Patan Academy Of Health Sciences Research Articles

Reflection on Five Months Rural District Hospital Posting of Final Year MBBS Students

Patan Academy of Health Sciences has been sending its undergraduate medical students to ruralpostings aligning with the national health system of Nepal to produce competent and empathetichealthcare professionals as a part of its social accountability. One such rural posting is a 20-weeklongdistrict posting where students are posted at district hospital and district health office. Wewere final-year students posted at Gulmi district for this purpose in the year 2021/22. We learnedthe functioning of a district hospital along with different clinical skills. We also learned to use thedistrict health information system and different qualitative tools in drafting district health reportsand strategic planning under the guidance of the District Health Office. Such exposure of medicalstudents is essential to develop competent and empathetic health professionals and similar provisionsshould be included in the undergraduate curriculum of other universities.

Non-communicable disease competencies in undergraduate medical (MBBS) curriculum of Patan Academy of Health Sciences, Nepal

In the absence of equitable and well-established health care delivery system, the populations of lower middle income countries are more vulnerable to the impact of the non-communicable diseases (NCDs). However, adequate focus on teaching the NCD related competencies in the curriculum of medical professionals is missing in many of these countries. The South-East Asia Regional (SEAR) NCD Network took an initiative to evaluate the NCD competencies in the pre -service curriculum of the health care providers. As part of this initiative Patan Academy of Health Sciences (PAHS), School of Medicine (SOM) conducted a competency matching exercise for the NCD related competencies in its undergraduate medical (MBBS) curriculum using the tools and format developed by SEAR NCD Network Partners. It was found that 46 out of 55 listed competencies were either fully or partially covered while 10 of the competencies were not addressed in the PAHS MBBS curriculum. Following this exercise, the working group at PAHS School of Medicine has come up with an action plan, has identified a few NCD related competencies to be certified along with the tools and timing of certification Competency in NCD management ensures that future physicians have the necessary skills and knowledge to provide appropriate treatment and care for patients with NCDs through early detection and effective patient education which can reduce the burden of NCDs and the costs associated.

Cardiopulmonary resuscitation: knowledge among nurses in selected departments of a teaching hospital, Nepal

Introduction: Cardiopulmonary Resuscitation (CPR) is considered a core emergency skill in which all health care professionals must be proficient. If early basic life support CPR is instantiated, the survival rate is improved. This study aims to assess the knowledge regarding CPR among nurses. Method: A descriptive cross-sectional study design was adopted among 150 nurses in critical care area of Patan Hospital Lalitpur Nepal, from January to April 2023. Researcher developed self-administered structured questionnaire was used for data collection. Statistical Package for Social Sciences (SPSS) version 20 was used for statistical analysis. Ethical approval was taken from the Institutional Review Committee of Patan Academy of Health Sciences. Result: Study revealed that majority 143(95.3%) of the respondents had knowledge regarding meaning of sudden cardiac death. Same as 137(91.3%) knew the indication of CPR and most of the respondents 140(93.3%) knew the carotid pulse should be checked before starting CPR. More than half 131(87.3%) had knowledge regarding ratio of chest compression. We found more than half respondents 83(55.3%) knew the best time to switch. Nearly half of the respondents 61(40%) knew the component of high-quality CPR whereas minority of the respondents; 20(13.3%) knew the algorithm of adult cardiac arrest. Conclusion: Majority of the respondents had knowledge regarding meaning, indication, site of pulse taking, and ratio of chest compression. Whereas more than fifty percent respondents had knowledge regarding, best time to switch, nearly half of respondents knew the components of CPR. Minority of respondents aware the algorithm of adult cardiac arrest.

