366","DOIUrl":"https://doi.org/10.22502/JLMC.V8I1.366","url":null,"abstract":"There was a time when epidemics were of interest only to historians. In spite of the knowledge of the risks of emergent infectious diseases, Coronavirus disease of 2019 (COVID-19) managed to disrupt the entire world. This new virus has the capacity to evade, adapt, diversify and persist. Human factors such as global travel, human-animal contact, urban crowding and ecological changes have helped favor the rapid spread. Epidemics are known to eventually resolve, whether succumbing to societal action or having exhausted the supplyof susceptible victims. COVID-19 too will be contained but it will leave a trail of devastating health consequences for low- and middle-income countries (LMIC) including Nepal.When governments responded in the hopes of slowing the course of the pandemic and reducing the total mortality, stringent controls were implemented, including school closures, bans on public gatherings, and other forms of isolation or quarantine. In Nepal, a nationwide complete lockdown commenced on the 24th March, 2020. This brought about a drastic decrease in demand for hospital services, mainly due to inaccessibility orthe health care seekers’ apprehension of contracting the virus during a hospital visit. Elective surgeries and procedures were temporarily discontinued and preventive care such as antenatal and well-baby visits came to a complete halt in majority of the institutions nationwide. Although mortality rates for COVID-19 appeared to be low in children and in women in the reproductive age, these groups might be disproportionately affected by thedisruption of routine health services, particularly in LMICs.","PeriodicalId":16109,"journal":{"name":"Journal of Lumbini Medical College","volume":"8 1","pages":"158-160"},"PeriodicalIF":0.0,"publicationDate":"2020-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42300469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pulse oximetry is an essential component of the standard care of COVID-19 patients. In the context of the spreading COVID-19 pandemic for which no targeted therapy or vaccines are yet available, early identification of the severe cases or cases with high risk of severe disease and appropriate supportive treatment are of paramount importance to save lives. Pulse oximetry is a cheap, fast, easy to use, noninvasive, painless and accurate tool that allows real-time monitoring of hypoxemia. As the primary target of the disease is the respiratory system pulse oximetry provides an unparalleled way to assess the severity of the disease, guide supportive therapies and monitor the clinical status and response to treatment with greater benefits in the low-resource settings. All settings from the quarantine facilities at the ground level to the ICUs in the highest level hospitals can utilize it to achieve their goals. To get the best of this tool, it needs to be used properly and the findings interpreted carefully. Role of basic understanding of the physiological principles and technology behind its use and awareness of its limitations cannot be overemphasized. The pulse oximetry readings are interpreted in the context of blood hemoglobin concentration, tissue perfusion, arterial blood carbon dioxide concentration and oxygen supplementation status.
{"title":"Principles, Utility and Limitations of Pulse Oximetry in Management of COVID-19","authors":"Lok Raj Joshi","doi":"10.22502/JLMC.V8I1.356","DOIUrl":"https://doi.org/10.22502/JLMC.V8I1.356","url":null,"abstract":"Pulse oximetry is an essential component of the standard care of COVID-19 patients. In the context of the spreading COVID-19 pandemic for which no targeted therapy or vaccines are yet available, early identification of the severe cases or cases with high risk of severe disease and appropriate supportive treatment are of paramount importance to save lives. Pulse oximetry is a cheap, fast, easy to use, noninvasive, painless and accurate tool that allows real-time monitoring of hypoxemia. As the primary target of the disease is the respiratory system pulse oximetry provides an unparalleled way to assess the severity of the disease, guide supportive therapies and monitor the clinical status and response to treatment with greater benefits in the low-resource settings. All settings from the quarantine facilities at the ground level to the ICUs in the highest level hospitals can utilize it to achieve their goals. To get the best of this tool, it needs to be used properly and the findings interpreted carefully. Role of basic understanding of the physiological principles and technology behind its use and awareness of its limitations cannot be overemphasized. The pulse oximetry readings are interpreted in the context of blood hemoglobin concentration, tissue perfusion, arterial blood carbon dioxide concentration and oxygen supplementation status.","PeriodicalId":16109,"journal":{"name":"Journal of Lumbini Medical College","volume":"8 1","pages":"105-110"},"PeriodicalIF":0.0,"publicationDate":"2020-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46311665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Koju, H. Joshi, S. Shrestha, R. Karmacharya, Narendra Shalike
