Emergency management for preventing and controlling nosocomial infection of the 2019 novel coronavirus: implications for the dermatology department

Association of residential land cover and wheezing among children and adolescents: A cross-sectional study in five provinces of China

The association between residential land cover (RLC) and wheezing remains poorly understood. This study aimed to investigate the association between RLC and wheezing in childhood and adolescence. A cross-sectional survey was conducted among children and adolescents in five provinces of China. Land cover data were obtained from the Cross-Resolution Land-Cover mapping framework based on noisy label learning, classifying land cover into five categories: cropland, forest, grass/shrubland, wetland, and impervious. Generalized linear mixed models were employed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of wheezing. Mediation analysis was employed to investigate whether ambient particulate matter (PM2.5) acts as a mediator in the association between RLC and wheezing. A total of 12,875 participants were included in the study, comprising 318 patients and 12,557 controls. Cropland500m was significantly associated with decreased odds of wheezing (OR: 0.929, 95% CI: 0.879-0.982), while impervious surfaces500m significantly was associated with increased odds of wheezing (OR: 1.056, 95% CI: 1.019-1.096) in all participants. In the stratified analysis, significant differences were found in the main outcomes between the adolescence group (age ≥10 years) and the childhood group (age <10 years) (Pinteraction < 0.05), while no significant differences were observed between the southern and northern regions, or between male and female respondents. Mediation analysis revealed that PM2.5 partially mediated the association between cropland500m and impervious surfaces500m with wheezing. RLC plays a significant role in wheezing during childhood and adolescence, with cropland offering protection and impervious surfaces posing a heightened risk.

Impact of COVID-19 on inpatient care related to skin conditions

Background

The COVID-19 pandemic significantly affected our society and healthcare system. This study aims to evaluate the effects of COVID-19 on the number of hospitalized patients with dermatological diseases in Croatia, as well as the number of these patients treated surgically and conservatively, before (2017-2019) and during the pandemic (2020-2021).

Materials and methods

This is a retrospective, comparative study of the hospital admission rate for patients with skin, subcutaneous tissue, and breast disorders both before and during the pandemic. This study used data from the Croatian Institute of Public Health (CIPH) and the Croatian Health Insurance Fund (CHIF). Inpatient data for the CHIF data collection were categorized using the Australian Refined Diagnosis Related Groups (AR-DRGs). All hospital admissions for dermatology patients at all non-specialized hospitals in Croatia were tracked during two periods, before (2017-2019) and during the pandemic (2020-2021).

Results

The average number of dermatology patients in all hospitals fell by 29% during the pandemic. The overall number of dermatological patients admitted to hospitals fell by 32% in 2020 and by 26% in 2021 when compared to the number of patients admitted each year on average over the preceding 3 years. Additionally, there was an average 22% fall in surgical procedures performed during the pandemic. The only exception for surgical procedures is Major Breast Reconstruction for which is noted an increase, as also for Malignant Breast Disorders, Minor Complexity and Major Skin Disorders, Minor Complexity in a group of non-surgically treated patients.

Conclusion

Examining the all consequences of the Croatian dermatological patient care interruption will require more investigation. Reduced access to medical care during the pandemic is anticipated to lead to later illness diagnosis, a later start to treatment, a poorer disease prognosis, as well as higher medical expenditures.

Nineteen months into the pandemic, what have we learned about COVID-19-related outcomes in patients with psoriasis?

BACKGROUND

The impact of psoriasis on the outcomes of Coronavirus disease 2019 (COVID-19) is yet to be precisely delineated.

OBJECTIVES

To assess the risk of COVID-19, COVID-19-associated hospitalization, and mortality among patients with psoriasis as compared with age-, sex-, and ethnicity-matched control subjects. In addition, we aim to delineate determinants of COVID-19-associated hospitalization and mortality in patients with psoriasis.

METHODS

A population-based retrospective cohort study was performed to longitudinally follow patients with psoriasis and their matched controls with regard to COVID-19-related outcomes. The risk of COVID-19 infection, COVID-19-associated hospitalization, and mortality were assessed using uni- and multi-variable Cox regression analyses. Determinants of COVID-19-associated hospitalization and mortality were evaluated using multivariable logistic regression analysis.

RESULTS

The study population included 144 304 patients with psoriasis and 144 304 age- and sex-matched control individuals. Patients with psoriasis displayed a slightly elevated risk of SARS-CoV-2 infection (fully-adjusted HR, 1.05; 95% CI, 1.03-1.08; p < 0.001). Relative to controls, patients with psoriasis had comparable multivariate risk of COVID-19-associated hospitalization (fully-adjusted HR, 1.08; 95% CI, 0.99-1.18; p = 0.065) and COVID-19-associated mortality (fully-adjusted HR, 0.88; 95% CI, 0.73-1.05; p = 0.162). When evaluating individuals hospitalized due to COVID-19, patients with psoriasis were more likely to have type-2 diabetes mellitus (adjusted OR, 1.24; 95% CI, 1.03-1.50; p = 0.027) and obesity (adjusted OR, 1.37; 95% CI, 1.13-1.65; p = 0.001) relative to controls.

CONCLUSIONS

While patients with psoriasis are at a higher risk of contracting SARS-CoV-2 infection, they are not more susceptible to the complications of COVID-19.

Cutaneous Manifestations of COVID-19 in the Lower Limbs: A Narrative Review

In 2020, the World Health Organization declared the COVID-19 pandemic. This infectious pathology can be associated with different manifestations in different body systems, among which are dermatological lesions. The purpose of this work is to determine the most frequent dermatological signs, in the lower limbs, produced by SARS-CoV-2. To carry this out, a bibliographic search was performed in the following databases: PubMed, SciELO, ScienceDirect, Cochrane Database of Systematic Reviews, and the Google Scholar literature. The inclusion criteria were articles that included confirmed subjects or those with a clinical suspicion of COVID-19, written in the Spanish or English languages, and the results presented clinical manifestations in the lower extremities. Initially, 128 scientific documents were identified and, after reading the title and abstract, 18 articles were selected. The most frequent skin lesions on the lower limbs are acral lesions such as pernio erythema or ischemic lesions, maculopapular rash, petechiae, and erythematous plaques.

Maximum Entropy (MaxEnt) Based DEMATEL and Its Application in Emergency Management

Since DEMATEL can visualize the structure of complex causal relationships, it is widely used in decision making. One of the important steps in DEMATEL is normalization, and it has received a lot of attention in recent years. Maximum entropy is a universal principle, and it is an effective tool for determining the amount of information existed in evidence. In this paper, maximum entropy based DEMATEL, named as MaxEnt-DEMETEL is proposed, the greatest contribution in this paper is the use of maximum entropy principle to determine the normalized direct influence matrix, which makes it possible to obtain the normalized matrix with minimal information loss. Emergency management is illustrated to show the superiority of the proposed method.

Critical success factors for epidemic emergency management in colleges and universities during COVID-19: A study based on DEMATEL method

Colleges and universities are considered as one of the "main battlefields" of epidemic prevention and control, wherein, they have difficulty in clarifying and identifying the critical points for emergency management due to the complexity and multiplicity of influencing factors. Therefore, this study aims to identify the most effective Critical Success Factors (CSFs) for COVID-19 prevention and control in China. This study uses the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method. This study has finally identified five Critical Success Factors (CSFs), which are 1) the training of emergency management professionals, 2) the cultivation of coordinating abilities, 3) the establishment of an epidemic prevention and control leadership team, 4) the development of corresponding responsibility awareness, and 5) the regulation of online public opinions. By focusing on these five CSFs, it can effectively facilitate colleges and universities to optimize their entire emergency management system in the process of normalization and professionalization of campus emergency management.

Teledermatology in the time of COVID-19

AIMS

The enormous spread of the novel Corona virus disease (COVID-19) represents a challenge to dermatological practice. Accumulating evidence has suggested a possible role of teledermatology in facing this challenge. In this article, we aimed to give a general overview of teledermatology in terms of models of practice, modes of delivery, advantages, limitations, ethical considerations and legislative challenges as well as discussing, using examples from literature, how dermatological practice can benefit from teledermatology during the time of the COVID-19 pandemic.

DISCUSSION AND CONCLUSION

Teledermatology could be an accessible, accurate and cost-effective substitute for conventional face-to-face dermatological consultations during the COVID-19 pandemic. However, teledermatology practice needs updated legislation and guidelines. More efforts should be done to encourage dermatologists, especially in underserved communities, to provide teledermatology services. Ethical issues and data security related to teledermatology have to be considered.

“An integrated system, three separated responsibilities”, a new fever clinic management model, in prevention and control of novel coronavirus pneumonia

BACKGROUND

Since December 2019, there have been many new cases of coronavirus pneumonia in Wuhan, Hubei Province, which has gradually spread throughout the country.

AIM

To explore our hospital’s innovative management system to ensure the efficient operation of fever clinics during the epidemic, since controlling the spread of disease is an important way to prevent and control the epidemic.

METHODS

In total, 200 outpatients with fever at our hospital between November 2019 and July 2020 were selected and allocated into two groups.

RESULTS

The fever clinic in our hospital operated smoothly, and infection with the novel coronavirus disease (COVID-19) has not been reported in our hospital. Additionally, we did not have any cases of missed diagnosis. The awareness regarding COVID-19 infection sources, transmission routes, early symptoms, and preventive measures was significantly higher in our fever clinic than in those of the pre-management group.

CONCLUSION

"An integrated system, three separate responsibilities" ensured the efficient functioning of our fever outpatient clinic and early screening of COVID-19 cases, which effectively curbed the transmission of COVID-19 and hence prevented COVID-19 pneumonia epidemic in our hospital, ultimately achieving the maximum effect of epidemic prevention and control.

