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A primary function of this stain is to identify tuberculosis in lung tissue. In-text: (Routine Stains & Special Stains, 2015) Your Bibliography: 2015. In a clinical histology laboratory, all specimens are initially stained with H&E and special or advanced stains are only ordered if additional information is needed to provide a more detailed analysis, for example to differentiate between two morphologically similar cancer types. This involves fixing the tissue (so it does not decay) then hardening and supporting it so that it can be cut to the very thin sections needed (typically 27 m). 76{0qej@>\NY{TJ}Fs\8#P%}rcf,6JY0"g From translational research to routine diagnostics or AI development. One way we can achieve this vision is by helping improve staining quality. Because of the volume of H&E staining needed, most clinical laboratories use fully automated systems and manual staining is now rare. Our Open Innovation (OI) partnerships enable easy integration across technologies, supporting fluorescent and chromogenic protocols, and helping to answer your most pressing research questions. By colouring otherwise transparent tissue sections, these stains allow highly trained pathologists and researchers to view, under a microscope, tissue morphology (structure) or to look for the presence or prevalence of particular cell types, structures or even microorganisms such as bacteria. The A to Z of Histological Stains Published September 6, 2017 Posted in: Microscopy and Imaging With the use of stains and dyes, histology allows researchers to visualize particular tissue structures, the chemical elements within cells, tissues, and even microorganisms. Fewer resources, more to do, and less time to get work done. In surgery every moment matters. The most sensitive stain for mycobacteria is the auramine stain which requires a fluorescence microscope for viewing. From glass slides and coverslips to wax and bulk reagents, smooth running of any laboratory depends on a consistent supply of high-quality consumables. It does stain a lot of things and, therefore, can have a high background. Table 9.1 Commonly used stain for different substances. The reticulin fibers are black and better defined in section A (Gordon & Sweets method). 18 0 obj <> endobj xref 18 41 0000000016 00000 n WebIn this handbook are collected the components and the main staining protocols of special stains kit. The Leica Biosystems Life Science peer-reviewed publication repository offers a method for building a bibliography of scientific publications referencing Leica Biosystems Life Sciences products. Modern Multiplex Solutions for the Research Lab, Multiplexing addresses the need for researchers to assess multiple biomarkers (protein and/or nucleic acid markers) at specific locations within a tissue sample, Integrated Translational Research Solutions. Webneeds [1]. In the histopathology laboratory, the term routine staining refers to the hematoxylin and eosin stain (H&E) that is used routinely with all tissue specimens to reveal the underlying tissue structures and conditions. Developed in-house with 20+ years of experience, these robust antibodies are optimized for automated and manual applications. The method relies upon the melanin granules to reduce ammoniacal silver nitrate (but argentaffin, chromaffin, and some lipochrome pigments also will stain black as well). If you have viewed this educational webinar, training or tutorial on Knowledge Pathway and would like to apply for continuing education credits with your certifying organization, please download the form to assist you in adding self-reported educational credits to your transcript. 0000032778 00000 n 0000023865 00000 n Anatomic Pathology Special Stains - Cleveland Clinic The Papanicolaou stain is recommended for the staining of alcohol fixed cytology slides. Web Privacy Policy | Links from websites affiliated with The University of Texas Health Science Center at San Antonio's website (uthscsa.edu) to other websites do not constitute or imply university endorsement of those sites, their content, or products and services associated with those sites. WebThe term special stains traditionally referred to any staining other than an H&E. The variety of stains also means that special staining is not as automated as H&E staining. 