Cervical cytology was introduced by George
Papanicolaou into clinical practice in 1940. In 1945,
the Papanicolaou smear received the endorsement of
the American cancer society as an effective method
for the prevention of cervical cancer .
www.drvikramsaraswat.co.in
www.drsaraswatpathlabs.com
Cell blocks are an integral part of cytology preparations and ancillary testing.
In certain settings, such as molecular testing of lung cancer or by a commercial laboratory, they are the preferred cytology preparation.
To optimize them, care in specimen procurement, triage, and improvement in current processing techniques are necessary.
Urine analysis is an integral part of a clinical laboratory. automation techniques in urine biochemistry, their priniciplas and microscopy along with their advantages and disadvantages are outlined.
This presentation i have made to understand the approach to a kidney biopsy in depth. kidney biopsy is not done in all centers and that's why its difficult to understand it. i have put some cases also to understand it better.
Cervical cytology was introduced by George
Papanicolaou into clinical practice in 1940. In 1945,
the Papanicolaou smear received the endorsement of
the American cancer society as an effective method
for the prevention of cervical cancer .
www.drvikramsaraswat.co.in
www.drsaraswatpathlabs.com
Cell blocks are an integral part of cytology preparations and ancillary testing.
In certain settings, such as molecular testing of lung cancer or by a commercial laboratory, they are the preferred cytology preparation.
To optimize them, care in specimen procurement, triage, and improvement in current processing techniques are necessary.
Urine analysis is an integral part of a clinical laboratory. automation techniques in urine biochemistry, their priniciplas and microscopy along with their advantages and disadvantages are outlined.
This presentation i have made to understand the approach to a kidney biopsy in depth. kidney biopsy is not done in all centers and that's why its difficult to understand it. i have put some cases also to understand it better.
diagnosis of malaria parasites include four species (P.falciparum , P.vivax P.ovale and P.malariae ) . simple and very clear presentation with pictures of different species and different stages.
Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is one of the world’s leading causes of death, particularly among children in developing countries.
Introduction Malaria
Chronology in Malaria
Epidemology
Life cycle
Pathogenesis and clinical feature
Lab Test
Treatment of Malaria
Prevention of Malaria
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
3. INTRODUCTION
• Microscopy remains the cornerstone of diagnostic laboratory testing for
blood parasites
• It requires minimal amount of reagents and equipment, but this method
depends on accuracy of well-trained and experienced technologists
• Other techniques for detection is Rapid methods (antigen
detection)which is on point care and antibody detection which has its
own advantages and disadvantages
• Molecular method (PCR) is the newest technique which is mainly used in
reference labs and research purposes.
4. PLASMODIUM
CASE I
• A 11 year boy came to emergency dept. with history of fever, temp 40 °C,
abdominal tenderness, no other abnormalities.
Hb – 8.3mmol/L
platelets- 56 × 109/L
leukocyte count of 4.5 × 109cells/L, RF of lymphocyte seen
CRP – 127mg/L
lactate dehydrogenase level 278U/L
5. 1. SMEAR PREPARATION: (CONVENTIONAL)
• Thick smear- parasite screening,
thin smear- species identification
• Stained by- giemsa/Leishman at pH7.2
• 5 minutes spent in thick film is equivalent to 1
hour spent in thin film.
• In thick smear-
• In thin smear- no. of parasites in 1ul of blood =
red cell count in million/cumm x parasite
percentage
6. • Advantage- Sensitivity of thick blood film is about 50parasite/ul
less equipments required
mostly used in tertiary centres
• Drawback- 60min of preparation time,
labour intensive
interpretation of the result requires expertise
low sensitivity in low parasite level
• .
In- Plasmodium falciparum malaria- parasites are often missed, so requires repetitive testing as the parasites are
sequestered in tissue capillaries for part of the asexual cycle and, parasite may not always be present in the
peripheral blood. Thus a P. falciparum infection might be missed unless blood samples are repeated daily
7.
8.
9.
10. 2. Fluorescent microscopy
• A) The quantitative buffy coat or QBC11
• Blood collected in capillary with anticoagulant filled upto 2/3rd and ends sealed
centrifuge at 1200 rpm for 5 minutes
• Dye: acridine orange dye
• Tube is viewed using special objective (paralens) attached to florescence
microscope.
• Staining parasite DNA-
• ADVANTAGE: Rapid alternative to blood smear
Sensitivity of 90% in acute infection
can detect 100 parasite/ul
Nuclei- bright green,
Cytoplasm- yellow orange
11. • DISADVANTAGE: Expensive apparatus
Expertise
False positive: Howell- Jolly bodies and reticulocytes
50% sensitivity in low parasitamia
species identification difficult
B) Kawamoto technique
DYE: acridine orange process + anticoagulant
An interference filter is put in pathway of transmitted light beam
Similar to QBC
• benzothiocarboxypurine (BCP)-the Fluorochrome to stain the nucleic acids of
any malaria parasites in the sample.
