Mucocutaneous manifestations of COVID-19-related multisystem inflammatory syndrome in adults: an update.

Multisystem inflammatory syndrome in adults (MIS-A) is an inflammatory condition that affects multiple extrapulmonary organ systems (cardiac, gastrointestinal tract, dermatological and/or neurological), attributed to a postinfectious and atypical complication occurring weeks to months after infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The diagnosis is primarily based on findings encompassing persistent fever, elevated inflammatory markers, multiorgan involvement and a temporal relationship with COVID-19 infection. The existing literature on MIS-A, although growing, is limited to case reports and small case series. It is imperative that dermatologists be aware of this entity and aid the critical care team to ensure timely diagnosis and early therapeutic intervention. In this review, we concisely highlight the varied presentations, pathogenesis and treatment options in MIS-A.

Antifungal stewardship: What we need to know.

Antimicrobial stewardship refers to a well-coordinated program which promotes the scientific and rational use of antimicrobials, reduces the chances of drug resistance and improves patient outcomes. A comprehensive English language literature search was done across multiple databases (PubMed, EMBASE, MEDLINE and Cochrane) for the period 1990-2022, revealing a large volume of reports of growing resistance to established antifungal therapies, against a backdrop of irrational and unscientific prescriptions. As a result of this, antifungal stewardship, a new kid on the block, has recently garnered attention. This review article is an attempt to summarise the basic concept of stewardship programs, highlighting the dire need to implement the same in the present situation of antifungal resistance and treatment failure.

Apremilast in Paediatric Dermatoses - A Comprehensive Review.

Apremilast has recently garnered attention in the management of multiple dermatological conditions including psoriasis. The comparable effectiveness with immunosuppressive drugs and a favorable side effect profile makes the drug, a prudent alternative for managing a gamut of dermatoses. In this article, we have reviewed the literature on apremilast use in children.

Transverse erythronychia: A unique nail manifestation of COVID-19 infection and brief review of COVID-19 associated nail changes.

Over the past 2 years, a plethora of mucocutaneous manifestations have been described to be associated with coronavirus 2019 (COVID-19) infection. Nail changes attributed to COVID-19 have rarely been documented in the literature. We describe here a unique nail finding 'transverse erythronychia' due to COVID-19 and review the literature on the diverse nail pathology attributed to the disease.

Evidence-Based Guidelines for SARS-COV-2 Vaccination of Patients of Skin Allergic Diseases and Patients on Immuno-Therapeutics.

There is a dearth of data regarding the safety and timing of the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) vaccination of patients on immunosuppressive or immunomodulatory therapies. However, data from other vaccine trials may be extrapolated to get an idea regarding the recommendation of SARS-COV-2 vaccines. All the novel SARS-COV-2 vaccines are non-live, thus ensuring the safety of the vaccines. However, the vaccines may not be able to generate an equipotent immunogenic response in patients receiving immunotherapeutics, in comparison to those who are not. We have attempted to put forward certain statements, with respect to SARS-COV-2 vaccination of patients who are on treatment for different dermatological conditions. However, the risk-benefit ratio must be discussed between the patient and the physician, and the final call should be individualized.

Tofacitinib in paediatric dermatoses: a narrative review.

Tofacitinib has revolutionized the treatment of numerous dermatological conditions in different age groups. However, evidence for its effectiveness, safety and tolerability in the paediatric population is limited. We performed a literature search, which showed that oral tofacitinib is a reliable option in refractory juvenile dermatomyositis, severe alopecia areata, atopic dermatitis and psoriasis. Topical tofacitinib is an effective option in vitiligo and halo naevus. The risk-benefit ratio should be assessed prior to consideration of this molecule. In this narrative review, we have attempted to present a summary of the evidence of using tofacitinib (oral and topical) in paediatric dermatoses.

Applications of machine learning for COVID-19 misinformation: a systematic review.

