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Nanoparticles (1-100 nanometres in size), products of nanotechnology, offer a modern way to transport anti-cancer drugs by acting as transporters of drugs into tumor cells, hence quenching tumor cell proliferation. Such nanoparticles may be formulated to bind to the tumor cell membrane or inhibit specific reactions of tumor biosynthetic pathway by gene repression, or directly bind to the active sites of essential enzymes in the biosynthetic pathway. Consequently, drugs are completely delivered to the desired cancerous cells without system interference. Liposomal doxorubicin and albumin-bound paclitaxel are two examples of nanotechnologically developed drugs for treating cancer. Modern knowledge of nanotechnology opens up new opportunities for innovative research on cancer therapies and administration and helps minimize harm to healthy cells. This review focuses on the doses and routes of administration of these chemotherapeutic agents used in treating cancers.

Amiodarone is a lipophilic structure with a half-life of 25–100 days. Long-term oral amiodarone is associated with photosensitivity, thyroid dysfunction, and pulmonary and hepatic toxicity. Intravenous amiodarone can lead to sweating, heating sensation, nausea, phlebitis at the injection site, and rarely acute hepatitis. This is a compelling case of a 60-year-old male who developed acute liver injury 24–36 h after starting amiodarone. All the possible causes of acute liver injury were ruled out, and his liver enzymes improved after discontinuing amiodarone.

Background/Aims Limited data exist comparing the safety and efficacy of direct-acting antivirals (DAAs) in hepatitis C virus (HCV) monoinfected and HCV/human immunodeficiency virus (HIV) coinfected patients in the real-world clinic practice setting. Methods All HCV monoinfected and HCV/HIV coinfected patients treated with DAAs between January 2014 and October 2017 in community clinic settings were retrospectively analyzed. Pretreatment baseline patient characteristics, treatment efficacy, factors affecting sustained virologic response at 12 weeks (SVR12) after treatment, and adverse reactions were compared between the groups. Results A total of 327 patients were included in the study, of which 253 were HCV monoinfected, and 74 were HCV/HIV coinfected. There was a statistically significant difference observed in SVR12 when comparing HCV monoinfection and HCV/HIV coinfection (94% and 84%, respectively, p=0.005). However, there were no significant factors identified as a predictor of a reduced response. The most common adverse effect was fatigue (27%). No significant drug interaction was observed between DAA and antiretroviral therapy. None of the patients discontinued the treatment due to adverse events. Conclusions In a real-world setting, DAA regimens have lower SVR12 in HCV/HIV coinfection than in HCV monoinfection. Further studies involving a higher number of HCV/HIV coinfected patients are needed to identify real predictors of a reduced response.

Ginkgolide A is a highly active platelet activating factor antagonist cage molecule which was isolated from the leaves of the Ginkgo biloba L. It is known for its inflammatory and immunological potentials. This review aims to sketch a current scenario on its therapeutic activities on the basis of scientific reports in the databases. A total 30 articles included in this review suggests that ginkgolide A has many important biological activities, including anti-inflammatory, anticancer, anxiolytic-like, anti-atherosclerosis and anti-atherombosis, neuro- and hepatoprotective effects. There is a lack of its toxicological (e.g. toxicity, cytotoxicity, genotoxicity and mutagenitcity) profile. In conclusion, ginkgolide A may be one of the potential therapeutic lead compounds, especially for the treatment of cardiovascular, hepatological, and neurological diseases and disorders. More studies are necessary on this hopeful therapeutic agent.

Introduction We aim to investigate Clostridium difficile infection (CDI) recurrence, severity, complications, and length of hospital stay in patients with and without prior history of appendectomy who were admitted to the hospital with CDI. Method We analyzed retrospective data for 862 patients, 18 years and older, with C. difficile inpatients diagnosed between January 1, 2017 and December 31, 2018 and sorted into two groups, with or without prior appendicectomy, to look for outcomes such as recurrence, hospital stay, complications, and related death in each group and use statistical analysis for comparison. Result There were 862 patients admitted with CDI, of which 122 (14.2%) had a prior history of appendectomy and 740 (85.8%) did not. Patients with an appendectomy prior were older (median age of 75 vs. 69, p = 0.0033) and had a higher proportion of females (68.9% vs. 53.6%, p = 0.0017). C. difficile recurrence in prior appendicectomy group vs. no appendectomy group was 12.3% and 9.3%, respectively, but no statistical difference was noted (p = 0.28). Also, there was no statistical difference in complications like ileus, colectomy, and mortality related to CDI in both groups. However, patients with appendectomies had significantly shorter hospital stays during C. difficile admission compared to patients without appendectomies (median of six days vs. seven days, p = 0.0014). Conclusion Our study shows that there is no statistical difference in the recurrence, severity, and complications of CDI in the presence or absence of the appendix but remarkably noted that people with prior appendicectomy had a shorter hospital stay.

