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Ceylan S, Guner Oytun M, Okyar Baş A, Balci C, Halil MG, Cankurtaran M, Doğu BB. How does hospitalization affect the frailty status of geriatric patients? Prospective study from internal medicine wards of a university hospital. Chronic Illn 2023:17423953231209461. [PMID: 37844580 DOI: 10.1177/17423953231209461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
OBJECTIVES Frailty is a dynamic process. Frailty in the baseline, discharge, and post-discharge are important in the management of patients. We aimed to see how hospitalization affects frailty and to evaluate its effects on health outcomes. METHODS It was conducted with patients aged 65 and over who were hospitalized in the internal medicine wards of a university hospital. Frailty was evaluated by Clinical Frailty Scale within the first 24 h of hospitalization, within 24 h before discharge, and at third months after discharge. RESULTS Ninety-six (57.8%) of patients at baseline, 79 (50.6%) at discharge, and 68 (47.9%) at 3 months were frail. According to baseline, 12 (7.7%) patients changed from frail to non-frail at discharge, while 4 (2.6%) patients became frail (p = 0.08). According to the baseline, 18 (12.5%) patients went from frail to non-frail at 3 months, while 7 (4.9%) patients turned frail (p = 0.04). In regression analysis, living with frailty at discharge and low education level increased re-hospitalization. Five or more are considered living with frailty. DISCUSSION Hospitalization may have positive effects on frailty in older adult patients hospitalized in internal medicine wards, the main effect is seen to be more significant in the post-discharge follow-up.
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Affiliation(s)
- Serdar Ceylan
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Merve Guner Oytun
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Arzu Okyar Baş
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Cafer Balci
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Meltem Gulhan Halil
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Cankurtaran
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Burcu Balam Doğu
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Halil MG, Demirkan K, Doganay M, Cengiz C, Gunduz M, Abbasoglu O. Accreditation of nutrition support teams: A new initiative by the Turkish Society of Clinical Enteral & Parenteral Nutrition. Nutrition 2023; 114:112112. [PMID: 37450961 DOI: 10.1016/j.nut.2023.112112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/20/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Accreditation is a process to evaluate compliance of an institution or organization with predetermined performance standards, focusing on achieving continuous improvement strategies and optimal quality standards and motivating the accredited organization to do so. There is no established accreditation program for nutrition support teams (NSTs) at national and international levels. In order to increase the standards of NSTs, developing an accreditation program is being planned by the Turkish Society of Clinical Enteral & Parenteral Nutrition (KEPAN). METHODS Accreditation standards were developed by a study group under the organization of KEPAN. Minimum standards for composition, qualifications, physical requirements, workflow charts, medical records, and both patient and health care providers' safety measures in NSTs were specified. These standards were uploaded to a computer program, and the necessary infrastructure for a web-based management of accreditation processes was developed. RESULTS An organization applying for accreditation should fill in the application form on KEPAN website electronically. Eligibility criteria for accreditation include number of NST members, physical environment, patient monitoring requirements, research, and training. A total of 22 standards are surveyed under 13 sections. These standards contain 61 criteria. To be accredited, each of 22 standards must score >70 and each of 13 sections must score >80. CONCLUSIONS In order to increase the quality of nutritional care and improve patient outcomes, an accreditation program has been developed. This program principally sets the basic standards, organizational scheme, and responsibilities of NSTs.
