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Ahmed F, Lim R, Moseley I, Hoang M, Wisco O, Robinson-Bostom L, Qureshi A, Cho E. Neighborhood-Level Socioeconomic Predictors of Melanoma Thickness, Ulceration, and Metastasis at a Rhode Island Academic Center. J Invest Dermatol 2023; 143:2541-2546.e2. [PMID: 37406960 DOI: 10.1016/j.jid.2023.06.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Fadwa Ahmed
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rachel Lim
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Isabelle Moseley
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Megan Hoang
- Brown University, Providence, Rhode Island, USA
| | - Oliver Wisco
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Leslie Robinson-Bostom
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Abrar Qureshi
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Epidemiology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Eunyoung Cho
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Epidemiology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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2
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Moseley I, Ahmed F, Lin E, Lim R, Hoang M, Baranwal N, Robinson-Bostom L, Libby T, Wisco O, Qureshi A, Cho E. Host and primary tumor factors for the development of multiple cutaneous squamous cell carcinomas among a retrospective cohort in Rhode Island. J Am Acad Dermatol 2023; 89:511-518. [PMID: 37011813 DOI: 10.1016/j.jaad.2023.03.038] [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: 08/16/2022] [Revised: 02/16/2023] [Accepted: 03/06/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Risk factors for a primary cutaneous squamous cell carcinoma (CSCC) are well-established; however, the host and primary tumor risk factors for subsequent CSCC have not been fully explored. METHODS We performed a retrospective chart review of patients diagnosed with CSCC in an academic dermatology clinic in Rhode Island from 2016-2019. Logistic regression was used to evaluate the associations between host factors and multiple CSCC and between primary tumor characteristics and the risk of subsequent CSCC. Adjusted odds ratios (aORs) and 95% CIs were calculated. RESULTS A total of 1312 patients with CSCC diagnoses were included. Host risk factors significantly associated with multiple CSCCs included: aged >80 years (aOR, 2.18; 95% CI, 1.46-3.31); history of: solid organ transplant (aOR, 2.41; 95% CI, 1.20-4.80); skin cancer (aOR, 1.96; 95% CI, 1.52-2.54); other cancer (aOR, 1.49; 95% CI, 1.11-2.00); family history of skin cancer (aOR, 1.36; 95% CI, 1.03-1.78); and actinic keratosis (aOR, 1.52; 95% CI, 1.18-1.95). Tumor location, diameter, histologic differentiation, and treatment were not significant predictors of subsequent CSCCs. LIMITATIONS Study patients were predominantly White and from a single institution, limiting the generalizability of results. CONCLUSIONS Certain host characteristics were associated with the development of subsequent CSCC, which may inform clinical guidelines for follow-up.
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Affiliation(s)
- Isabelle Moseley
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Fadwa Ahmed
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Erica Lin
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rachel Lim
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Megan Hoang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Navya Baranwal
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Leslie Robinson-Bostom
- Department of Dermatology, the Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Tiffany Libby
- Department of Dermatology, the Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Oliver Wisco
- Department of Dermatology, the Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Abrar Qureshi
- Department of Dermatology, the Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Eunyoung Cho
- Department of Dermatology, the Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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3
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Moseley I, Ragi SD, Handler MZ. Racial Disparities in the Treatment of Hidradenitis Suppurativa: An Analysis of Data from the National Ambulatory Medical Care Survey. J Drugs Dermatol 2023; 22:692-693. [PMID: 37410054 DOI: 10.36849/jdd.6803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Hidradenitis suppurativa (HS) is a painful, disfiguring, chronic inflammatory disease affecting the axillary, inframammary, and groin regions. Black Americans are disproportionately affected by HS. Structural barriers may be responsible for a lack of better prevention and management. This paper discusses possible reasons that may lead to a more severe presentation and barriers to treatment. Moseley I, Ragi SD, Handler MZ. racial disparities in the treatment of hidradenitis suppurativa: an analysis of data from the National Ambulatory Medical Care Survey. J Drugs Dermatol. 2023;22(7):692-694. doi:10.36849/JDD.6803.
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Ahmed F, Ragi SD, Moseley I, Mirza FN, Yumeen S, Vance T, Ouellette S, Rao B. Rosacea Diagnosis and Prescription Patterns in Underrepresented Groups: An All of Us Database Analysis. J Am Acad Dermatol 2023:S0190-9622(23)00531-5. [PMID: 37024052 DOI: 10.1016/j.jaad.2023.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Fadwa Ahmed
- The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Sara D Ragi
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Isabelle Moseley
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Fatima N Mirza
- Department of Dermatology, the Warren Alpert Medical School of Brown University, Providence, RI
| | - Sara Yumeen
- Department of Dermatology, the Warren Alpert Medical School of Brown University, Providence, RI
| | - Terrence Vance
- Department of Dermatology, the Warren Alpert Medical School of Brown University, Providence, RI
| | - Samantha Ouellette
- Department of Dermatology, the Warren Alpert Medical School of Brown University, Providence, RI
| | - Babar Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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5
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Ahmed F, Moseley I, Ragi SD, Ouellette S, Rao B. Vitiligo in underrepresented communities: An All of Us database analysis. J Am Acad Dermatol 2023; 88:945-948. [PMID: 36414097 DOI: 10.1016/j.jaad.2022.11.027] [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: 07/31/2022] [Revised: 11/04/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Fadwa Ahmed
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Isabelle Moseley
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Sara D Ragi
- Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | | | - Babar Rao
- Department of Dermatology, Robert Wood Johnson Medical School, New Brunswick, New Jersey
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6
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Moseley I, Ragi SD, Ouellette S, Rao B. Onychomycosis in underrepresented groups: an all of us database analysis. Arch Dermatol Res 2023; 315:647-651. [PMID: 36261664 DOI: 10.1007/s00403-022-02413-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/05/2022] [Accepted: 10/13/2022] [Indexed: 11/28/2022]
Abstract
Few research studies evaluating the impact of dermatologic diseases in the United States (US) have adequately included underrepresented groups. All of Us (AoU) is an ongoing precision medicine-based research initiative by the National Institutes of Health (NIH) that facilitates research in populations traditionally underrepresented in biomedical research by prioritizing them for data collection. Our objective was to evaluate the burden of onychomycosis in underrepresented groups defined by the framework provided by AoU. The AoU Registered Tier dataset version 5 was used which includes data collected between May 30, 2017 and April 1, 2021. We conducted a cross-sectional analysis linking survey and electronic health record (EHR) data to estimate the prevalence of onychomycosis in underrepresented groups defined by race, ethnicity, age (≥ 75 years), disability, sexual orientation/gender identity (LGBTQIA +), income (annual household income ≤ $35 000) and education (less than a high school degree). The latest All of Us data release includes 329,038 participants. Of these, 251,597 (76%) had EHR data and 13,874 had onychomycosis (overall prevalence, 5.5%; 95% CI, 5.4-5.6). Multivariate analyses adjusted by tinea pedis, diabetes mellitus, immune compromise, nail psoriasis, and insurance status, in addition to the aforementioned variables, revealed that, compared with White participants, Black and Hispanic participants had a higher adjusted odds of onychomycosis (OR, 1.29; 95% CI, 1.23-1.36 and OR, 1.24; 95% CI, 1.17-1.31, respectively). Higher adjusted odds of onychomycosis were also observed in underrepresented groups. Our findings suggest a disproportionately high burden of onychomycosis in underrepresented groups, although further studies are needed to replicate our findings and address this disparity.
