Introduction: Lower Respiratory Tract Infections (LRTI) caused by Carbapenem-resistant Enterobacteriaceae (CRE) has emerged as a major threat to modern medicine and have limited treatment options available. Timely detection of genotypes of carbapenemases in the clinical laboratory is of paramount importance to give appropriate treatment. Aim: To detect the proportion of common genes responsible for carbapenemase production (genotype) from CRE in a Tertiary Care Hospital in Southern India. Materials and Methods: The present cross-sectional study was conducted in the Department of Microbiology, Believers Church Medical College Hospital, Thiruvalla, Kerala, India, from March 2025 to September 2025. The study included a total of 125 isolates obtained from patients with (LRTIs). CRE reported from aerobic bacterial culture and sensitivity testing of respiratory samples that show resistance to one or more carbapenems (meropenem, imipenem or ertapenem) was subjected to carbapenemase gene detection. The genes detected were NDM-1, OXA-48, KPC and VIM using a Polymerase Chain Reaction (PCR) assay. Bacterial identification and antibiotic susceptibility testing were performed using the VITEK® 2 Compact system. The statistical analysis was done in Statistical Package for Social Sciences (SPSS) version 21.0. The association between variables were tested using Pearson’s Chi-Square Test. The p-value of <0.05 was considered statistically significant. Results: Out of the total 125 CRE isolates tested, Klebsiella pneumoniae was isolated from 123 (98.4%) samples and Enterobacter cloacae from 2 (1.6%) samples. The most common genotype of carbapenemase observed was NDM-1+OXA-48 33 (26.4%), followed by NDM-1 alone 28 (22.4%) and OXA-48 alone 28 (22.4%). NDM-1 (alone and in combination with other genes) constituted about 83 (66.4%), and OXA-48 (alone and in combination with other genes) was present in 75 (60%) of the isolates. Conclusion: The present study results indicate that NDM-1, followed by OXA-48, were responsible for carbapenemase production in more than 50% of CRE isolates tested. Among the total CRE isolates studied, 96.8% isolates were carbapenemase producers and 3.2% were non-carbapenemase producers. This high percentage of Carbapenemase-producing CRE is alarming. So, prompt detection of genotypes of CRE, strict antimicrobial stewardship practices, and infection control activities are absolutely essential in health care facilities to curtail CRE infections.

Introduction: Pleural Effusion (PE) results from an imbalance between pleural fluid production and absorption. It may occur due to multiple aetiologies, including heart failure, infections, malignancies, and liver disease. While Light’s criteria remain the gold standard for classification, they misclassify up to 25% of transudates. Additional biochemical markers such as pleural fluid cholesterol, Alkaline Phosphatase (ALP), and D-dimer have shown promise in enhancing diagnostic accuracy. Aim: To compare the diagnostic efficacy of pleural fluid total cholesterol, pleural ALP, and D-dimer levels with Light’s criteria in differentiating exudative from transudative PEs. Materials and Methods: The present hospital-based crosssectional study was conducted jointly in the Departments of Respiratory Medicine and Biochemistry at Adesh Medical College and Hospital, Shahabad (M), Kurukshetra, Haryana, India, from November 2022 to October 2023. A total of 100 adult patients presenting with PE were recruited. Each patient underwent detailed clinical history, physical examination, chest radiography or Computed Tomography (CT) when indicated, and routine laboratory investigations. Pleural fluid samples were analysed for protein, Lactate Dehydrogenase (LDH), cholesterol, ALP, and D-dimer, while corresponding serum levels were also measured. Effusions were classified as transudative or exudative using Light’s criteria. Data were statistically analysed using independent t-test, Chi-square or Fisher’s exact test, binary logistic regression, and Receiver Operating Characteristic (ROC) curve analysis. A p-value <0.05 was considered statistically significant. Results: In the present study, 71% of participants were male, and the mean age was comparable between the exudative and transudative groups. Pleural fluid cholesterol, pleural ALP, pleural/serum ALP ratio, pleural D-dimer, and pleural/serum D-dimer ratio were significantly higher in exudates than in transudates (p <0.001). ROC analysis demonstrated that all parameters had an Area Under the Curve (AUC) of 1.0, with 100% sensitivity and specificity at the identified cut-off values. Logistic regression analysis identified serum ALP as a protective factor and the pleural/serum LDH ratio as an independent predictor of exudative effusion. Conclusion: Pleural fluid cholesterol, ALP, and D-dimer, along with their respective ratios, are highly reliable in differentiating exudative from transudative PEs and may serve as valuable adjuncts to Light’s criteria. These findings warrant validation in larger multicentric studies.

