How quality of life of elderly individuals living at home or in nursing homes is related to multi-purpose activities?

The aim of this study was to determine the effects of multi-purpose activities on the quality of life of elderly individuals living either in a nursing home or in their own homes. Sixty-seven volunteers aged >60 were surveyed: 34 living in a nursing home and 33 living at-home. Participants performed activities consisting of physical, cognitive tasks, and handicrafts twice weekly for 12 weeks. Each participant completed the 36-item Short Form Health Survey both before and after the program, and the results were compared between the groups. At the completion of the program, the general health, vitality, physical functioning, physical role, energy level, and social functioning parameters of the survey of the at-home group were better than were those of the nursing home group. When the data of both groups were compared, an improvement in the social functioning, general health, physical functioning, energy level, and mental health parameters were seen for the at-home group, but not among the nursing home participants. Companionship enabled easy and efficient performance of activities of at-home participants, thereby positively affecting their quality of lives.

Severe pulmonary arterial hypertension and massive ascites in a patient with systemic lupus erythematosus and secondary Sjogren's syndrome.

BACKGROUND: Pulmonary arterial hypertension (PAH), is a rare manifestation of systemic lupus erythematosus (SLE), characterized by pulmonary arterial remodeling leading to right ventricular failure and death. To date, optimal management of SLE-associated PAH should be clarified, especially regarding the respective places of immunosuppressants and PAH vasodilator treatments. CASE REPORT: We report the case of a 48-year-old woman with SLE and secondary Sjogren syndrome, associated with severe PAH and lupus peritonitis with massive ascites, who showed a remarkable response, both for SLE flare and PAH, to a treatment combining immunosuppressants and pulmonary arterial vasodilator treatment. CONCLUSION: This observation highlights the interest of combining immunosuppressive therapy in SLE-PAH, whose modalities in association with PAH treatments should be clarified.

Association of soluble ST2 with functional capacity in outpatients with heart failure.

BACKGROUND: Biomarkers play an important role in the risk stratification of patients with heart failure (HF). Recent studies have shown that soluble suppression of tumorigenicity 2 (sST2), a member of the interleukin 1 receptor family, is associated with disease prognosis in acute and chronic HF. In this study we aimed to investigate the relation between sST2 level and functional capacity in outpatients with systolic HF. PATIENTS AND METHODS: This study included 120 HF patients with reduced ejection fraction (HFrEF; EF ≤ 40%). The mean age of patients was 66 ± 11 years. Advanced HF (New York Heart Association [NYHA] functional class III-IV) was observed in 35 patients (29%). RESULTS: sST2 levels were on average higher in patients with NYHA functional classes III and IV than in patients with NYHA functional classes I and II (51 [9-198] vs. 25 ng/ml [9-118], p < 0.001). In a multiple logistic regression model, sST2 level (OR: 1.044, p = 0.004, 95% CI: 1.014-1.075), hemoglobin level (OR: 0.590, p = 0.001, 95% CI: 0.433-0.805), total cholesterol level (OR: 0.977, p = 0.004, 95% CI: 0.962-0.993), and age (OR: 1.066, p = 0.047, 95% CI: 1.001-1.136) were associated with poor functional capacity. In receiver operating characteristic (ROC) curve analysis, the optimal cut-off value of sST2 for predicting poor functional capacity was >42 ng/ml, with 63% sensitivity and 88% specificity (AUC: 0.810, 95% CI: 0.728- 0.875). CONCLUSION: Higher sST2 levels were strongly associated with poor NYHA functional class, independent of cardiac risk factors, in outpatients with HFrEF.

Influence of influenza vaccination on recurrent hospitalization in patients with heart failure.

