Herbal active ingredient-loaded poly(ω-pentadecalactone-co-δ-valerolactone)/gelatin nanofibrous membranes.

Recently, there has been an accelerating interest in novel biocompatible wound dressings made of nano-sized materials, especially nanofibers. Electrospun nanofibers provide high surface area and mimic the extracellular matrix which enhances biocompatibility. Besides, nanofibrous structures have high active ingredient loading capacity as a result of their high surface-to-volume ratio and porosity. In the present study, curcumin-loaded poly(ω-pentadecalactone-co-δ-valerolactone)/gelatin (PDL-VL/Gel) nanofibrous membranes were fabricated to be used for healing skin wounds. Poly(ω-pentadecalactone-co-δ-valerolactone) copolymer has been enzymatically synthesized in previous studies, thus it improves the originality of the membrane. It was aimed to obtain a synergetic effect and increase the novelty of the work by blending synthetic and natural polymers. Moreover, it was preferred to provide antibacterial activity by the incorporation of a herbal ingredient (curcumin) as a natural alternative to commercial antibiotics. Varied amounts of curcumin (5-25 %, w:v) were electrospun together with PDL-VL/Gel (equal volume ratio) polymer blend (fiber diameters ranged between 554 and 1074 nm) and several characterizations (morphological and molecular structure, wettability characteristics, and thermal behavior) were applied to examine the curcumin incorporation. Afterwards, in vitro curcumin release studies were carried out and mathematical modeling was applied to release data to clarify the transport mechanism. Curcumin release profiles comprised of an initial burst release in the first hour followed by a sustained release through 24 h. Based on the antibacterial activity test results, 15 % curcumin loading ratio was found to be sufficient for the treatment of skin wounds infected by Gram-negative (E. coli) and Gram-positive (S. aureus and B. subtilis) bacteria. Additionally, nanofibrous membranes did not lead to cytotoxicity, and curcumin content further enhanced the viability of fibroblasts. Thus, the presented antibacterial nanofibrous membrane is suggested to be applied for the treatment of wound infections and accelerating the healing process.

Evaluation of vaccination status of health care workers for recommended vaccines and their acceptance of SARS-CoV-2 vaccines.

INTRODUCTION: Health care workers (HCWs) are disproportionately exposed to infectious diseases and play a role in nosocomial transmission, making them a key demographic for vaccination. HCW vaccination rates are not optimal in many countries; hence, compulsory vaccination policies have been implemented in some countries. Although these policies are effective and necessary under certain conditions, resolving HCWs' hesitancies and misconceptions about vaccines is crucial. HCWs have the advantage of direct contact with patients; hence, they can respond to safety concerns, explain the benefits of vaccination, and counter antivaccine campaigns that escalate during pandemics, as has been observed with COVID-19. METHOD: A short survey was carried out in May-June 2020 on the vaccination status of HCWs working with pediatric patients with COVID-19. The survey inquired about their vaccination status (mumps/measles/rubella [MMR], varicella, influenza, and diphtheria/tetanus [dT]) and willingness to receive hypothetical future COVID-19 vaccines. The respondents were grouped according to gender, age, occupation, and region. RESULTS: In total, 4927 HCWs responded to the survey. Most were young, healthy adults. The overall vaccination rates were 57.8% for dT in the past 10 years, 44.5% for MMR, 33.2% for varicella, and 13.5% for influenza. Vaccination rates were the highest among physicians. The majority of HCWs (81%) stated that they would be willing to receive COVID-19 vaccines. CONCLUSION: Although vaccination rates for well-established vaccines were low, a majority of HCWs were willing to receive COVID-19 vaccines when available. Education and administrative trust should be enhanced to increase vaccination rates among HCWs.

Comparison of SARS-CoV-2 Antibodies and Six Immunoassays in Pediatric and Adult Patients 12 Weeks After COVID-19.

