Nepalese Medical Journal <p>Nepalese Medical Journal is published by Health Education Agriculture Nepal (<a title="HEAD" href="" target="_blank" rel="noopener">HEAD Nepal</a>). The journal&nbsp;is an official peer-reviewed, medical journal which is published bi-annually and and doesn’t charge any fee for submission, processing, and publication. The journal receives original material of interest to the practitioners and scientists in the field of medicine related to the recent developments in Medical Sciences and all articles are Open Access.</p> <p><a href="" rel="license"><img src="" alt="Creative Commons Licence"></a><br>All articles published in the Journal of Pathology are licensed under a&nbsp;<a href="" rel="license">Creative Commons Attribution 4.0 International License</a>.<br>Journal of Pathology of Nepal is indexed on <a title="DOAJ-NMJ" href="">DOAJ</a></p> en-US <p>Copyright on any article published by Nepalese Medical Journal is retained by the author(s).</p><p>Authors grant Nepalese Medical Journal a license to publish the article and identify itself as the original publisher.</p><p>Authors also grant any third party the right to use the article freely as long as its integrity is maintained and its original authors, citation details and publisher are identified.</p><p><a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons Licence" /></a><br />All articles published in Nepalese Medical Journal  licensed under a <a href="" rel="license">Creative Commons Attribution 4.0 International License</a>.</p><p>This license permits use, distribution and reproduction in any medium, provided the original work is properly cited.</p> (Dr Shiva Raj KC) (Sioux Cumming) Tue, 07 Jan 2020 09:03:50 +0000 OJS 60 Visual Abstracts in Medical Journals <p>Social&nbsp;media, especially Twitter, crept into academic fields and have become a vital part of all the medical&nbsp;fields and journals.1 Medical journals have been increasingly using Twitter to disseminate their contents&nbsp;to attract a wider readership. The Transplantation Journal, that started tweeting from 2015 to “improve&nbsp;engagement with readership and connect with the authors”, showed that the papers that were tweeted&nbsp;were three times more likely to be downloaded than the non-tweeted ones (p&lt;0.001).<br>Some of the journals started new initiatives to improve their interactions with readers in social media&nbsp;like podcasts, video abstracts and reviews, and Visual Abstracts (VA). VA is a form of graphical abstract&nbsp;used by medical journals. VA was introduced in Annals of Surgery in July 2016.4 Other forms of&nbsp;graphical abstracts in the field of chemistry had appeared as early as 1976. VA is a visual summary of&nbsp;a research manuscript. It consists of a single-page poster that is simple, eye-catching and summarizes&nbsp;the background, methodology, results, and conclusion of the study. These are published or tweeted for&nbsp;improved dissemination of the paper, for deeper engagement of scientists, and to influence busy readers.</p> Nabin Bahadur Basnet ##submission.copyrightStatement## Tue, 31 Dec 2019 00:00:00 +0000 Outcome of Post Esophageal Variceal Band Ligation with Sucralfate and Proton Pump Inhibitor vs. Proton Pump Inhibitor Alone in Cirrhotic Patients <p><strong>Introduction:</strong> Endoscopic band ligation is the mainstay of treatment in bleeding varices in cirrhosis.&nbsp; Subsequent bleeding from the band ulcers is a possible complication. Proton pump inhibitors and&nbsp;Sucralfate are commonly used post band ligation and often in combination. The aim of the study&nbsp;was to identify the advantage of combining Sucralfate to proton pump inhibitor in reducing the&nbsp;number and size of band ulcers.