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Herpes Zoster (HZ) is the reactivation of a previous infection with varicella-zoster virus (VZV) which shares the same mode of transmission as HZ. It presents with painful erythematous vesicles in a dermatome which is characterized by a burning sensation before and after the rash. Any conditions with suppressed cellular immunity example diabetes mellitus, chronic obstructive pulmonary disease, asthma, cardiovascular diseases, chronic steroid uses, malignancy, etc. causes reactivation of the virus. Impaired immune responses in asthma patients either in any age group may increase their susceptibility to HZ infection owing to skewed Th1/Th2 immunity, resulting in predominant Th2 conditions and an unwarranted Th2 cell response against respiratory allergens. Similarly, many studies have delineated the association of asthma with HZ. However, the relation between steroid use in asthma and HZ is uncertain, its immunosuppressive effect might be responsible for increased susceptibility to the infection. As HZ increases the economic burden and morbidity, its prevention should use vaccines. There are two types of Food and Drug Administration (FDA)-approved vaccine available against HSV one of which is given as a single dose vaccine called Zostavax, for people 50-59 years but its efficacy falls after 3rd dose and on the subsequent 4th dose and is also contraindicated in human immunodeficiency virus/acquired immunodeficiency syndrome, pregnancy and people taking immunosuppressive drugs. Shingrix is preferred by FDA which is a two doses vaccine that is given 6 months apart for people above 50 years and to immunocompromised people. Hence, proper counseling and education about the risks of herpes should be informed to the patients with timely utilization of the vaccine.

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.

Background: Cardiovascular diseases account for most deaths and major proportion of disabilities worldwide. Major cardiovascular risk factors are implicated in almost 75% of cardiovascular diseases. There has been a rapid increase in prevalence of such risk factors in apparently healthy young adults of urban population. This study aimed to find prevalence of such risk factors in order to implement preventive strategies against cardiovascular diseases in our setting.Methods: A free heart camp was organized following wide dissemination of information through print, online, TV, radio and social media. Pretested data collection tool was used by trained enumerators using standard guidelines and calibrated devices. Demographic, anthropometric, physical examination and blood investigation data were obtained. Standard guidelines were followed to define and categorize the obtained information. Data was analyzed using SPSS V20.Results: A total of 5530 participants were enrolled after carefully applying inclusion and exclusion criteria. Mean age of study population was 38.14±13.03 years. There were 3298 (59.6%) males with mean age of 37.67±12.99 years and 2232 (40.4%) females with mean age of 38.84±13.05 years. Majority of study population (29.6%) belonged to 30-39 years age group. Prevalence of tobacco and alcohol consumption was 29.3%(95%CI:28.1-30.5) and 32.7%(95%CI:31.5-34.) respectively. Prevalence of inadequate fruits and vegetables intake, low physical activity and overweight or obesity was 75.4%(95%CI:74.3-76.6), 61.1%(95%CI:59.8-62.4) and 41.3%(95%CI:40.0-42.6) respectively. Prevalence of hypertension, diabetes and dyslipidemia was 26.4%(95%CI:25.3-27.6), 5.3%(95%CI:4.7-5.9) and 86.9%(95%CI:85.9-87.7) respectively. These results were statistically significant in both age and sex based distribution.Conclusions: Prevalence of major cardiovascular risk factors in apparently healthy adult population of Kathmandu Valley was high. Dyslipidemia, unhealthy diet, physical inactivity and overweight or obesity were most prevalent cardiovascular risk factors. Keywords: Cardiovascular risk factors; healthy adults; prevalence; urban population.

Epidermolysis bullosa is a rare inherited blistering disease with an incidence of 8-10 per million live births. Dystrophic epidermolysis bullosa is a type of epidermolysis bullosa caused by mutation in type VII collagen, COL7A1. There are 14 subtypes of dystrophic epidermolysis bullosa and 400 mutations of COL7A1. Electron microscopy is the gold standard diagnostic test but expensive. Immunofluorescence study is a suitable diagnostic alternative. Trauma prevention along with supportive care is the mainstay of therapy. Squamous cell carcinoma develops at an early age in epidermolysis bullosa than other patients, particularly in recessive dystrophic epidermolysis bullosa subtypes. Regular follow-up is imperative in detecting and preventing complications. Gene therapy, cell therapy and bone marrow transplantation are the emerging novel therapeutic innovations. Preventing possible skin and mucosal injury in patients requiring surgery should be worked on. Here, we present a case of dystrophic epidermolysis bullosa in a 26-year-old male. Keywords: blister; dystrophic epidermolysis bullosa; epidermolysis bullosa; knee disarticulation; surgery.