1
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Wilkowski CM, Brown-Korsah JB, Tripathi R, Bordeaux JS. Factors associated with time to surgical treatment for dermatofibrosarcoma protuberans. J Am Acad Dermatol 2024; 90:609-612. [PMID: 37871804 DOI: 10.1016/j.jaad.2023.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/10/2023] [Accepted: 10/03/2023] [Indexed: 10/25/2023]
Affiliation(s)
| | - Jessica B Brown-Korsah
- Department of Internal Medicine, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
| | - Raghav Tripathi
- Department of Dermatology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Jeremy S Bordeaux
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
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2
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Nayak PK, Nayak AK, Panda BB, Senapati A, Panneerselvam P, Kumar A, Tripathi R, Poonam A, Shahid M, Mohapatra SD, Kaviraj M, Kumar U. Rice-based integrated farming system improves the soil quality, bacterial community structure and system productivity under sub-humid tropical condition. Environ Geochem Health 2024; 46:65. [PMID: 38321197 DOI: 10.1007/s10653-024-01863-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/07/2024] [Indexed: 02/08/2024]
Abstract
Rice-based integrated farming system improves the productivity and profitability by recycling resources efficiently. In the sub-humid tropics, rice production without sufficient nutrient replenishment often leads to soil health and fertility degradation. There has been very limited research on soil health and fertility after adopting a multi-enterprising rice-based integrated farming system (IFS), notably in the rice-fish-livestock and agroforestry system, when compared to a conventional farming system (CS). Therefore, the present study analyzed the dynamics of soil properties, soil bacterial community structure and their possible interaction mechanisms, as well as their effect on regulating soil quality and production in IFS, IFSw (water stagnant area of IFS) and CS. The results indicated that soil nutrient dynamics, bacterial diversity indices (Shannon index, Simpson index, Chao 1, ACE and Fisher index) and system productivity were higher in IFSw and IFS compared to CS. Moreover, relative operational taxonomic units of dominant bacterial genera (Chloroflexi, Acidobacteria, Verrucomicrobia, Planctomycetes, Cyanobacteria, Crenarchaeota and Gemmatimonadetes) were also higher in IFSw and IFS compared to CS. Mean soil quality index (SQI) was highest in IFSw (0.780 ± 0.201) followed by IFS (0.770 ± 0.080) and CS (0.595 ± 0.244). Moreover, rice equivalent yields (REY) and rice yields were well correlated with the higher levels of soil biological indices (SQIBiol) in IFS. Overall, our results revealed that rice-based IFS improved the soil health and fertility and ensuing crop productivity through positive interaction with soil bacterial communities and nutrient stoichiometry leading to agroecosystem sustainability.
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Affiliation(s)
| | - A K Nayak
- ICAR-National Rice Research Institute, Cuttack, Odisha, 753006, India
| | - B B Panda
- ICAR-National Rice Research Institute, Cuttack, Odisha, 753006, India
| | - A Senapati
- ICAR-National Rice Research Institute, Cuttack, Odisha, 753006, India
| | - P Panneerselvam
- ICAR-National Rice Research Institute, Cuttack, Odisha, 753006, India
| | - A Kumar
- ICAR-National Rice Research Institute, Cuttack, Odisha, 753006, India
| | - R Tripathi
- ICAR-National Rice Research Institute, Cuttack, Odisha, 753006, India
| | - A Poonam
- ICAR-National Rice Research Institute, Cuttack, Odisha, 753006, India
| | - M Shahid
- ICAR-National Rice Research Institute, Cuttack, Odisha, 753006, India
| | - S D Mohapatra
- ICAR-National Rice Research Institute, Cuttack, Odisha, 753006, India
| | - Megha Kaviraj
- ICAR-National Rice Research Institute, Cuttack, Odisha, 753006, India
| | - Upendra Kumar
- ICAR-National Rice Research Institute, Cuttack, Odisha, 753006, India.
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3
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Wei AH, Fane LS, Tripathi R, Bordeaux JS. Differences in presentation of cutaneous melanoma among Asian American and Pacific Islander patients. J Am Acad Dermatol 2024; 90:380-382. [PMID: 37769905 DOI: 10.1016/j.jaad.2023.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/12/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Angela H Wei
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
| | - Lauren S Fane
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Raghav Tripathi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
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4
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Tripathi R, Ezaldein HH. Surgical management of seasonal flares in hidradenitis suppurativa. J Am Acad Dermatol 2024; 90:e21-e22. [PMID: 36935016 DOI: 10.1016/j.jaad.2023.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Raghav Tripathi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Harib H Ezaldein
- Miami Dermatology and Mohs Surgery, Miami, Florida; Bennett Surgery Center, Santa Monica, California
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5
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Zheng DX, Ahmed FA, Levoska MA, Tripathi R, Mulligan KM, Cwalina TB, Bordeaux JS, Ruiz ES, Rothermel LD, Hoehn RS, Scott JF. Association of sociodemographic characteristics with utilization of sentinel lymph node biopsy for American Joint Committee on Cancer 8th edition T1b cutaneous melanoma. Arch Dermatol Res 2023; 315:2697-2701. [PMID: 37249586 DOI: 10.1007/s00403-023-02641-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/04/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023]
Abstract
Sentinel lymph node biopsy (SLNB) is an important staging and prognostic tool for cutaneous melanoma (CM). However, there exists a knowledge gap regarding whether sociodemographic characteristics are associated with receipt of SLNB for T1b CMs, for which there are no definitive recommendations for SLNB per current National Comprehensive Cancer Network guidelines. We performed a retrospective analysis of the 2012-2018 National Cancer Database, identifying patients with American Joint Committee on Cancer staging manual 8th edition stage T1b CM, and used multivariable logistic regression to analyze associations between sociodemographic characteristics and receipt of SLNB. Among 40,458 patients with T1b CM, 23,813 (58.9%) received SLNB. Median age was 62 years, and most patients were male (57%) and non-Hispanic White (95%). In multivariable analyses, patients of Hispanic (aOR 0.67, 95%CI 0.48-0.94) and other (aOR 0.78, 95%CI 0.63-0.97) race/ethnicity, and patients aged > 75 (aOR 0.33, 95%CI 0.29-0.38), were less likely to receive SLNB. Conversely, patients in the highest of seven socioeconomic status levels (aOR 1.37, 95%CI 1.13-1.65) and those treated at higher-volume facilities (aOR 1.29, 95%CI 1.14-1.46) were more likely to receive SLNB. Understanding the underlying drivers of these associations may yield important insights for the management of patients with melanoma.
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Affiliation(s)
- David X Zheng
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106, USA.
