Which parameters affect long-term mortality in older adults: is comprehensive geriatric assessment a predictor of mortality?

BACKGROUND: Determining predictors of mortality among older adults might help identify high-risk patients and enable timely intervention. AIMS: The aim of the study was to identify which variables predict geriatric outpatient mortality, using routine geriatric assessment tools. METHODS: We analyzed the data of 1141 patients who were admitted to the geriatric medicine outpatient clinic between 2001 and 2004. Comprehensive geriatric assessment was performed by an interdisciplinary geriatric team. Mortality rate was determined in 2015. The parameters predicting survival were examined. RESULTS: Median age of the patients (415 male, 726 female) was 71.7 years (53-95 years). Mean survival time was 12.2 years (95 % CI; 12-12.4 years). In multivariate analysis, age (OR: 1.16, 95 % CI: 1.09-1.23, p < 0.001), smoking (OR: 2.51, 95 % CI: 1.18-5.35, p = 0.017) and metabolic syndrome (OR: 2.20, 95 % CI: 1.05-4.64, p = 0.038) were found to be independent risk factors for mortality. MNA-SF scores (OR: 0.84, 95 % CI: 0.71-1.00, p = 0.050) and free T3 levels (OR: 0.70, 95 % CI: 0.49-1.00, p = 0.052) had borderline significance. DISCUSSION: The present study showed that the risk conferred by metabolic syndrome is beyond its individual components. Our findings confirm previous studies on the prognostic role of nutritional status, as reflected by MNA-SF. Serum fT3, a simple laboratory test, may also be used in geriatric outpatient clinics to identify individuals at risk. CONCLUSIONS: The results of the study demonstrated the need for addressing modifiable risk factors such as smoking, metabolic syndrome, and undernutrition in older adults.

Potentially inappropriate prescribing according to the STOPP/START criteria for older adults.

BACKGROUND: The aim of this study was to demonstrate the prevalence and possible predictors of potentially inappropriate medications (PIMs) and potentially prescription omissions (PPOs) according to the Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria in geriatric patients. METHODS: A total of 374 patients (140 male, 234 female) aged ≥65 years were included. Comprehensive demographic and clinical data including age, gender, current diagnoses/medications, comorbid diseases and medical problems were noted. RESULTS: There were 154 (41.2 %) patients with at least one PIM. Most common PIMs were proton pump inhibitors for peptic ulcer disease (9.6 %), calcium-channel blockers (6.4 %) and anticholinergic/antispasmodic drugs (5.9 %) in chronic constipation. There were 274 (73.3 %) patients with at least one PPO. Most common PPOs were calcium-vitamin D supplement in osteoporosis (OP) (39.6 %), statin (22.5 %) and antiplatelet therapies (16.0 %) in diabetes mellitus (DM) with cardiovascular risk factors. PIM was independently associated with female gender (OR = 2.21, p = 0.003), number of medications (OR = 1.35, p < 0.001), Katz scores of daily life activities (OR = 0.87, p = 0.013) and OP (OR = 0.29, p < 0.001). PPO was independently associated with age (OR = 1.06, p = 0.009), Geriatric Depression Scale score (OR = 1.20, p = 0.007), DM (OR = 6.50, p < 0.001), chronic obstructive pulmonary disease (COPD) (OR = 5.29, p = 0.010), number of medications (OR = 0.88, p = 0.019), and incontinence (OR = 0.39, p = 0.043). CONCLUSION: High prevalence of PIMs and PPOs were found in geriatric patients. Number of medications, female gender, and dependency were associated with PIM. Age, higher scores of Geriatric Depression Scale, DM, and COPD were related with PPOs.

Phase angle assessment by bioelectrical impedance analysis and its predictive value for malnutrition risk in hospitalized geriatric patients.