This method overcomes some of the problems inherent in some fluorescence systems, such as the need for rapid examination
to prevent fading or precipitation of the dye
12.
13. • Optical imaging techniques Cho, S., Kim, S., Kim, Y., & Park, Y. (2012). Optical imaging techniques for the study of malaria)
A) In vitro optical imaging of infected
red blood cells (iRBC)
using exogenous labeling agents
B) In vitro optical imaging of
iRBC with intrinsic optical
signals
C) In vivo optical
imaging of malaria
infection
14. 3. Rapid Diagnostic tests (antigen test)
• PRINCIPLE:
Immunochromatography relies on the migration of liquid
across the surface of a nitrocellulose membrane.
Tests are based on the capture of parasite antigen from
peripheral blood using monoclonal antibodies prepared
against a malaria antigen target and conjugated to either a
liposome containing selenium dye or gold particles in a
mobile phase.
A second or third capture monoclonal antibody applied to
a strip of nitrocellulose acts as the immobile phase.
The migration of the antigen-antibody complex in the
mobile phase along the strip enables the labeled antigen
to be captured by the monoclonal antibody of the
immobile phase, thus producing a visible colored line.
labeled goat antimouse antibody controls the migration
15. • Antigens against which kits are available are 2 groups:
Expressed in all malarial species
They confirm infection
They are:
• PMA (plasma adolase)
• pLDH (Parasite Lactate Dehydrogenase)
Specific for species
• HISTIDINE rich protein – 2(HRP-2)- synthesized
by asexual blood stages and young gametocytes
of P.falciparum and expressed in red cell surface.
specificity >90%
• pfLDH
16. • ‘TWO LINE TEST’- anti-pfHRP2 band with positive control for falciparum
• ‘THREE LINE TEST’- P.falciparum specific antibody band +PMA/pLDH + positive control( species
specific only for p.falciparum)
• Research is happening on ADOLASE - enzymes within the glycolytic pathway of the malaria parasite
have been recognized and considered as targets for rapid malaria diagnostic tests.(common to all)
17. ADVANTAGE:
• Sensitivity 95% when 100 parasites per ml
• RAPID, SENSITIVE, NO SPECIAL EQUIPMENT, NO TRAINED PROFFESSIONAL
• HRP-2 can be used even in pregnancy
DISADVANTAGE:
• false positive : cross-reaction with autoantibodies (RA)
• Antigens remains positive even after 28 days of treatment
• Cannot differentiate parasite
• Few parasite have deleted HRP GENES – false negative
Few commercial available device are:
OptiMAL, ICT, Para-HIT-f, ParaScreen, Biolone, Paracheck
18. 4. Serological tests(antibody test)
IFAT, ELISA
Based on detection of antibodies against asexual blood stage malarial
parasite.
It is time consuming, subjective but highly sensitive and specific
DONE ON:
• screening blood donors involved in cases of transfusion-induced malaria
when the donor's parasitemia may be below the detectable level of blood
film examination
• testing a patient with a febrile illness who is suspected of having malaria but
repeated blood smears are negative
• testing a patient who has been recently treated for malaria but diagnosis is
questioned
19. ELISA
PRINCIPLE:
• The DiaMed ELISA malaria antibody test is based on binding of anti-
Plasmodium antibodies present in a serum sample to antigens
immobilized on 96-well plates.
• The antigens are a mixture of a total extract of cultured P. falciparum
and recombinant P. vivax antigens (MSP1 and CSP).
• SENSIVITY 94% SPECIFICITY 98%
• The test does not distinguish between IgG and IgM, or between
antibodies to P. falciparum, P. vivax,P. ovale and
P. malariae
20.
21. IFA
• PRINCIPLE: following infection with any Plasmodium species, specific
antibodies are produced within 2 wk of initial infection, and persist for
3- 6 months after parasite clearance.
• IFA uses specific antigen or crude antigen prepared on a slide, coated
and kept at -30°C until used, and quantifies both IgG and IgM
antibodies in patient serum samples.
Titers > 1 : 20 are usually deemed positive
< 1 : 20 unconfirmed
Titers > 1 : 200 can be classified as recent infection
22. • Species-specific testing is available
• ANTIGEN USED: meronts (on shizonts)
CIRCUM-SPOROZOITE (protein of surface of sprozoite)
• The patient's serum is exposed to the organisms; homologous antibody,
if present, attaches to the antigen, forming an antigen-antibody (Ag-Ab)
complex.
