Background Peritoneal seeding after abdominal surgery is a well known route of metastasis in intr... more Background Peritoneal seeding after abdominal surgery is a well known route of metastasis in intra-abdominal solid tumours. Direct mechanical contamination, local peritoneal trauma and subsequent inflammation, postoperative immunosuppression, and laparoscopic surgery are the proposed predisposing factors for this type of metastasis. These factors probably result in enhanced adhesion or growth of tumour cells. However, this route of metastasis has not yet been reported for lymphomas. Here, we report the first case of peritoneal seeding of lymphoma cells after an abdominal surgery. Case Description A 47-year-old man with mantle cell lymphoma had ascites because of infiltration of the liver. He underwent debulking splenectomy. The postoperative ascites cytology and control abdominal computed tomography imaging both confirmed peritoneal involvement and lymphoma progression. Demonstration of negative peritoneal involvement before surgery and close timing of peritoneal involvement after splenectomy suggested to us that the debulking surgery was the main cause of peritoneal seeding of lymphoma cells in our case. Conclusions Factors similar to those in solid tumour seeding may also be valid for lymphomas. Peritoneal seeding and consequent disease progression may be a potential complication of abdominal surgery in lymphoma with extensive intra-abdominal involvement.
Nearly one third of the old aged people fail to meet their daily dietary requirement for energy. ... more Nearly one third of the old aged people fail to meet their daily dietary requirement for energy. Two out of three elderly people stated that they do skip meals. Malnutrition (MN) is related with variety of geriatric syndromes like sarcopenia, dependency, falls and fractures. It can increase the risk of pressure ulcers, cognitive decline, infections, hospital stay, costs and mortality [1]. The prevalence of malnutrition is different in various care settings. It is 5-30% in community-dwelling elderly, 30-50% in nursing homes, and 50-70% in the hospitals [2-7]. Ulger et al. found increased 18-months mortality rate in nursing home residents with malnutrition risk (MR) or MN (N: 9.9%, MN risk: 24%, MN: 40.8%) [8]. Torma et al. also indicated increased mortality rate with malnutrition in nursing home independent from chronic diseases [9]. Anthropometric measurements, screening and assessment tests are used to diagnose MR and MN. Anthropometric measurements include weight, body mass index (BMI), circumferences of the extremities and skin-fold measurements. Height decreases with aging due the reasons such as senile kyphosis, shortening of spinal vertebrae and thinning of weight-bearing cartilage tissue. BMI < 21 kg/m 2 was considered as an indicator of malnutrition (MN) [10]. International Dietetics and Nutrition Terminology defined BMI < 23 kg/m 2 in elderly as underweight [11]. In elderly, calf circumference (CC) was found well correlated
PurposeFalls are a highly prevalent problem in hospitals and nursing homes with serious negative ... more PurposeFalls are a highly prevalent problem in hospitals and nursing homes with serious negative consequences such as injuries, increased care dependency, or even death. The aim of this study was to provide a comprehensive insight into institution‐acquired fall (IAF) prevalence and risk factors for IAF in a large sample of hospital patients and nursing home residents among five different countries.DesignThis study reports the outcome of a secondary data analysis of cross‐sectional data collected in Austria, Switzerland, the Netherlands, Turkey, and the United Kingdom in 2017 and 2018. These data include 58,319 datapoints from hospital patients and nursing home residents.MethodsDescriptive statistics, statistical tests, logistic regression, and generalized estimating equation (GEE) models were used to analyze the data.FindingsIAF prevalence in hospitals and nursing homes differed significantly between the countries. Turkey (7.7%) had the highest IAF prevalence rate for hospitals, and...
Objective: Patients with chronic kidney disease (CKD) are susceptible to systemic inflammation an... more Objective: Patients with chronic kidney disease (CKD) are susceptible to systemic inflammation and nutritional disorders, which are associated with morbidity and mortality. The aim of the present study was to evaluate the relationship between nutritional status, lean body mass, physical activity, and systemic inflammation in patients with stage 3-5 non-dialysis-dependent CKD. Methods: A total of 55 predialysis patients with CKD were included in this cross-sectional study. Patients were divided into two groups according to the Subjective Global Assessment: 35 with normal nutritional status (NN) and 20 with malnutrition (MN). Anthropometric measurements, fat-free mass, muscle strength, physical activity, biochemical parameters, and serum cytokine levels of the patients were compared. Results: Patients with CKD and malnutrition (CKD-MN) had higher serum phosphate, interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α levels and lower serum albumin levels and blood lymphocyte counts than those with CKD-NN independent from glomerular filtration rate. Regression analysis showed a relationship between MN and serum phosphate level, blood lymphocyte count, and serum IL-6 and TNF-α levels. Muscle strength and gait speed showed a positive relationship with nutritional status and negative relationship with inflammation. Conclusion: An increased inflammatory environment in patients with non-dialysis-dependent CKD was significantly associated with MN and decreased physical activity. An increased serum phosphate level appears to contribute to this MN-inflammation environment.
Hepatic encephalopathy is a common complication of end-stage liver disease. It happens in the pre... more Hepatic encephalopathy is a common complication of end-stage liver disease. It happens in the presence of significant hepatic dysfunction and the diversion of the portal blood to the systemic circulation (porto-systemic shunts). Hereditary Hemorrhagic Telangiectasia (HHT) or Osler-Weber-Rendu disease, can also involve the liver along with the skin, mucous membranes, lung, brain, and gastrointestinal tract. The prevalence of hepatic involvement in HHT ranges between 41% and 78%. Although most patients with HHT are asymptomatic, some may have symptoms due to high-output heart failure, portal hypertension and biliary disease. Less commonly, patients may also develop porto-systemic encephalopathy. In this case report, we present a woman aged 63 years, who was diagnosed as having hepatic encephalopathy due to a portosystemic shunt.
Angiotensin II promotes growth and angiogenesis via type 1 receptors (AGTR1) in certain tumors. I... more Angiotensin II promotes growth and angiogenesis via type 1 receptors (AGTR1) in certain tumors. In this study, we examine the bone marrow AGTR1 expression in multiple myeloma (MM) and its relationship with the regulation of angiogenesis and prognostic factors. Materials and Methods: Bone marrow AGTR1 mRNA levels of 39 MM patients and 15 healthy controls were analyzed with quantitative RT-PCR. Immunohistochemical staining of the tissue vascular endothelial growth factor (VEGF), CD34, and factor VIIIrAg (fVIIIrAg) was used to assess bone marrow angiogenesis. Results: Bone marrow samples of the patients showed increased VEGF, fVIIIrAg, and CD34 staining and higher AGTR1 expression levels when compared to controls. Patients with severe-diffuse bone marrow infiltration showed higher bone marrow VEGF, fVIIIrAg, CD34, and AGTR1 mRNA levels when compared to other patients. Conclusion: AGTR1 expression was found positively correlated with plasma β2-microglobulin level and patients with increased AGTR1 expression showed increased bone marrow CD34 levels.
To determine the prevalence of low muscle mass (LMM) and the relationship between LMM with functi... more To determine the prevalence of low muscle mass (LMM) and the relationship between LMM with functional and nutritional status as defined using the LMM evaluation method of European Working Group on Sarcopenia in Older People (EWGSOP) criteria among male residents in a nursing home. Male residents aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;60 years of a nursing home located in Turkey were included in our study. Their body mass index (BMI) kg/m(2), skeletal muscle mass (SMM-kg) and skeletal muscle mass index (SMMI-kg/m(2)) were calculated. The participants were regarded as having low SMMI if they had SMMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;9.2 kg/m(2) according to our population specific cut-off point. Functional status was evaluated with Katz activities of daily living (ADL) and Lawton Instrumental Activities of Daily Living (IADL). Nutritional assessment was performed using the Mini Nutritional Assessment (MNA). The number of drugs taken and chronic diseases were recorded. One hundred fifty-seven male residents were enrolled into the study. Their mean age was 73.1 ± 6.7 years with mean ADL score of 8.9 ± 2.0 and IADL score of 8.7 ± 4.6. One hundred twelve (71%) residents were aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;70 years. Thirty-five men (23%) had low SMMI in group aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;60 years, and twenty-eight subjects (25%) in the group aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;70 years. MNA scores were significantly lower in residents with low SMMI compared with having normal SMMI (17.1 ± 3.4 versus 19.6 ± 2.5, p = 0.005). BMI was significantly lower in the residents with low SMMI compared with normal SMMI (19.6 ± 2.7 versus 27.1 ± 4.1, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). ADL scores were significantly different between residents with low SMMI and normal SMMI in those aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;70 years (8.1 ± 2.6 versus 9.1 ± 1.6, p = 0.014). In regression analyses, the only factor associated with better functional status was the lower age (p = 0.04) while the only factor associated with better nutrition was higher SMMI (p = 0.01). Low SMMI detected by LMM evaluation method of EWGSOP criteria is prevalent among male nursing home residents. There is association of low SMMI with nutritional status and probably with functional status within the nursing home setting using the EWGSOP criteria with Turkish normative reference cut-off value.
There are few reports concerning Mycobacterium tilburgii infection in humans because this bacteri... more There are few reports concerning Mycobacterium tilburgii infection in humans because this bacterium is non-cultivatable. Herein, using new molecular techniques, we report the case of an immunocompromised patient with fatal disseminated lymphadenitis that was caused by M. tilburgii.26 years old Caucasian HIV negative female patient presented with abdominal pain. Her clinical assessment revealed disseminated lymphadenitis, that was acid fast bacilli positive. Further molecular evaluation showed the causative agent as M. tilburgii. Despite anti mycobacterial therapy and careful management of intervening complications patient died because of an intraabdominal sepsis. This is the first fatal M. tilburgii infection in the literature. This case points the importance of careful management of patient's immune status and intervening infections besides implementation of effective drug treatment.
