Search Results (208)

Background/Objectives: Parenteral nutrition (PN) supports patients unable to receive nutrients via the gastrointestinal tract, but it lacks the health-promoting natural bioactive compounds found in a typical oral diet. This study aimed to develop a human serum albumin-based intravenous delivery system for lutein (an antioxidant carotenoid with vision-supportive and hepatoprotective properties) as a PN additive. Methods: An albumin–lutein nanosuspension (AlbLuteN) was synthesized using a modified nanoparticle albumin-bound (nab^TM) technology and characterized physicochemically. The nanoformulation was added to four commercial PN admixtures to assess the supplementation safety throughout the maximum infusion period. Visual inspection and measurements of fat globules larger than 5 µm (PFAT5) and the mean hydrodynamic diameter (Z-average), zeta potential, pH, osmolality, and lutein content were performed to detect potential interactions and evaluate the physicochemical stability. Results: AlbLuteN consisted of uniform particles (Z-average of 133.5 ± 2.8 nm) with a zeta potential of −28.1 ± 1.8 mV, lutein content of 4.76 ± 0.39%, and entrapment efficiency of 84.4 ± 6.3%. Differential scanning calorimetry confirmed the amorphous state of lutein in the nanosuspension. AlbLuteN was successfully incorporated into PN admixtures, without visible phase separation or significant changes in physicochemical parameters. The PFAT5 and Z-average values remained within pharmacopeial limits over 24 h. No substantial shifts in zeta potential, pH, or osmolality were observed. The lutein content remained stable, with losses below 3%. Conclusions: AlbLuteN can be safely added to representative PN admixtures without compromising their stability. This approach offers a novel strategy for intravenous lutein delivery and may contribute to improving the nutritional profile of PN. Full article

Background/Objectives: Chemotherapy-induced alopecia is a common and distressing side effect of cancer treatment, significantly impacting patients’ psychological well-being. Nanocarriers offer a promising strategy for targeted drug delivery to hair follicles, while chitosan nanoparticles have demonstrated hair-growth-promoting properties. This study explores the potential of chitosan nanoparticles as a topical delivery system for five pharmacological agents—phenobarbital, pioglitazone, rifampicin, N-acetylcysteine, and tacrolimus—to prevent chemotherapy-induced alopecia. Methods: Drug-loaded chitosan nanoparticles were prepared using the ionic gelation technique and characterized by particle size, zeta potential, entrapment efficiency, FT-IR spectroscopy, and TEM imaging. Their efficacy was assessed in a cyclophosphamide-induced alopecia model in C57BL/6 mice through macroscopic observation, histopathological examination, and scanning electron microscopy of regrown hair. Results: The prepared particles were spherical, cationic, and between 205 and 536 nm in size. The entrapment efficiencies ranged from 8% to 63%. All five drugs mitigated follicular dystrophy, shifting the hair follicle response from dystrophic catagen to dystrophic anagen. Phenobarbital demonstrated the most significant hair regrowth and quality improvements, followed by N-acetyl cysteine and pioglitazone. Tacrolimus showed moderate efficacy, while rifampicin was the least effective. Conclusions: These findings suggest that phenobarbital-loaded chitosan nanoparticles represent a promising approach for the prevention and treatment of chemotherapy-induced alopecia, warranting further investigation for clinical applications. Full article

Background/Objectives: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Traditional diagnostics like EMG and NCSs are invasive and do not visualize nerve morphology. This study aims to evaluate the diagnostic and prognostic value of high-resolution ultrasonography in patients with CTS using a standardized scanning protocol and to evaluate the relationship between sonographic findings and traditional electrodiagnostic results. Methods: In this observational study with both prospective and retrospective components, 31 subjects were included. Between November 2023 and June 2024, 11 symptomatic CTS patients were scheduled for surgical decompression and 14 healthy controls were prospectively enrolled. Additionally, six post-surgical CTS patients who had undergone decompression between 2016 and 2021 were retrospectively included for comparative analysis. All underwent clinical and ultrasonographic assessments of the median nerve at predefined anatomical landmarks. EMG was performed in the CTS groups. Ultrasound was repeated at 1, 3, and 6 months postoperatively to monitor morphological changes. Results: CTS patients had significantly increased the median nerve CSA compared to controls. Postoperative ultrasound showed progressive CSA reduction correlating with clinical improvement and EMG recovery. The CSA correlated moderately to strongly with distal motor latency. Conclusions: High-resolution ultrasound is a reliable, non-invasive tool for diagnosing and monitoring CTS. Standardized protocols are needed to support broader clinical adoption and establish it as a standalone diagnostic method. Full article

