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Xia J, Patel H, Guo L, Hsu C, Revankar R, Torbeck R. The use of immunohistochemical staining in Mohs micrographic surgery for melanoma: a systematic review. Arch Dermatol Res 2023; 315:2769-2772. [PMID: 37603089 DOI: 10.1007/s00403-023-02711-5] [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: 04/25/2023] [Revised: 07/27/2023] [Accepted: 08/13/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Joyce Xia
- Renaissance School of Medicine at Stony Brook University, 100 Nicolls Rd., Stony Brook, NY, 11794, USA.
| | - Heli Patel
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Lily Guo
- Chicago Medical School at Rosalind Franklin University, North Chicago, IL, USA
| | - Cynhia Hsu
- Chicago Medical School at Rosalind Franklin University, North Chicago, IL, USA
| | - Rishab Revankar
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Revankar R, Patel H, Rojas M, Walsh S, McGee JS. Systematic review of TNFα-induced paradoxical psoriasis: Treatment outcomes of switching to alternative biologic therapies in inflammatory bowel disease patients. J DERMATOL TREAT 2023; 34:2133533. [PMID: 36205507 DOI: 10.1080/09546634.2022.2133533] [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] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The objective of this systematic review was to evaluate the efficacies of different biologic therapies in treating tumor necrosis factor-alpha (TNFα)-induced paradoxical psoriasis (PXP) and controlling inflammatory bowel disease (IBD) symptoms. METHODS We conducted a literature search of the Ovid EMBASE, Ovid Medline, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials databases from their inception to October 3, 2021. We considered all peer-reviewed, randomized controlled trials, chart reviews, and observational studies that discussed the TNFα-induced PXP treatment outcomes in IBD patients of switching to different biologic therapies. RESULTS Switching to ustekinumab (UST) resulted in complete or partial resolution of TNFα-induced PXP in 83.1% of patients (74 out of 89 patients), while switching to either vedolizumab (VDZ) or secukinumab led to complete resolution in 100% of patients (eight out of eight patients). Approximately 75.4% of patients who were switched to UST remained in IBD remission, 4.6% in partial remission, and 20.0% in the flare of IBD. CONCLUSIONS UST has sufficient data to demonstrate the efficacy in treating TNFα-induced PXP and controlling IBD symptoms concurrently. More data is needed to validate the efficacies of VDZ and SEC in treating TNFα-induced PXP in IBD patients.
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Affiliation(s)
- Rishab Revankar
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Heli Patel
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Mary Rojas
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha Walsh
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jean S McGee
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Yamanaka-Takaichi M, Revankar R, Shih T, Gall M, Hsiao JL, Shi VY, Alavi A. Expert consensus on priority research gaps in dietary and lifestyle factors in hidradenitis suppurativa: a Delphi consensus study. Arch Dermatol Res 2023; 315:2129-2136. [PMID: 36951970 DOI: 10.1007/s00403-023-02610-9] [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: 12/09/2022] [Revised: 01/27/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023]
Abstract
Hidradenitis suppurativa (HS) is a debilitating systemic inflammatory disease with limited treatment options. Although management through dietary and lifestyle changes is a primary interest of the HS patient community, there is lack of consensus regarding recommendations due to the paucity of evidence. To establish the priority research gaps on this topic, we performed and moderated a Delphi consensus study by integrating expert opinions and the relevant literature. Based on a literature review, research questions on dietary and lifestyle interventions in HS were constructed. HS dietary and lifestyle research questions were sent to an expert panel, consisting of 22 international members, including dermatologists, dietitians, pharmacists, and endocrinologists. Voting on the research questions was conducted using a modified Delphi technique. The primary outcome measure was whether participants could reach consensus on the priority of each research question in the HS dietary and lifestyle factors. After three rounds of surveys investigating the relationships between HS and various diet and lifestyle factors, "BMI", "Obesity", and "Smoking", reached consensus as high priority research questions. Low research priorities per consensus included "effects of iron supplements", "effects of magnesium supplements", "alcohol consumption" and "limiting Brewer's yeast intake. Smoking and obesity were identified as important research questions, concurrent to the literature indicating their association with more significant impact on disease activity. By shedding light on high priority research questions, our study provides a roadmap for further research on dietary and lifestyle modifications in HS and will help determine evidence-based lifestyle and dietary recommendations for patients with HS.
