Background:The Bethesda system (TBS) 2001 has subdivided the category of atypical squamous cells (ASC) into: ASC-US (undetermined significance) and ASC-H (cannot exclude high-grade squamous intraepithelial lesion (HSIL)). The present study is an analysis of ASC-US and ASC-H cases diagnosed in a screening program practiced in limited resource settings.Methods:During the period January 2005 to December 2008, a total of 9190 smears were received, of which 568 were unsatisfactory. Cases initially diagnosed as ASC-US (n=74) and ASC-H (n=29) on conventional cytology smears were reviewed. Biopsy and human papilloma virus (HPV) results were available in limited cases.Results:On review, diagnosis of ASC-US was retained in 49 (66.2%) of the 74 initially diagnosed ASC-US cases. Remaining 12 cases were re-labeled as negative for intraepithelial lesion or malignancy (NILM), nine as low-grade squamous intraepithelial lesion (LSIL), three as ASC-H and one case as squamous carcinoma (SCC). Similarly, on review, diagnosis of ASC-H cases was retained in 17 of the 29 initially diagnosed ASC-H cases. Seven cases were re-labeled as NILM, three as HSIL and one case each as ASC-US and SCC. Overall, 8622 cases (96.6%) were diagnosed as NILM, 72 (0.83%) as LSIL, 121 (1.40%) as HSIL, 23 (0.26%) as SCC, 50 (0.57%) as ASC-US cases, 20 (0.23%) as ASC-H, five (0.05%) as atypical glandular cells (AGC) and two cases as adenocarcinomas. Out of 50 ASC-US cases, biopsy in 23 cases showed presence of CIN 1 in 16 cases (69.5%) and CIN 2 in one case (4.34%), while the remaining six cases were negative for CIN/malignancy. The remaining 20 cases with unavailable biopsy results were HPV-positive. Out of 20 ASC-H cases, biopsy in 15 revealed CIN 2 and above in 11 cases (73.3%). Three cases (20%) revealed CIN 1.Conclusions:Critical review is helpful in further reducing the number of ASC cases. The percentage of cases with CIN 2 and above is higher with ASC-H cases. The reason for relative increase in HSILs in the present study included referral bias in the screening program.

Background: Urine cytology is a useful modality, primarily for the diagnosis and follow-up surveillance of high-grade urothelial carcinoma (HGUC). Its utility in diagnosing low-grade urothelial carcinoma (LGUC) remains controversial because of low reported sensitivity compared to cystoscopy. Aim: To study the cytomorphology of LGUC in voided urine samples and analyze its utility in diagnosis. Materials and Methods: This is a retrospective study of one year, including 48 voided urine samples in cases which were confirmed as LGUC on subsequent histology. Urine cytology smears of these cases, originally stained with Papanicolaou stain were reviewed, critically analyzed and the specific cytomorphologic and cystoscopic findings were documented. Results: On review 18 samples were re-categorized as LGUC which included 10 samples initially diagnosed as Negative for HGUC, 2 as Atypical Urothelial Cells – Not Otherwise Specified (AUC-NOS) and 6 as Suspicious for Carcinoma. In addition, another 3 samples with initial diagnosis of LGUC remained as LGUC on review. Thus, a total of 21 LGUC samples were identified after the review. 26 (54%) samples with a diagnosis of negative for HGUC remained negative even after review, as the tumor cells were not identified either due to sampling error or unrecognizable morphology. One (2%) samples of AUC-NOS remained the same on review due to very scant atypical cells. In 21 LGUC samples, cytology showed a dual population of benign differentiated urothelial cells and small urothelial cells with subtle nuclear atypia such as irregular and thickened nuclear membrane with increased nuclear cytoplasmic ratio. In 12 false negative LGUC samples, the diagnostic cells were camouflaged by their subtle nuclear atypia coupled with an overwhelming background of differentiated benign urothelial cells as both appeared almost similar in morphology. Papillary fragments were identified only in 2 samples. Conclusions: Diagnosis of LGUC on cytology is challenging and depends on the presence of diagnostic cells, pick up of diagnostic cells on screening and accurate interpretation. Special attention to papillary fragments and aforementioned nuclear atypia should be paid as tumor cells may resemble normal urothelial cells and can be easily missed.

