ISSN: 2148-4902 | E-ISSN: 2536-4553
Northern Clinics of İstanbul - North Clin Istanb: 11 (6)
Volume: 11  Issue: 6 - 2024
EDITORIAL
1. Front Matter

Pages I - VIII

RESEARCH ARTICLE
2. Patient satisfaction with health care services in Turkiye: A glimpse from nationwide Ministry of Health database
Suayip Birinci, Serdar Can Guven, Naim Ata, Mustafa Mahir Ulgu, Orhan Kucuksahin
doi: 10.14744/nci.2024.84584  Pages 495 - 500
OBJECTIVE: Patient satisfaction refers to the degree to which patients’ expectations from health care services are met and is a critical indicator used to measure the overall quality of this service. This study aims to analyze overall patient satisfaction and regarding factors in our country, providing valuable insights for policymakers, clinicians, and researchers who aim to improve the quality of health care services and patient outcomes. Furthermore, as a nationwide assessment, this study reveals the potential of big data analytics in health services.
METHODS: Integrated e-Pulse and Health Statistics and Causal Analysis (SINA) systems were used to gather satisfaction scores given by patients after any health care service obtained for overall health care service, physician, personnel other than physician, sanitization (from 0 to 100). The data were processed and analyzed using libraries Pandas and NumPy in the Python programming language.
RESULTS: A total of 37.674.978 scores were given by a total of 11.421.857 patients regarding health care service they obtained involving ratings of 207.339 physicians, between the years of 2016 and 2023. Mean health care rating was 80.4 over 100, mean physician rating was 82, mean rating for personnel other than physicians was 78.4 and mean rating for sanitization was 77.7. When the top 15 most scored facilities were investigated, overall point was highest for Family Medicine centers (94.62) and lowest for Women’s Health and Pediatric Diseases hospitals. When rate of 100 points given for each clinic after an admission was investigated, it was lowest for emergency medicine, pediatric emergency medicine, dentistry, endodontia, dermatology and pandemic clinics, and highest for oncology, radiation oncology and family medicine clinics. Waiting time to admission and length of hospital stay seemed to be important factors for patient satisfaction.
CONCLUSION: This is the largest study regarding patient satisfaction in Turkiye and was conducted by the foremost health care provider, the Ministry of Health. This limited data may provide implications to be assessed to keep the positive trend in our country in patient satisfaction and future analyses evaluating infinite potential factors to hasten the progress of health care in our country.

3. Evaluation of corporate experiences during the accreditation process in the field of health – A qualitative study
Tuncay Palteki, Nedim Havle, Demet Gokmen Kavak, Ayse Sibel Oksuz, Aykut Ilker Arslan, Ezgi Salar, Esengul Purkuloglu, Gamze Ozcan, Nesrin Aydemir, Ozlem Palancioglu, Yeliz Soy Kibriz
doi: 10.14744/nci.2023.28482  Pages 501 - 511
OBJECTIVE: In our study, we attempted to determine the accreditation process experience of hospital senior managers accredited by the Turkish Health Care Quality and Accreditation Institute (TUSKA). Along with the institutions’ accomplishments through the accreditation program, the major challenges they faced during the accreditation process were revealed.
METHODS: One of the qualitative research designs used was interpretive phenomenological analysis, which was carried out through semi-structured interviews with hospital senior managers.
RESULTS: In the study conducted with eight participants, 55 sub-themes emerged under 12 main themes. The participants expressed their opinions on a wide range of topics, from the achievements related to the accreditation process to the difficulties they encountered, from their strengths to the dissemination of accreditation throughout the country.
CONCLUSION: It has been understood that the national hospital accreditations carried out in our country provide important gains to the institutions in management and clinical activities, while the expectations on incentives and other similar issues have not yet been met.