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Affiliation(s)
| | - Rishab Revankar
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Terri Shih
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | - Jennifer L Hsiao
- Department of Dermatology, University of Southern California, Los Angeles, CA, USA
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
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Revankar R, Rojas M, Walsh S, Patel H, Revankar N, Han J, Parameswaran A. Anemia in patients with hidradenitis suppurativa : A systematic review with meta-analysis. Arch Dermatol Res 2023; 315:1639-1648. [PMID: 36781458 DOI: 10.1007/s00403-023-02559-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/02/2022] [Accepted: 01/31/2023] [Indexed: 02/15/2023]
Abstract
IMPORTANCE Hidradenitis suppurativa (HS) is associated with a number of physical and psychological comorbidities. Studies have suggested an association between HS and anemia; however, this association is not widely understood and may result in delayed diagnosis and treatment and possible increase in morbidity and mortality. OBJECTIVE To systematically review and perform a meta-analysis regarding the association between HS and anemia, and to characterize the subtypes of anemia associated with HS. DATA SOURCES A search of the EMBASE, Medline, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials databases from the time of database inception to September 25, 2022, yielded 313 unique articles. STUDY SELECTION All observational studies and randomized controlled trials published in English that examined the odds ratio (OR) of anemia in patients with HS were screened by 2 independent reviewers. Case reports were excluded. Among 313 unique articles, 7 were deemed eligible. DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines facilitated data extraction. The Newcastle-Ottawa Scale (NOS) was used to analyze risk of bias of included studies. In addition to OR and 95% confidence intervals, relevant data on patient demographics and anemia subtypes were also extracted. MAIN OUTCOMES AND MEASURES The primary outcome was the OR of anemia in HS patients. This study also attempted to characterize anemia subtypes associated with HS. RESULTS In total, 2 case-control and 5 cross-sectional studies featured a total of 11,693 patients. Among the studies, 4 of 7 demonstrated a statistically significant positive association between anemia and HS (ORs, 2.20 [1.42-3.41], 2.33 [1.99-2.73], 1.87 [1.02-3.44], and 1.50 [1.43-1.57]), with macrocytic and microcytic subtypes being most common. After adjusting for publication bias, meta-analysis with random effects revealed HS to be associated with increased odds of anemia compared to non-HS groups (OR 1.59 [1.19, 2.11]). CONCLUSIONS AND RELEVANCE There is a statistically significant positive association between HS and anemia, particularly for the aforementioned subtypes. Patients with HS should be screened for anemia. In case of lower hemoglobin concentration, the anemia of HS patients should be subdivided according to mean corpuscular volume of the red blood cells and further investigated depending on subtype.
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Affiliation(s)
- Rishab Revankar
- The Icahn School of Medicine at Mount Sinai, 50 E 9th St., Apt 7B3, New York, NY, 10029, USA.
