Effect of COVID-19 on Continuing Education Activities and Learner Interactions: Report from Six Accreditation Systems.

The COVID-19 pandemic has had disruptive effects on all parts of the health-care system, including the continuing education (CE) landscape. This report documents, what has happened in six different CE accreditation systems to CE activities as well as learners. Complete lockdown periods in the first part of the COVID-19 pandemic have inevitably led to reductions in numbers of the then predominant format of education, i.e. onsite in-person meetings. However, with impressive speed CE providers have switched to online educational formats. With regard to learner interactions this has compensated, and in some systems even overcompensated, the loss of in-person educational opportunities. Thus, our data convincingly demonstrate the resilience of CPD in times of a global health crisis and offer important insights in how CPD might become more effective in the future.

A Teledermatology Pilot Programme for the Management of Skin Diseases in Primary Health Care Centres: Experiences from a Resource-Limited Country (Mali, West Africa).

In sub-Saharan Africa, in particular in rural areas, patients have limited access to doctors with specialist skills in skin diseases. To address this issue, a teledermatology pilot programme focused on primary health centres was set up in Mali. This study was aimed at investigating the feasibility of this programme and its impact on the management of skin diseases. The programme was based on the store-and-forward model. Health care providers from 10 primary centres were trained to manage common skin diseases, to capture images of skin lesions, and to use an e-platform to post all cases beyond their expertise for dermatologists in order to obtain diagnosis and treatment recommendations. After training, the cases of 180 patients were posted by trained health workers on the platform. Ninety-six per cent of these patients were properly managed via the responses given by dermatologists. The mean time to receive the expert's response was 32 h (range: 13 min to 20 days). Analysis of all diseases diagnosed via the platform revealed a wide range of skin disorders. Our initiative hugely improved the management of all skin diseases in the targeted health centres. In developing countries, Internet accessibility and connection quality represent the main challenges when conducting teledermatology programmes.

[Cutaneous tuberculosis in Bamako, Mali]. / Tuberculose cutanée à Bamako, Mali.

INTRODUCTION: Tuberculosis is the most common mycobacteriosis in sub-Saharan Africa. Cutaneous tuberculosis is rare and underdiagnosed due to its clinical polymorphism and to the smallness of technical equipment. This study aims to describe the epidemiological, clinical, histopathological aspects of cutaneous tuberculosis in Bamako (Mali). METHODS: We conducted a cross-sectional descriptive study from January 1991 to December 2008. The study was performed in the Department of Dermatology at the National Center for Disease Control and in the Department of Pneumophtisiology at the Hospital of Point G. The patients with tuberculosis confirmed by histological and/or biological examination were included in the study. RESULTS: Out of 4269 patients? medical records, 61 cases of cutaneous tuberculosis were identified (1.43%). Men accounted for 59% of the cases (36 patients) and women 41% (25 cases); sex-ratio was 1.44. The age of the patients ranged from 3 months to 61 years, with an average age of 27.56 ± 36 years. The average length of follow-up was 10.9 ± 10 months. The identified clinical forms were scrofuloderma (41 cases), ulcerative form (13 cases), verrucous form (4 cases), and tuberculous Lupus (3 cases). Tuberculosis was associated with HIV in 7 cases, with leprosy in 3 cases. CONCLUSION: Cutaneous tuberculosis is underdiagnosed in Mali. Efforts are needed to improve the accessibility and the technical equipment available in the Departments, in order to conduct an extensive interdisciplinary study on this pathology.

[Geriatric dermatoses in patients hospitalized in the Department of Dermatology in Bamako (Mali)]. / Dermatoses gériatriques en hospitalisation dermatologique à Bamako (Mali).

INTRODUCTION: Skin diseases in the aging population vary and are a key concern for clinicians in terms of diagnosis, management and follow-up. This study aims to describe the epidemiological and clinical aspects of skin diseases among geriatric patients hospitalized in the Department of Dermatology at the National Center In Support Of Disease, Bamako. METHODS: We conducted a cross-sectional case study of patients with geriatric dermatoses hospitalized in the Department of Dermatology at the National Center In Support Of Disease from 1 January 2010 to 31 December 2014. Out of 398 patients hospitalized, 76 patients aged 60 years and over were included in the study. Data entry was accomplished using Epidata 3.1 software, while data analysis was performed using stata 14 software. RESULTS: The prevalence of skin diseases among hospitalized geriatric patients was 19.10%. The age of the patients varied from 60 to 95 years, with an average age of 68.85 years. We enrolled 29 men and 47 women, with a sex-ratio of 0,60. The main diseases reported were dermohypodermitis (44.74%), autoimmune bullous dermatitis (13.16%), toxidermia (10.53%), venous ulcers (6.58%), arterial ulcers (3.95%), malignant tumors (5.27%), diabetic wounds (3.95%). Four patients died (5,26%). CONCLUSION: This study has assessed a high prevalence of subjects aged 60 and over hospitalized in the Department of Dermatology in Bamako. Moreover, it has confirmed that dermohypodermitis are the most frequent skin diseases among geriatric patients hospitalized in Mali.

