Journal of Nepal Medical Association <p>Journal of Nepal Medical Association is an internationally peer reviewed, MedLine/PubMed indexed,&nbsp;a general medical journal of Nepal Medical Association. JNMA is the first and oldest medical journal from Nepal since 1963 AD. JNMA is available at <a href="">PubMed</a>, <a href=";query&quot;%3A%7B&quot;filtered&quot;%3A%7B&quot;filter&quot;%3A%7B&quot;bool&quot;%3A%7B&quot;must&quot;%3A%5B%7B&quot;term&quot;%3A%7B&quot;index.issn.exact&quot;%3A&quot;1815-672X&quot;%7D%7D%2C%7B&quot;term&quot;%3A%7B&quot;_type&quot;%3A&quot;article&quot;%7D%7D%5D%7D%7D%2C&quot;query&quot;%3A%7B&quot;match_all&quot;%3A%7B%7D%7D%7D%7D%2C&quot;from&quot;%3A0%2C&quot;size&quot;%3A100%7D">DOAJ</a>, <a href=";btnG=&amp;hl=en&amp;as_sdt=0%2C5">Google Scholar,</a>&nbsp;Index Copernicus, EBSCO, EMBASE and other repositories.&nbsp;</p> <p>The JNMA abide by:<br>1. International Committee of Medical Journal Editors for Uniform Requirements for Manuscripts Submitted to Biomedical Journals<br>2. World Association of Medical Editors for best editorial practice<br>3. Council of Science Editors for best editorial practice<br>3. Committee on Publication Ethics for practising good publication ethics</p> <p>&nbsp;JNMA is included and associated with</p> <p><a href=""><img src="" alt="Member of OASPA" height="75"></a>&nbsp;,<img src="" alt="Search JNMA article in DOAJ">&nbsp;,&nbsp;&nbsp;<a href=";as_epq=&amp;as_oq=&amp;as_eq=&amp;as_occt=any&amp;as_sauthors=&amp;as_publication=jnma&amp;as_ylo=&amp;as_yhi=&amp;hl=en&amp;as_sdt=0%2C5"><img src="" alt="Search JNMA article in Google Scholar" height="75"></a>,<img src="" alt="Member of OASPA" width="121" height="75">,<img src="" alt="" height="75">,</p> <h1><a href=";Full=journal%20of%20nepal%20medical%20association" target="_blank" rel="noopener">Science Citation Index</a></h1> Nepal Medical Association en-US Journal of Nepal Medical Association 0028-2715 <p>JNMA allow to read, download, copy, distribute, print, search, or link to the full texts of its articles and allow readers to use them for any other lawful purpose. The author(s) are allowed to retain publishing rights without restrictions. The JNMA work is licensed under a <a href="" rel="license">Creative Commons Attribution 4.0 International License</a>. More about <a href="">Copyright Policy</a>.</p> Prevalence of Organic Colonic Lesions by Colonoscopy in Patients Fulfilling ROME IV Criteria of Irritable Bowel Syndrome <p class="p2"><span class="s2"><strong>Introduction: </strong></span>Irritable bowel syndrome occurs as recurrent abdominal pain that is related to defecation and associated with change in frequency and/or form of stool. Few Patients with IBS may have organic lesions detectable at colonoscopy.</p> <p class="p2"><span class="s2"><strong>Methods: </strong></span>A cross sectional study was carried out in 140 consecutive patients of IBS fulfilling the ROME IV criteria. The study was conducted in Gastroenterology unit, Department of Medicine, Bir hospital, Kathmandu from July 2016 to September 2017. All patients underwent full colonoscopy along with biopsy from sigmoid colon and any visibly abnormal areas.</p> <p class="p2"><span class="s2"><strong>Results: </strong></span>The average age of patients was 37.5 years with 76 (52.8%) males. Forty-two (30%) had IBS-D, 36 (26%) had IBS-C, 31 (22%) had IBS-M and 31 (22%) had IBS-U. Dyspepsia was seen in 16 (11.4%) and fear of TB/Malignancy/IBD was seen in 27 (19.2%). Organic lesions were seen in 39 (27.85%) patients. Nonspecific colitis was seen in 10 (7.1%) followed by ileal erosions in 7 (5%), polyps in 8 (5.7%), hemorrhoids in 6 (4.2%) and diverticula in 3 (2.1%). Only one (0.71%) patient had microscopic colitis and one (0.71%) had malignant lesion seen at histopathological examination. Females with IBS-D had more organic findings than males (P=0.03, RR=4.13, 95% CI=1.21-15.71).</p> <p class="p3"><span class="s2"><strong>Conclusions: </strong></span>The prevalence of organic lesions in patients with IBS fulfilling ROME IV criteria is 27%. Dyspepsia is the most common comorbidity and fear of TB/malignancy/IBD is the most common reason for seeking health care. Females with IBS-D have a higher risk of detecting organic lesions by colonoscopy and histopathology examination.