Publications by authors named "Amar D Desai"

17 Publications

  • Page 1 of 1

Bullous Pemphigoid Following the Moderna mRNA-1273 Vaccine.

Cureus 2022 Apr 13;14(4):e24126. Epub 2022 Apr 13.

Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.

As the onset of novel variants of the severe acute respiratory syndrome coronavirus 2 virus pushes policy-makers to push widespread vaccination efforts, it is likely that an increased number of severe cutaneous adverse reactions (SCARs) will present. Therefore, it is important to understand the presentation of possible SCARs. However, data are limited regarding which SCARs are most likely to be found following vaccination, and specific presentations in certain demographic groups, such as postmenopausal women, remain widely unknown. Here, we present the case of a 73-year-old female with no medical history or allergies presenting with a unique reaction of systemic bullous pemphigoid following the Moderna mRNA-1273 vaccine. To our knowledge at the time of this writing, based on a thorough review of the literature using PubMed, no such cases exist following the Moderna vaccine in the United States in elderly, postmenopausal women. We present a brief discussion on the presentation and management to hopefully alleviate future morbidity from similar reactions with increased distribution of the vaccine.
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http://dx.doi.org/10.7759/cureus.24126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9106564PMC
April 2022

Don't blame the nails for SARS-CoV-2 hospitalizations and mortality.

Arch Dermatol Res 2022 Feb 17. Epub 2022 Feb 17.

Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, 9th Floor, New York, NY, 10012, USA.

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http://dx.doi.org/10.1007/s00403-022-02337-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8853190PMC
February 2022

Predictors of time to definitive surgery and survival in Merkel cell carcinoma: analysis of the US National Cancer Database.

Clin Exp Dermatol 2022 Feb 12. Epub 2022 Feb 12.

Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA.

Background: Merkel cell carcinoma (MCC) is an aggressive cancer, and it has been suggested that earlier treatment would allow for better patient outcomes. However, the causes of delays in the initiation of treatment and the effects of delayed treatment on survival of patients have not fully been explored, and the effects of treatment delays for MCC are not yet fully understood.

Aim: To determine the effect of time to treatment initiation (TTI) on mortality in MCC and to determine the predictors of TTI itself.

Methods: This was a retrospective cohort analysis of the US National Cancer Database (NCDB) for cases of MCC from 2004 to 2016, excluding individuals with Stage IV MCC, as surgery is not the preferred treatment for this group. The time difference between initial biopsy of MCC and definitive surgery (TTI) was stratified into five groups by 30-day intervals.

Results: In total, 12 157 patients [7491 (61.6%) men, 4666 (38.4%) women; mean ± SD age 74.4 ± 10.9 years] were included in the study. A risk for longer TTI was seen in black individuals (OR = 1.7, 95% CI 1.2-2.6) and in elderly individuals aged > 70 years (OR = 1.7, 95% CI 1.2-2.5). Kaplan-Meier survival analysis showed that individuals with TTI < 30 days had a significantly longer overall survival than those with TTI > 120 days (6.1 vs. 4.8 years, P < 0.001). However, after controlling for clinical and tumour factors in Cox multivariable analysis, no difference in survival was noted for TTI < 30 days and TTI > 120 days [hazard ratio (HR) = 0.9, 95% CI 0.8-1.1). Worse outcomes were also associated with increasing age (HR = 2.0, 95% CI 1.7-2.5), male sex (HR = 1.2, 95% CI 1.2-1.3), higher Charlson-Deyo comorbidity score (HR = 1.4, 95% CI 1.3-1.5), lack of radiation therapy (HR = 0.8, 95% CI 0.8-0.9), lack of private insurance (HR = 0.7, 95% CI 0.6-1.0), and use of surgical technique other than Mohs micrographic surgery or wide local excision (HR = 1.2, 95% CI 1.2-1.3).

Conclusion: Although TTI is a useful prognostic metric in isolated survival analysis, its utility declines when other factors are controlled for in the analysis. Age, radiotherapy, type of surgery performed, comorbidities, tumour size and lymph node involvement may be important predictors of survival.
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http://dx.doi.org/10.1111/ced.15133DOI Listing
February 2022

Sex Disparities in Pediatric Acute Rhinosinusitis: A National Perspective.

