bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuing Professional Development (CPD) Training Need Assessment for Medical Laboratory Professionals in Ethiopia
Authors: Gebregzabher E H , Tesfaye F , Cheneke W , Edao A , Kedida G 
Published: November 2022

Abstract

Introduction/Objective
Continuing professional development (CPD) is required for health workers in practice to update knowledge and skills regularly to match the changing complexity of healthcare needs. The objective of this study was to identify the training needs of Medical Laboratory professionals in Ethiopia.

Methods/Case Report
A total of 457 Medical Laboratory professionals from five region and two city administrations were involved in the study. Data was collected from August 02 to 21, 2021 with structured self-administered online tool with five-point Likert scale. The tool had consent, demography, cross-cutting issues, and main activity area specific to medical laboratory.

Results (if a Case Study enter NA)
Majority of the participants were male (80.1%). Participants from Amhara region 110 (24.1%) were the largest groups in the survey followed by Oromia 105(23%) and Addis Ababa 101(22.1%). The study participants comprised of 54.7% with a Bachelor degree, 31.3% with a diploma (Associate degree), and 14% with a Master’s degree. The participants had varying years of service, ranging from less than one year to over 10 years of experience. Most of the participants work as generalists (24.1%) followed by working in microbiology (17.5%) and Parasitology (16%). The majority (96.9%) was working in a public sector or training institutions and the rest were employed in the private sector. Our study showed that the three most important topics selected for training in the cross cutting health issues were health and emerging technology, computer skills and medico-legal issues. Topics under microbiology, clinical chemistry and molecular diagnostics were selected as the most preferred technical areas for training. Participants have also selected topics under research skill and pathophysiology. When the laboratory specific issues were regrouped based on areas of application as technical competence, research skill and pathophysiology, thirteen topics under technical competence, four topics under research skill and three topics under pathophysiology were picked as priority areas.

Conclusion
In conclusion, our study identified that CPD programs should focus on topics that address technical competence in microbiology, clinical chemistry and molecular diagnostics. Additionally competencies in research skill and updating knowledge in pathophysiology should also receive due attention in designing trainings.
Triaging of Bone Marrow for Esoteric Testing – Cost-effective and Patient-centric Approach Utilizing WHO Nomenclature for Hematolymphoid Malignancies
Authors: Kumari D , Sanchez-Salazar A , Villa C , Herschap B , Ehsan A 
Published: November 2022

Abstract

Introduction/Objective
Esoteric testing (ES) plays a major role in bone marrow (BM) evaluation. Providers usually order tests considering differential diagnoses based on clinical history. Hematopathologists (HP) while reviewing the BM consider modifying the standing orders. Knowledge and simple guidelines for triaging BM for ES are limited in the literature.

Methods/Case Report
Between 2015-2021, a total of 2560 BMs were selected. Initial tests that were ordered by providers were reviewed by HP considering clinical history, medical necessity, and preliminary BM morphology. Average Medicare fee schedule for 2022 was used for cost analysis. Types of ES were evaluated for Flow Cytometry (FC); Cytogenetics (CG); Fluorescence In-Situ Hybridization (FISH) and Molecular Genetics (MG). Immunostains were excluded in this study.

Results (if a Case Study enter NA)
Cases were evaluated and categorized as cytopenias, cytosis, staging, MPN, MDS, myelomas, treatment follow-up and miscellaneous indications. ES were modified based on medical necessity and blinded with insurance plans or payment status. Initial clinical orders were modified by HP as follows: FC-reduced 15%; CG-reduced 38%; FISH-modified 25%; MG-modified 40% (single assays or NGS). Overall healthcare savings by modifying tests were close to $1.2M.

