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Caro-Vegas C, Peng A, Juarez A, Silverstein A, Kamiyango W, Villiera J, McAtee CL, Mzikamanda R, Tomoka T, Peckham-Gregory EC, Moorad R, Kovarik CL, Campbell LR, Mehta PS, Kazembe PN, Allen CE, Scheurer ME, Ozuah NW, Dittmer DP, El-Mallawany NK. Pediatric HIV+ Kaposi sarcoma exhibits clinical, virological, and molecular features different from the adult disease. JCI Insight 2023; 8:e167854. [PMID: 37991023 PMCID: PMC10721314 DOI: 10.1172/jci.insight.167854] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUNDKaposi sarcoma (KS) is among the most common childhood cancers in Eastern and Central Africa. Pediatric KS has a distinctive clinical presentation compared with adult KS, which includes a tendency for primary lymph node involvement, a considerable proportion of patients lacking cutaneous lesions, and a potential for fulminant disease. The molecular mechanisms or correlates for these disease features are unknown.METHODSThis was a cross-sectional study. All cases were confirmed by IHC for KS-associated herpesvirus (KSHV) LANA protein. Baseline blood samples were profiled for HIV and KSHV genome copy numbers by qPCR and secreted cytokines by ELISA. Biopsies were characterized for viral and human transcription, and KSHV genomes were determined when possible.RESULTSSeventy participants with pediatric KS were enrolled between June 2013 and August 2019 in Malawi and compared with adult patients with KS. They exhibited high KSHV genome copy numbers and IL-6/IL-10 levels. Four biopsies (16%) had a viral transcription pattern consistent with lytic viral replication.CONCLUSIONThe unique features of pediatric KS may contribute to the specific clinical manifestations and may direct future treatment options.FUNDINGUS National Institutes of Health U54-CA-254569, PO1-CA019014, U54-CA254564, RO1-CA23958.
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Affiliation(s)
- Carolina Caro-Vegas
- UNC Lineberger Comprehensive Cancer Center and Center for AIDS Research, Chapel Hill, North Carolina, USA
| | - Alice Peng
- UNC Lineberger Comprehensive Cancer Center and Center for AIDS Research, Chapel Hill, North Carolina, USA
| | - Angelica Juarez
- UNC Lineberger Comprehensive Cancer Center and Center for AIDS Research, Chapel Hill, North Carolina, USA
| | - Allison Silverstein
- Texas Children’s Cancer & Hematology Center Global HOPE (Hematology-Oncology Pediatric Excellence) Program Malawi, Lilongwe, Malawi
- University of Colorado, Department of Pediatrics, Denver, Colorado, USA
| | - William Kamiyango
- Texas Children’s Cancer & Hematology Center Global HOPE (Hematology-Oncology Pediatric Excellence) Program Malawi, Lilongwe, Malawi
| | - Jimmy Villiera
- Texas Children’s Cancer & Hematology Center Global HOPE (Hematology-Oncology Pediatric Excellence) Program Malawi, Lilongwe, Malawi
| | - Casey L. McAtee
- Texas Children’s Cancer & Hematology Center Global HOPE (Hematology-Oncology Pediatric Excellence) Program Malawi, Lilongwe, Malawi
- Baylor College of Medicine (BCM), Department of Pediatrics, Houston, Texas, USA
- Texas Children’s Hospital Cancer & Hematology Center, Houston, Texas, USA
| | - Rizine Mzikamanda
- Texas Children’s Cancer & Hematology Center Global HOPE (Hematology-Oncology Pediatric Excellence) Program Malawi, Lilongwe, Malawi
| | - Tamiwe Tomoka
- University of North Carolina Project-Malawi, Kamuzu Central Hospital Pathology Laboratory, Lilongwe, Malawi
| | - Erin C. Peckham-Gregory
- Texas Children’s Cancer & Hematology Center Global HOPE (Hematology-Oncology Pediatric Excellence) Program Malawi, Lilongwe, Malawi
- Baylor College of Medicine (BCM), Department of Pediatrics, Houston, Texas, USA
- Texas Children’s Hospital Cancer & Hematology Center, Houston, Texas, USA
| | - Razia Moorad
- UNC Lineberger Comprehensive Cancer Center and Center for AIDS Research, Chapel Hill, North Carolina, USA
| | | | - Liane R. Campbell
- Baylor College of Medicine (BCM), Department of Pediatrics, Houston, Texas, USA
- BCM International Pediatric AIDS Initiative Children’s Foundation Tanzania, Mbeya, Tanzania
| | - Parth S. Mehta
- Texas Children’s Cancer & Hematology Center Global HOPE (Hematology-Oncology Pediatric Excellence) Program Malawi, Lilongwe, Malawi
- Baylor College of Medicine (BCM), Department of Pediatrics, Houston, Texas, USA
- Texas Children’s Hospital Cancer & Hematology Center, Houston, Texas, USA
| | - Peter N. Kazembe
- BCM International Pediatric AIDS Initiative Children’s Foundation Malawi, Lilongwe, Malawi
| | - Carl E. Allen
- Texas Children’s Cancer & Hematology Center Global HOPE (Hematology-Oncology Pediatric Excellence) Program Malawi, Lilongwe, Malawi
- Baylor College of Medicine (BCM), Department of Pediatrics, Houston, Texas, USA
- Texas Children’s Hospital Cancer & Hematology Center, Houston, Texas, USA
| | - Michael E. Scheurer
- Texas Children’s Cancer & Hematology Center Global HOPE (Hematology-Oncology Pediatric Excellence) Program Malawi, Lilongwe, Malawi
- Baylor College of Medicine (BCM), Department of Pediatrics, Houston, Texas, USA
- Texas Children’s Hospital Cancer & Hematology Center, Houston, Texas, USA
| | - Nmazuo W. Ozuah
- Texas Children’s Cancer & Hematology Center Global HOPE (Hematology-Oncology Pediatric Excellence) Program Malawi, Lilongwe, Malawi
- Baylor College of Medicine (BCM), Department of Pediatrics, Houston, Texas, USA
- Texas Children’s Hospital Cancer & Hematology Center, Houston, Texas, USA
| | - Dirk P. Dittmer
- UNC Lineberger Comprehensive Cancer Center and Center for AIDS Research, Chapel Hill, North Carolina, USA
| | - Nader Kim El-Mallawany
- Texas Children’s Cancer & Hematology Center Global HOPE (Hematology-Oncology Pediatric Excellence) Program Malawi, Lilongwe, Malawi
- Baylor College of Medicine (BCM), Department of Pediatrics, Houston, Texas, USA
- Texas Children’s Hospital Cancer & Hematology Center, Houston, Texas, USA
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McMahon DE, Schuetz AN, Kovarik CL. Emerging infectious diseases of the skin: a review of clinical and histologic findings. Hum Pathol 2023; 140:196-213. [PMID: 37454994 DOI: 10.1016/j.humpath.2023.07.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
Emerging infectious diseases are of great importance to public health and clinical practice. This review aims to characterize the clinical and histopathologic features of emerging infectious diseases with cutaneous manifestations in order to increase awareness of these entities among dermatologists, pathologists, and dermatopathologists.
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Affiliation(s)
- Devon E McMahon
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Audrey N Schuetz
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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3
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Campbell LR, Silverstein A, Peckham-Gregory E, Kamiyango W, Villiera J, McAtee CL, Bacha JM, Kovarik CL, Mehta PS, Chanroo T, Kapesa A, Malingoti B, Mzikamanda R, Ozuah NW, Allen CE, Scheurer ME, El-Mallawany NK. Divergent clinical presentations and outcomes among children and adolescents with Kaposi sarcoma in Malawi and Tanzania. HIV Med 2023. [PMID: 36627111 DOI: 10.1111/hiv.13455] [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: 08/16/2022] [Accepted: 12/18/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The Kaposi sarcoma (KS) T0 versus T1 staging classification does not address the unique clinical features of paediatric KS in human gammaherpesvirus 8 (HHV-8) endemic regions of Africa. This study seeks to define patterns of childhood KS using a paediatric-specific approach. METHODS The Lilongwe paediatric KS staging classification categorizes disease based on clinical phenotype: stage 1 = mild/moderate KS limited to cutaneous/oral involvement, stage 2 = primarily lymphadenopathic disease, stage 3 = woody edema KS, stage 4 = visceral and/or severe/disseminated mucocutaneous disease. Characteristics and outcomes were evaluated from paediatric referral centres in Lilongwe, Malawi, and Mbeya, Tanzania. RESULTS Among 171 patients, the median age was 9.3 years, 37% (n = 63) were female, and 87% (n = 149) had HIV. Breakdown by stage was as follows: 18% (n = 31) stage 1, 33% (n = 56) stage 2, 19% (n = 33) stage 3, and 30% (n = 51) stage 4. Age (younger stage 2 and older stage 3), severe CD4 count suppression (lower CD4 for stages 1 and 4), and presence of severe anaemia and thrombocytopenia (worse for stages 2 and 4) differed across stages. Estimated 2-year event-free survival/progression-free survival/overall survival by stage was as follows: stage 1, 81%/81%/87%; stage 2, 50%/50%/63%; stage 3, 24%/49%/81%; and stage 4, 29%/34%/54%. Sub-analysis of stage 2 lymphadenopathic KS demonstrated superior long-term 6-year event-free survival of 70% (95% confidence interval [CI] 49-83) for younger children (aged <7 years) versus 27% (95% CI 8-51) for older children. CONCLUSIONS This paediatric-specific staging classification categorizes patients with distinct characteristics and patterns of treatment response. This platform may guide clinicians to provide risk-stratified treatment with the hope of improving survival among children with KS.
