Pathology Commons^™

Hla-Ii-Dependent Neuroimmune Changes In Group A Streptococcal Necrotizing Fasciitis, Ganesh Ambigapathy, Santhosh Mukundan, Kumi Nagamoto-Combs, Colin Combs, Suba Nookala

Biomedical Sciences Faculty Publications

Streptococcus pyogenes (Group A Streptococcus, GAS) bacteria cause a spectrum of human diseases ranging from self-limiting pharyngitis and mild, uncomplicated skin infections (impetigo, erysipelas, and cellulitis) to highly morbid and rapidly invasive, life-threatening infections such as streptococcal toxic shock syndrome and necrotizing fasciitis (NF). HLA class II allelic polymorphisms are linked with differential outcomes and severity of GAS infections. The dysregulated immune response and peripheral cytokine storm elicited due to invasive GAS infections increase the risk for toxic shock and multiple organ failure in genetically susceptible individuals. We hypothesized that, while the host immune mediators regulate the immune responses against …

September 2023: Region 10 Emerging Special Pathogen Treatment Center (Resptc) At Providence Sacred Heart Medical Center & Children’S Hospital, Providence - Special Pathogens Program

Special Pathogens Newsletters

REGION 10 SPECIAL PATHOGENS NEWSLETTER

Outpatient Management Of Urinary Tract Infections By Medical Officers In Nairobi, Kenya: Lack Of Benefit From Audit And Feedback On Adherence To Treatment Guidelines, Florence Mbatia, James Orwa, Mary B. Adam, Gulnaz Mohamoud, Rodney Adam

Family Medicine, East Africa

Introduction: Acute uncomplicated urinary tract infections are common in outpatient settings but are not treated optimally. Few studies of the outpatient use of antibiotics for specifc diagnoses have been done in sub-Saharan Africa, so little is known about the prescribing patterns of medical ofcers in the region.

Methods: Aga Khan University has 16 outpatient clinics throughout the Nairobi metro area with a medical ofcer specifcally assigned to that clinic. A baseline assessment of evaluation and treatment of suspected UTI was performed from medical records in these clinics. Then the medical ofcer from each of the 16 clinics was recruited from …

Renal Cell Carcinoma With Fibromyomatous Stroma Has A Distinctive Staining Pattern With Gata3 And Cd133 From Clear Cell Rcc And Clear Cell Papillary Rcc (Ccp-Rcc), Brandon Metcalf, Jining Feng, Leilei Chen, Vaishali Pansare, Ping L. Zhang

Conference Presentation Abstracts

Context: Renal cell carcinoma with fibromyomatous stroma (RCC-FMS) is a provisional entity of renal cell neoplasm that can be difficult to distinguish from low-grade clear cell RCC and clear cell papillary renal cell carcinoma (CCP-RCC) owing to its fibromyomatous stroma, low-grade nuclei, and clear cell cytoplasm.

Design: In this pilot study, we evaluated the utility of GATA3 and CD133 (a stem cell marker) as immunostain markers for the standard panel of cytokeratin 7 (CK7), CD10, and CAIX in distinguishing RCC-FMS from clear cell RCC and CCP-RCC. We stained 6 RCC-FMSs, 5 clear cell RCCs, and 5 CCP-RCC samples for all …

Igm-Dominant Immune Complex-Mediated Glomerulonephritis Should Be Classified As Membranoproliferative Glomerulonephritis, Igm Subtype, Sarang Khan, Brandon Metcalf, Wei Li, Hassan Kanaan, Ping L. Zhang

Conference Presentation Abstracts

Context: Immunoglobulin M (IgM) glomerulopathy usually presents as drug-resistant nephrotic syndrome and is characterized by diffuse effacement of foot processes and scattered mesangial IgM deposits, which is considered within the spectrum of minimal change disease and primary focal segmental glomerulosclerosis. However, IgM-dominant immune complex–mediated glomerulonephritis (IgM-ICMGN) is a rare renal entity and usually characterized by a membranoproliferative pattern with light microscopy; dominant IgM staining by immunofluorescent staining; and subendothelial, mesangial, and occasional subepithelial deposits by electron microscopy.

Design: We report our experience of 5 IgM-ICMGN cases with their pathologic phenotypes and clinical scenarios.

Results: Patient ages ranged from 47 to …

Using An Artificial Intelligence (Ai) Tool (Chatgpt) To Identify The Main Indications And Side Effects Of Drugs In Patient Medical Records, Mai Elzieny, Zhenhong Qu

Conference Presentation Abstracts

Context: Drug history is important clinical information for the correct histologic diagnosis of a wide variety of nonneoplastic diseases, such as hepatitis, gastritis, and colitis. As pathologists, however, keeping a strong knowledge of all drugs (and variations of drug names) can be challenging. Using online databases to find relevant drug information one at a time is very time-consuming.

