Chylous ascites following retroperitoneal lymphadenectomy in a patient with recurrent dysgerminoma of ovary: A case report

Chylous ascites is an uncommon condition of accumulation of milky fluid rich in lymph and chylomicrons in the peritoneal cavity. Post-surgical complications following dissection near the base of the mesentery, retroperitoneum, or near the cisterna chyli, malignancies (e.g., pancreatic adenocarcinomas, lymphoma, gastric carcinoma), cirrhosis, and trauma are the prime causes of chylous ascites. Here we report a rare case of chylous ascites following clearance of isolated paraaortic nodal recurrence in a 28-year-old female with dysgerminoma of ovary. The patient developed chylous ascites on the fifth day following surgery, which was confirmed by an increased drain fluid triglyceride level. She was managed conservatively with dietary modification including a high-protein and carbohydrate but low-fat-based diet mainly containing medium-chain fatty acids. Subsequently, she recovered from chylous ascites on the sixteenth day, completed second line chemotherapy, and is now doing well.

Anxiety among Pregnant Women Attending Obstetrics Unit of a Tertiary Care Centre during the COVID-19 Pandemic: A Descriptive Cross-sectional Study

Introduction

The disastrous effect of COVID-19 pandemic on the mental health of vulnerable populations like pregnant women should not be neglected. The objective of the study was to find out the prevalence of anxiety among pregnant women attending the obstetrics unit of a tertiary care centre during the COVID-19 pandemic.

Methods

A descriptive cross-sectional study was conducted from 16 May 2020 to 30 July 2020 among pregnant women attending obstetrics unit of a tertiary care centre. Ethical approval was obtained from the Institutional Review Committee (Reference number: 365/076/077-IRC). Convenience sampling method was used. Pregnancy-related anxiety questionnaires were used and semi-structured questionnaires were used for sociodemographic data. Point estimate and 95% Confidence Interval were calculated.

Results

Out of 115 pregnant women, anxiety was found in 21 (18.26%) (11.20-25.32, 95% Confidence Interval).

Conclusions

Anxiety among the pregnant women reported in this study was found to be lower than similar studies conducted in similar settings.

Keywords

anxiety; COVID-19; pregnancy.

Psychological Distress and Coping among Pregnant Women during the COVID 19 Pandemic

BACKGROUND

Mental health of pregnant individuals has been profoundly affected by the COVID-19 pandemic. Effective coping strategies are found to be associated with better psychological wellbeing during the COVID-19 pandemic. The objective of the present study is to assess psychological distress and coping among pregnant women during the COVID-19 pandemic.

METHODS

A descriptive cross sectional study was conducted from May 2020 to July 2020 among 115 pregnant women attending obstetric unit of a tertiary care centre using convenience sampling technique. Ethical approval was obtained from the Institutional Review Committee of the Institute. Covid-19 Peritraumatic Distress Index and Brief COPE inventory was used to collect the data. Data entry was done in Microsoft Office Excel 2007 and analysed in SPSS version 16.

RESULTS

Psychological distress was found in 2.6% of the participants. Psychological distress was significantly associated with occupation, fear of ANC visit, fear of visit to hospital for other health problems and fear of being alone or without help around delivery. Emotion focused coping was the most commonly used coping strategies among the pregnant women with the mean score of 21.37±3.130. Psychological distress and over all coping strategies had a positive correlation (<0.001).

CONCLUSIONS

Psychological distress was found to be low among the pregnant women in this study. Fear of being without help and fear of contacting the virus during the visit to the hospital during the Covid-19 pandemic were the likely reasons of the psychological distress in the pregnant women.

Low yield but high levels of multidrug resistance in urinary tract infections in a tertiary hospital, Nepal

SETTING

There are concerns about the occurrence of multidrug resistance (MDR) in patients with urine tract infections (UTI) in Nepal.

OBJECTIVE

To determine culture positivity, trends in MDR among Escherichia coli and Klebsiella pneumoniae infections and seasonal changes in culture-positive UTI specimens isolated from 2014 to 2018 at the B P Koirala Institute of Health Sciences, Dharan, Eastern Nepal.

DESIGN

This was a cross-sectional study using secondary laboratory data.

RESULTS

Among 116,417 urine samples tested, 19,671 (16.9%) were culture-positive, with an increasing trend in the number of samples tested and culture positivity. E. coli was the most common bacteria (54.3%), followed by K. pneumoniae (8.8%). Among E. coli and K. pneumoniae isolates, MDR was found in respectively 42.5% and 36.0%. MDR was higher in males and people aged >55 years, but showed a decreasing trend over the years. The numbers of isolates increased over the years, with a peak always observed from July to August.

