Pediatric resident's perception of night float system compared to 24 hours system, a prospective study.

BACKGROUND: The study aims to evaluate the perceptions of pediatric residents under the night float (NF) on-call system and its impact on well-being, education, and patient safety compared with the traditional 24-h on-call system. METHODS: The study is prospective in nature and conducted on two pediatric resident training centers who apply the NF on-call system as a pilot project. Senior residents (PGY-3 and PGY-4) enrolled in the two training centers were invited to participate before and 6 months after the implementation of the change in the on-call system. A self-administered online questionnaire was distributed. Responses were rated using a five-point Likert-type scale (1 = strongly disagree; 5 = strongly agree). The items covered three main domains, namely, residents' well-being, ability to deliver healthcare, and medical education experience. Pre- and post-intervention scores were presented as means and compared by t-test for paired samples. RESULTS: A total of 42 residents participated in the survey (female = 24; 57.1%). All participants were senior residents; 25 (59.6%) were third-year residents (PGY-3), whereas 17 (40.4%) were fourth-year residents (PGY-4). The participants reported that many aspects of the three domains were improved with the introduction of the NF system. The system was perceived to exert less adverse health effect on the residents (mean: 2.37 ± 1.01) compared with the 24-h on-call system (mean: 4.19 ± 0.60; P < 0.001). In addition, the NF system was perceived to lead to less exposure to personal harm and result in less negative impact on quality of care, better work efficiency, reduced potential for medical errors, more successful teaching, and less disruptions to other rotations compared with the 24 h on-call system (P < 0.001). CONCLUSION: The perception of senior residents toward the 24-h on-call system pertains to negative impacts on well-being, education, and patient safety compared with on-call systems with restrictive duty hours, such as the NF system, which is perceived to be less harmful, to exert positive impacts on the quality of delivered healthcare services, and more useful from pedagogic aspect.

Acne Fulminans: Case Series and Review of the Literature.

Acne fulminans (AF) is a rare manifestation and the most severe form of the entire clinical spectrum of acne. The disease is destructive and is characterized by the sudden onset of painful and ulcerative pustules and systemic symptoms including high fever, hepatomegaly, polyarthralgia, leukocytosis, plaquetose, and increased inflammatory markers and transaminases. Osteolytic lesions in multiple skeletal sites could also be associated. The use of isotretinoin is considered a related trigger, as well as the use and cessation of testosterone, although a bacterial infection, a drug-induced disease, or an intake of anabolic androgenic steroids has been suggested. The treatment of AF is challenging and controversial. The recommended treatment is aggressive and consists of a combination of oral steroids and low doses of isotretinoin, with no consensus at this time. The patient may require several weeks of hospitalization to control the eruption. The cutaneous lesions usually leave scars and milia. We report on two boys and two girls presenting with AF, triggered by isotretinoin in three patients and by an antibiotic in one patient. All the patients treated with corticosteroids and isotretinoin with success.

Combining Isotretinoin and Topical Cholesterol/Atorvastatin in the Treatment of Linear Porokeratosis: A Case Report.

Linear porokeratosis (LP) is an epidermal keratinization disorder manifesting in the form of annular plaques with an atrophic center and hyperkeratotic margins. Although rare, LP carries a significant risk of skin cancer. Histological examination usually reveals the cornoid lamella, a parakeratosis column visualized in the outer layer of the epidermis. First-line treatment of LP is retinoids. However, the effects of combination therapy of isotretinoin and topical statins on LP are not well-understood. Herein, we attempted treatment with both isotretinoin and 2% cholesterol/atorvastatin ointment, with considerable improvement observed using the former but not the latter. These findings suggest that 2% topical cholesterol/atorvastatin treatment may not carry any additional benefits, even if used alongside retinoids. Further studies are needed to assess the potential effects of statins on LP.

Management of Atopic Dermatitis in Adults in Saudi Arabia: Consensus Recommendations from the Dermatological Expert Group.

Background: Atopic dermatitis (AD) is a long-term, pruritic, recurrent, systemic, inflammatory skin disorder. In the Middle East region, the burden of AD is understudied, and there is a dearth of AD guideline documents for practitioners. Methods: An expert panel meeting, encompassing 12 dermatologists from the Kingdom of Saudi Arabia (KSA), was congregated to develop evidence- and experience-based consensus recommendations for AD management, especially in adults in KSA. They completed a questionnaire with seven clinical statements, and a consensus was defined when the responses of ≥75% of participants coincided. Results: The expert recommendations were as follows: American Association of Dermatology guidelines are to be followed for defining AD; Eczema Area and Severity Index or SCORing atopic dermatitis index may be used to quantify the disease severity; Dermatology Life Quality Index may be used to determine the impact of AD on patients' quality of life; Atopic Dermatitis Control Tool may be used to assess long-term disease control in AD patients; and the European guidelines are to be followed for the management of AD. In AD patients who are inadequately controlled with topical or systemic therapies, the preferred systemic agent for use either alone or in combination with topical treatments is dupilumab, cyclosporine, methotrexate, phototherapy, or other available systemic treatments that may include mycophenolate mofetil or oral corticosteroids. Conclusion: These expert recommendations assist physicians by providing a reference framework for optimal care of adult AD patients.

