Publications by authors named "Shreya Patel"

68 Publications

Amount, Type, and Timing of Domain-Specific Moderate to Vigorous Physical Activity Among US Adults.

J Phys Act Health 2021 Aug;18(S1):S114-S122

Background: Surveillance of domain-specific physical activity in the United States is lacking. Thus, the authors describe domain-specific moderate to vigorous physical activity (MVPA) in a nationwide sample of US adults.

Methods: Participants from the AmeriSpeak panel (n = 2649; 20-75 y; 50% female) completed the Activities Completed Over Time in 24-Hours previous-day recall. The authors estimated average MVPA duration (in hours per day) overall and in major life domains by sex, age, race/ethnicity, and education. They also described the most commonly reported MVPAs and timing of MVPA during the day.

Results: Across all life domains, participants reported an average of 2.5 hours per day in MVPA. Most MVPA was accumulated during work (50% of total, 1.2 h/d) and household activities (28%, 0.7 h/d) with less MVPA reported in leisure time (15%, 0.4 h/d). Time reported in MVPA varied by sex, and race/ethnicity (P < .05). Walking at work and for exercise, childcare, and walking for transportation were the most commonly reported domain-specific MVPAs. A greater proportion of MVPA took place in the morning (∼06:00 h) and evening (∼18:00 h).

Conclusions: Work and household activities accounted for 78% of overall MVPA reported, while leisure-time MVPA accounted for only 15% of the total. Encouraging MVPA during leisure time and transportation remain important targets for promoting MVPA in US adults.
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http://dx.doi.org/10.1123/jpah.2021-0174DOI Listing
August 2021

The impact of diabetes mellitus on medical complication and mortality rates among inpatients with bullous pemphigoid.

Ir J Med Sci 2021 Aug 16. Epub 2021 Aug 16.

Department of Dermatology, Rutgers New Jersey Medical School, Newark, NJ, USA.

Background: There is currently limited population-based data on the effect of type 2 diabetes mellitus (T2DM) on bullous pemphigoid (BP) inpatients.

Aims: To evaluate the relative comorbidities, medical complications, and mortality rates between BP inpatients with and without T2DM.

Methods: All inpatients with a primary BP diagnosis in the National Inpatient Sample from 2003 to 2012 were queried. BP inpatients with or without T2DM were compared to identify disparities in relative comorbidities and medical complications. Comorbidities were established using the Agency for Healthcare Research and Quality standardized values. Medical complications were classified using ICD-9 codes.

Results: Of the 1978 BP patients identified, 660 (33.4%) had a concurrent diagnosis of T2DM. These patients had significantly higher rates of concurrent comorbidities, including chronic renal failure, congestive heart failure, iron deficiency anemia, hypertension, obesity, and peripheral vascular disease. On bivariate analysis, T2DM patients also had significantly higher rates of medical complications including acute kidney injury (14.5% vs. 10.1%, p = 0.004) and venous thromboembolism (1.8% vs. 0.5%, p = 0.012). On multivariable-adjusted analysis, the odds of venous thromboembolism (OR = 3.01, p = 0.027) remained increased. Inpatient mortality did not differ between the groups.

Conclusions: Our findings suggest that BP inpatients with T2DM have a greater medical comorbidity and complication burden. However, inpatient mortality was not increased.
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http://dx.doi.org/10.1007/s11845-021-02726-9DOI Listing
August 2021

Characterization of Biopsies by Dermatologists and Nonphysician Providers in the Medicare Population: A Rapidly Changing Landscape.

Dermatol Surg 2021 Aug 4. Epub 2021 Aug 4.

Department of Dermatology, Boston University Medical Center, Boston, Massachusetts; Department of Dermatology, Tufts Medical Center, Boston, Massachusetts.

Background: Previous studies show that nonphysician providers may require a higher number of biopsies to identify skin malignancies than dermatologists. Therefore, understanding the trends behind the types of providers performing biopsies may help analyze their impact on this vulnerable population.

Objective: This retrospective study analyzes changes in nationwide, regional, and state-level data on the number and proportion of biopsies performed by dermatologists compared with nonphysician providers.

Materials And Methods: Biopsy cases were isolated in the Medicare database from 2012 to 2018 using the HCPCS codes 11,100 and 11,101. Cases were limited to biopsies performed by a dermatologist, nurse practitioner (NP), or physician assistant (PA).

