bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Detection by Immunofixation Electrophoresis (IFE) of Monoclonal Proteins in Veteran Patients with Hypogammaglobulinemia on Negative Serum Protein Electrophoresis, the Veteran Affairs Medical Center (VAMC) Experience
Authors: Petersen J M , Litman M , Millili R , Jhala D 
Published: October 2020

Abstract

Introduction/Objective
Serum protein electrophoresis (SPEP) is the backbone laboratory test for the detection of abnormal monoclonal proteins. However, IFE is a sensitive assay that can sometimes detect monoclonal proteins even when the corresponding SPEP is negative. The fact that IFE is more sensitive than SPEP combined with the need to avoid overutilization of IFE has led to published algorithms for guidance. Hypogammaglobulinemia in a new patient has been recognized in these algorithms as a reason to reflex to IFE when SPEP is negative, though studies on veteran patients are sparse. Therefore, this QA study of the percentage of positive IFEs in negative new SPEP veteran patients with hypogammaglobulinemia was undertaken to ensure reflex IFEs would still be indicated.

Methods
As part of a quality assurance/quality improvement project, a retrospective Vista/Fileman search of all SPEPs with IFE performed from January 2017 to February 2019 was undertaken to identify cases of SPEPs showing hypogammaglobulinemia (&lt;0.7 g/dL). Diagnostic comments were then analyzed to identify cases of hypogammaglobulinemia along with the M-spike (&lt;0.1 g/dL) to identify negative SPEPs. Only those cases that were consistent with first time hypogammaglobulinemia without an obvious M-spike were included and tabulated for calculations. Any result that was not negative for a monoclonal band was considered as positive.

Results
There were a total of 194 specimens that met the criteria of SPEP with hypogammaglobulinemia and standard comments consistent with first time analysis and without an obvious M-spike on SPEP. Out of these 194 specimens, 45 had a positive result, either as a monoclonal band comigrating with the beta protein peak or as a very faint gamma or beta monoclonal band. This represented approximately 23% of the specimens, about double the literature published rate for the non-veteran population.

Conclusion
The performance of IFE on new hypogammaglobulinemia veteran patients appears to be indicated like previously published algorithms and is supported by the fact that about double (23%), compared to the non-veteran population, had positive IFEs despite negative SPEPs. IFE is a helpful tool for new hypogammaglobulinemia patients for the detection of monoclonal proteins despite negative SPEPs.
Cytology-Histology Correlation of Hydatid Cyst: A Case Study and Literature Review
Authors: Agarwal A , Rosca O , Mody K , Mukherjee I 
Published: October 2020

Abstract
Casestudy: Hydatid cyst results when humans get infected by ingesting the eggs of Echinococcus Granulosus. Upon release, the six-hooked oncospheres penetrate the intestinal wall and migrate via circulation to various organs, mostly liver and lung. Here, they develop into hydatid cyst. The cyst enlarges gradually and is filled with daughter cysts and protoscolices.
We report the case of a 69-year old female, native of Uzbekistan, who presented with right upper quadrant pain. Imaging showed a 20 cm liver cyst and multiple pelvic cysts with a stage of CE2 implying that they were most likely functional. Serum Echinococcal antibody was positive. After 2 months of Albendazole treatment, there was no radiological change. The patient underwent laparoscopic puncture aspiration and injection with 20% saline (PAIR) and pericystectomy of the pelvic cysts. The aspirate revealed scattered scolices, inflammatory cells and abundant amorphous debris consistent with hydatid cyst. Bilateral 5-cm pelvic cysts had pale yellow, soft to firm walled, multiple cavities. Microscopy revealed a fibrofatty outermost layer with chronic inflammation and a two-layered cyst wall including a thin germinal epithelium covered by a thick acellular outer membrane. Multiple parasites, some degenerate (dense eosinophilic) were present, confirming the cytologic diagnosis of cystic echinococcosis. Following further treatment with Albendazole, she underwent a robotic assisted PAIR and partial peri-cystectomy of the liver cyst with repair of the duct to cyst communication. The liver cyst contained daughter cysts of Echinococcus and brood capsule with protoscolices. After 2 months more of Albendazole her Elisa was intermediate.
A prior study reported cytopathologic diagnosis of hydatid cyst in 17 patients evaluated for various masses. Our case highlights the role of cytology sampling in confirming the diagnosis of hydatid disease. Potentially fatal in untreated patients, this entity has to be considered in the differential diagnosis of cystic lesions.
Quality and Patient Safety in a Pathology Residency Training Program
Authors: Demkowicz R , Sapatnekar S , Chute D 
Published: October 2020

Abstract

Introduction/Objective
Since the start of the new millennium, optimization of Quality and Patient Safety (QPS) has taken a renewed focus in the healthcare industry. Consequently, the Accreditation Council for Graduate Medical Education has mandated that QPS be a part of residency training. We have previously presented our curriculum designed to meet the specific needs of Pathology training programs, and covering four content areas: Handoffs, Error Management, Laboratory Administration, and Process Improvement. We are now presenting implementation.