<br><strong>Materials and Methods:</strong> This was an open-label comparative study conducted in a tertiary level&nbsp;hospital of Nepal. Patients with cirrhosis after band ligation were included. Eligible patients were&nbsp;randomized into a proton pump inhibitor alone (Group A) or proton pump inhibitor and sucralfate&nbsp;group (Group B) and they underwent upper gastrointestinal endoscopy after two weeks. Baseline&nbsp;parameters, number and mean size of band ulcers were compared.<br><strong>Results:</strong> A total of 58 patients, 29 in each group, were evaluated. The baseline characteristics were&nbsp;comparable. EBL was done for bleeding varices in 51.7% and as primary prophylaxis in the rest&nbsp;of them. All the patients had band ulcers after two weeks. The mean size of the largest ulcer was&nbsp;1.62±0.72 and 1.10±0.60 (p=0.78) respectively in groups A and B. Low albumin was significantly&nbsp;associated with OR of 8.7 (95% CI:1.68-44.99) for the formation of multiple (more than two)&nbsp;ulcers (p=0.01).<br><strong>Conclusions:</strong> The ulcer formation was universal after band application. The addition of sucralfate&nbsp;did not offer more benefits in terms of the number and mean size of the ulcer. Low albumin was the&nbsp;independent predictor for multiple ulcer formation.</p> Binod Karki, Ramila Shrestha, Bidhan Nidhi Paudel, Sudhamshu KC, Dibas Khadka, Suresh Thapa, Bibek Kumar Purbey, Sanjit Karki, Pukar Thapa, Amrendra Mandal ##submission.copyrightStatement## Tue, 10 Dec 2019 00:00:00 +0000 Use of Low Dose Pregabalin for Attenuation of Hemodynamic Response to Laryngoscopy and Intubation in Treated Hypertensive Patients <p><strong>Introduction:</strong> Laryngoscopy and tracheal intubation are two powerful noxious stimuli that can be&nbsp;potentially deleterious especially in hypertensive patients. This study evaluated the efficacy of low&nbsp;dose oral pregabalin used as a premedication for attenuation of this marked sympathetic response&nbsp;of airway instrumentation.<br><strong>Materials and Methods:</strong> This was a double-blind randomised study done at a tertiary level referral&nbsp;hospital. The trial was registered as UMIN-000037103 ( Patients&nbsp;were randomly assigned into two groups. Placebo arm received multivitamin capsule and treatment&nbsp;arm received Cap. Pregabalin (75 mg), 60 minutes before the induction of general anesthesia.&nbsp;The level of preoperative sedation was assessed with the Ramsay Sedation Scale. Heart rate,&nbsp;systolic, diastolic and mean arterial blood pressure were monitored and recorded before and during&nbsp;induction, during laryngoscopy and 1, 3 and 5 minutes of intubation.<br><strong>Results:</strong> A total of 50 patients, 25 in each arm were enrolled. The baseline characteristics were&nbsp;comparable. SBP was significantly lower in the Pregabalin group than in Placebo at all the periods&nbsp;of recording, however, DBP and MAP decreased significantly during, after 1 and 3 minutes of&nbsp;laryngoscopy (p=0.001). Sedation was significantly better in the Pregabalin group with 86% in RSS&nbsp;3 compared to 80% of a placebo arm in RSS2 (P &lt;0.001).<br><strong>Conclusions:</strong> Premedication with a single oral dose of Pregabalin (75 mg) is effective for sedation&nbsp;and attenuation of hemodynamic response to direct laryngoscopy and endotracheal intubation in&nbsp;controlled hypertensive patients without any side effects.</p> Puja Thapa, Sunita Panta, Mallika Rayamajhi, Santosh Khadka, Bishwo Ram Amatya, Ashish Shah, Thanesore Rizal, Bhuwan Raj Kunwar ##submission.copyrightStatement## Sun, 15 Dec 2019 00:00:00 +0000 Outcomes of Retrograde Intra-Renal Surgery <p><strong>Introduction:</strong> Miniaturization of endoscopic instruments has gained wide popularity in the&nbsp;treatment of renal calculi. Retrograde intra-renal surgery and holmium laser in combination has&nbsp;already proven its superiority when compared to other modalities in the treatment of renal calculi.&nbsp;This study was conducted to assess the outcome of retrograde intra-renal surgery in renal stone&nbsp;disease.