A Study of Reproducibility of Papanicolaou Society of Cytopathology System of Reporting Respiratory Cytology-A Single Institutional Experience on Image Guided Aspiration Cytology

Background: Cytologic examination of specimens obtained from the respiratory tract is a primary and frequently the initial diagnostic technique performed in patients with pulmonary abnormalities. Fine needle aspiration (FNA) is extensively used for diagnosis of pulmonary lesions. The Papanicolaou Society of Cytopathology (PSC) issued a new classification for respiratory cytology and criteria, risk of malignancy, post-cytologic diagnosis management and follow-up. Methods: Respiratory FNA specimens obtained between January 2015 to March 2021 were reviewed and reclassified according to PSC guidelines. Cytologic category as per PSC system was assigned after reviewing by two pathologists. Risk of malignancy for each category was calculated for cases where biopsy was available for correlation. Results: Three eighty-four samples were classified as non-diagnostic (30.5%), negative for malignancy (13.3%), atypical (0.5%), neoplastic (benign/ low malignant potential) (0%), suspicious for malignancy (5.7%%) and malignancy (50%). Risk of malignancy for malignant category (Category V and Category VI) was 64.1% and for non-malignant (Category I to Category IV) cases was 35.9%. Overall, there was lesser incidence of atypical category and more specific diagnoses were possible on cytology in non-malignant category. Sensitivity and specificity for malignant cases was 99.33% and 100% respectively. Conclusion: Our study substantiates that use of PSC guidelines improves the overall reporting of respiratory cytology due to the use of standardized terminology.

Spectral features and optimal Hierarchical Attention Networks for Pulmonary abnormality detection from the Respiratory Sound signals

The most important concern in the medical field is to consider the analysis of data and perform accurate diagnosis. However, the analysis of pulmonary abnormalities may depend on the diagnostic experience and the medical skills of the physicians, and is a time-consuming practice. In order to solve such issues, an efficient Water Cycle Swarm Optimizer-based Hierarchical Attention Network (WCSO-based HAN) is developed for detecting the pulmonary abnormalities from the respiratory sounds signals. However, the developed optimization technique named WCSO is devised by incorporating the Water Cycle Algorithm (WCA) with Competitive Swarm Optimizer (CSO). Here, the pre-processing is performed using the Hanning window and Spectral gating-based noise reduction method in order to remove the falsifications or noises from the signal. Thereafter, the process of feature extraction is carried out to extract the significant features, such as Bark frequency Cepstral coefficient (BFCC) and the short term features, such asspectral flux and spectral centroid. Once the significant features are extracted, classification is performed using HAN where the training procedure of HAN is carried out using WCSO. Furthermore, the developed WCSO-based HAN obtained efficient performance using True Positive Rate (TPR), True Negative Rate (TNR) and accuracy with the values of 0.943, 0.913, and 0.923 using dataset 1, respectively.

A case series of 13 patients with COVID-19 associated respiratory symptoms treated with Nebulized OTR4120 (Cacipliq20®)

We report a series of 13 patients with COVID-19 treated with Cacipliq20®, an heparan sulfate mimetic approved for the treatment of hard to heal cutaneous ulcers. Heparan sulfates play important roles in tissue repair and possess antiviral activity. Cacipliq20® was administered through nebulization at a dose of 45 mg twice a day for 5.5 consecutive days. All patients presented respiratory symptoms with some dyspnea and in most cases pulmonary abnormalities on chest CT-Scan. Eight patients presented with a moderate form of the disease, three patients with a severe form, one with a mild form, and one with a critical form. In all patients the treatment was added to the standard of care. Ten patients were treated during the acute stage of the disease (<4 weeks from symptoms onset) while 3 patients were in the post-acute stage (>4 weeks from symptoms onset). A second treatment was administered for another 5.5 days in 6 patients. All patients showed clinically improvement after treatment. The time to first improvement ranged from 2 to 4 days after first treatment onset with a median of 3 days. Time to full clinical recovery ranged between 6 to 27 days from treatment onset with a median of 6 days. Lung CT scans followed clinical impression and showed a clear improvement of the lesions in most cases. The treatment was well tolerated in all patients. These preliminary observations should justify further evaluation through a well-designed placebo-controlled therapeutic trial.

