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Background India has the highest burden of both Tuberculosis and MDR-Tuberculosis based on estimates reported in the Global Tuberculosis Report 2016. The estimates have been revised upwards based on the newer evidence, and the current study was done to estimate the prevalence of bacteriologically positive pulmonary Tuberculosis among the adult population and to provide baseline information for future measurements of Tuberculosis burden and trends. Methods A cluster-based sampling design was adopted in 10 districts of Kashmir valley in India. Assuming a prevalence of 217 per lakh population, a design effect of 2.5, a relative precision of 0.25% and the expected participation rate of 80%, a sample size of 49,716 was achieved. A total of 67 clusters were identified where each cluster had 750 subjects aged ≥15 years, and eligible individuals were questioned for pulmonary symptoms suggestive of Tuberculosis. Results Of the total 42,805 that were interviewed, 3.85% had pulmonary Tuberculosis symptoms. A total of 1539 sputum samples were collected from symptomatic and 1351 chest X- rays were done. Cartridge based nucleic acid amplification test (CBNAAT) tests were done on individuals with suspicious X-ray findings. The prevalence of bacteriologically positive pulmonary Tuberculosis was found to be 147 per 100,000 population. Females are affected more than males, and the age of female Tuberculosis patients is less than that of males. Conclusion The study is the first survey of its kind providing a baseline for further research in the state. CBNAAT is going to be game-changer which surmounts the drawbacks of sputum smear microscopy.

Background: Bacterial contamination in operation theatres (OT’s) and other specialized care units is a major factor for nosocomial infection. Surgical Site Infection (SSI) contributes to 33.1% of nosocomial infection. Microbial contamination of OT’s is a major risk factor for surgical site infection. Aim of study is to identify bacterial colonization of indoor air of OT’s, labor rooms (LR’s) and specialized new born care units (SNCU’s). Material & methods: Air sampling of 29 (OT’s), 9 (LR’s) and 5 (SNCU’s) was done by settle plate method. Surfaces samples were taken by wet swabs from different sites and equipments in nutrients broth. Samples were then transported to laboratory and processed according to standard operation procedures. Results: Total of 184 swabs were taken, out of which 134 (72.82%) were found to be positive for bacterial growth. A total of 43 air samples were taken out of which 41 were found to be positive for bacterial contamination. Least CFU/m3 was found in ophthalmology OT (4.4-10 CFU/m3) and highest in gynecology and obstetrics OT (4.4-268.7 CFU/m3. Conclusion: Surfaces and air in various health facilities of studied hospitals were found contaminated with different types of bacteria including potential pathogens that pose a great risk to patients. Hygiene and sanitation need to be improved in these hospitals to control nosocomial infection and for better management of patients.

Aim/Background: This chapter will address the clinical challenges of COVID-19 through the lens of informatics, detailing examples of how these challenges have been tackled.

Hepatitis C virus (HCV) has infected approximatelly 130–170 milion individuals in the form of chronic liver infection and hepatocellular carcinoma. In the majority of patients with the increased risk for hepatocellular carcinoma the initial rearrangement is fibrosis. HCV is a bloodborne virus. The most common route of the infection are drug use, injections, unsafe health care performance, transfusion and sexual transmission. The incubation period ranges from 2 to 6 weeks in case of HCV. HCV infection is diagnosed in the process of detecting of anti-HCV antibodies and if positive, a nucleic acid test for HCV ribonucleic acid (RNA) is done. Currently, the most promising treatment agents are direct-acting antivirals (DAAs). They have shown limited viral resistance, long treatment duration and higher cost with no proven benefits in the prevention of graft reinfections in HCV individuals. In the light of the aforementioned, there is a need to a more dubious research in the quest for the effective therapeutic modalities.