Otolaryngol Head Neck Surg 2022 Feb 8:1945998221077190. Epub 2022 Feb 8.

Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.

Objective: This study aims to provide an age-stratified analysis of associations with patient sex in pediatric inpatients with acute rhinosinusitis (ARS).

Study Design: Retrospective cohort study.

Setting: National administrative database.

Methods: The 2016 Kids' Inpatient Database was queried for pediatric inpatients (<21 years old) with ARS ( J01). Orbital and intracranial sequelae were selected via codes. Statistical associations by sex were determined via univariate and multivariable analyses. Weighted measures are reported to provide national estimates.

Results: Of the 5882 patients identified with ARS, 2404 (40.9%) were female and 3478 (59.1%) were male. Male patients were younger than female patients (mean, 9.3 vs 9.9 years; < .001). Multivariable analysis indicated that males and females had similar total charges ($71,094 vs $66,892, = .464) and length of stay (5.8 vs 6.1 days, = .263). However, male patients underwent more procedures (1.8 vs 1.5, < .001). Mortality was similar between male and female patients (odds ratio [OR], 0.91; = .664). Male patients also had increased odds for having orbital (OR, 1.58; < .001) and intracranial (OR, 1.99; < .001) complications. Differences in sex-dependent sequela risk were starkest in patients aged 14 to 20 years, with male patients being more likely to have orbital (OR, 2.91; < .001) and intracranial (OR, 3.86; < .001) complications.

Conclusion: In a cohort of pediatric inpatients with ARS, males have increased odds for orbital and intracranial sequelae and undergo more procedures than females. However, males and females have similar charges and length of stay. Our study highlights age-stratified differences in ARS across patient sex.
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http://dx.doi.org/10.1177/01945998221077190DOI Listing
February 2022

The importance of mentorship during research gap years for the dermatology residency match.

Int J Dermatol 2022 Jan 30. Epub 2022 Jan 30.

Department of Dermatology, Weill Cornell Medicine, New York, NY, USA.

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http://dx.doi.org/10.1111/ijd.16084DOI Listing
January 2022

Impact of Social Determinants of Health on Stereotactic Radiotherapy for Vestibular Schwannoma.

Laryngoscope 2022 Jan 25. Epub 2022 Jan 25.

Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Objectives/hypothesis: Linear accelerator (LINAC) and Gamma Knife (GK) are common stereotactic radiation therapies for treating vestibular schwannoma (VS). There is currently limited literature examining specific demographic and socioeconomic factors, which influence the type of stereotactic radiation therapy a patient with VS receives.

Study Design: Retrospective database review.

Methods: The National Cancer Database was queried for cases of VS between 2004 and 2016. Patient demographic characteristics were compared using chi-squared and t-tests between GK and LINAC treated groups. Multivariate regression analysis was performed to assess predictors of stereotactic radiation therapy received.

Results: Of the 6,208 included patients, 5,306 (85.5%) received GK and 902 (14.5%) received LINAC. The mean age of GK patients was significantly lower than that of LINAC patients (58.0 vs. 59.7, P < .001). Individuals treated with GK had greater proportions of private insurance (P < .001) and incomes greater than $63,332 (P = .003). A greater proportion of GK patients were treated in academic centers (P < .001), in high-volume facilities (P < .001), in metropolitan areas (P < .001), and in the Northeastern United States (P < .001). On multivariate logistic regression analysis, region, metropolitan area, facility type, tumor size, and distance traveled by patients independently predict receipt of GK versus LINAC.

Conclusion: Differences in patient demographics and other social determinants of health influence choice of GK versus LINAC therapy for VS patients. Future studies focused on addressing barriers to care, which may influence postprocedural quality of life and clinical outcomes associated with these two treatments are necessary to better understand the impact of these social differences.

Level Of Evidence: 4 Laryngoscope, 2022.
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http://dx.doi.org/10.1002/lary.30016DOI Listing
January 2022

Arrhythmias in the COVID-19 patient.

Heart Rhythm O2 2022 Feb 14;3(1):8-14. Epub 2022 Jan 14.

Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.

