Cells In Smears Research Articles

Nonneoplastic Cervical Cytology.

Diagnostic cytology of cervix can be made strong if normal cytology is known thoroughly. Cervical lining comprises three layers of squamous cells, the basal, intermediate, and superficial cells. Knowing the dimensions of these cells, especially the intermediate cells, helps to diagnose the squamous intraepithelial lesions accurately. Furthermore, recognizing the parabasal cells in the menopausal smears, either singly or as syncytial aggregates, is important to avoid overdiagnosis of squamous intraepithelial lesions. The other cell type in the cervical lining is the endocervical glandular epithelium. Exfoliated endocervical cells may at times resemble endometrial glandular cells. The morphology and differences between these two cell types have been highlighted. It is essential to recognize and report endometrial cells in women of 40 years and above according to the recent Bethesda System for Reporting Cervical Cytology. The squamous epithelium of cervix and vagina is highly sensitive to estrogen and progesterone hormones. Hence, the Pap smears, if desired, can help in evaluating the hormonal status of the woman. The ratio of parabasal, intermediate, and superficial squamous cells can help in calculating various maturation indices.

Гематологічні показники у пацієнтів із ішемічною хворобою серця в критичному стані

The purpose of the study was to investigate and evaluate the data of hematological studies in women and men with ischemic heart disease in critical condition. Materials and methods. The results of examination of 14 patients with ischemic heart disease in critical condition, who will be hospitalized for approximately the same period of time in the intensive care unit of the cardiology department of the Municipal Non-Profit Enterprise of Kharkiv City Council "Regional Clinical Hospital" were included in the study. The patients included 7 women and 7 men aged 38 to 60 years who were diagnosed with acute myocardial infarction at the clinic. Laboratory tests were performed at the time of hospitalization and after 3–4 consecutive days in the dynamics of treatment. Morphological evaluation of blood cells in a blood smear and quantitative indicators were included in hematological examination and were determined on a hematological analyzer ABX MICROS 60 OT (France). Results and discussion. The study found that women had an increase in white blood cell count, hemoglobin concentration an average and mean erythrocyte hemoglobin increases at the time of hospitalization. Increase in the number of leukocytes, decrease in hemoglobin and erythrocytes were found in men. On the dynamics of treatment for 3–4 days, the number of leukocytes in women decreased by almost 1.4 times compared to the data time of hospitalization, while in men — only by 1.02 time, 4 out of 7 men even had an increase in leukocytes. The number of erythrocytes, the concentration of hemoglobin in females has changed a lot, and the MCN indicator has dropped to the same level. The number of erythrocytes and hemoglobin concentration almost did not change in men. Conclusion. In women and men with ischemic heart disease in a critical condition some differences in hematological parameters were noted. It must be taken into account based on the principles of 4P therapy. Inflammation, according to leukocytosis, was higher in women at the time of hospitalization, but after treatment the reduction was more significant than in men. The numbers of erythrocytes, hemoglobin concentration, erythrocyte index of mean erythrocyte hemoglobin were slightly higher in women than in men. These indicators were mostly reduced in men. Received results show that an increase in procoagulant status was more characteristic for women, and the development of an anemic state was more typical for men. On days 3–4, complete recovery of hematological parameters have not yet occurred, the exception was a slight decrease in the number of leukocytes. This indicates a decrease in the intensity of inflammation. Prospects of further researches. The obtained results of hematological studies of critically condition of patients with ischemic heart disease confirm the importance of laboratory tests for the timely identification of the risk of complications and monitoring the state and prognosis of the disease in men and women

Improving cervical cancer classification with imbalanced datasets combining taming transformers with T2T-ViT.

