Assessment of nutritional status of a group of elderly individuals living in a nursing home or own home

Yaşlı nüfusun birçok ülkede olduğu gibi ülkemizde de hızla arttığı bilinmektedir. Yaşlılık döneminde, sağlığın iyileştirilmesi ve geliştirilmesinde, yaşam süresinin ve kalitesinin artırılmasında yeterli ve dengeli beslenme ayrı bir öneme sahiptir. Bu çalışma, İstanbul İli’nde kurumda ve kendi evinde yaşayan 65 yaş ve üzeri bireylerin beslenme durumlarının değerlendirilmesi amacıyla yapılmıştır. 1 Ağustos-30 Ekim 2019 tarihleri arasında gerçekleştirilen çalışmaya, kendi evinde yaşayan 100 (55 kadın, 45 erkek) ve farklı özel kurumlarda yaşayan 95 (48 kadın, 47 erkek) olmak üzere toplam 195 birey dahil edilmiştir. Bireylerin demografik özellikleri, beslenme durumları, antropometrik ölçümleri, 24 saatlik geriye dönük besin tüketimleri kaydedilmiş, malnütrisyon durumlarını belirlemek için Mini Nütrisyonel Değerlendirme (MNA) testi uygulanmıştır. Verilerin istatistiksel olarak değerlendirilmesinde SPSS 18.0 programı kullanılmıştır. Evde ve kurumda yaşayan bireylerin yaş ortalamaları sırasıyla: 71,8 ± 5,8 yıl ve 73,8 ± 6,2 yıl olarak bulunmuştur. BKİ ortalaması evde yaşayanlarda 27,1 ± 4,2 kg/m2 ve kurumda yaşayanlarda 25,1 ±3,6 kg/m2 olarak saptanmış, evde yaşayan bireylerin %68’inin, kurumda yaşayanların %46,4’ünün kilolu veya obez oldukları belirlenmiştir (p<0,05). Bireylerin ortalama enerji alımları, evde ve kurumda yaşayanlarda sırasıyla: 1641,7 ± 282,4 ve 1491,1 ± 235,6 kalori olarak bulunmuştur (p˂0,05). MNA sonuçlarına göre evde yaşayan bireylerin %25’inde, kurumda yaşayanların %52,6’sında malnütrisyon riski ve/veya malnütrisyon görülmüştür. Sonuç olarak, evde yaşayan yaşlı bireylerin beslenme durumlarının kurumda yaşayan bireylerden daha iyi olduğu saptanmıştır. Yaşam kalitelerinin iyileştirilmesi, sağlık harcamalarının azaltılması için yaşlı bireylerin düzenli aralıklarla takiplerinin yapılması, beslenme durumlarının değerlendirilmesi önemlidir.It has been known that the elderly population increases rapidly in our country as in many countries. In old age, adequate and balanced nutrition has a special importance in the improvement of health, quality of life and lenghtening lifespan. This study was conducted to evaluate the nutritional status of 65 years and older people living in the city of Istanbul. A total of 195 individuals, 100 (55 females, 45 males) from their own home and 95 (48 females, 47 males) from different private nursing homes, were included in the study which conducted between 1 August-30 October 2019. Individuals' demographic characteristics, nutritional status, anthropometric measurements, 24-hour retrospective food consumptions were recorded and Mini Nutritional Assessment (MNA) test was applied to determine malnutrition status. SPSS 18.0 program was used in statistical evaluation of the data. The average age of the individuals living in the home and the nursing home was found to be 71.8±5.8 and 73.8±6.2 years respectively. The mean BMI was 27.1±4.2 kg/m2 at home and 25.1±3.6 kg/m2 at nursing home. It was found that 68% of the individuals living in the home and 46.4% of the people living in the nursing home were slightly obese or obese (p<0.05). The mean energy expenditures of the individuals were found to be 1641.7 ± 282.4 and 1491.1 ± 235.6 kcal respectively in the home and nursing homes (p˂0.05). According to MNA results, malnutrition risk or malnutrition was seen in 25% of the people living in their homes and 52.6% of the people living in the nursing home. As a result, the nutritional status of elderly people living at their homes was found to be better than those living in nursing homes. In order to improve their quality of life and reduce health expenditures, it is important to follow up the elderly at regular intervals and to evaluate their nutritional status