Availability of personal protective equipment among dermatologists in the COVID-19 pandemic: Assessment and risk factors in a web-based, global study

Background: The availability of personal protective equipment (PPE) among dermatologists during the Coronavirus Disease 2019 (COVID-19) pandemic has not been studied. Methods: We have assessed PPE availability among dermatologists and relevant aspects of hospital service by surveying 733 dermatologists. Results: Considerable percentages of respondents had to purchase their own PPE (40.2%) and were not provided with it at the hospital (37.7%). Only 27% of respondents provided hospital service, and 18.4% were assigned to nondermatologic duty. A substantial percentage (64.4%) indicated the availability of hospital-issued management guidelines (HIMG) for COVID-19 patients. Nearly half of the survey participants (49.1%) responded that the health care system was not equipped for the pandemic. Purchasing one's own PPE was strongly associated with the private practice setting and continent, with the highest rates in Central and South America and in Europe (P < .001). PPE availability at a hospital was associated with 2 continents, with the highest rates in Europe and in North America (P < .001). In logistic regression, the most important factor reducing the odds ratio (OR) for purchasing their own PPE was HIMG for COVID-19 patients (OR, 0.55; 95% confidence interval [CI], 0.32-0.97). Respondents’ assessment that the health care system was equipped for COVID-19 was the most powerful increaser of OR for PPE availability (OR, 9.43; 95% CI, 5.37-16.56) followed by >1,000 COVID-19 cases in a participant's country. Conclusions: Substantial percentages of respondents had to purchase their own PPE and were not provided with it at the hospital. Strategies to increase PPE availability should be implemented by hospitals, industry, and government authorities.

Global impact on dermatology practice due to the COVID-19 pandemic

This contribution focuses on the effects of coronavirus disease 2019 (COVID-19) on dermatology practice. We discuss the impact on practice volume and procedures and on the considerable increase in teledermatology use. We also describe the important roles that dermatologists have played in enhancing infection prevention and on the frontline. During the crisis, dermatologists have faced the challenge of a shortage of resources, such as personal protective equipment, in the health care system. In addition, they have been involved in managing cutaneous manifestations related to COVID-19 and occupational disease caused by personal protective equipment. Dermatologists have made a diligent effort to identify melanoma and to ensure the treatment of high-risk skin cancers. Safety guidelines have been suggested to minimize the potential risks associated with the systemic use of immunosuppressant agents and immunomodulators in patients with severe inflammatory skin disease during the pandemic. Finally, social distancing necessitated that dermatology conferences take place virtually and teaching via e-learning increased.

E-Triage Systems for COVID-19 Outbreak: Review and Recommendations

With population growth and aging, the emergence of new diseases and immunodeficiency, the demand for emergency departments (EDs) increases, making overcrowding in these departments a global problem. Due to the disease severity and transmission rate of COVID-19, it is necessary to provide an accurate and automated triage system to classify and isolate the suspected cases. Different triage methods for COVID-19 patients have been proposed as disease symptoms vary by country. Still, several problems with triage systems remain unresolved, most notably overcrowding in EDs, lengthy waiting times and difficulty adjusting static triage systems when the nature and symptoms of a disease changes. In this paper, we conduct a comprehensive review of general ED triage systems as well as COVID-19 triage systems. We identified important parameters that we recommend considering when designing an e-Triage (electronic triage) system for EDs, namely waiting time, simplicity, reliability, validity, scalability, and adaptability. Moreover, the study proposes a scoring-based e-Triage system for COVID-19 along with several recommended solutions to enhance the overall outcome of e-Triage systems during the outbreak. The recommended solutions aim to reduce overcrowding and overheads in EDs by remotely assessing patients' conditions and identifying their severity levels.

Risk of COVID-19 Infection, Hospitalization, and Mortality in Patients with Psoriasis Treated by Interleukin-17 Inhibitors

BACKGROUND

The risk of the infection and its complications under this drug class remains to be determined.

OBJECTIVE

To evaluate the risk of COVID-19, COVID-19-associated hospitalization, and mortality among patients with psoriasis treated by IL-17I.

METHODS

A population-based cohort study was performed to compare psoriasis patients treated by IL-17I (n = 680) with those treated by methotrexate (n = 2,153) and non-systemic/non-immunomodulatory treatments (n = 138,750) regarding the incidence of COVID-19 and its complications.

RESULTS

The use of IL-17I was not associated with an increased risk of COVID-19 infection [adjusted HR for IL-17I vs. methotrexate: 0.91 (95% CI, 0.48-1.72); IL-17I vs. non-systemic/non-immunomodulatory treatments: 0.92 (95% CI, 0.54-1.59)]. IL-17I was associated with comparable risk of COVID-19-associated hospitalization [adjusted HR for IL-17I vs. methotrexate: 0.42 (95% CI, 0.05-3.39); IL-17I vs. non-systemic/non-immunomodulatory treatments: 0.65 (95% CI, 0.09-4.59)] and COVID-19-associated mortality [adjusted HR for IL-17I vs. methotrexate: 7.57 (95% CI, 0.36-157.36); IL-17I vs. non-systemic/non-immunomodulatory treatments: 7.05 (95% CI, 0.96-51.98)]. In a sensitivity analysis, neither secukinumab nor ixekizumab imposed an elevated risk of any of the outcomes of interests.

CONCLUSIONS

IL-17I treatment does not confer an increased risk of COVID-19 infection or its complications in patients with psoriasis. Our findings support the continuation of IL-17I treatment during the pandemic.

Impact of COVID-19 pandemic on dermatology practices: Results of a web-based, global survey

The spectrum and magnitude of changes in dermatology practice induced by the COVID-19 pandemic have not been adequately studied.

OBJECTIVE

This study aimed to assess the immediate and long-term effects of the pandemic on dermatology practice on a large scale, including the clinical activity of participants, frequency and types of procedures used, and teledermatology (TD) use.

