Sudden onset of symptoms in concurrent Takayasu arteritis and Ulcerative colitis: A case report with neurological complications.

Key Clinical Message: The rare co-occurrence of takayasu arteritis (TAK) and ulcerative colitis (UC), presenting with asymptomatic onset and neurological complications, highlights the importance of an integrated diagnostic approach for overlapping autoimmune conditions. Abstract: We present a rare case of a 44-year-old female diagnosed with both UC and TAK, characterized by an unusual acute asymptomatic onset accompanied by neurological manifestations. The patient exhibited symptoms of acute ischemic stroke along with vascular abnormalities, as well as colon inflammation associated with UC. The patient's asymptomatic presentation at the onset differs from previously reported cases. The presence of additional complications, such as hepatocellular adenoma and primary sclerosing cholangitis, further complicated the diagnostic challenges. The patient's treatment involved a combination of methylprednisolone, azathioprine, and prednisolone leading to improved clinical outcomes. This case emphasizes the complexity involved in diagnosing overlapping conditions and highlights the significance of TAK in presenting atypical manifestations in relation to UC. Furthermore, this case contributes to the limited literature, underscoring the need for early detection and comprehensive treatment approaches.

Eosinophilic granulomatosis with polyangiitis following flu guard influenza vaccination: A case report.

Key Clinical Message: This case highlights a potential association between influenza vaccination and the development of eosinophilic granulomatosis with polyangiitis (EGPA), prompting the need for increased vigilance regarding vaccine-related autoimmune reactions. While causality remains unclear, clinicians should consider this possibility in patients presenting with EGPA-like symptoms shortly after vaccination. Abstract: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis characterized by tissue infiltration by eosinophils and hyper eosinophilia. We present a case of EGPA in a middle-aged man following influenza vaccination. The patient developed respiratory symptoms, skin lesions, joint pain, and neurological deficits. Diagnostic tests revealed eosinophilia, positive anti-neutrophil cytoplasmic antibodies, and elevated acute phase reactants. This report highlights a potential association between influenza vaccination and EGPA.

Autoimmune inflammatory rheumatic diseases post-COVID-19 vaccination.

Vaccination against COVID-19 is one of the critical tools to provide herd immunity, reduce mortality, and control the pandemic worldwide. Despite the safety of vaccination against SARS-CoV-2 in the healthy population, a minority of people may develop rare post-vaccine adverse reactions such as autoimmune syndromes. The current study aimed to identify and present a series of patients with de-novo autoimmune rheumatic diseases (ARDs) associated with COVID-19 vaccines. Inclusion criteria were the onset of ARDs symptoms at ∼3-4 weeks post-vaccination, age ≥ 16, no previous history of ARDs, meeting the classification criteria for one of the ARDs, and staying in the follow-up. The most commonly used vaccines in patients were Sinopharm [7 cases (50%)] and AstraZeneca [6 cases (42.9%)]. ARDs were significantly more common in subjects who received the AstraZeneca vaccine than in those who received other vaccines. Based on the results, patients were diagnosed with rheumatoid arthritis or one of its subtypes (5 cases), vasculitis (4 cases), systemic lupus erythematosus (3 cases), and peripheral seronegative spondyloarthritis (2 cases). Except for one patient with self-limitation of ARD, others were treated with disease-modifying antirheumatic drugs, and one case developed irreversible neurological complications. Indeed, our data can warn physicians about the possibility of ARDs post-vaccination, lead to faster diagnosis, prevent loss of window of opportunity for treatment, and prevent irreversible organ damage. Based on the published literature, autoimmune phenomena post-COVID-19 vaccination may be related to the overstimulation of mediators and cytokines due to complicated antigen-specific/non-specific immunological responses and mechanisms.

Association of Foxp3 rs3761548 polymorphism with cytokines concentration in gastric adenocarcinoma patients.

T regulatory cells (Tregs) and related-cytokines are effectively engaged in the process of tumor immune escape and functionally inhibit immune response against the tumor. This study aimed to investigate the association of Foxp3 gene single nucleotide polymorphism (SNP) (rs3761548) with serum IL-35, IL-10, and TGF-ß levels in gastric adenocarcinoma (GA) patients. The blood samples were obtained from 150 GA patients and 166 control subjects. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was done to genotyping of Foxp3 gene polymorphism (rs3761548). The serum cytokines levels were measured using the ELISA method. According to genotyping, the AA, and AC genotypes and A allele demonstrated significantly greater risk of GA. Considering the Lauren classification, our results revealed a greater risk of GA progression in patients with AC + AA genotype compared to CC genotype. Moreover, significantly increased levels of IL-10, IL-35, and TGF-ß were observed in GA patients compared to controls and also in diffuse-type compared to the intestinal type of GA patients. The IL-35, IL-10 concentrations in GA patients displayed significant differences between the participants with CC, AC and AA genotypes. Further analysis indicated the prognostic role of serum IL-35, IL-10, and TGF-ß levels in GA patients. Our results confirmed that the Foxp3 polymorphism (rs3761548) could influence the predisposition to GA and the serum IL-10, IL-35, and TGF-ß levels. Thus, this polymorphism might be involved in the GA progression through influencing Tregs function and the secretion of immunomodulatory cytokines.