BACKGROUND: Phase angle (PhA) value determined by bioelectrical impedance analysis (BIA) is an indicator of cell membrane damage and body cell mass. Recent studies have shown that low PhA value is associated with increased nutritional risk in various group of patients. However, there have been only a few studies performed globally assessing the relationship between nutritional risk and PhA in hospitalized geriatric patients. The aim of the study is to evaluate the predictive value of the PhA for malnutrition risk in hospitalized geriatric patients. METHODS: One hundred and twenty-two hospitalized geriatric patients were included in this cross-sectional study. Comprehensive geriatric assessment tests and BIA measurements were performed within the first 48 h after admission. Nutritional risk state of the patients was determined with NRS-2002. Phase angle values of the patients with malnutrition risk were compared with the patients that did not have the same risk. The independent variables for predicting malnutrition risk were determined. SPSS version 15 was utilized for the statistical analyzes. RESULTS: The patients with malnutrition risk had significantly lower phase angle values than the patients without malnutrition risk (p = 0.003). ROC curve analysis suggested that the optimum PhA cut-off point for malnutrition risk was 4.7° with 79.6 % sensitivity, 64.6 % specificity, 73.9 % positive predictive value, and 73.9 % negative predictive value. BMI, prealbumin, PhA, and Mini Mental State Examination Test scores were the independent variables for predicting malnutrition risk. CONCLUSIONS: PhA can be a useful, independent indicator for predicting malnutrition risk in hospitalized geriatric patients.

Sarcopenia in critically ill patients.

Sarcopenia occurring as a primary consequence of aging and secondary due to certain medical problems including chronic disease, malnutrition and inactivity is a progressive generalized loss of skeletal muscle mass, strength and function. The prevalence of sarcopenia increases with aging (approximately 5-13 % in the sixth and seventh decades). However, data showing the prevalence and clinical outcomes of sarcopenia in intensive care units (ICUs) are limited. A similar condition to sarcopenia in the ICU, called ICU-acquired weakness (ICU-AW), has been reported more frequently. Here, we aim to examine the importance of sarcopenia, especially ICU-AW, in ICU patients via related articles in Medline.

Malnutrition in Community-Dwelling Elderly in Turkey: A Multicenter, Cross-Sectional Study.

BACKGROUND: This study aimed to investigate the prevalence of malnutrition and explore the somatic, psychological, functional, and social or lifestyle characteristics linked to malnutrition in elderly people at a hospital in Turkey. MATERIAL AND METHODS: This study included 1030 patients older than 65 years of age who were seen at the internal medicine and geriatrics outpatient clinics of the study centers in Istanbul, Ankara, Duzce, Corum, Mardin, Malatya, and Diyarbakir provinces between January and December 2014. All patients underwent Mini Nutritional Assessment (MNA) and Geriatric Depression Scale (GDS) tests via one-on-one interview method. The demographic properties of the patients were also recorded during this interview. RESULTS: Among 1030 patients included in this study, 196 (19%) had malnutrition and 300 (29.1%) had malnutrition risk. The malnutrition group and the other groups were significantly different with respect to mean GDS score, income status, educational status, the number of children, functional status (ADL, IADL), the number of patients with depression, and the number of comorbid disorders. According to the results of the logistic regression analysis, age (OR=95% CI: 1.007-1.056; p=0.012), BMI (OR=95% CI: 0.702-0.796; p<0.001), educational status (OR=95% CI: 0.359-0.897; p=0.015), comorbidity (OR=95% CI: 2.296-5.448; p<0.001), and depression score (OR=95% CI: 1.104-3.051; p=0.02) were independently associated with malnutrition. CONCLUSIONS: Our study demonstrates that age, depression, BMI, comorbidity, and the educational status were independently associated with malnutrition in an elderly population.

Association of depression and sleep quality with complications of type 2 diabetes in geriatric patients.

