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1.
Sensors (Basel) ; 22(5)2022 Feb 26.
Article in English | MEDLINE | ID: covidwho-1737012

ABSTRACT

Several factors are motivating the development of preventive, personalized, connected, virtual, and ubiquitous healthcare services. These factors include declining public health, increase in chronic diseases, an ageing population, rising healthcare costs, the need to bring intelligence near the user for privacy, security, performance, and costs reasons, as well as COVID-19. Motivated by these drivers, this paper proposes, implements, and evaluates a reference architecture called Imtidad that provides Distributed Artificial Intelligence (AI) as a Service (DAIaaS) over cloud, fog, and edge using a service catalog case study containing 22 AI skin disease diagnosis services. These services belong to four service classes that are distinguished based on software platforms (containerized gRPC, gRPC, Android, and Android Nearby) and are executed on a range of hardware platforms (Google Cloud, HP Pavilion Laptop, NVIDIA Jetson nano, Raspberry Pi Model B, Samsung Galaxy S9, and Samsung Galaxy Note 4) and four network types (Fiber, Cellular, Wi-Fi, and Bluetooth). The AI models for the diagnosis include two standard Deep Neural Networks and two Tiny AI deep models to enable their execution at the edge, trained and tested using 10,015 real-life dermatoscopic images. The services are evaluated using several benchmarks including model service value, response time, energy consumption, and network transfer time. A DL service on a local smartphone provides the best service in terms of both energy and speed, followed by a Raspberry Pi edge device and a laptop in fog. The services are designed to enable different use cases, such as patient diagnosis at home or sending diagnosis requests to travelling medical professionals through a fog device or cloud. This is the pioneering work that provides a reference architecture and such a detailed implementation and treatment of DAIaaS services, and is also expected to have an extensive impact on developing smart distributed service infrastructures for healthcare and other sectors.


Subject(s)
COVID-19 , Skin Diseases , Artificial Intelligence , COVID-19/diagnosis , Humans , SARS-CoV-2 , Skin Diseases/diagnosis , Software
2.
Hautarzt ; 73(4): 291-297, 2022 Apr.
Article in German | MEDLINE | ID: covidwho-1733959

ABSTRACT

BACKGROUND: The persistent global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can manifest on the skin in addition to the already known organ systems. Various clinical patterns of skin manifestations associated with coronavirus disease 2019 (COVID-19) have been described. In view of the associated morbidity and mortality, knowledge of cutaneous manifestations in the setting of COVID-19 may be helpful in early detection, risk stratification, diagnosis and treatment. Thus, we provide a summary of the various dermatologic findings associated with COVID-19, including clinical presentation, current pathophysiological concepts, and management, to support early diagnosis and treatment. GOAL: The current literature regarding skin lesions associated with COVID-19 and the most important aspects are analyzed. MATERIALS AND METHODS: A literature search was performed in PubMed and Medline databases until February 28, 2021. RESULTS AND CONCLUSION: The classification of skin manifestations in the context of SARS-CoV­2 infection according to clinical dermatological patterns can help to identify patients with increased risk at an early stage and to treat them adequately to counteract a possibly more severe course of the disease as it occurs, e.g., in livedo. Thus, knowledge of the pathophysiological mechanisms can improve management of the disease and support possible countermeasures in coping with the disease.


Subject(s)
COVID-19 , Skin Diseases , Humans , Pandemics , SARS-CoV-2 , Skin/pathology , Skin Diseases/diagnosis , Skin Diseases/etiology , Skin Diseases/therapy
3.
Cleve Clin J Med ; 89(3): 161-167, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1726177

ABSTRACT

Cutaneous findings can be clues to diagnosis and infection severity in viral illnesses, including COVID-19. The authors provide an update on the diagnostic and prognostic value of the 5 most common cutaneous abnormalities associated with COVID-19 in adult patients: morbilliform rash, urticaria, vesicles, pseudo-chilblains, and vaso-occlusive lesions.


