Atypical glandular cells (AGC): Cytology of glandular lesions of the uterine cervix.

The Pap smear is a well-known screening tool for squamous lesions of the uterine cervix. However, its screening role in glandular lesions is less effective. The incidence of squamous cell carcinoma of the cervix has dramatically decreased with the advent of Pap smear and recent understanding related to HPV carcinogenesis of cervical cancers including the advent of HPV vaccines. However, in recent years, the incidence of glandular abnormalities, diagnosed on Pap smears, has increased with greater sensitivity and precision. The incidence of atypical glandular cells (AGC) is approximately 0.18-0.74% of all cervical smears with a reported prevalence of 2.5% among all Pap smears. A high degree of suspicion, good clinical history, and the presence of diagnostic cytomorphological findings are essential for the proper interpretation of glandular cell abnormalities. A methodical approach to evaluate Pap smear greatly helps interpretation and avoids the diagnostic pitfalls. The Bethesda System for reporting cervical cytology has categorized glandular cell abnormalities into various categories as follows: Endocervical adenocarcinoma in situ (AIS)Atypical glandular cells (AGCs) Endocervical cells: a1 NOS or specify in comments; a2 Favor neoplasticEndometrial cells: NOS or specify in comments Adenocarcinoma (AdCa) EndocervicalEndometrialExtrauterineNOS Subtle differences in quantitative and qualitative cytologic features are essential for distinguishing one category from another. In this chapter, we highlight an organized approach for the interpretation of glandular abnormalities in Pap smear for our readers. This is an overview of the Bethesda categories, the reason for classification, and differential diagnosis with key characteristic features. An approach to the methodical evaluation of hyperchromatic crowded groups is discussed with key cytomorphologic differences. An algorithmic approach is suggested to facilitate the interpretation of various AGC categories.

Squamous intraepithelial lesions (SIL: LSIL, HSIL, ASCUS, ASC-H, LSIL-H) of Uterine Cervix and Bethesda System.

For every 100,000 women in the United States, eight new cervical cancer cases and two deaths are reported as per the most recent (2017) Center of Disease Control and Prevention statistics. Of all the gynecologic cancers (ovary, uterus, cervix, vagina, and vulva), only cervical cancer has a screening test. Cervical Pap test (or Pap smear) is the best screening method for cervical precancerous lesions and is best reported using a unified and a well-established reporting system like The Bethesda System. In this system, "Epithelial cell abnormality: Squamous" includes squamous intraepithelial lesion (SIL) category which encompasses a spectrum of squamous cell lesions starting from the precancerous lesions of low-grade SIL (LSIL) to high-grade SIL (HSIL), and ultimately invasive squamous cell carcinoma. However, depending on the qualitative and quantitative limitations with the specimen, some equivocal morphological features suggestive of squamous cell abnormality may fall under equivocal category: "Atypical Squamous Cells" (ASCs), which are subdivided into two categories; "Atypical Squamous Cells of Undetermined Significance" (ASC-US) or "Atypical Squamous Cells, HSIL cannot be excluded" (ASC-H), based on the suspected underlying lesion LSIL versus HSIL, respectively. This review provides the key cytologic features that distinguish Bethesda squamous categories from other important entities, using algorithmic approach and illustrations of common cytomorphologic patterns for clear identification of those entities in practice. The important mimickers which may be considered during the differential interpretation of SIL are discussed and presented here in a brief cytomorphologic review.

Health risk estimation of metals bioaccumulated in commercial fish from coastal areas and rivers in Bangladesh.

Metal contaminations in commercial fish have become a great public health concern worldwide including Bangladesh. The current study was conducted to provide preliminary evidence of nine metals in three commercially significant fish namely Pampus argenteus, Sardinella longiceps and Tenualosa ilisha collected from four coastal stations- Kuakata, Pathorghata, Cox's Bazar, and Pirojpur, and eight stations of five rivers- Padma, Meghna, Jamuna, Katcha, and Nobogonga in Bangladesh. High magnitudes of Pb (0.74-4.59 mg/kg ww), Cd (0.07-0.24 mg/kg ww), and Mn (0.45-2.03 mg/kg ww) were recorded in the sampling stations that exceeded the maximum permissible limits (MPL) proposed by different recognized organizations. Significant mean differences of metal concentrations were observed (p < 0.05) between species and stations. In fish samples, excessive metals accumulations were recorded from Kuakata (St.1) at the coastal area, and Nobogonga (St. 12) among the rivers. The health risk assessment (HRA) was carried out comprehensively via the estimated daily intake (EDI), target hazard quotient (THQ), hazard index (HI), and target cancer risk (TR) calculations. The outcomes of EDI, THQ, and HI suggest that chronic exposure to towering Pb content might pose potential health threats to inhabitants particularly living in highly polluted stations of the coastal area. In addition, the massive TR values of Cd intake through fish consumption from the coastal area might create cancer risks. Accordingly, the ingestion of metals contaminated fish portends chronic as well as acute health risks to Bangladeshi people living both at home and abroad.

