Evaluation of emergency department admissions of mass casualty patients using the revised trauma score, injury severity score, and trauma and injury severity score.

BACKGROUND: There is a need for studies evaluating prognostic scoring systems in mass trauma patients in conflict regions to predict patient prognosis for emergency surgical prioritization. In this study, we aimed to evaluate scoring systems such as the Revised Trauma Score (RTS), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS) in trauma patients admitted due to mass trauma in Northern Syria. METHODS: This study was a retrospective evaluation of patients admitted due to mass trauma to the emergency departments of hospitals in Northern Syria. The diagnostic efficiency of RTS, ISS, and TRISS scoring systems was evaluated in these admissions in the first half of 2021. RESULTS: The most common causes of mass trauma were bomb blast (67.3%), gunshot (28.8%), and 14 (3.9%) patients admitted with other causes. When the odds ratio (OR) was analyzed, a one-unit increase in the RTS score increased the odds of survival by a factor of 6.133, and a one-unit increase in the TRISS score increased the odds of survival by a factor of 1.057. Differently, it was found that each 1-unit increase in ISS decreased the patient's probability of survival by 0.856 units. When RTS, TRISS, and ISS scores were analyzed, the area under the ROC curve was statistically significant for all of them (p<0.001) and all of them had a diagnostic value for mortality with sensitivities of 99.0%, 94.8%, and 91.9%; specificities of 87.8%, 90.5%, and 88.6; AUC of 0.958, 0.975, and 0.958, respectively. CONCLUSION: The use of trauma scoring systems, especially TRISS, may be useful for prioritizing patients in mass casualty settings in the presence of overcapacity.

A case of seatbelt-induced mesenteric injury and delayed colon ischemia after a car accident.

Trauma is the sixth leading cause of death globally and the leading cause of morbidity and mortality in young patients. Blunt bowel and mesenteric injuries are rare, occuring in only 1-5% of blunt abdominal traumas, and are associated with high morbidity and mortality. In this report, we present a case of a patient with sigmoid colon perforation due to ischemia caused by mesenteric injury, who was admitted to the hospital with abdominal pain two days after a car accident. A twenty-one-year-old man was admitted to the emergency department with abdominal pain and vomiting, having been involved in a car accident as a driver two days prior. Computed tomogra-phy revealed free air in the abdomen, originating from the perforation of the sigmoid colon wall, and free fluid in the pelvic area. The patient underwent immediate laparotomy. Exploration revealed a rupture in the sigmoid mesocolon, causing ischemia and perforation. Additionally, there was a rupture in the mesentery of the terminal ileum close to the ileocecal valve, but without ischemia. Partial sig-moid colon and ileal resections were performed, followed by colocolic anastomosis and double-barrel ileostomy. He was discharged in good health after a 20-day hospital stay. Thorough clinical examination and radiological evaluation can aid in detecting visceral injuries in trauma patients. Early recognition and repair of intestinal damage can prevent severe complications.

Does F-18 FDG-PET/CT Have an Additional Impact on Axillary Approach in Early-Stage Breast Cancer?

Objective: Breast cancer (BC) is a significant health concern and one of the most diagnosed cancers in women, both in Turkey and globally. Despite advances in the management of BC, axillary lymph node involvement remains a significant consideration for treatment planning, local recurrence, and prognosis. We aimed to evaluate the contribution of F-18 fluorodeoxyglucose-positron emission tomography/computed tomography (F-18 FDG-PET/CT) in detecting axillary lymph node metastasis compared to ultrasound (US). Materials and Methods: Eighty patients who were diagnosed with stage I and II BC and underwent US and F-18 FDG-PET/CT scans before surgery were enrolled in this study. Those who did not undergo F-18 FDG-PET/CT imaging, patients with distant metastases at the time of diagnosis and patients with micrometastases in the axilla were excluded from the analysis. Imaging results of the status of axillary lymph nodes were verified with the final pathology report of axillary lymph nodes. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of F-18 FDG-PET/CT for the detection of ipsilateral axillary lymph node metastases were 75%, 77.27%, 72.97%, 79.07%, and 76.25%. The corresponding values for US were 72.22%, 81.82%, 76.47%, 78.26%, and 77.50%, respectively. When US finding is negative or suspicious in axillary lymph node evaluation, the accuracy of F-18 FDG-PET/CT for the detection of ipsilateral axillary lymph node metastases were 65.38%, 83.33%, 70.83%, and 79.55%, respectively. Conclusion: This study found that F-18 FDG-PET/CT does not provide an additional advantage over US in assessing the axilla in early-stage disease.