CONCLUSION

Low culture positivity is worrying and requires further work into improving diagnostic protocols. Decreasing trends in MDR are a welcome sign. Information on seasonal changes that peak in July-August can help laboratories better prepare for this time with adequate buffer stocks to ensure culture and antibiotic susceptibility testing.

Analysis of Cesarean Section at a Tertiary care centre in Eastern Nepal according to Robson's Ten Group classification System (TGCS): A hospital based cross sectional study

Introduction: Cesarean sectionis on the rising trend,so WHO proposes that health care facilities uses the Robson's 10 group classification system to audit their Cesarean section rates. This classification will helpto developstrategies to reduce these rates. Objective: The objective of this study was to classify the women coming for delivery into the 10 Robson’s group,to interpret the 10 group classification and to know the highest rate of cesarean section in the group. Methodology: This was a hospital basedcross sectional study carried out in the Department of Obstetrics and Gynaecology, for a period of 6months. All women undergoing deliverywere recruited for study .Based onthe  patient’s obstetric parameters, women were assigned to one of 10 groups as per Robson’s 10-group classification system.The relative size of each group, the cesarean section rate in each group, and the absolute and relative contributions to the overall cesarean section rate was then reported. Results: During the study period, the overall Cesarean Section rate was 33.40%.Highest contribution was by Robson's Group 2(Nulliparous, single cephalic, ≥ 37 weeks, induced or CS before labor(9.84%) followed by Group 1(Nulliparous, single cephalic, ≥ 37 weeks, in spontaneous labor)(7.73%) and Group 5(Previous CS, single cephalic, ≥ 37 weeks)  (5.75%). Least contribution was by Groups 8(All multiple pregnancies (including previous CS)and 9[All abnormal lies (including previous CS)]0.20% and 0.27% respectively. All women in group 9(all abnormal lies including previous CS)had 100% Cesarean rate. Conclusions: With reductions in the primary cesarean section rates and encouragingpatients forVBACcould reduce the contribution of Robson's groups towards the absolute Cesarean Section rates.

Primary Malignant Melanoma of Uterine Cervix

Primary malignant melanoma of cervix (PMMC) is rare and aggressive cancer of uterine cervix. It presented as vaginal discharge, post coital bleding and blackish cervical growth that was biopsied and radical hysterectomy performed immediately after getting the histopathological diagnosis at stage-1B2 (FIGO staging, 2018). Post-treatment, she was recurrence free at nine months of regular follow up visit. Keywords: cervix, malignant, melanoma, primary

Mobile Phone Dependence among Undergraduate Students of a Medical College of Eastern Nepal: A Descriptive Cross-sectional Study

INTRODUCTION

Mobile phones are becoming increasingly indispensable in daily life of the students which has resulted in mobile phone dependence. The objective of the study was to find the prevalence of mobile phone dependence among undergraduate students of a medical college of Eastern Nepal.

METHODS

A descriptive cross-sectional study was conducted from October 2016 to March 2017 on a total of 390 undergraduate students aged between 17 and 25 years using stratified sampling technique. Students using mobile phones for more than one year was included in the study. Students were requested to complete a pretested self-administered questionnaire which comprised their socio-demographic characteristics, pattern of mobile phone usage and mobile phone addiction index developed by Leung.

RESULTS

The prevalence of mobile phone dependence among the undergraduate students was found to be 85 (21.8%). Mobile phone dependence was found to be related with time spend on mobile; calls per day, money spend on recharge per month and years of ownership of mobile phone. There was no difference between males and females with regard to mobile phone dependence.

CONCLUSIONS

The present study found that mobile phone dependence was common among the undergraduate medical students. These results suggest the need to develop educational programme to educate the students to use mobile phone meaningfully.