Background: Rectal cancer is one of the most common cancers in Kashmir, India. The clinical course of patients treated with surgery alone has been characterized by a high death rate and also by the pain and disability associated with pelvic recurrence of the tumor. Adjuvant radiation combined with chemotherapy has been studied for prevention of such recurrences. We treat more than 200 rectal cancer patients annually at our center. Most of the patients registered at our center are those who have been already subjected to surgery at the peripheral hospitals. We studied role of 5-fluorouracil (5-FU) and calcium leucovorin concurrently with radiotherapy in Dukes’ stage B2 and C and toxicities thereof in the adjuvant setting. Objective : To assess the outcome of concurrent chemoradiation in operated locally advanced treated cancer patients. Materials and Methods : In operated Dukes’ B2 and C rectal cancer patients, we conducted a prospective non-randomized study comprising of 40 patients between 2012 and 2014. Patients were treated with two hours protracted infusion of calcium leucovorin 500 mg/m 2 on day 1 followed by 5-fluorouracil 500 mg/m 2 on days 1 to 5 and repeated four weekly for total of six cycles. Radiotherapy of 45 Gray in 20 fractions was delivered concurrently with chemotherapy for first two cycles. Results : Combination of chemotherapy and radiotherapy in a concurrent setting appears to be more efficient in reducing local recurrence rates and improving survival than either modality alone. Toxicities with this schedule were mostly gastrointestinal mucositis, but no treatment interruption was needed. Conclusion : A combination of 5-fluorouracil and radiotherapy can be administered in operated locally advanced rectal cancer patients. J Enam Med Col 2015; 5(3): 139-144

Aims: This study was undertaken to determine the prevalence and pathogenicity of coagulase-negative staphylococci in clinical samples and to study the antibiotic-sensitivity pattern of the coagulase-negative isolates. Methods: A prospective study was conducted over a period of two years on patients admitted in the Sher-i-Kashmir Institute of Medical Sciences. Blood, urine, pus, catheter tips, cerebrospinal fluid and peritoneal fluid samples of patients who fulfilled the criteria for being labeled as nosocomial were cultured. Results: One hundred and six strains of coagulase negative staphylococci were isolated from the samples and among them 90 isolates were identified as Staphylococcus epidermidis (84.90%). Most of the coagulase-negative staphylococci isolates were resistant to penicillin, cephalosporins and fluoroquinolones. Methicillin resistance was found in a significant number of coagulase-negative isolates. All the isolates were found to be sensitive to vancomycin. Conclusions: The results of the study emphasized that isolation of coagulase-negative staphylococci should be viewed with serious concern and accurate species identification and antimicrobial susceptibility testing should be performed in all cases. DOI: http://dx.doi.org/10.3126/njog.v9i2.11769

Blockchain technology has an enormous scope to revamp the healthcare system in many ways as it improves the quality of healthcare by data sharing among all the participants, selective privacy and ensuring data safety. This paper explores the basics of blockchain, its applications, quality of experience and advantages in disease surveillance over the other widely used real-time and machine learning techniques. The other real-time surveillance systems lack scalability, security, interoperability, thus making blockchain as a choice for surveillance. Blockchain offers the capability of enhancing global health security and also can ensure the anonymity of patient data thereby aiding in healthcare research. The recent epidemics of re-emerging infections such as Ebola and Zika have raised many concerns regarding health security which resulted in strengthening the surveillance systems. We also discuss how blockchains can help in identifying the threats early and reporting them to health authorities for taking early preventive measures. Since the Global Health Security Agenda addresses global public health threats (both infectious and NCDs); strengthen the workforce and the systems; detect and respond rapidly and effectively to the disease threats; and elevate global health security as a priority. The blockchain has enormous potential to disrupt many current practices in traditional disease surveillance and health care research.

Mumps is a public health problem on a global scale caused by mumps virus, a member of family paramyxoviridae. An effective form of vaccination exists and is incorporated into routine immunization schedules in over 100 countries, usually in the form of the Measles, Mumps and Rubella (MMR) vaccine. This is not the case in India, as mumps is not viewed as a significant enough public health problem by the government to warrant such an intervention. This original research paper discusses about outbreaks of mumps in Kashmir, India and aims to add to the body of literature to support the routine immunization with the mumps vaccine. From July to September 2017, there were 15 outbreaks and 260 cases of mumps recorded in the region by the Integrated Disease Surveillance Programme (IDSP). We conclude that the Indian Government should include the MMR vaccination in the Universal Immunization Programme. This would result in clinical and economic benefits by reducing outbreaks and associated morbidity of mumps, in addition to tackling the recognized morbidity and mortality of rubella and measles. To support the global health security, there is a great need to strengthen surveillance, adhere to the World Health Organization&rsquo, s International Health Regulations (IHRs), and pay attention to emerging and re-emerging infectious agents, including paramyxovirus group.

