The role of telepathology in improving cancer diagnostic and research capacity in sub-Saharan Africa.

Non-communicable disease (NCD), including cancer, disproportionately affect Low- and Middle-Income Countries (LMICs). This inequity is in part due to limitations of pathology services, both human and infrastructural. While significant improvements have been made to address these gaps, creative approaches that are mindful of regional priorities, cultural differences, and unique local challenges are needed. In this perspective, we will describe the implementation of telepathology services in sub-Saharan Africa (SSA) that serve as cornerstones for direct patient care, multi-disciplinary care coordination, research programs, and building human capacity through training. Models and challenges of system implementation, sustainability, and pathologist engagement will be discussed. Using disease and site-specific examples, we will suggest metrics for quality control and improvement initiatives that are critical for providing high-quality cancer registry data and necessary for future implementation of therapeutic and interventional clinical trials.

Comprehensive molecular profiling of pancreatic ductal adenocarcinoma in FNA, biopsy, and resection specimens.

BACKGROUND: Molecular testing to identify molecular alterations in pancreatic ductal adenocarcinoma (PDAC) has been increasingly requested because of potential therapeutic implications. In this study, we compared the performance of PDAC fine-needle aspiration (FNA), fine-needle biopsy (FNB), and resection specimens for comprehensive molecular analysis. METHODS: A next-generation sequencing-based Oncomine Comprehensive Assay (OCA) was used to analyze molecular alterations in FNA, FNB, or resection specimens. We examined adequacy and success rates for completion of molecular testing and catalogued molecular alterations in these specimen types. RESULTS: The cohort included 23 FNA, 20 FNB, and 27 resection cases. Gene mutation or amplification analysis was successful in 18 (78%) FNA and 16 (80%) FNB specimens, whereas gene fusion assessment succeeded in 12 (52%) FNA and 12 (60%) FNB samples. All 27 (100%) resection specimens were adequate for complete OCA. There were significant differences in success rates for mutation and amplification analysis between resection and FNA or FNB specimens (P < .01) but not between FNA and FNB samples (P > .05). Manual microdissection was less likely to be performed for FNA specimens than FNB or resection specimens (P < .01). KRAS mutation was the most common mutation identified (90%), followed by mutations in TP53 (64%), CDKN2A (25%), and SMAD4 (15%) genes. CONCLUSIONS: Our study demonstrated similar success rates for comprehensive molecular analysis using FNA and FNB specimens of PDAC, suggesting that FNA material could serve as an alternative source for comprehensive molecular testing. The molecular alterations identified in these specimens may have potential diagnostic and therapeutic implications.

Pathology Engagement in Global Health: Survey Data of Global Pathology Interest and Barriers.

CONTEXT.­: Although pathology is essential to almost every practice in medicine, laboratory medicine professionals do not routinely volunteer in global health practice. OBJECTIVE.­: To gather information about the experience and interest levels of the pathology community in global health work. DESIGN.­: Data were analyzed from an 8-question, online, anonymous survey directed toward anyone working in the field of pathology and laboratory medicine. The survey collected data from respondents on their interest level in participating in global health pathology, potential barriers to participation, and the types of volunteer opportunities that would be of interest. RESULTS.­: A total of 267 people participated in the survey, of whom 142 (53%) were American citizens. One hundred seventy (64%) indicated that they had never volunteered in a low-resource setting. The majority of respondents (237; 89%) indicated interest in global pathology opportunities. More than half of the 267 respondents indicated interest in short-term trips (136; 51%), digital education opportunities (138; 52%), and reviewing slides/cases digitally (160; 60%). Lack of time to travel and lack of financial support were the 2 most cited reasons for lack of participation. One hundred nine respondents (41%) indicated that they were "willing and able, but do not know where to start." CONCLUSIONS.­: Our data demonstrate that laboratory medicine professionals are highly interested in global pathology efforts, but factors such as lack of time, lack of funding, and lack of knowledge of potential volunteer opportunities are barriers to participation. A significant number of respondents were willing and able to participate, indicating that pathology and laboratory medicine professionals may be an untapped resource for global health volunteers.

Measuring the Efficacy of Pathology Career Recruitment Strategies in US Medical Students.

