ROLE OF INTERLEUKIN-6 AND PROCALCITONIN AS INFLAMMATORY BIOMARKERS IN EVALUATING COVID-19 DISEASE SEVERITY ON HRCT CHESTAN EXPERIENCE AT CMH QUETTA

Objective: To explore the relation of Interleukin-6 and Procalcitonin with COVID-19 severity on high resolution computerized tomogram (HRCT) chest. Study Design: Randomized Control Trial (NCT04945811). Place and Duration of study: Pathology Department, Combined Military Hospital Quetta, from April 2020 to May 2021. Methodology: Serum Interleukin-6 and Procalcitonin of 100 consenting COVID-19 positive patients from April 2020 to May 2021 were assessed at Pathology department Combined Military Hospital Quetta and their levels were correlated with severity of lung involvement on HRCT Chest Results: Serum Interlukin-6 levels were significantly raised in 97 patients with mean levels of 20.43 ± 19.66 (pg/ml). Serum procalcitonin levels were also significantly raised in 95 patients with mean levels of 0.43 ± 0.24 (ng/ml). Conclusion: Interlukin-6 and procalcitonin are important biomarkers for diagnosis and predicting severity of COVID-19 pneumonia.

Analysis of lethal cases of pneumonia caused by SARS-CoV-2 virus according to the data of pathology department of Kharkiv Regional Clinical Hospital for the first half of 2021

Background. Given the great medical, social and economic significance of clinical research, pathogenesis and epidemiology of coronavirus infection, it is important to study the epidemiological and pathomorphological features of this infection in Ukraine, especially in fatal cases of this disease. Objective: to analyze the lethal cases of pneumonia caused by SARS-CoV-2 in comparison with lethal cases of pneumonia of other etiologies according to the pathology department of Kharkiv Regional Clinical Hospital for the first half of 2021. Methods. The material of this study was the observation of an autopsy from the archival material the pathology department of Kharkiv Regional Clinical Hospital. The study of autopsy protocols took into account the seasonality of the disease, sex and age of the deceased, the number of bed-days, data of clinical diagnosis and coincidences of pathological diagnosis, as well as the ICD code. 256 protocols of pathological examinations for the first half of 2021 were studied. Results. Of the 256 deaths from pneumonia of various etiologies, 201 (78.52%) were caused by SARS-CoV-2 infection. The highest number of deaths from pneumonia was registered in March, April and May 2021. The number of deaths of patients aged 18-44 years was 4.3% of the total, 45-59 years – 13.28%, 60-74 years – 47.27%, 75-90 years – 35.16%. The study sample among patients died of pneumonia caused by SARS-CoV-2 was dominated by women (57.42%, 147 cases), the number of men was 42.58% (109 cases). The direct causes of death were pulmonary-heart failure, multiple organ failure, acute pulmonary insufficiency, chronic pulmonary insufficiency, and pulmonary embolism. Conclusion. The obtained data can be useful for the analysis of regional features of epidemiology and pathogenesis of coronavirus disease in eastern Ukraine.

Clinicopathological study of male breast lesion at a tertiary care in western India (Maharashtra)

Male breast cancer is a rare disease compared to female breast cancer. The reason of the low incidence rate in men is the relatively low amount of breast tissue along with the difference in their hormonal environment. Even though breast tissue is less in men as compared to women, the factors that influence malignant changes are similar. The rare nature of disease and lack of surveillance system for male breast cancer it makes a difficult disease to study. Present study was carried out to understand clinipathological features of male breast lesions.A retrospective descriptive study was carried out in a tertiary care center for 5yeras duration (Jan 2014 to Dec 2018) at pathology department. Demographic, history and histopathological details of male breast lesion were retrieved from database at pathology department.Median age of cases was 58.34+6.67yrs and range of 54-80years. Very few had family history of breast cancer. Alcoholism, obesity and chronic liver disease were risk factors. Most of them were diagnosed as gynecomastia on histopathology findings. One case of phylloid tumor.Changing lifestyle and environmental condition may rise MBC in the future, understanding epidemiology and pathology is need of time for early diagnosis and management.

