Infections In The Elderly Critically-Ill Patients

Infections are leading causes of morbidity and mortality in the advanced aged. Various factors including immunosenescens, comorbid chronic diseases, and alterations in normal physiological organ functions may modify the frequency and severity of infections in elderly patients. Normal body reactions to ensuing infection, such as increased body temperature, may be blunted in those patients causing difficulties in differential diagnosis between infection and other diseases. In severe infections the respiratory and urinary tracts are the most frequently involved systems which may be accompanied by severe sepsis. Bacteremia and sepsis are also associated with indwelling vascular catheters in the elderly who are admitted to the intensive care unit (ICU). Older patients are more vulnerable to the Clostridioides difficile infection, as well. Although the general management of infections in severely ill elderly patients is not different than in younger patients, meticulous care in fluid management and careful individualized optimization in antibiotic therapy, along with the other principals of antimicrobial stewardship are warranted in order to prevent increased mortality caused by infection. Organized team management when treating critically ill elderly patients in the ICU is essential and will reduce the morbidity and mortality due to infection in such patients.PubMedWo

CHADS(2) and CHA(2)DS(2)-VASc Scores Can Guide the Evaluation of Cryptogenic Ischemic Stroke

Background and Aims: Cryptogenic ischemic strokes (CIS) are treated with antiplatelets for stroke prevention in routine clinical practice. The objective of this study was to investigate whether the CHADS(2) and CHA(2)DS(2)-VASc scores may be used to identify the patients with CIS at higher risk of ischemic stroke despite antiplatelet therapy

Could Cardiac Troponin I Levels Predict Mortality In The Elderly?

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Short-term treatment with medium cut-off dialyzers increases muscle mass with preserved fat tissue in maintenance HD patients

Background and Aims: Protein-energy wasting is a significant complication of maintenance hemodialysis (HD) patients characterizedby reduced fat or muscle mass and strength. The combination of non-modifiable general and disease-related factors, such as uremictoxin accumulation and systemic inflammation, is responsible for this condition. Medium cut-off (MCO) membranes are designed toprovide clearance of large-middle molecular weight uremic toxins and inflammatory cytokines without causing loss of albumin. Thisstudy aimed to investigate the short-term effect of MCO dialyzers on fat tissues and muscle mass.Method: We conducted a prospective, single-center cross-over study on maintenance HD patients treated with regular low-flux(LF) dialyzers. Fat tissues were measured with a skinfold caliper and mid-upper arm circumference. Muscle thickness and strengthparameters from six different muscle groups were evaluated with ultrasound. The baseline (control) parameters were measuredunder LF dialyzers, and the measurements were repeated two weeks after switching to MCO dialyzers for the patients ordered bytheir clinicians according to the clinical indications.Results: The median age was 69.5 (50.3,78.8) years, and 60% of the patients were female. Two weeks after switching to MCO, the Kt/Vs,urea reduction ratios, mean serum albumin, dry weight, and body mass index scores were similar. Mean skinfold thickness and midupper arm circumference were 15 mm (11,17) and 28mm (27,30) under LF and 16mm (14,19) and 28mm (27,30) under MCO dialyzers(p=0.82 and p=0.27). Rectus abdominis and external oblique muscle groups remained similar. Internal and external oblique musclethickness were significantly increased (p=0.002 and p=0.001). Mean rectus femoris and gastrocnemius medialis (GKM) thicknesseswere 1.19cm (0.99,1.33) and 1.16cm (0.9,1.4) under LF and 1.31cm (1.20, 1.40) and 1.24cm (0.95,1.40) under MCO dialyzers (p=0.002 andp=0.02). Mean GKM fibrile length and pennation angles were 2.4cm (2.2,2.8) and 20o (18,23) under LF and 2.7cm (2.4, 2.9) and 22o (19,24)under MCO dialyzers (p=0.007 and p=0.001).Conclusion: Our study showed that MCO dialyzers increase muscle mass with preserved fat tissues in HD patients, short-term followup. This favorable effect might be due to the clearance of uremic toxins, which cannot be removed with conventional methods. Iflong-term studies support our findings, MCO dialyzers would be a milestone for the treatment of sarcopenia in HD patients</p

Masked hypertension is associated with end organ damage in geriatric age: Geriatric MASked Hypertension and End organ damage (G-MASH-End organ Study)

