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Background: Infertility is “failure to achieve a clinical pregnancy after >= 12 months of regular unprotected sexual intercourse”. Abnormal semen parameters are found in 50% of the infertile couples. Thus, Semen analysis is usually the first step in evaluating male partner in infertile couples. Material and methods: This is a 2 years retrospective study including 103 cases. Patient’s clinical history was taken and Semen sample was obtained by masturbation in sterile universal container following abstinence of 3-5 days. Using WHO standards, Samples were examined for various physical parameters and sperm motility. Sperms were counted with improved neubauer chamber and stained with Pap stain to observe morphology. Results: Total 103 male partners of infertile couples were investigated. Abnormal seminal parameters were found in 57.2% with maximum number in 4th decade (41.7%). Abnormal appearances included transparent (5.8%), opaque (1.9%) and reddish brown (1.9%). Hypospermia was seen in 23.3% and increased liquefaction time in 1.9% samples. Sperm concentration and total sperms/ejaculate were reduced in 30.7 % and 31.7% cases respectively. Total Sperm motility was below WHO lower reference range in 16.5% cases. However, progressive motility alone was below lower reference range in 25.8% cases. On morphology, maximum defects were seen in the head of spermatozoa. Leucocytospermia was seen in in 9.9 % . Abnormalities in sperm count included oligozoospermia (21.4%), Cryptozoospermia (2.9%) and azoospermia (3.9%). Oligozoospermia was the commonest microscopic abnormality followed by Asthenozoospermia (14.6%). Conclusion: Semen analysis is the cornerstone of investigating male infertility.

Introduction: Intestinal obstruction is the impairment or arrest of the passage of contents through the intestine. Tubercular aetiology is the commonest cause of small intestinal obstruction in developing countries, while postoperative adhesions are common in developed countries. Neoplastic aetiology is more common in Large Bowel Obstruction (LBO). Clinical and radiological findings are non specific, and histopathology is required for a definitive diagnosis of the aetiology. Aim: To study histopathological examination of obstructive lesions of the small and large intestine. Materials and Methods: The present cross-sectional study was conducted from January 2020 to September 2021, including a total of 77 cases of intestinal obstruction due to mechanical causes. Detailed gross and microscopic examinations were performed, along with routine and special stains (wherever required), in the Department of Pathology at Government Medical College, Haldwani, Nainital, Uttarakhand. Data were presented in numbers and percentages. Results: The present study showed a male predominance 46 (59.8%) with a male to female ratio of 1.5:1. The most commonly affected age group was 31-40 years 20 (25.9%). Constipation (76; 98.7%) was the most common clinical symptom, followed by abdominal pain 72 (93.5%). The small intestine was more commonly involved 35 (45.5%), with the ileum being the most commonly affected site 40 (53.2%). Among cases of large intestine obstruction, the caecum was the most common site 10 (14.2%). Perforation was the most common gross finding 25 (32.9%). Non specific inflammatory pathology was the most common cause of obstruction (23.5%), followed by adenocarcinoma (20.8%). Tubercular pathology was the third most common cause (11.9%). Conclusion: The present study highlights the important pathologies in the aetiology of obstruction. Prevention and early intervention can help control some of the infective diseases and avoid such emergencies. Early diagnosis and treatment of neoplastic pathology, which is a leading cause of LBO, are beneficial for the better management of patients. A detailed histopathological study of small intestinal specimens should be conducted in constant correlation with clinical and radiological findings for an accurate diagnosis.

