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Clinical nutrition outpatient clinics (CNOCs) are the mainstay of the nutrition bundle in hospitals. They are important for the diagnosis, treatment, and follow-up of outpatients with malnutrition (MN) and sarcopenia. The aim of this study was to evaluate changes in muscle mass during the treatment of MN in patients admitted to CNOCs.A total number of 1118 patients were included in this retrospective cohort descriptive study. Data including medical history, weight loss, anthropometric measurements, MN diagnosis (according to ESPEN definition), nutrition treatment, bioelectrical impedance analysis and laboratory examinations were noted for the first admission and the follow-up.This retrospective, cohort descriptive study included 1118 patients. The mean age of the participants was 54 ± 22 y (18-101 y) and half of the patients were men. Of the 1118 patients, 37,7% were ≥65 y of age. Cancer (32.2%) was the most frequent diagnosis followed by diabetes (16.7%) and dementia (11.3%). MN prevalence was 51.6%. Protein- and energy-enriched diet, oral enteral nutrition supplementation, tube enteral feeding, and parenteral nutrition were used in 42.7%, 69.6%, 11%, and 2.7% of the patients with MN, respectively. Skeletal muscle mass was significantly increased in MN, cancer, neuromuscular diseases (NMD) and patients ≥65 y of age in the first 6 mo, and could be maintained during the next 6 mo of follow-up. Patients with cancer, chronic kidney disease, and NMD and those ≥65 y of age were able to increase their body mass index.MN treatment and follow-up can restore muscle mass especially in patients ≥65 y of age and in those with chronic diseases. CNOCs are beneficial in the treatment and follow-up of MN.

Key summary points Aim To evaluate sarcopenia risk in hospitalized older patients. Findings The percentage of patients at risk of sarcopenia defined by the SARC-F was 48.8%. Sarcopenia risk was associated with unfavorable health care outcomes including dependency, malnutrition, and dysphagia. Message Sarcopenia risk is related with unfavorable outcomes in hospitalized patients and it is important to recognize sarcopenia at an early stage and to prevent its progression, before dependency develops. Purpose To investigate the risk of sarcopenia in hospitalized older patients and to assess the associations between sarcopenia risk and health care outcomes including dependency, malnutrition, and dysphagia. Methods This multicenter cross-sectional study was a part of the annual National Prevalence Measurement of Quality of Care (LPZ) in Turkey. Hospitalized patients age 65 and older were included in the study. The SARC-F was used to assess risk of sarcopenia. Dependency was appraised according to the Care Dependency Scale (CDS). Nutritional status was established with respect to the Malnutrition Universal Screening Tool (MUST). Dysphagia was screened by two structured questions. Results A total of 492 patients were included in the analysis. Two hundred and forty patients (48.8%) were at risk of sarcopenia. Sarcopenia risk was more prevalent among women (p = 0.007) and patients with risk of sarcopenia were older (p < 0.001). Hospital stay was longer and malnutrition and dysphagia were more prevalent in patients with sarcopenia risk than without (all p < 0.001). All nutritional interventions were applied mostly to patients with sarcopenia risk than without. In multivariate analysis, advanced age (OR: 1.068, CI 1.032-1.104, p < 0.001), female gender (OR: 2.414, CI 1.510-3.857, p < 0.001), and dependency (OR: 5.022, CI 2.922-8.632, p < 0.001) were independently associated with sarcopenia risk. Conclusions Sarcopenia risk is related with unfavorable outcomes in hospitalized patients. Primarily older female patients are at risk for sarcopenia. It is important to recognize sarcopenia at an early stage and to prevent its progression, before dependency develops. The SARC-F may be a useful tool for screening sarcopenia risk in hospitalized patients., Nutricia Turkey, This work was supported by Nutricia Turkey. The funding played no role in study design, collection, analysis, interpretation of data, writing the manuscript, or the decision to submit for publication.

Objective Angiotensin II promotes growth and angiogenesis via type 1 receptors (AGTR1) in certain tumors. In this study, we examine the bone marrow AGTR1 expression in multiple myeloma (MM) and its relationship with the regulation of angiogenesis and prognostic factors. Materials and methods Bone marrow AGTR1 mRNA levels of 39 MM patients and 15 healthy controls were analyzed with quantitative RT-PCR. Immunohistochemical staining of the tissue vascular endothelial growth factor (VEGF), CD34, and factor VIIIrAg (fVIIIrAg) was used to assess bone marrow angiogenesis. Results Bone marrow samples of the patients showed increased VEGF, fVIIIrAg, and CD34 staining and higher AGTR1 expression levels when compared to controls. Patients with severe-diffuse bone marrow infiltration showed higher bone marrow VEGF, fVIIIrAg, CD34, and AGTR1 mRNA levels when compared to other patients. Conclusion AGTR1 expression was found positively correlated with plasma β2-microglobulin level and patients with increased AGTR1 expression showed increased bone marrow CD34 levels.

Percutaneous endoscopic gastrostomy (PEG) has been widely used since 1980 in enteral feeding of patients that are not able to be fed orally for a long time. The aim of this study is to evaluate the PEG indications, effectiveness and PEG related complications from a single center in Istanbul, Turkey.265 patients with PEG who were followed up by the clinical nutrition team of a university hospital between 2010-2018 were evaluated retrospectively. Nutritional Risk Screening-2002 (NRS-2002) test, anthropometric measurements, bioelectrical impedance analysis and laboratory data were used to evaluate the patients' nutritional status.The most common indications for PEG were dementia (35.1%), amyotrophic lateral sclerosis (22.6%), stroke (15.8%), and cancer (14%). The mean body weight of the patients was increased after PEG (63.5±12.2 vs 62.0±12.7 kg). Mid upper arm circumference and calf circumference of the patients increased after PEG (27.5±2.5 vs 25.4±3.1 cm and 32.2±7.9 vs 29.6±5.9 cm, respectively). Serum albumin of the patients was increased significantly after PEG (3.34±0.69 g/dL to 3.64±0.65 g/dL) without any significant change in serum CRP. Subgroup analyses showed a significant increase in the mean serum albumin of patients with dementia after PEG (3.23±0.67 g/dL to 3.54±0.58 g/dL). Local insertion site infection occurred in 15 patients (5.6%) and only 3 patients had systemic inflammatory symptoms after local infection (1.1%).The results of our study showed that long-term enteral feeding with PEG is an effective and safe method that provides improvement in nutritional status.