Coronavirus disease 2019 (COVID-19) has encompassed the globe since it was first observed just under 2 years ago. Although the disease is predominantly a respiratory illness, there have been observed complications throughout the various organ systems. Namely, cardiovascular complications, and, more specifically, arrhythmic complications have been described throughout the pandemic in patients with COVID-19. Management of atrial arrhythmias, ventricular arrhythmias, and bradyarrhythmias in patients with COVID-19 infection has been largely guided by our prior experience in the management of these arrhythmias in similar patient populations without infection. However, this review aims to highlight the specific considerations as they pertain to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the various arrhythmic manifestations observed with this disease.
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http://dx.doi.org/10.1016/j.hroo.2022.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8758199PMC
February 2022

Scaling the gates: Mentor relationships and scholarly work facilitate dermatology residency placement.

J Am Acad Dermatol 2022 05 7;86(5):e233-e234. Epub 2022 Jan 7.

Department of Dermatology, Weill Cornell Medicine, New York, New York. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2021.12.053DOI Listing
May 2022

Autonomic dysfunction post-acute COVID-19 infection.

HeartRhythm Case Rep 2022 Mar 27;8(3):143-146. Epub 2021 Nov 27.

Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.

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http://dx.doi.org/10.1016/j.hrcr.2021.11.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8626157PMC
March 2022

Long-term complications of COVID-19.

Am J Physiol Cell Physiol 2022 01 24;322(1):C1-C11. Epub 2021 Nov 24.

Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, New York.

SARS-CoV-2 has rapidly spread across the globe and infected hundreds of millions of people worldwide. As our experience with this virus continues to grow, our understanding of both short-term and long-term complications of infection with SARS-CoV-2 continues to grow as well. Just as there is heterogeneity in the acute infectious phase, there is heterogeneity in the long-term complications seen following COVID-19 illness. The purpose of this review article is to present the current literature with regards to the epidemiology, pathophysiology, and proposed management algorithms for the various long-term sequelae that have been observed in each organ system following infection with SARS-CoV-2. We will also consider future directions, with regards to newer variants of the virus and their potential impact on the long-term complications observed.
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http://dx.doi.org/10.1152/ajpcell.00375.2021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8721906PMC
January 2022

Attenuating persistent sodium current-induced atrial myopathy and fibrillation by preventing mitochondrial oxidative stress.

JCI Insight 2021 10 28;6(23). Epub 2021 Oct 28.

Division of Cardiology, Department of Medicine, and.

Mechanistically driven therapies for atrial fibrillation (AF), the most common cardiac arrhythmia, are urgently needed, the development of which requires improved understanding of the cellular signaling pathways that facilitate the structural and electrophysiological remodeling that occurs in the atria. Similar to humans, increased persistent Na+ current leads to the development of an atrial myopathy and spontaneous and long-lasting episodes of AF in mice. How increased persistent Na+ current causes both structural and electrophysiological remodeling in the atria is unknown. We crossbred mice expressing human F1759A-NaV1.5 channels with mice expressing human mitochondrial catalase (mCAT). Increased expression of mCAT attenuated mitochondrial and cellular reactive oxygen species (ROS) and the structural remodeling that was induced by persistent F1759A-Na+ current. Despite the heterogeneously prolonged atrial action potential, which was unaffected by the reduction in ROS, the incidences of spontaneous AF, pacing-induced after-depolarizations, and AF were substantially reduced. Expression of mCAT markedly reduced persistent Na+ current-induced ryanodine receptor oxidation and dysfunction. In summary, increased persistent Na+ current in atrial cardiomyocytes, which is observed in patients with AF, induced atrial enlargement, fibrosis, mitochondrial dysmorphology, early after-depolarizations, and AF, all of which can be attenuated by resolving mitochondrial oxidative stress.
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http://dx.doi.org/10.1172/jci.insight.147371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8675199PMC
October 2021

Assessing Patient Satisfaction Following Blepharoplasty Using Social Media Reviews.

Aesthet Surg J 2022 02;42(3):NP179-NP185

Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.

Background: Because patient satisfaction is a significant qualitative consideration in measuring aesthetic surgery outcome, it is important to characterize the individual factors that shape the patient perspective about blepharoplasty.

Objectives: This study analyzed reviews by blepharoplasty patients on the aesthetic surgery social media platform RealSelf.com to determine which aspects of the surgical process have the most significant impact on patient satisfaction.

