Disease Severity Scale Research Articles

Incidence of Natural Virus Infection on Selected Improved Genetic Varieties of Cassava (Manihot esculenta Crantz) in Minna, Northern Nigeria

Cassava is a major staple food source for millions of people in Africa. It is one of the most cultivated root crops and it is a sustainable source of food security and family income for the poor in the developing world. Despite its economic significance, cassava yield is significantly reduced by viral diseases which can often result in 100 % yield loss in susceptible cultivars. Through a field-based randomized complete block-designed experiment, the present study screened five cassava genotypes in three replications at Teaching and Research Farm, Federal University of Technology, Minna, Nigeria. Collected samples were scored based on disease severity scale and data were subjected to ANOVA. Research results reveal that the five genotypes (PRV A, TME 419, TMS 98/0505, TMS 98/0581, and TMS 30572) were asymptomatic throughout the growing season, suggesting that all treatments were resistant to natural virus infection. Despite all treatments being resistant to virus infection, TME 419 had a better growth and yield performance compared to other treatments. Hence, the cassava genotypes identified in this study could be used for future breeding programs as resistant varieties to virus diseases in Minna, which can enhance food security and family income. Additionally, more research is needed to better understand the effect of diseases on these selected varieties.

P0238 Reliability of magnetic resonance imaging indices for evaluating perianal fistulizing disease activity in paediatric Crohn’s disease

Abstract Background Progress in clinical trials and drug development for paediatric perianal fistulising CD (pfCD) depends upon accurate, reproducible imaging to assess disease activity and measure treatment response. We evaluated the inter- and intra-rater reliability of existing radiologic disease activity indices and anatomical classification systems previously identified as appropriate for assessment of paediatric pfCD.1 Methods A retrospective cohort (N=50) of magnetic resonance imaging (MRI) exams representing a full spectrum of paediatric (<18 years) perianal CD severity was selected by a single expert paediatric radiologist. Methods described by Zou2 were used to estimate sample size. Three separate radiologists (2 paediatric) blinded to clinical information assessed pfCD in the exams using the Magnetic Resonance Novel Index for Fistula Imaging in CD (MAGNIFI-CD), Van Assche Index (VAI), modified VAI (mVAI), Paediatric MRI based Perianal Crohn’s disease (PEMPAC) index, a visual analogue scale (VAS) of overall pfCD disease severity (range, 0-100 mm), as well as with the Park’s and St. James University Hospital anatomic classification systems. Two radiologists read all exams twice, separated by 2 weeks, and 1 radiologist read the exams once (250 total reads). Intra- and inter-rater reliability was evaluated using intraclass correlation coefficients (ICC; equivalent to weighted kappa). Precision of the ICC estimates was quantified with 95% confidence intervals (CIs) obtained using clustered bootstrapping. Degree of reliability was interpreted with benchmarks proposed by Landis and Koch3. Results Median age of children was 13.5 years (IQR 11.4-16.1), and 64% were male. Median Paediatric Crohn’s Disease Activity Index score at time of imaging was 17.5 (IQR 10-32.5). Substantial (ICC>0.61) inter-rater reliability was observed for MAGNIFI-CD, VAI, and mVAI (Table 1), with the highest ICCs observed for the mVAI (0.72 [0.6 to 0.79]). Moderate (ICC>0.41) inter-rater reliability was observed for PEMPAC, St. James University Hospital classification, and the VAS, and fair (ICC>0.21) inter-rater reliability was observed for Parks classification. Intra-rater reliability was nearly perfect (ICC>0.81) for the VAS, and substantial for all indices except for Parks classification, which had moderate (0.60 [0.44 to 0.75]) intra-rater reliability (Table 1). Conclusion Most existing multi-item MRI-based disease activity indices and the St. James Hospital classification were reliable for the assessment of paediatric pfCD in our cohort. Our preliminary results suggest that the disease activity indices may have utility to measure treatment effect in paediatric pfCD clinical trials.

Comparative study between fractional laser assisted drug delivery of botulinum toxin versus botulinum toxin injection in primary palmar and axillary hyperhidrosis.

