59 results on '"Devon E McMahon"'
Search Results
2. Barriers and facilitators to chemotherapy initiation and adherence for patients with HIV-associated Kaposi’s sarcoma in Kenya: a qualitative study
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Devon E. McMahon, Rhea Singh, Linda Chemtai, Aggrey Semeere, Helen Byakwaga, Merridy Grant, Miriam Laker-Oketta, Celestine Lagat, Sigrid Collier, Toby Maurer, Jeffrey Martin, Ingrid V. Bassett, Lisa Butler, Samson Kiprono, Naftali Busakhala, and Esther E. Freeman
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Kaposi sarcoma ,HIV/AIDS ,Chemotherapy ,Treatment ,Adherence ,Africa South of the Sahara ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Kaposi sarcoma is one of the most prevalent HIV-associated malignancies in sub-Saharan Africa and is often diagnosed at advanced stage of disease. Only 50% of KS patients who qualify for chemotherapy receive it and adherence is sub-optimal. Methods 57 patients > 18 years with newly diagnosed KS within the AMPATH clinic network in Western Kenya were purposively selected to participate in semi-structured interviews stratified by whether they had completed, partially completed, or not completed chemotherapy for advanced stage KS. We based the interview guide and coding framework on the situated Information, Motivation, Behavioral Skills (sIMB) framework, in which the core patient centered IMB constructs are situated into the socioecological context of receiving care. Results Of the 57 participants, the median age was 37 (IQR 32–41) and the majority were male (68%). Notable barriers to chemotherapy initiation and adherence included lack of financial means, difficulty with convenience of appointments such as distance to facility, appointment times, long lines, limited appointments, intrapersonal barriers such as fear or hopelessness, and lack of proper or sufficient information about chemotherapy. Factors that facilitated chemotherapy initiation and adherence included health literacy, motivation to treat symptoms, improvement on chemotherapy, prioritization of self-care, resilience while experiencing side effects, ability to carry out behavioral skills, obtaining national health insurance, and free chemotherapy. Conclusion Our findings about the barriers and facilitators to chemotherapy initiation and adherence for KS in Western Kenya support further work that promotes public health campaigns with reliable cancer and chemotherapy information, improves education about the chemotherapy process and side effects, increases oncology service ability, supports enrollment in national health insurance, and increases incorporation of chronic disease care into existing HIV treatment networks.
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- 2022
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3. A dermatologic assessment of 101 mpox (monkeypox) cases from 13 countries during the 2022 outbreak: Skin lesion morphology, clinical course, and scarring
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Sonya Prasad, Cristina Galvan Casas, Alexis G. Strahan, L. Claire Fuller, Klint Peebles, Andrea Carugno, Kieron S. Leslie, Joanna L. Harp, Teodora Pumnea, Devon E. McMahon, Misha Rosenbach, Janet E. Lubov, Geoffrey Chen, Lindy P. Fox, Allen McMillen, Henry W. Lim, Alexander J. Stratigos, Terrence A. Cronin, Mark D. Kaufmann, George J. Hruza, Lars E. French, Esther E. Freeman, Prasad, S, Casas, C, Strahan, A, Fuller, L, Peebles, K, Carugno, A, Leslie, K, Harp, J, Pumnea, T, Mcmahon, D, Rosenbach, M, Lubov, J, Chen, G, Fox, L, Mcmillen, A, Lim, H, Stratigos, A, Cronin, T, Kaufmann, M, Hruza, G, French, L, and Freeman, E
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medical dermatology ,mpox ,immunocompromised ,general dermatology ,international health ,infectious disease ,vaccine ,viru ,skin lesion ,global health ,monkeypox ,viral infection ,Dermatology - Abstract
Background: In the 2022 mpox (monkeypox) outbreak, 79,000 global cases have been reported. Yet, limited dermatologic data have been published regarding lesion morphology and progression. Objective: The objective of this study was to characterize skin lesion morphology, symptomatology, and outcomes of mpox infection over time. Methods: The American Academy of Dermatology/International League of Dermatological Societies Dermatology COVID-19, Mpox, and Emerging Infections Registry captured deidentified patient cases of mpox entered by health care professionals. Results: From August 4 to November 13, 2022, 101 cases from 13 countries were entered, primarily by dermatologists (92%). Thirty-nine percent had fewer than 5 lesions. In 54% of cases, skin lesions were the first sign of infection. In the first 1-5 days of infection, papules (36%), vesicles (17%), and pustules (20%) predominated. By days 6-10, pustules (36%) were most common, followed by erosions/ulcers (27%) and crusts/scabs (24%). Crusts/scabs were the predominant morphology after day 11. Ten cases of morbilliform rash were reported. Scarring occurred in 13% of the cases. Limitations: Registry-reported data cannot address incidence. There is a potential reporting bias from the predilection to report cases with greater clinical severity. Discussion: These findings highlight differences in skin findings compared to historical outbreaks, notably the presence of skin lesions prior to systemic symptoms and low overall lesion counts. Scarring emerged as a major possible sequela.
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- 2023
4. 25 Years of Kaposi Sarcoma Herpesvirus: Discoveries, Disparities, and Diagnostics
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Devon E. McMahon, Toby Maurer, and Esther E. Freeman
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Published
- 2020
- Full Text
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5. The American Academy of Dermatology and International League of Dermatological Societies Monkeypox Registry: Expanding the COVID-19 registry to emerging infections
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Esther E. Freeman, Cristina Galvan Casas, Sonya Prasad, Claire Fuller, Klint Peebles, Misha Rosenbach, Lindy Fox, Devon E. McMahon, Alexis Strahan, Janet Lubov, Geoffrey Chen, Cuong V. Nguyen, Allen McMillen, Henry W. Lim, Alexander J. Stratigos, Mark D. Kaufmann, George J. Hruza, and Lars French
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Humans ,COVID-19 ,Monkeypox ,Registries ,Dermatology ,United States ,Societies, Medical - Abstract
The World Health Organization declared the global monkeypox outbreak a public health emergency of international concern in July 2022. In response, the American Academy of Dermatology and International League of Dermatological Societies expanded the existing COVID-19 Dermatology Registry to become the "AAD/ILDS Dermatology COVID-19, Monkeypox, and Emerging Infections Registry." The goal of the registry is to rapidly collate cases of monkeypox and other emerging infections and enable prompt dissemination of findings to front-line healthcare workers and other members of the medical community. The registry is now accepting reports of monkeypox cases and cutaneous reactions to monkeypox/smallpox vaccines. The success of this collaborative effort will depend on active case entry by the global dermatology community.
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- 2022
6. Mpox first skin lesion location: a reflection of mode of transmission?
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Lubov, J, Strahan, A, Prasad, S, Galvan Casas, C, Claire Fuller, L, Peebles, K, Carugno, A, Leslie, K, Harp, J, Pumnea, T, Mcmahon, D, Rosenbach, M, Chen, G, Fox, L, Mcmillen, A, Lim, H, Stratigos, A, A Cronin, T, Kaufmann, M, Hruza, G, French, L, E. Freeman., E, Janet E. Lubov, Alexis Strahan, Sonya Prasad, Cristina Galvan Casas, L. Claire Fuller, Klint Peebles, Andrea Carugno, Kieron S. Leslie, Joanna L. Harp, Teodora Pumnea, Devon E. McMahon, Misha Rosenbach, Geoffrey Chen, Lindy P. Fox, Allen McMillen, Henry W. Lim, Alexander J. Stratigos, Terrence A Cronin, Mark D. Kaufmann, George J. Hruza, Lars E. French, Esther E. Freeman., Lubov, J, Strahan, A, Prasad, S, Galvan Casas, C, Claire Fuller, L, Peebles, K, Carugno, A, Leslie, K, Harp, J, Pumnea, T, Mcmahon, D, Rosenbach, M, Chen, G, Fox, L, Mcmillen, A, Lim, H, Stratigos, A, A Cronin, T, Kaufmann, M, Hruza, G, French, L, E. Freeman., E, Janet E. Lubov, Alexis Strahan, Sonya Prasad, Cristina Galvan Casas, L. Claire Fuller, Klint Peebles, Andrea Carugno, Kieron S. Leslie, Joanna L. Harp, Teodora Pumnea, Devon E. McMahon, Misha Rosenbach, Geoffrey Chen, Lindy P. Fox, Allen McMillen, Henry W. Lim, Alexander J. Stratigos, Terrence A Cronin, Mark D. Kaufmann, George J. Hruza, Lars E. French, and Esther E. Freeman.