BACKGROUND: Diabetes mellitus (DM) is highly prevalent and increasing in geriatric population. Depression and sleep disorders occur at a higher rate in patients with diabetes compared with controls. AIM: The purpose of this study was to demonstrate whether diabetic complications influence the sleep quality and depression in elderly patients. METHODS: 154 geriatric diabetic patients (male/female: 69/85) were enrolled in this study. Patients were investigated for microvascular and macrovascular complications. The Pittsburgh Sleep Quality Index (PSQI) and Geriatric Depression Scale (GDS) were performed for assessment of sleep quality and depression, respectively. Linear regression analysis was performed to identify significant independent related factors for GDS and PSQI scores. RESULTS: Microvascular and macrovascular complications were found in 47.4 % and 29.2 of study population. PSQI and GDS scores of patients with microvascular complications were significantly higher than those of patients without microvascular complications (8.23 ± 3.83 vs 5.76 ± 3.04, p 0.001; 11.07 ± 6.07 vs 6.94 ± 5.35, p 0.001), respectively. There was no difference in GDS scores between the patients with and without macrovascular complications. There was a positive correlation between DM duration and PSQI, GDS scores. Neuropathy was an independent variable for poor sleep quality (OR 1.362, 95 % CI 0.032-2.692, p 0.045) and depression (OR 2.909, 95 % CI 0.610-5.209, p 0.014). CONCLUSION: Depression status and sleep quality are strongly influenced by diabetic complications and DM duration in elderly patients.

Influence of antimuscarinic therapy on cognitive functions and quality of life in geriatric patients treated for overactive bladder.

OBJECTIVES: Incidences of overactive bladder (OAB) and cognitive dysfunction increase with aging. Treatment of OAB with antimuscarinic agents may result in cognitive decline, especially in patients with Alzheimer's disease (AD). The aim of this study is to evaluate the effect of antimuscarinic treatment on cognitive functions, depression, and quality of life (QOL) of patients with OAB. METHODS: This non-interventional prospective observational study was conducted in a geriatric medicine outpatient clinic. Overall, 168 OAB patients were enrolled. Patients were followed up in five groups: oxybutynin, darifenacin, tolterodine, trospium, and control groups. Follow-up visits were done at second, third, and sixth months. Comprehensive geriatric assessment, cognitive and mood assessment, QOL scales (IIQ-7, UDI-6) were performed. RESULTS: Mean age of the patients was 73.5 ± 6.1. Of the 168 patients, 92.3% were female, 83.3% benefited from the treatment, and 37.1% discontinued the medication. Discontinuation rate and frequency of side effects were more frequent in the oxybutynin group. Mini Mental State Examination scores did not decline after treatment, even in AD patients. Geriatric Depression Scale scores, Activities of Daily Living scores, and QOL scores significantly improved after treatment. CONCLUSION: Antimuscarinic agents are effective in OAB treatment. They have a positive impact on daily life activities, depression, and QOL indices. Furthermore, they do not have a negative effect on cognitive function in older adults with or without AD.

Differences in evaluation between geriatric and adult patients requiring pulmonary consultation.

OBJECTIVE: The main aim of the study was to investigate the effects of age in pulmonary consultation and to evaluate differences between geriatric and adult patients. MATERIAL AND METHODS: Consultation referrals to the clinic of chest diseases for patients from emergency, inpatient and outpatient clinics of a tertiary care general hospital between December 2010 and April 2011 were examined retrospectively. The patients were divided into two groups, namely those aged 65 years and over (geriatric patients) and those under the age of 65 years (adults). RESULTS: Out of 272 patients 135 (49.6%) were geriatric patients and 137 (50.4%) were adult patients. The mean age of the geriatric patients and adults was 75.6±7.1 years and 49.7±11.8 years, respectively. While the geriatric patients showed a significantly higher presence of pathologies in chest radiography, respiratory complaints and concomitant diseases compared to the adult group, the respiratory function test results were lower. The complaint of shortness of breath was higher in the geriatric group compared to the adult group (71% in geriatric patients and 59.1% in adults). The most common diagnosis was chronic obstructive pulmonary disease (COPD, 37%) in the geriatric patients and asthma (27.7%) in the adult patients. As to the results of consultations, treatment-oriented recommendations were given for 63 (46.6%) geriatric patients and approval for operation was given for 75 (54.7%) adult patients. CONCLUSION: Consultants should take the age of patients into consideration during evaluation in order to achieve the most appropriate treatment plan for these patients and reduce the potential postoperative complications to a minimum.

Serum nitric oxide levels in patients with benign and malignant biliary disease: a prospective single center study.