Nanoemulsions as a Promising Carrier for Topical Delivery of Etodolac: Formulation Development and Characterization.

This research primarily focuses on the development of innovative topical nanoemulsions for etodolac, aimed at surmounting its inherent limitations. The preparation of etodolac nanoemulsions is accomplished through a combination of high shear homogenization and ultrasonication methods. The optimization of the formulation components is systematically conducted using the design of experiments methodology. The droplet size (DS), polydispersity index (PDI), and zeta potential (ZP) of the optimized formulation were assessed using the differential light scattering (DLS) technique. Surface morphology examinations were conducted using electron microscopy, while interactions between excipients and the drug were analyzed through FTIR analysis. Additionally, in vitro release and ex vivo permeability studies were carried out. Furthermore, anti-inflammatory activity was evaluated in the context of a carrageenan-induced paw edema model in rats. The DS, PDI, and ZP of the optimal formulation were 163.5 nm, 0.141, and -33.1 mV, respectively. The in vitro release profile was assessed as a sustained release by following a non-Fickian drug transport. The flux of etodolac nanoemulsions and coarse dispersions were 165.7 ± 11.7 µg/cm2 h and 59.7 ± 15.2 µg/cm2 h, respectively. Enhanced edema inhibition was observed at 13.4%, 36.5%, and 50.65% for the 6th, 8th, and 24th hours, respectively. Taken together, these results confirmed that nanoemulsions are promising carriers for the topical delivery of etodolac.

RELATION OF FEMUR FRACTURES LOCATION WITH CLINICAL OUTCOMES IN ELDERLY PATIENTS.

Objectives: This study was designed to investigate the possible relationship between the anatomical location of the PFF (head-neck fractures) and the demographic features, comorbidities, and risk factors of elderly patients. Methods: 233 patients aged 65 years and over, who were admitted to the emergency department with a diagnosis of proximal femur fracture were included in this study. Results: Most patients (59.6%) had a trochanteric fracture. The incidence of trochanteric fractures had a statistically significant positive correlation with age. Falls at ground level were found to be highly associated with trochanteric fractures (92,8%). At least one complication was observed in 57 (41,0%) cases and 31 (22,3%) died in one year, of the patients with trochanteric fractures. Comorbidity was not related to fracture location statistically. Fall ground level (p = 0.013), complication rate (73.7%; p <0.001), and Charlesen comorbidity index (p = 0.019) were statistically significantly associated with death. The logistic regression analysis of variables determined that only the quantity of comorbidities may be related to femoral neck fractures (p = 0.047). Conclusion: Female patients with trochanteric fractures were found to be older than male patients. Fall ground level, mortality, and complications were more frequently seen in patients with trochanteric fractures. Level of Evidence II, Retrospective study.

