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Introduction: The global surge in cesarean deliveries necessitates safe anesthetic practices to optimize outcomes. While the neuraxial block is the preferred method, specific conditions warrant general anesthesia. This study is aimed to determine the prevalence of cesarean sections under general anesthesia at a tertiary care center. Methods: A descriptive cross-sectional study was conducted on cesarean sections performed between April 14, 2013, and April 13, 2023, at a tertiary care center. Ethical approval was obtained from the Institutional Review Committee (Reference number: 20092023/01). Total sampling was done. Data for the past ten years were manually collected from hospital records using a self-structured proforma and analyzed using Microsoft Excel 2018 and IBM SPSS version 26. The point estimate and 95% confidence interval were calculated for the study. Results: In this study, there were 216 (2.98%) (95% CI: 2.59-3.38%) cesarean sections under general anesthesia in 10 years. Notably, among them, there were 103 (47.69%) primigravida, nullipara 130 (60.19%), 135 (62.50%) with no living children, and 161 (74.54%) without any past abortions. In most cases, 182 (84.26%) were emergency procedures and 34 (15.74%) were elective. Fetal bradycardia with distress was the primary indication observed in 121 (56.02%) cases, followed by 32 (14.81%) maternal requests. Additionally, twenty-one cases were found initially planned as cesarean sections under subarachnoid block but were converted to general anesthesia. The prevalence in this study was found within the recommended limits. Conclusions: The findings highlight that the majority of these procedures were emergency cases, predominantly due to fetal distress, with a notable proportion involving primigravida and nulliparous women.

Mumps is a highly contagious viral infection caused by paramyxovirus. It usually presents with fever and parotid gland swelling. It may be associated with complications like aseptic meningitis, encephalitis, oophoritis, orchitis, pancreatitis. The incidence of mumps infection is increasing in Nepal. This paper aims to advocate for the introduction of vaccination against mumps in the national immunization schedule.

Introduction: Job satisfaction is an attitudinal variable representing the extent to which people like or dislike their jobs. It is a critical factor influencing healthcare quality, patient outcomes, and overall well-being in medical professionals. This study aimed to determine Job Satisfaction among medical doctors in Nepal. Methods: A descriptive cross-sectional study was conducted among medical doctors of Nepal between June 2023 and August 2023 after obtaining ethical approval from the Ethical Review Board of Nepal Health Research Council. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 380 participants, 63 (16.58%) (12.84-20.32 at 95% Confidence Interval) expressed satisfaction. The number of satisfied participants above 40 years were 10 (16%) and less than 40 years were 53 (84%). Out of 63, 46 (73.02%) were male and 17 (26.98%) were females. Conclusions: Job satisfaction among doctors practicing in Nepal was found to be lower than the studies conducted in similar settings.

Sjogren’s syndrome is a chronic multisystem autoimmune disease presenting a wide variety of clinical manifestations ranging from mild sicca symptoms to severe systemic symptoms involving pulmonary, renal, musculoskeletal, cutaneous, and haematological diseases. These symptomatic diversities can delay the correct diagnosis of Sjogren’s Syndrome for a long time. Here, we report the case of a 59-year-old woman with fatigue and weakness in whom bicytopenia was documented. A thorough bicytopenia workup brought us to the final diagnosis of Sjogren’s syndrome. Hydroxychloroquine was started which normalized the patient’s blood parameters and clinical symptoms. The haematological alterations in Sjogren’s syndrome are not pathognomonic. However, only bicytopenia can be the initial presentation of Sjogren’s syndrome as in our patient. Therefore, inexplicable bicytopenia in a middle-aged female may alert the clinician about the possibility of Sjogren’s syndrome.

Introduction: Portal hypertension is increased pressure within the portal vein. A portal pressure gradient of more than 10 mmHg is defined as "clinically significant portal hypertension" due to manifestations such as splenomegaly, gastroesophageal varices, ascites, hepatorenal syndrome, hepatopulmonary syndrome, hepatic encephalopathy, and spontaneous bacterial peritonitis. The aim of this study was to find out the prevalence of portal hypertension among patients with chronic liver disease admitted to the Department of Internal Medicine of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients with chronic liver disease in the Department of Internal Medicine of a tertiary care centre from 1 January 2021 to 31 December 2022 after obtaining ethical approval from the Institutional Review Committee. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 247 patients with chronic liver disease, the prevalence of portal hypertension was 38 (15.38%) (10.88-19.88, 95% Confidence Interval). A total of 16 (42.11%) patients were in the age group of 51-60 years and males were 36 (94.74%). Ascites as a complication were found in 4 (10.53%). Conclusions: The prevalence of portal hypertension among chronic liver disease inpatients in a tertiary care centre was found to be lower than other studies done in international settings.

Introduction: Dental caries is an alarming public health problem globally causing significant morbidity and mortality. Early diagnosis and prompt treatment help in the prevention of complications. The aim of this study was to find out the prevalence of dental caries among patients visiting the dental Outpatient Department in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients visiting the dental Outpatient Department in a tertiary care centre. Data collection was done from 15 November 2022 to 15 February 2023 after taking ethical approval from the Institutional Review Committee (Reference number: 236/078/079). All patients visiting the dental Outpatient Department above 18 years of age who provided written informed consent were included in this study. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 270 patients, the prevalence of dental caries was 214 (79.26%) (74.42-84.10, 95% Confidence Interval). Conclusions: The prevalence of dental caries among patients was higher than other studies done in similar settings.

Introduction: Traumatic brain injuries are one of the leading causes of mortality, morbidity, and economic burden in context to Nepal. Non-contrast computed tomography is used for rapid diagnosis and repeat computed tomography helps to detect the progression and complications of cerebral injury. The aim of this study was to find out the prevalence of traumatic brain injury among patients admitted in the neurosurgical unit in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among patients admitted to the neurosurgery unit in the tertiary care centre from 1 August 2019 to 29 August 2020. Ethical approval was taken from Institutional Review Committee (Reference number: CMC-IRC/075/076-156). Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 350 patients admitted in the neurosurgical unit, the prevalence of traumatic brain injury was 140 (40%) (34.87-45.13, 95% Confidence Interval). Change in management was required among 28 (20%) when computed tomography was done within 12-24 hours. Among them, 27 (19.29%) underwent surgical intervention after a repeat computed tomography scan. Conclusions: The prevalence of traumatic brain injury was found to be higher than similar studies done in similar settings.

