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Kamal K, Afzal N, Ziad A, Santiago-Soltero K, Charrow A. Lack of association of exogenous testosterone administration with exacerbation of preexisting hidradenitis suppurativa. JAAD Int 2024; 15:182-184. [PMID: 38651038 PMCID: PMC11033186 DOI: 10.1016/j.jdin.2023.11.016] [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: 04/25/2024] Open
Affiliation(s)
- Kanika Kamal
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Najiba Afzal
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- University of California, Davis, School of Medicine, Sacramento, California
| | - Amina Ziad
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Karla Santiago-Soltero
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Alexandra Charrow
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
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Ly S, Manjaly P, Kamal K, Theodosakis N, Charrow A, Mostaghimi A. Insurance coverage among the largest insurers per state for laser hair removal in the treatment of hidradenitis suppurativa. J Am Acad Dermatol 2024; 90:859-862. [PMID: 38128832 DOI: 10.1016/j.jaad.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Sophia Ly
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Priya Manjaly
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Nicholas Theodosakis
- Harvard Medical School, Harvard University, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexandra Charrow
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts.
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Manjaly P, Sanchez K, Gregoire S, Ly S, Kamal K, Mostaghimi A. Superficial and Bullous Neutrophilic Dermatoses: Sneddon-Wilkinson, IgA Pemphigus, and Bullous Lupus. Dermatol Clin 2024; 42:307-315. [PMID: 38423689 DOI: 10.1016/j.det.2023.08.010] [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] [Indexed: 03/02/2024]
Abstract
Sneddon-Wilkinson disease (SWD), IgA pemphigus, and bullous systemic lupus erythematosus (BSLE) are superficial and bullous neutrophilic dermatoses. They are all characterized by sterile neutrophilic infiltrate but differ in the level of skin affected and presence of autoantibodies. Both SWD and IgA pemphigus present with grouped flaccid pustules and have epidermal involvement; it is unclear whether they are distinct or exist on a spectrum of the same disease. IgA pemphigus is distinguished from SWD by positive direct immunofluorescence showing intercellular IgA deposition. BSLE presents with tense bullae, dermal neutrophilic infiltrate, and direct immunofluorescence showing linear IgG deposition along the dermal-epidermal junction.
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Affiliation(s)
- Priya Manjaly
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA; Boston University School of Medicine, Boston, MA 02118, USA
| | - Katherine Sanchez
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Samantha Gregoire
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Sophia Ly
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Kamal K, Manjaly P, Ly S, Zhou G, Theodosakis N, Mostaghimi A. Characterizing differences in outpatient dermatologic care utilization among disaggregated Asian American subgroups. Arch Dermatol Res 2024; 316:95. [PMID: 38427050 DOI: 10.1007/s00403-024-02832-5] [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: 10/31/2023] [Revised: 10/31/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
Despite having significantly higher rates of atopic dermatitis, psoriasis, and pigmentary disorders compared to White patients, studies suggest that Asian Americans are underrepresented in outpatient dermatology clinics. In this study, we utilize the National Health Interview Survey (NHIS) and prioritize disaggregated analyses to evaluate differences between the most populous Asian American subgroups (Chinese, Filipino, Indian, and "Other") in utilization of outpatient dermatologic care. We utilized multivariable logistic regression to compare outpatient dermatologic care use between each Asian American subgroup and Non-Hispanic Whites. Out of 96,559 adults, our study included 5264 self-identified Asian American and 91,295 non-Hispanic White adults. Most Asian participants were female, had health insurance, and had incomes > 2 times above the federal poverty line. We found that, compared to 21.4% for NH whites, lifetime prevalence of total body skin exam was highest among Filipino Americans (12.3%) and lowest among Indian Americans (7%). Additionally, all Asian American subgroups had a significantly lower odd than NH Whites of ever having a total body skin exam, with Indian Americans having the lowest odds. While the benefit of TBSEs in Indian Americans is unclear, it is possible that differing cultural perceptions about dermatologic needs, barriers to care, or immigration status may be contributing to the observed difference. Furthermore, the Indian diaspora encapsulates a range of skin tones, risk factors, and behaviors that may differentially influence dermatologic disease risk, similar to trends identified among Hispanic patients (Trepanowski et al. in J Am Acad Dermatol 88:1206-1209, 2023). Additional research utilizing the seven national databases that have been identified as providing disaggregated Asian racial information (Kamal et al. in J Am Acad Dermatol, 2023) may be useful to further illuminate avenues for intervention.
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Affiliation(s)
- Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, PBB-B 421, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Priya Manjaly
- Department of Dermatology, Brigham and Women's Hospital, PBB-B 421, 75 Francis Street, Boston, MA, 02115, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Sophia Ly
- Department of Dermatology, Brigham and Women's Hospital, PBB-B 421, 75 Francis Street, Boston, MA, 02115, USA
| | - Guohai Zhou
- Department of Dermatology, Brigham and Women's Hospital, PBB-B 421, 75 Francis Street, Boston, MA, 02115, USA
| | | | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, PBB-B 421, 75 Francis Street, Boston, MA, 02115, USA.
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5
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Lim YH, Saberi SA, Kamal K, Jalian HR, Avram M. Retrospective Analysis of US Litigations Involving Dermatologists From 2011 to 2022. Dermatol Surg 2024:00042728-990000000-00698. [PMID: 38416806 DOI: 10.1097/dss.0000000000004142] [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: 03/01/2024]
Abstract
BACKGROUND Physician malpractice lawsuits are climbing, and the reasons underlying litigation against dermatologists are unclear. OBJECTIVE To determine the reasons patients pursue litigation against dermatologists or dermatology practices. MATERIALS AND METHODS A retrospective analysis of all state and federal cases between 2011 and 2022 was performed after a query using "Dermatology" and "dermatologist" as search terms on 2 national legal data repositories. RESULTS The authors identified a total of 48 (37 state and 11 federal) lawsuits in which a practicing dermatologist or dermatology group practice was the defendant. The most common reason for litigation was unexpected harm (26 cases, 54.2%), followed by diagnostic error (e.g. incorrect or delayed diagnoses) (16 cases, 33.3%). Six cases resulted from the dermatologist failing to communicate important information, such as medication side effects or obtaining informed consent. Male dermatologists were sued at a rate 3.1 times higher than female dermatologists. CONCLUSION Although lawsuits from patients against dermatologists largely involve injury from elective procedures, clinicians should practice caution regarding missed diagnoses and ensure critical information is shared with patients to safeguard against easily avoidable litigation.
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Affiliation(s)
- Young H Lim
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - Mathew Avram
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
- Dermatology Laser and Cosmetic Center, Massachusetts General Hospital, Boston, Massachusetts
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Kamal K, Afzal N, Ziad A, Charrow A. Association between exogenous testosterone use and new diagnosis of hidradenitis suppurativa: A case series. JAAD Case Rep 2024; 44:27-29. [PMID: 38292574 PMCID: PMC10824676 DOI: 10.1016/j.jdcr.2023.11.012] [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] [Indexed: 02/01/2024] Open
Affiliation(s)
- Kanika Kamal
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Najiba Afzal
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- School of Medicine, University of California, Davis, Sacramento, California
| | - Amina Ziad
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Alexandra Charrow
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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7
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Kamal K, Xiang DH, Young K, Mostaghimi A, Barbieri JS, Cohen JM, Theodosakis N. Comorbid psychiatric disease significantly mediates increased rates of alcohol use disorder among patients with inflammatory and pigmentary skin disorders: a case-control study in the All of Us Research Program. Arch Dermatol Res 2024; 316:79. [PMID: 38252292 DOI: 10.1007/s00403-023-02803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024]
Abstract
Dermatologic diseases have a well-documented association with depression and anxiety, which are in turn often comorbid with alcohol use disorder (AUD). Nonethleess, the relationship between dermatologic disease and AUD, and the relative contribution of depression and anxiety, are poorly understood. Here, we utilize the National Insittutes of Health All of Us Research Program to investigate the association between inflammatory and pigmentary dermatologic diseases with AUD. Furthermore, we investigate whether comorbid depression and anxiety mediates this relationship. We employed a matched case-control model with multivariable logistic regression. We also employed a mediation analysis. We found an increased odds of AUD among patients with atopic dermatitis, acne/rosacea, hidradenitis suppurativa, psoriasis, and pigmentary disorders (vitiligo, melasma, and post-inflammatory hyperpigmentation). This was partially mediated by anxiety and depression, especially for diseases with a significant cosmetic component. Overall, these findings highlight the profound psychological and physical health effects that inflammatory and pigmentary disease can have on patients, both independently and in combination with comorbid psychiatric disease.
