Investigation of SCCmec types using the real time PCR method in cefoxitin-resistant Staphylococcus aureus isolates.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen that can cause many community and hospital-acquired infections. This study was conducted to investigate the SCCmec gene types responsible for methicillin resistance in MRSA isolates isolated from hospitalised patients. MATERIAL AND METHODS: MRSA isolates isolated from samples sent from various clinics to Gaziantep University Hospital Microbiology Laboratory between March 2021-January 2022 were included in the study. Bacteria were identified using by VITEK 2 automated system. Cefoxitin (FOX) resistance was determined by the disc diffusion method according to EUCAST standards. Cefoxitin resistance was confirmed by the Penicillin Binding Protein 2' latex agglutination test. Types of mecA, mecC, coa, nuc, Panton Valentin Leukocidin (PVL), ccrC2, class A mec, SCCmec types in isolates detected as MRSA were investigated by real-time PCR. RESULTS: In this study, 116 isolates meeting the study criteria were examined. By detecting the nuc and coa genes in all isolates by PCR, the phenotypic identification of S.aureus was confirmed. While the mecA gene was detected in all MRSA isolates, no mecC gene was detected in any isolates. Detected SCCmec types were as follows; SCCmec Type 1 (2.6%), Type II (28.4%), Type III (12.9%), Type IVa (11.2%), Type IVb (3.4%), Type IVc (3.4%), Type IVg (12.1%), Type V (0.9%), Type VII (4.3%), Type VIII (18.1%), Type IX (0.9%), Type XII (1.7%). On the other hand, SCCmec Type VI, X, XI and XIII were not found in any isolate. It was determined that four of the MRSA isolates (3.4%) carried the PVL gene that two (50%) of these were found in SCCmec Type VIII. CONCLUSION: Monitoring of FOX resistance is an effective and safe method for determination of MRSA isolates. The change in the mec gene causes resistance, which should be monitored regularly with molecular methods. Our study is the first study in Turkey.

Evaluation of real-time PCR and flow cytometry efficiency in rapid detection of carbapenemase-producing Enterobacteriales.

INTRODUCTION: Infections due to carbapenem-resistant Enterobacteriales, which have increased worldwide in recent years, cause concern. This study aimed to rapidly detect carbapenemase gene region by using flow cytometry in Enterobacteriales isolates and to evaluate its efficiency and susceptibility by comparing it with polymerase chain reaction (PCR). METHODOLOGY: In the study, 21 isolates obtained from the blood cultures of patients hospitalized in intensive care units and found to intermediate or resistant to at least one carbapenem in the automated system, and 14 isolates belonging to the carbapenem-susceptible Enterobacteriales family were included. Carbapenemase gene regions were investigated by PCR after their susceptibility was determined by disk diffusion method. Bacterial suspensions were treated with meropenem + specific carbapenemase inhibitors (EDTA or APBA) and Temocillin and stained with thiazole orange (TO) and propidium iodide (PI) to show dead/live cell differentiation. Dead/live cell percentages were calculated after reading on the flow cytometer device. RESULTS: In the ROC analysis of the flow cytometry method, the cut-off value, specificity, and susceptibility of PI staining rates for meropenem were found as 14.37%, 100%, and 65%, respectively. It was found that the flow cytometry method was well-compatible with PCR in the detection of the carbapenemase gene region. CONCLUSIONS: Flow cytometry will continue to be a promising method for the detection of antimicrobial susceptibility and resistance due to its rapid analysis of many cells and its high compatibility with PCR results.

Cryptococcal meningitis in a non-HIV patient with solid organ transplantation.

Cryptococcal meningitis (CM) is often associated with human immunodeficiency virus (HIV). Recently, this microorganism has been increasingly identified in HIV-negative patients. CM cases are encountered in HIV-negative individuals, especially secondary to liver disease, solid organ transplantation (SOT), tuberculosis, lymphoproliferative diseases with T-cell-mediated immunological disorders, long-term corticosteroid use, malignancies, diabetes mellitus, and sarcoidosis. Our patient is an HIV-negative, SOT case with CM. It should be considered that CM can also occur in HIV-negative patients. As in our case, patients receiving long-term immunosuppressive therapy should be evaluated for CM, and renal functions should be closely monitored during treatment. There is a need for more case reports on the subject, especially in CM detected HIV-negative patients, due to the different treatment protocols and challenging clinical conditions compared to HIV-positive cases.

