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Background Oxaliplatin is a key drug in treatment of gastrointestinal (GI) cancer. Peripheral neuropathy (PN) is a troublesome and dose-dependent adverse effect of oxaliplatin. It can occur in two distinct forms: acute and chronic. Its incidence is estimated about 65-98%, of which 22% of cases need to stop chemotherapy. In some cases, PN has a long-lasting effect on patient's quality of life (QOL). Therefore, this study was done to evaluate efficacy of duloxetine on prevention of oxaliplatin- induced peripheral neuropathy (OIPN) in patients with GI cancer. Methodology In this randomized and double -blind clinical trial study conducted in a tertiary teaching hospital, eligible patients were divided into two groups. Treatment group received duloxetine the day before initiation of chemotherapy regimen at a dose of 30 mg/day for one week and then, the dose was titrated up to 60 mg/day until 12 weeks. For placebo group, one placebo capsule was prescribed daily for one week followed by 2 capsules daily until 12 weeks. In each of chemotherapy courses, PN was assessed using national cancer institute-common terminology criteria for adverse effects (NCI-CTCAE v4.03). Also, chemotherapy -related QOL at the baseline and 12 weeks was assessed by functional assessment of cancer treatment gynecologic oncology group - neurotoxicity (FACT/GOG-NTX). Results Forty patients were randomly assigned to treatment and placebo groups which were similar to each other in terms of chemotherapy regimen, type, and stage of cancer. Analysis of results obtained from the NCI-CTCAE (v4.03) showed that duloxetine could prevent worsening of paresthesia more than placebo ( P = 0.025) and patients in duloxetine group experienced less peripheral sensory neuropathy ( P = 0.001) than placebo group. Analysis of results obtained from the FACT/GOG-NTX demonstrated a significant worsening of tingling and discomfort in hands ( P = 0.002, 0.001, respectively) and feet ( P = 0.017, 0.019, respectively) in placebo group compared to duloxetine group. Also, patients experienced more cold temperature -induced pain in extremities ( P = 0.001) in placebo group compared to duloxetine group. On the other hand, duloxetine could not improve QOL ( P = 0.06) and had not significant effects on trouble feeling the shape of small objects in hand ( P = 0.420) or trouble buttoning buttons ( P = 0.086). The P-value < 0.05 was considered to be statistically significant.

Recent evidence suggests the link between adherence to an acidogenic diet and the risk of some types of cancers, such as colorectal and breast cancers. This systematic review and meta-analysis aimed to clarify the association between dietary acid load and cancer risk.Online databases ( PubMed, Scopus, EMBASE, Scholar Google and ISI web of sciences ) were searched between January 1990 and May 2021. The risk ratio (RR) was extracted from eligible studies and random-effects meta-analysis was performed to calculate pooled RR of studies. Nine studies (three cohorts, six case-control) were included. Higher dietary acid load scores [including potential renal acid load (PRAL) and net endogenous acid production (NEAP)] were associated with the increased risk of cancer [RRPRAL, 1.77; 95% confidence interval (CI), 1.27-2.46; n = 8; RRNEAP, 1.58, 95% CI: 1.20-2.09, n = 7). Dose-response analysis suggested that a 20-score increase in dietary PRAL and NEAP was associated with 27 and 8% higher risk of cancer, respectively (RRPRAL, 1.27; 95% CI, 1.02-1.60; nonlinearity P = 0.12; RRNEAP, 1.08; 95% CI, 1.02-1.13, nonlinearity P = 0.06). A significant positive relationship between dietary PRAL and risk of cancer was only observed in the subgroup of women. Associations were significant in both men and women for dietary NEAP. Subgroup analyses based on cancer type were only possible for breast cancer. There was no significant association between dietary acid load (PRAL and NEAP) and breast cancer risk.Our analysis showed that high adherence to an acidogenic diet is associated with an increased risk of cancer. The protocol for this meta-analysis was registered in PROSPERO registration no. CRD42019146460.

A 52-year-old woman with metastatic pancreatic adenocarcinoma underwent imaging with 18F-FDG PET/CT and 68Ga-FAPI-46 PET/CT, which demonstrated malignancy recurrence in the surgical bed with multiple metastatic lesions, more extensive on 68Ga-FAPI-46 PET/CT. The patient was a candidate for therapy with 177Lu-FAPI-46 due to high uptake of lesions in 68Ga-FAPI-46 images and no other available therapeutic option. Posttreatment 177Lu-FAPI-46 scans showed rather rapid washout of the radiopharmaceutical from tumoral lesions. This case report suggests that, although 68Ga-FAPI-46 is a promising agent for tumor imaging, 177Lu-FAPI-46 may not be an optimal compound for theranostic applications.