Design: Sixty-seven drugs were collected from the medical records of 5 randomly selected patients. ChatGPT (https://chat.openai.com/chat) was instructed to identify (1) the main clinical indications, and (2) the major side effects of each drug, using the prompt “List the major indications and …

Enhancing Pathology Report Analysis With Artificial Intelligence: A Validation Study Of Chatgpt's Effectiveness In 444 Cases, Zhenhong Qu, Megan Wang, Christian Santiago, Jack W. Qu, Ping Zhang

Conference Presentation Abstracts

Context: Despite years of efforts, the pathology report lacks standardization for its gross description. This inevitably leads to the occasional omission of key data elements, and difficulty to identify key elements in a lengthy unstructured report. A novel artificial intelligence (AI) tool, ChatGPT by OpenAI (San Francisco, California), was reportedly proficient in extracting keywords from text content. We assess the effectiveness of ChatGPT to quickly find multiple data elements in reports and detect missing data elements.

Design: Gross description of 444 pathology reports of several common organ types was submitted to ChatGPT (https://chat.openai.com/chat) that extracted and listed key data elements …

Combined Smad4 And Imp3 Immunohistochemical Stains To Increase The Probability Of Diagnosing Pancreatic Adenocarcinomas In Fine-Needle Biopsies, Reenal Patel, Ashbita Pokharel, Ping L. Zhang, Zhenhong H. Qu

Conference Presentation Abstracts

Context: SMAD4 and IMP3 are useful stains in diagnosing pancreatic cancer but not perfect to reach that goal individually. We attempted to determine if using both SMAD4 and IMP3 can increase the diagnostic specificity of fine-needle biopsies (FNBs) for pancreatic adenocarcinomas, as FNBs often showed limited tissue for the morphologic evaluation.

Design: Fifteen FNBs with or without prior cytology were evaluated with both SMAD4 and IMP3 stains. Nuclear loss of SMAD4 was graded as 0 (no loss), 1–2+ (partial loss), and 3+ (total loss), whereas IMP3 was graded 0–3+ by staining intensity. Staining results were correlated with morphologic changes for …

Malignant Tumors Arising From Adult Polycystic Kidney Disease, Yazan Al-Othman, Mai Elzieny, Christopher Thorburn, John D. Schwartz, Susan I. Daraiseh, Hassan D. Kanaan, Zhenhong H. Qu, Ping L. Zhang

Conference Presentation Abstracts

Context: The prevalence of renal tumors arising from adult polycystic kidney disease (APKD) has been rarely reported in the pathology literature. We report our findings of various renal tumors in APKD nephrectomy specimens.

Design: We searched our database for APKD during the past 11 years and identified various primary malignant tumors within the kidneys of APKD.

Results: Forty-eight nephrectomies with APKD were evaluated. Ten malignant tumors were identified in the APKD kidneys, indicating a prevalence of 20.8% (10/48; Table). These included 4 clear cell (CC) renal cell carcinomas (RCCs) ranging from 1 mm to 6.7 cm, 3 papillary RCCs …

Monoclonal Immunoglobulin-Associated Glomerulopathy: Single Health Center Experience With 16 Cases, Brandon Metcalf, Yazan A. Al-Othman, James Huang, Wei Li, Hassan D. Kanaan, Ping L. Zhang

Conference Presentation Abstracts

Context: In addition to monoclonal cryoglobulinemic glomerulopathy, nonorganized monoclonal immunoglobulin (Ig) can deposit in glomeruli, causing either proliferative glomerulonephritis or membranous glomerulopathy. We present our experience related to this phenomenon.

Design: Sixteen cases of monoclonal immunoglobulin-associated glomerulopathy (MIAGN) from 14 patients were identified during the past 13 years and their pathologic and clinical features were collected and presented.

Results: One case of membranous glomerulopathy with monoclonal immunoglobulin deposits (MGNMID) (also called membranous glomerulopathy with light-chain–restricted deposits) was found. The patient was a 71-year-old woman with serum creatinine at 0.7 mg/dL and nephrotic syndrome (urine protein to creatinine ratio at 5.41), …

Doac Therapy Associated With Macroscopic Hematuria: Investigation Of The Underlying Urologic Etiologies, Catherine Xie, Mary Wyrzykowski, Subhash Edupuganti, Ming Xie

Conference Presentation Abstracts

Context: Direct oral anticoagulants (DOACs) have gained wide use in prevention and treatment of thromboembolic diseases. Both major and nonmajor bleeding events have been reported. Hematuria is a common bleeding complication in patients receiving DOACs.

