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"Gupta, Aditya"
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The Iot hacker's handbook : a practical guide to hacking the Internet of things
Take a practioner's approach in analyzing the Internet of Things (IoT) devices and the security issues facing an IoT architecture. You'll review the architecture's central components, from hardware communication interfaces, such as UARTand SPI, to radio protocols, such as BLE or ZigBee. You'll also learn to assess a device physically by opening it, looking at the PCB, and identifying the chipsets and interfaces. You'll then use that information to gain entry to the device or to perform other actions, such as dumping encryption keys and firmware. As the IoT rises to one of the most popular tech trends, manufactures need to take necessary steps to secure devices and protect them from attackers. The IoT Hacker's Handbook breaks down the Internet of Things, exploits it, and reveals how these devices can be built securely. What You'll Learn: Perform a threat model of a real-world IoT device and locate all possible attacker entry points -- Use reverse engineering of firmware binaries to identify security issues -- Analyze, assess, and identify security issues in exploited ARM and MIPS based binaries -- Sniff, capture, and exploit radio communication protocols, such as Bluetooth Low Energy (BLE), and ZigBee.
Book
Epidemiological landscape of androgenetic alopecia in the US: An All of Us cross-sectional study
Androgenetic alopecia (AGA) is extremely prevalent with a multifactorial etiology.
We conducted a cross-sectional study using the All of US (AoU) dataset Sept 2024 to better understand the epidemiology, social determinants and management of AGA.
Most males were 20-39 years old and females 60-69 years old. Men typically have an earlier onset of AGA than females. Male AGA is generally managed with finasteride; oral minoxidil is prescribed in younger males. Females are prescribed spironolactone and oral minoxidil with finasteride in post-menopausal females. There was very little dutasteride prescribed. Topical minoxidil is available over the counter and was not evaluated. Early in 2011 there were reports of the Post-Finasteride Syndrome (PFS); subsequently, the finasteride prescription rate fell to about 10-20% of the pre-PFS prescription rate. There was increased reporting for AGA in those who drink, have an annual household income ≥$75,000, and those with a higher level of education. There was also higher reporting of female AGA in those with anxiety and depression. Patients with higher income and education may have less pressing medical concerns enabling them to bring their AGA to the physician's attention. Females in whom the AGA affects their anxiety and depression may seek help for the AGA as a way to address their underlying disorder.
This study provides a snapshot of the epidemiology and management of AGA in the USA. AGA is linked to the social determinants of health; addressing the AGA may help better manage the underlying mental and physical state.
Journal Article
Epidemiological trends and healthcare disparities in onychomycosis: An analysis of the All of Us research program
Onychomycosis is a common, difficult to treat nail disorder. Our objective was to explore disparities in current clinical management practices for onychomycosis in patients from underrepresented groups and with specific comorbidities. We conducted a cross-sectional study using the All of Us (AoU) research program. The AoU program gathers survey, and electronic health records from participants in the United States with the aim of increasing the representation of minorities groups in health research under the framework of precision medicine. We identified 18,763 onychomycosis patients (2017–2022) and compared the rates of diagnostic testing, prescription medications and surgical procedures. Younger patients were more likely to receive oral medications, while older patients were more likely to undergo surgical nail procedures. Patients with lower income and education, Black and Hispanic patients were less likely to receive testing to confirm diagnosis, and less likely to receive prescription medications (topical and/or oral) except in the case of fluconazole. Lower income and education were associated with a higher likelihood of debridement and trimming procedures, while Black and Hispanic patients were less likely to undergo these procedures. Patients with disabilities also received different treatments when compared to able-bodied individuals, being less likely to receive ciclopirox, efinaconazole and terbinafine, but more likely to undergo debridement and trimming procedures. There are clear differences in the management of onychomycosis in the different demographic and comorbid populations that we studied. Efforts to reduce these inequalities, such as expanded health coverage, reducing communication barriers and increasing patient and physician education are needed.
Journal Article
Understanding the evolving treatment landscape of hidradenitis suppurativa: An analysis of All of Us
Hidradenitis suppurativa (HS) is a chronic skin condition with significant burden for affected patients. The development of new therapies in the last decade has brought hope for better patient outcomes, but understanding the use of these new drug classes is necessary to ensure patient access to care.
We analysed data from 2636 HS patients within NIH's All of Us research program from June 2017 and October 1, 2023 to examine the likelihood of patients receiving certain classes of drugs based on socio-demographic factors and comorbid health conditions, as well as how these drug classes impact quality of life. We also examined trends in the number of prescriptions over time.
Antibiotics were most frequently prescribed, with higher numbers administered to females. Small molecule inhibitors and biologic medications were prescribed at low levels. We found that socio-demographic factors such as ethnicity, income and insurance provider influence the types of drugs patients are most likely to receive, with African American individuals more likely to receive antibiotics and immunosuppressive drugs and less likely to receive small molecule inhibitors. We also found that comorbid conditions significantly influence the likelihood of patients receiving specific drugs, with higher odds of receiving biologics if a patient has a comorbid rheumatic/autoimmune disorder. Antibiotics and immunosuppressive drugs were associated with less favourable quality of life measures, as well as a higher likelihood of anxiety and depression.