BACKGROUND: Despite advances in new diagnostic modalities, the differentiation of malignant from benign causes of biliary obstruction still remains difficult. The nitric oxide (NO) system is considered to be an important component in mediating cytokine activation of macrophages in inflammation. It also modulates tumorigenesis and regulates cell proliferation, angiogenesis, survival, and DNA repair. Although NO and its role in pancreatobiliary disorders has not been studied previously, the present study is designed to evaluate NO synthesis and metabolism in patients with biliary obstruction and to determine its usefulness in differentiating between benign and malignant causes of biliary obstruction. MATERIALS AND METHODS: Seventy-nine consecutive patients (60 malignant and 19 benign) with a history of biliary obstruction either with a benign or a malignant cause and 23 age-matched and sex-matched controls were included in this prospective study. NO metabolites, and conventional inflammation and tumor markers were determined. RESULTS: In patients with malignant biliary obstruction (MBO), serum NO metabolites were found to be significantly elevated (P<0.001). The receiver operating characteristic analysis showed that an NO level of 1.095 was the best cut-off value for predicting a malignant biliary stricture with a sensitivity of 78.3% and a specificity of 84.2% (area under the curve=0.821). Correlation analysis suggested that carbohydrate antigen 19-9 and carcinoembryonic antigen levels were correlated with NO levels for differentiating benign from malignant cause of biliary obstruction. CONCLUSIONS: Serum NO-associated tissue injury might be associated with the development of pancreatobiliary neoplasia by creating a local environment that is enriched with reactive oxygen species, cytokines, and other growth factors that may promote endothelial cell apoptosis. Moreover, serum NO levels may be used as an adjunctive marker to identify malignant causes of the obstructive jaundice.

Inoperable isolated cardiac hydatid cyst controlled with albendazole in an older adult with dementia.

Hydatid cyst, a human parasitic disease, remains a clinical problem in undeveloped and developing countries. Although liver and lungs are regular sites of infection, rarely other organs such as the heart can be involved. Herein, we report an isolated cardiac hydatid cyst in an 87-year-old man. He had a history of dementia for 5 years and no history for cardiac or pulmonary disease. He presented with exertional dyspnoea which continued up to 6 months. The diagnosis was made by echocardiography and computed tomography (CT). The patient was inoperable and was treated with albendazole 10 mg/kg for 6 months. After a 6-month follow-up, echocardiography revealed reduction in the size of the cyst. We believe this is the first documented case of cardiac hydatid cyst which regressed with only medical treatment in an older adult with dementia.

Mean platelet volume is a useful indicator of systemic inflammation in cirrhotic patients with ascitic fluid infection.

AIM: Ascitic fluid infection (AFI) consists primarily of two variants, namely, culture-negative neutrocytic ascites and spontaneous bacterial peritonitis (SBP). Mean platelet volume (MPV) has begun to be used as a simple and inexpensive indicator of inflammation in some diseases. We aimed to analyse whether platelet size alterations would be useful in predicting AFI in cirrhotic patients. MATERIAL AND METHODS: A total of 135 patients with ascites due to cirrhosis and 55 control subjects were enrolled in this study. According to ascitic fluid analysis, 58 patients were considered to have AFI. MPV and inflammatory parameter values were determined for all study participants. The ability of MPV values to predict AFI in cirrhotic patients was analysed using receiver operator characteristic (ROC) curve analysis. RESULTS: A statistically significant increase in MPV levels was observed in cirrhotic patients with AFI compared to cirrhotic patients without AFI and healthy controls (p < 0.001). A statistically significant increase was observed in the AFI group with respect to MPV, C-reactive protein (CRP) and white blood cell (WBC) levels. ROC curve analysis suggested that the optimum MPV level cut-off point for cirrhotic patients with AFI was 8.45, with a sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 70.7%, 67.5%, 75.4% and 62.1%, respectively (area under curve: 0.768). CONCLUSION: Our study shows that MPV is increased in cirrhotic patients with AFI. MPV measurement can considered to be an accurate diagnostic test in predicting AFI, possibly due to an ongoing systemic inflammatory response.

Alzheimer's disease is associated with a low prevalence of hypertension.

