Procedural dermatology and its unmet need.

Procedural dermatology includes invasive conventional dermatologic surgeries which involve significant use of knife and suture, minimally invasive procedures and device-based procedures. Device-based procedures are the easiest to learn and are less prone to human errors due to automation but can lead to monotony, while conventional surgeries require significant skill, craftsmanship and interest. There has been a recent shift in the approach to procedural dermatology as a therapeutic option with complementary and combination models replacing the conventional hierarchical model in which procedures were last in the step-ladder approach. The demand for both conventional dermatologic surgeries and minimally invasive cosmetic procedures is increasing. Unfortunately, this demand has not been met with adequate supply. Consequently, the number of trained professionals with expertise in these procedures is very limited; they are far outnumbered by unqualified practitioners. A limited number of dermatologic surgeons practicing conventional surgeries has resulted in huge waiting lists for vitiligo surgeries, inappropriate excisions for skin cancers and poor cosmetic outcomes of excisions without proper knowledge of flaps and grafts. Increasingly procedures are being performed by inadequately trained personnel, resulting in complications. There is also an absence of good quality research on the subject of procedural dermatology, which has resulted in a lack of standardisation of various procedures and knowledge about the efficacy of various drug-procedure and procedure-procedure combinations. An increasing variety of gimmicky but costly procedures are being offered to the public without much evidence of efficacy. Individual institutional and broad policy directives are needed to address these issues. Special emphasis is required on formal hands-on procedural dermatology training during residency and beyond it.

Impact of SARS-CoV-2 pandemic on dermatology residents: A nationwide French study.

Background Coronavirus disease 2019 (COVID-19) has changed the practice of all health-care professionals. Determining the impact could prevent repercussions in future crisis. Objectives The objectives of the study were to assess the impact of the COVID-19 pandemic on dermatology residents' professional practice, working conditions, academic training and mental health. Methods An online questionnaire was sent to all French dermatology residents. We compared the activity of residents working in areas heavily impacted by COVID-19 to others. Logistic multivariate regressions were done, using as outcome variables the negative impact of the COVID crisis on residents' possibility to practice dermatology during the crisis, supervision, academic training and working more than 50 h/week. The last part of the questionnaire was the burnout questionnaire of Maslach. Results A total of 246 residents filled the questionnaire. Residents working in highly impacted COVID areas (odds ratio, OR 0.34 confidence interval, CI [0.18, 0.61], P ≤ 0.001), first-year postgraduate (PGY-1) residents (OR 0.46 CI [0.23, 0.91], P = 0.023) and those in private practice (OR 0.10 CI [0.01, 0.57], P = 0.032) were significantly less able to maintain dermatology activities. Worse supervision was significantly more frequent with non-PGY-1 residents (OR 3.24 CI [1.65, 6.65], P < 0.001). One hundred and eighty one residents claimed the pandemic to have a negative effect on their dermatology curriculum with no difference according to their regions' affection by COVID-19. This was mostly attributed to the cancelation of courses and congresses. PGY-1 residents (OR 2.09 CI [1.09, 4.04], P = 0.029) and residents in highly affected areas (OR 1.79 CI [1.01, 3.18], P = 0.049) were more at risk of working above the maximal legal working time. None of the residents was free of burnout symptoms. Conclusion Dermatology residents have been highly affected by COVID-19. It might be important to have a more integrated healthcare system to fight times of crisis with the least repercussions on residents.

Informe de rotación electiva: Coordinación de Tuberculosis y Lepra. Dirección de Respuesta al VIH, ITS, HV y TB. Ministerio de Salud de la Nación

El presente informe da cuenta de los objetivos propuestos y las actividades realizadas en el marco de la rotación electiva en la Coordinación de Tuberculosis y Lepra del Ministerio de Salud de la Nación, llevada adelante desde el 2 de marzo hasta el 13 de mayo de 2022. La elección de este espacio está vinculada al proceso de inserción en el área de tuberculosis iniciado en la rotación interna en el CeSAC 24 el primer cuatrimestre de 2021. Luego de haber participado en el consultorio interdisciplinario, se propuso conocer las acciones implementadas a nivel central y programático para el abordaje de la tuberculosis, con el objetivo de comprender los puntos de encuentro y desencuentro entre las intervenciones del primer nivel de atención y las particularidades de la gestión y la política pública. (AU)

Temporal Variation in Ankle Fractures and Orthopedic Resident Program Planning in an Urban Level 1 Trauma Center.

