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Abstract Background In this article we analyzed the extent of the usage of Theories of Change (TOCs) and causal pathways in the evaluation of immunization programs to identify the challenges to generating evidence on how interventions improve immunization. Methods We analyzed the use of the TOC in impact evaluations (IEs) of immunization interventions published after 2010, and its associated articles. The review includes studies from Evidence Gap Map and Yale review that were conducted in May and March of 2020, respectively. We synthesized data on six domains using NVIVO — program theory, context, assumptions, usage of TOC, use in evaluation, and description causal pathways. Results Our review included 47 large-scale and 45 small-to medium-scale interventions. Of the included studies, 19% used a TOC, 56% described a causal pathway or used a conceptual diagram with varying degrees of detail, and 25% of the IEs did not provide any information on how their intervention was expected to affect change. Only 19 of the 92 IEs explicitly outlined any assumptions associated with the implementation of the interventions. Forty studies measured the outputs or intermediate outcomes leading to improved immunization coverage. Conclusion Future implementers and evaluators need to develop clear TOCs that are based on established theory and have clearly articulated the underlying assumptions. Large-scale health system strengthening initiatives implemented by governments, also need to build TOCs and integrate them into their results frameworks. Additionally, there is a need to combine both impact and process evaluations to understand the how context affects the causal pathways.

IntroductionDespite the advances in vaccination, there are still several challenges in reaching millions of children in low- and middle-income countries (LMICs). In this review, we present an extensive summary of the various strategies used for improving routine immunization in LMICs to aid program implementers in designing vaccination interventions.MethodsExperimental and quasi-experimental impact evaluations conducted in LMICs evaluating the effectiveness of interventions in improving routine immunization of children aged 0–5 years or the intermediate outcomes were included from 3ie’s review of systematic reviews. Some additional impact evaluation studies published in recent years in select LMICs with large number of unvaccinated children were also included. Studies were coded to identify interventions and the barriers in the study context using the intervention framework developed in 3ie’s Evidence Gap Map and the WHO’s Behavioral and Social Drivers (BeSD) of vaccination framework, respectively. Qualitative analysis of the content was conducted to analyze the intervention strategies and the vaccination barriers that they addressed.Results and conclusionOne hundred and forty-two impact evaluations were included to summarize the interventions. To address attitudinal and knowledge related barriers to vaccination and to motivate caregivers, sensitization and educational programs, media campaigns, and monetary or non-monetary incentives to caregivers, that may or may not be conditional upon certain health behaviors, have been used across contexts. To improve knowledge of vaccination, its place, time, and schedule, automated voice messages and written or pictorial messages have been used as standalone or multicomponent strategies. Interventions used to improve service quality included training and education of health workers and providing monetary or non-monetary perks to them or sending reminders to them on different aspects of provision of vaccination services. Interventions like effective planning or outreach activities, follow-up of children, tracking of children that have missed vaccinations, pay-for-performance schemes and health system strengthening have also been used to improve service access and quality. Interventions aimed at mobilizing and collaborating with the community to impact social norms, attitudes, and empower communities to make health decisions have also been widely implemented.

Background: As oral cavity and oropharynx cancers are the second most common type of tobacco-related cancer reported in Jaipur city so it is imperative to study the drug utilization pattern in these cancers. Objectives: The objective of this study was to evaluate the trends in drug usage patterns for oral cancer patients in Jaipur city. Methods: The prescriptions of oral cancer patients attending the outpatient department of SMS Medical College and Bhagwan Mahaveer Cancer and Research Centre from May 2017 to August 2017 were studied. They were studied for WHO Prescribing indicators for good prescribing practice. Results: A total of 188 prescriptions were studied. Average number of drugs per prescription was 7.4±1.8. The combination of paclitaxel and carboplatin was the most frequently prescribed antineoplastic drug, prescribed to 29.8% of patients. The drafting of the prescriptions was of average quality. In 5% of the prescriptions, a diagnosis was omitted, and in 48% of the prescriptions, the patient’s weight and/or body surface area (BSA) were omitted. Only 52% of the prescriptions contained the medications’ generic names. Conclusion: The quality of prescribing was fair and moderately acceptable. To ensure rational prescribing and safe and successful treatment of cancer patients, interventions such as new policy formulation and educational measures should be developed.

