Objective: The aim of this study is to study the incidence of the underlying etiology of pancytopenia presenting at our institution with a clinical and hematological correlation. Materials and Methods: A prospective study of 12 months' duration was carried out, which included patients of all age groups. Of the 60 patients presenting with pancytopenia, bone marrow aspiration and biopsy were done on 30 cases, after taking an informed consent. Patients who had received previous blood transfusion and were on chemo- and radiotherapy were excluded. A detailed clinical examination of all cases was carried out. Results: The most common etiology of pancytopenia in our study was normoblastic erythroid hyperplasia (30%), followed by megaloblastic anemia (20%). This was followed by acute myeloid leukemia (13.3%) and closely by micronormoblastic erythroid maturation (10%) and miscellaneous etiologies. Conclusion: The varied causes of pancytopenia can be attributed to the geographic area, genetic differences, stringency of diagnostic criteria, and differences in the methodology used. There are varying trends in its clinical pattern, treatment modalities, and outcomes. The severity of pancytopenia and the underlying pathology determines the management and prognosis. Thus, identification of the correct cause will help in implementing the appropriate therapy.

Background: In India, adolescent age group (10-19 years) constitutes 21.4% of the total population. The health and nutritional status of the adolescents is an index of its future manpower. It is well recognized worldwide that anthropometric measurements are indispensable in diagnosing undernutrition. Objective: To assess the nutritional status and morbidity pattern among school-going adolescents. Materials and Methods: A descriptive cross-sectional study was carried out in three randomly selected co-educational schools of Burdwan District of West Bengal in May 2013 among 424 adolescents in the age group of 10-19 years from class V to class XI (except class X), using a predesigned pretested proforma. Results: The prevalence of underweight and stunting were 53.31% and 47.41%, respectively, which was significantly higher in early adolescence than in late adolescence and more in boys than in girls. About 55.18% had pallor, 40.33% had dental caries, 33.49% were suffering from refractive errors, 23.11% had history of worm infestation, 38.90% had skin problems, and 68.61% adolescents had ENT problems. Conclusion: The health and nutritional status among the school-going adolescents was found to be poor.

Context: Most of the females suffer from breast diseases during their life at some time or the other. Confirmation of breast diseases by clinical examination and pathological confirmation by fine needle aspiration cytology (FNAC) and histopathologic examination has been found to be an important part of diagnostic workup in breast diseases. Aims: To establish a clinicopathologic correlation in patients suffering from breast diseases. Settings and Design: We conducted a prospective study from December 2008 to August 2010. One hundred and twenty-one cases were enrolled using simple random sampling methods. Materials and Methods: Data including age, complaints, and clinical examination was collected from patients presenting for FNAC with breast complaints. Results: A total of 128 cases were studied which included 101 benign cases, 21 malignant cases, and 6 inadequate cases. The final 122 cases included 3 (2.5%) cases of acute mastitis, 2 cases (1.6%) of tubercular mastitis, 44 cases (36.1%) of fibroadenoma, 42 cases (34.4%) of benign breast disease with non-specific descriptive diagnosis, 2 cases (1.6%) of fibrocystic disease, 3 cases (2.5%) of galactocele, 1 (0.9%) case of lactational adenoma, 2 cases (1.6%) of cellular fibroadenoma, and 2 cases (1.6%) of phyllodes tumor. Apart from this, there were 21 cases (17.21%) of ductal carcinoma. Majority of benign cases were between 30 and 39 years of age (43.6%). Majority of malignant cases fell between 50 and 59 years of age (47.6%). Majority (61.5%) of lumps (>3 cm) were malignant, whereas 94.8% of lumps (<3 cm) were benign. Left breast was commonly involved (49.18%) than the right breast (44.26%). Superolateral quadrant (63.1%) was the most commonly involved quadrant. Histology was available for 35 benign cases (34.65%) and out of total malignant cases (21), histology was available for 14 cases (66.66%). No discrepancy was noted.

