Routine Microscopy Research Articles

Desmoplastic myxoid tumor of pineal region, SMARCB1-mutant, in young adult.

We present a young adult woman who developed a myxoid tumor of the pineal region having a SMARCB1 mutation, which was phenotypically similar to the recently described desmoplastic myxoid, SMARCB1-mutant tumor of the pineal region (DMT-SMARCB1). The 24-year-old woman presented with headaches, nausea, and emesis. Neuroimaging identified a hypodense lesion in CT scans that was T1-hypointense, hyperintense in both T2-weighted and FLAIR MRI scans, and displayed gadolinium enhancement. The resected tumor had an abundant, Alcian-blue positive myxoid matrix with interspersed, non-neoplastic neuropil-glial-vascular elements. It immunoreacted with CD34 and individual cells for EMA. Immunohistochemistry revealed loss of nuclear INI1 expression by the myxoid component but its retention in the vascular elements. Molecular analyses identified a SMARCB1 deletion and DNA methylation studies showed that this tumor grouped together with the recently described DMT-SMARCB1. A cerebrospinal fluid cytologic preparation had several cells morphologically similar to those in routine and electron microscopy. We briefly discuss the correlation of the pathology with the radiology and how this tumor compares with other SMARCB1-mutant tumors of the nervous system.

Rapid Discrimination of Tuberculosis and Sarcoidosis by Next-Generation Sequencing

Background: Tuberculosis (TB) is caused by the infection of Mycobacterium tuberculosis (MTB) and shares highly similar clinical, radiological, and histopathological characteristics with sarcoidosis (SA). Correctly distinguishing SA from TB is still one of the clinical challenges. Methods: This study enrolled 44 TB patients and 47 SA patients that were clinically diagnosed by chest radiography, pathological examination, routine smear microscopy, and culture. The MTB genome was captured and sequenced directly from tissue specimens by operation or biopsy and evaluated the feasibility of next-generation sequencing (NGS) for the MTB genome in the differential diagnosis of TB from SA. Findings: Following the depth > 10× and coverage > 15% filter of the sequencing data, TB patients were well identified by the NGS approach directly in using of operation or biopsy specimens without clinical pretreatment. The sensitivity, specificity, and concordance of NGS diagnostic method was 81.8% (36/44), 95.7% (45/47) and 89.0% (81/91), respectively (Kappa value = 0.78, 95%CI = 0.65-0.91 P-value = 0.00). Interpretation: Our study established an improved method of rapid strategy in distinguishing patients with TB, and have a potential benefit in clinical implications. Funding Statement: This work was supported by the Shanghai Science and Technology SMEs Technology Innovation Fund (1702H117500), the Jiaxing Leading Talent Entrepreneurship Project, and the Technology innovation projects of Jiaxing. Declaration of Interests: The authors declare no potential conflicts of interest. Ethics Approval Statement: This study was conducted according to the principles of the World Medical Association Declaration of Helsinki. The study was approved specifically by the Internal Review Board of the Affiliated Zhongshan Hospital, Fudan University. All participants were informed and consent to participate in this retrospective study (IRB approval No. B2017-122).

Cytologic comparative analysis between stained and unstained smears of urine sediment in urinary tract pathologies

Aim: To analyse the routine microscopic examination of urine specimens in urinary tract pathologies and compare the cytological examination of unstained and stained urine sediment samples (Papanicolaou and Romanowsky stains) to establish clinicocytological correlation.Material and Method: The present study was conducted among 500 patients coming to either OPD /admitted to CSSH with urinary pathology. In patients with a clinical history suggestive of any urinary pathology freshly voided urine samples were collected. Samples were centrifuged at 1500rpm for 10 minutes. In case of less cellularity, Cytospin at 3000rpm for 5-10 minutes was done. From the sediment, three smears were prepared i.e. smear 1 (routine urine microscopy), smear 2 by Romanowsky stain (Leishman Geimsa) and smear 3 by Papanicolaou method. Results: In the current study, urinary tract pathologies were found to be more common in females (326) as compared to males (174). Majority of patients were in the 3rd and 4th decade of life accounting for 184 cases (38%) and 153 cases (36%) respectively. Stained smears detect high n/c ratio, pus cells, bacilli/fungi and bare nuclei among 95.85%, 99.07%, 99.07% and 0%of UTI samples respectively, while unstained smears detect high n/c ratio, pus cells, bacilli/fungi and bare nuclei in 91.24%, 96.3%, 97.23% and 44.24% of the UTI samples respectively.Conclusion: We can conclude that this study demonstrates the high correlation between the cytological examination of urine specimen in fresh smears and in the Papanicolaou-stained smears.