Objetivos: Este estudo foi desenhado para investigar a possível relação entre a localização anatômica da PFP (fraturas de cabeça e pescoço) e as características demográficas, comorbidades e fatores de risco de pacientes idosos. Métodos: Foram incluídos 233 pacientes com idade igual ou superior a 65 anos, admitidos no pronto-socorro com diagnóstico de fratura do fêmur proximal. Resultados: A maioria dos pacientes (59,6%) apresentou fratura trocantérica. A incidência de fraturas trocanterianas apresentou correlação positiva estatisticamente significativa com a idade. Verificou-se que as quedas no nível do solo estão altamente associadas às fraturas trocantéricas (92,8%). Pelo menos uma complicação foi observada em 57 (41%) casos e 31 (22,3%) morreram em um ano, dos pacientes com fraturas trocantéricas. A comoborbidade não foi realizada estatisticamente com a localização da fratura. Queda do nível do solo (p = 0,013), taxa de complicações (73,7%; p < 0,001), índice de comorbidade charlesen (p = 0,019) foram estatisticamente significativamente associados à morte. Na análise de regressão logística das variáveis, determinou-se que apenas a quantidade de comorbidades pode estar relacionada às fraturas do colo do fêmur (p = 0,047). Conclusão: Pacientes do sexo feminino com fraturas trocantéricas foram consideradas mais velhas do que pacientes do sexo masculino. Queda no nível do solo, mortalidade e complicações foram observadas com mais frequência em pacientes com fraturas trocantéricas. Nível de evidência II, Estudo retrospectivo .

SPECT/CT Lymphoscintigraphy Accurately Localizes Clipped and Sentinel Nodes After Neoadjuvant Chemotherapy in Node-Positive Breast Cancer.

PURPOSE: The aim of this study was to evaluate the impact of SPECT/CT lymphoscintigraphy on targeted axillary dissection (TAD) in node-positive breast cancer (BC) patients who had undergone neoadjuvant chemotherapy (NAC). METHODS: Sixty-two female BC patients with biopsy-confirmed axillary nodal metastases underwent NAC, followed by breast surgery with TAD. A metallic clip was placed in the sampled LN before NAC. On the day of surgery, a periareolar intradermal 99m Tc-nanocolloid injection was administered, followed by SPECT/CT lymphoscintigraphy. The clipped nodes were localized on CT images, assessed for 99m Tc uptake before surgery, and confirmed during the procedure. RESULTS: T1-4, N1-2 patients were enrolled in the study. All patients underwent sentinel lymph node (SLN) biopsy. The clipped node was the SLN in 54 (88.5%) patients. In 3 patients (4.9%), a clip was found in a nonsentinel lymph node. In 4 patients, the clips were not visible on SPECT/CT images, and lymph nodes were not found during the procedure. SPECT/CT correctly localized the clipped lymph node in all patients. The overall false-negative rate for TAD was 3.33%. The mean follow-up duration was 29 months, and there were no axillary recurrences. CONCLUSIONS: SPECT/CT lymphoscintigraphy can accurately localize clipped nodes and SLNs after NAC in patients with node-positive BC.

Evaluation of prognostic scoring systems in patients hospitalized from the emergency department in a low-income region: northern Syria after internal turmoil as a different universe.

BACKGROUND: In low-income or underdeveloped countries with conflict and internal unrest, healthcare facilities and staff are limited. For these reasons, it is necessary to use the most straightforward scoring systems to ensure that health facilities and staff are used effectively and to expedite processes through early and effective interventions for patients. In this study, we evaluate and compare the scoring systems used to predict patient prognosis for Emergency Department (ED) patients in northern Syria, which is an area marred by conflict and internal unrest. METHODS: In this study, patients hospitalized in the Afrin, Azez Vatan, Jarablus, Tel Abyad, Rasulayn, El Bab, and Çobanbey hospitals in northern Syria were investigated. Only patients that were hospitalized in the emergency departments of these hospitals, including wards and intensive care units, were included in the study. Patients that were hospitalized from 03/01/2021 to 08/31/2021, the study period, were prospectively analyzed. Vital signs, medical histories and demographic data of the patients were recorded by calculating National Early Warning Score 2 (NEWS2), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), and HOTEL Score (hypotension, oxygen saturation, low temperature, electrocardiogram, loss of independence). Acceptance parameters and scores were analyzed using statistical methods and by comparing groups. RESULTS: : All four scoring systems were found to be effective in predicting mortality regarding ROC curve analysis. However, the statistical significance of the RAPS was slightly stronger than that of the other scores and REMS had the highest sensitivity and specificity amongst the four systems, at 86.2% and 84.1%, respectively. Regarding the risk of hospitalization in the ICU (p < 0.05), the sensitivity values of the cut-off values offered by the scoring systems remained below 0.70 regarding ROC curve analysis. RAPS had the highest sensitivity (65.2%) of the four systems with a cut-off value of 1.5. DISCUSSION: This study in northern Syria has shown that although RAPS had stronger statistical power, REMS had better sensitivity and specificity for the prediction of mortality. Additionally, RAPS had better sensitivity for ICU risk. This study will contribute to the evaluation of healthcare in similar regions and to cost-effective healthcare delivery by using scoring systems for ED patients' admission.