KURUMDA VE KENDİ EVİNDE YAŞAYAN BİR GRUP YAŞLI BİREYİN BESLENME DURUMLARININ DEĞERLENDİRİLMESİ

Yaşlı nüfusun birçok ülkede olduğu gibi ülkemizde de hızla arttığı bilinmektedir. Yaşlılık döneminde, sağlığın iyileştirilmesi ve geliştirilmesinde, yaşam süresinin ve kalitesinin artırılmasında yeterli ve dengeli beslenme ayrı bir öneme sahiptir. Bu çalışma, İstanbul İli’nde kurumda ve kendi evinde yaşayan 65 yaş ve üzeri bireylerin beslenme durumlarının değerlendirilmesi amacıyla yapılmıştır. 1 Ağustos-30 Ekim 2019 tarihleri arasında gerçekleştirilen çalışmaya, kendi evinde yaşayan 100 (55 kadın, 45 erkek) ve farklı özel kurumlarda yaşayan 95 (48 kadın, 47 erkek) olmak üzere toplam 195 birey dahil edilmiştir. Bireylerin demografik özellikleri, beslenme durumları, antropometrik ölçümleri, 24 saatlik geriye dönük besin tüketimleri kaydedilmiş, malnütrisyon durumlarını belirlemek için Mini Nütrisyonel Değerlendirme (MNA) testi uygulanmıştır. Verilerin istatistiksel olarak değerlendirilmesinde SPSS 18.0 programı kullanılmıştır. Evde ve kurumda yaşayan bireylerin yaş ortalamaları sırasıyla: 71,8 ± 5,8 yıl ve 73,8 ± 6,2 yıl olarak bulunmuştur. BKİ ortalaması evde yaşayanlarda 27,1 ± 4,2 kg/m2 ve kurumda yaşayanlarda 25,1 ±3,6 kg/m2 olarak saptanmış, evde yaşayan bireylerin %68’inin, kurumda yaşayanların %46,4’ünün kilolu veya obez oldukları belirlenmiştir (p<0,05). Bireylerin ortalama enerji alımları, evde ve kurumda yaşayanlarda sırasıyla: 1641,7 ± 282,4 ve 1491,1 ± 235,6 kalori olarak bulunmuştur (p˂0,05). MNA sonuçlarına göre evde yaşayan bireylerin %25’inde, kurumda yaşayanların %52,6’sında malnütrisyon riski ve/veya malnütrisyon görülmüştür. Sonuç olarak, evde yaşayan yaşlı bireylerin beslenme durumlarının kurumda yaşayan bireylerden daha iyi olduğu saptanmıştır. Yaşam kalitelerinin iyileştirilmesi, sağlık harcamalarının azaltılması için yaşlı bireylerin düzenli aralıklarla takiplerinin yapılması, beslenme durumlarının değerlendirilmesi önemlidir.It has been known that the elderly population increases rapidly in our country as in many countries. In old age, adequate and balanced nutrition has a special importance in the improvement of health, quality of life and lenghtening lifespan. This study was conducted to evaluate the nutritional status of 65 years and older people living in the city of Istanbul. A total of 195 individuals, 100 (55 females, 45 males) from their own home and 95 (48 females, 47 males) from different private nursing homes, were included in the study which conducted between 1 August-30 October 2019. Individuals' demographic characteristics, nutritional status, anthropometric measurements, 24-hour retrospective food consumptions were recorded and Mini Nutritional Assessment (MNA) test was applied to determine malnutrition status. SPSS 18.0 program was used in statistical evaluation of the data. The average age of the individuals living in the home and the nursing home was found to be 71.8±5.8 and 73.8±6.2 years respectively. The mean BMI was 27.1±4.2 kg/m2 at home and 25.1±3.6 kg/m2 at nursing home. It was found that 68% of the individuals living in the home and 46.4% of the people living in the nursing home were slightly obese or obese (p<0.05). The mean energy expenditures of the individuals were found to be 1641.7 ± 282.4 and 1491.1 ± 235.6 kcal respectively in the home and nursing homes (p˂0.05). According to MNA results, malnutrition risk or malnutrition was seen in 25% of the people living in their homes and 52.6% of the people living in the nursing home. As a result, the nutritional status of elderly people living at their homes was found to be better than those living in nursing homes. In order to improve their quality of life and reduce health expenditures, it is important to follow up the elderly at regular intervals and to evaluate their nutritional status