BACKGROUND: The current study aimed to evaluate the influence of regular annual influenza vaccinations on cardiovascular (CV) death and heart failure-related hospitalizations (HFrH) in stable outpatients with heart failure with reduced ejection fraction. METHODS: The Turkish research team-HF (TREAT-HF) is a network undertaking multicenter, observational cohort studies in HF. This study is a subgroup analysis of TREAT-HF outpatient cohorts who completed a questionnaire on influenza vaccination status and for whom follow-up data were available. A total of 656 patients with available follow-up data for CV death and HFrH including recurrent hospitalization were included in the study. Patients were classified into two groups: those who received regular influenza vaccination (40 %) and those who did not receive vaccination. RESULTS: During a mean follow-up of 15 ±6 months, 113 (18 %) patients had CV death and 471 (72 %) patients had at least one HFrH. The CV death rate was similar in both groups of patients (16 vs. 19 %, p = 0.37), whereas, HFrH and recurrent HFrH were significantly less frequently encountered in patients who received regular influenza vaccination than in those who did not receive vaccination (43 vs. 92 % and 16 vs. 66 %, p < 0.001, respectively). In a multivariate Cox proportional hazards model - in addition to a few clinical factors - vaccination status (HR = 0.30, 95 % CI = 0.17-0.51, p < 0.001) and graduation from university (HR = 0.35, 95 % CI = 0.17-0.72, p = 0.004) remained independently associated with the risk of recurrent HFrH. CONCLUSION: Regular influenza vaccination does not influence CV deaths; however, it decreases HFrH including recurrent episodes of HFrH in outpatients with heart failure with reduced ejection fraction.

Cancer antigen 125 levels and increased risk of new-onset atrial fibrillation.

OBJECTIVE: Elevated cancer antigen 125 (CA-125) levels are associated with cardiopulmonary disorders such as acute and chronic heart failure (HF), coronary artery disease, chronic obstructive pulmonary disease, and atrial fibrillation (AF). The development of atrial fibrillation (AF) is related to morbidity and mortality in patients with HF: therefore, it is important to identify patients with increased risk for development of AF. We investigated whether plasma CA-125 levels in patients with hospitalized systolic HF could predict the development of AF. PATIENTS AND METHODS: A total of 149 consecutive patients with sinus rhythm who were admitted to the emergency department with hospitalized systolic HF were evaluated prospectively. Serum CA-125 levels were obtained after initial stabilization during their hospital stay. RESULTS: AF developed in 36 (% 24.2) patients during a follow-up period of 22.1 ± 11  months (range 3-61). CA-125 levels were significantly higher in patients who developed AF than in patients with sinus rhythm [99 U/ml (48-172) vs. 47 U/ml (18-108), p = 0.001]. The optimal cut-off level of CA-125 to predict development of AF was found to be > 68.49 U/ml. CA-125 > 68.49 U/ml, left atrial diameter, right ventricular dilatation, moderate to severe mitral and tricuspid regurgitations were found to have prognostic significance in univariate analysis. In a multivariate Cox proportional hazards model with the backward stepwise method, CA-125 > 68.49 U/ml (HR = 2.693, % 95 CI = 1.285-5.641, p = 0.009) and moderate to severe mitral regurgitation (HR = 2.708, % 95 CI = 1.295-5.663, p = 0.008) were associated with an increased risk of new-onset AF after adjustment for variables found to be statistically significant in univariate analysis and correlated with CA-125 level. CONCLUSION: CA-125 level is associated with the development of AF in patients with hospitalized systolic HF.

Effect of Hypericum thymbrifolium BOISS. ET NOE, Hypericum scabrum L. and Eryngium creticum LAM. plant extracts on Leishmania major, Leishmania tropica and Leishmania infantum/donovani strains and their cytotoxic potential.

Leishmaniasis causes significant morbidity and mortality worldwide. In our country, there has been a significant increase in the number of cases of leishmaniasis in the last decade. In our study, the effects of Hypericum thymbrifolium, Hypericum scabrum and Eryngium creticum plant extracts were tested on Leishmania major, Leishmania tropica and Leishmania infantum/donovani, which were clinically resistant by not responding to Glucantime® therapy. Cytotoxicity of these extracts were evaluated by XTT method in the human fibroblast cell line. Possible active ingredients were detected by GC-MS analysis from plant extracts. Glucantime® resistance was detected at concentrations of 50 µg/mL and lower in 4 of the 7 strains tested. No living leishmania parasites were found in leishmania strains treated with plant extracts at concentrations of 100 µg/mL or higher. The concentrations of plant extracts included in the study on the WI-38 human fibroblast cell line were not cytotoxic. According to the GC-MS analysis, several active substances with biological activities and anti-parasitic effects, such as Thiophene, Germacrene-D, trans-Geranylgeraniol, Pyridine, and Maleimides, were identified. Based on the findings of the study, it is believed that these identified active substances when supported by in-vivo studies, will pave the way for future research and have the potential to be developed as anti-leishmania drugs.

