Luciana Botinelly Mendonça Fujimoto

High-Resolution Anoscopy in the Diagnosis of Anal Cancer Precursor Lesions in Renal Graft Recipients

BackgroundRenal graft recipients are one of the population groups known to be at high risk of developing anal cancer. This study investigated the presence of subclinical anal squamous intraepithelial lesions and the diagnostic ability of high-resolution anoscopy in detecting these lesions in renal graft recipients followed-up in Manaus.MethodsIn a cross-sectional study, 50 renal graft recipients were interviewed and submitted to high-resolution anoscopy with biopsies of acetowhite lesions or of the anal transition zone mucosa when acetowhitening was absent. Considering the histopathological reports of the examined anal specimens as the gold standard, the diagnostic validation and precision measures of high-resolution anoscopy were calculated as well as the prevalence of anal squamous intraepithelial lesions in the studied population.ResultsIn 42 renal graft recipients with satisfactory histopathological readings, prevalence of anal squamous intraepithelial lesions or condyloma acuminatum (ASIL-ACU) was 23.81%. Sensitivity of high-resolution anoscopy was 100%; specificity, 65.63%; positive predictive value, 47.62%; negative predictive value, 100%; and kappa coefficient, 0.48.ConclusionsWith a prevalence of 23.81% of subclinical ASIL-ACU lesions, the studied renal graft recipients had all these lesions detected by high-resolution anoscopy, notwithstanding most anal transition zone acetowhitened biopsied areas did not reveal histopathological aspects of anal cancer precursor lesions or condyloma acuminatum. Therefore, greater experience with the diagnostic tool was felt necessary to enhance its positive predictive value, specificity and diagnostic precision.Renal graft recipients are one of the population groups known to be at high risk of developing anal cancer. This study investigated the presence of subclinical anal squamous intraepithelial lesions and the diagnostic ability of high-resolution anoscopy in detecting these lesions in renal graft recipients followed-up in Manaus. In a cross-sectional study, 50 renal graft recipients were interviewed and submitted to high-resolution anoscopy with biopsies of acetowhite lesions or of the anal transition zone mucosa when acetowhitening was absent. Considering the histopathological reports of the examined anal specimens as the gold standard, the diagnostic validation and precision measures of high-resolution anoscopy were calculated as well as the prevalence of anal squamous intraepithelial lesions in the studied population. In 42 renal graft recipients with satisfactory histopathological readings, prevalence of anal squamous intraepithelial lesions or condyloma acuminatum (ASIL-ACU) was 23.81%. Sensitivity of high-resolution anoscopy was 100%; specificity, 65.63%; positive predictive value, 47.62%; negative predictive value, 100%; and kappa coefficient, 0.48. With a prevalence of 23.81% of subclinical ASIL-ACU lesions, the studied renal graft recipients had all these lesions detected by high-resolution anoscopy, notwithstanding most anal transition zone acetowhitened biopsied areas did not reveal histopathological aspects of anal cancer precursor lesions or condyloma acuminatum. Therefore, greater experience with the diagnostic tool was felt necessary to enhance its positive predictive value, specificity and diagnostic precision.

Evaluation of autofocus functions of conventional sputum smear microscopy for tuberculosis

This article presents a systematic analysis of focus functions in conventional sputum smear microscopy for tuberculosis. This is the first step in the development of automatic microscopy. Nine autofocus functions are analyzed in a set of 1200 images with varying degrees of content density. These functions were evaluated using quantitative procedures. The main accomplishment of this work was to show that an autofocus function based on variance measures produced the best results for tuberculosis images.

Automatic identification of tuberculosis mycobacterium

Introduction According to the Global TB control report of 2013, “Tuberculosis (TB) remains a major global health problem. In 2012, an estimated 8.6 million people developed TB and 1.3 million died from the disease. Two main sputum smear microscopy techniques are used for TB diagnosis: Fluorescence microscopy and conventional microscopy. Fluorescence microscopy is a more expensive diagnostic method because of the high costs of the microscopy unit and its maintenance. Therefore, conventional microscopy is more appropriate for use in developing countries. Methods This paper presents a new method for detecting tuberculosis bacillus in conventional sputum smear microscopy. The method consists of two main steps, bacillus segmentation and post-processing. In the first step, the scalar selection technique was used to select input variables for the segmentation classifiers from four color spaces. Thirty features were used, including the subtractions of the color components of different color spaces. In the post-processing step, three filters were used to separate bacilli from artifact: a size filter, a geometric filter and a Rule-based filter that uses the components of the RGB color space. Results In bacillus identification, an overall sensitivity of 96.80% and an error rate of 3.38% were obtained. An image database with 120-sputum-smear microscopy slices of 12 patients with objects marked as bacillus, agglomerated bacillus and artifact was generated and is now available online. Conclusions The best results were obtained with a support vector machine in bacillus segmentation associated with the application of the three post-processing filters.

