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Öğe Cholinergic system in patients with chronic kidney disease: cognitive and renal implications(2025) Xu, Hong; Eriksdotter, Maria; Hafez, Gaye; Sumonto, Mitra; Bruchfeld, Annette; Pesic, Vesna; Unwin, Robert; Wagner, Carden A.; Massy, Carsten; Massy, Ziad A.; Zoccali, Carmine; Pepin, Marion; Capasso, Giovambattista; Liabeuf, Sophie; CONNECT Action (Cognitive Decline in Nephro-Neurology European Cooperative Target)Cholinergic synapses are widespread throughout the human central nervous system. Their high density in the thalamus, neocortex, limbic system, and striatum suggests that cholinergic transmission plays a vital role in memory, attention, learning and other higher cognitive functions. As a result, the brain's cholinergic system occupies a central position in research on normal cognition and age-related cognitive decline, including dementias such as Alzheimer's disease. In addition to its role in the brain, neuronal cholinergic pathways are essential for the physiological regulation of bodily organs, including the kidneys, through the parasympathetic branch of the peripheral nervous system. Chronic kidney disease (CKD) is a non-communicable disease with a global prevalence of approximately 10%. Cognitive impairment is common among patients with CKD, with reported prevalence rates ranging from 30% to 60%, depending on definitions and assessment methods used. Given the importance of the cholinergic system in cognitive processes, it may be a key area of focus for evaluating cognitive function in this population. In this current narrative review, we will first examine evidence linking the cholinergic system to cognitive functions; with a specific focus on drugs that affect this system. we will then discuss the potential implications of cholinergic function in patients with CKD.Öğe The interface of depression and diabetes: treatment considerations(2025) Fanelli, Giuseppe; Raschi, Emanuel; Hafez, Gaye; Matura, Silke; Schiweck, Carmen; Poluzzi, Elisabetta; Lunghi, CarlottaThis state-of-the-art review explores the relationship between depression and diabetes, highlighting the two-way influences that make treatment challenging and worsen the outcomes of both conditions. Depression and diabetes often co-occur and share genetic, lifestyle, and psychosocial risk factors. Lifestyle elements such as diet, physical activity, and sleep patterns play a role on the development and management of both conditions, highlighting the need for integrated treatment strategies. The evidence suggests that traditional management strategies focusing on either condition in isolation fall short of addressing the intertwined nature of diabetes and depression. Instead, integrated care models encompassing psychological support and medical management are recommended to improve treatment efficacy and patient adherence. Such models require collaboration across multiple healthcare disciplines, including endocrinology, psychiatry, and primary care, to offer a holistic approach to patient care. This review also identifies significant patient-related barriers to effective management, such as stigma, psychological resistance, and health literacy, which need to be addressed through patient-centered education and support systems. Future directions for research include longitudinal studies in diverse populations to further elucidate causal relationships and the exploration of novel therapeutic targets, as well as the effectiveness of healthcare models aimed at preventing the onset of one condition in individuals diagnosed with the other.Öğe Clinical research framework proposal for ketogenic metabolic therapy in glioblastoma(2024) Duraj, Tomas; Kalamian, Miriam; Zuccoli, Giulio; Maroon, Joseph C.; D'Agostino, Dominic P.; Scheck, Adrienne C.; Poff, Angela; Winter, Sebastian F.; Hu, Jethro; Klement, Rainer J.; Hickson, Alicia; Lee, Derek C.; Cooper, Isabella; Kofler, Barbara; Schwartz, Kenneth A.; Phillips, Matthew C. L.; Champ, Colin E.; Zupec-Kania, Beth; Tan-Shalaby, Jocelyn; Serfaty, Fabiano M.; Omene, Egiroh; Arismendi-Morillo, Gabriel; Kiebish, Mİchael; Cheng, Rİchard; El-Sakka, Ahmed M.; Pflueger, Axel; Mathews, Edward H.; Worden, Donese; Shi, Hanping; Cincione, Raffaele Ivan; Spinosa, Jean Pierre; Slocum, Abdul Kadir; İyikesici, Mehmet Salih; Yanagisawa, Atsuo; Pilkington, Geoffrey J.; Chaffee, Anthony; Abdel-Hadi, Wafaa; Elsamman, Amr K.; Klein, Pavel; Hagihara, Keisuke; Clemens, Zsofia; Yu, George W.; Evangeliou, Athanasios E.; Nathan, Janak K.; Smith, Kris; Fortin, David; Dietrich, Jorg; Mokherjee, Purna; Seyfried, Thomas N.Glioblastoma (GBM) is the most aggressive primary brain tumor in adults, with a universally lethal prognosis despite maximal standard therapies. Here, we present a consensus treatment protocol based on the metabolic requirements of GBM cells for the two major fermentable fuels: glucose and glutamine. Glucose is a source of carbon and ATP synthesis for tumor growth through glycolysis, while