Introduction: Endoscopic rapid urease test is a simple and most widely used test to detect the presence of urease in the gastric mucosa. Many studies have reported prevalence of H. pylori infection in relation to age, gender and site of ulcer. Therefore, this study was designed to determine the prevalence and significance of H. pylori in peptic ulcer disease. Methods: A retrospective review was carried out for patients with peptic ulcer disease who had undergone upper GI endoscopy in Department of Internal Medicine at Kathmandu Model Hos­pital. The records from January 2013 to December 2017 were analyzed. Any patient with previously diagnosed peptic ulcer, history of active bleeding, cancer and incomplete records were excluded. Peptic ulcer associated with H. pylori was diagnosed on the basis of endoscopic rapid urease test. Results: Among the 418 diagnosed case of peptic ulcer disease by upper GI endoscopy from Jan 2013 to Dec 2017, 213 tested positive for H. pylori by rapid urease test. Among the positive cases, over a half were males patients. Majority (23.9%) of the patients were in the age group of 35-44 years. Prevalence of H. pylori in duodenal ulcer was 51.6% followed by combined gastro-duodenal ulcer (26.8%) and gastric ulcer (21.6%). H. pylori was significantly associated with duodenal ulcer (p<0.0001). Conclusion: This study demonstrated relatively high prevalence of H. pylori infection in patients with duodenal ulcer who had undergone upper GI endoscopy.

Diabetes Ketoacidosis in association with acute myocardial infarction is quite frequent but is also associated with higher morbidity and mortality. These two can trigger each other, different hypothesis have been proposed to explain this phenomenon but still it is difficult to know which one appears first. We report a referred case to our centre with acute Myocardial Infarction and diabetic ketoacidosis promptly initiated treatment of diabetic ketoacidosis along with primary PCI. Keywords: Cardiogenic shock; diabetic ketoacidosis; metabolic acidosis; myocardial Infarction

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Background and Aims: The COVID 19 pandemic have affected the patients with ST segment elevation myocardial infarction as the number of patients presenting with STEMI declined substantially and those who underwent primary PCI had poor outcome. Our aim was to analyze the in-hospital and 30-days mortality in STEMI undergoing Primary PCI during second wave of COVID 19. Methods: A prospective cohort study was conducted at Shahid Gangalal National Heart Centre, Bansbari, Kathmandu. Convenience sampling of patients who underwent primary PCI were enrolled in this study and were followed up for 30 days. Numerical variables were described as Mean ± Standard Deviation (SD) and categorical variables were described as frequency and percentage. p values were calculated and considered significant if < 0.05. Results: During this study period of 2 months from 1st May 2021 to 30th June 2021, 97 patients with STEMI underwent primary PCI, including 12 (12.47%) COVID 19 positive cases. 30 days mortality was 15.4% including in-hospital mortality of 11.34%. Among COVID 19 positive cases, in-hospital mortality was 33.33% and 30-days mortality was 55.55% which was significantly higher than non COVID 19 patient who underwent primary PCI (P=0.003). Conclusion: Overall, mortality rate of primary PCI during COVID 19 second wave has been increased and mortality of COVID 19 positive patients who underwent primary PCI was significantly higher than non-COVID 19 patients who underwent primary PCI.

Background: With rise in prevalence of conventional risk factors like diabetes, hypertension, smoking, dyslipidemia and obesity the incidence of coronary artery disease in young patients have increased in the recent decades even in developing world. There have been multiple studies done in Nepal studying the angiographic profile of coronary disease in general population. However, only few studies has been done till date on the angiographic profile in the young population in our country. Aims and Objectives: In this study, we aim to determine the angiographic profile of young patient ≤ 40 years in a tertiary care centre of Nepal. Materials and Methods: A retrospective analytic study was done in Shahid Gangalal National Heart Centre from January 2019 to December 2019. Individuals of both genders with age ≤ 40 years who underwent coronary angiography were included. Results: Total 109 patients were included. Out of 109, 89 were male and 20 were female. The mean age for male was 35.55 ± 4.31 and for female was 38.55 ± 1.90 (P = 0.003). Among 61 (55.96%) patients who had significant coronary artery disease, 33 patients (30.27%) with single vessel disease, 15 patients (13.76%) had double vessel disease, and 13 patients (11.92%) had triple vessel disease. Left anterior descending (LAD) artery was found to be most frequently involved in all patterns of Coronary artery disease (CAD). Smoking was the most common coronary risk factor present in 29.3% of patients followed by hypertension, family history of premature CAD and diabetes in 14.6%, 7.5% and 5.5% of patients respectively. Overall, the prevalence of smoking was more in males (31.4%) than in females (20%). Conclusion: Single vessel disease (SVD) was most prevalent in young patients with significant CAD. LAD is the most commonly involved coronary artery followed by Right coronary artery (RCA) and Left Circumflex (LCX).