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Affiliation(s)
- Meltem Gulhan Halil
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Mutlu Doganay
- Department of General Surgery, Faculty of Medicine, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Turkey
| | - Canan Cengiz
- Health Institutes of Turkey, Turkish Health Care Quality and Accreditation Institute, Ankara, Turkey
| | - Murat Gunduz
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Osman Abbasoglu
- Clinical Nutrition Master's Program, Hacettepe University, Ankara, Turkey
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Caliskan H, Sahin UK, Baydan M, Ozsurekci C, Aycicek S, Dogrul T, Sumer F, Balci C, Esme M, Unsal P, Aksoy S, Kirdi N, Halil MG, Cankurtaran M, Dogu BB. Balance performance measured by posturography in mild-moderate Alzheimer's Disease: An undervalued assessment. Geriatr Nurs 2023; 53:33-39. [PMID: 37422938 DOI: 10.1016/j.gerinurse.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE The aim of the study was to compare balance performance in mild-moderate stage Alzheimer's disease (AD) patients and healthy peers using clinical balance tests and computerized posturography. METHODS We recruited 95 patients and divided them into two groups; 51 patients (62 % (n=32) female) in AD group and 44 patients in healthy controls group (50 % (n=22) female). Berg Balance Scale (BBS) and Timed Up & Go (TUG) test were performed. Computerized posturography was performed. RESULTS The mean age was 77.2±5.5 years in the AD group and 73.8±4.4 years in the control group (p<0.001). Sensory organization test composite equilibrium score (60[30-81], p<0.001), step quick turn-sway velocity (69.2 [38.2-95.8], p<0.001) and step quick turn-time (3.8 [1.6-8.4], p<0.001) were significantly impaired in mild-moderate stage AD patients. Berg Balance Scale (50 [32-56], p<0.001) and TUG test (13.0 [7.0-25.7], p<0.001) results were worse in AD. CONCLUSIONS Computerized posturography measures were impaired in mild-moderate AD patients. The results highlight importance of early screening for balance and fall risk in AD patients. The study provides multi-dimensional and holistic assessment of balance performance in early-stage AD patients. Alzheimer's disease patients at earlier stages are prone to fall risk and should be evaluated accordingly.
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Affiliation(s)
- Hatice Caliskan
- Hacettepe University School of Medicine, Internal Medicine Department, Division of Geriatrics, Ankara, Turkey.
| | - Ulku Kezban Sahin
- Hacettepe University Health Sciences, Physiotherapy Department, Ankara, Turkey
| | - Mine Baydan
- Hacettepe University Health Sciences, Audiology Department, Ankara, Turkey
| | - Cemile Ozsurekci
- Hacettepe University School of Medicine, Internal Medicine Department, Division of Geriatrics, Ankara, Turkey
| | - Sengul Aycicek
- Hacettepe University School of Medicine, Internal Medicine Department, Division of Geriatrics, Ankara, Turkey
| | - Tuna Dogrul
- Hacettepe University School of Medicine, Internal Medicine Department, Division of Geriatrics, Ankara, Turkey
| | - Fatih Sumer
- Hacettepe University School of Medicine, Internal Medicine Department, Division of Geriatrics, Ankara, Turkey
| | - Cafer Balci
- Hacettepe University School of Medicine, Internal Medicine Department, Division of Geriatrics, Ankara, Turkey
| | - Mert Esme
- Hacettepe University School of Medicine, Internal Medicine Department, Division of Geriatrics, Ankara, Turkey
| | - Pelin Unsal
- Hacettepe University School of Medicine, Internal Medicine Department, Division of Geriatrics, Ankara, Turkey
| | - Songul Aksoy
- Hacettepe University Health Sciences, Audiology Department, Ankara, Turkey
| | - Nuray Kirdi
- Hacettepe University Health Sciences, Physiotherapy Department, Ankara, Turkey
| | - Meltem Gulhan Halil
- Hacettepe University School of Medicine, Internal Medicine Department, Division of Geriatrics, Ankara, Turkey
| | - Mustafa Cankurtaran
- Hacettepe University School of Medicine, Internal Medicine Department, Division of Geriatrics, Ankara, Turkey
| | - Burcu Balam Dogu
- Hacettepe University School of Medicine, Internal Medicine Department, Division of Geriatrics, Ankara, Turkey
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Ceylan S, Guner Oytun M, Okyar Bas A, Kahyaoglu Z, Ayaz CM, Balci C, Dogu BB, Cankurtaran M, Halil MG. Changes in Place of Death of Older Adults during the COVID-19 Pandemic: A Retrospective Study from an Aging Country. Omega (Westport) 2023:302228231154361. [PMID: 36715548 PMCID: PMC9892879 DOI: 10.1177/00302228231154361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In the COVID-19 pandemic, due to the difficulties in patients' applications to health centres, changes have occurred in the places of death of older adults. It is aimed to investigate the change in the places of death of older adults in Turkey, which is one of the countries most affected by the pandemic. Patients admitted to the geriatric outpatient clinic of a university hospital from 01.01.2013 to 29.02.2020 were included. Place and date of death were recorded as hospital or out-of-hospital death. According to results, while the median age of those who died during the pandemic was higher than before (p < 0.001) and during the pandemic, the hospital mortality ratio was higher than before. During the pandemic period, the hospital mortality ratio of older adults has increased in Turkey. This situation, which has occurred despite the increasing healthcare burden, can show the importance of the measures taken and robust health infrastructure.