Background: Abnormal uterine bleeding [AUB] is one of the most common presentations among women of all age groups. It is ‘Bleeding from the uterine corpus that is abnormal in volume, regularity or timing for the majority of last 6 months. Common pathologies include hormonal imbalance patterns, atrophic endometrium, endometritis, endometrial polyp, endometrial hyperplasia and endometrial carcinoma. Material & Methods: All specimens of endometrial curettage, biopsy and hysterectomy received in department of pathology GMC, Haldwani from January 2020 to September 2021 , have been included in the study. Specimens were fixed in 10% formalin and processed routinely. Clinical details and endometrial thickness by ultrasonography were recorded and analysed. Microscopic examination was performed after routine and special stains. Results: Out of a total of 103 cases, abnormal uterine bleeding was frequently observed in the age group 40 – 49 years, followed by 50 – 59 years. Most common presenting complaint was menorrhagia followed by post menopausal bleeding. Most common histopathological finding was proliferative phase endometrium followed by secretory phase endometrium. The range of endometrial thickness recorded in the proliferative phase was mostly 4-9 mm followed by the secretory phase with 9 – 15 mm. Two cases of endometrial carcinoma were seen after 5th decade onward. All cases of endometrial hyperplasia and carcinoma had an endometrial thickness of more than 15 mm. Conclusion: AUB may be the only presenting complaint in patients with malignant or pre-malignant endometrial lesions. Histopathology helps to reach a definitive diagnosis crucial for management. Keywords: Abnormal uterine bleeding, Endometrial sampling, Endometrial thickness, Endometrial hyperplasia, Endometrial carcinoma

ABSTRACT: Purpose: The impact of the COVID-19 pandemic on antimicrobial resistance (AMR) is largely studied in healthcare settings. There is a need to understand the fluctuations in AMR during pandemic at the community level. With urinary tract infection (UTI) being one of the most common infections in the community, the AMR profile of community-acquired UTI (CA-UTI) is considered representative AMR at the community level. Methods: The study was taken in a cohort of patients with a clinical diagnosis of CA-UTI. The four study sites represented different community health centres in India. Escherichia coli isolates were analysed phenotypically and genotypically for AMR pre-COVID (October 2019–February 2020) and in the first (March 2020–February 2021) and second waves of COVID-19 (March 2021–December 2021). Results: E. coli was the predominant uropathogen (229, 82%). Increased susceptibility to nitrofurantoin was observed during the pandemic. Reduced susceptibility to first-line oral antibiotics and carbapenems was seen during the second wave, and an increased minimum inhibitory concentration (MIC50) to beta-lactams and fluoroquinolones was seen during the pandemic. Genomic analysis of E. coli isolates showed some AMR genes (aacC1, aacC4, SHV, QepA) only during the second wave. Conclusion: One good outcome of the pandemic was increased susceptibility to nitrofurantoin, while drawback was a significant decrease in susceptibility to oral antibiotics during the second wave and increased MIC50 of some antibiotics. Decreased susceptibility to last-resort carbapenems and the occurrence of various AMR genes during the second wave of the pandemic are of great concern.

Background India continues to be a country with a high burden of tuberculosis. Tuberculous lymphadenitis is one of the commonest manifestations of extra pulmonary tuberculosis. The aim of this study was to find the commonest cause of superficial lymphadenopathy and to describe the various cytological patterns of tuberculous lymphadenitis. Materials and Methods This was a cross sectional study conducted between June 2022 and September 2023. All patients with superficial lymphadenopathy were included in the study. All slides were stained with H & E, PAP and MGG. Acid fast staining for tubercular bacilli was done on smears with cytological features of tuberculosis and in all cases where pus was aspirated. Results A total of 300 aspirations were done. Maximum aspirates were blood mixed material (81.6%). 144 cases were of tubercular lymphadenitis with cervical group of lymph nodes (75.6%) being the commonest location. Maximum cases of tubercular lymphadenitis were in the age group of 21-30 years (36) and showed a female preponderance (75). Out of the 144 cases 43.75% showed AFB positivity on ZN stain. Epithelioid cell granuloma with necrosis was the commonest cytological pattern seen (41.7%) and showed maximum AFB positivity. Minimum AFB positivity was seen with smears showing caseous necrosis only. Conclusions Superficial lymphadenopathy is one of the commonest indications for FNAC and tuberculosis is the commonest etiology in our region. Coupled with ZN staining a reliable and early diagnosis of tuberculous lymphadenitis can be given avoiding a biopsy. In patients where AFB is not demonstrated on ZN staining, a microbiological confirmation could be sought for diagnosis.