The inflammable growth of misinformation on social media and other platforms during pandemic situations like COVID-19 can cause significant damage to the physical and mental stability of the people. To detect such misinformation, researchers have been applying various machine learning (ML) and deep learning (DL) techniques. The objective of this study is to systematically review, assess, and synthesize state-of-the-art research articles that have used different ML and DL techniques to detect COVID-19 misinformation. A structured literature search was conducted in the relevant bibliographic databases to ensure that the survey was solely centered on reproducible and high-quality research. We reviewed 43 papers that fulfilled our inclusion criteria out of 260 articles found from our keyword search. We have surveyed a complete pipeline of COVID-19 misinformation detection. In particular, we have identified various COVID-19 misinformation datasets and reviewed different data processing, feature extraction, and classification techniques to detect COVID-19 misinformation. In the end, the challenges and limitations in detecting COVID-19 misinformation using ML techniques and the future research directions are discussed.

Spectrum of Mucocutaneous Reactions to COVID-19 Vaccination: A Report from a Web-Based Study from India.

Background: With the COVID-19 vaccination taking stride all across the globe, there are multiple reports of vaccine-induced adverse reactions (cutaneous and systemic). Objectives: To study the frequency and characteristics of mucocutaneous reactions to COVID-19 vaccines. Methods: An online questionnaire-based study was performed among the recipients of COVID-19 vaccines. Results: Majority (73.6%) of the responders had received the Covishield vaccine (AstraZeneca-Oxford), while 26.4% had been vaccinated with Covaxin (Bharat Biotech-ICMR). One or more post-vaccination mucocutaneous effects were experienced in 87 (19.6%) participants. Vaccine-associated mucocutaneous changes were observed in 19.7% and 22.2% of individuals who received Covishield and Covaxin, respectively. Local injection site reaction was the predominant mucocutaneous finding, followed by urticarial rash, exacerbation of preexisting dermatoses, morbilliform rash, apthous ulcers, pityriasis rosea like eruption, telogen effluvium, herpes zoster, purpuric rash, erythema multiforme and others. Anaphylaxis was reported in three individuals. However, fatality was not reported in any of the vaccine recipients. Intergroup assessment of parameters with respect to type of vaccine was found to be insignificant. Conclusion: Majority reported mild and self-limiting reactions. This outcome should not discourage the common man in getting vaccinated.

Adaptive UNet-based Lung Segmentation and Ensemble Learning with CNN-based Deep Features for Automated COVID-19 Diagnosis.

COVID-19 disease is a major health calamity in twentieth century, in which the infection is spreading at the global level. Developing countries like Bangladesh, India, and others are still facing a delay in recognizing COVID-19 cases. Hence, there is a need for immediate recognition with perfect identification of infection. This clear visualization helps to save the life of suspected COVID-19 patients. With the help of traditional RT-PCR testing, the combination of medical images and deep learning classifiers delivers more hopeful results with high accuracy in the prediction and recognition of COVID-19 cases. COVID-19 disease is recently researched through sample chest X-ray images, which have already proven its efficiency in lung diseases. To emphasize corona virus testing methods and to control the community spreading, the automatic detection process of COVID-19 is processed through the detailed medication reports from medical images. Although there are numerous challenges in the manual understanding of traces in COVID-19 infection from X-ray, the subtle differences among normal and infected X-rays can be traced by the data patterns of Convolutional Neural Network (CNN). To improve the detection performance of CNN, this paper plans to develop an Ensemble Learning with CNN-based Deep Features (EL-CNN-DF). In the initial phase, image scaling and median filtering perform the pre-processing of the chest X-ray images gathered from the benchmark source. The second phase is lung segmentation, which is the significant step for COVID detection. It is accomplished by the Adaptive Activation Function-based U-Net (AAF-U-Net). Once the lungs are segmented, it is subjected to novel EL-CNN-DF, in which the deep features are extracted from the pooling layer of CNN, and the fully connected layer of CNN are replaced with the three classifiers termed "Support Vector Machine (SVM), Autoencoder, Naive Bayes (NB)". The final detection of COVID-19 is done by these classifiers, in which high ranking strategy is utilized. As a modification, a Self Adaptive-Tunicate Swarm Algorithm (SA-TSA) is adopted as a boosting algorithm to enhance the performance of segmentation and detection. The overall analysis has shown that the precision of the enhanced CNN by using SA-TSA was 1.02%, 4.63%, 3.38%, 1.62%, 1.51% and 1.04% better than SVM, autoencoder, NB, Ensemble, RNN and LSTM respectively. The comparative performance analysis on existing model proves that the proposed algorithm is better than other algorithms in terms of segmentation and classification of COVID-19 detection.

