Synthesis and Characterization of ZnO Nanoparticles Derived from Biomass (Sisymbrium Irio) and Assessment of Potential Anticancer Activity.

Cancer treatment development is hampered by chemotherapy side effects, drug resistance, and tumor metastasis, giving cancer patients a gloomy prognosis. Nanoparticles (NPs) have developed as a promising medicinal delivery technique in the last 10 years. The zinc oxide (ZnO) NPs can precisely and captivatingly promote the apoptosis of cancer cells in cancer treatment. There is also an urgent need to discover novel anti-cancer therapies, and current research suggests that ZnO NPs hold significant promise. ZnO NPs have been tested for phytochemical screening and in vitro chemical efficiency. The green synthesis method was employed for the preparation of ZnO NPs from Sisymbrium irio (L.) (Khakshi). An alcoholic and aqueous extract of S. irio was prepared using the Soxhlet method. Various chemical compounds were revealed in the methanolic extract through qualitative analysis. The results of quantitative analysis showed that the total phenolic content has the highest amount (42.7861 mgGAE/g), while the resultant amounts of (5.72175 mgAAE/g) and (15.20725 mgAAE/g) were obtained in total flavonoid content and antioxidant property, respectively. ZnO NPs were prepared using a 1:1 ratio. The synthesized ZnO NPs were identified to have a hexagonal wurtzite crystal arrangement. The nanomaterial was characterized by scanning electron microscopy, transmission electron microscopy, and UV-visible spectroscopy. The ZnO-NPs' morphology exhibited an absorbance at 350-380 nm. Furthermore, different fractions were prepared and assessed for anticancer activity. As a result of this anticancer activity, all fractions exhibited cytotoxic activity against both BHK and HepG2 human cancer cell lines. The methanol fraction showed the highest activity of 90% (IC50 = 0.4769 mg/mL), followed by the hexane fraction that showed 86.72%, ethyl acetate showed 85%, and chloroform fraction showed 84% against BHK and HepG2 cell lines. These findings suggested that synthesized ZnO-NPs have anticancer potential.

Klatskin Tumor in the Light of ICD-O-3: A Population-Based Clinical Outcome Study Involving 1,144 Patients from the Surveillance, Epidemiology, and End Result (SEER) Database (2001-2012).

Introduction Klatskin tumors (KTs) occur at the confluence of the right and left extrahepatic ducts and are classified based on their anatomical and histological codes in the International Classification of Diseases for Oncology (ICD-O). The second edition of the ICD-O (ICD-O-2) allocated a distinctive histological code to KT, which also included intrahepatic cholangiocarcinoma (CC). This unclear coding may result in ambiguous reporting of the demographic and clinical features of KT. The current study aimed to investigate the demographic, clinical, and pathological factors affecting the prognosis and survival of KT in the light of the updated third edition of ICD-O, Ninth Revision (ICD-O-3). Methods Data of 1,144 patients with KT from the Surveillance, Epidemiology, and End Result (SEER) database (2001-2012) were extracted. Patients with KT were analyzed for age, sex, race, stage, treatment, and long-term survival. The data were analyzed using chi-square tests, t-tests, and univariate and multivariate analyses. The Kaplan-Meier analysis was used to compare long-term survival between KT and subgroups of all biliary CCs. Results Of all biliary CCs, KT comprised 9.35%, with a mean age of diagnosis of 73±13 years, and was more common in men (54.8%) and Caucasian patients (69.5%). Histologically, moderately differentiated tumors were the most common (38.9%) followed by poorly differentiated (35.7%), well-differentiated (23.3%), and undifferentiated tumors (2.2%) (p<0.001). Most tumors in the KT group were 2-4 cm in size (41.5%), while fewer were >4 cm (29.7%) and <2 cm (28.8%) (p<0.001). ICD-O-3 defined most KTs in extrahepatic location (53.5%), while the remainder were in other biliary locations (46.5%) (p<0.001). Most KT patients received no treatment (73%), and for those who were treated, the most frequent modality was radiation (52.7%), followed by surgery (28.1%), and both surgery and radiation (19.2%) (p<0.001). Mean survival time for KT patients treated with surgery was inferior to all CCs of the biliary tree (1.72±2.61 vs. 1.87±2.18 years) (p=0.047). Multivariate analysis identified regional metastasis (OR=2.8; 95% CI=2.6-3.0), distant metastasis (OR=2.1; 95% CI=1.9-2.4), lymph node positivity (OR=1.6; 95% CI=1.4-1.8), Caucasian race (OR=2.0; 95% CI=1.8-2.2), and male sex (OR=1.2; 95% CI=1.1-1.3) were independently associated with increased mortality for KT (p<0.001). Conclusion The ICD-O-3 has permitted a greater understanding of KT. KT is a rare and lethal biliary malignancy that presents most often in Caucasian men in their seventh decade of life with moderately differentiated histology. Surgical resection does not provide any survival advantage compared to similarly treated biliary CCs. In addition, the combination of surgery and radiation appeared to provide no added survival benefits compared to other treatment modalities for KT.

