ABSTRACT
Background: The COVID-19 pandemic has shifted healthcare from physical in-person patient visits to teleconsultations in order to curtail the spread of this virus. Dermatology, being a visual science, lends itself amenably to teleconsultation. Objective: This study was performed to assess the basic dermatological diseases which are more easily diagnosable and managed through teleconsultation, distinguishing them from diseases for which a face-to-face consultation may be a better option and to delineate the factors affecting the image quality which is the cornerstone of a teledermatology consultation. Methods: A retrospective observational study was conducted over a three-month period during the pandemic. Store and forward, video conferencing, and hybrid consultations were included. Two dermatologists of different clinical experience independently assessed the clinical photographs of the patients and gave each photograph an objective score (Physician Quality Rating Scale) and a diagnosis. The diagnostic concordance between the two dermatologists as well as the correlation of this score with the certainty of diagnosis was calculated. Results: A total of 651 patients completed the study. Mean PQRS score of Dermatologist 1 was 6.22 while the mean score of Dermatologist 2 was 6.24. Patients in whom both the dermatologists were absolutely certain about their diagnosis had a higher PQRS score and interestingly had a higher education level than the rest. There was 97.7 percent diagnostic concordance between the two dermatologists. Infections, acne, follicular disorders, pigmentary disorders, tumors, and STDs had the largest proportion of cases wherein both the dermatologists were in total agreement with each other. Conclusion: Teledermatology might be best for the care of patients with characteristic clinical presentation or for follow-up of already diagnosed patients. It can be used in the post-COVID era to triage patients requiring emergency care and reduce patient wait times.
ABSTRACT
Role of flow-mediated dilatation (FMD) testing in the assessment of the macrovascular dysfunction in systemic sclerosis (SS) and correlation of FMD values with disease severity. Twenty-five patients of SS and 25 healthy age-matched controls were recruited. Modified Rodnan skin thickness score (MRSS) was used for skin thickness assessment. FMD values were measured in the brachial artery. FMD values done at baseline before the initiation of treatment were lower in SSc patients (4.044 ± 2.742) compared to the healthy controls (11.076 ± 5.896) (P < 0.05). Comparison of FMD values between patients with limited cutaneous systemic sclerosis (LSSc) and diffuse cutaneous systemic sclerosis (DSSc) showed a trend toward lower in LSSc (3.182 ± 2.482) as compared to DSSc patients (5.111 ± 2.711); however, the difference was not statistically significant. Patients with lung manifestations on high-resolution CT chest showed lower FMD values (2.66 ± 2.23) compared to those without HRCT changes (6.45 ± 2.56) (P < 0.05). We demonstrate that FMD values in SSc patients were lower when compared to healthy controls. Patients with SS having pulmonary manifestations showed a lower value of FMD. Key Points ⢠FMD is a simple non-invasive tool to assess the endothelial function in patients with systemic sclerosis. ⢠Lower values of FMD in systemic sclerosis suggest that the endothelial dysfunction and values can also be correlated with other organ involvement such as lung and skin involvement. So, lower FMD values might be a useful marker for disease severity.