Cervical cell classification has important clinical significance in cervical cancer screening at early stages. However, there are fewer public cervical cancer smear cell datasets, the weights of each classes’ samples are unbalanced, the image quality is uneven, and the classification research results based on CNN tend to overfit. To solve the above problems, we propose a cervical cell image generation model based on taming transformers (CCG-taming transformers) to provide high-quality cervical cancer datasets with sufficient samples and balanced weights, we improve the encoder structure by introducing SE-block and MultiRes-block to improve the ability to extract information from cervical cancer cells images; we introduce Layer Normlization to standardize the data, which is convenient for the subsequent non-linear processing of the data by the ReLU activation function in feed forward; we also introduce SMOTE-Tomek Links to balance the source data set and the number of samples and weights of the images we use Tokens-to-Token Vision Transformers (T2T-ViT) combing transfer learning to classify the cervical cancer smear cell image dataset to improve the classification performance. Classification experiments using the model proposed in this paper are performed on three public cervical cancer datasets, the classification accuracy in the liquid-based cytology Pap smear dataset (4-class), SIPAKMeD (5-class), and Herlev (7-class) are 98.79%, 99.58%, and 99.88%, respectively. The quality of the images we generated on these three data sets is very close to the source data set, the final averaged inception score (IS), Fréchet inception distance (FID), Recall and Precision are 3.75, 0.71, 0.32 and 0.65 respectively. Our method improves the accuracy of cervical cancer smear cell classification, provides more cervical cell sample images for cervical cancer-related research, and assists gynecologists to judge and diagnose different types of cervical cancer cells and analyze cervical cancer cells at different stages, which are difficult to distinguish. This paper applies the transformer to the generation and recognition of cervical cancer cell images for the first time.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11042-022-12670-0.

Evaluation of the Cytology and Histology of Uterus and Cervix as Predictors of Estrous Stages In Ewes and Dairy Cows

The aim of this study was to describe in ewes and dairy cows, uterine, cervical and vaginal aspect in a physiological context, using cytological and histological techniques as a gold standard. Reproductive tracts of slaughtered cows and ewes were collected from a commercial slaughterhouse in the region of batna. The reproductive phase of each tract was estimated by ovarian performance. Cytobrush samples from the uterus and cervix were prepared. The smears were stained and examined for differential cellular counts. Furthermore, biopsy samples fixed in 10% buffered formaldehyde, embedded in paraffin, sectioned and stained with hematoxylin and eosin. The results showed no significant difference (P≥0.05) for cellular densities between cervical and uterine in different phases of estrus cycle (follicular and luteal phases) of the ewes and cows. However, there were significant differences in the percentage of neutrophil cells of uterine and cervix smears in tracts with a corpus luteum (CL) or without a CL. in spite of, the following histological changes were observed during the estrous cycle in cows and ewes. Histological examination was a useful diagnostic method that provided rich detail on endometrial inflammation, and allowed evaluation of different components of the tissue such as the epithelium, lamina propria, endometrial glands, and blood vessels. Therefore, in cows and ewes cervical smears may be used for evaluation of uterine condition.

Comparative staining of Rhinolophus spp. white blood cells in blood smears.

Background and Aim:A drawback of studies on bat blood smears in the field is the lack of time for fixation because blood sampling using a non-lethal method often provides less time for fixation in smear preparations due to the small volume of blood collected. Usually, there is insufficient blood for another smear preparation, so it is necessary to use blood smears as rationally as possible, especially for rare bats. Many stains are used for staining peripheral blood smears, and they have advantages and disadvantages. This study aimed to examine commonly used stains for blood smears to select the best stain for staining peripheral blood smears in bats.Materials and Methods:In this study, 48 blood smears of Rhinolophus spp. bats were examined using several blood staining methods. Four methods that showed the best results were used in further experiments: Romanowsky-Giemsa, Pappenheim, hematoxylin-eosin, and eosin methylene blue.Results:Comparative analysis of different methods for staining bat blood smears revealed that the most convenient method for analyzing blood cells is Pappenheim method.Conclusion:Staining blood smears using Pappenheim method yield the least number of unsuccessful blood smear stains and are quite effective for the morphological analysis of blood cells.

Establishment of morphological reference values for the differential count of white blood cells in peripheral blood smear, as well as nucleated cells and megakaryocytes in bone marrow smear

