Evaluation of Phobia, Knowledge, Attitude and Practice about SARS-CoV-2 Infection, a Study on Healthcare Workers and Their 1st Degree Relatives

BACKGROUND

Phobia as a psychological disorder seems to be aggravated during health crises like the current COVID-19 outbreak. On the other hand, people's knowledge about a situation can help decrease the resulting fear.

STUDY DESIGN

This is a cross-sectional analytical study to evaluate the COVID-19 related phobia and to measure knowledge, attitude, and practice of our target Iranian population about COVID-19.

METHODS

In this study, DSM-5 specific phobia questionnaire, adapted to SARS-CoV2-19 infection, was used to evaluate the COVID-19 related phobia. Moreover, the knowledge, attitude, and practice (KAP) questionnaire, specific for SARS-CoV-2 infection, was applied.

RESULTS

Phobia score was significantly higher in 1st-degree relatives of healthcare staff (20.38±5.82) than healthcare staff (18.36±5.68) (p=0.021). Females showed a significantly more severe phobia (20.27±5.41) than males (17.72±5.35, p=0.001). COVID-19 phobia was significantly more severe in those with past psy-chiatric conditions than in those without psychiatric history (p<0.05). The 1st-degree relatives of healthcare staff had a significantly lower level of knowledge about SARS-CoV-2 infection (8.19±1.65) than healthcare staff (9.08±1.28, p=0.001). Additionally, age had a positive significant correlation with knowledge and practice towards SARS-CoV-2 infection.

CONCLUSION

Both Iranian healthcare staff and 1st-degree relatives of healthcare workers are suffering from moderate COVID-19 phobia. Females are more concerned than males about COVID-19. Phobia is more severe in people with underlying psychiatric conditions than other people. The knowledge level of Iranian healthcare workers and 1st-degree relatives of healthcare staff about COVID-19 is acceptable but it needs improvement in certain areas.

Phobia and Fear of COVID-19: origins, complications and management, a narrative review

Introduction

The outbreak of Coronavirus Disease 2019 (COVID-19) have changed into a global crisis. Psychologically, this process of alteration can lead to feelings of fear, insecurity, and anxiety. This fear and anxiety can be caused by a variety of factors. However, due to the lack of extensive studies at this time, there are little data on these conditions related to COVID-19. Therefore, in this narrative review, we have tried to identify the most important possible causes of anxiety and fear due to this disease, based on logical shreds of evidence. Then we tried to discuss the consequences and ways to manage and prevent them.

Methods

The current focus was on three major axes of corona-phobia, fear and anxiety. PubMed, Science Direct, Scopus, Google Scholar and authoritative news and information sources were considered as the data sources.

Results

Findings from the analysis of the results revealed that, in addition to the real and the logical reasons which belong to the intrinsic properties of SARS-CoV-2, some misleadings and misconceptions induced by media, governmental policies, public awareness level, and non-scientific speculations and contradictory data expressed by experts, researchers and scientific societies, could provide the way for the development of corona-phobia, and fear.

Conclusions

Each of these causal components, in its place, leads to some degrees of psychological disorders and subsequent consequences and complications. Finally, here we reviewed, summarized the previous research findings on how to prevent and manage this type of psychological disorder, and made comparisons.

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Induced by Imatinib

INTRODUCTION

Imatinib is the treatment of choice in patients with locally advanced or metastatic gastrointestinal stromal tumours (GIST). Clinical tolerance of imatinib is excellent except for the common adverse drug reaction (ADR). Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) is a severe, potentially life-threatening drug-induced hypersensitivity reaction, characterized by cutaneous eruptions, fever, diffuse lymphadenopathy, along with eosinophilia, and elevated liver function tests. This ADR is rarely reported with imatinib. Only four cases of DRESS syndrome associated with imatinib have already been published.

CASE REPORT

We report an exceptional case of DRESS syndrome associated with imatinib in a 46 year-old woman with GIST. Two weeks after she had started imatinib therapy, she developed a skin rash, with eosinophilia and elevated liver tests. Plasma level of imatinib was within the therapeutic range. Imatinib was immediately discontinued. A favourable outcome was slowly observed after the drug had been stopped.

