Microscopic Examination Of Smears Research Articles

NURSING CARE FOR PATIENTS WITH LEPROSY TREATED BY PRIMARY CARE: INTEGRATIVE REVIEW

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Its predilection for the skin and peripheral nerves gives this disease particular characteristics, making its diagnosis simple. Brazil continues to be the second country in the world in terms of the number of cases, after India. Approximately 94% of known cases in the Americas and 94% of newly diagnosed cases are reported in Brazil. The disease manifests itself in two stable and opposing poles (virchowian and tuberculoid) and two unstable groups (indeterminate and dimorphic). In another classification, the disease is divided into tuberculoid, borderline or dimorphic forms, which are divided into dimorphic-tuberculoid, dimorphic-dimorphic and dimorphic-lepromatous and lepromatous forms. Microscopic examination of smears is the most useful complementary test for diagnosis. Treatment of leprosy includes: specific chemotherapy, suppression of reactive eruptions, prevention of physical disability, physical and psychosocial rehabilitation. Polychemotherapy based on rifampicin, dapsone and clofazimine has proven to be very effective and the prospects for controlling the disease in Brazil are real in the short term.

Assessment and correction of local antimicrobial protection factors in women with chronic recurrent vulvovaginal candidiasis and type 2 diabetes mellitus

Aim. Evaluation and correction of local antimicrobial protection factors in women with type 2 diabetes mellitus (DM 2) and chronic recurrent vulvovaginal candidiasis (rVVC). Materials and methods. The study involved 100 women undergoing outpatient follow-up at the age of 40.9±5.8 years, with a body mass index of 29.8±3.5. The period was 2022–2023. The examination included anamnesis, collection of anthropometric data, calculation of body weight, microscopic examination of smears from the cervical canal and vagina, Gram-stained before treatment, in the 1st and 3rd months after its completion, identification pathogenic microorganisms using PCR, colposcopy, ultrasound of the pelvic organs. Indicators of glycosylated hemoglobin in the subjects at the control points of the study: at 1 month the average values were 5.9±2.9%, at 3 months – 5.9±3.0%, the average value was 5.9±3.1%. Candida species were identified by the bacteriological method using Sabouraud dextrose agar (growth of colonies of fungi of the genus Candida in an amount of more than 103 CFU/ml). Immunological methods for studying antimicrobial protection factors included studying the number of neutrophil granulocytes (NG) on the surface of the mucous membranes of the vulva and vagina, their phagocytic and NBT-reducing activity in a latex test. Randomization of patients into groups: group 1 included 50 (50%) women with DM 2 who, as part of complex therapy for rVVC received the drug Genferon® 1 intravaginal suppository of 500 thousand units 2 times a day for 10 days and fluconazole 150 mg orally three times with an interval of 72 hours at the first stage of treatment; group 2 included 50 (50%) women who received therapy with fluconazole 150 mg three times with an interval of 72 hours. The maintenance anti-relapse course therapy in both groups included the use of fluconazole 150 mg once a week for 6 months. In group 1st anti-relapse therapy was supplemented by the administration of the drug Genferon® 1 intravaginal suppository of 500 thousand units at night 3 times a week for 3 months, after which the vaginal microbiota was corrected for 2 weeks using vaginal suppositories, containing Lactobacillus acidophilus in an amount of at least 108 CFU. In group 2nd, basic anti-relapse antimycotic therapy was not accompanied by the prescription of any immunomodulatory or probiotic drugs. Results. The etiological agents of rVVC in women of late reproductive age in 79% (n=79) и 28% (n=28), respectively, were C. albicans and C. glabrata, which during the period of acute of the disease were detected by culture in the vaginal discharge at more than 104 CFU/ml. Chronic recurrent course of vulvovaginal candidiasis in women with DM 2 was characterized by exacerbations 4 or more times a year, accompanied by the corresponding clinical picture: white or yellowish-white cheesy discharge from the genital tract, itching or burning in the anogenital area, discomfort in the external genital area, dyspareunia, dysuria, decreased phagocytic activity of NG in vaginal secretions by 25.8%, impairment of their spontaneous and latex-induced NBT-reducing activity by 35.2%, functional reserve by 23.0% relative to reference values. The use of the drug Genferon® as part of complex therapy for rVVC contributed to a decrease in the number of Candida spp. in 1st and 3d months of observation after completion of anti-relapse therapy, normalization of cellular factors of innate immunity of the mucous membranes, faster resolution of the clinical manifestations of an episode of the disease. The decrease in the number of relapses over a 12-month observation period compared to the control group was also facilitated by an increase in the protective properties of the vaginal mucosa due to the restoration of the vaginal microbiota with the help of lactobacilli acidophilus. Conclusion. The etiological agents of rVVC in women of late reproductive age are C. albicans and C. glabrata. Subcompensated DM 2 is a risk factor for rVVC, which requires additional monitoring of microbiological parameters of the vaginal microbiota. rVVC in women with DM 2 is associated with an increase in the number of NG in the vaginal secretion, a decrease in their phagocytic activity and functional reserve compared to the reference values. Combination therapy of rVVC with topical recombinant interferon α2b, benzocaine and taurine in the formulation of Genferon® (suppositories) is an effective method to improve the clinical and immunological efficacy of therapy.