Design: This study retrospectively investigates the underlying urologic etiologies responsible for DOAC therapy–related macroscopic hematuria. During a 1-year period, hospitalized patients with prolonged PTT and DOAC therapy–related hemorrhage were identified. Medical chart review focused on urology consult and related laboratory and imaging findings.

Results: Among 93 patients with DOAC therapy–related hemorrhage, 15 had macroscopic hematuria (16%), including 11 men and 4 women with a median …

Audit Tumor Reports In Pathology For Completeness And Compliance By An Artificial Intelligence Tool, Chatgpt, Ashbita Pokharel, Keran Zhao, Reenal Patel, Jack W. Qu, Zhenhong Qu

Conference Presentation Abstracts

Context: A tumor synoptic report (TSR) audit is an important quality control tool for compliance with reporting requirements; however, no simple audit tool is readily available to most pathologists. ChatGPT (https://chat.openai.com/chat) is an emerging artificial intelligence tool with wide applications. Its ability to extract data from text content has been widely reported but lacks evidence-based validation for its application in medicine. We assess the effectiveness of ChatGPT to identify and extract key data elements of TSRs and detect missing elements.

Design: Forty synoptic reports of malignant tumors of the lung, kidney, colon, and uterus were collected randomly. Key data elements …

Serum Tests For Donor-Derived Cell-Free Dna Are Well Correlated With Renal Transplant Rejection In Renal Biopsies: Our Preliminary Experience Of New Surveillance For Monitoring Rejection, Reenal Patel, Brandon Metcalf, Dilip Samarapungavan, Hassan D. Kanaan, Wei Li, Sarah T. Suliman, Atul Singh, Ping L. Zhang

Conference Presentation Abstracts

Context: Noninvasive serum test for donor-derived cell-free DNA (dd-cfDNA) has been found useful for monitoring acute cellular rejection (ACR) and antibody-mediated rejection (AMR) since 2018, and the accepted threshold to indicate rejection is 1%. The goal of this pilot study was to determine if this test can correlate with renal biopsy results during a 1-year period when the dd-cfDNA test was initiated in our medical center.

Design: Renal transplant biopsies were evaluated for various rejection and nonrejection etiologies. Their corresponding dd-cfDNA percentages were identified. The biopsy data and dd-cfDNA results were correlated.

Results: During a year, we noticed a trend …

The Combination Of Platelet Rich Plasma And Corticosteroids In Musculoskeletal And Musculotendinous Pathologies, Mikayla Stoudt

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Background

- 126 million Americans reported to have a musculoskeletal or musculotendinous pathology in 2012¹

- Combined direct and indirect cost of these injuries in 2015 was $874 billion¹

- Corticosteroid injections have been the mainstay of invasive management after conservative methods fail
Long-term effects of corticosteroids

• Intra-articular injections for knee osteoarthritis resulted in cartilage volume loss¹⁰
• Harm to flexor tendons, neurovascular structures, and compromised integrity^{7, 11}

- Platelet Rich Plasma

• Sample patient blood --> Centrifuge --> Separate plasma and platelets from other blood products --> Reconcentrate the platelets into the plasma
• Platelets release growth factor …

Persistent Foci Of Infection: A Case Of Two Mycotic Aneurysms Separated In Time In A Patient With Infective E. Faecalis Endocarditis, Julia C. Stone, Joel Thompson, Joseph Hatem, Evan Basha

Advances in Clinical Medical Research and Healthcare Delivery

This is a case report of a patient who presented with mycotic aneurysms of two different blood vessels at separate hospital visits following a diagnosis of infective endocarditis.

Sars-Cov-2 Infection In Unvaccinated High-Risk Pregnant Women In The Bronx, Ny, Usa Is Associated With Decreased Apgar Scores And Placental Villous Infarcts, Sandra E. Reznik, Patricia M. Vuguin, Alexa Cohen, Rasha Khoury, Olivier Loudig, Ridin Balakrishnan, Susan A. Fineberg, Francine Hughes, Malini Harigopal, Maureen J. Charron

School of Medicine Faculty Publications

Babies born to severe acute respiratory syndrome corona virus-2 (SARS-CoV-2)-infected mothers are at greater risk for perinatal morbidity and more likely to receive a neurodevelopmental diagnosis in the first year of life. However, the effect of maternal infection on placental function and neonatal outcomes varies depending upon the patient population. We set out to test our hypothesis that maternal SARS-CoV-2 infection in our underserved, socioeconomically disadvantaged, mostly unvaccinated, predominantly African American and Latina population in the Bronx, NY would have effects evident at birth. Under IRB approval, 56 SARS-CoV-2-positive patients infected during the “first wave” of the pandemic with alpha …

