Insights into geriatric health: primary sarcopenia and innate immunity dynamics, examining SARC-F, serum TLR 4, TLR 9, and resolvin levels.

The aim of this study is to evaluate the relationship between serum TLR (Toll Like Receptor) 4, 9 and Resolvin E1 levels and primary sarcopenia in geriatric patients and to compare the diagnostic accuracy of these biomarkers with the SARC-F score. A total of 88 patients aged 65 years and older were evaluated in the study. Comorbidities and geriatric syndromes were identified and patients with secondary sarcopenia were excluded. EWGSOP2 criteria were used as diagnostic criteria for sarcopenia and SARC-F questionnaire was used to find individuals at risk for sarcopenia. Serum TLR 4, 9 and Resolvin E1 levels were analyzed by ELISA. There were no significant differences between the two groups in terms of age and gender (p = 0.654 and p = 1.000, respectively). SARC-F, serum TLR 9 and Resolvin E1 were significantly higher in the sarcopenia group compared to the non-sarcopenia group (p < 0.001, p < 0.001 and p = 0.040, respectively). Statistically significant parameters were evaluated by multiple regression analysis. TLR 9 and SARC-F score were both found to be associated with sarcopenia in multivariate logistic regression analysis [Odds ratio (OR) 3145, (95%) confidence interval (CI) 5.9-1,652,888.3, p = 0.012; OR 4.788, (95%) CI 2.148-10.672, p < 0.001, respectively]. ROC curve analysis showed that the area under the ROC curve (AUC) for TLR 9 and SARC-F was 0.896 (p < 0.001) and 0.943 (p < 0.001), respectively. Although this study supports the use of the SARC-F questionnaire in daily practice, serum TLR 9 levels may be an alternative to SARC-F in cases where SARC-F is not feasible.

Systemic inflammatory response index and monocyte-to-high density lipoprotein ratio- new biomarkers remarking the inflammation in primary sarcopenia: The SIMPS study.

OBJECTIVE: To investigate the relationship of sarcopenia with systemic inflammation response index (SIRI), monocyte to high-density lipoprotein ratio (MHR) and platelet parameters in geriatric patients. METHODS: We designed a cross-sectional retrospective study in patients presented to a geriatric outpatient clinic for the first time. The diagnosis of sarcopenia was made in accordance with the EWGSOP2 criteria. SIRI, MHR, mean platelet volume /Platelet count (MPV/Plt), platelet distribution width /Platelet (PDW/Plt), platelet/lymphocyte ratio (PLR) were calculated from fasting blood test results at the time of admission. RESULTS: Among 262 patients, 79 patients (30.1%) with sarcopenia had significantly higher frequencies of delirium, hypothyroidism, chronic kidney disease and probable depression (p=0.010; p=0.018; p=0.034; p<0.001). Malnutrition scores and cognitive impairment scores were significantly lower in sarcopenic group (p<0.001 for both). Patients with sarcopenia had significantly higher MHR, SIRI and C-reactive protein values than patients without sarcopenia (p<0.001; p=0.001 and p=0.006, respectively). No significant difference was found between the groups in terms of MPV/Plt, PDW/Plt, PLR (p=0.605; p=0.920; p=0.510). Area under the curve for MHR was 0.675 (95% CI: 0.604-0.746, p0.99. CONCLUSIONS: The finding of higher MHR and SIRI in geriatric sarcopenia patients supports low-grade chronic inflammation in the pathophysiology of sarcopenia. These non-invasive, cost-effective and simple parameters based on traditional peripheral blood cell counts may be warning signs for sarcopenia in the geriatric population (Tab. 3, Fig. 1, Ref. 25). Text in PDF www.elis.sk Keywords: primary sarcopenia, inflammation, systemic inflammation response index, monocyte/high-density lipoprotein ratio, platelet parameters.

Concomitant Polymyalgia Rheumatica and Giant Cell Arteritis Associated with Cystic Echinococcosis: A Rare Geriatric Case.

