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Inflammatory markers such as neutrophil-lymphocyte ratio (NLR) and eosinophil count are known prognostic indicators for SJS/TEN severity. This study explored the correlation of systemic immune-inflammatory index (SII), platelet-lymphocyte ratio (PLR) and NLR with SCORTEN and patient outcomes. A retrospective audit of 34 SJS/TEN patients (25 SJS, 3 SJS/TEN overlap, 6 TEN) was conducted from 2018 to 2022 revealed mean admission values of SII 1597 (standard deviation (SD) 1904.18), NLR 6.52 (SD 5.99) and PLR 201.74 (SD 135.01). Cut-off values for predicting mortality were SII 1238.25 (area under ROC (AUROC) 0.82), NLR 8.32 (AUROC 0.8) and PLR 284.66 (AUROC 0.78). Multiple logistic regression using a backward stepwise method identified SCORTEN as a significant factor associated with mortality (p=0.029) after adjusting for SII, NLR and PLR. None of the inflammatory markers significantly predicted mortality, although admission PLR may be a potential risk factor (p=0.053).
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Patients with chronic spontaneous urticaria (CSU) have an increased risk of psychological distress. This cross-sectional study aimed to determine factors associated with psychological burden, quality of life (QoL) and patient satisfaction among adults living with CSU. Participants completed the self-administered Urticaria Activity Score-7 (UAS-7), Depression Anxiety Stress Scale (DASS 21), Dermatology Life Quality Index (DLQI), and Short Assessment Patient Satisfaction (SAPS) questionnaires. Multivariate logistic regression was used to determine the independent predictors of depression, anxiety, stress, QoL and patient satisfaction. From a total of 115 subjects with a median age of 42.6 years, range (19-89 years). 60.9% subjects reported moderate-to-severe CSU, 26.1% reported symptoms of depression, 54.8% had anxiety, 40.0% had stress, and 36.5% reported severely impaired QoL. The median UAS-7 score was 20 (IQR 11-27) while the median score of DLQI was 8 (IQR 4-13). The median score of SAPS was 20 (IQR 17-21). Low-income and severe disease were the significant predictors for depression while severe disease was predictive of impaired QoL and depression. Subjects who were diagnosed at older ages and those who required medical leave due to flares of CSU were less likely to be satisfied with their care. (192 words).
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Urticária Crônica , Satisfação do Paciente , Humanos , Adulto , Adulto Jovem , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Qualidade de Vida , Bem-Estar Psicológico , Estudos TransversaisRESUMO
BACKGROUND: Airline pilots face significant ultraviolet radiation exposure resulting in an increased risk of sun damage and skin cancers. We aimed to evaluate sun-protective practices and associated factors among airline pilots. METHODS: We disseminated an online questionnaire evaluating the use of sunscreen, sunglasses, hats and protective clothing during daytime hours in the cockpit and during outdoor activities to 346 global commercial airline pilots, and we received 220 completed responses. The Pearson chi-squared test or Fisher's exact test where necessary were used to determine possible factors associated with the use of sun-protective practices. Potential confounders were adjusted for using multivariate analyses. RESULTS: The most common sun protective behaviour was the wearing of sunglasses during daytime flights (89.5%), followed by the use of caps during outdoor activities (47.7%). More pilots applied sunscreen during daytime flights (14.1%) compared with walk-arounds (8.2%). Males were less likely to use sunscreen during flights (adjusted odds ratio, aOR = 0.76), use sunscreen for walk-arounds (aOR = 0.175) and wear long sleeves (aOR = 0.013). Pilots who flew less than 30 h a month in high latitude regions were less likely to use a cap or hat outdoors (aOR = 0.419) or use sunscreen during walk-arounds (aOR = 0.241). Younger pilots were also less likely to use caps or hats outdoors (aOR = 0.446). CONCLUSION: Male pilots and those who spent less time in high latitudes were less likely to practice sun protection. Targeted educational efforts may be implemented to reduce occupational ultraviolet exposure.