Varicella-zoster virus (VZV) infection is generally considered as a benign and self-limiting disease. However, individuals with VZV infection can have disseminated to various organs leading to serious complications, particularly in adults. This pattern is more prevalent in immunosuppressed individuals. Disseminated varicella is historically known to involve the central nervous system (CNS), liver, and lungs. However, dissemination of varicella to the pancreas and subsequently causing acute pancreatitis has been rarely reported. We present a case of disseminated varicella infection in a newly diagnosed human immunodeficiency virus (HIV) patient causing acute pancreatitis at initial disease presentation and subsequently leading to multi organ dysfunction. A 42-year-old African American female who was initially being treated for Pneumocystis carinii pneumonia (PCP) at an inner-city hospital developed severe epigastric pain radiating to back along with nausea on day 2 of admission. Physical findings revealed tachycardia, epigastric tenderness and newly formed vesicular rash involving the neck and face classical of varicella infection. Skin biopsy and serum sample confirmed varicella infection by VZV polymerase chain reaction (PCR) test. Labs revealed elevated lipase, amylase at a level diagnostic of acute pancreatitis. The patient had no other risk factors for pancreatitis. She was started on intravenous Acyclovir and intravenous hydration with isotonic normal saline. She was managed conservatively for other systemic complications. Pancreatitis resolved after five days of clinical presentation. She completed two weeks of Acyclovir, her condition steadily improved and she was successfully discharged home with no further recurrence. Acute pancreatitis is a rare infectious association of disseminated varicella infection. Clinicians should always be mindful of this infectious etiology as one of the rare differentials for acute pancreatitis as this is a treatable cause and could prevent morbidity, mortality associated with this condition if treated timely.

Fifty-five-year-old female with a past medical history of gastroesophageal reflux disease was admitted to hospital due to increased confusion, and muscle cramps for last 15 days. She was taking famotidine 20 mg twice a day for the last 2 years. She was alert and oriented to person and place only. She had dry skin, positive Chvostek’s and Trousseau’s sign. Blood work showed 141 mmol/L of sodium, 0.7 mg/dl of creatinine, 5.7 mg/dl of calcium, 0.55 mg/dl of magnesium, low PTH but normal parathyroid related peptide PTHrP, vitamin D (25) and vitamin D (1.25). She was discharged home on electrolyte supplements. She was readmitted with very low calcium and magnesium. Extensive workup including 24 h of urine calcium and magnesium was unimpressive. She was treated with IV therapy and discharged to follow up with nephrology in the clinic, and famotidine was discontinued on second discharge. Her calcium and magnesium levels remained normal, and in a few weeks later, oral electrolyte supplements were discontinued.

Background Despite recent advances in chronic hepatitis C (CHC) treatment, only a small proportion of patients are connected with care and receive treatment. Internal medicine (IM) residents spend nearly one-third of their training in primary care settings and play a crucial role in diagnosing and counseling patients as well as linking patients with care and following up. Methods IM residents in a community hospital completed an anonymous questionnaire regarding their knowledge, attitude, and practice associated with CHC treatment and its challenges. Results Descriptive analysis of the survey showed that there is a substantial gap in knowledge regarding the newer treatment of CHC between IM residents' perceptions of patient awareness and IM residents. Conclusion Updated education regarding CHC that is geared towards medical residents and focused on new modalities of treatment can narrow the gap and lead to considerable increases in the rates of diagnosis and treatment and decreases in morbidity and mortality.

Background: Depressive disorder is a recurrent illness that affects large numbers of the general population worldwide. In recent years, the goal of depression treatment has moved from symptomatic response to that of full remission. However, treatment-resistant depression is a major challenge in the treatment of depression or depression-related disorders. Consensus opinion, therefore, suggests that effective combined aggressive initial treatment is the most appropriate strategy. Objectives: This study aimed to evaluate the effects of quercetin (QUR) and/or ascorbic acid (AA) on Phenobarbital-induced sleeping mice. Methods: QUR (50 mg/kg) and/or AA (25 mg/kg) with or without intraperitoneally pre-treated with GABA receptor agonist (diazepam: 2 mg/kg, i.p.) or antagonist (Flumazenil: 2.5 mg/kg, i.p.) to underscore the effects, as well as the possible involvement of the GABA receptor in the modulatory action of QUR and AA in sleeping mice. Additionally, an in silico study was undertaken to predict the involvement of GABA receptors in the sleep mechanism. Results: Findings suggest that the pretreatment of QUR and AA modulated the onset and duration of action of the standard drugs in experimental animals. The acute administration of QUR and/or AA significantly (p &lt, 0.05) reversed the DZP-mediated onset of action and slightly reversed the duration of sleep time in comparison to the vehicle (control) group. A further combination of QUR or AA with the FLU resulted in an enhancement of the onset of action while reducing the duration of action, suggesting a FLU-like effect on the test animals. In in silico studies, AA and QUR showed good to moderate binding affinities with GABAA and GABAB receptors. Conclusions: Both QUR and AA produced a stimulatory-like effect on mice, possibly through the GABAA and GABAB receptor interaction pathways. Further studies are necessary to verify this activity and clarify the exact mechanism of action(s) involved.

