The relationship between vitamin d levels and cardiovascular risk scores in geriatric patients with type 2 diabetes mellitus

Objective: The aim of this study is to evaluate the relationship between vitamin D levels and various cardiovascular risk scoring systems such as QRISK2, BNF, ASSING, SCORE and Framingham in geriatric diabetic patients. Methods: 60 diabetic geriatric patients with vitamin D deficiency (10–30 ng/mL) and 40 geriatric patients with vitamin D deficiency (<10 ng/mL) were included in the study. The scores of the patients indicating cardiovascular disease risks such as QRISK2, BNF, ASSIGN, SCORE and Framingham were calculated. All values were compared between these two groups. Results: While the Framingham risk score (p<0.001), BNF (p=0.001) and SCORE (p<0.001) were found to be significantly higher in patients with vitamin D deficiency, other scores did not significantly differ between the groups. There was a weak but statistically significant neg- ative correlation between 25[OH] D levels with Framingham risk score (p<0.001 r=-0.384), BNF score (p=0.003 r=-0.299), and Score score (p=<0.001 r=-0.407). Conclusion: In the present study, we found a close relationship between the Framingham, BNF and ASSIGN cardiovascular risk score and serum vitamin D concentrations in diabetic geriatric patients

Relationship between epicardial fat tissue thicknessand CRP and neutrophil-lymphocyte ratio in metabolicSyndrome patients over 65 years

Objective: There are no data evaluating the association of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) withepicardial fat tissue thickness (EFTT) in elderly metabolic syndrome (MS) patients. In this study, we aimed to investigate the rela tionship 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) withoutMS 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 andlongitudinal EFTT were increased in MS patients (p<0.001). There was a significant correlation between the EFTT and NLR but notwith 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 yearswith MS. In geriatric MS patients, higher NLR level may be an indicator of increased visceral fat around the myocardium

Rare severe coagulopathy secondary due to dabigatran use

Dabigatran atriyal fibrilasyon (AF) varlığında oluşabilecek inmelerin önlenmesinde kullanılan oral direkt trombin inhibitörüdür. Vitamin K antagonistleri ve varfarin kullanımına kıyasla kanama yan etkilerinin daha az görülmesi ve laboratuar takibi gerektirmemesi açısından güvenle tercih edilebileceği savunulmaktadır. Bu yazıda dabigatran kullanımına bağlı ciddi kanama bozukluğu gelişen 83 yaşındaki bilinen kronik renal hasar, epilepsi, AF tanıları olan bayan hasta sunuldu. Oral antikoagülan ilaçlar atriyal fibrilasyon olgularında sistemik tromboemboliler ve iskemik inmelerin önlenmesinde önem arz etmektedir fakat vakamızda olduğu gibi ciddi kanamalara yol açabilmektedir. Renal yetmezlik gibi hastalığı olan yaşlı hastalarda antikoagulan ilaçların doz ayarlanması dikkatlice yapılması gerekmektedir. Vakamız dabigatran kullanımına bağlı kanama ile PT, aPTT ve INR değerlerinde belirgin uzamanın görüldüğü nadir vakalar arasında yer alması nedeniyle ilginçtir.Dabigatran is an oral direct thrombin inhibitor used to prevent strokes that may occur in the presence of atrial fibrillation (AF). Compared to the use of vitamin K antagonists and warfarin, it is argued that it can be safely preferred in terms of less bleeding side effects and not requiring laboratory follow-up. In this case-report, an 83-year-old female patient with known chronic renal damage, epilepsy and AF who developed severe bleeding disorder due to dabigatran use is presented. Oral anticoagulant drugs are important in the prevention of thromboembolism, but they can cause serious bleeding as in our case. In cases such as renal insufficiency, the dose of anticoagulant drugs should be carefully adjusted. Our case is interesting because it is among the rare cases in which a significant prolongation of PT, aPTT and INR values are observed due to bleeding due to dabigatran use

The relationship between the Geriatric Nutrition Risk Index (GNRI) and the prognosis of COVID-19 in diabetic geriatric patients

Background: Malnutrition is one of the important conditions that determine the course of patients in acute critical illnesses. In the present study, we evaluated the relationship between Geriatric Nutrition Risk Index (GNRI) and COVID-19 prognosis in geriatric diabetic patients. Patients and methods: In this study, 110 patients between the ages of 65 and 80 who were interned due to COVID-19 disease with a diagnosis of diabetes mellitus were included. Biochemical blood tests were analysed. The GNRI was calculated to assess the nutritional risk status. As a result of GNRI, the patients were divided into 4 groups according to their scores: severe risk (&lt; 82 points), intermediate risk (82–91 points), low risk (92–97 points) and no risk (≥ 98 points). The length of stay, saturation levels, intubation status and discharge type of the patients were recorded. All parameters were compared in these groups. Results: According to the GNRI, 11.8% of the patients had severe malnutrition, 20.9% had moderate and 8.1% had mild malnutrition, while 59.0% had no risk of malnutrition. When patients are divided into four groups according to GNRI groups, age, urea, creatinine, lymphocyte, procalcitonin, leukocyte, thrombocyte, haemoglobin, spo2 and po2 levels, intubation, and intensive care referral rates were significant different (p &lt; 0.05). In the correlation analysis, we found a negative significant correlation between GNRI and height, length of hospital stays, d-dimer, CRP, leukocyte, neutrophil lymphocyte ratio and neutrophil. Conclusions: There is a significant relationship between GNRI and the prognosis of COVID-19 in geriatric diabetic patients. Patients with a low GNRI score have a longer hospital stay, a higher need for intensive care and mechanical ventilation, and a poor prognosis