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Affiliation(s)
- Serdar Ceylan
- Division of Geriatrics, Department
of Internal Medicine, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
| | - Merve Guner Oytun
- Division of Geriatrics, Department
of Internal Medicine, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
| | - Arzu Okyar Bas
- Division of Geriatrics, Department
of Internal Medicine, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
| | - Zeynep Kahyaoglu
- Division of Geriatrics, Department
of Internal Medicine, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
| | - Caglayan Merve Ayaz
- Department of Infectious Disease
and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Cafer Balci
- Division of Geriatrics, Department
of Internal Medicine, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
| | - Burcu Balam Dogu
- Division of Geriatrics, Department
of Internal Medicine, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
| | - Mustafa Cankurtaran
- Division of Geriatrics, Department
of Internal Medicine, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
| | - Meltem Gulhan Halil
- Division of Geriatrics, Department
of Internal Medicine, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
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Sengul Aycicek G, Ozsurekci C, Caliskan H, Kizilarslanoglu MC, Tuna Dogrul R, Balci C, Unsal P, Esme M, Yavuz BB, Cankurtaran M, Halil MG. Ultrasonography versus bioelectrical impedance analysis: which predicts muscle strength better? Acta Clin Belg 2021; 76:204-208. [PMID: 31847723 DOI: 10.1080/17843286.2019.1704989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background & Aim: Muscle strength seems to be more relevant to the functionality than muscle mass in sarcopenia. Different diagnostic techniques are available for the evaluation of muscle mass. Ultrasonography (USG) seems to have some advantages compared to other techniques especially bioelectrical impedance analysis (BIA) including being not affected of the results by the factors like extreme body mass indexes (BMI) or hypervolemia. The aim of the study is to determine and compare the muscle strength prediction value of muscle mass measured by using USG or BIA and determine the cut-off values for the Turkish population.Methods: One hundred and thirty six patients admitted to geriatrics outpatient clinic for comprehensive geriatric assessment were included in the study. Body composition was determined by BIA and skeletal muscle mass ındex (SMI) was measured. Thickness of the gastrocnemius muscle was measured via USG. Diagnosis of sarcopenia was made according to the EWSGOP 2 diagnostic criteria.Results: The best cut-off value for gastrocnemius muscle thickness to predict low HGS was ≤13.8 mm (AUC:0.690,p <0.001). SMI was not found to predict low HGS (AUC:0.573,p >0.05). Comparison of AUCs for gastrocnemius muscle thickness and SMI showed that gastrocnemius muscle thickness had higher AUC (p=0.008). For predicting sarcopenia, the best cut-off value of gastrocnemius muscle thickness was found to be ≤12.3 mm in women (AUC: 0.862,p <0.001) and ≤12.3 mm in men (AUC:0.900, p < 0.001).Conclusions: In this study, we found that gastrocnemius thickness measured by USG seems to predict low HGS better than SMI measured by BIA.
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Affiliation(s)
- Gozde Sengul Aycicek
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cemile Ozsurekci
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hatice Caliskan
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Muhammet Cemal Kizilarslanoglu
- Konya Education and Research Hospital, Palliative Care Center and Geriatrics, University of Health Sciences, Konya, Turkey
| | - Rana Tuna Dogrul
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cafer Balci
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Pelin Unsal
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mert Esme
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcu Balam Yavuz
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Gulhan Halil
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Unsal P, Sengul Aycicek G, Deniz O, Esme M, Dikmeer A, Balcı C, Koca M, Ucar Y, Boga I, Burkuk S, Halil MG, Cankurtaran M, Dogu BB. Insomnia and falls in older adults: are they linked to executive dysfunction? Psychogeriatrics 2021; 21:359-367. [PMID: 33684960 DOI: 10.1111/psyg.12677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Insomnia increases the incidence of falls and impairs executive function. Moreover, falls are associated with executive function impairment. The relationship between falls and executive function in patients with insomnia is not clear. The aim of this study was to evaluate relationship between falls and executive function in individuals with insomnia and a control group. METHODS This study involved 122 patients (47 insomnia, 75 controls). The Mini-Mental State Examination, Quick Mild Cognitive Impairment Screen, Trail Making Test A, clock-drawing test, and digit span test were used to measure executive function. Semantic and working memory dual task was also performed. Fall history was recorded and the Falls Efficacy Scale - International administered. RESULTS The median age of the patients was 71 years (range: 65-89 years), and 60.7% were women. The insomnia group scored lower on the three-word recall than the control group (P = 0.005), but there was no difference between the groups on cognitive tests. Fall history and fear of falling were more frequent in the insomnia group (P = 0.003, P < 0.001). Semantic and working memory dual tasks were correlated with clock-drawing test only in the insomnia group (r = -0.316, P = 0.031; r = -0.319, P = 0.029). Depression (odds ratio (OR) = 9.65, P = 0.001) and Trail Making Test A (OR = 1.025, P = 0.07) were independently associated with insomnia. Four-metre walking speed (OR = 2.342, P = 0.025), insomnia (OR = 3.453; P = 0.028), and the semantic memory dual task (OR = 1.589; P = 0.025) were also independently associated with falls. CONCLUSION Our study showed that dual tasking and executive function are related to falls in patients with insomnia. Managing insomnia and assessment of executive dysfunction may have beneficial effects on preventing falls.
