Nilgun Erten

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.

Investigation of circulating lncRNAs in B-cell neoplasms.

Long non-coding RNAs (lncRNA) which are longer than 200 base pairs in length, play an important role in cellular machinery. Chronic lymphocytic leukemia (CLL) and multiple myeloma (MM) are neoplasms of B-cells. In our study we aimed to investigate circulating lncRNA levels of CLL and MM patients. For this purpose we selected 5 candidate lncRNAs (TUG1, LincRNA-p21, MALAT1, HOTAIR, and GAS5) where the first two are regulated by p53. Analyses were performed by real-time PCR using cDNA synthesized from plasma RNAs. In both disease groups differential levels of plasma lncRNAs were observed. LincRNA-p21 was the only molecule displaying significant changes in the CLL group while all remaining lncRNAs showed significant differences in the MM group. In the MM group only TUG1 showed higher levels than the healthy volunteers. In conclusion, the expression levels of the candidate lncRNA molecules display a general trend for tissue- and disease-specific expression which can provide important potential biomarkers specific to the particular disease type. However, further studies are necessary to elucidate their involvement in disease development and progression.

Prevalence of sarcopenia and its association with functional and nutritional status among male residents in a nursing home in Turkey

The prevalence of sarcopenia differs between different populations, ages, gender and between settings such as the community and nursing homes. Studies on the association of sarcopenia with functional status revealed conflicting results whereas its association with nutritional status is well documented. We aimed at investigating the prevalence of sarcopenia and its association with functional and nutritional status among male residents in a nursing home in Turkey. Fat free mass (FFM) was detected by bioelectric impedance analysis. Functional status was evaluated with Katz activities of daily living (ADL) and Lawton Instrumental activities of daily living (IADL). Nutritional assessment was performed by Mini Nutritional Assessment Test (MNA®). One hundred fifty-seven male residents composed the study cohort. Mean age was 73.1 ± 6.7 years. The prevalence of sarcopenia was 85.4%. No significant correlation was found between sarcopenia and ADL or IADL. There was a weak but significant correlation between IADL score and FFM (r = 0.18; p = 0.02). Sarcopenic residents had lower MNA score than non-sarcopenic residents (18.1 ± 3.2 vs. 21.8 ± 0.8, p = 0.02). FFM was significantly lower in the residents with malnutrition compared to well-nourished residents (26.8 ± 1 kg/body surface area vs. 28.1 ± 1.8 kg/body surface area, p < 0.05). In conclusion, the prevalence of sarcopenia was very high among male nursing home residents in Turkey. Sarcopenia was associated with low nutritional status but not with functional status.

Sequence-Specific Histone Methylation Is Detectable on Circulating Nucleosomes in Plasma

BACKGROUND alterations in DNA methylation and histone modifications have been implicated in carcinogenesis. Although tumor-specific alterations in DNA methylation can be detected in the serum and plasma of cancer patients, no data are available on the presence of histone modifications in circulating blood. We investigated whether histone methylation, as a model of histone modifications, is detectable in plasma. Because methylation at histone 3 lysine 9 (H3K9) has been demonstrated to be enriched at sites of repetitive ALU elements, we addressed the specificity of histone-methylation detection and hypothesized that if monomethylated H3K9 (H3K9me1) is detectable in plasma, the concentrations in mononucleosomes and oligonucleosomes would be different. We also analyzed a single-copy gene, CDKN2A. METHODS we enrolled 21 multiple myeloma patients in the study. We used ELISA and real-time PCR analysis to evaluate nucleosomes and cell-free DNA, respectively, as evidence of the presence of histones and associated DNA in circulating blood. H3K9me1 was analyzed by chromatin immunoprecipitation. RESULTS ELISA and real-time PCR assays indicated the presence of free nucleosomes and DNA in plasma, and the results were quantitatively correlated (P < 0.001). The detection of histone methylation on free nucleosomes was sequence dependent. Fragments representing mono- and oligonucleosomes differed with respect to H3K9me1 concentrations (P = 0.004), in accordance with our hypothesis. In addition, the detection rate and concentrations of H3K9me1 were significantly higher on the fragment covering both mononucleosomes and oligonucleosomes than on the CDKN2A promoter (P < 0.001). CONCLUSIONS if validated in further studies, our findings may be a basis for investigations of cancer-specific alterations in histone modifications in the circulation.