Therapeutic venesection is a cornerstone in the management of polycythaemia to reduce hyperviscosity and thrombotic risk. However, its application in patients receiving anticoagulation, particularly heparin, is complex due to the potential for bleeding complications. The current case report describes a 40-year-old male who presented with progressive breathlessness, fatigue, and pedal oedema. Laboratory investigations revealed polycythaemia with elevated haemoglobin and haematocrit levels. The patient was diagnosed with acute pulmonary thromboembolism and severe pulmonary artery hypertension. He was initiated on unfractionated heparin therapy. Due to persistent symptoms and hyperviscosity, therapeutic venesection was performed after temporarily withholding heparin. A total volume of 450 mL of blood was removed. The procedure was well tolerated, with stable vital signs, and the patient showed symptomatic improvement following venesection. The present case highlights the therapeutic benefit and safety of venesection in a patient with polycythaemia and pulmonary thromboembolism receiving anticoagulation. Meticulous risk assessment, temporary cessation of anticoagulation at the time of venesection, and strict procedural monitoring were critical in preventing complications. A multidisciplinary approach ensured optimal patient outcomes. The novelty of the current case lies in the successful integration of therapeutic venesection in a high-risk anticoagulated patient, guided by an individualized risk-benefit assessment and coordinated multidisciplinary management to optimise safety and outcomes in complex thrombotic scenarios.

Penile metastasis from occult prostatic acinar adenocarcinoma is extremely rare and has been described in only a few case reports in the literature. The incidence of metastasis from known prostatic adenocarcinoma to the penis is less than 0.3%. The present case report involves a 72-year-old man presented with a hard penile mass measuring 2×1.5×1 cm for three months. He also reported lower urinary tract symptoms, two or three episodes of haematuria, anorexia, weight loss, and low back pain. A wedge biopsy of the penile mass was initially reported as adenosquamous carcinoma. Contrast-Enhanced Computed Tomography (CECT) revealed a heterogeneously enhancing, irregular distal penile lesion measuring 2×1.5×1 cm. Mild prostatomegaly measuring 36 cc was noted. Serum Prostate-Specific Antigen (PSA) level was 34 ng/mL. Three weeks later, the patient developed acute urinary retention, and the PSA level increased to 54 ng/mL. Total Penectomy and Transrectal Ultrasound (TRUS) guided biopsy of the prostate were performed. Histopathology revealed prostatic adenocarcinoma with a Gleason score of 8 (4+4), corresponding to Grade Group 4, while the penectomy specimen showed metastatic prostatic adenocarcinoma. Immunohistochemistry (IHC) demonstrated strong positivity for NK3 homeobox 1 (NKX3.1) and PSA, confirming the prostatic origin of the penile lesion. Unlike the present case, most reported patients with penile metastasis from prostatic adenocarcinoma have a known history of prostate cancer diagnosed years before the appearance of penile lesions. Presentation of occult prostatic carcinoma as a primary penile malignant tumour is highly unusual. Thorough clinical evaluation of the prostate in patients with genitourinary malignancies is therefore essential, particularly in the presence of elevated PSA levels.

