Global Assessment Scale Research Articles

Salicylic Acid Peel and Fusion Peel with Salicylic & Mandelic Acid Peel for Treatment of Acne Scars - A Comparative Study

Abstract Introduction. Acne vulgaris is one of the most common skin diseases affecting more than 85% of individuals worldwide. The study aimed to compare the therapeutic efficacy of Salicylic acid peel and Salicylic acid - mandelic acid peel for treatment of acne scars. Material and Methods. A comparative study was conducted on 41 patients, divided into two groups based on treatment choice by the subjects. Group A (23) were treated with 30% salycilic acid peels, and group B (18) were treated with 20% salycilic acid and 10% mandelic acid peels at an interval of 2 weeks for three sessions. The physician’s global assessment scale and clinical photographs were used at the end of three sessions. All the data were analysed using SPSS considering P<0.05 as significant. Results. Of the total 41 patients analyzed, the mean age in both the groups were comparable. (Group A: 20.4 years; Group B: 20.5 years). Duration of acne was >12 months in both the groups 13 (56.52%) & 10 (55.56%)). Thirteen patients (56.52%) in group A and 1 (5.56%) in group B had no side effects which was statistically significant (p=0.01). Using the physician’s global assessment scale 51-75% (Good) an improvement was seen in grade I 4 (17%) and 18 (78%) in grade II in group A and 2 (11%) in grade I and 12 (67%) in grade II in group B, respectively which was statistically significant (p=0.001). Conclusion. Both agents showed almost equal efficacy in improving mild-to-moderate acne scars. Adverse effects were less with Salicylic acid peel compared with mandelic acid peel..

Risk Factors Associated with Methotrexate Intolerance in Rheumatoid Arthritis Patients.

BackgroundMethotrexate (MTX) Intolerance Severity Score (MISS) has been previously validated in the Arabic language and has helped to detect high levels of intolerance in rheumatoid arthritis (RA) patients. The aim of the current study was to evaluate patient and disease characteristics associated with a high risk of MTX intolerance.Materials and MethodsA cross-sectional interview-based survey was conducted using adult RA patients as a study group, who were visiting a specialized rheumatology clinic at King Saud University Medical City. The Arabic MISS was used in this survey. Statistical analyses were performed to understand associations between MTX-intolerant and MTX-tolerant patients.ResultsA total of 117 patients were involved in this study. Of those, 101 (86.3%) were females with a mean (SD) disease duration of 6.6 (5.7) years. The median (interquartile range (IQR)) Disease Activity Score-28 (DAS28) was 3.6 (3.6–4.1). MTX intolerance was observed in 55 (47%) patients. The most predominant component in patients with a positive test was the behavioral component. Intolerant patients had a higher median of pain (47.3 vs. 50.0; P = 0.010) and patient global assessment (50.0 vs. 60.0; P = 0.004) scales compared to those in tolerant patients. Additionally, MTX intolerance was associated with the female gender (adjusted odds ratio (AOR) 6.724; 95% CI 1.420, 31.843, P = 0.016), marital status (AOR 2.549; 95% CI 1.037, 6.270, P = 0.042) and DAS28 (AOR 1.612; 95% CI 1.032, 2.517, P = 0.036). There was no significant difference between the two groups in the remaining disease activity parameters, background therapies, seropositivity, and smoking status (P > 0.05).ConclusionPatient characteristics, rather than disease activity, significantly impact MTX intolerance. Behavioral component is the main driver of intolerance. Intolerant patients have higher patient-reported outcomes. Qualitative studies are needed to explore causes and potential solutions to MTX intolerance.

An exploratory study of the prevalence of mental health symptoms among girls living in 5 childcare institutions in Goa and Mumbai

BackgroundIndia is home to 240 million adolescents and 170 million are vulnerable to or experiencing difficult circumstances. The most vulnerable of these children are housed in the estimated 7800 nationwide childcare institutions (CCIs). Recent media reports have put a spotlight on these homes for a lack of mental health care as well as neglect, sexual and physical abuse. In this paper, we sought to determine the prevalence and severity of mental health symptoms of the girls living in CCIs. MethodsThis is a cross sectional study of N = 110 girls, age 11–18, living in 5 childcare institutions in Mumbai and Goa. We gathered demographic information from the girls. For mental health screening we used: a) Strengths and Difficulties Questionnaire (SDQ); b) Patient Health Questionnaire-9 (PHQ-9); and c) The Children's Global Assessment Scale (CGAS). ResultsOn the PHQ, 17% of girls screened positively for moderate or severe level of depression and 40% reported thoughts they would be better off dead or of hurting themselves. On the SDQ, 52% of the girls had a total difficulty score above 20 suggesting that 52% need a referral to a child and adolescent mental health specialist for treatment. In the regression model, family psychiatric history was significantly associated with depression. ConclusionOur findings reiterate a need for mental health care in CCIs in India.

