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Background: Consensus guidelines and recommendations play an important role in fostering quality, safety, and best practices, as they represent an expert interpretation of the biomedical literature and its application to practice. However, it is unclear whether the recent collective experience of implementing telemedicine and the concurrent growth in the evidence base for teledermatology have resulted in more robust guidance. Objective: The objective of this review was to describe the extent and nature of currently available guidance, defined as consensus guidelines and recommendations available for telemedicine in dermatology, with guidance defined as consensus or evidence-based guidelines, protocols, or recommendations. Methods: We conducted a single-reviewer scoping review of the literature to assess the extent and nature of available guidance, consensus guidelines, or recommendations related to teledermatology. We limited the review to published material in English since 2013, reflecting approximately the past 10 years. We conducted the review in November and December of the year 2022. Results: We identified 839 potentially eligible publications, with 9 additional records identified through organizational websites. A total of 15 publications met the inclusion and exclusion criteria. The guidelines focused on varied topics and populations about dermatology and skin diseases. However, the most frequent focus was general dermatology (8/15, 53%). Approximately half of the telemedicine guidance described in the publications was specific to dermatology practice in the context of the COVID-19 pandemic. The publications were largely published in or after the year 2020 (13/15, 87%). Geographical origin spanned several different nations, including Australia, the United States, European countries, and India. Conclusions: We found an increase in COVID-19-specific teledermatology guidance during 2020, in addition to general teledermatology guidance during the period of the study. Primary sources of general teledermatology guidance reported in the biomedical literature are the University of Queensland's Centre for Online Health and Australasian College of Dermatologists E-Health Committee, and the American Telemedicine Association. There is strong evidence of international engagement and interest. Despite the recent increase in research reports related to telemedicine, there is a relative lack of new guidance based on COVID-19 lessons and innovations. There is a need to review recent evidence and update existing recommendations. Additionally, there is a need for guidance that addresses emerging technologies. © Mollie R Cummins, Triton Ong, Julia Ivanova, Janelle F Barrera, Hattie Wilczewski, Hiral Soni, Brandon M Welch, Brian E Bunnell.
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The aim of t he study: to assess the importance of the inflammatory status of the body in patients with diabetic 2 type and severe COVID-19 as an unfavorable factor for the occurrence of arterial thrombosis of the lower extremities, the course of acute ischemia and the prognosis for ischemic limb. Materials and Methods. The study included 35 patients with type 2 diabetes mellitus and acute arterial thrombosis of the lower extremities without a history of intermittent claudication with an ischemia of 6-12 h, who underwent urgent surgical successful thrombectomy. All studied patients were tested for the SARS-CoV-2 virus, 18 had a negative result (control group), the diagnosis of COVID-19 in 17 patients of the main group was confirmed by a transcriptional polymerase chain reaction. The average age of patients in the control group was 72.3 yrs, the main group - 69.8 yrs. Results. During examination, distal forms of arterial thrombosis were registered in 70.6 % of patients in the main group and 72.2 % in the controls. The concentration of myoglobin in the serum at 6 h after the surgery was the highest, reaching the highest values in patients of the main group. There was a significantly lower concentration of myoglobin in the control group during the first days after the restoration of blood flow. ICAM-1 levels were significantly higher in the COVID-19 group than in the control group during the first day after blood flow recovery The association between endothelial dysfunction and subsequent thrombotic events is already well known in cardiovascular disease and diabetes. Six of our cases had comorbidities such as arterial hypertension, dyslipidemia, diabetes mellitus, and signs of chronic arterial disease. Thus, previous endothelial activation status caused by these comorbidities exacerbated endothelial dysfunction caused by SARS-CoV-2 infection and its inflammatory response, and may have been the cause of the most common fatalities described in these patients. Recurrences of thrombosis in the early postoperative period occurred in 5 (29.4 %) patients of the main group, which led to amputation. In the control group, recurrent thrombosis led to amputation in 2 (11.1 %) cases. In 7 patients of the main group (41.2 %) and 2 patients of the control group (11.1 %) in the early postoperative period developed adverse cardiopulmonary events, which in 4 patients of the main group (23.5 %) caused death. Conclusions. ?ur results suggest the involvement of endothelial dysfunction and thrombosis in COVID-19. Consistent with this hypothesis, patients with type 2 diabetes mellitus and severe COVID-19 have been noted to have significant increase in serum level of inflammatory markers (TNF-a, IL-1β, IL-6, IL-8, IL-10). One of the significant factors of endothelial dysfunction as a result of our study was ICAM-1 thereby indicating the occurrence of macrophage activation syndrome. These thrombotic events can be fatal in patients with type 2 diabetes, and early diagnosis can help health professionals adjust the anticoagulation regimen and affect endothelial stabilization in high-risk patients, alleviate thrombogenic events, systemic inflammatory response syndrome, and multiorgan failure. © 2022 National Academy of Medical Science and Ministry of Health of Ukraine. All rights reserved.
