No abstract

Background: Permanent pacemaker implantation (PPI) is considered the most effective and safe procedure for treatment of symptomatic bradyarrythmia. In this study we evaluated incidence of intraoperative and early postoperative (three month) outcome of PPI in our center. Method: This is a cross sectional study carried out over a period twenty months between Jan 2017 and August 2018. All patients undergoing PPI at Nobel Medical College were enrolled in the study. Details of demographic data, medical history, hardware used and complications were recorded. Prospective follow up was done in outpatient department upto three months. Result: A total of seventy-six patients were enrolled in the study. Fifty-one (67%) were male and twenty-five (33%) were female. Ninety percent of the patient was above the age of sixty-five years. Fifty-five (71%) received single chamber and twenty-one (28%) received dual chamber pacemaker. Majority of the patient (87%) had a diagnosis of complete heart block. There was no mortality unto 3 months. Majority (92%) of the patient had no complications at all. Two patients had pocket site infection. Lead dislodgment was noted in three patients. Lead perforation and acute temponade occurred during intraoperative period in one case, which was successfully managed by pericardiocentesis. Conclusion: In summary permanent pacemaker implantation was effective and relatively safe procedure in our center with no mortality.

BackgroundSmoking, diabetes mellitus, hypertension and dyslipidemia are known as conventional risk factors of coronary artery disease (CAD) and the prevalence of it varies across populations. There is paucity of data in our country about the prevalence of risk factors for acute coronary syndrome (ACS). This study aims to assess the prevalence of these conventional risk factors in patients who were admitted in Nobel medical college, with the diagnosis of ACS. Material & MethodsIn this observational study, we enrolled 102 patients diagnosed as ACS with stenosis ≥50% of any epicardial arteries as shown on angiography admitted in Nobel Medical College between September 2015 to March 2017 and evaluate the prevalence of conventional risk factors. In addition, we analyzed the lipid profiles within 24 hour of the event. ResultsMean age of the patients was 59 years. Two third (66.7%) of the patients were male. Left anterior descending artery (43.13%) was the most common culprit lesion followed by RCA in 35.29%. Dyslipidemia was present in 73.5%, hypertension in 46.1%, smoking in 38.2% and diabetes in 37.3%. Prevalence of hypertension, diabetes and dyslipidemia was similar among male and female. Smoking (44.1%vs26.5%) was more common in male (P=<0.05). TG ≥150 mg/dl was seen in 52% study population and higher level of TG was seen in younger population ≤45 years compared to ≥45 years old (p=0.013). Conclusion Present study showed high prevalence of hypertension, smoking, diabetes and dyslipidemia in patients with ACS, suggesting the need of aggressive risk factor reduction in general population.

No abstract

Background and Aims: Peripartum cardiomyopathy (PPCM) is an uncommon complication of pregnancy with variable outcome. There is paucity of data related to its outcomes in Nepal. We studied the clinical and echocardiographic outcome of PPCM patients in eastern part of Nepal.Methods: In this prospectively designed study all patients admitted with the diagnosis of acute severe PPCM at Nobel Medical College, Biratnagar, meeting the inclusion criteria over a period of 14 month, were enrolled and followed up for 3 months post partum.The LVEF and Left ventricular end diastolic dimension (LVEDD) was assessed by echocardiography at baseline and 3 months postpartum. Mortality and survival with normal or depressed ejection fraction were determined. Predictors of outcome were evaluated. Statistical analysis were done using SPSS version 17.Results: Mean age of the study population was 27.6}5.6 years. Ninety five percent of patient had term delivery. Sixty four percent were primigravida. Eighty four percent had the symptoms onset in post partum period. Pulmonary edema was present in 64% during first hospital admission. Mortality was 9% during 3-month follow up period. Thirty six percent had complete recovery of LVEF at 3 months. Fifty five percent survived with depressed LVEF. Age, LVEF less than 30% and LVEDD more than 60 mm at study entry did not correlate significantly with poor clinical recovery at 3 months.Conclusion: This study demonstrates that survival outcome is better even in the patients with severe acute PPCM with early diagnosis and proper management of heart failure.