Ranjana Hawaldar

Background and Objective: India has experienced a massive surge of COVID 19 cases and death since its appearance in January 2020. Aims: In the present cohort study, the percent positivity of non-hospitalized COVID-19 cases among male and female of different age group were analysed, during both first and second wave. Materials and Methods: A total of 1,75,739 patients, from non-hospitalised settings, were referred/walked-in to our diagnostic centre in the present cohort study between August 2020-June 2021. The collection and testing were approved by NABL, Government of India. Results: Of the tested samples, 40999 (39.15%) males and 28730 (40.46%) females were positive for COVID-19. The second wave (February 2021-June 2021) detected higher number of positive cases (13,922 vs 55,807, p60 years of age (37.47±16.69) in both waves and lowest amongst 18-30 years (23.17±13.86%). Fever was the predominant symptom in both waves (95%) followed by cough (70% vs 86%). Abdominal pain, nausea and chest pain were prominent in the first wave. Conclusion: Few reports are available from India on non-hospitalized COVID-19 patients. This study will help for developing knowledge on the role of symptomatic and asymptomatic cases in transmission of SARS-CoV-2 in Central part of India amongst non-hospitalized cases and will help for developing strategies to prepare for impending subsequent waves in disparate population groups across India.   Keywords: COVID 19, First wave, Second wave, Pandemic in India, RTPCR.

Introduction: It is said that children are less affected by SARSCoV2 infection because of their young immune system, so they have relatively milder symptoms as compared to adults. So the true incidence of SARSCoV2 is not known in this age group. Serosurveys in the paediatric age group can give a much better estimate of the incidence of SARSCoV2 infection in asymptomatic and symptomatic children Objectives: The present study was undertaken to study the seroprevalence of SARSCoV2 antibodies in children below 18 years of age, by measuring the S1RBD domain of spike protein neutralizing IgG antibody levels. Materials and Methods: This was a retrospective study carried out from August 2020 to August 2021 in a private diagnostic centre of Central India. 539 children of both genders from newborn babies upto 18 years of age were included in the study. US FDA Emergency Use Authorized [EUA], Atellica Solution SARS-CoV-2 IgG assay that detects anti S1-RBD antibodies including neutralizing IgG against SARS-CoV-2 was used for antibody estimation. Antibody level ?1 was termed reactive or seropositive and below 1 were considered to be non reactive or seroneagtive Results: There were 321 males and 218 females with a male to female ratio of 1.47 :1. 57% male children were seropositive while 61.9% female children showed seropositivity with an overall positivity rate of 58.99%. Conclusion: The findings of our study suggest that chidren below 5 years and adolescents exhibit higher antibody responses as compared to children between 5-10 years of age. The results of our study would be of help in formulating surveillance and vaccination strategies for children and in implementing public safety guidelines.   Keywords: SARSCoV2, SARSCoV2 IgG antibody, Seropositivity, Paediatric population.

Introduction: India began administration of COVID-19 vaccines on 16 January 2021. Reliable quantification of the antibody response to SARS-CoV-2 vaccination is highly relevant for identifying possible vaccine efficiency and estimating the time of protection. Healthcare Professionals were the first group of beneficiaries of this vaccine. Objectives: we aimed to evaluate the neutralizing [anti-RBD] antibody responses induced by COVID-19 vaccines after first and booster dose in healthcare professionals Materials and Methods: 69 healthcare professionals [HCPs] Were enrolled for the evaluation study. The COVISHILED vaccine developed by AstraZeneca, University of Oxford and manufactured and distributed in India by the Serum Institute of India was administered to all the participants. All participants were evaluated to detect levels neutralizing IgG antibodies on three occasions:,first pre vaccination level, second on approximately 27th day and third on 68th day from baselining & first vaccine dose to assess change in levels of neutralizing IgG antibodies post vaccination Results: On approximately 27 day from first vaccine dose, 45 out of 51 participants in investigational cohort were sero-converted for anti-RBD antibodies. Out of 6 participants that were yet to sero-convert 5 demonstrated increased level of neutralizing [anti-RBD] antibodies but did not cross the reactivity threshold to confirm presence of neutralizing [anti-RBD] antibodies. On approximately 68 day from second vaccine dose, 49 out of 51 participants in investigational cohort were sero-converted for anti-RBD antibodies. 4 additional participants sero-converted post booster dose .96.0% produced neutralizing [anti-RBD] antibodies post vaccination. 2 participants continued to remain non-reactive. Conclusion: This is the first data of serological responses to COVID-19 vaccines in IBD patients with detailed analysis of antibodies RBD/spike proteins represented amongst HCPs from central India. Study also demonstrates that the level of neutralizing antibodies produced may vary due to several contributing factors and hence periodic monitoring of neutralizing antibodies before and post vaccination can help evaluate adaptive immune response induced by specific individual in response to vaccine administered. Keywords : Vaccination, Covishield, Immunity, S1RBD, HCPs.

