Introduction: Cutaneous Leishmaniasis is a vector borne disease caused by the bite of an infected sandfly. The disease is rare in Nepal with only few cases reported till date. We report the largest collection of patients over six years.Objective: To describe the clinical, epidemiological and pathological aspect of Cutaneous Leishmaniasis in Midwestern region of Nepal Materials and Methods: Thirty-three patients referred to the department of Pathology for fine needle aspiration were diagnosed as Cutaneous leishmaniasis based on detection of Leishmania donovani in the fine needle aspiration smears. Demographic data and clinical details including site, size, and duration of disease onset were recorded on a printed proforma. Statistical analysis was done using SPSS version 16.0 for windows. Results:A total of 33 patients with age ranging from 11 years to 65 years were included in the study. Mean age was 26.5±11.5 years. Most patients were in the age group 21-40 years. Male: Female ratio was 1.7:1. Mean duration of disease was 5.3±4.4 months. Thirty patients had single lesion. Lesions were either of plaque type (84.9 %) or papulonodular type (15.1%). Conclusion:Cutaneous leishmaniasis is uncommon in Nepal. So, it is often neglected. It is in an increasing trend. Cutaneous leishmaniasis should be included in the differential diagnosis of a non-healing ulcer.

Aim: To study the prevalence of hypertension in hemorrhagic stroke in patients admitted in medical units of Nepalgunj Medical College Teaching Hospital (NGMCTH), Kohalpur. Background : Hemorrhagic stroke has remained a serious disease despite recent advances in medical treatment. It is one of the most common emergencies encountered in clinical practice and predominantly effects elderly population leading to chronic disability and dependency. This study was designed to identify hypertension as a major cause of Intracerbral hemorrhage (ICH). Material and methods: This is a cross sectional descriptive study conducted in the department of medicine of NGMCTH, Kohalpur between June 2017 and November 2017. A total of 51 patients were included in the study. History and clinical examinations were recorded. Plain CT scan head, ECG and chest x-ray PA view were done and the data were recorded and analysed. Result: The age of patients ranged from 48 to 89 years with the mean age of 66.72 years. Among 51 patients, high BP at presentation along with ECG showing LVH was seen in 38 patients (74.5%) and chest x-ray PA view showing cardiomegaly was seen in 31 patients (60.8%). Most commonly involved ethinic group was Tharu (45.1%). Conclusion: Hypertension is a major cause of ICH. So, early detection and regular treatment of hypertension with appropriate antihypertensive drugs and life style modification would prevent ICH.

Introduction: Cervical cancer is a common health problem in Nepal. There is paucity of data regarding the spectrum of findings in cervical Pap in western Nepal. This study was aimed to study the cytological patterns in cervical Pap smears in patients in a tertiary hospital of Nepal. Methods: This is a prospective, cross sectional, hospital based study. Clinical features of patients who had presented with Pap smear was noted in a structured proforma. Pap smears were studied by a senior pathologist and reported based on revised Bethesda system (2014). Results: Most of the cases belonged to 31-40 years 399 (42.8%). Unsatisfactory/ inadequate sample was present in 133(14.05%) with obscuration due to inflammatory exudate being most common cause. Negative for intraepithelial lesion or malignancy rate was noted in 798 (85.54%) with 477(51.2%) being normal findings. Epithelial cell abnormalities were noted in 116 (14.5 %) smears. Low-grade squamous intraepithelial lesion constituted 321(34.5%), High grade squamous intraepithelial lesion 273(29.3 %) and Atypical squamous cells of undetermined significance 153(16.4%) of epithelial cell abnormalities. Squamous cell carcinoma was present in 9(1%) of all reviewed smears. There was no statistical significance between the age and abnormalities of Pap smear (p=0.9). Conclusions: Pap smear is pivotal in cervical cancer screening in developing countries. It also identifies various inflammatory, infective, benign and malignant pathologies at the earliest thereby decreasing the morbidity and mortality.

Background: Majority of cirrhotic patients develop  varices over their lifetime and it is anticipated that roughly one third of varices will develop bleeding. Child Turcotte Pugh (CTP) class predicts the risk of variceal bleeding and has been used as a prognostic tool inpatients of liver cirrhosis. Objective: To correlate grade of esophageal varices in Upper Gastrointestinal endoscopy with Child Turcotte Pugh class in patients of liver cirrhosis. Material and method: This is a cross sectional descriptive study conducted in thedepartment of medicine of NGMCTH, Kohalpur between December 2017 to November 2018. A total of 97 patients were included inthe study who were diagnosed as cirrhosis of liver clinically and radio logically. Patient were classified into CTP class A, B and According to CTP score. UGI endoscopy was performed and endoscopic grading of esophageal varices were correlated with CTP classand the data were recorded and analysed. Result: Mean of patients was 50 years. Among 97 patients, 30 (30.9%) were in CTP class A,30 (30.9%) in CTP class B and 37 (38.1%) were in CTP class C. 25 (25.8%) had small varices, 50 (51.5%) had large varices with red colorsign, 20 (20.6%) had large varices without red color sign and 2 (2.1%) had no varices. Most of the patients in CTP class B and C hadlarge varices with red color sign whereas CTP class A had small varices. Conclusion: The cirrhotic patients in CTP class B and C havelarge varices with red color sign and have more chances of bleeding. Hence, routine screening is indicated to determine the presenceof varices. Porphylactic therapy after identifying large varices will decrease the incidence of bleeding leading to reduction inmortality rate.

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