INTRODUCTION: Parasitic infections could be an important triggering factor for autoimmune diseases. We present a clinical case of concomitant polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) induced with cystic echinococcosis (CE). CASE PRESENTATION: A 74-year-old male was admitted with a 2-month history of progressive pain at the shoulders and hip, movement restriction, and constitutional symptoms. As a result of the examinations performed due to rheumatological complaints, PMR and GCA were diagnosed. The cystic appearance, which was incidentally detected in the liver 6 months ago and not examined at that time, was found to be hydatid cyst. Medical treatment was initiated for all three conditions and the patient's symptoms improved significantly. DISCUSSION: Parasite infections may cause various autoimmune diseases because of molecular mimicry or sustained immune activation. Echinococcus granulosus is a very complex multicellular parasite and highly immunogenic for humans. Some body parts of the parasite, the outer surface and secreted particles, stimulate the host immune system strongly. CONCLUSION: The first case in the literature of coexistence of PMR and GCA associated with CE. Autoimmune diseases should be evaluated in patients with CE. Furthermore, CE should be considered in patients with autoimmune diseases in the presence of a cyst.

Predictive Strategies to Reduce the Risk of Rehospitalization with a Focus on Frail Older Adults: A Narrative Review.

Frailty is a geriatric syndrome that has physical, cognitive, psychological, social, and environmental components and is characterized by a decrease in physiological reserves. Frailty is associated with several adverse health outcomes such as an increase in rehospitalization rates, falls, delirium, incontinence, dependency on daily living activities, morbidity, and mortality. Older adults may become frailer with each hospitalization; thus, it is beneficial to develop and implement preventive strategies. The present review aims to highlight the epidemiological importance of frailty in rehospitalization and to compile predictive strategies and related interventions to prevent hospitalizations. Firstly, it is important to identify pre-frail and frail older adults using an instrument with high validity and reliability, which can be a practically applicable screening tool. Comprehensive geriatric assessment-based care is an important strategy known to reduce morbidity, mortality, and rehospitalization in older adults and aims to meet the needs of frail patients with a multidisciplinary approach and intervention that includes physiological, psychological, and social domains. Moreover, effective multimorbidity management, physical activity, nutritional support, preventing cognitive frailty, avoiding polypharmacy and anticholinergic drug burden, immunization, social support, and reducing the caregiver burden are other recommended predictive strategies to prevent post-discharge rehospitalization in frail older adults.

Comprehensive evaluation of older patients with suspected malignancy: 5-year experience of a tertiary geriatric inpatient unit.

OBJECTIVE: Geriatric cancer population is growing. Both cancer and geriatric conditions are associated with some degree of inflammatory burden. To comprehensively present our five years of experience in patients with suspicion of a malignancy, signs and symptoms that are more prominent as indicator of malignancies, conditions that cause malignancy-like symptoms, and common malignancies and newly diagnosed malignancies in geriatric patients with a history of cancer. METHODS: Patients hospitalized with suspected malignancy in a geriatric inpatient unit were included. Demographic data, hospitalization symptoms, clinical findings, smoking history, laboratory and further examinations, comprehensive geriatric assessment scores, length of hospital stay and discharge diagnoses were examined. Endoscopy and colonoscopy findings were also recorded. RESULTS: Of the 1,104 patients hospitalized for various reasons in the five-year period, 197 (106 women) were suspected of having a malignancy. Mean age was 78.22 ± 7.27. A total of 65 (33%) patients were diagnosed with a malignancy. Amount of smoking (pack/year) and geriatric depression scale (GDS) scores were significantly higher in malignant group (p = .009; p < .001; respectively). Of the hospitalization symptoms, frequency of lumbar-hip-back pain was significantly higher in the malignant group (p = .043). The three most common cancers were hematologic (32%), lung (15%), and gastrointestinal cancers (15%). Gastritis was the most common pathological finding from gastroscopies (58%), and adenoma from colonoscopies (24%). Malignancies were detected in 40% of patients with a history of malignancy, and 55% of the newly detected malignancies were new primaries. Immunoglobulin G4-related disease was one of the detected interested benign conditions. CONCLUSION: The frequency and presentation patterns of malignancies may differ in older adults. Depressive symptoms are common in geriatric cancer patients. Geriatric patients with a history of malignancy should be evaluated in detail for new primary malignancies.

The Role of NF-κB, PPAR-α, and PPAR-γ in Older Adults with Metabolic Syndrome.

