Abraar Karan, MD MS MPH DTM&H

All Publications

• The need for point-of-care tests for mpox. Lancet (London, England) Dhillon, R. S., Karan, A., Srikrishna, D., Mombouli, J. V. 2024

  View details for DOI 10.1016/S0140-6736(24)01825-7

  View details for PubMedID 39250918

• Enhancing wastewater testing for H5N1 surveillance. The Lancet. Infectious diseases Dhillon, R. S., Karan, A., Srikrishna, D. 2024

  View details for DOI 10.1016/S1473-3099(24)00503-6

  View details for PubMedID 39151442

• Treatment of Mpox with Suspected Tecovirimat Resistance in Immunocompromised Patient, United States, 2022 EMERGING INFECTIOUS DISEASES Contag, C. A., Mische, L., Fong, I., Karan, A., Vaidya, A., Mccormick, D. W., Bower, W., Hacker, J. K., Johnson, K., Sanjuan, P., Crebbin, L., Temmins, C., Sahni, H., Bogler, Y., Cooper, J. D., Narasimhan, S. 2023; 29 (12): 2520-2523

  Abstract

  Reports of tecovirimat-resistant mpox have emerged after widespread use of antiviral therapy during the 2022 mpox outbreak. Optimal management of patients with persistent infection with or without suspected resistance is yet to be established. We report a successfully treated case of severe mpox in California, USA, that had suspected tecovirimat resistance.

  View details for DOI 10.3201/eid2912.230849

  View details for Web of Science ID 001113404100022

  View details for PubMedID 37856215

  View details for PubMedCentralID PMC10683816

• Surveillance of complicated mpox cases unresponsive to oral tecovirimat in Los Angeles County, 2022. The Journal of infectious diseases Karan, A., Shah, N., Garrigues, J. M., Alarcόn, J., Hemarajata, P., Finn, L. E., Poortinga, K., Danza, P., Kulkarni, S., Kim, M., Terashita, D., Green, N. M., Balter, S. 2023

  Abstract

  The Los Angeles County Department of Public Health established a surveillance system to identify complicated (advanced HIV or hospitalized) mpox cases. From August 1st to November 30th, 2022, we identified 1,581 mpox cases of which 134 were complicated (8.5%). A subset of eight cases did not recover after either initiating or completing a course of oral tecovirimat. All eight patients were HIV positive and had advanced HIV (CD4 <200 cells/mm3). We identified eight distinct mutations previously associated with tecovirimat resistance in specimens collected from six patients. Ongoing surveillance of viral evolution requires close coordination between health departments and front-line providers.

  View details for DOI 10.1093/infdis/jiad517

  View details for PubMedID 37995310

• Community spread of a human monkeypox virus variant with a tecovirimat resistance-associated mutation. Antimicrobial agents and chemotherapy Garrigues, J. M., Hemarajata, P., Espinosa, A., Hacker, J. K., Wynn, N. T., Smith, T. G., Gigante, C. M., Davidson, W., Vega, J., Edmondson, H., Karan, A., Marutani, A. N., Kim, M., Terashita, D., Balter, S. E., Hutson, C. L., Green, N. M. 2023: e0097223

  View details for DOI 10.1128/aac.00972-23

  View details for PubMedID 37823631

• Monitoring routes of transmission for human mpox LANCET Karan, A., Contag, C. A., Pinksy, B. 2023; 402 (10402): 608-609

  View details for Web of Science ID 001061845100001

• Health inequities continue to drive the public health threat of mpox. BMJ (Clinical research ed.) Karan, A., Contag, C., Barry, M. 2023; 381: p1391

  View details for DOI 10.1136/bmj.p1391

  View details for PubMedID 37353231

• Identification of Tecovirimat Resistance-Associated Mutations in Human Monkeypox Virus - Los Angeles County. Antimicrobial agents and chemotherapy Garrigues, J. M., Hemarajata, P., Karan, A., Shah, N. K., Alarcón, J., Marutani, A. N., Finn, L., Smith, T. G., Gigante, C. M., Davidson, W., Wynn, N. T., Hutson, C. L., Kim, M., Terashita, D., Balter, S. E., Green, N. M. 2023: e0056823

  View details for DOI 10.1128/aac.00568-23

  View details for PubMedID 37338408

• Prevalence of Mpox (Monkeypox) in patients undergoing STI screening in northern California, April-September 2022. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology Contag, C. A., Renfro, Z. T., Lu, J., Shen, S., Karan, A., Solis, D., Huang, C., Sahoo, M. K., Yamamoto, F., Jones, M. S., Lin, J., Levy, V., Pinsky, B. A. 2023; 164: 105493

  Abstract

  Despite the sharp increase in mpox (formerly monkeypox) incidence and the wide geographic spread of mpox during the 2022 outbreak, the community prevalence of infection remains poorly characterized. This study is a retrospective epidemiologic survey to estimate mpox prevalence.Samples obtained for sexually transmitted infection (STI) testing from April to September 2022 in the public hospital and clinic system of San Mateo County, California were screened for mpox virus (MPXV) using polymerase chain reaction.16/1,848 samples from 11/1,645 individuals were positive for MPXV by qPCR. 4/11 individuals with positive MPXV testing were cisgender women, 2 of whom were pregnant at the time of sample collection. Both deliveries were complicated by chorioamnionitis. Anorectal and oropharyngeal samples were the most likely to be positive for MPXV (4/60 anorectal samples and 4/66 oropharyngeal samples compared with 5/1,264 urine samples and 3/445 vaginal samples).Our study is one of the first epidemiologic surveys for MPXV infection outside of sexual health/STI clinic settings. Relatively high rates of MPXV from oropharyngeal and anorectal samples reinforces the importance of MPXV testing at various anatomic sites, particularly if patients are presenting with non-lesional symptoms (pharyngitis, proctitis). However, the United States Food and Drug Administration (FDA) has not yet authorized non-lesional MPXV testing. The identification of MPXV in women in our cohort suggests that the rates of mpox in women may have previously been underestimated and highlights the risk of pregnancy complications associated with mpox.

  View details for DOI 10.1016/j.jcv.2023.105493

  View details for PubMedID 37220710

  View details for PubMedCentralID PMC10184869

• Retrospective Screening of Clinical Samples for Monkeypox Virus DNA, California, USA, 2022. Emerging infectious diseases Contag, C. A., Lu, J., Renfro, Z. T., Karan, A., Salinas, J. L., Khan, M., Solis, D., Sahoo, M. K., Yamamoto, F., Pinsky, B. A. 2023; 29 (4): 848-850

  Abstract

  We retrospectively screened oropharyngeal and rectal swab samples originally collected in California, USA, for Chlamydia trachomatis and Neisseria gonorrhoeae testing for the presence of monkeypox virus DNA. Among 206 patients screened, 17 (8%) had samples with detectable viral DNA. Monkeypox virus testing from mucosal sites should be considered for at-risk patients.

