We have had experience with the Hemocue and haemoglobin colour chart
in India and would like to commnet on the report.
For Hemocue they give a cost per test as $0.75 when in fact the cost
of a single cuvette is $0.94 (UK). Further the cost of the instrument in
their report is surprisingly low when compared with colourimeters. For
example the Jenway 6051 costs £799 and the Hemocue £400. In...
We have had experience with the Hemocue and haemoglobin colour chart
in India and would like to commnet on the report.
For Hemocue they give a cost per test as $0.75 when in fact the cost
of a single cuvette is $0.94 (UK). Further the cost of the instrument in
their report is surprisingly low when compared with colourimeters. For
example the Jenway 6051 costs £799 and the Hemocue £400. In table 5,
equipment costs give a four fold difference when in fact it is only
double. Although perhaps of less importance the colour scale is given as
zero when each costs $5 (without delivery charge) and, in our own
experience, infrequent use needs replacing every 2 years.
In addition
there will be the cost of the strips used with the card. We would suggest
that adopting the very expensive Hemocue methodfor widespread estimation
of haemoglobin will delay the introduction of more useful multi-parameter
tests such as semi-automated FBC. We have used the haemoglobin colour
scale in various situations in India including rural and slum antenatal
clinics, medical camps in remote locations, family planning clinics, etc.
In our comparison (unpublished) of the colour scale results against a
reference method our findings are almost identical to those given in Table
2.
Dr RP Britt
Former Haematologist at Hillingdon Hospital and visiting Haematologist to
Ludhiana.
Address: Woodgate, Latchmoor Grove, Gerrards Cross, Bucks, SL9 8LN.
Uterine cervical cancer is one of the most common cancers in women. An estimated 500,000 cases of invasive cancer are diagnosed worldwide each year. Mexico has one of the high incidence rates of cervical cancer 50 cases per 100,000 women. Each year almost 5,000 Mexican women die for this
disease. The high incidence of this disease may reflect the deficiency of early detection screening programs used....
Uterine cervical cancer is one of the most common cancers in women. An estimated 500,000 cases of invasive cancer are diagnosed worldwide each year. Mexico has one of the high incidence rates of cervical cancer 50 cases per 100,000 women. Each year almost 5,000 Mexican women die for this
disease. The high incidence of this disease may reflect the deficiency of early detection screening programs used.
From 1990 to nowadays a plethora of new diagnostic methods have been tried, including fluorescence spectroscopy, new improves to the cytological techniques, as well as molecular biological tests.
Cervical Intraepithelial Neoplasias (CIN) produced by the Human Papilloma Virus (HPV) frequently is not diagnosed by means of the simple techniques described previously. In many medical consulting offices the lack of the optimal equipment, and a simple test to diagnose this disease
have done that the gynaecologists must use laboratory tests that have the consequent waiting times.
The aim of this document is the introduction of a new colposcopic system knows as: The actinic light colposcope and its methodology has been developed to resolve the above problems. The new instrument is specifically for diagnoses the Cervical Intraepithelial Neoplasia.
This new colposcopy technique could be use as screening cervical cancer program, patients and institutions avoid costly studies and procedures that require long times to perform in order to obtain reliable results in the detection of CIN. The results by this technique are obtained in the same moment that the procedure is performed.
The comparative results in this study with 106 women was: the rates from False-positives 3% and False-negatives 13%, against the rates of the "Classical Colposcopy" with ranges from 4 to 33% False-positive and 40 to
62% False-negatives. We expect that in a future this colposcope of actinic light will have a dispositive for a photodynamic therapy (PDT), given 2 functions: Diagnostic and treatment at same moment that the detections are done.
Joel Gerardo Diaz S. MD.
Please follow these links for more information:
New colposcopy technic in the prevention of cervical cancer
Kerr has succinctly outlined the events in the past six decades that assisted the clinicians in a judicious care of infectious diseases [1]. During the past decade several automated devices have been marketed that would reduce the turnaround period for bacteriological culture and susceptibility assays. While the majority of investigators found
such systems to be so commendable, the recent controlled inve...
Kerr has succinctly outlined the events in the past six decades that assisted the clinicians in a judicious care of infectious diseases [1]. During the past decade several automated devices have been marketed that would reduce the turnaround period for bacteriological culture and susceptibility assays. While the majority of investigators found
such systems to be so commendable, the recent controlled investigation on clinical outcome of mortality, morbidity and cost on utility of the Vitek 2 system hospitalized patients in the Netherlands is intriguing. In the 1,100-bed tertiary care teaching hospital there was little utility of the Vitek 2 system as against the conventional overnight methods [2].
