Human telomerase RNA component (hTERC) gene expression and chromosome 7 ploidy correlate positively with histological grade of cervical intraepithelial neoplasia.

OBJECTIVE: Cervical cancer screening by primary human papilloma virus detection and cytology is fraught with low specificity and variable sensitivity, respectively. Cytology-histology correlation remains modest. Biomarkers associated with early genetic events in cervical squamous carcinogenesis and detectable in cytology material are likely to be relevant. Human telomerase RNA component (hTERC) gene overexpression and aneuploidy are promising candidates in view of their reported early and consistent association with cervical squamous oncogenesis. METHODS: We analysed hTERC gene expression and chromosome 7 ploidy by fluorescent in-situ hybridisation (FISH) in 50 women with cytological precursor squamous intraepithelial lesions and available histology outcomes. Results were expressed as percentages of cells showing ≥3 signals, mean signals/nucleus, and maximum amplitude across various cytology and histology categories. Proportions of positive cases were calculated from threshold values derived from 6 controls. Distribution of above indices with respect to ≥cervical intraepithelial neoplasia 2 (CIN2) was explored. RESULTS: For both genetic aberrations, there was significant positive correlation (for all indices) between the proportion of positive cases and worsening cytological and histological outcomes (P < .05), with significant intergroup differences (P < .05). High-grade lesions (≥CIN2) had significantly higher results compared to

Comparison of Keyes Punch Biopsy Instrument with Cervical Punch Biopsy Forceps for Diagnosing Cervical Lesions.

OBJECTIVE: To assess the feasibility and efficacy of Keyes punch biopsy instrument (KP) in diagnosing cervical lesions and compare it with cervical punch biopsy forceps (CP). METHODS: 75 women having satisfactory colposcopy with abnormal transformation zone were included and paired colposcopic directed biopsies were taken using KP followed by CP from the same target area. RESULTS: It was feasible in all cases to take cervical biopsy with KP after increasing its effective length. The volume of gross specimen obtained by KP was less than CP (0.076 ± 0.097 vs. 0.101 ± 0.156 cm3, p = 0.061), however on microscopic examination, mean length and mean depth of tissue in KP was greater than CP by 0.06 mm (p = 0.810) and 0.14 mm (p = 0.634) respectively. Exact agreement was found with the final surgical specimen in 42% of cases in both the biopsy forceps. CONCLUSION: KP is almost at par with CP for diagnosing preinvasive cervical lesions and is a useful adjunct to the existing armamentarium of biopsy forceps.

Diagnostic utility of Wilms' tumour-1 protein (WT-1) immunostaining in paediatric renal tumours.

BACKGROUND & OBJECTIVES: Renal tumours constitute about 7 per cent of all neoplasms in children. It is important to differentiate Wilms' tumour (commonest tumour) from non-Wilms' tumours. The aim of this study was to evaluate the immunoexpression and diagnostic role of Wilms' tumour-1 protein (WT1) in paediatric renal tumours. METHODS: A total of 53 cases of renal tumours in children (below 18 yr) who underwent total nephrectomy were included in this retrospective study. WT1 immunostaining was done using mouse monoclonal WT1 antibody (clone: 6F-H2). RESULTS: Of the 53 cases, 38 (72%) were of Wilms' tumour. Non-Wilms' group (15) included six cases of mesoblastic nephroma (MN), two each of clear cell sarcoma (CCSK), renal cell carcinoma (RCC) and peripheral neuroectodermal tumour (PNET) and one each of angiomyolipoma (AML), rhabdomyosarcoma (RMS) and malignant rhabdoid tumour (MRT). Proportion of WT1 positivity in Wilms' tumour was 100 per cent in contrast to 26.7 per cent in non-Wilms' tumours ( P<0.001). Epithelial and blastemal components of Wilms' tumour showed moderate (2+) nuclear and cytoplasmic staining in 80 (24/30) and 75 per cent (24/32) cases, respectively. MN, PNET, CCSK and AML were negative for WT1. RMS, RCC and MRT showed cytoplasmic staining, strongest in RMS. No significant association was seen between WT1 expression and NWTSG (National Wilms' Tumor Study Group) stage. INTERPRETATION & CONCLUSIONS: WT1 helps to differentiate Wilms' tumour from other paediatric renal tumours. It may help in differentiating the two subgroups of Wilms' tumour which have distinct molecular pathogenesis and biological behaviour, however, further prospective studies are required for validation of this hypothesis.