  View details for DOI 10.3201/eid2904.221576

  View details for PubMedID 36918374

  View details for PubMedCentralID PMC10045697

• Lack of preparedness for the next pandemic is an emergency. BMJ (Clinical research ed.) Karan, A. 2023; 380: p489

  View details for DOI 10.1136/bmj.p489

  View details for PubMedID 36858452

• Case Report: Monkeypox - Not Just a Rash. The American journal of tropical medicine and hygiene Contag, C. A., Karan, A., Studemeister, L., Bansil, R., Fong, I., Srinivasan, K., Salinas, J. L., Narasimhan, S., Cooper, J. D., Sahni, H. 2023

  Abstract

  Mpox (formally monkeypox) is an Orthopoxvirus associated with both zoonotic and person-to-person spread. Human mpox classically presents with rash and systemic symptoms. Although sporadic outbreaks of mpox have occurred worldwide, the 2022 outbreak is the first of pandemic significance. Thousands of geographically dispersed cases were reported beginning in May 2022. The clinical presentations and outcomes of mpox infection have varied greatly based on viral clade. Further guidance is needed for clinicians to diagnose and treat this emerging infection. We present five clinical vignettes of confirmed cases diagnosed in June and July 2022 in northern California to demonstrate the range of mpox disease, including myocarditis, pharyngitis, epididymitis, and proctitis. We note a significant overlap with HIV infection and a high rate of concurrent sexually transmitted infection. Given the heterogenous presentations of mpox disease, clinicians should maintain a high degree of suspicion in patients with oropharyngeal or genital lesions, proctitis, or new rash.

  View details for DOI 10.4269/ajtmh.22-0626

  View details for PubMedID 36716741

• Air quality disasters aren't going away. Here's how we can protect ourselves. Karan, A., et al LA Times. 2023
• SARS-CoV-2 Reduction in Shared Indoor Air. JAMA Srikrishna, D., Karan, A., Dhillon, R. S. 2022; 328 (21): 2162-2163

  View details for DOI 10.1001/jama.2022.18028

  View details for PubMedID 36472600

• Occupational Monkeypox Virus Transmission to Healthcare Worker, California, USA, 2022. Emerging infectious diseases Alarcón, J., Kim, M., Balanji, N., Davis, A., Mata, F., Karan, A., Finn, L. E., Guerrero, A., Walters, M., Terashita, D., Balter, S. E. 2022; 29 (2)

  Abstract

  Risk for transmission of monkeypox virus (MPXV) (clade IIb) to healthcare workers (HCWs) is low. Although many cases have been reported among HCW, only a few have been occupationally acquired. We report a case of non-needle stick MPXV transmission to an HCW in the United States.

  View details for DOI 10.3201/eid2902.221750

  View details for PubMedID 36469326

• Overcoming "failures of imagination"-rethinking the US covid-19 pandemic response. BMJ (Clinical research ed.) Dhillon, R., Karan, A. 2022; 379: o2397

  View details for DOI 10.1136/bmj.o2397

  View details for PubMedID 36198405

• Human Monkeypox without Viral Prodrome or Sexual Exposure, California, USA, 2022. Emerging infectious diseases Karan, A., Styczynski, A. R., Huang, C., Sahoo, M. K., Srinivasan, K., Pinsky, B. A., Salinas, J. L. 2022; 28 (10)

  Abstract

  We report human monkeypox in a man who returned to the United States from the United Kingdom and reported no sexual contact. He had vesicular and pustular skin lesions but no anogenital involvement. The potential modes of transmission may have implications for the risk of spread and for epidemic control.

  View details for DOI 10.3201/eid2810.221191

  View details for PubMedID 35971952

• Lack of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission from a healthcare worker to a cohort of immunosuppressed patients during the SARS-CoV-2 omicron variant surge, California, 2022. Infection control and hospital epidemiology Karan, A., Ferguson, J., Salinas, J. L. 2022: 1-2

  View details for DOI 10.1017/ice.2022.175

  View details for PubMedID 35794737

• The covid-19 pandemic will end with public health tools, not clinical ones. BMJ (Clinical research ed.) Karan, A. 2022; 377: o1561

  View details for DOI 10.1136/bmj.o1561

  View details for PubMedID 35750340

• We need more support and less normalcy to stop airborne viruses. BMJ (Clinical research ed.) Karan, A. 2022; 377: o976

  View details for DOI 10.1136/bmj.o976

  View details for PubMedID 35418446

• We cannot afford to repeat these four pandemic mistakes. BMJ (Clinical research ed.) Karan, A. 2022; 376: o631

  View details for DOI 10.1136/bmj.o631

  View details for PubMedID 35587391

• What the face mask debacle can teach us about pandemic response. BMJ (Clinical research ed.) Karan, A. 1800; 376: o85

  View details for DOI 10.1136/bmj.o85

  View details for PubMedID 35022183

• Covid-19: An urgent call for global "vaccines-plus" action BMJ-BRITISH MEDICAL JOURNAL Greenhalgh, T., Griffin, S., Gurdasani, D., Hamdy, A., Katzourakis, A., McKee, M., Michie, S., Pagel, C., Roberts, A., Yates, K., Alwan, N., Agius, R., Ahmed, H., Ashworth, S., Augst, C., Bacon, S. L., Bergholtz, E. J., Blanchflower, D., Bosman, A., Ben Alaya, N., Brown, K., Butler, M., Byrne, M., Cacciola, R., Cane, D. J., Cascini, F., Chahed, M., Cheng, K. K., Costello, A., Morris, A., Davies, R., Davis, C., Delaney, B., Dewald, D., Drew, D., Ewing, A., Drury, J., Fisman, D., Friel, S., Gasperowicz, M., Grimes, D., Haque, Z., Haseltine, W. A., Hegarty, O., Hodes, S., Hughes, E., Hyde, Z., Iannattone, L., Jadad, A. R., Jha, N., Jimenez, J., Jimenez, J., Johnson, J., Karan, A., Khunti, K., Khuri-Bulos, N., Kim, W., Knight, M. J., Lavoie, K. L., Lawton, T., Lazarus, J. V., Leonardi, A., Leshem, E., Lightstone, L., Markov, P. V., Martin-Moreno, J. M., Meier, P., Mesiano-Crookston, J., Mishra, A., Moore, M., Moschos, S. A., Naylor, C., Nichols, T., Nicholl, D., Norheim, O. F., Oliver, M., Peters, C., Pillay, D., Pimenta, D., Pirzada, K., Pope, C., Prather, K. A., Preest, G., Quereshi, Z., Rabiei, K., Ray, J., Reddy, K., Ricciardi, W., Rice, K., Robertson, E., Roberts, K., Ryan, T., Salisbury, H., Scally, G., Schooley, R. T., Shah, V., Silver, J., Silvey, N., Sivan, M., Souza, L., Staines, A., Tomlinson, D., Tukuitonga, C., Vincent, C., Vipond, J., West, R., Weyand, A. C., Ziauddeen, H., World Federation Public Hlth Assoc 2022; 376: o1

  View details for DOI 10.1136/bmj.o1

  View details for Web of Science ID 000740515600001

  View details for PubMedID 34980603

• Preventing SARS-CoV-2 Transmission in Health Care Settings in the Context of the Omicron Variant. JAMA Klompas, M., Karan, A. 2022

  View details for DOI 10.1001/jama.2022.0262

• The Biden Administration is wrong. Many N95 masks are comfortable- and they work. Karan, A., Srikrishna, D., Dhillon, R. Washington Post. 2022
• It’s time to redouble and refocus our efforts to fight covid, not retreat multi-author letter, n., et al BMJ. 2022
• Don't pretend we are back to normal. Fight for cleaner air to prevent COVID. Karan, A., SriKrishna, S., Dhillon, R. LA Times. 2022
• Polio is back-- aided by global health failures that spread COVID and monkeypox Karan, A., Maldonado, B. LA Times. 2022
• Why Masks Still Matter Karan, A., Yamey, G. TIME. 2022
• The Omicron Wave Is Receding But the Pandemic Is Far From Over Yamey, G., Karan, A., Dhillon, R. TIME Magazine. 2022
• How an outbreak became a pandemic: a chronological analysis of crucial junctures and international obligations in the early months of the COVID-19 pandemic. Lancet (London, England) Singh, S., McNab, C., Olson, R. M., Bristol, N., Nolan, C., Bergstrom, E., Bartos, M., Mabuchi, S., Panjabi, R., Karan, A., Abdalla, S. M., Bonk, M., Jamieson, M., Werner, G. K., Nordstrom, A., Legido-Quigley, H., Phelan, A. 2021