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- 2023
7. Mpox in persons living with HIV: results from an international dermatologic registry
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Strahan, A, Lubov, J, Prasad, S, Galvan Casas, C, Claire Fuller, L, Peebles, K, Carugno, A, Leslie, K, Harp, J, Pumnea, T, Mcmahon, D, Rosenbach, M, Chen, G, Fox, L, Mcmillen, A, Lim, H, Stratigos, A, A Cronin, T, Kaufmann, M, Hruza, G, French, L, Freeman, E, Alexis Strahan, Janet Lubov, Sonya Prasad, Cristina Galvan Casas, L. Claire Fuller, Klint Peebles, Andrea Carugno, Kieron S. Leslie, Joanna L. Harp, Teodora Pumnea, Devon E. McMahon, Misha Rosenbach, Geoffrey Chen, Lindy P. Fox, Allen McMillen, Henry W. Lim, Alexander J. Stratigos, Terrence A Cronin, Mark D. Kaufmann, George J. Hruza, Lars E. French, Esther E. Freeman, Strahan, A, Lubov, J, Prasad, S, Galvan Casas, C, Claire Fuller, L, Peebles, K, Carugno, A, Leslie, K, Harp, J, Pumnea, T, Mcmahon, D, Rosenbach, M, Chen, G, Fox, L, Mcmillen, A, Lim, H, Stratigos, A, A Cronin, T, Kaufmann, M, Hruza, G, French, L, Freeman, E, Alexis Strahan, Janet Lubov, Sonya Prasad, Cristina Galvan Casas, L. Claire Fuller, Klint Peebles, Andrea Carugno, Kieron S. Leslie, Joanna L. Harp, Teodora Pumnea, Devon E. McMahon, Misha Rosenbach, Geoffrey Chen, Lindy P. Fox, Allen McMillen, Henry W. Lim, Alexander J. Stratigos, Terrence A Cronin, Mark D. Kaufmann, George J. Hruza, Lars E. French, and Esther E. Freeman
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- 2023
8. The impact of the American Academy of Dermatology/International League of Dermatological Societies COVID-19 registry during the pandemic: 2500 cases across 72 countries
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Alexis G. Strahan, Janet E. Lubov, Sonya Prasad, Lindy P. Fox, Devon E. McMahon, Rhea Singh, Misha Rosenbach, Seemal R. Desai, Henry W. Lim, Bruce H. Thiers, George J. Hruza, Lars E. French, and Esther E. Freeman
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Dermatology - Published
- 2023
9. The role of dermatology in Kaposi sarcoma diagnosis across 3 regions in sub-Saharan Africa
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Mukendi K.A. Kayembe, Ingrid V. Bassett, Esther E. Freeman, Naftali Busakhala, Susan Regan, Kara Wools-Kaloustian, Surbhi Grover, Devon E. McMahon, Tlotlo Ralefala, Jeffrey N. Martin, Vivian Kwaghe, Divya Seth, Elima Jedy-Agba, Linda Oyesiku, Karen Mosoajane, Toby Maurer, Kenneth Iregbu, Victoria L. Williams, and Antoine Jaquet
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medicine.medical_specialty ,Sub saharan ,business.industry ,MEDLINE ,Cancer ,Dermatology ,medicine.disease ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Global health ,Medicine ,Sarcoma ,business - Published
- 2021
10. Hair and nail reactions represent a small proportion of all <scp>COVID</scp> ‐19 dermatologic reactions in an analysis of an international <scp>COVID</scp> ‐19 dermatological registry
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Amar D. Desai, Julianne M. Falotico, Devon E. McMahon, Esther E. Freeman, Lars E. French, and Shari R. Lipner
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Dermatology - Published
- 2022
11. COVID-19 Vaccines and the Skin
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Qisi Sun, Esther E. Freeman, Devon E. McMahon, and Ramie Fathy
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medicine.medical_specialty ,Side effect ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Dermatology ,Clinical trial ,Pandemic ,Medicine ,Mass vaccination ,Observational study ,business ,Local injection ,Adverse effect - Abstract
In 2021, we entered a new phase of the COVID-19 pandemic. As mass vaccinations are underway and more vaccines are approved, it is important to recognize cutaneous adverse events. We review the dermatologic manifestations of COVID-19 vaccines as reported in clinical trial data and summarize additional observational reports of skin reactions to COVID-19 vaccines. Early-onset local injection reactions were the most common cutaneous side effects observed in clinical trials; delayed injection reactions were the most common cutaneous side effect reported outside of clinical trials. Understanding the landscape of cutaneous manifestations to COVID-19 vaccines is key to providing appropriate vaccine guidance.
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- 2021
12. Dermatology COVID-19 Registries
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Dmitri Wall, Esther E. Freeman, Devon E. McMahon, George J. Hruza, Christopher E.M. Griffiths, Nekma Meah, Grace Chamberlin, Leslie Castelo-Soccio, Haley B. Naik, Alan D. Irvine, Kelly M. Cordoro, Carsten Flohr, Phyllis I. Spuls, Satveer K. Mahil, Michelle A. Lowes, Steven R. Feldman, Irene Lara-Corrales, Catherine H. Smith, Angelo V. Marzano, Rodney Sinclair, Esther A. Balogh, and Lars E. French
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medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Public health ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Dermatology ,Patient care ,Pandemic ,Global health ,Medicine ,Pediatric dermatology ,business - Abstract
During the COVID-19 pandemic, rapid, real-world evidence is essential for the development of knowledge and subsequent public health response. In dermatology, provider-facing and patient-facing registries focused on COVID-19 have been important sources of research and new information aimed at guiding optimal patient care. The 7 dermatology registries included in this update now include more than 8000 case reports sourced from physicians and patients from countries all over the world.
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- 2021
13. Beyond T Staging in the 'Treat-All' Era: Severity and Heterogeneity of Kaposi Sarcoma in East Africa
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Michael Kanyesigye, Esther E. Freeman, Naftali Busakhala, Susan Regan, Mwebesa Bwana, Aggrey Semeere, Megan Wenger, Ingrid V. Bassett, Helen Byakwaga, Elyne Rotich, Miriam Laker-Oketta, Kara Wools-Kaloustian, Devon E. McMahon, Matthew Ssemakadde, Philippa Kadama-Makanga, Charles Kasozi, Jeffrey N. Martin, and Job Kisuya
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Adult ,Male ,sub-Saharan Africa ,medicine.medical_specialty ,Clinical Sciences ,global health ,HIV Infections ,Kaposi ,Disease ,Severity of Illness Index ,Article ,Rare Diseases ,Disease severity ,Clinical Research ,Virology ,Internal medicine ,medicine ,Advanced disease ,East africa ,Humans ,cancer ,Uganda ,biopsy ,Pharmacology (medical) ,delayed diagnosis ,Stage (cooking) ,Sarcoma, Kaposi ,Neoplasm Staging ,business.industry ,Advanced stage ,HIV ,Kaposi sarcoma ,Sarcoma ,staging ,medicine.disease ,Kenya ,AIDS ,Emerging Infectious Diseases ,Infectious Diseases ,Public Health and Health Services ,Marked heterogeneity ,Female ,Infection ,business - Abstract
BackgroundAlthough many patients with Kaposi sarcoma (KS) in sub-Saharan Africa are diagnosed with AIDS Clinical Trials Group (ACTG) T1 disease, T1 staging insufficiently captures clinical heterogeneity of advanced KS. Using a representative community-based sample, we detailed disease severity at diagnosis to inform KS staging and treatment in sub-Saharan Africa.MethodsWe performed rapid case ascertainment on people living with HIV, aged 18 years or older, newly diagnosed with KS from 2016 to 2019 at 3 clinic sites in Kenya and Uganda to ascertain disease stage as close as possible to diagnosis. We reported KS severity using ACTG and WHO staging criteria and detailed measurements that are not captured in the current staging systems.ResultsWe performed rapid case ascertainment within 1 month for 241 adults newly diagnosed with KS out of 389 adult patients with suspected KS. The study was 68% men with median age 35 years and median CD4 count 239. Most of the patients had advanced disease, with 82% qualifying as ACTG T1 and 64% as WHO severe/symptomatic KS. The most common ACTG T1 qualifiers were edema (79%), tumor-associated ulceration (24%), extensive oral KS (9%), pulmonary KS (7%), and gastrointestinal KS (4%). There was marked heterogeneity within T1 KS, with 25% of patients having 2 T1 qualifying symptoms and 3% having 3 or more.ConclusionMost of the patients newly diagnosed with KS had advanced stage disease, even in the current antiretroviral therapy "treat-all" era. We observed great clinical heterogeneity among advanced stage patients, leading to questions about whether all patients with advanced KS require the same treatment strategy.