Vesical preservation in patients with late bladder exstrophy referral: histological insights into functional outcome.

PURPOSE: We evaluated bladder growth after combined bladder and epispadias repair in children 5 years or older, and correlated the histological findings with final surgical outcomes. MATERIALS AND METHODS: We prospectively evaluated 8 late bladder exstrophy referrals from a series of 26 patients treated during a 5-year period. Evaluated outcome measures were bladder capacity (expressed as percentage of expected bladder capacity for age), upper tracts status, continence and histological findings (collagen-to-smooth muscle ratio and type III-to-total collagen ratio). Data were analyzed using nonparametric Spearman rank correlation coefficient and Mann-Whitney U test. RESULTS: Mean age at combined bladder and epispadias repair was 8.9 years. Volitional voiding with a mean ± SD bladder capacity of 90 ± 7.48 ml was achieved in all patients except 1 with a suprapubic fistula. However, mean ± SD bladder capacity was 33.1% ± 7.47% of expected bladder capacity, and was inversely proportional to age at surgery. Mean ± SD compliance and pressure specific bladder volume less than 20 cm H2O were 13.86 ± 4.97 ml/cm H2O and 69.29 ± 18.07 ml, respectively. Two patients had nonobstructive hydroureteronephrosis with bilateral polar scarring. Mean ± SD collagen-to-smooth muscle and type III-to-total collagen ratios were 2.96 ± 1.062 and 0.4 ± 0.106, respectively. The latter showed a significant negative correlation to bladder compliance (p = 0.025). CONCLUSIONS: Successful anatomical closure stimulates bladder growth, even in cases of late referral. However, due to histological alterations, these bladders are poorly distensible and noncompliant. Thus, to have an acceptable functional outcome with preserved upper tracts, augmentation cystoplasty is needed in cases of late referral.

Inflammatory myofibroblastic tumor: an unusual mimicker of childhood intrathoracic tuberculosis.

Inflammatory myofibroblastic tumors are rare lesions of uncertain etiology that are often difficult to diagnose because of their myriad clinical presentations. Not uncommon, they mimic persistent pneumonia. We report a 4-year-old girl who presented with prolonged pyrexia, weight loss, severe anemia, hepatosplenomegaly, and nonresolving pneumonia. Initial investigations including flexible bronchoscopy and bronchial washing for usual causes of persistent pneumonia, such as tuberculosis and other infections, were negative. Chest computed tomography revealed a well-defined lesion involving the lingula and left upper lobe with extension into the subpleural space. Pleural tap and biopsy was also noncontributory. Thoracoscopic biopsy was suggestive of an inflammatory myofibroblastic tumor. As the lesion was encasing the major vessels, it was considered inoperable. The patient did not respond to steroid therapy and etoricoxib and later succumbed to the illness. This uncommon tumor should be considered in the differential diagnosis of children who presented with unresolving consolidation with pyrexia.

Endodermal sinus tumor of vagina posing a diagnostic challenge and managed by chemotherapy and novel posterior sagittal surgical approach: lessons learned.

Vaginal germ cell tumor (GCT) is a rare gynecological malignancy with no more than 100 reported cases in the international medical literature. It is an unusual, but an important, cause of premenarchal vaginal bleeding in a child. This article describes a 2-year-old child with vaginal GCT, initially misdiagnosed as rhabdomyosarcoma (on imprint smear cytology) and then as clear cell adenocarcinoma. The authors highlight the salient differentiating clinical, radiological and histological features to prevent misdiagnosis in future. The report emphasizes the need for increased awareness and screening for vaginal GCT by estimation of serum α-fetoprotein levels, in all patients with premenarchal vaginal bleeds, to prevent inadvertent operative interventions.

Amoebic anal fistula: new insight into an old disease.

A 67-year-old gentleman underwent fistulectomy for low trans-sphincteric anal fistula along with curettage for an associated abscess extending proximally for half a centimeter into the intersphincteric plane. The roof of the cavity became clearly visible after satisfactory culmination of the surgical procedure. Histopathological examination of the fistulous tract and the curetted granulation tissue revealed presence of multiple trophozoites of Entamoeba histolytica exhibiting erythrophagocytosis in the background of mixed inflammatory infiltrate. This case report provides the outlook that yields the novel insight into the possible role of Entamoeba histolytica in the pathogenesis and persistence of the fistulous tract.

The nutrition and therapeutic potential of millets: an updated narrative review.

