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Öğe Association of sarcopenia with depressive symptoms and functional status among ambulatory community-dwelling elderly(Elsevier Ireland Ltd, 2018) Kilavuz, Asli; Meseri, Reci; Savas, Sumru; Simsek, Hatice; Sahin, Sevnaz; Bicakli, Derya Hopanci; Sarac, Fulden; Uyar, Mehmet; Akcicek, FehmiObjective: Sarcopenia, functional disability, and depression are common problems in the elderly. Sarcopenia is associated with physical disability, functional impairment, depression, cardiometabolic diseases, and even mortality. This study aims to determine the association of sarcopenia with depression and functional status among ambulatory community-dwelling elderly aged 65 years and older. Materials and method: The sample of this cross-sectional study consisted of 28,323 people, aged 65 years and older, living in Bornova, Izmir. Multi-stage sample selection was performed to reach 1007 individuals. However, 966 elderly people could be reached, and 861 elderly people who can walk were included in the study. The data were collected by the interviewers at home through face-to-face interview. Results: The mean age was 72.2 +/- 5.8 (65-100) years. The prevalence of functional disability, depressive symptoms, and sarcopenia were 21.7%, 25.2%, and 4.6%, respectively. In multivariate analysis depression was associated with sarcopenia, being illiterate and divorced, perception of the economic situation as poor/moderate, increased number of chronic diseases, and having at least one physical disability. IADL associated functional disability with sarcopenia, being illiterate/literate and female, increased age and number of medications, and the BMI. Conclusion: Sarcopenia in ambulatory community-dwelling elderly is significantly associated with depressive symptoms and functional disability. Elderly people at high risk of sarcopenia should be screened for functional disability and depression. Appropriate interventions should also be implemented.Öğe The characteristics of older people suicides by sex and age subgroups(Elsevier Ireland Ltd, 2020) Kaya, Ahsen; Tasar, Pinar Tosun; Meral, Orhan; Sahin, Sevnaz; Balkay, Mustafa; Aktas, Ekin Ozgur; Akcicek, FehmiAs the older population steadily grows, a corresponding increase in elderly suicides is also expected. In addition, due to differences in the physical and psychosocial characteristics of this age group, the characteristics of elderly suicides are predicted to be different to those of other groups. In this study, we aimed to report the characteristics of suicides 60 years and older according to sex and age subgroups. We retrospectively reviewed the autopsy reports of individuals aged 60 and older who committed suicide in Turkey during the 10-year period between 2005 and 2014. Their age, sex, cause of death, and year, month, season, place, and method of suicide were analyzed. Comparisons were made based on sex, age subgroup, demographic variables, and descriptive characteristics of the suicides. Of 17,942 forensic autopsies, 525 were elderly suicides. Of these, 77.3% were men and the mean age was 71.26 +/- 8.16 (range, 60-94) years. There were statistically significant differences in suicide method according to sex (p < 0.001, X = 43.984) and age subgroups (p = 0.001, X = 51.457). For both sexes, hanging was the most common suicide method (59.4%) and the majority of suicides occurred at home (73.1%). The suicides occurred more frequently in the 65-74 age subgroup, in the summer, and in the months of June and July. Identifying the characteristics of elderly suicides, especially by sex and age subgroups, may be beneficial for suicide risk assessment and the development of prediction and prevention programs.