scholarly journals Histopathological Changes in Helicobacter pylori Associated Gastritis and Scope of Special Stain and Immunohistochemistry as Diagnostic Aids

2020 ◽  
Vol 7 (50) ◽  
pp. 3027-3032
Author(s):  
Ruby Elizabeth Elias ◽  
Bindiya Gisuthan ◽  
Sreeganesh A.S

BACKGROUND Helicobacter pylori associated chronic gastritis plays a vital role in the development of majority of gastric adenocarcinomas and most gastric MALT (Mucosa Associated Lymphoid Tissue) lymphomas. Many diagnostic methods are available for the identification of this organism. However, in gastroenterology practice, histopathological examination of biopsy samples provides visual identification of the pathogen and the associated mucosal changes with special stains like Giemsa. The aim of this study was to evaluate the efficacy of three stains H & E- (Haematoxylin and Eosin), Giemsa and IHC (Immunohistochemistry) in the identification of H. pylori. Associated histologic changes were noted and the relationship between the degree of colonisation and the activity and chronicity of gastritis were analysed. METHODS 585 gastric biopsies taken from dyspeptic patients were evaluated for gastritis, based on updated Sydney System. In 250 randomly selected cases, three staining methods were used. RESULTS Out of 585 cases, 413 (70.60 %) had features of chronic gastritis. Mild chronic gastritis was the commonest finding and is seen in most cases of mild H. pylori colonisation. When activity was monitored, mild activity was the most frequent finding [225 (38.46 %)]. Majority of the severe activity cases showed severe H. pylori colonisation. 13.16 %, 4.79 % and 7.35 % showed intestinal metaplasia, atrophy and dysplastic changes respectively. Out of 250 cases, H & E and Giemsa stains showed 45.6 % and 57.2 % positivity while IHC demonstrated maximum number of positivity (156 cases - 62.4 %). Sensitivity and specificity of H & E was found to be 77.90 % and 98.95 %, positive predictive value was 99.13 % and negative predictive value was 69.18 %. For Giemsa stain, sensitivity was 91.67 %, specificity was 100 %, positive predictive value was 100 % and negative predictive value was 87.85 %. DISCUSSION H. pylori gastritis was a frequent finding in dyspeptic patients in southern part of India. When chi-square test was done, a significant statistical relationship between the severity of H. pylori colonisation, activity and chronicity of gastritis was noted. P value was < 0.001. With the use of special stain, Giemsa and ancillary techniques like IHC, the detection rate of H. pylori was enhanced considerably. CONCLUSIONS With increasing number of H. pylori in the mucosa, there was increase in the chronicity and activity of gastritis. Although immunohistochemistry revealed more cases of H. pylori, Giemsa can be a cost-effective substitute, because of its high specificity and positive predictive value. KEYWORDS H. pylori Gastritis, Giemsa, Haematoxylin and Eosin Stain, Immunohistochemistry

2013 ◽  
Vol 8 (1) ◽  
pp. 11-14 ◽  
Author(s):  
MM Shahin Ul Islam ◽  
Shamsun Nahar ◽  
Mst Naznin Sarker ◽  
ASM Salimullah ◽  
Mohammad Asadur Rahman ◽  
...  

Helicobacter pylori is a Gram negative bacteria which causes chronic gastritis, peptic ulcer disease, primary B-cell gastric lymphoma, and adenocarcinoma of the stomach. There are a set of laboratory tests to diagnose H. pylori infection with a variable accuracy, they are divided into non-invasive tests and invasive tests. Non-invasive tests include serology, urea breath test (UBT) and stool antigen test (SAT). Invasive tests include rapid urease test (RUT), histology and culture. This cross sectional study was carried out in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and H. pylori laboratory of International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) from July 2008 to September 2009 to evaluate the efficacy of RUT, SAT and Culture as a diagnostic tool for H. pylori. Dyspeptic patients were collected from outpatient department of BSMMU. Out of 224 dyspeptic patients 149 patients had ulcers or erosions in the stomach or duodenum. Stool sample could be collected from 139 patients. RUT has sensitivity of 100%, specificity 80.28%, positive predictive value 85% and negative predictive value 100%. Regarding culture, sensitivity is 100%, specificity 94.37%, positive predictive value 95% and negative predictive value 100%. Stool antigen test has sensitivity 95.94%, specificity 92.31%,positive predictive value 93% and negative predictive value 95%. DOI: http://dx.doi.org/10.3329/fmcj.v8i1.16890 Faridpur Med. Coll. J. 2013;8(1): 11-14