Millets are ancient small grains grown in arid and semiarid regions of the world. They are staple food for many people in Asia and Africa. They are abundant sources of minerals and vitamins, giving them the name Nutricereals. Moreover, millets contain valuable phytochemicals that impart therapeutic properties for various disorders and diseases, thus giving them nutraceutical value. A wide array of biochemical compounds are present in the plant parts as well as the grains. In the oldest texts of medicine in India and China, millets are mentioned for use for their medicinal value. There has been expanding interest and emerging facts about millets and their therapeutic uses. Ample evidence shows that consumption of millets amounts to correction of life style and metabolic disorders. Therapeutic properties of millets can be viewed in two ways, supplementary nutrition through minerals and vitamins, and therapeutic value through the presence of phytochemicals and specialty compounds that include flavonoids, phenolics, anthocyanidins and others that have antioxidant potential. Millets are gluten free, have low glycemic index and the phytochemicals aid in correction of lifestyle disorders and prevention of ailments like carcinogenesis. Supplementary benefits include treatment of anemia and calcium deficiency especially for pregnant women and young children. With the improvements in analytical methods for detection of various compounds, it is possible to identify the compound-specific genotypes in millets that can cater to the pharmacy industry. End-use specific genotypes can be bred to meet the demand. Millets being climate resilient, can contribute to a healthier life and better world through economic usage of natural resources.

Colonic perforation with peritonitis in amoebiasis: a tropical disease with high mortality.

BACKGROUND: Invasive colonic amoebiasis presents primarily with dysentery; colonic perforation occurs rarely. Cases of amoebic colonic perforations have been reported sporadically over the past 20 years. METHODS: A retrospective study was done in the surgical unit of a tertiary care hospital in North India. The case records of those patients were reviewed who underwent exploratory laparotomy from January 2011 to September 2012 and were diagnosed with amoebic colonic perforation on histopathological examination. Details concerning the clinical presentation, investigations, intraoperative findings, operative procedures, and postoperative outcomes were retrieved. RESULTS: Amongst, a total of 186 emergency exploratory laparotomies carried out during the study, 15 patients of amoebic colonic perforation were identified. The median age of the patients was 42 years (IQR 32.0-58.0) and the male to female ratio was 13:2. Previous history of colitis was present in only 1 patient. The preoperative diagnosis was perforation peritonitis in 12 patients; and intussusception, intestinal obstruction and ruptured liver abscess in 1 patient each. Ten patients had single perforation while 5 had multiple colonic perforations. All the patients except one had perforations in the right colon. Bowel resection was performed depending upon the site and extent of the colon involved-right hemicolectomy (8), limited ileocolic resection (6) and sigmoidectomy (1). Bowel continuity could be restored only in 2 of the 15 patients and a stoma was constructed in the remaining 13 patients. The overall mortality rate was found to be 40% (6/15). CONCLUSION: Amoebic colonic perforation is associated with unusually high mortality.

Alteration in key oncoprotein expression in gastric adenocarcinoma - An immunohistochemical study.

Objective: This study was conducted to evaluate the frequency and clinicopathologic correlates of human epidermal growth factor receptor 2 (HER-2)/neu and betacatenin (BC) oncoproteins in gastric adenocarcinoma and to seek correlation if any between their expression status. Materials and Methods: This cross-sectional analytical immunohistochemistry (IHC) study was performed on 50 cases of gastric adenocarcinoma. HER-2/neu immunoexpression was scored as per criteria by Ruschoff et al. as positive (3+), equivocal (2+), and negative (1+, 0). Aberrant BC expression was categorized as nuclear, cytoplasmic, and reduced membranous immunoexpression. Protein expression results of both oncoproteins were correlated with conventional clinicopathological parameters. Correlation between immunoexpression profiles of both proteins was also analyzed. P <0.05 was considered statistically significant. Results: HER-2/neu positivity (2 + and 3+) was seen in 94% of the cases; almost 60% had strong (3+) expression. All cases showed aberrant BC immunoexpression (any pattern) except 2 cases that revealed negative expression (a form of aberrant immunoexpression) and were removed from analysis due to a very small number. The pattern of BC expression was as follows: nuclear expression (38%), cytoplasmic expression (82%), reduced membranous expression (96%), no staining (4%) cases. HER-2/neu expression correlated with age. No significant correlation was found between any of the 2 oncoprotein immunoexpression and other clinicopathological parameters (P > 0.05). Concordance between protein expression of HER-2/neu and BC was seen in >93% cases, however, the correlation was not significant. Conclusion: HER-2/neu and BC oncoprotein expression are frequently dysregulated in gastric adenocarcinomas. The significance of pathways involving HER-2/neu and BC in gastric carcinogenesis should be explored.