Contamination of Low Frictional Elastomeric Ligatures by Streptococcus mutans: A Prospective RT-PCR and AFM Study.

OBJECTIVE: To compare Streptococcus mutans colonization between low-friction elastomeric ligatures and to correlate microbial colonization levels with the surface roughness status. METHODS: The study included 160 premolars of 10 patients. During the study period, which consisted of 4 sessions each lasting 4 weeks, the ligature types Slide™ Low-Friction Ligature (Leone, Firenze, Italy), Tough-O Energy™ (Rocky Mountain Orthodontics, Denver, USA), and Sili Ties™ (Dentsply Sirona, Surrey KT13 0NY, UK), and steel ligatures (American Orthodontics, Sheboygan, USA) as a control, were fixed to the premolar teeth by clockwise rotation among the jaw quadrants. The plaque index (PI) and gingival index (GI) were obtained before bonding (T0), 6 weeks after bonding (T1), and subsequently every 4 weeks (T2, T3, T4). Presence of S. mutans was analyzed by real-time polymerase chain reaction at T1, T2, T3, T4. Surface roughness was evaluated with Atomic Force Microscopy (AFM) before ligation (Ra0) and after (Ra1) ligation. The paired t-test, ANOVA, repeated measures of ANOVA, and the Kruskal-Wallis test were used for the statistical analysis. RESULTS: S. mutans colonization was significantly higher on the Slide group (P < .05). The lowest Ra0 was seen in Slide and the highest was seen in the Tough-O Energy group. There was no correlation between S. mutans colonization and Ra1 parameters of elastomeric groups (P > .05). CONCLUSION: S. mutans colonization showed variations in low-friction elastomeric ligatures independent of surface roughness. Ringshaped low-friction elastomeric ligatures were not different from the steel ligature in terms of S. mutans colonization.

Thymoquinone ameliorates delayed cerebral injury and cerebral vasospasm secondary to experimental subarachnoid haemorrhage.

AIM OF THE STUDY: Among subarachnoid haemorrhage (SAH) patients, delayed cerebral injury (DCI) and infarction are the most important causes of death and major disability. Cerebral vasospasm (cVS) and DCI remain the major cause of death and disability. Thymoquinone (TQ) is the substance most responsible for the biological activity of nigella sativa (NS) and is useful in the treatment of ischaemic and neurodegenerative diseases, oxidative stress, inflammatory events, cardiovascular and neurological diseases. We conducted an experimental study aimed to investigate the preventive and corrective effects of TQ. MATERIALS AND METHODS: 24 Sprague-Dawley rats were randomly divided into three groups. The first was the control group which was a sham surgery group. The second group was the SAH group where the double haemorrage SAH protocol was used to induce vasospasm. The third group was the SAH+TQ group, where cVS was induced by the SAH protocol and the animals received oral 2 cc thymoquinone solution for seven days at a dose of 10 mg/kg, after the induction of SAH. The rats were euthanised seven days after the first procedure. The degree of cerebral vasospasm was evaluated by measuring the basilar artery luminal area and arterial wall thickness. Apoptosis was measured by the western blot method at brainstem neural tissue. Oxidative stress was measured by the Erel Method. Endothelin-1 was measured with ELISA analysis at blood. Statistical analysis was performed. RESULTS: Endothelin-1 values were found to be statistically significantly lower in the control and SAH+TQ groups compared to the SAH group (P < 0.001). Mean lumen area values were significantly higher in the control and SAH+TQ groups than in the SAH group (P < 0.001). In the control and SAH+TQ groups, wall thickness values decreased significantly compared to the SAH group (P < 0.001). OSI values were significantly lower in the control and SAH+TQ groups than in the SAH group (P < 0.001). Apoptosis was significantly lower in the control and SAH+TQ groups than in the SAH group (P < 0.001). CONCLUSION: Our results show that post-SAH TQ inhibits/improves DCI and cVS with positive effects on oxidative stress, apoptosis, ET-1, lumen area, and vessel wall thickness, probably due to its anti-ischaemic, antispasmodic, antioxidant, anti-inflammatory, anti-apoptotic and neuroprotective effects.

