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Background: To study common gynaecological problems in adolescent girls and to establish the need of adolescent clinic.Methods: A prospective study was conducted including 250 adolescent girls attending gynaecology OPD. Girls were evaluated by detailed history, thorough clinical examination and investigations such as haemogram, coagulation profile, hormonal assays, ultrasound examination of abdomen and pelvis, as and when indicated.Results: Majority of girls had complaints related to menstrual disorders i.e. 58.3%. Most common causes of menstrual abnormalities were dysfunctional uterine bleeding (42.85%) followed by polycystic ovarian syndrome (26.19%) and pelvic inflammatory disease (15.47%).Conclusions: Problems are specific to this age group, setting up of separate adolescent clinics is desirable of efficient management where they can be provided adequate privacy to discuss their problems openly.

Background: Paired kidney exchange (PKE) is a therapeutic strategy where two or more pairs of donor and recipient exchange kidneys between themselves in order to avail an immunologically better compatible organ. It is a cheaper option as compared to the complicated and expensive procedures of pretransplant immune desensitization or ABO-incompatible kidney transplantation. PKE demands high level of commitment from the patients, donors and the transplantation medical team. This is a report of two-way PKE done in the pioneer transplant institute of Nepal. Methods: Medical records of patients who had undergone PKE in the institute were retrieved. Necessary data was captured and retrospective analysis of the characteristic data was done. Results: First two-way PKE was done in February 14, 2018. Six pair of two-way PKE were performed in the last 4 years. Four (66.67%) pairs were due to unavailability of blood group compatible donor in the legitimate living donor pool and two (33.33%) pairs were due to positive tissue crossmatch despite having a blood group compatible donor. Three (25%) recipients and nine (75%) donors were female. Mean age at transplantation was 40.16 (range, 24-63 years). Basiliximab was used as induction agent in one patient who was treated for hepatitis C, while all others were induced with rabbit thymoglobulin. Three had rejection. One had mixed cellular and humoral rejection on day 4 of transplantation. One had a cellular rejection in the ninth month while the other had a humoral insult, after a year of kidney transplant. Eleven (91.6%) of them survived for at least 6 months. Nine (90%) of the 10 patients transplanted at least 12 months before analysis survived at least one year. Of the total 12 patients, two died. Both deaths were both due to sepsis. Conclusions: PKE is a rationale strategy to reduce the costs of kidney transplantation.

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