This work uncovers the varied landscape of HS treatment in the US and highlights the factors that influence treatment choices and how these treatments impact quality of life. It also provides an understanding of the social disparities that some populations face when accessing HS care, informing future decisions and practices to reduce these inequities.
Journal Article
Onychomycosis in Older Adults: Prevalence, Diagnosis, and Management
The risk of having onychomycosis increases with age. Data suggest that the prevalence of onychomycosis may be ≥ 20% in subjects aged ≥ 60 years and ≥ 50% in those aged ≥ 70 years. Older males are 2.1 times more prone to onychomycosis than are females. Although most nail dystrophies (approximately 50%) are caused by onychomycosis, proper clinical assessment followed by mycological examination is recommended to exclude other conditions such as nail trauma, lichen planus, and psoriasis. The US FDA-approved onychomycosis treatments are systemic antifungals (terbinafine and itraconazole) for severe onychomycosis and topical antifungals (ciclopirox 8%, efinaconazole 10%, and tavaborole 5%) for mild-to-moderate onychomycosis. Oral fluconazole is used off-label, and itraconazole may be considered for non-dermatophyte onychomycosis. Recently, fosravuconazole was approved in Japan for onychomycosis treatment. Although the treatment options and durations are the same for older patients as for other age groups, a clinical decision should take into account various age-related factors such as comorbidities, polypharmacy, hepatic and renal insufficiency, and noncompliance. Clinicians should also consider possible drug interactions and side effects when choosing a particular antifungal. Since the recurrence rate of onychomycosis is high, older patients should practice sanitization techniques, consider lifestyle changes, and perhaps consider using a topical antifungal as long-term maintenance therapy one to three times per week to prevent the recurrence of onychomycosis or to treat early disease.
Journal Article
Mechanisms of resistance against allylamine and azole antifungals in Trichophyton: A renewed call for innovative molecular diagnostics in susceptibility testing
The emergence of antifungal resistance calls for continued research efforts to better guide healthcare providers in treatment selection and outcomes. Unlike bacterial infections, treatment of superficial fungal infections is mainly limited to allylamines (terbinafine) and azoles (itraconazole). Here, we aim to update our current understanding of resistance mechanisms against allylamine and azole antifungals in the Trichophyton genus. Resistance development has been demonstrated in vitro by challenging Trichophyton isolates with allylamines or azoles at levels below the minimum inhibitory concentration (MIC), which corroborates the observation of clinical resistance. Frequently reported mechanisms of resistance include: (I) Alterations of the drug target by single-nucleotide variations (SNVs) of the SQLE/ERG1 and ERG11 genes; in particular, SQLE SNVs (Leu393Phe, Leu393Ser, and Phe397Leu) have been frequently reported in isolates with high terbinafine MICs; (II) overexpression of the target enzyme for azoles ( ERG11 ) and downstream genes in the ergosterol biosynthesis pathway can decrease the effective drug concentration as well as prevent the depletion of ergosterol and the accumulation of toxic sterol intermediates; (III) the up-regulation of drug efflux channels—belonging to the ABC superfamily ( PDR1 , MDR2 , MDR3 , MDR4 ), MFS superfamily ( MFS1 ), or Pma1 (plasma membrane ATPase 1)—can reduce the effective concentrations of terbinafine and azoles. The possibility of multidrug resistance has been shown in Trichophyton strains, of both human and animal origins, harboring multiple resistance mechanisms (e.g., target alteration/overexpression and drug efflux channels). Tackling the issue of antifungal resistance will require an integrated approach with multidisciplinary efforts including surveillance initiatives and antifungal stewardship programs. However, these efforts are hampered by the current limited accessibility of antifungal susceptibility testing as well as the limited choice of antifungals available in routine practice. A better understanding of resistance mechanisms could help develop targeted, molecular-based assays.
Journal Article
Differential Diagnosis, Prevention, and Treatment of mpox (Monkeypox): A Review for Dermatologists
The current 2022 mpox (monkeypox) outbreak has been officially recognized as a public health emergency. The mpox clinical symptoms include high fever, fatigue, chills, headache, swollen lymph nodes, muscle aches, and a disseminated painful rash. However, recent cases of mpox have shown a shift in clinical symptoms, with anogenital skin lesions emerging as the predominant feature. Due to the predominant skin manifestations of mpox, dermatologists could be crucial in detecting new mpox cases and educating frontline healthcare professionals about mpox. The mpox virus is continuously evolving and has several variants. Genome sequencing has revealed that the Clade IIb variant is responsible for the 2022 mpox outbreak. Mpox spread may occur through animal-to-human and human-to-human transmission; however, unlike coronavirus disease 2019 (COVID-19), long-range airborne transmission has not been reported. Healthcare professionals are at higher risk of becoming infected since they are usually in close contact with both the patients and potentially contaminated fomites (e.g., examination table, gowns, gloves). Both public and healthcare professionals should take preventive and avoidance measures to limit the spread. Mpox is usually self-limiting and may require only symptomatic treatment; however, it may cause severe complications in special populations such as immunocompromised individuals. For severe infection, clinicians may consider antiviral drugs (off-label), tecovirimat and brincidofovir, originally approved for smallpox treatment. Two smallpox vaccines, ACAM2000
and JYNNEOS
, can be used as pre-exposure prophylaxis against mpox. JYNNEOS
, which carries approval for mpox use, has less adverse effect potential than ACAM2000
, and may also be used as post-exposure prophylaxis, preferably within 4 days of exposure.
