Malnutrition and Depressive Symptoms in Elderly Palliative Care Patients.

Objective: The aim of this study is to determine the prevalence of and relationship between malnutrition and depressive symptoms in older palliative care inpatients. Methods: One hundred and thirty-six older adults were included in the study. The Geriatric Depression Scale, Mini Nutritional Assessment Short Form, Mini Mental State Examination, Barthel index, and Lawton & Brody index were used to evaluate the mood, nutrition status, mental status, and activities of daily living of the patients. Results: The mean age of the patients was 74.88 ± 8.82 years, and 63.2% of the patients were female. According to the nutritional assessment, 39.7% of the patients suffered from malnutrition, while 47.1% were at risk for it, and depressive symptoms were detected in 79.4% of the patients. A strong negative correlation was found between the scores for nutritional and depressive symptoms (r = -.750, 95% CI = -.834 to -.668). Conclusion: Malnutrition, risk of malnutrition, and depressive symptoms were found to occur often among the patients, and the relationship between them was statistically significant. Our results highlight that the quality of life of palliative care patients could be improved by providing adequate nutrition and psychological support.

Is increased neutrophil lymphocyte ratio remarking the inflammation in sarcopenia?

OBJECTIVES: Increasing data suggests that chronic inflammation has an essential role on development of muscle dysfunction and progression of sarcopenia in aging population. The aim of the present study was to compare Neutrophil Lymphocyte Ratio (NLR) levels in sarcopenic and non-sarcopenic individuals and to present the correlation between NLR and other inflammatory markers. METHODS: A total of 105 subjects with sarcopenia (male/female: 54/51, mean age 72.8 ±â€¯7.3) and 314 subjects as non-sarcopenic (male/female: 125/189, mean age 71.44 ±â€¯5.4) were enrolled in this cross-sectional study. Sarcopenia was diagnosed according to The European Working Group on Sarcopenia in Older People criteria. Comprehensive geriatric assessment was performed to participants. Complete blood count, biomarkers of inflammation (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)) of all patients were measured. RESULTS: NLR levels were found to be higher in the sarcopenic group (2.52 ±â€¯1.30 vs 2.21 ±â€¯0.93, p < 0.013, respectively). Compared to non-sarcopenic participants white blood cell (WBC), ESR and CRP levels were also higher in sarcopenic group. There was a positive correlation between CRP, WBC, total body fat ratio and NLR (r: 0.433, p < 0.001; r: 0.237, p: 0.022; r: 0.339, p < 0.001, respectively). A strong negative correlation was identified between fat free mass and NLR levels in sarcopenic individuals (r: -0.755, p < 0.001). The result of the logistic regression analysis depicted that NLR is an independent predictor for sarcopenia (OR = 1.31; 95% CI = 1.06-1.62, p: 0.013). CONCLUSION: Increased NLR levels may indicate that inflammation may have a significant role in development of sarcopenia in the elderly population.

Health-related quality of life and fall risk associated with age-related body composition changes; sarcopenia, obesity and sarcopenic obesity.

BACKGROUND: Sarcopenia, obesity, and sarcopenic obesity are various features of the ageing process that can cause important health issues. The present study was undertaken to investigate the interrelationship between those body composition changes, including their clinical components and the quality-of-life variables. METHODS: A total of 423 individuals aged 65 years or older was included in this cross-sectional study. Sarcopenia was diagnosed according to The European Working Group on Sarcopenia in Older People criteria. Body composition parameters were measured with a bioelectrical impedance analyser, and Turkish population-based cut-off points were preferred for diagnosis of sarcopenia. Comprehensive geriatric assessment was performed on all patients. A logistic regression analysis was performed to identify important factors for sarcopenia and sarcopenic obesity. RESULTS: The prevalence of sarcopenic, obese and sarcopenic obese subjects was 14%, 35% and 11% respectively. The lowest mean gait speed and hand grip strength values were seen in the sarcopenic obese group (0.6 ± 0.3 m/s and 19.7 ± 9.8 kg respectively). Sarcopenic obese participants were associated with the highest rate for fall risk. The scores for domains of health-related quality of life were worse in both obesity and sarcopenic obesity when compared to others. Body mass index (BMI), number of drugs used, total body fat ratio and geriatric depression scale-short form scores were negatively correlated with all dimensions of SF-36 quality-of-life scale. CONCLUSIONS: Sarcopenia, obesity and sarcopenic obesity are associated with many negative health outcomes, such as high fall risk and low health-related quality of life in geriatric population.

The effect of blood glucose regulation on sarcopenia parameters in obese and diabetic patients.