</p> Mukesh Sharma Paudel Amrendra Kumar Mandal Barun Shrestha Nandu Silwal Poudyal Sudhamshu KC Sitaram Chaudhary Ramila Shrestha Khushboo Goel ##submission.copyrightStatement## 2018-02-28 2018-02-28 56 209 487 492 Factors Predicting Mortality of Variceal Bleeding in Liver Cirrhosis <p class="p2"><span class="s2"><strong>Introduction: </strong></span>Acute variceal bleeding in liver cirrhosis is an immediate life-threatening condition and amajor complication of portal hypertension associated with higher morbidity, mortality and hospital costs than any other causes of UGI bleeding. Therefore, early stratification and initiation of therapy based on several factors can reduce mortality associated with it. We aimed to study the predictors of mortality in acute variceal bleeding in LC.</p> <p class="p2"><span class="s2"><strong>Methods: </strong></span>An observational prospective study was conducted in Gastroenterology and Hepatology units of Bir Hospital, Kathmandu, Nepal from April 1, 2016 to May 30, 2017. Patients were included if they had underlying liver cirrhosis and presented upper GI bleeding which were proven to be secondary to variceal bleeding.</p> <p class="p2"><span class="s2"><strong>Results: </strong></span>Seventy-five patients with mean age of 52.5 years were available or the analysis. The M:F ratio was 2.1:1. There were 66 patients in mortality group and 9 in survivor group. The mean CTP and MELD score were 10.17±1.66 and 20.40±8.29 respectively. Among the predictors of the mortality studied, CTP score, MELD score, mean arterial pressure, Serum bilirubin, serum creatinine, need of FFP as well as PRP transfusion, presence of hepatorenal syndrome and hepatic encephalopathy were high in mortality group with statistical significance. On multivariate analysis, high CTP and high serum creatinine level were only significant predictors of mortality. Receiver operating curve for predicting accuracy of mortality was significant with higher MELD and higher CTP score.</p> <p class="p3"><span class="s2"><strong>Conclusions: </strong></span>Strong predictors of mortality in patients with cirrhosis presenting with variceal bleeding are CTP score and high serum creatinine level.</p> Amrendra Kumar Mandal Mukesh Sharma Paudel Sudhamshu KC Sitaram Chaudhary Bidhan Nidhi Paudel Nandu Silwal Poudyal Barun Shrestha Rajan Kanth Paritosh Kafle ##submission.copyrightStatement## 2018-02-28 2018-02-28 56 209 493 496 Prevalence of Non-Communicable Diseases and its Associate Factors among Government Employees in Biratnagar, Nepal <p class="p2"><span class="s2"><strong>Introduction: </strong></span>Non-communicable diseases have along duration and slow progression. It is estimated that the attribution of NCDs in mortality has been rising gradually in Nepal. This study aimed to estimate the prevalence and factors associated with NCDs in Biratnagar, Nepal.</p> <p class="p2"><span class="s2"><strong>Methods: </strong></span>A cross-sectional study was conducted among government employees in Biratnagar, Nepal from August to December 2016. We used self-administrated modified WHO STEPS survey questionnaire and distributed to all government employees of Biratnagar Sub-Metropolitan. We used complete filled 323 questionnaires to analyze and draw the results.</p> <p class="p2"><span class="s2"><strong>Results: </strong></span>The prevalence of NCDs was found 72 (22.3%). Hence, 322 (99.6%)government employees had exposed at least one established risk factor of the NCDs. The prevalence of use of any type of tobacco products was 60 (18.5%) and consumption of alcoholic products was 187 (57.9%). More than two-thirds respondents answered that they consumed fruits once a week. Most government employees consumed vegetable regularly.The majority 193 (59.6%) respondents used motorcycle and electric rickshaw as means of transportation. Out of the total participants 60 (18.6%), 19 (5.9%), and 6 (1.9%) reported hypertension, diabetes, and cardiovascular diseases respectively.</p> <p class="p3"><span class="s2"><strong>Conclusions: </strong></span>Prevalence of Non-Communicable Diseases has been seen in Government Employees in Biratnagar, Nepal. Most of them had at least one associated factor related to NCD was found.</p> Roshan Neupane Tulsi Ram Bhandari ##submission.copyrightStatement## 2018-02-28 2018-02-28 56 209 497 503 Appropriateness of Indications of Upper Gastrointestinal Endoscopy and its Association With Positive Finding <p>Introduction: &nbsp;Upper Gastrointestinal Endoscopy(UGIE) is a frequently advised investigation for upper abdominal symptoms. Studies have questioned the appropriateness of indications for UGIE and have shown that inappropriate indications range from 5% to 49%. The unnecessary UGIE expose patients to the risk. The number of UGIE is rising in our region and we assume so is the number of unnecessary UGIE. With an aim to evaluate the appropriateness of the indications of UGIE and compare its association with positive findings, we conducted a cross-sectional descriptive study.