Search

Background and Aim: This study aimed to define the relapse frequency and risk determinants in chronic hepatitis B (CHB) patients who discontinued nucleoside analog (NA) treatment, were HBeAg-negative, and had achieved both a virological and biochemical response. Materials and Methods: This retrospective cohort study reviewed patients with HBeAg-negative CHB who received antiviral therapy for at least 65 months between January 1, 2013, and December 31, 2020. These patients discontinued treatment after demonstrating a biochemical and virological response and were evaluated at 6, 12, and 24 months post-treatment discontinuation. Results: Sixty-seven patients with CHB who received NA therapy for at least 65 months, discontinued treatment, and had undetectable HBV DNA and normal ALT values were evaluated. After cessation of NA therapy, a relapse was observed in 38 patients (56.7%). The relapse rate was 71.0% in patients treated with tenofovir disoproxil fumarate (TDF) as the last NA type and 37.9% in patients treated with entecavir (ETV) (p=0.017). The cutoff value for the best estimate of age for predicting relapse was 42 years. The relapse rate was 69.2% in patients aged ≥42 years and 39.2% in patients aged <42 years (p=0.007). The relapse rate was 51.3% in patients with a pre-treatment fibrosis score of 2, 56.0% in those with a fibrosis score of 3, and 100% in those with a fibrosis score of 4 (p=0.089). Conclusion: Among HBeAg-negative CHB patients who achieved a virological and biochemical response to long-term antiviral therapy, those aged 42 years and older, those with high fibrosis scores before treatment, and those who used TDF before treatment cessation should be closely monitored for relapse, especially in the first 12 months after stopping NA treatment. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the prevalence of fear of falling and associated factors in older adults with heart failure. Methods: A prospective, cross‐sectional study. The study included 100 geriatric patients who were hospitalised and treated in the cardiology department of our hospital with ventricular ejection fraction (LVEF) lower than 50% for at least 1 year. A series of geriatric assessments were performed by face‐to‐face interview on the day of admission. Electrocardiography (ECG) and transthoracic echocardiography (TTE) were also performed on the day of admission. Results: The median age of the patients was 72 years, and 72.0% were men. Falls Efficacy Scale scores indicated a fear of falling in 46 (46.0%) of the patients. Charlson Comorbidity Index (CCI) was significantly higher in patients with fear of falling (P < 0.001). Severe depression, severe clinical insomnia, daytime sleepiness, and malnutrition were significantly more frequent among patients with fear of falling. Fear of falling was associated with significantly lower LVEF (P = 0.001). The presence of severe depression increased the risk of fear of falling by 13.97 times (95% CI: 3.064–63.707; P = 0.001), and the presence of daytime sleepiness increased the risk by 3.49 times (95% CI: 1.012–12.037; P = 0.048). A one‐unit increase in CCI increased the risk of fear of falling by 1.56 times (95% CI: 1.093–2.238; P = 0.014). Conclusions: Heart failure patients with concomitant depression, sleep disorders, and high comorbidities have greater fear of falling. [ABSTRACT FROM AUTHOR]

Introduction: Our study aimed to determine the frequency of malnutrition and associated risk factors in older patients receiving palliative care. Material and methods: This prospective cross-sectional study was performed with older patients hospitalized and treated in the palliative care unit of our university between December 1, 2022 and June 1, 2023. The demographic characteristics of the patients, reasons for palliative care admission, and the referring unit were recorded. The patients' nutritional status was assessed using the full mini nutritional assessment (MNA) and the geriatric nutritional risk index (GNRI). Selected laboratory parameters were recorded at admission to the palliative care unit. Results: The 371 patients included in the study had a median age of 74 years and 58.5% were female. Malnutrition was detected more frequently in geriatric palliative care patients with cerebrovascular disease, malignancy, dementia, and congestive heart failure. Malnutrition was detected in 69.32% of the patients according to GNRI and in 64.80% according to MNA. Prealbumin had the highest specificity (92.3%) at a cut-off value of 0.175 mg/dl. The multivariate logistic regression model created with these variables showed that female sex, Ca, Cl, prealbumin, and hemoglobin were significant independent risk factors for malnutrition (p < 0.05). Female sex was associated with 2.5 times higher odds of malnutrition. Conclusions: The prevalence of malnutrition was found to be high among geriatric palliative care patients in our study. The geriatric nutritional risk index can be used to diagnose malnutrition in immobile older palliative care patients and may be applied in routine patient follow-up to help improve quality of life. [ABSTRACT FROM AUTHOR]

