Levels of amyloid beta-42, interleukin-6 and tumor necrosis factor-alpha in Alzheimer's disease and vascular dementia.

Amyloid ß42 (Aß42) and proinflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) have been suggested to contribute to the pathogenesis of Alzheimer's disease (AD) and vascular dementia (VaD). Our aim was to examine whether the changes in these parameters would be able to discriminate the patients with AD from those with VaD and from healthy individuals. We have analyzed the levels of Aß42, IL-6 and TNF-α in the serum of newly diagnosed 28 AD patients, 16 VaD patients and 26 healthy non-demented controls. We also investigated whether there is an association between Aß42, IL-6 and TNF-α levels and mini-mental state examination (MMSE) scores and body mass indexes (BMI) of patients. Our data showed a significant decrease in serum Aß-42 levels in AD patients compared to VaD patients and controls. Levels of IL-6 and TNF-α were not different between AD patients, VaD patients and controls. We observed a correlation between Aß-42 levels and MMSE scores and BMI levels in both AD and VaD patients. However, Aß-42 levels were not correlated with IL-6 and TNF-α levels. Significantly lower levels of Aß42 found in the serum of AD patients than that of VaD patients and controls suggests that it can be a specific biochemical marker for AD.

Consistency of postmortem interval estimations of physicians using only postmortem changes of putrefied dead bodies.

The postmortem interval is estimated based on physical, biochemical, and morphologic changes in dead bodies, scene investigation findings, and judicial investigation findings. Many factors affect the onset and the course of the postmortem changes. There is no established method for accurate estimation of the postmortem interval, especially with regard to putrefied dead bodies. Aiming to determine the consistency and the variation of postmortem interval estimations in cases with various putrefaction degrees by forensic medicine assistants and specialists from different centers, a prospective study was undertaken. A form containing data about the time, environment, and geographical location where the cases were found, along with their postmortem changes was mailed to 110 forensic medicine assistants and specialists from different centers, who were also asked to note their postmortem interval estimations. About half of the forms were returned. Those postmortem interval estimations made based on the information included in the forms, showed great variability between the participants, and in only 6 cases a consistency exceeding 50% was found between the participants and the autopsy teams. It is not possible to estimate the postmortem interval in a standard way by using only the postmortem changes of putrefied bodies. Therefore, especially in the cases involving putrefied bodies, in addition to the postmortem changes, factors such as environmental conditions, the scene, and judicial investigation findings should be taken into consideration.

Protective effects of leptin on ischemia/reperfusion injury in rat bladder.

The aim of the study was to evaluate protective effects of exogenous leptin on ischemia/reperfusion (I/R)-induced injuries to the urinary bladder tissue and to investigate the effect on tumor necrosis factor alpha (TNF-alpha) levels and apoptotic cells during I/R injury. Bladder I/R injury was induced by abdominal aorta occlusion by ischemia for 45 min, followed by 60 min of reperfusion in rats. The rats were divided into three groups: control (n = 8 + 8), I/R (n = 8 + 8) and I/R+leptin group (n = 8 + 8). The rats in the I/R+leptin group were treated intraperitoneally with leptin (10 microg/kg) 60 min prior to ischemia induction. At the end of the reperfusion period, urinary bladders of the first eight rats from each group were removed for TUNEL staining processing while the others were removed for biochemical analyses for MDA and TNF-alpha levels. In the I/R group, the ratios of TUNEL-positive nuclei were higher than the control and the I/R+leptin groups. The MDA and TNF-alpha levels of the bladder tissue in the I/R group were higher than the control and leptin-treated groups. TUNEL-staining and biochemical studies revealed that leptin has a protective effect on urinary bladder I/R injury.

[Levosimendan and dobutamine have a similar profile for potential risk for cardiac arrhythmias during 24-hour infusion in patients with acute decompensated heart failure]. / Levosimendan ve dobutamin akut dekompanse kalp yetersizliginde 24 saatlik infüzyon sirasinda benzer aritmi potansiyeli göstermektedir.

