Clinical Profile and Upper Gastrointestinal Endoscopy Findings of Patients Presenting with Liver Cirrhosis with Portal Hypertension

ABSTRACT Introduction: Liver cirrhosis of is a common problem faced by physicians in worldwide and is also responsible for 11th most common cause of death globally. Data regarding prevalence of esophageal varices and other upper gastrointestinal changed in patients with liver cirrhosis is scare in Nepal. So this study was done to find out clinical profile and upper gastrointestinal endoscopy findings of patients presenting with liver cirrhosis with portal hypertension. Methods: This was a cross-sectional observational hospital based study conducted in the department of internal medicine and endoscopy unit of the Universal College of Medical Sciences, Bhairahawa, Nepal. The study was done from 21 February 2019 to 20 November 2019 in the patients presented with liver cirrhosis with portal hypertension. The upper gastrointestinal endoscopy was done in all cases. The data was collected using the predesigned pro-forma. Results: Total 89 patients with liver cirrhosis were enrolled with mean age of 51.84±12.26 years and male : female ratio of 3.68 : 1. As per Child Pugh classification (CTP) 45 patients (51%) were in Class C, 33 patients (37%) were in Class B and 11 patients (12%) were in Class A. Esophageal Varies were present in 51 (57.3%) patients. According to Westaby classification grade I esophageal varices were seen in 17 (19,1%), grade II esophageal varices were seen in 26 (29.2%), grade III esophageal varices were in 8 (8.9%) patients. Portal hypertensive gastropathy (PHG) were seen in 64 (71%) patients. Conclusions: The prevalence of esophageal varices in cirrhotics was 57% whereas PHG was seen in 71 % patients

Examining the Nonlinear Effects in Satisfaction-Loyalty-Behavioral Intentions Model

Extant research has widely investigated linear functional forms in satisfaction and loyalty models. In this study with the use of nonlinear form, the relationship between satisfaction, attitudinal loyalty, purchase loyalty and customer behavioral intentions, such as willingness to pay more and external and internal complaining responses in the context of business-to-consumer e-commerce, has been discussed. It has found modest empirical support for nonlinear effects in the relationship. Results support nonlinearity only in the case of attitudinal loyalty to internal complaining response link. Results also present evidence about the mediating role of attitudinal loyalty in the relationship between satisfaction, purchase loyalty, willingness to pay more and internal complaining responses. [W.P. No.2007-11-01]Nonlinearity, satisfaction, attitudinal loyalty, purchase loyalty, behavioral intentions

Clinical Profile and Outcome of Patients Presenting with Mushroom Poisoning in a Tertiary Care Center of Eastern Nepal

Introduction: Accidental mushroom poisoning is constantly seen and regularly reported from all over world. Exact magnitude of problem and its clinical profile in Nepal is not well known. This study was done to evaluate clinical profile and treatment outcome of patients presenting with mushroom poisoning in the department of internal medicine, BPKIHS, Dharan. 
 Methods: It is a prospective observational study conducted in department of internal medicine, BPKIHS, Dharan from 1st January 2008 to 31st December 2009. Informed consent was taken. All the patients were subjected to necessary laboratory investigation. They were followed up at 1 week and 1 month after discharge. 
 Results: All together 60 patients were analyzed. Majority of subjects 56 (93.3%) were from rural areas. Vomiting and diarrhea were the two most common presentations seen in 56 (93.3%) subjects. The latent period for the symptoms were > 6 hours in 4 (6.7%) and < 6 hours in 56 (93.3%) subjects. Fulminant hepatic failure was seen in 6 (10%) subjects and among them 4 (66.7%) expired. After admission 3 (5%) subjects developed GI bleeding. Average duration of hospital stay was 4.6 days. In follow up recovery was complete in all subjects who survived the acute phase of poisoning. 
 Conclusions: Especially in patients coming during rainy season mushroom poisoning should be considered in the differential diagnosis of acute gastroenteritis. Mortality is high in subjects with FHF whereas recovery is complete in subjects who survived the acute phase. Keywords: fulminant hepatic failure; gastroenteritis; mushroom poisoning; wild mushrooms