Palmar hyperhidrosis is common condition that is challenging to treat. Nonsurgical treatments include topical antiperspirants, iontophoresis, anticholinergic drugs and botulinum toxin injections. To evaluate the safety and efficacy of ablative fractional laser therapy, combined with topically applied botulinum toxin versus its injection for the treatment of hyperhidrosis. This study included 40 patients with pimary hyperhydrosis divided into two groups. Group A (n = 20) diagnosed with primary axillary hyperhidrosis was further subdivided into 2 equal subgroups; for which was used fractional laser assisted drug delivery of botulinum toxin in right axilla and botulinum toxin injection in left axilla. Group B (n = 20) diagnosed with primary palmer hyperhidrosis was further subdivided into 2 equal subgroups; for which was used fractional laser assisted drug delivery of botulinum toxin in right palm and botulinum toxin injection in left palm. There was a statistically significant decrease in the hyperhidrosis disease severity scale (HDSS) in all subgroups after treatment as compared to before treatment. Following 3 months of treatment, the amount of sweat as detected by transepidermal water loss (TEWL) was statistically significantly lower in the injection subgroup in both the axillary group (p = 0.075) and the palmer group (p < 0.001). The use of both botulinum toxin injection and laser assisted botulinum toxin drug delivery were associated with significant improvement in the manifestation, disease severity and quality of life in the cases with both axillary and palmer hyperhidrosis. Fractional CO2 laser-assisted drug delivery (LADD) represents a safe, minimally invasive procedure that enhances the delivery of BTX-A.

Evaluation of Efficacy and Safety of miraDry® Procedure in the Treatment of Primary Axillary Hyperhidrosis.

Primary axillary hyperhidrosis significantly impacts the quality of life of affected individuals. miraDry®, a non-invasive local precisely controlled thermal energy procedure, represents a promising treatment option. This retrospective analysis aimed to evaluate the treatment success and patient safety following miraDry® procedure in the treatment of primary axillary hyperhidrosis. A total of 139 patients receiving miraDry® procedure from 2019 to 2023 with miraDry® fresh protocol for treatment of excessive axillary hyperhidrosis were analyzed. Subjective assessment was performed before and after treatment using hyperhidrosis disease severity scale (HDSS). Minor test (iodine starch test) was done before treatmentand 6 months after treatment to objectively quantify sweat severity. Patients with subjective or objective unsatisfied results after first procedure were scheduled for a second treatment. The majority of treated patients (84%) could effectively be treated with one single treatment, while only 16% (n = 22) required a secondary intervention. HDSS after treatment completion (single and double treatment) showed a significant improvement (p < 0.001) in subjective evaluation of the treatment success. Minor tests demonstrated a significant reduction in sweat severity (p < 0.001), with 95% of patients experiencing no or minimal sweating after treatment completion. The miraDry® procedure demonstrated a favorable safety profile with typical and transient treatment reactions that mostly resolved within 6 months (94.2%) CONCLUSION: Our data demonstrate that miraDry® procedure is an effective and safe treatment option for primary axillary hyperhidrosis, which results in an immense improvement in quality of life and high satisfaction of affected individuals. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Safety and efficacy of glycopyrronium tosylate in patients with primary axillary hyperhidrosis: a systematic review and meta-analysis

Hyperhidrosis affects approximately 4.8% of the US population, impairing quality of life with excessive sweating. Glycopyrronium tosylate (GT), a topical anticholinergic, treats primary axillary hyperhidrosis in adults and pediatric patients. Despite its use, comprehensive evaluation of GT’s long-term safety and efficacy has been lacking. This systematic review and meta-analysis aimed to assess GT’s effectiveness and safety profiles. Following Cochrane and PRISMA guidelines, we conducted a thorough search of electronic databases for clinical trials on GT. Studies underwent quality assessment and data extraction based on predefined criteria. Primary outcomes included changes in the Dermatology Life Quality Index (DLQI), Hyperhidrosis Disease Severity Scale (HDSS), and Axillary Sweating Daily Diary (ASDD) or its change score (ASDD-C). Secondary outcomes evaluated safety concerns like mydriasis, dry mouth, urinary hesitation, and treatment-emergent adverse events. Our analysis, integrating data from three randomized controlled trials, highlights GT’s efficacy in improving quality of life and reducing sweating severity. Although minor adverse effects were reported, no significant increase in serious adverse events was observed. These findings suggest GT as a promising treatment for primary axillary hyperhidrosis, with benefits outweighing minimal side effects.