  Abstract

  Understanding the spread of SARS-CoV-2, how and when evidence emerged, and the timing of local, national, regional, and global responses is essential to establish how an outbreak became a pandemic and to prepare for future health threats. With that aim, the Independent Panel for Pandemic Preparedness and Response has developed a chronology of events, actions, and recommendations, from December, 2019, when the first cases of COVID-19 were identified in China, to the end of March, 2020, by which time the outbreak had spread extensively worldwide and had been characterised as a pandemic. Datapoints are based on two literature reviews, WHO documents and correspondence, submissions to the Panel, and an expert verification process. The retrospective analysis of the chronology shows a dedicated initial response by WHO and some national governments, but also aspects of the response that could have been quicker, including outbreak notifications under the International Health Regulations (IHR), presumption and confirmation of human-to-human transmission of SARS-CoV-2, declaration of a Public Health Emergency of International Concern, and, most importantly, the public health response of many national governments. The chronology also shows that some countries, largely those with previous experience with similar outbreaks, reacted quickly, even ahead of WHO alerts, and were more successful in initially containing the virus. Mapping actions against IHR obligations, the chronology shows where efficiency and accountability could be improved at local, national, and international levels to more quickly alert and contain health threats in the future. In particular, these improvements include necessary reforms to international law and governance for pandemic preparedness and response, including the IHR and a potential framework convention on pandemic preparedness and response.

  View details for DOI 10.1016/S0140-6736(21)01897-3

  View details for PubMedID 34762857

• The Risk of SARS-CoV-2 Transmission from Patients with Undiagnosed Covid-19 to Roommates in a Large Academic Medical Center. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Karan, A., Klompas, M., Tucker, R., Baker, M., Vaidya, V., Rhee, C., CDC Prevention Epicenters Program 2021

  Abstract

  We assessed SARS-CoV-2 transmission between patients in shared rooms in an academic hospital between September 2020-April 2021. 11,290 patients were admitted to shared rooms, of whom 25 tested positive. Among 31 exposed roommates, 12 (39%) tested positive within 14 days. Transmission was associated with PCR cycle thresholds ≤21.

  View details for DOI 10.1093/cid/ciab564

  View details for PubMedID 34145449

• Rethinking vaccine hesitancy among minority groups. Lancet (London, England) Khan, M. S., Ali, S. A., Adelaine, A., Karan, A. 2021

  View details for DOI 10.1016/S0140-6736(21)00938-7

  View details for PubMedID 33894143

• Why should healthy front-line workers get vaccine boosters? Not to protect themselves. Karan, A. Washington Post. 2021
• The pandemic is out of control in India. These quick interventions would help. Bhadra, A., Karan, A., Srikrishna, D., Dhillon, R. Washington Post. 2021
• Herd immunity is not a helpful concept for Covid19. It's time to retire it. Karan, A., Parsonnet, J. Washington Post. 2021
• The CDC's latest blunder is really about trust, not masks Karan, A. STAT News. 2021
• A natural pandemic has been terrible. A synthetic one would be even worse Karan, A., Luby, S. STAT News. 2021
• What a recent Covid-19 flight outbreak tells us about spread on planes Karan, A. Vox. 2021
• America needs better masks to fight Covid-19 Karan, A., Dhillon, R., Srikrishna, D. CNN. 2021
• Along with vaccine rollouts, the U.S. needs a National Hi-Fi Mask Initiative Karan, A., Dhillon, R., Srikrishna, D. STAT News. 2021
• The government can — and should — send high-quality masks to every American Dhillon, R., Karan, A., Beier, D., Srikrishna, D. Washington Post. 2021
• Give people better tools to stop viral transmission, and trust that they will use them Karan, A. British Medical Journal. 2021
• Vaccines are great, but testing and tracing will stamp out transmission Karan, A., Dhillon, R. Washington Post. 2021
• How to Protect Yourself Against Coronavirus Variants Karan, A. New York Times. 2021
• Why We're Terrible At Weighing The Risks Of The J&J Vaccine Karan, A., Katz, I., Zeckhauser, R. NPR (Boston)/ WBUR. 2021
• Solving global vaccine inequity requires new incentives for pharmaceutical companies Karan, A., Pogge, T. British Medical Journal. 2021
• How Covid reveals the hypocrisy of the global health experience. Karan, A. NPR. 2021
• I'm a doctor in the US, fighting to save my family in India from covid Karan, A. Washington Post. 2021
• Healthcare System Stress Due to Covid-19: Evading an Evolving Crisis. Journal of hospital medicine Karan, A., Wadhera, R. K. 2021; 16 (2): 127

  View details for DOI 10.12788/jhm.3583

  View details for PubMedID 33523798

• Mitigating trafficking of migrants and children through disaster risk reduction: Insights from the Thailand flood International Journal of Disaster Risk Reduction Stoklosa, H., Burns, C. J., Karan, A., et al 2021; 60
• There is no stopping covid-19 without stopping racism. BMJ (Clinical research ed.) Karan, A., Katz, I. 2020; 369: m2244

  View details for DOI 10.1136/bmj.m2244

  View details for PubMedID 32518097

• To control the covid-19 outbreak, young, healthy patients should avoid the emergency department BMJ-BRITISH MEDICAL JOURNAL Karan, A. 2020; 368: m1040

  View details for DOI 10.1136/bmj.m1040

  View details for Web of Science ID 000523762400004

  View details for PubMedID 32184232

• The responsibility and potential of public health. Lancet (London, England) Dhillon, R. S., Karan, A. 2020; 395 (10217): 29

  View details for DOI 10.1016/S0140-6736(19)31911-7

  View details for PubMedID 31908278

• How Should Global Health Security Priorities Be Set in the Global North and West? AMA journal of ethics Karan, A. 2020; 22 (1): E50-54

  Abstract

  Epidemics threaten all countries, yet epidemic responses are not implemented in all countries. One reason why is that transnational disease containment efforts (to keep diseases from spreading across borders) differ in important ways from efforts to protect those in countries where an epidemic is active. This article explores these 2 approaches to global health security and suggests reasons to reconsider prioritizing the former first.

