Umit Cintosun

Metformin Decreases Thyroid Volume and Nodule Size in Subjects with Insulin Resistance: A Preliminary Study.

Objective: The aim of this study was to investigate the effects of metformin on thyroid volume and nodule size. Subjects and Methods: Prospective data were gathered on 100 newly diagnosed subjects with insulin resistance (68 female, 32 male) between August 2008 and May 2010. Each subject followed a standard diet and exercise program, and received 1,700 mg/day of metformin therapy for 6 months. The height, weight, waist circumference (WC) and thyroid hormone levels of each subject were measured. Additionally, the dimensions of the thyroid lobes and maximum diameter of each thyroid nodule were determined by ultrasonography. BMI and thyroid volumes were also calculated. Insulin resistance was estimated by homeostasis model assessment. All these parameters were measured at the beginning and at the end of the treatment period. Results: BMI and WC decreased significantly after metformin therapy (34.5 ± 5.1 vs. 32.7 ± 4.8, p < 0.0001, and 106.3 ± 11.8 vs. 101.8 ± 19.0 cm, p = 0.008, respectively). Insulin resistance also decreased after metformin therapy (4.5 ± 1.9 vs. 2.9 ± 1.7, p < 0.0001). The mean thyroid volume (22.5 ± 11.2 vs. 20.3 ± 10.4 ml, p < 0.0001) and mean thyroid nodule size (12.9 ± 7.6 vs. 11.7 ± 7.2 mm, p < 0.0001) also decreased after treatment. Conclusion: In subjects with insulin resistance, metformin therapy significantly decreased thyroid volume and nodule size.

Sarcopenia is more than simply documenting low skeletal muscle mass

As elderly patients have increasingly been admitted to surgery due to medical advances, conditions (but not socalled diseases) such as sarcopenia, frailty, and delirium have emerged as novel measures of perioperative and postoperative morbidity and mortality. In a recent article in Cancer, Psutka et al reported sarcopenia to be a predictor of cancer-specific survival and all-cause mortality after radical cystectomy, which is a major treatment option for patients with bladder cancer. The authors concluded that the assessment of sarcopenia prior to bladder surgery by computed tomography (CT) scan (L3 muscle index) was helpful in predicting survival after radical cystectomy. Although this is an important finding, the methods used to test the outcome measures may be argued against based on the current recommendations to define sarcopenia, which is no longer known as simple loss of muscle mass due to ageing. It was only within the past few years that the European Society for Clinical Nutrition and Metabolism, the International Academy on Nutrition and Aging, and the International Association of Gerontology and Geriatrics for the European Region started working collaboratively to reach a consensus for diagnostic criteria for age-related sarcopenia. This consensus report defined sarcopenia as the presence of low muscle mass plus low muscle function (muscle strength or physical performance). Moreover, the presence of low muscle mass with preserved function, which is a common clinical condition, was defined as “presarcopenia.” Therefore, estimation of muscle function is very important in making the diagnosis of sarcopenia. In this context, the probable misclassification of subjects with “presarcopenia” as being sarcopenic cannot be ignored in the study by Psutka et al, and might require further verifications. Second, although CT and magnetic resonance imaging are the 2 gold standard options for measuring muscle mass, validation of single-slice CT to define muscle mass, which was the only tool used in the study by Psutka et al, was assessed only by comparing with dual-energy x-ray absorptiometry, which is not regarded a good standard technique.