Screening Taro Germplasm against Bacterial Blight Incited by Xanthomonas axonopodis pv. dieffenbachia

Sixty-four Taro germplasm accessions from north east India along with two national released varieties were evaluated in natural epiphytotic field condition against bacterial blight incited by Xanthomonas axonopodis pv. dieffenbachia for two consecutive seasons during 2018 and 2019 at an Experimental Farm for Horticultural crops, Assam Agricultural University, Jorhat. The results obtained for the two growing seasons were pooled together. Per cent disease incidence and disease severity ranged from 23.81 (Nepali-2) to 78.57 % (SC-1) and 14.17 (Nepali-2) to 67.50 % (SC-1) respectively. The area under the disease progress curve (AUDPC) which directly corresponds to the bacterial disease infection with time resulting in more susceptibility to the disease ranged from 1612.5 (Sreekiran) to 9812.5 (SC-1). AUDPC was calculated from the per cent disease severity obtained from the first day of disease observation till the last day i.e. from 60 to 240 days after transplanting (DAT). The disease reactions of different germplasm to bacterial blight of colocasia were evaluated based on the disease severity (%) and disease rating scale whereby no cultivars were immune and highly susceptible to the disease. Four accessions viz. Sreekiran, Naga-2, Chandil Pin, Nepali-2 were resistant, twenty-one were moderately resistant, twenty-six were moderately susceptible and fifteen were susceptible. Variety/germplasm resistant to bacterial blight of Taro have not been reported till date. Proper selection of resistant varieties will be useful in breeding programmes and for further crop improvement.

The Validity and Reliability of the Turkish version of Modified Medical Research Council Dyspnea Scale in Systemic Sclerosis Patients with Interstitial Lung Disease.

The aim was to investigate the validity and reliability of the Turkish version of the Modified Medical Research Council (mMRC) Dyspnea Scale in Systemic Sclerosis (SSc) patients with Interstitial Lung Disease. Thirty patients diagnosed with SSc according to the 2013 EULAR/ACR criteria were included. After recording the demographic data of the patients, dyspnea was evaluated with the Visual Analogue Scale (VAS), exercise capacity with the 6 Minute Walk Distance (6MWD), fatigue level with the Fatigue Severity Scale (FSS), disease activity with the Medsger Disease Severity Scale, skin involvement with the Modified Rodnan Skin Score, and dyspnea level with the mMRC Dyspnea Scale. The mMRC Dyspnea Scale was administered to the patients with SSc who did not receive any treatment for test-retest reliability at 1-week intervals. The observed scale range in mMRC (TR) was 0-4, and twelve out of the thirty patients (40%) were classified as having "moderate dyspnea." mMRC (TR) showed a significant moderate positive correlation with VAS dyspnea (rho: 0.718), a low negative correlation with 6MWD (rho: -0.445), and a low positive correlation with FSS (rho: 0.385). The weighted kappa statistic, used as an agreement scale for ordinal responses, was found to be 0.587 (indicating moderate agreement). The Turkish version of the mMRC Dyspnea Scale demonstrates validity and reliability in SSc patients with interstitial lung disease.

A Pivotal Study on the Safety and Effectiveness of a Targeted Alkali Thermolysis Patch for Treatment of Primary Axillary Hyperhidrosis or Excessive Axillary Sweating.