Context: The immunity in HIV-infected patients becomes low due to involvement of CD4 cells. The single best predictor of AIDS onset identified is the percentage or absolute number of circulating CD4+ T cells. However, providences in resource-constraint settings may not have access to this laboratory measurement, or its cost may be prohibitive resulting in the need for an alternative, surrogate marker. Hence, total lymphocyte count (TLC) was evaluated as a probable surrogate marker for CD4 count in this study. Aims: To evaluate the correlation of CD4 counts with the TLC for predicting the progression of HIV infection, and to determine a range of TLC cut-offs for predicting CD4 count <200 cells/μl, which is important for the initiation of antiretroviral therapy (ART) and opportunistic infection (OI) prophylaxis. Settings and Design: This study was conducted in the Department of Microbiology at Government Medical College, Aurangabad. Materials and Methods: A total of 250 HIV-positive patients were included in the study. Their Complete Blood count and CD4 count were measured and the TLC was computed. Statistical Analysis Used: SPSS software version 10.0. Results: A positive correlation between TLC and CD4 count was observed in our study, highlighting the role of this surrogate marker in resource-limited settings. Further, a TLC cut-off of ≤1700 cells/μl was found to be the best predictor for a CD4 count <200 cells/μl. Conclusions: A general correlation between the surrogate marker TLC and expensive CD4 counts could be elicited for the population under study. A TLC cut-off of ≤1700 cells/μl was the best predictor of CD4 count <200 cells/μl. This study demonstrates the ability of TLC, whether used as a continuous or dichotomous data, to predict CD4 count or a CD4 count <200 cells/μl, respectively.

Background and Objective: A common side effect with phenytoin is gingival hyperplasia. This apparent stimulatory effect of phenytoin on connective tissue suggested the possibility for its use in wound healing. This study aims to evaluate the effect of 1% and 2% phenytoin ointment on the excisional wound healing process in experimental albino rats, in comparison to 5% betadine ointment. Materials and Methods: Albino rats of Wistar strain (150200 g) were divided randomly into four groups (n = 6). The animals were anesthetized with ether, shaved on the back, and the skin was disinfected using cotton and alcohol wipes. Excisional round, full-thickness skin wounds of diameter 15 mm were created in the paravertebral area, at 5 mm from the midline on the back of all the animals, using sterile disposable acuderm biopsy needle. The following medications were applied topically to the wound twice daily for a maximum of 20 days. Group A rats served as negative control (untreated). Group B rats were applied 5% betadine ointment (positive control). Group C and group D rats had 1% and 2% phenytoin powder applied on them, respectively. Wound healing was measured on days 0, 4, 8, 12, 16, and 20 of the experiment. Number of days taken for complete epithelization of wound was also noted. Statistical analysis was done using analysis of variance (ANOVA) followed by TukeyKramer test and P < 0.05 was considered significant. Results: Both 1% and 2% phenytoin powder hastened healing and reduced the time taken for complete epithelization of excisional wound in albino rats, when compared to negative control (P < 0.05). While 2% phenytoin powder was superior (P < 0.05) to both 1% phenytoin powder and 5% betadine, the latter two were comparable (P > 0.05). Conclusion: 2% phenytoin may be considered as an important agent for wound healing, but its role in the healing of infected wound needs to be explored further.

Background: Type 2 diabetes is investigated as a risk factor for peripheral neuropathy. In whole body simple reaction time (WBSRT), the reaction time is split into two chronoscopic readings C1 and C2. C1 measures the time required for central processing which requires cognition and C2 measures total reaction time. C2-C1 measures the time required for peripheral motor response, i.e. the required for conduction of impulse in motor nerve fiber. We hypothesized that WBSRTC2-C1 will be delayed in diabetes and WBSRTC2-C1 will have predictive value in detecting peripheral neural dysfunction. Settings and Design: Hospital-based case control study. Materials and Methods: This study was conducted on 120 subjects using whole body reaction timers with the criteria of age (40-60 years) and type 2 diabetes and the results were compared with an equal number of age- and sex-matched controls. Statistical analysis was done by independent t-test and duration of diabetes was correlated with the time required for motor response (WBSRTC2-C1) using Pearson's correlation. Predictive value of WBSRTC2-C1 was calculated by using receiver operating characteristic (ROC) curve. Results: WBSRTC2-C1 (334 ± 67 ms) in diabetics was more delayed than WBSRTC2-C1 (297 ± 66 ms) in controls, indicating peripheral neural dysfunction in diabetes. There was no significant correlation between HbA1c, diabetic duration with WBSRTC2-C1 in diabetes. ROC curve for WBSRTC2-C1 to predict peripheral neuropathy was insignificant. Conclusion: Though WBSRTC2-C1 is delayed in diabetics, it alone cannot predict peripheral neural dysfunction in diabetics.