Methods
To implement this curriculum, we 1) created online modules for self-directed learning on basic topics (using courses developed by IHI and CAP, and assigned articles), and paired these with faculty-facilitated interactive learning activities on more complex topics, including proficiency testing, root cause analysis and test utilization, 2) assigned every resident to a QPS project that was aligned with departmental priorities, led by a faculty advisor, and ran over 8- 10 months, and 3) appointed a QPS Chief Resident to coordinate and support the residents’ QPS activities. We measured the impact of the curriculum by comparing RISE laboratory accreditation percentiles and QPS curriculum quiz scores before and after curriculum implementation.

Results
After its implementation, RISE percentiles increased by at least 25 for every PGY, and QPS quiz scores increased by at least 10% for 3 of 4 PGY. Every QPS project was presented at Grand Rounds, and 4 were presented externally, including 2 at national conferences.

Conclusion
Our curriculum was successful in improving residents’ knowledge and competence in QPS. Challenges included designing appropriate learning activities, tracking completion of activities, coordinating faculty schedules and maintaining resident buy-in to the curriculum. We believe that the basic structure of our curriculum offers a solid foundation to which revisions can be made as QPS priorities evolve, and which can be readily adapted to other programs and locations.
Building Entrustable Professional Activities In Residency Training: Peripheral Blood Smear And Body Fluid Analysis
Authors: Theil K S , Nakashima M O , Ondrejka S L , Cotta C V 
Published: October 2020

Abstract

Introduction/Objective
Entrustable professional activities (EPAs) are defined as specialty-specific tasks representing a unit of professional practice that can be entrusted to unsupervised performance by a trainee following attainment of sufficient task-specific competence. EPAs and periodic competency assessments also provide a framework for evaluating relevant ACGME milestones. We describe our experience creating EPAs for peripheral blood smear (PBS) and body fluid (BF) analysis through which residents became qualified to act as laboratory testing personnel.

Methods
Training occurred during a 6 week “boot camp” for PGY2 and PGY4 residents in July-August 2018 and July-August 2019. Training for PBS included didactic lectures in automated hematology and RBC morphology (2 hr) and WBC and platelet morphology (2 hr); faculty-guided microscope reviews of RBC (2 hr) and WBC morphology (2 hr) using a training checklist; completion of RBC and WBC self-assessment quizzes; and a 40 question graded exam that covered cell identification, lab protocols, and case scenarios. Training for BF included didactic lectures (2 hr); faculty-guided microscope review of BF slides using a training checklist; completion of a BF self-assessment quiz; and a 40 question graded exam that covered cell identification, lab protocol, and case scenarios. Following successful completion of the graded exam residents were deemed competent to perform unsupervised review of cases initially flagged as abnormal by laboratory technologists; they were required to obtain attending review prior to release of results in defined situations. Formal competency assessments according to CLIA standards were done at 6 and 12 months after initial training. Impact on laboratory workflow and turnaround time was assessed before and after training.

Conclusion
We successfully created EPAs for PBS and BF analysis through which residents became qualified to act as laboratory testing personnel. There was no adverse impact on laboratory turnaroud time, and the number of PBS and BF cases requiring attending pathologist review decreased. Residents appreciated this tangible opportunity to gain graduated responsibility that prepared them for future practice. Periodic competency assessments provide an opportunity to evaluate relevant ACGME milestones. Our training and assessment program and EPAs can serve as a template for other residency programs.
Evaluation Of Some Markers Of Haemolysis – Endothelial Dysfunction And Haematological Parameters In People With Sickle Cell Disease Leg Ulcers
Authors: Otokiti O E , Bassey G M 
Published: October 2020

Abstract

Introduction/Objective
Sickle cell leg ulcer (SCLU) is one of the commonest cutaneous manifestation of the sickle cell anaemia (SCA). This study was designed to evaluate the haematological parameters and contribution of haemolysis to leg ulcers in persons with sickle cell anaemia