Introduction: There are various modalities of breaking urinary tract calculus. The aim of this study was to compare outcome between laser and pneumatic lithotripsy in patients with upper ureteric calculus in terms of stone free rate, proximal migration and complication. Methods: This was a prospective comparative study done in 210 patients with upper ureteric calculus. The patients were randomized into two groups (Laser Lithotripsy and Pneumatic Lithotripsy) from April 2018 to June 2019. The main objective of both the procedures was to break stone into particles less than 3 mm which was confirmed by X-ray KUB and ultrasonography of abdomen and pelvis after six weeks and to compare effectiveness in terms of immediate stone free rate, proximal migration, operative duration and post-operative complication. Results: There was no difference in age, gender and stone size in both groups. Immediate stone free rate was 99.05% in Laser Lithotripsy and 76.19% in Pneumatic Lithotripsy (p value<0.001). Proximal migration in Laser Lithotripsy was 0.95% and 23.81% in Pneumatic Lithotripsy (p<0.001). There was significantly prolonged operative duration in Pneumatic Lithotripsy (14.7±4.77 min vs 13.31±3.24 in Laser Lithotripsy, p=0.014). Complications were more in Pneumatic Lithotripsy group, which was statistically significant (p=0.017). Conclusion: Both pneumatic and laser lithotripsy are effective and safe modalities for treating upper ureteric calculus, however laser has less chances of proximal migration and higher immediate stone free rate with less complication
{"title":"A Comparative Study Between Pneumatic and Laser Lithotripsy for Proximal Ureteric Calculus","authors":"R. Koju, H. Joshi, S. Shrestha, R. Karmacharya, Narendra Shalike","doi":"10.22502/JLMC.V8I1.303","DOIUrl":"https://doi.org/10.22502/JLMC.V8I1.303","url":null,"abstract":"Introduction: There are various modalities of breaking urinary tract calculus. The aim of this study was to compare outcome between laser and pneumatic lithotripsy in patients with upper ureteric calculus in terms of stone free rate, proximal migration and complication. Methods: This was a prospective comparative study done in 210 patients with upper ureteric calculus. The patients were randomized into two groups (Laser Lithotripsy and Pneumatic Lithotripsy) from April 2018 to June 2019. The main objective of both the procedures was to break stone into particles less than 3 mm which was confirmed by X-ray KUB and ultrasonography of abdomen and pelvis after six weeks and to compare effectiveness in terms of immediate stone free rate, proximal migration, operative duration and post-operative complication. Results: There was no difference in age, gender and stone size in both groups. Immediate stone free rate was 99.05% in Laser Lithotripsy and 76.19% in Pneumatic Lithotripsy (p value<0.001). Proximal migration in Laser Lithotripsy was 0.95% and 23.81% in Pneumatic Lithotripsy (p<0.001). There was significantly prolonged operative duration in Pneumatic Lithotripsy (14.7±4.77 min vs 13.31±3.24 in Laser Lithotripsy, p=0.014). Complications were more in Pneumatic Lithotripsy group, which was statistically significant (p=0.017). Conclusion: Both pneumatic and laser lithotripsy are effective and safe modalities for treating upper ureteric calculus, however laser has less chances of proximal migration and higher immediate stone free rate with less complication","PeriodicalId":16109,"journal":{"name":"Journal of Lumbini Medical College","volume":"8 1","pages":"55-59"},"PeriodicalIF":0.0,"publicationDate":"2020-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47421595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The current outbreak of corona virus disease (COVID-19), declared as public health emergency of national and international concern by World Health Organization (WHO), led to unprecedented public health responses in Nepal and many countries around the world including travel restriction, closure of educational institutions, curfews in some places and quarantines. This pandemic has affected lives of millions in different ways in different geographic locations worldwide. Beyond the immediate threat to health, unemployment, insecurity, etc., education is one of the sensitive areas which has been affected tremendously, students in Nepal not being an exception. The closure of all educational institutions effective from 18th March, 2020 followed by the nationwide lockdown from 24th March, 2020 till date enforced by Government of Nepal (GoN) as an effort to limit the spread of COVID-19 has shed a light on numerous issues affecting the access to education. As per the United NationsEducational, Scientific and Cultural Organization (UNESCO) report 2020, a total of 1,190,287,189learners are currently affected constituting 68% of the total enrolled learners worldwide because of temporary or indefinite country wide school closures implemented by the respective governments in an attempt to slow the spread of COVID-19. In Nepal alone 8,796,624 students have reportedly been affected.