Background: We aimed to determine the utility of different electrodiagnostic (EDx) methods in diagnosing meralgia paresthetica (MP). Methods: Twenty-nine MP patients and 26 controls were included. Sensory nerve action potential (SNAP) and somatosensory evoked potential (SEP) of the lateral femoral cutaneous nerve (LFCN) and tibial SEPs were measured bilaterally. Results: At least one LFCN SNAP was unobtainable in 18 patients (62%) and two controls (8%). In all remaining 11 patients, SNAPs were abnormal at least unilaterally. By contrast, LFCN SEPs were recorded bilaterally in all subjects and were abnormal in 16 patients (sensitivity 48%). Patients’ tibial SEP latency was significantly larger than that of controls (p < 0.001). Conclusions: LFCN NCSs are superior to SEP in the evaluation of MP. However, SEP studies may be useful in old (>60 years) and obese subjects with unobtainable LFCN SNAP. Longer tibial SEP points to subclinical neuropathy in MP patients predisposed to LFCN entrapment. Full article

Introduction: Supraglottic airway devices play an important role in airway management in both pre-hospital as well as in-hospital settings. They are a well-recognised alternative to definitive airways in current medical practice. However, despite their wide use in clinical practice, little is known about their performance in patients with restricted access. This study aims to evaluate the time required to insert a supraglottic airway device and achieve a successful ventilation of four different devices in a simulated condition of an entrapped trauma patient with simultaneous cervical spine immobilisation. The ease-of-use and first-attempt success rate were also assessed. Methods: Fully qualified paramedics participated in this randomised, controlled manikin trial. A manikin with the cervical collar on was placed on the driver’s seat of a passenger car. Access to the manikin was only allowed from the front. The I-gel, the SLIPA, the LMA Supreme, and the Ambu AuraGain were evaluated. The time required to insert the device and achieve successful ventilation was recorded. The first-attempt success rate and the ease-of-use by the operator were also assessed. Results: The LMA Supreme required the shortest mean time to insert and ventilate the manikin, 10.5 s (±1.7) vs. 16.4 s (±8.4), p < 0.001. The use of the LMA Supreme was associated with the highest first-attempt success rate—88%. The SLIPA device outperformed all other studied devices with regard to ease-of-use and user-friendliness. Its mean score was 8.3 out of 10. Conclusions: The LMA Supreme was superior in terms of both the insertion-to-ventilation time as well as the first-attempt success rate. The SLIPA device was found to be easier to use and more user-friendly. Full article

Background/Objectives: Filamentous fungi, in particular the species Aspergillus, Scedosporium, and Exophiala, frequently colonize the lungs of cystic fibrosis (CF) patients. Chronic colonization is linked to hypersensitivity reactions and persistent infections leading to a significant long-term decline in lung function. Azole antifungal therapy such as voriconazole (VRC) slows disease progression, particularly in patients with advanced CF; however, excessive mucus production in CF lungs poses a diffusional barrier to effective treatment. Methods: Here, biodegradable nanohydrogels (NHGs) recently developed as nanocarriers were evaluated for formulating VRC as a platform for treating fungal infections in CF lungs. The NHGs entrapped up to about 30 μg/mg of VRC, and physicochemical properties were investigated via dynamic laser light scattering and nanoparticle tracking analysis. Diameters were 100–400 nm, and excellent colloidal stability was demonstrated in interstitial fluids, indicating potential for pulmonary delivery. Nano-formulations exhibited high in vitro cytocompatibility in A549 and HEK293T cells and were tested for the release of VRC under two different sink conditions. Results: Notably, the antifungal activity of VRC-loaded nanohydrogels was up to eight-fold greater than an aqueous suspension drug against different fungal species isolated from CF sputum, regardless of the presence of a CF artificial mucus layer. Conclusions: These findings support the development of potent VRC nano-formulations for treating fungal disorders in CF lungs. Full article

