Effect of fosfomycin-induced hypernatremia on patients' hospital stay length and survival.

BACKGROUND AND OBJECTIVE: Hypernatremia is a possible side effect of intravenous fosfomycin. The aim of this study was to investigate the effects of changes in sodium (Na) levels on hospital stay and survival in patients hospitalized in the intensive care unit receiving fosfomycin. SUBJECTS AND METHODS: This study was conducted retrospectively on the files of patients over the age of 60, who were admitted to the Internal Medicine Intensive Care Unit. Plasma sodium levels were observed and documented over a period of 14 days. The patients were divided into two groups (Hypernatremia group Na > 145 mEq/L vs normonatremia group 135-145 mEq/L). In addition, daily sodium changes were noted for 14 days in patients. RESULTS: The mean age of the patients was 75 years. Hospitalization days were longer for hypernatremia patients (31.5 days vs 41 days, p = 0.003). Patients with hypernatremia had an extended duration of stay in the intensive care unit. (21 days vs 31 days p = 0.002). The 1-month survival rate was 61.4% in patients with hypernatremia and 24.9% in patients without hypernatremia (p = 0.004). The absence of hypernatremia increases mortality by 2.09 times (95% CI 1.35-3.23). When discharge and mortality rates were analyzed according to sodium fluctuation, discharged patients exhibited a lower sodium fluctuation (4 min/max (-10/19) vs 6 min/max (-16/32) p < 0.001). CONCLUSION: In conclusion, the strength of our study is that it specifically focuses on the consequences of the sodium fluctuation on patient management and provides results.

Can Pseudothrombocytopenia be recognised at first look?

Our aim was to determine the laboratory parameters that distinguish pseudothrombocytopenia from true thrombocytopenia. A total of 107 patients who were referred to the adult hematology outpatient clinic with thrombocytopenia and subsequently diagnosed with acute myeloid leukaemia, immune thrombocytopenia and pseudothrombocytopenia were included in our study. Hemogram parameters on admission, platelet value in the control hemogram and peripheral smear findings were recorded. Forty three (40.2%) males and 64 (59.8%) females, were included in our study. There were 25 patients in the leukaemia group, 39 in the immune thrombocytopenia group and 43 in the pseudothrombocytopenia group. Control platelet value and red cell distribution width/platelet ratio were found to be statistically significantly different between the 3 groups. Receiver operating characteristic analysis based on platelet values showed that platelet value ≤ 38,000/µL (86% sensitivity, 78.1% specificity, P < .001), difference between 2 consecutively measured platelet levels ≤ 11. 000/µL (79.1% sensitivity, 79.7% specificity, P < .001), red cell distribution width/platelet ratio ≥ 0.413 (90.7% sensitivity, 78.1% specificity, P < .001) were found to be in favor of true thrombocytopenia. In the differentiation of pseudothrombocytopenia and true thrombocytopenia, the difference between the hemogram parameters at the time of admission and the platelet count in the control blood count may be guiding. This result may reduce patient and physician anxiety and prevent patient referral.

Pectoralis muscle index might be a factor associated with frailty in older women with breast cancer.

BACKGROUND: To investigate the possible relationship between pectoralis muscle (PM) measurement and frailty in older women with breast cancer (BC) (preoperatively defined as stage 1, 2, and 3 diseases). METHODS: This retrospective, observational study was conducted at Konya Training and Research Hospital between June and December 2020. A total of 102 patients [median age 62.5 years, median follow-up period two years] were included in the study. PM measurements were obtained from thorax computerized tomography (CT). Pectoralis muscle index (PMI) was calculated by dividing the PM area by the height square of the patients (cm2/m2). Pectoralis muscle density (PMD) was evaluated using CT findings, including their Hounsfield Units (HU). Frailty status and sarcopenia-risk assessments were done by a telephone interview in September 2020 using the FRAIL index (categorized as robust or nonrobust) and SARC-F questionnaire (classified as no sarcopenia-risk or risk of sarcopenia), respectively. PM measurements were compared between robust and nonrobust patients and between patients with a risk of sarcopenia and no sarcopenia risk. RESULTS: The nonrobust patients had lower pectoralis major muscle index (PMaMI) (p = 0.041) and pectoralis major muscle density(PMaD) (p = 0.020) levels than robust patients in the whole study sample. PMI (p = 0.017) and PMaMI (p = 0.010) levels were significantly lower in the nonrobust patients than in robust patients with early-stage BC. Frailty status was positively correlated with age (rho: 0.621; p < 0.001), BC stage (rho: 0.220; p = 0.026), and SARC-F score (rho: 0.747; p < 0.001), and negatively correlated with PMaMI (rho: -0.197; p = 0.047) and PMaD (rho: -0.237; p = 0.016). There were significant associations between PMaMI (OR: 0.467, 95% Confidence Interval (CI): 0.226-0.962 p = 0.039) and PMI (OR: 0.543, 95% CI: 0.299-0.986 p = 0.045) levels with frailty status (being nonrobust) in regression models. DISCUSSION: In the study, it has been shown that pectoralis muscle assessment might be a related parameter to frailty in older women with breast cancer.