Which body mass index (BMI) is better in the elderly for functional status

BMI is commonly used indicator of malnutrition and 18.5-24.9 kg/m(2) is generally regarded optimal. However, there is an ongoing debate on ideal range for elderly. BMI cut-off values vary also between ethnic groups. We aimed to investigate relationships between BMI, functional status and malnutrition in elderly living in a nursing home in Turkey. BMIs of 254 residents were calculated. Chronic diseases and currently used drugs were noted. Functional status was evaluated with Katz-activities-of-daily-living (ADL) and Lawton-instrumental-activities-of-daily-living (IADL). Nutritional assessment was performed by Mini-Nutritional-Assessment (MNA) test. Mean age was 75.2 ± 8.2 years. Subjects were classified into 4 groups as BMI <18.5, 18.5-24.9, 25-29.9, and ≥ 30.0 kg/m(2). ADL scores and IADL scores were higher in higher BMI groups. There were no differences in terms of age-number of chronic diseases. Even in BMI ≥ 35 kg/m(2) residents, ADL was significantly higher than 25-34.9 kg/m(2) residents. BMI was significantly correlated with ADL and IADL scores. In Groups 3 and 4, there were 22.2% and 9.1% residents without normal nutrition, respectively. Better functional status was associated with higher BMI values even in BMIs ≥ 30 kg/m(2). In elderly, relative high rates of undernutrition may be present in BMIs regarded as overweight or obese.

Frequent copresence of methylated DNA and fragmented nucleosomal DNA in plasma of lymphoma patients

BACKGROUND The circulating DNA in plasma/serum of cancer patients has been shown to reflect the characteristics of the tumor DNA including molecular changes, such as methylation, point mutations and microsatellite instability. Fragmented nucleosomal DNA in plasma resulting from apoptotic death of the tumor cells may also provide an indication for tumor DNA. In this study, we comparatively analysed plasma DNA methylation and presence of fragmented nucleosomal DNA in patients with lymphoproliferative diseases. METHODS Methylation in the first exon of the tumor supressor gene p16 was investigated by the methylation-sensitive restriction enzyme-related PCR. DNA fragmentation in plasma was analysed by gel electrophoresis. RESULTS p16 gene methylation was found to occur in 73% of patients but in none of the 20 healthy controls. Nucleosomal DNA fragmentation was detectable in 81% of patients. In 67% of patients, copresence of both parameters was observed. Presence of both parameters was associated with the stage of disease which was more pronounced for nucleosomal DNA fragmentation. CONCLUSIONS Our results suggest that presence of methylated and apoptotic DNA in plasma of patients with lymphoproliferative diseases is a frequent event and may be used as a marker for early diagnosis and during the follow-up of the disease.

Bsmi polymorphism in the vitamin D receptor gene is associated with leg extensor muscle strength in elderly men.

Background and aims: Sarcopenia is defined as a reduction in skeletal muscle mass, strength, and endurance observed with advancing age. Although Vitamin D receptor (VDR) polymorphism is reported to be associated with muscle mass and strength, evidence for this is limited and conflicting. In this study, we examined the association between the polymorphisms of VDR gene BsmI, TaqI and FokI and muscular mass and strength in elderly men. Methods: This is a cross-sectional study conducted in a university hospital. One hundred and twenty men over 65 years of age participated, all participants were active men living independently in Istanbul, who were followed as outpatients in geriatric polyclinics. Most common diagnoses were hypertension, hyperlipidemia, and mild to moderate osteoarthritis. Morbid obese patients were not included in the study. Genomic DNA was extracted from peripheral blood, and VDR genotypes were determined by the polymerase chain reaction. The peak torque of the knee flexors and extensors was measured on a Cybex 350 dynamometer. Body muscle mass was calculated by using bioelectric impedance analysis. Results: The extensor strength of the knee was higher in BB homozygotic men than in the Bb/bb group. No significant association was found with TaqI and FokI haplotypes. There was no significant association between muscle mass and strength, or between muscle mass and VDR genotype. Conclusion: Our data suggest that VDR gene BsmI polymorphism is associated with muscular strength in elderly men.