Pantoprazole Sodium–Induced Hyponatremia in a Frail Elderly Adult

elderly adult with an itchy, psoriasiform scalp eruption. Individuals at higher risks include those who are bedbound with multiple medical comorbidities and poor mobility. The prognosis in MF is worse in men, older adults, at a higher stage of disease, and with the folliculotropic variant of MF. This woman had at least T3N1M0B0 disease, compatible with Stage IIB, which is advanced. Overall survival at this stage is 37.8% to 63.2% at 5 years after diagnosis and 19.8% to 53.2% at 10 years. Systemic therapy is indicated because of extensive skin and lymph node involvement. Choices include retinoid (bexarotene), interferon, histone deacetylase inhibitors (e.g., romidepsin, vorinostat), chemotherapy (e.g., methotrexate, doxorubicin, gemcitabine, cyclophosphamide, chlorambucil, fludarabine, etoposide), and biologic agents (e.g., bortezomib, alemtuzumab). Because these treatments are expensive and not readily available, this woman was fortunate to receive the biological treatment and chemotherapy free of charge and had a good outcome.

Bioelectric impedance analysis in pregnant women

While performing a dilation, evacuation, and curettage to emergently treat a cervical pregnancy (gestational age unknown) they encountered profuse arterial hemorrhage. This bleeding was controlled with suction curettage and cervical packing. This outcome reinforces my recommendation to do no cervical dilation prior to suction curettage evacuation, and sharp curettage is to be avoided. In my view, the approach by Drs Habek and Prka to not use a cervical infiltration hemostatic agent may have contributed to their patient’s blood loss. Use of this agent can be accomplished quickly and it is a step that I do not recommend be excluded. I can support not placing the cerclage suture because I have never had to tie this during the procedure. Large Foley catheter balloons should be

Defining Randomly Measured Glycemic Values As a Risk Factor for Dementia: Accurate and Adequate?

among older African American patients with cancer. Oncol Nurs Forum 2013;40:394–402. 3. Laurence B, Haywood C Jr, Lanzkron S. Dental infections increase the likelihood of hospital admissions among adult patients with sickle cell disease. Community Dent Health 2013;30:168–172. 4. Laurence B, Mould-Millman N, Scannapieco F et al. Hospital admission for pneumonia more likely with concomitant dental infections. Clin Oral Investig 2015;19:1261–126. 5. Xiao H, Tan F, Goovaerts P et al. Construction of a comorbidity index for prostate cancer patients linking state cancer registry with inpatient and outpatient data. J Registry Manag 2013;40:159–164. 6. Barros A, Hirakata V. Alternatives for logistic regression in cross-sectional studies: An empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 2003;3:21. 7. Cummings P. The relative merits of risk ratios and odds ratios. Arch Pediatr Adolsc Med 2009;163:438–445.

Nutrition interventions in bed rest trials

to the editor: In a recent journal article, Krainski and colleagues ([5][1]) reported that high-intensity, short-duration rowing ergometry and supplemental resistive strength exercise preserved skeletal muscle function and structure while partially preventing atrophy. This finding is important

Assessment of geriatric predictors of adherence to Zoledronic acid treatment for osteoporosis: a prospective follow-up study

ABSTRACT Objectives Discontinuation of bisphosphonate treatment remains high even with the long acting parenteral options. Whether there are some unidentified causes of noncompliance more specific to aged individuals is unknown. The aim of this study was to investigate baseline predictors of adherence to Zoledronic acid (ZOL) infusions among non-demented older adults with osteoporosis. Methods Patients aged ≥ 65 years who received a first ever ZOL infusion for osteoporosis were prospectively enrolled. Risk factors for osteoporosis and fractures, comorbidities, geriatric assessment measures, including depression, and anticholinergic burden were determined at baseline. Adherence was defined as taking the next ZOL infusion at 12 months. Results A total of 187 participants were included (mean age: 75.7 ± 6.3 years, female: 77.5%). Adherence to the next ZOL infusion was 66.8% (n = 125). Non-adherent participants (n = 62, 33.2%) had significantly higher frequency of historical height decrease and depression at baseline. Poor adherence was associated with height decrease, presence of depression, and higher anticholinergic burden in univariate analysis. After adjustment for relevant confounders, fragility fracture history (OR: 0.38, 95%CI: 0.17–0.86, p = 0.020), depression (OR: 0.32, 95%CI: 0.12–0.82, p = 0.018), and higher anticholinergic burden (OR: 0.67, 95%CI: 0.49–0.93, p = 0.017) were the predictors of lower adherence to ZOL infusion. Conclusions The rate of adherence to the next ZOL infusion was still suboptimal among older women and men in this study. Past osteoporotic fractures, depression, and higher anticholinergic drug burden predicted poor ZOL adherence. It was a novel finding that drug-related anticholinergic side effects adversely influenced adherence to another medication without anticholinergic properties.