The impact of COVID-19 pandemic on anxiety levels among patients who have to go to the hospital due to chronic illnesses: A prospective study.

INTRODUCTION: Cancer and hemodialysis (HD) patients are at high risk for COVID-19. In our study, we aimed to evaluate the effect of pandemic on anxiety in these patients. METHODS: One hundred and six oncology and 97 HD patients participated in the study. Anxiety levels were assessed by using the Beck Anxiety Inventory (BAI) and State-Trait Anxiety Inventory (STAI). At the end of 8-month follow-up, these questionnaires were re-administered. RESULTS: During this period, 38 patients (38/203; 18.7%) had COVID-19 infection. Twenty-three patients (23/203; 11.3%) died due to COVID-19 and/or other causes. One hundred and thirteen of the remaining patients were participated in the second questionnaire. Having COVID-19 was not the independent factor for changes in STAI, and BAI scores in any regression models. CONCLUSION: Having COVID-19 does not affect the increased anxiety levels in HD and oncology patients. The effect of the pandemic may have remained in the background, as these patients have more concerns about their own diseases.

Validity and reliability of Fried frailty phenotype in Turkish population.

BACKGROUND: Frailty is an important, multidimensional geriatric syndrome defined as increased vulnerability to stressors. Fried frailty phenotype (FFP) is one of the most widely used models to define physical frailty. The aim of this study is to investigate the crosscultural validity and reliability of Fried frailty phenotype (FFP) in older Turkish population. METHODS: A total of 450 patients, aged 59 years and over, were included. FFP translated into Turkish was used. Hand grip strength cut-off values that best predict low skeletal muscle mass index (SMI) for Turkish men and women were calculated. A modified version of FFP was created by rescoring FFP according to these cut-off values applicable to Turkish population. Correlation analysis between the frailty assessment by comprehensive geriatric evaluation of clinician experienced in geriatric medicine, and FFP and modified version of FFP were performed for validation. Thirty-five patients underwent frailty assessment with FFP twice for reliability assessment. Inter-rater and intra-rater agreements were investigated. RESULTS: Clinician's decision of frailty status demonstrated significant agreement with the results of FFP, as well as modified FFP. Interrater and intra-rater compliance were good. Best hand grip strength cut-off values for predicting low SMI in older Turkish population were determined as ≤13.6 kg (AUC: 0.841, p < 0.001) for women and ≤27.7 kg for men (AUC: 0.779; p < 0.001). Modified FFP had a good agreement with the FFP. DISCUSSION: FFP is a valid and reliable tool for Turkish population.

Assessment of the Appropriateness of Prescriptions in a Geriatric Outpatient Clinic

Objectives: Appropriateness of the geriatric outpatients' medications needs special attention due to risks of falls, fractures, depression, hospital admissions and mortality. This study aimed to identify current practice on medication usage by using the 2nd version of "Screening Tool of Older People's Potentially Inappropriate Prescriptions" and "Screening Tool to Alert Doctors to Right Treatment" criteria and affecting factors for the Turkish population. Materials and Methods: This cross-sectional study was conducted between September 2015 and May 2016 at a university research and training hospital's geriatric outpatient clinic. Patients aged ≥65 years and had ≥5 different prescribed medications (considered as polypharmacy) were recruited. The main outcome measure was the frequency of inappropriate medications identified by clinical pharmacist in the outpatient clinic according to the 2nd version of the criterion sets. Results: A total of 700 patients (440 female) were included in this study. According to the results, 316 patients (45.1%) with at least one potentially inappropriate medication and 668 patients (98.3%) with at least one potential prescription omission were detected. Potentially inappropriate medications were associated with the number of medications used per patient [odds ratio (OR): 1.20 p<0.001], living alone (OR: 4.12 p=0.02), and having congestive heart failure (OR: 2.41 p<0.001). Twenty-two (27.5%) out of 80 criteria and 4 (11.8%) out of 34 criteria did not apply to the study population. Conclusion: Detecting inappropriate medications to maintain treatment effectiveness is necessary to provide the optimum therapy. Despite the awareness of polypharmacy in outpatient clinics it is still one of the important causes of inappropriate prescription followed by vaccination rate. Therefore, with the contribution of clinical pharmacist using these available criteria is important, moreover modification of these criteria according to the local needs to be considered to achieve better outcomes.

