Evaluation of risk scores as predictors of mortality and hospital length of stay for older COVID-19 patients.

Objective: This study was intended to research the sensitivity of the Charlson Comorbidity Index (CCI), COVID-GRAM, and MuLBSTA risk scores for hospital length of stay (LOS) and mortality in older patients hospitalized with coronavirus disease 2019 (COVID-19). Methods: A total of 217 patients (119 women) were included in the study. The first clinical signs, comorbidities, laboratory and radiology findings, and hospital LOS were recorded for each patient. The CCI, COVID-GRAM, and MuLBSTA risk scores were calculated, and their sensitivities for hospital LOS and mortality were evaluated using receiver operating characteristic (ROC) curve analysis. Results: Of the hospitalized patients, 59 (27.2%) were followed in the intensive care unit, and mortality developed in 44 (20.3%). The CCI positively correlated with COVID-GRAM and MuLBSTA scores (P < 0.001). COVID-GRAM and MuLBSTA results correlated with LOS and mortality (P < 0.001). According to the ROC curve analysis, the cutoff points for mortality were 5 for CCI, 169 for COVID-GRAM, and 9 for MuLBSTA. Conclusion: Older patients with comorbidities are the major risk group for severe COVID-19. COVID-GRAM and MuLBSTA scores appear to be sensitive and reliable mortality indicators for these patients.

Relationship between diabetic polyneuropathy, serum visfatin, and oxidative stress biomarkers.

BACKGROUND: Diabetic polyneuropathy is a very common complication of diabetes. Numerous studies are available in terms of pathogenesis. But examination methods with low reliability are still not standardized and generally time consuming. High-sensitive, easy-to-access methods are expected. Biochemical markers are one of the subjects of research. We aimed to discover a potential biomarker that can be used for this purpose in patients with diabetes who have not yet developed symptoms of neuropathy. AIM: To determine the place and availability of visfatin and thiol-disulfide homeostasis in this disorder. METHODS: A total of 392 patients with type 2 diabetes mellitus were included in the study. The polyneuropathy clinical signs were evaluated with the Subjective Peripheral Neuropathy Screen Questionnaire and Michigan Neuropathy Screening Instrument questionnaire and examination. The biochemical parameters, oxidative stress markers, visfatin, and thiol-disulfide homeostasis were analyzed and correlated with each other and clinical signs. RESULTS: Subjective Peripheral Neuropathy Screen Questionnaire and Michigan Neuropathy Screening Instrument questionnaire with examination scores were correlated with each other and diabetes duration (P < 0.005). Neuropathy related symptoms were present in 20.7% of the patients, but neuropathy related findings were observed in 43.9% of the patients. Serum glucose, glycated hemoglobin, and visfatin were positively correlated with each other. Also, these parameters were positively correlated with the total oxidative stress index. Total and native thiol was positively correlated with total antioxidant status and negatively with oxidant status. Inversely thiol-disulfide positively correlated with higher glucose and oxidant status and negatively with total antioxidant status (P < 0.005). There was no correlation between visfatin and thiol-disulphide (P = 0.092, r = 0.086). However, a significant negative correlation was observed between visfatin and total with native thiol (P < 0.005, r = -0.338), (P < 0.005, r = -0.448). CONCLUSION: Diagnosis of neuropathy is one of the issues studied in patients with diabetes. Visfatin and thiol-disulfide balance were analyzed for the first time in this study with inspiring results.

The impact of obesity on acute pancreatitis outcomes in older patients.

PURPOSE: Although obesity is an established risk factor for a number of diseases, several epidemiological studies have demonstrated that older obese patients have better survival rates than non-obese old patients in various disease states. In this context, the relationship between obesity and acute pancreatitis outcome in older patients is controversial. Therefore, the authors aimed to investigate the impact of obesity on acute pancreatitis outcomes in older patients. METHODS: Patients aged > 65 years who had been hospitalized for acute pancreatitis were retrospectively analyzed. Among them, 190 patients were included. The median age was 73 (68-79) years, and 118 (62.1%) were women. Obesity was assessed according to body mass index, and patients were classified as either obese or non-obese. The primary endpoint of the study was in-hospital major adverse events (major in-hospital complications and death). The secondary endpoints were acute pancreatitis recurrence, 30-day all-cause mortality, and long-term all-cause mortality. RESULTS: A total of 77 (40.5%) patients were obese. In-hospital major adverse events were observed in 40 (21.1%) patients. There was no statistical difference in major in-hospital adverse events between the two groups (27 [23.9%] in non-obese patients vs. 13 [16.9%] in obese patients, p = 0.24). Further, the 30-day mortality, long-term survival, and acute pancreatitis recurrence rates were similar (all p > 0.05). The median follow-up time was 18 (0-80) months. CONCLUSION: Obesity does not result in higher mortality or complications in older patients with acute pancreatitis. Although the underlying mechanism needs to be elucidated, the deleterious effect of obesity seems to be diminished in older patients.