RESULTS AND CONCLUSION

This case was scored three according to the European Registry of Severe Cutaneous Adverse Reactions Study Group (RegiSCAR). The Naranjo score for imatinib was five (probable).

[Erythrasma: study of 16 cases]

BACKGROUND

Erythrasma is a chronic bacterial infection due to Corynebacterium minutissimum, affecting the interspaces of the toes, the axillary folds and the groin. Its impact is underestimated as it is often misdiagnosed ad wrongly taken as a dermatophytic infection.

AIM

Through a hospital series, we report the epidemiologic and clinical features of erythrasma, as well as the therapeutic ways. methods: A retrospective study over a 20 year period and including the patients diagnosed as having erythrasma after a Wood's light examination. results: There were 16 patients (6 males and 10 females) with an average age of 44.6 years-old. The majority of our patients consulted on hot season. Clinical examination showed macular plaques with clear limits, erythematous in 6 cases and yellowish in the remaining cases. The lesions were located at the axillary folds in 13 cases; the groin in 2 cases and at all folds in one case. Treatment with erythromycin (topical or general administration) was the most prescribed. Outcome was generally favourable, but recurrences have been noticed.

CONCLUSION

Erythrasma is a frequent misdiagnosed infection and often confused with a mycosis (especially in the interspaces of the toes); knowing that antimycotic agents are efficient in erythrasma. This is probably the reason of the small number of patients in our series.

Bowen's disease: epidemiological and clinical study of 9 Tunisian cases

BACKGROUND

Bowen's disease (BD) is a form of in situ SCC, characterized by chronic and progressive course, with low potential for invasive malignancy.

AIM

To assess epidemiology and clinical features of BD in a Tunisian cohort.

METHODS

A retrospective study of 9 cases of BD managed in a Tunisian dermatology department.

RESULTS

There were 7 males (77.8%) and 2 females (22.2%). The mean age of patients was about 68.8 years (46-89). Lesions were solitary in 7 cases and occurred in various sites: face (1 patient), trunk (2 patients), limbs (6 patients). The mean diameter of the tumour was about 3.4 cm. Lesions presented clinically as an enlarging well demarcated erythematous plaque with irregular borders and crusted or scaling surface. Histological examination showed in all cases abnormal keratinocytes with disordered maturation and loss of polarity replacing the epidermis in its whole thickness. The main treatment was surgery (N=5). Only one patient had radiotherapy (case 1). Outcome was mentioned in 2 patients who remained free from recurrence respectively after a follow-up of 1 and 12 years.

CONCLUSION

Our series outlines epidemiological and clinical features of BD in Tunisia through a small but representative sample. As in the literature, this condition prevailed mainly over 60 years. In our study, BD occurred predominantly in men and affected nonexposed sites in 8 cases. This profile is uncommon in a sunny country in Tunisia, in the absence of other aetiological agents.

Adenolipoma of the skin

Adenolipoma of the skin (ALS) is an uncommon histological variant of lipoma, characterized by the presence of normal eccrine sweat glands inside the fat proliferation. A 32-year-old woman presented to our department with a slow-growing, painless subcutaneous soft tumour located on the upper part of the right thigh. Microscopically, there was lobulated adipose tissue proliferation with well-differentiated eccrine glands and ducts in the periphery and centre of the nodule. These features were suggestive of ALS. ALS is a rare microscopic variant of cutaneous lipoma having similar clinical features to lipoma. The most frequent locations of this tumour are thighs (as in our patient), shoulders, chest and arms. Histologically, the tumour is composed of lobulated adipose tissue with larger and more prominent lobules than those in normal subcutaneous adipose tissue. A well-developed capsule may also be identified. Eccrine glands and ducts, without proliferative changes, are well-differentiated within the adipose tissue. Differential diagnosis of adenolipoma includes the common lipoma and its variants, skin tag and other hamartomatous lesions, such as nevus lipomatosus superficialis, and the lipomatous variant of eccrine angiomatous hamartoma.