Effect of anxiety on COVID-19 infection in hemodialysis patients.

Some evidence suggests that anxiety deteriorate the immune system. We aimed to determine the effect of anxiety on COVID-19 infection in hemodialysis (HD) patients. Our study was conducted with 80 HD patients. State-Trait Anxiety Inventory (STAI), and Beck Anxiety Inventory (BAI) questionnaires were administered between April 15 and May 1, 2020. These patients were followed up for about 8 months and COVID-19 infection, hospitalization, and death rates were recorded. Twenty-one (26%) of the patients were diagnosed with COVID-19 infection. Fourteen out of twenty one (66.6%) of the patients were hospitalized, and 8/21 (38%) of them died due to COVID-19. STAI-S (p= 0.006) and BAI (p= 0.021) scores were found to be higher and STAI-T (p= 0.040) score was found to be lower in HD patients who were infected with COVID-19 compared to without, at the follow-up period. It might be concluded in this study that COVID-19 was more common in anxious HD patients.

Adherence to the Mediterranean diet in Turkish hospitalized older adults and its association with hospital clinical outcomes.

AIM: To identify the Mediterranean diet adherence in Turkish older inpatients and its relation to clinical outcomes. METHODS: A total of 200 hospitalized patients over 60 years old (mean age; 72.9 ± 8.5 years, 59.5% female) were included in the study. Beside evaluating the demographic properties, they were evaluated by Elderly Dietary Index (EDI), Mini-nutritional assessment-short form (MNA-SF), and FRAIL index. Length of hospital stay, need of intensive care, and hospital clinical outcomes were also recorded. RESULTS: According to the EDI scoring, the rate of unhealthy diets among study population was 91.5% and 56% of the patients were frail and 17% were malnourished. EDI score was significantly and positively correlated with height (rho=0.183), weight (rho=0.142), MNA-SF score (rho=0.204), glomerular filtration rate (GFR) (rho=0.152), and alanine-aminotransferase (ALT) (rho=0.278) levels (p = 0.009; 0.046; 0.004; 0.032; and <0.001, respectively). EDI scores were higher in male and married patients when compared to female and widow ones (p = 0.001 and 0.023, respectively). There was a negative, moderate, and statistically significant correlation between EDI score and length of hospital stay in patients hospitalized for infectious diseases (rho:-0.510; p = 0.036). EDI score was also significantly related to frailty status (p = 0.017) and malnutrition (p = 0.026). The EDI score was found to be an independent parameter for frailty in a regression analysis model (OR=0.826;%95 CI: 0.713-0.959; p = 0.012). CONCLUSION: It was shown that hospitalized older adults had a low adherence to the Mediterranean diet. Unhealthy diet group might be associated with poor clinical outcomes such as malnutrition, frailty, increased length of hospital stay, and recurrent emergency department admissions.

Predictive ability of the G8 screening test to determine probable sarcopenia and abnormal comprehensive geriatric assessment in older patients with solid malignancies.

BACKGROUND: Pre-treatment evaluation for sarcopenia is recommended in cancer patients. New screening tests that are less time-consuming and can identify patients who will potentially benefit from geriatric assessment are being developed; the G8 geriatric screening test is one such example. We aimed to investigate whether the G8 screening test can detect probable sarcopenia and is valid and reliable compared to a comprehensive geriatric assessment (CGA) in Turkish older adults with solid cancers. METHODS: We included solid cancer patients referred to a single center. Probable sarcopenia and abnormal CGA were defined as low handgrip strength. Cut-offs for handgrip strength in the Turkish population have been previously determined to be 32 kg for males and 22 kg for females and impairment in at least one of the CGA tests, respectively. The CGA tests comprised KATZ Basic Activities of Daily Living Scale Lawton-Brody Instrumental Activities of Daily Living Scale, Mini-Mental-State Examination Scale, Geriatric Depression Scale-15, and Mini-Nutritional Assessment Short Form. Receiver operating characteristic curve analyses evaluated the test's predictive ability. Intra-rater and inter-rater reliabilities were assessed. RESULTS: The median age of the 76 patients included was 72 (65-91) years. There was a moderate correlation between handgrip strength and the G8 test total score. The sensitivity and specificity of the G8 test to detect probable sarcopenia alone (cut off score = 12.5) were 50 and 92%, respectively (AUC: 0.747; p < 0.001); to determine abnormal CGA plus probable sarcopenia (cut off score = 13) were 93.33 and 86.89%, respectively (AUC: 0.939; p < 0.001); and to detect abnormal CGA alone (cut off score = 14) were 79.63 and 95.45%, respectively (AUC: 0.893; p < 0.001). The G8 test results agreed with those of CGA (κ = 0.638; p < 0.001). Both inter- and intra-rater assessments of G8 scores revealed a strong agreement (Interclass correlation coefficient = 0.979, p < 0.001 and ρ = 0.994, p < 0.001, respectively). CONCLUSIONS: The Turkish version of the G8 test is a good screening tool to detect probable sarcopenia alone and in conjunction with abnormal CGA in older patients with solid malignancies. The G8 screening tool may thus be useful in detecting probable sarcopenia in Turkish older adults with solid cancers.