Evaluation of the relationship between serum apelin levels and vitamin D and mean platelet volume in diabetic patients.

OBJECTIVES: It was reported that Vitamin D deficiency was associated with a greater risk of cardiometabolic diseases, obesity, impaired glucose tolerance and diabetes mellitus type 2, arterial hypertension, and dyslipidemia. Apelin is an adipocytokine suspected to have a role in skeletal muscle glucose utilization and glycemic regulation which may be a promising treatment modality for diabetes. It was recently reported that increased mean platelet volume (MPV) was emerging as an independent risk factor for thromboembolism, stroke, and myocardial infarction. In patients with diabetes, MPV was higher compared with the normal glycemic controls; in addition, it has been proposed that an increase in MPV may play a role in the micro- and macro-vascular complications related to diabetes. We postulated that deficiency in Vitamin D levels might be associated with higher MPV and lower serum apelin levels leading a further increase in insulin resistance in diabetic patients. So, we aimed to investigate Vitamin D levels, MPV and serum apelin levels in diabetic patients and their correlations between each other. MATERIALS AND METHOD: This is a cross-sectional study design. Seventy-eight patients with Diabetes Mellitus type 2, admitted to our outpatient clinic of internal medicine department at Bezmialem Vakif University, were included in our study. Forty-one patients were female; 37 patients were male. Serum apelin levels, fasting glucose levels, urea, creatinine, triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting serum insulin level, HbA1c, free T3, free T4, TSH, vitamin D (25-OH Vitamin D) and complete blood counts were analyzed in all subjects. RESULTS: Each sex was analyzed separately. We found that a positive correlation existed between serum apelin levels and BMI in female patients. (r: 0.380, P: 0.014) There was also a significant positive correlation between MPV and HbA1c and fasting glucose levels and a negative correlation between MPV and PLT. (r: 0.377, P: 0.021; r: 0.395, P: 0.014; r: -0.401, P: 0.011; respectively) We failed to show a significant relationship between serum vitamin D levels, serum apelin levels and MPV in patients with diabetes mellitus type 2. CONCLUSION: We failed to show an association between vitamin D, apelin and MPV higher volumes of which may have a role in cardiovascular complications related to diabetes by increasing platelet activation.

An unusual cause of peritonitis in peritoneal dialysis patients: Pantoea agglomerans.

Peritonitis is a serious infection and early diagnosis and treatment is mandatory. A variety of microorganisms are identified in these cases and during recent years a new one was included, Pantoea agglomerans. In this case report, a female patient on continuous ambulatory peritoneal dialysis therapy with a peritonitis episode caused by this organism is described. The source of infection was thought to be due to contact of catheter with non-sterile surfaces. In microbiologic culture, this organism was identified and the patient successfully treated with a three week course of gentamicin therapy. The number of reported cases with this organism has increased in last years and various infection localizations and clinical progress patterns have been identified. In peritoneal dialysis patients presenting with peritonitis, this organism must be kept in mind.

A comparison of end-stage renal disease and Alzheimer's disease in the elderly through a comprehensive geriatric assessment.

PURPOSE: The percentage of patients receiving haemodialysis (HD) treatment and of patients with Alzheimer's disease (AD) within the elderly population is increasing day by day. Functional dependence, malnutrition, cognitive impairment or depression impairs the quality of life and increases mortality in both diseases. This study aims to assess HD and AD patients through comprehensive geriatric assessment (CGA) and compare their results. METHOD: A total of 579 patients (121 HD, 188 AD patients and 270 control subjects) over the age of 65, who were followed at geriatric and nephrology departments between January 2011 and July 2012, were included in this prospective cross-sectional study. Mini-Mental State Examination, Mini-Nutritional Assessment, Geriatric Depression Scale and basic and Instrumental Activities of Daily Living indexes were applied to all patients. The results obtained were compared among the patient groups. RESULTS: The mean age of the participants was 72.6 ± 8.2. Based on the CGA findings, the results for both groups were considerably different from control group. While depression scores were observed higher in HD patients than in AD patients, cognition, nutrition and functional capacity were mostly affected in AD patients. CONCLUSION: The management of geriatric HD patients is substantially complex. Depression, cognitive impairment and decrease in functional capacity can often be overlooked, so findings may be ascribed to underlying kidney impairment. Therefore, comprehensive geriatric assessment should be regularly performed in HD patients in order to detect problems at an early stage, to take necessary preventative measures, to initiate treatment as soon as possible and to enhance quality of life.