| | - Mary Rojas
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha Walsh
- The Icahn School of Medicine at Mount Sinai, 50 E 9th St., Apt 7B3, New York, NY, 10029, USA
| | - Heli Patel
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nikita Revankar
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Joseph Han
- The Icahn School of Medicine at Mount Sinai, 50 E 9th St., Apt 7B3, New York, NY, 10029, USA
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Patel H, Revankar R, Valliani A, Revankar N, Yerigeri S, Kaskas N, Stoff B. Teledermatology in medical student, postgraduate trainee, and global dermatology education: A systematic review. JAAD Int 2023; 11:106-111. [PMID: 36941913 PMCID: PMC10018315 DOI: 10.1016/j.jdin.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 02/22/2023] Open
Abstract
Background In the aftermath of the COVID-19 pandemic, medical students and residents in the U.S. and globally have gained more exposure to teledermatology, both for the purposes of clinical practice and education. Objective We conducted a systematic review to assess outcomes from teledermatology interventions for dermatology trainees in the U.S. and globally in accordance with Preferred Reporting Items for Systematic Reviews (PRISMA). Methods We searched MEDLINE, EMBASE, Web of Science, and Cochrane CENTRAL for articles written in English and published database inception to November 20, 2022. Results In total, 15 studies met the inclusion criteria. Outcomes reported ranged broadly from resident-provider concordance rates, diagnostic accuracy in comparison to control groups, number of patients seen, and self-reported satisfaction and improvement. Generally, studies indicated high satisfaction rates and improvement in educational outcomes among medical students, residents, and other trainees in the global health setting. Limitations Because of the heterogeneity of study design and outcomes reported, meta-analysis could not be performed. Conclusion Teledermatology can be successfully deployed for clinical care and education domestically and in the global health setting.
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Affiliation(s)
- Heli Patel
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia
| | | | - Aly Valliani
- The Icahn School of Medicine at Mount Sinai, New York
| | - Nikita Revankar
- East Carolina University Brody School of Medicine, Greenville, North Carolina
| | | | - Nadine Kaskas
- The Icahn School of Medicine at Mount Sinai, New York
| | - Benjamin Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
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Han J, Tai H, Poplausky D, Young J, Revankar R, Baek P, Walsh S, Gulati N. Management of lentiginous melanoma with imiquimod assessed by reflectance confocal microscopy. Skin Health and Disease 2023; 3:e212. [PMID: 37013121 PMCID: PMC10066750 DOI: 10.1002/ski2.212] [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] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Joseph Han
- Department of Dermatology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Hansen Tai
- Department of Dermatology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Dina Poplausky
- Department of Dermatology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Jade Young
- Department of Dermatology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Rishab Revankar
- Levy Library Icahn School of Medicine at Mount Sinai New York New York USA
| | - Peter Baek
- Department of Dermatology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Samantha Walsh
- Levy Library Icahn School of Medicine at Mount Sinai New York New York USA
| | - Nicholas Gulati
- Department of Dermatology Icahn School of Medicine at Mount Sinai New York New York USA
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Metri KG, Raghuram N, Narayan M, Sravan K, Sekar S, Bhargav H, Babu N, Mohanty S, Revankar R. Impact of workplace yoga on pain measures, mental health, sleep quality, and quality of life in female teachers with chronic musculoskeletal pain: A randomized controlled study. Work 2023; 76:521-531. [PMID: 36847050 DOI: 10.3233/wor-210269] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Chronic pain conditions such as low back pain, knee pain and cervical pain are highly prevalent among female teachers. Chronic pain significantly affects the mental health, sleep and quality of life among teachers. OBJECTIVE This study is intended to investigate the impact of a workplace yoga intervention on musculoskeletal pain, anxiety, depression, sleep, and quality of life (QoL) among female teachers who had chronic musculoskeletal pain. METHOD Fifty female teachers aged between 25-55 years with chronic musculoskeletal pain were randomized to either the yoga group (n = 25) or the control group (n = 25). The yoga group received a 60-minute structured Integrated Yoga intervention (IY) four days a week for six consecutive weeks at school. The control group received no intervention. OUTCOME MEASURES Pain intensity, anxiety, depression, stress, fatigue, self-compassion, sleep quality, and quality of life were assessed at the baseline and six weeks. RESULTS A significant (p < 0.05) reduction in pain intensity and pain disability in the yoga group was observed after 6-week compared to baseline. Anxiety, depression, stress, sleep scores and fatigues also improved in the yoga group after six weeks. The control group showed no change. Post score comparison showed a significant difference between the groups for all the measures. CONCLUSION Workplace yoga intervention is found to be effective in improving pain, pain disability, mental health, sleep quality among female teachers with chronic musculoskeletal pain. This study strongly recommends yoga for the prevention of work-related health issues and for the promotion of wellbeing among teachers.
