Effect of Hyaluronic Acid on the Self-Assembly of a Dipeptide-Based Supramolecular Gel.

The combination of polymers and low molecular weight (LMW) compounds is a powerful approach to prepare new supramolecular materials. Here we prepare two-component hydrogels made by a well-known and biologically active polymer, hyaluronic acid (HA), and a dipeptide-based supramolecular gelator. We undertake a detailed study of materials with different compositions including macroscopic (hydrogel formation, rheology) and micro/nanoscopic characterization (electron microscopy, X-ray powder diffraction). We observe that the two components mutually benefit in the new materials: a minimum amount of HA helps to reduce the polymorphism of the LMW network leading to reproducible hydrogels with improved mechanical properties; the LMW component network holds HA without the need for an irreversible covalent crosslinking. These materials have a great potential for biomedical application as, for instance, extracellular matrix mimetics for cell growth. As a proof of concept, we have observed that this material is effective for cell growth in suspension and avoids cell sedimentation even in the presence of competing cell-adhesive surfaces. This may be of interest to advanced cell delivery techniques.

Identification of Four Similar Cell Culture Media According to their Glucose, Glutamine, and Pyruvate Content by Handheld Raman Spectroscopy.

PURPOSE: This study describes the first efforts to build a spectral library to identify four cell culture media in powder form with spectra obtained with a handheld Raman spectrometer. These complex mixtures contain over 30 components and are among the most widely used cell culture media. METHODS: A total of 32 spectra were collected for the four Dulbecco's Modified Eagle Medium cell culture media and pure materials (glucose and L-glutamine) in powder form. The spectra were preprocessed using standard normal variate with second derivative, and the barcode method before performing principal component analysis (PCA). RESULTS: The PCA model differentiated the pure glucose and the cell culture media according to the glucose concentration along the first principal component. The second principal component differentiated the three cell culture media with high glucose content according to the pyruvate concentration. The correlation coefficient showed that powdered cell culture media with high glucose concentration have a higher correlation with pure glucose, when compared with the cell culture media with low glucose. CONCLUSION: The Raman spectra made it possible to differentiate the four DMEM in the cell culture media from the majority of the external samples used in the method evaluation. However, sample heterogeneity affected the predictions. Additional studies are needed to improve the method's ability to differentiate the DMEM with high glucose.

The Use of a Closed Feed Frame for the Development of Near-Infrared Spectroscopic Calibration Model to Determine Drug Concentration.

PURPOSE: This study evaluates the use of the closed feed frame as a material sparing approach to develop near-infrared (NIR) spectroscopic calibration models for monitoring blend uniformity. The effect of shear induced by recirculation on NIR spectra was also studied. METHODS: Calibration models were developed using NIR spectra obtained in the closed feed frame for two cases. For case 2, blends that flowed through the open feed frame were predicted with the model. The shear effect of the feed frame on the blends was assessed through the characterization of powder properties before and after recirculation. RESULTS: The physical characterization of the blends confirmed that the powder properties were not altered after recirculation within the closed feed frame. Both calibration models provided highly accurate predictions of the test sets with low bias (0.03% w/w and -0.06% w/w) and relative standard error of prediction (1.9% and 3.7%), respectively. The predictive performance of the calibration models was not affected by the shear effect. CONCLUSION: Recirculation within the closed feed frame did not change the physical properties of the blends studied. The prediction of blends flowing through the open feed frame was possible with a calibration model developed in the closed feed frame. The closed feed frame could reduce the materials needed to develop calibration models by more than 90%.

[Single-pass albumin dialysis as treatment of acute on chronic liver failure during COVID-19 pneumonia. report of one case]. / Diálisis de albúmina de paso único (SPAD) como soporte hepático extracorpóreo en paciente COVID-19 crítico. Caso clínico.

Liver transplantation is the only effective therapy to reduce the high mortality associated with acute liver failure and acute on chronic liver failure (ACLF). Single-pass albumin dialysis (SPAD) is an extracorporeal supportive therapy used as a bridge to liver transplantation or regeneration. We report a 44-year-old man with alcoholic cirrhosis admitted for critical COVID-19 pneumonia that evolves with ACLF. SPAD technique was performed completing six sessions, with a reduction of bilirubin and ammonia levels. He evolved with severe respiratory failure and refractory septic shock, dying. SPAD is a safe and efficient technique aimed to eliminate liver toxins, preventing multiorgan damage interrupting the process known as the "autointoxication hypothesis". It is easy to implement in any critical patient unit and has lower costs than other extracorporeal liver support therapies.