Introduction: Hypothyroidism is a common endocrine disorder occurring in pregnancy. Maternal and fetal complications are present in these patients. Timely identification and treatment help in the prevention of complications. The aim of this study was to find out the prevalence of hypothyroidism among pregnant women attending the Outpatient Department of Obstetrics in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in a tertiary care centre after taking ethical approval from the Institutional Review Committee (Reference number: 08/2021). Data from 1 January 2016 to 31 December 2020 were collected between 1 November 2021 to 31 November 2021. All pregnant women who had undergone thyroid level assessment in each trimester (first, second and third) and had delivered in the same centre were included in the study. However, pregnant women with comorbidities like hypertension, overt diabetes mellitus, hyperthyroidism, renal disease, cardiac disease, and neurological disorder were excluded. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 216 pregnant patients, the prevalence of hypothyroidism was 74 (34.25%) (27.92-40.57, 95% Confidence Interval). Maternal complications were seen in 33 (44.59%). The commonest complication was oligohydramnios 10 (13.51%) followed by preterm delivery 8 (10.81%). Conclusions: The prevalence of hypothyroidism among pregnant women was found to be higher than other studies done in similar settings.

Introduction: More than 700, 000 people die due to suicide every year. Suicide is the fourth leading cause of death among 15-29 year-olds. A total of 77% of global suicides occur in low- and middle-income countries. There is an increasing number of suicide all over the world. There is limited data regarding this issue. The available data are based on police reports or on specific populations. The aim of this study was to find out the prevalence of suicidal attempts among psychiatry patients presented to the Department of Emergency of a tertiary care centre. Methods: A Descriptive cross-sectional study was done in a tertiary care centre from January 2019 to July 2020 after taking Ethical approval from the same institute. Beck Suicide Intent Scale, MINI-7, IPDE and PLESS were used to assess suicidal intent, psychiatric comorbidities, personality disorder and life stress event scores respectively. Bronfenbrenner’s Social Ecological Model was used to access various stressors. Point estimate and 95% Confidence Interval were calculated. Results: The Prevalence of suicidal attempts among psychiatry patients in the emergency department was 265 (24.50%), (21.66-26.74, 95% Confidence Interval). The majority were females 135 (51%). The majority attempted at home 238 (89.81%). Poisoning was the most common mode of attempting suicide. Conclusions: The Prevalence of suicidal attempts among psychiatry patients was higher than in the other studies done in similar settings.

Introduction: Road Traffic Accidents, are one of the major neglected global health burdens which are predicted to be the 7th leading cause of global deaths by 2030 as per the World Health Organization hence, seem to be one of the major global threats in near future. Most road traffic accidents affect the most vulnerable age groups in developing countries. The aim of this study was to find out the prevalence of road traffic accidents among patients visiting the Department of Emergency of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients visiting the department of emergency of a tertiary care centre from 16 September 2022 to 15 October 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: IRC-DMCRI: 307/079/080). All the road traffic accidents cases recorded in the Emergency Department from 14 April 2021 to 13 April 2022 were taken. Convenience sampling was used. Point estimate and 95% confidence interval were calculated. Results: Among 29735 patients, the prevalence of road traffic accidents was 1340 (4.50%) (4.26-4.74, 95% Confidence Interval). Among these, 1037 (77.4%) were male and 303 (22.6%) were female. Road traffic accidents among two-wheelers were 1065 (79.48%) followed by pedestrian 703 (52.46%). Mangsir witness the higher number of cases, 137 (13.90%) followed by Kartik, 170 (12.69%). Conclusions: The prevalence of road traffic accidents was similar to other studies done in similar settings. In our study, young people of highly productive and active age groups were the most common victims.

Idiopathic intracranial hypertension is characterised by increased intracranial pressure of unknown aetiology. It is usually seen among obese women who are of childbearing age. With an incidence of 0.9 per 100,000 in women of childbearing age, the incidence in obese women is as high as 19.3 per 100,000. Here, we represent the case of a 31-year-old, non-obese primigravida with hypothyroidism which was diagnosed as idiopathic intracranial hypertension during pregnancy. This patient, was managed with multi-disciplinary considerations so as to avoid complications in perioperative period.

Introduction: Hysteroscopy is a procedure used widely for diagnostic and therapeutic purposes. Hysteroscopy enables visualisation of the endometrial cavity and if possible treatment in the same setting avoiding invasive procedure. The objective of the study was to find out the prevalence of hysteroscopy among gynaecological patients attending the outpatient department of Obstetrics and Gynaecology in a tertiary care centre. Methods: A descriptive cross-sectional study was done among gynaecological patients from 1 January 2016 to 1 January 2020 visiting the outpatient Department of Obstetrics and Gynaecology in a tertiary care centre after ethical approval from the Institutional Review Committee (Registration number: 029/2021). Convenience sampling was used. Data regarding demographic parameters, hysteroscopy findings, procedures performed, histopathological findings and complications were retrieved from the electronic database of the hospital. Point estimate and 95% Confidence Interval were calculated. Results: Among 319 gynaecological patients, hysteroscopy was done in 72 (22.57%) (17.98-27.16, 95% Confidence Interval) patients. Conclusions: The prevalence of hysteroscopy among gynaecological patients was higher to the studies done in similar settings.