Background: The role of ultrasonography (US) in the practical management of polyneuropathies, particularly axonal, remains unclear. The present study aimed to explore the contribution of the US examination of polyneuropathies in daily clinical practice. Methods: We performed a retrospective chart review of patients with clinical and electrophysiological diagnoses of polyneuropathy referred to our US laboratory over eight years. The contribution of US examination in this patient population was evaluated. Results: We analyzed 201 consecutive patients (66% men), aged 12–90 years (mean (SD), 62 (15) years). The most common referral questions were differentiation of hereditary from acquired demyelinating polyneuropathies (71 (35%) patients, sensitivity 63%, specificity 88%), and additional focal neuropathies in patients with generalized neuropathies (51 (25%) patients, sensitivity 75%, specificity 34%). The US examination was pathological in 158 (79%) of patients. The most common US finding was nerve enlargement at typical entrapment sites (73 (36%) patients), followed by proximal nerve thickening (34 (17%) patients). The US provided new diagnoses in 7 (3.5%) patients, contributed to diagnoses in 39 (19%) patients, and confirmed diagnoses in 50 (25%) patients. Conclusion: Our study demonstrated the ability of peripheral nerve US to provide useful additional diagnostic information in about half of the referred patients with polyneuropathy. Full article

Background/Objectives: Dry eye disease (DED), also known as “keratoconjunctivitis sicca”, is a common chronic ocular surface disease accompanied by inflammation and diminished tear production. Bovine Lactoferrin (BLF), a multi-functional iron-binding glycoprotein found in tears, decreased significantly in patients with DED, used for the treatment of dry eye, conjunctivitis, and ocular inflammation. BLF has limited therapeutic efficacy due to poor ocular bioavailability. Methods: This study developed and optimized a BLF-loaded nanosuspension (BLF-NS) using the Box–Behnken Design (BBD). Optimized BLF-NS was then incorporated with polyvinyl pyrrolidone (PVP) and hydroxypropyl methyl cellulose (HPMC) dissolving microneedles (MNs). The formulations were characterized by Scanning and transmission microscopy, DSC, FTIR, ex vivo studies in corneal tissue from sheep and tested for its antibacterial and antifungal efficacy against Methicillin-Resistant Staphylococcus aureus (MRSA), Staphylococcus aureus, and Aspergillus niger, respectively. Moreover, they were tested for their Benzalkonium chloride (BCL) dry eye in a rabbit model. Results: The optimized nanosuspension showed a vesicle size of (215 ± 0.45) nm, a Z.P (zeta potential) of (−28 ± 0.34) mV, and an Entrapment Efficiency (EE%) of (90 ± 0.66) %. The MNs were fabricated using a ratio of biodegradable polymers, PVP/HPMC. The resulting BLF-NS-MNs exhibited sharp pyramidal geometry with high mechanical strength, ensuring ocular insertion. In vitro release showed 95% lactoferrin release over 24 h, while ex vivo permeation achieved 93% trans-corneal delivery. In vivo, BLF-NS-MNs significantly reduced pro-inflammatory cytokines (TNF-α, IL-6, MMP-9, IL-1β, MCP-1) and upregulated antioxidant and anti-inflammatory genes (PPARA, SOD 1), restoring their levels to near-normal (p < 0.001). Conclusions: The nanosuspension combined with MNs has shown higher ocular tolerance against DED ensured by the Draize and Schirmer Tear Test. Full article

Background/Objectives: Pudendal neuralgia (PN) is a debilitating chronic pain condition resulting from injury, inflammation, or entrapment of the pudendal nerve. It significantly affects patients’ quality of life and poses challenges to treatment due to its complex etiology. Conventional therapies often provide limited or temporary relief. The impar ganglion block (IGB) has emerged as a potential intervention for managing refractory pelvic pain syndromes. This systematic review aimed to evaluate the clinical efficacy, safety, and applicability of IGB in treating patients with PN. Methods: This systematic review evaluates the efficacy and clinical applicability of IGBs in treating PN. Following PRISMA-P 2020 guidelines, a systematic search was conducted in PubMed/MEDLINE, Embase, LILACS, and Cochrane Library. Eligible studies included RCTs, observational studies, and case series assessing pain reduction and quality of life post-IGB. Non-neuropathic pelvic pain studies were excluded. The ROBVIS tool assessed the risk of bias. Results: Of 306 articles screened, 16 met eligibility criteria. Studies showed that the IGB provides significant pain relief, particularly for refractory cases. Image-guided techniques enhanced precision and reduced complications. Combination therapies with corticosteroids yielded longer-lasting analgesia. However, methodological inconsistencies and varied patient selection limited generalizability. Conclusions: The IGB is a minimally invasive, effective option for managing PN. Further high-quality RCTs are needed to standardize protocols, optimize patient selection, and evaluate long-term efficacy. A multidisciplinary approach remains essential. Full article