Objective: Patients receiving palliative care are more prone to dermatological disease. The aim of our study was to determine the frequency of dermatological diseases and associated factors in patients receiving palliative care support. Methods: This prospective observational study included inpatients in the palliative care unit of our university hospital in Erzurum/TURKEY. The patients were evaluated by the same dermatologist within the first 48 h of admission and 3 days a week during follow-up. Demographic data, reasons for admission to the palliative care unit, and skin lesions at the time of admission and during follow-up were recorded. Results: The median age of the 259 patients included in the study was 77.0 years (min- max, 19-108) and 54.4% were women. Dermatological disease was detected in 246 patients (96.1%) at admission to the palliative care unit and in 185 patients (71.4%) patients during follow-up. The most common dermatological disease at admission was dry skin (n = 175, 67.6%), which was also the most common cause of pruritis (n = 29, 11.2%). The most common skin infection was dermatophytosis (n = 57, 22.0%) and the most common type of dermatitis was contact dermatitis (n = 17, 6.6%). Nearly all tumors were benign (n = 32, 12.4%) and most chronic wounds were pressure ulcers (n = 96, 37.1%). During hospital follow-up, the most frequent dermatitis was contact dermatitis (n = 44, 17.0%), the most frequent skin infection was candidiasis (n = 25, 9.7%), the most common chronic wound was pressure ulcers (n = 25, 9.7%), the most common dermatological disease was urticaria (n = 14, 5.4%), and all cases of pruritus were associated with dry skin (n = 8, 3.1%). Conclusions: The frequency of dermatological findings is high among patients receiving palliative care. Therefore, dermatologists should be included in multidisciplinary palliative care teams and evaluate palliative care patients early and regularly. [ABSTRACT FROM AUTHOR]

Introduction: Effective palliative care reduces unnecessary hospital admissions and intensive care length of stay. The present study aimed to investigate the parameters associated with mortality in patients receiving palliative care support. Material and methods: This prospective observational study was conducted among inpatients in a palliative care unit. Results: A total of 177 patients hospitalized in the palliative care unit were included in the study. Of the patients, 84 (47.5%) were female and the mean age was 72.49 ±15.12 years. At the end of the follow-up period in the palliative care unit, 67 patients (37.9%) had died. A one-unit increase in albumin was associated with 66.6% lower odds of mortality [odds ratio (OR): 0.334, 95% confidence interval (CI): 0.141–0.791; p = 0.013] and a one-unit increase in Karnofsky performance scales (KPS) score was associated with 4.8% lower odds of mortality (OR: 0.952, 95% CI: 0.925–0.980; p = 0.001). In contrast, the odds of mortality were 4.851 times higher in patients with congestive heart failure (95% CI: 1.716–13.717; p = 0.003), 4.442 times higher in patients with solid organ malignancy (95% CI: 1.420–13.894; p = 0.01), 3.727 times in the presence of hypoxia at admission (95% CI: 1.504–9.239; p = 0.005), and 3.626 times higher in patients who developed an infection during follow-up (95% CI: 1.523–8.635; p = 0.004). Conclusions: The results ofthis study suggest that congestive heart failure, solid organ malignancy, hypoxia at admission, infection during follow-up, and low albumin level and KPS score may be indicators of poor outcome. [ABSTRACT FROM AUTHOR]

In this study, we aimed to compare vitamin D (25 Hydroxy Vitamin D (25 OH D)) levels in Hidradenitis Suppurativa (HS) patients with healthy control groups, and to investigate its possible relationship with disease severity. Our study is a retrospective cross-sectional study. A total of 36 patients diagnosed with HS who presented to our Dermatology clinic between January 2019 and December 2022 were included. Vitamin D levels were recorded by reviewing the patients' files and compared with healthy control groups. The relationship between the patients' 25 OH D levels and disease severity score was determined. The median age of the patient group was 33.5 (IQR; 25.2-42) years, and 30 (83.3%) were male. The median age of the healthy control group was 34.5 (IQR; 24-42), and 21 (58.3%) were male. In patients with severe 25 OH D deficiency, statistically significant findings were observed with a higher frequency of Hurley-3 disease severity score, whereas patients with mild to moderate deficiency or normal 25 OH D levels showed a higher frequency of disease severity classified as Hurley-1. (p=0.022). Additionally, patients with severe vitamin D deficiency had significantly higher C-reactive protein levels and body mass index (p=0.036 and p=0.044, respectively). Among patients with active lesions such as abscesses, nodules, and fistula, significantly lower vitamin D levels were observed compared to those without such lesions (p=0.020, p=0.032, and p=0.017, respectively). Vitamin D level in patients with HS (13.42 ng/mL (IQR: 8.00-18.65)) compared to the healthy control group (18.00 ng/mL (IQR: 14.12-22.87)) was statistically significant. was significantly lower (p=0.001). Vitamin D levels of HS patients are lower than healthy control groups. Inflammatory lesions are more common in patients with severe vitamin D deficiency and the disease tends to be more severe. [ABSTRACT FROM AUTHOR]