  View details for DOI 10.1001/amajethics.2020.50

  View details for PubMedID 31958391

• Culture, Context, and Epidemic Containment --, N. AMA Journal of Ethics. 2020
• Coronavirus—containing the parallel epidemics of xenophobia and misinformation Karan, A. British Medical Journal. 2020
• If You Get Critically Ill With COVID-19, How Far Should Doctors Go To Keep You Alive? Karan, A., Shannon, E. NPR (Boston)/ WBUR. 2020
• Covid-19—on trust, experts, and the brilliance of everyday people Karan, A. British Medical Journal. 2020
• The thankless task of social distancing Karan, A. Vox. 2020
• If you get covid-19, leaving your house may be the best way to protect your family Karan, A. Washington Post. 2020
• A Plan to Safely Reopen the U.S. Despite Inadequate Testing Dhillon, R., Karan, A., Beier, D., Sullivan, A., Chowell, G., Chowell, D., Srikrishna, D. Harvard Business Review. 2020
• Alone with our patients in a pandemic Karan, A. British Medical Journal. 2020
• A doctor on how to make Covid-19 decisions when so much is unknown Karan, A. Vox. 2020
• We Need Better Masks Dhillon, R., Karan, A., Beier, D., Srikrishna, D. Harvard Business Review. 2020
• Sports can’t restart safely right now Karan, A., Dhillon, R. Washington Post. 2020
• We could control the coronavirus by winter if we start using rapid tests Dhillon, R., Karan, A., Srikrishna, D. Washington Post. 2020
• The U.S. Needs Smarter Lockdowns. Now. Dhillon, R., Karan, A. Harvard Business Review. 2020
• We can’t stop covid-19 if we don’t know where and why it’s spreading Dhillon, R., Karan, A. Washington Post. 2020
• Trump’s case should not change how we think about covid-19 Karan, A. Washington Post. 2020
• It's Easy To Say, 'Wear A Mask'. But People Need More Advice On Managing The Risk Of COVID-19 Karan, A., Dhillon, R. NPR (Boston)/ WBUR. 2020
• Essential Workers Need Better Masks Srikrishna, D., Karan, A., Beier, D., Dhillon, R. Harvard Business Review. 2020
• To Solve The Pandemic, Biden Must Focus On Equity Karan, A., Dhillon, R., Walton, D., Katz, I. NPR. 2020
• Stigma is making the COVID-19 pandemic more invisible Karan, A. Boston Globe. 2020
• Pandemics are stopped by people—here’s what we, as individuals, can still do Karan, A. British Medical Journal. 2020
• Responding to Global Public Health Crises Karan, A. AMA Journal of Ethics. 2020
• A perpendicular framing for global health LANCET Dhillon, R. S., Karan, A., Marten, R. 2019; 394 (10210): 1708

  View details for DOI 10.1016/S0140-6736(19)32464-X

  View details for Web of Science ID 000496920300018

  View details for PubMedID 31630792

• It's Time To End The Colonial Mindset In Global Health Karan, A. NPR. 2019
• Should you be worried about Ebola? It depends on where you live Karan, A. Los Angeles Times. 2019
• The Blind Men and the Elephant - Aligning Efforts in Global Health NEW ENGLAND JOURNAL OF MEDICINE Dhillon, R. S., Karan, A. 2018; 378 (15): 1374–75

  View details for DOI 10.1056/NEJMp1800883

  View details for Web of Science ID 000429718500003

  View details for PubMedID 29641955

• Does the Stockholm Syndrome affect female sex workers? The case for a "Sonagachi Syndrome" BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS Karan, A., Hansen, N. 2018; 18: 10

  Abstract

  Female sex workers are subjected to intense physical, sexual, and mental abuses that are well documented in the medical and public health literature. However, less well-studied are the mental coping mechanisms that are employed by women in this population to survive. The Stockholm Syndrome has been discussed in the news media as a potential phenomenon in this vulnerable population, but has not been formally studied. From a previous retrospective qualitative analysis reviewing interviews with women in sex work throughout India, we found that the four main criteria for Stockholm Syndrome (perceived threat to survival; showing of kindness from a captor; isolation from other perspectives; perceived inability to escape) are present in narrative accounts from this population. Thus, we propose that Stockholm Syndrome should be considered as a contributing phenomenon with regard to the psychological challenges faced by female sex workers, and can likely help guide interventions accordingly.

  View details for DOI 10.1186/s12914-018-0148-4

  View details for Web of Science ID 000424676700001

  View details for PubMedID 29409491

  View details for PubMedCentralID PMC5802051

• Caring about the Congo shouldn't require an Ebola epidemic Karan, A. Boston Globe. 2018
• We Need to Stop Ebola for the Right Reasons Karan, A., Mukherjee, J. PLoS Global Health Blog (discontinued). 2018
• The Most Important Tool For Doctors Fighting DRC’s Ebola Crisis Isn’t Medicine Karan, A. Huffington Post. 2018
• Ebola In The DRC Is More About The DRC Than It Is About Ebola Karan, A., Katz, I., Jha, A. Health Affairs. 2018
• Global general pediatric surgery partnership: The UCLA-Mozambique experience JOURNAL OF PEDIATRIC SURGERY Amado, V., Martins, D. B., Karan, A., Johnson, B., Shekherdimian, S., Miller, L. T., Taela, A., DeUgarte, D. A. 2017; 52 (9): 1528–33

  Abstract

  There has been increasing recognition of the disparities in surgical care throughout the world. Increasingly, efforts are being made to improve local infrastructure and training of surgeons in low-income settings. The purpose of this study was to review the first 5-years of a global academic pediatric general surgery partnership between UCLA and the Eduardo Mondlane University in Maputo, Mozambique.A mixed-methods approach was utilized to perform an ongoing needs assessment. A retrospective review of admission and operative logbooks was performed. Partnership activities were summarized.The needs assessment identified several challenges including limited operative time, personnel, equipment, and resources. Review of logbooks identified a high frequency of burn admissions and colorectal procedures. Partnership activities focused on providing educational resources, on-site proctoring, training opportunities, and research collaboration.This study highlights the spectrum of disease and operative case volume of a referral center for general pediatric surgery in sub-Saharan Africa, and it provides a context for academic partnership activities to facilitate training and improve the quality of pediatric general surgical care in limited-resource settings.Level IV.

  View details for DOI 10.1016/j.jpedsurg.2016.12.026

  View details for Web of Science ID 000410651900029

  View details for PubMedID 28087136

  View details for PubMedCentralID PMC5498270

• The potential for political leadership in HIV/AIDS communication campaigns in Sub-Saharan Africa GLOBAL HEALTH ACTION Karan, A., Hartford, E., Coates, T. J. 2017; 10: 1–7

  Abstract

  The HIV/AIDS epidemic has become a point of important political concern for governments especially in Sub-Saharan Africa. Clinical and public health interventions to curb the epidemic can be greatly enhanced with the strategic support of political leaders.We analyzed the role of national political leadership in large-scale HIV/AIDS communications campaigns in 14 countries in Sub-Saharan Africa.We primarily reviewed grey and white literature published from 2005-2014. We further triangulated data from in-person and phone interviews with key public health figures.A number of themes emerged supporting political leaders' efforts toward HIV/AIDS program improvement, including direct involvement of public officials in campaign spearheading, the acknowledgment of personal relationship to the HIV epidemic, and public testing and disclosure of HIV status. Areas for future improvement were also identified, including the need for more directed messaging, increased transparency both nationally and internationally and the reduction of stigmatizing messaging from leaders.The political system has a large role to play within the healthcare system, particularly for HIV/AIDS. This partnership between politics and the health must continue to strengthen and be leveraged to effect major change in behaviors and attitudes across Sub-Saharan Africa.

  View details for DOI 10.1080/16549716.2017.1270525

  View details for Web of Science ID 000397602000001

  View details for PubMedID 28156196

  View details for PubMedCentralID PMC5328337

• Medical "Brain Drain" and Health Care Worker Shortages: How Should International Training Programs Respond? AMA journal of ethics Karan, A., DeUgarte, D., Barry, M. 2016; 18 (7): 665-675

  Abstract

  The movement of health care workers from countries with resource scarcity and immense need ("source" countries) to areas of resource abundance and greater personal opportunity ("destination" countries) presents a complex set of decisions and relationships that affect the development of international health care systems. We explore the extent to which ethical quandaries arising from this movement are the responsibility of the said actors and the implications of these ethical quandaries for patients, governments, and physicians through the case of Dr. R, a surgeon from Nigeria who is considering working in the United States, where he is being trained to help develop surgical capacity in his country. We suggest how Dr. R, the United States, and Nigeria all contribute to "brain drain" in different but complementary ways.

