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Evaluate the safety and tolerability of losmapimod in the treatment for FSHD. FSHD is a relentless, variably progressive disease leading to accumulation of disability over decades. Fulcrum is developing losmapimod, a small molecule p38 alpha/beta MAPK inhibitor, to treat FSHD. Losmapimod has been generally well-tolerated in more than 3,600 subjects across multiple clinical studies, including >100 subjects with FSHD. Fulcrum has assessed losmapimod in FSHD in one completed phase 1 study (FIS 001-2018) and two ongoing Phase 2 studies in the open label extension period (FIS 001-2019 and FIS 002-2019). Subjects aged 18-65 years with genetically confirmed FSHD1, clinical severity score 2-4, and MRI-eligible muscles for biopsy were exposed to losmapimod 7.5 or 15 mg twice daily PO for 14 days and up to 76 weeks. In study FIS 001-2018, 6 subjects were exposed to 7.5 mg and 11 subjects to 15 mg twice daily dosing for 14 consecutive days. In studies FIS 001-2019 and FIS 002-2019, 14 and 77 subjects respectively, received at least one dose of losmapimod 15 mg twice daily for up to 76 weeks. A total of 108 subjects with FSHD1 have been exposed to losmapimod, with approximately 131 patient-years of exposure. Fifty-seven subjects have been exposed to losmapimod for 12 to 18 months, and 30 have been exposed for over 18 months. Most adverse events (AEs) observed during the studies were considered of mild to moderate in severity. The most common AEs were alanine aminotransferase (ALT) increase, headache, dizziness, dry skin, eczema and gastrointestinal disorders. The majority of AEs resolved with continued dosing. Dosing has been paused for 14 days in four subjects (3 in FIS 001-2019 and 1 in FIS 002-2019) subjects due to COVID-19 infection. There were no reported drug related SAEs, deaths, discontinuations due to AEs, or clinically significant changes in vital signs, clinical laboratory results, or ECG parameters. Losmapimod given as up to 15 mg twice daily in >100 subjects with FSHD1 for up to 76 weeks has been generally well-tolerated, consistent with that previously reported in other patient populations. Therefore, the benefit-risk profile of losmapimod for the treatment of FSHD remains favorable.Copyright © 2022
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Objective: To investigate epidemiological features of skin damage among front-line healthcare workers fighting against COVID-19 pandemic. Method(s): A self-designed questionnaire was released on an online survey website "wenjuan.com", and sent to the front-line medical staff caring for patients with confirmed COVID-19 in 6 infectious disease wards of the General Hospital of Central Theater Command of PLA via WeChat from March 10th to 20th, 2020. Then, the questionnaires were collected, a database was established, and statistical analysis was performed on the incidence, types and epidemiological characteristics of skin damage among the medical staff. Result(s): A total of about 550 medical staff were surveyed, 404 questionnaires were collected, of which 391 were valid, and 303 cases had skin damage. The survey showed that females, hand cleaning frequency > 10 times per day, wearing three-level protective equipment for more than 6 hours per week were risk factors for skin damage, and frequent use of a hand cream could reduce skin problems. Among the respondents, the incidence of skin damage was significantly higher in the females (79.81%, 249/312) than in the males (38.35%, 54/79;chi2 = 4.741, P = 0.029), and higher in the groups with hand cleaning frequency of 10-20 times per day (79.73%, 118/148) and > 20 times per day (85.71%, 84/98) than in the group with hand cleaning frequency of 1-10 times per day (69.66%, 101/145;chi2 = 9.330, P = 0.009). The incidence of skin damage was significantly lower in the group wearing protective equipment for 1-5 hours per week (64.04%, 73/114) than in the groups wearing protective equipment for 6-10 hours per week (81.48%, 66/81), 11-15 hours per week (95.24%, 20/21), 16-20 hours per week (81.82%, 36/44), 21-25 hours per week (86.49%, 32/37), and > 25 hours per week (80.85%, 76/94;chi2 = 19.164, P = 0.002). Among the 391 respondents, the skin damage related to disinfection and protective equipment mainly manifested as dry skin (72.89%), desquamation (56.78%), skin pressure injury (54.48%), skin maceration (45.01%), and sensitive skin (33.50%);acne (27.11%) was the related skin disease with the highest incidence, followed by facial dermatitis (23.27%), eczematous dermatitis (21.48%), folliculitis (18.92%), dermatomycosis (11.00%), urticaria (9.21%), etc. Conclusion(s): There was a high incidence of skin damage related to protective equipment among the front-line healthcare workers fighting against COVID-19, and strengthening skin protection could markedly reduce the incidence of skin damage.Copyright © 2020 by the Chinese Medical Association.
