Effect of polymer type on characteristics of buccal tablets using factorial design

A two factor three level factorial design was used to investigate the effects of carbopol and cationic hydrophilic polymers which have a common use in buccal drug formulations. Statistical models with interaction terms were derived to evaluate influence of carbopol (X1) and chitosan (X2) on tablet disintegration (Y1) and dissolution (Y2), mechanical properties (Y3), swelling (Y4). Tablet disintegration studies were carried out using two different pH environments within buccal region pH limits and also two different commonly used dissolution methods for buccal tablets were also investigated to compare the effect of polymer type on dissolution. Polymer type and ratio affect the characteristics of the buccal tablets due to their different physicochemical behavior at buccal pH. Also significant variances between dissolution profiles for buccal tablets, using either USP Paddle or flow through cell methods were found. These results indicate that both polymer type and ratio as well as combination of them effects the drug behavior in different ways.     

Response to controlled ovarian stimulation and oocyte quality in women with myotonic dystrophy type I

Purpose In women the relationship between myotonic dystrophy type I and fertility remains controversial. The objective of this study was to evaluate the ovarian reserve, ovarian response to stimulation and oocyte quality in these patients. Materials and methods We compared 15 myotonic dystrophy type I patients with 39 age matched controls with isolated male factor infertility necessitating ICSI. Results All parameters of ovarian reserve (day 3 FSH and E2, antral follicle count and delta E2) were significantly better in the controls. Despite having significantly lower doses of gonadotrophin, the control group attained a higher number of retrieved oocyte–cumulus complexes (p < 0.04). Analysis of cytoplasmic and extracytoplasmic dysmorphism did not reveal any difference between the two groups. Fertilisation rate and top grade embryos on day 3 were similar in both groups. Conclusion The present study suggests that though women with myotonic dystrophy type I have a reduced ovarian reserve and respond poorly to controlled ovarian stimulation, there is no impact on oocyte and embryo quality. Hence suggesting that successful ART is feasible with appropriate selection in women with mild myotonic dystrophy. Capsule Women with myotonic dystrophy type I have reduced ovarian reserve and respond poorly to controlled ovarian stimulation, though there is no impact on oocyte quality.     

Community-based research: cost of the tests used for anti-HBc total seropositivity only and hepatitis B screening

Our study aimed to determine anti-HBc total (IgG+IgM) seroprevalence in the adult population aged ≥15 and to compare the cost of testing for HBsAg and anti-HBs in only anti-HBc positive (+) subpopulation to that in the whole population for HBV screening. The study involved a face-to-face survey and peripheral blood sampling from 452 adult subjects for HBV tests. HBV-DNA PCR was studied only in anti-HBc(+)subjects. Of the 452 subjects anti-HBc total was positive in 192 (42.47%), of which: (a) 27 (14.06%) were HBsAg(+), anti-HBs negative (-), (b) 126 (65.62%) were HBsAg(-), anti-HBs(+), (c) 39 were HBsAg(-), anti-HBs(-). This last group (c) were tested for HBV-DNA PCR and six (15.38%) were positive. When we perform HBsAg and anti-HBs tests in all 452 subjects as in routine practice in blood banks, the cost is 3320 Euros. However, when all subjects are tested for anti-HBc total at first and then only anti-HBc total(+) ones are tested for HBsAg and anti-HBs, the cost is 2929 Euros. The cost difference between the two methods is 391 Euros for 452 subjects. Accordingly, our HBV screening algorithm brings a financial saving of 11.78% and helps to identify the isolated anti-HBc total(+) subjects who carry potential risk for spreading HBV.     

Procalcitonin can be used as a marker of premature atherosclerosis in acromegaly

The objective of the study was to evaluate arterial morphologic changes of early atherosclerosis and changes in procalcitonin (PCT) levels in patients with acromegaly according to disease activity. Thirty-three active and 20 inactive acromegaly patients followed at Endocrinology-Metabolism out-patient clinic of Cerrahpasa Medical Faculty between 2004 and 2008 were included in the study. Twenty gender and age matched healthy subjects were included as the control group. Intima-media thickness (IMT) of the carotid arteries was measured by ultrasonography. Blood was drawn for biochemical tests and the serum concentrations of C-reactive protein (CRP) and PCT. Intergroup analysis revealed no significant differences between Growth hormone (GH), insulin like growth factor-1 (IGF-1), and IMT (P?=?0.42, P?=?0.47 respectively). No significant differences were found in the fibrinogen, CRP and PCT levels of the acromegaly patients and the subjects in the control group (P?=?0.57, P?=?0.84, P?=?0.68 respectively). In the patients with IMT????1?mm, PCT (0.4 [IQR: 0.4?C0.55]) levels were significantly different from the patients without atherosclerosis (0.06 [IQR: 0.05?C0.12], P?<?0.001). The correlation between IMT and PCT (P?=?0.001, r?=?0.47) was more significant than the correlation between IMT and CRP (P?=?0.01, r?=?0.28). There was a positive correlation between IMT and atherosclerotic risk factors such as age (P?=?0.01, r?=?0.27) and body mass index (BMI; P?=?0.005, r?=?0.32). Our results showed that PCT increases before CRP and it can be useful for the assessment of premature atherosclerosis in acromegaly as well.     