Child and Parental Characteristics of Medication Use for Attention-Deficit/Hyperactivity Disorder.

Objectives: To investigate child and parental characteristics of medication use for attention-deficit/hyperactivity disorder (ADHD).Methods: Participants were part of the prospective population-based Norwegian Mother, Father and Child Cohort study (MoBa) (n = 114,500 children, 95,000 mothers, and 75,000 fathers). This cohort was linked to the Norwegian Prescription Database (NorPD) and the Norwegian Patient Registry (NPR) to compare child and parental characteristics in children medicated and not medicated for ADHD during years 2008–2013.Results: One thousand seven hundred and sixty-four children (74% boys) with ADHD (International Classification of Diseases [ICD-10]: F90 and F98.8) were identified. One thousand three hundred and sixty-two (77%) used medication. Boys and girls did not differ in the use of ADHD medication (both 77%). Mean age at first prescription was 9 years in both boys and girls, and age at ADHD diagnosis was 8 years in medicated and unmedicated children. Significantly more hyperkinetic conduct disorders (F90.1), and significantly fewer with attention-deficit disorder (F98.8) were found among the medicated children compared to the unmedicated children. The medicated children also had a significantly lower global functioning (Child Global Assessment Scale). Child disruptive symptoms reported in the MoBa child age 3 year questionnaire were significantly higher in children who used medication compared to the nonusers (t = 2.2, p = 0.03), and group differences in ADHD symptoms at age 3 years were close to significant (t = 1.8, p = 0.07). Other preschool child and parental characteristics were not significantly different in the two groups.Conclusion: In this large birth cohort study, where a great majority of children with ADHD used medication, only child characteristics were significantly associated with the use of medication. We could not replicate previous findings suggesting that “environmental factors,” such as parental education and psychopathology, drive medication use. The small differences between medicated and unmedicated children in this cohort study, where a majority used medication, might be due to strong established clinical practices where medication is offered as a treatment option, particularly for hyperkinetic conduct disorder in an egalitarian high-income society.

Structural Brain Patterns Associated with Traumatic Stress Resilience and Susceptibility to Mood and Anxiety Symptoms in Youths

Understanding biological mechanisms underlying traumatic stress resilience is critical and can advance preventive psychiatry. Brain phenotypes of stress resilience have been investigated in animals, but such data in humans is scarce. Here we characterize cross-sectional brain correlates of traumatic stress resilience and susceptibility to mood and anxiety psychopathology (MAP) in community youth with substantial trauma exposure. Philadelphia Neurodevelopmental Cohort youths with high-quality structural neuroimaging data were included (N = 1392, mean age ~ 15). MAP was quantified using a dimensional factor score. Resilience and susceptibility were ascertained retrospectively and defined as low/high MAP (respectively) in relation to trauma exposure. This resilience-susceptibility construct was operationalized as the interaction term between trauma exposure and MAP. Clinical functioning level was quantified with the Children Global Assessment Scale. Statistical models examined association of volume, cortical thickness, and gray matter density with resilience, covarying for age, sex, race, socioeconomic status, and image quality. Resilience was associated with better clinical functioning and with specific neural correlates, such that in extensive traumatic stress exposure, smaller brain volume was associated with low MAP; while in low trauma exposure, smaller volumes were correlated with higher MAP. This pattern was evident in total brain volume (trauma by MAP interaction, F(1, 1383), p < .05), and in volumes of white matter, parietal lobe, basal ganglia, and within basal ganglia (nucleus accumbens, globus pallidus, and putamen) (all FDR corrected p’s < .05). Exploratory analyses revealed no such interaction in the hippocampus or amygdala. Findings suggest that in substantial childhood/adolescent life trauma exposure, larger brain volume, usually considered protective, is inversely associated with resilience.

