A Comprehensive Analysis of Skin Cancer Concerns and Protective Practices in Manitoba, Canada, Highlights Lack of Skin Cancer Awareness and Predominance of High-Risk Sun Exposure Behaviors.

The rapidly increasing skin cancer rates in Canada are alarming, with current data estimating that 1/3 of Canadians will be affected in their lifetime. Thus, deeper understanding of high-risk sun exposure behaviors is needed to help counter this trend. Only limited action has been taken by federal/provincial governments to reduce skin cancer incidence. A cross-sectional survey study was conducted in Manitoba, with frequency counts, means, and percentages used to encapsulate responses. Age- and gender-adjusted odds ratios were calculated using logistic regression analyses. Our study identified worrying inadequacies in sun protective behaviors and attitudes, with the threat of such high-risk behaviors amplified by a lack of skin cancer awareness. Alarming elements were noted in participants' sun exposure history (>65% reported a history of sunburns, >50% previously used a tanning bed, and >75% recently tanned for pleasure), beliefs and attitudes (>50% believe that they look better/healthier with a tan, and >40% believe that having a base tan is protective against further sun damage), and sun protection efforts (sun protective clothing was used <60% of the time, sunscreen was used by <50%, and there was a lack of knowledge about sunscreen characteristics in ~30% of respondents), in addition to significant differences being established between demographic subgroups (based on gender, age, skin phototype, income, and education attained). This study provides worrisome insight onto the grim landscape of sun protective behaviors and attitudes in Manitoba, which will inevitably translate into higher skin cancer rates and should serve as a call to action to promote targeted public health messaging in this jurisdiction and beyond.

COVID-19 and Cancer Care: A Review and Practical Guide to Caring for Cancer Patients in the Era of COVID-19.

COVID-19, a novel infectious disease caused by the emergence of the SARS-CoV-2 virus in 2020, has had a profound impact on healthcare, both at the individual and population level. The impact at the population level was felt most acutely during the emergency phase of the pandemic, with hospital capacity issues leading to widespread disruptions and delays in the delivery of healthcare services such as screening programs and elective surgeries. While hospitals are no longer being acutely overwhelmed by COVID-19 patients, the impact of the virus on vulnerable patient populations such as cancer patients continues to be of ongoing consequence. Cancer patients remain at high risk of hospitalization, ICU admission, and death due to COVID-19, even in the era of vaccination. Infection prevention and risk mitigation strategies such air quality control, masking, testing, vaccination, and treatment should therefore be integrated into the usual care and counseling of cancer patients moving forward to avoid preventable morbidity and mortality from this infection and ensure the safety of this vulnerable cohort as they navigate their cancer diagnosis and treatment in the era of COVID-19.

Overcoming financial and social barriers during COVID-19: A medical student-led medical education innovation.

Background: Underrepresented minorities in medicine (URMM) may face financial and social limitations when applying to medical schools. The computer-based assessment for sampling personal characteristics (CASPER) test is used by many medical schools to assess the nonacademic competencies of applicants. Performance on CASPER can be enhanced by coaching and mentorship, which URMMs often lack, for affordability reasons, when applying to medical schools. Methods: The CASPER Preparation Program (CPP) is a free, online, 4-week program to help URMM prepare for the CASPER test. CPP features free medical ethics resources, homework and practice tests, and feedback from tutors. Two of CPPs major objectives include relieving URMM of financial burdens and increasing their accessibility to mentorship during the COVID-19 pandemic. A program evaluation was conducted using anonymous, voluntary postprogram questionnaires to assess CPPs efficacy in achieving the aforementioned objectives. Results: Sixty URMMs completed the survey. The majority of the respondents strongly agreed or agreed that CPP relieves students of financial burden (97%), is beneficial for applicants with low-socioeconomic statuses (98%), provides students with resources they could not afford (n = 55; 92%), and enables access to mentors during the pandemic (90%). Discussion: Pathway coaching programs, such as the CASPER Preparation Program, have the potential to offer URMMs mentorship and financial relief, and increase their confidence and familiarity with standardized admission tests to help them matriculate into medical schools.

A Retrospective Study of Complications of Enteral Feeding in Critically Ill Children on Noninvasive Ventilation.

