The Latest Eczema Medical Journal Articles
Keep up to date with the latest research in eczema. Check out the latest eczema articles from leading medical journals in a single view, helping you discover relevant articles quickly and easily.
- Recommended core outcome instruments for health-related quality of life, long-term control and itch intensity in atopic eczema trials: results of the HOME VII consensus meeting.The Harmonising Outcome Measures for Eczema (HOME) initiative has established a core outcome set of domains for atopic eczema clinical trials. Previous consensus meetings have agreed upon preferred instruments for clinician-reported signs (Eczema Area and Severity Index – EASI) and patient-reported symptoms (Patient-Oriented Eczema Measure – POEM). This paper reports consensus decisions from the HOME […]
- Risk of Skin Disorders in Patients with Celiac Disease: A Population-Based Cohort Study.Although dermatitis herpetiformis is closely associated with celiac disease (CD), data on the relationship between CD and other dermatologic disorders have been mixed. We aimed to quantify the risk of skin disorders in patients after CD diagnosis in a population-based setting.Using data from all 28 pathology departments in Sweden 1969-2016, we identified patients with CD. […]
- Measurement properties of the Patient-Reported Outcomes Information System (PROMIS® ) Itch Questionnaire: itch severity assessments in adults with atopic dermatitis.Itch is the most common and burdensome symptom of atopic dermatitis (AD, also simply known as eczema). However, there is limited data to support the validity of different approaches to measure the severity of itch in AD, such as numeric rating scales (NRS), verbal rating scales (VRS), and frequency of itch. In this study, we […]
- Real-world effectiveness and tolerability of dupilumab in adult atopic dermatitis: A single centre, prospective one-year observational cohort study of the first 100 patients treated.Dupilumab (Dupixent®) is the first biologic drug licensed for treatment of adults with atopic dermatitis (AD). Data regarding its long-term real-world effectiveness and tolerability are limited. We report comprehensive outcome data at one year for the first 100 adult patients initiated on dupilumab in a specialist eczema clinic (May 2017-November 2019). In this prospective, observational […]
- “Fake news” in dermatology. Results from an observational, cross-sectional study.Social networks have become a means for disseminating information on health-related matters.Describe the characteristics and analyze the accuracy of the dermatology content that is most often shared on the most popular social networks.The content most often shared on social networks (Facebook, Pinterest, Twitter, and Reddit) between March 2019 and March 2020 was analyzed using the […]
- Atopic eczema and obesity: a population-based study.Atopic eczema is a common chronic inflammatory skin disease. Research suggests an association between atopic eczema and obesity, with inconsistent evidence from European populations.To explore the association between diagnosed atopic eczema and being overweight or obese, and whether increased atopic eczema severity was associated with higher body mass index.We undertook a cross-sectional analysis within a […]
- Tralokinumab for moderate-to-severe atopic dermatitis: results from two 52-week, randomized, double-blind, multicentre, placebo-controlled phase III trials (ECZTRA 1 and ECZTRA 2).Tralokinumab, a fully human monoclonal antibody, specifically neutralizes interleukin-13, a key cytokine driving peripheral inflammation in atopic dermatitis (AD). In phase II studies, tralokinumab combined with topical corticosteroids provided early and sustained improvements in AD signs and symptoms.To evaluate the efficacy and safety of tralokinumab monotherapy in adults with moderate-to-severe AD who had an inadequate […]
- Tralokinumab plus topical corticosteroids for the treatment of moderate-to-severe atopic dermatitis: results from the double-blind, randomized, multicentre, placebo-controlled phase III ECZTRA 3 trial.Tralokinumab is a fully human monoclonal antibody that specifically neutralizes interleukin-13, a key driver of atopic dermatitis (AD).To evaluate the efficacy and safety of tralokinumab in combination with TCS in patients with moderate-to-severe AD who were candidates for systemic therapy.This was a double-blind, placebo plus optional TCS-controlled phase III trial. Patients were randomized 2 : […]
- Dupilumab treatment ameliorates clinical and hematological symptoms, including blood eosinophilia, in patients with atopic dermatitis.Atopic dermatitis (AD) is an allergic disease that affects individuals of various ages. Recently, the IL-4/13 inhibitor dupilumab has gained regulatory approval for clinical use in AD patients. Dupilumab has been reported to reduce several markers of AD, including the serum levels of thymus and activation-regulated chemokine (TARC/CCL17), blood lactate dehydrogenase (LDH), and serum total […]