Objective An umbrella review providing a comprehensive synthesis of the interventions that are effective in providing routine immunisation outcomes for children in low and middle-income countries (L&MICs).Design A systematic review of systematic reviews, or an umbrella review.Data sources We comprehensively searched 11 academic databases and 23 grey literature sources. The search was adopted from an evidence gap map on routine child immunisation sector in L&MICs, which was done on 5 May 2020. We updated the search in October 2021.Eligibility criteria We included systematic reviews assessing the effectiveness of any intervention on routine childhood immunisation outcomes in L&MICs.Data extraction and synthesis Search results were screened by two reviewers independently applying predefined inclusion and exclusion criteria. Data were extracted by two researchers independently. The Specialist Unit for Review Evidence checklist was used to assess review quality. A mixed-methods synthesis was employed focusing on meta-analytical and narrative elements to accommodate both the quantitative and qualitative information available from the included reviews.Results 62 systematic reviews are included in this umbrella review. We find caregiver-oriented interventions have large positive and statistically significant effects, especially those focusing on short-term sensitisation and education campaigns as well as written messages to caregivers. For health system-oriented interventions the evidence base is thin and derived from narrative synthesis suggesting positive effects for home visits, mixed effects for pay-for-performance schemes and inconclusive effects for contracting out services to non-governmental providers. For all other interventions under this category, the evidence is either limited or not available. For community-oriented interventions, a recent high-quality mixed-methods review suggests positive but small effects. Overall, the evidence base is highly heterogenous in terms of scope, intervention types and outcomes.Conclusion Interventions oriented towards caregivers and communities are effective in improving routine child immunisation outcomes. The evidence base on health system-oriented interventions is scant not allowing us to reach firm conclusions, except for home visits. Large evidence gaps exist and need to be addressed. For example, more high-quality evidence is needed for specific caregiver-oriented interventions (eg, monetary incentives) as well as health system-oriented (eg, health workers and data systems) and community-oriented interventions. We also need to better understand complementarity of different intervention types.

Alopecia (baldness) refers to loss of hair from part of head (scalp) or whole body and can be temporary or permanent. It can be genetic, result of hormonal imbalance, medical diseases, auto-immune conditions, chemotherapy or a normal part of aging. Anybody can lose hair on their head, but it is more common in men. Androgenetic alopecia and alopecia areata are common hair loss disorders affecting both men and women. AGA is the most common type of alopecia and is due to androgen hormone related problem and the major cause of AAis autoimmune disorder. Telogen effluvium is a common, transient form of hair loss that can be due to medication, pregnancy, hypothyroidism, or some type of physical or psychological stressor such as surgery or a severe illness.

The C5a peptidase from Streptococcus pyogenes (ScpA) is a highly specific enzyme with potential therapeutic value. ScpA is a good model for studying determinants of specificity in the multidomain immunomodulatory enzymes (IMEs), which comprise a large family of bacterial surface proteases. The surface exposed region of ScpA has 5 main domains which includes 3 C-terminal Fn3-like domains (Fn1, Fn2 and Fn3) (Kagawa et al. 2009). Progressive deletion of the Fn3-like domains from the C-ter resulted in loss of enzyme activity and showed an important role for the Fn2 domain in enzyme function. Functional investigation of specific acidic residues on the Fn2 domain identified 3 residues 30–50 Å from the catalytic site (D783, E864 and D889) which impacted to differing degrees on binding and on catalysis, supporting the presence of an exosite on the Fn2. In particular, residue D783 was observed to impact on both substrate binding affinity and the activity of ScpA. A double mutant cycle analysis showed energetic coupling between the targeted ScpA residues and residues in the core portion (residues 1–67) of the C5a substrate. The data supports the presence of a communication network between the active site and the exosite on Fn2. These findings provide a basis for rational engineering of this important enzyme family to enhance stability, activity and/or specificity.

