Journal of Nepal Medical Association <p><strong>About JNMA<br></strong>Journal of Nepal Medical Association (JNMA) is an international peer-reviewed, MedLine/PubMed indexed,&nbsp;a general medical journal of Nepal Medical Association. JNMA is the first and oldest medical journal from Nepal since 1963 AD. JNMA is available at <a href="">PubMed</a>, <a href=";query&quot;%3A%7B&quot;filtered&quot;%3A%7B&quot;filter&quot;%3A%7B&quot;bool&quot;%3A%7B&quot;must&quot;%3A%5B%7B&quot;term&quot;%3A%7B&quot;index.issn.exact&quot;%3A&quot;1815-672X&quot;%7D%7D%2C%7B&quot;term&quot;%3A%7B&quot;_type&quot;%3A&quot;article&quot;%7D%7D%5D%7D%7D%2C&quot;query&quot;%3A%7B&quot;match_all&quot;%3A%7B%7D%7D%7D%7D%2C&quot;from&quot;%3A0%2C&quot;size&quot;%3A100%7D">DOAJ</a>, <a href=";btnG=&amp;hl=en&amp;as_sdt=0%2C5">Google Scholar,</a>&nbsp;Index Copernicus, EBSCO, EMBASE and other repositories.&nbsp;<br>JNMA abide by:<br>1. 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The author(s) are allowed to retain publishing rights without restrictions. The JNMA work is licensed under a <a href="" rel="license">Creative Commons Attribution 4.0 International License</a>. More about <a href="">Copyright Policy</a>.</p> Prevalence of Retrocaecal Appendix among Patients with Appendicitis in A Tertiary Care Hospital of Nepal <p><strong>Introduction</strong>: Appendicitis is one of the most common causes of acute abdomen. The clinical<br>presentation of appendicitis and its susceptibility to acute inflammation may be affected by the<br>length and position of vermiform appendix. Length and position of appendix are variable. The<br>aim of the study was to find the prevalence of retrocaecal appendix among patients undergoing<br>appendectomy for appendicitis.</p> <p><br><strong>Methods</strong>: A descriptive cross-sectional study was performed in 264 patients undergoing<br>appendectomy in Department of Surgery, Nobel Medical College, Biratnagar, Nepal 1st May, 2018<br>to 15th May, 2019. Ethical approval was taken. Simple random sampling was done. The position of<br>appendix was noted before appendectomy. Subgroup analysis was done on the basis of gender and<br>length of appendix recorded in centimeters with a measuring scale immediately after removal of<br>appendix. Data was collected in excel and was analyzed in SPSS version 16.</p> <p><br><strong>Results</strong>: Prevalence of retrocaecal appendix among patients with appendicitis was 95 (35.98%).<br>Similarly, other positions noted were pelvic in 67 (25.37%), post-ileal in 61 (23.10%), pre-ileal in 11<br>(4.16%) and subcaecal in 30 (11.36%) individuals. The length of appendix ranged from 1.7 cm to 14.7<br>cm. The mean length was 8.67±2.44 cm.</p> <p><br><strong>Conclusions</strong>: The most common position of appendix in patients with appendicitis is retrocaecal<br>position followed by pelvic position in both males and females.</p> Sanzida Khatun Dipendra Thakur Diwakar Kumar Shah ##submission.copyrightStatement## 2019-06-30 2019-06-30 57 217 10.31729/jnma.4370 Prevalence of Agenesis of Mandibular Third Molars in A Tertiary Healthcare Centre of Nepal <p><strong>Introduction</strong>: Racial variation, genetic inheritance and various other factors can affect the jaw size and ultimately the tooth size and number. Studies for agenesis of mandibular third molars have been carried out in various populations but the data relating to these are not evident from most of the parts of Nepal. Hence, the objective of the present study is to determine the prevalence of agenesis of mandibular third molars among the population of patients visiting the Department of Oral Medicine and Radiology of B. P. Koirala Institute of Health Sciences.</p> <p><br><strong>Methods</strong>: This descriptive cross-sectional study was conducted at Department of Oral Medicine And Radiology, College of Dental Surgery, B. P. Koirala Institute of Health Sciences from September 2015 to September 2016 after taking ethical approval from Institutional Review Committee. Two hundred and eighty four patients (568 sites of third molar bilaterally), visiting the Department of Oral Medicine and Radiology were studied with Panoramic Radiograph to assess for agenesis of mandibular third molars bilaterally. Data was entered in Microsoft Excel sheet and transferred to Statistical Package for the Social Sciences version 11.5.