Results: From 2012 to 2018, national biopsy rates per 100,000 Medicare beneficiaries for dermatologists decreased by 6%, whereas those for NPs and PAs increased by 97% and 82%, respectively. Each state showed variation in both the proportion of biopsies by provider type and the net change in biopsies rates over time. All states saw increases in the number of biopsies per 100,000 Medicare beneficiaries by nonphysician providers.

Conclusion: As the number of Medicare beneficiaries continues to grow, nonphysician providers are performing an increasing proportion of biopsies, with specific states and regions being affected more than others.
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http://dx.doi.org/10.1097/DSS.0000000000003150DOI Listing
August 2021

Surgical Treatment for Intrahepatic, Peri-Hilar, and Distal Cholangiocarcinoma: 20-Single Institutional Year Experience.

Am Surg 2021 Jul 27:31348211034751. Epub 2021 Jul 27.

Department of General Surgery, 156400Mayo Clinic, Jacksonville, FL, USA.

Background: Surgical resection is the curative treatment for all subtypes of cholangiocarcinoma (CCA), including intrahepatic, hilar/peri-hilar, and distal. This study evaluates patients with CCA who underwent surgery and determines factors that impact their survival.

Methods: A retrospective cohort study was performed for patients who underwent surgical resection for CCA at our institution from 1995 to 2016. Demographics, operative variables between CCA tumors, and postoperative complications were analyzed. Predictors of overall and recurrence-free survival were determined via statistical analysis.

Results: A total of 170 patients with a mean age of 61 years old underwent surgical resection of intrahepatic (n = 64, 37.6%), hilar/peri-hilar (n = 75, 44.1%), and distal (n = 31, 18.2%) CCA. Operations performed included liver resections (n = 83, 48.8%), liver transplants (n = 56, 32.9%), and pancreaticoduodenectomies (n = 31, 18.2%). The overall survival rate at 1, 5, and 10 years was 81.1%, 32.4%, and 17.2%, respectively. Low pathological stage and negative resection margins were associated with lower recurrence and higher survival rates. Tumor location and the type of operation performed were not predictive of recurrence or OS in this cohort.

Discussion: This study shows that definitive surgical resection with negative margins can result in long-term survival even at 10 years. Small tumor size and low pathological stage are predictive of higher survival rates post-surgery, emphasizing the importance of early diagnosis and appropriate surgical treatment in achieving positive outcomes.
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http://dx.doi.org/10.1177/00031348211034751DOI Listing
July 2021

Sedentary Behavior in United States Adults: Fall 2019.

Med Sci Sports Exerc 2021 Jul 23. Epub 2021 Jul 23.

Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO Risk Factor Assessment Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control, Atlanta, GA Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD Department of Geography, University of Hong Kong, Hong Kong, China Department of Kinesiology, California Polytechnic State University, San Luis Obispo, CA Health Behaviors Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD.

Purpose: Higher levels of sedentary behavior are associated with early mortality, but the distribution of sedentary time by classes of behavior and demographic groups is poorly described in United States (US) adults. To quantify the amount and sources of sedentary time in US adults we conducted a nationwide survey using a novel validated self-administerd previous-day recall method and compare these values with a commonly used sitting time question.

Methods: Participants from the AmeriSpeak panel aged 20 to 75 years (N = 2,640) completed up to two Activities Completed over Time in 24 Hours (ACT24) previous day recalls. Recalls were conducted on randomly selected days in October and November 2019. Survey sample design were applied to reflect the US population.

Results: Mean age was 45.3 years, 51% were female, 67% non-Hispanic white, and 37% had a body mass index of ≥30 kg/m2. US adults reported a mean 9.5 hrs/d of sedentary time (95% confidence interval [CI] 9.4, 9.7 hrs/d), which was 34% more than reported using a common surveillance measure (p < 0.01). Most daily sedentary time was accumulated in the leisure and work life domains, with leisure accounting for 47% (4.3 hrs/d [95%CI 4.2, 4.5 hrs/d]) of the total sedentary time. Eighty-two percent of leisure time was spent sedentary, mainly watching television/videos or engaged in internet/computer use.