BACKGROUND/OBJECTIVES: Sarcopenia and sarcopenic obesity (SO) are geriatric syndromes leading to ... more BACKGROUND/OBJECTIVES: Sarcopenia and sarcopenic obesity (SO) are geriatric syndromes leading to physical disability, poor quality of life and death. The aim of this study was to investigate the prevalence of sarcopenia and SO in nursing homes in Turkey and to define local disparities for diagnosing sarcopenia and SO. SUBJECTS/METHODS: This cross-sectional multicenter study was performed in 711 patients in 14 nursing homes. Comprehensive geriatric assessment tests, handgrip strength and calf circumference (CC) measurements were carried out. Sarcopenia was both defined by handgrip strength and CC criteria. RESULTS: According to handgrip strength measurement, 483 (68%) of patients were sarcopenic (male: 72%, female: 63.8%), 228 were non-sarcopenic. The prevalence of SO was 22% (13.7% in men, 30.2% in women). Patients (82.5%) who were diagnosed as sarcopenic by the handgrip strength test were not sarcopenic according to CC sarcopenia criteria. Therefore, we tried to determine the optimal CC value for diagnosing sarcopenia in our population. CONCLUSIONS: Both sarcopenia and SO were prevalent among Turkish nursing home elderly residents. Most of the patients with sarcopenia were obese or overweight. We showed that diagnosing sarcopenia with CC measurement underestimated the sarcopenia prevalence assessed by handgrip strength. So we concluded that, although different assessment methods are recommended for the diagnosis of sarcopenia local disparities should be considered.
Introduction: Malnutrition and nutrition-related diseases are associated with hospital admissions... more Introduction: Malnutrition and nutrition-related diseases are associated with hospital admissions, disability, institutionalization, and mortality in older people. Specialists in Geriatric Medicine and nutrition evaluate nutritional status as part of the comprehens ive geriatric assessment; however, malnutrition still remains under-recognized and undermanaged. Our survey explored nutrition assessment approaches used in daily clinical practice by geriatricians across Europe. Methods: A 19-item survey on methods and instruments for malnutrition assessment in geriatric settings, and details of any national guidelines, was sent to 40 postgraduate fellows of the European Academy of Medicine of Ageing (EAMA, 2017-2019 class). Results: Thirty-six of the 40 eligible EAMA participants, representing 14 European countries, responded. In clinical practice, MNA and MNA-SF were most frequently used for screening (44.1%, 52.9%, respectively) and diagnosing (45.7%, 40.0%) malnutrition. Weight loss (n=36, 100%), body mass index (n=30, 85.7%), and low energy/food intake (n=27, 77.1%) were the most frequent clinical variables considered. The absolute and relative amount of weight loss, and over what time period, varied widely. These routinely considered clinical factors contribute to validated GLIM, ASPEN-AND and ESPEN criteria for diagnosis of malnutrition, but these criteria were seldom used (GLIM=0%, ASPEN=0%; n=9, ESPEN=25.7%). National guidelines were available in 9 of the 14 countries, and generally recommended MNA and MNA-SF for community-dwelling and hospitalized older patients. Albumin was often suggested as a nutritional marker. Highlights Nutritional assessment performed by geriatricians in clinical practice varies widely across European countries.
To evaluate sarcopenia risk in hospitalized older patients. The percentage of patients at risk of... more To evaluate sarcopenia risk in hospitalized older patients. The percentage of patients at risk of sarcopenia defined by the SARC-F was 48.8%. Sarcopenia risk was associated with unfavorable health care outcomes including dependency, malnutrition, and dysphagia. Sarcopenia risk is related with unfavorable outcomes in hospitalized patients and it is important to recognize sarcopenia at an early stage and to prevent its progression, before dependency develops. To investigate the risk of sarcopenia in hospitalized older patients and to assess the associations between sarcopenia risk and health care outcomes including dependency, malnutrition, and dysphagia. This multicenter cross-sectional study was a part of the annual National Prevalence Measurement of Quality of Care (LPZ) in Turkey. Hospitalized patients age 65 and older were included in the study. The SARC-F was used to assess risk of sarcopenia. Dependency was appraised according to the Care Dependency Scale (CDS). Nutritional status was established with respect to the Malnutrition Universal Screening Tool (MUST). Dysphagia was screened by two structured questions. A total of 492 patients were included in the analysis. Two hundred and forty patients (48.8%) were at risk of sarcopenia. Sarcopenia risk was more prevalent among women (p = 0.007) and patients with risk of sarcopenia were older (p < 0.001). Hospital stay was longer and malnutrition and dysphagia were more prevalent in patients with sarcopenia risk than without (all p < 0.001). All nutritional interventions were applied mostly to patients with sarcopenia risk than without. In multivariate analysis, advanced age (OR: 1.068, CI 1.032–1.104, p < 0.001), female gender (OR: 2.414, CI 1.510–3.857, p < 0.001), and dependency (OR: 5.022, CI 2.922–8.632, p < 0.001) were independently associated with sarcopenia risk. Sarcopenia risk is related with unfavorable outcomes in hospitalized patients. Primarily older female patients are at risk for sarcopenia. It is important to recognize sarcopenia at an early stage and to prevent its progression, before dependency develops. The SARC-F may be a useful tool for screening sarcopenia risk in hospitalized patients.