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Affiliation(s)
- Kanika Kamal
- Harvard Medical School, Boston, MA, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Arash Mostaghimi
- 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
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Nicholas Theodosakis
- Department of Dermatology, Massachusetts General Hospital, 55 Fruit St., BH616, Boston, MA, 02114, USA.
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Kamal K, Riew GJ, Hijaz B, Helfgott SM, Laga AC, Nambudiri VE. Generalized pustular psoriasis-like widespread eruption following COVID-19 infection in a patient with spondyloarthropathy on adalimumab. Exp Dermatol 2024; 33:e14889. [PMID: 37452555 DOI: 10.1111/exd.14889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
Generalized pustular psoriasis (GPP) is a form of pustular psoriasis that is distinguished by recurring or persistent outbreaks of non-acral primary sterile pustules. These eruptions can occur with or without systemic inflammation. Various factors, such as medications, stress and viral infection, have been identified as potential triggers for GPP flares. While several cases have detailed GPP-like eruptions in the setting of coronavirus disease 2019 (COVID-19) infection, few have explored the interplay between infection and biologic use in the development of GPP. In this case, we detail the history and management of a 45-year-old male patient with a prior history of spondyloarthropathy managed on a tumour necrosis factor-α inhibitor and recent COVID-19 infection presenting with a new, spreading pustular rash.
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Affiliation(s)
- Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Grant J Riew
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Baraa Hijaz
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Simon M Helfgott
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alvaro C Laga
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Vinod E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Kamal K, Xia E, Li SJ, Alavi A, Cogen AL, Firooz A, Marzano AV, Kaffenberger BH, Sibbald C, Fernandez AP, Callen JP, Dissemond J, Gontijo JRV, Shams K, Gerbens LA, French LE, Gould LJ, Bissonnette R, Shaigany S, Tolkachjov S, Yamamoto T, Wei-Ting Huang W, Ortega-Loayza AG, Mostaghimi A. Eligibility Criteria for Active Ulcerative Pyoderma Gangrenosum in Clinical Trials: A Delphi Consensus on Behalf of the UPGRADE (Understanding Pyoderma Gangrenosum: Review and Assessment of Disease Effects) Group. J Invest Dermatol 2023:S0022-202X(23)03193-7. [PMID: 38110114 DOI: 10.1016/j.jid.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023]
Abstract
At present, there are no standardized guidelines for determining patient eligibility for pyoderma gangrenosum (PG) clinical trials. Thus, we aim to determine which clinical features, histopathological features, or laboratory features should be included in active ulcerative PG clinical trial eligibility criteria for treatment-naïve patients and patients already treated with immunomodulating medications (treatment-exposed patients). This study employed 4 rounds of the Delphi technique. Electronic surveys were administered to 21 international board-certified dermatologists and plastic surgeon PG experts (June 2022-December 2022). Our results demonstrated that for a patient to be eligible for a PG trial, they must meet the following criteria: (i) presence of ulcer(s) with erythematous/violaceous undermining wound borders, (ii) presence of a painful or tender ulcer, (iii) history/presence of rapidly progressing disease, (iv) exclusion of infection and other causes of cutaneous ulceration, (v) biopsy for H&E staining, and (vi) a presence/history of pathergy. These criteria vary in importance for treatment-naïve versus treatment-exposed patients. Given the international cohort, we were unable to facilitate live discussions between rounds. This Delphi consensus study provides a set of specific, standardized eligibility criteria for PG clinical trials, thus addressing one of the main issues hampering progress toward Food and Drug Administration approval of medications for PG.
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Affiliation(s)
- Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Eric Xia
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sara J Li
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Tufts Univeresity School of Medicine, Boston, Massachusetts, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anna L Cogen
- Divison of Dermatology, University of Washington, Seattle, Washington, USA
| | - Alireza Firooz
- Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Benjamin H Kaffenberger
- Department of Dermatology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Cathryn Sibbald
- Division of Pediatric Dermatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Anthony P Fernandez
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA; Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jeffrey P Callen
- Division of Dermatology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Medical Center Essen, Essen, Germany
| | | | - Kave Shams
- Inflammatory Skin Disease Group, Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Louise A Gerbens
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Lars E French
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany; Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Lisa J Gould
- Department of Surgery, South Shore Hospital, South Weymouth, Massachusetts, USA
| | | | - Sheila Shaigany
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Stanislav Tolkachjov
- Epiphany Dermatology, Dallas, Texas, USA; Department of Dermatology, University of Texas at Southwestern, Dallas, Texas, USA; Texas A&M College of Medicine, Dallas, Texas, USA; Baylor University Medical Center, Dallas, Texas, USA
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - William Wei-Ting Huang
- Department of Dermatology, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Nock MR, Kamal K, Zampella JG, Roberson ML, Cohen JM, Barbieri JS. Barriers to Care Among Sexual and Gender Minority Individuals With Chronic Inflammatory Skin Diseases in the US. JAMA Dermatol 2023; 159:1323-1331. [PMID: 37755822 PMCID: PMC10535014 DOI: 10.1001/jamadermatol.2023.3328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/20/2023] [Indexed: 09/28/2023]
Abstract
Importance Research on the prevalence of barriers to care among sexual and gender minority (SGM) patients with chronic inflammatory skin diseases (CISDs) in the US is limited. Objective To compare the prevalence of cost and noncost barriers to care among SGM and non-SGM patients with CISDs and to analyze the prevalence of barriers based on SGM status and race and ethnicity. Design, Setting, and Participants A cross-sectional study of health care access and utilization survey data collected by the National Institutes of Health's All of Us Research Program between May 31, 2017, and July 1, 2022, was conducted. Participants were adults aged 18 years or older with CISDs who enrolled in All of Us directly online or through partner health care practitioner organizations located across the US. Exposures Chronic inflammatory skin diseases, sexual orientation and gender identity, and race and ethnicity. Main Outcome and Measures The main outcome was the experience of cost and noncost barriers to health care among SGM patients with CISDs. Multivariable logistic regression was used to examine the association of SGM status with experiencing barriers to care. Results This study included 19 743 patients with CISDs; 1877 were SGM patients (median age, 40.5 years [IQR, 28.7-57.9 years]; 1205 [64.2%] assigned female sex at birth) and 17 866 were non-SGM patients (median age, 57.1 years [IQR, 40.8-68.1 years]; 13 205 [73.9%] assigned female sex at birth). Compared with non-SGM patients, SGM patients with CISDs were significantly more likely to delay specialist care (adjusted odds ratio [AOR], 1.23; 95% CI, 1.03-1.47), mental health care (AOR, 1.62; 95% CI, 1.37-1.91), and filling a prescription (AOR, 1.30; 95% CI, 1.11-1.52) because of cost. In addition, SGM patients with CISDs were significantly more likely than non-SGM patients to delay care because of transportation issues (AOR, 1.49; 95% CI, 1.22-1.80) and not having a health care practitioner who shares the same background with regard to race and ethnicity, religion, native language, sexual orientation, and gender identity (AOR, 1.39; 95% CI, 1.19-1.62). Sexual and gender minority patients with CISDs were also significantly more likely than non-SGM patients to report not always being treated with respect by their health care practitioners (AOR, 1.47; 95% CI, 1.30-1.65). Conclusions and Relevance The findings of this cross-sectional study of survey data suggest that SGM patients with CISDs may be disproportionately affected by cost and noncost barriers to health care. Dermatologists and other health care practitioners caring for SGM patients with CISDs have an important role in helping to address these barriers and larger systemic issues for SGM patients at both the patient and system levels.
