Nanotechnology is the science of nanoscale, which is the scale of nanometers or one billionth of a meter. Nanotechnology encompasses a broad range of technologies, materials, and manufacturing processes that are used to design and/or enhance many products, including medicinal products. This technology has achieved considerable progress in the oncology field in recent years. Most chemotherapeutic agents are not specific to the cancer cells they are intended to treat, and they can harm healthy cells, leading to numerous adverse effects. Due to this non-specific targeting, it is not feasible to administer high doses that may harm healthy cells. Moreover, low doses can cause cancer cells to acquire resistance, thus making them hard to kill. A solution that could potentially enhance drug targeting and delivery lies in understanding the complexity of nanotechnology. Engineering pharmaceutical and natural products into nano-products can enhance the diagnosis and treatment of cancer. Novel nano-formulations such as liposomes, polymeric micelles, dendrimers, quantum dots, nano-suspensions, and gold nanoparticles have been shown to enhance the delivery of drugs. Improved delivery of chemotherapeutic agents targets cancer cells rather than healthy cells, thereby preventing undesirable side effects and decreasing chemotherapeutic drug resistance. Nanotechnology has also revolutionized cancer diagnosis by using nanotechnology-based imaging contrast agents that can specifically target and therefore enhance tumor detection. In addition to the delivery of drugs, nanotechnology can be used to deliver nutraceuticals like phytochemicals that have multiple properties, such as antioxidant activity, that protect cells from oxidative damage and reduce the risk of cancer. There have been multiple advancements and implications for the use of nanotechnology to enhance the delivery of both pharmaceutical and nutraceutical products in cancer prevention, diagnosis, and treatment.
Introduction: Patients with drug-induced liver injury (DILI) are often asymptomatic and have undetected increases in their liver function tests (LFTs). Symptoms of DILI, if present, are vague, mimic a host of diseases, and are attributable to other etiologies before DILI is considered. In our case, we present a series of overlapping and vague symptoms that ultimately were attributed to DILI. Case Description/Methods: We describe the case of a 43-year-old male who presented to his cardiologist office with complaints of chest pain followed by shortness of breath (SOB). The patient has a past history for coronary artery disease and two kidney transplants on tacrolimus. Due to the patient's cardiac history, cardiac catheterization was performed which did not show any signs of re-stenosis or obstructive disease. He underwent evaluation for possible pulmonary cause as well including pulmonary function testing and diagnostic imaging which were normal. Laboratories drawn showed elevated liver enzymes (ALT 154, AST 56) and gamma-glutamyl transferase (GGT) of 382 with a normal total bilirubin. Abdominal ultrasound showed no evidence of biliary dilation, choledocholithiasis, or structural abnormality. On further review, patient had recently started a second immunosuppressant, mycophenolate, around the time he started to experience these unexplained symptoms. Additionally, on thorough physical exam, it was noted that the patient's subjectively stated chest pain was isolated to the epigastrium on palpation. Liver enzymes were continually monitored with eventual return to normal ranges with resolution of reported pain and SOB without having to hold any immunosuppressant agents. Discussion: This case illustrates the unusual clinical presentation of hepatic injury secondary to an unusual cause of DILI. It was surmised that the mild transient elevation in liver enzymes and GGT was due to the initiation of mycophenolate. Mycophenolate is known to cause liver injury in rare cases and in the setting of inflamed liver tissue irritating Glisson's capsule, abdominal tenderness can develop. It is important to perform an encompassing physical examination to correlate patients' subjective complaints with objective findings. For patients taking hepatotoxic medications, widening one's differential diagnosis to include DILI can ensure minimalization of liver damage.
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