OBJECTIVES: This study aims to evaluate the effect of blood glucose regulation on sarcopenia parameters in sarcopenic, obese, and poorly- regulated diabetic patients. PATIENTS AND METHODS: Between June 2013 and December 2013, a total of 147 patients (64 males, 83 females; mean age 70.3±6.3 years; range, 60 to 90 years) who were diagnosed with sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria were included in the study. All patients were obese with a body mass index (BMI) of >30 kg/m2 and their glycated hemoglobin (HbA1c) levels were above 8%. Sarcopenia parameters including the gait speed, muscle strength, muscle mass, and handgrip strength were assessed. After a six-month treatment period, the patients were divided into two groups according to their HbA1c levels as having <8% or >8%. Sarcopenia parameters were evaluated before and after receiving treatment. RESULTS: The mean disease duration was 16±6.2 years. Sixty patients were found to have a HbA1c level of <8% and 45 patients with a HbA1c level of ≥8% at sixth months of follow-up. In better regulated group, sarcopenia parameters such as gait speed, muscle mass, and handgrip strength improved; however, only the change in the muscle mass was found to be statistically significant (p=0.041). There was no significant change in the parameters of sarcopenia in the patient group with a HbA1c level ≥8%. A negative correlation was found between the muscle mass and HbA1c levels in good- and poorly-regulated groups (p=0.039 r:-0.327 and p=0.044 r:-0.183, respectively). CONCLUSION: Our study demonstrates that lowering HbA1c levels may have positive effects on the muscle mass even in diabetic and sarcopenic obese elderly individuals.

Quality of life and fall risk in frail hospitalized elderly patients

Background/aim: Frailty is a complex, multifactorial, and important geriatric syndrome characterized by decline in physiological reserves and functional deficiency in multiple systems. The aim of the current study is to investigate the prevalence of frailty and to determine the correlation between quality of life (QoL) and falling risk in geriatric hospitalized patients. Materials and methods: A total of 420 patients, aged 65 years and above, were enrolled in the study. All participants were hospitalized at a university hospital in the internal medicine clinics. The Cardiovascular Health Study (CHS) frailty scale, Health-Related Quality of Life Short Form (SF-36) scale, and Hendrich II Fall Risk Model were administered to the patients. Demographic data of patients, number of chronic diseases, and information on used medication were also collected.Results: The median age of patients was 71.9 ± 6.3 years and 49.5% of the patients were female. By applying the CHS frailty scale, the proportion of frail patients was determined to be 65.5%. There were statistically significant differences among quality of life mean scores of robust, prefrail, and frail patients (P < 0.001). Frail patients had the lowest scores in all SF-36 subgroups. Eighty-three (19.8%) patients were in the low-risk group while 337 (80.2%) were high-risk according to the Hendrich II Fall Risk Model. The rate of patients with high falling risk and poor QoL reached a maximum in the frail group (96%).Conclusion: Frailty is an important geriatric syndrome in elderly hospitalized patients. Poor QoL and high falling risk are issues commonly experienced with frailty.

A case of vemurafenib-induced polyarhritis in a patient with melanoma: how to manage it?

Vemurafenib is an inhibitor of the BRAF V600E mutation which is associated with tumor responses in patients with metastatic melanoma. Although it is generally well tolerated, common side effects of vemurafenib have been reported. Arthralgia is one of the more common adverse event associated with vemurafenib. We herein report a 49-year-old woman diagnosed with metastatic melanoma harboring the BRAF V600E mutation with severe polyarthritis associated with vemurafenib after 7 days of treatment. Sonographic examination of affected joints revealed synovitis and the patient's articular symptoms were improved by analgesic and anti-inflammatory treatment, including corticosteroids. During therapy with selective BRAF inhibitors, arthritis represents a new adverse event that can require dose reduction. In case of this adverse event, treatment with anti-inflammatory drugs, such as ibuprofen and prednisone, should be initiated early to keep patients on treatment and to avoid drug discontinuation and tumor progression.

Increased mean platelet volume in patients with idiopathic subjective tinnitus.

Tinnitus is the perception of sound with no external stimulus and idiopathic subjective tinnitus is the most common type in adults. Mean platelet volume (MPV) alterations were shown in some inflammatory diseases and were evaluated as a clinically useful marker. Our aim was to investigate MPV alterations in idiopathic subjective tinnitus patients. A total of 101 patients and 54 age- and sex-matched healthy control subjects were enrolled in the study. Patients included in the study had complaints of tinnitus for at least 3 months. All patients underwent detailed otolaryngologic examination, blood sampling, pure tone audiometry, magnetic resonance imaging of ear, and vertebrobasilar artery Doppler ultrasonography to make the differential diagnosis of tinnitus. Blood sampling consisted of renal-liver-thyroid function tests, lipid profile, and complete blood count. All tests and examinations except the imaging modalities were also performed for the control group. There were no differences in age and sex distribution of groups. Mean platelet volume values were significantly increased in tinnitus patients when compared with controls (p = 0.001). We think that MPV can be qualified as a useful marker in tinnitus patients.

