Thermosensitive In situ Gelling System for Dermal Drug Delivery of Rutin.

Objectives: Rutin has been broadly applied for treating several diseases due to its pharmacological activities. However, its low aqueous solubility limits its absorption and bioavailability. This research aims to increase the solubility of rutin using cyclodextrin and to develop a temperature-triggered in situ gelling system for dermal application. Materials and Methods: The solubility of rutin was increased with sulfobutyl ether-ß-cyclodextrin (SBE-ß-CD). Rutin- SBE-ß-CD inclusion complex was prepared by kneading and freeze dying method. Structural characterization was carried out using differential scanning calorimetry and fourier transform infrared spectroscopy. In situ gel formulations were prepared with pluronic F127 (PF127), a thermosensitive polymer, and chitosan (CH), a natural, biodegradable, and mucoadhesive hydrophilic polymer. In situ gel characteristics such as pH, clarity, gelation temperature, and viscosity were determined. Results: When the solubility diagrams were examined, it was concluded that SBE-ß-CD showed a linear increase, therefore, AL-type diagram was selected. The formulations were produced using different amounts of PF127 and a fixed ratio of CH. Three in situ gels were evaluated for their pH, gelling temperature, and the rheological behaviors, and one formulation was selected. It was observed that the formulations had a pH between 6-6.1, and their gelation temperature decreased with increasing PF127 that was between 20°C to 34°C. For the selected formulation (formulation E3), 0.5% rutin and rutin/SBE-ß-CD were transferred to the in situ gelling system. Because of in vitro release studies, it was observed that the release of the rutin/SBE-ß-CD inclusion complex containing NZ formulation showed a higher burst effect than the others and the release continued for 6 hours. Conclusion: The results indicated that the combination of PF127 and CH can be a hopeful in situ gelling vehicle for dermal delivery of rutin and rutin/SBE-ß-CD.

Design and in vitro evaluation of tenofovir-loaded vaginal gels for the prevention of HIV infections.

Infection with the human immunodeficiency virus (HIV) is affecting women disproportionally with increasing incidence rates over the last decades. Tenofovir is one of the most commonly used antiretroviral agents, which belongs to the nucleoside/nucleotide reverse transcriptase inhibitor family, for the prevention of HIV acquisition. In scope of this study, a thermogelling system containing tenofovir-loaded chitosan nanoparticles for the controlled release of tenofovir was developed and characterized. The in vitro release studies have shown that the burst release effect was decreased to 27% with f-TFV CS NPs-Gel. Gelation temperature of developed formulation was found as 26.6 ± 0.2 °C, which provides ease of administration while gelation occurs after the administration to the vagina. The work of adhesion values was used as parameters for comparison of mucoadhesive performance and the mucoadhesion of f-TFV CS NPs-Gel was found as 0.516 ± 0.136 N.s at 37 °C. The biocompatibility of blank formulations was evaluated by cell viability studies using L929 cells, in which Gel + CS NPs formulation was found to be safe with 82.4% and 90.2% cell viability for 1:16 and 1:32 dilutions, respectively. In conclusion, an improved tenofovir containing vaginal gel formulation was successfully developed and evaluated for preventing HIV transmission.

Is the time from the onset to the treatment a prognostic indicator for hearing recovery in idiopathic sudden sensorineural hearing loss?

OBJECTIVES: This study aims to investigate whether the time from the onset of symptoms to the start of treatment is a prognostic indicator in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). PATIENTS AND METHODS: In this study, 96 patients (58 males, 38 females; mean age 37.8±2.5 years; range 16 to 67 years) who were diagnosed with ISSNHL in our clinic between January 1992 and April 2010 were retrospectively analyzed. All patients were treated with dextran 40 (rheomacrodex), pentoxifyllin, vitamin B complex and vitamin C regimen over 10 days with hospitalization and bed rest. The patients were tested by pure-tone audiometry. Audiograms were obtained on alternate days and at the end of the treatment. RESULTS: There was a complete recovery in 45 (60%) of 75 patients whose treatment was started in the first seven days, while a partial recovery was observed in 17 (22.66%) and no recovery was observed in 13 (17.33%). There was a complete recovery in two (9.52%) of 21 patients whose treatment was started after the eighth day, while a partial recovery was observed in seven (33.33%) and no recovery was observed in 12 (57.14%). CONCLUSION: Our study results suggest that treatment outcomes are better in the patients presenting to hospital at an early stage of loss of hearing.