Evaluation of clinical outcomes and comparison of prediction models in the burn population hospitalized from the emergency department: Can burn mortality scores be used in a post-conflict area such as northwest Syria?

BACKGROUND: Burns are a global health problem, especially in low- and middle-income countries. The use of models to predict mortality is more common in developed countries. In northern Syria, internal unrest has continued for 10 years. A lack of infrastruc-ture and difficult living conditions increase the incidence of burns. This study in northern Syria contributes to the predictions of health services provided in conflict regions. The first objective of this study specific to northwestern Syria was to assess and identify risk factors in the burn victim population hospitalized as emergencies. The second objective was to validate the three well-known burn mortality prediction scores to predict mortality: the Abbreviated Burn Severity Index (ABSI) score, Belgium Outcome of Burn Injury (BOBI) score, and revised Baux score. METHODS: This was a retrospective analysis of the database of patients admitted to the burn center in northwestern Syria. Patients who were admitted to the burn center as emergencies were included in the study. Bivariate logistic regression analysis was performed to compare the effectiveness of the three included burn assessment systems in determining the risk of patient death. RESULTS: A total of 300 burn patients were included in the study. Of them, 149 (49.7%) were treated in the ward, and 46 (15.3%) in the intensive care unit; 54 (18.0%) died, and 246 (82.0%) survived. The median revised Baux scores, BOBI scores, and ABSI scores of the deceased patients were significantly higher than those of the surviving patients (p=0.000). The cut-off values for the revised Baux, BOBI, and ABSI scores were set at 105.50, 4.50, and 10.50, respectively. For predicting mortality at these cut-off values, the revised Baux score had a sensitivity of 94.4% and a specificity of 91.9%, and the ABSI score had a sensitivity of 68.8% and a specificity of 99.6%. However, the cut-off value of the BOBI scale, calculated as 4.50, was found to be low (27.8%). The low sensitivity and negative predictive value of the BOBI model suggest that it was a weaker predictor of mortality than the others. CONCLUSION: The revised Baux score was successful in predicting burn prognosis in northwestern Syria, a post-conflict region. It is reasonable to assume that the use of such scoring systems will be beneficial in similar post-conflict regions where limited opportunities exist.

Relation of femur fractures location with clinical outcomes in elderly patients / Relação da localização das fraturas de fêmur com desfechos clínicos em pacientes idosos

ABSTRACT Objectives: This study was designed to investigate the possible relationship between the anatomical location of the PFF (head-neck fractures) and the demographic features, comorbidities, and risk factors of elderly patients. Methods: 233 patients aged 65 years and over, who were admitted to the emergency department with a diagnosis of proximal femur fracture were included in this study. Results: Most patients (59.6%) had a trochanteric fracture. The incidence of trochanteric fractures had a statistically significant positive correlation with age. Falls at ground level were found to be highly associated with trochanteric fractures (92,8%). At least one complication was observed in 57 (41,0%) cases and 31 (22,3%) died in one year, of the patients with trochanteric fractures. Comorbidity was not related to fracture location statistically. Fall ground level (p = 0.013), complication rate (73.7%; p <0.001), and Charlesen comorbidity index (p = 0.019) were statistically significantly associated with death. The logistic regression analysis of variables determined that only the quantity of comorbidities may be related to femoral neck fractures (p = 0.047). Conclusion: Female patients with trochanteric fractures were found to be older than male patients. Fall ground level, mortality, and complications were more frequently seen in patients with trochanteric fractures. Level of Evidence II, Retrospective study.