Platelet-rich plasma for male genital lichen sclerosus resistant to conventional therapy: First prospective study.

Ultrapotent topical corticosteroids and circumcision are usually effective for male genital lichen sclerosus (MGLSc); however, refractory cases are often referred to our Male Genital Dermatology Unit. Treatment with autologous platelet-rich plasma (TPRP) has recently been advocated as a safe and effective treatment option, but there have been no prospective studies in men to date. The objective of this study is to assess the safety and efficacy of TPRP for MGLSc resistant to conventional therapy. A prospective, open-label, single-arm, therapeutic study was carried out in this study. Inclusion criteria: resistant to conventional therapy for at least 6 months. Procedure: infiltration of 0.1 mL/cm2 PRP every 8 weeks. Monthly data recording: visual appearance with photographs and external scoring by an expert using Investigator's Global Assessment Scale (IGA scale 0-5), symptoms (scale 0-5), quality of life (QoL; Dermatology Life Quality Index [DLQI]), and complications. No. of patients included was n = 5. No. of patients excluded during treatment was n = 1. Mean initial IGA: 3.6. Mean initial DLQI: 6. TPRP n = 34 (range: 2-9; average: 6.8 per patient). Mean IGA at 18 months: 3.25. Mean DLQI at 18 months: 1.25. All patients reported being completely asymptomatic at 10 months. No. of patients with complications is n = 1 (balanitis). TPRP seems to be safe and effective, regarding symptom control and improvement in QoL; however, visual changes were minimal.

Percutaneous tibial nerve stimulation for the treatment of interstitial cystitis/bladder pain syndrome: a pilot study.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pain condition that requires multimodal management. The American Urologic Association includes sacral neuromodulation in the treatment algorithm for refractory IC/BPS. We sought to determine the rate of overall symptom improvement of IC/BPS symptoms, using validated measures, after treatment with percutaneous tibial nerve stimulation (PTNS), a form of peripheral neuromodulation. This was a single-arm, dual-center, pilot study examining a standard PTNS protocol in subjects with IC/BPS. Our primary outcome was subject response of "moderately" or "markedly improved" on the Global Response Assessment (GRA) scale after 12-weekly PTNS sessions. Assuming a 60% response rate, 24 subjects were needed to detect a response rate between 40 and 80% with 95% confidence. Secondary objectives included change in urinary frequency on a 24-h bladder diary, bladder pain as measured by VAS and responses to validated questionnaires for pelvic pain and IC/BPS. Of 21 subjects enrolled, 16 initiated and 10 completed the PTNS treatment course. The GRA response rate was 40% at week 6 and 30% at week 12. Seventy percent of the cohort had some degree of improvement. There were no adverse events. While only a minority of subjects with IC/BPS were responders to PTNS per GRA criteria, 70% of the cohort had some degree of improvement. Due to low recruitment and loss to follow-up, we did not achieve our predetermined significance. However, our promising findings add to the limited literature on this subject.

A Randomised Controlled Trial of the Efficacy and Safety of 0.25% Desoximetasone Cream (Topoxy) Compared with 0.25% Desoximetasone Cream (Topicorte) for the Treatment of Scalp Psoriasis

Objective: To compare the efficacy and safety of a generic desoximetasone cream (Topoxy) with the reference form, Topicorte, for the treatment of scalp psoriasis.Methods: A randomised, double-blind, controlled study was conducted. Altogether, 105 patients with psoriasis lesions covering more than 10% of the scalp were randomised into three groups. The first, second and third groups received a placebo, Topoxy and Topicorte, respectively. The scalp psoriasis severities were assessed at weeks 0, 2, 4 and 8, using the Investigator Global Assessment (IGA) scale and Total Sign Score (TSS). The safety profiles of the products were assessed by the patients and physicians.Results: Topoxy and Topicorte were significantly more effective than the placebo in achieving at least a two-grade improvement in the IGA score from baseline at weeks 2, 4 and 8, and there were no significant differences between Topoxy and Topicorte. The TSS of both creams were significantly lower than that of the placebo at weeks 2, 4 and 8. All patients tolerated well to the therapy.Conclusion: Topoxy and Topicorte had comparable efficacies for scalp psoriasis., The medications were superior to the placebo in all parameters, and&nbsp; had a good safety profile.

