Identifying Malnutrition in Oncology Outpatients Using Different Screening Tools.

OBJECTIVE: To compare the results of different nutritional screening tools, including NRS-2002, PG-SGA, and NUTRISCORE for the detection of malnutrition in oncology outpatients. STUDY DESIGN: A descriptive study. Place and Duration of the Study: Daily Chemotherapy Unit, Umraniye Training and Research Hospital, Istanbul, Turkiye, between June and July 2021. METHODOLOGY: A total of 69 patients were included in the study, receiving cancer therapy in an outpatient setting. The NRS-2002, PG-SGA, and NUTRISCORE scores were calculated to determine the nutritional status. RESULTS: The mean age of the patients was 56.74 ± 13.48 years, and 59.4% were females. The mean BMI was 27.29 ± 5.27 kg/m2. Among the patients, 55.1% had insufficient nutritional intake or were at risk of malnutrition according to the NRS-2002, 40.6% according to NUTRISCORE, and 59.4% according to the PG-SGA. There was a significant agreement between the results of the NRS-2002 and PG-SGA in a McNemar test (Kappa: 0.320, p = 0.008). CONCLUSION: NRS-2002 and PG-SGA tools offered greater sensitivity in terms of capturing more patients in the precachectic state than NUTRISCORE. Among these, the NRS-2002 is a shorter test, and thus, would seem to be more practical than the PG-SGA. KEY WORDS: Oncology, Malnutrition, Screening tools, NRS-2002, PG-SGA, NUTRISCORE.

Evaluation of the effects of anakinra treatment on clinic and laboratory results in patients with COVID-19.

OBJECTIVE: Some anti-cytokine treatments are being used to control the hyperinflammatory condition defined as cytokine storm that develops during COVID-19 infection. In this study, we aim to investigate the effects of anakinra, an IL-1 antagonist, on the clinical status and laboratory values of hospitalized patients with the COVID-19 infection. The aim of the study was to investigate the effects of anakinra, an IL-1 antagonist, on the clinical and laboratory results of hospitalized patients with COVID-19 infection. METHODS: This study was planned as a retrospective study. The age, gender, and current comorbidities of a total of 66 patients who were treated with anakinra for COVID-19 infection from November 2020 to January 2021 were analyzed. The amount of oxygen demand (L/s), the type of oxygen supplementation, oxygen saturation, radiological findings, WBC count, lymphocyte count, neutrophil count, C-reactive protein, LDH, ferritin, fibrinogen, D-dimer levels were monitored before the treatment, and after the anakinra treatment, newly gathered results were compared. Patients' hospitalization period, oxygen need, and their clinical status at discharge were evaluated. The effects of early anakinra treatment (9 days before and after the onset of symptoms) on the prognosis were evaluated. SPSS version 21.0 provided by IBM Company in the USA, Chicago, IL was used for statistical analysis and p<0.05 was considered significant. RESULTS: Sixty-six patients were included in the study. There was no significant gender difference in the prognosis of the patients. There was a significant difference in the statistical deterioration in patients with comorbidities (p=0.004). Patients who started the anakinra treatment at an early stage developed less need for intensive care and low mortality ratios (p=0.019). There were significant improvements on the levels of WBC (p=0.045), neutrophils (p=0.016), lymphocyte (p=0.001), LDH (p=0.005), ferritin (p=0.02), and fibrinogen (p=0.01) after the administration of anakinra therapy. CONCLUSION: We found that earlier and appropriate use of anakinra therapy in COVID-19 patients with the signs of macrophage activation syndrome reduces the need for oxygen support in patients and contributes to improvement in laboratory results and radiological findings, and most importantly reduces the need for intensive care.

The results of following type 2 diabetes patients with mobile health services during the COVID-19 pandemic.