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- 2021
14. Skin reactions to COVID-19 vaccines: An American Academy of Dermatology/International League of Dermatological Societies registry update on reaction location and COVID vaccine type
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Kimberly G. Blumenthal, Lindy P. Fox, Ramie Fathy, Lars E. French, Anisha Tyagi, Esther E. Freeman, George J. Hruza, Qisi Sun, Devon E. McMahon, and Rhea Singh
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2019-20 coronavirus outbreak ,Skin reaction ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Medicine ,Dermatology ,business ,Virology - Published
- 2022
15. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases
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Kimberly G. Blumenthal, Anisha Tyagi, Jules B. Lipoff, Henry W. Lim, Lindy P. Fox, Devon E. McMahon, Danna Moustafa, Seemal R. Desai, Lars E. French, Erin Amerson, Bruce H. Thiers, Esther E. Freeman, George J. Hruza, and Misha Rosenbach
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Adult ,Male ,medicine.medical_specialty ,COVID-19 Vaccines ,mRNA ,Dermatology ,registry ,Global Health ,Article ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Pfizer ,vaccine ,medicine ,Humans ,Registries ,Erythema multiforme ,Chilblains ,Adverse effect ,SARS-CoV-2 ,business.industry ,public health ,COVID-19 ,Middle Aged ,medicine.disease ,Morbilliform ,Vaccination ,Delayed hypersensitivity ,Moderna ,030220 oncology & carcinogenesis ,Pityriasis rosea ,Female ,Drug Eruptions ,business ,Shingles - Abstract
Background Cutaneous reactions after messenger RNA (mRNA)-based COVID-19 vaccines have been reported but are not well characterized. Objective To evaluate the morphology and timing of cutaneous reactions after mRNA COVID-19 vaccines. Methods A provider-facing registry-based study collected cases of cutaneous manifestations after COVID-19 vaccination. Results From December 2020 to February 2021, we recorded 414 cutaneous reactions to mRNA COVID-19 vaccines from Moderna (83%) and Pfizer (17%). Delayed large local reactions were most common, followed by local injection site reactions, urticarial eruptions, and morbilliform eruptions. Forty-three percent of patients with first-dose reactions experienced second-dose recurrence. Additional less common reactions included pernio/chilblains, cosmetic filler reactions, zoster, herpes simplex flares, and pityriasis rosea-like reactions. Limitations Registry analysis does not measure incidence. Morphologic misclassification is possible. Conclusions We report a spectrum of cutaneous reactions after mRNA COVID-19 vaccines. We observed some dermatologic reactions to Moderna and Pfizer vaccines that mimicked SARS-CoV-2 infection itself, such as pernio/chilblains. Most patients with first-dose reactions did not have a second-dose reaction and serious adverse events did not develop in any of the patients in the registry after the first or second dose. Our data support that cutaneous reactions to COVID-19 vaccination are generally minor and self-limited, and should not discourage vaccination.
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- 2021
16. Telling the story of intersectional stigma in HIV‐associated Kaposi's sarcoma in western Kenya: a convergent mixed‐methods approach
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Sigrid Collier, Rhea Singh, Aggrey Semeere, Helen Byakwaga, Miriam Laker‐Oketta, Devon E. McMahon, Linda Chemtai, Merridy Grant, Lisa Butler, Laura Bogart, Ingrid V. Bassett, Samson Kiprono, Toby Maurer, Jeffrey Martin, Naftali Busakhala, and Esther E. Freeman
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Infectious Diseases ,Public Health, Environmental and Occupational Health ,Humans ,HIV Infections ,Longitudinal Studies ,Kenya ,Sarcoma, Kaposi - Abstract
The experience of stigma can be multifaceted for people with HIV and cancer. Kaposi's sarcoma (KS), one of the most common HIV-associated cancers in sub-Saharan Africa, often presents with visible skin lesions that may put people at risk for stigmatization. In this way, HIV-associated KS is unique, as people with KS can experience stigma associated with HIV, cancer, and skin disease simultaneously. The aim of this study is to characterize the intersectionality of HIV-related, cancer-related and skin disease-related stigma in people living with HIV and KS.We used a convergent mixed-methods approach nested within a longitudinal study of people with HIV-associated KS in western Kenya. Between February 2019 and December 2020, we collected quantitative surveys among all participants and conducted semi-structured interviews among a purposive sample of participants. Quantitative surveys were adapted from the abridged Berger HIV Stigma Scale to assess overall stigma, HIV-related stigma, cancer-related stigma, and skin disease-related stigma. Qualitative data were coded using stigma constructs from the Health Stigma and Discrimination Framework.In 88 semi-structured interviews, stigma was a major barrier to KS diagnosis and treatment among people with HIV-associated KS. Participant's stories of stigma were dominated by HIV-related stigma, more than cancer-related or skin disease-related stigma. However, quantitative stigma scores among the 117 participants were similar for HIV-related (Median: 28.00; IQR: 28.0, 34.0), cancer-related (Median: 28.0; IQR: 28.0, 34.8), and skin disease-related stigma (Median: 28.0; IQR: 27.0, 34.0). In semi-structured interviews, cancer-related and skin disease-related stigma were more subtle contributors; cancer-related stigma was linked to fatalism and skin-related stigma was linked to visible disease. Participants reported resolution of skin lesions contributed to lessening stigma over time; there was a significant decline in quantitative scores of overall stigma in time since KS diagnosis (adjusted β = -0.15, p0.001).This study highlights the role mixed-method approaches can play in better understanding stigma in people living with both HIV and cancer. While HIV-related stigma may dominate perceptions of stigma among people with KS in Kenya, intersectional experiences of stigma may be subtle, and quantitative evaluation alone may be insufficient to understand intersectional stigma in certain contexts.
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- 2022
17. Healthcare Costs and Financial Barriers to Diagnosis and Treatment of People Living with HIV-Associated Kaposi’s Sarcoma in Western Kenya: A Qualitative Analysis
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Rhea Sing, Sigrid Collier, Aggrey Semeere, Helen Byakwaga, Miriam Laker-Oketta, Devon E. McMahon, Linda Chemtai, Merridy Grant, Lisa M. Butler, Ingrid V. Bassett, Samson Kiprono, Toby Maurer, Jeffrey Martin, Naftali Busakhala, and Esther E. Freeman
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- 2022
18. Stigma in the Diagnosis and Treatment of HIV-associated Kaposi’s Sarcoma
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Sigrid Collier, Rhea Sing, Aggrey Semeere, Helen Byakwaga, Miriam Laker-Oketta, Devon E. McMahon, Linda Chemtai, Merridy Grant, Lisa M. Butler, Ingrid V. Bassett, Samson Kiprono, Toby Maurer, Jeffrey Martin, Naftali Busakhala, and Esther E. Freeman
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- 2022
19. Developing a Platform for Global Health Dermatology Mentorship and Collaboration
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Devon E. McMahon, Linda Oyesiku, L.C. Fuller, and Esther E. Freeman
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Teledermatology ,medicine.medical_specialty ,business.industry ,Dermatology ,Health professions ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Mentorship ,Alliance ,030220 oncology & carcinogenesis ,Global health ,Neglected tropical diseases ,medicine ,business - Abstract
The International Alliance for Global Health Dermatology (GLODERM) was formed in 2019 with the aim to unite efforts toward skin health, open to members from any health profession, any country, and at any stage of training. This article highlights the case for such an alliance; discusses existing opportunities and gaps in global health dermatology; describes the development of a new international alliance; proposes future directions; and reflects on lessons learned.
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- 2021
20. Nodules in a sporotrichoid (lymphangitic) distribution
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Devon E McMahon, Cristina Thomas, Rhea Singh, and Esther E Freeman
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Lymphangitis ,Humans ,General Medicine - Published
- 2022
21. Identifying gaps in global health dermatology: a survey of GLODERM members
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W. Rehmus, C van Hees, S A Norton, H Beltraminelli, Erin Amerson, Linda Oyesiku, Esther E. Freeman, Karolyn A. Wanat, Roderick Hay, Aileen Y. Chang, Toby Maurer, Alexia P. Knapp, Carrie L. Kovarik, L.C. Fuller, Victoria L. Williams, Devon E. McMahon, and Amy K. Forrestel
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Medical education ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,education ,Medical school ,MEDLINE ,Dermatology ,Global Health ,Article ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Multidisciplinary approach ,Surveys and Questionnaires ,Political science ,Global health ,Health for all ,Humans - Abstract
Global health is a multidisciplinary field with a focus on improving health for all people worldwide. Interest in global health continues to grow, with 24% of U.S. medical students completing global health experiences during medical school.
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- 2021
22. The spectrum of COVID-19–associated dermatologic manifestations: An international registry of 716 patients from 31 countries
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Henry W. Lim, Lindy P. Fox, Junko Takeshita, Carrie L. Kovarik, Bruce H. Thiers, Devon E. McMahon, Esther E. Freeman, George J. Hruza, Lars E. French, Seemal R. Desai, Jules B. Lipoff, Misha Rosenbach, and Joanna Harp
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Critically ill ,Hospitalized patients ,business.industry ,Incidence (epidemiology) ,MACULAR ERYTHEMA ,Dermatology ,Morbilliform ,Pathophysiology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Purpura ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,In patient ,medicine.symptom ,business ,Mild disease ,Skin Findings - Abstract
Background Coronavirus disease 2019 (COVID-19) has associated cutaneous manifestations. Objective To characterize the diversity of cutaneous manifestations of COVID-19 and facilitate understanding of the underlying pathophysiology. Methods Case series from an international registry from the American Academy of Dermatology and International League of Dermatological Societies. Results The registry collected 716 cases of new-onset dermatologic symptoms in patients with confirmed/suspected COVID-19. Of the 171 patients in the registry with laboratory-confirmed COVID-19, the most common morphologies were morbilliform (22%), pernio-like (18%), urticarial (16%), macular erythema (13%), vesicular (11%), papulosquamous (9.9%), and retiform purpura (6.4%). Pernio-like lesions were common in patients with mild disease, whereas retiform purpura presented exclusively in ill, hospitalized patients. Limitations We cannot estimate incidence or prevalence. Confirmation bias is possible. Conclusions This study highlights the array of cutaneous manifestations associated with COVID-19. Many morphologies were nonspecific, whereas others may provide insight into potential immune or inflammatory pathways in COVID-19 pathophysiology.
