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Aradhana Harrison , Aswathy Prabha , Karishma Krishna , Vejay Viknesh Marudhadurai , Jahnavi Chikkegowda, Rajshree Choudhary ,
Volume 18, Issue 5 (9-2024)
Abstract

Background: β-thalassemia trait (BTT) can be screened by several discriminator indices (DIs) using complete blood counts (CBC). These DIs can help differentiate BTT from other causes of anaemia, thus reducing the financial burden of laboratory testing. At standard cut-off values, statistical analyses traditionally used to compare the diagnostic competence of these DIs give variable results. This study establishes new optimal cut-off values to improve the applicability of these DIs for BTT screening.
Methods: This was a retrospective study conducted on anaemic adults whose high-performance liquid chromatography (HPLC) and CBC results achieved over the past 6 months were reviewed. Based on HPLC reports, patients were categorised into BTT and non-BTT groups, with each group comprising 25 age- and sex-matched patients. Discriminator indices, including Mentzer’s Index (MI), Green and King Index (GKI), Sehgal Index (SI), Shine and Lal Index (SLI), Srivastava Index (SrI), and England and Fraser Index (EFI), were calculated for both groups. Statistical analysis was performed respective to standard cut-off values to establish new optimal cut-off values with the highest sensitivity and specificity.
Results: According to the results, SrI emerged as the best index, offering high sensitivity, specificity, Youden’s Index, accuracy, and odds ratio. On the other side, SLI and GKI were observed to be poor indices with low sensitivity and specificity. The new optimal cut-off values for the best performance of each DI for BTT screening were as follows: SrI ≤3.5, MI ≤11.4, GKI ≤59.7, SI ≤709.4, SLI ≤941.1, and EFI ≤1.91.
Conclusion: The performance of DIs at standard cut-off values was poor to screen BTT. New optimal cut-off values provided maximal sensitivity and specificity thereby enhancing their performance as screening parameters for BTT in regions with a high-prevalence of the condition. Further studies are warranted to substantiate the new cut-off values for BTT screening.

 

Fasahath Jahan Uzma , Shilpa L, Prathima S,
Volume 18, Issue 6 (11-2024)
Abstract

Background: Cervical cancer has seen a significant decline in death rates due to early diagnosis and treatment. The Pap test remains valuable but exhibits limitations, such as false positives and false negatives, with the former associated with atrophy-related changes. This article aims to bring attention to cervical carcinoma screening, focusing on the interpretation of atrophy-related changes in Pap smears and minimizing intervention.
Methods: This retrospective study, conducted at a tertiary care center, evaluated cases with intra-epithelial abnormalities or malignancies in Pap smears.
Results: A total of 11,680 cervical cytology smears received in the Department of Pathology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, over 7.5 years (From January 1, 2016, to June 30, 2023), were reviewed. Of these, 56 cases exhibited epithelial abnormalities and were categorized as follows: 1. Atypical squamous cells of undetermined significance, 2. Low-grade squamous intraepithelial lesion, 3. High-grade squamous intraepithelial lesion, and 4. Malignancy. Among the 56 smears, 40 (71%) showed co-existent atrophy. Biopsies were available for 22 smears, and atrophy with epithelial abnormalities co-existed in 16 (28%) of these cases. Of these 16 cases, only eight (50%) were found to have abnormalities greater than Cervical Intraepithelial Neoplasia II dysplasia. This results in the positive predictive value of cervical cytology smears detecting epithelial abnormalities in cases with co-existing atrophy-related changes being only 50%.
Conclusion: The article emphasizes the importance of cautious interpretation of Pap smears in the presence of atrophy.

 


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