Methods
A comparative cross-sectional study of 73 participants (24 sickle cell leg ulcer-SCLU, 24 sickle cell without leg ulcer-SCWLU and 25 healthy controls). Physical examination was conducted to grade the SCLU. ELISA kits were used to analyse Nitric oxide, while FBC, Reticulocyte count, liver function test (AST and ALT), total Bilirubin (unconjugated and conjugated) were determined using standard methods. ANOVA was used to compare the association between sickle cell leg ulcers and markers of haemolysis-endothelial dysfunction among the three groups. Probability score of less than 5% (p-values&lt;0.05) was considered statistically significant

Results
There was no statistically significant difference in the age distribution of the participants in this study. Those with SCLU were diagnosed at an older age and majority (52.2%) had clinical stage 2 leg ulcer. Among the markers for haemolysis-endothelial dysfunction (HED); Reticulocyte production index (PRI) was lower in SCLU (1.87 + 0.72) compared to SCWLU, (2.04 + 0.78) p= 0.01. Total and unconjugated bilirubin (µmol/L) level was higher for SCLU (53.0 + 17) in comparison to SCWLU (42.2 + 8.2) with statistical significance of p=0.00. Aspartate and alanine transaminases (AST and ALT) (U/L) were higher in SCLU in comparison with SCWLU, (60.1 + 21.5, 43.8 + 15.8 and 30.1 + 13, 29.8 + 11.7) respectively, and was statistically significant p= 0.00. However Nitric oxide was not statistically different between SCLU and SCWLU mean ± SD (49.57 + 12 and 46.19 + 9) respectively. p = 0.35

Conclusion
Markers of haemolysis were higher in participants with sickle cell leg ulcer (SCLU) when compared to those without leg ulcer (SCWLU). However, no statistically significant difference was obtained for Nitric oxide (NO) between the two groups. Therefore, markers of haemolysis cannot be used as an effective predictor for risk of developing SCLU but early diagnosis of SCA can prevent SCLU.
A Rare Case Of Kikuchi-Fujimoto Disease Displaying Chromosomal Abnormality
Authors: Zhang Y , Ding L , Aftab L , Rushton P 
Published: October 2020

Abstract

Introduction/Objective
Histiocytic necrotizing lymphadenitis, also known as Kikuchi-Fujimoto disease (KFD), is a rare and benign self-limiting process primarily affecting 20~35-year-old Asian women with spontaneous remission after weeks to months of illness. Although the involvement of T cell-mediated immune response, infections, and HLA class II gene have been proposed as possible etiologies, the detailed pathogenesis has not been elucidated. Very few literatures exhibited KFD displaying chromosomal abnormality such as t(2:16).

Methods
Here, we report a rare case of KFD with novel karyotype abnormalities in a 24-year-old African American male. It presented as painless cervical lymphadenopathy for one month without fever, night sweats, or weight loss. An excisional biopsy of the lymph node (LN) was performed.

Results
Tissue culture for bacteria and flow cytometry of the LN were negative. Histopathology revealed numerous pale circumscribed foci composed of lymphocytes, histiocytes, plasmacytoid dendritic cells, and abundant karyorrhectic debris in the background of coagulative necrosis. No neutrophils or hematoxylin bodies are seen.
Immunohistochemical studies showed CD3+/CD4+ T lymphocytes, CD68+ histiocytes, and CD123+ plasmacytoid dendritic cells. Abnormal karyotype was observed as: 46, XY, del(6) (q?16q?22).

Conclusion
We present this case to demonstrate that 1. Although KFD is most prevalent in young Asian females, it may occur in both genders and other ethnical groups and perhaps represents an underdiagnosed process. 2. KFD can mimic a variety of diseases such as rheumatologic, infectious, and hematologic malignancies; a thorough workup including serology, culture, and flow cytometry is needed to exclude serious diseases such as systemic lupus erythematosus and malignancy to render an early diagnosis which may avoid unnecessary diagnostic and therapeutic interventions. 3. Cytogenic abnormalities, although observed in many malignancies, should not be used as a sole determinant of malignancy, and the interpretation needs to be in a relevant clinical and histopathological context in a multidisciplinary setting to avoid misdiagnosis and inappropriate treatment.
Discordant Lymphoma: A Sequential Case of Burkitt Lymphoma and Classic Hodgkin Lymphoma
Authors: Mai B , Berumen A , Herrmann A , Chen L 
Published: October 2020

Abstract

Casestudy
A discordant lymphoma is a rare condition in which two or more subtypes of lymphomas can occur in different anatomic sites; the distinct sub-classifications can present concurrently or sequentially. We present a rare case of a second primary Classic Hodgkin Lymphoma (CHL) several years after achieving remission from an unusual presentation of a non-Hodgkin lymphoma (NHL).