Öğe A cross-sectional study on sarcopenia using EWGSOP1 and EWGSOP2 criteria with regional thresholds and different adjustments in a specific geriatric outpatient clinic(Springer, 2020) Savas, Sumru; Taskiran, Emin; Sarac, Fulden Z.; Akcicek, FehmiKey summary pointsAimTo evaluate the impact of (1) different adjustments of body size, (2) regional grip strength thresholds, and (3) EWGSOP1 and EWGSOP2 algorithm on sarcopenia prevalence using regional muscle mass thresholds in a geriatric outpatient clinic specific to endocrinological problems.FindingsThere was no sarcopenic patient with the height square adjusted regional muscle mass thresholds for EWGSOP1 and EWGSOP2. Sarcopenia prevalence was 11.7% with EWGSOP2, and 41.1% by the use of regional grip strength thresholds for EWGSOP2 with body mass index adjustments.MessageThe prevalence of sarcopenia varied significantly regarding the adjustment method for muscle mass in this specific patient group including normal to overweight and obese individuals, and also the regional grip strength thresholds whereas the comparison of the two criteria was not possible due to lack of sarcopenic individuals with height square adjusted regional muscle mass thresholds. AbstractPurposeThe aim of this study was to determine the prevalence of sarcopenia according to different methods in older outpatients using regional threshold values of muscle mass and muscle strength.MethodsWe used data from our university hospital's geriatric outpatient clinic specific to endocrinological problems, retrospectively. Sarcopenia was defined according to European Working Group on Sarcopenia in Older People (EWGSOP)1 and EWGSOP2 criteria using regional threshold values of skeletal muscle mass (SMM) with the use of different adjustments, and also according to EWGSOP2 with regional threshold values of grip strength.ResultsAmong 248 study participants, 53.6% were obese. There was no sarcopenic patient with the height square adjusted regional SMM thresholds for EWGSOP1 and EWGSOP2. Sarcopenia prevalence was 11.7% with EWGSOP2, and 41.1% by the use of regional grip strength thresholds for EWGSOP2 with body mass index adjustments for SMM. the comparison of EWGSOP1 versus EWGSOP2 was not possible due to lack of sarcopenic patients with height adjustment.ConclusionsThe prevalence of sarcopenia varied significantly with the application of different adjustment methods for SMM, and the use of regional grip strength thresholds in the specific patient group with normal to overweight and obese individuals. the use of regional thresholds of grip strength increased the prevalence of EWGSOP2-defined sarcopenia. the impact of the adjustment methods, the characteristics of the study population, and the regional thresholds should be taken into consideration while evaluating the results of sarcopenia studies.Öğe Delirium is associated with increased mortality in the geriatric population(Taylor & Francis Ltd, 2018) Tasar, Pinar Tosun; Sahin, Sevnaz; Akcam, Nur Ozge; Dinckal, Cigdem; Ulusoy, Merve Gulsah; Sarikaya, Ozan Fatih; Duman, Soner; Akcicek, Fehmi; Noyan, AysinObjective: The aim of this study was to investigate the prevalence of delirium and its association with mortality rates in elderly inpatients.Methods: The medical records of 1435 patients over 65years old who were treated at a regional university hospital and were referred to the university's Consultation and Liaison Psychiatry Clinic for psychological evaluation were retrospectively analyzed. Patients with and without a diagnosis of delirium were compared. The National Survival Database was used to determine mortality rates.Results: The prevalence of delirium was 25.5%. The delirium group was older (p<.0001) and had a larger proportion of males (p<.0001). Mortality rate was higher in the delirium group at 1, 2, 3, 4, and 5years (p<.0001 for all). Age, gender, lower urinary system diseases, chronic liver disease, solid hematologic malignancy, infections, and Alzheimer's disease emerged as significant parameters associated with mortality. Multivariate analysis of these parameters indicated that comorbid diseases (lower urinary system diseases, chronic liver disease, solid hematologic malignancy, infections, and Alzheimer's disease) are risk factors for mortality independent of demographic data such as age and gender.Conclusions: Independent of all other factors, delirium is associated with higher mortality risk.