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Indian Journal of Pathology &... May 2022Autoimmune encephalitis is a group of non-infectious immune-mediated inflammatory disorders manifesting with epilepsy and encephalitis syndromes that are associated with... (Review)
Review
Autoimmune encephalitis is a group of non-infectious immune-mediated inflammatory disorders manifesting with epilepsy and encephalitis syndromes that are associated with autoantibodies in the serum and/or cerebrospinal fluid (CSF). Pathogenic autoantibodies have been discovered against intracellular onconeural antigens, surface neuronal, or synaptic antigens with distinctive pathogenesis that underlie differences in response to immunotherapy. The onconeural antigens incite cytotoxic T-cell-mediated neuronal destruction, whereas surface antigens trigger direct damage by autoantibodies via complement mediated pathways, and hence respond well to immunomodulatory therapy, in contrast to poor response in the former. Neuroimaging, electroencephalogram, and CSF findings being non-specific, detection of autoantibodies is essential for a confirmatory diagnosis. Detection methods available include tissue-based assay, cell-based assays, immunoblot, cell culture, flow cytometry, and enzyme-linked immunosorbent assays. In this review, we discuss the various testing modalities available for onconeural and cell surface antibodies, their sensitivity and specificity and the emerging role of the pathologist in the diagnosis of autoimmune encephalitis. Early diagnosis is crucial for instituting treatment and preventing morbidity and mortality.
Topics: Autoantibodies; Encephalitis; Hashimoto Disease; Humans; Pathologists
PubMed: 35562150
DOI: 10.4103/ijpm.ijpm_41_22 -
Pathologica Oct 2023Even if the SARS-CoV-2 pandemic has been declared over, several risks and clinical problems remain to be faced, including long-COVID sequelae and possible outbreaks of... (Review)
Review
Even if the SARS-CoV-2 pandemic has been declared over, several risks and clinical problems remain to be faced, including long-COVID sequelae and possible outbreaks of pathogenic variants. Intense research on COVID-19 has provided in these few years a striking amount of data covering different fields and disciplines, which can help to provide a knowledge shield against new potential infective spreads, and may also potentially be applied to other fields of medicine, including oncology and neurology. Nevertheless, areas of uncertainty still remain regarding the pathogenic mechanisms that subtend the multifaceted manifestations of the disease. To better clarify the pathogenesis of the disease, a systematic multidisciplinary evaluation of the many mechanisms involved in COVID-19 is mandatory, including clinical, physiological, radiological, immunological and pathological studies. In COVID-19 syndrome the pathological studies have been mainly performed on autopsy cases, and only a few studies are available on biopsies. Nevertheless, these studies have provided relevant information that can substantially contribute to decipher the complex scenario characterizing the different forms of COVID-19 and long-COVID-19. In this review the data provided by pathological investigations are recapitulated and discussed, in the light of different hypothesis and data provided by clinical, physiological and immunological data.
Topics: Humans; COVID-19; Pathologists; Post-Acute COVID-19 Syndrome; SARS-CoV-2; Biology
PubMed: 38054899
DOI: 10.32074/1591-951X-954 -
Clinical and Molecular Hepatology Feb 2023Non-alcoholic fatty liver disease (NAFLD) is a spectrum of diseases characterized by fatty accumulation in hepatocytes, ranging from steatosis, non-alcoholic... (Review)
Review
Non-alcoholic fatty liver disease (NAFLD) is a spectrum of diseases characterized by fatty accumulation in hepatocytes, ranging from steatosis, non-alcoholic steatohepatitis, to cirrhosis. While histopathological evaluation of liver biopsies plays a central role in the diagnosis of NAFLD, limitations such as the problem of interobserver variability still exist and active research is underway to improve the diagnostic utility of liver biopsies. In this article, we provide a comprehensive overview of the histopathological features of NAFLD, the current grading and staging systems, and discuss the present and future roles of liver biopsies in the diagnosis and prognostication of NAFLD.