Comparative Evaluation of Predictive Ability of Comprehensive Geriatric Assessment Components Including Frailty on Long-Term Mortality.

Background: This study aims to compare the predictive value of all comprehensive geriatric assessment (CGA) parameters with the predictive value of frailty assessment (with Edmonton Frailty Scale (EFS) and Fried Frailty Index (FFI)) for long-term mortality, in older adults.Methods: A total of 967 patients were included, consecutively. At the first admission, age, gender, comorbidities, number of drugs, and laboratory values of the patients were recorded. Each patient underwent CGA which consisted of anthropometric measurements, functional, cognitive, mood, nutritional, gait, fall, sleep duration, and frailty assessment. Fifty-seven months after the first admission, CGA parameters were analyzed to determine their predictive abilities on long-term mortality due to all causes, comparatively.Results: The median age was 73 years (range 65-94 years). The median follow-up time was 39.9 months (range 0.5-57.3 months). Serum albumin level, FFI, EFS, instrumental activity of daily living (IADL) score, and walking time were the best predictors of mortality. There was no significant difference between these parameters in predicting mortality.Conclusion: FFI and EFS have similar predictive value for mortality. In busy clinical practice, a new index based on IADL, walking time, and serum albumin level may be an alternative of frailty assessment for predicting mortality.

Ultrasonography versus bioelectrical impedance analysis: which predicts muscle strength better?

Background & Aim: Muscle strength seems to be more relevant to the functionality than muscle mass in sarcopenia. Different diagnostic techniques are available for the evaluation of muscle mass. Ultrasonography (USG) seems to have some advantages compared to other techniques especially bioelectrical impedance analysis (BIA) including being not affected of the results by the factors like extreme body mass indexes (BMI) or hypervolemia. The aim of the study is to determine and compare the muscle strength prediction value of muscle mass measured by using USG or BIA and determine the cut-off values for the Turkish population.Methods: One hundred and thirty six patients admitted to geriatrics outpatient clinic for comprehensive geriatric assessment were included in the study. Body composition was determined by BIA and skeletal muscle mass index (SMI) was measured. Thickness of the gastrocnemius muscle was measured via USG. Diagnosis of sarcopenia was made according to the EWSGOP 2 diagnostic criteria.Results: The best cut-off value for gastrocnemius muscle thickness to predict low HGS was ≤13.8 mm (AUC:0.690,p <0.001). SMI was not found to predict low HGS (AUC:0.573,p >0.05). Comparison of AUCs for gastrocnemius muscle thickness and SMI showed that gastrocnemius muscle thickness had higher AUC (p=0.008). For predicting sarcopenia, the best cut-off value of gastrocnemius muscle thickness was found to be ≤12.3 mm in women (AUC: 0.862,p <0.001) and ≤12.3 mm in men (AUC:0.900, p < 0.001).Conclusions: In this study, we found that gastrocnemius thickness measured by USG seems to predict low HGS better than SMI measured by BIA.