METHODS

This web-based, global survey included 733 dermatologists. The primary outcomes are percentages of respondents providing in-person consultations, hospital service, and TD and performing procedures. Factors in logistic regression models that may influence the odds ratio (OR) for TD use during pandemic and for future use also were analyzed.

RESULTS

The percentages of respondents providing in-person consultations (46.6% vs. 100% before the pandemic) and hospital service (27% vs. 52.8% before the pandemic) as well as performing procedures (25.6% vs. 100% before the pandemic) decreased, whereas practicing TD increased three-fold (75.2% vs. 26.1% before the pandemic) during the pandemic (p < .001 for each). Practice location was associated with TD use during the pandemic and with its expected use in the future (p < .001 for both), with North American respondents indicating the highest use. TD use during the pandemic showed a positive correlation with TD use before the pandemic, performing procedures and, more specifically, with biopsies of suspicious pigmented lesions during the pandemic (p < .001 for each). TD use before the pandemic was the most powerful predictor of TD use during the pandemic (OR: 16.47; 95% confidence interval, 7.12-38.06). More than two third of participants (68.6%) expect to use TD in the future. The factor with the largest increase in OR on the expectation of future TD use was >1000 COVID-19 cases in the country (OR: 3.80; 95% confidence interval, 2.33-6.21).

CONCLUSION

This survey indicates a profound immediate effect of the pandemic on dermatology practice. The pandemic appears to have substantially contributed to an increased use of TD in the long run.

Corona viruses: reaching far beyond the common cold

Background

Human coronaviruses (HCoVs) are one of the most common causes of the “common cold”. Some HCoV strains, however, can cause fatal respiratory disease. Some examples of these diseases are severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and Coronavirus Disease 19 (COVID-19). This article will review the etiology, clinical features, diagnosis, and management of HCoVs.

Methods

A systematic literature review was performed using the terms “human coronaviruses”, “MERS-CoV”, “SARSCoV”, “SARS-CoV2”, “COVID-19”, and “common cold” in OVID MEDLINE, PubMed, and Cochrane Library.

Findings

Most HCoVs cause mild upper respiratory infections which resolve with supportive care and no sequelae. In recent decades, however, there have been outbreaks of novel HCoVs that cause more severe disease. This is largely due to HCoVs having large genomes which undergo frequent recombination events, leading to the emergence of novel and more virulent strains of the virus. These severe respiratory illnesses can lead to acute respiratory distress requiring invasive intervention, such as mechanical ventilation. These severe infections can lead to long-lasting sequelae in patients. Scientists continue to investigate potential treatments for these viruses, though supportive care remains the gold standard. Scientists have succeeded in developing numerous vaccines for the SARS-CoV-2 virus, and ongoing data collection and analysis will shed even more light on the next steps in fighting the COVID-19 pandemic.

Conclusion

Due to the frequency of recombination events and the subsequent emergence of novel strains, HCoVs are becoming more prevalent, making them a global health concern as they can lead to epidemics and pandemics. Understanding the epidemiology, etiology, clinical features, diagnosis, and management of HCoVs is important, especially during this worldwide pandemic.

Associations between COVID-19 and skin conditions identified through epidemiology and genomic studies

Background

Coronavirus disease 2019 (COVID-19) is commonly associated with skin manifestations, and may also exacerbate existing skin diseases, yet the relationship between COVID-19 and skin diseases remains unclear.

Objective

By investigating this relationship through a multiomics approach, we sought to ascertain whether patients with skin conditions are more susceptible to COVID-19.

Methods

We conducted an epidemiological study and then compared gene expression across 9 different inflammatory skin conditions and severe acute respiratory syndrome coronavirus 2–infected bronchial epithelial cell lines, and then performed a genome-wide association study transdisease meta-analysis between COVID-19 susceptibility and 2 skin diseases (psoriasis and atopic dermatitis).

Results

Skin conditions, including psoriasis and atopic dermatitis, increase the risk of COVID-19 (odds ratio, 1.55; P = 1.4 × 10⁻⁹) but decrease the risk of mechanical ventilation (odds ratio, 0.22; P = 8.5 × 10⁻⁵). We observed significant overlap in gene expression between the infected normal bronchial epithelial cells and inflammatory skin diseases, such as psoriasis and atopic dermatitis. For genes that are commonly induced in both the severe acute respiratory syndrome coronavirus 2 infection and skin diseases, there are 4 S100 family members located in the epidermal differentiation complex, and we also identified the “IL-17 signaling pathway” (P = 4.9 × 10⁻⁷⁷) as one of the most significantly enriched pathways. Furthermore, a shared genome-wide significant locus in the epidermal differentiation complex was identified between psoriasis and severe acute respiratory syndrome coronavirus 2 infection, with the lead marker being a significant expression quantitative trait locus for S100A12 (P = 3.3 × 10⁻⁷).

Conclusions

Together our findings suggest association between inflammatory skin conditions and higher risk of COVID-19, but with less severe course, and highlight shared components involved in anti–COVID-19 immune response.

Knowledge, attitude, and preventive behaviors of Hormozgan residents toward COVID-19, one month after the epidemic in Iran

Aim

COVID-19 has become prevalent in the world since December 2019. The further prevalence of the disease can be prevented by correct management of society and increasing knowledge, practices, and attitudes of the people. The present research aimed to evaluate the knowledge, attitudes, and preventive behaviors of people in Hormozgan in the south of Iran toward COVID-19.

