Teledermatology in the COVID-19 pandemic: a systematic review

Background

Teledermatology (TD) has emerged as a critical way of delivering care remotely in the COVID-19 pandemic.

Objective

We conducted a systematic review to assess how TD has been implemented worldwide.

Methods

We searched PubMed, Scopus, Embase, Web of Science, and Google Scholar for articles on the use of TD for patient care, written in English and published from December 1, 2019, to October 15, 2020.

Results

Twenty-seven studies were included, involving 16,981 patients. There was significant uptake of TD during the pandemic. Synchronous TD appeared to be more commonly implemented than asynchronous TD. Common ambulatory dermatoses such as acne or eczema were reported to be more amenable to TD assessment and management. TD also appeared to be useful for the diagnosis of cutaneous involvement of COVID-19 infection and follow-up of stable oncodermatology cases.

Limitations

A pooled analysis of all relevant outcomes was not always possible due to the heterogeneity in the methodologies of included studies.

Conclusion

TD is a useful and convenient tool for the management of common ambulatory dermatoses in the COVID-19 pandemic.

An overview of lower limb cellulitis in an acute medical ward-a few lessons we can learn

Lower limb cellulitis is a common cause for hospital admissions. In this retrospective study, we assessed the characteristics and outcome of patients admitted in an acute medical unit. The mean duration of treatment was 10.48 days, with 95.5% receiving antibiotics for more than 5 days. Mean length of stay (LOS) was 5.19 days. 12-month readmission rate was higher in patients with diabetes, chronic kidney disease (CKD) and previous stroke. Diabetes, CKD, previous stroke, and elevated procalcitonin levels were independently associated with prolonged admission (>3 days).

Pernicious anaemia presenting as hyperpigmentation

An adult East Asian woman presented with sudden onset of hyperpigmented macules on her oral mucosal surfaces, palms and soles, in association with hypoguesia and loss of weight. This was found to be associated with underlying severe vitamin B12 deficiency secondary to pernicious anaemia.

Incidental pineal cysts in children who undergo 3-T MRI

BACKGROUND

Pineal cysts, both simple and complex, are commonly encountered in children. More cysts are being detected with MR technology; however, nearly all pineal cysts are benign and require no follow-up.

OBJECTIVE

To discover the prevalence of pineal cysts in children at our institution who have undergone high-resolution 3-T MRI.

MATERIALS AND METHODS

We retrospectively reviewed 100 consecutive 3-T brain MRIs in children ages 1 month to 17 years (mean 6.8 ± 5.1 years). We evaluated 3-D volumetric T1-W imaging, axial T2-W imaging, axial T2-W FLAIR (fluid attenuated inversion recovery) and coronal STIR (short tau inversion recovery) sequences. Pineal parenchymal and cyst volumes were measured in three planes. Cysts were analyzed for the presence and degree of complexity.

RESULTS

Pineal cysts were present in 57% of children, with a mean maximum linear dimension of 4.2 mm (range 1.5-16 mm). Of these cysts, 24.6% showed thin septations or fluid levels reflecting complexity. None of the cysts demonstrated complete T2/FLAIR signal suppression. No cyst wall thickening or nodularity was present. There was no significant difference between the ages of children with and without cysts. Cysts were more commonly encountered in girls than boys (67% vs. 52%; P = 0.043). There was a slight trend toward increasing pineal gland volume with age.

CONCLUSION

Pineal cysts are often present in children and can be incidentally detected by 3-T MRI. Characteristic-appearing pineal cysts in children are benign, incidental findings, for which follow-up is not required if there are no referable symptoms or excessive size.

Role of intraoperative transesophageal echocardiography in determining aortic annulus diameter in homograft insertion

The sizing of aortic valve (AV) homografts for optimum function requires an accurate measurement of the aortic annulus. Typically, this measurement is obtained directly with sizers in the open aorta. We describe the use of intraoperative transesophageal echocardiography (IOTEE) to measure the aortic annulus and select the appropriate AV homograft before cardiopulmonary bypass and aortic cross-clamping. Thirty-two patients underwent AV homograft insertion between March 1993 and March 1996 and had IOTEE. There were 13 women and 19 men. Mean age was 58 +/- 14 years. IOTEE measurements were satisfactory in sizing in all patients, and no extraordinary surgical measures were necessary to insert the AV homografts. Early postoperative follow-up showed trivial or mild regurgitation of all homografts. Prebypass IOTEE is reliable in guiding the selection of optimal AV homografts.

Alterations of GABA metabolism and seizure susceptibility in the substantia nigra of the kindled rat acclimating to changes in osmotic state

Seizure susceptibility and GABA metabolism were altered in the substantia nigra [SN] of adult male Sprague Dawley rats when these animals were acclimating to an altered plasma osmolality. Changes in GABA metabolism were measured in vivo in SN of the freely moving rat. Suitable precautions were taken to avoid any post-mortem flux of glutamate to GABA and to correct for the underestimation of GABA build up in SN due to the finite diffusion rate of gamma-vinyl GABA [GVG] after stereotaxic injection of small amounts into one side of the brain. Control experiments provided evidence that changes in osmolality, within a normal physiological range, did not affect significantly gamma-aminobutyric acid transaminase [GABA-T]. Also kindling via the medial septum [MS], in the absence of electrical stimulation did not alter GABA metabolism in SN, thus providing a stable baseline for studies of osmotic effects. Hyperosmolality was associated with a rise in seizure thresholds, with a marked reduction of the rate of GABA synthesis in SN, and with a substantial increase in turnover time of the GABA pool. Hypoosmolality, of a degree known to be associated with mild cerebral edema and swelling localized to astrocytes, markedly reduced seizure threshold, and reduced GABA pool size in SN, but did not alter the rate of GABA synthesis significantly. These results demonstrate by new and independent means the relationship between GABA metabolism in the SN and seizure susceptibility in vivo.

Changes of amino acid gradients in brain tissues induced by microwave irradiation and other means

Focused microwave irradiation to the head (FMI) has been used extensively by neurochemists for rapid inactivation of enzymatic activity in brain tissues and the preservation, for in vitro analysis, of in vivo substrate concentrations. Periodically the suitability of this technique for regional studies has been questioned. Evidence has now been obtained, on the basis of altered concentration gradients for GABA and taurine from the Substantia Nigra (SN) to an Adjacent Dorsal Area (ADJ), that FMI not only inactivates enzymes, but also facilitates rapid diffusion of small molecules from areas of high concentrations to adjacent areas of lower concentration. To a lesser extent, the implantation of plastic injection cannulas also decreased these concentration gradients. These results offer clear evidence that FMI is ill suited and unreliable for studies designed to map and compare the "in vivo" regional concentrations of diffusible organic molecules (such as amino acids) in brain tissues. Any invasive technique that compromises membrane barriers is likely to produce smaller similar effects.