Management of Vitiligo Amidst the COVID-19 Pandemic: A Survey and Resulting Consensus.

BACKGROUND: COVID-19 pandemic has changed the approach of dermatologists, with respect to management of numerous conditions, vitiligo being one of them. However, there is a lack of consensus on how to deal with patients of vitiligo, as we battle this pandemic. AIM: To conduct a questionnaire-based survey, amongst expert dermatologists; in order to understand the impact of COVID-19 on the management of vitiligo. MATERIALS AND METHODS: An online semi-structured English questionnaire was prepared and the link was circulated among 50 pan-Indian expert dermatologists, through various platforms (snowball sampling). Confidentiality and anonymity were strictly maintained. Responses were analyzed at the end of the study and a consensus statement was generated. RESULTS: 42.22% of the respondents believed that teleconsultation is adequate for the diagnosis and management of most cases of vitiligo. 64.44% were found to be comfortable in prescribing oral medications, even during the COVID-19 pandemic; of which 62% would prefer to prescribe systemic steroids; followed by 17%, 11%, 7%, and 3% who would prefer cyclosporine, azathioprine, mycophenolate mofetil, and methotrexate, respectively. 64.44% respondents would recommend phototherapy in their office and 80% would prefer home-based phototherapy (PUVAsol or handheld NBUVB devices). 86.67% would prefer to stop the oral immunosuppressive drugs, till the COVID-19 RTPCR positive patients are tested negative. LIMITATIONS: The results are based on a survey of a small albeit selected group of dermatologists who decided on the currently available information on COVID-19. The same may change depending on the nature of further available information on the virus and its effect on how we manage the patients. CONCLUSIONS: Cases for initial consultation may be seen physically, and those for follow-up may be scheduled for teleconsultation. Topical therapy may be used without any hesitation. Phototherapy may be best advised with either PUVAsol or home-based phototherapy units (handheld NBUVB devices). With regards to systemic immunosuppressives, oral minipulse therapy may be preferable in view of lesser requirement of monitoring. Surgery for vitiligo should be performed only if the psychological well-being is severely affected.

"David vs. Goliath": A simple antigen detection test with potential to change diagnostic strategy for SARS-CoV-2.

INTRODUCTION: As regard to all pandemics, the current COVID-19 pandemic, could also have been better managed with prudent use of preventive measures coupled with rapid diagnostic tools such as rapid antigen tests, but their efficacy is under question because of projected lower sensitivity as compared to Real Time Reverse Transcriptase Polymerase Chain Reaction, which although considered gold standard has its own limitations. METHODOLOGY: A prospective, single centre study was carried out to evaluate the performance of Standard Q COVID-19 Ag, a rapid immuno-chromatographic assay for antigen detection, against TrueNat, a chip-based, point-of-care, portable, Real-Time PCR analyzer for diagnosis of COVID-19; on 467 nasal swab samples from suspected subjects at a fever clinic in North India in month of July 2020. RESULTS: Of the 467 specimens tested, TrueNat showed positive result in 29 (6.2%), majority of whom were asymptomatic (72.4%) while 4/29 (13.9%) had influenza like illness and 2/29 (6.8%) presented with severe acute respiratory illness. Compared to TrueNat, Rapid antigen test gave concordance for 26 samples, while for 2 samples the result was false positive; giving an overall sensitivity of 89.7% (95% CI = 72.6- 97.8) and a specificity of 99.5%, indicating strong agreement between two methods. CONCLUSION: Community prevalence plays an important role is choosing the laboratory test and result interpretation. Rapid antigen detection tests definitely have a big role to play, especially in resource limited setting, for early diagnosis as well as for source control to halt the spread.

Clinical Dermatology and COVID-19 Pandemic: Narrative Review.

The coronavirus disease of 2019 (COVID-19) pandemic has radical repercussions on every aspect of medical science, including dermatology. The magnitude of the impact on clinical dermatology cannot be overemphasized. Dermatologists have been forced to modify and reconsider the way they consult patients. Teledermatology has come up in a big way, with most of the clinicians resorting to technology and software-based consultations. Management of different dermatological conditions like papulosquamous disorders, vesiculobullous disorders, malignancies, etc., needs to be modified as per the different recommendations proposed by expert panels. This review is an attempt to highlight the impact of this destructive pandemic on various aspects of clinical dermatology.