glutamine provides nitrogen, carbon, and ATP synthesis through glutaminolysis. As no tumor can grow without anabolic substrates or energy, the simultaneous targeting of glycolysis and glutaminolysis is expected to reduce the proliferation of most if not all GBM cells. Ketogenic metabolic therapy (KMT) leverages diet-drug combinations that inhibit glycolysis, glutaminolysis, and growth signaling while shifting energy metabolism to therapeutic ketosis. The glucose-ketone index (GKI) is a standardized biomarker for assessing biological compliance, ideally via real-time monitoring. KMT aims to increase substrate competition and normalize the tumor microenvironment through GKI-adjusted ketogenic diets, calorie restriction, and fasting, while also targeting glycolytic and glutaminolytic flux using specific metabolic inhibitors. Non-fermentable fuels, such as ketone bodies, fatty acids, or lactate, are comparatively less efficient in supporting the long-term bioenergetic and biosynthetic demands of cancer cell proliferation. The proposed strategy may be implemented as a synergistic metabolic priming baseline in GBM as well as other tumors driven by glycolysis and glutaminolysis, regardless of their residual mitochondrial function. Suggested best practices are provided to guide future KMT research in metabolic oncology, offering a shared, evidence-driven framework for observational and interventional studies.Öğe Antioxidant, anti-tyrosinase activities and characterization of phenolic compounds for some plants from the Marmara Region, Türkiye(2024) Meriç, Zehra İlke; Nath, Ebru Özdemir; Doğan, Ahmet; Bitiş, LeylaIn this study, antioxidant, anti-tyrosinase, and sun protection factor (SPF) values of 26 extracts obtained from 24 plants naturally grown in the Marmara Region were investigated, and phenolic compound characterization of 8 active plants was performed. All of the plants mentioned in this study have been evaluated for their Sun Protection Factor (SPF) values for the first time, as well as 3 of them evaluated for antioxidant activity and 15 of them evaluated for tyrosinase inhibition for the first time. The results showed that the plant extracts generally exhibited high antioxidant activities. In terms of DPPH radical scavenging activity, Cota tinctoria (L.) J. Gay exhibited a very close IC50 value (0.038 mg/mL) to the standard compounds, ascorbic acid and quercetin. Plantago major L. subsp. intermedia (Gilib.) Lange demonstrated the highest CUPRAC radical scavenging activity (0.187 mM ascorbic acid equivalent). Hypericum perforatum L. was determined to have the highest total phenolic content (0.268 mg GAE g/extract). Among the plant extracts, Sambucus ebulus L. fruit extract exhibited the highest tyrosinase inhibition (IC50 0.08 mg/mL), showing a similar effect to the standard compound kojic acid. The extract with the highest SPF value was calculated Inula oculuschristi L. extract, with a value of 28.55. The phenolic compound analysis of eight plants, which have been determined to exhibit high efficacy in both antioxidant activities and tyrosinase inhibition, was conducted. Some of phenolic compounds obtained from these eight plants were novel for these species. According to the experiments conducted in this study, Euphorbia helioscopia has high potential as natural sources of antioxidants and skin whiteners.Öğe Identifying and presenting key country-specific indicators related to medication adherence: a comprehensive study across European countries(2024) Agh, Tamas; Garuoliene, Kristina; Granas, Anne Gerd; Gregorio, Joao; Aksoy, Nilay; Khanyk, Nataliia; Hadziabdic, Maja Ortner; Kardas, Przemyslaw; European Network to Advance Best Practices and Technology on Medication Adherence (ENABLE) CollaboratorsThis study tackles the critical challenge of medication non-adherence in healthcare by pinpointing indicators related to medication adherence (IRMAs) across 39 European countries and Israel. Utilizing a structured expert survey methodology within the European Network to Advance Best Practices and Technology on Medication Adherence (ENABLE; COST Action CA19132), our research identified key country-specific IRMAs and collected data on these indicators to understand the multifaceted nature of medication adherence. The research was conducted in two phases: firstly, defining key IRMAs through a two-round expert survey, and secondly, gathering country-specific data on these IRMAs through literature reviews and additional expert surveys. The study revealed a diverse range of 26 top-ranked IRMAs, including six related to country characteristics, four to social/economic factors, three each to therapy-related and patient-related factors, one to condition-related factors, and nine to healthcare system-related factors. The availability of country-specific data on these IRMAs varied among the countries, highlighting the need for more comprehensive data collection and research. The findings from this study not only underscore the complexity of predicting medication adherence but also lay the groundwork for developing targeted, country-specific interventions to improve adherence. Moreover, this research offers valuable insights for policymakers, highlighting the importance of understanding the multifaceted nature of medication adherence and offering a valuable resource in formulating targeted health policies to enhance health outcomes and reduce the economic burden associated with medication non-adherence.