Equine keratomycosis due to Aspergillus flavus in Argentina

A 9-year-old gelding presented a corneal ulcer unresponsive to treatment in his right eye. The trauma was caused by vegetal material. The ophthalmologic exam revealed paraxial corneal opacity, whitish discharge, peripheral oedema, congestion of conjunctival vessels and corneal angiogenesis. Microscopic examination of smears revealed the presence of neutrophils and fungal hyphae. On day 3 of culture, several small white fluffy colonies that rapidly turned to pale green were detected. These colonies were isolated to study their micro and macromorphology. Microscopic examination revealed the presence of colourless, thick-walled, roughened conidiophores, ranging from 340 to 1650 μm in length, with globose to sub-globose vesicles, ranging from 22 to 48 μm in diameter. Vesicles had one or two series of phialides. Conidia were globose, olive-green with slightly rough, thin walls that ranged from 3 to 7 μm in diameter. Molecular identification was also performed. Both techniques confirmed the presence of Aspergillus flavus complex. Topical treatment with natamycin resulted in healing within 10 days. To our knowledge, this is the first case of equine keratomycosis reported in Argentina.

Evaluation of new haematology analyser, XN-31, for malaria detection in blood donors: A single-centre study from India.

Malaria continues to be a significant public health concern in India, with several regions experiencing endemicity and sporadic outbreaks. The prevalence of malaria in blood donors, in India, varies between 0.02% and 0.07%. Common techniques to screen for malaria, in blood donors and patients, include microscopic smear examination and rapid diagnostic tests (RDTs) based on antigen detection. The aim of this study was to evaluate a new fully automated analyser, XN-31, for malaria detection, as compared with current practice of using RDT. Cross-sectional analytical study was conducted to evaluate clinical sensitivity and specificity of new automated analyser XN-31 among blood donors' samples and clinical samples (patients with suspicion of malaria) from outpatient clinic collected over between July 2021 and October 2022. No additional sample was drawn from blood donor or patient. All blood donors and patients' samples were processed by malaria rapid diagnostic test, thick-smear microscopy (MIC) and the haematology analyser XN-31. Any donor blood unit incriminated for malaria was discarded. Laboratory diagnosis using MIC was considered the 'gold standard' in the present study. Clinical sensitivity and specificity of XN-31 were compared with the gold standard. Fife thousand and five donor samples and 82 diagnostic samples were evaluated. While the clinical sensitivity and specificity for donor samples were 100%, they were 96.3% and 100% for diagnostic samples. Automated haematology analysers represent a promising solution, as they can deliver speedy and sensitive donor malaria screening assessments. This method also has the potential to be used for pre-transfusion malaria screening along with haemoglobin estimation.

Molecular test for screening malaria-infected blood donors to maximise recipient safety in Acre State, a Brazilian endemic area.