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- 2020
23. The international medical elective in Nepal: perspectives from local patients, host physicians and visiting students
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Rajeev Shrestha, Rajendra Koju, Devon E. McMahon, Shrinkhala Shrestha, and Biraj Man Karmacharya
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Adult ,Male ,medicine.medical_specialty ,Nepali ,Medical Elective ,Students, Medical ,020205 medical informatics ,education ,Global health ,Language barrier ,International Educational Exchange ,medical students ,02 engineering and technology ,Language exchange ,Likert scale ,Interviews as Topic ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Nepal ,Physicians ,Surveys and Questionnaires ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,medical student education ,Humans ,030212 general & internal medicine ,Original Research ,Descriptive statistics ,Health professionals ,Education, Medical ,Communication Barriers ,General Medicine ,Middle Aged ,language.human_language ,Content analysis ,Family medicine ,language ,Female ,Clinical Competence ,Curriculum ,Educational Measurement ,international health elective ,Psychology ,medical education ,international medical elective - Abstract
Objectives To understand the impact of the international medical elective (IME) on Nepali patients and physicians alongside visiting European and American medical students. Methods At a hospital in Nepal, semi-structured interviews were conducted with 15 patients and 15 physicians about positive and negative experiences with visiting medical students. Likert scale surveys about knowledge of Nepal, clinical competencies, and post-elective feedback were administered to 56 visiting medical students before and after their elective. Interviews were coded using conventional content analysis and surveys were analyzed using descriptive statistics and paired t-tests. Results Emergent positive themes from interviews were that visiting students enhanced the reputation of the hospital, afforded financial benefits, improved international collaboration, and increased knowledge, culture and language exchange. However, negative themes were the language barrier and time expended to orient students. Before vs. after the elective, visiting students had increased knowledge of Nepal's healthcare system (M=1.9, SD=0.6 vs. M=3.2, SD=0.6, t(55)=-10.22, p
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- 2019
24. Varicella‐zoster and herpes simplex virus reactivation post‐COVID‐19 vaccination: a review of 40 cases in an International Dermatology Registry
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Lars E. French, Grace Chamberlin, Henry W. Lim, Lindy P. Fox, Jules B. Lipoff, Devon E. McMahon, Harry L. Greenberg, Cynthia Lee, Anisha Tyagi, Marlys S. Fassett, Esther E. Freeman, George J. Hruza, Misha Rosenbach, Seemal R. Desai, Kimberly G. Blumenthal, Bruce H. Thiers, and Ramie Fathy
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Herpesvirus 3, Human ,2019-20 coronavirus outbreak ,COVID-19 Vaccines ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Dermatology ,medicine.disease_cause ,Herpes Zoster ,Letters To The Editor ,Chickenpox ,Humans ,Simplexvirus ,Medicine ,Registries ,Letter to the Editor ,SARS-CoV-2 ,business.industry ,Vaccination ,COVID-19 ,Herpes Simplex ,medicine.disease ,Virology ,Infectious Diseases ,Herpes simplex virus ,business ,Shingles - Published
- 2021
25. Clinical and Pathologic Correlation of Cutaneous COVID-19 Vaccine Reactions including V-REPP: A Registry Based Study
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Jules B. Lipoff, Bruce H. Thiers, Esther E. Freeman, Seemal R. Desai, Devon E. McMahon, George J. Hruza, Kimberly G. Blumenthal, Lars E. French, Ramie Fathy, Rosalynn M. Nazarian, William Damsky, Henry W. Lim, Carrie L. Kovarik, Lindy P. Fox, Grace Chamberlin, Anisha Tyagi, and Misha Rosenbach
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bullous pemphigoid ,pityriasis rosea ,registry ,Stevens-Johnson syndrome ,papular ,chilblains ,mRNA-1273 ,Zoster ,urticaria ,erythromelalgia ,AZD1222 ,vaccine ,Erythema multiforme ,Registries ,dermatopathology ,medicine.diagnostic_test ,lichen planus ,Pityriasis ,psoriasis ,dermatology ,Moderna ,Dermatopathology ,morbilliform ,medicine.medical_specialty ,Ad26.COV2.S ,COVID-19 Vaccines ,Johnson & Johnson Janssen ,Oxford-AstraZeneca ,Skin Diseases ,Article ,Biopsy ,medicine ,Humans ,pernio ,Chilblains ,dermal hypersensitivity reaction ,delayed large local ,business.industry ,SARS-CoV-2 ,erythema multiforme ,COVID-19 ,Exanthema ,medicine.disease ,Dermatology ,papulosquamous ,Skin biopsy ,Pityriasis rosea ,Histopathology ,pathology ,Pfizer-BioNTech ,BNT162b2 ,business - Abstract
Background Cutaneous reactions after COVID-19 vaccination have been commonly reported; however, histopathologic features and clinical correlations have not been well characterized. Methods We evaluated for a history of skin biopsy all reports of reactions associated with COVID-19 vaccination identified in an international registry. When histopathology reports were available, we categorized them by reaction patterns. Results Of 803 vaccine reactions reported, 58 (7%) cases had biopsy reports available for review. The most common histopathologic reaction pattern was spongiotic dermatitis, which clinically ranged from robust papules with overlying crust, to pityriasis rosea-like eruptions, to pink papules with fine scale. We propose the acronym “V-REPP” (vaccine-related eruption of papules and plaques) for this spectrum. Other clinical patterns included bullous pemphigoid-like (n = 12), dermal hypersensitivity (n = 4), herpes zoster (n = 4), lichen planus-like (n = 4), pernio (n = 3), urticarial (n = 2), neutrophilic dermatosis (n = 2), leukocytoclastic vasculitis (n = 2), morbilliform (n = 2), delayed large local reactions (n = 2), erythromelalgia (n = 1), and other (n = 5). Limitations Cases in which histopathology was available represented a minority of registry entries. Analysis of registry data cannot measure incidence. Conclusion Clinical and histopathologic correlation allowed for categorization of cutaneous reactions to the COVID-19 vaccine. We propose defining a subset of vaccine-related eruption of papules and plaques, as well as 12 other patterns, following COVID-19 vaccination.
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- 2021
26. 25 Years of Kaposi Sarcoma Herpesvirus: Discoveries, Disparities, and Diagnostics
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Esther E. Freeman, Devon E. McMahon, and Toby Maurer
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Cancer Research ,Oncology ,business.industry ,Commentaries ,Herpesvirus 8, Human ,MEDLINE ,Humans ,Medicine ,Sarcoma ,business ,medicine.disease ,Bioinformatics ,Sarcoma, Kaposi - Published
- 2020
27. Subepidermal blistering eruptions, including bullous pemphigoid, following COVID-19 vaccination
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Noel Turner, Lindy P. Fox, Devon E. McMahon, Ramie Fathy, Monica N. Valentin, Mary M. Tomayko, Ohara Aivaz, Tena Rallis, William Damsky, and Esther E. Freeman
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Pemphigoid ,Subepidermal blistering ,COVID-19 Vaccines ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Immunology ,Vaccination ,Disease Management ,medicine.disease ,Dermatology ,Disease susceptibility ,Blister ,Correspondence ,Pemphigoid, Bullous ,Immunology and Allergy ,Medicine ,Humans ,Bullous pemphigoid ,Disease Susceptibility ,business - Published
- 2021
28. Preface: COVID-19 and Dermatology: One Year in Review
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Devon E. McMahon and Esther E. Freeman
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Year in review ,MEDLINE ,COVID-19 ,Dermatology ,Article ,Pandemic ,Humans ,Medicine ,business ,Pandemics - Published
- 2021
29. Learning from disease registries during a pandemic: Moving toward an international federation of patient registries
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Leslie Castelo-Soccio, Lars E. French, Esther E. Freeman, George J. Hruza, A.L. Bosma, B.W.M. Arents, Henry W. Lim, G. Fletcher, Christian Apfelbacher, Raed Alhusayen, Christopher E.M. Griffiths, Irene Lara-Corrales, Nekma Meah, Satveer K. Mahil, Esther A. Balogh, A.H. Musters, Haley B. Naik, Carsten Flohr, Manja Bloem, Devon E. McMahon, T. Burton, Phyllis I. Spuls, Katherine York, John R. Ingram, Michael D. Kappelman, Catherine H. Smith, Desmond J. Tobin, Steven R. Feldman, Laita Bokhari, Alan D. Irvine, Dmitri Wall, Ian McNicoll, Nicole Fagan, Rodney Sinclair, Dermatology, APH - Methodology, and APH - Quality of Care
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030203 arthritis & rheumatology ,Operationalization ,SARS-CoV-2 ,MEDLINE ,COVID-19 ,Timeline ,Dermatology ,Disease ,medicine.disease ,Edited by Min Deng, MD ,Data sharing ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Software deployment ,General partnership ,Pandemic ,medicine ,Humans ,Graduate Medical Education Rounds ,Registries ,Medical emergency ,Business ,Pandemics - Abstract
High-quality dermatology patient registries often require considerable time to develop and produce meaningful data. Development time is influenced by registry complexity and regulatory hurdles that vary significantly nationally and institutionally. The rapid emergence of the coronavirus disease 2019 (COVID-19) global pandemic has challenged health services in an unprecedented manner. Mobilization of the dermatology community in response has included rapid development and deployment of multiple, partially harmonized, international patient registries, reinventing established patient registry timelines. Partnership with patient organizations has demonstrated the critical nature of inclusive patient involvement. This global effort has demonstrated the value, capacity, and necessity for the dermatology community to adopt a more cohesive approach to patient registry development and data sharing that can lead to myriad benefits. These include improved utilization of limited resources, increased data interoperability, improved ability to rapidly collect meaningful data, and shortened response times to generate real-world evidence. We call on the global dermatology community to support the development of an international federation of patient registries to consolidate and operationalize the lessons learned during this pandemic. This will provide an enduring means of applying this knowledge to the maintenance and development of sustainable, coherent, and impactful patient registries of benefit now and in the future.