One-third of US adults are bothered by excessive sweating, approximately 5% are diagnosed with hyperhidrosis. A topical patch using targeted alkali thermolysis (TAT) was developed for treatment of this condition. This study was intended to assess the efficacy and safety of the TAT-Patch for axillary sweat reduction. A randomized, multicenter, double-blind, sham-controlled, pivotal trial enrolled 120 subjects to a bilateral axillary treatment with a TAT patch (63 subjects) or sham patch (57 subjects). The primary end point was achieved; 64% of TAT-treated versus 44% of sham-treated subjects ( p = .0332) improved from Hyperhidrosis Disease Severity Scale (HDSS) 3/4 to HDDS 1/2 at 4 weeks. Targeted alkali thermolysis treatment also showed a statistically significant improvement over sham treatment for all secondary end points, including gravimetric sweat production and subject-reported quality-of-life (QoL) assessments. The duration of effect is approximately 3 months, determined by the time to return to baseline HDSS. Mild-to-moderate treatment-site adverse events (AEs) were reported in 22% of TAT patch subjects. No serious or severe AEs were reported. HDSS, GSP, and QoL findings confirm clinically meaningful sweat reduction and a significant improvement in quality of life following a single TAT patch treatment. This device has potential to offer a new, noninvasive treatment option that is well tolerated with minimal downtime.

Longitudinal validity of the Hyperhidrosis Quality of Life Index (HidroQoL©) in a phase IIIb clinical trial population with hyperhidrosis: responsiveness and meaningful change.

The Hyperhidrosis Quality of Life Index (HidroQoL ©) is a well-developed patient-reported outcome measure assessing the quality of life (QoL) impacts in hyperhidrosis, which has proven very good measurement properties, such as structural validity and internal consistency. We aimed to investigate responsiveness over time and estimate values for meaningful within-person change (MWPC) towards symptom improvement for different measurement time points (4 and 12 weeks), extending the existing validity evidence in patients with primary axillary hyperhidrosis. Data (from a phase IIIb clinical trial) was collected at baseline, week 4, week 8, week 12, week 28, week 52, and week 72. For the assessment of responsiveness, HidroQoL change scores were correlated with corresponding change scores of the Hyperhidrosis Disease Severity Scale (HDSS), the Dermatology Life Quality Index (DLQI), and the gravimetric sweat production based on a-priori formulated hypotheses. Furthermore, it was tested whether the different HDSS change score groups differed significantly from each other over time and whether the HidroQoL was sensitive towards these group differences over time. This was extended by the calculation of matched-pair tests and effect sizes to test significance for each change group separately. For the estimation of MWPC thresholds towards symptom improvement, different anchor-based and integrated approaches were used. In total, the sample was composed of 357 patients with primary axillary hyperhidrosis. For the assessment of responsiveness, 5 out of 14 a-priori hypotheses regarding the correlation of the change scores could be confirmed, whereas the rejected hypotheses only marginally differed from the expected values. Furthermore, regarding responsiveness, the HidroQoL showed sensitivity towards symptom improvement at each measurement time point. Effect sizes were large as expected (d ≥ 0.806). MWPC thresholds towards symptom improvement were proposed for two measurement time points: 5 (week 4) and 6 (week 12). Increasing MWPC values over time were observed. This study extends the evidence for the longitudinal validity of the HidroQoL up to 72 weeks and proposed MWPC thresholds for different time intervals (4 and 12 weeks) after baseline, aiding interpretability. Results concur with findings from previous validation studies.

Grading of diabetic retinopathy using a pre-segmenting deep learning classification model: Validation of an automated algorithm.

To validate the performance of autonomous diabetic retinopathy (DR) grading by comparing a human grader and a self-developed deep-learning (DL) algorithm with gold-standard evaluation. We included 500, 6-field retinal images graded by an expert ophthalmologist (gold standard) according to the International Clinical Diabetic Retinopathy Disease Severity Scale as represented with DR levels 0-4 (97, 100, 100, 103, 100, respectively). Weighted kappa was calculated to measure the DR classification agreement for (1) a certified human grader without, and (2) with assistance from a DL algorithm and (3) the DL operating autonomously. Using any DR (level 0 vs. 1-4) as a cutoff, we calculated sensitivity, specificity, as well as positive and negative predictive values (PPV and NPV). Finally, we assessed lesion discrepancies between Model 3 and the gold standard. As compared to the gold standard, weighted kappa for Models 1-3 was 0.88, 0.89 and 0.72, sensitivities were 95%, 94% and 78% and specificities were 82%, 84% and 81%. Extrapolating to a real-world DR prevalence of 23.8%, the PPV were 63%, 64% and 57% and the NPV were 98%, 98% and 92%. Discrepancies between the gold standard and Model 3 were mainly incorrect detection of artefacts (n = 49), missed microaneurysms (n = 26) and inconsistencies between the segmentation and classification (n = 51). While the autonomous DL algorithm for DR classification only performed on par with a human grader for some measures in a high-risk population, extrapolations to a real-world population demonstrated an excellent 92% NPV, which could make it clinically feasible to use autonomously to identify non-DR patients.

