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Ramachandran V, Jairath NK, Orlow SJ. A Decade of Venture Investment in Artificial Intelligence in Dermatology Amidst Macroeconomic Shifts and Technological Advancements. J Invest Dermatol 2024:S0022-202X(24)00193-3. [PMID: 38613529 DOI: 10.1016/j.jid.2024.02.024] [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: 01/24/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 04/15/2024]
Affiliation(s)
- Vignesh Ramachandran
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA.
| | - Neil K Jairath
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Seth J Orlow
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
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2
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Sikora M, Buontempo MG, Ramachandran V, Knutsen DA, Meehan SA, Hejazi EZ, Caplan AS, Lo Sicco KI, Tattersall IW. Eosinophilic Pustular Folliculitis in an HIV-Positive 63-Year-Old Male. Am J Med 2024:S0002-9343(24)00204-3. [PMID: 38588935 DOI: 10.1016/j.amjmed.2024.03.032] [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: 01/29/2024] [Revised: 03/07/2024] [Accepted: 03/16/2024] [Indexed: 04/10/2024]
Affiliation(s)
| | - Michael G Buontempo
- Department of Dermatology, Hackensack Meridian School of Medicine, Nutley, NJ
| | - Vignesh Ramachandran
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
| | - Dorothy A Knutsen
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Langone Health, New York, NY
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
| | - Emily Z Hejazi
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Avrom S Caplan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
| | - Kristen I Lo Sicco
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
| | - Ian W Tattersall
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY.
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3
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Buontempo MG, Ramachandran V, Freedman J, Meehan SA, Lo Sicco K, Saitta PA. General dermatology and dermatology in primary health care. Clin Exp Dermatol 2024:llae086. [PMID: 38504473 DOI: 10.1093/ced/llae086] [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] [Received: 09/05/2023] [Revised: 01/15/2024] [Accepted: 03/18/2024] [Indexed: 03/21/2024]
Abstract
This manuscript presents a Specialty Certificate Examination case in general dermatology and primary health care, featuring a 54-year-old woman with a chronic growth on her left buttock. The case posed a diagnostic challenge, based on the presence of multiple soft nodules, and histological findings of mature adipocytes within the dermis.
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Affiliation(s)
- Michael G Buontempo
- Department of Dermatology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Vignesh Ramachandran
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Jeremy Freedman
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Peter A Saitta
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
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4
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Ramachandran V, Pahalyants V, Cheraghlou S, Jairath N. Fostering innovation as a pillar of academic advancement in medicine: Strategies for incentivizing innovation in academic dermatology. Australas J Dermatol 2024; 65:224-225. [PMID: 37876303 DOI: 10.1111/ajd.14176] [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: 09/08/2023] [Revised: 09/18/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023]
Affiliation(s)
| | - Vartan Pahalyants
- Department of Dermatology, New York University, New York, New York, USA
| | - Shayan Cheraghlou
- Department of Dermatology, New York University, New York, New York, USA
| | - Neil Jairath
- Department of Dermatology, New York University, New York, New York, USA
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Buontempo MG, Ramachandran V, Mazori DR, Femia A, Sikora M, Sicco KL, Caplan AS. Erythema Ab Igne: Decoding Skin Presentations of Vasculitis Mimickers in Autoimmunity. Am J Med 2024; 137:224-226. [PMID: 37871732 DOI: 10.1016/j.amjmed.2023.10.006] [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] [Received: 09/27/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Michael G Buontempo
- Department of Dermatology, Hackensack Meridian School of Medicine, Nutley, NJ
| | - Vignesh Ramachandran
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
| | - Daniel R Mazori
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
| | - Alisa Femia
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
| | - Michelle Sikora
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
| | - Avrom S Caplan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY.
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Jairath NK, Qiblawi S, Jeha GM, Pahalyants V, Jairath R, Cheraghlou S, Ramachandran V, Xu YG, Aylward J. Leveraging OpenAI's Advanced Data Analysis Tool in Dermatology: Opportunities and Challenges. J Invest Dermatol 2024:S0022-202X(24)00100-3. [PMID: 38325577 DOI: 10.1016/j.jid.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Neil K Jairath
- Department of Dermatology, NYU Langone Medical Center, New York, New York, USA.
| | - Sultan Qiblawi
- Department of Dermatology, University of Wisconsin, Madison, Wisconsin, USA
| | - George M Jeha
- Department of Dermatology, Louisiana State University Health Sciences Center, New Orleans, Los Angeles, USA
| | - Vartan Pahalyants
- Department of Dermatology, NYU Langone Medical Center, New York, New York, USA
| | - Ruple Jairath
- Department of Dermatology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Shayan Cheraghlou
- Department of Dermatology, NYU Langone Medical Center, New York, New York, USA
| | | | - Yaohui Gloria Xu
- Department of Dermatology, University of Wisconsin, Madison, Wisconsin, USA
| | - Juliet Aylward
- Department of Dermatology, University of Wisconsin, Madison, Wisconsin, USA
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Needle CD, Ramachandran V, Oza VS. Knotted lanugo in a newborn: Cultural practices revealed. Pediatr Dermatol 2024; 41:164-165. [PMID: 38072005 DOI: 10.1111/pde.15490] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/26/2023] [Indexed: 01/30/2024]
Abstract
Across the world, there are varied cultural practices applied in the newborn period that pediatric dermatologists need to be familiar with. This report details a 9-day-old girl who presented with black, spike-like hairs across the back after her mother had been rubbing breast milk on her back in a circular motion for the first 7 days of life. On dermatoscopic exam, these lesions were found to be tight bundles of lanugo hairs, consistent with a diagnosis of knotted lanugo. Improved understanding of cultural practices and newborn skin care routines is critical for diagnosis, treatment, and counseling.
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Affiliation(s)
- Carli D Needle
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York, USA
| | - Vignesh Ramachandran
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York, USA
| | - Vikash S Oza
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York, USA
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8
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Tan SLW, Tan HM, Israeli E, Fatihah I, Ramachandran V, Ali SB, Goh SJA, Wee J, Tan AQL, Tam WL, Han W. Up-regulation of SLC7A11/xCT creates a vulnerability to selenocystine-induced cytotoxicity. Biochem J 2023; 480:2045-2058. [PMID: 38078799 DOI: 10.1042/bcj20230317] [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: 07/28/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
The SLC7A11/xCT cystine and glutamate antiporter has emerged as an attractive target for cancer therapy due to its selective overexpression in multiple cancers and its role in preventing ferroptosis. Utilizing pharmacological and genetic approaches in hepatocellular carcinoma cell lines, we demonstrate that overexpression of SLC7A11 engenders hypersensitivity towards l-selenocystine, a naturally occurring diselenide that bears close structural similarity to l-cystine. We find that the abundance of SLC7A11 positively correlates with sensitivity to l-selenocystine, but surprisingly, not to Erastin, an inhibitor of SLC7A11 activity. Our data indicate that SLC7A11 acts as a transport channel for l-selenocystine, which preferentially incites acute oxidative stress and damage eventuating to cell death in cells that highly express SLC7A11. Hence, our findings raise the prospect of l-selenocystine administration as a novel strategy for targeting cancers that up-regulate SLC7A11 expression.
