Background Pachydermoperiostosis (PDP) is a rare disorder characterized by clubbing of the fingers, thickening of the skin (pachyderma), and excessive sweating (hyperhidrosis). It typically appears during childhood or adolescence, often around the time of puberty, and progresses slowly. Clinical presentations of PDP can be confused with secondary hypertrophic osteoarthropathy, psoriatic arthritis, rheumatoid arthritis, thyroid acropachy, and acromegaly. Case presentation A Mongolian male, aged 19 years, resident of a hilly district of Nepal, with history of consanguinity, presented to our outpatient department with chief complaints of pain and swelling in both hands and feet for 6 years. The pain was insidious in onset, throbbing in nature, and not relieved by over-the-counter medications. The patient also complained of profuse sweating, progressive enlargement of hands and feet, and gradual coarsening of facial features. On examination there were marked skin folds in the forehead, face, and eyelids. Clubbing and swelling of bilateral knee joints and ankle joints was also evident. He was subsequently investigated extensively for acromegaly. Insulin-like growth factor-1 level and oral glucose tolerance test were normal. Radiography of various bones showed periosteal hypertrophy with subperiosteal bone formation. Conclusions PDP should be considered as a differential diagnosis when a patient presents with hypertrophic osteoarthropathy and acromegalic features.

A pleural effusion is defined to be eosinophilic when 10% or more of the white blood cells in pleural fluid are eosinophils. Despite the multitude of studies enumerating the causes of eosinophilic pleural effusion (EPE), 14%-25% of such cases remain idiopathic even after thorough work-up. We report a case report of a 28-year-old never smoker male from the Rukum district of Nepal who presented to the emergency department (ED) with a chief complaint of shortness of breath associated with a low grade fever, nonproductive cough, and pleuritic right-sided chest pain for two weeks. There was no past medical and surgical history of note. Clinical examination revealed findings suggestive of a right-sided pleural effusion and relevant laboratory and radiological investigations were performed. Symptomatic treatment for the fever was administered. Full blood count showed a leukocytosis of 34 × 10 9 /L with an absolute eosinophil count (AEC) of 7.5 × 10 9 /L (22%). Peripheral blood smear showed normocytic normochromic erythrocytes with eosinophilia (morphologically normal eosinophils). Autoimmune profile was normal, inflammatory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were raised, and an ultrasound and a plain radiograph of the chest confirmed the right-sided pleural effusion. Empirical anti-helminthic coverage was instituted. Subsequent infectious disease work-up was negative. An ultrasound-guided thoracentesis was performed, and the straw-colored pleural fluid showed an exudative picture which was eosinophil-predominant (42%). No malignant cells were detected. Failure of response to anti-helminthic therapy for one week led the team to start oral prednisolone 1 mg/kg once daily with the dose tapered subsequently. The patient responded dramatically. This was continued for one week and a regression of pleural effusion was demonstrated on chest radiography with a normalization of inflammatory parameters (ESR and CRP) and peripheral blood counts. Outpatient follow-up after one month showed no remaining clinical and radiological signs of EPE, and the peripheral eosinophilia resolved. As far as we know, this is the first case report of idiopathic EPE in the context of Asia. There are many causes of EPE, and some of them are still being discovered.

This study investigates the framing of the ratification of the Nepali Constitution and the disagreement it raised in newspaper articles published in two countries, Nepal and India, for six months. Using framing analysis, this study compares the way in which Indian and Nepali newspapers differed in terms of frames, tone, and news sources while covering the ratification of Nepal's constitution and the conflict raised after that in the form of an economic blockade (embargo). The content analysis reveals significant differences in the conflict frames between the two countries' newspapers. Newspapers differed also in how they presented the stories, as Indian newspapers used an anti-constitution tone, while Nepali stories were more likely to use a proconstitution tone. And both countries heavily relied on their official sources for the news.

Squamous cell carcinoma of the vulva is predominantly a disease of postmenopausal women; it accounts for 5% of all female genital malignant neoplasms. Postoperative recovery in two among the five operated patient was late as their vulval wound underwent dehiscence. Other three patients had an uneventful post operative period. Histopathology report showed Squamous cell carcinoma in all the cases. Lymphnodes was negative for malignant cells in all the cases. DOI: http://dx.doi.org/10.2126/joim.v35i1.8902   Journal of Institute of Medicine, April, 2013; 35:71-73

Squamous cell carcinoma of the vulva is predominantly a disease of postmenopausal women; it accounts for 5% of all female genital malignant neoplasms. Postoperative recovery in two DPRQJ WKH ¿YH RSHUDWHG SDWLHQW ZDV ODWH DV WKHLU YXOYDO ZRXQG XQGHUZHQW GHKLVFHQFH 2WKHU three patients had an uneventful post operative period. Histopathology report showed Squamous cell carcinoma in all the cases. Lymphnodes was negative for malignant cells in all the cases.