Anthropometric measurements may be informative for nursing home-acquired pneumonia.

OBJECTIVE: To evaluate the relationship between anthropometric measurements and Nursing Home-Acquired Pneumonia (NHAP) risk. METHODS: Consecutive patients of 65 years or elderly who were living in the Balikli Rum Hospital Nursing Homes were included in this prospective study. At the beginning of this study, the patients' anthropometrics values were measured. The patients were followed for one year, and any incidences of pneumonia attacks were recorded. The relationship between the anthropometric measurements and pneumonia occurrences was analyzed. RESULTS: There were 133 inmates at the initial assessments. Of 108 patients who were eligible for the study, 77 (72.2%) were female and 37 (27.8%) were male. The mean age of the group was 79.8±10.5. Patients were assigned to a group according to the presence of pneumonia during the one -year follow-up. There were 74 (55.6%) patients who had suffered from at least one attack of pneumonia during the follow-up period. The mean triceps skinfold was significantly thinner in the pneumonia group, and the mean handgrip measurements in both the dominant and non-dominant hands were significantly weaker in the pneumonia group. Furthermore, the frequency of Chronic Obstructive Pulmonary Diseases (COPD) was significantly higher in this group (p < 0.001). CONCLUSIONS: The risk of pneumonia was high in the elderly population who live in nursing homes. Simple anthropometric values may be predictive of the potential for Nursing Home-Acquired Pneumonia.

A rare case of paralysis in an endemic area.

Thyrotoxicosis mostly presents with tachycardia, tremor, weight loss and other hypermetabolism signs. However, there are other unusual signs of thyrotoxicosis such as paralysis. This unusual clinical presentation may postpone prompt diagnosis and treatment. In this case report, we present a 27-years-old woman, who presented with quadriparesis at the emergency department.

Is handgrip strength and key pinch measurement related with biochemical parameters of nutrition in peritoneal dialysis patients?

BACKGROUNDS & OBJECTIVE: End-stage renal disease (ESRD) frequently causes Protein Energy Wasting (PEW), which is an important morbidity and mortality factor. Although it is difficult to assess PEW with a reliable method, there are various methods such as Handgrip strength test (HST), serum albumin, cholesterol, etc. HST is a simple and reliable antropometric method which is used for nutritional status and body muscle strength. This study aims to assess the relationship between HST and biochemical markers in evolution of nutritional status of ESRD patients. METHODS: This cross-sectional study included 36 consecutive patients, who are on peritoneal dialysis and 36 healthy -control subjects. Jamar-hand dynamometer was used for handgrip strength test; a pinch gauge was used for key pinch. Other antropometric tests included skin fold thicknesses at biceps, triceps, umbilical, suprailiac and subscapular regions; circumferences at waist hip, neck and midarm. Biochemical tests were performed only in Peritoneal Dialysis (PD) group. SPSS for Windows ver. 15.0 was used for statistics. RESULTS: The mean age of patients was 49.3±14.4, and mean age of control group was 43.8±10.6 (p=0.075). In PD group dominant hand dynamometer test 1,2 and 3 results were 19.3±9.3 kg, 25.3±10.8 kg, 25.5± 10.6 kg and; 34.2±10.3 kg, 34.4±9.8 kg, 34.6±10.0 kg for control group (p< 0,001). Right key pinch results were 6.7±1.9 kg for patients; 13.5±4.5 kg for control group (p<0.001). Left key pinch results were 6.8±1.9 kg for patients; 13.2±4.4 kg for control group (p<0.001). There was not any significant relationship concerning handgrip or key pinch tests with biochemical parameters. CONCLUSION: Handgrip Strength Test and key pinch may be reliable, cheap and easily performed tests for the diagnosis of Protein Energy Wasting in patients on Peritoneal Dialysis.

The correlation between fear of falling and upper extremity muscle strength.