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Affiliation(s)
- Shawn Lu Wen Tan
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Proteos, Singapore 138673, Republic of Singapore
| | - Hui Min Tan
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Proteos, Singapore 138673, Republic of Singapore
| | - Erez Israeli
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Proteos, Singapore 138673, Republic of Singapore
- Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Indah Fatihah
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Proteos, Singapore 138673, Republic of Singapore
| | - Vignesh Ramachandran
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Proteos, Singapore 138673, Republic of Singapore
| | - Shamsia Bte Ali
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Proteos, Singapore 138673, Republic of Singapore
| | - Shane Jun An Goh
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Proteos, Singapore 138673, Republic of Singapore
| | - Jillian Wee
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Proteos, Singapore 138673, Republic of Singapore
| | - Alicia Qian Ler Tan
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Proteos, Singapore 138673, Republic of Singapore
| | - Wai Leong Tam
- NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, 14 Medical Drive, Singapore 117599, Republic of Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 8 Medical Drive, Singapore 117597, Republic of Singapore
- Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), 60 Biopolis Drive, Genome, Singapore 138672, Republic of Singapore
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, Singapore 117599, Republic of Singapore
| | - Weiping Han
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Proteos, Singapore 138673, Republic of Singapore
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Bawany F, Ramachandran V, Rodriguez E, Kim RH, Weber JS, Tattersall IW. Linear IgA bullous dermatosis induced by nemvaleukin alfa, an engineered interleukin 2 molecule, in a patient with treatment-refractory metastatic melanoma. JAAD Case Rep 2023; 41:7-9. [PMID: 37842150 PMCID: PMC10568223 DOI: 10.1016/j.jdcr.2023.08.040] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Affiliation(s)
- Fatima Bawany
- Department of Dermatology, New York University, New York, New York
| | | | | | - Randie H. Kim
- Department of Dermatology, New York University, New York, New York
| | - Jeffrey S. Weber
- Department of Medical Oncology, New York University, New York, New York
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Ramachandran V, Jairath N, Cheraghlou S, Palhayants V. Revolutionizing Dermatology Residency: AI for Knowledge and Clinical Milestones Assessment. Clin Exp Dermatol 2023:llad324. [PMID: 37715693 DOI: 10.1093/ced/llad324] [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] [Received: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 09/18/2023]
Abstract
Artificial intelligence can be adapted and utilized to augment resident education in order to assess clinical milestones in real-time, providing powerful insights for educators and trainees alike. Further research on integrating such technology into our models of learning fosters the growth of our specialty and trainees' aptitudes.
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Affiliation(s)
| | - Neil Jairath
- Department of Dermatology, New York University, New York, NY
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11
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Ramachandran V, Loya A, Ozog DM, Lim HW. Second primary malignancies in patients with Merkel cell carcinoma: a national database study. Int J Dermatol 2023; 62:e512-e514. [PMID: 36880530 DOI: 10.1111/ijd.16638] [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] [Received: 09/22/2022] [Revised: 01/18/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023]
Affiliation(s)
| | - Asad Loya
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - David M Ozog
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA
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Yan D, Ramachandran V, Weston G, Kim RH, Latkowski JA. Diagnosing mycosis fungoides after initiation of therapy with dupilumab: a case report and literature review. Int J Dermatol 2023; 62:e500-e503. [PMID: 36946434 DOI: 10.1111/ijd.16641] [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] [Received: 09/22/2022] [Revised: 01/09/2023] [Accepted: 03/01/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Di Yan
- Department of Dermatology, New York University, New York, NY, USA
| | | | - Gillian Weston
- Department of Dermatology, New York University, New York, NY, USA
| | - Randie H Kim
- Department of Dermatology, New York University, New York, NY, USA
- Section of Dermatopathology, Department of Dermatology, New York University, New York, NY, USA
| | - Jo-Ann Latkowski
- Department of Dermatology, New York University, New York, NY, USA
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Ramachandran V, Phan K. Mohs micrographic surgery versus wide local excision for eyelid melanoma: An analysis of a national database. J Plast Reconstr Aesthet Surg 2022; 75:4410-4415. [PMID: 36257889 DOI: 10.1016/j.bjps.2022.08.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/18/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although eyelid melanomas represent less than 1% of eyelid neoplasms, they have the worst prognosis. Wide local excision (WLE) and Mohs micrographic surgery (MMS) are mainstay treatment options. We conducted a retrospective analysis to assess all-cause and cause-specific mortality rates in patients undergoing WLE or MMS for eyelid melanoma. METHODS A retrospective analysis of Surveillance, Epidemiology, and End Results (SEER) registry was performed for eyelid melanoma treated with WLE or MMS. Cases were limited to American Joint Committee on Cancer (AJCC) stage T1 primary malignancies. RESULTS A total of 45 cases of WLE were identified along with 48 cases of MMS for eyelid melanoma. There was no significant difference between subgroups in age group, sex, race, ethnicity, marital status at diagnosis, AJCC N stage, AJCC M stage, melanoma histology, chemotherapy use, and radiotherapy use. Among the cohort, all tumors were unilateral. Kaplan-Meier analysis with log-rank demonstrated no significant difference between MMS and WLE subgroups with regard to overall survival (P = 0.662) and cancer-specific survival (P = 0.494). Cox regression adjusting for variables with α<0.10 and found no significant difference in all-cause mortality (HR, 0.923; 95% CI 0.310-2.747; P = 0.885) or cancer-specific mortality (HR, 0.518; 95% CI 0.047-5.711; P = 0.591) when patients who underwent MMS were compared to those who underwent WLE. CONCLUSION While our study is limited by a small number of patients, our analysis demonstrated no significant difference in all-cause or cause-specific survival for patients with eyelid melanoma treated with MMS compared with WLE. In areas requiring preservation of tissue due to cosmetic or functional purposes, MMS is a reasonable surgical approach.
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Affiliation(s)
| | - Kevin Phan
- Department of Dermatology, Liverpool Hospital, Liverpool, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales (UNSW), Liverpool, Sydney, Australia
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14
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Belzer A, Ramachandran V, Meehan SA, Pomeranz MK, Matatova M. A rare case of pruritic papular eruption of human immunodeficiency virus in a patient without a diagnosis of acquired immunodeficiency syndrome. JAAD Case Rep 2022; 32:23-25. [PMID: 36606203 PMCID: PMC9807780 DOI: 10.1016/j.jdcr.2022.11.021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Annika Belzer
- Yale School of Medicine, New Haven, Connecticut,Correspondence to: Annika Belzer, BS, 188 Willow St, Apartment No. 2, New Haven, CT 06511.
| | - Vignesh Ramachandran
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York
| | - Shane A. Meehan
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York,Department of Pathology, NYU Langone Health, New York, New York
| | - Miriam K. Pomeranz
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York
| | - Marina Matatova
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York
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Ramachandran V, Modder M, Zhang L, Krumm C, In Het Panhuis W, Schönke M, Lu YC, Hla T, Lee AH, Rensen P, Tontonoz P, Kooijman S, Najafi-Shoushtari H. MicroRNA 33A controls SREBP-2 and LXR dependent regulation of the LDL receptor pathway. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.446] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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16
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Ramachandran V. Myonecrosis complicating uncontrolled diabetes mellitus. Proc AMIA Symp 2022; 35:693-694. [DOI: 10.1080/08998280.2022.2086787] [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: 10/18/2022] Open
Affiliation(s)
- Vignesh Ramachandran
- Department of Dermatology, New York University, New York, New York
- Department of Internal Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
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Ramachandran V, Ayaz T, Loya A. Runner Up: Association of Insurance Coverage with Diagnosis of Malignant Melanoma Before and After the Affordable Care Act: A National Database Study. J of Skin 2022; 6:s38. [DOI: 10.25251/skin.6.supp.38] [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] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract not available.