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific humoral immune persistence has been proposed to be affected by patients' characteristics. Moreover, available conflicting assay results are needed to be settled through comparative research with defined clinical specimens. Methods This prospective study investigated SARS-CoV-2-specific antibodies among 43 adults and 34 children at a mean of 12 weeks after the onset of COVID-19 symptoms using six serological assays and compared their performance. We used two Euroimmun (Euroimmun, Luebeck, Germany), two automated Roche Elecsys (Basel, Switzerland), and two rapid immuno-chromatographic Ecotest (Matrix Diagnostics, Assure Tech. (Hangzhou) Co., L, China) assays to investigate SARS-CoV-2 antibodies. Results The findings showed that the Roche Elecsys anti-S total test yielded the best positivity/sensitivity (children 94.1% and adults 93.0%; p = 0.877) while five immunoglobulin IgG targeting assays had similar positivity/sensitivity between children (88.2% to 94.1%) and adults (88.4% to 93.0%) (p > 0.05). Although IgM positivity was relatively low (p < 0.001), it was found in the majority of our pediatric and adult patients (67.6% and 86.0%, respectively; p = 0.098). SARS-CoV-2 S IgG titers were found to be higher among males in pediatric and adult groups compared to females (p = 0.027 and p = 0.041, respectively). Furthermore, we observed significantly higher antibody titers among pneumonia patients (p = 0.001). Conclusion Overall, we concluded SARS-CoV-2 antibody persistence over an average of 12 weeks after the onset of COVID-19 symptoms. While automated Roche Elecsys total antibody assays yielded the best sensitivity (> 90%) and five assays targeting IgG had acceptable performance. Patients with pneumonia and males have higher antibody titers. The effect of antibody persistence on re-infections should be monitored in longitudinal studies.

Nine-month course of SARS-CoV-2 antibodies in individuals with COVID-19 infection.

BACKGROUND: The continual course of the pandemic points to the importance of studies on the rate and durability of protective immunity after infection or vaccination. AIMS: In this study, we aimed to monitor anti-nucleocapsid (N) and anti-spike (S) antibodies against SARS-CoV-2 nearly 9 months duration after infection. METHODS: Anti-nucleocapsid (N) (at 11-15-20-29-38 weeks) and anti-spike antibodies (at 11 and 38 weeks) against SARS-CoV-2 were monitored during 38 weeks after the initial symptoms of COVID-19. RESULTS: Of 37 cases between 18 and 57 years old, 54% were women. The findings showed that anti-N antibodies decreased significantly after the 15th week (between 15 and 20 weeks, p = 0.016; 20-29 weeks, p = 0.0009; and 29-38 weeks, p = 0.049). At the 38th week, mean antibody levels decreased 35% compared to the 11th week, and 8% of the cases turned negative results. Anti-N antibody average level was 56.48 on the 11th week (the cut-off index threshold ≥ 1). It was estimated statistically that it would decrease to an average of 20.48 in weeks 53-62. In females, average antibody levels of all measurements were lower than males (p > 0.05). Anti-S antibody levels 14% increased at 38th week compared to 11th week (quantitative positivity threshold ≥ 0.8 U/ml), and no cases were negative at 38th week. CONCLUSIONS: Patients had ≥ 90% positivity after at least 9 months of symptoms, both anti-N and anti-S antibodies. In all samples, both anti-N and anti-S antibody levels were lower in females. The findings suggest that the quantitative values of anti-S antibodies remained high for at least 9 months and could provide protection.

Electrospun poly(ω-pentadecalactone-co-ε-caprolactone)/gelatin/chitosan ternary nanofibers with antibacterial activity for treatment of skin infections.