Conclusions: US adults appear to spend more time in sedentary behavior than previously thought and the majority of this time is accumulated at work and in leisure-time. Reducing sedentary screen-time during leisure in favor of physically active could be an important intervention target in the effort to increase physical activity in US adults.
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http://dx.doi.org/10.1249/MSS.0000000000002751DOI Listing
July 2021

Inhibition of translation initiation factor eIF4a inactivates heat shock factor 1 (HSF1) and exerts anti-leukemia activity in AML.

Leukemia 2021 09 14;35(9):2469-2481. Epub 2021 Jun 14.

Department of Leukemia, Section of Molecular Hematology and Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Eukaryotic initiation factor 4A (eIF4A), the enzymatic core of the eIF4F complex essential for translation initiation, plays a key role in the oncogenic reprogramming of protein synthesis, and thus is a putative therapeutic target in cancer. As important component of its anticancer activity, inhibition of translation initiation can alleviate oncogenic activation of HSF1, a stress-inducible transcription factor that enables cancer cell growth and survival. Here, we show that primary acute myeloid leukemia (AML) cells exhibit the highest transcript levels of eIF4A1 compared to other cancer types. eIF4A inhibition by the potent and specific compound rohinitib (RHT) inactivated HSF1 in these cells, and exerted pronounced in vitro and in vivo anti-leukemia effects against progenitor and leukemia-initiating cells, especially those with FLT3-internal tandem duplication (ITD). In addition to its own anti-leukemic activity, genetic knockdown of HSF1 also sensitized FLT3-mutant AML cells to clinical FLT3 inhibitors, and this synergy was conserved in FLT3 double-mutant cells carrying both ITD and tyrosine kinase domain mutations. Consistently, the combination of RHT and FLT3 inhibitors was highly synergistic in primary FLT3-mutated AML cells. Our results provide a novel therapeutic rationale for co-targeting eIF4A and FLT3 to address the clinical challenge of treating FLT3-mutant AML.
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http://dx.doi.org/10.1038/s41375-021-01308-zDOI Listing
September 2021

Population Size Estimation of Female Sex Workers in Hai Phong, Vietnam: Use of Three Source Capture-Recapture Method.

J Epidemiol Glob Health 2021 06 20;11(2):194-199. Epub 2021 Mar 20.

Division of Global HIV and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Introduction: A study was conducted in three districts in Hai Phong province, Vietnam to estimate the population size of the Female Sex Workers (FSW) in June-July 2019.

Methods: The procedures included selection of three districts, compilation of a list of accessible venues where FSW congregate, distribution of first unique objects (first capture) and second unique objects (second capture) to FSW in randomly selected venues and implementation of a Mini-Respondent Driven Sampling (mRDS) Survey (third capture). Population size of the FSW was calculated based on the number of FSW in each round, number of FSW 'recaptured' during the second and the third captures. Additionally, personal network size data captured in the mRDS was used to measure the population of FSW within the three districts using Successive Sampling Population Size Estimates (SS-PSE).

Results: The total estimated FSWs in the three selected districts, using Three Source Capture-Recapture (3S-CRC) was 958, which is slightly lower than that estimated using SS-PSE - 1192. The 3S-CRC method yielded a provincial estimate of 1911 while the SS-PSE method resulted in a total of 2379 FSW for the province.

Conclusion: Two techniques produced different PSE at both the district and the province levels and resulted in estimates lower than ones produced using programmatic data. For planning HIV prevention and care service needs among all FSWs, additional studies are needed to estimate the number of sex workers who are not venue-based and use social media platforms to sell services.
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http://dx.doi.org/10.2991/jegh.k.210312.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242110PMC
June 2021

Selection of patients for large mailed fecal immunochemical test colorectal cancer screening outreach programs: A systematic review.

J Med Screen 2021 Mar 8:969141321997482. Epub 2021 Mar 8.

Division of Gastroenterology, University of California, San Francisco, CA, USA.

Objective: Digital health care offers an opportunity to scale and personalize cancer screening programs, such as mailed outreach for colorectal cancer (CRC) screening. However, studies that describe the patient selection strategy and process for CRC screening are limited. Our objective was to evaluate implementation strategies for selecting patients for CRC screening programs in large health care systems.

Methods: We conducted a systematic review of 30 studies along with key informant surveys and interviews to describe programmatic implementation strategies for selecting patients for CRC screening. PubMed and Embase were searched since inception through December 2018, and hand searches were performed of the retrieved reference lists but none were incorporated ( = 0). No language exclusions were applied.

