M. Akif Karan

Malnutrition in the elderly and its relationship with other geriatric syndromes.

BACKGROUND & AIMS Age related decline in food intake is associated with various physiological, psychological and social factors. Our aim was to assess the nutritional status of our elderly patients and its association with other geriatric syndromes. METHODS In this cross-sectional population based study, Mini Nutritional Assessment (MNA) test was used to evaluate nutritional status of 413 elderly patients who were admitted to our outpatient clinic in the last 12 months. MNA test results were compared with the laboratory findings and established geriatric syndromes. RESULTS Poor nutritional status was found in 44% of the patients (n=181: 13% malnutrition, 31% malnutrition risk). Malnutrition rate was higher among those with subsequent hospitalization (n=122, 25% vs 8%). Patients with poor nutritional status had lower blood haemoglobin, serum total protein and albumin, and revealed more chronic diseases and geriatric syndromes (6 ± 2 vs 3 ± 2, p<0.0001). Patients with depression, fecal incontinence, decreased cognitive function and functional dependence showed poor nutritional status according to MNA test results. CONCLUSIONS Malnutrition rate of our patients was comparable with the previous data. Malnutrition risk showed positive correlation with the number of existing geriatric syndromes. Depression, dementia, functional dependence and multiple co-morbidities were associated with poor nutritional status.

Acute Wood or Coal Exposure with Carbon Monoxide Intoxication Induces Sister Chromatid Exchange

Objective: The object of this study was to investigate the genotoxic effect of acute overexposure to combustion products originating from coal or wood stoves in patients presenting with acute carbon monoxide intoxication. Study Design: In a prospective study, we analyzed the frequency of sister chromatid exchange and the carboxyhemoglobin concentration in 20 consecutive patients without a history of smoking or drug use who had been treated in the Emergency Care Unit of Istanbul Medical Faculty due to acute carbon monoxide intoxication. All of these cases were domestic accidents due to dysfunctioning coal or wood stoves. The results were compared with a control group of 20 nonsmoking, nondrug-using healthy individuals matched for age, sex, and absence of other chemical exposure. Results: The mean sister chromatid exchange frequency per metaphase was significantly higher in the study group compared to the control group: 8.11±2.39 vs. 6.33±1.60 (p=0.008). We found that there was no positive correlation between the blood carboxyhemoglobin concentration and sister chromatid exchange frequency. Conclusions: These results suggest that acute exposure to combustion products of wood or coal is genotoxic to DNA. Potential causes of genotoxicity include known mutagenic compounds present in coal or wood smoke and ash, oxygen radicals formed during combustion, as well as hypoxic and reperfusion injury mechanisms initiated by carbon monoxide intoxication. Additional studies on separate carbon monoxide exposure from smoke and ash are needed to understand individual genotoxic contributions and mechanisms.

The Effect of Air Pollution and Meteorological Parameters in Istanbul on Hospital Admissions for Acute Coronary Syndrome

It is known that air pollution and meteorological parameters have a negative effect on various respiratory and cardiovascular parameters. In this study, the relationship between emergency hospital admissions for acute coronary syndrome (ACS) and the meteorological and air pollution parameters over the same period were investigated. Some 2889 patients admitted to the emergency internal medicine unit between 1997-2001 were included in this study. The number of patient admissions per month with a diagnosis of ACS were determined and the relationship between meteorological parameters (pressure, temperature, humidity) and mean values of parameters of pollution including carbon monoxide (CO), sulphur dioxide (SO2), nitric oxide (NO), nitrogen dioxide (NO2), mass of particles smaller than 10 m (PM10) were investigated. Monthly admission figures for ACS were positively correlated with pressure and negatively correlated with temperature. No relationship between air humidity and admission for ACS was detected. There was also positive correlation between ACS and SO2, CO, NO and PM10levels. The results showed that the most important meteorological parameter that increased the number of admissions for ACS was a decrease in air temperature, and the most important pollution parameter was SO2. Admission for ACS significantly increased in winters and springs in comparison with summers (RR 1.15%95 CI(1.039-1.279); RR 1.16%95 CI(1.046-1.291)). Air pollution and meteorological parameters should be seen as a widespread public health problem, which can trigger admission and even death due to ACS. Greater effort should be expended to further lower air pollution levels.

Relationship between insulin-like growth factor 1 and bone mineral density in men aged over 65 years.

Objective: To determine the association between insulin growth factor 1 (IGF-1) and bone mineral density (BMD) in men over 65 years of age. Subjects and Methods: Forty-one male patients aged 65–88 years without a history of drug use or illness which is known to affect BMD were enrolled in the study. The control group consisted of 20 healthy men (19–62 years old). An immunoradiometric assay was used to measure IGF-1 levels. Dual-energy X-ray absorptiometry was used to determine BMD at the proximal femur and lumbar spine. A detailed questionnaire was used to assess the epidemiological findings. Results: The men over 65 years of age had a lower mean IGF-1 level (102.04 ± 36.65 vs. 196.62 ± 84.86 ng/ml) and a lower mean BMD at the femoral neck, trochanter and intertrochanteric zones, Ward’s triangle and total hip than the controls. No statistically significant association was observed in the BMD of the lumbar vertebrae between the patients and controls. IGF-1 levels were strongly and negatively correlated with age (p < 0.0001, r = –0.82). Logistic regression analysis showed that low IGF-1 levels were strongly associated with osteopenia of the total hip, femoral neck, trochanter and intertrochanteric zone. Conclusion: The finding shows that low serum IGF-1 levels were associated with an increased risk of hip osteopenia and, hence, at least partly responsible for the osteopenia observed in men aged 65 years or over.

Extrapulmonary sarcoidosis with chronic renal failure.

We present a young woman with extrapulmonary sarcoidosis who had been treated for tuberculosis 15 years earlier. The initial diagnosis had been made on the basis of liver biopsy. The patient later developed bilateral visual loss secondary to uveitis. We identified noncaseating granulomatous lesions in the kidney, intra-abdominal lymph node, and previous liver biopsy specimens. Although rare, renal sarcoidosis can manifest itself as hypercalcemic nephropathy, granulomatous interstitial nephritis, renal tubular dysfunction, or glomerulonephritis. Corticosteroids are the treatment of choice.