Mortality-Related Risk Factors in Geriatric Patients with Hip Fracture.

BACKGROUND: Mortality rates after hip fractures increase by up to 30% with age. This study investigated the contribution of various parameters to prognosis and mortality. METHODS: Our study prospectively examined patients with hip fracture aged 65 years and over who applied to the Atatürk University Medical Faculty Hospital Orthopedics Service in 2020-2021. RESULTS: The 120 patients included in the study had a mean age of 79.71±7.27 years, and 51.7% were female. Twenty patients (16.7%) died within the first 30 days after a hip fracture. They had a significantly lower median Lawton-Brody instrumental activities of daily living (IADL) scale score (p=0.045) and a higher rate of malnutrition according to the Mini Nutritional Assessment (MNA) score (p=0.016). Additionally, these patients with 30-day mortality had a significantly lower rate of surgical treatment (p=0.027) and a longer time from injury to surgery (p=0.014). The time to surgery was a significant independent risk factor for 30-day mortality, with each 1-hour delay increasing the odds of mortality by 1.066 (odds ratio [OR]=1.066; 95% confidence interval [CI], 1.001-1.013; p=0.013). In addition, the presence of malnutrition was another independent risk factor that increased the odds of mortality by 4.166 times (OR=4.166; 95% CI, 1.285-13.427; p=0.017). CONCLUSION: We recommend placing more importance on supportive treatment in patients presenting with hip fractures, especially in those with malnutrition; performing surgical intervention as early as possible; and more closely following up with patients with the aforementioned risk factors.

Relationship between Sarcopenia and Mortality in Elderly Inpatients.

OBJECTIVE: Sarcopenia, a geriatric syndrome, is an indicator of poor prognosis in elderly inpatients. In this study, we aimed to determine the effect of sarcopenia on mortality in elderly patients. MATERIALS AND METHODS: Mobile/immobile geriatric inpatients, treated in the internal medicine ward between February and November 2018, were included in the study between Days 2 and 7 of hospitalization. The patients' fat-free mass (FFM) was measured by bioimpedance. The FFM index (FFMI) (kg/m2) was determined by dividing fat-free mass by body surface area (FFM/BSA). Sarcopenia was defined as a FFMI value at least two standard deviations below the gender-specific mean of normal young adults. RESULTS: The study included 200 geriatric inpatients; 96 (48.0%) were men, and the mean age was 74.49±6.32 years. Sarcopenia was detected in 28 (14%) of the patients. Diabetes mellitus was associated with a significantly lower sarcopenia prevalence (p=0.006). The risk of sarcopenia was 9.046 times higher in malnourished patients. The sarcopenia group had more deaths (p=0.012). CONCLUSION: Sarcopenia in geriatric inpatients increased the length of hospital stay and mortality. Our findings may guide future studies examining the relationship between sarcopenia and mortality among elderly inpatients in other hospitals.

The value of C-reactive protein in infection diagnosis and prognosis in elderly patients.

BACKGROUND: The aim of this study was to determine the value of C-reactive protein level in the diagnosis and prognosis of infection in elderly patients. STUDY POPULATION: This prospective study included inpatients in the palliative care unit during the 1-year period between January 2016 and January 2017. Patients' demographic data, Acute Physiology and Chronic Health Evaluation score, and Charlson Comorbidity Index were recorded. RESULTS: A total of 233 patients were included in the study. A total of 199 instances of infection were diagnosed in 175 of those patients; 75.3% of the infections were detected at admission and 24.7% during hospitalization. At a cut-off value of 4.82, CRP value had 81.0% specificity and 75.4% sensitivity in the diagnosis of infection. Among the patients with infection, there was no difference between those who died and those who survived in terms of baseline CRP level, but a significant difference emerged in CRP level at 48 and 96 h. Factors which were found to significantly reduce survival time were the presence of chronic kidney disease, chronic obstructive pulmonary disease, hypoxia and tachycardia at admission, APACHE-II score over 20.5, initial albumin level below 2.44 g/dL, and serum CRP clearance rates of less than 11% at 48 h and 20% at 96 h. CONCLUSION: In elderly patients with infection, the initial CRP value alone does not have prognostic value, but changes observed in serial CRP measurement are a valid indicator of prognosis.