Öğe THE DETERMINATION OF THE STATUS OF EMERGENCY DEPARTMENT USE BY ELDERLY PATIENTS AND OF THE INDICATORS FOR AMBULANCE USE(Gunes Kitabevi Ltd Sti, 2018) Yenal, Sinan; Keser, Gokhan; Mandiracioglu, Aliye; Yalcin, Mehmet Akif; Bayram, Basak; Akcicek, FehmiIntroduction: This study was prepared with the objective of determining the ratio of use of ambulances by the patients 65 years of age and older who applied to emergency department and the indicators for the use of ambulances. Materials and Method: This cross-sectional research study, enrolled patients at least 65 years of age or older, who applied to the emergency department in Izmir Dokuz Eylul University Hospital. Two measurement tools were prepared with the objective of gathering the study data. The first measuring tool was prepared with the objective of evaluating the indicators of ambulance use by the patients, whereas the second measuring tool was for the situations of using emergency department. Results: 555 patients were included in the study. Only 34.2% of these patients reported that they came to the emergency department with an ambulance. It was observed that patients living with their families, and those with medical emergencies, i.e. who did not experience a trauma or an accident, used ambulances less frequently for going to the emergency department (p<0.05). Among patients who came to the emergency department with private vehicles, 59.2% stated that they did not call an ambulance because they thought that it would be quicker to come with their own resources. On the other hand, among patients who came to the hospital with an ambulance, a ratio of 67.4% replied that they called the ambulance because of emergency. Conclusion: The results of this study suggest that public awareness about 112 ambulance systems should be increased, especially for elderly patients.Öğe The effect of chemotherapy on nutritional status and weakness in geriatric gastrointestinal system cancer patients(Elsevier Science Inc, 2018) Bicakli, Derya Hopanci; Ozveren, Ahmet; Uslu, Ruchan; Dalak, Reci Meseri; Cehreli, Ruksan; Uyar, Mehmet; Karabulut, Bulent; Akcicek, FehmiObjectives: Malnutrition is common in patients with geriatric gastrointestinal system (GIS) cancer. This study aimed to evaluate patients with geriatric GIS cancer in terms of nutritional status and weakness and determine the changes caused by chemotherapy (CT). Methods: Patients with geriatric GIS cancer who received CT were included in the study. Their nutritional status was assessed with the Mini Nutritional Assessment, and weakness was assessed with the handgrip strength/body mass index ratio. After CT (minimum 4 wk and maximum 6 wk later), patients were assessed for the same parameters. Results: A total of 153 patients aged >= 65 y (mean age, 70.5 +/- 5.6 y; 44 female and 109 male) were evaluated. The population consisted of patients who were diagnosed with colorectal (51.6%), gastric (26.8%), pancreatic (11.8%), hepatic (7.2%), biliary tract (2%), and esophageal (0.7%) cancer. Of these patients, 37.9% were malnourished, 34.6% were at risk of malnutrition, and 27.5% were well nourished. After one course of CT, the frequency of malnutrition increased to 46.4% (P = 0.001). The patient groups with the highest rates of weakness were those who were diagnosed with biliary tract, hepatic, and colorectal cancer (33.3%, 27.3%, and 20%, respectively). Weakness was significantly increased after one course of CT in patients who received CT before (P = 0.039). Conclusions: Malnutrition and weakness were common in patients with geriatric GIS cancer, and even one course of CT worsened the nutritional status of the patients. Patients who have received CT previously should be carefully monitored for weakness. (C) 2017 Elsevier Inc. All rights reserved.Öğe The effects of mycophenolate mofetil on encapsulated peritoneal sclerosis model in rats(Dustri-Verlag Dr Karl Feistle, 2012) Hur, Ender; Bozkurt, Devrim; Timur, Ozge; Bicak, Selahattin; Sarsik, Banu; Akcicek, Fehmi; Duman, SonerIntroduction: Encapsulated peritoneal sclerosis (EPS) is a devastating complication of peritoneal dialysis. We aimed to investigate the effects of mycophenolate mofetil (MMF) treatment in experimental EPS in rats. Methods: 40 nonuremic Wistar albino rats were divided equally into 4 groups: control rats received 2 nil isotonic saline intraperitoneally daily for 3 weeks without any other treatment. The chlorhexidine gluconate group received intraperitoneally 2 ml/200 g injection of chlorhexidine gluconate and ethanol dissolved in saline for 3 weeks. The resting group received chlorhexidine gluconate (0 - 3rd week) + peritoneal resting (4th - 6th week). The MMF group received chlorhexidine gluconate (0 - 3rd week) + 125 mg/l MMF in drinking water (4th - 6th week). Dialysate cytokine levels, leukocyte count, peritoneal thickness, inflammation and fibroblast activities were evaluated. Results: Although the MMF and resting groups showed beneficial effects on ultrafiltration and D-1/D-0 glucose compared to the chlorhexidine gluconate group, only MMF treatment improved dialysate TGF-beta 1, VEGF and MCP-1 levels compared to the resting group. Inflammatory activity and vascularity observed in a tissue biopsy, including capillaries number per mm(2) of submesothelial area, decreased in the treatment group. Conclusions: MMF treatment has beneficial effects on EPS via inhibiting inflammation and neovascularisation by reducing dialysate VEGF overexpression.