Development of an Antiviral Ion-Activated In Situ Gel Containing 18ß-Glycyrrhetinic Acid: A Promising Alternative against Respiratory Syncytial Virus.

The human respiratory syncytial virus (hRSV) is a major cause of serious lower respiratory infections and poses a considerable risk to public health globally. Only a few treatments are currently used to treat RSV infections, and there is no RSV vaccination. Therefore, the need for clinically applicable, affordable, and safe RSV prevention and treatment solutions is urgent. In this study, an ion-activated in situ gelling formulation containing the broad-spectrum antiviral 18ß-glycyrrhetinic acid (GA) was developed for its antiviral effect on RSV. In this context, pH, mechanical characteristics, ex vivo mucoadhesive strength, in vitro drug release pattern, sprayability, drug content, and stability were all examined. Rheological characteristics were also tested using in vitro gelation capacity and rheological synergism tests. Finally, the cytotoxic and antiviral activities of the optimized in situ gelling formulation on RSV cultured in the human laryngeal epidermoid carcinoma (HEp-2) cell line were evaluated. In conclusion, the optimized formulation prepared with a combination of 0.5% w/w gellan gum and 0.5% w/w sodium carboxymethylcellulose demonstrated good gelation capacity and sprayability (weight deviation between the first day of the experiment (T0) and the last day of the experiment (T14) was 0.34%), desired rheological synergism (mucoadhesive force (Fb): 9.53 Pa), mechanical characteristics (adhesiveness: 0.300 ± 0.05 mJ), ex vivo bioadhesion force (19.67 ± 1.90 g), drug content uniformity (RSD%: 0.494), and sustained drug release over a period of 6 h (24.56% ± 0.49). The optimized formulation demonstrated strong anti-hRSV activity (simultaneous half maximal effective concentration (EC50) = 0.05 µg/mL; selectivity index (SI) = 306; pre-infection EC50 = 0.154 µg/mL; SI = 100), which was significantly higher than that of ribavirin (EC50 = 4.189 µg/mL; SI = 28) used as a positive control against hRSV, according to the results of the antiviral activity test. In conclusion, this study showed that nasal in situ gelling spray can prevent viral infection and replication by directly inhibiting viral entry or modulating viral replication.

Biopolymer-Based Nanogel Approach in Drug Delivery: Basic Concept and Current Developments.

Due to their increased surface area, extent of swelling and active substance-loading capacity and flexibility, nanogels made from natural and synthetic polymers have gained significant interest in scientific and industrial areas. In particular, the customized design and implementation of nontoxic, biocompatible, and biodegradable micro/nano carriers makes their usage very feasible for a range of biomedical applications, including drug delivery, tissue engineering, and bioimaging. The design and application methodologies of nanogels are outlined in this review. Additionally, the most recent advancements in nanogel biomedical applications are discussed, with particular emphasis on applications for the delivery of drugs and biomolecules.

Development of piperine nanoemulsions: an alternative topical application for hypopigmentation.

This study, it was aimed to develop a topical piperine nanoemulsion (P-NE) using an ultrasonic emulsification process to find an alternative treatment option for some hypopigmentation disorders such as vitiligo. Results showed that 150 mg piperine loaded NE with 1:2 oil phase to Smix ratio and manufactured with 20 min ultrasonication duration with the pre-emulsification step was the most durable formulation with a mean globule size of 216.00 ± 2.65, a PdI value of 0.094 ± 0.02 and a zeta potential value of -27.50 ± 2.48 mV. After three months of storage, the selected P-NE (coded as F3P2) remained kinetically stable without visual changes. This formulation displayed a sustained release pattern with a release of 81.92% ± 3.04% piperine after 72 h. According to our in vitro activity experiments, it was determined that the P-NE had no toxic effect including the dose of 5 mg/mL, and the highest P-NE formulation dose of 5 mg/mL increased tyrosinase activity by 32.77% ± 9.09% and melanogenesis activity by 34.90% ± 0.73%. In conclusion, it was demonstrated that the P-NE formulation may serve as a promising therapy for the efficient treatment of vitiligo. Moreover, P-NE formulation may also help in preventing irregular pigmentation and skin cancer, associated with the conventional treatment methods.

Effectiveness of Two Different Methods on the Perceived Pain and Satisfaction During Intramuscular Antibiotic Injection: ShotBlocker and Local Vibration.