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Affiliation(s)
- Isabelle Moseley
- The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, USA.
| | - Sara D Ragi
- The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, USA
| | - Samantha Ouellette
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Babar Rao
- Department of Dermatology, Robert Wood Johnson Medical Centre, Rutgers University, New Brunswick, NJ, 08901, USA
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Ahmed F, Moseley I, Lin E, Lim R, Baranwal N, Hoang M, Libby T, Wisco O, Robinson-Bostom L, Gupta S, Qureshi A, Cho E. The Association of Neighborhood-Level Socioeconomic Status and Tumor Diameter in Squamous Cell Carcinoma. J Invest Dermatol 2023; 143:170-172. [PMID: 36037927 DOI: 10.1016/j.jid.2022.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Fadwa Ahmed
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Isabelle Moseley
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Erica Lin
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Rachel Lim
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Navya Baranwal
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Megan Hoang
- Division of Biology and Medicine, Brown University, Providence, Rhode Island, USA
| | - Tiffany Libby
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Oliver Wisco
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Leslie Robinson-Bostom
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Sameer Gupta
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Abrar Qureshi
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Eunyoung Cho
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA; Channing Division of Network Medicine, Department of Medicine Research, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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8
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Moseley I, Ragi SD, Ouellette S, Rao B. Condyloma acuminata in under-represented groups: an All of Us database analysis. Sex Transm Infect 2022; 98:620-621. [PMID: 35428700 DOI: 10.1136/sextrans-2022-055467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/02/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Isabelle Moseley
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sara D Ragi
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Samantha Ouellette
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Babar Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
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Gallo Marin B, Ezemma O, Frech FS, Flores Servin JC, Rhee BS, Mulligan KM, O' Connell KA, Moseley I, Wambier CG. An Analysis of Information Sources of YouTube Videos Pertaining to Tattoo Removal: Cross-sectional Study. JMIR Dermatol 2022; 5. [DOI: 10.2196/42759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background
The American Academy of Dermatology and the Food and Drug Administration recommend consultation with a dermatologist prior to undergoing laser tattoo removal. However, non–health care professionals offer tattoo removal. Understanding the information available on the internet for patients regarding tattoo removal is important given that individuals are increasingly consulting digital sources to make decisions regarding skin care. Prior research has identified that YouTube contains misinformation on dermatologic health.
Objective
Here, we present a cross-sectional study that determined the sources of information in YouTube videos that discuss tattoo removal and described the content presented to viewers.
Methods
Using the query “tattoo removal,” we reviewed English-language YouTube videos that explicitly discussed tattoo removal. The following data were recorded: profession of the presenter, tattoo removal method discussed, whether an explicit recommendation to see a dermatologist or physician was present in the video, and number of views.
Results
We analyzed 162 YouTube videos. We found that the majority were presented by non–health care professionals (n=125, 77%), with only 4 (3.7%) records of this subset recommending viewers to seek consultation from a dermatologist to ensure safe and adequate tattoo removal.
Conclusions
Based on our findings, we recommend that dermatologists and other health care professionals provide high-quality, evidence-based information to viewers on tattoo removal and encourage dermatology societies to share via their social media platforms information about the importance of consulting a dermatologist for tattoo removal.
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10
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Ragi SD, Moseley I, Ouellette S, Rao B. Epidemiology and Survival of Kaposi's Sarcoma by Race in the United States: A Surveillance, Epidemiology, and End Results Database Analysis. Clin Cosmet Investig Dermatol 2022; 15:1681-1685. [PMID: 36003526 PMCID: PMC9394645 DOI: 10.2147/ccid.s380167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/13/2022] [Indexed: 11/26/2022]
Abstract
The introduction of highly active antiretroviral treatment (HAART) for acquired immunodeficiency syndrome (AIDS) has led to a significant decrease in the incidence of Kaposi’s sarcoma (KS) in recent years. However, a concomitant increase in racial disparities in KS has arisen. Here, we analyze data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program for epidemiology and survival of Kaposi’s sarcoma by race. The highest incidence was observed among Black patients (incidence rate (IR), 1.189; 95% confidence interval (CI), 1.092–1.189), followed by White patients (IR, 0.486; 95% CI, 0.473–0.498). Relative survival at 1, 3, and 5 years differed significantly by race, with White patients having the highest survival rates (84.26%, 77.79%, and 74.79% at 1, 3, and 5 years respectively) and Black patients demonstrating the lowest (71.50%, 61.37%, and 57.38%), with intermediate survival rates in Asians/Pacific Islanders (AAPI) (80.62%, 71.19%, and 67.28%) and American Indians/Alaska Natives (AIAN) (80.56%, 61.45%, and 61.45%). We conclude that there are significant racial disparities in the incidence, epidemiology, and survival of KS.
