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The most common causes of acute hepatitis in children are hepatitis A and autoimmune hepatitis. Hepatitis in the course of Wilson's disease is sporadically registered in adolescents. An increase of activity of aminotransferases both in the course of multisystem inflammatory syndrome in children (MIS-C) and in the course of COVID-19 has been observed. Hepatitis is common in children with MIS-C and is associated with a more severe presentation and persistent elevation of liver function tests. To date, no cases of acute hepatitis in children due to COVID-19 have been reported. We present 2 cases of acute hepatitis in children where the only cause seems to be a previous asymptomatic SARS-CoV-2 infection.Copyright © 2023 Termedia Publishing House Ltd.. All rights reserved.
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The world invasion of dangerous virus diseases such as Covid 19, in the last few years, force people to wear masks as precaution. Although this prudence reduces the risk of infection and viruses' spread, it adds difficulty to distinguishing or identifying a person. This paper proposes a method to analyze images of masked persons for classifying their gender, in addition to identifying the colors of their skin and their eyes. We apply residual learning using the convolutional neural network (CNN) based on the visible part of the face. Cloud computing resources have been used as a convenient environment of substantial computing ability. Also, new database of RGB face images was created for testing. Experiments have been operated on the constructed database beside other datasets of facial images after cropping. The proposed model gives 96% gender classification accuracy and 100% skin/eye color identification. © 2023, Ismail Saritas. All rights reserved.
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The socioeconomic context and population vulnerability are directly associated with violence in the country. In Brazil, the Criminal Code provides the illicit act and punishes the aggressor who offends the physical aggression from a person. Interpersonal violence is an illegal act and is associated with the vulnerability of victims. Therefore, the study of the epidemiological profile of victims of interpersonal violence is needed to alert the population about their susceptibility. The present study aimed to design the epidemiological profile of victims of bodily injury from interpersonal violence in the region of Maringa, in the state of Parana, and to study the characterization of dental injuries in terms of permanent weakness and deformity. Four thousand nine hundred sixty-two reports performed between 2018 and 2020 were analyzed using descriptive statistics. Data collected included: sex, age, marital status, the region affected by the bodily injury, type of dental trauma, and responses to "weakness" or/and "permanent deformity". During the period studied, there was a prevalence of female victims (57.8%), white skin color (80.2%), aged between 21 and 30 years (24.9%), single (54.9%), and the most affected region was the upper limbs (32.1%). Regarding bodily injuries with dental involvement, 67 cases were reported, male victims were prevalent (60.3%), and dental fracture was highlighted with 54.4% of examined injuries. The implementation of the Forensic Dentistry Centre took place in August 2019 at the Medico-Legal Institute of Maringa. Also, with the interruption of expert activities in 2020 - due to the COVID-19 pandemic - relevant outcomes regarding permanent weakness were observed. The epidemiological profile of victims is characterized by the female sex, white skin color, the age group from 21 to 30 years old, and singles. Regarding dental trauma, male victims, and dental fractures were prevalent. Furthermore, there was an increase in the classification of "permanent weakness", as well as a slight increase in cases of "further assessment required" for permanent deformity.Copyright © 2023 Faculdade de Medicina de Ribeirao Preto - U.S.P.. All rights reserved.
