The Role of Speedy/RINGO Protein in Breast Cancer as a Future Biomarker.

Background/Aim: Cyclin-dependent kinases (CDKs) are proteins that require the binding of regulatory subunits called cyclins and play a key role in cell cycle progression and activation. CDKs play a key role in carcinogenesis of many solid malignancies, and inhibition of these proteins has produced anti-cancer effects demonstrated in preclinical studies. This narrative review was conducted to develop a hypothetical approach to determine whether Speedy/RINGO, a protein associated with CDK2, could be a possible predictive factor in breast cancer patients treated with a CDK4/6 inhibitor. Materials and Methods: A literature search was conducted in PubMed, Web of Science, Medline, and Google Scholars search engines to match the following words: "Speedy/RINGO" or "Spy1" and "CDKs" or "Cyclin-dependent kinases (CDKs)" and "CDK4/6 inhibitors" and "Regulation" and "Molecular" and "Breast cancer" and "Carcinogenesis". Only articles investigating the relationship between the Speedy/RINGO protein and CDKs at the molecular level were included. Literature information was compiled by trying to establish a relationship with our hypothesis question. Results: Speedy/RINGO is a tightly regulated proto-oncogenic mammalian protein playing important roles in the somatic cell cycle. Studies have emphasized that although it does not have amino acid sequence homology with cyclins, it can activate CDK2. In addition, results showing molecular compensation of CDK4/6 inhibition through CDK2 activation, also showed that CDK2 can predict drug resistance. Another important finding was that overexpressed Speedy/RINGO, during CDK4/6 inhibitor treatment, could strongly activate CDK2, resulting in a negative response to treatment. Conclusion: Although many predictive factors have been investigated to indicate response to CDK4/6 inhibitors or determine drug resistance, a consensus biomarker has yet to be established. In light of the information obtained from our review, it can be concluded that the Speedy/RINGO protein may have an important role as a predictive biomarker in terms of response to treatment, continuity of treatment and drug resistance in patients treated with CDK4/6 inhibitors.

Trans-Amplifying RNA: A Journey from Alphavirus Research to Future Vaccines.

Replicating RNA, including self-amplifying RNA (saRNA) and trans-amplifying RNA (taRNA), holds great potential for advancing the next generation of RNA-based vaccines. Unlike in vitro transcribed mRNA found in most current RNA vaccines, saRNA or taRNA can be massively replicated within cells in the presence of RNA-amplifying enzymes known as replicases. We recently demonstrated that this property could enhance immune responses with minimal injected RNA amounts. In saRNA-based vaccines, replicase and antigens are encoded on the same mRNA molecule, resulting in very long RNA sequences, which poses significant challenges in production, delivery, and stability. In taRNA-based vaccines, these challenges can be overcome by splitting the replication system into two parts: one that encodes replicase and the other that encodes a short antigen-encoding RNA called transreplicon. Here, we review the identification and use of transreplicon RNA in alphavirus research, with a focus on the development of novel taRNA technology as a state-of-the art vaccine platform. Additionally, we discuss remaining challenges essential to the clinical application and highlight the potential benefits related to the unique properties of this future vaccine platform.

Trans-amplifying RNA expressing functional miRNA mediates target gene suppression and simultaneous transgene expression.

The co-delivery of microRNAs (miRNAs) and protein-coding RNA presents an opportunity for a combined approach to gene expression and gene regulation for therapeutic applications. Protein delivery is established using long mRNA, self-, and trans-amplifying RNA (taRNA), whereas miRNA delivery typically uses short synthetic oligonucleotides rather than incorporating it as a precursor into long RNA. Although miRNA delivery into the cell cytoplasm using long genomes of RNA viruses has been described, concerns have remained regarding low processing efficiency. However, miRNA precursors can be released from long cytoplasmic alphaviral RNA by a cytoplasmic fraction of Drosha. taRNA, a promising vector platform for infectious disease vaccination, uses a nonreplicating mRNA expressing an alphaviral replicase to amplify a protein-coding short transreplicon-RNA (STR) in trans. To investigate the possibility of simultaneously delivering protein expression and gene silencing, we tested whether a taRNA system can carry and release functional miRNA to target cells. Here, we show that mature miRNA is released from STRs and silences specific targets in a replication-dependent manner for several days without compromising the expression of STR-encoded proteins. Our findings suggest that incorporating miRNAs into the taRNA vector platform has the potential for gene regulation alongside the expression of therapeutic genes.

