Cost-of-Illness in Psoriasis: Comparing Inpatient and Outpatient Therapy

Treatment modalities of chronic plaque psoriasis have dramatically changed over the past ten years with a still continuing shift from inpatient to outpatient treatment. This development is mainly caused by outpatient availability of highly efficient and relatively well-tolerated systemic treatments, in particular BioLogicals. In addition, inpatient treatment is time- and cost-intense, conflicting with the actual burst of health expenses and with patient preferences. Nevertheless, inpatient treatment with dithranol and UV light still is a major mainstay of psoriasis treatment in Germany. The current study aims at comparing the total costs of inpatient treatment and outpatient follow-up to mere outpatient therapy with different modalities (topical treatment, phototherapy, classic systemic therapy or BioLogicals) over a period of 12 months. To this end, a retrospective cost-of-illness study was conducted on 120 patients treated at the University Medical Centre Mannheim between 2005 and 2006. Inpatient therapy caused significantly higher direct medical, indirect and total annual costs than outpatient treatment (13,042 € versus 2,984 €). Its strong influence on cost levels was confirmed by regression analysis, with total costs rising by 104.3% in case of inpatient treatment. Patients receiving BioLogicals produced the overall highest costs, whereas outpatient treatment with classic systemic antipsoriatic medications was less cost-intense than other alternatives.     

Molecular Farming in Plants: A Current Perspective

The low cost of production makes plants an ideal candidate for producing many high value compounds through genetic engineering. Expression of vaccines, therapeutic proteins, nutraceuticals, industrial enzymes, and other bio-polymers has been achieved in different plants. A few products for human health care that have been produced in plant systems are currently undergoing human clinical trials. Some recombinant molecules produced in plants for diagnostic use are currently available in the market and several other compounds are in the pipeline for commercialization. The involvement of several biotechnology companies and the successes achieved provide promise for the growth of this emerging field, “Molecular Farming”.     

Etiopathogenesis of Psoriasis from Genetic Perspective: An updated Review

Psoriasis is an organ-specific autoimmune disease characterized by the aberrant proliferation and differentiation of keratinocytes, leading to skin lesions. Abnormal immune responses mediated by T cells and dendritic cells and increased production of inflammatory cytokines have been suggested as underlying mechanisms in the pathogenesis of psoriasis. Emerging evidence suggests that there is a heritable basis for psoriatic disorders. Moreover, numerous gene variations have been associated with the disease risk, particularly those in innate and adaptive immune responses and antigen presentation pathways. Herein, this article discusses the genetic implications of psoriatic diseases'' etiopathogenesis to develop novel investigative and management options.     

Alligators and Endocrine Disrupting Contaminants: A Current Perspective

Many xenobiotic compounds introduced into the environment byhuman activity have been shown to adversely affect wildlife.Reproductive disorders in wildlife include altered fertility,reduced viability of offspring, impaired hormone secretion oractivity and modified reproductive anatomy. It has been hypothesizedthat many of these alterations in reproductive function aredue to the endocrine disruptive effects of various environmentalcontaminants. The endocrine system exhibits an organizationaleffect on the developing embryo. Thus, a disruption of the normalhormonal signals can permanently modify the organization andfuture function of the reproductive system. We have examinedthe reproductive and developmental endocrinology of severalpopulations of American alligator (Alligator mississippiensis)living in contaminated and reference lakes and used this speciesas a sentinel species in field studies. We have observed thatneonatal and juvenile alligators living in pesticide-contaminatedlakes have altered plasma hormone concentrations, reproductivetract anatomy and hepatic functioning. Experimental studiesexposing developing embryos to various persistent and nonpersistentpesticides, have produced alterations in gonadal steroidogenesis,secondary sex characteristics and gonadal anatomy. These experimentalstudies have begun to provide the causal relationships betweenembryonic pesticide exposure and reproductive abnormalitiesthat have been lacking in pure field studies of wild populations.An understanding of the developmental consequences of endocrinedisruption in wildlife can lead to new indicators of exposureand a better understanding of the most sensitive life stagesand the consequences of exposure during these periods.     