</p> <p><br><strong>Results</strong>: Out of 284 participants, 568 sites of mandibular third molars were evaluated and agenesis was seen among 163 (28.7%) participants at the confidence interval of 95% (28.643 to 28.757). Total numbers of patient with single missing mandibular third molar were 35 (6.2%). Twenty one had agenesis only on the right side and 14 had agenesis only on the left. The total number of patients with agenesis of both the mandibular third molars was 64 (22.5%).</p> <p><br><strong>Conclusions</strong>: Agenesis was highly prevalent in this study group. The likelihood of third molar being absent on one side, when there was concurrent missing third molar on the other side of mandible was also high.</p> Pragya Regmee Jyotsna Rimal Ichha Kumar Maharjan Surya Raj Niraula ##submission.copyrightStatement## 2019-06-30 2019-06-30 57 217 10.31729/jnma.4421 Prevalence of Community-Acquired Pyoderma in Dermatological Outpatient Department of A Tertiary Care Hospital <p><strong>Introduction</strong>: Pyoderma is defined as any purulent skin disease and represents infections in<br>epidermis and dermis or hair follicles. This study aims to find out the prevalence of communityacquired pyoderma in dermatological outpatient department of a tertiary care hospital.</p> <p><br><strong>Methods</strong>: A descriptive cross-sectional study was carried out among patients who presented at<br>dermatology outpatient department of Kathmandu Medical College Teaching Hospital between<br>December 2018 and March 2019 after ethical clearance from institutional review committee.<br>Convenience sampling method was done. Data was collected and analysis was done using SPSS<br>software, point estimate at 95% CI was calculated along with frequency and proportion for binary<br>data.</p> <p><br><strong>Results</strong>: Out of 385 cases, 72 (18%) cases were of community-acquired pyoderma. Prevalence of<br>community-acquired pyoderma is 72 (18%) at 95% CI(). Primary pyoderma was seen in 49 (12.72%)<br>mainly folliculitis 17 (4.41%), furunculosis 16 (4.15%), impetigo 6 (1.55%), abscess 6 (1.55%) and<br>bacterial paronychia 4 (1.03%). Staphylococcus aureus was the most common organism isolated in 42<br>(58.3%) cases and Staphylococcus epidermidis was isolated in 3 (4.17%) cases. Staphylococcus aureus<br>was most sensitive to Vancomycin 42 (100%) followed by Gentamycin 40 (95.2%), Ciprofloxacin 40<br>(95.2%) and Ceftriaxone 40 (95.2%). Highest resistance was seen to Azithromycin in 13 (30.95%),<br>followed by Cloxacilllin in 11 (26.19%). Males were affected predominantly in 49 (68.06%) as<br>compared to females in 23 (31.94%).</p> <p><br><strong>Conclusions</strong>: Prevalence of community-acquired pyoderma is high among patients visiting<br>dermatological outpatient departments of a tertiary care hospital compared to other studies.<br>Antibiotic resistance of commonly used antibiotics are increasing and thus proper culture<br>and sensitivity reports may be required to guide our treatment</p> Rupak Bishwokarma Ghimire Khilasha Pokhrel Sanjubabu Shrestha ##submission.copyrightStatement## 2019-06-30 2019-06-30 57 217 10.31729/jnma.4430 Prevalence of Perinatal Deaths in A Tertiary Care Hospital of Nepal <p><strong>Introduction</strong>: Perinatal mortality indicates quality of maternal and neonatal care and is high in<br>Nepal. This study was conducted to find out the prevalence of perinatal deaths in a tertiary care<br>center.</p> <p><br><strong>Methods</strong>: This descriptive cross-sectional study was conducted from July 2017 to June 2018 at KIST<br>Medical College and Teaching Hospital. Details of each perinatal death were filled in predesigned<br>proforma from hospital in-patient records within 24 hours of perinatal death. The total of 1088 cases<br>were selected for the study and convenience sampling was done. Statistical analysis was done with<br>Statistical Package for Social Sciences (SPSS 17.0).