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Background: The use of antimicrobials has been expanded during the COVID-19 pandemic. This study aims to assess the knowledge and practices of disinfectants and sanitizers use among Jordanian people during the (COVID-19) pandemic. Methods: A web-based cross-sectional descriptive questionnaire was distributed across Jordan between August and September 2020. The questionnaire consisted of three sections inquiring about demographics and general characteristics of the surveyed sample, evaluating the respondents' knowledge about disinfectants, as well as respondents' practices. The questionnaire was completed by 403 literate adult respondents. Results: Our results indicate that Jordanian adults have used disinfectants increasingly during the COVID-19 outbreak. Knowledge of our study sample was considerably affected by gender (p=0.044), income (p=0.001), and profession (p<0.001). 80.8% of those participants reported skin-related side effects due to disinfectant use during the pandemic. The most used disinfectants were ethanol, followed by soap and water. Generally, study respondents showed positive practices toward the use of disinfectants during the time of the pandemic with few high-risk practices reported. Interestingly, the positive practices applied by Jordanian adults were minimally and not significantly affected by the knowledge about antimicrobials' safe and effective use. Conclusions: There is an urgent need for a structured effort to increase public awareness regarding the safe and effective use of disinfectants against SARS-CoV-2 transmission. © 2023 DSR Publishers/The University of Jordan.
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Background The preventive measures of coronavirus disease-19 (COVID-19) transmissions require the healthcare workers (HCWs) to be more cautious. Irritants or allergens exposure from these measures might induce adverse skin reactions and lead to the development of occupational contact dermatitis (OCD). Methods Questionnaires were distributed to HCWs in COVID-19 isolation ward of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. The questionnaire consisted of personal and work characteristics, clinical history, skin complaints, and occupational exposures. Results Fifty-three completed questionnaires were gathered from eligible subjects. History of atopic dermatitis (AD) was found on 8 subject (15.09%). Many of the subjects had complained of dry skin (28.30%), itchy skin (26.41%), and redness of skin (20.75%) on the hands in the last 12 months. As many as 50.94% of the subjects washed their hands with water and soap at least 6-10 times a day and 49.06% used hand sanitizers 6-10 times a day. The use of PPE were mostly 4 hours a day or less. There were associations between history of AD with complaints related to hand dermatitis (p=0.004) and history of AD with incidence of OCD assessed with Mathias criteria (p=0.016). It was also found that the use of gloves for 2 or more hours a day was associated with skin complaints after gloves use (p=0.021) and the use of hand sanitizer for more than 10 times a day was associated with complaints related to hand dermatitis (p=0.041). Conclusion The repeated and prolonged exposure to irritative or allergenic substances contained in PPE and hand hygiene products is related to OCD, particularly hand dermatitis, among HCWs in COVID-19 isolation ward. Copyright © 2023 Pakistan Association of Dermatologists. All rights reserved.
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Annotation: Pandemics of coronoviral infection continues affecting the wold community, and with the comprehension of its pathological physiology an interest in endocrine effects of SARSCoV- 2 grows too. It was determined, that the main target organs affected by SARS-CoV-2 were lungs and immune system, while it is still not clear if SARS-CoV-2 has any impact on the thyroid function. In patients infected with SARS-CoV, coronovirus relevant to SARS-CoV-2, damage of parafollicular and follicular cells in thyroid glands was seen at autopsy. The Objective: To assess the consequent effect of Covid- 19viral infection on thyroid functions prior to operation period. Materials and Research Methods: While performing retrospective analysis we checked 110 case histories of patients receiving in-patient therapy in Vitamed clinic and Turakulov RSSPMC of Endocrinology from May 2020 to January 2021.We revealed 53 patients who recovered from Covid-19. We checked thyroid hormones (TTH, free T4, total T3), performed ultra sound imaging and histological test of thyroid gland, CBA, and biochemical tests. Result(s): Among 53 patients, who recovered from COVID-19, there were 40 (75%) women and 13 (25%) men. The age of the patients varied from 30 to 78 years old (average 52.6 years old). Eleven patients out of 53 complained discomfort at the frontal side of neck, dry skin, feeling of a lump in throat, loss of hair, weakness, and shortbreathing. Ultra sound imaging revealed presence of nodes. Histological tests showed, that 7 patients had thyroid cancer. Ultra sound showed, that six patients out of 11 had TI-RADS 4, four had TI-RADS 3, and one had TI-RADS 5.Histological tests revealed, that six patients out of 11 hadBETHESDA 4, two had BETHESDA 5, and two patients had histologically revealed BETHESDA 2.