The etiopathogenesis of metabolic syndrome (MetS) has not been fully understood yet, and chronic low-grade inflammation is thought to be associated with the development of complications related to MetS. We aimed to investigate the role of Nuclear factor Kappa B ( NF-κB ), Peroxisome Proliferator-Activated Receptor- α and γ (PPAR-α, and PPAR-γ) which are the main markers of inflammation in older adults with MetS. A total of 269 patients aged≥18, 188 patients with MetS who met the diagnostic criteria of the International Diabetes Federation, and 81 controls who applied to geriatrics and general internal medicine outpatient clinics for various reasons were included in the study. Patients were separated into four groups: young with MetS (< 60, n=76), elderly with MetS (≥60, n=96), young control (< 60, n=31), elderly controls (≥60, n=38). Carotid intima-media thickness (CIMT) and NF-κB , PPAR-α, and PPAR-γ plasma levels were measured in all of the participants. Age and sex distribution were similar between MetS and control groups. C-reactive protein (CRP), NF-κB levels (p=0.001) and CIMT (p<0,001) of MetS group were significantly higher than in the control groups. On the other hand, the PPAR-γ (p=0.008) and PPAR-α (p=0.003) levels were significantly lower in MetS. ROC analysis revealed that the NF-κB, PPAR-α, and PPAR-γ could be used to indicate MetS in younger adults (AUC: 0.735, p<0.000; AUC: 0.653, p=0.003), whereas it could not be an indicator in older adults (AUC: 0.617, p=0.079; AUC:0.530, p=0.613). It seems that these markers have important roles in MetS-related inflammation. In our results, suggest that the indicator feature of NF-κB , PPAR-α and PPAR-γ in recognizing MetS in young individuals is lost in older adults with Mets.

Matrix Metalloproteinases/Tissue Inhibitors of Metalloproteinases Ratio: A Biomarker of Bone Resorption in Geriatric Osteoporosis?

BACKGROUND: Matrix metalloproteinases (MMPs) play an important role in bone resorption and are regulated by tissue inhibitors of metalloproteinases (TIMPs). We investigated the use of MMP2/TIMP2 and MMP9/TIMP1 ratios as biomarkers of bone resorption in geriatric osteoporosis and evaluated the relationship between osteoporosis and geriatric syndromes. METHODS: This analytical cross-sectional study involved 87 patients (41 with osteoporosis) treated at the geriatric outpatient clinic of a university hospital. The demographic characteristics, comprehensive geriatric assessment scores, laboratory findings, and bone mineral density of the patients were recorded. Serum MMP9, TIMP1, MMP2, and TIMP2 levels were analyzed by enzyme-linked immunosorbent assay (ELISA). RESULTS: We enrolled 41 and 46 patients with and without osteoporosis, respectively. The groups showed no significant differences in MMP2/TIMP2 and MMP9/TIMP1 ratios (p=0.569 and p=0125, respectively). While the basic activities of daily life (BADL) scores in the osteoporosis group were higher than those in the group without osteoporosis, the instrumental activities of daily life (IADL) scores were significantly lower (p=0.001 and p=0.007, respectively). No significant differences were observed in Mini-Nutritional Assessment, Mini-Mental State Examination, and Geriatric Depression Scale scores (p=0.598, p=0.898, and p=0.287, respectively). CONCLUSION: This is the first study to examine the relationship between osteoporosis and several geriatric syndromes, as well as the relationship between osteoporosis and serum MMP, TIMP values, and MMP/TIMP ratios in geriatric patients. Our results showed that osteoporosis causes dependency in both BADLs and IADLs, and that the MMP2/TIMP2 and MMP9/TIMP1 ratios provided no additional benefit in demonstrating bone resorption in geriatric osteoporosis.

The impact of sarcopenia and obesity on mortality of older adults: five years results.