</p> <p><br><strong>Results</strong>: Out of 1088 births selected for the study, there were 16 cases of perinatal deaths. Hence,<br>the prevalence of the perinatal deaths in KIST Medical College and Teaching Hospital is found to be<br>1.47%. In the same way, perinatal mortality rate, stillbirth rate and early neonatal mortality rate were<br>calculated and found to be 14.61 per 1000 births, 8.21 per 1000 births and 6.44 per 1000 live births<br>respectively. Preterm neonates constituted of 71.4% of early neonatal deaths.</p> <p><br><strong>Conclusions</strong>: Perinatal mortality rate was 50% lower than that of national survey, however comparable<br>with study at another tertiary care center at Kathmandu. Stillbirth and prematurity contributed<br>significantly to perinatal mortality. Provision of good antenatal surveillance, identification of high<br>risk pregnancies and good neonatal care to preterm neonates would be required to reduce perinatal<br>mortality.<br><br></p> Yam Dwa Sunita Bhandari ##submission.copyrightStatement## 2019-06-30 2019-06-30 57 217 10.31729/jnma.4431 Prevalence of Ruptured Intracranial Aneurysms in A Tertiary Care Hospital of Nepal <p><strong>Introduction</strong>: Intracranial aneurysms affect 3-8 percent of the world’s population, with ruptured<br>aneurysms being the most common cause of subarachnoid hemorrhage. The sensitivity of Computed<br>Tomography Angiogram in diagnosing intracranial aneurysm is 97%. The aim of our study is to find<br>out the prevalence of ruptured intracranial aneurysms among all the admitted cases encountered in<br>our hospital.</p> <p><br><strong>Methods</strong>: A descriptive cross-sectional study was done at Upendra Devkota Memorial National<br>Institute of Neurological and Allied Sciences from 2016 to 2018. Convenience sampling method was<br>done. In order to detect the site and size of aneurysms16 slice Siemens Computed Tomography with<br>Computed Tomography angiogram was used. Ethical approval was obtained from the Institutional<br>Review Board at Upendra Devkota Memorial National Institute of Neurological and Allied Sciences.<br>Based on demographic data and computed tomography angiography findings, various morphometric<br>parameters along with demographic parameters were considered for the study.</p> <p><br><strong>Results</strong>: Among 10,856 cases, prevalence of ruptured intracranial aneurysms were found in 42<br>(0.386%) [Confidence Interval= 0.395 to 0.377]. Among 42 cases, Middle Cerebral Artery aneurysm<br>was present on 16 (39.02%) followed by Anterior Communicating Artery on 14 (34.14%), then<br>Posterior Communicating Artery on 5 (12.19%). The largest neck and dome size were seen in basilar<br>tip aneurysm with size of 11mm and 8mm respectively. The most common type was Fischer grade 4.</p> <p><br><strong>Conclusions</strong>: The prevalence of ruptured intracranial aneursyms were found to be higher as<br>compared to the other international studies.</p> Suraj Thulung Binit Aryal Aashish Baniya Kajan Ranabhat Bibhusan Kalu Shrestha ##submission.copyrightStatement## 2019-06-30 2019-06-30 57 217 10.31729/jnma.4328 Prevalence of Depression in Patients with CKD 5 on Hemodialysis at A Tertiary Care Center in Nepal <p><strong>Introduction</strong>: Co-morbid depression impacts negatively on quality of life in Chronic Kidney Disease<br>patients. It is unclear if self-reported depression rating scales can be used accurately for screening.<br>The aim of this study was to estimate prevalence of depression in patients on hemodialysis using<br>Patient Health Questionnaire-9 and compare Patient Health Questionnaire-9, Max Hamilton Rating<br>scale and International Classification of Disease-10 for diagnosis of depression.</p> <p><br><strong>Methods</strong>: It was descriptive cross-sectional study conducted from November 2017 till June 2018.