Transdermal drug delivery systems (TDDSs) provide a non-invasive alternative to oral and parenteral routes, delivering drugs into the bloodstream while avoiding gastrointestinal degradation and first-pass metabolism. Despite benefits like enhanced bioavailability and patient compliance, the stratum corneum limits drug permeation. Ethosomes overcome the stratum corneum barrier with superior flexibility and permeability compared to liposomes. Ethanol disrupts the skin’s lipid bilayer, enabling deep penetration and efficient drug delivery. Ethosomes offer high entrapment efficiency and stability, delivering both hydrophilic and lipophilic drugs. However, challenges like stability optimization and clinical translation persist. This review examines the structural components, preparation methods, and therapeutic applications of ethosomes in metabolic and chronic diseases, including diabetes, cardiovascular diseases, neurodegenerative disorders, arthritis, and cancers. Moreover, it highlights the potential of ethosomes to revolutionize TDDSs for managing chronic and metabolic diseases, providing a foundation for further research and clinical development. Full article

Background: Conventional approaches in treating psoriasis demonstrate several complications. methotrexate (MTX) has been frequently used for its efficacy in managing moderate to severe psoriasis. However, MTX acts as an antagonist in regular dosage, which creates a patient compliance issue with undesirable consequences for patients, which necessitates development of an innovative approach to enhance skin permeation. Therefore, this study examines the improved topical administration of MTX utilizing a transferosome-loaded microneedle (MNs) array patch for the management of psoriasis. Methods: A design of experiment was used assess the effect of phospholipid content and edge activator type on vesicle size and entrapment efficiency (EE) to fabricate and optimize transferosome-loaded MTX. Furthermore, the MTX was incorporated within MNs and assessed for in vitro-ex vivo-in vivo parameters. Results: The morphology result revealed vesicles mean diameter of 169.4 ± 0.40 nm and EE of 69 ± 0.48 (%). Compared to traditional formulations (MTX patch and gel), the optimized transferosome-loaded dissolving MN array patch showed a substantial increase in diffusion of MTX tested over rat skin. Furthermore, an enhanced therapeutic benefit at the application site through cumulative drug release profiles suggested sustained release of MTX over 24 h. Moreover, in vivo experiments showed that the MN array patch exhibited higher accumulation, compared to conventional formulation tested. In addition, the plasma concentration measurements demonstrated a reduction in systemic exposure to MTX, diminishing the possibility of intricacy while preserving localized therapeutic efficacy. The capability of the MN array patch to lance the epidermal layers was proven by histological assessments. Conclusions: Thus, transferosome-loaded MNs is a viable method of delivering MTX topically with prolonged drug release and reduced systemic toxicity. Full article

The classical approach for the preparation of an endodontically treated molar with a post and core involves widening the anatomically complex system of canals, which may be narrow or curved with variable angulation. The aforementioned along with the fact that restorative dentistry stands against the wastage of tooth tissue make endocrowns an appealing alternative. Bindl and Mörmann first described an all-ceramic crown anchored to the internal portion of the pulp chamber and on the cavity margins, thus obtaining macromechanical retention provided by the axial opposing pulpal walls and microretention attained with the use of adhesive cementation. The purpose of this report is to describe the protocol for the treatment plan selection, preparation, impression, and adhesive cementation of an endocrown with a follow-up of 5 years. A 56-year-old male patient presented to the Postgraduate Clinic of Prosthodontics seeking rehabilitation for tooth No. #36. A clinical examination revealed multiple immediate composite resin restorations with unacceptable morphology and adaptation to the remaining tooth as well as a lack of a contact point but, rather, a large, concave contact area facilitating food entrapment. Since the tooth was endodontically treated, the proposed treatment plan included the fabrication of an all-ceramic endocrown. The steps of preparation, attribution of the correct shape, impression, and adhesive luting under rubber dam isolation are thoroughly described. The final functional and aesthetic result, patient’s satisfaction, and the 5-year follow-up render restorations such as endocrowns, which draw their retention from adhesive luting, a viable alternative to conventional approaches. Full article