Methylphenidate in Autism Spectrum Disorder: A Long-Term Follow up Naturalistic Study.

Autism spectrum disorder (ASD) often co-occurs with attention deficit/hyperactivity disorder (ADHD). Although methylphenidate (MPH) efficacy and safety are well-demonstrated for ADHD, evidences are scant in the context of ASD. This naturalistic study aimed to analyze long-term MPH efficacy and safety in 40 ADHD children and adolescents with comorbid ASD, comparing them with 40 ones affected by ADHD without ASD. Treatment lasted from 6 to 156 months (longer than 24 months in more than three quarters of patients). Efficacy and safety were measured by clinical global impression and children global assessment scales; influence of intellectual functioning was examined. Comparisons between groups were made by Wilcoxon or Friedmann tests; relationships between functioning scores and other characteristics were analyzed by ordinal logistic and linear regression. Results demonstrated that MPH in patients with ASD was associated with significative reduction of illness severity, clinical improvement and amelioration of global functioning, without significant differences with patients having ADHD without ASD. The trend of reduction of illness severity and increase of global functioning were favorably related with intellectual functioning. No serious adverse events were reported. The findings showed that long-term MPH was effective and well-tolerated in ADHD children and adolescents with comorbid high functioning ASD.

Psychometric properties of the Weiss Functional Impairment Rating Scale parent and self-reports in a Norwegian clinical sample of adolescents treated for ADHD

Objective To analyze the psychometric properties of the Norwegian version of the Weiss Functional Impairment Rating Scale parent and self-reports (WFIRS-P and WFIRS-S) in adolescents with ADHD. Methods 102 clinically referred patients, of which 86% were enrolled in an ongoing RCT program (Clinical trials NCT02937142), were diagnosed with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders version IV (DSM-IV). The conceptual framework of the WFIRS-P and the WFIRS-S was evaluated using confirmatory factor analysis (CFA), reliability was estimated using Cronbach’s alpha, convergent and divergent validity was assessed using correlations with the Children’s Global Assessment Scale (C-GAS) and the ADHD Rating Scale-IV (ADHD-RS-IV). Results CFA supported the original factor structure of the questionnaires, both a first-order and a second-order model revealed acceptable model fit. Internal consistency was satisfactory across domains. The parent-adolescent agreement was moderate. The correlations between the C-GAS and the total scores of the WFIRS-P and WFIRS-S were low to moderate (r = –0.29 to −0.38). The ADHD-RS-IV correlated moderately (r = 0.49) with WFIRS-P, the correlation with WFIRS-S was weak (r = 0.28) supporting divergent validity. In multiple regression analyses, the ADHD-RS total score was the strongest predictor of the total score in both the WFIRS questionnaires, with internalizing disorder showing an additional small contribution. Age, gender and full-scale IQ gave no additional contribution in explaining the variance. Conclusions The findings support the use of the Norwegian version of the WFIRS-S and the WFIRS-P in the evaluation of functional impairment in adolescents with ADHD.

A randomized blinded retrospective study: the combined use of micro-needling technique, low-level laser therapy and autologous non-activated platelet-rich plasma improves hair re-growth in patients with androgenic alopecia

ABSTRACT Introduction Mini-invasive therapies based on autologous non-activated Platelet-Rich Plasma (ANA-PRP), Low-Level Laser Therapy (LLL-T), and Micro-Needling Technique (MN-T) used in combining for hair re-growth need to be standardized. Objectives The work aims to show in vivo outcomes resulted from retrospective case-series study in which ANA-PRP + MN-T + LLL-T were used in combined in patients affected by Androgenic alopecia. Methods 23 patients were treated, of which 13 males were classified in stage I–V by the Norwood–Hamilton scale, and 10 females were classified in stage I–III by the Ludwig scale. Assessment of hair re-growth was evaluated with photography, physician’s and patient’s global assessment scale, and standardized phototrichograms during a follow-up: T0 – baseline, T1 – 12 weeks, T2 – 23 weeks, T3 – 44 weeks, T4 – 58 weeks. Results Interesting outcomes represented by a hair density increase of 81 ± 5 hairs/cm2 and 57 ± 7 hairs/cm2 respectively at T1 and T2 compared with baseline (173 ± 5 hairs/cm2 at T1 and 149 ± 9 hairs/cm2 at T2 versus 92 ± 2 hairs/cm2 at baseline) were observed using computerized trichograms. Expert Opinion The main limitation in the autologous regenerative therapies and biotechnologies in hair-regrowth is the extreme variability of PRP products used, in the absence of standardized protocols and widely shared. Appropriate PRP preparations have to be pick after carefully thinking about their bio-molecular specifications and intended indications for use in patients. This approach will aid in matching the optimal PRP product to specific patient factors, leading to improved outcomes and the elucidation of the cost-effectiveness of this treatment. The combined use of biotechnologies as the association of PRP with micro-needling and low-level laser therapy may improve the results in terms of hair count and hair density compared with those obtained by alone PRP. All the procedures must be performed in the full respect of international and local rules. Conclusions The effect of the combined use of MN-T, LLL-T, and ANA-PRP has been demonstrated.