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Affiliation(s)
- Sara D Ragi
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Isabelle Moseley
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Samantha Ouellette
- Department of Dermatology, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Babar Rao
- Department of Dermatology, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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11
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Moseley I, Ragi SD, Ouellette S, Rao B. Tinea Pedis in Underrepresented Groups: An All of Us Database Analysis. Mycoses 2022; 66:29-34. [PMID: 35997514 DOI: 10.1111/myc.13522] [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: 04/29/2022] [Revised: 08/11/2022] [Accepted: 08/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tinea pedis is the most common form of dermatophytosis resulting in interdigital infections. All of Us (AoU) is a National Institute of Health initiative with an emphasis on patient populations traditionally underrepresented in biomedical research. OBJECTIVES Our objective was to evaluate the burden of tinea pedis in underrepresented groups in the United States, utilizing the novel AoU research program. METHODS We analyzed AoU Registered Tier dataset version 5, which includes data collected between May 30, 2017 and April 1, 2021. We conducted a cross-sectional analysis linking survey and electronic health record (EHR) data to estimate the prevalence of tinea pedis in underrepresented groups. RESULTS AoU data release includes 329,038 participants. Of these, 251,597 (76.5%) had electronic health record data and 6,932 had tinea pedis (overall prevalence, 2.76%; 95% CI, 2.69-2.82). Multivariate analyses revealed that, compared with White participants, Black and Hispanic participants had a higher adjusted odds of tinea pedis (OR, 1.29; 95% CI, 1.20-1.38 and OR, 1.38; 95% CI, 1.28-1.48, respectively). Higher adjusted odds of tinea pedis were observed in underrepresented groups defined by: age >=75 years (OR, 1.45; 95% CI, 1.33-1.57), LGBTQ status (OR, 1.17; 95% CI, 1.09-1.27), less than a high school education (OR, 1.22; 95% CI, 1.11-1.34), income <$35 000 (OR, 1.09; 95% CI, 1.02-1.16), and physical disability (OR, 1.56; 95% CI, 1.08-1.24). CONCLUSIONS Our findings are consistent with overall age, and gender-specific prevalence estimates from prior epidemiologic studies, validating the scientific consistency of the new AoU database. Additionally, there may be an increased burden of tinea pedis among Black and Hispanic individuals.
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Affiliation(s)
- Isabelle Moseley
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Sara D Ragi
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Samantha Ouellette
- Robert Wood Johnson Medical School, Department of Dermatology, New Brunswick, NJ
| | - Babar Rao
- Robert Wood Johnson Medical School, Department of Dermatology, New Brunswick, NJ
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Moseley I, Ragi SD, Ouellette S, Rao B. Tinea versicolour in underrepresented groups: An All of Us database analysis. Skin Health Dis 2022; 3:e152. [PMID: 36751318 PMCID: PMC9892469 DOI: 10.1002/ski2.152] [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] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Tinea versicolour, used interchangeably with pityriasis versicolour (PV), is a superficial fungal infection of the stratum corneum caused by Malassezia furfur, a fungus of the normal flora of the skin. PV occurs when conditions favour proliferation of the organism's mycelial form, such as in environments with high temperatures/humidity, in immunodeficient/immunocompromised states, and during pregnancy. PV presents as numerous well- demarcated macules with a powdery scale. Prior epidemiologic studies have indicated that underrepresented groups defined by race experience a higher burden of PV as compared to White patients. However, the burden of PV in other underrepresented groups has not previously been examined, as underrepresented groups are frequently excluded from studies evaluating the impact of dermatologic disease. The new National Institute of Health All of Us Research Program (AoU) aims to build one of the world's largest and most diverse databases to promote elucidation of health disparities, particularly in communities that have been historically excluded from biomedical research.
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Affiliation(s)
- Isabelle Moseley
- The Warren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Sara D. Ragi
- The Warren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Samantha Ouellette
- Department of DermatologyRobert Wood Johnson Medical SchoolNew BrunswickNJUSA
| | - Babar Rao
- Department of DermatologyRobert Wood Johnson Medical SchoolNew BrunswickNJUSA
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Moseley I, Yang EJ, Mathieu RJ, Elco C, Massoud CM. Wells’ syndrome as a presenting sign of COVID-19 in the setting of allergic rhinitis and iron deficiency anemia. JAAD Case Rep 2022; 23:27-30. [PMID: 35261918 PMCID: PMC8890785 DOI: 10.1016/j.jdcr.2022.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Isabelle Moseley
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Correspondence to: Isabelle Moseley, AB, 555 South Water Street Apt 319 Providence, RI 02903.
| | - Eric J. Yang
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Regine J. Mathieu
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christopher Elco
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cathy M. Massoud
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Moseley I, Greenberg R, Wasserman M, Thavaseelan S, Cancian M. Leukocytoclastic vasculitis leading to penile necrosis and ischemia of the bladder and urethra. Urol Case Rep 2021; 40:101902. [PMID: 34745896 PMCID: PMC8551586 DOI: 10.1016/j.eucr.2021.101902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/16/2021] [Indexed: 11/28/2022] Open
Abstract
We report a case of leukocytoclastic vasculitis-induced penile necrosis in a 69-year-old male with no previous urologic history. After suffering an ischemic event to the distal shaft of the penis as well as an ischemic event involving the right side of the bladder, he underwent suprapubic tube placement for urinary diversion. Despite attempts at anticoagulation for penile salvage, he lost the distal aspect of the glans penis to auto-necrosis. Ultimately, the underlying disease was determined to be systemic ANCA-associated vasculitis, and the patient was treated with rituximab and prednisone as well as penile wound debridement.
