The Prevalence and Awareness of Regular Follow Up of Patients Treated with Phototherapy for Skin Cancer Surveillance.

Objective Background: Regular full-body skin examination is commonly ignored in patients post-phototherapy, despite ultraviolet (UV) radiation being carcinogenic. Our objectives are to assess the prevalence of regular follow-up and full-body skin examination for patients treated with phototherapy, as well as the relationship between phototherapy exposure and the development of skin cancer in Saudi Arabia. Methods Settings Design: This was a cross-sectional retrospective study conducted from January 2022 to July 2022. The study included 99 patients, selected via simple random sampling, from King Saud University Medical City, Riyadh, Saudi Arabia, who underwent phototherapy for at least 8 weeks and were followed for a minimum of 18 months post-treatment. Patients who met the inclusion criteria were called and given a questionnaire. Results: Out of 99 patients, only 26 (26.26%) underwent full-body skin examinations by their physicians after phototherapy treatment. The average follow-up time after phototherapy was 3.2 years. Most study participants (85.85%) were unaware that cancer was a possible complication of phototherapy. Participants with knowledge about skin cancer complications were more likely to have undergone a full-body exam (P = 0.001). None of the participants developed any type of skin cancer after phototherapy. Conclusion: Patients treated with phototherapy had no adequate information about the risk of skin cancer. The incidence of skin cancer was zero in our small cohort. Dermatologists in Saudi Arabia do not have an evidence-based notion regarding the risk of skin cancer among the Arab population after phototherapy. Since There is a lack of data examining the relationship between phototherapy and skin cancer in the Arab region, this study should trigger future studies with large populations and longer follow up periods.

The burden of viral infections in pediatric intensive care unit between endemic and pandemic coronavirus infections: A tertiary care center experience.

OBJECTIVES: To measure the prevalence of viral infections, length of stay (LOS), and outcome in children admitted to the pediatric intensive care unit (PICU) during the period preceding the COVID-19 pandemic in a MERS-CoV endemic country. METHODS: A retrospective chart review of children 0-14 years old admitted to PICU with a viral infection. RESULTS: Of 1736 patients, 164 patients (9.45%) had a positive viral infection. The annual prevalence trended downward over a three-year period, from 11.7% to 7.3%. The median PICU LOS was 11.6 days. Viral infections were responsible for 1904.4 (21.94%) PICU patient-days. Mechanical ventilation was used in 91.5% of patients, including noninvasive and invasive modes. Comorbidities were significantly associated with intubation (P-value = 0.025). Patients infected with multiple viruses had median pediatric index of mortality 2 (PIM 2) scores of 4, as compared to 1 for patients with single virus infections (p < 0.001), and a median PICU LOS of 12 days, compared to 4 in the single-virus group (p < 0.001). Overall, mortality associated with viral infections in PICU was 7 (4.3%). Patients with viral infections having multiple organ failure were significantly more likely to die in the PICU (p = 0.001). CONCLUSION: Viral infections are responsible for one-fifth of PICU patient-days, with a high demand for mechanical ventilation. Patients with multiple viral infections had longer LOS, and higher PIM 2 scores. The downward trend in the yearly rate of PICU admissions for viral infections between the end of the MERS-CoV outbreak and the start of the COVID-19 pandemic may suggest viral interference that warrants further investigations.

Monitoring the effect of TNF-alpha inhibitors on laboratory parameters and adverse effects in different diseases: a retrospective, single-center study.

BACKGROUND: The introduction of biological treatments has revolutionized the management of moderate-to-severe psoriasis. Multiple clinical trials have established the efficacy of biological agents in the treatment of moderate-to-severe psoriasis. Nevertheless, there are no clear indications for optimal monitoring intervals during treatment. OBJECTIVES: Collect and analyze laboratory evaluation data from patients receiving biological therapy to provide a better understanding of the need for laboratory investigations before and during treatment with biological agents, and to analyze adverse events and other factors. DESIGN: Retrospective cohort SETTINGS: Tertiary care center in Riyadh, Saudi Arabia. PATIENTS AND METHODS: Data were collected from the electronic medical records of patients attending the dermatology, rheumatology, and gastroenterology clinics from June 2014 to June 2019. The laboratory parameters of patients who have received one of the TNF-alpha inhibitors (adalimumab, etanercept, or infliximab) were collected starting at baseline and up to at least one year from treatment initiation. MAIN OUTCOME MEASURES: The time points at which patients developed significantly abnormal laboratory results during treatment with one of the TNF-alpha inhibitors. SAMPLE SIZE: 250 patients RESULTS: Most patients were treated with adalimumab (38.4%); a similar proportion (38%) with infliximab, whereas only 23.6% were treated with etanercept. The majority of the significant abnormal laboratory results occurred at baseline, 3-6 and 9-12 months. Most abnormalities were among patients using infliximab, followed by etanercept, and then adalimumab. The median number of laboratory abnormalities for dermatology patients was significantly lower than that for gastroenterology patients (P<.001), and for rheumatology patients (P=.002). CONCLUSIONS: Because dermatology patients showed a lower median number of laboratory abnormalities than patients treated by other specialties in our study, we believe that dermatology patients require less frequent laboratory monitoring. Therefore, we recommend laboratory evaluation at baseline, after 3-6 months, 1 year from the beginning of treatment, and annually thereafter for patients using TNF-alpha inhibitor agents. However, more frequent testing might be warranted according to patient comorbidities, concomitant medications, and physician judgment. LIMITATIONS: Single center and retrospective design. CONFLICT OF INTEREST: None.