Treatment of idiopathic onychodystrophy with a 1064 nm picosecond neodymium-doped:yttrium aluminum garnet laser: A retrospective study.

Laser treatment has emerged as a novel treatment modality for onychodystrophy. Only a few small series have assessed the efficacy of laser treatment in onychodystrophy, most of which were case reports. The therapeutic effect of the 1064nm neodymium-doped:yttrium aluminum garnet (Nd:YAG) laser for onychodystrophy has been demonstrated. Recently, the picosecond Nd:YAG (PSNY) laser has been introduced to improve various skin disorders. The aim of this study was to verify the efficacy of a 1064nm PSNY in management of idiopathic onychodystrophy. We present a case series of dystrophic nails treated with a PSNY for onychodystrophy improvement. Planimetry using ImageJ software was used to calculate lesion reduction and proximal clear nail growth. Clinical improvement was assessed using a 5-point Global Assessment Scale (GAS). Adverse events were also assessed. Twenty-five patients (11 males and 14 females) with a total of 128 nails (94 finger nails and 34 toe nails) were treated. The mean treatment number was 8.7±6.2, and the mean total duration of treatment was 33.4±34.6weeks. The average proportion of the lesion area decreased significantly (from 65.9% to 46.6%) after PSNY treatment (P<.001). The mean GAS (3.16±1.18) exhibited fair improvement, and there were no serious adverse events. The 1064nm PSNY laser can provide fair improvement for onychodystrophy with a good prognosis at least during the follow-up period and optimal cosmetic results in Asian patients.

Efficacy and safety of oral dapsone in acne vulgaris – experience of a tertiary care teaching hospital in central Lahore

Background: Acne is the eighth most prevalent disease affecting 9.4% of the population worldwide and its prevalence in our country is estimated to be around 5%. Severe inflammatory acne is most likely to leave scars and in order to prevent facial disfigurement due to acne scarring, early treatment is desirable. Various treatment options have been formulated for acne, and are tailored according to the severity of the disease. Numerous clinical trials have been conducted till now, to determine the usefulness and side effect profile of such therapies, making acne treatment a highly studied area in dermatology. Objective of this study is to highlight the fact that oral Dapsone could be used as a cheaper alternate to isotretinoin in recalcitrant severe acne, especially in females where retinoids are sometimes contraindicated.&#x0D; Patients and methods: 51 patients, suffering from severe nodulocystic acne, fulfilling the criteria, were enrolled from the Department of Dermatology, Sir Ganga Ram Hospital, Lahore. All the study patients were given oral Dapsone 50mg for initial two weeks and then 100mg daily for the next 10 weeks along with oral cimetidine and topical clindamycin application twice daily. Investigator Global Assessment Scale (IGAS) was employed to measure effectiveness. The treatment was considered ʽeffectiveʹ if the patient achieves 2 or more than 2-grade improvement or almost clear or clear skin at the end of 12 weeks according to IGAS scale. The lesion counts were also done before the start of therapy (day 1) and at every two weeks follow up for 12 weeks. The change in lesion count observed between the baseline number and that seen at follow up visits was also used to evaluate the effectiveness of oral Dapsone. Safety was analyzed by fortnightly visits of the patients to look for any undesirable side effects and monitoring of the hematologic profile of the patients. Final follow up was done at the end of 16 weeks.&#x0D; Results: The study was conducted on 51 patients, with a ratio of 1:3 for males and females and a mean age of 25.2 years (SD ±5.81). At 12th week, patients had significant reduction in their acne lesions; with 7 patients (13.7%) showing completely clear skin, 17 patients (33.3%) had almost clear skin, 5 patients (9.8%) had 3-grade improvement. Twelve patients (23.5%) had 2-grade improvement from baseline score and only 2 patients (3.9%) had 1-grade improvement from baseline. Based on percentage reduction of lesions, excellent response was seen in 32 patients (62.7%), good response in 9 patients (17.6%), moderate response in 2 patients (3.9%), while no patient showed poor response. Dapsone was discontinued in 8 patients due to derangement of hematologic profile.&#x0D; Conclusion: Oral Dapsone, when given carefully, is a very effective therapeutic option in severe recalcitrant acne, with limited side effects.