Gastric tumors are important gastrointestinal malignancies, and the prediction of therapeutic responses and related factors are important to improve the prognosis. Hence the aim of this study was to determine the therapeutic response to ramucirumab + folfiri in patients with metastatic gastric cancer.In this prospective cohort, 13 consecutive patients with metastatic gastric cancer attending Taleghani Hospital that underwent ramucirumab + folfiri therapy were enrolled, and the therapeutic response among them was determined.The results in this study demonstrated that initial therapeutic response was 92.3% and the Progression-free Survival (PFS) was 16.2 months (84.6%) (CI95%:13.2-19.3). The nine-month PFS was 69.2%. Total survival was 16.7 months (CI95%:13.5-19.9).Ultimately, according to the obtained results, it may be concluded that the therapeutic response to ramucirumab + folfiri in a patient with metastatic gastric cancer is good, and the use of this regimen is recommended.

Endothelial injury by toxins, drugs, immune complexes leads to activation of coagulation cascade and thrombosis, which result in platelet consumption and red blood cell injury These thrombotic microangiopathies can potentially injure numerous organs and result in organ dysfunction In this case, we present the fourth reported patient with thrombotic thrombocytopenic purpura associated with COVID-19 © 2021, Tehran University of Medical Sciences All rights reserved

Coronavirus disease 2019 (COVID-19) pandemic has affected more than 40 million people worldwide. Some patients had episodes of symptom recurrence after the first episode of infection with variable intervals. There are multiple issues and hypotheses about re-infection or re-activation of the virus, especially in immunocompromised patients. In this paper, we present details of an individual with a recent history of COVID-19 who proceeded to acute myeloid leukaemia M3 and immunosuppression by chemotherapy, then we review some recently published articles about possible re-infection or re-activation.

Introduction: The main pathogenesis of COVID-19, especially in patients with moderate to severe COVID-19 pneumonia, is through cytokine release syndrome. This cytokine release causes tissue edema, chemotaxis of immune cells, and also vascular endothelial disruption. Thalidomide is an old drug with several effects on inflammation and also on immune cells physiology. Materials and Methods: 50 patients with moderate COVID-19 pneumonia, were included in this study in the Thalidomide group and control group. We administered Thalidomide 100 mg daily for 14 days + Dexamethasone + Remdesivir in the Thalidomide group and Dexamethasone + Remdesivir as the standard of care in our center in the control group. We evaluated oxygen saturation improvement to more than 94% and also the duration of hospital admission and mortality in our study. Results: We did not find any difference between these two groups in terms of duration of hospital stay (8.9 days in the Thalidomide group versus 9.6 in the control group), improvement of oxygen saturation at the first week and second week (Pvalue: 0.70 and 0.826 respectively). There was no mortality in both groups. At the end of second week of treatment, the levels of inflammatory markers were not statistically different between these two groups (ESR, CRP, ferritin, LDH, fibrinogen with Pvalue: 0.509, 0.440, 0.121, 0.005, 0.114 respectively). Only LDH in the Thalidomide group was significantly lower at the end of the second week than the control group. Conclusion: In our study, we did not find any relation between Thalidomide administration and effects on oxygen saturation improvement and also the duration of hospital admission and mortality.

Highlights • COVID-19 associated microangiopathies. • TTP as an unusual microangiopathy and its complication. • Standard of treatment in COVID-19 and TTP., Introduction Thrombotic microangiopathies are a group of disorders that are mainly related to endothelial dysfunction. This category of endothelial dysfunction results of several imbalances between platelets, endothelium and immune system, also cytokine production. Aim of this study To report cases with thrombotic thrombocytopenic purpura (TTP) and COVID-19 and review COVID-19 endothelial dysfunction literature. Methods Primary laboratory data, peripheral blood smear, ADAMTS13 antigen activity level, and antibody ordered for each of these four patients. Treatments for COVID-19 administered for all patients. Traditional treatments for TTP also were administered. Results There were numerous schistocytes (more than 5%) in peripheral blood smears for each patient. ADAMTS13 antigen activity level was below 10%, and ADAMTS13 antibody was elevated for each patient. COVID-19 PCR was positive for all patients, and CT-Scans were indicative of the involvement of COVID-19. Conclusion In this case series, we reported four COVID-19 patients who presented with signs and symptoms of anemia and thrombocytopenia, resulting in thrombotic thrombocytopenic purpura.