OBJECTIVES: Unlike traditional inotropic agents, levosimendan is thought to have a lower potential to induce arrhythmias because it does not increase intracellular calcium levels and myocardial oxygen consumption. We compared the potential effect of levosimendan and dobutamine to induce cardiac arrhythmias in patients with decompensated heart failure. STUDY DESIGN: Fifty patients with acute decompensated heart failure (NYHA class III-IV, ejection fraction <35%) who were in need of inotropic support were randomized to dobutamine (n=25; mean age 69±10 years) or levosimendan (n=25; mean age 67.5±11.5 years) and underwent 24-hour Holter monitoring before and during inotropic infusion. Holter recordings were analyzed with respect to heart rate (HR), ventricular premature contraction (VPC), couplets of VPC, supraventricular premature contraction (SVPC), paroxysmal atrial fibrillation (PAF), and nonsustained ventricular tachycardia (NSVT). RESULTS: Before infusions, the two groups were similar with respect to HR, VPC, couplets of VPC, SVPC, and PAF episodes, but the number of NSVT episodes was significantly higher in the levosimendan group. Heart rate and the number of VPCs increased significantly during infusions of levosimendan (p=0.036 and p<0.001, respectively) and dobutamine (for both p<0.001). Increase in couplets of VPC was significant only with dobutamine (p=0.012). The episodes of NSVT and PAF increased with levosimendan, without reaching significance. Levosimendan and dobutamine groups were similar in terms of percentage changes in arrhythmias (55±224% vs. 11±16% for VPC; 2±2.7% vs. 12±9% for couplets of VPC; 3.4±5.8% vs. 16±39% for SVPC, 0.4±2.8% vs. -2±0% for NSVT) and percentage change in total arrhythmias (41±190% vs. 18±35.4%), and the mean HR, VPC, couplets of VPC, SVPC, and episodes of NSVT and PAF (p>0.05). CONCLUSION: Our findings suggest that levosimendan and dobutamine have a similar profile for potential risk for cardiac arrhythmias.

Soluble P selectin levels in chronic liver disease: relationship to disease severity.

BACKGROUND/AIMS: Thrombocytopenia and platelet function abnormalities are problems commonly found in patients with chronic liver disease (CLD). Despite lack of widespread recognition as to the clinical significance of Soluble P-selectin (sP-selectin), in that increased levels of sP-selectin have been described in patients with CLD, it has been proposed as a marker of in-vivo platelet activation. The study's aim was to determine whether levels of sP-selectin in patients with CLD increase in accordance with the degree of liver failure, the likelihood of CLD patients with high sP-selectin levels being more prone to thrombosis, as well as investigating the coagulation and fibrinolytic parameters related to the sP-selectin. METHODOLOGY: This study was comprised of two groups: 40 patients with cirrhosis and portal hypertension (28 males and 12 females); and a control group of 10 healthy volunteers (6 males and 4 females). In both groups, biochemical parameters, sP-selectin, coagulation and fibrinolytic activity levels were measured and a Doppler ultrasound was performed. RESULTS: Plasma sP-selectin levels were found to be higher in the patients compared to those of the control group (p < 0.01), while at the same time significant differences were observed with respect to the stage of disease. Patients with low platelet counts were found to have higher sP-selectin levels than those with normal platelet counts (p < 0.01). Seven patients (17.5%) were seen to have portal vein thrombosis upon doppler ultrasound examination, while sP-selectin levels were significantly lower in those patients with thrombosis than those without (p < 0.05). It was our finding that sP-selectin levels inversely correlated with anti thrombin III. CONCLUSIONS: In conclusion, sP-selectin levels related to the degree of liver disease and thrombosis are seen together with low platelet and sP-selectin levels in patients with cirrhosis.

Effect of Work-Related Factors on Lower Urinary Tract Symptoms in Nurses and Secretaries.