Efficacy and safety of topical glycopyrronium bromide in treating axillary hyperhidrosis: systematic review and meta-analysis

BackgroundHyperhidrosis (HH), characterized by excessive sweating, poses a significant challenge to patients’ quality of life. This meta-analysis evaluates the safety and efficacy of topical glycopyrronium bromide (GBP) in treating primary hyperhidrosis, a chronic condition affecting various body regions. Despite its prevalence, primary axillary hyperhidrosis is often undertreated due to a lack of awareness and social stigma.MethodsFollowing PRISMA guidelines, we conducted a systematic review and meta-analysis of randomized controlled trials comparing GBP to a placebo in primary hyperhidrosis patients. Eligibility criteria included outcomes related to perspiration suppression and symptom improvement.ResultsFour RCTs involving 1401 patients were included. GBP significantly increased Hyperhidrosis Disease Severity Scale (HDSS) responders (RR = 2.33, 95% CI [1.99 to 2.74], p < 0.00001) and Axillary Sweating Daily Diary (ASDD/ASDD-C) responders (MD = 3.07, 95% CI [2.32 to 4.06], p < 0.002) without significantly causing adverse events. Dermatology life quality index was also significantly improved in the GBP group (MD = -2.32, 95% CI [-3.09, -1.55], P < 0.00001).ConclusionGBP demonstrated effectiveness in reducing sweat production while improving HDSS and DLQI scores. Adverse events included dry mouth and anticholinergic effects. Dry eye and local skin reactions were not significant, which makes GBP promising in managing primary hyperhidrosis, offering improvements in symptoms and quality of life. While adverse events should be considered, further research with larger sample sizes and long-term follow-up is warranted for comprehensive clinical integration.

Iontophoresis Improves the Impact on the Quality of Life of Children with Primary Hyperhidrosis-A Prospective Study and a Short Review.

Primary hyperhidrosis (PH) is a somatic and idiopathic pediatric skin disease. The eccrine glands are tiny and very numerous, with approximately 3 million distributed throughout the skin. There is no commonly accepted amount of sweating to define hyperhidrosis, but people with this disease suffer real limitations integrating into society, which can be quantified through quality of life measurement scales. We want to draw attention to this disease and its impact on children's quality of life because it is significant and there are no studies conducted on groups consisting solely of children. There are various quality of life evaluation questionnaires for hyperhidrosis. We studied 103 children with hyperhidrosis by monitoring their sweat severity and its impact on quality of life, using the Hyperhidrosis Disease Severity Scale. We compared the scale results before and after 10 days of iontophoresis. This study includes only children under 18 years old, treated with iontophoresis. The average age of the group is 11.84 ± 2.89 years. Treatment success is recorded in 68 (66.02%) children, but a change in the score is recorded in 74 (71.84%) children. The average HDSS score at T0 is 2.95 ± 0.70, compared to the HDSS score at T1 of 1.92 ± 0.86. Hyperhidrosis has a negative impact on daily life, especially self-esteem, occupational productivity, emotional well-being, and interpersonal relationships. Iontophoresis is a safe and effective treatment method that reduces the severity of hyperhidrosis and increases the quality of life.

Fractional CO2 Laser-Assisted Delivery of Botulinum Toxin-A Versus Aluminum Chloride in Treatment of Primary Palmar Hyperhidrosis.