Results: Common criteria for outreach exclusion included: being up-to-date with routine CRC screening ( = 22), comorbidities ( = 20), and personal history ( = 22) or family history of cancer ( = 9). Key informant surveys and interviews were performed ( = 28) to understand data sources and practices for patient outreach selection, and found that 13 studies leveraged electronic medical care records, 10 studies leveraged a population registry (national, municipal, community, health), 4 studies required patient opt-in, and 1 study required primary care provider referral. Broad ranges in fecal immunochemical test completion were observed in community clinic ( = 8, 31.0-59.6%), integrated health system ( = 5, 21.2-82.7%), and national regional CRC screening programs ( = 17, 23.0-64.7%). Six studies used technical codes, and four studies required patient self-reporting from a questionnaire to participate.

Conclusion: This systematic review provides health systems with the diverse outreach practices and technical tools to support efforts to automate patient selection for CRC screening outreach.
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http://dx.doi.org/10.1177/0969141321997482DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8423851PMC
March 2021

Effect of older age on complications and mortality in inpatients with Stevens-Johnson syndrome or toxic epidermal necrolysis.

J Am Acad Dermatol 2021 Feb 20. Epub 2021 Feb 20.

Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey; Department of Pathology, Immunology, and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2021.02.046DOI Listing
February 2021

Effects of Chronic Dietary Exposure to Phytoestrogen Genistein on Uterine Morphology in Mice.

J Agric Food Chem 2021 Feb 2;69(5):1693-1704. Epub 2021 Feb 2.

Department of Animal Sciences, University of Illinois, Urbana, Illinois 61801, United States.

Genistein is naturally occurring in plants and binds to estrogen receptors. Humans are mainly exposed through diet, but the use of supplements is increasing as genistein is claimed to promote health and alleviate menopausal symptoms. We analyzed diverse uterine features in adult mice chronically fed genistein for different times. The luminal epithelium height was increased in females treated with 500 and 1000 ppm at PND 95, and the width of the outer myometrium was increased in females treated with 1000 ppm at PND 65 compared to that in controls. An increase in proliferation was noted in the inner myometrium layer of animals exposed to 300 ppm genistein at PND 185 compared to that in controls. Luminal hyperplasia was greater in the 1000 ppm group at PND 65, 95, and 185, although not statistically different from control. These results indicate that genistein may exert estrogenic activity in the uterus, without persistent harm to the organ.
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http://dx.doi.org/10.1021/acs.jafc.0c07456DOI Listing
February 2021

Dermatofibroma Botryoides on Nipple: A Report.

Indian J Dermatol 2020 Nov-Dec;65(6):558-560

Department of Dermatology, Immunology, and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.

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http://dx.doi.org/10.4103/ijd.IJD_235_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810086PMC
January 2021

Reduction of pulmonary exacerbations in young children with cystic fibrosis during the COVID-19 pandemic.

Pediatr Pulmonol 2021 05 12;56(5):1271-1273. Epub 2021 Jan 12.

Division of Pediatric Pulmonology, Allergy, and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.

To assess the impact of COVID-19 restrictions on cystic fibrosis (CF) pulmonary exacerbations (PEx) we performed a retrospective review of PEx events at our CF Center and compared the rate of PEx in 2019 versus 2020. Restrictions on social interaction due to the COVID-19 pandemic were associated with a lower number of PEx events at our pediatric CF Center, suggesting that these restrictions also reduced exposure to other respiratory viral infection in children with CF.
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http://dx.doi.org/10.1002/ppul.25250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014497PMC
May 2021

Comparison of mortality and medical complications between older and younger malignant melanoma inpatients.

Dermatol Ther 2021 01 26;34(1):e14537. Epub 2020 Nov 26.

Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA.

