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Rob Rubin Group

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Smear Extra Quality


Detecting cervical cancer early with a Pap smear gives you a greater chance at a cure. A Pap smear can also detect changes in your cervical cells that suggest cancer may develop in the future. Detecting these abnormal cells early with a Pap smear is your first step in halting the possible development of cervical cancer.




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Depending on the type of Pap testing you're undergoing, your doctor transfers the cell sample collected from your cervix into a container holding a special liquid to preserve the sample (liquid-based Pap test) or onto a glass slide (conventional Pap smear).


If only normal cervical cells were discovered during your Pap smear, you're said to have a negative result. You won't need any further treatment or testing until you're due for your next Pap smear and pelvic exam.


If abnormal or unusual cells were discovered during your Pap smear, you're said to have a positive result. A positive result doesn't mean you have cervical cancer. What a positive result means depends on the type of cells discovered in your test.


Atypical squamous cells of undetermined significance (ASCUS). Squamous cells are thin and flat and grow on the surface of a healthy cervix. In the case of ASCUS, the Pap smear reveals slightly abnormal squamous cells, but the changes don't clearly suggest that precancerous cells are present.


Background: The microscopic examination of sputum for acid-fast bacilli, is a simple and rapid test that is used to provide a presumptive diagnosis of infectious tuberculosis. While patients with tuberculosis with sputum smears negative for acid-fast bacilli are less infectious than those with positive smears, both theoretical and empirical evidence suggest that they can still transmit Mycobacterium tuberculosis. We aimed to estimate the risk of transmission from smear-negative individuals.


Methods: As part of an ongoing study of the molecular epidemiology of tuberculosis in San Francisco, patients with tuberculosis with mycobacterial isolates with the same DNA fingerprint were assigned to clusters that were assumed to have involved recent transmission. Secondary cases with tuberculosis, whose mycobacterial isolates had the same DNA, were linked to their presumed source case to estimate transmission from smear-negative patients. Sensitivity analyses were done to assess potential bias due to misclassification of source cases, unidentified source cases, and HIV-1 co-infection.


Findings: 1574 patients with culture-positive tuberculosis were reported and DNA fingerprints were available for 1359 (86%) of these patients. Of the 71 clusters of patients infected with strains that had matching fingerprints, 28 (39% [95% CI 28-52]) had a smear-negative putative source. There were 183 secondary cases in these 71 clusters, of whom a minimum of 32 were attributed to infection by smear-negative patients (17% [12-24]). The relative transmission rate of smear-negative compared with smear-positive patients was calculated as 0.22 (95% CI 0.16-0.32). Sensitivity analyses and stratification for HIV-1 status had no impact on these estimates.


Interpretation: In San Francisco, the acid-fast-bacilli smear identifies the most infectious patients, but patients with smear-negative culture-positive tuberculosis appear responsible for about 17% of tuberculosis transmission.


Sputum smear examination for acid-fast bacilli (AFB) can diagnose up to 50-60% of cases of pulmonary tuberculosis in well-equipped laboratories. In low-income countries, poor access to high-quality microscopy services contributes to even lower rates of AFB detection. Furthermore, in countries with high prevalence of both pulmonary tuberculosis and HIV infection, the detection rate is even lower owing to the paucibacillary nature of pulmonary tuberculosis in patients with HIV infection. In the absence of positive sputum smears for AFB, at primary care level, most cases of pulmonary tuberculosis are diagnosed on the basis of clinical and radiological indicators. This review aims to evaluate various criteria, algorithms, scoring systems, and clinical indicators used in low-income countries in the diagnosis of pulmonary tuberculosis in people with suspected tuberculosis but repeated negative sputum smears. Several algorithms and clinical scoring systems based on local epidemiology have been developed to predict smear-negative tuberculosis. Few of these have been validated within the local context. However, in areas where smear-negative tuberculosis poses a major public-health problem, these algorithms may be useful to national tuberculosis programmes by providing a starting point for development their own context-specific diagnostic guidelines.


