Short term outcome of patients with hematochezia and normal initial colonoscopic findings: do they really need further screening?

In a significant number of the patients with hematochezia, colonoscopy turns out to be normal and therefore is unable to determine the cause of bleeding. This study investigates outcomes and possible necessity for further work up in cases of hematochezia with normal colonoscopy. Ninety-seven patients with normal colonoscopy were followed for at least one year from the time of colonoscopy by regular visits and phone calls. Mortality and recurrent bleeding were recorded as primary end points. Those with recurrent or continued hematochezia were invited for a new visit and further work up. Among the ninety seven patients, nine cases [9.3%] were lost at follow ups, 10 experienced rebleeding [10.3%], and the remaining 78 [80.4%] were apparently healthy and had no further complaints. There were two mortalities during the follow up, one due to gastric cancer and the other due to cerebrovascular accident. It is unusual for the cases of hematochezia with a normal initial colonoscopy to have recurrent bleeding as a result of a significant missed lesion in the colon

effect of simvastatin on lowering panel reactive antibody titer in sensitized dialysis patients: a randomized placebo controlled clinical trial

Patients with panel reactive antibodies [PRA] have many difficulties to find a crossmatch-nega- tive kidney for transplantation and are at a higher risk of post-transplantation rejection. To evaluate the effect of simvastatin on PRA and post-transplant outcome of these sensitized pa- tients. 82 patients with end-stage renal disease [ESRD] with a PRA >/= 25% were evaluated. In a one-year follow-up, the patients were treated with simvastatin. These patients were compared with 82 matched con- trols receiving placebo tablets. At the end of the second and 12th month, PRA was rechecked in all patients. Those patients who underwent transplantation continued to take simvastatin six months after transplanta- tion. Serum creatinine levels were checked at monthly intervals post-operation. The mean +/- SD PRA level at the end of the second month was 36.63% +/- 31.14% and 45.34% +/- 24.36% in cases and controls, respectively [P=0.012]. Seven patients in the case group and 10 in the control group were lost to follow-up. The remaining patients continued to take simvastatin for 12 month. The mean +/- SD PRA level at the end of the 12[th] month was 24.02% +/- 31.04% in cases and 43.15% +/- 26.56% in controls [P=0.001]. 25 patients underwent renal transplantation and continued to receive simvastatin 6 months after transplantation. These patients were matched with 25 controls treating with placebo. The mean +/- SD creatinine level 6 months after kidney transplantation was 2.05 +/- 1.14 mg/dL and 3.15 +/- 1.09 mg/ dL in cases and controls consecutively [P=0.02]. Simvastatin can be safely used to lower PRA and improve post-transplantation outcomes

[Relation between C.32 A>T Polymorphism in TLR7 and response to treatment in Chronic HCV-infection]

Hepatitis C virus [HCV]-infection leads to development of chronic hepatitis, liver cirrhosis and hepatoma. Both the liver damage and extrahepatic manifestation of HCV are immune-mediated. Since HCV is an RNA virus, a role for toll like receptor 7 [TLR7] in the immune response against HCV is likely. The aim of the present study was to determine the frequency of C.32T allele of TLR-7 in general and chronic HCV hepatitis, and its effect on treatment of HCV. This case -control study was carried out on 154 patients of chronic hepatitis C in 2008-2009. The patients were selected from referrals to Hepatitis clinic at Shahid Motahari Polyclinic affiliated to Shiraz University of Medical Sciences, Shiraz, Iran which had indication of treatment. The patients were randomly selected according to inclusion and exclusion criteria. Control group consisted of 225 healthy subjects. The frequency of C.32T allele of TLR-7 was determined in154 patients with chronic HCV-infection, and in 225 healthy controls. Treatment with interferon-alpha and ribavirin was performed after genotype determination. Sustained virologic response [SVR] and end treatment response [ETR] were determined and effect of C.32T allele of TLR-7 on outcomes of treatment was evaluated. The frequency of C.32T allele of TLR-7 in patients with chronic hepatitis C was 15.33% in male, 14.67% in female and totally 15.2%. The frequency of C.32T allele of TLR-7 in healthy control group was 16.24% in male, 10.3% in female and totally 14.67%. The rate of Sustained Virologic Response [SVR] was 75%, but in patients that had C.32T allele of TLR-7, SVR was 55% [p=0.046]. c.32A>T single nucleotide polymorphism of TLR-7, by impairment of TLR-7 function, can be considered among host factors that had unfavorable effect on response rate to treatment of patients with chronic HCV hepatitis