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Pathak GN, Pathak AN, Mital V, Dhillon J, Feldman SR, Rao BK. Vitiligo outpatient management in the United States: findings from the 2012-2019 National Ambulatory Medical care Survey (NAMCS). J DERMATOL TREAT 2024; 35:2311793. [PMID: 38342494 DOI: 10.1080/09546634.2024.2311793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2024]
Affiliation(s)
- Gaurav N Pathak
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Anurag N Pathak
- Department of Computer Science, Rutgers University School of Arts and Sciences, New Brunswick, New Jersey
| | - Vibha Mital
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Jimmy Dhillon
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
| | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
- Department of Dermatology, Rao Dermatology, Atlantic Highlands, New Jersey
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Kansal A, Latour JM, See KC, Rai S, Cecconi M, Britto C, Conway Morris A, Dominic Savio R, Nadkarni VM, Rao BK, Mishra R. Correction to: Interventions to promote cost-effectiveness in adult intensive care units: consensus statement and considerations for best practice from a multidisciplinary and multinational eDelphi study. Crit Care 2024; 28:121. [PMID: 38610027 PMCID: PMC11015536 DOI: 10.1186/s13054-024-04888-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Affiliation(s)
- Amit Kansal
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, Jurong Health Campus, National University Health System, Singapore, Singapore.
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kay Choong See
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Sumeet Rai
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Carl Britto
- Division of Critical Care, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, USA
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
- John V Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Vinay M Nadkarni
- Department of Anesthesiology, Critical Care, and Pediatrics at the Children's Hospital of Philadelphia (CHOP), University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - B K Rao
- Department of Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
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Farabi B, Atak MF, Harris U, Kahn J, Khan S, Fink V, Hartmann D, Rao BK, Jain M. Ex vivo confocal microscopy features of common benign lesions that mimic non-melanoma skin cancers: Towards clinical integration. J Biophotonics 2024; 17:e202300386. [PMID: 38200691 DOI: 10.1002/jbio.202300386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
Ex vivo confocal microscope (EVCM) rapidly images freshly excised tissue at a histopathological resolution. EVCM features of keratinocyte skin cancers are well-established, but those of benign clinical mimickers remain scarce. We describe EVCM features of common benign lesions and compare them with their malignant differentials. EVCM was used to image 14 benign and 3 cancer tissues. We compared EVCM features of benign lesions with corresponding histopathology and with those of keratinocyte cancers. Key features of benign lesions were identified and differentiated from malignant lesions. Elastin and fat appeared prominent in EVCM; while koilocytes and melanin were difficult to identify. Visualization of entire epidermis was challenging due to difficulty of tissue flattening during imaging. Benign lesions can be differentiated from keratinocyte cancers with EVCM. Using EVCM, a rapid, bedside diagnosis and management of skin neoplasms is possible, especially in a remote location without a histopathology lab.
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Affiliation(s)
- Banu Farabi
- New York Medical College, Valhalla, New York, USA
- Dermatology Department, NYC Health + Hospital/Metropolitan, New York, New York, USA
- Dermatology Department, NYC Health + Hospital/South Brooklyn, Brooklyn, New York, USA
| | - Mehmet Fatih Atak
- New York Medical College, Valhalla, New York, USA
- Internal Medicine Department, NYC Health + Hospitals/Metropolitan, New York, New York, USA
| | - Ucalene Harris
- Dermatology Department, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Julia Kahn
- New York Medical College, Valhalla, New York, USA
| | - Samavia Khan
- Dermatology Department, Rutgers University, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, USA
| | - Veronica Fink
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Daniella Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Babar K Rao
- Dermatology Department, Rutgers University, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, USA
- Dermatology Department, Weil Cornell Medicine, New York, New York, USA
| | - Manu Jain
- Dermatology Department, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Dermatology Department, Weil Cornell Medicine, New York, New York, USA
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Truong TM, Pathak GN, Singal A, Taranto V, Rao BK. Deucravacitinib: The First FDA-Approved Oral TYK2 Inhibitor for Moderate to Severe Plaque Psoriasis. Ann Pharmacother 2024; 58:416-427. [PMID: 37341177 DOI: 10.1177/10600280231153863] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE The objective of this study was to review the safety and efficacy of deucravacitinib, a tyrosine kinase 2 (TYK2) inhibitor for moderate to severe plaque psoriasis. DATA SOURCES Literature was reviewed from MEDLINE and Clinicaltrials.gov up to December 2022 using the terms "deucravacitinib" and "BMS-986165." STUDY SELECTION Relevant articles in English relating to the pharmacodynamics, pharmacokinetics, efficacy, and safety of deucravacitinib were included. A total of 6 trial results were included. STUDY SELECTION AND DATA EXTRACTION Deucravacitinib showed clinical efficacy across all the phase II and III clinical trials. Excluding the long-term extension study, there were 2248 subjects across all studies, with 63.2% of patients receiving deucravacitinib 6 mg daily. Of these subjects, the average proportion achieving a PASI 75 (a reduction of greater than 75% in the Psoriasis Area and Severity Index) at week 16 was 65.1%. Patients receiving deucravacitinib 6 mg once daily had a higher rate of achieving both PASI 75 response and a Static Physician's Global Assessment (sPGA) score of 0 or 1, compared with oral apremilast 30 mg twice daily. The safety profile of deucravacitinib includes mild adverse events (AEs), most commonly nasopharyngitis, with serious AEs reported ranging from 1.35% to 9.5%. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON WITH EXISTING MEDICATIONS While many available therapies for moderate to severe plaque psoriasis rely on an injectable dosage form or extensive monitoring, deucravacitinib can potentially reduce patient medication-related burden. This review summarizes the efficacy and safety of oral deucravacitinib for the treatment of severe plaque psoriasis. CONCLUSION Deucravacitinib shows a consistent efficacy and safety profile as the first oral TYK2 inhibitor approved for adult patients with moderate to severe plaque psoriasis who are eligible for systemic therapy or phototherapy treatment.
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Affiliation(s)
- Thu Minh Truong
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
- School of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gaurav N Pathak
- School of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Amit Singal
- School of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
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Alomary SA, Mackenzie E, Khan S, Rao BK. Mobile apps in dermatology: Bridging innovation and care. Skin Res Technol 2024; 30:e13640. [PMID: 38424722 PMCID: PMC10904765 DOI: 10.1111/srt.13640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Simona A. Alomary
- Department of DermatologyRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | - Elyse Mackenzie
- Department of DermatologyRutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Samavia Khan
- Department of DermatologyRutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Babar K. Rao
- Department of DermatologyRutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
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Pathak GN, Chandy RJ, Pathak SS, Rao BK, Feldman SR. Comorbidities of psoriasis in underrepresented patient populations: An All of Us database analysis. J Am Acad Dermatol 2024; 90:e80-e82. [PMID: 37806530 DOI: 10.1016/j.jaad.2023.08.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Gaurav N Pathak
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey; Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
| | - Rithi J Chandy
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey; Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Suraj S Pathak
- Department of Computer Science, Manning College of Information and Computer Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey; Department of Dermatology, Rao Dermatology, Atlantic Highlands, New Jersey
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Department of Dermatology, University of Southern Denmark, Odense, Denmark
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Pathak GN, Truong TM, Singal A, Taranto V, Rao BK, Jacobsen AA. From the Cochrane Library: Systemic Interventions for Steven-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), and SJS/TEN Overlap Syndrome. JMIR Dermatol 2024; 7:e46580. [PMID: 38289652 PMCID: PMC10865192 DOI: 10.2196/46580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 09/20/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Gaurav Nitin Pathak
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, United States
| | - Thu Minh Truong
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, United States
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Amit Singal
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Viktoria Taranto
- Department of Dermatology, New York Institute of Technology, Glenhead, NY, United States
| | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, United States
- Department of Dermatology, Rao Dermatology, Atlantic Highlands, NJ, United States
| | - Audrey A Jacobsen
- Department of Dermatology, Hennepin Healthcare, Minneapolis, MN, United States
- Department of Dermatology, University of Minnesota, Minneapolis, MN, United States
- Department of Dermatology, Veterans Affairs Medical Center, Minneapolis, MN, United States
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Pathak GN, Pathak SS, Truong TM, Tan IJ, Rao BK. Pyoderma gangrenosum in underrepresented patient populations: An All of Us database analysis. Int Wound J 2024; 21:e14388. [PMID: 37699866 PMCID: PMC10784621 DOI: 10.1111/iwj.14388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023] Open
Affiliation(s)
- Gaurav N. Pathak
- Department of DermatologyRutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Suraj S. Pathak
- Manning College of Information and Computer Sciences, University of MassachusettsAmherstMassachusettsUSA
| | - Thu M. Truong
- Department of DermatologyRutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
- Department of DermatologyRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | - Isabella J. Tan
- Department of DermatologyRutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Babar K. Rao
- Department of DermatologyRutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
- Department of DermatologyRao DermatologyAtlantic HighlandsNew JerseyUSA
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Kansal A, Latour JM, See KC, Rai S, Cecconi M, Britto C, Conway Morris A, Dominic Savio R, Nadkarni VM, Rao BK, Mishra R. Interventions to promote cost-effectiveness in adult intensive care units: consensus statement and considerations for best practice from a multidisciplinary and multinational eDelphi study. Crit Care 2023; 27:487. [PMID: 38082302 PMCID: PMC10712165 DOI: 10.1186/s13054-023-04766-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND There is limited evidence to guide interventions that promote cost-effectiveness in adult intensive care units (ICU). The aim of this consensus statement is to identify globally applicable interventions for best ICU practice and provide guidance for judicious use of resources. METHODS A three-round modified online Delphi process, using a web-based platform, sought consensus from 61 multidisciplinary ICU experts (physicians, nurses, allied health, administrators) from 21 countries. Round 1 was qualitative to ascertain opinions on cost-effectiveness criteria based on four key domains of high-value healthcare (foundational elements; infrastructure fundamentals; care delivery priorities; reliability and feedback). Round 2 was qualitative and quantitative, while round 3 was quantitative to reiterate and establish criteria. Both rounds 2 and 3 utilized a five-point Likert scale for voting. Consensus was considered when > 70% of the experts voted for a proposed intervention. Thereafter, the steering committee endorsed interventions that were identified as 'critical' by more than 50% of steering committee members. These interventions and experts' comments were summarized as final considerations for best practice. RESULTS At the conclusion of round 3, consensus was obtained on 50 best practice considerations for cost-effectiveness in adult ICU. Finally, the steering committee endorsed 9 'critical' best practice considerations. This included adoption of a multidisciplinary ICU model of care, focus on staff training and competency assessment, ongoing quality audits, thus ensuring high quality of critical care services whether within or outside the four walls of ICUs, implementation of a dynamic staff roster, multidisciplinary approach to implementing end-of-life care, early mobilization and promoting international consensus efforts on the Green ICU concept. CONCLUSIONS This Delphi study with international experts resulted in 9 consensus statements and best practice considerations promoting cost-effectiveness in adult ICUs. Stakeholders (government bodies, professional societies) must lead the efforts to identify locally applicable specifics while working within these best practice considerations with the available resources.