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Fasih A Ahmed
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Melissa A Levoska
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raghav Tripathi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathleen M Mulligan
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Thomas B Cwalina
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Emily S Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Luke D Rothermel
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Richard S Hoehn
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Thompson KG, Manoharan D, Tripathi R, Rizk E, Lai J, Carpenter J, Gage D, Jilani S, Lin S, Bibee KP, Scott JF. Predictors of patient satisfaction with Mohs micrographic surgery at time of surgery and 3 months postsurgery: A prospective cohort study. J Am Acad Dermatol 2023; 89:992-1000. [PMID: 37422015 DOI: 10.1016/j.jaad.2023.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Despite the importance of patient satisfaction in ensuring high-quality care, studies investigating patient satisfaction in Mohs micrographic surgery (MMS) are limited. OBJECTIVE We investigated the factors associated with patient satisfaction in MMS for nonmelanoma skin cancer and how patient satisfaction changes in the postoperative period. METHODS In this prospective cohort study including 100 patients, patient satisfaction surveys were administered at the time of surgery and at 3 months postsurgery. Sociodemographic characteristics, medical history, and surgical parameters were collected by chart review. Univariate linear and logistic regression models were created to examine these relationships. RESULTS Decreased satisfaction was observed in patients requiring 3 or more MMS stages both at the time of surgery (P = .047) and at 3 months post-surgery (P = .0244). Patients with morning procedures ending after 1:00 pm had decreased satisfaction at the time of surgery (P = .019). A decrease in patient satisfaction between the time of surgery and 3 months postsurgery was observed in patients with surgical sites on the extremities (P = .036), larger preoperative lesion sizes (P = .012), and larger defect sizes (P = .033). LIMITATIONS Single-institution data, self-selection bias, and recall bias. CONCLUSION Patient satisfaction with MMS is impacted by numerous factors and remains dynamic over time.
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Affiliation(s)
| | - Divya Manoharan
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Raghav Tripathi
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland
| | - Emanuelle Rizk
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jonathan Lai
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jenny Carpenter
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Davies Gage
- School of Medicine, University of Maryland, Baltimore, Maryland
| | - Sumrah Jilani
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Shirley Lin
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kristin P Bibee
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland; Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland; Clinical Skin Center of Northern Virginia, Fairfax, Virginia
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7
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Tripathi R, Larson K, Fowler G, Vetto JT, Bordeaux JS, Yu WY. The Role of Clinicopathologic Nomograms for Melanoma in the Era of Gene Expression Profiling. Ann Surg Oncol 2023; 30:6359-6360. [PMID: 37369885 DOI: 10.1245/s10434-023-13814-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Raghav Tripathi
- Department of Dermatology, Johns Hopkins Medicine, Baltimore, MD, USA.
| | | | - Graham Fowler
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - John T Vetto
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Jeremy S Bordeaux
- Department of Dermatology, Case Comprehensive Cancer Center, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Wesley Y Yu
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
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8
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Fane LS, Wei AH, Tripathi R, Bordeaux JS. Asian American and Pacific Islander patients with melanoma have increased odds of treatment delays: A cross-sectional study. J Am Acad Dermatol 2023; 89:529-536. [PMID: 37224968 DOI: 10.1016/j.jaad.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/26/2023] [Accepted: 05/06/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Asian American and Pacific Islander (AAPI) melanoma patients have higher mortality than non-Hispanic White (NHW) patients. Treatment delays may contribute, but whether AAPI patients have longer time from diagnosis to definitive surgery (TTDS) is unknown. OBJECTIVES Investigate TTDS differences between AAPI and NHW melanoma patients. METHODS Retrospective review of AAPI and NHW melanoma patients in the National Cancer Database (NCD) (2004-2020). The association of race with TTDS was evaluated by multivariable logistic regression, controlling for sociodemographic characteristics. RESULTS Of 354,943 AAPI and NHW melanoma patients identified, 1155 (0.33%) were AAPI. AAPI patients had longer TTDS for stage I, II, and III melanoma (P < .05 for all). Adjusting for sociodemographic factors, AAPI patients had 1.5 times the odds of a TTDS between 61 and 90 days and twice the odds of a TTDS >90 days. Racial differences in TTDS persisted in Medicare and private insurance types. Uninsured AAPI patients had the longest TTDS (mean, 53.26 days), while those with private insurance had the shortest TTDS (mean, 34.92 days; P < .001 for both). LIMITATION AAPI patients comprised 0.33% of the sample. CONCLUSIONS AAPI melanoma patients have increased odds of treatment delays. Associated socioeconomic differences should inform efforts to reduce disparities in treatment and survival.
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Affiliation(s)
- Lauren S Fane
- School of Medicine, Case Western Reserve University, Cleveland, Ohio.
| | - Angela H Wei
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Raghav Tripathi
- Department of Dermatology, Johns Hopkins, Baltimore, Maryland
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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9
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Tripathi R, Larson K, Fowler G, Han D, Vetto JT, Bordeaux JS, Yu WY. A Clinical Decision Tool to Calculate Pretest Probability of Sentinel Lymph Node Metastasis in Primary Cutaneous Melanoma. Ann Surg Oncol 2023; 30:4321-4328. [PMID: 36840860 PMCID: PMC9961302 DOI: 10.1245/s10434-023-13220-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/24/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Although sentinel lymph node biopsy (SLNB) status is a strong prognostic indicator for cutaneous melanoma, unnecessary SLNBs have substantial cost and morbidity burden. OBJECTIVE This study was designed to develop, validate, and present a personalized, clinical, decision-making tool using nationally representative data with clinically actionable probability thresholds (Expected Lymphatic Metastasis Outcome [ELMO]). METHODS Data from the Surveillance, Epidemiology, and End Results (SEER) Registry from 2000 to 2017 and the National Cancer Database (NCDB) from 2004 to 2015 were used to develop and internally validate a logistic ridge regression predictive model for SLNB positivity. External validation was done with 1568 patients at a large tertiary referral center. RESULTS The development cohort included 134,809 patients, and the internal validation cohort included 38,518 patients. ELMO (AUC 0.85) resulted in a 29.54% SLNB reduction rate and greater sensitivity in predicting SLNB status for T1b, T2a, and T2b tumors than previous models. In external validation, ELMO had an accuracy of 0.7586 and AUC of 0.7218. Limitations of this study are potential miscoding, unaccounted confounders, and effect modification. CONCLUSIONS ELMO ( https://melanoma-sentinel.herokuapp.com/ ) has been developed and validated (internally and externally) by using the largest publicly available dataset of melanoma patients and was found to have high accuracy compared with other published models and gene expression tests. Individualized risk estimates for SLNB positivity are critical in facilitating thorough decision-making for healthcare providers and patients with melanoma.