S84 8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33-S143 results, evidence ... more S84 8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33-S143 results, evidence summary, commentary, and bottom line conclusions. Literature search yielded 326 citations. Three studies were selected: Lauque 2004, Pivi 2011, and de Sousa 2011. These studies investigated the effect of ONS compared with care as usual or a nutrition educational program. They demonstrated that ONS improved AD patients' nutritional status. However, these studies had several shortcomings: the place of residence was unclear (n = 2) or patients were hospitalized (n = 1), undernutrition was not an inclusion criterion (n = 1), study groups were small (n = 2) and the process of randomisation and blinding was not described (n = 3). Despite the negative consequences of weight loss in AD patients, insufficient data exist regarding the effect of ONS in undernourished community-dwelling AD patients. We are therefore planning a RCT to answer this question. Disclosure.-No significant relationships.
all included patients and subgroups. Determination of predictors was done by multivariable binary... more all included patients and subgroups. Determination of predictors was done by multivariable binary logistic regression. Results.– Four hundred and forty-two people aged 75 years or older were included in the study, 73.5% (n=325) were admitted to the hospital, of which 35.1% (n=114) were admitted to an acute geriatric ward. Of the patients being discharged from the ED, 26.5% (31/117) had an unplanned ED revisit within 3 months. Nursing care at home (OR 4.63, 95% CI 1.45–14.77) and depression (OR 3.91, 95% CI 1.16–13.19) were found to be independent predictors for unplanned ED readmission in the multivariable analysis. A significant trend was found for falls in the last year (OR 2.99, 95% CI 0.95–9.37). Conclusion.–This study confirms thehigh readmission rates of older persons being discharged from the ED and suggests the potential value ofmultidisciplinary, psychosocial and functional assessment, interventions and follow-up to avoid early-unplanned ED readmissions.
S106 8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33-S143 but only half of ... more S106 8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33-S143 but only half of them will develop permanent hypoparathryoidism [4]. Conclusions.-Because of the treatment's efficiency it is important to exclude hypoparathyroidism, one cause of reversible dementia. Disclosure.-No significant relationships.
European Journal of Geriatrics and Gerontology, 2021
Objective: Malnutrition, pressure ulcers, falls, pain, and restraints are important quality of ca... more Objective: Malnutrition, pressure ulcers, falls, pain, and restraints are important quality of care indicators in healthcare settings. The Landelijke Prevalentiemeting Zorgkwaliteit-National Care Indicators Prevalence Study is an annual international multicenter cross-sectional prevalence measurement of care problems in the institution, department, and patient-level across Europe. This study aimed to measure the prevalence of care problems among older adults in Turkish hospitals. Materials and Methods: A multicenter, cross-sectional study was performed using a standardized and tested questionnaire. Data were collected from older adult patients (65 years and over) in the hospitals. The study was conducted in 12 centers from 6 big cities of the country in November 2017 and 2018.
OBJECTIVE The aim of this study was to investigate the differences in the quality of nutritional ... more OBJECTIVE The aim of this study was to investigate the differences in the quality of nutritional care among Austria, Switzerland, and Turkey. METHODS This was a cross-sectional multicenter study. Data were collected using a standardized questionnaire. Descriptive statistics and univariate and multivariate logistic regression (adjusted for age, sex, number of diagnoses, and care dependency) analyses were performed. RESULTS Taking part in the study were 6293 patients from 62 hospitals. The prevalence of risk for malnutrition and the patients was 14.5% in Austria, 16.5% in Switzerland, and 33.7% in Turkey. Standardized screening procedures were applied in 51.3% of Austrian, 53.6% of Swiss, and 38.4% of Turkish patients. The interventions applied in patients at risk varied significantly between Austrian, Swiss, and Turkish hospitals for all but two interventions. Referrals to dietitians were lower in Austria (35.8%) and Switzerland (37.7%) compared with Turkey (61%). Turkish patients received more frequent oral nutritional supplementation, an energy-protein-enriched diet, or parenteral nutrition compared with those in Austrian or Swiss hospitals. The differences in the quality of nutritional care between Austrian and Swiss hospitals were only marginal. Of at-risk patients, 15.3% in Austria, 11.4% in Switzerland, and 5.5% in Turkey did not receive any intervention. CONCLUSIONS The findings of this study indicated that significant differences exist in the prevalence, identification and treatment of malnutrition, and the fulfillment of structural quality indicators. Standards and guidelines need to be developed that can be used by all countries. The severity of the malnutrition situation in hospitals needs further attention in future management policies.
