Prevalence of infectious organisms observed in cervical smears between 1997-2014 at mubarak al kabeer hospital, kuwait

Objectives: This study aimed to examine gynaecological infectious agents observed in conventional and modified Papanicolaou cervical smears [CS] at a tertiary care hospital in Kuwait

Methods: This retrospective study analysed 121,443 satisfactory CS samples collected between 1997–2014 at the Mubarak Al-Kabeer Hospital, Kuwait. Conventional CS samples were obtained between 1997-2005, while modified CS were obtained between 2006-2014 following the introduction of ThinPrep testing [Hologic Corp., Bedford, Massachusetts, USA]. All samples were initially screened by cytoscreeners before being analysed by cytopathologists to determine the presence of specific infectious agents

Results: Overall, 8,836 [7.28%] of the cervical samples had infectious agents; of these, 62.48% were conventional and 37.52% were modified CS samples. The most frequently observed infectious agents were Candida species [76.05%], Trichomonas vaginalis [9.72%], human papillomavirus [HPV; 9.3%], Actinomyces-like organisms [3.23%], Chlamydia trachomatis [1.27%] and the herpes simplex virus [HSV; 0.43%]. There were significantly more cases of Candida species, HPV-associated changes, C. trachomatis, T. vaginalis and Actinomyces-like organisms detected in conventional compared to modified CS samples [P <0.050 each]. However, there was no statistically significant difference in the frequency of HSV-associated changes [P = 0.938]. The presence of two infectious agents in the same sample was identified in 0.87% of samples

Conclusion: Among CS samples collected during an 18-year period, Candida species were most frequently detected, followed by T. vaginalis and HPV. The identification of potential infectious agents is a valuable additional benefit of Papanicolaou smear testing

Trends in epithelial cell abnormalities observed on cervical smears over a 21-year period in a tertiary care hospital in Kuwait

This study aimed to analyse trends in epithelial cell abnormalities [ECAs] in cervical cytology at a tertiary care hospital in Kuwait. ECAs in 135,766 reports were compared over three seven-year periods between 1992 and 2012. Conventional Papanicolaou [Pap] smear tests were used in the first two periods and ThinPrep [Hologic Corp., Bedford, Massachusetts, USA] tests were used in the third. Significant increases in satisfactory smears, atypical squamous cells of undetermined significance [ASCUS] and atypical glandular cells of undetermined significance/atypical glandular cells [AGUS/AGCs] were seen in the second and third periods [P <0.001]. No significant increases were observed among low-grade squamous intraepithelial lesions [LSILs] or high-grade squamous intraepithelial lesions [HSILs] [P >0.05]. An increase was noted in carcinomas between the first and second periods although a significant decline was seen in the third [P <0.014]. Satisfactory smears, ASCUS and AGUS/AGC increased during the study period although no significant increases in LSILs, HSILs or carcinomas were observed

Prevalence and correlation of human papilloma virus and its types with prognostic markers in patients with invasive ductal carcinoma of the breast in Kuwait

This study aimed to document the association of human papilloma virus [HPV] and its types in breast carcinoma tissues in Kuwaiti women, and correlate this with known prognostic markers. The clinicopathological data of archived tissue from 144 cases of invasive ductal breast carcinoma were studied [age, histological grade, size of tumour, lymph node metastases, oestrogen/progesterone receptors and human epidermal growth factor receptor 2 status]. HPV frequency was documented using immunohistochemistry [IHC] and chromogenic in-situ hybridisation [CISH]. HPV types were documented by CISH using HPV probes. CISH and IHC techniques were compared and HPV correlated with prognostic parameters. The HPV prevalence as determined by CISH and IHC was 51 [35.4%] and 24 [16.7%] cases, respectively. The sensitivity of HPV by IHC was 37.3% and specificity was 94.6%. The sensitivity and specificity of HPV-CISH compared to HPVIHC was statistically significant [P <0.001]. HPV-CISH was seen in 51 cases. A combination of HPV 6 and 11, and 16 and 18 was seen in 2 [3.9%] cases, and a combination of HPV 6, 11, 31 and 33 was seen in 7 [13.7%] cases. All three HPV probes: 6 and 11, 16 and 18, as well as 31 and 33 were present in 2 [3.9%] cases. The prevalence of HPVCISH in the Kuwaiti and non-Kuwaiti populations was 27 [52.9%] and 19 [37.2%], respectively. No correlation was observed with the prognostic parameters. The frequency of HPV in breast carcinoma cases in Kuwait was 35.4% [CISH]. Of those, 52.9% were Kuwaitis in whom both low- and high-risk HPV types were detected