Conclusion
Effective triaging of BM is a complex decision and can result in significant cost savings. Factors positively impacting these savings are: 1) expertise training in hematopathology, 2) personalized order of ES considering clinical indication, 3) peer-to- peer interaction with providers, and 4) the types of samples obtained. Collaborative efforts among pathologists and clinicians may lead to appropriate ordering of tests, cost- saving effective patient care with relevant diagnostic, therapeutic and prognostic information obtained as recommended by WHO nomenclature for hematolymphoid malignancies. In addition, established practice guidelines with personalized medicine will reduce the burden for pre-authorization when challenged with time sensitive samples obtained from cancer patients obtained thru invasive procedures.
Primary Chronic Myelogenous Leukemia Blast Crisis with Precursor B Lymphoblastic Leukemia, a Case Report
Authors: Wei E , Bellamkonda V , Polski J 
Published: November 2022

Abstract

Introduction/Objective
Primary chronic myelogenous leukemia (CML) blast crisis at the initial disease presentation is rare. Most CML blast crisis cases present with increased myeloblasts with a minority of patients showing lymphoblastic leukemia. Differentiating primary CML lymphoblast crisis from de novo acute lymphoblastic leukemia may represent a diagnostic challenge to both pathologists and treating clinicians. This distinction is important as it has significant implications on patient management.

Methods/Case Report
A 15-year-old male patient was admitted to our University Hospital for hyperleukocytosis. Patient reportedly had weight loss with occasional sweats and cervical lymphadenopathy. She was found to have massive splenomegaly. Peripheral blood showed hyperleukocytosis with predominance of granulocytes at all maturation stages ranging from blast to segmented neutrophils with increased blasts. Subsequent bone marrow findings were consistent with extensive involvement by B-lymphoblastic leukemia. Ten-color Flow cytometry showed approximately 30% blasts with rare lymphocytes and monocytes. The blasts revealed precursor B-lymphoblastic immunophenotypic expression of CD45, CD10, CD19, CD20, CD22, CD34, CD38, CD200, HLA-DR and TdT expression. The results were similar to that of peripheral blood. Granulocytes showed abnormal maturation pattern with increased immature precursors and partial expression of CD4 and CD56 with no abnormalities detected in lymphocytes. In this case, while the bone marrow findings are consistent with B-lymphoblastic leukemia, the peripheral blood findings are consistent with blast phase of chronic myeloid leukemia. Further evaluation by cytogenetic and molecular studies confirmed the presence of Philadelphia chromosome, p210 transcripts, and rearrangement of BCR-ABL1, which supported the impression of precursor B-lymphoblastic leukemia in primary blast phase of CML. The patient was treated with tyrosine kinase inhibitor combined chemotherapy and went into remission. She has been followed up without significant complications for a year.

Results (if a Case Study enter NA)
NA.

Conclusion
The diagnosis of CML in primary lymphoblastic crisis is rare and needs to be systemically excluded before giving the diagnosis of de novo BCR-ABL1-positive acute lymphoblastic leukemia. If the patient does not have splenomegaly or previous leukocytosis, it needs cytological examination and extensive molecular analyses.
Focal Myositis with CD8+T-Cell predominance: an Inflammatory Myositis Mimicking a Soft Tissue Neoplasm
Authors: Shaheen M , Warmke L , Nassiri M 
Published: November 2022

Abstract

Introduction/Objective
FM is a rare self-limiting T-cell rich lesion arising within muscles of young adults as a solitary lesion and can be confused with a variety of neoplastic/inflammatory conditions or lymphoma. Here we describe a rare T-cell rich variant of FM with CD8 predominance.

Methods/Case Report
A 51-year-old female presented with two-month history of left trapezius swelling. MRI showed an enhancing tumor within the muscle, suspicious of sarcoma, less likely myeloma.

Results (if a Case Study enter NA)
Biopsy showed diffuse infiltration of small lymphocytes in a fibrotic background and atrophic skeletal muscle. These lymphocytes stained positive for CD2, CD3, CD7, CD8, CD5 (partial), TIA1 (partial), CD43, CD57 and negative for CD4, CD30, CD56, CD57, granzyme B, perforin, BCL-6, BCL-2, Pax5, TCL1, and CD56. Ki-67 was (&lt;10%) with few background CD20+ B cells. By flow cytometry, the CD8+ T-cells co-express CD2, CD3, CD7, with dim CD5 expression. TCR gene rearrangement study by PCR showed no clonal TCR Gamma gene rearrangement.

Conclusion
FM is extremely rare with only 22 cases well-described in the literature, all predominantly composed of CD4+ T-cells, clinically concerning for low-grade sarcomas, as inflammatory myofibroblastic tumor, inflammatory leiomyosarcoma, or liposarcoma. Careful analysis is essential for correct diagnosis. Mimics include other causes of myositis, such as polymyositis and inclusion body myositis. Depending on the extent of lymphocytic infiltrate, gene rearrangement studies might be necessary to rule out clonality. Recognition of this rare entity with excellent prognosis is crucial to provide appropriate management and avoid unnecessary, aggressive procedures.
EBV+/HHV-8+/HIV+ high grade T Cell Lymphoma in the stomach
Authors: Li L , Cheng H 
Published: November 2022

Abstract

Introduction/Objective
T-cell Lymphoma is overly aggressive. T cells overgrow triggered by aberrant T-cell signaling and transform into a lymphoma. Virus infection contributes to the transformation, for example, EBV (Epstein Barr Virus) virus is associated with Extranodal NK/T-cell lymphoma, Angioimmunoblastic T-cell lymphoma, and peripheral T-cell lymphoma, HHV-8 is associated with Primary Effusion Lymphoma, Kaposi sarcoma, and very rarely associated with T cell lymphoma. The HIV (Human Immunodeficiency Virus) virus is associated with Burkitt lymphoma, Plasmablastic lymphoma et al. Among these lymphomas, only Primary Effusion lymphoma is associated with all three virus infections and is a B cell lymphoma. T cell lymphoma with all three infections has not been reported. Since most patients are diagnosed with advanced disease. So early diagnosis of this disease is especially important.

Methods/Case Report
An HIV+ 38-year-old male with no significant medical history complained of weakness, dizziness, and presenting with lower extremities swelling, and anemia for the last 2 weeks. The patient had a history of an unsafe sexual encounter with male sex workers but denies iv. drug use and blood transfusion. The screen before endoscopy reveals active, acute Hepatitis B Virus infection. Endoscopy findings show gastritis. The biopsy specimen shows mucosa is diffusely infiltrated by atypical plasmablastic cells. Immunostaining reveals they are positive for CD3, CD7, CD30, MUM1, CD43, and HHV8, but negative for Cd2, Cd4, Cd5, Cd8, Cd10, Cd21, Cd23, Cd25, Cd34, Cd56, Cd138, CD19, CD20, CD79a, PAX5, CD45, CD57, P53, CyclinD1, BCL6, BCL2, ALK, c-MYC, TdT, Granzyme B, TIA, S-100, Pancytokeratin. In situ hybridization for EBER is positive, but negative for Kappa and Lambda. The proliferative index (Ki-67) is high (99%). The morphologic and immunophenotypic features are consistent with an EBV CD30+ high-grade lymphoma. The sequencing from OnkoSightTM Advanced Chronic Lymphoid NGS Report shows a BCL-6 and EP300 mutation that has not been reported in a publicly available database (COSMIC; gnomAD).

Results (if a Case Study enter NA)
N/A.

Conclusion
To our knowledge, this is the first reported case of EBV+/HHV-8+/HIV+ high grade T Cell Lymphoma in the stomach. This type of lymphoma is extremely aggressive, and the early diagnosis is particularly important for prognosis.
Skin Necrosis in a Patient with Protein S Deficiency, Warfarin Anticoagulation, and Acute COVID-19 Infection: A Case Report
Authors: Torres C , Eby C 
Published: November 2022

Abstract

Introduction/Objective
Although thrombotic complications from COVID are well documented, the pathophysiology remains poorly understood, especially in patients with comorbid hypercoagulable risk factors and anticoagulant medication use. COVID has several dermatologic manifestations that may occur due to alterations in hemostasis. We present a case of skin necrosis in a patient with protein S deficiency, warfarin anticoagulation, and acute COVID infection.

