Author: Moeng, Keitumetse ; Viana, Raquel ; Loubser, Shayne ; Tiemessen, Caroline T. ; Fortuin, Tumelo L ; Mayaphi, Simnikiwe H ; Glass, Allison ; Tiemessen, Caroline T ; Fortuin, Tumelo L. ; Mayaphi, Simnikiwe H. ; Nkone, Paballo

BACKGROUNDCurrently, most HIV drug resistance PCR assays amplify the protease-reverse transcriptase (PR-RT) fragment separately from the integrase (IN) fragment. The aim of this study was to develop a multiplex PCR assay that simultaneously amplifies PR-RT and IN fragments for HIV-1 drug-resistance testing.METHODSThe in-house multiplex PCR assay was evaluated on extracted total nucleic acids obtained from the National Health Laboratory Service (NHLS) and Lancet laboratories. Sanger sequencing was performed on amplicons, and HIV-1 drug-resistance mutations (DRMs) were assessed using HIV Stanford drug resistance database.RESULTSThis study tested 59 patient samples with known HIV-1 viral load and DRM results; 41 from Lancet and 18 from NHLS. In-house multiplex PCR assay detected one or both fragments in most samples but had higher sensitivity for detection of IN fragment (93.2 %) compared to PR-RT fragment (83.1 %). There was 100 % concordance between Lancet assay versus in-house assay sequence data for IN DRMs, but lower concordance with PR-RT (87.0 %). The in-house multiplex PCR assay's precision and reproducibility analysis showed ≥99.9 % sequence similarity and yielded similar DRM results for both PR-RT and IN fragments.CONCLUSIONSThe in-house multiplex PCR assay demonstrated satisfactory performance and higher sensitivity for IN fragment amplification. This could be a cost-effective method for HIV-1 drug resistance testing as both PR-RT and IN fragments are successfully amplified in one reaction in most samples.

01 Sep 2024·Clinical Nuclear Medicine Open

Atypical Primary Sclerosing Cholangitis Findings on a 99mTc-Mebrofenin Scan

Author: Sadhabiriss, Dhiren ; Korowlay, Nisaar ; Kashala, Lusamba ; Maharaj, Masha ; Govender, Trisha ; Chotey, Nivesh ; Gounden, Strinivasen

AbstractWe present an 80-year-old woman with cholestatic liver disease. Ultrasound, CT, and MR cholangiopancreatography showed no substantial findings. The patient was referred for a hepatobiliary scan to examine the physiological pathway of bilirubin and to determine for any level of obstruction. The findings on the hepatobiliary scan suggested intrinsic pathology affecting the entire biliary tree, and histology was recommended. Histology confirmed primary sclerosing cholangitis (PSC). Although hepatobiliary scintigraphy in biliary stasis is well-known and well-published, hepatobiliary scintigraphy in PSC in adults is not well-documented. The hepatobiliary scintigraphy provided the primary and definitive imaging technique in directing the management and diagnosis of PSC in our patient.

01 Jul 2024·Archives of Pathology & Laboratory Medicine

Pathologic Findings in Severe Coal Workers’ Pneumoconiosis in Contemporary US Coal Miners

Article

Author: Iwaniuk, Cayla ; Cool, Carlyne D ; Murray, Jill ; Rose, Cecile S ; Vorajee, Naseema I ; Almberg, Kirsten S ; Zell-Baran, Lauren M ; Go, Leonard H T ; Cohen, Robert A ; Franko, Angela D ; Sanyal, Soma ; Green, Francis H Y

Context.—The pathology of coal workers’ pneumoconiosis (CWP) and its most severe form—progressive massive fibrosis (PMF)—in US coal miners has changed in recent years. Severe disease is occurring in younger miners and has been linked to an increase in silica dust exposure.Objective.—To update the description of the pathologic features of CWP in contemporary miners compared to historical miners.Design.—This study is a retrospective expert classification of lung tissue from 85 historical and contemporary coal miners with PMF. Significant pathologic features were scored by using a standardized instrument with consensus achieved for major findings, including newly defined categories of PMF as coal-type, mixed-type, and silica-type.Results.—Pathologic features associated with silica dust exposure, including silica-type PMF, mineral dust alveolar proteinosis (MDAP), and immature (early stage) silicotic nodules, were increased in contemporary miners. Detailed descriptions of the pathology of contemporary CWP with illustrative figures are provided.Conclusions.—Silica-related pathologies are more common in contemporary miners. Severe forms of CWP can be detected by subtyping PMF lesions (if present) or by identification of mature and immature silicotic nodules, coal mine dust–related alveolar proteinosis, and severe inflammation in coal miners’ lungs. Silica-type PMF cases showed significantly higher levels of MDAP than either mixed- or coal-type PMF (P < .001). High profusion of birefringent silica/silicate particles was observed more frequently in cases with immature (early stage) silicotic nodules (P = .04). Severe inflammation was also significantly increased in contemporary miners (P = .03). Our findings underscore the urgent need to revise current exposure limits and monitoring of respirable crystalline silica in US coal mines.

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