Twin-to-twin transfusion syndrome: new macroscopic and microscopic findings

Background Twin-to-twin Transfusion Syndrome (TTTS) is a serious complication of monochorionic twin pregnancies. Affects about 10% to 15% of pregnancies and it is associated with high fetal and neonatal mortality, as well as cardiac and neurological morbidity in surviving fetuses. The main objective was to characterize a series of fetuses with TTTS since the pathophysiology of the syndrome is not fully understood and the clinical spectrum is broad. Methods Post-mortem macroscopic and microscopic examination of 26 fetuses (from 2010 to 2020) with TTTS syndrome. Results The most frequent macroscopic findings in placenta were discrepancy in size and pallor/placental congestion. Other macroscopic findings not described in the literature were calcifications, areas of infarction and hematomas. Infarction areas and villi heterogeneity growth were the most common microscopic findings, described in the literature. Regarding the fetus, the restriction of intrauterine growth, the alteration of anthropometric parameters and the presence of a plethoric/anemic fetus were the main characteristics associated with this syndrome. The most common microscopic findings were signs of anoxia and congestive organs, already described in the literature. We also found frequently pulmonary abnormalities as new findings in our study. Conclusions The results allowed the identification of TTTS aspects that can contribute to the characterization of this syndrome. Given that the progression of TTTS remains unpredictable and the mortality rate for both fetuses is 90%, it becomes increasingly important to identify strategies for diagnosing and characterizing the syndrome.

Appearance of COVID-19 pneumonia on 1.5 T TrueFISP MRI

Objective: To evaluate the performance of 1.5 T true fast imaging with steady state precession (TrueFISP) magnetic resonance imaging (MRI) sequences for the detection and characterization of pulmonary abnormalities caused by coronavirus disease 2019 (COVID-19). Materials and Methods: In this retrospective single-center study, computed tomography (CT) and MRI scans of 20 patients with COVID-19 pneumonia were evaluated with regard to the distribution, opacity, and appearance of pulmonary lesions, as well as bronchial changes, pleural effusion, and thoracic lymphadenopathy. McNemar’s test was used in order to compare the COVID-19-associated alterations seen on CT with those seen on MRI. Results: Ground-glass opacities were better visualized on CT than on MRI (p = 0.031). We found no statistically significant differences between CT and MRI regarding the visualization/characterization of the following: consolidations; interlobular/intralobular septal thickening; the distribution or appearance of pulmonary abnormalities; bronchial pathologies; pleural effusion; and thoracic lymphadenopathy. Conclusion: Pulmonary abnormalities caused by COVID-19 pneumonia can be detected on TrueFISP MRI sequences and correspond to the patterns known from CT. Especially during the current pandemic, the portions of the lungs imaged on cardiac or abdominal MRI should be carefully evaluated to promote the identification and isolation of unexpected cases of COVID-19, thereby curbing further spread of the disease.

Comparison of Residual Pulmonary Abnormalities 3 Months After Discharge in Patients Who Recovered From COVID-19 of Different Severity

Background and Objectives: To investigate whether coronavirus disease 2019 (COVID-19) survivors who had different disease severities have different levels of pulmonary sequelae at 3 months post-discharge.Methods: COVID-19 patients discharged from four hospitals 3 months previously, recovered asymptomatic patients from an isolation hotel, and uninfected healthy controls (HCs) from the community were prospectively recruited. Participants were recruited at Wuhan Union Hospital and underwent examinations, including quality-of-life evaluation (St. George Respiratory Questionnaire [SGRQ]), laboratory examination, chest computed tomography (CT) imaging, and pulmonary function tests.Results: A total of 216 participants were recruited, including 95 patients who had recovered from severe/critical COVID-19 (SPs), 51 who had recovered from mild/moderate disease (MPs), 28 who had recovered from asymptomatic disease (APs), and 42 HCs. In total, 154 out of 174 (88.5%) recovered COVID-19 patients tested positive for serum SARS-COV-2 IgG, but only 19 (10.9%) were still positive for IgM. The SGRQ scores were highest in the SPs, while APs had slightly higher SGRQ scores than those of HCs; 85.1% of SPs and 68.0% of MPs still had residual CT abnormalities, mainly ground-glass opacity (GGO) followed by strip-like fibrosis at 3 months after discharge, but the pneumonic lesions were largely absorbed in the recovered SPs or MPs relative to findings in the acute phase. Pulmonary function showed that the frequency of lung diffusion capacity for carbon monoxide abnormalities were comparable in SPs and MPs (47.1 vs. 41.7%), while abnormal total lung capacity (TLC) and residual volume (RV) were more frequent in SPs than in MPs (TLC, 18.8 vs. 8.3%; RV, 11.8 vs. 0%).Conclusions: Pulmonary abnormalities remained after recovery from COVID-19 and were more frequent and conspicuous in SPs at 3 months after discharge.