Waterborne diseases, such as Hepatitis A and E, are major public health concerns in most of the developing nations, indicating the need for proper outbreak prevention, surveillance, and timely management. This study presents data regarding the prevalence and epidemiological characteristics of hepatitis A and E outbreaks as well as water quality in Kashmir, India, during 2015–2017. Hepatitis outbreaks were initially investigated by rapid response teams, under the Integrated Disease Surveillance Programme. Suspected cases were further evaluated by blood sampling to confirm the disease along with water sampling evaluation. Between 2015 and 2017, 23 disease outbreaks were recorded; among these, four outbreaks occurred in 2015, 12 in 2016, and seven in 2017. Specifically, 12 of the total outbreaks were concerned with hepatitis A infection, 10 concerned hepatitis E infection, and one involved eight cases of jaundice with neither hepatitis A virus nor hepatitis A virus detected in blood sampling. Overall, during the aforementioned period, 393 cases of hepatitis A or E were detected. Regarding water quality, which was evaluated using the most probable number method for counting coliform, 38 of 50 water samples were found to be unfit for human consumption and one source was found to be suspicious. This study of prevalence and epidemiology of hepatitis A and E along with its relationship with water quality and socioeconomic factors, such as poor hygiene and lack of access to safe water, aids towards the implementation of effective preventive sanitary measures and public health actions.

Recently, Acinetobacter emerged as an important pathogen and the rate of isolation has increased since the last two decades worldwide. Objectives of the present study were to see the incidence of Acinetobacter infection at a tertiary care hospital at Kashmir, India, demographic features of the infections, species identification and antibiotic sensitivity and resistance pattern of the isolates. The clinical samples submitted to Microbiology laboratory at SKIMS over a period of 2 years (June, 2001 to June, 2003) were investigated. Identification, speciation and antibiotyping were performed for the isolates of Acinetobacter recovered from clinical samples including urine, pus, sputum, blood, CSF and other body fluids. Clinical and demographic characteristics were studied retrospectively. Out of a total of 5352 infected samples, 258 (4.8%) were found to be due to Acinetobacter. The organism was responsible for 76 (39.64%) cases of urinary tract infection and 38 (29.45%) cases of wound infection and was most prevalent in the intensive care unit (29.84%). A. baumannii was the most predominant species. Prolong hospital stay, Mechanical ventilation and Intensive Care Units were found to be potential risk factors. High level of resistance was recorded for Ampicillin (86.3%), Cefazolin (93.2%) Gentamicin (61.5%), Cefotaxime (65.8%), Ceftriaxone (61.5%) and Ciprofloxacin (69.2%). Although no specific pattern during antibiotyping was observed, but most of them were multi-drug resistant. Nosocomial infections by multi-drug-resistant Acinetobacter have emerged as an increasing problem especially in the intensive care units of the hospital. The analysis of risk factors and susceptibility pattern will be useful in understanding epidemiology of this organism in a hospital setup. Key words: Acinetobacter, Nosocomial infection, Antibiotyping, Multi-drug resistant doi: 10.3329/bjmm.v3i1.2969 Bangladesh J Med Microbiol 2009; 03 (01): 34-38