A solitary pilar leiomyoma of the trunk

Smooth muscle tumours arising in the skin are divided into angioleiomyomas, genital leiomyomas and pilar leiomyomas. Limited data about solitary leiomyoma are available in the literature. We herein report a case of a 66-year-old man who presented to our department with a slowly progressing cutaneous tumour of the right scapular area that had developed over the past 12 years. Histopathological and immunohistochemical results were consistent with the diagnosis of pilar leiomyoma. Pilar leiomyoma is a benign smooth muscle tumour arising from arrector pili muscle. Tumours can be painful from compression of cutaneous nerves or because of fibre contraction within the tumour in case of cold weather or emotional stress. This case is noteworthy as the piloleiomyoma was solitary, located on the trunk and had an unusual nipple aspect.

Isolated genital annular lichen planus

Annular lichen planus is a rarely reported variant of lichen planus (LP). Although genital lesions are frequent in patients with LP, isolated genital LP is rarely reported. We present a case of a 29-year- -old circumcised man with an asymptomatic annular lesion of the penis. Histopathological features were consistent with LP. Topical clobetasol was prescribed, with clinical improvement. It is important to consider annular LP among the possible diagnoses of individual annular genital lesions.

[Pseudoxanthoma elasticum: a study of 22 cases]

Pseudoxanthoma elasticum is a heritable connective-tissue disorder affecting the eye, skin, and vascular system. The aim of our study was to specify the epidemiological and clinical characteristics of this disease in a hospital series. A total of 22 patients were included during a period of 19 years. There were 15 women and 7 men. Patient's mean age was of 36,1 years. Parental inbreeding was reported in 10 cases. However, the parents were apparently healty. All patients exhibited cutaneous signs. The association between pseudoxanthoma elasticum and elastosis perforans serpiginosa was reported in two cases. The histological features were characteristic in all cases. The ophthalmologic examination realized on 13 patients revealed angioid streaks in 6 cases and a orange peel aspect in one case. Cardiac evaluation performed in 11 patients did not reveal specific PXE abnormalities. A follow-up was recommended in the majority of the cases. In conclusion, a family history of PXE was frequently reported in our study mainly among brothers and sisters. The disease was probably of autosomal recessive transmission. Cutaneous lesions were often the first signs. A list of laboratory investigations is useful to search for asymptomatic visceral localizations and specify their frequency.

Atypical clinical appearance and localization of trichilemmoma. a case report

Trichilemmoma is a benign cutaneous tumor that shows characteristics of differentiation similar to the outer hair sheath. We report the case of a woman presenting with a nodular tender mass of the back that was diagnosed as an isolated trichilemmoma. Several lines of evidence suggest that trichilemmoma should be considered in the differential diagnosis of any indistinct facial papule. This report documents a non-facial example of trichilemmoma. Atypical clinical appearance and localization of this neoplasm in our patient suggest that only histological findings are specific of this tumor.

Spontaneous pneumothorax in adulthood varicella

Varicella is a generalized viral infection that is generally benign if it occurs in childhood, but it has a severe outcome in adulthood. Pneumonia is the main complication of adulthood varicella and may lead to respiratory failure. Spontaneous pneumothorax is a rarely reported complication during varicella in adult patients. Only one case of spontaneous pneumothorax associated with varicella pneumonia (VP) was published in 1990. We report a new case of pneumothorax in VP.

Cutaneous metastases from internal cancers

BACKGROUND

Cutaneous metastases (CMs) from carcinoma are relatively uncommon, being usually late events in the course of internal malignancies. CMs from internal tumors seen at a secondary dermatological centre in Tunis are reported.

METHODS

A retrospective review of the available clinical records and histological material of all patients with CMs from internal malignancies was performed over a 14-year period.

RESULTS

Fourteen cases of CMs were recorded: 8 males and 6 females. The age range was 53 to 96 years, with a mean of 63.5 years for males and 76.5 years for females. CMs represented the first indication of an internal malignancy in 64% of cases. Firm solitary or multiple nodules were the most relevant clinical presentation (93%). Preferred sites were the thorax (50%), the abdomen (29%), and the head and neck region (21%). The common sites of primary malignancy were the lungs (38%) in males and breast (33%) in females. Four out of 14 patients died within a short follow-up period (mean 9.5 months).

DISCUSSION

CMs are relatively rare in patients with internal cancers, but they may be a presenting sign of such cancers.

