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Immunochromatography test (ICT) (Paracheck Pf) for diagnosis of Plasmodium falciparum (Pf) infection was compared with the conventional smear examination method. A total of 350 specimens of blood from cases of fever were investigated (falciparum malaria 220, vivax malaria 100, controls 30). Paracheck Pf ICT was found to have enormous advantages over smear examination due to its high degree of sensitivity, specificity, speed and ease of performance. Paracheck Pf ICT test kits are stable at room temperature. Regimental medical officers (RMOs) and nursing assistants with minimal training can safely practise Paracheck Pf ICT method. Introduction of this test method in the Armed Forces can facilitate early diagnosis and specific treatment of falciparum malaria even at far flung places. This will have enormous beneficial effect in reducing morbidity due to malaria and saving precious lives. In short as well as long term, it is a viable cost effective option.

Agenesis of gall bladder is a clinical rarity, as most of the diagnoses are made at autopsy. Preoperative diagnosis of this anomaly is fraught with follies. External biliary fistulae are usually result of complications of trauma or biliary surgery. Internal fistulae on the other hand may result from erosion of wall by a stone, cancerous growth or peptic ulcer. Sites of opening of internal fistulae are stomach, duodenum, jejunum, ileum or colon. These should be suspected if gas shadows are seen in biliary tree.

Indoor workload of a zonal service hospital for one month was studied. Service personnel and their dependents form the bulk of workload. Though the absolute number of ex-servicemen and their dependents is small, the resources spent on them are quite high. The average stay in hospital is 15 days. Rapid turnover of the patients reveals appropriate utilization of resources. Optimization of resources is possible by reducing the number of admissions for administrative purposes.

Homologous blood transfusion, despite numerous and serious transfusion associated hazards, is an important treatment modality. Transmission of infectious agents like HIV, hepatitis viruses, malaria, etc is a distinct possibility notwithstanding careful screening of the blood. Predeposit autologous blood transfusion (PABT) and per operative acute normovolemic haemodilution (ANH) are two comparatively safer, simpler and practical alternatives. Unfortunately, their potential remains unexploited. Earnest motivation efforts at PABT and ANH have paid handsome dividends in our hospital. These have now become very popular amongst surgeons as well as the patients. These techniques can be easily adapted at all hospitals to reduce the demand for homologous blood transfusion. ANH can be safely practised even in hospitals without a blood bank.

Dermatophytosis and dermatomycosis in patients reporting to Command Hospital (SC) were studied over a period of 3 years. A total of 126 cases were investigated. Commonest clinical diagnosis was tinea corporis (39.68%) followed by onychomycosis (20.63%). Some patients had infections of multiple sites. Direct examination under KOH and dimethyl sulfoxide (DMSO) revealed fungal elements in 43 (34.12%) cases. Fungi were isolated from 44 (34.92%) cases. Commonly isolated fungi were Candida albicans 11 (25%), Trichophyton spp 8 (18.18%), Microsporum audouinii 2(4.55%) and Epidermophyton floccosum 1(2.27%).

Consumer Protection Act (CPA) has been formulated to protect the interests of consumers. Many a doctors feel that medical services should be excluded from CPA and only doctors should be assigned to judge other doctors. Consumer protection from unscrupulous doctors has been attempted by the State throughout the history of medicine. These ancient legislations and practices are reviewed. Unfaltering honesty of purpose, truthfulness to the patients and raising the standard of medical practice are the only ways of ensuring that the CPA is not exploited against the doctors.

The use of disposable syringes, needles and other 'disposable' items has gained wide popularity in hospital practice. The supposed advantages are ensuring sterility and preventing the spread of infection from patient to patient. However are these aims really being met? In the present state of awareness and disposal procedures being followed we are not achieving aims and it may even be more prudent to go back to the glass syringes with proper autoclaving facilities. Alternatively there is the need to improve the disposal facilities in hospitals for the disposable articles.

Mycotic keratitis is a distressing infection and may lead to permanent blindness. Fifty two cases of suspected mycotic keratitis were studied from Jan 91 to Sep 94. Specimens were collected on swabs in 20 cases and by corneal scraping in 32 cases. Wet mount examination of the specimens revealed fungal elements in 8 (15.4%) cases, of which 3 specimens were collected on swabs and 5 by corneal scraping. Fungi were isolated from a total of 12 (23.1%) specimens 5 of which were obtained by swabs while 7 by corneal scraping. Important pathogens were Fusarium spp, Aspergillus spp, Candida albicans and Cephalosporium spp. Direct examination of the specimens was found to be less sensitive than culture for the diagnosis of mycotic keratitis.