Improving diagnosis of tuberculous lymphadenitis by combination of cytomorphology and MPT64 immunostaining on cell blocks from the fine needle aspirates.

BACKGROUND: Extra pulmonary tuberculosis (EPTB) constitutes 18% of all tuberculosis (TB) cases and tuberculous lymphadenitis (TBL) constitutes 20-40% of EPTB. Diagnosis of TBL is challenging because of the paucibacillary nature of the disease. OBJECTIVE: To investigate the diagnostic potential of a new antigen detection test based on the detection of M. tuberculosis complex specific antigen MPT64 from fine needle aspirate (FNA) cytology smears and biopsies obtained from patients with clinically suspected TBL using immunohistochemistry (IHC). MATERIALS AND METHODS: This study was conducted at Khyber Teaching Hospital and Rehman Medical Institute, Peshawar, Pakistan, from January 2018 to April 2019. Samples, including FNA (n = 100) and biopsies (n = 8), were collected from 100 patients with presumptive TBL. Direct smears and cell blocks were prepared from the FNA samples. All samples were subjected to hematoxylin-eosin (H&E) staining, Ziehl-Neelsen (ZN) staining, and immunostaining with polyclonal anti-MPT64 antibody. The culture was performed only for biopsy specimens. All patients were followed until the completion of anti-TB treatment. The response to treatment was included in the composite reference standard (CRS) and used as the gold standard to validate the diagnostic tests. RESULTS: The sensitivity, specificity, positive and negative predictive values for ZN staining were 4.4%,100%,100%,56%, for culture were 66%,100%,100%,50%, for cytomorphology were 100%,90.91%,90%,100%, and for immunostaining with anti-MPT64 were all 100%,respectively. The morphology and performance of immunohistochemistry were better with cell blocks than with smears. CONCLUSION: MPT64 antigen detection test performed better than ZN and cytomorphology in diagnosing TBL. This test applied to cell blocks from FNA is robust, simple, and relatively rapid, and improves the diagnosis of TBL.

Paediatric Urinary Tract Infection: A Hospital Based Experience.

INTRODUCTION: Paediatric Urinary Tract Infection (UTI) is one of the commonly encountered entities by paediatricians. Studies have shown easy vulnerability of paediatric urinary tract in any acute febrile illness and a miss in diagnosis could have long term consequences like renal scaring with its adverse effects. Bearing these evidence based preludes in view we designed our study to know the prevalence of UTI in Kashmir province. AIM: Aim of the present study was to know the prevalence of UTI in febrile children and to know the sensitivity of different imaging modalities like Renal and Urinary Bladder Ultrasonography (RUS), Voiding Cystourethrography (VCUG) and Dimercaptosuccinic Acid (DMSA) scan in diagnosing UTI. MATERIALS AND METHODS: A total of 304 patients, between 2 months to 10 years, with axillary temperature of ≥ 100.4oF (38oC), who did not have a definite source for their fever and who were not on antibiotics were included in the study. Detailed history and through clinical examination was done to rule out any potential or definite focus of infection as per the predesigned proforma. Routine urine examination with culture and sensitivity, followed by RUS and VCUG was done in all patients where routine urine examination was suggestive of UTI. DMSA was done in only culture proven cases after 6 months to document the renal scarring. RESULTS: Out of 304 children, 140 were males and 164 were females, UTI was present in 40 patients who had fever without any apparent cause giving a prevalence of 13.2%. Escherichia coli (E. coli) were the commonest isolated organism, followed by Klebsiella and Citrobacter species. Renal and Urinary Bladder Ultrasonography (RUS) detected Vesicoureteral Reflux (VUR) in 25% (10/40) while VCUG showed VUR in 55% (22/40) giving a RUS sensitivity of 45% for detecting VUR. DMSA done only after 6 months in UTI diagnosed patients showed a renal scarring in 25% (10/40) patients. CONCLUSION: Missing a febrile paediatric UTI, can prove a future catastrophe if not timely diagnosed and treated.

Calcium supplements: an additional source of lead contamination.

The risk posed by the quantity of heavy metal lead present in Ca supplements is of grave concern. Some lead levels have been measured up to the extent of regulatory limit set by the United States. Calcium supplements inevitably get contaminated with lead as both are naturally occurring elements having the same charge density. Therefore, it is imperative to indicate the level of this toxic metal in these supplements in order to create awareness among consumers. The calcium in the supplements is derived from natural as well as synthetic/refined sources (chelated or non-chelated). In this study, a sophisticated analytical technique, atomic absorption spectrometer (both with FAAS and GFAAS modes of atomization), was used for the purpose of analyzing Pb contents in 27 commonly used Ca supplements manufactured by different national and multinational companies. The daily intake of lead through these supplements was calculated. Only 10% of the calcium supplements analyzed met the criteria of acceptable Pb levels (1.5 µg/daily dose) in supplements/consumer products set by the United States. It was also found that Pb intake was highest in chelated calcium supplements whereas lowest through calcium supplements with vitamin D formulation. The Pb concentration in calcium supplements was significantly increased (p < 0.001) according to their composition. In order to validate our results from the study conducted, IAEA-certified reference material (animal bone, H-5) was analyzed for Pb levels. The limit of detection of the method used was 0.05 µg/g and a 95% lead recovery of IAEA-certified reference material (animal bone, H-5).