Background: In an effort to reduce the burgeoning problem of cardiovascular diseases (CVD), it is imperative to understand the variation of risk factors across different geographic regions. This study aims to shed light on examining the leading risk factors of CVD and it's clustering across Nepal.Methods: Data from a nationally representative survey were analyzed to estimate the distribution of four major risk factors (high blood pressure, overweight, obesity, and smoking) of cardiovascular diseases. Similarly, this study also assessed the intra-cluster correlation coefficients (ICCs) of CVD risk factors at the household, community (urban/rural), district, and province level.Results: This study included 14 418 adult population with age of 15 years and above of which 41.7% were male and 58.3% were female. Higher prevalence of all four CVD risk factors was found in the richest quintile, people living in hilly region, most noticeably among residents of metropolitan city and in Gandaki, Bagmati, and Province 1. The ICC decreased as the socio-geographic clustering units decreased in size from province, district, and household level clustering. The ICC was highest at province level for "province 1" for raised blood pressure than other provinces. Conclusions: Risk factors of CVD in Nepal are concentrated prominent in highly urbanized areas and ICC is low as the level of geography decreased from province, district, and household. The findings can be applied in directing prevention activities at different levels to mitigate the higher burden of risk factors of CVD in Nepal.

Background and Aims: Diabetic patients are at increased risk of developing coronary artery disease. This study was conducted with the aim to compare the extent and severity of coronary artery disease in patients with and without diabetes presenting with non ST segment elevation myocardial infarction (NSTEMI). Methods: This was a single center, hospital based, cross sectional, observational comparative study in which total 172 patients presenting with NSTEMI were divided into two groups of 86 patients each based on presence or absence of diabetes mellitus. Demographic, laboratory and angiographic data were analysed and compared between two groups. Results: Among 86 patients enrolled in each group demographic characteristics and risk profile were not significantly different except for smoking status. Significant number of non-diabetics were current smoker (26.7% vs. 9.3%; p < 0.01). Hypertension was the most common risk factor in both groups. Non-diabetic patients had significantly high single vessel disease when compared to diabetics (11.6% vs 24.4%; p=0.03) while multivessel disease was significantly higher among diabetics (80.2% vs 59.3%; p<0.01). Diabetics had severe coronary artery disease with significantly high Gensini score (71.18±39.03 vs 59.84±33.68; p=0.04). There was no difference in terms of type of vessel affected. Conclusions: Diabetic patients presenting with NSTEMI are likely to have more severe and extensive coronary artery disease compared to non-diabetic patients.

Background: There is limited data on feasibility and safety of coronary interventions performed using radial artery at anatomical snuffbox as vascular access point in South Asian region. Our study attempts to evaluate the feasibility and safety of coronary angiography and percutaneous coronary intervention using transradial access at anatomical snuffbox.Methods: Transradial access at anatomical snuffbox was attempted in 128 consecutive patients, who were planned for coronary angiography and/or percutaneous coronary intervention. Success in vascular access, completion of planned procedure and complications encountered, including patency of radial artery after the procedure, were investigated. Results: A total of 128 patients (76 males [59.4%]; 52 females [40.6%]) between 44-78 years of age (mean age, 59.0 +/- 10.2 years) were included in the study. Distal radial artery puncture and sheath placement was successful in all patients however planned procedure was completed in 126 (98.4%) patients. Total 90 coronary angiographies and 36 percutaneous coronary interventions were performed of which five were primary percutaneous coronary intervention. We encountered brachial artery spasm among two patient (1.5%) and significant pain and swelling among three patients (2.3%). No bleeding complication, numbness or parasthesia were observed on follow-up. Patients had average pain rating of 2.4+/- 1.1 in visual analogue pain rating scale. There were no instances of radial artery occlusion after the procedure.Conclusions: Distal radial artery, at anatomical snuffbox, is a safe and feasible alternative vascular access site for coronary angiography and percutaneous coronary intervention. Keywords: Cardiac catheter; coronary angiography; feasibility studies; percutaneous coronary intervention; radial artery; vascular access device

