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Background and Aims: Diabetes mellitus is a well recognized risk factor for cardiovascular disease and acute coronary syndrome. It is becoming increasingly clear that pre-diabetic state is also associated with adverse clinical outcomes. However, evidence is limited regarding the prognostic value of 'prediabetes' on the clinical outcome of acute coronary syndrome. So, we aimed to assess the prevalence of prediabetes in acute coronary syndrome patients and its clinical outcome Methods: This was a single center descriptive cross-sectional study to know the prevalence of prediabetes in 115 patients consisting of 71 males and 44 females, admitted with acute coronary syndrome in the Department of Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal, between August 2020 to July 2021. Results: Based on the definition of 2020 American Diabetic Association, 35 (30.4%) patients were newly diagnosed diabetic, 46 (40%) patients were prediabetic and 34(29.6%) were non-diabetic. Based on HbA1c alone, 26.1% patients were classified as newly diagnosed diabetic patients, 38.3% patients were classified as prediabetic and 35.7% as non-diabetic. Compared with patients without diabetes, patients with prediabetes tended to have a longer hospital stay (p=0.04), higher creatine level (p=0.01) and higher incidence of heart failure (p=0.046). Conclusion: Prediabetes is common in patients presenting with acute coronary syndrome who are not previously known to have diabetes. Further multi-center studies with long term clinical follow-up are needed to draw a firm conclusion regarding the impact of prediabetes on clinical outcome

BACKGROUND The 24hr ECG Holter monitoring system is helpful in assessing cardiac arrhythmias in patients presenting with palpitation, dizziness, presyncope and syncope, which are not detected by standard office electrocardiogram. METHODS This was a single center prospective observational study conducted to assess the prevalence of cardiac arrhythmias among 78 patients consisting of 41 males and 37 females referred for 24 hr ECG Holter monitoring in BPKIHS, Dharan, Nepal, between October 2021 to December 2021. RESULTS The most common indication for 24 hr ECG Holter monitoring in these patients was unexplained palpitation. Ventricular ectopics were the most common arrhythmias detected, followed by supraventricular ectopics, most of which were benign. Among 18 patients with significant bradyarrhythmia, 3 had sinus bradycardia with significant pause, 3 had AF with significant pause, and 2 had high grade/complete AV block. CONCLUSIONS The study showed that most of the arrhythmias detected are benign and prevalence of potentially fatal ventricular and supraventricular tachyarrythmias are relatively low in our population.

BACKGROUND: There is unequivocal evidence showing that at hospital environment BP levels are usually different from measures found at other settings. Therefore, ambulatory BP is expected to be more dependable, as well as allow the identification of a relevant subgroup of white-coat hypertension patient. METHODS: This was a single center descriptive cross-sectional study conducted to assess the prevalence of white-coat hypertension among 50 participants consisting of 31 males and 19 females referred for 24 hour Ambulatory BP monitoring in BPKIHS, Dharan, Nepal, between October 2021 to December 2021. RESULTS: The prevalence of white-coat hypertension was 19 (32%) among 50 participants, while 31(62%) of them had sustained hypertension. Prevalence of WCHTN and sustained hypertension in young age ≤35 years was 4 (21.1%) and 10 (32.3%) respectively, similarly middle age 36-54 years was 13(68.4%) and 16(51.6%) and elderly ≥55 years was 2(10.5%) and 5(16.1%) respectively. Most participants were of middle age group 36-54 years’ age. While of sex distribution pattern of WCHTN and sustained hypertension, male was 11(57.9%) and 20 (64.5%) respectively and female was 8(36.8%) and 15(48.4%) respectively. The association between the demographic variables age, sex and BMI and white-coat HTN was not statistically significant. CONCLUSION: The study showed that White-coat hypertension was more common in male patients and in middle age group 36-54 years, but was not statistically significant. Prevalence of white-coat hypertension was 19(38%). There was no significant association between white-coat hypertension and demographic variables.

Background: Vitamin D deficiency may be a risk factor for coronary artery disease (CAD). We aimed to measure the prevalence of vitamin D deficiency in CAD and its association with severity of angiographic proven CAD. Methods: This prospective, cross-sectional study included 106 consecutive patients who were admitted for typical angina and had signs of myocardial injury (ECG findings and/ or elevated troponin I or CK-MB) and who underwent coronary angiography at the university hospital of BPKIHS from August 2020 to April 2021. Patients were categorized into angiographic proven CAD group and angiographic normal coronary artery group. Serum vitamin D level was classified as normal (≥ 30 ng/ml) and deficiency (< 30 ng/ml). Results: Out of 106 patients, 78 patients (73.6%) had vitamin D deficiency and 28 (26.4%) had normal vitamin D level (p = 0.39). Vitamin D level (mean ± SD) in patients with angiographic normal coronary artery and angiographic proven CAD were 25.94 ± 11.63 ng/ml and 26.07 ± 12.90 ng/ml respectively (p = 0.97). Prevalence of vitamin D deficiency was 75.0% and 64.3% in significant CAD group and normal coronary artery group respectively (p = 0.39). Similarly, frequency of vitamin D deficiency were 68.6%, 78.3% and 88.90% in single, double, and triple vessel disease respectively (p = 0.21). The vitamin D level (mean ± SD) in single, double and triple vessel disease were 27.31 ± 14.02 ng/ml, 25.69 ± 12.72 ng/ml, 23.08 ± 9.45 ng/ml respectively. Conclusion: The prevalence of vitamin D deficiency in both angiographic normal coronary artery and angiographic proven CAD were high but comparable. There was no association of vitamin D deficiency with severity of angiographic proven CAD.