Prevalence and outcome of hepatobiliary dysfunction in neonatal septicaemia.

BACKGROUND: Cholestatic jaundice and liver enzyme abnormalities have been reported in neonatal septicaemia; the course, pattern, and outcome of such hepatobiliary dysfunction have not been described. METHODS: One hundred fifty-three neonates with blood culture-positive sepsis were recruited from the neonatal intensive care unit of an urban hospital. Liver function tests were done on day 3 and day 10 in all of the cases. In babies with abnormal results (direct bilirubin >20% of total with a minimum level of 2/dL or alanine aminotransferase [ALT] >50  U/L), tests were repeated weekly for 1 month and then fortnightly for 3 months or until normalization of values. Anthropometry was recorded at all of these visits. RESULTS: Klebsiella pneumoniae was the commonest organism, isolated in 95.4% of subjects. Eighty-three (54.2%) subjects had hepatobiliary dysfunction in the form of either cholestatic jaundice (n = 65 [42.5%]) or derangement in ALT (n = 57 [37.3%]). The onset of cholestasis was seen by day 3 of sepsis in 80% (n = 52), with maximum value of direct bilirubin seen by the 10th day in 90% (n = 58). Only 15% (n = 10) continued to have cholestatic jaundice beyond 30 days of onset of sepsis, and it resolved by 60 days. Hepatic enzyme abnormalities followed a more protracted course: onset by day 10 in 95%, peak value by day 38 in 90%, and normalisation by 60 days in 82% of subjects. The prevalence of any hepatobiliary dysfunction was found less frequently in babies who died as compared with survivors (43.4% vs 56.7%; P < 0.01). The weight, length, and head circumference during follow-up visits were comparable between neonates with or without hepatobiliary dysfunction. CONCLUSIONS: Hepatobiliary dysfunction is common in Gram-negative neonatal septicaemia. The onset of abnormalities is early in most cases but ultimately resolve within 2 to 3 months after sepsis. The presence of conjugated hyperbilirubinemia in neonatal sepsis may carry a better prognosis in terms of survival and has no significant effect on growth during early infancy.

Clinicopathologic profile of benign breast conditions in Indian women: prospective study based on aberrations of normal development and involution classification.

BACKGROUND: Benign conditions of the breast are common, but a great deal of confusion exists in their nomenclature, classification, and, treatment protocols. The Aberration of Normal Development and Involution (ANDI) classification provides a comprehensive framework within which to correlate clinical presentation with pathogenesis. Most clinical studies have not used this classification system. We studied the spectrum of benign breast conditions in Indian patients with reference to the ANDI system and performed a clinicopathologic correlation. METHODS: This prospective study was carried out on 262 consecutive patients attending the surgery department on an outpatient basis for benign breast conditions. RESULTS: A total of 199 (76 %) patients had a diagnosis of benign breast disorder, and 44 (17 %) had benign breast disease. There were 19 (7 %) women with non-ANDI and other conditions. The spectrum of benign breast disorders included fibroadenoma 77, mastalgia with nodularity 98, galactocele 7, cysts 4, and nipple discharge (ND) 13. Benign breast diseases included giant/multiple fibroadenomas 18, incapacitating mastalgia and nodularity 13, subareolar abscess with mammary fistula 7, periductal mastitis with suppuration 4, and ND 2. Cytopathologic correlation performed in 115 patients showed nonproliferative disease in 82, proliferative disease without atypia in 19, proliferative disease with atypia in 3, and miscellaneous 11. CONCLUSIONS: The ANDI classification is a comprehensive system that delineates the borderline between normal and abnormal, achieves correlation of clinical signs and symptoms with histologic changes, and provides risk stratification and pragmatic definition of management protocols.

Endocervicoscopy with Office Hysteroscope for Complete Visualization of Transformation Zone in Cases of Invisible Squamocolumnar Junction on Colposcopy.