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Affiliation(s)
- Isabelle Moseley
- Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA
| | - Rachel Greenberg
- Department of Urology, Warren Alpert Medical School, Brown University, RI, 02903, USA
| | - Meredith Wasserman
- Department of Urology, Warren Alpert Medical School, Brown University, RI, 02903, USA
| | - Simone Thavaseelan
- Department of Urology, Warren Alpert Medical School, Brown University, RI, 02903, USA
| | - Madeline Cancian
- Department of Urology, Warren Alpert Medical School, Brown University, RI, 02903, USA
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Ranney ML, Pittman SK, Moseley I, Morgan KE, Riese A, Ybarra M, Cunningham R, Rosen R. Cyberbullying Prevention for Adolescents: Iterative Qualitative Methods for Mobile Intervention Design. JMIR Form Res 2021; 5:e25900. [PMID: 34448702 PMCID: PMC8433933 DOI: 10.2196/25900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/04/2021] [Accepted: 07/05/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cybervictimization among adolescents is associated with multiple negative mental health consequences. Although pediatricians often screen for cyberbullying, validated and acceptable programs to reduce the frequency and impact of adolescent cybervictimization are lacking. OBJECTIVE This study uses agile qualitative methods to refine and evaluate the acceptability of a mixed-modality intervention, initiated within the context of usual pediatric care, for adolescents with a history of cyberharassment and cyberbullying victimization. METHODS Three groups of adolescents were successively recruited from an urban primary care clinic to participate in three consecutive iterations (1, 2, and 3) of the program, which consisted of a brief in-clinic intervention followed by 8 weeks of daily, automated SMS text messaging. After 2 weeks of messaging, iteration 1 (I1) participants completed semistructured interviews regarding intervention experiences. Participant feedback was evaluated via framework matrix analysis to guide changes to the program for iteration 2 (I2). Feedback from 2-week interviews of I2 participants was similarly used to improve the program before initiating iteration 3 (I3). Participants in all 3 iterations completed the interviews after completing the program (8 weeks). Daily response rates assessed participant engagement, and satisfaction questionnaires assessed acceptability. RESULTS A total of 19 adolescents (aged 13-17 years) reporting past-year cybervictimization were enrolled: 7 in I1, 4 in I2, and 8 in I3. Demographic variables included the following: a mean age of 15 (SD 1.5) years; 58% (11/19) female, 42% (8/19) male, 63% (12/19) Hispanic, 37% (7/19) non-Hispanic, 79% (15/19) people of color, and 21% (4/19) White. A total of 73% (14/19) self-identified as having a low socioeconomic status, and 37% (7/19) self-identified as lesbian, gay, or bisexual. The average past 12-month cybervictimization score at baseline was 8.2 (SD 6.58; range 2-26). Participant feedback was used to iteratively refine intervention content and design. For example, participants in I1 recommended that the scope of the intervention be expanded to include web-based conflicts and drama, rather than narrowly focusing on cyberbullying prevention. On the basis of this feedback, the I2 content was shifted toward more general de-escalation skills and bystander empowerment. Overall, 88.34% (940/1064) of the daily queries sent to participants across all 3 iterations received a reply. Participant satisfaction improved considerably with each iteration; 0% (0/7) of I1 participants rated the overall quality of Intervention to Prevent Adolescent Cybervictimization with Text message as excellent, compared to 50% (2/4) of I2 participants and 86% (6/7) of I3 participants. Engagement also improved between the first and third iterations, with participants replying to 59.9% (235/392) of messages in I1, compared to 79.9% (358/488) of messages in I3. CONCLUSIONS This study shows the value of structured participant feedback gathered in an agile intervention refinement methodology for the development of a technology-based intervention targeting adolescents.
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Affiliation(s)
- Megan L Ranney
- Center for Digital Health, Brown University, Providence, RI, United States.,Rhode Island Hospital, Providence, RI, United States
| | | | - Isabelle Moseley
- Center for Digital Health, Brown University, Providence, RI, United States
| | | | - Alison Riese
- Center for Digital Health, Brown University, Providence, RI, United States.,Rhode Island Hospital, Providence, RI, United States
| | - Michele Ybarra
- Center for Innovative Public Health Research, San Clemente, CA, United States
| | | | - Rochelle Rosen
- Center for Digital Health, Brown University, Providence, RI, United States.,Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
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Taylor VA, Moseley I, Sun S, Smith R, Roy A, Ludwig VU, Brewer JA. Awareness drives changes in reward value which predict eating behavior change: Probing reinforcement learning using experience sampling from mobile mindfulness training for maladaptive eating. J Behav Addict 2021; 10:482-497. [PMID: 34264854 PMCID: PMC8997232 DOI: 10.1556/2006.2021.00020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/21/2021] [Accepted: 03/06/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND AIMS Maladaptive eating habits are a major cause of obesity and weight-related illness. The development of empirically-based approaches, such as mindfulness training (MT) that target accurate mechanisms of action to address these behaviors is therefore critical. Two studies were conducted to examine the impact of MT on maladaptive eating and determine the involvement of reinforcement learning mechanisms underlying these effects. METHODS In Study1, maladaptive eating behaviors were assessed using self-report questionnaires at baseline and 8 weeks after an app-based MT intervention (n = 46). A novel mindful eating craving tool was embedded in our intervention to assess: eating behaviors (intake frequency/magnitude), and reward (contentment ratings) experienced after eating. Using a well-established reinforcement learning (Rescorla-Wagner) model, expected reward values (EV) were estimated as a function of contentment levels reported after eating. In Study2 (n = 1,119), craving tool assessments were examined in an independent sample using the app in a real-world naturalistic context. RESULTS Study 1's results revealed a significant decrease in EV and eating behaviors across craving tool uses. In addition, changes in reward values predicted decreases in eating behaviors. Finally, Study 1's results revealed significant pre-post intervention reductions in self-reported eating behaviors. In Study2, we observed a significant decrease in EV, but not in eating behaviors, across craving tool uses. Study 2 also revealed a predictive relationship between EV and eating behaviors. DISCUSSION AND CONCLUSIONS These results support the implementation of MT to prevent and treat maladaptive eating behaviors, which target reinforcement learning processes as mechanisms of action.