Öğe Insecticidal and AChE inhibitory activities of Matricaria chamomilla var. recutita essential oils collected from different regions against storage insect pests(Elsevier Ltd, 2024) Alkan, Mustafa; Servi, Hüseyin; Karakoç, Ömer Cem; Ertürk, Sait; Yücel, Yasemin Yücel; Polatoğlu, KaanThe essential oils of the flowers of Matricaria chamomilla var. recutita from İstanbul and Bursa were analyzed by GC-MS. The essential oil yields were 0.32 and 0.18 v/w, respectively. The main components of the essential oil of the İstanbul sample were bisabolene oxide (41.81%), (E)-β-Farnesene (7.52%), and bisabolol oxide B (3.18%). The main components of the oil from the Bursa sample were bisabolol oxide A (47.76%), (E)-β-Farnesene (12.75 %), bisabolol oxide B (3.47%), and bisabolene oxide (2.46%). The fumigant and contact insecticidal effects of these oils were determined against Sitophilus granarius, S. oryzae (Coleoptera: Curculionidae), Tribolium confusum, and T. castaneum (Coleoptera: Tenebrionidae). Additionally, the ovicidal effect of the oils was tested against T. confusum and Oryzaephilus surinamensis (Coleoptera: Silvanidae). The highest fumigant toxicity was observed against S. granarius, S. oryzae, and T. confusum (74.9–96.6% mortality) at the 20% application dose. The fumigant effect of the oils against T. castaneum was lower than the effect observed for other insect species. The highest contact toxicity was observed against S. granarius and S. oryzae (100% mortality) at a 100 μL/mL application dose. In terms of ovicidal efficacy, the oils obtained from Istanbul and Bursa were 19.7–37.7% effective on T. confusum eggs, while this ratio was 53.4–48.3% on O. surinamensis, respectively. Acetylcholinesterase inhibition of the oils was also investigated, and both oils produced mediocre activity.Öğe Phytochemical profiling, therapeutic target enzymes inhibitory, antioxidant, and cytotoxic potential of Cardopatium corymbosum(Elsevier B.V., 2024) Hasbal-Çelikok, Gözde; Çakmak, Nermin; Çelikok, Yasin; Duranay, Servet; Gürdal, Bahar; Nath, Ebru Özdemir; Yılmaz-Özden, TuğbaCardopatium corymbosum (L.) Pers. (Asteraceae) has been used ethnomedicinally against intestinal worms, for skin diseases, and in wound treatment. This study investigated the phytochemical profile and biological activities of ethanol (CCE), methanol (CCM), and water (CCW) extracts of C. corymbosum. LC-MS/MS analysis revealed the presence of various metabolites. Antioxidant activities of the extracts were determined by measuring 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging activities and ferric-reducing power (FRAP). The cytotoxicity against human breast cancer (MCF-7) and human umbilical vein endothelial (HUVEC) cell lines were determined using the (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) (MTT) assay. Enzyme inhibitory activities against α-amylase, α-glucosidase, acetylcholinesterase (AChE), butyrylcholinesterase (BChE), thioredoxin reductase (TrxR), and elastase were measured to assess potential antidiabetic, anti-Alzheimer's, anticancer, and antiaging/wound healing effects. CCM exhibited the highest total phenolic and flavonoid contents and antioxidant activity. Fumaric acid, chlorogenic acid, vanillic acid, and rutin were identified as major components in CCM. C. corymbosum extracts, particularly those from CCE and CCM, displayed significant cytotoxicity on MCF-7 cells while exhibiting lower toxicity towards HUVEC cells. Notably, CCM demonstrated potent α-glucosidase inhibitory activity, while no α-amylase inhibition was observed. All extracts showed weak inhibition of AChE, BChE, and elastase. Conversely, the extracts displayed moderate TrxR inhibitory activity. These findings suggest that C. corymbosum possesses significant antioxidant, enzyme inhibitory, and cytotoxic potential, highlighting its promise as a source of novel bioactive molecules.Öğe Applications of chitosan in prevention and treatment strategies of infectious diseases(2024) Sinani, Genada; Sessevmez, Melike; Şenel, SevdaChitosan is the most commonly investigated functional cationic biopolymer in a wide range of medical applications due to its promising properties such as biocompatibility, biodegradability, and bioadhesivity, as well as its numerous bioactive properties. Within the last three decades, chitosan and its derivatives have been investigated as biomaterials for drug and vaccine delivery systems, besides for their bioactive properties. Due to the functional groups in its structure, it is possible to tailor the delivery systems with desired properties. There has been a great interest in the application of chitosan-based systems also for the prevention and treatment of infectious diseases, specifically due to their antimicrobial, antiviral, and immunostimulatory effects. In this review, recent applications of chitosan in the prevention and treatment of infectious diseases are reviewed, and possibilities and limitations with regards to technical and regulatory aspects are discussed. Finally, the future perspectives on utilization of chitosan as a biomaterial are discussed.