Backgroundoxaliplatin is a key drug in gastrointestinal (GI) cancer treatment. Peripheral Neuropathy is a troublesome and dose-dependent adverse effect of oxaliplatin. It can occur in two distinct forms: acute and chronic. Its incidence is estimated about 65-98 percent, of which 22 percent needed to stop chemotherapy. In some cases peripheral neuropathy has a long lasting impact on patient’s quality of life. The purpose of this study is to evaluate the efficacy of duloxetine on the prevention of oxaliplatin induced peripheral neuropathy in GI cancer patients.MethodsIn this randomized and double blind study, which was conducted in a tertiary teaching hospital, eligible patients were divided in to two groups. Treatment group was received Duloxetine the day before chemotherapy regimen initiation with the dose of 30 mg/day for one week and then was titrated up to 60 mg/day until 12 weeks. One placebo capsule daily for one week then two capsules daily until 12 weeks was prescribed for placebo group. In every chemotherapy courses peripheral neuropathy was assessed by using NCI-CTCAE v4.03. Also chemotherapy related quality of life (QOL) at the baseline and 12 weeks was assessed by using FACT/GOG-NTX.ResultsForty patients were randomized to the treatment and placebo group which were similar with chemotherapy regimen, type and stage of cancer. Data analysis of NCI-CTCAE showed duloxetine could prevent worsening of paresthesia more than placebo (P = 0.025) and patients in duloxetine group experience less peripheral sensory neuropathy (P = 0.001) than placebo. FACT/GOG-NTX analysis showed significant worsening of tingling and discomfort in hands (respectively P = 0.002, 0.001) and feet (respectively P = 0.017, 0.019), having pain in hands and feet (P = 0.001) and difficulty breathing in cold temperature exposure (P = 0.023) in placebo compared with duloxetine group. In the other hand, duloxetine could not improve QOL (P = 0.06) and hadn’t significant effects on Trouble feeling the shape of small objects in hand (P = 0.420) or Trouble buttoning buttons (P = 0.086).Conclusion Duloxetine can consider as a safe and effective medication for the prevention of oxaliplatin induced peripheral neuropathy in GI cancer. Nonetheless, more studies with larger population are needed.Trial registrationIRCT20100127003210N15. Registered 25 Jun 2018, https://fa.irct.ir/user/trial/3256/view

Background Primary nasopharyngeal lymphoma (NPL) is a very rare tumor of Waldeyer ring (WR) lymphoid tissue. It is challenging to differentiate lymphoma infiltration of pituitary from a pituitary adenoma, meningioma infiltration, and other sellar lesions to plan a suitable treatment strategy. We presented for the first time a unique case of NPL with an unusual presentation of oculomotor nerve palsy associated with pan-pituitary involvement in a diabetic patient. Case presentation A 64-year old diabetic woman with no previous history of malignancy presented with intermittent diplopia for about the last nine months. Severe headache, left eye ptosis and hypoglycemic episodes were added to her symptoms after a while. Further complaints include generalized weakness, loss of appetite, generalized musculoskeletal pain, and 6–7 kg weight loss within six months. Her family history was unremarkable. Physical examinations of eyes indicated left eye 3rd, 4th, and 6th nerve palsy. But, she was not anisocoric, and the pupillary reflexes were normal on both eyes. No lymphadenopathy, organomegaly and other abnormalities were found. Magnetic resonance imaging (MRI) showed a heterogeneous enhancement in the seller and suprasellar regions, enlargement of the stalk, parasellar dural enhancement and thickening of the sphenoid sinus without bone erosion. Also, both cavernous sinuses were infiltrated and both internal carotid arteries were encased by the neoplastic lesion. It suggested an infiltrative neoplastic lesion which compressed the cranial nerves. Pituitary hormone levels assessment indicated a pan-hypopituitarism. Following nasopharyngeal mucosal biopsy, the immunohistochemistry (IHC) findings revealed a low-grade non-Hodgkin’s B-cell lymphoma. Systemic workup, including cerebrospinal fluid (CSF) studies, bone marrow aspiration, chest and abdominopelvic high-resolution computed tomography (HRCT) indicated no other involvement by the lymphoma. After chemotherapy courses, central adrenal insufficiency, partial central diabetes incipidious (CDI) and central hypothyroidism have been resolved. To our best knowledge, we found 17 cases of NPL with cranial nerve palsy, 1 case of NPL with pan-hypopituitarism and no NPL case with both cranial nerve palsy and pituitary dysfunction. Conclusions The incidence of cranial neuropathy in patients with diabetes should not merely be attributed to diabetic neuropathy without further evaluation.