In recent years, there is an increasing attention on biocompatible electrospun nanofibers for drug delivery applications since they provide high surface area, controlled and sustained drug release, and they mimic the extracellular matrix. In the present study, tetracycline hydrochloride (TCH) antibiotic loaded poly(ω-pentadecalactone-co-ε-caprolactone)/gelatin/chitosan nanofibrous membranes were fabricated as a controlled drug delivery system. Poly(ω-pentadecalactone-co-ε-caprolactone) copolymer has been enzymatically synthesized in previous studies, thus it provides an originality to the membrane. Combination of a synthetic polymer, a protein, and a polysaccharide in order to obtain a synergetic effect is another novelty of this work and there exists limited examples for such electrospun membrane. Varied amounts of TCH was electrospun together with poly(ω-pentadecalactone-co-ε-caprolactone)/gelatin/chitosan (50/40/10 vol ratio) polymer blend (fiber diameters ranged between 85.7-225.2 nm) and several characterizations (morphological and molecular structure, wettability characteristics, and thermal behavior) were applied to examine the drug incorporation. Subsequently, in vitro drug release studies were conducted and mathematical modeling was applied for the detection of transport mechanism of drug. TCH release proceeded 14 days through an initial burst release in first hour and followed by a sustained release. 1% TCH-loaded sample was shown as optimal preparation with 96.5% total drug release and 11.8% initial burst release. TCH-loaded preparations demonstrated a good antibacterial activity against Gram-positive (Staphylococcus aureus and Bacillus subtilis) bacteria and a limited effect (no inhibition zone observed below 3% TCH concentration) against Gram-negative (Escherichia coli) bacterium. Thus, TCH concentrations of ≥ 3% could be preferred to obtain a wide-spectrum effectiveness. The presented drug delivery system is suggested to be applied for treatment of skin infections as a wound dressing device.

SARS-CoV-2 seropositivity among pediatric health care personnel after the first peak of the pandemic: nationwide surveillance in Turkey.

BACKGROUND: Understanding SARS-CoV-2 seroprevalence among health care personnel is important to explore risk factors for transmission, develop elimination strategies and form a view on the necessity and frequency of surveillance in the future. METHODS: We enrolled 4927 health care personnel working in pediatric units at 32 hospitals from 7 different regions of Turkey in a study to determine SARS Co-V-2 seroprevalence after the first peak of the COVID-19 pandemic. A point of care serologic lateral flow rapid test kit for immunoglobulin (Ig)M/IgG was used. Seroprevalence and its association with demographic characteristics and possible risk factors were analyzed. RESULTS: SARS-CoV-2 seropositivity prevalence in health care personnel tested was 6.1%. Seropositivity was more common among those who did not universally wear protective masks (10.6% vs 6.1%). Having a COVID-19-positive co-worker increased the likelihood of infection. The least and the most experienced personnel were more likely to be infected. Most of the seropositive health care personnel (68.0%) did not suspect that they had previously had COVID-19. CONCLUSIONS: Health surveillance for health care personnel involving routine point-of-care nucleic acid testing and monitoring personal protective equipment adherence are suggested as important strategies to protect health care personnel from COVID-19 and reduce nosocomial SARS-CoV-2 transmission.

Controlled release of tetracycline hydrochloride from poly(ω-pentadecalactone-co-ε-caprolactone)/gelatin nanofibers.

Development of drug delivery systems is an extensively researched area in biomedical field. In recent years, there is an increasing interest on fabrication of biocompatible nanofibrous drug delivery systems. In the present study, poly(ω-pentadecalactone-co-ε-caprolactone)/gelatin nanofibrous membranes were fabricated for the controlled delivery and release of tetracycline hydrochloride (TCH) antibiotic. Poly(ω-pentadecalactone-co-ε-caprolactone) content provides an originality to the membrane, since it has been synthesized enzymatically previously. Varied amounts of tetracycline hydrochloride including poly(ω-pentadecalactone-co-ε-caprolactone)/gelatin (1:1, v:v) binary polymer blend was electrospun and characterizations (morphological and molecular structure, wettability characteristics, and thermal behavior) were applied to investigate the incorporation of drug molecule. Afterwards, in vitro drug release studies were carried out and mathematical modelling was applied to drug release data in order to clarify the transport mechanism of drug. TCH release profile comprised of an initial burst release in first hour and followed by a sustained release through 14 days which allowed sufficient antibacterial activity against both Gram-negative (Escherichia coli) and Gram-positive (Staphylococcus aureus and Bacillus subtilis) bacteria. The presented drug delivery system may be applied as an antibacterial wound dressing device for skin infections.