<br><strong>Materials and Methods:</strong> This retrospective study analyzed the outcome of retrograde intra-renal&nbsp;surgery in renal stone less than 2 cm size in the adults above 18 years of age from September 2018&nbsp;to August 2019 at Patan Hospital, Nepal. The outcome was assessed descriptively on postoperative&nbsp;pain and fever, stone localization, stone size, stone clearance, urosepsis, operative time, hospital&nbsp;stay, mortality, need of the second procedure.<br><strong>Results:</strong> A total of 62 patients underwent retrograde intrarenal surgery, out of which 48 cases&nbsp;were included. The mean age of the study population was 32.4± 14 years (19-68 years). Similarly,&nbsp;the mean operative time was 68± 12 (48-124 minutes) and mean hospital-stay was 3.2± 1.1 days.&nbsp;Postoperative pain and fever were observed in 14 (29.16%) &amp; 4(8.33%) patients respectively.&nbsp;Hematuria occurred in 6(12.50%) and urosepsis in 2(4.16%) of the patients. Complete stone&nbsp;clearance was achieved in 34(70.83%) and residual stones were present in 8(16.66%) and clinically&nbsp;insignificant radiological fragments were present in 6(12.50%) patients.<br><strong>Conclusions:</strong> Retrograde intrarenal surgery is a technically safe and effective procedure for the&nbsp;treatment of renal calculi, with minimal post-surgical morbidity.</p> Samir Shrestha, Pukar Maskey ##submission.copyrightStatement## Tue, 17 Dec 2019 00:00:00 +0000 A Comparative Study of RIPASA Score and Modified Alvarado Score in Acute Appendicitis in Nepalese Population <p><strong>Introduction:</strong> Although acute appendicitis is a common surgical condition, its diagnosis can be&nbsp;elusive at times with misdiagnosis leading to serious complications. Various scoring systems have&nbsp;been developed to overcome this dilemma and the reported accuracies of these scores vary greatly.<br><strong>Materials and Methods:</strong> A retrospective review of charts was carried out to identify all patients&nbsp;admitted to KIST medical college teaching hospital from May 2015 to April 2016 with the diagnosis&nbsp;of acute appendicitis. A total of 120 cases that underwent surgery for suspected acute appendicitis&nbsp;were included. Modified Alvarado score and RIPASA scores were computed for each patient and&nbsp;the suggested cutoff values were used to find out the accuracy of these scores. Histopathological&nbsp;confirmation/report was considered as the standard for comparison.<br><strong>Results:</strong> A negative appendectomy rate of 11.67 % was observed (9.64 % for males and 16.22 %&nbsp;for females). Complicated appendicitis was found in 27.36% of patients. Modified Alvarado score&nbsp;had a sensitivity of 61.32 % and specificity of 71.43 % at a cut of value of 7. At cut off of &gt; 7.5 for&nbsp;acute appendicitis, RIPASA score had a sensitivity of 97.17% and specificity of 57.14%. The accuracy of Modified Alvarado score was 62.5% while it was 92.5% for RIPASA score.<br><strong>Conclusions:</strong> RIPASA score demonstrated higher sensitivity and accuracy but lower specificity&nbsp;compared to the modified Alvarado score in our study group. More studies with larger sample size&nbsp;need to be carried out for further validation of this new score.</p> Niroj Banepali, Kamal Koirala, Rupesh Mukhiya, Rakesh Roshan Sthapit ##submission.copyrightStatement## Mon, 16 Dec 2019 00:00:00 +0000 Diffuse Alveolar Haemorrhage: A Single Centre Experience <p class="Normal1" style="text-align: justify; line-height: 200%;"><strong>Introduction:</strong> Diffuse alveolar hemorrhage results from an accumulation of red blood cells&nbsp;into the alveolar space. Symptoms of alveolar hemorrhage are dyspnea, hemoptysis, anemia,&nbsp;diffuse pulmonary infiltrates and hypoxemic respiratory failure. Diagnosis is established by&nbsp;bronchoalveolar lavage and treatment includes a combination of high dose systemic corticosteroids,&nbsp;immunosuppressant and plasma exchange. The aim of this study is to evaluate the clinical radiological&nbsp;profile and laboratory findings and utility of bronchoalveolar lavage in the diagnosis&nbsp;of diffuse alveolar hemorrhage.