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Byline: Jaimin. Shah, Shailendra. Solanki Context: Brain injury has become a silent epidemic and has very low survival and recovery rates because of inaccurate triaging, especially in absence of symptoms. [...]

* Context.--Flexible working at diverse or remote sites is a major advantage when reporting using digital pathology, but currently there is no method to validate the clinical diagnostic setting within digital microscopy. Objective.--To develop a preliminary Point-of-Use Quality Assurance (POUQA) tool designed specifically to validate the diagnostic setting for digital microscopy. Design.--We based the POUQA tool on the red, green, and blue (RGB) values of hematoxylin-eosin. The tool used 144 hematoxylin-eosin-colored, 5x5-cm patches with a superimposed random letter with subtly lighter RGB values from the background color, with differing levels of difficulty. We performed an initial evaluation across 3 phases within 2 pathology departments: 1 in the United Kingdom and 1 in Sweden. Results.--In total, 53 experiments were conducted across all phases resulting in 7632 test images viewed in all. Results indicated that the display, the user's visual system, and the environment each independently impacted performance. Performance was improved with reduction in natural light and through use of medical-grade displays. Conclusions.--The use of a POUQA tool for digital microscopy is essential to afford flexible working while ensuring patient safety. The color-contrast test provides a standardized method of comparing diagnostic settings for digital microscopy. With further planned development, the color-contrast test may be used to create a 'Verified Login' for diagnostic setting validation. (Arch Pathol Lab Med. 2019;143:1246-1255; doi: 10.5858/arpa.2018-0210-OA), One of the most cited advantages of making pathologic diagnoses digitally, using whole slide images viewed on a computer display, is the ability to work flexibly. (1) Recently, the Royal [...]

Background This study aimed to determine whether nitrite sticks are as sensitive at detecting urinary tract infection (UTI) in children Methods I reanalysed data on using nitrite sticks to detect UTIs for children aged either < 2 or 2-18 years. For sensitivity, evidence of a UTI was defined as level 1 when a single uropathogen grew [greater than or equal to] 10.sup.5 colony forming units/ml (cfu/ml) in two urine samples, level 2 when just one sample was cultured or a threshold of < 10.sup.5 cfu/ml was used, and level 3 if mixed growths or Staphylococcus albus was considered to be positive. For specificity, children were defined as uninfected if they had 1 sterile urine culture. I also reanalysed our previously published data by age. Results The sensitivity was lower for children aged < 2 years (11 studies, 1321 subjects) than for older children (9 studies, 295 subjects), whether the level-1 values or all the studies were analysed (Fisher's exact test, p < 0.0001 for both). The level-1 sensitivities were 0.23 in the infants and 0.81 among older children (odds ratio = 0.07, 95% confidence interval 0.03-0.18). The specificity was very high in infants (10 studies, 1783 cases) and older children (7 studies, 5952 cases), at 0.990 and 0.996. Conclusions Nitrite sticks only have a 23% sensitivity in children aged < 2 years, so cannot reliably rule out UTIs. A positive nitrite stick test is about 99% likely to indicate a UTI in children of any age., Author(s): Malcolm G. Coulthard [sup.1] Author Affiliations: (Aff1) 0000 0004 4904 7256, grid.459561.a, Great North Children's Hospital, , Queen Victoria Road, NE1 4LP, Newcastle upon Tyne, UK Introduction Young children [...]

Byline: Parul. Chojer, B. Mahajan Background: The collagen vascular disorders, particularly systemic sclerosis, dermatomyositis, systemic lupus erythematosus and mixed connective tissue disorder, are often characterized by microangiopathic abnormalities of the [...]

This column will provide information related to U.S. Food and Drug Administration (FDA) Emergency Use Authorizations (EUAs) granted due to the global COVID-19 pandemic. The current public health threat has [...]

While clear guidelines and best practices exist for the assessment of autism spectrum disorders (ASD), little information is available about assessing for ASD in culturally and linguistically diverse (CLD) populations. CLD populations might be misidentified and under-identified with ASD due to the assessment practices that we employ. Four autism diagnostic tools and six autism screeners were selected and evaluated for their cultural and linguistic responsiveness. Although the evaluation of ASD within CLD populations is highly complex, this study identified the need for improved autism assessment tools and practices. Without the appropriate assessment of these populations, CLD children will likely continue to be misidentified (or not identified at all) and will miss crucial intervention opportunities. Keywords Autism * Diagnostic assessment * Screening * Diverse populations, Introduction In recent years, the number of children diagnosed with autism spectrum disorders (ASD) has increased significantly. At present, ASDs are the fastest growing childhood neurodevelopmental disorders; recent estimates purport [...]

