bluuebunny/crossref_metadata_2025_split huggingface dataset:
Human Immunodeficiency Virus–Positive Patient Presenting With Acute Renal Failure and Hypercalcemia Diagnosed With Sarcoidosis
Authors: Dehghani Amir , Yousefi Elham , Alshal Mohamed , Xie Qiang , Zuretti Alejandro 
Published: September 2019

Abstract

Objectives
A 42-year-old African American man with a history of HIV infection on highly active antiretroviral therapy (HARRT) presented with excessive thirst, polydipsia, polyuria, weight loss, and abnormal kidney function tests. Physical examination was normal.

Methods
The patient workup results were as follows: calcium 13.8 mg/dL (8.4-10.3 mg/dL), ACE 88 U/L (8-52 U/L), PTH 7.34 pg/mL (14-72 pg/mL), 1,25 (OH)2 vitamin D 125 pg/mL (19.9-79.3 pg/mL), BUN 38 mg/dL (6-20 mg/dL), Cr 2.42 mg/dL (0.4-1.2 mg/dL), glucose 87 mg/dL (70-99 mg/dL), CD4 count 303/μL (544-1,894/μL). Chest CT scan showed diffuse pulmonary nodules with mediastinal and bilateral hilar lymphadenopathy. A transbronchial biopsy was performed.

Results
Biopsy revealed noncaseating granuloma and Schaumann bodies. AFB and GMS stains were negative for micro-organisms. These findings were compatible with sarcoidosis. The patient received prednisone and showed significant improvement in his renal function (creatinine: 1.23 mg/dL) and calcium level (9.12 mg/dL).

Conclusion
CD4+ T lymphocytes have a crucial role in the formation of sarcoid granulomas. However, HIV infection is characterized by a profound loss of the CD4+ T-lymphocytes. Therefore, sarcoidosis in HIV-positive patients is rare. The development of sarcoidosis usually occurs when a significant increase in CD4+ T-cell count induced by HAART has taken place. Pulmonary involvement and symptoms are responsible for the majority of the morbidity and mortality in sarcoidosis. Renal involvement is significantly less common than respiratory symptoms.
This patient was one out of two HI- positive cases of sarcoidosis among 200 patients who were diagnosed with sarcoidosis in our three major affiliated hospitals from 2000 to 2019. This case is unique and rare both in terms of unusual presentation of renal failure and hypercalcemia and also the co-occurrence of sarcoidosis in an HIV-positive patient while the CD4 count is lower than the normal limit.
Prevalence, Demographic Patterns, and Outcome of Childhood Malignancies in a Tertiary Hospital in Nigeria: A 15-Year Retrospective Study
Authors: Otokiti Oluwakemi , Temiye Edamisan 
Published: September 2019

Abstract

Objectives
Childhood cancers are increasingly recognized as a cause of childhood morbidity and mortality following improvement in immunization programs and sanitation against communicable diseases. With improvement in health care, better survival outcomes have been reported in childhood cancers worldwide. However, mortality associated with childhood cancers remains high in developing countries. This study aims to determine the prevalence, demographic characteristics, and outcome of childhood cancers seen in Lagos University Teaching Hospital, Lagos, Nigeria.

Methods
A retrospective study analyzed 749 cases of childhood malignancies between 2003 and 2017. Data on gender, age at diagnosis, diagnosis, and outcome were extracted using a data extraction proforma. Data were analyzed using SPSS v23. P value of .05 was considered statistically significant.

Results
Median age at diagnosis was 4.75 years with a male to female ratio of 1.3:1. Highest prevalence was noticed with hematological malignancies (41%), Wilm’s tumor (18%), retinoblastoma (13%), and soft tissue tumors (6.5%) and lowest prevalence with testicular cancers (0.3%). Apart from liver malignancy, males had a higher incidence in all malignancies. Median age at diagnosis was 12 years for nasopharyngeal carcinoma, 11 years for bone cancers, 8 years for gynecological cancers, 6 years for hematological cancers, and 0.47 years for testicular cancers. Overall mortality rate was 30%, and a significant number (53%) were lost to follow-up (discharged against medical advice, defaulted, financial burden, medical tourism). Hematological malignancies had the highest mortality rates, with Wilm’s tumor having best survival chances (lowest mortality).