<br><strong>Materials and Methods:</strong> In a retrospective review between February 2017 and December 2017,&nbsp;medical records of patients with a diagnosis of diffuse alveolar hemorrhage presenting at the&nbsp;National Academy of Medical Sciences, Kathmandu, Nepal, were analyzed. Clinical, radiology and&nbsp;laboratory results along with bronchoalveolar lavage results were extracted. Treatment received&nbsp;and clinical responses were evaluated.<br><strong>Results:</strong> A total of five patients were diagnosed to have diffuse alveolar hemorrhage based on&nbsp;bronchoalveolar lavage analysis. Three had hemorrhage secondary to Antineutrophil Cytoplasmic&nbsp;Antibody associated vasculitis, one had Systemic Lupus Erythematosus and the other Idiopathic&nbsp;Pulmonary Hemosiderosis. Renal involvement was present in three patients. All patients received systemic corticosteroids, three received Cyclophosphamide and one Rituximab for remission&nbsp;induction. Plasma exchange was done in two patients with severe hypoxemia. Of the five patients,&nbsp;four improved whereas one died.<br><strong>Conclusions:</strong> Diffuse alveolar hemorrhage presents with non-specific symptoms. Bronchoalveolar lavage is extremely&nbsp;useful to establish the diagnosis and exclude infections. Early initiation of immunosuppressant&nbsp;prevents respiratory failure and death.</p> Ashesh Dhungana, Prajowl Shrestha ##submission.copyrightStatement## Tue, 17 Dec 2019 00:00:00 +0000 Primary Salivary Gland Tumors- A two years study at Nobel Medical College <p><strong>Introduction:</strong> Salivary gland tumors are a heterogeneous group of neoplasms that are relatively&nbsp;rare but represent a wide variety of both benign and malignant histopathologic subtypes. The aim&nbsp;of this study was to find out the histopathological distribution of primary salivary gland tumors and&nbsp;correlate fine needle aspiration cytology reports with histological findings.<br><strong>Materials and Methods:</strong> A total of 83 patients attending the otorhinolaryngology department with&nbsp;salivary gland tumors were enrolled in our study. The histopathological findings were reported and&nbsp;correlated with cytological findings.<br><strong>Results:</strong> The mean age of the patient with salivary tumors was 43.11 ± 13.02 years. Out of 83&nbsp;cases, 3 (3.6%) patients were diagnosed as inflammatory lesions, 64 (77.1%) patients had benign&nbsp;salivary gland tumors and 16 (19.3%) of patients had malignant salivary glands tumors in&nbsp;histopathology. The sensitivity and specificity of FNAC in this series for detecting salivary gland&nbsp;malignancy were 68.8% and 98.5% respectively with an overall diagnostic accuracy of 92.8%. The&nbsp;most common salivary gland tumor was found to be pleomorphic adenoma (56.6%) and the most&nbsp;common malignant salivary gland tumor was found to be mucoepidermoid carcinoma (19.3%). The&nbsp;comparison of the incidence of salivary gland tumors in various age groups showed a statistically<br>significant difference (p=0.009).&nbsp;</p> <p><strong>Conclusions:</strong> Benign salivary tumors are more common than malignant tumors with the most&nbsp;common occurrence in parotid glands. Pleomorphic adenoma is the most common benign tumor&nbsp;whereas; mucoepidermoid carcinoma is the most common malignant tumor in patients visiting&nbsp;Nobel medical college.