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Affiliation(s)
- Raghav Tripathi
- Department of Dermatology, Johns Hopkins Medicine, Baltimore, MD, USA.
| | | | - Graham Fowler
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Dale Han
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - John T Vetto
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Wesley Y Yu
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
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10
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Tripathi R, Larson K, Fowler G, Han D, Vetto JT, Bordeaux JS, Yu WY. ASO Author Reflections: Using Big Data to Bring Precision Medicine to Melanoma Management. Ann Surg Oncol 2023; 30:4329-4330. [PMID: 36820933 DOI: 10.1245/s10434-023-13268-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Raghav Tripathi
- Department of Dermatology, Johns Hopkins Medicine, Baltimore, MD, USA.
| | | | - Graham Fowler
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Dale Han
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - John T Vetto
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Jeremy S Bordeaux
- Department of Dermatology, Case Comprehensive Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Wesley Y Yu
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
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Tripathi R, Larson K, Fowler G, Han D, Vetto JT, Bordeaux JS, Yu WY. ASO Visual Abstract: A Clinical Decision Tool to Calculate Pretest Probability of Sentinel Lymph Node Metastasis in Primary Cutaneous Melanoma. Ann Surg Oncol 2023; 30:4331-4332. [PMID: 37060399 DOI: 10.1245/s10434-023-13410-w] [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: 04/16/2023]
Affiliation(s)
- Raghav Tripathi
- Department of Dermatology, Johns Hopkins Medicine, Baltimore, MD, USA.
| | | | - Graham Fowler
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Dale Han
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - John T Vetto
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Wesley Y Yu
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
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12
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Cwalina TB, Jella TK, Tripathi R, Carroll BT. Financial stress among skin cancer patients: a cross-sectional review of the 2013-2018 National Health Interview Survey. Arch Dermatol Res 2023; 315:1003-1010. [PMID: 35192005 PMCID: PMC8861625 DOI: 10.1007/s00403-022-02330-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 11/12/2022]
Abstract
Financial stress among skin cancer patients may limit treatment efficacy by forcing the postponement of care or decreasing adherence to dermatologist recommendations. Limited information is available quantifying the anxiety experienced by skin cancer patients from both healthcare and non-healthcare factors. Therefore, the present study sought to perform a retrospective cross-sectional review of the 2013-2018 cycles of the National Health Interview Survey (NHIS) to determine the prevalence, at-risk groups, and predictive factors of skin cancer patient financial stress. Survey responses estimated that 11.45% (95% Cl 10.02-12.88%) of skin cancer patients experience problems paying medical bills, 20.34% (95% Cl 18.97-21.71%) of patients worry about the medical costs, 13.73% (95% Cl 12.55-14.91%) of patients worry about housing costs, and 37.48% (95% Cl 35.83-39.14%) of patients worry about money for retirement. Focusing on at-risk groups, black patients, uninsured patients, and patients with low incomes (< 200% poverty level) consistently experienced high rates of financial stress for each of the four measures. Multivariable logistic regression revealed low education, lack of insurance, and low income to be predictive of financial stress. These findings suggest that a considerable proportion of skin cancer patients experience financial stress related to both healthcare and non-healthcare factors. Where possible, the additional intricacy of treating patients at risk of high financial stress may be considered to optimize patient experience and outcomes.
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Affiliation(s)
- Thomas B Cwalina
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- Department of Dermatology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Tarun K Jella
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Raghav Tripathi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
- The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Bryan T Carroll
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
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13
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Marani M, Tripathi R, Scott JF. Predictors of Palliative Care Receipt in Merkel Cell Carcinoma. J Am Acad Dermatol 2023:S0190-9622(23)00682-5. [PMID: 37062461 DOI: 10.1016/j.jaad.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 04/18/2023]
Affiliation(s)
- Melika Marani
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raghav Tripathi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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14
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Tripathi R, Nijhawan RI, Bordeaux JS. Sebaceous carcinoma in solid organ transplant recipients: The elegant path from epidemiology to etiology. Cancer Epidemiol 2023; 84:102361. [PMID: 37062243 DOI: 10.1016/j.canep.2023.102361] [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: 11/19/2022] [Revised: 03/03/2023] [Accepted: 04/02/2023] [Indexed: 04/18/2023]
Abstract
Sebaceous carcinoma (SC) is a rare skin cancer associated with rapid progression and relatively poor survival, particularly in solid organ transplant recipients (SOTRs). Immunosuppressive regimens place SOTRs at substantially increased risk of a variety of skin cancers; recent research has shown a 25-fold increase in SC in the SOTR population, especially among lung recipients, older males, those with longer time since transplant, and patients undergoing induction therapy with thymoglobulin. The potential etiologic mechanisms underlying SC are multifaceted and complex. Immunosuppression creates a microcosm through which to view causative factors for carcinogenesis which has implications in elucidating mechanistic etiologies for SC far beyond the SOTR population, since not all cancers are more common in immunosuppressed patients. Research integrating the role of oncogenic viruses, underlying medical conditions, genetic risk factors, toxicity of prophylactic medications, drug-induced photosensitization, and T-cell deficiency/dysfunction is needed to better elucidate the factors underlying SC in immunosuppressed hosts. In this report, we integrate current research regarding SC in SOTR patients using the causal pie/sufficient-component cause model. In doing so, we provide a paradigm through which to view future research regarding the etiology of SC.
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Affiliation(s)
- Raghav Tripathi
- Johns Hopkins Medicine, Department of Dermatology, Baltimore, MD, USA.