Effects of Intrathecal Verapamil on Cerebral Vasospasm in Experimental Rat Study.

BACKGROUND: Verapamil, a calcium-channel blocker, has shown promising results on cerebral vasospasm. However, it has not yet been accepted for treatment or prevention purposes because of the associated side effects. Although the effective results of nimodipine and nicardipine's intrathecal administration are well known, intrathecal verapamil has not been considered earlier. We used an experimental subarachnoid hemorrhage-induced vasospasm model for the evaluation of vasodilator and neuroprotective effects of intrathecal verapamil. METHODS: A total of 24 Sprague-Dawley rats were randomly divided into the following 3 groups: group 1 (sham), group 2 (subarachnoid hemorrhage), and group 3 (verapamil). A double hemorrhage method was used. Group 2 did not receive any treatment. Verapamil (Eporon, Dem Ilac, Turkey) at a dose of 1000 µg/kg was given intrathecally to group 3 rats. The animals were euthanized on day 7 of the procedure. Arterial wall thickness and lumen diameter in the basilar arterial cross-sectional areas, endothelin-1 serum level, oxidative stress index, and apoptosis were measured in all groups. RESULTS: In the verapamil group, wall thickness, endothelin-1 level, oxidative stress index, and apoptosis were found to be significantly lower than the subarachnoid hemorrhage group, but the lumen diameter was found to be greater. Intrathecal verapamil was found to decrease vasospasm parameters and apoptosis and increase the antioxidant and antiapoptotic pathways. CONCLUSIONS: Our findings suggest that intrathecal verapamil can prevent vasospasm, oxidative stress, and apoptosis after experimental subarachnoid hemorrhage.

Genotyping Leishmania promastigotes isolated from patients with cutaneous leishmaniasis in south-eastern Turkey.

Objective Cutaneous leishmaniasis (CL) is a significant disease in south-eastern Anatolia because it is prevalent among Syrian refugees. We identified the causative Leishmania species in CL patients using molecular methods. Methods Novy-MacNeal-Nicolle medium was inoculated with aspirated fluid from suspected CL lesions and tested for amastigotes with Giemsa staining. PCR amplified the internal transcribed spacer 1 (ITS1) of the Leishmania genome in cultures containing Leishmania promastigotes from 100 patients, which were genotyped with a restriction fragment length polymorphism (RFLP) analysis. A phylogenetic tree was constructed from ITS1 sequences of 95 culture fluid samples from these patients. Results Leishmania amastigotes were detected in 92% of cultures with growth. Leishmania promastigotes were typed as Leishmania tropica with both PCR-RFLP and sequencing. Conclusions Identification of L. tropica as the causative agent of CL in our region allows the clinical course to be predicted, and guides treatment decisions and preventive measures.

Spontaneous Tumour Lysis Syndrome in a Multiple Myeloma.

The tumor lysis syndrome (TLS) is a collection of metabolic abnormalities that occur in consequence of the release of intracellular contents following lysis of tumor cells. TLS occurs spontaneously or after chemotherapy. Spontaneous TLS is uncommon occurrence in multiple myeloma (MM). We define a case of a 70-year-old woman patient who was found to have MM with spontaneous TLS, following a compression fracture of the T-12 vertebrae. While serum uric acid and phosphorous levels were high, low calcium levels were identified. There were also acute kidney injury and metabolic acidosis. Upon the diagnosis of TLS, she was treated with hydration, allopurinol, sodium bicarbonate, and calcium gluconate. The improvement of her laboratory data was observed. We submitted this case in order to draw attention to the presentation of MM with spontaneous TLS.

