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Öğe Characterization and Evaluation of Triamcinolone, Raloxifene, and Their Dual-Loaded Microspheres as Prospective Local Treatment System in Rheumatic Rat Joints(Elsevier Science Inc, 2014) Ocal, Yigit; Kurum, Baris; Karahan, Siyami; Tezcaner, Aysen; Ozen, Seza; Keskin, DilekIn this study, injectable microspheres were developed for the local treatment of joint degeneration in rheumatoid arthritis (RA). Microspheres loaded with triamcinolone (TA), a corticosteroid drug, and/or raloxifene (Ral), a cartilage regenerative drug, were prepared with a biodegradable and biocompatible polymer, polycaprolactone (PCL). Microspheres were optimized for particle size, structural properties, drug release, and loading properties. In vitro release of Ral was very slow because of the low solubility of the drug and hydrophobic nature of PCL. However, when coloaded with TA, both drugs were released at higher amounts compared with their single forms. Smallest particle sizes were obtained in dual drug-loaded microspheres. In vitro cytotoxicity tests showed biocompatibility of microspheres. In vivo bioefficacy of these microspheres was also examined in adjuvant-induced arthritis model in rats. In vivo histological studies of control groups showed development of RA with high median lesion score (5.0). Compared with control and intra-articular free drug injections, microsphere treatment groups showed lower lesion scores and better healing outcomes in histological evaluations. Results suggest that a controlled delivery system of TA and RAL by a single injection in inflamed joints holds promise for healing and suppressing inflammation. (c) 2014 Wiley Periodicals, Inc. and the American Pharmacists Association J Pharm Sci 103:2396-2405, 2014Öğe The GUSS test as a good indicator to evaluate dysphagia in healthy older people: a multicenter reliability and validity study(Springer, 2019) Umay, Ebru; Eyigor, Sibel; Karahan, Ali Yavuz; Gezer, Ilknur Albayrak; Kurkcu, Ayse; Keskin, Dilek; Calik, YalkinPurpose Dysphagia is known to be a disorder of the swallowing function, and is a growing health problem in aging populations. Swallowing screening tests have mostly been studied in comorbidities such as stroke associated with old age. There is no simple, quick and easy screening test to best determine the risk of oropharyngeal dysphagia in geriatric guidelines. We aimed to evaluate whether the Gugging Swallowing Screen (GUSS) test is an effective method for evaluating swallowing difficulty in healthy older people. Methods This cross-sectional and multicenter study was conducted at 13 hospitals between September 2017 and February 2019. The study included 1163 participants aged >= 65 years and who had no secondary dysphagia. Reliability was evaluated for data quality, scaling assumptions, acceptability, reliability, and validity as well as cutoff points, specificity and sensitivity. Results The age distribution of 773 (66.5%) patients was between 65 and 74 years and 347 (29.8%) of them were male and 767 (66%) patients were female. The average total GUSS score was 18.57 +/- 1.41. The Cronbach's alpha was 0.968. There was a moderate statistically significant negative correlation between the total GUSS and 10-item Eating Assessment Tool scores as well as between the total GUSS score and quality of life. The cutoff point of the total GUSS score was 18.50, sensitivity was 95.5% and specificity was 94.4%. Conclusions The GUSS test is a valid and reliable test to identify possible oropharyngeal dysphagia risk in healthy older people who had no secondary dysphagia. It is suitable as a screen test for clinical practice. Key summary pointsAim We aimed to evaluate whether the Gugging Swallowing Screen (GUSS) test is an effective method for evaluating swallowing difficulty in healthy older people. Findings Total GUSS score sensitivity was 95.5% and its specificity was 94.4%. Message The GUSS test is a valid and reliable test to identify possible oropharyngeal dysphagia risk in healthy older person who had no secondary dysphagia. It is suitable as a screen test for clinical practice.