The utilization of noninvasive ventilation (NIV) in pediatric intensive care units (PICUs), to support children with respiratory failure and avoid endotracheal intubation, has increased. Current guidelines recommend initiating enteral nutrition (EN) within the first 24-48 h post admission. This practice remains variable among PICUs due to perceptions of a lack of safety data and the potential increase in respiratory and gastric complications. The objective of this retrospective study was to evaluate the association between EN and development of extraintestinal complications in children 0-18 years of age on NIV for acute respiratory failure. Of 332 patients supported with NIV, 249 (75%) were enterally fed within the first 48 h of admission. Respiratory complications occurred in 132 (40%) of the total cohort and predominantly in non-enterally fed patients (60/83, 72% vs. 72/249, 29%; p < 0.01), and they occurred earlier during ICU admission (0 vs. 2 days; p < 0.01). The majority of complications were changes in the fraction of inspired oxygen (220/290, 76%). In the multivariate evaluation, children on bilevel positive airway pressure (BiPAP) (23/132, 17% vs. 96/200, 48%; odds ratio [OR] = 5.3; p < 0.01), receiving a higher fraction of inspired oxygen (FiO2) (0.42 vs. 0.35; OR = 6; p = 0.03), and with lower oxygen saturation (SpO2) (91% vs. 97%; OR = 0.8; p < 0.01) were more likely to develop a complication. Time to discharge from the intensive care unit (ICU) was longer for patients with complications (11 vs. 3 days; OR = 1.12; p < 0.01). The large majority of patients requiring NIV can be enterally fed without an increase in respiratory complications after an initial period of ICU stabilization.

Skin of Colour Dermatoses Self-Learning Module: Assessing Student Comprehension.

BACKGROUND: Dermatology for diverse skin types is a globally growing area of medicine, but the inclusion of skin of color dermatology has not yet been formally included across all Canadian undergraduate medical education curricula. There is also a paucity of representation of diverse skin types in most medical textbooks, research, and clinical trials. OBJECTIVES: The main objective was to develop a concise, Skin of Colour Dermatoses Self-Learning Module (SOCSLM) that could be implemented at an undergraduate medical education level. The secondary objective was to analyze participant responses to improve and add to learning module content. METHODS: From March to May 2022, second-year medical students at the University of Ottawa completed pre- and post-SOCSLM questionnaires which were available in French and English through their online student learning portals. The pre-test consisted of five multiple choice questions relating to images of dermatoses seen in diverse skin types. The post-test repeated the same five questions, rearranged, with an additional five new ones, and responses were analyzed. RESULTS: Twenty-five participants completed the surveys, and twenty responses were included. Percent correct answers increased between pre- and post-test, 51% vs 87%. In the post-test, questions repeated from the pre-test had a mean score of 95% while the new post-test questions had a mean score of 80%. Interest in dermatology did not have an impact on correct response rates. CONCLUSIONS: Skin of color dermatology self-learning modules may be an effective way to integrate skin of color dermatology into undergraduate medical curricula.

The CASPER preparation program innovation: increasing self-perceived competence and confidence of underrepresented applicants on the novel CASPER Snapshot and CanMEDS roles.

BACKGROUND: Underrepresented Minorities in Medicine (URMMs) may face financial and social limitations when matriculating into medical schools. Performance on situational judgment tests such as Computer-based Assessment for Sampling Personal Characteristics (CASPER) can be enhanced by coaching and mentorship. The CASPER Preparation Program (CPP) coaches URMMs to prepare for the CASPER test. During the coronavirus 2019 pandemic (COVID-19), CPP implemented novel curricula on the CASPER Snapshot and CanMEDS roles. METHODS: Pre and post-program questionnaires were completed by the students, which assessed their: 1) confidence in understanding the CanMEDS roles, and 2) perceived confidence in performing well and their familiarity and preparedness with the CASPER Snapshot. With a second post-program questionnaire, participants' scores on the CASPER test as well as medical school application outcome were also assessed. RESULTS: Participants reported a significant increase in the URMMs' knowledge, self-perceived competency to complete the CASPER Snapshot, and their anxiety significantly decreased. The level of confidence in understanding CanMEDS roles for a career in healthcare increased as well. The majority (91%) agreed that the feedback received from tutors was adequate and the virtual component of the program was beneficial during COVID-19. 51% of students scored in the highest quartile on the CASPER test and 35% received an offer of admission from CASPER-requiring medical schools. CONCLUSION: Pathway coaching programs have the potential to increase confidence and familiarity amongst URMMs for the CASPER tests and CanMEDS roles. Similar programs should be developed with the aim to increase the chances of URMMs matriculating into medical schools.