Conclusion
Prevalence patterns mirror what was obtained in other centers (Jos, Ife, and Ibadan). A mortality rate of 30% is significant. Financial burden, religious beliefs, delay in presentation, and ignorance are major hindrances to health care and might contribute significantly to overall mortality and outcome. More needs to be done concerning childhood cancers.
Diagnostic Efficacy of Cytological Preparations With Rapid Onsite Evaluation Compared With Thinprep Without Onsite Evaluation in Diagnosing Pancreatic Solid Masses
Authors: Chang Qing , Gimenez Cecilia , Reddy Kalpana 
Published: September 2019

Abstract

Objectives
The diagnostic efficacy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic solid masses varies widely depending on the presence of rapid onsite evaluation (ROSE) and the type of cytology preparations. The present study aims to compare the diagnostic efficacy of cytology smears (CS) and cell block (CB) with ROSE versus Thinprep slides (TpS) with CB without ROSE in diagnosing pancreatic solid masses.

Methods
Performed retroprospective review of 56 patients (2017-2018) with surgically confirmed pancreatic neoplasms including cytology preparation type and comparison of diagnostic efficacies.

Results
Out of 56 patients who underwent surgical resection, 30 patients were diagnosed with pancreatic ductal adenocarcinoma (PDAC) and 26 with pancreatic neuroendocrine tumor (PNET) or solid pseudopalliary neoplasm (SPN). Out of 30 surgically removed PDACs, 20 patients had prior cytology specimens while 10 had surgical core biopsies. Of the 20 cytology specimens, 12 patients had ROSE with concurrent CS and CB, and all cases were diagnosed as positive. Out of the 8 patients without ROSE, 3 patients (1 with bile duct brush, 2 with TpS and CB) were diagnosed as positive. The diagnostic efficacy was 100% (12/12) in patients with ROSE and CS compared to 37.5% (3/8) in patients without ROSE. In 26 non-PDAC cases, 21 patients had cytology specimens and 5 had surgical biopsies. Seventeen cases with ROSE and immunohistochemical stains (IHC) on CB were diagnosed as positive, while 4 cases without ROSE and IHC received atypical diagnoses, resulting in a decreased diagnostic efficacy from 100% (17/17) to 0% (0/4).

Conclusion
ROSE with CS and CB are superior to TpS and CB in diagnosing solid pancreatic masses. ROSE with IHC on CB is crucial for diagnosing PNET and SPN, while CS and CB are important for PDAC diagnosis.
Infusing CURE Into the Medical Laboratory Science Curriculum
Authors: Johnson Deborah , Barham Beverly 
Published: September 2019

Abstract

Introduction
One of the challenges for Medical Laboratory Science (MLS) educators in a university-based program can be providing meaningful research experiences for all students. The availability of research positions for undergraduate MLS students in individual research labs is limited or not available, often due to time constraints within the MLS course schedule or other variables in the students’ lives outside of academe.

Methods
This study introduced a CURE (course-based undergraduate research experience) into a junior-level MLS microbiology course, where all students in the junior cohort participated in the same research agenda during the same semester. The objective was to provide equal access and an equitable experience for each MLS student in the cohort. The research question was determined with input from students and instructors and had application within the microbiology course where it was being infused. The study protocol was designed during class time and most tasks were completed in class as well. From a pedagogical perspective, the CURE model is designed around five basic parameters, including (1) use of multiple scientific practices, (2) the outcome is unknown, (3) there is a broader relevance or importance beyond this classroom experience, (4) collaboration is essential among students and instructors, and (5) iteration is built into the process.

Conclusion
We found this CURE resulted in useful data for both students and other outside stakeholders. This differs from basic inquiry models where students participate in the protocol, including interpretation of the data, but the answer or outcomes are already known by the instructors. While the learning curve for students and instructors can be steep when infusing a CURE into an already heavy content course, the rewards of providing equal access and an equitable experience for the entire cohort are well worth the additional time spent preparing for this challenge.
Experience With a Research and Innovation Office to Support Laboratory Medicine and Pathology Research
Authors: Beinborn Julie , Saling Kenneth , Reed Katelyn , Ibrahim Mohamed , Feldman Andrew 
Published: September 2019

Abstract

Objectives
Translational research in laboratory medicine and pathology is transforming health care based on recent quantum advances in omics technologies, computational science, and precision medicine. However, high-volume clinical settings where this research may be most effective often have significant constraints on faculty time that challenge productivity. The objective of this study was to assess our experience with a new resource designed to address this challenge.

