Patients with diabetes foot infections were evaluated over a two year period to assess the bacteriological spectrum in the different Wagner's grades of foot wounds. Most of the diabetic foot wounds were found to be polymicrobic in nature with an average of 3.07 organisms isolated per case studied. Amongst a total of 775 clinical isolates, 71.09% were aerobic; whereas 28.91% were anaerobic pathogens. Gram-positive organisms like Staphylococcus spp. and Streptococcus spp. formed almost 50% of the clinical isolates in the first two grades and were reduced to less one-fourth of the total organisms in the last two grades. These was a significant increase in the gram-negative organisms and anaerobes in the last two grades.

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Simple, rapid, inexpensive methods such as pH determination, wet mount, KOH mount, amine test, Gram staining of vaginal discharge were undertaken prior to Pap stained smears of 158 patients of leucorrhoea. We were able to detect non-specific vaginitis (44.30%), Trichomoniasis (16.45%), Candida vaginitis (9.49%), gonococcal vaginitis (0.63%) and senile vaginitis (12 cases). No specific pathology was shown in 26 cases. 1.69% of the cases were of cervical erosion and 3.79% cases suggestive of squamous malignancy.

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Beta-Thalassemia is prevalent in a high frequency of 5-15% in selected geographical areas and ethnic communities. There is need to screen large populations for the heterozygotes of beta-Thalassemia. We have evaluated NESTROFT (Naked eye single tube red cell osmotic fragility test) with 0.36% buffered saline in this study. Of the population screened, 42 cases were positive with NESTROFT, of which 40 were positive with the confirmatory test for beta-Thalassemia. This implies a positive predictive value and specificity of 100%, negative predictive value of 83.3% and sensitivity of 95.2%.

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A total of 1315 breast lesions seen in women up to 40 years of age were registered in the files of Pathology Department. Out of these 807 were benign and 508 malignant lesions. Breast carcinoma was very rare up to second decade of life but its incidence progressively increased with age. Among benign tumours fibroadenomas were the commonest tumours. This study shows a higher incidence of inflammatory diseases and malignant tumours in young females as compared to the reports from the West.

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A malformation is a morphological defect of an organ, or a larger region of the body resulting from an intrinsically abnormal developmental process. In this analysis of 1421 neonatal autopsies performed between 1984 and 1993, 243 (17.1%) cases showed malformations. The data was analysed to find external cues to internal malformations. Twenty three (85%) of the 27 neonates with various facial abnormalities had associated internal malformations in the form of cardiac (n = 11; 40%), renal (n = 7; 25%), or gastrointestinal (n = 3; 11%) abnormalities and diaphragmatic hernia (n = 2). Sixty seven neonates had neural abnormalities. These were associated with cardiac (n = 7; 10%), renal (n = 12; 18%) or gastrointestinal (n = 7; 10%) abnormalities; 43 cases, however, did not have any associated malformations. Renal malformations (n = 66) had highest association with skeletal abnormalities (n = 9; 22%). As many as 45(76%) of the 59 cases with cardiac abnormalities had no external anomalies. Five cases of hypoplastic lungs were seen, all associated with external malformations.

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Kimura's Disease, a rare chronic inflammatory disorder with a benign course affecting the lymphoid tissue is reported hare in an 18 year old South Indian male who presented with bilateral solitary swelling over the mastoid region. Its fine needle aspiration cytology characterised by the Warthin-Finkeldey type giant cells against a background of a bimodal population of lymphocytes and eosinophils prompted the diagnosis of Kimura's disease at cytology itself. This was confirmed at histology. This is the third cytological report of its kind being reported in English literature. Literature with regard to the cytological appearances of Kimura's disease has been reviewed and the various differential diagnoses discussed.