Vesiculobullous and Other Cutaneous Manifestations of COVID-19 Vaccines: a Scoping and Narrative Review.

As coronavirus disease (COVID-19) vaccines continue to be administered, dermatologists play a critical role in recognizing and treating the cutaneous manifestations (CM) associated with the vaccines. Adverse cutaneous reactions of COVID-19 vaccines reported in the literature range from common urticarial to rare vesiculobullous reactions. In this study, we performed a (1) scoping review to assess the occurrences of vesicular, papulovesicular, and bullous CMs of COVID-19 vaccines and their respective treatments, and (2) a narrative review discussing other common and uncommon CMs of COVID-19 vaccines. Thirty-six articles were included in the scoping review, and 66 articles in the narrative review. We found that vesicular, papulovesicular, and bullous lesions are infrequent, reported mostly after the first dose of Moderna or Pfizer vaccines. Eleven of the 36 studies reported vesicular reactions consistent with activation or reactivation of the herpes zoster virus. Most vesicular and bullous lesions were self-limited or treated with topical corticosteroids. Other CMs included injection-site, urticarial or morbilliform reactions, vasculitis, toxic epidermal necrolysis, and flaring of or new-onset skin diseases such as psoriasis. Treatments for CMs included topical or oral corticosteroids, antihistamines, or no treatment in self-limited cases. Although most CMs are benign and treatable, the data on the effect of systemic corticosteroids and immunosuppressive therapies on the immunogenicity of COVID-19 vaccines is limited. Some studies report reduced immunogenicity of the vaccines after high-dose corticosteroids use. Physicians may consult local guidelines where available when recommending COVID-19 vaccines to immunosuppressed patients, and when using corticosteroids to manage the CMs of COVID-19 vaccines.

A rare case of granuloma faciale presenting with ulceration: A case report.

Granuloma faciale is an uncommon inflammatory dermatosis characterized by persistent dermal plaques, typically on the face, that mimic granulomatous disorders like sarcoidosis. Ulceration of granuloma faciale has very rarely been reported, and the plaques are usually asymptomatic and of cosmetic impact. We present a case of an 83-year-old male with recurrent granuloma faciale with spontaneous ulceration and monoclonal gammopathy of undetermined significance. Intralesional triamcinolone, 10 mg/mL monthly for 5 months, with pimecrolimus cream twice daily resolved the ulceration and the lesion continues to flatten and lighten. Ulceration is rare and atypical in granuloma faciale lesions which can be treated.

Teledermatology Utilization and Integration in Residency Training Over the COVID-19 Pandemic.

BACKGROUND: During the 2019 Coronavirus (COVID-19) pandemic, the Division of Dermatology, University of Ottawa, adapted pre-existing local healthcare infrastructures to provide increased provider-to-provider teledermatology services as well as integrated teledermatology into the dermatology residency training program. OBJECTIVES: (1) To assess the differences in utilization of provider-to-provider teledermatology services before and during the COVID-19 pandemic; and (2) to assess dermatology resident and faculty experiences with the integration of teledermatology into dermatology residency training at the University of Ottawa. METHODS: We conducted a cross-sectional analysis comparing provider-to-provider teledermatology consults submitted to dermatologists from April 2019 to October 2019 pre-pandemic with the same period during the pandemic in 2020. Two different questionnaires were also disseminated to the dermatology residents and faculty at our institution inquiring about their perspectives on teledermatology, education, and practice. RESULTS: The number of dermatologists completing consults, the number of providers submitting a case to Dermatology, and the number of consults initiated all increased during the pandemic period. Ninety-one percent of residents agreed that eConsults and teledermatology enhanced their residency education, enabled continuation of training during the pandemic, and that eConsult-based training should be incorporated into the curriculum. Ninety-six percent of staff incorporated a virtual dermatology practice model, and one-third used teledermatology with residents during the pandemic. Most staff felt there was value in providing virtual visits in some capacity during the pandemic. CONCLUSIONS: Our study confirms that the use of teledermatology services continues to increase accessibility during the pandemic. Teledermatology enhances the education and training of residents and will be incorporated into dermatology residency programs.