OBJECTIVES: To determine the relationship between fear of falling (FOF) and upper extremity muscle strength. METHODS: This cross-sectional study included 112 hospitalized, mobile patients. Forty-seven (42%) were males and 65 (58%) were females, and the mean age was 72.3. The study was carried out between September 2018 and September 2019 at Balikli Rum Hospital Nursing Homes, Istanbul, Turkey. Patients were tested using geriatric tools (such as Mini-Mental State Examination) and physical tests such as handgrip, key pinch and 6-meter up and go tests. RESULTS: The average annual falling number of elderly people with FOF was statistically significantly higher than that in those without FOF (p=0.001). Right handgrip, left handgrip, right key pinch, and left key-pinch mean values in elderly individuals with FOF were statistically significantly lower than those without FOF (p< 0.001, p< 0.001, p< 0.001, p< 0.001, respectively). CONCLUSION: The measurement of upper extremity strength could be a predicting parameter of FOF.

Ethical considerations at the end-of-life care.

The goal of end-of-life care for dying patients is to prevent or relieve suffering as much as possible while respecting the patients' desires. However, physicians face many ethical challenges in end-of-life care. Since the decisions to be made may concern patients' family members and society as well as the patients, it is important to protect the rights, dignity, and vigor of all parties involved in the clinical ethical decision-making process. Understanding the principles underlying biomedical ethics is important for physicians to solve the problems they face in end-of-life care. The main situations that create ethical difficulties for healthcare professionals are the decisions regarding resuscitation, mechanical ventilation, artificial nutrition and hydration, terminal sedation, withholding and withdrawing treatments, euthanasia, and physician-assisted suicide. Five ethical principles guide healthcare professionals in the management of these situations.

Appropriate neck circumference cut-off points for metabolic syndrome in Turkish patients with type 2 diabetes.

OBJECTIVE: To investigate the association between neck circumference (NC), overweight, and metabolic syndrome (MS) in Turkish patients with type 2 diabetes. METHODS: A total of 264 diabetic patients (mean age: 52.9±8.1 years) were recruited from two centers in Istanbul to perform anthropometric measurements, including waist and hip circumference, NC, and body mass index. Blood pressure, fasting glucose, and lipid profile (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride levels) were determined. RESULTS: NC correlated with waist circumference, systolic blood pressure, and triglycerides in men, whereas NC only correlated with waist circumference in women. Additionally, NC was shown to negatively correlate with high-density lipoprotein cholesterol in both men and women. Receiver operating characteristic analysis showed that the area under the curve for NC and overweight was 0.95 for both men and women (P<0.001). Moreover, a NC of 38cm for men and 37cm for women was the best cut-off point for determining overweight. The area under the curve for NC and MS was 0.87 for men and 0.83 for women (P<0.001). A NC of 39cm for men and 37cm for women was the best cut-off point to determine participants with MS. CONCLUSIONS: Our findings suggest a positive correlation of NC with MetS in Turkish patients with type 2 diabetes, and could be a useful and accurate tool to identify MS.

Idiopathic Systemic Capillary Leak Syndrome: A Case Report.

INTRODUCTION: Idiopathic systemic capillary leak syndrome (ISCLS) is rarely seen, and presents with recurrent episodes of hypotension, shock, hemoconcentration, and hypoproteinemia. The main pathology is the dysfunction of the vascular endothelium, and it is characterized by an increase of capillary permeability that is accompanied by the loss of intravascular fluid and protein. CASE PRESENTATION: We present a 58-year-old female who presented with peripheral edema, leg pain, and syncope at the emergency department. Interestingly demyemilising neuropathy, which is a rare finding, ensued on day 4. She is still being treated using intravenous immunoglobulin therapy. CONCLUSIONS: The early signs and symptoms of ISCLS may be subtle; therefore the diagnosis can easily be missed and prompt treatment of the syndrome may be postponed. Thus, the clinician must consider ISCLS in differential diagnosis in cases of hypotension, hemoconcentration, and hypoalbuminemia.

The role of geriatric assessment tests and anthropometric measurements in identifying the risk of falls in elderly nursing home residents.