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- 2021
30. Modernizing clinical practice guidelines for the American Academy of Dermatology
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Terrence A. Cronin, Hon S. Pak, Matthew Fitzgerald, Allen McMillen, Sameer Malik, Vidhya Hariharan, Lynn A. Cornelius, Jeremey S. Bordeaux, Kevin D. Cooper, Esther E. Freeman, Sandy Robinson, Devon E. McMahon, and Lindsy Frazer-Green
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medicine.medical_specialty ,business.industry ,Process (engineering) ,Dermatology ,Guideline ,Evidence-based medicine ,Clinical Practice ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Medicine ,business ,Working group ,Quality assurance - Abstract
The American Academy of Dermatology is modernizing its clinical practice guidelines to be more timely and easily interpretable, while decreasing the influence of conflicts of interest in guideline generation. The main changes include the transition from SORT to GRADE methodology and the requirement that nonconflicted members of the guideline work groups remain nonconflicted throughout the entire guidelines process.
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- 2020
31. Association Between Systemic Corticosteroid Treatment for Cutaneous Immune-Related Adverse Events and Survival Outcomes in Patients With Advanced Cancer
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Steven T. Chen, Nira A. Krasnow, Edward Li, Leah L. Thompson, Devon E. McMahon, Jaewon Yoon, and Michael S. Chang
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medicine.medical_specialty ,business.industry ,medicine.drug_class ,Corticosteroid treatment ,Cancer ,Dermatology ,medicine.disease ,Advanced cancer ,Immune system ,Internal medicine ,medicine ,Research Letter ,Corticosteroid ,In patient ,Adverse effect ,business ,Cohort study - Abstract
This cohort study investigates the association of systemic corticosteroid exposures with infectious complications and survival outcomes among patients with a cutaneous immune-related adverse event.
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- 2021
32. Cold and COVID: recurrent pernio during the COVID-19 pandemic
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Henry W. Lim, Jules B. Lipoff, Lindy P. Fox, Misha Rosenbach, Devon E. McMahon, Seemal R. Desai, Esther E. Freeman, George J. Hruza, Lars E. French, and Marlys S. Fassett
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Skin manifestations ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,SARS-CoV-2 ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,COVID-19 ,Dermatology ,medicine.disease ,Chilblains ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Pandemic ,medicine ,Research Letter ,Humans ,business ,Pandemics - Abstract
Pernio is a commonly reported cutaneous manifestation of SARS‐CoV‐2 infection.1 Our international registry of COVID‐19 dermatologic manifestations has collected 1,176 total cases of COVID‐19 skin manifestations, including 619 cases of pernio in suspected or confirmed COVID‐19 patients.1 Most patients with new‐onset pernio were entered into the registry after the first pandemic wave (79% in March‐May 2020). Starting in September 2020, the registry received reports of a subset of these patients who developed recurrent pernio in the following months.
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- 2021
33. Timing of PCR and antibody testing in patients with COVID-19–associated dermatologic manifestations
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Esther E. Freeman, George J. Hruza, Lindy P. Fox, Jules B. Lipoff, Lars E. French, Marlys S. Fassett, and Devon E. McMahon
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2019-20 coronavirus outbreak ,Time Factors ,biology ,Coronavirus disease 2019 (COVID-19) ,business.industry ,SARS-CoV-2 ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,public health ,MEDLINE ,COVID-19 ,Dermatology ,registry ,Virology ,Skin Diseases ,Article ,chilblains ,COVID-19 Nucleic Acid Testing ,biology.protein ,Medicine ,Humans ,In patient ,pernio ,Antibody ,business - Published
- 2021
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34. Emerging Evidence of the Direct Association Between COVID-19 And Chilblains-Reply
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Esther E. Freeman, Lindy P. Fox, Devon E. McMahon, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, and UCL - (SLuc) Service de dermatologie
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,SARS-CoV-2 ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Biopsy ,MEDLINE ,COVID-19 ,Dermatology ,medicine.disease ,Virology ,Chilblains ,Medicine ,Humans ,business ,Pandemics ,Skin - Abstract
In Reply We thank Freeman et al for their comment in reference to our recently published article in JAMA Dermatology. The authors rightly point out the limitations of this study in 31 patients with regard to early antibody testing and the imperfect sensitivities and specificities of these tests. However, we later reported updated data, including an additional 23 patients with chilblains.
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- 2021
35. Factors associated with adverse COVID-19 outcomes in patients with psoriasis—insights from a global registry–based study
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Silvia Pérez-Barrio, Lucy Moorhead, Manpreet Lakhan, Saskia Reeken, Vito Zeeshaan Hasab, Rogelio Mercado-Seda, Gustavo Anibal Cardozo, Georgi Popov, Enrique Loayza, Marie-Louise Svensson, Emmanuel Mahe, Fernando Valenzuela, Victoria King, Michela Magnano, Danielle Brassard, Annette Essex, Deanna Cummings, Manisha Panchal, Trupti V. Desai, Jennifer E. Carolan, Areti Makrygeorgou, Zenas Z N Yiu, Teena Mackenzie, Esteban Daudén, Emmanuel Toni, Ian Pearson, Andrea Carugno, Lorraine Gribben, Leontien de Graaf, Liv Eidsmo, Esther A. Balogh, Gloria Aparicio, Andrew Pink, Manel Velasco, Adrienne J. van Geest, Steven R. Feldman, Tiago Torres, Elzbieta Klujszo, Malcolm H.A. Rustin, Ignacio Yanguas, Anthony Bewley, Eliseo Martínez-García, Benhadou Farida, Emily Dwyer, Susannah Hoey, Richard B. Warren, Esther E. Freeman, Diana Ruiz Genao, Rohima Khatun, Giulia Rech, Elena B. Hawryluk, Zahira Koreja, Ricardo Romiti, Gonzalez A. Cesar, Alice Mwale, Charlotte Barclay, Aadarsh Shah, Catherine Quinlan, Kathryn G. Kerisit, Christopher E.M. Griffiths, Carla Tubau Prims, Lone Skov, Céline Phan, Vincent Descamps, Jenny Hughes, Siew Eng Choon, Shanti Ayob, Efrossini Carras, Girard Celine, Jo Lambert, Alberto Barea, Jonathan Barker, Reinhart Speeckaert, Raquel Rivera, Portia Goldsmith, Nick Dand, Beatriz Pérez-Suárez, Andrew DeCrescenzo, F. Meynell, Francesca Capon, Toomas Talme, Teresa Tsakok, Deepti Kolli, Stefano Piaserico, Jamie Weisman, Manuel D. Franco, K.J. Mason, Pablo De Caso, Catriona Maybury, Rachel Bak, Ann Sergeant, Keith Wu, Graham A. Johnston, Alexandra Paolino, Cécile Lesort, Mark Vandaele, H. McAteer, Birgitta Wilson Claréus, Sinead Langan, Jose-Manuel Carrascosa, Enikö Sonkoly, Claudia de la Cruz, Maruska Marovt, Luigi Naldi, Leila Asfour, Paola Di Meglio, Jose-Maria Ortiz-Salvador, Alekya Singapore, Peter Jenkin, Romana Ceovic, R. Taberner, P.J. Hampton, Alberto Romero-Maté, Russell W. Cohen, Omid Zargari, Maria Teresa Rossi, Devon E. McMahon, Denis Jullien, Bola Coker, Carrie Davis, Georgie King, Catherine H. Smith, Richard Woolf, Luis Puig, Ann Jones, Astrid van Huizen, Joseph J. Schwartz, Paolo Gisondi, Phyllis I. Spuls, Satveer K. Mahil, Sarah Kirk, Paulo Varela, K. Jackson, Ana Maria Morales Callaghan, Vito Di Lernia, Lieve Meuleman, Claudio Greco, Simina Stefanescu, Hervé Bachelez, Ana Martinez, Dermatology, AII - Inflammatory diseases, APH - Methodology, APH - Quality of Care, Mahil, S, Dand, N, Mason, K, Yiu, Z, Tsakok, T, Meynell, F, Coker, B, Mcateer, H, Moorhead, L, Mackenzie, T, Rossi, M, Rivera, R, Mahe, E, Carugno, A, Magnano, M, Rech, G, Balogh, E, Feldman, S, De La Cruz, C, Choon, S, Naldi, L, Lambert, J, Spuls, P, Jullien, D, Bachelez, H, Mcmahon, D, Freeman, E, Gisondi, P, Puig, L, Warren, R, Di Meglio, P, Langan, S, Capon, F, Griffiths, C, Barker, J, Smith, C, Shah, A, Barea, A, Romero-Mate, A, Singapore, A, Paolino, A, Mwale, A, Morales Callaghan, A, Martinez, A, Decrescenzo, A, Pink, A, Jones, A, Sergeant, A, Essex, A, Bewley, A, Makrygeorgou, A, van Huizen, A, Perez-Suarez, B, Farida, B, Clareus, B, Prims, C, Davis, C, Quinlan, C, Maybury, C, Cesar, G, Barclay, C, Greco, C, Brassard, D, Cummings, D, Kolli, D, Descamps, V, Genao, D, Carras, E, Hawryluk, E, Martinez-Garcia, E, Klujszo, E, Dwyer, E, Toni, E, Sonkoly, E, Loayza, E, Dauden, E, Valenzuela, F, Popov, G, King, G, Celine, G, Aparicio, G, Johnston, G, Cardozo, G, Pearson, I, Yanguas, I, Weisman, J, Carolan, J, Hughes, J, Ortiz-Salvador, J, Carrascosa, J, Schwartz, J, Jackson, K, Kerisit, K, Wu, K, Asfour, L, de Graaf, L, Lesort, C, Meuleman, L, Eidsmo, L, Skov, L, Gribben, L, Rustin, M, Velasco, M, Panchal, M, Lakhan, M, Franco, M, Svensson, M, Vandaele, M, Marovt, M, Zargari, O, De Caso, P, Varela, P, Jenkin, P, Phan, C, Hampton, P, Goldsmith, P, Bak, R, Speeckaert, R, Romiti, R, Woolf, R, Mercado-Seda, R, Khatun, R, Ceovic, R, Taberner, R, Cohen, R, Stefanescu, S, Kirk, S, Reeken, S, Ayob, S, Perez-Barrio, S, Piaserico, S, Hoey, S, Torres, T, Talme, T, Desai, T, van Geest, A, King, V, Di Lernia, V, Koreja, Z, and Hasab, V