| | - Rajiv I Nijhawan
- University of Texas Southwestern Medical Center, Department of Dermatology, Dallas, TX, USA
| | - Jeremy S Bordeaux
- Case Western Reserve University School of Medicine/University Hospitals Cleveland Medical Center, Department of Dermatology, Cleveland, OH, USA
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15
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Fane LS, Wei AH, Tripathi R, Bordeaux JS. Disparities between Asian groups in time to melanoma treatment: a cross-sectional study. J Am Acad Dermatol 2023:S0190-9622(23)00589-3. [PMID: 37054815 DOI: 10.1016/j.jaad.2023.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/15/2023]
Affiliation(s)
- Lauren S Fane
- Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Angela H Wei
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Raghav Tripathi
- Department of Dermatology, Johns Hopkins, Baltimore, Maryland
| | - Jeremy S Bordeaux
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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16
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Tripathi R, Wan AY, Mazmudar RS, Bordeaux JS, Scott JF. Workplace violence in academic dermatology practices across the United States: a cross-sectional pilot study. Int J Dermatol 2023; 62:e163-e165. [PMID: 35094413 DOI: 10.1111/ijd.16122] [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: 01/05/2022] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Raghav Tripathi
- University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA.,Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Angie Y Wan
- Case Western Reserve University School of Medicine/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Rishabh S Mazmudar
- Case Western Reserve University School of Medicine/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jeremy S Bordeaux
- Case Western Reserve University School of Medicine/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jeffrey F Scott
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Case Western Reserve University School of Medicine/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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17
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Joel MZ, Tripathi R, Scott JF. Predictors of receipt of sentinel lymph node biopsy in patients with malignant adnexal tumors of the skin. J Am Acad Dermatol 2022; 88:1179-1182. [PMID: 36529375 DOI: 10.1016/j.jaad.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Marina Z Joel
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Raghav Tripathi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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18
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Tu M, Tan VP, Yu JD, Tripathi R, Bigham Z, Barlow M, Smith JM, Brown JH, Miyamoto S. RhoA signaling increases mitophagy and protects cardiomyocytes against ischemia by stabilizing PINK1 protein and recruiting Parkin to mitochondria. Cell Death Differ 2022; 29:2472-2486. [PMID: 35760846 PMCID: PMC9751115 DOI: 10.1038/s41418-022-01032-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 01/31/2023] Open
Abstract
Mitophagy, a mitochondria-specific form of autophagy, removes dysfunctional mitochondria and is hence an essential process contributing to mitochondrial quality control. PTEN-induced kinase 1 (PINK1) and the E3 ubiquitin ligase Parkin are critical molecules involved in stress-induced mitophagy, but the intracellular signaling mechanisms by which this pathway is regulated are unclear. We tested the hypothesis that signaling through RhoA, a small GTPase, induces mitophagy via modulation of the PINK1/Parkin pathway as a protective mechanism against ischemic stress. We demonstrate that expression of constitutively active RhoA as well as sphingosine-1-phosphate induced activation of endogenous RhoA in cardiomyocytes result in an accumulation of PINK1 at mitochondria. This is accompanied by translocation of Parkin to mitochondria and ubiquitination of mitochondrial proteins leading to recognition of mitochondria by autophagosomes and their lysosomal degradation. Expression of RhoA in cardiomyocytes confers protection against ischemia, and this cardioprotection is attenuated by siRNA-mediated PINK1 knockdown. In vivo myocardial infarction elicits increases in mitochondrial PINK1, Parkin, and ubiquitinated mitochondrial proteins. AAV9-mediated RhoA expression potentiates these responses and a concurrent decrease in infarct size is observed. Interestingly, induction of mitochondrial PINK1 accumulation in response to RhoA signaling is neither mediated through its transcriptional upregulation nor dependent on depolarization of the mitochondrial membrane, the canonical mechanism for PINK1 accumulation. Instead, our results reveal that RhoA signaling inhibits PINK1 cleavage, thereby stabilizing PINK1 protein at mitochondria. We further show that active RhoA localizes at mitochondria and interacts with PINK1, and that the mitochondrial localization of RhoA is regulated by its downstream effector protein kinase D. These findings demonstrate that RhoA activation engages a unique mechanism to regulate PINK1 accumulation, induce mitophagy and protect against ischemic stress, and implicates regulation of RhoA signaling as a potential strategy to enhance mitophagy and confer protection under stress conditions.
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Affiliation(s)
- Michelle Tu
- Department of Pharmacology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0636, USA
| | - Valerie P Tan
- Department of Pharmacology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0636, USA
- Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Road, La Jolla, CA, 92037, USA
| | - Justin D Yu
- Department of Pharmacology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0636, USA
| | - Raghav Tripathi
- Department of Pharmacology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0636, USA
| | - Zahna Bigham
- Department of Pharmacology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0636, USA
| | - Melissa Barlow
- Department of Pharmacology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0636, USA
| | - Jeffrey M Smith
- Department of Pharmacology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0636, USA
| | - Joan Heller Brown
- Department of Pharmacology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0636, USA
| | - Shigeki Miyamoto
- Department of Pharmacology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0636, USA.
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19
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Marani M, Tripathi R, Scott JF. Utilization of sentinel lymph node biopsy for Merkel cell carcinoma. J Am Acad Dermatol 2022; 87:1404-1406. [PMID: 36084788 DOI: 10.1016/j.jaad.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Melika Marani
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Raghav Tripathi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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20
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Pasricha S, Diwan H, Tripathi R, Batra U, Gupta G, Sharma A, Durga G, Kamboj M, Nathany S, Gupta M, Koyyala V, Jajodia A, Mehta A. 357P Molecular stratification of small cell lung carcinoma subtypes by immunoexpression of ASCL1, NEUROD1, POU2F3 and YAP1 with clinicopathological correlation. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.395] [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: 12/07/2022] Open
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21
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Mazmudar RS, Tripathi R, Bordeaux JS, Scott JF. Trends in brand and generic drug utilization for dermatology providers from 2013–2019. Arch Dermatol Res 2022; 315:1041-1044. [PMID: 36309878 DOI: 10.1007/s00403-022-02431-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prescription drug costs have risen considerably in the United States and are projected to reach $560 billion by 2028. OBJECTIVE To evaluate brand and generic drug utilization and cost proportions within Medicare Part D. METHODS Prescription data for dermatology providers were obtained from the Centers for Medicare and Medicaid Services 2013-2019 Medicare Part D Prescribers by Provider datasets. Percentage of brand vs. generic drug claims and costs and cumulative annual growth rates (CAGRs) were calculated. For the most recent year of data (2019), we conducted additional sub-analyses for calculated percentages by prescriber variables. RESULTS The proportion of brand drug claims increased from 7.4% (in 2013) to 10.5% (2019) with a CAGR of 8.66%. In comparison, generic drug claims increased at a lower rate (CAGR 4.47%). The percentage of brand drug costs increased from 27.5% (in 2013) to 75.1% (2019). LIMITATIONS Inability to assess and generalize data for prescription patterns under non-Medicare plans. CONCLUSIONS Our study demonstrates a disproportionate rise in dermatologic brand drug claims and a substantial increase in costs associated with brand drugs. Brand-name drugs are associated with higher out-of-pocket expenses for patients, which can lead to decreased access and adherence to treatment.