Total aflatoxin and ochratoxin A levels, dietary exposure and cancer risk assessment in dried fruits in Türkiye.

This study aimed to measure total aflatoxin (AF) (AFB1, AFB2, AFG1, and AFG2) and ochratoxin A (OTA) levels in dried fruit samples and to evaluate the potential dietary exposure and cancer risk to these mycotoxins in Kayseri/Türkiye. Dried fruit samples were collected between April-May 2021. A total of 11 dried grapes and apricot samples, 7 dried fig and plum samples were collected. Total aflatoxins and OTA in dried fruits were determined by ELISA method. Then, the margin of exposure (MOE) and cancer risk were calculated. Total AF was detected in dried fruit samples between 42.86%, and 100%. Between 18.18% and 57.14% of samples exceeded the European Commission (EC) limits for total AF. Moreover, OTA was detected in all samples. Between 71.43% and 100% of samples exceeded the EC limits for OTA. Cancer risk due to OTA exposure was higher than total AF and it was determined that OTA exposure could pose a risk for public health (MOE < 10,000). Although mycotoxin exposure seems to be low due to the low consumption of dried fruit in Türkiye, the risk of exposure and cancer may increase because of complying with the recommendations of the dietary guidelines. The findings provide new insights into exposure to total AF and OTA through the consumption of dried fruit.

Targeting MDM2-p53 Axis through Drug Repurposing for Cancer Therapy: A Multidisciplinary Approach.

Cancer remains a major cause of morbidity and mortality worldwide, and while current therapies, such as chemotherapy, immunotherapy, and cell therapy, have been effective in many patients, the development of novel therapeutic options remains an urgent priority. Mouse double minute 2 (MDM2) is a key regulator of the tumor suppressor protein p53, which plays a critical role in regulating cellular growth, apoptosis, and DNA repair. Consequently, MDM2 has been the subject of extensive research aimed at developing novel cancer therapies. In this study, we employed a machine learning-based approach to establish a quantitative structure-activity relationship model capable of predicting the potential in vitro efficacy of small molecules as MDM2 inhibitors. Our model was used to screen 5883 FDA-approved drugs, resulting in the identification of promising hits that were subsequently evaluated using molecular docking and molecular dynamics simulations. Two antihistamine drugs, cetirizine (CZ) and rupatadine (RP), exhibited particularly favorable results in the initial in silico analyses. To further assess their potential use as the activators of the p53 pathway, we investigated the antiproliferative capability of the abovementioned drugs on human glioblastoma and neuroblastoma cell lines. Both the compounds exhibited significant antiproliferative effects on the abovementioned cell lines in a dose-dependent manner. The half-maximal inhibitory concentration (IC50) of CZ was found to be 697.87 and 941.37 µM on U87 and SH-SY5Y cell lines, respectively, while the IC50 of RP was found to be 524.28 and 617.07 µM on the same cell lines, respectively. Further investigation by quantitative reverse transcriptase polymerase chain reaction analysis revealed that the CZ-treated cell lines upregulate the expression of the p53-regulated genes involved in cell cycle arrest, apoptosis, and DNA damage response compared to their respective vehicle controls. These findings suggest that CZ activates the p53 pathway by inhibiting MDM2. Our results provide compelling preclinical evidence supporting the potential use of CZ as a modulator of the MDM2-p53 axis and its plausible repurposing for cancer treatment.

Silk fibroin nanoparticles and ß-tricalcium phosphate loaded tissue engineered gelatin bone scaffolds: A Nature-based, low-cost solution.