Methods: Blepharoplasty reviews were gathered from RealSelf.com with an automated web crawler. These reviews were characterized as positive or negative, then given a specific category that more specifically defined the theme of the review. Additional variables, including the specialty of the reviewed physician and any patient self-reported ratings, were documented.

Results: A total of 1991 reviews pertaining to blepharoplasty were collected. Among reviews with self-reported "worth it" ratings, 93.5% were positive. Following categorization of all reviews, 1865 (93.7%) were positive and 126 (6.3%) were negative. Of the positive reviews, the most common overall themes were bedside manner (n = 899, 48.2%), aesthetic result (n = 859, 46.1%), and overall comfort (n = 58, 3.1%). Among negative reviews, most pertained to aesthetic result (n = 100, 79.4%), and bedside manner (n = 14, 11.1%). The most frequently encountered physician specialties performing blepharoplasty were plastic surgery (n = 1101, 55.3%), ophthalmology (n = 634, 31.8%), and otolaryngology (n = 69, 3.5%).

Conclusions: The majority of reviews were positive. The most prominent factor driving positive reviews was bedside manner, followed by aesthetic results. Negative reviews were most frequently attributed to suboptimal aesthetic results. Most blepharoplasties in our study cohort were performed by plastic and oculoplastic surgeons.
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http://dx.doi.org/10.1093/asj/sjab345DOI Listing
February 2022

Cross-sectional analysis of scholarly work and mentor relationships in matched dermatology residency applicants.

J Am Acad Dermatol 2022 06 29;86(6):1437-1439. Epub 2021 Jun 29.

Department of Dermatology, Weill Cornell Medicine, New York, New York. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2021.06.861DOI Listing
June 2022

Cardiac Corrected QT Interval Changes Among Patients Treated for COVID-19 Infection During the Early Phase of the Pandemic.

JAMA Netw Open 2021 04 1;4(4):e216842. Epub 2021 Apr 1.

Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.

Importance: Critical illness, a marked inflammatory response, and viruses such as SARS-CoV-2 may prolong corrected QT interval (QTc).

Objective: To evaluate baseline QTc interval on 12-lead electrocardiograms (ECGs) and ensuing changes among patients with and without COVID-19.

Design, Setting, And Participants: This cohort study included 3050 patients aged 18 years and older who underwent SARS-CoV-2 testing and had ECGs at Columbia University Irving Medical Center from March 1 through May 1, 2020. Patients were analyzed by treatment group over 5 days, as follows: hydroxychloroquine with azithromycin, hydroxychloroquine alone, azithromycin alone, and neither hydroxychloroquine nor azithromycin. ECGs were manually analyzed by electrophysiologists masked to COVID-19 status. Multivariable modeling evaluated clinical associations with QTc prolongation from baseline.

Exposures: COVID-19, hydroxychloroquine, azithromycin.

Main Outcomes And Measures: Mean QTc prolongation, percentage of patients with QTc of 500 milliseconds or greater.

Results: A total of 965 patients had more than 2 ECGs and were included in the study, with 561 (58.1%) men, 198 (26.2%) Black patients, and 191 (19.8%) aged 80 years and older. There were 733 patients (76.0%) with COVID-19 and 232 patients (24.0%) without COVID-19. COVID-19 infection was associated with significant mean QTc prolongation from baseline by both 5-day and 2-day multivariable models (5-day, patients with COVID-19: 20.81 [95% CI, 15.29 to 26.33] milliseconds; P < .001; patients without COVID-19: -2.01 [95% CI, -17.31 to 21.32] milliseconds; P = .93; 2-day, patients with COVID-19: 17.40 [95% CI, 12.65 to 22.16] milliseconds; P < .001; patients without COVID-19: 0.11 [95% CI, -12.60 to 12.81] milliseconds; P = .99). COVID-19 infection was independently associated with a modeled mean 27.32 (95% CI, 4.63-43.21) millisecond increase in QTc at 5 days compared with COVID-19-negative status (mean QTc, with COVID-19: 450.45 [95% CI, 441.6 to 459.3] milliseconds; without COVID-19: 423.13 [95% CI, 403.25 to 443.01] milliseconds; P = .01). More patients with COVID-19 not receiving hydroxychloroquine and azithromycin had QTc of 500 milliseconds or greater compared with patients without COVID-19 (34 of 136 [25.0%] vs 17 of 158 [10.8%], P = .002). Multivariable analysis revealed that age 80 years and older compared with those younger than 50 years (mean difference in QTc, 11.91 [SE, 4.69; 95% CI, 2.73 to 21.09]; P = .01), severe chronic kidney disease compared with no chronic kidney disease (mean difference in QTc, 12.20 [SE, 5.26; 95% CI, 1.89 to 22.51; P = .02]), elevated high-sensitivity troponin levels (mean difference in QTc, 5.05 [SE, 1.19; 95% CI, 2.72 to 7.38]; P < .001), and elevated lactate dehydrogenase levels (mean difference in QTc, 5.31 [SE, 2.68; 95% CI, 0.06 to 10.57]; P = .04) were associated with QTc prolongation. Torsades de pointes occurred in 1 patient (0.1%) with COVID-19.