{"title":"Virtual Learning during COVID-19 Pandemic: Pros and Cons","authors":"Bipana Surkhali, C. K. Garbuja","doi":"10.22502/JLMC.V8I1.363","DOIUrl":"https://doi.org/10.22502/JLMC.V8I1.363","url":null,"abstract":"The current outbreak of corona virus disease (COVID-19), declared as public health emergency of national and international concern by World Health Organization (WHO), led to unprecedented public health responses in Nepal and many countries around the world including travel restriction, closure of educational institutions, curfews in some places and quarantines. This pandemic has affected lives of millions in different ways in different geographic locations worldwide. Beyond the immediate threat to health, unemployment, insecurity, etc., education is one of the sensitive areas which has been affected tremendously, students in Nepal not being an exception. \u0000The closure of all educational institutions effective from 18th March, 2020 followed by the nationwide lockdown from 24th March, 2020 till date enforced by Government of Nepal (GoN) as an effort to limit the spread of COVID-19 has shed a light on numerous issues affecting the access to education. As per the United NationsEducational, Scientific and Cultural Organization (UNESCO) report 2020, a total of 1,190,287,189learners are currently affected constituting 68% of the total enrolled learners worldwide because of temporary or indefinite country wide school closures implemented by the respective governments in an attempt to slow the spread of COVID-19. In Nepal alone 8,796,624 students have reportedly been affected.","PeriodicalId":16109,"journal":{"name":"Journal of Lumbini Medical College","volume":"8 1","pages":"154-155"},"PeriodicalIF":0.0,"publicationDate":"2020-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49334677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In Nepal, after the first case was diagnosed with Corona Virus Disease -19 (COVID -19) in a 32-year-old returnee from Wuhan, China on 13 January 2020, it took more than four months to reach a figure of 500 infected cases. Seventy of them have already recovered and returned home. However, the curve has been taking a steeper slope after the first 50 cases were documented. With the first mortality from COVID-19 confirmed on 16thMay, 2020, the fact that this pandemic is tightening its grip in the country is more evident now. And witheach passing day, more cases are being diagnosed. In such a situation, strategies of screening the infected/suspects are of paramount importance and those already in place should be strengthened. On March 19, the Nepal Medical Council asked all hospitals, both private and public, with over 100 beds to operate a separate fever clinics and postpone elective surgeries to conserve resources for an outbreak. Such fever clinicsaim at separating and filtering out the suspected/ diagnosed COVID-19 patients. Arguably started firstin Kathmandu Medical College, fever clinics now have been established and run in almost every largehealth care centers. United Nations International Children’s Emergency Fund (UNICEF) has been pivotal in supporting some of these centers. Rising up to the task, Lumbini Medical College and Teaching Hospital started its fever clinic from 22 March 2020 in a separate makeshift place which later moved to a more organized structure. The fever clinic is set up in a separate area in order to keep off suspected patients from the main hospital.
