Diagnostic triad of pulmonary anthracofibrosis in spiral CT scan - a retrospective study.

PURPOSE: Anthracosis, a form of pneumoconiosis commonly caused by air pollution and other environmental factors, is a new entity in respiratory disorders. Bronchoscopy and transbronchial lung biopsy (TBLB) are the gold standard of diagnosis. Herein, we evaluated the results of bronchoscopy and chest computed tomography (CT) scans of 187 anthracotic patients. MATERIAL AND METHODS: Between April 2016 and April 2017, 187 cases (99 males, mean age 65 ± 10.2 years) who underwent flexible bronchoscopy and TBLB for various indications were considered for this study. CT examinations of these patients were reported as "blind to bronchoscopy results" by two experienced board-certified radiologists. RESULTS: According to the results of bronchoscopy and TBLB, 100 patients were diagnosed as anthracotic. CT scans confirmed 71 of these cases as anthracosis. Sensitivity, specificity, PPV, NPV, and accuracy of hyperdense non-calcified mediastinal and hilar lymph nodes, known as "brilliant lymph nodes", compared to bronchoscopy were 55%, 92%, 89%, 64%, and 72%, respectively (CI: 95%). Also, there was a positive correlation between anthracosis and brilliant lymph nodes (p-value = 0). Analysis of hyper-attenuated lung with bronchoscopy estimated sensitivity, specificity, PPV, NPV, and accuracy gave 41%, 94%, 89%, 58%, and 65%, respectively (CI: 95%). The specificity of brilliant lymph nodes, hyper-attenuated lung, and multi-segmental atelectasis as a diagnostic "triad of anthracosis" was 100%. CONCLUSIONS: Based on our analyses, the triad of brilliant lymph nodes, hyper-attenuated lung, and multi-segmental atelectasis was identified as a reliable set of imaging findings for the diagnosis of anthracosis.

The Utility of Phosphohistone H3 in Inter-Observer Variability of Mitotic Count in Meningioma, is There Any Benefit?

OBJECTIVE: One of the most reliable and decisive histologic parameters with negative prognostic impact is tumor proliferation capacity . Quantification of mitosis in H&E stained slides could be problematic and is limited by poor reproducibility and lack of objectivity. This study was designed to evaluate inter-observer variability in mitotic count using Phosphohistone H3(PHH3). METHODS: Totally, 60 specimens with histologic diagnosis of meningioma were selected including 50 grade I, 7 grdae II and 3 grade III tumors. Mitotic figures were counted both in H&E stained sections and slides prepared by immunohistochemistry using Anti-Phosphohistone H3 Anti body by three observers with various level of expertise, independently. RESULTS: Mean mitotic count by PHH3 method was higher than H&E staining for all three observers. Observer 1 and 2 revealed good correlation in mitotic count using H&E method, while observer 3 showed disagreement with both of them. However, all of them had good correlation in mitotic count using PHH3 method (cc=0.956,0.947,0.909). CONCLUSION: Based on our findings, PHH3 revealed good agreement between pathologists with various level of expertise and has the capability for further contribution in meningioma grading classification and specially could be beneficial for less experienced pathologists.

Unexpected Presentation of COVID-19 in a 38-Year-Old Male Patient: A Case Report.

We presently report the case of COVID-19 in a 38-year-old male who had come to the primary health care clinic of Shahid Beheshti University of Medical Sciences, which specializes in the COVID-19 epidemic. He reported having fatigue, myalgia, fever, rash, and loss of taste and smell. The physical findings were maculopapular rash over his trunk, inguinal regions, and left arm, erythema of larynx with an aphthous lesion on left tonsil, he did not have a fever, and respiratory distress symptoms. There were no changes regarding COVID-19 in the spiral lung CT scan. However, the result of PCR for COVID-19 RNA was positive.

Necessity of Routine Repeat Testing of Critical Values in Various Working Shifts.

BACKGROUND & OBJECTIVE: Accurate and timely reporting of critical values is an important issue. There is some doubt whether repeat testing of critical values would offer any advantage over single testing or not. The aim of this study was evaluation of utility of routine repeat testing of critical values in our referral center and to compare probable variations in different working shifts. METHODS: Clinical results of serum Potassium, Calcium, Blood Hemoglobin and Prothrombin Time (INR: International Normalized Ratio) were evaluated for three months. RESULTS: Totally, 178, 96, 67 and 107 consecutive critical values for Potassium, Calcium, Hemoglobin and INR were reported, respectively. In potassium and Hemoglobin 5.05% and 1.17% of retest runs exceeded the accep1 tolerance limit. All of the calcium retest results were within the acceptable limit. For INR, 21/107 retest results did not meet the acceptable tolerance limit, nine still were critical. Afternoon working run performance was significantly better than the two others. CONCLUSION: Our observation suggests that routine repeat of hematology and chemistry critical test result is not necessary and may adversely affect patient safety measure. However, attention should be paid to results greater than analytical measurement range and all such results should be repeated before reporting.