Background:Hospital Acquired Urinary Tract Infection (HAUTI) is the commonest among the nosocomial infections, and hospital specific data concerning its magnitude and attributes is essential to its effective control.Materials and Methods:Prospective study was undertaken among 498 in-patients at the medical college hospital in Goa, employing the clinico-bacteriologic criteria of CDC, Atlanta, in the representative medicine and surgery wards. Antimicrobial sensitivity was tested using the Kirby-Bauer disc diffusion method.Statistical Analysis:Statistical significance of association was tested using the chi-square test and the unpaired t-test at 5% level of significance, while the strength of association was expressed as the Odd's ratio with 95% confidence interval calculated by Wolff's method.Results:While the overall infection rate was 8.03/100 admissions, 33.6% of the catheterized patients developed HAUTI. Effect of gender was found to remain restricted to the development of HAUTI among females at an earlier age and earlier in time series compared to males, but no overall difference in incidence in the two sexes. The factors significantly associated with HAUTI included: duration of hospitalization, per urethral catheterization and the duration of catheterization. E. coli, Pseudomonas, Kebsiella, and Candida accounted for over 90% of the isolates, and 73.5% of these were resistant to all the antibiotics for which sensitivity was tested. The remaining isolates demonstrated sensitivity to amikacin and/or cefoperazone-sulbactam.Conclusion:High infection rate coupled with widespread isolation polyantimicrobial resistant nosocomial pathogens emphasizes the importance of meticulous surveillance of nosocomial infections in the hospital, with due attention to antibiotic prescription practices.

Cholecystocolic fistula is a rare biliary-enteric fistula with a variable clinical presentation. Despite modern diagnostic tools, a high degree of suspicion is required to diagnose it preoperatively. Biliary-enteric fistulae have been found in 0.9% of patients undergoing biliary tract surgery. The most common site of communication of the fistula is a cholecystoduodenal (70%), followed by cholecystocolic (10–20%), and the least common is the cholecystogastric fistula accounting for the remainder of cases. These fistulae are treated by open as well as laparoscopic surgery, with no difference in intraoperative and postoperative complications.We report here a case of obstructive jaundice, which was investigated with a plain film of the abdomen, abdominal ultrasonography, and endoscopic retrograde cholangiopancreatography, but none of these gave us any clue to the presence of the fistula was discovered incidentally during an open surgery and was appropriately treated.

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Phyllodes tumor of the breast is an uncommonly encountered disease. They are rare fibroepithelial tumors that constitute <1% of all known breast neoplasms. These tumors were first characterized by Johannes Muller in 1838, and he coined the term cystosarcoma phyllodes to describe them, based on the "leaf-like" projections into cystic spaces and sarcomatous stroma. However, this is a misleading term as 70% of these tumors are benign in nature and only rarely demonstrate cystic features. These tumors may appear as benign fibroadenoma-like lesions, locally recurrent aggressive tumors, or widely metastatic malignant forms. When these advanced tumors ulcerate, they reduce the quality of life dramatically because of associated pain, infection, malodor, profuse discharge, and bleeding. The standard of care for the treatment of phyllodes tumor entails complete surgical excision with a margin of >1 cm. They most commonly metastasize through hematogenous spread; thus, there is no role for axillary lymph node dissection for the staging of these tumors. Local recurrent rates have been shown to decrease with the administration of adjuvant radiation therapy for borderline or malignant tumors following wide local excision. The tumor presenting as a fungating breast mass or "ruptured" breast is an even more rare presentation of an unusual disease. We report a case with an atypical presentation of a 60-year-old female with a huge exophytic fungating mass of the left breast infected with maggots. Cytology was suggestive of malignancy, so left mastectomy was performed. The final pathology report was consistent with phyllodes tumor. Our aim is to highlight the features of this rare breast cancer and the challenges in obtaining a definitive diagnosis.

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