List of TablesTable 1: Description of health statesTable 2: Age standardized rate and percentage change of all-age COPD prevalence and COPD attributable YLDs in 2021 by Sub-Saharan Africa countryTable 3: COPD attributable deaths and YLLs in 2021 and percentage change from 1990 to 2021 across Sub-Saharan Africa country

Background: Fatty liver disease, encompassing non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD), represents a significant global health burden with complex associations to various comorbidities. Objective: This study aims to characterize the clinical and comorbidity profile of patients with fatty liver disease compared to those without, with a focus on metabolic and gastrointestinal comorbidities. Methods: We conducted a retrospective analysis of 850 patients (432 with fatty liver disease and 418 without) from a tertiary care center. Demographic characteristics, clinical parameters, and comorbidities were compared between groups. Results: Patients with fatty liver disease demonstrated significantly higher BMI (29.71 ± 4.62 vs. 26.25 ± 3.90 kg/m 2, p<0.001) and liver enzymes compared to controls. Type 2 diabetes (49.3% vs. 35.9%, OR 1.74, p<0.001) and dyslipidemia (69.0% vs. 42.3%, OR 3.03, p<0.001) were significantly more prevalent in the fatty liver group, while hypertension, GERD, and pancreatitis showed no significant differences. The number of metabolic comorbidities increased with steatosis severity, and liver function tests demonstrated progressive deterioration with advancing steatosis grade. Conclusion: Fatty liver disease is strongly associated with metabolic comorbidities, particularly type 2 diabetes and dyslipidemia. The severity of liver steatosis correlates with both the burden of metabolic comorbidities and the degree of liver dysfunction.

Abstract Background: Non-alcoholic fatty liver disease (NAFLD), recently re-termed as metabolic dysfunction-associated steatotic liver disease (MASLD), is a global health concern affecting approximately 25% of adults. Complications such as portal hypertension and variceal bleeding are critical to diagnose but challenging with traditional invasive methods like hepatic venous pressure gradient (HVPG) measurement and esophagogastroduodenoscopy (EGD), which are not always feasible and carry risks. Objectives: This systematic review aim to evaluate the diagnostic accuracy of non-invasive methods for diagnosing portal hypertension and variceal bleeding in patients with NAFLD/MASLD cirrhosis, comparing these methods to invasive standards. Methods: A comprehensive literature search was conducted across PubMed, Cochrane Library, Google Scholar, and ScienceDirect from January 2000 to May 2024. Studies included evaluated non-invasive diagnostic techniques for portal hypertension and variceal bleeding, compared with HVPG and EGD, focusing on adult patients with confirmed NAFLD/MASLD cirrhosis. Data extraction covered study characteristics and diagnostic accuracy metrics. The quality of studies was assessed using the QUADAS-2 tool. Meta-analyses were performed using R and Python. Results: 11 studies involving 2,707 patients met the inclusion criteria. Liver stiffness measurement (LSM) via transient elastography demonstrated high sensitivity (85%) and specificity (79%) for diagnosing clinically significant portal hypertension (CSPH) at a 20 kPa cutoff. For severe portal hypertension (SPH), LSM had a sensitivity of 81% and specificity of 85% at 25 kPa. Combining LSM with platelet count resulted in a sensitivity of 97% but lower specificity (41%) for CSPH. Spleen stiffness measurement (SSM) also showed good diagnostic performance with a sensitivity of 89% and specificity of 75% for CSPH. Conclusions: Non-invasive tests, particularly LSM and SSM, show promise in diagnosing portal hypertension and variceal bleeding in NAFLD/MASLD cirrhosis. These methods offer high sensitivity, especially in combination, supporting their use in clinical settings to potentially reduce the need for invasive procedures.

