Introduction. Management of moderate-severe psoriasis is challenging in the presence of severe systemic comorbidities, such as HIV infection, recent history of cancer, latent tuberculosis infection, or advanced liver disease. These patients are almost invariably excluded from randomized clinical trials, an aspect that limits the availability of standardized therapeutic options. Material and methods. This narrative review summarizes the current literature on immunomodulatory therapeutic strategies in patients with psoriasis and severe systemic comorbidities, integrating existing evidence in the literature with relevant clinical observations from real-world practice. Results. Available data suggest that therapeutic decisions should be individualized according to the type of comorbidities and severity of the disease. In well-controlled HIV infection, conservative strategies may be preferred. In patients with a history of cancer, systemic therapies may be used with caution and in interdisciplinary collaboration. In latent tuberculosis infection, prophylaxis is necessary, but isoniazid-induced hepatotoxicity is an important limitation. In liver disease, biological therapies may constitute a safer alternative to conventional systemic therapy. Conclusion. In this context, patients with psoriasis and severe associated systemic comorbidities require a personalized, multidisciplinary approach and close monitoring. Real-world data play an essential role in guiding therapeutic decisions in this patient population.
Background and Aim: Various studies have reported that 4-7 percent of adults with palpable thyroid nodules that 50-70 percent of it’s diagnosed with high-accuracy sonography. Although most thyroid nodules are non-cancerous and do not require treatment, a small percentage of them are associated with a potential risk of malignancy, which is an important early diagnosis by ultrasound or pathology. The present study aimed to compare the ultrasound with the pathologic results of fine-needle aspiration (FNA) of thyroid nodules for the rapid diagnosis of thyroid malignancies in patients referred to Baqiyatallah Hospital. Methods: The study population consisted of 100 (80 female, 20 male) patients with thyroid nodules in the age range of 19-82 years referred to the radiology ward of Baqiyatallah Hospital who were studied by the cross-sectional method. All patients were first scoring by ultrasound, then fine needle aspiration with thyroid nodule ultrasound was performed, and the specimens were referred to the pathology department for further evaluation. Results: The pathologic results from fine-needle aspiration showed that only 8 of the 100 patients studied had malignant nodules that, by ultrasound scoring, 7 patients had 4 scores and 1 patient had 3 scores. However, the other 92 patients with benign nodules 57.60% of patients had score 1, 30.43% of patients had score 2 and 11.97% of patients had score 3. Conclusion: According to the results of this study, it seems that ultrasound scoring is useful in the rapid diagnosis of thyroid nodules and prevent unnecessary thyroid nodule FNA.