A Survey of Topical Cannabis Use in Canada.

BACKGROUND: Since its legalization in Canada, cannabis use has expanded to include commercially available topical formations. Several scientifically unsupported claims regarding the therapeutic efficacy of topical cannabis are also being made. Developing an understanding of the consumer uses of topical cannabis is important for clinicians to provide appropriate counseling and inform potential areas of therapeutic development. We are examining the prevalence, purpose of use, and sources of information regarding topical cannabis in the Canadian population, with a focus on dermatologic uses. METHOD: A cross-sectional, anonymous electronic, voluntary survey was developed to assess the use of topical cannabis amongst adults in Canada. RESULTS: Cannabis was used topically at least once by 24.3% of respondents who started the survey. The commonest form of topical cannabis were creams (26.2%). The most common dermatologic conditions being treated with topical cannabis included atopic dermatitis (25%), acne (19%), and anti-aging (16%); for non-dermatologic conditions, common uses were for joint stiffness or tendonitis (30%) and headaches and migraines (27%). Topical cannabis was reported to be most effective for joint stiffness and tendonitis, general muscular soreness, headaches, eczema, pruritus, acne, and psoriasis. Most respondents obtained and received information about topical cannabis from dispensaries. CONCLUSION: Canadians use topical cannabis for a broad range of systemic and dermatologic purposes, most of which have limited evidence. Future clinical studies are required to elucidate the therapeutic efficacy and safety of topical cannabis. Dermatologists should screen their patients for topical cannabis use and be aware of the limited evidence of therapeutic potential.

A Review of the Efficacy and Safety for Biologic Agents Targeting IL-23 in Treating Psoriasis With the Focus on Tildrakizumab.

Psoriasis is a chronic and debilitating inflammatory immune-mediated skin disorder. Several cytokines including interleukin (IL)-23 were demonstrated to play a central role in the pathogenesis of this disease. Treatment options for psoriasis range from topical to systemic modalities, depending on the extent, anatomical locations involved and functional impairment level. Targeting cytokines or their cognate receptors that are involved in disease pathogenesis such as IL-12/23 (i.e., targeting the IL-12p40 subunit shared by these cytokines), IL-17A, IL-17F, IL-17RA, and TNF-α using biologic agents emerged in recent years as a highly effective therapeutic option for patients with moderate-to-severe disease. This review provides an overview of the important role of IL-23 signaling in the pathogenesis of psoriasis. We describe in detail the available IL-23 inhibitors for chronic plaque psoriasis. The efficacy, pharmacokinetic properties, and the safety profile of one of the most recent IL-23 biologic agents (tildrakizumab) are evaluated and reviewed in depth.

Recalcitrant lymphocytoma cutis successfully treated with mycophenolate mofetil.

Lymphocytoma cutis reflects an exaggerated local immunologic reaction to a stimulus presenting on the head, neck, or upper extremities as a firm 1-3 cm erythematous and/or violaceous plaque or nodule. However, lymphocytoma cutis may be difficult to treat due to the variety of causative agents and the lack of reported successful treatments and outcomes. Here, we present a case of 68-year-old female with recalcitrant lymphocytoma cutis resistant to other first-line therapies including tacrolimus ointment and steroids. The red plaque on the patient's left cheek was eventually treated with mycophenolate mofetil. Mycophenolate mofetil was an accessible and effective therapeutic option to treat lymphocytoma cutis with minimal side effects.

Pharmacologic Treatment of Idiopathic Chilblains (Pernio): A Systematic Review.