Aim: To evaluate the role of endocervicoscopy for the visualization of the T3 transformation zone (TZ) on colposcopy. Materials and Methods: Forty patients with either abnormal Pap smear or positive VIA-VILI and T3 TZ on colposcopy were recruited from the colposcopy clinic and subjected to endocervicoscopy with a 4-mm office hysteroscope. The view of the endocervical canal was recorded before and after the application of 5% acetic acid and the squamocolumnar junction was identified in its entirety. An endocervical curettage was taken in all the cases and compared with the final histopathology report. Results: Squamocolumnar junction was visible in all the 40 cases; however, in two patients (5%), cervical dilatation had to be done. The positive predictive value (PPV) of endocervicoscopy in our study was 33.3% and negative predictive value (NPV) was 100%. Dense acetowhitening/irregular polypoidal endocervical mucosa with dilated blood vessels was significant in predicting the premalignant and malignant lesions with PPV of 67% and NPV of 100%. Conclusion: Endocervicoscopy allows a panoramic view of the endocervical canal. It is a safe, effective, and feasible technique for visualization of squamocolumnar junction with 5% acetic acid in cases of T3 TZ on colposcopy.

Limitations in the diagnosis of childhood teratoid lesions on fine needle aspiration cytology.

OBJECTIVE: To present and discuss our experience with cytologic study of fine needle aspiration for the diagnosis of histologically confirmed childhood teratomas/teratoid lesions and to highlight the limitations in diagnosis. STUDY DESIGN: Cases with histologic diagnosis of teratoma from the archives of the histopathology section of the Department of Pathology were identified. Only cases preceded by fine needle aspiration cytology were included in the study. RESULTS: The 11 cases of teratoma/teratoid lesions were from 4 males and 7 females. Their ages ranged from 3 months to 12 years (mean, approximately 3 years). The clinicoradiologic diagnosis varied between neuroblastoma, Wilms tumor and teratomas. The radiologic features were available in only 6 cases at the time of aspiration. Squamous cells were the main findings in cases diagnosed as teratomas. Other elements, like neuroectodermal cells and mesodermal derivatives like muscle, adipose tissue and columnar cells, were also seen. Immature mesenchymal fragments were recognized in 2 cases. CONCLUSION: Clinical details and radiologic investigations are crucial to the cytologic diagnosis of teratomas, differentiating them from the other common childhood tumors.

Disseminated tuberculosis: interesting hematological observations.

Disseminated tuberculosis can present in various ways including prolonged fever / pyrexia of unknown origin, hepatosplenomegaly, lymphadenopathy, meningitis and rarely extreme forms of hematological abnormalities such as pancytopenia and leukemoid reaction. We hereby report a case who presented with short history of fever, associated with vomiting and altered sensorium. He also had evidence of meningitis on neuroimaging with equivocal CSF finding. During his stay, he showed a spectrum of interesting hematological findings, including severe pancytopenia on peripheral smear, hemophagocytosis, epithelioid cell granuloma with Langhans' giant cells and focal necrosis consistent with tuberculosis on bone marrow examination. He showed an excellent clinical as well as hematological response to four drug antitubercular treatment (RHZE). The report highlights the significance of hematological picture in final confirmation of tuberculosis which may otherwise be passed off as nutritional or other unrelated causes.

Cellular mesenchymal epithelial transition (C-MET) gene copy number variation in gastric adenocarcinoma: A pilot search for new marker for targeted therapy in HER-2/neu resistance.

Increasing HER-2/neu resistance in gastric carcinoma has encouraged search for new biomarkers for targeted therapy. Cellular mesenchymal epithelial transition (C-MET) is one such tyrosine kinase inhibitor proposed for personalized salvage treatment. We determined frequency of C-MET gene copy number variation (CNV) by Fluorescent in-situ hybridization (FISH) in gastric adenocarcinoma (GAC) and sought its correlation with conventional clinicopathologic parameters. Dual-coloured FISH was done on 32 GAC cases. C-MET gene and centromere 7 signals were counted under fluorescent microscope and ratio was calculated for each case. Correlation between C-MET CNV and conventional clinic-pathologic parameters was done by Fischer exact test. CNV was identified in the form of amplification and polysomy (3.1% each) and associated with poorer prognostic parameters. Our pilot study highlights limited subset of patients that may benefit from anti-C-MET-targeted therapy and thus could be a novel biomarker for targeted intervention in GAC.

Cytologic diagnosis in benign odontogenic tumor with abundant calcification: a case report.