Radiation hybrid maps were constructed for river buffalo and cattle Y chromosomes. A total of 41 cattle-derived Y-chromosome molecular markers were selected and tested with 2 previously described 5,000-rad whole-genome radiation hybrid (RH) panels (river buffalo – BBURH5000 and cattle – BTARH5000) for generation of maps. Among the initial 41 selected markers, a subset of 26 markers generated PCR products suitable for scoring with the BBURH5000 panel. Of these, 19 markers (73%) were distributed in 1 linkage group spanning 341.3 cR. Retention frequencies (RF) for individual markers ranged from 17.8% for SMCY to 56.7% for BTY1, with an average RF of 37.6%. From the selected markers, 37 generated reliable scores using the BTARH5000 panel. The newly constructed BTAY RH map contains 28 markers distributed within 1 linkage group. Twenty-four of these markers had been previously mapped on BTAY using a 7,000-rad cattle-hamster WG-RH panel and 4 markers were mapped for the first time (ZFY, SeqRep, RepSeqS4 and BTY1). The length of the BTAY RH map was estimated to be 602.4 cR. Retention frequencies for individual mapped markers ranged from 10% (INRA126) to 63.3% (SeqRep), with an average RF of 35.3%. RH marker positions along the Y chromosome were compared between BBUY and BTAY, which revealed differences in the order of some of the markers. The BBUY pseudoautosomal region (PAR) is delineated by 3 BTAY PAR markers (MAF45, TGLA325 and UMN2008). These markers are telomeric in both species but are not found in the same order. Here we have demonstrated the effective use of bovine Y chromosome markers for the development of the first BBUY RH map. Likewise, these set of markers can be used for comparative assessment of Y chromosomes in other members of the Bovidae family.

Background: Pyrazinamide (PZA) is used frequently in monotherapy or in combination therapy with isoniazide and rifampicin in the management of patients with pulmonary tuberculosis (TB). However, hyperuricemia, arthralgia, or symptoms of gout may occur in patients treated long-term with PZA. Typically, aspirin therapy is instituted to reduce the inflammatory pain associated with arthralgia in patients being treated with PZA. The authors determined the incidence of hyperuricemia and arthralgias in TB patients treated with combination therapy and the effect of aspirin therapy on serum uric acid levels in these patients. Methods: The authors enrolled 50 patients categorized as having active pulmonary tuberculosis based on clinical history, physical exam findings, and related investigations. Whole blood samples were obtained from these patients before, during, and after combination therapy, following discontinuation of combination therapy, and after administration of aspirin. Uric acid was quantified in serum samples from all patients using the uricase method in the Hitachi 916 chemistry analyzer. The uric acid levels during and after discontinuation of combination therapy and after initiation of aspirin therapy were determined. In addition, the authors determined the incidence of hyperuricemia and arthralgia among these patients. Results: Combination therapy resulted in progressive hyperuricemia in about 50% of the patients between the 6th and 8th weeks of treatment. Arthralgia occurred in 22% of these cases. Discontinuation of combination therapy and institution of aspirin therapy for 2 weeks resulted in the return of uric acid levels to the pretreatment levels in these patients. Conclusion: Significant hyperuricemia, with some arthralgia, can occur in TB patients treated with combination therapy. Pyrazinamide is the most likely component of combination therapy responsible for these effects. However, aspirin therapy is effective in controlling joint pain in these patients and in reducing their hyperuricemia to normouricemic levels. Combination therapy remains a useful treatment in the management of patients with pulmonary TB, despite the relatively minimal side effects caused by PZA.

Background: To study the profile of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in tertiary care hospital setting, representing almost the whole affected population in Kashmir valley of India. Methodology: A total of 910 cases of pulmonary tuberculosis were enrolled over four years. Among these, cases of MDR-TB and XDR-TB were meticulously studied for drug susceptibility, treatment, adverse effects profile and overall survival. Results: Fifty-two (5.7%) cases of MDR-TB were identified, among which eight (15.3%) were diagnosed as XDR-TB on the basis of drug susceptibility testing, using the prescribed definition. The cases were sensitive to 2, 3, 4, 5 and more than 5 drugs in almost equal proportions. Thirty-seven (71.1%) cases were successfully cured; eleven (21.1%) patients died; and only four (7.6%) cases defaulted, indicating overall satisfactory adherence to treatment. Conclusion: For effective treatment of MDR-TB and XDR-TB, early case detection, improved laboratory facilities, availability of appropriate treatment regimens, and financial assistance in resource-limited settings through effective political intervention are necessary for better patient adherence and overall cure.