Topics: Humans; Non-alcoholic Fatty Liver Disease; Liver; Pathologists; Liver Cirrhosis; Hepatocytes; Biopsy
PubMed: 36384146
DOI: 10.3350/cmh.2022.0329 -
Journal of Clinical Pathology Aug 2022Gastrointestinal (GI) tract pathology represents one of the largest individual specialties within cellular pathology departments globally. As with other specialties,... (Review)
Review
Gastrointestinal (GI) tract pathology represents one of the largest individual specialties within cellular pathology departments globally. As with other specialties, clear communication with clinicians providing primary care for the patient is of utmost importance for optimal management and for appropriate use of resources such as endoscopy. A wide breadth of neoplastic and inflammatory conditions afflicts the GI tract. Here, we aim to illustrate how pathology reporting of GI tract specimens influences patient management and specifically how precise reporting of key parameters in different specimen types and different disease processes can directly impact patient care. We describe the potential clinical relevance of selected pathology data items pertinent to specific conditions and highlight areas of contention with respect to the significance of some pathology features. Recent guidelines are described where a change, for example, in diagnostic criteria for a condition is described, or criteria influencing further management such as endoscopic surveillance. The aim of this review is to focus on the clinical importance of careful written communication between the pathologist and primary clinician, illustrated by selective clinical scenarios involving the upper and lower GI tracts.
Topics: Endoscopy, Gastrointestinal; Gastrointestinal Tract; Humans; Pathologists
PubMed: 35853655
DOI: 10.1136/jclinpath-2021-207472 -
JAMA Network Open Jul 2020There is currently no national organization that publishes its data that serves as the authoritative source of the pathologist workforce in the US. Accurate physician...
IMPORTANCE
There is currently no national organization that publishes its data that serves as the authoritative source of the pathologist workforce in the US. Accurate physician numbers are needed to plan for future health care service requirements.
OBJECTIVE
To assess the accuracy of current pathologist workforce estimates in the US by examining why divergency appears in different published resources.
DESIGN, SETTING, AND PARTICIPANTS
This study examined the American Board of Pathology classification for pathologist primary specialty and subspecialties and analyzed previously published reports from the following data sources: the Association of American Medical Colleges (AAMC), the Accreditation Council for Graduate Medical Education (ACGME), a 2013 College of American Pathologists (CAP) report, a commercially available version of the American Medical Assoication (AMA) Physician Masterfile, and an unpublished data summary from June 10, 2019.
MAIN OUTCOMES AND MEASURES
Number of physicians classified as pathologists.
RESULTS
The most recent AAMC data from 2017 (published in 2018) reported 12 839 physicians practicing "anatomic/clinical pathology," which is a subset of the whole. In comparison, the current AMA Physician Masterfile, which is not available publicly, listed 21 292 active pathologists in June 2019. The AMA Physician Masterfile includes all pathologists in 15 subspecialized training areas as identified by the ACGME. By contrast, AAMC's data, which derive from the AMA Physician Masterfile data, only count physicians primarily associated with 3 general categories of pathologists and 1 subspecialty category (ie, chemical pathology). Thus, the AAMC pathology workforce estimate does not include those whose principal work is in 11 subspecialty areas, such as blood banking or transfusion medicine, cytopathology, hematopathology, or microbiology. An additional discrepancy relates to the ACGME residency (specialties) and fellowship (subspecialties) training programs in which pathologists with training in dermatopathology appear as dermatologists and pathologists with training in molecular genetic pathology appear as medical geneticists.
CONCLUSIONS AND RELEVANCE
This analysis found that most sources reported only select categories of the pathologist workforce rather than the complete workforce. The discordant nature of reporting may pertain to other medical specialties that have undergone increased subspecialization during the past 2 decades (eg, surgery and medicine). Reconsideration of the methods for determining the pathologist workforce and for all workforces in medicine appears to be needed.
