Backgroud Acute Upper Gastrointestinal Bleeding is a common medical emergency with a hospital mortality of approximately 10 percent. Higher mortality rate is associated with rebleeding. Rockall scoring system identifies patients at higher risk of rebleed and mortality.Objective To study the clinical and endoscopic profile of acute upper gastrointestinal bleed to know the etiology, clinical presentation, severity of bleeding and outcome.Method This is a prospective, descriptive hospital based study conducted in Gastroenterology unit of College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal from January 2012 to January 2013. It included 120 patients at random presenting with manifestations of upper gastrointestinal bleed. Their clinical and endoscopic profiles were studied. Rockall scoring system was used to assess their prognosis.Result Males were predominant (75%). Age ranged from 14 to 88 years, mean being 48.76+17.19. At presentation 86 patients (71.7%) had both hematemesis and malena, 24 patients (20%) had only malena and 10 patients (8.3%) had only hematemesis. Shock was detected in 21.7%, severe anemia and high blood urea were found in 34.2% and 38.3% respectively. Upper Gastrointestinal Bleeding endoscopy revealed esophageal varices (47.5%), peptic ulcer disease (33.3%), erosive mucosal disease (11.6%), Mallory Weiss tear (4.1%) and malignancy (3.3%). Median hospital stay was 7.28+3.18 days. Comorbidities were present in 43.3%. Eighty six patients (71.7%) had Rockall score < 5 and 34 (28.3%) had >6. Five patients (4.2%) expired. Risk factors for death being massive rebleeeding, comorbidities and Rockall score >6.Conclusion Acute Upper Gastrointestinal bleeding is a medical emergency. Mortality is associated with massive bleeding, comorbidities and Rockall score >6. Urgent, appropriate hospital management definitely helps to reduce morbidity and mortality.Kathmandu University Medical Journal Vol.12(1) 2014: 21-25

Background: The knowledge of distribution and pattern of liver disease in a tertiary care center provides an overview of disease pattern in a community. It also helps in planning and prioritizing strategies to treat the diseases and reduce their burden in the community. Methods: A retrospective study was conducted among patients admitted to the Liver unit, Bir Hospital from April 13, 2008 to October 16, 2008. Demographic profile and disease pattern was studied. Descriptive analysis was used to calculate frequencies and percentage and their relations. Results: Male to female ratio was 2.3:1. The mean age was 41.9 (SD 14.8). Median hospital stay was 8.0 days (Q25-75 6.0-12.0). The top three diseases were alcoholic liver disease 50 (38.5%), viral hepatitis 44 (33.8%), and liver abscess 11 (8.5%). Fifty (38.5%) patients had acute, 74 (56.9%) had chronic liver disease and 6 (4.6%) were malignancy. The main cause of acute disease were infections 41 (82.0%) especially Hepatitis E Virus (HEV). HEV was associated with acute liver failure and pregnancy which was 4 (18.2%) and 2 (12.5%) respectively. Chronic diseases were caused by alcohol 45 (60.8%) followed by infection of hepatitis B and C viruses 11 (14.8%). Cirrhosis was diagnosed in 37 (28.5%) with alcohol as the main cause. Conclusions: Majority had chronic liver disease (CLD), mostly due to alcohol, HBV and HCV. Alcohol was the leading cause of cirrhosis. Prevalence of Hepatitis E was found to be high in acute illness. Therefore, an initiative needs to be taken to decrease alcohol consumption along with HEV, HBV and HCV transmission through community health program. Key words: Alcohol, cirrhosis, hepatitis, liver disease   DOI: 10.3126/jnhrc.v7i1.2273 Journal of Nepal Health Research Council Vol. 7, No. 1, 2009 April 14-18

Introduction: The worldwide accepted tool for screening and monitoring gastro-oesophageal varices in patients with liver cirrhosis is upper gastrointestinal endoscopy. Endoscopy needs clinical expertise and has got its own procedure related complications. Repeated endoscopies may be expensive and patients tend to develop poor compliance. This study was undertaken to establish the role of noninvasive parameters in predicting gastro-esophageal varices. Methods: Two hundred patients with clinical features, laboratory and sonological findings suggestive of cirrhosis of liver and endoscopic evidence of portal hypertension were included in the study. Blood parameters like serum albumin, international normalized ratio (INR), platelets count and ultrasonography assessments of portal vein diameter and spleen size were compared with presence of gastro-oesophageal varices. Results: At cutoff point of 2.55g/dl, serum albumin had high specificity of 99% whereas platelets count <1,44,000/mm3 had 87.9% sensitivity for presence of oesophageal varices. Sensitivities of 92.72% and 94.5% while specificities of 90% and 75% were detected for presence of oesophageal varices when the cutoff values for portal vein diameter and spleen size were 12.25 mm and 13.9 cm respectively. Conclusions: Measurements of serum albumin, platelets count, portal vein diameter and spleen size by ultrasonography can be recommended as a non-invasive predictor for gastro-oesophageal varices in cirrhosis of liver. All these non-invasive parameters could be useful to patients with liver cirrhosis with portal hypertension in predicting presence of varices as well as in long-term clinical monitoring and management. Keywords: cirrhosis of liver; endoscopy; gastro-oesophageal varices; non-invasive predictors.