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Affiliation(s)
- Amit Kansal
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, Jurong Health Campus, National University Health System, Singapore, Singapore.
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kay Choong See
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Sumeet Rai
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Carl Britto
- Division of Critical Care, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, USA
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
- John V Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Vinay M Nadkarni
- Department of Anesthesiology, Critical Care, and Pediatrics at the Children's Hospital of Philadelphia (CHOP), University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - B K Rao
- Department of Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
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Farabi B, Khan S, Jamgochian M, Atak MF, Jain M, Rao BK. The role of reflectance confocal microscopy in the diagnosis and management of pigmentary disorders: A review. J Cosmet Dermatol 2023; 22:3213-3222. [PMID: 37759421 DOI: 10.1111/jocd.15827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/04/2023] [Accepted: 05/06/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM) has quickly transitioned from a research tool to an adjunct diagnostic bedside tool, providing the opportunity for noninvasive evaluation of skin lesions with histologic resolution. RCM is an optical imaging technique that uses near-infrared excitation wavelengths and safe low-power lasers. En-face images of different skin layers (up to the superficial dermis) are acquired in grayscale based on the reflective indices of tissue components. Melanin has the highest reflective index (contrast) and appears bright on RCM. AIMS We present a review of the current literature on the use of RCM in the diagnosis and management of pigmentary disorders. METHODS We reviewed PubMed and Ovid Medline databases from January 2000 to June 2021, using MeSH key terms: "reflectance confocal microscopy, confocal laser scanning microscopy, pigmentary disorders, treatment, melasma, vitiligo, freckles, solar lentigo, lentigo, tattoo, complications, melanoma, skin cancers, pigmented lesions, post inflammatory, melanin, photoaging" to identify studies and review articles discussing the use of RCM in the diagnosis and management of pigmentary disorders. RESULTS RCM findings of pigmentary disorders were divided into the following categories: (1) disorders of increased pigmentation (post-inflammatory hyperpigmentation, melasma, Riehl's melanosis, solar lentigines, ephelides, hori nevus, naevus of Ota, café-au-lait macules, melanocytic nevus, melanoma, nevus spilus, labial mucosal melanosis, and mucosal melanoma), (2) disorders of decreased pigmentation or depigmentation (post-inflammatory hypopigmentation, vitiligo, nevus depigmentosus, halo nevus), and (3) exogenous pigmentation (tattoo, ochronosis). CONCLUSION RCM has been explored and proven valuable for the evaluation and management of pigmentary disorders including melasma, vitiligo, solar lentigines, tattoo, and tattoo-related complications.
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Affiliation(s)
- Banu Farabi
- Dermatology Department, New York Medical College/Metropolitan Hospital Center, New York, New York, USA
| | - Samavia Khan
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
- Rao Dermatology, Atlantic Highlands, New Jersey, USA
| | - Marielle Jamgochian
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
| | - Mehmet Fatih Atak
- Dermatology and Venerology Department, Ankara University School of Medicine, Ankara, Turkey
| | - Manu Jain
- Dermatology Department, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Babar K Rao
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
- Rao Dermatology, Atlantic Highlands, New Jersey, USA
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
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Fong S, Mahmood E, Sanabria B, Ouellette S, Rao BK. In Vivo Reflectance Confocal Microscopy Evaluation of Microneedle Patch Penetration Depth. J Drugs Dermatol 2023; 22:1107-1110. [PMID: 37943270 DOI: 10.36849/jdd.6994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND Firstly, confirm penetration of the skin's most exclusive layer, the stratum corneum (SC), by commercially available microneedle patches using reflectance confocal microscopy (RCM). Secondly, determine the deepest layer of the skin penetrated by the microneedle patches. MATERIALS AND METHODS In this proof-of-concept study, 3 commercially available dissolving microneedle patches with different active ingredients were included in this study. RCM images of the cheek were taken prior to patch application at 4 different layers of the skin: stratum corneum, stratum spinosum-granulosum, dermal-epidermal junction, and papillary dermis. Patches were then applied to the cheeks of participants according to manufacturer guidelines. Immediately after removal, the same area and layers were imaged using RCM and assessed for features of penetration. RESULTS Micropores were visualized in RCM images of skin layers post-application of all patches when compared with imaging before application. Characteristics of penetration included uniformly sized, shaped, and spaced well-defined circular areas, which are the created micropores. All 3 patches penetrated the SC to the level of the papillary dermis. CONCLUSION This study confirms that the dissolving microneedle patches penetrate the most exclusive layer of the skin, the SC, down to the level of the papillary dermis as visualized through RCM. Confirming penetration with RCM shows the potential of these patches to be used for medication transmission. While future studies are needed to assess the efficacy of microneedle patches applied for their advertised skin conditions, confirming the penetration of the microneedle technology through RCM is a significant first step in this process. J Drugs Dermatol. 2023;22(11):1107-1110 doi:10.36849/JDD.6994.
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Chandy RJ, Razi S, Rubin A, Fung MA, Rao BK. Non-invasive tools in the diagnosis of melanoma: Reflectance confocal microscopy and pigmented lesion assay. Skin Res Technol 2023; 29:e13476. [PMID: 37881060 PMCID: PMC10512205 DOI: 10.1111/srt.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Rithi J. Chandy
- Center for DermatologyRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Shazli Razi
- Department of Internal MedicineJersey Shore University Medical CenterNeptuneUSA
| | - Alexandra Rubin
- Center for DermatologyRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Maxwell A. Fung
- Department of DermatologyUniversity of California Davis School of MedicineSacramentoCaliforniaUSA
| | - Babar K. Rao
- Center for DermatologyRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
- Rao DermatologyAtlantic HighlandsUnited States
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Ghani H, Richards E, Truong TM, Rao BK, Zhang A. A Review of the Efficacy of Topical Statins for Treating Disseminated Superficial Actinic Porokeratosis. J Drugs Dermatol 2023; 22:1053-1057. [PMID: 37801522 DOI: 10.36849/jdd.7540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Porokeratosis is a rare group of acquired or hereditary dermatoses characterized by linear or annular plaques with a keratotic border. DSAP is the most common porokeratosis, and lesions range from asymptomatic to pruritic circular pink to brown macules, papules, or plaques surrounded by a raised border. DSAP carries about 7.5-10% risk of malignant transformation to SCC or BCC. While in the past DSAP has been widely treated with topical diclofenac, ingenol mebutate, topical vitamin D analog, 5-fluorouracil, imiquimod, photodynamic therapy, retinoids, cryotherapy, and laser therapy, these therapies have shown limited efficacy and have caused adverse effects including inflammatory reactions, hyperpigmentation, pain, and erythema. Recently, a formulation of topical statin and cholesterol has surfaced as a new and promising treatment for DSAP which has shown clinical improvement with a tolerable adverse effect profile when compared to the current therapies. Of the 8 case studies with a total of 20 patients with DSAP, 90% (18/20) reported clinical improvement with various forms of topical statin therapy. While promising, larger randomized controlled trials are needed to evaluate the long-term use of topical statins for DSAP. J Drugs Dermatol. 2023;22(10): doi:10.36849/JDD.7540.