Objective: Malnutrition, pressure ulcers, falls, pain, and restraints are important quality of care indicators in healthcare settings. The Landelijke Prevalentiemeting Zorgkwaliteit-National Care Indicators Prevalence Study is an annual international multicenter cross-sectional prevalence measurement of care problems in the institution, department, and patient-level across Europe. This study aimed to measure the prevalence of care problems among older adults in Turkish hospitals. Materials and Methods: A multicenter, cross-sectional study was performed using a standardized and tested questionnaire. Data were collected from older adult patients (65 years and over) in the hospitals. The study was conducted in 12 centers from 6 big cities of the country in November 2017 and 2018. Results: Data from 12 Turkish hospitals were collected in 2017 and 2018. In 2017, pressure ulcer prevalence was 6.4%, malnutrition risk was 30.2%, falls was 9.1%, pain was 53%, and restraint was 22.1%. The prevalence of malnutrition risk, falls, and restraints increased to 32.1%, 10.8%, and 31.1% in 2018, respectively. Completely care-dependent patients’ rate in 2017 and 2018 was 17.4% and 12.8%, respectively. Protocol/guideline usage for pressure ulcers, malnutrition, and falls were 100%, which were 68.6% and 16.9% for pain and restraints, respectively. The main interventions for pressure ulcer prevention or treatment are pressure-relieving support surfaces and hydration or nutrition; for malnutrition are referral to a dietician and oral nutritional supplements; and for falls are patients or relative education, drug lists evaluation, bedside mattress utilization, and pharmacological pain treatments. Conclusion: Annual measurement of risk or prevalence, preventive measures, and treatment interventions of geriatric syndromes will provide better care plans for older adults.

Amac:Bu calismada, “Bakteriyel Topluluk Analiz Algoritmasi” olusturularak 16S ribozomal RNA (rRNA) Amplikon Dizileme (AD) stratejisine dayali Yeni Nesil Dizileme Teknolojisi kullanilarak gerceklestirilen bakteriyel topluluk analizlerinden elde edilen verilerin daha verimli kullanilabilmesi amaclanmistir. Gerec ve Yontem:Calismamizda, 96 insan bagirsak mikrobiyota orneginin 16S rRNA genlerinin V3-V4 bolgeleri Illumina MiSeq sistemi kullanilarak cift-sonlu dizileme yontemiyle dizilenmistir. Biyoinformatik analizler QIIME 2 acik kaynakli yazilimi ile gerceklestirilmistir. Bulgular:16S rRNA AD kosumundaki 96 ornegin tamaminin 16S rRNA V3-V4 bolgeleri basariyla dizilenmistir. Calismanin sonunda toplam okuma 23.42 M, kumelenme yogunlugu 883 K/mm2 , filtreyi gecen kume yogunlugu % 92.13, kalite skorlari ise > Q30 = % 76,7 olarak tespit edilmistir. Bu calismada elde ettigimiz veriler ve calisma surecinde olusan tecrube ve bilgi birikimimiz sonucunda laboratuvarimiz tarafindan bir Bakteriyel Topluluk Analiz Algoritmasi olusturulmustur. Sonuc:“Istanbul Tip Fakultesi, Klinik Nutrisyon ve Mikrobiyota Arastirma Laboratuvari Bakteriyel Topluluk Analiz Algoritmasi” laboratuvarimizda gerceklestirdigimiz calismalarin ayni standartlarda ve karsilastirilabilir olmasi icin kullanilacaktir. Bu algoritmanin ulkemizdeki arastirmacilar icin bir referans niteliginde olacagini dusunmekteyiz. Ayrica farkli merkezlerin bu algoritmayi kullanmalari durumunda elde edilecek veriler laboratuvarimizin verileriyle ve bu protokolu kullanan ulkemizdeki veya Dunyadaki diger merkezlerin verileriyle karsilastirilabilir olacaktir. Bu sekilde ulkemizdeki insan bagirsak mikrobiyotasi ile ilgili yapilan calismalarin veriminin ve elde edilen verilerin degerinin arttirilmasina katkida bulunmayi hedefliyoruz.

Objective: The aim of this study was to investigate the differences in the quality of nutritional care among Austria, Switzerland, and Turkey.Methods: This was a cross-sectional multicenter study. Data were collected using a standardized questionnaire. Descriptive statistics and univariate and multivariate logistic regression (adjusted for age, sex, number of diagnoses, and care dependency) analyses were performed.Results: Taking part in the study were 6293 patients from 62 hospitals. The prevalence of risk for malnutrition and the patients was 14.5% in Austria, 16.5% in Switzerland, and 33.7% in Turkey. Standardized screening procedures were applied in 51.3% of Austrian, 53.6% of Swiss, and 38.4% of Turkish patients. The interventions applied in patients at risk varied significantly between Austrian, Swiss, and Turkish hospitals for all but two interventions. Referrals to dietitians were lower in Austria (35.8%) and Switzerland (37.7%) compared with Turkey (61%). Turkish patients received more frequent oral nutritional supplementation, an energy-proteinenriched diet, or parenteral nutrition compared with those in Austrian or Swiss hospitals. The differences in the quality of nutritional care between Austrian and Swiss hospitals were only marginal. Of at-risk patients, 15.3% in Austria, 11.4% in Switzerland, and 5.5% in Turkey did not receive any intervention.Conclusions: The findings of this study indicated that significant differences exist in the prevalence, identification and treatment of malnutrition, and the fulfillment of structural quality indicators. Standards and guidelines need to be developed that can be used by all countries. The severity of the malnutrition situation in hospitals needs further attention in future management policies. (C) 2020 Elsevier Inc. All rights reserved.