Infrarenal Aorta Thrombosis Associated with H1N1 Influenza A Virus Infection.

Influenza viruses are members of the Orthomyxoviridae family, of which influenza A, B, and C viruses constitute three separate genera. Arterial thrombosis associated with H1N1 influenza A virus infection has rarely been reported. A Turkish man aged 28 years was admitted to our emergency department with dyspnea, bilateral lower extremity insensitivity, and cold. He reported symptoms of fever, myalgia, and cough, which he had had for fifteen days before being admitted to our hospital. The patient was tested for pandemic influenza A (H1N1) virus using polymerase chain reaction (PCR) tests, which were positive. Abdominal computerized tomography with contrast revealed a large occlusive thrombus within the infrarenal aorta.

The comparison of resistivity index and strain index values in the ultrasonographic evaluation of chronic kidney disease.

OBJECTIVES: Chronic kidney disease (CKD) is a disorder progressing to end-stage kidney failure. Early diagnosis and treatment are important for medical care. The aim of this prospective study was to define the strain index (SI) and resistivity index (RI) values in the same CKD group for each kidney separately at the same time, and also to compare the efficacy of SI and RI in the differentiation of normal population and CKD patients. MATERIALS AND METHODS: Toshiba Aplio 500 USG device and 3.5-5 MHz convex probe were used for USG, CDUSG, and USG elastography examinations. The patients were referred to radiology clinique from nephrology and endocrinology cliniques after GFR calculation. Patients with renal cyst, tumor, or obstructive renal disease were excluded. Healthy volunteers according to laboratory and clinical examinations were selected from non-kidney disease patients. RESULTS: A total of 121 CKD (68 men, 53 women) and 40 healthy volunteers (19 men, 21 women) were participated. The mean SI and RI values of CKD were significantly higher than the normal healthy volunteers (p < 0.05). The SI and RI values of right and left kidney did not show any difference in CKD patients (p values were 0.381 for SI and 0.821 for RI). The sensitivity and the specificity of the SI were higher than RI. CONCLUSION: The RI and SI values of kidneys in CKD patients were significantly higher than those of apparently normal kidneys. SI was more sensitive than RI in our study. Determining cut-off SI and RI values between normal and damaged renal parenchyma can help in the diagnosis and follow up of CKD patients. ADVANCES IN KNOWLEDGE: To the best of our knowledge, this is the first study comparing RI and SI in CKD patients, and SI is found to be more sensitive than RI for the evaluation of CKD.

Using different chemical methods for deposition of copper selenide thin films and comparison of their characterization.

Different chemical methods such as Successive Ionic Layer Adsorption and Reaction (SILAR), spin coating and spray pyrolysis methods were used to deposite of copper selenide thin films on the glass substrates. The films were characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), atomic force microscopy (AFM), energy dispersive X-ray analysis (EDX) spectroscopy and UV-vis spectrophotometry. The XRD and SEM studies showed that all the films exhibit polycrystalline nature and crystallinity of copper selenide thin films prepared with spray pyrolysis greater than spin coating and SILAR methods. From SEM and AFM images, it was observed copper selenide films were uniform on the glass substrates without any visible cracks or pores. The EDX spectra showed that the expected elements exist in the thin films. Optical absorption studies showed that the band gaps of copper selenide thin films were in the range 2.84-2.93 eV depending on different chemical methods. The refractive index (n), optical static and high frequency dielectric constants (ε0, ε∞) values were calculated by using the energy bandgap values for each deposition method. The obtained results from different chemical methods revealed that the spray pyrolysis technique is the best chemical deposition method to fabricate copper selenide thin films. This absolute advantage was lead to play key roles on performance and efficiency electrochromic and photovoltaic devices.

Similarity analysis of soils formed on limestone/marl-alluvial parent material and different topography using some physical and chemical properties via cluster and multidimensional scaling methods.

