Out-of-pocket costs for patients with psoriasis in an outpatient dermatology referral service

Abstract Background: Psoriasis is a chronic disease that derives great costs to the health care system. In Colombia, due to deficiencies in this system, patients are more likely to incur in out-of-pocket expenses; money that has never been quantified in this country. Objectives: To quantify out-of-pocket expenses and to analyze their relation to patients' clinical and labor characteristics in a cohort of psoriatic patients. Methods: A single-center, cross-sectional study was performed, evaluating psoriasis patients. Results: A total of 100 psoriasis patients were analyzed. We identified that patients with higher dermatology life quality index and in phototherapy treatment were the ones that had higher out-of-pocket costs (p = 0.006 and 0.005, respectively). We found no correlation between out-of-pocket costs and occupational status, psoriasis area severity index or other types of treatment. The largest amount of money was used to buy medications and bus transportation with a maximum up to 440.50 and 528.60 USD, respectively. Among the 100 participants the total expense was 11131.90 USD in a 6-month period. Study limitations: Lack of measurement of the labor productivity and labor absenteeism secondary to sick leave. Conclusion: Out-of-pocket costs are similar with what was shown in previous studies. We found statistically significant differences for the DLQI in comparison with out-of-pocket expenses, regardless of the PASI level. Phototherapy treatment also had statistically significant differences in relationship with out-of-pocket expenses, when compared to other treatments, because it requires higher expenses in transportation, copayments, and alimentation during appointment assistance.

Out-of-pocket costs for patients with psoriasis in an outpatient dermatology referral service.

BACKGROUND: Psoriasis is a chronic disease that derives great costs to the health care system. In Colombia, due to deficiencies in this system, patients are more likely to incur in out-of-pocket expenses; money that has never been quantified in this country. OBJECTIVES: To quantify out-of-pocket expenses and to analyze their relation to patients' clinical and labor characteristics in a cohort of psoriatic patients. METHODS: A single-center, cross-sectional study was performed, evaluating psoriasis patients. RESULTS: A total of 100 psoriasis patients were analyzed. We identified that patients with higher dermatology life quality index and in phototherapy treatment were the ones that had higher out-of-pocket costs (p = 0.006 and 0.005, respectively). We found no correlation between out-of-pocket costs and occupational status, psoriasis area severity index or other types of treatment. The largest amount of money was used to buy medications and bus transportation with a maximum up to 440.50 and 528.60 USD, respectively. Among the 100 participants the total expense was 11131.90 USD in a 6-month period. STUDY LIMITATIONS: Lack of measurement of the labor productivity and labor absenteeism secondary to sick leave. CONCLUSION: Out-of-pocket costs are similar with what was shown in previous studies. We found statistically significant differences for the DLQI in comparison with out-of-pocket expenses, regardless of the PASI level. Phototherapy treatment also had statistically significant differences in relationship with out-of-pocket expenses, when compared to other treatments, because it requires higher expenses in transportation, copayments, and alimentation during appointment assistance.

Cutaneous smooth muscle tumors associated with Epstein-Barr virus in an adult patient with HIV

Abstract Epstein Barr virus-associated smooth muscle tumors are an uncommon neoplasm that occurs in immunosuppressed patients of any age. Usually, it presents as multifocal tumors mainly in the spinal cord, epidural region, gastrointestinal tract and liver, upper respiratory tract and skin, the latest with few cases reported in the literature and related with human immunodeficiency virus infection and acquired immune deficiency syndrome. The authors present the first case of a Colombian adult patient with human immunodeficiency virus infection and multifocal Epstein Barr virus-associated smooth muscle tumors in the skin and epidural region, confirmed by histopathology, immunohistochemistry and in situ hybridization studies.

Cutaneous smooth muscle tumors associated with Epstein-Barr virus in an adult patient with HIV.

Epstein Barr virus-associated smooth muscle tumors are an uncommon neoplasm that occurs in immunosuppressed patients of any age. Usually, it presents as multifocal tumors mainly in the spinal cord, epidural region, gastrointestinal tract and liver, upper respiratory tract and skin, the latest with few cases reported in the literature and related with human immunodeficiency virus infection and acquired immune deficiency syndrome. The authors present the first case of a Colombian adult patient with human immunodeficiency virus infection and multifocal Epstein Barr virus-associated smooth muscle tumors in the skin and epidural region, confirmed by histopathology, immunohistochemistry and in situ hybridization studies.