• Fluorescein-labeled antihuman antibody is then added, which attaches
to the patient's malaria-specific antibodies.(MSP ANTIBODY) When
examined with a fluorescence microscope, a positive reaction is when
the parasites fluoresce an apple green color.
23.
24. ADVANTAGE
• Considered gold standard for antibody testing
• Simple and highly sensitive
DISADVANTAGES
• Time consuming
• Cannot be automated which limits the number sera for study
• Influenced by technician training
• Florescent microscope required
25. • 5. Molecular diagnostic methods:
PCR Technique
• Enzymatic synthesis to amplify nucleotides in
vitro
• Primer targets- 18sSSU RNA , OR TARGETS
circumsporozoite surface protein/cytochrome
B gene
• Used as reference test for evaluating the
newer diagnostic tests
26.
27. Advantage- genotypic variation
PCR inhibitors or DNA degradation can give false negative result
Most specific and sensitive in low parasitemia or mixed infection
Detects 0.02-1 parasites/ ul of blood
Species of malaria can be identified
DISADVANTAGE: longer time required
cannot be used to determine exactly how many copies have been
generated.
Other pcr used are-
Modified PCR- reverse transcription PCR, Nested PCR real-time PCR
28. Real-time PCR (qPCR)
• that can be used to quantify the number of copies of a target sequence
in a patient’s sample
• used to detect the mRNA product of DNA transcription
• By detecting fluorescence (SYBR Green®) in the exponential phase
• By using a known series of diluted standards
• It attaches to double-stranded DNA in the minor groove and fluoresces
29.
30. LAMP TECHNIQUE
• Simple and inexpensive-
detects conserved 18S
ribosome RNA gene of
P.falciparum
• Cells visualized with
FITC- CONJUGATED anti-
DIG antibody using
florescence microscope
• Reagents require cold
storage
35. • FCM assay
• RBC is lysed before fixation
• Blood cells+lysing agent +fixative Rupture of RBCs releasing of
parasites, WBC are intact
• Staining used for parasite is Hoechst33258 + propidium deoxide
other dyes: SYBR green 1 & CD 235A
• 1 million events acquired
36.
37.
38.
39. • Analysis of blood-stage development and determination of susceptibility to drugs by
flow cytometry are reproducible and rapid and detection of blood-stage parasites
appears to be sensitive and reproducible
• DNA-specific dyes are especially useful because the parasites multiply inside the
RBCs. As RBC does not contain DNA, DNA-specific fluorescence from infected RBC can
only be due to fluorescence of dyes bound to parasite DNA
• The total DNA content of a parasite is 100-200 times less than that of nucleated
blood cells. Therefore, the nucleated blood cells can easily be distinguished from
parasites on the basis of the difference in fluorescence intensity
• Consequently, infected cells can be discriminated from noninfected cells based on
their fluorescence intensity.
• The advantages of flow cytometry are the speed of measurement, the accuracy,
reproducibility, and the large number of parasites analyzed
40. AUTOMATED BLOOD CELL COUNTERS (ACC)
• Principle: detection of hemozoin, which is produced when the intra-erythrocytic malaria
parasite digest host haemoglobin and crystallize the released toxic heme into hemozoin in
the acidic food vacuole.
• Hemozoin within phagocytotes can be detected by depolarization of laser light, as cells pass
through a flowcytometer channel.
• Cell-Dyn 3500- detects malaria pigment (hemozoin) in monocytes, sensitivity 95%
specificity 88%
• BECKMAN coulter- VCS-to detect activated monocytes 98%sensitivity, 94%specificity
Advantage -useful for diagnosing clinically
unsuspected malaria.
Disadvantages- labour intensiveness, the need for trained
technicians, costly diagnostic equipment, and that false-
positives may occur with other bacterial or viral infections.
-
41. MASS SPECTROPHOTOMETRY
• A novel method for in vitro detection of malaria parasites, with a sensitivity of 10
parasites/μl of blood, has been reported recently.
• It comprises a protocol for cleanup of whole blood samples, followed by direct
ultraviolet laser desorption mass spectrometry (LDMS).
• In malaria, heme from hemozoin is the parasite-specific biomarker of interest.
• LDMS is rapid, high throughput, and automated.
