Physalis alkekengi L.(Solanaceae) is a popular plant in traditional European and Chinese folk medicine, and it has been reported to have many ethnopharmacological properties including antifungal, anti-cough, anti-inflammatory, analgesic, and febricide activities. Some active components from Physalis species have been investigated. However, no antimicrobial activity studies on extracts and physalins of P. alkekengi have been carried out. In this study, we attempted to identify the possible antimicrobial activities of the methanol extract from aerial parts of P. alkekengi and the dichloromethane extract from calyces of the plant. The extracts were tested against five Gram-positive and five Gram-negative bacteria and five Candida species by using disk diffusion and broth microdilution methods. The extracts were fractionated to isolate physalins using chromatographic techniques, and physalin D was isolated from the extracts. The structure of the compound was elucidated on the basis of (1)H-NMR spectroscopic study, and confirmed by comparison with a reference sample and literature data. Results indicated that all the extracts and physalin D were characterized by antibacterial action, especially against Gram-positive bacteria, with MIC values between 32 and 128 mug/mL. The methanol extract had moderate activity against fungi at MICs ranging from 128 to 512 mug/mL, but the dichloromethane extract and physalin D had low activity against fungi at MICs ranging from 256 to 512 mug/mL. Additionally, the antioxidant activity of physalin D was evaluated by qualitative DPPH (1,1-diphenyl-2-picrylhydrazyl) radical and TBA (thiobarbituric acid) assays. Physalin D showed low antioxidant activity with an IC(50) value of >/= 10 +/- 2.1.

Electrochemistry based unidimensional nanoelectrodes, such as carbon nanotubes and metallic nanowires, is now a reality that is leaving the academy and reaching a broad range of high-tech companies around the world. The intrinsic properties of electron-electron interactions, sizes and geometries significantly differentiate those nanostructures from conventional macroelectrodes or electrodes with sizes in a millimetric range. The inherent properties as well as the configuration of carbon nanotubes and metallic nanowires as electrochemical sensors are the main focus of this review. Applications and some future trends on developing of a clear pathway for assembly and integration of these into functional materials, are summarized as well.

The chemical composition of pectin production wastewater and its toxicity during biological treatment were investigated. Samples of wastewater from different steps of a pectin production wastewater biological treatment plant were investigated including the influent of the treatment (1), after denitrification tank (2), after anaerobic treatment (3) and final effluent (4). The conventional physicochemical characteristics of samples did not indicate wastewater toxicity. However, toxicity assessments carried out on Vibrio fischeri and Scenedesmus subspicatus indicated low EC50 values. The fractionation of the samples using an XAD resin showed that the toxicity was associated with the organic matter. Wastewater apparent molecular mass distributions were 14.3, 25.0, 24.4 and 29.6 kDa for samples 1-4, respectively. Finally, characteristics of the sample by pyrolisis-gas chromatography-mass spectrometry (Py-CG-MS) demonstrated its polyphenolic nature and a 23% increase in the levels of such compounds after the first biological treatment step.

Tularaemia is a zoonotic disease caused by Francisella tularensis . In this report, we have presented an early stage case of tularemia with fever and pharyngitis and two cases from the same non-endemic region with typical lymphadenitis. All three patients were treated with non-specific medications in healthcare centres, the treatment being directed towards symptoms resembling those of upper respiratory tract infections. However, there was no regression in their complaints. Because the first case had been treated earlier, his lymphadenopaties regressed and there was no suppuration. The other two cases, which had been suspected to be exposed to the same pathogen based on their histories, were at a mild acute phase and presented to our clinic with typical lymphadenitis. The diagnoses of each of the three patients were made serologically. An early clinical recovery was achieved in the first patient with streptomycin (1 x 1 g/day im) and doxycyline (2 x 100 mg/day peroral) therapy. The therapy was prolonged to 4 weeks in the other two cases according to lymph node response and no complications occurring in their follow-ups. It can be concluded that tularaemia should be considered in the differential diagnosis of patients with fever, pharyngitis, conjunctivitis and cervical lymphadenopathies that do not respond to beta -lactam antibiotics.