  View details for DOI 10.1001/journalofethics.2016.18.7.ecas1-1607

  View details for PubMedID 27437816

• Evaluating the socioeconomic and cultural factors associated with pediatric burn injuries in Maputo, Mozambique PEDIATRIC SURGERY INTERNATIONAL Karan, A., Amado, V., Vitorino, P., Kulber, D., Taela, A., DeUgarte, D. A. 2015; 31 (11): 1035–40

  Abstract

  Pediatric burn injuries are one of the leading causes of preventable morbidity and mortality in Sub-Saharan Africa. Research on the complex system of social, economic and cultural factors contributing to burn injuries in this setting is much needed.We conducted a prospective questionnaire-based analysis of pediatric burn patients presenting to the Hospital Central de Maputo. A total of 39 patients were included in the study. Interviews were conducted with the children's caretakers by two trained medical students at the Eduardo Mondlane Medical School in Maputo with the aid of local nursing staff.Most burns occurred from scald wounds (26/39) particularly from bathwater, followed by fire burns (11/39). Burns occurred more frequently in the afternoon (16/39) and evening (16/39). Over one quarter of burns (9/33) occurred in the absence of a caretaker. One-third (12/36) of participants attempted to treat the burn at home prior to bringing the child into the hospital, and roughly two-thirds (24/37) reported using traditional remedies for burn care. The average household had just 2 rooms for an average of 5 family members. Most burns were second degree (25/37).Prevention efforts in this setting are much needed and can be implemented taking complex cultural and social factors into account. Education regarding regulation of water temperature for baths is important, given the prevalence of scald burns. Moreover, the introduction of low-cost, safer cooking technology can help mitigate inhalation injury and reduce fire burns. Additionally, burn care systems must be integrated with local traditional medical interventions to respect local cultural medicinal practices.

  View details for DOI 10.1007/s00383-015-3761-5

  View details for Web of Science ID 000363040200005

  View details for PubMedID 26280740

  View details for PubMedCentralID PMC4609601

• Ebola and the need for restructuring pharmaceutical incentives JOURNAL OF GLOBAL HEALTH Karan, A., Pogge, T. 2015; 5 (1): 44–47

  View details for DOI 10.7189/jogh.05.010303

  View details for Web of Science ID 000370619100004

  View details for PubMedID 25734003

  View details for PubMedCentralID PMC4337146

• The effect of multimedia interventions on the informed consent process for cataract surgery in rural South India INDIAN JOURNAL OF OPHTHALMOLOGY Karan, A., Somasundaram, P., Michael, H., Shayegani, A., Mayer, H. 2014; 62 (2): 171–75

  Abstract

  The provision of ocular surgical interventions for poorer, less educated populations is increasing as a result of increased globalization and outreach. However, these populations still have trouble understanding surgical concepts and are not always fully informed decision makers.We aimed to test the effect that a multimedia addition to a traditional verbal informed consent would have on patient comprehension of relatively difficult cataract surgical concepts.We conducted a randomized controlled trial with relatively uneducated patients reporting to a private surgical hospital in Chennai, India. 47 patients were placed into the intervention group and 50 patients were placed into the control group.The intervention group was presented with a scripted verbal informed consent as well as a 3-fold pamphlet and a presentation with a 3-dimensional model of the eye. The control group was only presented with a scripted verbal informed consent. The two groups were tested using an 11 item "True/False/I don't know" quiz directly before the informed consent, directly after the informed consent, and one-day postoperatively.Scores on the quiz were compared across groups and time-points using paired t-tests.Patients in the both groups showed a significant improvement in scores between pre- and post-informed consent quizzes (P value on the order of 10(-6)) and the improvement in scores was significantly greater in the intervention group than the control group (P value on the order of 10(-16)). There was no significant difference observed in either group with regards to the change in scores between post-informed consent and post-operative quizzes.Multimedia aids in addition to a standard informed consent process are effective in improving patient comprehension even for patients with low literacy and limited knowledge of surgical interventions.

  View details for DOI 10.4103/0301-4738.116488

  View details for Web of Science ID 000348927800014

  View details for PubMedID 24008787

  View details for PubMedCentralID PMC4005233

• The influence of poverty and culture on the transmission of parasitic infections in rural nicaraguan villages. Journal of parasitology research Karan, A., Chapman, G. B., Galvani, A. 2012; 2012: 478292

  Abstract

  Intestinal parasitic infections cause one of the largest global burdens of disease. To identify possible areas for interventions, a structured questionnaire addressing knowledge, attitude, and practice regarding parasitic infections as well as the less studied role of culture and resource availability was presented to mothers of school-age children in rural communities around San Juan del Sur, Nicaragua. We determined that access to resources influenced knowledge, attitude, and behaviors that may be relevant to transmission of parasitic infections. For example, having access to a clinic and prior knowledge about parasites was positively correlated with the practice of having fencing for animals, having fewer barefoot children, and treating children for parasites. We also found that cultural beliefs may contribute to parasitic transmission. Manifestations of machismo culture and faith in traditional medicines conflicted with healthy practices. We identified significant cultural myths that prevented healthy behaviors, including the beliefs that cutting a child's nails can cause tetanus and that showering after a hot day caused sickness. The use of traditional medicine was positively correlated with the belief in these cultural myths. Our study demonstrates that the traditional knowledge, attitude, and practice model could benefit from including components that examine resource availability and culture.

  View details for DOI 10.1155/2012/478292

  View details for PubMedID 22934154

• Mpox Outbreak - Los Angeles County, California, May 4-August 17, 2023 MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT Leonard, C. M., Poortinga, K., Nguyen, E., Karan, A., Kulkarni, S., Cohen, R., Garrigues, J. M., Marutani, A. N., Green, N. M., Kim, A. A., Sey, K., Perez, M. J. 2024; 73 (2): 44-48

  Abstract

  Since May 2022, approximately 2,500 mpox cases have been reported in Los Angeles County (LAC), California. Beginning in May 2023, the LAC Department of Public Health observed a consistent increase in mpox cases after a prolonged period of low incidence. A total of 56 cases were identified during May 4-August 17, 2023. A minority of mpox patients were fully vaccinated (29%). One patient was hospitalized; no deaths were reported. Two cases of reinfection occurred, both of which were associated with mild illness. The increasing number of cases during this period was significant, as few other health departments in the United States reported an increase in mpox cases during the same period. The outbreak spread similarly to the 2022 U.S. mpox outbreak, mainly through sexual contact among gay, bisexual, and other men who have sex with men. Vaccination against mpox became available in June 2022 and has been shown to be effective at preventing mpox disease. This outbreak was substantially smaller than the 2022 mpox outbreak in LAC (2,280 cases); possible explanations for the lower case count include increased immunity provided from vaccination against mpox and population immunity from previous infections. Nonetheless, mpox continues to spread within LAC, and preventive measures, such as receipt of JYNNEOS vaccination, are recommended for persons at risk of Monkeypox virus exposure.