Accuracy and Reliability Study of the Simplified Nutritional Assessment Questionnaire (SNAQ) in Turkish Patients in Nutritional Evaluation

Aim:This study aims to reveal the accuracy and reliability of Simplified Nutritional Assessment Questionnaire (SNAQ), which is a test relatively simple and easy to apply, in the Turkish population.Materials and Methods:This study was planned as monocentric and prospective. Patients who were hospitalized in the internal medicine ward and over 65 years old participated in the study. Since there is no SNAQ test in Turkish, its English version was translated into Turkish by a certified translator, and then translated back into English again for verification. The sample size of the study was determined as 200 patients. For each patient included in the study, Mini Nutritional Assessment, Nutritional Risk Screening-2002 and SNAQ tests were applied.Results:Participants consisted of 51% female and 49% male. 55.5% were at the age between 65 and 74 years, 23.5% were between 75 and 84 years, and 21% were over 85 years old. The reliability coefficient of the SNAQ test was found as 0.86. This value satisfied the lower limit criterion of 0.60 proposed in the literature.Conclusion:Turkish SNAQ was validated and proved to be reliable for the nutritional evaluation of the geriatric Turkish patient population

The Relationship Between Frailty and Treatment Compliance in Diabetic and Geriatric Patients Using Insulin

Aim: Understanding and detecting frailty makes convenience to healthcare providers for deciding on appropriate therapy and follow-up strategy.In this study, we tried to determine the relationship between compliance to therapy, hypoglycemia and frailty in the elderly diabetic patients underinsulin therapy.Materials and Methods: One hundred sixty-seven patients diagnosed with diabetes mellitus and under insulin therapy were recruited for the study.Criteria of frailty according to the Cardiovascular Health Study (CHS) were used to determine frailty. According to CHS, patients fulfilling three ormore criteria out of five were regarded as frail elderly. Hypoglycemia rates and compliance to treatment were compared between the groups.Results: 44.3% of our patients were regarded as frail elderly and the rate of hypoglycemia was higher in this group. A dignificant relationshipbetween subgroups of frailty and insulin was detected. Frailty rate was 28.6% in the basal insulin therapy group, 37.1% in the basal-bolus therapygroup and 40% in the premixed insulin group. In the frail elderly group, the rate of moderate hypoglycemia was significantly higher than in thenon-frail group (40.2% vs 20%). Severe hypoglycemic episodes were observed more frequently in the frail elderly group than in the non-frail group(24.6% vs 12.7%).Conclusion: Frailty increases the risk of moderate and severe hypoglycemia. Before planning and starting insulin therapy, frailty must be detectedand taken into consideration

The Relationship Between Frailty and Treatment Compliance in Diabetic and Geriatric Patients Using Insulin

Aim:Understanding and detecting frailty makes convenience to healthcare providers for deciding on appropriate therapy and follow-up strategy. In this study, we tried to determine the relationship between compliance to therapy, hypoglycemia and frailty in the elderly diabetic patients under insulin therapy.Materials and Methods:One hundred sixty-seven patients diagnosed with diabetes mellitus and under insulin therapy were recruited for the study. Criteria of frailty according to the Cardiovascular Health Study (CHS) were used to determine frailty. According to CHS, patients fulfilling three or more criteria out of five were regarded as frail elderly. Hypoglycemia rates and compliance to treatment were compared between the groups.Results:44.3% of our patients were regarded as frail elderly and the rate of hypoglycemia was higher in this group. A dignificant relationship between subgroups of frailty and insulin was detected. Frailty rate was 28.6% in the basal insulin therapy group, 37.1% in the basal-bolus therapy group and 40% in the premixed insulin group. In the frail elderly group, the rate of moderate hypoglycemia was significantly higher than in the non-frail group (40.2% vs 20%). Severe hypoglycemic episodes were observed more frequently in the frail elderly group than in the non-frail group (24.6% vs 12.7%).Conclusion:Frailty increases the risk of moderate and severe hypoglycemia. Before planning and starting insulin therapy, frailty must be detected and taken into consideration

The association between erectile dysfunction and subclinical hypothyroidism in males with type 2 diabetes mellitus

