Effect of COVID-19 Pandemic on Hepatocellular Carcinoma Diagnosis: Results from a Single Turkey Center Study.

BACKGROUND AND AIMS: Currently malignancies of the liver are the sixth most frequently diagnosed cancers worldwide. The admission of patients to hospitals decreased due to the restriction of the Coronavirus disease 2019 (COVID-19) pandemic, especially patients suspected with cancer were delayed in their diagnosis and treatment. With this study, we aimed to investigate whether the Covid-19 pandemic caused a decrease in the number of hepatocellular cancers (HCC) or a delay in its diagnosis. METHODS: The study, which included newly diagnosed HCC patients, was conducted as a retrospective cross sectional study, in a single Turkey medical center. The patients were divided into pre-COVID-19 and post- COVID-19 two-year periods and compared in terms of tumor size, biochemical parameters, clinical and demographic features. RESULTS: A total of 63 HCC patients, 46 (73%) patients before the COVID-19 pandemic and 17 (27%) patients diagnosed during the COVID-19 pandemic were included. Maximum diameter of lesions and serum alpha- fetoprotein levels showed a statistically significant difference between the groups. Maximum tumor size in the pre-COVID-19 period was 4.58±3.77 mm, while in the COVID-19 period was 7.42±6.88 mm, the difference between two groups being statistically significant (p<0.05). HCC in the pre-COVID-19 period were detected mostly at Barcelona Clinic for Liver Cancer (BCLC) stage A (45.7%, n=21), while in the COVID-19 period most of HCC were detected at stage B (35.3%, n=6). CONCLUSIONS: The COVID-19 pandemic limited the access of patients to screening programs for HCC. The significant disruption in screening cirrhotic patients for HCC has led to a delay in diagnosis.

Is increased neutrophil lymphocyte ratio remarking the inflammation in sarcopenia?

OBJECTIVES: Increasing data suggests that chronic inflammation has an essential role on development of muscle dysfunction and progression of sarcopenia in aging population. The aim of the present study was to compare Neutrophil Lymphocyte Ratio (NLR) levels in sarcopenic and non-sarcopenic individuals and to present the correlation between NLR and other inflammatory markers. METHODS: A total of 105 subjects with sarcopenia (male/female: 54/51, mean age 72.8 ±â€¯7.3) and 314 subjects as non-sarcopenic (male/female: 125/189, mean age 71.44 ±â€¯5.4) were enrolled in this cross-sectional study. Sarcopenia was diagnosed according to The European Working Group on Sarcopenia in Older People criteria. Comprehensive geriatric assessment was performed to participants. Complete blood count, biomarkers of inflammation (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)) of all patients were measured. RESULTS: NLR levels were found to be higher in the sarcopenic group (2.52 ±â€¯1.30 vs 2.21 ±â€¯0.93, p < 0.013, respectively). Compared to non-sarcopenic participants white blood cell (WBC), ESR and CRP levels were also higher in sarcopenic group. There was a positive correlation between CRP, WBC, total body fat ratio and NLR (r: 0.433, p < 0.001; r: 0.237, p: 0.022; r: 0.339, p < 0.001, respectively). A strong negative correlation was identified between fat free mass and NLR levels in sarcopenic individuals (r: -0.755, p < 0.001). The result of the logistic regression analysis depicted that NLR is an independent predictor for sarcopenia (OR = 1.31; 95% CI = 1.06-1.62, p: 0.013). CONCLUSION: Increased NLR levels may indicate that inflammation may have a significant role in development of sarcopenia in the elderly population.

Health-related quality of life and fall risk associated with age-related body composition changes; sarcopenia, obesity and sarcopenic obesity.

BACKGROUND: Sarcopenia, obesity, and sarcopenic obesity are various features of the ageing process that can cause important health issues. The present study was undertaken to investigate the interrelationship between those body composition changes, including their clinical components and the quality-of-life variables. METHODS: A total of 423 individuals aged 65 years or older was included in this cross-sectional study. Sarcopenia was diagnosed according to The European Working Group on Sarcopenia in Older People criteria. Body composition parameters were measured with a bioelectrical impedance analyser, and Turkish population-based cut-off points were preferred for diagnosis of sarcopenia. Comprehensive geriatric assessment was performed on all patients. A logistic regression analysis was performed to identify important factors for sarcopenia and sarcopenic obesity. RESULTS: The prevalence of sarcopenic, obese and sarcopenic obese subjects was 14%, 35% and 11% respectively. The lowest mean gait speed and hand grip strength values were seen in the sarcopenic obese group (0.6 ± 0.3 m/s and 19.7 ± 9.8 kg respectively). Sarcopenic obese participants were associated with the highest rate for fall risk. The scores for domains of health-related quality of life were worse in both obesity and sarcopenic obesity when compared to others. Body mass index (BMI), number of drugs used, total body fat ratio and geriatric depression scale-short form scores were negatively correlated with all dimensions of SF-36 quality-of-life scale. CONCLUSIONS: Sarcopenia, obesity and sarcopenic obesity are associated with many negative health outcomes, such as high fall risk and low health-related quality of life in geriatric population.