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Affiliation(s)
- Michael R. Nock
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Kanika Kamal
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - John G. Zampella
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Mya L. Roberson
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Jeffrey M. Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - John S. Barbieri
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
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Riew GJ, Kamal K, Hijaz B, Awh KC, Nambudiri VE. Clinical music interventions and music therapy in dermatology. Arch Dermatol Res 2023; 315:2485-2490. [PMID: 37208459 DOI: 10.1007/s00403-023-02634-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 02/16/2023] [Accepted: 05/04/2023] [Indexed: 05/21/2023]
Abstract
Music interventions in medicine have been shown to reduce anxiety and depression, decrease pain, and improve quality of life; however, a review of clinical music interventions in dermatology is lacking. Studies have shown that playing music for patients undergoing dermatologic procedures (Mohs surgery and anesthetic injections) can decrease pain and anxiety. Patients with pruritic conditions-such as psoriasis, neurodermatitis, atopic dermatitis, contact eczema, and situations requiring hemodialysis-have exhibited decreased levels of disease burden and pain when listening to preferred music, pre-chosen music, and live music. Studies suggest that listening to certain types of music may also alter serum cytokines, affecting the allergic wheal response. Additional research is necessary to determine the full potential and practical applications for clinical music interventions in dermatology. Future research should focus on targeting skin conditions that may benefit from the psychological, inflammatory, and immune effects of music.
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Affiliation(s)
- Grant J Riew
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Baraa Hijaz
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Katherine C Awh
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vinod E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
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Ly S, Manjaly P, Kamal K, Shields A, Wafae B, Afzal N, Drake L, Sanchez K, Gregoire S, Zhou G, Mita C, Mostaghimi A. Comorbid Conditions Associated with Alopecia Areata: A Systematic Review and Meta-analysis. Am J Clin Dermatol 2023; 24:875-893. [PMID: 37464249 DOI: 10.1007/s40257-023-00805-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Alopecia areata (AA) is a complex autoimmune condition resulting in nonscarring hair loss. In recent years, many studies have provided new evidence on comorbid diseases present in patients with AA. However, some studies have conflicting results, and analyses conducting a comprehensive approach are lacking. OBJECTIVE The aim of our study was to provide an updated systematic review and meta-analysis of medical comorbidities associated with AA. METHODS We searched PubMed, Embase, and Web of Science for case-control, cross-sectional, and cohort studies investigating medical comorbidities in AA published from inception through 1 February 2023. RESULTS We screened 3428 abstracts and titles and reviewed 345 full text articles for eligibility. Ultimately, 102 studies were analyzed, comprising 680,823 patients with AA and 72,011,041 healthy controls. Almost all included studies (100 of 102 studies) were of satisfactory to high quality (Newcastle-Ottawa scale score ≥ 4). Among patients with AA, comorbidities with the highest odds ratios (OR) compared with healthy controls and data available from more than one study included vitamin D deficiency (OR 10.13, 95% CI 4.24-24.20), systemic lupus erythematous (OR 5.53, 95% CI 3.31-9.23), vitiligo (OR 5.30, 95% CI 1.86-15.10), metabolic syndrome (OR 5.03, 95% CI 4.18-6.06), and Hashimoto's thyroiditis (OR 4.31, 95% CI 2.51-7.40). AA may be a protective factor for certain disorders, for which the AA group had lower odds compared with healthy controls, such as irritable bowel syndrome (OR 0.38, 95% CI 0.14-0.99) and colorectal cancer (OR 0.61, 95% CI 0.42-0.89). CONCLUSION These findings corroborate and contextualize the risks across comorbidities for patients with AA. Further work should be done to identify the underlying pathophysiology and understand appropriate screening criteria.
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Affiliation(s)
- Sophia Ly
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Priya Manjaly
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Ali Shields
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Bruna Wafae
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Najiba Afzal
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Lara Drake
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Katherine Sanchez
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Samantha Gregoire
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- University at Buffalo Jacobs School of Medicine, Buffalo, NY, USA
| | - Guohai Zhou
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Carol Mita
- Countway Library of Medicine, Harvard University, Boston, MA, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
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13
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Charfo M, Bouceta A, Errami A, Mokri A, Kamal K, Drighil A. [Rare case of incomplete Shone syndrome in adult man with marfanoid morphotype]. Ann Cardiol Angeiol (Paris) 2023; 72:101632. [PMID: 37639736 DOI: 10.1016/j.ancard.2023.101632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 08/31/2023]
Abstract
Shone syndrome is a rare and complex congenital heart disease. It is characterized in its complete form, by a constellation of the four potentially obstructive lesions of the left heart side. Incomplete Shone's complex includes 2 or 3 of the characteristic lesions which, include a supravalvular mitral membrane, valvular mitral stenosis (MS) by a parachute mitral valve (PMV), subaortic stenosis and aortic coarctation (Coa). We describe here, the case of a 35-year-old man, hospitalized for chronic dyspnea and in whom, the diagnosis of incomplete Shone's complex is retained by echocardiographic analysis. Observed lesions include a parachute mitral valve responsible for mild regurgitation and moderate mitral stenosis, bicuspid aortic valve, and pseudo interruption of the aorta with dilatation of the ascending aorta and a patent ductus arteriosus. This case is the 2nd on 3942 patients in Drighil congenital heart disease registry.
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Affiliation(s)
- M Charfo
- Centre hospitalier universitaire Ibn Rochd, Département de cardiologie, Casablanca, Maroc.
| | - A Bouceta
- CHU Ibn Rochd of Casablanca, Département de Cardiologie, Maroc
| | - A Errami
- CHU Ibn Rochd of Casablanca, Département de Cardiologie, Maroc
| | - A Mokri
- CHU Ibn Rochd of Casablanca, Département de Cardiologie, Maroc
| | - K Kamal
- Centre hospitalier universitaire Ibn Rochd, Département de cardiologie, Casablanca, Maroc
| | - A Drighil
- CHU Ibn Rochd, Faculté de Médecine et de Pharmacie de Casablanca, Maroc
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14
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Kamal K, Riew GJ, Lee MS, Nambudiri VE. Aggregating Asian American racial data in publicly available national healthcare databases exacerbates health disparities and blunts distinctions. J Am Acad Dermatol 2023; 89:867-869. [PMID: 37245834 DOI: 10.1016/j.jaad.2023.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Grant J Riew
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Michelle S Lee
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Vinod E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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15
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Kamal K, Young K, Ly S, Manjaly P, Xiang DH, Zhou G, Mostaghimi A, Theodosakis N. Investigating the association between gender minority identity and skin cancer prevalence: A cohort study in the United States All of Us research program. J Eur Acad Dermatol Venereol 2023; 37:e1151-e1153. [PMID: 37114382 PMCID: PMC10524765 DOI: 10.1111/jdv.19156] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Affiliation(s)
- K Kamal
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - K Young
- Harvard Medical School, Boston, Massachusetts, USA
| | - S Ly
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - P Manjaly
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - D H Xiang
- Harvard Medical School, Boston, Massachusetts, USA
| | - G Zhou
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - A Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - N Theodosakis
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Abstract
Despite societal, legal, and cultural improvements in their well-being, sexual and gender minority (SGM) people in the United States still face substantial physical and mental health disparities that are exacerbated by physician stigma and lack of training. Although there have been efforts at medical schools nationwide to address these disparities and interweave SGM health education into existing preclerkship courses, opportunities to practice related clinical skills during the clerkship years remain largely elective. Furthermore, national survey data from 2020 indicate that SGM Americans continue to delay or avoid medical care because of physician discrimination. By providing predominantly opt-in opportunities for hands-on SGM health clinical training, educators risk perpetuating existing structural inequities and widening health disparities. In this article, the authors advocate for required SGM health clinical training for all undergraduate medical students, regardless of intended specialty. They highlight 3 types of elective SGM health clinical training models currently in use at medical schools across the country, including student-run clinics, advanced electives, and longitudinal scholarly concentrations. Using these examples, the authors then outline ways that educators can interweave required SGM health clinical training into undergraduate medical education, including with the recruitment and retention of SGM faculty, staff, and students; required SGM standardized patient experiences; the integration of SGM clinical opportunities throughout the core clerkships; and partnerships with SGM health centers. Using these methods, medical schools can mobilize passionate students, faculty, and leaders to both counter the bigotry and hate faced by SGM populations and develop innovative strategies to improve SGM patient health outcomes and expand opportunities for SGM health scholarship.