OBJECTIVE: The aim of this study is to determine the level of compliance with treatment and achieving metabolic goals in type 2 diabetes mellitus (T2DM) patients who are remotely monitored with mobile health (mHealth) technologies during the pandemic. METHODS: A total number of 86 patients were included in the study. Data from two periods were used: from 1 month before the date when the first COVID-19 case in Turkiye was reported on March 11, 2020 (Febraury 10, 2020-March 31, 2020) and from the pandemic was severe between April 01, 2020 and May 31, 2020. Participants' mean blood glucose, step count, blood pressure, body weight, and diet compliance levels were evaluated. RESULTS: When the blood sugar, blood pressure, and weight averages of the patients were compared between the pre-pandemic period and the pandemic months separately, no significant difference was observed. However, it was observed that the number of steps decreased significantly compared to the period before the pandemic (p<0.05). It was determined that 88% of the participants were able to access health services without applying to the hospital. CONCLUSION: In this study, we showed that patients with T2DM who were followed up with mHealth technologies provided the necessary metabolic control and compliance with the treatment during the pandemic.

The effect of interleukin-6 level at the time of hospitalisation on erectile functions in hospitalised patients with COVID-19.

We evaluated the relationship between erectile dysfunction (ED) and IL-6 levels in males with COVID-19. The study included 80 male patients aged 30-45 years who were hospitalised due to COVID-19. The International Index of Erectile Function (IIEF-5) questionnaire was used to assess erectile function. The IIEF-5 questionnaire was re-administered at a 3-month control visit after discharge, and the change score from baseline was recorded. The patients were divided into three groups according to the IIEF-5 score at 3 months as Group 1 (severe ED), Group 2 (moderate ED) and Group 3 (no ED), and into two groups according to IL-6 level at the time of admission as Group A (IL-6 ≤ 50 ng/ml) and Group B (IL-6 > 50 ng/ml). The change in the IIEF-5 score (p < .001) was significantly greater in Group B than in Group A. There was also significant difference in IL-6 between Group 1 and Group 2 (p = .008). The correlation analysis revealed a moderate correlation between IL-6 level and the change in IIEF-5 score and D-dimer level (r:0.529, p < .001) and a weak correlation between IL-6 level and FSH (r:0.309, p = .005). The present study suggests that elevated IL-6 levels in male patients hospitalised due to COVID-19 might be related to the risk of developing ED.

Relationship between Epicardial Fat Tissue Thickness and CRP and Neutrophil-Lymphocyte Ratio in Metabolic Syndrome Patients Over 65 Years.

OBJECTIVE: There are no data evaluating the association of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) with epicardial fat tissue thickness (EFTT) in elderly metabolic syndrome (MS) patients. In this study, we aimed to investigate the relationship of EFTT with CRP and NLR in patients with MS over 65 years. METHODS: A cross-sectional study was performed. Fifty patients (patient group) with MS and 25 subjects (control group) without MS were allocated in the study. All parameters were compared in patient and control groups. The correlations between NLR, CRP, and EFTT were evaluated. RESULTS: White blood cell and neutrophil levels were higher in MS group (p=0.020 and p=0.019, respectively). Both transverse and longitudinal EFTT were increased in MS patients (p<0.001). There was a significant correlation between the EFTT and NLR but not with CRP in the MS group (r=0.4, p=0.003). CONCLUSION: Our study showed that both longitudinal and transverse EFTT are associated with NLR in patients older than 65 years with MS. In geriatric MS patients, higher NLR level may be an indicator of increased visceral fat around the myocardium.

Serum Amino Acid Levels and Mortality in Patients Undergoing Percutaneous Endoscopic Gastrostomy.

OBJECTIVE: To evaluate the effect of feeding via percutaneous endoscopic gastrostomy tube (PEG) on serum amino acid levels and mortality. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey, from January 2016 to February 2019. METHODOLOGY: Patients over 18 years of age, who were indicated for PEG due to loss of swallowing reflex, were included in the study. The follow-up period of the study was one year. The patients were reevaluated on the 3rd, 6th, and 12th months after inclusion. Anthropometric measurements, and nutritional status were evaluated at each visit, and quantitative amino acid levels were analysed. Statistical significance was accepted as p <0.05. RESULTS: The study was carried out with a total of 53 cases (23 men and 30 women) ranging in the age from 18 to 91 years. While 13 patients were still alive, 40 patients died before completing one year. The levels of glutamine, leucine, taurine, and threonine were significantly different between surviving patients and dead. A statistically significant difference was found between the levels of citrulline (p <0.001), ornithine (p = 0.036) and tyrosine (p = 0.011) during the four different visits of patients who survived. In patients who died, a significant difference was found between the levels of threonine, ornithine, and aspartic acid (p <0.043 for all) between visits. Citrulline and tyrosine levels were found to be significantly increased in surviving patients. CONCLUSION: The amino acid profiles of malnourished patients vary considerably. Increase in citrulline, ornithine and tyrosine levels are noted in surviving patients. Key Words: Amino acid, Percutaneous endoscopic gastrostomy, Malnutrition, Mortality.