Journal Article
High prevalence of mixed infections in global onychomycosis
Onychomycosis is estimated at a prevalence of 10% worldwide with the infecting organism most commonly Trichophyton rubrum (T. rubrum). Traditional culture identification of causative organisms has inherent risks of overestimating dermatophytes, like T. rubrum, by inhibiting the growth of possible nondermatophyte mould (NDM) environmental contaminants which could be causative agents. Recently, molecular methods have revealed that a proportion of onychomycosis cases in North America may be caused by mixed infections of T. rubrum as an agent co-infecting with one or more NDM. Determining the global burden of mixed infections is a necessary step to evaluating the best therapies for this difficult-to-treat disease. To determine the prevalence of mixed infections in a global population, nail samples from onychomycosis patients in Brazil, Canada, and Israel (n = 216) were analyzed by molecular methods for the presence of dermatophytes and five NDMs. If an NDM was detected, repeat sampling was performed to confirm the NDM. T. rubrum was detected in 98% (211/216) of infections with 39% mixed (84/216). The infection type was more likely to be mixed in samples from Brazil, but more likely to be a dermatophyte in samples from Canada and Israel (Χ2 = 16.92, df = 2, P<0.001). The most common cause of onychomycosis was T. rubrum. In all countries (Brazil, Canada and Israel combined) the prevalence of dermatophyte (Χ2 = 211.15, df = 3, P<0.001) and mixed (dermatophyte and NDM; Χ2 = 166.38, df = 3, P<0.001) infection increased with patient age. Our data suggest that mixed infection onychomycosis is more prevalent than previously reported with the aging population being at increased risk for mixed infections.
Journal Article
Systematic review of exosome treatment in hair restoration: Preliminary evidence, safety, and future directions
Background Exosomes are small extracellular vesicles with potential roles in modulating the hair growth cycle and are an emerging therapy for patients with alopecia. In recent years, researchers have made significant progress in deciphering the network of cellular interactions and signaling pathways mediated by the transfer of exosomes. This has opened the door to a wide range of potential therapeutic applications with an increasing focus on its application in precision medicine. Aim To evaluate current published evidence, both preclinical and clinical, on the use of exosomes for hair restoration. Methods In January 2023, a systematic search was conducted using PubMed, Embase, and the Cochrane Library. Records were identified, screened, and assessed for eligibility as per the PRISMA guideline. Results We identified 16 studies (15 preclinical and 1 clinical) showing varying degrees of efficacy using exosomes derived from sources including adipose‐derived stem cells (ADSCs) and dermal papilla cells (DPCs). Applications of exosomes isolated from ADSCs (ADSC‐Exo) and DPCs have shown early promising results in preclinical studies corroborated by results obtained from different model systems. Topical ADSC‐Exo has been tried successfully in 39 androgenetic alopecia patients demonstrating significant increases in hair density and thickness. No significant adverse reactions associated with exosome treatment have been reported thus far. Conclusions Although current clinical evidence supporting the use of exosome treatment is limited, there is a growing body of evidence suggesting its therapeutic potential. Further studies are warranted to define its mechanism of action, optimize its delivery and efficacy, and to address important safety concerns.
Journal Article
New Antifungal Agents and New Formulations Against Dermatophytes
A variety of oral and topical antifungal agents are available for the treatment of superficial fungal infections caused by dermatophytes. This review builds on the antifungal therapy update published in this journal for the first special issue on Dermatophytosis (Gupta and Cooper 2008;166:353–67). Since 2008, there have not been additions to the oral antifungal armamentarium, with terbinafine, itraconazole, and fluconazole still in widespread use, albeit for generally more severe or recalcitrant infections. Griseofulvin is used in the treatment of tinea capitis. Oral ketoconazole has fallen out of favor in many jurisdictions due to risks of hepatotoxicity. Topical antifungals, applied once or twice daily, are the primary treatment for tinea pedis, tinea corporis/tinea cruris, and mild cases of tinea unguium. Newer topical antifungal agents introduced include the azoles, efinaconazole, luliconazole, and sertaconazole, and the oxaborole, tavaborole. Research is focused on developing formulations of existing topical antifungals that utilize novel delivery systems in order to enhance treatment efficacy and compliance.
Journal Article