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Affiliation(s)
- Kanika Kamal
- K. Kamal is a medical student, Harvard Medical School, Boston, Massachusetts
| | - Alex S Keuroghlian
- A.S. Keuroghlian is director, Division of Education and Training, The Fenway Institute, director, Division of Public and Community Psychiatry, Massachusetts General Hospital, and codirector, Harvard Medical School Sexual and Gender Minority Health Equity Initiative, Boston, Massachusetts
| | - Jennifer Potter
- J. Potter is cochair, The Fenway Institute, program lead, Harvard Medical School-Fenway Health LGBTQIA+ Health Fellowship Program, codirector, Harvard Medical School Sexual and Gender Minority Health Equity Initiative, and internist, Division of General Medicine, Beth Israel Lahey Health, Boston, Massachusetts
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17
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Gao JL, Kamal K, Peebles K. Equity for Sexual and Gender Diverse Persons in Medicine and Dermatology. Dermatol Clin 2023; 41:299-308. [PMID: 36933919 DOI: 10.1016/j.det.2022.10.001] [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] [Indexed: 02/04/2023]
Abstract
Dermatologists can play a key role in improving health equity for sexual and gender diverse (SGD) patients through cultivating awareness of how their patients' sexual and gender identity may affect their skin health, developing SGD-inclusive curricula and safe spaces in medical training, promoting workforce diversity, practicing with intersectionality in mind, and engaging in advocacy for their patients, whether it be through daily practice, legislative and public policy initiatives, or research.
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Affiliation(s)
- Julia L Gao
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Dermatology, Beth Israel Deaconess Medical Center, 1340 Boylston Street, Boston, MA 02215, USA; George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03766, USA.
| | - Kanika Kamal
- Harvard Medical School, Harvard University, 25 Shattuck Street, Boston, MA 02115, USA
| | - Klint Peebles
- Department of Dermatology, Kaiser-Permanente Mid-Atlantic Permanente Medical Group, 1221 Mercantile Lane, Largo, MD 20774, USA
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18
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Sanchez K, Kamal K, Manjaly P, Ly S, Mostaghimi A. Clinical Application of Artificial Intelligence for Non-melanoma Skin Cancer. Curr Treat Options Oncol 2023; 24:373-379. [PMID: 36917395 PMCID: PMC10011774 DOI: 10.1007/s11864-023-01065-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 03/15/2023]
Abstract
OPINION STATEMENT The development and implementation of artificial intelligence is beginning to impact the care of dermatology patients. Although the clinical application of AI in dermatology to date has largely focused on melanoma, the prevalence of non-melanoma skin cancers, including basal cell and squamous cell cancers, is a critical application for this technology. The need for a timely diagnosis and treatment of skin cancers makes finding more time efficient diagnostic methods a top priority, and AI may help improve dermatologists' performance and facilitate care in the absence of dermatology expertise. Beyond diagnosis, for more severe cases, AI may help in predicting therapeutic response and replacing or reinforcing input from multidisciplinary teams. AI may also help in designing novel therapeutics. Despite this potential, enthusiasm in AI must be tempered by realistic expectations regarding performance. AI can only perform as well as the information that is used to train it, and development and implementation of new guidelines to improve transparency around training and performance of algorithms is key for promoting confidence in new systems. Special emphasis should be placed on the role of dermatologists in curating high-quality datasets that reflect a range of skin tones, diagnoses, and clinical scenarios. For ultimate success, dermatologists must not be wary of AI as a potential replacement for their expertise, but as a new tool to complement their diagnostic acumen and extend patient care.
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Affiliation(s)
- Katherine Sanchez
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA.,Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Priya Manjaly
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA.,Boston University School of Medicine, Boston, USA
| | - Sophia Ly
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA.,College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, US, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, 02115, USA.
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19
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Kamal K, Li JJ, Keuroghlian AS. Addressing the Physical and Mental Impacts of Postsurgical Scarring Among Transgender and Gender Diverse People. LGBT Health 2023; 10:259-262. [PMID: 36796004 DOI: 10.1089/lgbt.2022.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Few studies have considered the diverse mental and physical health impacts of scarring among transgender and gender diverse (TGD) patients after medically necessary gender-affirming surgery (GAS). For some TGD patients, post-GAS scarring may exacerbate gender dysphoria. For others, it is a physical representation of authenticity. The dearth of research or validated instruments capturing the diversity of priorities and concerns pre- and post-GAS hinders providers' ability to deliver optimal clinical care throughout the gender-affirmation process and impedes progress for evidence-based policy change regarding post-GAS scar treatment. This article provides suggestions for future research directions to address post-GAS scar-related health needs.
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Affiliation(s)
- Kanika Kamal
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jason J Li
- Harvard Medical School, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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20
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Kumaraswamy MK, Chethan S, Shanthakumar KS, Kamal K. Prospective observational study of clinical outcomes in using posterior interosseous free flap for finger defects. Acta Chir Plast 2023; 65:6-12. [PMID: 37211418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Finger injuries are common in hand and plastic surgery practice. There are various options for reconstructing finger defects. Moderate sized skin defects of the fingers which need flaps are commonly covered using various abdominal flaps. These conventional workhorse flaps are thick, need two-staged procedures and require the hand to be kept in a cumbersome position. The radial artery or the ulnar artery flap need sacrifice a major vessel. To address the above, we have used the posterior interosseous artery free flap to cover finger defects. This was a prospective observational clinical study done on 15 patients admitted to a tertiary level hospital from July 2017 to July 2021. These patients had accidental industrial injuries with a loss of soft tissue on the fingers. There were finger fractures in 6 cases. These patients underwent posterior interosseous artery free flap cover. The flap size ranged from 6 × 3 cm to 10 × 4 cm. We had to cover the donor defects with skin graft in all our cases. Fourteen out of 15 flaps survived, with loss of one flap due to venous congestion. The mean two-point discrimination was 7.8 mm, with a total active motion percentage of more than 70% in 11 out of 15 cases. The posterior interosseous artery flap is a thin and pliable one stage flap, and may not need further flap thinning either, thereby establishing itself as a single stage procedure and moreover not requiring sacrifice a major vessel.
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21
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Kamal K, Imadojemu S, Charrow A. Why Diversity in Dermatology Clinical Trials Should No Longer Be Optional: Dismantling Structural Racism in Dermatology. JAMA Dermatol 2022; 158:353-354. [PMID: 35195659 DOI: 10.1001/jamadermatol.2021.5190] [Citation(s) in RCA: 2] [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] [Indexed: 01/19/2023]
Affiliation(s)
- Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sotonye Imadojemu
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Alexandra Charrow
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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22
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Abstract
Melasma is a chronic and relapsing skin condition. Although melasma is usually asymptomatic, it can be associated with immense psychosocial stress and greatly impact a patient's quality of life. Over the years, many different treatments have been used, ranging from daily photoprotection, topical lightening creams, and oral agents to laser and light-based therapies; however, efficacy is often limited with such treatments, and there is currently no effective modality to prevent recurrence. Although treatment strategies had originally centered on the use of hydroquinone, newer modalities now include oral tranexamic acid and lasers. We examined previous and ongoing debates related to melasma treatments and have reviewed the current efficacy and safety of available treatments. Critical components essential to the successful management of melasma are the setting of patient expectations and assurance of treatment compliance.
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Affiliation(s)
- Kanika Kamal
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA.
