Objectives: Epstein-Barr virus (EBV) is associated with a broad spectrum of clinical conditions. However, real-world data on EBV DNA testing patterns and positivity across clinical settings remain limited. We evaluated testing trends, clinical indications, EBV-DNA positivity rates, and viral load distribution across major clinical groups in a tertiary-care setting. Materials and Methods: We retrospectively analyzed EBV DNA testing data from 404 patients tested using whole blood at a tertiary-care center in North India between 2024 and 2025. Viral loads were quantified by real-time polymerase chain reaction. Testing indications, detection rates, and viral load distributions were evaluated across clinical subgroups. Statistical analysis: Categorical variables were compared using the χ 2 test or Fisher’s exact test. Normality was assessed using the Shapiro-Wilk test, followed by the Kruskal-Wallis test for multiple comparisons of viral load data. Results: EBV DNA was detected in 25.50% of cases. The highest positivity rate (36.84%) was observed among patients with secondary immunodeficiency, all of whom were human immunodeficiency virus (HIV) positive. Lymphoproliferative disorders constituted the largest referral group (26.48%), followed by renal transplant recipients (12.62%). Median viral loads were highest among HIV-positive patients (1.67 × 10 5 copies/mL) and renal transplant recipients (1.26 × 10 5 copies/mL). Conclusion: EBV-DNA testing was requested across diverse clinical settings, extending beyond traditionally recognized high-risk populations such as transplant recipients and patients with immunodeficiency. HIV-positive individuals showed the highest observed positivity rate and median viral load. These findings provide a real-world overview of EBV-DNA testing patterns and EBV DNAemia across diverse clinical populations.
Recent studies highlight the role of Hippo signaling pathway molecules, particularly yes-associated protein (YAP) and kidney and brain expressed protein (KIBRA), in regulating podocyte homeostasis. The main objective of the study is to study the immunohistochemical expression of phosphorylated YAP (p-YAP) and KIBRA in podocytopathies and to correlate it with different clinico-pathological factors. The study included all histologically proven cases of focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) from January 2022 to September 2024. Clinical and pathological parameters were recorded. All cases were subjected to immunohistochemical staining for p-YAP. KIBRA immunostaining was performed in a subset of cases. Data were summarized using Microsoft Excel 2020. Comparisons between groups were made using the Mann-Whitney U Test. Pearson Chi-Square test was used to compare categorical variables. The study included 66 cases of FSGS and six cases of MCD. p-YAP immunohistochemistry was interpreted in 68 cases: 62 FSGS cases and six MCD cases. Among the FSGS cases, 42 cases had positive staining for p-YAP. No association of p-YAP staining was observed with different clinical and pathological features. KIBRA expression was observed in six of the eight cases tested. The presence of p-YAP staining in a significant proportion of FSGS cases raises a possible role of the Hippo signaling pathway, which was further strengthened by demonstration of KIBRA staining in a subset of such cases. Future studies should be planned to study a large cohort of proteinuric patients and explore the potential implications of the Hippo signaling pathway in such cases.
Meningiomas are the most common primary intracranial neoplasms. Most meningiomas arise in intracranial or intraspinal locations. Meningiomas involving the orbits are much rarer. They can be further classified as primary, of orbital origin or secondary, arising intracranially and extending into the orbit. Diagnosing meningiomas can be relatively easy on resection specimens with classic morphology; however, it can be difficult when tissue is received as smaller biopsies. This study aimed to describe the challenges faced in diagnosing meningiomas in unusual locations and on smaller tissue biopsies. This retrospective study from the pathology department of a tertiary care hospital describes a series of six cases of orbital meningioma diagnosed over a period of 2 years. Four of these cases were of primary orbital origin, and two were secondary. There was a wide variation in the age of the patients, ranging from 10–70 years. The male-to-female ratio was 4:2. We encountered diagnostic challenges in two cases because the histopathological features seen on smaller biopsies appeared to overlap with those of other tumors. Our article aims to share with pathologists and clinicians the characteristics of this rare location of meningiomas and apprise them about the various challenges faced in diagnosing such tumors, owing to their uncommon location, as well as when faced with smaller tissue biopsies with a lack of classical morphology. A combination of clinicopathological correlation and immunohistochemistry can be useful in overcoming these diagnostic hurdles.
