Background and Aims: The use of coronary angiography in diagnosing coronary artery disease is limited by its invasive property. In the other hand correct interpretation of tread mill test data and its use as a key diagnostic modality also has been a problem. The study was thus aimed to see the diagnostic accuracy of treadmill test to rule out coronary artery disease.Methods: We included all the patients who had positive tread mill stress test and underwent coronary angiography and were subsequently analyzed for presence of coronary artery disease.Results: A total of 303 patients were included with 119 males and 184 females with mean age of 53.6±10.5 yrs and 51.7±8.6 yrs respectively. Normal coronaries was seen in 114(54.0%), borderline lesion in 29 (13.7%) and significant lesion in 68 (32.2%) with 48(22.7%) having single vessel disease, 29(13.7%) double vessel disease and 14(6.6%) triple vessel disease. Coronary artery diseases was highest among diabetics (57.7%, OR 1.72 (95 % CI: 0.92 to 3.20), p value-0.08).Similarly the risk of coronary artery disease was significantly highest among patient with ≥2 risk factor (OR: 8.10,95 % CI: 4.96 to 13.24, P < 0.0001). Gender distribution showed that coronary artery disease was significantly higher in males than females (53% vs 35% respectively, OR: 2.08, 95 % CI: 1.30 to 3.32, p value-0.002).Conclusion: The value of tread mill test to predict coronary artery disease is highest in patients with two or more risk factor especially in those with diabetes with significance increased among males.

Background: The diagnosis rate of coronary artery disease (CAD) has been dramatically increased with the development of interventional technique. Coronary angiography (CAG) is the “gold standard” tool for CAD diagnosis. Due to its invasive property, CAG has been limited. Treadmill test (TMT) is still broadly used as an economic and simple method to screen and assist the diagnosis of CAD. However, correct interpretation of such data is essential in determining diagnostic and treatment strategies. Methods: All the patients attending outpatient department of Manmohan Cardiothoracic Vascular and Transplant Center (MCVTC) and having positive findings in tread mill stress test (TMT) using Bruce protocol underwent selective coronary angiography (CAG), in MCVTC Cath Lab using standard technique and were analyzed in multiple views with significant coronary stenosis defined as of ≥70 % lesion, 50-60% as borderline and 20-30% as minor coronary artery disease. Results: A total of 303 patients (mean age 52.8 ±9.7 yrs) were included during a study period of approximately 1½ yrs (Oct 2015 to Dec 2016), among whom male were of average 53.6 ±10.5 yrs and female were of 51.7±8.6 yrs. Risk factor estimation among patients showed that 49.3 % were hypertensive, 29.9% were overweight, 15.2% were diabetic and 5.7% were smoker. Coronary angiography of patients revealed normal coronaries in 114(54.0%), borderline lesion in 29(13.7%) and significant lesion in 68 (32.2%). Among those with diagnosed coronary artery disease (CAD), 48(22.7%) had single vessel disease, 29(13.7%) had double vessel disease and 14(6.6%) had triple vessel disease. The sub group analysis based on of risk factor and coronary artery disease showed coronary artery diseases was highest among diabetics (57.7%) followed by smokers (55%) compared. The risk of Coronary artery disease found to be significantly higher among patient with ≥2 CAD risk factor. Males with stress test positive had significantly higher chances of having CAD than females (53% vs 35% respectively). Conclusion: Coronary artery disease (CAD) among patients with TMT positive status is higher in patients with diabetics and smokers, especially those with two or more CAD risk factors. Results of this study showed that the pretest probability of treadmill stress-test is higher in males with two or more CAD risk factor especially diabetes and smoking compared to the female counterparts with similar factors, so should be supplemented by other non-invasive techniques (such as stress echocardiography, myocardial perfusion imaging) for further confirmation of diagnosis. (such as Astress echocardiography, myocardial perfusion imaging) for further confirmation of diagnosis.

Clinical findings of foreign body aspiration, generally, are subtle. Scrutinous clinical suspicion is always recommended. Here, we present a rare case of an adult male, who under the influence of alcohol had aspirated a row of his artificial denture without his conscience of where his denture got missing and presented to our outpatient department with non-specific symptoms. With clinical examination and advanced diagnostics, he was successfully managed with rigid bronchoscopy. With the advancement in diagnostic techniques and our widened knowledge of the condition, utmost early detection has been possible and our case report reinforces the need for a low threshold for foreign body aspiration suspicion, especially in adults with dentures, and the use of rigid bronchoscopy as a plausible tool for the prompt management of the aspiration.

Purpose Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity worldwide. COPD is associated with clinically relevant pulmonary and extrapulmonary manifestations, including hypoxemia and weight loss. The correlation of body mass index (BMI) and oxygen saturation (SpO 2 ) with COPD grades may provide a useful additional marker for understanding and managing the disease. The aim of the study was to study the correlation of BMI and oxygen saturation with COPD in patients presenting to a tertiary care center in Nepal. Patients and Methods A descriptive cross-sectional study was conducted among 145 COPD patients visiting the Department of Medicine in Shree Birendra Hospital between 1 March 2019 and 28 February 2020. A non-probability purposive sampling method was used and data were analyzed using SPSS version 21. A p -value of <0.05 was considered significant. Results Out of 145 COPD patients, 58 (40%) were underweight, 53 (36.55%) were of normal weight, 20 (13.79%) were overweight, and 14 (9.6%) were obese. The number of underweight patients was highest in COPD grade 4 and lowest in COPD grade 1. The proportion of subjects with underweight BMI and hypoxia increased with COPD severity, and both were statistically significant ( p -values <0.01). Conclusion Our study shows that BMI and oxygen saturation have an inverse association with COPD severity. The correlation of BMI and oxygen saturation with COPD grade could provide a supplementary marker of disease severity, which could be useful in the understanding of the disease process and subsequent management of COPD.

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