AIM: Sarcopenia and obesity can cause severe physical and metabolic complications. We aimed to investigate the risk of mortality associated with sarcopenia and obesity in older adults. METHOD: We designed a retrospective, observational cohort study showing the 5-year mortality of older patients in a tertiary geriatric outpatient clinic. Sociodemographic characteristics, medical history, anthropometric measurements, medications, and comorbidities were recorded. Sarcopenia was evaluated with skeletal muscle mass, handgrip strength, and gait speed. We defined sarcopenic obesity as sarcopenia plus obesity (as a body mass index ≥ 30 kg/m2). We classified the participants into four groups according to whether they were sarcopenic and/or obese: non-sarcopenic non-obese, non-sarcopenic obese, sarcopenic non-obese, and sarcopenic obese. The final overall survival of the patients was obtained from the hospital data system. RESULTS: Of the 175 patients, the mean age was 76.1 ± 6.4, and the majority were female (n = 120). Sixty-eight had sarcopenia (39%). The prevalence of obesity was 27%. Thirty-eight patients had died within five years (22%). The mortality rate was significantly higher in the oldest (age 85 and above) and sarcopenic groups (p < 0.001, 0.004, respectively). The mortality rate was highest in the sarcopenic obese group (40.9%). Age (HR: 1.13, 95% CI: 1.07-1.19, p: < 0.001), sarcopenic obesity (HR: 4.85, 95% CI: 1.91-12.31, p: 0.001), sarcopenia (HR: 2.26, 95% CI: 1.15-4.43, p: 0.018) and obesity (HR: 2.15, 95% CI: 1.11-4.17, p: 0.023) were independently associated with mortality at 5 years. The Kaplan-Meier analysis and Log-Rank test showed that sarcopenic obese patients had the highest cumulative mortality incidence rates. CONCLUSION: Sarcopenic-obese participants had the highest mortality incidence compared to those without obesity or sarcopenia. In addition, the presence of sarcopenia or obesity alone also had a significant role in mortality risk. So, we should especially focus on maintaining or increasing muscle mass and preventing obesity.

The relationship between malnutrition and neutrophil-to-lymphocyte ratio in hospitalized older patient.

OBJECTIVES: Aging is characterized by appetite loss and cachexia, i.e., factors that contribute to malnutrition. An inflammation marker, neutrophil-to-lymphocyte ratio (NLR), is a significant prognostic predictor of many geriatric syndromes. We aim to determine the association between NLR and malnutrition. METHODS: We designed a retrospective study on hospitalized patients in the geriatric unit of a university hospital between January 2019 and January 2021. Demographic data, chronic diseases, history of smoking, length of hospital stay, number of drugs, laboratory and further examinations, and comprehensive geriatric assessment scores were recorded from the hospital data system. The nutritional status of the patients was evaluated using the mini-nutritional assessment (MNA) questionnaire. RESULTS: Of the 220 patients, 121 (55 %) were female, and the mean age was 77.9 ± 7.3 years. According to the MNA, 60 % (n = 132) were malnourished or at risk of malnutrition. As many as 47.3 % (n = 104) of the patients had depressive symptoms, and 41.4 % (n = 91) were cognitively impaired. The mean age (79.3 ± 7.3), NLR, and GDS scores were significantly higher, and MMSE scores were significantly lower in malnourished patients or in those at risk of malnutrition as compared to patients with normal nutritional status. We showed that NLR (OR: 1.248; 95% CI: 1.066‒1.461; p = 0.006), age (OR: 1.056; 95% CI: 1.005‒1.109; p = 0.031), depressive symptoms (OR: 1.225; 95% CI: 1.096‒1.369; p 4.5, with a sensitivity of 37.9 %, specificity of 85.2 %, negative predictive value of 47.8 %, and positive predictive value of 79.4 %. CONCLUSION: NLR, age, depressive symptoms, and cognitive impairment were independently associated risk factors for malnutrition. NLR may be a useful nutritional marker for evaluating the nutritional status of hospitalized geriatric patients (Tab. 4, Fig. 1, Ref. 28). Text in PDF www.elis.sk Keywords: malnutrition, neutrophil-to-lymphocyte ratio, geriatric syndromes, inpatient, older adults.

Frequency and Risk Factors of Re-hospitalization in Geriatric Inpatient Wards: A Multicenter Retrospective Analysis.

PURPOSE: We aimed to evaluate frequency and risk factors of re-hospitalization which are not stated in comorbidity indexes in geriatric wards. METHODS: A total of 585 patients who were admitted to tertiary care geriatric inpatient clinics at least once between 1 September 2017 and 1 September 2018 and who survived to discharge during initial hospitalization were included in this cross-sectional retrospective multicenter study. RESULTS: Overall, 507(86.7%) patients were hospitalized once for treatment during the study period, while re-hospitalization occurred in 78(13.3%) patients. Rates of previous surgery (10.3 vs. 3.0%, p = .006), urinary incontinence (UI) (50.0 vs. 36.3%, p = .021), controlled hypertension (64.1 vs. 46.4%, p = .024), malnutrition (55.1 vs. 29.6%, p = .014) were significantly higher in re-hospitalized patients. Re-hospitalized patients were younger (mean ± SD 76.4 ± 8.3 vs. 79.6 ± 7.9 years, p = .002) than once-hospitalized patients. Multivariate logistic regression analysis revealed the younger patient age (OR, 0.942, 95% CI 0.910 to 0.976, p = .001), higher Modified Charlson Comorbidity Index (MCCI) score (OR, 1.368, 95% CI 1.170 to 1.600, p < .001) to significantly predict the increased risk of re-hospitalization. CONCLUSIONS: Our findings showed that previous history of surgery and geriatric syndromes such as UI, malnutrition were determined to significantly predict the increased risk of re-hospitalization. We suggest that these risk factors be added to prognostic tools designed for elderly patients.