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Pilotos , Neoplasias Cutâneas , Queimadura Solar , Humanos , Masculino , Protetores Solares/uso terapêutico , Raios Ultravioleta/efeitos adversos , Roupa de Proteção , Neoplasias Cutâneas/prevenção & controle , Neoplasias Cutâneas/tratamento farmacológico , Queimadura Solar/prevenção & controleRESUMO
INTRODUCTION: The majority of patients with Human Immunodeficiency Virus (HIV) will have cutaneous manifestation during their disease course. We report the spectrum of cutaneous manifestations and clinicopathological concordance in the diagnosis of skin diseases in patients with HIV. METHODS: A retrospective review of all cutaneous manifestations of HIV-infected patients with skin biopsy-proven histopathological confirmation, treated in the University of Malaya Medical Centre, from 2016 till 2018, was performed. Clinical characteristics and histopathological correlation of these patients were reviewed. RESULTS: A total of 38 cases were included where the median age was 40.5 (interquartile range (IQR) 13.3). The median duration of HIV diagnosis to the development of skin disease was 3 years (IQR 7.8). Majority of our patients were male (89.5%, n = 34), and the commonest mode of transmission is men who have sex with men (36.8%, n = 14). Most patients (92.1%, n = 35) had Acquired Immunodeficiency Syndrome when they presented with skin diseases, predominantly non-infectious types (51.4%, n = 19). Commonest skin diseases include eczema (n = 7) and pruritic papular eruption of HIV (n = 6). Papules and plaques were the commonest morphology for both infectious and non-infectious skin diseases. Duration of HIV diagnosis (P = 0.018) and non-compliance to Highly Active Antiretroviral Therapy (HAART) (P = 0.014) were significantly associated with the development of non-infectious skin diseases. Overall, clinicopathological concordance was 84.2% in our centre. CONCLUSION: A wide spectrum of cutaneous diseases can occur in HIV patients depending on the degree of immunosuppression. skin biopsy along with appropriate stains, and microbiological cultures are important in helping clinicians clinch the right diagnosis.
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Infecções Oportunistas Relacionadas com a AIDS/complicações , Síndrome da Imunodeficiência Adquirida/complicações , Índice de Gravidade de Doença , Dermatopatias Infecciosas/patologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/patologia , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/imunologia , Adulto , Terapia Antirretroviral de Alta Atividade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Dermatopatias Infecciosas/etiologia , Centros de Atenção TerciáriaRESUMO
PURPOSE: To evaluate ocular surface changes among patients with psoriasis in Malaysia, a developing country in Southeast Asia. METHODS: An interdisciplinary case-control study (60 psoriasis patients and 40 control subjects) to look at the differences in ocular surface manifestations between patients with psoriasis and a group of age-, gender- and ethnicity-matched healthy controls. RESULTS: One hundred and twenty eyes of 60 patients with psoriasis and 80 eyes of 40 healthy controls without psoriasis were included in the study. Mild-to-moderate psoriasis was found in 42 patients (70%), while 18 patients (30%) had severe psoriasis. Psoriatic arthritis was found in 19 patients (32%). Of the 60 psoriatic patients, the prevalence of ocular involvement was 65% (39/60), in which 32% (19/60) had dry eyes, 27% (16/60) had lid margin abnormalities, 33% (20/60) had cataract, and one had history of anterior uveitis. Compared to controls, ocular surface of psoriatic patients showed more eyelid margin abnormalities, higher meibomian gland loss and lower tear film break-up time. The estimated odds ratio for dry eyes in the psoriasis group was 2.2 (95% CI: 0.8-6.9). CONCLUSION: Ocular surface disorders encompassing eyelid margin abnormalities, meibomian gland loss and tear dysfunction occur at an earlier and higher rate among psoriatic patients.
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Síndromes do Olho Seco , Doenças Palpebrais , Estudos de Casos e Controles , Países em Desenvolvimento , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/epidemiologia , Síndromes do Olho Seco/etiologia , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/epidemiologia , Humanos , Glândulas Tarsais , LágrimasRESUMO
BACKGROUND: The ageing skin is more susceptible to pruritic dermatoses, which are associated with adverse psychosocial effects and reduced quality of life among older adults. This cross-sectional study aimed to identify the burden of pruritus and factors associated with its presence and severity among older adults recruited to the Malaysian Elders Longitudinal Research study. METHODS: Seven hundred seventy individuals aged 55 years (lower age limit) and above were interviewed as to whether they experienced pruritus during the preceding week and the locations involved if present. The association between generalised pruritus, sleep quality, and major systemic risk factors were explored. RESULTS: 5.97% of respondents reported generalised pruritus. Generalised pruritus was associated with poorer sleep quality, with Pittsburgh Sleep Quality Index score above 6. Mean haemoglobin level was lower in subjects with generalised pruritus (13.14 g/dL) but there was no significant difference in the frequency of generalised pruritus and severe generalized pruritus between subjects with clinically defined anaemia. Also, there were no significant associations between other major systemic risk factors and generalised pruritus in this population-based study. There was no association between generalised pruritus with depression, anxiety or stress. CONCLUSION: The negative effect of pruritus on sleep quality suggests a possible deleterious effect of pruritus on health and quality of life. Further prospective research on the longer-term effects of pruritus on health status is now warranted. (222 words).