Subject and methods

The present cross-sectional research was conducted over 2 months (March 2020–April 2020). The online questionnaire comprised four sections: demographic information, knowledge, attitude, and behavior toward COVID-19. Knowledge included 36 items, attitude eight items, and behavior ten items. The collected data were analyzed statistically using SPSS ver. 22. The split-half method was used to test the reliability of knowledge and the estimated value was 0.84. That of attitude and behavior was estimated via Cronbach’s alpha and was found to be 0.81 and 0.75, respectively.

Results

A total number of 2024 participants with an average age of 33.94 years took part in this research. Of all participants, 64.4% were female. According to the results, 65.8% enjoyed a good level of knowledge and 34.2% enjoyed an average level. In addition, 63.2% demonstrated a good attitude and 36.8% an average level. A large percentage of participants (90.6%) had good practices and only 9.4% had an average level of practices.

Conclusion

The present findings show that participants had a relatively good level of knowledge, positive attitude, and good behavior concerning COVID-19.

Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers When Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus: A Quality Improvement Project

PURPOSE

Extended use of N95 respirator masks is far more prevalent during the coronavirus disease 2019 (COVID-19) pandemic. As WOC nurses, we were tasked with formulating procedures for protecting the facial skin integrity of healthcare workers (HCWs) using personal protective devices when caring for patients with suspected or active COVID-19, while avoiding contamination when the masks are donned or doffed. This quality improvement project describes how we approached this project within the limited time frame available as we cared for patients with established and suspected COVID-19.

PARTICIPANTS AND SETTING

This project focused on HCW use of N95 respirator masks and dressings currently available in our facility. The 4 WOC nurses acted as quality improvement project directors and as participants. The setting for our project was our facility's simulation laboratory.

APPROACH

We evaluated 6 topical products (an alcohol-free liquid acrylate, thin film dressing, thin hydrocolloid dressing, hydrocolloid blister care cushion, thin foam transfer dressing, and thick foam dressing) applied to skin in contact with 3 N95 respirators; all are available on our facility's formulary and all are in widespread clinical use. After the product was applied to the face and nose, the N95 respirator was donned and evaluated for fit. Participants then wore the devices for 10 hours and doffed the mask using established facility procedures. In order to evaluate for potential contamination including possible aerosolization, we applied a commercially available fluorescent lotion to simulate the presence of infectious particles. Contamination was assessed using an ultraviolet light for all dressings except for the alcohol-free liquid acrylate. We also evaluated cutaneous responses (skin integrity, irritation, comfort) during this period.

OUTCOMES

We found that contamination of the simulated pathogen did not occur with removal of any of the protective products. No skin irritation was noted with any of the tested products after a 10-hour wear time underneath the N95 respirator masks, but mild discomfort was experienced with 3 of the dressings (thin film dressing and both hydrocolloid dressings).

CONCLUSION

Based on these experiences, we recommend application of an alcohol-free liquid acrylate film to prevent facial skin injury associated with friction from the extended use of an N95 respirator mask. We further recommend performing a fit test and user-performed seal check with the use of any topical dressing and especially those that add cushion. For the duration of the COVID-19 pandemic, we recommend use of protective dressings to maintain skin integrity and protection from coronavirus infection as HCWs continue to provide care to all of patients under their care.

Examining recommendations for the use of biologics and other systemic therapies during COVID-19: a review and comparison of available dermatology guidelines and patient registries

BACKGROUND

The novel coronavirus (COVID-19) has an affinity for almost every organ system, including the skin. This review article will compile and compare dermatology guidelines related to the dermatologic care of patients during the COVID-19 pandemic.

OBJECTIVE

To review and compare the available guidelines and recommendations on use of biologics and other systemic therapies in dermatology patients.

METHODS

We conducted a search for guidelines and recommendations for dermatology providers, with specific attention to the management of biologics and non-biologic systemic agents during COVID-19. International and United States-based guidelines specific to the field of dermatology and guidance for healthcare providers were used as inclusion criteria. Available registries were included as well.

CONCLUSION

The guidelines stress a shared decision-making approach with risk-benefit analysis and treatment strategy modifications tailored to each unique patient case. The guidelines were all concordant with one another in highlighting the importance that patients should not discontinue their medications without first speaking with their providers.

Prolonged prothrombin time at admission predicts poor clinical outcome in COVID-19 patients

BACKGROUND

The prognostic value of coagulation disorder in coronavirus disease 2019 (COVID-19) patients should be demonstrated.

AIM

To investigate the abnormalities of coagulation parameters in the patients with COVID-19 and their prognostic values.

METHODS

Consecutive patients admitted in the isolation ward of Renmin Hospital of Wuhan University from January 31 to February 5, 2020 with confirmed COVID-19 were included. The primary outcomes were death and survival as of March 11. Demographics, vital signs, comorbidities and laboratory tests were collected and compared between those who died and survivors. Logistic regression analysis for prognostic factors was performed. Kaplan-Meier analysis was used to compare the estimated survival rate between patients with prolonged prothrombin time and normal prothrombin time.

