Background: Teledermatology offers an opportunity to continually deliver care during the coronavirus disease 2019 pandemic. Objective: To provide quantitative data about the use of teledermatology. Methods: Retrospective analysis of teledermatology consultations was performed from March 16 to May 1, 2020. The number/type of encounters, differences in diagnoses, and prescriptions between asynchronous and synchronous teledermatology visits were analyzed. Results: A total of 951 visits (36.2%) were asynchronous whereas 1,672 visits (63.8%) were synchronous. Only 131 (<5%) visits required an acute in-person follow-up. The diagnosis of acne was more frequent with asynchronous visits (p < 0.002, Bonferroni corrected). Antibiotics and nonretinoid acne medications were prescribed more with asynchronous visits, whereas immunomodulators and biologics were more commonly prescribed with synchronous visits (p < 0.02, Bonferroni corrected). Providers at our institution were split on preferred mode (54.2% synchronous, 45.8% asynchronous); however, synchronous visits were preferred for complex medical dermatology patients and return patients (p < 0.05). Limitations: This study is limited by being a single-center study. Conclusions: Asynchronous teledermatology was used more for acne management, whereas synchronous teledermatology was preferable to providers for complex medical dermatology. Postanalysis of the data collected led us to institute a hybridization of our asynchronous and synchronous teledermatology.
IntroductionDirofilariasis, including heartworm disease, is a major emergent veterinary parasitic infection and a human zoonosis. Currently, experimental infections of cats and dogs are used in veterinary heartworm preclinical drug research.MethodsAs a refined alternative in vivo heartworm preventative drug screen, we assessed lymphopenic mouse strains with ablation of the interleukin-2/7 common gamma chain (γc) as susceptible to the larval development phase of Dirofilaria immitis.ResultsNon-obese diabetic (NOD) severe combined immunodeficiency (SCID)γc−/− (NSG and NXG) and recombination-activating gene (RAG)2−/−γc−/− mouse strains yielded viable D. immitis larvae at 2–4 weeks post-infection, including the use of different batches of D. immitis infectious larvae, different D. immitis isolates, and at different laboratories. Mice did not display any clinical signs associated with infection for up to 4 weeks. Developing larvae were found in subcutaneous and muscle fascia tissues, which is the natural site of this stage of heartworm in dogs. Compared with in vitro-propagated larvae at day 14, in vivo-derived larvae had completed the L4 molt, were significantly larger, and contained expanded Wolbachia endobacteria titres. We established an ex vivo L4 paralytic screening system whereby assays with moxidectin or levamisole highlighted discrepancies in relative drug sensitivities in comparison with in vitro-reared L4 D. immitis. We demonstrated effective depletion of Wolbachia by 70%−90% in D. immitis L4 following 2- to 7-day oral in vivo exposures of NSG- or NXG-infected mice with doxycycline or the rapid-acting investigational drug, AWZ1066S. We validated NSG and NXG D. immitis mouse models as a filaricide screen by in vivo treatments with single injections of moxidectin, which mediated a 60%−88% reduction in L4 larvae at 14–28 days.DiscussionFuture adoption of these mouse models will benefit end-user laboratories conducting research and development of novel heartworm preventatives via increased access, rapid turnaround, and reduced costs and may simultaneously decrease the need for experimental cat or dog use.
Institutional Review Board approval. Store-andforward teledermatology consults are submitted through a shared electronic medical record, and a response is generated #24 hours by our team of teledermatology consultants. Among these, a subcohort was identified with ''Stevens Johnson syndrome,'' ''SJS,'' ''toxic epidermal necrolysis,'' or ''TEN'' in the referring differential diagnosis.Owing to the inability of dermatology to meet the skin burden of hospitalized patients, 4 inpatient teledermatology consultation at hospitals without a dermatologic consultant may prevent misdiagnosis of SJS/TEN, limit some unnecessary expenses related to transfer costs and inappropriate therapeutics, and permit an earlier time to discharge.Among 73 patients with a referring differential diagnosis of SJS/TEN, 71 (97%) were given a different diagnosis (Table I). The teledermatology consultant diagnostic impression in 26 patients (36.6%) was ''morbilliform'' or ''exanthematous drug rash.'' In addition, 1 patient with drug rash with eosinophilia and systemic symptoms was identified and treated remotely. Of 71 patients, 15 (21%) were receiving systemic steroids and 16 (23%) intravenous antibiotics. The eDermatology consultant recommended stopping steroids or antibiotics 60% and 81% of the time, respectively. All 71 patients were discharged in good condition an average of 11.8 days later.Two of the 73 patients were given a consultant diagnosis of SJS/TEN, both with consistent histopathology. These patients were transferred to a higher level of care (Fig 1).No., Number; SD, standard deviation. *The eDermatology consultant diagnoses in 71 of 73 patients were not consistent with SJS/TEN. y Transfer was recommended for 1 patient with of diffuse immunobullous disease, 1 patient with of erythema multiforme major, and 2 patients with SJS/TEN.
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