Objective: To establish the morphological reference values for the differential count of white blood cells in peripheral blood smear as well as nucleated cells and megakaryocytes in bone marrow smear. Methods: From April 2012 to June 2020, 4 221 healthy donors for hematopoietic stem cell transplantation in Hebei Yanda Lu Daopei Hospital were selected. The median age was 36 (3-72) years old, including 2 520 males and 1 701 females. They were divided into four groups according to age: children group, with age≤14 years old [n=334, 11 (3-14) years old], youth group, with age >14 years old and <45 years old [n=2 855, 33 (15-44) years old], middle-aged adult group, with age ≥45 years old and < 60 years old [n=929, 49 (45-59) years old], and older adult group, with age ≥60 years old [n=103, 62 (60-72) years old]. Gender subgroups were established in each age group. According to different hematopoietic characteristics, the children group were divided into two subgroups: children group 1 [n=48, 6 (3-7) years old] and children group 2 [n=286, 11 (8-14) years old]. According to the clinical routine, 100 white blood cells in peripheral blood, 200 nucleated cells in bone marrow, and cell numbers/4.5 cm2 for megakaryocytes were classified and counted. The results of cell count in different age and gender groups were compared, and the reference values of morphological classification were established for different groups with statistical or clinical significance. Results: Due to the existence of statistically significant differences between children and adult groups and different gender subgroups in adults (all P<0.05), the reference values were established for children group and adult gender subgroups. The counts of segmented neutrophils and lymphocytes in peripheral blood were 46.65(43.97-49.32)% and 44.00(10.60-65.10)% in children group 1, 50.73(49.50-51.96)% and 39.55 (38.36-40.74)% in children group 2, and 57.00 (39.00-75.23) % and 33.00 (17.00-52.00) % in adult group, respectively. Bone marrow segmented neutrophils, orthochromatic erythroblasts, and mature lymphocytes were 11.54 (10.68-12.41)%, 14.20 (13.19-15.21)%, and 23.99 (22.06-25.92)% in children group 1, 12.50 (7.00-21.50)%, 15.00(9.50-25.50)%, and 21.02 (20.24-21.81)% in children group 2, 13.50 (7.50-21.00)%, 16.50 (10.50-26.00)%, and 15.50 (7.50-26.00)% in adult male group, and 14.50 (8.00-24.50)%, 14.50 (9.00-23.00)%, and 17.50 (8.50-29.00)% in adult female group, respectively. The myelopoiesis/erythropoiesis ratio in children group, adult male group and adult female group was 1.86∶1 (1.14∶1-3.23∶1), 1.96∶1 (1.12∶1-3.19∶1), 2.22∶1 (1.30∶1-3.69∶1), respectively. The numbers of granular megakaryocytes and thromocytogenic megakaryocytes were 138 (25-567) cells/4.5cm2 and 86 (13-328) cells/4.5 cm2 in children group, and 92 (13-338) cells/4.5 cm2 and 38 (3-162) cells/4.5 cm2 in adult group, respectively. Conclusion: The morphological reference values for the differential count of white blood cells in peripheral blood smear as well as nucleated cells and megakaryocytes in bone marrow smear are successfully established, which is helpful to improve the application of morphological examination in disease screening, diagnosis and monitoring.

POS-890 SECONDARY HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS SYNDROME REVEALING PLASMA-CELL LEUKEMIA IN A COVID-19 PATIENT PRESENTING WITH KIDNEY INJURY

Plasma cell leukemia (PCL) is a rare, but very aggressive, plasma cell dyscrasia defined by an increased percentage of circulating plasma cells (>20%) and/or absolute number (>2 × 109/l) of plasma cells in the peripheral blood smear. In this pandemic COVID-19, we report the first case of secondary hemophagocytic lymphohistiocytosis (sHLH) syndrome revealing PCL in women affected by SARS- CoV-2 with severe Kidney failure.

Dietary alpha‐linolenic acid reduces platelet activation and collagen‐mediated cell adhesion in sickle cell disease mice

BackgroundSickle cell disease (SCD) is a genetic hemoglobinopathy associated with high morbidity and mortality. The primary cause of hospitalization in SCD is vaso‐occlusive crisis (VOC), mediated by alteration of red blood cells, platelets, immune cells and a pro‐adhesive endothelium. ObjectivesWe investigated the potential therapeutic use of the plant‐derived omega‐3 alpha‐linolenic acid (ALA) in SCD. MethodsBerkeley mice were fed a low‐ or high‐ALA diet for 4 weeks, followed by analysis of liver fibrosis, endothelial activation, platelet activation and formation of platelet‐neutrophils aggregates. Aggregation of platelets over collagen under flow after high‐ALA was compared to a blocking P‐selectin Fab. ResultsDietary high‐ALA was able to reduce the number of sickle cells in blood smear, liver fibrosis, and the expression of adhesion molecules on the endothelium of aorta, lungs, liver and kidneys (VCAM‐1, ICAM‐1 and vWF). Specific parameters of platelet activation were blunted after high‐ALA feeding, notably P‐selectin exposure and the formation of neutrophil‐platelet aggregates, along with a correspondingly reduced expression of PSGL‐1 on neutrophils. By comparison, in vivo treatment of SCD mice with the anti‐P‐selectin Fab was able to similarly reduce the formation of neutrophil‐platelet aggregates, but did not reduce GpIbα shedding nor the activation of the αIIbβ3 integrin in response to thrombin. Both ALA feeding and P‐selectin blocking significantly reduced collagen‐mediated cell adhesion under flow. ConclusionsDietary ALA is able to reduce the pro‐inflammatory and pro‐thrombotic state occurring in the SCD mouse model and may represent a novel, inexpensive and readily available therapeutic strategy for SCD.