RESULTS

The total number of patients with confirmed COVID-19 who were enrolled was 213. The median age was 62 years, and 95 patients (44.6%) were men. Fifty-one patients were critical (23.9%), 79 patients were severe (37.1%) and 83 patients were moderate (39%). As of March 11, 2020, 99 patients were discharged (46.5%), 79 patients (37.1%) stayed in the hospital and 35 patients (16.2%) died. Median time to death was 6 (4-8) d, while median hospital stay was 32 (22-36) d in survivors (P < 0.001). More men (P = 0.002) and elderly patients (P < 0.001) were found in the group of those who died. The respiration rate at admission was higher in the group of those who died (P < 0.001). The incidences of hypertension (P = 0.028), cerebrovascular disease (P < 0.001), chronic kidney disease (P = 0.02) and chronic obstructive pulmonary disease (P < 0.001) were higher in the group of those who died. Platelet count was decreased in the group of those who died (P = 0.002) whereas prothrombin time (P < 0.001), activated partial thromboplastin time (P = 0.033), concentration of D-dimer (P < 0.001) and fibrin degradation products (P < 0.001) were increased in the group of those who died. Prothrombin time [odds ratio (OR): 2.19, P = 0.004], respiration rate (OR: 1.223, P < 0.001), age (OR: 1.074, P < 0.001) and fibrin degradation products concentration (OR: 1.02, P = 0.014) were predictors of death. The survival rate was significantly lower in patients with prolonged prothrombin time compare to those with normal prothrombin time (P < 0.001).

CONCLUSION

Prothrombin time, concentration of fibrin degradation products, respiration rate and age were predictive factors for clinical outcomes of COVID-19 patients.

Changing trends in dermatology practice during COVID-19 pandemic: A single tertiary center experience

The aim of this study was to evaluate the changing trends in dermatology clinical practice at a tertiary center during the coronavirus disease 2019 (COVID‐19) pandemic. This retrospective cohort study was conducted on patients who were admitted to Ufuk University Hospital with dermatologic complaints/diseases before and during the pandemic. The patients were divided into two groups: (a) the pre‐pandemic period (March‐May 2019) and (b) the Pandemic period (March‐May 2020). Demographic features, clinical characteristics, dermatologic diseases/complaints, dermatologic procedures/interventions, hospitalization rate, and use of biologic agents were compared between the two groups. Total number of hospital admissions have decreased from 1165 to 717. Admission rates for acne, dermatophytosis, and benign neoplasm of the skin significantly lower during the pandemic period (P values were .02, .04, and .006, respectively). Contact dermatitis, acne accompanying dermatitis, cicatricial hair loss, lichen planus, and zona zoster infection rates were significantly higher (P values were .007, <.001, .009, .04, and .03, respectively). Rates of biopsy and electrocautery procedures were decreased significantly (P values were <.001 and .002, respectively). The hospitalization rate was similar between the groups (P = .51). However, the use of biologic agents significantly decreased during the pandemic period (P = .01). Updated clinical protocols should be established for the new normal period in accordance with these findings.

Global coronavirus pandemic ( SARS‐CoV ‐2): Past , present , and future of pediatric dermatology

Two months have passed since the World Health Organization (WHO) declared the pandemic of the Coronavirus Disease 19 (COVID‐19), caused by the SARS‐CoV‐2 virus, on 11 March 2020. Medical and healthcare workers have continued to be on the frontline to defeat this disease, however, continual changes are being made to their working habits which are proving to be difficult. Although the skin is not the main target of the SARS‐CoV‐2 infection, it is strongly involved both directly and indirectly, in many aspects of dermatological disease management, and particularly in pediatric dermatology. In this manuscript, our goal was to provide a “up‐to‐date” account on this topic, through analysis of current literature and sharing our experiences during this pandemic.

Recommendations for Cutaneous and Aesthetic Surgeries during COVID-19 Pandemic

Background:

Amid the coronavirus disease 2019 (COVID-19) pandemic, dermatologists must be prepared to restructure their practice of procedural dermatology and cutaneous aesthetic surgeries. The COVID-19 pandemic has presented several challenges and has ushered in several changes in practice such as teledermatology, with many physicians adopting virtual consultations and treatments. Performing procedures in the times of COVID-19 pandemic presents challenges such as risk of transmission to doctors and staff due to potential aerosolization, release of virus droplets during the procedures, and risk of virus transfer through the instruments both in the peri- and postoperative period. This can have several medical, administrative, and legal implications.

Objectives:

This document aimed to outline best practices that can be followed in this scenario to perform cutaneous surgeries and procedures to ensure safer skin surgery.

Recommendations:

Standard precautions include social distancing of at least 1 m, hand hygiene, appropriate use of personal protective equipment (PPE), safe injection practices, sterilization and disinfection of medical devices, environmental cleaning, and respiratory hygiene. It is generally advisable to see patients only by appointments. Each clinic should have a special area at entry for screening patients and providing sanitizers and masks. Procedures, which are of short duration, performed on nonfacial areas are considered as low risk and require donning surgical mask. Procedures involved with minimal invasiveness and bleeding, short duration procedures on the face such as injectables, chemical peels, and aerosol-generating procedures on nonfacial areas are considered moderate risk. These procedures need apron with head cover, N95 mask, face shield, double gloves, and smoke evacuator with high-efficiency particulate air (HEPA) or ultralow particulate air (ULPA) filter. Aerosol and plume-regenerating procedures (such as ablative lasers on the face), prolonged surgeries on head (such as hair transplantation), intraoral, and intranasal procedures are considered high risk. These procedures must be carried out with full body cover with surgical gown, head cover, N95 mask, face shield, double gloves, and smoke evacuator. Physicians should be aware of local epidemiological situation and adhere to the relevant guidelines issued by the relevant governmental agencies.