Background and aims The aim of this study was to determine the prevalence of malnutrition risk and sarcopenia in our elderly (≥ 65 years) nursing home residents and find out their association with mortality. Material and method This prospective observational study with a follow-up of 12 months was done in 402 subjects (65 years old or older) living in a nursing home. Nutritional status was determined with Mini Nutritional Assessment (MNA). Sarcopenia was diagnosed according to European Working Group on Sarcopenia in Older People (EWGSOP) with the measurements of muscle mass, muscle strength and physical performance using mid upper arm muscle circumference (MUAC, cm), calf circumference (CC), a standardized handheld dynamometer and gait speed. Nutritional status and sarcopenia were compared with the 1-year mortality rate. Results According to MNA, 56.5% of the individuals were normal, 24.8% had malnutrition risk (MR) and 18.7% had malnutrition (MN). Sarcopenia was diagnosed in 73.3% of the residents. Reduced muscle strength was found in 94.5% of the population. MN/MR were found associated with sarcopenia ( P P P = 0.012). Malnutrition and sarcopenia were found related with mortality independent from other factors. Conclusion Malnutrition and sarcopenia are prevalent in nursing home residents. It is important to diagnose and treat malnutrition and sarcopenia in elderly nursing home residents for both can increase mortality independently.

Objective: To determine the prevalence and the factors associated with urinary incontinence (UI) among inpatients in Turkey. Method: the population of this study comprised of patients screened by the "National Prevalence Measurement of Quality of Care (LPZ)" study in 2017 and 2018. Age, gender, comorbidities, length of hospital stay, sedative medications, SARC-F score, anthropometric measurements, and care parameters such as malnutrition, falls, UI-fecal incontinence (FI), restraints, and care dependency score (CDS) were noted. the LPZ questionnaire was performed by trained researchers, and multiple logistic regression analysis was performed to determine the factors associated with UI. Results: the prevalence of UI was 29.4 % among 1176 inpatients, and 41.6 % in patients >= 65 years. Urinary incontinence was associated with older age (OR, 1.966, 95 % CI 1.330-2.905), female sex (OR, 2.055, 95 % CI 1.393-3.030), CDS (OR, 3.236, 95 % CI 2.080-5.035), the number of comorbidities (OR, 1.312, 95 % CI 1.106-1.556), end-of life management (OR, 3.156, 95 % CI 1.412-7.052), sedative medications (OR, 1.981, 95 % CI 1.230-3.191), and FI (OR, 12.533, 95 % CI 4.892-32.112) in all adults, where CDS (OR, 2.589, 95% CI 1.458-4.599), end-of life management (OR, 2.851, 95 % CI 1.095-7.424), sedative medications (OR, 2.529, 95 % CI 1.406-4.548), and FI (OR, 13.138, 95 % CI 4.352-39.661) were associated with UI among geriatric patients. Conclusions: the factors associated with UI in geriatric and all adult inpatients are CDS, sedative medications, end-of life management, and FI plus older age, female sex, and comorbidities for the latter. the factors associated with UI vary in different age groups., Nutricia Turkey, This work was supported by Nutricia Turkey.

Introduction: Wernicke’s encephalopathy (WE) is an underdiagnosed neuropsychiatric disorder especially in non-alcoholic groups that causes morbidity-mortality if diagnosis is delayed. Korsakoff syndrome is a chronic consequence of this condition characterized by persistent memory impairment. in this study we present a series of non-alcoholic patients with WE. the purpose of this study was to analyze the predisposing factors in non-alcoholic patients with WE and emphasize the importance of early diagnosis and treatment with thiamine supplementation. Methods: the clinical records of 6 cases with WE followed by gastrointestinal tract disease and/or surgery who were admitted to our Medical Faculty between 2012 and 2014 were retrospectively reviewed. Results: the study included 3 men and 3 women in the age range of 24 to 55. All patients had gastrointestinal tract diseases and/or had undergone gastrointestinal surgeries, and were non-alcoholic. Vomiting, weight loss, and parenteral nutrition were the frequent precipitating factors. the classic triad of mental impairment, oculomotor alterations and gait ataxia was present in 4 of the 6 patients. Magnetic Resonance Imaging showed typical signal alterations in the medial thalami, mammillary bodies and the periaqueductal region of patients in various degrees. Clinical improvement was seen in each patient after thiamine supplementation. Discussion: Physicians should be aware of the predisposing factors and symptoms to prevent or optimize the management of this potentially devastating disease. Thiamine supplementation should be considered in patients with gastrointestinal tract diseases or those who have undergone surgery. Amaç: Wernicke ensefalopatisi (WE) özellikle non-alkolik grupta yeterince tanınmayan, geç kalınırsa mortalite ve morbidite ile sonuçlanan, nöropsikiyatrik bir hastalıktır. Korsakoff sendromu ise bu durumun kalıcı hafıza bozukluğu ile giden kronik bir sonucudur. Bu çalışmada, WE olan non-alkolik hasta serisi sunulmaktadır. Çalışmadaki amacımız WE olan non-alkolik hastalardaki predispozan faktörleri analiz etmek ve erken tanı ile tiamin replasmanının önemini vurgulamaktır. Yöntem: Tıp Fakültemize 2012–2014 yılları arasında başvuran, gastrointestinal sistem hastalığı ve/veya cerrahisini takiben WE gelişen altı olgunun klinik kayıtları retrospektif olarak değerlendirildi. Bulgular: Yaşları 24 ile 55 arasında değişen üç kadın, üç erkek hasta değerlendirildi. Hastaların hepsinde non-alkolik tipte gastrointestinal sistem hastalığı vardı ve/veya gastrointestinal sistem cerrahisi uygulanmıştı. En sık presipitan faktörler kusma, kilo kaybı ve parenteral beslenmeydi. Altı hastanın dördünde yürüme ataksisi, okulomotor değişiklikler ve mental yetersizlikten oluşan klasik triad mevcuttu. Manyetik rezonans görüntülemelerinde hastalarda medial talamus, mamiller cisimcikler ve periakuaduktal alanlarda değişik derecelerde sinyal değişiklikleri izlendi. Tiamin replasmanından sonra hastaların hepsinde klinik düzelme gözlendi. Tartışma: Klinisyenler, potansiyel yıkıcı etkileri olan bu hastalığın tedavisini optimize etmek ya da önleyebilmek için semptomlar ve predispozan faktörler açısından uyanık olmalıdır. Tiamin replasmanı, gastrointestinal sistem hastalığı ya da bu konuda cerrahi uygulanan hastalarda akılda tutulmalıdır.