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Park KE, Ramachandran V, Tran J, Joshi TP, Garg N, Duvic M. Association of Flame-Retardant Clothing with Mycosis Fungoides: A Retrospective Analysis. Dermatol Pract Concept 2022; 12:e2022091. [PMID: 35646447 PMCID: PMC9116524 DOI: 10.5826/dpc.1202a91] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Mycosis fungoides (MF), the most prevalent form of cutaneous T-cell lymphoma (CTCL), has been associated with a variety of environmental and occupational exposures. Flame-retardant clothing (FRC), in contrast to flame-resistant clothing, is chemically treated and may constitute a previously unrecognized occupational hazard. Objectives To report an association between FRC and MF. Methods After encountering several young male patients whose onset of MF coincided with the occupational use of FRC and occupation as fire fighters, we did a retrospective search. Additional biopsy proven MF patients with use of FRC were identified by the EPIC electronic medical record using the search terms “CTCL, mycosis fungoides, flame, and flame-retardant.” Results Eight MF patients, all males, ranging in age from 31 years to 64 years (median age, 35 years) with exposure to FRC were identified. MF remission was noted in three patients who discontinued FRC use and in one patient who used a cotton undershirt barrier, while disease persistence was noted in one patient who continued to use FRC. Conclusions FRC appears to be associated with development of MF through chronic antigen stimulation. Use of FRC is an occupational hazard for fire fighters. Any patient whose MF coincides with use of FRC should avoid further exposure through avoidance or switching to clothing made from inherently flame-resistant fibers.
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Affiliation(s)
- Katherine E. Park
- Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Vignesh Ramachandran
- Department of Dermatology, New York University Grossman School of Medicine, New York, New York, USA
| | - Jessica Tran
- Department of Dermatology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Tejas P. Joshi
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Naveen Garg
- Department of Radiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Madeleine Duvic
- Department of Dermatology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
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Ramachandran V, Bouras L, Akhtar R. P.20 “Out of severe COVID in peripartum women”. Int J Obstet Anesth 2022. [PMCID: PMC9060834 DOI: 10.1016/j.ijoa.2022.103316] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Ramachandran V. Mucocutaneous manifestations of systemic amyloidosis in a Black patient. QJM 2022; 115:237-238. [PMID: 35179575 DOI: 10.1093/qjmed/hcac046] [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] [Received: 02/06/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- V Ramachandran
- Department of Internal Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USADepartment of Dermatology, New York University, New York City, NY, USA
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Ramachandran V. Hypercalcemia as the Initial Presentation of Acute T-cell Leukemia/Lymphoma. Cureus 2022; 14:e23705. [PMID: 35505762 PMCID: PMC9056156 DOI: 10.7759/cureus.23705] [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] [Accepted: 03/31/2022] [Indexed: 11/28/2022] Open
Abstract
Adult T-cell leukemia/lymphoma (ATLL) is a T-cell malignancy that generally presents with widespread involvement of lymph nodes, peripheral blood, and/or skin. It is an uncommon malignancy linked to the human T-lymphotropic virus 1 (HTLV-1). Herein, we present a case of ATLL that was diagnosed after a patient presented to our hospital with nonspecific symptoms of fatigue and weakness and was subsequently found to have hypercalcemia secondary to his blood malignancy. We engage in a discussion of the etiology, epidemiology, and management of patients with this rare malignancy as well as the mechanisms that result in hypercalcemia.
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Ramachandran V, Tumyan G, Loya A, Treat K, Vrcek I. Sebaceous Carcinoma Masquerading As Orbital Cellulitis. Cureus 2022; 14:e22288. [PMID: 35350510 PMCID: PMC8933264 DOI: 10.7759/cureus.22288] [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] [Accepted: 02/15/2022] [Indexed: 12/02/2022] Open
Abstract
Sebaceous cell carcinoma is an uncommonly encountered cutaneous malignancy. Often considered a great masquerader, sebaceous cell carcinoma arises from meibomian glands and can have a poor prognosis if not diagnosed early. In this case report, we present a patient with sebaceous cell carcinoma who presented to our emergency department with a clinical presentation that was concerning for orbital cellulitis. The patient was initially started on intravenous antibiotics. However, workup, including imaging and laboratory results, pointed toward malignancy as the diagnosis. The patient underwent an incisional biopsy and pathology confirming the diagnosis of sebaceous cell carcinoma. We engaged in further discussion of this peculiar cutaneous masquerader, differential diagnoses, and important considerations.
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Shah KP, Ramachandran V, Nicholas SK, Hanson IC, Lotze TE, Martinez CA, Fishman DS. Severe Combined Immunodeficiency with De Novo Duchenne Muscular Dystrophy Mutation. JPGN Rep 2022; 3:e135. [PMID: 37168752 PMCID: PMC10158261 DOI: 10.1097/pg9.0000000000000135] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/17/2020] [Indexed: 05/13/2023]
Abstract
Both severe combined immunodeficiency (SCID) syndrome and Duchenne muscular dystrophy (DMD) are rare conditions. Patients with X-linked SCID have pathogenic variants of the IL2RG gene, resulting in defective cellular and humoral immunity. DMD is also an X-linked condition caused by a dystrophin gene mutation, causing progressive proximal muscle weakness. We present a patient diagnosed with SCID at birth who underwent matched unrelated donor bone marrow transplant (BMT). Several months after, he was noted to have persistently elevated aminotransferases. Despite a lack of clinical signs of graft versus host disease (GvHD), a liver biopsy revealed mild GvHD. Creatine kinase (CK) levels of >19,000 U/L prompted evaluation for muscular dystrophies. Given BMT, genetic analysis was not an option. Muscle biopsy confirmed DMD. This case highlights the complexity of diagnosing and managing uncommon genetic conditions through a multidisciplinary team-based approach. This case is only the second reported case of SCID and DMD together.
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Affiliation(s)
| | | | - Sarah K. Nicholas
- From the Baylor College of Medicine, Houston, TX
- Section of Allergy and Immunology, Texas Children’s Hospital, Houston, TX
| | - Imelda C. Hanson
- From the Baylor College of Medicine, Houston, TX
- Section of Allergy and Immunology, Texas Children’s Hospital, Houston, TX
| | - Timothy E. Lotze
- From the Baylor College of Medicine, Houston, TX
- Section of Neurology, Texas Children’s Hospital, Houston, TX
| | - Caridad A. Martinez
- From the Baylor College of Medicine, Houston, TX
- Section of Hematology-Oncology, Texas Children’s Hospital, Houston, TX
| | - Douglas S. Fishman
- From the Baylor College of Medicine, Houston, TX
- Section of Gastroenterology, Hepatology and Nutrition, Texas Children’s Hospital, Houston, TX
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Dalal SR, Ramachandran V, Khalid R, Keith Manuel F, Knowles JR, Jones JA. Increased Intraocular Pressure in Glaucomatous, Ocular Hypertensive, and Normotensive Space Shuttle Crew. Aerosp Med Hum Perform 2021; 92:728-733. [PMID: 34645553 DOI: 10.3357/amhp.5455.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Glaucoma and ocular hypertension (OHT) are prevalent diseases with baseline intraocular pressure (IOP) elevations that future astronauts and spaceflight participants may suffer from. Preflight, in-flight, and postflight IOP measurements were collected aboard two U.S. Space Shuttle Program missions in normotensive control, OHT, and glaucomatous crewmembers. METHODS: Five subjects (three controls, one glaucomatous, one OHT) were studied aboard 2-wk Space Shuttle missions. Baseline IOP (triplicate; handheld tonometry) was recorded during training 12 mo preflight, in flight (114 d), and postflight (329 d). Subjective symptoms were recorded via questionnaires. Data were analyzed using a spreadsheet with two-sample t-tests. P-value < 0.05 determined significance. RESULTS: IOP increased for all in-flight vs. preflight measurements for controls (N 3, 48.9, 16.9, 5.85), OHT (N 1, 20.3), and glaucomatous (N 1, 32.2) groups. IOP eventually returned to baseline postflight [Return (R)35 d], except for the astronaut with OHT (R917). Subjective symptoms, likely multifactorial, included blurredvision, decreased visual acuity, and headaches. DISCUSSION: IOP increased during spaceflight and normalized upon return. Astronauts and commercial spaceflight participants may need screening for elevated IOP to potentially prevent sequelae related to glaucoma and OHT, the former which requires treatment in flight and the latter which may need prophylaxis. Previous studies have shown elevated IOP upon entry into microgravity with various normalization timeframes in flight and postflight. It is unclear how increased IOP relates to spaceflight-associated neuro-ocular syndrome (SANS); however, several hypotheses exist. Treatment strategies should be available for acute and chronic ocular pathology during spaceflight despite the unique challenges of eye-drop application in microgravity. Dalal SR, Ramachandran V, Khalid R, Manuel FK, Knowles JR, Jones JA. Increased intraocular pressure in glaucomatous, ocular hypertensive, and normotensive space shuttle crew. Aerosp Med Hum Perform. 2021; 92(9):728733.