Background: To study the status of zinc as a micronutrient in pulmonary tuberculosis, in our population, with the aim to see the effectiveness of therapy. Methodology: This prospective study includes 50 patients with pulmonary tuberculosis and 30 subjects as the control group. The patients were placed into three stages (1 to 3) on the basis of chest radiographic findings. Serum zinc levels were estimated before, during, and after completion of antitiberculosis therapy. Results: Statistically significant fall in serum zinc levels was seen with advanced age and disease, and the levels improved after initiation of antituberculosis therapy. Conclusion: Estimation of serum zinc levels is an important tool in diagnosis and monitoring of response to treatment in pulmonary tuberculosis, and even a booster of the immunological mechanisms if instituted during the course of treatment.

The present study aimed at evaluating the vertical migration of Haemonchus contortus third stage larvae (L3) on Brachiaria decumbens grass, as well as at verifying whether larval numbers on pasture varies over the day due to climatic conditions. Feces containing H. contortus L3 were deposited on the soil in the middle of herbage which was initially 30 cm high. Seven days later, samples of different herbage strata (0-10, 10-20 and >20 cm), remaining feces and a layer of approximately 1cm soil were collected. Tests were carried out in four periods: September 2006, December 2006, March 2007, and June 2007. Samples were collected at sunrise, mid-day, sunset, and mid-night. The humidity and temperature conditions observed in different months influenced larval migration from the feces to the grass. In September, December and March, it rained after fecal deposition on pasture, which favored migration of larvae from the feces to the herbage. Conversely, in June 2007, when there was no rainfall after fecal deposition and temperatures were lower, L3 were mainly recovered from feces. As regards the vertical migration of larvae, the numbers of H. contortus L3 in the forage strata remained relatively constant over the day. This indicates there is not a determined period in which sheep on pasture are at higher risk of infection. Finally, in all collection periods a considerable amount of third stage larvae was observed on the herbage top, which is the first plant part consumed by sheep.

Summary Objective An earthquake struck Kashmir on 8 October 2005. A central team of public health specialists was sent to Kashmir to assess the public health measures required following the earthquake, and to assist in institution of public health measures. Study design Epidemiological and environmental investigation in Tangdar block (Kupwara district) and Uri Tehsil (Baramula district). Methodology Visits to villages affected by the earthquake, rehabilitation camps and health care, examination of cases with acute diarrhoeal disease (ADD), environmental observations, collection of clinical samples from ADD cases and environmental samples from drinking water sources, and laboratory methods. Results In total, 1783 cases of ADD were reported between 14 October and 17 December 2005 in Tangdar (population 65000). The overall attack rate was 20% in children under 4 years of age. Twelve cases of ADD with loose motions without blood were studied, and 11 rectal swabs and one stool sample were processed. No bacterial enteropathogens could be isolated, but three of the 12 samples yielded rotavirus antigen on enzyme-linked immunosorbent assay. Twelve of 13 (92.3%) water samples, collected from various stream or tap water (source: spring/stream) sources, were unsatisfactory ( P = 0.001) using the H 2 S strip method compared with other sources (well/mineral water). All eight water sources in Tangdar block were unsatisfactory, indicated by blackening of H 2 S filter paper strips. Following the earthquake, drinking stream water or tap water without boiling or chlorination may have led to a common source water-borne outbreak of rotavirus gastroenteritis. Other contributing factors were: overcrowding; poor sanitation; open-air defaecation; poor hygiene; and living in makeshift camps near streams. Person-to-person transmission may also have contributed to perpetuation of the outbreak. Following the establishment of medical camps and information, education and communication regarding the need to drink boiled water and follow safer hygienic practices, the outbreak was brought under control. Conclusions The earthquake in Kashmir in 2005 led to widespread contamination of drinking water sources such as stream and tap water (source: stream or spring). This appears to have led to a common source outbreak of rotavirus between October and December 2005, leading to ADD, amongst infants and small children, transmitted by the faecal-oral route and perpetuated by person-to-person transmission.