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Saleem MA, Shah RR, Sharif S, Rana D, Waqas N, Rao BK. Comparing the Efficacy for Pulse Versus Continuous Dose Terbinafine Therapy in Patients With Onychomycosis. J Drugs Dermatol 2023; 22:1017-1020. [PMID: 37801521 DOI: 10.36849/jdd.7323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Recently, treatment outcomes in patients with toenail onychomycosis have improved considerably due to more effective oral antifungal medications such as terbinafine and itraconazole. These medications can either be used continuously for several weeks at a lower dose or intermittently (pulsed) at a higher dose. Previous literature comparing pulse and continuous therapy has generated mixed results. Our study aims to compare the efficacy, in terms of clinical cure rate, of continuous vs pulse dose terbinafine regimens for toenail onychomycosis. Sixty patients with onychomycosis of Fitzpatrick skin types IV to VI, between 15 and 65 years of age, were divided into a continuous treatment group receiving 250 mg terbinafine once daily for 12 weeks and a pulse treatment group receiving 250 mg twice daily terbinafine for 1 week repeated every 4 weeks for 12 weeks. Each patient was followed up at weeks 4, 8, and 12. Efficacy of the continuous treatment group was significantly greater at 76.67% compared with 26.67% in the pulse treatment group. Thus, we conclude that the clinical cure rate of a continuous dose regimen of terbinafine is a superior treatment option for toenail onychomycosis. However, we also suggest further studies including combinations of multiple agents and hybrid regimen models for the optimal onychomycosis treatment. J Drugs Dermatol. 2023;22(10): doi:10.36849/JDD.7323R1.
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Sanabria B, Berger LE, Mohd H, Benoit L, Truong TM, Michniak-Kohn BB, Rao BK. Clinical Efficacy of Topical Vitamin C on the Appearance of Wrinkles: A Systematic Literature Review. J Drugs Dermatol 2023; 22:898-904. [PMID: 37683066 DOI: 10.36849/jdd.7332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
PURPOSE A rise in market demand for anti-aging skin care products has resulted in a proliferation of cosmeceuticals, including products that contain vitamin C. Many topicals containing vitamin C claim to reduce the appearance of wrinkles. However, these claims have not been systematically evaluated. METHODS A systematic review of literature published between January 2015 and September 2022 was performed per PRISMA guidelines. Scopus, Web of Science, and PubMed were queried for records relevant using the following Medical Subject Heading (MeSH) terms: “Topical Vitamin C OR Ascorbic acid”, “Vitamin C efficacy”, “dermatology”, “cosmetology”, and “skin anti-aging”. Variables of interest included: study type, study location, study duration, sample size, patient description, type and ingredients of the topical formulation, outcome measurement, results, and adverse events. RESULTS After deduplication, consideration of inclusion and exclusion criteria, and title/abstract screening, 5,428 initial records were reduced to 7 articles, including 4 meeting Level IB criteria, one meeting Level IIA criteria, and 2 meeting Level IIB criteria. Methods for assessing clinical improvements included global photodamage score, skin topography assessment, reflectance confocal microscopy (RCM) skin analysis, Dynamical Atlas, and participant self-assessment. Conclusions: While 4 of the 7 studies met Level IB evidence, further high-quality, prospective, and comparative studies are indicated to better elucidate the role of topical vitamin C in wrinkle reduction. All the studies used vitamin C in combination with other ingredients or therapeutic mechanisms, thereby complicating any specific conclusions regarding the efficacy of vitamin C. Citation: Sanabria B, Berger LE, Mohd H, et al. Clinical efficacy of topical vitamin C on the appearance of wrinkles: a systematic literature review. J Drugs Dermatol. 2023;22(9):898-904. doi:10.36849/JDD.7332.
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16
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Razi S, Truong TM, Sekhon P, Ouellette S, Rao BK. Subacute cutaneous lupus erythematosus with a psoriasiform presentation: A diagnostic clinical conundrum. Clin Case Rep 2023; 11:e7893. [PMID: 37736481 PMCID: PMC10509344 DOI: 10.1002/ccr3.7893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/05/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023] Open
Abstract
Key Clinical Message For practitioners experiencing worsening psoriasis, subacute cutaneous lupus erythematosus (SCLE) with a psoriasiform presentation should be ruled out. Initial treatment for a presumptive diagnosis of psoriasis using hydroxychloroquine or ultraviolet phototherapy may cause SCLE to worsen. Abstract Psoriasiform subacute cutaneous lupus erythematosus is an unusual presentation scarcely reported in literature. We report a case of a 54-year-old man who presented with an itchy, papulosquamous rash of the upper extremities and face for 7 months. The initial physical examination revealed the classical morphology of psoriasis. One and a half years after the diagnosis of clinical worsening, the patient noticed a new papular eruption on the right posterior upper arm. A skin biopsy was performed, confirming a diagnosis of subacute cutaneous lupus erythematosus. This case report highlights the importance of considering rare presentations of cutaneous lupus erythematosus and therapeutic challenges in management.
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Affiliation(s)
- Shazli Razi
- Rao DermatologyAtlantic HighlandsNew JerseyUSA
- Department of Internal MedicineJersey Shore University Medical CenterNeptuneNew JerseyUSA
| | - Thu M. Truong
- Rao DermatologyAtlantic HighlandsNew JerseyUSA
- Center for DermatologyRutgers Robert Wood Johnson Medical SchoolSomersetNew JerseyUSA
- Department of MedicineRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | | | - Samantha Ouellette
- Rao DermatologyAtlantic HighlandsNew JerseyUSA
- Center for DermatologyRutgers Robert Wood Johnson Medical SchoolSomersetNew JerseyUSA
| | - Babar K. Rao
- Rao DermatologyAtlantic HighlandsNew JerseyUSA
- Center for DermatologyRutgers Robert Wood Johnson Medical SchoolSomersetNew JerseyUSA
- Department of DermatologyWeill Cornell MedicineNew YorkNew YorkUSA
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Affiliation(s)
- Thu M. Truong
- Rao Dermatology, Atlantic Highlands, New Jersey
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Gaurav N. Pathak
- Rao Dermatology, Atlantic Highlands, New Jersey
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Babar K. Rao
- Rao Dermatology, Atlantic Highlands, New Jersey
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Department of Dermatology, Weill Cornell Medicine, New York, New York
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18
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Affiliation(s)
- Gaurav N. Pathak
- Rao Dermatology, Atlantic Highlands, New Jersey
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Thu M. Truong
- Rao Dermatology, Atlantic Highlands, New Jersey
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Babar K. Rao
- Rao Dermatology, Atlantic Highlands, New Jersey
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
- Department of Dermatology, Weill Cornell Medicine, New York, New York
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19
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Noureen U, Shah RR, Waqas N, Sharif S, Shah A, Rao BK. Efficacy of Intralesional Vitamin D3 for Treatment of Verruca Vulgaris: A Randomized Control Study. J Clin Aesthet Dermatol 2023; 16:47-50. [PMID: 37636250 PMCID: PMC10452478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Cutaneous warts are benign epithelial lesions caused by human papillomavirus and are common entities, affecting nearly 10 percent of the United States population. While most warts spontaneously resolve, the immunocompromised are susceptible to recalcitrant warts which often require medical treatment. Most current therapies use either physical or chemical destruction for wart removal, but these treatments are associated with adverse effects. Intralesional vitamin D3 has the potential to demonstrate a stronger treatment response due to its ability to stimulate the immune system at the injection site via cell-mediated immunity. We sought to test the efficacy of intralesional vitamin D3 for wart treatment in a sample size of 70 patients over a three-month period. Efficacy was determined as "excellent" if there was greater than a 90-percent reduction in both size and number of lesions, "good" if there was a 60 to 89-percent reduction, and "fair" if there was less than a 60-percent reduction. Treatment efficacy was excellent in 20 (28.6%) patients, good in 29 (41.4%) patients, fair in 18 (25.7%) patients, and poor in three (4.3%) patients. Patients in the younger age group had a higher treatment efficacy compared to other treatment groups. Thus, intralesional vitamin D3 has promising qualities as a treatment for cutaneous warts and should be considered at the clinician's disposal. Vitamin D is an innovative approach for treating warts without the various side effects posed by other commonly used agents. The unique features of this treatment modality including its simplicity, safety, and efficiency make it a promising option for a very common cutaneous condition.
