Report of a rare case of nasal mucosa pyoderma vegetans in a patient with ulcerative colitis

Some dermatologic manifestations are common in ulcerative colitis [UC]. Herein, we present a 36-year-old woman with ulcerative colitis and uncommon nasal mucosa pyoderma vegetans. The patient presented to our hospital with symptoms of active colitis and a concomitant 3×4×5 cm dermato-mucosal lesion in her left nasal lumen. After surgery of the mucosal lesion, the treatment for her active colitis was initiated with intravenous infliximab and oral asacol. After a 1-year follow-up, no sign of recurrence favoring mucosal lesion was noted and symptoms of ulcerative colitis were managed properly

Mean polyp per patient is an accurate and readily obtainable surrogate for adenoma detection rate: results from an opportunistic screening colonoscopy program

The incidence of colorectal cancer is rising in several developing countries. In the absence of integrated endoscopy and pathology databases, adenoma detection rate [ADR], as a validated quality indicator of screening colonoscopy, is generally difficult to obtain in practice. We aimed to measure the correlation of polyp-related indicators with ADR in order to identify the most accurate surrogate [s] of ADR in routine practice. We retrospectively reviewed the endoscopic and histopathological findings of patients who underwent colonoscopy at a tertiary gastrointestinal clinic. The overall ADR and advanced-ADR were calculated using patient-level data. The Pearson's correlation coefficient [r] was applied to measure the strength of the correlation between the quality metrics obtained by endoscopists. A total of 713 asymptomatic adults aged 50 and older who underwent their first-time screening colonoscopy were included in this study. The ADR and advanced-ADR were 33.00% [95% CI: 29.52-36.54] and 13.18% [95% CI: 10.79-15.90], respectively. We observed good correlations between polyp detection rate [PDR] and ADR [r=0.93], and mean number of polyp per patient [MPP] and ADR [r=0.88] throughout the colon. There was a positive, yet insignificant correlation between advanced ADRs and non-advanced ADRs [r=0.42,p=0.35]. MPP is strongly correlated with ADR, and can be considered as a reliable and readily obtainable proxy for ADR in opportunistic screening colonoscopy programs

Correlation between cigarette smoking and urine cotinine level in gastric cancer patients

Various substances in cigarette smoke including nicotine have been shown to promote/induce cancer cell proliferation. Since cotinine has a longer half life and stability in the blood, it has become the preferred biomarker for cigarette smoking exposure. Seventy-three gastric cancer patients were included in this study. The tumor tissues were stained with H and E for pathological evaluation. The cotinine levels were measured in urine using a competitive ELISA. Tumors were 90% adenocarcinoma with 63% intestinal and 37% diffuse subtypes. Tumors were poorly [45.2%] or moderately differentiated [41.1%] and localized mainly [77%] in the upper part of stomach. The levels of cotinine were significantly different between smoker [283.83 +/- 178.10 ng/mL] and non-smoker [39.28 +/- 113.34 ng/mL] groups [p < 0.001]. However, there is no-significant correlation between tumor characteristics and cotinine level in smoker patients. Cotinine level correlates with smoking in gastric patients, however, correlation with the tumor features has not been observed

Characteristics of colorectal polyps and cancer; a retrospective review of colonoscopy data in Iran

Early diagnosis and endoscopic resection of adenomatous polyps is the main approach for screening and prevention of colorectal cancer [CRC]. We aimed to assess polyp detection rate [PDR] and to characterize demographic, clinical, and pathological features of colorectal polyps in an Iranian population. We retrospectively analyzed the data from 5427 colonoscopies performed during 2007-2012 at Masoud Clinic, the main endoscopy center associated with Sasan Alborz Biomedical Research Center, in Tehran, Iran. Our sample included 2928 [54%] women and 2499 [46%] men, with the mean age of 48.3 years [SD=16.1]. The most common reasons for colonoscopy included screening in 25.0%, and gastrointestinal bleeding in 15.2%. Cecal intubation was successful in 86% of patients. The quality of bowel preparation was fair to excellent in 78.1% [n=4235] of colonoscopies. Overall PDR was 42.0% [95% CI: 40.6-43.3]. The PDR in men [51.1%, 95% CI: 49.1-53.1] was significantly higher than women [34.2%, 95% CI: 32.4-35.9, p<0.001]. Polyps were more frequently observed in patients after the 6th decade of life [F=3.2; p=0.004]. CRC was detected in 2.9% [73/2499] of men and 1.9% [57/2928] of women [p=0.02]. The mean age for patients with cancer was significantly higher than that for individuals with polyps, 60.9 [SD=13.4] year vs. 56.9 [SD=13.7] year, respectively [p=0.001]. Almost 82.8% of the lesions were precancerous with tubular type predominance [62.3%] followed by tubulo-villous [10.3%], villous [6.6%], and serrated [3.6%]. Hyperplastic/inflammatory polyps comprised 17.2% of lesions. Distal colon was more prone to develop polyps and cancer than proximal colon in our series. These findings provide a great infrastructure for next preventive programs and have implications for colorectal cancer screening at population-level