Methods
In September 2016, we established the Research and Innovation Office (RIO) in the Department of Laboratory Medicine and Pathology, Mayo Clinic–Rochester. The goal was to provide infrastructure to unburden faculty from performing administrative, organizational, and operational tasks related to research. Over 30 months, we solicited faculty input into desired services, conducted surveys on utility and ease of use, and tracked metrics, including faculty participation, numbers of projects, and publications.

Results
Faculty members were highly satisfied with the range of services, ease of use, and service-oriented approach of RIO. Initial services included project organization, institutional process support (eg, IRB protocol management), biospecimen requests and handling, and data management. Based on early feedback, patient consenting, budget support, and manuscript assistance were added as additional services. Total RIO staff increased from 6 to 10 during in the first 30 months. Over this time, 97 of 160 faculty members (60%) utilized RIO services in over 1,000 discrete project requests. Annual departmental publications increased by 50% during this time.

Conclusion
Faculty time is a critical element for translational research productivity in laboratory medicine and pathology departments. Numerous tasks previously performed by faculty could be managed effectively by a team of research facilitators that unburdened constraints on research time and led to high levels of faculty engagement, satisfaction, and productivity. This model may promote advances in transformative laboratory medicine and pathology research in high-volume clinical settings.
Utilization of Apple iPads in Student Clinical Rotations to Improve Safety and Streamline Information Access
Authors: Harrison Jenica , Perkins Lisa , Nadder Teresa 
Published: September 2019

Abstract

Introduction
American Society for Microbiology, Guidelines for Biosafety in Teaching Laboratories (2012) state that educators must use best practices to minimize risk of biohazard contamination to students. Integrating mobile digital devices into Medical Laboratory Science (MLS) programs’ clinical training is potentially one means of reducing this risk. Historically, student assignments and evaluations for clinical rotations were in paper format. The purpose of this pilot project was to ascertain attitudes from students and clinical educators on using mobile devices as a laboratory bench-side educational tool during clinical rotations.

Methods
In this prospective study, three senior-level MLS students used Apple iPads (Apple, Inc; Cupertino, CA) in concert with Google Drive (Google; Mountain View, CA) in lieu of paper manuals during Hematology and Transfusion Medicine clinical rotations at Virginia Commonwealth University Health in fall 2018. Two VCUH clinical educators from these laboratories also participated. All participants were trained on usage and access of electronic material on the iPads as well as proper cleaning of the devices. As a comparison, student participants used paper clinical manuals during their Chemistry and Microbiology rotations. In addition, the clinical educators used paper versions of clinical manuals during four of five student rotations that occurred in fall 2018. Prestudy surveys were used to assess attitudes toward mobile devices. Focus groups, for students and clinical educators, separately, were conducted after completion of the clinical rotations.

Conclusions
The results of the study indicate that advantages of employing mobile devices include improvement of safety by eliminating transfer of paper worksheets from laboratory to the outside, ability to electronically monitor students’ progress through clinical laboratory rotations, and ease of accessibility to electronic references at the bench-side. Moving forward, the study will expand to include additional disciplines and students as well as employment of styli and DocuSign (DocuSign, Inc.; San Francisco, CA).
Predicting the Optimal Maintenance Dose of Warfarin (Marevan) Based on Multiple Influential Factors
Authors: Elsafty Ahmed , Gumenyak Maryana , Agranovsky Elena 
Published: September 2019

Abstract

Introduction
Although there are new anticoagulant drugs, warfarin is useful after surgery. The safety margin of warfarin is narrow, requiring precise dosing to avoid unpredicted bleeding and thrombophilia/embolisms. The initial dose is adjusted depending on the prothrombin time–international normalized ratio (PT-INR) level to establish the maintenance dose. The monitored adjustment may take several days.

