A 25 year old man was admitted to otorhinolaryngology department with a mass in the ear canal. The patient had a history of tympanoplasty with mastoidectomy in another centre (for chronic otorrhea) 2 years earlier. Details of the surgery were not available. He had no discharge during this time and he came to our hospital for routine follow-up visits. On otomicroscopy a white mass was noticed in the superior part of the canal, the origin of which could not exactly be localized. On palpation with a blunt instrument it proved to be soft. No otorrhea was noted in the canal and the tympanic membrane seemed to be intact in the visible area.

Dear editor: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously called nCoV-2019, has become a public health emergency. Multiple cases of primary infection have been reported from diff erent countries, but there are few cases of recurrent infection. (1, 2) Here, two COVID19 cases are reported who developed COVID-19 recurrent infection...

Background: Febrile Convulsion is the most common convulsive disorder in children, occurring in 2 to 4% of the pediatric population and recurring in 30-50% of cases. Considering the varying RECURRENCE rates reported, this study was conducted at the pediatric ward of the Shahid Beheshti General Hospital, between 2000-2001 to determine the frequency of RECURRENCE and related risk factors in children presenting with their first episode of febrile convulsion.Materials & Methods: A two–year cohort study was performed on 50 children presenting with the first attack of febrile convulsion. Patient demographic data including age, sex, type and duration of seizure, family history of febrile seizure or epilepsy and the interval between fever onset and occurrence of seizure were recorded in questionnaires. Those patients, for whom prophylactic medication was not administered, were followed at three–month intervals for up to one year. Findings were statistically analyzed using Fisher’s exact test.Results: RECURRENCE was observed in twelve children (24%) out of the fifty, being most common in patients aged less than one year (54.4%). RECURRENCE rates among children with a positive family history of febrile convulsion, presence of complex febrile seizure and positive family history of epilepsy were 42.1%, 42.8% and 25% respectively. From among those children with a “less than one hour” interval between fever onset and occurrence of seizure, RECURRENCE occurred in 43-7% of cases, while in those with a “more than one hour interval”,  14.7% experienced RECURRENCE.Conclusion: RECURRENCE rates are increased by certain factors including age-below one year-, positive family history of febrile convulsion, and a “less than one hour” interval between time of fever onset and seizure occurrence.  

Primary hyperoxaluria is a genetic disorder in glyoxylate metabolism that leads to systemic overproduction of oxalate. Functional deficiency of alanine-glyoxylate aminotransferase in this disease leads to recurrent nephrolithiasis, nephrocalcinosis, systemic oxalosis, and kidney failure. We present a young woman with end-stage renal disease who received a kidney allograft and experienced early graft failure presumed to be an acute rejection. There was no improvement in kidney function, and she was required hemodialysis. Ultimately, biopsy revealed birefringent calcium oxalate crystals, which raised suspicion of primary hyperoxaluria. Further evaluations including genetic study and metabolic assay confirmed the diagnosis of primary hyperoxaluria type 1. This suggests a screening method for ruling out primary hyperoxaluria in suspected cases, especially before planning for kidney transplantation in patients with end-stage renal disease who have nephrocalcinosis, calcium oxalate calculi, or a family history of primary hyperoxaluria.

Complex inherited diseases affected by an interaction between collective effects of the genotype at one or multiple loci either to increase or to lower susceptibility to disease, combined with a variety of environmental exposures that may trigger, accelerate, exacerbate, or protect against the disease process. The new aspects of genetic techniques have been opened for diagnosis and analysis of inherited disorders. While appropriate Mendelian laws is applied to estimate the RECURRENCE risk of single gene diseases, using empirical RECURRENCE risks are the most important and available method to evaluate pedigree of complex (multifactorial), chromosomal, and unknown etiology disorders. Although, generally, empirical recurrent risks are not accurate, either because of the difference of gene frequencies and environmental factors among populations or heterogeneity of disease; using results of plenty family population studies, computerized estimating programs, genotyping technologies, and Genome-wide association studies (GWASs) of single nucleotide polymorphisms (SNPs), can make it possible nowadays to estimate these risks. The specific family situation and importance RECURRENCE risks of some common complex genetic diseases will be presented in this review and some important multifactorial disorders’ RECURRENCE risks will be summarized to help genetic counselors for supporting families and representing better view of genetic disorders.