Overexpression of DEK oncogene is associated with increased proliferation of carcinoma cells and it is observed in several solid tumors due to the amplification of the 6p22.3 chromosomal region where DEK locates. Although the same chromosomal amplification occurs in multiple myeloma (MM), a plasma cell neoplasm, whether the expression and the copy number of the DEK gene are affected in MM remains elusive. We show that despite the increased copy number in CD138positive MM cells (4 out of 41 MM samples), DEK mRNA expression was down-regulated compared with that in CD138negative bone marrow (BM) cells of the same patients (P

Diabetes is reported to accelerate sarcopenia (age-related loss of muscle mass and function). We aimed to assess muscle mass and strength in elderly diabetics, elderly non-diabetics, younger diabetics and healthy subjects, and to define correlates of muscle mass and strength in these subjects.Sixteen elderly diabetics, 16 younger diabetics, 16 elderly non-diabetics and 18 younger non-diabetics were included. Elderly and diabetic subjects were first evaluated with exercise testing. Isokinetic leg extension and flexion tests were performed using a Cybex 350 dynamometer. Muscle mass was calculated using bioelectric impedance analysis.Muscle mass was similar between all groups; however, muscle strength was significantly lower in diabetic and non-diabetic elderly subjects compared with younger diabetic subjects and non-diabetics. Muscle strength was positively correlated with albumin, metabolic equivalent and hemoglobin, and inversely correlated with age, HbA1c, functional capacity and CRP. Independent correlates of muscle strength were age and hemoglobin. There was no clinically significant correlate of muscle mass. Presence or duration of diabetes was not associated with muscle mass or strength.Uncomplicated diabetes does not seem to accelerate aging-related muscle mass or strength loss. Exercise test parameters may be useful markers in the screening of sarcopenia.

Sarcopenia and sarcopenic obesity (SO) are geriatric syndromes leading to physical disability, poor quality of life and death. The aim of this study was to investigate the prevalence of sarcopenia and SO in nursing homes in Turkey and to define local disparities for diagnosing sarcopenia and SO. This cross-sectional multicenter study was performed in 711 patients in 14 nursing homes. Comprehensive geriatric assessment tests, handgrip strength and calf circumference (CC) measurements were carried out. Sarcopenia was both defined by handgrip strength and CC criteria. According to handgrip strength measurement, 483 (68%) of patients were sarcopenic (male: 72%, female: 63.8%), 228 were non-sarcopenic. The prevalence of SO was 22% (13.7% in men, 30.2% in women). Patients (82.5%) who were diagnosed as sarcopenic by the handgrip strength test were not sarcopenic according to CC sarcopenia criteria. Therefore, we tried to determine the optimal CC value for diagnosing sarcopenia in our population. Both sarcopenia and SO were prevalent among Turkish nursing home elderly residents. Most of the patients with sarcopenia were obese or overweight. We showed that diagnosing sarcopenia with CC measurement underestimated the sarcopenia prevalence assessed by handgrip strength. So we concluded that, although different assessment methods are recommended for the diagnosis of sarcopenia local disparities should be considered.

Background and aim Malnutrition is related with serious morbidity and mortality in institutionalized older adults. The aim of this study is to determine the frequency of malnutrition in nursing homes and care homes and to identify the factors associated with malnutrition in these settings. Methods This multicenter study was conducted in 14 centers of nursing homes/care homes in three different cities. Total number of 1797 residents aged ≥ 65 years was enrolled. Malnutrition screening was made by Mini Nutritional Assessment Short Form (MNA-SF) and full MNA. Statistical analyses were conducted by SPSS 15.0. Results The median age (min–max) of the study population was 78.0 (65.0–108.0) and 917 (51%) were female. MNA-SF score of the residents was 11 (0-14). According to the MNA-SF 850 (49.3%) residents had normal nutritional status, 654 (38.3%) residents were at malnutrition risk, and 204 (11.9%) had malnutrition. Number of medications, gender, duration of stay in the institution, frequency of family visits, social security status, type of nursing home (government or not), daily life activities (ADL), Geriatric Depression Scale (GDS) and MMSE scores, get up & go test, hypertension, dementia, depression, and Parkinson disease were associated with malnutrition. Regression analyses revealed that get up&go test, GDS, hypertension, and ADL were independently related to malnutrition diagnosed by MNA-SF. Conclusion This study provides important information on the prevalence and associated factors of malnutrition in a large multicentered setting of nursing homes and care homes. It will direct the screening plans and interventions taken in order to detect, prevent, and manage malnutrition in these settings.