Öğe Adherence to the antirheumatic drugs: a systematic review and meta-analysis(2024) Aksoy, Nilay; Öztürk, Nur; Agh, Tamas; Kardas, PrzemyslawIntroduction: This systematic review and meta-analysis aimed to analyze the adherence rate for conventional and biological disease-modifying antirheumatic drugs (DMARDs) utilizing different assessment measures. Method: A systematic literature search was performed in four electronic databases, including PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL), covering the time frame from April 1970 to April 2023. Studies that present data on medication adherence among adult patients with rheumatoid arthritis (RA), specifically focusing on DMARDs (conventional or biological), were included in the analysis. The adherence rate for different assessment measures was documented and compared, as well as for conventional and biological DMARDs. A random-effects meta-analysis was performed to assess adherence rates across different adherence assessment measures and drug groups. Results: The search identified 8,480 studies, out of which 66 were finally included in the analysis. The studies included in this meta-analysis had adherence rates ranging from 12 to 98.6%. Adherence rates varied across several adherent measures and calculation methods. Using the subjective assessment measures yielded the outcomes in terms of adherence rate: 64.0% [0.524, 95% CI 0.374-0.675] for interviews and 60.0% [0.611, 95% CI 0.465-0.758] for self-reported measures (e.g., compliance questionnaires on rheumatology CQR-5), p > 0.05. In contrast, the objective measurements indicated a lower adherence rate of 54.4% when using the medication event monitoring system (p > 0.05). The recorded rate of adherence to biological DMARDs was 45.3% [0.573, 95% CI 0.516-0.631], whereas the adherence rate for conventional DMARDs was 51.5% [0.632, 95% CI 0.537-0.727], p > 0.05. In the meta-regression analysis, the covariate "Country of origin" shows a statistically significant (p = 0.003) negative effect with a point estimate of -0.36, SE (0.12), 95% CI, -0.61 to -0.12. Discussion: Despite its seemingly insignificant factors that affect the adherence rate, this meta-analysis reveals variation in adherence rate within the types of studies conducted, the methodology used to measure adherence, and for different antirheumatic drugs. Further research is needed to validate the findings of this meta-analysis before applying them to clinical practice and scientific research. In order to secure high reliability of adherence studies, compliance with available reporting guidelines for medication adherence research is more than advisable.Öğe Assessment of primary health-care providers’ knowledge of Alzheimer’s disease in Turkey(Emerald Publishing, 2024) Ayhan, Yunus Emre; Özmen, Muhammet; Öztürk, Nur; Aksoy, NilayPurpose: Alzheimer’s disease (AD) is the primary cause of dementia in elderly people and needs extensive professional care. The aim of our study was to assess the level of knowledge among primary health-care providers, primarily Family Physicians (FPs) and community pharmacists (CPs), about AD and its treatment. Design/methodology/approach: A cross-sectional study using Google Forms sent by email or message to FPs and CPs in Istanbul in June–July 2023. Turkish modified the Alzheimer’s Disease Knowledge Scale (ADKS) and Alzheimer’s Medicines Knowledge Level Questionnaire (AMKLQ) were used in this study. Findings: A total of 63 FPs with a mean age of 35.3 ± 7.8 and 138 CPs with a mean age of 38.6 ± 12.6 enrolled in the study. There was no statistically significant difference between FPs and CPs in terms of total ADKS score (19.82 ± 2.30 vs 19.23 ± 3.08, p = 0.136), but there was a significant difference in terms of total AMKLQ score (4.31 ± 1.40 vs 3.81 ± 1.49, p = 0.020). Health-care providers with Alzheimer’s training had a higher total AMKLQ score (OR =1.08 CI 95% [1.03–1.14], p = 0.012). Originality/value: FPs’ knowledge of AD is on par with that of CPs. Nevertheless, it has been observed that FPs have more proficiency in delivering accurate responses to the AMKLQ and ADKS inquiries, which encompass crucial details regarding the treatment of AD. The sole determinant of the highest mean AMKLQ score was found to be professional education. Collectively, these arguments emphasize the need for primary health-care practitioners to obtain comprehensive and ongoing education regarding AD and its treatment.