ERROR! No headcode.htm file found.

Bio

Bio


I am an infectious disease fellow in the Division of Infectious Diseases and Geographic Medicine with interests in emerging infections, infectious disease epidemiology, and global health equity.
_______

I completed my residency in internal medicine at the Brigham and Women's Hospital and Harvard Medical School, and as a graduate of the Doris and Howard Hiatt Residency in Global Health Equity. I earned my MD from the UCLA David Geffen School of Medicine where I served as Student Body President; an MPH from the Harvard T.H. Chan School of Public Health; a Diploma in Tropical Medicine and Hygiene (DTM&H) from the London School of Hygiene and Tropical Medicine; and my undergraduate degree w/ distinction from Yale University in political science, where I was a Yale Journalism Scholar.

From February to October 2020, I worked on COVID19 response for the state of Massachusetts as a medical fellow to Dr. Monica Bharel, MA Commissioner of Public Health. From November to January 2021, I worked as a research consultant to the WHO commissioned Independent Panel for Pandemic Preparedness and Response on Covid-19 epidemiology. I also served as a research assistant for the Harvard College Fall course on Covid-19 and epidemics. Furthermore, I was involved in Biden-Harris campaign's Covid-19 policy writing for school reopenings. Prior to this, I studied epidemic response and emerging infectious diseases, with a focus on rural pathogens, including Ebola. In 2018, I co-founded Longsleeve insect repellent, winner of the 2018 Harvard Business School New Venture Competition and a finalist in the 2019 Harvard President's Challenge, which we hope will have a notable impact on curbing transmission of vector-borne epidemic outbreaks. I also led the American Medical Association's Journal of Ethics theme issue on pandemic response, published in January 2020; and I am a peer-reviewer for the CDC's Emerging Infectious Diseases Journal.

My previous work over the past 13 years has included various projects in Latin America (Mexico, Honduras, Nicaragua, Haiti, Dominican Republic), Asia (India, Thailand), and Sub-Saharan Africa (Rwanda, Uganda, Mozambique). In 2011-2012, as a Yale Parker Huang Fellow, I conducted an anthropological research study in India exploring sex trafficking and intergenerational sex work in Hyderabad and Delhi. I am also interested in the intersection between medical ethics and global health (particularly neocolonialism). I participated as a medical fellow in Auschwitz studying the history of the Holocaust for the FASPE program in 2016; and led the AMA Journal of Ethics twice (2016-17 on international healthcare systems; 2019-20 on pandemic response).

Since January 2019, I have also been a columnist at the British Medical Journal. Prior to that, I co-edited the book, "Protecting the Health of the Poor", which was published in December 2015. I have authored works in the NEJM, The Lancet, The BMJ, Academic Medicine, Health Affairs, NPR, WaPo, Vox, Los Angeles Times, CNN, Scientific American, Huffpost, Boston Globe, Harvard Business Review, and other major publications. Press coverage has included: NBC, ABC, BBC, PBS, CBS, CNN, MSNBC, Washington Post, New York Times, Bloomberg, Boston Globe, ProPublica, WSJ, TIME, TMZ, Science Friday, Medium, The Verge, Politico, CBC News, MTV News, Democracy Now, NPR, ESPN, The Atlantic, The Hill, Business Insider, Vice, Mother Jones, Boston Magazine, Vox, Healthline, Forbes, Slate, STAT News, Harvard Public Health Magazine (cover story Spring 2020), and others

Clinical Focus


  • Infectious Diseases
  • Fellow

Honors & Awards


  • K. Frank Austen Resident Research Award for Disruption of Scientific Thinking, Brigham and Women's Hospital (2021)
  • 40 Under 40, National Minority Quality Forum (2020)
  • 50 Experts to Trust in a Pandemic, Medium (2020)
  • 40 Under 40, Medtech Boston Healthcare Innovators (2018)
  • Global Health Equity Residency, Brigham and Women's Hospital (2018)
  • New Venture Competition Winner (Longsleeve Insect Repellent), Harvard Business School (2018)
  • STAT Wunderkind, STAT News (2018)
  • Inaugural Global Health Alumni Leadership Award, Unite for Sight (2017)
  • Aesculapius Student Service Award, UCLA David Geffen School of Medicine (2016)
  • FASPE Fellow, Fellowship at Auschwitz for the Study of Professional Ethics (2016)
  • Student Body President; Commencement Speaker, UCLA David Geffen School of Medicine (2016)

Professional Education


  • Residency, Internal Medicine, Brigham and Women's Hospital, Harvard Medical School
  • DTM&H, London School of Hygiene and Tropical Medicine
  • MPH, Harvard School of Public Health
  • MD, University of California, Los Angeles
  • BA, Yale University

Research & Scholarship

Projects


  • Independent Panel for Pandemic Preparedness and Response, WHO IPPPR

    Epidemiology research regarding early SARS-CoV-2 spread from Wuhan, China.

    Location

    Boston, MA

  • Harvard GenEd Course 1170: Confronting COVID19: Science, History, Policy, Harvard University

    Research Assistant to Dr. Ingrid Katz and Dr. Allan Brandt

    Location

    Boston, MA

  • Massachusetts State Covid19 Response, Massachusetts Department of Public Health

    Medical fellow to Commissioner Monica Bharel

    Location

    Boston, MA

  • Biden-Harris Campaign- Covid19 Reopening Schools Policy, Harvard University

    Worked under Dr. Ingrid Katz

    Location

    Boston, MA

  • Epidemiology of Covid19 Hospital-based Transmission, Brigham and Women's Hospital

    Assessing risk of SARS-Cov-2 transmission between shared roommates

    Location

    Boston, MA

  • Covid19 Medical Contributor, NPR, National Public Radio

    Location

    Boston, MA

  • Columnist, British Medical Journal

    Location

    London, UK

  • Ethics of Pandemic Response, AMA Journal of Ethics

    Editor of theme issue on pandemics, 2019

    Location

    Boston, MA

  • Network Modeling for Epidemics Course, University of Washington

    Location

    Seattle, WA

  • Reviewer, Emerging Infectious Diseases Journal, Centers for Disease Control (CDC)

    Primarily Covid19 articles

    Location

    Atlanta, Georgia

Publications

All Publications


  • 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

  • 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
  • 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

  • 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

  • There is no stopping covid-19 without stopping racism. BMJ (Clinical research ed.) Karan, A. n., Katz, I. n. 2020; 369: m2244

    View details for DOI 10.1136/bmj.m2244

    View details for PubMedID 32518097

  • The responsibility and potential of public health. Lancet (London, England) Dhillon, R. S., Karan, A. n. 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. n. 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

  • A perpendicular framing for global health LANCET Dhillon, R. S., Karan, A., Marten, R. 2019; 394 (10210): 1708
  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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 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

  • 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

  • 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

Stanford Medicine Resources: