The present study was conducted in the department of Haematology and Transfusion Medicine, Government Medical College & Hospital, Chandigarh over a period of 32 months. During this period pancytopenia was an indication for bone marrow (aspiration and or trephine) in 77 out of a total of 205 cases (37.6%). The most common cause of pancytopenia as revealed by bone marrow was megaloblastic anaemia (68%) followed by aplastic anaemia (7.70%). This study also revealed few uncommon and rare, but interesting causes of pancytopenia like drug induced agranulocytosis, hemophagocytic syndrome and waldenstroms macroglobinemia.

The presence of both components (antigen and antibody) in circulating immune complexes (CIC) were detected in tuberculosis in children. Fifty two patients with pulmonary and extrapulmonary tuberculosis showed the presence of either components or both. CIC--antigen was present in 92.3% (48/52) and CIC antibody in 88.96% (46,52). Out of these 52 patients, 20 were proved cases, CIC antigen (ag) and CIC--antibody (ab) were present in 100% (20/20). In the control group both CIC-ag and CIC-ab and CIC = ab can be taken as an additional marker in diagnosis of tuberculosis.

One of the greatest challenges of transfusion medicine is the prevention of transmission of infectious diseases through blood transfusion. The aim of this study is to present the current status of transfusion transmitted diseases among healthy unpaid blood donors so as to heighten the awareness of the complications of blood transfusion and make usmore vigilant with regard to the specifics of blood collection and testing as well as judicious use of blood. 8617 donors donated at St. Johns Medical College Hospital Blood bank from 1st. September 1997 to 31st August 1998. The tests done on all units included testing for HIV 1&2, HBsAg, HCV, VDRL and malarial parasites. The seropositivity among donors for HIV was 0.44%, for HBsAg 1.86%, for HCV 1.02% and for VDRL 1.6% No MP Positives were picked up in the study period. The focus has been on HIV so far. We have found the magnitude of hepatitis to be far more than that of HIV. Hence testing for HCV routinely is recommended.

The Beta haemloytic streptococci (BHS) are well recognised human pathogens causing a variety of infections, including septicemia. It is important to ensure their isolation from clinical specimens by using optimum media. Moreover, since the different groups have different pathogenic potential, it is equally important to routinely serogroup them; this is emphasized here. Since, BHS are uniformly will greatly decrease morbidity and mortality due to BHS infection.

Methicillin resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen. Recently, there have been reports of increasing prevalence of MRSA in the community. We here report an outbreak of post operative wound sepsis by MRSA in the surgical ward of LN hospital. A surveillance study for MRSA was undertaken in the corresponding surgical ward, operation theater and OPD and the source of this outbreak was traced to an outdoor patient with community acquired MRSA infection. A total of 320 clinical and environmental samples were screened for MRSA. Seventy (21.8%) S. aureus were obtained, of which 12.8% were resistant to methicillin. 14% of the MRSA infections were from the community. Nasal carriage rates of MRSA in the screened hospital staff and admitted patients were 5.8% and 4.3% respectively. None of the environmental sites sampled yielded MRSA. A study of antibiogram revealed that all the MRSA were uniformly resistant to penicillin, erythromycin, gentamicin, tobramycin and tetracycline and sensitive to vancomycin. All isolates belonged to the same biotype and were nontypable by the standard set of phages.

The histopathology of the antral mucosa of patients with acid peptic disease was studied in relation to Helicobacter pylori infection. Three hundred and fifty-five patients underwent gastroscopy and biopsy on 443 occasions. During each gastroscopy, two antral samples were taken for Rapid Urease Test (RUT) for H. pylori and two antral samples for histopathology. Haematoxylin and Eosin and modified Giemsa stained sections were studied. Histopathological changes in the antrum and the density of H. pylori were graded according to the Sydney System criteria. There was a significant association between the RUT and histology results for detection of H. pylori. The overall prevalence of H. pylori was 61.4% with a maximum incidence in the third and fourth decades of life, and an equal sex distribution. H. pylori colonisation was seen in 90.7% of patients with duodenal ulcer, 66.7% with gastric ulcer and 44.3% with non-ulcer dyspepsia. H. pylori colonisation was associated with more severe antral chronic active gastritis, lymphoid follicles, intestinal metaplasia and dysplasia. Elimination of H. pylori by treatment with anti-H. pylori regimens resulted in regression of the changes.

Diagnosis of tuberculosis in body fluids remains an enigma. This study is an attempt to evaluate various modalities like smear, culture & PCR for the same. Out of 110 samples of body fluids, 68(61.8%) were negative by all the modalities, 11(10%) could be diagnosed by all modalities. 25(22.72%) were diagnosed by PCR alone. 3(2.7%) showed a growth on culture alone while 3 cases (2.7%) could be demonstrated only on smear.

Ecological niches of Staphylococcus aureus are the anterior nares. Carriage of Staphylococcus aureus in the nose appears to play a key role in the epidemiology and pathogenesis of infection. Numerous studier have shown that elimination of nasal carriage using Mupirocin also eliminated hand carriage and the spread of infections in hospitals. Lipovitellin-Salt-Mannitol Agar was used for screening, isolation and presumptive identification of Staphylococcus aureus from nasal carriers. From November; 97 to August'98, 724 nasal swabs were cultured and 18.23% of health care workers were found to be nasal carriers of Staphylococcus aureus. Of these 12.15% were carriers of MRSA. The carrier rate was highest in December' 97 (32.07%). All MRSA carriers were treated with local application of Mupirocin for three days. A study of the antibiogram of the clinical isolates during the corresponding period showed 100% susceptibility of MRSA to Vancomycin. Susceptibility of MRSA to Clindamycin, Netilmycin, Rifampicin & Ofloxacin was 86.6%, 69.5%, 66% & 64.7% respectively.

Proteinuria is one of the markers of renal diseases. Its quantitative measurements alone limited diagnostic conclusions. To determine the extent of precipitated proteinuria as a tool for diagnosis, I used the precipitated urine protein without any effect of any chemical and heat for protein precipitation utilizing an approach which was developed previously (Ahmed Mukhtar, 1997 & 1998). Two samples of urine (5 c.c each) from two different occasions were collected from 8 renal transplant recipients with and 7 normal healthy persons without any history of renal involvement. The samples were dried at room temperature without adding any chemical for 24 hours and precipitated urine was diluted in 0.3-0.5 ml distilled water. Then were run on Bekman apparatus Paragon Electrophoresis System and scanned for electrophoresis bands for the following proteins in BDF hospital: albumin, alpha 1, alpha 2, beta, and gamma. The pattern of electrophoresis graph and bands were different in the urine of patients compared to the urine of healthy persons. There were alterations in alpha 1 and beta proteins in the urine of renal transplant recipients. This technique illustrates a feasible approach to estimate the protein alteration in renal transplant recipients, and this pilot study could be used as a tool for further studies.

Silver nucleolar organizer region (AgNOR) staining was employed in one hundred specimens of endometrium. These included fifteen normal controls (Proliferative + Secretory endometrium) and eighty five lesions. Endometrial lesions comprised of endometritis (15), endometrial hyperplasia (25) and endometrial carcinoma (45). Three micron thick sections of paraffin embedded tissue were subjected to AgNOR staining as described by Crocker and Smith with a little modification of 0.01% safranin counterstain--The mean AgNOR scores were found to increase steadily from normal to endometritis to endometrial hyperplasia and carcinoma--The observations revealed statistically significant differences in values between atypical hyperplasia and carcinoma also. AgNOR staining and scoring is simple, inexpensive and a useful adjunct to routine histopathology to evaluate endometrial lesions especially to differentiate borderline lesions. Though scores cannot be standardized and fixed for a particular lesion as there are intralaboratory variations.

A total of 175 cases of dermatophytoses were studied. Out of all the clinical types, Tinea corporis (T. corporis) was found to be the predominant clinical type (24.57%) followed by tinea cruris (T. cruris) (22.28%). Incidence of Tinea barbae (T. barbae) and Tinea imbricata (T. imbricata) was the least (2.85%) and 0.57% respectively. Out of 175 cases of dermatophytoses, 66 (37.71%) cases were positive on microscopic examination, out of which 27 (40.90%) cases were positive by culture also. Out of the 175 cases of dermatophytoses, 109 (62.28%) were engative on microscopic examination, out of which 13 (11.92%) were culture positive. In this study, Trichophyton was the commonest genus of dermatophyte isolated, with Trichophyton rubrum (T. rubrum) being the commonest species (28.12%), followed by Trichophyton mentagrophyte. (T. mentagrophyte) (25.0%) Trichophyton soudanense (T. soundanense), which is a rare species (not reported from any studies) was isolated from cases of T. corporis and T. cruris.