Objectives: The rise of extended-spectrum beta-lactamase (ESBL) and AmpC beta-lactamase enzymes among Enterobacterales significantly limits therapeutic options in healthcare settings. Local surveillance is critical to guide empirical therapy. This study aimed to determine the prevalence, co-production, and clinical risk factors of ESBL and AmpC-producing Enterobacterales in a tertiary care hospital in Amritsar. Material and Methods: A prospective, laboratory-based surveillance study was conducted from January 2023 to June 2024. Clinical isolates of Enterobacterales ( n = 200) demonstrating resistance to third-generation cephalosporins (ceftazidime or cefotaxime) during routine antimicrobial susceptibility testing were evaluated. Phenotypic confirmation of ESBL production was performed using the Clinical and Laboratory Standards Institute combination disk method. AmpC enzyme production was determined via the cefoxitin-cloxacillin double-disk synergy test. Statistical analysis: Data were analyzed with IBM Statistical Package for the Social Sciences version 20, using frequency tables, Chi-square tests, and descriptive statistics, with significance set at p ≤ 0.05. Results: Among the 200 cephalosporin-resistant Enterobacterales strains evaluated, ESBL production was phenotypically confirmed in 160 isolates (80%), AmpC beta-lactamase was detected in 77 isolates (38.5%), while co-production of both was observed in 72 strains. A history of invasive devices or clinical procedures was significantly associated with both ESBL, AmpC, and ESBL-AmpC co-production ( p = 0.013, 0.005, and 0.002, respectively). The remaining 38 screening-positive, unconfirmed strains likely represent alternative, nonenzymatic resistance mechanisms such as outer membrane porin loss or efflux pump upregulation. Conclusions: This study demonstrates a high institutional prevalence of ESBL and AmpC co-production among clinical Enterobacterales isolates, strongly associated with invasive procedures. In resource-limited settings lacking molecular diagnostics, routine phenotypic screening using simple, cost-effective methods is essential to optimize clinical treatment and antimicrobial stewardship
Proenkephalin A 119–159 (PENK/penKid) is a circulating peptide increasingly investigated as a functional biomarker of glomerular filtration and acute kidney dysfunction. This integrative review critically examines diagnostic, prognostic, analytical, and implementation evidence relevant to laboratory medicine. A structured search of MEDLINE/PubMed, Embase, Web of Science, Scopus, and Cochrane CENTRAL covered January 2009–2026 and was complemented by a targeted PubMed/MEDLINE search through July 31, 2026. Diagnostic-performance metrics were extracted only when explicitly reported. Across 11 observational studies included in a 2023 meta-analysis, PENK showed pooled sensitivity of 0.69, specificity of 0.76, and summary receiver operating characteristic area under the curve of 0.77 for acute kidney injury, with substantial heterogeneity and a pooled optimal threshold of 57.3 pmol/L. More recent studies demonstrate marked scenario dependence, including high negative predictive value in selected perioperative and transplantation settings but variable specificity and positive predictive value. Circulating PENK is strongly influenced by glomerular filtration itself; advanced chronic kidney disease, dialysis status, hemodynamic instability, sepsis, and cardiovascular comorbidity complicate interpretation. Analytical studies support favorable sample stability and serum/plasma comparability for specific assay formats, whereas biological-variation data remain limited and cross-platform harmonization is incomplete. PENK should therefore be interpreted as a functional and risk-stratification biomarker rather than assumed to be a stand-alone diagnostic test. Its most credible current role is complementary to creatinine and, where appropriate, injury/stress biomarkers, pending multicenter validation of standardized assays, cut-offs, sampling windows, and biomarker-guided clinical pathways.