Cell HE staining smears and paired cell paraffin sections in detection of epithelial growth factor receptor gene of pleural fluid specimens.

The advanced non-small cell lung cancer (NSCLC) patients with pleural effusion have no opportunity for surgery treatment. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are the first-line drugs for these patients with EGFR-sensitive mutation. However, the disease progression and drug update during or after treatment of EGFR-TKIs bring more challenges and puzzles to clinical diagnosis and treatment, which inevitably requires archived pleural cell samples for EGFR re-examination or comparative study. Understanding the DNA quality of archived pleural fluid samples and effectively using archival data of pleural fluid cells are of great significance for tracing the origin of cases and basic medical research. This study aims to evaluate the consistency of EGFR mutant gene expression between the 2 methods, and to explore a reliable way for preserving cytological data and making full use of cytological archival data via cell HE staining smear and cell paraffin section. A total of 57 pleural fluid cytology cases in the Department of Pathology of China Aerospace Center Hospital from October 2014 to April 2021 were selected. Tumor cells were detected by cell HE staining smears and immunohistochemical staining for TTF-1 and Napsin A in the paired cell paraffin sections. There were more than 200 tumor cells in cell HE staining smear and the proportion of tumor cells were ≥70% in matched cell paraffin sections. Patients with 2 cell smears (one for cell data retention and the other for DNA extraction) were selected as the research subjects, and 57 pleural fluid samples were enrolled. EGFR gene mutation was detected by amplification refractory mutation system-polymerase chain reaction in 57 paired cell HE staining smears and cell paraffin sections. DNA concentration was 2 ng/μL. Cell HE smear was amplified side-by-side with DNA samples from paired cell paraffin sections. Result determination was according to the requirements of the reagent instructions. The external control cycle threshold (Ct) value of the No. 8 well of the samples to be tested was between 13 and 21, which was considered as successful and reliable samples. When the Ct value of EGFR gene mutation was <26, it was considered as positive; when the Ct value was between 26 and 29, it was critical positive; when the Ct value was equal or more than 29, it was negative. ΔCt value was the difference between mutant Ct value and externally controlled Ct value. The smaller the ΔCt value was, the better the quality of DNA of the detected sample was. Among the 57 pleural effusion samples, 42 patients were hospitalized with pleural effusion as the first symptom, accounting for 73.7% (42/57). EGFR mutation was detected in 37 samples [64.9% (37/57)]. The mutation rate for 19del was 37.8% (14/37) while for L858R was 48.6% (18/37). Females were 56.7% (21/37) of mutation cases. The mutation consistency rate of cell HE staining smear and matched cell paraffin sections was 100%. The ΔCt values of cell HE staining smears were less than those of matched cell paraffin sections. The mutation Ct values of 37 cytological samples were statistically analyzed according to the preservation periods of the years of 2014-2015, 2016-2017, 2018-2019, and 2020-2021. There were significant differences in cell paraffin section in the years of 2014-2015 and 2016-2017 compared with the years of 2018-2019 and 2020-2021, while no significant differences were found in cell HE staining smear. Statistical analysis of externally controlled Ct values of 57 cytological samples showed that there were significant differences between cell HE staining smears and cell paraffin section in the years of 2014-2015 and 2016-2017, compared with the years of 2018-2019 and 2020-2021. The mutational Ct values of 37 paired cell blocks and smears were all <26, and the externally controlled Ct values of 57 paired cell paraffin sections and HE staining smears were all between 13 and 21. The DNA quality of cell HE smears and matched cell paraffin section met the qualified requirements. Two methods possess show an excellent consistency in detecting EGFR mutation in NSCLC pleural fluid samples. The DNA quality of cell HE staining smear is better than that of cell paraffin sections, so cell HE staining smear can be used as important supplement of the gene test source. It should be noted that the limitation of cell HE staining smears is non-reproducibility, so multiple smears of pleural fluid are recommended to be prepared for multiple tests.

