Aims: To evaluate Liquid Based Cytology (LBC) diagnostic performance compared with Conventional Pap Smear (CPS) for cervical cancer screening and to compare the sensitivity and specificity of the two cytology methods with gold standard cervical biopsy. Methods: This is a hospital based cross-sectional study conducted from April 2017 to April 2018 in 110 sample randomly selected at gynecology OPD in Paropakar Maternity and Women’s Hospital. Paired samples (CPS and LBC) were taken from the same patient. Abnormal epithelial lesion detected in LBC and CPS was sent for biopsy. Bethedsa reporting system was followed and data analyzed in terms of diagnostic accuracy. Results: LBC vs CPS for satisfactory report was 96.4% vs 91.8% while unsatisfactory was 3.6% vs 1.8% (p=0.02). The detection of premalignant lesions was ASCUS 2.7%, HSIL 4.5%, ASCUS-H 1.8% and LSIL 0.9% by LBC while by CPS- ASC-US 0.9%, HSIL 3.6%, LSIL 1.8% and ASC-H 0.9% were detected. The sensitivity and specificity of LBC vs CPS was 100% vs 88% and 81.8% vs 99% respectively. The positive predictive and negative predictive value of LBC vs CPS was 81.8% vs 88% and 100% vs 99% respectively. Conclusions: Cell pick-up was satisfactory in both LBC and CPS. The sensitivity and positive predictive value of CPS is similar whereas the positive predictive value of LBC is less than its sensitivity. Cervical cancer screening with CPS is effective alternative over LBC by its cost and level of accuracy.

Introduction: Central vein catheterization can be introduced in subclavian vein (SCV), internal jugular vein or femoral vein for volume resuscitation and invasive monitoring technique. Due to anatomical advantage and lesser risk of infection subclavian vein is preferred. Either supraclavicular (SC) or infraclavicular (IC) approach could be used for subclavian vein catheterization. The aim of the study was to compare SC and IC approach in ease of catheterization of SCV and record the complications present if any. Methods and materials: This was a hospital based comparative, interventional study conducted from November 2016 to October 2017 in Operation Theater in Bir Hospital. In this study, 70 patients for elective surgical cases meeting the inclusion criteria were randomly enrolled. Then samples were equally divided by lottery into either supraclavicular or infraclavicular approach groups. The Access time, cannulation success rate, attempts made for successful cannulation of vein, easy insertion of catheter and guide wire, approximate inserted length of catheter and associated complications in both groups were recorded. Data was entered in statistical software SPSS 16. Chi-square test was used. P value < 0.05 was considered significant. Results: The mean access time in group SC for SCV catheterization was 2.12 ± 0.81 min compared to 2.83 ± 0.99 min in group IC (p-value= 0.002). The overall success rate in catheterization of the right SCV using SC approach (34 / 35) was better as compared with group IC (33 / 35) using IC approach. First successful attempt in the SC group was 74.28% as compared with 57.14% in the IC group. Conclusion: The SC approach of SCV catheterization can be considered alternative to IC approach in terms of landmark accessibility, success rate and rate of complications.

Paraurethral vaginal leiomyoma is the infrequent case to be described. Approximately 300 cases have been described so far. Imaging modalities aid in identifying the morphological, structural characteristics of the mass and its relationship to the surrounding structures. Thirty-six years old married women presented with a vulvar mass of (3x5) cm2. Her associated complaints were left shift of the urinary stream and dyspareunia. Ultrasonography and cystography revealed a mass with no relationship with bladder or uterine structure. Surgical excision was performed. The histopathological report confirmed the diagnosis of paraurethral vaginal leiomyoma. Surgical excision is the treatment of choice and diagnosis is confirmed by histopathological examination.

Aims: To explore the past experience of women during childbirth in terms of respectful maternity on institutional deliveries in the region. Methods: This is a cross sectional descriptive study among women during outdoor visit at Karnali Academy of Health Sciences in Jumla from April to August 2020. Data were analyzed in terms of seven components of respectful maternity care. Results: The prevalence of obstetrics mistreatment was 78.5%. From 200 respondents, more than half had hospital delivery and one-fourth at local birthing center. Two-third of them perceives the care provided to them was proper and 85% opt to visit again to the same center in next pregnancy. Around 70-80% by ethnic group and at least three-fourth by the site of delivery have experienced at least one type of mistreatment. Conclusions: Indicators of respectful maternity care are not satisfactory in the western mountainous region. Keywords: institutional delivery, mistreatment, respectful maternity care

Accidental foreign body ingestion is a common problem encountered in Emergency. Deliberate foreign body ingestion may result due to an act of insanity or an act of daring. A shaman locally known as Dhami was brought to Emergency with the history of ingestion of bell clappers. He denied the history of psychiatric illness or substance abuse. On physical examination, there were signs of peritonitis. Laparotomy was done to remove the foreign bodies. Post-operative period was uneventful. Apart from the surgical intervention, psychological counselling was given to him. This is a rare interesting case due to the fact that the 15 cm long foreign bodies passing all the way through without significant injury and finally causing obstruction in ileocecal junction and perforation in the distal ileum.