Urinary survivin mRNA expression and urinary nuclear matrix protein 22 BladderChek[R] and urine cytology in the detection of transitional cell carcinoma of the bladder

To compare the diagnostic performance of urine cytology [UC], survivin mRNA expression, and the NMP22 BladderChek[R] [NMP22BC] test for the detection, grading and staging of transitional cell carcinoma [TCC] of the bladder. Voided urine samples collected from 25 healthy controls and 80 patients diagnosed with TCC of the bladder were subjected to UC, the NMP22BC test and reverse-transcription real-time PCR for survivin mRNA expression. Survivin mRNA expression showed the highest sensitivity [87.5%] followed by the NMP22BC test [61.3%] while UC exhibited the lowest sensitivity [40%]. All three urine markers had a similar specificity of 96% [95% CI 80.5-99.3%]. Survivin mRNA expression was the only urine marker that showed a significant difference in relation to tumour histological grade [X[2] 8.5, p = 0.015]. None of the three urine markers was significantly related to tumour pathological stages. The diagnostic sensitivity of urinary urviving mRNA expression was superior to that of UC and the NMP22BC test and correlates with tumour pathological grade but not stage

Fine needle aspiration cytology in the diagnosis of superficial lymphadenopathy in children and adolescents: an analysis of 869 cases

Fine needle aspiration cytology [FNAC] in children has gained acceptance gradually and is currently used extensively as an initial diagnostic tool. This study was undertaken to determine the value of FANC in peripheral lymphadenopathy in pediatric and adolescent patients in Kuwait. Retrospective. Mubarak Al-Kabeer Hospital, Kuwait. Eight hundred and sixty-nine children and adolescents [ranging from five months to 20 years] from January 2000 to September 2009. FNAC. The spectrum of disease of lymph nodes in pediatric and adolescent age groups, using FNAC. Out of the 4116 lymph node aspirates performed, the cytology reports of 869 [21.1%] pediatric aspirates were reviewed. There were 409 [51.3%] male and 388 [48.7%] female patients. Seventy-two [8.3%] were considered unsatisfactory. Out of the 797 [91.7%] satisfactory aspirates, reactive lymphoid tissue was reported in 616 cases [77.3%], lymphadenitis in 115 [14.4%], atypical cytology in 18 [2.3%], lymphoreticular malignancy in 46 [5.7%] and metastatic tumor in 2 [0.3%]. The lymphadenitis included 8, 66, 23 and 18 cases of necrosis only, granulomatous lymphadenitis, necrotizing granulomatous lymphadenitis and tuberculous lymphadenitis [where acid fast bacilli were detected respectively. FNAC of lymph nodes in children and adolescents is feasible and reliable. Majority of the nodes revealed reactive lymphoid tissue and helped allay the fears of parents thereby preventing unnecessary surgery

Correlation of fine needle aspiration cytological features of extra-pulmonary tuberculous lesions with detection of acid fast bacilli-Mubarak Al Kabeer hospital, Kuwait experience