0000015594 00000 n They can be used to contrast skeletal ,cardiac or smooth muscle. (PDF) Special Stains | Prof. Hesham N Mustafa - Academia.edu /s{pEH>A4i,E 5!4EPjl!gBDP 4LJlXuJ b2> PL?qMDkN c`&AYr1Xhq`4f;W"E@k %R,)IEHcH|^r)e.8gPr~ 0 U endstream endobj 39 0 obj <>stream The Gomori Trichrome is a simplification of the more elaborate Masson trichrome stain and combines the plasma stain (chromotrope 2R) and connective tissue stain to provide a brilliant contrasting picture. Leica Biosystems can clarify your organizations path to digitally driven discoveries or diagnostics. HISTOPATHOLOGY Figure 9: Modified GMS Silver Stain (Left: Pneumocystis, lung) (Right: Aspergillus infection, lung). An Intro to Routine and Special Staining in Histopathology The paraffin section process is as follows: Hematoxylin and Eosin (H&E) stainingis used routinely in histopathology laboratories as it provides the pathologist/researcher a very detailed view of the tissue. Bacilli are rod-shaped bacterial organisms. In a clinical histology laboratory, all specimens are initially stained with H&E and special or advanced stains are only ordered if additional information is needed to provide a more detailed analysis, for example to differentiate between two morphologically similar cancer types. Adopting digital pathology is complex, but it doesnt have to be complicated. Our goal is to shape the future with novel technologies that inspire every researchers exploration of biology. In this silver impregnation stain for reticulin, the fibers are poorly demonstrated and there is a background scum (precipitate) on the slide. Often used to stain kidney biopsies, liver biopsies, certain glycogen storage diseases in striated muscles and suspected fungal infections. Developed in-house with 20+ years of experience, these robust antibodies are optimized for automated and manual applications. It is used to assist in differentiating collagen and smooth muscle in tumors and assists in the detection of diseases or changes in connective/muscle tissue. Researchers need clear results to discover new treatments. Special stains Cryostats for your Cancer or Neuroscience research needs. Sometimes when results are poor, it is difficult or impossible to work out why because protocol changes have not been recorded. The variety of stains also means that special staining is not as automated as H&E staining. These sections of formalin-fixed submucosa have been stained with Masson trichrome stain. Figure 16: Gomori Trichrome (green) (submucosa). The process for frozen section preparation is as follows: When paraffin sections are to be prepared the specimen is first preserved with a fixative and then the tissue structure is supported by infiltrating the specimen with paraffin wax. Special stain in histopathology - [PDF Document] The University of Texas Health Science Center at San Antonio, also called UT Health San Antonio, is a leading academic health center with a mission to make lives better through excellence in advanced academics, life-saving research and comprehensive clinical care including health, dental and cancer services. {N3P5$9g*'kV5,3!lK8:+*o>Kx/|+ Use microscopic control at crucial stages such as differentiation steps. The slides are then dried in an oven or on a hot plate to remove moisture and help the tissue adhere to the slide. While we cant eliminate these pressures, we can help you make the most of each minute, meet your metrics, and consistently deliver slides on-time. 1. TITLE: Special Stains Overview. 2. DEFINITION : The You can download the paper by clicking the button above. The termspecial stainstraditionally referred to any staining other than an H&E. In this field from the lamina propria of small intestine, the cytoplasm of plasma cells has stained with hematoxylin except for the pale peri-nuclear area, which corresponds with a well-developed Golgi apparatus, Figure 5. Often used to stain kidney biopsies, liver biopsies, certain glycogen storage diseases in striated muscles and suspected fungal infections. 0000058874 00000 n The Gomori Trichrome is a simplification of the more elaborate Masson trichrome stain and combines the plasma stain (chromotrope 2R) and connective tissue stain to provide a brilliant contrasting picture. Eosin is anacidicdye that is typically reddish or pink. Our broad range of tissue processors means you can choose the right instrument for your laboratory's space, throughput, and workflow needs. Hematoxylin reacts like abasicdye with a purplish blue colour. In this case, the stain was performed correctly following the lab protocol and including a preliminary chromic acid step (sensitization or secondary mordanting). Special Stains Manoj Madakshira Gopal 5.4K views43 slides. The Modified GMS Silver stain is intended for use in histological observation of fungi, basement membrane and some opportunistic organisms such as pneumocystis carinii in tissue specimens. (PDF) Special Stains | Prof. Hesham N Mustafa - Academia.edu Figure 15: Gomori Trichrome (blue) (submucosa). It achieves this by clearly staining cell structures including the cytoplasm, nucleus, and organelles and extra-cellular components. K4M. One way we can achieve this vision is by helping improve staining quality. Both these sections of skin from the same block have been stained with the PAS method. Some require refrigeration because they are inclined to support the growth of fungi or molds. A comprehensive range of probes, detection, ancillaries, and instruments for automated or manual ISH detection in fluorescence and brightfield applications. 