Pseudobasophilia as a Screening Tool in Dengue: A Single Center Study.

Objectives Proper serological testing for the definite diagnosis of dengue is costly and may not be easily available in a resource-limited setting. Hematological parameters can help in the early identification of dengue cases. This study aims to evaluate the occurrence and utility of pseudobasophilia in identifying dengue-affected patients. Materials and Methods This retrospective cross-sectional study included 1,304 dengue cases confirmed by serology and 1,044 dengue serology negative acute febrile illness cases as controls. Complete blood count (CBC) values of the first EDTA (ethylenediamine tetraacetic acid) blood sample from automated hematology analyzers were reviewed. The hematological parameters in the dengue and control groups were compared and the variation of these parameters with the day of fever was also analyzed. Statistical Analysis Mann-Whitney's test, Kruskal-Wallis test, and Fisher's exact test were used for statistical analysis. A p -value < 0.05 was considered statistically significant for all tests. Results There was a statistically significant variation between dengue cases and controls for hematocrit, platelet count, mean platelet volume, total white blood cell count, and absolute basophil count. The dengue group had a higher hematocrit from day 2 to day 10, platelet count ≤ 100,000/µL from day 4 to day 9, higher mean platelet volume from day 2 to day 7, leucopenia from day 3 to day 5, and higher absolute basophil count from day 2 to day 10. Interestingly, pseudobasophilia was seen in 533 (40.87%) of dengue cases and only 3 (0.28%) of the controls. Pseudobasophilia was also observed to have an increasing trend to the day of fever. Conclusion Pseudobasophilia along with other CBC parameters is useful and cost effective for the early identification of dengue. This can prompt early investigations and supportive treatment leading to improved clinical outcomes.

The Bethesda System for Reporting Thyroid Cytopathology: A Cytohistological Study.

INTRODUCTION: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a significant step to standardize the reporting of thyroid fine needle aspiration (FNA). It has high predictive value, reproducibility, and improved clinical significance. AIM: The study was aimed to evaluate the diagnostic utility and reproducibility of "TBSRTC" at our institute. Methods and Material. The study included 646 thyroid FNAs which were reviewed by three pathologists and classified according to TBSRTC. Cytohistological correlation was done for 100 cases with surgical follow-up and the sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and risk of malignancy (ROM) were calculated. The interobserver variation among three pathologists was also assessed. RESULTS: The distribution of cases in various TBSRTC categories is as follows: I-nondiagnostic 13.8%, II-benign 75.9%, III-atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) 1.2%, IV-follicular neoplasm (FN)/suspicious for follicular neoplasm (SFN) 3.7%, V-suspicious for malignancy (SM) 2.6%, and VI-malignant 2.8%. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy are 72.4%, 94.3%, 84%, 89.2%, and 87.9%, respectively. The ROM of various TBSRTC categories were II-8.5%; III-66.7%; IV-63.6%; and V and VI-100%. Cohen's Weighted Kappa score was 0.99 which indicates almost perfect agreement among the three pathologists. CONCLUSIONS: Our study substantiates greater reproducibility among pathologists using TBSRTC to arrive at a precise diagnosis with an added advantage of predicting the risk of malignancy which enables the clinician to plan for follow-up or surgery and also the extent of surgery.

Predictors of Unsatisfactory Conventional Pap Smears.

OBJECTIVE: The objective of this study is to determine the clinical predictors of unsatisfactory Pap smears. METHODOLOGY: This was a case-control study done in a tertiary care institute. All unsatisfactory conventional pap (CP) smears between January 2015 and June 2017 were retrieved, and the slides were viewed. Clinical details were recorded from request forms and case files. Simple and multiple logistic regression analyses were used to identify the predictors of unsatisfactory CP smears. RESULTS: In this study, we have included 314 unsatisfactory Pap smears and 541 controls with satisfactory Pap smears. Clinical parameters such as older age and cervical erosion proved to be important predictors of unsatisfactory pap smears. The most common reason for unsatisfactory pap smears was due to a paucity of epithelial elements (66.6%), followed by obscuration of smear details by blood/inflammatory cells/mucus (9.9%) and air drying artifacts (4.4%). There were multiple reasons in 19.1% of cases with unsatisfactory pap smears. CONCLUSION: Our study shows that older age groups and cervical erosion are predictors of unsatisfactory pap smears. Incidence of unsatisfactory pap smears can be reduced by education and retraining of health-care workers and doctors.