Use of Immunomagnetic Separation tool in Leishmania promastigotes capture

Immunomagnetic Separation (IMS) assay has been used for isolation of viable whole organisms. The objective of our work is to produce anti-Leishmania magnetic beads and to assess the efficiency of the IMS technique on Leishmania promastigote capture in culture media.Polyclonal anti-Leishmania antibodies were produced by intravenous injection of viable metacyclic promastigotes of Leishmania (L.) major to rabbit. Purified anti-Leishmania IgG was assessed for their reactivity against both L. major and L. infantum promastigotes then covalently conjugated to magnetic beads and used for IMS. This latter was applied on either L. major promastigote cultures of known concentrations or early stage (24h, 48h, 72h) Novy-MacNeal-Nicolle (NNN) cultures of tissue fluid obtained from cutaneous leishmaniasis (CL) lesions. Promastigotes capture was assessed by either microscopy or qPCR after sample boiling.Indirect immunofluorescence assay showed that polyclonal antibodies reacted against both L. major and L. infantum promastigotes. In 50 µL solution, immunomagnetic beads were able to capture 5 live promastigotes out of 20 and 1050 out of 2500, giving an estimated efficiency of 25-42%. The efficiency of the IMS was lower for a lower number of parasites but still repeatable. On the other hand, IMS-qPCR applied to 14 NNN cultures of confirmed Leishmania lesions showed a higher sensitivity to detect live parasites than routine microscopy observation of promastigotes growth (93% positivity at 72h versus 50% positivity within 2-4 weeks incubation). The estimated number of captured parasites at 72h ranged from 1 to more than 100 parasites / 50 µL liquid phase of culture.These preliminary results open the way for interesting perspectives in the use of cultures for leishmaniasis diagnosis and also for other applications such as Leishmania detection in cultures taken from reservoir animals or sandflies.

Antimicrobial resistance pattern of urinary tract pathogens from tertiary care hospitals in Bangladesh

Background: In Bangladesh, urinary tract infection (UTI) patients usually self-medicate or receive empirical treatment from physicians to start immediate treatment or to avoid expensive medical care. A study of 2016 in Bangladesh showed resistance to antibiotics like quinolones (52%), 3rd generation cephalosporin (51.1%), cotrimoxazole (47%) and imipenem (1%) in UTI. To understand the national situation of antimicrobial resistance (AMR), Institute of Epidemiology, Disease Control and Research (IEDCR), the national institute of epidemiology of Bangladesh, started a surveillance in ten tertiary care hospitals since 2017 from six types of specimens including urine of UTI patients. Objectives of this study were to determine the distribution and antibiotic resistance patterns of UTI pathogens. Methods and materials: We analyzed data of UTI patients enrolled in five initially started sites of AMR surveillance in 2018. UTI patient was defined as >5 years old patient attending outdoor, with abrupt onset of frequency of micturition & urgency with fever, chill or burning sensation of urine or loin pain. Epidemiological data and urine sample were collected. Sample were tested for routine microscopy examination and antimicrobial susceptibility test (AST). AST was performed by disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guideline. We included intermediate and resistant zone in calculation of resistance. Results: In 2018, a total of 1779 UTI patients reported, 439 (24%) had growth in culture. Culture positivity was more in UTI with >5 pus cells/high power field (HPF) (54/439, 80%) on microscopy than <5 pus cells/HPF (85/439, 19%). About 8% patient took antibiotics previously. Culture positive UTI was more in female 323 (73%) than male 116 (26%). Common pathogens were Escherichia coli (57.4%), Klebsiella (17.3%) and Staphylococcus aureus (10.93%). Escherichia coli was resistant 57% to quinolones, 55% to 3rd generation cephalosporin, 54% to cotrimoxazole and 5% to imipenem; Klebsiella was resistant 37% to third generation cephalosporin, 57% to quinolones, 54% to cotrimoxazole and 8.6% to imipenem. Gram negative bacteria also showed resistance to imipenem. Conclusion: Urinary pathogens showed higher resistance against commonly used antibiotics like quinolone, 3rd generation cephalosporin and cotrimoxazole. We recommend to conduct studies on prescription pattern and physicians should be aware about resistance pattern to treat accordingly.