The aim of this study is to analyze the similarity of soils formed on limestone/marl alluvial parent material and different topography using some physical and chemical properties via cluster analysis (CA) and multidimensional scaling analysis (MDSA). Physical and chemical soil properties included in this study are texture, CaCO3, organic matter, pH, electrical conductivity, cation exchange capacity, and available water content. The study was carried out in Çetinkaya region located on Bafra Deltaic Plain. The study area has two main physiographic units. The first one is the flat or gently slope alluvial lands (0-2 %), and the other one involves hills with slopes ranging from middle to steep (3-20 %). The soil in the study area is mainly classified as entisol, inceptisol and vertisol. According to the CA results, while C horizons of the soils formed on alluvial deposits (typic ustifluvent and typic ustipsamment) bear similarity, Ap horizons of the soils formed on lime/marl parent material (vertic ustorhent, vertic calciustept, and calci haplustert) appear in the same group. Additionally, in order to support CA, MDSA was performed. Significant correlations were observed between the results of both analyses.

Affects of different tillage managements on soil physical quality in a clayey soil.

This study, conducted in 2011, researches the effects of different tillage practices on the physical soil quality of clayey soil. This soil quality index (SQI) assessment was made by studying the changes in physical soil functions such as suitability for root development, facilitation for water entry, movement and storage, and resistance against surface degradation based on tillage management. When compared with the control parcel, statistically significant decreases were seen in the SQI with different tillage practices (p < 0.05). Among the tillage practices, the highest SQI was seen with the plow + rotary tiller + direct seeding machine, while the lowest SQI was seen with the direct drilling practice. On the other hand, the statistically insignificant effects of tillage practices on the soil quality of the study area were considered to be a result of either the study period or the joint effect of soil texture and climatic features. Thus, long-term tillage practices were recommended in order to get healthier information about soil quality by considering soil and climatic conditions. In addition, for heavy clayey soils, reduced tillage practices, which included plowing, were thought to develop physical soil qualities of root development and water movement.

Right heart free-floating thrombus in a pregnant woman with massive pulmonary embolism: a case of 'emboli in transit'.

The mainstay of treatment for massive pulmonary embolism in nonpregnant individuals is urgent thrombolytic therapy, but experience with these drugs in pregnancy is limited. We report a case of a 36-year-old woman at 27 weeks' gestation who was admitted with a massive, life-threatening pulmonary embolism. The diagnosis was rapidly accomplished in the coronary care unit by transthoracic echocardiography that showed signs of pulmonary hypertension as well as a large, free-floating thrombus in the right heart. As she was hemodynamically unstable, we started treatment with tissue plasminogen activator resulting in complete resolution of cardiorespiratory symptoms. A live baby was delivered by Caesarean section at 37 weeks of gestation, and no complications were seen during the 1-year follow-up. The present case report emphasizes the pivotal role of repeat echocardiography in clinical decision-making and the life-saving potential of thrombolytic therapy without serious adverse effects.

The relationship between aortic knob width and various demographic, clinical, and laboratory parameters in stable hemodialysis patients.

Accelerated atherosclerosis is very common in hemodialysis (HD) patients and is related to morbidity and mortality. The aortic knob width (AKW), which can easily be calculated on chest radiographs has also been found to be related to atherosclerosis in patients with normal renal function. The importance of AKW in HD patients is not known. The current study is aimed to investigate factors associated with increased AKW in HD patients. The study participants had their medical history taken and a physical examination conducted, with calculation of dialysis adequacy and AKW. AKW was calculated from the chest x-rays at the end of the dialysis session, when the patients were in their dry weight. A total of 91 HD patients and 65 patients with normal renal function (as a control group) were included. The mean of the AKW was 35.0±5.8 mm in HD patients and 26.6±4.3 mm in the control group (P<0.0001). Stepwise linear regression analysis of both groups combined revealed that age (P: 0.001), male gender (P<0.0001), systolic BP (P<0.0001), presence of HD treatment (P: 0.016), and albumin levels (P: 0.021) were inde-pendently related with increased AKW. On the other hand, in HD patients stepwise linear regression showed that age (P<0.0001), pre-dialysis systolic BP (P: 0.003), male gender (P<0.0001), being a non-smoker (P: 0.002), total cholesterol (P: 0.001), and intact parathormone levels (P: 0.005) were independently associated with increased AKW. In conclusion, AKW is increased in HD patients when compared with the normal population. These preliminary findings may enhance the use of chest radiography as a screening method, and if confirmed, can assist risk stratification in HD patients.