A Survival Guide for the Rapid Transition to a Fully Digital Workflow: The “Caltagirone Example”

Digital pathology for the routine assessment of cases for primary diagnosis has been implemented by few laboratories worldwide. The Gravina Hospital in Caltagirone (Sicily, Italy), which collects cases from 7 different hospitals distributed in the Catania area, converted the entire workflow to digital starting from 2019. Before the transition, the Caltagirone pathology laboratory was characterized by a non-tracked workflow, based on paper requests, hand-written blocks and slides, as well as manual assembling and delivering of the cases and glass slides to the pathologists. Moreover, the arrangement of the spaces and offices in the department was illogical and under-productive for the linearity of the workflow. For these reasons, an adequate 2D barcode system for tracking purposes, the redistribution of the spaces inside the laboratory and the implementation of the whole-slide imaging (WSI) technology based on a laboratory information system (LIS)-centric approach were adopted as a needed prerequisite to switch to a digital workflow. The adoption of a dedicated connection for transfer of clinical and administrative data between different software and interfaces using an internationally recognised standard (Health Level 7, HL7) in the pathology department further facilitated the transition, helping in the integration of the LIS with WSI scanners. As per previous reports, the components and devices chosen for the pathologists’ workstations did not significantly impact on the WSI-based reporting phase in primary histological diagnosis. An analysis of all the steps of this transition has been made retrospectively to provide a useful “handy” guide to lead the digital transition of “analog”, non-tracked pathology laboratories following the experience of the Caltagirone pathology department. Following the step-by-step instructions, the implementation of a paperless routine with more standardized and safe processes, the possibility to manage the priority of the cases and to implement artificial intelligence (AI) tools are no more an utopia for every “analog” pathology department.

An Epidemiological Survey of Tongue Lesions in the Oral Pathology Department of Khorasgan Dental School From 2010 to 2020

Background and aims: Many pathologic conditions can affect the tongue and their pattern of occurrence may differ. The objective of this study was the epidemiological survey of tongue lesions reported in a 10-year period in the Oral Pathology Department of Khorasgan Dental School. Methods: In this cross-sectional study, 800 biopsy records were retrieved from the archives of the Oral Pathology Department of Khorasgan Dental School and examined. Moreover, the prevalence of lesions was investigated in terms of age and gender using descriptive statistics. Results: The prevalence of lesions analyzed in the present study was 4.37%. About 71.42% of the participants were female and 28.58% were male. Irritation fibroma had the highest frequency (20%). The most frequent lesion among women was lichen planus with a prevalence of 20% and the most frequent lesion among men was irritation fibroma with a prevalence of 30%. The highest frequency was observed in the age group of 21-30 years. Squamous papilloma, lichen planus, and irritation fibroma were the most common lesions with a prevalence of 25%. No lesion was detected in people aged 1-10 years. Conclusion: In the present study, reactive lesions were the most prevalent tongue lesions. According to the findings, changing the lifestyle and observing oral hygiene seem to help prevent these lesions to a large extent.

Pepper Stip: An Abiotic Disorder of Unknown Cause Affecting Pepper Fruit

Pepper stip (meaning speck in German), also referred to as color speck or colour spotting outside the US, is considered a physiological disorder of pepper. The disorder is believed to be related to high calcium status with levels of NH3-N and K playing a role. This 3-page factsheet of the UF/IFAS Plant Pathology Department summarizes known symptoms, causes, and potential environmental stressors that may result in stip development on peppers. Written by Camille McAvoy and Pamela Roberts.

Histopathological Evaluation of Endoscopic Esophageal Biopsies

Background: Esophageal lesions have a wide range of clinical and pathologic spectrum. Understanding the endoscopic and pathologic features of esophageal lesions is critical for detecting, differentiating, and managing them. Esophageal lesions incidence might be neoplastic or non-neoplastic. Aim: The current study aims to assess the clinical, endoscopic and histopathological evaluation of Esophageal Lesions. Materials and Methods: The current cross-sectional study was conducted on 102 esophageal lesions received at the Pathology Department of Gulab Devi Chest Hospital, Lahore for the period during June 2020 to May 2021. Endoscopy was used to obtain esophageal biopsies of either gender, regardless of their age. Each case was microscopically evaluated, and biopsy specimens were immediately secured in 10% buffered neutral formalin. Data analysis and collection was done in SPSS version 21. Results: Out of 102 endoscopic esophageal biopsies referred to Pathology Department for histopathological evaluation,male and female prevalence were 68 (66.7%) and 34 (33.3%) respectively. The overall mean age was 53.24±6.73 with an age range from 21 to 80 years. Based on age, the patient’s biopsies were categorized into six groups. A higher prevalence of esophageal lesions was observed in 51-60 (36.3%) years followed by age group 61-70 years (23.5%). Of the 102 patient’s biopsies,66 (64.7%) biopsy revealed squamous cell carcinoma, squamous dysplasia cases were 12 (11.8%), squamous papilloma was seen in one (0.98%) case, Adenocarcinoma cases were 4 (3.9%), Barrett’s esophagus was 4 (3.9%), esophagitis was 11 (10.8%) and squamous epithelium only was present in 4 (3.9%) cases. Conclusion: Esophageal cancer is the common digestive tract malignancy. Malignancy can be distinguished from non-neoplastic masses on endoscopy by their symptoms, appearanceand size. For an early esophageal disease diagnosis, endoscopy is a popular and developed inspection means which can identify Barrett’s esophagus and squamous dysplasia from malignant lesions,which can help in proper treatment and follow-up. Microscopic evaluation of lesions labeled as inflammatory on endoscopy can turn out to be malignant. This demonstrates the importance of microscopic examination as a confirmatory diagnostic tool. Accurate diagnosis can be carried out on microscopic examination with immunohistochemistry and histochemical stains. Keywords: Esophagus; Epithelial lesions; Sub-epithelial lesions; Endoscopy