Subject(s)
COVID-19 , Exanthema , Skin Diseases , Adult , COVID-19/diagnosis , Exanthema/etiology , Exanthema/pathology , Humans , SARS-CoV-2 , Skin/pathology , Skin Diseases/diagnosis , Skin Diseases/etiology
4.
Cutis ; 109(1): E43-E45, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1704284

ABSTRACT

COVID-19 was declared a global pandemic by the World Health Organization on March 11, 2020, and within the following 2 months, most states had issued mandatory stay-at-home orders, leaving many patients without access to outpatient care. Similar to many other outpatient-based specialties, dermatology quickly adopted telemedicine into clinical practice, and this expansion of virtual communication provided (1) increased access for patients living in remote areas, (2) ease of multidisciplinary collaboration, and (3) new opportunities for training and education. This article highlights the caveats of teledermatology, such as the need for excellent visual diagnostic skills and the vulnerability of patient privacy and protected information. Additionally, as teledermatology is poised to further expand in the future, it is critical to reflect on patient safety as well as its clinical efficacy in comparison to in-person evaluation.


Subject(s)
COVID-19 , Dermatology , Skin Diseases , Telemedicine , Humans , SARS-CoV-2 , Skin Diseases/diagnosis
7.
An Bras Dermatol ; 97(1): 75-88, 2022.
Article in English | MEDLINE | ID: covidwho-1509458

ABSTRACT

This article will address the main aspects of skin manifestations associated with COVID-19, based on a review of the literature published to date. Since the beginning of the pandemic, more than 1,500 articles have been published on the subject. Regarding the pathophysiology, it is believed that the same mechanisms responsible for the disease in the main target organs also act in the skin, although they are not yet fully elucidated. The actual frequency of dermatological manifestations remains uncertain - it can range from 0.2% to 45%, being close to 6% in systematic reviews. Pioneering studies of large case series conducted in European countries and the USA provide the first information on the main skin manifestations associated with COVID-19 and propose classifications regarding their clinical presentation, pathophysiology, as well as their frequencies. Although there is yet no consensus, maculopapular eruptions are considered the most frequent presentations, followed by erythema pernio-like (EPL) lesions. Manifestations such as urticaria, vesicular conditions and livedo/purpura/necrosis are rare. The time of onset, severity, need for specific treatment and prognosis vary according to the clinical presentation pattern. The increasing histopathological description of skin conditions can contribute to the diagnosis, as well as to the understanding of the pathophysiology. Also, in the dermatological field, the relationship between COVID-19 and androgens has been increasingly studied. Despite all the generated knowledge, the actual biological meaning of skin manifestations remains uncertain. Therefore, the exclusion of the main differential diagnoses is essential for the correlation between skin manifestation and COVID-19.


Subject(s)
COVID-19 , Skin Diseases , Humans , Pandemics , SARS-CoV-2 , Skin Diseases/diagnosis , Skin Diseases/etiology , Systematic Reviews as Topic
8.
Clin Dermatol ; 39(3): 384-404, 2021.
Article in English | MEDLINE | ID: covidwho-1491859

ABSTRACT

Globalization entails several medical problems along with economic and social complications. Migrations from other continents, increasing numbers of tourists worldwide, and importation of foreign parasites (eg, Aedes albopictus) have made diseases previously unknown in Europe a reality. The rapid spread of the coronavirus disease 2019 pandemic throughout the world is a warning that other epidemics are still possible. Most, if not all of these diseases, transmitted by viruses or bacteria, present with cutaneous symptoms and signs that are highly important for a speedy diagnosis, a fundamental concept for arresting the diseases and saving lives. Dermatologists play a significant role in delineating cutaneous and mucosal lesions that are often lumped together as dermatitis. We provide a review of many of these cutaneous and mucosal lesions that sometimes are forgotten or even ignored.


Subject(s)
Bacterial Infections , COVID-19 , Skin Diseases , Humans , Pandemics , SARS-CoV-2 , Skin Diseases/diagnosis
9.
J Cutan Med Surg ; 26(2): 189-197, 2022.
Article in English | MEDLINE | ID: covidwho-1477178

ABSTRACT

Coronavirus disease (COVID-19) skin manifestations have been increasingly reported in medical literature. Recent discussions have identified a lack of images of skin of color (SOC) patients with COVID-19 related skin findings despite people with skin of color being disproportionately affected with the disease. There have been calls to prioritize the identification of COVID-19 skin manifestations in patients with SOC and disseminate these findings. The objective of this article is to review the existing literature on COVID-19 skin manifestations and, where possible, discuss how they may present differently in patients with SOC. Further research is needed to allow primary care physicians and dermatologists to be aware of and easily identify patients with cutaneous findings that may be secondary to COVID-19. Patients presenting with idiopathic dermatologic manifestations should be considered for COVID-19 testing and follow public health guidelines for self-isolation.