Malignant Extrarenal Rhabdoid Tumor in a 5-Month-Old Male With Mediastinal and Heart/Great Vessel Involvement

Abstract Introduction/Objective Extrarenal rhabdoid tumor is a high-grade soft-tissue predominately pediatric malignancy with a frequency of 0.15 per million children less than 15 years. It is associated with del(22) (q11.2) with SMARCB1 loss, recognized by loss of INI-1 staining. It has distinct perinuclear hyaline inclusions; however, this feature can be present in other tumors. We describe a malignant extrarenal rhabdoid tumor involving the heart and great vessels to highlight the multiple modalities required for the diagnosis of this tumor in this unusual location. Methods We utilized routine histology, immunohistochemistry, and electron microscopy. Results This 5 -month -old male presented with respiratory distress due to a mass that invaded the heart, surrounding the great vessels. The tumor was composed of sheets of polygonal large cells with light pink to clear cytoplasm, eccentric nuclei with mild anisonucleosis, peripherally marginating chromatin, prominent nucleoli, with 2 mitoses per 10 high power field. Hyaline perinuclear inclusions were inapparent. There were frequent clusters of lymphocytes and eosinophils, with 10 percent necrosis and moderately increased vascularity. The tumor was positive for vimentin, SMA, EMA, MSA, S-100, keratin, and WT1, and negative for INI-1, CD34, ALK, AFP, PLAP, CD30, myogenin, NeuN1, synaptophysin, chromogranin, and NSE. Electron microscopy demonstrated occasional cells with perinuclear collections of intermediate filaments, some with whorls. The strong positivity for vimentin, keratin, SMA, MSA, S-100, negative staining for INA-1 and CD34, and visualization of perinuclear intermediate filament whorls by electron microscopy helped make the diagnosis of extrarenal rhabdoid tumor. Conclusion Malignant extrarenal rhabdomyosarcomas may occur in the middle mediastinum, invade the heart, occur in the first 6 months of life, and not have the typical rhabdoid cells. Diagnoses depend on multiple modalities

Matisse and the Organoids: The Art of Science

Over the past few decades, scientists have transformed the way they do and understand science. They are now exploring their more creative side. This approach has accelerated fascinating discoveries such as human induced pluripotent stem cells and brain organoids; however, they have not been able to jump over the communication barrier with society. La Danse des Astrocytes, a scene observed during a routine microscopy session working on midbrain organoids, has motivated this essay, which urges scientists to find new forms of science communication and to work as a community to achieve the consolidation of a scientific culture.

Evaluation of the colorimetric malachite green loop-mediated isothermal amplification (MG-LAMP) assay for the detection of malaria species at two different health facilities in a malaria endemic area of western Kenya

BackgroundPrompt diagnosis and effective malaria treatment is a key strategy in malaria control. However, the recommended diagnostic methods, microscopy and rapid diagnostic tests (RDTs), are not supported by robust quality assurance systems in endemic areas. This study compared the performance of routine RDTs and smear microscopy with a simple molecular-based colorimetric loop-mediated isothermal amplification (LAMP) at two different levels of the health care system in a malaria-endemic area of western Kenya.MethodsPatients presenting with clinical symptoms of malaria at Rota Dispensary (level 2) and Siaya County Referral Hospital (level 4) were enrolled into the study after obtaining written informed consent. Capillary blood was collected to test for malaria by RDT and microscopy at the dispensary and county hospital, and for preparation of blood smears and dried blood spots (DBS) for expert microscopy and real-time polymerase chain reaction (RT-PCR). Results of the routine diagnostic tests were compared with those of malachite green loop-mediated isothermal amplification (MG-LAMP) performed at the two facilities.ResultsA total of 264 participants were enrolled into the study. At the dispensary level, the positivity rate by RDT, expert microscopy, MG-LAMP and RT-PCR was 37%, 30%, 44% and 42%, respectively, and 42%, 43%, 57% and 43% at the county hospital. Using RT-PCR as the reference test, the sensitivity of RDT and MG-LAMP was 78.1% (CI 67.5–86.4) and 82.9% (CI 73.0–90.3) at Rota dispensary. At Siaya hospital the sensitivity of routine microscopy and MG-LAMP was 83.3% (CI 65.3–94.4) and 93.3% (CI 77.9–99.2), respectively. Compared to MG-LAMP, there were 14 false positives and 29 false negatives by RDT at Rota dispensary and 3 false positives and 13 false negatives by routine microscopy at Siaya Hospital.ConclusionMG-LAMP is more sensitive than RDTs and microscopy in the detection of malaria parasites at public health facilities and might be a useful quality control tool in resource-limited settings.