Drug- and herb-induced liver injury: a case series from a single center.

BACKGROUND/AIMS: Drug-induced liver injury (DILI) is common worldwide and has a potentially fatal outcome. It accounts for more than half of the cases of acute liver failure in the United States. Herb-induced liver injury (HILI) is a less documented condition but a growing problem. We present here the clinical characteristics and outcome of patients with drug- and herb-induced liver injury from our center. MATERIALS AND METHODS: In this 4-year retrospective study, 82 patients in whom there was a causal or highly probable relationship between herbal medicine or drug use and liver disease are presented. RESULTS: The mean age of patients was 43.1±14.8 years; sexual distribution was 53 females and 29 males. The major cause of hepatotoxicity was drugs (87.8%), with herbal medicine accounting for 12.2%. The leading causative agents were nonsteroidal anti-inflammatory drugs (NSAIDs) (23.1%), followed by antibiotics (19.5%). The pattern of hepatotoxicity was hepatocellular in 35 patients (42.6%), mixed in 28 (34.1%), and cholestatic in 19 patients (23.1%). Teucrium polium (known popularly as felty germander), which is a traditionally used herbal medicine of the Labiatae family in our region, was the most common cause of herb-induced liver injury and responsible in 7 of 10 herbal hepatotoxic cases. Acute liver failure developed in 3 patients (two patients related with flurbiprofen and diclofenac and one patient due to an isoniazid-rifampicin combination). CONCLUSION: Antibiotics and NSAIDs were the most common etiologic agents for drug-induced liver injury. Surprisingly, herbs follow these groups of drugs and must be questioned more carefully.

An evaluation of oxidative stress and antioxidant capacity in patients with myofascial pain syndrome.

OBJECTIVE: To evaluate total antioxidant capacity (TAC) and total oxidative stress (TOS) values in patients with myofascial pain syndrome (MPS). METHOD: The study comprised 38 patients diagnosed with MPS and 30 healthy volunteers. The age, body mass index (BMI) and pain scores (evaluation by visual analogue scales) of all the participants were recorded. The TAC, TOS and oxidative stress index (OSI) levels were compared between the MPS and control groups. RESULTS: There was no significant difference between the MPS and control groups in respect of demographic characteristics. The TAC levels were determined to be significantly lower and TOS levels and OSI values, significantly higher in the MPS patients than in the control group. CONCLUSION: The results of this study determined that the oxidant/antioxidant balance was impaired in MPS patients and thus MPS can be considered to be related to an increase in oxidative stress.

Palosuran treatment effective as bosentan in the treatment model of pulmonary arterial hypertension.

Pulmonary arterial hypertension (PAH) is a progressive and fatal disorder that any valuable advance in the management of diseases has crucial importance. The present study aimed to compare the Endothelin1 (ET1) inhibitor bosentan which is regarded as standard therapy with different dose regimens of palosuran which is urotensin-II (UII) inhibitor and explore the discrepancy for mean pulmonary arterial pressure (mPAP), UII, ET1 levels, and pulmonary vascular pathology. Seventy rats were randomly divided into seven groups of ten animals each: group 1 (control group) received the vehicle subcutaneously, instead of monocrotaline (MCT) and vehicle; group 2 (MCT group) received subcutaneous MCT and vehicle; and group 3 (MCT + palosuran 30 mg) received subcutaneous MCT and palosuran. Other groups consist of group 4 (MCT + palosuran 100 mg), group 5 (MCT + bosentan 30 mg), group 6 (MCT + bosentan 100 mg), and group 7 (combination therapy). Serum ET1, UII, mPAP levels, and pulmonary arteriolar pathology of different diameter vessels of all groups have been measured and recorded. The ET1 and UII levels of untreated rats (group 2) were significantly higher than the other groups (p < 0.05). Moreover, mPAP levels of group 2 were significantly higher than the other groups (p = 0.001). Finally, 50-125-µm diameter of arteriole wall thickness was found to be significantly thicker in monocrotaline group compared to groups 4 and 6 (p < 0.001). Statistical differences of wall thickness/diameter ratios of arteries and arterioles larger than 125 was found to be significant between group 5, group 6, and the control group (p < 0.001). UII inhibitor is at least as effective as standard therapy bosentan. Findings of this study consolidate that palosuran could be a new future promising therapeutic option in PAH.

Thrombocytopenia caused by albendazole in a patient with Sjögren's syndrome: A case report.