Background and Aims: Among the various biomarkers, high sensitivity C-Reactive Protein (hs-CRP) has been widely studied and is easy to use in the prognostication of patients with acute ST elevation myocardial infarction (STEMI). This study aimed to associate serum level of hs-CRP with in-hospital mortality in patients presented with acute STEMI. Methods: This was a hospital-based prospective observational study conducted in Shahid Gangalal National Heart Centre among patients presented to the emergency department with chest pain of less than 24 hours duration, who were diagnosed subsequently to have STEMI. Patients who had known chronic inflammatory diseases, septic foci and chest pain of over 24 hours were excluded from the study. Blood sample for Hs-CRP was sent from the emergency department and was measured with Finecare TM FIA system; Model number: FS-112. The study was conducted from April 2019 to March 2020. Patient outcomes were stratified as per the four groups of serum level of hs-CRP and among them the relationship between mortality and hs-CRP level was tested with chi-square test. The p-value across the groups was again tested for inter-group significance using the Bonferroni adjusted significance level. Results: 140 patients (112 males and 28 females) with mean age of 58.1±14.86 years were enrolled in the study. There was no increased in-hospital mortality in acute STEMI patients who had serum level of hs-CRP below 3 mg/l. In-hospital mortality showed an increasing trend above this level but it reached statistical significance beyond 10 mg/l only. Thirty five percent of our patients of acute STEMI were found to have serum level of hs-CRP above this threshold. The total in-hospital mortality was 13 (9.28%). Conclusion: The increased serum level of hs-CRP was associated with increased in-hospital mortality in patients with acute STEMI.

Introduction and background: Unilateral absence of pulmonary artery (UAPA) is a very rare condition, with an estimated prevalence of 1 in 200,000 population, which is commonly associated with various cardiovascular anomalies or can occur in an isolated manner. Isolated cases survive to adulthood and remain asymptomatic, but they may frequently experience hemoptysis, repeated infections, or symptoms like dyspnea and chest pain. Due to the rarity of the disorder and its ambiguous appearance, diagnosis can be very challenging. Case presentation: We present a case of a 28-year-old male who visited our center with the diagnosis of ventricular septal defect with Eisenmenger syndrome elsewhere for further evaluation and was found to have right-sided UAPA with ipsilateral pulmonary hypoplasia and some associated cardiac anomalies. Clinical discussion: Discussions are held regarding typical chest radiograph findings, diagnostic methods, and possible therapies. Conclusion: Physicians should be aware of UAPA, which might go undiagnosed for several years despite regular medical care and can show up later in life, causing chronic respiratory symptoms along with Eisenmenger syndrome and ventricular septal defect like in our case.

Background and Aims: ACEF score is simple risk score which uses only three parameters for predicting mortality and postcontrast acute kidney injury (PC-AKI). This study was designed to look into various risk factors and ACEF score for patients undergoing Percutaneous Coronary Intervention (PCI). Methods: This is single-centre, observational, cross-sectional study. The patients were divided into tertiles.Bivariate analysis of various risk factors and ACEF score was done for PC-AKI as well as In-hospital and 30-day mortality. Results: Total 257 patients were included.The total mortality among PCI patients were low: In-hospital (0.8%) and 30-day (1.9%). The risk factor for increased mortality were higher Killip class and reduced Ejection Fraction (EF). PCAKI occurred in one-fifth. The risk factors for PC-AKI were increasing age, higher Killip class, diabetes, reduced EF, emergency PCI procedure and higher contrast volume. Hydration with NS was protective against PC-AKI. Mean ACEF score was higher among those who died within 30 days (p=0.35) and who developed PC-AKI (p<0.001). ACEF-low had trend toward better outcome with no mortality (p=0.17) and had low risk of PC-AKI (p=0.026). ACEF-moderate had reduced risk of PC-AKI (p=0.029), however was not associated with increased odds of 30-day mortality (p=0.66). ACEF-high showed significantly increased odds of mortality (p=0.04) and PC-AKI (p<0.001). Discriminatory capacity of ACEF score to detect 30-day mortality was good (AUC 0.82, p= 0.016) and goodness of fit=0.70. Discriminatory capacity of ACEF score to detect PC-AKI was fair (AUC 0.7, p<0.001) and goodness of fit=0.62. Conclusions: ACEF score fairly predicts the short-term mortality and PC-AKI in patients undergoing PCI.