Öğe The Effects of Vitamin D on Gentamicin-Induced Acute Kidney Injury in Experimental Rat Model(Hindawi Ltd, 2013) Hur, Ender; Garip, Alev; Camyar, Asuman; Ilgun, Sibel; Ozisik, Melih; Tuna, Sena; Olukman, Murat; Ozdemir, Zehra Narli; Sozmen, Eser Yildirim; Sen, Sait; Akcicek, Fehmi; Duman, SonerIntroduction. Acute kidney injury (AKI) pathogenesis is complex. Findings of gentamicin nephrotoxicity are seen in 30% of the AKI patients. Vitamin D has proven to be effective on renin expression, inflammatory response, oxidative stress, apoptosis, and atherosclerosis. We aimed to investigate the effect of vitamin D in an experimental rat model of gentamicin-induced AKI. Methods. Thirty nonuremic Wistar albino rats were divided into 3 groups: Control group, 1 mL saline intramuscular (im) daily; Genta group, gentamicin 100 mg/kg/day (im); Genta + vitamin D, gentamicin 100 mg/kg/day (im) in addition to 1 alpha, 25 (OH)(2)D-3 0.4 mcg/kg/day subcutaneously for 8 days. Blood pressures and 24-hour urine were measured. Blood urea and creatinine levels and urine tubular injury markers were measured. Renal histology was semiquantitatively assessed. Results. Urea, creatinine and urine neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1 were all increased in Genta group indicating AKI model. Systolic blood pressure decreased, but urine volume and glutathione increased in Genta + Vit D group compared to Control group. Histological scores indicating tubular injury increased in Genta and Genta + Vit D groups. Conclusions. Vitamin D does not seem to be effective on histological findings although it has some beneficial effects via RAS system and a promising effect on antioxidant system.Öğe The Effects of Vitamin D on Gentamicin-Induced Acute Kidney Injury in Experimental Rat Model(Hindawi Ltd, 2013) Hur, Ender; Garip, Alev; Camyar, Asuman; Ilgun, Sibel; Ozisik, Melih; Tuna, Sena; Olukman, Murat; Ozdemir, Zehra Narli; Sozmen, Eser Yildirim; Sen, Sait; Akcicek, Fehmi; Duman, SonerIntroduction. Acute kidney injury (AKI) pathogenesis is complex. Findings of gentamicin nephrotoxicity are seen in 30% of the AKI patients. Vitamin D has proven to be effective on renin expression, inflammatory response, oxidative stress, apoptosis, and atherosclerosis. We aimed to investigate the effect of vitamin D in an experimental rat model of gentamicin-induced AKI. Methods. Thirty nonuremic Wistar albino rats were divided into 3 groups: Control group, 1 mL saline intramuscular (im) daily; Genta group, gentamicin 100 mg/kg/day (im); Genta + vitamin D, gentamicin 100 mg/kg/day (im) in addition to 1 alpha, 25 (OH)(2)D-3 0.4 mcg/kg/day subcutaneously for 8 days. Blood pressures and 24-hour urine were measured. Blood urea and creatinine levels and urine tubular injury markers were measured. Renal histology was semiquantitatively assessed. Results. Urea, creatinine and urine neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1 were all increased in Genta group indicating AKI model. Systolic blood pressure decreased, but urine volume and glutathione increased in Genta + Vit D group compared to Control group. Histological scores indicating tubular injury increased in Genta and Genta + Vit D groups. Conclusions. Vitamin D does not seem to be effective on histological findings although it has some beneficial effects via RAS system and a promising effect on antioxidant system.