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Affiliation(s)
- Liane R Campbell
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, Texas, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Baylor College of Medicine Children's Foundation-Tanzania, Mbeya, Tanzania
| | - Allison Silverstein
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi.,Department of Hospice and Palliative Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Erin Peckham-Gregory
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - William Kamiyango
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi
| | - Jimmy Villiera
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi
| | - Casey L McAtee
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi.,Global HOPE, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
| | - Jason M Bacha
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, Texas, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Baylor College of Medicine Children's Foundation-Tanzania, Mbeya, Tanzania
| | | | - Parth S Mehta
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Global HOPE, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
| | - Toni Chanroo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi
| | - Asulwisye Kapesa
- Baylor College of Medicine Children's Foundation-Tanzania, Mbeya, Tanzania
| | - Beatrice Malingoti
- Baylor College of Medicine Children's Foundation-Tanzania, Mbeya, Tanzania
| | - Rizine Mzikamanda
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi
| | - Nmazuo W Ozuah
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi.,Global HOPE, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
| | - Carl E Allen
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Global HOPE, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
| | - Michael E Scheurer
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Nader K El-Mallawany
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Global HOPE, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
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4
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Lamb JE, Fitzsimmons R, Sevagamoorthy A, Kovarik CL, Shin DB, Takeshita J. Patient Factors Associated With Teledermatology Visit Type and Submission of Photographs During the COVID-19 Pandemic: Cross-sectional Analysis. JMIR Dermatol 2022; 5:e38694. [PMID: 37632882 DOI: 10.2196/38694] [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: 04/12/2022] [Revised: 08/10/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated the widespread adoption of teledermatology, and this continues to account for a significant proportion of dermatology visits after clinics have reopened for in-person care. Delivery of high-quality teledermatology care requires adequate visualization of the patient's skin, with photographs being preferred over live video for remote skin examination. It remains unknown which patients face the greatest barriers to participating in a teledermatology visit with photographs. OBJECTIVE The aim of this study was to identify patient characteristics associated with type of telemedicine visit and the factors associated with participating in teledermatology visits with digital photographs versus those without photographs. METHODS We performed a cross-sectional analysis of the University of Pennsylvania Health System electronic health record data for adult patients who participated in at least 1 teledermatology appointment between March 1, 2020, and June 30, 2020. The primary outcomes were participation in a live-interactive video visit versus a telephone visit and participation in any teledermatology visit with photographs versus one without photographs. Multivariable logistic regression was performed to evaluate the associations between patient characteristics and the primary outcomes. RESULTS In total, 5717 unique patients completed at least 1 teledermatology visit during the study period; 68.25% (n=3902) of patients participated in a video visit, and 31.75% (n=1815) participated in a telephone visit. A minority of patients (n=1815, 31.75%) submitted photographs for their video or telephone appointment. Patients who submitted photographs for their teledermatology visit were more likely to be White, have commercial insurance, and live in areas with higher income, better education, and greater access to a computer and high-speed internet (P<.001 for all). In adjusted analysis, older age (age group >75 years: odds ratio [OR] 0.60, 95% CI 0.44-0.82), male sex (OR 0.85, 95% CI 0.75-0.97), Black race (OR 0.79, 95% CI 0.65-0.96), and Medicaid insurance (OR 0.81, 95% CI 0.66-0.99) were each associated with lower odds of a patient submitting photographs for their video or telephone visit. Older age (age group >75 years: OR 0.37, 95% CI 0.27-0.50) and Black race (OR 0.82, 95% CI 0.68-0.98) were also associated with lower odds of a patient participating in a video visit versus telephone visit. CONCLUSIONS Patients who were older, male, or Black, or who had Medicaid insurance were less likely to participate in teledermatology visits with photographs and may be particularly vulnerable to disparities in teledermatology care. Further research is necessary to identify the barriers to patients providing photographs for remote dermatology visits and to develop targeted interventions to facilitate equitable participation in teledermatology care.
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Affiliation(s)
- Jordan E Lamb
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Robert Fitzsimmons
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Anjana Sevagamoorthy
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel B Shin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Junko Takeshita
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
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5
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Kovarik CL, Sanabria B, Stoff BK. Image Consent and the Development of Image-Based Artificial Intelligence. JAMA Dermatol 2022; 158:589. [PMID: 35416918 DOI: 10.1001/jamadermatol.2022.0689] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.,Department of Internal Medicine, Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Bianca Sanabria
- Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Benjamin K Stoff
- Department of Dermatology, Department of Pathology, and Laboratory Medicine, Emory Center for Ethics, Emory University, Atlanta, Georgia
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6
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Wang RH, Barbieri JS, Kovarik CL, Lipoff JB. Synchronous and asynchronous teledermatology: A narrative review of strengths and limitations. J Telemed Telecare 2022; 28:533-538. [PMID: 35108130 DOI: 10.1177/1357633x221074504] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The policy changes prompted by the COVID-19 pandemic caused synchronous models (primarily video visits) to supplant asynchronous models (store-and-forward or shared digital photographs) as the default and predominant modality of teledermatology care. Here, we call attention to the unique strengths and limitations of these models in terms of clinical utility, accessibility, and cost-effectiveness. Strengths of synchronous visits include direct physician-patient interaction and current reimbursement parity; limitations include variable video image quality, technological difficulties, and accessibility barriers. Strengths of asynchronous visits include greater convenience, especially for clinicians, and potential for image quality superior to video; limitations include less direct physician-patient communication, barriers to follow-up, and limited reimbursement. Both synchronous and asynchronous models have been shown to be cost-effective. Teledermatology is positioned to play a prominent role in patient care post-pandemic. Moving forward, dermatologists are challenged to optimize teledermatology use in order to improve outcomes, efficiency, and workflows to meet diverse patient needs. Future directions will depend on sustainable reimbursement of both teledermatology formats by government and private payers.
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Affiliation(s)
- Robin H Wang
- 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John S Barbieri
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jules B Lipoff
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,43358Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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7
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Silverstein A, Kamiyango W, Villiera J, Peckham-Gregory EC, McAtee CL, Scheurer ME, Cox CM, Kovarik CL, Campbell LR, Allen CE, Mehta PS, Kazembe PN, Ozuah NW, El-Mallawany NK. Long-term outcomes for children and adolescents with Kaposi sarcoma. HIV Med 2021; 23:197-203. [PMID: 34634187 DOI: 10.1111/hiv.13191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/20/2021] [Revised: 08/27/2021] [Accepted: 09/23/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Kaposi sarcoma (KS) is one of the most common childhood cancers in eastern and central Africa. It has become a treatable disease with increasing availability of antiretroviral therapy (ART) and chemotherapy. We aimed to fill the data gap in establishing whether long-term survival is achievable for children in low-income countries. METHODS We retrospectively analysed data for children and adolescents aged ≤ 18.9 years diagnosed with HIV-related or endemic KS from 2006 to 2015 who received standardized institutional treatment regimens utilizing chemotherapy plus ART (if HIV-positive) at a tertiary care public hospital in Lilongwe, Malawi. Long-term survival was analysed and mortality was associated with KS for those with refractory/progressive disease at the time of death. RESULTS There were 207 children/adolescents with KS (90.8% HIV-related); 36.7% were alive, 54.6% had died, and 8.7% had been lost to follow-up. The median follow-up time for survivors was 6.9 years (range 4.2-13.9 years). Death occurred at a median of 5.3 months after KS diagnosis (range 0.1-123 months). KS progression was associated with mortality for most (61%) early deaths (survival time of < 6 months); conversely, KS was associated with a minority (31%) of late-onset deaths (after 24 months). The 7-year overall survival was 37% [95% confidence interval (CI) 30-44%] and was higher for those diagnosed between 2011 and 2015 compared to 2006-2010: 42% (95% CI 33-51%) versus 29% (95% CI 20-39%), respectively (P = 0.01). Among the 66 HIV-positive survivors, 58% were still on first-line ART. CONCLUSIONS Long-term survival is possible for pediatric KS in low-resource settings. Despite better survival in more recent years, there remains room for improvement.
