Thursday, June 06, 2013

What if pathologists didn't exist?

Most of the world has no idea what pathologists do, short of the forensic ones who appear on T.V. in crime-related shows. Even many of our clinician colleagues don't fully understand what is involved in our work. Medical charts are typically full of verbiage indicating that, "the specimen was sent to pathology and the diagnosis came back..." as if this all happens magically in a "black box." Tissue is inserted into a machine and the diagnosis comes out the other end. Well... maybe one day but not in my (or your) lifetimes.

One of our former residents tipped me off to the link below from the Royal College of Pathologists of Australasia (RCPA). If you've never attended one of their meetings and are looking for a good reason to visit the land down under, I strongly recommend it. The RCPA decided to have a little fun with the concept of what medicine would be like without a pathologic underpinning.

http://worldwithoutpathology.rcpa.edu.au/

The site begins with the following message:

"If Pathologists didn't exist where would the answers come from? Pathology is the study of the nature and causes of diseases. It underpins every aspect of medicine, from diagnosis to monitoring, and is vital for research. Without pathologists, any answers found would be questionable to say the least. Every medical test, a case of trial and error. Exactly the kind of words you don't want to hear when it comes to your health. Watch the videos and see for yourself."

What follows then is series of short, very well done and admittedly quite silly videos with the serious premise that without pathologists clinicians would be absolutely clueless about diagnosing disease. Much like tribal "witch doctors" they might be relegated to devising and using all sorts of impractical, irreproducible, and completely non-functional schemes to aid in diagnosis. If you need a good laugh check this out. Afterwards think about what this says about our pivotal role in medicine. If you have non-medical friends who want to know if you're a "real doctor," and they have a good sense of humor, pass this link on to them!

Posted by Stacey E. Mills, MD at 2:34 PM

Fuente: Pⁿ Blog

The Pⁿ Blog is a forum for opinions, questions, controversies, and instructive discussions across the field of pathology and its relevant subspecialties.

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The Occasional Role of Low-risk Human Papillomaviruses 6, 11, 42, 44, and 70 in Anogenital Carcinoma Defined by Laser Capture Microdissection/PCR Methodology: Results From a Global Study

Guimerà, Núria; Lloveras, Belén; Lindeman, Jan; Alemany, Laia; van de Sandt, Miekel; Alejojo, Maria; Hernandez-Suarez, Gustavo; Bravo, Ignacio G.; Molijn, Anco; Jenkins, David; Cubilla, Antonio; Muñoz, Nubia; de Sanjose, Silvia; Bosch, Francesc Xavier; Quint, Wim

Abstract: Low-risk human papillomaviruses (LR-HPVs) have been associated occasionally with clinically and pathologically unusual anogenital malignancies. The relation between clinicopathologic features and any pathogenetic role of LR-HPV remains unclear. From a global study of 13,328 anogenital carcinomas, we identified 57 cases in which whole-tissue polymerase chain reaction using SPF10-LiPA25 showed single LR-HPV infection. In 43/46 (93.5%) available carcinomas, multiple polymerase chain reaction assays confirmed single detection of HPV6, 11, 42, 44, or 70 DNA. In 75% (n=32) of these, LR-HPV DNA was confirmed in tumor cells by laser capture microdissection. In 2 cases, including 1 adenocarcinoma, viral DNA was only found outside the tumor. All anogenital tumors with confirmed HPV6/11 showed a distinctive range of papillary, warty or warty-basaloid, squamous, or transitional histology with patchy or negative p16INK4a expression. HPV6-associated cervical tumors occurred at a low median age. HPV42/70 was associated with typical squamous cell carcinoma showing diffuse p16INK4a staining like high-risk HPV–related malignancies. HPV44 was found in malignant cells in 1 case. Viral taxonomy and theoretical analysis show that HPV6/11 belong to a different genus from HPV42/70 with E6/E7 gene products that would not bind pRb or p53, whereas HPV42/70 could bind pRb. Our data support the causal involvement of LR-HPVs in the carcinogenesis of <2% of anogenital malignancies of 2 distinct clinicopathologic patterns related to the genetic structure of the HPV types 6/11 and 70/42. HPV42/70 was associated with typical squamous carcinomas. Importantly all carcinomas associated with HPV6/11 globally showed verruco-papillary, well-differentiated, squamous, or transitional histology without p16INK4a expression.

Am J Surg Pathol September 2013 - Volume 37 - Issue 9 - p 1299–1310
doi: 10.1097/PAS.0b013e31828b6be4

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Datasets and Tissue Pathways

The College's Standards and Datasets for Histopathology Reporting on Cancers and Tissue Pathways have been written to help pathologists work towards a consistent approach for the reporting of the more common cancers and to define the range of acceptable practice in handling pathology specimens. The table in their web page provides links to the cancer dataset documents and to the 'tissue pathways' for non-malignant diseases for each site. NICE has accredited the process used by The Royal College of Pathologists to produce its Cancer Datasets and Tissue Pathways guidance. Accreditation is valid for five years from July 2012 and is retrospectively applicable to documents produced using the processes described in our 2012 guidelines for writing datasets and tissue pathways. All guidance produced following the accredited process bears the NICE accreditation mark. More information on accreditation can be viewed at nice.org.uk/acreditation

Click for more information on datasets, tissue pathways and the Working Group on Cancer Services, including guidance for authors.

Fuente: Datasets and Tissue Pathways

HIV in the United States – Statistics Overview – Statistics Center – HIV/AIDS.