Sjögren's syndrome (SS) is an autoimmune disease characterised by a chronic inflammatory response mainly localised to the lachrymal and salivary glands. Haematological abnormalities are common, although they rarely have clinical significance. Here, we report a patient with SS and thrombocytopenia caused by albendazole. Haematological abnormalities such as thrombocytopenia are seen in approximately 5-15% of SS patients; however, this disease is usually asymptomatic and can often be recovered to normal levels with corticosteroids. If it is not, we should keep in mind other reasons for the thrombocytopenia, such as drug use.

Heart rate variability in familial Mediterranean fever patients.

OBJECTIVE: Familial Mediterranean fever (FMF) is an autosomal recessive autoimmune disease, presenting with the attacks of fever and inflammation of serous membranes. One of the leading causes of death in autoimmune rheumatologic diseases is cardiovascular events. The purpose of this study is to evaluate the effects of FMF on the autonomic nerve and cardiovascular systems by measuring the indices of heart rate variability (HRV). MATERIAL AND METHODS: Thirty FMF patients and the same number of healthy volunteers were enrolled to the study. Standard deviation of all R-R intervals (SDNN), the square root of the sum of the square of the differences between successive R-R intervals (RMSSD), standard deviation of 5-minute mean values of R-R interval (SDANN), low frequency (LF), and high frequency (HF) were measured. RESULTS: Time domain indices (SDNN, SDANN, and RMSSD) were: 124.67±40.79, 129.87±36.43 (p=0.605); 11.43±38.41, 11.23±38.98 (p=0.984); and 33.43±17.39, 38.17±12.8 (p=0.235) for FMF patients and controls, respectively, and similar in both groups. Frequency domain indices (HF, LF, and LF/HF) were: 290.41±290.25, 322.20±222.54 (p=0.639); 596.16±334.07, 805.80±471.00 (p=0.051); and 3.57±2.57, 3.05±1.40 (p=0.338) for FMF patients and controls, respectively, and similar in both groups. CONCLUSION: The HRV parameters were similar in both groups. However, studies including larger populations and using different methods are required to clarify if autonomic dysfunction exists in patients with FMF.

Mean platelet volume seems to be a valuable marker in patients with systemic sclerosis.

The predictors for the development of cardiovascular diseases and peripheral arterial diseases in patients with systemic sclerosis (SSc) were not clearly established, and there is no specific study conducted to investigate the mean platelet volume (MPV) levels in SSc patients. Therefore, this study evaluates the MPV levels in SSc and possible relationship between SSc, its clinical features and activity/severity scores, and MPV. In total, 76 SSc patients (67 women and 9 men, mean age 50.44 ± 13.21 years) diagnosed according to the classification criteria of the American College of Rheumatology and 45 healthy volunteers were enrolled into study. Data relating to anamnesis, physical examination, MPV, erythrocyte sedimentation rate, C-reactive protein levels, electrocardiography, echocardiography, high-resolution computerized tomography findings, complaints, and treatment processes were recorded into the database. Of the total cases, 17 had (22.3 %) cardiac involvement, 45 had gastrointestinal involvement (59.2 %), 47 had (61.8 %) lung involvement, 31 (32 %) had finger flexion deformity, and 27 (35.5 %) had digital ulcers at the fingertips. The mean MPV levels of SSc patients were significantly higher than those of the control group (p = 0.008). The mean MPV levels of SSc patients with cardiac involvement, digital ulcers, and gangrene presence were significantly high, and lower in Ilomedin-receiving patients than in the Ilomedin naives (p < 0.05). A negative relationship was discovered between the mean MPV levels, Valentini score, and Disease Severity Index of the patients with systemic sclerosis (p = 0.006, r = -0.310; p = 0.047, r = -0.229). MPV levels were significantly elevated in SSc patients and they were negatively correlated with disease activity scores. Increased MPV levels would be a predictive marker in the diagnosis of macrovascular and microvascular disease involvement in SSc patients.

A patient with pneumopericardium secondary to extranodal T-cell lymphoma.

Natural killer (NK)/T-cell lymphomas represent a rare type of lymphoma derived from either activated NK cells or cytotoxic T cells. Most cases with T/NK cell lymphoma present with extranodal manifestations. Primary nodal disease is very rare. The upper respiratory tract is the most common site involved in extranodal disease. Symptoms include epistaxis and nasal obstruction. T/NK cell lymphomas show aggressive and invasive clinical progression, with a poor prognosis. Without treatment, survival is measured in months. We report a case of a 51-year-old male patient with pneumopericardium as a complication of intestinal T/NK cell lymphoma. To the best of our knowledge, this is the first report showing pneumopericardium as a fatal complication of T/NK cell lymphoma. Pneumopericardium should be considered in patients diagnosed with T/NK cell lymphoma presenting with chest pain.