Evaluation of the relation between cardiac biomarkers and thorax computed tomography findings in COVID-19 patients.

Background: Troponin levels may be elevated in COVID-19 infection. The aim of this study was to the explore relation between troponin levels and COVID-19 severity. Materials, methods & Results: One hundred and forty consecutive patients with COVID-19 pneumonia were included. Diagnosis of COVID-19 pneumonia was based on positive chest computed tomography (CT) findings. Quantitative PCR test was performed in all patients. Only 74 patients were quantitative PCR-positive. Twenty four patients had severe CT findings and 27 patients had progressive disease. These patients had significantly lower albumin and higher ferritin, D-dimer, lactate dehydrogenase, C-reactive protein, and high-sensitivity cardiac troponin I (hs-cTnI). Conclusion: COVID-19 patients with severe CT findings and progressive disease had higher hs-cTnI levels suggesting the use of hs-cTnI in risk stratification.

The Relationship Between Osteoarthritis and Sarcopenia in Geriatric Diabetic Patients.

Objectives: Osteoarthritis is a common disease affecting the quality of life in the elderly population. Osteoarthritis is a painful condition commonly encountered in patients aged 65 years and older and it may cause muscle weakness. Sarcopenia is a condition that has an increasing prevalence in the elderly population. The present study evaluated the relationship between sarcopenia and osteoarthritis. Methods: The study included 100 patients aged 65 years and older who were diagnosed with diabetes mellitus. The patients were divided into two groups as Group 1 and Group 2. Group 1 was composed of 50 patients with diabetes and osteoarthritis and Group 2 was composed of 50 patients with diabetes but without osteoarthritis. A detailed medical history was obtained from all patients and all patients underwent physical examination. The get-up and go test was performed, handgrip strength was measured with a hand dynamometer, bioimpedance analysis was performed, and mid-upper arm circumference, calf circumference and waist circumference were measured, and laboratory tests including complete blood count, biochemical nutritional parameters, liver and kidney function tests, and erythrocyte sedimentation rate were ordered. The Kellgren and Lawrence grading system was used to evaluate the severity of osteoarthritis and the skeletal muscle mass index was used to evaluate the muscle mass. These parameters were compared between the two groups. Results: Of the study participants, 1% had severe sarcopenia, 22% had moderate sarcopenia, and 77% did not have sarcopenia. Albumin (p=0.013), magnesium (p=0.038), total protein (0.004), erythrocyte sedimentation rate (p=0.047), hemoglobin level (p=0.018), muscle strength (p=0.046), height (p=0.033), and muscle mass (p<0.05) were significantly different in patients with osteoarthritis compared to patients without osteoarthritis. Patients with osteoarthritis achieved poorer results on the get-up and go test (p=0.014), and mid-upper arm circumference (p=0.028), and calf circumference (p=0.016) were lower in this group. There was a negative moderate correlation between the muscle mass and the Kellgren and Lawrence grade (p<0.05, r: -0.405), whereas there was a positive moderate correlation between sarcopenia index and the Kellgren and Lawrence grade (p<0.05, r: 0.320) in patients with osteoarthritis. Conclusion: The present study is the first to evaluate the relationship between sarcopenia and osteoarthritis in geriatric diabetic patients. The present study found a significant relationship between osteoarthritis and sarcopenia in geriatric patients with type II diabetes mellitus. The authors suggest that pain associated with osteoarthritis results in immobility, decrease in functional performance, and thus development of sarcopenia.