Cronkhite-Canada syndrome is characterized by gastrointestinal and ectodermal manifestations. In this paper, we describe a 64-year-old Iranian male, presenting with Cronkhite-Canada syndrome with metastatic colon cancer. The patient was suffering from hair loss, which occurred on the scalp at first and then, during 5 months, extended to the whole body. After that, his sense of taste was impaired, and 2 months later, gastrointestinal symptoms gradually started, with weight loss of 20 kg over 2 months with an initial weight of 100 kg. Finally, he was admitted to our center 10 months after the onset of symptoms. On skin examination, generalized hair loss and hyperpigmentation and dysmorphic nail changes were observed. Multiple polyps within the colon and sigmoid were observed on colonoscopy. According to biopsies, a serrated adenoma and an invasive adenocarcinoma were reported in the ascending colon and sigmoid, respectively. Other polyps were pseudopolyps, and their characteristics were not significant. Computed tomography of the lungs and abdomen showed multiple adenopathies. On biopsy, metastatic adenocarcinoma was reported. The patient underwent chemotherapy with FOLFIRI and ERBITUX. Finally, after 5 courses of chemotherapy, his regimen was changed to FOLFOX and Avastin because of evidence of progression on computed tomography. The etiology of Cronkhite-Canada syndrome is currently unknown, and the optimal therapy has not been reported so far. This syndrome has many complications; the major of them is malignancy, and the prognosis is poor with a mortality rate of 50%. Therefore, annual monitoring is necessary in these patients.

Introduction: Although weekly paclitaxel and carboplatin regimen is as effective as the standard method for treatment of advanced ovarian cancer, it has less frequently been used as neoadjuvant therapy. Objectives: To reduce the side effects of typical every three-week chemotherapy and increase progression-free survival (PFS) rate, this study aimed to evaluate the feasibility of using weekly paclitaxel as neoadjuvant therapy in patients with epithelial ovarian cancer. Patients and Methods: This pre-post clinical trial was conducted on 14 patients with stage IIIC (8 patients) and IV (6 patients) advanced ovarian carcinoma. All the patients received the three courses of treatment and then underwent interval debulking surgery. After the surgery, patients received three or five courses based on their stages. Every neoadjuvant chemotherapy course consisted of weekly paclitaxel (80 mg/m2 ) and carboplatin (AUC=6) every 3 weeks. After every 21 days of treatment course, the patients were evaluated to investigate their response to treatment and side effects. Patients were followed up for at least 6 months. Results: The mean (SD) age of the patients was 64±8 years. After three courses of neoadjuvant chemotherapy, one patient (7%) had a complete response and 13 patients (93%) had a partial response. During the treatment period, two patients (14%) developed anemia, one patient (7%) developed neutropenia, two patients (14%) developed thrombocytopenia, and six patients (43%) developed neuropathy. The median (interquartile range) of PFS was 13 months (9.5-16.25). Conclusion: The findings showed that a weekly paclitaxel and carboplatin regimen as neoadjuvant therapy could be effective in the treatment of advanced ovarian cancer. However, it is necessary to conduct multicenter studies with larger sample sizes. Trial registration: Registration of trial protocol has been approved in Iranian Registry of Clinical Trial (identifier: IRCT2017050333789N1; http://en.irct.ir/trial/25978)

Background The hypothesis of an effect by thiazolidinedione on leukemia cells was proposed 2 decades ago, but there is little clinical evidence regarding its efficacy. We evaluated the safety and efficacy of adding pioglitazone to standard induction chemotherapy in patients with acute myeloid leukemia (AML). Patients and Methods In this randomized clinical trial, newly diagnosed AML patients were randomized to 1 of 2 groups. Patients in both groups received cytarabine (100 mg/m2 per day for 7 days) and daunorubicin (60 mg/m2 per day for 3 days). Patients in the pioglitazone group additionally received oral pioglitazone (45 mg per day). The 2 groups were compared according to remission rate, laboratory findings, and adverse events during treatment. Results Forty patients were evaluated, 20 patients in each group. The complete remission rate was 20% more in the pioglitazone group compared to the control group (P = .202). Complications due to pioglitazone discontinuation were observed in 2 cases. The mean serum alanine aminotransferase in the fourth treatment week was significantly more in pioglitazone group compared to the control group (65.5 vs. 33.6 mg/dL, P = .039). The mean serum creatinine in all treatment phases was significantly higher in the pioglitazone group compared to the control group (P .05). Conclusion Adding pioglitazone to cytarabine and daunorubicin increased the remission rate in AML patients compared to control subjects. Although this difference in remission rate between the 2 groups was not statistically significant, it could be important in the clinical setting. Pioglitazone may provide benefits as an adjuvant therapy for AML patients without causing serious adverse events.