Although blood transfusion is an essential therapeutic procedure, it can present risks, including transmitting infectious diseases, such as malaria. In Acre, the thick blood smear microscopic examination (TBS) is used to screen infected malaria blood donors. However, TBS has low sensitivity for detecting Plasmodium in situations of low parasitaemia, such as those presented by asymptomatic clinically healthy individuals. To investigate the pertinence of using polymerase chain reaction (PCR) to detect malarial infection for screening blood donors in Cruzeiro do Sul, Acre, an endemic high-risk malaria area in the Legal Amazon. A cross-sectional study was conducted among individuals eligible and ineligible to be blood donors, according to clinical and epidemiological criteria. Besides the mandatory screening of HCV, HBV, and HIV tests, malaria PCR and TBS were also carried out on all blood donor candidates who attended the Cruzeiro do Sul Blood Centre from July to September 2022. Of the 230 participants, 209 (91%) were eligible for blood donation by clinical-epidemiological screening. Surprisingly, no blood donor candidate reported a history of malaria. All TBS microscopic tests were negative at the time of recruitment. However, samples from four blood donor candidates (two eligible by clinical and epidemiological malaria criteria and two ineligible by hypertension and recent tattoo) were positive by Plasmodium and P. vivax molecular tests. Malaria molecular techniques for screening blood donors should be introduced in the Brazilian Blood Centres to maximise recipient safety. Furthermore, selecting zero-risk donors could pave the way to build a transmissible malaria-free environment in the blood bank context in the near future.

Ayurvedic management of Allergic rhinitis with Shirisha avaleha and Anu taila pratimarsha nasya: A case report

Abstract: Allergic Rhinitis (AR) is a chronic inflammatory Immunoglobulin E (IgE)-mediated disease of the nasal mucosa which is triggered by the inhalation of seasonal or perennial allergens. It is characterized by watery nasal discharge, sneezing, and itching in the nose. A 27-year-old male patient came to the Shalakya tantra outpatient department with complaints of excessive sneezing, runny nose, headache, and nasal blockage for the last two years. He also complained of itching in the eyes, nose, and palate. The screening was done using the Score for Allergic Rhinitis (SFAR) questionnaire, which was 14 (positive AR) before treatment. The patient was prescribed with Anu taila pratimarsha nasya (~low-dose medication through the nasal route) along with oral administration of Shirisha avaleha for four weeks. The patient showed marked relief in symptoms of AR along with an improvement in IgE level from 334 IU/mL to 42.2 IU/mL. The SFAR score was reduced to 4 after management. The nasal smear microscopic examination was negative after four weeks of treatment, which was positive before treatment. There was no recurrence during a follow-up of four weeks. The treatment reveals that Ayurvedic interventions are effective in the management of ARs quite efficiently.

Cryptosporidiosis in HIV-seronegative patients: A case series

Enteric infections by are a frequent cause of diarrhea among immunocompromised and HIV infected patients but there are limited reports of their occurrence in immunocompetent patients. Cryptosporidiosis is a faeco-orally transmitted protozoan infection and is one of the leading causes of chronic parasitic diarrhea. Here we report a case series of cryptosporidiosis from three different patients where two patients are immunocompetent and one is a post renal transplant case. All the patients came with watery diarrhea for which stool samples were collected and examined by modified Ziehl Neelsen acid fast staining (Kinyoun’s method). On microscopic examination of smear, multiple, pink, round to oval acid fast oocysts of 4-6µm diameter were seen against a blue background morphologically resembling . Early diagnosis and prompt initiation of antiparasitic drugs aids in timely treatment and prevention of disseminated cryptosporidiosis.