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Clinical Information Patient Initials or Identifier Number: BP4****/22 Relevant Clinical History and Physical Exam: A 55 Y / Female C/C : Pain, numbness, cold sensation & weakness of left upper limb for 2 hours. Risk Factor : Hypertension, diabetes mellitus O/E : Pale, cold and absent of radial, ulnar, brachial pulse of left upper limb. Muscle power 3/5 left side. So2 86%, BP undetectable. Right upper limb were normal. BP 160/90 mm of hg, pules : 112 b/min, RR : 26/min. Body Temperature 37.5 C [Formula presented] [Formula presented] Relevant Test Results Prior to Catheterization: CBC : WBC 7450, HB % 10.8 g/dl, ESR 20mm in 1st hour, Platelets : 262000, SARS Cov2 Antigen : Negative PT 14.3 sec, INR : 1.07 APTT : 32.4 sec. blood group: O positive Serum Creatinine : 1.1 mg/dl Plasma glucose 9.7 mmmol/l HIV Ab : Negative HBs Ag : Negative Anti-HCV : Negative Urine R/E : Normal lipid profile : Cholesterol 280mg/dl Vascular duplex ultrasound of left upper limb : A dilated echogenic thrombus had blocked the left subclaviav artery lumen. Relevant Catheterization Findings: Conventional angiography with the lowest amount of contrast agent through the right femoral artery, revealed that left subclavian artery thrombosis with total occlusion distal to Left internal mammary artery. [Formula presented] [Formula presented] [Formula presented] Interventional Management Procedural Step: A5Fr MPA catheter with side holes was negotiated through a right femoral sheath and was placed in the left subclavian artery. Initially thrombus aspiration was done with Eliminate aspiration catheter (TERUMO) with no success. Then suction was done with the MPA catheter itself with partial removal of thrombus. Then a 5Fr Pigtail catheter was placed inside the thrombus and kept in situ. For residual thrombus 250,000u of Inj. Streptokinase as a thrombolytic drug was given through the Pigtail catheter as bolus over 30 min. The maintenance dose 100,000 u per hour was given over 24 hours through the Pigtail catheter via infusion pump. After 24 hours of thrombolytic therapy, her pain was reduced, the left hand became slightly warm, and distal pulses were feebly palpable. Moreover, the skin colour returned to near normal with improvement of pallor. Bleeding was well controlled at the catheter site. Doppler sounds revealed partial improvement of arterial flow. After evaluation of partial improvement, a low dose 1000 iu per hour of heparin (UFH)was infused intravenously for 24 hours. After 48 hours, repeat angiography via the inserted catheter at the site did not reveal any atherosclerotic plaque and confirm the thrombosis-dissolution. The latter practice demonstrated a good blood flowto the left upper distal limb leaving a little thrombus in the superficial palmer arch. [Formula presented] [Formula presented] [Formula presented] Conclusion(s): Catheter-based thrombus aspiration and thrombolytic therapy is primarily reserved for patients with acute viable limb ischemia. As observed in the presented case, thrombus aspiration and thrombolytic therapy is recommended to be considered as an alternative therapeutic method for patients with arterial thrombosis due to the rapid response, shorter treatment time and lower cost, compared to common and sometimes unsuccessful therapies.Copyright © 2023
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The COVID-19 pandemic diverted medical education within dermatology towards technology-enhanced learning (TEL) delivery. Concurrent societal movements also raised awareness of racial inequalities in health outcomes. This has been highlighted as a priority within dermatology research and education (Guckian J, Ingram J, Rajan N, Linos E. Dermatology is finally talking about race. Br J Dermatol 2021;185: 875-6). The British Association of Dermatology acknowledges that 'the education of undergraduate and postgraduates. . .needs to be updated to better include skin of colour' (https://www.bad. org.uk/healthcare-professionals/inclusivity-and-representation). Numerous distance courses in this domain have been piloted, but there is little published evidence regarding efficacy or sustainability. This study evaluated whether TEL methodologies can facilitate effective and sustainable ethnic dermatology education. The study explored the existing competence and confidence of a cohort of dermatology trainees towards managing dermatology conditions affecting skin of colour, specifically central centrifugal cicatricial alopecia (CCCA) and keloid scarring. The short- and long-term impact of TEL interventions upon trainees' confidence and competence of managing these conditions was investigated. A prospective cohort study was designed and included 14 dermatology registrars and regional fellows across Yorkshire. A Zoom teaching session was provided, covering keloid scarring and CCCA, supported by a 'flipped-classroom' approach via pre-reading materials. Survey methodology was used;three questionnaires were circulated: presession (survey 1), postsession (survey 2) and 6 weeks afterwards (survey 3). These featured multiple choice questions gathering data regarding participant knowledge and questioned confidence and competence. Multiple-choice questions were normed by 15 external trainees to ensure suitable difficulty. Presession, 64% participants felt that, on completion of specialty training, they would be competent in treating patients with ethnic skin. Ninety-three per cent believed that formal outcomes related to ethnic dermatology should be included in the curriculum. Postsession, 42% strongly agreed that the teaching course would change their practice. Fifty per cent felt that the teaching content was 'somewhat new'. Average knowledge scores demonstrated an initial rise then fall (survey 1: 5.67/10;survey 2: 7.83/10;survey 3: 6.36/10). Despite an innovative TEL education session, trainee knowledge did not significantly improve and improvement did not prove sustainable 6 weeks after teaching. Trainees were not confident in adopting newly acquired knowledge on skin of colour into their practice. Results show that the benefit of providing TEL education on ethnic dermatology may prove transient, and there is disparity in the perceived and actual benefit of ethnic dermatology education. Systemic solutions may be warranted, combining both education and human factors, including tackling systemic injustices and social inequalities.