A New Method for the Sputum Cytology Test Without Direct Contact to Specimens During COVID-19 Pandemic.

BackgroundCoronavirus disease 2019 (COVID-19) pandemic continues to spread across the world. Specimens of blood, body fluids and excreta received in the department of pathology undoubtedly increased the risk of infection, especially in some hospitals that are short of professional protection capability. Here we provided a new simple way for the sputum cytology test during the COVID-19 pandemic.MethodsSputum samples from 30 patients with lung cancer were collected and divided into two groups, including the control group and the experimental group. Samples of the control group were processed in the biological safety cabinet, while the experimental group was put into the sealed specimen bag directly and pretreated with 75% medical alcohol. Then the cell morphology and tumor cell identification were analyzed by cell smears and liquid-based cell staining. The expression of cell antigens was determined by immunohistochemical staining.ResultOur result showed that both sputum samples in two groups exhibited complete cell structure and clear morphology according to the cell smear and liquid-based cell staining. In addition, the immunohistochemical result showed that cell antigens, including cytokeratin (CK), leukocyte common antigen (LCA), and thyroid transcription factor-1 (TTF1), were specifically expressed in the cell membrane, cytoplasm, and nucleus, respectively. The tumor cells were distributed diffusely, and cell antigens were located accurately after pretreatment with 75% medical alcohol and were consistent with that of the control group.ConclusionUsing 75% medical alcohol to pretreat sputum specimens has no obvious impact on cell morphology and antigens expression. Our study provided a new method for the sputum cytology test with no direct contact so as to protect medical staff against the virus during COVID-19 outbreak.

WBC-AMNet: Automatic classification of WBC images using deep feature fusion network based on focalized attention mechanism.

The recognition and classification of White Blood Cell (WBC) play a remarkable role in blood-related diseases (i.e., leukemia, infections) diagnosis. For the highly similar morphology of different WBC subtypes, it is too confused to classify the WBC effectively and accurately for visual observation of blood cell smears. This paper proposes a Deep Convolutional Neural Network (DCNN) with feature fusion strategies, named WBC-AMNet, for automatically classifying WBC subtypes based on focalized attention mechanism. To obtain more localized attention of CNN, the fusion features of the first and the last convolutional layer are extracted by focalized attention mechanism combining Squeeze-and-Excitation (SE) and Gather-Excite (GE) modules. The new method performs successfully in classifying monocytes, neutrophils, lymphocytes, and eosinophils on the complex background with an overall accuracy of 95.66%, better than that of general CNNs. The multi-classification accuracy of WBC-AMNet with the background segmentation is over 98% in all cases. In addition, Gradient-weighted Class Activation Mapping (Grad-CAM) is employed to visualize the attention heatmaps of different feature maps.

Extraction and Separation of Overlapped Squamous Cell Cytoplasm with Disjoint Nuclei in Cervical Pap Smear Image

The automated analysis of Papanicolaou (Pap) smear images is a challenging issue due to the occlusion of cells. The feature extraction and interpretation depend on the accuracy of cell segmentation. This is important to find the difference between normal and abnormal cells. However, most of the time complications are due to overlapping in the Pap smear cells. The overlapping can be in nuclei regions or cytoplasmic regions or sometimes both the regions. There are two types of cells found in Pap smear images – Columnar and Squamous cells. Most of the time abnormalities are found in squamous cells which in turn may lead to cervical cancer. Hence, this work concentrates on the separation of squamous cells in which cytoplasmic regions are overlapped with disjoint nuclei regions. The main objective of this work is to identify the intersecting points where cytoplasmic regions of two cells meet, called Concavity points, which are calculated using a scope of points along the cytoplasmic boundary of the cells, and separating the cells along with these concavity points.

Analysis of laryngeal brush biopsy-based cytology results in patients of the 4th Military Teaching Hospital and Polyclinic in Wrocław in years 2019-2020.

