Typhoid appendicitis and 'the man from Istanbul'.

We describe typhoid appendicitis in a 19-year-old girl. The appendix showed aggregates of macrophages in the mucosa and in the wall. Blood culture yielded Salmonella enterica serovar Typhi. The presence of macrophages in an appendicectomy specimen should prompt the pathologist to consider the possibility of typhoid fever, even in the absence of supporting microbiological investigations.

Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action.

Modern, affordable pathology and laboratory medicine (PALM) systems are essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries (LMICs). In this last in a Series of three papers about PALM in LMICs, we discuss the policy environment and emphasise three crucial high-level actions that are needed to deliver universal health coverage. First, nations need national strategic laboratory plans; second, these plans require adequate financing for implementation; and last, pathologists themselves need to take on leadership roles to advocate for the centrality of PALM to achieve the Sustainable Development Goals for health. The national strategic laboratory plan should deliver a tiered, networked laboratory system as a central element. Appropriate financing should be provided, at a level of at least 4% of health expenditure. Financing of new technologies such as molecular diagnostics is challenging for LMICs, even though many of these tests are cost-effective. Point-of-care testing can substantially reduce test-reporting time, but this benefit must be balanced with higher costs. Our research analysis highlights a considerable deficiency in advocacy for PALM; pathologists have been invisible in national and international health discourse and leadership. Embedding PALM in LMICs can only be achieved if pathologists advocate for these services, and undertake leadership roles, both nationally and internationally. We articulate eight key recommendations to address the current barriers identified in this Series and issue a call to action for all stakeholders to come together in a global alliance to ensure the effective provision of PALM services in resource-limited settings.

Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions.

Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs). Increasing and retaining a quality PALM workforce requires access to mentorship and continuing professional development, task sharing, and the development of short-term visitor programmes. Opportunities to enhance the training of pathologists and allied PALM personnel by increasing and improving education provision must be explored and implemented. PALM infrastructure must be strengthened by addressing supply chain barriers, and ensuring laboratory information systems are in place. New technologies, including telepathology and point-of-care testing, can have a substantial role in PALM service delivery, if used appropriately. We emphasise the crucial importance of maintaining PALM quality and posit that all laboratories in LMICs should participate in quality assurance and accreditation programmes. A potential role for public-private partnerships in filling PALM services gaps should also be investigated. Finally, to deliver these solutions and ensure equitable access to essential services in LMICs, we propose a PALM package focused on these countries, integrated within a nationally tiered laboratory system, as part of an overarching national laboratory strategic plan.

CIA, MoSSAD, NKGB and SURETE in medical research: The RAW truth.

Background: We aimed to categorize the types of productivity among published scientists and correlate them with the Nobel Prize. Data source: Nobel Foundation website ( www.nobelprize.org/nobel_organizations/nobelfoundation/) and PubMed database. Inclusion criteria: Scientists born from 1867, the year in which Alfred Nobel patented dynamite to accumulate his fortune, which in turn led to the establishment of Nobel's famous will in 1895. Design: Retrospective analysis of the Nobel awards since 1901. Results: We propose an eponymous formulation called Pai-Kan Footprints (PKF) each with an alphabet tag of a recognized gumshoe agency.

Geographic eponyms: A history of geography in medicine.

Geographic eponyms have commonly been used in medical terminology, with diseases and medical entities being named after the place where the condition was discovered (e.g. Bombay Blood group) or invented (Jaipur Foot) or where the disease was first detected (Rocky Mountain Spotted fever) or where a consensus meeting has been held (Banff) or for other reasons (Argentina flag, Congo red stain). In 2015, the WHO decided to adopt a politically correct method to name infectious diseases in the future. We illustrate, in verse form, some of the places that have been used in medical terminology, over the centuries. An accompanying essay explains the specific reasons for the selection of these locales in our vocabulary.

Gastrointestinal ALκ amyloidosis presenting as protein-losing enteropathy correctly diagnosed by immunohistochemistry using amyloid-type-specific antibodies.