Mucinous Cystic Neoplasms (MCNs) of the hepatobiliary tract constitute <5% of all hepatic cysts. Present case report is of MCN of the liver with radiological dilemma and special emphasis on histopathology combined with immunohistochemistry. The present case is a 36-year-old female who presented with pain in the upper abdomen for five months. The pain was insidious in onset, mild in intensity, dull aching, and non radiating. There was a history of intermittent loose stools. Routine laboratory investigations such as complete blood count, liver function tests, and renal function tests were within normal limits. Viral markers including Human Immunodeficiency Virus (HIV), Hepatitis B Surface antigen (HbsAg), and anti-HCV were negative. Ultrasound abdomen showed a well-defined cystic lesion measuring 6.5×4.8 cm in the left lobe of the liver (segment II/III) with thin internal echoes. A radiological diagnosis of hydatid cyst was made. Laparoscopic deroofing of the cyst with drainage was performed, and the specimen was sent for histopathological examination. Grossly, the specimen consisted of grey-brown tissue fragments measuring 6.5×3 cm. On microscopic examination, the cyst was lined by cuboidal to columnar epithelium with mucinous cytoplasm and basally oriented nuclei. The subepithelium showed ovarian-like stroma. A diagnosis of benign MCN was made on histopathology. Immunohistochemistry using Oestrogen Receptor (ER) showed strong nuclear positivity in the stromal cells, confirming the diagnosis. The postoperative period was uneventful, and the patient improved symptomatically.

Introduction: The Lower Gastrointestinal Tract (LGIT) is susceptible to a broad spectrum of disorders, ranging from non neoplastic conditions to premalignant and malignant lesions. Endoscopic biopsy, coupled with histopathological examination, remains a cornerstone in the diagnosis and management of these conditions. Aim: To study the histopathological spectrum of LGIT biopsies. Materials and Methods: A cross-sectional observational study was conducted for 18 months in the Department of Pathology at Jagjivan Ram Hospital, Western Railways, Mumbai, Maharashtra, India. A total of 250 LGIT biopsies received between October 2022 and April 2024 were included in the study. Biopsies were processed and examined using standard histopathological protocols. Special stains, including Periodic Acid-Schiff (PAS), Ziehl-Neelsen Acid-Fast Bacilli (AFB), Masson’s trichrome, Alcian blue, and Congo red, were performed wherever indicated. Clinical data including age, sex, presenting symptoms, and biopsy site were analysed for their association with histopathological findings. These findings included assessment of mucosal architecture, crypt distortion, lamina propria cellularity, inflammatory infiltrate patterns, ulceration, granuloma formation, dysplasia, and tumour grade. Categorical variables were expressed as numbers and percentages, while quantitative variables were expressed as mean±standard deviation or median with interquartile range. Quantitative variables were compared using Analysis of Variance (ANOVA), whereas qualitative variables were analysed using the Chi-square test or Fisher’s exact test when expected cell counts were less than five. Data were entered in Microsoft Excel and analysed using Statistical Package for the Social Sciences (SPSS) version 25.0. A p-value <0.05 was considered statistically significant. Results: Patients ranged in age from 1 to 86 years, with a mean age of 46.3 years. The study population showed a slight male predominance, with a male-to-female ratio of 1.17:1. The most common clinical presentations were chronic diarrhoea in 101 (40.4%) cases and bleeding per rectum in 95 (38%) cases. The colon was the most frequent biopsy site, accounting for 100 (40%) cases, followed by the rectum in 60 (24%) cases. Histopathological evaluation revealed non neoplastic lesions in 208 (83.2%) cases, with non specific inflammation being the most common finding in 128 (51.2%) cases. Premalignant lesions were identified in 19 (7.6%) cases, predominantly tubular adenomas, while malignant lesions were seen in 23 (9.2%) cases, mainly adenocarcinomas. Neoplastic lesions showed a significant association with higher age (mean age 64.7 years) and bleeding per rectum (p-value<0.0001). Conclusion: LGIT biopsies demonstrate a wide histopathological spectrum, with non neoplastic lesions being the most common, followed by premalignant and malignant conditions. Clinical features, particularly bleeding per rectum and anaemia, showed a significant association with neoplastic lesions. Histopathological evaluation remains indispensable for accurate diagnosis, guiding therapy, and improving patient care.