Mycobacterium tuberculosis recognition with conventional microscopy

This paper presents a new method for segmentation of tuberculosis bacillus in conventional sputum smear microscopy. The method comprises three main steps. In the first step, a scalar selection are made for characteristics from the following color spaces: RGB, HSI, YCbCr and Lab. The features used for pixel classification in the segmentation step were the components and subtraction of components of these color spaces. In the second step, a feedforward neural network pixel classifier, using selected characteristics as inputs, is applied to segment pixels that belong to bacilli from the background. In third step geometric characteristics, especially the eccentricity, and a new proposed color characteristic, the color ratio, are used to noise filtering. The best sensitivity achieved in bacilli detection was 91.5%.

Avaliação do protocolo PCR4 de Marchetti em tecidos parafinizados para o diagnóstico da tuberculose cutânea e ganglionar

BACKGROUND: Cutaneous lymph node tuberculosis (CLTb) represents 25.4% of all cases of extra-pulmonary Tb in the state of Amazonas. The current methods of diagnose including bacteriological and histopathological assays involve some technical difficulties, and the polymerase chain reaction - PCR arise as an alternative method allowing specific results faster than the others. In this context the accuracy of PCR4 Marchetti et al. protocol was compared with traditional methods. MATERIAL AND METHOD: Nested-PCR for IS6110 (123 pb) were applied on 83 CLTb suspicious formalin fixed and paraffin embedded samples of tissues (52 cutaneous and 31 lymph node), obtained from 1997 to 2002. All cases were evaluated by bacteriological and histopathological methods. Accuracy analyses were carried out between the PCR amplification results and those related on bacteriological and histopathological methods. RESULTS AND DISCUSSIONS: Positive results of PCR4 were about 50.6% (59.6% in cutaneous samples and of 35.5% in lymph nodes samples). In both groups were observed false-negative and false-positive results. Some hypotheses that explain those results are related to the presence of IS6110 in environmental mycobacterias in the Amazon region and the absence of standardized DNA concentration to amplification assays. CONCLUSIONS: The proposed protocol was as positive as others ones available in the literature. Definitive Tb diagnostic can be obtained on lymph node paraffin embedded PCR in association with bacteriological or histopathological method. A better accuracy of an amplification assay applied to cutaneous Tb suspicious lesions has to be still under research.

Dermoid cyst of the pancreas: a case report

Dermoid cysts or mature cystic teratomas are mesenchymal neoplasms most commonly found in the ovaries, but which may occur in any location along the pathways of ectodermal cell migration. They are rarely seen in the pancreas, where they show a slight preference for the pancreatic head. We report a case of dermoid cyst of the pancreas in a 69-year-old male patient, discussing the epidemiology, clinical presentation, diagnosis and treatment of this neoplasm. Since preoperative diagnosis is difficult, given its rarity in this site, it is usually diagnosed by histopathology of the specimen.

Intervención educativa para recolección de esputo de la tuberculosis: un estudio casi experimental

Objetivo: avaliar a qualidade da amostra de escarro antes e apos as orientacoes de Enfermagem ao paciente. Metodos: estudo com delineamento de pesquisa quase experimental, do tipo grupo unico, antes e depois, nao randomizado. Participaram do estudo pacientes com suspeita de tuberculose pulmonar, sintomaticos respiratorios por mais de tres semanas, maiores de 18 anos, de ambos os sexos e sem antecedente de tuberculose nos ultimos dois anos. A intervencao educativa consistiu em orientacoes individualizadas sobre a coleta da amostra de escarro, fundamentadas nas diretrizes do Ministerio da Saude do Brasil e na entrega de folder explicativo. Resultados: participaram 138 pacientes com suspeita de tuberculose pulmonar. Os resultados evidenciaram importante acrescimo das amostras com particulas purulentas, volume maior que 5mL e aumento na taxa de pacientes diagnosticados com tuberculose, apos a intervencao educativa. Conclusao: comprovou-se que, apos a intervencao educativa, obtiveram-se amostras de escarro com maior qualidade, com aspecto e volume satisfatorios para efetividade do exame baciloscopico.Abstract Objective: to evaluate the quality of the sputum sample before and after the Nursing guidance to patients. Methods: this is a quasi-experimental research design, single group type, before and after, non-randomized study. The study enrolled patients with suspected pulmonary tuberculosis, respiratory symptomatic patients for over three weeks, aged over 18 years, of both genders and without tuberculosis history in the last two years. The educational intervention consisted of individualized guidance on the collection of sputum sample, which was based on the guidelines of the Ministry of Health of Brazil and on the explanatory folder delivery. Results: in this study participated 138 patients with suspected pulmonary tuberculosis. The results showed significant increase of the samples with purulent particles, volume greater than 5 mL and increased rate of patients diagnosed with tuberculosis, after the educational intervention. Conclusion: it was shown that after the educational intervention, it was observed sputum samples with better quality, with satisfactory aspect and volume for the effectiveness of the bacilloscopic examination.