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Affiliation(s)
- Pelin Unsal
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gozde Sengul Aycicek
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Olgun Deniz
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mert Esme
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ayse Dikmeer
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cafer Balcı
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Koca
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Ucar
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ilker Boga
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Suna Burkuk
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Gulhan Halil
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcu Balam Dogu
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Balli FN, Unsal P, Halil MG, Dogu BB, Cankurtaran M, Demirkan K. Effect of clinical pharmacists' interventions on dementia treatment adherence and caregivers' knowledge. Geriatr Gerontol Int 2021; 21:506-511. [PMID: 33851746 DOI: 10.1111/ggi.14170] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 11/28/2022]
Abstract
AIM Poor adherence with dementia medications is common among patients and caregivers, owing to the absence of perceived effect, polypharmacy, and adverse effects. The aim of this study was to evaluate the effect of clinical pharmacists' interventions on the adherence to dementia treatment and the caregivers' knowledge of dementia. METHODS This study was conducted at a geriatric outpatient clinic of the university hospital between October 2018 and April 2019. The Morisky Green Levine Adherence Scale (MGLS) to patients or caregivers and the Dementia Knowledge Assessment Tool Version Two (DKAT2) to caregivers were applied at the beginning of the study and 4 months later by a clinical pharmacist. After the scales were applied in the first interview, verbal information about the importance of adherence to dementia treatment, and incorrect answers of caregivers in DKAT2 were provided by the clinical pharmacist. RESULTS A total of 94 patients and 91 caregivers were included in the study. High adherence to treatment was determined in 70.2% of the patients in the first interview and in 95.7% in the second interview (P < 0.001). The mean score of DKAT2 was 15.53 ± 2.44 in the first interview, while the median score of DKAT2 in the second interview was 19.11 ± 1.25 (P < 0.001). CONCLUSION The intervention of clinical pharmacists significantly increased the adherence to dementia treatment and the caregivers' knowledge of dementia. Close monitoring of dementia patients and caregivers by clinical pharmacists and collaboration with a multidisciplinary team play an important role in dementia care. Geriatr Gerontol Int 2021; 21: 506-511.