Prevalence of Renal Cell Carcinoma in Samples Sent to the Pathology Department of Kabul University of Medical Sciences and City Medical Laboratory

Background: Renal cell carcinoma (RCC) is the most common malignant tumor of the kidney. This tumor originates from the epithelial cells of the renal tubules and is located mainly in the cortical region of the kidney. It constitutes approximately 90% of all kidney malignancies and 2% of all cancers in adults. Objectives: The present study was conducted to determine the prevalence of RCC and its histological subtypes in samples sent to the Pathology Department of Kabul University of Medical Sciences and City Laboratory. Methods: This is a retrospective cohort study of 81 nephrectomy and partial nephrectomy samples registered in the laboratory of the Pathology Department of Kabul University of Medical Sciences and City Medical laboratory database from March 2016 to August 2020. Results: A total of 81 samples were included in this study. The mean and standard deviation (SD) age of the patients was 44.4 ± 20.5. Of 81 samples, 62 (76.6%) were malignant kidney tumors, 13 (16.0%) were inflammatory kidney disease, 4 (4.9%) were polycystic kidney disease, and 2 (2.5%) were benign kidney tumors. Among 62 cases of malignant kidney tumor, 53 (85.48%) were RCC. The high incidence of RCC was in the age group of 56 to 65 years with a mean of 52.2 years; 56.60% of RCC cases were male and 43.39% were female. Based on the histological studies, 75.47% were clear cell renal cell carcinoma (ccRCC) type, followed by 18.86% papillary renal cell carcinoma (PRCC), and 6% chromophobe renal cell carcinoma (ChRCC). Conclusions: Most common malignant tumor of the kidney in the samples included in this study was RCC in the age group of 56 to 65 years and it was more frequent among men compared to women, whereas the most common histological subtype was ccRCC. The findings are in concordance with international literature.

CYTO-DIAGNOSIS OF PLEURAL EFFUSIONS: A COMBINED APPROACH TO MORPHOLOGICAL FEATURES IN ROUTINELY STAINED CYTOLOGY SMEARS AND CELL BLOCK TECHNIQUE

Introduction: Pleural cavity is a potential space between the parietal pleura and visceral pleural. It consists of some amount of uid called pleural uid which is normally less than 25ml. Pleural uid is produced by parietal lining and absorbed by visceral lining. Fluid is produced by plasma ltration through capillary endothelial cells. Aims & Objectives:Acombined approach of cytology and cell block technique in diagnosing the cause of pleural effusion. To evaluate the utility of cell block preparation over the conventional smear in the cytodiagnosis of serous effusions. Material & Methods: The present study was conducted on patients having pleural effusions. The cases and specimens were selected from the outdoor as well as indoor patients admitted in a tertiary care centre of North India and also from those sent directly to Pathology department from other hospitals. The duration of study was from January 2019 to September 2020. The specimens obtained were processed in the biochemistry, cytopathology and histopathology laboratory in the Pathology department of GSVM Medical College, Kanpur. Result And Analysis: Out of 100 cases studied it was found that 83 (83%) cases were of reactive pleural effusion and 17 (17%) cases were of malignant pleural effusions.Out of 17 malignant effusion, 16 (94%) cases were exudative, while 1 (6%) case was transudative.Only 8 cases of adenocarcinoma were diagnosed on smear examination, while 11 cases were diagnosed on cell block examination. 3 cases of poorly differentiated carcinoma were diagnosed on conventional smear and 5 cases on cell block examination.Out of total 17 malignant pleural effusions diagnosed by cell block, only 12 cases were diagnosed by conventional smear examination. Hence diagnostic yield increased by 30% using cell block preparations. Conclusion: Thus it was concluded that routine centrifuge is not satisfactory in reporting uids with scant cellularity. Hence for uids with scant cellularity cell block preparation is a useful method. Also the morphology of the cells were well appreciated by cell block as compared to routine centrifuge, thus aiding in accurate diagnosis. In this study the diagnoses which were missed or incompletely diagnosed on conventional smear were diagnosed by cell block.