Abstract Background Urinary tract infection (UTI) in children is a common bacterial infection. The emergence of extended-spectrum beta-lactamases (ESBLs) poses a major challenge against the treatment of uropathogens. We aimed to characterize the E. coli isolates recovered from children with UTI for their resistance profile and circulating sequence types (ST). Methods Children (> 1.5–18 years of age) from different community health centres of India with symptoms of UTI were enrolled. Isolates causing significant bacteriuria were identified by Matrix-Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) and tested for antimicrobial susceptibility by the automated system, VITEK-2 (Biomeriux, Durhum, US). Nineteen E. coli isolates (15 ESBL positive and 4 ESBL negative) were sequenced in Oxford Nanopore platform followed by core-genome phylogeny, accessory genome cluster analysis, identification of sequence types, mobile genetic elements, genetic antimicrobial resistance markers. The correlation between detection of antimicrobial resistance genes with phenotypic resistance profiles was also investigated. Results Eleven percent of children had significant bacteriuria [male:female—1:1, > 50% were 11–18 years of age group]. E. coli was predominant (86%) followed by K. pneumoniae (11%). Susceptibility of E. coli was highest against fosfomycin (100%) followed by carbapenems (90.7%) and nitrofurantoin (88.8%). ST131 (15.8%) and ST167 (10.5%) found as high-risk clones with the presence of plasmid [IncFIB (63.1%), IncFIA (52.6%)], and composite transposon [Tn2680 (46.6%)] in many isolates. Few isolates coharboured multiple beta-lactamases including bla NDM-5 (33.3%), bla OXA-1 (53.3%), bla CTX-M-15 (60%) and bla TEM-4 (60%). Conclusions This study highlights horizontal transmission of resistance genes and plasmids in paediatric patients at community centers across the nation harbouring multidrug-resistant genes such as bla NDM-5 and bla CTX-M-15 associated with high-risk clones ST131 and ST167. The data is alarming and emphasizes the need for rapid identification of resistance markers to reduce the spread in community. To our knowledge, this is the first multicentric study targeting paediatric UTI patients from the community setting of India.

Abstract Background Indiscriminate and widespread use of antibiotics has resulted in emergence of many antibiotic-resistant organisms. Antibiotic administration during pregnancy is mostly avoided, unless there is compelling medical condition. We hypothesized that the uropathogens isolated from pregnant women would be more susceptible to antibiotics compared to those isolated from nonpregnant women, thus will be helpful in formulating separate empiric guideline for pregnant women based on the resistance pattern. Methods This was a prospective cross-sectional study conducted over a period of 2 years in which females with the clinical diagnosis of either cystitis or asymptomatic bacteriuria during pregnancy were included from the community settings. Uropathogen species and their antimicrobial resistance pattern were compared between the pregnant and nonpregnant groups. After accounting for centre-to-centre variation and adjusting for age and socio-economic status, the adjusted odds ratio for antibiotic resistance was calculated and compared between pregnant and nonpregnant women using logistic regression analysis. Results A total of 1758 women (pregnant: 43.3%; nonpregnant: 56.6%) were screened in the study over a period of 2 years, out of which 9.3% (163/1758) were having significant bacteriuria. Escherichia coli and Klebsiella pneumoniae were the two commonest uropathogen in both the groups; their prevalence being 83.6% in pregnant women and 85.2% in nonpregnant women, respectively. Resistance against ampicillin, cefixime, cefoxitin, ceftazidime, ceftriaxone and amoxicillin-clavulanic acid were found significantly lower in the pregnant women compared to nonpregnant. After adjusting the age and socio-economic status accounting for centre-to-centre variation, the odds of resistance for cefixime, amoxicillin-clavulanic acid and co-trimoxazole were found lower and statistically significant among the pregnant women group. Conclusions The antimicrobial resistance was significantly higher among the community-dwelling nonpregnant women compared to pregnant women in case of few antibiotics. The study highlighted the need of building local antibiogram that could help to initiate the empirical treatment and thus prevent emergence of antimicrobial resistance.