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Objective: Evaluate the safety and tolerability of losmapimod in the treatment for FSHD. Background: FSHD is a relentless, variably progressive disease leading to accumulation of disability over decades. Fulcrum is developing losmapimod, a small molecule p38 α/β MAPK inhibitor, to treat FSHD. Losmapimod has been generally well-tolerated in more than 3,600 subjects across multiple clinical studies, including >100 subjects with FSHD. Fulcrum has assessed losmapimod in FSHD in one completed phase 1 study (FIS 001-2018) and two ongoing Phase 2 studies in the open label extension period (FIS 001-2019 and FIS 002-2019). Methods: Subjects aged 18-65 years with genetically confirmed FSHD1, Clinical Severity Score 2-4, and MRI-eligible muscles for biopsy were exposed to losmapimod 7.5 or 15 mg twice daily PO for 14 days and up to 76 weeks. In study FIS 001-2018, 6 subjects were exposed to 7.5 mg and 11 subjects to 15 mg twice daily dosing for 14 consecutive days. In studies FIS 001-2019 and FIS 002-2019, 14 and 77 subjects respectively, received at least one dose of losmapimod 15 mg twice daily for up to 76 weeks. Results: A total of 108 subjects with FSHD1 have been exposed to losmapimod, with approximately 131 patient-years of exposure. Fifty-seven subjects have been exposed to losmapimod for 12 to 18 months, and 30 have been exposed for over 18 months. Most adverse events (AEs) observed during the studies were considered of mild to moderate in severity. The most common AEs were alanine aminotransferase (ALT) increase, headache, dizziness, dry skin, eczema and gastrointestinal disorders. The majority of AEs resolved with continued dosing. Dosing has been paused for 14 days in four subjects (3 in FIS 001-2019 and 1 in FIS 002-2019) subjects due to COVID-19 infection. There were no reported drug related SAEs, deaths, discontinuations due to AEs, or clinically significant changes in vital signs, clinical laboratory results, or ECG parameters. Conclusion: Losmapimod given as up to 15 mg twice daily in >100 subjects with FSHD1 for up to 76 weeks has been generally well-tolerated, consistent with that previously reported in other patient populations. Therefore, the benefit-risk profile of losmapimod for the treatment of FSHD remains favorable.
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Introduction: Complex regional pain syndrome (CRPS) is a debilitating condition characterized by disproportionate pain to the inciting event, changes in sensation, autonomic abnormalities, and motor dysfunction, as defined by the Budapest criteria. It is difficult to treat, often requiring trials of multiple medications or more invasive measures such as a spinal cord stimulator (SCS) to manage symptoms. The onset of symptoms typically follows tissue damage and may be exacerbated by further injury or systemic stressors. One such stressor appears to be COVID-19 infection, which has already been implicated in cases of neuropathic pain. We present a case of a 60-year-old woman with CRPS type I status post SCS placement with a flare-up attributable to COVID-19 infection. Methods: We describe the following patient's case in pertinent detail. The patient's written consent was obtained prior to the undertaking of this report. Results: A 60-year-old woman presented with a right-sided rotator cuff tear with subsequent repair in 2018 which incited pain and related symptoms. CRPS was diagnosed when her symptoms progressed to right thumb numbness as well as right hand color changes, numbness, and weakness. An SCS was placed in August 2019 which provided pain relief, but the patient presented with exacerbation of symptoms in December 2020, coinciding with COVID-19 infection. She experienced migration of symptoms into the right shoulder which has been significantly interfering with work and sleep. She continued to report pain, swelling, stiffness, dry skin, and temperature changes in her right hand. Conclusion: COVID-19 has been found to present with a widely variable clinical presentation with equally varied sequelae, termed Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Human coronaviruses are known to possess neuroinvasive capabilities, typically manifesting as anosmia in the case of COVID-19 but may also present as neuropathic pain. If not attributable to direct viral invasion, the pathophysiologic underpinnings may be related to proinflammatory cytokines and pain-generating neuropeptides. Our case suggests that COVID-19 infection may play a role in exacerbating symptoms of CRPS. Disclosure: Gabrielle Fernandez, BA: None, Ganiru Anunike, BA: None, Nitin Goyal, MD: None