The impact of COVID-19 pandemic on the geriatric inpatient unit.

OBJECTIVE: We aimed to determine the effects of the pandemic on the inpatients in the geriatric unit by comparing the demographic and clinical characteristics, reasons for hospitalization, morbidity, and mortality of the patients before and during the pandemic. METHODS: The population of this retrospective, cross-sectional study consisted of inpatients in the geriatric unit for two years (11 March 2019-10 March 2021). The patients were separated into two groups according to the hospitalization time as pre-COVID-19 and COVID-19 period. Hospitalization types, reasons for hospitalization, length of stay, demographic data, chronic diseases, drugs, developed morbidities, discharge, and 1-year mortality status of the patients were recorded. RESULTS: Three hundred and fifty patients were included in our study. The mean age was 80.4 ± 8.02. It was observed that the number of hospitalized patients decreased by ∼50% in the COVID-19 period. However, there was a significant decrease in hospitalization due to the control of chronic diseases during the COVID-19 period (p = .008). The number of inpatients from the emergency department was found to be higher during the COVID-19 period (p < .001). Regarding the presence of geriatric syndromes, polypharmacy (p = .011) and delirium (p = .035) were found to be significantly less in the pre-COVID-19 period. The percentage of malnutrition was also detected as lower, but it was not statistically significant. In terms of 1-year mortality, although not statistically significant, the all-cause mortality rate was higher during the COVID-19 period (p = .08). CONCLUSIONS: Pandemic has greatly affected the geriatric unit. The prognosis of the patients has worsened and mortality rates have increased. Physiological and psychological deterioration caused by quarantine measures, worsening chronic diseases, and immunosenescence affected the prognosis of geriatric patients. This adds to the previous literature by proving the fact that older individuals are the most vulnerable group in the pandemic.

Depressive symptoms are associated with sarcopenia and malnutrition in older adults.

BACKGROUND: Depression is one of the most common mental disorders among older adults and depressive symptoms are strongly associated with adverse health outcomes. We aim to examine whether depressive symptoms are associated with sarcopenia and malnutrition in older adults. METHODS: We reviewed hospital records of 447 patients (≥65 years) who were admitted to the outpatient clinics, retrospectively. In addition to demographic characteristics, all participants were measured for usual gait speed (UGS), handgrip strength (HGS) and skeletal muscle mass (SMMI) by using bioelectrical impedance analysis. The Geriatric Depression Scale (GDS) was used to assess depressive symptoms. Nutritional status was screened by a mini-nutritional assessment (MNA). Cognitive function was assessed from the Mini-Mental State Examination (MMSE). RESULTS: Of the 215 participants who remained after performing exclusion criteria (a clinical diagnosis of dementia (n 63), stroke (n 61), Parkinson's disease or other neurodegenerative disease (n 30), previous depression diagnosis or antidepressant medication use (n 144)), the mean age was 78 ± 8.3, the majority were female (n 133) and almost half had depressive symptoms (49.3%). Thirty-six percent had malnutrition, and 23 % had sarcopenia. The participants with depressive symptoms had lower MMSE scores (P < 0.001) and correlated with muscle mass (P < 0.001, r = -0.382), muscle strength (P < 0.001, r = -0.288), and MNA (P < 0.001, r = 0.355). Multivariate logistic regression showed that depressive symptoms were independently associated with low muscle strength (HGS: odds ratio (OR) 0.913, 95% CI: 0.866-0.962, P = 0.001), low muscle mass (SMMI: OR, 0.644, 95% CI: 0.509-0.814, P < 0.001), sarcopenia (OR, 2.536, 95% CI: 1.256-5.117, P = 0.009) and malnutrition (OR, 2.667, 95% CI: 1.467-4.850, P = 0.001). CONCLUSION: This study demonstrated that depressive symptoms were independently associated with sarcopenia and malnutrition in older adults. Depressive disorders may lead to impaired cognitive dysfunction. Older adults at increased risk of sarcopenia and malnutrition should be screened for depression earlier.