Introduction: Medical students encounter multiple psychological changes in the transformation from young insecure students to efficient physicians. They have to balance the personal, social and academic dimention in a busy schedule. So, this study aimed to find out the prevalence of depression among medical students of a medical college. Methods: A descriptive cross-sectional study was conducted among medical students of a medical college from 2 May 2017 to 16 October 2017 after taking ethical approval from the Departmental Research Unit (Reference number: Psy/73/078/079). Students participated voluntarily in the study from first to fourth year and written informed consent was taken. Depression, Anxiety and Stress Scale-42 scale was filled by the students taking their own time and privacy to assess their depression, anxiety and stress. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 302 medical students, 86 (28.47%) (23.38-33.56, 95% Confidence Interval) had depression. A total of 31 (36.04%) had mild, 31 (36.04%) had moderate, 12 (13.95%) had severe and 12 (13.95%) had extremely severe depression. Among them 55 (63.95%) were males and 31 (36.04%) were females. Conclusions: The prevalence of depression among medical students was similar to the other studies conducted in similar settings. Studies concerning the subjective well-being of medical students should be continued and strategic plans and programs should be conducted to help the students manage their stress and depressive symptoms right from the time they join the medical school and continued till they finish the course.

Lesbian, gay, bisexual, transgender, queer, and intersex are at increased risk of getting infected with sexually transmitted infections, suicidal behaviours, and substance and physical abuse. Stigmatization and discriminatory attitudes toward the community have led to disparities while receiving healthcare. In this article, we discuss the condition of healthcare in sexual minorities in Nepal, the major barriers to accessing healthcare facilities, the roles played by nongovernmental organizations, and the possible ways to improve healthcare in the lesbian, gay, bisexual, transgender, queer, and intersex community.

Autoimmune hepatitis is a rare form of chronic liver inflammation that begins as acute hepatitis and progresses to chronic liver disease. It presents with varied clinical features from acute hepatitis to chronic liver diseases like chronic viral hepatitis and alcoholic liver disease, making it difficult to diagnose in the absence of a high index of suspicion and adequate laboratory support. Autoimmune hepatitis is divided into two categories autoimmune hepatitis-1 and autoimmune hepatitis-2 based on the antibodies involved. We discuss the case of a 37-year-old woman who developed autoimmune hepatitis-1, with swelling and epigastric pain. These symptoms later progressed to liver cirrhosis leading to the death of the patient. Autoimmune hepatitis is extremely sensitive to immunosuppressive medication, it is necessary to maintain a high suspicion index for the disease because a prompt diagnosis can be an integral step toward a better prognosis of the disease.

Methemoglobinemia is a rare condition characterised by hypoxic state manifesting as headache, nausea, fatigue, and confusion. We report a 2-year-old boy presenting with fever and cough for 7 days with an episode of hypoxia as the saturation declined and did not improve on face mask oxygenation. On further evaluation, acute intravascular hemolysis was established following decreased haemoglobin level, increased levels of lactate dehydrogenase, and unconjugated bilirubin in the setting of documented infection. Assessment of arterial blood gas showed a significantly raised saturation gap and detection of methemoglobin confirmed the diagnosis. He was managed conservatively with packed red blood cells transfusion following which hypoxia was corrected. Methemoglobinemia as a result of hemolysis can be a non-cardio-respiratory cause of hypoxia and inciting aetiology needs to be addressed.

Protein S is a vitamin K-dependent protein that acts as a break in secondary hemostasis by inactivating activated factor V and activated factor VIII. We report a case of a 40 years old male who had the first episode of deep vein thrombosis of the left lower limb 10 years back, which despite treatment, reoccurred 3 months later in the bilateral lower limb. Thrombophilic screening showed severe protein S deficiency. The patient then developed deep vein thrombosis of both upper limbs. The patient was advised to place an inferior vena cava filter, which he denied. The patient is now presenting with multiple episodes of post-thrombotic syndrome. Such attacks are treated with elastic compression stockings, rivaroxaban, and morphine. However, despite medication, the pain has not yet subsided. Hence, even though protein S deficiency is the rare cause of deep vein thrombosis when recurrent should be considered despite its rare occurrence.

Introduction: Preoperative anxiety is universal in patients before surgery. It is mostly unaddressed by health professionals due to a lack of time. The objective of this study was to find out the prevalence of preoperative anxiety among patients undergoing elective surgery in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted on 385 surgical patients in the Department of Anaesthesia, from 27 November 2021 to 20 April 2022 in a tertiary care hospital posted for elective surgery. Ethical approval was obtained from the Institutional Review Committee (Reference number: MEMG/481/IRC). A convenience sampling was used. The level of anxiety and need for information was assessed using the Amsterdam Preoperative Anxiety and Information Scale questionnaire in a preoperative holding area. Point estimate and 95% Confidence Interval were calculated. Results: Out of 385 patients posted for elective surgery, preoperative anxiety was present in 88 (22.85%) (18.66-27.04, 95% Confidence Interval) patients. The mean Amsterdam Preoperative Anxiety and Information Scale score for total anxiety and need for information was 13.59±2.47 and 5.91±3.06 respectively. Anxiety was present in 60 (68.18%) females, 45 (51.13%) young patients aged

Introduction: The outbreak of COVID-19 as changed patterns of mortality in different setups. The rate of suicide has increased in some countries during the pandemic while the overall death rates have decreased. The study was conducted with objective to find out the prevalence of unnatural deaths among the autopsy cases brought at tertiary care hospital during COVID-19 pandemic period. Methods: This is a descriptive cross-sectional study using the records of the medico legal autopsies conducted from 24th March 2020 to 23rd August 2020 during the COVID-19 pandemic in Pokhara Academy of Health Sciences. Ethical approval was taken from Institutional Review Committee of Pokhara Academy of Health Sciences (Reference number 28.2077/78). Whole sampling method was used. Records which were available were included in the study whereas those cases whose complete records were not available were excluded. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: Out of 188 deaths studied at the autopsy during the COVID-19 pandemic period, the prevalence of unnatural deaths was 147 (78.19%) (71.04-85.33 at 95% Confidence Interval). Among these deaths, 109 (74.14%) were males and 38 (25.85%) were females. Suicide was the most common manner attributing to 78 (53.06%) of the unnatural deaths. Conclusions: The prevalence of suicide was more than those demonstrated by earlier observations in similar settings before the pandemic period. Suicidal deaths were more common during the COVID 19 pandemic. This is an indicator of frustration of the people and necessary steps have to be taken to decrease such deaths in similar conditions to come.

