Prevalence and Associates of Frailty Status in Different Stages of Chronic Kidney Disease: A Cross-Sectional Study.

OBJECTIVES: Frailty is a state of homeostenosis associated with adverse outcomes. Chronic kidney disease (CKD) increases considerably by aging and shares the common risk factors with frailty. We aimed to examine the prevalence and independent associates of frailty status in CKD patients. DESIGN: In this single-centre, cross-sectional study, we used the five-item Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight (FRAIL) scale to evaluate frailty. A binary logistic regression analysis model including the parameters found to have relationship with frailty in univariate analyses was used to detect independent associates of frailty status. Odds ratio (OR) and 95% confidence interval (CI) were given. PARTICIPANTS: Study included 148 patients aged 18-80. Sixty (60) patients were end stage renal disease (ESRD) patients on maintenance hemodialysis (HD) (at least for 3 months) and 88 were stage 3-4 CKD patients. Thirty-seven (37) patients (42%) were eGFR G3a, 31 patients (35.3%) were eGFR G3b and 20 patients (22.7%) were eGFR G4 in stage 3-4 CKD patients. MEASUREMENTS: Demographics, etiology of CKD, comorbidities, regular drugs, dialysis-related and laboratory data were recorded. FRAIL scale was scored as follows; 0=robust, 1-2=prefrail, and ≥3= frail. The frailty status was compared between frail+prefrail group vs robust (non-frail) group. RESULTS: The prevalences of prefrailty and frailty were 68.3% and 3.3% in HD group and 53.4% and zero in stage 3-4 CKD group, respectively (p = 0.025). In the multivariate logistic regression analysis, being in HD group (OR=3.87, 95% CI= 1.06-14.19, p=0.04), older age (OR=1.09, 95% CI= 1.04-1.13) and female sex (OR=9.13, 95%CI= 2.82-29.46) were independent risk factors for frailty (p<0.001, for both). CONCLUSION: Prefrailty and frailty are quite common among HD and CKD stage 3-4 patients. Being an HD patient is an independent risk factor for non-robust (frail or prefrail) status. Our findings point out a remarkably high prevalence of frailty severity (prefrailty/frailty) phenotype among patients with advanced CKD stages.

Serum soluble tumour necrosis factor related apoptosis-inducing ligand level and peripheral eosinophil count in patients with nasal polyposis.

BACKGROUND: Nasal polyposis is one of the most common inflammatory pathologies of the nasal cavity. Eosinophilic inflammation plays an important role in the pathogenesis. This study aimed to investigate soluble tumour necrosis factor related apoptosis-inducing ligand levels and eosinophil count in nasal polyposis patients. METHODS: The study was performed on 24 adult nasal polyposis patients and 24 age-matched healthy individuals. The patients had not received any medical or surgical treatment. Pre-operative computed tomography scans were assessed using the Lund-MacKay grading system, and soluble tumour necrosis factor related apoptosis-inducing ligand levels were measured with a sandwich enzyme-linked immunosorbent assay. RESULTS: Compared with controls, eosinophil levels in nasal polyposis patients were increased (p = 0.024), but there was no significant difference in soluble tumour necrosis factor related apoptosis-inducing ligand levels (p = 0.529). The Lund-MacKay mean grading was 12.43 ± 6.9. There was no correlation between soluble tumour necrosis factor related apoptosis-inducing ligand level and Lund-MacKay grading and eosinophil count. CONCLUSION: There was no relationship between soluble tumour necrosis factor related apoptosis-inducing ligand level and blood eosinophil or clinical markers; however, soluble tumour necrosis factor related apoptosis-inducing ligand level remains of interest for future studies.

Catheter Ablation Of Atrial Fibrillation In The Elderly: Risk Benefit Analysis.

Over the past decade, catheter ablation has emerged as an important therapeutic option and reserved for drug refractory symptomatic paroxysmal and persistent atrial fibrillation (AF). Although elderly population constitutes the significant amount of AF patients, literature data is inadequate regarding the use of catheter ablation for elderly AF patients. Since there has been significant improvement in efficacy and safety of the AF ablation in last decade, it has become widespread accross the whole world. As the life expectancy continues to grow in population and outcomes of catheter ablation for AF further improve, higher number of elderly patients are likely to undergo catheter ablation for AF. Therefore, in this paper we reviewed the published literature to date regarding the clinical efficacy and safety of catheter ablation for AF in elderly patients.

Tuning the Kondo effect in thin Au films by depositing a thin layer of Au on molecular spin-dopants.

We report on the tuning of the Kondo effect in thin Au films containing a monolayer of cobalt(II) terpyridine complexes by altering the ligand structure around the Co(2+) ions by depositing a thin Au capping layer on top of the monolayer on Au by magnetron sputtering (more energetic) and e-beam evaporation (softer). We show that the Kondo effect is slightly enhanced with respect to that of the uncapped film when the cap is deposited by evaporation, and significantly enhanced when magnetron sputtering is used. The Kondo temperature (TK) increases from 3 to 4.2/6.2 K for the evaporated/sputtered caps. X-ray absorption spectroscopy and surface-enhanced Raman spectroscopy investigation showed that the organic ligands remain intact upon Au e-beam evaporation; however, sputtering inflicts significant change in the Co(2+) electronic environment. The location of the monolayer-on the surface or embedded in the film-has a small effect. However, the damage of Co-N bonds induced by sputtering has a drastic effect on the increase of the impurity-electron interaction. This opens up the way for tuning of the magnetic impurity states, e.g. spin quantum number, binding energy with respect to the host Fermi energy, and overlap via the ligand structure around the ions.