Bahcesehir long-term population-based screening compared to National Breast Cancer Registry Data: effectiveness of screening in an emerging country

PURPOSEWe aimed to show the effects of long-term screening on clinical, pathologic, and survival outcomes in patients with screen-detected breast cancer and compare these findings with breast cancer patients registered in the National Breast Cancer Registry Data (NBCRD).METHODSWomen aged 40–69 years, living in Bahcesehir county, Istanbul, Turkey, were screened every 2 years using bilateral mammography. The Bahcesehir National Breast Cancer Registry Data (BMSP) data were collected during a 10-year screening period (five rounds of screening). BMSP data were compared with the NBCRD regarding age, cancer stage, types of surgery, tumor size, lymph node status, molecular subtypes, and survival rates.RESULTSDuring the 10-year screening period, 8758 women were screened with 22621 mammograms. Breast cancer was detected in 130 patients; 51 (39.2%) were aged 40–49 years. The comparison of breast cancer patients in the two programs revealed that BMSP patients had earlier stages, higher breast-conserving surgery rates, smaller tumor size, more frequent negative axillary nodal status, lower histologic grade, and higher ductal carcinoma in situ rates than NBCRD patients (p = 0.001, for all).CONCLUSIONThese results indicate the feasibility of successful population-based screening in middle-income countries.

Breast cancer is the most frequent cancer and cause of cancer-related deaths among Turkish women, as well as globally (1–5). Although the incidence of breast cancer increases every year, mortality rates are decreasing in developed countries because of nationwide screening programs and modern treatment options (5, 6). An invited mammography screening program for women aged between 40 and 69 years revealed a 60% reduction in cancer-related 10-year mortality in a landmark study (7). A systematic review of Myers et al. (8) showed that breast cancer screening reduced mortality by 20% in average-risk women of all age groups. However, this review did not evaluate the differences between annual and biannual mammographic screening.In 2004, the Cancer Control Department of Turkey recommended biannual mammographic screening for women aged 50–69 years, based on European Guidelines. The population of Turkey is relatively young, and almost half of all breast cancer patients in Turkey are younger than 50 years. According to and National Breast Cancer Registry Data (NBCRD) reports, the starting age for mammography screening was set as 40 years. The Bahcesehir Mammographic Screening Program (BMSP) was the first organized population-based 10-year (2009–2019) mammography screening program in Turkey, a middle-income country.Turkish Federation of Breast Diseases Societies started a voluntary data registry program that was provided by breast surgeons working in secondary or tertiary hospitals. This program aimed to collect detailed information of breast cancer patients and to pool comprehensive country-specific breast cancer data. This registry, namely the NBCRD, was the first specified database on breast cancer in the country and was started in 2005, before the BMSP (9). Data from 36 centers were collected for 10 years. However, the cancer registry is a standard database containing general information as defined by the International Agency for Research on Cancer standards.The aim of this study was to show the feasibility of a population-based breast cancer screening program in an emerging, middle-income country, Turkey. The objective of our study was to evaluate the effectiveness of a population-based breast cancer screening program by comparing it with NBCRD data.     

Differentiating clinical and echocardiographic characteristics of chordal rupture detected in patients with rheumatic mitral valve disease and floppy mitral valve: impact of the infective endocarditis on chordal rupture.

AIMS: We aimed to compare the clinical and echocardiographic correlates of chordal rupture in patients with rheumatic mitral valve disease and floppy mitral valve. METHODS AND RESULTS: The study group comprised of 224 patients who underwent transthoracic and transesophageal echocardiography because of the severe mitral regurgitation. Chordal rupture was detected in 58 (25.9%) out of the 224 patients, in 33 out of the 83 (39.7%) patients with floppy mitral valve, and in 25 out of the 141 (17.7%) patients with rheumatic mitral valve disease. Chordal rupture was more frequently associated with anterior leaflet (80%) in patients with rheumatic mitral valve disease, and posterior leaflet (72.7%) in patients with floppy mitral valve (p<0.05). Univariate correlates of chordal rupture were age, male sex, posterior mitral leaflet thickening and chordal elongation in patients with floppy mitral valve (p<0.05), and chordal shortening (p<0.0001) and infective endocarditis involving mitral anterior leaflet (p<0.05) in rheumatic group. Independent predictors of chordal rupture were age (>50 years), posterior mitral leaflet thickness (> or =0.45cm), and male sex (p<0.05) in patients with floppy mitral valve while infective endocarditis involving mitral anterior leaflet (p<0.05) in patients with rheumatic mitral valve disease. Patients with chordal rupture due to floppy mitral valve had an older age (p<0.0001), a male dominance, longer mitral leaflets and chordae, and a larger mitral annulus circumference (p<0.05) as compared to those with rheumatic chordal rupture. Despite the comparable severity of mitral regurgitation and left atrial diameters between the two groups of chordal rupture (p>0.05), functional class and pulmonary artery systolic pressure were higher, and atrial fibrillation, acute deterioration, infective endocarditis, mitral leaflet rupture and need for mitral valve surgery in the 3 months were more frequent in rheumatic chordal rupture subgroup (p<0.05). CONCLUSION: Chordal rupture seems to be more frequently associated with anterior mitral leaflet in rheumatic mitral valve disease, whereas it was the posterior leaflet in floppy mitral valve. Chordal rupture was related to male sex, older age, posterior leaflet thickening, and chordal elongation in patients with floppy mitral valve. However, infective endocarditis, acute deterioration, and need for early mitral surgery were more frequent in patients with rheumatic chordal rupture.