Fabrication and characterization of electrospun biopolyester/gelatin nanofibers.

Poly(ω-pentadecalactone-co-ε-caprolactone) copolymer (PDL-CL) is an enzymatically synthesized aliphatic biopolyester, which has been participated in a nanofibrous structure for the first time. Electrospinning of this synthetic polymer by blending with a natural polymer such as gelatin (Gel) could provide new characteristics that are significant for biomedical applications, such as drug delivery, wound healing, and tissue engineering. In the present study, PDL-CL/Gel nanofibrous membranes were successfully produced and characterized. The average diameter of nanofibers was 305.0 ± 45.5 nm that may be beneficial in applications mentioned above. In order to increase hydrolytic resistance, cross-linking with glutaraldehyde vapor was applied. Cross-linking for 2 h was enough to obtain a nanofibrous membrane that was able to resist in pH 7.4 phosphate buffered saline for 30 days. In addition, contact angle measurement results had shown that, cross-linked nanofibrous membrane had good wettability, which is a required specification to be applied in biomedical field. Hence, this study provides an overview on fabrication of fine PDL-CL/Gel nanofibers, which may have potential to be used in biomedical area.

[Evaluation of Micafungin Use in Children]. / Çocuklarda Mikafungin Kullaniminin Degerlendirilmesi.

Micafungin is recommended especially in patients with liver and kidney failure and in the presence of other side effects due to antifungals apart from its known priority indications such as invasive candidiasis. The aim of this study was to evaluate the children who have received micafungin treatment. In the study, 125 children who were hospitalized in the pediatric wards and intensive care units of our hospital and had used micafungin between November 2016 and January 2019 were analyzed retrospectively. Clinical data, micafungin indication, blood values on the first and fourth days of the treatment, side effects of the drug and efficacy were evaluated. Sixty percent (75/125) of the patients were male and the mean age of all the patients were 58 ± 67 (0-215, 30) months. Approximately half of the cases (48%) had malignancy and 13% of them were premature. Sixty-two percent (n= 37) of the malignencies were hematological (27 acute lymphocytic leukemia, nine acute myeloid leukemia, one myelodysplastic syndrome) and 38% (n= 23) were oncological (six neuroblastoma, four Hodgkin lymphoma, two Non-Hodgkin's lymphoma, five sarcomas, one hepatoblastoma, five others) malignencies. The major cause of hospitalization was sepsis (53%). The patients had several risk factors like immunosuppressive therapy (n= 68, 54%), neutropenia (n= 61, 49%), central venous catheter (n= 102, 82%), nasogastric tube (n= 63, 50%), endotracheal intubation tube (n= 49, 39%), urinary catheter (n= 14, 11%) and total parenteral nutrition (n= 81, 65%). Thirteen percent (n= 16) of the cases were post-operative patients. Candida species were cultivated in 97 clinical specimens (blood, endotracheal aspirate, sputum, urine, etc.) among 23 (18%) of the patients. Thirteen (10%) of the patients had candidemia and 62% of them were non-albicans strains. In all candidemias, strains were echinocandin susceptible, and blood cultures were negative within four days. When all the patients (n= 125) were evaluated, a significant decrease in C-reactive protein, an increase in sodium, and a decrease in alanine aminotransferase were observed on the fourth day of micafungin treatment (p<0.05). A total of 39 (31%) patients underwent various antifungal treatments for median seven (1-60) days prior to micafungin treatment. Fourteen (36%) of these 39 patients, had elevated liver function tests (LFT), 10 (26%) of them had hypokalemia, and five (13%) of them had elevated renal function tests. Ten (26%) patients had antifungal-induced hypokalemia previously; and potassium levels were normalized after micafungin treatment (p= 0.0001). The patients for which micafungin treatment was chosen due to elevated liver function tests (n= 47, 38%), whether the antifungalinduced or not; alanine aminotransferase and aspartate aminotransferase levels were decreased after micafungin treatment (p= 0.0001 and p= 0.0001, respectively). Nineteen (15%) of the patients have died within the first 30 days of micafungin treatment and one of them had candidemia. No micafungin treatment related significant side effects were observed in any of the patients. Our study showed that micafungin could be a safe and effective option in pediatric cases including newborns with high liver and kidney function tests.