Öğe The relationship of serum vitamin D receptor levels with disease activity and clinical parameters in patients with ankylosing spondylitis(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2019) Kultur, Turgut; Oztas, Dilek; Keskin, Dilek; Keskin, Goksal; Inal, Ali; Kara, HalilObjectives: The aim of this study was to investigate the relationship between serum vitamin D receptor (SVDR) levels and disease activity parameters in patients with ankylosing spondylitis (AS). Patients and methods: Between July 2016 and January 2017, a total of 62 patients (51 males, 11 females; mean age 36.5 +/- 12.8 years; range, 23 to 49 years) with AS and 32 healthy volunteers (25 males, 7 females; mean age 41.57 +/- 13.6 years; range, 26 to 48 years) were included in the study. The SVDR levels were measured using the enzyme-linked immunosorbent assay. Erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) levels were recorded. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores were used to assess disease activity. Results: Although there was no significant difference between the patient and control groups (p=0.66), SVDR levels were significantly elevated in patients with active AS (BASDAI score >= 4) (p=0.01). The SVDR levels significantly increased in AS patients with peripheral joint involvement and enthesitis (p=0.01, p=0.05, respectively). The SVDR levels significantly elevated in patients treated with non-steroidal anti-inflammatory drugs, compared to those treated with biological agents and control group (p=0.01, p=0.03, respectively). The SVDR levels were positively correlated with the BASDAI, CRP and ESR in the patient group (p=0.01, r=0.751; p=0.01, r=0.75; p=0.01, r=0.81, respectively). Conclusion: Our study results suggest that serum SVDR levels are associated with the disease activity and clinical parameters in patients with AS. Based on these findings, SVDR level may be used as a marker of disease activity in AS.Öğe The Effect of Lower Urinary Tract Dysfunction on Quality of Life and Caregiver Burden in Stroke Patients(2023) Agir, Hatice; Okumuş, Müyesser; Keskin, DilekABSTRACT Objective: Lower urinary tract dysfunction (LUTD) is an important burden factor for patients and their caregivers. In this study, we aimed to investigate the impact of LUTD on caregiver burden and quality of life of stroke patients. Material and Methods: The study included 75 stroke patients and their caregivers followed in the physical medicine and rehabilitation clinic. Zarit Caregiver Burden Scale (ZCBS) was used to evaluate the caregiver burden, and the Incontinence Quality of Life (I-QOL) Scale was used to evaluate the effect of urinary symptoms on patients' quality of life. Urinary symptoms of the patients were evaluated with Danish Prostatic Symptom Score (DAN-PSS-1), functional status and activities of daily living were evaluated with Functional Independence Measure (FIM) and Barthel Index (BI). The patient's mood status was questioned with Hospital Anxiety and Depression Scale (HADS). Results: A total of 75 stroke patients, 38 (50.7%) women, and 37 (49.3%) men, with a mean age of 61.76±10.6 (37-80) years, and 75 caregivers participated in the study. A statistically significant difference was observed regarding FIM, BI, I-QOL and subgroups, DAN-PSS-1 scores between low/moderate and severe/overburden caregivers (p<0.001). The ZCBS scores of the caregivers of the patients whose HADS were higher than normal were significantly higher (p<0.01 and p<0.001, respectively). A statistically significant correlation was observed between the patients' DAN-PSS-1 and I-QOL-total and subgroups, BI, FIM total, and sub-scores (p<0.01). Conclusion: We found that LUTD in stroke patients reduces the patient's quality of life and increases the caregiver burden.Öğe Wet electrospun silk fibroin/gold nanoparticle 3D matrices for wound healing applications(Royal Soc Chemistry, 2016) Akturk, Omer; Kismet, Kemal; Yasti, Ahmet C.; Kuru, Serdar; Duymus, Mehmet E.; Kaya, Feridun; Keskin, DilekThis study aimed to fabricate 3D silk fibroin (SF) matrices for skin tissue engineering applications. SF/poly(ethylene oxide) solutions were wet electrospun to obtain a fibrous network (0.7-20 mm diameter), which were then lyophilized to obtain 3D porous nanofibrous matrices (SFM-E: ethanol treated silk fibroin matrices). SF matrices were loaded with citrate-capped gold nanoparticles (AuNPs, 14.27 ppm, D-average = 24 nm) (SFM-AuE: ethanol treated silk fibroin matrices incorporated with AuNPs) and investigated for structural and chemical properties, in vitro biocompatibility and in vivo full-thickness dermal wound healing efficacy in a rat model. AuNP incorporation enhanced the degradation profiles and