Trends in Incidence and Outcomes of Clostridium difficile Colitis in Hospitalized Patients of Febrile Neutropenia: A Nationwide Analysis.

INTRODUCTION: Clostridium difficile infection (CDI) has been attracting attention lately as the most common hospital acquired infection. Patients with neutropenia because of malignancy seem to be at an increased risk for developing CDI. There is currently limited data that assesses the national burden and outcomes of CDI in Febrile Neutropenia (FN). METHODS: We analyzed the National Inpatient Sample (NIS) database for all subjects with discharge diagnosis of FN with or without CDI (ICD-9 codes 288.00, 288.03,780.60, and 008.45) as primary or secondary diagnosis during the period from 2008 to 2014. All analyses were performed with SAS, version 9.4 (SAS Institute). RESULTS: From 2008 to 2014 there were total 19422 discharges of FN patients with CDI. There was a rising incidence of CDI in patients with FN from 4.11% (in 2008) to 5.83% (in 2014). The In-hospital mortality showed a decreasing trend from 7.79% (in 2008) to 5.32% (in 2014), likely because of improvements in diagnostics and treatment. The overall mortality (6.37% vs. 4.61%), length of stay >5 days (76.45% vs. 50.98%), hospital charges >50,000 dollars (64.43% vs. 40.29%), colectomy and colostomy (0.35% vs. 0.15%), and discharge to skilled nursing facility (10.47% vs. 6.43%) was significantly more in FN patients with CDI versus without CDI over 7 years (2008 to 2014). Age above 65 years, Hispanic race, hematological malignancies, urban hospital settings, and sepsis were significant predictors of mortality in febrile neutropenia patients with CDI. DISCUSSION: Despite the significant decrease in mortality, the incidence of CDI is rising in hospitalized FN patients with underlying hematological malignancies. Risk factor modification, with the best possible empiric antibiotic regimen is imperative for reducing mortality and health care costs in this cohort.

Rising Events and Improved Outcomes of Gastrointestinal Bleed With Shock in USA: A 12-year National Analysis.

OBJECTIVE: Limited information is available based on single-center studies on trends of incidence and outcomes in gastrointestinal (GI) bleed with shock. METHODS: We analyzed data from 2002 to 2013 National Inpatient Sample. Using ICD-9 codes we identified 6.4 million hospital discharges of GI bleed from National Inpatient Sample database. Events were analyzed based on type of GI bleed, in-hospital mortality, hemodynamic status, and use of blood products. RESULTS: GI bleed with shock results in higher hospital mortality (20.77% with shock vs. 2.6% without shock). Between 2002 and 2013, there has been an increase in the percentage of upper and lower GI bleed with shock (1.35% to 4.92% and 1.49% to 3.06%) along with a reduction in mortality in both upper GI bleed with shock (26.9% to 13.8%) and lower GI bleed with shock (54.7% to 19.7%). Consistent with the rise in GI bleed with shock was an increase in blood product utilization. Packed red blood cell (pRBC) transfusion was associated with reduction in mortality in both nonvariceal upper GI bleed with shock (18.3% without pRBC vs. 13.9% receiving pRBC) and lower GI bleed with shock (36.05% without pRBC vs. 22.13% receiving pRBC), but did not affect mortality in variceal upper GI bleed with shock (31.79% vs. 32.22%). CONCLUSIONS: GI bleed with shock carries a higher mortality and have been steadily increasing from 2002 to 2013. pRBC transfusion was associated in improved mortality in GI bleed with shock except variceal bleed.

A Case of Vogt-Koyanagi-Harada Syndrome Mimicking Optic Neuritis.

Vogt-Koyanagi-Harada syndrome is a rare disease that occurs commonly in pigmented individuals of Asian origin. A 25-year female presented in medical outpatient department (OPD) of Al-Khidmat Teaching Hospital, Mansoora, Lahore with headache and neck stiffness. She was referred to eye OPD for the complaint of decreased vision. On examination, there was 6/24 vision, sluggish pupillary reaction and disc hyperemia in both eyes. She was treated as a case of optic neuritis. Few days later, she developed bilateral panuveitis, shallow exudative detachments and alopecia. Clinical picture with normal magnetic resonance imaging (MRI) and laboratory tests helped us in reaching the diagnosis of Vogt-Koyanagi-Harada syndrome.