2002 ◽  
Vol 9 (5) ◽  
pp. 1044-1048 ◽  
Author(s):  
Tseng-Shing Chen ◽  
Fen-Yau Li ◽  
Full-Young Chang ◽  
Shou-Dong Lee

ABSTRACT The clinical significance of high levels of antibody against Helicobacter pylori is still unclear. We sought to evaluate whether the serum antibody levels could predict the presence of macroscopic gastroduodenal disease, to identify factors that correlate with antibody levels in a multivariate context, and to determine the predictive value of antibody levels for diagnosing H. pylori infection. The grades of gastritis and density of H. pylori colonization were scored separately using the updated Sydney system for antral and body mucosa. An enzyme-linked immunosorbent assay (ELISA) for the quantitative detection in serum of IgG antibodies to H. pylori was performed. Of the 170 dyspeptic patients, 105 (62%) had H. pylori infection. There was no difference in antibody levels among endoscopic findings of normal mucosa, chronic gastritis, and duodenal ulcer. On multivariate linear regression analysis, the status of H. pylori infection, mononuclear cell infiltration of body mucosa, and age correlated with antibody levels. The negative predictive value for antibody levels of <30 U/ml is 94%, and the positive predictive value of antibody levels of >70 U/ml is 98%. We conclude that serum antibody levels do not predict the severity of gastroduodenal diseases or the density of H. pylori colonization in H. pylori-infected dyspeptic patients. Higher levels are associated with the presence of H. pylori infection, the chronic gastritis score of the corpus, and older age. Setting a gray zone is necessary for ELISA, since the accuracy in this zone does not allow a precise determination of H. pylori status.


Author(s):  
Iqbal Rashid ◽  
Langalibalele H. Mabuza ◽  
Indiran Govender ◽  
Deidre Pretorius

Background: Optimum sputum results for acid-fast bacilli (AFB) microscopy are linked to a sputum quantity of at least 5.0 mL. This study was aimed at establishing the effect of sputum quantity in the pick-up rate of AFB microscopy by comparing sputum samples of 5.0 mL and 2.0 mL.Methods: An analytical cross-sectional study was carried out at the Dr George Mukhari Hospital (DGMH) in Pretoria, South Africa, from 05 January 2007 to 04 January 2008.Two sputum samples, 5.0 mL and 2.0 mL, were collected from each of the 330 adult PTB (pulmonary tuberculosis) suspects. Fluorescence microscopy was used in the sputum analysis. The yield through microscopy of the 2.0 mL specimen versus the 5.0 mL specimen was compared and analysed, using culture results as the gold standard.Results: From a sample of 330 specimens, 77 tested AFB positive on microscopy. In the 5.0 mL samples, the sensitivity was 76.6% (95% CI, 66.0% – 84.7%), specificity 99.6% (95% CI 97.8% – 99.9%), positive predictive value (PV+) 98.3% (95% CI 91.1% – 99.7%), negative predictive value (PV-) 93.3% (95% CI 89.7% – 95.7%), the likelihood ratio (LR) for a positive microscopy 192 and the LR for a negative test was 0.23. In the 2.0 mL specimens, the sensitivity was 75.3% (95% CI 64.6% – 83.6%), specificity 99.2% (95% CI 97.1% – 99.8%), positive predictive value (PV+) 96.7% (95% CI 88.6% – 99.1%), negative predictive value (PV-) 93.0% (95% CI 89.3% – 95.4%), the LR for a positive microscopy was 94 and 0.25 for a negative microscopy. There was a statistically significant association (p-value < 0.001) between the microscopy and culture tests in both the 5.0 mL and the 2.0 mL specimen categories. The strength of association between the microscopy and culture, as indicated by the kappa test was 0.83 and 0.81 in the 5.0 mL and 2.0 mL categories, respectively.Conclusion: Compared to the 2.0 mL specimen category, the yield for AFB microscopy in the 5.0 mL specimen category was consistently superior, as indicated by the higher sensitivity, specificity, predictive values and the likelihood ratios in the 5.0 mL specimen category. It is recommended that sputum specimen collection for AFB microscopy should aim for a minimum volume of 5.0 mL.