- Dupilumab provides favourable long-term safety and efficacy in children aged ≥ 6 to < 12 years with uncontrolled, severe atopic dermatitis: results from an open-label phase IIa study and subsequent phase III open-label extension study.Children aged ≥6 to <12 years with severe atopic dermatitis (AD) have limited treatment options. In a 16-week, randomized, placebo-controlled, phase III trial in children, dupilumab, a monoclonal antibody inhibiting interleukin (IL)-4/IL-13 signaling, significantly improved signs and symptoms with acceptable safety; longer-term safety and efficacy data are lacking.To report the pharmacokinetic profile and long-term safety […]
- What are the best endpoints for Eczema Area and Severity Index and Scoring Atopic Dermatitis in clinical practice? A prospective observational study.Multiple strategies have been used to evaluate the minimal important change (MIC) of the Eczema Area and Severity Index (EASI) and Scoring Atopic Dermatitis (SCORAD). The meaningfulness of these MICs is not well established across all severities of atopic dermatitis (AD).To determine the MIC of percentage and absolute improvement of EASI and SCORAD scores in […]
- What’s new in atopic eczema? An analysis of systematic reviews published in 2018. Part 1: prevention and topical therapies.This review is part of a series of annual updates that summarize the evidence base for atopic eczema (AE). The aim is to provide a succinct guide for clinicians on the key findings from 14 systematic reviews on the prevention and topical treatment of AE published or indexed in 2018. Various supplements, including long-chain polyunsaturated […]
- Real-world evidence of dupilumab efficacy and risk of adverse events: a systematic review and meta-analysis.Dupilumab, the first biological drug to be approved for the treatment of moderate-to-severe atopic dermatitis (AD) in adolescents and adults has shown good efficacy and safety in clinical trials.To evaluate real-world data on the efficacy and safety of dupilumab in AD.Pubmed and Embase were searched for observational studies with data on efficacy, drug survival and […]
- Water hardness and a possible genetic link with eczema in children.Previous studies have found a possible link between the risk of children developing atopic eczema, and hardness of the water used at home. The harder the water (containing more calcium), the more children seemed to develop eczema. Yet a study in children with eczema using water softeners to reduce water hardness had shown no difference […]
- The need for dose-response studies; time for a reminder?At the end of a long life, there are too many old haunts to revisit, but by chance I encountered the paper by Heetfeld and colleagues,1 which challenged the idea that skin of people with atopic eczema is supersensitive to irritants. That was surprising, and therefore interesting; so I read it. But, to my further […]
- The role of dermatology in African patients referred for health treatment in an European Center.Nowadays, due to the migratory movement between African and European countries, there is a crescent number of dermatoses seen in patients with skin of colour in our clinical practice.A retrospective 5-year study was conducted in a Portuguese Hospital, a referral centre for patients evacuated from Portuguese-speaking African countries to several medical specialities, under a specific […]
- Scratch damaged tight junction through Akt/CLDN1 axis in atopic dermatitis.Atopic dermatitis (AD) is a common, chronic, severely pruritic, eczematous skin disease that seriously deteriorates the quality of life of patients. Scratch is a cardinal symptom of AD. Although the vicious “itch-scratch cycle” continues and aggravates skin barrier dysfunction in AD, how scratch induces skin barrier dysfunction through tight junction remains unclear.To study the effect […]
- Trial of Nemolizumab and Topical Agents for Atopic Dermatitis with Pruritus.Nemolizumab is a subcutaneously administered humanized monoclonal antibody against interleukin-31 receptor A, which is involved in pruritus and inflammation in atopic dermatitis. In phase 2 studies, nemolizumab lessened the severity of atopic dermatitis.In a 16-week, double-blind, phase 3 trial, we randomly assigned Japanese patients with atopic dermatitis and moderate-to-severe pruritus and an inadequate response to […]