Background: Risk stratification is critical in the management of acute myeloid leukemia (AML) and among the favorable subset translocations known, 8;21 seems elusive in our clinical practice as regards the response remission status. This led us to review our patients retrospectively to highlight this ambiguity. Patients and Methods: A retrospective study was carried out on a total of 20 patients positive for translocation (8;21) and negative for FLT3 and NPM gene mutation. These patients were treated with standard AML treatment protocols. Post induction day 14 and day 28 assessments were done. Four patients died during induction chemotherapy and all the remaining patients were in remission. Subsequently, these patients were subjected to consolidation chemotherapy. Results: Out of total of 16 (80%) survivors, 10 (50%) could not maintain the remission status on a mean follow-up of 6 months and were treated with a different induction protocol. After the second induction, all patients were in remission at day 28, but this remission again was short lasting (<3 months). Conclusion: One needs to be careful in treatment of AML with translocation (8;21) and this should not be taken as a single criterion for treatment of these patients. These patients should be subjected to additional somatic mutation analysis before final risk stratification.

Background: The importance of a clean environment and linen for optimal patient care has been stressed upon since the very inception of hospitals. Individuals who work in a laundry are required to be adequately informed about the physical and health hazards present in the laundry, the known risks, and what to do if an accident occurs. Every laundry worker must be trained to know the location and proper use of the available personal protective clothing and equipment. Therefore, safe environment in the laundry is essential to maintain their health, and awareness programs should be conducted. Objective of the Study: To assess the awareness regarding occupational health hazards among the employees in the Laundry Department. Materials and Methods: The research method adopted in this study is of a descriptive type. The study was conducted in the Laundry Department of the selected hospital. The sample consisted of 15 respondents. All the employees in the department were included. The tools used to collect the data were an informal interview and the check-list and observation methods. The collected data was analyzed by percentage. Result: The study reveals that a majority of the respondents were knowledgeable about the occupational health hazards and safety measures. However, very few of them were aware of the types of occupational hazards. Conclusion: Awareness of occupational health and safety among the employees is important in the laundry area; therefore, planned orientation, training programs, and proper guidance to the employees will help reduce any kind of danger involved in the job and adoption of the necessary safety measures.

Context: The goal of universal access to antiretroviral therapy (ART) by 2010 was set at 80%, but most countries could not meet the target. In 2011, the international community recommitted the goal of universal access to ART by 2015. The Millennium Development Goal included halting and beginning to reverse the spread of human immunodeficiency virus (HIV) by 2015. Aim: To assess the knowledge and self-reported practice with regard to ART among HIV-positive people, to find the relationship between the knowledge and self reported practice, to find the relationship between knowledge and self-reported practice and to associate the knowledge and practice with the selected demographic data. Setting and Design: The ART Centre, Mangalore, descriptive correlational survey design. Materials and Methods: A Structured Interview Schedule on 60 patients who were on ART for >2 months. Statistical Analysis: Frequency, Mean, SD, mean percentage, Karl Pearson's Correlation Coefficient, and Chi-square for association. Result: The majority (78.3%) had good knowledge, 15% had very good knowledge, and a few had average knowledge (6.6%). Most had a safe practice 76.7%) and a few had a very safe practice (23.3%). The Karl Pearson's correlation coefficient ((r = 0.22), P value (0.82) > 0.05 level) revealed no significant correlation. Association was found between the knowledge level and type of family and reason for HIV testing. Conclusion: Pooled results showed that the overall knowledge and ART practice were good and safe.

Purpose: Multiple methods of accelerating fracture healing have been proposed and some are approved for use in the clinical settings. A low intensity (30 nW/cm ² ) pulsed ultrasound (LIPUS) signal will promote fracture healing. This study is conducted to determine the effect of LIPUS on fresh fracture healing. Materials and Methods: Out of the 60 patients with diaphyseal fractures of the tibia and femur fixed with an interlocking nail, 33 received LIPUS and 27 were kept as control. Ultrasound treatment was started three days after surgery, 20 minute sessions each day, for 30 days. The rate of fracture healing in the LIPUS group was compared with that of the control group. Six orthopedic surgeons and two radiologists analyzed the follow-up x-rays. Results: Five out of the six surgeons interpreted that there was significantly more callus formation and union in the LIPUS group compared to the control group, especially in the initial stage of healing. The need for dynamization decreased by 50% in the LIPUS group. Both radiologists interpreted that there was significantly more callus in the case where ultrasound was administered, when they evaluated the same with an diagnostic ultrasound scan at the fracture site. Conclusion: The present study establishes the relation between low intensity pulsed ultrasound therapy and fresh fracture healing, especially in the early stages. We strongly recommend the use of LIPUS as an adjunct therapy where the surgeon anticipates delayed union of the fracture.

