The present study was designed to ascertain the percentage of occurrence and causes of pancytopenia. All the cases of pancytopenia from July 2001 to June 2002 (one year) were examined in the Department of haematology, Safdarjung Hospital, New Delhi. Bone marrow aspirations/biopsy were performed in most of the cases (200 out of 250 cases). The commonest cause of pancytopenia, in our hospital was Megaloblastic anaemia (72%), followed by Aplastic anaemia (14%) and others.

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HCV isolates from around the world show substantial nucleotide sequence variability throughout the viral genome. Based on the identification of these genome differences various genotypes and subtypes have been described from different geographical regions. They have been tentatively classified into six major genotypes and more than 30 subtypes, but new subtypes are continually being discovered. In recent years, substantial evidence has emerged indicating that typing and subtyping for HCV is clinically important. The present study aims at determining and comparing the prevalence of different genotypes from different parts of India (North, South, East and West). A total of 153 samples representing different regions have been genotyped in our lab. Our studies document a high prevalence of genotype 3 (> 76%) and very low prevalence of genotype 2 (< 2%), as a whole. However, genotype 3a has been found to be the highest (50%) with a decreased frequency of approximately 25% in the case of 3b, approximately 14% in 1b and approximately 10% in 1a, whereas a minimal number (approximately 4%) of genotype 4 has been found only in Southern and Western India.

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The present study was carried out to compare the subgingival plaque microflora in mango leaf users. Fifty subjects of both sexes, 25 of them used tooth brush and 25 used mango leaf as their home care hygiene device were included in the study. The microbiological evaluation for specific bacterial counts of Actinobacillus actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Fusobacterium nucleatum and Peptostreptococcus micros were carried out for all subject. Specific microbial evaluation revealed significant decrease in the proportion of P. intermedia and P. gingivalis in mango leaf users compared to tooth brush users. It shows that mangiferin possesses antibacterial activity in vivo against specific periodontal pathogens such as P. intermedia and P. gingivalis. Use of mango leaf in conjunction with a tooth brush will be a good home care device for maintenance of oral hygiene.

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Naked Eye Single Tube Redcell Osmotic Fragility Test (NESTROFT) was applied to 110 patients of suspected cases of beta-Thalassemia and other haemoglobinopathies. Out of 110 patients, 10 cases were of beta-Thalassemia major, 35 of Thalassemia minor and 65 of sickle cell disease. The study was carried out to evaluate the effectiveness of NESTROFT as a screening test for beta-Thalassemia trait. The test was successful in detecting 34/35 subjects with beta-Thalassemia trait. Sensitivity of the test was 97.1% and specificity was 100%. The test was positive in detecting other haemoglobinopathies like sickle cell disease also. The test proved to be simple, cheap easy to perform and adaptable for mass screening coming close to an ideal screening test for beta-Thalassemia trait.

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The leaf and seed extracts of the Plant Azardirachta indica were tested for antidermatophytic activity against dermatophytes such as Trichophyton ruberum, Trichophyton, Mentagrophytes, Trichophyton violaceum, Microsporum nanum and Epidermophyton floccosum by tube dilution technique. The minimum Inhibitory concentration (MIC) of neem seed extract was found to be lower tan that of neem leaf when tested against different species of Dermatophytes.

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100 Cases of invasive breast cancer were studied for Tumor type, Tumor site, Nodal Status, Mitotic counts, Nuclear pleomorphism, Tubule formation and Nottingham modification of Bloom Richardson Grading. The follow up of the 82 patients treated with surgery and adjuvant treatment was available. Mitotic activity index (MAI) counted with strict criteria of elston CW, emerged as one of the most significant prognostic parameter followed by overall grade in predicting Tumor free survival (TFS) for the patients. Mitotic count also correlated well with overall Grade and lymph node status in predicting the TFS. This parameter is very useful where advanced studies like flowcytometry and immunohistochemical studies of the cell proliferation marker are not available.