| | - Kerry Heitmiller
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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23
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Amar IM, Abd El-Shafi A, Kamal K. Optimal Tolerance Assignment with Automatic Feature Detection.(Dept.M). MEJ Mansoura Engineering Journal 2021; 21:33-45. [DOI: 10.21608/bfemu.2021.151524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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24
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Kamal K, Charrow A, LaChance A. Amending iPLEDGE: Why "Abstaining from Abstinence" May Harm LGBTQ+ Patients. J Clin Aesthet Dermatol 2021; 14:12. [PMID: 34221220 PMCID: PMC8211342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Kanika Kamal
- Ms. Kamal is with Harvard Medical School in Boston, Massachusetts. Drs. Charrow and LaChance are with the Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexandra Charrow
- Ms. Kamal is with Harvard Medical School in Boston, Massachusetts. Drs. Charrow and LaChance are with the Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Avery LaChance
- Ms. Kamal is with Harvard Medical School in Boston, Massachusetts. Drs. Charrow and LaChance are with the Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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25
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Thomas AK, Smith AM, Kamal K, Gordon LT. Should you use frequent quizzing in your college course? Giving up 20 minutes of lecture time may pay off. Journal of Applied Research in Memory and Cognition 2020. [DOI: 10.1037/h0101845] [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: 11/08/2022]
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26
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Ungaro RC, Yarur A, Jossen J, Phan BL, Chefitz E, Sehgal P, Kamal K, Bruss A, Beniwal-Patel P, Fox C, Patel A, Bahur B, Jain A, Stein D, Naik S, Dubinsky MC. Higher Trough Vedolizumab Concentrations During Maintenance Therapy are Associated With Corticosteroid-Free Remission in Inflammatory Bowel Disease. J Crohns Colitis 2019; 13:963-969. [PMID: 31087100 PMCID: PMC7185193 DOI: 10.1093/ecco-jcc/jjz041] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Vedolizumab is an anti-α4β7 biologic approved for ulcerative colitis [UC] and Crohn's disease [CD]. We aimed to examine the association of maintenance vedolizumab concentrations with remission. METHODS We performed a cross-sectional multi-centre study of inflammatory bowel disease [IBD] patients on maintenance vedolizumab. A homogeneous mobility shift assay [HMSA] was used to determine trough serum concentrations of vedolizumab and anti-drug antibodies [ATVs]. The primary outcome was corticosteroid-free clinical and biochemical remission defined as a composite of clinical remission, normalized C-reactive protein [CRP] and no corticosteroid use in 4 weeks. Secondary outcomes included corticosteroid-free endoscopic and deep remission. Vedolizumab concentrations were compared between patients in remission and with active disease. Logistic regression, adjusting for confounders, assessed the association between concentrations and remission. RESULTS In total, 258 IBD patients were included [55% CD and 45% UC]. Patients in clinical and biochemical remission had significantly higher vedolizumab concentrations [12.7 µg/mL vs 10.1 µg/mL, p = 0.002]. Concentrations were also higher among patients in endoscopic and deep remission [14.2 µg/mL vs 8.5 µg/mL, p = 0.003 and 14.8 µg/mL vs 10.1 µg/mL, p = 0.01, respectively]. After controlling for potential confounders, IBD patients with vedolizumab concentrations >11.5 µg/mL were nearly 2.4 times more likely to be in corticosteroid-free clinical and biochemical remission. Only 1.6% of patients had ATVs. CONCLUSIONS In a large real-world cohort of vedolizumab maintenance concentrations, IBD patients with remission defined by objective measures [CRP and endoscopy] had significantly higher trough vedolizumab concentrations and immunogenicity was uncommon.
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Affiliation(s)
- Ryan C Ungaro
- The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jacqueline Jossen
- The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Becky L Phan
- The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ezra Chefitz
- The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Priya Sehgal
- The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kanika Kamal
- The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Amir Patel
- Medical College of Wisconsin, Madison, WI, USA
| | - Bayda Bahur
- Prometheus Laboratories Inc., San Diego, CA, USA
| | - Anjali Jain
- Prometheus Laboratories Inc., San Diego, CA, USA
| | | | - Snehal Naik
- Prometheus Laboratories Inc., San Diego, CA, USA
| | - Marla C Dubinsky
- The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Corresponding author: Marla C. Dubinsky MD, Chief, Pediatric GI and Hepatology, Co-Director, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Tel: 212-241-5415;
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27
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Agrawal M, Cohen-Mekelburg S, Kayal M, Axelrad J, Galati J, Tricomi B, Kamal K, Faye AS, Abrudescu P, Scherl E, Lawlor G, Sultan K, Lukin D, Colombel JF, Ungaro RC. Disability in inflammatory bowel disease patients is associated with race, ethnicity and socio-economic factors. Aliment Pharmacol Ther 2019; 49:564-571. [PMID: 30663075 DOI: 10.1111/apt.15107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/22/2018] [Accepted: 11/30/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Race, ethnicity and socio-economic status impact clinical outcomes in inflammatory bowel disease (IBD) patients. However, their impact on disability has not been studied. AIM To determine the association between race, ethnicity and socio-economic factors with disability in IBD, using the validated IBD disability index (IBD-DI). METHODS Ambulatory IBD patients were enrolled at five academic centres participating in the New York Crohn's and Colitis Organization. We assessed the IBD-DI, and collected clinical and socio-economic data. Factors associated with moderate-to-severe disability (IBD-DI score > 35) on univariable analysis were tested in multivariable models with adjusted odds ratios (aOR) and 95% confidence intervals (CI) reported. RESULTS In this study, 323 patients (57.3% CD, 51.4% female) were enrolled; 17.7% were Hispanic, 17% were non-Hispanic black, 56.0% were non-Hispanic Caucasian and 9.3% belonged to non-Hispanic non-black minority races. However, 39.0% of patients were publicly insured and 38.4% of patients had low annual household income (<$50 000). 100 (31.0%) patients reported moderate-to-severe disability. On multivariable analysis, Hispanic ethnicity (aOR 2.7, 95% CI 1.3-5.6), non-Hispanic non-black minority race (aOR 3.5, 95% CI 1.3-8.9), public payer (aOR 2.1, 95% CI 1.1-4.0) and low annual household income (aOR 3.0, 95% CI 1.7-5.4) were associated with moderate-to-severe disability controlling for disease characteristics. CONCLUSIONS IBD patients who are minorities, have public insurance, or low household income, are 2-3 times more likely to report moderate-to-severe disability independent of disease characteristics in the United States. Future studies are needed to study their complex relationship and to mitigate disability.
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Affiliation(s)
- Manasi Agrawal
- Division of Gastroenterology, Montefiore Medical Center, Bronx, New York.,Division of Gastroenterology, Lenox Hill Hospital, New York, New York
| | | | - Maia Kayal
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York
| | - Jordan Axelrad
- Division of Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York.,Division of Gastroenterology and Hepatology, New York University Langone Medical Center, New York, New York
| | - Jonathan Galati
- Division of Gastroenterology and Hepatology, Weil Cornell Medical Center, New York, New York
| | - Brad Tricomi
- Albert Einstein College of Medicine, Bronx, New York
| | - Kanika Kamal
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York
| | - Adam S Faye
- Division of Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York
| | - Paul Abrudescu
- Division of Gastroenterology and Hepatology, Northwell University, Long Island, New York
| | - Ellen Scherl
- Division of Gastroenterology and Hepatology, Weil Cornell Medical Center, New York, New York
| | - Garrett Lawlor
- Division of Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York
| | - Keith Sultan
- Division of Gastroenterology and Hepatology, Northwell University, Long Island, New York
| | - Dana Lukin
- Division of Gastroenterology, Montefiore Medical Center, Bronx, New York.,Division of Gastroenterology and Hepatology, Weil Cornell Medical Center, New York, New York
| | | | - Ryan C Ungaro
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York
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Bansal T, Kiran S, Kamal K, Bangarwa N. Anesthetic management for lobectomy of a 2-month-old infant with bronchogenic cyst: Case report along with review of literature. Saudi J Anaesth 2017; 11:340-342. [PMID: 28757838 PMCID: PMC5516500 DOI: 10.4103/sja.sja_48_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 11/30/2022] Open
Abstract
Bronchogenic cyst, a benign congenital cystic lesion of the lung, is a rare cause of respiratory distress in children comprising 7.5% of all mediastinal masses. A thorough preoperative evaluation is crucial to plan for definitive intra- and post-operative management. All patients should be thoroughly evaluated for the presence of compression, deviation or distortion of airways and great veins. The easiest means of providing one lung ventilation in pediatrics is to intubate the main stem bronchus of the nonoperated lung. Other options available for pediatric one lung ventilation are single lumen endobronchial tubes, micro cuff tubes, Marraro bilumen tubes, and bronchial blockers. We hereby present a case report of a 2-month-old infant posted for excision of bronchogenic cyst along with a review of literature.
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Affiliation(s)
- T Bansal
- Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - S Kiran
- Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - K Kamal
- Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - N Bangarwa
- Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
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Affiliation(s)
- K. Kamal
- University of Health Sciences Rohtak; Haryana India
| | - T. Bansal
- University of Health Sciences Rohtak; Haryana India
| | - S. Saini
- University of Health Sciences Rohtak; Haryana India
| | - G. Vashisht
- University of Health Sciences Rohtak; Haryana India
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Abstract
In this study the predictions and probabilities of calcium carbonate scale formation and corrosion occurrence inside Gumry Field Process Facilities (GFPF) and produced water injection process units (PWTP) was carried out. This was done calculating the Langelier Saturation Index (LSI), Ryznar Stability Index (RSI), Puckorius Scaling Index (PSI). The samples results for LSI index and PSI index were compared and found that all samples under threaten of calcium carbonate scale. The samples results for RSI index and found that all samples under formation of heavy calcium carbonate scale. Special excel computer program was designed to calculate the (LSI, RSI, PSI). The scale was cleaned and removed by 10% diluted hydrochloric acid and commercial scale inhibitor.