Background: Episiotomy rates remain high in some regions, despite questions about its benefits. This study investigates the prevalence of episiotomy in a rural Ethiopian hospital (2019) and explores links between episiotomy use, labor complications (vacuum deliveries), and newbornhealth (low Apgar scores).Methods: A cross-sectional study reviewed 300 vaginal deliveries at Batu General Hospital from January-March 2019. We analyzed data on maternal age, mode of delivery, neonate sex, first-minute Apgar score, and episiotomy use.Results: Episiotomy was performed in 26% (78/300) of deliveries. Mothers who delivered with vacuum assistance were 15.17 times more likely to experience episiotomy compared to those with spontaneous vaginal delivery. Deliveries with low Apgar scores had 6.11 times higher odds of episiotomy compared to normal Apgar scores.Conclusion: This study highlights a high episiotomy rate in this setting.Labor complications, particularly those requiring instrumental deliveriesand resulting in low Apgar scores, are significantly associated withepisiotomy use. Further investigation is needed to determine if reducingunnecessary episiotomy is feasible while ensuring safe deliveries formothers and newborns in this context.  

Background:Non-alcoholic fatty liver disease (NAFLD) is a growing global health concern, affecting approximately25% of adults worldwide (WHO). The disease spectrum ranges from simple steatosis to non-alcoholicsteatohepatitis (NASH), which can progress to fibrosis, cirrhosis, and liver cancer. Complications such asportal hypertension and esophageal varices pose diagnostic challenges due to the limitations of traditionalinvasive methods like hepatic venous pressure gradient (HVPG) measurement and endoscopy, which arecostly, not widely accessible, and carry inherent risks.Objectives:This review aims to evaluate the effectiveness of non-invasive techniques for diagnosing portalhypertension and variceal bleeding in patients with NAFLD cirrhosis. It seeks to identify the most reliableand accurate non-invasive diagnostic methods and compare them with invasive techniques such as HVPG and esophagogastroduodenoscopy (EGD).Search Methods:A comprehensive and systematic literature search was conducted across databases including PubMed, Cochrane Library, Google Scholar, and ScienceDirect.Selection Criteria: Studies were selected based on predefined eligibility criteria, focusing on adult participants with confirmed NAFLD cirrhosis and the evaluation of non-invasive diagnostic techniques for portal hypertension and variceal bleeding.Data Collection and Analysis:Data extraction covered study characteristics, participant demographics, and diagnostic accuracy metrics such as sensitivity, specificity, PPV, NPV, and DOR. Two independent reviewers performed the extraction, resolving discrepancies through discussion. The quality of included studies was assessed using theQUADAS-2 tool, focusing on bias risk and applicability.Main Results:The review identified 11 studies with a total of 2,707 patients. Liver stiffness measurement (LSM) using transient elastography demonstrated high sensitivity (85%) and specificity (79%) for diagnosing clinically significant portal hypertension (CSPH) at a cutoff value of 20 kPa. For severe portal hypertension (SPH), LSM had a sensitivity of 81% and specificity of 85% at a threshold of 25 kPa. The combination of LSM and platelet count showed high sensitivity (97-98%) for detecting esophageal varices (EV) and high-risk esophageal varices (HREV), but lower specificity (32-74%). Spleen stiffness measurement (SSM)exhibited good diagnostic performance, with a sensitivity of 89% and specificity of 75% for CSPH at acutoff of 40 kPa. Real-time tissue elastography (RTE) showed a sensitivity of 90% and specificity of 51%for CSPH. The Liver Stiffness-Spleen Diameter to Platelet Ratio Score (LSPS) demonstrated a sensitivityof 89% and specificity of 75% for diagnosing HREV.Authors' Conclusions:Non-invasive tests, particularly LSM and SSM, have shown promising diagnostic accuracy for identifying portal hypertension and variceal bleeding complications in NAFLD patients. The high sensitivity of thesetests, especially when used in combination, supports their role in ruling out these conditions in clinicalsettings. The specificity of LSM at higher thresholds underscores its utility in confirming diagnoses of CSPH, SPH, and HREV. Further research is needed to address variability in test performance, standardize protocols, and explore the integration of novel biomarkers and imaging modalities to enhance diagnostic precision and clinical applicability. The value of NITs in reducing the need for invasive diagnostics and improving patient management is significant, making them a valuable addition to clinical practice.Keywords:Non-alcoholic fatty liver disease (NAFLD), Portal hypertension, Variceal bleeding, Non-invasive tests, Liver stiffness measurement (LSM), Transient elastography, Spleen stiffness measurement (SSM), Diagnostic accuracy, Sensitivity, Specificity, Cirrhosis, Esophageal varices, High-risk esophageal varices, Hepatic venous pressure gradient (HVPG), Esophagogastroduodenoscopy (EGD), Chronic liver disease.