“ROLE OF TB PCR IN CLINICALLY DIAGNOSED AND TREATED CASES OF TUBERCULAR PLEURAL EFFUSION”.

Background: Tuberculosis is still a major health problem worldwide. It is estimated that about one-third of the world's population is infected with mycobacterium tuberculosis. While pulmonary tuberculosis is most common presentation; pleural effusion is one of the common complications of primary tuberculosis or in conjunction with pulmonary infiltrate typical of post primary tuberculosis. Diagnosis of pleural tuberculosis (TB) remains a challenge due to its nonspecific clinical presentation and paucibacillary nature.TB PCR is a self-automated method from Roche for the detection of mycobacterium tuberculosis. This test allows for detection and identification of MTB from direct specimens within 24 – 48 hours of the receipt in the laboratory. We determined the role of TB PCR in diagnosis of tubercular etiology in pleural effusion in our study. Materials and methods: Prospective and analytical studyin a tertiary care centre of the study area was conducted after Ethics Committee permission. The study period was from June 2018 to December 2019.Data of 36tubercular pleural effusion patients was retrieved. Role of TB PCR in the diagnosis of tubercular etiology was assessed. Results: Pleural fluid samples collectedwere sent for various investigations like Routine microscopy, cytology, Pleural fluid pH, protein, LDH and TB PCR. Serum protein and serum LDH were also done.The diagnosis of Tubercular Pleural Effusion was made by clinical examination, radiological presentation, results of pleural fluid investigations and response to Anti Tubercular treatment collectively. Out of the 36 patients diagnosed to have tubercular pleural effusion, 8(22%) patient’s pleural fluid TB PCR report was positive. Conclusion:TB PCR is not a useful test in the diagnosis of tubercular etiology in pleural effusion.

Transplantation of Autologous Peritoneum Using Ileal Seromuscular Flaps for Orthotopic Neobladder Reconstruction

Objective To develop an ideal surgical procedure for neobladder reconstruction in experimental porcine models. Methods Six experimental female pigs weighting 28-33 kg underwent transplantation of autologous peritoneum for bladder reconstruction under general anesthesia.The flaps were used to reconstruct the orthotopic neobladder by suturing with the edges of the triangle and neck of the remnant bladder.The ureteral catheters were removed on the 5 th postoperative day and the balloon catheter was removed on the 7 th postoperative day.Voiding behaviour was monitored.The animals were euthanized at week 12 for routine pathology,immunohistochemistry,and electron microscopy. Results All the pigs survived after the surgery,and no postoperative complication such as peritonitis,intestinal obstruction,or urinary fistula was observed.All the peritoneum-ileum composite free valves survived after transplantation.Voiding behaviour was normal after catheter removal,and the urine was clear.At autopsy,reconstructed bladders were healthy.Pathological examination showed the neobladder had been covered by continuous urothelium while the peritoneum disappeared and showed no ileal mucosa regrowth and residual.Scanning electron microscope showed the transitional cells of neobladder were complete and orderly,and the urothelium around suture border was continuous and showed no malposition. Conclusions Reconstruction of bladder by autologous peritoneum and ileal seromuscular flaps is an ideal approach in the experimental pigs as it can prevent regrowth of ileal epithelial cells and avoid the complications of conventional enterocystoplasty.Its clinical application deserves further investigations.

Investigating mitochondrial autophagy by routine transmission electron microscopy: Seeing is believing?

Mitochondrial autophagy is affected in many diseases. In the past few years, the multiple-steps process of selective degradation of mitochondria has been dissected in details by combining outcomes from different approaches. Perhaps one of the most rigorous methods to clearly visualise mitochondria undergoing autophagic engulfment and degradation, is transmission electron microscopy (TEM). In this opinion paper, we want to give a brief summary of the mitophagic process, and by which means mitophagy can be addressed, including TEM analysis. We will report examples of autophagy and mitophagy-related TEM images, and discuss how to decipher the different steps of the mitophagic process by routine TEM. In our opinion, this technique can be used as a powerful confirmatory approach for mitochondrial autophagy and can provide details of the organelle fate throughout the course of mitophagy with no substantial sample manipulation.

