We evaluated the performance of oral swab specimen both health-care worker (HCW) collected and self-collected for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) detection with rapid antigen test (RAT) as compared to reverse transcriptase polymerase chain reaction (RT-PCR). Of the 529 participants enrolled, 121 (22.8%) were RT-PCR positive. Among the RT-PCR positives, 62 (51.2%) were RAT positive using oral swab. When compared with RT-PCR, RAT with oral swab had sensitivity and specificity of 63.3 and 96.8% respectively among symptomatic individuals. No statistically significant difference was observed in RAT positivity with HCW collection and self-collection, p = 0.606. Ct values were significantly lower in RT-PCR and RAT positive samples (ORF gene: 18.85 ± 4.36; E gene: 18.72 ± 4.84) as compared to RT-PCR positive and RAT negative samples (ORF gene: 26.98 ± 7.09; E gene: 26.97 ± 7.07), p < 0.0001. Our study demonstrated moderate sensitivity of RAT with oral swab in symptomatic individuals. Oral swab was the preferred sampling by almost all participants in terms of convenience and comfort as compared to nasopharyngeal swab. Oral swabs have utility for SARS-CoV-2 antigen detection among symptomatic individuals residing in remote rural areas and can serve as an initial screening tool during COVID-19 spikes when cases rise exponentially and laboratory capacities for RT-PCR testing become overwhelmed.

Skin cancer is an overarching label used to classify a variety of cutaneous malignancies. Surgical excision procedures are the commonly used treatments for these lesions; however, the choice to perform operative intervention may be influenced by other factors. Established research and literature suggest that topical treatments limit the need for surgical intervention and its commonly associated adverse effects, including infection and scarring. In addition, the growing indications for the usage of topical therapies in BCC treatment, as well as their increased availability and therapeutic options, allow for their greater applicability in the dermatology clinic. Certain topical therapies have been highlighted in research, especially those targeting basal cell carcinoma (BCC) and actinic keratosis (AK). There is also a clear correlation between cost and treatment outcomes, considering BCC’s ever-growing prevalence and the proportion of excised lesions being reported as malignant. This review will discuss BCC and AK lesion criteria that result in the most successful outcomes using topical treatments, then highlight the various topical treatment options, and finally address their clinical significance moving forward.

Facial intramuscular injections of Botulinum toxin (BoNT) injections are among the most common cosmetic procedures in dermatology. Rarely, serious adverse reactions such as blepharoptosis, diplopia and periorbital hematoma may occur with improper administration technique. Here we report a case of painless diplopia 5 weeks post‐BoNT injection for ‘crow's feet’ likely due to inadvertent BoNT diffusion into the lateral rectus muscle causing a temporary palsy. This case aims to raise awareness of proper cosmetic BoNT injection techniques in the periorbital area to avoid ophthalmic complications.

UNSTRUCTURED Steven-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome are a spectrum of life-threatening conditions characterized by sloughing of the skin and epidermal necrosis. SJS/TEN generally occurs after initiation of a new medication and lead to infection, electrolyte imbalances, multi-organ failure and death. Despite the mortality risk, there is a lack of consensus in the acute management of SJS/TEN, with systemic interventions and supportive measures being the general course of treatment. This manuscript aims to summarize the key findings from the original Cochrane systematic review of interventions for treatment of SJS, TEN and SJS/TEN overlap syndrome. To evaluate the systemic therapies for SJS/TEN, a systematic review of clinical trials and prospective observational comparative studies of SJS/TEN was conducted. The primary endpoint was disease specific mortality (DSM) and adverse events (AE's) leading to discontinuation of the systemic treatment therapy. Secondary endpoints included time to complete re-epithelialization, intensive care unit length of stay, total hospital length of stay, illness sequelae, and AE's. Key comparator studies across different treatment options were also included to highlight the optimal agent for SJS/TEN treatment. Nine total studies were identified and included in the systematic review. Systemic corticosteroids had a higher risk of DSM compared to other therapeutic agents. Corticosteroids and IVIG compared to IVIG alone showed no difference in risk of DSM, time to re-epithelialization, and length of stay. The patients receiving etanercept were 49% less likely to have DSM compared to prednisolone. Serious adverse events (SAE's) such as sepsis and respiratory failure occurred with etanercept and corticosteroids, but it was unclear whether these AE’s led to treatment discontinuation. In the cyclosporine versus IVIG comparator group, it was uncertain if there was a difference in mortality. Future studies including larger clinical trials are needed to evaluate direct comparisons between different treatment agents to optimize agent selection for SJS/TEN management.

The present study was conducted to compare the performance of patient self‐collected oral swab (OS) with healthcare worker (HCW)‐collected nasopharyngeal swab (NPS) for SARS‐CoV‐2 detection by reverse transcription polymerase chain reaction (RT‐PCR) in real‐world setting. Paired OS and NPS were collected from 485 consecutive individuals presenting with symptoms of coronavirus disease‐19 (COVID‐19) or asymptomatic contacts of COVID‐19 cases. Both specimens were processed for RT‐PCR and cycle threshold (Ct) value for each test was obtained. Positive percent agreement (PPA), negative percent agreement (NPA), overall percent agreement (OPA) and kappa were calculated for OS RT‐PCR compared with NPS RT‐PCR as reference. A total of 116/485 (23.9%) participants were positive by NPS RT‐PCR. OS had PPA of 71.6%, NPA of 98.8%, OPA of 92.4% and kappa of 0.771. Almost all participants (483/485, 99.6%) reported OS as a convenient and comfortable sample for SARS‐CoV‐2 testing over NPS. All participants with Ct values <25 and majority (90.8%) with Ct values <30 were detected by OS. To conclude, OS self‐sampling was preferred in comparison with NPS due the ease and comfort during collection. The performance of OS RT‐PCR for SARS‐CoV‐2 detection, however, was sub‐optimal in comparison with NPS RT‐PCR.