2019 ◽  
Vol 26 (08) ◽  
pp. 1229-1232
Author(s):  
Khadija Kiran ◽  
Amtul Huda ◽  
Zuhair Bhatti

To investigate the role of IL-21 as diagnostic marker in diagnosis of rheumatoid arthritis. Study Design: Cross sectional study. Setting: Department of Physiology and Orthopedic Gujranwala Medical College, Gujranwala. Period: October 2017 to October 2018 in one year duration. Materials and Methods: A total of 150 patients were included in the study, main variables assessed in this study were positive predictive value negative predictive value, sensitivity, specificity and accuracy of IL-21 in diagnosis of rheumatoid arthritis. SPSS version 23 was used to analyze the data. P value less than or equal to 0.05 was taken as significant. Study was started after permission from hospital ethical committee and patients were informed in detail about disease and procedure to be done. Non probability consecutive sampling was used. Results: The estimated sensitivity was 93.6%. The estimated specificity was 50%. Positive predictive value was 96.3% and negative predictive value was 35.7%. The overall accuracy was 90.6% for diagnosing rheumatoid arthritis. Conclusion: IL-21 induces MMP3 in rheumatoid arthritis patients, identification of IL-21 from synovium of patients indicates the presence of rheumatoid arthritis. We observed 90.6% diagnostic accuracy of IL-21 for rheumatoid patients taking RA factor as gold standard of diagnostic tool.


2020 ◽  
Vol 11 (4) ◽  
pp. 6478-6485
Author(s):  
Babu Rajendran ◽  
Suwetha Babu ◽  
Sheju Jonathan Jha J

Correlation of pleural fluid cholesterol level with light’s criteria to differentiate exudate from transudate pleural effusion. Classification of transudate and exudate clinically was done independently based on the light's criteria. Pleural fluid cholesterol levels of 100 selected patients were obtained. The cholesterol levels were compared with the earlier obtained data to study its specificity and sensitivity in differentiating exudate from transudate effusion. It was found that pleural fluid cholesterol in comparison to protein values in differentiating exudate from transudate showed a sensitivity of 79.55%, specificity of 91.07%, the positive predictive value of 87.50%, the negative predictive value of 85.00%, with a P-value of <0.001. Comparison of pleural fluid cholesterol with LDH values showed a sensitivity of 86.36% specificity of 94.64%, the positive predictive value of 92.68%, the negative predictive value of 89.83%, with a P-value of <0.001. Also, a comparison of pleural fluid cholesterol to light's criteria showed a sensitivity of 100% and 86.4% in the transudative group and sensitivity of 100% and 91.1 % in the exudative group, respectively. Routine measurement of pleural fluid cholesterol may serve as a valuable diagnostic indicator for differentiating exudate from transudate effusion.


2022 ◽  
Vol 38 (3) ◽  
Author(s):  
Madeeha Rehan ◽  
Attika Khalid ◽  
Fariha Nasreen