It has been recognized for many years that root canal instrumentation produces a smear layer that covers the surfaces of prepared canal walls. This layer contains inorganic and organic substances such as fragments of odontoblastic processes and necrotic debris. There is a lack of agreement regarding the effect of the smear layer on the quality of instrumentation and obturation, but the smear layer itself may be infected and may protect the bacteria within the dentinal tubules. Various methods have been used to remove the smear layer. Conflicting results have been obtained from numerous in vitro studies regarding the significance of the presence or the removal of the smear layer.


Acid- Fast Bacilli (AFB) smear and culture are two separate tests always performed together at the MSPHL, Tuberculosis (TB) Unit. AFB smear refers to the microscopic examination of a fluorochrome stain of a clinical specimen. The AFB culture is the inoculation of a clinical specimen onto culture media Becton-Dickinson Mycobacteria Growth Indicator Tube (B-D MGIT broth) and Lowenstein-Jensen (L-J) media slant, incubation at 37C for up to six (6) weeks and detection of growth or no growth during this incubation period.


Pap smears can detect cervical or vaginal cancer in its early stages. They can also screen for sexually transmitted infections (STIs), fibroids, and various types of vaginal problems. The pelvic exam includes a breast/chest examination, which can help detect signs of breast/chest cancer.


Purpose: This procedure briefly describes the steps necessary to certify laboratories, pap smear, HIV testing and screening mammography services in North Carolina. The Medical Care Commission has rulemaking authority for laboratories performing pap smears and screening mammography services, per N.C. General Statutes 143B-165 (PDF, 15 KB). Rules in Title 10A of the North Carolina Administrative Code apply (10A NCAC 13M). HIV testing is done in accordance with rules adopted by the Commission for Health Services at 10A NCAC 42D, per N.C. General Statute 130A-148 (PDF, 18 KB).


Finding a provider you trust can help you feel more in control and comfortable during your first Pap smear. Dr. Nicole Spady, an OB-GYN with Kettering Health, says patients can ask for a male or female doctor depending on preference, and they can also ask for a different provider if they feel the need to.


Taking pain medication, such as Tylenol or Advil, a few hours before your exam can help alleviate some discomfort. Dr. Spady also shares that scheduling your Pap smear during a certain time in your menstrual cycle can help as well.


Specimen processing (ie, N-acetyl-L-cystine-sodium hydroxide treatment or equivalent, concentration, grinding, both or neither), mycobacterial culture, and smear when appropriate (smears are not performed on blood or when there is less than 2 mL of fluid). Identification by DNA probes or sequencing will be performed at an additional charge. This culture will often detect Nocardia species and other aerobic actinomyces, and identification appropriate for these organisms will be included.


Biopsy or body fluid: Transbronchial biopsy cultures may be of assistance in diagnosing tuberculosis in sputum smear-negative cases; however, sputum and bronchial washing cultures have a higher yield.1,2 In one study, only 2 out of 12 (16%) transbronchial biopsies were positive, and in those cases the biopsy was not the only source of culture-positive material.1


Urine: Positive acid-fast stained smears with low numbers of organisms are not diagnostic, because of the presence of Mycobacterium smegmatis in genital secretions of normal patients.


Concentrated smears are stained with auramine/rhodamine and read by fluorescence microscopy. Broth-based and/or agar-based culture. Culture is held for six weeks before negative is reported. Organisms are identified by use of DNA probes and/or nucleic acid sequencing.


This test is set up in the LabCorp computer as a sequential series of tests to comply with customer needs and bill for testing that is performed. Smear, when appropriate, is a separate test along with appropriate specimen processing needed to perform the smear and culture. The culture portion of the test is also separate, and, once growth of acid-fast organisms (or other aerobic actinomycetales) is detected, the culture portion is reported and identification testing begins with DNA probes. The results of DNA probes will be reported whether positive or negative. If all DNA probes are negative, identification will proceed by DNA sequencing.


Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis has been noted to occur from patient to patient and from patient to health care worker. Acid-fast bacilli isolation precautions and adherence to appropriate infection control procedures are recommended until at least three smears from specimens collected on different days are negative.19,20


A pap test, also known as a pap smear, is a test to look for changes to the cervix that may indicate cervical cancer or a precancerous condition. The cells taken from the cervix during the pap test can also be used to test for the presence of HPV and can determine the HPV sub-type. 041b061a72


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