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Affiliation(s)
- Uzma Noureen
- Drs. Noureen, Waqas, and Sharif are with the Department of Dermatology at Rawalpindi Medical University in Rawalpindi, Pakistan
| | - Rohan R. Shah
- Mr. Rohan R. Shah and Mr. Amar Shah are with the Department of Dermatology at Rutgers New Jersey Medical School in New Brunswick, Jersey
| | - Nadia Waqas
- Drs. Noureen, Waqas, and Sharif are with the Department of Dermatology at Rawalpindi Medical University in Rawalpindi, Pakistan
| | - Shawana Sharif
- Drs. Noureen, Waqas, and Sharif are with the Department of Dermatology at Rawalpindi Medical University in Rawalpindi, Pakistan
| | - Amar Shah
- Mr. Rohan R. Shah and Mr. Amar Shah are with the Department of Dermatology at Rutgers New Jersey Medical School in New Brunswick, Jersey
| | - Babar K. Rao
- Dr. Rao is with the Department of Dermatology at Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey and the Department of Dermatology at Weill Cornell Medical School in New York, New York
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20
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Razi S, Ouellette S, Khan S, Oh KS, Truong TM, Rao BK. Role of VivaScope 2500 ex vivo confocal microscopy in skin pathology: Advantages, limitations, and future prospects. Skin Res Technol 2023; 29:e13388. [PMID: 37357649 PMCID: PMC10250963 DOI: 10.1111/srt.13388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/27/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Vivascope 2500 ex vivo confocal microscopy (EVCM) is an emerging optical imaging device that allows nuclear level resolution of freshly excised tissues. EVCM provides, rapid real-time pathological examination in many subspecialties of pathology including skin, prostate, breast, liver, etc. In contrast to traditional time-consuming frozen sectioning and histological analysis. AIMS To evaluate the current state of EVCM utilization. MATERIALS AND METHODS This study highlights the advantages, limitations, and prospects of EVCM in skin pathology. RESULTS Our findings demonstrate that EVCM is a promising adjunctive tool to assess margins in Mohs surgery and to provide rapid, accurate diagnosis of cutaneous tumors, infectious and inflammatory diseases. CONCLUSION EVCM is a revolutionary device that can be used as an adjunct to paraffin-fixed, hematoxylin and eosin-stained slides and frozen sectioning. Additional refinements are required before EVCM can be used as an alternative to frozen sectioning or traditional tissue processing.
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Affiliation(s)
- Shazli Razi
- Department of Dermatology and PathologyRao DermatologyNew YorkNew YorkUSA
| | - Samantha Ouellette
- Department of Dermatology and PathologyRao DermatologyNew YorkNew YorkUSA
- Center for Dermatology, Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNew JerseyUSA
| | - Samavia Khan
- Department of Dermatology and PathologyRao DermatologyNew YorkNew YorkUSA
- Center for Dermatology, Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNew JerseyUSA
| | - Kei Shing Oh
- Department of Pathology and Laboratory MedicineMount Sinai Medical CenterMiami BeachFloridaUSA
| | - Thu M. Truong
- Department of Dermatology and PathologyRao DermatologyNew YorkNew YorkUSA
- Center for Dermatology, Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNew JerseyUSA
- Department of MedicineRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | - Babar K. Rao
- Department of Dermatology and PathologyRao DermatologyNew YorkNew YorkUSA
- Center for Dermatology, Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNew JerseyUSA
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21
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Farabi B, Rao BK, Jain M. Identifying Pitfalls for Diagnosing Pigmented Bowen Disease on Reflectance Confocal Microscopy: Misleading Dendritic Cells. Dermatol Pract Concept 2023; 13:dpc.1301a30. [PMID: 36892388 PMCID: PMC9946061 DOI: 10.5826/dpc.1301a30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Banu Farabi
- Department of Dermatology, New York Medical College, Valhalla, New York, NY, USA
- Department of Dermatology, NYC Health + Hospitals/Metropolitan, New York, NY, USA
- Department of Dermatology, NYC Health + Hospitals/Coney Island, Brooklyn, NY, USA
| | - Babar K. Rao
- Department of Dermatology, Weil Cornell Medical School, NY, USA
| | - Manu Jain
- Department of Dermatology, Weil Cornell Medical School, NY, USA
- Dermatology Department, Memorial Sloan Kettering Cancer Center, NY, USA
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22
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Otto TS, Rubin A, Haroon A, Ashforth G, Rao BK. 35328 Morbidities associated with solitary keratoacanthomas. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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23
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Kumar A, Sabharwal P, Gupta P, Singh VK, Rao BK. Reply to Letter to the Editor: A Fatal Case of Acute Disseminated Encephalomyelitis—A Diagnosis to Ponder in Pandemic. Indian J Crit Care Med 2022; 26:1062. [PMID: 36213708 PMCID: PMC9492756 DOI: 10.5005/jp-journals-10071-24304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Kumar A, Sabharwal P, Gupta P, Singh VK, Rao BK. Reply to Letter to the Editor: A Fatal Case of Acute Disseminated Encephalomyelitis—A Diagnosis to Ponder in Pandemic. Indian J Crit Care Med 2022;26(9):1062.
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Affiliation(s)
- Amber Kumar
- Department of Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Pranshuta Sabharwal
- Department of Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Prasoon Gupta
- Department of Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
- Prasoon Gupta, Department of Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India, Phone: +91 9891571699, e-mail:
| | - Vinod Kumar Singh
- Department of Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - BK Rao
- Department of Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
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24
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Jinger D, Kumar R, Kakade V, Dinesh D, Singh G, Pande VC, Bhatnagar PR, Rao BK, Vishwakarma AK, Kumar D, Singhal V. Agroforestry for controlling soil erosion and enhancing system productivity in ravine lands of Western India under climate change scenario. Environ Monit Assess 2022; 194:267. [PMID: 35262801 DOI: 10.1007/s10661-022-09910-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
Soil erosion in semi-arid climate leading to the development of ravine lands is the most severe form of land degradation. Ravine lands are formed when soil is not fully covered by the vegetation throughout the year and sporadic vegetation is not able to bind the soil particles from being washed away by rainfall. Throughout the globe, ravine lands have severe limitations for their rehabilitation and sustainable utilization as a consequence of its unique topographical features. Climatic and edaphic stresses make crop production extremely challenging in these lands. Practicing sole cropping promotes erosion, produces low crop yield, utilizes high energy, and emits greenhouse gasses (GHGs). Tree cultivation either sole or in combination with crops (agroforestry) has a strong potential to control erosion, produce sustainable economic yield, reduce energy consumption, and sequester greater amount of atmospheric carbon dioxide in biomass and soil carbon pools besides providing various ecosystem services. Therefore, practicing agroforestry could be a promising approach to obtain the greater environmental and economic benefits in the ravine lands. The present study was conducted on three systems, i.e., sole crop cultivation (cowpea + castor), agroforestry (sapota + cowpea + castor), and sole sapota plantation, to evaluate their impact on soil erosion, runoff, system productivity, profitability, energetics, and carbon sequestration during the 4-year period (2017-2020). The results revealed that agroforestry reduced the total soil loss and runoff by 37.7% and 19.1%, respectively, compared to the sole crop cultivation. Likewise, the highest system productivity as cowpea equivalent yield (CEY) was obtained under agroforestry system that increased the CEY by 162% and 81.9%, compared to sole crop and sole tree plantation, respectively. The climate change mitigation potential in terms of net carbon balance was observed highest in sole tree plantation (8.4 t/ha) followed by agroforestry system (5.9 t/ha) and lowest in sole cropping system (-2.8 t/ha). Therefore, an agroforestry system could be recommended for controlling soil erosion, improving system productivity and profitability, and reducing energy consumption as well as mitigating climate change in ravine lands.
