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Background: Most of the bleeding in the lower gastrointestinal tract are usually located in the rectum, colon and terminal ileum. Colonoscopy is an invasive procedure used for both diagnostic and therapeutic purposes for detection of lower gastrointestinal (GI) tract pathologies and haemorrhage. Aims and Objective: The purpose of the study was to understand the clinical profile and colonoscopic findings in patients with lower gastrointestinal haemorrhage. Materials and Methods: Seventy-two patients presenting with lower GI haemorrhage were included in the study. All patients underwent colonoscopy after achieving hemodynamic stability and bowel preparation. Clinical profile and colonoscopic findings were studied. Results: The common aetiologies of lower GI haemorrhage were haemorrhoids followed by nonspecific colitis, colorectal polyp and carcinoma of colon. Rectum followed by sigmoid harbored majority of pathologies that presented with lower GI haemorrhage. Conclusions: The diagnosis of the pathological lesion and management of underlying cause not only prevents another episode of lower GI haemorrhage but also help in reducing morbidity and mortality. Colonoscopy or at least sigmoidoscopy is strongly recommended for evaluation, diagnosis and management of lower GI haemorrhage.

Background: Colonoscopy is an invasive procedure used for both diagnostic and therapeutic purpose for detection and management of the diseases of rectum, colon, and terminal ileum. This study was undertaken to assess the clinical profile and endoscopic findings in patients undergoing colonoscopy.    Methods: One hundred and sixty patients underwent colonoscopy from January 2018 till  December 2019.  Clinical profile, endoscopy and histological findings were studied from the hospital departmental records. Results: The commonest indications for performing colonoscopy were chronic diarrhea, altered bowel habits, chronic abdominal pain and bleeding per rectum. Colitis of unspecified etiology followed by ulcerative colitis and polyps were the common colonoscopy findings. Colorectal carcinoma were not uncommon. Conclusions: Colonoscopy is the gold standard modality for diagnosis of pathologies of lower gastro intestinal tract and should be an integral part of management. Screening colonoscopy is strongly recommended. Keywords: colitis; colonoscopy; colorectal disease  

Introduction: Green snakes found in hilly areas of Nepal cause significant morbidity in form of local swelling and bleeding manifestations. Polyvalent antivenoms are not indicated for the treatment. Specific management protocols are not endorsed for its bite. Conventionally, vitamin K and fresh frozen plasma are used to correct deranged coagulation in green snake bite.Objectives: The objective of this study was to evaluate the effectiveness of addition of tranexamic acid to the conventional method in green snake bite in western region of Nepal.Methodology: A hospital based, prospective comparative cross-sectional study was conducted at Department Medicine Manipal Teaching Hospital, Pokhara, Nepal from April 2014 to October 2017. It included 110 patients aged 15 to 76 years of both genders with confirmed history of green snake bite. Participants were alternately randomized into two groups; conventional group, tranexamic acid group. Duration of hospital stay was considered the primary outcome measure for this study while INR levels were considered the secondary outcome measure. Data were collected in a preformed pro forma and analyzed using SPSS version 16.0. Differences were considered significant if p-value is < 0.05.Results: The age (mean: 35.41; SD=17.23) of the study population ranged from 15 -76 years. The median duration of hospital stay in conventional group was 8 days (Inter Quartile Range = 7 to 8) and in tranexamic acid group was 6 days (Inter Quartile Range: 5 to 6). Mean INR was statistically significantly different at day 5 and day 6 in favor of tranexamic acid group (p<0.001)Conclusion: Treatment with tranexamic acid reduced the median duration of hospital stay by two days. Statistically significant differences in mean International Normalized Ratio levels were seen at day 5 and 6 of hospitalization (p<0.001). BJHS 2018;3(1)5 : 346-349

Background: Nonalcoholic fatty liver disease (NAFLD) is the leading cause of diffuse liver disease with a global prevalence of 25.24% and progresses to fibrosis and nonalcoholic steatohepatitis (NASH). Diagnosing NAFLD requires demonstration of increased liver fat and ultrasound imaging is widely used for screening. Specific blood tests to diagnose NAFLD and NASH are not yet available and alanine transaminase (ALT) has been used as a marker in population based studies. Aims and Objective: This study was aimed to compare the liver enzymes and sonological grading in NAFLD. Materials and Methods: A prospective hospital based observational study was carried out in 85 patients presenting to medical outpatient department (OPD) with ultrasonogical evidence of nonalcoholic fatty liver (NAFL) from January 2016 to December 2016. The patients were sent for liver enzymes and serum ALT,aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT) were particularly correlated with the grade of NAFL.Data were collected on a preformed proformaand analyzed using the Statistical Package for the Social Sciences (SPSS)20.0 (SPSS Inc., Chicago, IL, USA). Results: In our study, mean age of the patients was 46.08 years and most of the patients were in age group of 40-60 years. Females (65.88%) were more affected than males (34.12%). There were 71 (83.5%) patients with grade 1 NAFL and 14 (16.5%) patients with grade 2 NAFL. The level of serum ALT increased with higher grades of NAFL. The mean ALT in grade 1 NAFL was 29.14±19.41 and in grade 2 NAFL was 42.19±2157; p= 0.027. Comparison of serum AST and GGT with ultrasonological grading did not show statistical difference. Conclusion: Serum ALT levels correlated with the ultrasonological grades of NAFLD (p = 0.027) whereas AST and ALT did not show statistical correlation with grades of fatty liver. Our study suggests for large sample size study for AST and GGT values relationship with ultrasonological grades.

