Browsing by Author "Gnawali, Arun"
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Publication Clinical Spectrum and Demographic Profile of Alcoholic Liver Disease Among Females Attending Tertiary Care Center in Nepal(Institute of Medicine, 2021) Koirala, Dinesh; Anees, Shahbaaz; Pathak, Rahul; Bhandari, Brindeswari Kafle; Jha, Anurag; Hamal, Rabin; Gnawali, Arun; Bhusal, MohanABSTRACT Introduction: Alcohol is the most common abused substance in Nepal. Women tend to present with more severe liver disease with a shorter period of excessive drinking and at a lower daily alcohol intake compared to men. Methods: Adult female patients aged 16 years and above, with a diagnosis of ALD were included for a period of 1 year. Liver disease secondary to other causes were excluded. Demographic profiles, clinical features, laboratory, endoscopic findings, Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD) of the patients were recorded. Results: A total of 144 female patients with ALD were included in the study. The mean age of the patients was 48.6 years (SD=12.7). Majority of the patients were from Hilly region (n=66, 45.8%), married (n=135, 93.8%), housewife (n=83; 57.6%), Hindu by religion (n=93; 64.6%), and Tamang (n =39; 27.1%) by caste. Most common clinical features of the patients were abdominal distension (n=117; 81.2%), bilateral lower limb swelling (n=89; 61.8%), jaundice (n=54; 37.5 %) and anorexia (n=53; 36.8%). The main reason for alcohol consumption was found to be family custom in 42.3%. Esophageal varix was present in 119 (82.6%) patients. Out of 124 patients with cirrhosis, 63 (50.8%) patients were in CTP stage C and 103 (83.1%) patients had MELD score ≥ 16. Conclusion: ALD was predominantly seen among the younger female patients. The most common clinical presentations were abdominal distension, bilateral lower limb swelling, jaundice and anorexia. Among the cirrhotic patients, most of patients were in CTP class C and had MELD score ≥ 16. Keywords: Alcoholic liver disease, clinical profile, demographic profile, femalePublication Comparison of Acute Physiology and Chronic Health Evaluation II, Bedside Index for Severity in Acute Pancreatitis and Modified Computed Tomography Severity Index Scores in Predicting the Outcome in Acute Pancreatitis in a Tertiary Care Centre in Nepal(Nepal Health Research Council, 2023) Pandey, Rajesh; Pathak, Rahul; Jha, Anurag; Gnawali, Arun; Koirala, DineshAbstract Background: It is important to identify the severity of acute pancreatitis in the early course of the disease. Methods: This prospective observational study included 83 patients with acute pancreatitis. The Acute Physiology and Chronic Health Evaluation II and the Bedside Index for Severity in Acute Pancreatitis scores were assessed within 24?hours of admission, and the modified computed tomography severity index score was calculated in those patients who underwent contrast enhanced computed tomography. The sensitivity, specificity, positive predictive value, and negative predictive value of scoring systems were calculated. The area under the curve was calculated for assessing the prognostic value of scoring systems. Results: The modified computed tomography severity index was the most accurate score in predicting severity and local complications with an area under the curve of 0.92 and 0.91, respectively. The Bedside Index for Severity in Acute Pancreatitis score was the most accurate in predicting organ failure and the need for intensive care unit admission with an area under the curve of 0.70 and 0.78 respectively. Conclusions: The results of this study demonstrate that modified computed tomography severity index and Bedside Index for Severity in Acute Pancreatitis scores had overall better predictive value than the Acute Physiology and Chronic Health Evaluation II score in predicting severity, organ failure, local complication, and need for intensive care unit admission. Keywords: Acute pancreatitis; APACHE II; BISAP; modified CTSIPublication Hepatocellular Carcinoma among Patients with Chronic Liver Disease in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2024) Gnawali, Arun; Pathak, Rahul; Koirala, Dinesh; Pandey, Rajesh; Hamal, Rabin; Jha, Anurag; Bhandari, Brindeswari Kafle; Gyawali, SiddinathAbstract Introduction: Hepatocellular carcinoma is the most common primary liver cancer. Viral hepatitis, alcohol abuse, and autoimmune hepatitis are the common causes of hepatocellular carcinoma. Usually patients present at advanced stages where curative treatment is no longer possible. This study aimed to find the prevalence of hepatocellular carcinoma among patients with chronic liver disease in a tertiary care centre. Methods: This is a descriptive cross-sectional study conducted in a single tertiary care centre from March 2020 to August 2022. The study was done among inpatients of the Department of Gastroenterology after ethical approval from the Institutional Review Committee. A total population sampling method was used and data were collected using predetermined proformas. Point estimate at 95% Confidence Interval was calculated. Results: Among 1440 patients, hepatocellular carcinoma was seen in 54 (3.75%) (2.77-4.73, 95% Confidence Interval). At the time of diagnosis, 48 (88.89%) were symptomatic. The presenting symptoms were weight loss seen in 35 (64.81%) being the most common. Out of them, 37 (68.52%) consumed alcohol and 40 (74.07%) smoked cigarettes. Conclusions: Hepatocellular carcinoma is a notable concern. Alcohol-related liver cirrhosis is the most frequent condition encountered in patients with hepatocellular carcinoma in our setting.