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Öğe Online simulation versus traditional classroom learnings in clinical pharmacy education: effect on students' knowledge, satisfaction and self-confidence(BioMed Central, 2025) Selçuk, Aysu; Öztürk, Nur; Önal, Nurbanu; Bozkır, Asuman; Aksoy, NilayBackground: Over the course of the past few years, the area of medical education has experienced a substantial movement towards the establishment of online learning platforms and resources. This study aimed to to evaluate the efficacy of an online simulation learning intervention, MyDispense®, compared to traditional classroom learning in terms of enhancing knowledge, satisfaction, and self-confidence among participants. Methods: A multicentre randomized controlled study was conducted among pharmacy students who were assigned either intervention MyDispense® or control traditional classroom learning groups. They were eligible if they previously had experience with online simulation learning. A previously validated questioner were used to measure the outcome of knowledge, satisfaction and self-confidence. Results: Both the intervention and control groups revealed significant improvement in knowledge, the P value for pre-post knowledge scores for each group was < 0,001. Despite these internal improvements, this study's findings showed no statistically significant differences (p > 0.05) between the intervention and control groups on knowledge gain, satisfaction, or self-confidence. This represents comparable outcomes irrespective of the group's exposure to intervention. Conclusion: The study evaluated the efficacy of online simulation learning intervention MyDispense® in comparison to traditional classroom learning. While both strategies effectively improved knowledge, satisfaction, and self-confidence, the findings demonstrated that the online simulation yielded equivalent learning benefits. MyDispense® could be an alternative to traditional education in situations where face to face learning is not feasible, with comparable learning outcomes. Clinical trial number: not applicable.Öğe Chemotherapy-related cognitive impairment and kidney dysfunction(2025) Simeoni, Mariadelina; Mulholland, Michele M.; Workeneh, Biruh T.; Capasso, Anna; Capasso, Anna; Hafez, Gaye; Liabeuf, Sophie; Malyszko, Jolanta; Mani, Laila-Yasmin; Trevisani, Francesco; De, Ananya; Wagner, Carsten A.; Massy, Ziad A.; Unwin, Robert; Capasso, Giovambattista; CONNECT Action (Cognitive Decline in Nephro-Neurology European Cooperative Target) collaboratorsCancer and kidney diseases (KD) intersect in many ways resulting in worse outcomes. Both conditions are correlated with cognitive impairment, which can be exacerbated in cancer patients by known effects of many antineoplastic drugs on cognition, leading to a phenomenon known as chemotherapy-related cognitive impairment (CRCI). This manifests as poor attention span, disturbed short-term memory, and general mental sluggishness. This literature review explores CRCI and investigates the potential impact of KD on this phenomenon. Additionally, we highlight the shared pathogenetic mechanisms (including neurotoxicity, neuroinflammation, oxidative stress, vascular disease, electrolyte, and acid-base imbalances), clinical presentation and imaging findings between cognitive impairment in KD and CRCI. The disruption of the blood-brain barrier might be a key mechanism for increased brain permeability to anticancer drugs in nephropathic patients with cancer. Based on existing knowledge, we found a potential for heightened neurotoxicity of antineoplastic drugs and a synergistic potentiation of cognitive impairment in cancer patients with KD. However, further translational research is urgently required to validate this hypothesis.Öğe Big databases and biobanks for studying the links between CKD, cognitive impairment, and dementia(2025) Zoccali, Carmine; Mallamaci, Frances; Rosenberg, Kerry; Unwin, Robert; Silva, Pedro Imenez; Simeoni, Maria Adelina; Hafez, Gaye; Capasso, Giovambattista; Nitsch, Dorothea; CONNECT Action (Cognitive Decline in Nephro-Neurology European Cooperative Target) collaboratorsResearch on cognitive function in individuals with chronic kidney disease (CKD) is critical due to the significant public health challenge posed by both CKD and cognitive impairment. CKD affects approximately 10-15% of the adult population, with higher prevalence in the elderly, who are already at increased risk for cognitive decline. Cognitive impairment is notably higher in CKD patients, particularly those with severe stages of the disease, and progresses more rapidly in those on dialysis. This review explores how data from large biobank studies such as the Alzheimer's