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Affiliation(s)
- Véronique A. Taylor
- Mindfulness Center, Brown School of Public Health and Warren Alpert Medical School, Brown University, 121 South Main Street, Providence, RI 02903, USA,Corresponding author. E-mail:
| | - Isabelle Moseley
- Mindfulness Center, Brown School of Public Health and Warren Alpert Medical School, Brown University, 121 South Main Street, Providence, RI 02903, USA
| | - Shufang Sun
- Mindfulness Center, Brown School of Public Health and Warren Alpert Medical School, Brown University, 121 South Main Street, Providence, RI 02903, USA
| | - Ryan Smith
- Laureate Institute for Brain Research, 6655 South Yale Ave, Tulsa, OK 74136, USA
| | - Alexandra Roy
- Mindfulness Center, Brown School of Public Health and Warren Alpert Medical School, Brown University, 121 South Main Street, Providence, RI 02903, USA
| | - Vera U. Ludwig
- Mindfulness Center, Brown School of Public Health and Warren Alpert Medical School, Brown University, 121 South Main Street, Providence, RI 02903, USA,Department of Neuroscience, Perelman School of Medicine & Wharton Neuroscience Initiative, University of Pennsylvania, 106 Steinberg-Dietrich Hall, 3620 Locust Walk, Philadelphia, PA 19104, USA
| | - Judson A. Brewer
- Mindfulness Center, Brown School of Public Health and Warren Alpert Medical School, Brown University, 121 South Main Street, Providence, RI 02903, USA
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Chuck C, Kalagara R, Moseley I, Martin T. Prehospital Antiemetic Therapy in Campus-Based EMS Services: A Cross-Sectional Analysis of Statewide EMS Protocols. ACTA ACUST UNITED AC 2020. [DOI: 10.30542/jcems.2020.03.01.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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Jenkins C, Rose GE, Bunce C, Cree I, Norton A, Plowman PN, Moseley I, Wright JE. Clinical features associated with survival of patients with lymphoma of the ocular adnexa. Eye (Lond) 2003; 17:809-20. [PMID: 14528242 DOI: 10.1038/sj.eye.6700379] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [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: 11/09/2022] Open
Abstract
PURPOSE Although systemic or eyelid involvement by ocular adnexal lymphoma carries a worse prognosis, there have been few reports of the outcome in relation to clinical presentation. The outcome of malignant ocular adnexal lymphoma was, therefore, related to presenting clinical symptoms and signs. DESIGN AND METHODS A retrospective, noncomparative case-note review of 326 patients treated in the Orbital Clinic at Moorfields Eye Hospital. The associations between presenting symptoms or signs and three outcome measures (v.i.) were assessed by univariate and multiple variable regression together with Kaplan-Meier analysis. MAIN OUTCOME MEASURES (i) Presence of extra-orbital disease at the time of presentation; (ii) development of systemic lymphoma after new presentation with solely ocular adnexal disease; and (iii) death attributable to widespread lymphoma. RESULTS Presentation with disseminated disease was rarer with over 1 year's ophthalmic symptoms (odds ratio (OR) 0.7; 95% CI 0.5-0.9) and much more frequent with bilateral adnexal disease (OR 5.8; 95% CI 3.0-11.2). With solely adnexal disease at presentation, subsequent extra-orbital lymphoma was more frequent and earlier with lacrimal gland disease (as compared to those without; hazard ratio (HR) 1.9; 95% CI 1.2-4.5) or with eyelid disease (compared to those without; HR 2.4; 95% CI 1.2-4.5), or with bilateral disease (compared to unilateral disease; HR 2.6; 95% CI 1.4-5.2). Prior or concurrent systemic disease was the most significant predictive factor for lymphoma-related death (HR 6.8; 95% CI 4.3-10.9), but tumour-related death was also commoner and earlier with bilateral disease (HR 2.4; 95% CI 1.4-4.0) or where a relative afferent papillary defect was present (HR 2.8; 95% CI 1.6-4.9). Similarly, the rate of tumour-related death was slightly less where symptoms had been present for more than a year (HR 0.8; 95% CI 0.7-1.0) and slightly greater in the elderly (HR 1.03; 95% CI 1.01-1.05). Conjunctival lymphoma had the lowest rate of extra-orbital spread and lymphoma-related death, the rate of these two events being sequentially greater for patients with predominantly deep orbital lymphoma, lacrimal gland lymphoma, or eyelid lymphoma. CONCLUSION These data suggest that presenting symptoms and signs of patients with ocular adnexal lymphoma are significantly associated with the risk of systemic disease at orbital presentation, the rate of subsequent spread, and the rate of lymphoma-related death.
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Affiliation(s)
- C Jenkins
- Orbital Clinic Moorfields Eye Hospital City Road, London, UK
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Moseley I. MAGNETIC RESONANCE SPECTROSCOPY IN MULTIPLE SCLEROSIS.: Edited by M. Filippi, D. L. Arnold and G. Comi. 2000. Milan: Springer. Price DM 129. Pp. 165. ISBN 88-470-0123-4. Brain 2001. [DOI: 10.1093/brain/124.10.2119] [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: 11/12/2022] Open
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Abstract
BACKGROUND The paranasal sinuses are intimately related to the orbit and consequently sinus disease or surgery may cause severe orbital complications. Complications are rare but can result in serious morbidity, the most devastating of which is severe visual loss. METHODS A retrospective review was undertaken of four cases of severe orbital trauma during endoscopic sinus surgery. RESULTS All the cases suffered medial rectus damage, one had additional injury to the inferior rectus and oblique, and two patients were blinded as a result of direct damage to the optic nerve or its blood supply. CONCLUSION Some ophthalmic complications of endoscopic sinus surgery are highlighted, the mechanisms responsible are discussed, and recommendations for prevention, early recognition, and management are proposed.
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Affiliation(s)
- C Rene
- Moorfields Eye Hospital, London EC1V 2PD, UK
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Moseley I. Neuroimaging, volumes 1 and 2. J Neurol Neurosurg Psychiatry 2000; 69:407B. [PMID: 10945822 PMCID: PMC1737077 DOI: 10.1136/jnnp.69.3.407b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jenkins C, Rose GE, Bunce C, Wright JE, Cree IA, Plowman N, Lightman S, Moseley I, Norton A. Histological features of ocular adnexal lymphoma (REAL classification) and their association with patient morbidity and survival. Br J Ophthalmol 2000; 84:907-13. [PMID: 10906102 PMCID: PMC1723589 DOI: 10.1136/bjo.84.8.907] [Citation(s) in RCA: 180] [Impact Index Per Article: 7.5] [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: 11/04/2022]
Abstract
BACKGROUND The histological characteristics of ocular adnexal lymphomas have previously provided only a limited guide to clinical outcome for affected patients. This clinicopathological relation was re-examined using the Revised European American Lymphoma (REAL) system to classify the tumours in a large cohort of patients. METHODS The biopsies and clinical follow up data for 192 patients with ocular adnexal lymphoma were reviewed, the biopsies being regraded in accordance with the REAL classification. For each of five histological groups, logistic regression analysis was used to determine the odds ratios (OR) for the presence of systemic disease at the time of orbital diagnosis and Cox regression analysis was used to assess the hazard ratios (HR) for disseminated disease and lymphoma related death. For 108 patients in whom extraorbital spread occurred, the histological category of lymphoma was compared with the sites of dissemination. RESULTS At presentation, the frequency of previous or concurrent extraorbital disease increased from marginal zone lymphoma (OR 1.0), diffuse lymphoplasmacytic/lymphoplasmacytoid lymphoma (OR 2.3), follicle centre lymphoma (OR 3.8), diffuse large B cell lymphoma (OR 4.0) to other histological lymphoma variants (OR 26.8). For all histological types, the estimated risk of extraorbital disease and lymphoma related death continued for many years and the proportion of patients with at least one extraorbital recurrence after 5 years was 47% for MZL, 48% for LPL, 64% for FCL, 81% for DLCL, and 95% for other lymphoma variants. The corresponding estimated rates for 5 year lymphoma related mortality were 12%, 19%, 22%, 48%, and 53% respectively. CONCLUSIONS Patients with ocular adnexal lymphoma can be classified by REAL into five distinct groups, which show a progressive increase in the risks of extraorbital disease at diagnosis, of disease dissemination with time, and of tumour related death.