Autopsies in the elderly: Erzurum study.

INTRODUCTION: Clinical and forensic autopsies are the best methods for determining cause of death. The aim of this study was to determine demographic and etiologic characteristics in geriatric forensic cases analyzed in Erzurum, Turkey. MATERIALS AND METHODS: Autopsy reports and prosecution documents of decedents aged 65 and older autopsied in the Morgue Specialization Department of the Forensic Medicine Institute, Erzurum Division between January 1, 2010 and December 31, 2015 were screened retrospectively. RESULTS: The study included 399 subjects with a mean age of 74.38 ± 7.28 years. A large proportion of the subjects were in the young and middle old age group (n = 218, 54.63%) and male (n = 286, 71.68%). Autopsy was performed on 198 (49.62%) of the subjects, cause of death was determined by post-mortem external examination in 199 (49.87%), and documents were unavailable for 2 subjects. Cause of death was determined as natural in 130 (32.58%) of the decedents and unnatural in 269 (67.42%). The most common natural cause of death was cardiovascular disease (n = 94, 76.4%). Unnatural causes of death included accident in 223 (82.90%), suicide in 25 (9.30%) and homicide in 21 (7.80%) of the decedents. A large proportion of the accidents were traffic accidents (n = 120, 53.80%). The most common method of committing suicide was hanging (n = 15, 60%), whereas homicides were most often committed by blunt force trauma (n = 9, 42.86%). CONCLUSION: Our data are consistent with the literature, allowing for some variation based on regional sociocultural characteristics.

High C-Reactive Protein and Low Albumin Levels Predict High 30-Day Mortality in Patients Undergoing Percutaneous Endoscopic Gastrotomy.

BACKGROUND: Percutaneous endoscopic gastrotomy (PEG) enables long-term enteral feeding. The aim of this study was to identify biomarkers that may guide the decision of whether to perform the elective procedure of PEG. METHODS: The medical records of all patients who underwent PEG in our hospital from 2010 to 2016 were screened retrospectively. Patients with mortality within a 30-day follow-up period and those without were compared using the Chi-square test, and continuous variables were compared with the Kruskal-Wallis and Mann-Whitney U tests. Receiver operating characteristic (ROC) curve analysis was used to demonstrate the ability of biomarkers to predict mortality; a cut-off point was determined and its sensitivity, specificity, and positive and negative predictive values were calculated. The Youden index was used to determine the cut-off point. Kaplan-Meier analysis was used to identify PEG-related mortality risk factors and a Cox regression model was applied for risk characterization. RESULTS: A total of 120 patients who underwent PEG were evaluated in the study. The mean age was 67.00 ± 18.00 years. The most common indication for PEG was cerebrovascular disease, in 69 (57.5%) of the patients. Infection of the PEG site was most common within 14 days after PEG tube placement, occurring in 13 patients (10.3%). The mortality rate among patients with post-PEG infection was 68.2%, significantly higher than in patients without infection (P = 0.012). Thirty-four patients (28.3%) died within 30 days of undergoing PEG. CRP values ≥ 78.31 mg/L increased mortality by 8.756-fold, and albumin levels < 2.71 g/dL increased mortality by 2.255-fold. CONCLUSION: Our results indicate that the presence of both high CRP level and low albumin level were associated with significantly higher rate of mortality (73.1%) in patients who underwent PEG.

Dietary and demographical risk factors for oesophageal squamous cell carcinoma in the Eastern Anatolian region of Turkey where upper gastrointestinal cancers are endemic.