The effect of sleep apnea syndrome on the development of diabetic nephropathy in patients with type 2 diabetes.

AIMS: Type 2 diabetes mellitus and obstructive sleep apnea syndrome (OSAS) are serious comorbidities. Effects of OSAS on diabetic microvascular complications are ongoing research subjects. We evaluated the incidence of OSAS in Type 2 diabetes mellitus patients with nephropathy and with no renal involvement. METHODS: A total of 52 people with diabetes were enrolled in this study. Patients body mass indices were calculated and fasting glucose, glycosylated hemoglobin, urea, creatinine, total lipid profile, and urinary albumin excretion were evaluated. Full polysomnography was used to detect sleep disorders. RESULTS: Baseline characteristics and laboratory results of the patients were similar. Meeting criteria for OSAS was detected in 35 of the 54 patients (67.3%). 25 patients (48%) had mild, six patients (11.5%) had moderate, and four patients (7.7%) had severe sleep disorders. There was no significant relationship between respiratory obstructive parameters and microalbuminuria (R=0.91, p=0.362). Substantial correlation was detected between lower values of serum triglyceride levels and lower respiratory indices (R=0.299, p=0.031). CONCLUSIONS: In type 2 diabetes accompanying OSAS affects glucose regulation but its effect on nephropathy development is currently a subject of research.

Myeloid/natural killer cell precursor acute leukemia with tetraploidy.

Myeloid/natural killer (NK) cell precursor acute leukemia is characterized by coexpression of myeloid and natural killer cell antigens and an aggressive clinical course. Here we report a case of myeloid/NK precursor acute leukemia in a 37-year-old woman. Clinical presentation was correlated with leukemic blast morphology, immunophenotype, and cytogenetic analysis. The patient had noted fever, weakness, purpura, peripheral lymphadenopathy, and moderate hepatosplenomegaly. Peripheral blood smears and bone marrow aspirate smears at presentation revealed blastic cells, which were generally L2 shaped, with variation in cell size, round to moderately irregular nuclei and prominent nucleoli, pale cytoplasm, and a lack of azurophilic granules. Immunophenotypic analysis of the blasts displayed coexpression of myeloid and natural killer cell antigens with relatively immature phenotype: CD7+, CD33+, CD34+, CD56+, CD57+, CD16-, MPO-. Cytogenetic analysis of marrow cells showed 62% of cells with a normal female karyotype; in the remaining 38%, tetraploid changes were detected, where the chromosome number was 92, with no preferential losses or gains of chromosomes. Fluorescence in situ hybridization analysis revealed the same abnormality. The patient did not respond to chemotherapy (cytosine arabinoside and idarubicin) and died of a septic complication on the 34th day after admission. To our knowledge, this is the first description of tetraploidy in myeloid/NK cell precursor acute leukemia.

Biventricular diastolic dysfunction in patients with autosomal-dominant polycystic kidney disease.

BACKGROUND: Left ventricular diastolic dysfunction has been shown in patients with autosomal-dominant polycystic kidney disease (ADPKD). However, there is no study evaluating right ventricular functions in these patients. METHODS: In the present study, diastolic functions of both ventricles in normotensive and hypertensive ADPKD patients with well-preserved renal function were investigated. Fifteen hypertensive and 16 normotensive patients with ADPKD with well-preserved renal function, 16 patients with essential hypertension, and 24 healthy subjects were included in the study. Conventional left and right ventricular echocardiographic measurements were performed in all subjects. Left and right ventricular functions were investigated both by myocardial performance index (MPI) [calculated by dividing the sum of isovolumic contraction time and isovolumic relaxation time (IVRT) by ejection time] and by tissue Doppler imaging (TDI). RESULTS: Left ventricular deceleration time and IVRT were significantly prolonged in hypertensive patients with ADPKD compared with patients with essential hypertension and even in normotensive patients with ADPKD compared with healthy subjects. Left and right MPIs were significantly higher in patients with ADPKD compared with healthy subjects, showing systolic and diastolic dysfunction. Moreover, by using TDI, the peak early diastolic mitral annular velocity (Em) to peak late diastolic mitral annular velocity (Am) ratio and the peak early diastolic tricuspid annular velocity (Et) to peak late diastolic tricuspid annular velocity (At) ratio were decreased in patients with ADPKD, suggesting biventricular diastolic dysfunction. CONCLUSION: Both hypertensive and normotensive patients with ADPKD show significant biventricular diastolic dysfunction, suggesting cardiac involvement very early in the course of ADPKD.