Objective
To formulate a valid and reliable equation that indicates the daily maintenance dose of warfarin “Marevan” to achieve closest PT-INR levels to the targets.

Methods
Studies were conducted on 150 adult patients treated with daily doses of warfarin “Marevan” for different therapeutic/prophylactic indications with variable PT-INR results (1.15-12.7). The samples were drawn at least 2 days after the drug initial administration. Laboratory tests were analyzed using fully automated machines with reviewed quality control and preanalytical precautions. A continuous multiple regression analysis was undertaken. The dependent variable was the daily warfarin “Marevan” dose in milligrams. The independent variables included PT-INR, serum albumin concentration, patient age, hematocrit, height, weight, and estimated total plasma albumin amount. A review of the clinical history and disease category was undertaken and paired with the findings to validate and discover the equation’s limitations.

Results
Multiple regression analysis revealed significant results (multiple r > 0.8 with minimal two-sided P values). A reliable equation was developed to predict the warfarin “Marevan” dose, which mostly achieves a PT-INR level of 3.0 or any targeted level. The equation encompassed almost two-thirds of all potential variables, including the effect of other drugs’ interaction. Clinically, the equation was applicable to cases with coexisting lupus thrombophilia, severe anemia, or renal or liver diseases. In the presence of moderate or severe cold agglutinins, the equation predicted underestimated doses.

Conclusion
Predicted warfarin “Marevan” dose = + 45.9505 + (0.770598 × PT.INR) – (5.67861 × Serum.Albumin.Concentration) – (0.0933151 × Patient.Age.In.Years) + (0.507168 × Hematocrit) – (0.296932 × Height.In.Centimeters) – (0.21711 × Weight.In.Kilograms) + (0.290377 × Estimated.Total.Plasma.Albumin.Amount).
Metastatic CD138+ Lobular Breast Carcinoma Mimicking a Plasma Cell Neoplasm
Authors: Canevari Margaux , Wells Justin , Pryor Eric 
Published: September 2019

Abstract
We present a case of an 85-year-old female who received a bone marrow biopsy for concern over myelodysplastic symptoms and was subsequently diagnosed with a CD138-positive metastatic lobular breast carcinoma that mimicked a plasma cell neoplasm. Her medical history included endometrial serous adenocarcinoma (pT1a N0), severe mitral regurgitation, and atrial fibrillation. She presented with a 3-month history of thrombocytopenia (60,000/mcL) and a down-trending macrocytic anemia (nidus hemoglobin: 6-7 g/dL) that prompted a bone marrow biopsy. The aspirate smears were aparticulate and hemodiluted, while the touch preparations revealed a homogeneous population of large, plasmacytoid cells. These were again seen filling the medullary cavity on the bone marrow biopsy with eccentrically placed nuclei containing nucleoli and abundant eosinophilic cytoplasm. The cells were CD138, cytokeratin 7 and 8/18, mammoglobulin, and GATA-3 positive. They were cytokeratin 20, TTF-1/Napsin, PAX-8, and uroplakin negative. Further testing revealed the cells to be estrogen receptor positive (strong, 90%+), progesterone negative, HER2 negative, p120 positive (strong cytoplasmic), and E-cadherin negative. The patient’s prior serous adenocarcinoma histomorphology was not consistent with the plasmacytoid cells. Prior literature revealed a case report on a metastatic lobular carcinoma to bone marrow and discussion on the morphologic similarities, but the case was CD138 negative. This case highlights that CD138 can be positive in certain carcinomas, some of which can have a plasmacytoid morphology. Suspicion should be raised in an elderly female population.
Immunophenotypic Analysis of Peripheral T-Cell Lymphomas: A Single-Center Retrospective Review of Flow Cytometric Analysis
Authors: Abbott Daniel , Kroft Steven , Hintzke Maria , Carrillo-Polanco Luis , Cunningham Ashley , Astle John , Leventaki Vasiliki , Harrington Alexandra 
Published: September 2019

Abstract

Background
Peripheral T-cell lymphomas (PTCLs) are heterogenous, mature T-cell neoplasms that are a diagnostic challenge, requiring a combination of morphologic assessment and ancillary studies. Flow cytometry (FC) is a tool used routinely in lymphoma diagnosis; however, most analyses are limited to B-cell evaluation and pathologists generally lack experience evaluating for PTCL. We aimed to describe the immunophenotypic aberrancies observed by FC in PTCL.

