RESUMO
Giant condyloma accuminata or Buschke-Lowenstein tumor is a rare entity characterized by a large verrucous or cauliflower-shaped lesion primarily affecting the anogenital region. It forms part of a disease spectrum between classic condyloma accuminata and squamous cell carcinoma. Classically, it is thought to arise from previous human papilloma virus infection. Surgical management is usually the treatment of choice despite their high rate of soft tissue infiltration and recurrence. We herein describe a case of a 40-year-old male patient with cystic fibrosis diagnosed with giant condyloma accuminata without human papilloma virus or other paradigmatic risk factors that was treated with near-total surgical resection.
RESUMO
OBJECTIVES: We describe retention in care, medication for opioid use disorder (MOUD) prescribing, and urine toxicology outcomes of a comprehensive perinatal shared medical appointment model that combined medication, group-based counseling, and recovery supports. METHODS: We conducted a retrospective study of program retention between 11/1/16 and 3/31/20 in pregnant and postpartum women with substance dependence or use disorder. Disengagement reasons, MOUD prescribing, and urine toxicology were abstracted from medical records. A Cox proportional hazards model was used to evaluate risk factors for program disengagement. RESULTS: Approximately 87% of patients had OUD and 80% were pregnant at the initial visit (N = 140). Retention at 3 months, 6 months, 1 year, and 2 years was approximately 86%, 78%, 66%, and 48%, respectively. Over 97% of patients were prescribed MOUD and 88% of all urine toxicology results were negative for non-prescribed opioids. Patients enrolled after initiation of wraparound services (HR 0.52, 95% CI 0.28 - 0.96) and those attending more shared medical appointments (HR 0.90, 95% CI 0.87 - 0.93) had a lower hazard of disengagement after controlling for other covariates. Loss to follow-up was the most common disengagement reason. CONCLUSIONS: A low-threshold, comprehensive perinatal shared medical appointment program had high retention rates, increased access to evidence-based MOUD, and high rates of opioid-negative urine toxicology. Participants enrolled after wraparound services began had a lower hazard of disengagement. Future research in perinatal substance use should evaluate the most optimal and cost-effective components of comprehensive programs to inform standard of care.