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Affiliation(s)
- Dinesh Jinger
- ICAR-Indian Institute of Soil and Water Conservation, Research Center, Vasad, 388306, Anand, Gujarat, India.
| | - Raj Kumar
- ICAR-Indian Institute of Soil and Water Conservation, Research Center, Vasad, 388306, Anand, Gujarat, India
- ICAR-Central Soil Salinity Research Institute, Karnal, 132001, Haryana, India
| | - Vijaysinha Kakade
- ICAR-Indian Institute of Soil and Water Conservation, Research Center, Vasad, 388306, Anand, Gujarat, India
- ICAR-National Institute of Abiotic Stress Management, Baramati, 413115, Pune, Maharashtra, India
| | - D Dinesh
- ICAR-Indian Institute of Soil and Water Conservation, Research Center, Vasad, 388306, Anand, Gujarat, India
| | - Gaurav Singh
- ICAR-Indian Institute of Soil and Water Conservation, Research Center, Vasad, 388306, Anand, Gujarat, India
| | - V C Pande
- ICAR-Indian Institute of Soil and Water Conservation, Research Center, Vasad, 388306, Anand, Gujarat, India
| | - P R Bhatnagar
- ICAR-Indian Institute of Soil and Water Conservation, Research Center, Vasad, 388306, Anand, Gujarat, India
- ICAR-Central Soil Salinity Research Institute, Karnal, 132001, Haryana, India
| | - B K Rao
- ICAR-Indian Institute of Soil and Water Conservation, Research Center, Vasad, 388306, Anand, Gujarat, India
- Water and Land Management Training and Research Institute, Hyderabad, 500030, Telangana, India
| | - A K Vishwakarma
- ICAR-Indian Institute of Soil and Water Conservation, Research Center, Vasad, 388306, Anand, Gujarat, India
- ICAR-Indian Institute of Soil Science, Bhopal, 462038, Madhya Pradesh, India
| | - Dinesh Kumar
- ICAR-Indian Institute of Soil and Water Conservation, Research Center, Datia, 475661, Madhya Pradesh, India
| | - Vibha Singhal
- ICAR-Indian Institute of Soil and Water Conservation, Dehradun, 248195, Uttarakhand, India
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25
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Rubin A, Haroon A, Rao BK, Firoz BF. Utility of Optical Imaging in a Patient With Recurrent, Multifocal Hydroxyurea-Associated Basal Cell Carcinoma. Dermatol Surg 2022; 48:155-156. [PMID: 34743120 DOI: 10.1097/dss.0000000000003279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Alexandra Rubin
- Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, Center for Dermatology, Somerset, New Jersey
- Rao Dermatology, Atlantic Highlands, New Jersey
| | | | - Babar K Rao
- Rao Dermatology, Atlantic Highlands, New Jersey
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26
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Farabi B, Jamgochian M, Rao BK. Multicentric Reticulohistiocytosis with Dermatomyositis-Like Features: A Case Report with Dermoscopy and Reflectance Confocal Microscopy Findings. J Cutan Pathol 2021; 49:388-392. [PMID: 34787922 DOI: 10.1111/cup.14170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 11/01/2021] [Accepted: 11/14/2021] [Indexed: 11/27/2022]
Abstract
Multicentric reticulohistiocytosis is an insidious-onset, non-Langerhans-cell histiocytosis affecting joints and skin. Early diagnosis is important to prevent destructive arthritis and disease-related complications. Reflectance confocal microscopy (RCM) is a technique that allows the visualization of the epidermis and superficial dermis non-invasively on a horizontal plane with quasi-histologic images of the skin. RCM features of non-Langerhans cell histiocytosis including Rosai-Dorfman disease, adult xanthogranuloma (AXG) and, juvenile xanthogranuloma (JXG) have been reported. However, RCM features of MRH have not previously been described. Herein, we present the RCM features of a case of MRH with dermoscopic and histopathologic features. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Banu Farabi
- Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ, USA
| | - Marielle Jamgochian
- Dermatology Department, Rutgers University, Robert Wood Johnson Medical Center, NJ, USA
| | - Babar K Rao
- Dermatology Department, Rutgers University, Robert Wood Johnson Medical Center, NJ, USA
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Atak MF, Farabi B, Kalelioglu MB, Rao BK. Pigmented purpuric dermatosis after BNT162B2 mRNA COVID-19 vaccine administration. J Cosmet Dermatol 2021; 21:435-437. [PMID: 34791786 PMCID: PMC8661805 DOI: 10.1111/jocd.14607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/22/2021] [Accepted: 11/01/2021] [Indexed: 01/15/2023]
Affiliation(s)
| | - Banu Farabi
- Internal Medicine Department, Saint Peter's University Hospital-Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | | | - Babar K Rao
- Dermatology Department, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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28
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Nawrocki S, Rubin A, Srivastava R, Chamorro P, Rao BK, Wassef CM. A case of dermatofibrosarcoma protuberans and reflectance confocal microscopy of a post-surgical skin graft. Skin Res Technol 2021; 28:365-367. [PMID: 34751469 PMCID: PMC9907619 DOI: 10.1111/srt.13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/16/2021] [Indexed: 11/30/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is an overall rare malignancy yet is one of the most common cutaneous sarcomas. The diagnosis of DFSP is typically made following histopathologic examination of the lesion, classically revealing a storiform pattern of spindle cells with elongated nuclei infiltrating the dermis and subcutis. Surgical excision is the standard treatment. Local recurrence is estimated to occur in 20-50% of cases, thus frequent postsurgical monitoring is required. Noninvasive imaging modalities offer a potential alternative to multiple repeat biopsies. We report the first case where reflectance confocal microscopy accompanied clinical examination in monitoring for DFSP recurrence postsurgical excision.
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Affiliation(s)
- Shiri Nawrocki
- Center for Dermatology, Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Alexandra Rubin
- Center for Dermatology, Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Radhika Srivastava
- Center for Dermatology, Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Paola Chamorro
- Center for Dermatology, Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Babar K Rao
- Center for Dermatology, Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Cindy M Wassef
- Center for Dermatology, Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
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29
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Farabi B, Seminario-Vidal L, Jamgochian M, Akay BN, Atak MF, Rao BK, Karagaiah P, Grabbe S, Goldust M. Updated review on prognostic factors in mycosis fungoides and new skin lymphoma trials. J Cosmet Dermatol 2021; 21:2742-2748. [PMID: 34687485 DOI: 10.1111/jocd.14528] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ten-year survival rates in mycosis fungoides (MF) broadly varies, however, there is no standardized prognostic index available. This is presumably due to low prevalence, heterogeneity, and diagnostic challenges in MF. Recent studies have focused on identifying objective prognostic indices by using different parameters for survival determinants. The Cutaneous Lymphoma International Prognostic Index (CLIPI) and the Prospective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) represent prototypical studies that identify prognostic factors, seeking to improve management and outcomes in early-stage MF. Detecting these factors and stratifying MF patients according to their disease progression risk may help to manage these patients more efficiently. AIMS Review the current literature to determine the risk factors determining prognosis in MF. METHODOLOGY A Comprehensive literature search was performed using electronic online databases "PubMed" and "Google Scholar" using key words 'prognostic factor', 'prognostic indicator', 'mycosis fungoides', 'Sezary syndrome', 'Skin Lymphoma', 'Cutaneous Lymphoma'. Articles published in English language were considered for the review. RESULTS The strongest prognostic factor in MF patients is the stage of the disease. T stage and the presence of extracutaneous disease are the most important factors for survival. Other factors that are associated with worse prognosis are male gender, age >60, presence of plaques, folliculotropism, eosinophilia and lymph node stage above N1/Nx. Elevated LDH was associated with later tumor stages and large cell phenotype at diagnosis had a better prognosis. KIR3DL2 was associated with malignant transformation. CONCLUSION The PROCLIPI study has assessed risk factors collected in MF patients from different countries and across different ethnicities following a rigorous clinicopathologic process. The findings presented here illustrated that disease prognosis in early stages depends on many contributing factors. Detection and stratification of such factors may allow a personalized approach to management of these patients.