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A total of 463 patients clinically suspected of enteric fever and 100 healthy individuals were investigated by coagglutination (COAG) and countercurrent immunoelectrophoresis (CIEP) for rapid diagnosis of enteric fever. The S. typhi was grown in blood culture in 32 (6.91%) and Widal test was positive in 126 (27.21%) cases. The serum COAG with local antiserum was positive in 165 (35.64%), serum COAG with standard antiserum in 163 (35.21%), Blood culture supernatant (BCS) COAG in 153 (33.05%), serum CIEP for antigen (Ag) in 118 (25.09%), BCS CIEP in 99 (21.39%) while serum CIEP for antibody (Ab) was positive in 34 (7.34%) cases. Only two healthy controls revealed positive COAG result with local antiserum. The sensitivity of all antigen detection tests was 100% except BCS CIEP (98.25%) in the first week of fever and declined rapidly to 75.79% for serum COAG tests, 69.47% for BCS COAG and dramatically to 37.89% for serum CIEP for Ag and 22.11% for BCS CIEP tests during the second week whereas the sensitivity of serum CIEP for Ab detection rose from 17.54% to 23.16% from first to second week of illness. In view of the resulting data, it is suggested that both COAG and CIEP may be employed for the rapid diagnosis of enteric fever in the routine clinical setup.

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Peliosis of spleen is usually associated with peliosis of liver. Oval to round markedly dilated blood filled cystic spaces predominantly in parafollicular area is the characteristic feature of peliosis to differentiate it from congested sinuses. Exposure to viruses chemicals, contraceptive steroids or chronic debilitating disorders including malignancies are the various possible etiological factors. Though peliosis may remain asymptomatic, fatal intraperitoneal haemorrhage may occur due to its rupture. We report a case of peliosis of spleen presenting as splenic rupture with haemoperitoneum.

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200 uveitis cases and 100 controls were serologically analysed for Toxoplasma antibodies (Ab) using indirect fluorescent antibody test (IFAT-IgG, Igm) and enzyme linked immunosorbent assay (ELISA IgG, IgM). Ophthalmologically cases were segregated into 4 groups anterior uveitis, posterior uveitis, pan uveitis and varied presentation uveitis. Toxoplasma seropositivity of 32% in cases and 4% in controls was established. IHA, IFAT, ELISA detected 20%, 18% and 32% cases as seropositive respectively, IFAT being most specific (100%) and ELISA most sensitive (41.37%). Insignificant change in Ab titre was observed in sequential samples of seropositive cases. Posterior Uveitis cases had the maximum seropositivity (41.7%). Highest seropositivity was in 16-25 years age group with no sex preponderance. Dietary habits and occupational history had no bearing on Toxoplasma infection. Results indicate that serology in mandatory for diagnosing Toxoplasma as a cause of uveitis, 2 or more tests on a single serum sample detecting IgG and Igm Ab are the best indicators of infection.

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Contrary to earlier definition of Barrett's oesophagus which referred to the presence of metaplastic columnar epithelium of either gastric or intestinal type, the new definition lays stress on presence of specialised columnar epithelium (SEC) with goblet cells. Hence this study was carried out to determine the frequency of specialised columnar epithelium in Indian population. 150 cases of dyspepsia underwent esophagogatro duodenoscopy with esophageal biopsy. Slides were stained with routine H and E stain and alcian blue-PAS stain. Histologically, esophagitis was found in 75 (50%) and columnar epithelium-gastric type in 63 (42%) cases only 4 (2.6%) cases showed presence of specialised columnar epithelium which were labelled as Barrett's esophagus, giving an incidence of 2.6% in this study.

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Myospherulosis is a rare condition. The authors report a unique case of this entity arising in paranasal sinus. The review of literature with emphasis on pathogenesis is also discussed.

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V. cholerae 01 E1 Tor isolated during Cholera epidemic of 1994 and V cholerae 0139 serotype isolated during 1993 epidemic were subjected to the study of proteases and other enzymes. Out of 26 strains of V. cholerae 01 studied, gelatinase and caseinase activity was seen in 100 and 69.23 percent strains respectively. All strains showed catalase and oxidase activity. Of the other enzymes studied 19.23, 65.38 and 57.69 percent strains were positive for DNAse, lipase and phosphatase respectively. None of the strains showed lecithinase activity. Similar findings were observed in 22 strains of V. cholerae 0139 except all strains were positive for phosphatase activity. Role of enzymes in virulence is suggested.

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Hyalinizing trabecular adenoma is a recently described benign thyroid tumor, almost exclusively occurring in females. The morphological features of this entity overlap with both papillary and medullary carcinoma to varying extent. This, in turn, creates a situation of serious diagnostic pitfall particularly for a false positive diagnosis of papillary carcinoma in fine needle aspiration (FNA) cytology. False consideration of medullary carcinoma is also possible by the unwary especially if staining for Congo red and/or immunostaining for calcitonin is not resorted to. At histologic level, the distinctive architectural pattern is however of great help and thus poses a much lesser danger of misdiagnosis. We relate here our experience in a recently encountered case of hyalinizing trabecular adenoma and describe detailed FNA cytologic and histologic findings along with immunohistochemical profile using a panel of eight monoclonal antibodies. The tumor proliferative potential has also been assessed using MIB-1 (Ki-67) immunostaining. The various pros and cons of diagnostic pitfalls are discussed.