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Affiliation(s)
| | | | | | - A. Lila
- Central Petroleum Laboratory
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31
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Shi H, Wen J, LI Z, Elsayed M, Kamal K, LI Z, Wen J, Shi H, El Shal A, Youssef D, Caubet C, Lacroix C, Benjamin B, Bandin F, Bascands JL, Monsarrat B, Decramer S, Schanstra J, Laetitia DB, Ulinski T, Aoun B, Ozdemir K, Dincel N, Sozeri B, Mir S, Dincel N, Berdeli A, Mir S, Akyigit F, Mizerska-Wasiak M, Panczyk-Tomaszewska M, Szymanik-Grzelak H, Roszkowska-Blaim M, Jamin A, Dehoux L, Monteiro RC, Deschenes G, Bouts A, Davin JC, Dorresteijn E, Schreuder M, Lilien M, Oosterveld M, Kramer S, Gruppen M, Pintos-Morell G, Ramaswami U, Parini R, Rohrbach M, Kalkum G, Beck M, Carter M, Antwi S, Callegari J, Kotanko P, Levin NW, Rumjon A, Macdougall IC, Turner C, Booth CJ, Goldsmith D, Sinha MD, Camilla R, Camilla R, Loiacono E, Donadio ME, Conrieri M, Bianciotto M, Bosetti FM, Peruzzi L, Conti G, Bitto A, Amore A, Coppo R, Mizerska-Wasiak M, Roszkowska-Blaim M, Maldyk J, Chou HH, Chiou YY, Bochniewska V, Jobs K, Jung A, Fallahzadeh Abarghooei MH, Zare J, Sedighi Goorabi V, Derakhshan A, Basiratnia M, Fallahzadeh Abarghooei MA, Hosseini Al-Hashemi G, Fallahzadeh Abarghooei F, Kluska-Jozwiak A, Soltysiak J, Lipkowska K, Silska M, Fichna P, Skowronska B, Stankiewicz W, Ostalska-Nowicka D, Zachwieja J, Girisgen L, Sonmez F, Yenisey C, Kis E, Cseprekal O, Kerti A, Szabo A, Salvi P, Benetos A, Tulassay T, Reusz G, Makulska I, Szczepanska M, Drozdz D, Zwolnska D, Sozeri B, Berdeli A, Mir S, Tolstova E, Anis L, Ulinski T, Alber B, Edouard B, Gerard C, Seni K, Dunia Julienne Hadiza T, Christian S, Benoit T, Francois B, Adama L, Rosenberg A, Munro J, Murray K, Wainstein B, Ziegler J, Singh-Grewal D, Boros C, Adib N, Elliot E, Fahy R, Mackie F, Kainer G, Polak-Jonkisz D, Zwolinska D, Laszki-Szczachor K, Zwolinska D, Janocha A, Rusiecki L, Sobieszczanska M, Garzotto F, Ricci Z, Clementi A, Cena R, Kim JC, Zanella M, Ronco C, Polak-Jonkisz D, Zwolinska D, Purzyc L, Zwolinska D, Makulska I, Szczepanska M, Peco-Antic A, Kotur-Stevuljevic J, Paripovic D, Scekic G, Milosevski-Lomic G, Bogicevic D, Spasojevic-Dimitrijeva B, Hassan R, El-Husseini A, Sobh M, Ghoneim M, Harambat J, Bonthuis M, Van Stralen KJ, Ariceta G, Battelino N, Jahnukainen T, Sandes AR, Combe C, Jager KJ, Verrina E, Schaefer F, Espindola R, Bacchetta J, Cochat P, Stefanis C, Leroy S, Leroy S, Fernandez-Lopez A, Nikfar R, Romanello C, Bouissou F, Gervaix A, Gurgoze M, Bressan S, Smolkin V, Tuerlinkx D, Stefanidis C, Vaos G, Leblond P, Gungor F, Gendrel D, Chalumeau M, Rumjon A, Macdougall IC, Turner C, Rawlins D, Booth CJ, Simpson JM, Sinha MD, Arnaud G, Arnaud G, Anne M, Stephanie T, Flavio B, Veronique FB, Stephane D, Mumford L, Marks S, Ahmad N, Maxwell H, Tizard J, Vidal E, Amigoni A, Varagnolo M, Benetti E, Ghirardo G, Brugnolaro V, Murer L, Aoun B, Christine G, Alber B, Ulinski T, Aoun B, Decramer S, Bandin F, Ulinski T, Degi A, Degi A, Kerti A, Kis E, Cseprekal O, Szabo AJ, Reusz GS, Ghirardo G, Vidoni A, Vidal E, Benetti E, Ramondo G, Miotto D, Murer L. Paediatric nephrology. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kamal K, Teji T, Manjeet M, Pyre P. Ameliorative potential of angiotensin1-7/Mas receptor axis in streptozotocin-induced diabetic nephropathy in rats. ACTA ACUST UNITED AC 2010; 32:19-25. [DOI: 10.1358/mf.2010.32.1.1434160] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ghai A, Wadhera R, Kamal K, Verma V. Mediastinitis after oesophagoscopy: A case report. Southern African Journal of Anaesthesia and Analgesia 2009. [DOI: 10.1080/22201173.2009.10872604] [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]
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34
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Taxak S, Lal J, Kamal K, Andrew C. Damaged Proseal™ LMA cuff at the inflation line site. Southern African Journal of Anaesthesia and Analgesia 2008. [DOI: 10.1080/22201173.2008.10872561] [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]
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35
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Ghai A, Kiran S, Wadbera R, Kamal K. Airway obstruction following mandibular surgery—a case report. Southern African Journal of Anaesthesia and Analgesia 2008. [DOI: 10.1080/22201173.2008.10872548] [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]
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Trifilio S, Kamal K, Pennick G, Pi J, Golf M, Mehta J. 430: Discordance between voriconazole dose and plasma concentrations. Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2007.01.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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38
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Chawla A, Kulkarni G, Kamal K, Zini A. Microsurgical Varicocelectomy for Recurrent or Persistent Varicoceles Associated With Orchalgia. J Urol 2006. [DOI: 10.1016/s0022-5347(06)00177-7] [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: 10/24/2022]
Affiliation(s)
- A. Chawla
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - G. Kulkarni
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - K. Kamal
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - A. Zini
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Singh D, Kiberd BA, West KA, Kamal K, Balbontin F, Belitsky P, Lawen J. Importance of peak PRA in predicting the kidney transplant survival in highly sensitized patients. Transplant Proc 2003; 35:2395-7. [PMID: 14611966 DOI: 10.1016/j.transproceed.2003.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Do patients with high historic peak panel-reactive antibodies (PRA) remain high risk if their PRA levels fall before transplantation? We examined retrospectively 406 first and repeat kidney recipients with a peak PRA of >50%, who were transplanted from our center between January 1990 and December 2001. Univariate analysis by log-rank test was performed for variables that affect graft survival. The factors tested included current PRA, peak PRA, difference between peak and current PRA (DeltaPRA), HLA mismatch, gender, age, transplant number, and donor source. Receiver operator characteristic curves (ROC) were generated to obtain the best cutpoints for current PRA and DeltaPRA. Current PRA (P < .0001), peak PRA (P = .0004), and DeltaPRA (P = .0015) were significant predictors by univariate analysis. However, in a multivariate model, peak PRA was not significant. Current PRA (P < .0001) was significantly associated with graft survival, while DeltaPRA showed a strong trend to significance (P = .05). Current PRA of <26% and DeltaPRA of >37% were the best cutpoints for separating good and poor outcomes. This study shows that current PRA and DeltaPRA impact on graft survival in highly sensitized (>50%) patients. Sensitized patients with peak PRA >50% who subsequently have a drop in PRA to <26% are at lower risk of graft loss than those with a persistently high PRA. A fall in peak PRA of >37% at the time of transplant appears to be of benefit only in those patients who achieve a current PRA of <26%.