- What’s new in atopic eczema? An analysis of systematic reviews published in 2018. Part 2: systemic therapies.This review forms part of an annual update series on atopic eczema (AE), where systematic reviews (SRs) are gathered and appraised to provide a summary of key recent research findings. The focus of this article is systemic therapies used in AE, while a review on prevention and topical therapies is provided in Part 1. In […]
- Views and experiences of managing eczema: systematic review and thematic synthesis of qualitative studies.The number of qualitative studies on eczema has increased rapidly in recent years. Systematically reviewing these can provide greater understandings of people’s perceptions of eczema and eczema treatments.We sought to systematically review and thematically synthesise qualitative studies exploring views and experiences of people with eczema and parents/carers of children with eczema.We searched MEDLINE, PsycINFO, CINAHL […]
- Patient-Reported Outcomes for Measuring Sleep Disturbance in Pediatric Atopic Dermatitis: cross sectional study of PROMIS Pediatric Sleep Measures and Actigraphy.Most children with atopic dermatitis(AD) suffer from sleep disturbance, but reliable and valid assessment tools are lacking.To test PROMIS (Patient Reported Outcomes Measurement Information System) sleep measures in pediatric AD and to develop an algorithm to screen, assess and intervene to reduce sleep disturbance.A cross-sectional study was conducted with AD children ages 5-17 years and […]
- Efficacy and Patient-Reported Outcomes from a Phase IIb, Randomized Clinical Trial of Tapinarof Cream for the Treatment of Adolescents and Adults with Atopic Dermatitis.Tapinarof is a topical therapeutic aryl hydrocarbon receptor modulating agent (TAMA) under investigation for atopic dermatitis (AD) and psoriasis treatment.Phase IIb, double-blind, vehicle-controlled study randomized adolescents and adults with AD to receive tapinarof cream 0.5%, 1%, or vehicle, once (QD) or twice daily (BID) for 12 weeks with 4-week follow-up. Outcomes included Investigator Global Assessment […]
- 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 84 weeks of dupilumab treatment.An observational prospective cohort study was conducted, including atopic dermatitis patients starting dupilumab in routine clinical care.Of the 221 included patients, 103 used systemic therapy at baseline. […]
- Assessing the need for routine safety testing for patients being treated with dupilumab for moderate-to-severe atopic dermatitis.Atopic dermatitis (also known as AD or eczema) is a common skin disease that can cause intense and persistent itching and rashes. Skin creams or ointments are not suitable or effective for some patients with moderate-to-severe AD. In these patients, oral (taken by mouth) or injected medications may be required. Some of those oral or […]
- Initial validation of the product of the signs global assessment and body surface area (SGAxBSA) in atopic dermatitis.Current valid instruments that measure the signs of AD in clinical trials may not be suitable for clinical practice due to their complexity. The product of a clinician-derived 5-point signs global assessment and body surface area (SGAxBSA) may represent a simple approach to quickly assess the severity of signs in patients with AD in clinical […]
- The clinical significance of fungi in atopic dermatitis.Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases and is caused by multiple factors including genetic factors, skin barrier defects, host immune responses, allergen sensitivity, environmental effects, and infections. Commonly, bacterial and viral infections are present in the eczematous lesions of AD patients and clearly aggravate the symptoms. However, studies […]
- Effect of statin use on incidence of eczema and atopic dermatitis: a retrospective cohort study.Click here to read the full article @ Journal of the American Academy of Dermatology
- Measurement properties of the Rajka-Langeland severity score in children and adults with atopic dermatitis.Multiple atopic dermatitis (AD) severity scales exist, with no gold-standard for use in clinical practice.Determine the measurement properties of the Rajka-Langeland score and compare with other clinician-reported outcomes in adults and children with AD.We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n=424).Rajka-Langeland had good concurrent validity with eczema area […]
- Topical timolol in chronic, recalcitrant fissures and erosions of hand eczema.Click here to read the full article @ Journal of the American Academy of Dermatology
- Atopic dermatitis in the elderly Caucasian population: diagnostic clinical criteria and review of the literature.Atopic dermatitis (AD) is a chronic relapsing eczematous dermatitis typically affecting young patients in a percentage from 15 to 20%; although it typically affects young people and adults, recent papers highlighted the emerging of the disease in the elderly population.The aim of the study was to identify the clinical criteria and allergic sensitization that may […]