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Darkground Microscopy (DGM) was initially done on Plasma in the Department of Microbiology, Kasturba Medical College, Manipal for 44 cases of suspected Leptospiral hepatorenal involvement. A total of 60 sera were collected from these patients and stored at -70 degrees C. Passiive haemagglutination test (PHA) was performed on 25 sera and latex agglutination test on 35 sera (Leptospira antigen Seiken) Leptospira was detected by Darkground Microscopy in 12 patients (27.27%). Serology was positive in 16 samples (36.36%) of which 7 (15.90%) by PHA and 9 by Latex agglutination (20.45%). Serological tests confirmed the findings of Darkground Microscopy. DGM was found to be simple and rapid and could be performed on all suspected patients.

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Computers are increasingly playing an important role in the field of medicine. A computer aided expert system has been developed for the differential diagnosis of jaundice. In this article the major features and application of this modular software are discussed.

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Between July 1996 to June 1997 a total of 531 Stool samples from cases of acute diarrhoea, dysentry, colitis admitted to Kasturba Medical College Hospital, Manipal were investigated. Shigella were isolated from 29 samples (5.46%). Out of them, Shigella flexneri were 16 (55.17%), Shigella boydii 8 (27.58%), Shigella dysentriae 3 (10.34%) and Shigella sonnei 2 (6.89%). Five strains of Shigella flexneri and one strain of Shigella dysentriae were found to show resistance to Nalidixic acid and the newer fluoroquinolones viz., Ciprofloxacin, Norfloxacin and Ofloxacin. The in vitro 'R' factor transfer study showed that the resistance was not transferable.

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A thirty-four years old woman presented with pure squamous cell carcinoma of the breast, a very rare occurrence in the younger age group. A simple mastectomy with axillary clearance was performed, followed by adjuvant radiotherapy & chemotherapy. The patient is doing well, with no evidence of recurrence thirty months (2 1/2 years after the treatment. Primary pure squamous cell carcinoma of the breast is a very rare disease. The exact histogenesis still remains obscure. There seems to be no specific prognostic correlation with the morphological characteristics of squamous cell carcinoma of the breast. The clinical behaviour of this tumor is also uncertain. Thus, further study is required to determine whether primary pure squamous cell carcinoma of the breast is to be treated as a separate entity or as the common type of breast cancer (i.e. adenocarcinoma or adenocarcinoma with squamous metaplasia.)

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A case of primary teratoma of the liver in a 10 months old male child is being reported for its rarity. It is the first case report in Indian literature.

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Serious incompatibility was noted in a patient diagnosed as acute Guillain Barre syndrome treated with intravenous immunoglobulin. Patient had positive direct and indirect antiglobulin test and the auto control was negative. There was no clinical signs of hemolysis. Patient's blood group was O D positive and cross matched several units of ABO compatible D positive and D negative blood. Only one unit was compatible. These findings suggest that the particular intravenous immunoglobulin contained a mixture of saline and immune antibodies having different specificity. As the number of patients getting treated with intravenous immunoglobulin is on the rise more and more compatibility problems should be anticipated and should be borne in mind during serological testing and evaluation.

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We report the unusual fixed cutaneous variety of sporotrichosis in a patient hailing from Uttarkashi (Uttar Pradesh) in the north-western part of India.

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Dyshormonogenesis is a rare cause of goitre. It is manifestation of mutation in genes controlling the proteins involved in synthesis of thyroid hormones. Though there is wide spectrum of biochemical and clinical presentation, pathological features are similar in all defects. Nonencapsulated nodules with minimal regressive changes and lack of lymphocytic infiltration are important diagnostic features. Clear cell change as seen in this case is common and needs to be differentiated from parathyroid adenoma. Hypercellularity with cellular atypia should not lead to misdiagnosis of malignancy.

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Benign melanocytic proliferation in the mucosal glands of rectum is described in a 56 year old female with primary melanoma of rectum.

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