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Background/Introduction: Untreated, symptomatic, severe aortic stenosis carries significant mortality and morbidity. Timely intervention is pivotal to ensure patient safety. The COVID-19 pandemic created unprecedented challenges to the UK's National Health Service (NHS), resulting in the deferral of all elective work, including TAVI services from March 2020. Purpose: To evaluate clinical outcomes and time delays in patients undergoing TAVI during the pandemic period compared to an age and risk factor-matched cohort of patients prior to COVID-19. We hypothesized that there were significant time delays, more emergency procedures and related adverse outcomes in patients who underwent TAVI during the pandemic period. Methods: We analysed prospectively collected data (patient characteristics, procedural details, complications and in-hospital outcomes) of 210 consecutive patients who underwent TAVI between March 2019 and February 2021 in a tertiary centre in the UK (The centre serves for a population of 2.5 million and provided in-patient treatment for 5590 COVID-positive patients over a 12 month period). We compared time-lags from an initial referral to outpatient review, CT aortograms, valve implantation and 30-day mortality between patients who underwent TAVI between March 2019 and Feburary 2020 (N=134) and those who underwent TAVI between March 2020 and February 2021 (COVID Group=76). Results: The mean age of the cohort was 81.4±6.6 years and majority were females (51%) and were in moderate risk category (EuroSCORE II=4.55±5.5). Of the total cohort, 4 (5.3%) patients acquired COVID-19 pneumonia during the hospital stay. The age, cardiovascular comorbidities and risk scores were comparable between the control group and the COVID cohort. (Table 1). There were no significant differences in procedural complications in the control group compared to the COVID-19 group (Table 1). The median waiting time from referral to TAVI clinic was significantly shorter in the COVID-19 group (33 (8-66) vs. 51 (17-89) days (P=0.04)) and there was no significant difference in time delays for CT aortogram, MDT or TAVI procedure between the two groups. The median length of stay (2 (2-4) vs 2.5 (2-9) days) and 30 day mortality (1.4% vs 5.3%) was comparable between the two groups (Table 1). Conclusion: Contrary to our hypothesis, our analysis demonstrated that there were no significant time delays, excess complications or mortality in TAVI procedures during the COVID-19 pandemic period despite the excess burden imposed on our local health services. More importantly, very few TAVI patients acquired COVID-19 infection during in-hospital stay. This is likely due to prompt identification of innovative ways of re-configuring an existing local patient pathway, by the TAVI team, to deliver safe and uninterrupted TAVI services during this unprecedented pandemic setting. (Figure Presented).
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Background/Introduction Untreated, symptomatic, severe aortic stenosis carries significant mortality and morbidity. Timely intervention is pivotal to ensure patient safety. The COVID-19 pandemic created unprecedented challenges to the UK's National Health Service (NHS), resulting in the deferral of all elective work, including TAVI services from March 2020. We sought to evaluate clinical outcomes and time delays in patients undergoing TAVI during the pandemic period compared to an age and risk factor-matched cohort of patients prior to COVID-19. We hypothesized that there were significant time delays, more emergency procedures and related adverse outcomes in patients who underwent TAVI during the pandemic period. Methods We analysed prospectively collected data (patient characteristics, procedural details, complications and in-hospital outcomes) of 210 consecutive patients who underwent TAVI between March 2019 and February 2021 in a tertiary centre in the UK (The centre serves for a population of 2.5 million and provided in-patient treatment for 5590 COVID-positive patients over a 12-month period). We compared time-lags from an initial referral to outpatient review, CT aortograms, MDT discussions, valve implantations and 30-day mortality between patients who underwent TAVI between March 2019 and February 2020 (Control group=134) and those who underwent TAVI between March 2020 and February 2021 (COVID Group=76). Results The mean age of the cohort was 81.9 ±6.4 years compared to 80.9±6.9 in the COVID-19 group. 59% of the control group and 43% of the COVID-19 group were female. Majority were in the moderate risk category (EuroSCORE II=4.55±5.5). Mean Katz index in the control group was 5.4 ±0.9 and 5.7±0.5 in the COVID-19 cohort. Patient characteristics are summarised in table 1. Of the total cohort, 4 (5.3%) patients acquired COVID-19 pneumonia during the hospital stay. The comorbidities and risk scores were comparable between the control group and the COVID cohort. (Table 1). There were no significant differences in procedural complications in the control group compared to the COVID-19 group (table 2). The median waiting time from referral to TAVI clinic was significantly shorter in the COVID-19 group (33 (8-66) vs. 51(17-89) days (P=0.04)) and there was no significant difference in time delays for CT aortogram, MDT or TAVI procedure between the two groups (Figure 1). The median length of stay (2 (2-4) vs 2.5(2-9) days) and 30-day mortality (1.4% vs 5.3%) was comparable between the two groups. Conclusion Contrary to our hypothesis, our analysis demonstrated that there were no significant time delays, excess complications or mortality in TAVI procedures during the COVID-19 pandemic period despite the excess burden imposed on our local health services. More importantly, very few TAVI patients acquired COVID-19 sepsis during in-hospital stay. This is likely due to prompt identification of innovative ways of re-configuring an existing local patient pathway, by the TAVI team, to deliver safe and uninterrupted TAVI services during this unprecedented pandemic setting.