نرگس قندی

Psoriasis is a systemic and non-transmissible chronic inflammatory autoimmune skin disease that about 2-3% of Iranians suffer from it. Cost of management and budgeting and planning for the treatment of patients with psoriasis requires accurate information. The present study estimates the direct and indirect costs for one-year treatment of patients admitted in Razi Dermatology Hospital.

In this descriptive-analytical study, treatment costs of 170 patients with psoriasis, including direct (medical and non-medical) and indirect costs were evaluated by census method and using a researcher-made checklist, from October 2017 to October 2018. The fee was collected through reviewing patients' bills in the hospital information system and through telephone interviews with patients.

The average cost of one year was 9037480 Tomans ($ 758), of which direct cost of treatment was 90.22% (8178681 Tomans) and indirect cost of treatment was 9.78% (858799 Tomans). The highest cost of treatment was related to pharmaceutical services with 5825233 Tomans. Also, the total direct medical cost was equal to 7069890 Tomans, of which 62% was the insurance share and 38% was the patient share. The findings showed that injecting biological drugs and accommodation had a significant effect on the direct cost of treatment. Supplementary insurance and accommodation variables also affect out-of-pocket costs.

Drugs made up most of the costs. The high price of biologics and the low coverage of these drugs by insurance companies have caused many economic problems for these patients. According to the findings of this study, it seems necessary to review the more complete insurance coverage of these drugs as well as the use of charitable assistance to cover part of the cost for treatment.

So far, the relationship between patient experiences and the quality of services provided to them has not been widely studied. However, evidence suggests that improving patient experiences can improve clinical outcomes. The aim of this study was to determine the satisfaction of parents of children referring to the pediatric clinic as well as the related factors.

This descriptive study was conducted using a pre-designed Press Ganey questionnaire in Persian language and through interviews with 207 parents of children who referred to the pediatric clinic of Razi Dermatology Hospital in 2018. 

Of the 207 participants, 87 were fathers (42%) and 105 were mothers (50.7%). The remaining 15 had other relationships with the child. Overall satisfaction (recommending our clinic to others) was 62.8%. Also, 72.5% of the participants believed they would recommand their doctors. The lowest level of satisfaction was due to the lack of introduction of clinic staff and the difficulties in setting up an appointment. The factors that most closely correlate with the patientchr('39')s overall satisfaction included respectively: the cheerfulness of the visit by the doctor, the confidence in the doctor, and the likelihood of recommending the doctor.

The relationship between a physician and a patient is significantly related to the quality of patientschr('39') experiences in the pediatric dermatology clinic. Families and patients, when evaluating their experiences, focused on clear language and doctorchr('39')s sensitivity.

Regarding to the prevalence of polycystic ovarian syndrome and its complication in women at reproductive age, this study was performed with aim to evaluate the relationship between total testosterone and sonographic findings in two groups of married hirsute women with normal and oligomenohrric mensturation in order to find it as a predictor and diagnostic factor to replace with current methods.

This case control study was performed on 93 hirsute patients in two groups of normal and oligomennohric menstruation in 2017-2018. Ferriman-Gallwey checklist was completed after clinical examination by gynecologist and then the patients were evaluated by vaginal ultrasonography and serum testosterone test. Data were analyzed by SPSS software (version 22) and t-test, Chi-square, Correlation, and regression tests. P<0.05 was considered statistically significant.

The level of total was 0.02- 2.8 nmol/lit, the mean of testosterone in regular menstruation group was 0.85 and in irregular menstruation group was 1.52. In regular menstrual hirsute group, there was significant relationship between hirsutism score in lower abdominal and thigh, and in irregular menstruation group, in lower abdominal and thigh and arm (p<0.05). In oligomennohric group, direct linear significant relationship was found between Gallwey score and sonographic findings (p<0.05). In addition, every quantified sonographic markers were checked with age, finally reverse linear relationship was found between mean number of follicles< 6 mm and age which indicates that the number of follicles< 6 mm will decrease with increasing age (p=0.01)

In both groups, the relationship between total testosterone and lower abdominal, thigh and arm hair growth is clear that can be as a predictor factor for total testosterone level. However the sonographic findings are as predictor factor in irregular mensturation patients group.