Introduction: Malignant thyroid nodules are clinically euthyroid and appear as cold nodules on scintigraphy. Malignancy in hyper-functioning thyroid nodule is rare. Case report: A 48-year-old male with painless swelling on the right side of his neck for the last 4 months complained of feeling hot all the time, sweating and unintentionally losing about 20 pounds. On physical examination, there was a 3-cm mobile, non-tender mass on the right supra-clavicular area biopsy of which was consistent with metastatic papillary carcinoma of thyroid. Neck imaging showed a cystic mass in the right supra-clavicular fossa region, bilateral neck adenopathy and multiple thyroid nodules. Subsequent thyroid radionuclide scans showed three hyper-functioning nodules, which were later demonstrated to be a follicular variant of papillary microcarcinoma. He was treated with total thyroidectomy followed by radioactive iodine thyroid ablation therapy. Conclusion: Physicians need to be aware and vigilant for the possibilities of malignancy in a hyper-functioning thyroid nodule when evaluating any thyroid nodule.

Objective: Autoimmune pathologies are a growing aspect of medicine. Knowledge about atypical cases is essential. This report will describe a case of unusual, alternating fluctuations in thyroid function.Abbreviations: FT4 = free thyroxine; TSH = thyroid-stimulating hormone; TSI = thyroid-stimulating immunoglobulinMethods: We report a case of thyrotoxicosis alternating with hypothyroidism in a 44-year-old, African-American woman and detail the clinical course and management.Results: The patient presented in a mildly thyrotoxic state with features of thyroiditis that resolved soon thereafter. Subsequently, the course shifted toward a hypothyroid state with a thyroid-stimulating hormone (TSH) level of 24.53 μIU/ml (normal range is 0.45 to 4.5 μIU/ml; measured September 5, 2013) and free thyroxine (FT4) of 0.35 ng/dL (normal range is 0.5 to 1.40 ng/dL; measured September 5, 2013). It ensued with alternating hypothyroid and hyperthyroid trajectories for several cycles. Clinical management was adjusted to negotiate each progression. During certain intervals, levothyroxine was increased. At other visits, it was decreased. Periods without medication were observed as well. Furthermore, methimazole and metoprolol were utilized when required. Reversal of the condition occurred repeatedly. The entire course is tracked with over 30 instances of thyroid function measures that included hypothyroid, euthyroid (TSH at 1.54 μIU/mL, FT4 at 1.16 ng/dL) and thyrotoxic states (TSH at

Drug-induced liver injury (DILI) is the most common cause of acute liver failure in the USA. DILI can be broadly classified as Intrinsic and Idiosyncratic. Identifying predictors and at-risk patients are challenging but can have a substantial clinical implication. This case report series demonstrates the importance of valproic acid, fluconazole, and amiodarone as potential hepatoxic agents of drug-induced liver injury leading to acute hepatic failure. The causality in all cases was established by Roussel Uclaf Causality Assessment Method/Council for International Organizations of Medical Sciences score and Naranjo Algorithm. Obesity, hypo-perfusion state, and concurrent hepatotoxic agent might identify at-risk patients. Further studies are required to understand the risk factors.

Isolated hyperbilirubinemia as a manifestation of alcoholic liver disease without significant liver abnormalities is seen very rarely. We report such a case where a patient with chronic alcoholism presented to the ER with acute jaundice with bilirubin of 24.8 mg/dl, predominantly conjugated in nature along with mild elevation of AST (76 IU/L). There were no other abnormalities of the liver function. The patient underwent extensive laboratory and imaging tests that excluded extrahepatic cholestasis, viral and autoimmune hepatitis, ischemic hepatitis, and so forth. Liver biopsy excluded hemochromatosis, dysplasia, or malignancy and other differentials. Bilirubin gradually trended down to 7.3 mg/dl when alcohol consumption was stopped.