We report the case of a 33-week-old female fetus born with craniorachischisis to a gravida 5, para 4 (3104) mother with no previous history of conceiving a child with a neural tube defect. Craniorachischisis is characterized by anencephaly and an open defect extending from the brain to the spine and is the most severe and fatal type of neural tube defect. Although the cause of neural tube defects is hypothesized to be multifactorial and is usually sporadic, the risk is increased in neonates born to mothers with a family history or a previous pregnancy with neural tube defect, both of which are not present in the index case. This case is unique in that only during the fifth pregnancy did the couple conceive a child with a neural tube defect, emphasizing that folic acid supplementation, the sole preventive measure proven to decrease the risk of neural tube defects, remains to be important in the periconceptual period for all women of childbearing age.
Autopsy ; Congenital Abnormalities ; Neural Tube Defects ; Neural Tube Defects

Operations research (OR) is a valuable yet underutilized field in clinical laboratory management, offering practical solutions to optimize workflows, resource allocation, and decision-making. Despite its potential, the adoption of OR methodologies remain limited due to a lack of training and familiarity among pathologists and laboratory professionals. This paper addresses this gap by presenting an accessible introduction and practical guide to analyzing operations research problems in clinical laboratories using computer-assisted simulations in R, implemented within the R Studio environment.

The proposed framework emphasizes simplicity and flexibility, leveraging the extensive capabilities of base R to model and analyze critical OR questions. The paper outlines step-by-step methods for defining problems, constructing simulation models, and interpreting results, ensuring that readers can replicate and adapt these techniques to their unique laboratory contexts.

Key features of the framework include its emphasis on reproducibility, customization, and the integration of data-driven insights into decision-making processes. Case studies and examples drawn from real-world laboratory scenarios illustrate the application of R simulations to address challenges such as minimizing turnaround times, balancing staffing levels, and managing inventory efficiently.

This guide aims to empower laboratory professionals and pathologists with the tools and skills to integrate operations research into their practice, fostering a culture of innovation and efficiency in clinical settings. By bridging the gap between OR theory and practical application, this paper contributes to the broader adoption of computational approaches in laboratory management, ultimately enhancing the quality and sustainability of healthcare services.

Neoplasms of the urachus are uncommon, consisting of only 0.17% of all bladder malignancy. Mucinous cystic tumor of low malignant potential (MCLTMP) is a rare subtype with only 26 cases reported in the literature as of 2023. These tumors may present in a variety of ways such as hematuria, mucusuria, lower abdominal pain and irritative lower urinary tract symptoms. This is a case of 43-year-old female presenting at the emergency room for abdominal pain initially managed as a case of ovarian new growth in complication who underwent exploratory laparotomy, adhesiolysis, bilateral salpingectomy, partial cystectomy enbloc removal of urachal with anterior peritonectomy and excision of umbilicus. Histopathologic examination revealed mucinous cystic tumor of low malignant potential (MCLTMP) of the urachus. It is important to consider the possibility of a ruptured urachal cyst in a female patient who presents with hypogastric abdominal pain. A transabdominal and transvaginal ultrasound may lead to an incorrect diagnosis. In such cases where the patient presented with an acute abdomen, knowledge that a ruptured urachal cyst maybe a differential for such masses would lead to a strategic laparotomy incision aimed at a possible en-bloc removal of the umbilicus while maintaining the connections of the possible urachal mass to the urinary bladder.