OBJECTIVE: The objective of the present study was to examine the relationship between work-related factors and lower urinary tract symptoms (LUTS) and to emphasize the vicious circle between symptoms and work conditions. METHODS: The Turkish version of the Nurse Bladder Survey was used to estimate the prevalence of LUTS and to assess the relationship between individual characteristics, personal habits and work-related factors in nurses and secretaries who were working in Eskisehir Osmangazi University Hospital. The Turkish version of the Short Form 36 Health Survey was used to assess the nurses' and secretaries' health-related quality of life (HRQL). RESULTS: Of the 281 women who participated in the study, 218 (77.5%) and 63 (22.5%) were nurses and secretaries, respectively. There were no significant differences in personal habits and work-related factors between the nurses and secretaries. Of the study participants, 121 (43.1%) experienced at least one type of LUTS. There were no significant differences in the prevalence of any type of LUTS between the two groups. Only the mean scores of social functioning were significantly different for nurses and secretaries on the other aspects of HRQL in the SF-36. When the nurses with LUTS and the secretaries with LUTS were compared, the secretaries had a greater score on the general health domain than nurses. CONCLUSION: There is a vicious circle between symptoms and work conditions. To prevent the working women from harmful effects of this circle, the employers should be aware of this health problem; working conditions should be improved; educational programs for LUTS should be organized and the working women should be encouraged to go to the health providers to seek treatment when the symptoms occurred.

Serum cystatin C and urinary enzymes as screening markers of renal dysfunction in diabetic patients.

BACKGROUND: In clinical practice, the assessment and follow-up of early renal dysfunction is important in diabetic nephropathy. Therefore, this study was designed to determine whether the serum cystatin C (Cys C) and activities of some tubular enzymes could be used as screening markers for renal dysfunction in diabetic patients. METHODS: Serum Cys C levels and urinary activities of N-acetyl-b-D-glucosaminidase (NAG), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) and whole blood glycolyse hemoglobin (HbA1C) were measured in 56 diabetic patients and 20 healthy subjects (controls). The results were compared with serum creatinine (Cr) and creatinine clearance (CCr), which were measured and estimated with the Cockcroft-Gault formula (CCG) and 24-hr urine microalbuminuria (MAU). We examined the influence of albuminuria, HbA1C and CCr levels of patients on the levels of the analyzed parameters. Sensitivity and specificity for the diagnosis of renal impairment were calculated by a receiver operating characteristics (ROC) curve for serum Cys C, Cr and urinary enzymes. RESULTS: In normoalbuminurics, only serum Cys C levels and urinary NAG activities were found elevated as compared to controls. In addition to the elevation of serum Cys C levels and urinary activities of NAG, urinary ALP and LDH activities were also found elevated in microalbuminurics. Serum Cys C levels and urinary NAG, ALP, LDH activities started to increase above the normal range when CCr declined and while serum Cr was in the normal range in patients with 50

Stature and sex estimate using foot and shoe dimensions.

The aim of the study was to develop a formula to estimate the stature and sex of an individual using foot and shoe dimensions. To this aim the stature, right and left shoe sizes, and maximum and minimum feet length and width measurements of a target group of 569 individuals were taken. The group was composed of 294 males and 275 females. The highest correlation coefficient was found in length measurements. A notable difference between males and females existed with regard to both right and left foot and shoe length and width averages and shoe sizes (p < 0.001). Among the group, a significant correlation was found in regard to stature and right shoe length (r = 0.591, p < 0.001), with the correlation between stature and right foot length and stature and right shoe length being 0.579 (p < 0.001); as for the female group, there was a significant correlation between stature and right foot length and stature and right shoe length (r = 0.460, p < 0.001). Thus the regression formula obtained are as follows: for the right side: sex = 69.169 + 0.173 (maximum foot length) - 0.368 (maximum foot width) - 0.820 (shoe length) + 0.224 (shoe width) - 1.280 (shoe number). For the left side: sex = 69.551 + 0.276 (maximum foot length) - 0.504 (maximum foot width) - 0.739 (shoe length) + 0.344 (shoe width) - 1.360 (shoe number). In application of the formula, if sex is lower than 0.50, the shoe belongs to a male, if higher, then to female. The formula which was obtained in regression analysis in order to estimate the stature when the measurements of shoe and foot were known. For the right side, stature = 47.93 + 1.083 (maximum foot length) + 0.788 (shoe length) 1.813 (shoe number) (SEE:31.410). For the left side: stature = 47.33 + 1.139 (maximum foot length) + 0.593 (shoe length) x 1.924 (shoe number) (SEE:31.607). It was understood that foot and shoe sizes are a criteria to estimate the stature of a person that there was a strong relationship between foot and shoe length and width and that these can be used to aid estimation. It was found that in sex estimate, foot and shoe lengths are better in helping the estimate than width measurements, and that the use of shoe measurements rather than bare foot measurements are better to obtain meaningful results.