• Compared with the microscopic method, which requires a skilled microscopist
LDMS can analyze a sample in < 1 min
42. • FISH-Fluorescence in situ hybridization is a cytogenetic technique used to
detect and localize the specific nucleic acid (DNA or RNA) sequences by
hybridizing with complementary sequences labeled with fluorescent probes
Blood+ anticoagulant + Alexa 488 green fluorescent dye to label plasmodium
specific probe+ counter stain
16S ribosomal RNA (rRNA) was used as a target for developing FISH assays
for diagnosing malaria for the following reasons:
(1) rRNA is highly abundant in the cell cytoplasm and therefore can be
visualized using sequence-specific fluorescence probes under a
microscope, without target sequence amplification
(2) As a consequence of variable nucleotide sequence conservation, it is
possible to find short nucleotide stretches that are unique to the genus,
species, sub-species or strain
43. FISH detects only live parasites with intact rRNA
The assays consist of six steps: smear preparation,
fixation, hybridization, washing, counterstaining and
viewing the processed smear under a fluorescence
microscope.
44. • FISH assays have other advantages over microscopic examination of
Giemsa stained smears viz. (1) FISH detects specific 18S rRNA fragment
in live parasites whereas by microscopy, Giemsa stained live and dead
parasites are detected since parasite detection and speciation is based
on the morphology only. (2) Since rRNA is present in the cytoplasm of
the parasite, the whole cell fluoresces when viewed under the
fluorescence microscope. Ribosomal rRNA is a unique molecule with
highly conserved and variable regions. Thus, it is possible to design
genus, species and strain specific probes.
• Dias- no experience in fluorescent microscopy.
45. • BABESIA
Case 2
A 50yr old previously spelenectized pt. came to OPD with fever and
chills for 2 weaks, sweating, myalgias, fatigue. On blood examination
pt. had Neutropenia, thrombocytopenia, decresed Hb, haematocrit,
Haptoglobulin, increased bilirubin, reticulocyte count, lactate
dehydrogenase, urobilinogen, and urine hemoglobin The laboratory
picture of hemolytic anemia with raised liver enzymes (aspartate and
alanine transaminase, alkaline phosphatase),
46. • incubation – 1-4 wk following tick bite (Ixodid ticks)
6 wk following infected blood transfusion
• CF: Fever, chills, sweat, headache, vomiting, abd pain,diarrhea, joint pain
Babesia species
Small Babesia---B.Microti B.GIBSONI
-
Large Babesia --B.BovisB. Canis B.divergans
47. • A)CONVENTIONAL
Microscopy: Ring forms can be round, oval, pyriform or ameboid shape
existing in singles, pairs tetrads- “MALTESE-CROSS APPEARANCE”
• This ring form is similar to plasmodium falci schizont bit we can differentiate
by absence of hemozoin pigment and absence of sizont and gametocytes in
Babesia
• QBC: Not recommended as poses difficulty
differentiating Plasmodium and Babesia.
• CULTURE:
Time taking, not used for human
48. IFAT:
• Most common serology test- only for B.microti the test has been
standardised
• Detects specific antibodies – CDC proposed IgG antibody kit
Titre > 1:64 – seropositive, even after 8-12 months of infection
> 1:1024 – acute infection
• IgG cant differentiate b/w recent and past infection
• So, IgM does but there is many false positive result.
49.
50. IFA was and then probed with 1:128 dilutions of the plasma samples at 37°C for 1h.
Slides of Babesia sp. obtained from Focus Diagnostics were blocked with Phosphate Buffered Saline
(PBS) containing 5% bovine serum albumin (BSA) and 5% goat serum for 30 min at room temperature
After three washings with PBS at 5 min intervals, slides were incubated with a mixture of 1:100 dilution of 4′, 6-
diamidino-2-phenylindole (DAPI) to stain parasite DNA observed by blue fluorescence and anti-human Alexa
488 conjugated goat antibodies
After 1h incubation at 37°C in dark, slides were washed three times with PBS at 5 min interval
Cover glasses were then mounted using 1:1 mixture of glycerol and PBS and sealed with nail enamel to prevent
evaporation and drying. Slides were examined by fluorescent microscope using oil emersion objective. Green
fluorescence indicated that patient plasma contains antibodies against B. microti
51. 1.A single negative IFA test result does not exclude the possibility
of Babesia
2.Other Babesia antibodies may cross-react and yield a false
positive Babesia IFA test.
3.Results should be interpreted in conjunction with other laboratory and
clinical findings.
• The B. microti IFAT has a reported sensitivity of 88^96% and speci¢city of
90^100%.
• ELISA:
• Babesia merozoite surface proteins (BMN1-17 and MN-10) and have
been employed in ELISA
52. • MOLECULAR:
FISH:
• The FISH assay is based on two fundamental principles:
Hybridization directly on a thin blood smear with a fluorescein-
labeled Babesia specific probe
Identification of Babesia parasites on a blood smear by viewing with a
fluorescent microscope
is designed for qualitative detection of ribosomal RNA of Babesia parasites
directly in a blood smear. The test’s highest degree of specificity is
provided by nucleic acid probes, which bind to RNA sequences of
the Babesia. This test detects all species of Babesia
53. PCR:
• Diagnostic method of choice
• Target is detection of babesia srr is 18S rRNA
• Real time PCR – high sensitivity of detecting 20 genome copies/ul ~ 0.0001%
Agarose gel (2%) analysis of a PCR diagnostic test for detection of Babesia microti DNA.