Primary palmar hyperhidrosis (PPH) constitutes a distressing dermatologic condition that greatly affects patients' quality of life. Its management still needs to be addressed to find a suitable therapeutic modality that is readily available, cost effective, and gives patients a quite long disease-free period. To assess the efficacy of fractional CO2 laser as a delivery method for botulinum toxin-A (BTX-A) and aluminum chloride in treating PPH. Twenty-four subjects with PPH were treated on both hands with fractional CO2 laser followed on the right hand with topical BTX-A and on the left hand with topical aluminum chloride. Minor's starch-iodine test and Hyperhidrosis Disease Severity Scale (HDSS) were used for evaluation of treatment response and for follow-up. There was a significant improvement in HDSS in both groups, but there was no statistically significant difference in the therapeutic response for both modalities. There was a statistically significant longer disease-free period in the BTX-A-treated hands. Fractional CO2 laser-assisted drug delivery (LADD) represents a safe, minimally invasive procedure that enhances the delivery of BTX-A and aluminum chloride, the two most widely used agents for treating PPH, with a comparable anhidrotic response.

SCREENING OF COTTON (GOSSYPIUM HIRSUTUM L.) GERMPLASM AGAINST COTTON LEAF CURL VIRUS (CLCUV)

Cotton Leaf Curl Virus (CLCuV) is a devastating disease affecting cotton production worldwide, particularly in South Asia and Africa transmitted by the whitefly (Bemisia tabaci). CLCuV infection leads to severe symptoms, including leaf curling, vein thickening, stunted growth, and significant yield losses. Developing resistant cotton varieties is the most suitable strategy for managing CLCuV, given the limitations and environmental concerns associated with chemical controls. This study aimed to evaluate the resistance and susceptibility of different cotton varieties to CLCuV under natural field conditions and artificially infected condition using a disease severity scale ranging from 0 (highly resistant) to 5 (susceptible). A total of five cotton varieties, were assessed at three critical growth stages: vegetative, flowering, and boll formation. Disease severity, and yield components were recorded to determine extent of resistance of each variety. The results indicated that genotypes and treatments had significant variation in control compared to T1. According to DSI, NIAB-852 was scored as resistant with 10% infected leaves. FH-142 and CIM-496 were scored as tolerant according to DSI with 10-25% infection in leaves. NIAB Karishma and CIM-448 were scored as moderately susceptible with 50-75% infection. All genotypes had significant reduction in number of bolls, boll weight and seed cotton yield in T1 than control. These findings provide valuable insights into the effectiveness of existing cotton germplasm against CLCuV and highlight the need for continuous evaluation and development of resistant varieties. The study highlights the importance of generating resistant cultivars, thereby ensuring sustainable cotton production.

Treatment of Primary Axillary Hyperhidrosis with Two Doses of Botulinum Toxin A-Observational Study.

Hyperhidrosis (HH) is defined as the production of more sweat than is necessary for its thermoregulatory function, negatively affecting patients' quality of life and interfering with their social, work and family life. In this context, the aim of thisstudy was to evaluate the efficacy of two different doses of botulinum toxin type A (50 or 100 units) in each axilla in severe primary axillary hyperhidrosis. A descriptive, observational, cross-sectional and post-authorisation study was conducted onpatients referred to our department.Thirty-one patients with severe primary axillary hyperhidrosis were included, some of whom received more than one infiltration during the follow-up period, performing a total of 82 procedures. They were assigned by simple random sampling to two types of treatment: infiltration of 50 or 100 units (U) of botulinum toxin A per axilla.Hyperhidrosis severity was assessed using the Hyperhidrosis Disease Severity Scale (HDSS), and quality of life was assessed using the Dermatology Life Quality Index (DLQI) questionnaire. Onabotulinum toxin A infiltration reduced the severity of hyperhidrosis and improved the quality of life of the treated patients, with no significant differences between the two groups.

Plasma matrix metalloproteinases and tissue inhibitors of metalloproteinases explored in relation to the severity and progression of diabetic retinopathy in patients with type 1 diabetes: baseline and prospective analyses

AimsTo explore whether circulating matrix metalloproteinase-2 (MMP-2), MMP-9, MMP-9/neutrophil gelatinase-associated lipocalin, MMP-9/tissue inhibitor of metalloproteinase-1 (TIMP-1), MMP-14, TIMP-2 and TIMP-3 were associated with the severity and progression of diabetic retinopathy...