Introduction: Menopause is defined as the complete cessation of menstruation for consecutive 12 months which occurs due to the loss of follicular activity of ovaries from the late 40s to early 50s. The menopausal symptoms are often distressing but lack of awareness leads to failure in addressing the problem. This study aimed to find out the prevalence of menopausal symptoms among postmenopausal women visiting the outpatient department of a tertiary care centre. Methods: This descriptive cross-sectional study was done among postmenopausal women in the outpatient department of a tertiary care centre from 10 March 2021 to 10 March 2022 after taking ethical approval from the Institutional Review Committee (Reference number: MEMG/IRC/420/GA). Convenience sampling was done. Demographic data were collected using predesigned proforma and menopausal symptoms were evaluated using Rajanobritta Lakshan Mapak, the Nepali version of the menopausal rating scale. Point estimate and 95% Confidence Interval were calculated. Results: Among 424 postmenopausal women, menopausal symptom was found in 411 (96.48%) (94.73-98.23, 95% Confidence Interval). The mean age at menopause was 49±4.70 years. The most common symptom these women presented with was somatic symptoms seen in 382 (92.94%) women. Conclusions: The prevalence of menopausal symptoms is found to be higher than the other studies done in similar settings.

Introduction: Patients with COVID-19 are characterised by abnormal levels of inflammatory biomarkers. Elevated D-dimer in COVID-19 patients is associated with increased mortality. This study aimed to find out the prevalence of raised D-dimer among COVID-19 patients in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted in COVID-19 unit of a tertiary care centre from 23 January 2021 to 19 June 2021. The ethical approval was taken from the Institutional Review Committee (Reference number: 077/078/159). D-dimer values and demographic data of the hospital-admitted COVID-19 patients were recorded. Convenience sampling technique was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 180 patients with COVID-19 admitted in the hospital, the D-dimer levels were raised in 85 (47.22%) (39.93-54.51, 95% Confidence Interval) patients. Conclusions: The prevalence of raised D-dimer among admitted COVID-19 patients was found to be lower when compared to other studies conducted in similar settings.

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.

Introduction: Acute exacerbation of chronic obstructive pulmonary disease is a life-threatening condition triggered by infections or non-infectious agents. Antibiotics use in such cases prevents severe deterioration and treatment failure. Past studies have shown inappropriate use of antibiotics in different health care settings. The objective of this study was to find out the prevalence of antibiotics use in patients with acute exacerbation of chronic obstructive pulmonary disease in the Department of Internal Medicine of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among 108 patients with acute exacerbation of Chronic Obstructive Pulmonary Disease admitted to Department of Internal Medicine of a tertiary care centre from 12th February, 2022 to 15th April, 2022 after taking ethical clearance from Institutional Review Committee (Reference number: 417). Convenience sampling was done. Data analysis was done using the Statistical Package for the Social Sciences version 23.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data along with median and interquartile range for continuous data. Results: The prevalence of antibiotics use among study participants was 106 (98.15%) (95.61-100.69 at a 95% Confidence Interval). Penicillin 82 (75.93%) was the most commonly used antibiotics group. Conclusions: The use of antibiotics in acute exacerbation of chronic obstructive pulmonary disease was higher as compared to other similar studies.

Introduction: Neural adaptation to physical training allows a person to better coordinate the activation of all relevant muscles producing maximum force. Nerve conduction velocity measures the speed of impulse along the motor neuron and is strongly associated with muscle contraction time. This study aimed to find out the mean motor nerve conduction velocity of the right ulnar nerve among physically trained adult males in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted in the Neurophysiology Laboratory of a tertiary care centre from 3rd November, 2019 to 2nd November, 2020. Thirty young adult males who were engaged in the physical training at a training centre for more than 3 months were studied after receiving ethical approval from the Institutional Review Committee (Reference number: 1578/019). Motor nerve conduction parameters of the right ulnar nerve were measured and data were entered in Microsoft Excel. Statistical analysis was done using the Statistical Packages for the Social Sciences version 25.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentages for binary data, and mean and standard deviation for continuous data. Results: Among 30 males studied, the mean motor nerve conduction velocity of the ulnar nerve was found to be 61.02±5.86 m/sec (58.92-63.11 at 95% Confidence Interval). The mean distal latency and amplitude of the muscle action potential were 2.33±0.53 ms and 8.08±1.17 mv respectively. Conclusions: Our study found that the mean nerve conduction velocity of the ulnar nerve was similar when compared to studies conducted in similar settings.

People from rural areas of Nepal struggle to have access to adequate medical care on time. Most of the tertiary centres are overburdened by patients, while the peripheral health facilities have been unable to function efficiently due to a lack of infrastructures and skilled manpower needed to run hospitals smoothly. We present a case of a 21-year-old primigravida at 41 weeks and 3 days of gestation with mild COVID-19 symptoms who underwent a Caesarean section for non-progression of labour and foetal distress at a primary health care centre in Nepal; however, both maternal and foetal outcomes were favourable. Therefore, upgrading the quality of care in peripheral health facilities can help in the achievement of accessibility, equity, and quality in health care service in Nepal.

Introduction: Median nerve passes between two heads of pronator teres muscle while passing through the elbow. Detailed knowledge of these variations in the course of Median Nerve in relation to pronator teres and its neighboring structure is required for diagnosis of pronator syndrome. The aim of the study is to find out the proportion of Median Nerve passing below the ulnar head of pronator teres in cadavers of a medical college in Western Nepal. Methods: A descriptive cross-sectional study was carried out at the Department of Anatomy in a medical college of Nepal from 20th July 2021 to 2nd September 2021 after ethical clearance from the same institution (Reference number: UCMS/IRC/079/21). Variations in the course of the median nerve while passing through pronator teres were observed, recorded and photographed. Convenience sampling method was used. Data were analyzed using Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage. Results: Out of 54 prosected specimens of upper limbs, 4 (7.40%) (0.418-14.38 at 95% Confidence Interval) Median Nerve passed below the ulnar head of pronator teres muscle and in 50 (92.60%) specimens Median Nerve passed between two heads of pronator teres. Conclusions: Our study shows that the median nerve passed below the ulnar head of pronator teres muscle is higher as compared to other studies done in similar settings. Thus, knowledge of variations in the course of Median Nerve in elbow has immense importance in the academic and clinical arena.