[Epidemio-clinical profile of dermatoses in children receiving dermatological consultation in the Department of Dermatology at the National Center for Disease Control in Bamako (Mali)]. / Profil épidémio-clinique des dermatoses chez les enfants vus en consultation dermatologique dans le service de dermatologie du centre national d'appui à la lutte contre la maladie à Bamako (Mali).

INTRODUCTION: Skin diseases are a major public health problem in developing countries. In common practice, children represent the most affected segment of the population. This study aims to describe the epidemiological and clinical aspects of skin diseases in children aged 0-15 years receiving dermatological consultation in the Department of Dermatology at the National Center for Disease Control in Bamako (Mali). METHODS: We conducted a cross-sectional study in the Department of Dermatology and Venereology at the National Center for Disease Control from 1 January 2009 to 31 December 2009.Out of a total of 16339 patients who had undergone a dermatological consultation 5149 children were included in the study. RESULTS: Dermatitis-frequency in hospital attending children was 31.51%. We enrolled 2838 boys (55,10%) and 2311 girls (44.90%), with a sex-ratio of 1,22. Patient age ranged from 03 days to 15 years with an average age of 8 ± 5.7 years. Infectious dermatoses accounted for 55.10% of all dermatoses, immuno-allergic dermatoses (32.5%), inflammatory dermatoses (11.85%). CONCLUSION: Our study highlights the severity of infectious and immuno-allergic pathologies and the necessity to promote simple preventive measures such as hygiene, buying a clipper for each child.

[Endemic Kaposi's sarcoma in Dakar: 29 cases]. / Maladie de kaposi endemique a Dakar: etude de 29 cas.

INTRODUCTION: There is a lack of data on endemic Kaposi's sarcoma in sub-Saharan Africa. The goal of this study was to clarify its epidemiological, clinical and therapeutic aspects in that region. PATIENTS AND METHODS: A 7-years retrospective study, including all patients with endemic Kaposi's disease diagnosis was carried out. RESULTS: We identified 29 cases of endemic Kaposi's representing 1.2% of total hospitalizations and an incidence of 4.4. The mean age and the sex ratio were 63.2 years 2.22 respectively. The average delayed time to seek for medical care was 6.75 months. Cutaneous manifestations were dominated by angiomatous papulonodular lesions in 15 cases (51.72%) ulcerated lesions in 8 cases (27.58%), lymphedema in 5 cases (17.24%), a sarcomatous degeneration in 2 cases and verrucous papules in one case. Mucosal involvement was observed in 7 cases (24.13%). The extracutaneous lesions were noted in 18 cases, with 6 cases of bone, 5 cases of lymph nodes, 5 cases of gastrointestinal and 2 cases of lung involvement. The outcome was favorable for single-agent chemotherapy with bleomycin in more than half of the cases. Recurrences were observed in 2 patients, 2 cases were died and 7 cases never came back. CONCLUSION: Endemic Kaposi's disease is more frequent in elderly people with a higher frequency of extracutaneous involvement and florid forms.