Gastric cancer is considered the fourth most common cancer and second most common cause of cancerrelated mortalities worldwide. Gastric cancer develops more frequently among elderly. The oxaliplatin/5FU/leucovorin (FOLFOX) regimen has shown a notable activity against gastric cancer.To evaluate the responses and complications of FOLFOX4 regimen as first line chemotherapy in elderly patients with advanced gastric cancer.From October 2014 to November 2015, a total of 21 patients with metastatic or local AGC (advanced gastric cancer) were analyzed. All patients were administered a FOLFOX4 regimen consisting of a 2h infusion of oxaliplatin 85 mg/m2 (day 1), continuous infusion of 1000mg/ m2 5Fu in 24h., and leucovorin 200 mg/m2 in 2h infusion as a firstline chemotherapy.A total of 18 patients were assessable for efficacy and toxicity. One of 18 patients achieved a complete response, and 12 had partial responses, giving an overall response rate of 72.6%. Three (16%) patients demonstrated stable disease and 2 (12%) progression. The median progression free survival was 7.3 months, and the median overall survival was 11.9 months. One patient had grade 3 neuropathy. No other grade 3 or 4 NCICTC were seen.The FOLFOX4 regimen used in our study was both active and acceptable for AGC in elderly patients as neoadjuvant and main therapy.

Introduction: Sarcoma of the cervix is uncommon and its prevalence is about 1% of malignancies of the cervix. One type of sarcoma is leiomyosarcoma and the location of this tumor in cervix is very rare. Although uterine sarcoma can involve the cervix and lead to misdiagnosis of cervical leiomyosarcoma, the location of the bulk of the tumor in uterine cervix (not isthmus) for diagnosis of cer- vical leiomyosarcoma is mandatory. The origin of sarcoma is from mesodermal tissue. Due to the rarity of cervical leiomyosarcoma and response to debulking surgery after recurrence, report of this case is interesting. Case Presentation: We hereby report on a 34-year-old unmarried patient, who was a known case of leiomyosarcoma of uterine cervix that was referred with recurrence of tumor in parietal peritoneum, retropobic retzius space and around the bladder and ureter and sigmoid colon. The patient was treated with debulking surgery of the tumor and chemotherapy. Conclusions: Sarcoma as a genital tract malignancy is very rare and the location of sarcoma at pediatric age is in the vagina and at middle age is in the cervix and at postmenopausal women in the uterine corpus. Cervical sarcoma as a rare tumor of the cervix arises from stromal tissue. Due to hematogenous spread of sarcoma, metastasis in lungs is seen and recurrence of this tumor is not uncommon. In this article, recurrence of a known case with leiomyosarcoma of uterine cervix in previous hysterectomy that responded to debulking surgery with removal of metastatic lesions in peritoneal and retroperitoneal spaces and adjuvant therapy with standard chemotherapy drugs and monoclonal antibody therapy is reported. Due to non-hormonal dependence of sarcoma to hormonal secretion from the ovaries and benefit of the ovaries in young women for protection of bone health and cardiovascular system, oophorectomy is a challenging idea and an issue of debate, thus primary surgery, in this case oophorectomy, was not done.

Background: The pancreatic neuroendocrine tumor (pNET) is relatively rare and generally felt to follow an indolent course. EUS has an important role in detection of pNET. This is a review of clinical and radiological presentation and pathologic reports of 22 patients with pNET. Patients and methods: In this study we analyzed clinical and radiological presentations and pathologic reports of all relevant cases who were referred to Taleghani hospital for 3 years since 2008. Results: A total of 22 patients 28-74 years old (mean=49) were enrolled between 2008 and 2011. Among the total, 13 (59%) were male, 9 (41%) were female and 16 (72.7%) had functional tumors. The results of CT were negative in 12 (54%) cases but EUS was capable of detecting the lesions in these patients, cysts being found in 4 (19%) patients. Conclusion: EUS is a highly sensitive procedure for the localization of functional pNETs and especially insulinomas. Nonfunctional tumors were detected in more advanced and late stages and cystic lesions were more common in this group.

We report a rare case of pancreas tumor (lymphoma) in a patient with a history of chronic hepatitis C virus (HCV) infection without treatment, with a high viral load (20,199,805 IU/ml). He presented with abdominal pain, jaundice, weight loss and sweating. Computed tomography showed a hypodense mass located in the head of the pancreas, and immunohistochemistry of a specimen obtained by endoscopic ultrasound-guided fine needle aspiration revealed non-Hodgkin’s lymphoma of the pancreas, B cell type. An association of HCV infection with pancreatic lymphoma has only been reported rarely in the literature and its clinical significance is uncertain.