DPPH Radical Scavenging, Phenolic and Antimicrobial Activity of Momordica charantia and Rheum ribes

Guder, Aytac/0000-0002-1190-8749WOS: 000438848100055In this study was to investigate total phenolic contents, 1, 1-Diphenyl-2-picrylhydrazyl (DPPH center dot), antimicrobial and antifungal activity by using different extract of Momordica charantia and Rheum ribes. The extraction applied to different part of Momordica charantia as husk and fruit and Rheum ribes as blossom and stem. Three different were used extraction solvent such as hexane, ethanol and water/acetic acid (1%). The highest radical scavenging activity was observed in ethanol extract of rhubarb blossom, acetic acid (1%) extract of rhubarb showed remarkable radical scavenging activity and the highest phenolic content value was observed acetic acid (1%) extracts of bitter melon. The highest antimicrobial efficacy against C. albicans was provided by the ethanol extract of the part of crust of Momordica charantia and acetic acid-water extraction of the blossom of Rheum ribes.Giresun UniversityGiresun University [FEN-BAP-A-160317-45]This study was supported by Giresun University (FEN-BAP-A-160317-45) Scientific Research Project

Gastrostomy in hospitalized patients with acute stroke: "NoroTek" Turkey point prevalence study subgroup analysis

Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NöroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69±14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (β): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (β): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (β): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin’s scale score 0-2) functional outcome [exp (β): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (β): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NöroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.Amaç: Akut nörovasküler hastalıklarda nütrisyonel durum ve disfaji değerlendirmesi ve enteral beslenme kararı önemli prognoz belirleyicilerindendir. Gereç ve Yöntem: NöroTek, 10 Mayıs 2018’de (Dünya İnme Farkındalık Günü) Türkiye’nin tüm sağlık alt bölgelerine yayılmış 87 hastanenin katılımıyla gerçekleştirilen bir nokta prevalans çalışmasıdır. Hastanede yatan ve bu alt çalışma için toplanan verisi tam olan toplam 972 nörovasküler hasta (kadın: %53, yaş: 69±14 yıl; 845’i akut iskemik inme; 119’u intraserebral hematom ve 8’i post-resüsitasyon ensefalopatisi) analiz edildi. Bulgular: Gastrostomi iskemik inmeli hastaların %10,7, intraserebral kanamalıların %10,1 ve post-resusitasyon ensefalopatisi olanların %50’sine uygulanmıştır. Perkütan endoskopik gastrostomi (PEG) gereksiniminin bağımsız belirleyicileri, iskemik inme grubunda kabul NIHSS [exp (β): 1,09, %95 güven aralığı (GA): 1,05-1,14, puan başına] ile hem iskemik hem de hemorajik inmelerde mekanik ventilasyon uygulanmış olmasıdır [iskemik için: exp (β): 6,18, %95 GA: 3,16- 12,09] ve hemorajik inme için: [exp (β): 26,48, 95% GA: 1,36-515,8]. İnme olgularında PEG uygulaması hastane içi mortalite için bağımsız belirleyici değildi [exp (β): 1,731, 95% GA: 0,785-3,829]. Ancak, PEG uygulanmış olması taburculuk esnasında iyi prognoza (modifiye Rankin skoru 0-2) sahip olabilme için anlamlı bir negatif etmen olarak bulundu [exp (β): 0,032, %95 GA: 0,004-0,251]. Hastanede yatan nörovasküler hastaların yaklaşık üçte ikisinde malnütrisyon ve yutma bozukluğu açısından değerlendirme yapılmıştı. Nutrisyonel status değerlendirmesinin %69’u ve disfaji değerlendirmesinin %76’sı ilk 48 saat içinde gerçekleştirilmişti. Tüple enteral nütrisyon uygulama oranı %39’du. Beslenme tüplerinin %83,5’i ilk 2 gün içinde yerleştirilirken beslenme tüpü olan hastaların %28’ine daha sonra PEG açılmıştı. Sonuç: NöroTek çalışması ile Türkiye’de hastanede yatan akut inme hastalarında nutrisyonel uygulamaların temel kalite ölçütlerine ilişkin ilk güvenilir ve büyük ölçekli veri sağlanmıştır. Ekonomik olması ve doğruluğu açısından nokta yaygınlık yönteminin bu tip verilerin temini için daha fazla kullanılması mantıklıdır