Introduction: The COVID-19 pandemic has raged on for about a year. In India, 10,880,603 individuals were infected as on 12th February 2021. Cross-sectional population seroprevalence data is crucial to plan vaccination strategies to cover the most susceptible sub-populations beyond the prioritized groups. Notably, a seroprevalence data based on measurement of clinically relevant neutralizing antibodies to SARS-CoV-2 infection, gives a legitimate estimate of the extent of immunity for baselining a population. Objectives: This study examines the cross-sectional seroprevalence of anti-SARS-CoV-2 neutralizing IgG antibodies in 1561 individuals from city of Indore in India, using first and by far the only SARS-CoV-2 IgG assay approved under EUA by the USFDA for semiquantitative measurements. Materials and Methods: A cross-sectional retrospective study was conducted using the serum samples obtained from 1561 between 7th September 2020 to 9th December 2020. Siemens Healthineers COV2G assay that detects neutralizing IgG against the S1-RBD (receptor binding domain of spike protein subunit 1 antigen was selected to be used in this study. Participants were tested for seroconversion by the measurement of anti-SARS-CoV-2 S1 RBD IgG antibodies on Atellica Solution, and were categorized as seropositive if SARS-CoV-2 antibodies were detected at a threshold of > 1.0 index value; or seronegative if SARS-CoV-2 antibodies were below the threshold. Results: We report an overall seroconversion rate of 33% across our cohort. 50% of the symptomatic population demonstrated seropositivity. 30% of asymptomatic population also demonstrated seropositivity. Out of 194 individuals with positive RT-PCR test, 52% [n=101] were sero positive. And of the 196 individuals with negative RT-PCR test, 34% [n=66] were sero positive. Conclusion: This serosurveillance study highlights the importance of measuring the prevalence of neutralizing antibody titers in general population across disparate groups. Along with other studies, may subsequently guide policy making and developing vaccination strategies for those other than the prioritized groups. Insight into the current seroprevalence of SARS-CoV-2 antibodies within this cohort is of direct relevance as a reference point for future community serological surveys. Keywords: Serosurveillance, S1RBD IgG, SARSCoV2, RT-PCR, COV2G assay.