Retinal vascular morphological characteristics in diabetic retinopathy: an artificial intelligence study using a transfer learning system to analyze ultra-wide field images.

To investigate the morphological characteristics of retinal vessels in patients with different severity of diabetic retinopathy (DR) and in patients with or without diabetic macular edema (DME). The 239 eyes of DR patients and 100 eyes of healthy individuals were recruited for the study. The severity of DR patients was graded as mild, moderate and severe non-proliferative diabetic retinopathy (NPDR) according to the international clinical diabetic retinopathy (ICDR) disease severity scale classification, and retinal vascular morphology was quantitatively analyzed in ultra-wide field images using RU-net and transfer learning methods. The presence of DME was determined by optical coherence tomography (OCT), and differences in vascular morphological characteristics were compared between patients with and without DME. Retinal vessel segmentation using RU-net and transfer learning system had an accuracy of 99% and a Dice metric of 0.76. Compared with the healthy group, the DR group had smaller vessel angles (33.68±3.01 vs 37.78±1.60), smaller fractal dimension (Df) values (1.33±0.05 vs 1.41±0.03), less vessel density (1.12±0.44 vs 2.09±0.36) and fewer vascular branches (206.1±88.8 vs 396.5±91.3), all P<0.001. As the severity of DR increased, Df values decreased, P=0.031. No significant difference between the DME and non-DME groups were observed in vascular morphological characteristics. In this study, an artificial intelligence retinal vessel segmentation system is used with 99% accuracy, thus providing with relatively satisfactory performance in the evaluation of quantitative vascular morphology. DR patients have a tendency of vascular occlusion and dropout. The presence of DME does not compromise the integral retinal vascular pattern.

The reliability and validity of a developed anxiety scale specific to primary focal hyperhidrosis symptoms

BackgroundPatients with primary focal hyperhidrosis (hyperhidrosis) are known to have higher levels of anxiety induced by sweating than those who do not. However, in hyperhidrosis, no scale has been developed to measure anxiety specific to hyperhidrosis symptoms. Therefore, this study aimed to develop an anxiety scale specific to hyperhidrosis symptoms (ASSHS) and to verify its reliability and validity.MethodsBased on previous studies on hyperhidrosis and a preliminary survey conducted with 26 university students who met the diagnostic criteria for hyperhidrosis, 40 items that adequately reflected anxiety specific to hyperhidrosis symptoms were obtained. A survey was done to examine the internal consistency and validity of the our developed ASSHS. In total, 1,207 participants (680 male and 527 female; mean age ± standard deviation 18.7 ± 0.9 years) were included. A second survey (re-survey) was conducted three weeks later to verify the reliability. It included 201 participants (85 male and 116 female; mean age ± standard deviation 18.6 ± 0.7 years). The survey items included (1) the diagnostic criteria for hyperhidrosis, (2) our anxiety scale developed for primary focal hyperhidrosis symptoms (ASSHS), (3) Hyperhidrosis Disease Severity Scale (HDSS), (4) State-Trait Anxiety Inventory (STAI), (5) Hospital Anxiety and Depression Scale (HADS), (6) Dermatology Life Quality Index (DLQI), and (7) presence of anxiety induced by sweating.ResultsThe results of the factor analysis revealed 10 items with one factor, “anxiety specific to hyperhidrosis symptoms.” The alpha coefficient of the ASSHS was α = 0.94. The correlation coefficient between the scores at re-test was r = 0.75. A moderate positive correlation was found between the ASSHS, HDSS (r = 0.53), and anxiety induced by sweating (r = 0.47) (all p < 0.001). Additionally, participants with hyperhidrosis symptoms had significantly higher ASSHS scores than did those without hyperhidrosis symptoms (p < 0.001). Those with mild/moderate hyperhidrosis and those with severe hyperhidrosis had significantly higher the ASSHS scores than did those without hyperhidrosis (p < 0.001).ConclusionsThis scale has sufficient reliability and validity as an instrument to measure anxiety specific to hyperhidrosis symptoms.

