Risk of Cardiac Arrhythmias Among Climbers on Mount Everest.

Importance: Arterial hypoxemia, electrolyte imbalances, and periodic breathing increase the vulnerability to cardiac arrhythmia at altitude. Objective: To explore the incidence of tachyarrhythmias and bradyarrhythmias in healthy individuals at high altitudes. Design, Setting, and Participants: This prospective cohort study involved healthy individuals at altitude (8849 m) on Mount Everest, Nepal. Recruitment occurred from January 25 to May 9, 2023, and data analysis took place from June to July 2023. Exposure: All study participants underwent 12-lead electrocardiogram, transthoracic echocardiography, and exercise stress testing before and ambulatory rhythm recording both before and during the expedition. Main Outcome: The incidence of a composite of supraventricular (>30 seconds) and ventricular (>3 beats) tachyarrhythmia and bradyarrhythmia (sinoatrial arrest, second- or third-degree atrioventricular block). Results: Of the 41 individuals recruited, 100% were male, and the mean (SD) age was 33.6 (8.9) years. On baseline investigations, there were no signs of exertional ischemia, wall motion abnormality, or cardiac arrhythmia in any of the participants. Among 34 individuals reaching basecamp at 5300 m, 32 participants climbed to 7900 m or higher, and 14 reached the summit of Mount Everest. A total of 45 primary end point-relevant events were recorded in 13 individuals (38.2%). Forty-three bradyarrhythmic events were documented in 13 individuals (38.2%) and 2 ventricular tachycardias in 2 individuals (5.9%). Nine arrhythmias (20%) in 5 participants occurred when climbers were using supplemental bottled oxygen, whereas 36 events (80%) in 11 participants occurred at lower altitudes when no supplemental bottled oxygen was used. The proportion of individuals with arrhythmia remained stable across levels of increasing altitude, while event rates per 24 hours numerically increased between 5300 m (0.16 per 24 hours) and 7300 m (0.37 per 24 hours) before decreasing again at higher altitudes, where supplemental oxygen was used. None of the study participants reported dizziness or syncope. Conclusion and Relevance: In this study, more than 1 in 3 healthy individuals experienced cardiac arrhythmia during the climb of Mount Everest, thereby confirming the association between exposure to high altitude and incidence of cardiac arrhythmia. Future studies should explore the potential implications of these rhythm disturbances.

Autoimmune Thyroid Disease in Patients with Hypovitaminosis D in Department of Biochemistry of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Autoimmune thyroid disease is characterised by the generation of autoantibodies against self-antigens such as thyroid peroxidase, thyroglobulin, and thyroid-stimulating hormone receptor. Recent studies have implicated the role of hypovitaminosis D to immune dysfunction, failure of self-tolerance and generation of autoantibodies. This study aimed to find out the prevalence of autoimmune thyroid disease among hypovitaminosis D patients in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among participants between the ages of 18 years to 65 years who visited the Department of Biochemistry of a tertiary care centre between the periods of July 2018 to December 2019. The study was initiated after receiving ethical approval from the Institutional Review Committee (Reference number: 42,8/074/075-IRC). Data was collected using a self-administered questionnaire followed by anthropometric measurement and blood collection. Thyroid hormone, thyroid peroxidase antibody and 25-hydroxy vitamin D were measured by chemiluminescence technique. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 83 patients, 39 (46.98%) (42.32-51.63, 95% Confidence Interval) had autoimmune thyroid disease. Conclusions: The prevalence of autoimmune thyroid disease among patients with hypovitaminosis D was similar to studies conducted in comparable settings. Keywords: autoimmune diseases; prevalence; thyroid; vitamin D.

Anaemia among Patients of Heart Failure in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Anaemia is an important comorbidity common in patients with heart failure and is associated with poor clinical status and worse outcomes. In Nepal few studies have evaluated anaemia amongst patients suffering from heart failure. We intended to find out the prevalence of anaemia in patients with heart failure in a tertiary care centre. METHODS: This is a descriptive cross-sectional study conducted among patients of heart failure presenting to tertiary care hospital in eastern Nepal from April 2017 to January 2018. Ethical approval was taken from the Institutional Review Committee of a tertiary care centre (reference number: IRC/0842/016). Using the convenience sampling method, 100 patients were enrolled in the study. Blood samples from the patients were taken for haemoglobin and serum iron studies. Data was analysed using Statistical Package for Social Sciences version 11. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage. RESULTS: Among 100 patients with heart failure, 82 (82%) (74.47-89.53 at 95% Confidence Interval) had anaemia. Mean haemoglobin level of the study population was 10.40±2.73 g/dl. Fifty four (54%) of patients had iron deficiency status irrespective of presence or absence of anaemia. CONCLUSIONS: Prevalence of anaemia among patients of heart failure in our study was found to be higher than various other homologous international studies.