</p> <p>Methods: All patients undergoing diagnostic UGIE during the study period were included in the study. Appropriateness of indications for UGIE was defined as per American Society for Gastrointestinal Endoscopy(ASGE) criteria as “appropriate” and “inappropriate”. UGIE endoscopy findings were classified as “significant” and “insignificant” based on endoscopy findings. The extent of this association between the appropriateness of indications and UGIE findings was expressed as the odds ratio (OR) of finding a relevant diagnosis in patients with an ‘‘appropriate’’ indication compared with those with an ‘inappropriate’’ indication.</p> <p>Results: Seventy-nine patients were included in the study. Fifty- two (65.8 %) of the indications were considered appropriate as per ASGE guidelines. Thirty-three (63.5%) of the appropriate indications has clinically significant finding as compared to seven (25.9%) of inappropriate indication with an odds ratio of 4.962 (95%CI:1.773 – 13.890, p=0.002) which is statistically significant.</p> <p>Conclusions: &nbsp;Appropriate indications have significantly higher rates of clinically significant findings. Use of guidelines may decrease the number of unnecessary procedures.</p> Tanka Prasad Bohara Uttam Laudari Abishek Thapa Shail Rupakheti Mukund Raj Joshi ##submission.copyrightStatement## 2018-02-28 2018-02-28 56 209 504 509 Clinico-radiological Observations in Meconium Aspiration Syndrome <p class="p1"><span class="s2"><strong>Introduction: </strong></span>To understand and report the prevalence of meconium aspiration syndrome and the clinico-radiological features in a tertiary care hospital of western Nepal.</p> <p class="p2"><span class="s2"><strong>Methods: </strong></span>An observational study carried out for a year in 2014-15 in all babies with MAS. Clinical and radiological profiles of MAS in relation to gender, gestational age, mode of delivery, birth weight, Apgar score, thickness of meconium, age at admission and the immediate outcome were studied.</p> <p class="p2"><span class="s2"><strong>Results: </strong></span>Out of 584 admitted newborns (male=389; female=186) during the study period, 78 (13.4%) had meconium aspiration syndrome with male: female ratio of 1.2:1. Majority of babies admitted to NICU had thick meconium [n=52 (66.7%)]. There was no statistical significant difference in various parameters such as Apgar score at 1 and 5 minutes, respiratory distress, birth asphyxia, duration of oxygen use, MAS severity and chest x-ray in those with thick MAS compared to thin. Among all newborns with MAS, 59% (n=46) had abnormal radiological findings with over two-folds in those with thick MAS (71.7%)] compared to thin (28%). Hyperinflation (47.8%), diffuse patchy infiltration (37%), consolidation (21.7%) collapse (8.7%), right lung fissure (6.5%) and pneumothorax (8.7%) were the abnormal radiological findings seen in MAS babies. The odds of having APGAR score at 1 minute at least 7 or more was twice unlikely in those having thick meconium compared to thin (P=0.02)</p> <p class="p3"><span class="s2"><strong>Conclusions: </strong></span>Thick meconium is relatively common with more significant abnormal radiological findings and low Apgar score.</p> Susana Lama Shyam Kumar Mahato Nagendra Chaudhary Nikhil Agrawal Santosh Pathak Om Prakash Kurmi Baldev Bhatia Kailash Nath Agarwal ##submission.copyrightStatement## 2018-02-28 2018-02-28 56 209 510 515 Prevalence and Factors Associated with Microalbuminuria among Type 2 Diabetic Patients : A Hospital Based Study <p class="p2"><span class="s2"><strong>Introduction: </strong></span>Microalbuminuria is the earliest clinical evidence of diabetic nephropathy. However, prevalence and associated factors with microalbuminuria among type 2 diabetic patients has been understudied area of research in Nepalese context. This study aimed to determine the prevalence and factors associated with microalbuminuria among type 2 diabetic patients.