In sub-Saharan Africa, in particular in rural areas, patients have limited access to doctors with specialist skills in skin diseases. To address this issue, a teledermatology pilot programme focused on primary health centres was set up in Mali. This study was aimed at investigating the feasibility of this programme and its impact on the management of skin diseases. The programme was based on the store-and-forward model. Health care providers from 10 primary centres were trained to manage common skin diseases, to capture images of skin lesions, and to use an e-platform to post all cases beyond their expertise for dermatologists in order to obtain diagnosis and treatment recommendations. After training, the cases of 180 patients were posted by trained health workers on the platform. Ninety-six per cent of these patients were properly managed via the responses given by dermatologists. The mean time to receive the expert’s response was 32 h (range: 13 min to 20 days). Analysis of all diseases diagnosed via the platform revealed a wide range of skin disorders. Our initiative hugely improved the management of all skin diseases in the targeted health centres. In developing countries, Internet accessibility and connection quality represent the main challenges when conducting teledermatology programmes.
Background: Psoriasis is a chronic recurrent inflammatory dermatosis occurring in genetically predisposed individuals. Its dramatic nature of the lesions, successive flare-ups, and skin discomfort may affect the quality of life of patients and result in a depressive tendency. Objective: To assess the impact of psoriasis on the quality of life of patients and the relationship between disease severity and quality of life. Methods: A descriptive cross-sectional study was carried out in Bamako from September 3, 2018 to August 30, 2019. The Dermatology Life Quality Index (DLQI) and Psoriasis Area Severity Index (PASI) were used to assess quality of life and factors of disease severity. Inclusion was based on clinical and histopathologic criteria. Questionable cases were excluded from the study. Results: A total of 106 cases of psoriasis were identified out of 24,000 consultations, i.e., a hospital frequency of 0.44%. Of these cases, 54 were included. Males accounted for 70% of the cases, and the average age was 37. The distribution of the social repercussions of the disease was as follows: disability (68.52%), non-participation in ceremonies (20.37%), stigmatization (18.52%), isolation (12.96%), work stoppage (11.11%), and non-sharing of meals (9.26%). However, the reception by caregivers was satisfactory in 96.30% of cases, and 85% of patients scored ≤ 10 on DLQI, suggesting that they had good quality of life. Among the patients with psoriasis, 35.04%, 12.96%, and 50.00% had mild, moderate, and severe disease, respectively. Conclusion: Quality of life is multifactorial and has no direct association with the severity of psoriasis. Dermatologists must take into account the dimensions of symptoms and psychological state when managing patients with psoriasis.
This 33-year-old lady was hospitalised for systemic lupus and received corticosteroid therapy; upper limb edoema developed as a result. The interview revealed a theory of trauma related to a fall in the bathroom. During the examination, it was discovered that the patient’s overall health was quite poor and that her left upper limb was edematous, unpleasant to the touch, and covered in an erythematous plaque with blisters and a necrosis area. After 72-hours, ciprofloxacin, gentamycin, and amoxicillin antibiotic treatment had no noticeable effects. A bacteriological examination of the ulcer indicated the presence of Providencia stuartii, which is susceptible to cefotaxime but resistant to ciprofloxacin and amoxicillin. The biological evaluation revealed hyperleukocytosis (12,800 white blood cells/L), thrombocytopenia (103,000/L), and anaemia (9.1 g/dL). Following the administration of cefotaxime together with surgical debridement, apyrexia set in within 24-hours, and full recovery occurred three-weeks later. The search for atypical germs and the performance of an antibiogram must be mandated in front of an acute necrotizing dermohypodermatitis (AND) due to the odd location, the circumstances of the occurrence, and the clinical component.
Background This was a descriptive and prospective study that focused on 73 cases of delirium of skin infestation (DSI) from January 1st to December 31st, 2018, in the dermatology department of the Bamako Dermatology Hospital (HDB). Aim The aim of this work was to describe the epidemiological and clinical profile of delusions of infestation (Ekbom syndrome), to deepen our knowledge of the disease in order to improve its overall management. Methods We carried out a descriptive cross-sectional study of cases of identity document (ID) seen in dermatological consultation in the HDB dermatology department between January 1st and December 31st, 2018. Now, this department is the largest dermatological reference center in the country. In our study, we have included any patient with delirium of parasitic infestation (defined as an unshakeable conviction that small vermin, insects, lice, maggots, proliferate in the skin and sometimes in the body without biological proof). Results Delirium of skin infestation constituted 0.3% of consultations in the service. The average age was 52-years with extremes ranging from 12 to 85-years. They were 45 female (62%) and 28 male (45%). The age group (25-64) was the most represented. Out-ofschool patients represented 65% of the sample. Among them, 6 cases (8%) were known in psychiatry. The agents incriminated by the patients were mainly ants, earthworms and cicadas. The specimen sign was found in 89% of cases. Insomnia was the most frequent associated sign, at 75%. The types of lesion complications observed in our patients were mainly lichenification, ulceration and excoriation. Seventy-two percent (72%) of patients have refused referral to the mental health service. The profile of Ekbom syndrome was the one of the adult women, described in the previous work. Conclusion Delirium of skin infestation is generally considered as rare disease, increasingly observed during our dermatology consultations. Its frequency is probably underestimated.
Background: Mali, like many Sub-Saharan African countries, is experiencing an acute crisis with respect to the shortage of qualified health professionals. This crisis is even more acute when it comes to specialized medical fields such as dermatology. To address this shortage, a tele-dermatology project has been launched in Mali since 2015 in order to provide access to specialized care to the most remote populations.Objective: The aim of our study is to assess the medico-economic benefits of the pilot phase of this project.Methods: We conducted a retrospective cross-sectional study of all requests for expert advice sent to dermatology experts through the "Bogou" tele-expertise platform.The sample consisted of 52 patients at eight remote sites and ten health professionals, including 4 specialists.The economic study was done using a parameter of cost analysis and the professional evaluation of healthcare providers. It compared consultation and transportation fees (on-site and off-site), and used a questionnaire assessing items on a 5-level Lickert scale and open-ended questions to evaluate the satisfaction of health professionals. Data analysis was performed by SPSS v25.Results: During the period, 374 requests for tele-expertise were made for the benefit of 52 patients. 89.3% of requests were answered by specialists, with an average response time of 46 hours 59 minutes and extremes from 7 minutes to 415 hours 4 minutes. Eczema was the most common medical condition diagnosed. 98% of patients had never completed a dermatological consultation because of a lack of means to travel to the only specialized center in the country. Consequently, they were all very satisfied or satisfied with the tele-expertise service. The 52 participating patients in project have realized a great financial benefit. Together they saved an average of 5,824,500 XOF (9429 euros).All the health professionals surveyed also expressed satisfaction with the application. They confirmed that the project has enabled them to strengthen their skills in the management of dermatological pathologies.Conclusion: Based on the results of our study, we can say that tele-dermatology allows access to specialized care and a reduction in the costs of care for patients in remote areas.
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