Candidiasis mucocutánea crónica: una mirada al entendimiento genético / Chronic mucocutaneous candidiasis: a look at genetic understanding

RESUMEN La candidiasis mucocutánea crónica se caracteriza por infecciones recurrentes o persistentes en la piel, las uñas y las mucosas, producida por especies de Candida sp. Esta va a ser secundaria a cualquier alteración en la inmunidad antimicótica, en la cual no solo la producción de IL-17, sino cualquier defecto en la diferenciación de los linfocitos T hacia su perfil TH17, juegan un papel fundamental y van a desencadenar una susceptibilidad a esta infección, que dependiendo de la etiología genética, puede ser una manifestación sindrómica con otras características clínicas y endocrinológicas asociadas. Aquí revisamos de manera práctica, clara y concisa los defectos genéticos hasta ahora encontrados, implicados en la aparición de la candidiasis mucocutánea crónica.

SUMMARY Chronic mucocutaneous candidiasis is an infectious phenotype characterized by recurrent or persistent infections in the skin, nails and mucous membranes produced by Candida sp. This is secondary to any alteration in the antifungal immunity, in which not only the production of IL-17, but any defect in the differentiation of the T lymphocytes towards their TH17 profile, play a fundamental role and will unchain a susceptibility to this infection; that depending on the genetic etiology, can be a syndromic manifestation with other associated infectious and endocrinological clinical characteristics. Here, we review in a practical, clear and concise manner, the genetic defects so far found to be involved in the appearance of chronic mucocutaneous candidiasis.

Locally aggressive trichilemmal carcinoma.

Trichilemmal carcinoma is a rare adnexal neoplasia with histologic features reminiscent of the outer root sheath of hair follicles. The clinical presentation of trichilemmal carcinoma is variable, as it may mimic basal cell carcinomas and squamous cell carcinomas, thus requiring histologic diagnosis. We report the case of a patient with aggressive trichilemmal carcinoma in the auricle.

Locally aggressive trichilemmal carcinoma

Abstract: Trichilemmal carcinoma is a rare adnexal neoplasia with histologic features reminiscent of the outer root sheath of hair follicles. The clinical presentation of trichilemmal carcinoma is variable, as it may mimic basal cell carcinomas and squamous cell carcinomas, thus requiring histologic diagnosis. We report the case of a patient with aggressive trichilemmal carcinoma in the auricle.

["Where there's a woman, there's a Pap smear": the meanings assigned to cervical cancer prevention among women in Salvador, Bahia State, Brazil]. / "Tem mulher, tem preventivo": sentidos das práticas preventivas do câncer do colo do útero entre mulheres de Salvador, Bahia, Brasil.

This study focuses on the meanings assigned to practices for cervical cancer prevention among women from low-income neighborhoods in Salvador, Bahia State, Brazil. This was a qualitative study based on content analysis of semi-structured interviews with 15 women 24 to 68 years of age. The results showed high appreciation of the Pap smear test, performed as part of routine gynecological examination (but without the patient necessarily having biomedical knowledge of its role). Besides accessibility and quality of health services, other factors influence the way the women assign meaning to cervical cancer prevention. Moral values associated with sexuality and gender influence risk perception, adoption of preventive practices, and interpretation of cervical cytology results. The ongoing practice of the Pap smear test is part of the construction of femininity, which is associated with maturity and personal responsibility for self care in a context of medicalization of the female body.