[Evaluation of shrinkage of surgical margins on tongue specimens following formalin fixation]. / Formalin fiksasyonu sonrasi dil örneklerinde cerrahi sinir küçülmesinin degerlendirilmesi.

OBJECTIVES: This study aims to evaluate the alterations in distances to the surgical margins on sheep tongue specimens, through resection, formalin fixation, frozen section, and microscopic examination. MATERIALS AND METHODS: Fifty fresh sheep tongues were used in the study. A metal plate was fixed on the lateral aspect of each tongue to represent tumor tissues. A total of 40 specimens with either 1 cm or 2 cm distances as surgical safety margins of the surrounding plate were prepared using either scalpel or monopolar cautery (10 specimens were prepared for each group). Additional 10 specimens with 1 cm safety margins were prepared using either scalpel or monopolar cautery (5 specimens per group) for frozen section examination. Distances to the metal plates before resection were compared with the ones which were determined after resection, frozen section examination, 24-hour formalin fixation and microscopic examination. RESULTS: Distances to the surgical margins were found to be decreased in all specimens after resection, 10% formalin fixation and microscopic examination. The distances to the surgical margins were observed to be reduced by 6.5-7.5% on average after resection, 10-12% on average after formalin fixation and 30% on average after microscopic examination, compared to the baseline values. The level of shrinkage was reduced by 6.3-10% following microscopic section preparation during frozen section examination. CONCLUSION: Seven to eight-millimeter distance to the surgical margin at minimum should be maintained to achieve a 5 mm in height surgical safety margin during sheep tongue resection. The distance defined by the pathologist may be multiplied with 1.42 to estimate around in-situ distance to the surgical margins. Therefore, 1.42 may be used as a corrective factor for sheep tongue tissues.

Chronic otitis media with multiple complications.

Chronic otitis media (COM) is defined as persistent infection or inflammation of the middle ear and mastoid air cells. The proximity of the middle ear cleft and mastoid air cells to the intratemporal and intracranial compartments places structures located in these areas at increased risk of infectious complications. The complications of COM are divided into intracranial and extracranial complications. The development and appropriate use of antibiotics have led to a decrease in these potentially devastating complications. However, they continue to occur, and clinical vigilance is required for early detection and treatment. We reported a case with multiple complications, both intracranial and extracranial secondary to COM.

A giant juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibromas are locally growing and highly vascular tumors. They are primarily treated through surgical excision ranging from an open approach to an endoscopic approach. We presented a 20-year-old man with a giant juvenile nasopharyngeal angiofibroma that bilaterally obliterated the pterygopalatine fossa, invaded the sphenoid bone, and extended to the left nasal passage. His complaints were epistaxis and nasal obstruction. After embolization, the patient was treated surgically using the endoscopic approach and declared cured and discharged without any complications.

Parotid tail pleomorphic adenoma extending to the parapharyngeal space.

Parapharyngeal space tumors are rare, accounting for 0.5% of head and neck neoplasms. Most of them are benign and originate in the salivary glands, especially the pleomorphic adenoma. We presented a 47-year-old man with parotid tail pleomorphic adenoma extending to the parapharyngeal space. The patient applied to our clinic with the complaints of a painless mass on his neck and in his mouth for 3 months. After fine needle aspiration biopsy, the mass was diagnosed as pleomorphic adenoma. The patient was hospitalized and operated in our clinic. As we see in literature review, parapharyngeal space tumors are rare, and most of them are pleomorphic adenomas arising from the deep lobe of the parotid gland and extend into the PPS.

Evaluation of hearing in patients with familial Mediterranean fever.

Familial Mediterranean fever (FMF) is a common and well-understood hereditary periodic fever syndrome. Hereditary periodic fever syndromes include a group of multisystem diseases characterized by recurrent fever attacks with inflammation affecting skin, joints, and some other tissues. These are FMF, tumor necrosis factor receptor, tumor necrosis factor receptor associated periodic syndrome, hyperimmunglobulinemia D syndrome, Muckle-Wells syndrome, and familial cold urticaria. In literature, it is determined that some of these diseases cause hearing loss. In light of the foregoing, we thought that FMF patients may have the same type of subclinical hearing loss and, therefore, the hearing ability of these patients was evaluated with otoacoustic emission and high frequency audiometry tests.

