Impact of COVID-19 Pandemic on Dermatology Teaching Program in India: A Survey on the Faculty and Residents' Perspective

Background

Impact of COVID-19 pandemic has been immense. An innocent casualty of this disaster is medical education and training. Dermatology, which primarily deals with out-patient services, medical and surgical interventions, and in-patient services, was one of the worst hit. The National Medical Commission of India has implemented competency-based medical education (CBME) in Dermatology, Venereology, and Leprosy since 2019. The new curriculum relies on acquiring practical and procedural skills, training skills in research methodology, professionalism, attitude, and communication.

Objectives

The study was undertaken to understand the implications of the COVID-19 pandemic on postgraduate dermatology CBME training in India.

Materials and Methods

A questionnaire-based survey was carried out on postgraduate dermatology teachers and residents in India after obtaining ethics committee approval. An online semi-structured English questionnaire was administered by Google Forms. The calculated sample size was 366 dermatology faculty and 341 postgraduate students. Validity (Content validity ratio (CVR) ≥0.56) and reliability (Cronbach's alpha coefficient 0.7249) of the questionnaire were determined.

Results

Among the 764 responses received, 51.4% reported that their institutes were converted to exclusive COVID hospitals. Domains of dermatology education affected were procedural training (n = 655), bedside clinical teaching (n = 613), outpatient department-based clinical teaching (n = 487), bedside laboratory procedures (n = 463), research activities (n = 453), histopathology (n = 412), and theory classes (n = 302). To keep up with the teaching-learning process, online platforms were mostly utilized: Zoom Meeting (n = 379), Google Meet (n = 287), and WhatsApp Interaction (n = 224). Teaching during ward rounds was significantly more affected in exclusively COVID institutes than non-exclusive COVID institutes (P < 0.001). Psychomotor skill development suffered a major jolt with 26.7% of respondents reporting a standstill (P < 0.001). Communication skills among students suffered due to social distancing, mask, and poor attendance of patients. According to 23.84% of respondents, formative assessment was discontinued.

Conclusion

Online seminars, journal clubs, and assessments have been incorporated during the pandemic. Online modalities should be used as a supplementary method as psychomotor skills, communication skills, research work, and bedside clinics may not be replaced by the e-learning.

Clinical and Dermoscopic Evaluation of Melasma in Men- An Observational Study at a Tertiary Health Care Centre in Western Odisha, India

Introduction: Melasma is one of the most common cause of facial hypermelanosis presenting as symmetrical hyperpigmented macules over sun exposed areas especially in women and sizeable proportion in men causing a detrimental effect on the quality of life. Aim: To evaluate the clinical profile and dermoscopic features of melasma in men. Materials and Methods: A cross-sectional, observational study was conducted at Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Burla, Odisha, India, from November 2018 to October 2020. 245 men, clinically diagnosed with melasma were included in the study with due consent and evaluated for age, family history, skin type, drug intake history, duration, duration of sun exposure, disease pattern, Melasma Area Severity Index (MASI) Score and dermoscopic feature. Data was collected using questionnaire, managed by Microsoft excel 2016 and analysed using Statistical Package for Social Sciences (SPSS) 20.0. Results: Melasma occurred most commonly in the age group of 31-35 years (37.9%) with mean age of occurrence being 34.5±7.9 years affecting most commonly Fitzpatrick skin type IV (47.3%). There was positive family history in 63 patients (29.7%) and history of Diabetes Mellitus (DM) type 2 in 24 cases (9.7%). There was increased occupational sun exposure in 93% of cases with average duration of exposure being 7-8 hours/day in 98 cases (42.9%). The most common clinical pattern observed was malar pattern in 156 cases (63.6%) and epidermal dermoscopic pattern in 128 cases (52.2%). Majority of cases had a MASI Score between 5-10 with mean being 8.7±7.7. On comparing MASI Score and sun exposure, the average sun exposure was highest for a MASI Score 20-25 i.e., 7.4 hours/day. Conclusion: The most common age group affected by melasma in males is 20-40 years, with prevalence being greater in higher Fitzpatrick skin type (III, IV), with positive history of occupational sun exposure and positive family history. The severity of melasma in form of MASI score was formulated. The knowledge acquired through the study can help bridge the knowledge gap to improve its management and quality of life.

Facial Acanthosis Nigricans: A Morphological Marker of Metabolic Syndrome

Introduction:

Acanthosis nigricans (AN) is a frequently encountered entity. Facial AN (FAN) is a subset of AN which is being increasingly recognized. Recently, reports hypothesizing the association of FAN with features of metabolic syndrome have been published.

Aims and Objectives:

The aim of this study was to study the clinicodemographic profile of patients with FAN, and to assess the correlation of hypertension, increased waist–hip ratio (WHR), increased body mass index (BMI), type 2 diabetes mellitus, deranged lipid profile, serum insulin, and impaired oral glucose tolerance test (OGTT) (parameters of metabolic syndrome) in these patients, as well as to determine the most significant predictor (highest relative risk) of development of FAN.