Background/Objectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and various surgical techniques are used for its treatment. Extended open carpal tunnel release (EOCTR) has been proposed for improved nerve decompression. This study compares the clinical and functional outcomes of open carpal tunnel release (OCTR) and EOCTR in severe CTS, hypothesizing superior functional outcomes and lower pain levels with EOCTR. Methods: This retrospective study included 53 patients (45 females, 8 males) with severe CTS confirmed by electromyography. Patients underwent either OCTR (n = 28) or EOCTR (n = 25) between January 2020 and February 2023. The EOCTR techinque involved additional neurolysis of the recurrent motor branch and palmar cutaneous branch of the median nerve. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), the Visual Analog Scale (VAS) for pain, and hand strength measurements. Complications and recovery parameters were also analyzed. Results: EOCTR resulted in significantly lower postoperative VAS scores (3.31 vs. 3.78, p < 0.001), DASH scores (16.54 vs. 20.68, p < 0.001), and BCTQ symptom scores (1.87 vs. 2.01, p < 0.001). No significant differences were found in grip strength (p = 0.52) or pinch strength (tip-to-tip: p = 0.54, lateral: p = 0.061, 3-point: p = 0.17). No major complications occurred, and pillar pain was similar in both groups (p = 0.82), resolving with conservative treatment. Conclusions: EOCTR with additional palmar cutaneous branch of the median nerve neurolysis may provide better short-term functional outcomes and lower pain levels compared to OCTR in severe CTS. Further prospective studies are needed to validate the long-term benefits and safety of this surgical approach. Full article

Background: Obturator nerve entrapment can result from endogenous and exogenous causes. Due to its long course, which includes both endopelvic and exopelvic segments, the nerve is susceptible to irritation from multiple etiologies. However, as obturator nerve entrapment is relatively uncommon, a thorough understanding of endogenous factors contributing to nerve entrapment is lacking. Nevertheless, understanding the endogenous factors contributing to obturator nerve entrapment is crucial for an effective treatment approach. Material and Methods: We performed a systematic literature search on studies investigating the diagnostic and (surgical) therapeutic approaches to obturator neuropathy due to endogenous causes. Studies were grouped according to the etiology responsible for nerve irritation. Lastly, data were synthesized to create a clinical work-up flowchart for obturator nerve entrapment syndromes due to endogenous causes. Results: Data from 45 studies comprising 175 patients met our inclusion criteria. We were able to summarize these data into six broad etiologies (tumor, obturator hernia, endometriosis, cystic lesions, vascular, and idiopathic causes) responsible for nerve irritation and saw that the most important factors for therapy are the onset of the symptoms and the anatomical localization. MRI emerged as the most valuable diagnostic tool for chronic conditions, especially in identifying the precise etiology and location of nerve compression. Conclusions: This review offers a structured framework for diagnosing and managing obturator nerve entrapment due to endogenous causes. We propose a diagnostic and therapeutic algorithm based on the identified etiologies to facilitate clinical decision-making. Full article

Cancer is considered as the second leading cause of death worldwide. Chemotherapy, radiotherapy, immunotherapy, and targeted drug delivery are the main treatment options for treating cancers. Chemotherapy drugs are either available for oral or parenteral use. Oral chemotherapy, also known as chemotherapy at home, is more likely to improve patient compliance and convenience. Oral anti-cancer drugs have bioavailability issues associated with lower aqueous solubility, first-pass metabolism, poor intestinal permeability and drug absorption, and degradation of the drug throughout its journey in the gastrointestinal tract. A highly developed carrier system known as lipid polymer hybrid nanoparticles (LPHNs) has been introduced. These nanocarriers enhance drug stability, solubility, and absorption, and reduce first-pass metabolism. Consequently, this will have a positive impact on oral bioavailability enhancement. This article provides an in-depth analysis of LPHNs as a novel drug delivery system for anti-cancer agents. It discusses an overview of the limited bioavailability of anti-cancer drugs, their reasons and consequences, LPHNs based anti-cancer drug delivery, conventional and modern preparation methods as well as their drug loading and entrapment efficiencies. In addition, this article also gives an insight into the mechanistic approach to oral bioavailability enhancement, potential applications in anti-cancer drug delivery, limitations, and future prospects of LPHNs in anti-cancer drug delivery. Full article