دکتر عباس کریمی

This article discusses the diagnosis and monitoring of patients with colorectal cancer using liquid biopsy. Colorectal cancer is one of the most common types of cancer worldwide; moreover, its diagnosis and monitoring is of great importance due to various factors such as lifestyle, environmental and genetic factors. There are various methods for diagnosing and monitoring colorectal cancer which can be used as the basis for selecting appropriate treatment methods such as surgery, chemotherapy, targeted therapy, immunotherapy, gene therapy and combination therapies.

Methods and Materials:

the current study has been performed through searching “Liquid biopsy”, “Colorectal Cancer”, “Tumor educated platelets”, “Biomarker”, and “Chemotherapy” keywords in various databases including PubMed, Scopus, Web of Science, and Google Scholar until Dec 2023. Out of the 297 articles, 49 articles were selected and they were included in the study based on the inclusion and exclusion criteria.

Liquid biopsy-based analysis of circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), and tumor-educated platelets (TEPs) provide useful tools for early detection, monitoring treatment response, detecting disease recurrence, and identifying tumor heterogeneity and drug resistance mechanisms in colorectal cancer.

This article examines that due to the molecular characteristics of the tumor during the course of the disease and the genetic and phenotypic heterogeneity of the tumor between primary and metastatic lesions, liquid biopsy can be used as a new solution for diagnosis and monitoring of patients with colorectal cancer.

Pemphigus vulgaris is the most common autoimmune blistering disease. Prednisone، commonly in combination with an immunosuppressive adjuvant such as azathioprine or cyclophosphamide، is the standard treatment for pemphigus vulgaris. Approximately 5% to 15% of mortality of the disease is due to the complications of corticosteroids therapy. The aim of this study was to determine the prevalence and risk factors of steroid-induced diabetes in pemphigus patients hospitalized in Razi hospital، Tehran in 2009 and 2010.

In this cross-sectional study، 177 first-time admitted pemphigus vulgaris patients were studied regarding presence of risk factors for steroid-induced diabetes. Those risk factors were included age، sex، blood pressure، body mass index (BMI)، family history of diabetes، medications used before and after initiation of treatment، fasting blood sugar (FBS)، triglyceride (TG) high density lipoprotein (HDL)، low density lipoprotein (LDL) levels at the time of admission، and three weeks after the treatment was started.

Twenty-nine patients (16. 3%) were diagnosed with diabetes based on three weeks FBS levels evaluations. There were significant associations between BMI، HbA1c and taking nervous system agents and diabetes (P<0. 05)، but the differences between sex، family history، blood pressure، TG، LDL levels and occurrence of diabetes were not significant (P>0. 05).

Close monitoring of FBS levels before and within the first three weeks of the initiation of steroid therapy allows early detection of storied-induced diabetes in pemphigus patients. Moreover، evaluation of other risk factors associated with diabetes may provide the opportunity of early diagnosis and treatment of steroid-induced diabetes.

Pemphigus is a chronic autoimmune blistering disease characterized by intraepidermal blisters. These blisters damage the skin barrier and increase the risk of life-threatening infections. Nasal colonization of Staphylococcus aureus can increase the risk of infections and delay the wound healing process. The aim of this study was to determine the frequency of staphylococcal carriers in hospitalized patients with pemphigus.

In this prospective cross-sectional study، medical records of 72 hospitalized patients with pemphigus in the period from March 2013 to March 2014 were reviewed. Samples were collected from anterior nares and cultured at the time of admission and one week after hospitalization for evaluation of S. aureus colonization and Methicillin-resistant Staphylococcus aureus (MRSA) types.

Forty-five patients (62. 5%) were male and 27 patients (37. 5%) were female. The frequency of S. aureus carriers was 58. 3%. Thirty patients had colonization at the time of hospital admission; among them، 22 (73. 3%) patients had MRSA. In forty (55. 6%) patients colonization were found one week after hospitalization. Thirty-three (82. 5%) patients in this group were MRSA positive. There was no significant difference between S. aureus colonization at the time of admission and one week after hospitalization (P>0. 05).

S. aureus and MRSA carriers (communityacquired and hospital-acquired carriers) were prevalent among patients with pemphigus. With identifiction and isolation of carriers of S. aureus in pemphigus patients، not only could prevent spreading S. aureus and MRSA associated infections، bul also would facilitate wound healing. More robust studies are required to assess the role of potential riskfactors.

Pemphigus vulgaris is a rare autoimmune intraepidermal blistering disease affecting the skin and mucous membranes. Copper and zinc are two necessary trace elements in the human body that have antioxidant activity in the wound healing process. The aim of this study was to determine the serumic level of zinc and copper in newly diagnosed patients with pemphigus vulgaris.

