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Tan AJ, Archila M, Barbieri JS, Mostaghimi A, Scherer AM, Perez-Chada LM, Asgari MM, Gelfand JM, Noe MH. Understanding patient perspectives on vaccine decision making in adults with autoimmune bullous diseases: a qualitative study. Arch Dermatol Res 2024; 316:125. [PMID: 38637431 DOI: 10.1007/s00403-024-02862-z] [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: 12/22/2023] [Revised: 12/22/2023] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
Patients with autoimmune bullous diseases are at an increased risk of infection, both from the underlying skin disease and from immunosuppressive treatments. Limited information is available on vaccine beliefs and behaviors in dermatology patients and adults with autoimmune bullous diseases in particular. To understand vaccine decision making, identify perceived risks and benefits of vaccinations, and discuss individual experiences in patients with autoimmune bullous diseases in the United States. A qualitative study was performed utilizing semi-structured interviews, and analysis was conducted on NVivo. Patterns were identified in the coded data, and representative quotations were recorded for each major theme. Interviews were conducted between February 15, 2022 and September 15, 2022. Twenty patients with a diagnosis of bullous pemphigoid, mucous membrane pemphigoid, pemphigus vulgaris, or pemphigus foliaceous were interviewed. Of the 20 participants, 14 (70%) were female, with a mean (SD, range) age of 64.8 (13.2, 34-83) years. Key themes that emerged from qualitative analysis of the interviews included patient concerns regarding their increased susceptibility to infection, potential exacerbation of skin disease following vaccination, and the effect of immunosuppressive medications on humoral response to vaccines. Lack of appointment availability, difficulty accessing vaccines, and cost were commonly identified barriers to vaccination. These findings provide valuable knowledge for dermatologists in regard to providing counseling specific to patient concerns and to improve communication surrounding vaccination in the dermatology setting.
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Affiliation(s)
- Alice J Tan
- University of Massachusetts Medical School, Worcester, MA, USA
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02215, USA
| | - Marjorie Archila
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02215, USA
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02215, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02215, USA
| | - Aaron M Scherer
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Lourdes M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02215, USA
| | - Maryam M Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Megan H Noe
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02215, USA.
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2
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Tan AJ, Su KA, Deng A, Belazarian L. A solitary polypoid papulonodule on the knee of a 13-year-old girl. Pediatr Dermatol 2024; 41:334-335. [PMID: 38044548 DOI: 10.1111/pde.15476] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Alice J Tan
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Katherine A Su
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - April Deng
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Pathology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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3
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Xia J, Tan AJ, Gabel CK, Nguyen ED, Chand S, Rrapi R, Dobry AS, Garza-Mayers AC, Ko LN, Shah R, St John J, Nigwekar SU, Kroshinsky D. Prevalence and risk factors for development of recurrent calciphylaxis. J Am Acad Dermatol 2024:S0190-9622(24)00380-3. [PMID: 38382710 DOI: 10.1016/j.jaad.2024.02.019] [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: 08/30/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Joyce Xia
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alice J Tan
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Colleen K Gabel
- Department of Dermatology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Emily D Nguyen
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Sidharth Chand
- Department of Dermatology, University of California Irvine Health, Irvine, California
| | - Renajd Rrapi
- Department of Dermatology, New York University Langone Health, New York, New York
| | - Allison S Dobry
- Department of Dermatology, University of California San Francisco Health, San Francisco, California
| | - Anna Cristina Garza-Mayers
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Lauren N Ko
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Radhika Shah
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jessica St John
- Department of Dermatology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Sagar U Nigwekar
- Harvard Medical School, Boston, Massachusetts; Department of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Xia J, Tan AJ, Ostrowski S, Smith GP, Kroshinsky D. Transition to virtual dermatology grand rounds leads to improvement in faculty attendance: A single institution experience. J Eur Acad Dermatol Venereol 2023; 37:e1288-e1289. [PMID: 37328922 DOI: 10.1111/jdv.19272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/12/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Joyce Xia
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alice J Tan
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephen Ostrowski
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gideon P Smith
