bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mesenteric Cysts: A Retrospective Review. Its Not All That Simple
Authors: Bourgeau M , Avadhani V 
Published: October 2020

Abstract

Introduction/Objective
Mesenteric cysts are rare intra-abdominal lesions in adults. However, with the advanced imaging techniques and laparoscopic techniques, they are more often being identified and resected when clinically significant. There is a lack of detailed information in histopathology (except as case reports) since mesentery is generally neglected in our organ-based textbooks. The aim of our study is to highlight the importance of identifying and classifying mesenteric cystic lesions; they are not all that simple.

Methods
We performed a retrospective search on all mesenteric cysts submitted as excisions in our electronic database from 2013-2019. We classified them as per the de Perrot (PMID: 11053936) classification with modification.

Results
Our search showed: A. Lymphatic origin-11 (lymphangioma-10, Lymphangioma hamartomatous-1, associated with LAM-0), B. Mesothelial origin-68 (Benign mesothelial cysts-57, multilocular mesothelial cyst-11), C. Enteric origin- 3, D. Urogenital origin (Urachal cyst, mullerian inclusion cyst)-9, E. Mature cystic teratom-2, F. Pseudocyst-12, G. Epithelial cyst (not urogenital)- 11 (a/w LAMN-3, MCN-4, Mucinous cystadenoma-4), H. Associated with carcinoma-2.
Case illustration: A 61-year-old male presented with worsening dysphagia, emesis and hiccups. A CT scan showed a 21.2 cm cystic mass with at least one septation (Fig 1). The cyst was resected. On gross pathological examination, the cyst measured 18 cm in greatest dimension with a thick, rough, tan-brown capsule. Microscopic examination showed a fibrous capsule, and cyst wall composed of numerous lymphatic vessels (CD31 positive) and prominent smooth muscle proliferation (Desmin positive). Scattered lymphoid aggregates were also present throughout the cyst wall. No definite epithelial lining was identified and was suspected to have been denuded. HMB-45 immunostain was negative, ruling out association with LAM. The final diagnosis of a Lymphangiomyoma, hamartomatous was rendered.

Conclusion
Though most of the mesenteric cysts are benign, some of them are significantly important such as Lymphangiomyoma (esp secondary to LAM), MCN, those associated with LAMN etc. and identifying and differentiating from their mimics has distinct clinical implications.
Status of Histopathology Services In Ethiopia
Authors: Yeabyo G O 
Published: October 2020

Abstract

Introduction/Objective
Cancer is one of a great public health problem in developing countries like Ethiopia and scarcity of histopathology laboratory is another burden for diagnosis and follow up of cancer diseases. The main purpose of this study is to evaluate the accessibility of histopathology services in Ethiopia.

Methods
Cross sectional study design were used to analyze the status of histopathology services in Ethiopia.

Results
There are 13 histopathology laboratories in the nation and a survey was conducted at these institutions.
Out of these 13 Histopathology services seven are located in the capital, Addis Ababa and six found out of the capital located in four different regions. About 40,239,100 habitants have no histopathology service around their catchment area.

Conclusion
There are very limited histopathology laboratories, as a result diagnosis and prevention of cancer diseases are inadequate throughout the country.
Reducing Inappropriate Overutilization of the Massive Transfusion Protocol
Authors: Nguyen P T , Boral L I , O’Brien J , Zhang D , Gao Y , Bernard A 
Published: October 2020

Abstract

Introduction/Objective
Massive transfusion protocols (MTPs) make it possible to deliver blood products to exsanguinating patients in an efficient, sustained, and immediate manner. However, overutilization of MTPs continues to remain a significant problem for hospital blood banks. The study aims to address the characteristics of possibly inappropriate MTP activations during the first phase (cooler) at a level 1 trauma academic medical center.