Association of environmental and meteorological factors on the spread of COVID-19 in Victoria, Mexico, and air quality during the lockdown.

This study aims to analyze the correlation between environmental factors and confirmed cases of COVID-19 pandemic in Victoria, Mexico. The analysis is performed at the micro-level, filtering only confirmed cases of COVID-19 that are located near air quality monitoring stations, within an approximate coverage of 2.5 km, in order to identify a possible specific association between PM2.5, PM10, carbon monoxide (CO), relative humidity, temperature, absolute humidity, and total confirmed cases of COVID-19. The results evidenced that the cases of COVID-19 were very strongly associated with CO concentration. Our results also suggested that particulate matter pollution (PM2.5 and PM10) exposure have a significant correlation for confirmed cases of COVID-19. Furthermore, we studied the changes in air quality during the COVID-19 outbreak by comparing the average concentration of the four weeks before lockdown (February 16 to March 14, 2020) and the following twelve weeks during the partial lockdown (March 15 to June 06, 2020), revealing a very significant decrease of pollutants.

[Clinical features of COVID-19 infection among patients consulting at an emergency service]. / Evaluación de los predictores clínicos de infección respiratoria aguda por coronavirus SARS-CoV-2 en población adulta.

BACKGROUND: COVID-19 is a serious public health problem worldwide. AIM: To describe the clinical features of COVID-19 infection in adult patients consulting at an Emergency Service. MATERIAL AND METHODS: Descriptive prospective study of adult patients with suspected COVID-19 consulting between April 1 and July 31, 2020, at the Emergency Service of a clinical hospital. Clinical features, chronic comorbidities and demographic data were recorded. RESULTS: We assessed 2,958 adult patients aged 42 ± 15 years (46% males). In 54% of them, COVID-19 infection was confirmed, 40% had preexisting diseases, especially hypertension (15%), hypothyroidism (6%), diabetes (6%), asthma (5%) and obesity (6%). The main clinical manifestations associated with COVID-19 were general malaise (79%), anorexia (38%), myalgia (64%), fever (52%), headache (70%), anosmia/dysgeusia (60%), cough (56%), dyspnea (54%) and diarrhea (36%). In the multivariate analysis, the main clinical predictors of COVID-19 infection were malaise, anorexia, fever, myalgia, headache, nasal congestion, cough, expectoration, anosmia/dysgeusia, and history of close contact with a SARS-CoV-2 patient. Odynophagia and chest discomfort were negative predictors of the disease. The history of fever associated with anorexia, cough, and dyspnea or anosmia/dysgeusia and close contact with a SARS-CoV-2 patient had high specificity and positive predictive value for COVID-19 infection. CONCLUSIONS: Clinical features of COVID-19 infection were highly unspecific in these patients. Clinical diagnostic prediction models could be useful to support healthcare decision making at primary care setting.

[Clinical features and predictors of severity in 1022 adults with COVID-19]. / Manifestaciones clínicas y predictores de gravedad en pacientes adultos con infección respiratoria aguda por coronavirus SARS-CoV-2.

BACKGROUND: In December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan city and spread rapidly throughout China and the world. AIM: To describe the clinical features, risk factors, and predictors of hospitalization in adult patients treated for acute respiratory infections associated with coronavirus SARS-CoV-2. MATERIAL AND METHODS: Descriptive prospective study of ambulatory and hospitalized adult patients with confirmed COVID-19 attended between April 1 and May 31, 2020. Clinical features, chronic comorbidities and demographic data were recorded, and patients were followed for two months as outpatients. RESULTS: We assessed 1,022 adults aged 41 ± 14 years (50% men) with laboratory-confirmed COVID-19. One-third had comorbidities, specially hypertension (12.5%), hypothyroidism (6.6%), asthma (5.4%) and diabetes (4.5%). Hospital admission was required in 11%, 5.2% were admitted to critical care unit and 0.9% were connected to mechanical ventilation. Common symptoms included fatigue (55.4%), fever (52.5%), headache (68.6%), anosmia/dysgeusia (53.2%), dry cough (53.4%), dyspnea (27.4%) and diarrhea (35.5%). One third of patients reported persistence of symptoms at one-month follow-up, specially fatigue, cough and dyspnea. In the multivariate analysis, age, fever, cough, dyspnea and immunosuppression were associated with hospitalization and ICU admission. Age, male sex and moderate-severe dyspnea were associated with requirement of mechanical ventilation. The main predictors of prolonged clinical course were female sex, presence of comorbidities, history of dyspnea, cough, myalgia and abdominal pain. CONCLUSIONS: Clinical features of COVID-19 were highly unspecific. Prediction models for severity, will help medical decision making at the primary care setting.