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Affiliation(s)
- D Singh
- Kidney Transplant Program, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia, Canada
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Abstract
OBJECTIVES To examine sperm DNA denaturation (DD) in fertile and infertile men and assess the variability of conventional semen parameters and sperm DD in repeated semen samples from infertile men. METHODS Twenty-one consecutive nonazoospermic, infertile men each submitted two semen samples, 2 to 6 weeks apart. We examined semen samples from consecutive fertile men (n = 10) presenting for vasectomy as controls. Standard semen parameters (World Health Organization criteria) and sperm chromatin structure (evaluated by flow cytometry analysis of acridine orange-treated spermatozoa and expressed as the percentage of spermatozoa with denatured DNA) were monitored. RESULTS Fertile men had a significantly higher sperm concentration and percentage of sperm motility and a significantly lower percentage of sperm with DD than did infertile men (36 +/- 5.2 x 10(6)/mL versus 12.5 +/- 2.2 x 10(6)/mL, 60.0% +/- 5.2% versus 30.1% +/- 4.1%, and 8.9% +/- 1.9% versus 20.3% +/- 2.5%, respectively, P <0.05). The sperm concentration, sperm motility, and percentage of spermatozoa with DD were not significantly different between the first and second semen samples from the infertile men. Sperm DD showed the lowest average within-subject coefficient of variation (SD/mean), followed by motility and concentration (coefficient of variation 21%, 24%, and 35%, respectively). CONCLUSIONS Our data demonstrate that infertile men have significantly higher sperm DD compared with fertile men and that sperm DD exhibits a low coefficient of variation ( approximately 20%) on repeated assessment. These data suggest that sperm DD has a relatively low degree of biologic variability.
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Affiliation(s)
- A Zini
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Gray GC, Kassira EN, Rodier GR, Myers MC, Calamaio CA, Gregory M, Nagi MA, Kamal K, Botros BA, Soliman AK, Hassan NF, Gregory R, Arunkumar BK, Cope A, Hyams KC. Remote village survey for agents causing hepatosplenic disease in the Republic of Yemen. Trop Doct 1999; 29:212-9. [PMID: 10578634 DOI: 10.1177/004947559902900408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The objective of this study was to epidemiologically describe potential infectious agents among rural people in the Republic of Yemen. This would aid clinicians in designing empirical therapy and public health officials in planning disease prevention. We sought to examine evidence for the geographical distribution of pathogens causing human hepatic and splenic disease among villagers and domestic animals living in three remote areas with differing altitudes. In June 1992, a cross-sectional survey was conducted at three survey sites of differing altitudes: 3080, 1440 and 250 m above sea level. Questionnaires, parasitic and serological tests were administered to 627 human volunteers. Additionally 317 domestic animals were studied. Malaria, schistosomiasis, and hepatitis B and C infections were found to be likely causes of human hepatic or splenic disease. Additionally, evidence of human and animal infections with the agents of brucellosis and Q fever was found: IgG antibodies against hepatitis E virus were discovered in two (2.0%) of the 100 volunteers. The prevalence of markers for human and animal disease was often lowest at the village of highest elevation, suggesting that increasing altitude, as a surrogate or a true independent risk factor, was protective against infection with the agents studied.
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Affiliation(s)
- G C Gray
- US Naval Medical Research Unit No. 3 Cairo, Egypt.
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Peruski LF, Kay BA, El-Yazeed RA, El-Etr SH, Cravioto A, Wierzba TF, Rao M, El-Ghorab N, Shaheen H, Khalil SB, Kamal K, Wasfy MO, Svennerholm AM, Clemens JD, Savarino SJ. Phenotypic diversity of enterotoxigenic Escherichia coli strains from a community-based study of pediatric diarrhea in periurban Egypt. J Clin Microbiol 1999; 37:2974-8. [PMID: 10449484 PMCID: PMC85425 DOI: 10.1128/jcm.37.9.2974-2978.1999] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
No past studies of diarrhea in children of the Middle East have examined in detail the phenotypes of enterotoxigenic Escherichia coli (ETEC) strains, which are important pathogens in this setting. During a prospective study conducted from November 1993 to September 1995 with 242 children under 3 years of age with diarrhea living near Alexandria, Egypt, 125 episodes of diarrhea were positive for ETEC. ETEC strains were available for 98 of these episodes, from which 100 ETEC strains were selected and characterized on the basis of enterotoxins, colonization factors (CFs), and O:H serotypes. Of these representative isolates, 57 produced heat-stable toxin (ST) only, 34 produced heat-labile toxin (LT) only, and 9 produced both LT and ST. Twenty-three ETEC strains expressed a CF, with the specific factors being CF antigen IV (CFA/IV; 10 of 23; 43%), CFA/II (5 of 23; 22%), CFA/I (3 of 23; 13%), PCFO166 (3 of 23; 13%), and CS7 (2 of 23; 9%). No ETEC strains appeared to express CFA/III, CS17, or PCFO159. Among the 100 ETEC strains, 47 O groups and 20 H groups were represented, with 59 O:H serotypes. The most common O serogroups were O159 (13 strains) and O43 (10 strains). O148 and O21 were each detected in five individual strains, O7 and O56 were each detected in four individual strains, O73, O20, O86, and O114 were each detected in three individual strains, and O23, O78, O91, O103, O128, and O132 were each detected in two individual strains. The most common H serogroups were H4 (16 strains), 12 of which were of serogroup O159; H2 (9 strains), all of which were O43; H18 (6 strains); H30 (6 strains); and H28 (5 strains); strains of the last three H serogroups were all O148. Cumulatively, our results suggest a high degree of clonal diversity of disease-associated ETEC strains in this region. As a low percentage of these strains expressed a CF, it remains possible that other adhesins for which we either did not assay or that are as yet undiscovered are prevalent in this region. Our findings point out some potential barriers to effective immunization against ETEC diarrhea in this population and emphasize the need to identify additional protective antigens commonly expressed by ETEC for inclusion in future vaccine candidates.
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Affiliation(s)
- L F Peruski
- U.S. Naval Medical Research Unit No. 3, Cairo, Egypt.
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Khalil SB, Cassels FJ, Shaheen HI, Pannell LK, El-Ghorab N, Kamal K, Mansour M, Savarino SJ, Peruski LF. Characterization of an enterotoxigenic Escherichia coli strain from Africa expressing a putative colonization factor. Infect Immun 1999; 67:4019-26. [PMID: 10417169 PMCID: PMC96691 DOI: 10.1128/iai.67.8.4019-4026.1999] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
An enterotoxigenic Escherichia coli (ETEC) strain of serotype O114:H- that expressed both heat-labile and heat-stable enterotoxins and tested negative for colonization factors (CF) was isolated from a child with diarrhea in Egypt. This strain, WS0115A, induced hemagglutination of bovine erythrocytes and adhered to the enterocyte-like cell line Caco-2, suggesting that it may elaborate novel fimbriae. Surface-expressed antigen purified by differential ammonium sulfate precipitation and column chromatography yielded a single protein band with M(r) 14,800 when resolved by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (16% polyacrylamide). A monoclonal antibody against this putative fimbrial antigen was generated and reacted with strain WS0115A and also with CS1-, CS17-, and CS19-positive strains in a dot blot assay. Reactivity was temperature dependent, with cells displaying reactivity when grown at 37 degrees C but not when grown at 22 degrees C. Immunoblot analysis of a fimbrial preparation from strain WS0115A showed that the monoclonal antibody reacted with a single protein band. Electron microscopy and immunoelectron microscopy revealed fimbria-like structures on the surface of strain WS0115A. These structures were rigid and measured 6.8 to 7.4 nm in diameter. Electrospray mass-spectrometric analysis showed that the mass of the purified fimbria was 14,965 Da. The N-terminal sequence of the fimbria established that it was a member of the CFA/I family, with sequence identity to the amino terminus of CS19, a new CF recently identified in India. Cumulatively, our results suggest that this fimbria is CS19. Screening of a collection of ETEC strains isolated from children with diarrhea in Egypt found that 4.2% of strains originally reported as CF negative were positive for this CF, suggesting that it is biologically relevant in the pathogenesis of ETEC.