Sampling error in histopathology findings of nonalcoholic fatty liver disease: a post mortem liver histology study

Many clinical trials and natural history studies on nonalcoholic fatty liver disease [NAFLD] and nonalcoholic steatohepatitis [NASH] rely heavily on liver histology to define their endpoints. There are many indications that the liver is not uniformly involved in NAFLD thus sampling error is a major concern. This study aims to evaluate the uniformity of various histologic features in livers affected with NAFLD. Samples from a forensic autopsy series were studied and subjects with NAFLD identified. We took specimens from three different parts of each liver and recorded the degrees of steatosis, hepatocyte ballooning, lobular inflammation, portal inflammation, and fibrosis. A NASH activity index [NAI] which is the sum of scores of histologic features was also calculated. The agreement between the 3 samples from each liver was studied. There were 945 autopsies performed; 896 were suitable for histologic evaluation and 283 had NAFLD. Of these, 146 livers were available to our study from which 438 samples were taken. Fibrosis [intra-class correlation [ICC] = 0.87], lobular inflammation [kappa = 0.83], and portal inflammation [kappa = 0.83] were fairly uniformly distributed in the damaged liver. Steatosis was less uniform [kappa = 0.64], and hepatocyte ballooning was least uniformly distributed [kappa = 0.57]. The ICC for NAI was 0.86, which indicated good agreement. The individual histologic features of NAFLD and NASH are not uniformly distributed in the liver. Hepatocyte ballooning is especially non-uniform. Such non-uniformity should be taken into account when interpreting results of studies that rely on paired biopsies. A summary score such as NAI is less affected by sampling error

potential role of APOBEC3G in limiting replication of hepatitis B virus

Recent findings introduced APOBEC3G [A3G] as a host factor that blocks viral replication. It induces G to A hypermutations in viral DNA at the step of reverse transcription and in response to interferon. This study aimed to investigate the expression of liver A3G protein in association with both replication of hepatitis B virus [HBV] and frequency of G to A mutations in BCP [basal core promoter]-PC [pre-core] region. Fifty-one liver biopsies of naive chronic hepatitis B [CHB] patients enrolled for the expression of A3G were done by immunohistochemistry [IHC] standard method. The presence of HBV DNA and sequences of BCP-PC region at the time of liver biopsy was investigated in all patients. Among 34 patients with detectable HBV DNA, 31 carried 1-5 G to A mutations in the BCP-PC region. IHC results showed that the expression level of A3G in CHB patients' liver was very low. Of all patients, A3G is expressed in three undetectable HBV DNA subjects and a patient with 2.24 x 10[4] copies ml[-1] of HBV DNA. G to A mutated residues were indicated at positions 1727, 1757 and 1896 of the HBV genome of this patient. This study indicates that despite very low levels of both A3G in liver and the number of positive subjects, A3G has a potential role to restrict the in vivo replication of HBV

Metformin in nonalcoholic steatohepatitis: a randomized controlled trial

Nonalcoholic Steatohepatitis [NASH] is a common liver disease that can progress to cirrhosis or hepatocellular carcinoma. It is estimated that up to 3% of the Iranian population have this condition. Although the pathogenesis of NASH is incompletely understood, there is significant evidence pointing to the importance of insulin resistance. Metformin is an oral hypoglycemic agent known to improve insulin resistance. This study examines the effectiveness of metformin on biochemical and histological improvement among NASH patients in a randomized double-blind controlled trial. This study enrolled 33 biopsy-proven NASH patients. Other causes of liver disorders were excluded. Subjects were randomized to receive either metformin, 500 mg twice daily, or an identical-looking placebo. Overweight patients were also instructed to lose weight. Treatment continued for 6 months. Patients were regularly visited and liver enzyme levels recorded. Compliance and any adverse drug effects were recorded. In the metformin group, the mean aspartate aminotransferase [AST] level dropped from 61.2 IU/L to 32.7 IU/L and the mean alanine aminotransferase [ALT] level dropped from 85.1 IU/L to 50.8 IU/L. The mean AST level in the placebo group dropped from 54.3 IU/L to 37.9 IU/L, whereas the mean ALT level dropped from 111.8 IU/L to 55.4 IU/L in the placebo group. The decrease in liver enzymes was significant in both groups, but the magnitude of decrease was not significantly different. The improvement observed in liver enzyme levels is totally attributable to weight loss. Metformin had no significant effect on liver enzyme levels