Quantitative Image Format for Electron Microscopy

AbstractExperimental data, simulation, data analysis and visualisation require image file formats that are open source and able to contain and manage quantitative data. Quantification techniques bring the new challenge of managing image calibration parameters and formulas in an open and efficient format, compatible with routine microscopy workflows. A practical approach to quantitative image format is presented and discussed here, relying on open and extensible file formats - Tagged Image File (TIF) and Extensible Metadata Platform (XMP).

The applicability of Papanicolaou Society of Cytopathology system on reporting endoscopic ultrasound-guided fine needle aspiration cytology specimens of pancreatic lesions in situations with limited availability of ancillary tests. Experience at a single laboratory.

The Papanicolaou Society of Cytopathology (PSC) system of reporting pancreatobiliary cytology is a standardised reporting nomenclature that uses a six-tiered scheme of diagnostic categories utilising routine microscopy and ancillary tests such as biochemical and molecular analysis of cyst fluids and immunochemistry. The objective of this study was to determine the applicability of the PSC system on endoscopic ultrasound-guided fine needle aspiration cytology samples reported at the cytopathology laboratory, Mubarak Al Kabeer Hospital, in Kuwait with special emphasis on situations with limited availability of ancillary tests. In total, 132 cases of endoscopic ultrasound-guided fine needle aspiration cytology samples from pancreatic lesions were categorised according to PSC system guidelines after examining the glass slides and reviewing the clinical, imaging and ancillary test findings. These review diagnoses were compared with the diagnoses rendered during initial reporting. Correlation with histopathology reports was done wherever available. In 23 (17.42%) of 132 cases, re-categorisation was necessary between initial and reviewed diagnoses. In 16 cases, re-categorisations were because of non-analogous categories between initial and reviewed diagnosis. In the remaining seven, they were due to identification of newer cytomorphological and imaging findings or because of issues arising from unavailability of sufficient material for ancillary investigations. All cases could be categorised using the PSC system with a moderate number of re-categorisations between initial and reviewed diagnoses. In certain circumstances, limited availability of ancillary tests, resulted in non-diagnostic categories whereas in other such circumstances, diagnostic categories could be assigned with certain conceptual modifications to the PSC guidelines.

Evaluation of Chicago sky blue stain against Potassium Hydroxide-Dimethyl Sulfoxide wet mount in the identification of dermatophytes

Background: Dermatophytoses infections are widespread in the developing world. The laboratory diagnosis of dermatophytes has been a challenge as it involves microscopy and trained personnel. Potassium hydroxide wet mount with dimethyl sulfoxide added is routinely used in direct microscopy. But it lacks color contrast and the hyphae may be missed on routine microscopy. The study aimed to evaluate the effectiveness of the Chicago sky blue stain against routine potassium hydroxide-dimethyl sulfoxide (KOH/DMSO) wet mount in direct microscopy.&#x0D; Patients and methods: The study was carried out at the Department of Microbiology, Postgraduate Medical Institute, Lahore over a period of nine months from July 2013 till March 2014. Patients of either gender regardless of age, clinically diagnosed as having dermatophytoses by dermatologists were selected for this study. Specimens from 100 patients were collected from the dermatology outdoor of a tertiary care hospital for this study. They were evaluated microscopically with routine potassium hydroxide-dimethyl sulfoxide (KOH-DMSO) wet mount and Chicago sky blue (CSB) stain. Data were collected and entered in Statistical Package for the Social Sciences (SPSS) version 20.0.&#x0D; Results: Out of a total of 100 samples collected from skin, hair and nails, 59% were positive on direct microscopy with KOH/DMSO wet mount. Whereas direct microscopy using CSB stain revealed dermatophytes in 62% of cases.&#x0D; Conclusion: Chicago sky blue staining is a better technique for the detection of dermatophytes as compared to potassium hydroxide wet mount examination. It is simple, rapid, and easy to interpret. We recommend the use of this technique to improve the detection of dermatophytes without awaiting the results of the culture.