RESUMO Objetivos: Este estudo foi desenhado para investigar a possível relação entre a localização anatômica da PFP (fraturas de cabeça e pescoço) e as características demográficas, comorbidades e fatores de risco de pacientes idosos. Métodos: Foram incluídos 233 pacientes com idade igual ou superior a 65 anos, admitidos no pronto-socorro com diagnóstico de fratura do fêmur proximal. Resultados: A maioria dos pacientes (59,6%) apresentou fratura trocantérica. A incidência de fraturas trocanterianas apresentou correlação positiva estatisticamente significativa com a idade. Verificou-se que as quedas no nível do solo estão altamente associadas às fraturas trocantéricas (92,8%). Pelo menos uma complicação foi observada em 57 (41%) casos e 31 (22,3%) morreram em um ano, dos pacientes com fraturas trocantéricas. A comoborbidade não foi realizada estatisticamente com a localização da fratura. Queda do nível do solo (p = 0,013), taxa de complicações (73,7%; p < 0,001), índice de comorbidade charlesen (p = 0,019) foram estatisticamente significativamente associados à morte. Na análise de regressão logística das variáveis, determinou-se que apenas a quantidade de comorbidades pode estar relacionada às fraturas do colo do fêmur (p = 0,047). Conclusão: Pacientes do sexo feminino com fraturas trocantéricas foram consideradas mais velhas do que pacientes do sexo masculino. Queda no nível do solo, mortalidade e complicações foram observadas com mais frequência em pacientes com fraturas trocantéricas. Nível de evidência II, Estudo retrospectivo.

Awareness of damage control surgery and resuscitation practice: Rational emergency surgical trends in mass trauma events in Syria.

BACKGROUND: Mass trauma is an event in which the number of patients temporarily exceeds the capacity of medical personnel to provide optimal care. Looking at the global terrorism index, Syria is one of the most terrorism-affected countries in the Middle East, and the threat of terrorist attacks that can cause mass trauma persists. When it comes to dealing with mass trauma, the damage control approach has come to the forefront in recent years. In our study, we aimed to assess the awareness and training effectiveness of emergency physicians and surgeons on damage control surgery and resuscitation in Northwest Syria, where mass trauma due to terrorist attacks and social events is common. METHODS: A trauma team from Çobanbey Hospital in Northwest Syria conducted training on damage control and resuscitation. Syrian physicians who participated in this training were administered a damage control and resuscitation questionnaire before and after the training. RESULTS: A total of 43 subjects were enrolled in the study, and their mean age was 44.04±9.01 years. The majority of the physicians who participated in the training were from Elbab (23.3%), Afrin (23.3%), and Çobanbey (20.9%). The average work experience of the physicians was 14 years and the average number of non-elective surgeries performed in the last year was 47.5. While the average total score (pre-test) before the training was 67, the average total score (post-test) after the training increased to 72, and this difference was statistically significant (p=0.008). While the pre-test and post-test scores of those who were trained and had practiced placing intrathoracic clamp-wound clamp and trauma laparotomy were significantly higher than those who were not trained and had not used them (p<0.05), the difference between the pre-test and post-test scores of those who were not trained and had not used them was statistically significant (p<0.05). CONCLUSION: It is well known that there have been internal unrest and terrorist attacks in Northwest Syria for more than 10 years. It is important for physicians in this region to know the damage control strategies. In this regard, we have found that awareness among physicians has increased as a result of the training we have provided on damage control.

Evaluation of wound healing potential of new composite liposomal films containing coenzyme Q10 and d-panthenyl triacetate as combinational treatment.