  View details for Web of Science ID 001159328100001

  View details for PubMedID 38236779

  View details for PubMedCentralID PMC10803096

• Monitoring routes of transmission for human mpox. Lancet (London, England) Karan, A., Contag, C. A., Pinksy, B. 2023; 402 (10402): 608-609

  View details for DOI 10.1016/S0140-6736(23)01131-5

  View details for PubMedID 37597882

• To Have an Almost-Normal Summer, Do This Now: Guidance from a global health doctor Karan, A. Medium. 2021
• We must stop blaming- and start protecting- unvaccinated people Karan, A. British Medical Journal. 2021
• Incremental Policy Can’t Keep Up With Exponential Spread Karan, A. Medium. 2021
• Messaging About Covid-19 Needs to Account for Privilege Karan, A. Medium. 2021
• How do we deal with “old guard” bigotry in healthcare? Karan, A. British Medical Journal. 2020
• Why I Said Nothing When My Med School Professor Made Racist Remarks Karan, A. NPR (Boston)/ WBUR. 2020
• Second-guessing may do more harm than good — especially among doctors Karan, A. Los Angeles Times. 2020
• Hollywood and Gun Violence Karan, A. Scientific American. 2020
• The Unsung Coronavirus Heroes Karan, A. Medium. 2020
• What We Can Learn from Past Covid19 Outbreaks Karan, A. Medium. 2020
• Here Comes the Pandemic Winter Karan, A., Dhillon, R. NPR (Boston)/ WBUR. 2020
• We Are All Tired Of The Pandemic — But Our Actions Can Still Make A Big Difference Karan, A. NPR (Boston)/ WBUR. 2020
• The dehumanisation of the patient BMJ-BRITISH MEDICAL JOURNAL Karan, A. 2019; 367: l6336

  View details for DOI 10.1136/bmj.l6336

  View details for Web of Science ID 000498179100009

  View details for PubMedID 31690568

• Doing things for no reason in the hospital BMJ-BRITISH MEDICAL JOURNAL Karan, A. 2019; 364: l841

  View details for DOI 10.1136/bmj.l841

  View details for Web of Science ID 000460389900008

  View details for PubMedID 30808632

• Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center. Circulation. Heart failure Eberly, L. A., Richterman, A. n., Beckett, A. G., Wispelwey, B. n., Marsh, R. H., Cleveland Manchanda, E. C., Chang, C. Y., Glynn, R. J., Brooks, K. C., Boxer, R. n., Kakoza, R. n., Goldsmith, J. n., Loscalzo, J. n., Morse, M. n., Lewis, E. F., Abel, S. n., Adams, A. n., Anaya, J. n., Andrews, E. H., Atkinson, B. n., Avutu, V. n., Bachorik, A. n., Badri, O. n., Bailey, M. n., Baird, K. n., Bakshi, S. n., Balaban, D. n., Barshop, K. n., Baumrin, E. n., Bayomy, O. n., Beamesderfer, J. n., Becker, N. n., Berg, D. D., Berman, A. N., Blum, S. M., Boardman, A. P., Boden, K. n., Bonacci, R. A., Brown, S. n., Campbell, K. n., Case, S. n., Cetrone, E. n., Charrow, A. n., Chiang, D. n., Clark, D. n., Cohen, A. J., Cooper, A. n., Cordova, T. n., Cuneo, C. N., de Feria, A. A., Deffenbacher, K. n., DeFilippis, E. M., DeGregorio, G. n., Deutsch, A. J., Diephuis, B. n., Divakaran, S. n., Dorschner, P. n., Downing, N. n., Drescher, C. n., D'Silva, K. M., Dunbar, P. n., Duong, D. n., Earp, S. n., Eckhardt, C. n., Elman, S. A., England, R. n., Everett, K. n., Fedotova, N. n., Feingold-Link, T. n., Ferreira, M. n., Fisher, H. n., Foo, P. n., Foote, M. n., Franco, I. n., Gilliland, T. n., Greb, J. n., Greco, K. n., Grewal, S. n., Grin, B. n., Growdon, M. E., Guercio, B. n., Hahn, C. K., Hasselfeld, B. n., Haydu, E. J., Hermes, Z. n., Hildick-Smith, G. n., Holcomb, Z. n., Holroyd, K. n., Horton, L. n., Huang, G. n., Jablonski, S. n., Jacobs, D. n., Jain, N. n., Japa, S. n., Joseph, R. n., Kalashnikova, M. n., Kalwani, N. n., Kang, D. n., Karan, A. n., Katz, J. T., Kellner, D. n., Kidia, K. n., Kim, J. H., Knowles, S. M., Kolbe, L. n., Kore, I. n., Koullias, Y. n., Kuye, I. n., Lang, J. n., Lawlor, M. n., Lechner, M. G., Lee, K. n., Lee, S. n., Lee, Z. n., Limaye, N. n., Lin-Beckford, S. n., Lipsyc, M. n., Little, J. n., Loewenthal, J. n., Logaraj, R. n., Lopez, D. M., Loriaux, D. n., Lu, Y. n., Ma, K. n., Marukian, N. n., Matias, W. n., Mayers, J. R., McConnell, I. n., McLaughlin, M. n., Meade, C. n., Meador, C. n., Mehta, A. n., Messenger, E. n., Michaelidis, C. n., Mirsky, J. n., Mitten, E. n., Mueller, A. n., Mullur, J. n., Munir, A. n., Murphy, E. n., Nagami, E. n., Natarajan, A. n., Nsahlai, M. n., Nze, C. n., Okwara, N. n., Olds, P. n., Paez, R. n., Pardo, M. n., Patel, S. n., Petersen, A. n., Phelan, L. n., Pimenta, E. n., Pipilas, D. n., Plovanich, M. n., Pong, D. n., Powers, B. W., Rao, A. n., Ramirez Batlle, H. n., Ramsis, M. n., Reichardt, A. n., Reiger, S. n., Rengarajan, M. n., Rico, S. n., Rome, B. N., Rosales, R. n., Rotenstein, L. n., Roy, A. n., Royston, S. n., Rozansky, H. n., Rudder, M. n., Ryan, C. E., Salgado, S. n., Sanchez, P. n., Schulte, J. n., Sekar, A. n., Semenkovich, N. n., Shannon, E. n., Shaw, N. n., Shorten, A. B., Shrauner, W. n., Sinnenberg, L. n., Smithy, J. W., Snyder, G. n., Sreekrishnan, A. n., Stabenau, H. n., Stavrou, E. n., Stergachis, A. n., Stern, R. n., Stone, A. n., Tabrizi, S. n., Tanyos, S. n., Thomas, C. n., Thun, H. n., Torres-Lockhart, K. n., Tran, A. n., Treasure, C. n., Tsai, F. D., Tsaur, S. n., Tschirhart, E. n., Tuwatananurak, J. n., Venkateswaran, R. V., Vishnevetsky, A. n., Wahl, L. n., Wall, A. n., Wallace, F. n., Walsh, E. n., Wang, P. n., Ward, H. B., Warner, L. N., Weeks, L. D., Weiskopf, K. n., Wengrod, J. n., Williams, J. N., Winkler, M. n., Wong, J. L., Worster, D. n., Wright, A. n., Wunsch, C. n., Wynter, J. S., Yarbrough, C. n., Yau, W. Y., Yazdi, D. n., Yeh, J. n., Yialamas, M. A., Yozamp, N. n., Zambrotta, M. n., Zon, R. n. 2019; 12 (11): e006214

  Abstract

  Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race. This study examined the relationship between race and admission service, and its effect on 30-day readmission and mortality Methods: We performed a retrospective cohort study from September 2008 to November 2017 at a single large urban academic referral center of all patients self-referred to the emergency department and admitted to either the cardiology or general medicine service with a principal diagnosis of HF, who self-identified as white, black, or Latinx. We used multivariable generalized estimating equation models to assess the relationship between race and admission to the cardiology service. We used Cox regression to assess the association between race, admission service, and 30-day readmission and mortality.Among 1967 unique patients (66.7% white, 23.6% black, and 9.7% Latinx), black and Latinx patients had lower rates of admission to the cardiology service than white patients (adjusted rate ratio, 0.91; 95% CI, 0.84-0.98, for black; adjusted rate ratio, 0.83; 95% CI, 0.72-0.97 for Latinx). Female sex and age >75 years were also independently associated with lower rates of admission to the cardiology service. Admission to the cardiology service was independently associated with decreased readmission within 30 days, independent of race.Black and Latinx patients were less likely to be admitted to cardiology for HF care. This inequity may, in part, drive racial inequities in HF outcomes.

