Associations of EWGSOP1 and EWGSOP2 probable sarcopenia definitions with mortality: A comparative study.

BACKGROUND & AIMS: Sarcopenia is a well-defined geriatric syndrome and a major cause of disability and mortality. We investigate the associations of alternative sarcopenia definitions with mortality in community-dwelling older adults. METHODS: Sarcopenia was defined based on the EWGSOP1 and EWGSOP2 probable sarcopenia criteria, with standard handgrip strength (HGS) cut-offs of 30/20 kg for an EWGSOP1 definition and 27/16 kg for an EWGSOP2 definition, or alternatively, population-specific cut-offs of 35/20 kg for a EWGSOP2 definition. The 5-year mortality rate was assessed in the accessible cases. RESULTS: The prevalence of sarcopenia among 204 older adults [53.9% female; aged 74.5 ± 7.0] was 4.9% based on the EWGSOP1 criterion, 23.5% according to the EWGSOP2-suggested standard (British) HGS cut-offs and 50.0% based on the EWGSOP2 population-specific cut-offs. In the 103 accessible patients, the mortality rate was 30.1%. Cox-regression analyses adjusted for parameters determined through univariate analyses [age and sarcopenia definitions (in 3 different models)], showed that the EWGSOP1 definition (HR = 4.26, 95% CI = 1.45-12.42, p = 0.008) and EWGSOP2 probable sarcopenia definition with population-specific cut-offs (HR = 2.58, 95% CI = 1.12-5.93, p = 0.03) were associated with a greater mortality risk, while the EWGSOP2 probable sarcopenia definition with standard-cut offs was not (p = 0.09). CONCLUSIONS: This is the first study to investigate the associations of EWGSOP2-defined probable sarcopenia with mortality based on standard vs. population-specific HGS cut-offs. The results suggest that population-specific cut-offs should be used when available. We suggest that conducted in community-dwelling older adults, our results have implications for most of older adults.

Description of damage in different clusters of patients with antiphospholipid syndrome.

OBJECTIVE: To identify the different clinical phenotypes of antiphospholipid syndrome (APS) by using cluster analysis and describe cumulative damage of disease clusters. METHODS: This retrospective study includes patients with APS (±systemic lupus erythematosus (SLE)). Two-step cluster analysis was applied by considering clinical data. Damage was calculated for all patients by applying damage index for APS (DIAPS). RESULTS: A total of 237 patients (198 females; median age of 43 years; median follow-up of 9.5 years) were classified into four clusters. Cluster 1 (n = 74) consisted of older patients with arterial-predominant thrombosis, livedo reticularis, and increased cardiovascular risk; cluster 2 (n = 70) of SLE+APS patients with thrombocytopenia and heart valve disease; cluster 3 (n = 59) of patients with venous-predominant thrombosis, less extra-criteria manifestations; and cluster 4 (n = 34) of patients with only pregnancy morbidity with lower frequency of extra-criteria features and cardiovascular risk. Patients with SLE+APS (n = 123) had the highest mean DIAPS. Regarding clusters, 1 and 2 had high cumulative damage. While cumulative survival rates of clusters did not differ, cluster 2 and 3 had lower survival rates at further years. There was no correlation between DIAPS and mortality. CONCLUSION: SLE+APS patients with extra-criteria manifestations and older APS patients with arterial thrombosis and increased cardiovascular risk have higher cumulative damage. Effective treatment of SLE disease activity and control of cardiovascular risk may help to reduce cumulative damage in these patients.

Cytomegalovirus reactivation during adult acute lymphoblastic leukemia maintenance: do we underestimate (un)expected guest of pediatric approach?

Among acute lymphoblastic leukemia (ALL), 40% of affected patients are diagnosed after the age of 20. Compared to pediatricians, adult hemato-oncologists are less familiar with complex pediatric ALL regimens and have perceived that pediatric ALL regimens are too toxic in the adult population. Meanwhile, multiple retrospective analyzes showed the superiority of pediatric regimens among the older adults and young adolescents (AYAs) group over adult regimens. A series of prospective studies have made it apparent that pediatric-inspired ALL regimens are feasible in AYAs, with manageable toxicities and potentially more encouraging results. However, the complications in the adult population are still to be explored. Although cytomegalovirus (CMV) viremia and infections are increasingly recognized in pediatric ALL cases, we generally do not experience it frequently in adult cases with conventional strategies. Herein we represent a 38-year-old man diagnosed with ALL and treated with pediatric inspired GRAALL-2003 protocol. Following a successful induction phase, he had pancytopenia, deep lymphopenia, fever and diarrhea in the 9th month of maintenance therapy. With increased serum ferritin and triglyceride levels, he had features of macrophage activation syndrome. The bone marrow biopsy did not reveal any relapse or hemophagocytosis. We detected highly increased levels of CMV DNA (657.262 copies/mL) in blood analysis.

The sustained virologic response of nonresponder hepatitis C virus patients with retreatment.

BACKGROUND: Pegylated interferon and ribavirin combination therapy remain the first-line treatment for chronic hepatitis C virus (HCV) infection. In contrast to the large number of studies in treatment-naive patients, the effectiveness of retreatment in patients who have previously failed pegylated interferon based therapy is not much reported. OBJECTIVES: The aim of this retrospective study was to focus on the efficacy of pegylated interferon alpha and ribavirin in retreated chronic hepatitis C patients. PATIENTS AND METHODS: All patients were treated with pegylated interferon alpha either 2a (180 µg) or 2b (1.5µg/kg) subcutaneously once weekly for a 48-week period, plus ribavirin 1000-1200 mg/day. The patient who had a negative HCV RNA at the end of 48 weeks were followed up for 24 weeks, and the patients who relapsed in the post-treatment follow-up period of 24 weeks were treated again with pegylated interferon alpha; but if the first treatment was administered with pegylated interferon alpha 2a, the second was administered with pegylated interferon alpha 2b and if pegylated interferon alpha 2b, then the second with pegylated interferon alpha 2a. RESULTS: We evaluated the outcome of our patients with chronic HCV who achieved a viral response at the end of the therapy, but did not achieve sustained virologic response; 54% (38/70) of patients did achieve sustained virologic response, while 46% (32/70) of patients did not (eight patients did not achieve early virologic response, five patients were nonresponders at 24th week of the treatment, the remaining 19 patient had negative HCV at the end of the therapy but did not achieve sustained virologic response). We began from 19 patients to 8 patients, who had negative HCV RNA at the end of the treatment, but did not achieve sustained virologic response, interferon plus ribavirin therapy again. If the patient had interferon alpha 2a, we gave in the second tour alpha 2b; and if alpha 2b, then alpha 2a. The early virologic response of these nine patients were found to be 63% (5/8). These 5 patients who had rapid virologic response and early virologic response at the second therapy achieved sustained virologic response this time. CONCLUSIONS: These findings suggest that the standard 48-week treatment is insufficient and that an extended course of treatment may be necessary. Relapse is a poorly understood clinical outcome in the treatment of chronic HCV patients. Retreatment can give a chance to some patients specially who have early virologic response and negative HCV RNA at the end of the first therapy.