Intorduction: Vulval disorders can be of venereal and non-venereal etiology. Establishing non-venereal causation of vulval disorder helps in alleviating fears in patients with the condition. These patients are better dealt in a multidisciplinary clinic as patients with these disorders frequently visit dermatologists and gynecologists for the treatment. Objectives: To study the clinico-demographic profile of women with non-venereal vulval disorders and to determine their relative frequency. Materials and Methods: This is an observational, descriptive study done at the Departments of Dermatology and Venereology and Gynecology and Obstetrics, Nepal Medical College Teaching Hospital. All consenting female patients with problems pertaining to female external genitalia were recruited for the study after excluding venereal diseases. Details of the patients were obtained and entered in a predesigned proforma. Results: Seventy-five females were recruited during a period of 20 months with a mean age of 34.79±17.90 years. Majority were married, uneducated and homemakers. Duration of disease ranged from 3 days to 35 years. Itching was the commonest presenting complaint (82.67%) followed by redness (32.00%), burning sensation (26.67%), white lesions (24.00%) and pain (24.00%). Commonest diagnosis was lichen sclerosus (17.33%), followed by candidiasis (14.67%). Patients presenting with vulval symptoms without lesions were diagnosed with non-specific vulval pruritus (9.33%) and vulvodynia (2.67%). Conclusion: Itching is the most common presenting complaint and contrary to the popular belief, inflammatory disorders especially lichen sclerosus, rather than infections were common diagnoses in females with non-venereal vulval disorders.

Purpose Displaced type 2 lateral end clavicle fractures have a tendency to delayed union or non-union. Various methods of stabilisation of the displaced lateral end fractures are described. The increasing use of implants to fix such fractures also necessitates extensive dissection for implant retrieval. Adequate reduction and minimal tissue trauma during implant placement and removal would be ideal modalities for fixation of such fractures. Methods All displaced type 2 lateral end clavicle fractures fulfilling our inclusion criteria were reduced with a small anterosuperior incision. Anteroposterior drill holes were made in both the fragments and a nonabsorabable polyester suture was passed through. The fracture was reduced and fixed with transacromial smooth Kirshner wires. The suture was tied with the knot superiorly in a figure-eight manner. The arm was supported in an arm pouch for six weeks. The Kirshner wire was routinely removed after six weeks in an out-patient department. Clinico-radiological outcome was studied at six weeks, and monthly intervals thereafter until union. Results All 16 fractures united. The mean average age of patients was 36.25 years with a SD of 11.35. There was no loss of reduction even after removal of Kirshner wires at six weeks. The mean average time of union was 10.75 weeks with a SD of 3.92. All patients regained near normal range of motion, and the mean average constant score at the end of one year was 98.37 with a SD of 2.87. All patients returned to preinjury level by the one-year follow-up. The range of motion remained the same in those who were followed up in successive years. Skin impingement with bent Kirshner wires were noted in four cases. Kirshner wires backed out in one case before six weeks but there was no loss of reduction. Infection and Kirshner wire breakage were not noted in our series. Conclusion The clinico-radiological outcomes with our modified tension band fixation for displaced type 2 lateral end clavicle fractures were encouraging and comparable with earlier studies.

Background: Accurate estimation of fetal weight is of paramount importance in the management of labour and delivery.Methods: This was a cross sectional study conducted over a period of 6 months in a tertiary care teaching hospital. All singleton term mothers with cephalic presentation and intact membranes with ultrasound examination done within a week were included in the study. IUFD, multiple gestation, malpresentation, diagnosed oligohydramnios or polyhydramnios, pelvic and or abdominal masses, and current weight more than 80 Kgs were excluded from the study. Expected fetal weight was estimated by clinical method (Johnson's formula), which was compared with Ultrasound weight estimation (Hadlock method) and actual birth weight. Results:The estimated mean birth weight by clinical method was 3492.75±393.16g, by Ultrasound was 3230.02±407.22g and actual mean birth weight was 3236.32±472.87g. The estimated birth weight by ultrasonographic method showed slightly stronger positive correlation (r=0.54; p<0.001) with actual birth weight as compared to the clinical method (r=0.44; p<0.001). The error of estimation of weight by clinical method showed significant negative correlation (r=-0.24; p=0.01) with gestational age, however ultrasonographic method did not show significant correlation (r= +0.045; p=0.64). The sensitivity and specificity of clinical method and ultrasonographic method for identifying fetal birth weight above 3500 gm was 69.23; 65.67% and 46.15; 80.60%, respectively. Conclusions:Ultrasound was more reliable method to establish fetal weight at term and more consistent in various period of gestations. Clinical method can be reliably used to screen large babies in centers where ultrasound has limited availability.

The traditional approach for plating of distal tibia had many problems. Minimally invasive percutaneous plate osteosynthesis for periarticular fractures are considered ideal these days with the availability of locking compression plate. However, this procedure demands radiation exposure. Indirect reduction, percutaneous plate positioning, and drill guide insertion all may require abundant radiation exposure. Minimizing radiation can still be done at the cost of extended skin incision. But we describe our technique of minimizing radiation and incision in minimally invasive percutaneous plate osteosynthesis in distal tibial fractures.

Introduction: Metabolic syndrome in polycystic ovarian syndrome is associated with a long-term risk of developing type 2 diabetes mellitus and cardiovascular disease. This study aims to find the prevalence of metabolic syndrome among patients with polycystic ovarian syndrome presenting to a tertiary care hospital. Methods: A descriptive cross-sectional study was done on women attending the obstetrics and gynecology outpatient department of a tertiary care hospital from June 2020 to May 2021. A total of 106 women diagnosed with polycystic ovarian syndrome using Rotterdam criteria 2003 were recruited for the study and cases of metabolic syndrome was defined according to the modified American Heart Association/National Heart Lung and Blood Institute. Ethical approval was taken from the Institutional Review Committee of Nepal Medical College and Teaching Hospital (Reference number: 001-077/078). Convenience sampling was done. The collected data was entered and analyzed in Statistical Package for the Social Sciences version 21. Calculation of point estimate at 95% confidence interval was done along with frequency and proportion for binary data. Results: Among 106 women with polycystic ovarian syndrome, 50 (47.1%) had metabolic syndrome (37.59-56.60 at 95% Confidence Interval). The most common component of metabolic syndrome was low high-density lipoprotein cholesterol in 90 (84.9%) followed by central obesity in 60 (56.6%), hypertriglyceridemia in 47 (44.33%), high fasting sugar in 34 (32.07%), and high blood pressure in 14 (13.2%). Conclusions: The prevalence of metabolic syndrome among patients with the polycystic ovarian syndrome was similar to other studies done in similar settings.