<br>Ethical approval was taken from Ethical Review Board, Nepal Health Research Council. Informed<br>and written consent was taken. Patients undergoing hemodialysis at Nepal Medical College for &gt;<br>3 months duration were included in study. Patients on hemodialysis were asked to fill validated<br>Nepali translated version of Patient Health Questionnaire -9. Psychiatrist administered Max<br>Hamilton Rating scale for diagnosis and categorization of depression and confirmed depression<br>based on International Classification of Disease -10. Statistical Package for Social Sciences version 20<br>was used for statistical analysis.</p> <p><br><strong>Results</strong>: Total of 100 patients completed study. Median age was 47.5 years. Prevalence of depression<br>was 78 (78%) using Patient Health Questionnaire-9 and 65 (65%) using Max Hamilton Rating scale<br>and 51 (51%) using International Classification of Disease -10. Mean depression in males using Patient<br>Health Questionnaire -9 was 7±4.33 and in females was 11.04±5.90. The most common symptom was<br>fatigue among 82 (82%).</p> <p><br><strong>Conclusions</strong>: There is a high prevalence of depression in patients with Chronic Kidney Disease on<br>hemodialysis compared to general population.</p> Krishna Kumar Agrawaal Pramod Kumar Chhetri Pradip Man Singh Dhiraj Narayan Manandhar Prakash Poudel Anjeel Chhetri ##submission.copyrightStatement## 2019-06-30 2019-06-30 57 217 10.31729/jnma.4408 Prevalence of Teenage Pregnancy in A Community Hospital of Rural Nepal: A Cross-Sectional Study <p><strong>Introduction</strong>: Teenage pregnancy is a public health concern. Maternal and neonatal health outcomes<br>are negatively impacted in teenage pregnancy. The objective of the study is to find the prevalence of<br>teenage pregnancy in a community hospital of rural Nepal.</p> <p><br><strong>Methods</strong>: A descriptive cross-sectional study was conducted at Okhaldhunga Community Hospital,<br>Okhaldhunga, Nepal. Ethical approval was taken from the Institutional Review Committee of the<br>hospital. Data were retrieved from July 2007 to July 2017 from the hospital record books. The total of<br>7054 records of deliveries were reviewed from the hospital records and whole sampling was done.<br>Subgroup analysis was done on basis of age, ethnicity, gravida, para, period of gestation, mode of<br>delivery, maternal or neonatal complications and birth weight. Datas were entered and analyzed<br>using Microsoft Excel.</p> <p><br><strong>Results</strong>: The total of 7054 deliveries were conducted in ten years among which 2050 (29.06%) were<br>teenage deliveries at the confidence interval of 95% (28.52% - 29.06%). The highest percentage of<br>teenage delivery was found among Janajati ethnicity of 1056 (53.3%). Amongst teenage delivery, a<br>significant tear was found in 157 (7.9%) as a maternal complication. Perinatal deaths were found in<br>27 (1.4%). The cesarean section rate was 839 (11.9%) among all deliveries.</p> <p><strong>Conclusions</strong>: The trend of teenage pregnancy remains almost same over ten years in the<br>Okhaldhunga Community Hospital. The overall prevalence of teenage delivery is higher than the<br>national figure. Low birth weight babies, premature delivery, perineal and cervical tears were the<br>common complications. Further health education and awareness programs might help to reduce the<br>teenage pregnancy rate.</p> Muna Maharjan Niresh Thapa Narayani Maharjan Pabita Rai Prakash Pun Marcia A Petrini Jiong Yang ##submission.copyrightStatement## 2019-06-30 2019-06-30 57 217 10.31729/jnma.4083 Outcomes of Inverted Internal Limiting Membrane Flap Technique for Large Idiopathic Macular Holes Surgery in Patients at A Tertiary Care Hospital <p><strong>Introduction</strong>: Large macular holes cause significant reduction in central visual acuity. The aim of<br>the study is to find out short term anatomical and visual outcomes of inverted internal limiting<br>membrane flaps technique for large macular holes (base diameter&gt;1000μm) surgery in patients<br>at a tertiary care hospital.