Laboratory/Pathology Services and Blood Bank

Pathology and its laboratories are central in support of every facet of cancer care in a CCC center, from diagnosis, to patient support during treatment, research, therapeutic drug manufacture and development and bio-banking.We have approached this discussion from the perspective of the timeline of a patient’s journey through cancer care. We begin with screening programs, high quality diagnostics and then maintaining quality supportive cancer care. Specialised services such as cellular therapies and haematopoietic stem cell transplantation with their unique requirements are considered and lastly we discuss the vital role of clinical trials and research in comprehensive cancer care with a focus on biobanks.We also examine the role of the diagnostic laboratories and their clinical and scientific staff in shaping an integrated cancer diagnostic report, as an integral part of a cancer Multidisciplinary Team (MDT) or “Tumour Board”. Increasingly, integration of a large amount of clinical data, laboratory results and interpretation of complex molecular and genomic datasets is required to underpin the role of CCC’s as centres of clinical excellence and to collaborate with partners in local, national and international research protocols.

Digital Pathology in Cameroon

PURPOSE Cancer is becoming increasingly prevalent among the group of treatable diseases in African countries. There is a shortage of clinicians and pathologists available for cancer diagnosis and treatment. These limited resources must be efficiently used to maximize the number of patients treated. One of the critical factors in treatment efficiency is the correct and timely diagnosis of specimens by pathologists. However, there is currently a significant shortage of cancer care clinicians in Africa and an even more considerable shortage of pathologists. This article presents an example in which telepathology was used to mitigate the lack of pathologists in Cameroon. METHODS The telepathology workaround was implemented in a district hospital based in Cameroon's Adamawa region, where a European surgeon provides cancer treatment. A small histology laboratory there is run by one histotechnologist who processes surgical biopsies into histology slides. As there are no pathologists on site, these slides are digitally scanned using a mobile phone and a whole slide imaging (WSI) scanner. The slides are then shared electronically with a volunteering pathologist in Europe who provides a diagnostic report. RESULTS From 2018 to July 2019, specimens for 101 patients were photographed through an iPhone connected to a microscope eyepiece producing several individual images per specimen. From July 2019 to December 2020, slides from 282 patients were scanned using WSI and digitally transmitted. CONCLUSION WSI on hematoxylin and eosin histology slides for remote diagnosis can increase cancer treatment efficacy and reduce overtreatment of tumors clinically suspicious for malignancy in under-resourced countries with a lack of pathologists.

Thuma Mina - an Isaiah 6:8 perspective in crossfire with Step-aside: SA ruling party’s moral restoration efforts

This article builds on the excellent article by Prof. Kgatle and Mashau who examined the prospects and success of the presidency of Cyril Ramaphosas by reflecting on the concept of Thuma Mina. In this article, Ramaphosas Thuma Mina's manifesto is placed in the same restorative context as the implementation of the African National Congress (ANC) step-aid resolution. Almost 27 years of democracy today since the ANCs came to power in South Africa in 1994, and yet members' moral values continue to decline, as reflected in Gwede Mantashe's devastating Organizational Diagnostic Report. This paper reflects the concept of Thuma Mina at Isaiah 6: 8 as redirected into politics by Cyril Ramaphosa to fight corruption in collaboration with the resolution of the 54th Conference. The Thuma Mina Group's implementation of StepAside threatened the unity of the ANC when the then suspended ANC General Secretary suspended his own suspension to suspend ANC President Cyril Ramaphosa. If the Magashule group succeeds in flaunting the party rules and rejecting the Step-Aside policy, this will lead to a political catastrophe. This paper uses two disciplines (theology and politics) to shed light on the prospects of Thuma Mina as advocated by President Cyril Ramaphosa, along with the fair implementation of the ANC's Step Aside resolution. This study is important as it provides a more concise understanding of the concept of Thuma Mina campaign.

Histopathologic interpersonal overview of generalized pustular cutaneous reaction to Hydroxychloroquine (HCQ): New challenging clinical manifestation

Background: Pathologic examination of Acute Generalized Exanthematous Pustulosis (AGEP) and Pustular Psoriasis (PP) are similar. We encountered many patients with PP or AGEP who cannot be distinguished clinically, pathologically and based on disease course from each so we designed a comprehensive interpersonal histopathologic overview of these patients' samples. Method: Histopathological data of 16 patients over 3.5 years were analyzed. Four pathologists separately reviewed specimens based on eighteen criteria (9 Epidermal and 9 Dermal). Severity score for each criterion was considered as to be (0 to 3+). We compared the final pathologic diagnosis with primary one. Results: Neutrophilic and lymphocytic infiltration in dermis were seen in all cases of AGEP while intraepithelial pustules. Subcorneal and intraepithelial pustules, spongiosis, neutrophilic exocytosis, neutrophilic and lymphocytic infiltration in dermis were observed in all cases of PP. The most severe neutrophilic inflammation; acanthosis and neutrophilic or lymphocytic infiltration were seen in PP. The authors of this study have been reported generalized pustular clinical presentations of patients have been taken HCQ, and in the recent pandemic it is also one of the concerns that many studies have been focused (....). Conclusion: When primary histopathologic report is AGEP/PP overlap, clinical judgment is the best way to manage and it is more probable that the final diagnosis being PP. When only AGEP or PP is histopathologic diagnostic report, it is usually enough to make final diagnosis and appropriate management. Key words: hydroxychloroquine, HCQ, generalized pustular cutaneous eruption, Pustular Psoriasis (PP), Acute Generalized Exanthematous Pustulosism, AGEP, Histopathological overview, pathology, review