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Affiliation(s)
- Allison Silverstein
- Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Houston, TX, USA.,Baylor College of Medicine, Children's Foundation Malawi, Lilongwe, Malawi.,Baylor College of Medicine, Houston, TX, USA
| | - William Kamiyango
- Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Houston, TX, USA.,Baylor College of Medicine, Children's Foundation Malawi, Lilongwe, Malawi
| | - Jimmy Villiera
- Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Houston, TX, USA.,Baylor College of Medicine, Children's Foundation Malawi, Lilongwe, Malawi
| | - Erin C Peckham-Gregory
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Casey L McAtee
- Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA.,Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Michael E Scheurer
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Carrie M Cox
- Baylor College of Medicine, Children's Foundation Malawi, Lilongwe, Malawi.,Baylor College of Medicine, Houston, TX, USA
| | | | - Liane R Campbell
- Baylor College of Medicine, Houston, TX, USA.,Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Tanzania, Mbeya, Tanzania
| | - Carl E Allen
- Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA.,Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Parth S Mehta
- Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA.,Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Peter N Kazembe
- Baylor College of Medicine, Children's Foundation Malawi, Lilongwe, Malawi
| | - Nmazuo W Ozuah
- Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Houston, TX, USA.,Baylor College of Medicine, Children's Foundation Malawi, Lilongwe, Malawi.,Baylor College of Medicine, Houston, TX, USA.,Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Nader Kim El-Mallawany
- Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA.,Texas Children's Cancer and Hematology Centers, Houston, TX, USA
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8
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McMahon DE, Kovarik CL, Damsky W, Rosenbach M, Lipoff JB, Tyagi A, Chamberlin G, Fathy R, Nazarian RM, Desai SR, Lim HW, Thiers BH, Hruza GJ, French LE, Blumenthal K, Fox LP, Freeman EE. Clinical and pathologic correlation of cutaneous COVID-19 vaccine reactions including V-REPP: A registry-based study. J Am Acad Dermatol 2021; 86:113-121. [PMID: 34517079 PMCID: PMC8431833 DOI: 10.1016/j.jaad.2021.09.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [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: 06/30/2021] [Revised: 08/22/2021] [Accepted: 09/02/2021] [Indexed: 01/20/2023]
Abstract
Background Cutaneous reactions after COVID-19 vaccination have been commonly reported; however, histopathologic features and clinical correlations have not been well characterized. Methods We evaluated for a history of skin biopsy all reports of reactions associated with COVID-19 vaccination identified in an international registry. When histopathology reports were available, we categorized them by reaction patterns. Results Of 803 vaccine reactions reported, 58 (7%) cases had biopsy reports available for review. The most common histopathologic reaction pattern was spongiotic dermatitis, which clinically ranged from robust papules with overlying crust, to pityriasis rosea-like eruptions, to pink papules with fine scale. We propose the acronym “V-REPP” (vaccine-related eruption of papules and plaques) for this spectrum. Other clinical patterns included bullous pemphigoid-like (n = 12), dermal hypersensitivity (n = 4), herpes zoster (n = 4), lichen planus-like (n = 4), pernio (n = 3), urticarial (n = 2), neutrophilic dermatosis (n = 2), leukocytoclastic vasculitis (n = 2), morbilliform (n = 2), delayed large local reactions (n = 2), erythromelalgia (n = 1), and other (n = 5). Limitations Cases in which histopathology was available represented a minority of registry entries. Analysis of registry data cannot measure incidence. Conclusion Clinical and histopathologic correlation allowed for categorization of cutaneous reactions to the COVID-19 vaccine. We propose defining a subset of vaccine-related eruption of papules and plaques, as well as 12 other patterns, following COVID-19 vaccination.
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Affiliation(s)
- Devon E McMahon
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Damsky
- Department of Dermatology, Yale-New Haven Hospital, New Haven, Connecticut
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jules B Lipoff
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anisha Tyagi
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Grace Chamberlin
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Ramie Fathy
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rosalynn M Nazarian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Seemal R Desai
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas; Innovative Dermatology, Plano, Texas
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Bruce H Thiers
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - George J Hruza
- Department of Dermatology, St. Louis University, St. Louis, Missouri
| | - Lars E French
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany; Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Kimberly Blumenthal
- Division of Rheumatology, Allergy, Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Lindy P Fox
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts.
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9
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Slaught C, Madu P, Chang AY, Williams VL, Kebaetse MB, Nkomazana O, Molefe-Baikai OJ, Bekele NA, Omech B, Kellman PJ, Krasne S, Kovarik CL. Novel Education Modules Addressing the Underrepresentation of Skin of Color in Dermatology Training. J Cutan Med Surg 2021; 26:17-24. [PMID: 34340596 DOI: 10.1177/12034754211035093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Representative images of pathology in patients with skin of color are lacking in most medical education resources. This particularly affects training in dermatology, which relies heavily on the use of images to teach pattern recognition. The presentation of skin pathology can vary greatly among different skin tones, and this lack of representation of dark skin phototypes challenges providers' abilities to provide quality care to patients of color.In Botswana and other countries in sub-Saharan Africa, this challenge is further compounded by limited resources and access to dermatologists. There is a need for improved and accessible educational resources to train medical students and local medical providers in basic skin lesion description and diagnosis. OBJECTIVES We examined whether online Perceptual and Adaptive Learning Modules (PALMs) composed of representative dark skin images could efficiently train University of Botswana medical students to more accurately describe and diagnose common skin conditions in their community. METHODS Year 4 and 5 medical students voluntarily completed PALMs that teach skin morphology, configuration, and distribution terminology and diagnosis of the most common dermatologic conditions in their community. Pre-tests, post-tests and delayed-tests assessed knowledge acquisition and retention. RESULTS PALMs training produced statistically significant (P < .0001) improvements in accuracy and fluency with large effect sizes (1.5, 3.7) and good retention after a 12.5-21-week median delay. Limitations were a self-selected group of students, a single institution, slow internet connections, and high drop-out rates. CONCLUSIONS Overall, population-specific PALMs are a useful tool for efficient development of pattern recognition in skin disease description and diagnosis.
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Affiliation(s)
- Christa Slaught
- 78843 Department of Dermatology, Oregon Health and Sciences University, Portland, OR, USA
| | - Pamela Madu
- 12223 Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Aileen Y Chang
- 8785 Department of Dermatology, University of California San Francisco School of Medicine, CA, USA
| | - Victoria L Williams
- 14640 Botswana University of Pennsylvania Partnership, Gaborone, Botswana.,Merck & Co, Inc, North Wales, PA, USA.,14640 Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, PA, USA
| | - Masego B Kebaetse
- 54547 Department of Medical Education, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Oathokwa Nkomazana
- 54547 Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Negussie A Bekele
- 54547 Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Bernard Omech
- 487455 Faculty of Health Sciences, Lira University, Uganda
| | - Philip J Kellman
- 8783 Department of Psychology, University of California, Los Angeles, CA, USA
| | - Sally Krasne
- 12222 Department of Physiology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Carrie L Kovarik
- 14640 Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, PA, USA
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10
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Nelson CA, Pachauri S, Balk R, Miller J, Theunis R, Ko JM, Kovarik CL. Dermatologists' Perspectives on Artificial Intelligence and Augmented Intelligence - A Cross-sectional Survey. JAMA Dermatol 2021; 157:871-874. [PMID: 34037674 DOI: 10.1001/jamadermatol.2021.1685] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | | | - Rosie Balk
- American Academy of Dermatology, Rosemont, Illinois
| | | | | | - Justin M Ko
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Internal Medicine, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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11
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Affiliation(s)
- Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Emily Y Chu
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Adewole S Adamson
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin.,LIVESTRONG Cancer Institutes, The University of Texas at Austin
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12
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Pei S, Fischer AS, Yan AC, Jen M, Kovarik CL, Chu EY, Rubin AI. Lymphedematous verrucous changes of the genital skin: an extraintestinal manifestation of Crohn disease. J Cutan Pathol 2021; 48:465-468. [PMID: 33470431 DOI: 10.1111/cup.13723] [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: 12/24/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Susan Pei
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew S Fischer
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Albert C Yan
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melinda Jen
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carrie L Kovarik
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Y Chu
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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13
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Williams VL, Kovarik CL. Global Dermatology and Telemedicine. Dermatol Clin 2021. [DOI: 10.1016/s0733-8635(20)30080-2] [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: 11/30/2022]
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14
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Affiliation(s)
- Carrie L Kovarik
- Perelman School of Medicine, Department of Dermatology, University of Pennsylvania, Philadelphia
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15
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Jariwala NN, Snider CK, Mehta SJ, Armstrong JK, Smith-McLallen A, Takeshita J, Kovarik CL, Lipoff JB. Prospective Implementation of a Consultative Store-and-Forward Teledermatology Model at a Single Urban Academic Health System with Real Cost Data Subanalysis. Telemed J E Health 2020; 27:989-996. [PMID: 33147111 DOI: 10.1089/tmj.2020.0248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Teledermatology may increase access to care but has not been widely implemented due, in part, to lack of insurance coverage and reimbursement. We assessed the impact of implementing a consultative store-and-forward teledermatology model on access to care, medical cost, and utilization. Materials and Methods: Prospective implementation of teledermatology occurred at five University of Pennsylvania Health System primary care practices from June 27, 2016, to May 25, 2017. Primary outcomes included time to case completion, proportion of patients completing in-person dermatology visits, and total outpatient costs. Medical and pharmacy claims data were used for utilization and cost subanalysis. Results: The study included 167 patients and 1,962 controls with a 6-month follow-up. Median time to definitive dermatologist response was 0.19 days (interquartile range [IQR]: 0.03-2.92) for intervention and 83.60 days (IQR: 19.74-159.73) for controls. In medical claims subanalysis, no significant differences in mean outpatient costs ($3,366 vs. $2,232, p = 0.1356) or total medical costs ($3,535 vs. $2,654, p = 0.2899) were detected. Conclusions: Implementation of teledermatology improved access to care, and within this small sample, remained comparable in terms of cost and utilization. Thus, these data suggest teledermatology may improve access without increasing utilization or cost.
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Affiliation(s)
- Neha N Jariwala
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher K Snider
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shivan J Mehta
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Junko Takeshita
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics; Center for Clinical Epidemiology and Biostatistics; University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jules B Lipoff
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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Williams VL, Kovarik CL. The Growing Importance of Dermatology on the Global Stage. Dermatol Clin 2020; 39:xiii-xiv. [PMID: 33228866 DOI: 10.1016/j.det.2020.09.001] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Carrie L Kovarik
- 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 19104, USA.