In all probability, round the clock functioning of microbiology laboratory and frequent dialogues with health care professionals looking after the hospitalized cases would enhance the clinical utility of any conventional or automated microbiology reporting system. That has been apparent during extended clinical microbiology contact in a tertiary care hospital in the Indian capital metropolis of New Delhi.
Sant Parmanand Hospital, a private sector tertiary care 140-bed hospital in the Indian capital metropolis of New Delhi is managed by a benevolent organization that aims to impart first-rate medical care at rational and reasonably priced expenditure. The microbiology laboratory personnel are available round the clock. Rather than vouching for
apparently quicker but fairly expensive assays like the Vitek 2 system, a reduction with the turnaround time for microbiology reporting has been attempted. Instead of the conventional overnight gap between inoculation of culture media and recording of growth characters, the hospital would follow a 6-8 hour gap for reading the inoculated culture media. Furthermore, there is a constant dialogue with clinicians regarding any growth of pathogenic bacteria. The antibiotics sensitivity profiles are also communicated verbally to nurses, residents, or the consultants charged with care of patients in the wards. The round-the-clock activities reduced the turnaround time by at least one day. There has been no fiscal cost on the organization or the patients.
The utility of the exercise towards appropriate chemotherapy was evident in two patients with methicillin resistant Staphylococcus aureus (MRSA). A shift from cephalosporins recipe to vancomycin was effective in recovery of two MRSA patients in the surgical intensive care unit [3]. Concurrently, a point-of-care rapid diagnosis on scraping from outpatients with corneal ulcerations has been arranged. Scraped tissues are stained with Leishman and an interim cytological diagnosis towards any fungal, viral or bacterial involvement communicated and discussed with the ophthalmologists [4]. While no systematic evaluation has been carried out on the clinical impact, the clinicians have appreciated the reduced turnaround time. The clinicians have been rather incredulous about the utility of the
automation in the microbiology. While automation could be of significant benefit within the laboratory itself, communication with those directly responsible for patient care is vital to improve the quality of healthcare [5]. Last but not least, testing of antimicrobials has been probably the single most important area for close communication between the infectious disease clinician and the clinical microbiologist. Certainly working together of clinical microbiologist and clinicians to resolve basic issues about methods to use for antimicrobial susceptibility testing, agents to test, and the format to use for reporting results would be both cost-efficient and useful towards clinical management of hospitalized and outpatients in tertiary care hospitals. Irrespective of the availability of automated susceptibility assay formats, disk diffusion technology [1] would assist clinicians in offering judicious therapeutic recipe to patients.
ARYA, Subhash C.
AGARWAL, Nirmala
Sant Parmanand Hospital
18 Alipore Road
Delhi- 110054, India
Email: subhashji{at}hotmail.com
References
1. Kerr JR. Antibiotic treatment and susceptibility testing. Journal of
Clinical Pathology 2005; 58:786-787
2. Bruins M, Oord H, Bloembergen P, et al. Lack of effect of shorter
turnaround time of microbiological procedures on clinical outcomes: a
randomised controlled trial among hospitalized patients in the
Netherlands. Eur J Clin Microbiol Infect Dis 2005; 24:305-311
3. Arya SC, Kapoor S, Agarwal N, Bhasin R. Re: Evaluation of a disk
diffusion method with cefoxitin (30 mG) for detection of Methicillin-
resistant Staphylococcus aureus. European Journal of Clinical Microbiology
and Infectious Diseases 2004; 23(11): 867-868
4. Anand R, Agarwal N, Arya SC, Shah HK Taneja M. Leishman staining in
field diagnosis of corneal ulcer. Saudi Medical Journal 2004; 25:2026-2027
5. Dupont PF. Automation in microbiology: a physician's viewpoint. Am J
Med Technol. 1983; 49(5): 323-325
I read with interest the paper by Ananthanarayanan et al.[1] on
‘Immunohistochemical assays in prostatic biopsies processed in Bouin’s
fixative’. They rightly point out the problems encountered when trying to
perform immunohistochemistry or other molecular techniques on Bouin’s
fixed biopsies.
However, there are other and more fundamental problems with Bouin’s
fixative for prostatic tissue t...