Analysis of ethmoid roof and skull base with coronal section paranasal sinus computed tomography.

Chronic paranasal sinus disease is one of the most common causes of application to physicians in pediatric and adult patients. In the surgical treatment of these diseases, endoscopic sinus surgery is an application that is often done to increase the quality of the patient's life. On account of this, the anatomic variations in skull basement must be well known to avoid possible major complications that may occur during the operation. Recent developments in paranasal sinus surgery also enhanced the need for examining exhaustively the anatomy of this region and existing pathology. Superiority of computed tomography (CT) has an unquestionable importance for the evaluation of anatomic structure and pathology compared with conventional radiographs. A likely anatomic knowledge is needed for a safe surgery. Before the surgery, determining the anatomic variations makes the operation safer and increases the prospects, so we can prevent complications that may occur during the surgery. In this study, CT coronal sections of 300 patients who were admitted to the Department of Ear Nose Throat of Medical Faculty of Cumhuriyet University Research and Training Hospital between the dates December 2008 and January 2011 with complaints of nasal flow and postnasal drip were studied. According to coronal section CT examinations, the patients were divided into 2 groups. Group 1, with 156 cases (64%), showed mucosal changes, and in 144 cases (36%), no mucosal changes were established (group 2). In comparison between the sexes, in groups 1 and 2 females, significant difference was determined for other parameters except the average height of the ethmoid roof. In the comparison between the sexes, in groups 1 and 2 males, significant difference was determined for all parameters. The difference between these 2 rates was statistically significant. Keros types 1 and 2 cases were compared with the control group, and there was no statistically significant difference. Notwithstanding, at the comparison of the Keros type 3 with the control group, there was a statistically significant difference for all the parameters (maximum orbital height, the length of the middle concha, and the nasal wall). It seems to be important for us to know the average length of the peripheral anatomic structures to avoid serious complications that may occur during the operation. Careful preoperative review of paranasal sinus CT scans in patients undergoing sinus surgery seems to be the most important to prevent severe intraoperative complications.

Tularemia and the oculoglandular syndrome of Parinaud.

An 18-year-old female came to our clinic with complaints of a tender lump just under her jaw on the left side and another lump in front of her left ear, ecchymosis around the eye and some redness in the eye at the same side. After administering antibiotic therapy for two days we suspected of tularemia and referred the patient to the Infectious Diseases Department. A serum sample was taken and a fine needle aspiration biopsy was performed. The patient was diagnosed with tularemia, the oculoglandular syndrome of Parinaud. Tularemia should also be kept in mind for differential diagnosis in patients with both ocular and glandular symptoms in endemic regions like Turkey and the appropriate therapy should be initiated immediately.

Primary malignant melanoma of the nasal cavity.

Primary malignant melanoma of the nose and paranasal sinus mucosa is a rare disease and seen in less than 1% among all melanomas. Malignant melanomas have 2 origins: cutaneous and mucosal. The mucosal form has a worse prognosis because of its aggressiveness compared with that of the cutaneous form. Mucosal melanomas often occur at a rate of 2% to 3% among all melanomas and are typically found in the nasal cavity and paranasal sinuses. Generally, it is more common in males and in those older than 50 years. In this study, 4 patients were observed at the Cumhuriyet University Faculty of Medicine; 2 of them were a 64-year-old man and an 82-year-old woman who had a malignant melanoma originating from the nasal septal mucosa, 1 patient was a 72-year-old woman whose malignant melanoma originated from the inferior turbinate, and 1 patient was a 77-year-old woman with a sinonasally located melanoma. The conditions of these patients were discussed under the light of literature instructions.

Tularemia and the oculoglandular syndrome of Parinaud

An 18-year-old female came to our clinic with complaints of a tender lump just under her jaw on the left side and another lump in front of her left ear, ecchymosis around the eye and some redness in the eye at the same side. After administering antibiotic therapy for two days we suspected of tularemia and referred the patient to the Infectious Diseases Department. A serum sample was taken and a fine needle aspiration biopsy was performed. The patient was diagnosed with tularemia, the oculoglandular syndrome of Parinaud. Tularemia should also be kept in mind for differential diagnosis in patients with both ocular and glandular symptoms in endemic regions like Turkey and the appropriate therapy should be initiated immediately.