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Loya A, Ramachandran V, Ayaz T, Weng CY. Second primary malignancies after ocular adnexal lymphoma diagnosis. BMC Ophthalmol 2021; 21:162. [PMID: 33827494 PMCID: PMC8028208 DOI: 10.1186/s12886-021-01921-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 03/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although studies have investigated the risk of second primary malignancies (SPMs) associated with lymphoma of various sites, limited studies have investigated this risk in patients with lymphoma originating within the ocular adnexa. We conducted a retrospective study to assess incidence of secondary malignancies in patients with a prior diagnosis of ocular adnexal lymphoma (OAL) and to determine latency periods and age-groups at increased risk for SPM occurrence. METHODS Retrospective analysis was performed on data obtained from Surveillance, Epidemiology, and End Results (SEER) 9 database. Patients with an initial primary malignancy diagnosis of OAL between 1973 and 2015 were included in the study. Standardized incidence ratios (SIR) and excess absolute risks (EAR) compared to a SEER reference population with similar sex, race, age, and calendar year were computed for SPMs. Excess absolute risk is per 10,000 individuals; alpha of 0.05 was used. RESULTS Of 1834 patients with primary ocular adnexal lymphoma, 279 developed a secondary malignancy during average follow-up of 110.03 months (+/- 88.46), denoting higher incidence than expected (SIR 1.20; 95% CI, 1.07 to 1.35; EAR 30.56). Amongst the primary lymphoma cohort, 98.7% (1810/1834) of patients had non-Hodgkin's lymphoma and amongst those that developed secondary malignancies, 99.6% (278/279) had non-Hodgkin's lymphoma. Patients exhibited increased incidence of lymphohematopoietic and non-lymphohematopoietic second malignancies and no secondary malignancies of the eye or orbit. Patients had increased incidence of secondary malignancies in the first year (SIR 2.07; 95% CI, 1.49 to 2.79; EAR 150.37) and 1-5 years following lymphoma diagnosis (SIR 1.24; 95% CI, 1.01 to 1.51; EAR 34.89). Patients with various OAL subtypes demonstrated differing patterns of site-specific and overall SPM risk. CONCLUSIONS Patients with prior diagnosis of ocular adnexal lymphoma possess increased risk of hematologic and non-hematologic secondary malignancies. Risk of secondary malignancy could vary by lymphoma subtype. Patients with ocular adnexal lymphoma may benefit from regular surveillance to promote early detection of second primary malignancies.
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Affiliation(s)
- Asad Loya
- Baylor College of Medicine, School of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Vignesh Ramachandran
- Baylor College of Medicine, School of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Talha Ayaz
- University of Texas Medical Branch at Galveston, School of Medicine, 301 University Blvd., Galveston, TX, 77555, USA
| | - Christina Y Weng
- Baylor College of Medicine, Department of Ophthalmology-Cullen Eye Institute, 1977 Butler Boulevard, Houston, TX, 77030, USA.
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26
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Ramachandran V, Kim KM, Zhang L. Disseminated Nonsegmental Vitiligo Associated With Halo Nevi and Premature Gray Hair. Cureus 2021; 13:e13868. [PMID: 33859916 PMCID: PMC8038926 DOI: 10.7759/cureus.13868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Halo nevi (HN) are acquired melanocytic nevi circumferentially surrounded by a depigmented patch. HN are commonly associated with vitiligo and can be associated with uveal, mucosal, or cutaneous melanoma in certain patient populations. HN may also have localized leukotrichia of terminal hair overlying the nevus. We report a less common triad of rapid-onset HN, nonsegmental vitiligo, and premature hair graying (PHG) of scalp hair.
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Affiliation(s)
| | | | - Lisa Zhang
- Dermatology, Henry Ford Health System, Detroit, USA
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27
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Mageswari S, Rajan HM, Balusamy M, Elavarasu G, Vijayaprabha R, Ramachandran V, Britto JJ, Jayaraman Y. Childlessness among Muthuvan Tribes of Tamil Nadu, India: An Exploratory Study. Indian J Community Med 2021; 46:141-144. [PMID: 34035596 PMCID: PMC8117903 DOI: 10.4103/ijcm.ijcm_437_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/22/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction: Childlessness is a global concern and it has serious demographic, social, and health implications. The declining Muthuvan child population may reduce their population on the whole. Objective: The study explored the prevalence of childlessness and its underlying reasons in the Muthuvan tribes of Tamil Nadu. Subjects and Methods: The study applied the mixed-method design, and the snowball technique was adopted to identify eight Muthuvan hamlets. Descriptive and thematic analysis was done for the collected quantitative and qualitative information. Results: The study found the prevalence of childlessness among Muthuvan couples as 30.65%. The underlying reasons were their cultural practices of confinement during menstruation and restriction on engaging in productive work and family care, which gave them the idea of regular intake of oral contraceptive pills and lessen their desire to have children. Conclusion: The study concludes that the comfort of their daily life has taken over more important than the consequences of objects used for comfort, to their health and future generations.
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Affiliation(s)
- S Mageswari
- Health Systems Research and MRHRU, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - H Magesh Rajan
- Health Systems Research and MRHRU, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - M Balusamy
- Health Systems Research and MRHRU, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - G Elavarasu
- Health Systems Research and MRHRU, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - R Vijayaprabha
- Health Systems Research and MRHRU, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - V Ramachandran
- Health Systems Research and MRHRU, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - J John Britto
- Health Systems Research and MRHRU, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Yuvaraj Jayaraman
- Health Systems Research and MRHRU, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
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Ramachandran V, Phan K, Smith SD. Association between pemphigus and systemic lupus erythematosus: a systematic review and meta-analysis. An Bras Dermatol 2021; 96:243-245. [PMID: 33632594 PMCID: PMC8007545 DOI: 10.1016/j.abd.2020.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/23/2020] [Indexed: 10/25/2022] Open
Affiliation(s)
- Vignesh Ramachandran
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, United States.
| | - Kevin Phan
- Department of Dermatology, Liverpool Hospital, Sydney, Australia; University of New, South Wales, Sydney, Australia
| | - Saxon D Smith
- Department of Dermatology, The Dermatology & Skin Cancer Centre, Sydney, Australia
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29
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Kamat IS, Ramachandran V, Eswaran H, Guffey D, Musher DM. Procalcitonin to Distinguish Viral From Bacterial Pneumonia: A Systematic Review and Meta-analysis. Clin Infect Dis 2021; 70:538-542. [PMID: 31241140 DOI: 10.1093/cid/ciz545] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/23/2019] [Indexed: 12/21/2022] Open
Abstract
Because of the diverse etiologies of community-acquired pneumonia (CAP) and the limitations of current diagnostic modalities, serum procalcitonin levels have been proposed as a novel tool to guide antibiotic therapy. Outcome data from procalcitonin-guided therapy trials have shown similar mortality, but the essential question is whether the sensitivity and specificity of procalcitonin levels enable the practitioner to distinguish bacterial pneumonia, which requires antibiotic therapy, from viral pneumonia, which does not. In this meta-analysis of 12 studies in 2408 patients with CAP that included etiologic diagnoses and sufficient data to enable analysis, the sensitivity and specificity of serum procalcitonin were 0.55 (95% confidence interval [CI], .37-.71; I2 = 95.5%) and 0.76 (95% CI, .62-.86; I2 = 94.1%), respectively. Thus, a procalcitonin level is unlikely to provide reliable evidence either to mandate administration of antibiotics or to enable withholding such treatment in patients with CAP.
