Sarah A. Hamza

Does self-reported sleep quality predict poor cognitive performance among elderly living in elderly homes?

Objectives: Sleep complaints are common among elderly, especially institutionalized elderly, as they experience poorer sleep quality and higher use of sedative hypnotics, when compared to community-dwelling elderly. Recent findings suggest that there may be a relationship between poor quality of sleep and cognitive deficits. This study aimed at studying the relation between sleep quality and cognitive performance in older adults living in elderly homes. Method: 100 elderly living in an elderly home in El Mansoura, Egypt, were recruited in this study, 50 cases with subjective poor quality of sleep and 50 controls with subjective good quality of sleep as assessed by Pittsburgh sleep quality index (PSQI). Each participant went through comprehensive geriatric assessment (CGA), including geriatric depression scale (GDS), assessment of cognitive function by mini mental state examination (MMSE). Results: 52% of poor sleepers showed impaired MMSE, while only 24% of good sleepers had impaired MMSE. Both orientation and (attention and calculation) were more affected (P = 0.027 and 0.035, respectively). Linear correlation coefficient between PSQI and different variables revealed significant negative correlation with total MMSE score, attention and calculation. Conclusion: Poor quality of sleep is related to cognitive impairment among elderly living in elderly homes and this problem should be taken in consideration among this group of elders.

Thiamine Level in Hospitalized Elderly Egyptian Patients with Congestive Heart Failure and Left Ventricular Systolic Dysfunction

ACKNOWLEDGMENTS Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this letter. Author Contributions: Barbara Bardenheier, Pascale Wortley, and Abigail Shefer: development of study concept, interpretation of data, and writing of manuscript. Sponsor’s Role: None.

Proinflammatory cytokines in Egyptian elderly with chronic obstructive pulmonary disease

Background: The pulmonary component of chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. Hypothesis: The levels of the proinflammatory cytokines, interleukin 1 beta (IL-1β), tumor necrosis factor alfa (TNF-α), and C-reactive protein (CRP), in elderly patients suffering from COPD are increased. Settings and Design: A case control study involving 90 elderly participants from the outpatient clinics of Ain Shams University hospitals. Materials and Methods: The 90 subjects were subdivided into three equal groups ’ group I (control), group II (patients with COPD), and group III (patients with COPD and cardiovascular complications). Comprehensive clinical assessment, pulmonary functions, and echocardiography were performed. The levels of IL-1β, TNF-α, and CRP were measured in the patients’ serum and compared. Statistical analysis: SPSS (Statistical Package for Social Science) version 10. Results: IL1-βand CRP were significantly higher in the third group than the first group (P <0.05). There was a similar significant difference between the second and third group as regards IL1-βand CRP (P < 0.05). Positive significant correlation between CRP and TNF-α with stage of COPD according to FEV1 (P <0.05) were found. Conclusions: Complicated cases of COPD had higher levels of IL1-β and CRP and the more severe the cases, the higher the levels of CRPand TNF-α.

Type 2 diabetes raises serum sclerostin levels and disturbs the relation between sclerostin and bone mineral density: a call for caution with antisclerostin therapy in osteoporosis

Background Sclerostin is an osteocyte-secreted protein that negatively regulates osteoblasts. Wnt signaling may be crucial in the pathogenesis of impaired bone quality in type 2 diabetes mellitus (T2DM). The possibility that currently studied antisclerostin bone-forming agents could be useful to T2DM patients with osteoporosis needs further investigations. Aim The aim of this study was to investigate the relationship between serum sclerostin and bone mineral density in T2DM patients, in comparison with nondiabetic individuals. Patients and Methods This study was conducted on 21 T2DM patients and 22 nondiabetic individuals. All participants were 60 years or older. They underwent history taking, clinical examination, routine lab investigations, and glycated hemoglobin assessment. Serum sclerostin was measured by ELISA. Bone mineral density (BMD) was measured at the left femoral neck and lumbar spine. Results Serum sclerostin level was significantly higher in T2DM patients compared with nondiabetic individuals. Male participants showed significantly higher sclerostin levels among the nondiabetic individuals, whereas this difference was not significant among T2DM patients. The Bone mineral density (BMD) and t- values of T2DM patients and the nondiabetic group were not significantly different. We found a significant positive correlation between sclerostin level and lumbar spine BMD among nondiabetic individuals, whereas among T2DM patients, this correlation was not significant. Sclerostin levels did not show a significant difference between diabetic osteoporotic and diabetic nonosteoporotic patients. Conclusion Patients with T2DM have raised sclerostin levels that, unlike those in nondiabetic individuals, are not correlated with BMD. This pathological condition that is specific to diabetes necessitates further study, careful assessment of the role of antisclerostin therapy, and probable dose adjustment for osteoporosis in T2DM patients.

Depression as a Predictor of Length of Hospital Stay in Elderly Patients Admitted to Ain Shams University Hospitals

Background: Depression among the physically ill is common and frequently under-diagnosed. Elderly patients with depressive symptoms are at higher risk of hospital admission for non psychiatric conditions and are more likely to have longer hospital stays and worse hospital outcomes, compared with non depressed patients. Objectives: The aim of this study was to find out if depression can be considered a predictor of prolonged hospital stay in elderly patients. Design: A prospective cohort study. Participants: 205 consecutive patients 60 years and over both males and females. Settings: Ain shams university hospitals. Measurements: All participants were assessed using comprehensive geriatric assessment including Geriatric depression scale (GDS) and the length of stay was registered. Results: Depressed patients had longer length of hospital stay compared to non depressed patients and the least length of hospital stay was for cases with no risk on GDS scale compared to other groups and the difference is highly significant statistically (p=<0.001). Conclusion: length of hospital stay is significantly longer among depressed elderly. Key wards: Depression –Length of hospital stay– Elderly

Studying inflammatory markers and their relationship with coronary risk factors in elderly egyptian people with diabetes mellitus.

To the Editor: Patients with diabetes mellitus are at risk of atherosclerosis and its clinical sequelae, particularly coronary artery disease (CAD). CAD remains the most important cause of mortality in people with diabetes mellitus. Inflammation plays a role in the development of CAD and predicts risks in healthy subjects. C-reactive protein (CRP) has been shown to be a useful prognostic indicator in acute coronary syndrome and is a predictor for coronary events in individuals. A high level of interleukin-6 (IL-6) plays a role in the pathogenesis of coronary heart diseases. IL-1b and IL-6 may contribute to the pathogenesis of coronary syndromes. It has been found that inflammatory markers could be used to identify persons with diabetes mellitus who are at risk of CAD. We set out to assess the relationship between inflammatory markers and coronary risk factors in elderly Egyptian people with diabetes mellitus.