Introduction: The diagnosis and monitoring of SARS-CoV-2 infection (COVID-19 illness) are based on two different types of tests: (i) RT-PCR (reverse-transcription polymerase chain reaction) test that detects the presence of viral RNA, and (ii) antibody test that detects antibodies to SAR-CoV-2. Studies have demonstrated that antibody testing is useful for the identification of asymptomatic or subclinical infection of SARS-CoV-2 among close contacts with COVID-19 patients, including the HCP. Objectives: This study presents the first SARS-CoV-2 seroprevalence study among 307 HCP in Central India. This study also evaluates the risk of exposure of the HCP of different roles/departments to COVID-19 infection by the SARS-CoV-2 antibody seroconversion rate. Materials and Methods: A cross-sectional study was conducted using serum obtained from 307 HCP, who were on duty in the hospitals in Indore City of Central India during the COVID-19 pandemic from March till June 2020. Siemens Healthineers COV2T assay that detects total antibody (including IgM and IgG) against the S1-RBD (receptor binding domain of spike protein subunit 1) antigen was selected to be used in this study due to its robust sensitivity and specificity, compared to IgG or IgM assay alone Results: Overall, the prevalence of COVID-19 infection among HCP in Central India hospital is 7.82% (n=24/307) as evaluated using SARS-CoV-2 total antibody test. Of the 307 HCP. Seropositivity rate varies widely by professions/departments ranging from intensivists (66.7%), general surgeons (25%), ophthalmologist (20%), pediatrician (20%), anesthetist (12.5%), radiologist (10%), general physician (9.7%) to gynaecologist (4.9%). Conclusion: This seroprevalence study, along with other studies, highlights the importance of SARS-CoV-2 antibody in seroprevalence and epidemiology studies which may subsequently guide the policy-making in implementing an effective infection control strategy to curb SARS-CoV-2 transmission in the hospital settings; on top of the use as aid-in-diagnosis, contact-tracing, pre and post vaccination screening and evaluation of convalescent plasma therapy. Keywords: COVID- 19, Siemens healthineers, Seroprevalence

Introduction: In December 2019, Wuhan, a province in China, reported an outbreak of pneumonia which was said to be due to a novel strain of Coronavirus. Initially, it was named as 2019-nCoV by WHO and later as SARS CoV -2. Early and accurate detection of SARS CoV 2 is necessary for isolating and treating the infected individuals. WHO has recommended molecular methods as the method of choice for detection of SARS CoV 2 viral infection. Recently, ICMR, the apex body for medical research and validation of methods, recommended an indigenous Truenat RTPCR (Molbio diagnostics)system for screening of SARS CoV2 infection to NABL accredited private laboratories. Materials and Methods: This observational study was carried out in the molecular biology department of our diagnostic centre between 11th May to 12th June 2020. A total of 1000 Patients of all ages and both sexes were included in the study. Results: There were 604 (60.4%) males and 396 females (39.6%) with a male to female ratio of 1.52:1. A total of 63 males (67.7%) and 30 females (32.2%) were positive for E gene. Out of total 93 E gene positive patients, 73 were positive by a confirmatory test with an overall detection rate of 7.3%. Out of the 73 confirmed SARS CoV 2 patients, symptomatic cases accounted for 63% of overall positive patients, followed by asymptomatic (24.6%) and preoperative patients (3.45%), 2.7% each of follow up positive cases and contacts of positive patients and 1.36% in pregnant females. Conclusion: Truenat RTPCR is one such promising indigenous equipment which is cost effective and can be used to diagnose Corona infection in small laboratories and community centres with minimum infrastructure. This will help in reducing the burden on government laboratories. Keywords: Coronavirus, SARS CoV2, Truenat, RT PCR, Ct value.

Introduction: Several bacteria like E.Coli, Klebsiella, Acinetobacter, Pseudomonas etc cause infections in various body fluids. Infections of the body fluids are mostly a medical emergency and may be life threatening if not managed timely. Very limited data are available about the antibiotic susceptibility of bacteria causing infection of body fluids. This retrospective study was undertaken between January to October 2019 in the Microbiology department of our diagnostic centre with the aim of identifying the bacteria causing infection of various body fluids and also to study their antibiotic susceptibility pattern. Materials and Methods: This was a retrospective study carried out on 216 patients of all ages and both sexes registered for culture and sensitivity of different body fluids in the Microbiology department of our diagnostic centre between January to October 2019. The fluids included in the study were CSF, pleural, peritoneal, amniotic, ascitic, vitreous, synovial, aqueous, BAL fluid, bile fluid, semen, drain fluids from surgical sites, Endotracheal secretions and cystic fluids from breast, ovary and other sites. Results: Male to female ratio was 2.17:1. The most common body fluid was cerebrospinal fluid (CSF) 31.02%, Klebsiella sps (22.9%) was the most frequently isolated bacteria, followed by Pseudomonas (21.3%), Acinetobacter (13.11%), Citrobacter (11.9%), E.Coli (8.19%), Stap. Aureus (8.19%), Enterococcus (4.91%), Stenotrophomonas (3.25), Candida sps (3.21%), Burkholderia and Proteus (1.63%) each. Gram positive bacteria were grown in 13.11% cases and 83.62% showed growth of Gram negative bacilli. Conclusion: Regular monitoring and surveillance of organisms causing infection of body fluids is required for formulating an antibiotic and infection control policy so as to guide the clinicians in choosing appropriate antibiotics before a culture report is available thus preventing the development of antimicrobial resistance. Keywords: Body fluids, CSF, MRSA, Antibiotic sensitivity.

