Widespread cutaneous small vessel vasculitis secondary to COVID-19 infection Dear Editor, Since the beginning of the coronavirus disease (COVID)-19 pandemic, various dermatological manifestations including chilblain-like lesions, livedo reticularis, urticaria, varicella-like, petechial, and maculopapular exanthems have been reported. 1-4 COVID-19-induced cutaneous small vessel vasculitis (CSVV) has also been recently described. 5 CSVV refers to a subgroup of vasculitis localized to the skin. Drugs and infections are chief causes of CSVV. A 47-year-old otherwise healthy male presented to our emergency department with a 6-day history of skin and oral lesions, low grade fever, malaise, and polyarthralgia. The rash started as small red to violaceous plaques on the legs and extended to the arms and trunk. He simultaneously developed a painful tongue sore and gum bleeding. On the third day, a persistent dry cough developed. He denied a history of recent travel, sick contacts, insect bites, medication use, and family history of autoimmune disorders. On examination, temperature was 37.5°C (99.5°F).
Vitamin D deficiency may be caused by reduced sun exposure, decreased intake of vitamin D-containing food or by its reduced absorption, decreased endogenous synthesis (via decreased 25-hydroxylation in the liver as a result of liver disease or decreased 1-hydroxylation in the kidney due to kidney disease), increased hepatic catabolism, or end-organ resistance to Vitamin D. [1] High-risk group for Vitamin D deficiency includes dark-skinned people, obese people, individuals taking medications that accelerate the metabolism of Vitamin D (such as phenytoin), patients on general medical service, institutionalized individuals, individuals with limited effective sun exposure due to protective clothing or consistent use of sunscreens, and those with malabsorption, including inflammatory bowel disease and celiac disease.Vitamin D has pleiotropic properties in "off-target" sites and can influence cell proliferation, muscle performance, energy metabolism, and bone strength, independent of its actions on calcium absorption. [1] Vitamin D deficiency leads Background: Vitamin D deficiency is very common worldwide but highly prevalent in the Gulf region. The clinical manifestations of Vitamin D deficiency vary depending on the severity and duration of the deficiency. Effective treatment should correct the vitamin D levels and improve other metabolic markers. Objectives: We aimed to (1) compare the efficacy of Vitamin D3 and Vitamin D2 in terms of raising serum 25(OH) total Vitamin D levels, (2) evaluate the time of its attainment, and (3) demonstrate the effect of replacement with either preparation on serum markers of bone or calcium metabolism. Patients and Methods: We conducted a randomized controlled study involving 250 adults with Vitamin D deficiency or insufficiency, assigned into 1:1 ratio to receive weekly capsules of either 50,000 IU of D2 or 50,000 IU of D3 for up to 12 weeks. Serum total Vitamin D level, calcium, phosphorus, alkaline phosphatase, and parathyroid hormone (PTH) levels were measured at 0, 8, and 12 weeks. Analysis of variance and nonparametric test Kruskal-Wallis were used for the comparison of quantitative values and the Chi-square test for comparison of categorical variables. Results: After 8 weeks of treatment, the improvement in Vitamin D level was greater for patients in the D3 group (mean = 18.74, standard error [SE] = 1.08) than that for D2 group (mean = 5.88, SE = 0.65), F (1, 240) = 113.840; P < 0.0005. Similarly after 12 weeks, the improvement in Vitamin D levels was greater for those in the D3 group (mean = 20.76, SE = 1.14) than that for the D2 group (mean = 7.93, SE = 0.79), F (1, 224) = 90.78; P < 0.0005. At 12 weeks, serum calcium, phosphorus, alkaline phosphatase, and PTH levels were not significantly different between the D3 and D2 treatment groups. Conclusions: Vitamin D3 is more efficacious and faster in increasing the level of total Vitamin D than Vitamin D2. However, no significant differences were evident on calcium, phosphorus, alkaline phosphatase, or PTH levels between groups.
Background: A postgraduate training program should be focused on positive and healthy educational environment. Postgraduate trainees suffer invariably during their training when the hospital educational environment is stressful. It is, therefore very important to assess the training environment of an institute as a part of good educational practice. Aims: The aim of this study is assess and compare the clinical learning environment in the postgraduate training programs in Dubai and Sialkot. We also measure the perception of autonomy, the perception of teaching, and the perception of social support to identify more specific weaknesses and strengths in an educational environment. We demonstrate the appropriate steps, focusing on the Postgraduate Hospital Educational Environment Measure (PHEEM). Methods: PHEEM questionnaire was completed by 95 postgraduate residents in an observational, quantitative study involving a cross sectional survey of the perception of attitudes and behavior in postgraduate training programs in Dubai (UAE) and Sialkot (Pakistan). Results: We used “IBM SPSS STATISTICS 21” software for data analysis. The results were analyzed and compared between postgraduate residents from Dubai and Sialkot. The total PHEEM score we achieved in our study is 104.8. The comparative scores achieved between Dubai and Sialkot residents by three domains of PHEEM inventory include Perception of role autonomy (34.44/35.85), Perception of teaching (36.60/40.65), and Perception of social support (24.42/24.42) respectively. There is no statistically significant association between PG year of training and country of training but there is statistically significant association between gender and country of training. Conclusion: PHEEM is a simple, multidimensional, valid and highly reliable instrument measuring the educational environment among postgraduates working in different cultures and clinical disciplines. There are more positive than negative as far as the learning environment is concerned in both Dubai and Sialkot; however, there is room for improvement. Perception of social support and role autonomy is identical in Dubai and Sialkot. But teaching is better in Sialkot, attributed mainly to pediatric residency.
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