Background: rapid and accurate diagnosis of extrapulmonary tuberculosis (EPTB) continues to be a challenge. Although culture remains the most sensitive method for confirmation of TB, the prolonged time required for culture, limit its contribution to clinical decision making. Our study aims to assess the performance of Xpert MTB/RIF test against smear and culture-confirmed cases of extrapulmonary TB. Methods: A total, 272 non-respiratory specimens (tissues, 88 (32.4%), pleural fluids, 60 (22.1%), CSF, 48 (17.6), aspirate 36 (13.2), ascetic fluid, 20 (7.4), urine, 8 (2.9), body fluid and pus 5 (1.8) each, and blood 2 (0.73) submitted to the laboratory for Mycobacteria over two-year period were comparatively investigated with the molecular-based Gene Xpert MTB/RIF assay system and conventional smear and solid culture methods. Result: The reliability indices of the Gene Xpert MTB/RIF assay are higher compared to smear. The overall sensitivity (82.1%) of the Gene Xpert MTB/RIF assay is significantly higher than smear (46.9 %). The highest Mtb positivity agreement between the Xpert MTB/RIF assay and Mtb culture was found in pus and CSF specimens (100 % [95% CI, 91.1 % to 100 %]) each, while the lowest Mtb positivity agreement was found in the ascetic fluids specimens (50% [95% CI, 44% to 58%]). The Area under the curve (AUC) of the Receiver Operator Characteristic (ROC) curve to assess the accuracy of smear was 0.737 (with 95% CI of 0.600-0.874), whereas the AUC of the ROC curve for Xpert MTB/RIF was 0.946 (with 95% CI of 0.000-1.00). Conclusion: The Xpert assay showed superior performance over the conventional smear for the rapid detection of M. tuberculosis, in (EPTB).

Medical ethics is an important code for the clinical practitioners in order to understand public health interventions. Various ethical dilemmas are observed in various environments thereby standardization of institutional policies and regulations are not initiated. Thus this study was aimed to analyze the perception of learning medical ethics among undergraduate medical students. A standardized, pre tested questionnaire was used to interpret the data thereby their knowledge and attitude towards practicing medical ethics in their profession. As a result, 64.9% accepted the importance of informed consent; most of them (95.3%) attended bioethics training programme. Social media (64.9%) play a vital role in imparting knowledge about medical ethics than other sources. Most of the participants accepted that consent is required for surgery alone than for investigations and medications. Further the corresponding author also conducting a simple survey for assessing the knowledge among medical students resulting of clinical case records (73.7%) followed by simulated patient interaction and multiple choice questions. This study is to be extended with more number of participants with multiple institutional involvement and other medical disciplines to finalize the data.

Fluoroquinolones are being extensively used for the treatment of OPD patients suffering from various infective diseases. Extensive use of these of drugs has resulted in high drug resistance among common pathogens. We analyzed the current antibiotic resistance pattern of E.coli to fluoroquinolones for four consecutive years. 9186 samples were processed and 716 E.coli were isolated. Antimicrobial susceptibility testing was done in accordance with latest Clinical and Laboratory Standards Institute (CLSI) guidelines.6644were urinary samples followed by blood (1321), pus ((704), and miscellaneous (517). Maximum positivity was seen in pus samples (43.18%, 308/704) followed by miscellaneous (18.56%, 96/517), blood (18.01%, 238/1321).Antibiotic resistance trend, during 2016, revealed least resistance against levoflox (12%) followed by gatiflox (13%) and moxifloxacin (28%). Maximum resistance was seen against norflox (42%) and ciproflox (40%). Nitrofurantoin showed minimum resistance (8%) among all. We observed a pattern of decreasing resistance against fluoroquinolones for E.coli during the study period.

Core needle biopsy (CNB) is a part of triple assessment for preoperative evaluation and diagnosis of breast cancer as it can distinguish benign and malignant lesion, insitu and invasive cancers. In addition to its primary role in establishing histologically diagnosis it can provide prognostic information like grade and type of tumor which can influence initial therapeutic decisions. We present the result of 80 patients of palpable breast lesion who underwent for core needle biopsy followed by therapeutic surgical excision. Diagnosis of lesion along with histological typing and grading of invasive carcinoma were determined in both core needle biopsy and excision and the result compared. We observed 83.2% agreement for histological typing. There was 66 % agreement with overall grade (kappa K value-0.56),71.2% for tubule formation score 66.6% for nuclear pleomorphism,55% for mitoses (component of Bloom Richardson grading).Only 45cases of grade 1 shows concordance but 80% of grade 3 cases show concordance between CNB and surgical excision. This result is of important clinical relevance as these are the patients potentially most likely to benefit from neoadjuvant therapy. The Major problem with assessing of grading of tumor on CNB is due to under sampling of most representative areas. Hence quadrant wise sampling with increase of attempts in different directions and assistance of image guidance would improve the accuracy of CNB.