Introduction: Acute kidney injury is a rare complication of pregnancy and is associated with high maternal morbidity and mortality. Obstetric factors associated with it are preeclampsia/eclampsia, sepsis, hemorrhage and dehydration. Here, we aim to find out the prevalence of complete recovery of renal function among obstetric patients with acute kidney injury. Methods: This is a descriptive cross-sectional study conducted in a tertiary care hospital from 1st July 2020 to 30th June 2021 where obstetric patients who had developed acute kidney injury were included and followed till 6 weeks of diagnosis. Ethical approval was obtained from Institutional Review Committee of Nobel Medical College and Teaching Hospital (IRC- NMCTH 437/2020). The convenience sampling method was used. Data entry and analysis were done using Statistical Package for Social Sciences version 21. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of total 66 obstetric patients with acute kidney injury, 45 (68.2%) (57-79.3 at 95% Confidence Interval) had complete recovery of renal function. Rate of renal function recovery in Stage 1, Stage 2 and Stage 3 acute kidney injury were 19 (90%), 19 (86%) and 7 (58%) respectively. The most common causes of acute kidney injury were Preeclampsia/eclampsia 18 (40%), sepsis 23 (28.8%) and hemorrhage 10 (22.2%). Conclusions: The prevalence of complete recovery in obstetric patients with acute kidney injury was similar to findings from other studies done in similar settings.

Introduction: Thyroid hormone is known to affect reproductive biology. Abnormal uterine bleeding is one of the common presentations in gynaecology outpatient departments and thyroid dysfunction is known to affect its progression. This study aims to find the prevalence of thyroid dysfunction in diagnosed cases of abnormal uterine bleeding in patients in a tertiary hospital of eastern Nepal. Methods: A descriptive cross-sectional study was conducted in patients diagnosed with abnormal uterine bleeding in a tertiary care hospital of eastern Nepal from April 2019-March 2020 after taking ethical clearance from the Institutional Review Committee. On basis of inclusion and exclusion criteria, 95 cases of abnormal uterine bleeding were included in the study. A blood sample was taken and a thyroid function test was done by chemiluminescence assay on an automated analyzer. Convenient sampling method was used for sample collection. Statistical analysis was done using Statistical Package for the Social Sciences version 16. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of the total cases of abnormal uterine bleeding, 15 (15.79%) (8.46-23.12 at 95% Confidence Interval) had thyroid dysfunction. Among total cases, 80 (84.21%) were euthyroid. The mean age of the patients was 33±8 years. Among thyroid dysfunction, 9 (60.0%) were hypothyroid, 4 (26.66 %) were subclinical hypothyroid, and 2 (13.33 %) were hyperthyroid. Conclusions: Thyroid dysfunction was common among patients with abnormal uterine bleeding, with hypothyroidism being the most common type.

Introduction: Thyroid hormones have a major influence on synthesis, mobilization and metabolism of lipids. Hypothyroidism accounts for a notable cause of secondary dyslipidemia. This can increase the risk for cardiovascular morbidity and mortality. This study was performed to find out the prevalence of lipid profile abnormalities in newly diagnosed primary hypothyroid states. Methods: This descriptive cross-sectional study was conducted among 71 patients in the context of newly diagnosed primary hypothyroidism patients visiting outpatient department of internal medicine from 9th December 2018 to 30th June 2020 after taking ethical clearance from Institutional Review Committee. Case screening for lipid profile changes was performed at the time of diagnosis of primary hypothyroidism. A convenience sampling method was used. Data entry and descriptive analysis were done in Statistical Package for the Social Sciences version 16.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: In this study including 71 cases of newly diagnosed primary hypothyroidism, 49 (69.0%) (95% Confidence Interval= 58.24-79.76) had abnormal lipid profiles. Among them, 5 (38.5%) out of 13 (18.3%) cases of subclinical hypothyroidism and 44 (75.9%) out of 58 (81.7%) cases of overt hypothyroidism had abnormal lipid profiles. Conclusions: The prevalence of abnormal lipid profile parameters was similar to the study done in various studies in similar settings except for high-density lipid which showed both similarity and dissimilarity with other studies. Our study suggested that all newly diagnosed cases of primary hypothyroidism are to be investigated for dyslipidemia thus ensuring early treatment and prevention of complications.

Introduction: Tuberculosis has high burden in developing countries like Nepal. This study aims to determine the prevalence of tuberculosis among patients admitted in the department of medicine of a tertiary hospital. Methods: A descriptive cross-sectional study of all the patients admitted to the tertiary care hospital from 1st January 2017 to 31st December 2019 was done. Ethical approval was obtained from Institutional Review Committee (Ref: drs2006181387). Convenience sampling method was used. A descriptive analysis of demographic, clinical and laboratory profile of patients was made using Microsoft Excel version 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 6829 patients admitted to the department of medicine, 209 (3.06%) (2.65-3.47 at 95% CI) patients were diagnosed with tuberculosis. Among them, 147 (70.33%) were males and the mean age was 49.77 years. Pulmonary and extra-pulmonary tuberculosis were present in 153 (73.20%) and 56 (26.79%) patients, respectively. Bacteriological confirmation was limited to 107 (70%) of pulmonary tuberculosis and 3 (5%) of extrapulmonary tuberculosis. Fever was the commonest presentation in 166 (79.42%) followed by cough in 164 (78.46%), anorexia in 108 (51.67%), weight loss 104 (49.76%), and others. Conclusions: The study showed that the prevalence of tuberculosis among admitted patients was higher than national prevalence.

