Early Colonoscopy in Patients With Acute Diverticular Bleeding Is Associated With Improvement in Healthcare-Resource Utilization

Background: Diverticular bleeding (DB) is the most common cause of severe acute lower gastrointestinal bleeding (GIB) in developed countries. The role of early colonoscopy (\u3c24 hours) continues to remain controversial and data on early colonoscopy in acute DB are scant. We aimed to evaluate the effect of timing of colonoscopy on outcomes in patients with acute DB using a nationwide inpatient sample. Methods: Data from the nationwide inpatient sample from 2012 to 2014 were used. The ninth version of the International Classification of Diseases coding system ICD 9 was used for patient selection. We included discharges with the primary and secondary inpatient diagnosis of diverticulosis with bleeding and diverticulitis with bleeding. Discharges with no primary or secondary diagnosis of diverticulosis with bleeding, diverticulitis with bleeding, patients who were less than 18 years old and those who did not undergo colonoscopy during the admission were excluded. The primary outcomes were length of stay (LOS) and total hospitalization costs. Results: A total of 88 600 patients were included in our analysis, amongst whom 45 020 (50.8%) had colonoscopy within 24 hours of admission (early colonoscopy), while 43 580 (49.2%) patients had colonoscopy after 24 hours of admission (late colonoscopy). LOS was significantly lower in patients with early colonoscopy as compared to those with late colonoscopy (3.7 vs 5.6 days, P \u3c 0.0001). Total hospitalization costs were also significantly lower in patients with early colonoscopy ($9317 vs$11 767, P \u3c 0.0001). There was no difference in mortality between both groups (0.7 vs 0.8%). After adjusting for potential confounders, the differences in LOS and total hospitalization costs between early and late colonoscopy remained statistically significant. Conclusions: Early colonoscopy in acute DB significantly reduced LOS and total hospitalization costs. There was no significant difference in mortality observed. Performance of early colonoscopy in the appropriate patients presenting with acute DB can have potential cost-saving implications. Further research is needed to identify which patients would benefit from early colonoscopy in DB

Cytochrome P450 1B1 Overexpression in Cervical Cancers: Cross-sectional Study

BackgroundCurrent standard treatments for patients with recurrent cervical cancer are not very effective and are associated with severe toxicity. Recently, the rational approach for the discovery of new therapies for cervical cancer is based on the alterations in the molecular biology of cancer cells. One of the emerging molecular changes in cancer cells is the aberrant expression of cytochrome P450 1B1 (CYP1B1). This unique enzyme has been reported to be selectively overexpressed in several cancers. ObjectiveThe aim of this study was to examine CYP1B1 expression in cervical cancers and to assess the enzyme’s relationship with several clinicopathological features. MethodsImmunohistochemistry was performed to examine CYP1B1 expression in 100 patient samples with cervical cancer and 10 patient samples with normal healthy cervical tissues. ResultsCYP1B1 was expressed in the majority of the cervical cancer samples (91/100, 91.0%) but not in normal healthy cervical samples. The difference in the expression of CYP1B1 between healthy and tumorous cervical tissues was significant (P=.01). Moreover, the frequency of CYP1B1 expression was found to be significantly higher in patients with advanced grades of the disease (P=.03) and in patients having metastasis to the lymph nodes (P=.01). Surprisingly, there was a significantly higher expression of CYP1B1 in patients with a high prevalence of human papilloma virus 16/18 (P=.04). ConclusionsThe differential profile of CYP1B1 expression between cervical cancer tissues and normal cervical tissues suggests that CYP1B1 may be used as a target for future therapeutic exploitations

The Impact of Opioid Epidemic Trends on Hospitalized Acute Pancreatitis Patients

Introduction: Opioid use disorder (OUD) has become a public health crisis in the United States. OUD has been shown to have worse outcomes in patients with chronic conditions. Although opioids are widely used for pain management in acute conditions such as acute pancreatitis (AP), the impact of OUD on outcomes in patients with AP remains unknown. We aimed to evaluate the prevalence, trends and impact of OUD on outcomes in hospitalized patients with AP. Methods: This was a retrospective cohort study using the national inpatient sample (NIS) database from 2005-2014. Patients with a primary diagnosis of AP and OUD-related diagnosis were included. OUD-related diagnosis were identified using previously published studies. The primary outcome was to evaluate the prevalence and trend of OUD in hospitalized AP patients over time. Secondary outcomes were to assess the impact of OUD: i) in-hospital mortality, and ii) healthcare resource utilization (length of stay and total hospitalization costs). We used a multivariable regression analysis to adjust for potential confounders. Results: A total of 2,593,831 patients were hospitalized with AP from 2005-2014, out of which 37,829 (1.5%) had concomitant diagnosis of OUD. The prevalence of OUD in AP has doubled over the last decade from 1% in 2005 to 2.1% in 2014 [Figure 1]. After adjusting for potential confounders, AP patients with OUD had increased odds of in-hospital mortality [aOR: 1.4, (95 % CI: 1.2 – 1.7, P\u3c0.001)]. Patients with AP who had OUD were found to have significantly higher adjusted mean length of stay (adjusted mean difference: 1.3 days, (95% CI: 1.3-1.4), P\u3c0.001) and total hospitalization cost (adjusted mean difference: $2353, (95% CI: 2179-2508), p\u3c0.001) [Table 1]. Conclusions: OUD is an independent predictor of mortality and increased healthcare resource utilization in patients hospitalized with AP. The opioid epidemic is not only leading to worse outcomes in patients with chronic medical conditions as previously thought, but these patients also have worse outcomes when hospitalized for an acute pathology such as acute pancreatitis. Opioids should be prescribed judiciously in patients with acute pancreatitis upon discharge from the hospital

