Background: Breast cancer is the second most common malignancy among Nepalese women with prevalence of 28.5 per 100,000 population.  In Nepal due to lack of uniform health resources and awareness, breast cancer cases reporting is different in three geographical regions. This study aims to look at the difference in prevalence of breast cancer in different geographical regions. Materials and Methods: A single center descriptive retrospective study to analyze the prevalence of breast cancer in different geographical regions among patients visiting BPKMCH from January 2014 to December 2018 was designed and patients’ information available at medical record were obtained. Analysis was completed with SPSS Statistics. Results: During the period of 5-year total 2115 cases of breast cancer were seen at the Department of Surgical Oncology at BPKMCH. These cases comprised of 2052 female and 63males. The mean age of presentation was 48 years. Maximum number of cases 65% (1376) were from terai region of Nepal. Conclusions: This study provides clue regarding higher cases of breast cancer among individuals from terai region of Nepal.

Cancer pain is caused by continuous tissue injury, which may be due to surgery, infiltration of the surrounding organs including nerves, as well as from mucositis after chemo- or radiotherapy. The pain experienced by cancer patients needs a multimodal approach, including ketamine. Nerve involvement, chronic opioid therapy and continuous nociceptive input cause hyperalgesia. Chronic stimulation of the dorsal root neurons leads to hyperalgesia and resistance (tolerance) to μ opioid analgesics (hyperalgesia-tolerance). The NMDA receptor antagonist ketamine reverses tolerance to morphine. The management of cancer patient’s pain with ketamine as an adjuvant to opioids is presented in case reports of two patients with cancer-related neuropathic pain, in which pain proved untreatable with the usual conventional pain therapies. Ketamine was administered IV route, in addition to morphine and the pain was controlled successfully in these patients. No side-effects were noted except drowsiness which responded to a reduction in the opioids dose.

Background: Carcinoma stomach is a multifactorial disease accounting for second most common cancer among male and fifth most common cancer among Nepalese population. The prevalence of stomach cancer is partially influenced by geographical variation, social and cultural factors that significantly affect disease reporting and seeking medical care. In this study we have analyzed geographical trends in prevalence of stomach cancer among patients visiting BPKMCH. Materials and Methods: A single center descriptive retrospective study to analyze the geographical trends among stomach cancer patients visiting BPKMCH from January 2013 to December 2017 was designed and patients’ information available at medical record were obtained. Analysis was completed with SPSS Statistics. Results: During the period of 5-year total 832 cases of stomach cancer were seen at the Department of Surgical Oncology at BPKMCH. These cases comprised of 349 female and 483 males with male to female (M: F) ratio of 1.4:1. The mean age of presentation was 55 years. Maximum number of cases 57.3% (477) were from terai region of Nepal. Conclusions: This study provides clue regarding higher cases of stomach cancer among male patients and from terai region of Nepal. 

Corona virus disease 2019 (COVID 19) has put huge challenge to the health delivery system all across the globe. The risk of mortality due to COVID 19 is highest on critically ill patients and those with preexisting disease. Palliative and end of life care are no exceptions to the surge in increased demand for health care services. It is now an essential part of global health care. The benefits of early palliative care are already well established. In the pandemic like this, we must not pull back the services, particularly in these vulnerable groups. It is important to determine how best to deliver palliative care during this crisis. It may include preparedness to shift the focus of resources to community level and the innovative use of telemedicine. Use of telemedicine is to ease patients and minimize caregiver distress, and to prevent hospitalizations. The fear of contracting COVID-19 and the emotional burden during diagnosis requires the need of continuous psychosocial support. These challenges should be handled by specialized and skilled interdisciplinary palliative care team.