&lt;b&gt;Introduction:&lt;/b&gt; Cytological examination of exfoliated epithelial cells of the uterine cervix, oral cavity, or rectum has been successfully used in the diagnostics of pathological conditions of these organs for many years. In these cases, the test material is collected from the available regions. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Aim:&lt;/b&gt; The aim of the study consisted in the analysis of cytological smears of laryngeal epithelial cells from patients hospitalized at the Department of Otolaryngology, Head and Neck Surgery of the 4th Military Teaching Hospital and Polyclinic in Wrocław in years 2019-2020. The analysis was aimed at demonstrating whether representative laryngeal epithelial material could be obtained from brush biopsies. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Material and methods:&lt;/b&gt; The study was carried out in 92 subjects aged between 26 and 85 years, including 34 women (37.0%), from whom material for cytological examination had been collected from the larynx in the course of microsurgical procedures carried out using the Kleinsasser laryngeal instrument set in 2019-2020. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results: &lt;/b&gt;Analysis was performed on 90 out of 92 cell smears (97.8%). Two smears were not qualified for analysis due to ille-gibility. The smears were assessed using a proprietary scale consisting in a modification of the Bethesda system. Abnormal results of cytological examinations were obtained in a majority of cases. HSILs with invasive features were the most common abnormal results of cytological examinations. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusions:&lt;/b&gt; Laryngeal epithelial cells can be successfully evaluated by means of cytological examination. Abnormal presen-tation of cytological smear is frequently hypercellular, with inflammatory cells being observed less frequently. No statistically significant relationship was observed between the results of the cytological examination and the overall quality of the smear, number of cells, number of erythrocytes, or the severity of inflammation.

Diagnosis of Pleural Fluid Effusions by Cell Block and Pleural Biopsy - A Comparative Study.

Cytological smear and cell block are commonly used to diagnose pleural fluid effusion. However, there is a paucity of information in the literature where a comparison between a cytological smear and a cell block with corresponding pleural biopsy has been done. This study aimed to evaluate the accuracy of cytological smears, cell blocks, and pleural biopsy for the diagnosis of malignant tumors. In this cross-sectional study, analysis of successive pleural fluid samples received by the department was done. The sample was divided into equal halves of 5 ml each. One was used for conventional smear and the second was used for the preparation of cell block. The cell block was prepared by centrifuging the specimen of fluid at 2500 rpm for 15 min. A pleural biopsy was obtained by using Cope's pleural biopsy needle. A total of n = 50 cases were included in the study. A total of n = 8 cases were diagnosed as malignant by cell smear and n = 4 cases were suspicious for malignancy. By cell block, n = 10 cases of malignancy were diagnosed and n = 1 case was suspicious for malignancy. By biopsy, n = 11 cases were diagnosed as malignant and n = 1 case was suspicious for malignancy. Out of the total, n = 2 cases were diagnosed as squamous cell carcinoma by biopsy; one case was diagnosed by cell block; and the other was reported as suspicious for malignancy. The study shows that cell blocks are complementary to the cell smear technique in over diagnosis and categorization of benign as well as malignant cells. The cell blocks were more useful in the diagnosis of malignancy because of better preserved architectural patterns as seen in corresponding histopathology sections. It, therefore, appears that the cell blocks are a perfect fit to bridge the cytology and histopathology.

Identification of Candida colliculosa in an oral ulcer of a pediatric hematological patient

INTRODUCTION: Candida colliculosa is a yeast of food origin classified as Non-Albicans Candida (NAC), with its pathogenic potential confirmed, but little known. Like other opportunistic infections, diseases caused by NAC species are most commonly found in immunosuppressed patients. OBJECTIVES: The objective of this work is to report the case of a pediatric patient who developed an atypical lesion associated with Candida colliculosa in the mouth. CASE REPORT: A 9-year-old boy under chemotherapeutic treatment for Acute Myeloid Leukemia developed edema in the lower lip, with a persistent crusted ulcer circumscribed by an erythematous, painless, and progressing negatively. He was using antibiotics, antifungals, antiemetics, and antihistamines. RESULTS: It was decided to perform complementary exams for final diagnosis. Cell smears were collected for exfoliative cytology, direct mycological, bacterial and viral culture, and fungi investigation. No viruses and bacteria were identified. A direct mycological examination showed yeast cells without pseudohyphae and a Maldi-TOF technique confirmed the diagnosis of Candida colliculosa. FINAL CONSIDERATIONS: The use of antifungal agents associated with the patient's immunological recovery led to the complete healing of the lesion and hospital discharge. Identification of the fungal species was important not only to establish the diagnosis and most appropriate treatment but also to avoid the fungus spreading in the hospital environment.

