Cost-efficacy and pharmacoeconomics of scalp lesions of psoriatic patients in current Japanese health-care insurance system.

Psoriatic scalp lesion is occasionally recalcitrant to topical or systemic treatments including biologic agents. The combined active vitamin D3 /corticosteroids are more expensive despite their marked efficacy. The aim of the present study is to evaluate total costs as well as costs versus efficacy of topical scalp psoriasis treatments under the current Japanese health-care insurance system. A prospective study was performed from the database of an outpatient clinic. The medical costs of scalp psoriasis patients were evaluated in a prospective manner in each case over a total 12-month duration from July 2017 until August 2019. The total cost of the combined active vitamin D3 /corticosteroid gel (combined gel) was higher (¥79 350) than that of topical corticosteroid lotion (¥22 970). The cost versus efficacy of the combined gel was lower (¥2026/cost for the reduction of 1 Psoriasis Scalp Severity Index [1PSSI] score) than that of topical corticosteroid lotion (¥2316/1PSSI). The reduction of PSSI score was observed by changing from topical corticosteroid lotion to topical combined gel. The combined gel showed the best cost efficacy in terms of medical economic burden in the current Japanese insurance system.

Variations in antibiotic susceptibility of group B Streptococcus in Japanese women: A long-term population-based cohort study.

OBJECTIVE: To investigate the long-term antibiotic susceptibility of group B Streptococcus (GBS) present in the vagina. MATERIALS AND METHODS: A population-based retrospective cohort study was performed. A total of 19,899 women who underwent vaginal swab examination between 2005 and 2017 was enrolled. Specimens were cultured on modified Drigalski agar, blood agar, and chocolate agar media. Antibiotic susceptibilities of GBS were assessed using eight antibiotics, namely penicillin-G (PC-G), cefotiam (CTM), cefditoren (CDTR), ceftriaxone (CTRX), meropenem (MEPM), chloramphenicol (CP), levofloxacin (LVFX), and azithromycin (AZM), by the broth microdilution method when GBS was positive in the culture. The main outcome was antibiotic sensitivity based on the culture results. RESULTS: GBS was 100% susceptible to PC-G, CTM, CTRX, CDTR, and MEPM. However, the susceptibility trend showed a considerable decrease for CP (99%-81%), LVFX (91%-70%), and AZM (87%-57%). CONCLUSIONS: Our study demonstrated a significant decrease in the antibiotic sensitivity of GBS in Japan in the past 13 years. Based on these results, current policies on antibiotic resistance of GBS in maternal and neonatal care may need to be reassessed.

Cost-efficacy and pharmacoeconomics of psoriatic patients in Japan: Analysis from a single outpatient clinic.

Compared with topical corticosteroids, topical combined active vitamin D3 /corticosteroids and especially biologics are more expensive despite their marked efficacy in the treatment of psoriasis. The aim of the present study is to evaluate total costs as well as costs versus efficacy of various psoriasis treatments under the current Japanese health-care insurance system. A prospective study was performed from the database of a single clinic located in Hokkaido Prefecture. Cost and quality of life of psoriatic patients were evaluated in a prospective manner during a total of 12 months from March 2017 until June 2018. Quality-adjusted life year (QALY) of biologics was the highest among all treatments. Among the topical treatments, the cost versus efficacy of combined active vitamin D3 /corticosteroid was lowest (¥10 557/1 Psoriasis Area and Severity Index). Furthermore, incremental cost-effectiveness ratio (ICER) of combined active vitamin D3 /corticosteroid was ¥1 024 031/QALY when compared with topical corticosteroid treatment alone. The topical combined active vitamin D3 /corticosteroid treatment showed the best cost-efficacy in terms of medical economic burden.

Vulvar intraepithelial neoplasia treated with a combination of surgical excision and laser ablation during pregnancy.

Most vulvar intraepithelial neoplasias are associated with human papillomavirus. However, detailed surgical plans during pregnancy are rarely discussed. We suggest that the treatment policy should focus on performing surgical excision on multifocal lesions, combined surgical excision/laser ablation on single lesions, and preserving unaffected perineal skin, if possible.

Economic burden of psoriatic patients in Japan: Analysis from a single outpatient clinic.