Introduction: Non-alcoholic fatty liver disease is fatty infiltration of the liver in the absence of other causes of steatosis. It is strongly associated with central adiposity, high body mass index, insulin resistance states, hypertension, hyperlipidemia which are features of metabolic syndrome. The objective of study is to find out the carotid intima-media thickness of non alcoholic fatty liver disease patients attending a tertiary care center. Methods: This was a descriptive cross sectional study conducted at National Academy of Medical Sciences, Bir Hospital from July 2018 to June 2019 among 70 diagnosed cases of non alcoholic fatty liver disease based on ultrasound findings. Data collection was started after receiving ethical approval from Institutional Review Board of the Institute. Convenience sampling method was used. Data were entered using Microsoft Excel. The carotid intima-media thickness of both sides were measured by ultrasound. Statistical Package for Social Sciences version 20 was used for analysis. Results: Out of 70 cases, the mean carotid intima-media thickness was 0.7140±0.1796mm on right and 0.7161±0.1828mm on left side. Among 70 cases 45 (64.3%) were Grade II non alcoholic fatty liver disease and 25 (35.7%) were Grade I. It was 0.5720±0.1275mm and 0.7929±0.1546mm in Grade I and II non alcoholic fatty liver disease cases respectively on right side whereas it was 0.5676±0.1259mm and 0.7987±0.1557mm respectively on left side. Conclusions: This study showed increased carotid intima-media thickness in non alcoholic fatty liver disease cases.

Introduction: Understanding a child with any episode of febrile seizure is important so that special attention could be given. The objective of this study was to find the prevalence of febrile seizure in children attending a tertiary centre in western Nepal. Methods: A descriptive cross-sectional study was performed in a tertiary care centre at the department of Pediatrics after taking approval from the Institutional Review Committee. Study was conducted among the children presented with febrile seizure from 18th October 2017 to 12th April 2020. Patient files were retrospectively reviewed. Convenience sampling method was used. Data and descriptive analysis were done using Statistical Package for the Social Sciences version 25. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Of the total 4701 admitted children during a study period, 217 (4.61%) (3.41-5.81 at 95% Confidence Interval) children had febrile seizure. Out of them, 154 (70.9%) male and 63 (29.1%) female with 168 (77.4%) simple and 49 (22.6%) complex febrile seizure. The mean age of presentation was at 23.2±13.61 months whereas mean age for male and female were 22.99±13.86 months and 23.73±13.09 months respectively. Recurrent febrile seizure noted in 68 (31.3%) children and fever in half the cases 110 (50.7%) was caused by Upper Respiratory Tract Infection. Conclusions: Simple febrile seizure was more common and the peak age of presentation was in the second year of life and more commonly in male. One third of febrile seizures were recurrent and half the children had upper respiratory tract infection as the most common etiology of fever.

Introduction: Healthcare workers are always at the risk of exposure to different diseases like respiratory illness including COVID-19. Using appropriate face mask or respiratory protective equipment correctly can prevent transmission of diseases from and to healthcare workers while caring for patients. The study aimed to find out the practice regarding use of face masks during the COVID-19 pandemic in a tertiary care center. Methods: A descriptive cross-sectional study was conducted at a tertiary care hospital during June-July 2020 after receiving ethical approval from the review committee regarding practice of use of face masks. Convenience sampling method was used and a sample size of 162 was taken. Descriptive statistical analysis was done. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 162 participants, 123 (75.9%) knew the correct way of using the masks (72.5-79.3 at 95% Confidence Interval). Conclusions: In this study regarding practice of use of face masks, most of the healthcare workers knew the correct way of using masks and practised hygiene before and after using masks.

Introduction: Sudden outbreak of COVID-19 pandemic has affected the educational system worldwide, forced the medical colleges to close due to lock down, and disrupted the classroom face-to-face teaching process. As a result, medical colleges shifted to an online mode of teaching. The aim of this study is to find out the perception towards online classes during COVID-19 lockdown period among MBBS and BDS students at a medical college of Nepal. Methods: This was a descriptive cross-sectional study carried out at Universal College of Medical Sciences and Teaching Hospital among first and second year Bachelor in Medicine, Bachelor of Surgery and Bachelor in dental surgery students from 1st June 2020 to 30th August 2020. Ethical approval was taken from Institutional Review Committee of Universal College of Medical Sciences and Teaching Hospital (IRC UCMS, Ref: UCMS/IRC/025/20). Convenient sampling method was used. Semi-structured questionnaire was used. Statistical Package for Social Sciences 22 was used for analysis and frequency and percentage was calculated. Results: One hundred fifty six (73.93%) students were enjoying online learning only to some extent, 135 (63.98%) felt online class not equally effective as face-to-face teaching. The students had disturbance during online classes as internet disturbance 168 (79.60%), and electricity problem 47 (22.3%). Similarly, many students 155 (73.50%) felt external disturbance, headache 26 (12.3%), and eye strain 26 (12.3%). Conclusions: Most of the students suffered from disturbances during online classes probably because of internet and electricity problem. When compulsory to conduct online classes, students felt that not more than three online classes per day should be conducted to avoid eye strain and headache.

Introduction: The outbreak of coronavirus disease in Nepal led medical colleges to suspend in person teaching-learning activities and ultimately online platform was introduced to deliver the contents of medical education. The objective of this study was to describe the perception of medical students towards online teaching-learning introduced during the COVID-19 outbreak in Nepal. Methods: An online survey using a descriptive cross-sectional study design was carried out among 515 undergraduate medical students currently enrolled in medical colleges in Nepal. A semi-structured questionnaire in Google form was utilized to collect data. The link of the Google form was sent to the potential respondents through email and social media. Descriptive statistics, including frequency, percentage, mean, and standard deviation were used to analyze data in SPSS vs20. Ethical approval was sought from Nepal Health Research Council to conduct this study, and digital informed consent was taken from study respondents. Results: The overall score of perception of online teaching-learning was 17.61±7.19, which indicated many problems in this method of teaching-learning. The mean score of perception of online teaching-learning was found to be different across sex, location of enrolled medical colleges, having a personal electronic device, having an internet connection at residence, having separate room/space for attending online classes, and self-rated computer skills. Moreover, only 28 (5.4%) of respondents had perceived online teaching-learning as a better method of delivering content of medical curricula. Conclusions: Surveyed medical students in Nepal were found to perceive many problems in online teaching-learning. Moreover, management and faculty members need to take the necessary measures for enhancing the online teaching-learning quality.