In this study, 50 newly diagnosed patients with pemphigus vulgaris admitted to Razi Hospital in Tehran were studied with regards to their serum levels of copper and zinc alongside age, sex, body mass index (BMI), smoking and drug abuse status.

Eighteen percent (9 cases) and 50% (25 cases) of the patients showed copper and zinc deficiency, respectively. There was no significant association between copper and zinc levels and smoking, age, BMI or suffering from a chronic disease (P>0.05). Mean copper levels in women and men were not significantly with their respective different normal levels (P>0.05). Serum zinc level in men was lower than its normal range (P<0.05), but in women was not significantly different from its normal level.

Serum concentration of copper and zinc did not show any association with pemphigus disease. Since decreased levels of copper and zinc may result in an increase of oxidative activity in autoimmune diseases enhancing disease severity, therefore conducting a robust case-control study for evaluating the their roles in disease severity may pave the way to treatment of those diseases.

Bullous pemphigoid is an acquired autoimmune disease with subepidermal blisters commonly seen in the elderly over 60 years old. The exact survival rate of the patients with bullous pemphigoid was not available in Iran. The aim of this study was to evaluate the risk factors of 5-year mortality of bullous pemphigoid patients.

In this retrospective study, 66 bullous pemphigoid patients referred to Razi hospital from 1986 to 2006 were studied. Age, sex, consumed corticosteroid type, duration of hospitalization, and clinical form of bullous pemphigoid, ESR and comorbidities were evaluated to determine the risk factors associated with patients’ 5-year mortality rate.

Forty-seven patients (71.2 %) had 5-year survival. The most common comorbidities were cardiovascular diseases (28.8%), diabetes (15%) and chronic respiratory diseases (9%). There was a significant relationship between the age and the 5-year survival rate, in other words patients aged over 70 years had a less 5-year survival rate (P<0.001). There was no statistically significant association with gender, the type of corticosteroid, the disease clinical forms, duration of hospitalization or ESR and 5-year survival (P>0.05).

The current study found a significant relationship between the age of the patients and 5-year survival. Larger studies considering more potential risk factors and more appropriate designs might help to estimate the survival rate of patients with bullous pemphigoid more precisely.

Alopecia Areata is a chronic inflammatory disease which involves hair follicles. The aim of this study was to assess the efficacy of oral sulfasalazine in the treatment of recalcitrant alopecia areata.

Patients with refractory alopecia areata who were eligible for the study, after providing informed consent were treated with oral sulfasalazine for 6 months. After completion of treatment, regrowth of vellus and terminal hairs were determined based on clinical examination and comparing the new photographs with the baseline ones.

Sixteen patients were enrolled in the present study but only 5 patients completed it. No response was seen in 3 patients. After 4 months, 55-60% response to treatment was observed in 1 patient, but the disease relapsed at the end of fourth month. In 1 patient, 15% hair regrowth was observed but treatment was discontinued after the second month due to side effects. Side effects were observed in 2 patients.

Since only refractory alopecia areata patients had been enrolled to the study, the results could not be generalized to all patients with alopecia areata. Therapeutic response in the patients with alopecia areata is disappointing and any poor treatment response or failure of treatment in refractory cases of the disease cannot rule out the efficacy of the drug in the milder forms of the alopecia areata.

Background an

parapsoriasis is a rare chronic idiopathic dermatosis which commonly manifests with round or oval scaling and itching erythematosus plaques on trunk and extremities. Considering the size of the lesions, parapsoriasis is divided into two groups: small plaque and large plaque. Study of demographic characteristics of this disease may help to identify the high risk groups who are more susceptible to cutaneous lymphoma with high mortality as well as proper allocation of health service resources.

In this retrospective cross-sectional study, affected parapsoriasis patients whom were referred to Razi Hospital in Tehran between April 2003 to March 2009 were studied. Three hundred and twenty patients were investigated for variables: age, sex, place of residence, location of the lesions and clinical subgroups according to the histopathology reports.

53.4% of patients were female. The disease was most commonly observed in age group of 20 to 50 years and the mean age of the patients was 43.3 years. Eighty-five percent of the patients were inhabitant of Tehran province. 88.1% of patients had large plaque lesions and 11.9% had small plaque lesions. The most common sites of lesions were on the trunk (53.4 %) followed by the extremities (38.7%).

Based on these findings, it was determined that parapsoriasis most commonly affects middle-aged women. Involvement of trunks and extremities were most commonly observed. Large plaque type was the most common type.