MANIFESTATIONS OF THE POST-COVID SYNDROME IN THE ORAL CAVITY

Corona virus infection currently remains a key question giving new and new strains. The disease itself has a multisymptomatic course, in which various organs and systems are affected. The oral cavity is no exception. For dentists, it becomes an important task to detect lesions of the oral cavity at various stages of the disease development and during the so-called recovery period, to increase the effectiveness of treatment and, if necessary, to refer the patient to narrow specialists: a neuropathologist, psychologist or other doctor in order to develop rehabilitation measures.
 The aim is to study the manifestations of post-covid syndrome in the oral cavity.
 Materials and methods. On the basis of the Department of Dentistry of the National Institute of Scientific Research of the IFNMU, as part of the advisory assistance for diseases of the oral cavity, in the period from 2021 to 2022, an examination of 33 patients who suffered from a coronavirus disease of varying degrees of severity was carried out. These patients were referred for consultation from private dental institutions, dental polyclinics in the city of Ivano-Frankivsk and the region. A significant part of patients sought help online. Clinical research methods included collection of complaints, anamnesis of the disease, analysis of extracts of medical histories from medical institutions. The dental examination was carried out according to the generally accepted scheme: examination of the oral cavity, in particular, the condition of the mucous membrane (color, moisture, presence of pathological formations), the condition of the periodontal tissues, oral hygiene, hard tissues of the teeth, orthopedic structures, traumatic factors, bad habits were evaluated.
 Research results. Results of the study Based on the results of the examination of the patients, we diagnosed a number of pathological conditions of the oral cavity, which included candidal stomatitis (glossitis) and they accounted for 30% of the examined, lichen planus - 30% of cases. These are the persons who were hospitalized for a covid disease. In the rest of the patients who suffered from the disease in a mild form, periodontal tissue damage was noted in 25%, the presence of aphthous rashes in 15% of cases. From the number of people examined, we observed combined pathologies in 5 people: candidiasis, ChPL and glossitis or gingivitis (periodontitis) and aphthae. Microscopic examination of smears from the oral cavity indicates a significant number of fungi of the genus Candida, provided that there is no bacterial flora, that is, dysbacteriosis was observed. Having analyzed the prevalence of pathological conditions of the oral cavity in the examined patients, the tendency of the formation of candidal stomatitis in patients on the background of antibiotic therapy of pneumonia is followed. The development of lichen planus, which the patients had not observed before, is a consequence of stress and shock during the illness.
 Conclusions. The obtained results of the examination justify the need to carry out a dental examination of persons suspected of being infected with coronavirus -19 even after clinical recovery. The task of the dentist is to timely diagnose lesions of the oral cavity, to choose the most adapted treatment algorithm for the identified pathology in order to prevent complicated progression.

Cytological structure of a vaginal stroke in American mink during estrus

The article presents the data of domestic and foreign authors on the features of the oestrous process of American minks. The results of studies of the cytological structure of the vaginal smear in American minks during estrus are presented. The study was conducted on clinically healthy American mink females of the Standard dark brown (+/+) genotype in 92 animals before the technological rut (February 20-28). A vaginal smear was taken at different periods of changes in the external genital organs - the genital loop, taking into account the scoring of its development (from 0 to 5 points). Microscopic examination of smears taken during this period showed a predominance of superficial, intermediate, and parabasal cells and a small number of basal and spindle cells. The analysis of the nuclear-cytoplasmic ratio made it possible to indicate the specificity of the morphometric parameters of the cells of the vaginal integumentary epithelium. Surface epitheliocytes and intermediate cells have a sizeable cytoplasmic area and a low nuclear-cytoplasmic ratio of 0.034. Parabasal cells have the minimum size of the nucleus and cytoplasm but a high value of the nuclear-cytoplasmic percentage, seven times higher than that of superficial cells and three times intermediate. Quantitative proportions of epithelial cells of the vaginal smear cytogram from February 20 to 28 correspond to the proestrus-estrus stage. The data obtained indicate significant features of the morphological changes in the integumentary epithelium of the vagina and the difference in the cytological dynamics of the oestrous cycle in American minks from other mammals. The cytogram of the vaginal smear of minks with a 4-5 point assessment of the readiness of females for mating does not contain the predominant number of keratinized epithelial cells, which is characteristic of most mammals during the period of ovulation. An important morphological criterion in the analysis of the vaginal smear cytogram in minks is the value of the ratio of superficial and parabasal cells and scales and parabasal cells.

