Nishit Patel - Academia.edu (original) (raw)

Papers by Nishit Patel

Dermatologic Surgery, Aug 1, 2011

PubMed, 2020

The relationship between physicians and pharmaceutical companies has caused the medical community... more The relationship between physicians and pharmaceutical companies has caused the medical community to question the degree to which pharmaceutical interactions and incentives can influence physicians' prescribing habits. Our study aimed to analyze whether a change in institutional policy that restricted the availability of in-office samples for patients resulted in any measurable change in the prescribing habits of faculty physicians in the Department of Dermatology and Cutaneous Surgery at the University of South Florida (USF)(Tampa, Florida). Medical records were retrospectively reviewed for common dermatology diagnoses-acne vulgaris, atopic dermatitis, onychomycosis, psoriasis, and rosacea-before and after the pharmaceutical policy changes, and the prescribed medications were recorded. These medications were then categorized as brand name, generic, and over-the-counter (OTC). Statistical analysis using a mixed effects ordinal logistic regression model accounting for baseline patient characteristics was conducted to determine if a difference in prescribing habits occurred.

PubMed, Nov 16, 2017

Keloids negatively impact the health and quality of life of many affected dermatologic patients. ... more Keloids negatively impact the health and quality of life of many affected dermatologic patients. Treating keloids is often difficult, and suboptimal responses are frequent. Fortunately, there are many treatment options available to the clinician that may lead to improved clinical outcomes. We present a review of currently available therapeutic options. Intralesional steroid injection remains the first-line treatment for keloids. Imiquimod, direct interferon therapy, or intralesional 5-flurouracil may alleviate the need for excessive corticosteroid therapy. Radiation and laser therapy are emerging therapeutic options that have demonstrated efficacy in reviewed studies. Given the unsatisfactory outcomes associated with pressure dressings, vitamin E, ablative laser, and surgical excision, these options should be avoided in keloid management. Further research is needed to evaluate the efficacy and recurrence associated with the reviewed therapeutics.

PubMed, Feb 1, 2013

Pemphigus vulgaris (PV) is a life-threatening autoimmune bullous disorder. Although systemic cort... more Pemphigus vulgaris (PV) is a life-threatening autoimmune bullous disorder. Although systemic corticosteroids are the standard treatment for PV, efficient transition to a steroid-sparing immunosuppressant is critical. There is significant debate in the literature as to what the optimal, first-line steroid-sparing agent should be in patients with PV. Mycophenolate mofetil (MMF), in particular, is a promising agent that should be strongly considered as a first-line steroid-sparing agent. The authors review treatment options for PV and describe a severe case treated successfully with prednisone and MMF as a first-line steroid-sparing agent. The patient's clinical improvement was rapid, and all PV lesions completely resolved. The dosage of prednisone was safely tapered using MMF, and the patient did not experience any flares or significant side effects during the course of treatment. Therapy for PV with systemic corticosteroids and MMF therapy was effective and well tolerated.

Dermatologic Therapy, Feb 12, 2021

Dear Editor, The use of systemic agents is considered standard of care in patients with moderate ... more Dear Editor, The use of systemic agents is considered standard of care in patients with moderate to severe psoriasis, and these therapeutic agents are marked by a favorable risk-benefit profile, however, are plagued by high attrition. One questionnaire-based survey of 692 patients who had previously taken a biologic agent found that patients discontinued their medications after 11 to 20.5 months. Our study aims to present additional real-world clinical data regarding the reasons behind discontinuation of these novel agents and the drug survival in an academic setting. A study cohort of 127 patients seen in a 5-year time frame at the departments of dermatology and/or rheumatology between June 2012 and April 2017 was identified by the following inclusion criteria: age greater than or equal to 18-years-old, visit diagnoses related to psoriasis and/or active psoriatic arthritis identified by ICD-9 and ICD10 codes, and use of etanercept, adalimumab, infliximab, secukinumab, ustekinumab, or apremilast. Patients were excluded if they were taking more than one systemic agent. The primary outcome measure was time to all-cause medication time to discontinuation (TTD) for any reason. Patients were censored if they did not discontinue the treatment at the end of study period, discontinued due to death, or if lost to follow-up. Survival curves were constructed using Kaplan-Meier analysis. Discontinuation was defined as termination of therapy for any reason, subdivided into primary failure (failure to achieve 75% reduction in PASI by week 12-16 of therapy) and secondary failure (loss of effect after time). Drug survival of biologic agents was defined as the time from initiation to discontinuation. The median survival time for all-cause treatment discontinuation was 444 days (95% CI: 361, 525) (Table 1). Secukinumab had the highest survival at 504 days (95% CI [240, undecided]), and adalimumab the lowest at 342 days (95% CI [280, 859]). There was no significant difference in TTD among the novel medications (Figure 1). There was no relationship between medical history and discontinuation (Table 2). Secondary failure was the most frequently reported reason for treatment discontinuation (Table 3). The next most common reason included “other” reasons such as concern for (latent) infection, underlying cancer, and so forth. This is followed by initial lack of efficacy, adverse events, then insurance problems. Patients who experienced initial lack of efficacy had shorter TTD than those in other groups (P < .05). On an individual drug basis, the most common reasons for discontinuation were initial lack of efficacy for apremilast; loss of efficacy for etanercept, adalimumab, ustekinumab, and secukinumab; and adverse events for infliximab (Table 4). Failure of biologic agents is usually due to loss of efficacy. The exception appears to be infliximab, which usually fails due to adverse events. In our study, most drugs similarly tended to fail due to secondary failure. Only infliximab failed most commonly due to adverse events. Some studies have reported significant differences in survival data between these drugs, particularly in favor of ustekinumab. In our study, secukinumab was the agent with the highest median TTD, though not significantly. Other studies report no significant difference in drug survival, coinciding with our study. Others have suggested that female gender, obesity, smoking, and metabolic syndrome are risk factors for treatment failure. None of these were seen in our study. The mechanism behind initial unresponsiveness and loss of response over time is not completely understood, but may be due to the development of autoantibodies or anti-drug antibodies. Limitations include a retrospective study design, small sample size, and variability in sample size for each medication, especially secukinumab. In conclusion, our data suggest that survival of these drugs is comparable, and the choice of agent should be individualized.