Introduction: Increase in the levels of cholesterol, triglycerides and LDL cholesterol (LDL-C) and low HDL Cholesterol (HDL-C) is known to be a risk factor for coronary artery disease (CAD) and myocardial ischaemia. Studies have shown that dyslipidemia in Indians show a unique pattern of low HDL-C, high triglycerides, and high LDL-C but such studies are few and far between. The present study was undertaken in our diagnostic centre with the aim of determining the trends in the lipid values of urban population of Indore and also to determine the gender differences in the cholesterol, HDL-C, LDL-C, Triglycerides values in the study population. Materials and Methods: This study was carried out on a total of 5857 patients of all ages and both sexes registered in our diagnostic centre for lipid profile test on 22,23 and 24 November 2019. Dyslipidemia was defined as per the National cholesterol education programme (NCEP) and ATPIII criteria. Statistical analysis was performed on all lipid parameters and expressed as mean ± SD and median. Results: The mean age of females was 49±12.7 years and males was 51±13.9 years with a male to female ratio of 1.34:1. The mean cholesterol value was 167.7±35.8 mg/dl and was highest in 41-50 years age group with a mean of 172.7±34.7 mg/dl.The mean triglycerides value was 140.1±79.8 mg/dl and was highest in 41-50 years of age group. The mean HDL -C was 40.5±9.7 mg/dl. Mean LDL-C was 99.3±29.5 mg/dl. The risk ratio > 4.5 was observed in 2290(39%) patients out of which 1596(47.47%) were males and 694(27.82%) were females. Conclusion: Dyslipidemia is a major risk factor for coronary artery disease and stroke and there is an alarming increase in the incidence of CAD in younger age groups. Large scale, cross sectional, population based Studies on the pattern of dyslipidemia are needed to frame a health care policy which would be more preventive and predictive in future Keywords: Dyslipidemia, HDL-C, LDL-C, CHD, Hypercholesterolemia, Hypertriglyceridemia.

Introduction: Congenital anomalies are very uncommon in thyroid gland and dual ectopic thyroid (DET)is even more rare entity. Till date only about 30 cases of DET have been reported in the world literature, majority of them being in the anterior midline neck region: Case Report: Here we report a case of a seven year old male child with dual ectopic thyroid in lingual and subhyoid regions with mild hypothyroidism. The diagnosis of DET was based on CT scan findings and FNAC of the subhyoid swelling. The normal thyroid gland was not visualized in the neck on CT scan. The microscopyof the aspirate revealed abundant thick and thin colloid with normal thyroid follicular cells arranged in small sheets and clusters along with cyst macrophages confirming the swelling to be of thyroid origin. Conclusion: Ectopic thyroid tissue is a rare entity and dual ectopic thyroid with absence of thyroid gland in its normal location is extremely rare. Clinical, radiological and cytological analysis helps in arriving at a diagnosis. Keywords: Dual ectopic thyroid, ETT, CT scan, FNAC, DET, TDC.