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Affiliation(s)
| | - Nagaratna Raghuram
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA University), Bangalore, India
| | - Meera Narayan
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA University), Bangalore, India
| | - Karthik Sravan
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA University), Bangalore, India
| | - Sanjana Sekar
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA University), Bangalore, India
| | - Hemant Bhargav
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Natesh Babu
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA University), Bangalore, India
| | - Sriloy Mohanty
- Department of Integrative Medicine and Research, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Basu-Ray I, Metri K, Khanra D, Revankar R, Chinnaiyan KM, Raghuram N, Mishra MC, Patwardhan B, Sharma M, Basavaraddi IV, Anand A, Reddy S, Deepak KK, Levy M, Theus S, Levine GN, Cramer H, Fricchione GL, Hongasandra NR. A narrative review on yoga: a potential intervention for augmenting immunomodulation and mental health in COVID-19. BMC Complement Med Ther 2022; 22:191. [PMID: 35850685 PMCID: PMC9289356 DOI: 10.1186/s12906-022-03666-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/05/2022] [Indexed: 12/15/2022] Open
Abstract
Background The ongoing novel coronavirus disease 2019 (COVID-19) pandemic has a significant mortality rate of 3–5%. The principal causes of multiorgan failure and death are cytokine release syndrome and immune dysfunction. Stress, anxiety, and depression has been aggravated by the pandemic and its resultant restrictions in day-to-day life which may contribute to immune dysregulation. Thus, immunity strengthening and the prevention of cytokine release syndrome are important for preventing and minimizing mortality in COVID-19 patients. However, despite a few specific remedies that now exist for the SARS-CoV-2virus, the principal modes of prevention include vaccination, masking, and holistic healing methods, such as yoga. Currently, extensive research is being conducted to better understand the neuroendocrinoimmunological mechanisms by which yoga alleviates stress and inflammation. This review article explores the anti-inflammatory and immune-modulating potentials of yoga, along with its role in reducing risk for immune dysfunction and impaired mental health. Methods We conducted this narrative review from published literature in MEDLINE, EMBASE, COCHRANE databases. Screening was performed for titles and abstracts by two independent review authors; potentially eligible citations were retrieved for full-text review. References of included articles and articles of major non-indexed peer reviewed journals were searched for relevance by two independent review authors. A third review author checked the excluded records. All disagreements were resolved through discussion amongst review authors or through adjudication by a fourth review author. Abstracts, editorials, conference proceedings and clinical trial registrations were excluded. Observations Yoga is a nonpharmacological, cost-effective, and safe intervention associated with several health benefits. Originating in ancient India, this vast discipline consists of postures (asanas), breathing techniques (pranayama), meditation (dhyana/dharana), and relaxation. Studies have demonstrated yoga’s ability to bolster innate immunity and to inhibit cytokine release syndrome. As an intervention, yoga has been shown to improve mental health, as it alleviates anxiety, depression, and stress and enhances mindfulness, self-control, and self-regulation. Yoga has been correlated with numerous cardioprotective effects, which also may play a role in COVID-19 by preventing lung and cardiac injury. Conclusion and relevance This review paves the path for further research on yoga as a potential intervention for enhancing innate immunity and mental health and thus its role in prevention and adjunctive treatment in COVID-19.