Conventional formulations can not achieve wound healing efficiently and fail to accelerate wound regeneration. To overcome these problems, it was planned to develop nanoformulations that perform a positive effect on the wound healing duration and are suitable for topical use. In this study, liposomal film formulations that encapsulated d-panthenyl triacetate (PTA) and coenzyme Q10 (CoQ10) were optimized by using response surface methodology (RSM) and were analyzed for their wound healing efficacy and cytotoxicity on fibroblast (CCD1079 Sk) and keratinocyte (HEKa) cells. Swelling index, puncture strength, and puncture deformation values, which were choosen as dependent variables for the liposomal film formulation were found as 556.9% ± 21.3, 3.98 ± 0.98 N/mm2, and 6.57% ± 1.12, respectively. Cumulative release of 65.32% for PTA and 12.23% for CoQ10 was obtained after 24 hours of in vitro release study in sink conditions. The in vitro cytotoxicity and wound healing assay results suggested that optimum formulation could be used safely on fibroblast and keratinocyte cells and provided wound closure entirely after 24 h. Consequently, the optimum liposomal film containing PTA and CoQ10 formulations could be proposed as an innovative approach in wound healing treatment, considering their release, mechanical properties, stability, and effectiveness.

Facial paralysis as the only symptom of COVID-19: A prospective study.

PURPOSE: Idiopathic facial palsy is called as Bell's palsy and reports showed that facial paralysis increased during COVID-19 pandemic period. There are many reports about the relationship between COVID-19 and facial paralysis but there is no prospective study. SARS-CoV-2 IgG and IgM antibodies increase in COVID-19. Our purpose is to investigate SARS-CoV-2 IgG + IgM antibody in the Bell's palsy. METHODS: Prospective cross-sectional study was planned. Patients with acute peripheral facial paralysis with no reason and diagnosed as Bell's palsy was included in the study. In order to investigate SARS-CoV-2 in the etiologies of these patients, SARS-CoV-2 IgM + IgG (total) test was studied. SARS-CoV-2 IgG + IgM was measured by using the ADVIA Centaur® test kit. Test reports result in index values and as nonreactive or reactive. The results were analyzed. RESULTS: Forty-one patients were included in the study. The average age of the patients was 41,7. 17 (41,4%) were female and 24 (58,6%) were male. 21 patients had left-sided; 20 had right-sided paralysis. SARS-CoV-2 IgG + IgM values were measured two times of the patients. First control was in the first week of facial paralysis, 10 (24,3%) positivity was found. The average index of the positive patients were 6,74 (min.1,39-max.10) in the first control and 9,585 in the second control (min.8,7-max. 10). CONCLUSION: We found that the SARS-CoV-2 IgM + IgG antibody test was positive in 24.3% of the patients with Bell's palsy. The results are higher than the seroprevalence studies conducted in asymptomatic individuals. Facial paralysis could be the only symptom of COVID-19 but further studies must be done.

Prognostic value of thiol/disulfide homeostasis in symptomatic patients with heart failure.

We aimed to examine the role of thiol/disulphide homeostasis (TDH) in heart failure and its stages and the prognosis of heart failure. A total of 140 subjects were included in the study. Total and native thiol levels were higher in the control group compared to the patient groups (p < .001). While the average disulphide/total thiol ratio was similar in groups 1 and 2, it was found to be significantly lower in the control group compared to other groups and significantly higher in group 3 compared to other groups (p < .05). Mean native thiol and total thiol levels were found lower in patients with mortality compared to surviving patients (p < .001). In ROC curve analysis, it was determined that the total thiol level had 81.8% sensitivity and 83.1% specificity, and native thiol level had 81.8% sensitivity and 84.3% specificity. We found that TDH was impaired in favour of disulphide in cases of heart failure.

Injuries related to animal sacrifice during the Feast of Sacrifice in Turkey.