Disease Neuroimaging Initiative, UK Biobank, and others could be used to enhance understanding the progression and interplay between CKD and cognitive decline. Each of these data sources has specific strengths and limitations. Strengths include large sample sizes and longitudinal data across different groups, and in different settings. Addressing limitations leads to challenges in dealing with heterogeneous data collection methods, and addressing missing data, which requires the use of sophisticated statistical techniques. Combining data from multiple databases can mitigate individual study limitations, particularly via the 'epidemiological triangulation' concept. Using such data appropriately holds immense potential to better understand the pathobiology underlying CKD and cognitive impairment. Addressing the inherent challenges with a clear strategy is crucial for advancing our understanding and improving the lives of those affected by both CKD and cognitive impairment.Öğe Genetic and circulating biomarkers of cognitive dysfunction and dementia in CKD(2025) Zoccali, Carmine; Mallamaci, Francesca; Wagner, Carsten A.; Unwin, Robert; Nedergaard, Maiken; Hafez, Gaye; Malyszko, Jolanta; Pepin, Marion; Massy, Ziad; Paolisso, Giuseppe; Remuzzi, Giuseppe; Capasso, Giovambattista B.; CONNECT Action (Cognitive Decline in Nephro-Neurology European Cooperative Target) collaboratorsChronic kidney disease (CKD) is commonly accompanied by cognitive dysfunction and dementia, which, in turn, increase the risk of hospitalization, cardiovascular events and death. Over the last 30 years, only four studies focused on genetic markers of cognitive impairment in CKD and kidney failure (KF), indicating a significant gap in research. These studies suggest potential genetic predispositions to cognitive decline in CKD patients but also underscore the necessity for more comprehensive studies. Seventeen reports have established connections between cognitive function and kidney disease markers such as estimated glomerular filtration rate (eGFR), Cystatin C and albuminuria. A rapid eGFR decline has been associated with cognitive deterioration and vascular dementia, and mild to moderate eGFR reductions with diminished executive function in elderly men. Various biomarkers have been associated to Alzheimer’s disease or dementia in CKD and KF. These include amyloid beta and phosphorylated tau proteins, uremic toxins, gut microbiota, metabolic indicators, hypertension, endothelial dysfunction, vitamins and inflammation. However, the causal relevance of these associations remains unclear. Overall, the available evidence points to a complex interplay between the different biomarkers and cognitive health in CKD patients, underscoring the need for more research to elucidate these relationships.Öğe Cognitive impairment in kidney transplanted patients(2025) Malyszko, Jolanta; Golenia, Aleksandra; Farisco, Michele; Lo Re, Vincenzina; Klimkowicz-Mrowiec, Aleksandra; Capasso, Giovambattista; Goumenos, Dimitris; Rroji, Merita; Figurek, Andreja; Hafez, Gaye; CONNECT Action (Cognitive Decline in Nephro-Neurology European Cooperative Target) collaboratorsChronic kidney disease affects almost all of the organs. Recently, more attention has been paid to the kidney and the central nervous system connections. In patients on kidney replacement therapy, including kidney transplantation, there is an increased prevalence of cognitive impairment, and depression and other neurological complications, such as cerebrovascular disorders and movement disorders. Kidney transplant recipients need an assessment for the risk factors and the pattern of cognitive impairment (memory, attention and executive function decline). This enables an accurate diagnosis to be made at an earlier stage. Partial post-transplant cognitive impairment recovery is also important. Finally, doctors and patients alike face numerous ethical concerns and challenges regarding the transplantation of kidneys and other solid organs. In this review, we examined some key issues regarding cognitive impairment in kidney transplant patients. We focused on the mechanism of cognitive impairment in kidney transplant recipients, patterns of cognitive impairment; evaluation of patients with cognitive impairment for kidney transplantation, the potential impact of cognitive impairment on waitlisted and transplanted patients on patient care, non-pharmacological interventions and unmet medical needs, psychological and ethical issues in kidney transplantation, and unmet needs. As cognitive impairment in kidney transplant recipients is an underestimated, underrecognized but clinically relevant problem, screening for cognitive function before and after kidney transplantation would be worth considering in standard routine practice.