A Review of the Dermatological Manifestations of Coronavirus Disease 2019 (COVID-19)

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has affected 210 countries and territories around the world. The virus has spread rapidly, and the disease is still extending up to now. The pathophysiology for SARS-CoV-2 has not been well elucidated, and diverse hypotheses to date have been proposed. Initially, no skin manifestations were observed among patients with COVID-19, but recently a few cases have been described. In this review, we discuss these various cutaneous manifestations and skin problems related to personal protective equipment, as well as different cutaneous anti-COVID-19 drug-associated reactions. We also focus on the currently proposed managements of these rare manifestations.

COVID-19 Therapeutic Options Under Investigation

Since its emergence in China in December 2019, COVID-19 has quickly spread around the globe causing a pandemic. Vaccination or the development of herd immunity seems the only way to slow down the spread of the virus; however, both are not achievable in the near future. Therefore, effective treatments to mitigate the burden of this pandemic and reduce mortality rates are urgently needed. Preclinical and clinical studies of potential antiviral and immunomodulatory compounds and molecules to identify safe and efficacious therapeutics for COVID-19 are ongoing. Two compounds, remdesivir, and dexamethasone have been so far shown to reduce COVID-19-associated death. Here, we provide a review of the potential therapeutic agents being considered for the treatment and management of COVID-19 patients.

The most common pediatric and adult dermatology patient complaints in a month of the COVID-19 pandemic in Turkey

Severe acute respiratory syndrome coronavirus 2 is the coronavirus strain that causes coronavirus disease 2019 (COVID‐19). The World Health Organization (WHO) has designated the ongoing COVID‐19 outbreak a Public Health Emergency of International Concern. WHO declared COVID‐19 as a pandemic on 11 March 2020. During the pandemic and lockdown period, many dermatologic clinics were temporarily closed in Turkey as well as all over the world. Taking the necessary precautions, the hospital continued to examine all emergent and elective patients who applied to our dermatology clinic. We investigated the most common reasons for admission of pediatric and adult patients who were admitted to our outpatient clinic between 30 March and 30 April 2020, the period with the highest number of COVID‐19 patients in Turkey. In children and adult age groups, the most common reason for admission was acne (N: 10 [16.4%] and N: 89 [20.9%], respectively). Of the 99 acne patients, 70 (70.7%) were using systemic isotretinoin and applied to our clinic to repeat the prescription or continue the agent. The number of pediatric patients admitted to the dermatology department drastically reduced during the lockdown period, which was attributed to the curfew for children in the country.

Lessons from dermatology about inflammatory responses in Covid-19

The SARS‐Cov‐2 is a single‐stranded RNA virus composed of 16 non‐structural proteins (NSP 1‐16) with specific roles in the replication of coronaviruses. NSP3 has the property to block host innate immune response and to promote cytokine expression. NSP5 can inhibit interferon (IFN) signalling and NSP16 prevents MAD5 recognition, depressing the innate immunity. Dendritic cells, monocytes, and macrophages are the first cell lineage against viruses' infections. The IFN type I is the danger signal for the human body during this clinical setting. Protective immune responses to viral infection are initiated by innate immune sensors that survey extracellular and intracellular space for foreign nucleic acids. In Covid‐19 the pathogenesis is not yet fully understood, but viral and host factors seem to play a key role. Important points in severe Covid‐19 are characterized by an upregulated innate immune response, hypercoagulopathy state, pulmonary tissue damage, neurological and/or gastrointestinal tract involvement, and fatal outcome in severe cases of macrophage activation syndrome, which produce a ‘cytokine storm’. These systemic conditions share polymorphous cutaneous lesions where innate immune system is involved in the histopathological findings with acute respiratory distress syndrome, hypercoagulability, hyperferritinemia, increased serum levels of D‐dimer, lactic dehydrogenase, reactive‐C‐protein and serum A amyloid. It is described that several polymorphous cutaneous lesions similar to erythema pernio, urticarial rashes, diffuse or disseminated erythema, livedo racemosa, blue toe syndrome, retiform purpura, vesicles lesions, and purpuric exanthema or exanthema with clinical aspects of symmetrical drug‐related intertriginous and flexural exanthema. This review describes the complexity of Covid‐19, its pathophysiological and clinical aspects.