Tissue engineering has recently attracted attention as an alternative to traditional treatment methods for tissue and organ damage. Since bone is one of the most important vital parts of the body, the treatment of bone damage is important. Silk fibroin is a natural polymer with properties such as biocompatibility and biodegradability, which attracts attention with its controlled release, especially in drug delivery systems. In this study, gelatin-based scaffolds loaded with silk fibroin nanoparticles and ß -tricalcium phosphate (ß -TCP) were developed to be used as a potential drug delivery system in bone tissue engineering. The chosen nanoparticle formulation has a 294 nm average diameter with a 0.380 polidispersity index (PDI). In vitro characterization of scaffolds was performed by mechanical, morphological characterization, swelling capacity, Differential Scanning Calorimetry (DSC), Fourier-Transform Infrared Spectroscopy (FT-IR) measurements, and biocompatibility was evaluated by cell culture studies. Swelling index, tensile strength, elongation at break, and Young modulus of the ß -TCP and silk nanoparticles loaded scaffold were found as 456%, 1.476 MPa, 6.75%, and 24 MPa, respectively. In vitro cell culture studies have shown that scaffolds prepared in the present study can accelerate osteoblast differentiation and increase the healing rate of bone tissues. In addition, they have the potential to be used as a drug delivery system in bone tissue engineering that needs to be evaluated with further studies.

Pupillographic Analysis of COVID-19 Patients: Early and Late Results After Recovery.

Objectives: We aimed to investigate the short- and long-term static and dynamic pupillary responses of patients recovered from coronavirus disease-19 (COVID-19) using quantitative infrared pupillography. Methods: This study included patients who recovered from COVID-19 (Group 1) and age- and gender-matched controls (Group 2). A detailed ophthalmic examination was performed at 1 month and 6 months after the diagnosis of COVID-19. Photopic, mesopic, and scotopic pupil diameters (PDs) were measured using a quantitative infrared pupillography which was integrated into Scheimpflug/Placido photography-based topography system. PDs at 0, 2nd, 4th, and 6th seconds, and average pupil dilation speeds at 2nd, 4th, 6th, and 8th seconds were recorded. Results: Eighty-six eyes of 86 patients (Group 1: n=42; Group 2: n=44) were included. While the mean photopic, mesopic, and scotopic PDs were significantly larger in the COVID-19 group than the control group in the 1st month (p=0.035, p=0.017, p=0.018, respectively), no statistically significant difference was found in the 6th month. Besides, average pupil dilation speeds and PDs at the 0, 2nd, 4th, and 6th seconds were not statistically significantly different between the two groups in the 1st month and 6th month. Conclusion: PDs were significantly larger in COVID-19 patients in all light intensities in the 1st month after COVID-19. However, pupillary dilation was transient, and no significant difference was found in the 6th month. We suggest that the transient pupillary dilation may be secondary to the autonomic nervous system dysfunction and/or optic nerve and visual pathways alterations following COVID-19.

Comparative efficacy and tolerability of pharmacological interventions for acute bipolar depression in adults: a systematic review and network meta-analysis.