Methods
This was a retrospective review of 328 phase 1 MTPs out of 696 total MTPs performed during a two-year period (Jan 1, 2017 and Dec 31, 2018) and divided into three categories: trauma, non-trauma surgery, and medicine services. We assumed that a possibly inappropriate MTP for trauma cases would show an Assessment of Blood Component (ABC) score of 1 or less and physicians used clinical discretion. For possibly inappropriate MTP non- trauma surgical and medicine cases, we devised a new system where we looked at only whether the blood pressure was equal to or less than 90 mm Hg and/or the pulse was greater than or equal to 120 beats per minute. If there was a score of 0 where there were neither vital sign criteria, then the MTP was considered possibly inappropriate.

Results
For trauma service, there were 43/168 (25.6%) cases that had an ABC score of 0, 49/168 (29.2%) cases that had an ABC score of 1, 53/168 (31.5%) cases that had an ABC score of 2, 21/168 (12.5%) cases that had an ABC score of 3, and only 2/168 (1.2%) case that had an ABC score of 4. Non-trauma surgery service had 31/51 (60.8%) cases with a new score of 0, 20/51 (39.2%) cases with a new score of 1, and 0/51 (0%) cases with a new score of 2. Medicine services had 57/109 (52.3%) patients with a new score of 0, 47/109 (43.1%) patients with a new score of 1, and 5/109 (4.6%) patients with a new score of 2. Non-trauma surgery service had the greatest possibly inappropriate MTP activations [31/51 cases (60.8%)], followed by trauma [92/168 (54.8%) cases] and medicine [57/109 (52.3%) cases].

Conclusion
Our study shows greater overutilization with MTPs using clinical judgment than with using the ABC criteria. Non-trauma surgery service had the greatest number of possibly inappropriate MTP activations at our hospital without having a significantly abnormal pulse or blood pressure. While ABC criteria is already liberal for activating an MTP, physician discretion appears to be more liberal in activating a possibly inappropriate MTP.
Curating Archival Anatomic Pathology Material For Machine Learning Algorithm Development
Authors: Collins A , Norgan A , Garcia J J 
Published: October 2020

Abstract

Introduction/Objective
Advances in whole slide imaging have enabled the application of machine learning algorithms to anatomic pathology. In the current state, the development of accurate algorithms requires robust training data with correctly assigned diagnostic and classification labels. Increasingly, institutions have looked to their archival slides as a source of “ground truth” for algorithm development. However, the curation and use of archival data poses several challenges. Here, we share lessons learned from reviewing head and neck pathology consult cases spanning a 10- year period at Mayo Clinic Rochester.

Methods
Archived surgical pathology slides from 2,590 consult cases were reviewed. Clinical and demographic information was recorded for each case, including surgical date, surgical procedure, anatomic site, age, gender and diagnosis. Cases were excluded from the curated archive if there was insufficient volume or quality of tissue to render a specific diagnosis (141 cases, 5.6%). Slides with a range of tissue size and quality, from numerable laboratories were included in the curated archive. Selected cases were collated by anatomic site: ear, gnathic, larynx, nasopharynx, neck, oral cavity, oropharynx, salivary gland and sinonasal tract.

Results
Common diagnostic reconciliations (115 cases, 4.4%) fell within the following categories: (1) novel entities (59 cases, 2.3%), including biphenotypic sinonasal sarcoma and clear cell carcinoma; (2) novel classifications (21 cases, 0.8%), as seen in HPV-related oropharyngeal squamous cell carcinoma and polymorphous adenocarcinoma; and (3) novel grading schema (35 cases, 1.4%), as seen in keratinizing dysplasia and oropharyngeal malignancies.

Conclusion
Several nuances emerged in the process of reviewing slides, highlighting the need for continual amendment of any machine learning dataset over time. Curating anatomic pathology cases for machine learning algorithm development requires the recognition of emerging entities, with re-classification and re-grading as needed.
Community Health Screening And Education Through Laboratory Science Workshop: Participant Evaluation Of The 2018 Pilot Program In Aco, Peru
Authors: Ellis J R , Vreeland J , Jaimes F 
Published: October 2020

Abstract

Introduction/Objective
Public health outreach initiatives underutilize laboratory medicine students and professionals. This poster will discuss a novel bilingual community health screening and education (CHS & E) through laboratory science service-learning (SL) study abroad (SA) program that could be utilized to improve community engagement and understanding of public health issues from a lab perspective.