Comparative analysis of perceived stress in dermatologists and other physicians during national lock-down and COVID-19 pandemic with exploration of possible risk factors: A web-based cross-sectional study from Eastern India

Since the declaration of coronavirus disease 2019 (COVID-19) as global pandemic, several countries including India have enforced a national lock-down. We aimed to compare the perceived stress of dermatologists and nondermatologists, due to lock-down and COVID-19 pandemic and analyze the role of possible risk factors. We conducted a web-based cross-sectional study to determine the perceived stress of doctors using the Perceived Stress Scale-10 and evaluate possible risk factors. Among 384 valid responders, we had 37.5% dermatologists and 62.5% nondermatologists. Perceived stress was more in nondermatologists compared to dermatologists, but not statistically significant (P = 0.1). Degree of stress was also comparable (P = 0.5). Higher stress was significantly associated with females and unmarried individuals in both groups. Risk of infecting self or colleagues or family members and lack of protective gear at work place were top causes of stress. Perceived stress is increased in all doctors due to COVID-19 pandemic and lock-down. Even dermatologists have developed high stress due to current situation, comparable to nondermatologists, despite being traditionally considered an outpatient speciality with minimum stress. Thus, proper mental health care policies should be adopted for all doctors, including dermatologists.

Dermatologists and SARS-CoV-2: the impact of the pandemic on daily practice

Since the first case of 'pneumonia of unknown aetiology' was diagnosed at the Wuhan Jinyintan Hospital in China on 30 December 2019, what was recognized thereafter as 'severe acute respiratory syndrome coronavirus 2' (SARS-CoV-2) has spread over the four continents, causing the respiratory manifestations of coronavirus disease-19 (COVID-19) and satisfying the epidemiological criteria for a label of 'pandemic'. The ongoing SARS-CoV-2 pandemic is having a huge impact on dermatological practice including the marked reduction of face-to-face consultations in favour of teledermatology, the uncertainties concerning the outcome of COVID-19 infection in patients with common inflammatory disorders such as psoriasis or atopic dermatitis receiving immunosuppressive/immunomodulating systemic therapies; the direct involvement of dermatologists in COVID-19 care for patient assistance and new research needs to be addressed. It is not known yet if skin lesions and derangement of the skin barrier could make it easier for SARS-CoV-2 to transmit via indirect contact; it remains to be defined if specific mucosal or skin lesions are associated with SARS-CoV-2 infection, although some unpublished observations indicate the occurrence of a transient varicelliform exanthema during the early phase of the infection. SARS-CoV-2 is a new pathogen for humans that is highly contagious, can spread quickly, and is capable of causing enormous health, economic and societal impacts in any setting. The consequences may continue long after the pandemic resolves, and new management modalities for dermatology may originate from the COVID-19 disaster. Learning from experience may help to cope with future major societal changes.

COVID-19 and dermatology: a comprehensive guide for dermatologists

Linked articles: COVID‐19 SPECIAL FORUM. J Eur Acad Dermatol Venereol 2020; 34: e291–e310.

Update to device-related pressure ulcers: SECURE prevention. COVID-19, face masks and skin damage

The 2019 novel coronavirus disease (COVID-19) pandemic has brought the effects of device-related pressure ulcers (DRPU) into sharp focus. With the increased use of personal protective equipment (PPE), including face masks, continuous positive airway pressure (CAPP) masks and other devices, the incidence of DRPUs among health professionals and patients alike has risen starkly. As such, the Journal of Wound Care (JWC) consensus document, Device-related pressure ulcers: SECURE prevention, published in February 2020, is more relevant than ever. To help support patients and frontline health professionals, JWC is republishing the consensus in a digital format, along with a new introductory article outlining the DRPU risks posed by PPE and other medical devices used by patients and health professionals during the pandemic, and how the skin damage can be avoided. The aim is to provide frontline staff with a clear, simple strategy on how to prevent the risk of personal skin damage and/or DRPU during the pandemic, as well as point them in the direction of more indepth guidance on long-term strategies for prevention, for both themselves and patients.

Recommendations for prevention and management of COVID-19 in peritoneal dialysis patients

The World Health Organization characterized coronavirus disease (COVID-19) as a pandemic on March 11, 2020. Peritoneal dialysis patients have a weakened immune system that is associated with a high morbidity of infection. Thus, COVID-19 prevention measures and management for patients on peritoneal dialysis are urgent and critical. Based on published research on COVID-19 and previous clinical practices for similar coronavirus outbreaks, we aimed to make recommendations to manage patients undergoing peritoneal dialysis.

COVID-19 pandemic and the skin: what should dermatologists know?

The world has changed dramatically since the COVID-19 pandemic began. In addition to our social, occupational, and personal lives, the new coronavirus also poses novel challenges for all physicians, including dermatologists. Several skin conditions have emerged, mainly as a result of prolonged contact with personal protective equipment and excessive personal hygiene. Pressure injury, contact dermatitis, itch, pressure urticaria, and exacerbation of preexisting skin diseases, including seborrheic dermatitis and acne, have been described. We have focused on the dermatologic aspects of the COVID-19 infection so that dermatologists are aware of the skin complications and preventive measures can be taken in the COVID-19 pandemic.

The Multifaceted Engagement of the Dermatologist in the Covid-19 Pandemic

Dermatologists worldwide are engaged in the struggle against Covid-19. They limited their daily activity to priority cases, intending to reduce the exposure of patients in the waiting room. Teledermatology was recommended as an efficient alternative to assure patients' needs and safety. At the same time, dermatologists had to manage the skin injuries of frontline healthcare workers; to characterize the cutaneous manifestations of Covid-19; to assess the optimal treatment of patients with skin diseases, especially those taking immunomodulating and immunosuppressant molecules; and finally to promote balanced precautions in healthy persons.