Öğe Evaluation of attempted older adults suicides admitted to a University Hospital Emergency Department: Izmir study(Elsevier Science Bv, 2017) Gokcelli, Duygu Keskin; Tasar, Pinar Tosun; Akcam, Nur Ozge; Sahin, Sevnaz; Akarca, Funda Karbek; Aktas, Ekin Ozgur; Duman, Soner; Akcicek, Fehmi; Noyan, AysinIntroduction: Advanced age is one of the risk factors for attempting suicide. Suicide attempts are one of the reasons for elderly patients to admit emergency services. The aim of this study was to investigate the relationship between suicidal behavior and sociodemographic factors and concurrent somatic diseases. Methods: The medical records of patients aged 60 years and over who presented to the emergency department of our university hospital for attempted suicide between the dates of January 1, 2007 and December 31, 2015 were screened retrospectively. Individuals recorded as cases of suicide on the forensic case report form were identified, the data recorded at our hospital were obtained, and telephone interviews were conducted to acquire any missing data. Results: A total of 63 patients with a mean age of 65.88 years were included in the study. A large proportion of the suicide attempts occurred in the years 2014 and 2015. Overall, 23.8% of the patients had a previous history of suicide attempt. Overdose was the method in 74.6% of the suicide attempts, and 70.2% were impulsive; 63.5% of the patients had a history of psychiatric disease. The most common psychopathology was major depressive disorder. Conclusion: We found that suicide attempts were more common among older adults with a history of depression, that approximately one in four had previously attempted suicide, and that the majority of individuals attempting suicide chose to use their own medication.Öğe FACTORS RELATED TO FALLS AND THE FEAR OF FALLING AMONG ELDERLY PATIENTS ADMITTED TO THE EMERGENCY DEPARTMENT(Gunes Kitabevi Ltd Sti, 2019) Savas, Sumru; Yenal, Sinan; Akcicek, FehmiIntroduction: This study was conducted to investigate the fear of falling and admissions related to falls, also the associated factors with each of them among elderly patients who are admitted to the emergency department. Materials and Method: The population of this study consisted of patients aged 65 years and over who were admitted to the emergency department in August 2015. The measurement tool included questions regarding outcomes, functional state, sociodemographic data, balance and walking problems, and admissions to the emergency department due to falls within the past year which was filled by a trained interviewer via semi-structured interviews with the patients and/or their relatives. The logistic regression was applied for the analysis. Results: of the 555 patients who were included in the study, 12.6% were admitted because of falls. Admissions due to falls were associated with admissions to the emergency department over the past year due to falls, living in nursing homes, and fear of falling. The fear of falling was shown in 22.2% of the study group, and it was found to be associated with female sex, marital status, falling status, and better functional state. Conclusion: There was a significant relationship between falls and the fear of falling among older patients admitted to the emergency department. There is need for further prospective studies to better understand the effect of fear of falling on falls.Öğe Features of Pressure Ulcers in Hospitalized Older Adults(Lippincott Williams & Wilkins, 2014) Aygor, Hulya Eskiizmirli; Sahin, Sevnaz; Sozen, Emine; Baydal, Basak; Aykar, Fisun Senuzun; Akcicek, FehmiBACKGROUND: The objectives of this study were to examine the prevalence and risk of pressure ulcers (PrUs) among hospitalized patients 65 years or older in a university hospital setting and to assess the potential for prevention and healing in that population. METHODS: The retrospective study conducted at the general medicine departments of Ege University Hospital in Izmir, Turkey, included 209 patients (115 females, 94 males) 65 years or older, who had been admitted to the hospital for a variety of reasons between April 1, 2011, and October 1, 2011. The following tools were used to collect data: a data collection form to identify the sociodemographic and medical characteristics of the patients, the Braden Risk Assessment Scale to assess the risk of PrUs, and a form to monitor PrUs, which included the site of the PrU, the category, and the PUSH (Pressure Ulcer Scale for Healing) score, a tool for tracking changes in PrUs status applied at weekly intervals. RESULTS: The mean patient age was 73 (6.4) years. The prevalence of PrUs was 5.8% during the hospital stay. Pressure ulcers appeared most frequently in the ischeal tuberosity area (40%), and 45.2% of all PrUs observed were category II. The comorbidities of the patients who had PrUs were as follows: rheumatoid arthritis, 40% (n = 5); acute renal failure, 24% (n = 3); multiple myeloma, 8% (n = 1); chronic renal failure, 8% (n = 1); pneumonia, 8% (n = 1); and acute lymphoblastic leukemia, 8% (n = 1). CONCLUSIONS: Pressure ulcers are a common healthcare complication in the older adult population, with potentially severe consequences. The most important intervention that healthcare professionals can make to reduce PrUs is to determine and address risk factors.