The Streptococcal C5a peptidase (ScpA) specifically inactivates the human complement factor hC5a, a potent anaphylatoxin recently identified as a therapeutic target for treatment of COVID-19 infections. Engineering of ScpA to enhance its potential as a therapeutic will require detailed examination of the basis for its highly selective activity. The emerging view of ScpA and related subtilases is that selection of their substrates is a dynamic two-step process involving flexibility in the domains around the active site and in the C-ter of the substrate. Surface plasmon resonance (SPR) analyses of the ScpA-hC5a interaction have shown that high affinity binding of the substrate is driven by electrostatic interactions between an exosite on the Fn2 domain of the enzyme and the bulky N-ter cleavage product (PN, ’core’ residues 1-67) of C5a [1]. Introduction of a D783A mutation in the Fn2 exosite, located approximately 50 Å from the catalytic serine, was shown to significantly reduce substrate binding affinity and kcat of the enzyme. X-ray crystallographic studies on the D783A mutant (ScpAD783A) were undertaken to better interpret the impact of this mutation on the specificity and activity of ScpA. Here we present the 1.9 Å X-ray diffraction data for ScpAD783A and the molecular replacement solution for the structure. Both raw diffraction images and coordinates have been made available on public databases. Additional details on the related SPR and enzyme kinetics analyses on ScpAD783A reported in Jain et al. [2].

Objective To support evidence-informed decision-making, we created an evidence gap map to characterise the evidence base on the effectiveness of interventions in improving routine childhood immunisation outcomes in low-income and middle-income countries (LMICs).Methods We developed an intervention–outcome matrix with 38 interventions and 43 outcomes. We searched academic databases and grey literature sources for relevant impact evaluations (IEs) and systematic reviews (SRs). Search results were screened on title/abstract. Those included on title/abstract were retrieved for full review. Studies meeting the eligibility criteria were included and data were extracted for each included study. All screening and data extraction was done by two independent reviewers. We analysed these data to identify trends in the geographic distribution of evidence, the concentration of evidence across intervention and outcome categories, and attention to vulnerable populations in the literature.Results We identified 309 studies, comprising 226 completed IEs, 58 completed SRs, 24 ongoing IEs and 1 ongoing SR. Evidence from IEs is heavily concentrated in a handful of countries in sub-Saharan Africa and South Asia. Among interventions, the most frequently evaluated are those related to education and material incentives for caregivers or health workers. There are gaps in the study of non-material incentives and outreach to vulnerable populations. Among outcomes, those related to vaccine coverage and health are well covered. However, evidence on intermediate outcomes related to health system capacity or barriers faced by caregivers is much more limited.Conclusions There is valuable evidence available to decision-makers for use in identifying and deploying effective strategies to increase routine immunisation in LMICs. However, additional research is needed to address gaps in the evidence base.

Objective To support evidence informed decision-making, we systematically examine the effectiveness and cost-effectiveness of community engagement interventions on routine childhood immunisation outcomes in low-income and middle-income countries (LMICs) and identify contextual, design and implementation features associated with effectiveness.Design Mixed-methods systematic review and meta-analysis.Data sources 21 databases of academic and grey literature and 12 additional websites were searched in May 2019 and May 2020.Eligibility criteria for selecting studies We included experimental and quasi-experimental impact evaluations of community engagement interventions considering outcomes related to routine child immunisation in LMICs. No language, publication type, or date restrictions were imposed.Data extraction and synthesis Two independent researchers extracted summary data from published reports and appraised quantitative risk of bias using adapted Cochrane tools. Random effects meta-analysis was used to examine effects on the primary outcome, full immunisation coverage.Results Our search identified over 43 000 studies and 61 were eligible for analysis. The average pooled effect of community engagement interventions on full immunisation coverage was standardised mean difference 0.14 (95% CI 0.06 to 0.23, I2=94.46). The most common source of risk to the quality of evidence (risk of bias) was outcome reporting bias: most studies used caregiver-reported measures of vaccinations received by a child in the absence or incompleteness of immunisation cards. Reasons consistently cited for intervention success include appropriate intervention design, including building in community engagement features; addressing common contextual barriers of immunisation and leveraging facilitators; and accounting for existing implementation constraints. The median intervention cost per treated child per vaccine dose (excluding the cost of vaccines) to increase absolute immunisation coverage by one percent was US$3.68.Conclusion Community engagement interventions are successful in improving outcomes related to routine child immunisation. The findings are robust to exclusion of studies assessed as high risk of bias.