INTRODUCTION: En Afrique sub-saharienne il existe peu de données concernant la maladie de kaposi endémique. L'objectif de ce travail, était de préciser ses aspects épidémiologiques, cliniques et thérapeutiques. MALADES ET MÉTHODES: Une étude rétrospective d'une durée de 7 ans, recensant tous les malades présentant une maladie de kaposi endémique. RÉSULTATS: Nous avions recensé 29 cas de maladie de kaposi endémique représentant 1,2% des hospitalisés soit une fréquence annuelle de 4,14 cas par an. La moyenne d'âge était de 63,2 ans et le sex-ratio de 2,22. Le délai moyen de consultation était de 6.75 mois. Les manifestations cutanées étaient dominées par les lésions papulo-nodulaires angiomateuses dans 15 cas (51,72%), de lésions ulcérées dans 8 cas (27,58 %), d'un lymphœdème dans 5 cas (17,24%), une dégénérescence sarcomateuse sans 2 cas et des papules verruqueuses dans un cas. Les localisations muqueuses étaient notées dans 7 cas (24,13%). Les atteintes extracutanées notées dans 18 cas, étaient osseuses dans 6 cas, ganglionnaires dans 5 cas, digestives dans 5 cas et pulmonaires dans 2 cas. L'évolution était favorable sous monochimiothérapie à la bléomycine dans plus de la moitié des cas. Les récidives étaient observées chez 2 malades, des perdus de vus dans 7cas et 2 cas de décès. CONCLUSION: La maladie de kaposi endémique prédomine chez les personnes âgées avec une fréquence élevée des atteintes extracutanées et des formes florides.

Dermatitis of the folds in black Africans in Bamako, Mali.

Dermatitis of the folds (intertrigo) is a frequent reason for attending consultations, particularly in Africa, where the hot and humid climate constitute an aggravating factor. It is a complex pathology with multiple and intricate etiologies. The aim of this study was to describe epidemiological and etiological aspects of dermatitis of the folds in black-skinned subjects in Bamako (Mali). We conducted a transversal descriptive survey of cases of localized dermatitis of the folds of the skin in dermatology clinics in Bamako. In total, 141 cases of intertrigo were identified: 96 female subjects (68%) and 45 male subjects. The average age of patients was 30 ± 18 years (2-80 years). The majority of patients were seen between March and June; 52% of patients had already received treatment before the consultation. The lesions affected skin folds of the groin area and/or area between the buttocks in 95 patients (57.4%), and folds of the armpits and area under the breasts were affected in 46 cases (42.6%). Eczema, erythrasma, and fungal disease were the most frequently observed pathologies. Of interest to this study is the topographical approach that a dermatologist must adopt when diagnosing certain forms of dermatitis. In populations with specific cultural practices, apart from a thorough knowledge of these specific factors, treatment of these conditions requires certain harmful attitudes and behaviors to be abandoned.

Pruritus in dermatological hospital in Bamako, Mali.

Pruritus is a symptom frequently encountered in dermatology consultations. For practitioners working in a tropical environment, particularly in Africa, the diagnosis of pruritus remains a constant problem. The aim of this study was to describe the epidemioclinical aspects and the etiologies of pruritus encountered at the dermatological hospital in Bamako. We conducted a prospective survey on a cohort of patients attending the Department of Dermatology at the Centre National d'Appui (CNAM-Ex Institut Marchoux) in the Fight against Disease over a 1-year period (June 1, 2009-May 31, 2010). Consequently, the study included every patient, whatever their age and gender, that agreed to take part in the survey and whose main reason for attending for a consultation was "pruritus." The clinical and biological data were entered and analyzed using Epi Info software, version 6.04 fr. A total of 232 patients (163 women, 69 men) attended because of pruritus out of 1761 overall patients (i.e., a prevalence of 13.17%). The mean age of the patients was 33 ± 19 years. Dermatological causes represented 95% of the etiologies. This work allowed us to observe the systemic causes of pruritus in the dermatological environment in Mali and greater likelihood of black women to attend because of pruritus.

[Etiology of acquired hypochromic patches in dermatological area in Mali]. / Etiologies Des Hypochromies Acquises En Milieu Dermatologique.

INTRODUCTION: In dark skin patients, hypopigmentation is the most disfiguring condition. Very few studies on hypochromic disorders have been conducted in specialized health centers. The present study is aimed to describe the etiologies of hypochromic patches in dermatological area, in Bamako. METHODS: We carried out a cross sectional study in the Dermatology Clinic of the "Centre National d'Appui à la lutte contre la Maladie (CNAM, Ex Institut Marchoux)". All acquired hypochromic patches (HP) were selected. HP was defined as a "skin patch lighter in pigmentation than normal surrounding skin with a diameter of at least 1 cm". The diagnosis was mainly based on clinical findings. RESULTS: The prevalence of HP was 3.42% and the main causes were seborrheic dermatitis (23.3%), pytiriasis alba (20.15%), vitiligo (18.9%), pityriasis versicolore (18.5%) and leprosy (12.6%). CONCLUSION: There are many causes of HP including leprosy, a disease though rare to date, but still prevalent in dermatological area.