Orthogeriatrics: a vital requirement for improving fragility fracture patient care internationally with particular reference to Turkey

peer reviewedPurpose: Orthogeriatrics is a team approach that aims to provide adequate and timely intervention for individuals suffering from fragility fractures, particularly hip fractures. These patients are mostly the frailest older adults. The aim of orthogeriatrics is to re-gain functionality as early as possible and to decrease disability and mortality. Some developed countries have established orthogeriatric services, while many others, including Turkey, have so far not. Here, to identify areas for improvement, we outline the status of the orthogeriatrics in older adults in Turkey. Methods: We present clear calls for action, emphasizing possible and noteworthy areas for improvement. Results: Our proposals include the need for an easily applied, short version of comprehensive geriatric assessment; appropriate laboratory testing on admission; paracetamol with a special emphasis in its dosings and clues for state-of-the-art analgesic management; the essential need to introduce oral nutritional supplementation, irrespective of nutritional status; the need for vitamin D commencement, in almost all patients; and starting osteoporosis treatment in fracture hospitalization, whenever appropriate. Last but not least, the ever-increasing prerequisite to establish “fracture liaison services” is stipulated. Conclusion: We suggest that our recommendations offer great potential in Turkey, for the improvement of frail fracture patients’ care. We call the other countries that do not have established orthogeriatric lines to model our approach to improve the management of fracture patients globally

Stratification strength and light climate explain variation in chlorophyll a at the continental scale in a European multilake survey in a heatwave summer

To determine the drivers of phytoplankton biomass, we collected standardized morphometric, physical, and biological data in 230 lakes across the Mediterranean, Continental, and Boreal climatic zones of the European continent. Multilinear regression models tested on this snapshot of mostly eutrophic lakes (median total phosphorus [TP] = 0.06 and total nitrogen [TN] = 0.7 mg L−1), and its subsets (2 depth types and 3 climatic zones), show that light climate and stratification strength were the most significant explanatory variables for chlorophyll a (Chl a) variance. TN was a significant predictor for phytoplankton biomass for shallow and continental lakes, while TP never appeared as an explanatory variable, suggesting that under high TP, light, which partially controls stratification strength, becomes limiting for phytoplankton development. Mediterranean lakes were the warmest yet most weakly stratified and had significantly less Chl a than Boreal lakes, where the temperature anomaly from the long-term average, during a summer heatwave was the highest (+4°C) and showed a significant, exponential relationship with stratification strength. This European survey represents a summer snapshot of phytoplankton biomass and its drivers, and lends support that light and stratification metrics, which are both affected by climate change, are better predictors for phytoplankton biomass in nutrient-rich lakes than nutrient concentrations and surface temperature

An under-diagnosed geriatric syndrome: Sleep disorders among older adults

Introduction: Sleep disorders are commonly under-diagnosed in the geriatric population. We aimed to determine the prevalence of sleep problems among older adults admitted to the geriatrics out-patient clinic.Methods: Two hundred and three patients (136 female) older than 75 years of age were included in the study. Patients underwent comprehensive geriatric assessment, including identification of sleep problems using the Sleep Disturbance Scale, Rapid eye movement (REM) sleep behavior disorder (RBD) Single-Question Screen questionnaire (RBD1Q) and The Johns Hopkins Restless Leg Syndrome Severity Scale. Demographic and clinical data including age, sex, medications, comorbid diseases, body mass index and functional scores was noted.Results: The mean age of the patients was 80.92±4.3 years. 35.5% of the patients had findings of REM-SBD and 32.5% of the patients had restless legs syndrome. Ninety-seven percent of the patients answered ‘yes’ to at least one of the sleep disturbance scale questions. There was no significant difference between male and female groups.Conclusion: We observed that sleep disorders were common among older adults. For this reason, the course and quality of sleep should be examined in all patients as a routine part of comprehensive geriatric assessment.Keywords: Comprehensive geriatric assessment, older adults, sleep disorder

An under-diagnosed geriatric syndrome: sleep disorders among older adults

Introduction: Sleep disorders are commonly under-diagnosed in the geriatric population. We aimed to determine the prevalence of sleep problems among older adults admitted to the geriatrics out-patient clinic.Methods: Two hundred and three patients (136 female) older than 75 years of age were included in the study. Patients underwent comprehensive geriatric assessment, including identification of sleep problems using the Sleep Disturbance Scale, Rapid eye movement (REM) sleep behavior disorder (RBD) Single-Question Screen questionnaire (RBD1Q) and The Johns Hopkins Restless Leg Syndrome Severity Scale. Demographic and clinical data including age, sex, medications, comorbid diseases, body mass index and functional scores was noted.Results: The mean age of the patients was 80.92±4.3 years. 35.5% of the patients had findings of REM-SBD and 32.5% of the patients had restless legs syndrome. Ninety-seven percent of the patients answered ‘yes’ to at least one of the sleep disturbance scale questions. There was no significant difference between male and female groups.Conclusion: We observed that sleep disorders were common among older adults. For this reason, the course and quality of sleep should be examined in all patients as a routine part of comprehensive geriatric assessment.Keywords: Comprehensive geriatric assessment, older adults, sleep disorder

Organic biomolecules bind to phosphate through borate linkages in aqueous solution: a possible role of boron as a phosphorylation chaperone in the prebiotic world

Abstract: Solutions of salicyclic, ascorbic, and citric acids were reacted with boric acid, followed by NaH 2 PO 4 . The products, triphosphateborate ester of salicylic acid ( 1 ), orthosphateborate ester of ascorbic acid ( 2 ), triphosphateborate ester of ascorbic acid ( 3 ), and orthosphateborate ester of citric acid ( 4 ), were ash precipitated with cold acetone and characterised by microanalysis, thermal analysis, FT-IR, Raman, 11 B NMR, 31 P MAS NMR, and mass spectroscopic techniques. Analytical results indicated the presence of {C{O{B{O{P{ linkages with the attached phosphate groups varying between orthophosphate and triphosphate, depending on the starting material. The biomolecules studied in this work may serve as models in the B{P-organic system and the results would provide a possible contribution to boron prebiotic chemistr