Cytomegalovirus (CMV) infection is generally associated with significant immunosuppression. Cellular immunity is particularly important and corticosteroid treatment increases the risk of CMV infection substantially. Immunocompetence generally decreases with age, older patients are at higher risk for developing CMV disease than are younger patients. CMV infection in the immunocompetent adults is quite rare. Esophagitis is the second most common gastrointestinal manifestation of CMV infection after colitis. Herein, we present three cases of giant cell arteritis who developed CMV esophagitis after various periods of corticosteroid treatment. CMV infection should be included in the differential diagnosis of GI disease in immunocompromised patients, and the clinician should pursue appropriate diagnostic and therapeutic interventions aggressively.

To determine the prevalence of low muscle mass (LMM) and the relationship between LMM with functional and nutritional status as defined using the LMM evaluation method of European Working Group on Sarcopenia in Older People (EWGSOP) criteria among male residents in a nursing home.Male residents aged 60 years of a nursing home located in Turkey were included in our study. Their body mass index (BMI) kg/mOne hundred fifty-seven male residents were enrolled into the study. Their mean age was 73.1 ± 6.7 years with mean ADL score of 8.9 ± 2.0 and IADL score of 8.7 ± 4.6. One hundred twelve (71%) residents were aged 70 years. Thirty-five men (23%) had low SMMI in group aged 60 years, and twenty-eight subjects (25%) in the group aged 70 years. MNA scores were significantly lower in residents with low SMMI compared with having normal SMMI (17.1 ± 3.4 versus 19.6 ± 2.5, p = 0.005). BMI was significantly lower in the residents with low SMMI compared with normal SMMI (19.6 ± 2.7 versus 27.1 ± 4.1, p 0.001). ADL scores were significantly different between residents with low SMMI and normal SMMI in those aged70 years (8.1 ± 2.6 versus 9.1 ± 1.6, p = 0.014). In regression analyses, the only factor associated with better functional status was the lower age (p = 0.04) while the only factor associated with better nutrition was higher SMMI (p = 0.01).Low SMMI detected by LMM evaluation method of EWGSOP criteria is prevalent among male nursing home residents. There is association of low SMMI with nutritional status and probably with functional status within the nursing home setting using the EWGSOP criteria with Turkish normative reference cut-off value.

OBJECTIVE: Poor recognition and monitoring of nutritional status is the most important cause of malnutrition in hospitalized patients. The aim of this study was to assess the nutritional status of a group of patients and compare the results with their serum prealbumin levels. METHODS: Ninety-seven patients admitted consecutively to the hospital were enrolled in the study. The risk of malnutrition was assessed according to anthropometric data and the Subjective Global Assessment and Nutrition Risk Screening 2002 tools. The nutritional statuses of the patients were compared with their age, gender, body mass index, medical history, weight loss and routine biochemical analyses, including prealbumin and length of hospital stay. RESULTS: According to the Nutrition Risk Screening 2002, 57% of the patients were malnourished or at risk of malnutrition, correlating well with the Subjective Global Assessment (pOBJETIVO: Falha no reconhecimento e acompanhamento do estado nutricional é a razão mais importante da desnutrição em pacientes hospitalizados. Este estudo objetivou avaliar o estado nutricional dos pacientes e comparar os resultados com os níveis séricos de pré-albumina. MÉTODOS: Foram incluídos 97 pacientes no estudo, internados consecutivamente. O risco de desnutrição foi avaliado de acordo com dados antropométricos e com a Avaliação Subjetiva Global e Triagem de Risco Nutricional 2002. Os estados nutricionais dos pacientes foram comparados com suas idades, sexo, índice de massa corporal, histórico médico, perda de peso e análises bioquímicas, incluindo pré-albumina e tempo de permanência hospitalar. RESULTADOS: De acordo com o Triagem de Risco Nutricional 2002, 57% dos pacientes estavam desnutridos ou em risco de desnutrição, apresentando boa correlação com o Avaliação Subjetiva Global (p

Background and aims: Sarcopenia is defined as a reduction in skeletal muscle mass, strength, and endurance observed with advancing age. Although Vitamin D receptor (VDR) polymorphism is reported to be associated with muscle mass and strength, evidence for this is limited and conflicting. In this study, we examined the association between the polymorphisms of VDR gene BsmI, TaqI and FokI and muscular mass and strength in elderly men. Methods: This is a cross-sectional study conducted in a university hospital. One hundred and twenty men over 65 years of age participated, all participants were active men living independently in Istanbul, who were followed as outpatients in geriatric polyclinics. Most common diagnoses were hypertension, hyperlipidemia, and mild to moderate osteoarthritis. Morbid obese patients were not included in the study. Genomic DNA was extracted from peripheral blood, and VDR genotypes were determined by the polymerase chain reaction. The peak torque of the knee flexors and extensors was measured on a Cybex 350 dynamometer. Body muscle mass was calculated by using bioelectric impedance analysis. Results: The extensor strength of the knee was higher in BB homozygotic men than in the Bb/bb group. No significant association was found with TaqI and FokI haplotypes. There was no significant association between muscle mass and strength, or between muscle mass and VDR genotype. Conclusion: Our data suggest that VDR gene BsmI polymorphism is associated with muscular strength in elderly men.