Methods/Case Report
A 48-year-old female, BMI &gt;50, heterozygous Protein S (PS) deficiency, Factor V Leiden, and history of recurrent venous thromboembolic events on warfarin, tested positive for COVID. Her only symptom was fatigue. Several days later, the patient developed painful ecchymoses and erythematous blisters on her breast, arm, and abdomen. Laboratory results showed INR 3.6, fibrinogen 675-1054 gm/dL, WBC 15k with absolute neutrophilia, and D-dimer 2274 ug/L DDU. The patient confirmed compliance with her maintenance warfarin dose. Biopsy showed thrombotic vasculopathy without leukocytoclastic vasculitis. Wound cultures were negative.

Results (if a Case Study enter NA)
NA.

Conclusion
The patient’s history and presentation were concerning for warfarin induced skin necrosis. However, the patient had taken warfarin for &gt; 20 years and had an INR of 3.6 which substantiated that warfarin was not discontinued or missed. A retrospective review of INR results during acute COVID infection showed a decrease in time in therapeutic range and an increase in supratherapeutic INRs, suggesting COIVD patients may require decreased warfarin doses. Additionally, PS levels decline in patients with COVID; a similar effect is seen with HIV and Varicella infections. It is theorized that this may be mediated by an increase in C4b binding protein, an acute phase reactant that regulates the complement cascade and binds PS. With an infectious source ruled out and the patients’ known comorbid conditions, an acute exacerbation of the patients underlying hypercoagulable state is the likely driver of the patient’s skin necrosis with COVID as the probable precipitator. In summary, inherited and acquired hypercoagulable risk factors should be included in the differential diagnosis as a cause of skin changes in patients with COVID infection. Although histology may be helpful in diagnosing the cause of skin changes with COVID, laboratory results and clinical correlation are key in identifying a etiology.
To Normalize or Not? Dilute Russell Viper Venom Time testing
Authors: Zhang Y , Creer M , Oladipo O 
Published: November 2022

Abstract

Introduction/Objective
Background: Antiphospholipid antibodies bind phospholipid bound proteins. Criteria for diagnosis of the antiphospholipid syndrome includes detection of either a lupus anticoagulant (LA) or anticardiolipin/anti B2GP1 antibodies and thrombotic events or pregnancy loss. Functional LA is detected by prolonged dRVVT clotting time (dCT) of patient plasma in the presence of limited phospholipid (screen) followed by a 1:1 mix of patient and normal pooled plasma to rule out procoagulant deficiency (mix). Confirmation is achieved by addition of excess phospholipid shortening the dCT and increasing the screen/confirm ratio (SCR). Normalization involves testing pooled reference plasma to determine the SCR with an added calculation step to correct for reagent/instrument differences. We compared the SCR in patient plasma with that obtained using reference plasma to determine impact on clinical decision making.

Methods/Case Report
Methods: 404 patients had dRVVT testing (STAGO STA-R Evolution) from 09/2021 to 05/2022. Positive screens (≥51 seconds) underwent mixing studies followed by confirmatory tests (&gt;=46 seconds). The dRVVT of reference pooled plasma was also measured (George King Normal Pooled Plasma). A positive conventional or normalized SCR was defined as an SCR &gt; 1.2 and comparison was by the paired t test.

Results (if a Case Study enter NA)
6.4% (26) of the 404 samples tested were confirmed positive for LA by both methods, out of which 12 had a clinical history of thrombosis. Although a statistically significant difference between the two groups (p=0.0096) was found, the magnitude of absolute SCR differences (0.1s) was within total allowable error limits and there was 100% concordance of positive and negative results between the 2 groups.

Conclusion
There is no clinically significant difference between the two groups. Normalization had no benefit in our patient population, therefore no need for the extra calculation step. Others have reported that normalization is useful for inter-method and inter-laboratory studies and not for within method LA detection consistent with our results.
In-clinic Phlebotomists: A Patient Centered Solution to Improve Care and Quality Scores
Authors: Olson J , Gingrich D , Haynes A 
Published: November 2022

Abstract

Introduction/Objective
Phlebotomists play a central role in health care delivery, as the collection of a sample is the fundamental step in the performance of a laboratory test. Gaps between a patient’s ideal care and the care they are receiving often include unperformed laboratory tests. For pediatric patients, screening for lead levels is recommended, and the percent of patients who complete this screening is a quality metric included in quality and HEDIS scores. The Laboratory Medicine Department, in conjunction with the Pediatric medicine department undertook an effort to increase the number of children compliant with this screening measure.

