RESUMO
BACKGROUND: Electron microscopy (EM), once an important component in diagnosing pediatric diseases, has experienced a decline in its use. To assess the impact of this, pediatric pathology practices were surveyed regarding EM services. METHODS: The Society of Pediatric Pathology Practice Committee surveyed 113 society members from 74 hospitals. Settings included 36 academic tertiary, 32 free-standing children's, and 6 community hospitals. RESULTS: Over 60% maintained in-house EM services and had more than 2 pathologists interpreting EM while reporting a shortage of EM technologists. Freestanding children's hospitals had the most specimens (100-200 per year) and more diverse specimen types. Hospitals with fewer than 50 yearly specimens often used reference laboratories. Seventeen had terminated all in-house EM services. Challenges included decreasing caseloads due to alternative diagnostic methods, high operating costs, and shortages of EM technologists and EM-proficient pathologists. Kidney, liver, cilia, heart, and muscle biopsies most often required EM. Lung/bronchoalveolar lavage, tumor, skin, gastrointestinal, nerve, platelet, and autopsy samples less commonly needed EM. CONCLUSIONS: The survey revealed challenges in maintaining EM services but demonstrated its sustained value in pediatric pathology. Pediatric pathologists may need to address the centralization of services and training to preserve EM diagnostic proficiency among pathologists who perform ultrastructural interpretations.
RESUMO
Skin of color refers to individuals whose skin color ranges from very light beige to very dark brown. Anthropologists and sociologists have previously recognized the importance of an objective classification of skin color for individuals with skin of color that does not include race and ethnicity. Since 1975, dermatologists have used the Fitzpatrick classification of sun-reactive skin types to categorize patients with skin of color; this classification was established for psoriasis patients participating in using oral methoxsalen and phototherapy clinical trial to determine the initial ultraviolet A dose. The Fitzpatrick classification merely classifies individuals as white, brown, and black; the individuals with white skin are further divided into four groups based on their burning or tanning capacity. This classification system does not provide reliable information with regard to the risk of skin cancer for individuals with darker skin color and does not aid in the evaluation of medical conditions with cutaneous involvement or assessment of appropriate cosmetic interventions for aesthetic management. Many clinicians, including forensic pathologists, incorporate the patient's race or ethnicity in their medical evaluation to describe the individual's skin color. Established scales for skin of color either include white skin color, or include 10 or more color types, or include both. We introduce a simple and rapidly performed scale that is not based on race or ethnicity to categorize persons with skin of color. The colorimetric scale ranges from very light beige to very dark brown and does not include white skin. The scale has five colors ranging from lightest (skin color type 1) to darkest (skin color type 5): very light beige (skin color type 1), light brown (skin color type 2), medium brown (skin color type 3), dark brown (skin color type 4), and very dark brown (skin color type 5); an individual with white skin would have a skin color type 0 in this classification of patient skin color. In conclusion, a scale that is not based on race or ethnicity is useful for categorizing individuals with skin of color not only for sociologists but also for clinicians who treat these patients. This colorimetric scale will be helpful for dermatologists to categorize persons with skin of color to predict their risk for developing skin cancer and to assessing appropriate cosmetic procedures and devices for these patients. In addition, the colorimetric scale will be useful for not only forensic pathologists but also other clinicians to provide a non-racial and non-ethnic designation of skin color type for their patients.