Propolis (bee glue) is a natural resinous hive product, collected from various plant sources. It has attracted much attention as a useful substance applied in medicine due to its pharmacological activities. It was aimed to investigate the in vitro effects of an ethanolic extract of Adana propolis samples on the growth of Leishmania tropica. Parasite cells were treated with five concentrations (25, 50, 100, 50, 500, and 750 mug/ml) of the propolis. The number of promastigotes in each concentration was calculated using a hemocytometer slide at 24, 48, and 72 h after being harvested. In the experiments, it was determined that the concentrations up to 100 mug/ml of the propolis did not exhibit antileishmanial activity against the parasites cells. At these concentrations, there was no changes in terms of morphologically. In addition, there was no statistically significant difference in terms of cell count between control and these three groups (p > 0.05). However, in culture media containing the propolis samples at 250, 500, and 750-mug/ml concentrations, statistically significant differences in cell counts were observed, as compared to the control group (p < 0.05). Our results demonstrate that ethanolic extracts of Adana propolis samples reduce the proliferation of L. tropica parasites significantly.

OBJECTIVE: Although urinary tract infections (UTIs) are the most common hospital-acquired infections, the epidemiology of these UTIs is not well defined in Turkey. The aim of this surveillance study was to determine micro-organisms responsible for UTI, their antibiotic sensitivities and to describe the incidence and risk factors of nosocomial urinary tract infections (NUTI). SUBJECTS AND METHODS: This was a prospective surveillance study including cases of NUTI in intensive care units and various inpatient clinics. This study was carried out between November 2000 and January 2002. The following information was recorded: patients' age, gender, type of infection (hospital-acquired), presence of urinary catheter, intensive care unit admission, duration of hospital stay, type of organisms isolated and their antimicrobial susceptibility. The diagnosis of NUTI was based on criteria established by the Centers for Disease Control, Atlanta. Mini Api and conventional culture methods were used to determine the causative agents. The agents were isolated on eosin methylene blue agar and 5% sheep blood agar Statistical analyses of data were by chi-square test and logistic regression. RESULTS: In this study, 618 (2.1%) nosocomial infections (NIs) were determined in 29,778 patients, and 178 of these infections were NUTI (28.8%, 178/618). The mean age of NUTI patients was 61.0 +/- 19.4 years (0-91 years) and 82 NUTI patients (46.1%) were male and 96 (53.9%) were female. The most frequently isolated micro-organism was Escherichia coli (31.4%) followed by Candida spp (21.3%), Klebsiella spp (10.6%) and Enterococcus spp (6.9%). Compared to the rate of other NIs, the rate of NUTI increased by 1.011 times per year of age, by 2.052 times in females and by 3.83 times in patients with urinary catheters (p < 0.05). The most effective antibiotics against Gram-negative bacteria were found to be imipenem and meropenem. CONCLUSIONS: Important factors to prevent NUTI are to avoid unnecessary urethral catheterization, to choose narrow spectrum antibiotics according to antibiotic sensitivities, to investigate regularly the causative micro-organisms and their resistance patterns and to update the treatment protocols.

Staphylococcus aureus is the most common cause of serious infections in patients undergoing long-term haemodialysis (HD). S. aureus infections in HD patients are associated with considerable morbidity and mortality. Especially, methicillin-resistant S. aureus (MRSA) strains are becoming increasingly multidrug-resistant and have recently developed resistance to vancomycin, used successfully to treat MRSA for more than 30 years. In vitro determination of resistance patterns of S. aureus is critical in terms of administering suitable antimicrobial treatment. The objective of this study was to identify the frequency of S. aureus among diabetic and non-diabetic HD patients and to investigate resistance patterns against various antibiotics used broadly for treatment. This study was carried out between January 2004 and December 2004. In the present survey, 261 patients undergoing HD treatment from three HD units in Hatay were examined. A total of 148 Staphy-lococcus aureus strains were processed to assess their occurrence rates and antimicrobial susceptibility profiles. S. aureus positivity was determined in 148 (56.7%) of the 261 HD patients and 26 (16.2%) of the 160 individuals in the control group. The difference was significant (p < 0.001). HD length was found to be 38.4 +/- 24.3 months in the patients of S. aureus carrier and 27.3 +/- 18.5 months in non-carrier patients. Significant correlation was also identified between durations those on HD and the isolation of S. aureus (p < 0.001). However, the carrier state was unrelated to the presence of diabetes mellitus (DM), age or sex. In conclusion, nasal carriage of S. aureus was found to be more prevalent in HD patients than that in those in the control group. Also, it is concluded that DM was not a risk factor for the nasal carriage of S. aureus. In addition, the rates of antibiotic resistance of S. aureus strains were found to be quite higher in HD patients than in the control group (p < 0.05).

