Browsing by Author "Malla, B"
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Publication Clinical Practice Recurrent Severe Obscure Gastro Intestinal- Bleeding in a 20 Year Old Man(Kathmandu Unversity, 2013) Breidert, M; Mandal, A; Koller, A; Huellebrand, N; Malla, BABSTRACT Morbus Osler-Weber-Rendu syndrome also known as Hereditary hemorrhagic telangiectasia (HHT) and Meckel’s diverticulum is a rare combination disorder. Our case presented with the recurrent obscure gastrointestinal (GI) bleeding for several years. He came with a massive active lower gastrointestinal bleeding. Ultimatively, he underwent an exploratory laparotomy along with intraoperative colonoscopy. A Meckel’s diverticulum in combination with multiple erosions was found as a probable cause of the massive gastrointestinal bleeding. An ileo-caeacal resection had been performed and by the pathologist multiple telangiectasias in the resected ileum were established. Blood was sent for genetics and was negative for ENG, ALK-1, and SMAD-4 genes. The patient was discharged after 10 days from time of admission and is under regular follow up without any further bleeding. In this case, despite sophisticated techniques for investigations the cause of the GI-bleeding with several esophagogastroduodenoscopies and colonoscopies, mesenteric angiography and finally an oral double balloon enteroscopy was misdiagnosed till the intra operative endoscopy showed a middle GI-bleeding. The management for obscure GI-bleeding is discussed for countries with lower medical facilities like Nepal in our case with Morbus Osler-Weber-Rendu syndrome. KEY WORDS Meckel`s diverticulum, middle gastrointestinal bleeding, morbus osler-weber-renduPublication Community health programmes for health promotion in rural community of Nepal(Institute of Medicine, 2007) Rosyara, KP; Malla, BAbstract Introduction: Community-based health programme is one of oldest multidisciplinary programme which effect lives of individuals in the community. These programmes in community settings are implemented to promote reproductive health, to prevent unintended pregnancy and to promote access to reproductive and preventive health services and beside that these programmes have been working to provide immunization vaccine, sexual transmission infections, community health education, community sanitarily systems, awareness regarding safe drinking water. Objectives: to identify the community health programmes which has been accessed in rural and peripheral residential area of Kirtipur Municipality Machhegaun, Kathmandu. Materials and Methods: An exploratory research design was followed with the help of semistructured questionnaire and information was obtained from the pre-selected area. A household survey was done by door-to-door visit. A total of eighty females were included in the study and the respondents attitude was studied. The study was conducted during the month of May to June 2007. The questionnaire was pre tested among ten females and their responses were not included in the final analysis. Results: Thirty seven females out of the eighty respondents were taken from nuclear family and rest forty three were from joint family. Further more in demographic variables showed most of respondents were in agriculture, which covers sixty five percentages. Other twenty five percentages were engaged in other fields, such as business, service daily wages etc. Hundred percentages of the respondents were covered by vaccines and fifty percentages females used permanent family planning and only 21.25 percentages used temporary family planning tools. But 28.75 percentages women did not use family planning tools. Majority of females got their first child between the age 20 to 39 year and rest 18.75 percentages got below 20 years and 25 percentages got above 40 years. Conclusion: The respondents opinion was positive and, community health programmes were playing vital role in the community to promote health status of the people. The respondents felt that there was an unfair advantage of community health programmes lunched in the area and Government, non government health institute and private medical service providers were playing leading role to change people to healthy behavior. Keywords: Community health, health promotion, healthy behavior, community peoplePublication Do behavioral patterns of university students of Nepal make them vulnerable to HIV/AIDS?