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Revankar R, Blum F, Yeung H. 32631 Survey-based study to understand HS patient experiences and perceptions about I&D procedures. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.490] [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: 11/25/2022]
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Shenvi CL, Wang Y, Revankar R, Phillips J, Bush M, Biese KJ, Aylward A, D'Onofrio G, Platts‐Mills TF. Use of a Brief Negotiation Interview in the emergency department to reduce high-risk alcohol use among older adults: A randomized trial. J Am Coll Emerg Physicians Open 2022; 3:e12651. [PMID: 35156089 PMCID: PMC8828696 DOI: 10.1002/emp2.12651] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/19/2021] [Accepted: 12/28/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine whether a Brief Negotiation Interview (BNI) performed in the emergency department (ED) can reduce future rates of alcohol use among older adults who are high-risk drinkers. METHODS Adults aged 65 years and older in a single academic ED were screened for high-risk alcohol use based on the National Institute for Alcohol Abuse and Alcoholism definition of >7 drinks per week or >3 drinks per occasion. Eligible individuals who were high-risk drinkers who passed a cognitive impairment screener and who consented to enrollment were randomly assigned to receive the BNI versus usual care. Outcomes were assessed at 3, 6, and 12 months. The primary outcome was the rate of high-risk alcohol use at 6 months. RESULTS Of 2250 ED patients who were screened, 183 (8%) met the criteria for high-risk alcohol use. Of those, 98 (53%) patients met full criteria and consented to participation. Of the participants, 67% were men and 83% were non-Hispanic White. There was no significant difference in the primary outcome of high-risk alcohol use at 6 months between the BNI at 59.1% (95% confidence interval [CI], 45.5%-76.8%) and the control at 49.1% (95% CI, 36.9%-65.2%). However, there was a significant time-effect reduction in alcohol consumption and rates of high-risk alcohol use for both groups. CONCLUSION Among older adults who met the criteria for high-risk alcohol use, the BNI in the ED did not result in a reduction in high-risk alcohol use at 6 months, although both groups showed significant reductions after their ED visit. Further work is needed to determine the optimal setting and time to use the BNI to impact high-risk alcohol use in this population.
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Affiliation(s)
- Christina L. Shenvi
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Yushan Wang
- Wake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | | | | | - Montika Bush
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Kevin J. Biese
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Aileen Aylward
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Gail D'Onofrio
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
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Abstract
Background The effectiveness of virtual dermatology curricula in developing countries remains unclear despite an urgent need due to the pandemic and other factors. Objective To compare a virtual dermatology curriculum deployed in Gondar, Ethiopia with a traditional in-person course. Methods We developed a free, on-line dermatology course. 104 trainees from the University of Gondar, Ethiopia, completed the course. Pre- and post-course surveys measuring self-reported proficiency were administered. End-of-Course surveys were distributed to elicit feedback on the course. Performance on final examinations was compared to a historical control group, which did not participate in the course but received standard in-person training. Results Compared to historical controls (n = 236), the pilot cohort (n = 104) averaged over 4 points higher on the final exam (P < .0001). Most participants were satisfied with all aspects of the on-line course and desire at least a component of virtual learning in the future. Limitations This pilot study was performed at a single institution, and the participants were not randomized. Further studies in demographically diverse cohorts are needed to validate the results. Conclusion This dermatology curriculum is a free, innovative platform that can be adapted for dermatology trainees in resource-limited settings.