Öğe Investigation of antioxidant, antityrosinase, anticollagenase and cytotoxic effects of some Asphodelus species as potential dermocosmetic agent(2024) Badem, Merve; Kanbolat, Şeyda; Kanbolat, Şeyda; Çolak, Nevin Ulaş; Şener, Sıla Özlem; Ali, Yasemin Altun; Erdemir, Burcu; Sarı, Sena; Şenel, Hatice; Arıkan, Fatma; Nath, Ebru ÖzdemirVarious studies have reported the antimicrobial, antifungal, and antioxidant effects of Asphodelus species. These species are used in the treatment of various skin-related issues such as acne, abscesses, psoriasis, burns, alopecia, wound healing, and eczema in folk medicine. The purpose of the present study is to determine the antioxidant, antityrosinase, anticollagenase and cytotoxic effects of Asphodelus aestivus and Asphodelus fistulosus as potential dermocosmetic agent, as well as the phenolic substance profiles of the species by Reversed phase high performance liquid chromatography (RP-HPLC). Antioxidant capacity of the species was determined by total phenolic and flavonoid content determination, cupric ion reducing power (CUPRAC), ferric ion reducing power (FRAP) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity assays. Enzyme inhibition studies were conducted spectrophotometrically. The cytotoxic activity was analyzed by the 3-(4, 5-dimethylthiazolyl-2)-2, 5diphenyltetrazolium bromide (MTT) assay. As a result, it was determined that the methanolic extracts obtained from the species showed strong antioxidant activity. Based on the CUPRAC and DPPH results, A. aestivus was found to be more effective while according to the FRAP results, A. fistulosus exhibited greater effectiveness. A. fistulosus was discovered to be abundant in phenolic substances, while A. aestivus was found to be richer in flavonoids. It has also been observed that the methanolic extracts have a high inhibitory effect on collagenase and tyrosinase enzymes. It is believed that the species can be used as a potential resource in the treatment of skin aging and hyperpigmentation problems in the dermocosmetic industry. It is thought that the data obtained in the study will lead to further studies.Öğe Development of phytotherapeutic nanoformulation containing Gypsophila eriocalyx and its evaluation as a candidate formulation for osteoporosis treatment on human bone marrow stem cells(2024) Kaymak, Sibel; Kurtur, Ozan Barış; Gök, Bahar; Budama-Kılınç, Yasemin; Keçel-Gündüz, Serda; Nath, Ebru Özdemir; Kartal, MuratIntroduction: Osteoporosis, one of the common bone diseases, manifests itself as a decrease in bone mass. Recently, the use of medicinal plants in the search for effective and low-toxicity therapeutics for the prevention or treatment of osteoporosis has become a trending topic. Objective: In this study, we aim to prepare a controlled drug carrier system loaded with Gypsophila eriocalyx to determine its potential for anti-osteoporosis applications. Methods: Gypsophila eriocalyx extract (GEE) was prepared, and components were determined. The molecular interactions of the components with Cathepsin K (CatK), which is used as a target in drug development against osteoporosis, were revealed by in silico molecular docking and MD methods. ADMET profiles were also examined. GEE-loaded chitosan nanoparticles (CNPs) were synthesized. The nanoparticles' morphology, encapsulation efficiency, loading capacity, release profile, average size, polydispersity index, and zeta potentials were determined. The cytotoxic effects of GEE and GEE-loaded CNPs on the L929 and osteogenic proliferation profiles on human bone marrow stem cells (hBMC) were examined. Results: The MD analysis revealed no breaks or atomic changes in the dynamic system, and the docking analysis confirmed the continued interaction of identical residues. It was determined that the GEE-loaded CNP formulation was produced successfully, had no toxic effect on the L929, and had an osteogenic proliferation effect on hBMC. Conclusion: In line with the in vitro and in silico results obtained, it was evaluated that GEE-loaded CNPs can be used as a controlled drug release system as a candidate formulation with phytotherapeutic properties for osteoporosis treatment.q1.Öğe Achene macro-micromorphology of Pulicaria (Asteraceae) from Turkiye and its taxonomic significance(2024) Gürdal, Bahar; Nath, Ebru ÖzdemirThe genus Pulicaria Gaertn. belongs to the tribe Inuleae Cass. and it is represented by six species P. arabica (L.) Cass., P. armena Boiss. & Kotschy ex Boiss., P. dysenterica (L.) Gaertn., P. odora (L.) Rchb., P. sicula (L.) Moris, and P. vulgaris Gaertn. in Turkiye. P. armena is endemic to the country. In this study, fruit macro-micromorphological characteristics of six Pulicaria species from Turkiye were demonstrated using stereo-microscope and scanning electron microscopy. The colors of the achenes range from light-brown to brown. The shapes are obovate to elliptic in outline. The pappus is persistent in all studied species, with two rows of pappus hairs except in P. sicula. Its pappus