0000015192 00000 n Improve quality, reduce errors, and save time with dedicated plug and play consumables. They can be used to contrast skeletal, cardiac or smooth muscle. Note the lack of differential coloration of muscle in section B (intestine). Trichrome stains are used to stain and identify muscle fibers, collagen and nuclei. Unsubscribe at any time. Histology, Biochemistry, and Molecular Imaging Core To browse Academia.edu and the wider internet faster and more securely, please take a few seconds toupgrade your browser. All our reagents are stored on the shelf above the staining bench. These liver sections were stained by the same method. There are two main techniques used for this, referred to as frozen sections and paraffin-embedded sections. The term special stains has long been used to refer to a large number of alternative staining techniques that are used when the H&E does not provide all the information the pathologist or researcher needs. This stain uses carbol-fuchsin to stain the lipid walls of acid fast organisms such as M. tuberculosis. Special stains are not routinely used. Get more Knowledge Pathway content delivered directly to your inbox. Figure 15: Gomori Trichrome (blue) (submucosa). english - bamed 0000013485 00000 n Hematoxylin is extracted from the logwood tree and purified. Special stains in histopathology Ekta Jajodia 146K views82 slides. Leica Biosystems Knowledge Pathway content is subject to the Leica Biosystems website terms of use, available at: Legal Notice. H & E stain, Special stain, Histopathology, Pathologist. There are a variety of Romanowsky-type stains with mixtures of methylene blue, azure, and eosin compounds. 210-567-7000, Contact Translational research projects are as novel as the technologies that drive them. There is constant pressure to quickly produce reliable results. A: Wet section (no coverslip) viewed under a microscope with closed condenser diaphragm. LEICA and the Leica Logo are registered trademarks of Leica Microsystems IR GmbH. Note the false background. Our purpose is to enable researchers to accelerate their journey, transforming scientific exploration into translational outcomes. r ^1 HQE~]!OO q^.^H%/]sz#('Qzi f0Dd5Jr%avcJ|+d%-vc gq]Ye-ZjU+>{%~zDnG,aLF6,w{>LWh;'hN;K=TRr?${VJ^ cuN3G$IvV@JV:@k(DcJ2(bP` $3L%Zv#4SRXYD2/zon}F4MFp$;xaVX3W9jhR7Bh?|n73nc6*,S?? (PDF) Special Stains in Histopathology: An Oral Pathology WebIn the histopathology laboratory, the term routine staining refers to the hematoxylin This combination is used as the dyes stain different tissue elements. The tissue on the slide is now ready for staining. The Gomori Trichrome is a simplification of the more elaborate Masson stain and combines the plasma stain (chromotrope 2R) with the connective tissue stain to provide a brilliant contrasting picture. Tissue can be pre-digested with hyaluronidase to provide more specificity. Just following the method and not really knowing what should be seen in the finished section will lead to poor results. Chemical Analysis, Life Sciences, and Diagnostics | Agilent 0000002016 00000 n 0000002051 00000 n 4b\+Fn ndO5[|AFpa(FolmrZ[s$^ >ed,SawHN5 ?bRnpozVTWLKQg Webwith the common skeletal stains we use such as, Alcian Blue/Hematoxylin/Orange G, Safaranin O/Fast Green. This review assesses and compiles the current available literature to provide a sense of the rich legacy of histopathological analysis. California: Do Not Sell or Share My Data. 0000024581 00000 n Minute amounts of ferric iron (haemosiderin) are commonly found in bone marrow and in the spleen. Both these sections of skin from the same block have been stained with the PAS method. A predigestion step with amylase will remove staining for glycogen. Histology stains, fluorescent stains and special stains are used to stain specific cell and tissue structures, and also to stain microorganisms to help identify the location of primary antibody staining. Ocular melanin takes hours to bleach, while that from skin takes minutes. At Leica Biosystems, our vision is to advance cancer diagnostics and improve lives. Eosin Y is most popular. They can be used to contrast skeletal, cardiac or smooth muscle. They are quick to produce, but typically do not create