The Relationship between Vitamin D Level and Lower Urinary Tract Symptoms in Women.

OBJECTIVES: In the literature, the effects of vitamin D on lower urinary tract symptoms (LUTS) have been investigated. Conflicting results have been reported in these studies conducted. LUTS is more common in women. In this study, we aimed to evaluate the relationship between vitamin D and LUTS in female patients using the uroflowmetric method. METHODS: This retrospective cohort study included 186 female patients who were admitted with LUTS. Demographic characteristics, medical history, calcium (Ca) and vitamin D, including laboratory studies and uroflowmetry results, as maximum urine flow rate (Qmax), average urine flow rate (Qav) and voided volume (V) were recorded. Patients were divided into two groups according to age (18-50 and ≥51) and vitamin D levels (<20 and ≥20). Laboratory parameters and uroflowmetry results were compared between groups. RESULTS: Mean age was 56.85±12.95 years. Mean vitamin D level was 21.19±13.93 ng/mL (2.5-83.5). Mean Qmax value was 35.41±12.63, whereas the mean Qav was 19.13±9.89, and the mean V was 446.60±165.08 mL. Vitamin D levels differed according to age groups (p=0.044). No significant difference was observed between groups according to Qmax, Qav and V values (p>0.05). No significant correlation was detected between vitamin D level and Qmax, Qav and V values. However, a negative correlation was detected between serum Ca level and V values (p=0.042) in the low vitamin D group. CONCLUSION: There was no direct relationship between vitamin D levels and LUTS in respect to uroflowmetry. However, we determined that Ca levels affect the uroflowmetry parameter in patients with low vitamin D levels. There is a need for further studies emphasizing serum Ca levels in addition to vitamin D levels in patients with LUTS.

Determining INR Awareness of the Patients who Use Warfarin and Rates of Achieving the Target Dosage.

OBJECTIVES: Warfarin is the most frequently used therapy as an oral anticoagulant medication for reducing the risk of thromboembolic complications. However, poor adherence to therapy may cause ineffective INR levels with increased complication risk. In our study, we aimed to show the rates of INR awareness of patients with atrial fibrillation (AF) using warfarin and whether they achieved the targeted INR values. METHODS: In this study, 300 male (60%, n=180) and female (40%, n=120) patients over 18 years of age who applied to warfarin polyclinic and were receiving warfarin treatment due to AF were included. The levels of INR between 2-3 were estimated as effective. Same questionnaire was applied to all patients. RESULTS: Our study showed that 57% of the patients who used warfarin were not in the therapeutic range. We also determined that INR awareness was extremely low in the majority of the patients. In this study, 72.2% of the patients who used warfarin did not know the definition of INR, 68% of the patients did not know the side effects of the medicine, 75.7% of the patients did not know the precautions needed to be taken in daily life and 83.7% of the patients did not know the foods rich in vitamin K. Patients who knew the meaning of INR were more likely have INR levels in the effective range, but these rates were not statistically significant. There was no statistically significant relationship between the educational level, marital status, and INR control frequency of the patients with the achievement of targeted INR levels. CONCLUSION: At the beginning of the warfarin treatment, advantages and disadvantages should be balanced by the doctor. The patient and patient's relatives should be informed directly and comprehensibly about the effects and side effects of the medicine, as well as the interactions, pursuance and precautions need to be taken in daily life. Various modern methods should be enabled for surveillance and the patients who are not in the therapeutic range should be followed closer.

A case of tuberculosis presented by obstructive jaundice tuberculosis-related mechanical icterus.