Surveillance of avian malaria and related haemoparasites in common terns (Sterna hirundo) on the Atlantic coast of South America.

Haemosporidia (Apicomplexa, Haemosporida) are protozoa that infect vertebrate blood cells and are transmitted by vectors. Among vertebrates, birds possess the greatest diversity of haemosporidia, historically placed in 3 genera: Haemoproteus, Leucocytozoon and Plasmodium, the causative agent of avian malaria. In South America, existing data on haemosporidia are spatially and temporally dispersed, so increased surveillance is needed to improve the determination and diagnosis of these parasites. During the non-breeding season in 2020 and 2021, 60 common terns (Sterna hirundo) were captured and bled as part of ongoing research on the population health of migratory birds on the Argentinian Atlantic coast. Blood samples and blood smears were obtained. Fifty-eight samples were screened for Plasmodium, Haemoproteus and Leucocytozoon, as well as for Babesia parasites by nested polymerase chain reaction and by microscopic examination of smears. Two positive samples for Plasmodium were found. The cytochrome b lineages detected in the present study are found for the first time, and are close to Plasmodium lineages found in other bird orders. The low prevalence (3.6%) of haemoparasites found in this research was similar to those reported for previous studies on seabirds, including Charadriiformes. Our findings provide new information about the distribution and prevalence of haemosporidian parasites from charadriiforms in the southernmost part of South America, which remains understudied.

Evaluation of the efficacy of stomatitis prevention in prosthetics with complete dentures with additional fixation with the cream.

The objective of the study is to evaluate a microbiological efficacy of prevention and development of prosthetic stomatitis in full removable prosthetics. All patients with complete absence of the teeth on the lower jaw were divided into four groups: individuals who used full removable dentures and did not use any fixation agents and adhered to conventional oral hygiene; patients with full removable dental prostheses who used the cream "Corega" to strengthen the fixation from the first day of prosthetics and adhered to conventional oral hygiene; patients with complete removable dentures who used Corega Comfort (GSK) to strengthen the fixation from the first day of prosthetics and adhered to conventional oral hygiene; patients with complete removable dentures who used Corega Comfort (GSK) to enhance the fixation and performed antibacterial cleaning of dentures using Biotablets "Corega" for cleaning dentures from the first day of prosthetics. Microbiological and mycological examination of the patients included microscopic examination of smears using conventional and luminescent methods of staining smears from the denture surface. The data obtained show that probiotic species of microbial flora of the oral cavity are prone to colonization on the surface of complete removable acrylic dental prostheses when using fixation creams "Corega" and Corega Comfort (GSK), which is not characteristic of acrylic dentures without additional fixation. This flora much exceeds virulent one and Candida fungi quantitatively. It can be concluded that the use of complete removable dentures with the application of biotablets "Corega", can significantly (one hundred times) reduce the contamination of the dental prosthesis after 1 month of the follow-up. In general, pathogenic inoculation the application of this type of denture hygiene the makes it possible to achieve reduction of the number of streptococcal colonies by several times. Key words:Fixation gel, Candida fungi, patient, oral cavity, microbial content.

Applying Metagenomic Analysis Using Nanopore Sequencer (MinION) for Precision Medicine in Bacterial Keratoconjunctivitis: Comprehensive Validation of Molecular Biological and Conventional Examinations.

Smear microscopic examination and culture of the corneal scrapings are the gold standards for the diagnosis of bacterial keratoconjunctivitis. High-sensitivity molecular biological examinations of the ocular surface specimens are used clinically. However, the results require careful interpretation to avoid the unintentional detection of indigenous bacteria. Results of conventional and state-of-the-art examinations require clinical verification for specificity and sensitivity. In this study, smear microscopic examination, culture, and nanopore sequencing using the MinION of ocular surface specimens from eight clinically diagnosed bacterial keratoconjunctivitis cases were performed and compared. Seven of the eight cases (87.5%) were smear positive and five (62.5%) were culture positive. The former showed the same genus in >60% of the classified reads as one specific bacterium inferred from the smear microscopy when sequenced by the MinION. In two of the three culture-negative cases, the smear-positive images were highly reminiscent of the species comprising most of the MinION sequences. Four of the five culture-positive cases were consistent with the most prevalent bacteria in the sequencing results. Probable contamination among specimens processed on the same day were observed. In conclusion, the microscopic examination of the corneal scraping specimens may be more sensitive and specific than the culture examination. Additionally, although metagenomic analysis using the MinION contributes to more precise medication for bacterial keratoconjunctivitis, contamination can affect the results.