BACKGROUND: Oesophageal squamous cell carcinoma (ESCC) is endemic in the Eastern Anatolian region of Turkey. The present study was performed to identify risk factors for ESCC that specifically reflect the demography and nutritional habits of individuals living in this region. MATERIALS AND METHODS: The following parameters were compared in 208 ESCC patients and 200 control individuals in the Eastern Anatolian region: age, sex, place of living, socioeconomic level, education level, smoking, alcohol intake, nutritional habits, and food preservation methods. RESULTS: The mean age of ESCC patients was 56.2 years, and 87 (41.8%) were 65 years-old or older. The ratio of women to men in the patient group was 1.39/1. ESCC patients consumed significantly less fruit and yellow or green vegetables and more hot black tea, 'boiled yellow butter', and mouldy cheese than did control individuals. Residence in rural areas, smoking, and cooking food by burning animal manure were also significantly associated with ESCC. CONCLUSIONS: The consumption of boiled yellow butter and mouldy cheese, which are specific to the Eastern Anatolian region, and the use of animal manure for food preparation were identified as risk factors in this region. Further studies are required to potentially identify the carcinogenic substances that promote the development of ESCC in this region.

The relationship between arteriovenous fistula success and inflammation.

BACKGROUND: Arteriovenous fistula (AVF) is the most important vascular access method for hemodialysis (HD). In this study, the relationship between AVF success and inflammation in patients who had HD due to end-stage renal failure (ESRF) was investigated. MATERIAL AND METHOD: In the study, a total of 658 patients, who started HD for ESRF, were evaluated retrospectively. A total of 386 patients were included in this study. The demographic data and C-reactive protein, albumin and fibrinogen levels were investigated in patients with recognized success AVF. RESULTS: In total 311 patients with successful AVF and 75 unsuccessful AVFs were found. In unsuccessful AVF group the average low albumin level, high C-reactive protein and fibrinogen levels were found to be statistically meaningful when compared with successful AVF group (p < 0.001, p < 0.001, p < 0.001). CONCLUSION: As a result, we think that the evaluation of inflammation before creating AVF in HD patients is very important for increasing the success of AVF.

Echinococcus alveolaris: presenting as a cerebral metastasis.

Echinococcus multilocularis (EM) is caused by the larval stage of the tapeworm. The main endemic regions for human alveolar echinococcosis are Central Europe, Russia, Turkey, Japan, China, Eastern France, North America. EM is an endemic disease in Turkey and especially common in the eastern Anatolia Region as seen in our case. The liver is the primary focus of the disease, cerebral localization is rare. Cerebral hydatid disease is approximately 5% of alveolar hydatid cases and generally considered to be fatal. Surgical treatment should be considered whenever possible. We present a case of cerebral alveolar hydatid disease that was thought to be cerebral metastasis.

Comet assay and analysis of micronucleus formation in patients with rheumatoid arthritis.

Oxidants play a significant role in causing oxidative stress, which underlies the pathogenesis of rheumatoid arthritis (RA). Genetic factors that predispose individuals to RA are considered to play an important role in the development of the disease. The aim of this study was to determine, by use of the comet assay and the micronucleus (MN) test, whether DNA damage has an effect on the pathogenesis of RA. Furthermore, our aim was to show if there is an association between oxidative stress and DNA damage in RA. This study was conducted between January and June 2010 in the Erzurum Training and Research Hospital. We analyzed lymphocytes from patients with RA (12 in active and 31 in inactive periods) and 30 healthy controls for effects in the comet assay and the MN test. In addition, the levels of malondialdehyde (MDA) and superoxide dismutase (SOD), the activity of glutathione peroxidase (GSH-Px), the erythrocyte sedimentation rate (ESR) and the high-sensitivity C-reactive protein (hs-CRP) rate were determined in all the subjects. The comet-tail length, the MN frequencies and the MDA levels were significantly higher in patients--both in the active and the inactive period--than in the controls. In contrast, the SOD and GSH-Px levels were significantly lower in both patient groups than in the controls. Our results suggest that an increased plasma MDA level and decreased plasma GSH-Px and SOD levels reflect the higher degree of oxidative stress in RA patients, a situation that may impair genetic stability in those patients. Thus, the results suggest that increased DNA damage may play an important role in the pathogenesis of RA.