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Cucka B, Biglione B, Xia J, Tan AJ, Chand S, Rrapi R, El Saleeby C, Kroshinsky D. Complicated Cellulitis is an Independent Predictor for Increased Length of Stay in the Neonatal Intensive Care Unit. J Pediatr 2023; 262:113581. [PMID: 37353147 DOI: 10.1016/j.jpeds.2023.113581] [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: 10/18/2022] [Revised: 05/23/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To assess cellulitis in the neonatal intensive care unit (NICU) setting and identify risk factors for its disease severity and whether cellulitis influences length of stay (LOS). STUDY DESIGN In this retrospective study, patients with cellulitis were identified using the electronic health record while admitted to the NICU at Massachusetts General for Children from January 2007 to December 2020. Demographic and clinical data were extracted from patient records. Two multivariable logistic regression models were constructed to assess for independent predictors for increased LOS (≥30 days) and complicated cellulitis in the hospital. RESULTS Eighty-four patients met the study criteria; 46.4% were older than 14 days at the time of diagnosis of cellulitis, 61.9% were non-White, and 83.3% were born prematurely; 48.8% had complicated cellulitis as defined by overlying hardware (41.7%), sepsis (7.1%), requirement for broadened antibiotic coverage (7.1%), bacteremia (4.8%), and/or abscess (3.6%). The mean hospital LOS was 58.5 ± 36.1 days SD, with 72.6% having a LOS greater than 30 days. Independent predictors of increased LOS were extreme prematurity (<28 weeks' gestation) (OR: 14.7, P = .03), non-White race (OR: 5.7, P = .03), and complicated cellulitis (OR: 6.4, P = .03). No significant predictors of complicated cellulitis were identified. CONCLUSIONS This study identifies complicated cellulitis in the NICU as an independent predictor of increased hospital LOS in neonates. Implementation of strategies to mitigate the development of cellulitis may decrease LOS among this high-risk population.
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Affiliation(s)
- Bethany Cucka
- Department of Dermatology, Massachusetts General Hospital, Boston, MA
| | - Bianca Biglione
- Department of Dermatology, Massachusetts General Hospital, Boston, MA
| | - Joyce Xia
- Department of Dermatology, Massachusetts General Hospital, Boston, MA
| | - Alice J Tan
- Department of Dermatology, Massachusetts General Hospital, Boston, MA
| | - Sidharth Chand
- Department of Dermatology, Massachusetts General Hospital, Boston, MA
| | - Renajd Rrapi
- Department of Dermatology, Massachusetts General Hospital, Boston, MA
| | - Chadi El Saleeby
- Divisions of Hospital Medicine and Infectious Disease, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA; Harvard Medical School, Boston, MA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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Tan AJ, Xia J, Nguyen ED, Danesh MJ, Elman SA, Jothishankar B, Azimi E, Kwon JY, Raskin KA, Robbins GK, Winograd J, Hoang MP, Kroshinsky D. Sweet syndrome following routine orthopedic surgeries: A case series of 7 patients with surgical rechallenges. JAAD Case Rep 2023; 40:136-140. [PMID: 37817889 PMCID: PMC10562088 DOI: 10.1016/j.jdcr.2023.07.039] [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: 10/12/2023] Open
Affiliation(s)
- Alice J. Tan
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Joyce Xia
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily D. Nguyen
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Melissa J. Danesh
- Department of Dermatology, University of California, Davis, California
| | - Scott A. Elman
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
| | - Balaji Jothishankar
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ehsan Azimi
- Dermatology Private Practice, Comprehensive Dermatology of Long Beach, Long Beach, California
| | - John Y. Kwon
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kevin A. Raskin
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory K. Robbins
- Department of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan Winograd
- Department of Plastic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Mai P. Hoang
- Department of Dermatopathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
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Tan AJ, Xia J, Herringshaw E, Mayur O, Iqbal A, Cucka B, Biglione B, Locascio JJ, Kroshinsky D. Gender disparities in isotretinoin prescribing patterns for pediatric patients before and during practice changes introduced by the COVID-19 pandemic. Pediatr Dermatol 2023; 40:869-872. [PMID: 37495565 DOI: 10.1111/pde.15394] [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: 02/16/2023] [Accepted: 06/24/2023] [Indexed: 07/28/2023]
Abstract
Isotretinoin is a systemic therapy approved for acne and has historically required lab monitoring in addition to adherence to the iPLEDGE Risk Evaluation and Mitigation Strategy (REMS) given the medication's teratogenic effects. The COVID-19 pandemic resulted in the expansion of telemedicine, acceptance of remote pregnancy tests, and relaxation of lab monitoring practices. A retrospective review of 142 pediatric patients was conducted, and multivariate linear regression was performed to examine differences in prescribing patterns pre-COVID and during COVID. Backward elimination identified gender and the interaction between acne severity and number of systemic treatments tried before isotretinoin as significant factors associated with increased number of visits to isotretinoin initiation, with females requiring more visits before starting isotretinoin at every acne severity level and even after accounting for systemic treatments previously tried. While the changes catalyzed by the pandemic may have improved visit-related burdens for patients and caregivers, female patients with acne continue to be delayed in receiving isotretinoin even when adjusting for acne severity and systemic treatments trialed, underscoring persistent gender disparities in prescribing practices for isotretinoin.