Methods
In collaboration with The Foundation for International Medical Relief of Children (FIMRC), Texas State University faculty member, Joanna Ellis, and five CLS senior-level students traveled to Huancayo, Peru in June of 2018 for a CHS & E through lab science SL-SA program. Utilizing the self-powered Lab-in-a-Suitcase from International Aid, the group conducted four CHS & E through lab science events in four different communities. We conducted hemoglobin, urinalysis, glucose, cholesterol, and STI screenings on more than 160 people. The CUY Project was the most involved activity with six interactive stations for the families to learn about anemia, parasites, and nutrition through lab tests. Parents and children learned more about their conditions through interactive lab science activities and tests. Following the workshop, parent participants were given an anonymous survey about their knowledge before and after the workshop as well as their suggestions for its improvement.

Results
The lab-science based activities illustrated the biological impact of their lifestyle and dietary choices in a new and impactful way. Participants self-assessed that they learned significantly more about anemia and diabetes during the workshop. Participants learned more about hygiene than they knew before the workshop; however, the increase was not statistically significant. Parent participants surveyed (100%) stated that the workshop would help them make decisions in caring for their children and would help prevent future health problems.

Conclusion
Although the newest iteration of the workshop is entitled Health Education Advances with Lab Science (HEALS) this poster will describe the preparation, implementation, and first stage of evaluation of the CHS & E through laboratory science workshop in Peru. This poster session is an opportunity to discuss how laboratory professionals can interact with their community and showcase the value of the field in public health education initiatives.
Valuable Hospital and Laboratory Practice in an Integrated Medical System for HIV Infection Prevention Interventions at a Veteran Affairs Medical Center (VAMC)
Authors: Petersen J M , Jhala D 
Published: October 2020

Abstract

Introduction/Objective
Patient focused integrated health systems have been described in the literature as being more likely to obtain positive health outcomes in their patient populations. This has particularly been the case for screenings with follow-up interventions as necessary. The usefulness of an Integrated Medical System in optimizing quality medical care for HIV infection and in monitoring patients already on Pre-Exposure Prophylaxis (PrEP) has been previously discussed in the literature. However, when it comes to the screening and initial identification of HIV- negative patients who may benefit from HIV preventive therapies such as PrEP, the literature is sparse. Here we report the useful initial identification of potential patients in a VAMC.

Methods
As part of a quality assurance/improvement project, a search in Vista/Fileman from June 2018 to February 2020 was performed for all patients with a positive sexually transmitted disease (STD) test result - PCR testing for gonorrhea/chlamydia and RPR - during this time period. A medical chart review was performed to determine the HIV status of the patient, and if negative for HIV, whether PrEP was discussed with the patient by the clinical primary care team or the infectious disease consult. The number of patients who ultimately began PrEP as a result of this initial identification was tabulated.

Results
A total of 58 unique patients who tested positive for an STD were successfully identified as being potential candidates for PrEP by the clinical primary care teams or the infectious disease consult in the Integrated Medical System, and as a result the possibility of PrEP was discussed with all 58. In the end, 28 of these patients started PrEP interventions after discussion with their clinical providers. In all patients, these patients were initially identified by a positive STD test result. This is out of a total of 220 HIV negative patients that had been reviewed by their respective clinical providers upon being alerted by the computerized patient record system.

Conclusion
The Integrated Medical System at the VAMC successfully screened and identified patients who may benefit from PrEP. This is a significant example of an integrated medical system successfully screening and providing quality care for identified patients who otherwise would not have had this health preserving intervention.
Resistant Bacteria Isolated from Blood Culture of Febrile Neutropenic Cancer Patients
Authors: Abdelmonem M , Gad AlKarim A , Eissa S , Boraik A , Shedid M 
Published: October 2020

Abstract

Introduction/Objective
Bacteremia is one of the major causes of life-threatening complications in patients with cancer. Significant changes in the spectrum of microorganisms isolated from blood culture BC have been reported in cancer patients over the past years.
This study aimed to determine the predominant bacterial species causing bacteremia among febrile neutropenic FN cancer patients at the National Cancer Institute in Egypt (NCI).