BACKGROUND: Calcifying cystic odontogenic tumor (CCOT) accounts for a mere 2-6.8% of odontogenic tumors. The cytologic features of this uncommon entity are not well characterized and may prove challenging in atypical smears, as in our case. CASE: Fine needle aspiration biopsy (FNAB) was performed on a right cheek swelling in a 15-year-old girl. Smears showed numerous polyhedral epithelial cells and occasional columnar cells with calcification and Congo red-negative extracellular homogenous material in the background. The initial diagnosis of CCOT on cytology was confirmed subsequently by histopathologic examination of the excision specimen. CONCLUSION: Absence of the characteristic ghost cells or basaloid cells as in our case presents an atypical microscopic picture that may be misdiagnosed as other epithelialodontogenic tumors with calcification. Correlation with clinicaland radiologic information is important in interpretation of FNAB of odontogenic tumors.

Low-dose mifepristone in treatment of uterine leiomyoma: a randomised double-blind placebo-controlled clinical trial.

AIMS: To evaluate the effect of low-dose mifepristone on leiomyoma-related symptoms, uterine and leiomyoma in women with symptomatic leiomyomata. METHODS: In a double-blind placebo-controlled trial, 40 patients with symptomatic leiomyoma and normal endometrial histology were randomised to receive 10 mg mifepristone (group 1) or placebo (group 2) daily for three months. Leiomyoma-related symptoms, uterine, leiomyoma and largest leiomyoma volumes were assessed at baseline and every month for three months. Endometrial biopsy was repeated at the end of therapy. RESULTS: Significant change was noticed between the two groups for mean menstrual blood loss (MBL) by first month. Menstrual blood loss declined by 94.8% in group 1 at three months and 84.2% patients attained amenorrhoea in this group. In group 1 complete relief of dysmenorrhoea occurred in significant number of women (80%) but only 33% patients got rid of pelvic pain. There was no change in these symptoms in group 1 Backache, urinary complaints and dyspareunia were not relieved in either group. Uterine, leiomyoma and largest leiomyoma volume declined by 26-32% in group 1 as compared to none in group 2, and this difference was statistically significant only by the end of the third month of therapy. Mean haemoglobin increased from 9.5 to 11.2 g/dL in group 1. In group 1, at the end of therapy, 63.1% of patients had endometrial hyperplasia without atypia. CONCLUSIONS: Ten milligrams mifepristone for three months is effective in reducing MBL, increasing haemoglobin and reducing uterine and leiomyoma volume with side-effect of endometrial hyperplasia.

Association of abnormal cervical cytology with coinfection of human papillomavirus and Chlamydia trachomatis.

INTRODUCTION: Chlamydia trachomatis (CT) and human papillomavirus (HPV) are considered to be major sexually transmitted infections (STIs) and likely health hazard among women. In addition, HPV and CT are considered as potential cofactors in the development of cervical intraepithelial neoplasia (CIN). OBJECTIVES: The main objective of this study was to investigate the association of HPV and CT infection with the presence of abnormal cervical cytology. MATERIALS AND METHODS: A cross-sectional study was carried out on 90 women with complaints of vaginal discharge attending STI clinic in a tertiary care hospital in New Delhi. Papanicolaou staining and polymerase chain reaction were done for the detection of HPV and CT. Statistical analyses were performed for comparison. RESULTS: Abnormal cervical cytology was observed in 42.2% of the study participants (41.1% low-grade squamous intraepithelial neoplasia and 1.1% high-grade intraepithelial neoplasia). HPV and CT were positive in 21.1% and 31.5% of participants with abnormal cervical cytology, respectively. Coinfection with HPV and CT was observed in 84.2% of participants with cervical atypia. Further, genital herpes was diagnosed in 18.9% of the studied population and a significant association was observed between genital herpetic ulcers and abnormal cervical cytology (P = 0.016). CONCLUSION: CT was found to be a significant risk factor for cervical cytological abnormalities in our study. HPV and CT coinfection were also associated with a higher prevalence of cervical atypia. As chlamydial infection is easily treatable, we recommend screening and treatment of all women of the reproductive age group for Chlamydia to decrease the risk of cervical dysplasia. LIMITATION: This is a single-center STI clinic-based study. Multicenter and community-based studies with a larger cohort will confirm the association.

Trivial trauma, heart disease and medico-legal interpretation of death.

Forensic experts are often required to give an opinion on the cause of death and its medico-legal interpretation in cases where an individual dies after receiving non-fatal injuries and at autopsy is discovered to have had a natural disease that alone could have caused death. The significance of this varies in different countries depending on the local laws relating to death in cases of trivial trauma associated with natural disease. This paper discusses this issue from an Indian perspective with the help of an illustrative case report and highlights the importance of the forensic pathologist in such cases.