Diabetic retinopathy in patients with newly diagnosed type 2 diabetes mellitus

Introduction: Diabetic retinopathy (DR) is the leading cause of visual impairment worldwide including Nepal and studies from populations have shown that up to 10% of diabetic patients have vision-threatening DR, with up to 5% requiring treatment at this initial visit. Within this context, this study aims to evaluate the presence of DR in newly diagnosed diabetic patients, presenting in the outpatient department of ophthalmology, at Patan Academy of Health Sciences. Method: It is a retrospective cross-sectional study carried out in referred cases of newly diagnosed type 2 Diabetes Mellitus (DM) from January 2021 to December 2022. Information regarding age, gender, Body Mass Index (BMI), blood pressure (BP), Triglyceride (TG), proteinuria, and findings of fundus evaluation were extracted from the record maintained in the Department of Ophthalmology. Result: Out of 102 patients with mean age of 49.1±13.6 y, 14(13.73%) had DR, 11(10.8%) had mild Non-proliferative Diabetic Retinopathy (NPDR) and three (2.9%) had moderate NPDR. There was female predominance 56(54.9%), 50(49%) patients were overweight or obese (BMI≥25 kg/m2), 15(14.7%) patients had proteinuria and 28(27.5%) had fasting hypertriglyceridemia and additional ocular anomaly was identified in 33(32.4%) patients. Conclusion: Diabetic retinopathy is already present in significant proportion of newly diagnosed type 2 DM patients. Routine screening for DR at the time of diagnosis can improve ocular outcomes in newly diagnosed diabetics with targeted early treatment. Future research should evaluate this in wider population to generate guidelines for need of mandatory eye evaluation at diagnosis. 

Hospital based one-stop crisis management centre at patan academy of health sciences: New avenues for the mental health professionals

Gender-based violence (GBV) is a public health concern with high rates of mental disorders. One Stop Crisis Management Centre (OCMC) was established in 2010 in different hospitals throughout the nation for the management of gender-based violence (GBV) against women by the Government of Nepal. With establishment of OCMC throughout the nation to tackle and manage these GBV, the role of mental health professionals has been highlighted in many ways. OCMC is full of opportunities and challenges to improve mental health issues of patients with GBV as well as define and recognize the roles and responsibilities of mental health experts.

Mentorship Programme for Undergraduate Medical Students.

Mentorship is seen as a continuous journey of discovery, shared learning, and personal and professional development to achieve leadership and excellence. Medical schools can be monitored with respect to the provision of mentorships as a quality characteristic. So, the aim of our study was to know the prevalence and the impact of mentorship program in medical schools of Nepal and the need of this program in medical schools all over Nepal. A descriptive cross-sectional study was conducted among medical students in medical schools in Nepal. Ethical approval from the Nepal Health Research Council (NHRC) was obtained (Ref. 667). The cumulative data obtained nationwide was entered in computerized spreadsheet software (Microsoft Excel) and analyzed using MS Excel and SPSS 16.0. Patan Academy of Health Sciences (PAHS) 131 (50.8%) had highest prevalence of mentorship program. Out of 258 students, 110 (42.6%) knew that there was mentorship program in their medical schools. The study found the role of mentors in building rapport with faculties (61.82%), developing professional skills (81.82%) and learning evidence-based medicine (74.55%). 98.8% participants soughed for the need of this program in their medical schools. The prevalence of mentorship program among medical school in Nepal was found to be low. Individuals involved in the mentor-mentee relationship found the role of mentor not only on academics but also on their personal and social enterprises. Medical students who were familiar with the concept of this program reported its need in medical school.

Quality of Life of Patients With Chronic Kidney Disease Under Maintenance Hemodialysis and Their Caregivers: A Cross-Sectional Study.

Maintenance hemodialysis (MHD) prolongs the life of patients with end-stage chronic kidney disease (CKD), but this process can change their lifestyle, affecting their quality of life (QoL). Patients with MHD require their caregivers' assistance in daily management and repeated hospital visitation. This places a burden on caregivers affecting their QoL. Both patient and caregiver form a unit during the caregiving process. This study aims to compare and correlate the QoL of patients with CKD under MHD with their caregivers, considering their common familial and socioeconomic backgrounds. This is a cross-sectional, comparative study in the Hemodialysis Unit of Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal. Patients aged >14 years with CKD under MHD and caregivers staying with the patient at their resident place for a minimum of two months were included in the study. QoL of patients with CKD under MHD was compared with caregivers under different domains of the physical component summary (PCS) and mental component summary (MCS) scores using an SF-36 (Short form-36) health survey questionnaire. Data was collected and entered in Microsoft Excel 2010/Epi info version 7.2 and analyzed. The overall QoL of caregivers was better than CKD patients under MHD in terms of both PCS score(48.13 vs. 35.36) and MCS score (48.11 vs. 43.25) and was statistically significant (p-value: <0.001) in both scores. The patient's QoL was not significantly correlated with the caregiver's PCS score (p-value: 0.635). Still, there was a significant correlation between QoL and MCS scores (p-value: 0.006). Similarly, caregivers had better QoL than CKD patients under MHD under all eight domains, which was statistically significant. No significant correlation was found between the frequency and duration of MHD with PCS and MCS scores of both patient and caregiver. Overall, the physical and mental QoL of the caregiver was better than CKD patients under MHD. Further studies need to be conducted to assess the QoL of both groups compared to the healthy population to address the issue of hemodialysis patients and their caregivers.