</p> <p class="p2"><span class="s2"><strong>Methods: </strong></span>This study was a hospital-based cross-sectional study. Blood samples for serum creatinine, Hemoglobin A1C, Fasting blood sugar and urine sample for microalbumin and urine creatinine were collected and analyzed using validated and standardized tools from a total of 400 Type 2 diabetic patients in Devdaha Medical College and Teaching Hospital, Rupandehi, Nepal from August 2014 to September 2017. Microalbuminuria was defined as urinary albumin-to-creatinine ratio greater than 30 and less than300 μg /mg of creatinine</p> <p class="p2"><span class="s2"><strong>Results: </strong></span>Of 400 type 2 diabetic patients, 186 (46.5%) had microalbuminuria. The mean values of FBS, HbA1C, serum creatinine, microalbumin, microalbumin/urine creatinine ratio were higher in microalbuminuria group. Microalbuminuria was significantly positively correlated with duration of diabetes, FBS, HbA1C, serum creatinine, microalbumin, microalbumin/ urine creatinine, systolic blood pressure and diastolic blood pressure (P&lt; 0.01).</p> <p class="p3"><span class="s2"><strong>Conclusions: </strong></span>Our study demonstrated that nearly half of the type 2 diabetic patients had microalbuminuria. Our results emphasize to increase to accessibility to microalbuminuria testing for all the type 2 diabetic patients and bring them under medical supervision to reduce the unwanted complications of diabetes mellitus.</p> Bikram Khadka Mohan Lal Tiwari Binod Timalsina Prabodh Risal Suprita Gupta Dilaram Acharya ##submission.copyrightStatement## 2018-02-28 2018-02-28 56 209 516 521 Pattern of Mobile Phone Use among Students of An Institution <p class="p1">&nbsp;</p> <p class="p2"><span class="s2"><strong>Introduction: </strong></span>The charm of mobile phone is more among young generation and the increasing use can lead to various harmful effects and may result in dependence. The objective of the study is to evaluate the pattern of mobile phone use among medical students.</p> <p class="p2"><span class="s2"><strong>Methods: </strong></span>A descriptive cross sectional study was conducted on a total of 229 medical students aged between 18 and 25 years who were using mobile phones for more than 1 year by using simple random sampling technique. Students were requested to complete a pre-tested self-administered questionnaire which comprised their socio-demographic characteristics and pattern of mobile phone usage.</p> <p class="p2"><span class="s2"><strong>Results: </strong></span>Among the total 229 students, all of them had their own smart phones. Major purpose of using mobile was for calling, listening music, taking photos/videos and internet use. Most of the students 97 (42.4%) have owned mobile phones since 4-6 years. The median time spent by the students on the mobile phone using different features of mobile phone was 3.5 hours. Majority of the students i.e. 157 (68.5%) use mobile phones at night. The median amount of money spent on recharge per month was 500. Age of student was significantly (P &lt;0.05) associated with calls per day. There was no significant association of pattern of mobile phone use with other selected socio-demographic variables</p> <p class="p3"><span class="s2"><strong>Conclusions: </strong></span>Students were found to use mobile phone excessively. The pattern of mobile phone usage among the students in this study may signal the evolution of mobile phone use from a habit to an addiction.</p> Kriti Thapa Rita Pokharel Rambha Sigdel Surya Prasad Rimal ##submission.copyrightStatement## 2018-02-28 2018-02-28 56 209 522 526 Operative Management of late Presented Displaced Lateral Condyle Fracture of Humerus in Children <p class="p2"><span class="s2"><strong>Introduction: </strong></span>Management of late presented displaced fracture of lateral condyle of humerus in children is controversial, many recommend conservative management due to fear of complications like avascular necrosis but recently many are advocating for operative management with good results hence we studied the outcome of operative management in late presented displaced lateral condyle fracture of humerus in children.</p> <p class="p2"><span class="s2"><strong>Methods: </strong></span>We studied 22 children aged between 4 to 11 years, presenting 3 to 16 weeks from injury. All underwent open reduction and internal fixation with Kirschner wires with or without additional screw and followed up for average 18.05 months. Elbow range of motion, angular or local deformity, premature fusion of physis, avascular necrosis and fracture union were noted and analyzed using modified Aggarwal et al criteria.</p> <p class="p2"><span class="s2"><strong>Results: </strong></span>We had 9 (40.91%) excellent, 5 (22.73%) good, 5 (22.73%) fair, 3 (13.63%) poor result. Overall satisfactory results were seen in 19 (86.37%); 3 (13.63%) had poor result , one due to AVN, two due to premature fusion of physis and visible local deformity. All poor result were seen among delay of operation 6 weeks or later. There was significant improvement of elbow range of motion and all fracture united.