</p> <p><br><strong>Methods</strong>: A descriptive cross-sectional study was conducted in a tertiary care hospital from<br>January 2018 to December 2018 after ethical clearance from the institutional review committee.<br>The study was done in 12 patients with idiopathic macular holes (base diameter&gt;1000μm), they<br>were repaired with 25 gauge pars plana vitrectomy with brilliant blue assisted large inverted<br>internal limiting membrane flap technique. Statistical analyses were performed using SPSS 19.0.</p> <p><br><strong>Results</strong>: All twelve eyes had complete anatomical closure. Mean best corrected visual<br>acuity preoperatively was 1.48 logMAR±0.246. The mean macular hole base diameter was<br>1217.0±196.77μm. The mean age of patients was 68.75±4.97 years. Postoperatively,<br>mean best corrected visual acuity was 0.978 logMAR±0.12. There were no postoperative<br>complications. All the patients perceived decreased size of central scotoma.</p> <p><br><strong>Conclusions</strong>: Inverted internal limiting membrane flaps for large macular holes is suitable method<br>for closure of the very large hole, restoration of functional vision and decreased size of central<br>scotoma.</p> Kiran Shakya Ram Prasad Pokhrel Om Krishna Malla ##submission.copyrightStatement## 2019-06-30 2019-06-30 57 217 10.31729/jnma.4393 Knowledge and Practices of Pregnant Women regarding Oral Health in A Tertiary Care Hospital in Nepal <p><strong>Introduction</strong>: Poor dental hygiene has been associated with various perinatal complications in studies<br>done worldwide but few studies in Nepal have explored the knowledge of pregnant ladies regarding<br>dental hygiene. The aim of the study was to know the knowledge and practices of pregnant women<br>regarding oral health in a tertiary care center in Nepal.</p> <p><br><strong>Methods</strong>: A qualitative study was carried out in Nobel Medical College and Teaching Hospital from<br>January 15, 2018 to June 15, 2018 after approval from the Institutional Review Committee of Nobel<br>Medical College. Convenience sampling was done. Fifty pregnant women admitted in antenatal<br>ward were interviewed regarding their knowledge of dental care in pregnancy, the common dental<br>problems they faced and the treatment taken. A predesigned proforma was used and results were<br>analyzed using SPSS version 17.</p> <p><br><strong>Results</strong>: Twenty two (44%) patients reported dental problems during pregnancy. Bleeding gums<br>was seen in 7 (14%) and toothache in 7 (14%) were commonly reported dental problems. Forty seven<br>(94%) patients acknowledged that routine dental care was needed for health, only 6 (12%) were<br>aware that poor dental health could affect baby weight. Oral health not seen as priority in 24 (48%)<br>was the main barrier to seeking dental care in pregnancy followed by costs of treatment in 18 (36%)<br>and safety concerns in pregnancy in 8 (16%) cases.</p> <p><br><strong>Conclusions</strong>: Though dental problems were a common occurrence in pregnancy, utilization of<br>services was low for the same. The participants reported significant barriers to obtaining dental care<br>including lack of knowledge about the importance of maternal oral health and the treatment costs.</p> Neha Gupta Manisha Chhetry ##submission.copyrightStatement## 2019-06-30 2019-06-30 57 217 10.31729/jnma.4420 Outcomes of Ligation without Revascularization in Pseudoaneurysms of Peripheral Arteries in Intravenous Drug Users <p><strong>Introduction</strong>: Management of pseudoaneurysms in intravenous drug users is complex and<br>challenging due to an associated infection and unavailability of autologous vein grafts. Here we<br>observe the outcomes of ligation and local debridement as a primary modality of treatment in this<br>subset of patients with pseudoaneurysms.