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Introduction: During the COVID-19 pandemic, alternatives to face-to-face teaching were on the urge. What's more, in the context of the respiratory support of COVID patients, the training and capacitation of personnel capable of taking care of these patients was critical. Aims and objectives: Develop a Virtual Reality (VR) app for remote training of medical staff in the management of different acute respiratory diseases, including COVID-19. Method(s): Pulmonologists and software developers designed an app based on a virtual hospital using VR glasses. The teacher programs different clinical scenarios, where the student can converse with the patient and explore him, observing the respiratory mechanics and the skin coloration, auscultating different noises in various cardiac and pulmonary foci, edema in the lower extremities, etc. The student can request different tests (blood analysis, radiography, etc.) and prescribe treatment, including oxygen therapy and respiratory support. The clinical situation of the patient can change during the simulation. Result(s): Different acute respiratory diseases were successfully simulated, with a correct interaction between the student and the teacher. Conclusion(s): VR can be used as a tool for the remote training of medical staff, and provide high fidelity simulations for training in a wide variety of clinical situations.
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The proceedings contain 331 papers. The topics discussed include: barriers to and facilitators of implementation of the dermatology curriculum across UK medical schools: results of a national survey and recommendations;what has been the impact of COVID-19 redeployment on dermatology trainees professional identity? an interpretative phenomenological study;diversifying educational resources during the COVID-19 pandemic: delivering educational dermatology podcasts and webinars for healthcare professionals;pandemic placement: delivering the dermatology undergraduate curriculum at a UK medical school during the COVID-19 crisis;skin of color representation in dermatology and undergraduate medical textbook images: a meta- analysis;the impact of the COVID-19 pandemic on dermatology ST3 application preparation: a national survey of junior doctors in the UK;Pemphix to pemphigus vulgaris: the journey to classifying blisters;scleroderma or scleroedema? The complex classification of systemic sclerosis;lessons from Sushruta revealing the Ayurvedic ancestry of dermatology;and PS02: experiences and understanding of body image dissatisfaction in individuals with a chronic dermatological condition: an interpretative phenomenological analysis.
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The study aimed to investigate ethnic/racial disparities in COVID-19 mortality in Brazilian federative units and their respective capitals in 2020. Population data and number of COVID-19 deaths were extracted by skin color (white, black, brown and indigenous) from all Brazilian states and their respective capitals. The mortality rate of COVID-19 by ethnicity in Brazilian states was higher between people from brown skin color, followed by indigenous and black. Only in one state, in the Federal District and in the federal capital, age-standardized mortality rates were higher among white's people. There is a high percentage of deaths from COVID-19 higher than expected among non-white individuals, especially in south-central states and capitals of the country. Mortality from COVID-19 affect ethnic-racial groups unevenly in Brazil and the number of excess deaths among non-whites was over 9000. Urgent government measures are needed to reduce the racial disparity in health indicators in Brazil.