Clinical and immunological benefits of convalescent plasma therapy in severe COVID-19: insights from a single center open label randomised control trial

IntroductionA single center open label phase II randomised control trial was done to assess the pathogen and host-intrinsic factors influencing clinical and immunological benefits of passive immunization using convalescent plasma therapy (CPT), in addition to standard of care (SOC) therapy in severe COVID-19 patients, as compared to patients only on SOC therapy. MethodsConvalescent plasma was collected from patients recovered from COVID-19 following a screening protocol which also included measuring plasma anti SARS-CoV2 spike IgG content. Retrospectively, neutralizing antibody content was measured and proteome was characterized by LC-MS/MS for all convalescent plasma units that were transfused to patients. Severe COVID-19 patients with evidence for acute respiratory distress syndrome (ARDS) with PaO2/FiO2 ratio 100-300 (moderate ARDS) were recruited and randomised into two parallel arms of SOC and CPT, N=40 in each arm. Peripheral blood samples were collected on the day of enrolment (T1) followed by day3/4 (T2) and day 7 (T3). RT-PCR and sequencing was done for SARS-CoV2 RNA isolated from nasopharyngeal swabs collected at T1. A panel of cytokines and neutralizing antibody content were measured in plasma at all three timepoints. Patients were followed up for 30 days post-admission to assess the primary outcomes of all cause mortality and immunological correlates for clinical benefits. ResultsWhile across all age-groups no statistically significant clinical benefit was registered for patients in the CPT arm, significant immediate mitigation of hypoxia, reduction in hospital stay as well as survival benefit was recorded in severe COVID-19 patients with ARDS aged less than 67 years receiving convalescent plasma therapy. In addition to its neutralizing antibody content a prominent effect of convalescent plasma on attenuation of systemic cytokine levels possibly contributed to its benefits. ConclusionPrecise targeting of severe COVID-19 patients is necessary for reaping the clinical benefits of convalescent plasma therapy. Clinical trial registrationClinical Trial Registry of India No. CTRI/2020/05/025209

Ecological risk and source apportionment of heavy metals in surface water and sediments on Saint Martin's Island in the Bay of Bengal.

The study aimed to determine eight hazardous heavy metals in surface water and sediment samples collected from the Naf River, Shah Porir Dwip (estuary), and mostly around Saint Martin's Island in the Bay of Bengal. The results of heavy metals in water samples were ranged as Pb 14.7-313.0, Cd 33.0-70.0, Cr < 11.0-37.0, Cu 38.0-57.0, Zn 26.8-69.2, Ni 102.0-285.0, and Hg 0.3-1.6 µg L-1. The concentrations of metals in sediment samples were ranged as Pb < 10.0-37.5, Cd 0.2-1.0, Cr < 5.0-30.1, Cu < 3.0-30.9, Zn 24.1-88.0, Ni < 4.0-48.3, As 0.1-7.3, and Hg < 0.01-0.08 mg kg-1 dw. Ni and Cr were strongly correlated, suggesting that this pair of metals might diffuse from a common origin. The contamination factor (Cif) demonstrated that sediment samples were mostly contaminated by Cd and slightly contaminated by Pb and Zn. The geoaccumulation index (Igeo) revealed considerable values for Cd on Saint Martin's Island. Cd as a single regulator posed moderate to considerable risk frequently among the sampling stations. Pollution load index (PLI) values remained below 1 (< 1), which indicated a decrease from baseline pollution value among all stations. However, potential ecological risk (PER) was graded for two stations (St1 and St13) with a moderate-risk zone due to the Cd contribution. However, shipping emission and lithogenic sources were the most predominant for heavy metals in the sediment, which were determined by applying the principal component analysis-absolute principal component score (PCA-APCS). Graphical abstract.

Health risk assessment of heavy metal accumulation in the Buriganga and Turag River systems for Puntius ticto, Heteropneustes fossilis, and Channa punctatus.

This study aimed to assess the effects of major ecotoxic heavy metals accumulated in the Buriganga and Turag River systems on the liver, kidney, intestine, and muscle of common edible fish species Puntius ticto, Heteropneustes fossilis, and Channa punctatus and determine the associated health risks. K was the predominant and reported as a major element. A large concentration of Zn was detected in diverse organs of the three edible fishes compared with other metals. Overall, trace metal analysis indicated that all organs (especially the liver and kidney) were under extreme threat because the maximum permissible limit set by different international health organizations was exceeded. The target hazard quotient and target cancer risk due to the trace metal content were the largest for P. ticto. Thus, excessive intake of P. ticto from the rivers Buriganga and Turag could result in chronic risks associated with long-term exposure to contaminants. Histopathological investigations revealed the first detectable indicators of infection and findings of long-term injury in cells, tissues, and organs. Histopathological changes in various tissue structures of fish functioned as key pointers of connection to pollutants, and definite infections and lesion types were established based on biotic pointers of toxic/carcinogenic effects. The analysis of histopathological alterations is a controlling integrative device used to assess pollutants in the environment.