Previous studies have identified older age as a negative prognostic factor in malignant melanoma patients. To compare comorbidities, medical complications, and inpatient mortality between younger and older malignant melanoma inpatients. All adult patient encounters with a diagnosis of cutaneous malignant melanoma were identified using the 2003 to 2012 National Inpatient Sample database. Concurrent comorbidities and inpatient medical complications were queried. Comparisons were made between older and younger adults, defined as ≥65 years and 18 to 64 years, respectively. In total, 8153 patient encounters were identified in the database (51.6% older and 48.4% younger). Older adults had a higher prevalence of numerous comorbidities, including chronic pulmonary disease, chronic renal failure, congestive heart failure, diabetes mellitus, hypertension, hypothyroidism, peripheral vascular disease, and pulmonary circulation disorder (P < .001). In contrast, younger adults were more likely to have obesity (P < .001) and coagulopathy (P = .005). On multivariable analysis of medical complications, older adult inpatients were more likely to experience urinary tract infection (OR = 1.54, P = .021), but less likely to experience acute respiratory failure (OR = 0.46, P = .012) and venous thromboembolism (OR = 0.44, P = .026). Notably, inpatient mortality did not significantly differ. Older adult inpatients with malignant melanoma have different comorbidities than younger patients and have a larger overall comorbidity burden. Surprisingly, however, the odds of most inpatient medical complications and mortality were found to be similar in younger vs older patients.
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http://dx.doi.org/10.1111/dth.14537DOI Listing
January 2021

Physician perception of targeted temperature management after cardiac arrest: An underappreciated barrier?

Resuscitation 2020 Dec 9;157:174-175. Epub 2020 Nov 9.

Division of Critical Care Medicine, Department of Emergency Medicine, University of Florida, Gainesville, FL, USA. Electronic address:

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http://dx.doi.org/10.1016/j.resuscitation.2020.10.014DOI Listing
December 2020

Colorectal Cancer Screening and COVID-19.

Am J Gastroenterol 2021 02;116(2):433-434

Department of Medicine, University of California, San Francisco, California, USA.

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http://dx.doi.org/10.14309/ajg.0000000000000970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553028PMC
February 2021

Hibernoma of the Eyelid.

Indian J Dermatol 2020 Jul-Aug;65(4):331-332

Rutgers New Jersey Medical School, Newark, NJ, USA. E-mail:

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http://dx.doi.org/10.4103/ijd.IJD_345_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7423218PMC
August 2020

Gingival Lesion in a 23-Year-Old Woman with Nevus of Ota in the Gingiva.

Skinmed 2020 1;18(3):170. Epub 2020 May 1.

Rutgers-New Jersey Medical School, Newark, NJ.

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May 2020

Advanced Notification Calls Prior to Mailed Fecal Immunochemical Test in Previously Screened Patients: a Randomized Controlled Trial.

J Gen Intern Med 2020 10 3;35(10):2858-2864. Epub 2020 Aug 3.

Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA.

Background: Phone calls as part of multimodal fecal immunochemical test (FIT) outreach are effective but resource-intensive. Previous studies of advanced notification calls before FIT mailing have not differentiated patients' prior screening status.

Objective: To determine the effectiveness of a phone call preceding mailing of a FIT kit on test completion rate for patients who have completed a prior FIT.

Design: Randomized controlled trial nested within a larger study. All patients were assigned to receive organized mailed FIT outreach in the larger study.

Participants: Patients in a safety-net health setting ages 50-75 years old with a previously negative FIT.

Interventions: Patients were assigned to either receive an advanced notification phone call or no phone call preceding a mailed FIT kit. Both groups received an informational postcard prior to the mailed FIT.

Main Measures: The primary outcome was FIT completion rate at 1 year. The secondary outcomes were FIT completion rates at 60, 90, and 180 days, rates stratified by demographic subgroups, and rates according to outcome of the phone call.

Key Results: A total of 1645 patients were assigned to advanced notification calls and 1595 were assigned to no call preceding the FIT mailing. Although FIT completion rate was higher at day 60 (55.5% vs. 50.8%, p < 0.01), an advanced notification call did not significantly improve FIT completion at 1 year (70.9% vs. 69.9%, p = 0.52). Of the patients assigned to receive an advanced notification call, 90.5% were spoken with or left a voicemail; patients who were spoken with were more likely to complete a FIT at 1 year compared with patients who were only left a voicemail or could not be left a voicemail (79.9% vs. 69.2% vs. 49.6%, p < 0.01).

Conclusions: Advanced notification phone calls prior to FIT mailing did not improve rates at 1 year for patients with a previously negative FIT.
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http://dx.doi.org/10.1007/s11606-020-06009-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572934PMC
October 2020

Disestablishmentarianism: Or Why Political Correctness Is Racist, Anti-Gay, Anti-Transgender, Misogynist, Anti-Science, and Anti-You.