</p> Niraj Nepal, Prabesh Kumar Choudhary, Manish Kumar Das, Meenakshi Basnet, Sagar Paudel ##submission.copyrightStatement## Sun, 15 Dec 2019 00:00:00 +0000 Comparison of Use of Misoprostol versus Manual Vacuum Aspiration in the Treatment of Incomplete Abortion <p><strong>Introduction:</strong> Early pregnancy failure is a major health problem throughout the world. Expulsion&nbsp;of some but not all products of conception before 20 weeks of pregnancy abortion is incomplete&nbsp;abortion. This study was to find about the safety, efficacy, and acceptability of misoprostol in&nbsp;comparison to manual vacuum aspiration for the treatment of incomplete abortion so the safe and&nbsp;convenient method can be used in diverse settings in different parts of our country.<br><strong>Materials and Methods:</strong> A prospective comparative interventional study carried out between&nbsp;October 2011 to March 2012 AD (Kartik 2068 to Chaitra 2068 BS) in Paropakar Maternity and&nbsp;Women’s Hospital, Thapathali. All eligible women with a diagnosis of incomplete abortion of &lt; 13&nbsp;weeks of gestation either from LMP or Ultrasound were divided into two groups. Group 1 includes&nbsp;all odd numbers of cases under study group to whom 600 mcg Misoprostol was given orally. Group&nbsp;2 includes all even the number of cases under study group to whom manual vacuum aspiration was&nbsp;done.<br><strong>Results:</strong> Out of 60 women enrolled in the study, 30 were enrolled in Group 1(Misoprostol P.O.)&nbsp;and 30 in Group 2 (manual vacuum aspiration). The study showed no significant difference in the&nbsp;efficacy of the Misoprostol as compared to manual vacuum aspiration (93.33% vs. 100%).<br><strong>Conclusions:</strong> The efficacy of oral Misoprostol is as effective as manual vacuum aspiration in the&nbsp;treatment of first trimester incomplete abortion with comparable success rate.</p> Bishal Khaniya, Rashmi Yadav ##submission.copyrightStatement## Thu, 19 Dec 2019 00:00:00 +0000 Overlap of Sleep Disorders and Chronic Respiratory Diseases: An Emerging Health Dilemma <p><strong>Introduction:</strong> The burden of Overlap Syndrome (coexistence of sleep-related breathing disorders in&nbsp;patients with respiratory diseases) is high in developing countries, and such a phenomenon implies&nbsp;higher morbidity. The study was conducted to measure the prevalence of sleep-related breathing&nbsp;disorders in patients with Respiratory Symptom Complex and to identify factors associated with the&nbsp;severity of sleep-related breathing disorders.<br><strong>Materials and Methods:</strong> A hospital-based cross-sectional study of 50 patients with respiratory&nbsp;symptom complex was conducted at BP Koirala Institute of Health Sciences. Structured proforma&nbsp;and Polysomnography were used for analysis.<br><strong>Results:</strong> There were 24 patients (48%) with COPD, 18 (36%) with Bronchial Asthma. 6 patients&nbsp;(12%) with Bronchiectasis and 2 patients with Interstitial Lung Disease. 60% (n=30) patients had&nbsp;sleep-related breathing disorder or Overlap syndrome, 14 patients (46.67%) had mild sleep-related&nbsp;breathing disorder while 16 (53.33%) patients had moderate to severe type. 62.5% COPD patients,&nbsp;55.55% Bronchial Asthma patients, 50% of patients with Interstitial Lung Disease and 50% Post-TB Bronchiectasis patients had a sleep-related breathing disorder. There was a significant positive&nbsp;correlation between the presence of sleep-related breathing disorder in patients with respiratory&nbsp;symptom complex and high neck circumference (0.499, p-value &lt;0.001), waist circumference (0.293,&nbsp;p-value = 0.039) and hip circumference (0.371, p-value = 0.008).<br><strong>Conclusions:</strong> Overlap Disorders comprising sleep disorders in patients with chronic respiratory&nbsp;diseases are high in developing countries. Routine sleep history and polysomnography in all&nbsp;patients with Respiratory Symptom Complex can detect sleep-related breathing disorders.