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Introduction: Hand dermatitis causes significant physical, psychosocial, and economic burden. The internet is a major source of health education for patients. Here, we evaluate the readability, quality, and comprehensiveness of online health resources on hand dermatitis. Methods: On July 27th 2021, a Google search was conducted with terms “hand dermatitis” and “hand eczema” and the first 40 items were evaluated. Articles that were advertisements, blogs, intended for professionals, scientific papers, or irrelevant were excluded. Contents of articles were evaluated using several validated grading tools/criteria for readability and quality and Pearson’s correlation assessed the relationship between readability and quality. Results: Twenty-three articles met inclusion criteria. Average readability was at the 11th-grade level (range 7.7-15.6). University-level reading comprehension (≥13th grade) was required for 5/23 websites. The highest quality website based on the Discern instrument was Medical News Today (55.5);nearly half of the websites (48%, 11/23) rated as poor or very poor. The average JAMA benchmark score was only 1.4/4. Nineteen websites contained images (83%) and only 4 websites (21%) included images representing hand dermatitis in skin of color (SOC). Quality and readability of the articles were significantly correlated (P =.02). Conclusion: Our results demonstrate that generally, articles were too difficult to read, have low quality, and lack representation of SOC images. With increases in hand dermatitis in the setting of frequent hand-hygiene practices during the COVID-19 pandemic, it is important for online health information to improve in readability, quality, and inclusion of SOC images to optimize online patient education.
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Objectives: To compare the number of deaths that occurred in the state of Amazonas and in Brazil, from March 16th to August 20th 2020, using the variables skin color, sex, place of death, age group and association with COVID-19, and secondly, to verify whether between 2019 and 2020, in the period from March 16th to August 20th, there was a significant change in the number of deaths from diseases not associated with COVID-19. Methods: We searched the databases of the Brazilian public agency "Transparency Portal" for the data on deaths that occurred in the state of Amazonas and Brazil in the period from March 16th to August 20th, 2019 and 2020. The absolute frequencies and percentages of the variables studied were used for statistical analysis. Results: COVID-19 was responsible for an 11.01% increase in deaths in Brazil;however, this rate quadrupled in the state of Amazonas. In relation to age group, there was a similar percentage between Amazonas and the national average. The stratified analysis showed significant differences between genders and races, with higher death rates in men and people of brown/black skin. The number of deaths at home increased significantly, especially those from causes not associated with COVID-19. Conclusions: The national drop in deaths from diseases not associated with COVID between March and August 2020 in Brazil is misleading and may be due to the result of misreported causes of death.
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Introduction: Social isolation, as a result of the coronavirus pandemic, favored the exposure of elderly people to stressors that may have compromised the quality of sleep. Objective: To verify the quality of sleep of elderly people in the face of the COVID-19 pandemic. Methods: A study was carried out with 305 elderly from 61 cities, recruited through social networks, from February- June/2021. The online questionnaire included general data (city, age, gender, skin, color, education level). Questions were asked about the practice of Physical Activity (PA), the quality of sleep during the pandemic (Mini Sleep Questionnaire/MSQ altered sleep score ≥ 25;EPWORTH-sleepiness score ≥ 10 points) and whether was diagnosed with COVID-19. Results: Out of 305 individuals who participated, 71% were between 60 to 69 years, and 72% were women. In addition, 59.5% practiced some type of physical activity, 9.5% contracted the SARS-CoV2 virus, 65% reported that their sleep pattern was not altered by the pandemic, 28.8% had impaired sleep quality, 72% were not taking sleep medication. The sleepiness was within the normal range. The relation of sleep quality of elderly practitioners of PA did not show statistically significant difference in relation to those who did not practice it during the pandemic. Sleep quality and the diagnosis of COVID-19 did not present relevant statistical data either. Although the individuals did not show any change in sleep quality during the pandemic, the data signaled a poor quality of sleep in the elderly surveyed, with a score showing an overall mean (MSQ) of 31.7 indicating severe difficulty in sleeping. In this study, women had a higher sleep quality score (32.6) than men (29.5), signaling the worsening of sleep in females. Elderly people in age group 70 years more demonstrated a better sleep pattern than age group 60 to 69 years. There was a statistically significant difference in the quality of sleep of the elderly who snored (33.1) compared to those who did not snore (28.0) and those who took a nap during the day (32.7) and those who did not take a nap (30,4). Tiredness was also shown to be a sign of worsening sleep quality when related to those who were not tired during the day. Conclusion: The results suggest that there were no significant changes in the sleep pattern of the elderly during the period evaluated in the pandemic. The changes found were similar in the literature for this population.