Obstructive jaundice caused by tuberculosis lymphadenitis is a rare condition. It can mimic clinical and radiological findings of hepatobiliary malignancies. The authors report a 24-year-old male patient who presented with abdominal pain, fever and jaundice for the last two weeks. It was found that cholestasis enzymes were increased by 2-3 fold and direct bilirubin was 6.13 mg/dL. Imaging studies revealed conglomerated lymph nodes with some cavitary lesions and dilated intrahepatic biliary canal secondary to compression by the lymph nodes. Tuberculosis was found to be positive in the polymerase chain reaction analysis of the aspirate that was obtained in the guidance of imaging studies. M. tuberculosis complex was isolated from mycobacterial culture. Anti-tuberculosis treatment was initiated. Clinical, laboratory and radiological findings completely resolved by medical therapy alone. Tuberculosis lymphadenitis should be kept in mind in cases presenting with obstructive jaundice in endemic areas and interventional diagnostic techniques should be preferred in eligible patients.

Association of neutrophil-gelatinase-associated lipocalin with microvascular complications in patients with type 2 diabetes: a cross-sectional study.

Diabetic nephropathy and diabetic retinopathy are serious microvascular complications of diabetes mellitus. Recent studies have demonstrated that neutrophil-gelatinase-associated lipocalin (NGAL) may be accompanied by these complications during and before the appearance of microalbuminuria. In this study, we set out to research the role of NGAL in patients with diabetic nephropathy and diabetic retinopathy. MATERIAL AND METHODS: Eighty-two patients with type 2 diabetes were enrolled in our study. Urinary microalbumine and NGAL levels were measured in urine samples over 24 hours. We also studied NGAL levels in serum. All patients went through an ophthalmologic examination. The results were evaluated based on the presence of microalbuminuria and retinopathy. RESULTS: There were no significant differences in serum and urine NGAL levels between normoalbuminuric (n = 66) and microalbuminuric (n = 16) patients. We also did not find any significant difference in patients with retinopathy (n = 16) or without retinopathy (n = 66). CONCLUSION: There are controversial findings about the role of NGAL in diabetic patients in medical literature. Standard values of urine and serum NGAL levels have yet to be determined. Our study suggests that NGAL is not a useful marker to differentiate microalbuminuric patients from normoalbuminuric subjects. We also did not find a relationship between NGAL levels and the presence of retinopathy. Additional studies with larger sample sizes will be required to confirm or refute these findings.

The effect of vitamin D levels on gastrointestinal bleeding in patients with warfarin therapy.

: Upper tract gastrointestinal system (GIS) bleeding is considered as an important cause of morbidity and mortality despite modern and advanced endoscopic interventions. In patients with thrombotic state and vitamin D deficiency, vitamin D analogs and vitamin D receptor activators have been determined as adjunctive anticoagulant treatment in previous studies. However, these studies did not evaluate or reveal the possible bleeding diathesis. In this article, we evaluated the vitamin D status in patients with warfarin treatment and upper tract GIS bleeding. A total of 75 patients with a definite diagnosis of upper tract GIS bleeding who had a treatment of warfarin and current vitamin D measurement; and a total of 75 control patients without any recent or prior GIS bleeding who had a treatment of warfarin and current vitamin D measurement were enrolled to the study. GIS bleeding group had a proportionally higher vitamin D treatment (29.3 vs. 17.3%). In GIS bleeding group, the prevalence of vitamin D level less than 20 ng/ml was significantly lower (66.7 vs. 82.7%; P = 0.024) and the prevalence of vitamin D level at least 30-100 ng/ml was significantly higher (25.3 vs. 10.7%; P = 0.019). According to a subgroup analysis; in patients with a vitamin D level at least 30-100 ng/ml, major bleeding rate was significantly higher compared with other patients. There was not a significant difference regarding mortality between the groups. Our study is the first which represents the possible bleeding effect of elevated vitamin D levels and vitamin D treatment in patients with warfarin treatment.

Association of vitamin D status and the risk of cardiovascular disease as assessed by various cardiovascular risk scoring systems in patients with type 2 diabetes mellitus.