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Blood transfusion is an important mode of transmission of infections to the recipient. The aim of the study was to assess the prevalence of transfusion transmissible infections and the possible risk factors among blood donors. During the study period (1994-99) donor samples were screened for HBsAg, HIV, HCV and Syphilis. The relevant donor history was examined to identify the risk factors leading to transfusion transmissible infections. The prevalence of infection was 3.1% among donors, with HBsAg constituting 1.3%, HCV 1.4%, HIV 0.2% and RPR 0.2%. In a classification based on occupation, class III donors (drivers, Businessmen & men in uniform) showed a significantly higher incidence of transfusion transmissible infections for HIV (0.38%) and Syphilis (0.36%). Health care workers constituted only a small fraction of the study; prevalence of infections was low among them. History of jaundice or hospitalization was not associated with higher incidence of seropositivity. Seropositivity for HIV is relatively low compared to similar studies conducted in other regions of the country. This finding is attributed to the pre donation counseling in donor selection. An important outcome of the study is that Class III donors form a high-risk group for transfusion transmissible infections.

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The histological evolution of Focal Segmental Glomerulosclerosis (FSGS) is poorly documented due to variation in the time at which the biopsy is taken. We looked at patients presenting with steroid resistant nephrotic syndrome (SRNS) in which the first biopsy was performed within 3 months of presentation. FSGS lesion was demonstrable in 68.5% of cases in the first biopsy. Glomerular size was increased in 86% of patients indicating that is an early event in the course of the disease. The group was heterogenous with respect of mesangial cellularity, mesangial matrix, position of FSGS lesion in the glomeruli, glomerular size, lamina densa thickness and immunofluorescence findings. No association of morphological features was seen permitting subclassification of this group on morphological grounds. Thus, both the FSGS lesion and glomerular enlargement occur early in the evolution of idiopathic FSGS presenting with SRNS.

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Histopatholgoical analysis of cutaneous lesions in 195 patients with HIV/AIDS was carried out between 1989 to 1997 at tertiary level public hospital in Mumbai. 104/195 (53%) cases showed infectious diseases which comprised of molluscum contagiosum (28), condyloma accuminata (18), verruca vulgaris (7), varicella zoster (5), syphilis (14), tuberculosis (13), donovanosis (4), leprosy (2), chancroid (2), bacillary angiomatosis (2), lymphogranuloma venercum (1), Norwegian scabies (3), leishmaniasis (2), demodicidosis (1), crytococcosis (1), tinea versicolor (1). In 12 (6%) cases neoplasms were observed which included squamous cell carcinoma (9), basal cell carcinoma (2) and kaposi's sarcoma (1) case. The miscellaneous conditions were observed in 66(33.5%) cases which comprised of psoriasis (21), papular urticaria (13), Reiter's disease (7) and eosinophilic folliculitis (6). The prevalence of cutaneous tuberculosis observed in this study is high as compared with western literature while the prevalence of kaposis's sarcoma is quite low as compared with reports from Africa, USA and United Kingdom.

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Biopsies from 300 cases with clinical diagnosis of carcinoma cervix were subjected to H&E staining, PAS with diastase and alcian blue at pH 2.5. Interpretation of cases on basis of H&E staining alone and on basis of H&E and mucin stains was done and results compared with each other. Categorization into squamous cell carcinoma (well, moderately & poorly differentiated), adenocarcinoma and mixed carcinoma was done. Morphologic assessment of cases of H&E stain revealed 282 (94%) cases of squamous cell carcinoma, 8 (2.66%) cases of adeno carcinoma and 10 (3.38%) cases of mixed carcinoma respectively. While on the basis of H&E and mucin stains, squamous cell carcinoma case turned out to be 266 (88.66%) in number; mixed carcinomas which included adenosquamous carcinoma and squamous cell carcinoma with mucin secretion accounted for 26 (8.66%) of cases, number of adenocarcinoma was unchanged i.e. 8 (2.66%). 16 of 282 cases (5.6%) diagnosed as squamous cell carcinoma on H&E stain alone were reclassified as mixed carcinoma on inclusion of mucin stains. Thus mucin stains are very helpful in deciding the types of carcinoma cervix and should be done in all cases of carcinoma cervix in order to avoid errors in diagnosis and to detect poorly differentiated mixed carcinomas, which may escape detection by H&E staining.