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Affiliation(s)
- Banu Farabi
- Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey, USA
| | - Lucia Seminario-Vidal
- Department of Dermatology, Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, University of South Florida Health Morsani College of Medicine, Tampa, Florida, USA
| | - Marielle Jamgochian
- Department of Dermatology, Robert Wood Johnson Medical Center, Rutgers University, New Brunswick, New Jersey, USA
| | | | | | - Babar K Rao
- Dermatology Department, Weil Cornell Medicine, NY, Somerset, New Jersey, USA
| | - Priyanka Karagaiah
- Department of dermatology, Bangalore Medical College and Research Institute, Bangalore, India
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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Rubin A, Haroon A, Chuchvara N, Rao BK, Firoz BF. 25886 Recurrent basal cell carcinoma of the scalp in a patient on long-term hydroxyurea therapy. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Atak MF, Farabi B, Akbayrak A, Kalelioğlu MB, Rao BK. Acute generalized exanthematous pustulosis following treatment with favipiravir in a patient with COVID-19 without hydroxychloroquine use: Report of the first case. J Cosmet Dermatol 2021; 20:2387-2389. [PMID: 34139069 PMCID: PMC8447299 DOI: 10.1111/jocd.14304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Banu Farabi
- Department of Medicine, Saint Peter's University Hospital, New Brunswick, NJ, USA
| | - Atiye Akbayrak
- Department of Dermatology, Gazi Osman Pasa University Hospital, Tokat, Turkey
| | | | - Babar K Rao
- Department of Medicine, Saint Peter's University Hospital, New Brunswick, NJ, USA
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Chuchvara N, Berger L, Reilly C, Maghari A, Rao BK. Langerhans Cells as Morphologic Mimickers of Atypical Melanocytes on Reflectance Confocal Microscopy: A Case Report and Review of the Literature. Dermatol Pract Concept 2021; 11:e2021078. [PMID: 34123568 DOI: 10.5826/dpc.1103a78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 10/31/2022] Open
Abstract
Pagetoid spread of melanocytes in the epidermis is a common indicator of melanocytic atypia, both histopathologically and with reflectance confocal microscopy (RCM). Specifically on RCM, large, bright, atypical dendritic and/or roundish cells are characteristic of melanoma. However, intraepidermal Langerhans cells (ILC) create the potential for diagnostic ambiguity on RCM. We describe one case of a pigmented facial lesion that was initially diagnosed as lentigo maligna (LM) due to numerous atypical perifollicular dendritic cells on RCM. Additionally, we present the findings of a literature review for similar reported cases conducted by searching the following terms on PubMed: reflectance confocal microscopy, RCM, lentigo maligna, melanoma, Langerhans cells, dendritic cells, and atypical cells. In our case, the lesion was determined to be a solar lentigo on histopathology. Immunohistochemistry (IHC) with CD1a identified the atypical-appearing cells as ILC, as it did in 54 reported cases of benign lesions (benign melanocytic nevus, Sutton/halo nevus, labial melanotic macule, and solar lentigo) misdiagnosed as malignant on RCM (melanoma, lip melanoma, lentigo maligna, and LM melanoma). According to our case and the literature, both ILC and atypical melanocytes can present with atypical-appearing dendritic and/or roundish cells under RCM. Currently, there is no method to distinguish the two without IHC. Therefore, the presence of pagetoid cells should continue to alert the confocalist of a potential neoplastic process, prompting biopsy, histopathologic diagnosis, and IHC differentiation.
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Affiliation(s)
- Nadiya Chuchvara
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, US
| | - Lauren Berger
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, US
| | - Catherine Reilly
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, US
| | - Amin Maghari
- Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, US
| | - Babar K Rao
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, US.,Department of Dermatology, Weill Cornell Medicine, New York, New York, US
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Gill M, Pellacani G, Grant-Kels JM, Ardigò M, Chen CSJ, Gonzalez S, Guitera P, Longo C, Malvehy J, Markowitz O, Puig S, Rabinovitz H, Rao BK, Scope A, Ulrich M. Lost in translation: true clinical impact of reflectance confocal microscopy overlooked in 'Biopsy outperforms reflectance confocal microscopy in diagnosing and subtyping basal cell carcinoma: results and experiences from a randomized controlled multicentre trial'. Br J Dermatol 2020; 184:775-776. [PMID: 33090465 DOI: 10.1111/bjd.19602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/11/2020] [Indexed: 01/12/2023]
Affiliation(s)
- M Gill
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA.,SkinMedical Research and Diagnostics, P.L.L.C., Dobbs Ferry, NY, USA.,Faculty of Medicine and Health Sciences, University of Alcala de Henares, Madrid, Spain
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - J M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT, USA.,Department of Dermatology, University of Florida, Gainesville, FL, USA
| | - M Ardigò
- San Gallicano Institute IRCCS, Rome, Italy
| | - C-S J Chen
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S Gonzalez
- Faculty of Medicine and Health Sciences, University of Alcala de Henares, Madrid, Spain
| | - P Guitera
- Sydney Melanoma Diagnostics Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, Australia.,Melanoma Institute Australia, Sydney, NSW, Australia
| | - C Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy
| | - J Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - O Markowitz
- Icahn School of Medicine, Kimberly and Eric J. Waldman Department of Dermatology, Mount Sinai Hospital System, New York, NY, USA
| | - S Puig
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | | | - B K Rao
- Departments of Dermatology and Pathology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA.,Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - A Scope
- The Kittner Skin Cancer Screening & Research Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Ulrich
- CMB Collegium Medicum Berlin, Berlin, Germany
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Abstract
A 27-year-old patient presented with acral chilblain-like lesions atypical of dermatological presentations appearing in current reports of COVID-19. Prominent bullae had formed on the dorsa of her toes and became haemorrhagic 2 days after the initial presentation. The patient had no underlying medical conditions, including any history of collagen vascular disease, Raynaud’s phenomenon, chilblains or cold exposure, and was not taking any medications. The patient reported 10 days of ageusia and anosmia 6 weeks prior to the manifestation of her toe lesions, with no other symptoms. A nasopharyngeal swab test for SARS‐CoV‐2 RNA was positive. It is important that physicians recognise the myriad of cutaneous lesions associated with COVID-19 in this ongoing pandemic.
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Affiliation(s)
- Alexandra Rubin
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
| | - Mahin Alamgir
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
| | - Julia Rubin
- Independent Researcher, New York, New York, USA
| | - Babar K Rao
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA.,Dermatology, Weill Cornell Medical College, New York, New York, USA
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Mehta Y, Chaudhry D, Abraham OC, Chacko J, Divatia J, Jagiasi B, Kar A, Khilnani GC, Krishna B, Kumar P, Mani RK, Rao BK, Singh PK, Singh S, Tiwary P, Wattal C, Govil D, Dixit S, Samavedam S. Critical Care for COVID-19 Affected Patients: Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020; 24:222-241. [PMID: 32565632 PMCID: PMC7297240 DOI: 10.5005/jp-journals-10071-23395] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The global pandemic involving severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) has stretched the limits of science. Ever since it emerged from the Wuhan province in China, it has spread across the world and has been fatal to about 4% of the victims. This position statement of the Indian Society of Critical Care Medicine represents the collective opinion of the experts chosen by the society. HOW TO CITE THIS ARTICLE Mehta Y, Chaudhry D, Abraham OC, Chacko J, Divatia J, Jagiasi B, et al. Critical Care for COVID-19 Affected Patients: Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020;24(4):222-241.
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Affiliation(s)
- Yatin Mehta
- Institute of Critical Care and Anesthesiology, Medanta: The Medicity, Gurugram, Haryana, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - OC Abraham
- Infectious Disease Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jose Chacko
- Critical Care Medicine, Narayana Hrudyala, Bengaluru, Karnataka, India
| | - Jigeeshu Divatia
- Critical Care and Anesthesia, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bharat Jagiasi
- Department of Critical Care, Reliance Hospital, Navi Mumbai, Maharashtra, India
| | - Arindam Kar
- CK Birla Hospitals; CMRI Institute of Critical Care; Indian Society of Critical Care Medicine; European Society of Intensive Care Medicine
| | - GC Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St. John's Hospital, Bengaluru, Karnataka, India
| | - Prashant Kumar
- Department of Anesthesiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - RK Mani
- Critical Care and Pulmonology, Batra Hospital and Medical Research Centre, New Delhi, India
| | - BK Rao
- Department of Critical care and Emergency Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Pawan K Singh
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sanjeev Singh
- Amrita Institute of Medical Sciences, Ernakulam, Kerala, India; Amrita Hospitals, Faridabad, Haryana, India
| | - Pavan Tiwary
- All India Institute of Medical Sciences, New Delhi, India
| | - Chand Wattal
- Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesiology, Medanta: The Medicity, Gurugram, Haryana, India
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
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Chuchvara N, Patel R, Srivastava R, Reilly C, Rao BK. The growth of teledermatology: Expanding to reach the underserved. J Am Acad Dermatol 2020; 82:1025-1033. [DOI: 10.1016/j.jaad.2019.11.055] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/17/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
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Mehta Y, Chaudhry D, Abraham OC, Chacko J, Divatia J, Jagiasi B, Kar A, Khilnani GC, Krishna B, Kumar P, Mani RK, Rao BK, Singh PK, Singh S, Tiwary P, Wattal C, Govil D, Dixit S, Samavedam S. Critical Care for COVID-19 Affected Patients: Updated Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020; 24:S225-S230. [PMID: 33354047 PMCID: PMC7724933 DOI: 10.5005/jp-journals-10071-23621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The management of coronavirus disease-2019 (COVID-19) is witnessing a change as we learn more about the pathophysiology and the severity of the disease. Several randomized controlled trials (RCTs) and meta-analysis have been published over the last few months. Several interventions and therapies which showed promise in the initial days of the pandemic have subsequently failed to show benefit in well-designed trials. Understanding of the methods of oxygen delivery and ventilation have also evolved over the past few months. The Indian Society of Critical Care Medicine (ISCCM) has reviewed the evidence that has emerged since the publication of its position statement in May and has put together an addendum of updated evidence. How to cite this article: Mehta Y, Chaudhry D, Abraham OC, Chacko J, Divatia J, Jagiasi B, et al. Critical Care for COVID-19 Affected Patients: Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020;24(Suppl 5):S225–S230.