Preventive and Tumor-Suppressive Effects of Lactobacillus Paracasei X12 in Rat Model of Colorectal Cancer.

The paper in hand seeks to evaluate the tumor-suppressive and apoptotic effects of L. paracasei X12 in 1, 2-dimethylhydrazine (DMH)-induced rat colon carcinogenesis. The rats were divided into three groups (n = 8-12 per group); L. paracasei X12 was administrated to these animals for forty weeks. The findings of this study indicated that L. paracasei X12 administration prevented severe weight loss in DMH-treated rats. It was also determined that L. paracasei X12 administration could prevent the neoplasia incidence, cell proliferation and it also could suppress the tumors' growth. Additionally, a significant improvement was observed in apoptosis indexes and cell proliferation in probiotic-treated rats. In conclusion, this study provides insights into the therapeutic potential of L. paracasei X12 with emphasis on the issue that modulation of apoptosis pathway could leave beneficial effects in the prevention and suppression of colorectal cancer (CRC). However, further studies are in support to clarify the mechanisms involved in the tumor-suppressive effect of probiotics.

Survival of familial adenomatous polyposis coexistence colorectal cancer in Iran.

CONTEXT: Familial adenomatous polyposis (FAP) is an autosomal dominant disorder. Colorectal cancer (CRC) has been implicated as the most common cause of death in FAP patients, especially in those with coexisting CRC at initial diagnosis (FAP-CRC). AIM: We aimed to determine the survival rate of FAP-CRC and the factors affecting FAP-CRC survival. SETTING AND DESIGN: This was a retrospective cohort FAP study conducted in northwest Iran. SUBJECTS AND METHODS: From 2006 to 2016, 51 FAP-CRC individuals were selected from among 4588 CRC patients. STATISTICAL ANALYSIS: A Student's t-test, life table method, log-rank tests, a Kaplan-Maier survival curve, and Cox regression analysis were performed and a value of P < 0.05 was set as statistically significant. RESULTS: A total of 51 FAP-CRC patients were selected, (30 males and 21 females), with a mean age of 42.2 years at diagnosis. The most common presenting symptom was abdominal pain and the most common primary tumor site was the rectum. The 1-, 5- and 10-year overall survival rates were 76%, 59%, and 52%, respectively. Factors affecting the FAP-CRC survival rate, namely, sex, age at CRC diagnosis, and extracolonic manifestations showed no significant differences. The difference in 5-year survival rates between patients with colon and rectal cancers was significant (75% vs. 33%, P = 0.02). The survival rate was significantly higher among patients with disease Stages I and II than those in disease Stages III and IV (P = 0.001). 5-year survival rates in patients with ileal pouch-anal anastomosis and ileorectal anastomosis were 71% and 78%, respectively (P = 0.001). There was an interesting difference in survival between FAP and attenuated FAP (P = 0.01). In cox regression analysis, distant metastasis was a significant predictor of survival (P = 0.001). CONCLUSIONS: Long-term survival from FAP-CRC remains poor; therefore, early-stage detection and the choice of an appropriate surgical method can improve survival in such patients.

Impact of tumor length on survival for patients with resected esophageal cancer.

BACKGROUND: Tumor length in patients with esophageal cancer (EC) has recently received great attention. However, its prognostic role for EC is controversial. The purpose of our study was to characterize the prognostic value of tumor length in EC patients and offer the optimum cut-off point of tumor length by reliable statistical methods. MATERIALS AND METHODS: A retrospective analysis was conducted on 71 consecutive patients with EC who underwent surgery. ROC curve analysis was used to determine the optimal cut-off point for tumor length, measured with a handheld ruler after formalin fixation. Correlations between tumor length and other factors were surveyed, and overall survival (OS) rates were compared between the two groups. Potential prognostic factors were evaluated by univariate Kaplan-Meier survival analysis. A P value less than 0.05 was considered significant. RESULTS: There were a total of 71 patients, with a male/ female divide of 43/28 and a median age of 59. Characteristics were as follows: squamous/adenocarcinoma, 65/6; median tumor length, 4 (0.9-10); cut-off point for tumor length, 4cm. Univariate analysis prognostic factors were tumor length and modality of therapy. One, three and five year OS rates were 84, 43 and 43% for tumors with ≤4cm length, whereas the rates were 75, 9 and 0% for tumors >4 cm. There was a significant association between tumor length and age, sex, weight loss, tumor site, histology, T and N scores, differentiation, stage, modality of therapy and longitudinal margin involvement. CONCLUSIONS: Future studies for modification of the EC staging system might consider tumor length too as it is an important prognostic factor. Further assessment with larger prospective datasets and practical methods (such as endoscopy) is needed to establish an optimal cut-off point for tumor length.