composed of one row of capillary bristles. Others have the outer row developing into a small crown and the inner row consisting of capillary bristles. All taxa have glandular trichomes, except for P. arabica. An identification key is also provided to differentiate between Pulicaria species. Fruit features provide a useful tool for differentiating the examined species. RESEARCH HIGHLIGHTS: Achene macro-micromorphology of Pulicaria species was studied via LM and SEM. A diagnostic key based on achene features was created for Pulicaria species. Achene features provide a useful tool for differentiating the examined species.vÖğe Drugs with a negative impact on cognitive functions (part 3): antibacterial agents in patients with chronic kidney disease(2024) Liabeuf, Sophie; Hafez, Gaye; Pesic, Vesna; Spasovski, Goce; Bobot, Mickael; Maciulaitis, Romaldas; Bumblyte, Inga Arune; Ferreira, Ana Carina; Farinha, Ana; Malyszko, Jolanta; Pepin, Marion; Massy, Ziad A.; Unwin, Robert; Capasso, Giovambattista; Mani, Laila-Yasmin; CONNECT Action (Cognitive Decline in Nephro-Neurology European Cooperative Target)The relationship between chronic kidney disease (CKD) and cognitive function has received increased attention in recent years. Antibacterial agents (ABs) represent a critical component of therapy regimens in patients with CKD due to increased susceptibility to infections. Following our reviewing work on the neurocognitive impact of long-term medications in patients with CKD, we propose to focus on AB-induced direct and indirect consequences on cognitive function. Patients with CKD are predisposed to adverse drug reactions (ADRs) due to altered drug pharmacokinetics, glomerular filtration decline, and the potential disruption of the blood-brain barrier. ABs have been identified as a major cause of ADRs in vulnerable patient populations. This review examines the direct neurotoxic effects of AB classes (e.g. beta-lactams, fluoroquinolones, aminoglycosides, and metronidazole) on the central nervous system (CNS) in patients with CKD. We will mainly focus on the acute effects on the CNS associated with AB since they are the most extensively studied effects in CKD patients. Moreover, the review describes the modulation of the gut microbiota by ABs, potentially influencing CNS symptoms. The intricate brain-gut-kidney axis emerges as a pivotal focus, revealing the interplay between microbiota alterations induced by ABs and CNS manifestations in patients with CKD. The prevalence of antibiotic-associated encephalopathy in patients with CKD undergoing intravenous AB therapy supports the use of therapeutic drug monitoring for ABs to reduce the number and seriousness of ADRs in this patient population. In conclusion, elucidating AB-induced cognitive effects in patients with CKD demands a comprehensive understanding and tailored therapeutic strategies that account for altered pharmacokinetics and the brain-gut-kidney axis.Öğe Essential oil composition of Isatis floribunda Boiss. ex. Bornm. and acetylcholinesterase inhibitory activity of its extract(Istanbul Medipol University, 2024) Güzel, Elif; Yücel, Yasemin Yücel; Alkan, Mustafa; Polatoğlu, KaanThis study aims to investigate the essential oil composition of aerial parts of Isatis floribunda, and the acetylcholinesterase inhibitory activity of its extracts. Essential oil of the aerial parts of the plant material was obtained and the GC-MS analysis was performed. Then, extracts of the plant material were obtained, and in vitro acetylcholinesterase inhibitory assay was performed. GC-MS analysis demonstrated that the composition of Isatis floribunda is rich in fatty acid compounds, with the major compounds including dodecanoic acid, nanocosane, hexadecenoic acid, tetradecanoic acid, methyl octadecenoate, decanoic acid, and hexahydrofarnesyl acetone. Methanolic extract of the plant species has demonstrated strong acetylcholinesterase inhibitory activity with the IC50 value of 0.16 mg/mL. Essential oil composition of Isatis floribunda has been determined to be rich in fatty acid components, these compounds could demonstrate potent acetylcholinesterase inhibition. Therefore, a novel medication from Isatis floribunda extracts could be discovered against Alzheimer’s disease.Öğe Pan-European survey on medication adherence management by healthcare professionals(2024) Kamusheva, Maria; Aarnio, Emma; Qvarnström, Miriam; Hafez, Gaye; Mucherino, Sara; Potocnjak, Ines; Treciokiene, Indre; Mihajlovic, Jovan; Ekenberg, Marie; Boven, Job F. M. van; Leiva-Fernandez, Francisca; European Network to Advance Best Practices and Technology on Medication AdherencE (ENABLE)Aims: While medication adherence (MA) is a key prerequisite for achieving optimal clinical and economic outcomes, nonadherence is highly prevalent. Assessing how healthcare professionals (HCPs) in Europe manage MA, focusing on measurement, reporting and interventions, is the subject of this study. Methods: A cross-sectional study was conducted among 40 European countries