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Affiliation(s)
- Fatma Nisa Balli
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Turkey
| | - Pelin Unsal
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Gulhan Halil
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcu Balam Dogu
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Turkey
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Sari A, Esme M, Aycicek GS, Armagan B, Kilic L, Ertenli AI, Halil MG, Akdogan A. Evaluating skeletal muscle mass with ultrasound in patients with systemic sclerosis. Nutrition 2020; 84:110999. [PMID: 33160811 DOI: 10.1016/j.nut.2020.110999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/14/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Patients with systemic sclerosis (SSc) have an increased risk for loss of skeletal muscle mass. Ultrasonography (US) is a safe and promising method to evaluate muscle mass. In this study, we aimed to assess the frequency and clinical associations of low muscle mass status in patients with SSc, investigate the correlations between muscle mass sonographically measured regional muscle thicknesses (MTs), and explore the utility of US in predicting low muscle mass. METHODS A total of 93 patients with SSc (86 women) were included in the study. Appendicular skeletal muscle mass (ASM) was calculated using a bioelectric impedance analysis and adjusted for height2 (ASM index, ASMI). Low muscle mass was defined as an ASMI of <7.26 kg/m2 for men and <5.50 kg/m2 for women. MT of the gastrocnemius medialis (GM), rectus femoris (RF), rectus abdominis (RA), external oblique (EO), internal oblique (IO), and transverse abdominis (TA) muscles were assessed by US. Correlations between ASMI and individual MTs were evaluated. Receiver operating characteristic analysis was used to determine the optimal cutoff values of MTs in predicting low muscle mass. RESULTS Low muscle mass was present in 13.9% of patients. Diffuse disease subset (53.8% vs 17.5%), antitopoisomerase-1 antibody positivity (76.9% vs 47.5%), and malnutrition (61.5% vs 8.8%) were more frequent in patients with low muscle mass (P < 0.05 for all). MTs of RA (0.54 vs 0.75 cm), TA (0.30 vs 0.34 cm), and GM (1.23 vs 1.51 cm) muscles were significantly lower in patients with low muscle mass (P < 0.05 for all). RA (r = 0.322; P = 0.002), external oblique (r = 0.310; P = 0.002), TA (r = 0.205; P = 0.049), and GM (r = 0.513; P < 0.001) MTs were positively correlated with ASMI. Selected cutoff values for GM and RA MTs showed the highest sensitivity (92.3% for both) and negative predictive value (97.9% and 97.6%, respectively) in predicting low muscle mass status (area under the curve: 0.846 and 0.760, respectively) in the receiver operating characteristic analysis. CONCLUSIONS Low muscle mass is prevalent in SSc and patients with diffuse disease are at particular risk for this condition. US measurement of abdominal and calf MTs may be used as a screening method to detect low muscle mass due to its high sensitivity and negative predictive value.
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Affiliation(s)
- Alper Sari
- Department of Rheumatology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | - Mert Esme
- Department of Geriatrics, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Gozde Sengul Aycicek
- Department of Geriatrics, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Berkan Armagan
- Department of Rheumatology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Levent Kilic
- Department of Rheumatology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ali Ihsan Ertenli
- Department of Rheumatology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Meltem Gulhan Halil
- Department of Geriatrics, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ali Akdogan
- Department of Rheumatology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Ozsurekci C, Arik G, Halil MG. Comparing the adequacy of the MNA-SF, NRS-2002 and MUST nutritional tools in assessing malnutrition in hip fracture operated elderly patients. Clin Nutr 2017; 36:913. [PMID: 28238341 DOI: 10.1016/j.clnu.2017.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Cemile Ozsurekci
- Department of Geriatric Medicine, Hacettepe University Medical Faculty, Ankara, Turkey.
| | - Gunes Arik
- Department of Geriatric Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Meltem Gulhan Halil
- Department of Geriatric Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
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Emri S, Kilickap S, Kadilar C, Halil MG, Akay H, Besler T. Serum levels of alpha-tocopherol, vitamin C, beta-carotene, and retinol in malignant pleural mesothelioma. Asian Pac J Cancer Prev 2013; 13:3025-9. [PMID: 22994705 DOI: 10.7314/apjcp.2012.13.7.3025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The aim of this study was to investigate the possible relationship between antioxidant vitamin levels and malignant pleural mesothelioma (MPM). For this purpose, we measured the serum levels of 4 antioxidant vitamins, β-carotene, α-tocopherol, retinol, and ascorbic acid, in patients with environmentally induced MPM and in healthy controls from one tremolite village (Kureysler), the biggest erionite village (Tuzkoy) and Ankara. A total of 160 subjects were enrolled in the study, 42 (26.3%) diagnosed with MPM and 118 (73.7%) healthy subjects. A comparison was made between the MPM group and three control groups of which two were exposed and one was unexposed to mineral fibers. The study population consisted of 82 males (51%) and 78 females (49%) with a mean of age of 44.8±14 years (range; 20-65 years). Lowest levels of β-carotene, ascorbic acid, and α-tocopherol were found in MPM patients (MPM vs control groups combined, p<0.0001 for each antioxidant vitamin), without any relation to age or sex. There was no significant difference between the antioxidant levels of healthy controls of Tuzkoy and Ankara. In conclusion; our findings suggested an increased risk of MPM being associated with low levels of α-tocopherol and ascorbic acid in patients with MPM.
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Affiliation(s)
- Salih Emri
- Department of Chest Disease, Hacettepe University Faculty of Medicine, Ankara, Turkey
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