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17
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El-Mallawany NK, Kamiyango W, Villiera J, Peckham-Gregory EC, Scheurer ME, McAtee CL, Allen CE, Kovarik CL, Frank D, Eason AB, Caro-Vegas C, Chiao EY, Schutze GE, Ozuah NW, Mehta PS, Kazembe PN, Dittmer DP. Kaposi Sarcoma Herpesvirus Inflammatory Cytokine Syndrome-like Clinical Presentation in Human Immunodeficiency Virus-infected Children in Malawi. Clin Infect Dis 2020; 69:2022-2025. [PMID: 31102440 DOI: 10.1093/cid/ciz250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/17/2018] [Accepted: 03/20/2019] [Indexed: 12/20/2022] Open
Abstract
We describe 7 human immunodeficiency virus-infected Malawian children with Kaposi sarcoma who met criteria for Kaposi sarcoma herpesvirus (KSHV) inflammatory cytokine syndrome. Each presented with persistent fevers, bulky lymphadenopathy, massive hepatosplenomegaly, and severe cytopenias. Plasma analyses were performed in 2 patients, both demonstrating extreme elevations of KSHV viral load and interleukin 6.
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Affiliation(s)
| | | | - Jimmy Villiera
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe
| | | | - Michael E Scheurer
- Baylor College of Medicine
- Texas Children's Cancer and Hematology Centers, Houston
| | - Casey L McAtee
- Baylor College of Medicine
- Texas Children's Cancer and Hematology Centers, Houston
| | - Carl E Allen
- Baylor College of Medicine
- Texas Children's Cancer and Hematology Centers, Houston
| | | | - Dale Frank
- University of Pennsylvania, Philadelphia
| | - Anthony B Eason
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Carolina Caro-Vegas
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Elizabeth Y Chiao
- Center for Innovation, Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center
- Baylor College of Medicine, Department of Medicine, Section of Infectious Diseases
| | | | - Nmazuo W Ozuah
- Baylor College of Medicine
- Texas Children's Cancer and Hematology Centers, Houston
| | - Parth S Mehta
- Baylor College of Medicine
- Texas Children's Cancer and Hematology Centers, Houston
| | - Peter N Kazembe
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe
| | - Dirk P Dittmer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
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18
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Anshelevich EE, Barbieri JS, Kovarik CL. Intralesional cidofovir for treatment of recalcitrant warts in both immunocompetent and immunocompromised patients: A retrospective analysis of 58 patients. J Am Acad Dermatol 2020; 84:206-207. [PMID: 32348821 DOI: 10.1016/j.jaad.2020.04.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Ellen E Anshelevich
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John S Barbieri
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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19
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McCormick DW, Bacha JM, El-Mallawany NK, Kovarik CL, Slone JS, Campbell LR. Disseminated cysticercosis and Kaposi sarcoma in a child with HIV/AIDS: A case report. BMC Infect Dis 2020; 20:309. [PMID: 32334521 PMCID: PMC7183726 DOI: 10.1186/s12879-020-05039-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/24/2020] [Accepted: 04/16/2020] [Indexed: 12/22/2022] Open
Abstract
Background Clinical manifestations of extraneural infection with the pork tapeworm Taenia solium typically affect the muscles, eyes, alimentary canal, and/or subcutaneous tissues. Children living with HIV are at increased risk for more widespread and severe manifestations of food-borne opportunistic infections, including T. solium, due to fluctuating levels of immunosuppression. We present a case of disseminated T. solium in a HIV-positive child with Kaposi sarcoma living in Tanzania with cysticercosis presenting as widespread subcutaneous nodules. Case presentation A 4-year-old HIV-positive boy in Southern Tanzania presented for evaluation of > 30 violaceous skin lesions, few subcutaneous nodules, and a circumferential violaceous penile lesion which rapidly grew after initiation of ART. The patient was clinically diagnosed with Kaposi sarcoma and started on chemotherapy with bleomycin, vincristine, and doxorubicin. He completed 10 cycles of chemotherapy, with full resolution of the violaceous skin and penile lesions but persistence of his subcutaneous nodules, thus paclitaxel was added. After 12 additional cycles of paclitaxel, his subcutaneous nodules enlarged, and biopsy of a scapular subcutaneous nodule was performed. Histopathology revealed a cystic structure with a central larval scolex and serrated spiral canal consistent with T. solium, which confirmed a diagnosis of disseminated cysticercosis. He completed a 10-day course of praziquantel and albendazole with resolution of the subcutaneous nodules. Conclusions Disseminated cysticercosis is an unusual opportunistic infection which can present as subcutaneous nodules without other typical cysticercosis symptoms. Immunosuppression – from HIV and/or chemotherapy – may unmask cysticercosis in children in endemic regions and result in more severe manifestations of this disease. Cysticercosis should remain on a clinician’s differential for subcutaneous nodules, especially in children living with HIV. Cysticercosis can mimic Kaposi sarcoma, and histopathology is essential to accurately diagnose and manage patients with concerning skin lesions.
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Affiliation(s)
- David W McCormick
- Baylor College of Medicine, 1 Baylor Plaza BCM 620, Houston, TX, 77030-3411, USA.
| | - Jason M Bacha
- Baylor College of Medicine, 1 Baylor Plaza BCM 620, Houston, TX, 77030-3411, USA.,Baylor International Pediatric AIDS Initiative (BIPAI) at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.,Baylor College of Medicine Children's Foundation - Tanzania, Pediatrics, Mbeya, Tanzania
| | - Nader K El-Mallawany
- Baylor College of Medicine - Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - J S Slone
- Baylor College of Medicine - Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Liane R Campbell
- Baylor College of Medicine, 1 Baylor Plaza BCM 620, Houston, TX, 77030-3411, USA.,Baylor International Pediatric AIDS Initiative (BIPAI) at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.,Baylor College of Medicine Children's Foundation - Tanzania, Pediatrics, Mbeya, Tanzania
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20
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Nguyen CV, He Q, Rady PL, Tyring SK, Miller DD, Rubin N, Kovarik CL. Presence of human papillomavirus DNA in voriconazole-associated cutaneous squamous cell carcinoma. Int J Dermatol 2020; 59:595-598. [PMID: 32060904 DOI: 10.1111/ijd.14820] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/17/2019] [Accepted: 01/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Voriconazole and genus beta human papillomavirus (HPV) are independently associated with the development of photo-exposed cutaneous squamous cell carcinoma (SCC) but have not been evaluated concurrently. The objective of this study is to determine the prevalence and type of detectable HPV DNA in voriconazole-associated SCC. METHODS SCCs from immunosuppressed patients, in those with and without voriconazole exposure, were evaluated by PCR analysis for HPV DNA and compared to SCC from non-immunosuppressed patients. An additional expanded PCR analysis of all SCC that developed in the voriconazole group was also performed. RESULTS HPV DNA was detected by PCR in all groups regardless of the immunosuppression status (80.5%) with beta HPV most prevalent (64.3-78.6%). However, immunosuppressed patients were significantly more likely to be infected by beta HPV types 5, 8, 14, 20, and 21 (P-value 0.014), and represented the majority of beta HPV types found in the voriconazole group. CONCLUSIONS In this retrospective study, beta HPV 5, 8, 14, 20, and 21 were commonly detected in voriconazole-associated SCC. The results indicate a possible role of beta HPV in the pathogenesis of cutaneous SCC in photo-exposed areas. Further studies are needed to establish the role of HPV and voriconazole in the pathogenesis of the lesion.
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Affiliation(s)
- Cuong V Nguyen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Qin He
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Peter L Rady
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stephen K Tyring
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Daniel D Miller
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - Nathan Rubin
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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21
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Wang RH, Barbieri JS, Nguyen HP, Stavert R, Forman HP, Bolognia JL, Kovarik CL. Clinical effectiveness and cost-effectiveness of teledermatology: Where are we now, and what are the barriers to adoption? J Am Acad Dermatol 2020; 83:299-307. [PMID: 32035106 DOI: 10.1016/j.jaad.2020.01.065] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [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: 09/26/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
There has been rapid growth in teledermatology over the past decade, and teledermatology services are increasingly being used to support patient care across a variety of care settings. Teledermatology has the potential to increase access to high-quality dermatologic care while maintaining clinical efficacy and cost-effectiveness. Recent expansions in telemedicine reimbursement from the Centers for Medicare & Medicaid Services (CMS) ensure that teledermatology will play an increasingly prominent role in patient care. Therefore, it is important that dermatologists be well informed of both the promises of teledermatology and the potential practice challenges a continuously evolving mode of care delivery brings. In this article, we will review the evidence on the clinical and cost-effectiveness of teledermatology and we will discuss system-level and practice-level barriers to successful teledermatology implementation as well as potential implications for dermatologists.
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Affiliation(s)
- Robin H Wang
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - John S Barbieri
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Harrison P Nguyen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert Stavert
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Howard P Forman
- Department of Public Health (Health Policy), Economics, and Management, Yale University, New Haven, Connecticut
| | - Jean L Bolognia
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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22
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Ruoss AV, Short WR, Kovarik CL. The Patient's Perspective: Reorienting Dermatologic Care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning Patients. Dermatol Clin 2019; 38:191-199. [PMID: 32115128 DOI: 10.1016/j.det.2019.10.003] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The past decade has seen significant advancements in care and representation of LGBTQ patients in American health care. These efforts have primarily taken the form of institutional policy changes and medical staff training in cultural competency. Drawing from patient interviews and author expertise, this article discusses the patient experience as the starting point for the development of effective, inclusive policy. Looking to the related field of LGBTQ youth wellness and education, and focusing on an integrative approach to LGBTQ health care within the University of Pennsylvania Health System, this article seeks to reframe the discussion about the care of LGBTQ-identifying patients in dermatologic practices.
