Targeting IL-17 in psoriasis: From cutaneous immunobiology to clinical application

Psoriasis vulgaris is a chronic, immune-mediated inflammatory skin disease associated with complex genetic susceptibility. Although the hallmark of psoriasis is characterized by cutaneous inflammation and keratinocyte hyperproliferation, recent studies show that the pathologic features observed in psoriasis arises as a result of innate and adaptive immune activation in genetically prone individuals. Studies focused on the microenvironment in the skin of psoriasis lesions have revealed novel cellular and cytokine abnormalities of the immune system. One pathway important is the role of the T_H17/IL-17 dysregulation. The recent development of biologics that target the IL-17 cytokine pathway has confirmed the importance of T_H17 and IL-17 homeostasis in the skin and yielded potent therapies in the treatment of psoriasis, and potentially other autoimmune diseases.     

Epidemiology of medical complaints in Mexico: identifying a general profile.

OBJECTIVE: To determine the problems that were the sources of the complaints most frequently received at the National Commission of Medical Arbitration (CONAMED) in Mexico, as well as the diagnoses most frequently related, the institutions involved, and the populations affected. DESIGN: From all complaints received from 1 January 1998 to 31 December 2000, we chose a random sample of 639 complaints and carried out our study using a cross-sectional design. SETTING: CONAMED receives complaints from Mexico City and the surrounding areas. PARTICIPANTS: Patients attending public and private health institutions from the three levels of medical attention who submitted a complaint to the CONAMED in Mexico. MAIN OUTCOME MEASURES: Assessment of health care quality (good practice or malpractice). Type of malpractice (negligence, lack of skill, or deceit). Main motives of complaint. RESULTS: We analyzed 639 complaints; 57.6% were submitted by women, average age 41.0 years. Surgical treatment was the main cause of complaint. Most frequent diagnoses were diseases of the digestive system. Evaluation of medical practice revealed 36.5% of malpractice. Lack of skill accounted for 67.4% of those cases. CONCLUSIONS: Malpractice was identified in a third of the complaints, and lack of skill was the main reason for malpractice. Surgical patients were the most frequently affected. The other two-thirds of the complaints were related to lack of communication between patients and physicians. These results suggest potential points of intervention to decrease the risk and the conflict.     

Appointment-based models: A comparison of three model designs in a large chain community pharmacy setting

Objectives

To compare the effects of 3 different appointment-based model (ABM) designs on medication adherence and medication use outcomes controlling for patient and pharmacy characteristics.

Estimation of residual renal function using beta-trace protein: Impact of dialysis procedures

Beta-trace protein (BTP), a low molecular weight protein of 23-29 kDa, has been proposed as a promising biomarker to estimate residual renal function (RRF) in patients on maintenance hemodialysis (HD). Indeed, BTP is cleared by native kidney but not during conventional HD session. By contrast, the removal rate of BTP using convective processes (mainly hemodiafiltration [HDF]) and peritoneal dialysis (PD) has been little or not investigated. Therefore, an aim of this study was to evaluate the impact of dialysis procedures (high-flux HD, on-line post-dilution HDF and PD) on BTP removal in comparison with beta-2 microglobulin (B2M) and cystatin C (CYSC) removals after a single session. In addition, the ability of BTP to predict RRF in PD was assessed. This observational cross-sectional study included a total of 82 stable chronic kidney disease patients, 53 patients were on maintenance dialysis (with n = 26 in HD and n = 27 in HDF) and 29 were on PD. Serum concentrations of BTP, B2M, and CYSC were measured (a) before and after a single dialysis session in HD and HDF anuric patients to calculate reduction percentages, (b) in serum, 24-hour-dialysate and 24-hour-urine in PD patients to compute total, peritoneal, and urinary clearance. RRF was estimated using four equations developed for dialysis patients without urine collection and compared to the mean of the urea and creatinine clearances in PD. The concentrations of the three studied molecules were significantly reduced (P < .001) after dialysis session with significantly higher reduction ratio using HDF compared to HD modality (P < .001): BTP 49.3% vs 17.5%; B2M 82.3% vs 69.7%; CYSC 77.4% vs 66% in HDF and HD, respectively. In non-anuric PD patients, B2M and CYSC were partly removed by peritoneal clearance (72.3% and 57.6% for B2M and CYSC, respectively). By contrast, BTP removal by the peritoneum was negligible and a low bias for the BTP-based equation to estimate RRF (−1.4 mL/min/1.73 m²) was calculated. BTP is significantly removed by high-flux HD or HDF, thereby compromising its use to estimate RRF. By contrast, BTP appears as a promising biomarker to estimate RRF in PD patients since it is not affected by peritoneal clearance, unlike B2M and CYSC, and it is well correlated to RRF.     

Physicians' opinions of a health information exchange

Background

Arizona Medicaid developed a Health Information Exchange (HIE) system called the Arizona Medical Information Exchange (AMIE).

Objective

To evaluate physicians'' perceptions regarding AMIE''s impact on health outcomes and healthcare costs.

Measurements

A focus-group guide was developed and included five domains: perceived impact of AMIE on (1) quality of care; (2) workflow and efficiency; (3) healthcare costs; (4) system usability; and (5) AMIE data content. Qualitative data were analyzed using analytical coding.

Results

A total of 29 clinicians participated in the study. The attendance rate was 66% (N=19) for the first and last month of focus-group meetings and 52% (N=15) for the focus group meetings conducted during the second month. The benefits most frequently mentioned during the focus groups included: (1) identification of “doctor shopping”; (2) averting duplicative testing; and (3) increased efficiency of clinical information gathering. The most frequent disadvantage mentioned was the limited availability of data in the AMIE system.

Conclusion

Respondents reported that AMIE had the potential to improve care, but they felt that AMIE impact was limited due to the data available.