Figure: Estimated New HIV Infections in the United States, 2010, for the Most Affected Subpopulations

Fast Facts

• More than 1.1 million people in the United States are living with HIV infection, and almost 1 in 6 (15.8%) are unaware of their infection.
• Gay, bisexual, and other men who have sex with men (MSMa), particularly young black/African American MSM, are most seriously affected by HIV.
• By race, blacks/African Americans face the most severe burden of HIV.

Fuente: HIV in the United States: At A Glance

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A Switch from White to Brown Fat Increases Energy Expenditure in Cancer-Associated Cachexia

Michele Petruzzelli, Martina Schweiger, Renate Schreiber, Ramon Campos-Olivas, Maria Tsoli, John Allen, Michael Swarbrick, Stefan Rose-John, Mercedes Rincon, Graham Robertson, Rudolf Zechner, Erwin F. Wagner

Highlights

• WAT browning contributes to high energy expenditure in cancer-associated cachexia
• Systemic inflammation and IL-6 induce and sustain WAT browning in cachexia
• Inhibition of WAT browning ameliorates the severity of cachexia
• Cancer cachexia patients stain positive for UCP1 protein in WAT

Cell Metabolism Available online 17 July 2014. In Press, Corrected Proof — Note to users
DOI: http://dx.doi.org/10.1016/j.cmet.2014.06.011

Fuente: Echa un vistazo al Tweet de @elmundosalud

Wikipedia vs Peer-Reviewed Medical Literature for Information About the 10 Most Costly Medical Conditions

Fuente: Echa un vistazo al Tweet de @Skepticscalpel

Ver Abstact y enlace del artículo.

Could HIV self-testing be a game changer in Africa?

Source: Thomson Reuters Foundation - Mon, 14 Jul 2014 10:48 GMT

LONDON (Thomson Reuters Foundation) - In Africa, where fewer than half the people know their HIV status, HIV self-testing is being explored as a way of encouraging more individuals, particularly in high risk groups, to know their status as a first step to seeking treatment, an AIDS charity said on Monday.

Despite decades of investment in testing and counselling for the human immunodeficiency virus (HIV) that causes AIDS, only about 15 percent of Zambians, 25 percent of South Africans and 39 percent of Swazis had been tested for HIV in 2011, U.N. figures show. In Botswana, the rate was higher with 62 percent of the population tested for HIV in 2011.

Experts say one of the main reasons people in sub-Saharan Africa used to give for not getting tested 10 or 15 years ago was the lack of treatment for HIV. But today, drugs that can control the virus for decades are increasingly available.

"Some people continue to live in denial. But we also know that some people don't know their status because of stigma and discrimination," said Felicitas Chiganze, chief operating officer of the Southern African AIDS Trust, which works on the response to HIV in six African countries.

The group published legal research on Monday comparing laws and outlining the human rights implications of HIV self-testing in 10 countries: Botswana, Malawi, Mozambique, Tanzania, Zambia and Zimbabwe where it works, and the United States, France, Britain and South Africa.

"We felt that if there was some initiative or some method that would enable people to know their status without going through some of the formal channels, that this could actually contribute to increasing the uptake for HIV testing," Chiganze told Thomson Reuters Foundation by telephone from Johannesburg.

She said sex workers and men who have sex with men are among the groups facing the heaviest burden of HIV, yet are some of the most hard to reach in terms of testing and treatment.

National Cancer Institute: HPV and Cancer. Reviewed: 03/15/2012

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HPV is the Driving Force behind the Rise of Oropharyngeal Cancer

Online Exclusives
14 Jul 2014 7:03 PM

Echa un vistazo al Tweet de @ASCO

Fuente: Connection ASCO.org

10/07/2014 - ForumLibertas.com Diario Digital

El sida “se ha incrementado significativamente” en Cataluña: el 81% de los nuevos casos en Barcelona se da entre homosexuales. El VIH entre el colectivo gay registrado en territorio catalán aumentó un 7,6% anual entre 2001 y 2011 y supone más del 61% de los nuevos diagnósticos. "En diez años podríamos encontrarnos con una alarmante situación en la que más del 40% de los hombres que tienen sexo con hombres entre 40 y 50 años de edad vivirían con el VIH", alerta un informe

Increasing HPV vaccination rates can prevent 50,000 cases of cervical cancer!

Echa un vistazo al Tweet de @CDCSTD

Fuente: CDC_Cancer

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UNDERSTANDING & UTILIZING DIGITAL PATHOLOGY AS A TOOL FOR ADVANCING PATHOLOGY PRACTICE AND ENABLING ENHANCED PATIENT CARE

2014 Agenda Just Launched Download the PDF Brochure

Early Registration - delegates save 20% with discount code:NN/EB/20 Offer ends Friday 1 August, 2014*

| Speakers | Free Newsletter | Register today |

Dear If you are involved with Pathology then you are standing at the frontier of fundamental change in technology that will have a huge impact on health care strategies, health care delivery and work patterns. Understanding how is essential.

"Once data is available digitally, it opens up huge opportunities to redesign process-driven services to create patient-centric care systems. Digitally enabled laboratory medicine services have the potential to bring pathologists closer to patients and so to speed up and improve the patient experience."

National
Pathology Programme NHS 

10 most common cancers among males and females in UK 2012

Fuente: Office National Statistics > Statistical bulletin: Cancer Registration Statistics, England, 2012
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Esté libre del Tabaco. Esta es la campaña en español lanzada en los EEUU por el HHS.gov U.S. Department of Health & Human Services: espanol.smokefree.gov

La campaña se ha difundido, entre otros medios, a través de Twitter desde las cuentas @HHGov y @NCImcMedia Echa un vistazo al Tweet de @NICmdMedia : Here is a Spanish version of the article on Smoking & Cancer for the LGBT Community: http://1.usa.gov/1xj0dis

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