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Affiliation(s)
- Andrew V Ruoss
- The Greenwich Country Day School, Greenwich, CT 06830, USA
| | - William R Short
- Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, 2 Maloney Building, 3600 Spruce Street, Philadelphia, PA 19104, USA.
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23
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Barbieri JS, Yang X, Kovarik CL. Evaluating the cost-effectiveness of teledermatology. J Am Acad Dermatol 2019; 81:765-766. [DOI: 10.1016/j.jaad.2018.06.074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 11/28/2022]
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24
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Abstract
INTRODUCTION Mobile health has a promising future in the healthcare system in most developed countries. China's rapidly developing mobile technology infrastructure offers an unprecedented opportunity for wide adoption of mobile health interventions in the delivery of effective and timely healthcare services. However, there is little data on the current extent of the mobile health landscape in China. The aim of this study was to systematically review the existing mobile health initiatives in China, characterise the technology used, disease categories targeted, location of the end user (urban versus rural), and examine the potential effects of mobile health on health system strengthening in China. Furthermore, we identified gaps in development and evaluation of the effectiveness of mobile health interventions. METHODS A systematic review of the literature published from 18 December 2015 - 3 April 2019 was conducted and yielded 2863 articles from English and Chinese retrieval database and trial registries, including PubMed, EMBASE, China National Knowledge of Infrastructure and World Health Organization International Clinical Trials Registry Platform. Studies were included if they used mobile health to support patient healthcare outcomes. RESULTS A total of 1129 full-text articles were assessed and 338 were included in this study. The review found that most studies targeted client education and behaviour change via applications (apps) (65.4%), including WeChat, and text messaging (short text messages) (19.8%) to improve patient medical treatment outcomes such as compliance and appointment reminders. The most common disease-specific mobile health interventions focused primarily on chronic disease management and behaviour change in cardiology (13.3%), endocrinology/diabetes (12.1%), behavioural health (11.8%), oncology (11.2%) and neurology (6.8%). The mobile health interventions related to nutrition (0.6%) and chronic respiratory diseases (1.6%) are underrepresented in mobile health in comparison to the burden of disease in China. The majority (90.0%) of the mobile health interventions were conducted exclusively in urban areas, with few opportunities reaching rural populations. CONCLUSIONS Overall, mobile health has a promising future in China, with recent rapid growth in initiatives. The majority are focused on education and behaviour change in the realm of chronic diseases and target patients in urban areas. The imbalance in mobile health between the urban and rural areas, as well as between population disease spectrum and health service delivery, pose substantial dilemmas. However, mobile health may be redirected to correct this imbalance, possibly improving access to healthcare services, and filling the gaps in order to improve health equity for the underserved populations in China.
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Affiliation(s)
- Xiaoshi Yang
- Department of Social Medicine, China Medical University, P.R. China.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, USA
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, USA
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25
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Forrestel AK, Kovarik CL, Katz KA. Sexually acquired syphilis: Historical aspects, microbiology, epidemiology, and clinical manifestations. J Am Acad Dermatol 2019; 82:1-14. [PMID: 30986477 DOI: 10.1016/j.jaad.2019.02.073] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [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: 10/05/2018] [Revised: 02/10/2019] [Accepted: 02/12/2019] [Indexed: 01/03/2023]
Abstract
Syphilis is caused by infection with the spirochetal bacterium Treponema pallidum subsp. pallidum. It was first recognized in the late 15th century. Since 2000, the incidence of sexually acquired syphilis has increased substantially in the developed world, with men who have sex with men and persons living with HIV infection disproportionately affected. Clinical manifestations of syphilis are protean and often include mucocutaneous manifestations. The first article in this continuing medical education series reviews historical aspects, microbiology, epidemiology, and clinical manifestations of sexually acquired syphilis.
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Affiliation(s)
- Amy K Forrestel
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth A Katz
- Department of Dermatology, Kaiser Permanente, San Francisco, California
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26
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Forrestel AK, Kovarik CL, Katz KA. Sexually acquired syphilis: Laboratory diagnosis, management, and prevention. J Am Acad Dermatol 2019; 82:17-28. [PMID: 30986474 DOI: 10.1016/j.jaad.2019.02.074] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 11/25/2022]
Abstract
The methods used for the laboratory diagnosis of syphilis include direct detection of Treponema pallidum subspecies pallidum and serologic testing. Serologic testing relies on both nontreponemal and treponemal tests. In newly developed reverse-sequence screening algorithms, treponemal tests are performed before nontreponemal tests. The management of syphilis requires appropriate staging, treatment, and follow-up of patients along with the prompt reporting of infections to public health authorities to assist with prevention and control efforts. Benzathine penicillin G remains the treatment of choice for all stages of syphilis. Screening of populations at higher risk for syphilis is recommended by the US Centers for Disease Control and Prevention, the US Preventive Services Task Force, and the World Health Organization. The second article in this continuing medical education series reviews the testing for and the management of sexually acquired syphilis.
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Affiliation(s)
- Amy K Forrestel
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth A Katz
- Department of Dermatology, Kaiser Permanente, San Francisco, California
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Slaught C, Williams V, Grover S, Bigger E, Kayembe M, Chiyapo S, Jackson NJ, Dryden-Peterson S, Kovarik CL, Wanat KA. A retrospective review of patients with Kaposi's sarcoma in Botswana. Int J Dermatol 2018; 58:707-712. [PMID: 30460985 DOI: 10.1111/ijd.14305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 10/14/2018] [Accepted: 10/24/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Despite widespread antiretroviral coverage in Botswana, Kaposi's sarcoma (KS) remains among the most common malignancies. To date, adult KS in Botswana is not well characterized. The diagnosis relies on clinical suspicion that is often confirmed by histopathology given the implications of treatment; however, this poses a significant resource burden. METHODS We conducted a retrospective review of the cohort of patients biopsied for possible KS at Princess Marina Hospital, the main dermatology referral site in Botswana, from September 2008 through June 2015 to describe the demographics, human immunodeficiency virus (HIV) characteristics, and clinical presentations of these patients. Histopathologic diagnoses were reviewed, and positive predictive value (PPV) was used to characterize the accuracy of clinical suspicion of KS. RESULTS A total of 441 patients received 450 biopsies where KS was on the differential diagnosis, and 239 patients (54%) were ultimately diagnosed with KS. The KS cohort was more likely to be male (58% vs. 37%, P < 0.001), HIV positive (94% vs. 85%, P < 0.05), and have lower CD4 counts at the time of biopsy (274 cells/μl vs. 362 cells/μl, P < 0.05). The PPV of clinical suspicion of KS was 58%. When KS was not histopathologically diagnosed, clinically benign diseases were found in 17%, medically significant conditions requiring alternative therapies in 78%, and life-threatening diseases in 5%. DISCUSSION Our study reinforces the risk factors in development of KS. The poor PPV supports the important role of histology in KS diagnosis to both ensure appropriate treatment and prevent overtreatment. Improved accessibility to biopsy and augmentation of local dermatopathologic services would likely improve diagnostic accuracy and treatment.
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Affiliation(s)
- Christa Slaught
- Department of Dermatology, Oregon Health and Sciences University, Portland, OR, USA
| | - Victoria Williams
- Ministry of Health of Botswana, Gaborone, Botswana.,Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | - Elizabeth Bigger
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Mukendi Kayembe
- Department of Anatomical Pathology, National Health Laboratory, Gaborone, Botswana.,Department of Pathology, University of Botswana School of Medicine, Gaborone, Botswana
| | - Sebathu Chiyapo
- Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | - Nicholas J Jackson
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Scott Dryden-Peterson
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Botswana Harvard AIDS Institute, Gaborone, Botswana.,Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Karolyn A Wanat
- Department of Dermatology and Pathology, University of Iowa, Iowa City, IA, USA
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El-Mallawany NK, Villiera J, Kamiyango W, Peckham-Gregory EC, Scheurer ME, Allen CE, McAtee CL, Legarreta A, Dittmer DP, Kovarik CL, Chiao EY, Martin SC, Ozuah NW, Mehta PS, Kazembe PN. Endemic Kaposi sarcoma in HIV-negative children and adolescents: an evaluation of overlapping and distinct clinical features in comparison with HIV-related disease. Infect Agent Cancer 2018; 13:33. [PMID: 30455728 PMCID: PMC6230225 DOI: 10.1186/s13027-018-0207-4] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/31/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Endemic Kaposi sarcoma (KS) was first described in African children over fifty years ago, but has recently been overshadowed by HIV-related disease. We aimed to evaluate the similarities and differences between endemic HIV-negative and epidemic HIV-positive pediatric KS in a KS-associated herpesvirus-endemic region of Africa. METHODS We describe clinical characteristics of 20 HIV-negative children with endemic KS over a six-year period and compare findings with a historical control-an HIV-related pediatric KS cohort from Lilongwe, Malawi. RESULTS The HIV-negative endemic KS cohort was 70% male with a median age of 9.3 years. Lymph node involvement was present in 50%, hyperpigmented skin lesions in 45%, and woody edema in 40%. One patient (5%) presented with oral KS involvement and no patients presented initially with visceral KS. Significant anemia (hemoglobin < 8 g/dL) and thrombocytopenia (platelet count < 100 × 109/L) were found at time of original KS diagnosis in 45 and 40% respectively. In both HIV-negative and HIV-positive cohorts, lymphadenopathy was the most common presentation, prototypical skin lesions were often absent, severe cytopenias were a common clinical feature, and treatment outcomes were similar. Patients with endemic KS demonstrated less frequent oral involvement (5% versus 29%, P = 0.03) and a lower proportion of patients with visceral involvement (0% versus 16%, P = 0.06). CONCLUSIONS These data suggest clinical overlap between epidemiological variants. Treatment protocols for pediatric KS in sub-Saharan Africa should be devised to include both endemic HIV-negative and epidemic HIV-related disease to better define the clinical and biological comparison.