Comparison of radiation-induced oral mucositis scoring systems.

BACKGROUND: A number of oral toxicity scoring systems have been described, but their direct comparison has rarely been undertaken and little data exists. An impediment to mucositis research has been the lack of an accepted, validated scoring system. The objective of this study was to design a test and validation of scoring systems. MATERIALS AND METHODS: Forty-three patients with head and neck malignancies who had been irradiated were evaluated. Five different mucositis scoring systems (World Health Organization, Radiation Therapy Oncology Group, "Hickey", "Van der Schueren" and "Makkonen") were compared with each other. RESULTS: Daily mucositis scores demonstrated a high correlation among scoring systems (P < 0.05 and coefficient of correlation kappa and r = 0.5-0.95). Objective mucositis scores demonstrated a strong correlation with symptoms. CONCLUSIONS: All scoring systems were equally valid. The exact grading of mucositis is achieved by combining clinical information about pain and nutritional status with oral mucosal reactions.

Diagnostic value of heart-type fatty acid binding protein determined by the rapid qualitative chromatographic immunoassay method for the detection of minor myocardial damage in patients presenting with non-ST elevation acute coronary syndrome.

OBJECTIVE: The aim of this prospective study was to evaluate the diagnostic value of heart-type fatty acid binding protein (H-FABP) determined by qualitative immunoassay method for the detection of minor myocardial damage (MMD) in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). METHODS: The study consisted of 62 patients with NSTE-ACS. Cardiac troponin I (cTnI) and creatine kinase MB isoenzyme (CK-MB) values were measured at arrival. Myoglobin and H-FABP were obtained if cTnI level was found to be elevated. A control group included 20 subjects with normal cTnI and CK-MB values. H-FABP was determined by a rapid qualitative immunochromatographic test. Patients were classified as MMD-ACS group if they had abnormal cTnI and normal CK-MB (n=24) and as NSTEMI-ACS group if they had elevated both cTnI and CK-MB (n=38). The diagnostic accuracy of H-FABP for minor myocardial damage was determined using ROC analysis. RESULTS: The sensitivity of the H-FABP was significantly higher for NSTEMI-ACS than for MMD-ACS (44.7% vs 0%, p<0.001) and its specificity was 95% for both groups. The diagnostic efficacy rates for myoglobin and H-FABP were 75% and 43% for MMD-ACS, 74% and 62% for NSTEMI-ACS. Positive predictive value for H-FABP and myoglobin were found to be 0% and 80.8% in MMD-ACS, 94% and 87% in NSTEMI-ACS and negative predictive value was 44% and 69.5% in MMD-ACS, 47.5% and 59% in NSTEMI-ACS, respectively. AUC for myoglobin was significantly greater than that for H-FABP in MMD-ACS group (0.754 vs 0.525, p=0.027). The sensitivity of the H-FABP was significantly higher in patients with >3-fold increase in cTnI than those with <3-fold increase in cTnI (46.8% vs. 6.7%, p<0.001). A positive correlation was found between the magnitude of cTnI rise and H-FABP results (r=0.45, p<0.001). CONCLUSIONS: H-FABP determined by the rapid qualitative immunochromatographic test has almost similar diagnostic value to that of myoglobin for identifying NSTEMI-ACS, however, does not seem to represent diagnostic potential for the detection of MMD.

[The prevalence of intestinal parasites according to the distribution of the patients' gender and parasite species for five years at the Osmangazi University Medical Faculty]. / Eskisehir Osmangazi Universitesinin Bes Yillik Bagirsak Paraziti Prevalansinin Türlere ve Cinsiyetlere Göre Dagilimi.

