Cardiovascular disease is the commonest cause of death globally and is the major contributor to the burdenof premature mortality and morbidity. Coronary artery disease ( CAD) is greatest killer of mankind. Coronaryartery disease in western industrialized countries show a declining trend. However developing countrieshave shown an alarming increase. The identification of major risk factors and effective control of themthrough population based strategies of prevention were mainly responsible for this decline.A few cases ofacute myocardial infarction were seen in Kathmandu ,Nepal in 1950 and in the sixties the incidence startedrising rapidly. In a study between 1960-1968 a total of 150 cases were reported with myocardial infarctionin Kathmandu , Nepal. Although national datas for incidence and prevalence on CAD in Nepal is notavailable, hospital based datas on admission pattern in different hospitals of Kathmandu, capital city ofNepal show 40 fold increase in incidence of acute myocardial infarction (AMI) in last 30 years. Prevalenceof coronary artery disease (CAD) estimated from these figures of AMI cases indicate that 5 % of adultpopulation in Kathmandu suffer from CAD. Hence, Coronary artery disease is emerging as epidemic in Kathmandu, Nepal.Key Words: Coronary artery disease (CAD), acute myocardial infarction (AMI), Epidemic.

Background: Diabetes is a metabolic disease which affects various organs of the body like heart, eye, kidney, skin and peripheral nerves. Diabetic cardiomyopathy is defined as the appearance of the symptoms of Congestive heart failure in diabetic patient in the absence of hypertension and any structural or congenital heart disease. The aim of the study is to find the relation between type 2 diabetes mellitus and cardiomyopathy, highlighting the variation in incidence according to age, sex and severity on basis of Doppler echocardiographic diagnosis. Methods: The prospective study was conducted for the duration of one year on 100 newly diagnosed Type 2 Diabetes patients aged between 30-60 years. Doppler echocardiography and HbA1c level of the patients was done. The study was conducted on the basis of grading of diastolic dysfunction on echocardiography. Quantitative data was analysed with the help of 't' test and qualitative data with the ChiSquare and Fisher Exact Test. Statistical significance was taken as P < 0.05. Results: In this study, 39% of the newly diagnosed type 2 diabetes mellitus patients developed diabetic cardiomyopathy. In females, the disease was statistically absent in more patients (35) as compared to males (26) (<0.05). The commonest age group affected by grade 1 disease was 41-50 years. The incidence of grade 2 disease was more in age group 51-60 years. The grade 1 diabetic cardiomyopathy was statistically more common in males as compared to females (<0.05). The grade 2 diabetic cardiomyopathy was more common in females, but was statistically insignificant. Patients with HbA1c <8 have 16% chances to get LVDD with significant P value of 0.02. Patients with HbA1c between 8 to 10 have 30% chances to get LVDD with significant P value of 0.01. Conclusion: Diabetic cardiomyopathy is an important complication of type 2 diabetes mellitus patient. HbA1c level and Doppler echocardiography plays an important role in estimating the prevalence and severity of diabetic cardiomyopathy.

Background:To assess the occurrence of risk factors in patients with STEMI with special reference to Thyroid functions and Thyroid profile (Hypothyroidism/ Hyperthyroidism). Methods: A total of 140 patients diagnosed with ST segment elevation myocardial infarction (STEMI) admitted to ICU/CCU of NIMS Medical College & Hospital over the period of 18 months (june 2016 -november 2017) will be included in the study and subsequently evaluated for presence of risk factors and thyroid dysfunction. Majority of subjects belonged to rural areas located near to the hospital of either sex above the age of 18 years. On the basis of history, clinical examination, inclusion and exclusion criteria of the study, subjects were selected. It is an observational cross-sectional study. Statistical analysis were done using Fisher test, student 't' test and Chi-Square test. 'p' value less than 0.05 is taken as significant. Results: Out of 140 patients with STEMI, 20 patients had thyroid dysfunction while 120 patients had euthyroid status. Subclinical hypothyroidism were reported in 12 (8.6%) patients while Hypothyroidism were noticed in 4 (2.9%) patients. Subclinical hyperthyroidism and Hyperthyroidism were observed in 3 (2.1%) and 1( 0.7%) patients, respectively. Out of 140 patients with STEMI, 2 patients with euthyroid status died while 8 patients with thyroid dysfunction died with p=0.001 which was statistically significant Conclusion: Thyroid dysfunction significantly increases relative risk of mortality as compared to euthyroid function in patients with STEMI.

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Background: Cervical cancer is the most common cancers in female population of Nepal. Though considered a slow growing cancer, majority of patients still present very late.  Methodology: One hundred patients of cancer cervix were retrospectively analysed to see their spectrum of clinical presentation and care pathway from January 2012 to April 2012.  Results: The clinical spectrum showed they presented to clinic after average of 9 months of symptoms. Squamous cell cancers were the main histology. Majority of cases were in FIGO stage of II and IIIB. Radiation therapy with tele-therapy and brachytherapy was the main modality of treatment (94%) of cases.  Conclusion: Late stage of presentation is a very common phenomenon in the patients with cancer of cervix. Need screening programs in systematic manner to detect early stage diseases and for better care.