Performance and preference of problem-based learning (PBL) and lecture-based classes among medical students of Nepal.

Background: PBL (problem based learning) is new active learning educational strategy that has been extensively tested and used in recent years. Patan Academy of Health Sciences (PAHS) is one of medical schools from Nepal, a Low Income Country (LIC) implementing PBL for undergraduate medical education. This study aims to compare PAHS students' understanding and knowledge retention when taught through PBL and lecture-based classes and compare students' perceptions of PBL and lectures in medical education. Methods: This is a cross-sectional study of medical students of a PBL based medical school in Nepal, a non-Western low-income country. Ethical approval was given by the institutional research committee of the Patan Academy of Health Sciences. Understanding and knowledge retention was assessed with 50 vignette-based multiple-choice questions, half of which were taught through PBL sessions, and the remaining half were taught in didactic lectures during basic science years of medical school. A separate pre-validated perception questionnaire was used to assess students' preferences regarding PBL and lectures. Results: Out of 107 students, 99 participated in the understanding and knowledge retention questionnaires and 107 completed perception questionnaires. Understanding and knowledge retention of students was found to be the same for topics taught by PBL and lectures, with median scores of 17 and s16, respectively. PBL were mostly preferred for the physiology (59.81%), pathology (51.40%) and pharmacology (53.27%) concepts, and lectures were mostly preferred for the anatomy (78.50%), biochemistry (45.79%), and microbiology (42.99%) topics. Students wanted the same concepts to be taught through both PBL and lectures, especially for anatomy. Conclusions: Understanding and knowledge retention is the same for topics taught by either PBL or lectures during the basic science years of undergraduate medical education. Students prefer PBL for physiology, pathology, and pharmacology-related concepts, conventional didactic lecture for physiology and microbiology, and a combination of lecture and PBL sessions for anatomy.

Pattern of malocclusion in orthodontic patients at a tertiary care centre

Introduction: Malocclusion is the most common dentofacial abnormality in human population, which can cause dental caries, periodontal disease and aesthetic problems. It is closely related to psychosocial wellbeing. The prevalence of malocclusion varies among different age and ethnic groups. The aim of this study was to assess the pattern of malocclusion occurring in orthodontic patients. Method: A 4-year data from 14 Apr 2018 to 13 Apr 2022 were collected retrospectively by the principal investigator (PI) from the pre-treatment record and an acceptable study cast from the Dental Department at Patan Hospital, Patan Academy of Health Sciences. Angle’s classification of malocclusion was used to classify malocclusion. The collected data were entered, and statistical analysis was carried out by using SPSS version 25. Chi-square test was applied to test the significant differences. The comparison was made between male and female and age group 6-12 years and 13 years and above for the Angle’s classification. Result: A total of 384 patients included in the study, female patients were 263(68.5%). Prevalence for malocclusion was 267(69.5%) of Angle’s class I, while Class II and Class III were 111(28.9%) and 6(1.6%) respectively. The study revealed not statistically significant. Majority 372(96.9%) belong to 13 y and above age group while only 12(3.1%) belong to 6-12 y age group. Conclusion: Angle’s Class I malocclusion was most prevalent with the least common being Angle’s Class III malocclusion. No statistically significant relationship was found. Almost all subjects were 13 years and above age group.

Postpartum hemorrhage: clinical features and management in a tertiary care center of Nepal

Introduction: Obstetric haemorrhage continues to account for a substantial proportion of maternal deaths in Nepal, despite implementation of different strategies. The most common type of obstetric haemorrhage is postpartum hemorrhage (PPH), mainly primary. Understanding its burden in the health care setting was the objective of this study by assessing its prevalence, associated factors and management. Method: This was a retrospective study conducted at Patan Academy of Health Sciences from Mar 2019 to Mar 2022. Demographic, obstetrical, medical factors and management of primary PPH was collected from medical record. Statistical analysis was done using Statistical Packages for Social Sciences (SPSS-20). Results were expressed using frequencies, tables and figures. Result: From a total 17,770 deliveries, primary PPH was seen in 84(0.47%). Most of them 49(58.3%) were multipara. The frequency and impact of PPH can be effectively reduced by reducing avoidable risk factors, especially those related to obstetric interventions as increased caesarean section rate which was 48(57.1%) among primary PPH. Other associated risk factors were induction of labor 32(38.1%), pre-existing medical diseases 32(38.1%), history of antepartum hemorrhage 15(17.9%), previous caesarean section 19(22.6%). Uterine atony 43(51.2%), abnormal placentation disorder 16(19%), genital trauma 9(10.71%), retained tissue 5(5.95%) were the leading causes of PPH. PPH in morbidly adherent placenta like placenta accreta spectrum was 8(9.5%) and placenta increta 1(1.2%). PPH was controlled by conservative management in 24(28.6%). Surgical intervention was required in 34(40.5%) including hysterectomy in 14(16.7%). Conclusion: PPH can be minimized by extra vigilance and planned conjoined management.