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Fine needle aspiration cytology is now recommended as the first choice for the evaluation of palpable thyroid nodules. A total of 170 fine needle aspirates of thyroid were evaluated in which the subsequent biopsy were also available for histopathological examination. The age ranged from 16 to 70 years. The cytological diagnosis were compared with the histological results which revealed the sensitivity of 61.90% and 80.95%, the specificity of 99.31% and 76.55%, positive predictive value of 92.86% and 33.33%, negative predictive value of 94.74% and 96.52% and accuracy index of 94.58% and 77.11% were found, when considering suspicious cases alternatively as positives and negatives. Similar statistics from other series of studies revealed almost same results in which cytological results of thyroid lesions were compared with histological results. This suggests that FNAC is an effective and accurate technique for the diagnosis and further management of palpable thyroid nodules.

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To evaluate the use of antibody detection kits in the diagnosis of pulmonary tuberculosis in an endemic area, serum samples from cases (sputum smear positive for AFB) and controls (healthy young adults) were collected and tested using five different kits. Sensitivity, specificity and predictive values were calculated using smear positivity as gold standard. Sensitivity of tests varied from 46% to 68% and the specificity from 68% to 100%. None of the kits evaluated can be used as a single screening test for tuberculosis. However kits with good specificity may be used in conjunction with conventional methods for diagnosis.

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Artificial neural network (ANN) is the unique system, which simulates human brain in many respects and there is high hope that it may achieve higher mental functions. In this brief review we have discussed the basic mechanism of artificial neural network along with its application in the field of pathology.

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Human toxocariasis caused by Toxocara canis is common in both developing and developed countries and leads to visceral larva migrans with high morbidity and mortality. Ascariasis caused by Ascaris lumbricoides, too has global distribution and in India, high prevalence rate has been reported in Kashmir (J & K State). Both nematode parasites, Toxocara canis and A. lumbricoides require similar biological and environmental conditions for the development of eggs in soil. Therefore, the present study was attempted to detect the antibody response to T. Canis excretory-secretory (ES) antigen by enzyme linked immunosorbent assay in patients attending Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir to assess the magnitude of human toxocariasis in Kashmir, the highly endemic area of ascariasis. Interestingly, it was observed that 38 (82.60%) out of 46 patients harbouring Ascaris Iumbricoides had positive antibody response to T. Canis ES antigen while none of the 15 normal healthy subjects from the same endemic zone, 25 from low endemic zone Chandigarh and 15 from other parasitic infections (hookworm, hydatidosis, cysticercosis) indicated detectable positive response. Majority of the ascariasis positive patients studied were in the age group of 21-40 years. However, one ascariasis patient studied in the age group of 1-10 years (4 years old) had also positive antibody response to T. Canis antigen. This study is the first report of human toxocariasis in Kashmir, India, an endemic zone for ascariasis and emphasizes the need for detailed epidemiological study for the ultimate prevention and control of this disease

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Forty Eight cases of adnexal masses were subjected to ultrasound and FNAC. In this study, FNAC could differentiate benign and malignant adnexal masses in 98% of cases where as ultrasound was successful in 85% of cases. FNAC is a safe simple, rapid & reliable investigation. The complex adnexal masses present a diagnostic challenge with particular reference to the findings predictive of malignancy.

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Trichosporon beigelli has been reported to cause invasive disease such as blood stream infection in severely immunocompromised patients. Two cases of urinary and disseminated trichosporonosis by Trichosporon beigelli in hospitalized patients, with predisposing factors such as prolonged hospital stay, continuous urinary catheterization and broad spectrum antibiotics are reported.

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The aim of the present study was to determine the etiological agents, predisposing factors and important diagnostic tests in keratomycosis in Patna. During period of 2 years, 204 clinically suspected cases of keratomycosis were studied by microscopy (10% KOH smear preparation and Gram's staining) and culture (for bacteria as well as fungus). Out of 204 clinically suspected cases, 76 cases (37.23%) were reported positive for fungus by microscopy and culture. 77% cases were between the age group of 21 to 50 years. Males were more than double the number of females affected. 82% patients were farmers by occupation. 81.58% cases gave a definite history of antecedent corneal trauma. 6.58% cases were known diabetics. Peak incidence was recorded in the months of September-October of the years. Single fungal isolates were present in 63 cases (31%) and multiple were there in 3 cases (1.47%). Mixed isolates of bacteria and fungi were there in 4.90% cases. The predominant isolate was Aspergillus species--42 cases (52.26%) followed by Candida--7 cases (9.21%), Penicillium--6 cases (7.89%) and Fusarium-6 cases (7.89%). Ten (13.15%) of fungal isolates remained unidentified. Therefore mycotic keratitis should be suspected in every patient with a corneal lesion and should be ruled out promptly to save sight and before commencing steroids and antibiotics.