CONTEXT.­: Multiple articles and surveys in the literature suggest that medical students find a career in pathology undesirable and believe it is disproportionately focused primarily on the autopsy. OBJECTIVE.­: To measure the effect of applied interventions on medical student attitudes about the field of pathology. DESIGN.­: This prospective study involving medical students from first through fourth year was conducted as a pilot study in 2 medical schools in the United States. A 2-part anonymous survey regarding interest in pathology as a career and familiarity with the specialty using a 10-point scale was given to first- and second-year medical students before and after they listened to a 10-minute pathology career presentation. The same survey was given to third- and fourth-year medical students before and after a 4-week pathology elective. RESULTS.­: A total of 121 and 83 students responded to the survey before and after the intervention, respectively. Of the 121 students who responded to the survey before the intervention, 106 (87.6%) had not spent significant time in a pathology laboratory before the intervention. The majority of responses in interest in career, job responsibilities, and features of pathologists before and after the intervention demonstrated a statistically significant difference (P < .001). We compared survey scores of presentation versus 4-week rotation groups before and after the intervention. Students who experienced the presentation did not differ from students who experienced the rotation in the majority of questions related to interest in career, job responsibilities, and features of pathologists. CONCLUSIONS.­: Our study suggests that pathology exposure strategies can have a beneficial effect on student perceptions of the field and consideration of a career in pathology. Overall, the presentation intervention seemed to have the greatest effect on the first- and second-year students.

Primary Lung Cribriform Adenocarcinoma With Squamoid Morules Harboring Somatic CTNNB1 Mutation in a Never-Smoked Healthy Adolescent.

Primary lung adenocarcinomas are rare in pediatric patients, and even rarer in patients without precedent malignancy or congenital malformation. Here we present the first reported case of primary lung cribriform adenocarcinoma with squamoid morules in a previously healthy adolescent female. Molecular testing identified CTNNB1 mutation in the tumor and excluded other common mutations in lung adenocarcinoma. Our case suggests molecular alterations to the same signaling pathway can lead to similar histomorphology regardless of the tissue of origin.

Social Media Engagement at Academic Conferences: Report of the Association of Pathology Chairs 2018 and 2019 Annual Meeting Social Media Committee.

The use of social media at academic conferences is expanding, and platforms such as Twitter are used to share meeting content with the world. Pathology conferences are no exception, and recently, pathology organizations have promoted social media as a way to enhance meeting exposure. A social media committee was formed ad hoc to implement strategies to enhance social media involvement and coverage at the 2018 and 2019 annual meetings of the Association of Pathology Chairs. This organized approach resulted in an 11-fold increase in social media engagement compared to the year prior to committee formation (2017). In this article, the social media committee reviews the strategies that were employed and the resultant outcome data. In addition, we categorize tweets by topic to identify the topics of greatest interest to meeting participants, and we discuss the differences between Twitter and other social media platforms. Lastly, we review the existing literature on this topic from 23 medical specialties and health care fields.

Disease, drugs, or dinner? Food histology can mimic drugs and parasites in the gastrointestinal tract.

Microscopic foreign objects are sometimes found in gastrointestinal (GI) tract specimens. Some signify important diagnostic findings, such as parasitic or bacterial organisms and some medication resins. Partially digested fruits and vegetables can also be present, and some have been described in the literature as potential mimickers of clinically important findings. While animal protein appears as skeletal muscle on histologic examination, fruits and vegetables can show a wide variation under the microscope. To our knowledge, a thorough histologic examination of commonly eaten fruits and vegetables has not been published in the pathology literature. Herein, we present key morphologic features of fruits and vegetables that might be found in GI specimens, emphasizing potential mimics of significant pathologic findings.

Utilizing Social Media to Spread Knowledge: The Association of Pathology Chairs Experience at the 2018 Annual Meeting.

Participants at academic conferences frequently use social media to disseminate educational content learned while at the meeting. Although most agree that this activity is harmless, some have expressed concern regarding the accuracy of the shared content and whether it truly reflects the intent and message of the speaker. As part of the goals of the APC 2018 social media committee to promote excellence through social media, a study was conducted to measure the perceived accuracy of tweets that represented an opinion or statement from a speaker and was shared during the annual meeting. Tweets shared on Twitter using the meeting hashtag (#APCPRODS2018) were collected and a survey unique to each speaker was created, to which 54% responded. The majority of speakers regarded the use of Twitter at the conference as beneficial in spreading their intended message in an accurate way. This study exemplifies the positive impact that social media use can have at academic meetings.

Myocarditis: somethings old and something new.

"Since the pathological conditions take place at the cellular level, viral myocarditis and postinfectious autoimmunity can be suggested but not diagnosed clinically. All clinical methods including imaging techniques are misleading if infectious agents are involved. Accurate diagnosis demands simultaneous histologic, immunohistochemical, and molecular biological workup of the tissue. If the primary infectious or immune-mediated causes of the disease are carefully defined by clinical and biopsy-based tools, specific antiviral treatment options in addition to basic symptomatic therapy are available under certain conditions. These may allow a tailored cause-specific treatment that improves symptoms and prognosis of patients with acute and chronic disease." Uwe Kühl; Heinz-Peter SchultheissViral myocarditis.Swiss Medical Weekly. 144():w14010, JAN 2014 DOI:10.4414/smw.2014.14010.