Acute renal failure due to leukaemic infiltration in chronic lymphocytic leukaemia: case report

A 73‐year‐old woman was presented with altered mental status and disorientation. She was diabetic and hypertensive, and she had experienced an ischemic cerebrovascular accident 3 years ago. Physical examination revealed the findings of chronic obstructive pulmonary disease, cor pulmonale and congestive heart failure. Hepatomegaly, splenomegaly and ascites were found and might be associated with postsinusoidal portal hypertension secondary to congestive heart failure. Laboratory tests showed uremia, lymphocytosis and thrombocytopenia. Neurologic findings were related with uremia and hypoxia. Multiple pathologic lymphadenopathies were seen in abdominal ultrasonography and thoracic computed tomography. Bone marrow histology indicated chronic lymphocytic leukaemia (CLL). The reason for acute renal failure was leukaemic infiltration of the kidneys due to CLL that was shown with renal biopsy. Blood urea nitrogen (BUN) and serum creatinine responded well to cyclophosphamide and methyl prednisolone treatment. In CLL, direct renal involvement is frequently seen in autopsy studies especially in advanced disease, however, renal failure due to leukaemic infiltration is extremely rare.

Relation between hand grip strength, respiratory muscle strength and spirometric measures in male nursing home residents

Abstract Adverse-outcomes related to sarcopenia are mostly mentioned as physical disability. As the other skeletal muscles, respiratory muscles may also be affected by sarcopenia. Respiratory muscle strength is known to affect pulmonary functions. Therefore, we aimed to investigate the relations between extremity muscle strength, respiratory muscle strengths and spirometric measures in a group of male nursing home residents. Among a total of 104 male residents, residents with obstructive measures were excluded and final study population was composed of 62 residents. Mean age was 70.5 ± 6.7 years, body mass index: 27.7 ± 5.3 kg/m2 and dominant hand grip strength: 29.7 ± 6.5 kg. Hand grip strength was positively correlated with maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) (r = 0.35, p < 0.01 and r = 0.26, p < 0.05, respectively). In regression analysis, the only factor related to MIP was hand grip strength; among spirometric measures only parameter significantly related to grip strength was peak cough flow (PCF). The association of PCF with grip strength disappeared when MIP alone or “MIP and MEP” were included in the regression analysis. In the latter case, PCF was significantly associated only with MIP. We found peripheric muscle strength be associated with MIP and PCF but not with MEP or any other spirometric parameters. The relation between peripheral muscle strength and PCF was mediated by MIP. Our findings suggest that sarcopenia may affect inspiratory muscle strength earlier or more than the expiratory muscle strength. Sarcopenia may cause decrease in PCF in the elderly, which may stand for some common adverse respiratory complications.

Fever of unknown origin: a report of 57 cases

Fever of unknown origin (FUO) is defined as the body temperature higher than 38.3 °C on several occasions and lasting longer than 3 weeks, with the aetiology remaining uncertain after 1 week of investigation. In this study, we reviewed 57 patients with FUO hospitalised in our inpatient department between 1998 and 2003. The median age of the patients was 44 years (17–84), and 26 were males (46%), while 31 were females (54%). In 24 patients (42%), infectious diseases such as tuberculosis (12 patients) and brucellosis (5 patients) were found under the aetiology of FUO. Inflammatory rheumatic diseases were the second most common cause of FUO (17 patients, 30%), while malignancies were found in 10 patients (18%). In six patients (10%), aetiology could not be identified. In conclusion, infectious diseases especially tuberculosis and brucellosis are the leading causes of FUO in our country.