</p> Puru Koirala, Narendra Bhatta, Ram Hari Ghimire, Deebya Raj Mishra, Bidesh Bista, Bhupendra Shah ##submission.copyrightStatement## Sun, 22 Dec 2019 00:00:00 +0000 Epidemiological Profile and Determinants of Tuberculosis in Urban Nepalese Population <p><strong>Introduction:</strong> Tuberculosis has evolved through ages to remain a major cause of morbidity and&nbsp;mortality worldwide. Despite having a very successful Directly Observed Treatment, Short-course&nbsp;program, tuberculosis is still one of the most widespread infections in Nepal. This study was done&nbsp;to observe the epidemiological profile of tuberculosis patients in an urban Nepalese population.<br><strong>Materials and Methods:</strong> 585 newly diagnosed cases of pulmonary and extrapulmonary&nbsp;tuberculosis in two tertiary level hospitals in the country were enrolled in the study during a period&nbsp;of 18months. A standard questionnaire was formatted and the required information was acquired&nbsp;with the help of interview and investigation reports.<br><strong>Results:</strong> The mean age of presentation was 35.76 with a male to female ratio of 1.48:1.57% of the cases had less than primary education with 26 % being illiterates. The most commonly&nbsp;involved occupational group was farmers (22%) followed by students (20%) and laborers (14%).&nbsp;22% of cases had a history of contact with tuberculosis in the family. 41 % were smokers and 18&nbsp;% abused alcohol. Pulmonary tuberculosis comprised 68% of the total cases. The most common&nbsp;extrapulmonary presentation was lymph node TB (28%) followed by pleural effusion (21.5%) and&nbsp;tubercular meningitis (16%).<br><strong>Conclusions:</strong> Young people with lower literacy levels and with a family history of tuberculosis are&nbsp;at increased risk of acquiring tuberculosis and&nbsp;community approaches for tuberculosis control should target this group to reduce the burden of the disease</p> Subash Bhatta, Nayana Pant ##submission.copyrightStatement## Sun, 22 Dec 2019 00:00:00 +0000 Sonographic Assessment of Renal Length of Adults in Lagos, Nigeria <p><strong>Introduction:</strong> Ultrasound is an important imaging modality used in the prognosis and diagnosis of renal conditions and diseases and also in the evaluation of kidney donors. This study aimed at&nbsp;providing a reference for the normal metric variables of the kidney such kidney lengths of healthy&nbsp;Nigerian adults in Lagos State and to compare with previously obtained results.<br><strong>Materials and Methods:</strong> This study was conducted in the radiology department of Ikorodu&nbsp;Hospital. This study adopted a descriptive cross-sectional&nbsp;study design with a cluster sampling approach which consisted of 150 adults (with 300 kidneys)&nbsp;participants ages 18-87 years. Real-time gray-scale ultrasonic scanning using Prosound 3500 Aloka&nbsp;device and a 3.5–5 MHz curvilinear explorer was employed for the abdominal imaging. The data&nbsp;acquired were compiled and explored via the Statistical Package for the Social Sciences (SPSS)&nbsp;version 20. The student’s t-test was utilized in probing for statistical significance between age as&nbsp;well as gender in relation to renal length. P-value &lt; 0.05 was adjudged to be significant.<br><strong>Results:</strong> The kidney length was of a greater distance in males, and the length of the left kidney was&nbsp;more extensive than that of the right kidney in both sexes. Average kidney length was greater on&nbsp;the left when compared to the right among the various age groups. No significant association was&nbsp;noted between kidney length and age as well as gender.<br><strong>Conclusions:</strong> Normal values for kidney length and diversifications in the kidney length of healthy&nbsp;adults in Nigeria have been established.