- Subjects
Male ,IMID, immune-mediated inflammatory disease ,immunosuppressant ,BMI, body mass index ,ACEi, angiotensin-converting enzyme inhibitor ,PsoProtect, Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 infecTion ,Logistic regression ,Systemic therapy ,030207 dermatology & venereal diseases ,0302 clinical medicine ,RC705 ,Interquartile range ,COVID-19 ,biologics ,hospitalization ,immunosuppressants ,psoriasis ,risk factors ,Risk Factors ,Epidemiology ,Immunology and Allergy ,030212 general & internal medicine ,Registries ,NSAID, non-steroidal anti-inflammatory drug ,610 Medicine & health ,COVID-19, Coronavirus disease 2019 ,TNF, tumor necrosis factor ,Age Factors ,Middle Aged ,Hospitalization ,risk factor ,95% CI, 95% confidence interval ,Female ,JAK, Janus kinase ,biologic ,Adult ,medicine.medical_specialty ,Immunology ,Lower risk ,SARS-CoV-2, severe acute respiratory syndrome coronavirus 2 ,Article ,03 medical and health sciences ,Sex Factors ,Internal medicine ,Psoriasis ,medicine ,Humans ,SARS-CoV-2 ,IFN, interferon ,IQR, interquartile range ,psoriasi ,business.industry ,Odds ratio ,medicine.disease ,ARB, angiotensin II receptor blocker ,IL, interleukin ,OR, odds ratio ,business ,Body mass index - Abstract
Background The multi-morbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse COVID-19 outcomes but data are limited. Objective Characterize the course of COVID-19 in psoriasis and identify factors associated with hospitalization. Methods Clinicians reported psoriasis patients with confirmed/suspected COVID-19 via an international registry, PsoProtect. Multiple logistic regression assessed the association between clinical/demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviours. Results Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% a non-biologic and 10% no systemic treatment for psoriasis. 348 (93%) fully recovered from COVID-19, 77 (21%) were hospitalized and nine (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted OR 1.59 per 10 years, 95% CI 1.19-2.13), male sex (OR 2.51, 95% CI 1.23-5.12), non-white ethnicity (OR 3.15, 95% CI 1.24-8.03) and comorbid chronic lung disease (OR 3.87, 95% CI 1.52-9.83). Hospitalization was more frequent in patients using non-biologic systemic therapy than biologics (OR 2.84, 95% CI 1.31-6.18). No significant differences were found between biologic classes. Independent patient-reported data (n=1,626 across 48 countries) suggested lower levels of social isolation in individuals receiving non-biologic systemic therapy compared to biologics (OR 0.68, 95% CI 0.50-0.94). Conclusion In this international moderate-severe psoriasis case series, biologics use was associated with lower risk of COVID-19-related hospitalization than non-biologic systemic therapies, however further investigation is warranted due to potential selection bias and unmeasured confounding. Established risk factors (being older, male, non-white ethnicity, comorbidities) were associated with higher hospitalization rates. Clinical Implications We identify risk factors for COVID-19-related hospitalization in psoriasis patients, including older age, male sex, non-white ethnicity and comorbidities. Use of biologics was associated with lower hospitalization risk than non-biologic systemic therapies., Capsule summary: In this global registry-based study, risk factors for COVID-19-related hospitalization in psoriasis patients were older age, male sex, non-white ethnicity and comorbidities. Use of biologics was associated with lower hospitalization risk than non-biologic systemic treatment.
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- 2021
36. Long COVID in the skin: a registry analysis of COVID-19 dermatological duration
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Devon E. McMahon, Misha Rosenbach, Henry W. Lim, Lindy P. Fox, Lars French, Seemal Desai, Jules B. Lipoff, Jason G. Cyster, Antonia E. Gallman, Marlys S. Fassett, Esther E. Freeman, and George J. Hruza
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,SARS-CoV-2 ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Comment ,MEDLINE ,COVID-19 ,Chilblains ,Infectious Diseases ,Post-Acute COVID-19 Syndrome ,Internal medicine ,Medicine ,Humans ,Duration (project management) ,Young adult ,business - Published
- 2021
37. Novel Diagnostics for Kaposi Sarcoma and Other Skin Diseases in Resource-Limited Settings
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Dongkyun Kang, Linda Oyesiku, Devon E. McMahon, Aggrey Semeere, and Esther E. Freeman
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Buruli ulcer ,Microbiological Techniques ,medicine.medical_specialty ,Leishmaniasis, Cutaneous ,Dermatology ,Onchocerciasis ,Article ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Elephantiasis, Filarial ,Cutaneous leishmaniasis ,Leprosy ,medicine ,Humans ,Intensive care medicine ,Buruli Ulcer ,Sarcoma, Kaposi ,Lymphatic filariasis ,Microscopy, Confocal ,business.industry ,Epidemiologic Surveillance ,Equipment Design ,medicine.disease ,Molecular Diagnostic Techniques ,Point-of-Care Testing ,030220 oncology & carcinogenesis ,Yaws ,Health Resources ,Sarcoma ,Dermatopathology ,business ,Limited resources ,Nucleic Acid Amplification Techniques - Abstract
In resource-limited settings, point-of-care diagnostic devices have the potential to reduce diagnostic delays and improve epidemiologic surveillance of dermatologic conditions. We outline novel-point-of care diagnostics that have recently been developed for dermatologic conditions that primarily affect patients living in resource-limited settings, namely, Kaposi sarcoma, cutaneous leishmaniasis, leprosy, Buruli ulcer, yaws, onchocerciasis, and lymphatic filariasis. All of the technologies described in this article are prototypes, and some have undergone field testing. These devices still require validation in real-world settings and effective pricing to have a major impact on dermatologic care in resource-limited settings.
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- 2020
38. Developing a Platform for Global Health Dermatology Mentorship and Collaboration: Introducing the International Alliance for Global Health Dermatology
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Linda, Oyesiku, Devon E, McMahon, Lucinda Claire, Fuller, and Esther E, Freeman
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Consumer Advocacy ,International Cooperation ,Research Support as Topic ,Mentors ,Humans ,Dermatology ,Global Health ,Policy Making - Abstract
The International Alliance for Global Health Dermatology (GLODERM) was formed in 2019 with the aim to unite efforts toward skin health, open to members from any health profession, any country, and at any stage of training. This article highlights the case for such an alliance; discusses existing opportunities and gaps in global health dermatology; describes the development of a new international alliance; proposes future directions; and reflects on lessons learned.