Association between anticholinergic drug burden with sarcopenia, anthropometric measurements, and comprehensive geriatric assessment parameters in older adults.

BACKGROUND: Older patients use multiple drugs due to their comorbidities and most of these drugs have anticholinergic drug burden (ADB). We aimed to investigate the association between ADB and sarcopenia, anthropometric measurements, and comprehensive geriatric assessment (CGA) parameters in older adults. METHODS: Patients ≥65 years who applied to geriatrics outpatient clinic between January 2019-March 2020 were included. Patients with cognitive dysfunction were excluded. CGA tests were conducted on patients. Handgrip strength (HGS), bioelectrical impedance analysis (BIA), and a 6-meter walking test were used for sarcopenia definition. The Anticholinergic Cognitive Burden (ACB) scale was used to calculate the ADB. RESULTS: Totally 256 patients (women/men:180/76) were included. The mean age was 82±6.8. Two groups were created as without ADB (n=116) and with ADB (n=140). Sarcopenia was higher in the ADB group (p=0.04). In women and men as ADB increased HGS decreased (respectively; p=0.023 r=-0.170, p=0.031 r=-0.248) and Basic Activities of Daily Living (BADL) test score increased (respectively; p= <0.001 r= 0.292, p=0.04 r= 0.244). In the linear regression (LR) analysis age and BADL test score had significant association with ADB in women (respectively; p=0.001, p=0.023). CONCLUSION: The finding that sarcopenia is higher in the patients with ADB and HGS decreases as ADB increases, suggesting that ADB may be a risk factor for sarcopenia by decreasing HGS. Also, it has been determined that, especially in older women, as ADB increases, the dependence on basic daily living activities increases.

Clinical outcomes of geriatric patients with COVID-19: review of one-year data.

AIMS: In this study, we aimed to reveal mortality rates and factors affecting survival in geriatric patients infected with COVID-19. METHODS: This is a retrospective study of 873 geriatric patients with COVID-19 who were hospitalized between March 11, 2020 and March 11, 2021. Demographic, clinical, laboratory data, and treatment options were obtained from electronic medical records. Multivariate logistic regression was used to explore the risk factors for in-hospital death. RESULTS: During the specified period, 643 patients were discharged, and 230 patients died in the hospital. The mean age was 75.08 ± 7.39 years (mean ± SD) and 51.8% were males. We found that older age (≥ 85), polypharmacy, dyspnea, abnormal thorax computed tomography (CT), lower doses of anticoagulation, and high values of white blood cell, aspartate aminotransferase, C-reactive protein, lactate dehydrogenase, ferritin were associated with a significant increase in mortality (P < 0.001 for all). Although all of these values were significant in multivariate logistic regression analysis, the most important ones were dyspnea (Odds ratio (OR) 57.916, 95% confidence interval (CI) 23.439-143.104, P < 0.001), polypharmacy (OR 6.782, 95% CI 3.082-14.927, P < 0.001), and thorax CT classification (typical; OR 9.633, 95% CI 2.511-37.122, P < 0.001). CONCLUSION: Older age, polypharmacy, dyspnea, and abnormal thorax CT were the most significant mortality criteria and in addition appropriate anticoagulant use was associated with reduced mortality. Identifying the risk factors to predict mortality in older adults with COVID-19 is important to treat future cases successfully.

Sarcopenia assessment by new EWGSOP2 criteria for predicting chemotherapy dose-limiting toxicity in patients with gastrointestinal tract tumors.

INTRODUCTION: In 2019, The EWGSOP2 group made updates on the definition and diagnosis of sarcopenia. The aim of this study is to determine the possible risk factors for chemotherapy dose-limiting toxicity (DLT). METHODS: Newly diagnosed gastrointestinal (GI) cancer patients were included in this prospective observational study. Chemotherapy DLTs were recorded in patients receiving platinum-based therapy. The patients were divided into two groups according to the current sarcopenia criteria. RESULTS: 75 patients were included in the final analysis. Chemotherapy DLT occurred in 52% (n = 39) of all patients who received platinum-based chemotherapy. DLT rates were 78.9% and 42.9% in sarcopenic and non-sarcopenic patients, respectively (p = 0.007). According to the results of the multivariate analysis, the only sarcopenia was found as a statistically significant risk factor for DLT. CONCLUSION: Assessment of sarcopenia evaluated with the current EWGSOP2 diagnostic criteria is useful in predicting chemotherapy DLT development in patients with a diagnosis of GI cancer. In the future, current EWGSOP2 recommendations should be considered while designing a study investigating the correlation between sarcopenia and chemotoxicity.

