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Background: Preeclampsia is one of the major health-related ailments causing increased maternal morbidity and mortality, and complicates up to 10% of pregnancies. The study aims to find out the utility of platelet indices for early prediction of preeclampsia. Materials and Methods: It was a prospective case-control study that included a total of 84 patients (42 in the study group with preeclampsia and 42 controls with normal blood pressure) during a one-year study period. Fresh blood samples (2 ml) were collected for the platelet indices - platelet count (PC), plateletcrit (PCT), mean platelet volume (MPV), and platelet distribution width (PDW) – and were analyzed by fully automated cell counter by impedance method, and compared between the two groups. Results: Both groups were comparable in terms of age, parity, gestational period, and body mass index. The PC and MPV showed a significant difference; (1.98±0.7 vs. 2.42±0.8; p= 0.01) and (12.44±0.6 vs.10.0±0.48; p= 0.03) between the two groups respectively. However, the difference between the two groups was not statistically significant for PCT and PDW. Conclusions: The low platelet count and an increased mean platelet volume were significant in patients with preeclampsia compared to the control group. It could be a marker for early diagnosis of preeclampsia in pregnancy.

Background: Incidence of cervical cancer has decreased in the developed world due to use of Pap smear as a screening tool. It has been proven as a sensitive screening tool for cervical cancer but its coverage is very low in Nepal. The objective of this study is to find out the incidence of cervical epithelial cell abnormality, its demographic distribution and common presenting symptoms. Materials and Methods: This retrospective comparative study was conducted in Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. A total of 950 patients attending gynecological department with various symptoms were enrolled. Only 902 patients were included in the study after excluding inadequate samples. Results: The mean age of patient was 37.94 ± 12.74 years with minimum age of 18 and maximum age of 79 years. The mean age of patients with epithelial abnormality was 47.88 ± 8.87 years. The highest number of Atypical squamous cells of undetermined significance was observed between 51-60 years (1.1%) whereas Low and High grade squamous intraepithelial lesion were mostly observed between 41-50 years (3.2% and 0.4% respectively). The most common symptom was vaginal discharge (41.6%) followed by pain abdomen (23.1%). Conclusions: Pap smear is a cost effective, sensitive and simple screening test for cervical premalignant and malignant lesions.

Background: Malaria is a major health problem especially in developing countries. It is a major cause of morbidity and mortality especially in the tropics. There are several hematological changes in this particular disease, which includes thrombocytopenia, anemia , atypical lymphocytosis and infrequently intravascular coagulation. The aim of the study is to detect and compare the severity of various hematological changes, especially thrombocytopenia in the particular type of malaria. Materials and Methods: This was an observational study done on the patients attending the outpatient and inpatient departments clinically suspected for malaria in Nobel Medical College, Biratnagar, Nepal. Thick and thin slides were made and stained with Leishman’s stain for malarial parasites and also antigen tests were included wherever necessary. Other tests included were, complete blood counts. Results: Amongst the included 800 patients with suspicion of malaria, 135 (17%) patients demonstrated malarial parasites on peripheral blood film. Male predominance in male to female predominance of 3.5:1 was observed. Total number of 120 out of 135 had thrombocytopenia. Thrombocytopenia was observed higher in P. Vivax (79.3%) followed by Mixed infection (17%) and P. falciparum (3.7%) respectively. Conclusion: Anemia with mainly thrombocytopenia was mainly seen in P. Vivax type followed by P. Falciparum. Since thrombocytopenia is associated with malaria, which is demonstrated in our study, treating physicians should keep malaria as one of the differential diagnosis in patients with fever and low platelets.

Background: Carcinoma cervix is among a curable cancer, if identified at an early stage. Pap smear is a simple, safe, noninvasive, outdoor and effective method for detection of lesions of the cervix but it fails to localize the lesion. Cervical biopsy, on the other hand is a gold standard but invasive technique.Materials and Methods: A prospective cross-sectional study was done in Nobel medical college from January 16, 2017 to January 15, 2018 where all pap smears received in a Department of Pathology were included in the study. However, only cases that had undergone both Pap smear and cervical biopsy were compared. Out of the 1492 pap smears, 118 cases underwent biopsy. Correlation was then done regarding cytological and histological diagnosis.Results: Majority of the cytological findings were normal. 7 patients of HSIL revealed moderate dysplasia and higher lesions in biopsy. 2 cases were that of adenocarcinoma which were diagnosed as inflammatory smear in Pap smear.Conclusion: Cervical Pap smear is reliable screening test to identify high grade squamous cell lesions and carcinoma, but it fails to localize the lesion and adenocarcinoma is hard to identify in a pap smear. Hence, cervical biopsy should be carried out to confirm the findings of Pap smear and in case of strong clinical suspicion.