I read with interest the paper by Ananthanarayanan et al.[1] on
‘Immunohistochemical assays in prostatic biopsies processed in Bouin’s
fixative’. They rightly point out the problems encountered when trying to
perform immunohistochemistry or other molecular techniques on Bouin’s
fixed biopsies.
However, there are other and more fundamental problems with Bouin’s
fixative for prostatic tissue that have not been considered. The main
reason for using Bouin’s is the better fixation of the cells achieved.
There is superior visualisation of nucleoli and other nuclear details.
This will be especially helpful in the diagnosis of high grade prostatic
intraepithelial neoplasia (PIN). The advantages of this are superficially
obvious, but the dangers are many. The technique will logically mean an
increase in the diagnosis of PIN and carcinomas. However there is, to my
knowledge, no study delineating the accuracy of Bouin’s fixed material in
diagnosing prostate cancer or PIN. None is quoted in the paper by
Ananthanarayanan et al and correlation with radical prostatectomy
specimens is crucial for a determination of the uses of this technique.
Research and audit of the diagnosis of prostatic cancer and PIN has
occurred virtually exclusively in formalin fixed specimens. Therefore,
whether this change in fixative is justified is entirely unknown.
The supposition is that Bouin’s fixed biopsies will lead to an
increase in test sensitivity. However, there are obvious dangers of loss
of test specificity: an over diagnosis of PIN leading to unnecessary re-
biopsies, or in worst case scenarios, even unnecessary surgery could
occur. It should also be held in mind that while Ananthanarayanan et al
are using this method for biopsies, they do not state whether this method
is used for radical prostatectomies or trans-urethral specimens leading to
further possible problems in interpretation and diagnostic correlation.
The variability of prostate biopsy processing and staining has been
pointed out in previous issues.[2, 3] There is huge pressure, in the current
climate, to diagnose more prostate cancer. The validity and intra observer
variations of new methodologies, which potentially increase the
sensitivity of a test should be thoroughly audited and ideally published
before they take over as a routine part of clinical practice.
References
1. Ananthanarayanan V, Pins MR, Meyer RE, Gann PH.
Immunohistochemical assays in prostatic biopsies processed in Bouin's
fixative. J Clin Pathol 2005;58:322-4.
2. O Biedryzci, M Varma, DM Berney. Variations in the processing of
prostatic needle cores in the UK: What is safe?. J Clin Path 2003; 56:341-3.
3. M Varma, D M Berney, B Jasani, A Rhodes. Technical Variations In
Prostatic Immunohistochemistry: Need For Standardisation And Stringent
Quality Assurance In PSA And PSAP Immunostaining J Clin Pathol 2004;
57:687-90.
Kaushik et al.[1] have demonstrated significantly different gene
expression in a small sample of patients with chronic fatigue syndrome.
They suggest these observations are consistent with a complex pathogenesis
involving T cell activation and abnormalities of neuronal and
mitochondrial function, possibly as a result of virus infection or
organophosphate exposures.
Kaushik et al.[1] have demonstrated significantly different gene
expression in a small sample of patients with chronic fatigue syndrome.
They suggest these observations are consistent with a complex pathogenesis
involving T cell activation and abnormalities of neuronal and
mitochondrial function, possibly as a result of virus infection or
organophosphate exposures.
We suggest that chronic ricketssial infections would be an equally
plausible hypothesis, consistent with Kaushik's observations, and worthy
of further study. Like viruses rickettsiae are obligate intracellular
parasites. Jadin[2] observed in South Africa that, for 500 patients
diagnosed with CFS, ME or depression, 80% tested positive to abnormally
high levels of ricketssial antibodies using a multiple microagglutination
test for antibodies to R Prowazeki, R Mooseri, R Conori, and Coxiella
Burnetti ( itself a neo rickettsia).[3]
In the clinical practice of one of the authors (Kemp) all chronically
unwell patients, in whom fatigue and/or fibromyalgia are significant, are
routinely tested for rickettsia using IgG serology. Over a recent three
year period 67% of 750 such patients returned positive serology to at
least one of the four rickettsial groups tested, with a titration level of
1/128 or greater considered positive. This data will be submitted for
publication at a later time.
Of the seropositive patients only a very small percentage test
positive to rickettsiae via real time PCR testing. Moreover very few can
recall any incidents in their medical history which would be consistent
with an acute rickettsial infection. Most respond significantly to
extended antibiotic treatment, mainly using rotating tetracyclines, as
described by Jadin (op cit).