The relationship between neutrophil/lymphocyte ratio and the TIMI flow grade in patients with STEMI undergoing primary PCI.

OBJECTIVES: ST segment elevation myocardial infarction (STEMI) is an important cause of the morbidity and mortality in coronary artery disease. The aim of this study is to investigate the relationship between hematologic parameters and post primary PCI coronary no-reflow. PATIENTS AND METHODS: A total of 145 consecutive STEMI patients (mean age=58.2±12.3 years) and healthy volunteer admitted within 6 hours from symptom onset were enrolled to the study in the cardiology clinics. The STEMI patients were divided into 2 groups based on the Thrombolysis In Myocardial Infarction (TIMI) flow grade. No-reflow was defined as post-PCI TIMI Flow Grade 0, 1 or 2 and angiographic success was defined as TIMI Grade 3 Flow. RESULTS: Diabetes mellitus hypertension and smoking status were similar between groups. With respect to baseline laboratory status, fasting glucose, blood urea nitrogen, creatinine levels were not significantly different between groups. The neutrophil/lymphocyte (N/L) ratio was also significantly higher in STEMI group (7.1±4.6 vs. 2.3±1.7, p < 0.001). Additionally, N/L ratio was also significantly higher in No-reflow group (TIMI Flow Grade 0, 1 or 2) group (13.1±4.5 vs. 5.3±2.7, p < 0.001). CONCLUSIONS: The N/L ratio, which is cheaply and easily measurable laboratory data is independently associated with post primary PCI coronary no-reflow.

Newborn hearing screening programme outcomes in a research hospital from Turkey.

BACKGROUND: Universal neonatal hearing screening programmes are encouraged to define and manage hearing loss in early ages of life. The aim of this study is to introduce our 14-month three-step hearing screening programme results with 16 975 births in Turkey. METHODS: In healthy neonates, Transient Evoked Otoacoustic Emission (TEOAE) is served as the initial screening in the first day of life. In newborns that did not meet pass criteria TEOAE was repeated in 10-day period. If the second test was 'refer' again, the screening was completed with auditory brainstem response (ABR). Additionally, ABR was performed for the neonates with neonatal intensive care unit (NICU) requirement and at high audiologic risk. Neonates who failed the screening test with ABR were referred for further evaluation. RESULTS: A total of 15 323 newborns and 1652 NICU infants were tested. The screening coverage was 94.4%; 14 521 neonates (94.7%) passed the first screening step (TEOAE), while 802 (5.2%) neonate failed. In total, 322 (40.1%) of the neonates out of 802 was subjected to the second TEOAE after 10 days have failed and ABR was applied. From the neonates participated the third step (ABR) totalling 1974, 43 (2.17%) of neonates obtained a 'refer' response. Out of these 43 neonates, 17 neonates were (39.5%) NICU infants. From the 43 neonates, 38 cases (88.4%) were found to have hearing impairment. The false-positive rate for first step screening with TEOAE was 4.9%; second step with TEOAE was 1.85% and for ABR was 0.25%. CONCLUSIONS: It is apparent that three step national hearing screening programme which has been applied for the latest years in Turkey is an accurate and non-invasive method to determine the congenital hearing loss. In the future, screening programmes could be rearranged with two steps as initial with TEOAE and retest with ABR and the coverage of the screening programme can be extended.

Consistency test of coincidence-summing calculation methods for extended sources.

An internal consistency test of the calculation of coincidence-summing correction factors FC for volume sources is presented. The test is based on exact equations relating the values of FC calculated for three ideal measurement configurations. The test is applied to a number of 33 sets of FC values sent by 21 teams. Most sets passed the test, but not the results obtained using the quasi-point source approximation; in the latter case the test qualitatively indicated the magnitude of the bias of FC.