Relationship between brain computed tomography findings and bispectral index score in patients presenting with head trauma.

OBJECTIVE: Head trauma is one of the most important emergency health problems both in the world and in our country. The objective in our study is to (i) state the correlation between the findings of bispectral index score (BIS) and computed tomography (CT), which are used to evaluate the level of consciousness of patients with isolated head trauma, and (ii) investigate objective results about the patient's level of consiousness/alertness according to the CT modality, which is used frequently. METHODS: This prospective study was carried out between 03.01.2014 and 09.01.2014 in the emergency department of Fatih Sultan Mehmet Education and Research Hospital. The average BIS scores were correlated with the Glasgow Coma Scale (GCS) point, the Canadian CT Head Rule major and minor criteria, and the pathologic findings in CT imaging. The patients' demographic features, vital signs at admission, and arrival times at the hospital were investigated. RESULTS: In our study, 64 (31.7%) patients were female, and 138 (68.3%) patients were male. The mean BIS scores were 84.99±11.20 (86.05) and 93.78±3.80 (95.05) in patients with and without CT pathologies, respectively. The correlation between CT pathology and BIS scores was statistically significant: BIS scores were lower in patients with CT pathologies (p=0.001; p<0.01). There was a statistically significant positive correlation between the BIS and GCS scores (45.6%) (p<0.05). CONCLUSION: We showed that most head traumas occur after dangerous accidents, and according to the results, we can predict that males are more frequently affected than females. There was a statistically significant positive correlation between BIS scores and GCS points. In our study, the BIS scores were statistically significantly lower in patients with CT pathology than in patients without. We can predict that if the BIS score of the patient is low, then there will be the presence of pathology on CT imaging.

The Role of Intralipid Emulsion in the Rat Model of Digoxin Intoxication.

Although the mechanism of action is not well known, intravenous lipid emulsion (ILE) has been shown to be effective in the treatment of lipophilic drug intoxications. It is thought that, ILE probably separates the lipophilic drugs from target tissue by creating a lipid-rich compartment in the plasma. The second theory is that ILE provides energy to myocardium with high-dose free fatty acids activating the voltage-gated calcium channels in the myocytes. In this study, effects of ILE treatment on digoxin overdose were searched in an animal model in terms of cardiac side effects and survival. Forty Sprague-Dawley rats were divided into five groups. As the pre-treatment, the groups were administered saline, ILE, DigiFab and DigiFab and ILE. Following that, digoxin was infused to all groups until death except the control group. First arrhythmia and cardiac arrest observation times were recorded. According to the results, there was no statistically significant difference among the group in terms of first arrhythmia time and cardiac arrest times. However, when the saline group compared with ILE-treated group separately, significant difference was observed. DigiFab, ILE or ILE-DigiFab treatment make no significant difference in terms of the first arrhythmia and cardiac arrest duration in digoxin-intoxicated rats. However, it is not possible to say that at the given doses, ILE treatment might be successful at least as a known antidote. The fact that the statistical significance between the two groups is not observed in the subgroup analysis, the study should be repeated with larger groups.