OBJECTIVES: To determine the relation among the risk of falls, geriatric assessment, and anthropometric measurements, including the mini mental state examination, geriatric depression scale, handgrip test, and key pinch test. METHODS: This prospective study included 89 residents hospitalized between May 2014 and September 2015 in the geriatric care unit of the Istanbul Balikli Rum Hospital, Istanbul, Turkey. Patients were followed-up for one year, and their falls were recorded. Medical records of the included patients were retrieved and analyzed. RESULTS: A total of 89 patients, comprising 37 men and 52 women with an average age of 75.8 +/- 8.2 years were included in the study. The residents' annual falling averages were 1.0 +/- 1.5. The most significant factors were identified to be predicted muscle mass, skeletal muscle index, whole body bioimpedance, dominant arm muscle strength, dominant arm bioimpedance, and free fat mass.  CONCLUSIONS: The mini mental test, geriatric depression scale and lawton-brody scale combined with the handgrip, 6-meters walking, and bioimpedance tests are favorable for detecting the risk of falls and recurrent falls in vulnerable elderly nursing home residents.

Appropriate neck circumference cut-off points for metabolic syndrome in Turkish patients with type 2 diabetes / Puntos de corte del perímetro del cuello apropiados para el síndrome metabólico en pacientes turcos con diabetes tipo 2

Objective: To investigate the association between neck circumference (NC), overweight, and metabolic syndrome (MS) in Turkish patients with type 2 diabetes. Methods: A total of 264 diabetic patients (mean age: 52.9±8.1 years) were recruited from two centers in Istanbul to perform anthropometric measurements, including waist and hip circumference, NC, and body mass index. Blood pressure, fasting glucose, and lipid profile (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride levels) were determined. Results: NC correlated with waist circumference, systolic blood pressure, and triglycerides in men, whereas NC only correlated with waist circumference in women. Additionally, NC was shown to negatively correlate with high-density lipoprotein cholesterol in both men and women. Receiver operating characteristic analysis showed that the area under the curve for NC and overweight was 0.95 for both men and women (P<0.001). Moreover, a NC of 38cm for men and 37cm for women was the best cut-off point for determining overweight. The area under the curve for NC and MS was 0.87 for men and 0.83 for women (P<0.001). A NC of 39cm for men and 37cm for women was the best cut-off point to determine participants with MS. Conclusions: Our findings suggest a positive correlation of NC with MetS in Turkish patients with type 2 diabetes, and could be a useful and accurate tool to identify MS (AU)

Objetivo: Investigar la asociación entre el perímetro del cuello (PC), el sobrepeso y el síndrome metabólico (SM) en pacientes turcos con diabetes tipo 2. Métodos: Se reclutó un total de 264 pacientes diabéticos (edad media: 52,9±8,1 años) de 2 centros de Estambul a quienes se realizaron medidas antropométricas, incluidas las de los perímetros de la cintura y la cadera, el PC y el índice de masa corporal. Se determinaron la presión arterial, la glucosa en ayunas y el perfil lipídico (colesterol total y de las lipoproteínas de alta y baja densidad y triglicéridos). Resultados: El PC se correlacionaba con el perímetro de la cintura, con la presión arterial y con los triglicéridos en los varones, pero solo con el perímetro de la cintura en las mujeres. Se comprobó además una correlación negativa del PC con el colesterol de las lipoproteínas de alta densidad tanto en varones como en mujeres. El análisis de las características operativas del receptor mostró que el área bajo la curva del PC y el sobrepeso era de 0,95 tanto en varones como en mujeres (p<0,001). Además, un PC de 38cm en varones y de 37cm en mujeres era el mejor punto de corte para determinar los participantes con sobrepeso. El área bajo la curva del PC y el SM era 0,87 en los varones y de 0,83 en las mujeres (p<0,001). Un PC de 39cm en varones y de 37cm en mujeres era el mejor punto de corte para determinar los participantes con SM. Conclusiones: Nuestros hallazgos indican una correlación positiva del PC con el SM en los pacientes turcos con diabetes tipo 2, que podría ser una herramienta útil y exacta para identificar el SM (AU)