Decolorization of sugar syrups using commercial and sugar beet pulp based activated carbons.

Sugar syrup decolorization was studied using two commercial and eight beet pulp based activated carbons. In an attempt to relate decolorizing performances to other characteristics, surface areas, pore volumes, bulk densities and ash contents of the carbons in the powdered form; pH and electrical conductivities of their suspensions and their color adsorption properties from iodine and molasses solution were determined. The color removal capabilities of all carbons were measured at 1/100 (w/w) dosage, and isotherms were determined on better samples. The two commercial activated carbons showed different decolorization efficiencies; which could be related to their physical and chemical properties. The decolorization efficiency of beet pulp carbon prepared at 750 degrees C and activated for 5h using CO2 was much better than the others and close to the better one of the commercial activated carbons used. It is evident that beet pulp is an inexpensive potential precursor for activated carbons for use in sugar refining.

Natural radioactivity measurement in pumice samples used raw materials in Turkey.

The activity concentrations of 232Th, 226Ra, and 40K in different pumice samples have been determined by high-resolution gamma-ray spectrometry using a 110% HpGe detector. The radium equivalent activities (Raeq), external hazard index (Hex), and internal hazard index (Hin) associated with the natural radionuclides and representative level index (Igamma r) are calculated to assess the radiation hazard of the natural radioactivity in the pumice samples. The mean values of the measured radioactivity concentrations of 232Th, 226Ra, and 40K for pumice samples from the region of lakes (ROL) are 232.4+/-8.0, 196.9+/-7.8, and 1325.8+/-20.4 Bqkg(-1) and for pumice samples from Cukurova region (CR) 16.3+/-4.0, 16.1+/-4.9, and 479.7+/-170.4 Bqkg(-1), respectively. The calculated Raeq values vary from 435.9+/-12.5 to 883.6+/-41.5 Bqkg(-1) with a mean of 630.9+/-20.2 Bqkg(-1) for the ROL samples and from 49.7+/-3.3 to 101.9+/-7.2 Bqkg(-1) with a mean of 76.3+/-23.7 Bqkg(-1) for the CR samples. For the ROL samples, Raeq are above the limit of 370 Bqkg(-1), equivalent to external gamma dose of 1.5 mSv yr(-1), recommended for the safe use of construction materials by NEA-OECD, while for the CR samples, Raeq values are lower than the limit.

On cholinergic mechanisms in the optokinetic nystagmus of the frog: antagonistic effects of muscarinic and nicotinic systems.

In a monocular situation, an intravitreal injection of acetylcholine (ACh) agonists (especially muscarinic agonists like muscarine or oxotremorine) provoked both the suppression of the optokinetic nystagmus (OKN) related to the injected eye, and the appearance of a nasal-temporal (N-T) component in the OKN triggered by the contralateral non-injected eye. These two effects were added in a binocular condition. Similar results were obtained with ACh nicotinic antagonists (D-tubocurarine, alpha-bungarotoxin, hexamethonium and gallamine). ACh muscarinic antagonists (atropine, scopolamine) had only moderate effects and failed to provoke an N-T component in the contralateral OKN. These data show that ACh mechanisms are involved in the control of the frog OKN, especially in directional asymmetry, nicotinic and muscarinic systems acting in an antagonistic way.

Glutamatergic separation of ON and OFF retinal channels: possible modulation by glycine and acetylcholine.

When intravitreally injected into the frog in vivo, 2-amino-4-phosphonobutyrate (APB) and cis-2,3-piperidine dicarboxylic acid (PDA) showed opposite effects on ON and OFF retinal channels: APB abolished the ON responses in the electroretinogram and in ganglion cell activity, and increased OFF responses. At the same time the receptive field area was enlarged, and the inhibition exerted by the surround was suppressed. A cholinergic/glycinergic loop involving amacrine cells was suggested to be the pathway of the inhibitory ON input upon the OFF channel. PDA abolished the OFF responses in the ERG and in ganglion cell activity, while increasing the ON response in the ERG and decreasing the ganglion cell sensitivity at ON. The receptive field area was not modified, but the inhibition exerted by the surround was suppressed, probably by a blockade of horizontal cell glutamate receptors.