PCR was performed using a nested protocol with primers BAB1 and BAB4 (first round)
and BAB2 and BAB3 (second round).
* Lane S: Molecular base pair standard (50-bp ladder). Black arrows show
the size of standard bands.
* Lane 1: First step amplification with primers BAB1 and BAB4 of the
nested PCR protocol for detection of B. microti in DNA extracted from
whole blood. The specimen, serologically positive for B. microti, was
submitted to the CDC by the American Red Cross. The red arrow shows
the single-step PCR diagnostic band for B. microti (size: 238 bp).
* Lane2: Nested PCR with primers BAB2 and BAB3 using as template the
product of the first step amplification. The blue arrow shows the nested
PCR diagnostic band for B. microti (size: 154 bp). Please note the
enhanced sensitivity of B. microti DNA detection with the nested reaction.
54. • The Babesia microti/duncani Polymerase Chain Reaction (PCR) screen
is an assay that detects Babesia DNA in whole blood and speciates
to B. microti and B. duncani. The combination of the following three
steps imparts a very high specificity and sensitivity to the test:
• Hybridization/Selection
• Amplification of Babesia-specific DNA
• Detection of Babesia-specific amplified DNA fragments
55. • LEISHMANIA
• A 41-year-old, HIV-positive man from Bangladesh presented to the HIV
clinic with fatigue and abdominal fullness, high fever. The laboratory
workup revealed mild pancytopenia and elevated liver function
enzymes. Computed tomography identified hepatosplenomegaly and
inguinal nodules. bone marrow (BM) biopsy was performed. The
peripheral blood (PB) smear showed rouleaux and monocytes with
intracellular microorganisms bearing prominent nuclei and adjacent rod-
shaped. The BM biopsy and aspirate smear were hypercellular, and also
demonstrated histiocytes with similar intracellular microorganisms.
There was no evidence of hemophagocytosis..
56. SMEAR: geimsa stain: LD
bodies(Amastigote)
CONVENTIONAL TESTS:
Splenic aspirate or liver biopsy.
Bone marrow aspiration of a patient with visceral leishmaniasis
showing Leishman-Donovan bodies being visualized as small,
ovoid structures with a rounded basophilic nucleus and an
elongated kinetoplast, within macrophages as well as
extracellularly
57. SEROLOGICAL TESTS:
IFAT
• If the anti- bodies persist in low litres it is an indication of a probable
relapse.
• Titres above 1:20 are significant and above 1:128 are diagnostic
• The test is based on detecting antibodies, which are demonstrated in the
very early stages of infection and are undetectable six to nine months
after cure.
• sensitive (96%) and specific (98%)
58. ELISA
• Recently, several recombinant antigens like rGBP from L. donovani, rORFF
from L. infantum, rgp63, rK9, rK26 and rK39 from L.chagasi have been
developed and tested.
• Of these, the rK39 antigen is found to be highly sensitive and predictive
of onset of disease manifestation in VL patients.
DAT
• The antigen is prepared from promastigotes of L. donovani and test can
be carried out on plasma, serum, blood spots and whole blood.
• Antibody titres of 1: 3200 are considered positive
Culture: Nicolle-NovyMacneal (NNN media) from clinical specimen
59. • CHROMATOGRAPHIC STRIP TEST
• A membrane strip which also contains a conjugate dye region is coated
with this protein. Through capillary action, the patient serum will react
with the dye and antigen to quickly indicate the presence of anti-rK39
immunoglobulin G (IgG) in a patient sample.
60. • MOLECULAR
PCR
• Recently, molecular probes, using kinetoplast DNA (kDaNA), ribosomal
RNA (rRNA), mini exon derived RNA (medRNA) and genomic repeats
have been evaluated.
• Different DNA sequences in the genome of leishmania like ITS region,
gp63 locus, telomeric sequences, sequence targets in rRNA genes such
as 18s rRNA and SSU-rRNA and both conserved and variable regions in
kinetoplast DNA (kDNA) minicircles are being used by various workers
• Drawback - this technique is not automated and is laborious, which
limits its use to a small number of samples.
61. • PCR-ELISA
• The kDNA PCR-ELISA is based on the capture of an amplified product
with a sense primer labelled with biotin at the 5′end in the polystyrene
plate coated with streptavidin, followed by hybridisation with a
fluorescein-labelled probe at the 5′ end and an antifluorescein-
peroxidase conjugate for detection
• DNA TARGET- kDNA from parasites
• DNA extracted BY- “QIAamp DNA mini” kit .