The thyroid hormone plays an important role in regulating the mood and cognitive functions of the body. Studies have revealed that although a majority of the cases of depression are associated with euthyroidism, thyroid dysfunction has commonly been seen associated with depression. The most commonly seen thyroid abnormality in the thyroid patients are raised levothyroxine (T4), decreased tri-iodothyronine (T3), and raised thyrotropin release hormone (TRH) levels, and a blunted thyroid stimulating hormone (TSH) response. A majority of the patients with abnormal thyroid function tests are associated with subclinical hypothyroidism. It is also believed that T3 supplementation, even in the euthyroid patients with depression, is associated with improvement in their depression scores.

Fatty replacement of non-lipomatous tumors is rare. We report a case of retroperitoneal ganglioneuroma, showing fatty replacement in a 17-year-old adolescent male. The patient presented with a left lumbar mass. Ultrasound and computed tomography (CT) examination showed a 5 × 6 cm mass near the left adrenal gland. A diagnosis of myelolipoma was made clinically due to the proximity of the tumor to the adrenal gland and fat content of the tumor. Microscopic examination of the growth revealed extensive foci of fat scattered between the ganglioneuroma component. Fatty replacement of the ganglioneuroma has been documented only in four cases so far. A short review of the differential diagnosis of fat containing retroperitoneal masses is made along with emphasis on the pathological and clinical implications of lipomatous change.

Presentation of dengue fever can range from asymptomatic infection to life-threatening dengue hemorrhagic fever and dengue shock syndrome. We report a case of dengue fever presenting as encephalitis, which is very rare.

Huntington's Disease (HD) is an autosomal dominant progressive degenerative disorder of the basal ganglia characterized by motor, cognitive, and psychiatric manifestations, with an estimated prevalence of 1.75 per 100,000. It can present any time between infancy and senescence. Mood disorders, obsessive compulsive symptoms, psychosis, delirium, sexual disorders, and 'frontal' syndromes, have been reported in patients with HD. Delusions are seen in only about 5-12%. Indian data on HD has been largely through case reports. Given this background, we present an uncommon case with clinical features suggestive of HD and organic delusional disorder. This case report presents the psychiatric and neurological features of a 39-year-old male, who presented with abnormal choreiform movements since eight years, followed by a delusion of infidelity, and a family history suggestive of HD. Differential diagnosis and laboratory results, including neuroimaging and treatment, are presented. Delusions are the common manifestation of psychosis in patients with brain disorders, occurring more often than a formal thought disorder. Lesions of the temporal lobes or caudate nuclei and bilateral brain involvement are common in disorders manifesting psychosis. However, reasons for the infrequent occurrence of delusions in HD, in comparison to other neurodegenerative disorders, are unknown.

Zygomycosis is a serious and often rapidly fatal infection especially in immunocompromised patients. Rhinocerebral mucormycosis is the most common clinical form, accounting for about 50% of the reported cases. Impaired delivery of the antifungal drugs to the site of infection because of vascular thrombosis, and limited aggressive surgery because of the complex anatomy of the rhino-orbital region warns that early diagnosis and aggressive management is required in these patients. We encountered a rare case of zygomycosis of the temporal bone causing skull base osteomyelitis in a diabetic patient. The causative agent for skull base osteomyelitis has mainly been Pseudomonas aeruginosa, and rarely Aspergillus, but zygomycosis has not been mentioned as its cause in literature. Hence, we are reporting this case.

This report describes a case of adrenal histoplasmosis along with disseminated cutaneous involvement in a 48-year-old immunocompetent male. The patient presented with multiple erythematous nodules on the skin of the scalp, face, back, thigh, abdomen, and soles. Abdominal computed tomography (CT) imaging revealed bilateral adrenomegaly, with hepatosplenomegaly. Histological examination of the biopsy specimen from both the skin lesion and CT-guided fine-needle aspiration cytology (FNAC) aspirates of the adrenal gland showed a granulomatous infiltrate with numerous intracellular Periodic Acid Schiff (PAS)-positive rounded yeast cells within the macrophages. Culturing of these materials, incubated in Sabouraud's agar, showed growth of Histoplasma capsulatum. Treatment with itraconazole showed an excellent response.

