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Rational use of drugs has immense impact on quality health care. Developing nations have 80% essential drug list prescription. Even though WHO estimates 15-25% antibiotics prescription in these regions, majority of Nepalese patients are prescribed more than one antibiotic in addition to inappropriate prescription in 10%-42% patients.Moreover, Nepal stands as a leading antibiotics prescribing Asian nation. Escalating irrational prescription and excessive over the counter use of antibiotics at peripheral regions of Nepal is possibly leading the emergence of multidrug resistant bacteria.Organisms like S. pneumoniae, K. pneumoniae, Salmonella spp., E. coli, N. gonorrhea, MRSA are rapidly developing first-line, second-line and multi-drug resistance in Nepal. Antimicrobial resistance is the biggest global health concern of the present day threatening the emergence of post antibiotic era. Timely intervention is must to safeguard future generation.Keywords: Antimicrobial resistance; irrational prescription; primary health care.

Gestational trophoblastic neoplasia is extremely rare entity accounting 1% of all gynecological malignancies. Invasive mole is a form of Gestational trophoblastic neoplasia which is locally invasive with propensity of metastasis. Association of partial mole with invasive mole and/or theca lutein cysts is a rare occurrence. Large cysts may present with complications. A case with these rare combinations presented at 15+3 weeks period of gestation as acute abdomen due to torsion of bilateral theca lutein cysts is reported. Right salpingo-ophorectomy with untwisting of left cyst was done. Six cycles of chemotherapy was given with regular βhCG monitoring. First trimester dating scan would have helped in early diagnosis, treatment and prevention of complications. Keywords: Invasive mole; theca lutein cysts; torsion.