Acute Stroke Management in Türkiye: Intravenous Tissue Plasminogen Activator and Thrombectomy NöroTek: Türkiye Neurology Single Day Study

Objective: To reveal the profile and practice in patients with acute stroke who received intravenous tissue plasminogen activator (IV tPA) and/or neuro-interventional therapy in Türkiye. Materials and Methods: On World Stroke Awareness Day, May 10, 2018, 1,790 patients hospitalized in 87 neurology units spread over 30 health regions were evaluated retrospectively and prospectively. Results: Intravenous tPA was administered to 12% of 859 cases of acute ischemic stroke in 45 units participating in the study. In the same period, 8.3% of the cases received neurointerventional treatment. The rate of good prognosis [modified Rankin score (mRS) 0–2] at discharge was 46% in 83 patients who received only IV tPA [age: 67 ± 12 years; National Institutes of Health Stroke Scale (NIHSS): 12 ± 6; hospital stay, 24 ± 29 days]; 35% in 51 patients who underwent thrombectomy (MT) alone (age: 64 ± 13 years; NIHSS: 14.1 ± 6.5; length of hospital stay, 33 ± 31 days), 19% in those who received combined treatment (age: 66 ± 14 years; NIHSS: 15.6 ± 5.4; length of hospital stay, 26 ± 35 days), and 56% of 695 patients who did not receive treatment for revascularization (age: 70 ± 13 years; NIHSS: 7.6 ± 7.2; length of hospital stay, 21 ± 28 days). The symptom-to-door time was 87 ± 53 minutes in the IV treatment group and 200 ± 26 minutes in the neurointerventional group. The average door-to-needle time was 66 ± 49 minutes in the IV tPA group. In the neurothrombectomy group, the door-to-groin time was 103 ± 90 minutes, and the TICI 2b-3 rate was 70.3%. In 103 patients who received IV tPA, the discharge mRS 0–2 was 41%, while the rate of mRS 0–1 was 28%. In 71 patients who underwent neurothrombectomy, the mRS 0–2 was 31% and mRS 0–1 was 18%. The door-to-groin time was approximately 30 minutes longer if IV tPA was received (125 ± 107 and 95 ± 83 minutes, respectively). Symptomatic bleeding rates were 4.8% in IV recipients, 17.6% among those who received only MT, and 15% in combined therapy. Globally, the hemorrhage rate was 6.8% in patients receiving IV tPA and 16.9% in MT. Conclusion: IV thrombolytic and neurointerventional treatment applications in acute ischemic stroke in Türkiye can provide the anticipated results. Heterogeneity has begun to be reduced in our country with the dissemination of the system indicated by the “Directive on Health Services to be Provided to Patients with Acute Stroke.”. © Copyright 2023 by the Turkish Neurological Society / Turkish Journal of Neurology published by Galenos Publishing House

Atrial Fibrillation Management in Acute Stroke Patients in Türkiye: Real-life Data from the NöroTek Study

Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Turkiye. Within the scope of NoroTek-Turkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms.Materials and Methods: On May 10, 2018 (World Stroke Awareness Day), 1,790 patients hospitalized at 87 neurology units in 30 health regions were prospectively evaluated. A total of 929 patients [859 acute ischemic stroke, 70 transient ischemic attack (TIA)] from this study were included in this analysis.Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received "effective" treatment [international normalization ratio >= 2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug.Conclusion: NoroTekTR revealed the high but expected frequency of AF in acute stroke in Turkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Turkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by AF