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Affiliation(s)
| | - Kassahun Bilcha
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.,Department of Dermatovenereology, University of Gondar, Gondar, Ethiopia
| | - Annisa Befekadu
- Department of Dermatovenereology, University of Gondar, Gondar, Ethiopia
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Benjamin Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
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Revankar R, Murrell DF, Murase JE. Shedding light on the impact of hidradenitis suppurativa on women and their families: A focus of the International Journal of Women's Dermatology. Int J Womens Dermatol 2021; 7:661-663. [PMID: 35028360 PMCID: PMC8714601 DOI: 10.1016/j.ijwd.2021.08.005] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Rishab Revankar
- The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dedee F. Murrell
- Department of Dermatology, St. George Hospital, UNSW Faculty of Medicine, Sydney, Australia
| | - Jenny E. Murase
- Department of Dermatology, University of California, San Francisco, California
- Department of Dermatology, Palo Alto Foundation Medical Group, Mountain View, California
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13
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Affiliation(s)
| | - Rishab Revankar
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Department of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.,Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA
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Shenvi CL, Weaver MA, Biese KJ, Wang Y, Revankar R, Fatade Y, Aylward A, Busby‐Whitehead J, Platts‐Mills TF, D'Onofrio G. Identification and characterization of older emergency department patients with high-risk alcohol use. J Am Coll Emerg Physicians Open 2020; 1:804-811. [PMID: 33145524 PMCID: PMC7593462 DOI: 10.1002/emp2.12196] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/31/2020] [Accepted: 07/01/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND High-risk alcohol use in the elderly is a common but underrecognized problem. We tested a brief screening instrument to identify high-risk individuals. METHODS This was a prospective, cross-sectional study conducted at a single emergency department. High-risk alcohol use was defined by National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines as >7 drinks/week or >3 drinks/occasion. We assessed alcohol use in patients aged ≥ 65 years using the timeline follow back (TLFB) method as a reference standard and a new, 2-question screener based on NIAAA guidelines. The Alcohol Use Disorders Identification Test (AUDIT) and Cut down, Annoyed, Guilty, Eye-opener (CAGE) screens were used for comparison. We collected demographic information from a convenience sample of high- and low-risk drinkers. RESULTS We screened 2250 older adults and 180 (8%) met criteria for high-risk use. Ninety-eight high-risk and 124 low-risk individuals were enrolled. The 2-question screener had sensitivity of 98% (95% CI, 93%-100%) and specificity of 87% (95% CI, 80%-92%) using TLFB as the reference. It had higher sensitivity than the AUDIT or CAGE tools. The high-risk group was predominantly male (65% vs 35%, P < 0.001). They drank a median of 14 drinks per week across all ages from 65 to 92. They had higher rates of prior substance use treatment (17% vs 2%, P < 0.001) and current tobacco use (24% vs 9%, P = 0.004). CONCLUSION A rapid, 2-question screener can identify high-risk drinkers with higher sensitivity than AUDIT or CAGE screening. It could be used in concert with more specific questionnaires to guide treatment.
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Affiliation(s)
- Christina L. Shenvi
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Mark A. Weaver
- Department of Mathematics and StatisticsElon UniversityElonNorth CarolinaUSA
| | - Kevin J. Biese
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Yushan Wang
- Wake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | | | - Yetunde Fatade
- Department of Internal MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Aileen Aylward
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Jan Busby‐Whitehead
- Division of GeriatricsUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Timothy F. Platts‐Mills
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Gail D'Onofrio
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
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Mahenthiran J, Revankar R, Koka V, Hoo J, Shenoy M. Spontaneous coronary artery dissection presenting as acute myocardial infarction. J Natl Med Assoc 2000; 92:87-90. [PMID: 10800297 PMCID: PMC2640533] [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: 02/16/2023]
Abstract
Spontaneous coronary artery dissection is a rare entity being increasingly diagnosed as a cause of acute myocardial infarction, especially in cases of low cardiac risk female patients. This is one such case report of a black female patient, who suffered an acute anterior wall myocardial infarction due to an idiopathic spontaneous coronary artery dissection of the left anterior descending artery. She was treated with a thrombolytic agent in the acute phase, uneventfully. An urgent coronary angiogram demonstrated an intimal tear with a dissection of the left anterior descending artery. She survived the acute event and her subsequent hospital course was uncomplicated. Hence she was treated medically for her ischemic event and left ventricular systolic dysfunction with a favorable outcome. This case is yet another report of a survivor treated with a thrombolytic agent for the acute myocardial infarction due to spontaneous coronary artery dissection.
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Affiliation(s)
- J Mahenthiran
- Division of Cardiology, Coney Island Hospital, Brooklyn, New York 11235, USA
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