(Institute of Medicine, 2007) Joshi, DR; Khattri, DB; Rosyara, KP; Malla, BAbstract Introduction: Nepal is confronted with the increasing incidence of HIV among young adults. The University students at their age are at increased risk of the disease, determined by their behaviors Thus, Assessment of knowledge, attitude, and beliefs of them are essential prior to implementation of prevention and control strategies. Methods: This cross sectional study was carried out in 2006 among university students at Tribhuvan University, Kirtipur, Nepal. A total of 100 students participated from different departments. The questionnaire design included background characteristics, condom use, knowledge and opinion towards HIV/ AIDS, Sexual risk behavior and sexual relation, symptoms on STI and HIV/ AIDS, stigma and discrimination regarding HIV/AIDS. Results: The median age of male respondents was 26 years and that of female was 23 years. Among married respondents (16.7%), female respondents were married at younger age (F=23yrs, M=24yrs). The majority of them were unemployed (78.1%). The major sources of information regarding HIV/ AIDS were television (95.8%) and radio (91.7%). Only 13.5% of respondents (F=12%, M=15.2%) knew about voluntary counseling and testing services (VCT). The age of first sexual intercourse was 22 years; same for both men and women. Among them, 65.4 % admitted using condoms during first intercourse. Family planning centre was the major condom supply source (78.1%). Use of condoms was the most common perceived method of protection against HIV/AIDS for both male (93.5%) and female (78%). Seventy- nine percentage of respondents maintained that HIV is transmitted by sharing of food, and mother to child, and HIV+ individuals looked healthy. Conclusions: This study provides empirical evidence of stirring knowledge about HIV and sexual behavior among adults; however; needs further examination through a longitudinal study. Keywords: Sexual behaviour, human immunodeficiency virusPublication Intrauterine Condom Tamponade in Management of Post Partum Haemorrhage(Nepal Health Research Council, 2010) Pandey, S; Amatya, S; Thapa, K; Malla, BBackground: Uterine tamponade is often used to control post partum hemorrhage. Among various methods, condom Foley’s catheter  tamponade is simple, easy to use and is believed to be effective. The study evaluates outcome of condom Foley’s catheter tamponade. Results: The condom tamponade stopped bleeding in all the cases. Average amount of blood loss was 1221ml. No complications were noted. Methods: In this prespective observational study, condom tamponade was applied to fourteen cases with varying degrees of PPH, not controlled with pharmacologic measures. The efficacy on control of bleeding was assessed along with the total amount of blood loss and any complications. Conclusions: Thus, condom tamponade is an effective method to control intractable PPH.  It’s simple and does not require expertise to use, so, it can have a wide application even in resource poor settings.    Key words: condom tamponade, intrauterine, post partum haemorrhagePublication Laparoscopic Cholecystectomy and Common Bile Duct Exploration in Situs Inversus Patients(Kathmandu University, 2021) Simkhada, S; Malla, B; Shrestha, RABSTRACT Situs inversus is a congenital condition in which the major visceral organs are reversed from their normal positions, estimated to occur in 1 in 5000–20,000 births. Incidence of gallbladder stone disease is same in these patients and normal patients. Laparoscopic cholecystectomy remains the treatment modality, and performing it successfully in these patients even rarer. We report a 54 years gentleman with gall stone, and 63 years lady who had both gall stone and common bile duct stone along with situs inversus. The mirror image reversibility of the abdominal viscera was seen in both cases. Ports were placed on the opposite side as the liver and the gallbladder were on the left side. Dissection was difficult because being a right- handed surgeon, the non-dominant hand would be the working hand. However, no perioperative complications occurred. It is technically challenging and requires a proper orientation of the left upperquadrant of abdomen. KEY WORDS Common bile duct exploration, Laparoscopic cholecystectomy, Situs inversusPublication Outcomes of Laparoscopic Cholecystectomy in a Tertiary Hospital in Nepal(Kathmandu University, 2023) Shakya, YR; Manandhar, A; Laudari, U; Patel, JN; Karmacharya, RM; Sah, S; Malla, B; Shrestha, B; Maharjan, S; Dahal, AABSTRACT Background Laparoscopic Cholecystectomy (LC) is the gold-standard surgery for symptomatic cholelithiasis with low mortality and morbidity. Objective The main objective of this study is to study the outcomes of laparoscopic cholecystectomy in Dhulikhel Hospital over the period of seven years. Method The records of all the patients who underwent laparoscopic cholecystectomy in Dhulikhel Hospital from January 1, 2015, to December 31, 2021 were reviewed. Patient demographics, indication of surgery, hospital stay, and number of conversions to open cholecystectomy were collected. The percentage, mean and median were calculated for socio-demographic information and Chi-square test was performed to measure the association between socio-demographic characteristics, duration of hospital stay, and operative procedure. Result Out of 2106 patients who underwent laparoscopic cholecystectomy from January 1, 2015, to December 31, 2021, 584 (27.73%) were male, and 1522 (72.27%) were female. The female-to-male ratio was 2.6:1. The median age of the patients was 40 years (IQR=52-30). Most common indications for surgery were symptomatic cholelithiasis in 1740 (82.62%) patients along with chronic cholecystitis in 268 (12.73%) patients, and Post ERCP Cholecystectomy in 92 (4.37%) patients. Median hospital stay was three days. Out of 2106 cases, 24 