Clinical Pathology Puns

It's been a while since I weighed in on anything related to SARS-CoV-2/COVID. I see many posts describing the 'on the ground' impact of the Delta variant with desperate pleas for people to get vaccinated and wear masks. I couldn't agree more with these sentiments, but I will take a bit of a different educational approach. I am in a unique position to report on what is going on with the virus itself and how it interacts with the vaccines. I'm currently the Special Assistant to the National Director of Pathology and Lab Medicine for the entire VA system, with a specific role in advising on elements of COVID testing for the system. As such, I have a front row seat to all of the latest data, as we have to use those data in making our national policy decisions. So, here are a few important points about the Delta variant that may be of acute interest along with some education and salient points about the vaccines. I'll do my best to stitch this all together to where it makes some sense:

1. The Delta variant (lineage B.1.617.2) has a particular collection of mutations in the spike protein (that knob-like projection you see in renderings of the virus) that make it extremely effective in attaching to human cells and gaining entry. If the original CoV-2 strains were covered in syrup, this variant is covered in ultra-fast drying Gorilla Super Glue (industrial strength).

2. There are two recent publications which demonstrate that the viral loads in the back of the throats of infected patients are 1000X higher with Delta variant than with previous variants. I can tell you from data in my own labs, that is absolutely true! We are seeing viral signals we NEVER saw last year using the exact same assays.

3. This much higher load PLUS the ultra-'stickiness' of the Delta strains for adhering to human cells makes it remarkably more infectious than previous strains. You may have heard of R0 (Read: R naught) which is, in a nutshell, the expected number of persons to which an infected person would be expected to transmit the virus. Early versions of the virus had a 2 to 2.5 R0 value. So one infected person would infect two or so people on average. Delta has an R0 of about 8! In the infectious disease world, that's almost unheard of. Chickenpox and Measles are about all we have ever seen that spread that efficiently from human to human. This changes the story line completely from earlier in the pandemic and makes this surge, in many ways, like a completel

I am really interested into cytology these days Also i need good pathology book to clear and revise me concept I would appreciate your help Thank you in advance😇

Hi guys! I just had a simple question about the field. I’m a junior in college and filling out applications next summer. I have thought about specializing.

I was just wondering, do pathologists still see live patients? Or do they just get slides/biopsies/necropsies? I’d still like to see live patients, but I’m not sure if that’s typical or if it just depends on the workplace. Thanks!!

Random question. One of my pathology mentors told me that when he trained pathology still required an intern year in a clinical specialty. Why was this requirement removed? It seems that there are some subspecialties that can still include some patient interaction (i.e., transfusion med with aphoresis clinics, cytopath with FNA clinics, hemepath with BM biopsies). Diagnostic radiology still requires an intern year and seems comparable in my (not yet in clerkships) mind. Any insight is appreciated!

Hello! I'm a med student interested in going into Clinical Pathology! Was wondering what resources the residents in the CP-only programs like to use in their studies? Any specific Qbanks or comprehensive textbooks? Any good resources to review before starting residency? Any and all study advice would be much appreciated!

Hey all, what books or other resources do you recommend for studying pathology in a holistic context? I'm working towards becoming a clinical herbalist registered through the American Herbalists Guild, and am hoping to find a resource that describes pathology in a modern day context, addressing the socioeconomic and environmental connections with human pathology. Thanks in advance!

A 70 year old female with jaundice and a head mass of the pancreas. Surgery with biopsy was performed.

What is your diagnosis?

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Hi there, I'm a nontrad M4. My undergrad major was chemistry (graduated with honors from a respected US university) but decided to pursue medicine instead of a PhD because I liked the practicality of it vs going down an esoteric rabbit hole with academic chemistry research. Also worked with too many perpetual post-docs and wasn't a fan of the difficulties of securing an academic position. Still have always been drawn to the research side of medicine, which was how I found pathology. Now considering the fellowships in the post title and thinking that they would be a great synthesis of my interests, but I'm wondering if the same job scarcity applies or if MDs (or MD/PhDs) have more doors open. I'm open to industry as well as academia. Have a family and would prefer to be efficient - prefer not to get PhD, considering CP only track, but I've read some other threads about CP-only vs AP/CP and I'm aware of the disadvantages. Not opposed to doing traditional AP/CP with 1-2 years fellowship and not dead set on these specialties, just wondering if by considering a career in clinical chemistry/chemical path I'm setting myself up for a lot of nail biting with job searches and salary.

Is it an important factor?

Is the Masters of Clinical Pathology (coursework) something that is worth doing? I'm kind of interested, but not sure what it can lead me to.

Hi all!

I am an incoming pathology resident who have decided to pursue forensic pathology. I've had experience with the specialty through an elective rotation so I know the typical duties and responsibilities. However, I was doing some research the other day and stumbled across some websites that mention clinical forensic pathologists who can examine living patients too in cases of abuse, rape or neglect. This sounds really appealing to me and it'll be great to be taking on the usual FP cases and examining living patients as well, and in a sense dealing with the full spectrum of life and death. Are there any FPs out there doing this and if so how do you get there? Any insights on who or where I should contact to figure out more?

Thank you!!

I'm just looking for a good book that will help with the USMLE

I was wondering if you all had any unique perspectives on the patient impact of pathology.

University of Colorado Department of Otolaryngology–Head & Neck Surgery is pleased to announce an opening for our 2021/2022 Speech-Language Pathology Clinical Fellowship

The CU Department of Otolaryngology Clinical Fellowship is led by an inter-professional team that includes voice-specialized speech language pathologists, a dysphagia-specialized speech language pathologist, three fellowship-trained laryngologists and two fellowship-trained head and neck surgeons. The entire field of voice, airway and swallow-related pathology is addressed in this fellowship with the benefit of utilizing state-of-the-art equipment and techniques. This program aims to provide fellows with an excellent exposure to the full spectrum of voice, airway and swallowing disorders, and their medical and surgical management. Through bimonthly, interdisciplinary voice and swallow rounds, clinic-based teaching, and progressive responsibility in behavioral treatment of voice and swallowing disorders, the fellows receive a well-balanced academic experience. Each fellow will learn to hone their teaching skills by participating in the training of medical students and residents when appropriate, and by participating in resident didactics.

More information here: https://medschool.cuanschutz.edu/otolaryngology/education/slp-fellowship

Apply here: https://cu.taleo.net/careersection/2/jobdetail.ftl?job=19512

45-year-old female with a 3.5 cm breast nodule. larger diameter, mobile, not very painful, ultrasound BIRADS 4. Resection was performed.

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71-year-old male with ultrasound diagnosis of cholelithiasis, without other data. Cholecystectomy was performed.

What is your diagnosis?

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48 year old female with non-palpable mammary nodule, BIRADS 4B microcalcification mammography. A biopsy was performed.

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25-year-old female, obese, with abdominal pain in the right upper quadrant. Cholecystectomy was performed.

What is your diagnosis?

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A 50 year old male with a 3 cm tumor nodule diameter located on the lateral aspect of the left neck, adjacent to a medium-sized vessel. Tumor resection was performed. DIAGNOSIS?

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4 years old female with bleeding polypoid lesion in the rectum. The lesion was excised. What is your diagnosis and histopathological criteria?

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16 year old male with multiple polypoid lesions in the stomach and small intestine. Polypectomy was performed. What is the diagnosis and histopathological criteria?

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