Type 2 diabetes mellitus (DM) has emerged as the commonest cause of end-stage renal disease. Haemodialysis (HD) treatment constitutes a high-risk environment for the transmission of hepatitis C virus (HCV). The aim of this study was to establish a potential relationship between type 2 DM and HCV infection in HD patients. Of the 267 HD patients, 67 (25.1%) had type 2 DM and 200 (74.9%) were with diverse aetiology for end-stage renal disease. The serum markers of HCV infection were tested by a second-generation enzyme-linked immunosorbent assay test for antibodies and by qualitative reverse-transcription polymerase chain reaction technique for viral RNA. The overall prevalence of anti-HCV antibodies and HCV RNA was found to be 12.7%(34/267) and 10.1%(27/267), respectively. Patients with type 2 DM were found to have a higher HCV prevalence compared with non-diabetic patients [20.8%(14/67) vs. 10%(20/200)](p < 0.05). The mean period on dialysis of anti-HCV-positive patients with type 2 DM was shorter than that observed for anti-HCV-positive non-diabetic patients (43.9 +/- 9.8 months vs. 59.7 +/- 28.4 months)(p < 0.05). This study has shown that although the period on dialysis of diabetic patients are shorter than non-diabetic patients, the prevalence of HCV in HD patients with type 2 DM is higher than that detected in non-diabetic HD patients.

The aim of this study was to investigate antioxidant, anti-inflammatory, and antibacterial properties of propolis in the treatment of experimental Staphylococcus aureus keratitis. Twenty young New Zealand white rabbits were used in this experiment. Staphylococcus aureus were given by intrastromal injection to 16 rabbits and 4 rabbits were used as control group (Group 1). Group 2 was treated with phosphate-buffered solution drops; Group 3 was administered ethanolic extract of propolis drops; Group 4 received topical ciprofloxacin drops; Group 5 was treated with topical ciprofloxacin drops along with ethanolic extract of propolis drops. The eyes were examined by slit lamp to assess corneal opacity. And then, corneas were removed to determine nitric oxide (NO) levels and count bacteria. Corneas were also evaluated histologically. Corneal NO concentration in gruop 5, treated with a combination of propolis and ciprofloxacin was determined significantly lower (10.0+/- 1.8 mumol/g wet tissue) than in Group 4, treated with ciprofloxacin (24.0+/- 3.1 mumol/g wet tissue), from Group 3, treated with propolis (15.6+/- 1.8 mumol/g wet tissue), and treated with PBS (44.7+/- 7.8 mumol/g wet tissue). There were significantly fewer bacteria in eyes that received propolis plus ciprofloxacin than in eyes treated with ciprofloxacin (p = 0.0001) or propolis (p = 0.0001) or eyes treated with PBS (p = 0.0001). The light microscopic examination revealed that the control group showed normal corneal morphology. In the nontreated group, sections of the stromal infiltration revealed the presence of inflammatory cells, which were diffusely distributed (p < 0.05). Administrations of ciprofloxacin plus propolis resulted in a significantly reduced histological damage with fewer bacterial inoculation of the corneal stroma in comparison with the other groups (p < 0.05). Based on these findings, we suggest that ethanolic extract of propolis has antioxidant, anti-inflammatory, and antibacterial properties for S. aureus keratitis in rabbits.