The Role Of Dlc1Β In Attenuating Cardiac Ischemia-Reperfusion Injury During Heart Transplantation, Samantha L. Collings

Electronic Thesis and Dissertation Repository

Cardiac ischemia-reperfusion injury (IRI) occurs intra-operatively during heart transplantation (HTx), underpinning graft survival. Past research implicated the PI3K/Akt1 & RhoA/ROCK pathways in IRI. Rho-GTPase activity/Akt regulates Deleted-in-liver-cancer 1 protein’s beta-isoform (DLC1β). Therefore, we hypothesized that DLC1β overexpression (OE) had anti-apoptotic effects. In vitro, HL-1 cells (mouse cardiomyocytes) received chamber hypoxia-oxygenation reperfusion (H/R) for 24H4R with/without DLC1β plasmid, before collection for protein/mRNA analyses. DLC1β-OE resulted in downregulated pro-apoptotic mRNA expression (Bax/Cycs/Casp3), upregulated protective mRNA targets (BCl2/Akt1) and less late/early apoptosis via flow cytometry. Results were confirmed via H9C2 (rat cardiomyocyte) cell lines. In vivo, C57/BL6 mice received heterotopic HTx with/without DLC1β-OE …

Development, Roll-Out And Implementation Of An Antimicrobial Resistance Training Curriculum Harmonizes Delivery Of In-Service Training To Healthcare Workers In Kenya, Josiah Njeru, Joshua Odero, Sheilla Chebore, Mungai Ndung’U, Emmanuel Tanui, Evelyn Wesangula, Romona Ndanyi, Susan Githii, R Gunturu, Willy Mwangi

Pathology, East Africa

Background: Antimicrobial resistance (AMR) is an increasingly severe threat to global public health that requires action across different sectors. Selection of appropriate antimicrobials is an urgent challenge due to the emergence of drug resistance. In 2017, Kenya developed an AMR policy and National Action Plan to drive prevention and containment of AMR. A priority activity under AMR surveillance strategic objective was to develop a national AMR training curriculum for in-service healthcare workers. In this paper we discuss the development process, gains achieved through implementation across the country and lessons learned.

Methods: An initial stakeholders’ forum was convened to …

Spatial Analyses Of Immune Cell Infiltration In Cancer: Current Methods And Future Directions: A Report Of The International Immuno-Oncology Biomarker Working Group On Breast Cancer, David Page, Chowdhury Jahangir, Sara Verbandt, Rajarsi Gupta, Jeppe Thagaard, Reena Khiroya, Zuzana Kos, Khalid Abduljabbar, Sunil Badve, Shahin Sayed

Pathology, East Africa

Abstract: Modern histologic imaging platforms coupled with machine learning methods have provided new opportunities to map the spatial distribution of immune cells in the tumor microenvironment. However, there exists no standardized method for describing or analyzing spatial immune cell data, and most reported spatial analyses are rudimentary. In this review, we provide an overview of two approaches for reporting and analyzing spatial data (raster versus vector-based). We then provide a compendium of spatial immune cell metrics that have been reported in the literature, summarizing prognostic associations in the context of a variety of cancers. We conclude by discussing two well-described …

Pitfalls In Machine Learning-Based Assessment Of Tumor-Infiltrating Lymphocytes In Breast Cancer: A Report Of The International Immuno-Oncology Biomarker Working Group On Breast Cancer, Jeppe Thagaard, Glenn Broeckx, Chowdhury Arif Jahangir, Sara Verbandt, Rajarsi Gupta, Reena Khiroya, Khalid Abduljabbar, Gabriela Acosta Haab, Balazs Acs, Shahin Sayed

Pathology, East Africa

Abstract: The clinical significance of the tumor-immune interaction in breast cancer is now established, and tumor-infiltrating lymphocytes (TILs) have emerged as predictive and prognostic biomarkers for patients with triple-negative (estrogen receptor, progesterone receptor, and HER2-negative) breast cancer and HER2-positive breast cancer. How computational assessments of TILs might complement manual TIL assessment in trial and daily practices is currently debated. Recent efforts to use machine learning (ML) to automatically evaluate TILs have shown promising results. We review state-of-the-art approaches and identify pitfalls and challenges of automated TIL evaluation by studying the root cause of ML discordances in comparison to manual TIL …