In this study aimed to examine the effectiveness of ShotBlocker and local vibration on the perceived pain and satisfaction during intramuscular antibiotic injection. The sample of the randomized controlled experimental study consisted of 100 patients (32 in vibration group, 35 in ShotBlocker group, 33 in control group) who applied to the adult emergency clinic for antibiotic (amoxicillin/cefuroxime sodium) injection between April and May 2021. The study data were collected using the Structured Information Form, VAS for Pain and VAS for Satisfaction. CONSORT statement was followed for reporting. After the intramuscular antibiotic injection, a significant difference was found between the groups in terms of the mean scores of VAS for Pain and VAS for Injection Satisfaction (p < .001). It was determined that local vibration application was more effective in reducing the pain and in increasing satisfaction that occurs during intramuscular antibiotic injection according to ShotBlocker and control groups.

Self-disclosure, empathy and anxiety in nurses.

PURPOSE: This study aimed to examine the relationship between self-disclosure, empathy, and anxiety in nurses. DESIGN AND METHODS: The study was conducted with 255 nurses working in hospitals in Turkey. Data were collected using a Sociodemographic Form, the Self-Disclosure Scale (SDS), the Basic Empathy Scale (BES), and the Spielberger State-Trait Anxiety Inventory (STAI). FINDINGS: A statistically significant positive relationship was found among the SDS, BES, and Spielberger STAI. PRACTICE IMPLICATIONS: Psychiatric nurses should ensure the reduction of nurses' anxiety levels by planning different interventions such as psychotherapy, counseling, and training. They may determine nurses' self-disclosure and empathy skills as well as their needs.

The Effect of Cold Therapy Applied to the Incision Area After Abdominal Surgery on Postoperative Pain and Analgesic Use.

BACKGROUND: Cold therapy is one of the most common nonpharmacologic pain treatments. Despite the existence of many studies about cold therapy, few have examined the effects of cold therapy after abdominal surgery. AIMS: The purpose of the study was to investigate the effect of cold therapy applied to the incision area after abdominal surgery on postoperative pain and analgesic use. DESIGN: This study was a randomized controlled trial METHODS: The sample included 60 patients (30 control, 30 experimental) undergoing abdominal surgery. Researchers recorded information from a patient information form, a visual analogue scale (VAS), a pain evaluation form, and the vital signs recording form. RESULTS: There was no statistically significant difference in pain level between the experimental and control groups as measured by VAS at postoperative hour 1 (p > .05). Furthermore, no statistically significant difference in VAS pain levels between groups was observed at postoperative hours 1, 2, and 8 prior to application of cold therapy (p > .05). Then, when cold therapy was applied at hours 1, 2 and 8, the pain level decreased significantly in the experimental group (p =.001). Pain also decreased in the control group between hours 1 and 8, but this decrease was not as great as that in the experimental group (p = .024). CONCLUSIONS: Both groups had decreased pain levels, and the decrease in the experimental group was greater than in the control group but cold therapy had no statistically significant effect on analgesics use.

Impact of the HEAD-US Scoring System for Observing the Protective Effect of Prophylaxis in Hemophilia Patients: A Prospective, Multicenter, Observational Study

Objective: This study aimed to observe the preventive effect of prophylactic treatment on joint health in people with hemophilia (PwH) and to investigate the importance of integration of ultrasonographic examination into clinical and radiological evaluation of the joints. Materials and Methods: This national, multicenter, prospective, observational study included male patients aged ≥6 years with the diagnosis of moderate or severe hemophilia A or B from 8 centers across Turkey between January 2017 and March 2019. Patients were followed for 1 year with 5 visits (baseline and 3th, 6th, 9th, and 12th month visits). The Hemophilia Joint Health Score (HJHS) was used for physical examination of joints, the Pettersson scoring system was used for radiological assessment, point-of-care (POC) ultrasonography was used for bilateral examinations of joints, and the Hemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) score was used for evaluation of ultrasonography results. Results: Seventy-three PwH, of whom 62 had hemophilia A and 11 had hemophilia B, were included and 24.7% had target joints at baseline. The HJHS and HEAD-US scores were significantly increased at the 12th month in all patients. These scores were also higher in the hemophilia A subgroup than the hemophilia B subgroup. However, in the childhood group, the increment of scores was not significant. The HEAD-US total score was significantly correlated with both the HJHS total score and Pettersson total score at baseline and at the 12th month. Conclusion: The HEAD-US and HJHS scoring systems are valuable tools during follow-up examinations of PwH and they complement each other. We suggest that POC ultrasonographic evaluation and the HEAD-US scoring system may be integrated into differential diagnosis of bleeding and long-term monitoring for joint health as a routine procedure.