Acceptance of Teledermatological Practices: A Cross-Sectional Study of Practicing Saudi Dermatologists.

BACKGROUND: The increase in demand for Telemedicine globally has continued to rise in recent months, showing remarkable success in a variety of medical fields. As dermatology shows one of the most prolific rates of success, having a clear national picture of practitioner opinion on the subject is important. In this study we aimed to quantify the overall level of acceptance and satisfaction of Saudi dermatologists towards the practice of teledermatology. DESIGN AND SETTING: Data was collected by means of a survey which included demographic data and level of exposure and overall satisfaction towards Telemedicine in their field.  Results: A total of 102 questionnaires were returned of which 57.8% had engaged in at least one teleconsultation. Of these, 71.2% showed support for the technology, with negative responses being associated with poor infrastructure or implementation in the workplace. CONCLUSION: The acceptance of dermatologists to teledermatology consultations in Saudi Arabia shows a positive tendency, with the majority of those who engaged in the practice saying they would do so again and find it satisfactory. Creating more reliable and robust tools and greater training in their use would be beneficial for its further incorporation.

The current reproduction number of COVID-19 in Saudi Arabia: is the disease controlled?

The infectiousness of COVID-19 is high among the susceptible population, making the calculation of the reproduction number (R) an essential step to implement preventive measures. We aim to estimate COVID-19 transmission to determine if the disease is successfully controlled or extra measured should be adopted to attain this goal. The daily incidence data of COVID-19 in Saudi Arabia from March 2nd, 2020, to April 4th, 2021, were obtained from the continuously updated Saudi Ministry of Health COVID-19 repository. To get accurate estimation of the situation over the last 4 months (from December 1st, 2020, to April 4th, 2021), we calculated the weekly (every 7 days) R starting from March 2nd, 2020, and till the last week of the available data. The calculated values of R were represented as median, first quantile (Q1), and third quantile (Q3). As early as the first week of December 2020, the median R was 0.81 (0.80-0.83) which means that each existing infected case would transmit infection to only one person. This was followed by fluctuations over the next few weeks around R value of 1, reaching its highest level of 1.45 (1.42-1.47) between December 31st, 2020, and January 6th, 2021. This was followed by a relatively steady decline over the following weeks, with some till mid-March where the R values started to slightly rise again. Social distancing, protective precautions, avoiding abuse of the partial lifting, expanding the screening process, and other Saudi measures sound to be successful and should be replicated in similar communities. This measure should be continued till the vaccination process is completed, to reduce the number of contacts and to avoid uncontrolled transmission of the disease.

Hemimaxillary Enlargement, Asymmetry of the Face, Tooth Abnormalities, and Skin Findings (HATS) Syndrome: A Case Report and Review of the Literature.

Hemimaxillary enlargement, asymmetry of the face, tooth abnormalities, and skin findings (HATS) syndrome, a rare developmental disorder, involves the first and second branchial arches and is characterized by hemimaxillary enlargement, abnormal appearance of skin and teeth, and facial asymmetry. It is generally detected at birth or during early childhood and is associated with unilateral abnormalities of the face, including the bones, teeth, gums, and skin. Becker nevus is the most common cutaneous manifestation of HATS syndrome. Although patients with HATS syndrome have been treated with various therapeutic regimens, no standard or definitive treatment regimen has been established. This study describes this rare condition in a 12-year-old girl.

LEOPARD Syndrome with PTPN11 Gene Mutation in Three Family Members Presenting with Different Phenotypes.

LEOPARD syndrome (LS) is a rare autosomal dominant disorder that is characterized by multiple lentigines and various congenital anomalies. The clinical diagnosis of LS requires molecular confirmation. The most frequently reported mutations in LS patients are in the protein tyrosine phosphatase nonreceptor type 11 gene, PTPN11 . Herein, we report the cases of three family members from two generations who are affected by LS and all carry the PTPN11 mutation c.836A > G (p.Tyr279Cys), identified by next-generation sequencing, while exhibiting different phenotypes.

Systemic Type I IFN Inflammation in Human ISG15 Deficiency Leads to Necrotizing Skin Lesions.

Most monogenic disorders have a primary clinical presentation. Inherited ISG15 deficiency, however, has manifested with two distinct presentations to date: susceptibility to mycobacterial disease and intracranial calcifications from hypomorphic interferon-II (IFN-II) production and excessive IFN-I response, respectively. Accordingly, these patients were managed for their infectious and neurologic complications. Herein, we describe five new patients with six novel ISG15 mutations presenting with skin lesions who were managed for dermatologic disease. Cellularly, we denote striking specificity to the IFN-I response, which was previously assumed to be universal. In peripheral blood, myeloid cells display the most robust IFN-I signatures. In the affected skin, IFN-I signaling is observed in the keratinocytes of the epidermis, endothelia, and the monocytes and macrophages of the dermis. These findings define the specific cells causing circulating and dermatologic inflammation and expand the clinical spectrum of ISG15 deficiency to dermatologic presentations as a third phenotype co-dominant to the infectious and neurologic manifestations.