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Affiliation(s)
- Ishan S Kamat
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Harish Eswaran
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Danielle Guffey
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Daniel M Musher
- Department of Medicine, Baylor College of Medicine, Houston, Texas.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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Sengan S, Arokia Jesu Prabhu L, Ramachandran V, Priya V, Ravi L, Subramaniyaswamy V. Images super-resolution by optimal deep AlexNet architecture for medical application: A novel DOCALN1. IFS 2020. [DOI: 10.3233/jifs-189146] [Citation(s) in RCA: 9] [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: 11/15/2022]
Abstract
In the last decade, numerous researches have been focused on Image Super-Resolution (SR); this recreation or improvement model is vital in different research areas. Recently, deep learning algorithm finds useful to advance in the resolution of the medical output. Here, we devise a novel Deep Convolutional Network model along with the optimal learning rate of the Rectified Linear Unit (ReLU) intended for Medical Image Super-Resolution (MISR). For getting the optimal values of Deep Learning AlexNet structure, Modified Crow Search (MCS) is utilized, which is mainly depends on the behavior of crow sets. The chosen Alexnet lacks in a sort of suitable supervision for upgrading execution of the proposed model that effectively aims to overfit. The proposed design, i.e., MISR, named Deep Optimal Convolutional AlexNet (DOCALN), derives the optimal values of learning rates of the ReLU activation function. Based on this optimal deep learning structure, the Low Resolution (LR) medical images can be applied. Experimentation results of our proposed model are compared with variants of Convolution Neural Networks (CNN) concerning different measures such as image quality assessment, SR efficiency analysis, and execution time.
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Affiliation(s)
- Sudhakar Sengan
- Department of Computer Science and Engineering, Sree Sakthi Engineering College, Coimbatore, Tamil Nadu, India
| | - L. Arokia Jesu Prabhu
- Department of Computer Science and Engineering, Sri Shakthi Institute of Engineering and Technology, Coimbatore, Tamil Nadu, India
| | - V. Ramachandran
- Department of Computer Science and Engineering, Sri Shakthi Institute of Engineering and Technology, Coimbatore, Tamil Nadu, India
| | - V. Priya
- Department of Computer Science and Engineering, Mahendra Institute of Technology, Namakkal, Tamil Nadu, India
| | - Logesh Ravi
- Sri Ramachandra Faculty of Engineering and Technology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Ramachandran V, Park KE, Loya A, Duvic M. Second primary malignancies in blastic plasmacytoid dendritic cell neoplasm: A national database study. J Am Acad Dermatol 2020; 83:1786-1789. [PMID: 32278799 DOI: 10.1016/j.jaad.2020.03.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Vignesh Ramachandran
- Baylor College of Medicine, Houston, Texas; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Katherine E Park
- Baylor College of Medicine, Houston, Texas; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Asad Loya
- Baylor College of Medicine, Houston, Texas
| | - Madeleine Duvic
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Santhakumar A, Ganesh B, Malathi M, Nagaraj J, Manikandan N, Padmapriya V, Kirubakaran B, Govindasamy C, Ramachandran V, Sridhar R, Kumar P, Rajan S, Elangovan A. Confined vulnerability of HIV infection among pregnant women attending antenatal care clinics in Karnataka, India: Analysis of data from the HIV sentinel surveillance 2017. Clinical Epidemiology and Global Health 2020. [DOI: 10.1016/j.cegh.2020.04.003] [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: 10/24/2022] Open
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Ramachandran V, Nguyen J, Caruso C, Rao D. Hirschsprung’s Disease: Two Cases of Total Intestinal Aganglionosis. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.159] [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: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Hirschsprung’s disease is a disorder associated with an absence of ganglion cells in a segment of the bowel. Total colonic and small bowel aganglionosis occurs in less than 1% of all Hirschsprung’s disease patients. Even rarer is the finding of Haddad syndrome, the coexistence of congenital central hypoventilation syndrome and Hirschsprung’s disease. Congenital central hypoventilation syndrome has approximately 1,000 reported cases, with colonic aganglionosis being associated with 15-20% of those cases. The prevalence of Hirschsprung’s disease with congenital renal anomalies may be another underreported finding.
Methods
Here, we report two rare cases of Hirschsprung’s disease with significant extension in the small bowel. One case involves a 38-week gestational age male infant admitted for apnea and another case involves 39-week gestational age female infant admitted for vomiting.
Results
Both infants had rectal suction biopsies confirming the absence of ganglion cells. The male infant had mapping biopsies which histologically showed hypertrophic nerve fibers and an absence of ganglion cells in the colon extending up to 70 cm proximal to the ileocecal valve. Calretinin immunostaining confirmed aganglionsis. Genetic testing showed a PHOX2B gene mutation carrying 32 polyalanine repeat mutations, confirming a diagnosis of congenital central hypoventilation syndrome coexisting with Hirschsprung’s disease. The female infant had intraoperative frozen sections that identified ganglion cells throughout the colon. On permanent sections, there was an absence of ganglion cells in the upper rectum extending up to 65 cm proximal to the ileocecal valve. She also was noted to have agenesis of the left kidney and a urachal remnant. Genetic testing was negative for RET mutations.
Conclusion
Overall, these cases provide further information on a rare variant of Hirschsprung’s disease that includes significant portions of the small bowel. Additionally, this study adds to the documented reports of Haddad syndrome and the connections between renal anomalies with Hirschsprung’s disease. Last, this series alludes to the difficulties of frozen section diagnosis of this disease.
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Affiliation(s)
- V Ramachandran
- Pediatric Surgery, University of Missouri, Columbia, Missouri, UNITED STATES
| | - J Nguyen
- Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, UNITED STATES
| | - C Caruso
- Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, UNITED STATES
| | - D Rao
- Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, UNITED STATES
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Phan K, Mangkorntongsakul V, Ramachandran V, Loya A, Smith SD. Pemphigus and diabetes mellitus: a systematic review and meta-analysis. Int J Dermatol 2020; 60:e1-e3. [PMID: 33070309 DOI: 10.1111/ijd.15238] [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: 08/26/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Kevin Phan
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,University of New South Wales, Sydney, Australia
| | | | | | - Asad Loya
- Baylor College of Medicine, Houston, TX, USA
| | - Saxon D Smith
- The Dermatology & Skin Cancer Centre, St Leonards, Sydney, Australia
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35
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Affiliation(s)
- Kevin Phan
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,University of New South Wales, Sydney, Australia
| | - Asad Loya
- Baylor College of Medicine, Houston, TX, USA
| | | | - Saxon D Smith
- Department of Dermatology, Royal North Shore Hospital, Sydney, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.,The Dermatology and Skin Cancer Centre, Sydney, Australia
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36
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Phan K, Ramachandran V, Smith SD. Association between pemphigus and psoriasis: a systematic review and meta-analysis. Dermatol Online J 2020; 26:13030/qt5g78q4f4. [PMID: 32941727] [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] [Received: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023] Open
Abstract
Pemphigus has been associated with other autoimmune and autoinflammatory disorders. Specifically, some case reports in the literature document coexistence of pemphigus with psoriasis, but this association is lacking larger scale investigation. With this in mind, we conducted a systematic review and meta-analysis to evaluate the association between pemphigus and psoriasis. In doing so, we found an association between the two conditions. Pemphigus was more common in patients with psoriasis than in controls (OR 2.64, 95% CI 1.24-5.59, P=0.01), with heterogeneity (I2=94%). We go on to propose pathophysiologic mechanisms and its relevance for diagnostic and management considerations.