{"title":"Limitations of COVID-19 Fever Clinic as the First Point of Contact: Are We Relying Too Much? An Experience from a Tertiary Center","authors":"D. Shrestha","doi":"10.22502/JLMC.V8I1.352","DOIUrl":"https://doi.org/10.22502/JLMC.V8I1.352","url":null,"abstract":"In Nepal, after the first case was diagnosed with Corona Virus Disease -19 (COVID -19) in a 32-year-old returnee from Wuhan, China on 13 January 2020, it took more than four months to reach a figure of 500 infected cases. Seventy of them have already recovered and returned home. However, the curve has been taking a steeper slope after the first 50 cases were documented. With the first mortality from COVID-19 confirmed on 16thMay, 2020, the fact that this pandemic is tightening its grip in the country is more evident now. And witheach passing day, more cases are being diagnosed. In such a situation, strategies of screening the infected/suspects are of paramount importance and those already in place should be strengthened. On March 19, the Nepal Medical Council asked all hospitals, both private and public, with over 100 beds to operate a separate fever clinics and postpone elective surgeries to conserve resources for an outbreak. Such fever clinicsaim at separating and filtering out the suspected/ diagnosed COVID-19 patients. Arguably started firstin Kathmandu Medical College, fever clinics now have been established and run in almost every largehealth care centers. United Nations International Children’s Emergency Fund (UNICEF) has been pivotal in supporting some of these centers. Rising up to the task, Lumbini Medical College and Teaching Hospital started its fever clinic from 22 March 2020 in a separate makeshift place which later moved to a more organized structure. The fever clinic is set up in a separate area in order to keep off suspected patients from the main hospital.","PeriodicalId":16109,"journal":{"name":"Journal of Lumbini Medical College","volume":"8 1","pages":"156-157"},"PeriodicalIF":0.0,"publicationDate":"2020-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48315956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Piryani, S. Piryani, S. Piryani, Dhana Ratna Shakya, M. Huq
Cambridge Dictionary defines ‘lockdown’ as a situation in which people are not allowed to enter or leave a building or area freely because of an emergency. Merriam-Webster outlines three definitions of lockdown: a) the confinement of prisoners to their cell for all or most of the day as a temporary security measure, b) an emergency condition in which people are temporarily prevented from entering or leaving a restricted area during a threat of danger and c) a temporary condition imposed by governmental authorities as during theoutbreak of an epidemic disease in which people are required to stay at their homes and refrain from orlimit activities outside the home involving public contact. Our focus, here, is on lockdown strategy adopted to contain corona virus disease 2019 (COVID-19) pandemic.
{"title":"COVID-19 And Lockdown: Be Logical in Relaxing It","authors":"R. Piryani, S. Piryani, S. Piryani, Dhana Ratna Shakya, M. Huq","doi":"10.22502/JLMC.V8I1.361","DOIUrl":"https://doi.org/10.22502/JLMC.V8I1.361","url":null,"abstract":"Cambridge Dictionary defines ‘lockdown’ as a situation in which people are not allowed to enter or leave a building or area freely because of an emergency. Merriam-Webster outlines three definitions of lockdown: a) the confinement of prisoners to their cell for all or most of the day as a temporary security measure, b) an emergency condition in which people are temporarily prevented from entering or leaving a restricted area during a threat of danger and c) a temporary condition imposed by governmental authorities as during theoutbreak of an epidemic disease in which people are required to stay at their homes and refrain from orlimit activities outside the home involving public contact. Our focus, here, is on lockdown strategy adopted to contain corona virus disease 2019 (COVID-19) pandemic.","PeriodicalId":16109,"journal":{"name":"Journal of Lumbini Medical College","volume":"8 1","pages":"150-153"},"PeriodicalIF":0.0,"publicationDate":"2020-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41928025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Pattern of Head Injuries in Western Hilly Region of Nepal: A Hospital-based Cross-sectional Study","authors":"S. Sah, B. Neupane, A. Atreya, Naresh Karki","doi":"10.22502/JLMC.V8I1.297","DOIUrl":"https://doi.org/10.22502/JLMC.V8I1.297","url":null,"abstract":"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.","PeriodicalId":16109,"journal":{"name":"Journal of Lumbini Medical College","volume":"8 1","pages":"65-70"},"PeriodicalIF":0.0,"publicationDate":"2020-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47450102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The poor state of health care in Nepal will be burdened further following the SARS-CoV-2 pandemic. The government failed in timely stockpiling of medical supplies and equipment, development of health infrastructure, including laboratories and quarantine centres, restriction and screening of international travel and information dissemination to the general public. While efforts have now been made to increase the capacity for diagnostic test for SARS-CoV-2, the government still needs to further increase the availability and accessibility throughout the country. This would be the first step in fighting the pandemic. However, it is also important to prepare for the worst case. Similarly, advocacy programs should be developed to inform the general public and alleviate their fears about the disease. These measures would not only help Nepal’s capability to respond to the COVID-19 outbreak but could lay the foundations to improve the health of the citizens in general, even after this epidemic is controlled and could go a long way in developing trust of the government in the populace.