Abstract Immunisation is one of the most cost‐effective interventions to prevent and control life‐threatening infectious diseases. Nonetheless, rates of routine vaccination of children in low‐ and middle‐income countries (LMICs) are strikingly low or stagnant. In 2019, an estimated 19.7 million infants did not receive routine immunisations. Community engagement interventions are increasingly being emphasised in international and national policy frameworks as a means to improve immunisation coverage and reach marginalised communities. This systematic review examines the effectiveness and cost‐effectiveness of community engagement interventions on outcomes related to childhood immunisation in LMICs and identifies contextual, design and implementation features that may be associated with effectiveness. We identified 61 quantitative and mixed methods impact evaluations and 47 associated qualitative studies related to community engagement interventions for inclusion in the reteview. For cost‐effectiveness analysis 14 of the 61 studies had the needed combination of cost and effectiveness data. The 61 included impact evaluations were concentrated in South Asia and Sub‐Saharan Africa and spread across 19 LMICs. The review found that community engagement interventions had a small but significant, positive effect on all primary immunisation outcomes related to coverage and their timeliness. The findings are robust to exclusion of studies assessed as high risk of bias. Qualitative evidence indicates appropriate intervention design, including building in community engagement features; addressing common contextual barriers of immunisation and leveraging facilitators; and accounting for existing implementation constraints and practicalities on the ground are consistently cited as reasons for intervention success. Among the studies for which we were able to calculate cost‐effectiveness, we find that the median non‐vaccine cost per dose of intervention to increase immunisation coverage by 1% was US $3.68. Given the broad scope of the review in terms of interventions and outcomes, there is significant variation in findings. Among the various types of community engagement interventions, those that involve creation of community buy‐in or development of new cadres of community‐based structures were found to have consistent positive effect on more primary vaccination coverage outcomes than if the engagement is limited to the design or delivery of an intervention or is a combination of the various types. The evidence base for sub‐group analysis for female children was sparse (only two studies) and the effect on coverage of both full immunisation and third dose of diphtheria pertussis tetanus for this group was insignificant.

Background: The emergence of COVID-19 pandemic posed a serious challenge to undergraduate medical education. With the principles of social distancing in place, all classroom sessions had to be suspended during the lockdown. Therefore, tele-teaching was planned and live online classes were regularly held for all undergraduate medical students at our institute. This study was conducted to gather the students’ perception of tele-teaching through live online classes. Methods: The present descriptive cross-sectional study enrolled 680 undergraduate students in Sawai Man Singh Medical College, Jaipur, India. It was conducted after two months of regular live teleteaching during April-May 2020, immediately after the lockdown was announced. The classes were held through video conference platform, Cisco WebEx software, for all medical undergraduates at our institute. Two sessions were held every day for each of the four batches of Bachelor of Medicine and Bachelor of Surgery (MBBS). The students’ perception was collected at the end of two months of such teaching, through a pre-validated open-ended questionnaire using Google Form platform. Result: Majority of students [n=493, (72.5%)] found the online classes beneficial and were satisfied with the content and relevance of the courses delivered. The most common challenges were internet connectivity issues and limited interaction with the faculty, yet the students’ general perceptions reflect that they have benefitted from these online classes during the pandemic period and want them to continue even after the lockdown. Conclusion: This study described the undergraduate medical students’ response to the live online classes and the encountered challenges. It concluded that this endeavour was a welcome note for the students as well as the medical teachers, in the time of COVID-19 pandemic, when all undergraduate teaching/learning had come to a standstill.

The Streptococcal C5a peptidase (ScpA) specifically inactivates the human complement factor hC5a, a potent anaphylatoxin recently identified as a therapeutic target for treatment of COVID-19 infections. Biologics used to modulate hC5a are predominantly monoclonal antibodies. Here we present data to support an alternative therapeutic approach based on the specific inactivation of hC5a by ScpA in studies using recombinant hC5a (rhC5a). Initial characterization of ScpA confirmed activity in human serum and against rhC5a desArg (rhC5adR), the predominant hC5a form in blood. A new FRET based enzyme assay showed that ScpA cleaved rhC5a at near physiological concentrations (Km 185 nM). Surface Plasmon Resonance (SPR) and Isothermal Titration Calorimetry (ITC) studies established a high affinity ScpA-rhC5a interaction (KD 34 nM, KDITC 30.8 nM). SPR analyses also showed that substrate binding is dominated (88% of ΔG°bind) by interactions with the bulky N-ter cleavage product (PN, ’core’ residues 1–67) with interactions involving the C-ter R74 contributing most of the remaining ΔG°bind. Furthermore, reduced binding affinity following mutation of a subset of positively charged Arginine residues of PN and in the presence of higher salt concentrations, highlighted the importance of electrostatic interactions. These data provide the first in-depth study of the ScpA-C5a interaction and indicate that ScpA’s ability to efficiently cleave physiological concentrations of C5a is driven by electrostatic interactions between an exosite on the enzyme and the ‘core’ of C5a. The results and methods described herein will facilitate engineering of ScpA to enhance its potential as a therapeutic for excessive immune response to infectious disease.