BACKGROUND: Bipolar depression constitutes a major public health problem due to its substantial burden of disease. Although pharmacological interventions are available, guidelines required updated evidence synthesis to improve their current recommendations. In order to inform evidence-based prescribing, we investigated the comparative efficacy and tolerability of pharmacological interventions for acute bipolar depression. METHODS: We conducted a systematic review and network meta-analysis. We searched for randomised controlled trials comparing pharmacological interventions with each other or placebo in adults with acute bipolar depression (type I, type II, or not otherwise specified), excluding those with substance misuse, unipolar depression, or schizophrenia, in MEDLINE, Embase, PsycINFO, Google Scholar, Cochrane Library, Web of Knowledge, CINAHL, and LILACS from database inception up to April 13, 2023. Criteria for eligibility were a duration of 2-16 weeks with masked outcome assessments, and we included combination, add-on design, and monotherapy studies. The co-primary outcomes were depressive symptoms, examined with standardised mean differences (SMDs), and manic switch, examined with odds ratios (ORs). We also investigated dropouts due to any reason, inefficacy, adverse events, and important side-effects as secondary outcomes. The confidence in the evidence was evaluated using Confidence-In-Network-Meta-Analysis (CINeMA). The study was registered with PROSPERO, CRD42020171726. RESULTS: We analysed data from 101 randomised controlled trials covering 20 081 participants, 8063 men (41·7%) and 11 263 women (58·3%; sex not available in four studies), mean age 41·0 years (range of means 28·7-53·6 years), and 68 medications and placebo. Ethnicity data were not available. With moderate confidence in the evidence, olanzapine plus fluoxetine, quetiapine, olanzapine, lurasidone, lumateperone, cariprazine, and lamotrigine were more efficacious than placebo in reducing depressive symptoms, with SMDs ranging from 0·41 (95% CI 0·19-0·64) for olanzapine plus fluoxetine to 0·16 (0·03-0·29) for lamotrigine. Several other drugs might also be efficacious, but the confidence in the evidence was very low to low. Antidepressants as a class seem to be efficacious, but had a higher risk for manic switch compared to antipsychotics. Medications differed in their side-effect profiles. INTERPRETATION: This is, to our knowledge, the largest network meta-analysis of pharmacotherapy for bipolar depression to date. Olanzapine plus fluoxetine, quetiapine, olanzapine, lurasidone, lumateperone, cariprazine, and lamotrigine were found to be more efficacious than placebo in adults with acute bipolar depression, with good confidence in the evidence, and to differ in their side-effect profiles. These findings can inform evidence-based care and the development of treatment guidelines internationally. FUNDING: None.

The effect of video-based fistula care education on hemodialysis patients' self-care behaviors: A randomized controlled study.

OBJECTIVE: This study aimed to determine the effect of face-to-face and video-based education for fistula care on hemodialysis patients' self-care behaviors. METHODS: The study was conducted as a randomized controlled experimental study. Accordingly, 60 patients were included in the study for 95% strength. Fistula care training was given to the patients in the control group using face-to-face education technique. Fistula care training was given to the patients in the experimental group using a video-based technique. RESULTS: The analysis showed that the post-test second week (p = 0.044) and fourth week (p = 0.00) mean scores of the experimental group were higher compared to those of the control group. CONCLUSION: These results showed that the video-based education given to hemodialysis patients was more memorable and instructive than the verbal education, and it was observed that the video-based education showed a higher level of success in developing self-care skills.

A potential posttranscriptional regulator for p60-katanin: miR-124-3p.

Katanin is a microtubule severing protein belonging to the ATPase family and consists of two subunits; p60-katanin synthesized by the KATNA1 gene and p80-katanin synthesized by the KATNB1 gene. Microtubule severing is one of the mechanisms that allow the reorganization of microtubules depending on cellular needs. While this reorganization of microtubules is associated with mitosis in dividing cells, it primarily takes part in the formation of structures such as axons and dendrites in nondividing mature neurons. Therefore, it is extremely important in neuronal branching. p60 and p80 katanin subunits coexist in the cell. While p60-katanin is responsible for cutting microtubules with its ATPase function, p80-katanin is responsible for the regulation of p60-katanin and its localization in the centrosome. Although katanin has vital functions in the cell, there are no known posttranscriptional regulators of it. MicroRNAs (miRNAs) are a group of small noncoding ribonucleotides that have been found to have important roles in regulating gene expression posttranscriptionally. Despite being important in gene regulation, so far no microRNA has been experimentally associated with katanin regulation. In this study, the effects of miR-124-3p, which we detected as a result of bioinformatics analysis to have the potential to bind to the p60 katanin mRNA, were investigated. For this aim, in this study, SH-SY5Y neuroblastoma cells were transfected with pre-miR-124-3p mimics and pre-mir miRNA precursor as a negative control, and the effect of this transfection on p60-katanin expression was measured at both RNA and protein levels by quantitative real-time PCR (qRT-PCR) and western blotting, respectively. The results of this study showed for the first time that miR-124-3p, which was predicted to bind p60-katanin mRNA by bioinformatic analysis, may regulate the expression of the KATNA1 gene. The data obtained within the scope of this study will make important contributions in order to better understand the regulation of the expression of p60-katanin which as well will have an incontrovertible impact on the understanding of the importance of cytoskeletal reorganization in both mitotic and postmitotic cells.