Pharmacological study of the chicken's monocular optokinetic nystagmus: involvement of the ON retinal channel evidenced by the glutamatergic separation of ON and OFF pathways.

The chicken's monocular optokinetic nystagmus (OKN), recorded by the magnetic search coil technique, displays a directional asymmetry, the temporal-nasal (T-N) stimulation being more efficient than the nasal-temporal (N-T) one to evoke the reflex. The intravitreal administration of APB, a glutamate agonist which selectively blocks the ON retinal channel strongly reduced the eye monocular OKN; it also induced spontaneous eye movements in the T-N direction. The intravitreal injection of PDA another glutamate analog, which reduces the OFF channel, while increasing the activity of the ON channel, induced a large increase in OKN velocity gain, especially for a N-T stimulation at the lowest drum speeds. These results indicate the main involvement of the ON retinal channel in the OKN genesis and the inhibitory effect of the OFF channel upon this oculomotor reflex.

Pharmacological study of the chicken's monocular optokinetic nystagmus: effects of GABAergic agonist and antagonists.

When injected into the chicken open eye, the GABA-agonist THIP and the GABA-antagonists bicuculline and picrotoxin induced spontaneous eye movements in nasal-temporal (N-T) and in temporal-nasal (T-N) direction, respectively. These spontaneous movements were scarcely modulated by optokinetic stimulation, irrespective of the direction of stimulation. It is suggested that they are due to the suppression of directional selectivity of retinal ganglion cells. When injected into the closed eye, GABAergic drugs did not produce spontaneous nystagmus. THIP provoked a reduction of the N-T component, without modifying the T-N one, while GABA antagonists induced a significant increase in OKN performance, especially for the N-T direction of stimulation. In these conditions, picrotoxin also provoked an increase in the duration of both components of optokinetic after nystagmus, indicating a direct effect of the drug upon the velocity-storage system.

Determination of the energy dependence of the BC-408 plastic scintillation detector in medium energy x-ray beams.

The energy dependence of the response of BC-408 plastic scintillator (PS), an approximately water-equivalent material, has been investigated by employing standardized x-ray beams. IEC RQA and ISO N series x-ray beam qualities, in the range of 40-100 kVp, were calibrated using a PTW-type ionization chamber. The energy response of a thick BC-408 PS detector was measured using the multichannel pulse height analysis method. The response of BC-408 PS increased gradually with increasing energy in the energy range of 40-80 kVp and then showed a flat behavior at about 80 to 120 kVp. This might be due to the self-attenuation of scintillation light by the scintillator itself and may also be partly due to the ionization quenching, leading to a reduction in the intensity of the light output from the scintillator. The results indicated that the sensitivity drop in BC-408 PS material at lower photon energies may be overcome by adding some high-Z elements to its polyvinyltoluene (PVT) base. The material modification may compensate for the drop in the response at lower photon energies. Thus plastic scintillation dosimetry is potentially suitable for applications in diagnostic radiology.

Measurements on the spectroscopic performance of CdZnTe coplanar grid detectors.

A performance study was performed for CdZnTe coplanar grid (CPG) detectors when used as γ-ray spectrometers. The detectors have the crystal volumes of 1, 1.6875 and 2.25 cm(3), respectively. Time stability of each CdZnTe CPG detector was investigated in a long-term operation (time span of 0.25 to about 100 h). The spectroscopic performances were measured at different bias voltages and at various photon energies ranging from 59.6 keV ((241)Am) to 1332.5 keV ((60)Co) for each detector, and evaluated by using the following parameters: energy resolution in FWHM, peak tailing in peak-to-valley (P/V) ratio and in FWHM/FW.25 M ratio, and photofraction using the acquired γ-ray spectra. No polarization effect was observed in terms of count rate, energy resolution and peak centroid shift. The obtained results indicate that better time stability and excellent spectroscopic performances of the present CdZnTe CPG detectors are shown for a room temperature γ-ray spectroscopy.

Correction methodology for the spectral interfering γ-rays overlapping to the analytical peaks used in the analysis of 232Th.