Lung Ultrasound in Diagnosis of Interstitial Lung Disease.

Interstitial lung disease denotes a group of disorders which mainly affects pulmonary interstitium consisting of connective tissue fibers that support the lungs. High-resolution computed tomography is currently the main imaging modality of diagnosis, however except for few major cities in the country, availability of computed tomography scan facility is sparse in remote areas; thus relevant use of lung ultrasound in patients with suspected interstitial lung disease could be rewarding. A single center cross-sectional clinical diagnostic study was carried out at department of Radiology and Imaging, Patan Academy of Health Sciences after approval from institutional review committee. Lung ultrasound was done prior to patients undergoing high-resolution computed tomography chest. Senstivity, specificity, positive predictive value , negative predictive value , and accuracy of different echographic criteria-positive chest area score, total B lines score 5 and total B lines score 10 were calculated. Association of non-homogeneity of B lines and pleural line abnormalities with presence of interstitial lung disease, and association between B3 and B7 lines with alveolar and interstitial pattern were derived. Sensitivity (97.4%) and negative predictive value (97.9%) of total B lines score 5 was the highest. Maximum specificity (70.7%), PPV (61.4%) and accuracy (77.2%) was ofpositive chest area score. Pleural line abnormalities showed highly significant association with interstitial lung disease(p=0.003). B3 and B7 lines illustrated very highly significant association with alveolar and interstitial pattern respectively (p<0.001). Lung ultrasound can be a valid and reliable additional imaging method in evaluation of ILD in appropriate clinical scenario.

Accuracy of point of care ultrasound in the diagnosis of long bone fractures in the emergency department

Introduction: Long bone fractures account for a significant portion of injuries in the emergency department (ED). This study aimed to determine the accuracy of point of care ultrasound (POCUS) compared to x-ray in the diagnosis of long bone fractures in the ED.&#x0D; Method: This cross-sectional study assessed 147 patients presenting to the ED of Patan Academy of Health Sciences (PAHS), with suspected long bone fractures, from Oct 2021   through Jun 2022. In all patients, POCUS examination was done by emergency fellows and then standard plain x-ray was performed. Data were analyzed by SPSS 28.0 to determine sensitivity and specificity.&#x0D; Result: A total of 147 patients were included in the study. Compared with x-ray, sensitivity, specificity, PPV and NPV of POCUS in determining fractures was found to be 86%, 98.96%, 97.72% and 93.2%, respectively. Based on bone injured, the highest sensitivity and specificity were obtained with forearm fractures, which was equal to 97.22% and 100%, respectively. Based on age categorization, the highest sensitivity (100%) and specificity (100%) were obtained in pediatric age group i.e. up to 16 years.&#x0D; Conclusion: This study demonstrated that POCUS has high sensitivity and specificity in the diagnosis of long bone fractures, compared to x-ray.

Knowledge and practice of sunscreen use among medical students at Patan Academy of Health Sciences, Nepal

Introduction: (259 words) Sunscreen is essential in preventing skin damage caused by harmful ultraviolet radiation. Regular and appropriate sunscreen application delays photoaging and reduces skin cancer risk. This study aims to assess the general knowledge and practice of sunscreen among medical undergraduates in Nepal.

