Background: Over the last few years fungal infection rates have increased and a change is seen in their epidemiology and antifungal susceptibility pattern. Hence this study was conducted to learn the distribution of Candida species in various samples and their antifungal susceptibility pattern.Material and Methods: A total of 60Candida isolates were included in the study. Identification was done by colony morphology and Gram stain. Speciation was carried out by Germ-tube test, urease test, chlamydoconidia production test, colony characteristics on chromogenic agar medium, sugar assimilation test,sugar fermentation testand Vitek2 compact(Biomeriux, France) using ID-YST cards. Antifungal testing was done on Vitek2 compact using AST YS01 cards which included fluconazole, voriconazole, amphotericin b, caspofungin, micafungin and flucytosine.Results: 60 Candida isolates were included in this study. Samples from which Candida species were isolated were sputum (45%), urine (33.5%), pus (12%), vaginal swab (5%), endotracheal secretion (1.5%), blood (1.5%) and tissue (1.5%). Isolates from males and females were 30% and 70% respectively. Isolates from geriatric age group (>65 years) and adults (18-65 years) were 52% and 48% respectively. Isolates from samples received from IPD, OPD and ICU were 58%, 34% and 8% respectively. Out of all isolates, Candida albicans was 58%, Candida tropicalis 20%, Candida glabrata 10%, Candida parapsilosis 9% and Candida krusei3%. All Candida species (except Candidaglabrata) showed 100% sensitivity to amphotericin b and caspofungin. Sensitivity to azole group of drugs was 100% among NAC except C. glabrata and C. krusei and more than 90% among C. albicans.Conclusion: Candida albicans was the commonest isolate followed by C. tropicalis among the NAC. Overall also, C. Albicans were predominant as compared to Non albicans Candida (NAC) species. All Candidaisolates except (C. glabrata) showed good sensitivity to all antifungals.

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Xanthoma of bone is a rare disorder of bone which occurs due to cholesterol deposits in the bone. Clinically the patients usually present with pain or fracture of the affected bone. Radiologically it presents as a lytic lesion, often with cortical expansion or disruption. Xanthoma of bone is usually associated with hyperlipidemia but rare cases of non- hyperlipidemia xanthoma are also reported, termed as primary bone xanthoma. Here we present a rare case of a 46-year-old male who presented with pain and swelling in the right middle finger.  X ray showed lytic lesion in the proximal phalanx of right middle finger. Laboratory tests showed normal lipid profile. Bone biopsy and histological examination is necessary for diagnosis and to differentiate it from Rosai–Dorfman disease, Langerhans cell histiocytosis and fibrous/post traumatic dysplasia, malignant fibrous histiocytoma, or metastatic renal cell carcinoma. A diagnosis of primary bone xanthoma was made based on histology and immunohistochemistry. The fracture was treated surgically. The case report emphasises the role of histology in diagnosis of this rare clinical entity.

Castleman disease is an uncommon, non-clonal, lymphoproliferative disorder characterized by lymphadenopathy and symptoms related to hypercytokinemia. Clinically it is classified as unicentric and multicentric disease. Multicentric disease is further subclassified as HHV- 8 associated disease and idiopathic disease, which is the rarest subtype. The incidence of idiopathic disease is estimated to be 5 per million person years. The diagnosis of Idiopathic Multicentric Castleman disease is complicated by an array of clinical mimics and non-specific symptoms. We report a rare case of Idiopathic Multicentric Castleman disease in a young female where a detailed pathological work up helped to secure the diagnosis and exclude its mimics.

Introduction: Histopathological evaluation of synovial tissue is not routinely done for diagnosis in patients of arthritis, however it is of diagnostic value in patients, particularly if the joint involvement is monoarticular.A final diagnosis may be arrived at after considering the clinical and serological findings. Materials and Methods:We have analyzed a series of 46 cases which included 24 diagnostic biopsies and 22 cases of synovium sampled during joint replacement surgeries. Tissue was processed routinely, stained with Haematoxylin and Eosin and special stains whennecessary. Histopathological findings were correlated with clinical, radiological, serological findings, TB culture and TB-PCR results wherever available. Results:We observed that knee joint was most commonly affected (73.91). Chronic non-specific inflammation was the most common histological finding seen in 15 cases (32.60%), 5 cases of which was further diagnosed as tuberculous synovitis based on, clinical and laboratory findings. This was followed by 11 cases (23.91%) of chronic degenerative osteoarthritis, nine (19.56%) cases of rheumatoid arthritis, and 5 cases (10.86%) of granulomatous inflammation. Other specific diagnosis included synovial lipomatosis, non-hemophilichemosiderotic synovitis, synovial chondromatosis, gouty arthritis and pseudogout. In this study, we have discussed the importance of histopathological evaluation and clinical correlation in diagnosing synovial lesions. Conclusion:Histopathological findings in synovial lesions has its own limitations and may also be modified by treatment or chronicity of disease. However when correlated with clinical, serological and other investigations, it is of diagnostic importance in synovial lesions.