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Affiliation(s)
- Alice J Tan
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joyce Xia
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emilee Herringshaw
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Omkar Mayur
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Arshia Iqbal
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bethany Cucka
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bianca Biglione
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph J Locascio
- Harvard Catalyst Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
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8
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Noe MH, Archila M, Barbieri JS, Goldman N, Lopez CG, Mostaghimi A, Scherer AM, Tan AJ, Perez-Chada LM, Asgari MM, Gelfand JM. The patient perspective on vaccine uptake in adults with psoriasis and eczema. Arch Dermatol Res 2023; 315:1583-1592. [PMID: 36749390 PMCID: PMC9904245 DOI: 10.1007/s00403-023-02546-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/05/2023] [Accepted: 01/22/2023] [Indexed: 02/08/2023]
Abstract
Having a chronic disease is one of the most consistent factors associated with vaccine uptake for adults in the general population, but vaccination beliefs and behaviors specific to those with chronic skin diseases have not been explored. The objective of this study was to explore factors associated with vaccine uptake and barriers to vaccination in adults with psoriasis and eczema. Virtual, video-based semi-structured interviews were performed with adults who self-reported a diagnosis of psoriasis or eczema. Interviews explored themes around healthcare decision making, perceived risks/benefits to vaccination, barriers, and vaccine knowledge. Thematic analysis was used to analyze the data. Of 34 study participants, 25 participants (74%) were females and 9 (26%) were males, with a mean age of 50.8 years (SD: 16.4, range: 24-71 yrs). Half of participants (n = 17) had psoriasis, and half (n = 17) had eczema. Participants recognized both personal and societal benefits to vaccines. Common vaccination barriers identified were access to appointments, concerns about side effects, and misinformation. Physicians, friends/family, and media, including internet resources, were health information resources identified by patients. These results summarize the unique patient perspective around vaccine uptake in adults with eczema and psoriasis and represent an important first step in a multi-pronged approach to improve vaccination rates in adults with chronic skin diseases.
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Affiliation(s)
- Megan H Noe
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.
| | - Marjorie Archila
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Nathaniel Goldman
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- School of Medicine, New York Medical College, New York, NY, USA
| | - Christina G Lopez
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Aaron M Scherer
- Department of Internal Medicine, University of Iowa, Iowa, IA, USA
| | - Alice J Tan
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Maryam M Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
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Xia J, Tan AJ, Biglione B, Cucka B, Ko L, Nguyen ED, Khoury CC, Robinson MK, Nigwekar SU, Kroshinsky D. Nephrogenic Calciphylaxis Arising after Bariatric Surgery: A Case Series. Am J Nephrol 2023; 55:196-201. [PMID: 37487472 DOI: 10.1159/000531784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/22/2023] [Indexed: 07/26/2023]
Abstract
Nephrogenic calciphylaxis is associated with multiple risk factors including long-term dialysis dependence, hyperphosphatemia, hypercalcemia, parathyroid hormone derangements, vitamin K deficiency, obesity, diabetes mellitus, warfarin use, and female sex. Bariatric surgery is known to cause altered absorption, leading to mineral and hormonal abnormalities in addition to nutritional deficiency. Prior case reports on calciphylaxis development following bariatric surgery have been published, though are limited in number. We report a case series of five bariatric patients from a single institution who developed nephrogenic calciphylaxis between 2012 and 2018. These patients had a history of bariatric surgery, and at the time of calciphylaxis diagnosis, demonstrated laboratory abnormalities associated with surgery including hypercalcemia (n = 3), hyperparathyroidism (n = 2), hypoalbuminemia (n = 5), and vitamin D deficiency (n = 5), in addition to other medication exposures such as vitamin D supplementation (n = 2), calcium supplementation (n = 4), warfarin (n = 2), and intravenous iron (n = 1). Despite the multifactorial etiology of calciphylaxis and the many risk factors present in the subjects of this case series, we submit that bariatric surgery represents an additional potential risk factor for calciphylaxis directly stemming from the adverse impact of malabsorption and overuse of therapeutic supplementation. We draw attention to this phenomenon to encourage early consideration of calciphylaxis in the differential for painful skin lesions arising after bariatric surgery as swift intervention is essential for these high-risk patients.