Background Peritoneal seeding after abdominal surgery is a well known route of metastasis in intr... more Background Peritoneal seeding after abdominal surgery is a well known route of metastasis in intra-abdominal solid tumours. Direct mechanical contamination, local peritoneal trauma and subsequent inflammation, postoperative immunosuppression, and laparoscopic surgery are the proposed predisposing factors for this type of metastasis. These factors probably result in enhanced adhesion or growth of tumour cells. However, this route of metastasis has not yet been reported for lymphomas. Here, we report the first case of peritoneal seeding of lymphoma cells after an abdominal surgery. Case Description A 47-year-old man with mantle cell lymphoma had ascites because of infiltration of the liver. He underwent debulking splenectomy. The postoperative ascites cytology and control abdominal computed tomography imaging both confirmed peritoneal involvement and lymphoma progression. Demonstration of negative peritoneal involvement before surgery and close timing of peritoneal involvement after splenectomy suggested to us that the debulking surgery was the main cause of peritoneal seeding of lymphoma cells in our case. Conclusions Factors similar to those in solid tumour seeding may also be valid for lymphomas. Peritoneal seeding and consequent disease progression may be a potential complication of abdominal surgery in lymphoma with extensive intra-abdominal involvement.
Nearly one third of the old aged people fail to meet their daily dietary requirement for energy. ... more Nearly one third of the old aged people fail to meet their daily dietary requirement for energy. Two out of three elderly people stated that they do skip meals. Malnutrition (MN) is related with variety of geriatric syndromes like sarcopenia, dependency, falls and fractures. It can increase the risk of pressure ulcers, cognitive decline, infections, hospital stay, costs and mortality [1]. The prevalence of malnutrition is different in various care settings. It is 5-30% in community-dwelling elderly, 30-50% in nursing homes, and 50-70% in the hospitals [2-7]. Ulger et al. found increased 18-months mortality rate in nursing home residents with malnutrition risk (MR) or MN (N: 9.9%, MN risk: 24%, MN: 40.8%) [8]. Torma et al. also indicated increased mortality rate with malnutrition in nursing home independent from chronic diseases [9]. Anthropometric measurements, screening and assessment tests are used to diagnose MR and MN. Anthropometric measurements include weight, body mass index (BMI), circumferences of the extremities and skin-fold measurements. Height decreases with aging due the reasons such as senile kyphosis, shortening of spinal vertebrae and thinning of weight-bearing cartilage tissue. BMI < 21 kg/m 2 was considered as an indicator of malnutrition (MN) [10]. International Dietetics and Nutrition Terminology defined BMI < 23 kg/m 2 in elderly as underweight [11]. In elderly, calf circumference (CC) was found well correlated
PurposeFalls are a highly prevalent problem in hospitals and nursing homes with serious negative ... more PurposeFalls are a highly prevalent problem in hospitals and nursing homes with serious negative consequences such as injuries, increased care dependency, or even death. The aim of this study was to provide a comprehensive insight into institution‐acquired fall (IAF) prevalence and risk factors for IAF in a large sample of hospital patients and nursing home residents among five different countries.DesignThis study reports the outcome of a secondary data analysis of cross‐sectional data collected in Austria, Switzerland, the Netherlands, Turkey, and the United Kingdom in 2017 and 2018. These data include 58,319 datapoints from hospital patients and nursing home residents.MethodsDescriptive statistics, statistical tests, logistic regression, and generalized estimating equation (GEE) models were used to analyze the data.FindingsIAF prevalence in hospitals and nursing homes differed significantly between the countries. Turkey (7.7%) had the highest IAF prevalence rate for hospitals, and...
Objective: Patients with chronic kidney disease (CKD) are susceptible to systemic inflammation an... more Objective: Patients with chronic kidney disease (CKD) are susceptible to systemic inflammation and nutritional disorders, which are associated with morbidity and mortality. The aim of the present study was to evaluate the relationship between nutritional status, lean body mass, physical activity, and systemic inflammation in patients with stage 3-5 non-dialysis-dependent CKD. Methods: A total of 55 predialysis patients with CKD were included in this cross-sectional study. Patients were divided into two groups according to the Subjective Global Assessment: 35 with normal nutritional status (NN) and 20 with malnutrition (MN). Anthropometric measurements, fat-free mass, muscle strength, physical activity, biochemical parameters, and serum cytokine levels of the patients were compared. Results: Patients with CKD and malnutrition (CKD-MN) had higher serum phosphate, interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α levels and lower serum albumin levels and blood lymphocyte counts than those with CKD-NN independent from glomerular filtration rate. Regression analysis showed a relationship between MN and serum phosphate level, blood lymphocyte count, and serum IL-6 and TNF-α levels. Muscle strength and gait speed showed a positive relationship with nutritional status and negative relationship with inflammation. Conclusion: An increased inflammatory environment in patients with non-dialysis-dependent CKD was significantly associated with MN and decreased physical activity. An increased serum phosphate level appears to contribute to this MN-inflammation environment.