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Affiliation(s)
- C Jenkins
- Orbital Clinic, Moorfields Eye Hospital, London
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Moseley I. Book Review: How to Write and Publish a Scientific Paper, 5th Edn. Cephalalgia 2000. [DOI: 10.1046/j.1468-2982.2000.00016.x] [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: 11/20/2022]
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Abstract
AIMS To investigate the prevalence and clinical associations of senile scleral plaques. METHODS Unselected, consecutive computed tomographic (CT) images of elderly people were reviewed for the presence of calcification indicating senile scleral plaques. RESULTS No definite calcification was seen in 100 men or 100 women aged 60-69 years; equivocal changes were seen in one woman. There were three definite examples and one equivocal case of calcification in 100 women and four definite cases in 100 men aged 70-79 years. However, in a group of 71 men and women patients aged 80 years or more, 16 definite cases were seen, indicating a prevalence of 22%. CONCLUSIONS Apart from advanced age, and a mild association with the extent of calcification of the carotid siphon, no clinical or radiological features were identified which consistently characterized a total of 28 patients with this form of ocular calcification; an association with cataract probably reflected simply the recruitment base. Scleral plaques would appear to be a degenerative phenomenon without clinical significance, most likely to be detected in patients presenting with unrelated ophthalmological complaints.
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Affiliation(s)
- I Moseley
- Radiology Department, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK
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Abstract
We reviewed computed tomography (CT) studies in 30 patients with histologically confirmed orbital rhabdomyosarcoma. There were 17 male and 13 female patients, mean age 8.8 years (median age 7 years, age range 1 month to 51 years). The tumour occupied the intra and extraconal compartments in 14 (47%) cases; it was solely extraconal in 11 (37%) and intraconal in five (16%). Within the orbit the upper inner quadrant was the most common site, 20 (67%) of the tumours lying in this region. More than one quadrant was involved in 16 (53%) cases. The epicentre of the tumour was in the eyelids of three (10%) patients. At presentation the mean size of the mass was 25 x 17 mm in long and short axis diameters, respectively. The tumours were of soft tissue density with moderately well defined margins and an irregular shape. They showed mild to moderate contrast enhancement. Calcification was seen in one case. Changes in the adjacent bone were seen in at least 12 (40%) patients. Intracranial extension was present in one (3%) patient and invasion of the paranasal sinuses was also seen in one (3%) patient. The intraorbital structures were displaced or encased by the tumour mass. The globe was displaced and distorted but not invaded by the tumour. Magnetic resonance imaging (MRI) studies were also reviewed in five patients. On T1-weighted images the tumour gave a similar signal to muscle but on T2-weighted images it gave a higher signal.
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Affiliation(s)
- S A Sohaib
- Department of Radiology, The Royal Hospitals Trust, The Royal London Hospital, UK
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Moseley I, Gass A. Magnetic resonance imaging in optic neuropathy. Clin Neurosci 1997; 4:302-19. [PMID: 9292260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Magnetic resonance imaging has revolutionised the ability to investigate intrinsic disease of the anterior optic pathways. We review the data accumulated from this technique not only in the conditions, such as neoplasia, which have traditionally been the domain of neuroimaging, but also in inflammatory, metabolic and degenerative diseases.
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Affiliation(s)
- I Moseley
- National Hospital for Neurology and Neurosurgery, London, England
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Moseley I, Stevens J. What are the indications for a carotid duplex scan? Clin Radiol 1997; 52:481-2. [PMID: 9202599 DOI: 10.1016/s0009-9260(97)80018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Edan G, Miller D, Clanet M, Confavreux C, Lyon-Caen O, Lubetzki C, Brochet B, Berry I, Rolland Y, Froment JC, Cabanis E, Iba-Zizen MT, Gandon JM, Lai HM, Moseley I, Sabouraud O. Therapeutic effect of mitoxantrone combined with methylprednisolone in multiple sclerosis: a randomised multicentre study of active disease using MRI and clinical criteria. J Neurol Neurosurg Psychiatry 1997; 62:112-8. [PMID: 9048709 PMCID: PMC486720 DOI: 10.1136/jnnp.62.2.112] [Citation(s) in RCA: 256] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the efficiency of mitoxantrone in multiple sclerosis. METHODS Forty two patients with confirmed multiple sclerosis, selected as having a very active disease on clinical and MRI criteria were randomised to receive either mitoxantrone (20 mg intravenously (IV) monthly) and methylprednisolone (1 g iv monthly) or methylprednisolone alone over six months. In the steroid alone group five patients dropped out due to severe exacerbation. RESULTS Blinded analysis of MRI data showed significantly more patients with no new enhancing lesions in the mitoxantrone group compared with the steroid alone group, (90% v 31%, P < 0.001). In the mitoxantrone group there was a month by month decrease almost to zero in the number of new enhancing lesions, and in the total number of enhancing lesions, whereas both remained high in the steroid alone group. The differences were significant for both indices at all months from 1-6. Unblinded clinical assessments showed a significant improvement in change in EDSS at months 2-6 in the mitoxantrone group, with a final mean improvement of more than one point (-1.1 v + 0.3; P < 0.001). There was a significant reduction in the number of relapses (7 v 31; P < 0.01), and an increase in the number of patients free of exacerbation (14 v 7; P < 0.05). CONCLUSION In this selected group of patients with multiple sclerosis with very active disease, mitoxantrone combined with methylprednisolone was effective in improving both clinical and MRI indices of disease activity over a period of six months whereas methylprednisolone alone was not. Further double blinded long term studies are needed to properly evaluate the effect of mitoxantrone on progression in disability.