Introduction: Anti Mullerian Hormone(AMH) is homodimeric protein that is classified under the superfamily of transforming growth factor beta(TGF-b ). The granulose cells of the primary, preantral and small antral follicles of the ovary express this hormone. AMH levels remain fairly constant throughout the cycle which makes it a favourable and suitable marker for determining the ovarian reserve in women of reproductive age. The present retrospective study was carried out with the aim of studying the AMH levels in women upto 50 years of age coming to our diagnostic centre for AMH screening for different reasons Materials and Methods: This was a retrospective study conducted between January to August 2019 in women upto 50 years of age coming to our diagnostic centre for AMH screening test. They were divided into further classified as 10.0 ng /ml .The mean and median values were calculated for each group. Results: AMH levels below 1 ng/ml were observed in 102/400(25.5%) patients. AMH levels between 1-4 ng/ml was observed in 171/400 (42.75%) women. High AMH values between 4-8 ng/ml were observed in 90/400(22.5%) women out of which66/90(73.33%)were in 21-30 years age range, followed by 18.89% in 31-40 years, 6.67% below 20 years and 1.11?ove 40 years of age Conclusion: Since AMH levels do not vary with the days of the menstrual cycle in women, it is one of the best markers available in the current scenario for assessing the ovarian reserve in women of reproductive age group. Our study emphasizes the observation that PCOS is a growing health problem in women of reproductive age due to several factors like sedentary life style, lack of exercise and unhealthy eating habits which can be easily managed by lifestyle changes. Keywords: Anti Mullerian hormone, LH, FSH, PCOS.

Introduction: Citrobacter are motile, straight, gram negative bacilli and are facultative anaerobes. Nosocomial infections by Citrobacter account for about 3-6% of all infections caused by Enterobacteriaceae. Urinary tract infections are the most common infection caused by Citrobacter sps. followed by infections of GI tract, skin and soft tissues and pneumonia. The present study was conducted in the microbiology department of our diagnostic centre between July to December 2018 with the aim of studying the prevalence of Citobacter infections in our clinical setting and also to study its antibiotic sensitivity pattern. Materials and Methods: This was a prospective study carried out in Microbiology department of our diagnostic centre between July to December 2018.A total of 3758 patients of both sexes registered for culture and sensitivity testing were included in the study. Samples were collected by following thorough aseptic techniques in sterile containers/swabs and were plated on 5% sheep blood agar and Maconkey agar and incubated at 37O C for 18-24 hours. Isolated organism was identified by Gram’s stain and colony morphology and further by biochemical tests. Antibiotic sensitivity was done on Vitec II (Biomerieux). Results: Out of 3758 clinical specimens received in the laboratory for culture and sensitivity, bacterial growth was observed in 1226(32.6%) specimens. Growth of Citrobacter sps was observed in 1.22% (15/1226) of all positive cultures. Citrobacter was isolated in 12(2.19%) urine cultures, and one each in blood pus and vaginal swab. In urinary isolates, Nalidixic acid was resistant and intermediate sensitivity to Ciprofloxacin. In blood and vaginal swab, Citrobacter showed sensitivity to Piperacillin/ Tazobactum, Cefoperazone/ Sulbactum, Ertapenen, Meropenem and Imipenem, Amikacin, Gentamycin, Tigecycline, Nitrofurantoin and Colistin. In pus, sensitivity was observed to Piperacillin/Tazobactumand Colistin only while all other antibiotics were resistant. Conclusion: Citrobacter sps is emerging as an opportunistic pathogen especially in immunocompromised patients and in hospital settings with resistance to multiple drugs. Thorough aseptic precautions by hospital staff and proper surveillance measures will help in preventing emergence of multidrug resistant strains of Citrobacter sps. Keywords: Citrobacter, Multi drug resistance, Nosocomial infection.

Introduction: Synovial sarcoma (SS) is a rare highly malignant soft tissue tumor of young adults .It generally develops in close proximity to joints of extremities but contrary to its name, it does not originate from synovial cells but is of mesenchymal origin. Upto 10% of soft tissue sarcomas are synovial sarcomas. SS of the Temporomandibular joint (TMJ) is a very rare entity. Here, we report a case of synovial sarcoma of the tempromandibular joint in a 22 year old male patient. Case report: A Male patient, 22 years of age had a complaint of a painful swelling in the left pre-auricular region since 2 months..CBCT of the left TMJ revealed advanced Osteolytic changes in the left condylar head region. The affected region had an irregular ‘moth-eaten appearance. USG guided FNAC revealed biphasic pattern of malignant cells with both epithelial and stromal elements. Histopathology of the tumor showed a cellular tumor with biphasic appearance. Immunohistochemistry (IHC) results showed positivity for CK (MNF) which is expressed in epithelial elements.70%of the spindle cells expressed TLE-1 positivity and moderate expression for BCL-2 and CD 99. The histomorphological and IHC findings were consistent with the diagnosis of biphasic synovial sarcoma. Conclusion: Synovial Sarcomas are very rare in the TMJ region. A CBCT investigation can best define the outline of such tumors, degree of bone involvement & destruction. A high index of suspicion along with CBCT and radiological evaluation, FNAC and histopathological assessment usually clinches the diagnosis. Keywords: Synovial Sarcoma, TMJ, CBCT, Synovium.