4. Dodder (Cuscuta sp.) extract prevents cognitive deficits in a rat model of hepatic encephalopathy
Omercan Albayrak, Bilge Nur Hatipoglu, Dilek Ozbeyli, Ali Sen, Turkan Koyuncuoglu, Ozge Cevik, Feriha Ercan, Fatma Kanpalta, Ahmet Dogan, Seren Ede Pazarbasi, Goksel Sener
doi: 10.14744/nci.2023.95776  Pages 512 - 519
OBJECTIVE: In our study, the protective effect of dodder plant extract against encephalopathy induced by cholestatic liver disease model was investigated.
METHODS: Spraque Dawley rats were used in the study. For the cholestatic liver disease model, the bile duct ligation (BDL) was applied. The groups were determined as control, Cuscuta sp. (CUS), BDL and BDL + CUS. Double ligation was performed in the bile duct in the BDL groups. For the applications, saline (SF) was administered to the control and BDL groups for 28 days while 250 mg/kg of Cuscuta sp. extract was given by oral gavage to the CUS and BDL + CUS groups. At the end of the experiment, cognitive evaluations were made by applying new object recognition and Morris water maze tests. After these tests, blood-brain barrier (BBB) measurements were made in half of the groups. In the other half of the groups, brain tissue samples were taken by decapitation and transforming growth factor-beta (TGF-β), 8-hydroxydeoxyguanosine (8-OHdG) and sodium-potassium adenosine triphosphatase (Na+/K+-ATPase) measurements were made in the tissues. Histological examinations of the tissues were also performed.
RESULTS: Cognitive performance was low, and BBB permeability was found to be increased in the group with bile duct ligation. In addition, TGF-β and 8-OHdG levels were increased in tissues, while Na+/K+-ATPase enzyme activity was suppressed. Treatment with Cuscuta sp. increased cognitive performance and decreased BBB permeability. Other biochemical parameters examined were significantly (p<0.05–0.001) reversed and supported by histological findings.
CONCLUSION: Our findings in the study suggest that dodder plant may be beneficial for the protection of cognitive performance and brain tissue in encephalopathy caused by cholestasis.

5. The frequency of macroprolactinemia among patients with hyperprolactinemia in a central laboratory of a training and research hospital
Nilufer Bayraktar
doi: 10.14744/nci.2023.94758  Pages 520 - 524
OBJECTIVE: Macroprolactinemia is a well-described endocrine disorder, with its results leading to unnecessary tests and overtreatment. However, routine macroprolactin screening is not performed in many laboratories. Routinely used prolactin assays can result in false diagnosis of hyperprolactinemia in patients with no signs and symptoms related to hyperprolactinemia and clinicians should be aware of macroprolactinemia frequency encountered with the method in use. In this study, it was aimed to examine the frequency of macroprolactinemia among patients with hyperprolactinemia.
METHODS: Prolactin analyses were performed on Roche Cobas® e801 immunoanalyzer using the Elecsys Prolactin II electrochemiluminesence immunoassay (Roche Diagnostics, Mannheim, Germany). Samples were provided from 14 different hospitals in total and evaluated with the same method in a single central laboratory. In order to precipitate the samples for macroprolactin analysis, polyethylene glycol (PEG) 6000 was used.
RESULTS: In this study, we evaluated 1100 patients with hyperprolactinemia and determined the frequency of macroprolactinemia to be 9.6% (recovery cut-off value <40%), while 8.5% of the patients were in the gray zone (recovery cut-off value 40% to <60%).
CONCLUSION: Laboratories should consider regularly screening for macroprolactinemia in all hyperprolactinemic samples and collaborate with clinicians to raise awareness about the prevalence of this condition.

6. Systematic review of survey/questionnaire-based drug utilization studies in Turkiye
Onur Gultekin, Nazim Haspolat, Bahar Cicek, Dieudonné Havyarimana, Ahmet Akici, Volkan Aydin
doi: 10.14744/nci.2024.60252  Pages 525 - 533
OBJECTIVE: Drug utilization studies (DUS), providing insights into various aspects of pharmacoepidemiology from prescribing to medication use, can be conducted through real-world data from health records and survey-based data. In this study, we aimed to describe survey/questionnaire-based DUS conducted in Turkiye.
METHODS: We searched online databases for the most frequently used keywords in DUS from January 1993 till May 2023 and identified 180 survey-based DUS conducted in Turkiye. We described DUS by their populations, sociodemographic characteristics, timeframe, setting and provinces, data collection method, medication categories, and article-specific variables were evaluated.
RESULTS: We identified that 68.3% of the DUS were in English and 91.7% were indexed in Web of Science (median 1 [interquartile range: 1–2] citation). We found that 21.7% of the articles (n=39) had pharmacology affiliation. Adults are the target population in 37.8% of the studies and age and gender were not reported in 27.2% and 16.7%, respectively. The response rate was not stated in 55.0%. We determined that 48.3% of the studies were focused on a single medication/medication group. The mean time from data collection to publication was 2.5±1.9 years, and the highest number of articles (10.6%) were published in 2021.
CONCLUSION: Our systematic review shows that the majority of DUS were listed in well-known international indices, suggesting that our local studies invoke global interest and hold a valuable position in health research. Nevertheless, lack of reporting of methodological characteristics in substantial part of the studies can be considered an important room for improvement of DUS.