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Affiliation(s)
- Joyce Xia
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA,
| | - Alice J Tan
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bianca Biglione
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bethany Cucka
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren Ko
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Emily D Nguyen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Charbel C Khoury
- Department of Nephrology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Malcolm K Robinson
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Metabolic and Bariatric Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sagar U Nigwekar
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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10
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Tan AJ, Streicher JL, Merola JF, Noe MH. Vaccine considerations for adult dermatology patients on immunosuppressive and immunomodulatory therapies: a clinical review. Dermatol Online J 2021; 27. [PMID: 34755974 PMCID: PMC9020387 DOI: 10.5070/d327955114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 11/08/2022] Open
Abstract
Adults with chronic inflammatory skin disease are at increased risk of vaccine-preventable illnesses and infections, likely because of the underlying disease itself and also their treatment with immunosuppressive and immunomodulatory medications. Despite the association between these agents and increased susceptibility to infection, vaccination rates in dermatology patients remain low. Although preventative care such as vaccinations is typically managed by primary care providers, dermatologists serve a critical role in spreading awareness of the specific risks of immunosuppressive and immunomodulatory agents and promoting understanding of individualized vaccine recommendations. In this review, we provide evidence-based information on vaccine recommendations for adult dermatology patients, specific to age and medication use.
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Affiliation(s)
| | | | | | - Megan H Noe
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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11
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Franciosi EB, Tan AJ, Kassamali B, Leonard N, Zhou G, Krueger S, Rashighi M, LaChance A. The Impact of Telehealth Implementation on Underserved Populations and No-Show Rates by Medical Specialty During the COVID-19 Pandemic. Telemed J E Health 2021; 27:874-880. [PMID: 33826411 DOI: 10.1089/tmj.2020.0525] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A unique and sudden need for virtual medical visits created by the coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented expansion of telemedicine across nearly all medical specialties in the United States. In addition to providing essential medical services during the pandemic, telemedicine has the potential to expand health care access to underserved populations by eliminating traditional barriers to care such as transportation needs, distance from specialty providers, and approved time off from work. However, the literature regarding telehealth accessibility for low-income, non-English-speaking, and minority patients remains limited. Through a cross-sectional analysis comparing 2019 clinic visits with 2020 telehealth visits at the UMass Memorial Medical Center, we demonstrate specialty-specific changes in patient demographics, including a younger population, fewer non-English-speaking patients, and a relative preservation of minority, Medicaid, and Medicare patients among telehealth visits in comparison to clinic visits. We also demonstrate that nonsurgical specialties had significantly lower no-show rates and the greatest number of telehealth visits. Overall, our findings highlight the potential shortcomings of telemedicine in servicing non-English-speaking patients, while maintaining that it is an important tool with the potential to improve access to health care, particularly in nonprocedural specialties.