Particulate matter 1µm (PM1) dataset collected by low-cost sensors in residential and industrial areas at the neighborhood level.

The incursion of low-cost sensors (LCS) for monitoring particulate matter in different fractions of particles (PM10, PM2.5, and PM1) allows the characterization of the concentration levels of specific sources or events, including the analysis of ultrafine fractions (PM1). Several studies have documented adverse effects on human health due to exposure to PM1, such as morbidity and mortality from respiratory, cardiovascular, and, in some cases, carcinogenic diseases. Hence, studying the concentration levels and the sources that cause PM1 is imperative. LCS is an alternative to understanding contaminant concentration levels by considering spatial and temporal community dynamics by monitoring critical zones. Furthermore, collecting and managing large amounts of data through automatic processing and analysis generates information to support decision-making to reduce exposure and risks to people's health. The dataset presents the concentration level of PM1 (µg/m3) calculated from the particles of size 0.03 µm, 0.05 µm, and 1.0 µm recorded and counted by the sensor in a sample per minute for 24 h for seven continuous days. The values of the meteorological factors of relative humidity, temperature, and heat index complement these attributes. The dataset comprises records collected (in the same period) at four particulate matter monitoring stations, which compose an LCS network supported by Internet of Things (IoT) technologies. The data collection points were located in different areas of Reynosa, Mexico, considering strategic places for monitoring environmental pollution, such as industrial parks, residential areas, avenues with high vehicular traffic and transportation of heavy cargo, and an airport.

Reducing Stigma Toward People with Serious Mental Illness Through a Virtual Reality Intervention: A Randomized Controlled Trial.

Background: Stigma toward people with serious mental illnesses (SMI), like schizophrenia, is a serious global public health challenge that limits the quality of life of those affected and poses a major barrier that keeps people from seeking professional help. There is an urgent need for novel, effective, and scalable interventions to decrease stigmatized perceptions of chronic psychotic disorders and to reduce the health burden imposed by them. Method: We conducted a randomized controlled trial to assess the impact of a new immersive virtual reality game (Inclúyete-VR) on the level of stigma toward people with SMI, measured by the Attribution questionnaire (AQ-27). Participants in the experimental group were exposed in an immersive way to hallucinations common in schizophrenia, then shown different psychosocial resources available for their recovery and social inclusion; those in the control group used VR software unrelated to mental health. VR sessions were delivered through Oculus headgear and lasted 25 minutes. Results: We randomly assigned 124 university students (55% female) to experimental or control conditions (n = 62 each). We used mixed ANOVA to compare outcomes before and after the intervention between the two groups. We found a significant intervention-by-time interaction (P < 0.001), with a reduction in the experimental group of overall stigma levels on the AQ-27 scale and its three subscales: dangerousness-fear, avoidance, and lack of solidarity (P < 0.001 for all). Conclusions: The Inclúyete-VR software proved effective in the short term in reducing stigma toward people with severe mental illness. The program's longer-term efficacy, scalability, and dissemination remain to be studied. ClinicalTrials.gov Identifier: NCT05393596.

A biopsychosocial-spiritual wellness check program for internal medicine residents: A brief report.