Carbon dioxide ablative laser treatment of acquired junctional melanocytic nevi.

Junctional melanocytic nevi are common. Furthermore, surgical treatment of these nevi can be challenging due to scar formation. The study aims to detect the efficacy and safety of the CO2 fractional laser for treating acquired junctional melanocytic nevi and usefulness of dermatoscopy for the monitoring of the nevus. We conducted a retrospective review of 618 patients with 1545 facial junctional melanocytic nevi. CO2 fractional laser was applied to 2-month intervals until complete clearance was reached. The effect of the therapy was monitored by clinical and dermatoscopy. The Global Assessment Scale (GAS) scores were used to assess the results. 1320 nevi (85%) were treated in just one session. In addition, 120 (8%) and 75 (5%) required second and third sessions, respectively. Only thirty nevi (2%) need more than three sessions. Consequently, at the end of one-year follow-up, patients' (97%) and physicians' (95%) GAS scores were rated as excellent and good, respectively. Moreover, hyper/hypopigmentation, fibrosis, dimples, erythema, and scars were observed as side effects at the 1-year follow-up. CO2 laser is effective in completely removing small acquired junctional melanocytic nevus. Furthermore, dermatoscopy appears to be helpful for monitorization of the nevi in the follow-up period.

Validity of EQ-5D-5L, Skindex-16, DLQI and DLQI-R in patients with hidradenitis suppurativa.

Numerous generic, skin- and disease-specific health-related quality of life (HRQoL) measures are available for patients with hidradenitis suppurativa (HS). Yet, robust psychometric evidence is lacking in many aspects of these outcome measures. We sought to determine convergent and known-groups validity of multiple generic and skin-specific HRQoL measures and to identify predictors of impaired HRQoL in patients with HS. Between 2017 and 2019, a multicentre cross-sectional study was carried out involving 200 consecutive HS patients. HRQoL outcomes included the EQ-5D-5L, EQ visual analogue scale (EQ VAS), Skindex-16, Dermatology Life Quality Index (DLQI) and DLQI-Relevant (DLQI-R). Disease severity was graded by HS-Physician's Global Assessment (HS-PGA) scale and the Modified Sartorius scale (MSS). Overall, 77%, 56%, 51%, 46% and 28% reported problems in the pain/discomfort, usual activities, anxiety/depression, mobility and self-care dimensions of EQ-5D-5L. Mean ± SD EQ VAS, DLQI and DLQI-R scores were 64.29 ± 22.68, 11.75 ± 8.11 and 12.19 ± 8.33, respectively. Skindex-16 responses indicated that the emotional burden of HS (64.55 ± 29.28) far exceeded those of functioning (49.40 ± 34.70) and physical symptoms (46.74 ± 29.36). EQ-5D-5L, EQ VAS, DLQI, DLQI-R and Skindex-16 total scores had moderate or strong correlations with each other (range: |0.487| to |0.993|), weak or moderate correlations with HS-PGA (|0.350| to |0.433|) and weak correlations with MSS (|0.324| to |0.389|). DLQI-R slightly outperformed DLQI both in terms of convergent and known-groups validity. Being female, lower education level, more severe disease and genital involvement were associated with worse HRQoL (P < 0.05). This study provides high-quality evidence that among skin-specific outcomes, the DLQI, DLQI-R and Skindex-16, and among generic instruments, the EQ-5D-5L are suitable to be used in HS patients. In future research, we recommend the use of existing well-validated HRQoL tools instead of developing new measures for each study. The development of composite measures that combine physician- and patient-reported outcomes is not supported by evidence in HS. [Correction added on 25 July 2020, after first online publication: in the Abstract section, the ± signs were missing and have been added to this version.].