• Negative DNA extraction controls were performed for each experiment
by the addition of all reagents except the sample.
• The yield was determined by absorbance at 260 nm in a
spectrophotometer PCR-ELISA
63. • IN HUMANS, T.cruzi is in 2 forms- amatigote
and trymastigote
A)CONVENTIONAL
• Giemsa stain,thick and thin smear
• Quantitative Buffy Coat (QBC®; Becton
Dickinson)
64. • B)SEROLOGY
• ICT Card test- cytoplasmic repetitive antigen (CRA) and flagellar
repetitive antigen (FRA) proteins from Trypanosoma cruzi
• ELISA
• C) molecular
• Pcr- TARGET- Highly repetitive nuclear & kinetoplast DNA (k DNA)
• Primer TCZ1-TCZ2 for nuclear repetitive 188bp sequence
• Primer S35-S36 against 330 bp kinetoplast minicircle
• PCR is useful in – Persons with borderline serology results Received
specific treatment Acute or congenital disease
67. A)Conventional tests
DEMONSTRATIONG THE CIRCULATING MICROFILARIA
Microfilariae circulate in blood at night (nocturnal periodicity) so optimal
time for drawing blood is between 10pm to 4am
Blood collected in EDTA, GEIMSA, WRIGHT- GEIMSA STAIN,
AHAD proposed rapid method using Zeil-Neelson carbol fuschin followed
by Leishman’s stain.
Thick blood smear :for detection of microfilarie
68. CONCENTRATION OF BLOOD WITH
POLYCARBONATE MEMBRANE FILTER
It is a concentration technique used to trap
microfilariae on polycarbonate filter after red
blood cells are lysed. 1-2ml intravenous blood
filtered through 3um pore size membrane
filter and the filter paper is examined
directly under microscope.
Used when microfilarial load is low
DEC
For day time filarial parasite testing
QBC
Detection of microfilariae using
microhematocrit tube coated with acridine
orange
69. B) Antigen and antibody testing
IMMUNO CHROMATOGRAPHIC TEST:
• ANTIGEN TESTING:Most sensitive and convenient
Gold standard for W.bancrofti
2 types: POC (point of care) , ELISA
Poc-BinaxNOW (rapid)
Filarial card test(rapid)
Filarial strip test (2013)rapid
Og4c3 antigen
70. ELISA
Og4C3 antigen detection
• Antibodies detection: Wb123
BM14/Wb123
Multiplex bead assay
Biplex WD123/OV16 (rapid)
Wb- SXP-1 ELISA
• 3)DNA
• PCR – detection of filarial DNA in human blood
targets pWb12 for w.bancrofti
Shotgun metagenomics, which is applied to the direct sequencing of DNA
extracted from a sample without culture or target-specific amplification
or capture, has been widely used
71. REFERENCE:
• Rosenblatt JE, Reller LB, Weinstein MP. Laboratory diagnosis of infections due to blood and tissue
parasites. Clinical infectious diseases. 2009 Oct 1;49(7):1103-8.
• https://www.cdc.gov/dpdx/diagnosticprocedures
• Dacie 12th edition
• mckenzie
• Moody, A. (2002). Rapid Diagnostic Tests for Malaria Parasites. Clinical Microbiology Reviews, 15(1),
66–78.doi:10.1128/cmr.15.1.66-78.2002
• Roobsoong et al.: A rapid sensitive, flow cytometry-based method for the detection of Plasmodium
vivax-infected blood cells. Malaria Journal 2014 13:55.
• https://igenex.com/disease/babesia/#drawer-1
• Parija SC, Dinoop KP, Venugopal H. Diagnosis and management of human babesiosis. Tropical
parasitology. 2015 Jul;5(2):88.
• J, Mark O, Weltman H, Barcelo N, Lo W, Wronska D, Kakkilaya S, Rao A, Bhat ST, Sinha R, Omar S.
Fluorescence in situ hybridization (FISH) assays for diagnosing malaria in endemic areas. PLoS One.
2015 Sep 2;10(9):e0136726.
72. • Ragavan, K. V., Kumar, S., Swaraj, S., & Neethirajan, S. (2018). Advances in
biosensors and optical assays for diagnosis and detection of malaria. Biosensors
and Bioelectronics, 105, 188–210.doi:10.1016/j.bios.2018.01.037
• Shah J, Mark O, Weltman H, Barcelo N, Lo W, Wronska D, Kakkilaya S, Rao A, Bhat
ST, Sinha R, Omar S. Fluorescence in situ hybridization (FISH) assays for diagnosing
malaria in endemic areas. PLoS One. 2015 Sep 2;10(9):e0136726.