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Affiliation(s)
- Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta: The Medicity, Gurugram, Haryana, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - O C Abraham
- Infectious Disease Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jose Chacko
- Critical Care Medicine, Narayana Hrudyala, Bengaluru, Karnataka, India
| | - Jigeeshu Divatia
- Critical Care and Anesthesia, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bharat Jagiasi
- Department of Critical Care, Reliance Hospital, Navi Mumbai, Maharashtra, India
| | - Arindam Kar
- CK Birla Hospitals, Gurugram, Haryana, India; CMRI Institute of Critical Care, Kolkata, West Bengal, India; Indian Society of Critical Care Medicine; European Society of Intensive Care Medicine
| | - G C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St. John's Hospital, Bengaluru, Karnataka, India
| | - Prashant Kumar
- Department of Anaesthesiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - R K Mani
- Critical Care and Pulmonology, Batra Hospital and Medical Research Centre, New Delhi, India
| | - B K Rao
- Department of Critical Care and Emergency Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Pawan K Singh
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sanjeev Singh
- Amrita Institute of Medical Sciences, Ernakulam, Kerala, India; Amrita Hospitals, Faridabad, Haryana, India
| | - Pavan Tiwary
- All India Institute of Medical Sciences, New Delhi, India
| | - Chand Wattal
- Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesiology, Medanta: The Medicity, Gurugram, Haryana, India
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
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Rungta N, Zirpe KG, Dixit SB, Mehta Y, Chaudhry D, Govil D, Mishra RC, Sharma J, Amin P, Rao BK, Khilnani GC, Mittal K, Bhattacharya PK, Baronia AK, Javeri Y, Myatra SN, Rungta N, Tyagi R, Dhanuka S, Mishra M, Samavedam S. Indian Society of Critical Care Medicine Experts Committee Consensus Statement on ICU Planning and Designing, 2020. Indian J Crit Care Med 2020; 24:S43-S60. [PMID: 32205956 PMCID: PMC7085818 DOI: 10.5005/jp-journals-10071-g23185] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Indian Society of Critical Care Medicine (ISCCM) guidelines on Planning and Designing Intensive care (ICU) were first developed in 2001 and later updated in 2007. These guidelines were adopted in India, many developing Nations and major Institutions including NABH. Various international professional bodies in critical care have their own position papers and guidelines on planning and designing of ICUs; being the professional body of intensivists in India ISCCM therefore addresses the subject in contemporary context relevant to our clinical practice, its variability according to specialty and subspecialty, quality, resource limitation, size and location of the institution. Aim: To have a consensus document reflecting the philosophy of ISCCM to deliver safe & quality Critical Care in India, taking into consideration the requirement of regulatory agencies (national & international) and need of people at large, including promotion of training, education and skill upgradation. It also aiming to promote leadership and development and managerial skill among the critical care team. Material and Methods: Extensive review of literature including search of databases in English language, resources of regulatory bodies, guidelines and recommendations of international critical care societies. National Survey of ISCCM members and experts to understand their viewpoints on respective issues. Visiting of different types and levels of ICUs by team members to understand prevailing practices, aspiration and Challenges. Several face to face meetings of the expert committee members in big and small groups with extensive discussions, presentations, brain storming and development of initial consensus draft. Discussion on draft through video conferencing, phone calls, Emails circulations, one to one discussion Result: Based upon extensive review, survey and input of experts' ICUs were categorized in to three levels suitable in Indian setting. Level III ICUs further divided into sub category A and B. Recommendations were grouped in to structure, equipment and services of ICU with consideration of variation in level of ICU of different category of hospitals. Conclusion: This paper summarizes consensus statement of various aspect of ICU planning and design. Defined mandatory and desirable standards of all level of ICUs and made recommendations regarding structure and layout of ICUs. Definition of intensive care and intensivist, planning for strength of ICU and requirement of manpower were also described. HOW TO CITE THIS ARTICLE Rungta N, Zirpe KG, Dixit SB, Mehta Y, Chaudhry D, Govil D, et al. Indian Society of Critical Care Medicine Experts Committee Consensus Statement on ICU Planning and Designing, 2020. Indian J Crit Care Med 2020;24(Suppl 1):S43-S60.
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Affiliation(s)
- Narendra Rungta
- Department of Critical Care Foundation, Critical Care, MJ Rajasthan Hospital, Jaipur, Rajasthan, India, e-mail:
| | - Kapil Gangadhar Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India, , e-mail:
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan & MJM Hospital, Pune, Maharashtra, India, , 020-25531539 / 25539538, e-mail:
| | - Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta The Medicity, Sector-38, Gurgaon, Haryana, India, Extn. 3335, e-mail ID:
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India, , e-mail:
| | - Deepak Govil
- Department of Critical Care, Medanta Hospital, The Medicity, Gurugram, Haryana, India, , e-mail:
| | - Rajesh C Mishra
- Department of Critical Care, Saneejivini Hospital, Vastrapur, Ahmedabad, Gujarat, India, , e-mail:
| | - Jeetendra Sharma
- Department of Critical Care, Artemis Health Institute, Gurgaon, Haryana, India, , e-mail:
| | - Pravin Amin
- JLN Medical College, Jaipur, Rajasthan, India, e-mail:
| | - B K Rao
- Department of Critical care & Emergency Medicine, Sir Ganga Ram Hospital, Delhi, India, e-mail:
| | - G C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India, , e-mail:
| | - Kundan Mittal
- Department of Pediatrics, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, e-mail:
| | | | - A K Baronia
- Department of Critical Care, SGPGI, Lucknow, Uttar Pradesh, India, e-mail:
| | - Yash Javeri
- Department of Critical Care, Anesthesia and Emergency Medicine, Regency Health, Lucknow, Uttar Pradesh, India, , e-mail:
| | - Sheila Nainan Myatra
- Department of Anesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India, e-mail:
| | - Neena Rungta
- Department of Anesthesia, JLN Medical College, Jaipur, Rajasthan, India, e-mail:
| | - Ranvir Tyagi
- Department of Anaesthesia and Critical Care Medicine, Synergy Plus hospital, NH 2 Sikandra, Agra, Uttar Pradesh, India, e-mail:
| | - Sanjay Dhanuka
- Eminent Hospital, 6/1 Old Palasia, Opposite Barwani Plaza, Indore, Madhya Pradesh, India, e-mail:
| | - Mahesh Mishra
- Department of Surgery, Mahatma Gandhi University of Medical Sciences & Technology, Riico Institutional Area, Tonk Road, Sitapura, Jaipur, Rajasthan, India, e-mail:
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India, , e-mail:
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Srivastava R, John A, Wassef C, Maghari A, Rao BK. Tender papules on the bilateral dorsal hands. Cutis 2019; 104:344-355. [PMID: 31939932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Radhika Srivastava
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
| | - Ann John
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
| | - Cindy Wassef
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
| | - Amin Maghari
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
| | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
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40
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John AM, Srivastava R, Francisco GM, Bhatti H, Rao BK. Modified Mohs micrographic surgery with rim and deep margin technique. Int J Dermatol 2019; 59:e31-e33. [PMID: 31483495 DOI: 10.1111/ijd.14628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/11/2019] [Accepted: 08/09/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Ann M John
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| | - Radhika Srivastava
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| | - Gina M Francisco
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| | - Hamza Bhatti
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA.,Department of Dermatology, Weill Cornell Medical Center, New York, NY, USA
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41
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Srivastava R, John JJ, Reilly C, John AM, Rao BK. Sniffing out malignant melanoma: a case of canine olfactory detection. Cutis 2019; 104:E4-E6. [PMID: 31675402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Radhika Srivastava
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
| | - Jason J John
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
| | - Catherine Reilly
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
| | - Ann M John
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
| | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA; and Department of Dermatology, Weill Cornell Medical Center, New York, New York, USA
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42
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Coups EJ, Manne SL, Ohman Strickland P, Hilgart M, Goydos JS, Heckman CJ, Chamorro P, Rao BK, Davis M, Smith FO, Thorndike FP, Ritterband LM. Randomized controlled trial of the mySmartSkin web-based intervention to promote skin self-examination and sun protection behaviors among individuals diagnosed with melanoma: study design and baseline characteristics. Contemp Clin Trials 2019; 83:117-127. [PMID: 31255801 PMCID: PMC6690854 DOI: 10.1016/j.cct.2019.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
>1.2 million people in the United States have a personal history of melanoma skin cancer and are at increased risk for disease recurrence and second primary melanomas. Many of these individuals do not follow recommendations to conduct regular, thorough skin self-examinations that facilitate early disease detection and do not sufficiently engage in sun protection behaviors. In this project, we are conducting a randomized controlled trial of an innovative, tailored, theory-driven Internet intervention-called mySmartSkin-to promote these behaviors among melanoma patients. This paper outlines the study design and characteristics of the study sample. A total of 441 patients were recruited (40.9% response rate) and randomized to the mySmartSkin or a Usual Care condition. Participants complete surveys at baseline and 8 weeks, 24 weeks, and 48 weeks later. The primary aim of the project is to examine the impact of mySmartSkin versus Usual Care on skin self-examination and sun protection behaviors. The secondary aim focuses on identifying mediators of the intervention's effects. In an exploratory aim, we will examine potential moderators of the impact of the intervention. At baseline, the recruited participants had a mean age of 61 years, 49% were female, 7.5% met criteria for having conducted a recent, thorough skin self-examination, and the mean score on the index of sun protection behaviors was 3.3 (on a scale from 1 to 5). The results of the project will determine whether the mySmartSkin intervention is efficacious in promoting skin self-examination and sun protection behaviors among individuals diagnosed with melanoma. Trial registration: ClinicalTrials.govNCT03028948.