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Vida Independente , Qualidade de Vida , Idoso , Estudos Transversais , Humanos , Malásia/epidemiologia , Prurido/diagnóstico , Prurido/epidemiologia , AutorrelatoRESUMO
There has been a rising incidence of skin cancers among Asians in recent years. We present a retrospective analysis of 106 skin cancers and analysed the demography, clinical subtypes of skin cancers and surgical techniques used for skin cancer treatment. In our population, skin cancers were most frequently basal cell carcinomas and diagnosed among ethnic Chinese patients.
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Neoplasias Cutâneas/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Etnicidade/estatística & dados numéricos , Feminino , Humanos , Linfoma Cutâneo de Células T/epidemiologia , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Doença de Paget Extramamária/epidemiologia , Estudos Retrospectivos , Sarcoma de Kaposi/epidemiologia , Distribuição por Sexo , População UrbanaRESUMO
BACKGROUND: Increasing incidence of dengue cases in Malaysia over the last few years has been paralleled by increased deaths. Mortality prediction models will therefore be useful in clinical management. The aim of this study is to identify factors at diagnosis of severe dengue that predicts mortality and assess predictive models based on these identified factors. METHOD: This is a retrospective cohort study of confirmed severe dengue patients that were admitted in 2014 to Hospital Kuala Lumpur. Data on baseline characteristics, clinical parameters, and laboratory findings at diagnosis of severe dengue were collected. The outcome of interest is death among patients diagnosed with severe dengue. RESULTS: There were 199 patients with severe dengue included in the study. Multivariate analysis found lethargy, OR 3.84 (95% CI 1.23-12.03); bleeding, OR 8.88 (95% CI 2.91-27.15); pulse rate, OR 1.04 (95% CI 1.01-1.07); serum bicarbonate, OR 0.79 (95% CI 0.70-0.89) and serum lactate OR 1.27 (95% CI 1.09-1.47), to be statistically significant predictors of death. The regression equation to our model with the highest AUROC, 83.5 (95% CI 72.4-94.6), is: Log odds of death amongst severe dengue cases = - 1.021 - 0.220(Serum bicarbonate) + 0.001(ALT) + 0.067(Age) - 0.190(Gender). CONCLUSION: This study showed that a large proportion of severe dengue occurred early, whilst patients were still febrile. The best prediction model to predict death at recognition of severe dengue is a model that incorporates serum bicarbonate and ALT levels.
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Dengue Grave/mortalidade , Adulto , Alanina Transaminase/sangue , Área Sob a Curva , Bicarbonatos/sangue , Creatinina/sangue , Feminino , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Curva ROC , Estudos Retrospectivos , Dengue Grave/diagnóstico , Taxa de Sobrevida , Adulto JovemRESUMO
BACKGROUND: Existing biomarkers such as AST, ALT and hematocrit have been associated with severe dengue but evidence are mixed. Recently, interests in creatine kinase as a dengue biomarker have risen. These biomarkers represent several underlying pathophysiological processes in dengue. Hence, we aimed to assess AST, ALT, CK and hematocrit in identification of severe dengue and to assess the correlational relationship amongst common biomarkers of dengue. METHODS: This was a retrospective cohort study of confirmed dengue patients who were warded in Kuala Lumpur Hospital between December 2014 and January 2015. CK, AST, ALT, hematocrit, platelet count, WBC and serum albumin were taken upon ward admission and repeated at timed intervals. Composite indices based on admission AST and ALT were analyzed. Correlation coefficients and coefficients of determination were computed. RESULTS: Among the 365 cases reviewed, twenty-two (6%) patients had severe dengue. AST and ALT were found to be good at identification of severe dengue. The AST2/ALT composite index was the most accurate (AUC 0.83; 95% CI 0.73 - 0.93). Optimal cutoff was 402 with a sensitivity of 59.1% (95% CI: 36.4 - 79.3%) and specificity of 92.4% (95% CI: 89.1 - 95.0%). Modified cutoff of 653 had a sensitivity of 40.9% (95% CI: 20.7 - 63.7%) and specificity of 97.4% (95% CI: 95.1 - 98.8%). Our analyses also suggested that several underlying biological processes represented by biomarkers tested were unrelated despite occurring in the same disease entity. Also, markers of plasma leakage were discordant and AST was likely hepatic in origin. CONCLUSIONS: The composite index AST2/ALT may be used as a marker for identification of severe dengue based on admission AST and ALT, with two choices of cutoff values, 402 and 653. AST is most likely of liver origin and CK does not provide additional value.