Genomic instability in patients with Barrett's esophagus.

Our study aimed to determine, by counting sister chromatid exchange (SCE) and micronucleus (MN) frequencies, whether genetic impairment and DNA damage have an effect on the pathogenesis of Barrett's esophagus (BE). This study was conducted between June 2007 and November 2008 in the Erzurum Training and Research Hospital. We analyzed SCE and MN frequencies in 30 patients with BE, and in 30 control cases. SCE was significantly increased in BE patients compared with controls (6.89 +/- 1.04 vs. 5.01+/- 0.88, P < 0.001). Similarly, MN was significantly increased in BE patients compared with controls (3.48 +/- 1.08 vs. 1.83 +/- 0.64, P < 0.001). Our data indicate that the increased SCE and MN rates in lymphocytes of patients with BE may reflect genomic instability or deficiency of DNA repair capacity.

Risk factors leading to reduced bone mineral density in hemodialysis patients with metabolic syndrome.

Although metabolic syndrome (MS) is associated with low bone mineral density (BMD) in the general population, it is unknown whether similar associations exist in patients with chronic kidney disease. We investigated risk factors that can lead to low BMD values in hemodialysis patients with MS according to the diagnostic criteria set by International Diabetes Federation (IDF) in this study. A total of 64 patients with MS undergoing hemodialysis and 60 hemodialysis patients who were matched in terms of age, gender, and hemodialysis duration without MS were enrolled in the study. BMD was measured at lumbar vertebra (LV) and femur neck (FN) by performing dual-energy X-ray absorptiometry (DEXA). LV and/or FN-BMD results revealed that, of the hemodialysis patients with MS, 45% had osteoporosis and 48% had osteopenia. On the other hand, of the hemodialysis patients without MS, 42% had osteoporosis and 52% had osteopenia. Low BMD values were observed to be correlated negatively with age, hemodialysis period, and parathormone (PTH) both in the group with MS and in the group without MS. Height, weight, BMI, calcium, phosphorus, alkaline phosphatase, heparin, and vitamin D therapy and urea reduction ratio were not established to be correlated with BMD.

Relationship between insulin resistance and inflamation markers in hemodialysis patients.

OBJECTIVE: The prevalence and risk factors of cardiovascular disease (CVD) are increasing in end stage renal disease (ESRD) patients. In this study, we sought to research the relationship between the insulin resistance, which is one of the risk factors for CVD, and the inflammation markers, especially C-reactive protein, fibrinogen, uric acid, and homocysteine levels in our patients who were recently diagnosed with ESRD and started hemodialysis. MATERIALS AND METHODS: 64 HOMA-IR-positive and 114 HOMA-IR-negative patients were enrolled in this study. Blood samples were obtained from the patients for fasting plasma glucose, insulin, CRP, fibrinogen, uric acid, total homocysteine, urea, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceride, total protein, and albumin analysis after physical examinations and anamnesis were completed. RESULTS: Fibrinogen and CRP levels of HOMA-IR-positive HD patients were significantly increased compared to non-insulin resistants. Furthermore, there is significant positive relationship between insulin resistance and serum CRP and fibrinogen levels in these HOMA-IR-positive HD patients (r = 0.258, p < 0.001). CONCLUSION: We found out that the fibrinogen and CRP levels are significantly high in HOMA-IR positive HD patients, according to determine the risk ratio for coronary artery disease in HD patients, and think that an assessment of insulin resistance is necessary.

Dietary Habits, demographical, and socio-economical risk factors of the newly diagnosed gastric cancers in the Eastern Anatolia Region of Turkey: an endemic upper gastrointestinal cancer region.