Previous studies have described the mechanism of ankle fractures, their seasonal variation, and fracture patterns but never in conjunction. In addition, the cohorts previously studied were either not from trauma centers or were often dominated by low-energy mechanisms. The present study aimed to describe the epidemiology of ankle fractures presenting to an urban level 1 trauma center. The records from an urban level 1 trauma center located in the Midwestern United States were retrospectively reviewed, and the injury mechanism and energy, time of injury, day of week, month, and patient characteristics (age, gender, comorbidities, smoking status) were collected. The fractures were classified using the AO (Arbeitsgemeinschaft für Osteosynthesefragen), Lauge-Hansen, and Danis-Weber systems. Of these systems, the Lauge-Hansen classification system resulted in the greatest number of "unclassifiable" cases. Most ankle fractures were due to high-energy mechanisms, with motor vehicle collisions the most common high-energy mechanism. The review found that most ankle fractures were malleolar fractures, regardless of the mechanism of injury. The ankle fracture patients had greater rates of obesity, diabetes, and smoking than present in the region where the hospital is located. The fractures were most likely to occur in the afternoon, with more fractures presenting on the weekend than earlier in the week and more fractures in the fall and winter than in the spring and summer. The temporal variation of these fractures should be considered for health services planning, in particular, in regard to resident physician staffing at urban level 1 trauma centers.

Variability in Fluoroscopic Image Acquisition During Operative Fixation of Ankle Fractures.

The goal of this study was to determine whether injury, level of surgeon training, and patient factors are associated with increased use of fluoroscopy during open reduction and internal fixation of ankle fractures. These relationships are not well defined. The study was a retrospective chart review of patients treated at an academic institution with primary open reduction and internal fixation of an ankle. Patient demographics, including sex, age, and body mass index, were collected, as was surgeon year of training (residency and fellowship). Image acquisition data included total number of images, total imaging time, and cumulative dose. Ankle fractures were classified according to the Weber and Lauge-Hansen classifications and the number of fixation points. Bivariate analysis and multiple regression models were used to predict increasing fluoroscopic image acquisition. Alpha was set at 0.05. Of 158 patients identified, 58 were excluded. After bivariate analysis, fracture complexity and year of training showed a significant correlation with increasing image acquisition. After multiple regression analysis, fracture complexity and year of training remained clinically significant and were independent predictors of increased image acquisition. Increasing fracture complexity resulted in 20 additional images, 16 additional seconds, and an increase in radiation of 0.7 mGy. Increasing year of training resulted in an additional 6 images and an increase of 0.35 mGy in cumulative dose. The findings suggest that protocols to educate trainee surgeons in minimizing the use of fluoroscopy would be beneficial at all levels of training and should target multiple fracture patterns.

A study of knowledge, attitude and practices regarding leprosy among undergraduates and interns of a medical college and hospital from rural India.

Leprosy is an Infectious disease caused by Mycobacterium leprae and acquired through droplet infection. India has been carrying the 2/3rd global leprosy burden. Inadequate or incorrect information and knowledge about the disease and its treatment are the root causes of many stigmas and inhibitions prevalent in the various sections of the community. The present study was undertaken to assess the knowledge, attitude and practices (KAP) regarding leprosy among undergraduates (final year medical students) and interns of Rural Medical College and Pravara Rural Hospital, Loni, Maharashtra, India. It is heartening to note that most of students and interns had good knowledge about regimens, counselling and were willing to work in leprosy. There were, however, misconceptions about several aspects of diseases which were more in case of final year students compared with interns. Significant improvementin the knowledge of interns in comparison offinal year MBBS students was mostly noted on the aspects like transmission of leprosy, involvement of ulnar nerve in the leprosy, immunological relevance, use of vaccine, treatment of leprosy affected person and leprosy associated stigma. This positive change in attitudes as well as knowledge highlight the requirement of proper training and clinical exposure of medical students and important role of internship. There is need to focus on important aspects (such as cardinal signs, public health aspects and definitions, infectivity, misconception about marriage in which insignificant changes were observed.

Journal club: screen, select, probe & evaluate.

Postgraduate dermatology training programs like seminars, panel discussions, and case presentations help residents to acquire knowledge. Journal club (JC) exercises help residents to update themselves with the current literature. What article a resident should choose and how a resident should evaluate and analyze an article or critically appraise a topic are issues that are most relevant for the success of a JC. Little guidance is available in the biomedical literature on how to deal with such issues. The objective of this article is to provide guidance to neophytes on dealing with JC exercises in a way that helps them in learning the critical appraisal skills. A review of the literature and of the author's experience in JC exercises will be presented. Knowing the methodology of rapid screening of articles along with the art of evaluating them, coupled with a sound knowledge of epidemiology and bio-statistics, helps a resident to select appropriate articles and discard poorly conceived or designed topics that may not generate interest in JC attendees. Hence, such an approach helps the resident in acquiring new knowledge in the shortest time. Choosing the right topic and then applying the newly obtained information to clinical practice, participants succeed in making the JC a valuable learning experience. Further, such well-formatted JCs help residents to improve the quality of health care delivered to patients.