In this study, patients (outpatients and inpatients) with various gastrointestinal system complaints presenting at various clinics of the Eskisehir Osmangazi University Medical Faculty, from February 2003-December 2007 were investigated for the presence of intestinal parasites. The prevalence of intestinal parasites was evaluated according to parasite species, gender of the patients and the years, in which cases were seen. A total of 34,733 stool samples were prepared by formal-ethyl acetate concentration and examined in saline and iodine preparations microscopically with 10x and 40x magnifications. Also trichrome stained preparations of non-pathogenic amoebas and modi-fied Erlich-Ziehl-Nielsen stained preparations for Cryptosporidium spp were examined by oil-immersion objectives (100x). One or more parasites were found in 1252 of the 34,733 stool samples (including nonpathogenic protozoa).the overall prevalence of intestinal parasitic infection rate was 3.6%, of these patients, 52.5% were female and 47.5% male. Predominant parasites were Entamoeba histolytica/dispar group amoebas (31% (397/1252), followed by Giardia intestinalis 19% (236/1252), Blastocystis hominis 7% (108/1252), and Cryptosporid-ium parvum %4.5 (56/1252). Since the cellophane type method was only used in a few cases; the rates detected in helminth cases in this study were different from other studies. The ratio of E. vermicularis was found to be 2.3% (29/1252), Taenia saginata 0.8% (10/1252) and Strongyloides stercoralis 0.4% (5/1252). In comparison to a previous 10 year retrospective study which was performed in our hospital, we detected an important decrease in prevalence of parasites. But the presence of intestinal parasites is still an important problem.

Both levosimendan and dobutamine treatments result in significant reduction of NT-proBNP levels, but levosimendan has better and prolonged neurohormonal effects than dobutamine.

Levosimendan and dobutamine are comparable inotropic drugs as regards their hemodynamic effects and clinical outcomes in decompensated heart failure (HF). The aim of this study was to compare the effects of levosimendan and dobutamine treatment on NT-proBNP levels in patients with decompensated HF. Forty-four patients with decompensated HF and ejection fraction <35% received either a 24-h infusion of levosimendan (n=26) or dobutamine (n=18). NT-proBNP was measured at baseline and 12 h, 24 h and 48 h after the initiation of drug infusion. NT-proBNP levels at baseline, 12 h, 24 h and 48 h were 16,879+/-2437, 16,004+/-2635, 12,881+/-2305 and 11,078+/-2092 pg/ml, respectively, in the levosimendan group and 16,031+/-3463, 15,908+/-3806, 12,271+/-3299 and 14,840+/-4009 pg/ml, respectively, in the dobutamine group. NT-proBNP decreased significantly at 24 h in response to both levosimendan and dobutamine treatment (p<0.01 and p<0.05, respectively) with no significant difference among the treatment groups. In the dobutamine group, NT-proBNP increased at 48 h (p=n.s. vs. baseline), in contrast, NT-proBNP reduction continued for up to 48 h in the levosimendan group (p<0.001 vs. baseline). Although not statistically different, a greater percentage of NT-proBNP reduction was observed with levosimendan treatment at both 24 h (-25+/-7% vs. -20+/-10%) and 48 h (-32+/-7% vs. -20+/-11%) compared to dobutamine. Both levosimendan and dobutamine treatments result in significant reduction of NT-proBNP levels at the end of the 24-h infusion. However, compared to dobutamine, levosimendan has better and prolonged effects on NT-proBNP levels in decompensated HF.

Effects of carvacrol on defects of ischemia-reperfusion in the rat liver.

Many plants found in nature have been used to treat various illnesses. One such plant is oregano (Kekik in Turkish). Health beneficial effects of carvacrol obtained from oregano oil have been shown scientifically. We have investigated the comparative effects of carvacrol in the liver of rats subjected to ischemia-reperfusion defect, with silymarin. To test the effects we formed four groups using male Wistar albino rats. Group I was control. The other three groups of animals were administered 60min prior to surgical operation single doses of physiological serum, carvacrol and silymarin, respectively. Group II, III and IV animal were subjected to 45min long liver ischemia and 60min reperfusion. Blood and tissue samples were collected for biochemical and histological analysis following the test. AST and ALT values obtained after biochemical analysis of the serums showed statistically significant difference in group II than the other three groups. A statistical evaluation of the serum AST levels among the groups II, III and IV showed that both groups III and IV which had no difference in between were significantly different in a positive way from group II (p<0.001). As to the serum ALT levels, difference between group II and group III (p<0.001) and group II and group IV (p<0.01) was found significant. No statistical difference was observed in groups I, III and IV for GSH, MDA and CAT levels of the liver. A statistical evaluation of the GSH level in group III and group IV was found to be significantly different from group II (p<0.001) without any difference between them. A similar evaluation for MDA and CAT levels among the revealed no difference between group III and group IV, however, group II showed difference with group II and group IV (p<0.05). Histological findings were in harmony with the biochemical results. We conclude that carvacrol protects the liver against defects caused by ischemia and reperfusion, and carvacrol is not hepatotoxic at the applied dosage.