Skinmed 2020 1;18(2):74-76. Epub 2020 Mar 1.

Department of Dermatology and Cutaneous Biology, and the Jefferson Center for International Dermatology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.

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May 2021

Exploration of Confounding Due to Poor Health in an Accelerometer-Mortality Study.

Med Sci Sports Exerc 2020 12;52(12):2546-2553

Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD.

Purpose: Confounding due to poor health is a concern in accelerometer-based studies of physical activity and health, but detailed investigations of this source of bias are lacking.

Methods: US adults (n = 4840) from the National Health and Nutrition Examination Survey (2003 to 2006) wore an accelerometer for 1 to 7 d (mean = 5.7 d) and were followed for mortality through 2015. Logistic regression was used to examine odds ratios between poor health (chronic conditions, self-reported health, mobility limitations, frailty) and low physical activity levels; Cox models were used to estimate adjusted hazard ratios (HR) and 95% CI for mortality associations for a 1 h·d increase in moderate-to-vigorous-intensity physical activity (MVPA) using two commonly used cut-points (MVPA760, MVPA2020). Modeling scenarios with shorter and longer follow-up time, increasing adjustment for poor health, by age group, and after excluding early years of follow-up were used to assess bias.

Results: Over a mean of 10.1 yr of follow-up, 1165 deaths occurred. Poor health was associated with low MVPA760 levels and increased mortality risk. In fully adjusted MVPA760 models, HR was 26% stronger comparing 0 to 4 yr (HR = 0.46) with 0 to 12 yr of follow-up (HR = 0.62), particularly in older adults (65 yr and older). Increasing statistical adjustment for poor health attenuated MVPA760 associations by 13% to 15%, and exclusion of the first 2 yr of follow-up had limited effects. Comparable results were obtained with the MVPA2020 cut-point.

Conclusions: We did not find evidence that confounding by health status resulted in entirely spurious MVPA-mortality associations; however, potential bias was appreciable in modeling scenarios involving shorter follow-up (<6 yr), older adults, and more limited statistical adjustment for poor health. The strength of MVPA-mortality associations in studies reflecting these scenarios should be interpreted cautiously.
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http://dx.doi.org/10.1249/MSS.0000000000002405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669589PMC
December 2020

Team-Based Approach to Management of Hypertension Associated with Angiogenesis Inhibitors.

J Cardiovasc Transl Res 2020 06 19;13(3):463-477. Epub 2020 May 19.

MedStar Heart and Vascular Institute, Washington, DC, USA.

Angiogenesis inhibitors, also known as vascular endothelial growth factor (VEGF) or vascular signaling pathway (VSP) inhibitors, have improved care of neoplastic diseases over the past decade. However, cardiovascular toxicities associated with these agents, such as hypertension and less commonly left ventricular systolic dysfunction and heart failure, have often been a limiting factor for continued use. Balancing the benefits of these agents with the associated toxicities is critical to ensure these therapies do not negatively impact oncological outcomes. The care of cancer patients with cardiovascular risks is challenging due to the heterogeneity of cardiovascular complications, paucity of evidence-based guidelines, and lack of channels for collaboration among healthcare providers. Herein, we provide a team-based approach for treatment of angiogenesis inhibitor-induced hypertension along with recommendations on monitoring and appropriate selection of anti-hypertensive agents.
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http://dx.doi.org/10.1007/s12265-020-10024-5DOI Listing
June 2020

Outcomes of Minimally Invasive Versus Open Major Hepatic Resection.

J Laparoendosc Adv Surg Tech A 2020 Jul 23;30(7):790-796. Epub 2020 Apr 23.

Department of Surgery, Mayo Clinic, Jacksonville, Florida, USA.