Hand and heart, hand in hand: is radiological hand osteoarthritis associated with atherosclerosis?

AIM: Increasing evidence suggests that atherosclerosis contributes to the initiation or progression of osteoarthritis (OA). It has been suggested that atherosclerosis may cause vascular insufficiency which may lead to or progress OA. In this study, the association between the severity of radiologic hand OA and atherosclerosis was analyzed in women. METHODS: Sixty-one women, ≥ 50 years of age, free of hand symptoms were enrolled in the study. Postero-anterior views of both hands were obtained using digital radiography. A total of 14 joints were assessed for radiographic OA according to Kellgren/Lawrence (K/L) score. An OA-affected joint was defined as K/L score of ≥ 2. Hand OA was defined as ≥ 3 joints of both hands affected with OA and severity of hand OA was defined as total K/L scores of all 14 joints of both hands. Gensini scoring was used to evaluate the patients for atherosclerosis severity. RESULTS: The patient characteristics such as presence of diabetes, smoking, hypertension, dyslipidemia and medications used were similar for patients with and without hand OA (P > 0.05) and did not correlate with Gensini or hand OA scores. The mean Gensini scores of patients with hand OA was 21.5 ± 17.1 and without hand OA was 11.8 ± 9.2 (P = 0.017). The degree of osteoarthritic joint involvement and Gensini scores showed a positive correlation (r = 0.332, P = 0.009). CONCLUSION: Hand OA may be a benign clinical finding that may suggest a possible serious underlying atherosclerosis. Patients with significant hand OA should be screened for atherosclerosis to prevent serious coronary artery disease and related comorbidities.

Clinical and demographic findings of patients with rheumatoid arthritis and ankylosing spondylitis treated in a tertiary care center in Turkey.

BACKGROUND/AIM: Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are 2 common rheumatic diseases that are frequent causes of disability. In this descriptive study, demographic, clinical, and laboratory findings of patients with RA and AS being followed in a tertiary care center in Turkey were reported. MATERIALS AND METHODS: The patient data of 45 RA and 45 AS cases were collected retrospectively from electronic medical records. Demographic findings, clinical and laboratory assessments of disease activity, drugs used for the treatment, and effect on quality of life of patients with RA and AS were analyzed. RESULTS: In RA patients, 27% had mild, 44% had moderate, and 29% had severe disease and 25% of the patients had satisfactory functional state. In AS patients, the mean Bath Ankylosing Spondylitis Disease Activity Index score was 4.6 ± 2.3 and 64% had active disease. Sixteen percent of the patients with AS reported satisfactory functional state. In RA cases, the highest percentage of patients were treated with biological agents. In AS cases, 24% of patients were treated with NSAIDs and 22% received biological agents. CONCLUSION: In our tertiary care center, the majority of patients with RA and AS had active disease with unsatisfactory functional states.

The relationship between red cell distribution width with erythropoietin resistance in iron replete hemodialysis patients.