Aim: Overt hypothyroidism is known to affect sexual functions, but data on subclinical hypothyroidism (SCH) are insufficient. We aimed to investigate the relationship between erectile dysfunction (ED) and SCH in men with type 2 Diabetes Mellitus. Methods: This cross-sectional study included 117 diabetic patients aged between 45-70 years who applied to our outpatient clinic between March and June 2018. Biochemical blood tests and levels of hormones were analyzed. International erectile function index-5 (IIEF-5) questionnaire was applied for the assessment of ED. According to the IIEF-5 questionnaire scores, patients were grouped as severe ED (n=47), moderate ED (n=46), and no ED (n=24). Patients were also grouped according to the level of thyroid-stimulating hormone (TSH) into 3 groups; 0.27-2.49 mU/l (n=58), 2.5-4.2 mU/l (n=33), and >4.2 mU/l (n=26). Statistically significance level was set at 0.05. Results: 40% of the patients had severe ED and 39% moderate ED, while 21% had no ED. The TSH levels were significantly different between the ED groups (p<0.001). A significant negative correlation was found between the IIEF-5 score and the TSH levels (p<0.001, r=-0.453). The IIEF-5 score, and duration of ED were significantly different between the TSH groups (both; p<0.001). Conclusions: SCH is closely associated with ED in diabetic men. So, we recommend conducting thyroid function tests in diabetic men with ED and screening for ED in men with SCH

COVID-19 nedeniyle interne edilen geriatrik hastalarda malnütrisyon riski ile prognoz arasındaki ilişki

Objective: We evaluated the effect of nutritional status on the prognosis of the disease in geriatric patients hospitalized due to COVID-19 disease. Materials and Methods: 110 patients over 65 years old were included. Malnutrition risk was assessed by Nutritional Risk Screening 2002 (NRS 2002). The patients were divided into two groups according to the NRS 2002 score (≥3 as group-1, <3 as group-2). Prognosis markers of the patients were recorded. Statistical significance level was set at p<0.05. Results: The study was conducted 110 patients (Man/ Woman:51/59). In group-1, duration of hospitalization, tomography involvement, intubation rate and referral to intensive care, respiratory rate, leukocyte count, C reactive protein (CRP), ferritin, d-dimer levels were higher than group-2 (p<0.05). In group 1; 35 cases were discharged, 18 cases were transferred to 1st level intensive care, and 2 cases were transferred to 3rd level intensive care. In the group 2, 53 cases were discharged, and 2 cases were transferred to 1st level intensive care unit. There was a significant positive correlation between NRS 2002 score and age, respiratory rate, leukocyte, CRP, d dimer and days of hospitalization score (p<0.05). Conclusion: Malnourished patients have higher poor prognostic markers, longer hospital stay and more intensive care needs.Amaç: Çalışmamızda COVID-19 hastalığı nedeniyle hastaneye yatırılan geriatrik hastalarda nutrisyon durumunun hastalığın prognozuna olan etkisini değerlendirdik. Materyal ve Metot: Bu prospektif tek merkezli çalışmaya pandemi servisimize yatırılan 65 yaş üstü 110 COVID-19 tanılı hasta dâhil edildi. Malnutrisyon riski Nutrityonel Risk Taraması 2002 (NRS 2002) ile değerlendirildi. Hastalar NRS 2002 skoruna göre ≥3 puan (1. grup) ve <3 puan (2. grup) olacak şekilde iki gruba ayrıldı. Hastaların prognoz belirteçleri kaydedildi. Tüm bu parametreler bu iki grup arasında değerlendirildi. İstatistiksel anlamlılık düzeyi p<0,05 olarak belirlendi. Bulgular: Çalışmaya toplam 110 hasta (Erkek/ Kadın:51/59) dahil edildi. 1.grupta yatış süresi, tomografi tutulumu, entübasyon ve yoğun bakıma sevk oranları, lökosit, C reaktif proteini (CRP), ferritin, d-dimer düzeyleri 2. gruba göre daha yüksekti (p<0,05). 1.gruptaki 35 olgu taburcu, 18 olgu 1. basamak yoğun bakıma sevk, 2 olgu 3. basamak yoğun bakıma sevk edildi. 2. Grupta ise 53 olgu taburcu, 2 olgu 1. basamak yoğun bakıma sevk edildi. NRS2002 skoru ile yaş, solunum sayısı, lökosit, üre, kreatinin, CRP, d-dimer ve yattığı gün sayısı arasında pozitif yönde anlamlı bir ilişki saptandı (p<0,05). Sonuç: COVID-19 tanısı ile hastaneye yatırılan geriatrik hastalarda nutrisyonel durumun hastalığın prognozunu etkilediğini gösterdik. Malnütre hastaların prognostik belirteçleri daha kötü, hastanede yatış süresi daha uzundur ve yoğun bakım ihtiyacı belirgin olarak artmıştır

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