Colored Cellophane Use in Sputum Smear Microscopic Examination Performance in Pulmonary Tuberculosis Diagnosis

Colored Cellophane Use in Sputum Smear Microscopic Examination Performance in Pulmonary Tuberculosis Diagnosis

Analysis of The Effectiveness of Mycobacterium Tuberculosis Through Resistant Bacterial Staining and Molecular Rapid Tests

The diagnosis of TB can be confirmed by microscopic examination of smear on the sputum of the patient. However, because this method requires very expensive equipment, it is difficult to implement it in health facilities with simple facilities. Therefore, the Ziehl Neelsen staining method is a fairly simple method of choice and provides high sensitivity and specificity. In the research of Eka Kurniwan, et al. 2016, from the results of examining 40 samples with the Molecular Rapid Test (TCM), 16 people (40%) were found to be positive. The research objective was to know Mycobacterium tuberculosis through sputum examination through Ziehl Nelssen's acid-resistant bacteria staining and Molecular Rapid Test (TCM) of Puskesmas Dempo Palembang based on volume, odor, color and consistency. This type of research is a diagnostic test with a cross sectional study approach. Population and sample of 85 patients. The sampling technique in this study is using the total sampling method. Conclusion There is no effect based on volume, there is an effect based on the smell, color and consistency of sputum, there are differences in the results of Mycobacterium tuberculosis through sputum examination through Ziehl Nelssen's Acid-Resistant Bacteria Staining and Molecular Rapid Test (TCM) at Puskesmas Dempo Palembang.

Comparison of direct and indirect methods to maximise the detection of Babesia caballi and Theileria equi infections in Central Southern Italy

Equine piroplasmosis is a disease of equids, caused by tick-borne apicomplexan protozoan pathogens Babesia caballi and Theileria equi, which, according to the World Organisation for Animal Health (OIE), can be diagnosed by enzyme-linked immunosorbent assay (ELISA), immunofluorescent antibody test (IFAT) and polymerase chain reaction (PCR). The present study was conducted to evaluate and compare the assays available for the diagnosis of equine piroplasmosis. Data employed were obtained from 1300 blood samples collected between 2012–2014 from asymptomatic and symptomatic equines (horses and donkeys) of central-southern regions of Italy and analyzed by ELISA, IFAT, PCR (one commercial and one from literature) and blood smear microscopic examination. Statistical differences of the proportions of positivity for each parasite and group (asymptomatic and symptomatic) among the methods were verified by the z test to identify the most sensitive. The concordance between each pair of methods – for each parasite and within the groups – and trends in detection of suspect samples of four hypothetical diagnostic algorithms using serological and biomolecular assays were evaluated to identify the most suitable laboratory diagnostic workflow.The results of this study highlighted a lower capacity to detect suspect samples of commercial ELISA for B. caballi in all groups when compared to biomolecular methods and IFAT; and of the commercial PCRs in asymptomatic animals, identifying a PCR from literature and IFAT as the best choice for a combined diagnosis. For T. equi, IFAT detected more suspect samples than ELISA, even if the latter showed good performance and some samples were positive only by the ELISA and PCR, indicating that their simultaneous employment is still advantageous. Host-parasite interaction, amino-acid/genetic diversity and differences in detection limits among the assays could be among the reasons in explaining the present results.In view of further studies, ELISA should be used in combination with PCR, that should regularly be included in the laboratory diagnosis to maximise the detection of early infections and support the evaluation of pharmacological treatment.