the same section quality of as the paraffin technique.. Learning objectives Learning objectives, Bancroft's Theory and Practice of Histological Techniques, International Journal of Medical Laboratory Research (IJMLR), Dyes and Stains: from molecular structure to histological application, The influence of inorganic salts when staining with preformed metal complex dyes, Eponyms in the dermatology literature linked to Stains used in Skin biopsies, Histomorphological Studies on the Prostate Gland of Donkey Equus Asinus during Different Seasons, Staining methods applied to glycol methacrylate embedded tissue sections, PATHOLOGY PRACTICAL BOOK PATHOLOGY PRACTICAL BOOK, Harsh mohan pathology practical book 2nd edition, Dyes and other colorants in microtechnique and biomedical research, Anatomical, Histological and Histochemical Adaptations of the Reptilian Alimentary Canal to Their Food Habits: II-Chamaeleon africanus, Histological and Histochemical Studies on the Ampulla of the Deferent Duct of Donkey (Equus asinus), Anatomical, histological and histochemical adaptations of the avian alimentary canal to their food habits: I-Coturnix coturnix, Pelvic Urethra and its Associated Glands in Donkey (Equus asinus): Histological and Histochemical Findings with Special Reference to their Seasonal Variations, Computer-assisted image analysis in the diagnosis of gynaecological lesions: A quantitative and comparative investigation of haematoxylin-eosin with special dyes on tissue, Morphology and Histochemistry of Juvenile American Alligator ( Alligator mississippiensis ) Nephrons, Morphology and Histochemistry of Juvenile Male American Alligator (Alligator mississippiensis) Phallus, Junqueira's Basic Histology Text and Atlas, 14th Edition, Junqueiras Basic Histology Text and Atlas 14th Edition Vet Books ir, The Eye and Ear: Special Sense Organs Appendix: Light Microscopy Stains, TAXONOMY AND BIOLOGY OF SIPUNCULANS, WITH EMPHASIS ON THE MORPHOLOGY OF PHASCOLION STROMBUS (MONTAGU, 1804). Histopathology of biodegradable polymers: terials, special emphasis should be given for providing a detailed summary of pathology results in addition. This section shows large deposits of extraneous microorganisms which have grown in the staining solution (in this case hematoxylin) then been deposited on top of the section. It is very sensitive, but specificity depends upon interpretation. The process for frozen section preparation is as follows: When paraffin sections are to be prepared the specimen is first preserved with a fixative and then the tissue structure is supported by infiltrating the specimen with paraffin wax. HSM0W=$RUi[HPpX!*l"3UBZ#j7 gRZJ)lZfu?U8__BrX Introduction to Histology Stains | histology - University of Michigan These sections of formalin-fixed submucosa have been stained with Masson trichrome stain. Be aware of the shelflifeof the reagents you are using. II. There are two eosin variants typically used in histology: eosin Y which is slightly yellowish and eosin B which is slightly bluish. Intraoperative consultations require rapid responses to surgical staff. There are two eosin variants typically used in histology: eosin Y which is slightly yellowish and eosin B which is slightly bluish. Delicate reticular fibers, which are argyrophilic, can be seen. 0000016581 00000 n Every BOND system is complete, automated, and engineered for speed, reliability and accuracy with each configuration tailored to address discovery challenges. Scan - Aperio Digital Pathology Slide Scanners. 21440 W. Lake Cook Road 0000052893 00000 n Figure 16: Gomori Trichrome (green) (submucosa). Special stain in HIstopathology Presented by Dr. Mahesh Guide: Dr. S. Copyright Leica Biosystems Nussloch GmbH2023, HistoCore PELORIS 3 - High Throughput, 1hr Rapid Parallel Processing, HistoCore PEGASUS - Medium Throughput, Parallel Processing, HistoCore PEGASUS Plus - Medium Throughput, Parallel Processing + Tracking, HistoCore PEARL - Small Footprint, Intuitive User Interface, HistoCore AUTOCUT - Automated Rotary Microtome, HistoCore MULTICUT - Semi-Automated Rotary Microtome, HistoCore BIOCUT - Manual Rotary Microtome, Leica RM2125 RTS - The Essential Microtome, Leica CM1950 - Large Specimen Numbers, Varying Specimen Types, Leica CM1860 - Routine Histopathology Applications, Leica CM1520 - Value-priced cryostat for routine histology and Mohs surgery, Leica CM3600 XP - Whole Body Sectioning with GLP documentation, Leica CV5030 - Fully Automated Glass Coverslipper, ThermoBrite - ISH/FISH Slide Denaturation/Hybridization Instrument, ThermoBrite Elite - Fully Integrated, Automatic ISH/FISH Slide Processing System, Aperio GT 450 - Automated, High Capacity Digital Pathology Slide Scanner, Aperio CS2 High