Study of demography risk factors of simple and complex febrile seizure and associated infection in children at tertiary care center

Introduction: Febrile seizures are seizures that occur in children between 6 to 60 months with a temperature of 38°C or higher. It commonly affects male with a peak incidence in below 2 years old. This study aims at identifying the demographic profile of children admitted with the diagnosis of febrile seizure in order to anticipate the condition and counsel the parents. Method: This is a retrospective cross sectional study conducted in the pediatric ward of Patan Hospital. Medical records of the patients admitted with a diagnosis of febrile seizure (simple or complex) in pediatric ward of Patan Hospital between January 2016 to 2019 were reviewed and data mentioned in the proforma were collected. Ethical approval was taken from the Institutional Review Committee of Patan Academy of Health Sciences (IRC-PAHS). The data was analyzed using Statistical Packages for Social Sciences Version 25 and frequency and proportion was calculated. Result: Out of 277 cases fulfilling the study criteria, 70.4% had simple febrile seizure whereas 29.6% had complex febrile seizure. The mean age of the patients was 23.13 months ±12.8 and the median was 19 months (IQR: 14-29). Around 58.12% were males and 41.88% females. Viral fever accounted for the maximum number of infections in around 22.3% (62/277) of patients and viral URTI in 20.21% (56/277). Conclusion: The study adds to the existing knowledge of febrile seizure in order to help the clinician anticipate febrile seizure.

Diagnostic role of ovarian – adnexal reporting and data system magnetic resonance imaging scoring system for evaluation of indeterminate adnexal lesions

Introduction: Magnetic resonance imaging (MRI) plays an important role in distinguishing malignant from benign adnexal mass which are indistinguishable from ultrasonography. This can help in early diagnosis and treatment of indeterminate adnexal lesions. This study aims to evaluate the features suggestive of malignant features and  accuracy of ovarian adnexal reporting and data system (O-RADS) MRI score in distinguishing benign from malignant lesions when compared with histopathology which is gold standard.&#x0D; Method: This was a retrospective study of MRI pelvis carried out in patients with indeterminate adnexal lesions who had MRI pelvis done from 2018 to 2022 at Patan Hospital, Lalitpur, Nepal.  Ethical approval was obtained from the institutional review committee of Patan Academy of Health Sciences. MRI diagnosis based on O-RADS MRI score was compared with histopathology diagnosis and sensitivity, specificity was calculated. Chi square test was computed and p-value less than 0.05 was considered statistically significant.&#x0D; Result: Among 175 patients, 135 had benign and 40 had malignant lesions. Malignancy was common in middle aged patients (41-60years).MRI features of malignancy were multilocular, solid cystic lesion with contrast enhancement, septations and diffusion restriction. Significant statistical association of O-RADS MRI score was found with histopathology diagnosed malignancy.  92.5% of malignancy had O-RADS MRI score of 4 and 5.The sensitivity and specificity of MRI diagnosing indeterminate lesion was 92.5% and 91.85% respectively.&#x0D; Conclusion: O-RADS MRI scoring is significantly associated with histopathology proven adnexal malignancy hence helps in accurately diagnosing indeterminate adnexal lesions and stratisfying the risk of malignancy.

Qualitative Analysis of Resident as a Teacher Module in Post Graduate General Practice Residency Program.

Residents need to show their proficiency in clinical and teaching skills. A good amount of their time during residency is spent teaching their juniors. Moreover, once they graduate, their roles will be clinician and teacher. Therefore, the "Resident as a teacher" module was included in the curriculum of the general practice residency program at Patan Academy of Health Sciences. This study was designed to evaluate the change in the teaching skills of residents after going through the module. This was a qualitative study where three groups were interviewed. The first group was residents who underwent 'Resident as Teacher Training' and were involved in teaching their juniors. The second group was junior residents who were involved as learners and the third group was faculties. The questionnaire was used for interviewing and the thematic analysis was done and the findings of these three groups were analyzed. There was a total of 25 general practice residents who were interviewed. The residents who were involved in teaching (N=11) stated that the training program increased their confidence 8(72.7%) and communication skills 8(72.7%). The residents who were learners (N=9) stated that they are more comfortable with the seniors in teaching and learning sessions. Faculties (N=5) stated that residents interacted well. Barriers to effective teaching were, difficult to manage time for preparation and supervision by faculty. General practice residents who went through the Resident as Teacher module stated that they were confident and had improvement in their teaching skills.

Overuse of Intravenous Proton Pump Inhibitors in General Medicine and Surgery Wards.