BACKGROUND: The Feast of Sacrifice is a significant annual religious festival in Muslim countries. In these festivals, thousands of animals are usually sacrificed by inexperienced individuals. Thus, many injuries occur during sacrificing of animals. OBJECTIVES: Describe injuries related to animal sacrifice or meat processing. DESIGN: Cross-sectional descriptive study. SETTINGS: Three hospitals in different cities of Turkey. SUBJECTS AND METHODS: Severity and type of injuries that occur during animal sacrifice or meat processing after the sacrifice and hospital costs. MAIN OUTCOME MEASURES: Identification and classification of sacrifice related injuries. SAMPLE SIZE: 301 injured individuals. RESULTS: The mean age of the patients was 42.5 (14.8) years and 83.1% of the subjects were male. Most (90.0%) injuries were penetrating injuries and 10.0% were blunt traumas. Upper and lower extremity injuries were identified in 77.4% and 17.9% of cases, respectively. Almost half of the injuries were on the left hand (49.8%). Almost all (96.6%) cases were treated and discharged from emergency services. Median hospital cost per patient was 103.14 Turkish Liras (35.95-852.66 Turkish Liras) (19.53 USD [6.80-161.48 USD]). CONCLUSIONS: Even though injuries related to animal sacrifice are usually caused by minor sharp objects, they can be severe and life threatening on rare occasions. To minimize the injuries that may occur during this period, public education and more convenient sacrifice centers may be helpful. LIMITATIONS: Small sample, single country, and short duration of the study. CONFLICT OF INTEREST: None.

Targeted Nanomedicines for Cancer Therapy, From Basics to Clinical Trials.

Traditional systemic chemotherapy involves the wide distribution of drug molecules in the body, causing toxic side effects in the healthy tissues and limiting the therapeutic dose required at the site of drug action. In order to decrease side effects and increase the drug efficacy, recent research on chemotherapy focuses on drug targeting. Targeted therapy can be achieved by several mechanisms including; 1) using an antibody as a drug that is specific to a disease biomarker, 2) using an antibody (or peptide) as a targeting agent conjugated to the drug molecule, 3) delivering the drug molecules to the target tissue in a nano-carrier with or without the targeting agent attached on its surface. The third approach involves the nanomedicines that can be targeted to diseased tissues by both passive (extravasating at diseased sites due to leaky vasculature) and active (specific interaction of the targeting agent with disease biomarker) targeting mechanisms. In this review we will cover the passively targeted nanomedicines prepared using nano drug carriers. Ideally the carrier particle should be in the right size (1-100nm), stable enough to prevent drug leakage during circulation, and safe not to cause any damage to healthy tissues. Competition for all these properties generated many different types of materials to be used as nanodrug delivery systems. After a brief review of most commonly used drug carriers, we discuss the clinical use of the targeted nanomedicines with regard to their pharmacokinetic and pharmacodynamics properties, and how these properties vary from conventional formulations providing free drugs in the circulation after administration.

Inhibition of Amyloid ß Aggregation Using Optimized Nano-Encapsulated Formulations of Plant Extracts with High Metal Chelator Activities.

BACKGROUND: The role of Fe+2, Cu+2 and Zn+2 in facilitating aggregation of Amyloid ß (Aß) and consequently, the progression of Alzheimer's disease (AD) is well established. OBJECTIVE: Development of non-toxic metal chelators is an emerging era in the treatment of AD, in which complete success has not been fully achieved. The purpose of this study was to determine plant extracts with high metal chelator and to encapsulate them in nano-micellar systems with the ability to pass through the Blood Brain Barrier (BBB). METHODS: Extracts of 36 different Anatolian plants were prepared, total phenolic and flavonoid contents were determined, and the extracts with high content were examined for their Fe+2, Cu+2 and Zn+2 chelating activities. Apolipoprotein E4 (Apo E) decorated nano-formulations of active extracts were prepared using Poly (Lactide-co-Glycolide) (PLGA) (final product ApoEPLGA) to provide BBB penetrating property. RESULTS: Verbascum flavidum aqueous extract was found as the most active sample, incubation of which, with Aß before and after metal-induced aggregation, resulted in successful inhibition of aggregate formation, while re-solubilization of pre-formed aggregates was not effectively achieved. The same results were obtained using ApoEPLGA. CONCLUSION: An optimized metal chelator nano-formulation with BBB penetrating ability was prepared and presented for further in-vivo studies.

Deionized water can substitute common bleaching agents for nonvital tooth bleaching when treated with non-thermal atmospheric plasma.