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Affiliation(s)
- Nader Kim El-Mallawany
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, TX USA
- Texas Children’s Cancer and Hematology Centers, Baylor College of Medicine, Global HOPE (Hematology-Oncology Pediatric Excellence), 1102 Bates Street, Feigin Tower, Suite 1025.16, Houston, TX 77030 USA
| | - Jimmy Villiera
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Kamuzu Central Hospital, Lilongwe, Malawi
| | - William Kamiyango
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Kamuzu Central Hospital, Lilongwe, Malawi
| | - Erin C. Peckham-Gregory
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, TX USA
- Texas Children’s Cancer and Hematology Centers, Baylor College of Medicine, Global HOPE (Hematology-Oncology Pediatric Excellence), 1102 Bates Street, Feigin Tower, Suite 1025.16, Houston, TX 77030 USA
| | - Michael E. Scheurer
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, TX USA
- Texas Children’s Cancer and Hematology Centers, Baylor College of Medicine, Global HOPE (Hematology-Oncology Pediatric Excellence), 1102 Bates Street, Feigin Tower, Suite 1025.16, Houston, TX 77030 USA
| | - Carl E. Allen
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, TX USA
- Texas Children’s Cancer and Hematology Centers, Baylor College of Medicine, Global HOPE (Hematology-Oncology Pediatric Excellence), 1102 Bates Street, Feigin Tower, Suite 1025.16, Houston, TX 77030 USA
| | - Casey L. McAtee
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, TX USA
- Texas Children’s Cancer and Hematology Centers, Baylor College of Medicine, Global HOPE (Hematology-Oncology Pediatric Excellence), 1102 Bates Street, Feigin Tower, Suite 1025.16, Houston, TX 77030 USA
| | - Alejandra Legarreta
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, TX USA
- Texas Children’s Cancer and Hematology Centers, Baylor College of Medicine, Global HOPE (Hematology-Oncology Pediatric Excellence), 1102 Bates Street, Feigin Tower, Suite 1025.16, Houston, TX 77030 USA
| | - Dirk P. Dittmer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC USA
| | | | - Elizabeth Y. Chiao
- Center for Innovation, Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX USA
- Baylor College of Medicine, Department of Medicine, Section of Infectious Diseases, Houston, TX USA
| | - Stephen C. Martin
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, TX USA
- Texas Children’s Cancer and Hematology Centers, Baylor College of Medicine, Global HOPE (Hematology-Oncology Pediatric Excellence), 1102 Bates Street, Feigin Tower, Suite 1025.16, Houston, TX 77030 USA
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Nmazuo W. Ozuah
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, TX USA
- Texas Children’s Cancer and Hematology Centers, Baylor College of Medicine, Global HOPE (Hematology-Oncology Pediatric Excellence), 1102 Bates Street, Feigin Tower, Suite 1025.16, Houston, TX 77030 USA
| | - Parth S. Mehta
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, TX USA
- Texas Children’s Cancer and Hematology Centers, Baylor College of Medicine, Global HOPE (Hematology-Oncology Pediatric Excellence), 1102 Bates Street, Feigin Tower, Suite 1025.16, Houston, TX 77030 USA
| | - Peter N. Kazembe
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Kamuzu Central Hospital, Lilongwe, Malawi
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Marek AJ, Chu EY, Ming ME, Khan ZA, Kovarik CL. Piloting the Use of Smartphones, Reminders, and Accountability Partners to Promote Skin Self-Examinations in Patients with Total Body Photography: A Randomized Controlled Trial. Am J Clin Dermatol 2018; 19:779-785. [PMID: 30062632 DOI: 10.1007/s40257-018-0372-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the use of a mobile application (app) in patients already using total body photography (TBP) to increase skin self-examination (SSE) rates and pilot the effectiveness of examination reminders and accountability partners. DESIGN Randomized controlled trial with computer generated randomization table to allocate interventions. SETTING University of Pennsylvania pigmented lesion clinic. PARTICIPANTS 69 patients aged 18 years or older with an iPhone/iPad, who were already in possession of TBP photographs. INTERVENTION A mobile app loaded with digital TBP photos for all participants, and either (1) the mobile app only, (2) skin examination reminders, (3) an accountability partner, or (4) reminders and an accountability partner. MAIN OUTCOME MEASURE Change in SSE rates as assessed by enrollment and end-of-study surveys 6 months later. RESULTS Eighty one patients completed informed consent, however 12 patients did not complete trial enrollment procedures due to device incompatibility, leaving 69 patients who were randomized and analyzed [mean age 54.3 years, standard deviation 13.9). SSE rates increased significantly from 58% at baseline to 83% at 6 months (odds ratio 2.64, 95% confidence interval 1.20-4.09), with no difference among the intervention groups. The group with examination reminders alone had the highest (94%) overall satisfaction, and the group with accountability partners alone accounted for the lowest (71%). CONCLUSION A mobile app alone, or with reminders and/or accountability partners, was found to be an effective tool that can help to increase SSE rates. Skin examination reminders may help provide a better overall experience for a subset of patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02520622.
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Affiliation(s)
- Andrew J Marek
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Department of Medicine, MedStar Harbor Hospital, Baltimore, MD, USA.
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Emily Y Chu
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael E Ming
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Zeeshan A Khan
- Department of Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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30
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Madu PN, Williams VL, Noe MH, Omech BG, Kovarik CL, Wanat KA. Autoimmune skin disease among dermatology outpatients in Botswana: a retrospective review. Int J Dermatol 2018; 58:50-53. [DOI: 10.1111/ijd.14201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 01/12/2018] [Revised: 05/10/2018] [Accepted: 08/06/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Pamela N. Madu
- Department of Dermatology Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Victoria L. Williams
- Department of Dermatology Perelman School of Medicine University of Pennsylvania Philadelphia PA USA
- Botswana Ministry of Health Gaborone Botswana
| | - Megan H. Noe
- Department of Dermatology Perelman School of Medicine University of Pennsylvania Philadelphia PA USA
| | - Bernard G. Omech
- Department of Internal Medicine University of Botswana School of Medicine Gaborone Botswana
| | - Carrie L. Kovarik
- Department of Dermatology Perelman School of Medicine University of Pennsylvania Philadelphia PA USA
| | - Karolyn A. Wanat
- Department of Dermatology University of Iowa Carver College of Medicine Iowa City IA USA
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31
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Mosojane KI, Sowash M, Williams VL, Kovarik CL. Multifocal verrucous plaques in an apparently immunocompetent female. Int J Dermatol 2018; 57:1509-1512. [PMID: 29884986 DOI: 10.1111/ijd.14083] [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: 10/11/2017] [Revised: 05/01/2018] [Accepted: 05/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Madeleine Sowash
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Victoria L Williams
- Princess Marina Hospital, Gaborone, Botswana.,Botswana UPenn Partnership, Gaborone, Botswana.,Department of Dermatology and Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carrie L Kovarik
- Department of Dermatology and Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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32
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Nelson CA, Kovarik CL, Barbieri JS. Human-computer symbiosis: enhancing dermatologic care while preserving the art of healing. Int J Dermatol 2018; 57:1015-1016. [PMID: 29873395 DOI: 10.1111/ijd.14071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 04/27/2018] [Accepted: 05/16/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John S Barbieri
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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33
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Marek AJ, Chu EY, Ming ME, Khan ZA, Kovarik CL. Impact of a smartphone application on skin self-examination rates in patients who are new to total body photography: A randomized controlled trial. J Am Acad Dermatol 2018; 79:564-567. [PMID: 29438760 DOI: 10.1016/j.jaad.2018.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 12/28/2017] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Andrew J Marek
- Department of Medicine, MedStar Harbor Hospital, Baltimore, Maryland
| | - Emily Y Chu
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael E Ming
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zeeshan A Khan
- Department of Medicine, Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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34
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Chavez AB, Kovarik CL. Commentary: The ethics of volunteerism: Whose cultural and ethical norms take precedence? J Am Acad Dermatol 2018; 78:429-430. [PMID: 29332720 DOI: 10.1016/j.jaad.2017.08.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 08/29/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Afton B Chavez
- Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island; Warren Alpert Medical School, Brown University, Providence, Rhode Island.