Eosinophilic gastroenteritis: a case series from Iran

Eosinophilic gastroenteritis [EG] is a rare inflammatory disorder of the gastrointestinal [GI] tract. There have been several case series of patients with EG from the western world and East Asia. However, there has not been a report of patients with EG from the Middle East region. The aim of this study is to describe clinical characteristics and treatment response in a series of EG patients from Iran. We retrospectively reviewed charts with a diagnosis of EG from 1997 to 2010 at Shariati Hospital and the private clinics of the authors. Clinical characteristics of the patients were evaluated, and the treatment response and relapse rate were assessed. Twenty-two patients [9 male] with EG were identified. Mean age of the patients was 45.1 +/- 15.5 [range: 27-75] years. Median duration between symptom onset and diagnosis was 12 [range 1- 48] months. Twenty [90%] patients had mucosal involvement, one [5%] had muscular involvement and one [5%] had subserosal involvement. Patients were followed for a median duration of 36.5 [range 4- 123] months. Two [90%] patients had mucosal involvement, one [5%] had muscular involvement and one [5%] had subserosal involvement. Patients were followed for a median duration of 36.5 [range 4-123] months. Two patients had spontaneous remission with supportive care. The remaining 20 patients responded well to oral corticosteroid treatments. The relapse rate was 33%. Episodes of relapse were successfully controlled with a repeat course of corticosteroids. Two patients with several relapses required maintenance treatment with azathioprine. The clinical characteristics and treatment responses of EG patients from Iran are similar to reports from other parts of the world. Patients need to undergo close follow up after treatment to detect early signs of relapse

Inflammatory myofibroblastic tumor of the small bowel: a case report

Inflammatory Myofibroblastic Tumor [IMT] is a rare neoplastic lesion with tendency toward local aggressive behavior and recurrence. The tumor most commonly occurs in the pulmonary system of children and young adult, although it may rarely develop in older patients and other organs. Symptoms are non-specific and depend on the location of the tumor. The gastrointestinal tract is rarely the primary site of origin for this lesion. We report an unusual presentation of this rare lesion in a 58 year old woman with intussusception and partial intestinal obstruction

P21 [Waf1/Cip1] gene polymorphisms and possible interaction with cigarette smoking in esophageal squamous cell carcinoma in northeastern iran: a preliminary study

The incidence of esophageal squamous cell carcinoma [ESCC] is very high in northeastern Iran. However, the genetic predisposing factors to ESCC in this region have not been clearly defined. The P21 [waf1/cip1] gene is involved in the arrest of cellular growth, as induced by the p53 tumor suppressor gene. Two polymorphisms of p21 gene in codon 31 [p21 C98A, dbSNP rs1801270] and the 3'UTR [p21 C70T, dbSNP rs1059234] ma-y affect protein expression and play a role in cancer susceptibility. The present study aimed to investigate the association of p21 polymorphisms in codon 31 and the 3'UTR, and cigarette smoking on the risk of ESCC in northeastern Iran. A case-control study was carried out to detect the p21 polymorphism in the 3'UTR and codon 31 of samples from 126 ESCC cases and 100 controls from 2006 to 2007. There were no significant differences of age and sex between cases and controls. Genotyping of p21 polymorphisms were determined with the PCR-RFLP method. Conditional logistic regression was used to adjust for potential confounders. None of the p21 genotypes were significantly associated with risk of ESCC, even after adjusting for age and gender [P=0.52, OR=1.24; 95%CI: 0.63-2.42]. However, the presence of these polymorphisms in combination with cigarette smoking had a synergistic interaction in ESCC carcinogenesis in northeastern Iran [P=0.02, OR=8.38; 95%CI: 1.03-67.93]. Our data suggests that these two p21 polymorphisms, both alone and in combination, are not genetic susceptibility biomarkers for ESCC. However, their interaction with cigarette smoking may influence the susceptibility to ESCC development in northeastern Iran