The role of user charges and structural attributes of quality on the use of maternal health services in Morocco

Health care decision makers in settings with low levels of utilization of primary services are faced with the challenge of balancing the sometimes competing goals of increasing coverage and utilization of maternity services, particularly among the poor, with that of ensuring the financial viability of the health system. Morocco is a case in point where this policy dilemma is currently being played out. This study examines the role of household out-of-pocket costs and structural attributes of quality on the use of maternity care in Morocco using empirical data collected from both households and health care facilities. A nested logit model is estimated, and the coefficient estimates are used to carry out policy simulations of the impact of changes in the levels of out-of-pocket fees and structural attributes of quality in order to help guide policy makers responsible for the design of pending social insurance programs. The results of the paper suggest that social insurance strategies that involve increases in out-of-pocket charges in the form of copayments could be implemented without untoward effects on appropriate use of maternity care for non-poor women, but would be contraindicated for poorer and rural households.     

Update on punctal plugs

Punctal plugs have offered a safe and often reversible treatment for aqueous-deficient dry eye for over three decades. However, they represent only one tool in our armamentrarium to help patients with dry eyes, and plugs do have limitations. This article briefly reviews the history of occlusive treatments for aqueous tear deficiency and provides an update of recent advancements in punctal and canalicular occlusive materials and techniques.     

Periodic lateralized epileptiform discharges associated with subdural hematoma.

A case presenting with headaches, organic dysfunction with visual hallucinations, and incontinence of urine, all of two days' duration is described here. EEG obtained on the fourth hospital day showed right-sided PLEDS and on the fifth hospital day a generalized seizure occurred. The other clinical and laboratory data led to a diagnosis of bilateral subdural hematomas. The patient recovered following surgical treatment. No etiologic factor other than the subdural hematomas was found to explain the PLEDS. Possible mechanisms of pathophysiology are discussed.     

The association between bladder-emptying methods and health-related quality of life among Iranian individuals with spinal cord injury

Objectives: In this study, we compared the health-related quality of life (HRQoL) among patients with spinal cord injury (SCI) using different bladder emptying methods including normal spontaneous micturition (NSM), micturition with assisted maneuvers (MAM), aseptic intermittent catheterization by patient (IC-P), aseptic IC by an attendant/caregiver (IC-A) and indwelling catheterization.

Design: Cross-sectional.

Setting: Tertiary rehabilitation center.

Participants: Patients referred to Brain and Spinal Cord Injury Research Center between 2012 and 2014.

Outcome measures: HRQoL was assessed by Short Form Health Survey (SF-36). Hierarchical regression analysis with adjustment for probable confounders (demographic and injury-related variables) was performed to assess the relationship between bladder-emptying method and total SF-36 score.

Results: Patients with injury at cervical sections had significantly lower scores in domain of physical functioning (PF), physical component summary (PCS) and total score (P: 0.001, <0.0001 and 0.027, respectively). Longer time since injury was associated with better scores of PCS, Mental component summary (MCS) and total score (P: 0.002, <0.0001 and 0.003, respectively). Regression analysis showed that the effect of bladder-emptying method on total score of SF-36 was significant (P < 0.0001) and this relationship remained significant after adjustment for probable confounders in the second step of hierarchical regression analysis (R: 0.923, R²: 0.852, Adjusted R²: 0.847, P?<?0.0001). Patients with NSM had the highest scores in SF-36 instrument and individuals with indwelling catheterization had the poorest HRQoL in all domains.

Conclusion: This study shows that the type of bladder management method affects HRQoL significantly in patients with SCI. Intermittent catheterization are recommended to be administered instead of indwelling catheterization to improve HRQoL.     

Mala s 12 is a major allergen in patients with atopic eczema and has sequence similarities to the GMC oxidoreductase family

Background: Atopic eczema (AE) is a chronic inflammatory skin disorder, characterized by impaired skin barrier and itch. The yeast Malassezia belongs to the normal human skin microflora and can induce IgE‐ and T‐cell‐mediated allergic reactions in AE patients. Previously, we have identified several IgE‐binding components in Malassezia sympodialis extract. Methods: Here, we report cloning, production and characterization of a M. sympodialis 67‐kDa allergen. Results: The sequence of the 67‐kDa protein, termed Mala s 12, showed sequence similarity to the glucose–methanol–choline (GMC) oxidoreductase enzyme superfamily and was expressed as a recombinant protein in Escherichia coli. The purified protein bound flavin adenine dinucleotide with 1:1 stoichiometry per monomer of protein. The protein‐bound flavin showed an extinction coefficient at 451 nm of 11.3 mM⁻¹cm⁻¹. The recombinant 67‐kDa protein did not show any enzymatic activity when tested as oxidase or dehydrogenase using choline, glucose, myo‐inositol, methanol, ethanol, 1‐pentanol, benzyl alcohol, 2‐phenylethanol, cholesterol or lauryl alcohol as possible substrates. Recombinant Mala s 12 was recognized by serum IgE from 13 of 21 (62%) M. sympodialis‐sensitized AE patients indicating that the 67‐kDa component is a major allergen. Conclusions: The data show that Mala s 12 has sequence similarity to the GMC oxidoreductase family and is a major allergen in AE patients.     

The Malassezia sympodialis allergen Mala s 11 induces human dendritic cell maturation, in contrast to its human homologue manganese superoxide dismutase

BACKGROUND: Recently, we identified a major Malassezia sympodialis allergen, Mala s 11, which displays a high degree of DNA sequence homology to human manganese superoxide dismutase (hMnSOD). In atopic eczema patients sensitized to M. sympodialis, hMnSOD can elicit eczematous reactions and positive skin prick tests, suggesting cross- reactivity to Mala s 11 based on molecular mimicry. The objective of the current study was to compare the influence of Mala s 11 and hMnSOD on human dendritic antigen-presenting cells. METHODS: Monocyte-derived dendritic cells (MDDCs) from healthy blood donors were co-cultured with recombinant Mala s 11 (rMala s 11), recombinant hMnSOD (rhMnSOD), lipopolysaccharide or cultured in medium alone. Phenotypic changes were analysed using flow cytometry and allogeneic lymphocyte proliferation assays. Cytokine release into culture supernatants was investigated using cytometric bead array. RESULTS: Whereas rhMnSOD did not affect the MDDC phenotype, rMala s 11 up-regulated the maturation marker CD83, the co-stimulatory molecules CD40, CD80, CD86 and HLA-DR to a similar extent as lipopolysaccharide. Furthermore, rMala s 11, but not rhMnSOD, induced significantly higher levels of TNF-alpha, IL-6, IL-8, IL-10 and IL-12p70 in the culture supernatants at 24 h in comparison with MDDCs cultured in medium alone. Finally, MDDCs pre-incubated with rMala s 11 induced a significantly higher proliferation of allogeneic CD14-depleted peripheral blood monocytes than MDDCs pre-incubated with rhMnSOD. CONCLUSION: Our results suggest that Mala s 11, but not hMnSOD, affects the immune response of healthy individuals through dendritic cell maturation and cytokine release. This indicates that dendritic cells possess the ability to distinguish between Mala s 11 and its human homologue MnSOD.     

Nodular colloid milium mimicking keloid

Colloid milium is a rare cutaneous deposit disease that usually presents clinically by the development of yellowish translucent or flesh‐colored papules or plaques on sun‐exposed skin. Histologically, it is characterized by the presence of colloid in the dermal papillae. In this case report, we present a 52‐year‐old man who presented with a nodule on his upper lip that mistakenly was diagnosed and treated as keloid.