Focus: Vaccines: Vaccination Recommendations for Psoriasis and Atopic Dermatitis Patients on Biologic Therapy: A Practical Guide

Novel biologic therapies have revolutionized the treatment of psoriasis and atopic dermatitis. Although they are generally safe, they are immunomodulatory and therefore unique considerations apply in regards to infections and vaccine administration. This review aims to provide a clear and practical guide for dermatologists or other healthcare providers to reference when caring for psoriasis or atopic dermatitis patients being treated with biologic therapies using currently available guidelines and clinical data. Vaccinations for approved biologics including TNFα, IL-12/23, IL-23, IL-17, and IL-4/13 inhibitors will be discussed, with a special note on current COVID-19 vaccination recommendations.     

The Discovery of Medicines from Plants: A Current Biological Perspective1

The Discovery of Medicines from Plants: A Current Biological Perspective. The last 50 years have seen tremendous innovations in the process of discovering novel bioactive compounds from plants. Every stage of the natural products discovery and development pipeline has seen major advances, so as a result, today it is possible to evaluate large numbers of plant extracts efficiently and in more effective ways against a wider array of disease targets. Despite all of these technological advances and numerous large-scale discovery efforts, the number of new drugs developed as natural products from plants to reach the market has been surprisingly low, very different from the continuing productive discovery work from microbes. The innovations in the discovery process are reviewed, possible explanations for low success of recent discovery efforts are explored, and an effort is made to estimate the future potential of plants as a discovery resource. It may be that the low rate of discovery during this developmental period of natural products discovery is a consequence of technological limitations of the discovery process rather than a lack of interesting compounds in plants, and that even when necessary assumptions are taken into account, conservative estimates would indicate great potential for the discovery of new drugs from plants.     

Neoadjuvant Therapy for Prostate Cancer: An Oncologist's Perspective

With increasing use of prostate-specific antigen as a screening tool, diagnosis of prostate cancer has undergone a stage migration toward early-stage disease. Although this has increased the proportion of men who are candidates for definitive, potentially curative therapy, it has also made clear the limitations of our current standard of care. Specifically, despite adequate local therapy, a significant proportion of men go on to develop progressive disease. Neoadjuvant systemic therapy is one approach that continues to be studied as a way to maximize cure rates in the setting of early-stage disease. This article reviews the current data regarding neoadjuvant therapy, both hormonal and chemotherapy, and discusses which men are appropriate candidates for this option.     

Infantile Enuresis: Current State-of-the-Art Therapy and Future Trends

Enuresis nocturna is a widespread problem among children, with up to 25% of all children possibly suffering from this condition. Several therapeutic modalities are currently available. This article reviews current state-of-the-art therapies, highlights current literature, and provides an update on recent developments within the field of enuresis nocturna.     

Current Therapy of Rheumatoid Arthritis

The well informed and well motivated patient with rheumatoid arthritis today has an excellent chance of avoiding serious disability and deformity. No available pharmacologic agent can permanently alter the course of the disease, and no pharmacologic agent can preclude the need for a balanced program emphasizing moderation, rest and constant attention to physical therapy.Early synovectomy is enjoying increasing popularity although the long-term benefits have yet to be established.The several drugs now undergoing trial hold little promise of materially altering the management of rheumatoid arthritis in the near future. The skills of physician, surgeon, and physiatrist must be brought to bear to provide optimal care.     

Cushing Syndrome: Current Concepts of Diagnosis and Therapy

A variety of diagnostic advances including radioimmunoassay of adrenocorticotropic hormone (ACTH) have increased the number of methods for laboratory investigation of Cushing syndrome.^* However, experience with these procedures has led to a recognition of their limitations. We have developed an algorithm which incorporates these newer techniques and minimizes the number of procedures required to diagnose the various causes of Cushing syndrome. At present, we recommend pituitary surgical operations for pituitary-dependent Cushing syndrome because we believe this disease is caused by the development of a pituitary ACTH-secreting tumor.