Multilocular cystic renal cell carcinoma recently has been excluded from clear cell renal cell carcinoma (ccRCC) category and re-designated as multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) and represents an extremely rare renal entity comprising <2% of all renal carcinoma and bears a low malignant potential which benefits either with simple nephrectomy or nephron sparing surgery. The pathologists need to be more cautious in diagnosing this rare entity as it mimics other diseases having reasonable prognosis. We herein report a case of MCRNLMP in an elderly patients with non-specific symptoms of 6 months duration, having a renal mass in the lower pole of the left kidney seen on computerized tomography. The final diagnosis of MCRNLMP was rendered after thorough histological and immune-histochemical evaluation. The patient was discharged after uneventful post-op duration and put up on regular follow up.

Anaplastic carcinoma of thyroid is a rare high grade neoplasm with unfavourable prognosis, accounting for less than 5% of all thyroid malignancies. It is responsible for high mortality and morbidity rate due to aggressive nature of carcinoma. Anaplastic carcinoma of thyroid is infrequently reported in the literature. Here we present a rare case of anaplastic carcinoma of thyroid in a 77 year old female who presented with large neck swelling.

Background: Dermatological lesions display a wide spectrum of diseases. Although common in the developing countries, they are not considered significant on assumptions of being always non-lethal and insignificant but are sometimes indicators to underlying systemic diseases. Aims and objectives: To observe and analyse the spectrum of dermatological disorders through histopathological examination. Material and Methods: This was a prospective study, carried out at tertiary care centre of Ahmedabad, Gujarat, India. A total of 127 cases including punch and excision biopsies of skin were studied over a period of 1 year and 6 months. Results: Out of the total 127 cases, 56 were males and 71 were females showing a slight female predilection. Skin lesions were divided into six groups of which inflammatory, malignant & benign neoplastic; & infectious skin lesions showed female predilection while spongiotic, psoriasiform and lichenoid skin lesions as well as leprosy and tuberculous skin lesions showed male predilection. Vesicobullous lesions were found to be gender neutral. The overall male to female ratio was found to be 0.8:1. Inflammatory lesions (33%) of skin formed the most common group of skin lesions in this study followed by benign tumours/cysts (27.5%) of skin. Conclusion: Skin lesions show a wide variety of histomorphology and they are sometimes an important manifestation of systemic diseases. Hence, a proper histopathological examination remains the gold standard in diagnosing skin diseases.

Background: Candida infections are among the most common fungal infection affecting immunocompromised patients in various disciplines of the health care system. In recent decades, due to dramatic increase in invasive fungal infections and related more common use of the antifungal therapy, resistance to antifungal agents has become an issue. Objectives: To determine the prevalence of candida species in various clinical specimen & their resistance to azole group of antifungal agents. Materials & Methods: This study was conducted at tertiary care hospital during January 2014 to June 2015. Total 23,896 samples (urine, blood, high vaginal swabs, oropharyngeal swab, body fluid, corneal scrapping, etc) were received over study period. Result: Out of total 8864 culture positive specimen, candida species were isolated in 644 specimens. Among total 644 Candida isolates, C.albicans is the most prevalent species (44%). Amphotericin B (99.6%) had the maximum rate of susceptibility amongst all the antifungal agents, followed by Voriconazole with 94.8% susceptibility. Fluconazole, Itraconazole & Miconazole were 73.3%, 73.44% & 74.22% susceptible respectively. Conclusion: Azole derivatives represent one of the major groups of antifungal drugs used in clinical practice to treat fungal infections. Empirical usage of Fluconazole in immune-compromised patients appeared to have played a major role in rising emergence of non albicans species resistant to Fluconazole.

Background: Large intestine and anal canal harbors various neoplastic and non-neoplastic lesions. Colorectal carcinoma is one of the leading cause of death. This study was aimed to evaluate and correlate the spectrum of various lesions of large intestine including anal canal in relation to age and sex of the patients and to compare the study done in our institute with other studies. Material and Methods: This one year study was done during the period of January 2018 to December 2018 in a tertiary care center which included 58 cases from large intestine and 16 cases of anal canal. All biopsies and resected specimens were fixed in formalin and stained with H&E and special stains like Periodic Acid Schiff (PAS) and Ziehl Neelsen (ZN) were done in required cases. Results: Out of 58 cases of large intestine 36 cases were non-neoplastic and 22 were neoplastic cases. 16 cases from anal canal were non-neoplastic lesions. Adenocarcinoma was the commonest malignant neoplastic lesion. Most of the cases presented with symptoms like bleeding per rectum, abdominal pain and constipation. Conclusion: The present study observed that non-neoplastic lesions were more common in large intestine and anal canal. There was a higher incidence in male patients. Neoplastic lesions were common in 3rd and 4th decade. Adenocarcinoma was the commonest among neoplastic lesions. This study also emphasizes histopathological evaluation is essential for early diagnosis of the tumors which will increase the survival rates of the patients.

Endometriosis is a clinico pathological condition which can be associated with significant morbidity and its attendant complications. The disease can present with diverse manifestations. The causes and mechanisms can be varied. The Clinicians and Pathologists should be aware of the natural history and course of disease so that the patients can be counselled with regards to prognosis and management of disease. This study is an attempt to reinforce the Medical fraternity with updated scientific information of Endometriosis. Various Clinico-Pathological methods are described for accurate prompt and early diagnosis of Endometriosis, so that vulnerable patients are benefitted.