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Affiliation(s)
- Rishabh S Mazmudar
- MetroHealth System/Case Western Reserve University School of Medicine, 2500 Metrohealth Dr, Cleveland, OH, 44109, U.S.A..
| | - Raghav Tripathi
- Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, U.S.A
| | - Jeffrey F Scott
- Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A
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22
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Munjal A, Tripathi R, Kinn P, Percival K, Ince D, Powers J. 35185 Impact of telehealth on duration of tetracycline prescription during COVID-19. J Am Acad Dermatol 2022. [PMCID: PMC9465276 DOI: 10.1016/j.jaad.2022.06.730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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23
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Moni SS, Sultan MH, Alshahrani S, Tripathi P, Assiri A, Alqahtani SS, Bakkari MA, Madkhali OA, Alam MF, Alqahtani AH, Tripathi R, Pancholi SS, Ashafaq M, Elmobark ME. Physical characterization and wound healing properties of Zamzam water. BRAZ J BIOL 2022; 82:e262815. [PMID: 35976285 DOI: 10.1590/1519-6984.262815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/23/2022] [Indexed: 01/06/2023] Open
Abstract
The objective of the study was to evaluate the quality of Zamzam water, holy water for Muslims and consumed for its medicinal value. The present study demonstrates the physicochemical characterization and wound healing property of Zamzam water. The physicochemical characterization of Zamzam water samples was analyzed for dissolved oxygen, pH, conductivity, total dissolved solids, redox potential, zeta potential, polydispersity index, and zeta size. The microbial quality of Zamzam water was also assessed by exposing water samples to open air. In this work, Zamzam water was also screened for the medicinal value through wound healing properties in Wistar rats. Zamzam water exhibited a unique physicochemical characterization with high levels of dissolved oxygen, zeta potential, polydispersity index, redox potential, total dissolved solids, and conductivity before exposure to open air. After open air exposure, Zamzam water resisted the growth of bacteria. The wound healing properties of Zamzam water in vivo showed a 96% of healing effect on 12th day observation. The wound healing was achieved by modulating pro-inflammatory cytokine such as interleukin -1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor -α (TNF-α). Followed by the level of apoptosis markers caspase-9 and caspase-3 were reduced. The present study proved that Zamzam water is a good-quality water and showed excellent wound healing property. Therefore, Zamzam water can be used for pharmaceutical formulations.
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Affiliation(s)
- S S Moni
- Jazan University, College of Pharmacy, Department of Pharmaceutics, Jazan, Kingdom of Saudi Arabia
| | - M H Sultan
- Jazan University, College of Pharmacy, Department of Pharmaceutics, Jazan, Kingdom of Saudi Arabia
| | - S Alshahrani
- Jazan University, College of Pharmacy, Department of Pharmacology and Toxicology, Jazan, Kingdom of Saudi Arabia
| | - P Tripathi
- Jazan University, College of Pharmacy, Department of Pharmacology and Toxicology, Jazan, Kingdom of Saudi Arabia
| | - A Assiri
- King Khalid University, College of Pharmacy, Department of Clinical Pharmacy, Abha, Kingdom of Saudi Arabia
| | - S S Alqahtani
- Jazan University, College of Pharmacy, Department of Pharmacy Practice, Jazan, Kingdom of Saudi Arabia.,Jazan University, College of Pharmacy, Pharmacy Practice Research Unit, Jazan, Kingdom of Saudi Arabia
| | - M A Bakkari
- Jazan University, College of Pharmacy, Department of Pharmaceutics, Jazan, Kingdom of Saudi Arabia
| | - O A Madkhali
- Jazan University, College of Pharmacy, Department of Pharmaceutics, Jazan, Kingdom of Saudi Arabia
| | - M F Alam
- Jazan University, College of Pharmacy, Department of Pharmacology and Toxicology, Jazan, Kingdom of Saudi Arabia
| | - A H Alqahtani
- Al- Dawaa Medical Services, Co Ltd, Riyadh, Kingdom of Saudi Arabia
| | - R Tripathi
- Jazan University, College of Pharmacy, Department of Pharmacy Practice, Jazan, Kingdom of Saudi Arabia
| | - S S Pancholi
- Jazan University, College of Pharmacy, Department of Pharmaceutics, Jazan, Kingdom of Saudi Arabia.,Ganpat University, S. K. Patel College of Pharmaceutical Education and Research, Mahesana, Gujarat, India
| | - M Ashafaq
- Jazan University, College of Pharmacy, Department of Pharmacology and Toxicology, Jazan, Kingdom of Saudi Arabia
| | - M E Elmobark
- Jazan University, College of Pharmacy, Department of Pharmaceutics, Jazan, Kingdom of Saudi Arabia
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24
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Erickson K, Tripathi R, Klatzky R, Bordeaux J, Carroll B. 254 Development and validation of the dysesthesia assessment questionnaire. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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25
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Munjal A, Tripathi R, Kinn P, Percival K, Ince D, Powers J. 386 Impact of telehealth appointments on pharmaceutical management of dermatological conditions. J Invest Dermatol 2022. [PMCID: PMC9296953 DOI: 10.1016/j.jid.2022.05.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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26
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Munjal A, Tripathi R. 344 Telehealth utilization among patients with skin cancer. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.353] [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: 11/16/2022]
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27
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Cwalina TB, Jella TK, Ramanathan D, Zheng DX, Tripathi R, Shah SD, Scott JF. Trends and risk factors of food insecurity within the pediatric atopic dermatitis population. Clin Exp Dermatol 2022; 47:1590-1592. [PMID: 35466434 DOI: 10.1111/ced.15236] [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] [Accepted: 04/19/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Thomas B Cwalina
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Tarun K Jella
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Diya Ramanathan
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - David X Zheng
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Raghav Tripathi
- Department of Internal Medicine, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Sonal D Shah
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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28
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Rehman R, Mateen M, Tripathi R, Fahs F, Mohammad TF. Teledermatology etiquette and the hijab: recommendations for culturally sensitive care. Int J Dermatol 2022; 62:e309-e310. [PMID: 35333377 DOI: 10.1111/ijd.16180] [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: 09/03/2021] [Accepted: 03/10/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Rafey Rehman
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Maaz Mateen
- University of Michigan-Ann Arbor, Ann Arbor, MI, USA
| | - Raghav Tripathi
- Department of Dermatology, Johns Hopkins University, Baltimore, MD, USA
| | - Fatima Fahs
- Department of Dermatology, Wayne State University, Detroit, MI, USA
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29
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Cullison CR, Tripathi R, Bordeaux JS. Identifying sociodemographic factors associated with hospitalization following primary excision of cutaneous melanoma. J Am Acad Dermatol 2022; 86:681-683. [PMID: 33667537 DOI: 10.1016/j.jaad.2021.02.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Christopher R Cullison
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
| | - Raghav Tripathi
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
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30
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Sharma J, Arora RS, Trehan A, Bakhshi S, Hazarika M, Verma N, Malhotra P, Tripathi R, Majhi I, Lowe J, William J, Bagai P, Guilmoto C, Arora R. Diagnosis interval is the largest contributor to time to diagnosis and treatment for childhood cancer patients in India results of the InPOG-ACC-16-02 study. Pediatric Hematology Oncology Journal 2022. [DOI: 10.1016/j.phoj.2022.10.246] [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: 11/27/2022] Open
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31
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Mulligan KM, Cullison CR, Zheng DX, Tripathi R, Beveridge MG, Ray AJ, Scott JF. Sociodemographic factors associated with scabies in the inpatient setting. Am J Infect Control 2021; 49:1558-1560. [PMID: 34052315 DOI: 10.1016/j.ajic.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
Knowledge regarding the inpatient burden of scabies is limited, as previous studies have focused on epidemiologic trends in the outpatient setting. Using the National Inpatient Sample to identify sociodemographic factors associated with scabies in hospitalized patients, we found that patients who were aged 40-64, male, homeless, Medicaid-insured/uninsured, and admitted to hospitals in ZIP codes of the lowest income quartile were more likely to be diagnosed with scabies.