IntroductionAs global child vaccination coverage has plateaued, understanding how to increase routine child vaccination rates further is key to avoiding preventable disease and death. To analyse how community engagement strategies can increase child vaccination, we synthesise the results from formative evaluations of interventions that aimed to increase vaccination coverage in Ethiopia, Myanmar, Nigeria, and Pakistan.MethodsThis paper uses an inductive qualitative approach to synthesise the results from the six evaluations, gathering lessons for designing context appropriate interventions that are feasible to implement and acceptable to providers, communities, and caregivers.ResultsAssessing contextual, caregiver-level and provider-level barriers to vaccination is key to identifying appropriate engagement strategies. Across all contexts, low knowledge about the schedule of vaccines and the importance of timeliness represented a barrier to child immunisation. Despite the variability in how studies measured and reported caregiver attitudes, vaccine hesitancy was not found to represent an important barrier to immunisation. Frontline health workers played a critical role in community engagement approaches to increase vaccination. Interventions successfully obtained community buy-in by centre-staging community members, especially leaders, ensuring their participation in monitoring, and making immunisation an agenda item on community platforms. Interventions were implemented through existing health systems with substantial assistance from research teams. Limited data was available about intervention costs.ConclusionsInterventions designed around community engagement strategies can be appropriate, acceptable, and feasible approaches to overcome barriers to vaccination in a variety of low- and middle-income country contexts. However, questions remain about the ability of health systems to implement interventions at scale, both from a cost perspective and a capacity perspective.

Background: This study aimed to understand the regional variation in the socio-demographic and clinical profile of human immunodeficiency virus (HIV) infected patients at antiretroviral therapy plus centre of Sawai Man Singh (SMS) hospital, Jaipur, India. Methods: A descriptive cross-sectional study was conducted on HIV patients from January to December 2019. The HIV-positive patients of all age groups and all categories were included in the study. The socio-economic status was assessed by BG Prasad classification-based consumer price index. However, the clinical staging was done according to the World Health Organization (WHO) classification of HIV/AIDS. Data were expressed as mean ± standard deviation. Results: Among 525 HIV patients 59.16% were males, 40.26% females and 0.57% intersex. About half (51.0%) in the reproductive age group with mean age 36 ±13 years. The commonest mode of HIV transmission was heterosexual (89.77%). Maximum belonged to social class I (57.84%) and class II (26.05 %) of BG Prasad's socioeconomic status. Each of the non-agricultural laborers and semi-skilled workers constitutes 18.0%, and the housewives were 23.6%. At the time of presentation, baseline CD4+Tcell count was

Onychomycosis is a fungal infection of the nail caused by dermatophytic (99%) and/or non-dermatophytic (1%) (including yeasts) infections of the nailplate. Among the non-dermatophytes, the yeast Candida albicans, Candida tropicalis, and other molds like Scopulariopsis spp., Scytalidium spp., Fusarium spp., and Aspergillus spp. may be responsible. Herein, we report a case of total dystrophic onychomycosis in a 41-year-old female, caused by Syncephalastrum racemosum and its complete improvement with a combination of oral pulse itraconazole and 1064 nm Q-switched Nd-YAG laser. This case is being reported due to the rarity of causative organism for onychomycosis and a novel approach in its treatment.

