Impact of the COVID ‐19 pandemic on patients with hidradenitis suppurativa

The COVID-19 pandemic caused collateral damage to patients with acute and chronic conditions. In this mono-centre cross-sectional study, we sought to evaluate the impact of the COVID-19 pandemic on patients with hidradenitis suppurativa (HS). In June 2020, we sent an anonymous survey to 109 patients, who were diagnosed with HS in our outpatient clinic from May 2018 to April 2020. Fifty patients (45.9%) completed and returned the survey. Forty-five participants (90.0%) denied any cancellation of hospitalisation due to the COVID-19 pandemic. Hospitalisation was postponed in 8% of cases and cancelled in 2%. Compared to prior to the pandemic, fewer patients consulted their primary physician for changing wound dressings and more changed the dressings themselves or were assisted by their family members. 13% of patients avoided doctor visits due to fear of COVID-19 and 26.1% minimised doctor visits. The Dermatology Life Quality Index showed a moderate to very severe impact on patients' Quality of Life (mean score = 10.06). Only one patient used telemedicine. Due to limited access to primary care and fear of COVID-19, the pandemic had a detectable impact on the hospital management of patients with HS in our facility. Telemedicine still plays a negligible role in primary wound care

Topische Therapie der Kopfhautschuppenflechte

Background: People with chronic plaque psoriasis often have lesions on the scalp that are difficult to treat. Our objective was to assess the efficacy and safety of topical treatments for scalp psoriasis. Methods: We searched the following databases up to August 2015: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, EMBASE and LILACS. We also searched five trial registers, screened abstracts of six psoriasis-specific conferences and checked the bibliography of included studies for further references to relevant randomised controlled trials (RCTs). Our quality of evidence assessment was based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group approach. We graded the quality of evidence for the following outcomes: 'clearance' or 'response' as assessed by the investigator global assessment (IGA) and 'response' according to the patient global assessment (PGA), improvement in quality of life, and the number of patients with adverse events (AE) requiring withdrawal of treatment. We expressed the results of the individual studies as risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes, and mean differences with 95% CI for continuous outcomes. If studies were sufficiently homogeneous, we metaanalysed the data by using the random-effects model. Results: We included 59 RCTs, with overall 11.561 participants. Most findings were limited to short-term treatments (< six months). Overall evidence was of moderate quality. According to the clinician and patients’ self-assessment a corticosteroid/vitamin D combination (e.g. betamethasone dipropionate plus calcipotriol) and corticosteroids of high and very high potency were more effective than vitamin D. The two-compound combination was superior to the corticosteroid alone, but the additional benefit was small. Reporting of quality of life data was insufficient to be included for meta-analyses and not feasible for quality of evidence assessment. The two-compound combination and corticosteroids caused fewer withdrawals due to AEs than vitamin D. There was no difference between the two-compound combination and corticosteroid monotherapy concerning this outcome. None of the studies stated which AE that caused withdrawal from treatment. However, the risk of withdrawing due to AEs was very small for all three therapies. Due to poor data evaluation of most other topical treatments was limited. Conclusion: Given the comparable safety profile and only slim benefit of the twocompound combination over the corticosteroid alone, monotherapy with generic topical corticosteroids of high and very high potency may be fully acceptable for short-term therapy. More quality of life data and long-term assessments are needed.Topische Therapie der Kopfhautschuppenflechte Hintergrund: Patienten mit Psoriasis vulgaris (Schuppenflechte) weisen häufig Herde im Bereich der Kopfhaut auf. Aufgrund der Behaarung sind die Herde mit topischen Präparaten schwierig zu behandeln. Diese systematische Übersichtsarbeit verglich topische Therapieformen der Kopfhautschuppenflechte im Hinblick auf Wirksamkeit und Verträglichkeit. Methodik: Die Literaturrecherche erfolgte bis August 2015 in folgenden Datenbanken: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, EMBASE und LILACS. Des Weiteren wurden fünf Studienregister, Abstracts sechs Psoriasis spezifischer Konferenzen, als auch die Referenzlisten eingeschlossener Studien untersucht. Es wurden ausschließlich randomisierte kontrollierte Studien eingeschlossen. Die Bewertung der Evidenzqualität erfolgte gemäß der Methodik der Grading of Recommendations Assessment, Development and Evaluation (GRADE) Arbeitsgruppe. Hierbei lag der Hauptfokus auf folgenden Outcomes: „clearance“ und „response“ gemäß des „investigator global assessment“ (IGA) und „response“ gemäß des „patient global assessment“ (PGA), Verbesserung der Lebensqualität, und die Anzahl der Patienten, die aufgrund von Nebenwirkungen die Behandlung unterbrechen mussten. Die Ergebnisse der jeweiligen Studien wurden als relatives Risiko mit 95% Konfidenzintervall (KI) für dichotome Outcomes und als Mittelwertdifferenz mit 95% KI für kontinuierliche Outcomes dargestellt. Ausreichend homogene Studien, wurden mittels Random-Effects-Model metaanalysiert. Ergebnisse: Insgesamt wurden 59 Studien mit 11561 Patienten eingeschlossen. Nahezu alle Ergebnisse beschränkten sich auf Kurzzeittherapien (kürzer als sechs Monate). Insgesamt war die Evidenzqualität moderat. Untersuchern und Patienten zufolge war das Kortikosteroid/Vitamin D Kombinationspräparat (z.B. Betamethasone Dipropionate plus Calcipotriol), als auch die Monotherapie mit einem Kortikosteroid von hoher und sehr hoher Potenz effektiver als Vitamin D. Das Kombinationspräparat zeigte bessere Ergebnisse als das entsprechende Kortikosteroid als Monotherapie, doch der Unterschied war gering. Daten zur Verbesserung der Lebensqualität wurden nur unzureichend berichtet und konnten keiner Metaanalyse unterzogen werden. Die Bewertung der Evidenzqualität war für dieses Outcome ebenfalls nicht möglich. Patienten mit Kombinationspräparat oder Kortikosteroid Monotherapie mussten seltener die Behandlung aufgrund von Nebenwirkungen abbrechen als mit Vitamin D. In Bezug auf Therapieabbrüche aufgrund von Nebenwirkungen unterschieden sich das Kombinationspräparat und das entsprechende Kortikosteroid als Monotherapie nicht. Keine der Studien berichtete welche Nebenwirkungen für einen Behandlungsabbruch verantwortlich waren. Insgesamt waren Behandlungsabbrüche jedoch sehr selten. Die Datenlage für andere topische Präparate war größtenteils ungenügend. Schlussfolgerung: In Anbetracht der ähnlich guten Verträglichkeit beider Präparate und des nur marginal effektiveren Kombinationspräparates, wäre die Monotherpie mit einem Kortikosteroid mit hoher oder sehr hoher Potenz für die Kurzzeitbehandlung der Kopfhautschuppenflechte ausreichend. Weitere randomisierte kontrollierte Studien zur Verbesserung der Lebensqualität, als auch zu Langzeittherapien sind allerdings notwendig um eine ausreichende Datenlage für erreichen