Topical and systemic agents have dramatically improved the treatment efficacy of psoriasis. Few reports, however, exist describing the economic burden in Japanese psoriatic patients. The aim of the study was to evaluate the total costs as well as cost versus efficacy of topical and systemic treatments of psoriatic patients under the Japanese health insurance system. The retrospective study was performed from the database of our clinic, which is located in Hokkaido Prefecture. Cost and effectiveness of psoriatic patients were evaluated during the 12-month period from April 2015 to March 2016. Data were collected and calculated for the total cost per year, treatment efficacy and cost versus efficacy. The mean total cost of topical corticosteroid treatment was ¥18 184/year and was lowest among the treatments. The systemic treatment with biologics was most expensive and the costs were over ¥400 000/year. Among the topical treatments, calcipotriol/betamethasone dipropionate was most expensive (¥34 693/year). However, cost versus efficacy was not significantly different from that of topical corticosteroid treatments. The cost of secukinumab was highest among all the treatments (¥631 600/year). However, treatment day per cost was lowest of all the psoriasis treatments. Biologics showed the highest cost than topical or systemic treatments. However, they showed most marked efficacy in terms of improving the psoriatic skin lesions.

Severe abdominal pain exacerbated by fetal movement is an early sign of the onset of uterine rupture.

OBJECTIVE: Uterine rupture is a rare but serious obstetric complication. However, prediction and diagnosis at an early stage remain difficult. Herein, we report a case of primary uterine rupture found earlier by a specific symptom. CASE REPORT: A 29-year-old patient was scheduled to undergo a cesarean section (CS) due to placenta previa. However, at Week 35, she began experiencing abdominal pain and uterine contractions. Subsequently, she began experiencing severe pain, which was enhanced by fetal movements. An emergency CS was performed due to continuous uncontrollable pain. When the abdominal cavity was opened, we found that much of the amniotic cavity had prolapsed outside the uterus. Despite performing total hysterectomy, both the mother and child had positive clinical courses. Uterine rupture was discovered early because of emergency CS. CONCLUSION: This case suggests that abnormal pain exacerbated by fetal movement can be a characteristic early sign of uterine rupture.

Nuchal cord complication in male small for gestational age increases fetal distress risk during labor.

OBJECTIVE: This study aimed to evaluate whether a nuchal cord increases the risk of perinatal complications during labor, and whether fetal growth and sex affect the risk of fetal distress. MATERIALS AND METHODS: Medical records of 1749 women with singleton pregnancies planning a vaginal delivery were enrolled. Patients were divided into two groups according to the presence or absence of a nuchal cord at birth. Multivariate logistic regression analyses, odds ratios (ORs), and 95% confidence intervals (CIs) were used to determine whether the risks of perinatal complications increased in the nuchal cord group. RESULTS: A nuchal cord is associated with higher risks of Rupture of membranes (ROM) prior to delivery (OR = 1.40, 95% CI: 1.12-1.76, p = 0.0031), need for augmentation during labor (OR = 1.68, 95% CI: 1.27-2.23, p = 0.0003), prolonged second stage of labor (OR = 2.54, 95% CI: 1.55-4.25, p = 0.0002), nonreassuring fetal heart risk during labor (OR = 2.89, 95% CI: 2.18-3.84, p < 0.0001), and instrumental delivery or cesarean delivery (OR = 2.00, 95% CI: 1.55-2.58, p < 0.0001). Fetal distress risk during labor was affected by fetal growth and sex, with male small for gestational age fetuses with a nuchal cord having a significantly higher risk than the control group (OR = 9.77, 95% CI: 3.67-25.79, p < 0.0001), despite there being no significant differences in the neonatal Apgar scores at 1 minute or 5 minutes, or in the need for neonatology between the two groups. CONCLUSION: Nuchal cord is associated with perinatal outcomes. Male small for gestational age fetuses with a nuchal cord have a significantly higher risk of fetal distress during labor. Our results suggest that evaluation of fetal sex and body weight is also important in antenatal ultrasonography if a nuchal cord is found.

Cutaneous S100-negative, CD1a-positive histiocytosis successfully treated with combination therapy of oral methotrexate and corticosteroid.