Dermatology Patients' Knowledge of Sunscreen Guidelines at a University Hospital in Saudi Arabia.

Objective: The goal of this study is to assess the knowledge and attitude of dermatology patients regarding sunscreen use as recommended by the American Academy of Dermatology. Methods: This was an observational cross-sectional study at a university hospital in Riyadh. Participants were asked to complete a questionnaire to measure their knowledge and attitude regarding sunscreen use. Results were analyzed using a chi-square test. Results: Most participants heard about sunscreen (93.4%) and had indicated previous sunscreen use (72%). Sunscreen use was higher among women and participants with a postgraduate education. Sunscreen knowledge was higher among women, participants with non-photosensitive disorders, and participants with Fitzpatrick I, II, and III skin types. A total of 80% knew the worst time for sun exposure, but only 20.5% of the participants knew that sunscreen should be applied daily throughout the year, and 13.5% knew the correct minimum recommended SPF. A total of 34% were aware of the minimum time allowed for sunscreen application before sun exposure, and 20% were aware of the longest period allowed between reapplications. Only 4.5% knew the proper amount of sunscreen to cover the entire body. Conclusion: Our study revealed that most participants had heard of sunscreen, however their knowledge of the guidelines for sunscreen use was poor. Only 33% of the participants had received a recommendation for using sunscreen from their general practitioner or dermatologist. More comprehensive and directed efforts need to be made in counselling and educating these patients on proper sunscreen practice.

The Impact of the COVID-19 Pandemic on Medical Interns' Education, Training, and Mental Health: A Cross-Sectional Study.

Background and objectives The novel coronavirus disease 2019 (COVID-19) pandemic has challenged healthcare systems worldwide. Various studies have revealed the negative impact of the pandemic on the education and mental health of medical students and residents. In this study, we aimed to explore the effects of the COVID-19 pandemic on medical interns' educational experience, clinical practice, and mental health. We also engage in a discussion on the compensatory methods that have been adopted to improve medical interns' learning processes during the ongoing pandemic. Methods This cross-sectional survey-based study was conducted at the King Saud University Medical City (KSUMC) in Riyadh, Kingdom of Saudi Arabia (KSA) from March to October 2020. The participants consisted of medical interns. The survey collected information on participants' demographics, training, and the educational and psychological impact of the pandemic. Results The survey was distributed to 480 medical interns, of whom 345 (71.8%) participated. Most of our sample (75.6%) believed that the COVID-19 pandemic has negatively impacted their cumulative experience. Regarding the pandemic's impact on training and education, it was found that the emergency department rotation was the most affected rotation (60.3%). The majority of the participants (55.9%) believed that all tracks have received equal education and the volume of patients seen by interns decreased by 91.9%. As for the compensatory methods, 73.3% reported the utilization of remote platforms. Regarding the pandemic's mental health impact, 36% believed that it has affected their mental health, where increased stress levels were noticed in 47.8% of participants. Statistical significance was found in both Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) scores, which indicated that during the pandemic, 20.6% of the participants suffered from depression, and 13.9% had moderate to severe anxiety. Conclusions This study highlights the negative educational and psychological impact of COVID-19 on medical interns. With emerging infectious diseases on the rise, recognizing the impact of COVID-19 on medical interns is vital to improving interns' educational experiences and mental health during future crises.

Adalimumab Therapy in a Patient with Psoriasis, Down Syndrome, and Concomitant Hepatitis B Virus Infection.

Down syndrome is the most common chromosomal disorder and may present with a combination of dysmorphic features, congenital heart disease, and immunological deficiency. The association between Down syndrome and psoriasis is unclear. The prevalence of psoriasis in patients with Down syndrome ranges from 0.5% to 8%. The safety of biologics in the treatment of Down syndrome-related psoriasis is still debated. Down syndrome results in mild immunological abnormalities; consequently, the risk of infectious complications during immunosuppressive therapy might be higher in this group of patients. We report a case of a 33-year-old male, a case of chronic plaque psoriasis, Down syndrome (DS), asthma, and hepatitis B. The patient was started on Calcipotriene 0.005%-betamethasone 0.064% ointment, which failed to control the patient's psoriasis; thus, adalimumab was started. His response to adalimumab was significant, where over 70% improvement of the psoriatic lesions was seen.