Background: Lichen planus(LP) is a unique common inflammatory disorder that is clinically characterized by violaceous pruritic flat polygonal papules or plaques. Recently, an association between LP and diabetes mellitus has been viewed with greater interest.Several studies done in assessing the association between these show conflicting results. Aims and Objectives: The aim of this study was to find an association between LP and diabetes mellitus. Materials and Methods: A cross-sectional comparative study was conducted in the Outpatient Department (OPD) of Dermatology, Bir Hospital. Any patient presenting at dermatology OPD above 16 years of age with LP were taken as cases. Age- and gender-matched patients with skin disease other than LP were taken as controls. The test was done by collecting 2ml of blood and serum HbA1c level was assessed allowing the blood to stand in a cuvette for 5 min inside the Erba Mannheim XL-300 analyzer to interact with DS5 reagent. The result was interpreted as per the calibration in the printed chromatogram. Results: Male preponderance with a male: female ratio of 1.08:1 was found in this study. The mean age of onset of LP was earlier in male 40.11 years than in female 44.66 years.Likewise, hypertrophic(30%) followed by eruptive(27.5%) wasthe most common variants of LP found in this study. Diabetes was more common in males(75%) with LP than in females(25%) with LP. Patients having longer duration of LP were more commonly associated with diabetes mellitus. Among clinical variants of LP, diabetes was associated more with eruptive variant followed by classic and hypertrophic variants. The prevalence of diabetes was higher in case(16%) than in control(4%),P=0.046. Conclusion: This study showed an association of LP with diabetes mellitus, the association being statistically significant(P=0.046). It, therefore, is desirable to do HbA1c level screening in patients with LP for timely detection of diabetes mellitus.

Background: Intertrochanteric fracture is a common condition seen in elderly population which is managed with operative procedure in the department of orthopedics. The proximal femoral nail antirotation (PFNA) system was developed by the AO/ASIF in 2004 for this fracture that provides optimal anchoring and stability when the implant is inserted into the osteoporotic bone. The main characteristic of the implant is the use of a single blade with a large surface area and insertion of the blade compacts the cancellous bone. Aims and Objectives: The aim of the study was to study the functional outcome of intertrochanteric fracture managed with PFNA2. Materials and Methods: The prospective and observational study was conducted in patients diagnosed with intertrochanteric fracture admitted in orthopedic ward, Western Regional Hospital, Pokhara. Pre- and post-operative fracture alignment, Harris hip score (HHS), post-operative complications were taken into account. Results: Out of 55 cases taken into study, 36 (65.45%) were male and 19 (34.55%) were female. Maximum number of patients allocated in our study falls in 71–80 years group (29%) with least number in age group of 90 years or more (1.9%). Right-sided intertrochanteric fracture were 27 (49%) and left side involved were 28 (51%). Twenty-eight (51%) falls in Type II and 27 (49%) falls in Type III Boyd and Griffin intertrochanteric fractures. There was a marked improvement in fracture alignment after the operation with various parameters taken into consideration. Pre-operative HHS was 5.52±5.38 (Poor) and immediately after the procedure, it was 30.41±3.04 (Poor), 89.86±3.59 (Good) at 6 months, and 95.56±1.257 (Excellent) at 12 months. One case had blade cut out at immediate post-operative period, eight cases had surgical site infection, and five cases had GT fracture. Conclusion: This study showed that PFNA2 is an effective operative procedure in management of intertrochanteric fractures by achieving better fixation through bone impaction especially in osteoporotic bone.

Background: Melasma is a common acquired pigmentary disorder that is aesthetically displeasing. Kligman’s and Modified Kligman’s formula using topical steroids, hydroquinone and retinoids, and various other depigmenting agents is being widely used all over for melasma with varying results. Chemical peeling is newly added to the therapeutic armamentarium and is showing encouraging results worldwide in patients with melasma. However, comparative studies are lacking in abundance in our part of the world. Aims and Objectives: To determine if serial trichloroacetic acid peels provide additional benefits when combined with time-tested topical therapy with hydroquinone 4% in patients with melasma. Materials and Methods: Fifty melasma patients were divided into two groups of 25 each. One group received serial trichloroacetic acid peel combined with topical hydroquinone 4%. The other group only received topical hydroquinone 4% cream. The results were evaluated by a clinical investigator both subjectively and with photographs taken at baseline, 12 weeks, and 21 weeks. For clinical evaluation, the melasma area and severity index (MASI) was used. Results: A significant decrease in MASI score from baseline to 21 weeks was observed in both groups (P<0.001). The group receiving the trichloroacetic acid peel 20% showed a trend toward more rapid and greater improvement, with statistically significant results (P<0.001). Only a few side effects were observed in the peel group. Conclusion: This study demonstrates that serial trichloroacetic acid peels provide an additional effect to a topical regimen of 4% hydroquinone cream for treating melasma in Fitzpatrick skin types III and above if used judiciously and under supervision. It demonstrates that superficial chemical peels can be used as an adjunct with better efficacy to treat patients with melasma.