Minimally invasive major hepatic resection (MIMHR) is increasingly being performed in tertiary centers using either hand-assisted laparoscopic surgery (HALS) or totally laparoscopic surgery (TLS). The outcomes data of MIMHR are scarce, especially in comparison to open major hepatic resection (OMHR). Our aim was to compare 90-day outcomes in major hepatic resections when minimally invasive approaches are attempted. At our institution, minimally invasive liver resection was formally introduced in January 2007, initially using the HALS approach. Since then, the use of TLS approach has increased. We collected data on all patients who underwent major liver resection between January 2007 and December 2017 at our institution. In an intention to treat fashion, we then compared MIMHR to OMHR. From January 2007 to December 2017, 669 patients underwent liver resection. Of these, 203 patients (30%) underwent major hepatic resection and MIMHR and OMHR were performed in 68 (33%) and 135 (67%) patients, respectively. The rate of conversion from minimally invasive to open was 30.9%. Overall, there were no significant differences in 90-day mortality (2.9% versus 1.5%;  = .499) or major complications (14.7% versus 14.8%;  = .985). MIMHR was associated with a shorter average postoperative hospital stay (6.2 days versus 7.9 days;  = .0110) and shorter average ICU stay (0.66 days versus 0.90 days;  = .0299) compared with OMHR. The minimally invasive approach to major liver resection is a safe and reasonable alternative to an open approach when performed by a surgeon experienced with the relevant surgical techniques. MIMHR may be associated with similar outcomes and a shorter postoperative hospital stay with no increase in 90-day postoperative complications to OMHR.
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http://dx.doi.org/10.1089/lap.2019.0615DOI Listing
July 2020

Hidradenoma Papilliferum: Everyone Else's Diagnosis.

Indian J Dermatol 2020 Mar-Apr;65(2):151-153

Department of Dermatology, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.

A 52-year-old female presented with an asymptomatic cyst-like lesion on her right labia majora present for several years. Excision revealed a 3-mm cystic lesion containing complex networks of thin fronds of clear apocrine cells and basaloid cells, features characteristic of hidradenoma papilliferum (HP). In contrast to the medical literature, the lesion was connected to the overlying epithelium by a straight duct, a feature characteristic of apocrine glands. Searching of six different dermatopathology study sets revealed 11 cases diagnosed as HP. Histological review of the eight available cases for review revealed none that were diagnosed correctly. Six were syringocystadenoma papilliferum and two were trichoepithelioma. HP is a fascinating lesion that needs further study and requires better diagnostic criteria.
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http://dx.doi.org/10.4103/ijd.IJD_256_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059462PMC
March 2020

Fixed Drug Eruptions: An Update, Emphasizing the Potentially Lethal Generalized Bullous Fixed Drug Eruption.

Am J Clin Dermatol 2020 Jun;21(3):393-399

Dermatology, Rutgers New Jersey Medical School, 185 South Orange Avenue, Medical Science Building H-576, Newark, NJ, 07103-2757, USA.

A fixed drug eruption (FDE) is a relatively common reaction associated with more than 100 medications. It is defined as a same-site recurrence with exposure to a particular medication. The primary approach and treatment for all types of FDEs are to identify and remove the causative agent, often accomplished by a thorough history of medication and other chemical exposures, and possibly prior episodes. The most common category of FDE, localized FDE, whether bullous or non-bullous, is self-limited. Although one can confirm the causative agent using oral challenge testing, it is not recommended due to the risk of severe exacerbation or possible generalization; patch testing is now preferred. Bullous FDE may resemble erythema multiforme. Treatment of localized FDE includes medication removal, patient counseling, and symptomatic relief. Failure to remove the causative agent in localized FDE can lead to recurrence, which is associated with increased inflammation, hyperpigmentation, and risk of a potentially lethal generalized bullous FDE (GBFDE), which may resemble Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Distinguishing GBFDE from SJS and TEN is salient and will be stressed: GBFDE has more rapid onset in 1-24 h rather than in weeks, less or no mucosal involvement, less or no systemic involvement, and a tendency for a more favorable prognosis; however, recent experience suggests it may be just as life-threatening. This review will provide a comprehensive update and approach to diagnosis and management.
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http://dx.doi.org/10.1007/s40257-020-00505-3DOI Listing
June 2020

A rare case of DRESS syndrome.

J Assoc Physicians India 2020 Jan;68(1):79

Jaslok Hospital and Research Centre.

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January 2020

Why Medical (and Dermatologic) Practice Has Become So Convoluted: The Complexity/Convolutional/Obfuscatory Kleptocracies.

Skinmed 2019 1;17(6):364-365. Epub 2019 Nov 1.

Department of Dermatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ.

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August 2020

The color of skin: red diseases of the skin, nails, and mucosa.