Results
A 40-year-old HIV-positive male presented to the emergency department for acute cholecystitis. Sections of his gallbladder revealed atypical monomorphic lymphocyte infiltrate that were diffusely positive for CD10, CD20, BCL6, and PAX5, and negative for BCL2, CD5, Cyclin D1, and MUM1. The proliferation index by Ki-67 was 100%.
EBER ISH is positive. A FISH assay for the C-MYC break apart probe and dual fusion of IgH and BCL2 showed a rearrangement of 8q24, highly suspicions for a 8;14 translocation, classically seen in Burkitt Lymphoma (BL).
Subsequently, he was placed on RA-DA-EPOCH and achieved remission.
Seven years later, he presented with nausea, vomiting, headaches, and blurry vision. An excisional biopsy of his right cervical lymph node was performed. The histological sections showed effaced nodal architecture with sclerotic fibrosis and necrosis. There were scattered Hodgkin cells/Reed-Sternberg (HRS) cells in the background of lymphocytes, plasma cells, histiocytes, and eosinophils. The HRS cells were positive for CD15, CD20 (weak), CD30, BCL6, MUM1, and PAX5 (weak), and negative for ALK, CD10, and CD45. EBER ISH was positive and HHV8 was negative. These features were consistent with a CHL, nodular sclerosis subtype.

Conclusion
Malignancies in HIV patients pose a unique challenge as they often possess distinct characteristics distinct, including unique aspects of tumor localization, atypical pathological features, unusual growth behavior, and advanced stage at presentation. Epstein-Barr virus (EBV) is strongly linked with several HIV-associated lymphomas, as it encodes several proteins including LMP-1, LMP-2A, BHRF-1, EBNA-3A, and EBNA-3C that are implicated in the development of NHLs. The identification of discordant lymphomas may have variable prognoses and different treatment modalities. In addition, the study of such discordant lymphoma cases may provide more insight on the etiology and inter-relationship of clonal evolution in lymphoma.
The Outcome Of Preoperative Transfusion Guideline On Sickle Cell Disease Patients At King Fahd Hospital-Jeddah (Ksa)
Authors: Felemban S M 
Published: October 2020

Abstract

Introduction/Objective
We have developed a local hospital transfusion guidelines to reduce and prevent the perioperative and the postoperative complications. This study was conducted to evaluate the outcome of practice for preoperative transfusion therapy in SCD patients in our institution.

Methods
A retrospective review of SCD patients undergoing surgery at King Fahd Hospital, Jeddah, Saudi Arabia was conducted between April 2005 and May 2010. The medical records were reviewed to define the perioperative risks and the postoperative complications in relation to the type of transfusion modality selected.

Results
The medical record of 75 sickle cell disease patients in whom the hematologists were consulted for their preoperative assessment. Preoperatively, 25.3 % had complete exchange transfusion (CETX), 17.3 % had partial exchange transfusion (PETX), 26.7 % had simple top up transfusion (STX) and 30.7 % had no transfusion (NTX). The postoperative complications were 20% vaso-occlusive crises (VOC), 2.7% acute chest syndrome (ACS), and 16% had fever. The mean duration for the hospital stay was 7.36 with SD of 5.83. There was no significant difference in the outcome between all types of transfusion modalities, the P value was (p 0.245), (p 0.282), (p 0.133), (p 0.220) for postoperative fever, VOC, ACS, and the length of hospital stay, respectively. However, The correlation was highly significant between the post-transfusion haemoglobin (Hb) level and the occurrence of postoperative fever (p 0.01) and VOC (p 0.03).
Interestingly, SCD patients who received hydroxyurea were observed to have less postoperative complication like fever, and the result was highly significant (P&lt;0.01), while those who received prophylactic heparin in the postoperative period were found to have a reduced length of hospital stay (p&lt;0.01) and vaso-occlusive crises (p &lt;0.01).