Background: Fine needle aspiration cytology is used as a primary diagnostic tool in thyroid lesions. But the bloody smears caused by negative pressure during aspiration compromise cellular concentration and cell morphology which may lead to its improper interpretation. FNNAC avoids active aspiration and depends on capillary tension to collect tissue sample in the needle bore, thus reducing bleeding and tissue trauma to the highly vascular thyroid. Material and Methods: This is a one year prospective study where FNNAC and FNAC were done on 87 patients. Cytopathologist was blind folded regarding the technique used and was asked to score the quality of slide base of Mair scoring system.Results: FNAC yielded significantly better material on the basis of hemorrhage and cellularity. Fifty six (64.37%) cases showed adequate diagnostic material in FNNAC technique while 54/87 (62.05%) cases showed adequate diagnostic material in FNAC technique. Twelve (13.79%) cases showed unsuitable diagnostic material in FNNAC technique and 26/ 87 (29.89%) cases unsuitable diagnostic material in FNAC technique. Among the individual criteria used in Mair scoring system, background clot/ blood was significantly low in FNNAC than FNAC with the p value less than 0.001. Amount of cellular material was significantly more in FNNAC with p value less than 0.001.Conclusion: FNNAC yielded more cellular and less hemorrhagic material and more diagnostic superior material than FNAC. Since thyroid is a highly vascular gland, FNNAC should be used instead of FNAC for less hemorrhagic and more cellular material.

Background: Upper gastrointestinal endoscopy is a common procedure done for suspected cases of gastric malignancies. Histopathological examination of gastric tissue has been a gold standard for the diagnosis. Imprint smears of the gastric biopsy specimen is a useful and rapid alternative diagnostic tool. This study was conducted to assess the accuracy of gastric biopsy imprint cytology as compared to the histopathology. Materials and Methods: Imprint smears were made from all cases of gastric biopsy specimens taken from suspected cases of gastric malignancies. They were evaluated by three pathologists and categorized in to negative for malignancy, suspicious of malignancy and positive for malignancy. The diagnosis given by imprint smears was compared with histopathology. With the help of sensitivity, specificity & accuracy and Kappa score, the agreement between the imprint smear and histopathology was determined. Results: Among the total 79 cases, 49 cases were chronic non specific gastritis and 22 were adenocarcinoma. The sensitivity, specificity, and overall accuracy of gastric biopsy imprint smear were 92.0%, 98.11% and 94.93% respectively. Kappa core was 0.88. Conclusions: The gastric biopsy imprint smears is a rapid diagnostic tool and can be used routinely as an adjunct to histopathology in the diagnosis of gastric malignancies.

A mixed adenoneuroendocrine carcinoma is a tumor composed of both adenocarcinoma and neuroendocrine carcinoma components, with each comprising at least one-third of the lesion, as defined by the World Health Organization classification of neuroendocrine neoplasms in 2010.. A 67-years-old male was admitted to the hospital with symptoms suggesting gastric cancer. Histopathology examination from endoscopic biopsy revealed adenocarcinoma. Later partial gastrectomy specimen examination the lesion show presence of well differentiated adenocarcinoma along with neuro endocrine carcinoma.

Background: Tumors of lung are common in Nepal. The risk of malignancy has to be judged prior to surgery for which bronchoscopy is often done. Brocho-alveolar lavage and bronchial biopsy are routine procedure done for diagnosis of lung cancer during bronchoscopy. This study was done to correlate the cytology of broncho-alveolar lavage specimen with histopathology in malignant tumors of the lug in our setup. Materials and methods: This study was conducted at department of pathology, Nobel Medical College from August 2017 to December 2018. Histopathology reports with malignancy were compared to their cytological diagnosis. Results: A total of 141 cases were included in the study. Among the study population, Bronchogenic carcinoma was found more prevalent in female. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of broncho-alveolar lavage in the diagnosis of lung cancer were 88.1%, 97.98%, 94.7%, 95.1% and 95.03% respectively. Conclusions: Brochoalveolar lavage cytology has a greater accuracy for the diagnosis of lung cancer; however, benign cases need regular follow up as there are false negative cases.