Subject(s)
COVID-19 , Skin Diseases , COVID-19/complications , COVID-19 Testing , Humans , SARS-CoV-2 , Skin Diseases/diagnosis , Skin Diseases/etiology , Skin Pigmentation
10.
J Cutan Med Surg ; 26(2): 135-142, 2022.
Article in English | MEDLINE | ID: covidwho-1435194

ABSTRACT

BACKGROUND: During the 2019 Coronavirus (COVID-19) pandemic, the Division of Dermatology, University of Ottawa, adapted pre-existing local healthcare infrastructures to provide increased provider-to-provider teledermatology services as well as integrated teledermatology into the dermatology residency training program. OBJECTIVES: (1) To assess the differences in utilization of provider-to-provider teledermatology services before and during the COVID-19 pandemic; and (2) to assess dermatology resident and faculty experiences with the integration of teledermatology into dermatology residency training at the University of Ottawa. METHODS: We conducted a cross-sectional analysis comparing provider-to-provider teledermatology consults submitted to dermatologists from April 2019 to October 2019 pre-pandemic with the same period during the pandemic in 2020. Two different questionnaires were also disseminated to the dermatology residents and faculty at our institution inquiring about their perspectives on teledermatology, education, and practice. RESULTS: The number of dermatologists completing consults, the number of providers submitting a case to Dermatology, and the number of consults initiated all increased during the pandemic period. Ninety-one percent of residents agreed that eConsults and teledermatology enhanced their residency education, enabled continuation of training during the pandemic, and that eConsult-based training should be incorporated into the curriculum. Ninety-six percent of staff incorporated a virtual dermatology practice model, and one-third used teledermatology with residents during the pandemic. Most staff felt there was value in providing virtual visits in some capacity during the pandemic. CONCLUSIONS: Our study confirms that the use of teledermatology services continues to increase accessibility during the pandemic. Teledermatology enhances the education and training of residents and will be incorporated into dermatology residency programs.


Subject(s)
COVID-19 , Dermatology , Internship and Residency , Skin Diseases , Telemedicine , COVID-19/epidemiology , Cross-Sectional Studies , Dermatology/education , Humans , Pandemics , Skin Diseases/diagnosis , Skin Diseases/therapy
11.
J Med Virol ; 93(10): 5756-5767, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1432444

ABSTRACT

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has become a significant health problem globally. The virus has spread widely and become a global pandemic. The pathophysiology for SARS-CoV-2 has not been explained clearly. It has been associated with several multiorgan symptoms, among which its dermatological manifestations are of great interest. Primarily, there has been no report of skin features among COVID-19 patients. Nevertheless, recently there have been several reports regarding COVID-19 patients who presented with cutaneous manifestations. In the current review, we focus on the various cutaneous manifestations of COVID-19 infection.


Subject(s)
COVID-19/complications , Skin Diseases/etiology , COVID-19/drug therapy , Dermatitis, Occupational/diagnosis , Dermatitis, Occupational/etiology , Dermatitis, Occupational/pathology , Dermatitis, Occupational/therapy , Diagnosis, Differential , Drug Eruptions/diagnosis , Drug Eruptions/etiology , Drug Eruptions/pathology , Drug Eruptions/therapy , Humans , Personal Protective Equipment/adverse effects , SARS-CoV-2 , Skin Diseases/diagnosis , Skin Diseases/pathology , Skin Diseases/therapy
12.
An Bras Dermatol ; 96(6): 672-687, 2021.
Article in English | MEDLINE | ID: covidwho-1415150

ABSTRACT

The skin, by reflecting internal processes, externalizes what happens inside the body in many diseases. Thus, the skin, as an organ, extrapolates its functions of protection, barrier and signals the existence of systemic diseases, expanding the importance of the dermatologist beyond the skin surface. Thus, the dermatologist investigates diagnostic hypotheses for conditions related to all systems and refers patients to the appropriate specialty. Combined with examination by a trained eye, the skin, due to its easy access, is still the ideal place for performing biopsies, which often clarify the diagnosis. This manuscript is the second part of the article on cutaneous manifestations of systemic diseases. In the first part, the cutaneous manifestations of the main rheumatologic and granulomatous diseases were described, and vascular manifestations were also addressed. In the present article, it will be discussed how metabolic, cardiovascular, kidney, and gastrointestinal diseases can manifest themselves in the integumentary system. Malignant diseases and their cutaneous implications, will also be discussed. Pruritus and its clinical cutaneous correspondence will be discussed. Finally, an update on cutaneous signs of SARS-CoV2 coronavirus infection will be presented.