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Squamous cell carcinoma is the most common malignant neoplasm of the oral cavity. Number of mechanisms plays a role at the molecular level to transform normal cell into a neoplastic cell. There are a gamut of genes, which are expressed among which bcl-2, have gained a unique importance as inhibitor of apoptosis. In normal epithelial cells Bcl-2 is restricted to stem cells and cells which undergo mitosis. Bcl-2 blocks the post-mitotic phase from apoptosis. Reports of Bcl-2 protein expression in carcinomas are conflicting such as down regulation to elevated expression. In the present study 67 cases of squamous cell carcinomas of varying grades were studied and uniform cytoplasmic positivity were noted in 12 cases for Bcl-2 protein. Bcl-2 prolongs cell survival in epithelial cells and there by giving way to other external stimulus like action of carcinogens and viral agents and interaction with other genes and aids in progression to neoplasia. The possible roles of bcl-2 in the pathogenesis of oral squamous cell carcinoma are discussed.

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A 17 days old male infant, who had features of Down Syndrome, presented with fever, refusal to feed and seizures. He had papular, crusted skin lesions, moderate hepatosplenomegaly and a rapid downhill course. Peripheral blood and bone marrow aspirate showed features of acute leukaemia. Congenital Leukaemia is a rare malignancy associated with a very poor prognosis. Paradoxically, many cases of Congenital Leukaemia, especially in infants with Down Syndrome, show spontaneous remission.

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Cryptococcal meningitis (CM) is the commonest life threatening opportunistic fungal disease in Human Immunodeficiency Virus (HIV) infected individuals. But there are very little reports of lymphadenopathy along with cryptococcal meningitis, although cases of pulmonary, Intestinal, Bone marrow and retinal involvement have been described earlier. Here we report a case of cryptococcal meningitis associated with generalized lymphadenopathy and hepatosplenomegaly.

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Secondary malignant giant cell tumour of bone occurs as a result of previous attempts at local control of a benign giant cell tumour of bone (GCT). Out of the total 445 conventional benign GCT of bone, therapeutic irradiation was given in 39 cases as the lesions were located in the vertebrae and pelvic bones where debulking surgery was not possible and the tumours were pressing on the spinal cord. The patients were followed up for 21 years. Out of 39 cases, 5 patients developed sarcomas of which 3 were fibrosarcomas, 1 was malignant fibrous histiocytoma while 1 was an osteosarcoma. All the patients developing post-radiation sarcomas died within a few months due to lung metastasis. In conclusion, all the patients with benign GCT of bone treated with radiation must be followed life long as they are prone to develop sarcomas.

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Extradural ependymomas arising from filum terminale externa in the sacrococcygeal region are very rare. Since 1937, out of 58 cases reported in English literature, only 13 cases of tumor located presacrally in the retrorectal space, have been reported. The authors report a 38 yrs old male with a primary ependymoma of the sacrococcygeal region causing extensive sacral destruction.

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Silver nucleolar organizer regions (AgNORs) were studied in one hundred specimens of endobronchial brushings. Bronchial biopsies were also obtained from these one hundred cases and subjected to AgNOR staining. These included twenty histologically normal cases, ten cases of inflammatory pathology and seventy cases of pulmonary neoplasms. Fixed cytologic smears and three micron thick sections of paraffin embedded tissue were subjected to AgNOR staining. The mean AgNOR counts in bronchial tissue showed a progressive and statistically significant increase from normal, through inflammatory to neoplastic lesions in both cytologic smears and histopathologic specimens. The AgNOR technique is simple, inexpensive and a useful adjunct to routine histopathology, to evaluate pulmonary lesions. The counts, however, cannot be standardized for a particular lesion as there are inter-laboratory variations.