Leukemia & Lymphoma, Jul 6, 2017

The role of cutaneous viral infections in the development of non-melanoma skin cancer (NMSC), inc... more The role of cutaneous viral infections in the development of non-melanoma skin cancer (NMSC), including cutaneous squamous cell carcinoma (SCC), among chronic lymphocytic leukemia (CLL) and blood and marrow transplant (BMT) patients is not established. CLL (n=977) and BMT (n=3,587) patients treated at the Moffitt Cancer Center were included in a retrospective cohort study. Human papillomavirus (HPV) and human polyomavirus (HPyV) DNA was examined in a subset of incident SCC tumors. Five year cumulative incidence of NMSC was 1.42% in both BMT (n=31 NMSCs) and CLL (n=18 NMSCs) cohorts. Of the 9 SCC tumors examined from each cohort, 22.2% and 33.3% were positive for viral DNA in the transplant (HPV 65, MCV) and CLL (HPV 38, HPV 15, HPyV6) cohort, respectively. Enhanced skin cancer screening of BMT/CLL patients should be conducted to better capture incident NMSCs and examine the role of viral infections in these tumors.

JAAD case reports, May 1, 2016

Journal of Adolescent Health, Mar 1, 2023

Current Problems in Cancer, Jul 1, 2015

British Journal of Dermatology, Oct 10, 2017

Keratinocyte carcinoma (KC) is the most common type of cancer among white populations, but it is ... more Keratinocyte carcinoma (KC) is the most common type of cancer among white populations, but it is even more common among solid organ transplant recipients (OTRs). The most frequent histological type of KC among OTRs is cutaneous squamous cell carcinoma (cSCC), followed by basal cell carcinoma, although the reverse is seen in the general population. Metastatic cSCCs are more frequent, and mortality is increased compared with immunocompetent populations. There is strong evidence that the risk of KC among OTRs rises with increasing time after transplantation and older age at transplantation, and that KC is enhanced in those with sun-damaged skin. This evidence suggests that accelerated accumulation of genetic damage from several sources leads to excess KC in OTRs. We describe international variation in KC and focus on trends in immunosuppressive regimens, the role of ultraviolet susceptibility and exposure, and the contribution of genetics to tumour development. Further epidemiological studies are needed to address gaps in our understanding of the mediation of excess KC by immunosuppressive drugs, viral infection, genetic susceptibility, timing of relevant ultraviolet exposure or some combination of these factors. What's already known about this topic? • Keratinocyte carcinomas (KCs) are the most commonly occurring cancers among white solid organ transplant recipients (OTRs). • Cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC) account for 90% of KCs. • Increased risks of metastases and mortality are associated with cSCC among OTRs. • Continued long-term studies of immunosuppressive regimens and KC incidence and mortality are needed to assess the overall impact on OTRs. What does this study add? • Epidemiological studies continue to uncover changes in KC trends, identify new targets for treatment or markers of progression, and strengthen strategies to stratify screening groups and identify target groups for more intense surveillance. Nearly 120 000 organs are transplanted per year worldwide (http://www.transplant-observatory.org). The extraordinary benefits of solid organ transplantation include extended lifespan and increased quality of life. Drawbacks include