While rickettsiae do produce some energy from independent metabolism[4], and can themselves produce small amounts of protein, the energy
required for cell division must come from the host cell's mitachondria and
the protein sequences from the host cytoplasm. Krausnik's observations of
significant perturbation of mitochondrial gene expression might therefore
be consistent with chronic rickettsial parasitic infections.
Unlike most viruses ricketsiae can live for quite extended periods in
extracellular fluid. Isolated (i.e. non parasitising) rickettsiae can
accumulate lysine and lyse erythrocytes, demonstrating their capacity to
operate an electron transport system.[5] Their survival in extracellular
fluid might contribute to chronic infection and be consistent with Chronic
Fatigue patient histories.
Writing in Nature in 1998 Anderson et al.[6] have demonstrated
through phylogenetic analyses that R. prowazekii is genetically very
closely related to mitochondria. At the time of writing they observed that
no other bacteria was as closely related to mitachondria.
While undoubtedly speculative, it is tempting to think that a
parasitic bacteria whose replication is absolutely dependent upon the host
cell's mitachondria and whose reproductive DNA formation requirements
closely match those of the host's mitachondria will be engaged in
competition with both the host cell's own energy and own reproductive
needs. If this competition resulted in lower levels of mitochondrial
capability then a rickettsial etiology for CFS might also explain the
functional fatigue seen as the very essence of chronic fatigue syndrome.
G C M Kemp MB BS(Melb) FRACGP, FACNEM
Burke Road Medical Centre
681 Burke Road
Camberwell 3134 Australia
R F Townsend PhD (UNSW) BE (Melb) BBus(Mitchell)
Honorary Research Fellow, Department of Biomolecular Engineering
University of Melbourne,
Parkville 3004 Australia
References
1. N Kaushik, D Fear, S C M Richards, C R McDermott, E F Nuwaysir, P
Kellam, T JHarrison, R J Wilkinson, D A J Tyrrell, S T Holgate and J R
Kerr Gene expression in peripheral blood mononuclearcells from patients
with chronic fatigue syndrome J. Clin. Pathol. 2005;58;826-832
2. C L Jadin, Common Clinical Windows on CFS and Rickettsial
Diseases. Journal of Chronic Fatigue Syndrome, 6 no 3 133-145 2000
3. Fiset, P., R. A. Ormsbee, R. Silberman, M. Peacock, and S. H.
Spielman.1969. A microagglutination technique for detection and
measurement ofrickettsial antibodies. Acta Virol. 13:60–66 and also Kazar,
J., R. Brezina, S. Schramek, A. Palanova, and B. Tvrda. 1981 Suitability
of the microagglutination test for detection of post-infection and post-
vaccination Q fever antibodies in human sera. Acta Virol. 25:235–240.
4. Rickettsial surival in synthetic in vitro solutions have
demonstrated that Rickettsial respiration is possible from a wide range of
amino acids and sugars,
5. Smith, D. K., and H. H. Winkler. 1977. Characterization of a
lysine-specific active transport system in Rickettsia prowazekii.J.
Bacteriol. 129:1349-1355.
6. The genome sequence of Rickettsia prowazekii and the origin of
mitochondria Siv G. E. Andersson, Alireza Zomorodipour, Jan O. Andersson,
Thomas Sicheritz-Ponte ,U. Cecilia M. Alsmark, Raf M. Podowski, A.
Kristina, Ann-Soe Eriksson, Herbert H. Winkler Nature vol 396 no 12
November 1998.
We read with interest the article by Dunn et al.[1] We have
reported unstained rod-shaped images of mycobacteria in Romanowsky-stained
aspirate smears of lymphnodes and bone marrow in patients with AIDS.[2,3]
These were subsequently confirmed to be acid-fast bacilli with Ziehl-
Neelsen stain. We referred to them as ‘negative images’. Maygarden and
Flanders first reported negative images of mycobacteria...