{"title":"Need for Prioritizing Health: An Old War-Cry Reiterated By COVID-19","authors":"R. Shrestha, S. Nepal, A. Atreya","doi":"10.22502/JLMC.V8I1.341","DOIUrl":"https://doi.org/10.22502/JLMC.V8I1.341","url":null,"abstract":"The poor state of health care in Nepal will be burdened further following the SARS-CoV-2 pandemic. The government failed in timely stockpiling of medical supplies and equipment, development of health infrastructure, including laboratories and quarantine centres, restriction and screening of international travel and information dissemination to the general public. While efforts have now been made to increase the capacity for diagnostic test for SARS-CoV-2, the government still needs to further increase the availability and accessibility throughout the country. This would be the first step in fighting the pandemic. However, it is also important to prepare for the worst case. Similarly, advocacy programs should be developed to inform the general public and alleviate their fears about the disease. These measures would not only help Nepal’s capability to respond to the COVID-19 outbreak but could lay the foundations to improve the health of the citizens in general, even after this epidemic is controlled and could go a long way in developing trust of the government in the populace.","PeriodicalId":16109,"journal":{"name":"Journal of Lumbini Medical College","volume":"8 1","pages":"99-104"},"PeriodicalIF":0.0,"publicationDate":"2020-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48868615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The coronavirus pandemic has changed the world everywhere, including the lives of high schoolers in America. The sudden sharp rise in coronavirus cases forced the closure of schools in Mid-March to curb the further spread of the virus. Several end-of-the-year celebrations, school activities, and examinations were canceled. At the same time, the cancellations gave a chance for the youth to adapt to uncertain situations and learn adifferent perspective of life. Living in Florida, a state that battles hurricanes for almost half a year, school closures have become the norm: it is not rare for students to be reminded to keep their textbooks and notes home for a week or two. Prepared from past closures due to hurricanes, the school district board already had a virtual school platform, and the principal instructed all students to shift to Zoom and alternative eLearning. However, when the coronavirus pandemic led to the indefinite closure of high schools across the country, thiswas something new, different, and unexpected that school communities had to face.