Öğe Geriatrics education is associated with positive attitudes toward older people in internal medicine residents: A multicenter study(Elsevier Ireland Ltd, 2015) Tufan, Fatih; Yuruyen, Mehmet; Kizilarslanoglu, Muhammet Cemal; Akpinar, Timur; Emiksiye, Sirhan; Yesil, Yusuf; Ozturk, Zeynel Abidin; Bozbulut, Utku Burak; Bolayir, Basak; Tasar, Pinar Tosun; Yavuzer, Hakan; Sahin, Sevnaz; Ulger, Zekeriya; Ozturk, Gulistan Bahat; Halil, Meltem; Akcicek, Fehmi; Doventas, Alper; Kepekci, Yalcin; Ince, Nurhan; Karan, Mehmet AkifObjective: The number of older people is growing fast in Turkey. In this context, internal medicine residents and specialists contact older people more frequently. Thus, healthcare providers' knowledge and attitudes toward older people is becoming more important. Studies that specifically investigate internal medicine residents' attitudes toward the elderly are scarce. We aimed to investigate the attitudes of internal medicine residents toward older people. Methods: This cross-sectional multicenter study was undertaken in the internal medicine clinics of six university state hospitals that provide education in geriatric care. All internal medicine residents working in these hospitals were invited to participate in this questionnaire study between March 2013 and December 2013. We recorded the participants' age, sex, duration of internal medicine residency, existence of relatives older than 65 years, history of geriatrics course in medical school, geriatrics rotation in internal medicine residency, and nursing home visits. Results: A total of 274 (82.3%) of the residents participated in this study, and 83.6% of them had positive attitudes toward older people. A geriatrics rotation during internal medicine residency was the only independent factor associated with positive attitudes toward the elderly in this multivariate analysis. A geriatrics course during medical school was associated with positive attitudes in the univariate analysis, but only tended to be so in the multivariate analysis. Conclusion: Geriatrics rotation during internal medicine residency was independently associated with positive attitudes toward older people. Generalization of geriatrics education in developing countries may translate into a better understanding and improved care for older patients. (C) 2015 Elsevier Ireland Ltd. All rights reserved.Öğe Human APRIL and FGF-21 and adhesion molecules in relation to cognitive function in elderly diabetic patients(Springer India, 2020) Savas, Sumru; Tayfur, Eda; Sarac, Fulden; Akbas, Sibel; Acarer, Ahmet; Gunduz, Cumhur; Akcicek, FehmiAim A diverse combination of etiologies such as vascular and inflammatory factors and social and physical inactivity may take place in the etiology of cognitive dysfunction (CD). Diabetes mellitus (DM) may contribute to CD over insulin resistance, inflammation, and vascular risk factors. However, mechanisms included in the process are not very clear. We aimed to investigate serum levels of selected biomarkers as a proliferation-inducing ligand (APRIL), FGF-21, P-selectin, soluble vascular cell, and intercellular adhesion molecules-1 (sVCAM-1 and sICAM-1) in elderly patients with DM in relation to cognitive function. Methods A group of 80 elderly type 2 diabetic patients from the outpatient clinic, consisting of 40 patients with CD (mini-mental state examination (MMSE) score < 24) and 40 individuals without CD were enrolled in the study. Anthropometric, sociodemographic, and functional-glycemic evaluations were determined. Biomarker levels were determined by enzyme-linked immunosorbent assay. Results Median sICAM-1 and FGF-21 levels were higher, and P-selectin level, activities of daily living (ADL), instrumental ADL, MNA, and MMSE scores were lower in the CD group (p = 0.002,p = 0.010,p = 0.001,p = 0.001,p < 0.001,p = 0.005,p < 0.001, respectively). There was no significant difference between the groups regarding age, gender, living status, education, cigarette and alcohol consumption, antidiabetic therapy as well as comorbidities such as hypertension and other diseases, depression, body composition, sVCAM-1, APRIL levels, and related biochemical values. Conclusion Median sICAM-1 and FGF-21 levels were higher and P-selectin level was lower in older diabetic patients with CD than in patients with normal cognitive status. Understanding the mechanisms may lead to the prevention or delay of CD in those patients.