Background : Breast metastasis is an extremely rare phenomenon. While nearly every malignancy has been described to metastasize to the breast; melanoma, lymphoma and leukemia tend to be the most common. Among these primary tumors, melanoma metastasis represents a diagnostic pitfall for both the clinicians and histopathologists. Methods : We report a case of widely metastatic malignant melanoma with diagnostic difficulties in both clinical and histopathological evaluation. Thorax CT, Abdominal MRI, tumor marker screening and two biopsies were performed to conclude the primary. Results : In clinical evaluation, there were rapidly proliferating multiple nodular lesions at the skin, breasts, lungs, ovaries and peritoneum accompanied by only increased CA 125 in tumor marker panel. The initial biopsy performed from a skin nodule was concordant with a metastatic carcinoma suggesting breast as the primary. The diagnosis was made by immunohistochemical staining of the second biopsy performed from a breast nodule. Conclusion : Although no strict clinical criteria exist to differentiate a melanoma metastasis to the breast from a primary breast carcinoma atypically rapid growth, normal Ca 15-3 level, and a history of prior melanoma may be helpful. However, it may be still misdiagnosed in some cases even histopathologically if the immunohistochemical staining is not performed.

Whole-body scintigraphy with Technetium-99m 2-methoxy-isobutyl-isonitrile ((99m)Tc-MIBI) has been proposed as a useful method for demonstrating the areas of active bone marrow infiltration in multiple myeloma (MM). In this study, we compared the (99m)Tc-MIBI scan with magnetic resonance imaging (MRI), skeletal X-ray survey, and biochemical markers of disease activity in MM to determine its potential in predicting the extension of the disease. Twenty-four myeloma patients had undergone to the (99m)Tc-MIBI scan. Only two patients showed negative results in the (99m)Tc-MIBI scan; one had clinically active disease, and the other was on remission. MRI was performed to 18 clinically active patients, and 16 of them showed positive myelomatous bone marrow involvement. No significant difference was found between the (99m)Tc-MIBI scan and MRI in predicting the extension of bone marrow infiltration in MM (p = 0.11). (99m)Tc-MIBI scores were correlated with bone marrow neoplastic plasma cell ratio (p = 0.005), serum paraprotein level (p0.001), serum lactate dehydrogenase (p = 0.031), and beta-2 microglobulin (p = 0.045). The (99m)Tc-MIBI scan showed disease activity better than the skeletal X-ray survey (x2 = 5.299, p = 0.021). A significant decrease was found in posttreatment (99m)Tc-MIBI scores of the patients with positive overall response (p = 0.016). The (99m)Tc-MIBI scan is a noninvasive test that can show the extension of the disease in MM. It seems that the (99m)Tc-MIBI scan and MRI show extension and intensity of the myelomatous bone marrow infiltration equally well. The (99m)Tc-MIBI scan can be an alternative to MRI when it is not available or if there is any limitations for its usage.

Soluble CD23 (sCD23) was proposed as a marker of disease activity and as an important prognostic parameter in B-cell chronic lymphocytic leukemia (B-CLL). In this study, prognostic significance of sCD23 in B-CLL was examined according to its temporal relationship with the known clinical parameters of the disease, CD38 and ZAP-70. Serum sCD23 levels of 36 B-CLL patients, followed up in our clinic between 1999 and 2005, and 15 healthy subjects were measured with enzyme-linked immunosorbent assay. The mean serum sCD23 level of the B-CLL patients (210.72 +/- 193.67 and 6-600 U/ml) was significantly higher than the control group (18.20 +/- 14.30 and 6-50 U/ml). Seventy-eight percent of the B-CLL patients with lymphocyte doubling time (LDT)12 months and 24% of patients with LDT12 months had high sCD23 levels (P = 0.008). Meanwhile, 81% of the patients with diffuse bone marrow infiltration and 33% of patients with nondiffuse infiltration had high levels of serum sCD23 (P = 0.029). A significant difference was found between B-CLL patients with Binet stages A and C (P = 0.009). Peripheral blood flow cytometry of the patients revealed a significant CD38 expression in patients with high serum sCD23 levels (P = 0.002). Similarly, an increased bone marrow zeta-chain associated protein kinase-70 (ZAP-70) expression was seen in patients with high serum sCD23 levels (P = 0.009, correlation co-efficient was 0.714). Cumulative and the progression free survivals of the patients with low serum sCD23 levels were 60.1 +/- 5.7 months [95% confidence interval (CI); 49.0-71.2] and 51.1 +/- 6.6 months (95% CI; 38.0-64.1), respectively. However, they were 43.8 +/- 6.5 months (95% CI; 31.0-56.6) and 26.5 +/- 6.4 months (95% CI; 14.0-39.1) in patients with high levels. Serum sCD23 is increased in B-CLL patients and can be used in the clinical follow-up of the disease in prediction of the tumor mass and prognosis.

There are few reports concerning Mycobacterium tilburgii infection in humans because this bacterium is non-cultivatable. Herein, using new molecular techniques, we report the case of an immunocompromised patient with fatal disseminated lymphadenitis that was caused by M. tilburgii.26 years old Caucasian HIV negative female patient presented with abdominal pain. Her clinical assessment revealed disseminated lymphadenitis, that was acid fast bacilli positive. Further molecular evaluation showed the causative agent as M. tilburgii. Despite anti mycobacterial therapy and careful management of intervening complications patient died because of an intraabdominal sepsis. This is the first fatal M. tilburgii infection in the literature. This case points the importance of careful management of patient's immune status and intervening infections besides implementation of effective drug treatment.