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Affiliation(s)
- S B Khalil
- Research Sciences Department, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
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Abstract
Diabetic microangiopathy has been implicated as a fundamental feature of the pathological complications of diabetes including retinopathy, neuropathy, and diabetic foot ulceration. However, previous studies devoted to examining the deleterious effects of elevated glucose on the endothelium have been performed largely in primary cultured cells of macrovessel origin. Difficulty in the harvesting and maintenance of microvascular endothelial cells in culture have hindered the study of this relevant population. Therefore, the objective of this study was to characterize the effect of elevated glucose on the proliferation and involved signaling pathways of an immortalized human dermal microvascular endothelial cell line (HMEC-1) that possess similar characteristics to their in vivo counterparts. Human dermal microvascular endothelial cells (HMEC-1) were grown in the presence of normal (5 mM) or high D-glucose (20 mM) for 14 days. The proliferative response of HMEC-1 was compared under these conditions as well as the cAMP and PKC pathways by in vitro assays. Elevated glucose significantly inhibited (P < 0.05) HMEC-1 proliferation after 7, 10, and 14 days. This effect was not mimicked by 20 mM mannitol. The antiproliferative effect was more pronounced with longer exposure (1-14 days) to elevated glucose and was irreversible 4 days after a 10-day exposure. The antiproliferative effect was partially reversed in the presence of a PKA inhibitor, Rp-cAMP (10-50 microM), and/or a PKC inhibitor, Calphostin C (10 nM). HMEC-1 exposed to elevated glucose (20 mM) for 14 days caused an increase in cyclic AMP accumulation, PKA, and PKC activity but was not associated with the activation of downstream events such as CRE and AP-1 binding activity. These data support the hypothesis that HMEC-1 is a suitable model to study the deleterious effects of elevated glucose on microvascular endothelial cells. Continued studies with HMEC-1 may prove advantageous in delineation of the molecular pathophysiology associated with diabetic microangiopathy.
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Affiliation(s)
- K Kamal
- Department of Surgery (Vascular), Yale University School of Medicine, New Haven, Connecticut 06510, USA
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Mills I, Cohen CR, Kamal K, Li G, Shin T, Du W, Sumpio BE. Strain activation of bovine aortic smooth muscle cell proliferation and alignment: study of strain dependency and the role of protein kinase A and C signaling pathways. J Cell Physiol 1997; 170:228-34. [PMID: 9066778 DOI: 10.1002/(sici)1097-4652(199703)170:3<228::aid-jcp2>3.0.co;2-q] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Smooth muscle cell (SMC) phenotype can be altered by physical forces as demonstrated by cyclic strain-induced changes in proliferation, orientation, and secretion of macromolecules. However, the magnitude of strain required and the intracellular coupling pathways remain ill defined. To examine the strain requirements for SMC proliferation, we selectively seeded bovine aortic SMC either on the center or periphery of silastic membranes which were deformed with 150 mm Hg vacuum (0-7% center; 7-24% periphery). SMC located in either the center or peripheral regions showed enhanced proliferation compared to cells grown under the absence of cyclic strain. Moreover, SMC located in the center region demonstrated significantly (P < 0.005) greater proliferation as compared to those in the periphery. In contrast, SMC exposed to high strain (7-24%) demonstrated alignment perpendicular to the strain gradient, whereas SMC in the center (0-7%) remained aligned randomly. To determine the mechanisms of these phenomena, we examined the effect of cyclic strain on bovine aortic SMC signaling pathways. We observed strain-induced stimulation of the cyclic AMP pathway including adenylate cyclase activity and cyclic AMP accumulation. In addition, exposure of SMC to cyclic strain caused a significant increase in protein kinase C (PKC) activity and enzyme translocation from the cytosol to a particulate fraction. Further study was conducted to examine the effect of strain magnitude on signaling, particularly protein kinase A (PKA) activity as well as cAMP response element (CRE) binding protein levels. We observed significantly (P < 0.05) greater PKA activity and CRE binding protein levels in SMC located in the center as compared to the peripheral region. However, inhibition of PKA (with 10 microM Rp-cAMP) or PKC (with 5-20 ng/ml staurosporine) failed to alter either the strain-induced increase in SMC proliferation or alignment. These data characterize the strain determinants for activation of SMC proliferation and alignment. Although strain activated both the AC/cAMP/PKA and the PKC pathways in SMC, singular inhibition of PKA and PKC failed to prevent strain-induced alignment and proliferation, suggesting either their lack of involvement or the multifactorial nature of these responses.
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MESH Headings
- Activating Transcription Factor 2
- Adenylyl Cyclases/metabolism
- Animals
- Aorta/cytology
- Cattle
- Cell Division/physiology
- Cells, Cultured/enzymology
- Cyclic AMP/metabolism
- Cyclic AMP Response Element-Binding Protein/metabolism
- Cyclic AMP-Dependent Protein Kinases/physiology
- Endothelium, Vascular/cytology
- Endothelium, Vascular/enzymology
- Leucine Zippers/physiology
- Muscle, Smooth, Vascular/chemistry
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/enzymology
- Protein Kinase C/physiology
- Signal Transduction/physiology
- Stress, Mechanical
- Transcription Factors/metabolism
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Affiliation(s)
- I Mills
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA
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Cohen CR, Mills I, Du W, Kamal K, Sumpio BE. Activation of the adenylyl cyclase/cyclic AMP/protein kinase A pathway in endothelial cells exposed to cyclic strain. Exp Cell Res 1997; 231:184-9. [PMID: 9056425 DOI: 10.1006/excr.1996.3450] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to assess the involvement of the adenylyl cyclase/cyclic AMP/protein kinase A pathway (AC) in endothelial cells (EC) exposed to different levels of mechanical strain. Bovine aortic EC were seeded to confluence on flexible membrane-bottom wells. The membranes were deformed with either 150 mm Hg (average 10% strain) or 37.5 mm Hg (average 6% strain) vacuum at 60 cycles per minute (0.5 s strain; 0.5 s relaxation) for 0-60 min. The results demonstrate that at 10% average strain (but not 6% average strain) there was a 1.5- to 2.2-fold increase in AC, cAMP, and PKA activity by 15 min when compared to unstretched controls. Further studies revealed an increase in cAMP response element binding protein in EC subjected to the 10% average strain (but not 6% average strain). These data support the hypothesis that cyclic strain activates the AC/cAMP/PKA signal transduction pathway in EC which may occur by exceeding a strain threshold and suggest that cyclic strain may stimulate the expression of genes containing cAMP-responsive promoter elements.
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Affiliation(s)
- C R Cohen
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut, 06510, USA
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Kamal K, Powell RJ, Sumpio BE. The pathobiology of diabetes mellitus: implications for surgeons. J Am Coll Surg 1996; 183:271-89. [PMID: 8784324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- K Kamal
- Department of Surgery (Vascular), Yale University School of Medicine, New Haven, CT 06510, USA
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Shaheen H, Shalaby K, Farid Z, Campbell J, Kamal K. Parasite-specific isotype and subclass antibody profiles during acute prepatent human schistosomiasis. Exp Parasitol 1996; 82:222-4. [PMID: 8617350 DOI: 10.1006/expr.1996.0028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- H Shaheen
- U.S. Naval Medical Research Unit No. 3 09835-0007, USA
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Marsh D, Hashim R, Hassany F, Hussain N, Iqbal Z, Irfanullah A, Islam N, Jalisi F, Janoo J, Kamal K, Kara A, Khan A, Khan R, Mirza O, Mubin T, Pirzada F, Rizvi N, Hussain A, Ansari G, Siddiqui A, Luby S. Front-line management of pulmonary tuberculosis: an analysis of tuberculosis and treatment practices in urban Sindh, Pakistan. Tuber Lung Dis 1996; 77:86-92. [PMID: 8733421 DOI: 10.1016/s0962-8479(96)90082-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
SETTING Karachi and Hyderabad, Pakistan. OBJECTIVE To describe the level and quality of tuberculosis (TB) case management by non-TB control program (TCP) physicians in urban Sindh, Pakistan. DESIGN We interviewed 152 adults with pulmonary TB confirmed by Karachi's TB control program regarding the initial management of their TB symptoms before entering the TCP. We also surveyed 65 general practitioners (GPs) attending continuing education seminars with a multiple choice test to assess their management of suspected pulmonary TB. We compared both results to guidelines from the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD). RESULTS Eighty percent (122/152) of patients first sought GPs. Only 14% of GPs performed any sputum test. At most, 17 (40%) of the 42 patients recalling their GP's treatment, received the recommended 4-drug regimen. However, 68% (45/65) of surveyed GPs chose correct treatment from a multiple choice format. But their initial laboratory investigations, follow-up, and treatment cessation criteria (9%, 9-31%, and 11% correct, respectively) demonstrated under-utilization of sputum tests and over-reliance on unhelpful tests. CONCLUSIONS GPs first saw most of these TCP patients, but their weak management likely hinders TB control. A partnership between TB control programs and GPs could improve case management and hasten TB control.
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Affiliation(s)
- D Marsh
- Department of Community Health Sciences, Aga Khan University, Pakistan
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Boug A, Biquand S, Biquand-Guyot V, Kamal K. The response of commensal Hamadryas baboons to seasonal reduction in food provisioning. revec 1994. [DOI: 10.3406/revec.1994.2480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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