Bladder dysfunction in type 2 diabetic patients.

AIMS: To reevaluate urodynamic findings of bladder dysfunction (BD) in type 2 diabetic patients with patient characteristics and concommittant chronic complications. METHODS: Patients (M/F:27/27) with lower urinary tract symptoms (LUTS) underwent a detailed urodynamic investigation. Urodynamic findings were classified as diabetic cystopathy [DC, characterized by impaired bladder sensation, increased post-void residual urine (PVR) and increased bladder capacity and decreased bladder contractility], detrusor overactivity, bladder outlet obstruction (BOO), urge and stress urinary incontinence or BD in which one of the alterations was included. Glycated hemoglobin (HbA1C), diabetic retinopathy, nephropathy, sensorimotor, and autonomic neuropathies were evaluated. RESULTS: BD was present in 74.07% of men (DC, 50%; BOO, 25%; detrusor overactivity, 25%) and in 59.26% of diabetic women (DC, 43.75%; detrusor overactivity, 31%; urge incontinence, 12.5%; stress urinary incontinence 12.5%). In men, age, duration of diabetes and HbA1C threshold values predicting BD were >64 years, >9 year, >7.9%, while in women, they were >56 years, >8 years, >7%, respectively. Prolongation of QTc, abnormal esophageal transit and gastric emptying times, diabetic retinopathy, and microalbuminuria were associated with an increased risk of PVR >or= 100 ml. CONCLUSIONS: DC was the most frequent finding in patients. Ageing, duration of diabetes, worse metabolic control, PVR 100 ml, cardiac, esophageal and gastric parasympathetic autonomic neuropathies, retinopathy, and microalbuminuria provided a means to predict BD in patients in order to investigate by urodynamics. The establishment of DC in at least 8-9 years after the diagnosis of type 2 DM was an important parameter to inform our diabetic patients.

Turkish nurses' information about, and administration of, chemotherapeutic drugs.

AIM: The aim of this study was to determine both the level of information that nurses possessed and the method of administration nurses used during chemotherapeutic drug preparation and administration. BACKGROUND: While compliance with the regulations related to chemotherapeutic drug preparation and administration seems to be very difficult, it is at the same time vital. METHODS: This descriptive study was conducted between 1 May 2002 and 1 May 2003 in the chemotherapy administration units of all hospitals in Eskisehir, west Turkey. The sample consisted of 121 nurses. Data were obtained first via questionnaire forms developed by the researchers to learn the level of awareness concerning exposure to chemotherapy. This was then followed up by the completion of observation forms during drug administrations. RESULTS: The average score for information levels pertaining to nurses' protection of the environment was 7.82 +/- 0.38 of a total of 14 points, and that of self-protection was 7.94 +/- 0.24 of a total of 11 points. Nurses showed that their actual administration method was insufficient according to their level of information, with average administration evaluations of 5.46 for protection of the environment and 6.59 for self-protection. The ratio for nurses' usage of the safety cabinet during the preparation of chemotherapeutic drugs was very low at 14.2%. Only 7.4% of nurses had received in-service education about chemotherapeutics. CONCLUSION: In order to ensure the taking of sufficient preventive precautions during the preparation and administration of chemotherapeutic agents, hospitals should be required to provide sufficient equipment and to give this precedence in hospital politics. RELEVANCE TO CLINICAL PRACTICE: Healthcare workers who prepare and administer chemotherapeutic drugs may experience the cytotoxic effects of the drugs through direct skin contact, respiratory and digestive system exposure, and these effects are vital to human life. Thus, it has been recognized that nurses' information and administrations during preparation and administration of chemotherapeutic drugs are of utmost vital importance in removing the harmful effects of chemotherapeutic agents.