Browsing by Author "Sharma, Sashi"
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Publication Nutritional Assessment of Patients with Liver Cirrhosis by Nutrition Screening Tool and Anthropometry at a Tertiary Care Center(Institute of Medicine, 2019) Sherpa, Tshering W; Pathak, Rahul; Khadga, Prem K; Sharma, Sashi; Hamal, Rabin; Jha, AnuragABSTRACT Introduction Malnutrition is one of the most common complications of liver cirrhosis. Yet, little attention is paid in evaluating nutrition in this group of patients. This study aims to assess malnutrition among cirrhotic patients using a nutrition screening tool and anthropometry. Methods This was a prospective, observational study of admitted patients with liver cirrhosis. In the study duration of 3 months, 50 patients met the inclusion criteria and were included. Nutritional assessment was performed using the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT), BMI and standard anthropometry including TSF, MUAC and MAMC. Results The mean age was 51.56 ± 11.50 with a Male to Female ratio of 3:2. Chronic alcohol consumption (72%) was the most common etiology while management of tense ascites (40%) was the most common reason for hospital admission. 58% had Child Pugh Class C cirrhosis while the remaining 42% were Class B. The average MELD Na score was 19.64 ± 6. Significant differences in anthropometric measurements including BMI, MUAC, TSF and MAMC were found between Child B and C cirrhosis. Similarly, those patients who had low, moderate and high risk of malnutrition by the RFH-NPT had significant differences in anthropometric measurements between them. Conclusion A significant number of patients had moderate to severe risk of malnutrition that correlated well with anthropometric measurements. The degree of malnutrition is parallel with the severity of liver disease among these patients. Both the RFH-NPT and anthropometry are relatively easy to perform and effective. Hence, they can be used as a practical means for identifying malnutrition among cirrhotic patients in routine clinical practice. Keywords: Anthropometry, liver cirrhosis, malnutritionPublication Prevalence of Covert Hepatic Encephalopathy in A Tertiary Care Centre(Nepal Medical Association, 2020) Pathak, Rahul; Ghimire, Pukar; Thapaliya, Sabin; Sharma, Sashi; Khadga, PremAbstract Introduction: Among patients with Hepatic Encephalopathy, prevalence of Minimal HE varies between 30-50%. Identifying patients with MHE has been shown to improve with medications and delay development of Overt HE, however only limited clinicians screen for MHE in patients due to time consuming neuropsychological and neurophysiological tests. The Number Connection Test is an easy way to evaluate patients to diagnose MHE. The aim of this study is to find out the prevalence of covert hepatic encephalopathy. Methods: The descriptive cross-sectional study was done to find out the prevalence of covert hepatic encephalopathy among patients with chronic liver disease. To diagnose Covert HE which included MHE as well, NCT was used in Devanagari script. Results: The prevalence of covert hepatic encephalopathy is found to be 56 (58.3%) at 90% confidence interval (58.23-58.37%). A total of 96 patients (71.9% male) were diagnosed as HE, with mean age of 49.6+11.8 years. The cause of CLD in 85 (88.5%) of these patients was alcohol, of which 76 (79.2%) consumed locally brewed alcohol. Of these 96 patients with HE, only 40 (41.7%) had overt HE. Among all these, maximum patients had MHE (37.5%). Conclusions: Our study showed that although the prevalence of minimal HE is quite high among cirrhotics, they are usually missed in clinical practice due to absence of symptoms. Active screening with easy-to-administer tests, like Number Connection tests, can help identify patients with minimal HE and hence treat them early. Keywords: chronic liver disease; covert hepatic encephalopathy; minimal hepatic encephalopathy; number connection test; overt hepatic encephalopathy.