Pemphigus vulgaris (PV) is an autoimmune blistering disease which is specific for skin and mucosal membranes. Its association with connective tissue diseases has already been reported. Considering this association, presence of Anti Nuclear Antibodies (ANAs) in PV patients will not be surprising. The aim of this study was to compare the frequency of ANA positive cases in patients suffering PV with a control group. In this case-control study, the cases were selected from the patients with PV whom were hospitalized at Razi Hospital, Tehran. The controls were chosen from patients who did not have PV. The data were collected using a questionnaire, which was designed for gathering information on participant's age, sex, PV phenotypes, and the result of ANA test. ANA positivity was assessed using indirect immunofluorescence, HEP2. In 8 (26.7%) of 30 PV patients and 3 (10.0%) of 30 controls ANA was positive (P=0.095). The most common ANA positive patterns among cases and controls were homogeneous and speckled patterns, respectively (P=0.26). Although in this study the frequency of positive ANA result among controls was similar to what were reported in previous studies, the frequency of this finding among PV patients was different from the previous reports. Differences in the sensitivity of the laboratory kits used in different studies as well as in the threshold for ANA positivity, and differences in the patient's eligibility criteria in different studies may explain the observed discrepancies. Clinical follow up of the PV and requesting an ANA test in the case of appearance of the signs of connective tissue diseases is recommended.

Hirsutism is a common clinical problem among women; however estimates regarding its prevalence in our population are limited. The objective of this study was to estimate the frequency and features of hirsutism in yound women in Iran.

This descriptive-cross sectional study was performed on 800 female (18-25 years) medical students of Tehran medical universities in 1999. Evaluation included a history and a modified Ferriman-Gallwey hirsutism score in four different androgen-sensitive skin areas. The volunteers recorded their weight and height, the presence of menstural dysfuncion, acne, positive family history for hirsutism, as well as ingestion of oral contraceptive pills, corticosteroids or anabolic steroids using a questionnaire. Data were analyzed using chi-square test and P<0.05 was considered significant.

The frequency of hirsutism in our population was 22.8% (183 of 800). 17.3%, 5.1% and 0.3% of the population studied had mild, moderate and severe hirsutism, respectively. The prevalence of obesity (body mass index > 25), acne, positive family history for hirsutism, menstrual dysfunction, and consumption of corticosteroid and OCP was significantly higher in hirsutes.

Hirsutism is a very common abnormality in this group of woman in Iran. Higher hirsutism frequency in this survey comparing to previous records in other population shows that the hirsutism definition and scoring system should be modified due to racial/ethnic variations in terminal hair quantity and distributions and different concept of this abnormality in each population.

Pemphigus vulgaris is a blistering autoimmune disease with suprabasal cleft formation, which is the most common autoimmune blistering disease in eastern countries, such as Middle East. Predisposition to pemphigus is linked to genetic factors. Tuberous sclerosis is also a genetic disorder of hamartoma formation in many organs, particularly the skin, brain, eye, kidney and heart. We report a 17-year-old boy with pemphigus vulgaris associated with tuberous sclerosis, which to our knowledge the first report of this association.

Azathioprine is the most widely used immunosuppressive agent as an adjunct to corticosteroids in the treatment of pemphigus vulgaris (PV). Thiopurine methyl transferase (TPMT) is a key enzyme in azathioprine metabolism and a genetic polymorphism controls its activity in human tissue. TPMT activity can provide a rational basis to determine suitable dose of azathioprine, theoretically. The aim of this study was to evaluate the clinical relevancy of this hypothesis in PV patients.

In this cross sectional study in Razi Hospital, the activity of TPMT in the red blood cells of 52 PV patients who received azathioprine for at least 12 months and 29 PV patients who did not receive this drug was measured and correlated to the clinical response and side effects observed.

The mean of TPMT activity was not significantly different in patients with unfavourable response, comparing to patients with favorable response to azathioprine (P=0.087). No relationship was observed between total dose of corticosteroid and TPMT activity (r=0.089, P=0.583). There was no difference between the mean of TPMT activity in patients receiving azathioprine and those not receiving this drug (P=0.36).

A direct relationship was not observed between TPMT activity and clinical efficacy and side effects in PV patients under treatment with azathioprine. Larger prospective studies in more homogenous patients are needed to evaluate the clinical relevance of TPMT polymorphism and to determine accurate azathioprine dosing guidelines based on TPMT activity.