Öğe The Impact of Strict Volume Control Strategy on Patient Survival and Technique Failure in Peritoneal Dialysis Patients(Karger, 2011) Kircelli, Fatih; Asci, Gulay; Yilmaz, Mumtaz; Ok, Ebru Sevinc; Demirci, Meltem Sezis; Toz, Huseyin; Akcicek, Fehmi; Ok, Ercan; Ozkahya, MehmetStrict volume control strategy provides better cardiac functions and control of hypertension in dialysis patients. We investigated the effect of this strategy on mortality and technique failure in peritoneal dialysis patients over a 10-year period. 243 patients were enrolled. Strict volume control by dietary salt restriction and ultrafiltration was applied. Mean systolic and diastolic blood pressures decreased from 138.4 +/- 29.9 and 86.3 +/- 16.8 to 114.9 +/- 32.3 and 74.7 +/- 18.3 mm Hg, respectively. Overall and cardiovascular mortality rates were 48.4 and 29.6 per 1,000 patient-years, respectively. In multivariate analysis, age, diabetes and baseline serum albumin level were independent predictors of overall mortality, and age, diabetes and baseline serum calcium of cardiovascular mortality. Residual diuresis and peritoneal equilibration test values were not related to mortality. Strict volume control leads to lower mortality than comparable series in the literature. Technique survival is better during the first 3 years, but not after 5 years. Copyright (C) 2011 S. Karger AG, BaselÖğe The investigation of asymptomatic swallowing disorder through surface electromyography in the geriatric population(Springer, 2020) Yuksel, Arif; Kulan, Can Ahmet; Akcicek, FehmiAim Swallowing is a vital activity. the difficulty while swallowing, referred to as swallowing disorder, is strongly associated with serious health problems in the elderly. the aim of this study is to enable early recognition of the swallowing function developing as an asymptomatic condition. Method Our study was conducted on elderly populations aged 65 years and over who met the exclusion criteria. Firstly, to be able to reach the number of sampling, "EAT-10 questionnaire", which also has a Turkish validation, was used to eliminate those with symptomatic swallowing disorders. the number of patients we reached was 320, but 7 dropped out of the study and therefore the study was carried out with a total of 313 [reached as 97.8% (up 95% G-power)]. Result We used validated sEMG test in the quantitative (objective) detection of asymptomatic swallowing disorder. in this method, asymptomatic swallowing disorder was detected in 39 cases (12.4%). Conclusion Swallowing disorder without symptoms is frequent and the sEMG test is useful in detecting it in the elderly population.Öğe LOW VITAMIN D LEVEL IN PATIENTS WITH ALZHEIMER'S DISEASE (DEVIT-ALZ): A CROSS-SECTIONAL MULTICENTER STUDY(Springer London Ltd, 2013) Naharci, Mehmet Ilkin; Karadag, Berrin; Sahin, Sevnaz; Ozkaya, Hilal; Safer, Umut; Curgunlu, Asli; Karaarslan Cengiz, Ozlem; Kuyumcu, Mehmet Emin; Bozoglu, Ergun; Doventas, Alper; Bahat Ozturk, Gulistan; Tasci, Ilker; Cankurtaran, Mustafa; Basat, Sema; Ciftci, Cavlan; Atli, Teslime; Karan, Mehmet Akif; Erdincler, Deniz Suna; Beger, Tanju; Akcicek, Fehmi; Ariogul, Servet; Doruk, HuseyinÖğe MANAGEMENT OF SYNCOPE IN THE ELDERLY(Gunes Kitabevi Ltd Sti, 2010) Sahin, Sevnaz; Akcicek, FehmiSyncope in elderly patients is a clinical syndrome frequently observed both in emergency rooms and outpatient clinics and it may cause mortality depending on the etiology. The main pathology at the background is global cerebral hypoperfusion. Although syncope may be seen at all age groups, it is more common in older ages. Age-associated changes in various physiological parameters contribute to development of syncope in the elderly and the underlying