Background Extensive clinical and genetic heterogeneity of inherited cancers has allowed multi-gene panel testing to become an efficient means for identification of patients with an inherited predisposition to a broad spectrum of syndromic and nonsyndromic forms of cancer. This study reports our experience with a 27-gene inherited cancer panel on a cohort of 630 consecutive individuals referred for testing at our laboratory with the following objectives: 1. Determine the rates for positive cases and those with variants of uncertain clinical significance (VUS) relative to data published in the recent literature, 2. Examine heterogeneity among the constituent genes on the panel, and 3. Review test uptake in the cohort relative to other reports describing outcomes for expanded panel testing. Methods Clinical and genomic data were reviewed on 630 individuals tested on a panel of 27 genes selected on the basis of high ([greater than or equai to] 40%) or moderate to low ([less than or equai to] 40%) lifetime risk of hereditary cancer. These patients were not enriched for adherence to the National Comprehensive Cancer Network (NCCN) criteria for Hereditary Breast and Ovarian Cancer (HBOC) or Lynch Syndrome (LS) and constitute a referral laboratory cohort. Results Sixty-five individuals with variants classified as pathogenic or likely pathogenic across 14 genes were identified for an overall positive rate of 10.3%. Although a family history of cancer constituted a major reason for referral, accounting for 84% of our cohort, excluding patients with a known familial variant did not have a significant impact on the observed positive rate (9% vs 10.3%). More than half (58%) of the pathogenic or likely pathogenic variants were observed in high or moderate to low risk genes on the panel, while only 42% occurred in classic HBOC or LS-associated genes. Conclusion These results provide the actual percentage of family or personal history of cancer that can be attributed to pathogenic or likely pathogenic variants in one or more of the genes on our panel and corroborate the utility of multi-gene panels over sequential testing to identify individuals with an inherited predisposition to cancer. Keywords: Inherited cancer panel, VUS, HBOC, Lynch syndrome, CMMRD, Variant classification, Author(s): Sabrina A. Gardner[sup.1] , Katelyn S. Weymouth[sup.1] , Wei S. Kelly[sup.1] , Ekaterina Bogdanova[sup.1] , Wenjie Chen[sup.1] , Daniel Lupu[sup.1] , Joshua Suhl[sup.1] , Qiandong Zeng[sup.1] , Ute Geigenmüller[sup.1] [...]

Background Vesicoureteral reflux (VUR) has a prevalence of 30-40% post-febrile urinary tract infection (UTI). If not detected early and treated, renal scarring, hypertension, and renal failure may occur. Micturating cystourethrography (MCU) is an invasive procedure associated with radiation exposure. Hence, this study aimed at evaluating the utility of ureteric jet Doppler waveform (UJDW) as a screening tool in detecting VUR, and at assessing the feasibility of performing it in children aged 2-4 years. Methods Any child 2-18 years old who needed an MCU was included. Exclusion criteria were active UTI, indwelling catheter, and inability to drink the required amount of fluid. The UJDW was performed prior to the MCU. Results One hundred eighty-two ureteric units were analyzed. Sensitivity and specificity of UJDW in detecting VUR was 80.3 and 87.9%. Twenty-three children (45 ureteric units), aged 2-4 years were compared with 73 children (137 ureteric units), aged 5-18 years. Sensitivity and specificity of UJDW in detecting VUR in 2-4 years was 77.3 and 91.3%, respectively; while in children >5 years, it was 81.8 and 87.1%, respectively. Conclusions UJDW has a uniformly high specificity regardless of age or etiological groups, making it a good tool for follow-up. UJDW is a feasible technique, even in children aged 2-4 years. Keywords Children * Micturating cystourethrography * Ureteric jet Doppler waveform * Vesicoureteral reflux, Introduction Vesicoureteral reflux (VUR) is a common risk factor for urinary tract infections (UTI) in children. It is seen in 30-50% of all children and 40-50% of infants presenting with [...]

Purpose To find an alternative device to solve the difficult airway in children. Method Fifteen patients, all ASA I-II, aged from 1.5 to 9 years, who were undergoing elective surgeries were included. Difficult endotracheal intubation, but not difficult ventilation, was possible for all. The adult fiberoptic bronchoscope (FOB) was used to provide a vision of the glottis, and the CARTO catheter (a cardiac interventional catheter) with adjustable tip was used to induce the endotracheal tube. Results All patients were successfully intubated within 1-2 min at the first attempt. Conclusion Combined use of adult FOB and CARTO catheter may be an alternative device for tracheal intubation in children with known difficult airway. Keywords Difficult airway * Fiberoptic intubation * Child, Introduction The difficult airway in children presents a challenge to anesthesiologists, and various techniques have been used. Fiberoptic intubation plays a central role in difficult airway management in children [1, [...]