Idiopathic chilblains is a cold-induced inflammatory condition that causes significant morbidity. When preventative measures alone are inadequate, oral nifedipine is generally recommended as first-line pharmacologic therapy. Given the natural course of this spontaneously remitting/relapsing condition, controls are needed to critically appraise studies and determine the value of treatments. We report a systematic review of placebo-controlled or comparative therapeutic trials for the treatment of idiopathic chilblains. Our search of PubMed, Embase, and Cochrane databases, identified 11 studies that met our inclusion criteria for a combined study population n = 576. Therapies included nifedipine, pentoxifylline, tadalafil, topical glyceryl trinitrate (GTN), topical minoxidil, diltiazem, corticosteroids, and vitamin D. There was moderate evidence to support the use of nifedipine and pentoxifylline in the treatment of severe or refractory cases of idiopathic chilblains, while other therapies had inadequate evidence or nonsignificant results compared to placebo.

Bridging the gap: improving CASPer test confidence and competency for underrepresented minorities in medicine through interactive peer-assisted learning.

BACKGROUND: The Computer-based Assessment for Sampling Personal Characteristics (CASPer) is a situational judgement test (SJT) adopted by medical schools to assess applicants' interpersonal skills. CASPer applicants must compose their responses to ethical dilemmas, thereby highlighting the applicant's rationale for ethical decision-making. Minority applicants usually lack access to a network of individuals who can offer guidance and expertise on ethical decision-making. As such, this study investigated the impact of a CASPer coaching program designed for minority applicants. METHODS: A free online intervention was designed to help minority applicants prepare for the CASPer test. The program consisted of 35 learners and three medical student tutors. Important attributes of the 4-week program included free access to a medical ethics book, feedback provision to in-class and homework student responses, and facilitation of a mock CASPer. Course feedback was collected. Additionally, a pre and post-program survey was administered to assess learners' competence and confidence surrounding CASPer test-taking. RESULTS: Our pre and post-program survey showed significant student improvement in familiarity with the test, increased competence, confidence and preparedness, as well as reduced anxiety (p < 0.05). CONCLUSIONS: Through peer-to-peer teaching and access to medical student mentors, our program addresses socioeconomic barriers that several minority applicants face when applying to medical school.

CONTEXTE: L'évaluation informatisée des caractéristiques personnelles (CASPer) est un test de jugement situationnel (TJS) adopté par les facultés de médecine pour évaluer les compétences interpersonnelles des candidats à l'admission. Les candidats à l'examen CASPer sont invités à répondre à des dilemmes éthiques pour montrer leur raisonnement dans la prise de décisions éthiques. Les candidats issus de minorités n'ont souvent pas accès à des personnes qui peuvent leur offrir des conseils et une expertise en matière de prise de décision éthique. La présente étude examine l'impact d'un programme de soutien du CASPer conçu pour les candidats issus des minorités. MÉTHODES: Un programme d'assistance gratuite en ligne d'une durée de quatre semaines a été conçu pour aider les candidats issus de minorités à se préparer à l'examen CASPer. L'encadrement était offert à 35 apprenants par trois tuteurs étudiants en médecine. Les principales caractéristiques du programme comprenaient l'accès sans frais à un manuel d'éthique médicale, un retour sur les réponses en classe et sur les devoirs, et l'animation d'un examen CASPer simulé. Nous avons recueilli les réactions des apprenants au programme et nous avons réalisé un sondage avant et après le programme pour évaluer les compétences et la confiance des étudiants en ce qui concerne l'examen CASPer. RÉSULTATS: Le sondage a montré qu'après le programme, les candidats avaient une bien meilleure connaissance du test, que leurs compétences, leur confiance et leur préparation s'étaient améliorées, et que leur niveau d'anxiété avait baissé (p < 0,05). CONCLUSIONS: Grâce au recours à l'apprentissage entre pairs et au mentorat par des étudiants en médecine, notre programme s'attaque aux obstacles socio-économiques que les candidats qui sont issus de minorités rencontrent dans le processus d'admission dans les facultés de médecine.

Can it make me white again? A case report of 88% phenol as a depigmenting agent in vitiligo.

Vitiligo is the most common depigmenting disorder. However, therapies prove to be time-consuming, costly, or slow to show efficacy. Here, we present a case of a 74-year-old female with vitiligo who underwent full-body depigmentation treatment 50 years ago. Brown patches of repigmentation appeared on the patient's face and arms and were eventually treated with 88% phenol. Patient was later switched to compounded 3% glutathione cream for a more sustained effect. Phenol was an accessible, economical, and easily administrable therapeutic option that can result in short-term depigmentation.