Impaired endothelium-dependent vasomotion is a diffuse disease process resulting in abnormal regulation of blood vessel tone and loss of several atheroprotective effects of the normal endothelium. The aim of the present study was to investigate the effects of aging and hypertension on endothelial function. Sixty-six geriatric subjects with ages over 60 (48 hypertensive and 18 healthy) and 40 middle-aged subjects (16 hypertensive and 24 healthy) were included in the study. Systemic vascular endothelial function was evaluated through measuring brachial arterial vasodilation, a physiologic answer to reactive hyperemia occured with increased blood flow in the vessel after transient ischemia (flow-mediated dilation, FMD%), and with carotid artery intima-media thickness (IMT) measurement, using high-resolution ultrasonography. Endothelial independent vasodilation was also measured after administration of sublingual isosorbide dinitrate (isosorbide dinitrate mediated dilation, IDNMD%). FMD% was significantly decreased in elderly and/or hypertensive (HT) patients (geriatric HT: 9.5 +/- 4.7%, geriatric non-HT: 12.7 +/- 5.5%, middle-aged HT: 12.9 +/- 4.3% and middle-aged non-HT: 18.9 +/- 8.1%) (geriatric HT versus geriatric non-HT (P = 0.02), geriatric HT versus middle-aged HT (P = 0.01), geriatric non-HT versus middle-aged non-HT (P = 0.008)). Both FMD% and IDNMD% were inversely correlated with age, baseline vessel diameter and carotid artery intima-media thickness. FMD% was also inversely correlated with diastolic blood pressure. No correlation was found between FMD% and systolic blood pressure, serum cholesterol and triglyceride levels. Endothelium dependent (EDD) and independent dilatation of large arteries decreased with aging even in the healthy elderly, and FMD further declined in HT elderly patients, indicating that age and hypertension independently impair endothelial function. Positive correlations with age and hypertension, and significant inverse correlation with FMD, makes carotid artery IMT a possible indicator of endothelial function.

The incidence of deep vein thrombosis (DVT) and pulmonary embolism has been increasing in the elderly because of hypercoagulability associated with aging. Age has also been identified as an independent risk factor for bleeding complications related to anticoagulation therapy. Inferior vena cava filters could be used as alternatives to anticoagulant therapy for the prevention of pulmonary embolism when anticoagulation is either contraindicated or ineffective. Here, we report two geriatric patients who had documented acute DVT and in whom inferior vena caval filter was used because of the patients have a contraindication to use an anticoagulation.

Two patients with Takayasu arteritis are reported who presented with fever of unknown origin. Takayasu arteritis was diagnosed at the prepulseless period after stenotic lesions of the aorta, and its branches were seen with imaging methods. In the first month of steroid treatment, hypertension developed in both patients that was related to fibrosis in stenotic lesions in renal arteries. Both patients were treated with percutaneous transfemoral renal angioplasty. Takayasu arteritis should be considered in the differential diagnosis of fever of unknown origin, especially in young women. Absence of the physical findings related to vasculitic lesions will not rule out the disease, which can be seen in the prepulseless period.

Priapism is a rare symptom with diverse etiological factors. Although most cases in adults are secondary to drug use and intracavernosal injections, blood dyscrasias and hypercoagulable states, vasculitis, penile metastases, neurological conditions, spider bites, carbon monoxide poisoning, and total parenteral nutrition may also result in priapism. We report a case of recurrent and refractory priapism in a 61-year-old man which was diagnosed as multiple myeloma after emergence of hypercalcemia and renal failure due to progression of the underlying pathology. The value of the initial diagnostic approach is emphasized.

Purpose: To evaluate diffusion-weighted imaging (DWI) features and signal intensity values at T2-weighted magnetic resonance (MR) imaging for differential diagnosis of benign retroperitoneal fibrosis (RPF) and plaque-like retroperitoneal malignant neoplasms. Materials and Methods: Institutional review board approval and informed consent were obtained for this retrospective study. Fifty-one patients with plaque-like confluent retroperitoneal soft-tissue masses were divided into three groups: group I, 25 patients with malignant RPF and retroperitoneal malignant neoplasm; group II, 16 patients with chronic RPF; and group III, 10 patients with active RPF. On T1-weighted (unenhanced and contrast material-enhanced), T2-weighted, and DWI (b = 1000 sec/mm(2)) images, apparent diffusion coefficient (ADC) values and quotients of postcontrast signal intensities between lesions and psoas muscle were evaluated. The chi(2) test was used to compare categorical values; one-way analysis of variance and Kruskal-Wallis tests were used to compare groups. Results: Overall sensitivity, specificity, and positive and negative predictive values of DWI findings were 92% (23 of 25 patients), 62% (16 of 26 patients), 70% (23 of 33 patients), and 89% (16 of 18 patients), respectively. Mean ADC values were 0.79 +/- 0.19 in group I, 1.43 +/- 0.16 in group II, and 0.91 +/- 0.14 in group III. When comparing values, differences between groups I and II (ADC values, P < .0001; DWI quotients, P < .0001; postcontrast quotients, P = .001) and groups II and III (ADC values, P < .0001; DWI quotients, P = .016; postcontrast quotients, P = .04) were significant. There was no significant difference between groups I and III or between the three groups when T2-weighted values were compared. Conclusion: ADC of chronic RPF was higher than that for active RPF or malignant RPF and retroperitoneal malignant neoplasm. DWI can contribute to differential diagnosis of chronic RPF and malignant neoplasms with RPF morphology. Lesions in the malignant group and active RPF group had similar enhancement patterns, while those in the chronic RPF group demonstrated less enhancement. Signal intensity values on T2-weighted images were not useful for differentiating these conditions.