METHODS AND MODELS FOR TEXTURE ANALYSIS OF LUNG PATHOLOGICAL CHANGES BASED ON COMPUTED TOMOGRAPHY FOR COVID-19 DIAGNOSIS

In recent years computed tomography of the lungs has been the most common diagnostic procedure aimed at detection of the pathological changes associated with COVID-19. The study is aimed at the use of the developed algorithmic support in combination with texture (geometric) analysis to highlight a number of indicators characterizing the clinical state of the object of interest. Processing is aimed at the solution of a number of diagnostic tasks such as highlighting and contrasting the objects of interest, taking into account the color coding. Further, an assessment is performed according to the appropriate criteria in order to find out the nature of the changes and increase both the visualization of pathological changes and the accuracy of the X-ray diagnostic report. For these purposes, it is proposed to use preprocessing algorithms for a series of images in dynamics. Segmentation of the lungs and areas of possible pathology are performed using wavelet transform and Otsu threshold value. Delta-maps and maps obtained using Shearlet transform with contrasting color coding are used as a means of visualization and selection of features (markers). The analysis of the experimental and clinical material carried out in the work shows the effectiveness of the proposed combination of methods for studying of the variability of the internal geometric features (markers) of the object of interest in the images.

Visualization and application of disease diagnosis codes for population health management using porcine diseases as a model

Accurate and timely results of diagnostic investigations and laboratory testing guide clinical interventions for the continuous improvement of animal health and welfare. Infectious diseases can severely limit the health, welfare, and productivity of populations of animals. Livestock veterinarians submit thousands of samples daily to veterinary diagnostic laboratories (VDLs) for disease diagnosis, pathogen monitoring, and surveillance. Individual diagnostic laboratory reports are immediately useful; however, aggregated historical laboratory data are increasingly valued by clinicians and decision-makers to identify changes in the health status of various animal populations over time and geographical space. The value of this historical information is enhanced by visualization of trends of agent detection, disease diagnosis, or both, which helps focus time and resources on the most significant pathogens and fosters more effective communication between livestock producers, veterinarians, and VDL professionals. Advances in data visualization tools allow quick, efficient, and often real-time scanning and analysis of databases to inform, guide, and modify animal health intervention algorithms. Value is derived at the farm, production system, or regional level. Visualization tools allow client-specific analyses, benchmarking, formulation of research questions, and monitoring the effects of disease management and precision farming practices. We present here the approach taken to visualize trends of disease occurrence using porcine disease diagnostic code data for the period 2010 to 2019. Our semi-automatic standardized creation of a visualization platform allowed the transformation of diagnostic report data into aggregated information to visualize and monitor disease diagnosis.

vcf2fhir: a utility to convert VCF files into HL7 FHIR format for genomics-EHR integration

Background VCF formatted files are the lingua franca of next-generation sequencing, whereas HL7 FHIR is emerging as a standard language for electronic health record interoperability. A growing number of FHIR-based clinical genomics applications are emerging. Here, we describe an open source utility for converting variants from VCF format into HL7 FHIR format. Results vcf2fhir converts VCF variants into a FHIR Genomics Diagnostic Report. Conversion translates each VCF row into a corresponding FHIR-formatted variant in the generated report. In scope are simple variants (SNVs, MNVs, Indels), along with zygosity and phase relationships, for autosomes, sex chromosomes, and mitochondrial DNA. Input parameters include VCF file and genome build (‘GRCh37’ or ‘GRCh38’); and optionally a conversion region that indicates the region(s) to convert, a studied region that lists genomic regions studied by the lab, and a non-callable region that lists studied regions deemed uncallable by the lab. Conversion can be limited to a subset of VCF by supplying genomic coordinates of the conversion region(s). If studied and non-callable regions are also supplied, the output FHIR report will include ‘region-studied’ observations that detail which portions of the conversion region were studied, and of those studied regions, which portions were deemed uncallable. We illustrate the vcf2fhir utility via two case studies. The first, 'SMART Cancer Navigator', is a web application that offers clinical decision support by linking patient EHR information to cancerous gene variants. The second, 'Precision Genomics Integration Platform', intersects a patient's FHIR-formatted clinical and genomic data with knowledge bases in order to provide on-demand delivery of contextually relevant genomic findings and recommendations to the EHR. Conclusions Experience to date shows that the vcf2fhir utility can be effectively woven into clinically useful genomic-EHR integration pipelines. Additional testing will be a critical step towards the clinical validation of this utility, enabling it to be integrated in a variety of real world data flow scenarios. For now, we propose the use of this utility primarily to accelerate FHIR Genomics understanding and to facilitate experimentation with further integration of genomics data into the EHR.

Development and implementation in medical practice of new information technologies and metrics for the analysis of subtle changes in the electromagnetic field of the human heart

The article details the concept of clinical information technology (IT), i.e. a set of methods and software and hardware combined into a technological chain, the product of which is an automated diagnostic report, prognostic report or recommendation on patient management tactics. There are several examples of innovative information technologies and metrics implemented by the authors in Ukraine and abroad, designed to register and evaluate subtle changes in the electromagnetic field of the heart for early diagnosis of the most common and dangerous heart diseases, especially coronary heart disease. It is shown that new metrics of analysis of spatial structure of 2D and 3D magnetocardiographic maps of current density distribution allow to diagnose with high accuracy various forms of myocardial ischemia. The new method of the electrocardiogram scaling is used in various areas of clinical medicine, sports medicine, occupational medicine, as well as in large-scale population studies.