Clinical Instructor, Pediatrics - Critical Care
Board Certification: American Board of Pediatrics, Pediatrics (2022)
Residency: Children's Hospital of Philadelphia Pediatric Residency (2022) PA
Medical Education: Stanford University School of Medicine (2019) CA
Racial, Ethnic, and Socioeconomic Disparities in Retinoblastoma Enucleation: A Population-Based Study, SEER 18 2000-2014.
American journal of ophthalmology
To determine the effect of race, ethnicity, and census-tract-level composite socioeconomic status (SES) on retinoblastoma enucleation. This study augments Truong et al., providing multivariate analyses combining sociodemographic and clinical characteristics with more accurate SES measures. We hypothesized children from non-white, Hispanic, and lower socioeconomic backgrounds would have increased adjusted odds of enucleation.Retrospective cohort analysis.Setting: Multicenter population-based study using the Surveillance, Epidemiology, and End Results (SEER) 18 Registries.Children aged 18 and under diagnosed with retinoblastoma between 2000-2014. Subjects were identified using International Classification of Diseases Oncology (ICD-O) site and morphology codes.Enucleation Odds Ratios and 95% Confidence Intervals RESULTS: Analysis of 959 retinoblastoma patients revealed that 70.8% were enucleated. Adjusted analyses showed associations between enucleation and Asian (Odds Ratio (OR) 2.00, Confidence Interval (CI) 1.08-3.71) or Black (2.42, 1.41-4.16) race, Hispanic ethnicity (1.69, 1.16-2.46), and low SES (1.68, 1.09-2.58). Significantly increased enucleation risk was associated with older age at diagnosis (Age 1-2 years 2.55, 1.80-3.61; >2 years 4.88, 2.57-9.25), unilateral disease (5.00, 3.45-7.14), and advanced stage (Regional 4.71, 2.51-8.84; Distant 3.15, 1.63-6.08). No interactions were observed between race, ethnicity, SES, and stage at diagnosis. Enucleation rates decreased over time across all racial, ethnic, and socioeconomic groups.Children from non-white, Hispanic, and lower socioeconomic backgrounds are more likely to receive enucleation. These associations are independent of stage of diagnosis, suggesting larger systemic disparities in retinoblastoma care. The origin of these differences requires further study and attention by clinicians and policy-makers.
View details for PubMedID 31077666
- The effect of statin exposure on choroidal neovascularization in nonexudative age-related macular degeneration patients EYE 2019; 33 (1): 163–65
The effect of statin exposure on choroidal neovascularization in nonexudative age-related macular degeneration patients.
Eye (London, England)
View details for PubMedID 30120400
Effect of Statin Exposure on Choroidal Neovascularization in Nonexudative Age-Related Macular Degeneration Patients
ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018
View details for Web of Science ID 000442912507068
Disparities in location of death of adolescents and young adults with cancer: A longitudinal, population study in California
2017; 123 (21): 4178–84
Patients with a terminal illness should have access to their chosen location of death. Cancer is the leading cause of non-accidental death among adolescents and young adults (AYAs; those aged 15-39 years). Although surveys have suggested that a majority of these patients prefer a home death, to the authors' knowledge, little is known regarding their barriers to accessing their preferred location of death. As a first step, the authors sought to determine, across a large population, 20-year trends in the location of death among AYA patients with cancer.Using the Vital Statistics Death Certificate Database of the California Office of Statewide Health Planning and Development, the authors performed a retrospective, population-based analysis of California patients with cancer aged 15 to 39 years who died between 1989 and 2011. Sociodemographic and clinical factors associated with hospital death were examined using multivariable logistic regression.Of 30,573 AYA oncology decedents, 57% died in a hospital, 33% died at home, and 10% died in other locations (eg, hospice facility or nursing facility). Between 1989 and 1994, hospital death rates decreased from 68.3% to 53.6% and at-home death rates increased from 16.8% to 35.5%. Between 1995 and 2011, these rates were stable. Those individuals who were more likely to die in a hospital were those aged <30 years, of minority race, of Hispanic ethnicity, who lived ≤10 miles from a specialty center, and who had a diagnosis of leukemia or lymphoma.Overall, the majority of AYA cancer deaths occurred in a hospital, with a 5-year shift to more in-home deaths that abated after 1995. In-hospital deaths were more common among younger patients, patients of minority race/ethnicities, and those with a leukemia or lymphoma diagnosis. Further study is needed to determine whether these rates and disparities are consistent with patient preferences. Cancer 2017;123:4178-4184. © 2017 American Cancer Society.
