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.

Aging and cardiac implantable electronic device complications: is the procedure safe in older patients?

BACKGROUND: In this study, we investigated whether there is a higher incidence of cardiac implantable electronic devices (CIED) procedures related complications in older (≥ 75 years) than in younger (< 75 years) patients. METHODS: This retrospective cohort study enrolled patients who had undergone CIED procedures (de novo implantation, system upgrade, generator substitution, pocket revision or lead replacement) at two heart centers in Turkey between January 2011 and May 2023. The primary composite endpoint included clinically significant hematoma (CSH), pericardial effusion or tamponade, pneumothorax, and infection related to the device system. Secondary outcomes included each component of the composite end point. RESULTS: The overall sample included 1923 patients (1419 < 75 years and 504 aged ≥ 75 years). There was no difference between the groups in terms of cumulative events defined as primary outcome (3.5% vs. 4.4%, p = 0.393). Infection related to device system was significantly higher in the ≥ 75 age group (1.8% vs. 3.4%, p = 0.034). There was no significant difference between the groups in terms of clinically significant hematoma and pneumothorax (0.7% vs. 0.4%, p = 0.451, 1.4% vs. 1.0%, p = 0.477, respectively). In multivariate model analysis, no association was found between age ≥ 75 years and infection related to the device system. CONCLUSION: Infection rates were relatively higher in the patient group aged ≥ 75 years. This patient group should be evaluated more carefully in terms of infection development before and after the procedure.

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.

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.

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.

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.

Predictors of 2-year mortality in geriatric patients hospitalized with COVID-19 in Türkiye: a retrospective cohort study.

Aim: To reveal factors affecting 2-year mortality in geriatric patients hospitalized with COVID-19.Methods: Demographic characteristics, clinical and laboratory data, thorax computed tomography (CT) images, second-year survival status, and causes of death were analyzed.Results: The 2-year post-discharge mortality rate of 605 patients was 21.9%. Mean age of patients in the deceased group was 76.8 ± 8.1 years, which was shorter than the life expectancy at birth in Türkiye. Older age (≥85), delirium, some co-morbidities, and atypical thorax CT involvement were associated with a significant increase in 2-year mortality (p < 0.05).Conclusion: This is the first study to evaluate factors associated with 2-year mortality in older COVID-19 patients. Identifying risk factors for long-term mortality in geriatric COVID-19 patients is important.

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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 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 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.

Fatigue and primary sarcopenia in geriatric patients.

OBJECTIVE: This study aimed to investigate the frequency of fatigue in geriatric patients with primary sarcopenia and to evaluate the relationship between fatigue and symptoms such as depression and sleepiness. METHODS: This case-control study was conducted between December 2020 and August 2021 in the geriatrics outpatient clinic of Istanbul University-Cerrahpasa. The European Working Group on Sarcopenia in Older People 2 criteria were considered for the diagnosis of sarcopenia. Demographic data, accompanying chronic diseases, comprehensive geriatric assessments, and laboratory values of the patients were noted. Scales used to assess fatigue in all participants include Fatigue Assessment Scale, Fatigue Severity Scale, and Fatigue Impact Scale and associated symptoms include Geriatric Depression Scale and Epworth Sleepiness Scale. RESULTS: The mean (standard deviation) age was 75.3 (7.1) for 51 primary sarcopenia (38 female) patients and 73.5 (5.8) for 51 control (37 female) patients. There was no significant difference between the two groups in terms of gender and age (p=0.822, p=0.171). The prevalence of hypertension was higher, and the level of education was lower in the sarcopenic group than in the nonsarcopenic group (p=0.017, p=0.013). Fatigue Assessment Scale, Fatigue Severity Scale, Fatigue Impact Scale total, Fatigue Impact Scale cognitive, Fatigue Impact Scale physical, and Fatigue Impact Scale social questionnaire scores were significantly higher in the sarcopenic group (all p<0.001). The Geriatric Depression Scale score was statistically higher in the sarcopenic group; however, there was no significant difference in the Epworth Sleepiness Scale score between the two groups (p=0.014, p=0.072). Multivariate analysis was performed on education level, hypertension, fatigue questionnaires, and Geriatric Depression Scale, which were found to be significant in the univariate logistic regression analysis. In the multivariate logistic regression analysis, only the Fatigue Impact Scale total was determined to be associated with sarcopenia [odds ratio 1.161, 95% confidence interval (1.084-1.242)]. CONCLUSION: In primary sarcopenia, there is mental and social fatigue as well as physical fatigue. Therefore, the prevention and treatment of sarcopenia in geriatric patients is important.

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.

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.

Comparison of attention for malnutrition research on social media versus academia: Altmetric score analysis.

OBJECTIVES: In this study, we aimed to provide bibliometric and Altmetric overviews and visualization and to evaluate the correlation between traditional bibliometric and Altmetric analyses in the field of malnutrition. METHODS: Articles published in the past decade were identified by searching for the term "malnutrition" on the Web of Science indexing database and research platform. The top 50 cited articles were analyzed in terms of title, study type, topic of study, first author, publication year, citation number, keywords, organizations, average citations per year, journal H index, impact factor, and Altmetric attention score. Also, the top 50 Altmetric articles published in the past decade about malnutrition were provided on the website Altmetric.com. RESULTS: Among the top 50 cited articles, the most common study type, topic of study, publication year, and keyword were, respectively, original scientific paper (n = 26), definition-diagnosis of malnutrition (n = 17), 2010 (n = 13), and malnutrition (n = 18). The article titled "Maternal and child undernutrition and overweight in low-income and middle-income countries" in Lancet had the highest citation number, and the article "Impacts of COVID-19 on childhood malnutrition and nutrition-related mortality" in Lancet had the highest Altmetric score. CONCLUSIONS: Evaluating academic publications with an Altmeric analysis in addition to a traditional bibliometric analysis is beneficial because Altmetric attention scores can give information about what the population wants to know about malnutrition and allows us to develop appropriate policies.