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Affiliation(s)
- Kevin Phan
- University of New South Wales, Sydney Department of Dermatology, Liverpool Hospital, Sydney.
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37
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O'Conor DK, Dalal S, Ramachandran V, Shivers B, Shender BS, Jones JA. Crew-Friendly Countermeasures Against Musculoskeletal Injuries in Aviation and Spaceflight. Front Physiol 2020; 11:837. [PMID: 32754055 PMCID: PMC7367058 DOI: 10.3389/fphys.2020.00837] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022] Open
Abstract
Aviation and space medicine face many common musculoskeletal challenges that manifest in crew of rotary-wing aircraft (RWA), high-performance jet aircraft (HPJA), and spacecraft. Furthermore, many astronauts are former pilots of RWA or HPJA. Flight crew are exposed to recurrent musculoskeletal risk relating to the extreme environments in which they operate, including high-gravitational force equivalents (g-forces), altered gravitational vectors, vibratory loading, and interaction with equipment. Several countermeasures have been implemented or are currently under development to reduce the magnitude and frequency of these injuries. Cervical and lumbar spine, as well as extremity injuries, are common to aviators and astronauts, and occur in training and operational environments. Stress on the spinal column secondary to gravitational loading and unloading, ± vibration are implicated in the development of pain syndromes and intervertebral disk pathology. While necessary for operation in extreme environments, crew-support equipment can contribute to musculoskeletal strain or trauma. Crew-focused injury prevention measures such as stretching, exercise, and conditioning programs have demonstrated the potential to prevent pre-flight, in-flight, and post-flight injuries. Equipment countermeasures, especially those addressing helmet mass and center of gravity and spacesuit ergonomics, are also key in injury prevention. Furthermore, behavioral and training interventions are required to ensure that crew are prepared to safely operate when faced with these exposures. The common operational exposures and risk factors between RWA and HPJA pilots and astronauts lend themselves to collaborative studies to develop and improve countermeasures. Countermeasures require time and resources, and careful consideration is warranted to ensure that crew have access to equipment and expertise necessary to implement them. Further investigation is required to demonstrate long-term success of these interventions and inform flight surgeon decision-making about individualized treatment. Lessons learned from each population must be applied to the others to mitigate adverse effects on crew health and well-being and mission readiness.
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Affiliation(s)
- Daniel K O'Conor
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Sawan Dalal
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Vignesh Ramachandran
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Bethany Shivers
- Human Systems Engineering, Naval Air Warfare Aircraft Division, Patuxent River, MD, United States
| | - Barry S Shender
- Human Systems Engineering, Naval Air Warfare Aircraft Division, Patuxent River, MD, United States
| | - Jeffrey A Jones
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, United States.,Commander Fleet Logistics Support Wing, Commander Naval Air Force Reserve, United States Navy Reserves, Naval Air Station JRB Fort Worth, TX, United States
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Joshua V, Kanagasabai K, Sabarinathan R, Ravi M, Kirubakaran BK, Ramachandran V, Shete V, Gowri AK, Murhekar MV. Space time analysis of dengue fever diagnosed through a network of laboratories in India from 2014-2017. J Vector Borne Dis 2020; 57:221-225. [PMID: 34472505 DOI: 10.4103/0972-9062.311774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES The Department of Health Research and the Indian Council of Medical Research, Government of India, have established Virus Research and Diagnostic Laboratory Network (VRDLN) to strengthen the laboratory capacity in the country for providing timely diagnosis of disease outbreaks. Fifty-one VRDLs were functional as on December 2017 and had reported about dengue fever across Indian states. The objectives of the study were to detect space time clusters and purely temporal clusters of dengue using Kulldorff's SaTScan statistics using patient level information; and to identify regions at greater risk of developing the disease using Kriging technique aggregating at district level. METHODS A total of 211,432 patients from 51 VRDLs were investigated for IgM antibodies or NS1 antigen against dengue virus during the period from 1 January 2014 to 31 December 2017 and among them 60,096 (28.4%) were found to be positive. Kulldorff's space time analysis was used to identify significant clusters over space and time. Kriging technique was used to interpolate dengue data for areas not physically sampled using the relationship in the spatial arrangement of the data set. Maps obtained using both the methods were overlaid to identify the regions at greater risk of developing the disease. RESULTS Kulldorff Space time Scan Statistics using the Bernoulli model with monthly precision revealed eight statistically significant clusters (P <0.001) for the time period, 1 January 2014 to 31 December 2017. Eight significant clusters identified were districts of Nagpur, Jhunjhunu, Gadag, Dakshin Kannada, Kancheepuram, Sivaganga, Ernakulam and Malda. The purely temporal clusters occurred during the last quarter of 2015 and 2016. The Kriging technique identified north eastern part of the country (Arunachal Pradesh, Nagaland and Manipur) and Gujarat. INTERPRETATION & CONCLUSION Dengue fever has spread in all directions in the country. Hence, it is need of the hour to perform an in-depth investigation.
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Affiliation(s)
- Vasna Joshua
- ICMR-National Institute of Epidemiology, Chennai, India
| | - K Kanagasabai
- ICMR-National Institute of Epidemiology, Chennai, India
| | | | - M Ravi
- ICMR-National Institute of Epidemiology, Chennai, India
| | | | | | - Vishal Shete
- ICMR-National Institute of Epidemiology, Chennai, India
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Kamat IS, Ramachandran V, Eswaran H, Guffey D, Musher DM. Reply to Peacock and Rafique and to Blot et al. Clin Infect Dis 2020; 71:247. [PMID: 31844878 DOI: 10.1093/cid/ciz952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ishan S Kamat
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - Harish Eswaran
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Danielle Guffey
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel M Musher
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
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Ramachandran V, Park KE, Torres-Cabala CA, Duvic M. Second primary malignancies in subcutaneous panniculitis-like T-cell lymphoma: a national database study. Clin Exp Dermatol 2020; 45:755-757. [PMID: 32359183 DOI: 10.1111/ced.14262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/01/2020] [Accepted: 04/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
- V Ramachandran
- Baylor College of Medicine, Houston, TX, USA.,Departments of, Department of, Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K E Park
- Baylor College of Medicine, Houston, TX, USA.,Departments of, Department of, Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C A Torres-Cabala
- Departments of, Department of, Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of, Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Duvic
- Departments of, Department of, Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Ramachandran V, Marimuthu RR, Chinnambedu RS. World War against COVID-19: How strong is our armamentarium? Med J Malaysia 2020; 75:314-315. [PMID: 32467555] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
No abstract provided.