Assessment of Achievement of American Diabetes Association (ADA) Targets in Patients with Type 2 Diabetes Mellitus at a Tertiary Care Centre in Eastern Nepal.

BACKGROUND: Management of type 2 diabetes is not limited to blood glucose control, it also addresses blood pressure and lipid levels in order to prevent associated vascular complications and improve the chances of survival and quality-of-life. Although the American Diabetes Association (ADA) has lain specific target levels for glycated hemoglobin, blood pressure and serum low density cholesterol to be achieved by non-pregnant patients with type 2 diabetes mellitus, these are not being achieved in practice. We took on this study to describe the extent of ADA target achievement at our center. METHODS: We analyzed data of type 2 diabetes patients who attended the endocrinology clinic at our hospital within the past 1 year from the start of the study. Data of the pregnant women and patients with mentions of conditions that might interfere with measurement of HbA1c were excluded. RESULTS: We analyzed 336 records, 45.8% (n=154) males and 54.16% (n=182) females. The mean age of patients was 52.28±11.9 years. The percentages of patients who had HbA1c <7%, blood pressure <140/90 mm of Hg, and LDL-c <100 mg/dL were 56.5%, 72%, and 56.3%, respectively. Only 37.8% of patients were found to have achieved all three ADA targets. Our findings show that a higher percentage of patients who were ≥50 years of age met LDL-c goals as compared to those <50 years of age, 61.9% vs 49% (P<0.05) and that blood pressure control was better among younger age group, 78.9% vs 66.7% (P<0.05). CONCLUSION: Our study highlights that a significant proportion of patients missed on achieving the ADA targets. This is worrisome and further studies should be done to find out possible reasons behind this.

Gender Differences in the Prevalence of Depression among the Working Population of Nepal.

OBJECTIVE: To estimate the prevalence of depression in the working population; to examine if any gender disparity prevails; and to determine the sociodemographic mediators of depression. METHODS: Data from previous research was retrieved for this study. Only paid workers were selected (n=160). Sociodemographic variables including prevalence of moderate depression were compared between the genders using Chi square test. Significant variables were subject to logistic regression. Validated Nepali version of the Beck Depression Inventory scale (BDI-Ia) was used to determine depressive symptoms with a cutoff score of ≥20 considered as moderate depression. RESULT: The overall prevalence of moderate depression was 15%, with higher prevalence among working women compared to men [χ 2 (df) = 6.7(1), P=0.01], those practicing religions other than Hinduism [χ 2 (df) = 5.5(1), P=0.01], those educated up to primary school compared to other education criteria [χ 2 (df) = 9.4(4), P=0.03], those having vitamin D deficiency compared to others [χ 2 (df) = 8.5(3), P=0.03], and sedentary lifestyle compared to active lifestyle [χ 2 (df) = 6.7(1), P=0.009]. The OR (95% CI) for moderate depression was significantly higher in women than in men [3.2 (1.1-9.6), P= 0.03] and sedentary lifestyle [2.9(1.1-8.2), P= 0.04] even after adjusting for confounding variables. CONCLUSION: Working women have increased odds of depression compared to men. Among various characteristics, sedentary lifestyle was the most important causative factor for depression among women.

Association between vitamin D deficiency and depression in Nepalese population.

Recent studies link vitamin D deficiency with depression; however evidences from the Nepalese population are scarce. The current study explored the association between vitamin D deficiency and depression among 300 adults of 18 years and above age residing in eastern Nepal. Validated Nepali version of the Beck Depression Inventory scale (BDI-Ia) was used to determine depressive symptoms and a BDI cutoff score of ≥20 was considered as clinically significant depression. Sociodemographic data were collected using semi-structured questionnaire. Blood samples were collected to measure serum 25­hydroxy vitamin D (25(OH)D) and classify vitamin D status (deficient, insufficient and sufficient). We used Chi-square test to identify the association of sociodemographic variables and vitamin D status with clinically significant depression. We found a significant association of gender, geographical location of residence, marital status, religion and vitamin D status with clinically significant depression. Binary logistic regression model was used to examine the likelihood of clinically significant depression among vitamin D deficient individuals. Vitamin D deficiency was significantly associated with increased odds of clinically significant depression even after adjusting for confounding variables. This finding suggests Vitamin D deficient people have increased odds of having clinically significant depression.