Topics: Forensic Pathology; Health Workforce; Humans; Neuropathology; Pathologists; Pathology; Pathology, Clinical; United States; Workforce
PubMed: 32672830
DOI: 10.1001/jamanetworkopen.2020.10648 -
Annales de Pathologie Feb 2021
Topics: Humans; Pathologists; Pathology; Pathology, Clinical
PubMed: 33413971
DOI: 10.1016/j.annpat.2020.12.004 -
Der Pathologe Mar 2022
Topics: Communication; Humans; Pathologists
PubMed: 35230514
DOI: 10.1007/s00292-022-01054-8 -
Journal of the American Society of... 2021
Topics: Biopsy; Cell Biology; Certification; Clinical Competence; Curriculum; Cytological Techniques; Education, Medical, Graduate; Humans; Pathologists; Pathology; Specialization
PubMed: 34629163
DOI: 10.1016/j.jasc.2021.07.004 -
Seminars in Diagnostic Pathology Mar 2023The field of medicine is undergoing rapid digital transformation. Pathologists are now striving to digitize their data, workflows, and interpretations, assisted by the... (Review)
Review
The field of medicine is undergoing rapid digital transformation. Pathologists are now striving to digitize their data, workflows, and interpretations, assisted by the enabling development of whole-slide imaging. Going digital means that the analog process of human diagnosis can be augmented or even replaced by rapidly evolving AI approaches, which are just now entering into clinical practice. But with such progress comes challenges that reflect a variety of stressors, including the impact of unrepresentative training data with accompanying implicit bias, data privacy concerns, and fragility of algorithm performance. Beyond such core digital aspects, considerations arise related to difficulties presented by changing disease presentations, diagnostic approaches, and therapeutic options. While some tools such as data federation can help with broadening data diversity while preserving expertise and local control, they may not be the full answer to some of these issues. The impact of AI in pathology on the field's human practitioners is still very much unknown: installation of unconscious bias and deference to AI guidance need to be understood and addressed. If AI is widely adopted, it may remove many inefficiencies in daily practice and compensate for staff shortages. It may also cause practitioner deskilling, dethrilling, and burnout. We discuss the technological, clinical, legal, and sociological factors that will influence the adoption of AI in pathology, and its eventual impact for good or ill.
Topics: Humans; Algorithms; Pathologists; Artificial Intelligence
PubMed: 36882343
DOI: 10.1053/j.semdp.2023.02.006 -
Current Hematologic Malignancy Reports Oct 2020Social media engagement by medical professionals with varied background subspecialties has steadily gained popularity in recent years. As a heavily visual discipline,... (Review)
Review
PURPOSE OF REVIEW
Social media engagement by medical professionals with varied background subspecialties has steadily gained popularity in recent years. As a heavily visual discipline, pathology has been able to leverage social media platforms for trainee education, curbside and official consultations, interdisciplinary communication, and interactions among medical professionals and patient education. The pathology community has been at the forefront of using social media as an educational forum, and the hematopathology community has emerged as one of the strongest and most influential presences on these online platforms. In this review, we perform an in-depth analysis of various Twitter metrics to demonstrate key trends in the usage of social media as it pertains to hematopathology using the hashtag #Hemepath and we describe specific details on how hematopathologists have managed to take advantage of Twitter in furthering our mission of advancing medical education and disseminating knowledge using these innovative virtual educational experiences.
RECENT FINDINGS
The hematopathology community has a great degree of enthusiasm among residents, fellows, and faculty in sharing educational material using case-based examples, participating in group-based online activities, introducing new publications by article authors or readership, and disseminating educational "pearls" from medical conferences, using hashtags and digital images that otherwise would not be readily available to many around the globe. This practice is helping reshape the structure of our field and is providing opportunities to optimize the educational experience by enhancing the instant exposure to cutting-edge information and expert opinions, among other valuable features. The hematopathology community has leveraged social media platforms for disseminating educational material and strengthening interdisciplinary interactions and is a "poster child" for a medical subspecialty that has thrived and flourished by more broadly adopting virtual educational platforms. We hope that this review will provide details on how social media platforms can be used by others in the medical field to achieve similar goals.
Topics: Attitude to Computers; Education, Medical; Health Knowledge, Attitudes, Practice; Hematology; Humans; Information Dissemination; Pathologists; Scholarly Communication; Social Media; Time Factors
PubMed: 33128122
DOI: 10.1007/s11899-020-00600-6