Eighteen 8-12 days old stray dog (canis familiaris mongrel) pups of either sex; 6 pups each in test groups and control group were infected with lepotspiral serovars autumnalis and canicola. The experimental animals, clinical, bacteriologic and histopathologic kinetics were observed. Both the serovars had evoked typical clinical manifestations. Leptospiraemia could be demonstratedin between the post inoculation (PI) days 1 & 5. Leptospiruria commensed in between the PI days 5 & 7 and lasted throughout the study period. Histopathologic study did not reveal any marked pathologic changes except hydropic changes in the liver of both the test groups.

In the present study delayed cutaneous hypersensitivity response (DNCB test) and humoral response (by uantification of immunoglobulins) ware carried out in 20 cases of leukaemias. None of the cases was found to be anergic or immunodeficient. In remission also patients showed the normal response.

We ought to obtain data on the prevalence of the newly discovered tranfusion transmittable hepatitis G virus in polytransfused b- thalassemia major children. Each individual had received multiple blood transfusions, from 12 to 36 per year. No documentation of prior hepatic infection was available. Serum samples were collected prospectively from the randomly selected subjects and were analyzed for HGV RNA by polymerase chain reaction using primer specific for two different regions of the HGV genome. Among the 100 individuals examined 21 were positive for HGV RNA. Four patients had evidence of dual infection, both HGV RNA and HCV RNA were isolated from their sera. While in one sample presence of both HGV RNA and HBV DNA was established. Only one child was positive for hepatitis E antibodies. The sera of 10 children were reactive for hepatitis B surface antigen whereas 35 individuals were positive for hepatitis C virus antibody. The ALT levels were variable in HGV infected children. Four out of 16 (25%) showed peak ALT levels of 218 IU/I, 8/16 (50%) children demonstrated slightly elevated ALT levels whereas 25% individuals showed normal ALT levels. Alkaline Phosphatase levels were elevated in 90% of the children and 20% patients of this series also had higher GGT levels. The observed AP levels were not statistically different among HGV, HGV/HCV or HGV/HBV groups. Even though the ALT levels were deranged in the children with HGV alone but none of the children had demonstrated symptoms of liver disease, their direct and total bilirubin levels were normal and no complain of jaundice was recorded. In conclusion, our findings suggested that like other blood borne hepatic viruses, HGV is also prevalent in the high risk group of multiple transfused patients in Pakistan but our results support the absence of any causal relationship between HGV and hepatitis.

Toxoplasmosis, a parasitic infection, varies in its prevalence in various countries. Some studies have suggested its role in the causation of abortions. We reviewed the records of Microbiology Department at Sher-i-Kashmir Institute of Medical Sciences, Srinagar (Kashmir) and found that out of 2371 women with recurrent abortions and 310 women with neonatal deaths tested for IgM antibody against toxoplasma, 1260 (53.14%) and 215 (69.35%) tested positive respectively. One hundred and twenty-two women with recurrent abortions and 55 women with neonatal deaths who had tested positive for IgM antibody were followed during subsequent pregnancy and were treated with spiramycin; 115 94.26%) in current abortion group and 35 (63.64%) in neonatal death group delivered normal babies. We discuss the role of seropositivity for toxoplasma in women during reproductive period.

Haemangiomas of large bowel are very rare. We report extensive colonic haemangiomatosis in one young boy affecting bladder, sigmoid colon & descending colon. The patient was managed with sphincter saving operation.

An unusual case of Flavobacterium meningosepticum pneumonia in an immunocompromised patient is reported. The necessity to recognize this opportunistic pathogen and its implication is discussed.

Meloidosis in a unusual site has been reported in a child. Complete identification of the organism has been presented.

Systemic histoplasmosis manifesting as an ulcerative eyelid lesion is rare. We describe a successfully treated case of histoplasmosis who presented with an eroding ulcer in the lid.

Patients with autoimmune hemolytic anaemia with raised lupus parameters may not present clinically with overt systemic lupus erythematosus (SLE) though a transitional form of the disease may exist between these two entities.