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Affiliation(s)
- G Edan
- Department of Neurology, Centre Hospitalier Universitaire, Rennes, France
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Abstract
AIMS/BACKGROUND Primary localised amyloidosis is rarely encountered in the orbit. The typical clinical and radiological appearances have not been clearly established, in particular the single site deposition of amyloid has never been proved. METHODS Six cases were reviewed in detail and their clinical and radiological characteristics are described here. Four patients had scintigraphy with 123I serum amyloid P component and one patient had typing of the amyloid fibrils. RESULTS All the patients had a firm mass in the upper orbit with a predilection for the region of the lacrimal gland. Computed tomography showed a homogeneous mass with thickening and irregularity of the adjacent bone and/or calcification within the mass. None was associated with systemic disease. Scintigraphy with 123I serum amyloid P component demonstrated that the amyloid was confined to the orbit. In one patient the amyloid fibrils were derived from an IgG4 heavy chain constant domain. The lesions were partially excised with subsequent clinical stability over 6 months to 18 years in all but one patient who had continued enlargement of the lesion. CONCLUSION There is a characteristic clinical and radiological pattern for primary localised amyloidosis of the orbit. The disease process is truly local and not part of a systemic process. A majority respond to simple debulking with subsequent observation.
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Affiliation(s)
- I E Murdoch
- Orbital Clinic, Moorfields Eye Hospital, London
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Moreau T, Coles A, Wing M, Thorpe J, Miller D, Moseley I, Issacs J, Hale G, Clayton D, Scolding N, Waldmann H, Compston A. CAMPATH-IH in multiple sclerosis. Mult Scler 1996; 1:357-65. [PMID: 9345418 DOI: 10.1177/135245859600100616] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [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: 02/05/2023]
Abstract
In a pilot study, seven patients with multiple sclerosis were treated with CAMPATH-IH which targets the CD52 antigen present on lymphocytes and monocytes. There was a substantial reduction in disease activity as measured by gadoliunium-enhancing lesions on MRI. Encouraged by this result a further seven patients have been treated with CAMPATH-IH; four also received anti-CD4 antibody. Lymphopaenia developed rapidly and was sustained for at least one year. In 12 patients, the first infusion of antibody was characterised by significant exacerbation or re-awakening of pre-existing symptoms lasting several hours. These clinical effects of antibody treatment correlated with increased levels of circulating cytokines. Peak levels of tumour necrosis factor alpha (TNF alpha) and interferon gamma (IFN gamma) occurred at 2 h whereas the rise in interleukin-6 (IL-6) was significantly delayed and peaked at 4 h after starting antibody treatment. The neurological symptoms could not be attributed directly to pyrexia and were not provoked (in one patient) by an artificial rise in temperature. In the remaining two patients, a single pre-treatment with intravenous methylprednisolone (500 mg) prevented both the transient increase in neurological symptoms and the cytokine release. Our results suggest that soluble immune mediators contribute to symptom production in multiple sclerosis by directly or indirectly blocking conduction through partially demyelinated pathways.
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Affiliation(s)
- T Moreau
- University of Cambridge Neurology unit, Addenbrooke's Hospital
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Reutens DC, Stevens JM, Kingsley D, Kendall B, Moseley I, Cook MJ, Free S, Fish DR, Shorvon SD. Reliability of visual inspection for detection of volumetric hippocampal asymmetry. Neuroradiology 1996; 38:221-5. [PMID: 8741191 DOI: 10.1007/bf00596533] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [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: 02/01/2023]
Abstract
Volumetric measurement of the hippocampus is of use in localisation of lesions causing focal epilepsy and in lateralisation of epilepsy due to mesial temporal sclerosis. However, it is time consuming and requires specialised equipment. Hence, we compared volumetric measurement with visual detection of hippocampal asymmetry by five trained observers. MRI studies of 19 neurologically normal subjects and of 34 consecutive patients with epilepsy and hippocampal volume ratios below the lowest normal value were employed. Agreement between visual and quantitative diagnoses was 59% for all subjects (kappa = 0.38) and 65% for those with volumetric hippocampal asymmetry. Disagreements in visual and volumetric lateralisation of hippocampal asymmetry were relatively uncommon. Visual estimates of the extent of hippocampal involvement and the observers' confidence in the diagnosis influenced the accuracy of visual inspection. However, discordance in diagnoses occurred even when confidence in the visual diagnosis was high. Reliable visual detection occurred for hippocampal volume ratios below 0.7, suggesting that visual determination of hippocampal asymmetry is of greatest clinical value in the lateralisation of seizure foci in patients already selected for the presence of intractable temporal lobe epilepsy. Volumetric measurements are particularly important if hippocampal asymmetry is used for seizure localisation in groups of patients with temporal or extratemporal epilepsy.
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Affiliation(s)
- D C Reutens
- National Hospital for Neurology and Neurosurgery, London, UK
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Abstract
We reviewed the CT studies of 176 patients with biopsy-proven inflammatory pseudotumour of the orbit, in an attempt to establish the incidence of bone sclerosis in this condition. We found 20 patients (11.5%) to show definite bone sclerosis and/or hyperostosis, and in a further 10 (6%) there was probable sclerosis, giving a total of 30 patients (17%) with some evidence of bony change. Bone-window films were available for a minority of patients, and the frequency of sclerosis was therefore probably underestimated. This feature, which presumably represents a low-grade, chronic sterile osteitis, has not previously been emphasised.
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Affiliation(s)
- G Quaghebeur
- Department of Radiology and Orbital Clinic, Moorfields Eye Hospital, UK
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Thorpe JW, Barker GJ, Jones SJ, Moseley I, Losseff N, MacManus DG, Webb S, Mortimer C, Plummer DL, Tofts PS. Magnetisation transfer ratios and transverse magnetisation decay curves in optic neuritis: correlation with clinical findings and electrophysiology. J Neurol Neurosurg Psychiatry 1995; 59:487-92. [PMID: 8530932 PMCID: PMC1073710 DOI: 10.1136/jnnp.59.5.487] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Conventional MRI sequences do not permit the distinction between the different pathological characteristics (oedema, demyelination, gliosis, axonal loss) of the multiple sclerosis plaque. Magnetisation transfer imaging and transverse magnetisation decay curve (tMDC) analysis may be more specific. These techniques have been applied to the optic nerves in 20 patients with optic neuritis and the results correlated with clinical and visual evoked potential (VEP) findings. tMDC analysis failed to identify separate intracellular and extracellular water compartments within the optic nerve but gave a measure of transverse relaxation time (T2) without the confounding effects of CSF in the nerve sheath. Both T2 and magnetisation transfer ratio (MTR) were abnormal after an episode of optic neuritis. T2 did not correlate with visual function or with VEP latency or amplitude. There was a significant correlation between MTR reduction and prolongation of VEP latency: this increased latency may reflect an effect of myelin loss on MTR. Longer lesions were associated with worse visual outcome, implying that the overall extent of pathological involvement is likely to influence the degree of functional deficit.