Intervenção educativa para a coleta de escarro da tuberculose: um estudo quase experimental

Objetivo: avaliar a qualidade da amostra de escarro antes e apos as orientacoes de Enfermagem ao paciente. Metodos: estudo com delineamento de pesquisa quase experimental, do tipo grupo unico, antes e depois, nao randomizado. Participaram do estudo pacientes com suspeita de tuberculose pulmonar, sintomaticos respiratorios por mais de tres semanas, maiores de 18 anos, de ambos os sexos e sem antecedente de tuberculose nos ultimos dois anos. A intervencao educativa consistiu em orientacoes individualizadas sobre a coleta da amostra de escarro, fundamentadas nas diretrizes do Ministerio da Saude do Brasil e na entrega de folder explicativo. Resultados: participaram 138 pacientes com suspeita de tuberculose pulmonar. Os resultados evidenciaram importante acrescimo das amostras com particulas purulentas, volume maior que 5mL e aumento na taxa de pacientes diagnosticados com tuberculose, apos a intervencao educativa. Conclusao: comprovou-se que, apos a intervencao educativa, obtiveram-se amostras de escarro com maior qualidade, com aspecto e volume satisfatorios para efetividade do exame baciloscopico.Abstract Objective: to evaluate the quality of the sputum sample before and after the Nursing guidance to patients. Methods: this is a quasi-experimental research design, single group type, before and after, non-randomized study. The study enrolled patients with suspected pulmonary tuberculosis, respiratory symptomatic patients for over three weeks, aged over 18 years, of both genders and without tuberculosis history in the last two years. The educational intervention consisted of individualized guidance on the collection of sputum sample, which was based on the guidelines of the Ministry of Health of Brazil and on the explanatory folder delivery. Results: in this study participated 138 patients with suspected pulmonary tuberculosis. The results showed significant increase of the samples with purulent particles, volume greater than 5 mL and increased rate of patients diagnosed with tuberculosis, after the educational intervention. Conclusion: it was shown that after the educational intervention, it was observed sputum samples with better quality, with satisfactory aspect and volume for the effectiveness of the bacilloscopic examination.

Educational intervention for collecting sputum for tuberculosis: a quasi-experimental study

Objetivo: avaliar a qualidade da amostra de escarro antes e apos as orientacoes de Enfermagem ao paciente. Metodos: estudo com delineamento de pesquisa quase experimental, do tipo grupo unico, antes e depois, nao randomizado. Participaram do estudo pacientes com suspeita de tuberculose pulmonar, sintomaticos respiratorios por mais de tres semanas, maiores de 18 anos, de ambos os sexos e sem antecedente de tuberculose nos ultimos dois anos. A intervencao educativa consistiu em orientacoes individualizadas sobre a coleta da amostra de escarro, fundamentadas nas diretrizes do Ministerio da Saude do Brasil e na entrega de folder explicativo. Resultados: participaram 138 pacientes com suspeita de tuberculose pulmonar. Os resultados evidenciaram importante acrescimo das amostras com particulas purulentas, volume maior que 5mL e aumento na taxa de pacientes diagnosticados com tuberculose, apos a intervencao educativa. Conclusao: comprovou-se que, apos a intervencao educativa, obtiveram-se amostras de escarro com maior qualidade, com aspecto e volume satisfatorios para efetividade do exame baciloscopico.Abstract Objective: to evaluate the quality of the sputum sample before and after the Nursing guidance to patients. Methods: this is a quasi-experimental research design, single group type, before and after, non-randomized study. The study enrolled patients with suspected pulmonary tuberculosis, respiratory symptomatic patients for over three weeks, aged over 18 years, of both genders and without tuberculosis history in the last two years. The educational intervention consisted of individualized guidance on the collection of sputum sample, which was based on the guidelines of the Ministry of Health of Brazil and on the explanatory folder delivery. Results: in this study participated 138 patients with suspected pulmonary tuberculosis. The results showed significant increase of the samples with purulent particles, volume greater than 5 mL and increased rate of patients diagnosed with tuberculosis, after the educational intervention. Conclusion: it was shown that after the educational intervention, it was observed sputum samples with better quality, with satisfactory aspect and volume for the effectiveness of the bacilloscopic examination.