A 54-year-old man presented with protein-losing enteropathy. Biopsies from the stomach, duodenum, ileum and colon showed deposits of amyloid. The bone marrow showed plasmacytosis. After an initial misdiagnosis of AA amyloid, a revised diagnosis of ALκ amyloidosis was made at an expert referral laboratory. Care must be taken in the use of antibodies and proper controls in the performance and interpretation of immunohistochemistry for amyloidosis. A wide panel of amyloid-type-specific antibodies must be used and interpreted in comparative mode to avoid misdiagnosis.

Nonneoplastic pathology of the appendix: A review article, based on the recent literature.

OBJECTIVES: The appendix, although considered a vestigial organ, is of considerable clinical importance because acute appendicitis is a common medical problem. There are also other disease processes involving the appendix. The appendix is among the first specimens that the pathologist (and surgeon) cuts one's teeth on. Thus, there may be a tendency to underestimate the clinically and prognostically significant appendiceal pathologies. METHODS: We provide a vade mecum of the pathologic features of a wide range of nonneoplastic appendiceal pathologies, with an emphasis on developing a practical approach to grossing, microscopy, and reporting-all with clinical and therapeutic implications. Much of this is based on literature on MEDLINE with reference to years 2008 to 2023, as well as on personal experiences and interpretations. RESULTS: The appendix can harbor a myriad of nonneoplastic pathologies, including infections, inflammations of varying etiologies (including interval appendectomy), endometriosis, diverticulosis, and so on. Chronic appendicitis, Crohn disease, and clinical audit are recurring themes while COVID-19 is a new entity. CONCLUSIONS: Most importantly, all pathologists should appreciate that the appendix is not as "routine" a specimen as one would want to believe.

Are surgeons spunkier than non-surgeons?

BACKGROUND: Surgeons are known to be bolder than other members of the medical profession. Testosterone levels are known to be higher in aggressive men. We wondered whether the above two statements indicated that the spunkiness of surgeons was related to higher testosterone levels. METHODS: Sixteen surgeons and 16 non-surgeons, all men, aged 32-59 years took part in a prospective study that assessed their testosterone levels. RESULTS: There was no statistical difference between the testosterone levels of the two groups. CONCLUSION: The reason for the gutsy behaviour of surgeons is not linked to their testosterone levels. Surgeons were disappointed to know this while non-surgeons were amused and a bit relieved.

Quality metrics in academia: time to revisit the rules?

Publication and citation metrics have been used for many years now as apparently objective parameters to evaluate educational institutions as well as individual researchers. A recent report in Science, about the Saveetha Institute of Medical and Technical Sciences (SIMATS), near Chennai, Tamil Nadu [1], highlights concerns about the value and limitations of such metrics in evaluating the importance of research publications, authors, journals and institutions.

Lacunae in Laboratory Medicine Services and in Pathology Education in Medical Schools in India.

CONTEXT.­: Laboratories of many medical college hospitals in India do not offer important diagnostic tests, most of which are routine in the West. This detracts from the service as well as the educational function of the college. OBJECTIVES.­: To provide the background to pathology and laboratory medicine services and education in India, and to create a questionnaire that will put the lack of tertiary care laboratory services in perspective. This article will help illustrate the lacunae in laboratory medicine services and in the education of students. For this, we present information on the health services and pathology education facilities in India. We propose a questionnaire comprising 30 questions in various disciplines in pathology and laboratory medicine. These questions will help administrators and bureaucrats evaluate the status of the laboratories with respect to the services provided. DATA SOURCES.­: Sources include Web sites of the government of India, including that of the National Accreditation Board for Testing and Calibration Laboratories; indexed medical journal articles; and standard books and white papers on health care in India. We also used our personal experiences and interpretations of the laboratory and medical education sector in India. CONCLUSIONS.­: Medical colleges in India need to offer specialized diagnostic services if they are to achieve the targets of universal health care as well as turning out competent doctors. The agencies responsible for health care in India should use the questionnaire as a first step toward improving laboratory services. Other low- and middle-income countries should also adopt this method.

Chatbots, generative AI, and scholarly manuscripts: WAME recommendations on chatbots and generative artificial intelligence in relation to scholarly publications.