Hepatic encephalopathy is a common complication of end-stage liver disease. It happens in the pre... more Hepatic encephalopathy is a common complication of end-stage liver disease. It happens in the presence of significant hepatic dysfunction and the diversion of the portal blood to the systemic circulation (porto-systemic shunts). Hereditary Hemorrhagic Telangiectasia (HHT) or Osler-Weber-Rendu disease, can also involve the liver along with the skin, mucous membranes, lung, brain, and gastrointestinal tract. The prevalence of hepatic involvement in HHT ranges between 41% and 78%. Although most patients with HHT are asymptomatic, some may have symptoms due to high-output heart failure, portal hypertension and biliary disease. Less commonly, patients may also develop porto-systemic encephalopathy. In this case report, we present a woman aged 63 years, who was diagnosed as having hepatic encephalopathy due to a portosystemic shunt.
Angiotensin II promotes growth and angiogenesis via type 1 receptors (AGTR1) in certain tumors. I... more Angiotensin II promotes growth and angiogenesis via type 1 receptors (AGTR1) in certain tumors. In this study, we examine the bone marrow AGTR1 expression in multiple myeloma (MM) and its relationship with the regulation of angiogenesis and prognostic factors. Materials and Methods: Bone marrow AGTR1 mRNA levels of 39 MM patients and 15 healthy controls were analyzed with quantitative RT-PCR. Immunohistochemical staining of the tissue vascular endothelial growth factor (VEGF), CD34, and factor VIIIrAg (fVIIIrAg) was used to assess bone marrow angiogenesis. Results: Bone marrow samples of the patients showed increased VEGF, fVIIIrAg, and CD34 staining and higher AGTR1 expression levels when compared to controls. Patients with severe-diffuse bone marrow infiltration showed higher bone marrow VEGF, fVIIIrAg, CD34, and AGTR1 mRNA levels when compared to other patients. Conclusion: AGTR1 expression was found positively correlated with plasma β2-microglobulin level and patients with increased AGTR1 expression showed increased bone marrow CD34 levels.
To determine the prevalence of low muscle mass (LMM) and the relationship between LMM with functi... more To determine the prevalence of low muscle mass (LMM) and the relationship between LMM with functional and nutritional status as defined using the LMM evaluation method of European Working Group on Sarcopenia in Older People (EWGSOP) criteria among male residents in a nursing home. Male residents aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;60 years of a nursing home located in Turkey were included in our study. Their body mass index (BMI) kg/m(2), skeletal muscle mass (SMM-kg) and skeletal muscle mass index (SMMI-kg/m(2)) were calculated. The participants were regarded as having low SMMI if they had SMMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;9.2 kg/m(2) according to our population specific cut-off point. Functional status was evaluated with Katz activities of daily living (ADL) and Lawton Instrumental Activities of Daily Living (IADL). Nutritional assessment was performed using the Mini Nutritional Assessment (MNA). The number of drugs taken and chronic diseases were recorded. One hundred fifty-seven male residents were enrolled into the study. Their mean age was 73.1 ± 6.7 years with mean ADL score of 8.9 ± 2.0 and IADL score of 8.7 ± 4.6. One hundred twelve (71%) residents were aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;70 years. Thirty-five men (23%) had low SMMI in group aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;60 years, and twenty-eight subjects (25%) in the group aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;70 years. MNA scores were significantly lower in residents with low SMMI compared with having normal SMMI (17.1 ± 3.4 versus 19.6 ± 2.5, p = 0.005). BMI was significantly lower in the residents with low SMMI compared with normal SMMI (19.6 ± 2.7 versus 27.1 ± 4.1, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). ADL scores were significantly different between residents with low SMMI and normal SMMI in those aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;70 years (8.1 ± 2.6 versus 9.1 ± 1.6, p = 0.014). In regression analyses, the only factor associated with better functional status was the lower age (p = 0.04) while the only factor associated with better nutrition was higher SMMI (p = 0.01). Low SMMI detected by LMM evaluation method of EWGSOP criteria is prevalent among male nursing home residents. There is association of low SMMI with nutritional status and probably with functional status within the nursing home setting using the EWGSOP criteria with Turkish normative reference cut-off value.
There are few reports concerning Mycobacterium tilburgii infection in humans because this bacteri... more There are few reports concerning Mycobacterium tilburgii infection in humans because this bacterium is non-cultivatable. Herein, using new molecular techniques, we report the case of an immunocompromised patient with fatal disseminated lymphadenitis that was caused by M. tilburgii.26 years old Caucasian HIV negative female patient presented with abdominal pain. Her clinical assessment revealed disseminated lymphadenitis, that was acid fast bacilli positive. Further molecular evaluation showed the causative agent as M. tilburgii. Despite anti mycobacterial therapy and careful management of intervening complications patient died because of an intraabdominal sepsis. This is the first fatal M. tilburgii infection in the literature. This case points the importance of careful management of patient's immune status and intervening infections besides implementation of effective drug treatment.