S100-negative, CD1a-positive histiocytosis is a rare histiocytic disorder characterized by proliferation of histiocytic cells possessing a phenotype of epidermal Langerhans cells except for the lack of S100 expression and Birbeck granules. We report the case of a Japanese man suffering from S100-negative, CD1a-positive histiocytosis. The patient showed numerous smooth erythematous 5-10-mm papules/nodules on most of his body. The key histopathological feature was the presence of dermal infiltrates of non-epidermotropic S100-negative CD1a-positive mononuclear cells. No systemic involvement was detected. Initially bath-psoralen plus ultraviolet A therapy was effective, but the lesions became recalcitrant to this treatment. Methylprednisolone pulse therapy followed by low-dose methotrexate (up to 30 mg/week) in combination with prednisolone (15 mg/day) effectively controlled the skin lesions.

Effects of citronellal, a monoterpenoid in Zanthoxyli Fructus, on the intestinal absorption of digoxin in vitro and in vivo.

Complementary and alternative medicines can be applied concomitantly with conventional medicines; however, little drug information is available on these interactions. Previously, we reported on the inhibitory effects of an extract and monoterpenoids (e.g., (R)-(+)-citronellal) contained in citrus herbs on P-glycoprotein (P-gp) using P-gp-overexpressed LLC-PK1 cells. The objective of the present study was to investigate the effects of (R)-(+)-citronellal on P-gp-mediated transport in the intestinal absorption process in vitro and in vivo. Transcellular transport of [(3)H]digoxin across Caco-2 cell monolayers was measured in the presence or absence of (R)-(+)-citronellal. (R)-(+)-citronellal reduced the basolateral-to-apical transport and efflux ratio for [(3)H]digoxin significantly. Serum concentration-time profiles and pharmacokinetic parameters of digoxin after intravenous and oral administration were analyzed in rats pretreated with oral (R)-(+)-citronellal. The bioavailability of digoxin after oral administration decreased significantly to 75.8% of that after intravenous administration at the same dose. (R)-(+)-citronellal increased the bioavailability of oral digoxin to 99.9% but had no effects on total body clearance, volume of distribution, or elimination rate. These findings suggest that (R)-(+)-citronellal can increase the bioavailability of oral digoxin based on the blockade of P-gp-mediated efflux of digoxin from intestinal epithelia to the lumen in the absorption process.

Inhibition of P-glycoprotein-mediated transport by extracts of and monoterpenoids contained in Zanthoxyli fructus.

Citrus (rutaceous) herbs are often used in traditional medicine and Japanese cuisine and can be taken concomitantly with conventional medicine. In this study, the effect of various citrus-herb extracts on P-glycoprotein (P-gp)-mediated transport was examined in vitro to investigate a possible interaction with P-gp substrates. Component monoterpenoids of the essential oil in Zanthoxyli fructus was screened to find novel P-gp inhibitors. LLC-GA5-COL150 cells transfected with human MDR1 cDNA encoding P-gp were used. Cellular accumulation of [3H]digoxin was measured in the presence or absence of P-gp inhibitors or test samples. Aurantii fructus, Evodiae fructus, Aurantii fructus immaturus, Aurantii nobilis pericarpium, Phellodendri cortex, and Zanthoxyli fructus were extracted with hot water (decocted) and then fractionated with ethyl acetate. The cell to medium ratio of [3H]digoxin accumulation increased significantly in the presence of the decoction of Evodiae fructus, Aurantii nobilis pericarpium, and Zanthoxyli fructus, and the ethyl acetate fraction of all citrus herbs used. The ethyl acetate fraction of Zanthoxyli fructus exhibited the strongest inhibition of P-gp among tested samples with an IC50 value of 166 microg/mL. Then its component monoterpenoids, geraniol, geranyl acetate, (R)-(+)-limonene, (R)-(+)-linalool, citronellal, (R)-(+)-citronellal, DL-citronellol, (S)-(-)-beta-citronellol, and cineole, were screened. (R)-(+)-citronellal and (S)-(-)-beta-citronellol inhibited P-gp with IC50 values of 167 microM and 504 microM, respectively. These findings suggest that Zanthoxyli fructus may interact with P-gp substrates and that some monoterpenoids with the relatively lower molecular weight of about 150 such as (R)-(+)-citronellal can be potent inhibitors of P-gp.