• Clement PW, Li KD. Peripheral blood and bone marrow involvement by visceral
leishmaniasis. Blood. 2017 Aug 3;130(5):692-.
• Salam MA, Khan MG, Bhaskar KR, Afrad MH, Huda MM, Mondal D. Peripheral
blood buffy coat smear: a promising tool for diagnosis of visceral leishmaniasis.
Journal of clinical microbiology. 2012 Mar 1;50(3):837-40.
Editor's Notes
Hemoparasites are organisms in blood which causes major illness to paitent and their detection is important for avoiding complications
Thick- counting 200 wbc in 100x oil immersion
Parasite percentage is calculated in 1000 rbc – the nuber of parasite seen
Estimation of degree of parasitemia is usful in p.falciparum
Morphological differentiation is necessary to know in basic level to identify stages and species of malarial parasite
p. Knowelsi later stages is same as malariae
B- ring form with maurer dots,
2nd- vivax with SCHUFFNER dot, ring with large chromatin, C distorted ameboid form
C – 16 developing merozoites- schizont, d- microgametocyte
the fluorochrome to stain the nucleic acids of any malaria parasites in the sample.
Pict 1 Trophozoites of P. falciparum stained with AO in the QBC UV fluorescence method.
Pic 2- Trophozoites of P. falciparum stained with BCP in the fluorescence method.--, RBC inclusions and the nuclei of leukocytes are poorly stained (Fig. 2).
Collect blood in capillary tube with EDTA by fringer prick methothod
Falci- smaller ratio of immature trophozoites
Vivax- freater ratio of immature trophozoite
Something new in florescence method
A– a) bright fiels image of plasmodium vivax including mature schizont releasing merozoites
b)Diffrential interference contrast(DIC) merge with wide field fluorescence image from merozoite(green)
c) 3D reconstructed image of merozoites from iRBC
d) Time lapse of parasite invasion
E anf f) flourecence intensity
B-- Dic (diffrentialintergace contrast) image of trophozoite stage of iRBC. B) sdizont stage of infected RBC C) topographic image
C-- To study the liver stage development of malaria in humans and rodents, luminescence image modified luciferase containing malaria parasites (PbGFP-Luccon) were used
in both cultured hepatocytes and the liver of living mice… as rbc gets destroyed in liver . In vivo green florescent protein was used
(pLDH) , an enzyme of glycolytic pathway found in all four human malaria species , LEVEL OF LDH co relates with parasite density
BinaxNOW recently approved by FDA. It is a rapid ICT card (or“dipstick”) assay that uses monoclonal antibodies to detect the histadine-rich protein 2 antigen of Plasmodium falciparum
The latter technique captures pLDH on a microtitre plate
with a speci¢c anti pLDH monoclonal antibody, then
quanti¢es the amount of enzyme captured with an
enzyme reaction utilizing APAD. The bound pLDH activ-
ity correlates well with viable parasite density on initial
diagnosis. But the pLDH activity has also been shown to
parallel the level of viable parasites during therapy
Immunoflouroscent antibody
ALSO FOR BLOOD DONORS
Cross reactions often occur between Plasmodium species and Babesia species.
P. falciparum, P. vivax, P. malariae, and P. ovale.
Modifies is done when traditional diagnostic methods are unclear for patients presenting with signs and symptoms of malaria.
Enzymaticallly amplifyying particular Segment of DNA. THERE are 3 steps denaturing, at 90-95 degree, annealing at primer temperature and extension at 72 degree
Therefore, when double-stranded PCR products are generated and SYBR Green® binds the DNA, the instrument software captures fluorescence. Other detection systems that provide more specific detection of the desired amplicon have been developed. One is the TaqMan system based on the 5′ exonuclease activity of DNA polymerase and captured fluorescence of a cleaved reporter dye-labeled probe. TaqMan technology has been success-fully incorporated into many clinical real-time protocols to providesensitive and specific detection
Serial dilutions done
Hybridization of labeled targets divided from nucleic acids in the test sample to probes on the array enables the probing of multiple gene targets in a single experiment. Ideally, this technique would be miniaturized and automated for point-of-care diagnostics [23]. A pan-microbial oligonucleotide microarray has been developed for infectious disease diagnosis and has identified P. falciparum accurately in clinical specimens [74]. This diagnostic technique, however, is still in the early stages of development
Infected RBC fixed with glutaraldehyde, paraformaldehyde or combination.
The fluorescence signal was generally dispersed
in the cytoplasm of ring-stage parasites, increasing
in abundance during trophozoite and early schizont
stages before concentrating in the perinuclear apical
end of forming merozoites in late segmenting schizonts.