Cancer Prevention Research, Jul 1, 2020

It is now well accepted that normal-appearing, but chronically UV-exposed skin, can harbor tremen... more It is now well accepted that normal-appearing, but chronically UV-exposed skin, can harbor tremendous mutational loads while maintaining homeostatic function. Even so, clones of keratinocytes harboring tumorigenic mutations can be readily observed using targeted and whole-exome sequencing. Therefore, it may be possible to objectively measure chronic, cumulative UV exposure as a means of predicting skin cancer risk and measuring molecular responses to chemoprevention by identifying UV-driven mutations or damage in epidermal keratinocytes. However, such a methodology requires the ability to noninvasively sample normal, nonlesional skin. We have previously optimized a novel surfactant mixture that, when coupled to ultrasound or mechanical abrasion, can noninvasively sample epidermis without scarring. This process can be tuned to selectively remove epidermis only. Within hours of application, a fibrinous exudate appears over the wound and this area heals completely within 2 weeks without scarring. Using a Hairless UV-driven model of squamous cell carcinoma, we have been able to sample and perform both exome and RNA sequencing with recovery rates of about 2.5-3.5 μg /cm2 of DNA and RNA. Using this model, we demonstrated a dose-dependent increase in mutational load in normal UV-exposed skin that reflects what is seen in humans. Mice were sampled and the DNA exome was sequenced (150X) following exposure to UV. Among the 28 most mutated genes across the exome, mice sampled after 1 month of UV exposure harbored variants in an average of 12 genes. After 3 months of UV exposure, followed by 2 months of no exposure, variants were observed in an average of 22 genes (80%) of the 28, suggesting continuing evolution of clones harboring mutations in exposed epidermis. Interestingly, at this relatively low coverage, none of the genes is strongly associated with skin cancer; instead, many are not expressed, reflecting the expansion of mutational burdens without strong selection on these alterations. We then extended our efforts into humans by sampling immunosuppressed solid organ transplant recipients with markedly elevated risk for skin cancer. Sun-exposed areas had an average of 4.5 times the number of variants than sun-protected areas across targeted exome sequencing of 348 cancer-related genes at a depth of ~5000X. Over 24 genes (including TP53, ATM, NOTCH, and KMT2 family members) were identified with nonsense C-T transitions, suggesting the presence of detectable (and potentially selected) mutational patterns in cancer-related genes that correlate with clinically relevant exposure. Our results collectively suggest that noninvasive sampling and genomic interrogation of normal-appearing epidermis is feasible and potentially useful as a risk prediction and chemoprevention assessment tool. This approach is easily extended to other surface epithelia, and we are currently enhancing the sensitivity of this assay based on identification of hotspots and nontranscribed genes as identified in our model. This abstract is also being presented as Poster A32. Citation Format: Kenneth Y. Tsai, Elnara Muradova, Sandy S. Ojeda, Charles H. Adelmann, Kimberly Nguyen, Samir Mitragotri, Nishit Patel. Noninvasive epidermal sampling as a means of genomic UV dosimetry [abstract]. In: Proceedings of the AACR Special Conference on Environmental Carcinogenesis: Potential Pathway to Cancer Prevention; 2019 Jun 22-24; Charlotte, NC. Philadelphia (PA): AACR; Can Prev Res 2020;13(7 Suppl): Abstract nr PR08.

International journal of engineering trends and technology, Apr 25, 2019

The primary objective is to design a chemical plant for the production of nitric acid by ammonia ... more The primary objective is to design a chemical plant for the production of nitric acid by ammonia oxidation process. Firstly, the description about the need of process design and which process to choose among the available for the production. Next step is performing material and energy balance for all equipment. Further, designing of all major equipment of the plant has to be done, followed by utilities and finally, the economic feasibility of the project has to be checked.

Australasian Journal of Dermatology, 2013

Journal of AOAC International, Jan 27, 2023

Medical Gas Research

Calcium ion-releasing ability of different calcium hydroxide-based pulp capping materials was com... more Calcium ion-releasing ability of different calcium hydroxide-based pulp capping materials was comparatively evaluated in this study. Different brands of cements were taken from different manufacturers and categorized into three groups. Three different brands of Ca(OH) 2 cements (Dycal, TheraCal, and Cal LC) were taken prepared by mixing and curing the cements as per the manufacturer's instructions. Consequently, ion release was measured after 7, 14, and 21 days by argon-based induction coupled plasma mass spectroscopy test. Within the limitations of this study, light-cured Ca(OH) 2 cements released a higher amount of calcium ions compared with self-cured Ca(OH) 2 cements. Theracal was found to be the highest light-cured calcium ion releasing materials throughout the period of 21 days. In conclusion, further clinical studies are warranted to substantiate the findings of this study.