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32
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Tripathi R, Mazmudar RS, Ezaldein HH, Bordeaux JS, Scott JF. National Characteristics of Pediatric Patients Hospitalized for Cutaneous Melanoma. J Pediatr Hematol Oncol 2021; 43:316-318. [PMID: 33181588 DOI: 10.1097/mph.0000000000002005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Raghav Tripathi
- Department of Dermatology, Case Western Reserve University School of Medicine
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Rishabh S Mazmudar
- Department of Dermatology, Case Western Reserve University School of Medicine
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Harib H Ezaldein
- Department of Dermatology, Case Western Reserve University School of Medicine
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Jeremy S Bordeaux
- Department of Dermatology, Case Western Reserve University School of Medicine
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Jeffrey F Scott
- Department of Dermatology, Case Western Reserve University School of Medicine
- Department of Dermatology Johns Hopkins University School of Medicine Baltimore, MD
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33
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Mazmudar RS, Sheth A, Tripathi R, Bordeaux JS, Scott JF. Inflation-Adjusted Trends in Medicare Reimbursement for Common Dermatologic Procedures, 2007-2021. JAMA Dermatol 2021; 157:1355-1358. [PMID: 34524396 DOI: 10.1001/jamadermatol.2021.3453] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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 Medicare enrollment, dermatologist utilization of Medicare, and dermatologic procedural volume have all increased over time. Despite this, there are limited studies evaluating changes in Medicare reimbursement within dermatology. Objective To identify trends in Medicare reimbursement for 46 common dermatologic procedures from 2007 to 2021. Design, Setting, and Participants In this cross-sectional study, reimbursement data were obtained from the Centers for Medicare & Medicaid Services Physician Fee Schedule for commonly used dermatologic Current Procedural Terminology (CPT) codes from 2007 to 2021. The CPT codes in several major dermatologic categories were analyzed, including skin biopsy, shave removal, benign/premalignant/malignant destruction, benign/malignant excision, Mohs micrographic surgery, simple/intermediate/complex repair, flap, graft, and laser/phototherapy. All procedure prices were adjusted for inflation to January 2021 dollar value. Main Outcomes and Measures The primary outcomes were percentage changes and cumulative annual growth rates of pricing for each dermatologic procedure. Results From 2007 to 2021, there was a mean decrease in dermatologic procedure reimbursement of -4.8% after adjusting for inflation. Mean inflation-adjusted changes in reimbursements during this time period significantly varied by procedure type, including skin biopsy (+30.3%), shave removal (+24.5%), benign/premalignant/malignant destruction (-7.5%), Mohs micrographic surgery (-14.4%), benign/malignant excision (-3.9%), simple/intermediate/complex repair (-9.9%), flap repair (-14.1%), graft repair (-12.0%), and laser/phototherapy (-6.6%; P < .001). Changes in reimbursement did not vary by anatomical risk categories. Conclusions and Relevance The findings of this cross-sectional analysis suggest that changes in Medicare reimbursement can have several downstream effects, including concomitant private insurance changes and decreased patient access. Future adjustments in reimbursement should balance high-value care with sustainable pricing to optimize patient access.
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Affiliation(s)
- Rishabh S Mazmudar
- Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Anjani Sheth
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Raghav Tripathi
- Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jeffrey F Scott
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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34
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Chu S, Schrom KP, Tripathi R, Conic RR, Ezaldein HH, Scott JF, Honda K. Pure and Mixed Desmoplastic Melanomas: A Retrospective Clinicopathologic Comparison of 33 Cases. Am J Dermatopathol 2021; 43:776-780. [PMID: 33534213 PMCID: PMC8310890 DOI: 10.1097/dad.0000000000001909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pure and mixed desmoplastic melanomas (DMs) may have different natural histories and behaviors. METHODS We conducted a retrospective review of patients diagnosed with DM at our institution between January 1997 and April 2019. A total of 33 unique DMs were identified and subsequently analyzed based on the histologic type (pure vs. mixed). RESULTS The majority (57.6%) of our cases were classified as pure histology. Patients with pure DMs were more likely to be men (P = 0.035) and be older than 65 years (P = 0.019) compared with patients with mixed DMs. Patients with mixed DM were more likely to have mitoses present (P = 0.001) compared with patients with pure DM. There were no differences in ulceration, perineural invasion, vascular invasion, or survival between patients with pure and mixed histologic subtypes. In addition, no differences in sentinel lymph node biopsy, radiation, or chemotherapy were noted between the 2 histologic subtypes. Immunohistochemistry showed that 27.3% of the pure DMs stained with Melan-A and HMB45 were positive for these immunomarkers. CONCLUSIONS Pure and mixed variants of DM were found to have similar clinicopathologic characteristics. Patients with the mixed histologic subtype were more likely to have mitoses, but no difference in the therapeutic management or patient survival was seen between the 2 subtypes.
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Affiliation(s)
- Sherman Chu
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Northwest, Lebanon, Oregon
| | - Kory P. Schrom
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Raghav Tripathi
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Rosalynn R.Z. Conic
- Department of Family and Preventive Medicine, University of California San Diego, San Diego, California
| | - Harib H. Ezaldein
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jeffrey F. Scott
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland
| | - Kord Honda
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Tripathi R, Bordeaux JS, Nijhawan RI. Utilization of palliative therapy for metastatic melanoma in the United States. J Am Acad Dermatol 2021; 85:1342-1345. [PMID: 34526230 DOI: 10.1016/j.jaad.2020.10.048] [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] [Received: 08/02/2020] [Revised: 09/25/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Raghav Tripathi
- Case Western Reserve University School of Medicine, Department of Dermatology, Cleveland, Ohio; University Hospitals Cleveland Medical Center, Department of Dermatology, Cleveland, Ohio.