A bibliometric analysis of sarcopenia: top 100 articles.

PURPOSE: The aim of this study is to investigate the emergence and development of sarcopenia research and guide to most cited articles for researchers. METHODS: Thomson Reuters' Web of Science database was used to search for all articles related to the term 'sarcopenia'. We also benefited from PubMed to find additional data about these articles. We analyzed the top 100 cited articles (T100) by topic, types of research methods, keywords, journal, author, year, institution, and average number of citations per year, as well. Correlations were also made between the total number of citations, the average number of citations per year (ACpY), impact factors, and the time period of publication. RESULTS: The median number of citations for the most cited articles was 309 (range is from 213 to 4,082). The most investigated topics of sarcopenia were definition-diagnosis (n = 35), prognosis (n = 19), and treatment-recommendation (n = 11). The European Working Group on Sarcopenia in Older People (EWGSOP) consensus definition published in 2010 had the highest total number of citations and ACpY. The most common types of research method, country, year, and keyword were epidemiological studies (n = 55), USA (n = 69), 2010 (n = 13), and sarcopenia (n = 39), respectively. No correlation exists between impact factor (IF) and number of citations or IF and ACpY. CONCLUSION: Despite some flaws, this study identifies the most significant contributions to sarcopenia research and reveals many important scientific breakthroughs and landmarks that took place over the years.

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.

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.

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.

Third-line treatment with second-generation tyrosine kinase inhibitors (dasatinib or nilotinib) in patients with chronic myeloid leukemia after two prior TKIs: real-life data on a single center experience along with the review of the literature.

OBJECTIVES: Newer tyrosine kinase inhibitors (TKIs) (bosutinib, ponatinib) and allogeneic hematopoietic stem cell transplantation (allo-HSCT) can be utilized as a salvage therapy in patients with chronic myeloid leukemia (CML) who failed two lines (imatinib → nilotinib or imatinib → dasatinib) of TKI therapy. However, these TKIs are not available in many countries and not all patients can undergo allo-HSCT. METHODS: In this study, CML patients who received dasatinib or nilotinib as a third-line treatment were retrospectively evaluated. RESULTS: Out of 209 patients, third-line dasatinib/nilotinib was administered in 21. During the follow-up, 16 out of 21 patients gained and/or maintained an optimal response, and 4 patients died due to progression. Seventeen patients were alive at the time of the analysis, of which 13 were still on TKI, whereas 4 patients quit treatment. DISCUSSION: In patients failing two lines of TKI, dasatinib or nilotinib can be beneficial and safely administered as a third-line treatment especially in nations with restricted resources.

Fatigue and primary sarcopenia in geriatric patients

SUMMARY OBJECTIVE: This study aimed to investigate the frequency of fatigue in geriatric patients with primary sarcopenia and to evaluate the relationship between fatigue and symptoms such as depression and sleepiness. METHODS: This case-control study was conducted between December 2020 and August 2021 in the geriatrics outpatient clinic of Istanbul University-Cerrahpasa. The European Working Group on Sarcopenia in Older People 2 criteria were considered for the diagnosis of sarcopenia. Demographic data, accompanying chronic diseases, comprehensive geriatric assessments, and laboratory values of the patients were noted. Scales used to assess fatigue in all participants include Fatigue Assessment Scale, Fatigue Severity Scale, and Fatigue Impact Scale and associated symptoms include Geriatric Depression Scale and Epworth Sleepiness Scale. RESULTS: The mean (standard deviation) age was 75.3 (7.1) for 51 primary sarcopenia (38 female) patients and 73.5 (5.8) for 51 control (37 female) patients. There was no significant difference between the two groups in terms of gender and age (p=0.822, p=0.171). The prevalence of hypertension was higher, and the level of education was lower in the sarcopenic group than in the nonsarcopenic group (p=0.017, p=0.013). Fatigue Assessment Scale, Fatigue Severity Scale, Fatigue Impact Scale total, Fatigue Impact Scale cognitive, Fatigue Impact Scale physical, and Fatigue Impact Scale social questionnaire scores were significantly higher in the sarcopenic group (all p<0.001). The Geriatric Depression Scale score was statistically higher in the sarcopenic group; however, there was no significant difference in the Epworth Sleepiness Scale score between the two groups (p=0.014, p=0.072). Multivariate analysis was performed on education level, hypertension, fatigue questionnaires, and Geriatric Depression Scale, which were found to be significant in the univariate logistic regression analysis. In the multivariate logistic regression analysis, only the Fatigue Impact Scale total was determined to be associated with sarcopenia [odds ratio 1.161, 95% confidence interval (1.084-1.242)]. CONCLUSION: In primary sarcopenia, there is mental and social fatigue as well as physical fatigue. Therefore, the prevention and treatment of sarcopenia in geriatric patients is important.