Combined sodium Dimercaptopropanesulfonate and zinc versus D-penicillamine as first-line therapy for neurological Wilson\u2019s disease

BackgroundEven though recent research has achieved significant advancement in the development of therapeutic approaches for Wilson’s diseases (WD), the current treatment options available for WD are still limited, especially for WD patients with neurological symptoms. This study is intended to compare the therapeutic approaches for WD patients with neurological symptoms receiving either combined sodium 2, 3-dimercapto-1-propane sulfonate (DMPS) and zinc treatment or D-penicillamine (DPA) monotherapy as first-line therapy, and identify the more effective therapeutic approach.MethodsThe case records of 158 patients diagnosed with neurological WD were retrospectively analyzed. These patients treated with intravenous DMPS + Zinc and in combination with oral zinc as a maintenance therapy (Group 1) or DPA alone (Group 2) for 1 year. During the period of treatment, the neurological symptoms of the patients were assessed using the Global Assessment Scale (GAS) and Barthel index. The key hematological and biochemical parameters of the patients (such as the levels of aminotransferase, serum ceruloplasmin, 24-h urine copper excretion), as well as adverse effects were recorded and analyzed.ResultsNinety-three patients in Group 1, displayed decreased GAS scores and increased Barthel indexes consistently in comparison with the baseline (P < 0.01). Among them, 82 patients (88.2%) exhibited significant neurological improvement after 1 year, while 8 patients (8.6%) experienced neurological deterioration. Among the 65 patients in Group 2, 37 patients (58.5%) exhibited neurological improvements, while 17 patients (26.2%) experienced neurological deterioration after 1-year follow up. Six patients discontinued their treatment midway due to their exacerbating neurological symptoms. A comprehensive comparison of the effectiveness of the two courses of treatment revealed that patients in group 1 demonstrated a higher improvement ratio (P < 0.01) and lower worsening ratio of the neurological symptoms for the patients (P < 0.01) in comparison to the patients in group 2. Meanwhile, renal function, liver enzyme and blood cell counts remained stabilized in group1.ConclusionsThis study indicates that the combined therapeutic approach of DPMS and zinc may be a preferred first-line therapy in treating the neurological symptoms of WD, in comparison to the treatment with DPA.

The role of physical pain in global functioning of people with serious mental illness

While people with serious mental illness (SMI) endorse clinical pain at rates on par or exceeding those in the general population, the association between pain and functioning remains unclear. In this paper we present data on the cross-sectional association between clinical pain and global functioning in a large, mixed diagnostic sample of people with SMI. Eight-hundred ninety-eight people diagnosed with bipolar disorder, major depressive disorder, or schizophrenia were administered the Global Assessment Scale and the 12-item Short Form Survey, which includes an assessment of the extent to which the experience of pain interfered with daily activities over the past month. People with major depressive disorder reported higher pain interference than those with schizophrenia and bipolar disorder. The presence of physical health conditions and psychiatric symptoms were also assessed. After controlling for age, gender, psychiatric symptoms, education level, and physical health problems, pain interference in the past month was associated with significantly lower global functioning. The findings suggest that the experience of pain is associated with poorer global functioning across major SMI diagnoses. Moreover, the impact of pain in global functioning appears independent of physical health problems, and thus may warrant routine screening from mental health providers.

Long-term effectiveness and safety of treatment with dupilumab in patients with atopic dermatitis: Results of the TREAT NL (TREatment of ATopic eczema, the Netherlands) registry

Evidence on long-term dupilumab treatment for atopic dermatitis in daily practice is lacking. To investigate patient characteristics, treatment aspects, effectiveness, and safety of up to 84weeks of dupilumab treatment. An observational prospective cohort study was conducted of patients with atopic dermatitis starting dupilumab in routine clinical care. Of the 221 included patients, 103 used systemic therapy at baseline. At 84weeks, we found a change of -15.2 (SE, 1.7) for the Eczema Area and Severity Index, -16.9 (SE, 1.4) for the Patient-Oriented Eczema Measure, and -17.2 (SE, 1.6) for the Dermatology Life Quality Index. We found a trend for improvement over time for the Investigator Global Assessment and Numerical Rating Scale for pruritus. Severe (n=79) including serious (n=11) adverse events were observed in 69 patients. Eye complaints were most frequently reported (n=46). Twenty-one patients adjusted the regular dosing schedule, and 14 patients discontinued treatment, mainly due to ineffectiveness (n=7). Only adverse events of severe and serious nature were registered for feasibility reasons. Daily practice dupilumab treatment of up to 84weeks is generally well-tolerated, apart from the reporting of eye complaints. It can be considered a long-term effective treatment for atopic dermatitis in combination with topical and initial concomitant systemic treatment, showing a sustained improvement of signs, symptoms, and quality of life.