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Adverse skin reactions are frequently reported by healthcare workers (HCWs) using face personal protective equipment (F-PPE) during the COVID-19 pandemic (Skiveren 2022). The skin is constantly provoked due to occlusion and friction by using F-PPE. This leads to itchy, dry, irritated, scaly and or red skin, which can be associated with eczema. This study is based on self-reported symptoms. Purpose: To describe the prevalence of red and irritated skin and risk factors related to the use of F-PPE among frontline HCWs at six Danish hospitals. Methods: A questionnaire survey was sent electronically to 22.993 HCWs. Results: The response rate was 44.7% (n=10.287). Of those, who used both surgical masks and FFP2-3, 37.8% (n=3893) reported red and irritated skin. Nurses were the largest group of responders (n=5924, 71.8%) and had significant more often red and irritated skin (n=2530, 42.7%) than physicians (n=553, 23.7%). Female HCWs (n=8854, 86.1%) had significant (p>0.001) more often symptoms (n=3575, 40.4%) than men (n=318, 22.2%). The responders who reported chronic skin disease like atopic dermatitis (n=560) had more often red and irritated skin (53.2%) than those without (37.0%) (p<0.001). Some skin types were more prone to have red and irritated skin;sensitive skin (42.2% based on n=1998), combined skin (42.2% based on n=1453), dry skin (32.2% based on n=5263), and oily skin (31.4% based on n=986). The difference between the skin types was significant, unless between dry and oily skin (p=0.629). Conclusions: To minimize adverse skin reactions due to the use of F-PPE, individual risk assessment is needed.
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OBJECTIVE: Mask usage and hand hygiene are the pillars of defense against the novel pathogen causing COVID-19. This study was conducted to compare these practices among healthcare workers (HCWs) and nonhealthcare workers (nonHCWs) and to examine the outlook toward the healthcare sector among the two. METHODS: A cross-sectional online survey (via Google forms) using snowball sampling was conducted. Appropriate ethical clearance was taken from the Institutional Ethical Committee (IEC). HCWs and nonHCWs 18 years of age or older with basic literacy in English and with internet access were included. RESULTS: There were 404 total respondents (M:F ratio: 0.87:1;mean age: 30.16±9.63 years). Among the respondents, 63.3 percent were HCWs while 35.6 percent were nonHCWs. Persons performing hand hygiene more than10 times/ day were found to be almost three times more likely to develop skin dryness (odds ratio [OR]: 2.95, 95% confidence interval [CI]: 1.372, 6.362). Female participants were found to be 2.5 times more likely to develop dryness (odds ratio: 2.594, 95% CI: 1.590, 4.234). Use of gloves was found to be a protective factor against development of dryness (odds ratio: 0.485,95% CI: 0.287, 0.818). A statistically significant correlation was found between mask acne and female respondents (p-value=0.000), HCWs (p-value=0.000), and use of N95 mask in combination with surgical mask (p-value=0.04). LIMITATIONS: Being an online survey, responses could not be captured from people with limited internet access and of lower socioeconomic strata. CONCLUSION: There is a considerable burden of preventive measures on HCWs and nonHCWs alike. Significant dermatological implications are seen with frequent hand hygiene and mask usage.
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Objective: To classify the haematological pattern, severity of anemia in children 5-12 years age admitted and to find its correlation with the clinical conditions. Methods Crossectional study of 160 patients in two years was done. Patients satisfying the inclusion criteria were selected for study. Relevant clinical data were recorded in a structured proforma including detailed history was recorded with particular symptoms suggestive of anemia such as weakness and easily fatigability, breathlessness on exertion and pica. A thorough clinical examination of every child was done followed by routine investigations for anemia Results Patients between 7-8 year were found to be the most affected. Anemia was found to be more common in female children as compared to male children (F:M=1.13). Anemia is more common in undernourished child. Most common presenting symptoms were gastrointestinal including vomiting, diarrhea and pain abdomen. Most common sign was Pallor followed by other common signs included signs of dehydration associated with diarrhea, hepatosplenomegaly. microcytic hypochromic anemia was the most common morphological type of anemia and macrocytic anemia was the least common.Thalassemia cases were most common among hemolytic anemias. Iron Deficiency Anemia (Nutritional Anemia) was the most common etiology of anemia. Conclusion Dietary deficits affect children aged 5 to 12, creating financial, emotional, and psychological burden for patients and their families, as well as depleting critical national resources. As a result, screening for these illnesses, as well as early detection of anemia and related problems, is essential.