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Introduction: Infertility is a global health issue and a socially destabilizing condition for couples with several stigmas including medical, social, psychological burdens and a marital disharmony. The aim was to study the outcome of laparoscopy in infertile females attending Nobel Medical College as laparoscopy is considered as a gold standard in investigation and treatment of infertility. Methods: A descriptive cross-sectional study was carried out in the department of Obstetrics and Gynaecology over a period of May 2018-April 2020, where the outcomes of laparoscopy in infertile females were studied. All the patients with abnormal HSG, unexplained infertility and adnexal mass in the background of infertility were enrolled. Results: Of the 100 infertile patients who underwent laparoscopy, 62 (62%) had evidence of tubal disease as documented by unilateral or bilateral block, 63 (63%) had peritubal adhesions and hydrosalpinx in 15 (15%). Associated pelvic pathology like endometriosis in 50 (50%) in the form of cyst, adhesions and complete and partial obliteration of Pouch of Douglas. Conclusion: Laparoscopy is definitely an effective diagnostic tool of tubal and pelvic pathology. Laparoscopy is recommended for all infertile females with suspected tubal factor and moreover it provides opportunity to correct the condition in possible cases.

Anti-Leucine-rich glioma-inactivated-1 encephalitis is a subtype of autoimmune encephalitis characterized by cognitive impairment, faciobrachial dystonic seizures, and behavioural changes. There is no reported case from Nepal. We report a case of a 54-year old male who presented with abnormal body movement, behavioural changes, rapid eye movement sleep behavioural changes, and cognitive decline. Investigations revealed magnetic resonance imaging findings of fluidattenuated inversion recovery intensity signal in bilateral temporal lobes with anti-leucine-rich glioma-inactivated-1 antibody in serum leading to diagnosis of anti-leucine-rich glioma-inactivated-1 encephalitis. He was treated with steroids and intravenous immunoglobulin. Timely diagnosis is vital to prevent complications and improve outcomes.

Paratubal cysts are generally small but there are rare cases of large paratubal cyst and this case is one of them. Here we report a case of a young female with complains of abdominal fullness since 3 months. On examination, a huge mass (25 x 25 cm) extending from symphysis pubis upto xiphisternum was noted. Ultrasongraphy showed a cystic mass of 27 x 27 cm. Intraoperatively, the cyst was paratubal. It was drained with the help of veress needle and laparoscopic cystectomy was done. A large adnexal cyst extending above umbilicus is traditionally managed by laparotomy. But with the advent of laparoscopy, even a huge cyst can be managed by laparoscopy.

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Introduction: Dramatic growth of the aging population resulted in an increased number of mental disorders and such data are limited in Nepal. The objective is to find out the psychiatric morbidities of elderly out-patients attending Baglung, Kusma, Walling, and Dumre out-reach clinics in Gandaki Province of Nepal. Methods: This was a descriptive cross-sectional study conducted in 392 patients attending out-reach clinics of Baglung, Kusma, Walling, and Dumre of Gandaki Province for one year with the convenient sampling method. Ethical approval was taken from the Institutional Review Committee of Manipal College of Medical Sciences, Pokhara. The diagnosis was done according to the International Classification of Disease-10 guidelines. Epi-info 7 was used and point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data and the analysis was done. Results: The prevalence of neurotic, stress-related, and somatoform disorders 145 (37.0%) was maximum followed by mood disorders 111 (28.3%). Maximum cases were in between 66 and 75 years, Brahmin and Chhetri caste, females, married, and from an extended nuclear family. There is more prevalence of female gender in all psychiatric diagnoses except in mental and behavioral disorders due to psychoactive substance use. There is more prevalence of age groups of patients less than or equal to 75 years in all the psychiatric diagnosis. Conclusions: Neurotic, stress-related, and somatoform disorders were the most common diagnosis. The risk of development of certain disorders based on gender and age group of the patients would be helpful for case identification.

Introduction: Nepal Society of Obstetricians and Gynecologists jointly with the Nepalese government and with the support from the International Federation of Obstetrics and Gynecology has implemented an initiative to institutionalize postpartum family planning services in selected major referral facilities of Nepal to address the gap of low uptake of postpartum family planning in Nepal. The aim of the study is to find the prevalence of the service coverage of postpartum contraception in the selected facilities. Methods: A descriptive cross-sectional study was conducted in seven major referral facilities across Nepal. Data were collected from the hospital records of all women who delivered in these facilities between October 2018 and March 2019. Ethical approval for this study was obtained from Nepal Health Research Council. Data analysis was done with SPSS version 23. Results: Among the 29,072 deliveries from all the facilities, postpartum family planning counseling coverage was 27,301 (93.9%). The prevalence of uptake of Postpartum Intrauterine Device is 1581 (5.4%) and female sterilization is 1830 (6.3%). In total 11387 mothers (52.2%) had the intention to choose a postpartum family planning method. However, 36% of mothers neither used nor had the intention to choose a postpartum family planning method. Conclusions: The coverage of Postpartum Intrauterine Device counseling service coverage in Nepal is higher in 2018 as compared to 2016-2017 and in other countries implementing Postpartum Intrauterine Device initiatives. However, the prevalence of service coverage of immediate Postpartum Family Planning methods, mainly Postpartum Intrauterine Device in 2018 is lower in Nepal as compared to 2016-2017, and other countries implementing Postpartum Intrauterine Device initiative. More efforts are needed to encourage mothers delivering in the facilities to use the postpartum family planning method.

Introduction: General anesthesia is feared to have adverse feto-maternal outcomes compared to neuraxial anesthesia. It is recommended to keep rate of caesarean sections under general anesthesia below 5% and 15% for elective and emergency caesarean sections respectively. This study was conducted to find out the prevalence of caesarean sections under general anesthesia at a tertiary care center in western Nepal. Methods: A descriptive cross-sectional study was conducted among caesarean sections conducted at Manipal Teaching Hospital, Pokhara, Nepal from January 2014 to December 2017. Ethical approval was taken from the Institutional Review Committee with reference number MEMG/IRC/GA/122. All the caesarean sections conducted during this study period were included in the study using whole sampling method. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Data for each patient was subsequently entered into an Excel spreadsheet and analyzed using Statistical Package for Social Sciences version 20. Results: Among 3613 cases, caesarean sections under general anesthesia was observed in 175 (4.84%) in our center over a period of four years at 95% Confidence Interval (4.13-5.55%). The yearly variations ranges from 2.83% to 8.99%. The rate of general anesthesia was found slightly higher in elective 31 (5.82%) as compared to emergency caesarean section 144 (4.67%). Conclusions: The four year medical records of our institution showed fluctuating trend of caesarian sections under general anesthesia. The rate of general anesthesia for emergency caesarian section was within the recommended rate while it was slightly higher in elective caesarian section.