Subject(s)
COVID-19 , Skin Diseases , Humans , RNA, Viral , SARS-CoV-2 , Skin , Skin Diseases/diagnosis , Skin Diseases/etiology
13.
An Bras Dermatol ; 96(6): 655-671, 2021.
Article in English | MEDLINE | ID: covidwho-1415149

ABSTRACT

The skin demonstrates what is happening in the body in many diseases, as it reflects some internal processes on the surface. In this sense, skin as an organ, goes beyond its protective and barrier functions, as it provides clues for the identification of some systemic diseases. The dermatologist then raises diagnostic hypotheses for conditions related to all systems and refers them to the appropriate specialty. With easy access to examination by trained eyes and biopsies, the skin can present specific or non specific alterations on histopathology. In the first case this combination establishes the diagnosis of the disease itself. Non specific manifestations can occur in a variety of contexts and then histopathology is not specific of a particular disease. This article is divided into two parts that will cover large groups of diseases. In this first part, cutaneous manifestations of the main rheumatologic diseases are described, which are the ones with the greatest interface with dermatology. The authors also talk about vascular manifestations and granulomatous diseases. In the second part, endocrinological, hematological, oncological, cardiovascular, renal, gastrointestinal diseases, pruritus and its causes are discussed, and finally, the dermatological manifestations of SARS-CoV-2 coronavirus infection. The authors' intention is that, by using direct and easily accessible language, aim to provide practical material for consultation and improvement to all dermatologists who recognize the importance of a comprehensive assessment of their patients.


Subject(s)
COVID-19 , Collagen Diseases , Skin Diseases , Humans , SARS-CoV-2 , Skin Diseases/diagnosis , Skin Diseases/etiology
14.
J Am Acad Dermatol ; 85(2): 301-310, 2021 08.
Article in English | MEDLINE | ID: covidwho-1379127

ABSTRACT

The skin often provides initial clues of hypercoagulability with features such as livedo reticularis, livedo racemosa, retiform purpura, necrosis, and ulcerations. Because these cutaneous manifestations are nonspecific, laboratory testing is often needed to evaluate for underlying causes of hypercoagulability. Importantly, these disorders are reported to be the most common mimicker, resulting in an erroneous diagnosis of pyoderma gangrenosum. Understanding inherent properties of, and indications for, available tests is necessary for appropriate ordering and interpretation of results. Additionally, ordering of these tests in an indiscriminate manner may lead to inaccurate results, complicating the interpretation and approach to management. This second article in this continuing medical education series summarizes information on methodology, test characteristics, and limitations of several in vitro laboratory tests used for the work up of hypercoagulability and vasculopathic disease as it pertains to dermatologic disease.


Subject(s)
Skin Diseases/blood , Skin Diseases/diagnosis , Thrombophilia/blood , Thrombophilia/diagnosis , Clinical Laboratory Techniques , Humans , Skin Diseases/etiology , Thrombophilia/complications
16.
Ann Diagn Pathol ; 54: 151807, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1356125