Patient‐dependent risk factors for wound infection after skin surgery: a systematic review and meta‐analysis

Postoperative wound infection in dermatologic surgery causes impaired wound healing, poor cosmetic outcome and increased morbidity. Patients with a high‐risk profile may benefit from perioperative antibiotic prophylaxis. The objective of this systematic review was to identify risk factors for surgical site infection after dermatologic surgery. In this article, we report findings on patient‐dependent risk factors. The literature search included MEDLINE, EMBASE, CENTRAL and trial registers. We performed meta‐analysis, if studies reported sufficient data to calculate risk ratios with 95% confidence intervals. Study quality was assessed according to the Newcastle‐Ottawa‐Scale. Seventeen observational studies that analysed 31213 surgical wounds were eligible for inclusion. Fourteen studies qualified for meta‐analysis. Nine studies showed good, three fair and five poor methodological quality. The reported incidence of surgical site infection ranged from 0.96% to 8.70%. Meta‐analysis yielded that male gender and immunosuppression were significantly associated with higher infection rates. There was a tendency towards a higher infection risk for patients with diabetes, without statistical significance. Meta‐analysis did not show different infection rates after excision of squamous cell carcinoma or basal cell carcinoma, but studies were substantially heterogenous. There was no significant association between risk for wound infection and smoking, age over 60 years, oral anti‐aggregation or anti‐coagulation or excision of malignant melanoma. In conclusion, the risk for surgical site infection in dermatologic surgery is low. Infection rates were increased significantly in male as well as immunosuppressed patients and non‐significantly in diabetics

Integrating Patient Data Into Skin Cancer Classification Using Convolutional Neural Networks: Systematic Review

BackgroundRecent years have been witnessing a substantial improvement in the accuracy of skin cancer classification using convolutional neural networks (CNNs). CNNs perform on par with or better than dermatologists with respect to the classification tasks of single images. However, in clinical practice, dermatologists also use other patient data beyond the visual aspects present in a digitized image, further increasing their diagnostic accuracy. Several pilot studies have recently investigated the effects of integrating different subtypes of patient data into CNN-based skin cancer classifiers. ObjectiveThis systematic review focuses on the current research investigating the impact of merging information from image features and patient data on the performance of CNN-based skin cancer image classification. This study aims to explore the potential in this field of research by evaluating the types of patient data used, the ways in which the nonimage data are encoded and merged with the image features, and the impact of the integration on the classifier performance. MethodsGoogle Scholar, PubMed, MEDLINE, and ScienceDirect were screened for peer-reviewed studies published in English that dealt with the integration of patient data within a CNN-based skin cancer classification. The search terms skin cancer classification, convolutional neural network(s), deep learning, lesions, melanoma, metadata, clinical information, and patient data were combined. ResultsA total of 11 publications fulfilled the inclusion criteria. All of them reported an overall improvement in different skin lesion classification tasks with patient data integration. The most commonly used patient data were age, sex, and lesion location. The patient data were mostly one-hot encoded. There were differences in the complexity that the encoded patient data were processed with regarding deep learning methods before and after fusing them with the image features for a combined classifier. ConclusionsThis study indicates the potential benefits of integrating patient data into CNN-based diagnostic algorithms. However, how exactly the individual patient data enhance classification performance, especially in the case of multiclass classification problems, is still unclear. Moreover, a substantial fraction of patient data used by dermatologists remains to be analyzed in the context of CNN-based skin cancer classification. Further exploratory analyses in this promising field may optimize patient data integration into CNN-based skin cancer diagnostics for patients’ benefits

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care