Background:Non-alcoholic fatty liver disease (NAFLD) is a growing global health concern, affecting approximately25% of adults worldwide (WHO). The disease spectrum ranges from simple steatosis to non-alcoholic steatohepatitis (NASH), which can progress to fibrosis, cirrhosis, and liver cancer. Complications such as portal hypertension and esophageal varices pose diagnostic challenges due to the limitations of traditional invasive methods like hepatic venous pressure gradient (HVPG) measurement and endoscopy, which are costly, not widely accessible, and carry inherent risks.Objectives: This review aims to evaluate the effectiveness of non-invasive techniques for diagnosing portal hypertension and variceal bleeding in patients with NAFLD cirrhosis. It seeks to identify the most reliable and accurate non-invasive diagnostic methods and compare them with invasive techniques such as HVPG and esophagogastroduodenoscopy (EGD).Search Methods: A comprehensive and systematic literature search was conducted across databases including PubMed, Cochrane Library, Google Scholar, and ScienceDirect. Selection Criteria: Studies were selected based on predefined eligibility criteria, focusing on adult participants with confirmed NAFLD cirrhosis and the evaluation of non-invasive diagnostic techniques for portal hypertension and variceal bleeding.Data Collection and Analysis: Data extraction covered study characteristics, participant demographics, and diagnostic accuracy metrics such as sensitivity, specificity, PPV, NPV, and DOR. Two independent reviewers performed the extraction, resolving discrepancies through discussion. The quality of included studies was assessed using theQUADAS-2 tool, focusing on bias risk and applicability. Main Results: The review identified 11 studies with a total of 2,707 patients. Liver stiffness measurement (LSM) using transient elastography demonstrated high sensitivity (85%) and specificity (79%) for diagnosing clinically significant portal hypertension (CSPH) at a cutoff value of 20 kPa. For severe portal hypertension (SPH), LSM had a sensitivity of 81% and specificity of 85% at a threshold of 25 kPa. The combination of LSM and platelet count showed high sensitivity (97-98%) for detecting esophageal varices (EV) and high-risk esophageal varices (HREV), but lower specificity (32-74%). Spleen stiffness measurement (SSM)exhibited good diagnostic performance, with a sensitivity of 89% and specificity of 75% for CSPH at a cutoff of 40 kPa. Real-time tissue elastography (RTE) showed a sensitivity of 90% and specificity of 51%for CSPH. The Liver Stiffness-Spleen Diameter to Platelet Ratio Score (LSPS) demonstrated a sensitivity of 89% and specificity of 75% for diagnosing HREV.Authors' Conclusions:Non-invasive tests, particularly LSM and SSM, have shown promising diagnostic accuracy for identifying portal hypertension and variceal bleeding complications in NAFLD patients. The high sensitivity of these tests, especially when used in combination, supports their role in ruling out these conditions in clinical settings. The specificity of LSM at higher thresholds underscores its utility in confirming diagnoses of CSPH, SPH, and HREV. Further research is needed to address variability in test performance, standardize protocols, and explore the integration of novel biomarkers and imaging modalities to enhance diagnostic precision and clinical applicability. The value of NITs in reducing the need for invasive diagnostics and improving patient management is significant, making them a valuable addition to clinical practice.Keywords:Non-alcoholic fatty liver disease (NAFLD), Portal hypertension, Variceal bleeding, Non-invasive tests, Liver stiffness measurement (LSM), Transient elastography, Spleen stiffness measurement (SSM), Diagnostic accuracy, Sensitivity, Specificity, Cirrhosis, Esophageal varices, High-risk esophageal varices, Hepatic venous pressure gradient (HVPG), Esophagogastroduodenoscopy (EGD), Chronic liver disease.