Epidemiological and parasitological studies on lymphatic filariasis in Argungu Local Government Area of Kebbi State, Nigeria

Mass Medicine Administration (MMA) with albendazole and ivermectin has been going on in Argungu Local Government Area of Kebbi State for over six years. Apart from the baseline mapping conducted by the state ministry of health in 2010 to identify communities eligible for MDA, no comprehensive study has been carried out on this disease in the area. This study is necessary to determine if transmission has been halted or not. A total of 425 volunteers in 6 rural villages were examined using Immunochromatographic Card Test (ICT) and routine microscopy . Physical manifestations and entomological studies were also carried out. Nine inhabitants, 9(0.4%) were positive using ICT with no microfilaria of W. bancrofti. Infection was significantly higher in Matan Fada Village (7.14%) (p&lt;-0.5), while three villages recorded 0.00% infection rate. Infection was higher in males than females, age group 10-19, in singles than married participants, pupils/students than other occupations (p&gt;0.5). There was weak negative correlation between ICT and hydrocele(r = -0.14) as well as lymphoedema (r = -0.012). 436 mosquitoes were dissected and none harboured microfilaria of W. bancrofti. It is concluded that transmission has been halted in 3 of the villages since they have met the WHO’s criteria of less than 1% seropositivity, and MMA should therefore be stopped in those villages. There is however continued surveillance, morbidity management and vector control.&#x0D; Keywords: Entamological studies; microfilaria; mobidity management.

Diagnosis of malaria by the optimal method in children with routine microscopy and its comparison

Background: The term malaria (meaning bad air of the marsh and swampland) first originated in the 17th century. Malaria is one of the most serious medical conditions, Malaria causes symptoms which usually include fever, fatigue, vomiting, and headaches. It may cause yellow skin, seizures, coma, or death in extreme cases. The population of tribal areas of Andhra Pradesh, Tamilnadu, Karnataka, Chhattisgarh, Gujarat, Bihar, Orissa, Northeastern states are contributing 50% of cases of Plasmodium falciparum.Methods: All the clinically suspected cases of Malaria, ‘The optiMAL’ test was done at the bedside and simultaneously thick and thin smears are prepared and sent for microscopic examination. Study was carried out at Narayana Medical College, Nellore, Andhra Pradesh, India. The total number of patients in our study was 150. 1-14 years of age were included in the present study after applying the inclusion and exclusion criteria.Results: The ‘OptiMAL’test method had excellent sensitivity and specificity (100%) for detecting plasmodium vivax, very good sensitivity, and specificity (98.57%, 100%) for detecting plasmodium falciparum. The optimal test had a positive predictive value of 100%, the negative predictive value of 98.61% with p-value &lt;0.001.Conclusions: Our study has shown that the 'OptiMAL' test is an easy and successful diagnostic test that can be performed at the bedside for malaria diagnosis. This is very similar to traditional microscopy and do not need highly qualified workers to conduct experiments or interpret.

P0490IS THE SEVERITY OF GLOMERULAR IGG STAINING IN PATIENT WITH IGA NEPHROPATHY USEFUL FOR PREDICTING POOR RENAL PROGNOSIS? THE DATA FROM TSN-GOLD WORKING GROUP

Abstract Background and Aims In IgA nephropathy (IgAN), which is characterized by mesangial IgA accumulation, there is the formation of circulating autoantibodies against galactose deficient IgA1s (Gd-IgA1). IgG / Gd-IgA1 immunocomplexes accumulate in the glomerular mesangium and play a role in the pathogenesis of IgAN. Recent studies have suggested a relationship between glomerular IgG deposition and the severity of glomerular inflammation. However, detection of the presence and severity of IgG in routine immunofluorescence microscopy (IFM) may fail. This study aims to investigate whether IgG positivity detected by IFM is associated with poor renal prognostic indicators and whether renal prognosis can be predicted according to IgG positivity. Method 4399 patients who were enrolled between May 2009-June 2019 in database of Turkish Society of Nephrology, Glomerular Diseases Working Group (TSN-GOLD) including 44 centers were evaluated. After exclusion criteria, 994 primary IgAN patients were included in the study. Glomerular IgG negative and positive patients were compared by means of Oxford classification scores, histopathological evaluations, proteinuria, creatinine, albumin, blood pressures. IgG positive patients were divided into subgroups according to the grade of the IFM positivity. The relationship between IgG positivity and poor prognosis criteria were evaluated. Results Demographic and biochemical findings of glomerular IgG positive and negative patients at the time of biopsy are shown in Table 1. No difference was found between the groups. There was no difference in the demographic and biochemical findings at the time of biopsy in IgG subgroup analyses (Table 2). There was no difference between the histopathological and Oxford MEST scores of the subgroups. Glomerular IgG positivity was not associated with diastolic blood pressure, systolic blood pressure, urea, uric acid, age, eGFR, albumin, proteinuria (p&amp;gt; 0.05 for all, r= -0.084, r= -0.102, r= -0.006, r=0.062, r= 0.014, r= -0.044, r= -0.061, r= -0.066, r= 0.150, respectively). Conclusion Glomerular IgG positivity detected by routine IFM in IgAN is not associated with poor renal prognostic indicators. It is difficult to predict renal prognosis by looking at the severity of IgG positivity at the baseline evaluation.

