Background Nepal has achieved a significant reduction of TB incidence over the past decades. Nevertheless, TB patients continue to experience barriers in access, diagnosis and completion of the treatment. The main objective of this study was to explore the factors affecting the access to the health services, diagnosis and the treatment completion for TB patients in central and western Nepal. Methods Data were collected using in-depth interviews (IDI) with the TB patients (n = 4); Focus Group Discussions (FGDs) with TB suspected patients (n = 16); Semi Strucutred Interviews (SSIs) with health workers (n = 24) and traditional healers (n = 2); and FGDs with community members (n = 8). All data were audio recorded, transcribed and translated to English. All transcriptions underwent thematic analysis using qualitative data analysis software: Atlas.ti. Results Barriers to access to the health centre were the long distance, poor road conditions, and costs associated with travelling. In addition, lack of awareness of TB and its consequences, and the belief, prompted many respondents to visit traditional healers. Early diagnosis of TB was hindered by lack of trained health personnel to use the equipment, lack of equipment and irregular presence of health workers. Additional barriers that impeded the adherence

Background: Various local anaesthetic agents are used for brachial plexus block.We compared effectiveness of addition of Dexamethasone versus Neostigmine to Lignocaine, adrenaline admixtures for Brachial plexus block in providing perioperative analgesia. Methods: Ninety patients were randomized in three groups and were received 24ml of study drugs. The groupA [Lignocaine with adrenaline (1.5%)], groupB [Lignocaine with adrenaline (1.5%)] +500μg Neostigmine, and group C (Lignocaine with adrenaline (1.5%) +4mg Dexamethasone) for brachial plexus block through supraclavicular approach. The observed parameters were onset of analgesia, completion of sensory and motor blockade, Duration of analgesia, Surgeon's score, side effects, number of supplemental analgesics doses and Visual analogue scale (VAS) score for pain in 12 hour of post-operative period. T he recent emergence of pain management as formal subspecialty and increasing importance of outpatient (Ambulatory) surgery in anaesthetic practice have further bolstered interest in peripheral nerve blocks. The peripheral nerve block may be used for surgical anaesthesia alone or, in conjunction with general anaesthesia and for the acute and chronic pain management. Many studies have been carried out for the search of better quality of analgesics in per-operative as well as in post operative period and it has been found that regional anaesthesia provides better result 1 . Brachial plexus block is an easy and relatively safe procedure for upper limb surgeries though there are different approaches to it, out of which supraclavicular approach is most consistent and widely used method for anaesthesia and peri-operative pain management in surgery below shoulder joint . So the provision of good quality of analgesia during and post -operative period is important not only to ease patients suffering and induce sense of well being but also improve the ability to ambulate early and thereby reducing post operative complication 2 .Various local anaesthetic agents are used for Brachial Plexus Block but most commonly used drugs are; Bupivacaine, and Lignocaine. Bupivacaine is long acting where as Lignocaine is short acting drug. Novel adjuncts studied to date include opioids, Clonidine, Neostigmine, Tramadol, Midazolam, Dexmeditomidine etc.Dexamethasone is very potent and highly selective glucocorticoid. Basically it is used as anti-inÀ ammatory and immunosuppressant. Its potency is about 40 times

All the pea varieties differed significantly (p < 0.05) in their phytic acid content. The field pea cultivars had significantly (p < 0.05) higher levels of phytic acid and polyphenols than those of vegetable pea varieties. All the domestic processing and cooking methods could reduce the contents of phytic acid and polyphenols but germination for 48 hours seemed to have a marked lowering effect on the levels of these antinutrients in peas.

With dismal survival rate pancreatic cancer remains one of the most aggressive and devastating malignancy. Predominantly, due to the absence of a dependable methodology for early identification and limited therapeutic options for advanced disease. However, it takes over 17 years to develop pancreatic cancer from initiation of mutation to metastatic cancer; therefore, if diagnosed early; it may increase overall survival dramatically, thus, providing a window of opportunity for early detection. Recently, genomic expression analysis defined 4 subtypes of pancreatic cancer based on mutated genes. Hence, we need simple and standard, minimally invasive test that can monitor those altered genes or their associated pathways in time for the success of precision medicine, and liquid biopsy seems to be one answer to all these questions. Again, liquid biopsy has an ability to pair with genomic tests. Additionally, liquid biopsy based development of circulating tumor cells derived xenografts, 3D organoids system, real-time monitoring of genetic mutations by circulating tumor DNA and exosome as the targeted drug delivery vehicle holds lots of potential for the treatment and cure of pancreatic cancer. At present, diagnosis of pancreatic cancer is frantically done on the premise of CA19-9 and radiological features only, which doesn't give a picture of genetic mutations and epigenetic alteration involved. In this manner, the current diagnostic paradigm for pancreatic cancer diagnosis experiences low diagnostic accuracy. This review article discusses the current state of liquid biopsy in pancreatic cancer as diagnostic and therapeutic tools and future perspectives of research in the light of circulating tumor cells, circulating tumor DNA and exosomes.

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