7. The evaluation of cyclin D1 expression in prostate carcinoma cases
Asude Aksoy, Selcen Vicdanli, Gokhan Artas
doi: 10.14744/nci.2023.79735  Pages 534 - 540
OBJECTIVE: Cyclin D1 (CDDN1) is an important protein for mitotic cell cycle advancement through the G1 phase and contributes to the control of the cyclin-dependent kinases CDK4 and CDK6. We evaluated the relationship between CDDN1 expression and clinicopathological features in prostate cancer (PCa) cases and whether CDDN1 could be used as a prognostic biomarker for PCa cases in this study.
METHODS: This study comprised ninety cases; seventy-five had PCa and fifteen had benign prostatic hypertrophy (BPH) diagnoses (as the control group). The pathological specimens were stained immunohistochemically and categorized as a ‘low’ (L) or a ‘high’ (H) group for CDDN1 expression. The cases’ clinicopathological features and survival rates were evaluated statistically, within a 95% confidence interval, p<0.05, retrospectively.
RESULTS: The median follow-up time was 75 (17–96) months, and the median overall survival (OS) was 87 months (CI 95%: 74.74–99.25). While the OS was 66 months (CI 95%: 49.61–82.38) in the H-CDDN1 group, the OS of the L-CDDN1 group was not yet reached. The OS of the L-CDDN1 group was longer in statistical significance (p=0.011). A Cox regression analysis revealed that the levels of CDDN1 expression, the values of lactate dehydrogenase, and post-treatment prostate specific antigen were found to be prognostic factors for OS in PCa cases (p<0.05).
CONCLUSION: Our results suggest the overexpression of CDDN1 is a potentially useful but poor prognostic biomarker for PCa cases.

8. Postoperative physical activity limitations and balance changes on patients who have been operated for breast cancer
Onur Zambak, Fikret Ezberci, Duygu Kurtulus, Huseyin Kerem Tolan, Hakan Cakit
doi: 10.14744/nci.2023.44538  Pages 541 - 546
OBJECTIVE: The purpose of this study is to assess the postoperative physical activity limitations and balance changes in patients who have been operated on for breast cancer. Some physical activity limitations and balance disorders can be expected after breast cancer surgery.
METHODS: From 2008 to 2016, 112 patients who underwent breast cancer surgery were included in this study. The patients who have some neurological, physical, pulmonary or cardiac diseases were not included. Patients were invited to the hospital. Lack of balance and physical activity limitations were evaluated with a questionnaire including 17 questions.
RESULTS: On the postoperative frequency distribution of physical activities criteria out of 112 patients %33.1 (n=37) people got 4 points and over while %66.9 (n=75) people got less than 4 points. After the operation, since more than 75 people got less than 4 points, it is accepted as inadequate in terms of physical activity. Looking at balance changes, in patients with breast-conserving surgery (BCS)were approximately 5.94–0.82 where as average modified radical mastectomy (MRM)was 5.94–0.41. According to criteria on postoperated patients’ balance changes, the value of f was 3.162, contrary to this, as the value of p was found 0.078. Differences between operation and balance changes were not significant.
CONCLUSION: The patients who have had breast cancer surgery, physical activities were limited and life quality was down after the operation. On the other hand, there was no significant difference on balance changes depending on the operations.

9. Changes in the frequency, presentation and surgical outcomes of complicated appendicitis during the pandemic
Tunc Eren, Leyla Zeynep Tigrel, Abdullah Kayali, Ahmet Naci Emecen, Ayse Nur Toksoz Yildirim, Hasan Huseyin Mutlu, Ozgur Ekinci, Orhan Alimoglu
doi: 10.14744/nci.2024.58897  Pages 547 - 554
OBJECTIVE: Coronavirus Disease 2019 (COVID-19) has affected every aspect of human life and all health care systems globally. The aim of this study was to investigate the effect of COVID-19 pandemic on the frequency, presentation and surgical outcomes of complicated appendicitis.
METHODS: Patients who underwent appendectomy for acute appendicitis one year before and one year after the declaration of the pandemic were investigated. Demographics and diagnostic findings as well as surgical and histopathological outcomes were recorded and statistically analyzed.
RESULTS: The study group of 409 patients was composed of 241 cases in the pre-pandemic group and 168 cases in the pandemic group revealing that the weekly total number of appendectomies decreased during the pandemic [pre-pandemic, median (IQR): 5 (3–6); pandemic, median (IQR): 3 (2–5); p=0.005]. The pandemic group was significantly associated with a longer time from emergency department admission to hospitalization, increased mean blood C-reactive protein levels and increased rate of postoperative complications (p=0.024, p=0.038 and p=0.004, respectively). Most importantly, pathological examinations revealed a higher number of complicated appendicitis cases in the pandemic group when compared to the pre-pandemic group [26 (15.5%) vs. 19 (7.9%), respectively] which corresponded to a 2.1-fold higher risk of being diagnosed with complicated appendicitis during the pandemic [OR: 2.1 (95% CI: 1.1–4.1), p=0.024].
CONCLUSION: While fewer appendectomies were performed during the pandemic, the incidence of complicated appendicitis and postoperative complications increased considerably.