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Affiliation(s)
- Ellen B Franciosi
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Alice J Tan
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bina Kassamali
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas Leonard
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Guohai Zhou
- Center for Clinical Investigation, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven Krueger
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Mehdi Rashighi
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Avery LaChance
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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12
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Franciosi EB, Tan AJ, Kassamali B, O'Connor DM, Rashighi M, LaChance A. Response to the influence of teledermatology on health care access and equity. J Am Acad Dermatol 2020; 84:e221-e222. [PMID: 33359783 DOI: 10.1016/j.jaad.2020.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Ellen B Franciosi
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA
| | - Alice J Tan
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA
| | - Bina Kassamali
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Mehdi Rashighi
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA
| | - Avery LaChance
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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13
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Franciosi EB, Tan AJ, Kassamali B, O'Connor DM, Rashighi M, LaChance AH. Understanding the impact of teledermatology on no-show rates and health care accessibility: A retrospective chart review. J Am Acad Dermatol 2020; 84:769-771. [PMID: 32926984 PMCID: PMC7484689 DOI: 10.1016/j.jaad.2020.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Ellen B Franciosi
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Alice J Tan
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Bina Kassamali
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel M O'Connor
- Harvard Combined Dermatology Residency Program, Boston, Massachusetts
| | - Mehdi Rashighi
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Avery H LaChance
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Affiliation(s)
- Gregory M. Orlowski
- Department of Dermatology, Worcester, Massachusetts
- Correspondence to: Gregory M. Orlowski, MD, PhD, Department of Dermatology, University of Massachusetts Medical School, Worcester, MA 01605.
| | - Alice J. Tan
- University of Massachusetts Medical School, Worcester, Massachusetts
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15
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Leaker BR, Malkov VA, Mogg R, Ruddy MK, Nicholson GC, Tan AJ, Tribouley C, Chen G, De Lepeleire I, Calder NA, Chung H, Lavender P, Carayannopoulos LN, Hansel TT. The nasal mucosal late allergic reaction to grass pollen involves type 2 inflammation (IL-5 and IL-13), the inflammasome (IL-1β), and complement. Mucosal Immunol 2017; 10:408-420. [PMID: 27677865 DOI: 10.1038/mi.2016.74] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/21/2016] [Indexed: 02/04/2023]
Abstract
Non-invasive mucosal sampling (nasosorption and nasal curettage) was used following nasal allergen challenge with grass pollen in subjects with allergic rhinitis, in order to define the molecular basis of the late allergic reaction (LAR). It was found that the nasal LAR to grass pollen involves parallel changes in pathways of type 2 inflammation (IL-4, IL-5 and IL-13), inflammasome-related (IL-1β), and complement and circadian-associated genes. A grass pollen nasal spray was given to subjects with hay fever followed by serial sampling, in which cytokines and chemokines were measured in absorbed nasal mucosal lining fluid, and global gene expression (transcriptomics) assessed in nasal mucosal curettage samples. Twelve of 19 subjects responded with elevations in interleukin (IL)-5, IL-13, IL-1β and MIP-1β/CCL4 protein levels in the late phase. In addition, in these individuals whole-genome expression profiling showed upregulation of type 2 inflammation involving eosinophils and IL-4, IL-5 and IL-13; neutrophil recruitment with IL-1α and IL-1β; the alternative pathway of complement (factor P and C5aR); and prominent effects on circadian-associated transcription regulators. Baseline IL-33 mRNA strongly correlated with these late-phase responses, whereas a single oral dose of prednisone dose-dependently reversed most nasal allergen challenge-induced cytokine and transcript responses. This study shows that the LAR to grass pollen involves a range of inflammatory pathways and suggests potential new biomarkers and therapeutic targets. Furthermore, the marked variation in mucosal inflammatory events between different patients suggests that in the future precision mucosal sampling may enable rational specific therapy.
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Affiliation(s)
- B R Leaker
- Respiratory Clinical Trials Ltd, London, UK
| | - V A Malkov
- Merck Research Laboratories, Rahway, New Jersey, USA
| | - R Mogg
- Merck Research Laboratories, Rahway, New Jersey, USA.,Present address: Celgene (L.N.C. and G.C.); Janssen R & D, Spring House, PA (R.M.); Alnylam (M.K.R.); Novartis (C.T.); GSK (N.A.C.); Otsuka (H.C.)
| | - M K Ruddy
- Merck Research Laboratories, Rahway, New Jersey, USA.,Present address: Celgene (L.N.C. and G.C.); Janssen R & D, Spring House, PA (R.M.); Alnylam (M.K.R.); Novartis (C.T.); GSK (N.A.C.); Otsuka (H.C.)