Introduction: Atherosclerosis is a chronic inflammatory condition n resulting from hyperlipidemia and involves platelet mediated recruitment of white blood cells to arteries. The platelet activation is measured indirectly through several platelet indices routinely available without any additional cost in newer fully automated haematology analysers. These indices include platelet count, mean platelet volume(MPV), platelet distribution width(PDW), plateletcrit(PCT), mean platelet(component) concentration (MPC), mean platelet dry mass (MPM), platelet large cell count and platelet large cell ratio (PLCR).. The present study was undertaken in the pathology department of our diagnostic centre to find an association between platelet indices reported by Advia 2120(Siemens) fully automated haematology analyser and hyperlipidemia. Materials and Methods: This was a prospective study carried out in our diagnostic centre from April to July 2018. 100 patients with hyperlipidemia without any associated diseases and 100 controls with normal lipid profile were included in the study. Statistical analysis was done using Pearson’s correlation test and data was expressed as mean ±SD for each parameter. A p value of < 0> Results: Maximum number of patients were in 41-60 years of age (65%). The male to female ratio was 1.7: 1 with 63% males and 37% females. The mean cholesterol ,mean triglyceride and mean HDL cholesterol level in study group was 218.6±36.3, 244.3±154,38.7±9.6 respectively and 158±26.8 ,94.1±34.8,and 42.1±9.3 in control group respectively. Mean LDL cholesterol was 131.1±39.4 in study group and 97.1±25.2 in control group. There was a significant difference in platelet counts in both groups with a p value of 0.01. PCT and MPC also showed a p value of 0.004. The mean platelet mass (MPM) was 2.17±0.2 in study group as compared to 2.13±021 in control group. Large platelet count was 7.09±4.9 in study group while it was 5.95±3.81 in control group which was also significantly different. Conclusion: Our study indicates that PCT, MPM large platelets and platelet count are significantly higher in hyperlipidemia patients.These indices are available without any additional cost to clinicians, pathologists and patients and can be used to assess the risk associated with hyperlipidemia. Keywords: Hyperlipidemia, MPV, Plateletcrit, MPC, MPM, PLC-R.

Introduction: Autoimmune diseases (AID) are a manifestation of a self damaging immune response of the body to its own antigen. In any suspected AID, the first test to be done is ANA detection by indirect immunofluoresence using HeP 2 cells due to its sensitivity. A positive ANA test is further evaluated by performing immunoblot test to detect specific antigens causing autoimmunity. The present study was undertaken to study the prevalence of antinuclear antibodies in patient population of Central Madhya Pradesh as well as to study the prevalence of disease specific antigens. Materials and Methods: A total of 650 patients of all ages and both sexes coming to our diagnostic centre between January to June 2018 for ANA testing were included in the study. Serum ANA was determined by indirect immunofluorescence (IIFA) using Hep 2 cell lines (Euroimmun, Germany). A positive result by IIFA was further tested by immunoblot method (Euroimmun, Germany) when requested by the clinician. Result: Out of 650 patients ANA screen was positive in 280 (43.08%) patients and negative in 209(32.15%) patients. ANA blot was requested in 161 patients (57.5%) of the total 280 ANA screen positive patients. Out of the 161 patients, 69 had a positive Immunoblot test for one or more antigens. Total 53.69% patients were positive by both ANA screen and immunoblot test. The total coincidence rate was 44.5% between ANA screen and ANA blot test with a positive coincidence rate of 81.6% and negative coincidence rate of 79.1%. Conclusion: ANA IIF is considered to be the gold standard screening test for detecting autoantibodies and ANA blot is done as a confirmatory test to detect specific autoantibodies against antigens causing autoimmunity. The combination of ANA IIF and ANA blot is an effective method to diagnose autoimmune diseases. If used alone, a possibility of missing a diagnosis is high and so a combinbation of these two tests is of great benefit to both the clinicians as well as laboratorians. Keywords: ANA, IIF, ANA blot, AID.

