BACKGROUND: Discharge tickets (DTs) convey important details related to hospitalization period and follow-up instructions. Therefore, quality of DTs may have significant bearing on subsequent patient care. AIMS, SETTING AND DESIGN: Aim of this retrospective study was to assess quality of handwritten DTs of breast cancer patients admitted at this institution. METHODS AND MATERIAL: DTs of 736 breast cancer patients were evaluated on six predetermined quality parameters by verifying entries from their respective case sheets drawn from the medical record department of this institution. These parameters included sections of discharge tickets dealing with central registration (CR) number, tumor stage, in-hospital treatment details, instructions for subsequent treatment and instructions regarding surgical wound care were evaluated for accuracy and clarity. General legibility was also assessed. The audit was done by the author. RESULTS: Almost all DTs were found to be legible and accurate for CR number. In-hospital treatment details were entered accurately in 98%. Tumor stage was correctly indicated in 57.5%. Follow-up and wound-care instructions were written clearly in 76.5% and 53.9% DTs, respectively. CONCLUSIONS: Handwritten DTs of breast cancer patients at this institution were satisfactory for three, but deficient for three other important quality parameters. These findings suggest that there is an acute need to review practice of preparing handwritten DTs in order to provide good quality of subsequent care.

BACKGROUND: Malaria is considered as the main differential diagnosis of acute febrile illness in the tropics, and alteration of various hem atological parameters has been observed in patients with malaria. AIM: To ascertain if certain hematological parameters increase the probability of malaria in patients with acute febrile illnesses. SETTINGS AND DESIGN: Hospital based, prospective cohort study. METHODS AND MATERIAL: All consecutive in patients with fever of less than seven days in duration were included in the study. Patients where localizing cause for fever could be determined were excluded. Hematological parameters (Hemoglobin, Red cell distribution width (RDW), Leukocyte count, and platelet counts) were determined by using automated counter, and peripheral smear examination for malarial parasite was taken as gold standard for the diagnosis of malaria. STATISTICAL ANALYSIS USED: Diagnostic accuracy was measured by computing sensitivity, specificity, predictive values and likelihood ratios. The precision of these estimates was evaluated using 95% confidence intervals. RESULTS AND CONCLUSIONS: A total of 184 patients were included in the study and 70 (38%) had a positive peripheral smear for malarial parasite. Thrombocytopenia alone (platelet countless than 150,000/mm3) was a predictor for malaria (Sn 60%, Sp 88%, LR+ 5.04) and in combination with anemia (Hb <10 g/dl) it was next best parameter (Sn 69%, Sp 74%, LR+ 2.77). RDW and leukocyte count were not predictive. The conclusion of this study is that the presence of thrombocytopenia in a patient with acute febrile illness increases the probability of malarial infection.

Inhalant abuse has been commonly reported especially in the young during the last decades globally. The reason for the relative paucity of literature from India may be attributed to a lack of knowledge about this growing problem among health professionals. A series of five cases of inhalant abuse is described in order to understand this growing public health concern. Most of the cases started inhalant abuse during adolescence. All patients except one abused typewriter erasing fluid and thinner which contains toluene. All the patients reported using inhalants as addictive substance because of their easy accessibility, cheap price, their faster onset of action and the regular 'high' that it provided. Whereas several features of inhalant dependence were fulfilled, no physical withdrawal signs were observed. The diagnosis of inhalant abuse can be difficult and relies almost entirely on clinical judgment. Treatment is generally supportive.

Pruritus or itch is a frequent symptom of patients with Hodgkin's disease. It often occurs during the clinical course of the disease and rarely may precede the diagnosis of underlying disease. In this report, we present a 16-year-old patient who had history of generalized pruritus without any skin rash for 4 years before the diagnosis of Hodgkin's disease. Within that period, she had received symptom-oriented medications, with no significant effect. After the first cycle of chemotherapy, her pruritus resolved completely. This case suggests that long-term generalized pruritus may be indicative of a significant underlying problem like Hodgkin's disease.