mechanical properties significantly. SFM-E and SFM-AuE showed similar cell attachment and layer by layer proliferation behaviour, but cells had more spread and flattened morphology on SFM-AuE. Both matrix extracts had high cell viability (>90%), indicating good in vitro biocompatibility. Wound closure was statistically more than the untreated skin control (UTSC) in SFM-E and SFM-AuE applied groups. The recovered tensile strength and elastic modulus of SFM-E and SFM-AuE (40-60%) were not as high as the unwounded skin control (UWSC), but they had elongation at break values similar to UWSC. This was attributed to the still ongoing medium to high inflammation levels leading to a low and immature extent of collagen fibrils on postoperative 14th day. There was only a small amount of epithelialization due to scab formation and medium to high level inflammation for both SFM-E and SFM-AuE, but they were better than UTSC in terms of neovascularization and granulation tissue formation. As a whole, inclusion of AuNPs to SF matrices at 14.27 ppm loading brought some enhancement in the matrix properties and did not cause any toxicity in in vitro and in vivo conditions and even had potency to promote wound healing stages.Öğe Which swallowing difficulty of food consistency is best predictor for oropharyngeal dysphagia risk in older person?(Springer, 2019) Umay, Ebru; Eyigor, Sibel; Karahan, Ali Yavuz; Keskin, Dilek; Karaca, Gulten; Unlu, ZelihaKey summary pointsAimOur aim was to investigate which swallowing difficulty of food consistency in older people who did not have any disease that might affect swallowing functions, and which symptoms were most likely related to oropharyngeal dysphagia (OD) risk.FindingsWe have found that the eating/drinking difficulty of thick liquids was the highest predictive value with respect to OD risk and the eating difficulty of mixed content food had the highest diagnostic ratio.MessageThe present study reports that even in older person who do not go to the hospital with the complaints of swallowing difficulty, the difficulty of swallowing thick liquids and especially the mixed content food should be questioned. AbstractPurposeThe present study aimed to investigate which swallowing difficulty of food consistency in participants over 65years of age who did not have any disease that might affect swallowing functions, and which symptoms were most likely related to oropharyngeal dysphagia (OD).MethodsThe cross-sectional and multicenter study was conducted at 12 hospitals including 883 participants aged >= 65years who were fed orally and who were admitted to the physical medicine and rehabilitation outpatient clinics between September 2017 and December 2018. Demographic characteristics were recorded. Katz Daily Living Activities Index (KDLAI), swallowing-related quality of life scale (Swal-QoL) and 10-item Eating Assessment Tool (EAT-10) were used. The participants were asked the yes or no questions including swallowing difficulty of various types of food consistency with the face-to-face interview.ResultsParticipants were divided into two groups as normal swallowing (EAT-10<3 group) (n=639) and OD risk groups (EAT-10 >= 3 group) (n=244) according to the EAT-10 scores. While there was no difference related to number of teeth and KDLAI scores between groups (p=0.327 and p=0.221, respectively), the significant difference was found between groups in terms of yes/no questions and Swal-QoL scores (p<0.05). Receiver operating characteristic analysis revealed that eating difficulty of mixed content food provided maximum sensitivity (99%) and eating/drinking difficulty of thick liquid had maximum specificity (77%). The higher area under curve was in eating/drinking difficulty of thick liquid (0.891), and higher positive likelihood ratio (LR) was eating/drinking difficulty of thick liquid (4.26) as well as lower negative LR was eating difficulty of mixed content food (0.01). The higher diagnostic odds ratio was eating difficulty of mixed content food (367.0), and the higher posttest probability was eating/drinking difficulty of thick liquid (0.211).ConclusionWhile eating difficulty of hard solid food is the most common symptom in healthy participants over 65years of age, the eating difficulty of thick liquids is the highest predictive value related to oropharyngeal dysphagia risk. Also, the eating difficulty of mixed content food had the highest diagnostic ratio.