[Adverse events related to systemic treatment using Glucantime for cutaneous leishmaniasis: a report from Tunisia]

Glucantime is the firstline treatment for cutaneous leishmaniasis in Tunisia. Adverse effects related to systemic administration of Glucantime are frequent. The purpose of this retrospective study was to review the files of 53 patients who were treated for cutaneous leishmaniasis using meglumine antimoniate at a dose of 60 mg/kg/day for 15 days during the period between 1998 and 2007. Adverse effects were observed in 5 men and 4 women with an average age of 40.8 years. Antimony intolerance occurred in 8 patients and stibio-intoxication occurred in 4. Glucantime was considered as the most likely cause of adverse effects in 6 patients and as the plausible cause in 3 patients. Fever was the most frequent complication of antimony intolerance followed by cough, myalgia, and cutaneous lesions. Hepatic cytolysis was the most frequent sign of stibio-intoxication. Asymptomatic elevation of amylase level to 108 UI/l was observed in one case. The most serious complication was acute toxic kidney failure on the 15th day of treatment. The incidence of adverse events to Glucantime ranges from 16% to 59%. The most severe complication is acute renal failure on the 15th day of treatment, as observed in one patient in this series. Patient status must be monitored by performing laboratory tests at the beginning and end of the treatment. Since cutaneous leishmaniasis observed in Tunisia is a self-healing dermatosis that never results in sequels, treatment with Glucantime should be discontinued in any patient who develops suspicious symptoms.

[Extrapalpebral sebaceous carcinoma]

Extra ocular sebaceous carcinoma is a rare carcinoma of the skin known to have difficulties of diagnosis because of its polymorphism of clinical and histopathological findings. His prognosis depends of the precocity of the diagnosis. This neoplasm is aggressive in 29%, lymph node and visceral metastasis aren't rare.

REPORT

A 62-year-old male had a dome-shaped and ulcerated tumor located on the left temple. The lesion appeared after eight months ago. It suspected a squamous cell carcinoma. The histologic findings revealed a sebaceous carcinoma in his mixed and moderately differentiated type.

COMMENTS

Sebaceous carcinoma exhibits a variety of histologic growth patterns and diverse clinical presentations that the diagnosis is often difficult. We discuss incidence as well as clinical, histological and established the diagnosis and the prognosis of this aggressive neoplasm.

Mycetoma: retrospective study of 13 cases in Tunisia

Mycetomas are inflammatory pseudotumors of chronic and progressive evolution, of fungal (Eumycetoma), or bacterial (Actinomycetoma) origin. We conducted a retrospective study of patients who have been consulted for mycetoma over a period of 28 years. Thirteen cases of mycetomas were collected during the 28-year period, 10 patients were of rural origin. The lesions were localized on the foot in all instances. There was no male predominance. Histopathological examination confirmed mycetoma in all 13 cases and the determination of the infectious agent in 9 cases: 4 actinomycotic and 5 fungal. Microbiological examination identified the species in 7 cases. Bone involvement was found in 10 cases. Eumycetomas were treated by ketoconazole. The other cases were treated as actinomycetomas by antibiotics. The antibiotic treatment was associated with surgical excision in 4 cases and with amputation in 1 case. Mycetomas are rare in Tunisia, and only observed sporadically, for this reason the diagnosis is usually late, with severe functional, psychological, and socioeconomic consequences.

Photo-onycholysis: two cases induced by doxycycline

Photo-onycholysis is a phototoxic reaction, which is usually drug-induced. It consists of the separation of the nail from the nail bed due to ultraviolet radiation. We report two cases of female patients who developed distal onycholysis while receiving doxycycline. Among the drugs that cause photo-onycholysis, the most frequently cited are tetracyclines, psoralens and fluoroquinolones. Photo-onycholysis is often distal, half-moon shaped and can be surrounded by pigmentation. Spontaneous recovery follows within a few months of discontinuing the drug.

Congenital lower lip pits: a case report

The Van der Woude syndrome is a rare autosomal-dominant condition typically comprising cleft lip or cleft palate and distinctive pits of the lower lips. The degree to which individuals carrying the gene are affected varies widely, even within families. The variable manifestations include lip pits alone, absent teeth, and isolated cleft lip and palate of varying degrees of severity. Other associated anomalies have also been described. We report a case of Van der Woud syndrome manifesting with isolated lower lip pits in an adolescent female with similarly affected family members.