10. Can HALP (Hemoglobin, albumin, lymphocyte, and platelet) score distinguish malignant and benign causes of extrahepatic cholestasis in patients with extrahepatic bile duct obstruction?
Ibrahimhalil Dusunceli, Zeynep Gok Sargin, Umut Celik, Fatih Sargin
doi: 10.14744/nci.2024.23169  Pages 555 - 559
OBJECTIVE: Cholestatic diseases are common and classified as benign or malignant based on their etiology. HALP is a unique nutritional immune marker that combines indicators of nutritional status, including hemoglobin and albumin, with immune function markers like lymphocyte and platelet counts. We investigated the HALP score’s ability to differentiate between benign and malignant causes in extrahepatic cholestasis patients.
METHODS: This research was designed as cross-sectional and retrospective. Between 1 January 2020–1 January 2022, patients diagnosed with extrahepatic cholestasis were included. The diagnoses were confirmed using non-invasive imaging methods, ERCP (endoscopic retrograde cholangiopancreatography), and tissue biopsy results. Based on the type of extrahepatic biliary obstruction, either benign or malignant, the patients were divided into two groups. The HALP score was calculated by multiplying the patient’s albumin (g/L), hemoglobin (g/L), and lymphocyte count (/L) and dividing by the platelet count (/L).
RESULTS: In 121 of 216 patients, extrahepatic cholestasis was caused by benign factors, mostly choledocholithiasis, while malignant causes, predominantly pancreatic head cancer, were responsible for extrahepatic cholestasis in 95 patients. The malignant cholestasis group had significantly higher bilirubin levels (p<0.001), lower hemoglobin levels (p=0.005), lower albumin levels (p<0.001), higher lymphocyte counts (p<0.001), and higher platelet levels (p=0.001) compared to the benign cholestasis group. There was no considerable difference in the HALP score between the two groups, as indicated by a p-value of 0.741.
CONCLUSION: The HALP score could not distinguish between benign and malignant causes of extrahepatic cholestasis.

11. Determination of nutritional status and protein-energy wasting in patients with diabetic nephropathy
Elif Karakas, Hatice Colak, Fatma Esra Gunes, Berna Karakoyun
doi: 10.14744/nci.2023.66503  Pages 560 - 568
OBJECTIVE: This study aims to evaluate the nutritional status of patients with stage 3 and 4 diabetic nephropathy (DN; DN-3 and DN-4) and to explain the effect of DN stages on the prognosis of protein-energy wasting (PEW).
METHODS: Data from demographic characteristics, anthropometric measurements, biochemical findings, food consumption records, and the Subjective Global Assessment (SGA) screening tool of 49 patients (25 DN-3; 24 DN-4) who were followed at the nephrology department were collected. The criteria of the International Society of Renal Nutrition and Metabolism (ISRNM) were used to determine PEW.
RESULTS: 56% of DN-3 and 66.7% of DN-4 have been diagnosed with diabetes for over 15 years. The groups differed in total body weight, body-muscle weight, creatinine, microalbuminuria, and eGFR values (p<0.05). Protein (g/kg) intake was only different between the groups (p<0.05). 18.4% of patients had SGA-B score, and 26.5% had PEW.
CONCLUSION: Our study provides a general impression about the presence of PEW in DN patients not receiving dialysis in Turkiye. In patients with DN-3 and DN-4, daily energy and macronutrient intakes are adequate by recommendation. According to ISRNM criteria, the prevalence of PEW increased with advancing disease stage. PEW was observed to be more effective than SGA in assessing malnutrition.