Conclusions And Relevance: In this cohort study, COVID-19 infection was independently associated with significant mean QTc prolongation at days 5 and 2 of hospitalization compared with day 0. More patients with COVID-19 had QTc of 500 milliseconds or greater compared with patients without COVID-19.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.6842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065381PMC
April 2021

Predictors of atrial fibrillation on implantable cardiac monitoring for cryptogenic stroke.

J Interv Card Electrophysiol 2021 Apr 2. Epub 2021 Apr 2.

Division of Cardiology, Section of Electrophysiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, NY, New York, USA.

Background: Since the CRYSTAL-AF trial, implantation and usage of implantable loop recorder (ICM) after cryptogenic stroke (CS) for detection of atrial fibrillation (AF) has increased. However, it is unclear which CS patients would most benefit from long term ICM monitoring. This study aims to determine the risk factors in patients that would confer maximum benefit from ICM placement following CS.

Methods: A Columbia University Institutional Review Board (IRB) approved retrospective analysis of medical records of 125 patients with CS followed by implantation of ICM was evaluated. Univariable and multivariable time-to-event analyses were performed on demographics, hours of activity and variability (HRV), stroke location, thrombosis etiology, and CHADS - VASc score. The primary outcome was presence of ICM-detected AF defined as AF lasting at least 2 min.

Results: One hundred twenty-five patients (mean 67.6 years ± 2.4 years, 60% male) were followed for at least 3 months. Twenty-two patients (18%) were found to have clinically verified detected AF; median of time to detection was 95 days. Upon univariable demographic analysis followed by multivariable Cox regression analysis, individuals with age 75 or older (HR: 3.987, p = 0.0046) or LVEF 40% and lower (HR: 3.056, p = 0.0213) had significantly higher risk of AF. Diabetics also had a lower AF detection in multivariable analysis (HR: 0.128, p = 0.0466).

Conclusions: Age 75 or older and LVEF ≤40% were the factors on multivariable analysis that predicted AF detection. Diabetes is a possible significant factor which should be evaluated further. CHADS - VASc score was notably not predictive of AF detected on ICM.
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http://dx.doi.org/10.1007/s10840-021-00985-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016653PMC
April 2021

Management of Arrhythmias Associated with COVID-19.

Curr Cardiol Rep 2020 11 24;23(1). Epub 2020 Nov 24.

Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.

Purpose Of Review: Cardiac arrhythmias are known complications in patients with COVID-19 infection that may persist even after recovery from infection. A review of the spectrum of cardiac arrhythmias due to COVID-19 infection and current guidelines and assessment or risk and benefit of management considerations is necessary as the population of patients infected and covering from COVID-19 continues to grow.

Recent Findings: Cardiac arrhythmias such as atrial fibrillation, supraventricular tachycardia, complete heart block, and ventricular tachycardia occur in patients infected, recovering and recovered from COVID-19. Personalized care while balancing risk/benefit of medical or invasive therapy is necessary to improve care of patients with arrhythmias. Providers must provide thorough follow-up care and use necessary precaution while caring for COVID-19 patients.
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http://dx.doi.org/10.1007/s11886-020-01434-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685181PMC
November 2020
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