Background:Evaluation of cytologic features is indispensable in the preoperative diagnosis and grading of infiltrating ductal breast carcinoma (CA) in fine-needle aspiration cytology (FNAC) material and this method can also provide additional information regarding intrinsic features of the tumor as well as its prognosis.Aim:This study has been done to evaluate comparatively the cytologic and histomorphologic grading of infiltrating ductal carcinoma of breast with specific reference to lymph node metastasis and its role in prognostication.Materials and Methods:Forty three patients who underwent FNAC and mastectomy for infiltrating ductal carcinoma were cytologically and histologically graded (employing Robinson's cytologic grading system and Elston's modification of Bloom-Richardson system, respectively). Statistical analysis was done employing ‘z’ test and χ2 test to compare the two grading system and to examine the degree of correlation between the cytologic and histologic grades. Multiple regression analysis was done to assess the significance of every cytologic and histologic parameter. All 43 cases, graded cyto-histologically were also evaluated for presence or absence of metastasis to the regional lymph nodes employing χ2 test.Results:With histologic grade taken as the standard, cytology was found to be fairly comparable, for grading breast carcinoma (overall sensitivity 89.1%, specificity 100%). Further comparison of the two grading systems by Z-test showed that difference between the cytologic and histologic grading was insignificant in all the three grade (P > 0.05). Of the six parameters studied, cell dissociation, nucleoli and chromatin pattern were the most influential features (P < 0.001). The statistically significant difference (p < 0.001) was found in incidences of axillary lymph node metastatic rate in three cytologic grades (15.4% in grade I vs. 83.3% in grade III) as well.Conclusions:Apart from being simple and noninvasive, cytologic grading is comparable to histologic grading and might provide relevant information on the aggressiveness of invasive ductal carcinoma of breast and could be a useful parameter to take into consideration when selecting mode of therapy and to predict tumor behavior.

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Objective: We aimed to study the seroprevalence of coronavirus disease 2019 (COVID-19) and sustainability of the immune response in health care workers (HCWs). A cross-sectional study was conducted between October 7 and November 30, 2020, in a multi-specialty hospital in Eastern India designated as COVID hospital during this pandemic. Study participants included 2,110 HCWs, including those who have recovered from COVID infection. Method: HCWs were required to complete a questionnaire and give written consent to participate in the study. Their venous blood sample was collected for serum analysis of IgG antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by chemiluminescent immunoassay. Results: Positive IgG antibodies were seen in 924 participants with a point prevalence of 43.79%. Slightly higher reactivity was seen in males. History of COVID-19 infection was noted in 10.9%, with the highest antibody response in 81% cases. A maximum of 87.9% reactivity was seen in the first two months, and a significant fall was noted in the fourth month, with reactivity seen in only 50% of the study participants. Conclusion: SARS-CoV-2 infection is associated with a variable immune response in the infected population. The declining trend of the antibodies correlates with short-lived protective immunity and the possibility of re-infection. Further studies are needed to explore the probable reasons for varied seroprevalence.

Ankylosing spondylosis (AS) is characterised by bilateral sacroiliitis, asymmetric peripheral oligoarthritis, association with the human leucocyte antigen-B27, enthesitis and dactylitis. The association of IgA vasculitis with AS has been documented in few case reports. We present a rare case of a man in his 40s with AS, who presented with fever, bloody loose stools, abdominal pain, lower limb arthritis, palpable purpura over the lower limbs. He subsequently, also developed renal involvement in the form of proteinuria. His skin biopsy showed evidence of leucocytoclastic vasculitis, while renal biopsy showed focal proliferative, necrotising IgA glomerulonephritis. He was thus diagnosed to have Henoch Schonlein purpura with IgA nephropathy in the background of AS. He was treated with steroids and mycophenolate mofetil with resolution of his symptoms.

During the development of the coelomic cavity, there is accessible communication between the urinary bladder and the umbilical wall through the urachus. Persistence of this tract results in urachal pathologies with variable symptoms. We present a case of an infected urachal cyst presenting as an umbilical mass with clear discharge in a 19-year-old male successfully managed laparoscopically.

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A 22-year-old female presented with large swelling on the right subscapular region for two years duration. It gradually increased in size approximately 9 x 7 x 6 cm, situated in dorsal aspect of shoulder complex near the tip of scapula. Previously; she was operated for similar swelling of gluteal region two years back. There was no family history and trauma. General examination was within normal limit. Local examination showed large size, subcutaneous swelling involving the lateral border and angle of scapula, which was firm to hard in consistency, not adherent to underlying muscle. Rib cage and skin over the swelling appeared normal. It was associated with mild pain and tenderness.Blood investigations included complete blood count -normal, Hbs Ag -negative, HCV Ab -negative, HIV I and II -negative, serum creatinine -0.9 mg/dl, serum calcium -9.0 mg/dl, serum phosphorus 3.6mg/dl, serum PTH -56 ng/dl, Vit D-10 ng/dl, ALP -49.2mg/dl, serum uric acid -2.9 mg/ dl were within normal limits, except ESR -49mm (westergrens method) and CRP -15.7 mg/dl.CECT findings showed subcutaneous multiple, rounded opacities separated by radiolucent lines (fibrous septa), which lie outside the joint capsule [Table/ Fig-1]. Under general anaesthesia, the mass was removed enbloc with pseudocapsule and was sent for histopathological examination. Gross findings revealed a well-defined mass with spongy, cystic spaces filled with yellowish necrotic debris and thickened wall [Table/ Fig-2]. Microscopy showed cystic spaces filled with necrotic calcified material, lymphoplasmacytic infiltrate, fair number of histiocytic and multinucleated osteoclastic type giant cells [Table /Fig-3,4]. Causes that may be responsible for calcification like chronic renal failure, primary hyperparathyroidism and myositis ossificans were ruled out. So a final diagnosis of idiopathic Tumoral calcinosis was given. We followed up the patient and observed that there was no recurrence. CASE-2A single bony swelling over left dorsal aspect of feet and ankle region since 4 years was presented in a 49-year-old male . It was slowly growing over a long time and there was no history of trauma. On local examination, there was a bony hard swelling, free of overlying skin, mobile in mediolateral plane. Blood test results of complete blood count, serum calcium, phosphorus, creatinine, serum Parathormone (PTH), Antinuclear Antibody Test (ANA) which all were within normal limits.

The thalassemias are the most common single-gene disorders of hemoglobin synthesis. The salient features of beta thalassemia major, in which both alleles of the HBB gene are affected, are transfusion dependency and iron overload. Although with advances in treatment, the life expectancy in such patients has increased, they have difficulty in conceiving. We report a case of pregnancy in a beta thalassemia major patient who was transfusion independent and had no iron overload. Genetic analysis revealed IVS 1-5 (G-C) mutation in the homozygous state which usually manifests in severe disease and blood transfusion dependency. On the contrary, she did not need blood transfusion, had a smooth antenatal period and a vaginal delivery at term with a favorable childbirth experience. This case report highlights complex genetic interplay and the role of fetal hemoglobin (HbF) enhancer loci which modulates HbF levels thereby raising total hemoglobin levels.