Asian Pacific Journal of Reproduction, 2022

Objective: To evaluate the effect of methanolic extract and ethyl acetate fraction of methanol ex... more Objective: To evaluate the effect of methanolic extract and ethyl acetate fraction of methanol extract prepared from the seeds of Blepharis (B.) persica on testosterone biosynthesis and also to elucidate the underlying mechanism. Methods: Forty-eight male Wistar rats were divided into eight groups (n=6 per group). Group I received 0.3% w/w gum acacia suspension p.o. and served as the normal control group. Group II was administered testosterone propionate in arachis oil i.m. as the positive control group. Group III to V received B. persica methanolic extract p.o. at doses of 50, 100 and 200 mg/kg body weight. Group VI to VIII received B. persica ethyl acetate fraction p.o. at doses of 50, 100 and 200 mg/kg body weight. The testis was used for biochemical estimation and histological studies. The effects of methanolic extract and ethyl acetate fraction of B. persica on testicular testosterone, mRNA expression corresponding to steroidogenic acute regulatory protein (StAR) and 3β-hydroxysteroid dehydrogenase (3β-HSD) along with 3β-HSD enzyme assay were evaluated in testicular tissues and sperm concentration. Ethyl acetate fraction of B. persica was subjected to column chromatography. In-vitro studies were performed using TM3 cell line at three dose levels (50, 100, 200 μg/mL), each for methanolic extract, ethyl acetate fraction and 2-benzoxazolinone for evaluation of their comparative effect on testosterone production. Results: Ethyl acetate fraction and methanolic extract of B. persica could elevate the testicular testosterone content compared to the normal control group. The treatment with methanolic extract and ethyl acetate fraction of B. persica increased the expression of mRNA corresponding to StAR by 6.7 fold and 10.6 fold, respectively, whereas the mRNA expression of 3β-HSD increased by 5.7 fold and 7.3 fold, respectively. Moreover, fraction and extract treatment exhibited increased 3β-HSD activity in the testicular tissues and were found to elevate sperm concentration in seminal fluid. The spermatogenic potential was further ensured by histological observations. 2-benzoxazolinone was isolated from ethyl acetate fraction and identified using spectral studies. It showed the ability to increase the testosterone content in the TM3 Leydig cells. Conclusions: Methanolic extract and ethyl acetate fraction of B. persica are able to increase the testicular testosterone in rats by elevating mRNA expression of StAR and 3β-HSD in testicular tissues, leading to increase the sperm concentration.

This project aims to develop and fabrication of an automatic tyre inflating system, this system e... more This project aims to develop and fabrication of an automatic tyre inflating system, this system ensures that tyres are properly inflated at all times. Roads are the most important modes of transport, now a days cars are integral part of it. Tyres lose air through normal driving-especially when run through pot holes and permeation. Considering today's ever increasing environmental threats; oil price hikes and energy consumption our system is most compatible and potential improvement in gas mileage and tyre wear reduction which leads to an increase in performance of tyre in diverse conditions. Moreover temperature changes are also one of the reason due to which tyres lose air. Thus vehicles run with an under-inflated tyre which may cause accidents. Studies show that a drop in tyre pressure by just a few PSI, can result in the reduction of gas mileage, tyre life, safety, and vehicle performance. The project aims to restore the tyre pressure on vehicles so that they are kept at optimum pressure levels, thus extending their life time at the same time saving the owner from fuel costs and maintenance cost incurred with underinflated tyres. IndexTerms-Arduino, GUI, Android.

Pediatric Emergency Care, 2020

Objectives The objective of this study was to estimate the width, height, and depth of the femora... more Objectives The objective of this study was to estimate the width, height, and depth of the femoral vein (FV) and internal jugular vein (IJV), both sites of potential central line placement in children, using point-of-care ultrasound. Methods This was a prospective observational study. Point-of-care ultrasound was used to measure the width, height, and depth of the right FV and IJV in 100 children. The primary outcome was a comparison of the widths of the FV and the IJV in the same child. Our primary hypothesis was that the IJV would be wider than the FV. Secondary outcome measures included comparison of the heights and depths the FV and IJV and description of vessel overlap frequency between the 2 sites. Results A total of 106 children were enrolled, with 6 subjects excluded, and equally divided into 5 age groups (0–30 days, 1–24 months, 2–5 years, 6–11 years, and 12–17 years). The FV/IJV width ratios (95% confidence interval) by age were 0.58 (0.49–0.68), 0.53 (0.43–0.66), 0.57 (0....