cases were converted to open cholecystectomy. Conclusion Laparoscopic cholecystectomy is the gold standard treatment for benign diseases of the gallbladder and can be performed safely as day care surgery to reduce the cost, length of hospital stay, and long waiting list in low and middle-income countries. KEY WORDS Cholecystectomy, Cholecystitis, Gallstone, Laparoscopy, Post-ERCPPublication Prevalence of Intestinal Parasitosis Infection in Malnutrition among Children in Rural Community of Sarlahi, Nepal(Nepal Health Research Council, 2004) B C, R K; Malla, B; Sherchand, J B; Ghimire, P; Gauchan, PPublication Role of Ultrasound as Compared with ERCP in Patient With Obstructive Jaundice(Kathmandu University, 2013) Karki, S; Joshi, KS; Regmi, S; Gurung, RB; Malla, BABSTRACT Background The diagnosis of obstructive jaundice relies on proper history taking, clinical examination, laboratory investigations and different non invasive imaging modalities like Ultrasonography (USG), Cholangio Computed Tomography (CCT), Magnetic resonance Imaging (MRI) with Magnetic Resonance Cholangio Pancreatography (MRCP) and invasive modalities like endoscopic retrograde cholangiography (ERCP) and percutaneous trans hepatic cholangiography (PTC). Objective To compare the role of ultrasound with endoscopic retrograde cholangiography and to determine the major causes of obstructive jaundice in our prospect. Methods This was a prospective, analytical study conducted on 88 patients presenting to Department of Radiodiagnosis and Imaging at Dhulikhel Hospital-Kathmandu University hospital from March 2011 to August 2012 with clinical diagnosis of obstructive jaundice. Sonographic evaluation was performed in Siemens acusion x-150 and x-300. The final diagnosis was made by endoscopic retrograde cholangiography and /or surgery and confirmed histopathologically. Results The most common benign causes of obstructive jaundice were choledocholithiasis (63%), CBD stricture (12.3%), cholangitis (8%) and pancreatitis (6.85%) whereas cholangio carcinoma (6.85%) and carcinoma head of pancreas (4%) comprised of the malignant causes . Ultrasonography had sensitivity of 100% and specificity of 89% in detecting choledocholithiasis. It was found to be 98.78% sensitive and 83.33% specific in cholangiocarcinoma. Similarly in pancreatitis, the sensitivity of ultrasonography was 97.59% and sensitivity was 66.67%. Conclusion Ultrasonography acts as a valuable diagnostic imaging modality in detecting the causes of obstructive jaundice. Due to its easy availability, non invasive nature and cost effectiveness, it can be considered as the first line imaging technique/ tool. ERCP is the invasive imaging tool and can be used for both diagnostic and therapeutic purpose. KEY WORDS ERCP, obstructive jaundice, ultrasonographyPublication Safety Profile and Patient Satisfaction of the Routine use of Propofol in Gastrointestinal Endoscopy(Kathmandu University, 2014) Gurung, RB; Purbe, B; Malla, B; Dhungel, A; Yogol, S; Poudel, A; Kunwor, K; Byanju, SABSTRACT Backgroud Routine use of sedation in upper gastrointestinal endoscopy is uncommon in Nepal. There is no study on use of propofol sedation in routine endoscopy examination in Nepal. This study was conducted in order to assess the patient satisfaction and safety profile in patient undergoing routine upper GI endoscopic examination on outpatients. Objective To study safety profile and patient satisfaction of use of propofol in patients undergoing upper GI endoscopy. Method A prospective, observational study was conducted in the endoscopy unit of Dhulikhel hospital, Kathmandu University Hospital from July 2011 to 2012 July. Patients who were referred to upper GI endoscopy were offered to sedation under propofol. Informed consent was taken after explaining side effects, advantages and risk-benefit to the clients. The propofol was administered by the endoscopy nurse under guidance and supervision of the endoscopy performing physician. Data were collected and analyzed using SPSS version 16.0 with 0.05 level of significance. Result Total of 203 patients included in the study. Among 203 patients, 21. 2% were males and 78.8% were females; 83.7% were of less than of 60 years age and 16.3% above 60 years of age. The mean total dose of propofol required was 136.08 ± 48.82 mg. Total of 29.1 % of cases required O2 administration during the procedure time due to transient drop in O2 saturation. Total of 4.4% of cases required fluid administration due to transient fall in blood pressure. Total of 68.0% of cases were completely sedated; 28.6% had minor restless and 3.4% showed agitation during induction period of propofol sedation. Total of 99.5% of patients reported pleasant experience while 0.5% reported unpleasant. Among 203 respondents, 98.5% responded they would prefer to do the procedure under propofol sedation in the future; 1.5% responded they did not want sedations in the future. Conclusion Upper GI endoscopy can safely be performed under propofol sedation administered by registered trained nurse under the supervision of endoscopist. KEY WORD Endoscopy, patient safety, patient satisfaction, propofol sedation