</p> <p class="p3"><span class="s2"><strong>Conclusions: </strong></span>Outcome of operation without bone grafting on lateral condyle fracture of humerus in children who presents late up to 5 weeks are excellent; whereas outcome of delayed operation up to 16 weeks also gives good functional recovery and union.</p> Rajendra Sanjel Chhetri Indra Dhakal Gopal Gnawali ##submission.copyrightStatement## 2018-02-28 2018-02-28 56 209 527 530 Variations in the Facial Dimensions and Face Types Among the Students of A Medical College <p class="p2"><span class="s2"><strong>Introduction: </strong></span>Facial dimensions and the face types are the most variable factors in human community. These dimensions have practical implications for the anthropologist, forensic experts, anatomists and surgeons. The present study is aimed to determine the facial dimensions and face types among the medical and nursing students.</p> <p class="p2"><span class="s2"><strong>Methods: </strong></span>A cross-sectional study was done among medical and nursing students of Devdaha Medical College and Devdaha College of Science and Technology from January 2017 to February 2018. There were 155 students of which 72 were males and 83 females. Facial height and width were measured and facial index was calculated. The collected data was entered and analyzed in SPSS 21 and differences in measurements among males and females were calculated.</p> <p class="p2"><span class="s2"><strong>Results: </strong></span>The mean facial height among the total population was 10.83 ± 0.74 cm and facial width was 12.39 ± 0.67 cm with the mean facial index of 87.44 ± 4.82. The most prevalent was the mesoprosopic face (n= 59, 38.06%) followed by leptoprosopic (n=43, 27.74%). The least prevalent face type was hyperleptoprosopic (n= 7, 4.52%) which was observed only in male individuals.</p> <p class="p3"><span class="s2"><strong>Conclusions: </strong></span>The present study depicts higher values of facial height, width and facial indexfor males when compared to the females. The present finding is based upon the indices and classification obtained from developed nation. Further studies with local data would help develop indices and classification for Nepalese population.</p> Anup Pandey Alok Atreya ##submission.copyrightStatement## 2018-02-28 2018-02-28 56 209 531 534 Cesarean Vs Vaginal Delivery : An Institutional Experience <p class="p1">&nbsp;</p> <p class="p2"><span class="s2"><strong>Introduction: </strong></span>According to the WHO, 15% of deliveries have precise indication for cesarean section where it is mandatory for the preservation of maternal and/or fetal health. Increasing rates of Lower Segment Caesarean Sections puts foreword various question that, whether a LSCS need to be reflected as a normal delivery in this twenty first century. There are conflicting reports regarding the safety of caesarean sections. While a significant number of cesarean delivery are performed for obstetrical indications, some are simply due to maternal request and may incur several risks for the child. Not much study has compared the complications of caesarean section with those of vaginal birth. Objective of this study is to find out and compare the common complications of cesarean section with vaginal deliveries on mothers.</p> <p class="p2"><span class="s2"><strong>Methods: </strong></span>A descriptive study was conducted in two selected hospitals of Rupandehi district, Nepal. Data was collected as per pretested structured proforma from 550 respondents randomly and analyzed by using SPSS, MANOVA and Chi-square test to determine associations between categorical variables.</p> <p class="p3"><span class="s2"><strong>Results: </strong></span>In total of 550 mothers, 408 (74.2%) had vaginal delivery and 142 (25.8%) had cesarean delivery.The common maternal complications were postpartum hemorrhage 116 (21.1%), prolonged labor 47 (8.5%) and wound infection 42 (7.6%).</p> <p class="p4"><span class="s2"><strong>Conclusions: </strong></span>The result of the study shows that the maternal complications were higher among LSCS compared to vaginal delivery.</p> Shanta Sharma Indra Dhakal ##submission.copyrightStatement## 2018-02-28 2018-02-28 56 209 535 539 Clinical Outcome and Safety Profile of Patients Underwent Hair Transplantation Surgery by Follicular Unit Extraction <p class="p1">&nbsp;</p> <p class="p2"><span class="s2"><strong>Introduction: </strong></span>Hair transplant surgery is a minimally invasive surgery, where hair follicle is transplanted from donor area of patient’s own body to the desired area.