Methods:

A multicentric case–control study was conducted (123 cases in each group) over a period of 2 years. Data were obtained on the basis of history, examination, and relevant laboratory investigations. Statistical analysis was done using Statistica version 6 (StatSoft Inc., 2001, Tulsa, Oklahoma, USA), SPSS statistics version 17 (SPSS Inc., 2008, Illinois, Chicago, USA), and GraphPad Prism version 5 (GraphPad Software Inc., 2007, San Diego, California, USA).

Results:

Mean age of the patients with FAN was 38.83 ± 8.62 years. Mean age of onset of the disease was 30.93 ± 8.18 years. The most common site of face involved was the forehead and temporal region. The most common pigmentation was brown-black. Male sex, positive OGTT, increased WHR, and increased BMI were most significantly related to FAN. Smoking was found to have a protective effect against the development of FAN.

Conclusion:

Here, we document a significant association between male patients with positive OGTT, increased WHR, and BMI and FAN. Thus, we propose that FAN could be considered a morphological marker of metabolic syndrome.

A Study of Clinical, Bacteriological & Histopathological Correlation in Leprosy Cases attending a Government Medical College in Western Odisha: Some Observations

The study was undertaken in VSS Institute of Medical Sciences to observe the clinical, bacteriological and histological diagnosis of leprosy patients attending the hospital who consented to undergo slit skin smear (SSS) examination, punch biopsy and participate in the study. Fifty leprosy patients aged 5 to 70 years, which included 41 male and 9 female patients participated in the study. These included 4 TT, 24 BT, 2 BB, 5 BL and 15 ILL clinically diagnosed patients as per the IAL classification (1982 ). SSS were undertaken from 4 sites, stained with ZN stain and BI calculated as per Ridley Scale. Four patients were skin smear negative all TT). Of the 24 BT patients enrolled in the study, 11 were skin smear negative while 13 were smear positive (BI ranging from 1+ to 4+); Both the BB cases, all 5 BL cases, and all the 15 LL cases were smear positive (BI range 2+ to 6+). Histologically there was complete parity and correlation in.the TT group, while the correlation was observed to be 83%, 50%, 60%, and 93% in the clinically diagnosed BT, BB, BL and LL patients respectively. The sample size in the study was small, however, the overall bacteriological skin smear negativity/positivity correlation was observed to be 53.6% for paucibacillary (TT+BT) disease and 100% for MB (BB, BL and LL) disease Histological correlation was 100%, 83%, 50%, 60% and 93% respectively for clinically diagnosed TT, BT, BB, BL and LL disease. A sizeable number of BT patients were found to be bacteriologically positive and were therefore being treated with lesser number of drugs as well duration under programme conditions, Although there is inter-observer variation and overlapping of clinical and histological diagnosis in the borderline patients (BT, BB & BL), bacteriological and histological confirmation helps in deciding on adequate treatmeht and should be undertaken.

Oral Tranexamic Acid with Fluocinolone-Based Triple Combination Cream Versus Fluocinolone-Based Triple Combination Cream Alone in Melasma: An Open Labeled Randomized Comparative Trial

Background:

Melasma is a common acquired cause of facial hyperpigmentation with no definitive therapy. Tranexamic acid, a plasmin inhibitor, has demonstrated depigmenting properties and combining this oral drug with other modalities of treatment has shown promising results.

Objectives:

To compare the efficacy of a combination of oral tranexamic acid and fluocinolone-based triple combination cream with that of fluocinolone-based triple combination cream alone in melasma among Indian patients.

Materials and Methods:

40 patients of melasma of either sex attending to dermatology OPD were enrolled in this study. Participants were randomly divided into two groups with 20 patients in each group. Group A patients were asked to apply the cream only and Group B patients received oral tranexamic acid 250 mg twice daily and applied a triple combination cream containing fluocinolone acetonide 0.01%, tretinoin 0.05%, and hydroquinone 2% once daily for 8 weeks. Response was evaluated using melasma area severity index (MASI) at baseline, 4 weeks, and 8 weeks.

Results:

40 patients completed the study. The MASI scores at baseline, 4 weeks and 8 weeks in group A were 15.425 + 1.09, 11.075 + 9.167 and 6.995 + 6.056 respectively and in group B 18.243 + 1.05, 6.135 + 4.94 and 2.19 + 3.38. Intergroup comparison showed a faster reduction in pigmentation in Group B as compared to Group A and the results were statistically significant at 4 weeks (P value 0.014) and 8 weeks (P value 0.000). The efficacy was maintained throughout the 6-month follow-up period.

Conclusion:

Addition of oral tranexamic acid to fluocinolone-based triple combination cream results in a faster and sustained improvement in the treatment of melasma.

Family motivation card: An innovative tool for increasing case detection in a resource poor setting

INTRODUCTION

Leprosy is a chronic infectious disease, causing various physical disabilities and deformities. Even today, stigma leads to late detection of new cases. Household contacts are considered a primary focus for the spread of infection.

AIM AND OBJECTIVE

To find new cases among household contacts of leprosy patients by providing a family motivation card (FMC) to each leprosy patient, thereby enabling early diagnosis and treatment leading to a decrease in disease and disability burden in the community.