A Fuzzy Strategy to Eliminate Uncertainty in Grading Positive Tuberculosis

Sputum smear microscopic examination is an effective, fast, and low-cost technique that is highly specific in areas with a high prevalence of pulmonary tuberculosis. Since manual screening needs trained pathologist in high prevalence zones, the possibility of deploying adequate technicians during the epidemic sessions would be impractical. This condition can cause overburdening and fatigue of working technicians which may tend to reduce the potential efficiency of Tuberculosis (TB) diagnosis. Hence, automation of sputum inspection is the most appropriate aspect in TB outbreak zones to maximize the detection ability. Sputum collection, smear preparing, staining, interpreting smears, and reporting of TB severity are all part of the diagnosis of tuberculosis. This study has analyzed the risk of automating TB severity grading. According to the findings of the analysis, numerous TB-positive cases do not fit into the standard TB severity grade while applying direct rule-driven strategy. The manual investigation, on the other hand, arbitrarily labels the TB grade on those cases. To counter the risk of automation, a fuzzy-based Tuberculosis Severity Level Categorizing Algorithm (TSLCA) is introduced to eliminate uncertainty in classifying the level of TB infection. TSLCA introduces the weight factors, which are dependent on the existence of maximum number of Acid-Fast Bacilli (AFB) per microscopic Field of View (FOV). The fuzzification and defuzzification operations are carried out using the triangular membership function. In addition, the [Formula: see text]-cut approach is used to eliminate the ambiguity in TB severity grading. Several uncertain TB microscopy screening reports are tested using the proposed TSLCA. Based on the experimental results, it is observed that the TB grading by TSLCA is consistent, error-free, significant and fits exactly into the standard criterion. As a result of the proposed TSLCA, the uncertainty of grading is eliminated and the reliability of tuberculosis diagnosis is ensured when adapting automatic diagnosis.

Costs and cost-effectiveness of Gene Xpert compared to smear microscopy for the diagnosis of pulmonary tuberculosis using real-world data from Arsi zone, Ethiopia.

BackgroundEarly diagnosis and treatment are one of the key strategies of tuberculosis control globally, and there are strong efforts in detecting and treating tuberculosis cases in Ethiopia. Smear microscopy examination has been a routine diagnostic test for pulmonary tuberculosis diagnosis in resource-constrained settings for decades. Recently, many countries, including Ethiopia, are scaling up the use of Gene Xpert without the evaluation of the cost and cost-effectiveness implications of this strategy. Therefore, this study evaluated the cost and cost-effectiveness of Gene Xpert (MTB/RIF) and smear microscopy tests to diagnosis tuberculosis patients in Ethiopia.MethodsWe compared the costs and cost-effectiveness of tuberculosis diagnosis using smear microscopy and Gene Xpert among 1332 patients per intervention in the Arsi zone. We applied combinations of top-down and bottom-up costing approaches. The costs were estimated from the health providers’ perspective within one year (2017–2018). We employed “cases detected” as an effectiveness measure, and the incremental cost-effectiveness ratio was calculated by dividing the changes in cost and change in effectiveness. All costs and incremental cost-effectiveness ratio were reported in 2018 US$.ResultsThe unit cost per test for Gene Xpert was $12.9 whereas it is $3.1 for AFB smear microscopy testing. The cost per TB case detected was $77.9 for Gene Xpert while it was $55.8 for the smear microscopy method. The cartridge kit cost accounted for 42% of the overall Gene Xpert’s costs and the cost of the reagents and consumables accounted for 41.3% ($1.3) of the unit cost for the smear microscopy method. The ICER for the Gene Xpert strategy was $20.0 per tuberculosis case detected.ConclusionUsing Gene Xpert as a routine test instead of standard care (smear microscopy) can be potentially cost-effective. In the cost scenario analysis, the price of the cartridge, the number of tests performed per day, and the life span of the capital equipment were the drivers of the unit cost of the Gene Xpert method. Therefore, Gene Xpert can be a part of the routine TB diagnostic testing strategy in Ethiopia.