A Study on Morphohistometric Changes of Placenta in Gestational Diabetes- A Comparative Analysis

Introduction:The placenta is a complex fetal organ that fulfills pleotrophic roles during fetal growth. Placenta is the most accurate record of the infant’s prenatal experience. Gestational diabetes is much common than preexisting diabetes .i.e. it complicates 2% to 5% of pregnancies. It seems reasonable to expect that biochemical changes occurring in the pregnant women with diabetes should be reflected in the placental structure. Aim &amp; objectives: In the present study an attempt is made to know the morphological changes of placenta in gestational diabetes mellitus.Subjects and Methods:In this study totally 60 placentae were studied, of which 30 were nondiabetic placentae and 30 from Gestational Diabetic mothers were studied macroscopically. Morphologically the shape, site of attachment of umbilical cord, central thickness of placenta was noted. Birth weight of the neonate and the placental ratio were also recorded. By using routine staining techniques and direct microscopy tissues of Gestational Diabetic placenta were studied qualitatively and compared them with normal placenta.Results:Our study demonstrates that there is a significant increase in weight and central thickness of placenta. Neonatal weight and placental ratio were also increased; there was no change in shape and site of attachment of umbilical cord in case of diabetic placenta when compared to normal. Conclusion:On the basis of results of present study it is concluded that diabetic placentae showed increase in weight and central thickness. Neonatal weight and placental ratio were also increased. These findings indicate that control of hyperglycemia only partially prevents the development of placental abnormalities.

Fusarium Infection Detected in Routine Urine Microscopy in an Immunocompromised Post-Renal Transplant Patient: A Case Report

Fusarium Infection Detected in Routine Urine Microscopy in an Immunocompromised Post-Renal Transplant Patient: A Case Report

Comparison of Digital Image Analysis and Conventional Microscopy in Evaluating Erythrocyte Morphology in Peripheral Blood Smears

Background and Objectives. The use of conventional microscopy still forms the basis for the morphologic evaluation of erythrocytes despite widespread use of automated tests in the hematology laboratory. This requires a considerable length of time and expertise, and have the potential of becoming a source of errors and delay in reporting. Advances in image processing and machine learning in recent years have shown acceptable performance characteristics and have promising applications in the diagnostic laboratory. Use of these newly-developed technologies can address the stated problems and provide an alternative approach in the microscopic analysis of erythrocytes. Methodology. This prospective validation study compared digital image analysis using a machine-learning based image recognition algorithm with conventional microscopy performed by a trained microscopist, which served as the reference standard. Random deidentified anticoagulated peripheral blood samples submitted to the hematology laboratory were assessed. Results. A total of 956 erythrocytes were evaluated after image processing using support vector machine and routine microscopy as classifiers of erythrocytes into three categories: size, central pallor, and shape. The tested software was able to achieve a strong level of agreement compared to conventional microscopy, having kappa values ranging from 0.81 to 0.86. Accuracy for size, central pallor and shape were 89.88%, 93.72% and 87.89%, respectively. Conclusion. The validated image recognition software is an acceptable diagnostic test in determining erythrocyte morphology in peripheral blood smears. Its integration can potentially minimize hands-on time and improve the diagnostic laboratory workflow. Registration. Philippine Health Research Registry (PHRR) ID: PHRR191211-002348; University of the Philippines Manila Research Ethics Board (UPMREB): 2019-356-01.