BACKGROUND/AIM: Dementia is one of the most common health problems in the world. Alzheimer's disease (AD) is the most common form of dementia. The relation between blood pressure (BP) and dementia has been the subject of numerous epidemiological studies, and midlife hypertension (HT) is a risk factor for AD. The association between BP and risk of dementia is lower in the older population. The aim of this study was to examine the association between the prevalence of HT and AD in elderly individuals. METHODS: In this cross-sectional study, 193 patients with AD and 1,860 patients with normal cognitive function were evaluated. RESULTS: The prevalence of HT was lower in the AD group (60.6 vs. 70.5%; p = 0.005). In multivariate analysis, AD was found to be negatively correlated with HT (OR = 0.649; 95% CI 0.461-0.916). CONCLUSION: The prevalence of HT was lower in patients with AD compared to subjects without AD. Physicians who deal with AD patients must keep in mind that the need for antihypertensive medication may decline during the dementia process.

The evaluation of neutrophil-lymphocyte ratio in Alzheimer's disease.

BACKGROUND/AIM: There is growing consensus in the literature that inflammation plays a significant role in the pathophysiology of Alzheimer's disease (AD). The blood neutrophil-lymphocyte ratio (NLR) is a new, inexpensive and easily applicable marker of inflammation. The aim of this study was to investigate the association between NLR, as an inflammatory biomarker, and AD. METHODS: 241 AD patients and 175 patients with normal cognitive function were evaluated in this study. RESULTS: The mean ± SD NLR of AD patients was significantly higher than that of patients with normal cognitive function (3.21 ± 1.35 vs. 2.07 ± 0.74, p < 0.001, respectively). Receiver operating characteristic curve analysis suggested that the optimum NLR cutoff point for AD was 2.48 with 69.29% sensitivity, 79.43% specificity, 82.30% positive predictive values and 65.30% negative predictive values. Logistic regression analysis showed that elevated NLR (OR: 4.774, 95% CI: 2.821-8.076, p < 0.001) was an independent variable for predicting AD. CONCLUSION: Elderly people with AD have higher NLR than healthy controls. Elevated NLR levels are usually considered as an inflammatory marker. The results of this study suggested that inflammation plays a role in the pathogenesis of AD.

Endoscopic and pathological aspects of gastric polyps: a Turkish referral center study.

BACKGROUND/AIMS: The aim of the present study was to retrospectively analyze all the polyps of patients undergoing endoscopic polypectomy or forceps biopsy according to their types, frequency, localization, number and gender distribution. METHODOLOGY: Data from patients who underwent upper endoscopy in the Türkiye Yüksek Ihtisas Postgraduate Research Hospital between March 2007 and November 2009 were analyzed retrospectively. Forceps biopsy or polypectomy were performed for all polypoid lesions that were identified during the endoscopy. RESULTS: In the study period, 14,935 patients underwent 18,522 upper endoscopies. After excluding cirrhotic patients, and patients with a history of prior gastrectomy, chronic gastritis and edema or congestion, the remaining 124 (0.83%) patients with gastric polyps were included in the study. Histopathologically, the most frequently diagnosed polyps were hyperplastic polyps (55.6%). Fundic gland polyps (9.7%), foveolar hyperplasia (8.1%) and inflammatory polyps (7.3%) were also frequent. Adenocarcinoma was more frequently seen in males, whereas hyperplastic polyps and carcinoid tumors were found more often in females, and this difference was statistically significant (p<0.009). CONCLUSIONS: Results of the present study indicate that hyperplastic polyps make up the largest group. Although there is widespread PPI use, no increases in the frequency of fundic gland polyps were observed. However, increases in the ratio of carcinoid tumors suggest a suspicion of tumor development with PPI use.

Can red cell distribution width help to discriminate benign from malignant biliary obstruction? A retrospective single center analysis.