The Eastern Anatolia Region of Turkey is an endemic upper gastrointestinal (esophageal and gastric) cancer region, and the incidence of these cancers are still increasing in the region. We investigated demographic features, dietary habits, and some possible etiologic factors for this high prevalence. Special attention was given to the relationship between consumption of boiled yellow butter and the occurrence of gastric cancer. Age, sex, residential area, socio-economical status, educational status, vegetable and fruit consumption, alcohol and tobacco use, tea consumption, boiled butter usage, cooking and storage methods of the patients with gastric cancer and controls were investigated in East Anatolian Regional Erzurum State Hospital. Helicobacter pylori infection for gastric cancer risk was not studied. Fruit, yellow-green vegetables, boiled butter, and breads baked by animal manure consumptions and no refrigeration are found to be statistically significant etiologic factors for gastric carcinogenesis. Dietary habits might be risk factors for gastric carcinogenesis among East Anatolian population. Some regional differences in food processing and preparation also seem to play a role in gastric carcinogenesis.

Micronucleus analysis in patients with colorectal adenocarcinoma and colorectal polyps.

AIM: To determine, by counting micronucleus (MN) frequencies, whether chromosomal or DNA damage have an effect on the pathogenesis of early colorectal adenocarcinoma (CRC). METHODS: We analyzed MN frequencies in 21 patients with CRC, 24 patients with colon polyps [10 neoplastic polyps (NP) and 14 non-neoplastic polyps (NNP)] and 20 normal controls. RESULTS: MN frequency was significantly increased in CRC patients and in NP patients compared with controls (3.72 +/- 1.34, 3.58 +/- 1.21 vs 1.97 +/- 0.81, P < 0.001). However, there was no difference in the MN frequency between CRC patients and NP patients (P > 0.05). Similarly, there was no difference in the MN frequency between NNP patients (2.06 +/- 0.85) and controls (P > 0.05). CONCLUSION: Our results suggest increased chromosome/DNA instabilities may be associated with the pathogenesis of early CRC.

Intraperitoneal dedifferentiated liposarcoma: a case report.

Dedifferentiated liposarcoma is a variant of liposarcoma with a more aggressive course. Mutations of the p53 gene have been found in different types of soft tissue sarcoma. It is generally accepted that p53 mutations in human malignant tumors are often related to a poor prognosis. In our case, analysis of p53 gene mutation in tumor samples was performed. p53 gene mutation was observed in dedifferentiated tumor tissue samples but not in well-differentiated tumor tissue samples. It has been reported that p53 gene mutation occurs most commonly in the retroperitoneum and rarely in other anatomic locations. Herein we report a case of dedifferentiated liposarcoma located at intraperitoneum.

Alteration of sister chromatid exchange frequencies in gastric cancer and chronic atrophic gastritis patients with and without H. pylori infection.

AIM: To determine, by counting sister chromatid exchange (SCE) frequencies, whether genetic impairment and DNA damage have an effect on the pathogenesis of gastric cancer (GC). METHODS: Analysis of SCE is a cytogenetic technique used to show DNA damage as a result of an exchange of DNA fragments between sister chromatids. We analyzed SCE frequency in 24 patients with GC, 26 patients with chronic atrophic gastritis (CAG), and 15 normal controls. The presence of H. pylori was confirmed by urease test, toluidine-blue stain and hematoxylin-eosin stain. RESULTS: SCE was significantly increased in H. pylori-negative GC patients, and in H. pylori-negative CAG patients compared with controls (7.41 +/- 1.36 and 6.92 +/- 1.20, respectively, vs 5.54 +/- 0.8, P < 0.001). There was no difference in the SCE frequency between H. pylori-negative GC patients and H. pylori-negative CAG patients (P > 0.05). On other hand, the SCE frequencies in H. pylori-positive GC patients were higher than those in H. pylori-positive CAG patients (9.20 +/- 0.94 vs 7.93 +/- 0.81, P < 0.01). Furthermore, H. pylori-positive GC patients had a higher SCE frequency than H. pylori-negative GC patients (9.20 +/- 0.94 vs 7.41 +/- 1.36, P < 0.001). Similarly, a significant difference was detected between H. pylori-positive CAG patients and H. pylori-negative CAG patients (7.93 +/- 0.81 vs 6.92 +/- 1.20, P < 0.05). CONCLUSION: We suggest the increased SCE in patients reflects a genomic instability that may be operative in gastric carcinogenesis.