PURPOSE: The aim of this study was to investigate the antimicrobial and anti-inflammatory properties of an ethanolic extract of propolis, a natural resin produced by honeybees, and to determine synergistic activity between ciprofloxacin and propolis in the treatment of experimental Staphylococcus aureus keratitis. METHODS: Sixteen young New Zealand white rabbits were given intrastromal injections of S. aureus strains. Twenty-four hours later, the rabbits were randomly divided into 4 groups: group 1 was treated with topical 0.3% ciprofloxacin drops along with the ethanolic extract of propolis drops; group 2 received topical 0.3% ciprofloxacin drops; group 3 was administered the ethanolic extract of propolis drops, and group 4, the control group, was treated with phosphate-buffered saline (PBS) drops. Drugs were instilled 8 times/day for 72 h. Twenty-four and 96 h after inoculation of bacteria, the eyes were examined by slit lamp to assess corneal opacity. Corneas were removed to count bacteria. RESULTS: Slit lamp examination showed that the corneal opacity scores were significantly lower in eyes that received propolis plus ciprofloxacin than in those treated with ciprofloxacin (p = 0.041) or propolis (p = 0.006) or control eyes treated with PBS (p = 0.0001). There was no significant difference in eyes treated with ciprofloxacin and propolis (p = 1.00). There were significantly fewer bacteria in eyes that received propolis plus ciprofloxacin than in those treated with ciprofloxacin (p = 0.0001) or propolis (p = 0.0001) or control eyes treated with PBS (p = 0.0001). There was no significant difference in eyes treated with ciprofloxacin and propolis (p = 0.38). CONCLUSIONS: Taking these findings into consideration, we suggest that the ethanolic extract of propolis has antimicrobial and anti-inflammatory properties for S. aureus keratitis. The combination of ciprofloxacin and propolis had better therapeutic effects than either agent alone.

Complementary and alternative medicine (CAM) is frequently used by patients with multiple sclerosis (MS). Some MS patients experience unexpected improvements of symptoms, which they relate to their use of CAM. The aim of this study was to obtain knowledge and develop understandings of such self-defined unexpected improvement of MS symptoms. Two cases were constructed based on documents and 12 qualitative interviews. Our aim was not to make generalisations from the cases, but to transfer knowledge as working hypotheses. We identified four health-related change processes: the process of losing bodily competence; the process of developing responsibility; the process of taking control; and the process of choosing CAM. The patients explained unexpected improvements in their MS symptoms as results of their own efforts including their choice and use of CAM. In our theoretical interpretations, we found the patients' redefinition of history, the concept of treatment and the importance of conventional health care to be essential, and leading to a change of patients' position towards conventional health care from recipients to explorers. The explorers can be perceived as boundary walkers reflecting limitations within the conventional health care system and as initiators regarding what MS patients find useful in CAM.

This study investigates conventional medicine utilization by wellness-motivated, complementary and alternative medicine (CAM) consumers. While CAM consumers are typically characterized as high health care utilizers, negative correlations have been found between CAM-based wellness programs and the consumption of conventional medical care. We use a nationally representative sample to analyze both illness- and wellness-motivated CAM users, with an interest in whether CAM therapies used for wellness replace conventional medicine, thus potentially offering cost offsets. Results indicate that motivation for CAM use is neither associated with a lower probability nor a lower rate of conventional medicine utilization. Increasingly, individuals, workplaces, and governments incorporate wellness programs involving CAM modalities into health care and policy; as the conventional and unconventional medical spheres begin to integrate and influence one another, understanding our pluralistic medical environment and its consumers will better enable policy makers to balance health and wellness initiatives with economic imperatives.

Aims and objectives. The aims of this study were to determine the prevalence of complementary and alternative medicine use in patients with arthritis, the types of complementary and alternative medicine used, pertinent socio-demographic factors associated with complementary and alternative medicine use and its perceived efficacy. Background. Arthritis is a major health issue, and the use of complementary and alternative medicine among patients with arthritis is common. Design. This is a descriptive cross-sectional study. Methods. Data were obtained from 250 patients with arthritis at the physiotherapy and immunology clinics Atatürk University Hospital in eastern Turkey between May-July 2005 using a questionnaire developed specifically for this study. The instrument included questions on socio-demographic information, disease specifics and complementary and alternative medicine usage. Results. Seventy-six per cent of participants reported use of at least one form of complementary and alternative medicine in the previous year. Complementary and alternative medicine users and non-users were not significantly different in most socio-demographic characteristics including age, gender, marital status and education level with the exception of economic status. We categorised treatment into six complementary and alternative medicine categories: 62.6% of patients used thermal therapies; 41.5% used oral herbal therapies; 40.5% used hot therapies; 32.6% used externally applied (skin) therapies; 28.4% used massage and 12.6% used cold therapies. All forms of complementary and alternative medicine except thermal and oral herbal therapies were perceived as very effective by more than half of study participants. Conclusions. Complementary and alternative medicine therapy is widely used by patients with arthritis and has perceived beneficial effects. Relevance to clinical practice. It is important for nurses and other health care professionals to be knowledgeable about the use of complementary and alternative medicine therapies when providing care to patients with arthritis because of possible interactions with other treatments, delays in seeking care and the potential for poor quality products. It is also essential for health professionals to discuss treatment options with patients and to monitor treatment efficacy.

