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      The Impact of COVID-19 on Medical Practice: A Nationwide Survey of Dermatologists and Healthcare Providers in Iraq

      research-article
      , MBChB, FABMS–Dermatology 1 , * , a , , MBChB, FABMS–Dermatology 2 , , , MBChB, FABMS–Dermatology 3 , * , , MBChB, FABMS–Dermatology 2 , , , MBChB, FABMS–Dermatology 4 , , , MBChB, FABMS–Dermatology 1 ,
      Clinics in Dermatology
      Elsevier Inc.
      PPE-related dermatoses, COVID-19 pandemic, COVID-19 and dermatology, COVID-19 cutaneous manifestations, Tele-medicine

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          The COVID-19 pandemic has dramatically changed medical practice worldwide. It posed a significant impact on different health services, including dermatology. A Cross-sectional observational study of 200 healthcare providers and 100 dermatologists (survey 1 and 2, respectively) were conducted to determine the prevalence of occupational skin diseases among healthcare providers working amid the pandemic, and to demonstrate the outbreak's impact on dermatology practice.

          Most healthcare providers (83%) reported hygiene-related hand dermatitis. The rates of PPE- related dermatoses were estimated to be 73%, including pressure injuries (51.9%), acne (33.1%), non-gloves contact dermatitis (29.9%), nonspecific eruption (17.5%), urticaria (9.1%) and skin infections (3.2%). The emerging COVID-19-related cutaneous manifestations were recognized by 20% of surveyed dermatologists, including maculopapular eruption (41.67%), urticaria (37.50%), chilblain (25%) and vasculitis (16.67). Telemedicine was provided by 73% of the dermatologists, and 89% reported minimal use of immunosuppressive drugs amid the pandemic.

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          Most cited references18

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          Clinical Characteristics of Coronavirus Disease 2019 in China

          Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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            Presumed Asymptomatic Carrier Transmission of COVID-19

            This study describes possible transmission of novel coronavirus disease 2019 (COVID-19) from an asymptomatic Wuhan resident to 5 family members in Anyang, a Chinese city in the neighboring province of Hubei.
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              Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study

              Summary Background Rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, prompted heightened surveillance in Shenzhen, China. The resulting data provide a rare opportunity to measure key metrics of disease course, transmission, and the impact of control measures. Methods From Jan 14 to Feb 12, 2020, the Shenzhen Center for Disease Control and Prevention identified 391 SARS-CoV-2 cases and 1286 close contacts. We compared cases identified through symptomatic surveillance and contact tracing, and estimated the time from symptom onset to confirmation, isolation, and admission to hospital. We estimated metrics of disease transmission and analysed factors influencing transmission risk. Findings Cases were older than the general population (mean age 45 years) and balanced between males (n=187) and females (n=204). 356 (91%) of 391 cases had mild or moderate clinical severity at initial assessment. As of Feb 22, 2020, three cases had died and 225 had recovered (median time to recovery 21 days; 95% CI 20–22). Cases were isolated on average 4·6 days (95% CI 4·1–5·0) after developing symptoms; contact tracing reduced this by 1·9 days (95% CI 1·1–2·7). Household contacts and those travelling with a case were at higher risk of infection (odds ratio 6·27 [95% CI 1·49–26·33] for household contacts and 7·06 [1·43–34·91] for those travelling with a case) than other close contacts. The household secondary attack rate was 11·2% (95% CI 9·1–13·8), and children were as likely to be infected as adults (infection rate 7·4% in children <10 years vs population average of 6·6%). The observed reproductive number (R) was 0·4 (95% CI 0·3–0·5), with a mean serial interval of 6·3 days (95% CI 5·2–7·6). Interpretation Our data on cases as well as their infected and uninfected close contacts provide key insights into the epidemiology of SARS-CoV-2. This analysis shows that isolation and contact tracing reduce the time during which cases are infectious in the community, thereby reducing the R. The overall impact of isolation and contact tracing, however, is uncertain and highly dependent on the number of asymptomatic cases. Moreover, children are at a similar risk of infection to the general population, although less likely to have severe symptoms; hence they should be considered in analyses of transmission and control. Funding Emergency Response Program of Harbin Institute of Technology, Emergency Response Program of Peng Cheng Laboratory, US Centers for Disease Control and Prevention.
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                Author and article information

                Journal
                Clin Dermatol
                Clin Dermatol
                Clinics in Dermatology
                Elsevier Inc.
                0738-081X
                1879-1131
                26 November 2020
                26 November 2020
                Affiliations
                [1 ]Baghdad Teaching Hospital, Department of Dermatology and Venereology
                [2 ]University of Tikrit, College of Medicine, Department of Dermatology and Venereology
                [3 ]University of Kerbala, College of Medicine, Department of Medicine
                [4 ]Al-iskandria Hospital, Department of Dermatology and Venereology
                Author notes
                [a ]Corresponding author: Mohammed Shanshal, MBChB, FABMS–Dermatology. Specialist Dermatologist at Baghdad Teaching Hospital, Department of Dermatology and Venereology. https://orcid.org/0000-0003-2877-5919.
                [⁎]

                Specialist dermatologist, MBChB, FABMS–Dermatology

                [ᶺ]

                Specialist dermatologist, MBChB, FIBMS–Dermatology

                Article
                S0738-081X(20)30228-5
                10.1016/j.clindermatol.2020.11.010
                7688429
                34518011
                845694b3-db44-40ff-8df2-99e1b55f5b19
                © 2020 Elsevier Inc. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                ppe-related dermatoses,covid-19 pandemic,covid-19 and dermatology,covid-19 cutaneous manifestations,tele-medicine

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