Effect of anticholinergic burden on the development of dementia in older adults with subjective cognitive decline

ABSTRACT OBJECTIVE: Data on the effect of anticholinergic cognitive burden (ACB) in older adults with subjective cognitive decline (SCD) are limited. We aimed to study whether ACB increases the future risk of dementia in older adults with SCD. METHODS: The retrospective cohort analysis was carried out on 1496 older adults. Out of those, 109 older patients with SCD followed up over 36 months were studied. They were divided into two groups according to cognitive status at last visit: group I included the subjects with SCD who did not progress to dementia and group II included those who progressed to dementia. The drugs with anticholinergic effects that were received by subjects three months or more were identified from records. The drugs were categorized as having absent (ACB = 0), possible (ACB = 1), and definite (ACB = 2) anticholinergic properties based on an ACB scale. ACB was calculated for each subject by adding the score of each drug and classified as no or low ACB (ACB ≤ 2) and high ACB (ACB ≥ 3). RESULTS: The mean age of all subjects was 72.5 ± 6.3 years and 66.1% of the sample was female. The median follow-up time for all subjects was 75 months (range, 36–185). Fifteen (13.8%) of 109 participants with baseline SCD developed dementia. High ACB was present in 12 subjects (12.8%) in group I and 7 subjects (46.7%) in group II (p = .001). The 75–84 and 85+ age groups (hazard ratio (HR) = 3.595; CI: 1.117–11.574; p = .032 and HR = 12.203; CI: 2.889–51.537; p = .001, respectively), hypertension (HR = 7.835; CI: 1.020–60.189; p = .048), and high ACB (HR = 4.312; CI: 1.563–11.899; p = .005) were found to be possible risk factors for dementia among subjects with SCD in the univariate model. In the final multivariate Cox regression model, subjects with high ACB had a 4.2-fold the risk of the development of dementia. Metoprolol (28.6%), trazodone (21.4%), and trospium (12.9%) were leading used drugs with anticholinergic properties. Among subjects with a total ACB score ≥ 3, the majority were on trospium (29.0%), followed by metoprolol (16.2%), paroxetine (16.2%), and trazodone (16.2%). CONCLUSION: We found that high ACB increases 4.2-fold the risk of the development of dementia in older adults with SCD in long-term follow up. The results of our study are promising, however, the effect of ACB on cognitive status among subjects with SCD is still lacking. To clarify the association between ACB and the risk of dementia, large and longer prospective studies are needed in this population.

Sarcopenia Is a Condition With Increasing Importance in Medical Oncology

A recent study reported that routinely screening for sarcopenia and nutritional status was helpful in determining toxicity and treatment in patients with non-small cell lung cancer. Although a decrease in muscle mass was detected in 68.8% of the participants, it is not evident what proportion the patients had true sarcopenia. Clarification of these issues may be relevant to the study results.

Sarcopenia as a predictor of major hepatectomy complications: a little addition.

1. Higashi T, Hayashi H, Taki K et al (2015) Sarcopenia, but not visceral fat amount, is a risk factor of postoperative complications after major hepatectomy. Int J Clin Oncol. doi:10.1007/ s10147-015-0898-0 2. Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39:412–423 3. Cintosun U, Tasci I, Binay Safer V et al (2015) Sarcopenia is more than simply documenting low skeletal muscle mass. Cancer 121(1):159 4. Parkin E, Plumb AA, O’Reilly D et al (2012) Body composition and outcome in patients undergoing resection of colorectal liver metastases. Br J Surg 99:550–557 To the Editor,