Impact of COVID-19 pandemic on acute dermatology referrals in a secondary and tertiary care Central London hospital. A retrospective comparison review of pre-COVID-19 era and COVID-19 pandemic.

BACKGROUND: Although Dermatology is largely considered an outpatient specialty, there is an increasing need for Dermatology input in the acute and inpatient setting. During the COVID-19 pandemic, Dermatology services had to be reorganized to facilitate staff redeployment and minimize the risk of exposure to COVID-19 for patients and staff. This led to an unprecedented increase in teleconsultations aided by clinical images. OBJECTIVES: The main aim of our retrospective study was to analyse the acute Dermatology referrals received in the pre-COVID-19 era and during COVID-19 pandemic. METHODS: We retrospectively analysed acute Dermatology referrals using the acute referral log. RESULTS: We retrospectively analysed 500 and 110 acute Dermatology referrals received in the pre-COVID-19 period and during COVID-19 pandemic, respectively. In the pre-COVID-19 era, consultations were most commonly requested by Oncology/Haemato-Oncology, Emergency Departments and General Practice, while during the COVID-19 pandemic General Practice was the most common source of referrals. A wide variety of dermatological conditions were encountered with the most common been eczematous dermatoses. CONCLUSIONS: Although Dermatology is largely an outpatient-based specialty, this study shows the demand for urgent Dermatology input the care of sick patients with severe skin diseases and in the management of skin problems in patients admitted or receiving treatment for other diseases. Re-organization of Dermatology services during the COVID-19 pandemic resulted in a marked increase in teleconsultations (28% versus 84.5%) and highlighted the importance of complete skin-directed physical examination by the referring clinician as well as procurement of good quality clinical images.

PPE-associated dermatoses: effect on work and wellbeing.

The COVID-19 pandemic has led to more stringent infection control practice within hospitals, with the added requirement of personal protective equipment (PPE). Consequentially, the incidence of PPE-related dermatoses in healthcare workers is increasing. Analysis of staff members seen in a dermatology self-referral service during the first COVID-19 peak revealed a wide range of healthcare professionals being affected, with irritant hand dermatitis and acneiform eruptions being the commonest diagnoses. These PPE-related dermatoses had significant effects on staff members' work and wellbeing, which improved following assessment and treatment by dermatology. Given the change to our behaviour wearing PPE daily, which is likely to continue for the foreseeable future, the consequences will inevitably affect both healthcare workers and the general public, with these common dermatoses presenting in both primary and secondary care. It is therefore imperative to recognise both the physical and emotional impact that COVID-19 PPE has, and initiate prompt treatment to improve wellbeing.

Structure, integrity, and function of the hypoplastic corpus callosum in spina bifida myelomeningocele.

Although there are many studies of people with complete or partial hypogenesis of the corpus callosum (CC), little is understood about the hypoplastic CC in which all structures are present but thinned. Spina bifida myelomeningocele (SBM) is a model organism for such studies because many have either a hypogenetic or hypoplastic CC. We used diffusion tensor tractography (DTT) to evaluate the hypoplastic CC in SBM and its relation to interhemispheric functions and intelligence quotient (IQ). Participants were individuals with SBM and an intact or hypoplastic CC (n=28), who were compared to a typically developing comparison group (n=32). Total and regional DTT volume and integrity measures (fractional anisotropy, axial diffusivity, and radial diffusivity) of the CC were related to measures of intelligence (IQ), bimanual motor functioning, and dichotic auditory performance. As predicted, DTT showed variations in volume and integrity that were maximized in the entire CC and the posterior CC. IQ correlated with entire CC volume, anterior and posterior regional CC volumes, and also with measures of integrity. Bimanual motor functioning correlated with the anterior and posterior volumes of the CC but not with any integrity measures. Axial diffusivity in the posterior CC was negatively correlated with right ear dichotic listening performance. The hypoplastic CC is not macrostructurally or microstructurally intact in SBM, even when it appears radiologically intact. Both volume and integrity of the posterior regions were related to reductions in IQ and to interhemispheric processing. These findings may transfer to other disorders characterized by a hypoplastic CC.