BACKGROUND/OBJECTIVES: Sarcopenia and sarcopenic obesity (SO) are geriatric syndromes leading to ... more BACKGROUND/OBJECTIVES: Sarcopenia and sarcopenic obesity (SO) are geriatric syndromes leading to physical disability, poor quality of life and death. The aim of this study was to investigate the prevalence of sarcopenia and SO in nursing homes in Turkey and to define local disparities for diagnosing sarcopenia and SO. SUBJECTS/METHODS: This cross-sectional multicenter study was performed in 711 patients in 14 nursing homes. Comprehensive geriatric assessment tests, handgrip strength and calf circumference (CC) measurements were carried out. Sarcopenia was both defined by handgrip strength and CC criteria. RESULTS: According to handgrip strength measurement, 483 (68%) of patients were sarcopenic (male: 72%, female: 63.8%), 228 were non-sarcopenic. The prevalence of SO was 22% (13.7% in men, 30.2% in women). Patients (82.5%) who were diagnosed as sarcopenic by the handgrip strength test were not sarcopenic according to CC sarcopenia criteria. Therefore, we tried to determine the optimal CC value for diagnosing sarcopenia in our population. CONCLUSIONS: Both sarcopenia and SO were prevalent among Turkish nursing home elderly residents. Most of the patients with sarcopenia were obese or overweight. We showed that diagnosing sarcopenia with CC measurement underestimated the sarcopenia prevalence assessed by handgrip strength. So we concluded that, although different assessment methods are recommended for the diagnosis of sarcopenia local disparities should be considered.
Introduction: Malnutrition and nutrition-related diseases are associated with hospital admissions... more Introduction: Malnutrition and nutrition-related diseases are associated with hospital admissions, disability, institutionalization, and mortality in older people. Specialists in Geriatric Medicine and nutrition evaluate nutritional status as part of the comprehens ive geriatric assessment; however, malnutrition still remains under-recognized and undermanaged. Our survey explored nutrition assessment approaches used in daily clinical practice by geriatricians across Europe. Methods: A 19-item survey on methods and instruments for malnutrition assessment in geriatric settings, and details of any national guidelines, was sent to 40 postgraduate fellows of the European Academy of Medicine of Ageing (EAMA, 2017-2019 class). Results: Thirty-six of the 40 eligible EAMA participants, representing 14 European countries, responded. In clinical practice, MNA and MNA-SF were most frequently used for screening (44.1%, 52.9%, respectively) and diagnosing (45.7%, 40.0%) malnutrition. Weight loss (n=36, 100%), body mass index (n=30, 85.7%), and low energy/food intake (n=27, 77.1%) were the most frequent clinical variables considered. The absolute and relative amount of weight loss, and over what time period, varied widely. These routinely considered clinical factors contribute to validated GLIM, ASPEN-AND and ESPEN criteria for diagnosis of malnutrition, but these criteria were seldom used (GLIM=0%, ASPEN=0%; n=9, ESPEN=25.7%). National guidelines were available in 9 of the 14 countries, and generally recommended MNA and MNA-SF for community-dwelling and hospitalized older patients. Albumin was often suggested as a nutritional marker. Highlights Nutritional assessment performed by geriatricians in clinical practice varies widely across European countries.
To evaluate sarcopenia risk in hospitalized older patients. The percentage of patients at risk of... more To evaluate sarcopenia risk in hospitalized older patients. The percentage of patients at risk of sarcopenia defined by the SARC-F was 48.8%. Sarcopenia risk was associated with unfavorable health care outcomes including dependency, malnutrition, and dysphagia. Sarcopenia risk is related with unfavorable outcomes in hospitalized patients and it is important to recognize sarcopenia at an early stage and to prevent its progression, before dependency develops. To investigate the risk of sarcopenia in hospitalized older patients and to assess the associations between sarcopenia risk and health care outcomes including dependency, malnutrition, and dysphagia. This multicenter cross-sectional study was a part of the annual National Prevalence Measurement of Quality of Care (LPZ) in Turkey. Hospitalized patients age 65 and older were included in the study. The SARC-F was used to assess risk of sarcopenia. Dependency was appraised according to the Care Dependency Scale (CDS). Nutritional status was established with respect to the Malnutrition Universal Screening Tool (MUST). Dysphagia was screened by two structured questions. A total of 492 patients were included in the analysis. Two hundred and forty patients (48.8%) were at risk of sarcopenia. Sarcopenia risk was more prevalent among women (p = 0.007) and patients with risk of sarcopenia were older (p < 0.001). Hospital stay was longer and malnutrition and dysphagia were more prevalent in patients with sarcopenia risk than without (all p < 0.001). All nutritional interventions were applied mostly to patients with sarcopenia risk than without. In multivariate analysis, advanced age (OR: 1.068, CI 1.032–1.104, p < 0.001), female gender (OR: 2.414, CI 1.510–3.857, p < 0.001), and dependency (OR: 5.022, CI 2.922–8.632, p < 0.001) were independently associated with sarcopenia risk. Sarcopenia risk is related with unfavorable outcomes in hospitalized patients. Primarily older female patients are at risk for sarcopenia. It is important to recognize sarcopenia at an early stage and to prevent its progression, before dependency develops. The SARC-F may be a useful tool for screening sarcopenia risk in hospitalized patients.