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The COVID-19 pandemic has given rise to the need to use personal protective equipment such as masks, among healthcare professionals and the general public. Numerous facial dermatoses linked to the use of masks have been described, from which the term maskneormaskacne has emerged. Although prolonged mask usage has been necessary, and a vast majority of people develop various skin conditions, there is a lack of research on the effects of masks on skin. In this article, we review alterations in biochemical properties of skin associated with mask use in individuals with skin of color and the factors predisposing them to developing acne. Because masks are crucial in preventing the spread of COVID-19, we also elucidate some fundamental strategies such as gentle skin care measures, decreasing the duration of mask wear, and following appropriate protocols for mask re-use, which may prevent mask acne and its long-term effects.
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Objective: To determine the degree of knowledge in the usage of pulse oximeter as a home assessment tool among the community in Malaysia. Methods: A cross-sectional survey was conducted in November 2021. The questionnaire assessed the knowledge in using pulse oximeters, user experience and opinions in using pulse oximeter as a home assessment tool during the pandemic. Results: A total of 504 respondents were included in the study, and the mean score in knowledge related to application of pulse oximetry was 73.00%, while the mean score in knowledge related to factors affecting pulse oximetry readings was only 38.51%. A total of 90.5% of the respondents recognised normal pulse rate and 88.5% knew the blood oxygen saturation levels of a healthy adult, while 69.4% recognised the definition of silent hypoxia. In addition, the majority of the respondents agreed that factors such as poor blood circulation (71.2%), excessive movements (69.8%), and hand position (60.7%) affected oximetry readings. However, 61.7%, 81.7%, 77.2% and 76.8% of the respondents could not identify nail polish, skin colour, skin thickness and tattoos as factors that may affect oximetry readings respectively. Conclusions: The respondents showed a satisfactory level of knowledge related to application of pulse oximetry, but a poor level of knowledge related to factors affecting pulse oximetry readings among the community in Malaysia. Continuous efforts in educating the community on the correct use of pulse oximeters are crucial for appropriate home assessment and avoiding unnecessary stress.
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This qualitative research study highlights medical mistrust as a significant barrier to quality health care for Black women. Unraveling mistrust is essential for reducing health disparities and improving well-being for women and their families. Three research sites were included: Florida, Ohio, and the U.S. Virgin Islands. Three 90-minute focus groups were convened with 10 women in each of them. The discussions were recorded. Five themes will be discussed through the voices of women from each of the sites. Mistrust of healthcare professionals was associated with fears about being rejected, embarrassed, and misunderstood during the clinical encounter. Others reported that providers who were reluctant to make physical contact with them during the clinical visits provoked feelings that the color of their skin might seem "dirty." Finally, this research will help to inform discussions about COVID-19 vaccine hesitancy, which remains a critical health concern among Black women and healthcare providers.
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Background and Aims: Stroke is one of the leading causes of death and disability in adults, accounting for a high number of hospitalizations worldwide. This study aims to evaluate the epidemiology of hospitalizations for stroke in Brazil during 2019 and 2020. Methods: Cross-sectional, descriptive and retrospective study, which evaluated the epidemiology of hospital admissions for stroke in the Brazilian National Health System in the years 2019 and 2020. Hospital admissions were evaluated by sex, race and age group using the national database (DATASUS - Department of Informatics of the Unified Health System). The official classification of race/skin color in Brazil is composed of five categories: White, Brown [Pardo], Black, Yellow and Indigenous. Results: During this time period, there was a total of 316,859 hospitalizations for stroke in the Brazilian National Health System, with 163,120 (51.5%) hospital admissions in 2019 and 153,739 (48.5%) in 2020. Also, 166,178 (52.4%) patients were male and 150,681 (47.6%) were female. Regarding race (n=250,446);106,998 (42.7%) patients considered themselves white, 116,601 (46.6%) brown, 17,085 (6.8%) black and 9,762 (3.9%) others. Regarding age groups;64,939 (20.5%) were >80 years old, 163,114 (51.5%) were 60-79, 74,605 (23.5%) were 40-59 and 14,201 (4.5%) were<40. Conclusions: The majority of patients hospitalized for stroke were 60-79 years old and white or brown. The similar number of hospital admissions in 2019 and 2020 may suggest that hospitalizations for stroke were not significantly impacted by hospital's oversaturation by the COVID-19 pandemic.