We read with interest the article by Dunn et al.[1] We have
reported unstained rod-shaped images of mycobacteria in Romanowsky-stained
aspirate smears of lymphnodes and bone marrow in patients with AIDS.[2,3]
These were subsequently confirmed to be acid-fast bacilli with Ziehl-
Neelsen stain. We referred to them as ‘negative images’. Maygarden and
Flanders first reported negative images of mycobacteria in patients with
AIDS.[4] In addition to finding these negative images of mycobacteria
within the cytoplasm of histiocytes, we have demonstrated them in the
background in the extracellular necrotic debris in the lymphnode aspirate
smears.[2]
Although the authors have reported their findings in granulomas, we
did not encounter granulomatous inflammation in the lymphnodes. The smears
showed only degerating and viable neutrophils and macrophages in a
necrotic background with negative images. This finding may be explained by
the fact that all our patients were HIV positive, in whom a granulomatous
response is not expected. The bone marrow biopsy, in one case, however
showed ill-defined granulomas and collections of foamy histiocytes, which
had plenty of intracellular negative images.
We also contrast the findings of the authors with respect to the PAS
negativity of the organisms. Papolla et al. demonstrated that in contrast
to other mycobacteria, including M.tuberculosis, M.avium-intracellulare
has a unique staining character of PAS positivity and acid-fastness.[5]
All our cases were also PAS positive.
The term pseudo-Gaucher cells may also be inappropriate in the sense
that these cells with intracellular negative images have very few, if any
similarities with the other pseudo-Gaucher cells found in conditions like
Chronic Myeloid Leukemia, where there is indeed presence of increased
glucocerebroside as in a true Gaucher cell.
We do however; concur with the fact, that a diligent search for these
negative images, both in the histiocytes and in the background, is a rapid
and inexpensive way of detecting mycobacteria before specific results are
available.
References
1. P Dunn, M-C Kuo and C-F Sun Pseudo-Gaucher cells in mycobacterial
infection: a report of two cases. Journal of Clinical Pathology
2005;58:1113-1114
2. Iyengar KR, Basu D Negative images in the fine needle aspiration
cytologic diagnosis of mycobacterial infections. Malaysian J Pathol 2001;
23: 89-92
3. Basu D and Nilkund J. Detecting mycobacteria in Romanowsky-stained
cytologic smears: a case report. Acta Cytol 2003: 47; 774-776
4. Maygarden SJ, Flanders EL. Mycobacteria can be seen as “negative
images” in cytology smears from patients with acquired immunodeficiency
syndrome. Mod Pathol 1989; 2:239-243.
5. Papolla MA, Mehta VT. PAS reaction stains phagocytosed atypical
mycobacteria in paraffin sections. Arch Pathol Lab Med 1984;108:372-373.
Dear Editor,
We have had experience with the Hemocue and haemoglobin colour chart in India and would like to commnet on the report.
For Hemocue they give a cost per test as $0.75 when in fact the cost of a single cuvette is $0.94 (UK). Further the cost of the instrument in their report is surprisingly low when compared with colourimeters. For example the Jenway 6051 costs £799 and the Hemocue £400. In...
Dear Editor,
Uterine cervical cancer is one of the most common cancers in women. An estimated 500,000 cases of invasive cancer are diagnosed worldwide each year. Mexico has one of the high incidence rates of cervical cancer 50 cases per 100,000 women. Each year almost 5,000 Mexican women die for this disease. The high incidence of this disease may reflect the deficiency of early detection screening programs used....
Dear Editor,
Kerr has succinctly outlined the events in the past six decades that assisted the clinicians in a judicious care of infectious diseases [1]. During the past decade several automated devices have been marketed that would reduce the turnaround period for bacteriological culture and susceptibility assays. While the majority of investigators found such systems to be so commendable, the recent controlled inve...
Dear Editor,
I read with interest the paper by Ananthanarayanan et al.[1] on ‘Immunohistochemical assays in prostatic biopsies processed in Bouin’s fixative’. They rightly point out the problems encountered when trying to perform immunohistochemistry or other molecular techniques on Bouin’s fixed biopsies.
However, there are other and more fundamental problems with Bouin’s fixative for prostatic tissue t...
Dear Editor,
Kaushik et al.[1] have demonstrated significantly different gene expression in a small sample of patients with chronic fatigue syndrome. They suggest these observations are consistent with a complex pathogenesis involving T cell activation and abnormalities of neuronal and mitochondrial function, possibly as a result of virus infection or organophosphate exposures.
We suggest that chronic rick...
Dear Editor,
We read with interest the article by Dunn et al.[1] We have reported unstained rod-shaped images of mycobacteria in Romanowsky-stained aspirate smears of lymphnodes and bone marrow in patients with AIDS.[2,3] These were subsequently confirmed to be acid-fast bacilli with Ziehl- Neelsen stain. We referred to them as ‘negative images’. Maygarden and Flanders first reported negative images of mycobacteria...
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