- Partner bereavement and risk of chronic urticaria, alopecia areata and vitiligo: cohort studies in the United Kingdom and Denmark.The pathogeneses of skin diseases are not fully understood. Psychological stress has been proposed to be associated with skin diseases, but the epidemiological evidence is limited [1, 2]. We have recently reported the associations between partner bereavement (an extreme life stressor) and psoriasis, atopic eczema and melanoma [3, 4]. In this study, we further investigated […]
- Spectrum of skin diseases in Amerindian villages of the Upper Oyapock, French Guiana.Due to their genetic characteristics, their isolation in rainforest areas, and their traditional way of life, Amerindian populations are likely to suffer from a specific spectrum of dermatoses. However, there are few available data on such skin disorders. Our aims were to describe all skin disorders in two Amerindian villages of French Guiana.This retrospective study concerned all patients who consulted in the […]
- Expression of retinoid receptors in hand eczema.Hand eczema is the most common occupational skin disease. The etiology is multifactorial. Systemic alitretinoin, a pan-retinoic receptor agonist, has proven efficacy in the treatment of recalcitrant chronic hand eczema; however, its precise mechanism of action in hand eczema is not fully understood.Assessment of the level of expression of retinoid receptors (RAR and RXR) in […]
- The European TREatment of ATopic eczema Taskforce (TREAT) Survey; prescribing practices in Europe for phototherapy and systemic therapy in moderate-to-severe adult atopic eczema patients.For many years dermatologists have had access to few therapies for patients with moderate-to-severe atopic eczema (AE). New promising therapies are entering the market but conventional phototherapies and systemic therapies have more well-known safety-profiles, lower costs and wider availability.To provide insight into current prescribing practices of conventional photo- and systemic immunomodulatory therapies for adults with […]
- Delgocitinib ointment, a topical Janus kinase inhibitor, in adult patients with moderate to severe atopic dermatitis: A phase 3, randomized, double-blind, vehicle-controlled study and an open-label, long-term extension study.Previous studies showed the potential effectiveness of delgocitinib ointment, a novel topical Janus kinase inhibitor, in atopic dermatitis (AD).This study aimed to evaluate the efficacy and safety of delgocitinib 0.5% ointment.In part 1, a 4-week double-blind period, Japanese patients aged 16 years or older with moderate or severe AD were randomly assigned in a 2:1 ratio to […]
- Validation of Patient-Reported Outcomes Information System Sleep Disturbance and Sleep-Related Impairment in Adults With Atopic Dermatitis.Sleep disturbances (SD) are common in adults with atopic dermatitis (AD). Patient-Reported Outcomes Measurement Information System (PROMIS™) SD and Sleep-Related Impairment (SRI) are validated questionnaires to assess sleep in adults. Little is known about their measurement properties in adults with AD.To assess the measurement properties of PROMIS SD and SRI 8-item short-forms in AD.We performed […]
- Eczema and water hardness: another piece of the puzzle found?Click here to read the full article @ The British journal of dermatology
- Cannabinoids for the Treatment of Chronic Pruritus: A Review.Medical marijuana is becoming widely available to patients in the U.S. and with recreational marijuana now legalized in many states, patient interest is on the rise. The endocannabinoid system plays an important role in skin homeostasis in addition to broader effects on neurogenic responses such as pruritus and nociception, inflammation, and immune reactions. There are […]
- Product of Investigator Global Assessment and body surface area (IGAxBSA): a practice-friendly alternative to the Eczema Area and Severity Index (EASI) to assess atopic dermatitis severity in children.Accurately documenting pediatric atopic dermatitis (AD) severity is important, but research tools, such as Eczema Area and Severity Index (EASI), are too time-consuming for clinical settings. Product of the Physician Global Assessment and affected percentage of body surface area (PGAxBSA) is a new, rapid measure of psoriasis severity.Evaluate an Investigator Global Assessment (IGA) and body […]
- Most eczema smartphone apps do not conform to clinical guidelines.Click here to read the full article @ The British journal of dermatology
- Dupilumab for the Treatment of Dyshidrotic Eczema in 15 Consecutive Patients.Click here to read the full article @ Journal of the American Academy of Dermatology