MATERIALS AND METHODS

100 patients diagnosed with leprosy (both new and old cases) were enrolled in the study. All patients were provided with a family motivation card. The purpose of giving the card was discussed in detail with each patient. New family contacts brought by old patients were examined thoroughly for the presence of leprosy. Digital color photographs were taken of all family contacts. Data analysis was done.

RESULTS

23 new cases of leprosy (15 (65%) MB and eight (35%) PB cases) were detected among family members of primary cases. Most cases belonged to the under 15 years (43.47%) and over 60 years (34.78%) age groups.

CONCLUSION

Adoption of a simple, cheap yet effective strategy such as the FMC could act as a bridge between intensive case-finding approaches, such as the Modified Leprosy Elimination Campaign (MLEC) and voluntary reporting.

Epidemiological pattern of psoriasis, vitiligo and atopic dermatitis in India: Hospital-based point prevalence

BACKGROUND

The knowledge of the prevalence of common dermatoses will be useful for optimum use of valuable resources of the country.

AIM

The aim of the study is to determine the pattern and prevalence of psoriasis, vitiligo and atopic dermatitis (AD) in India.

MATERIALS AND METHODS

This was a hospital-based study conducted on a single day in one medical college each in four zones of India.

RESULTS

The point prevalence of dermatological cases was 9.25%. The point prevalence of psoriasis, vitiligo and AD were 8%, 9.98% and 6.75% respectively. Chronic plaque type psoriasis was the most common (50%) clinical pattern. The most common site of involvement of psoriasis was the palms. Stable type of vitiligo was common which accounted for 65.21%. Lower lip was involved in 75% of mucosal vitiligo. Lower limbs were the most common site of onset of vitiligo. AD was most prevalent in the first decade (40.7%). Personal history of atopy was present in (59.5%) patients. Dry skin was present in 92.5% of patients.

CONCLUSIONS

Our data correlates with previous hospital-based prevalence studies of psoriasis, vitiligo and AD.

Prevalence of restless legs syndrome among leprosy patients: a hospital based study

INTRODUCTION AND OBJECTIVES

Restless legs syndrome (RLS) is a type of neurological disorder which presents with an uncontrollable urge to move legs and arms. It commonly affects legs more than arms. Data regarding prevalence of restless legs syndrome in leprosy are sparse. The aims and objectives of the study were to find out the prevalence of RLS in people affected by leprosy and to determine the presence and magnitude of sleep disruption in leprosy patients with RLS.

MATERIALS AND METHODS

Total 143 patients diagnosed with leprosy were enrolled in the study. A diagnosis of RLS and a severity assessment were made using the criteria described by International Restless Legs Syndrome Study Group. The Pittsburgh Sleep Quality Index (PSQI) was evaluated in all those who were diagnosed with RLS.

RESULTS

Out of 143 patients recruited in the study, 56 (39.16%) patients were found to be suffering from RLS. Mean Pittsburgh Sleep Quality Index global score was higher (16.55), and the value was specifically higher among patients presenting with Type-2 lepra reaction (17.8) and pure neuritic leprosy (15.93).

CONCLUSIONS

The frequency of RLS among leprosy patients is significantly higher. They suffer from bad sleep quality at night which significantly affects their quality of life. So all patients affected with leprosy should be evaluated for RLS and early treatment should be started to improve their sleep.

Metabolic syndrome and skin: psoriasis and beyond

Metabolic syndrome (Met S) is a clustering of risk factors comprising of abdominal obesity, dyslipidemia, elevated blood pressure, and abnormal glucose tolerance. The prevalence of Met S has been increasing in the last few years throughout the world. Psoriasis has consistently been associated with Met S as well as its various components. However, the association is no longer limited to psoriasis alone. Various dermatological conditions such as lichen planus, androgenetic alopecia, systemic lupus erythematosus, skin tags, acanthosis nigricans, and even cutaneous malignancies have also been found to be associated with this syndrome. Though chronic inflammation is thought to be the bridging link, the role of oxidative stress and endocrine abnormalities has recently been proposed in bringing them together.

Studies on the removal of arsenic (III) from water by a novel hybrid material

The present work provides a method for removal of the arsenic (III) from water. An ion-exchanger hybrid material zirconium (IV) oxide-ethanolamine (ZrO-EA) is synthesized and characterized which is subsequently used for the removal of selective arsenic (III) from water containing 10,50,100mg/L of arsenic (III) solution. The probable practical application for arsenic removal from water by this material has also been studied. The various parameters affecting the removal process like initial concentration of As (III), adsorbent dose, contact time, temperature, ionic strength, and pH are investigated. From the data of results, it is indicated that, the adsorbent dose of 0.7mg/L, contact time 50min after which the adsorption process comes to equilibrium, temperature (25±2), solution pH (5-7), which are the optimum conditions for adsorption. The typical adsorption isotherms are calculated to know the suitability of the process. The column studies showed 98% recovery of arsenic from water especially at low concentration of arsenic in water samples.