Methods/Case Report
A pilot effort to increase screening rates was implemented in a large multispecialty ambulatory clinic building. Despite having a phlebotomy collection clinic directly across the hall from the pediatric clinic, an identified barrier to screening completion was patients leaving the pediatric clinic after a well-child exam and bypassing the laboratory collection site. The reasons behind this bypass were multifaceted, but the percieved inconvenience of making a second stop was identified as a major contributing factor. To improve this, a phlebomtist from the ambulatory collection clinic was assigned each day to go to the pediatric clinic whenever a blood draw was requested. The rates of screening were tracked for patients in this clinic pre- and post pilot.

Results (if a Case Study enter NA)
The rates of lead screening for 15 month-old pediatric patients in the population attributed to the pilot clinic went from an average of 38.1% in the pre-pilot phase, to 59.7% in the post-pilot phase, a statistically significant increase p=0.0021 . This workflow was also noted to be a patient satisfier for both patient family and clinic teams.

Conclusion
Phlebotomy performed in a clinic room, immediately after a patient’s clinic visit improved compliance with lead screening. This can be attributed to patient’s willingness to have the care ‘come to them’ rather than needing to make a perceived ‘second stop’. Although this workflow was a slightly less efficient for phlebotomists, the daily number of draws was not overwhelming and the increased satisfaction for patient families was judged a reasonable trade off. This workflow is expected to be utilized at other multispecialty clinics in our health care system. This project demonstrated that by making small improvements in workflow, the laboratory can have a significant impact on quality metrics and satisfaction.
Using Early Exam Results to Predict Online MLS Program Success
Authors: Robertson C , Johnson N , Bird R , Key J 
Published: November 2022

Abstract

Introduction/Objective
The objective of this effort is to demonstrate the impact of early didactic exam results for potential early intervention for students in an online medical laboratory science bridge program.

Methods/Case Report
For this study, we took retrospective data of 299 students from 2018 to 2021 who took MLSC 4312, Hematology, in their first semester. We then analyzed their first exam score and then used this data to evaluate its potential use as an early predictor of overall student success in both this course and the program. Specifically, the exam one score in the course was used to evaluate progression to the second semester, graduation, UAMS GPA, and ASCP Board of Certification total score and Hematology sub-score. Descriptive statistics and 2-sample T-tests were calculated using Number Cruncher Statistical System. Fisher’s exact test was performed using Graphpad software.

Results (if a Case Study enter NA)
Of the 296 students whose records were examined, 49 scored below a 76% on Hematology exam 1. 247 students scored above 75%.35 students who scored below 76% progressed to the second semester and of those, 33 (94.2%) graduated on time. 14 students were dismissed from the program after the first semester. The overall graduation rate of students who started the program and scored less than 76% on the first hematology exam was 67%. Of the 247 students who scored above 76% on exam 1, 229 (93%) progressed to the second semester and of those, 214 graduated on time (93.4%). 18 of these students were dismissed from the program. The overall graduation rate of students who started the program and scored greater than 76% on the first hematology exam was 86.70%. The overall ASCP Board of Certification pass rate was almost 19 percent higher, 81.7% vs. 62.9% in those who scored greater than 76% on the first hematology exam. Each of the comparisons was statistically significant (P=&lt;0.05) using a 2-sample T-test or Fisher’s exact test as appropriate.

Conclusion
This study revealed the importance of doing well on the first major didactic exam in the Medical Laboratory Sciences program. Students who score &lt; 76% on their first exam fail to progress to the second semester at four times the rate of those who score &gt;76%. In addition, those who score &lt;76% and progress fail the ASCP Board of Certification Exam at almost double the rate of those who score &gt;76% on the first hematology exam. In the future, we will reach out earlier and offer targeted help to these students.