- Measuring atopic eczema symptoms in clinical practice: The First Consensus Statement from the Harmonising Outcome Measures for Eczema in Clinical Practice Initiative.Measuring patient-centered outcomes in clinical practice is valuable for monitoring patients and advancing real-world research. A new initiative from the Harmonising Outcome Measures for Eczema (HOME) group aims to recommend what might be recorded for atopic eczema (AE) patients in routine clinical care.Prioritize outcome domains to measure AE in clinical practice and select valid and […]
- The prevalence of and reasons for discontinuation of atopic eczema trials on ClinicalTrials.gov: a cross-sectional analysis.Research waste is a major issue in atopic eczema.1 One contributor is the premature discontinuation of trials. Although termination of trials is essential when participants are exposed to harm, many trials terminate for potentially avoidable reasons.2,3 Such avoidable trial termination presents many issues. These include ethical issues, from the wasted time and effort of voluntary […]
- Topical Corticosteroids and Type 2 Diabetes Mellitus: A Critical Appraisal.Topical corticosteroids are widely used to treat inflammatory or pruritic skin conditions. The impact of systemic absorption of topical corticosteroids on the risk of hyperglycemia, and subsequent type 2 diabetes is unclear. Andersen et al. aimed to determine if topical corticosteroid use for psoriasis and eczema,1 which affect 2-3% and 2-8% of adults worldwide, respectively, […]
- Clinicopathologic overlap of psoriasis, eczema, and psoriasiform dermatoses: A retrospective study of T helper type 2 and 17 subsets, interleukin 36, and β-defensin 2 in spongiotic psoriasiform dermatitis, sebopsoriasis, and tumor necrosis factor α inhibitor-associated dermatitis.T helper (Th) type 17 and Th2 cells mediate psoriasis and eczema, respectively. Some dermatoses exhibit overlapping clinicopathologic features, and their immunopathology is relatively unexplored.To determine whether Th17 and Th2 subsets and interleukin (IL) 36 and β-defensin 2 (BD-2) markers of IL-17 signaling expression can discriminate between biopsy samples of psoriasis and eczematous/spongiotic dermatitis and […]
- Measurement properties of the Patient-Reported Outcomes Measurement Information System Itch Questionnaire® (PIQ) Item Banks in adults with atopic dermatitis.The Patient-Reported Outcomes Measurement Information System (PROMIS®) Itch Questionnaire® (PIQ) was recently developed.To validate PIQ short-forms in adults with AD.Self-administered questionnaires and skin-examination were performed in 239 adults with AD in a dermatology practice setting.PIQ items had good content validity. PIQ item bank T-scores strongly correlated with each other, moderately correlated with numeric and verbal […]
- Early Life Exposure to Air Pollution and Incidence of Childhood Asthma, Allergic Rhinitis and Eczema.There is growing evidence that air pollution may contribute to the development of childhood asthma and other allergic diseases. In this follow-up of the Toronto Child Health Evaluation Questionnaire (T-CHEQ) study, we examined associations between early life exposures to air pollution and incidence of asthma, allergic rhinitis and eczema from birth through adolescence.1286 T-CHEQ participants […]
- Development and initial testing of a new instrument to measure the experience of eczema control in adults and children: Recap of atopic eczema (RECAP).Eczema control has been identified as an important outcome by key stakeholders in eczema research (including patients, carers, healthcare professionals, and researchers) but no validated instruments for the domain have been identified.to develop a measurement instrument to capture a patient’s perspective of eczema control that is suitable for use in eczema clinical trials.Best practice for […]
- Partner bereavement and risk of psoriasis and atopic eczema: cohort studies in the United Kingdom and Denmark.Stress is commonly cited as a risk factor for psoriasis and atopic eczema, but such evidence is limited.To investigate the association between partner bereavement (an extreme life stressor) and psoriasis or atopic eczema.We conducted cohort studies using data from the UK Clinical Practice Research Datalink (1997-2017) and Danish nationwide registries (1997-2016). Exposed cohort: Partners who […]
- A hands-off approach may be more successful in treating chronic hand eczema.Abstract empty Click here to read the full article @ The British journal of dermatology