{"title":"COVID-19: Emerging Challenges for Students in Medicine and Schools in the United States","authors":"Shrinit Babel, Surbhi Jain, L. Conger","doi":"10.22502/JLMC.V8I1.359","DOIUrl":"https://doi.org/10.22502/JLMC.V8I1.359","url":null,"abstract":"The coronavirus pandemic has changed the world everywhere, including the lives of high schoolers in America. The sudden sharp rise in coronavirus cases forced the closure of schools in Mid-March to curb the further spread of the virus. Several end-of-the-year celebrations, school activities, and examinations were canceled. At the same time, the cancellations gave a chance for the youth to adapt to uncertain situations and learn adifferent perspective of life. Living in Florida, a state that battles hurricanes for almost half a year, school closures have become the norm: it is not rare for students to be reminded to keep their textbooks and notes home for a week or two. Prepared from past closures due to hurricanes, the school district board already had a virtual school platform, and the principal instructed all students to shift to Zoom and alternative eLearning. However, when the coronavirus pandemic led to the indefinite closure of high schools across the country, thiswas something new, different, and unexpected that school communities had to face.","PeriodicalId":16109,"journal":{"name":"Journal of Lumbini Medical College","volume":"8 1","pages":"147-149"},"PeriodicalIF":0.0,"publicationDate":"2020-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48200807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Preoperative prediction of the factors leading to difficulty or conversion in cholecystectomy could help plan the surgical strategies and possible outcomes beforehand. The present study aimed to predict and analyze risk factors using a scoring system deemed responsible for surgical difficulties in patients undergoing cholecystectomy for symptomatic cholelithiasis. Methods: This hospital based prospective study was conducted at Department of Surgery, Lumbini Medical College and Teaching Hospital, Nepal. Various factors considered preoperatively were gender, age, previous history of hospitalization, impacted stone, obesity, gall bladder wall thickness, pericholecystic collection, previous abdominal scar and palpable gall bladder. Results: Among 177 cases operated, the mean age ±SD of the patients was 47.72±17.54 years. Conversion rate was 7.9 %. At preoperative score of 5; sensitivity, specificity, positive predictive value and negative predictive value were 89.40% (CI: 83.36%-93.82%), 69.23% (CI: 48.21 %-85.67%), 94.41%(CI: 90.44%-96.79%) and 52.94% (CI: 39.85%-65.64%) respectively{Area under curve– 0.74, p=0.0001, CI (0.637-0.846)}. Multivariate analysis showed abdominal scar {p=0.02, OR (CI): 5.2 (1.2-21.8)}, previous hospitalization {p=0.001, OR(CI): 6.8(2.2-20.8)} and thickened gall bladder wall {p= 0.03, OR(CI): 3.6(1.1-11.5)} to be statistically significant risk factors. Conclusion: With possible prediction beforehand, high risk group of patients can be identified and dealt accordingly to generate good surgical outcome avoiding complications.
{"title":"Validation of a Preoperative Scoring System to Predict Difficult Laparoscopic Cholecystectomy: A Nepalese Perspective","authors":"S. Baral, Neeraj Thapa, R. Chhetri","doi":"10.22502/JLMC.V8I1.323","DOIUrl":"https://doi.org/10.22502/JLMC.V8I1.323","url":null,"abstract":"Introduction: Preoperative prediction of the factors leading to difficulty or conversion in cholecystectomy could help plan the surgical strategies and possible outcomes beforehand. The present study aimed to predict and analyze risk factors using a scoring system deemed responsible for surgical difficulties in patients undergoing cholecystectomy for symptomatic cholelithiasis. Methods: This hospital based prospective study was conducted at Department of Surgery, Lumbini Medical College and Teaching Hospital, Nepal. Various factors considered preoperatively were gender, age, previous history of hospitalization, impacted stone, obesity, gall bladder wall thickness, pericholecystic collection, previous abdominal scar and palpable gall bladder. Results: Among 177 cases operated, the mean age ±SD of the patients was 47.72±17.54 years. Conversion rate was 7.9 %. At preoperative score of 5; sensitivity, specificity, positive predictive value and negative predictive value were 89.40% (CI: 83.36%-93.82%), 69.23% (CI: 48.21 %-85.67%), 94.41%(CI: 90.44%-96.79%) and 52.94% (CI: 39.85%-65.64%) respectively{Area under curve– 0.74, p=0.0001, CI (0.637-0.846)}. Multivariate analysis showed abdominal scar {p=0.02, OR (CI): 5.2 (1.2-21.8)}, previous hospitalization {p=0.001, OR(CI): 6.8(2.2-20.8)} and thickened gall bladder wall {p= 0.03, OR(CI): 3.6(1.1-11.5)} to be statistically significant risk factors. Conclusion: With possible prediction beforehand, high risk group of patients can be identified and dealt accordingly to generate good surgical outcome avoiding complications.","PeriodicalId":16109,"journal":{"name":"Journal of Lumbini Medical College","volume":"8 1","pages":"3-9"},"PeriodicalIF":0.0,"publicationDate":"2020-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47485073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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