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- 2020
39. Response to: 'Comment on ‘The spectrum of COVID-19-associated dermatologic manifestations: An international registry of 716 patients from 31 countries’'
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Lindy P. Fox, Devon E. McMahon, Esther E. Freeman, and Seemal R. Desai
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,vesicular ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,macular erythema ,Dermatology ,registry ,COVID toes ,Skin Diseases ,Article ,Global health ,medicine ,Humans ,pernio ,Registries ,urticarial ,SARS-CoV-2 ,business.industry ,Public health ,public health ,COVID-19 ,MACULAR ERYTHEMA ,Morbilliform ,retiform purpura ,morbilliform ,business - Published
- 2021
40. International collaboration and rapid harmonization across dermatologic COVID-19 registries
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Carsten Flohr, Phyllis I. Spuls, Matthew Fitzgerald, Catherine H. Smith, Rodney Sinclair, Irene Lara-Corrales, Lars E. French, Michael D. Kappelman, Alan D. Irvine, John R. Ingram, Raed Alhusayen, Leslie Castelo-Soccio, Satveer K. Mahil, Devon E. McMahon, Esther A. Balogh, Dmitri Wall, Marie Beylot-Barry, Christopher E.M. Griffiths, Nekma Meah, Esther E. Freeman, George J. Hruza, Haley B. Naik, Kelly M. Cordoro, Steven R. Feldman, Henry W. Lim, Dermatology, AII - Inflammatory diseases, APH - Methodology, and APH - Quality of Care
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Consensus ,Coronavirus disease 2019 (COVID-19) ,International Cooperation ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pneumonia, Viral ,global health ,Harmonization ,Dermatology ,Skin Diseases ,Betacoronavirus ,medicine ,Humans ,Registries ,Pediatric dermatology ,Pandemics ,atopic dermatitis ,SARS-CoV-2 ,business.industry ,hidradenitis suppurativa ,COVID-19 ,psoriasis ,alopecia ,JAAD Online ,pediatric dermatology ,Family medicine ,Epidemiological Monitoring ,Practice Guidelines as Topic ,Coronavirus Infections ,business - Published
- 2020
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41. Pernio-like skin lesions associated with COVID-19: A case series of 318 patients from 8 countries
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Lindy P. Fox, Esther E. Freeman, George J. Hruza, Junko Takeshita, Jules B. Lipoff, Devon E. McMahon, Bruce H. Thiers, Misha Rosenbach, Carrie L. Kovarik, and Lars E. French
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Coronavirus disease 2019 (COVID-19) ,Adolescent ,Pneumonia, Viral ,Dermatology ,Severity of Illness Index ,Skin Diseases ,Article ,chilblains ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Betacoronavirus ,Young Adult ,0302 clinical medicine ,COVID-19 Testing ,Bias ,Interquartile range ,Severity of illness ,medicine ,Humans ,Registries ,pernio ,Young adult ,Chilblains ,Pandemics ,business.industry ,Clinical Laboratory Techniques ,Foot ,SARS-CoV-2 ,Public health ,public health ,COVID-19 ,Middle Aged ,medicine.disease ,Hand ,Infectious disease (medical specialty) ,030220 oncology & carcinogenesis ,Female ,business ,Coronavirus Infections ,Foot (unit) - Abstract
Background Increasing evidence suggests pernio-like lesions are cutaneous manifestations of coronavirus infectious disease 2019 (COVID-19). Objective To describe clinical and pathologic findings of pernio-like lesions in patients with confirmed or suspected COVID-19. Methods An international dermatology registry was circulated to health care providers worldwide through the American Academy of Dermatology, International League of Dermatologic Societies, and other organizations. Results We documented 505 patients with dermatologic manifestations associated with COVID-19, including 318 (63%) with pernio-like lesions. Patients with pernio-like lesions were generally young and healthy, with relatively mild COVID-19. Of 318 patients with confirmed or suspected COVID-19 by providers, 23 (7%) were laboratory-confirmed COVID-19 positive, and 20 others (6%) were close contacts of patients with confirmed COVID-19. Given current testing criteria, many patients lacked COVID-19 testing access. For 55% of patients, pernio-like lesions were their only symptom. In patients with other COVID-19 symptoms, pernio-like lesions typically appeared after other symptoms. Pernio-like lesions lasted a median of 14 days (interquartile range, 10-21 days). Limitations A case series cannot estimate population-level incidence or prevalence. In addition, there may be confirmation bias in reporting. We cannot exclude an epiphenomenon. Conclusions Pernio-like skin changes of the feet and hands, without another explanation, may suggest COVID-19 infection and should prompt confirmatory testing.
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- 2020
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42. The American Academy of Dermatology COVID-19 registry: Crowdsourcing dermatology in the age of COVID-19
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Esther E. Freeman, George J. Hruza, Junko Takeshita, Lindy P. Fox, Devon E. McMahon, Bruce H. Thiers, Misha Rosenbach, Matthew Fitzgerald, and Lars E. French
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medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,International Cooperation ,Pneumonia, Viral ,Dermatology ,Crowdsourcing ,Skin Diseases ,Betacoronavirus ,Pandemic ,Medicine ,Humans ,Registries ,Pandemics ,Societies, Medical ,biology ,business.industry ,SARS-CoV-2 ,Academies and Institutes ,COVID-19 ,biology.organism_classification ,United States ,Family medicine ,business ,Coronavirus Infections - Published
- 2020
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43. Timing of PCR and Antibody Testing in Patients with COVID-19 associated dermatologic manifestations
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Marlys S. Fassett, Lindy P. Fox, Devon E. McMahon, and Esther E. Freeman
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,biology ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Assay sensitivity ,medicine.disease ,Laboratory results ,Dermatology ,medicine ,biology.protein ,In patient ,Viral shedding ,Antibody ,business ,Chilblains - Abstract
A recent study from Spain noted 40 patients with chilblain-like lesions in suspected COVID-19.1 None tested PCR positive for SARS-CoV-2, but 30% had detectable antibodies. The rapid increase in chilblain/pernio-like cases during the COVID-19 pandemic is likely SARS-CoV-2-associated. The relationship between skin symptom onset and COVID-19 PCR/antibody test timing, however, remains uncharacterized.We established an international registry for cutaneous manifestations of COVID-19.2, 3 Providers reported time between dermatologic symptom onset and positive/negative COVID-19 laboratory results, when available.From 8 April-30 June, 2020, 906 laboratory-confirmed or suspected COVID-19 cases with dermatologic manifestations were reported, 534 of which were chilblains/pernio.3 Among PCR-tested patients, 57%(n=208) overall and 15%(n=23) of chilblains/pernio cases were PCR-positive. Antibody positivity was 37%(n=39) overall and 19%(n=15) for chilblains/pernio.We evaluated 163 patients with timing information on PCR and/or antibody testing (Table 1). For patients with suspected COVID-19 and any cutaneous manifestation, PCR-positive testing occurred median 6 (IQR 1-14) days after dermatologic symptoms started while PCR-negative testing occurred median 14 (IQR 7-24) days later. For patients with pernio/chilblains, PCR-positivity was noted 8 (IQR 5-14) days after symptoms and negativity median 14 (IQR 7-28) days later. Antibody testing (IgM or IgG) was positive median 30 (IQR 19-39) days after symptom onset for all dermatologic manifestations and 27 (IQR 24-33) days after chilblains/pernio onset.Like Hubiche et al, our data highlight the low frequency of SARS-CoV-2 PCR+ testing in COVID-19 patients with cutaneous manifestations. Positive predictive values for COVID-19 PCR are influenced by viral shedding kinetics, which are difficult to assess in non-respiratory presentations.4 Our data reveal that early PCR testing is more likely to be positive than later testing, even when date-of-onset is defined by cutaneous manifestations rather than systemic symptoms.Most COVID-19 antibody data are from systemically-ill patients; the kinetics of antibody production in mild-to-moderate COVID-19 infections remain unclear.5 Here, positive antibodies resulted median 30 days from disease onset, beyond the frequently used 14-21 day testing window. In outpatients with true infection, many factors influence the likelihood of a positive antibody result: antibody production, test availability, assay sensitivity, and timing of care-seeking in relation to symptom-onset. These variables influence our interpretation of individual test results and our understanding of the association between pernio and COVID-19.More population-level testing data is necessary to optimize diagnostic test timing. Positive identification of COVID-19 in minimally-symptomatic patients, including patients with skin findings, is critical to the public health effort.
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- 2020
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44. Global resource shortages during COVID-19: Bad news for low-income countries
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Gregory A. Peters, Louise C. Ivers, Esther E. Freeman, and Devon E. McMahon
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2019-20 coronavirus outbreak ,Resource (biology) ,Asia ,Coronavirus disease 2019 (COVID-19) ,Nosocomial Infections ,Economics ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Ventilators ,Pneumonia, Viral ,RC955-962 ,Developing country ,Social Sciences ,Equipment ,Economic shortage ,Global Health ,Shortages ,Geographical Locations ,Betacoronavirus ,Nepal ,Arctic medicine. Tropical medicine ,Development economics ,Global health ,Medicine and Health Sciences ,Resource Management ,Humans ,Public and Occupational Health ,Developing Countries ,Pandemics ,Personal Protective Equipment ,Ventilators, Mechanical ,SARS-CoV-2 ,Public Health, Environmental and Occupational Health ,Afghanistan ,COVID-19 ,Socioeconomic Aspects of Health ,Viewpoints ,Laboratory Equipment ,Health Care ,Infectious Diseases ,People and Places ,Safety Equipment ,Engineering and Technology ,Health Resources ,Business ,Safety ,Public aspects of medicine ,RA1-1270 ,Coronavirus Infections - Published
- 2020
45. Feasibility and implementation of portable confocal microscopy for point-of-care diagnosis of cutaneous lesions in a low-resource setting
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Robert Lukande, Divya Seth, Aggrey Semeere, Guillermo J. Tearney, Jeffrey N. Martin, Dongkyun Kang, Hany Osman, Devon E. McMahon, R. Rox Anderson, Linda Oyesiku, Milind Rajadhyaksha, Esther E. Freeman, Priscilla Namaganda, Salvador González, and Miriam Laker-Oketta
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medicine.medical_specialty ,Microscopy, Confocal ,Low resource ,business.industry ,Point-of-Care Systems ,MEDLINE ,Dermoscopy ,Dermatology ,Equipment Design ,Skin Diseases ,Article ,law.invention ,Confocal microscopy ,law ,Image Processing, Computer-Assisted ,Medicine ,Feasibility Studies ,Humans ,Medical physics ,Smartphone ,business ,Point of care ,Skin - Published
- 2020
46. Creating Dermatology Guidelines for Covid-19: The Pitfalls of Applying Evidence Based Medicine to an Emerging Infectious Disease
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Esther E. Freeman and Devon E. McMahon
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medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,MEDLINE ,quality assurance ,Communicable Diseases, Emerging ,Article ,Betacoronavirus ,Pandemic ,medicine ,Humans ,Intensive care medicine ,Pandemics ,practice guidelines ,biology ,business.industry ,SARS-CoV-2 ,COVID-19 ,Evidence-based medicine ,biology.organism_classification ,medicine.disease ,United States ,dermatology ,Pneumonia ,medical ethics ,Practice Guidelines as Topic ,Emerging infectious disease ,business ,Coronavirus Infections ,evidence-based medicine - Abstract
The American Academy of Dermatology is modernizing its clinical practice guidelines to be more timely and easily interpretable, while decreasing the influence of conflicts of interest in guideline generation. The main changes include the transition from SORT to GRADE methodology and the requirement that nonconflicted members of the guideline work groups remain nonconflicted throughout the entire guidelines process.