etiology determines its prognosis. Among the many types of syncope in the elderly, cardiac syncope is the primary syndrome resulting in increased mortality. Therefore, identification of the etiology is very important in the management of syncope. When detailed anamnesis, physical examination and EKG are inadequate for the diagnosis of an elderly syncope patient, further invasive or noninvasive examination should be performed. In the case of syncope related to neural pathways, nonpharmacological approaches are preferred. Physicians should evaluate all the medications the patient is using and the withdrawal or reduction of culprit medication should be considered. Patients must be informed about the reasons and triggers of syncope. Patients with cardiac syncope require specific treatment and an implantable cardiac defibrillator (ICD) may be life saving for appropriate indications. Syncope in the elderly is an important geriatric syndrome that requires comprehensive assessment, rapid diagnosis and treatment.Öğe MANAGEMENT OF SYNCOPE IN THE ELDERLY(Gunes Kitabevi Ltd Sti, 2010) Sahin, Sevnaz; Akcicek, FehmiSyncope in elderly patients is a clinical syndrome frequently observed both in emergency rooms and outpatient clinics and it may cause mortality depending on the etiology. The main pathology at the background is global cerebral hypoperfusion. Although syncope may be seen at all age groups, it is more common in older ages. Age-associated changes in various physiological parameters contribute to development of syncope in the elderly and the underlying etiology determines its prognosis. Among the many types of syncope in the elderly, cardiac syncope is the primary syndrome resulting in increased mortality. Therefore, identification of the etiology is very important in the management of syncope. When detailed anamnesis, physical examination and EKG are inadequate for the diagnosis of an elderly syncope patient, further invasive or noninvasive examination should be performed. In the case of syncope related to neural pathways, nonpharmacological approaches are preferred. Physicians should evaluate all the medications the patient is using and the withdrawal or reduction of culprit medication should be considered. Patients must be informed about the reasons and triggers of syncope. Patients with cardiac syncope require specific treatment and an implantable cardiac defibrillator (ICD) may be life saving for appropriate indications. Syncope in the elderly is an important geriatric syndrome that requires comprehensive assessment, rapid diagnosis and treatment.Öğe NATIVE RENAL BIOPSIES PERFORMED IN OLDER ADULTS ARE INCREASING: TWELVE YEARS EXPERIENCE OF EGE UNIVERSITY(Gunes Kitabevi Ltd Sti, 2011) Hur, Ender; Bozkurt, Devrim; Taskin, Huseyin; Sarsik, Banu; Sen, Sait; Akcicek, Fehmi; Duman, SonerIntroduction: Determination of the frequency and prevalence of biopsy proven nephropathies in older adults and adults is important for epidemiological studies. Materials and Method: Predominant glomerulonephritis (GN) in native renal biopsies of adults and older adults (>= 65 years) were evaluated. Results: Among a total of 1702 renal biopsies (males 52%, ages 16-82, mean 40 +/- 15 years), 121 (7%) were performed in persons >= 65 years old. The mean age at the time of renal biopsy increased from 37.3 +/- 16.8 in 1996 to 44 +/- 16.1 years in 2009. The leading indications for biopsy in older and younger age groups were nephrotic syndrome (NS) (46.5% vs. 39.8% respectively), asymptomatic urinary abnormalities (20.9% vs. 33.4% respectively) acute renal failure (15.1% vs. 7.4% respectively) and hematuria (4.7% vs. 10.9% respectively). The etiologies of NS were amyloidosis, membranous GN and focal segmental glomerulosclerosis (FSGS) in both age groups. Primary GN was the predominant etiology in both age groups. Above 65 years, membranous (14.8%) and crescentic (9.9%) GNs were predominant while below 65 years IgA nephropathy (9%) was predominant. Among secondary GNs, amyloidosis (19%) and lupus nephritis (11.7%) were also predominant in the elderly and the younger persons respectively. Conclusion: The current data represents the experience of a single center. Such registries will allow epidemiologic studies to answer several open questions regarding both prevention and treatment of nephropathies in different age groups.