BACKGROUND/AIMS: Differentiation of benign obstructive jaundice from malignant obstructive jaundice still remains difficult, despite improvements in diagnostic modalities. The aim of this study is to evaluate the usefulness of red cell distribution width (RDW) in differentiating benign and malignant causes of obstructive jaundice. METHODOLOGY: One hundred and ninety four consecutive patients (101 malignant, 93 benign) with a history of obstructive jaundice were reviewed in the period between January 2008 and August 2009. Definition of biliary strictures was suggested by cholangiographic features and supported by brush cytology, fine needle aspiration (FNA) and the presence of mass or metastases by imaging and/or clinical followup. Patients were divided into two groups, benign and malignant, based on the discharge diagnosis. RESULTS: The receiver operating characteristic analysis showed that a RDW of 14.8% was the best cut-off value for predicting a malignant biliary stricture with a sensitivity of 72% and a specificity of 69% (AUC=0.755, 95% CI=0.649-0.810). RDW was increased (>14.8%) in 31.6% of benign cases and 68.4% of malignancies. Depressed RDW levels (<14.8%) were found in 72.9% of benign cases and 27.1% of malignancies, which was statistically significant (p<0.001). CONCLUSIONS: Our results show that RDW is useful in the differentiation of benign from malignant causes of biliary obstruction when using an optimized cut-off value. In patients in whom biliary obstruction is suspected, an elevated RDW value may be a reliable additional predictor for differentiating the underlying etiology of biliary obstruction.

Comparison of Mini Nutritional Assessment-Short and Long Form to predict all-cause mortality up to 7 years in geriatric outpatients.

BACKGROUND: We aimed to find out whether the Mini Nutritional Assessment-Short Form (MNA-SF) can predict mortality up to 7 years when compared with the Mini Nutritional Assessment-Long Form (MNA-LF) in geriatric outpatients. METHODS: This retrospective study was conducted in patients (≥65 years) who were admitted to the geriatric outpatient clinic of a university hospital. MNA-SF and MNA-LF results were available for all patients. Patients were grouped as normal nutrition status (score 12-14), at risk of malnutrition (score between 8 and 11), or malnourished (score ≤7) according to MNA-SF. Based on MNA-LF, patients had normal nutrition status (score ≥24), were at risk of malnutrition (score 17-23.5), or were malnourished (score <17). Survival of the patients was assessed retrospectively. RESULTS: The study included 209 patients (62.2% female). During the 7-year follow-up, 77 (36.8%) patients died. After adjusting for age, sex, and Charlson comorbidity index, MNA-SF was significantly associated with all-cause mortality during 6-month, 1-year, 3-year, 5-year, and 7-year follow-up time. MNA-LF was superior to MNA-SF to estimate 6-month (P = 0.004) and 1-year mortality (P = 0.031). There was no difference between MNA-SF and MNA-LF regarding 3-year, 5-year, and 7-year mortality. CONCLUSION: MNA-SF can predict short-term and long-term mortality in geriatric outpatients as well as MNA-LF. A cut-off value of 11, indicating risk of malnutrition according to MNA-SF, may be used for the risk estimation of 1-year, 3-year, and 5-year mortality. Therefore, this study highlights the importance of screening all geriatric outpatients for malnutrition and especially the risk of malnutrition for early intervention and treatment.

Comparison of the Efficacy of the Global Leadership Initiative on Malnutrition Criteria, Subjective Global Assessment, and Nutrition Risk Screening 2002 in Diagnosing Malnutrition and Predicting 5-Year Mortality in Patients Hospitalized for Acute Illnesses.

BACKGROUND: The Global Leadership Initiative on Malnutrition (GLIM) has developed new criteria for diagnosing patients with malnutrition. The aims of this study were to investigate the prevalence of malnutrition according to the GLIM criteria, Subjective Global Assessment (SGA), and Nutrition Risk Screening 2002 (NRS-2002) and their association with long-term mortality in patients hospitalized for acute illnesses. METHODS: A retrospective analysis was performed in a sample of 231 patients with different comorbidities hospitalized for acute illnesses in medical or surgical wards. Nutrition status was retrospectively assessed with GLIM criteria using patients' records at admission in addition to SGA and NRS-2002. The agreement between the tools was calculated using κ statistics, and the association of malnutrition according to each tool and mortality were analyzed using Cox regression analysis. RESULTS: The mean age of the patients was 62.2 ± 18.2 years, and 56.7% were women. The prevalence of malnutrition was 35.9% with GLIM criteria, 37.2% with SGA, and 38% with NRS-2002. The agreement between tools was good (GLIM-SGA, κ = 0.804; GLIM-NRS-2002, κ = 0.784). During a median follow-up period of 63.2 months, 79 deaths occurred. The sensitivity in predicting 5-year mortality was 59.49%, 58.23%, and 58.23%, and specificity was 76.32%, 73.68%, and 72.37% for GLIM criteria, SGA, and NRS-2002, respectively. After adjusting for confounders, GLIM criteria best predicted 5-year mortality (hazard ratio, 3.09; 95% CI, 1.96-4.86; P < .001). CONCLUSIONS: Our findings support the effectiveness of GLIM in diagnosing malnutrition and predicting all-cause mortality among patients hospitalized for acute illnesses.