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COVID-19, caused by SARS-CoV-2 virus, results in serious clinical manifestations in humans. The reactions, which are mainly respiratory, can also have significant effects on other body systems, such as cardiovascular, and can progress to death. Handwashing with running water and soap, and using alcohol-based antiseptic formulations are recognized measures in controlling COVID-19 spreading. Our study presents a review on hand hygiene and its relation with skin health in times of COVID-19. Handwashing with soap and running water promotes dirt removal and can inactivate SARS-CoV-2 by disrupting the viral lipid membrane. The use of alcohol-based antiseptic preparations on hands inactivates or inhibits the development of pathogenic microorganisms, such as the COVID-19 virus. World Health Organization recommends 80% ethyl alcohol-based or 75% isopropyl alcohol-based formulations for hand antisepsis, as they have a proven virucidal effect against SARS-CoV-2. Numerous problems can occur with frequent hand sanitizing regarding skin health. Skin dryness, increased skin sensitivity, and irritant contact dermatitis are some manifestations, which are mainly noticed in healthcare workers during COVID-19 pandemic. Accidents and burn risk involving alcohol-based antiseptic products are also a concern. From the pandemic beginning until November 2020, the Brazilian Burn Society has counted 700 hospitalizations due to serious burn accidents caused by 70% alcohol use, in liquid or gel form. For minimizing or avoiding dermatological reactions on hands, it is important to use antiseptic formulations and soaps containing moisturizing agents. The presence of humectants such as glycerin and emollients such as vegetable oils in the formulations can attract water and keep it in the skin, relieving hand skin irritation. So, humectants and emollients help maintaining the skin health in a proper hand hygiene routine. Even after most of world's population has been immunized with vaccines to prevent COVID-19, our hands will still have potential to transmit SARS-CoV-2 and it should not be overlooked. Understanding the state of the art of the antiseptic formulations and the impact of these products on hand skin health are critical to develop new knowledge on antiseptic products and their application in controlling infectious diseases spread, such as COVID-19.
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Background: The risk of transmission of novel SARS CoronaVirus-2 among health care workers can be reduced using personal protective equipment. It is critical to follow guidelines for appropriate use of protective gear to avoid its wastage. This study aimed to evaluate frontline healthcare workers' understanding of effective donning and doffing of protective equipment in the wake of recent emergence of corona virus disease.Physical impacts due to its prolonged usage were also identified. Material and Methods: A cross sectional survey was conducted targeting frontline health care workers from June till July 2021. Data was analyzed using SPSS version 24. Descriptive analysis was performed for qualitative variables.Chi-square test was utilized to determine association between qualitative variables and p <0.05 was considered to be statistically significant. Results: A total of 204 responses were received. Surgical masks (53.9%), gloves (51.5%), gowns (46.1%) and N95 respirator (40.7%) were most frequently used. Physicians had better knowledge on correct utilization of protective equipment as compared to non-physicians, p<0.001.Only 55.9% and 47.1% participants knew correct donning and doffing sequence respectively.The most prevalent mistakes while doffingwere touching front of mask and potentially contaminated surfaces followed by incorrect doffing sequence.Mostrespondentsmentioned scarcity of protective gear. Around 53% participants did not attend any training session on utilization of personal protective equipment. Prolonged exposure to masks and gloves led to acne, facial marks and itching. Frequent practice of hand hygiene was linked with skin dryness and cracking, p<0.001. Conclusion: We observed lack of expertise in donning and doffing technique. Mostly mistakes occurred during doffing, so interactive workshops are required to train health care workers.Most common dermatological manifestationsdue to use of masks and gloves included acne, facial markings, and itching. Adverse effects of prolonged use of PPE can be avoided by having shorter duration of working hours and giving rest during the shifts.