Monochromatic lights emitted by light-emitting diodes (LEDs) have generated great interest for efficient and controlled growth in vitro, especially of plants which are endangered or require specific intensity and wavelength of light. In the present study, we have evaluated the effect of monochromatic LEDs on in vitro morphogenesis: growth, proliferation of shoot cultures, and rooting of Dendrobium sonia. Different light sources viz. white LEDs (W), blue LEDs (B), yellow LEDs (Y) and red LEDs (R) were tested under photoperiod of 16 h of exposure and 8 h of dark. The frequency of morphogenesis depended on the wavelength of the applied monochromatic light. Higher wavelength monochromatic light (yellow light) was observed to induce higher shoot proliferation (98%), early PLB (protocorm-like bodies) formation, differentiation into green buds and shoot initiation as compared to red, blue and white light treatments. Yellow light also yielded higher number of shoots per explants (29 shoots/explant) than red, blue and white light treatments. The results suggest that the monochromatic light sources stimulate morphogenic effects on in vitro culture of Dendrobium sonia, and that yellow light treatment can be used to enhance the efficiency of micropropagation.

The effects of gamma radiation and monochromatic lights on growth of in vitro shoot cultures of orchid, Dendrobium sonia, were investigated. The gamma irradiated shoot cultures grown under white, blue, yellow and red monochromatic lights exhibited differential growth pattern. Shoot cultures gamma irradiated at 15–45 Gy showed reduced shoot length, fresh weight and leaf area. The monochromatic light significantly influenced survival rate and growth of irradiated shoots. The yellow and red light treatments positively influenced survival of gamma irradiated shoots with significant increase in fresh weight, shoot length and chlorophyll content. Yellow light was found to be most effective as leaf area was increased across the radiation dose range (15–100 Gy) compared to red light. The results demonstrated that the method of post-irradiation exposure could be useful to improve growth of gamma irradiated in vitro shoots, and help to recover orchid mutants with novel modifications. Keywords: Orchids, Gamma irradiation, Monochromatic light, In vitro mutagenesis, In vitro growth

Background Surgical intervention for ischemic colitis is associated with significant postoperative morbidity and mortality. Predictive factors of adverse outcomes have been reported in the literature, but are based on small sample populations. We sought to identify risk factors for mortality after emergent colectomy for ischemic colitis using a clinical outcomes database.Methods The American College of Surgeons National Surgical Quality Improvement Project database was queried from 2010 to 2015 to identify emergent colectomies performed for ischemic colitis using Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes. Univariate and multivariate logistic regression analysis was used to identify independent risk factors associated with increased risk of mortality.Results A total of 4548 patients undergoing emergent colectomies for ischemic colitis were identified. Overall, 30-day postoperative mortality was 25.3%. On univariate analysis, preoperative risk factors associated with a higher rate of mortality include dyspnea, functional status, ventilator dependency, history of chronic obstructive pulmonary disease, ascites, congestive heart failure exacerbation, hypertension, dialysis dependency, cancer, open wounds, chronic steroids, weight loss >10%, transfusions within 72 hours before surgery, septic shock and duration from hospital admission to surgery. Factors that were significant for mortality on logistic regression analysis include elderly age, poor functional status, multiple comorbidities, septic shock, blood transfusion, acute renal failure and the duration of time from hospital admission to surgery.Conclusions Postoperative morbidity and mortality rates for ischemic colitis remain significantly high. Identification of risk factors may help patient selection for surgical interventions, and make informed decisions with patients and family members. Although it is certainly challenging, early diagnosis and prompt surgical intervention for patients with ischemic colitis may improve outcomes.Study type and level of evidence Therapeutic/care management, level II

Solitary bone plasmacytomas and plasma cell myeloma are clonal proliferations of plasma cells. Many patients with solitary bone plasmacytomas develop plasma cell myeloma on follow-up. We present a case of a 70-year-old man who presented with fracture and a lytic lesion in the subtrochanteric region of the left femur and was assigned a diagnosis of solitary bone plasmacytoma. He received local curative radiotherapy. However, 4 months later his serum M protein and β2-microglobulin levels increased to 2.31 g/dL and 5.965 mg/L, respectively. He complained of abdominal fullness and constipation. Ultrasound and non-contrast CT imaging revealed multiple retroperitoneal masses. Colonoscopic examination was normal. Biopsy of the a retroperitoneal mass confirmed it to be a plasmacytoma. Repeat hemogram, blood urea, serum creatinine, skeletal survey, and bone marrow examination revealed no abnormalities. This is an unusual presentation of plasma cell myeloma, which manifested as multiple huge extramedullary retroperitoneal masses and arose from a solitary bone plasmacytoma, without related end organ or tissue impairment and bone marrow plasmacytosis. The patient succumbed to his disease 8 months after the appearance of the retroperitoneal masses. This case highlights the importance of close monitoring of patients diagnosed with solitary bone plasmacytoma with increased serum M protein and serum β2-microglobulin levels, so that early therapy can be instituted to prevent conversion to plasma cell myeloma.