Background: Global gene expression profiling for Invasive breast carcinoma (IBC) has identified intrinsic subtypes of IBC with differing clinical outcomes and response to therapy. As genotyping assays are limited by availability and cost, we have used Immunohistochemistry (IHC) surrogates to classify IBC into molecular subtypes. Methods: Representative tumor blocks of 158 surgical specimens of IBC between 2007 to 2017, were selected and IHC done for ER, PR, Her2, Ki67, CK 5/6 and EGFR. The cases were classified into 7 Molecular subtypes (Luminal A, Luminal B, Luminal HER2PR+, Luminal HER2PR-, HER2Enriched, Basal like (BLBC) and non classifiable (NCBC) and correlated with clinico-pathological findings. Five- year survival rate was calculated for patients diagnosed between 2007 to 2013. Result: The most common subtype was Luminal A (31.0%), followed by Luminal B (25.3%), NCBC (14.6%) and HER2 enriched (13.3%). Among post-menopausal women, common subtypes were Luminal A (33.8%) and Luminal B (24.4%). Among premenopausal women, most cases were NCBC (27.8%) and BLBC (22.2%).  61.2% of Luminal A were Grade2 and 22.4% were Grade 1. Many cases of Luminal B and HER2 positive cases were of Grade3 (45.0%) and (57.1%) respectively. Of the triple-negative category (BLBC & NCBC), 73% were Grade3 with statistically significant correlation (p value < 0.001). Most of these cases were in Tumor stage T2 (70%), followed by T1 (22.3%). Nodal metastasis was seen in 39.6% and 65% respectively of Luminal A and Luminal B subtypes. Distant metastases on follow-up were present in 15.8%, which included HER2 enriched subtype (28.5%), followed by BLBC (20.0%) and NCBC (17.4%). Luminal A cases, had better survival accounting for 88% of all survivors. Conclusion: Molecular subtyping of IBC using IHC was useful to understand the clinicopathological distinctiveness of each subtype.

Background: Co-infections with Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) lead to unfavourable outcomes. However, data on prevalence of various co-infections in SARS-CoV-2 positive patients on admission to the hospital is sparse. This study focusses on assessing co-infection rates and common pathogenic bacteria and fungus involved in these patients. Methods: Patients admitted between April 2020 and December 2020 with Corona Virus Disease-2019 (COVID-19) were included. Criteria for co-infection using definitions were developed. All microbiological investigations of these patients performed within first 48 hours of admission were analysed. Their demographic characteristics along with existing co-morbidities, presenting symptoms, other laboratory findings on admission and clinical outcome were also reviewed. Results: Of 1566 patients, 60% were males.64% belonged to 13-65 years age-group. 4% of COVID-19 positive patients were co-infected. 451 samples were received for culture of which urine were 66%, blood 23% and sputum 11%. 15% samples showed growth of which urine were 19%, blood 10% and sputum 2%. Bacteria isolated were 91% and fungus 9%. The common bacteria isolated were E. coli 46%, Klebsiella pneumoniae 25%, Stenotrophomonas maltophila 6% and Pseudomonas aeruginosa 4%. The common fungus isolated was Candida species 7%.10% of COVID-19 positive patients with co-infection expired and 90% recovered. Conclusion: We report a 4% rate of bacterial and fungal co-infection in COVID-19 positive patients on admission mostly related to Enterobacterales, Non-fermenting Gram-negative bacilli and Candida species. This data can be valuable in optimising the use of antibiotics and antifungals in our patients. Similar studies on co-infection and its various aspects are the need of the hour.