Introduction: WHO defines adolescent pregnancy as any pregnancy from a girl who is 10-19 years of age, the age being defined as her age at the time the baby is born. Globally, adolescent birth rate is 44 per 1000 women aged 15-19 years whereas 33 per 1000 in South East Asian region. The main objective of the study is to find the prevalence of adolescent pregnancy in a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted in Department of Obstetrics and Gynecology, Nobel Medical College and Teaching Hospital, Biratnagar over a period of six months from 1st January 2018 to 30th June 2018. Using the convenient sampling technique, 2688 samples were studied and the descriptive statistical analysis was done. Results: The prevalence of teenage pregnancy was found to be among 143 (5.3%) [5.3%±0.85% at 95% Confidence Interval]. Maximum adolescents of 95 (66.4%) presented at gestational age between 37 to 40 weeks. Regarding contraception, only 2 (1.4%) of teenage mothers had used Injectable Depo Provera. Conclusions: Adolescent pregnancy in developed countries is usually outside of marriage and carries a social stigma but in the context of developing countries it usually happens within marriage and half of them are planned reflecting educational status and contraception knowledge. Effective interventions need to be developed like strict enforcement of laws prohibiting teenage marriage.

Cancer registration is an organization for the systematic collection, storage, analysis, interpretation and reporting of data on subjects with cancer. Cancer Registry was initiated in 1995 and expanded as National Cancer Registry Program since 2003 by BP Koirala Memorial Cancer Hospital with the support of World Health Organization. NCRP currently includes 12 hospital-based registries. First time in Nepal, BPKMCH piloted population-based cancer registry in 2013, which included 15 districts covering 25.8% of total population of Nepal. NCRP is important to assure the quality of data from all the registries to ensure the availability of reliable and valid data of cancer cases. This will further help policymakers to develop prevention and control strategies of cancer. This paper reviews the current status of cancer registries in Nepal and discusses challenges and future prospective related to NCRP. National cancer registry should further include major hospitals in Nepal to give scientific information on cancer trends by community, provinces and regions and analyze on survival of cancer cases.

Introduction: Infertility is a global health issue and a socially destabilizing condition for couples with several stigmas including medical, social, psychological burdens and a marital disharmony. The aim was to study the incidence of infertility in couples attending outdoor of Nobel Medical College and to know the contributing factors among the infertile couples. Methods: A prospective cross-sectional study was carried out in the outpatient department of a teaching hospital July 2015-June 2016, where the incidence of infertility and the contributing factors for the same were evaluated. Results: The incidence of infertility in this study was 5.45% and it was dominated by secondary infertility. The most important cause was male factor in 37.39%. Majority of male factor abnormality was due to exposure to heat as these male work abroad in Arabian Countries. Conclusions: The study shows a dominance of secondary infertility and male factor being a major contributor. The most common semen abnormality was oligospermia. Keywords: infertility; incidence; oligospermia; semen. | PubMed

Kawasaki disease is an acute febrile condition seen in children. However, it is also well recognized that some patients do not fulfill the classic diagnostic criteria for the diagnosis of Kawasaki disease. The incomplete form of Kawasaki disease is termed as ‘Incomplete KD’ or ‘Atypical KD’. This is a case of 4 years old child with fever and mumps. He had bilateral cervical adenitis. Patient failed to respond to IV antibiotics fulfilled the criteria of incomplete Kawasaki disease. The child was managed with high dose aspirin until the child was afebrile for 48 hours. Kawasaki disease is a common vasculitis in children. Atypical cases might be missed if there is concomitant viral illness. Hence the identification and management of Kawasaki disease is paramount to decrease the mortality related to the cardiac disease.

Introduction: The medico legal reports and certificates prepared by doctors can be used as valuable documentary evidence in the court of law. The study was designed with objectives to explore the perception of judges and lawyers about the quality of medico legal reports prepared by the doctors and their competence in providing the expert evidence in the court. Methods: It is a questionnaire based cross sectional study conducted among the district judges and government attorneys of 75 districts of Nepal from March to May 2016. The data obtained was analysed by SPSS version 16.0. Results: Among a total of 78 participants who responded the questionnaire, 40 (51.3%) were district judges and 38 (48.7%) district attorneys. Most of them graded that the reports prepared by the doctors were just average. Among them, 49 (63.6%) strongly agreed and 28 (36.4%) partially agreed that the reports were useful in deciding the cases. A total of 44 (56.4%) respondents strongly agreed and 34 (43.6%) partially agreed that expert opinion of the doctors in the courts were useful to decide the cases. Seventy one (92.2%) of them rated general doctors as moderately competent. Conclusions: The medical reports prepared by the Nepalese doctors were just average as perceived by judges and lawyers and the competency in presenting the evidence in courts was moderate as rated by them.

Bilateral striopallidodentate calcinosis (BSPDC), commonly known as Fahr’s disease, is a rare syndrome characterised by symmetrical calcification over the basal ganglion and dentate nucleus. No case of Fahr's disease with associated manic symptoms has been described in the literature to date. We report an unusual case of Fahr’s Disease in a 18 year old unmarried male who presented to the emergency department of Universal College of Medical Sciences – Teaching Hospital, Nepal with symptoms of mania. This rare case of Fahr’s disease has been reported to highlight this unusual condition and its differentiation from the commoner Fahr’s syndrome.

Chorioangioma of placenta is the commonest benign tumour of the placenta. It consists of a benign angioma arising from chorionic tissue. We report a case of placental chorioangioma which was diagnosed in the post partum period in a patient with polyhydramnios who went into preterm labor and delivered a premature baby. Keywords: chorioangioma; placenta; polyhydramnios.