OBJECTIVE: The aim of the present study was to evaluate the relationship between vitamin D (25[OH]D) status and the risk of cardiovascular disease as assessed by various cardiovascular risk scoring systems such as QRISK2, BNF, ASSING, SCORE, and Framingham in patients with type 2 diabetes mellitus(T2DM). METHODS: The study included 108 patients with vitamin D insufficiency (25[OH]D ≥ 10-30 ng/mL) and 100 patients with vitamin D deficiency (25[OH]D < 10 ng/mL), who were admitted to the diabetes outpatient clinics due to T2DM and who were aged 45-65 years. QRISK2, BNF, ASSING, SCORE, and Framingham were calculated and compared between the two groups. RESULTS: HbA1c levels were significantly higher in patients with vitamin D deficiency. Patients with vitamin D deficiency had significantly higher Framingham risk score (p < .001) and significantly lower BNF score (p < .001), whereas other scores did not significantly differ between the groups. There was a moderate, statistically significant correlation between 25[OH]D levels and Framingham risk score in negative direction (r = 0.537) and a weak but statistically significant correlation between 25[OH]D levels and BNF score (r = 0.295). 25[OH]D levels were significantly higher and HbA1c levels were significantly lower in patients with Framingham cardiovascular risk score ≤10%. CONCLUSION: We found a close relationship with Framingham cardiovascular risk score in diabetic patients with very low serum vitamin D levels. Cardiovascular risk as assessed by the Framingham's scale increases with decreasing 25[OH]D levels. BNF score was negatively correlated with 25[OH]D levels.

The relationship between vitamin D level and erectile dysfunction in patients with type 2 diabetes mellitus.

Recent studies have suggested that a relationship could exist between 25-hydroxyvitamin D [25(OH)D] deficiency and erectile dysfunction (ED). The present study evaluated the relationship between 25(OH)D levels and ED in male patients with type 2 diabetes mellitus (DM). The study included 98 patients with type 2 DM aged between 18-80 years. The International Index of Erectile Function (IIEF-5) Questionnaire was administered. The patients were divided into three groups according to IIEF-5 scoring: IIEF-5 score between 5-10, severe ED; IIEF-5 score between 11-20, moderate ED; IIEF-5 score between 21-25, no ED. Biochemical parameters, 25(OH)D and hormonal analysis tests were obtained in all patients. All parameters were compared between these three groups. Of 98 patients included in the study, 32 had severe ED, 45 had moderate ED and 21 had no ED. The mean age was 55.12 ± 9.39 years and the mean 25(OH)D level was 13.69 ± 8.15 ng/ml. When the three groups were compared, 25(OH)D levels were significantly lower in patients with the IIEF-5 score between 5-10 (p = 0.020). There was a moderate positive relationship between IIEF-5 score and 25(OH)D level (r = 0.21, p = 0.038). The patients with severe ED have considerably lower 25(OH)D levels.

Thiamin and folic acid deficiency accompanied by resistant electrolyte imbalance in the re-feeding syndrome in an elderly patient.

INTRODUCTION: Re-feeding Syndrome (RS) is a deadly complication, which can be encountered during "refeeding" of malnourished patients. In these patients, thiamin deficiency may develop and "risk awareness" is the most significant factor in the management of these patients. In this case report, the treatment is presented of an elderly patient who was diagnosed with RS and followed-up in the intensive care unit (ICU) due to resistant fluidelectrolyte imbalance. CASE: An 87-year-old elderly woman was admitted to the hospital due to aspiration pneumonia. On day 4, during parenteral nutrition (30 kcal/kg/day), severe electrolyte imbalance developed. Total parenteral nutrition (TPN) was stopped, and enteral feeding together with potassium (90 mmol/day, i.v.) were started. During follow-up, plasma potassium values remained less than 3 mmol/L. Despite replacement therapy, hypoalbuminemia, hypomagnesemia, hypocalcemia, and hypophosphatemia persisted. Considering the parenteral nutrition (30 kcal/kg/day) during the hospitalization period, a diagnosis of RS was made. On day 10, thiamin (200 mg/day, i.v.) and folic acid (5 mg/day) were added, and the patient subsequently responded to electrolyte replacement treatment. The patient was discharged on day26 with a home-care plan. CONCLUSION: In patients with malnutrition, thiamin replacement should be given before starting nutrition to prevent RS. Energy intake should be 10kcal/kg/day at the start, and be gradually increased between days 4-10. Hemodynamic-laboratory parameters should be closely monitored. All these measures may be life-saving for patients at high risk.