Emotional labor among Turkish nurses: A cross-sectional study.

Nurses are the closest healthcare providers to patients and emotional labor is the most invisible part of nursing work. However, the management of emotions to promote organizational goals and to ensure patient satisfaction may have both positive and negative impacts on nurses' working life. The purpose of this cross-sectional, descriptive study was to examine the emotional labor behaviors of nurses and their opinions on emotional labor. Two hundred nineteen nurses working at public hospitals in Ankara between September and December 2018 participated to this study. Data were collected using the sociodemographic characteristics form and "The Scale of Emotional Labor Behavior for Nurses." Nurses had higher scores on the deep and sincere emotional acting subdimensions of the emotional labor scale than the surface acting subdimension. Findings suggest that nurses act deeply and intimately, instead of surface acting. Most of the nurses expressed that nurses were emotionally affected when caring for patients; however, nurses had to control their feelings toward patients and behave professionally to meet the expectations of their managers, which may lead to an implicit emotional dissonance. Based on the results of this study, we suggest to support nurses emotionally and to incorporate the topic of emotional labor into educational programs.

Expert consensus recommendations on the use of randomized clinical trials for drug approval in psychiatry- comparing trial designs.

The use of randomized clinical trials, in particular placebo-controlled trials, for drug approval, is the subject of long-standing debate in the scientific community and beyond. This study offers consensus recommendations from clinical and academic experts to guide the selection of clinical trial design in psychiatry. Forty-one highly cited clinical psychiatrists and/or researchers participated in a Delphi survey. Consensus statements were developed based on the findings of a published, peer-reviewed systematic review. Participants evaluated statements in two survey rounds, following the Delphi method. The expert panel achieved consensus on 7 of 21 recommendations regarding the use of randomized clinical trials. The endorsed recommendations were: (i) Results from placebo-controlled trials are the most reliable and (ii) are necessary despite the growing placebo-effect; (iii) it is ethical to enroll patients in placebo-arms when established treatment is available, if there is no evidence of increased health risk; (iv) There is a need to approve new drugs with the same efficacy as existing treatments, but with different side-effect profiles; (v) Non-inferiority trials incur an increased risk of approving ineffective medications; (vi) The risk of approving an ineffective drug justifies trial designs that incur higher costs, and (vii) superiority trials incur the risk of rejecting potentially efficacious treatments. The endorsed recommendations inform the choice of trial-design appropriate for approval of psychopharmacological drugs. The recommendations strongly support the use of randomized clinical trials in general, and the use of placebo-controlled trials in particular.

Current molecular and therapeutic advances in liposarcoma, rhabdomyosarcoma, leiomyosarcoma, synovial sarcoma, and angiosarcoma.

Sarcomas probably develop after malignant transformation of embryonic mesenchymal cells and have broad spectrum histopathologically since they can develop from striated skeletal muscle and smooth muscle, fat and fibrous tissue, bone, cartilage and other mesenchymal tissues. The most common histological subtypes of soft tissue sarcoma in adults are: liposarcoma, leiomyosarcoma, poorly differentiated pleomorphic sarcoma, and gastrointestinal stromal tumor. Molecular and genetic studies of soft tissue sarcomas, which are considered as heterogeneous groups in terms of their molecular and clinical characteristics, are still an important area of ​​interest The heterogeneity of the molecular and genetic alterations of these malignancies, which are mostly treated with surgery and chemotherapy, also offers hope to the researchers in terms of treatment targets. In this article, molecular biologic features of the soft tissue sarcomas including liposarcoma, rhabdomyosarcoma, leiomyosarcoma, synovial sarcoma, and angiosarcoma are discussed in the light of recent developments in molecular biology, targeted therapies and immunotherapy.

Innovation in measuring obese patients' blood pressure: measurement with conical wrapping technique.