Themes and trends for osteoporosis: the bibliometric and altmetric approach.

Our aim is to evaluate and compare the most discussed articles on osteoporosis in academia and social media. The treatment of osteoporosis was the most popular topic in the top 100 citation (n = 31) and altmetric lists (n = 47). The general public, as well as academia, is curious about the treatment of osteoporosis. PURPOSE: The main aim of this study is to investigate the trends in the field of osteoporosis and guide researchers by conducting bibliometric and altmetric analysis for osteoporosis with the most cited and discussed articles on social media. METHODS: The keyword "osteoporosis" was searched from the Web of Science All Databases and Altmetric.com website, and the top 100 (T100) citation and altmetric list was created, respectively. The T100 citation and altmetric list articles were analyzed and compared in terms of study type, topic of study, first author, publication year, citation number, journal quartile in category, impact factor, and Altmetric Attention Score (AAS). RESULTS: T100 cited articles: the median for citation number was 1117 (range: 717-3854) and the median for AAS was 9 (range: 0-371). T100 altmetric articles: the AAS median was 158 (range: 93-658) and citation number median was 31 (range: 0-2132). Only 6 articles were the same in both lists. The number of articles about treatment was 31 in the T100 citation list and 47 in the T100 altmetric list. The most ranked journals were "The New England Journal of Medicine" with 22 articles in the T100 citation list and "Osteoporosis International" with 16 articles in the T100 altmetric list. CONCLUSION: Unlike the citation number, one of the greatest contributions of AAS to researchers may be developing appropriate policies in the field of osteoporosis according to the interests of the society.

Association of FGF-19 and FGF-21 levels with primary sarcopenia.

AIM: Serum fibroblast growth factor (FGF)-19 and FGF-21 levels have been reported to be associated with muscle hemostasis. This study aims to explore the relationship between the levels of these markers and sarcopenia. METHODS: In our single-center, cross-sectional study, patients over 65 years old presenting to the geriatric outpatient clinic were included. Patients with secondary sarcopenia were excluded. The Strength-Assistance with walking-Rising from a chair-Climbing stairs and Falls (SARC-F) questionnaire was applied to all patients. Sarcopenia was determined by handgrip strength (HGS), bioelectrical impedance analysis and 6-m walk test. Serum samples were stored at -80°C until measurement. The ELISA method was used to assess FGF-19 and FGF-21 levels. RESULTS: In total, 88 patients (54 women) were included. There were 43 patients in the sarcopenia group and 45 patients without sarcopenia in the control group. In those with sarcopenia, FGF-19 was lower (P = 0.04) and FGF-21 was higher (P = 0.021). There was a direct correlation between FGF-19 with SARC-F and HGS (P = 0.04, B = 0.178, P = 0.006, B = 0.447) while FGF-21 was inversely correlated with HGS and positively correlated with 6-m walking time (P = 0.016, B = -0.428, P = 0.004, B = 0.506). CONCLUSIONS: Our results reveal that low FGF-19 and high FGF-21 may be associated with sarcopenia and this finding could be explained by the impacted muscle strength. Geriatr Gerontol Int 2021; 21: 959-962.

The relationship between primary sarcopenia and SARC-F, serum MMP9, TIMP1 levels, and MMP9/TIMP1 ratio in the geriatric patients.