INTRODUCTION: The pandemic has significantly impacted medical residents. We created and implemented a biannual biopsychosocial-spiritual Wellness Check Program (WCP) to help internal medicine residents self-assess for burnout, enhance resilience, and to promote early identification and referral to mental health services. We report the preliminary findings from our quality improvement pilot effort at Loma Linda University Health (LLUH). METHOD: Residents participated in biannual sessions with licensed therapists employed by Loma Linda University, Office of Physician Vitality (OPV). Visits consisted of an evidence-guided discussion about general wellbeing, relationships, family life, coping strategies, and referrals. Archived, confidential WCP session notes between July 1, 2019 and December 31, 2019 were reviewed and a simple tally system was used to record coping strategies, concerns, and referrals made. RESULTS: Partner and family issues were the most prevalent concern, followed by mental health issues, and relationships with colleagues, faculty, or staff. Most residents described several coping strategies: 66.36% listed two to three, and 26.36% listed four or more. Referrals were offered to community or employee assistance program therapists, follow-up with the OPV, psychiatry, couple counseling, given Web based psychoeducational links, or referred to their program director. Nine other residencies requested the WCP providing anecdotal evidence of its feasibility and usefulness. DISCUSSION: As the pandemic surged, these visits normalized reflections about wellbeing, intentional coping strategies, and resilience practices. We continue to gather data to refine and further structure this program and help residents monitor and address their resilience needs and wellness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Bilateral Tessier no. 7 cleft with an accessory maxilla and osseous choristoma: a case report.

Tessier no. 7 clefts are characterized by macrostomia, facial muscular diastasis and maxillary and zygomatic bone abnormalities. It is caused by a lack of ectomesenchyme formation or penetration of the maxillary and mandibular processes during the fourth and fifth weeks of development. A case of bilateral transverse facial cleft with an accessory maxilla and an osseous choristoma is presented. The diagnosis of accessory maxilla was based on clinical findings due to the inaccessibility of orthopantomography and computed tomography scan. Orbicularis oris muscle reconstruction, cheiloplasty and excision of accessory maxilla were done. Histopathological examination of the bony lesion showed an osseous choristoma. There were no postoperative complications or local recurrence of the lesion excised. This case report demonstrates the importance of early diagnosis and intervention in maxillofacial congenital anomalies. Cheiloplasty restores function and gives the patient a natural appearance. The excision of accessory bone prevents further complications in the child's growth.

Evaluation of a compact composite sensor array for concentration monitoring of solutions and suspensions via multivariate analysis.

Compact composite probes were identified as a priority to alleviate space constraints in miniaturized unit operations and pharmaceutical manufacturing platforms. Therefore, in this proof of principle study, a compact composite sensor array (CCSA) combining ultraviolet and near infrared features at four different wavelengths (280, 340, 600, 860 nm) in a 380 × 30 mm housing (length x diameter, 7 mm diameter at the probe head), was evaluated for its capabilities to monitor in situ concentration of solutions and suspensions via multivariate analysis using partial least squares (PLS) regression models. Four model active pharmaceutical ingredients (APIs): warfarin sodium isopropanol solvate (WS), lidocaine hydrochloride monohydrate (LID), 6-mercaptopurine monohydrate (6-MP), and acetaminophen (ACM) in their aqueous solution and suspension formulation were used for the assessment. The results demonstrate that PLS models can be applied for the CCSA prototype to measure the API concentrations with similar accuracy (validation samples within the United States Pharmacopeia (USP) limits), compared to univariate CCSA models and multivariate models for an established Raman spectrometer. Specifically, the multivariate CCSA models applied to the suspensions of 6-MP and ACM demonstrate improved accuracy of 63% and 31%, respectively, compared to the univariate CCSA models [1]. On the other hand, the PLS models for the solutions WS and LID showed a reduced accuracy compared to the univariate models [1].

Randomized Controlled Trial of Health Coaching for Parents of Children With Medical Complexity.

BACKGROUND AND OBJECTIVE: Parents of children with medical complexity (CMCs) struggle with managing their children's care needs. Health coaching provides patients with tools to take ownership of their care. We sought to assess the impact of health coaching for parents of CMCs on activation, child's health related quality of life (HRQL), and utilization. METHODS: Parents of CMCs receiving primary care at two academic primary care practices were randomized to receive 3-6 months of coaching from a trained health coach (n = 54) or usual care (n = 71). Parents were surveyed on activation, HRQL, and experience of care at baseline and the end of the study period. Markers of utilization (missed visit rates, ED, and admissions) were measured for 12 months prior to and after enrollment. Parametric, nonparametric, and Poisson regression were used to assess baseline differences in characteristics and average pre-post differences between the groups. RESULTS: At baseline, activation and rating of patient experience were high in both groups, while HRQL was one standard deviation below the population-based mean. Both groups had slight increases in HRQL and P-PAM without significant differences between groups. ED visits declined significantly more in the intervention group than the usual care group (0.68 visits, (-0.03, -1.32) P = .04); there were nonsignificant differences in changes in other utilization metrics. CONCLUSION: Health coaching was associated with a decrease in ED use but not in changes in activation, patient experience, or HRQL. More inquiry is needed to understand whether health coaching is an effective modality for improving care for children with medical complexity.