Conclusion
The guidelines for preoperative transfusion in SCD patients was effective in reducing the postoperative morbidity and mortality. However, the selection of the optimum regimen for different surgical types in sickle cell disease patients and the surgical situations where preoperative transfusion is needed were all established in this guidelines.
Targeting Mediators Of Chronic Inflammation: A Promising Alternative Therapeutic Use Of Plant-Derived Remedies With Potent Bioactivity And Lower Cytotoxicity
Authors: Adebayo S 
Published: October 2020

Abstract

Introduction/Objective
Medicinal plants have a long history of use and has been exploited for basic health care needs for many centuries. The various parts of plants are rich sources of a plethora of pharmacologically active remedies that has remained largely unexplored for their therapeutic capabilities. Grewia mollis is one of the medicinal plants that are used to treat painful inflammatory conditions including rheumatism and associated fever. The inhibition of enzymes involved in prostaglandin (PG) synthesis are of great interest in combating chronic inflammation. Cyclooxygenases (COX) and Lipoxygenases (LOX), in particular COX-2 and 5-LOX utilize different pathways for PG synthesis and are important drivers of chronic inflammation. However, the use of conventional anti-inflammatory drugs and specific enzyme inhibitors against them are associated with severe adverse side-effects and organ toxicities.
Therefore, attention has shifted to the search for potent and safer alternative strategies to treat chronic inflammation involving these mediators

Methods
The leaf part of G. mollis was extracted with solvents of varying polarities. The extracts were tested in vitro against COX-1, 2 and 5-LOX. In addition, the cytotoxicity and selectivity index of the plant extracts were evaluated using vero monkey kidney cells

Results
The hexane fraction of G. mollis leaf extracts had better inhibition against COX-1 (0,97±1,9 µg/mL) and COX-2 (1,13±0,2 µg/mL) when compared with the indomethacin control (1,30±0,6 µg/mL) and (1,52±0,2 µg/mL) respectively. Also, the butanol fraction inhibited 5-LOX (12,48±2,9 µg/mL) better than quercetin positive control (61,82±5,5 µg/mL). Overall, the extracts and fractions indicated reduced cytotoxicity (30,56-689,39 µg/mL) relative to the doxorubicin control (2,59 µg/mL).

Conclusion
The results indicated that extracts of G. mollis contained bioactive molecules capable of inhibiting the activities of C0X and 5-LOX with lower cytotoxicity. Pharmacologically active molecules with safety profile could be used, at least as a part of the template for remedies against mediators of chronic inflammation
Serology Curriculum For Residents Using Online, Case-Based Simulation Modules
Authors: Dent E A , Guarner J 
Published: October 2020

Abstract

Introduction/Objective
Although serology concepts are a frequent exam topic for Pathology trainees, serology education remains challenging, in part, because serologic test performance occurs in different laboratories (immunology, microbiology, or chemistry.) Serology education topics may be eclipsed by larger concerns of the laboratory where serology resides. To evaluate the utility and advantages of online modules as adjuncts to other education modalities used during a standalone serology rotation, we developed a one-week curriculum in which residents were given four case-based vignettes to discuss with faculty, eight online case-based simulation modules, and bench time in the laboratory performing serological tests (RPR, VDRL, hepatitis, and HIV).

Methods
The online modules are housed within an e-learning portal. Residents were asked to print certificate of completion for eight assigned modules. Residents were offered an anonymous survey of the rotation between one week and up to 2 months after completing the rotation.

Results
Twenty-three first-year residents (spanning a 3-year period) completed the online modules, and 10 (43.5%) completed the survey. The average percentage of correct answers ranged from 73% for the HIV module to 88% for the hepatitis B module. The number of residents with scores below 80% was highest for EBV and Cryptococcus modules (8 and 9 scoring &lt;80% respectively) and lowest for hepatitis B and toxoplasmosis modules (2 and 3 respectively). On the survey, residents stated they had repeated the online modules between 1 and 4 times, averaging between 1 and 2 attempts. Although there was no specific module rated as most enjoyable, the toxoplasmosis and EBV modules were picked by 3 out of 10 residents as his or her favorite. There was no consensus on which module was subjectively easiest or most difficult, nor which was least enjoyed. The majority of the residents (7/10) found the modules helpful and all ten residents stated that they “learned more” after completion of the modules because they reinforced (6/10) concepts important to serologic testing.

Conclusion
The online, case-based simulation modules are effective additions to a serology curriculum that includes case-based discussions and time in the laboratory performing tests. The online modules are effective because they provide additional structure and reinforce learning within the serology curriculum.