PURPOSE: The purpose of this study is to evaluate the relationship between serum MMP9 (Matrix metalloproteinase), TIMP1 (Tissue inhibitor of metalloproteinase) levels and MMP9/TIMP1 ratio and primary sarcopenia in geriatric patients, and compare the diagnostic accuracy of such biomarkers with that of the SARC-F score. METHODS: A total of 88 patients aged 65 years and older were assessed in the study. Comorbidities and geriatric syndromes were determined and patients with secondary sarcopenia were excluded. EWGSOP2 criteria were used as diagnostic criteria for sarcopenia and SARC-F questionnaire was used to find individuals at risk for sarcopenia. Serum MMP9 and TIMP1 levels were analyzed by ELISA method. RESULTS: SARC-F, serum MMP9 and MMP9/TIMP1 ratio were significantly higher in the group with sarcopenia compared to the group without sarcopenia (p = 0.001, p = 0.026 and p = 0.006, respectively). In univariate logistic regression analysis, while SARC-F score and MMP9/TIMP1 ratio were significant, MMP9, TIMP1, age and gender were not. In the multivariate logistic regression analysis of the SARC-F score and the MMP9/TIMP1 ratio, it was determined that both of them were associated with sarcopenia [Odds ratio (OR) 1.447 (95%) confidence interval (CI) 1.170-1.791, p = 0.001; OR 1.127, (95%) CI 1.016-1.249, p = 0.023, respectively]. ROC curve analysis showed that the area under ROC curve (AUC) of SARC-F and MMP9/TIMP1 was 0.703 (p = 0.001, %95 CI 0.594-0.812) and 0.670 (p = 0.006, %95 CI 0.557-0.783), respectively. CONCLUSION: Although this study supports the use of SARC-F questionnaire in daily practice; if SARC-F can't be applicable, the MMP9/TIMP1 ratio could be an alternative choice to the SARC-F.

Relationship between the types of urinary incontinence, handgrip strength, and pelvic floor muscle strength in adult women.

AIM: To investigate the relationship between handgrip strength with types of urinary incontinence (UI) and pelvic floor muscle strength (PFMS) in women. METHODS: Ninety-two women, who presented to the geriatric and urology outpatient clinics complaining of UI between July 2019 and February 2020 and had indicated to undergo urodynamic assessment after basic neurourological evaluation, were included in this cross-sectional study. The presence and types of UI were identified by clinical examination and urodynamic studies. Demographic parameters, anthropometric data, comorbidities and medications were recorded. The International Consultation on Incontinence Questionnaire-Short Form was applied. Handgrip strength (HGS) was measured by a hand dynamometer. The PFMS was subjectively assessed via vaginal digital palpation and measured quantitatively by the vaginal probe of the perineometer. RESULTS: Thirty-eight urodynamic stress, 28 detrusor overactivity, 26 urodynamic mixed UI patients were reported. Perineometer measurements were significantly lower in the urodynamic stress UI group compared to the other two groups (p = 0.020). There was no relationship between the types of urinary incontinence and HGS. However, a positive correlation was found between PFMS and HGS (p = 0.045, r = 0.298). CONCLUSION: The positive correlation between HGS and PFMS indicates that low HGS may be a marker for PFMS weakness. Furthermore, the association between sarcopenia and UI may be explained by this condition.

Factors affecting mortality in geriatric patients hospitalized with COVID-19

Background/aim: We aimed to investigate the factors affecting the mortality of patients aged 65 years or older who were hospitalized with the diagnosis of new coronavirus pneumonia (COVID-19). Materials and methods: This is a retrospective study of patients 65 years old or older with COVID-19 who were hospitalized in Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty Hospital, between March 11 and May 28, 2020. Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records. We used univariate and multivariate logistic regression methods to explore the risk factors for in-hospital death. Results: A total of 218 patients (112 men, 106 women) were included, of whom 166 were discharged and 52 died in hospital. With univariate analysis, various clinical features and laboratory variables were found to be significantly different (i.e. P < 0.05). In multivariate logistic regression analysis the following were independently associated with mortality: present malignancy [odds ratio (OR) = 4.817, 95% confidence interval (CI) = 1.107­20.958, P: 0.036]; dyspnea (OR = 4.652, 95% CI = 1.473­14.688, P: 0.009); neutrophil/lymphocyte ratio (NLR; OR = 1.097, 95% CI = 1.012­1.188, P: 0.025); the highest values of C-reactive protein (CRP; OR = 1.006, 95% CI = 1.000­1.012, P: 0.049), lactate dehydrogenase (LDH; OR = 1.002, 95% CI = 1.001­1.004, P: 0.003), and creatinine levels (OR = 1.497, 95% CI = 1.126­1.990, P: 0.006); oxygen saturation (SpO2) values on admission (OR = 0.897, 95% CI = 0.811­0.993, P: 0.036); and azithromycin use (OR = 0.239, 95% CI = 0.065­0.874, P: 0.031). Conclusion: The presence of malignancy; symptoms of dyspnea; high NLR; highest CRP, LDH, and creatinine levels; and low SpO2 on admission predicted mortality. On the other hand, azithromycin use was found to be protective against mortality. Knowing the causes predicting mortality will be important to treat future cases more successfully.