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Laboratories of many medical college hospitals in India do not offer important diagnostic tests, most of which are routine in the West. This detracts from the service as well as the educational function of the college. To provide the background to pathology and laboratory medicine services and education in India, and to create a questionnaire that will put the lack of tertiary care laboratory services in perspective. This article will help illustrate the lacunae in laboratory medicine services and in the education of students. For this, we present information on the health services and pathology education facilities in India. We propose a questionnaire comprising 30 questions in various disciplines in pathology and laboratory medicine. These questions will help administrators and bureaucrats evaluate the status of the laboratories with respect to the services provided. Sources include Web sites of the government of India, including that of the National Accreditation Board for Testing and Calibration Laboratories; indexed medical journal articles; and standard books and white papers on health care in India. We also used our personal experiences and interpretations of the laboratory and medical education sector in India. Medical colleges in India need to offer specialized diagnostic services if they are to achieve the targets of universal health care as well as turning out competent doctors. The agencies responsible for health care in India should use the questionnaire as a first step toward improving laboratory services. Other low- and middle-income countries should also adopt this method.

Piercings are a prevalent cultural and social phenomenon worldwide. Some of the complications of piercings include bleeding, infections, hypertrophic scars, keloid formation, granulomatous reaction, scar sarcoid etc. We report a case of delayed sarcoid-like granulomatous reaction following a religious piercing during the Thaipusam festival. There have been five such cases reported in literature to date.

Evaluation of the effectiveness of vaccination of animals against rabies is not routinely implemented. In cases where it is carried out, the rapid fluorescent focus inhibition test (RFFIT) or the fluorescent antibody virus neutralization (FAVN) test are the recommended tests. However, both of these tests require handling of live rabies virus (RABV), and are cumbersome to perform. In view of this, the enzyme-linked immunosorbent assay (ELISA) has been proposed as a surrogate test; however, availability of appropriate antigen is a major impediment for the development of ELISAs to detect anti-rabies antibodies. The most widely used antigen is the RABV glycoprotein (G) purified from cell culture-propagated virus, which requires a biosafety level 3 containment. The alternative is to use recombinantly expressed G, which needs to be to be properly glycosylated and folded to serve as the best antigen. The most suitable system for its production is the baculovirus expression system (BVES). However, purification of RABV G is challenging. We therefore tested partially purified preparations in the form of extracts of insect cells infected with baculovirus expressing RABV G, against sera from vaccinated dogs in an indirect ELISA. The results showed good concordance against RFFIT, with sensitivity and specificity of 90.48% and 80.00%, respectively. The system may be used for quick screening to determine the presence and an approximate level of antibodies, and can be modified to enable monitoring of mass dog vaccination programs, as well as to facilitate certification of dogs intended for international travel and transportation.

Buffaloes are the second largest source of milk. Mastitis is a major impediment for milk production, but not much information is available about bubaline mastitis, especially subclinical mastitis. The aim of this study was to (a) investigate the application of various tests for the diagnosis of bubaline subclinical mastitis, (b) identify the major bacteria associated with it, and (c) evaluate the antibiotic resistance pattern of the bacteria. To this end, 190 quarter milk samples were collected from 57 domesticated dairy buffaloes from organized (64 samples) and unorganized (126 samples) sectors. Of these, 48.4%, 40.0%, 45.8%, 61.1%, and 61.6% were positive for subclinical mastitis by somatic cell count, electrical conductivity, California mastitis test, bromothymol blue test, and N-acetyl glucosaminidase test, respectively. As compared to the gold standard of somatic cell count, California mastitis test performed the best. However, a combination of the two methods was found to be the best option. Microbiological evaluation, both by biochemical methods as well as by monoplex and multiplex polymerase chain reaction, revealed that coagulase-negative staphylococci were the most predominant (64.8%) bacteria, followed by streptococci (18.1%), Escherichia coli (9.8%) and Staphylococcus aureus (7.3%). Most of the pathogens were resistant to multiple antibiotics, especially to β-lactam antibiotics. We propose that California mastitis test be combined with somatic cell count for diagnosis of subclinical mastitis in domestic dairy buffaloes. Further, our results reveal high resistance of the associated bacteria to the β-lactam class of antibiotics, and a possible major role of coagulase-negative staphylococci in causing the disease in India.

Angiokeratoma is a vascular cutaneous disorder that is generally asymptomatic and presents with multiple dark red to blue or black papules over the skin. The prevalence of angiokeratoma increases as the age increases and it is more common after third and fourth decades of life. There are different types of angiokeratoma which may be localized forms (angiokeratoma of Mibelli, angiokeratoma circumscriptum, solitary angiokeratoma, and angiokeratoma of the scrotum or vulva) or diffuse variant (angiokeratoma corporis diffusum). Here, we report a series of five rare cases of angiokeratoma of Fordyce, of which two cases had vulval involvement and one case showed lesions on unilateral scrotal wall which was unusual.

WHO recommends infiltration of category III bite wounds, and category II wounds in immunocompromised individuals, with rabies immunoglobulins (RIG) to neutralize the virus at the site of exposure. Dilution with sterile normal saline is advised to ensure adequate wound infiltration. However, data on the extent of dilution across various RIGs and rabies monoclonal antibodies (RmAbs), and their effectiveness are lacking. This study aimed to generate evidence on dilution practices and outcomes following full-dose infiltration. To review the dilution ratios of RIGs and RmAbs used for full-dose wound infiltration in routine practice, and assess the clinical outcomes of the exposed individuals. A desk review was conducted on 223 animal bite cases managed at an Anti-Rabies Clinic, Bengaluru, India from January 2022 to December 2024. All animal bite victims received full-dose RIG or RmAb, diluted with normal saline as required for complete wound infiltration. Survival status was verified through telephonic follow-up. Of the 223 cases, 133 (60%) were males, 210 (94%) cases had dog bites, 71 (31.8%) had bite from suspect rabid animals.Among 210 cases who had dog bites, 65 (31%) were attributed to suspect rabid dogs. Dilution ratios reached up to 1:1 for HRIG, 1:5.4 for ERIG, 1:20.7 for Rabishield, and 1:8.2 for Twinrab. Special groups included one pregnant woman (Twinrab) and one woman on antiretroviral therapy (Rabishield). Survival was 100%, with no rabies cases observed during 6–42 months of follow-up. Diluted RIGs and RmAbs were found to be effective in preventing rabies when used for adequate infiltration of multiple and severe animal bite wounds, supporting the feasibility and safety of dilution practices in real-world clinical settings. •Real-world evidence on effectiveness of diluted RIGs and RmAbs for Category III animal bites.•High dilution ratios used safely, up to 1:20.7 for Rabishield and 1:8.2 for Twinrab.•Animal bite victims survived from rabies during 6–42 months of follow-up.•Diluted RmAbs were safe and effective in pregnant and immunocompromised subjects.•Findings support WHO guidelines on dilution of RIG for complete wound infiltration.

Epidermal cysts are the most common benign cutaneous cysts derived from the follicular epithelium and most commonly occur over the face, trunk, extremities, and scalp. We report a 34-year-old female who presented to our outpatient department with multiple yellowish raised lesions over the genital region for 3 years associated with itching. On examination, multiple yellowish papules were noted over the vulva. On puncturing one of the cysts, yellowish cheesy material was seen. A provisional diagnosis of steatocystoma multiplex was considered based on the morphology of the lesions. Histopathological examination showed findings leaning towards the diagnosis of an epidermal cyst.

Trichorrhexis nodosa (TN) is a hair shaft anomaly characterized by abnormal fragility and weak points (nodes) in the hair shaft. It can be congenital or acquired, with the acquired form being more common. Patients typically present with lusterless and fragile hair, an inability to grow hair to a normal length, fraying at the distal free end, and white knots and fractures along the hair shaft. This condition is often linked to daily hair care routines and exposure to chemicals or environmental factors that cause trauma to the hair. Diagnosis is typically confirmed through dermoscopy or microscopy, which reveal characteristic paintbrush-like hair fractures. Hair anomalies in sports have been rarely documented. Here, we report a unique case of acquired distal TN in a 19-year-old male professional volleyball player and a recreational swimmer with exposure to multiple environmental factors such as years of chlorine water exposure and training that may have contributed to this condition. The patient presented with a three-month history of abnormal hair fragility and glistening white areas along the hair shafts. Trichoscopy revealed multiple white nodes along the hair shafts, while light microscopy displayed nodular swellings with disruption of the cuticle and splaying out of cortical fibers. Scanning electron microscopy (SEM) further demonstrated the classical \"two brooms stuck in opposite direction\" or \"paintbrush fracture\" appearance. Based on the clinical presentation and microscopic findings, a diagnosis of diffuse distal acquired TN was made. The patient was advised to tonsure his head and use gentle, sulfate-free shampoo for regrown hair. Follow-up at six months showed no recurrence of lesions, highlighting the importance of identifying and addressing potential causative factors in managing this condition.

Malignant catarrhal fever (MCF) presents a sporadic yet significant threat to livestock and wildlife. A comprehensive investigation in Karnataka, India into the prevalence and transmission patterns of sheep-associated MCF (SA-MCF) was conducted. A total of 507 sheep peripheral blood leukocyte samples from 13 districts along with 27 cows and 10 buffalo samples from various regions in Karnataka were tested for SA-MCF infection i.e. Ovine gammaherpesvirus 2 (OvHV-2) using heminested PCR. Furthermore, serum samples collected from 73 cows and 15 buffalo suspected of MCF were tested using a commercially available ELISA kit. Additionally, histopathological examinations of affected tissues and phylogenetic analysis of viral tegument protein sequences were conducted. Our findings indicated a 20.11%, 33.33% and 20% positivity for OvHV-2 in sheep, cows and buffalo respectively by PCR. Statistical analysis revealed a significant association between the age of sheep and the detection of OvHV-2. Seven cows and one buffalo serum samples tested positive for ELISA. Clinical findings in bovids were consistent with typical MCF signs, and histopathological results revealed multi-organ involvement characterised by necrotising vasculitis and lymphoid hyperplasia. The nucleotide pairwise identity matrix revealed 99.5% identity between the sequences obtained in the study with sequences from other states. The phylogenetic analysis of partial tegument protein sequences from bovid and sheep samples suggested a close genetic relationship between the local OvHV-2 strains and those from various global regions. Crucially, this study underscores the widespread presence of SA-MCF in Karnataka, with significant implications for both livestock management and wildlife conservation.