Introduction: The neck swellings, specially of cystic nature, may be of thyroid origin, thymic cysts, thyroglossal duct cysts, branchial cleft cysts, bronchogenic cysts or lymphangiomas depending upon the site of origin. Parathyroid cysts constitute 0.5-1% of all neck cysts and are a rare entity. A strong index of suspicion is required for its correct diagnosis. Here, we report a case of parathyroid cyst in a 40 year old female and the clinicopathological findings which posed a diagnostic challenge, thus highlighting the importance of including parathyroid cysts in the differential diagnosis of neck cysts. Case Report: Fine needle aspiration was performed on the swelling and approximately 20 ml of watery, crystal clear fluid was aspirated from the cyst. Cytological examination was acellular. The fluid PTH level was 23.6 pg/ml, serum calcium was 8.6 mg/dl (normal reference range 8.5-10.1 mg/dl) and serum PTH level was 65.88 pg/ml (normal reference range 15-65 pg/ml. Conclusion: Parathyroid cysts are uncommon benign cystic lesions and may be functional or non functional in nature. FNA is a valuable diagnostic tool along with fluid PTH level. The parathyroid cysts should be included in the differential diagnosis of all anterior cystic neck swellings so that they are not missed or misdiagnosed as thyroid lesions. Keywords: Parathyroid cysts, PTH, FNAC, USG.

Introduction: Beta Thalassemia syndrome is a group of hereditary disorders characterized by genetic deficiency in the synthesis of beta globin chains located on chromosome 11. A major diagnostic challenge is to differentiate between mild microcytic hypochromic anaemia due to BTT from other causes such as iron deficiency (IDA), sideroblastic anaemia etc. The microcytic to hypochromic ratio (M/H ratio) is one of the simplest discriminant functions which is based on the fact that in Iron deficiency anaemia the RBCs are more hypochromic as compared to thalassemia trait. The present study was carried out in our diagnostic centre with the aim of evaluating the M/H ratio for screening patients for BTT. Materials and Methods: This was a retrospective study carried out on a total of 200 patients between January to April 2018 coming to our diagnostic centre for complete blood count and Hb electrophoresis for evaluating the M/H ratio to screen for BTT. HbA2 > 3.5% was considered to be diagnostic of BTT. M/H ratio as an indicator of differentiating between BTT and IDA was compared with other discriminant factors like England & Fraser, Mentzer Index, Shine & Lal Index and Shrivastava Index. Results: There were 73 (36.5%) male and 127 (63.5%) females with a M:F ratio of 0.57:1. Out of 200 patients, 22 (11%) patients were diagnosed as BTT. Of these M/H ratio was &lt;0.9 in 5 (22%) patients while >0.9 in 11 (77.27%) patients. England and Fraser index had highest specificity (94%) with a sensitivity of 23%. Shine and Lal had a specificity of 39% and sensitivity of 95%, Mentzer had a specificity of 83% and sensitivity of 45%, Srivastava had sensitivity and specificity of 36% and 78% respectively while M/H ratio had specificity (70%) and sensitivity (77%). Conclusion: M/H ratio provided by Advia 2120 hematology analyzer is as effective as preliminary screening tool for selection of samples for HbA2 estimation. It is a rapid, automated formula provided without any additional cost to the patient. Keywords: M/H ratio, BTT, IDA, Discriminant factor.