Tubercular epididymo-orchitis in not uncommon in a highly tuberculosis-prevalent developing country like India. However, it closely mimics a testicular tumor clinically, radiologically, and even serologically. This may lead to an unnecessary orchidectomy. Nevertheless, fine needle aspiration cytology can provide adequate material for cytological and microbiological examination and it helps to avoid unnecessary orchidectomy when there is suspicion of a testicular tumor.

Urinomas are formed when urine leaks outside its normal pathway of flow from the kidney to the urethra. In most cases it is found in the retroperitoneal space, around the perinephric region. Urinomas are formed secondary to obstruction (such as calculi, fibrosis, malignancy, etc.), or from trauma (blunt, penetrating or iatrogenic). Subcutaneous urinomas are extremely rare and to the best of our knowledge only two cases have been documented, both of which have resulted from renal trauma, secondary to renal transplantation and ureterocutaneostomy. We present the first and only known case of subcutaneous urinoma occurring as a sequelae to percutaneous nephrolithotomy (PCNL) with computed tomography (CT) correlation.

Ingestion or inhalation of foreign bodies can prove to be a diagnostic challenge. Unexplained throat pain and acute onset of dysphagia in an elderly patient should alert the clinician to the possibility of accidental foreign body ingestion. A patient presented with complaints of sudden onset of difficulty and pain in swallowing associated with ear pain, neck pain, and hypersalivation. The examination was within normal limits. It was on radiology that the suspicion of a foreign body was aroused. During esophagoscopy, an unsuspecting foreign body was discovered; a lower partial denture, swallowed unknowingly by the patient four days previously. Postoperatively the patient was stable. The case demonstrates how the clinician must have a high index of suspicion of foreign body ingestion, should a patient present with such symptoms. It also demonstrates the need for immediate and prompt intervention in order to prevent progression to fatal complications.

Chondroid syringoma or pleomorphic adenoma of the skin is a rare tumor arising from the eccrine glands. It is an asymptomatic slow growing tumor. We report a case of chondroid syringoma of the lower eyelid margin and lateral canthus in a middle-aged man, which was excised. The lid was reconstructed by lateral cantholysis and advancement flap for lid reconstruction. A possible diagnosis of chondroid syringoma should be borne in mind when solitary, firm tumors of the lid are presented.

Dermoid cysts are malformations that are rarely observed in the oral cavity. They can be congenital or acquired. They are further classified as anatomical and histological. We present here a case of an 11-year-old boy with a swelling in the floor of the oral cavity. Although various investigations pinpoint to the diagnosis, the final confirmation is obtained after histopathological examination of the excised cyst. Following enucleation via the intraoral approach the patient has been followed up for a period of 10 months, with no recurrence.

The Alport syndrome is a rare genetic disorder characterized by hematuria, sensorineural deafness, and ocular manifestations. The Alport syndrome accounts for 0.3 to 2.3% of end-stage kidney disease in young males and children. Here we report a case of the Alport syndrome, with all the characteristic features.

A human tail is a congenital, caudal, cutaneous appendage, which usually arises from the tip of the coccyx or it is a finger-like protrusion at the lumbosacral region. It usually indicates the presence of an underlying occult spinal dysraphism. Herein, the authors report a rare case of a human tail, along with multiple anomalies of the limbs in a newborn. The embryological basis for the association is also highlighted.

The presentation of a non-healing friable ulcerated growth in the oral cavity with cervical lymph nodes in an elderly patient, would in all possibilities, raise the first suspicion of malignancy. We present a case of an ulcerative nonhealing growth over the hard palate and left gingivobuccal sulcus, the biopsy of which revealed granulomatous lesions, leading to the suspicion of oral tuberculosis. The importance of early diagnosis and treatment lies in the fact that it can be easily confused with neoplastic or traumatic etiologies

The family is a primary unit in all the societies and is the crucial element around which health services are developed by the program managers. Prevention of disease and bringing improvement in the health conditions in any society is dependent upon the ability of the public health professionals to understand and improve the social or environmental factors. The family plays an important part in maintenance of the optimum level of health and in the dynamics of the disease. In addition, there are multiple functions and responsibilities associated with a family, all of which are relevant to health and health behavior. Realizing the impact of the family on the society and community, all the public health strategies are developed with the aim of appealing to the needs of the family. To conclude, the role of the family in the growth of society is of paramount importance, and thus, program managers should implement measures to ensure harmonization within the family for safeguarding the future of human generations in the years to come.