Öğe Medication adherence in the curricula of future European physicians, pharmacists and nurses - a cross-sectional survey(2025) Gottlieb, Hanna; Seghers, Laura; Leiva-Fernandez, Francisca; Ghiciuc, Cristina Mihaela; Hafez, Gaye; Herdeiro, Maria Teresa; Petrovic, Ana Tomas; Novais, Teddy; Schneider, Marie P.; Dima, Alexandra; Ekenberg, Marie; Wettermark, Björn; European Network to Advance Best Practices Technology on Medication Adherence (ENABLE)Aim: Many patients are not taking their medicines. It has substantial negative medical and economic consequences for patients and healthcare systems but there is limited knowledge on how medication adherence is integrated in medical education. This study seeks to investigate to what extent students in medicine, pharmacy and nursing in Europe are taught about medication adherence. Methods: A cross-sectional online survey was distributed to 731 persons teaching relevant courses across 142 European universities between February and June 2024. The survey addressed definitions of adherence and The ABC Taxonomy; methods to support adherence, methods to identify and monitor non-adherence; consequences and outcomes of non-adherence, and methods applied in teaching. They were also asked to provide links to their curricula. Responses from quantitative questions were analyzed descriptively. Word frequency and qualitative thematic analysis was used for the curricula inventory and analysis of free-text answers, respectively. Results: In total, 212 participants from 114 universities in 34 countries completed the survey. Respondents agreed to similar level on the need to enhance medication adherence teaching, with 72% in pharmacy, 71% medical, and 59% agreement in nursing education. The most taught topic across educations was the clinical impact of non-adherence, according to 89% in pharmacy, 84% medical, and 76% in nursing education. The ABC Taxonomy was taught in more than half of all pharmacy (73%), nursing (60%) and medical education (52%). In the qualitative analysis of free text-answers respondents emphasized the value of early, mixed method teaching. They reported a lack of guidance in teaching medication adherence, causing inconsistency in the educational quality and depth. Time constraints were highlighted as a significant challenge, while interprofessional collaboration and use of medication adherence technologies were seen as opportunities, though not widely implemented in teaching. The curricula inventory showed a substantial variance in how medication adherence content was described. Conclusion: There is a lack of consistent teaching on medication adherence in Europe, underlining the necessity to establish a unified curriculum incorporating the ABC taxonomy, and to include a more patient-centred approach to support medication adherence.Öğe Cognitive impairment in CKD patients: a guidance document by the CONNECT network(2025) Bolignano, Davide; Simeoni, Mariadelina; Hafez, Gaye; Pepin, Marion; Gallo, Antonio; Altieri, Manuela; Liabeuf, Sophie; Giannakou, Konstantinos; De, Ananya; Capasso, GiovambattistaCognitive impairment is a prevalent and debilitating complication in patients with chronic kidney disease (CKD). This position paper, developed by the Cognitive Decline in Nephro-Neurology: European Cooperative Target network, provides guidance on the epidemiology, risk factors, pathophysiology, diagnosis and clinical management of CKD-related cognitive impairment. Cognitive impairment is significantly more common in CKD patients compared with the general population, particularly those undergoing haemodialysis. The development of cognitive impairment is influenced by a complex interplay of factors, including uraemic neurotoxins, electrolytes and acid-base disorders, anaemia, vascular damage, metabolic disturbances and comorbidities like diabetes and hypertension. Effective screening and diagnostic strategies are essential for early identification of cognitive impairment utilizing cognitive assessment tools, neuroimaging and circulating biomarkers. The impact of various drug classes, including antiplatelet therapy, oral anticoagulants, lipid-lowering treatments and antihypertensive drugs, on cognitive function is evaluated. Management strategies encompass pharmacological and non-pharmacological interventions, with recommendations for optimizing cognitive function while managing CKD-related complications. This guidance highlights the importance of addressing cognitive impairment in CKD patients through early detection, careful medication management and tailored therapeutic strategies to improve patient outcomes.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.v