Nucleic Acid Amplification Tests (NAATs) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) have become routine. These methods are validated for use with urogenital samples and have a faster turn-around-time for results with automation. Testing of non-validated samples is common which raises concerns about assay performance. In Australia, the 2005 Public Health Laboratory Network (PHLN) guideline recommends repeat testing of all initial positive GC NAAT results with a suitable alternate NAAT assay. In this study, results from > 70,000 patient samples from 2 laboratories were reviewed in accordance with the PHLN recommendations. The laboratories used the APTIMA Combo 2 (AC2) and APTIMA Neisseria gonorrhoeae (AGC) assays with the PANTHER instrument.72,253 AC2 results were available for analysis which included 1,174 (1.68%) initially AC2 reactive (positive or equivocal) samples which also had results for the AGC assay used as the confirmatory assay. For the reactive samples, the agreement between the AC2 and AGC assays occurred in 97.19% of samples; 1135 were positive in both assays and 6 were equivocal in both assays. Sample types tested included those with manufacturer's validation claims; urine, ThinPrep, vaginal, endocervical and urethral swabs and non-validated samples including throat, rectal, eye and joint fluids. Samples from throat swabs showed the highest numbers of discordant results followed by rectal swab samples. The percentage agreement of results obtained from all sample types was excellent, with an overall PPV of > 99%.Without confirmatory testing, false positive results would have been reported for 13 samples representing 0.02% of all samples tested. This study demonstrates that the initial AC2 results can be accepted with high confidence. Background Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women. Since BV is associated with significant morbidity, accurate tools for diagnosing the disease are important. The Amsel criteria (AC) and Nugent score (NS) are currently used for BV diagnosis. Recently, a number of PCR-based tests providing objective, sensitive and specific BV detection have been described. This study aimed to evaluate a newly developed BV test based on quantitative detection of Gardnerella vaginalis, Atopobium vaginae, Lactobacillus spp. and total Bacteria using multiplex PCR. Methods PCR criteria were elaborated based on the relative counts of the targeted bacteria to classify vaginal microflora as BV, no BV or intermediate. Vaginal samples for the test evaluation were obtained from 274 patients addressing a gynaecologist for routine examination. All participants were of reproductive age, not pregnant and not menstruating at the time of enrollment. BV was diagnosed using the AC and NS. Results According to the NS results, 66 patients were BV positive, 156 were BV negative, and 52 were classified as intermediate. All patients positive by the NS were positive by the AC, and all patients negative by the NS were negative by the AC. Among 66 BV posi...

The novel coronavirus, designated as “Severe Acute Respiratory Syndrome Coronavirus 2” (SARS-CoV-2), is a new coronavirus that has evolved as a global pandemic recently, and it has created a widespread interest in coronaviruses causing human infections. This article compares the pathogenesis, distribution, clinical characteristics, and treatment of the three highly pathogenic coronaviruses that caused epidemics, namely, “Severe Acute Respiratory Syndrome Coronavirus” (SARS), “Middle East Respiratory Syndrome” (MERS), and SARS-CoV-2. This narrative review is prepared using the data compiled from literature search using relevant MeSH terms. The clinical manifestation of SARS-CoV-2 infection (COVID-19) is mild with relatively low fatality rate than the other two coronaviruses; however, its overall capability to cause explosive spread of the disease and reach a pandemic level is greater. Unlike SARS and MERS, COVID-19 has no accepted treatment protocols at present. Extensive studies and analyses on COVID-19 are necessary before making strong recommendations for or against any particular treatment, although some recent medications have shown great potential. COVID-19 still needs further investigation, where all of the lessons gained from previous outbreaks of SARS and MERS and the experience from the countries that managed COVID-19 seem to be the best approaches to counteract this new global hazard at present until effective preventive vaccines are available in sufficient quantity for mass vaccination programs worldwide.