Effects of Transcutaneous Electrical Nervous Stimulation (TENS) on Dysphonic Patients: A Systematic Review Study.

Background and Objectives: Transcutaneous electrical nerve stimulation (TENS), a pain-alleviating and muscle-relaxing treatment used in physio-therapeutic clinical practice, has recently appeared to be just as effective in dysphonia. This review aimed at clarifying whether TENS can be an effective practice in dysphonia therapy and/or management on its own or combined with other types of interventions and, hence, whether its practice can be a useful, more widespread establishment to speech and language therapy intervention methods. Materials and Methods: A search was conducted on the PubMed database using specific terms based on the PICO search strategy. Eventually, four randomized controlled studies and four clinical trials were included. The methodological quality of the included studies was evaluated using the physiotherapy evidence-based database (PEDro) assessment tool, and this indicated high-quality research with an average score of 8.43. Results: The studies utilized various TENS devices, predominantly the Dualpex 961 device (frequency of 10 Hz, phase of 200 ms). The assessment methods varied, including auditory perception, vocal therapy, electrostimulation, audio and video perceptual assessments, and laryngeal evaluations. The clinical outcomes of TENS showed a reduction in musculoskeletal pain in various areas, while the acoustic analysis results were significant in only one study. TENS was compared to manual laryngeal therapy (LMT), placebo TENS, and vocal therapy in different studies with mixed results. Conclusions: This review supports the idea that a multidimensional approach, incorporating various therapeutic modalities (TENS, LMT, speech therapy, and vocal training) can yield positive outcomes for patients with voice disorders. Further research is needed to explore the specific mechanisms of action and optimal treatment protocols for TENS in voice therapy.

The Effects of Solid and Liquid Lipids on the Physicochemical Properties of Nanostructured Lipid Carriers.

The aim of this work was to identify from a review of current literature the effects of lipids used in the development of Nanostructured Lipid Carriers (NLCs) on the physicochemical properties of the resulting formulation. The size of the solid lipid, affected by the molecular weight and the complexity of the structure, tends to affect the particle size of the final formulation proportionally; the higher the molecular weight and the more complex the molecular structure, the bigger the particle size of the NLCs. However, there is no straight correlation between the size and the structure of the liquid lipid and the particle size. Moreover, there seems to be a correlation of the solid to liquid lipid ratio which affects the particle size; there has been a trend of increasing particle size when more solid lipid was used. Regarding the entrapment efficiency, it is highly affected by the drug and its interaction with the lipids, as its solubility in the lipids needs to be high so the drug can stay entrapped within the lipid core. There was no direct correlation between the type of lipid used or the ratio and the zeta potential, which affects the stability of the NLCs.

Acute Appendicitis in a Diabetic Child with Salmonella Infection.

Acute appendicitis is the most frequent and challenging condition requiring emergent intrabdominal surgery in children. The diagnosis of appendicitis becomes more difficult and challenging in children, especially with other medical problems. Computed tomography is the primary tool for diagnosing or excluding appendicitis in cases with atypical presentation. Salmonella infections may present as acute abdominal problems in children. We present a clinical combination that has never been previously reported, of a diabetic girl with non-typhoid Salmonella infection, diagnosed with acute appendicitis. We wonder about the causal correlation of these diseases, versus their simple coexistence.

Paclitaxel-loaded micro or nano transfersome formulation into novel tablets for pulmonary drug delivery via nebulization.

A simplistic approach was adopted to manufacture novel paclitaxel (PTX) loaded protransfersome tablet formulations for pulmonary drug delivery. The large surface area offered by the pulmonary system acts as a desirable site for anti-cancer drug deposition; offering localized effect within the lungs. Protransfersomes are dry powder formulations, whereas transfersomes are liquid dispersions containing vesicles generated from protransfersomes upon hydration. Protransfersome powder formulations (F1-F27) (referred as Micro formulations based on transfersomes vesicles size post hydration) were prepared by employing a phospholipid (Soya phosphatidylcholine (SPC)), three different carbohydrate carriers (Lactose monohydrate, LMH; Microcrystalline cellulose, MCC; and Starch), three surfactants (i.e. Span 80, Span 20 and Tween 80) in three different lipid phase to carrier ratios (i.e. 1:05, 1:15 and 1:25 w/w), with the incorporation of PTX as a model drug. Hydrophobic chain of SPC may enhance PTX solubility, entrapment and targetted delivery via transfersome vesicles. Out of the 27 Micro protransfersome formulations, PTX-loaded LMH powder formulations F3, F6 and F9 (i.e. 1:25 w/w lipid phase to carrier ratio) exhibited excellent powder flowability via angle of repose (AOR) and good compressibility index due to associated smaller and uniform particle size and shape of LMH. Following hydration, these formulations also showed smaller volume median diameters (VMD) in micrometres (5.65 ± 0.85-6.76 ± 0.61 µm) and PTX entrapment of 93-96%. Hydrated transfersome formulations (F3, F6 and F9) were converted into Nano size via probe sonication and referred to as Nano formulations. These Nano formulations were converted into dry powder via spray drying (SD) (F3NSD, F6NSD and F9NSD) or freeze drying (FD) (F3NFD, F6NFD and F9NFD). Post manufacture of protransfersome tablets (i.e. 9 formulations), quality control tests were conducted in accordance to British Pharmacopeia (BP). Only the Micro formulations protransfersome tablets (i.e. F3, F6 and F9) passed the uniformity of weight test, exhibited high crushing strength and tablet thickness when compared to SD or FD protransfersome tablets. Micro protransfersome formulations (i.e. F3, F6 and F9) into tablets demonstrated a shorter nebulization time and high output rate when using Ultrasonic nebulizer compared to Vibrating mesh nebulizer (i.e. Omron NE U22). Based on formulations, characterizations and nebulizer performance; Micro protransfersome tablet formulations F3, F6 and F9 (i.e. 1:25 w/w) and Ultrasonic nebulizer were found to be a superior combination, eliciting enhanced output efficiency. Moreover, PTX-loaded F3, F6 and F9 tablet formulations (10%) exhibited toxicity (60, 68 and 67% cell viability) to cancer MRC-5 SV2 (i.e. immortalized human lung cells) while safe to MRC-5 (normal lung fibroblast cells) cell lines.