Background: In chronic hepatitis B patients with or exposed to the risk of osteoporosis or renal dysfunction, switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide fumarate (TAF) or entecavir (ETV) may be the right choice. Objectives: This study aimed to present real-life data in terms of the efficacy and safety of a TAF/ETV treatment change while receiving TDF. Methods: This retrospective study was conducted on 344 adult patients from 10 centers. The data of patients who had changed to ETV (n = 107) and TAF (n = 237) while receiving TDF were analyzed. The data collected at 0 and 6 months of treatment were analyzed. The virological response was assessed based on undetected hepatitis B virus (HBV) DNA. Serum alanine aminotransferase (ALT) values were used to evaluate the biochemical response. For renal function, serum creatinine and phosphorus, as well as estimated glomerular filtration rate (eGFR), were recorded. Moreover, lumbar spine and hip T-scores along with the serum lipid profile were evaluated. Results: The mean age of patients was 41.14 13.46 years, and 224 (65.1%) of the participants were male. The treatment arms were not significantly different in terms of demographic characteristics, comorbid diseases, infection duration, family history of HBV infection, blood platelet count, serum biomarkers, such as ALT, phosphorus, creatinine, total bilirubin, albumin, lipid profile, and HBV DNA levels at the beginning. No statistically significant difference was found between the proportion of undetectable HBV DNA of thetwotreatment groups after6months(P=0.221). The ALT normalization in the ETVandTAF groups at the sixthmonthcompared to the baseline levels was not significantly different (P = 0.853, P = 0.330, respectively). There wasnostatistically significant difference between the two treatment arms regarding changes in eGFR, creatinine, phosphorus, hip, and spine T-scores from baseline to 6 months (P = 0.296, P = 0.78, P = 0.141, P = 0.832, P = 0.947, respectively). In those who switched to TAF or ETV, low-density lipoproteins cholesterol were observed to be significantly higher after 6 months compared to baseline values (P = 0.002, P = 0.049, respectively). The TC increased significantly in the TAF group (P = 0.035). Conclusions: Our study showed that switching to ETV and TAF sustained the viral suppression and biochemical response achieved by TDF therapy. The treatment switch to TAF of ETV can control renal dysfunction and reduce bone mineral density caused by TDF. [ABSTRACT FROM AUTHOR]

Background: Chronic hepatitis B (CHB) is a viral infection that can result in life-threatening conditions, such as hepatocellular carcinoma and cirrhosis. Tenofovir, which is used for the treatment of CHB, is a nucleotide analog that inhibits HBV-DNApolymerase and has two formulations: disoproxil and alafenamide. In contrast to tenofovir disoproxil fumarate (TDF), tenofovir alafenamide fumarate (TAF) penetrates the whole hepatocyte without being eliminated due to its longer plasma half-life and greater plasma stability. As a result, side effects such as proximal renal tubulopathy and loss of bone density are less common in the treatment of TAF and have similar efficacy to TDF. Objectives: The purpose of the study was to evaluate the effectiveness and reliability of TAF using real-life data. Methods: This retrospective cohort study was carried out in secondary or tertiary healthcare centers in southern Turkey. A total of 480 patients aged 18 years and older were administered TAF for an appropriate indication by the infectious diseases and gastroenterology clinics of the healthcare centers participating in this study. The data collected at t = 0, t = 3, and t = 6 months of treatment were analyzed. The chi-square, Mann-Whitney U, Friedman, Wilcoxon, Cochran's Q, and McNemar's tests were used. Results: The mean age of the patients was 47.40 ± 14.5, and 327 of them (68.1%) were male. A total of 78.l% of the 480 patients who underwent the TAF treatment had previous antiviral therapy experience (TDF, n = 340; 70.8 %), and 2l.9% were treatment-naive. The most common reasons for the initiation of TAF treatment were the use of drugs affecting bone mineral density (BMD) (42.9%) and osteoporosis (22.3%). Patients who had taken TDF experienced a significant improvement in glomerular filtration rate (GFR), hip and spine T-scores, and phosphorus levels from t = 0 months to t = 6 months after switching to TAF (P < 0.05). For this group, no statistically significant difference was observed concerning LDL and cholesterol levels from t = 0 months to t = 6 months. Side effects were reported by 5.7% of patients in the third month and 7.l% in the sixth month, with the most common side effect being hair loss (l%). Conclusions: TAF was found to be an effective and safe alternative to TDF with lower incidences of its long-term effects, such as nephrotoxicity and decreased bone density. [ABSTRACT FROM AUTHOR]

