Isotretinoin induced small vessel vasculitis: a life-threatening pulmonary-renal syndrome-a case report.

Oral isotretinoin is a synthetic analog of vitamin - A, reserved for cases with severe resistant acne. We hereby report a case of drug-induced vasculitis (DV) from isotretinoin exposure leading to life-threatening pulmonary-renal syndrome requiring immunosuppression and plasmapheresis. A previously healthy 21-year-old female receiving oral isotretinoin presented with a 10-day history of worsening myalgias, arthralgias, and abdominal pain. Soon after admission she progressed to severe pulmonary-renal syndrome requiring intubation and renal replacement therapy. Urinalysis revealed >50 dysmorphic RBC with casts and renal ultrasound was unremarkable. Serological testing was only positive for antineutrophil cytoplasmic antibodies (ANCA) at 1:80 with Anti- proteinase 3 (PR3) at 830 AU/mL and Anti-histone Ab at 2.9. As clinical presentation and serology are highly suggestive of ANCA associated DV, plasmapheresis, and rituximab were also initiated along with the continuation of steroids. She clinically improved but remained dialysis dependent and received a live donor renal transplant. The temporal relationship of symptom onset and drug initiation with no other possible identifiable etiologies-DV in our case was attributed to isotretinoin exposure. Though considered safe, oral Isotretinoin in rare instances can cause the life-threatening pulmonary-renal syndrome. Given its widespread use, it is prudent that prescribers should educate patients regarding the possible symptoms of vasculitis and to seek immediate medical attention when warranted. Physicians should also be vigilant of this complication and should act swiftly to avoid uneventful outcomes.

Lack of Association between NOD2 rs3135500 and IL12B rs1368439 microRNA Binding Site SNPs and Colorectal Cancer Susceptibility in an Iranian Population.

OBJECTIVE: The purpose of this study was to evaluate the potential association between single nucleotide polymorphisms (SNPs) in microRNA (miRNA) binding sites in the NOD2 and IL12B gene 3.-untranslated regions and colorectal cancer (CRC) susceptibility in an Iranian population. METHODS: We genotyped NOD2 rs3135500 [3. untranslated region (UTR) A/G] and IL12B rs1368439 (3.UTR G /T) in a hospital-based study of 92 colorectal cancer cases and 105 healthy controls. All samples were genotyped by TaqMan assay via an ABI 7500 Real Time PCR System (Applied Biosystems) with DNA from FFPE tissue and peripheral blood. RESULTS: our results showed similar distribution of genotype and allelic frequencies of the NOD2 and IL12B polymorphisms between patients and controls. When the more common rs3135500 AA genotype was used as the reference, the rs3135500 AG and rs3135500 GG genotypes were not significantly associated with the risk of CRC (OR = 1.294, 95% CI: 0.524 -3.197; and OR = 2.230, 95% CI: 0.87 - 5.715, respectively), and The IL12B rs1368439 TG and IL12B rs1368439 GG genotypes were not significantly associated with the risk of CRC compared with the IL12B rs1368439 TT genotype (OR = 1.547 95% CI: 0.187- 12.771; and OR = 1.753, 95% CI: 0.217-14.157, respectively). CONCLUSION: NOD2 rs3135500 and IL12B rs1368439 SNPs were not genetic risk factors for colorectal cancer in the studied Iranian population.

Recurrence and Five -Year Survival in Colorectal Cancer Patients After Surgery.

BACKGROUND: Colorectal cancer (CRC) is a common malignancyworldwide and its outcome is most closely related to the extent of disease at presentation. Early diagnosis of an asymptomatic recurrence increases the likelihood of a complete surgical resection. OBJECTIVES: The aim of this study was to evaluate the incidence of colorectal cancer recurrence and survival rate within 5 years, after surgery. PATIENTS AND METHODS: During the 9-year period since 21st Mar, 2004 to 20th Mar, 2013, patients whose primary colorectal cancer were resected in Taleghani hospital, Tehran, Iran were selected in a historical cohort. The necessary data such as demographic, age, gender, family history of CRC, site and size of tumor, stage of tumor, operation details, histological results, treatment method, histopathologic, etc. were collected. Then the recurrence and survival of colorectal cancer within 5 years after operation and their risk factors were evaluated. P value less than 0.05 were considered significant. All analysis was done using SPSS software. RESULTS: A total of 107 patients underwent resection for colorectal cancer during the study period, with mean age of 53.50 ± 12.68 years (range 24 - 76 years), survival rate of 73.8% (rectum 70.0% and colon 75.9%), and mean survival time of 142.17 ± 21.60 month. The recurrence rate of CRC patients, during five years after surgery was 5.7%. Regional lymph nodes, Distance metastasis and Adjuvant therapy were significant prognosis factors of survival after surgery. CONCLUSIONS: The rate of recurrence in Iranian patients was low, which could be due to improvement of exactness and expertise of surgeons or better adjuvant therapy. The significant association between survival and adjuvant therapy clarifies this finding. Early diagnosis and primary detection could increase the rate of survival.