Developmental and sequenced one-to-one educational intervention (DS1-EI) for autism spectrum disorder and intellectual disability: a two-year interim report of a randomized single-blind multicenter controlled trial

BackgroundChildren with autism spectrum disorder (ASD) and moderate to severe intellectual disability (ID) face many challenges. There is little evidence-based research into educational settings for children with ID and ASD and in France. Little is known about how this unserved population could benefit from intervention and education. This study assessed the feasibility and efficacy of a new intervention model using an individualized educational approach.MethodsWe conducted a randomized, single-blind controlled trial to assess a novel intervention: the “Developmental and Sequenced One-to-One Intervention (DS1-EI)”. In DS1-EI, trained teachers worked one-to-one with each child in a small classroom setting, offering 10 h per week of the intervention. The focus was on encouraging spontaneous communication, promoting skills through play with peers, supporting positive interactions, and developmental and sequenced learning. We enrolled 5- to 9-year-old children with ASD and ID across 11 French child care institutions for children with co-occurring ASD and ID. Participants were matched in dyads by developmental quotient and randomized to the treatment-as-usual (TAU) group or the DS1-EI group. Independent raters blindly assessed the primary variables: The Childhood Autism Rating scale (CARS) and the Psychoeducational Profile, third edition (PEP-3). The secondary variables included the Vineland Adaptive Behavior Scale II (VABS-II) and the Clinical Global Assessment Scale (CGAS). Here we perform interim analyses at 24 months.ResultsAt baseline, 72 participants were randomized. Nine patients (5 in the DS1-EI group and 4 in the TAU group) dropped out of the study. Using linear mixed models, both intent-to-treat (ITT) and per-protocol (PP) analyses at the 12-, 18- and 24-month outcomes showed no significant group nor group-by-time interaction effects. However, we found significant improvements in most primary and secondary variables over time in both groups.ConclusionsThe study did not show that DS1-EI was superior to TAU in treating children with ASD and ID over 24 months. However, the low dropout rate shows that DS1-EI is feasible, and well accepted. As the study is still ongoing, we need to wait for data at 36 months to ensure whether DS1-EI could be recommended.Trial registrationANSM130282B-31 (April 16, 2013) and ACTRN12616000592448. Registered 6 May 2016, retrospectively registered, http://www.anzctr.org.au/

650 usec 1064nm Nd:YAG laser treatment of acne: A double‐blind randomized control study

A variety of energy-based devices have been used to treat acne. However, all studies have been subjective and have not involved double-blind and randomized controlled studies. We undertook a randomized controlled study evaluating the use of a 650 usec 1064nm Nd:YAG laser compared with a sham in the treatment of acne. A total of 20 subjects with moderate-to-severe acne were randomized to receive either 650 usec 1064nm Nd:YAG laser or sham treatment. All subjects received 3 treatments, two weeks apart, plus an additional session undertaken 4weeks after the 3rd treatment. Subjects were evaluated for investigator global improvement, improvement in inflammatory lesions, improvement in comedonal lesions, total porphyrin score, and total sebum score. The laser-treated group showed an Investigator's Global Assessment Scale (IGA) improvement of 26% compared with 7% for the sham group (a 271% improvement over sham treatment group). The treatment group also showed a decrease in the number of inflammatory lesions of 42% compared with 26% in the sham group (a 62% improvement over sham). The laser-treated cohort also experienced a reduction in total number of comedones similar to that seen with inflammatory lesions and a decrease in total porphyrin score. There was also an 18% reduction in sebum production in the treated group, compared with 9% in the sham group (a 100% improvement). This is the first study that has compared laser treatment of acne compared with a sham treatment. A 650 usec 1064nm Nd:YAG laser can effectively treat acne.