| | | | - A J Tan
- Imperial Clinical Respiratory Research Unit (ICRRU), St Mary's Hospital, Imperial College, London, UK
| | - C Tribouley
- Merck Research Laboratories, Rahway, New Jersey, USA.,Present address: Celgene (L.N.C. and G.C.); Janssen R & D, Spring House, PA (R.M.); Alnylam (M.K.R.); Novartis (C.T.); GSK (N.A.C.); Otsuka (H.C.)
| | - G Chen
- Merck Research Laboratories, Rahway, New Jersey, USA.,Present address: Celgene (L.N.C. and G.C.); Janssen R & D, Spring House, PA (R.M.); Alnylam (M.K.R.); Novartis (C.T.); GSK (N.A.C.); Otsuka (H.C.)
| | | | - N A Calder
- MSD (Europe) Inc., Brussels, Belgium.,Present address: Celgene (L.N.C. and G.C.); Janssen R & D, Spring House, PA (R.M.); Alnylam (M.K.R.); Novartis (C.T.); GSK (N.A.C.); Otsuka (H.C.)
| | - H Chung
- Present address: Celgene (L.N.C. and G.C.); Janssen R & D, Spring House, PA (R.M.); Alnylam (M.K.R.); Novartis (C.T.); GSK (N.A.C.); Otsuka (H.C.)
| | - P Lavender
- Department of Asthma, Allergy and Respiratory Science, King's College, London, UK
| | - L N Carayannopoulos
- Merck Research Laboratories, Rahway, New Jersey, USA.,Present address: Celgene (L.N.C. and G.C.); Janssen R & D, Spring House, PA (R.M.); Alnylam (M.K.R.); Novartis (C.T.); GSK (N.A.C.); Otsuka (H.C.)
| | - T T Hansel
- Imperial Clinical Respiratory Research Unit (ICRRU), St Mary's Hospital, Imperial College, London, UK
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Xu J, Wang YQ, Li ZQ, Ling L, Zeng BS, You L, Chen YZ, Aslam AFM, Huang YP, Tan AJ. Functional characterization of the vitellogenin promoter in the silkworm, Bombyx mori. Insect Mol Biol 2014; 23:550-557. [PMID: 24828437 DOI: 10.1111/imb.12102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Genetic transformation and genome editing technologies have been successfully established in the lepidopteran insect model, the domesticated silkworm, Bombyx mori, providing great potential for functional genomics and practical applications. However, the current lack of cis-regulatory elements in B. mori gene manipulation research limits further exploitation in functional gene analysis. In the present study, we characterized a B. mori endogenous promoter, Bmvgp, which is a 798-bp DNA sequence adjacent to the 5'-end of the vitellogenin gene (Bmvg). PiggyBac-based transgenic analysis shows that Bmvgp precisely directs expression of a reporter gene, enhanced green fluorescent protein (EGFP), in a sex-, tissue- and stage-specific manner. In transgenic animals, EGFP expression can be detected in the female fat body from larval-pupal ecdysis to the following pupal and adult stage. Furthermore, in vitro and in vivo experiments revealed that EGFP expression can be activated by 20-hydroxyecdysone, which is consistent with endogenous Bmvg expression. These data indicate that Bmvgp is an effective endogenous cis-regulatory element in B. mori.