Methods
A total of 300 BC collected from 300 FN cancer patients at NCI, Cairo. All cases were in patients with a mean age of 51 years, 158 patients were male (53%) while 142 patients were females (47%). BC was collected for microbiological investigations. Identification of the isolated organisms by the cultural characters (Morphological of bacterial isolates, Gram stain reaction, motility test, and biochemical tests) for each organism using standard semi- automated techniques.

Results
68 (22.6%) BC were positive while 232 (77.4%) BC were negative. Gram-negative bacteria isolated and identified in 11 blood cultures (16.17%), while gram-positive isolates identified in 57 BC (83.8%). Among the Gram- negative organisms, 4 (5.8%) were Pseudomonas aeruginosa, 4 (5.8%) were E. coli, 1 (1.5%) was Klebssila pneumoni, 1 (1.5%) was Acintobacter and 1 (1.5%) was Citrobacter frenudiri. Among the Gram-positive organisms, Coagulase-negative Staphylococci CNS were most predominant in most cases 35 (61.4%). 7 (12%) were S. aureus, 5 (8%) were S. epidermises, 5 (8%) were Streptococcus spp., 1 (1.5%) were Listeria spp., 4 (5.88%) Achromobacter spp., 4 (5.88%) were Gram-Positive Cocci and 1(1.5%) Micrococcus spp. The study of R-factor in all positive BC showed the resistant bacterial isolates to the commonly used antimicrobial agents, especially to ampicillin and penicillin.

Conclusion
This study showed that patients with febrile neutropenia are vulnerable to developing bacteremia. the prevalence rate of bacteremia in post-chemotherapy FN in our center is relatively high compared to the national rate. Multidrug-resistant are the main cause of bacteremia in febrile cancer patients in Egypt. There is a need for ongoing antimicrobial surveillance to guide antimicrobial therapy and support the development of infection control programs in Egypt
Improved Across the Board Access to SARS-CoV-2 Laboratory Testing in an Integrated Medical System; the Veteran Affairs Medical Center (VAMC) Experience
Authors: Petersen J M , Dalal S , Jhala D 
Published: October 2020

Abstract

Introduction/Objective
Due to the spread of SARS-CoV-2 – the causative pathogen behind COVID-19, a significant impact on society including significant death, morbidity, strain on the nation’s medical systems, and an economic shutdown of many sectors has come to pass. While society has been affected by this virus, it has also been documented in the mainstream news that this pandemic has disproportionately affected non-white minority groups, and that access to testing for vulnerable populations have been limited. Similarly, previously published epidemiological data by Zuvekas et al. show that populations with health insurance, higher socioeconomic class, and white in race have received significantly better access to private health care resources. As veterans represent a vulnerable population, as part of quality assurance, testing data was reviewed to verify that this trend was not also affecting the VAMC.

Methods
As part of a quality assurance/quality improvement project, a retrospective manual review of all SARS-CoV- 2 RT-PCR tests performed at the VAMC from March 11th, 2020 to April 13th, 2020. These tests were reviewed within the computerized medical record system to determine the age, gender, and ethnicity of the patients. The demographic data from this search was compared with the population statistics of the major metropolitan city that the VAMC is located in.

Results
Out of 571 patients who were tested for SARS-CoV-2, 264 (46%) had an ethnic African-Americans background, 135 (24%) had an ethnic Caucasian or white background, 8 had an ethnic Hispanic background, 3 had an ethnic native Hawaiian or other Pacific Islander background, 2 had an ethnic Asian background (0.4%), and 1 had an ethnic American Indian or Alaskan Native background. The rest had left ethnicity unanswered or was unknown/declined to state. The majority of those tested were males (392 or 69%). Ages of patients tested ranged from 24 to 98 years of age. The ethnic distribution of those tested was like the ethnic distribution within the city where the VAMC was located.