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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35
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El-Mallawany NK, Kamiyango W, Villiera J, Slone JS, Kovarik CL, Campbell LR, Agrawal AK, Dittmer DP, Eason AB, Ahmed S, Schutze GE, Scheurer ME, Kazembe PN, Mehta PS. Proposal of a Risk-Stratification Platform to Address Distinct Clinical Features of Pediatric Kaposi Sarcoma in Lilongwe, Malawi. J Glob Oncol 2017; 4:1-7. [PMID: 29272148 PMCID: PMC6180767 DOI: 10.1200/jgo.17.00054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Nader Kim El-Mallawany
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - William Kamiyango
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Jimmy Villiera
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Jeremy S Slone
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Carrie L Kovarik
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Liane R Campbell
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Anurag K Agrawal
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Dirk P Dittmer
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Anthony B Eason
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Saeed Ahmed
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Gordon E Schutze
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Michael E Scheurer
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Peter N Kazembe
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Parth S Mehta
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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Resneck JS, Abrouk M, Steuer M, Tam A, Yen A, Lee I, Kovarik CL, Edison KE. Choice, Transparency, Coordination, and Quality Among Direct-to-Consumer Telemedicine Websites and Apps Treating Skin Disease. JAMA Dermatol 2017; 152:768-75. [PMID: 27180232 DOI: 10.1001/jamadermatol.2016.1774] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Evidence supports use of teleconsultation for improving patient access to dermatology. However, little is known about the quality of rapidly expanding direct-to-consumer (DTC) telemedicine websites and smartphone apps diagnosing and treating skin disease. OBJECTIVE To assess the performance of DTC teledermatology services. DESIGN AND PARTICIPANTS Simulated patients submitted a series of structured dermatologic cases with photographs, including neoplastic, inflammatory, and infectious conditions, using regional and national DTC telemedicine websites and smartphone apps offering services to California residents. MAIN OUTCOMES AND MEASURES Choice of clinician, transparency of credentials, clinician location, demographic and medical data requested, diagnoses given, treatments recommended or prescribed, adverse effects discussed, care coordination. RESULTS We received responses for 62 clinical encounters from 16 DTC telemedicine websites from February 4 to March 11, 2016. None asked for identification or raised concerns about pseudonym use or falsified photographs. During most encounters (42 [68%]), patients were assigned a clinician without any choice. Only 16 (26%) disclosed information about clinician licensure, and some used internationally based physicians without California licenses. Few collected the name of an existing primary care physician (14 [23%]) or offered to send records (6 [10%]). A diagnosis or likely diagnosis was proffered in 48 encounters (77%). Prescription medications were ordered in 31 of 48 diagnosed cases (65%), and relevant adverse effects or pregnancy risks were disclosed in a minority (10 of 31 [32%] and 6 of 14 [43%], respectively). Websites made several correct diagnoses in clinical scenarios where photographs alone were adequate, but when basic additional history elements (eg, fever, hypertrichosis, oligomenorrhea) were important, they regularly failed to ask simple relevant questions and diagnostic performance was poor. Major diagnoses were repeatedly missed, including secondary syphilis, eczema herpeticum, gram-negative folliculitis, and polycystic ovarian syndrome. Regardless of the diagnoses given, treatments prescribed were sometimes at odds with existing guidelines. CONCLUSIONS AND RELEVANCE Telemedicine has potential to expand access to high-value health care. Our findings, however, raise concerns about the quality of skin disease diagnosis and treatment provided by many DTC telemedicine websites. Ongoing expansion of health plan coverage of these services may be premature. Until improvements are made, patients risk using health care services that lack transparency, choice, thoroughness, diagnostic and therapeutic quality, and care coordination. We offer several suggestions to improve the quality of DTC telemedicine websites and apps and avoid further growth of fragmented, low-quality care.
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Affiliation(s)
- Jack S Resneck
- Department of Dermatology, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco School of Medicine, San Francisco
| | - Michael Abrouk
- University of California, San Francisco School of Medicine, San Francisco
| | - Meredith Steuer
- University of California, San Francisco School of Medicine, San Francisco
| | - Andrew Tam
- University of California, San Francisco School of Medicine, San Francisco
| | - Adam Yen
- University of California, San Francisco School of Medicine, San Francisco
| | - Ivy Lee
- Pasadena Premier Dermatology, Pasadena, California
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Karen E Edison
- Department of Dermatology, University of Missouri, Columbia
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Rodriguez O, Kovarik CL. Immunostaining for High-Risk Human Papillomavirus in Condyloma Lesions in Immunocompromised Patients. Am J Clin Dermatol 2017; 18:413-417. [PMID: 28224503 DOI: 10.1007/s40257-017-0262-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) is the underlying infectious cause of condyloma acuminata (CA) and high-risk types of HPV can cause cancer. Condyloma may undergo malignant degeneration, particularly in immunosuppressed patients. The presence of high-risk HPV in CA is a risk factor for developing malignancy; however, determining which patients with condyloma are clinically at risk can be difficult. High-risk HPV can now be localized within CA using routine immunohistochemical stains. METHODS We examined HPV (cocktail, 16, 18) immunohistochemical staining of CA and the relevant clinical history from immunocompromised patients and compared them with age- and sex- matched immunocompetent patients with biopsied CA. RESULTS HPV was detected in 9 of the 12 specimens from immunocompromised patients (75%), and 6 of the 12 specimens from the age- and sex-matched comparison patients (50%). HPV-16 was detected in 7 of the 12 specimens from immunocompromised patients (58%), and 4 of the 12 specimens from comparison patients (33%). HPV-18 was not detected in any of the 21 specimens from immunocompromised or comparison patients for which the stain was available. CONCLUSION High-risk HPV is found within CA lesions, more often in immunocompromised patients, and confirming the presence of these HPV types with stains in high-risk patient populations may help guide the clinician in treatment and surveillance in certain cases.
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Affiliation(s)
- Olaf Rodriguez
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA, 19104, USA.
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Marek AJ, Chu EY, Ming ME, Kovarik CL. Assessment of smartphone applications for total body digital photography-guided skin exams by patients. J Am Acad Dermatol 2017; 75:1063-1064.e1. [PMID: 27745634 DOI: 10.1016/j.jaad.2016.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/01/2016] [Accepted: 06/03/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Andrew J Marek
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Emily Y Chu
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Michael E Ming
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
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Charny JW, Kovarik CL. LGBT access to health care: a dermatologist's role in building a therapeutic relationship. Cutis 2017; 99:228-229. [PMID: 28492595] [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: 06/07/2023]
Affiliation(s)
- Jacob W Charny
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
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Madu PN, Chang AY, Kayembe MK, Kovarik CL. Teledermatology as a Means to Provide Multispecialty Care: A Case of Global Specialty Collaboration. Pediatr Dermatol 2017; 34:e89-e92. [PMID: 28297155 DOI: 10.1111/pde.13079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Telemedicine can serve as a platform for specialty collaboration and potentially address the lack of specialized and subspecialized care globally. In this article we present a case in which the use of teledermatology facilitated global collaboration between multiple specialists and subspecialists, resulting in high-quality care of a child from a remote area of Botswana. We present the lessons learned and factors that should be considered when engaging in global specialty collaboration, especially between developed and developing countries. We also discuss the potential limitations of telemedicine when used within a global context. With these considerations in mind, global specialty collaboration facilitated by telemedicine can provide a potential solution to the lack of access to specialized and subspecialized care.
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Affiliation(s)
- Pamela N Madu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aileen Y Chang
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mukendi K Kayembe
- Department of Pathology, National Health Laboratory, Gaborone, Botswana
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Ha YP, Tesfalul MA, Littman-Quinn R, Antwi C, Green RS, Mapila TO, Bellamy SL, Ncube RT, Mugisha K, Ho-Foster AR, Luberti AA, Holmes JH, Steenhoff AP, Kovarik CL. Evaluation of a Mobile Health Approach to Tuberculosis Contact Tracing in Botswana. J Health Commun 2016; 21:1115-1121. [PMID: 27668973 PMCID: PMC6238947 DOI: 10.1080/10810730.2016.1222035] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Tuberculosis (TB) contact tracing is typically conducted in resource-limited settings with paper forms, but this approach may be limited by inefficiencies in data collection, storage, and retrieval and poor data quality. In Botswana, we developed, piloted, and evaluated a mobile health (mHealth) approach to TB contact tracing that replaced the paper form-based approach for a period of six months. For both approaches, we compared the time required to complete TB contact tracing and the quality of data collected. For the mHealth approach, we also administered the Computer System Usability Questionnaire to 2 health care workers who used the new approach, and we identified and addressed operational considerations for implementation. Compared to the paper form-based approach, the mHealth approach reduced the median time required to complete TB contact tracing and improved data quality. The mHealth approach also had favorable overall rating, system usefulness, information quality, and interface quality scores on the Computer System Usability Questionnaire. Overall, the mHealth approach to TB contact tracing improved on the paper form-based approach used in Botswana. This new approach may similarly benefit TB contact tracing efforts in other resource-limited settings.
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Affiliation(s)
- Yoonhee P Ha
- a Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania , USA
- b Center for Public Health Initiatives , University of Pennsylvania , Philadelphia , Pennsylvania , USA
- c Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Martha A Tesfalul
- d Doris Duke Clinical Research Fellowship Program, Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania , USA
- e Botswana-UPenn Partnership , Gaborone , Botswana
| | | | | | - Rebecca S Green
- a Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Tumelo O Mapila
- f Nextel Enterprises (Pty) Ltd. , Gaborone , Botswana
- g Graduate School of Technology Management , University of Pretoria , Pretoria , South Africa
| | - Scarlett L Bellamy
- a Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania , USA
- b Center for Public Health Initiatives , University of Pennsylvania , Philadelphia , Pennsylvania , USA
- c Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania , USA
- h Department of Biostatistics and Epidemiology, Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Ronald T Ncube
- i Botswana National Tuberculosis Programme , Republic of Botswana Ministry of Health , Gaborone , Botswana
| | - Kenneth Mugisha
- i Botswana National Tuberculosis Programme , Republic of Botswana Ministry of Health , Gaborone , Botswana
| | - Ari R Ho-Foster
- a Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania , USA
- e Botswana-UPenn Partnership , Gaborone , Botswana
| | - Anthony A Luberti
- a Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania , USA
- e Botswana-UPenn Partnership , Gaborone , Botswana
- j Center for Biomedical Informatics , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA
| | - John H Holmes
- a Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania , USA
- b Center for Public Health Initiatives , University of Pennsylvania , Philadelphia , Pennsylvania , USA
- c Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania , USA
- h Department of Biostatistics and Epidemiology, Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Andrew P Steenhoff
- a Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania , USA
- e Botswana-UPenn Partnership , Gaborone , Botswana
- k Department of Pediatrics, Division of Infectious Diseases , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA
| | - Carrie L Kovarik
- a Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania , USA
- e Botswana-UPenn Partnership , Gaborone , Botswana
- l Department of Dermatology , University of Pennsylvania , Philadelphia , Pennsylvania , USA
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Abstract
Tropical skin diseases are infectious conditions influenced by factors such as nutrition, housing, and the environment. Migration patterns have caused these conditions to be seen all around the world, not only in developing countries. Many of these diseases have a different presentation in childhood, which changes the diagnostic approach and management options. In this article, we review some of the most common tropical mycobacterial, protozoan, parasitic, and viral dermatologic conditions in children, including their epidemiologic, clinical, diagnostic, and therapeutic aspects.