S84 8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33-S143 results, evidence ... more S84 8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33-S143 results, evidence summary, commentary, and bottom line conclusions. Literature search yielded 326 citations. Three studies were selected: Lauque 2004, Pivi 2011, and de Sousa 2011. These studies investigated the effect of ONS compared with care as usual or a nutrition educational program. They demonstrated that ONS improved AD patients' nutritional status. However, these studies had several shortcomings: the place of residence was unclear (n = 2) or patients were hospitalized (n = 1), undernutrition was not an inclusion criterion (n = 1), study groups were small (n = 2) and the process of randomisation and blinding was not described (n = 3). Despite the negative consequences of weight loss in AD patients, insufficient data exist regarding the effect of ONS in undernourished community-dwelling AD patients. We are therefore planning a RCT to answer this question. Disclosure.-No significant relationships.
all included patients and subgroups. Determination of predictors was done by multivariable binary... more all included patients and subgroups. Determination of predictors was done by multivariable binary logistic regression. Results.– Four hundred and forty-two people aged 75 years or older were included in the study, 73.5% (n=325) were admitted to the hospital, of which 35.1% (n=114) were admitted to an acute geriatric ward. Of the patients being discharged from the ED, 26.5% (31/117) had an unplanned ED revisit within 3 months. Nursing care at home (OR 4.63, 95% CI 1.45–14.77) and depression (OR 3.91, 95% CI 1.16–13.19) were found to be independent predictors for unplanned ED readmission in the multivariable analysis. A significant trend was found for falls in the last year (OR 2.99, 95% CI 0.95–9.37). Conclusion.–This study confirms thehigh readmission rates of older persons being discharged from the ED and suggests the potential value ofmultidisciplinary, psychosocial and functional assessment, interventions and follow-up to avoid early-unplanned ED readmissions.
S106 8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33-S143 but only half of ... more S106 8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33-S143 but only half of them will develop permanent hypoparathryoidism [4]. Conclusions.-Because of the treatment's efficiency it is important to exclude hypoparathyroidism, one cause of reversible dementia. Disclosure.-No significant relationships.
European Journal of Geriatrics and Gerontology, 2021
Objective: Malnutrition, pressure ulcers, falls, pain, and restraints are important quality of ca... more Objective: Malnutrition, pressure ulcers, falls, pain, and restraints are important quality of care indicators in healthcare settings. The Landelijke Prevalentiemeting Zorgkwaliteit-National Care Indicators Prevalence Study is an annual international multicenter cross-sectional prevalence measurement of care problems in the institution, department, and patient-level across Europe. This study aimed to measure the prevalence of care problems among older adults in Turkish hospitals. Materials and Methods: A multicenter, cross-sectional study was performed using a standardized and tested questionnaire. Data were collected from older adult patients (65 years and over) in the hospitals. The study was conducted in 12 centers from 6 big cities of the country in November 2017 and 2018.
OBJECTIVE The aim of this study was to investigate the differences in the quality of nutritional ... more OBJECTIVE The aim of this study was to investigate the differences in the quality of nutritional care among Austria, Switzerland, and Turkey. METHODS This was a cross-sectional multicenter study. Data were collected using a standardized questionnaire. Descriptive statistics and univariate and multivariate logistic regression (adjusted for age, sex, number of diagnoses, and care dependency) analyses were performed. RESULTS Taking part in the study were 6293 patients from 62 hospitals. The prevalence of risk for malnutrition and the patients was 14.5% in Austria, 16.5% in Switzerland, and 33.7% in Turkey. Standardized screening procedures were applied in 51.3% of Austrian, 53.6% of Swiss, and 38.4% of Turkish patients. The interventions applied in patients at risk varied significantly between Austrian, Swiss, and Turkish hospitals for all but two interventions. Referrals to dietitians were lower in Austria (35.8%) and Switzerland (37.7%) compared with Turkey (61%). Turkish patients received more frequent oral nutritional supplementation, an energy-protein-enriched diet, or parenteral nutrition compared with those in Austrian or Swiss hospitals. The differences in the quality of nutritional care between Austrian and Swiss hospitals were only marginal. Of at-risk patients, 15.3% in Austria, 11.4% in Switzerland, and 5.5% in Turkey did not receive any intervention. CONCLUSIONS The findings of this study indicated that significant differences exist in the prevalence, identification and treatment of malnutrition, and the fulfillment of structural quality indicators. Standards and guidelines need to be developed that can be used by all countries. The severity of the malnutrition situation in hospitals needs further attention in future management policies.
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