Introduction: Infertility is defined as failure of a couple to conceive after twelve months of regular intercourse without the use of contraception in women &lt;35 years of age and after 6 months of regular intercourse without the use of contraception in women ?35 years. According to WHO statistics primary infertility rate in India varies between 3.9%-16.8%. The “male factor infertility is defined as an alteration in sperm concentration and/or motility and/or morphology in at least one of the two semen samples analyzed and collected one and four weeks apart. According to WHO statistics primary infertility rate in India varies between 3.9%-16.8%. It is mainly due to deficiency in semen quality. Objective: The present study was undertaken to evaluate the semen quality of men coming to our diagnostic clinic for semen analysis by sperm quality analyzer SQA (QwikCheck Gold). Materials and Methods: A total of 200 fresh semen samples from infertile men coming to our diagnostic center between July to September 2017 were included in the study. Each ejaculate was analyzed on SQA (QwikCheck Gold) (medical electronic system) by strictly following manufacturer instructions. Results: Azoospermia was observed in 6.5% of men. 79.5% men had optimum sperm concentration of >15 million/ml.34% men had less than 4% normal morphology of sperms. 39.5% patients had >40% motility. Teratospermia was observed in 60.5%patients. Poor sperm motility (asthenospemia) was observed in 61.5% patients. Conclusion: Semen analysis remains the main fool for evaluating male infertility. SQA (QwikCheck Gold) is a unique, compact desktop instrument which is rapid, runs on low cost, is easy to use and provides standardized quantitation of semen parameters. It can be used as a screening tool for semen quality determination and management of male infertility. Keywords: Semen, SQA (QwikCheck Gold), Azoospermia, Teratospermia.

Introduction: Respiratory tract infections (RTI) are one of the most common cause of infections and are responsible for loss of working hours in affected individuals. Many newer antibiotics have been introduced to treat these infections whose sensitivity pattern is still not clearly understood due to paucity of published data in this regard.Several studies have been published in different parts of the world but still there are limited data from Indian subcontinent. The present retrospective study was carried out in microbiology department of our diagnostic centre with the aim of analyzing the various causative bacteria of CAP and to study their antibiotic sensitivity pattern. Materials and Methods: The present retrospective study of sputum cultures was carried out between July to September 2017 in the microbiology department of our diagnostic centre. A total of 100 sputum samples collected from patients of all ages and both sexes were included in the study. Sputum samples were collected in wide mouth, sterile containers by standard protocols. Gram’s staining and Zheil Neelsen staining for acid fast bacilli was done after inoculating the specimen on Blood and MacConkey Agar plates. Results: There were 68 males and 32 females with a male to female ratio of 2.1:1. Maximum 23% patients were in 61-70 years age group followed by 15% each in 41-50 and 51-60 years age group. 3% patients were above 80 years of age. Normal bacterial flora was grown in 71% cases. Growth of pathogenic bacteria was observed in 29% cases. Klebsiella pneumoniae was the most commonly isolated micro-organism accounting for 13% cases. Staphylococcus aureus was isolated in 6% cases followed by Pseudomonas aeruginosa in 3% and 2% each of Enterococcus, E.coli and Candida species. Conclusion: The role of sputum culture has for long been debatable and is limited by the fact that it is difficult to obtain a deep cough specimen in paediatric and geriatric patients .However, epidemiological value of sputum cultures as a tool in providing information about microbiological profile and antibiotic sensitivity pattern in different geographical areas of the world cannot be underestimated. Keywords: Community acquired pneumonia, Chronic obstructive pulmonary disease, Sputum.

Leiomyosarcoma is the malignant counterpart of leiomyoma. It arises from smooth muscle of the uterus and is rare tumor that account for 2-5% of all uterine malignancy. We report a case of 60 years old female who presented with post menopausal bleeding with endometrial polyp. A total abdominal hysterectomy specimen was received in our center. A differential diagnosis of leiomyosarcoma/ Endometrial stromal sarcoma was made by histopathological examination. Immunohistochemistry report confirmed the diagnosis of uterine Leiomyosarcoma.   Keywords: Leiomyosarcoma, Postmenopausal bleeding, Endometrial polyp, Immunohistochemistry