Utility of anticoagulation, pre-smearing and post-smearing hemolytic techniques on morphological assessment and reproducibility in fluid cytology.

Objective: Knowledge of proper collection, storage, preservation, and processing techniques is critical to ensuring proper handling and analysis of fluid cytology specimens. This study was conducted to determine the effect of anticoagulation, pre-smearing acetic acid treatment technique, and saline rehydration technique on morphological assessment, reproducibility, and reporting in fluid cytology. Material and Methods: The study was carried out in the cytopathology laboratory over 2 months (April-May 2022), where 100 effusion samples were analyzed. At least 20-40 mL of fluid was collected in heparinized and non-heparinized containers for each patient. Samples were processed in cytospin and stained with Giemsa and Papanicolaou stains. For 70 hemorrhagic specimens, an extra smear was prepared from the sediment and subjected to the saline rehydration technique as per the Indian Academy of Cytologists (IAC) guidelines. Seventy-three hemorrhagic specimens whose quantity received was more than 35 mL were subjected to the pre-smearing technique. These smears were evaluated for (a) the presence or absence of blue background/any other background staining, (b) cellularity, (c) cell morphology and (d) the presence/absence of microclots. Results: Heparinized samples showed no compromise in cellular morphology or cellularity although a blue background was observed in an occasional case. The pre-smearing technique had less background hemorrhage and preserved cell characteristics. The post-smearing saline rehydration technique did not compromise the cellularity but distorted morphology and showed background staining. Conclusion: The pre-smearing acetic acid treatment showed better-preserved cellularity and cytomorphology with the absence of background staining when compared to the post-smearing saline rehydration technique.

Tubercular longitudinally extensive transverse myelitis with lower motor neuron paralysis.

Transverse myelitis typically extends two or less spinal segments, whereas longitudinal extensive transverse myelitis (LETM) extends three or more spinal segments in length and may occasionally span all the segments of the spinal cord. We present a case of spinal tuberculosis presenting with LETM with true lower motor neuron-type flaccid paraplegia.

A rare co-occurrence of optochiasmatic tuberculoma and guillain-barre syndrome as a paradoxical reaction in tubercular meningitis.

Tuberculosis (TB) is the leading infectious cause of death worldwide. Tubercular meningitis is the most severe form of extrapulmonary TB which carries high morbidity and mortality. Intracranial tuberculoma may develop paradoxically during the treatment of tubercular meningitis, which is a quite rare occurrence. There are many reported cases of paradoxical development of optochiasmatic tuberculoma during the treatment of tubercular meningitis, causing severe visual impairment. Association of Guillain-Barré syndrome with TB is a rare entity. However, the co-occurrence of optochiasmatic tuberculoma and Guillain-Barré syndrome is even rarer and not reported before in literature. Here, we present the first case of co-occurrence of optochiasmatic tuberculoma and Guillain-Barré Syndrome, developing as a paradoxical reaction in a 23-year-old male.

Tuberculosis in Chronic Kidney Disease.

INTRODUCTION: Given the increasing prevalence of chronic kidney disease (CKD) in tuberculosis (TB) endemic areas, a merging of CKD and TB epidemics could have significant public health implications, especially in low to middle income countries like India, which is experiencing rapid increase in CKD prevalence. The aim of this study is to analyze the prevalence of TB in patients with CKD. METHODS: A prospective study was done on 160 patients with CKD at Safdarjung Hospital, New Delhi, both with and without dialysis. The patients were investigated to detect any form of TB. RESULTS: 22 patients showed evidence of tubercular infection (13.7%). Of these 22 subjects, 17 had extra-pulmonary and only 5 had pulmonary TB. TB infection was more prevalent among the patients on dialysis (18) than those who were not on dialysis (4). CONCLUSION: Therefore, we infer that TB is more common in patients of CKD and patients of CKD need to be screened for TB more so due to their over lapping signs and symptoms.