Salmonella are a rare cause of infective endocarditis. This report describes a case where Salmonella typhi was isolated from the blood and urine of a patient with echocardiographically documented aortic valve disease and endocarditis. The patient was treated with two weeks of ceftriaxone (3 g/day) and amikacin (15 mg/kg/day), followed by a further two weeks of ceftriaxone (3 g/day) alone. He made a complete recovery.

Prepubertal testicular tumours are very rare and occur at an incidence of 0.5–2/100 000 children.1,2 Of all the paediatric malignancies they rank seventh in frequency and represent only 1% of all paediatric solid tumours.3 We conducted a study to see the pattern of prepubertal testicular tumours in Kashmir. The material for our study was obtained from the files of the histopathology section of the department of pathology, Government Medical College, Srinagar, Kashmir, …

Background : Data regarding the occurrence of hypertension and diabetes in the community are crucial for optimum allocation and utilization of health resources. Objective was to assess the efficacy of such field based exercise in detection of new undiagnosed cases and calculation of the consequent prevalence. Methods: A cross sectional community based study was carried out to find ou t prevalence of hypertension and diabetes amongst adults (35-64 years) in Chatergam, Budgam (Jammu and Kashmir) during Oct 2011 to Feb 2012 on a pre-tested structured questionnaire. Blood pressure was measured in 2077 adults and random blood sugar (RBS) was measured in 1732 subjects to detect diabetes. Data was analyzed to find out the distribution of systolic (SBP) and diastolic (DBP) and the prevalence of hypertension and diabetes along with 95 percent confidence intervals. Results: Mean SBP and DBP of 2077 subjects were 130.7 ± 40.3 and 83.1 ± 11.4 mm of mercury respectively. Values were the highest for both SBP and DBP amongst women of urban areas and in the 55 – 64 years of age. Quarter of studied persons (24.4%) had the family history of hypertension or diabetes or both. Based on the criteria of JNC 7, 41.1% subjects (95 % CI 38.9 – 43.2) were found hypertensive including 593 known cases (496 alone & 97 in combinations with diabetes). Prevalence of new cases of hypertension was 17.5 percent; it significantly increased with increasing age and was high amongst males and those residing in urban areas. 4.6% subjects (95% CI 3.6-5.7) were positive for diabetes based on RBS. Conclusion s: Considering high load of twin diseases and their impact on coronary vascular diseases (CVD), study emphasizes the need to implement an integrated population-based cost-effective control program with a focus on primordial and primary prevention.

Background: Chronic suppurative otitis media (CSOM) remains one of the most common childhood chronic infectious diseases worldwide, affecting diverse racial and cultural groups both in developing and industrialized countries. It involves considerable morbidity and can cause extra- and intra-cranial complications. The aim of this study was to determine the microbial diversity and the antibiogram of aerobic bacterial isolates among patients suffering from CSOM who attended the ENT Department of SMHS hospital, a tertiary care centre located in the heart of the Kashmir valley. Methods : A total of 154 patients clinically diagnosed with CSOM were enrolled in the study and the samples were obtained from each patient using sterile cotton swabs and cultured for microbial flora. Drug susceptibility testing for aerobic isolates was conducted using Kirby-Bauer disc diffusion method. Results : Out of total 154 ear swabs processed, microbial growth was seen in 138 (89.61%) while 16 (10.38%) samples showed no growth. In 102 (66.23%) samples mono-microbial growth was seen whereas 26 (16.88%) samples showed poly-microbial growth. The most frequent organism isolated was Pseudomonas aeroginsa followed by Staphylococcus aureus and Proteus sp. The most effective antibiotic against Pseudomonas aeroginsa was amikacin followed by imipenem and piperacillin plus tazobactam, while as Staphylococcus aureus showed maximum sensitivity to vancomycin. Conclusion: Otitis media linked with high levels of multiple antibiotic resistant bacteria is a major health concern in all age groups of the study population. An appropriate knowledge of the etiology and antibacterial susceptibility of microorganisms would contribute to a rational antibiotic use and the success of treatment for chronic supportive otitis media.