- Associations of eczema phenotypes with emotional and behavioural problems from birth until school age. The Generation R Study.Eczema phenotypes and emotional and behavioural problems are highly prevalent in childhood, but their mutual relationship is not fully clear.To examine the associations of eczema phenotypes with school-age emotional and behavioural problems, and the bidirectional associations of eczema and emotional and behavioural problems from birth until 10 years.This study among 5,265 subjects was embedded in […]
- The role of bacterial skin infections in atopic dermatitis: expert statement and review from the International Eczema Council Skin Infection Group.Patients with atopic dermatitis (AD) have an increased risk of bacterial skin infections that cause significant morbidity and, if untreated, may become systemic. Staphylococcus aureus (S. aureus) colonizes the skin of most AD subjects and is the most common organism to cause infections. Overt bacterial infection is easily recognised by the appearance of weeping lesions, […]
- A crosslinked polymer skin barrier film for moderate to severe atopic dermatitis: A pilot study in adults.Abstract: Occlusive treatments are a mainstay in atopic dermatitis (AD) management, but may not be well tolerated or lack compliance. A comfortable, semi-occlusive, artificial skin barrier that is well tolerated, provides protection, and reduces water loss, is desired.To evaluate, in adults with AD, the potential tolerability and therapeutic benefits of a crosslinked polymer skin barrier […]
- Dupilumab in adolescents with uncontrolled moderate-to-severe atopic dermatitis: results from a phase IIa open-label trial and subsequent phase III open-label extension.Abstract: Dupilumab (monoclonal antibody inhibiting IL-4/IL-13 signalling) is approved for use in adolescents aged ? 12 years with inadequately controlled moderate-to-severe atopic dermatitis (AD). Dupilumab significantly improved AD signs/symptoms in a 16-week, randomised, placebo-controlled phase III trial in adolescents (NCT03054428).To characterize the pharmacokinetics of dupilumab, and long-term safety and efficacy in adolescents.This was a global, […]
- Challenging a paradigm: Skin sensitivity to sodium lauryl sulfate is independent of atopic diathesis.Abstract: Sodium lauryl sulfate (SLS) is the best-studied detergent in irritant contact dermatitis. In atopic dermatitis, the two major pathophysiological abnormalities concern skin barrier function and regulation of cutaneous immune responses. The probability of atopic skin diathesis can be assessed by comprehensive analysis of patient history as well as clinical and laboratory findings resulting in […]
- Validation of the Dutch Quality of Life in Hand Eczema Questionnaire (QOLHEQ).Abstract: Measurement instruments should be validated for use in the population in which they are intended to be used.To assess validity, reproducibility, responsiveness and interpretability of the Dutch version of the Quality Of Life in Hand Eczema Questionnaire (QOLHEQ).Prospective validation study in adult patients with hand eczema. At three time points (T0 , baseline; T1 […]
- Predictors of severe asthma attack re-attendance in Ecuadorian children: a cohort study.Abstract: Asthma is a common cause of emergency care attendance in low and middle-income countries (LMICs). While few prospective studies of predictors for emergency care attendance have been undertaken in high-income countries, none have been done in a LMIC.We followed a cohort of 5-15?year olds treated for asthma attacks in Emergency Rooms (ERs) of public […]
- Onchocerciasis (river blindness): larva-induced eczema (onchodermatitis) from an important oculocutaneous tropical disease spilling over into North America and Europe.Abstract: Onchocerciasis is a leading cause of blindness in the world. It may be seen in temperate climates of the United States and Europe in immigrants and travelers from endemic regions, often linked to poverty and war. One should be aware of an incubation period that can be up to 15 months. In its early stage […]
- What’s new in atopic eczema? An analysis of systematic reviews published in 2017. Part 2: epidemiology, aetiology and risk factors.Abstract: This article forms part of a series of annual updates that summarizes the evidence base for atopic eczema (AE). It provides a summary of key findings from 28 systematic reviews that were published or indexed during 2017, and focuses on the epidemiology, aetiology and risk factors of AE. AE is the largest single contributor […]
- Skin diseases in rural Nyala, Sudan (in a rural hospital, in 12 orphanages, and in two refugee camps).Abstract: Skin diseases are considered to be common in Nyala, Sudan. This study was carried out to verify the prevalence of skin diseases in Nyala. This prospective observational study included skin examination of a total of 1802 people: 620 patients who were evaluated in the outpatient clinics (OC) and 1182 people from orphanages and refugee […]