Overuse of stress ulcer prophylaxis is prevalent globally despite guidelines leading to the added cost, especially the intravenous proton pump inhibitor (IVPPI). This study aims to analyze the prevalence of such overuse and be aware of rational use which may help develop local guidelines. This study analyzed the prospectively collected data on IVPPI use in adult patients in general wards of medicine and surgery at Patan Hospital, Patan Academy of Health Sciences, Nepal, from April-Jun 2022. Ethical approval was obtained. Variables analyzed were the patient's age, gender, history of peptic ulcer disease, risk for stress ulcer and gastrointestinal bleeding, the status of nil per os (NPO ≥12 hours), appropriate use of IVPPI, and cost. Prevalence of IVPPI use was 36.24% (274/756 admissions), surgery 39.45(189/479), medicine ward 30.68% (85/277). The mean age was 43.1 ±18.6 years, males 113(41.2%), surgery 189 (69%). Inappropriate overuse in 253(92.3%, significantly more in surgery-182 than medicine-7, p=0.001. Appropriate use was in 21 (7.7%, i.e., NPO-15, NPO + gastrointestinal bleed, and NPO + non steroid anti-inflammatory drugs each 3). Prevalence of IVPPI use was 36.24%. Inappropriate overuse of IVPPI was high (92.2%, 253/274), more in surgery. The nil per os status was the main reason for appropriate use of IVPPI.

Cardiovascular Fitness Assessment of Medical Students at Patan Academy of Health Sciences, Lalitpur, Nepal

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Prevalence and characteristics of relapse in patients with Alcohol Dependence Syndrome

Background: Relapse is an important but difficult phase of the management of alcohol dependence syndrome (ADS). Objective: To study the prevalence and characteristics of relapse in patients with ADS. Methods:This is a descriptive cross-sectional study on the patients with ADS presenting at the Department of Psychiatry, Patan Academy of Health Sciences, for the period of one year (June 2016 - May 2017). Data on the demographic and relapse characteristics were collected. Data were entered and analyzed in Microsoft Excel (MS Office 365, Microsoft Corporation, Washington, United States). Numerical variables were summarized with the median (Inter-Quartile Range [IQR]) and the categorical variables with proportions. Results: Altogether, 105 patients with ADS were studied, among which 59 patients had a relapse (56.1%). All of them were male with a median age of 42 years (Interquartile range (IQR) 35 to 52). The majority were married (55, 93.22%), manual labor as an occupation (32, 54.24%), were Janjati by ethnicity (37, 62.71%), and had received secondary education (19, 32.20%). The median age of starting alcohol consumption was 18 years (IQR 15 to 20) and the median duration of consumption was 22 years (IQR 15 to 30). The most common reason for relapse was peer pressure (25, 42.37%). The majority had relapsed once before (26, 44.07%). Mostly relapsed after abstinence of 1 to 3 months (22, 37.29%) and abstinence maintained by self-motivation (30, 50.85%). Comorbidity and family history of substance use was present in higher proportions. Conclusion: A high rate of relapse was found in our patients with peer pressure as the most common reason for the relapse.

Factors predicting early re-bleeding and in-hospital mortality after acute variceal hemorrhage in patients with cirrhosis

Introduction: Risk factors for early re-bleeding and in-hospital mortality following acute variceal hemorrhage (AVH) are incompletely understood. The aim of this study was to find out the risk factors for early re-bleeding within 5 days and in-hospital mortality after AVH in patients with cirrhosis.&#x0D; Method: This was an analytical cross-sectional study conducted in Department of Medicine, Patan Hospital, Patan Academy of Health Sciences (PAHS), Nepal from July 2021 to June 2022. The ethical clearance was obtained from the Institutional Review Committee-PAHS. Informed consent was taken from the patients. Patients aged &gt;18 y with diagnosed case of liver cirrhosis and endoscopy confirmed variceal bleeding were enrolled. All cases of early re-bleeding within 5 days and in-hospital outcome were recorded.&#x0D; Result: In this study total 72 patients were enrolled. The mean age of our patients was 51.68 y. Sixty seven (93%) of the patients improved, 3(4.16%) had early re-bleeding and 5(6.9%) died during the same hospital admission. Univariate analysis showed that early re-bleeding was significantly associated with the high PT/INR (p&lt;0.001) and high Child-Turcotte Pugh (CTP) score (p=0.032), whereas in-hospital mortality of patients was significantly associated with low Protein (p=0.044), high CTP score (p=0.041), high Model for End stage Liver Disease (MELD) score (p=0.002) and presence of gastric varices (p=0.008).&#x0D; Conclusion: High PT/INR and high CTP score are the risk factors of early re-bleeding after AVH in cirrhotic patients. Low Protein, high CTP and MELD scores, and presence of gastric varices are the factors associated with in-hospital mortality in these patients.