| | - Jeremy S Bordeaux
- Case Western Reserve University School of Medicine, Department of Dermatology, Cleveland, Ohio; University Hospitals Cleveland Medical Center, Department of Dermatology, Cleveland, Ohio
| | - Rajiv I Nijhawan
- University of Texas Southwestern Medical Center, Department of Dermatology, Dallas, Texas
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Russell ER, Tripathi R, Carroll BT. Emergency department utilization for impetigo among the pediatric population: A retrospective study of the national emergency department sample 2013-2015. Pediatr Dermatol 2021; 38:1111-1117. [PMID: 34338362 DOI: 10.1111/pde.14729] [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] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the large burden of impetigo in childhood and high frequency of pediatric emergency department (ED) visits for skin conditions, limited information exists on the use of EDs for impetigo among US children. OBJECTIVE Our study aimed to generate national estimates of ED utilization and to identify sociodemographic predictors of impetigo-related ED visits. METHODS This was a retrospective, cross-sectional study of children ages 1-17 presenting to EDs with a primary diagnosis of impetigo using years 2013-2015 of the Nationwide Emergency Department Sample. RESULTS Impetigo accounted for 163 909 of the 71 488, 511 pediatric ED visits and was the fourth most common presenting skin diagnosis. Controlling for sociodemographic factors, patients presenting to the ED with impetigo were most likely to be 6-11 years old, male, and from lower-income quartiles. Patients were most likely to be uninsured and most likely to present on weekends in the summer. CONCLUSION This study provided national-level estimates of ED use for impetigo among US children. Ultimately, the identification of factors associated with increased ED utilization may help in developing targeted interventions to reduce the use of emergency care for impetigo.
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Affiliation(s)
- Emma R Russell
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Raghav Tripathi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Bryan T Carroll
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center Department of Dermatology, Cleveland, OH, USA
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Tripathi R, Larson K, Bordeaux JS, Yu WY. 27573 A clinical decision tool to calculate probability of sentinel lymph node metastasis in cutaneous melanoma. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.034] [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: 11/16/2022]
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Tripathi R, Wan AY, Mazmudar RS, Bordeaux JS, Scott JF. 27091 Violence in academic dermatology practices across the United States: A cross-sectional survey study. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.141] [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: 11/15/2022]
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Tripathi R, Scott JF. 27101 Trends in utilization of palliative care for stage IV Merkel cell carcinoma in the United States. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tripathi R, Korman NJ, Ezaldein HH. Seasonal burden of National Emergency Department visits due to hidradenitis suppurativa. J Am Acad Dermatol 2021; 86:1362-1365. [PMID: 34051317 DOI: 10.1016/j.jaad.2021.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/20/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Raghav Tripathi
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Neil J Korman
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Tripathi R, Bordeaux JS, Rothermel L, Mangla A. Impact of immunotherapy on survival differences in patients with melanoma and chronic lymphocytic leukemia. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e21550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21550 Background: Chronic lymphocytic leukemia (CLL) is well known to be associated with secondary malignancies like melanoma. Patients with melanoma and CLL are known to have poorer prognosis compared to patients without CLL. Checkpoint inhibitors (CPI) started gaining traction in 2011 after ipilimumab approval and are widely used in treatment of advanced melanoma. The objective of this study is to determine the survival of patients with melanoma and CLL in the era of CPI (2011 onwards) compared to previous years. Methods: We identified patients with melanoma and CLL reported to the Surveillance, Epidemiology, and End Results (SEER-18) program. We created cohorts of patients with melanoma and CLL vs. melanoma without CLL and split the cohorts into patients diagnosed from 2000-2010 and 2011-2017 to evaluate the impact of immunotherapy on overall all-cause survival. Kaplain-Meier survival curves were created for each of the four cohorts using the Ederer/direct-adjusted survival method. Standard Cox regression models adjusted for age and sex used to compare survival between subgroups. Two-sided p-values < 0.05 were considered significant. Results: From 2000-2017, 536,264 patients with melanoma were included in this study. 2,945 [0.55%] patients had coexisting CLL. Most patients were male (303,477 [56.6%]), age 60-79 (235,833 [44.0%]), non-Hispanic white (499,151 [93.08%]), and diagnosed from 2000-2010 (285,292 [53.2%]) with melanoma of the trunk (156,722 [29.2%]). From 2000-2010, patients with melanoma had an average survival of 91.4 months (95% CI 88.7-94.1) and those with coexisting CLL had an average survival of 59.3 months (95% CI 58.1-60.6). From 2011-2017, patients with melanoma had an average survival of 129.1 months (95% CI 127.7-130.5) and those with coexisting CLL had an average survival of 116.0 months (95% CI 113.5-118.5). The difference in survival in patients with melanoma vs. melanoma and CLL in 2000-2010 (32.1 months) is significantly greater than that of patients from 2011-2017 (13.1 months, p < 0.05). Conclusions: Although CLL continues to confer a survival disadvantage in patients with melanoma, the survival of patients with CLL and melanoma is better in the CPI-era. We also demonstrate that in the CPI era the gap between the survival of patients with melanoma and CLL and melanoma alone is also reducing significantly.
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Affiliation(s)
- Raghav Tripathi
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jeremy S. Bordeaux
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH
| | - Luke Rothermel
- University Hospitals, Seidman Cancer Center and Department of Surgery, Cleveland, OH
| | - Ankit Mangla
- Case Western Reserve University, School of Medicine, Cleveland, OH
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Mazmudar RS, Tripathi R, Bordeaux JS, Scott JF. Trends in volume and reimbursement of trainee-assisted services in dermatology: A retrospective analysis of Medicare 2010-2018 claims data. J Am Acad Dermatol 2021; 86:1131-1133. [PMID: 33966911 DOI: 10.1016/j.jaad.2021.04.029] [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] [Received: 12/13/2020] [Revised: 03/25/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Rishabh S Mazmudar
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Raghav Tripathi
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jeffrey F Scott
- Case Western Reserve University School of Medicine, Cleveland, Ohio
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Cwalina T, Jella T, Zheng D, Tripathi R, Levoska M, Bordeaux J, Scott J. 292 Health information technology utilization among skin cancer patients. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tripathi R. Women substance use in india: An important but often overlooked aspect. Eur Psychiatry 2021. [PMCID: PMC9479927 DOI: 10.1192/j.eurpsy.2021.2163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Substance abuse has traditionally been considered as a disease of men. Women were believed to have some kind of immunity in terms of “social inoculation”. However, due to change in societal norms and beliefs, substance use is currently increasing among women also. Objectives To focus on female substance use in India Methods In India, traditional use of various substances by women during religious festivals is not unknown. Chewing tobacco is a common practice among many women across the country. Cultural use of alcohol has been known in some tribal populations but gradually the use is increasing. There is major difference in pattern of male and female substance use including initiation, progression, recovery and relapse. Women experience greater medical, physiological and psychological impairment and experience loss of control sooner than males. Teatment needs of female substance users is different and requires a gender specific comprehensive strategy which will require medical services, mental health services, services for family and child and employment opportunities. Results Currently, there is no Indian policy for women substance use. However, Government of India has started a convergence program which includes National AIDS Control program (NACP), National rural health mission (NRHM) and reproductive or sexually transmitted infection (RTI/STI) to combat some aspects. Conclusions
India is in great need of a policy or at least a standard operative protocol for management of female substance use disorder which may include screening for substance use disorder for all females accessing health sector, counselling, referral to addiction services, formation of a treating team and after –care. Disclosure No significant relationships.