To correlate the spectrum of cytomorphological changes in fine needle aspirates [FNA]of extrapulmonary tuberculous lesions with the demonstration of acid fast bacilli [AFB] by Ziehl-Neelsen [ZN] staining and culture of the mycobacterial organism Prospective, from January 2008 to August 2009 Mubarak Al Kabeer Hospital, Kuwait Three hundred and eighty-one patients with suspected tuberculosis FNA was done on lymph nodes [313 cases, 82%], soft tissue [37 cases, 10%], breast [24 cases, 6%], thyroid [3 cases, 1%] and epididymis [4 cases, 1%]. Papanicolaou and / or May-Grunwald-Giemsa [MGG] stained smears were classifiedinto:Group A: granulomas with necrosis [n=202,53%], Group B: granulomas alone [n=59, 15.5%], Group C: acellular necrosis alone [n=53, 13.9%] and Group D: acute inflammatory exudate [n=67,17.6%]. The cytomorphological features of extra-pulmonary tuberculosis in FNA were correlated with AFB demonstration by ZN staining and mycobacterial culture. The AFB positivity by ZN stain was 46.6, 7.9, 58.1 and 22% in groups A, B, C and D respectively. Culture was positive in 53.1, 6.7, 56 and 15.4% in groups A, B, C and D respectively. In 32 out of 109 cases both ZN staining and culture were positive. In 77 cases negative for AFB the culture was positive in 31.2% and negative in 68.8%. Evaluation of all FNA from suspected cases of tuberculosis should include staining for AFB and culture for mycobacteria

Changing spectrum of squamous cell abnormalities observed on papanicolaou smears in Mubarak Al-Kabeer Hospital, Kuwait, over a 13-year period

The aim of this study was to determine the incidence of squamous cell abnormalities in cervical cytology in Mubarak Al-Kabeer Hospital, Kuwait, and to document any change in the pattern of these lesions. Over a 13-year period [1992-2004], 86,434 cervical smears were studied in Mubarak Al-Kabeer Hospital, Kuwait. Conventional Pap smears were first examined by cytotechnicians and finally reported by cytopathologists. The smears were classified according to the modified Bethesda system. The age of presentation of squamous cell abnormalities in Kuwaiti women was analyzed. Smears from 83,052 [96.09%] patients were found satisfactory for reporting while the remaining 3.9% was unsatisfactory. Atypical squamous cells of undetermined significance [ASCUS] were seen in 1,790 [2.2%] cases, atypical glandular cells of undetermined significance [AGUS] in 630 [0.8%] cases, low grade squamous intraepithelial lesion including human papillomavirus changes [LSIL] in 824 [1.0%] cases, high grade squamous intraepithelial lesion [HSIL] in 189 [0.2%] cases, and carcinoma in 79 [0.1%] cases of which 44 [0.05%] were squamous cell carcinoma. A comparison of average cases/annum during the study period revealed a significant increase in ASCUS from 1.13 to 2.83% [p < 0.001] and AGUS from 0.33 to 1.08% [p < 0.001]. However, the percentage of LSIL, HSIL and carcinoma detected in Pap smears remained the same. A significant linear trend [p < 0.001] was observed in satisfactory smears, ASCUS and AGUS over the years. However, no significant change was found in the detection of LSIL, HSIL and carcinoma. A reduction in the age of LSIL/HSIL and an increasing trend in the number of Kuwaiti women over the years was also observed which makes screening of young women essential in Kuwait

Chronic lymphocytic [Hashimoto's] throiditis in Kuwait diagnosed by fine needle aspirates

A retrospective analysis of 4185 consecutive fine needle aspirates [FNA] of the thyroid over an eight year period at a teaching hospital in Kuwait revealed that 14.3% of all the aspirates had features of chronic lymphocytic [Hashimoto's] thyroiditis [HT]. The proportion of patients with HT showed a slight increase in the last two years but the pattern of clinical presentation has remained unchanged. Hashimoto's thyroiditis was most prevalent in the age group from 16 to 35 and the majority of young patients with Hashimoto's thyroiditis presented with diffuse goiter [DG] whereas multinodular goiter [MNG] and solitary thyroid nodule [STN] were more common in the older age group. Of patients who presented with STN, the most common abnormality on thyroid scan was a [cold nodule]. Functional disturbances [hypo and hyperthyroidism] occurred less frequently in patients presenting as STN than in patients presenting with DG or MNG. We conclude that FNA is indicated in all young patients with diffuse goiter in this region in order to facilitate early detection and initiation of suppressive thyroxine therapy. Further, when young patients present with [cold] solitary nodules of the thyroid, HT is a more common cause than a thyroid carcinoma in Kuwait