</p> <p class="p2"><span class="s2"><strong>Methods: </strong></span>Patient with hair transplant surgery from a clinic were followed up for one year. The patients were asked for their complications within 2 days, 7 days, one month, 2 to 6 months and one year for assessment of results, side effects. At the end of one-year, subjective evaluation was done with patient’s satisfaction to growth as- poor growth, satisfactory and good growth.</p> <p class="p2"><span class="s2"><strong>Results: </strong></span>Out of 152 patients, maximum patients 74 (48.6%) were in age group 21-30, followed by 61 (40.01%) in age group 31-40, mean age was 31.79, youngest being 21 years and oldest being 70 years of age. Among the complications, swelling of forehead was in more than two- thirds of the patients 106 (69.74%), followed by temporary hair fall noted in 65 (42.76%) of patients. Clients’ remarks noted at the end on one-year revealed 86.18% as excellent results, 11.84% as satisfactory and 1.97% as poor results.</p> <p class="p3"><span class="s2"><strong>Conclusions: </strong></span>Hair transplant sugary by FUE is a relatively safe surgery with optimum results and minimum complications, which can be useful to patients with androgenetic alopecia.</p> Rupak Bishwokarma Ghimire ##submission.copyrightStatement## 2018-02-28 2018-02-28 56 209 540 543 Supracrestal Non-Surgical Therapy in Periodontal Diseases <p class="p1">&nbsp;</p> <p class="p2">Periodontal diseases are the complex disease with a dynamic relationship between biofilm and the host immunoinflammatory response. The goal of periodontal therapy is to preserve the natural dentition and increase their longevity by creation of a favorable environment around the teeth. The mainstay to achieve this is by the non-surgical periodontal therapy, followed by surgical and other recent treatment modalities. However, there seems no sure indication to choose amongst them that are clinically significant and offer long term predictability. We report here two cases that had supracrestal defects and were treated with less invasive instrumentation and repeated full mouth scaling and root planing. This avoided a surgical intervention and was more cost-effective in treating moderate to severe young chronic periodontitis patients. The decision for the type of treatment needs to be critically assessed with a better understanding of the outcome, morphology of the defects, and type of teeth involved.&nbsp;</p> Khushboo Goel ##submission.copyrightStatement## 2018-02-28 2018-02-28 56 209 544 546 Unusual Presentation of Multiple Myeloma <p>Malignancy is an independent risk factor of venous thromboembolism, although it is difficult to determine whether occult cancer is the cause of unprovoked VTE. About 25% of patients with VTE remain idiopathic. Here, the authors report the case of a 63-year-old woman with a history of unprovoked VTE some 10 months previously who presented with recurrent cough and dyspnea of 6 months’ duration and was finally diagnosed to have multiple myeloma.</p> Sang Yeoup Lee Eun Jeong Choi Hyun Ju Lim ##submission.copyrightStatement## 2018-02-28 2018-02-28 56 209 547 549 Scar Endometriosis: Cytological Diagnosis <p>Endometriosis occurring in a surgical scar is called incisional endometriosis. It is rare and can be diagnosed on the basis of detailed history, careful clinical examination and characteristic histology. An interesting case with immunocytological (ICC) confirmation is being reported. A 28-year-old female presented with a mass over anterior abdominal wall, of 3 years duration.&nbsp; She had a past history of LSCS. On examination, the swelling was subcutaneous, measures 3x2cm was firm in consistency and located close to the previous incisional scar. Fine needle aspiration cytology was performed and the smears were moderately cellular and showed monolayered sheets of epithelial cells and stromal fragments. A cell block was also prepared that revealed few glands lined by tall columnar epithelium, surrounded by loose stroma. Immunohistochemistry panel comprising of CK 7 and CD 10 was performed, which were positive in glandular and stromal component respectively.</p> Urvashee Dwivedi Saumya Shukla Nidhi Anand Chetan Parashar Nuzhat Husain ##submission.copyrightStatement## 2018-02-28 2018-02-28 56 209 550 552 Fahr’s Disease Presenting with Manic Symptoms <p>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.</p> Sandip Subedi Sadan Mukhi Pradip Pandey ##submission.copyrightStatement## 2018-02-28 2018-02-28 56 209 553 555