The bleaching efficacy of common bleaching agents and deionized water treated with non-thermal atmospheric pressure plasma in the pulp chamber for nonvital tooth bleaching was evaluated. A total of 120 extracted human maxillary first incisors were stained using human blood. Teeth were randomly divided into eight groups (n = 15). In the first four groups, teeth were bleached using 35% hydrogen peroxide gel, 37% carbamide peroxide gel, 2:1 (w/v) sodium perborate paste, and deionized water for 30 min. In the remaining groups, bleaching agents were treated with non-thermal atmospheric plasma for 5 min inside the pulp chamber. Overall color changes (∆E) were determined using Commission Internationale de L'Eclairage Lab Colour System. The plasma-assisted tooth bleaching has not increased tooth temperature beyond 37°C. Bleaching efficacies of bleaching agents were significantly improved when treated with non-thermal atmospheric plasma compared to their application (P < 0.05). A remarkable bleaching effect was obtained when bleaching agents were substituted with water and when treated with non-thermal atmospheric plasma. Non-thermal atmospheric plasma treatment could be a novel tool for activation of bleaching agents in the pulp chamber for nonvital tooth bleaching procedure. Moreover, water could be used as a novel bleaching agent when treated with the non-thermal atmospheric plasma to eliminate possible risks which might arise from peroxide-containing agents.

Risperidone mucoadhesive buccal tablets: formulation design, optimization and evaluation.

The aim of this study was to design and optimize risperidone (RIS) mucoadhesive buccal tablets for systemic delivery as an alternative route. Direct compression method was used for the preparation of buccal tablets, and screening studies were conducted with different polymers to determine their effects on tablet characteristics. Carbopol® (CP) and sodium alginate (SA) were selected as two polymer types for further optimization studies by applying response surface methodology. Tablet hardness (TH), ex vivo residence time (RT), and peak detachment force (DF) from buccal mucosa were selected as three important responses. Physicochemical compatibility of formulation excipients and RIS was evaluated by using Fourier transform infrared (FT-IR) spectroscopy and differential scanning calorimetry (DSC) analysis. In vitro drug release profiles and release kinetics were investigated; swelling index and matrix erosion studies were conducted. Optimum formulation consisted of 16.4% CP and 20.3% SA, which provided 7.67±0.29 hour ex vivo RT, 45.52±4.85 N TH, and 2.12±0.17 N DF. FT-IR spectroscopy and DSC analysis revealed that there was no chemical interaction present between tablet ingredients. Cumulative RIS release of >90% was achieved after 8 hours of in vitro dissolution studies, which was supported by swelling and matrix erosion analysis. Mechanism of RIS release was fitted best to zero-order model, while release exponent (n) value of 0.77 demonstrated an anomalous (non-Fickian) release, indicating combined erosion and swelling mechanism. The results suggested that optimized buccal tablets of RIS would be a promising and alternative delivery system for the treatment of schizophrenia.

Therapeutic potential of drug delivery by means of lipid nanoparticles: reality or illusion?

BACKGROUND: Solid lipid nanoparticles (SLN) are colloidal drug carrier systems that contribute several properties required from a sophisticated drug delivery system for increasing drug bioavailability and providing effective therapy. Many advantages of SLN have been reported over traditional dosage forms and their colloidal counterparts in the studies since the early 1990s. They were optimized for oral drug delivery for the first time. The first SLN formulations were produced by reducing the particle size of solid lipid microparticles by spray congealing technique in the late 1980s. Then, studies have been continued investigating for their different administration routes else including parenteral, transdermal, ocular, nasal, respiratory etc. METHODS: Their foremost qualifications such as their biocompatible nature and high drug entrapment efficiency make them promising colloidal drug carrier systems for the effective treatment of serious disasters like genetic disorders and cancer. CONCLUSION: In this review, therapeutic potential of drug delivery of SLN and nanostructured lipid carriers (NLC, the second generation of SLN) are summarized considering researches and patents on their administration via different routes and their preparations in the pharmaceutical market.