Liver Cirrhosis among Young Adults Admitted to the Department of Gastroenterology in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Cirrhosis in young adults is an important health problem worldwide and is a common disease. Patients usually present late in a decompensated state with varied complications. However, national data on the exact burden of the disease is lacking. The aim of this study was to find out the prevalence of liver cirrhosis among young adults admitted to the Department of Gastroenterology in a tertiary care centre. Methods: A descriptive cross-sectional study was done among patients admitted to the Department of Gastroenterology in a tertiary care centre between 25 November 2021 to 30 November 2022 after receiving ethical approval from the Institutional Review Committee [Reference number: 227(6-11)E2-078/079]. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 989 patients, liver cirrhosis in young adults was seen in 200 (20.22%) (18.12-22.32, 95% Confidence Interval). Chronic alcohol use was the primary cause of cirrhosis seen in 164 (82%) cases. The most typical presenting symptom was abdominal distension seen in 187 (93.50%) patients. The most frequent complication was ascites seen in 184 (92%) patients. The most frequent endoscopic finding was gastro-oesophagal varices seen in 180 (90%) patients. There were 145 (72.50%) men and 55 (27.50%) women. Conclusions: The prevalence of liver cirrhosis in young adults was found to be lower than the other studies done in similar settings. Keywords: ascites; liver cirrhosis; prevalence.

Detection of Colonic Polyps During Colonoscopy in a Tertiary Care Center of Nepal.

BACKGROUND: Colorectal cancer is the third leading cause of cancer death in the world. Most colon cancer develop from the polyps. Data on the prevalence of colorectal polyps in Nepal is lacking. The objective was to determine the prevalence of colorectal polyps, site of occurrence and adenomas among various age groups. All polyps after removal by polypectomy was sent for histopathological examination. METHODS: Study was done in 1027 consecutive patients who underwent colonoscopy in the pre-specified time after excluding patients with colorectal cancer, Inflammatory Bowel Disease and polyposis syndromes. RESULTS: Among 1027 patients, the mean age was 45 years. 292 (28.43%) were below 40 years, whereas, 735 (71.57%) were above 40 years. Polyps were detected in 12.95% of overall patients and in 9.73% of patients over age 40. The most common location of polyps was rectum (46.62%). 43.61% were adenomatous polyps, 11.28% were hyperplastic polyps, 18.05% were juvenile polyps, 22.56% were inflammatory polyps and 1.50% were malignant adenocarcinoma. Polyp detection rate was 12.95%, whereas adenoma detection rate was 5.84%. 46.55% had advanced adenomas. A positive correlation between the size of polyp and adenomatous variety was found [Chi-square value ?2 = 8.42 (>3.841), p value <0.05]. Prevalence of adenomatous polyps was significantly higher above the age of 40 [Chi-square value ?2 = 11.53 (>3.841), p value<0.05].  Conclusions: The prevalence of polyp increases with age. With increasing age and size of polyp, the prevalence of adenomatous polyp increases significantly. One out of every eight people over 40 years had a colonic polyp.

The Assessment of Health-Related Quality of Life in Patients With Chronic Liver Disease: A Single-Center Study.

Aim The aim of this study was to investigate the factors affecting health-related quality of life (HRQOL) in Nepalese patients with chronic liver disease (CLD). Methods In this study, HRQOL was measured with validated Nepali versions of the short-form 36 (SF-36) survey. Socioeconomic factors, etiology, laboratory parameters, disease severity, and self-rated health perceptions on HRQOL were recorded for analysis. Results Sixty CLD patients were enrolled in the study. The following HRQOL scores were obtained: physical functioning (PF) (34.4 ±26.7), role limitation due to physical health (RLPH) (7.5 ±17.8), role limitation due to emotional problems (RLEP) (27.7 ±38.2), energy or fatigue (E/F) (38.5 ±21.5), emotional well-being (EWB) (57.7 ±22.8), social functioning (SF) (55.2 ±23.5), pain (44.8 ±30.3), and general health (GH) (38.2 ±17). Employed status and higher annual family income had a positive impact on HRQOL. Ascites and abnormal upper gastrointestinal endoscopic findings were associated with poor health status perceptions. More severe disease (higher Child-Pugh class) was associated with lower HRQOL scores. A significant negative correlation between the model for end-stage liver disease (MELD) score and HRQOL domains was observed (p: <0.05). Age, gender, religion, education, and duration of the diagnosis of CLD had no effect on HRQOL of CLD patients. Conclusion HRQOL in patients with CLD was lower than that in the general population. Unemployed status, low annual family income, ascites, abnormal upper gastrointestinal endoscopic findings, and higher Child-Pugh class and MELD scores were important factors that adversely affected HRQOL.

Assessment of Validity of SF 36 Questionnaire Using Nepali Language to Determine Health-related Quality of Life in Patients with Chronic Liver Disease: A Pilot Study.

OBJECTIVES: The main objective of this study was to translate and validate the short form 36 (SF-36) health survey questionnaire into the Nepali language using a standard protocol to determine health-related quality of life (HRQoL) in patients with chronic liver disease (CLD). METHODS: We conducted a cross-sectional study among 40 patients with CLD. A formal translation of SF-36 from English into the Nepali language was performed. Patients with CLD without other known co-morbidities were administered the Nepali version of SF-36. Cronbach's alpha and test-retest were performed for reliability analysis. RESULTS: Cronbach's alpha of overall SF-36 score was 0.85, and the test-retest correlation coefficient was 0.78 (p <0.05). CONCLUSION: The Nepali language version of SF-36 is valid and reliable.