Introduction: Resistance to carbapenems is a major concern for clinicians and infection control practitioners. Fast and simple detection methods are essential to protect our increasingly limited arsenal of antibiotics. A rapid biochemical method for detecting carbapenemase production has recently been proposed, namely the Carbapenemase Nordmann-Poirel test (Carba NP test), which is based on detecting hydrolysis of the β-lactam ring of imipenem. Aim: The aim of the present study was to assess the performance of the RAPIDEC® Carba NP test. Materials and Methods: The present retrospective validation study was conducted in the Department of Microbiology, Armed Forces Medical College (AFMC), Pune, India between January and April 2018. A total of 159 isolates, retrospectively collected from various specimens from patients admitted to the Intensive Care Unit (ICU) between January 2016 and December 2017, were included in the study. These isolates had previously been characterised as either carbapenemase producers (n=109) or non-producers (n=50), based on meropenem disc susceptibility testing and the presence or absence of carbapenemase genes. The carbapenemase genes screened included Klebsiella pneumoniae carbapenemase (KPC), New Delhi Metallo-βlactamase-1 (NDM-1), Oxacillinase-48 (OXA-48), Imipenemase (IMP), and Verona Integron-encoded Metallo-β-lactamase (VIM), using Polymerase Chain Reaction (PCR) assays. The RAPIDEC® CARBA NP test was performed and interpreted according to the manufacturer’s instructions to phenotypically detect carbapenemase production based on imipenem hydrolysis. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of RAPIDEC® CARBA NP were calculated using a 2×2 contingency table, taking PCR as the gold standard. Microsoft Excel was used for data analysis. Results: Among the 109 carbapenemase producers, the RAPIDEC® CARBA NP test was positive in 106 cases and negative in 3 cases. All 50 carbapenemase non-producers were negative by the assay. RAPIDEC® CARBA NP demonstrated a sensitivity of 97.25% {95% Confidence Interval (CI): 92.17%- 99.43%}, specificity of 100% (95% CI: 92.89%-100.00%), PPV of 100% (95% CI: 96.58%-100.00%), and NPV of 94.34% (95% CI: 84.52%-98.07%). Conclusion: The RAPIDEC® CARBA NP test is simple, easy to interpret, and cost-effective, providing a practical solution for early detection of carbapenemase-producing Gram-negative bacteria in microbiological laboratories, and is helpful in infection prevention and control measures.

Introduction: Rheumatoid Arthritis (RA) is a chronic autoimmune disease with a global prevalence of approximately 1%. It is characterised by persistent joint inflammation and the production of multiple autoantibodies, leading to joint destruction, deformities, physical disability, and a reduced quality of life. Rheumatoid Factor (RF) is an antibody that targets the Fc portion of human IgG, whereas Anti-Cyclic Citrullinated Peptide (Anti-CCP) is an autoantibody generated following citrullination, often appearing in the early stages of RA. Both RF and anti-CCP are considered valuable serological markers for diagnosing RA. Aim: To evaluate RF and anti-CCP antibody tests as diagnostic markers for RA. Materials and Methods: This cross-sectional study was conducted in the Department of Microbiology, Government Doon Medical College and Hospital, Dehradun, Uttarakhand, India over a 12-month period (May 2023 to April 2024). All clinically suspected RA patients above 10 years of age were included in the study. A total of 718 serum samples from clinically suspected RA patients were collected for AntiCCP and RF testing over one year. Blood samples were collected aseptically and serum was separated for testing. RF was detected using the latex agglutination method on an automated analyser (Bio Systems Diagnostics Pvt. Ltd., Tamil Nadu, India), with values >14 IU/mL considered positive. AntiCCP antibodies were analysed using a Chemiluminescent Immunoassay (CLIA)-based Abbott Architect iSystem (Abbott Diagnostics, Illinois, USA), with values >5 IU/mL considered positive. All tests were performed according to the manufacturer’s instructions. Demographic details such as age and gender were recorded for all participants. Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) version 23.0, with a p-value <0.05 considered statistically significant. Results: Of the 718 serum samples tested, 281 (39.1%) were positive for either Anti-CCP or RF. A total of 118 (16.4%) were Anti-CCP positive, and 109 (15.2%) were RF positive correspondingly among these samples. A total of 437 samples (60.9%) were negative for both Anti-CCP and RF. Among the 718 samples analysed, 163 (22.7%) were RF positive and AntiCCP negative, while 109 (15.2%) were positive for both AntiCCP and RF. Nine samples (1.25%) were exclusively Anti-CCP positive. Conclusion: Anti-CCP shows higher specificity and is useful in predicting disease progression, as it appears early in the course of RA. Patients who are RF seropositive but AntiCCP seronegative indicate that RF can be elevated in other autoimmune diseases, decreasing its diagnostic reliability for RA. Anti-CCP testing can aid in the early detection of RA, enabling targeted interventions that may modify disease progression and improve patient outcomes and quality of life.