Purpose: It is a question whether masked hypertension (MH) leads to end-organ damage in the geriatric age group. The aim of this study is to evaluate the associations between MH and end-organ damage such as left ventricular hypertrophy (LVH) and proteinuria in geriatric population. Materials and methods: One hundred and two patients who were admitted to the outpatient clinic were included in the study. These patients were also included in the GMASH-Cog study in 2016, which examined the relationship between MH and cognitive function. All patients underwent ambulatory blood pressure measurement procedures. Cardiac functions of all patients were determined by echocardiography. Spot urine albumin/creatinine ratio (ACR) was measured in all patients. Results: Forty four of 102 patients (43%) were diagnosed with MH. ACR was 9.61 mg/gr in the MH group and 7.12 mg/gr in the normal group (p = .021). In addition, left ventricular mass index (LVMI) was found to be higher in the MH group than in the normal group. Mean LVMI scores were 107.76 ± 16.37 in patients with MH and 100.39 ± 19.32 in the normotensive group (p = .046). Conclusion: MH is associated with end-organ damage in geriatric patients. Urinary albumin excretion and LVH which are the parameters of end-organ damage were significantly higher in MH patients. MH may cause end-organ damage and should not be overlooked in geriatric patients

Generic Imatinib Mesylate is as Effective as Original Glivec in the Clinical Management of CML

Unsustainable drug prices in chronic myeloid leukemia (CML) and cancer may be causing harm to patients. The aim of this multi-center study is to assess the efficacy of generic imatinib mesylate (IM) over Glivec in terms of hematological, cytogenetic, and molecular responses in CML. The data of 120 CML patients, who were treated with generic or original form of IM, were obtained from six different hematology clinics in Turkey between the years of 2009-2014 and analyzed retrospectively. Initial evaluation revealed that only one patient who was using original molecule switched to second generation tyrosine kinase inhibitor (TKI). In this period, hematological response(HR) was observed in 99.2% of the patients, cytogenetic response (CR) was observed in 88.7% of the patients (47 of 53), and molecular response (MR) was observed in 75% of the patients. Clinicians had a tendency to prefer generic molecules in each sequent visit, and this switch rate was statistically significant (p<0.001). 11 patients, who were using original molecules during all cohorts, switched to second generation TKI. On the other hand, only one patient, who was using generic molecules, switched to second generation TKI. Our paper may help to clarify the doubts about the efficacy of generic IM compared to original molecule. In our study we did not find any significant difference in HR, CR, and MR for original and generic drugs in each visit. Herein, we find low rates of need to switch to second generation TKIs with generic IM and no difference in treatment responses between generic and original molecules that confirms the non-inferiority of generic TKIs over original molecules

Eating attitudes of migraine patients in Turkey: a prospective multi-center study

Background: Migraine is a disease characterized by headache attacks. The disease is multifactorial in etiology and genetic and environmental factors play role in pathogenesis. Migraine can also be accompanied by psychiatric disorders like neurotism and obsessive compulsive disorder. Stress, hormonal changes and certain food intake can trigger attacks in migraine. Previous studies showed that eating attitudes and disorders are prevalant in patients with migraine. Eating disorders are psychiatric disorders related to abnormal eating habits. Both migraine and eating disorders are common in young women and personality profiles of these patient groups are also similar. A possible relationship which shows that migraine and eating habits are related can lead to a better understanding of disease pathogenesis and subsequently new therapeutic options on both entities. Association of migraine in relation to severity, depression and anxiety and eating habits and disorders were aimed to be investigated in this study. Methods: The study was designed as a prospective, multi-center, case control study. Twenty-one centers from Turkey was involved in the study. The gathered data was collected and evaluated at a single designated center. From a pool of 1200 migraine patients and 958 healthy control group, two groups as patient group and study group was created with PS matching method in relation to age, body-mass index, marital status and employment status. Eating Attitudes Test-26 (EAT-26), Beck’s Depression Inventory (BDI) and Beck’s Anxiety Inventory (BAI) were applied to both study groups. The data gathered was compared between two groups. Results: EAT-26 scores and the requirement for referral to a psychiatrist due to symptoms related to eating disorder were both statistically significantly higher in patient group compared to control group (p = 0.034 and p = 0.0001 respectively). Patients with migraine had higher scores in both BDI and BAI compared to control group (p = 0.0001 and p = 0.0001 respectively). Severity of pain or frequency of attacks were not found to be related to eating attitudes (r:0.09, p = 0.055). Conclusions: Migraine patients were found to have higher EAT-26, BDI and BAI scores along with a higher rate of referral to a psychiatrist due to symptoms. Results of the study showed that eating habits are altered in migraine patients with higher risk of eating disorders. Depression and anxiety are also found to be common amongst migraine patients