12. Investigation of the presence of Epstein-Barr virus in patients who had Oral Lichen Planus and Oral Lichenoid Contact Lesions with Real-time PCR method in serum, tissue, and saliva samples
Alaeddin Oral, Mustafa Onel, Mehmet Demirci, Cem Baysal, Arat Hulikyan, Hayriye Kirkoyun Uysal, Ali Agacfidan, Sertan Ergun
doi: 10.14744/nci.2024.63239  Pages 569 - 574
OBJECTIVE: Oral Lichen Planus (OLP) is an immune system disease and its cause has not been fully determined yet. Oral Lichenoid Contact Lesions (OLCL) is an allergic condition known to develop because of dental materials. It is considered that some infectious agents (e.g., Epstein-Barr virus (EBV)) play roles in the etiology of OLP and OLCL. The purpose of the present study was to investigate the presence of EBV in different clinical samples of patients who had OLP and OLCL, to show its relationship with OLCL, and to determine its role in etiopathogenesis in these patients.
METHODS: Twenty (20) OLCL, twenty-three (23) OLP, and twenty (20) healthy volunteers who applied to Istanbul University Faculty of Dentistry, Oral and Maxillofacial Surgery were included in the study, regardless of gender. Biopsy samples were taken from patients who had a 5mm punch, including the mucosa containing the lesion along with saliva and blood samples, and all clinical samples were sent to the Department of Medical Microbiology Laboratory under appropriate storage conditions. After the isolation of the DNA from clinical samples, EBV DNA was analyzed on the Light Cycler 480 II device by using Real-time PCR (RT-PCR) tests. The evaluation of the statistical data of the results was made by using the SPSS program.
RESULTS: When the data were evaluated, EBV DNA positivity was detected in 13.04% of the patients who had OLP, 10% of the patients who had OLCL, and 5% of the individuals in the Control Group. In saliva samples, EBV DNA was found positive in 21.74% of individuals with OLP, 15% of individuals with OLCL, and 10% of individuals in the Control Group. In the biopsy samples, EBV DNA was detected positive in 21.74% of the OLP patients, 15% of the OLCL patients, and 10% of the Control Group individuals.
CONCLUSION: Based on the findings of the present study, no significant differences were observed in the presence of EBV DNA or the quantitative viral load between patients with OLP, OLCL, and the Control Group. However, the quantitative EBV DNA results varied depending on the type of clinical sample selected. We believe that comprehensive studies that will include a larger number of samples must be conducted to determine the role of EBV in OLP and OLCL.

CASE REPORT
13. Insulin autoimmune syndrome without hypoglycemia: A different perspective of method interference
Fatih Yesildal, Ahmad Kado, Ferruh Kemal Isman
doi: 10.14744/nci.2022.80034  Pages 575 - 578
Insulin autoimmune syndrome (IAS) is a serious autoimmune disorder that may cause spontaneous hypoglycemia. IAS is characterized by hyperinsulinemia, normal C-peptide levels and positive anti-insulin antibody. The diagnosis is confirmed by demonstrating the presence of macroinsulin complex by polyethylene glycol (PEG) precipitation or gel filtration chromatography. Although some macrohormones like macroprolactin and some macroenzymes such as macroamylase are seen commonly, macroinsulinemia is a rare condition. In this report, we presented an IAS case from laboratory perspective by using three different immunoassays with different performances in eliminating macroinsulin interference. Besides presenting a case with IAS without hypoglycemia we evaluated the contribution of different immunoassays to the diagnosis of this syndrome. Immunoassays have different features, considering the analysis of macroinsulin or bioavailable insulin. In this case, the superiority or handicap of these immunoassays will be discussed in terms of analysis of total or free insulin.

14. Intraperitoneal "golden yellow" in a pediatric patient with Burkitt lymphoma: Xanthogranulomatous appendicitis
Elbrus Zarbaliyev, Mustafa Okumus, Payam Hacisalihoglu
doi: 10.14744/nci.2022.78477  Pages 579 - 582
Xanthogranulomatous inflammation is a rare chronic inflammatory reaction. Appendiceal involvement in the pediatric age group is extremely rare. We present a case of xanthogranulomatous appendicitis (XGA) that was detected incidentally during the excision of a residual intraabdominal mass in an 8-year-old male patient who was treated for Burkitt lymphoma. An 8-year-old male patient who had been diagnosed with Burkitt lymphoma underwent abdominal computerized tomography for evaluation after chemotherapy. An approximately 2.5 cm mass in the right lower quadrant of the abdomen was detected, and laparoscopic excision of the mass was planned. During the operation, it was noticed that the appendix (adjacent to the mass) was golden yellow in color and abnormal in appearance, so a synchronous appendectomy was performed. The pathology result of the mass was compatible with Burkitt lymphoma. Microscopic examination of the appendix revealed that the columnar surface epithelium had eroded and been replaced by fibrin and cell debris. Inflammatory cell infiltration rich in foamy histiocytes as well as lymphocytes and sparse neutrophils that form destructive aggregates was observed in all appendiceal layers. The final diagnosis of the appendectomy specimen was compatible with XGA. In very few XGA cases, the appendix is described as bright yellow or golden yellow. The diagnosis is usually made by the pathological examination after surgery. Though the diagnosis was made postoperatively in our case, there is now, for the first time in the literature, a view of the golden yellow color of XGA taken from an intraoperative video clip.