Effects of favipiravir on hematologic parameters and bone marrow in the rats

Favipiravir, a selective RNA polymerase inhibitor agent, is an antiviral drug currently used effectively in treating pandemic diseases such as Covid-19. The present study aims to determine the effects of favipiravir use on bone marrow and blood cells. Twelve male Wistar rats were divided into two groups, namely control and favipiravir groups. Physiological saline at a dose of 1 ml/kg was administered to the rats in the control group by oral gavage for 10 days. Rats in the favipiravir group were administered favipiravir by oral gavage at a dose of 200 mg/kg for 10 days. At the end of the study, the blood tissue was collected from the heart, and bone marrow samples were collected from the femur bone of the rats sacrificed under anesthesia. The hematologic parameters in the blood samples obtained were measured using an auto-analyzer device with the help of rat compatible kits. Bone marrow cell counts were performed by examining structural changes and myeloid and erythroid cell series in the smear samples. The results obtained in the study revealed that favipiravir use caused a decrease in the counts of some hematologic parameters containing erythrocytes, lymphocytes, and monocytes. In addition, it was determined that the ratio of myeloid and erythroid cells in bone marrow smears changed significantly with the use of favipiravir. It was concluded that treatment with favipiravir caused suppression of erythrocyte and some leukocyte series. The suppressor effects were also determined in bone marrow cell series in the rats.

Urotelial cells in cytopathological cervical smear: Case report with literature review

Urotelial cells in cytopathological cervical smear: Case report with literature review

Leukemia Cutis

Leukemia cutis is an infiltration of the skin by myeloid or lymphoid neoplastic leukocytes resulting in clinically identifiable cutaneous lesions. It may follow, precede, or occur concomitantly with the diagnosis of systemic leukemia. A 55-year-old female patient was a known case of acute myeloid leukemia (AML) and was on palliative chemotherapy. She presented to the Department of Dermatology with sudden-onset nodules over the chest and abdomen which were multiple, nontender and firm in consistency. Histopathological examination from the nodule over the abdomen suggested leukemic infiltration of the skin and repeat hemogram showed reappearance of blast cells in the peripheral smear, consistent with a diagnosis of leukemia cutis with relapsed AML. The case has been reported for its rarity and poor prognosis associated with its presentation.

Clinical Significance of Endometrial Cells in Pap Smear of Women Aged 40 Years and Older.

To investigate the histopathological follow-up results in women diagnosed with endometrial cells in the Papanicolaou (Pap) test. Between January 2013 to December 2018, women with endometrial cells on the Pap test were searched from the hospital electronic database. The patients with endometrial cells on the Pap test who underwent further histopathological evaluation and who were followed-up for at least 1 year were enrolled in the study, while those who had a Pap test result other than endometrial cells, were lost during follow-up, or had missing data were excluded. Out of 91,142 Pap smears, 121 (0.1%) cytologically had endometrial cells, and of those 65 cases were eligible for final analysis. The mean age of patients with premalignant/malignant lesions (57.7 ± 2.9) was higher than those with benign lesions (50.1 ± 0.7), with 77% of them in the postmenopausal period. Gynecologic premalignant/malignant lesions were detected in 9 (17.7%) patients including 2 (3.1%) endometrial hyperplasias and 7 (10.8%) endometrial cancers. The menopausal status (p=0.010) and being 50 years and older (p=0.002) were significantly associated with pre-neoplastic or neoplastic changes in patients with endometrial cells. The presence of endometrial cells in Pap tests may be a harbinger of endometrial pathologies, especially at the age of 50 years and over. The menopausal status is another possible determinant in detecting endometrial carcinoma. Further investigation may be suggested in women aged ≥50 years and postmenopausal in the event of endometrial cell detection.