In the γ-ray spectrometric analysis of the radionuclides, a correction factor is generally required for the spectral interfering γ-rays in determining the net areas of the analytical peaks because some interfering γ-rays often might contribute to the analytical peaks of interest. In present study, a correction methodology for the spectral interfering γ-rays (CSI) is described. In particular, in the analysis of (232)Th contained in samples, the interfering γ-rays due to (226)Ra, (235)U, (238)U and their decay products often overlap to the peaks of interest from (232)Th decay products, and vise versa. For the validation of the proposed CSI method, several certified reference materials (CRM) containing U and Th were measured by using a 76.5% efficient n-type Ge detector. The required correction factors were quantified for spectral interference, self-absorption and true coincidence summing (TCS) effects for the relevant γ-rays. The measured results indicate that if one ignores the contributions of the interfering γ-rays to the analytical peaks at 583.2 keV of (208)Tl and 727.3 keV of (212)Bi, this leads to a significantly systematic influence on the resulted activities of (232)Th. The correction factors required for spectral interference and TCS effects are estimated to be ∼13.6% and ∼15.4% for 583.2 keV peak. For the 727.3 keV peak, the correction factor is estimated to be ∼15% for spectral interference, and ∼5% for the TCS effects at the presently used detection geometry. On the other hand, the measured results also indicate that ignoring the contribution of the interfering γ-rays to the areas of the analytical peaks at 860.6 keV of (208)Tl, 338.3 and 911.2 keV of (228)Ac does not lead to any significant systematic influence on the (232)Th analysis. Because these factors are remained generally less than ∼5%, i.e., within overall uncertainty limits. The present study also showed that in view of both the spectral interference and TCS effects, the "cleaner" analytical peaks are seen at 338.3 keV (11.25%) and 911.2 keV (26.13%) of (228)Ac when high resolution γ-rays spectrometry was used in the (232)Th activity measurements. Therefore, they can be adopted as the "reference" peaks in the (232)Th analysis.

Methods for spectral interference corrections for direct measurements of 234U and 230Th in materials by gamma-ray spectrometry.

When the high-resolution gamma-ray spectrometry was used in the analysis of (234)U and (230)Th in samples, there is a much more need to correct for the measured activity results of (234)U and (230)Th mainly due to self-absorption effects and the interfering lines from (226)Ra, (235)U, (238)U and their decay products that often might be present in the samples. Therefore, in the present study, the methods for the spectral interference corrections for the analytical peaks of (234)U and (230)Th are suggested to take into account the contributions of the overlapping gamma rays to these peaks. For the method validation, direct gamma-ray spectrometric measurements were carried out using certified reference materials (CRM) by use of a 76.5 % n-type Ge detector. The activities measured for the CRM samples were corrected for spectral interferences, self-absorption and true coincidence-summing (TCS) effects. The obtained results indicate that ignoring of the contribution of the interference gamma rays to the main analytical peak at 53.2 keV of (234)U leads to a lager systematic error of 87.3-90.4 % for the measured activities of (234)U, and similarly if one ignores the contributions of the interference gamma rays to the main analytical peak at 67.7 keV of (230)Th, this leads to a much smaller systematic error of 2.1-2.7 % for the activities of (230)Th. Therefore, the required correction factors for spectral interferences to the analytical peaks of (234)U and (230)Th are not negligible and thus they should also be considered besides necessary self-absorption factors to determine more accurate activities in the samples. On the other hand, it is estimated that although the TCS effects on the main analytical peaks of both (234)U and (230)Th are negligibly small, those TCS correction factors for their interference gamma rays to these peaks should be taken into account when direct measurements are performed in a close-counting geometry condition. Otherwise, the resulted activities can have serious erroneous results for both (234)U and (230)Th while using gamma-ray spectrometry, thereby leading to inaccuracies in their derived quantities, for instance, the corresponding age determinations of the samples.

Renal abnormalities in a family with Alagille syndrome.

Alagille syndrome is largely unknown to the general internist because the diagnosis is usually made by a paediatrician. Nevertheless, it is important to be aware of this syndrome because it sometimes manifests later in life with a great variability in clinical presentation and important consequences for the individual patient. We therefore discuss this syndrome using a patient with the usual characteristics of this syndrome.