</p> <p><br><strong>Methods</strong>: This is a descriptive cross sectional study of 15patients over a period of 4 years who<br>presented with pseudoaneurysm of peripheral artery from intravenous drug use. In this study,<br>we describe the presentations and management outcomes in 15 patients with peripheral arterial<br>pseudoaneurysmfrom IV drug use.</p> <p><br><strong>Results</strong>: The most common site involved was common femoral artery among 12 (80%) patients<br>followed by superficial femoral artery among 8 (13.3%) patients and external iliac artery in 1 (6.7%)<br>patient. Twelve (80%) patients were having signs of infection. All patients underwent surgical<br>intervention which comprised of excision of pseudoaneurysm and ligation of artery without<br>revascularization among 12 (80%) patients and with revascularization with autologous venous graft<br>among 3 (20%) patients. There was no mortality or a major bleeding requiring re-exploration. None<br>of the patients developed limb ischemia necessitating amputation.One patient with femoral artery<br>ligation without revascularization at one year of follow up is having claudication on brisk walking.<br>There was one saphenous vein graft thrombosis in immediate postoperative period.</p> <p><br><strong>Conclusions</strong>: With the use of ligation without revascularization technique, there was no mortality or<br>major bleeding requiring re-exploration. None of the patients developed limb ischemia necessitating<br>amputation so this treatment modality seems promising in treatment of pseudoaneurysms in<br>intravenous drug users.</p> Lokesh Shekher Jaiswal Narendra Pandit Shailesh Adhikary ##submission.copyrightStatement## 2019-06-30 2019-06-30 57 217 10.31729/jnma.4472 Congenital Microphthalmia with Orbital Cyst: A Case Series <p>Microphthalmos results from incomplete invagination of the optic vesicle or closure of the<br>embryonic fissure. We present three patients with unilateral congenital microphthalmia with<br>cyst. None of them had vision in the affected eye since birth, with gradually increasing<br>mass encroaching towards lower fornix and lower eyelid ectropion. On examination and<br>investigations, patients had large orbital cyst with microphthalmia pushing the eyeball superiorly<br>and posteriorly in affected orbit. Microphthalmic globe with cyst was surgically excised and<br>histopathologically studied. Orbital cavity was big enough to occupy the conformer and the<br>prosthetic eye after 6 weeks. Diagnosis was confirmed by large communicating orbital cyst with<br>microphthalmia without systemic association in all the patients. None of the mothers of patients<br>had (antenatal care) ANC check up. All the parents had consanguineous marriage. ANC check<br>up with ultrasound at 14-16 weeks of pregnancy is important for genetic counselling.&nbsp;</p> Diwa Hamal Prerna Arjyal Kafle Prija Poudyal Rohit Saiju Hony KC Santosh kafle ##submission.copyrightStatement## 2019-06-30 2019-06-30 57 217 10.31729/jnma.4473 A Diagnostic Quandary of Calvarial Tuberculosis: A Case Report <p>Primary Calvarial Tuberculosis, a rare entity of skull is even rarer after second decade of life in a healthy person without evidence of tuberculosis elsewhere in the body. Most of the cases are often misdiagnosed as osteomyelitis/syphilis/bony metastasis.</p> <p>We report a case of primary skull tuberculosis in 26-year-old male with complains of headache and swelling in the right frontal region with no history of previous tuberculosis. The patient was operated and the histopathological examination of excised tissue was suggestive of tubercular pathology. The patient is doing well after anti-tubercular therapy.</p> <p>Being a rare disease, tubercular osteomyelitis of skull bones is often missed and misdiagnosed due to lack of clinical suspicion and slow growth of mycobacterium cultures. Histopathological examination of biopsy material and demonstration of acid-fast bacilli in the pus are helpful for diagnosis and early management of the disease.