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Several new monoclonal antibodies that interfere with interleukin (IL) cascades have come to market in recent years. They follow a generation of drugs that block tumor necrosis factor (TNF). It has been well established that TNF is important in the containment of Mycobacterium tuberculosis (Mtb) and that blocking this cytokine increases the risk of tuberculosis (TB) infection. Thus, judicious screening for Mtb of patients taking TNF blocking drugs has been the standard of care. It remains unclear if the newer monoclonal, interleukin blocking drugs, which affect IL-12, IL-23, and IL-17 pathways are associated with risk of Mtb reactivation. Herein we discuss what is known about the immunologic response to Mtb and discuss the data that is currently available for the new interleukin monoclonal antibody blocking medications regarding the risk of latent TB reactivation or active TB infection.

Background: The unique health care needs of the homeless population have been well-documented in the literature. However, fewer studies are available assessing the prevalent dermatologic conditions that impact this population. Objective: The purpose of our study was to assess the frequency of dermatologic conditions occurring in a shelter-based homeless population, to understand patient demographic characteristics, and determine the suspected skin malignancy rate. Methods: We completed a retrospective chart review of patients seen at the free dermatology clinic held at the South Park Inn (SPI) homeless shelter in Hartford. Two-hundred-seventy-three patient paper charts from August 2008 to February 2016 were reviewed. Results: The most common dermatologic conditions included acne vulgaris (18.7%), atopic dermatitis (10.6%), tinea pedis (9.2%), xerosis (8.1%), and folliculitis (5.1%). The rate of suspected skin malignancies in this population was 2.5%. Conclusions: Some of our findings mirror the frequency of dermatologic conditions identified in sheltered homeless populations in previous studies. Differences seen may be attributed to geographic and demographic variability. The suspected skin cancer rate, which has been rarely studied, is of particular interest due to this population's risk for chronic sun exposure, lack of consistent sunscreen use, and poor access to dermatologic screening, and should be more thoroughly investigated in future studies. [ABSTRACT FROM AUTHOR]

Objective: To investigate the lost revenue associated with Medicaid patients in a university-based dermatology practice over a one-year period compared to non-Medicaid patients. Specifically, the goal was to investigate the change in revenue if Medicaid visits were associated with a range of copayments. Results: The total billed across all encounters for the 2014 - 2015 fiscal year was $31 017 159, of which $3 715 393 (13.61%) was for Medicaid. The total revenue for all encounters was $12 267 832, of which $420 230 (3.55%) was for Medicaid. After adding potential copayments, the reduced financial impact that such fees would have had on our practice for the past fiscal year ranged from $745.85 at $0.05/visit to $149 170 at $10/visit. Conclusion: Adding a small copayment for Medicaid patients would decrease lost revenue. The degree of financial impact would vary based on the size of the copayment. Broad adoption of such a plan could significantly help hospitals reduce lost revenue. [ABSTRACT FROM AUTHOR]