This statement revises our earlier "WAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications" (January 20, 2023). The revision reflects the proliferation of chatbots and their expanding use in scholarly publishing over the last few months, as well as emerging concerns regarding lack of authenticity of content when using chatbots. These recommendations are intended to inform editors and help them develop policies for the use of chatbots in papers published in their journals. They aim to help authors and reviewers understand how best to attribute the use of chatbots in their work and to address the need for all journal editors to have access to manuscript screening tools. In this rapidly evolving field, we will continue to modify these recommendations as the software and its applications develop.

Esta declaración revisa las anteriores "Recomendaciones de WAME sobre ChatGPT y Chatbots en Relation to Scholarly Publications" (20 de enero de 2023). La revisión refleja la proliferación de chatbots y su creciente uso en las publicaciones académicas en los últimos meses, así como la preocupación por la falta de autenticidad de los contenidos cuando se utilizan chatbots. Estas recomendaciones pretenden informar a los editores y ayudarles a desarrollar políticas para el uso de chatbots en los artículos sometidos en sus revistas. Su objetivo es ayudar a autores y revisores a entender cuál es la mejor manera de atribuir el uso de chatbots en su trabajo y a la necesidad de que todos los editores de revistas tengan acceso a herramientas de selección de manuscritos. En este campo en rápida evolución, seguiremos modificando estas recomendaciones a medida que se desarrollen el software y sus aplicaciones.

Vitamin B12 deficiency in India: mean corpuscular volume is an unreliable screening parameter.

BACKGROUND: Vitamin B12 deficiency is thought to be more common than was previously believed, but there are little data from India on this. It has protean clinical manifestations, and raised mean corpuscular volume (MCV) is commonly used by physicians as an indicator for megaloblastic anaemia caused by vitamin B12 deficiency. We evaluated the clinical profiles of our patients with vitamin B12 deficiency and tried to ascertain how useful MCV and the peripheral smear were in diagnosis. METHODS: We evaluated the clinical picture, haematology indices and peripheral smear findings of 117 patients with low vitamin B12 levels. Serum folic acid, ferritin values and biopsy findings of some patients were also assessed. RESULTS: Patients were commonly detected to have reduced levels of serum vitamin B12 during the work-up for anaemia (n=45) or for neurological symptoms (n=31). Of the 94 cases in which smears were examined, 26 showed macrocytes and hypersegmented neutrophils were present in 24. Twentysix patients showed a raised MCV, 50 patients had an MCV within the reference range and 28 had low MCV. Pancytopenia was present in 5 patients. Concomitant iron deficiency, as judged by serum ferritin levels, was present in 18 patients. CONCLUSION: Vitamin B12 deficiency is not uncommon in India. It is often diagnosed during the work-up for a haematological disorder or for neurological symptoms. MCV is unreliable as a screening parameter for the presumed diagnosis of macrocytic anaemia, which is associated with vitamin B12 deficiency.

Report of a Case With Clinical and Pathologic Features of Castleman Disease That Predates Castleman's Report by More Than 50 Years.

CONTEXT.­: In 1954, Benjamin Castleman, MD, described what was then believed to be a new entity in lymph node pathology. Initially labeled "Hyperplasia of the mediastinal node" and then "Localized mediastinal lymph node hyperplasia resembling thymoma," we now recognize the condition with the eponym "Castleman disease." We document a paper that describes the same condition, a half century before Castleman did. OBJECTIVE.­: To report the striking resemblance between Castleman disease and the lymph node reported in the paper published by Edwin R. LeCount, MD, titled "Lymphoma, a benign tumor representing a lymph gland in structure," published in Journal of Experimental Medicine in 1899. We also provide an overview of the remarkable achievements of LeCount. DESIGN.­: We compared the elucidation in the original paper by LeCount with the morphologic details in the papers published by Castleman et al. Material on the life of LeCount was compiled from the scientific literature, the Internet, and the files of the University of Chicago. RESULTS.­: LeCount's description and illustrations of the lymph node are uncannily similar to the onion-skinning and vascularity that Castleman documented. CONCLUSIONS.­: LeCount deserves credit for his depiction of a hitherto-unreported entity.