Every year, many lives are lost because of the spread of infections in hospitals. These nosocomial infections, also called hospital acquired infections (HAI) are infections that patients acquire during the course of receiving healthcare treatment for other conditions. HAIs are a cause of significant morbidity and mortality in patients receiving healthcare, and the costs direct and indirect of these infections deplete the already limited financial resources allocated to healthcare delivery.

Rapid assessment of cataract blindness has been accepted as a robust tool to help planners in developing countries. Prevalence of cataract blindness can give important information about the impact of a cataract intervention programme. A study in this direction was carried out in Pulwama district of Jammu & Kashmir. Our results clearly showed that with the increase in age, the prevalence of bilateral cataract blindness increases manifold. However, gender did influence the prevalence of cataract in the present survey. The prevalence of bilateral cataract decreases considerably, with the increase in education of both the genders. Among both male and female respondents examined, 89 percent were having both eyes phakia. Similarly 79 percent of study population were not having lenticular opacity either in R/E or L/E in both males and females. Results show that the prevalence of bilateral cataract blindness in district Pulwama is 4.16 percent.

Over a period of 5 years from 1992 to 1997 a total of 3,532 patients of pyrexia of unknown origin (PUO) were subjected to Wright's tube agglutination test for brucellosis. Of the 3,532 patients tested, 28 (0.8%) were found seropositive for brucellosis. Males outnumbered females by a ratio of 3:1. Whereas the seroprevalence among males clearly was age-related, the seroprevalence among women was not. The highest number (43%) of positive males belonged to the age group 21-30 years. The majority of patients had titres of 1:160 or 1:256, high titres of 1:512 and 1:1024 were found in 21.4% patients.

The authors describe a case of myelolipoma, a relatively rare benign nonfunctioning tumor of the adrenal gland composed of mature adipose tissue interspersed with hematopoietic elements. Most myelolipomas are usually seen as an incidental finding at autopsy; however, very few symptomatic cases of myelolipoma are surgically resected. In this case of giant myelolipoma, an incidental finding of a stenotic growth in the transverse colon was also present. Histologically, the stenosing growth appeared as a well-differentiated adenocarcinoma.

Cystic dysplasia of the testis is a rare congenital defect that results in the formation of numerous irregularly shaped cystic spaces in the mediastinum testis. The clinical presentation of such a disorder usually occurs in the paediatric age group as an asymptomatic scrotal swelling that can mimic testicular tumours. The case presented in this paper is the first identified and diagnosed case of cystic dysplasia in Kashmir, India. A 2-year-old boy presented with a history of scrotal swelling since birth and was admitted to the Department of Surgery, Shri Mahraja Hari Sirgh Hospital, Srinagar, Kashmir, associated with Government Medical College, Srinagar, Kashmir, India. On examination, the …

This prospective study including 50 patients of pulmonary tuberculosis (TB) and 30 subjects as the control group was conducted to study the status of zinc as a micronutrient in pulmonary TB. There was a statistically significant fall in serum zinc levels with advanced age and disease and the levels improved after institution of antitubercular therapy. We conclude that estimation of serum zinc levels is an important tool in the diagnosis, monitoring of response to treatment in pulmonary TB, and booster of the immunological mechanisms if instituted in the therapy.

Between 1935 and 2001, many studies have appeared in the literature from different parts of the world on bone marrow invasion by solid tumours.1–4 After lymphoma, the primary tumours that most frequently involve the bone marrow are malignancies of the prostate, breast, lungs, thyroid, kidney, and stomach.4 Metastatic deposits of malignant melanoma have also been described.3 In many instances, primary tumours remain clinically undetected and are identified only at necropsy.1 The value of bone marrow aspiration in the diagnosis of malignant neoplasms was confirmed when four of eight cases of malignant melanoma were found to harbour tumour deposits in the bone marrow.3 In a series of 57 patients with known carcinoma of the prostate, five had carcinoma cells in the bone marrow, with no other diagnostic evidence of skeletal system involvement.2 The usefulness of such a comparatively simple procedure is emphasised by studies of large series of …