ABSTRACT

Digital pathology has become an integral part of pathology education in recent years, particularly during the COVID-19 pandemic, for its potential utility as a teaching tool that augments the traditional 1-to-1 sign-out experience. Herein, we evaluate the utility of whole slide imaging (WSI) in reducing diagnostic errors in pigmented cutaneous lesions by pathology fellows without subspecialty training in dermatopathology. Ten cases of 4 pigmented cutaneous lesions commonly encountered by general pathologists were selected. Corresponding whole slide images were distributed to our fellows, along with two sets of online surveys, each composed of 10 multiple-choice questions with 4 answers. Identical cases were used for both surveys to minimize variability in trainees' scores depending on the perceived level of difficulty, with the second set being distributed after random shuffling. Brief image-based teaching slides as self-assessment tool were provided to trainees between each survey. Pre- and post-self-assessment scores were analyzed. 61% (17/28) and 39% (11/28) of fellows completed the first and second surveys, respectively. The mean score in the first survey was 5.2/10. The mean score in the second survey following self-assessment increased to 7.2/10. 64% (7/11) of trainees showed an improvement in their scores, with 1 trainee improving his/her score by 8 points. No fellow scored less post-self-assessment than on the initial assessment. The difference in individual scores between two surveys was statistically significant (p = 0.003). Our study demonstrates the utility of WSI-based self-assessment learning as a source of improving diagnostic skills of pathology trainees in a short period of time.


Subject(s)
COVID-19/prevention & control , Clinical Competence , Education, Distance/methods , Education, Medical, Graduate/methods , Image Interpretation, Computer-Assisted/methods , Pathology, Clinical/education , Skin Diseases/pathology , Diagnostic Errors/prevention & control , Fellowships and Scholarships , Humans , Pathology, Clinical/methods , Skin Diseases/diagnosis , United States
18.
Dermatol Clin ; 39(4): 569-574, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1330741

ABSTRACT

Coronavirus Disease 2019 disproportionately affects Black and Hispanic/Latino populations. Racial disparities inherently exist in dermatology because of underrepresentation of skin of color populations in literature, reduced access to care for minority populations, and low diversity within the specialty of dermatology itself. Lack of imagery in dermatology can have detrimental consequences for patients of color. Dermatologists should note and disseminate cutaneous manifestations of patients of color to combat current racial imbalances.


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/ethnology , Cultural Diversity , Minority Groups/statistics & numerical data , Skin Diseases/ethnology , /statistics & numerical data , COVID-19/diagnosis , Health Status Disparities , Humans , SARS-CoV-2/isolation & purification , Skin Diseases/diagnosis
19.
J Med Virol ; 93(10): 5756-5767, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1303274

ABSTRACT

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has become a significant health problem globally. The virus has spread widely and become a global pandemic. The pathophysiology for SARS-CoV-2 has not been explained clearly. It has been associated with several multiorgan symptoms, among which its dermatological manifestations are of great interest. Primarily, there has been no report of skin features among COVID-19 patients. Nevertheless, recently there have been several reports regarding COVID-19 patients who presented with cutaneous manifestations. In the current review, we focus on the various cutaneous manifestations of COVID-19 infection.


Subject(s)
COVID-19/complications , Skin Diseases/etiology , COVID-19/drug therapy , Dermatitis, Occupational/diagnosis , Dermatitis, Occupational/etiology , Dermatitis, Occupational/pathology , Dermatitis, Occupational/therapy , Diagnosis, Differential , Drug Eruptions/diagnosis , Drug Eruptions/etiology , Drug Eruptions/pathology , Drug Eruptions/therapy , Humans , Personal Protective Equipment/adverse effects , SARS-CoV-2 , Skin Diseases/diagnosis , Skin Diseases/pathology , Skin Diseases/therapy
20.
Clin Dermatol ; 39(1): 33-40, 2021.
Article in English | MEDLINE | ID: covidwho-1300689

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has caused widespread disruptions in various sectors of medicine, including medical education. Although the necessary focus has been on patient care and public safety and the long-lasting impact of COVID-19 remains to be determined, the impact on medical education warrants further attention and action. While it seems minuscule compared with the toll the global pandemic has caused worldwide, the impact on medical education, including graduate medical education, carries the potential to alter career progression and outcomes. We have assessed the effects of COVID-19 on dermatology clinics, residency education, and medical education, exploring recommendations and actions taken by governing bodies and offering additional suggestions of our own.


Subject(s)
COVID-19/epidemiology , Certification , Dermatology/education , Internship and Residency , Skin Diseases , Accreditation , Biomedical Research , COVID-19/prevention & control , Curriculum , Humans , Internship and Residency/methods , Internship and Residency/organization & administration , Interviews as Topic , Personnel Selection , SARS-CoV-2 , Skin Diseases/diagnosis , Skin Diseases/pathology , Skin Diseases/therapy , Telemedicine , United States
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