Background: The RECURRENCE of ganglion cysts after surgical excision has a reported rate of 4% to 40%. RECURRENCE rate after revision surgical excision is unknown. The purpose of this study was to define the incidence of recurrent ganglion cysts in patients who underwent a secondary excision procedure. Methods: With Institutional Review Board approval, we retrospectively identified by CPT code and reviewed charts of patients who had recurrent ganglion cyst excision performed over a five-year period (2010 – 2014). RECURRENCE was defined as reappearance of a cyst in the same area as it was previously. Demographic information including RECURRENCEs and revision surgeries was collected in addition to outcome variables such as patient satisfaction, pain levels, and functional limitations. Results: Out of the 42 revision cases identified 20 patients were reached. Mean time to RECURRENCE of the cyst after the first ganglion cyst excision was 2. 5 years (range: 1 month-12 years). After the second ganglion cyst excision, three patients (15%) had a RECURRENCE, each occurring within one year (mean: 11 months; range: 9-12). One of the three patients underwent a third successful ganglion cyst excision. The other two patients declined surgical intervention to date. Patients without a second RECURRENCE (n=17) reported an average pain score of 0. 1 (range: 0-2) on a scale of 1-10. Three (18%) reported some difficulty with day-to-day activities due to their scar. Seven (41%) patients reported at least transient numbness or tingling. Mean satisfaction was 9. 8 on a scale of 1-10, and 100% reported that they would undergo another ganglion cyst excision should they ever have another RECURRENCE. Conclusion: Patients should be advised about the risk of RECURRENCE after re-excision of ganglion cysts, which was noted to be 15% in our cohort. This rate of RECURRENCE is similar to that of primarily excised cysts.

Dermatofibrosarcoma protuberans (DFSP) is a rare coetaneous sarcoma that originates from fibroblasts of dermis and presents as a non tender coetaneous nodule. Local slow invasion, RECURRENCE after therapy and low risk of metastasis are its main specifications. Pathology and immunohistochemistry are used to diagnose and wide surgery is the best approach for treatment. We present a case of recurrent DFSP and review the diagnostic and therapeutic modalities of this rare tumor. The patient was a 46 year old woman with 14 years history of a tumoral lesion in antero-superior part of her left shoulder and several RECURRENCEs after 4 excisional surgery for her lesion. Pathological and immunohistochemical surveys confirmed the diagnosis of DFSP. Previous studies performed on DFSP showed that it is a rare malignant coetaneous lesion that early diagnosis and appropriate treatment can lead to a better prognosis.

Background: Despite the effectiveness of pharmacotherapy in acute phase of bipolar mood disorder, patients often experience relapses or recurrent episodes. Hospitalization of patients need a great deal of financial and humanistic resources which can be saved through understanding more about the rate of relapse and factors affecting this rate.Methods: In a descriptive analytical study, 380 patients with bipolar disorder who were hospitalized in psychiatric emergency ward of Noor hospital, Isfahan, Iran, were followed. Each patient was considered for; the frequency of relapse and RECURRENCE, kind of pharmacotherapy, presence of psychotherapeutic treatments, frequency of visits by psychiatrist and the rank of present episode.Results: The overall prevalence of RECURRENCE was 42.2%. RECURRENCE was lower in patients using lithium carbonate or sodium valproate or combined therapy (about 40%), compared to those using carbamazepine (80%). RECURRENCE was higher in patients treated with only pharmacotherapy (44.5%) compared to-those treated with both pharmacotherapy and psychotherapy (22.2%). Patients who were visited monthy by psychiatrist had lower rate of RECURRENCE compared to those who had irregular visits.Conclusion: The higher rate of RECURRENCE observed in carbamazepine therapy may be due to its adverse reactions and consequently poor compliance to this drug. Lower rates of RECURRENCE with psychotherapy and regular visits may be related to the preventive effects of these procedures and especially to the effective management of stress.