Long-term safety and efficacy of Glycopyrronium tosylate in patients with primary axillary hyperhidrosis: a systematic review and meta-analysis

Background: Hyperhidrosis, a condition characterized by excessive sweating, affects ≈ 4.8% of the US population. (1) Glycopyrronium tosylate (GT) is a topical anticholinergic drug approved for primary axillary hyperhidrosis (PAH) treatment. (2) However, no meta-analysis exists on GT’s long-term safety and efficacy. Aim: To evaluate the long-term safety and efficacy of GT as a treatment for PAH. Methods: We systematically searched PubMed, Scopus, and ClinicalTrials.gov. Study selection, quality assessment, and data extraction followed the eligibility criteria. The primary endpoints were changes in the Dermatology Life Quality Index (DLQI), Hyperhidrosis Disease Severity Scale (HDSS), and Axillary Sweating Daily Diary (ASDD) or Axillary Sweating Daily Diary – Change (ASDD-C). Safety endpoints included mydriasis, dry mouth, urinary hesitation, and treatment-emergent adverse events (TEAEs). Statistical analysis was conducted using RevMan 5.1. Results: Our meta-analysis demonstrated that topical GT is clinically effective in treating PAH. GT significantly improves the quality of life of patients, as measured by the DLQI (MD = -2.81, 95% CI = [-4.04, -1.59],P = 0.001), HDSS (OR = 3.72, 95% CI = [2.92, 4.74], P = 0.001), and ASDD/ASDD-C (OR = 4.91, 95%CI = [3.75, 6.44], P = 0.001). Adverse effects such as mydriasis, dry mouth, and urinary hesitation were observed; however, no difference was found between GT and control groups in serious TEAEs, deaths, and severe TEAEs. Conclusion: Topical GT is effective with minimal side effects, providing a valuable option for patients unresponsive to or experiencing significant side effects from other treatments.

Evaluation of nail fold capillaroscopy changes in patients with diabetic retinopathy and healthy controls, and its correlation with disease duration, HbA1c levels and severity of diabetic retinopathy: An observational study.

Background Diabetic retinopathy (DR) is an important microvascular complication of long-term type 2 diabetes mellitus (T2DM) leading to blindness if not properly diagnosed and managed. It can develop as early as 7 years before the diagnosis of diabetes. Nail fold capillaroscopy (NFC) is a non-invasive technique for observing capillary microvasculature and there are few studies which have explored the use of NFC in diabetes mellitus patients. Objective To study the nail fold capillaroscopic alterations in patients with T2DM having diabetic retinopathy and compare them to healthy controls. The secondary objective was to correlate the NFC findings with the duration of diabetes, haemoglobin A1c (HbA1c) levels and the severity of DR. Materials and methods This cross-sectional observational study enrolled 200 patients - 100 cases with T2DM having diabetic retinopathy (as per the American Diabetes Association criteria and Diabetic Retinopathy Disease Severity Scale) and 100 healthy age and sex-matched controls. All patients were subjected to NFC and ophthalmological assessment. Results NFC revealed that patients with DR showed significantly higher frequencies of tortuous, dilated, bushy, meandering, angulated capillaries, avascular areas and micro-haemorrhages as compared to healthy controls (p < 0.05). In proliferative DR (PDR), the frequency of tortuous, bushy capillaries, and avascular areas was statistically high and the capillary density was reduced as compared to non-proliferative DR. The DR patients with longer disease duration (>20) years had a significantly higher frequency of tortuous capillaries, avascular areas, meandering, angulated and dilated capillaries. The frequency of tortuosity, avascular areas, and bushy areas was significantly higher in patients with poor glycaemic control (HbA1c >11). Limitations A larger sample size study with different demographic populations could have provided a broader picture of NFC changes in T2DM patients with DR. Discussion NFC may act as a surrogate marker of retinal involvement in patients with DM and should be performed at regular intervals. Conclusion NFC is a quick, simple, safe, and non-invasive method to assess the capillaroscopic alterations in diabetic patients which inturn can help in assessing the severity of DR.