Advances in telecommunication technology provide unique opportunities for the provision of medical services to underserved and geographically displaced patients. Health care professionals currently use voice and video systems to communicate with patients and colleagues in a variety of clinical venues. Unfortunately, such systems have limited presence in physical therapy settings. A variety of factors, including lack of familiarity with existing devices and perceived system purchase and operation costs, appear to be limiting its use. Even the terminology is confusing with such terms as telehealth, telemedicine, and telerehabilitation often used interchangeably. The purpose of this paper is to present an overview of this technology and to provide a clinical perspective regarding the use of telehealth in cardiopulmonary physical therapy practice.

PURPOSE: To identify patients' report of complementary and alternative medicine (CAM) use, along with their knowledge, their attitudes, and their use/willingness to use CAM. METHODS: A total of 353 patients were recruited through a 'convenience' sampling method in four metropolitan hospitals in Adelaide. Data were collected by means of questionnaires with open- and close-ended questions. RESULTS: The prevalence of CAM use among patients was 90.4%; although a considerable proportion of patients using CAM did not disclose this information to nurses/doctors (39.9%) and 20.7% said they would report it as "only when needed/or if asked to". A high proportion of patients reported using non-herbal supplements (60.3%) and massage therapy (45%) while most forms of therapies were mainly used "only when needed". The CAM domain most frequently used was biologically based therapies (68.8%). Patients rated themselves as having "none"(24.4%) or "very little"(42.5%) knowledge about most CAM, although nearly half (46.4%) of them had a positive attitude towards CAM. Use, knowledge, and attitudes towards CAM were also associated with diverse socio-demographic variables. This study provides a comprehensive analysis of the use of CAM by patients.

Abstract Objectives: Recent research shows a high rate of complementary and alternative medicine (CAM) use among persons with mental disorders, although correlates and patterns of CAM use are relatively unknown. This study tested whether CAM use is associated with perceived effectiveness of conventional treatment (i.e., psychotropic medication and psychotherapy) and medication compliance among persons with bipolar disorder. Design: Patients with bipolar disorder (n = 435) were included as part of a naturalistic cohort study. Measures of CAM utilization, medication compliance, and perceptions of the effectiveness of psychotropic medications and psychotherapy were based on previously established questionnaires. Associations were tested using bivariate and multivariate analyses. Results: Bivariate analyses showed that patients who did not perceive psychotherapy as effective at improving social, family, or job functioning reported greater CAM use. However, medication compliance was not significantly associated with use of CAM. Patients who used oral (e.g., herbal therapies) or cognitive (e.g., meditation) CAM were more likely to report that their medications were not effective at relieving manic or depressive symptoms. Users of cognitive CAM were more likely to report that their medications did not help with social, job, or family functioning, and that they did not prevent recurrences of manic or depressive episodes. None of the bivariate associations remained significant in multivariate analyses. Conclusions: Prior research has suggested that persons who are dissatisfied with treatment for medical conditions are more likely to use CAM therapies. However, the results of this study do not show CAM therapies to be associated with perceived effectiveness of treatments for mental health problems among this sample of persons with serious mental illnesses. This suggests that motivations for CAM use may vary by population and condition. Because few correlates of CAM use among persons with serious mental illnesses are known, providers should conduct routine assessments of CAM use.

Complementary and alternative medicine (CAM) has become popular with consumers worldwide and accounts for significant private and public health expenditures. According to earlier reports, the prevalence of CAM use by rheumatoid arthritis (RA) patients in the United States is anywhere between 28% and 90%. Extensive use among RA patients and the limited knowledge among physicians had confirmed the need to evaluate the increasing prevalence of various CAM modalities. The primary aim of this study was to identify the incidence of CAM usage among our RA patients. Additionally, we aimed to correlate patient demographics and disease characteristics with the use of specific CAM modalities. An analysis of data extracted from our institution's RA longitudinal registry was performed. The patients were asked to select from a list the modalities they were currently using and/or had used in the past. Of patients, 75.9% reported current or past use of CAM with >10% using 12 different modalities. Nutritional supplements and touch therapies were the most widely used overall, with mind-body therapies more prevalent among younger patients. CAM users were found to have more extra-articular manifestations and fewer comorbidities than non-CAM users. The use of CAM among RA patients is widespread with a broad spectrum of CAM modalities being used in early stages of the disease, frequently in conjunction with mainstream conventional treatments. Therefore, CAM may no longer be considered the rheumatoid patients' last resort.