INTRODUCTION: Accurate measurement of blood pressure (BP) is difficult in obese patients due to their upper arm shape and width. Errors made during BP measurement cause misdiagnosis or lead to wrong treatment. METHOD: The data of this methodological study were collected from 40 patients who were 18 years old or above, with a BMI above 25 kg/m2, and who were followed up with radial catheter arterial pressure in adult intensive care and postoperative care units between March and December 2020. RESULTS: In total 55% of the participants were male with a mean age of 63.9 years, mean height of 165.7 cm, mean weight of 85.2 kg and mean BMI of 31.0 ± 2.1 kg/m2. Intra-arterial BP (IABP) measurement values were found to be correlated with conical wrapping technique and cylindrical wrapping technique (P < 0.001). As a result, a statistically significance was found between conical SBP and intra-arterial SBP (r = 0.921; P < 0.05) and conical DBP and intra-arterial DBP (r = 0.902; P < 0.05). CONCLUSION: It was determined that the SBP and DBP results of the conical wrapping technique were closer to the results obtained by IABP measurements. For this reason, it is more appropriate to measure BP with conical wrapping technique in clinically obese patients.

SD-OCT assessment of macular and optic nerve alterations in patients recovered from COVID-19.

OBJECTIVE: To quantify microstructutal alterations in the macula and peripapillary retinal nerve fibre layer (RNFL) in patients recovered from coronavirus disease 2019 (COVID-19) using spectral domain optic coherence tomography (SD-OCT). DESIGN: Retrospective, observational. PARTICIPANTS: This comparative, cross-sectional study included patients who recovered from COVID-19 (Group 1) and age- and sex-matched normal controls (Group 2). METHODS: A comprehensive ophthalmic examination, including best-corrected visual acuity and biomicroscopic anterior and posterior segment examination was performed. SD-OCT analysis of the macula and peripapillary RNFL was obtained for each participant. In addition, patient demographics and comorbidities were recorded. RESULTS: 238 eyes of 122 subjects (Group 1: n = 63; Group 2: n = 59) were included. The incidence of coexisting comorbidity was higher in Group 1 (n = 26/63, 41.3%) compared with Group 2 (n = 12/59, 20.3%) (p = 0.013). The central foveal thickness (CFT) was significantly higher in Group 1 (271.0±26.8 µm) than Group 2 (263.2±22.0 µm) (p = 0.015). The average outer nuclear layer (ONL) thickness at central fovea in Group 1 (85.4±13.3 µm) was significantly thicker than that in Group 2 (81.4±15.2 µm) (p = 0.035). The mean peripapillary RNFL thickness of Group 1 (102.6±8.8 µm) and Group 2 (100.9±8.3 µm) were similar (p = 0.145). The mean choroidal thickness of groups at the fovea and at 1500 µm nasal and temporal to the fovea were not significantly different (p > 0.05 for all). CONCLUSION: Significant thickness alterations in individual retinal layers and CFT was detected in post-COVID-19 patients. The increase in CFT and ONL thickness might be attributed to direct infection or viral-induced inflammatory response of retina.

Public perceptions about nurses communicated via Twitter in Turkey.

OBJECTIVES: Social media platforms such as Twitter allow people to openly express their views about many topics, including the nursing profession. COVID-19 is currently a frequently searched and discussed topics on Twitter. This study was performed to identify the image of nursing in the social media before and during COVID-19 pandemic in Turkey, and to review of public perceptions about nurses' communication on twitter in Turkey. DESIGN: This study was conducted using content analysis with a sample of tweets posted on Twitter before and during the COVID-19 pandemic. Codes were created, including expressions of respect, anxiety, violence, gratefulness, anger, positivity, and negativity. RESULTS: Findings showed that 35.65% of the 373 tweets posted prior to the COVID-19 pandemic were positive while 64.35% were negative. During the pandemic 91.94% of the 1006 tweets were positive and 8.06% were negative. CONCLUSION: The results of this study suggests that public opinion about nurses, as reflected on Twitter during the COVID 19 pandemic, was positive.

Outcomes associated with different vaccines in individuals with bipolar disorder and impact on the current COVID-19 pandemic- a systematic review.