Introduction: Liver cirrhosis is an important health problem worldwide and is a common disease in Nepal. The profile of cirrhosis may vary due to different factors. This study was undertaken to see the demographic and clinical profiles of patients with cirrhosis of liver attending a tertiary care hospital in Central Nepal. Methods: Six hundred patients with clinical features, laboratory and sonological findings suggestive of chronic liver dysfunction and endoscopic evidence of portal hypertension were included in the study. Their demographic and clinical profile, endoscopic findings, outcomes during hospitalization were studied. Ethical approval was taken from Institutional Review Committee of College of Medical Sciences. SPSS 20 was used for statistical analysis. Results: The mean age of subjects was 54±11.84 years with 435 males (72.5%) and 165 (27.5%) females. Majority of 203 (33.8%) patients were from Mongol ethnicity followed by 127 (21.2%) Khas. Two hundred and twenty (36.6%) were farmers followed by 169 (28.2%) retired personnel. A total of 338 (56.4 %) patients were from rural areas. The commonest aetiology of cirrhosis was chronic alcohol consumption and seen in 552 (92%) patients. Abdominal distension was commonest presenting sign and observed in 561 (93.5%) patients. Ascites seen in 555 (92.5%) patients was the commonest complication followed by UGI bleed in 326(54.3%) patients. Gastro-oesophageal varices observed in 345 (57.5%) patients, was the most common endoscopic finding followed by portal gastropathy, peptic ulcer and erosive mucosal diseases. In patient mortality was noted in 92 (15.3 %) patients. Conclusions: This study highlights the burden of cirrhosis, usually caused by chronic alcohol consumption in Central Nepal. Majority of subjects were male, middle aged, farmers, from rural areas and predominantly observed in some ethnicity like Mongols. Cirrhotic patients usually present late with varied complications and have high mortality.   Keywords: cirrhosis of liver; complications; endoscopy.

Background: With increasing trends towards sedentary life style, obesity, diabetes mellitus, hypertension, and dyslipidaemia, the prevalence of metabolic syndrome (MetS) is rising in our country. In view of importance of diagnosis of MetS in day to day medical practice for early institution of life style therapies to reduce the atherosclerotic cardiovascular disease risk in susceptible population like in diabetes mellitus, this study has been undertaken to study the prevalence of metabolic syndrome in Nepalese diabetes by applying National Cholesterol Education Programme/Adult Treatment panel (NCEP/ATP) III and International Diabetes Federation (IDF) criteria.

Background: Hepatitis B vaccine is the single most effective and safest strategy for the prevention of the disease among health care workers (HCW), trainees and medical students. There is scanty information on knowledge, attitude and practice (KAP) regarding Hepatitis B vaccination among medical students who are likely to get exposed in the future as they start practicing. This study was undertaken to understand the knowledge, attitude and practice of hepatitis B vaccination among clinical medical students of Manipal College of Medical sciences at Pokhara, Nepal.Methods: Two hundred and four medical students were enrolled for an observational, cross-sectional study at Manipal College of Medical sciences at Pokhara, Nepal after obtaining ethical clearance from Institutional Review Committee. Answers to pre-tested questionnaire were collected. Knowledge, attitude and practice regarding Hepatitis B vaccination were studied. Results: All participants demonstrated good knowledge and positive attitude towards Hepatitis B infection and vaccination. However majority had poor practice towards it. Only 47.1% were completely vaccinated. The most common reason for non vaccination was that many thought they will vaccinate in internship or when they start practicing.Conclusion: Despite good knowledge and positive attitude towards Hepatitis B infection and vaccination, low rates of vaccination and poor practice was observed among HCW indicating the necessity of encouragement for vaccination and proper practices among them. All medical students should be immunized against Hepatitis B during their medical school. Regular Hepatitis B vaccination, educational and awareness programs must be conducted in coordination and with active participation of the medical students.Keywords: Attitude; Hepatitis B; knowledge; Medical students; Practice; Vaccination

Introduction: Upper gastrointestinal bleeding is a common acute medical emergency. Endoscopyis the gold standard diagnostic and therapeutic tool in the management of upper gastrointestinalbleed. This study was undertaken to address the clinical profile, endoscopic profile, and outcomes inpatients with upper gastrointestinal bleed. Methods: A descriptive cross-sectional study was conducted in a tertiary care teaching hospital inGandaki Province, Nepal from January 2018 to December 2019 after obtaining ethical clearancefrom Institutional Review Committee (MEMG/IRC/291/GA) and informed consent fromthe patient or patient relatives. The sample size was calculated. Six hundred and sixty patientswith upper gastrointestinal bleed were included in the study. Data entry was done in StatisticalPackages for the Social Sciences version 20. Results: Peptic ulcers and ruptured oesophageal varices are the common aetiologies of uppergastrointestinal bleed. Inpatient mortality was seen in 98 (14.8 %) patients. Upper gastrointestinalbleed of variceal etiology presents with a higher Rockall score and has more chances of rebleedingand has higher mortality than those with non-variceal aetiologies. Bad prognostic factors wererebleeding, variceal etiology, and comorbidities including cirrhotic and Rockall score > 6. Conclusions: Upper gastrointestinal bleeding is a common acute medical emergency. Early uppergastrointestinal endoscopy preferably within 24 hours is recommended for diagnosis, timelyintervention, and management of the patients with an upper gastrointestinal bleed that helps inreducing morbidity and mortality.  

Introduction: Upper Gastro-intestinal endoscopy is considered the best screening tool for varices in cirrhotic patients. It is still an expensive, invasive tool, has poor compliance and not routinely available in every hospitals in Nepal. This study was undertaken to establish the role of portal vein diameter and spleen size by ultrasonography in predicting gastroesophageal varices.