"Tem mulher, tem preventivo": sentidos das práticas preventivas do câncer do colo do útero entre mulheres de Salvador, Bahia, Brasil / "Where there's a woman, there's a Pap smear": the meanings assigned to cervical cancer prevention among women in Salvador, Bahia State, Brazil / "Hay mujer, hay Papanicolaou": sentidos de las prácticas preventivas del cáncer de cuello de útero entre mujeres de Salvador, Bahía, Brasil

O objetivo deste trabalho foi compreender os significados das práticas preventivas do câncer do colo do útero entre mulheres de bairros populares de Salvador, Bahia, Brasil. Trata-se de estudo qualitativo, baseado na análise de conteúdo de entrevistas semiestruturadas com 15 mulheres entre 24 e 68 anos. Os resultados evidenciam alta valorização do Papanicolaou, que é realizado como parte de exames de rotina, sem, no entanto, sustentar-se no conhecimento biomédico sobre as suas funções. Além da acessibilidade aos serviços de saúde e da qualidade destes, outros fatores interferem na forma como essas mulheres significam a prevenção do câncer do colo do útero. Valores morais associados à sexualidade e ao gênero interferem na percepção de risco, na adoção de práticas preventivas e na interpretação dos resultados da citologia cervical. A realização continuada do Papanicolaou faz parte da construção da feminilidade, que é associada com maturidade e responsabilidade pessoal pelo cuidado de si em um contexto de medicalização do corpo feminino.

This study focuses on the meanings assigned to practices for cervical cancer prevention among women from low-income neighborhoods in Salvador, Bahia State, Brazil. This was a qualitative study based on content analysis of semi-structured interviews with 15 women 24 to 68 years of age. The results showed high appreciation of the Pap smear test, performed as part of routine gynecological examination (but without the patient necessarily having biomedical knowledge of its role). Besides accessibility and quality of health services, other factors influence the way the women assign meaning to cervical cancer prevention. Moral values associated with sexuality and gender influence risk perception, adoption of preventive practices, and interpretation of cervical cytology results. The ongoing practice of the Pap smear test is part of the construction of femininity, which is associated with maturity and personal responsibility for self care in a context of medicalization of the female body.

El objetivo de este trabajo fue comprender los significados de las prácticas preventivas del cáncer de cuello de útero entre mujeres de barrios populares de Salvador, Bahía, Brasil. Se trata de un estudio cualitativo, basado en el análisis de contenido de entrevistas semiestructuradas con 15 mujeres entre 24 y 68 años. Los resultados evidencian una alta valorización del Papanicolaou, que es realizado como parte de exámenes de rutina sin estar basado, no obstante, en el conocimiento biomédico sobre sus funciones. Más allá de la accesibilidad y de la calidad de los servicios de salud, otros factores influyen en la forma en que estas mujeres consideran la prevención del cáncer de cuello de útero. Los valores morales asociados a la sexualidad y al género influyen en la percepción de riesgo, en la adopción de prácticas preventivas y en la interpretación de los resultados de la citología cervical. La realización continuada del Papanicolaou forma parte de la construcción de la feminidad, que está asociada con la madurez y la responsabilidad personal por el cuidado de uno mismo en un contexto de medicalización del cuerpo femenino.

N-alkylation of poloxamines modulates micellar assembly and encapsulation and release of the antiretroviral efavirenz.

Poloxamines (X-shaped poly(ethylene oxide)-poly(propylene oxide) (PEO-PPO) diblocks connected to a central ethylenediamine group) were N-methylated and N-allylated with the aim of widening their versatility as drug nanocarriers. The self-aggregation properties of various derivatives, covering a wide range of molecular weights and EO/PO ratios, were thoroughly investigated. The cytocompatibility of different modified poloxamines was compared to that of the pristine counterparts by MTT and LDH assays. The most hydrophilic varieties were highly cytocompatible even at concentrations of 5%. Toward the optimization of the oral pharmacotherapy of the Human Immunodeficiency Virus (HIV) infection in pediatric patients, the encapsulation and in vitro delivery of efavirenz (EFV), a lipophilic first-line antiretroviral drug, were evaluated. Pristine and N-alkylated poloxamines behaved as highly efficient EFV solubilizers enhancing the aqueous solubility of the drug between 166 and 7426-times. EFV promotes self-micellization of poloxamines; their tiny structural modification (i.e., just one methyl- or allyl-group) being able to regulate drug/micellar core interaction. Despite the physical stability of the micelles against dilution in physiological mimicking fluids, the N-alkylated derivatives were slightly more prone to disassembly promoting EFV release from the micellar reservoir. For all the derivatives evaluated, the in vitro release fitted zero-order kinetics and was sustained for at least 24 h. These findings point out N-alkylated poloxamines as promising nanocarriers for oral or parenteral drug delivery.