quality digital slides from your desktop, Aperio VERSA - Brightfield, Fluorescence & FISH Digital Pathology Scanner, Aperio ImageScope - Pathology Slide Viewing Software, HistoCore BIOCUT R - Mechanical Manual Rotary Microtome, HistoCore MULTICUT R - Semi-Automated Rotary Microtome, HistoCore AUTOCUT R - Automated Rotary Microtome for Research, HistoCore NANOCUT R - Automated Research & Special Applications Rotary Microtome, Leica VT1000 S - Vibrating blade microtome, Leica VT1200 - Semi-Automatic Vibrating Blade Microtome, Leica VT1200 S - Fully automated vibrating blade microtome, BOND RX-ADVANCE Advanced Research Staining Network, Research Microtomes - Research Rotary Microtomy Solutions, Vibratomes - Vibrating Blade Microtomy Solutions, Specimen Identification - Specimen Identification Solutions, The BOND RX Stainer - Automated Multiplexing Solutions, H&E Image Quality & Tissue-based Research, Benefits Of Automation For Tissue-Based Research, Modernization of Tissue-based, Biomarker-led Clinical Research, Strategies for Spatial Multi-omics: Co-detection of protein and RNA biomarkers on a single FFPE tissue section powered by InSituPlex Technology, Buying a Research Microtome: Why Quality Matters in Research Microtomy, Top Considerations When Buying a Digital Pathology Scanner, Apply for self-reported educational credits. Alcian Blue is normally prepared at pH 2.5 and is used to identify acid mucopolysaccharides and acidic mucins. Scanning is the first step in digital pathology; put your best foot forward. California: Do Not Sell or Share My Data. It discusses the principles of and offers clear guidance on all routine and special laboratory techniques. From translational research to routine diagnostics or AI development, there is an Aperio scanner for every need. Other than routine haematoxylin and eosin stain, various special stains are now essential parts in routine laboratory works. Lab: Special Histochemical Stains and Immunohistochemical WebStains play a vital role in any histopathological laboratory. Eosin is formed by a reaction between bromine and fluorescein. Manage Aperio Digital Pathology Software. Explore the virtual art gallery with images showing different staining techniques such as multiplex biomarker detection in tissue samples performed on the BOND RX fully automated stainer. Special Stains available include: The trichrome stain helps to highlight the supporting collagenous stroma in sections from a variety of organs. Create high-quality IHC slides with a complete solution of antibodies, ancillary reagents, and detection systems. ,PJ .rjP 3 Notes CYTOLOGY : STAINING METHODS - National Find information below about. Life-changing diagnoses for every patient reside in every slide. In surgery every moment matters. Figure 11: Perls Prussian Blue Iron (liver). Staff members achieve different results when supposedly using the same protocol. Download 101 Steps to Better Histology now! This stain is used to detect and identify ferric (Fe3+) iron in tissue preparations, blood smears,or bone marrow smears. Adopting digital pathology is complex, but it doesnt have to be complicated. A stain that combines the properties of both Alcian Blue and Periodic Acid Schiff staining. Use of special stains for tissues not only aids in distinguishing structural alterations of tissues but also alerts the physician to alterations in tissue function highly relevant to making a diagnosis, such as abnormal deposition or iron, abnormal deposition of protein [amyloidosis, paraproteinemia, etc., abnormal accumulation of glycogen or Hemotoxylin & Eosin (H & E) The most widely used stain in medical diagnosis. Mercurial fixatives seem to do a better job of preserving iron in bone marrow than formalin. The giemsa stain can be helpful for identifying components in a variety of tissues. This stain, often abbreviated as GMS, is used to stain for fungi and for Pneumocystis carinii. Note the brown staining of collagen. Included are cryptosporidium, isospora, and the hooklets of cysticerci. Consistently deliver the high-quality staining your department demands with integrated stains, stainers and expert advice. Standardize them as far as possible as they are frequently the cause of variable results. 