Summaryobjective To assess the efficacy of antimalarial treatment and molecular markers of Plasmodium falciparum resistance in the Chittagong Hill Tracts of Bangladesh.methods A total of 203 patients infected with P. falciparum were treated with quinine 3 days plus sulphadoxine/pyrimethamine (SP) combination therapy, and followed up during a 4-week period. Blood samples collected before treatment were genotyped for parasite mutations related to chloroquine (pfcrt and pfmdr1 genes) or SP resistance (dhfr and dhps).results Of 186 patients who completed follow-up, 32 patients (17.2%) failed to clear parasitaemia or became positive again within 28 days after treatment. Recurring parasitaemia was related to age (v 2 ¼ 4.8, P < 0.05) and parasite rates on admission (t ¼ 3.1, P < 0.01). PCR analysis showed that some of these cases were novel infections. The adjusted recrudescence rate was 12.9% (95% CI 8.1-17.7) overall, and 16.6% (95% CI 3.5-29.7), 15.5% (95% CI 8.3-22.7) and 6.9% (95% CI 0.4-13.4) in three age groups (<5 years, 5-14, ‡15). The majority of infections carried mutations associated with chloroquine resistance: 94% at pfcrt and 70% at pfmdr. Sp-resistant genotypes were also frequent: 99% and 73% of parasites carried two or more mutations at dhfr and dhps, respectively. The frequency of alleles at dhfr, dhps and pfmdr was similar in cases that were successfully treated and those that recrudesced.conclusions The clinical trial showed that quinine 3-days combined to SP is still relatively effective in the Chittagong Hill Tracts. However, if this regimen is continued to be widely used, further development of SP resistance and reduced quinine sensitivity are to be expected. The genotyping results suggest that neither chloroquine nor SP can be considered a reliable treatment for P. falciparum malaria any longer in this area of Bangladesh.

Background: Erythroderma or exfoliative dermatitis is an inflammatory disorder characterized by erythema and scaling in the body involving more than 90% of the body surface. Underlying etiologies which lead to erythroderma are commonly psoriasis (23%), spongiotic dermatitis (16%), drug hypersensitivity reactions (15%) and cutaneous T cell lymphoma (16%). Aims: The aim of our study was to find out the histopathologically erythroderma cases and to evaluate the clinicopathological correlation of such cases. Methods: Skin biopsies of 60 erythroderma cases were received in the department of Pathology. The samples were processed, stained and examined under light microscope. Results: Erythroderma was more common in males (60%) with male to female ratio 1.5:1. Mean age of incidence was 43.3 years. Majority of the cases were acute in onset (51.67%) with shortest duration of 5 days. Pre-existing dermatoses was responsible in 68.33% cases with maximum cases being psoriasis in 33.33% and eczema in 31.67%. Drug induced erythroderma was seen in 16.67% cases. Winter was the aggravating season in 48.14% patients especially in psoriasis. Systemic features such as fever, tachycardia, etc were reported in 76.67% cases. Scales were seen in 83.33% cases and nail changes in 68.33%. Out of 60 cases, 49 cases (81.67%) had positive clinicopathological correlation with best correlation seen in psoriatic erythroderma. P value is<0.001 with strong clinical significance. Conclusion: Erythroderma has many overlapping features which made the identification of underlying disease quiet challenging sometimes. Therefore thorough clinical examination and patients' detailed history along with microscopic findings is essential to rule out all the differential diagnosis.

PRCA is a rare disorder that can affect any age and both genders equally. PRCA may be congenital or acquired. Acquired PRCA can be primary or secondarily associated with thymoma, chronic lymphocytic leukemia, lymphoma, solid organ malignancy, parvovirus B19 infection, HIV, hepatitis, tuberculosis, autoimmune disorders, SLE, rheumatoid arthritis, due to some nutritional deficiency, drug induced or may present as an idiopathic disorder. We report a case of chronic acquired PRCA in a 40 year old male. Any anaemia of prolonged duration, not responding to conventional therapy should be evaluated by bone marrow studies to rule out ineffective erythropoiesis, dysplastic syndromes, infiltrative diseases of the bone marrow or a selective erythroid suppression. PRCA is a rare disorder with varied etiology, where no cause can be established, it is labeled as idiopathic PRCA, treatment is done with corticosteroids (first line of therapy), which show a response by 4 weeks. Other agents that can also be used are cyclosporine, cyclophosphamide, azathioprine, rituximab.

Background: Thrombocytopenia is commonly encountered in a wide range of haematological and non-haematological disorders. Bone marrow examination plays a major role in diagnosis. Aims: The aim of our study was to analyse the etiology and to study megakaryocytic series in different cases of thrombocytopenia, irrespective of age or sex. Methods: This prospective bone marrow aspiration study was done in 100 cases of thrombocytopenia, which were diagnosed on peripheral blood film, to analyse the causes of thrombocytopenia. Megakaryocytes were examined in terms of their number and morphology. Bone marrow aspiration smears were stained with Leishman stain andexamined under light microscope. Results: Megaloblasticanemia was the most common cause with 33 (33%) cases followed by acute leukemia with 21 (21%) cases, immune thrombocytopenic purpura with 11 (11%) cases, aplastic anemia with 9 (9%) cases, dimorphic anemia and chronic lymphoproliferative disorders with 6 (6%) cases each, systemic causes with 5(5%) cases, myelodysplastic syndrome with 3 (3%) cases, chronic myeloproliferativeleukemia with 2 (2%) cases and 1 (1%) case each of plasmodium vivax + kalaazar,kalaazar, microfilaria and multiple myeloma. Maximum numbers of dysplastic megakaryocytes were seen in 100% cases of MDS and CML. Most common morphological change seen was micromegakaryocytes. Conclusion: Bone marrow examination is an important step to arrive at the probable diagnosis of wide varieties of haematological disorders in the cases of thrombocytopenia. Correlation with clinical, peripheral blood film findings and bone marrow findings provide valuable insight into the etiology of thrombocytopenia.