  View details for DOI 10.1161/CIRCHEARTFAILURE.119.006214

  View details for PubMedID 31658831

  View details for PubMedCentralID PMC7183732

• Doing things for no reason in the hospital Karan, A. British Medical Journal. 2019
• Should family members be present during end of life medical emergencies? Karan, A. British Medical Journal. 2019
• Making sure patients understand and that doctors do too Karan, A. British Medical Journal. 2019
• Doctors and their Unhealthy Dependency on Tech Karan, A. Boston Globe. 2019
• Don't Let Your Institution Define You Karan, A. British Medical Journal. 2019
• Advice to New Doctors Karan, A. British Medical Journal. 2019
• The clinical value in listening Karan, A. Boston Globe. 2019
• Why Every Doctor Should Write Karan, A. British Medical Journal. 2019
• Medicine's Power Problem Karan, A. Scientific American. 2019
• Has the physical exam had its day? Karan, A. British Medical Journal. 2018
• Why Doctors Need To Remember That Sick Patients Were Once Healthy People Karan, A. NPR Boston/ WBUR. 2018
• When the Prescription is Not a Medicine but a Home Karan, A. Huffington Post. 2018
• The Forgotten Needs Of Refugees From Hurricane Irma Karan, A. NPR. 2018
• How to Prevent the Next Oxfam Scandal- a Yelp for International Aid? Karan, A., Taylor, L., Eyal, N. PLoS Global Health Blog (discontinued). 2018
• Why can't we accept that residents are being overworked? Karan, A. British Medical Journal. 2018
• The ethical implications of culture: challenges in the care of female sex workers in India Karan, A. Journal of Global Health Reports. 2018
• Changing the way we communicate about patients Karan, A. British Medical Journal. 2018
• Why we need more diversity in our doctors Karan, A. British Medical Journal. 2018
• Code Blue Confusion: He'd Checked 'Do Not Resuscitate' But Wanted To Live Karan, A. NPR Boston/ WBUR. 2017
• Some Thoughts From A New Doctor Karan, A. Huffington Post. 2017
• #WorldMalariaDay: can nets and sprays keep the bugs away? Karan, A. PLoS Blogs. 2017
• Women In India’s Cultural Sex Trade Need Healthcare Karan, A. Huffington Post. 2017
• The success trap of academic medicine and the need for change Karan, A. The British Medical Journal. 2017
• Publication should not be the endgame of medical research Karan, A. The British Medical Journal. 2017
• Please Keep Religious Intolerance Out of Medicine Karan, A. Huffington Post. 2017
• Medical students need to be quizzed, but ‘pimping’ isn’t effective Karan, A. STAT News. 2017
• Revisiting health as a human right—does everyone have the right to be healthy? Karan, A. The British Medical Journal. 2017
• A Doctor’s Dilemma: How We Confront Two “Right” Choices in Medicine & Public Health Karan, A. Huffington Post. 2017
• Do doctors’ other motivations, like the need for sleep, affect patient care? Karan, A. STAT News. 2017
• Understanding Leadership: What a Surgeon, a Senator, and the Former President of Mexico Have in Common. Karan, A. Huffington Post. 2017
• Why Mentorship Matters: Global Health Research Mentorship in LMICs Karan, A. PLoS blog (discontinued). 2017
• The Surprising Wishes Of India's Sex Workers Karan, A. NPR. 2017
• What we say to our patients matters, but how we say it matters more Karan, A. The British Medical Journal. 2017
• Incarceration is a dead end in the opioid epidemic Karan, A. AL dot com. 2017
• Has medical education done a disservice to new physicians? Karan, A. The British Medical Journal. 2017
• 'Trumpcare' Is Dangerous to the American Healthcare System Karan, A. The Wire. 2017
• Against Medical Advice: Sometimes, When Patients Defy Accepted Wisdom, So Must Doctors Karan, A. NPR Boston/ WBUR. 2017
• A Dance With Mrs Chan ANNALS OF FAMILY MEDICINE Karan, A. 2016; 14 (4): 380–81

  Abstract

  As a third-year medical student on an internal medical clerkship, I learned the most important lesson about how to care for patients. I saw my attending physician give attention first to the person he was treating, and then to the patient and her clinical picture. They are not the same, and our training in medical school does not always teach us this distinction. Months later I found myself with an opportunity to truly help another individual who had been clinically and emotionally overcome by his disease. My attending physician's lesson guided me in a very meaningful way: it allowed me to remind a man that he was more than the disease he was fighting. Many times, it may be something very little that we need to do or say but to our patients, these little things end up being the biggest of them all.

  View details for DOI 10.1370/afm.1922

  View details for Web of Science ID 000380145600016

  View details for PubMedID 27401429

  View details for PubMedCentralID PMC4940471

• Finding Who We Are in Those for Whom We Care Karan, A. Journal of General Internal Medicine. 2016
• Good Afternoon, Mrs. Gates Karan, A. UCLA Health Magazine. 2016
• Building Ethical Global Health Care Systems Karan, A. AMA Journal of Ethics. 2016
• To My Patients: An Apology, A Thank You Karan, A. The Gold Humanism Foundation. 2016
• From Delhi Slums to Los Angeles Wards: Lessons from a Year Working Against Sex Trafficking Karan, A. Journal of General Internal Medicine. 2016
• Hashtag Ebola Karan, A. The Medicine Maker. 2016
• It Costs Nothing to Care Karan, A. Costs of Care Blog. 2016
• Writing in medical school: how students can be a voice for their patients Karan, A. UCLA David Geffen School of Medicine. 2016
• Students can prevent global health groups from fabricating success stories Karan, A. STAT News. 2016
• The ACA: We Got Quantity but What About Quality? Karan, A. The Health Care Blog. 2016
• Students are the key to addressing the gap between academia and action in global health Karan, A. The British Medical Journal. 2016
• A Call for Courage in Uncertain Times: Curbing HIV/AIDS in Sub-Saharan Africa through Political Leadership Karan, A. PLoS Translational Global Health blog (discontinued). 2016
• Understanding cultural female sex work in India and why tradition must be challenged Karan, A. Lancet Global Health Blog (discontinued). 2016
• Supervising physicians’ bad behavior adds to depression in medical students Karan, A. STAT News. 2016
• To Dance Even When There is No Music Karan, A. The Lancet. 2015
• Are medical school rankings threatening the future of health care? Karan, A. Kevin MD. 2015
• The Case for Taking a Pill a Day to Prevent HIV Karan, A. The World (formerly Global Post). 2015
• Should Medical Schools Teach to the Boards? Karan, A. The Health Care Blog. 2015
• Lessons in Global Health: What Every Student Should Know Karan, A. American Medical Student Research Journal. 2015
• Marijuana and motor vehicle safety: An impending public health dilemma Karan, A. Kevin MD. 2015
• Teaching and Learning Moments It's Not Always About Health Care ACADEMIC MEDICINE Karan, A. 2014; 89 (7): 1023

