**7. Conclusion**

In summary, a couple of observational studies have shown that both aspirin and statins might have significant salutatory effects on infectious complications in hemodialysis patients. Of note, aspirin does not have growth inhibitory or bactericidal activity at pharmacologically relevant concentrations and thus may be less likely to promote bacterial resistance as traditional antimicrobials do (Eisen et al., 2009). The same might apply for statins as well (Jerwood & Cohen, 2008). However, retrospective and observational studies are prone to multiple sources of bias that are unquantifiable and of indeterminate direction. Thus, randomized prospective trials are needed to further investigate this exciting new approach to the prevention of infectious complications in dialysis patients.

### **8. References**


Honey has been used for the treatment of wounds since ancient times and its medicinal use is sanctioned by the Bible, Torah and Koran (Namias N., 2003). Johnson et al. conducted a prospective trial of topical honey versus topical Mupirocin ointment for the prevention of dialysis catheter associated infection. In a two year study period the authors enrolled 101 patients with tunneled dialysis catheters in their hospital based dialysis unit. Honey was applied three times a week to the dialysis catheter exit site in 51 patients while mupirocin ointment was used in 50 patients. No exit site infections were observed in either group and no difference in the rate of catheter associated bacteremia could be demonstrated. The cost of the Australian grown medicinal honey that the authors used was equivalent to mupirocin. As the authors noted, it is interesting that at the time of the study about 2% of staphylococcal isolates in their hospital were resistant to mupirocin while no bacterial resistance to honey has yet been reported despite millennia of being around (Johnson D.W.

In summary, a couple of observational studies have shown that both aspirin and statins might have significant salutatory effects on infectious complications in hemodialysis patients. Of note, aspirin does not have growth inhibitory or bactericidal activity at pharmacologically relevant concentrations and thus may be less likely to promote bacterial resistance as traditional antimicrobials do (Eisen et al., 2009). The same might apply for statins as well (Jerwood & Cohen, 2008). However, retrospective and observational studies are prone to multiple sources of bias that are unquantifiable and of indeterminate direction. Thus, randomized prospective trials are needed to further investigate this exciting new

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**7. Conclusion** 

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**22** 

*Turkey* 

**Sleep in Patients with** 

Mukadder Mollaoğlu *Cumhuriyet University* 

**ESRD Undergoing Hemodialysis** 

Sleep has been identified as an essential human need; this is partly because of the metabolic activities that occur while the individual is sleeping. Normal sleep is divided into non–rapid eye movement (NREM) and rapid eye movement (REM) sleep. NREM sleep comprises 75% to 80% of total sleep time (TST), and is characterized by relatively quiescent brain activity and decreased metabolic rate (Carskadon & Dement, 2000). NREM sleep consists of four stages (S1-S4), with each stage leading to a progressively deeper sleep. REM sleep follows slow wave sleep (SWS), or deep sleep, and increases over the night, comprising 20% to 25% of TST. REM sleep is characterized by an activated EEG pattern, muscle atonia, and episodic bursts of rapid eye movements. Normal sleep provides a period of physiologic and mental rest. During sleep, sympathetic tone decreases and parasympathetic tone increases, leading to a reduction in heart rate, arterial blood pressure, and cardiac output (Rosenthal, 1998). Deep sleep is theorized to be necessary for physiologic restoration. REM sleep is associated with dreaming, and is essential for maintaining emotional and cognitive well-being (Redline

Waking and consciousness depend on the activity, of neurons in the ascending reticular activating system of the brainstem. These neurons project into the thalamus, hypothalamus and basal forebrain and eventually send projections to the cortex. There are particular neurotransmitters, such as the catecholamines, acetylcholine, histamine, glutamate and aspartate, that are localized within the reticular formation and have important roles in cortical activation and arousal (Jones, 1989). Sleep-promoting neurotransmitters include gamma aminobutyric acid (GABA), adenosine, and melatonin. Specific stages of sleep are regulated by the turning "on" and "off" of various neurons. REM "on" cells use GABA, acetylcholine, and glutamine, whereas REM "off" cells use norepinephrine and serotonin." REM On cells" are cholinergic cells in the lateral pontine and medial medullary reticular areas that innervate the thalamus, hippocampus and hypothalamus. These cells discharge at high rates during REM and show little or no activity during NREM."REM Off cells" are noradrenergic and serotonergic cells found in the locus coeruleus and raphe. These are cells which are slow or silent during REM sleep. Affecting levels of norepinephirne or serotonin

Sleep regulation is a balance between a homeostatic sleep need and an intrinsic body clock, or circadian pacemaker. Located in the suprachiasmic nucleus, the circadian pacemaker determines the onset and termination of sleep, and is partially regulated by environmental

**1. Introduction** 

et al., 2004).

can have an effect on REM sleep (Hoyt, 2005).

