Introduction Because of the increasing emergence of skin manifestations of the coronavirus disease 2019 (COVID-19) worldwide, we investigated the published reports of these lesions. Methods We conducted a literature search for original and review articles published from November 11, 2019, to September 30, 2020. Results We determined five skin lesions common in patients with COVID-19: pseudo-chilblains, maculopapular, urticarial, vesicular, and vaso-occlusive lesions. These lesions manifest at various times in relation to COVID-19 symptoms, which may indicate whether the lesions are virus-induced or are delayed immunological responses to the infection. Skin lesions are more prevalent among Europeans and US residents than among Asians, as is pseudo-chilblain, and the morphology of the skin lesions varies between continents. Pseudo-chilblains are the most common COVID-19 skin manifestation in Europe and the United States, but there is only one reported case from Asian populations. Additionally, patients with vaso-occlusive lesions are more likely than those with pseudo-chilblains to be admitted to the intensive care unit and to die. Conclusion Different cutaneous manifestations in patients with COVID-19 could reflect a wide spectrum of viral interactions with the skin, though reporting bias may play a role as well.
Background Occupational dermatoses caused by personal protective equipment (PPE) in the current COVID-19 pandemic are emerging occupational health challenges which must be promptly and effectively addressed to ease the burden on our healthcare workers (HCWs). Objective A systematic review was conducted to determine common PPE-related dermatoses, affected body sites, and implicated occupational contactants. We further proposed solutions to mitigate this problem. Methods Online databases were searched for articles on PPE-related dermatoses in HCWs during COVID-19, written in English and published from January 1, 2020 to January 30, 2021. Results 16 studies, involving a total of 3958 participants, were included. The most common dermatoses were xerosis, pressure-related erythema, and contact dermatitis, mainly affecting the face and hands. The most widely implicated contactants were increased frequency of hand hygiene, gloves, N95 masks, and goggles. Proposed solutions were categorized into individual self-care, protection of the workforce, and long-term preventative measures. Conclusion Through measures such as regular basic skincare education, early access to specialty clinics via telemedicine, and the design of better-fit PPE, the challenges posed by PPE-related occupational dermatoses can be significantly reduced.
Background and Aims: The efficacy and safety of albumin infusion for treatment and prevention of overt hepatic encephalopathy (OHE) among cirrhosis patients remained controversial. We performed a systematic review and meta-analysis to evaluate the benefit of albumin infusion for the treatment and prevention of OHE. Methods: We performed a systematic search of 4 electronic databases up to 31st January 2021. The primary outcome was the resolution of OHE. Secondary outcomes were inpatient mortality and albuminassociated adverse events. We assessed the pooled odds' risk, pooled mean differences, 95% confidence interval and heterogeneity using Review Manager Version 5.3. Results: A total of 12 studies (2,087 subjects) were identified. Among cirrhosis patients with OHE, albumin infusion was associated with a lower pooled risk of OHE (OR = 0.43, 95%CI: 0.27, 0.68; I 2 = 0%). Among patients without baseline OHE, albumin infusion was associated with a lower pooled risk of developing OHE (OR = 0.53, 95%CI: 0.32, 0.86; I 2 = 62%). Albumin infusion was associated with a lower pooled risk of inpatient mortality (OR = 0.36, 95%CI: 0.21, 0.60; I 2 = 0%). Conclusion: Well-powered randomized trials are required to confirm the benefits of albumin infusion for the prevention and treatment of overt hepatic encephalopathy among decompensated cirrhosis patients.
Background Treatment guidelines are not well established in AIDS-related Kaposi sarcoma (KS).Objective We aim to review the evidence on efficacy of treatments for AIDS-related Kaposi sarcoma.Methods We searched the Cochrane Library, PubMed, and Embase Database from date of database inception till July 2020. Randomized controlled trials reporting intervention consisting of any type of treatment compared to control/placebo to a different treatment modality or different combination of treatment/treatment doses with a diagnosis of AIDSrelated KS are selected.Main outcomes and measures Primary outcomes were response rates defined as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Secondary outcomes were cosmesis and adverse outcomes such as pain and erythema.Results Thirteen out of 536 articles met our eligibility criteria. Three studies reported the efficacy of chemotherapy, two studies looked at different doses of radiotherapy regimes, and three studies compared different antiretroviral therapy (ART) and chemotherapy regimens. Other studies reported topical therapies such as alitretinoin gel, IM862, and bHCG injection which showed varied efficacies.Limitations Lack of standardization classification of disease activity and clinical outcomes and treatment modalities precluded meaningful comparison of studies. ConclusionThe evidence of efficacy of any particular intervention is overall varied and there was insufficient evidence to recommend any particular intervention. We have provided an overview of treatments for KS but larger studies need to be carried out to verify the efficacy of treatment options reported in the literature.
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