AIM: The purpose of this study was to assess the relationships between quality of life and use of complementary and alternative medicine (CAM) among Turkish cancer patients. METHODS: This cross-sectional study was conducted in Istanbul University Institute of Oncology, Turkey. Two-hundred patients were invited and informed consent was obtained, however 179 cancer patients completed the study. The Patient Characteristics form, The Nightingale Symptom Assessment Scale and The Functional Assessment of Cancer Therapy Scale were used in the evaluation of the patients' characteristics and quality of life. RESULTS: Some form of CAM had been used by 71.5% of the sample. Frequently used CAM methods appeared to be religious practices (68.2%) and only 37.4% of the patients used herbs. However, female patients, single patients, and individuals with metastatic disease and worse quality of life showed a tendency to use CAM more often. More than one-third of our patients began to use CAM immediately after being diagnosed with cancer and factors associated with CAM use varied according to the type of CAM. Although CAM use did not affect the patients' quality of life, logistic regression analysis revealed that gender, type of cancer diagnosis and education level were important factors to be considered in different CAM therapies. CONCLUSION: CAM use is common in cancer patients in Turkey. More discussion about CAM use should take place between patients and health professionals to inform the patients' decisions.

BACKGROUND:: This study explored factors related to practitioner-based complementary and alternative medicine (CAM) usage among primary care clinic patients in rural West Texas areas, including physicians' awareness of their patients' CAM use. METHODS:: A convenience sample was drawn from nine clinics that served low-income populations. Surveys were distributed to patients during a 6-week period in the winter of 2006. The analytical sample included 1731 participants. Logistic regressions were conducted to explore the factors related to CAM use. RESULTS:: Of 1731 subjects, 52.0%(900) reported that they were currently using or had used CAM. The main types of CAM practitioners were chiropractor (42.7%) followed by massage therapist (33.3%) and herbalist (8.3%). Those who had discussed the use of alternative medicine with their physicians and those who had more days where they felt worried in the past 30 days were more likely to use CAM than their counterparts. Patients whose healthcare was covered by nonprivate insurance, those who rated their healthcare providers more highly, and those who agreed that their doctor visits were obtainable were less likely to use CAM. CONCLUSIONS:: CAM use is clearly not uncommon among primary care patients in rural areas, with more than half of patients reporting some type of use. This study suggests that further research should elicit opinions on CAM among people who do not regularly access a conventional primary care provider, as well as assess the relationship between CAM and conventional medical treatment in terms of cost and health benefits.

Among patients with irritable bowel syndrome (IBS) enrolled in clinical trials of conventional medical therapy, the placebo response rate is high. IBS patients also frequently use complementary and alternative medicine (CAM), which may act through an 'enhanced placebo effect'. The purpose of this study was to estimate the magnitude of the placebo response rate in CAM trials for IBS and to identify factors that influence this response. We performed a systematic review and meta-analysis of randomized, placebo-controlled clinical trials of CAM therapies for IBS identified from MEDLINE/EMBASE/PsychLIT databases from 1970 to 2006. Placebo and active treatment response rates for global symptom improvement were assessed. Nineteen studies met the inclusion criteria. The pooled estimate of the placebo response rate was 42.6%(95% confidence interval, 38.0-46.5%). Significant heterogeneity existed across trials (range 15.0-72.2%, P < 0.00001). Higher placebo response rates correlated with a longer duration of treatment (r = 0.455, P = 0.05) and a greater number of office visits (r = 0.633, P = 0.03). Among IBS patients in CAM trials, the placebo response rate is high. That this rate is similar in magnitude to that seen in conventional medicine trials suggests that the placebo response is independent of the type of therapy used and that it is not particularly 'enhanced' in CAM trials.