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Affiliation(s)
- J W Thorpe
- NMR Research Unit, Institute of Neurology, London, UK
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Blumhardt LD, Miller DH, Sandercock PA, Moore AP, Brock L, Nixon T, Kendall B, Moseley I, McDonald WI. A prospective study of "undiagnosed" isolated myelopathy: II. Value of magnetic resonance imaging, evoked potentials and CSF analysis. Eur J Neurol 1995; 2:307-15. [PMID: 24283681 DOI: 10.1111/j.1468-1331.1995.tb00132.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We aimed to determine the sensitivity of available "diagnostic" tests in detecting subclinical abnormalities characteristic of multiple sclerosis (MS) in patients with unexplained isolated myelopathy, and any relationship between test results and level of disability. The trial investigations were carried out in 69 prospectively selected patients with acute or chronic noncompressive myelopathies. Magnetic resonance scans were the most sensitive individual tests, revealing asymptomatic brain lesions in 51 patients (74%, C.I. 64-84). An abnormal IgG/albumin ratio (IgG/A) was present in 29 (42%, C.I. 30-54), oligoclonal bands (OCB) in 27 (39%, C.I. 17-39) and abnormal evoked potentials (EP) (visual and/or auditory brain stem) in 19 cases (28%, C.I. 17-39). OCB and abnormal EP were found significantly less often than in control patients with clinically definite MS (CDMS) and significantly more often than in patients with myelopathy due to other conditions. The number of anatomical brain areas with lesions on magnetic resonance imaging (MRI) was significantly associated with CSF abnormalities; abnormal EP were correlated with abnormal MRI and elevated CSF immunoglobulins. Clinical classifications, age, symptom duration, disability levels and genetic factors did not appear to influence the prevalence of abnormal MRI or CSF. For the exclusion of compressive and structural diseases of the spinal cord, myelography has been superceded by cervical and thoracic MRI. In addition, MRI of the brain is the investigation of choice in patients with myelopathies that remain unexplained after spinal MRI. However, whether used alone or in combination with other tests, the specificity and predictive value of brain MRI abnormalities for the risk of developing MS, as well as the associated "false positive" rates, remain to be defined by long-term follow-up of prospectively ascertained and representative cases.
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Affiliation(s)
- L D Blumhardt
- Department of Neurological Science, Faculty of Medicine, University of Liverpool, LiverpoolThe Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Abstract
In a single-centre comparative randomised double-blind trial, 40 patients undergoing head CT were examined using iobitridol and compared with 40 examined using iohexol. The contrast media were assessed for clinical safety and diagnostic efficacy. No significant difference was observed between the two groups and there were no significant reactions. It is concluded that iobitridol is a safe and effective contrast medium.
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Affiliation(s)
- W Taylor
- Lysholm Department of Radiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Abstract
Multifocal fibrosclerosis is a condition of unknown aetiology, characterised by fibrous lesions occurring at a variety of sites. Clinical variants include retroperitoneal fibrosis, Riedel's thyroiditis, sclerosing cholangitis, and mediastinal fibrosis. Orbital pseudotumour has been reported as a manifestation of this condition. Three patients with multifocal fibrosclerosis in whom orbital involvement was the dominant feature are described.
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Affiliation(s)
- I Moseley
- Lysholm Department of Radiology, National Hospital for Neurology and Neurosurgery, London, UK
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Hodgson T, Kingsley D, Moseley I. What is the role of imaging in the follow-up of meningiomas? Clin Radiol 1994. [DOI: 10.1016/s0009-9260(05)82751-5] [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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Moreau T, Thorpe J, Miller D, Moseley I, Hale G, Waldmann H, Clayton D, Wing M, Scolding N, Compston A. Preliminary evidence from magnetic resonance imaging for reduction in disease activity after lymphocyte depletion in multiple sclerosis. Lancet 1994; 344:298-301. [PMID: 7914262 DOI: 10.1016/s0140-6736(94)91339-0] [Citation(s) in RCA: 155] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The central nervous system lesions of multiple sclerosis (MS) can be detected by magnetic resonance imaging (MRI) and the initial perivascular inflammatory component is distinguished by the presence of gadolinium enhancement. To assess the effect of systemic lymphocyte depletion on disease activity, seven patients with MS received a 10-day intravenous course of the humanised monoclonal antibody CAMPATH-1H (anti-CDw52). With some variations in the protocol, enhanced cerebral MR images were obtained monthly for 3-4 months before and at least 6 months after treatment. 28 enhancing areas were detected on the first series of 7 scans; 51 additional active lesions were identified on 18 scans before treatment; 15 were detected on 20 scans done over the next 3 months, but only 2 active lesions were seen on 23 scans during follow-up beyond 3 months. The difference in lesion incidence rate before and after treatment varied and the rate ratio was significantly reduced in only three patients. Collectively, in a "meta-analysis", the rate ratios were 0.15 [corrected] (95% CI 0.09-0.24) for all seven patients and 0.24 (0.14-0.42; p < 0.001) with exclusion of the patient whose scanning schedule differed. The effect of CAMPATH-1H on disease activity provides direct, but preliminary, evidence that disease activity in MS depends on the availability of circulating lymphocytes and can be prevented by lymphocyte depletion. It is too early to say anything about the clinical results of treatment with this agent.
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Affiliation(s)
- T Moreau
- University of Cambridge Neurology Unit, Addenbrooke's Hospital, UK
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Moseley I. Radiological features of orbital tumour. J R Soc Med 1993; 86:491. [PMID: 8078058 PMCID: PMC1294066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Moseley I. Retroorbital metastasis. J R Soc Med 1993; 86:370. [PMID: 20894877 PMCID: PMC1294498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- I Moseley
- Radiology Department, Moorfields Eye Hospital, City Road, London EC1V 2PD
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