</p> Sushan Homagain Suraj Shrestha Sushil Sah Gopal Sedain ##submission.copyrightStatement## 2019-06-30 2019-06-30 57 217 10.31729/jnma.4319 Leiomyosarcoma of the Inferior Venacava: A Case Report <p>Leiomyosarcoma of inferior venacava is a rare tumor. Female are most commonly affected and middle<br>segment of inferior vena cava is the commonest site. The diagnosis can sometimes be challenging<br>as patients present with non-specific symptoms. We present a case of a 65-year-old female who<br>presented with pain in hypochondrium and epigastric region since 4 months along with weight<br>loss, anorexia and vomiting. Histopathological examination revealed a capsulated, multilobated<br>tumor arising from muscle layer of inferior venacava with extraluminal growth pattern and tumor<br>cells showing cytoplasmic positivity for immuno-histochemical stain smooth muscle actin. With<br>the diagnosis of leiomyosarcoma of inferior venacava, excision of tumor was done with tangential<br>excision of 4 cm length of inferior venacava with primary repair.</p> Diksha Karki Paricha Upadhayaya Purbesh Adhikari Mona Dahal Bishow Prakash Jung Thapa Bandana Mudbhari Gopal Lama Neera Pathak ##submission.copyrightStatement## 2019-06-30 2019-06-30 57 217 10.31729/jnma.4455 Primary Pituitary tubercular Abscess: A Case Report <p>Primary pituitary tubercular abscess is a very rare and the majority are reported as case reports. It may present clinically with visual loss, headache, seizure, hormonal abnormalities or with cranial nerve palsies. MRI is the diagnostic modality and shows a cystic-solid mass in the sellar and suprasellar region, isointense on T1 and T2W images with heterogeneous areas and ring enhancement on contrast. Surgery remains the initial treatment and it is approached through the trans-sphenoidal/ trans-nasal or transcranial route followed by anti-Tubercular therapy. We report a case of PTA managed successfully with a brief review of its pathology.</p> Yam Bahadur Roka Narayani Roka Sagar Raj Pandey ##submission.copyrightStatement## 2019-06-30 2019-06-30 57 217 10.31729/jnma.4433 Ruptured Cesarean Scar Pregnancy: A Case Report <p>Cesarean scar pregnancy is a rare variant of ectopic pregnancy where the fertilized ovum gets implanted in the myometrium of the previous cesarean scar. The incidence of CSP among ectopic pregnancies is 6.1% and it is seen in approximately 1 in 2000 normal pregnancies.As trophoblastic invasion of the myometrium can result in uterine rupture and catastrophic hemorrhage termination of pregnancy is the treatment of choice if diagnosed in the first trimester. Expectant treatment has a poor prognosis and may lead to uterine rupture which may require hysterectomy and subsequent loss of fertility. We present a case report of a 24year old femaleG<sub>2</sub>P<sub>1</sub>L<sub>1</sub>with ruptured cesarean scar pregnancy who underwent emergency laparotomy and subsequently hysterectomy. In this case report, we aim to discuss ruptured cesarean scar pregnancy as obstetric emergency and methods by which we can make an early diagnosis that can be managed appropriately as to prevent maternal morbidity and mortality.</p> Prishita Shah Rosina Manandhar Meena Thapa Rachana Saha ##submission.copyrightStatement## 2019-06-30 2019-06-30 57 217 10.31729/jnma.4465 Dysphagia Induced by Nasal Septal Chondroma: A Case Report <p>Chondromas rarely occur in the nasal area and are usually found in the metaphyseal area of the<br>phalanges and metacarpals of the hands, as well as the pelvis, sternum and scapula. The authors<br>present an unusual case of dysphagia induced by histologically confirmed chondroma arising from<br>the nasal septum. Treatment is to completely remove the mass with adequate margins of normal<br>tissues to prevent recurrence and malignancy. Intranasal endoscopic removal of tumor with an<br>adequate margin of normal tissue. After one year of treatment, there was no evidence of recurrence.<br>We present a case of nasal septal chondroma in 18 year male.</p> Kang-Duk Suh Hyun-kyu Chae Mun-Young Chang Seog-Kyun Mun ##submission.copyrightStatement## 2019-06-30 2019-06-30 57 217 10.31729/jnma.3953