Bacterial vaginosis and other infections in pregnant women in Senegal

BackgroundBacterial vaginosis (BV) is associated with a higher risk of preterm delivery and spontaneous abortion. Yet little data on BV prevalence exist for sub-Saharan countries. The aim of this study was to estimate the prevalence of bacterial vaginosis and associated risk factors among pregnant women in Senegal.MethodsFrom October 2013 to December 2018, pregnant women in their third trimester were recruited in two primary health centers (one suburban, one rural) in Senegal. Healthcare workers interviewed women and collected a lower vaginal swab and a blood sample. Vaginal flora were classified into four categories using vaginal smear microscopic examination and Gram’s coloration. In our study, BV was defined as vaginal flora with no Lactobacillus spp. Variables associated with BV were analyzed using STATA® through univariate and multivariate analysis.ResultsA total of 457 women provided a vaginal sample for analysis. Overall, BV prevalence was 18.6% (85/457) [95% CI 15.4–22.6]) and was similar in suburban and rural areas (18.9% versus 18.1%, p = 0.843). Multivariate analysis showed that primigravidity was the only factor independently associated with a lower risk of BV (aOR 0.35 [95% CI 0.17–0.72]).ConclusionsOur study showed significant BV prevalence among pregnant women in Senegal. Although the literature has underscored the potential consequences of BV for obstetric outcomes, data are scarce on BV prevalence in sub-Saharan African countries. Before authorities consider systematic BV screening for pregnant women, a larger study would be useful in documenting prevalence, risk factors and the impact of BV on pregnancy outcomes.

Chronic wounds in Sierra Leone: Searching for Buruli ulcer, a NTD caused by Mycobacterium ulcerans, at Masanga Hospital.

Chronic wounds pose a significant healthcare burden in low- and middle-income countries. Buruli ulcer (BU), caused by Mycobacterium ulcerans infection, causes wounds with high morbidity and financial burden. Although highly endemic in West and Central Africa, the presence of BU in Sierra Leone is not well described. This study aimed to confirm or exclude BU in suspected cases of chronic wounds presenting to Masanga Hospital, Sierra Leone. Demographics, baseline clinical data, and quality of life scores were collected from patients with wounds suspected to be BU. Wound tissue samples were acquired and transported to the Swiss Tropical and Public Health Institute, Switzerland, for analysis to detect Mycobacterium ulcerans using qPCR, microscopic smear examination, and histopathology, as per World Health Organization (WHO) recommendations. Twenty-one participants with wounds suspected to be BU were enrolled over 4-weeks (Feb-March 2019). Participants were predominantly young working males (62% male, 38% female, mean 35yrs, 90% employed in an occupation or as a student) with large, single, ulcerating wounds (mean diameter 9.4cm, 86% single wound) exclusively of the lower limbs (60% foot, 40% lower leg) present for a mean 15 months. The majority reported frequent exposure to water outdoors (76%). Self-reports of over-the-counter antibiotic use prior to presentation was high (81%), as was history of trauma (38%) and surgical interventions prior to enrolment (48%). Regarding laboratory investigation, all samples were negative for BU by microscopy, histopathology, and qPCR. Histopathology analysis revealed heavy bacterial load in many of the samples. The study had excellent participant recruitment, however follow-up proved difficult. BU was not confirmed as a cause of chronic ulceration in our cohort of suspected cases, as judged by laboratory analysis according to WHO standards. This does not exclude the presence of BU in the region, and the definitive cause of these treatment-resistance chronic wounds is uncertain.

Pictorial guide to canine and feline blood smears. Part 3: abnormal findings – leukocytes and platelets

Background: A variety of diseases can cause morphological abnormalities of leukocytes and platelets. Most of these abnormalities cannot be detected without a blood smear examination. Accurate detection can aid in the diagnosis and the implementation of appropriate treatment.Aim of the article: This is the last in a series of three articles on practical haematology in dogs and cats. The aim of this article is to help veterinarians gain confidence in recognising common changes in the morphology of leukocytes and platelets that can be seen during a blood smear microscopic examination in clinical practice.