Background and aims: Ulcerative Colitis (UC) is an inflammator condition confined to the colon. Ulcerative colitis commonly presents with rectal bleeding, bloody diarrhea and abdominal pain. This research was undertaken to study the clinical profile and colonoscopic findings of the patient presenting with ulcerative colitis in a tertiary care center at Gandaki Province, Nepal . Methods: A hospital based prospective observational study was conducted from November 2017 till June 2020 in department of Medicine at Manipal teaching Hospital, Pokhara, Nepal after obtaining ethical approval from Institutional Research Committee and informed consent from patients or their relatives. Clinical profile and colonoscopic findings of patients with Ulcerative colitis were studied. Results: Results: Out of 274 colonoscopies, 60 patients (M:F= 3: 2) were diagnosed with UC. The mean age of subjects was 37}3.56 years. Chronic diarrhea and bloody diarrhea were the common presenting symptoms. Only proctitis (E1) was seen in 40 %, left sided colitis in 35% and pan colitis (E3) was observed in 25%. Rectal involvement and erythema was observed in all. Loss of vascularity (96.7%), erosions (93.3%), increased granularity (85%), followed by ulcers (73.3%) and spontaneous bleed on touch (50%) were the common findings in colonoscopy. Conclusion: Lower GI bleed is a common presenting manifestation in ulcerative colitis. Proctitis followed by left sided colitis was the common sites of involvement. Majority presented with disease of moderate severity. Most common features in UC patients were universal involvement of the rectum alongside erythema and erosions, loss of vascularity, increased granularity, followed by ulcers and spontaneous bleed on colonoscopy.

IntroductionUpper Gastrointestinal endoscopy is considered the best screening tool in detecting gastroesophagealvarices in patients with cirrhosis. Ultrasonography of the abdomen can be used forassessment of liver and portal system. This research was undertaken to demonstrate that theportal vein diameter and splenic size by ultrasonography can be used as a non-invasive predictorof gastro-esophageal varices. MethodsA cross-sectional hospital based study comprising of 290 consecutive patients with liver cirrhosiswere enrolled between November 2019 to November 2020. Clinical profile at admission andsonological splenic size and portal vein diameter were studied in all cirrhotic patients. Patientswere classified into 2 groups: one with presence of varices and second without varices. Data entrywas done in Statistical Packages for the Social Sciences version 20. ResultsThe mean age of subjects was 52±13.26 years with a range of 27 – 82 years of age (M:F=2:1). Thecommonest etiology of cirrhosis was chronic alcohol consumption. The prevalence of varices incirrhotics was 42.8%. Average portal vein diameter of patients without gastro-esophageal variceswas 11.12 ± 1.36 mm, while it was 12.81 ± 1.62 mm in patients with varices (p < 0.001). Averagespleen size in cirrhotics without varices was 12.44 ± 1.32 cm and with varices was 14.32 ± 2.42 cm.This difference was also statistically significant (p < 0.001). ConclusionsMeasurement of portal vein diameter and spleen size by ultrasonography can be recommendedas a non invasive predictor for gastro-oesophageal varices in patients with liver cirrhosis . Keywords: cirrhosis; portal vein diameter; spleen size; ultrasonography; gastro-oesophageal varices

Background: Globally prevalence of metabolic syndrome ranges from 10 to 84%, depending upon sex, age, race, and ethnicity, region and the definition used. There is limited literature in the prevalence of metabolic syndrome in Nepal. One nationwide survey study reported prevalence of metabolic syndrome is 15% and 16% according to ATP III and IDF criteria respectively. Aims and Objectives: The aims and objective of our study is to study the prevalence of metabolic syndrome and its components in tertiary care center. Material and Methods: This was a descriptive cross-sectional study. We used convenient method of sampling and data collection was done in between May 2019 to July 2019. Bivariate and multivariate logistic regression analysis was done for association of metabolic syndrome with different variables. Results: The total of 362 participants was included in the study. Among them 54.4% were 53 years and above and 45.6% were below 53 years of age. Among all participants 25% were diabetic and 55% were hypertensive. Among all participants metabolic syndrome was found in 45.3%. All components of metabolic syndrome were found to be significantly associated with metabolic syndrome both in bivariate and multiple regression analysis. Conclusion: The metabolic syndrome is very prevalent in our population. These findings prompt the concerned authorities to formulate strategies to prevent the risk factors.