Conclusion
Quality healthcare to the entire population also means that healthcare should be accessible to all members who require it. The VAMC offers broad access for testing to all its patients of all ethnicities. This demonstrates, in the changing healthcare landscape, one of the many advantages of the Veteran Affairs system.
Decreasing Extra Tube Collections in a Healthcare System
Authors: Evans K M 
Published: October 2020

Abstract

Introduction/Objective
To determine a mechanism for obtaining and utilizing data on extra specimens collected that were not used, monitoring collections and decreasing the need to collect these specimens in order to save the patient’s blood from being wasted, as well as the resources used to collect and house the extra specimens.

Methods
Internal database, Sunquest, and Tableau

Results
Starting in early 2017, statistics were pulled and analyzed by our Phlebotomy Best Practice committee in order to obatin a solid basis to review all extra specimens being collected (excluding blue, lavender, and lithium herparin tubes) by phlebotomy in order to save teh patient’s blood from being disposed of without being used for testing, continue to look for ways to maintain blood conservation and collections, cost effectiveness due to not having to use the supplies, as well as store the specimens that were not being used for testing.

Conclusion
As of January 2020, there has been a 30% decrease in collections (yearly - over 3 years), and a maximum 45% decrease in cost (thus far) of supplies and waste. It has been a larage patient and upper management satisfier; patient’s don’t question the number of tubes being taken, and the decrease in spending makes the VP happy!
B-Cell/Mixed Phenotype Acute Leukemia Following Lenalidomide Maintenance For Multiple Myeloma: A Study Of Two Cases
Authors: Fei F , Reddy V , Rosenblum F 
Published: October 2020

Abstract

Introduction/Objective
The incidence of patients with multiple myeloma (MM) followed by hematologic malignancies as second primary malignancy is around 0.8 – 3.1%. The majority of cases are myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML), however, acute lymphoblastic or mixed phenotype leukemia can be rarely observed.

Methods
A retrospective chart review was performed for patients diagnosed with acute lymphoblastic or mixed phenotype leukemia from January 2009 through February 2020. Two patients were identified and the corresponding clinical data were reviewed.

Results
Case 1 was a 74-year old male diagnosed with pre-B ALL 5 years after an IgG Lambda MM. His MM therapy included Bortezomib-based chemotherapy followed by Lenalidomide maintenance. Pre-B diagnosis was confirmed on a pelvic lesion biopsy with sheets of intermediate sized cells (CD45+, PAX5+, CD34+, CD43+, CD10+, BCL6+ and BCL2+). The patient had 4 cycles of HyperCVAD chemotherapy, followed by Blinatumomab and Inotuzumab treatment. Unfortunately, the patient was referred to hospice 2 years after the diagnosis of ALL. Case 2 was a 69-year old male diagnosed with mixed phenotype acute leukemia 8 years after an lgA Lambda MM with del 13q and Trisomy 11. The patient was treated with Bortezomib-based chemotherapy followed by autologous hematopoietic stem cell transplantation (auto-HSCT) and Lenalidomide maintenance. Bone marrow biopsy showed around 79% blasts (CD34+, PAX-5+, CD79a+ and MPO+). Flow cytometry from bone marrow showed 90% precursor B cells, however MPO was negative. Furthermore, a DNTM3A p.T835M missense variant (25-30% fraction) was identified by next generation sequencing (NGS). The patient was scheduled for Hyper-CVAD chemotherapy.

Conclusion
Lenalidomide maintenance following auto-HSCT is considered a standard therapy for MM patients. Recent studies indicate that Lenalidomide maintenance is associated with an increased risk of second primary hematologic malignancies. Although AML and MDS are more commonly seen, ALL and rarely mixed phenotype leukemias can occur.