Cytochrome 4Z1 Expression Is Correlated with Poor Prognosis in Patients with Cervical Cancer

Background: cervical cancer is one of the most common malignancies in women worldwide and its management remains challenging and complex. As Cytochrome4Z1 (CYP4Z1) is overexpressed in many tumours, its expression in cervical cancer is unknown. Therefore, the present study aimed to evaluate CYP4Z1 expression in cervical cancers. Methods: CYP4Z1 expression was immunohistochemically assessed in 100 cases of cervical cancers along with ten normal cervix tissues, and the enzyme’s relationship to several clinicopathological features and survival was explored. Results: CYP4Z1 was strongly expressed in 55% of cervical cancer patients. Normal cervix samples were negative for CYP4Z1 expression. Importantly, this expression was significantly found in patients with the late stage of the disease, lymph node metastasis, and high tumour invasion (p < 0.05). Interestingly, CYP4Z1 expression was significantly correlated with shorter survival times of cervical cancer patients. Univariate analysis showed that CYP4Z1 expression, tumour stage, lymph node metastasis, and tumour invasion were significantly correlated with patient survival (p < 0.05). The multivariate analysis revealed that only CYP4Z1 expression and tumour stage were significantly correlated with patient survival (p < 0.05). Conclusions: CYP4Z1 expression is associated with cervical cancer patients’ survival and may serve as an independent predictor of poor prognosis in cervical cancer patients

Phytochemical characterization and anti-cancer properties of extract of Ephedra foeminea (Ephedraceae) aerial parts

Purpose: To evaluate the phytochemical profile of methanol extract of Ephedra foeminea and assess its anti-carcer effect on a large set of normal and cancerous cell lines. Methods: Extraction of air-dried powder of aerial parts of E. foeminea was carried out with methanol. The bioactive compounds in the extract were determined using gas chromatography/mass spectrometry (GC-MS). The anti-cancer effect of the extract was determined by 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay against various types of normal and cancer cell lines. Serial concentrations of plant extract were used, ranging from 7.812 to1000 μg/mL. Doxorubicin (DOX) served as standard drug. The half-maximal concentration (IC50) values of the extract and DOX for each cell line were determined, and the selectivity index (SI) was computed. Results: Phytochemical analysis showed that the extract contained several bioactive compounds, including alkaloids, flavonoids, sterols and fatty acids. The hazardous ephedra alkaloids (ephedrine and pseudoephedrine) were absent in the plant extract. The extract showed significant anti-proliferative activity against cancer cell lines, when compared with the positive control, doxorubicin (p < 0.05). Selective and concentration-dependent cytotoxicity was exhibited in cancer cell lines of breast (MCF-7), lung (A549), colon (Caco-2), liver (HepG-2) and prostate (PC-3). Weak selectivity was produced in other cancer cell lines, i.e., human epithelioma (Hep-2) and cervical carcinoma (Hela). Interestingly, non-cancerous cells showed no or weak cytotoxicity. Conclusion: Ephedra foeminea exerts potential selectivity in anti-proliferative effect against some cancer cell lines. Thus, it is a promising drug source for the production of new and selective anti-cancer medicines

Training of hepatology providers improves the screening and resultant interventions for alcohol use disorder.

Alcohol use disorder (AUD) screening is important but focused training with using AUDIT-10 with counselling/mental health (MH) referral may be needed. We aimed to compare the effect of training on AUD screening/intervention in hepatology clinics in pre vs post-training phases of a quality-improvement initiative. Pre-training encounters were evaluated for inquiry into AUD, AUDIT-10 and MH referrals. Dedicated AUD-related training was provided to hepatology providers and analyses repeated post-training. Pre-training (n = 378) and post-training patients(n = 318) had similar demographics and disease characteristics. Post-training there was higher inquiry about alcohol(92% vs 80%, P \u3c .0001), counselling (82% vs 68%, P \u3c .0001). This led to higher diagnosis of drinkers (49% vs 31%, P \u3c .0001) of whom higher proportion had AUDIT-10 administered(91% vs 34%, P \u3c .0001) and referred to MH(29% vs 8%, P \u3c .0001). On regression presumed alcohol-related aetiology, younger age and post-training period were associated with AUDIT-10 administration. AUD-focused training significantly improves rates of screening and MH referral for problem drinking in a hepatology clinic population