Journal of

---

Background and Aim: 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.
Methods: 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 participants' age, sex, PV phenotypes, and the result of ANA test. ANA positivity was assessed using indirect immunofluorescence, HEP2.
Results: 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).
Conclusion: 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 patients' 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.

---

Background and Aim: 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.

Methods: 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. 

Results: 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 patient'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.

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

---

Background and Aim: 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.

Methods: 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.

Results: 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.

Conclusion: 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.