Bloody Diarrhea and Shiga Toxin Screening

Source: Ardissino G, Vignati C, Masia C, et al. Bloody diarrhea and Shiga toxin-producing Escherichia coli hemolytic uremic syndrome in children: data from the ItalKid-HUS network. J Pediatr. 2021; 237:34-40. e1; doi: 10.1016/j.jpeds.2021.06.048Investigators from multiple institutions conducted an analysis of data from a screening program for Shiga toxin (Stx) in children with bloody diarrhea. The screening program was developed for identification of children with Shiga toxin-Escherichia coli (STEC) infection for early diagnosis of STEC hemolytic uremic syndrome (STEC-HUS) by the ItalKid-HUS Network. The network includes 63 pediatric units in Northern Italy. Stool samples in children with acute bloody diarrhea were tested for Stx genes (Stx1 and Stx2). Patients who were Stx gene positive were monitored for hemoglobinuria as an early sign of STEC-HUS. Main study outcomes included rate of Stx positivity among children with bloody diarrhea and development of STEC-HUS. Criteria for a diagnosis of STEC-HUS were platelet count <150,000 mm3 or 50% acute reduction in platelet count, non-immune-mediated hemolysis, and evidence of renal damage (elevated serum creatinine [Cr], proteinuria, or hematuria). The utility of hemoglobinuria as a sign of STEC-HUS in children with Stx gene-positive bloody diarrhea was determined. Finally, the analysis also included children diagnosed with ongoing STEC-HUS who were not screened for Stx. Laboratory findings and long-term adverse outcomes (chronic kidney disease [CKD], extrarenal sequelae, or death) in children diagnosed through the screening program were compared to those diagnosed with ongoing STEC-HUS with chi square tests.A total of 4,767 children with bloody diarrhea were screened for the Stx gene from 2010 through 2019. The median age of these children was 3.4 years. Among the 4,767 patients screened, 214 (4.5%) were positive for Stx, including 62 with Stx1, 97 with Stx2, and 55 with both genes. In the 214 children who were Stx positive, 34 developed STEC-HUS (15.9% of Stx positive patients and 0.71% of screened children with bloody diarrhea). All of those who developed STEC-HUS were positive for Stx2. Overall, the risk of STEC-HUS was 0% for those with Stx1, 23.7% for those with Stx2, and 12.7% for those with both. In 63 patients with Stx2 who were screened, the sensitivity of hemoglobinuria as a marker for STEC-HUS was 100% (95% CI, 95%, 100%). specificity was 85% (95% CI, 77%, 91%), positive predictive value was 68% (95% CI, 55%, 79%), and negative predictive value was 100% (95% CI, 93%, 100%). There were an additional 95 children diagnosed with ongoing STEC-HUS. These children had a significantly higher Cr at HUS diagnosis than those identified through the screening program; the rate of long-term adverse outcomes was 15.8% in these patients vs 2.9% in those screened (P = 0.051).The authors conclude that 0.71% of children with bloody diarrhea who were screened for Stx developed STEC-HUS.Dr Rosenthal has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Bloody diarrhea dictates an evaluation of its cause. Among the most common causes in Western countries, STEC has been associated with HUS.1 The current researchers screened 4,767 children with bloody diarrhea for Stx; 214 were positive for Stx genes; 62 with Stx1, 97 with Stx2, and 55 with both genes. Notably, STEC-HUS developed only in children with Stx2 alone or in combination. In 63 patients with Stx2 who were screened, the sensitivity of hemoglobinuria as a marker for STEC-HUS was 100%.HUS is associated with a nonimmune hemolytic anemia, low platelet count, renal impairment, and multiorgan injury.1 The anemia is severe and microangiopathic, with fragmented red blood cells in the peripheral smear, circulating free hemoglobin, and elevated reticulocytes. Platelet count is <60,000/mm3 in most cases. Acute renal failure occurs in 55-70% of cases.2In 70% of cases in North America, STEC-HUS is secondary to infection with the E. coli serotype O157:H7.3 This serotype does not ferment sorbitol, making it distinguishable from most other fecal E. coli.4Unfortunately, there is no treatment of confirmed value for STEC-HUS, and care during the acute phase of the illness remains supportive. The use of antibiotics is controversial.5What have we learned from the current report? Among children with bloody diarrhea, STEC-HUS occurred only in those with Stx2 alone or in combination with Stx 1. Monitoring STEC patients with Stx2 with urine dipstick for hemoglobinuria can aid in recognizing renal complications early to optimize supportive care.Screen patients with bloody diarrhea for Stx, and if Stx2 positive, monitor for hemoglobinuria.STEC-HUS remains the leading cause of acute kidney injury in young children.6 Of import, early administration of intravenous fluids after timely diagnosis of STEC infection (sought by the current investigators) appears to decrease disease severity. (See AAP Grand Rounds. 2016;[5]:50.)6