Thai
adult uninfected blood was stained with anti-PfBiP Alexa
Fluor 660 for use as a negative control to define cell
populations with non-specific or background reactivity
Uninfected rbc is used as control of gating
Fluorescence In Situ Hybridization (FISH) Assays for Diagnosing Malaria in Endemic Areas – artle to add
1) All the processed smears were read with a 100X objective in a fluorescence microscope. (2) P. falciparum. P. vivax, P. knowlesi and negative control smears were read with a 100X objective on a regular microscope with a LED unit. Green fluorescence indicates the presence of Plasmodium ribosomal RNA (rRNA). (A) P. falciparum including crescent shaped gametocytes (B) P. vivax; (C) P. knowlesi; (D) P. ovale; (E) P. malariae; and (N) Negative Control; (A1) P. falciparum;. (B1) P. vivax; (C1) P. knowlesi; and (N1) Negative Control.
INDRECT IMMUNOFL ASSAY, The monoclonal antibodiesused in the OptiMAL test have been exhaustively tested for cross-reactivity with LDH from other blood protozoa such as Leishmania, Babesia, and pathogenic bacteria or fungi; no evidence of such cross-reactivity has been found
The Babesia Fluorescent In-Situ Hybridization (FISH) assay
PRIMER IS BAB1 BAB 4 , BAB 3 ND BAB3
GENE TO BE ENHANCED ISThe amplification program consisted of initial heating at 95°C for 10 min, followed by 50 cycles of heating at 95°C for 15s, annealing and fluorescence detection at 60°C for 30s, and polymerization at 72°C for 20s. Based upon the genome size (6.5 Mb), of B. microti [37], 8ng of DNA was calculated to contain 106 copies of Bmtpk gene
The differential diagnosis included infection, lymphoma, and secondary hemophagocytic lymphohistiocystosis (HLH), and a
Buffy-Amastigotes can be found in and around macrophages.
The typical morphology of amastigotes (oval or elliptical cells 2 to 4 μm in size, bounded by a cytoplasmic membrane containing the nucleus and kinetoplast, which are bound together at a right angle to each other and where the nucleus is larger than the kinetoplast) as demonstrated in splenic or bone marrow smears
((complete or partially complete cytoplasmic rim, is characteristic of the presence of amastigotes and makes them sufficiently different from the platelets, which are the only structures that may be confused with them. ))
For asymptomatic pt, endemic countries
Blood, serology, culture, PCR- detect 1 trypanomastigore in 20 ml of blood
Fluorescent dyes that stain nucleic acids have been used in the detection of blood parasites.
This results in a differential staining of nuclear DNA in green and of cytoplasmic RNA in red, which allows recognition of the parasites
Membrane Filter Procedure (adapted from (1, 13)):
1. Collect fresh blood in sodium citrate or EDTA.
2. Add 1 mL of the blood to 10 mL of 10% Teepol-saline solution (50 g Teepol concentrate to 450 mL saline)
3. Place a 25 mm Nucleopore filter of 5 μm porosity over a 25 mm supporting filter paper moistened with water securely into a filter holder.
4. Remove plunger from the barrel of a 20-mL syringe and connect barrel of syringe to filter holder.
5. Pour the blood-Teepol mixture (see step 2) into the barrel of syringe, replace plunger in syringe, and gently force the solution through the filter.
6. Remove the syringe from the filter holder, draw up 10 mL of water into syringe, reattach filter holder, and gently wash filter by flushing the water through it. Do this three times total.
7. Pass 3 mL of methanol through the filter to fix the microfilariae.
8. Remove the filter from the holder and place on a glass slide; allow to dry thoroughly. 9. Stain with Giemsa or preferred stain per normal procedure.
10. Dip the slide in toluene to avoid air bubble formation.
11.add a drop of mounting medium and a coverslip.
12. Examine the slide when dry.
FILARIASIS STRIP TEST (2013)-
75 μL of finger prick blood is added to a sample application pad that contains dried polyclonal antibody to CFA that has been labeled with colloidal gold. The labeled antibody binds to CFA (if it is present), blood cells are retained in the sample pad, and the labeled antigen–antibody complexes flow down a nitrocellulose strip with the plasma. The immune complexes are immobilized when they bind to a monoclonal antibody to CFA that has been striped across the nitrocellulose membrane, and this results in a positive test with a visible “T-line.” The procedural control “C-line” develops when excess labeled polyclonal antibody crosses a line that contains a secondary antibody to the immunoglobulin that was in the sample pad. Thus, samples that contain CFA produce visible T- and C-lines in the FTS, while negative samples only produce the C-line.
SEROLOGICAL TESTS
antifilarial IgG4 IgG2 in elephantiasis
Most sensitive and covinient