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Affiliation(s)
- Elliot J Coups
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Medicine, Rutgers Robert Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Health Behavior, Systems & Policy, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, United States.
| | - Sharon L Manne
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Medicine, Rutgers Robert Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Health Behavior, Systems & Policy, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Pamela Ohman Strickland
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Michelle Hilgart
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | | | - Carolyn J Heckman
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Medicine, Rutgers Robert Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Health Behavior, Systems & Policy, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Paola Chamorro
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Moira Davis
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, United States
| | - Franz O Smith
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, United States
| | | | - Lee M Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
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43
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Srivastava R, Manfredini M, Rao BK. Noninvasive imaging tools in dermatology. Cutis 2019; 104:108-113. [PMID: 31603963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The diagnosis of skin disease relies on visual inspection, often followed by biopsy and histopathologic examination, which remains the gold standard in diagnosis. New imaging tools, including dermoscopy, reflectance confocal microscopy (RCM), and optical coherence tomography (OCT), can provide noninvasive diagnoses while sparing unnecessary biopsies. We discuss dermoscopy, RCM, and OCT, and compare cost, clinical integration, reimbursement, and accuracy of these imaging modalities.
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Affiliation(s)
- Radhika Srivastava
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
| | - Marco Manfredini
- Department of Dermatology, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, and Department of Dermatology, Weill Cornell Medical Center, New York, New York, USA
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44
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Srivastava R, Rao BK. Back to the future: integrating technology to improve patient-provider interactions. Cutis 2019; 103:321-322. [PMID: 31348455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The adoption of electronic medical records (EMRs) resulted in both improvement and deterioration of different aspects of patient-provider interactions. We envision further integration of current and future technology to optimize patient-provider interactions, which we present using a hypothetical patient encounter.
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Affiliation(s)
- Radhika Srivastava
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
| | - Babar K Rao
- Department of Dermatology, Weill Cornell Medical Center, New York, New York; and Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
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45
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John AM, Francisco G, Srivastava R, Bhatti H, Rao BK. "Deep" vertical Mohs and closure with a tumor-free flap for dermatofibrosarcoma protuberans: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19847785. [PMID: 31065362 PMCID: PMC6488772 DOI: 10.1177/2050313x19847785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dermatofibrosarcoma protuberans is an uncommon low-grade malignant tumor that can invade locally and rarely metastasize. Dermatofibrosarcoma protuberans has a high rate of local recurrence due to incomplete excision, especially in deep tissues. Morbidity is often related to multiple local recurrences and removal of excessive tissue with large, complex repairs. We present a case of incompletely excised dermatofibrosarcoma protuberans after initial wide local excision. We subsequently employed a "deep" vertical Mohs micrographic surgical technique to remove the remaining tumor while creating a flap with the tumor-free superficial portion to preserve tissue and avoid a complicated repair. The patient is tumor-free for 7 years.
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Affiliation(s)
- Ann M John
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| | - Gina Francisco
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| | - Radhika Srivastava
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| | - Hamza Bhatti
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA.,Department of Dermatology, Weill Cornell Medical College, New York, NY, USA
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46
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Srivastava R, Reilly C, Francisco G, Bhatti H, Rao BK. Life of a Wound: Serial Documentation of Wound Healing After Shave Removal Using Reflectance Confocal Microscopy. J Drugs Dermatol 2019; 18:472-474. [PMID: 31141857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Reflectance Confocal Microscopy (RCM) is a new noninvasive skin imaging modality that is comparable to traditional histopathology. We present serial in vivo RCM imaging of an atypical nevus after shave excision over a 1-month period. Findings on RCM images are consistent with the inflammatory, proliferative, and remodeling phases of wound healing, and RCM may serve as a new tool to study wound healing in vivo over time. J Drugs Dermatol. 2019;18(5):472-474.
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47
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Srivastava R, Wassef C, Rao BK. The Dayanara effect: increasing skin cancer awareness in the Hispanic community. Cutis 2019; 103:257-258. [PMID: 31233576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Radhika Srivastava
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
| | - Cindy Wassef
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, and Department of Dermatology, Weill Cornell Medical Center, New York, New York, USA
| | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, and Department of Dermatology, Weill Cornell Medical Center, New York, New York, USA
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48
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Rao BK, John AM, Francisco G, Haroon A. Diagnostic Accuracy of Reflectance Confocal Microscopy for Diagnosis of Skin Lesions: An Update. Arch Pathol Lab Med 2018; 143:326-329. [DOI: 10.5858/arpa.2018-0124-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Histopathology is the current standard to diagnose skin disease. However, biopsy may not always be feasible, such as in patients with multiple nevi, a patient with a lesion on an aesthetically significant site, or in children. Recently, noninvasive techniques, including reflectance confocal microscopy (RCM), optical coherence tomography, and Raman spectroscopy, have enabled dermatologists to manage skin lesions in real time without the need for biopsy.
Objective.—
To report the updated diagnostic accuracy of RCM for equivocal skin lesions.
Design.—
In this study, we retrospectively reviewed our data of clinically suspicious lesions from 2010 to 2017 that were evaluated by RCM.
Results.—
Our results showed an overall sensitivity of 98.2% and specificity of 99.8%.
Conclusions.—
In conclusion, RCM is a noninvasive real-time tool with the potential to diagnose skin lesions with high accuracy and without biopsy.
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Affiliation(s)
- Babar K. Rao
- From the Department of Dermatology, Rutgers, Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Ann M John
- From the Department of Dermatology, Rutgers, Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Gina Francisco
- From the Department of Dermatology, Rutgers, Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Attiya Haroon
- From the Department of Dermatology, Rutgers, Robert Wood Johnson Medical School, Somerset, New Jersey
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49
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Affiliation(s)
- Gina Francisco
- Department of Dermatology, Rutgers–Robert Wood Johnson Medical School, Somerset, New Jersey
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50
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Yeager DG, Noor O, Rao BK. Reflectance confocal microscopy as a first-line diagnostic technique for mycosis fungoides. Cutis 2018; 102:56-58. [PMID: 30138497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma and is a diagnostic challenge in its early stages. It often can be misdiagnosed as chronic contact dermatitis, atopic dermatitis, psoriasis, or other common dermatoses. Histologic diagnosis remains the gold standard for MF; however, in many cases repeat biopsies may be needed over time, especially in early patch stages of MF. Reflectance confocal microscopy (RCM) is a quick and noninvasive diagnostic tool that may be useful to determine an appropriate area to biopsy. We present the case of a 60-year-old man with plaque and tumor lesions clinically suspicious for MF that had originally been misdiagnosed as psoriasis. Reflectance confocal microscopy was used to evaluate for findings specific to MF and to select an appropriate biopsy site. The features noted on RCM were consistent with MF, and subsequent biopsy revealed tumor-stage disease. This article describes a unique case in which RCM was used for initial primary diagnosis of tumor-stage MF in a clinical setting. As in prior studies, our evaluation failed to identify unique RCM features specific to tumor-stage MF when compared to plaque- or patch-stage disease. Nonetheless, RCM may be useful in providing a quick noninvasive diagnosis when the clinical presentation of MF is ambiguous, especially in early lesions.
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Affiliation(s)
- Danielle G Yeager
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Omar Noor
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Babar K Rao
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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