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

Tip 2 diabetes mellitus tanılı hastalarda ortostatik hipotansiyon ile D vitamini eksikliği arasındaki ilişki

Objective: Vitamin D deficiency is common in diabetic patients, and studies showed that it could lead to neuropathy. Therefore, we aimed to determine relationship between 25-hydroxyvitamin D (25(OH)D) levels and orthostatic hypotension (OH) which is a component of autonomic neuropathy in diabetic patients.Materials and Methods: A total of 118 patients with Type 2 diabetes mellitus and aged 50-65 years were included. Patients were divided into two groups as OH present and OH not present. 25(OH)D and other variable parameters were evaluated between these two groups.Results: A total of 118 patients, 66 female and 52 male, were included in this cross-sectional study. The mean age of the patients was 56.2±3.2 years.25(OH)D levels were found to be significantly lower in the group with OH (p0.05).Conclusion: 25(OH)D levels are significantly lower in diabetic patients with OH. Although an independent relationship between them has not been demonstrated, it can be thought that correcting Vitamin D deficiency will be beneficial in the treatment of OH.Amaç: D vitamini eksikliği diyabetik hastalarda sık görül-mekte ve çalışmalarda nöropatiye yol açabileceği gösteril-miştir. Bu çalışmada diyabetik hastalarda otonom nöropatinin bir bileşeni olan ortostatik hipotansiyon (OH) ile 25-hidroksivitamin D (25(OH)D) seviyesi arasındaki ilişkiyi belirlemeyi amaçladık. Materyal ve Metot: Çalışmaya 50-65 yaş arası diyabetik toplam 118 hasta dahil edildi. Hastalar OH varlığına göre iki gruba ayrıldı. 25(OH)D ve diğer değişken parametreler bu iki grup arasında değerlendirildi. Bulgular: Bu kesitsel çalışmaya 66 kadın ve 52 erkek olmak üzere toplam 118 hasta dahil edildi. Hastaların yaş ortalaması 56,2±3,2 yıl idi. 25(OH)D düzeyleri OH olan grupta anlamlı olarak daha düşük bulundu (p 0,05). Sonuç: OH'li diyabetik hastalarda 25(OH)D düzeyleri anlamlı olarak daha düşüktür. Aralarında bağımsız bir ilişki gösterilemese de OH tedavisinde D vitamini eksikli-ğinin düzeltilmesinin faydalı olacağı düşünülebilir

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

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

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 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 relationship between dynapenia and vitamin D level in geriatric women with type 2 diabetes mellitus

OBJECTIVE: In this study, we examined the possible relationship between dynapenia and vitamin D (VD) levels in geriatric women with type 2 diabetes mellitus (T2DM). METHODS: One hundred and twenty-two geriatric female patients aged 65-80 years with a diagnosis of T2DM were included in this prospective study. Physical examinations of the patients were performed, and biochemical tests were analyzed. The muscle strength of the patients was measured with a hand dynamometer. Dynapenia was defined as low grip strength with normal skeletal muscle mass index. In muscle strength measurements, for female patients, over 20 kg was accepted as normal and below 20 kg as decreased muscle strength. Patients were separated into three groups as 30 ng/ml according to VD levels; according to the status of dynapenia, they were divided into two groups as dynapenic and non-dynapenic. By comparing all these parameters between these groups, the relationship between VD level and dynapenia was evaluated. In statistical analysis, significance was accepted as p<0.05. RESULTS: While 54 of the patients (44.3%) met the dynapenia criterion, 68 patients (55.7%) were non-dynapenic. Patients were first compared according to their dynapenia status. VD level was significantly lower in the dynapenic group (p<0.05). In the correlation analysis, a moderate positive correlation was found between muscle strength and VD (p=0.033, r: 0.23). The patients were then compared according to the VD groups. In the VD insufficient group, muscle strength (p=0.015), body mass index (p=0.025), systolic blood pressure (p<0.01), and glucose (p<0.01) were statistically significantly higher. CONCLUSION: In the present study, we found a considerable relationship between VD levels and dynapenia in geriatric women with T2DM.Istanbul Beykoz State Hospita

The Association between Non-Alcoholic Fatty Liver Disease and Dynapenia in Men Diagnosed with Type 2 Diabetes Mellitus

Background: Dynapenia and non-alcoholic fatty liver disease (NAFLD) are common, especially in the middle and advanced-age diabetic male population. We aimed to examine the clinical features, NAFLD severity, and parameters associated with the presence of dynapenia in type 2 diabetes mellitus (T2DM) cases. Material and Methods: One hundred thirty-five male patients diagnosed with T2DM between 45 and 65 years of age were included. Patients were staged by ultrasonography according to NAFLD status. Results: There were significant differences in muscle strength, upper arm circumference, calf circumference, and up-and-go test scores between the mild-moderate-severe and non-NAFLD groups (p p p Conclusions: We detected a significant association between NAFLD and dynapenia in middle-aged men with T2DM. As muscle strength decreases, the amount of fat in the liver increases, and as the fat in the liver increases, muscle strength decreases

Serum amino acid levels and mortality in patients undergoing percutaneous endoscopic gastrostomy

Objective: To evaluate the effect of feeding via percutaneous endoscopic gastrostomy tube (PEG) on serum amino acid levels and mortality. Study design: Descriptive study. Place and duration of study: University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey, from January 2016 to February 2019. Methodology: Patients over 18 years of age, who were indicated for PEG due to loss of swallowing reflex, were included in the study. The follow-up period of the study was one year. The patients were reevaluated on the 3rd, 6th, and 12th months after inclusion. Anthropometric measurements, and nutritional status were evaluated at each visit, and quantitative amino acid levels were analysed. Statistical significance was accepted as p <0.05. Results: The study was carried out with a total of 53 cases (23 men and 30 women) ranging in the age from 18 to 91 years. While 13 patients were still alive, 40 patients died before completing one year. The levels of glutamine, leucine, taurine, and threonine were significantly different between surviving patients and dead. A statistically significant difference was found between the levels of citrulline (p <0.001), ornithine (p = 0.036) and tyrosine (p = 0.011) during the four different visits of patients who survived. In patients who died, a significant difference was found between the levels of threonine, ornithine, and aspartic acid (p <0.043 for all) between visits. Citrulline and tyrosine levels were found to be significantly increased in surviving patients. Conclusion: The amino acid profiles of malnourished patients vary considerably. Increase in citrulline, ornithine and tyrosine levels are noted in surviving patients

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