Background: Malaria diagnosis presents a challenge to all laboratories. In malaria-endemic areas, there is a need for rapid, sensitive and cost-effective method to effectively screen all samples, especially when the workload is very high. Various hematology analyzers have been investigated for detection of malaria in the past. Here, we present our experience of malaria detection in a cancer hospital where a large number of complete blood count requests are received either before or during chemotherapy. Fever, being a very common symptom in cancer patients, causes a suspicion of malaria. Aim: This study was conducted to assess the usefulness of hematology cell counter, viz. WBC-DIFF and WBC/BASO scatter plots and the flaggings generated in malaria-positive cases. The occurrence of pseudoeosinophilia as reported by previous studies was also assessed. The parasitic index was determined and its correlation with the abnormalities found on the Hematology analyzer was also studied. Materials and Methods: Blood samples were collected from 80 out-patient department and inpatients with various solid as well as hematological malignancies, who presented with acute febrile illness during September 2010 and January 2012, and for whom complete blood cell analysis and peripheral smear for malaria parasite had been requested. Results: Of the 80 patients who presented with fever and suspicion of malaria, 29 patients were positive for malaria and 10 cases were diagnosed incidentally by the findings on the cell counter and were confirmed by Giemsa-stained blood smears. The sensitivity and specificity of the abnormalities detected in the WBC-Diff channel in detecting malaria is 82% and 100% respectively. Using WBC-BASO channel abnormality for initial diagnosis the sensitivity and specificity is 50% and 92.5% respectively. The sensitivity and specificity with respect to pseudoeosinophilia is 18% and 100% respectively. The most common WBC and PLT flags were leukopenia, atypical lymphocytes, lymphopenia, WBC abnormal scattergram, platelet clumps, thrombocytopenia, platelet abnormal distribution flag. Conclusion: The instrument provides significantly valuable diagnostic parameters in detecting acute Plasmodium vivax malaria; however, it is not very useful for acute falciparum malaria infection. It is suggested that the laboratories using the hematology analyzers should be aware of such specific parameters, even in the absence of a clinical request.

Oligella ureolytica is an emerging bacteria rarely implicated as a human pathogen. It is infrequently recovered from clinical specimens probably because of inadequate processing of non-fermenting oxidase positive Gram negative bacilli. We present here a case of a 30 year old male suffering from right lung adenocarcinoma (moderately differentiated) with multiple abdominal lymph node metastasis with Syringohydromyelia whose blood culture yielded Oligella ureolytica in pure culture. Oligella ureolytica isolation in pure culture and the patient′s response to targeted treatment supported that Oligella ureolytica was the true causative agent of the blood stream infection. Early suspicion, diagnosis and treatment with potent antibiotics are needed to prevent further complications resulting from infection with this emerging pathogen.

Malaria diagnosis presents a challenge to all laboratories. In malaria endemic areas there is a need for rapid, sensitive and cost effective method to effectively screen all samples especially when the workload is very high. Various hematology analyzers have been investigated for detection of malaria in the past. Here we present our experience of malaria detection in a cancer hospital where a large number of complete blood counts requests are received either before or during chemotherapy. Fever being a very common symptom in cancer patients causes a suspicion of malaria. This study was conducted to assess the usefulness of Hematology cell counter viz. WBC-DIFF & WBC/BASO scatter plots and the flaggings generated in malaria positive cases. The occurrence of pseudoeosinophilia as reported by previous studies was also assessed. The parasitic index was determined and its correlation with the abnormalities found on the hematology analyzers was also studied. Of the 80 patients who presented with fever 29 patients were positive for malaria and 10 cases were diagnosed incidentally by the findings on the cell counter and were confirmed by Giemsa stained blood smears. The instrument provides significantly valuable diagnostic parameters in detecting acute Pl.vivax malaria however it is not very useful for acute falciparum malaria infection. It is suggested that the laboratories using the Hematology analyzers should be aware of such specific parameters, even with the absence of a clinical request