Pulmonary alveolar microlithiasis: an interesting case report with systematic review of Indian literature.

Pulmonary alveolar microlithiasis is a rare disease characterized by intra-alveolar presence of microliths. This study reports an interesting case of pulmonary alveolar microlithiasis and provides a systematic review of cases reported from India. A 23-year-old female presented with a history of cough, wheeze, chest pain, and episodic wheeze for five months. Pulmonary function tests demonstrated an obstructive pattern, and chest Xray showed fine micronodular opacities predominantly involving the middle and lower zones of both lungs. Transbronchial lung biopsy revealed the diagnosis. She responded well to inhaled steroid therapy. A systematic review of literature was performed and identified 73 cases of pulmonary alveolar microlithiasis reported from India. The mean (SD) age of the patients was 28.8 (14.9) years, with an almost equal male:female ratio. Many patients were asymptomatic at presentation. Breathlessness and cough were the most common symptoms, and the disease progressed into respiratory failure associated with cor pulmonale. About one-third of the cases were initially misdiagnosed and treated as pulmonary tuberculosis. Extra-pulmonary manifestations and comorbidities were also evident in our series. This systematic review helps to determine epidemiological and clinical characteristics of pulmonary alveolar microlithiasis. Further research is needed to elucidate the etiopathogenesis, diagnosis, and therapeutic options, which are beneficial in developing and identifying cost-effective treatment for pulmonary alveolar microlithiasis.

Utility of nuclear morphometry in effusion cytology.

BACKGROUND: The cytological analysis of serous effusions is a common investigation and yields important diagnostic information. However, the distinction of reactive mesothelial cells from malignant cells can sometimes be difficult for the cytopathologist. Hence cost-effective ancillary methods are essential to enhance the accuracy of cytological diagnosis. The aim of this study was to examine the utility of nuclear morphometry in differentiating reactive mesothelial cells from malignant cells in effusion smears. MATERIALS AND METHODS: Sixty effusion smears consisting of 30 effusions cytologically classified as malignant (adenocarcinomas) and 30 benign effusions showing reactive mesothelial cells were included in the study. ImageJ was used to measure the nuclear area, perimeter, maximal feret diameter, minimal feret diameter and the circularity. A total of ten representative cells were studied in each case. RESULTS: Significant differences were found between benign and malignant effusions for the nuclear area, perimeter, maximal feret diameter and minimal feret diameter. No significant difference was found for circularity, a shape descriptor. Receiver operating characteristic (ROC) curve analysis revealed that nuclear area, perimeter, maximal feret diameter, and minimal feret diameter are helpful in discriminating benign and malignant effusions. CONCLUSIONS: Computerised nuclear morphometry is a helpful ancillary technique to distinguish benign and malignant effusions. ImageJ is an excellent cost effective tool with potential diagnostic utility in effusion cytology.

Predictive value of micronucleus count in cervical intraepithelial neoplasia and carcinoma.

OBJECTIVE: A micronucleus is a small additional nucleus formed due to chromosomal loss or fragmentation. The aim of this study was to assess the utility of micronucleus count as a screening tool in cervical cancer. MATERIAL AND METHOD: A total of 132 cases consisting of 42 pre-neoplastic and neoplastic cases and 90 non-neoplastic cases were studied. Only routine Papanicolaou-stained cervical smears were used. In each smear, the number of micronucleated cells and binucleated cells were counted under oil immersion and expressed as a count per 1,000 cells. The micronucleated and binucleated cell counts in pre-neoplastic, neoplastic and non-neoplastic categories were compared for statistical significance. The counts were also correlated with age, duration of marital life, number of pregnancies and abortions. RESULTS: The micronucleus count and the binucleated cell count were significantly higher in the high -grade squamous intraepithelial lesion (HSIL) and invasive carcinoma categories compared to low -grade squamous intraepithelial lesion (LSIL) and non-neoplastic cases. Receiver operating characteristic (ROC) curve analysis revealed that micronucleus count and binucleated cell count possess a high degree of sensitivity and specificity for identifying HSIL and invasive carcinoma. CONCLUSION: Our results reveal that micronucleus evaluation in routine Pap smears is a very useful biomarker in cervical cancer screening. The binucleated cell count increases the predictive value of this simple test.