An Online Community for Patient with Psoriasis with Built-in Self-Reported Questionnaires.

This study presents an online psoriasis community developed with dermatologists in a PHR. We describe the interaction of users with this platform and the relationship between the use of self-report questionnaires, their results and users' subsequent contact with the healthcare system. Out of 2175 users that interacted with the platform, 477 visited the forums. 60% of those who completed questionnaires presented at least one abnormal result that prompted a recommendation for an outpatient visit. Although our data suggest a trend, we failed to find a statistically significant association between questionnaire severity and visits scheduling. To our knowledge, this is the first study that analyses the relationship between patient self-reported disease severity and the subsequent contact with the healthcare system.

Prevalence and characteristics of cutaneous sarcoidosis in Argentina.

BACKGROUND: Sarcoidosis is a multisystem granulomatous disease of unknown etiology. The incidence is higher in women than in men, according to some studies. Studies regarding prevalence and characteristics of cutaneous sarcoidosis in our region are scarce. OBJECTIVE: This study aimed to describe the characteristics of patients with cutaneous sarcoidosis and to estimate its prevalence. METHODS: A cross-sectional study was conducted of patients with cutaneous sarcoidosis between January 1, 2004 and April 30, 2019 at the Hospital Italiano de Buenos Aires in Argentina. We included all patients age >17 years with biopsy-proven cutaneous sarcoidosis. Isolated cutaneous sarcoidosis was defined as the presence of epithelioid noncaseating granulomas on a skin biopsy without further evidence of systemic involvement. To estimate period prevalence, we only considered the subgroup of patients affiliated with our private health system. RESULTS: A total of 38 patients with cutaneous sarcoidosis were included. The median age at the time of diagnosis was 55.5 years. There was a striking female predominance in our series (73.7%). Overall, 15 patients (39.5%) had isolated cutaneous sarcoidosis and 23 (60.5%) had systemic sarcoidosis with cutaneous involvement. The median follow-up of the study population from histological diagnosis was 50 months (interquartile range, 24-10 months). Regarding skin involvement, 28 patients (73.7%) presented with only sarcoidosis-specific lesions, 6 (15.8%) presented with erythema nodosum, and 4 (10.5%) presented with both sarcoidosis-specific lesions and erythema nodosum. Treatment was given to 29 patients (73.6%), with systemic and topical corticosteroids being the most frequent. The crude prevalence of cutaneous sarcoidosis was 16.9 (95% confidence interval, 10.6-25.5) per 100,000 persons. CONCLUSION: One of the major findings of our study was that 40% of patients had isolated cutaneous sarcoidosis.

An innovative sampling interface for monitoring flowing pharmaceutical powder mixtures.

A chute was designed following the principles of the Theory of Sampling to minimize the variations in powder flow and provide all particles in the flowing blends with the same opportunity of being selected as a sample. The design also reduces the thickness of the chute to allow the analysis of a higher portion of the flowing blends by a near infrared spectrometer. The blends that flowed through the chute had Carr's index values that fluctuated between 23 and 25 percent, indicating passable flowability. A powder fowling evaluation demonstrated that there was no powder accumulation at the inspection window of the chute. The mass flow rate profiles indicated that the system achieves mass steady-state in approximately 30 s and a throughput of 30 kg/h which makes it suitable for continuous manufacturing operations. An in-line NIR calibration model was developed to quantify caffeine concentrations between 1.51 and 4.52 % w/w. The spectra obtained from each experiment had minimal baseline variation. The developed NIR method was robust to throughput changes up to approximately ±7 %. The test blends in the caffeine concentration range between 2.02 % w/w and 4.02 % w/w met the dose uniformity requirements of the Ph.Eur. 9.0, chapter 2.9.47. Variographic analysis was done to estimate the analytical and sampling errors which yielded values below 0.01 (%w/w)2. The obtained results showed that this chute could also be used in a continuous manufacturing line or other applications with flowing powders.