and quantitative analysis was conducted via an online survey. The multi-language online survey was created using Webropol 3.0 survey and reporting tool. Descriptive statistics and chi-squared tests were applied. Results: In total, 2875 HCPs (pharmacists: 39.9%; physicians: 36.7%; nurses: 16.4%) from 37 European countries participated. The most used methods for MA assessment were direct communication with patients (86.4%) and referring to personal patient records (56.7%) (P < 0.0001). Physicians (74.9%) and nurses (58.8%) were more aware of problems related to MA in contrast to pharmacists (48.6%) (P < 0.001). Almost all HCPs (92.6%) indicated that MA-enhancing interventions involved mainly direct communication with nonadherent patients (93.3%) and their caregivers (55.7%). Medication review and related optimization of therapy were mainly performed in Western European countries (46.8%). Technological solutions were ranked as one of the less applied approaches (10-15%) (P < 0.001). Conclusions: HCPs in all European regions recognize MA management as an integral element of overall patient-centred care. More efforts are needed to ensure timely, adequate and relevant MA assessment, reporting and improvement and involvement of all HCPs, especially among pharmacists who were generally less aware of MA issues. Promotion and use of digital technological solutions should be the focus of current and future clinical practice to optimize MA management processes.Öğe Screening of antimicrobial, antibiofilm, and cytotoxic activities of some medicinal plants from Balıkesir province, Türkiye: potential effects of allium paniculatum flower(2024) Oyardı, Özlem; Hacıoğlu, Mayram; Özdemir, Ebru; Erbay, Meryem Şeyda; Kültür, Şükran; Güzel, Çağla BozkurtObjectives: Plant extracts are important natural resources that may have antimicrobial and antibiofilm effects against pathogens. This study was conducted to investigate the in vitro antimicrobial activities of methanol extracts of some medicinal plants (Achillea nobilis subspecies neilreichii (A. Kern.) Velen., Aetheorhiza bulbosa (L.) Cass, Allium paniculatum L, Asphodelus aestivus Brot., Ballota nigra L., Cistus laurifolius L., Cistus salviifolius L., Dioscorea communis (L.) Caddick and Wilkin, Galium verum L., Hypericum triquetrifolium Turra, Paliurus spina-christi Mill., Primula vulgaris Huds. subspecies rubra (Sm.) Arcang., Ranunculus arvensis L. and Teucrium polium L.) from Balıkesir province in Türkiye. Materials and methods: Preliminary antimicrobial activity screening was conducted for all extracts. Antibiofilm activity studies were conducted on mature Candida albicans biofilms. Moreover, the cytotoxicities of A. paniculatum flower extract on A549 and Vero cell lines were determined using a colorimetric tetrazolium-based assay. Results: A. paniculatum flower, P. vulgaris root, C. laurifolius, C. salviifolius, and A. nobilis displayed good activity [minimum inhibitory concentrations (MIC): 9.75, 156, 312, 312 and 312 μg/mL, respectively] against C. albicans American Type Culture Collection 10231. Biofilm studies were conducted on these plant extracts. The methanol extract of A. paniculatum flower decreased the number of C. albicans [colony-forming unit (CFU)/mL] in mature biofilm statistically at 32 x MIC and higher concentrations (p < 0.01). A. paniculatum flower extract had a cytotoxic effect (killing more than 50% of cells) at high concentrations, and its effect on Vero cells was similar to that on A549 cells. Conclusion: This study demonstrated the importance of the methanol extract of A. paniculatum flower as a natural alternative against C. albicans infections, including biofilms.Öğe Barriers and unmet educational needs regarding implementation of medication adherence management across Europe: insights from cost action enable(2024) Hafez, Gaye; Aarnio, Emma; Mucherino, Sara; Kamusheva, Maria; Qvarnström, Miriam; Potocnjak, Ines; Treciokiene, Indre; Mihajlovic, Jovan; Ekenberg, Marie; Boven, Job F. M. van; Leiva-Fernandez, Francisca; European Network to Advance Best Practices Technology on Medication AdherencE (ENABLE)Background: Medication adherence is essential for the achievement of therapeutic goals. Yet, the World Health Organization estimates that 50% of patients are nonadherent to medication and this has been associated with 125 billion euros and 200,000 deaths in Europe annually. Objective: This study aimed to unravel barriers and unmet training needs regarding medication adherence management across Europe. Design: A cross-sectional study was conducted through an online survey. The final survey contained 19 close-ended questions. Participants: The survey content was informed by 140 global medication adherence experts from clinical, academic, governmental, and patient associations. The final survey targeted healthcare professionals (HCPs) across 39 European countries. Main measures: Our measures were barriers and unmet training needs for the management of medication adherence across