Fever of unknown origin (FUO) is defined as the body temperature higher than 38.3 degrees C on several occasions and lasting longer than 3 weeks, with the aetiology remaining uncertain after 1 week of investigation. In this study, we reviewed 57 patients with FUO hospitalised in our inpatient department between 1998 and 2003. The median age of the patients was 44 years (17-84), and 26 were males (46%), while 31 were females (54%). In 24 patients (42%), infectious diseases such as tuberculosis (12 patients) and brucellosis (5 patients) were found under the aetiology of FUO. Inflammatory rheumatic diseases were the second most common cause of FUO (17 patients, 30%), while malignancies were found in 10 patients (18%). In six patients (10%), aetiology could not be identified. In conclusion, infectious diseases especially tuberculosis and brucellosis are the leading causes of FUO in our country.

A 73-year-old woman was presented with altered mental status and disorientation. She was diabetic and hypertensive, and she had experienced an ischemic cerebrovascular accident 3 years ago. Physical examination revealed the findings of chronic obstructive pulmonary disease, cor pulmonale and congestive heart failure. Hepatomegaly, splenomegaly and ascites were found and might be associated with postsinusoidal portal hypertension secondary to congestive heart failure. Laboratory tests showed uremia, lymphocytosis and thrombocytopenia. Neurologic findings were related with uremia and hypoxia. Multiple pathologic lymphadenopathies were seen in abdominal ultrasonography and thoracic computed tomography. Bone marrow histology indicated chronic lymphocytic leukaemia (CLL). The reason for acute renal failure was leukaemic infiltration of the kidneys due to CLL that was shown with renal biopsy. Blood urea nitrogen (BUN) and serum creatinine responded well to cyclophosphamide and methyl prednisolone treatment. In CLL, direct renal involvement is frequently seen in autopsy studies especially in advanced disease, however, renal failure due to leukaemic infiltration is extremely rare.

Systemic lupus erythematosus (SLE) is a multisystemic disease which potentially involves various organs including the skin, joints, kidneys, liver, hematopoetic system, and serous membranes. It is rarely seen in elderly males. The most common cardiovascular involvement type is pericarditis. Anti-Ro antibodies may be associated with neonatal lupus which causes heart blocks. Recent literature indicates that anti-Ro antibodies may be associated with various rhythm and conduction disturbances in the adulthood. The most common finding associated with anti-Ro antibodies is prolonged corrected QT (QTc) interval. Herein, we present an elderly male patient with anti-Ro-positive SLE associated with prolonged QTc interval and AV blocks that significantly improved after corticosteroid treatment.

Adipokine levels may have a role in the diagnostic and prognostic evaluation of malnutrition. The aim of the present study was to evaluate the correlation between malnutrition score and leptin, other biological markers, and body mass index (BMI) in the diagnosis of malnutrition in the elderly.In this cross-sectional observational study, we enrolled subjects over 70 years. Exclusion criteria were diabetes mellitus, obvious thyroid disorders, significant edema, renal dysfunction, chronic liver disease, symptomatic cardiovascular diseases, and malignity. Patients' demographic and medical data were recorded and anthropometric measurements were performed. Laboratory parameters including leptin, IGF-1, IGFBP-3, IL-6, TNF-α were measured. We defined malnutrition according to mini nutritional assessment (MNA) scale. Patients were divided into four groups according to BMI quartiles.Average age of the patients was 81.9 ± 4.8 years, 68.2 % female and 31.8 % male. According to their MNA scores, 103 (66.9 %) were well nourished, 33 (21.4 %) were under malnutrition risk and 18 (11.7 %) were malnourished. MNA total and screening scores were positively correlated with albumin, BMI, high-density lipoprotein cholesterol and estimated glomerular filtration rate. Serum leptin levels (ng/ml) were 18.9 ± 22.6, 22.3 ± 21.9, 51.9 ± 85.5, and 61.7 ± 56.1 in BMI groups 1-4, respectively. BMI was positively correlated with leptin and triglyceride levels. Leptin levels were similar among nutritional state groups. Neither BMI nor MNA scores had any significant correlation with adiponectin, ghrelin, IGF-1, or IGFBP-3.Adipokine levels do not seem to give relevant information in nutritional state assessment.

Edema can be observed as side-effect of many medications, of which calcium channel blockers are the best known. Elderly people use many more medications than their younger counterparts and are usually more prone to developing medication-induced side-effects. Atypical antipsychotics have occasionally been shown to induce peripheric edema. Age is put forward as a risk factor for olanzapine-induced edema. We present here the case of an elderly man who developed upper- and lower-limb edema during use of olanzapine to emphasize its relatively frequent association with edema in the elderly.

We present a young woman with extrapulmonary sarcoidosis who had been treated for tuberculosis 15 years earlier. The initial diagnosis had been made on the basis of liver biopsy. The patient later developed bilateral visual loss secondary to uveitis. We identified noncaseating granulomatous lesions in the kidney, intra-abdominal lymph node, and previous liver biopsy specimens. Although rare, renal sarcoidosis can manifest itself as hypercalcemic nephropathy, granulomatous interstitial nephritis, renal tubular dysfunction, or glomerulonephritis. Corticosteroids are the treatment of choice.

OBJECTIVE: Poor recognition and monitoring of nutritional status is the most important cause of malnutrition in hospitalized patients. The aim of this study was to assess the nutritional status of a group of patients and compare the results with their serum prealbumin levels. METHODS: Ninety-seven patients admitted consecutively to the hospital were enrolled in the study. The risk of malnutrition was assessed according to anthropometric data and the Subjective Global Assessment and Nutrition Risk Screening 2002 tools. The nutritional statuses of the patients were compared with their age, gender, body mass index, medical history, weight loss and routine biochemical analyses, including prealbumin and length of hospital stay. RESULTS: According to the Nutrition Risk Screening 2002, 57% of the patients were malnourished or at risk of malnutrition, correlating well with the Subjective Global Assessment (p