Clin Dermatol 2019 Sep - Oct;37(5):548-560. Epub 2019 Jul 30.

Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA. Electronic address:

Red color is pervasive in local and systemic skin conditions. It is a color that often reflects variations of dermal blood flow and extends beyond the rubor and calor of inflammation. The pathophysiology of red skin involves remote and local chemical mediators that dilate arteriolar smooth muscle and increase blood flow to superficial vessels and capillary beds. Incident light hits hemoglobin, which preferentially absorbs light of shorter wavelengths, such as blue, and reflects warmer colors. Due to its pervasiveness and consistency, red color is a useful descriptive factor in helping narrow a differential diagnosis. Red skin disorders include a variety of conditions involving endocrine mediators, cardiovascular responses, and the disruption of the skin barrier. An understanding of the blood's role in these disorders equips clinicians to generate differential diagnoses through the lens of pathophysiology. Dermatologists can improve management by considering red skin as part of systemic disease rather than as an isolated incident.
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http://dx.doi.org/10.1016/j.clindermatol.2019.07.017DOI Listing
June 2020

Public Health Surveillance: Electronic Reporting as a Point of Reference.

J Law Med Ethics 2019 06;47(2_suppl):19-22

Jennifer Black, J.D., was a Cherokee Nation Assurance contractor supporting the Public Health Law Program, Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention at the time of submission. Rachel Hulkower, J.D., M.S.P.H., is a Cherokee Nation Assurance contractor supporting the Public Health Law Program, Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention. Walter Suarez, M.D., M.P.H., is the executive director of Health IT Strategy and Policy, Kaiser Permanente, and member of the Governance Body of the Digital Bridge Initiative. Shreya Patel, J.D., is the National Health and Privacy Policy Advisor with Michigan Health Information Network Shared Services (MiHIN). Brandon Elliott, M.D., is a consultant with Velatura, a subsidiary of Michigan Health Information Network Shared Services (MiHIN).

Federal, state, and local laws shape the use of health information for public health purposes, such as the mandated collection of data through electronic disease reporting systems. Health professionals can leverage these data to better anticipate and plan for the needs of communities, which is seen in the use of electronic case reporting.
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http://dx.doi.org/10.1177/1073110519857309DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664801PMC
June 2019

Inverted Follicular Keratosis: Stand-Alone Entity or Variant.

Skinmed 2019;17(2):93-94. Epub 2019 May 29.

Department of Pathology and Laboratory Medicine Department of Dermatology; Rutgers New Jersey Medical School, Newark, NJ;

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December 2019

Effect of elderly status on postoperative complications in patients with sinonasal cancer.

Int Forum Allergy Rhinol 2019 02 23;9(2):220-224. Epub 2018 Nov 23.

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

Background: Elderly patients with multiple comorbidities may be at higher risk of postoperative complications. With an increasingly aging population, more data assessing for predisposing factors are needed in this at-risk group. In this study, we analyzed the effect of elderly status on relative comorbidities and complications of sinonasal cancer (SNC) patients receiving surgery.

Methods: A retrospective database analysis was performed using cases from the Nationwide Inpatient Sample (NIS) from 2003 to 2012. Patients with a diagnosis of malignant neoplasm of the nasal cavity or paranasal sinuses, who received surgery for sinonasal malignancy, including neck dissections, were selected. Demographics of interest included age, sex, race, type of admission, mean length of stay, and median hospital charges. Elderly and nonelderly patients were compared for differences in rates of acute medical complications, acute surgical complications, and relevant procedures during hospitalization.

Results: Of the 920 cases identified in the NIS, 382 (41.5%) were elderly (≥65 years). Cases of SNC were more frequently seen in males than females (p < 0.001). Elderly patients had significantly higher comorbidity rates compared with nonelderly patients, which included congestive heart failure, hypertension, diabetes, chronic pulmonary disease, and chronic renal failure (p < 0.001 for all). Elderly patients more frequently had postoperative cardiac complications (6.0% vs 0.5%, p < 0.001), but this finding was not statistically significant on multivariate analysis when controlling for race, sex, and comorbidities.

Conclusion: Elderly status is not an independent factor for postoperative complications in patients undergoing surgery for sinonasal malignancy.
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http://dx.doi.org/10.1002/alr.22239DOI Listing
February 2019
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