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Affiliation(s)
- J Xu
- Key Laboratory of Insect Developmental and Evolutionary Biology, Institute of Plant Physiology and Ecology, Chinese Academy of Sciences, Shanghai Institutes for Biological Sciences, Shanghai, China; University of Chinese Academy of Sciences, Beijing, China
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17
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Erin EM, Zacharasiewicz AS, Nicholson GC, Tan AJ, Higgins LA, Williams TJ, Murdoch RD, Durham SR, Barnes PJ, Hansel TT. Topical corticosteroid inhibits interleukin-4, -5 and -13 in nasal secretions following allergen challenge. Clin Exp Allergy 2006; 35:1608-14. [PMID: 16393327 DOI: 10.1111/j.1365-2222.2005.02381.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cytokines and chemokines produced by allergen-reactive T-helper type 2 (Th2) cells may be pivotal to the pathophysiology of allergic disorders. OBJECTIVE This study was performed to assess the effect of 7 days of topical corticosteroid on nasal allergen challenge (NAC) in terms of eosinophils, cytokines and chemokines obtained by nasal lavage and filter paper methods. METHODS Patients with grass pollen seasonal-allergic rhinitis (n = 13) out of season received nasal challenge following matched placebo (twice daily into each nostril for 7 days) and fluticasone propionate (100 microg twice daily into each nostril for 7 days). Chemokine and cytokine levels were analysed using a sensitive automated bead immunoassay system at intervals up to 8 h after NAC. RESULTS Levels of cytokines and chemokines from filter paper were generally higher than from nasal lavage. Fluticasone propionate caused a reduction in symptoms, total leukocyte counts and eosinophils, and abrogation of IL-4, IL-5, IL-6 and IL-13 responses in the filter paper taken in the late phase (P < 0.05 for IL-4 and IL-13, P < 0.01 for IL-5 and IL-6). Levels of chemokines (eotaxin, RANTES, MCP-1, MIP-1alpha, IL-8 and IP-10) were also reduced in the late phase (P < 0.01 at 8 h). However, levels of IL-2, IL-3, IL-7, IL-12 (p40 and p70), -15, TNF-alpha, IFN-gamma and GM-CSF were not affected. CONCLUSION Fluticasone propionate has selective inhibitory effects on Th2 cytokine synthesis following nasal challenge, while also decreasing release of chemokines, but not affecting levels of Th1 cytokines.
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Affiliation(s)
- E M Erin
- National Heart and Lung Institute (NHLI) Clinical Studies Unit, Imperial College, London, UK
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Tan AJ, He SP, Huang MX. [A matched case-control study on the relations between beta-carotene and lung cancer]. Zhonghua Liu Xing Bing Xue Za Zhi 1995; 16:199-202. [PMID: 7585896] [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: 01/26/2023]
Abstract
In order to discover the relationship between dietary nutrients intake and risk of lung cancer 1:1 matched case-control study on 156 recent histologiclly diagnosed primary lung cancer patients and 156 patients with respiratory tumour and other related diseases as controls, was conducted in Wuhan. All cases and controls were asked to participate in the nutritional assessment program and a food frequency questionnaire containing 64 food items was filled in. The findings showed that there was a statistically significant difference between dietary intake of beta-carotene between the two groups (2877.13 +/- 393.43 vs. 3445 +/- 430.98 micrograms/day). Having controled the confounding factor of cigarette smoking, a significant linear trend for lower dietary carotene intake toward higher lung cancer risk was observed.
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Affiliation(s)
- A J Tan
- Department of Epidemiology, Tongji Medical University, Wuhan
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20
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Li GG, Tan AJ. [A case-control study of serum beta-carotene and lung cancer]. Zhonghua Yu Fang Yi Xue Za Zhi 1994; 28:81-3. [PMID: 7924652] [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: 01/27/2023]
Abstract
A 1:2 matched case-control study was conducted in Wuhan area with conditional logistic regression model to study the relationship between occurrence of primary lung cancer and serum levels of beta-carotene. The results showed the lower the serum levels of beta-carotene, the higher the risk of lung cancer. It suggested the increase of serum beta-carotene with dietary intake could lower the risk of lung cancer.
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Affiliation(s)
- G G Li
- Department of Epidemiology, Tongji Medical University, Wuhan
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Abstract
An investigation was made of the feasibility of using tensile tests to detect alterations in the molecular structure of aortic valve tissue brought about by sterilizing or storage treatments. Stress-strain tests were carried out on fresh valve leaflets from pigs and repeated with the same specimens after specified sterilization or storage treatments. It was found that the stress at a given strain was increased by treatment with ethylene oxide, buffered formalin, and tissue culture solution and decreased by treatment with antibiotics. The least change was with tissue culture solution and antibiotics. It has been suggested that the best method of allograft sterilization should involve minimal structural alteration to the collagen and elastic components of the tissue. Thus, treatment with tissue culture solution and antibiotics seems appropriate.
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