Design
PTCLs with FC were collected, excluding primary leukemic processes. Four- and eight-color FC data were reanalyzed with the following antigens (when available): CD2, CD3, CD4, CD5, CD7, CD8, CD30, CD45, CD45RO, CD56, and CD57. Lymphoma cells were compared to normal T cells and an isotype control. Antigen expression was defined as >20%.

Results
Thirty-eight cases were analyzed (29 males, 9 females, 6-86 years, median 62 years), including 29 PTCLs NOS, 4 angioimmunoblastic T-cell lymphomas (AITLs), 3 anaplastic large cell lymphomas, 1 δγ-TCL, and 1 hepatosplenic TCL from 15 bone marrows, 14 lymph nodes, 6 bloods, 2 fluids, and 1 skin. Twenty cases were CD4+, 4 were CD8+, 3 were dual +, and 10 were dual –. Thirty-seven cases (97%) showed global aberrant antigen patterns, median 4 aberrancies/case (1-8). Lymphoma cells accounted for 0.07% to 68% (median 2.6%) of total events. Aberrant CD7 expression was present in 34 of 38 (89%) and was underexpressed in 22 of 34 (65%). CD3 and CD5 were aberrant in 79% of cases each, with two-thirds showing underexpression. CD2 and CD45RO were aberrant in two-thirds of PTCLs, with overexpression in 61% and 92% of those cases, respectively. One AITL showed no aberrancies.

Conclusions
Nearly all PTCLs show immunophenotypic aberrancy compared to normal T cells. Most commonly, PTCL showed aberrant underexpression of CD7, CD3, and CD5 and overexpression of CD2 and CD45RO. Our data support FC panels with CD2, CD3, CD4, CD5, CD7, CD8, and CD45RO to optimize recovery of aberrant T cells.
A 62-Year-Old African American Woman With Stable Lymphadenopathy Over 5 Years
Authors: El Achi Hanadi , Glass William , Velazquez Miriam , Hu Zhihong 
Published: September 2019

Abstract
The patient is a 62-year-old African American female with medical history of Plummer Vinson syndrome and CT scan in 2014 showing lymphadenopathy of the porta hepatis. Needle core biopsy of enlarged lymph nodes revealed sheets of polytypic plasma cells with no aberrant B or T cells or granulomas or hyaline-like depositions identified. The findings were suspicious for unicentric Castleman disease. In 2019, the patient presented with chronic fatigue without other systemic symptoms. Contrast CT revealed persistent retroperitoneal lymphadenopathy and calcified granulomas in the liver, spleen, and lung. Excision of portal and celiac nodes showed preserved nodal architecture with mild mantle zone expansion and marked hyaline-like deposition in the follicles. Sheets of mature plasma cells and focally increased vasculatures were seen in the interfollicular areas. Focally frequent nonnecrotizing granulomas were noted. Occasional giant cells and rare asteroid bodies were identified in the granulomas. Immunohistochemistry stain workup revealed normal distribution of the B and T lymphocytes. CD138 stain highlighted marked increased plasma cells and HHV8 was negative. Immunofluorescence microscopy for kappa and lambda did not show monoclonality; IgA was positive in <10% of plasma cells; special stain for Congo red and serum amyloid associated protein (SSA) IHC stain were strongly positive in the follicles. The overall findings are consistent with reactive lymphadenopathy with interfollicular polytypic plasmacytosis, noncaseating granuloma formation, and reactive amyloidosis. The features of mantle zone hyperplasia and polytypic plasmacytosis are suggestive of HHV8-negative/idiopathic unicentric Castleman disease. This case possibly represents an example of concurrent amyloidosis, sarcoidosis, and idiopathic unicentric Castleman disease. Given that SSA was recently reported to have a pathogenic role in granulomatous inflammation of sarcoidosis through sustained inflammatory reaction, the possibility of increased SSA triggering sarcoidoisis in this patient can be considered. However, the exact pathogenesis of these concurrent findings needs further investigation and clarification.