Evaluation of endoscopic characteristics of upper gastrointestinal polyps in patients with familial adenomatous polyposis.

BACKGROUND: Familial adenomatous polyposis (FAP) is a disease inherited in an autosomal dominant fashion. Most FAP patients develop upper gastrointestinal polyps; especially those in the antrum and duodenum are usually neoplastic. The aim of this study was to evaluate the prevalence of gastroduodenal polyps in Iranian FAP patients. MATERIALS AND METHODS: 28 patients affected by FAP underwent front-view and side-view endoscopy. Papillary biopsies were performed in all patients. Location of polyps, their number and size, pathology study, patient general information (gender, age, family history of FAP or colorectal cancer and gastroduodenal polyps) were analyzed. RESULTS: Gastric polyps were seen in 39.3 % of patients. Some 72.7% of the affected individuals had fundic gland polyps and 36.36% had hyperplastic polyps. Duodenal adenoma was observed in 25% of patients. While 57% of patients had tubular adenoma with low grade dysplasia, 42.8% showed tubulovillous adenoma with low grade dysplasia. CONCLUSIONS: Findings of this study indicated that the prevalence of gastroduodenal polyps in FAP patients is high and dysplasia may be evident in duodenal polyps. Therefore, it appears that routine gastroduodenal endoscopy in FAP patients is necessary.

Different frequency of epidermal growth factor rs76189946 polymorphism genotype in an Iranian colorectal cancer.

AIM: This study aimed to determinant association between rs76189946 polymorphism of EGF gene and risk of colorectal cancer in an Iranian population. BACKGROUND: Colorectal cancer (CRC) is the third most prevalent cancer in both genders worldwide. The determination of genetic variation becomes a new way to etiology of colorectal cancer. Epidermal growth factor (EGF) is a mitogen that plays an important role in cell growth and tumourigenesis, this protein acts by binding its receptor, EGFR. PATIENTS AND METHODS: DNA samples taken from totally 125 CRC patients and healthy controls were amplified by polymerase chain reaction (PCR) for the rs76189946 polymorphism. Genotypes were analyzed using restriction fragment length polymorphism (RFLP). Finally to confirm the RFLP procedure, 20 of the PCR products were sequenced using the ABI PRISM 3130xl Genetic Analyzer and chain termination method (Applied Biosystems, Carlsbad, CA). RESULTS: Genotype distribution and allele frequency was similar in CRC patients and controls individuals. We expect observe C and G allele in both groups but only was found C allele. CONCLUSION: In this study for first time we identified genetic distribution of exonic rs76189946 polymorphism in EGF gene both CRC patients and healthy controls. These results suggest there wasn't association between EGF polymorphism rs76189946 and risk of colorectal cancer in an Iranian population.

Frequency of snoring and symptoms of sleep apnea among Pakistani medical students.

BACKGROUND: Snoring and its related problem, sleep apnea, are very common. They occur in all ages and both sexes. Frequency varies in different communities therefore studies of other countries are invalid for Pakistan. The aim of this study is to assess the frequency of snoring and emergence of symptoms of sleep apnea among the affluent class young adult Pakistani population. METHODS: Subjects were evaluated through a questionnaire. Questions pertained to quality of sleep, intensity and frequency of snoring and presence of symptoms such as waking up choking, morning headaches and morning dry mouth. Data were collected for age, sex, height and weight. Subjects were also asked if they took alcohol or any drugs. RESULTS: A total of 111 subjects, M:F = 2:3, age range between 18-23 years, responded to the survey. The frequency of snoring was 27% in males and 12% in females, with males admitting to snoring more night in the week than the females. 92% of both males and females graded their snoring as being softer than the sound of talking. 15% of the males and 38% of the females said they snored in every body position. Percentages of male and female snorers exhibiting symptoms of sleep apnea were very similar, with choking arousals at 6% and 5% respectively. CONCLUSION: This study was done on the young Pakistani population for the determination of frequency of snoring and the emergence of symptoms of sleep apnea. The results are similar to studies done on the adult population with snoring more common and louder among the males.