15. Vena cava and renal vein thrombosis with pheochromocytoma: A case report
Ramazan Gundogdu, Kenan Caliskan, Ufuk Uylas, Nazim Emrah Kocer
doi: 10.14744/nci.2023.58997  Pages 583 - 585
Pheochromocytomas are potentially malignant and may manifest with vascular thrombi. We present the treatment of a patient with pheochromocytoma and tumor thrombosis of the renal vein and inferior vena cava. A thirty-eight-year-old male patient was admitted complaining of abdominal pain and headache. High levels of urinary catecholamine were detected. Magnetic resonance imaging revealed left pheochromocytoma with thrombosis of the inferior vena cava and the left renal vein. A left adrenalectomy and a thrombectomy with cavotomy were performed. The pathology results reported a 9.5 cm malignant pheochromocytoma. The patient’s symptoms dissipated after the operation and there were no signs of recurrence at the two-month follow-up. Preoperative radiological diagnostic examinations are valuable in the planning of pheochromocytoma surgery. We believe that adrenalectomy and thrombectomy can be performed on pheochromocytoma patients with vascular thrombi with low morbidity.

REVIEW
16. Advances in minimally invasive liver surgery
Hilmi Anil Dincer, Ahmet Bulent Dogrul
doi: 10.14744/nci.2024.42744  Pages 586 - 592
As in many surgical branches, minimally invasive methods are becoming increasingly prominent in hepatobiliary surgery. Nowadays, robotic and laparoscopic methods are among the hot topics in the current literature. Both laparoscopic and robotic surgery have better short-term results than open surgery in terms of the blood loss, need for blood transfusion, length of intensive care unit and hospital stay, and postoperative major complication rate. In addition to cosmetic benefits, minimally invasive methods have similar results to open surgery in terms of oncologic outcomes. Minimally invasive techniques for hepatocellular carcinoma, colorectal cancer liver metastasis and cholangiocarcinoma, which are the most common indications for surgery, also for donor and recipient surgeries in organ transplantation, can be safely applied in high-volume centers and by experienced surgeons. The use of robotic surgery is increasing especially in major hepatectomy operations. The main advantages of robotic surgery over laparoscopic surgery are less bleeding, less conversion rate and a shorter learning curve. However, there is a need for studies investigating the cost-effectiveness of robotic surgery, the production of devices such as robotic ultrasonographic dissectors, and the establishment of structured minimally invasive hepatobiliary surgery training programs. The aim of this review is to evaluate the recent findings and current evidence on minimally invasive hepatobiliary surgery.

17. Do we know about dynapenia?
Ridvan Sivritepe, Ozge Kiran Siyer, Serhat Mert Tiril, Sema Ucak Basat
doi: 10.14744/nci.2024.48642  Pages 593 - 599
Dynapenia is a condition characterized by decreased muscle strength and function in older adults that is not due to a specific underlying disease or medical condition. Dynapenia is common among older adults and has significant health effects, including functional impairment, disability, increased risk of falls, hospitalization, and death. Oxidative stress, mitochondrial dysfunction and chronic inflammation are involved in the etiopathophysiology of dynapenia. Diagnosis of dynapenia is based on the evaluation of muscle strength and function using methods such as hand grip strength, timed up and go test and short physical performance battery. Management of dynapenia involves a multifaceted approach that includes exercise, nutrition, pharmacological interventions, management of underlying medical conditions, and fall prevention strategies. With appropriate interventions, older adults with dynapenia can improve muscle strength and function, reduce the risk of falls and disability, and maintain their independence and quality of life.

LETTER TO THE EDITOR
18. Post-menopausal status in primary antiphospholipid syndrome is associated with low HDL-C levels
Jozélio Freire de Carvalho
doi: 10.14744/nci.2023.71363  Pages 600 - 603

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