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Fígado/enzimologia , Dengue Grave/diagnóstico , Dengue Grave/enzimologia , Adulto , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Creatina Quinase/sangue , Dengue/diagnóstico , Dengue/enzimologia , Feminino , Humanos , Masculino , Contagem de Plaquetas , Estudos Retrospectivos , Sensibilidade e Especificidade , Albumina Sérica/análiseRESUMO
In dermoscopic images, which allow visualization of surface skin structures not visible to the naked eye, lesion shape offers vital insights into skin diseases. In clinically practiced methods, asymmetric lesion shape is one of the criteria for diagnosing Melanoma. Initially, we labeled data for a non-annotated dataset with symmetrical information based on clinical assessments. Subsequently, we propose a supporting technique-a supervised learning image processing algorithm-to analyze the geometrical pattern of lesion shape, aiding non-experts in understanding the criteria of an asymmetric lesion. We then utilize a pre-trained convolutional neural network (CNN) to extract shape, color, and texture features from dermoscopic images for training a multiclass support vector machine (SVM) classifier, outperforming state-of-the-art methods from the literature. In the geometry-based experiment, we achieved a 99.00 % detection rate for dermatological asymmetric lesions. In the CNN-based experiment, the best performance is found 94 % Kappa Score, 95 % Macro F1-score, and 97 % weighted F1-score for classifying lesion shapes (Asymmetric, Half-Symmetric, and Symmetric).
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Melanoma , Redes Neurais de Computação , Neoplasias Cutâneas , Máquina de Vetores de Suporte , Humanos , Melanoma/diagnóstico por imagem , Melanoma/patologia , Melanoma/classificação , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/classificação , Dermoscopia/métodos , Interpretação de Imagem Assistida por Computador/métodos , Algoritmos , Pele/diagnóstico por imagem , Pele/patologiaRESUMO
OBJECTIVE: We aimed to analyze the clinical characteristics of patients with psoriasis and determine the predictive factors of psoriatic arthritis (PsA). METHODS: This retrospective cohort study was performed among patients with psoriasis. Demographic and clinical data were collected. Psoriasis treatment was categorized as topical agents, phototherapy, oral therapy, and biologics. Predictive factors of PsA development were determined using logistic regression analyses. RESULTS: We included 330 patients with psoriasis, and 83 (25%) patients developed PsA. Thirty-eight (45.8%) patients who developed PsA were Malay, 24 (28.9%) were Chinese, and 21 (25.3%) were Indian. The mean age of patients with PsA was 54.2 (±15.8) years, and the duration from diagnosis of psoriasis to diagnosis of PsA was 36 (3.5-114) months. Predictive factors for developing PsA were female sex (odds ratio [OR] = 3.33, 95% confidence interval [CI] 1.78-6.22), presence of nail involvement (OR = 5.36, 95% CI 2.50-11.51), severe psoriasis (OR = 27.41, 95% CI 7.58-99.11), and oral systemic therapy prior to PsA diagnosis (OR = 4.09, 95% CI 2.04-8.22). CONCLUSION: Patients with psoriasis who are female, have nail involvement, severe skin psoriasis, and require oral systemic therapy for psoriasis may have an increased risk of developing PsA.
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Artrite Psoriásica , Psoríase , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Masculino , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/tratamento farmacológico , Artrite Psoriásica/epidemiologia , Estudos Retrospectivos , Psoríase/complicações , Psoríase/diagnóstico , Psoríase/epidemiologia , Pele , Povo AsiáticoRESUMO
Skin disorders among individuals receiving palliative care may be associated with the primary condition or underlying comorbidities and patients may experience pruritus, discomfort or pain. Common conditions include xerosis, pressure ulcers, intertrigo, superficial fungal infections, telogen effluvium, pruritus, herpes zoster, eczematous disorders and edema. During end-of-life care, there is reduced skin perfusion and metabolism hence leading to susceptibility to infection, pressure and injury. Other factors affecting the skin include limited mobility, nutritional deficits and immunosuppression. Although treatment strategies for each skin condition are usually aligned with standard protocols, considerations among these patients include limited life-expectancies, potential treatment burden, drug-drug interactions as well as comfort-directed rather than cure-directed therapy. For patients with xerosis cutis, the regular use of moisturisers is recommended. The management and prevention of pressure ulcers include the strategies of skin assessment and care, pressure redistribution, nutrition and hydration and ulcer care. Superficial fungal infections require treatment with appropriate topical and/or systemic antifungals while antivirals and adjunctive treatment can be prescribed for herpes zoster. Treatment and symptom control of skin disorders in this population can improve quality of life and patients' comfort level.