</p> Ese Anibor ##submission.copyrightStatement## Sun, 22 Dec 2019 00:00:00 +0000 Gingival Overgrowth as a complication of kidney transplantation – Nepali perspective <p>Gingival Overgrowth is a known and common complication with multifactorial etiology seen in kidney transplant recipients. Gingival Overgrowth is induced in kidney transplant recipients by Cyclosporin A and Calcium Channel Blockers that are frequently prescribed to them as immunosuppressive and antihypertensive, respectively. There have been 1477 kidney transplantations in Nepal since&nbsp;the first kidney transplantation in 2008, but cases of gingival Overgrowth have not been reported in&nbsp;any publications. The aim of this review is to discuss the different aspects of gingival Overgrowth&nbsp;and its relevance to kidney transplant recipients of Nepal. This review will emphasize the need to&nbsp;examine the oral cavity of kidney transplant recipients. Genetic predisposition, oral health, and&nbsp;offending drugs are involved in the pathogenesis of gingival Overgrowth. This review discusses&nbsp;the pathogenesis, clinical features, and management aspects of gingival Overgrowth in kidney&nbsp;transplantation recipients. The reason for gingival Overgrowth not being reported in Nepal could&nbsp;be due to various reasons like favorable genes, good oral hygiene, or avoidance of drugs that&nbsp;cause gingival Overgrowth in kidney transplantation recipients. This could also be due to gingival&nbsp;Overgrowth being ignored by the patients and the treating doctors. These aspects are reviewed with&nbsp;reference to previous publications.</p> Swosti Thapa, Robin Bahadur Basnet, Bikal Shrestha, Amresh Thakur, Neesha Shrestha, Anup Lal Shrestha, Nabin Bahadur Basnet ##submission.copyrightStatement## Sun, 22 Dec 2019 00:00:00 +0000 Elevated Total Testosterone Level in an Adult with Erectile Dysfunction <p>Erectile dysfunction affects a growing number of men with a significant impact on social function.&nbsp;The cause may be medical and psychological both. Of many risk factors for erectile dysfunction, hyperthyroidism can lead to increased total testosterone by an increase in sex hormone-binding&nbsp;globulin secreted from the liver. Here, we present a case of an adult male with a high total&nbsp;testosterone level who complained of erectile dysfunction. On a complete review of medical&nbsp;history and additional laboratory tests, the diagnosis of hyperthyroidism leading to increased total&nbsp;testosterone was made. The complete review of the patient’s history before hormonal analysis helps&nbsp;to troubleshoot the mismatch between clinical symptoms and laboratory results.</p> Vivek Pant, Devish Pyakurel, Keyoor Gautam, Santosh Pradhan, Abha Shrestha ##submission.copyrightStatement## Tue, 24 Dec 2019 00:00:00 +0000 Sjögren–Larsson Syndrome: A Case Report of a Rare Neuro-cutaneous Disorder <p>Sjögren–Larsson syndrome is a rare autosomal recessive neuro-cutaneous disease. The dominant&nbsp;features are congenital ichthyotic hyperkeratosis, spastic diplegia and mild to moderate&nbsp;mental retardation. The cause of this syndrome is the deficiency of microsomal fatty aldehyde&nbsp;dehydrogenase. The deficiency of this enzyme results in the accumulation of fatty aldehydes and&nbsp;fatty alcohols in various tissues including skin. Here, we report a case presented with ichthyosis,&nbsp;bilateral lower limb spasticity, and mental retardation, diagnosed as Sjögren–Larsson syndrome.</p> Manish Pradhan, Arun Giri, Dipa Rai, Rajeev Yadav ##submission.copyrightStatement## Thu, 26 Dec 2019 00:00:00 +0000 An Unusual Case of Wart-like Presentation of Ocular Surface Squamous Neoplasia <p>The ocular surface squamous neoplasia refers to the entire spectrum ranging from mild to severe&nbsp;dysplasia to carcinoma in situ and invasive squamous cell carcinoma. Ocular surface squamous&nbsp;neoplasia may present clinically in various ways: gelatinous, velvety or papilliform or leukoplakic.&nbsp;This case report describes a 50-year-old male who presented with a filiform wart-like appearance&nbsp;of conjunctival mass unlike described earlier. Excisional biopsy was done and histopathology&nbsp;revealed intraepithelial neoplasia with high-grade dysplasia.</p> Nirsara Shrestha, Sangeeta Shrestha, Arjun Shrestha ##submission.copyrightStatement## Tue, 31 Dec 2019 00:00:00 +0000