Evaluation of Lower Urinary Tract Symptoms (LUTS): Severity Score and Symptom Association

Introduction: Lower urinary tract symptoms (LUTS) is a group of symptoms relating to stages of micturation such as storage symptoms, voiding dysfunction and post micturation dysfunction. Overactive bladder symptom score (OABSS) is a questionnaires with scores which helps in evaluating the severity of symptoms. Objectives To find the incidence of women visiting with LUTS and to evaluate storage symptoms in LUTS (urgency, urge incontinence, frequency) using OABSS (overactive bladder symptom score) questionnaires. Methodology This is a prospective study done from February 2016 to February 2017. Patients visiting Department of Obstetrics and Gynaecology with lower urinary tract symptoms (LUTS) were enrolled in the study after informed consent. Patients were assessed for types of LUTS and data were filled in the performa. If patients had urgency, urge incontinence, increased day time frequency, then the patients were explained and asked overactive bladder symptom score questionnaire (OABSS) and noted. Patients were then examined for pelvic floor dysfunction and neurological abnormalities for identifying association with the symptoms. Statistical analysis was done using SPSS 11.5. Results Fifty-seven patients were enrolled with lower urinary tract symptoms (LUTS) during study period. Forty-six patients had overactive bladder symptoms (OABS). LUTS were found in age ranging from 21 to 80 years. Majority of patients visiting out-patient department with LUTS were found to have urgency, urge incontinence, increased day time frequency, nocturia. Patients with urgency and urge incontinence showed significant correlation with increasing likert score of OABSS (p<0.05). But the increased day time frequency did not show any correlation with increasing score. The score showed significant correlation with combination of symptoms (urgency, urge incontinence and increased frequency) than patients presenting with single symptom. Conclusion Diagnosis of LUTS with valid assessment tools and treatment benefits patients with chronic urinary symptoms and also helps clinicians to further re-assess the treatment.

Pattern of Mobile Phone Use among Students of An Institution

  Introduction: The charm of mobile phone is more among young generation and the increasing use can lead to various harmful effects and may result in dependence. The objective of the study is to evaluate the pattern of mobile phone use among medical students. Methods: A descriptive cross sectional study was conducted on a total of 229 medical students aged between 18 and 25 years who were using mobile phones for more than 1 year by using simple random sampling technique. Students were requested to complete a pre-tested self-administered questionnaire which comprised their socio-demographic characteristics and pattern of mobile phone usage. Results: Among the total 229 students, all of them had their own smart phones. Major purpose of using mobile was for calling, listening music, taking photos/videos and internet use. Most of the students 97 (42.4%) have owned mobile phones since 4-6 years. The median time spent by the students on the mobile phone using different features of mobile phone was 3.5 hours. Majority of the students i.e. 157 (68.5%) use mobile phones at night. The median amount of money spent on recharge per month was 500. Age of student was significantly (P <0.05) associated with calls per day. There was no significant association of pattern of mobile phone use with other selected socio-demographic variables Conclusions: Students were found to use mobile phone excessively. The pattern of mobile phone usage among the students in this study may signal the evolution of mobile phone use from a habit to an addiction.

Pattern of Mobile Phone Use among Students of an Institution

INTRODUCTION

The charm of mobile phone is more among young generation and the increasing use can lead to various harmful effects and may result in dependence. The objective of the study is to evaluate the pattern of mobile phone use among medical students.

METHODS

A descriptive cross sectional study was conducted on a total of 229 medical students aged between 18 and 25 years who were using mobile phones for more than 1 year by using simple random sampling technique. Students were requested to complete a pre-tested self-administered questionnaire which comprised their socio-demographic characteristics and pattern of mobile phone usage.

RESULTS

Among the total 229 students, all of them had their own smart phones. Major purpose of using mobile was for calling, listening music, taking photos/videos and internet use. Most of the students 97 (42.4%) have owned mobile phones since 4-6 years. The median time spent by the students on the mobile phone using different features of mobile phone was 3.5 hours. Majority of the students i.e. 157 (68.5%) use mobile phones at night. The median amount of money spent on recharge per month was 500. Age of student was significantly (P <0.05) associated with calls per day. There was no significant association of pattern of mobile phone use with other selected socio-demographic variables Conclusions: Students were found to use mobile phone excessively. The pattern of mobile phone usage among the students in this study may signal the evolution of mobile phone use from a habit to an addiction.

Loading Dose only versus Standard Dose Magnesium Sulfate Seizure Prophylaxis in Severe Pre-eclamptic Women