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Affiliation(s)
- V Ramachandran
- Universiti Kuala Lumpur, Royal College of Medicine Perak (UniKL RCMP), Faculty of Medicine, Preclinical Department, Ipoh, Malaysia.
| | - R R Marimuthu
- Indian Council of Medical Research, ICMR-National Institute of Epidemiology (ICMR-NIE), Laboratory Division, Chennai, India
| | - R S Chinnambedu
- YRG Centre for AIDS Research and Education (YRG CARE), Infectious Diseases Laboratory, Chennai, India
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Shah KP, Goyal S, Ramachandran V, Kohn JR, Go JA, Wiley Z, Moturu A, Namireddy MK, Kumar A, Jacobs RC, Stampfl M, Shah JR, Fu J, Lin WV, Ho B, Wey G, Lin SY, Caruso AC, Gay LJ, Stewart DE, Andrabi S. Efficacy of quality improvement and patient safety workshops for students: a pilot study. BMC Med Educ 2020; 20:126. [PMID: 32326951 PMCID: PMC7181569 DOI: 10.1186/s12909-020-1982-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 02/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND While the Association of American Medical Colleges encourages medical schools to incorporate quality improvement and patient safety (QI/PS) into their curriculum, medical students continue to have limited QI/PS exposure. To prepare medical students for careers that involve QI/PS, the Institute for Healthcare Improvement chapter at an allopathic medical school and school of allied health professions initiated self-directed learning by offering student-led workshops to equip learners with skills to improve the quality and safety of healthcare processes. METHODS In this prospective cohort study, workshops were hosted for medical students between 2015 and 2018 on five QI/PS topics: Process Mapping, Root-Cause Analysis (RCA), Plan-Do-Study-Act (PDSA) Cycles, Evidence Based Medicine (EBM), and Patient Handoffs. Each workshop included a hands-on component to engage learners in practical applications of QI/PS skills in their careers. Change in knowledge, attitudes, and behaviors was assessed via pre- and post-surveys using 5-point Likert scales, and analyzed using either the McNemar test or non-parametric Wilcoxon signed-rank test. Surveys also gathered qualitative feedback regarding strengths, future areas for improvement, and reasons for attending the workshops. RESULTS Data was collected from 88.5% of learners (n = 185/209); 19.5% of learners reported prior formal instruction in these topics. Statistically significant improvements in learners' confidence were observed for each workshop. Additionally, after attending workshops, learners felt comfortable teaching the learned QI/PS skill to colleagues (mean pre/post difference 1.96, p < 0.0001, n = 139) and were more likely to pursue QI/PS projects in their careers (mean pre/post difference 0.45, p < 0.0001, n = 139). Lastly, learners demonstrated a statistically significant increase in knowledge in four out of five skills workshop topics. CONCLUSION Few medical students have formal instruction in QI/PS tools. This pilot study highlights advantages of incorporating an innovative, student-directed modified 'flipped classroom' methodology, with a focus on active experiential learning and minimal didactic instruction.
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Affiliation(s)
- Kevin P. Shah
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Shreya Goyal
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Vignesh Ramachandran
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Jaden R. Kohn
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Jonathan A. Go
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Zachary Wiley
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Anoosha Moturu
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Meera K. Namireddy
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Anjali Kumar
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Ryan C. Jacobs
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Matthew Stampfl
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Jesal R. Shah
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Justin Fu
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Weijie V. Lin
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Brandon Ho
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Grace Wey
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Sophie Y. Lin
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Andrew C. Caruso
- Department of Medicine, Section of General Internal Medicine, Baylor College of Medicine, Houston, TX USA
| | - Lindsey Jordan Gay
- Department of Medicine, Section of General Internal Medicine, Baylor College of Medicine, Houston, TX USA
| | - Diana E. Stewart
- Department of Medicine, Section of General Internal Medicine, Baylor College of Medicine, Houston, TX USA
- Department of Pediatrics, Section of Pediatric Hospital Medicine, Baylor College of Medicine, Houston, TX USA
| | - Sara Andrabi
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX USA
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Ramachandran V, Nguyen HY, Dao H. Does it match? Analyzing self-reported online dermatology match data to Charting Outcomes in the Match. Dermatol Online J 2020; 26:13030/qt4604h1w4. [PMID: 32621675] [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] [Received: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023] Open
Abstract
Dermatology is arguably the most competitive residency (81.6% match rate for United States allopathic seniors) with significantly more applicants than available positions. To objectify this process, the National Residency Match Program (NRMP) has produced bi-annual Charting Outcomes in Match (COM) datasets, which aggregate data from the prior two application cycles and tabulate statistics to aid applicants. In parallel, online forums provide medical trainees with vast amounts of information, including residency application insights. Reddit medical school subforum compiles annual spreadsheets of anonymous, individualized applicant data to aid future applicants. We compared this data to NRMP data to show that although the data means are similar (e.g. Step 1), the Reddit dermatology spreadsheet collects more data and the individualized nature aids applicants in a personalized way unlike the mean aggregate data in NRMP. Under univariate analysis, Alpha Omega Alpha status, overall publications, and dermatology-specific publications are associated with interview invitation rates. Although limitations of the study include small data size and reporting bias, this is the first of its kind to our knowledge to compare these two often-used tools to aid dermatology applicants. Future endeavors should expand anonymous data reporting and use the data to carry out more extensive studies to investigate factors influencing the application process.
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Solomon ZJ, Ramachandran V, Kohn TP, Nichols PE, Haney NM, Patel HD, Johnson MH, Koshelev MV, Dao H. The association of broadband internet access with dermatology practitioners: An ecologic study. J Am Acad Dermatol 2020; 83:1767-1770. [PMID: 32244018 DOI: 10.1016/j.jaad.2020.03.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 03/16/2020] [Accepted: 03/24/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Taylor P Kohn
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paige E Nichols
- Department of Urology, Mayo School of Medicine, Rochester, Minnesota
| | - Nora M Haney
- Department of Urology, Mayo School of Medicine, Rochester, Minnesota
| | - Hiten D Patel
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael H Johnson
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Misha V Koshelev
- Department of Dermatology, McGovern Medical School, Houston, Texas
| | - Harry Dao
- Department of Dermatology, Loma Linda University Health, Loma Linda, California
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Ramachandran V, Bertus B, Bashyam AM, Feldman SR. Treating Psoriasis With Halobetasol Propionate and Tazarotene Combination: A Review of Phase II and III Clinical Trials. Ann Pharmacother 2020; 54:872-878. [PMID: 32126800 DOI: 10.1177/1060028020910439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective: To review phase II and III clinical trial data to evaluate the efficacy and safety of the halobetasol propionate/tazarotene (HP/TAZ) combination lotion (Duobrii), a medication approved by the Food and Drug Administration in April 2019 for adults with plaque psoriasis. Data Sources: A systematic search (January 2005 to July 2019) of MEDLINE (PubMed) and EMBASE databases was performed using the terms halobetasol, tazarotene, halobetasol/tazarotene, Duobrii, and IDP-118. Study Selection and Data Extraction: Relevant English-language articles reporting on phase II and phase III clinical trials were included. Data from the individual trials were extracted independently and then cross-checked to ensure accuracy. Data Synthesis: HP/TAZ was safe and efficacious compared with HP alone, TAZ alone, or vehicle. More patients achieved treatment success, described as a ≥2-grade improvement on Investigator Global Assessment Scale, over 8 weeks of treatment and at the 4-week follow-up after treatment cessation. The most common adverse events were dermatitis, pain, and pruritus, which occurred more often in the TAZ groups compared with the HP/TAZ cohorts. Relevance to Patient Care and Clinical Practice: The once-daily HP/TAZ combination lotion simplifies psoriasis treatment and may facilitate adherence, which may improve psoriasis outcomes. Conclusions: HP/TAZ combination lotion is efficacious and safe for plaque psoriasis treatment, with more patients achieving end points and fewer side effects than in HP, TAZ, or vehicle-treated controls. Drug synergy may play a role. Importantly, patient adherence to a once-daily combinational therapy is likely to contribute to efficacy.