Long-Term Outcome of Cochlear Implantation in Post-meningitic Deafnes.

BACKGROUND: This study was planned (1) to evaluate long-term outcome after cochlear implantation in patients with post-meningitic deafness and (2) to compare the outcome measures with patients implanted for deafness due to other causes. METHODS: Records of 54 patients deafened as a sequel of bacterial meningitis and implanted at the largest university-based cochlear implant program in Turkey were retrospectively reviewed. Fifty-four age- and sex-matched patients with a similar interval of implant use were selected for controls. Surgical and long-term audiological outcome (in terms of categories of auditory performance-II scores) was assessed and compared. RESULTS: Twenty-seven (52%) patients had some degree of labyrinthitis ossificans and 19 of them had full electrode insertion via basal turn cochleostomy. Patients with and without labyrinthitis ossificans in the post-meningitic group had no difference in final categories of auditory performance-II score (P=.559). Median categories of auditory performance-II scores were 6 for post-meningitic group and 7 for controls, with a significant statistical difference (P < .001). Partial or full insertions did not differ in outcome (P=.938). Mean time to implantation was not correlated with the final categories of auditory performance-II score for the post-meningitic group (P=.695). CONCLUSION: Cochlear implant recipients deafened due to meningitis have a worse long-term hearing and speech performance as measured by categories of auditory performance-II than patients implanted for congenital deafness. The presence of labyrinthitis ossificans or the limited extent of electrode insertion produced overall results that were comparable with other cases.

Long-term Results of ABI in Children With Severe Inner Ear Malformations.

OBJECTIVE: To report the long-term outcomes of children who received auditory brainstem implant (ABI) because of severe inner ear malformations. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral otolaryngology clinic. SUBJECTS AND METHODS: Between July 2006 and October 2014, 60 children received ABI at Hacettepe University. Preoperative work up included otolaryngologic examination, audiological assessment, radiological evaluation together with assessment of language development and psychological status. The surgeries were performed via retrosigmoid approach with a pediatric neurosurgeon. Intraoperatively, electrical auditory brainstem response was utilized. Initial stimulation was done 4 to 5 weeks postoperatively. Outcomes were evaluated with Categories of Auditory Performance (CAP), speech intelligibility rate (SIR), functional auditory performance of cochlear implant (FAPCI) and Manchester Spoken Language Development Scale scores; receptive and expressive language ages were determined. RESULTS: Sixty children who received ABI were between ages of 12 and 64 months. Thirty-five patients with follow up period of at least 1 year, were reported in means of long-term audiological and language results. The most prevelant inner ear malformation was cochlear hypoplasia (n = 19). No major complication was encountered. Majority of the patients were in CAP 5 category, which implies that they can understand common phrases without lip reading. SIR was found out to be better with improving hearing thresholds. Children with ABI were performing worse than average cochlear implantation (CI) users when FAPCI scores were compared. Patients with the best hearing thresholds have expressive vocabulary of 50 to 200 words when evaluated with Manchester Spoken Language Development Scale. There was no relationship between the number of active electrodes and hearing thresholds. The type of inner ear anomaly with the best and the worst hearing thresholds were common cavity and cochlear aperture aplasia, respectively. Patients with additional handicaps had worse outcomes. Among 35 children, 29 had closed set discrimination and 12 developed open set discrimination above 50%. It was determined that, progress of the patients is faster in the initial 2 years when compared with further use of ABI. CONCLUSION: ABI is an acceptable and effective treatment modality for pediatric population with severe inner ear malformations. Bilateral stimulation together with CI and contralateral ABI should be utilized in suitable cases.

Recurrent aphthous ulcers in Fanconi's anaemia: a case report.

Fanconi's anaemia (FA) is an autosomal recessive disorder that is clinically characterized by aplastic anaemia, congenital malformations of the renal, cardiac, skeletal and skin structures, and an increased predisposition to malignancies. Patients with FA often present with bleeding and infection, which are symptoms related to thrombocytopenia and neutropenia. There are few reports of the oral manifestations of FA. We describe oral aphthous ulcerations in two siblings with FA. There was a rapid improvement and healing of ulcers after blood transfusions and increased haemoglobin levels. This may support the role of severe anaemia in oral ulcerations.