  View details for DOI 10.1097/ACM.0000000000000282

  View details for Web of Science ID 000338210000022

  View details for PubMedID 24979170

• Evaluation of Adverse Events in Self-Reported Sulfa-Allergic Patients Using Topical Carbonic Anhydrase Inhibitors JOURNAL OF OCULAR PHARMACOLOGY AND THERAPEUTICS Guedes, G. B., Karan, A., Mayer, H. R., Shields, M. 2013; 29 (5): 456–61

  Abstract

  To investigate whether a self-reported history of allergy to sulfa-based drugs is a predictor for subsequent adverse reactions to topical carbonic anhydrase inhibitors (CAIs).A retrospective case-controlled cohort study via chart review was performed on 1,287 patients with a diagnosis of glaucoma. The outcome measure was the development of an adverse reaction (either ocular, systemic, or both) within at least 30 days after receipt of 1 of 4 classes of topical glaucoma medications: CAIs (dorzolamide and brinzolamide), prostaglandin analogues, beta-adrenergic blockers, and alpha2-adrenergic agonists.Patients with a self-reported history of sulfa allergy had significantly more ocular adverse reactions after the initiation of any of the topical antiglaucoma medications when compared to those patients with no reported allergies. Patients with a self-reported sulfa allergy and patients who self-reported other, nonsulfa-related allergies had similar rates of adverse reactions to most of the topical medications. The patients reporting a sulfa allergy who used topical CAIs did not have more adverse reactions compared with patients who reported having other, nonsulfa-related allergies who used topical CAIs. Self-reported sulfa-allergic patients had similar rates of adverse reactions to topical CAIs compared with topical prostaglandin analogues.It may be safe to use a topical CAI in patients who report a history of a sulfa allergy. Patients with medication allergies of any kind may be more likely to develop allergic reactions to other, unrelated drug classes.

  View details for DOI 10.1089/jop.2012.0123

  View details for Web of Science ID 000319760600003

  View details for PubMedID 23445203

• The reality of medicine’s inherently unequal power dynamic Karan, A. Kevin MD. 2013
• Globalizing the Internet for Health Prevention Karan, A. PSI Impact (discontinued). 2013
• When Your Doctor Dies Karan, A. The Health Care Blog. 2013
• Campaigns and Public Messaging: Important Aspects of HIV Prevention and Treatment, but Fraught with Complex Challenges. Karan, A. PLoS Translational Global Health (discontinued). 2013
• The Other White Coat Phenomenon Karan, A. Centre for Medical Humanities . 2013
• Seasonal variations in dermatology manuscript submission JOURNAL OF DERMATOLOGICAL TREATMENT Alikhan, A., Karan, A., Feldman, S. R., Maibach, H. I. 2011; 22 (1): 60

  View details for DOI 10.3109/09546630903544428

  View details for Web of Science ID 000286812200012

  View details for PubMedID 20113215

• The effect of a visual aid on the comprehension of cataract surgery in a rural, indigent South Indian population. Digital journal of ophthalmology : DJO Karan, A. M., Campbell, D. J., Mayer, H. R. 2011; 17 (3): 16–22

  Abstract

  PURPOSE: To determine whether a visual aid improves the understanding and retention of information presented during informed consent for rural, indigent patients presenting for cataract surgery.MATERIALS AND METHODS: This was a randomized, unmasked, interventional study. We recruited patients who presented to the Hande Surgical Hospital in Chennai, India, for cataract surgery. Patients were randomized into two groups: verbal consent alone (group A) and verbal consent plus a poster (group B). Both groups completed an 11-question true/false quiz immediately before and after informed consent and one day after surgery.RESULTS: A total of 60 patients were recruited for the study, with 30 randomly assigned to each group; 23 patients from group A and 17 from group B completed the study. Informed consent improved patient scores in both groups; however, group B had significantly higher mean scores on postoperative day 1 (7.4 vs 8.7, P = 0.005) and significantly greater improvement in mean scores from pre-informed consent to postoperative day 1 (1.3 vs 3.6, P = 0.002).CONCLUSIONS: Informed consent improves patient understanding of cataract surgery. Using a visual aid during informed consent for cataract surgery improves understanding and retention of information more than verbal consent alone in a rural South Indian population.

  View details for DOI 10.5693/djo.01.2011.05.001

  View details for PubMedID 23362389

• The lesson of persistence Karan, A. Yale Alumni Magazine. 2011
• Microscopically differentiating dermatophytes from sock fibers JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Karan, A., Alikhan, A., Feldman, S. R. 2009; 61 (6): 1024–27

  Abstract

  Dermatophytes are responsible for a number of superficial fungal infections that affect millions worldwide. During microscopic observation a potassium hydroxide (KOH) fungal smear, various filamentous materials such as common textile fibers from socks can obfuscate proper discernment of dermatophytes.To differentiate dermatophytes from 9 common sock fibers.Nine different textile fiber samples were microscopically analyzed by using a KOH direct smear test; their defining structural features were compared and contrasted with those of dermatophytes.Although there are several similarities, sock fibers tend to have a non-septate, uniform structure which differentiates them from dermatophytes. Sock fibers are also significantly larger than dermatophytes and can be viewed better at lower magnifications.There is a lack of sock samples with 100% textile fiber composition. Also, fibers were examined in a clean setting, without the detritus that normally accompanies dermatophytes in a clinical setting.While textile fibers may be present in KOH preparations, their general appearance typically differs from that of dermatophytes; an observer who is familiar with these distinctions will be able to differentiate between the two.

  View details for DOI 10.1016/j.jaad.2008.11.010

  View details for Web of Science ID 000272346800010

  View details for PubMedID 19925927

• Toxicologic implications of cutaneous barriers: a molecular, cellular, and anatomical overview JOURNAL OF APPLIED TOXICOLOGY Karan, A., Alikhan, A., Maibach, H. I. 2009; 29 (7): 551–59

  Abstract

  The skin barrier is a complex system of chemical, biological and physical processes that together regulate the admission and expulsion of foreign agents in contact with the skin. The eggresive movement of the stratum corneum (SC) is often a measure of its integrity, and transepidermal water loss has typically been a gold standard. However, the skin barrier has several barrier systems, such as ion flux, O(2), CO(2) and pH, which can give an informative and sometimes more sensitive measure of the SC condition. Furthermore, the penetrative interactions with the barrier have focused around occlusive methods to promote drug delivery, the interactions of topically applied drugs with the barrier and the presence of environmental agents that can harm the barrier. However, the nature of penetrative barrier interactions must also be elucidated on a microscopic level. The variable nature of barrier function is demonstrated when comparing the skin properties of neonates and adults. In addition, new biochemical methods have used keratin metrics to improve diagnostic efficacy and barrier integrity analysis. This review addresses the aforementioned aspects of the skin barriers that require further study to help discern the complexity of this essential organ as it relates to dermatotoxicology and dermatopharmacology.

  View details for DOI 10.1002/jat.1461

  View details for Web of Science ID 000271407100001

  View details for PubMedID 19629956