Europe. Key results: In total, 2875 HCPs (pharmacists, 40%; physicians, 37%; nurses, 17%) from 37 countries participated. The largest barriers to adequate medication adherence management were lack of patient awareness (66%), lack of HCP time (44%), lack of electronic solutions (e.g., access to integrated databases and uniformity of data available) (42%), and lack of collaboration and communication between HCPs (41%). Almost all HCPs pointed out the need for educational training on medication adherence management. Conclusions: These findings highlight the importance of addressing medication adherence barriers at different levels, from patient awareness to health system technology and to fostering collaboration between HCPs. To optimize patient and economic outcomes from prescribed medication, prerequisites include adequate HCP training as well as further development of digital solutions and shared health data infrastructures across Europe.Öğe Cognitive decline related to chronic kidney disease as an exclusion factor from kidney transplantation: results from an international survey(2024) Farisco, Michele; Blumblyte, Inga, A.; Franssen, Casper; Nitsch, Dorothea; Zecchino, Irene; Capasso, Giovambattista; Hafez, GayeBackground and hypothesis: There seems to be a lack of consensus on the necessity and the modality of psychological and specifically cognitive assessment of candidates for kidney transplantation. Both points are often delegated to individual hospitals/centres, whereas international guidelines are inconsistent. We think it is essential to investigate professionals' opinions to advance towards a consistent clinical practice. Methods: This paper presents the results of an international survey among clinical professionals, mainly nephrologists from the CONNECT (Cognitive decline in Nephro-Neurology: European Cooperative Target) network and beyond (i.e. from personal contacts of CONNECT members). The survey investigated their opinions about the question of whether cognitive decline in patients with chronic kidney disease may affect their eligibility for kidney transplantation. Results: Our results show that most clinicians working with patients affected by chronic kidney disease think that cognitive decline may challenge their eligibility for transplantation despite data that suggest that, in some patients, cognitive problems improve after kidney transplantation. Conclusion: We conclude that three needs emerge as particularly pressing: defining agreed-on standards for a multifaceted and multifactorial assessment (i.e. including both clinical/medical and psychosocial factors) of candidates with chronic kidney disease to kidney transplantation; further investigating empirically the causal connection between chronic kidney disease and cognition; and further investigating empirically the possible partial reversibility of cognitive decline after kidney transplantation.Öğe Is ChatGPT reliable and accurate in answering pharmacotherapy-related inquiries in both Turkish and English?(2024) Öztürk, Nur; Yakak, İrem; Ağ, Melih Buğra; Aksoy, NilayIntroduction: Artificial intelligence (AI), particularly ChatGPT, is becoming more and more prevalent in the healthcare field for tasks such as disease diagnosis and medical record analysis. The objective of this study is to evaluate the proficiency and accuracy of ChatGPT in different domains of clinical pharmacy cases and queries. Methods: The study NAPLEX® Review Questions, 4th edition, pertaining to 10 different chronic conditions compared ChatGPT's responses to pharmacotherapy cases and questions obtained from McGraw Hill's, alongside the answers provided by the book's authors. The proportion of correct responses was collected and analyzed using the Statistical Package for the Social Sciences (SPSS) version 29. Results: When tested in English, ChatGPT had substantially higher mean scores than when tested in Turkish. The average accurate score for English and Turkish was 0.41 ± 0.49 and 0.32 ± 0.46, respectively, p = 0.18. Responses to queries beginning with "Which of the following is correct?" are considerably more precise than those beginning with "Mark all the incorrect answers?" 0.66 ± 0.47 as opposed to 0.16 ± 0.36; p = 0.01 in English language and 0.50 ± 0.50 as opposed to 0.14 ± 0.34; p < 0.05in Turkish language. Conclusion: ChatGPT displayed a moderate level of accuracy while responding to English inquiries, but it displayed a slight level of accuracy when responding to Turkish inquiries, contingent upon the question format. Improving the accuracy of ChatGPT in languages other than English requires the incorporation of several components. The integration of the English version of ChatGPT into clinical practice has the potential to improve the effectiveness, precision, and standard of patient care provision by supplementing personal expertise and professional judgment. However, it is crucial to utilize technology as an adjunct and not a replacement for human decision-making and critical thinking.