Introduction: Staphylococcus aureus is a bacterium associated with the majority of Skin and Soft Tissue Infections (SSTIs). It possesses a wide range of virulence factors and an inherent ability to acquire resistance mechanisms. The incidence of drug resistance in S. aureus has increased significantly. Mupirocin is a key treatment option for decolonisation of carriers. However, rising resistance to mupirocin poses a major challenge in the decolonisation of carriers and in preventing transmission of infection to susceptible individuals. Aim: To determine the mupirocin susceptibility pattern in Staphylococcus aureus isolated from SSTIs at a tertiary care hospital. Materials and Methods: The present study was an observational, cross-sectional study conducted over a period of two years in the Department of Microbiology, Shaheed Hasan Khan Mewati Government Medical College (SHKMGMC), Nalhar, Haryana, India. Out of a total of 2,156 pus samples, 160 isolates of Staphylococcus aureus were obtained and subjected to antimicrobial susceptibility testing using the disc diffusion method. Results: Of the 160 Staphylococcus aureus isolates, 31.87% were methicillin-resistant S. aureus (MRSA). Overall mupirocin resistance was observed in 15.6% of isolates. High-level mupirocin resistance and low-level mupirocin resistance were noted in 11.87% and 3.75% of isolates, respectively. Inducible clindamycin resistance was detected in 17.5% of isolates. Coresistance to mupirocin and MRSA was observed in 10.6% of cases, while combined resistance to mupirocin, MRSA, and inducible clindamycin was seen in 1.9% of isolates. Conclusion: The proportion of mupirocin resistance was higher among MRSA isolates. A significant association was observed between high-level mupirocin resistance and MRSA.

Introduction: Tuberculosis (TB), primarily caused by Mycobacterium tuberculosis, remains a major global health threat, further intensified by the emergence of drug-resistant strains. Rapid molecular diagnostic tools such as the GeneXpert MTB/RIF assay have significantly improved early detection of TB and identification of rifampicin resistance, offering faster and more accurate results than conventional methods. Aim: To compare smear microscopy with the GeneXpert MTB/ RIF assay for the rapid detection of Mycobacterium tuberculosis and simultaneous detection of rifampicin resistance. Materials and Methods: A cross-sectional study was conducted over one year (September 2022 to September 2023) at Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India. A total of 314 clinical specimens (233 pulmonary and 81 extrapulmonary) were tested using both Ziehl–Neelsen (ZN) staining and the GeneXpert MTB/RIF assay. Specimens were processed according to standard protocols for both diagnostic methods. Demographic details such as age and gender were recorded. Statistical analysis was performed using the Chi-square test, with a p-value <0.001 was considered statistically significant. Results: Among the 314 samples, males constituted the majority (204; 65%), and the most affected age group was 51- 70 years (133; 42.36%). Using GeneXpert, 87 (27.7%) samples tested positive for M. tuberculosis, whereas smear microscopy detected only 60 (19.1%). Among pulmonary samples (n=233), GeneXpert detected MTB in 81 (35%) cases, while smear microscopy detected 58 (25%). Among extrapulmonary samples (n=81), GeneXpert detected MTB in 6 (7%) cases, whereas smear microscopy detected only 1 (1%). Of the total samples, 59 (19%) were positive by both methods, 28 (9%) were positive only by GeneXpert, and 1 (0.3%) sample was positive only by smear. GeneXpert demonstrated a 6% higher diagnostic yield for extrapulmonary TB compared with smear microscopy. Rifampicin resistance was identified in 10 (11%) of the 87 GeneXpert-positive samples, indicating the presence of potential multidrug-resistant TB. Conclusion: The GeneXpert MTB/RIF assay is more sensitive than smear microscopy for detecting MTB in both pulmonary and extrapulmonary samples. It enables rapid diagnosis and simultaneous detection of rifampicin resistance, which is essential for the timely initiation of appropriate therapy.