Validation of Nutritional Risk Screening-2002 in a Hospitalized Adult Population.

BACKGROUND: Malnutrition in hospitalized patients is a serious problem and is associated with a number of adverse outcomes. The Nutritional Risk Screening-2002 (NRS-2002) tool was designed to identify patients at nutrition risk. The validation of NRS-2002 compared with detailed clinical assessment of nutrition status was not studied before in hospitalized Turkish adults. The aim of this study is to determine validity, sensitivity, and specificity of the Turkish version of NRS-2002 in a hospitalized adult population. METHODS: A total of 271 consecutive hospitalized patients aged >18 years admitted to surgical and medical wards of a university hospital in Turkey were included in this single-center non interventional validity study. Assessment by geriatricians was used as the reference method. Two geriatricians experienced in the field of malnutrition interpreted the patients' nutrition status after the evaluation of several parameters. Patients were divided into "at nutrition risk" and "not at nutrition risk" groups by geriatricians. Concordance between the 2 geriatricians' clinical assessments was analyzed by κ statistics. Excellent concordance was found; therefore, the first geriatrician's decisions were accepted as the gold standard. The correlation of nutrition status of the patients, determined with NRS-2002 and experienced geriatrician's decisions, was evaluated for the validity. RESULTS: NRS-2002 has a sensitivity of 88% and specificity of 92% when compared with professional assessment. The positive and negative predictive values were 87% and 92%, respectively. Testretest agreement was excellent as represented by a κ coefficient of 0.956. CONCLUSIONS: NRS-2002 is a valid tool to assess malnutrition risk in Turkish hospitalized patients.

A Novel On-Chip Method for Differential Extraction of Sperm in Forensic Cases.

One out of every six American women has been the victim of a sexual assault in their lifetime. However, the DNA casework backlog continues to increase outpacing the nation's capacity since DNA evidence processing in sexual assault casework remains a bottleneck due to laborious and time-consuming differential extraction of victim's and perpetrator's cells. Additionally, a significant amount (60-90%) of male DNA evidence may be lost with existing procedures. Here, a microfluidic method is developed that selectively captures sperm using a unique oligosaccharide sequence (Sialyl-LewisX), a major carbohydrate ligand for sperm-egg binding. This method is validated with forensic mock samples dating back to 2003, resulting in 70-92% sperm capture efficiency and a 60-92% reduction in epithelial fraction. Captured sperm are then lysed on-chip and sperm DNA is isolated. This method reduces assay-time from 8 h to 80 min, providing an inexpensive alternative to current differential extraction techniques, accelerating identification of suspects and advancing public safety.

Validation of the Turkish Version of the Quick Mild Cognitive Impairment Screen.

BACKGROUND: The objective of this study was to validate the Turkish version of the Quick Mild Cognitive Impairment (Q mci-TR) screen. METHODS: In total, 100 patients aged ≥65 years referred to a geriatric outpatient clinic with memory loss were included. The Q mci was compared to the Turkish versions of the standardized Mini-Mental State Examination and the Montreal Cognitive Assessment (MoCA). RESULTS: The Q mci-TR had higher accuracy than the MoCA in discriminating subjective memory complaints (SMCs) from cognitive impairment (mild cognitive impairment [MCI] or dementia), of borderline significance after adjusting for age and education ( P = .06). The Q mci-TR also had higher accuracy than the MoCA in differentiating MCI from SMC, which became nonsignificant after adjustment ( P = .15). A similar pattern was shown for distinguishing MCI from dementia. Test reliability for the Q mci-TR was strong. CONCLUSION: The Q mci-TR is a reliable and useful screening tool for discriminating MCI from SMC and dementia in a Turkish population.