Background & Objective: Undiagnosed malarial infectionis associated with significant mortality and morbidity. Laboratory investigations leading to rapid, accurate and timely diagnosis of malaria is still a challenge. This study was done to assess the utility of abnormal White blood cell differential fluorescence (WDF) scattergram for diagnosis of malaria. Our aim was to study the utility of WDF scattergram for early detection of malarial parasite. Methods: All EDTA anti-coagulated blood samples received in laboratory during a period from Dec 2019 to May 2020 were analyzed on anautomated hematology analyzer, Sysmex XN 1000. All abnormal WDF scattergrams pertaining to plasmodium specie were critically evaluated and recorded. Review of Leishman-stained peripheral smears as well as immune-chromatographic assay by rapid test devices (RTD) was done. Accordingly, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detection of malaria by abnormal scattergram were calculated. Results: Out of total 1, 26,000of samples analyzed, abnormal WDF scattergrams were detected in 96 cases. Amongst these, 95.8% (92) were positive for MP on Leishman-stained peripheral smear as well as on ICT with a p-value of 0.05. WDF scattergram abnormalities typical of malaria showed a sensitivity of 80% and specificity of 93.26%. Positive predictive value of 95.8% whereas negative predictive value of 99.9% was detected. Significant findings of hemolysis, platelet clumps, nucleated RBCS (NRBCs) and RBC agglutination were noted in cases (n=4) with abnormal WDF scattergram negative for malaria on peripheral smear. Conclusion: Interpretation of abnormal WDF scattergram not only increases the early detection rate for malarial parasite but isa strong indicator for presence of hemolysis, RBC agglutination, platelet clumps and leucoerythroblastic blood picture as well. doi: https://doi.org/10.12669/pjms.38.3.4702 How to cite this:Rehan M, Khalid A, Nasreen F. White blood cell differential fluorescence abnormal scattergram: A useful indicator for early detection of malarial parasite. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4702 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Author(s):  
Luke Burnett ◽  
Chunyang Wang ◽  
Feng Zhang ◽  
Stephan Adams ◽  
Joan Wilson ◽  
...  

Abstract Background Toxic epidermal necrolysis (TEN) is a severe, life-threatening mucocutaneous reaction, causing widespread sloughing of skin and mucosal surfaces. Accurate and prompt diagnosis is essential for optimal management and subsequent outcome. In this study, frozen sections were used as a rapid examination for initial diagnosis of TEN, and the frozen section diagnoses were assessed compared with permanent sections. Methods One hundred patients of suspected TEN were referred to our burn unit, and 67 had sufficient clinical findings for frozen and permanent biopsies. The accuracy of frozen section relative to permanent section was evaluated by calculating diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). And McNemar’s tests were used to analyze the difference between the two methods. Results Fifty-two specimens were classified as TEN by frozen section, 51 of which were confirmed by permanent biopsy. The exception was diagnosed as bullous pemphigoid on permanent section. Fifteen specimens were read as negative for TEN on frozen slides but 4 were changed to positive by permanent biopsy. Overall, the diagnostic accuracy of frozen section was 92.5%, with sensitivity and specificity 92.7% and 91.7% respectively. The positive predictive value, or coherence of positive diagnosis between the two methods, was as high as 98.1%, and the negative predictive value was 73.3%. The p-value of McNemar’s tests was 0.375, indicating there was no significant difference between the two biopsy methods. Conclusion The data suggest that as a rapid histological assessment, frozen section is a reliable tool in the early diagnosis of TEN.


2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Beng Kwang Ng ◽  
Pei Shan Lim ◽  
Mohamad Nasir Shafiee ◽  
Nur Azurah Abdul Ghani ◽  
Nor Azlin Mohamed Ismail ◽  
...  

Objective. To determine the diagnostic accuracy of placental alpha microglobulin-1 assay and standard diagnostic methods for detecting rupture of membrane.Study Design. Prospective diagnostic study, between June 2011 to November 2011 at a tertiary centre. Initial evaluation included both the standard diagnostic methods for rupture of membranes and placental alpha microglobulin-1 immunoassay. The actual rupture of membranes was diagnosed on review of the medical records after delivery (absence of membrane or a positive pad chart).Main Outcome Measures. Placental alpha microglobulin-1 immunoassay and standard diagnostic methods for diagnosis of rupture of membrane.Results. A total of 211 patients were recruited. At initial presentation, 187 patients (88.6%) had ruptured membranes, while 24 patients (11.4%) had intact membranes. Placental alpha microglobulin-1 immunoassay confirmed rupture of membranes at initial presentation with a sensitivity of 95.7% (179 of 187), specificity of 100% (24 of 24), positive predictive value of 100% (179 of 179), and negative predictive value of 75.0% (24 of 32). By comparison, the conventional standard diagnostic methods had a sensitivity of 78.1% (146 of 187), specificity of 100% (24 of 24), positive predictive value of 100% (146 of 146), and negative predictive value of 36.9% (24 of 65) in diagnosing rupture of membrane.Conclusion. Placental alpha-microglobulin-1 immunoassay is a rapid and accurate method for confirming the diagnosis of rupture of membrane. It was superior to conventional standard diagnostic methods (pooling, nitrazine, and ferning), the nitrazine test alone or fern test alone.