0000012883 00000 n Always use a control slide known to contain the structure/ substance you are trying to demonstrate. Our digital slide scanning products offer unprecedented image quality, speed and reliability for whole slide imaging; making Aperio ePathology scanners the optimal choice for research professionals. HT]o0}NO4Mj4j$$VPONn9>8_lNa]{pe0 @C6iA'InIS This involves fixing the tissue (so it does not decay) then hardening and supporting it so that it can be cut to the very thin sections needed (typically 27 m). Get Knowledge Pathway updates delivered directly to your inbox. Selected in-depth reviews of current practices and evidence-based solutions for the research community. Live and recorded scientific educational resources presented by industry thought leaders. The classic method for demonstrating iron in tissues. Vibrating microtomes (Vibratomes) by Leica Biosystems help you to accurately cut tissue under physiologial conditions without freezing or embedding. WebHistological stains (specialty) Technique Pathology, Anatomic Pathology Print PDF The Hematoxylin and Eosin (H&E) method is the routine, recognized stain used within histology laboratories; however, many other special tinctorial stains are used on specific tissue or cellular components to aid diagnosis of toxicological or pathological changes. We support scientists with solutions that bring automation, flexibility, and optimization to scale up your success and move quickly and efficiently into practical application. Tissue is quickly frozen to preserve and harden it. Special Stains - Department of Pathology and Laboratory Medicine Enabling clinicians to efficiently provide patients a highly confident diagnosis within 24 hours of biopsy. It stains glycogen, mucin, mucoprotein, glycoprotein, as well as fungi. The term special stains has long been used to refer to a large number of alternative staining techniques that are used when the H&E does not provide all the information the pathologist or researcher needs. Annotated Bibliography 1555-1995 Appended as Annex, Anatomical Studies on the Alimentary Tract of the Egyptian Typhlopid SnakeRhamphotyphlops Braminus, Jonqueira's basic histology text and atlas, Fluorescent-labelled aprotinin: a new reagent for the histochemical detection of acid mucosubstances, Veterinary Cytology Dog, Cat, Horse & Cow Self-Assessment (2007), The histochemistry of the labial salivary glands of the onehumped camel ( Camelus dromedarius ), Bone marrow aspirate and biopsy: a pathologist's perspective. Scanning is the first step in Digital Pathology; put your best foot forward. 0000007661 00000 n 4.2.1. We assume all reagents can be used for an indefinite period. Access additional educational resources to support your applications, including content with technical knowledge and "how-to" guides. @ hb```b`` @Q S"40`Fg:yUm;j\r:@]js+&_cUx:&_h6W `: S6p@P6I@h2HXD &-}o 33hqrb!`ZV! Perl's stain manoj pant 4.7K views17 slides. A reticulin stain occasionally helps to highlight the growth pattern of neoplasms. In this silver impregnation stain for reticulin, the fibers are poorly demonstrated and there is a background scum (precipitate) on the slide. Special stains are generally the non-routine stains applied to histological sections or cytological preparations, able to show specific tissue components, to differentiate cell types and de- tect the presence of any microorganisms. The process is more time-consuming than creating frozen sections, but provides better quality staining in most cases and the resultant samples (referred to as blocks) can be stored almost indefinitely. Intelligent automation for precise temperature control coupled with flexible, ergonomic configuration enable efficient workflow and maximized productivity. A section of liver stained with PAS. Standardize them as far as possible as they are frequently the cause of variable results. Bacteria appear on H and E as blue rods or cocci regardless of gram reaction. The Anatomical Record: Advances in Integrative Anatomy and Evolutionary Biology, Angel Garcia Martin, Juan Manuel Iglesias, What is histopathology? This would make a satisfactory control block for iron stains. Maps & Directions Some require refrigeration because they are inclined to support the growth of fungi or molds. Secure, scalable solutions with flexible deployment options enable anytime, anywhere access to your slides. Timing is always approximate. Just following the method and not really knowing what should be seen in the finished section will lead to poor results. Web[3,4]The most common special stains for microorganismsare the tissue Gramstain for bacteria (of which there are several common variants),[12-15] the Grocott-Gomori methenamine silver stain (GMS) for fungi and the Ziehl-Neelsen (ZN) and Kinyoun acid-fast stains for mycobacteria and nocardia. -LKcctmGeot*y"~sTi3viFo=(Tq" D endstream endobj 32 0 obj /Filter<>/PubSec<>>>/Reference[<>/Type/SigRef>>]/SubFilter/adbe.pkcs7.detached/Type/Sig>>>>/Type/Catalog/ViewerPreferences<>>> endobj 33 0 obj <>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 34 0 obj <>stream

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after effects of covid pneumonia