Intimate Partner Violence Experienced by Physicians.

PURPOSE: World Health Organization (WHO) defines intimate partner violence (IPV) as physical, sexual or psychological harm caused by an intimate partner or ex-partner. There are few studies describing interpersonal violence (IPV) among physicians. Our study describes IPV experienced by U.S. physicians. METHODS: This was a multicenter survey administered to 4 physician groups in 2015 to 2016. In total 400 respondents returned survey results. Measures included current IPV, childhood abuse, mental health, professional role, and demographics. RESULTS: IPV was reported by 24% of respondents. The most frequent abuses reported were: verbal (15%), physical (8%) followed by sexual abuse (4%) and stalking (4%). Logistic regression model found that IPV was more likely to be reported by older participants (aged 66-89), those who experienced childhood abuse, working less than full time, and had been diagnosed with a personality disorder. Women and Asian Americans reported slightly higher IPV rates. CONCLUSIONS: Our study has implications for both medical education and intervention development. Universal screening and education that addresses clinical implications when treating peers who experience IPV are needed. Workplace interventions that consider unique physician characteristics and experiences are needed, as well as programs that support sustained recovery. This is the first survey to our knowledge that confirms that physicians experience IPV at a rate consistent or higher than the national level. We developed a standardized instrument to assess IPV in male and female physicians at various career stages. We also identified significant predictors that should be included in IPV screening of potential physician victims.

Stressors and Coping Mechanisms Related to Burnout Within Urology.

OBJECTIVE: To identify factors and stress coping mechanisms associated with burnout within the field of urology. METHODS: A survey study was completed using the abbreviated Maslach Burnout Inventory to evaluate emotional exhaustion, depersonalization, and low personal achievement. Demographic information, training status, practice setting, work hours, and mechanisms used to cope with stress were evaluated. Participants were also asked to comment on contributors to burnout in an open-ended question. Univariate analysis and multivariate regression identified factors associated with measures of burnout. RESULTS: A total of 476 survey responses from 377 practicing urologists and 99 residents/fellows were included. Burnout was identified in 49.6% of all participants. Burnout through high emotional exhaustion was seen in 40.7%, high depersonalization in 30.7%, and low personal achievement in 18.3%. Trainees exhibited higher levels of depersonalization and lower levels of personal achievement. Higher levels of emotional exhaustion were identified in urologists in the middle of their careers and those in private practice. Urologists identified documentation, insurance and reimbursement, government regulations, medical practice expectations, and patient expectations as stressors contributing to burnout. Exercising and socializing were consistently associated with lower measures of burnout whereas stress eating and alcohol use were associated with higher measures of burnout on multivariate analysis. CONCLUSION: Burnout in urology was associated with trainee status, years in practice, and practice setting. Exercising and socializing were protective against burnout whereas stress eating and alcohol consumption were associated with higher rates of burnout.

Medical resource consumption of moderate/severe psoriasis in a private health organization of Buenos Aires, Argentina.

BACKGROUND: Despite the economic burden of psoriasis for patients and societies, scant information exists regarding the impact and burden of the disease in Argentina. OBJECTIVE: The objective of this study was to estimate medical resource consumption and direct health care costs for patients with moderate/severe psoriasis in Buenos Aires, Argentina from the perspective of the payer. METHODS: Adults with moderate/severe psoriasis (severity was defined as receiving systemic treatment), during January 2010-January 2014, aged 18 years and older, members of the Italian Hospital Medical Care Program with at least 18 months of follow-up were included. All data on hospitalizations, drug prescription, outpatient episodes, consultations, and investigations/tests in the 12 months before inclusion in the study were considered for the estimation of medical resource consumption and direct health care costs. First-quarter 2018 costs were obtained from the IHMCP and converted into US dollars (using the January 2018 exchange rate). RESULTS: A total of 791 patients were included. The mean age at diagnosis was 34±12 years. Almost 65% of the patients had a dermatologist as their usual source of care, 43% had internists, and 14% had rheumatologists. The average yearly direct cost was US$ 5326 (95% CI: 4125-7896) per patient per year. STUDY LIMITATION: The single center design and the retrospective nature are the main limitations. CONCLUSION: This is the first Argentine study that evaluated the costs of moderate/severe psoriasis by taking into consideration the direct medical costs of the disease.