Introduction: Magnesium sulfate is the drug of choice for prevention of seizures in the pre-eclamptic woman. There is no agreement in the published randomized trials regarding the optimal time to initiate magnesium sulfate, the dose to use (both loading and maintenance) as well as the duration of therapy. The objective of this study is to determine whether magnesium sulfate (MgSO4) prophylaxis is needed for up to 24 hours postpartum in all patients with severe pre-eclampsia for the prevention of seizure. Methods: It is a randomized controlled trial done on 60 pregnant women with severe preeclampsia randomized into standard dose regimen and loading dose only regimen. Results: Out of 30 cases in each group 1 (3.3%) patient in standard regimen and 2 (6.7%) patients in loading dose only developed seizure. The occurrence of seizure is not significant statistically. In both regimens there was no maternal mortality. Total of 3 patients needed MICU care and 12 patient developed maternal complications. MgSO4 toxicities were seen only in standard dose regimen that is in 17 (56.7%) of the patients. The median number of IM injections of MgSO4 received in standard dose regimen was 8±2.176. In standard dose regimen 73.3 percent baby were alive whereas in case of loading dose only regimen 93.3 percent of baby were alive after 48 hours of delivery. Conclusions: Single dose of magnesium sulfate is equally effective as standard dose regimen in terms of seizure prophylaxis in severe pre eclamptic women, with added advantage of reduced maternal toxicity and better neonatal outcome. Keywords:  severe preeclampsia; MgSO4; magnesium sulfate; loading dose; eclampsia.

Loading Dose only versus Standard Dose Magnesium Sulfate Seizure Prophylaxis in Severe Pre-eclamptic Women

INTRODUCTION

Magnesium sulfate is the drug of choice for prevention of seizures in the pre-eclamptic woman. There is no agreement in the published randomized trials regarding the optimal time to initiate magnesium sulfate, the dose to use (both loading and maintenance) as well as the duration of therapy. The objective of this study is to determine whether magnesium sulfate prophylaxis is needed for up to 24 hours postpartum in all patients with severe pre-eclampsia for the prevention of seizure.

METHODS

It is a randomized controlled trial conducted on 60 pregnant women with severe preeclampsia randomized into standard dose and loading dose only regimen.

RESULTS

Out of 30 cases in each group 1 (3.3%) patient in standard regimen and 2 (6.7%) patients in loading dose only developed seizure. The occurrence of seizure is not significant statistically. In both regimens, there was no maternal mortality. Total of 3 patients needed MICU care and 12 patient developed maternal complications. MgSO4 toxicities were seen only in standard dose regimen that is in 17 (56.7%) of the patients. The median number of IM injections of MgSO4 received in standard dose regimen was 8±2.176. In standard dose regimen 73.3 percent baby were alive whereas in case of loading dose only regimen 93.3 percent of baby were alive after 48 hours of delivery.

CONCLUSIONS

Single dose of magnesium sulfate is equally effective as standard dose regimen in terms of seizure prophylaxis in severe pre eclamptic women, with added advantage of reduced maternal toxicity and better neonatal outcome.

Health problems among the street children of Dharan municipality

Background: The street children, a marginalised and vulnerable population to poor health, have grown all over the world and also in our country. The continuous exposure to harsh environment and nature of their life style threatens their mental, physical, social and spiritual well being. With the increasing number the problem is also growing at an alarming proportion. It is therefore important to have baseline data on their health problems. Objectives: This study was conducted to identify the physical health problems among the street children of Dharan Municipality, Nepal. Materials and methods: This is a cross sectional descriptive study. Forty eight subjects were included in the study. Research instruments included an interview schedule, physical health examination performa and lab investigations (i.e. blood for haemoglobin, urine routine examination/microscopic examination, stool routine examination/ microscopic examination). Results: Study results showed that 68.8% of the street children were between 11-15 years of age, 95.8% were males. Out of the total subjects 81.2% were found to be rag pickers. Research findings reveal that 100% of the subjects had at least one or more health problems. The study revealed that majority 87.5% had the habit of cigarette smoking, 50% had habit of consuming alcohol and 72.9% had the habit of taking drug. Dendrite (glue sniffing) was the only drug used by the respondents in this study. The most common health problems were head lice infestation (81.2%), headache (66.7%), cut injury (60.4%), common cold (52.1%), dental caries (52%), burning micturation (47.9%), cough (47.9%), underweight (43.8%), abdominal pain (39.6%), tinnitus (37.55%), gum bleeding (33.3%), joint pain (31.2%), eye infl ammation (25%), leg cramps (25%), palpable lymph nodes (25%), chest pain (18.8%), skin lesions (16.7%), abnormal vision (8.3%). Conclusion: Most of the diseases were due to poor health habits. It was found that the nature of work, their life styles and the different types of behaviour they adapt finally lead them to many health problems. The health problem can be prevented, if an integrated program that involves all the issues are developed and implemented. Key words: Street children; health problems; Dharan. DOI: 10.3126/kumj.v7i3.2737 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 272-279