Bipolar disorder (BD) might be associated with higher infection rates of coronavirus disease (COVID-19) which in turn could result in worsening the clinical course and outcome. This may be due to a high prevalence of somatic comorbidities and an increased risk of delays in and poorer treatment of somatic disease in patients with severe mental illness in general. Vaccination is the most important public health intervention to tackle the ongoing pandemic. We undertook a systematic review regarding the data on vaccinations in individuals with BD. Proportion of prevalence rates, efficacy and specific side effects of vaccinations and in individuals with BD were searched. Results show that only five studies have investigated vaccinations in individuals with BD, which substantially limits the interpretation of overall findings. Studies on antibody production after vaccinations in BD are very limited and results are inconsistent. Also, the evidence-based science on side effects of vaccinations in individuals with BD so far is poor.

The Effect of ShotBlocker Application on Intramuscular Injection Pain in Adults: A Meta-Analysis.

This meta-analysis study was conducted to determine the effects of ShotBlocker application during administration of intramuscular injections to adult patients for providing an evidence-based practice. The PubMed, Scopus, Science Direct, Ovid and Google Scholar databases were used for the literature review. The literature review was conducted by two researchers using the key phrases intramuscular injection AND ShotBlocker AND pain AND adults. According to the result of the meta-analysis, the pain levels in the experiment group in which ShotBlocker was used during IM injection to adult patients was found to be significantly different in comparison to the control group (SMD = -0.769, 95% CI = -1.449 to -0.090, p = .027). As a result of the meta-analysis, it was found that ShotBlocker application in IM injection in adult patients reduced patients' pain intensity. High-quality studies conducted with appropriate research methods are required for achieving a more comprehensive and effective result.

Determining the Spiritual Care Requirements and Death Anxiety Levels of Patients Diagnosed with COVID-19 in Turkey.

Our study was conducted to determine the spiritual care needs and death anxiety levels of individuals diagnosed with COVID-19. The population consisted of patients who were diagnosed with COVID-19 in Turkey. The mean total Spiritual Care Requirements Scale score of the participants was 67.05 ± 26.30. The mean VAS for Death Anxiety score of the participants was 8.82 ± 1.26. In our study, it was found that the patients diagnosed with COVID-19 had an increased need for spiritual care and high levels of anxiety about death.

A comparative study of knotless versus knotted transscleral suture-fixated intraocular lens implantation.

PURPOSE: To compare functional outcomes and complication rates of two scleral fixated intraocular lens implantation (SFIOL) techniques. METHODS: In this retrospective study, there were 30 eyes of 30 patients who underwent SFIOL implantation for dislocation of the IOL or crystalline lens. Group 1 (n = 17) comprised patients who received scleral-fixated polymethylmethacrylate (PMMA) IOL implantation through a self-sealing sclerocorneal tunnel with the suture burial technique, and group 2 (n = 13) comprised patients who received scleral-fixated foldable acrylic IOL implantation with a cartridge using a self-sealing clear corneal incision (CCI) with knotless Z-suture technique between 2014 and 2019. Surgical outcomes concerning safety, efficiency, visual function, induced astigmatism with vector analysis, and complications were compared. RESULTS: The indications were dislocated crystalline lens (n = 5/30), dislocated IOL (n = 17/30), and dropped nucleus (n = 8/30). The mean follow-up time was 50.65 ± 14.02 months in group 1 and 15.69 ± 3.71 months in group 2 (P < 0.001). The postoperative visual acuity improvement was statistically significant in both groups (P < 0.001). Surgically induced astigmatism was significantly higher in group 1 (2.68 ± 1.04 D) compared with group 2 (1.6 ± 1.0 D) at month 12 (P = 0.001). Postoperative complications included suture exposure (n = 1 in group 1) and cystoid macular edema (n = 1 in group 1; n = 1 in group 2). CONCLUSION: Both SFIOL techniques are safe and effective in the absence of adequate capsular support. However, the knotless Z-suture technique appears to be superior to the suture burial technique with regard to suture exposure-related complications. In addition, self-sealing CCI appears to be superior to self-sealing sclerocorneal tunnel with regard to surgically induced astigmatism.