Frailty is associated with poor sleep quality in the oldest old

Background/aim: Sleep disorders and frailty increase with advancing age, along with physical disabilities, cognitive dysfunction, mood disorders, and social vulnerability. Thus, the study objective was to evaluate the relationship between frailty and sleep quality in the oldest old patients. Materials and methods: In this study, 100 patients aged ≥80 years were assessed using comprehensive geriatric assessment (CGA) including basic activities of daily living (ADL), instrumental ADL, handgrip strength, the Geriatric Depression Scale-15, the Mini- Mental State Examination, and the Mini-Nutritional Assessment-Short Form. The sleep quality and frailty status of the patients were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Fried Frailty Index, respectively. Results: The median age of the participants was 84 years (80­92), 55% of them were women, and 41% of them were frail. There was no statistically significant difference between the frail and nonfrail groups in terms of age, sex, and comorbidities (P > 0.050). The frail patients scored poorly according to the CGA tests when compared to the nonfrail ones (P < 0.050). The median score for the PSQI was significantly higher in the frail group, 12 points (3­19) versus 6 points (1­19) in the nonfrail patients (P < 0.001). The PSQI score (odds ratio [OR] of 1.308, 95% confidence interval [CI]: 1.092­1.566, P = 0.004), female sex (OR of 5.489, 95% CI: 1.063­28.337; P = 0.042), and the basic ADL score (OR of 0.383; 95% CI: 0.207­0.706; P = 0.002) were found to be independently associated with frailty using multivariate analysis. Conclusion: Sleep quality was significantly decreased in the oldest old frail patients compared to the nonfrail ones, and poor sleep quality was independently associated with frailty. Evaluating the sleep patterns of the oldest old patients with CGA in daily geriatric practice might help to improve the quality of life of frail patients.

Diaphragmatic muscle thickness in older people with and without sarcopenia.

BACKGROUND: Studies in mice have suggested that sarcopenic animals may have atrophic diaphragmatic muscles; however, to date, no clinical studies are available. AIMS: To investigate whether the diaphragmatic thickness is affected in older patients with sarcopenia and if this is associated with impaired respiratory functions. METHODS: Thirty sarcopenic and 30 non-sarcopenic elderly patients aged over 65 were included. All patients underwent comprehensive geriatric assessment. The diagnosis of sarcopenia was made according to the criteria of the European Working Group on Sarcopenia in Older People. Ultrasonographic evaluations of the patients were carried out by an experienced radiologist. Diaphragmatic thickness was measured in three positions: end of deep inspiration, quiet breathing, end of forced expiration. Peak expiratory flow (PEF) rate was evaluated by a peak flow meter. RESULTS: The mean age of the patients was 77 ± 6 years, and 58% were females. Diaphragmatic thickness in three different positions (deep inspiration [2.3 mm (min-max: 1.3-4.1) vs. 2.5 mm (min-max: 1.9-4.9)], quiet breathing [1.8 mm (min-max: 1.0-2.8) vs. 2.00 mm (min-max: 1.3-3.9)] and end of forced expiration [1.1 mm (min-max: 0.7-2.5) vs. 1.5 mm (min-max: 0.5-3.4)]) were found to be thinner in sarcopenic patients compared to non-sarcopenics (p = 0.02, p = 0.02, p < 0.01, respectively). Also, PEF rate results were lower in patients with sarcopenia (245 L/min [min-max: 150-500] vs. 310 L/min [min-max: 220-610], p < 0.01). Diaphragmatic muscle thicknesses in all three positions were independently associated with sarcopenia status of the participants. CONCLUSIONS: Our results suggest that sarcopenia in older people may be associated with reduced diaphragmatic muscle thickness and respiratory functions. Findings are needed to be confirmed in further multicenter studies with big sample sizes.

Validity and reliability of the G8 screening test in older non-cancer patients.

PURPOSE: A comprehensive geriatric assessment (CGA) is a time-consuming approach that requires a special team and a screening test, whereas the G8 screening test is a practical and validated test for screening cancer patients. This study aimed to evaluate the validity and reliability of the G8 test in older patients without cancer and to investigate its concordance with CGA in an outpatient clinic. METHODS: Two hundred older patients were included in the study. CGA and G8 tests were performed, and the concordance between them was evaluated for scale validity using Spearman correlation coefficients (r) and kappa analyses. Patients who obtained scores lower than the predefined cutoff values in at least one of the CGA tests were considered to have an abnormal CGA. Inter-rater and intra-rater concordance were assessed for reliability. RESULTS: Of the 200 patients, 57.4% were female, and the median age was 73 (63-93) years. There was a strong concordance between the CGA and G8 screening test (kappa: 0.630; p < 0.001). Inter-rater and intra-rater concordance in the reliability assessments were high (kappa: 0.886; kappa: 875; p < 0.001, respectively), and inter- and intra-clinician assessments of the G8 scores revealed significant correlations (r = 0.962 and r = 0.976, respectively; p < 0.001). CONCLUSION: The G8 screening test is a valid and reliable tool for older adults without malignancy. It is a quick and practical test for physicians who frequently admit older patients.