View details for PubMedID 28700812
Radiation History Affects Continence Outcomes After AdVance Transobturator Sling Placement in Patients With Post-prostatectomy Incontinence
2013; 82 (3): 713-717
To evaluate the effects of preoperative external radiation therapy (XRT) on a cohort of patients who underwent AdVance transobturator urethral sling (ATUS) placement for post-prostatectomy incontinence.Thirty-seven patients underwent placement of an ATUS from 2008 to 2010. Patients with and without a history of preoperative XRT were retrospectively compared in regard to their demographical, preoperative, perioperative, and postoperative details.The median follow-up was 17.3 months. Preoperative pad usage was significantly higher in the XRT patient group (P = .03). Overall, 19 patients (51.4%) used no pads, 10 patients (27.0%) were improved, 4 patients (10.8%) had no change, and 4 patients (10.8%) experienced worsening incontinence after the surgery. In patients with and without a history of XRT, 0 (0%) and 19 (63.3%) used no pads, 2 (28.6%) and 8 (26.7%) were improved, 2 (28.6%) and 2 (6.7%) showed no change, and 3 (42.9%) and 1 (3.3%) were worse, respectively. In comparing patients with more severe incontinence preoperatively (>1 pad/day), those with and without radiation, 0 (0%) and 7 (46.7%) used no pads, 2 (28.6%) and 7 (46.7%) were improved, 2 (28.6%) and 0 (0%) had no change, and 3 (42.9%) and 1 (6.7%) were worse, respectively, after ATUS placement. Thus, patients without XRT had an advantage in postoperative pad usage (P = .001), and, furthermore, had improved quality of life (86.2% vs 28.6%, P = .006).The ATUS provides excellent continence outcomes in patients suffering from post-prostatectomy urinary incontinence. However, previous pelvic irradiation seems to severely compromise the effectiveness of the ATUS.
View details for DOI 10.1016/j.urology.2013.03.075
View details for Web of Science ID 000323790800066
View details for PubMedID 23831073
Asthma Discordance in Twins Is Linked to Epigenetic Modifications of T Cells
2012; 7 (11)
T cells mediate the inflammatory responses observed in asthma among genetically susceptible individuals and have been suspected to be prone to epigenetic regulation. However, these relationships are not well established from past clinical studies that have had limited capacity to control for the effects of variable genetic predisposition and early environmental exposures. Relying on a cohort of monozygotic twins discordant for asthma we sought to determine if epigenetic modifications in T cells were associated with current asthma and explored whether such modifications were associated with second hand smoke exposures. Our study was conducted in a monozygotic twin cohort of adult twin pairs (n = 21) all discordant for asthma. Regulatory T cell (Treg) and effector T cell (Teff) subsets were assessed for levels of cellular function, protein expression, gene expression and CpG methylation within Forkhead box P3 (FOXP3) and interferon gamma-γ (IFNγ) loci. Comparisons by asthma and current report of exposure to second hand smoke were made. Treg from asthmatic discordant twins demonstrated decreased FOXP3 protein expression and impaired Treg function that was associated with increased levels of CpG methylation within the FOXP3 locus when compared to their non-asthmatic twin partner. In parallel, Teff from discordant asthmatic twins demonstrated increased methylation of the IFNγ locus, decreased IFNγ expression and reduced Teff function when compared to Teff from the non-asthmatic twin. Finally, report of current exposure to second hand smoke was associated with modifications in both Treg and Teff at the transcriptional level among asthmatics. The results of the current study provide evidence for differential function of T cell subsets in monozygotic twins discordant for asthma that are regulated by changes in DNA methylation. Our preliminary data suggest exposure to second hand smoke may augment the modified T cell responses associated with asthma.
View details for DOI 10.1371/journal.pone.0048796
View details for Web of Science ID 000312376100014
View details for PubMedID 23226205
View details for PubMedCentralID PMC3511472