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Epithelioid haemangioendothelioma is a well-recognized vascular neoplasm but can be mistaken for metastatic adenocarcinoma or other primary liver tumors. We present a case of epithelioid haemangioendothelioma of the liver in a 62 year old woman, in whom the diagnosis was missed by various pathologists. This patient presented with loss of appetite and weight, and fever. She rapidly deteriorated and died presumably of liver cell failure. The characteristic histological features and the positive immunostaining for endothelial markers (CD31 & Ulex europaeus) confirmed the diagnosis.

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Histopathology reports are important quality assurance tools and evaluation of pathological diagnoses described in them is an integral part of total quality control and quality improvement program. We describe a program based on slide circulation which was aimed at both continuing education to upgrade knowledge and proficiency testing of histopathologists. The performance of the participating pathologists was analyzed and the degree of agreement was also studied. The results showed improvement indicated by rising level of performance in 35.3% of consistent participants and increasing trend in the average score. The degree of agreement was comparatively low (65.29%). The practicability of this program and its acceptability as an EQAS was also investigated.

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A case of a recurrent sacro-coccygeal chordoma is reported which histologically showed an admixture of a conventional chordoma and a pleomorphic sarcoma. These tumours are called dedifferentiated chordomas and carry an ominous prognosis.

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Nasal cerebral heterotopia (nasal glioma) are rare congenital benign masses of neurogenic origin with intranasal location, or both. An extranasal case is reported in a 2-year-old-boy without any bony defect or connection with brain. Histology and immunohistochemistry confirmed the diagnosis.

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Due to the devastating nature of acute retinal necrosis syndrome (ARNS), early diagnosis is essential. 5 cases of clinically diagnosed ARNA were investigated for CMC, herpes simplex and varicella zoster virus (VZV) infections. Of the three VZV IgM positive cases, two were positive in acute blood samples and one in vitreous fluid. Thus VZU can be incriminated as the causative agent of ARNS cases in North India.

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Telepathology is the most recent addition to the diagnostic armory of the Pathologist. In spite of its relative limitations, as compared to Dynamic Telepathology, Static Telepathology has been widely accepted as a low-cost diagnostic and consultation tool, especially in those remote areas where expert opinions or second opinions on histopathology, cytopathology or haematopathology are not readily available to the reporting pathologist. For an accurate Telepathology performance, optimal quality of images is required. Knowledgeable use of available hardware and software have made it possible to produce high quality images, making Static Telepathology a reliable diagnostic tool.

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Mature cystic teratomas of ovary are common tumors. A few may exhibit malignant degeneration, most of these being invasive squamous cell carcinoma. We report a rare case of pure squamous cell carcinoma in situ in benign cystic teratoma.

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Juvenile Xanthogranuloma is a non-langerhans cell histiocytosis characterized by yellowish cutaneous nodules that usually appear in early infancy and childhood. Intramuscular variant is a rare form, with only eight reported cases, and none reported in ala of nose. Sheets of histiocytes, few touton giant cells and infiltrative borders makes it susceptible to misdiagnosis as childhood sarcomas or lymphoproliferative disorders. Awareness of the lesion aided by immunohistochemistry helps in reaching the proper diagnosis.

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Atypical fibroxanthoma has a wide spectrum of histological and cytological appearances. One recently described variant is atypical fibroxanthoma with touton type giant cells. We also came across this case in a 24 year old male student who presented with a sub epidermal nodule on the right shoulder for the last one year. The lesion was aspirated, it should spindle shaped cells, giant cells, and collagen. Giant cells had multiple vacuoles and pink colored granules in their cytoplasm. He was diagnosed as atypical fibroxanthoma. The tumor was excised and histopathology confirmed the diagnosis. Complete excision was curative.

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A 29 year old male drug addict, who was HIV positive presented with fever and hepatosplenomegaly. Bone marrow examination revealed Histoplasma capsulatum confirmed by PAS & GMS stains. However patient had a rapid downhill course with multiorgan failure and died before specific treatment could be instituted.

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A rare case of Castleman's disease of retroperitoneum is reported. The patient was an operated case of serous papillary carcinoma ovary. She was found to have an abdominal mass during follow-up. The mass was considered to be metastatic in origin and was resected. Histologically, it was diagnosed as a case of Castleman's disease.

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