Browsing by Author "Malla, K"
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Publication Anthropometric Measurements in Different Ethnic groups of Nepalese New Borns(Nepal Paediatric Society (JNPS), 2012) Malla, K; Mall, T; Rao, S; Gauchan, S; Basnet, S; Koirala, DPAbstract: Introduction: There is a wide variation in normal birth weight, length and head circumference of newborns. The standards formulated by Western workers may not be very reliable to this part of world because of wide variations in normal range of length, weight and head circumference in different ethnic groups. This study aims to determine the anthropometric values – birth weight, length and head circumference in Term and Preterm newborns of different ethnic groups in this region of the country and to see if this can be used as a standard for taking the anthropometric measurements. Materials and Methods: A prospective study of 600 newborns born in Manipal Teaching Hospital, Pokhara from July 2009–June 2010. A detailed anthropometric measurement (weight, length, and head circumference) of all newborns was taken on 3rd day of life. Results: Six major Ethnic groups were noted Brahmin, Gurung, Dalit, Chettri, Magar and Newar. There were 54 % males and 46% females among which 18.16% were preterms, 20.66% small for gestation age, 81.50% term and 0.33% posterm. The mean weight, length and head circumference of term babies were 2.817±0.61 gms, 47.68±2.48 cm, 33.56±2.02 cm and for preterm babies it was 2.215± 0.41 gms, 46.36±2.39 cm, 32.23±2.03 cm respectively. There were 25% low birth weight (n=151, highest number in Brahmins-27%), 74.16% normal weight (n=445) and 0.66% over weight (n=4, all were gurungs) babies. In Term newborns weight, length and head circumference was noted to be highest in Gurungs (3.3004gms, 49.35cm, 34.72cm) and was statistically significant (p<0.000). Weight and length of Brahmins was lowest (2.578 gms, 45.49cm) and head circumference was lowest in Dalits (30.88cm, statistically significant<0.000). In case of preterms highest weight and length was seen in Magars (2.387gms, 47.90cm) but head circumference was highest in Gurungs (34.18cm) whereas weight was lowest in chettri (2.1609gms), length in Brahmin (44.61cm) and OFC in Dalits (29.92cm). These parameters were directly proportion with gestation age and was statistically significant (p<0.000). Conclusion: The present study highlights the mean weight, length and head circumference of term and preterm newborns in different ethnic groups and gestation age. These parameters were directly proportion to gestation age but were variable in different Ethnic groups. Therefore a study in larger population could give us a different standard for anthropometric measurements in Nepalese newborns.Publication Infant Feeding Practices in Kaski District, Pokhara(Nepal Paediatric Society (JNPS), 2012) Basnet, S; Gauchan, E; Malla, K; Malla, T; Koirala, DP; Shah, R; Sedha, Y SedhaAbstract: Background: Children in developing countries are prone to infectious diseases due to insufficient and inappropriate feeding practices. Socio-demographic and socio-economic factors directly and indirectly play a role in influencing infant feeding practices. This study was conducted to assess the socio-demographic and economic factors associated with initiation of breastfeeding, complimentary feeding, and the various prelacteal feeds practiced in Kaski, Pokhara. Materials and Methods: In this prospective study, interviews were conducted to 500 mothers at Manipal Teaching Hospital who brought their child for treatment. The interviews were conducted in a questionnaire format relating to their demographic and financial statuses. Results: A total of 500 mothers were questioned, out of which 86.6% gave their child breastmilk as its first food. 47% initiated breastfeeding within half an hour of child’s birth. 86% gave Jaulo as the first complementary food to their children. About 26% of the mothers gave complementary feeding to their children before the recommended time of 6 months. Conclusion: Initiation of breastfeeding after life and complementary feeding practices overall has improved from previous studies. There is still need of making awareness campaigns and such in order to further improve this trend.Publication Myelofibrosis in a Child with Tuberculosis: A Case Report(Nepal Paediatric Society (JNPS), 2007) Malla, K; Malla, T; Thaplial, AAbstract: Myelofibrosis (MF), or fibrosis of the bone marrow, is an uncommon condition in children. Fewer than 100 cases have been described in the medical literature. Most cases in children arise secondary to other disease processes. We present a case of Myelofibrosis in a 12-year-old girl. The purpose of reporting this case is that this child had a diagnostic dilemma and was sent home with poor prognosis but with proper diagnosis and treatment she improved and may have a complete cure, as the myelofibrosis was secondary to tuberculosis.Publication Prognostic indicators in Haemolytic Uraemic Syndrome(Kathmandu University, 2004) Malla, K; Malla, T; Hanif, MdObjective: This study aims to review the clinical presentations of Haemolytic Uraemic Syndrome (HUS) and to compare the poor prognostic indicators with mortality. Methods and Materials: Prospective study carried out in Renal Dialysis ward of Dhaka Shishu Hospital, Bangladesh from September 2001- November 2003 for a period of 26 months. All children admitted to renal dialysis ward with oliguria or anuria with pallor was included in this study. HUS was confirmed after laboratory investigations showing features of hemolytic anaemia, thrombocytopenia and renal insufficiency. Various clinical presentations were reviewed. Then bad prognostic factors were compared with mortality. Results: There were total 25 cases of HUS in 26 months.17 (68%) were males and 8(32%) females.21 (84%) children were <5 years. Only 4(16%) were >5 years. Before onset of HUS 40% children had bloody diarrhoea, 36% had acute watery diarrhoea and 24% had others symptoms. The other presentations noted were fever 88%, respiratory distress and convulsion 52% and oliguria 40%, anuria 60%, reluctant to feed 40% and cough 28%. The main physical findings noted were irritability 40%, pallor 100%, dehydration 28%, puffy face with oedema 32%, high blood pressure 16%, hepatomegaly 28%, jaundice, sclerema and petechial rashes 8%, lethargic 16%, acidotic breathing 48% and rectal prolapse 12%. 44% children died after HUS and 56% recovered from the illness. Mortality was 66% when duration of illness before onset of HUS was >14 days. With duration of anuria <3 days there was no mortality but it was 91% and 100% with anuria >3-8days and >8 days respectively. Mortality was 78% when age was<18months and it was 75% when age was >5years.Diarrhoea associated HUS had 27% and non diarrhoea associated HUS had 85% mortality. Mortality was 77% and 100% respectively when HUS was associated with convulsion and hypertension. WBC >30,000 had mortality 100% and decreased platelet count <30,000 had mortality 80%. With creatinine level >700μmol/L mortality was 80% and with Serum potassium level 5.6- 7.5mmol/L mortality was 67%.Conclusion: HUS comprised of varieties of presentations. Diarrhoea was the commonest preceding illness before onset of HUS. The bad prognostic indicators carrying high mortality was duration of illness before onset of HUS >14 days, anuria >3days, age < 18 months and >5 years, Non diarrhoea associated HUS, HUS associated with convulsion and hypertension, WBC >30,000/cumm, platelets <30,000/cumm, creatinine level >700μmol/L and serum potassium level 5.6-7.5mmol/L. Since bad prognostic factors may progress rapidly to mortality, consultation with paediatrician and transfer to a tertiary care centre should be done when HUS is diagnosed so that it can be managed appropriately in time. Key words: Haemolytic Uraemic Syndrome-clinical presentation-mortality.Publication Recurrent pneumonia-H type Tracheoesophageal fistula, diagnostic dilemma(Nepal Paediatric Society (JNPS), 2014) Adhikari, S; Malla, K; Poudyal, PAbstract: Tracheoesophageal fistula (TEF) without associated esophageal atresia (EA) is a rare congenital anomaly. Most of the children are treated for episodes of pneumonia prior to definitive diagnosis. A 5 months infant presented with recurrent pneumonia and diagnosis of H type TEF was made with contrast esophagram.Publication Single visit approach for Cervical Cancer Prevention in a mobile screening clinic(Institute of Medicine, 2016) Singh, M; Shrestha, S B; Manandhar, A; Ranjit, R; Pradhan, R; Shah, A; Verma, S; Malla, KAbstract Introduction: Cervical cancer is the third most common cancer in women worldwide, but the most preventable cancer. The objectives was to determine the feasibility and acceptability of immediately treating VIA positive women with thermocoagulation in a single-visit approach (SVA) in preventing cervical cancer. Method: This was a community-based programme organized in collaboration with Nepal Australian Cervical Cancer Foundation and Thermocoagulation unit donated by Tropical Health and Education Trust in a mobile screening camp set up in five different underserved areas in Gorkha, Nepal. Total women were 1071 aged 30-60 yearrs in 5 days in December, 2016, had come for cervical cancer screening. Women who were VIA positive had thermocoaculation for treatment. Results: Total screened women were 1071, the rate of VIA positive was 115(10.7%). 100% percent of positive result accepted treatment. All VIA positive patients except for one woman who was suspected of having invasive cervical cancer had treatment with thermocoagulation. Of all treated women only 5(4.38%) had minor side effect. Conclusion: For cervical cancer screening, the single-visit program was feasible and the degree of acceptability was 100% in this underserved population. Single visit programs provide an opportunity to increase the rate of immediate treatment of lesions with minimal side effect compared with delayed treatment after obtaining colposcopy guided biopsy report in later visit. Keywords: cervical cancer, mobile screening, VIA, SVA, thermocoagulation