2020 ◽  
Vol 22 (1) ◽  
pp. 31-38
Author(s):  
G. V. Gavrilov ◽  
M. N. Radkov ◽  
B. V. Gaydar ◽  
D. V. Svistov ◽  
A. V. Stanishevskiy ◽  
...  

Introduction. Until now, the most informative methods for selecting patients with idiopathic normal pressure (iNPH) for neurosurgical treatment were invasive diagnostic methods: tap test, lumbar infusion test, external lumbar drainage. Nevertheless, choosing the sequence of using these diagnostic tools and the assessment of their results cause number of questions for doctors in everyday practice.The study objective is to assess the informational content of invasive tests for differential diagnosis of iNPH and to create an algorithm of applying mentioned methods for clinical purposes.Materials and methods. At least one of the invasive diagnostic methods was used for 374 patients, who were treated in the period from 2006 to 2018 in the neurosurgical clinic of S. M. Kirov Military Medical Academy. The patients with final diagnosis of iNPH (n = 231), aged 58–87 years old, were selected for shunt surgery. The informativeness measures were calculated for each method on the basis of revealed data.Results. Sensitivity and specificity of tap test were 57.5 and 86.4 %, respectively, positive predictive value – 92.5 %, negative predictive value – 41.3 %, accuracy – 64.9 %. For lumbar infusion test sensitivity was 39.1 %, specificity – 63.6 %, but we calculated low negative predictive value (20.0 %) and accuracy (43.9 %) of the method despite of relatively high positive predictive value (81.8 %). External lumbar drainage revealed the highest significance of positive predictive value (92.9 %).Conclusion. Excluding of lumbar infusion test from the pre-operative diagnostic algorithm of iNPH and recommendation for sequential using of tap-test and external lumbar drainage after questionable result of the last one are an advisable option for practitioners.


2019 ◽  
Vol 9 (2) ◽  
pp. 97-103
Author(s):  
Mashah Binte Amin ◽  
Tarana Yasmin ◽  
Samar C Sarkar ◽  
Khaleda Parvin Rekha ◽  
Rushaida Haque Leeba ◽  
...  

Background: Breast tumor remains a worldwide public health problem for women. Linear array sonography is currently one of the main diagnostic methods for detecting breast lumps. Duplex color Doppler sonography has been helpful to distinguish malignant from benign breast disease and also to predict the disease prognosis. Objectives: The purpose of this study was to evaluate the role of spectral Doppler as a method to measure the vascular resistance index in differential diagnosis between the benign and malignant breast neoplasm. Materials and Methods: This cross-sectional study was carried out in department of Radiology & Imaging of Enam Medical College & Hospital during January 2015 to December 2017. Sonography was done in 153 women having breast lumps. Among them histopathology was done in 105 cases. Ultrasonographic findings and histopathological report analyses were done using SPSS 13.0. Results: The study was done in 105 women with mean age 31.6 ± 4.5 years. On ultrasonogram, lesions were diagnosed as benign in 65 (62%) cases and malignant in 40 (38%) cases. Out of sonographically diagnosed 65 benign lesions having peripheral vascularity and decreased RI, 63 (97%) were proved benign histopathologically. With these criteria for diagnosis of benign lesion, sensitivity was 94%, specificity 92%, positive predictive value 95%, negative predictive value 89% and accuracy 93%. Sonographically 40 lesions were diagnosed as malignant. Among them 37 (92.5%) cases were proven malignant histopathologically and showed central vascularity and increased RI having sensitivity of 92%, specificity 94%, positive predictive value 89%, negative predictive value 95% and accuracy 93%. Conclusion: The analysis of vascular resistance index combined with findings on grayscale sonographic images correlates well with histopathological reports and can be of great assistance in the assessment of breast masses with high sensitivity and specificity. J Enam Med Col 2019; 9(2): 97-103


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