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- 2020
47. Superficial Cutaneous Zygomycosis Presenting as Resistant Intertrigo: A Case Report
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Jason E. Frangos, Devon E McMahon, Mary W Montgomery, and Kristen Hysell
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intertrigo ,0301 basic medicine ,medicine.medical_specialty ,Posaconazole ,Intertrigo ,Human immunodeficiency virus (HIV) ,United States of America ,medicine.disease_cause ,mucormycosis ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Mucor circinelloides ,Mucor ,biology ,business.industry ,Mortality rate ,Mucormycosis ,zygomycosis ,ID Case ,030108 mycology & parasitology ,biology.organism_classification ,medicine.disease ,Dermatology ,posaconazole ,dermatomycoses ,Infectious Diseases ,Oncology ,medicine.symptom ,Zygomycosis ,business ,medicine.drug - Abstract
Zygomycosis is an angioinvasive fungal infection with a high mortality rate. Cutaneous zygomycosis is the second most common form of the disease, typically characterized by necrotic eschars in an immunocompromised host. We report an unusual case of superficial intertrigo resistant to conventional therapies caused by Mucor circinelloides in a patient with HIV and diabetes.
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- 2020
48. The Neglected Hospital - The District Hospital's Central Role in Global Health Care Delivery
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Paul Farmer, Devon E. McMahon, Joseph Rhatigan, and Ruma Rajbhandari
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media_common.quotation_subject ,MEDLINE ,Developing country ,030204 cardiovascular system & hematology ,Global Health ,Health Services Accessibility ,Resource Allocation ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,District hospital ,Global health ,Medicine ,Humans ,Quality (business) ,030212 general & internal medicine ,Developing Countries ,health care economics and organizations ,media_common ,Quality of Health Care ,business.industry ,General Medicine ,Hospitals, District ,Chronic Disease ,Resource allocation ,business ,Delivery of Health Care - Abstract
The Neglected Hospital Advancing emerging surgery, noncommunicable-disease, and quality agendas in global health will be possible only if investments are aimed at strengthening an undervalued compo...
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- 2020
49. Time to address disparities in the standard of care for Kaposi sarcoma
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Miriam Laker-Oketta, Esther E. Freeman, and Devon E. McMahon
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medicine.medical_specialty ,Acquired Immunodeficiency Syndrome ,Standard of care ,Skin Neoplasms ,business.industry ,MEDLINE ,Standard of Care ,General Medicine ,medicine.disease ,Article ,Text mining ,medicine ,Health Resources ,Humans ,Sarcoma ,Intensive care medicine ,business ,Sarcoma, Kaposi - Abstract
BACKGROUND: Optimal treatment regimens for AIDS-associated Kaposi sarcoma, a frequent contributor to morbidity and mortality among people with HIV, have not been systematically evaluated in low-income and middle-income countries, where the disease is most common. In this study, we aimed to investigate optimal treatment strategies for advanced stage disease in areas of high prevalence and limited resources. METHODS: In this open-label, non-inferiority trial, we enrolled people with HIV and advanced stage AIDS-associated Kaposi sarcoma attending 11 AIDS Clinical Trials Group sites in Brazil, Kenya, Malawi, South Africa, Uganda, and Zimbabwe. Eligible participants were randomly assigned (1:1:1) with a centralised computer system to receive either intravenous bleomycin and vincristine or oral etoposide (the investigational arms), or intravenous paclitaxel (the control arm), together with antiretroviral therapy (ART; combined efavirenz, tenofovir disoproxil fumarate, and emtricitabine). The primary outcome was progression-free survival (PFS) at week 48, using a 15% non-inferiority margin to compare the investigational groups against the active control group. Safety was assessed in all eligible treated study participants. The study was registered with ClinicalTrials.gov, NCT01435018. FINDINGS: 334 participants were enrolled between Oct 1, 2013, and March 8, 2018, when the study was closed early due to inferiority of the bleomycin and vincristine plus ART arm, as per the recommendations of the Data and Safety Monitoring Board (DSMB). The etoposide plus ART arm also closed due to inferiority in March, 2016, following a DSMB recommendation. Week-48 PFS rates were higher in the paclitaxel plus ART arm than in both investigational arms. The absolute differences in PFS were –30% (95% CI –52 to –8) for the comparison of paclitaxel plus ART (week 48 PFS 50%, 32 to 67; n=59) and etoposide plus ART (20%, 6 to 33; n=59), and –20% (–33% to –7%) for the comparison of paclitaxel plus ART (64%, 55 to 73; n=138) and bleomycin and vincristine plus ART (44%, 35 to 53; n=132). Both CIs overlapped the non-inferiority margin. The most common adverse events, in 329 eligible participants who began treatment, were neutropenia (48 [15%]), low serum albumin (33 [10%]), weight loss (29 [9%]), and anaemia (28 [9%]), occurring at similar frequency across treatment arms. INTERPRETATION: Non-inferiority of either investigational intervention was not shown, with paclitaxel plus ART showing superiority to both oral etoposide plus ART and bleomycin and vincristine plus ART, supporting its use in treating advanced AIDS-associated Kaposi sarcoma in resource-limited settings.
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- 2020
50. Beyond T Staging in the Treat All Era: Capturing the Severity and Heterogeneity of Kaposi’s Sarcoma in East Africa
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Michael Kanyesigye, Job Kisuya, Helen Byakwaga, Esther E. Freeman, Charles Kasozi, Naftali Busakhala, Devon E. McMahon, Ingrid V. Bassett, Miriam Laker-Oketta, Megan Wenger, Kara Wools-Kaloustian, Philippa Kadama-Makanga, Elyne Rotich, Matthew Semakadde, Jeffrey N. Martin, Aggrey Semeere, and Mwebesa Bwana
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Physical examination ,Disease ,medicine.disease ,Clinical trial ,Acquired immunodeficiency syndrome (AIDS) ,Internal medicine ,medicine ,East africa ,Sarcoma ,Stage (cooking) ,business ,Kaposi's sarcoma - Abstract
BackgroundIn the treat-all era of HIV, Kaposi’s sarcoma (KS) remains one of the most incident cancers in sub-Saharan Africa. The majority of patients with KS are diagnosed at advanced disease stage in this setting. Staging systems for KS, specifically the AIDS Clinical Trials Group (ACTG) system, were developed in the pre-ART era, were not meant to guide treatment, and may not fully capture the clinical heterogeneity of advanced disease. There is no international consensus on which KS patients need chemotherapy in addition to antiretroviral therapy (ART). Understanding KS severity of disease in the current era would help to inform prognosis and clarify treatment guidelines.MethodsWe performed rapid case ascertainment (RCA) on people living with HIV ≥18 years old newly diagnosed with biopsy-proven KS from 2016 to 2019 at three clinic sites in Kenya and Uganda. As close as possible to time of diagnosis, we performed a structured interview, physical examination, and collection of laboratory specimens. We reported KS severity using ACTG and WHO staging criteria, as well as detailed measurements not captured in current staging systems.ResultsWe enrolled 264 adults newly diagnosed with KS. RCA was performed within 1 month of KS diagnosis for 62% of patients and within 6 months for 73% of patients. Patients were 61% Kenyan, 69% male, and with a median age of 35. Median CD4 count was 239 (IQR 87 to 408), with 72% of patients initiating ART greater than 60 days prior to diagnosis. The majority of patients had advanced stage of disease, with 82% qualifying as ACTG T1 and 64% as WHO Severe/Symptomatic KS. There was marked heterogeneity within advanced KS, with 25% of patients having two ACTG qualifiers and 3% of patients had three or more ACTG qualifiers.ConclusionThe majority of patients with KS in this study had advanced stage disease at time of diagnosis, highlighting the need to improve early diagnosis of KS. Within this group of advanced stage patients was large clinical heterogeneity, leading to questions about whether all patients with advanced KS require the same treatment strategy.
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- 2020
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