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Tripathi R, Rao R, Dhawan A, Jain R. Sleep problems in opioid dependent patients maintained on buprenorphine. Eur Psychiatry 2021. [PMCID: PMC9475826 DOI: 10.1192/j.eurpsy.2021.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionOpioid dependent individuals frequently complain of sleep problems in withdrawal and during abstinence.ObjectivesThe objectives were to assess the subjective sleep parameters among buprenorphine-maintained opioid-dependent patients and to correlate it with socio-demographics, concomitant drug use and treatment related variablesMethodsUsing a cross-sectional study design, 106 hundred six opioid-dependent patients maintained on buprenorphine for at least six months and on same dose in past month were interviewed. Sleep was assessed by Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale. Association between subjective sleep parameters, socio-demographics, concomitant drug use and treatment related variables was also studied.ResultsAll participants were males. Their mean age was 41.1 years (SD:14.3). The mean duration of illicit opioid use was 10 years (IQR: 5,22). About 63.2% (n=67) had PSQI scores more than 5 denoting sleep problem. The scores obtained in Epworth Sleeping Scale were in normal range. Mean subjective total sleep time of the sample was 403.5 (SD 94.8) minutes and median sleep latency was 35 (IQR 18.8, 62.5) minutes. Subjective total sleep time was significantly higher in participants who had use tobacco in the past three months (p value=0.03) and who were in moderate ASSIST risk category (p value=0.04). Subjective sleep latency was significantly higher (p value=0.04) in participants who had used opioids in last three months. It was observed that age was a significant predictor of subjective total sleep time and OST compliance was a significant predictor of sleep latency.ConclusionsA sizeable proportion of opioid dependent patients on buprenorphine have sleep problems
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Cwalina TB, Jella TK, Zheng DX, Tripathi R, Levoska MA, Bordeaux JS, Scott JF. Utilization of health information technology among skin cancer patients: A cross-sectional study of the National Health Interview Survey from 2011 to 2018. J Am Acad Dermatol 2021; 86:899-902. [PMID: 33744360 DOI: 10.1016/j.jaad.2021.03.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Thomas B Cwalina
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Tarun K Jella
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David X Zheng
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Raghav Tripathi
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Melissa A Levoska
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Tripathi R, Bordeaux JS, Nijhawan RI. Factors associated with time to treatment for Merkel cell carcinoma. J Am Acad Dermatol 2020; 84:877-880. [PMID: 33171163 DOI: 10.1016/j.jaad.2020.10.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/07/2020] [Accepted: 10/31/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Raghav Tripathi
- Case Western Reserve University School of Medicine, Department of Dermatology, Cleveland, Ohio; University Hospitals Cleveland Medical Center, Department of Dermatology, Cleveland, Ohio.
| | - Jeremy S Bordeaux
- Case Western Reserve University School of Medicine, Department of Dermatology, Cleveland, Ohio; University Hospitals Cleveland Medical Center, Department of Dermatology, Cleveland, Ohio
| | - Rajiv I Nijhawan
- University of Texas Southwestern Medical Center, Department of Dermatology, Dallas, Texas
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Tripathi R, Mazmudar RS, Knusel KD, Ezaldein HH, Belazarian LT, Bordeaux JS, Scott JF. Impact of congenital cutaneous hemangiomas on newborn care in the United States. Arch Dermatol Res 2020; 313:641-651. [PMID: 33078272 DOI: 10.1007/s00403-020-02147-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 11/26/2022]
Abstract
Little is known regarding the characteristics of newborns with congenital cutaneous hemangioma (CH) and the burden of CH on newborn care. The objective of this study is to describe the burden of CH on newborn inpatient stays in the United States. Specific aims include characterizing newborns with CH, assessing factors predictive of CH and procedures performed during hospitalization, determining characteristics associated with increased cost of care and length of stay in newborns with CH, and investigating trends in prevalence, length of stay, and cost of care. This is a nationally representative retrospective cohort study (National Inpatient Sample, 2009-2015). Sociodemographic factors associated with CH and risk factors for increased cost of care/length of stay were evaluated using weighted multivariable regression models. Overall prevalence of CH is 17.0 per 10,000 newborns. Cost of care and length of stay for newborns with CH are increasing over time. Controlling for all covariates, white (aOR 1.69), female (aOR 1.52) newborns from higher income families (aOR 1.44) were more likely to be born with CH (p < 0.001). Newborns with CH who were premature (aOR 3.88), underwent more procedures (aOR 8.81), and born in urban teaching hospitals (aOR 2.66) had the greatest cost of care (p < 0.001). Premature (aOR 3.74) newborns with CH in urban teaching hospitals (aOR 1.31) had the longest hospital stays (p < 0.001). The burden of CH in newborns is substantial and increasing over time. Understanding contributors to costly hospital stays is critical in developing evidence-based guidelines to reduce the growing impact of CH on newborn care.
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Affiliation(s)
- Raghav Tripathi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- Department of Dermatology, University Hospitals Cleveland Medical Center, Lakeside 3500, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Rishabh S Mazmudar
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Cleveland Medical Center, Lakeside 3500, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Konrad D Knusel
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Cleveland Medical Center, Lakeside 3500, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Harib H Ezaldein
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Cleveland Medical Center, Lakeside 3500, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Leah T Belazarian
- Department of Pediatrics and Department of Dermatology, University of Massachusetts Medical School and UMass Memorial Healthcare, Worcester, MA, USA
| | - Jeremy S Bordeaux
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Cleveland Medical Center, Lakeside 3500, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mazmudar RS, Fazio J, Garland K, Tripathi R, Clark M, Olasz E, Bordeaux JS, Scott JF. Predictors of patient-initiated communication after Mohs micrographic surgery: A multi-institutional prospective cohort study. J Am Acad Dermatol 2020; 85:1290-1293. [PMID: 32896594 DOI: 10.1016/j.jaad.2020.09.003] [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] [Received: 04/30/2020] [Revised: 08/20/2020] [Accepted: 09/01/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Rishabh S Mazmudar
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Justin Fazio
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kevin Garland
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Raghav Tripathi
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Melanie Clark
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Edit Olasz
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jeremy S Bordeaux
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jeffrey F Scott
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Mazmudar RS, Gupta N, Xiang L, Tripathi R, Bordeaux JS, Scott JF. Practices in higher-income communities are associated with shorter dermatologist wait times: A cross-sectional simulated telephone call study. J Am Acad Dermatol 2020; 83:911-912. [DOI: 10.1016/j.jaad.2019.12.042] [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] [Received: 06/05/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 11/25/2022]
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