COVID-19 and Healthcare Worker: What We Need to Know.

COVID-19 pandemic has challenged and overwhelmed most healthcare institutions and healthcare workers, across the world. Despite being unprepared for this pandemic, frontline workers have worked relentlessly to provide the much-needed care to these patients. Doctors from different branches of medicine, including dermatologists, came forward and played a substantial role in mitigating the impact of this pandemic on the general population. Sadly, in the process, these healthcare workers faced many personal, social, psychological, economic, and health-related issues. The psychological burden and health-related issues received due attention in the main-stream news as well as scientific research papers. With most frontline workers isolated from their families, social media became the new platform to reduce the sense of isolation and share their anxiety, insomnia, and fatigue. This article is aimed at highlighting various challenges faced by healthcare workers during the ongoing COVID-19 pandemic.

Recurrent COVID-19 infection in a health care worker: a case report.

BACKGROUND: Recurrent coronavirus disease 2019 (COVID-19) infection is an emerging problem and may prove to be one of the greatest problems in controlling the pandemic in the future. Recurrent infections can be due to reactivation of dormant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or reinfection with similar or different strains of SARS-CoV-2. CASE PRESENTATION: Here we present an interesting case of a health care worker working as a laboratory assistant at a COVID-19 laboratory who developed recurrent COVID-19 infection. He did not develop an immune response after the first episode of COVID-19; however, immunoglobulin G (IgG) antibodies were detected after the second episode. CONCLUSIONS: Through this case, we discuss the concept of reactivation and reinfection in the post-COVID period. We suggest that standard guidelines should be established to check for viral shedding and immune response among cured cases of COVID-19 after discharge via serial real-time polymerase chain reaction (RT-PCR) testing and IgG antibody detection. Further, strict hygiene practices should be stressed to these patients with possibility of COVID-19 recurrence.

An Observational Survey to Appraise the Influence of COVID-19 Pandemic on Dermatology Training Programs in India: Residents' Standpoint.

BACKGROUND: Given the all-encompassing foothold of COVID-19, it is plausible that the pandemic would have a long-lasting impact on medical training programs, including dermatology. We conducted a survey amongst the residents of dermatology (across India) to assess the impact of COVID-19 pandemic on their teaching and education programs. MATERIALS AND METHODS: An online semi-structured English questionnaire was prepared on the Google-forms platform and the link was circulated among the residents. The questionnaire comprised of five sections (demographic details, impact on clinical training, procedural training, academic curriculum, and research activities). Appropriate statistical tests were carried out to analyze the data obtained. RESULTS: Three-hundred and seventy-eight responses were taken into consideration. A majority of the respondents (63.5%) were engaged in both COVID-19-related duties and departmental work (out-patient and in-patient duty). Around two-thirds of the trainees (65.1%) claimed a reduction in patient footfall (greater than 50% compared to pre-COVID times). Sixty-nine percent reported a decline of more than 50% in in-patient admission; 47.6% felt that the discontinuity in patient care had severely affected their residency training; 50.8% highlighted that no procedures were being performed in their department; 54.5% opined that academic activities were relatively unhampered as regular seminars were being conducted through online web-based applications; and 65.1% of the trainees were not able to devote any time to their thesis-related work. CONCLUSION: Since the after-effects of this pandemic will last long, it is advisable that residents and faculties adapt themselves to web-based learning programs in the academic curriculum so that the training of the future consultants does not get jeopardized. Our survey, being the first of its kind in dermatology, will throw some light on the perspective of residents and the way forward to combat the untoward consequences on their training programs.

Psychological management of vitiligo during the COVID-19 pandemic

COVID-19 pandemic has changed our outlook toward the diagnosis and treatment of dermatological conditions. Accessibility to health care facilities has been jeopardized due to lockdowns, fear of contracting COVID infection, maintaining social distance, and financial concerns. Vitiligo, one of the notorious chronic dermatoses, had a negative impact on the quality of life of patients, even during pre-COVID era. Now, with the arrival of the pandemic, patients are unable to seek consultation for the disease. Stress being one of the key players in the pathogenesis of the disease, is leading to exacerbation of the condition. In this review, we have attempted to highlight the role of psychological management of vitiligo, amidst the ongoing pandemic