Background: As life expectancy at birth increases, the elderly population is growing, both in Turkey and globally. The aim of this study was to investigate the factors associated with 12-month mortality in patients receiving geriatric palliative care. Methods: Geriatric inpatients who were treated for 48 hours or more in the palliative care unit of our hospital between January 2016 and January 2017 were included in the study. Results: A total of 233 geriatric palliative care patients (50.6% women) with a mean age of 77.6 - 11.0 were included in the study. Eighty of the patients in our study died while in palliative care. Chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD) were significantly more common among the deceased patients. Of the 153 surviving patients, 94 (61.4%) died within 12months of discharge and 59 (38.6%) survived beyond 12 months. Presence of CKD was associated with a 2.17-fold reduction in survival time and albumin level < 3.2 mg/L with 2.12-fold reduction in survival time. In addition, post-discharge 12-month survival time was 1.80-fold shorter in the presence of solid organ malignancy, 2.06-fold shorter with APACHE-II score > 20.5, 1.60-fold shorter with Charlson Comorbidity Index (CCI) > 6.5, and 1.98-fold shorter with albumin levels < 3.2 mg/L. Conclusion: CKD and low albumin were identified as independent risk factors for reduced hospital survival time. Independent risk factors for shorter post-discharge survival time included the presence of solid organ malignancy, high APACHE-II score, high CCI, and low albumin level. [ABSTRACT FROM AUTHOR]

Objective: Sarcopenia, a geriatric syndrome, is an indicator of poor prognosis in elderly inpatients. In this study, we aimed to determine the effect of sarcopenia on mortality in elderly patients. Materials and Methods: Mobile/immobile geriatric inpatients, treated in the internal medicine ward between February and November 2018, were included in the study between Days 2 and 7 of hospitalization. The patients' fat-free mass (FFM) was measured by bioimpedance. The FFM index (FFMI) (kg/m²) was determined by dividing fat-free mass by body surface area (FFM/BSA). Sarcopenia was defined as a FFMI value at least two standard deviations below the gender-specific mean of normal young adults. Results: The study included 200 geriatric inpatients; 96 (48.0%) were men, and the mean age was 74.49±6.32 years. Sarcopenia was detected in 28 (14%) of the patients. Diabetes mellitus was associated with a signifi- cantly lower sarcopenia prevalence (p=0.006). The risk of sarcopenia was 9.046 times higher in malnourished patients. The sarcopenia group had more deaths (p=0.012). Conclusion: Sarcopenia in geriatric inpatients increased the length of hospital stay and mortality. Our findings may guide future studies examining the relationship between sarcopenia and mortality among elderly inpatients in other hospitals. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine the value of C-reactive protein level in the diagnosis and prognosis of infection in elderly patients.Study population: This prospective study included inpatients in the palliative care unit during the 1-year period between January 2016 and January 2017. Patients’ demographic data, Acute Physiology and Chronic Health Evaluation score, and Charlson Comorbidity Index were recorded.Results: A total of 233 patients were included in the study. A total of 199 instances of infection were diagnosed in 175 of those patients; 75.3% of the infections were detected at admission and 24.7% during hospitalization. At a cut-off value of 4.82, CRP value had 81.0% specificity and 75.4% sensitivity in the diagnosis of infection. Among the patients with infection, there was no difference between those who died and those who survived in terms of baseline CRP level, but a significant difference emerged in CRP level at 48 and 96 h. Factors which were found to significantly reduce survival time were the presence of chronic kidney disease, chronic obstructive pulmonary disease, hypoxia and tachycardia at admission, APACHE-II score over 20.5, initial albumin level below 2.44 g/dL, and serum CRP clearance rates of less than 11% at 48 h and 20% at 96 h.Conclusion: In elderly patients with infection, the initial CRP value alone does not have prognostic value, but changes observed in serial CRP measurement are a valid indicator of prognosis. [ABSTRACT FROM AUTHOR]

Background: In the past, Staphylococcus aureus infections have displayed various patterns of epidemiologic curves in hospitals, particularly in intensive care units (ICUs). This study aimed to characterize the current trend in a nationwide survey of ICUs in Turkey., Methods: A total of 88 ICUs from 36 Turkish tertiary hospitals were included in this retrospective study, which was performed during the first 3 months of both 2008 (period [P] 1) and 2011 (P2). A P value ≤.01 was considered significant., Results: Although overall rates of hospital-acquired infection (HAI) and device-associated infection densities were similar in P1 and P2, the densities of HAIs due to S aureus and methicillin-resistant S aureus (MRSA) were significantly lower in P2 (P < .0001). However, the proportion of HAIs due to Acinetobacter was significantly higher in P2 (P < .0001)., Conclusions: The incidence of S aureus infections is declining rapidly in Turkish ICUs, with potential impacts on empirical treatment strategies in these ICUs., (Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)