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Affiliation(s)
- Vignesh Ramachandran
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Baylor College of Medicine, Houston, Texas, USA
| | - Brooke Bertus
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Arjun M Bashyam
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Dermatology, University of Southern Denmark, Odense, Denmark
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Ramachandran V, Loya A, Shah KP, Goyal S, Hansoti EA, Caruso AC. Myers-Briggs Type Indicator in Medical Education: A Narrative Review and Analysis. Health Professions Education 2020. [DOI: 10.1016/j.hpe.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Pulikkotil SJ, Nath S, Ramachandran V. Determinants of periodontitis among a rural Indian population: A case control study. Community Dent Health 2020; 37:26-31. [PMID: 32031346 DOI: 10.1922/cdh_4632pulikkotil06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Identify the determinants of periodontitis in a rural Indian population aged 35-44 years. BASIC RESEARCH DESIGN Case-control clinical and questionnaire study in a cluster sample of 50 villages. METHODS A total of 3000 persons were screened for the presence of periodontitis using the CDC case definition in full mouth examination. Equal numbers of cases (604 persons with periodontitis) and controls (604 without periodontitis) were recruited and interviewed with a piloted questionnaire. Univariate and multivariate analysis estimated crude and adjusted odds ratios (aOR) respectively with 95% confidence limits. RESULTS Six factors were determined by multivariate analysis to predict periodontitis: education less than or equal to twelve years of schooling (aOR=2.51, 95% CI=1.18-5.34), alcohol consumption (aOR= 1.7, 95% CI=1.16-2.49), consuming a non-vegetarian diet (aOR=1.38, 95% CI=1.08-1.76), not drinking milk (aOR=1.7, 95% CI= 1.29-2.24), not using a toothbrush for cleaning of teeth (aOR=2.98, 95% CI =1.71-5.21) and not cleaning teeth at least once a day (aOR=2.13, 95% CI=1.58-2.87). CONCLUSION Risk factors for periodontitis in a rural Indian population were identified. Further studies should validate these findings and appropriate recommendations should be developed to decrease the prevalence and burden of periodontitis in this population.
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Affiliation(s)
- S J Pulikkotil
- Associate Professor, Department of Restorative dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - S Nath
- Reader, Kusum Devi Sunderlal Dugar Jain Dental College and Hospital, Kolkata, India
| | - V Ramachandran
- Deputy Director (Retired), National Institute of Epidemiology, India
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Phan K, Ramachandran V, Fassihi H, Sebaratnam DF. Comparison of Narrowband UV-B With Psoralen-UV-A Phototherapy for Patients With Early-Stage Mycosis Fungoides: A Systematic Review and Meta-analysis. JAMA Dermatol 2020; 155:335-341. [PMID: 30698622 DOI: 10.1001/jamadermatol.2018.5204] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Phototherapy is one of the mainstays of treatment for early mycosis fungoides (MF). The most common modalities are psoralen-UV-A (PUVA) and narrowband UV-B (NBUVB). Objective To compare the efficacy and adverse effects of PUVA vs NBUVB in early-stage MF. Data Sources A systematic review was performed by searching Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Ovid Medline, PubMed, Cochrane Library, American College of Physicians ACP Journal Club, and Database of Abstracts of Review of Effectiveness from inception to March 30, 2018. UV A, PUVA, mycosis fungoides, Sézary syndrome, cutaneous T-cell lymphoma, UV B, and UVB were used as either key words or MeSH terms. Study Selection Studies of cohorts with histologically confirmed early-stage MF, defined as stages IA, IB, and IIA, that compared PUVA vs NBUVB, had at least 10 patients in each comparator group, and reported outcomes of response to therapy. Exclusion criteria were studies with patients with stage IIB or higher MF, pediatric patients, fewer than 10 in each comparator group, noncomparative studies, case reports, and abstract studies. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. Data were pooled using a random-effects model with odds ratio (OR) as effect size. Main Outcomes and Measures Main outcomes were complete response rate, partial response rate, disease recurrence, and adverse effects, including erythema, nausea, pruritus, phototoxic effects, dyspepsia, and pain. Results Seven studies were included with a total of 778 patients (405 of 724 [55.9%] men; mean age, 52 years); 527 were treated with PUVA and 251 with NBUVB. Most of the included studies were of poor to moderate quality. Any response was found in 479 of the 527 (90.9%) patients treated with PUVA vs 220 of 251 (87.6%) treated with NBUVB (OR, 1.40; 95% CI, 0.84-2.34; P = .20). Complete response was found in 389 of 527 (73.8%) patients who received PUVA vs 156 of 251 (62.2%) who received NBUVB, which was statistically significant (OR, 1.68; 95% CI, 1.02-2.76; P = .04). Partial response was similar (90 of 501 [18.0%] vs 64 of 233 [27.5%]; OR, 0.58; 95% CI, 0.33-1.04; P = .07). No significant difference was found between PUVA and NBUVB in terms of adverse effects of erythema (38 of 527 [7.2%] vs 17 of 251 [6.7%]; P = .54), nausea (10 of 527 [1.9%] vs 3 of 251 [1.2%]; P = .72), pruritus (2 of 527 [0.4%] vs 4 of 251 [1.7%]; P = .26), phototoxic effects (7 of 527 [1.4%] vs 2 of 251 [0.9%]; P = .72), dyspepsia (6 of 527 [1.2%] vs 0 of 251 [0%]; P = .59), or pain (0 of 527 [0%] vs 2 of 251 [0.9%]; P = .50). Conclusions and Relevance The findings suggest that PUVA is a potential alternative to NBUVB in the management of early-stage MF. These findings have implications for clinicians involved in the management of early-stage MF.
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Affiliation(s)
- Kevin Phan
- Department of Dermatology, Liverpool Hospital, Liverpool, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, Sydney, Australia
| | | | - Hiva Fassihi
- St John's Institute for Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Deshan F Sebaratnam
- Department of Dermatology, Liverpool Hospital, Liverpool, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, Sydney, Australia
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Abstract
Introduction While prior studies have addressed the gender-specific survival of malignant melanoma, such investigation is lacking for melanoma in situ (MIS) and for the sun-exposed head and neck areas. Understanding the role of patient characteristics on disease prognosis is essential in determining optimal patient treatment and follow-up. We conducted a retrospective cohort study of patients diagnosed with MIS of the head and neck to assess the association of gender with long-term survival. Methods First primary cases of MIS diagnosed between 1998 and 2015 were extracted from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database. Cox regression analysis adjusting for demographic, tumor, and treatment characteristics was used to evaluate all-cause and cancer-specific mortality risks. Results After adjusting for demographic, tumor, and treatment data, males demonstrated significantly poorer overall survival (hazard ratio [HR] 1.484; 95% confidence interval [CI] 1.332, 1.653; P<0.001) and cancer-specific survival (HR 1.571; 95% CI 1.056, 2.338; P=0.026) compared to their female counterparts. Conclusion Proposed reasons for these findings include gender-based hormonal influence on cancer growth and development, gender-specific health utilization behaviors, and gender-based cosmetic impact of cutaneous malignancies. These findings do have limitations, including its retrospective nature, possible upgrading of MIS diagnoses during the study period, miscoding, and inability to account of lifestyle/modifiable/environmental risk factors. Nevertheless, it suggests a gender-specific survival difference, which may be further investigated and considered as part of clinician awareness, influence patient counseling, and screening for such patients.
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Affiliation(s)
| | - Asad Loya
- Medicine, Baylor College of Medicine, Houston, USA
| | - Kevin Phan
- Dermatology, Liverpool Hospital, Sydney, AUS
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Phan K, Ramachandran V, Smith SD. Association between pemphigus and psoriasis: a systematic review and meta-analysis. Dermatol Online J 2020. [DOI: 10.5070/d3268049899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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