Clinical and Antibiotic Management of Urinary Tract Infections Pre- and Postimplementation of the CLINITEK AUWi System From Siemens to Screen Out Negative Urine Samples Submitted for Culture: A Retrospective Cohort Study.

OBJECTIVE: To compare patterns of inpatient and outpatient antibiotic use between patients who awaited urine culture results and patients whose urine specimens had been submitted for culture and were screened using the CLINITEK AUWi System. METHODS: This quasi-experimental retrospective cohort study included patient records with a urine specimen and hospital admission from 1 month before to 1 month after implementation of the system. We compared data from the pre- and postimplementation groups using the χ2 test or Fisher exact test. RESULTS: A similar proportion of patients in the pre- and postimplementation groups were prescribed antibiotics (71.2% vs 80.0%; P = .45); the postimplementation group had a significantly shorter length of stay in hours (median, 226 vs 123; P = .005). The median inpatient antibiotic treatment duration was lower for those in the postimplementation group; however, the duration of outpatient antibiotic treatment was longer. CONCLUSION: Our findings suggest that screening specimens using the CLINITEK AUWi System may reduce the excess administration of antibiotics.

Comparison of patient hospital length of stay pre and post implementation of the CLINITEK AUWi System from Siemens to screen out negative urine samples intended for culture: A retrospective cohort study.

OBJECTIVE: To determine the impact of using the CLINITEK AUWi System to screen out negative urine samples intended for culture on patient length of stay and culture results at a community teaching hospital. DESIGN AND METHODS: We used a retrospective cohort design to compare length of stay for patients admitted before and after implementation of the CLINITEK AUWi System to screen urine samples prior to culture. Before implementation, all urine samples were sent to an external laboratory for culture. After implementation, urine samples were screened first, and culture was only performed for those samples above the 325 bacteria/µl cutoff. We assessed patient length of stay before and after implementation. RESULTS: Our study included 306 samples (168 pre, 138 post). In the post-implementation group, 60.9% of cultures were screened negative and not sent for culture, resulting in fewer negative culture results (74.4% vs 40.7%, p<0.001). Median overall length of stay was reduced from 176 h (IQR 234.75) to 128.5 h (IQR 192.5, p=0.018), a decrease of over 40 h. Differences in length of stay were especially pronounced among female patients, patients aged 80 or over, and patients with urinary tract disorder in the diagnostic differential. CONCLUSIONS: Use of the CLINITEK AUWi System reduced the need for culture by screening out 60.9% of samples as negative, and was associated with a shorter mean length of stay. Our findings have implications for cost savings, due to both the reduced length of stay and the reduced need for culture.

Expedient Lewis acid catalyzed synthesis of a 3-substituted 5-arylidene-1-methyl-2-thiohydantoin Library.

An efficient and rapid solution phase combinatorial synthesis of a 3-substituted 5-arylidene-1-methyl-2-thiohydantoin library was developed. The salient feature for this library production procedure is the addition of the Lewis acid catalyst, indium(III) trifluoromethanesulfonate, which serves to facilitate the direct condensation of aldehydes with 3-substituted 1-methyl-2-thiohydantoins. Use of this Lewis acid catalyst has resulted in faster reaction times, higher conversions and better purity profiles for these condensation reactions as compared to traditional uncatalyzed reactions. The resulting 315 member library of 3-substituted 5-arylidene-1-methyl-2-thiohydantoin is described.

Pyrazolo[1,5-a]pyrimidines. Identification of the privileged structure and combinatorial synthesis of 3-(hetero)arylpyrazolo[1,5-a]pyrimidine-6-carboxamides.

The pyrazolo[1,5-a]pyrimidine class of compounds has been identified as a privileged structure for library synthesis on the basis of several key characteristics of the core molecule. A chemical set in excess of 400 compounds was synthesized to give 3,6,7-substituted pyrazolo[1,5-a]pyrimidinecarboxamides 9. To facilitate the rapid preparation of this library, a preparative strategy included the synthesis of activated p-nitrophenyl esters, followed by subsequent scavenging of the p-nitrophenol leaving group. Excess reagents were also removed using scavenging reagents that were found to be compatible with the synthetic methodology and that afforded target compounds in acceptable purity and yields.