BACKGROUND: Recently, erythropoietin resistance (ER) has been shown to be related with cardiovascular and overall mortality in hemodialysis (HD) patients. Red blood cell distribution width (RDW) has also shown to be associated with cardiovascular and all cause mortality in general population. Thus in the current study we tested the hypothesis that RDW and erythropoietin resistance as determined by erythropoiesis stimulating agents (ESA) hyporesponsiveness index (EHRI) may be related with each other in iron replete HD patients. METHODS: Study participants underwent medical history taking, physical examination, calculation of dialysis adequacy and biochemical analysis. EHRI was calculated as the weekly dose of EPO divided by per kilogram of body weight divided by the hemoglobin level. RESULTS: Two separate analyses were performed. In the first analysis performed in 94 HD patients; the stepwise linear regression analysis revealed that being female (P=0.031), HD duration (P=0.021), presence of diabetes mellitus (P=0.008), RDW (P=0.023), and predialysis sodium (P=0.05) were independently related with logarithmically converted EHRI. We made second analysis after 4 months. The second analysis revealed that when compared to first EHRI, the EHRI was increased in 40, unchanged in one and decreased in 40 patients The second stepwise regression analysis also showed that the independent relationship with RDW and EHRI was persisted (ß=0.050, CI: 0.022-0.078, P=0.001). CONCLUSION: Red blood cell distribution width was independently related with EHRI in iron replete HD patients.

Sleep quality, depression, and quality of life in elderly hemodialysis patients.

OBJECTIVE: Both the incidence and the prevalence of end-stage renal disease (ESRD) in elderly patients are increasing worldwide. Elderly ESRD patients have been found to be more prone to depression than the general population. There are many studies that have addressed the relationship between sleep quality (SQ), depression, and health related quality of life (HRQoL) in ESRD patients, but previous studies have not confirmed the association in elderly hemodialysis (HD) patients. Therefore, the aim of the present study was to demonstrate this relationship in elderly HD patients. PATIENTS AND METHODS: Sixty-three elderly HD patients (32 females and 31 males aged between 65 and 89 years) were included in this cross-sectional study. A modified Post-Sleep Inventory (PSI), the Medical Outcomes Study 36-item short form health survey, and the Beck Depression Inventory (BDI) were applied. RESULTS: The prevalence of poor sleepers (those with a PSI total sleep score [PSI-4 score] of 4 or higher) was 71% (45/63), and the prevalence of depression was 25% (16/63). Of the 45 poor sleepers, 15 had depression, defined as a BDI score of 17 or higher. Poor sleepers had a significantly higher rate of diabetes mellitus (P = 0.03), significantly higher total BDI scores, and lower Physical Component Scale scores (ie, lower HRQoL) than good sleepers. The PSI-4 score correlated negatively with Physical Component Scale (r = -0.500, P < 0.001) and Mental Component Scale scores (r = -0.527, P < 0.001) and it correlated positively with the BDI score (r = 0.606, P < 0.001). In multivariate analysis, independent variables of PSI-4 score were BDI score (beta value [ß] = 0.350, P < 0.001), Mental Component Scale score (ß = -0.291, P < 0.001), and age (ß = 0.114, P = 0.035). CONCLUSION: Poor SQ is a very common issue and is associated with both depression and lower HRQoL in elderly HD patients.

Effects of epinephrine and cortisol on the analgesic activity of metyrosine in rats.

Some endogenous hormones (epinephrine and cortisol) can change an individual's pain threshold. Propranolol is a non-selective ß adrenergic receptor blocker which antagonises the anti-inflammatory effect of non-steroidal anti-inflammatory drugs via the ß1 and ß2 adrenergic receptors. The roles of epinephrine and cortisol were investigated in the analgesic activity of metyrosine in rats with reduced epinephrine levels induced by metyrosine. Pain threshold measurement was performed using an analgesimeter with different doses and the single or combined usage of metyrosine, prednisolone, metyrapone and propranolol in rats. Epinephrine and corticosterone levels were measured by high-performance liquid chromatography in metyrosineadministered rats. Metyrosine reduces the epinephrine levels without affecting the corticosterone levels, thereby creating an analgesic effect. It was determined that prednisolone did not have an analgesic effect in rats with normal epinephrine levels, but its analgesic activity increased with a parallel decrease in the epinephrine levels. Similarly, the combined use of prednisolone and metyrosine provided a stronger analgesic effect than that rendered by metyrosine alone. The strongest analgesic effect, however, was observed in the group of rats with the lowest epinephrine level in whom the metyrosine + prednisolone combination was administered. The findings of this study may be useful in severe pain cases in which the available analgesics are unable to relieve the individual's pain.