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Affiliation(s)
| | - Irene Lara-Corrales
- Dermatology Section, Department of Pediatric Medicine, Hospital for Sick Children University of Toronto, Toronto, Ontario, Canada
| | - Carrie L Kovarik
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elena Pope
- Dermatology Section, Department of Pediatric Medicine, Hospital for Sick Children University of Toronto, Toronto, Ontario, Canada
| | - Roberto Arenas
- Micology Section, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
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Abstract
Because of travel and migration patterns, tropical skin diseases are now seen all around the world, not just in tropical or developing countries. Nutrition, housing, and environmental factors play an important role in these infectious diseases, so when they appear out of their normal environments, their classic presentation may vary. Tropical diseases can also present differently in childhood, making their recognition, diagnosis, and management a clinical challenge. Health care providers in developed countries need to be familiar with tropical skin diseases and be able to diagnose them in returning travelers or immigrants in order to optimize care. This article aims to review the epidemiologic, clinical, diagnostic, and therapeutic aspects of some of the most common tropical dermatologic conditions in children.
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Affiliation(s)
| | - Irene Lara-Corrales
- Dermatology Section, Department of Pediatric Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Carrie L Kovarik
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elena Pope
- Dermatology Section, Department of Pediatric Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Roberto Arenas
- Mycology Section, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
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Affiliation(s)
- Karolyn A Wanat
- Assistant Professor, Department of Dermatology and Pathology, University of Iowa
| | | | | | - Carrie L Kovarik
- Associate Professor, Department of Dermatology and Dermatopathology, University of Pennsylvania
| | - Ivy Lee
- Clinical Assistant Professor, Olive View-University of California, Los Angeles Medical Center
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El-Mallawany NK, Kamiyango W, Slone JS, Villiera J, Kovarik CL, Cox CM, Dittmer DP, Ahmed S, Schutze GE, Scheurer ME, Kazembe PN, Mehta PS. Clinical Factors Associated with Long-Term Complete Remission versus Poor Response to Chemotherapy in HIV-Infected Children and Adolescents with Kaposi Sarcoma Receiving Bleomycin and Vincristine: A Retrospective Observational Study. PLoS One 2016; 11:e0153335. [PMID: 27082863 PMCID: PMC4833299 DOI: 10.1371/journal.pone.0153335] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/28/2016] [Indexed: 01/09/2023] Open
Abstract
Kaposi sarcoma (KS) is the most common HIV-associated malignancy in children and adolescents in Africa. Pediatric KS is distinct from adult disease. We evaluated the clinical characteristics associated with long-term outcomes. We performed a retrospective observational analysis of 70 HIV-infected children and adolescents with KS less than 18 years of age diagnosed between 8/2010 and 6/2013 in Lilongwe, Malawi. Local first-line treatment included bleomycin and vincristine plus nevirapine-based highly active anti-retroviral therapy (HAART). Median age was 8.6 years (range 1.7–17.9); there were 35 females (50%). Most common sites of presentation were: lymph node (74%), skin (59%), subcutaneous nodules (33%), oral (27%), woody edema (24%), and visceral (16%). Eighteen (26%) presented with lymphadenopathy only. Severe CD4 suppression occurred in 28%. At time of KS diagnosis, 49% were already on HAART. Overall, 28% presented with a platelet count < 100 x 109/L and 37% with hemoglobin < 8 g/dL. The 2-year event-free (EFS) and overall survival (OS) were 46% and 58% respectively (median follow-up 29 months, range 15–50). Multivariable analysis of risk of death and failure to achieve EFS demonstrated that visceral disease (odds ratios [OR] 19.08 and 11.61, 95% CI 2.22–163.90 and 1.60–83.95 respectively) and presenting with more than 20 skin/oral lesions (OR 9.57 and 22.90, 95% CI 1.01–90.99 and 1.00–524.13 respectively) were independent risk factors for both. Woody edema was associated with failure to achieve EFS (OR 7.80, 95% CI 1.84–33.08) but not death. Univariable analysis revealed that lymph node involvement was favorable for EFS (OR 0.28, 95% CI 0.08–0.99), while T1 TIS staging criteria, presence of cytopenias, and severe immune suppression were not associated with increased mortality. Long-term complete remission is achievable in pediatric KS, however outcomes vary according to clinical presentation. Based on clinical heterogeneity, treatment according to risk-stratification is necessary to improve overall outcomes.
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Affiliation(s)
- Nader Kim El-Mallawany
- Department of Pediatrics, Division of Hematology, Oncology, and Hematopoietic Stem Cell Transplantation, New York Medical College, Valhalla, New York, United States of America
- Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail:
| | - William Kamiyango
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Jeremy S. Slone
- Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children’s Cancer and Hematology Centers, Houston, Texas, United States of America
| | - Jimmy Villiera
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Carrie L. Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Carrie M. Cox
- Department of Pediatrics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, United States of America
| | - Dirk P. Dittmer
- Department of Microbiology and Immunology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Saeed Ahmed
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Gordon E. Schutze
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Michael E. Scheurer
- Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children’s Cancer and Hematology Centers, Houston, Texas, United States of America
| | - Peter N. Kazembe
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Parth S. Mehta
- Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children’s Cancer and Hematology Centers, Houston, Texas, United States of America
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46
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Rosen AR, Littman-Quinn R, Kovarik CL, Lipoff JB. Landscape of business models in teledermatology. Cutis 2016; 97:302-304. [PMID: 27163914] [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: 06/05/2023]
Abstract
Effective business models for teledermatology must be implemented to make the practice a feasible option for dermatologists to deliver care. This study sought to detect and report types of teledermatology business models in practice. We interviewed 19 private and academic dermatologists who have been reimbursed for teledermatology services. Most respondents described teledermatology business models fitting 4 categories-standard fee-for-service reimbursement from insurance, capitated service contracts, per-case service contracts, and direct to consumer-which are described in this article. We also anticipate new teledermatology business models will be needed as technology and insurance reimbursements evolve.
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Affiliation(s)
- Alex R Rosen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Ryan Littman-Quinn
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA
| | - Jules B Lipoff
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA
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47
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Forrestel AK, Kovarik CL, Mosam A, Gupta D, Maurer TA, Micheletti RG. Diffuse HIV-associated seborrheic dermatitis - a case series. Int J STD AIDS 2016; 27:1342-1345. [PMID: 27013615 DOI: 10.1177/0956462416641816] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 10/11/2015] [Accepted: 02/25/2016] [Indexed: 11/17/2022]
Abstract
Seborrheic dermatitis (SD) is reported to have distinct clinical and histologic presentations in patients with HIV infection. Here we present 20 cases to further define some of these unique characteristics. Common features include erythematous, scaly papules, and plaques involving areas beyond the typical seborrheic distribution; thick, greasy scale on the scalp; and an increased frequency of erythroderma. Histologically, there is widespread parakeratosis, spongiosis, and necrotic keratinocytes. Treatment is often difficult, requiring prolonged use of oral and topical antifungals and corticosteroids as well as antibiotics for bacterial superinfection. SD with these features represents a marker for HIV infection and can aid in early diagnosis.
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48
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Rodriguez O, Kovarik CL. Spectrum and progression of disease from condyloma to aggressive anogenital squamous cell carcinoma in 3 HIV-positive patients. JAAD Case Rep 2016; 2:47-50. [PMID: 27051826 PMCID: PMC4809480 DOI: 10.1016/j.jdcr.2015.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 11/06/2022] Open
Affiliation(s)
- Olaf Rodriguez
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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49
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Rubin CB, Kovarik CL. The nuts and bolts of teledermatology: Preventing fragmented care. J Am Acad Dermatol 2016; 73:886-8. [PMID: 26475549 DOI: 10.1016/j.jaad.2015.06.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/22/2015] [Accepted: 06/24/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Courtney B Rubin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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50
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Messenger E, Kovarik CL, Lipoff JB. Access to inpatient dermatology care in Pennsylvania hospitals. Cutis 2016; 97:49-51. [PMID: 26919355] [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: 06/05/2023]
Abstract
Access to care is a known issue in dermatology, and many patients may experience long waiting periods to see a physician. In this study, an anonymous online survey was sent to all 274 Pennsylvania hospitals licensed by the US Department of Health in order to evaluate current levels of access to inpatient dermatology services. Although the response rate to this survey was limited, the data suggest that access to inpatient dermatology services is limited and may be problematic in hospitals across the United States. Innovation efforts and further studies are needed to address this gap in access to care.
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Affiliation(s)
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA
| | - Jules B Lipoff
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA
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