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Öğe Delirium Caused by Hypercalcemia in Older Adults(Galenos Publ House, 2023) Yakaryilmaz, Funda Datli; Ozturk, Zeynel AbidinDelirium; can be described as a temporary and reversible brain dysfunction syndrome, which manifests itself primarily with physical, physiopathological and psychological disorders. The leading causes of delirium are pneumonia, cancer, urinary infection, electrolyte imbalance (hypo-hypernatremia, hypo-hypercalcemia, hypo-hypermagnesemia), dehydration, congestive heart failure, uremia and stroke. We present a 68-year-old male patient was admitted to the geriatric outpatient clinic with complaints of fatigue, abdominal pain, loss of appetite and weight loss that started about 4 weeks previously. His physical examination was conscious, awake, co-operative but time orientation was not complete. The delirium assessment scale (DAS) was used for delirium evaluation and MDAS 13/30 (delirium >11/30) was detected. At the end of the evaluation the patient was careless and deterioration was detected in the recall test of three items. During the first 48 hours of the treatment, the patient's serum calcium level regressed and the symptoms were controlled. Hyperparathyroidism, malignancy and long-lasting immobilization are the most common causes of hypercalcemia in the elderly. Neuropsychiatric symptoms due to hypercalcemia may occur initially with concentration and increase in sleep time. As the degree of hypercalcemia increases, depression, delirium, confusion and afterwards coma may develop. As described in our patient, acute onset of attention reduction and cognitive or sensory disturbances in the course of delirium are the main features of the fluctuating course. The cause of delirium in elderly patients is multifactorial, so pathologies that may cause delirium should be excluded individually. Delirium is multifactorial, causing serious problems for affected patients, family members, caregivers and healthcare providers. The general purpose of delirium treatment is therefore early diagnosis and treatment with a multidisciplinary approach, which are of great importance in appropriate cases with delirium.Öğe Evaluation of the Relationship Between Polypharmacy and Malnutrition in Diabetic Elderly(Galenos Publ House, 2022) Yakaryilmaz, Funda Datli; Eraydin, AytenAim: Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases in older adults. With advancing age, polypharmacy and proteinenergy malnutrition associated with chronic diseases can be seen frequently in T2DM patients due to metabolic causes and may adversely affect the prognosis. In this study, it was aimed to evaluate the relationship between polypharmacy and malnutrition in T2DM patients. Materials and Methods: Three hundred and twenty-one patients aged 65 years and over, diagnosed with T2DM and receiving oral anti-diabetic drug therapy, who applied to the Internal Medicine and Geriatrics outpatient clinic between February and November 2021, were included in the study. The data of the patients were obtained retrospectively from their medical files. The use of 5 or more drugs was considered as polypharmacy. Mini Nutritional Assessment-short form (MNA-SF) was used for nutritional status assessment. Results: The median number of concomitant medications used in patients followed up with the diagnosis of T2DM was 5. Polypharmacy was found in 209 (65.1%) patients, and severe polypharmacy was found in 21 (6.5%) patients. Malnutrition was found in 43 (20.6%) patients with polypharmacy, while 17 (80.1%) of 21 patients with severe polypharmacy had malnutrition. A positive correlation was found between the number of drugs and HbA1c, and a negative correlation with the MNA-SF score (r=0.792, p<0.001, r=-0.317, p<0.001, respectively). According to the logistic regression analysis, the presence of HbA1c and polypharmacy were found to be effective factors in the development of malnutrition (p=0.009, p=0.002). Conclusion: Current findings show that polypharmacy is quite common in elderly T2DM patients and often accompanies malnutrition. It is important to review the drugs used in each visit and to evaluate malnutrition that may be related to newly started or currently used drugs so that intertwined polypharmacy and malnutrition are not overlooked in elderly patients.Öğe Geriatric Nutrition Risk and Creatinine Indexes in Estimating the Nourishment Situation of Elderly Hemodialysis Patients(Mattioli 1885, 2022) Yakaryilmaz, Funda Datli; Pembegul, Irem; Kara, MuratObjective: Malnutrition is a common complication in hemodialysis (HD) patients, although it cannot be evaluated adequately due to the limitations of available malnutrition screening tools. The aim of our study is to evaluate the relationship between Mini nutritional Assesment-Short Form (MNA-SF) and objective malnutrition tool Geriatric Nutritional Risk Index (GNRI) and Creatinine Index (CI) in HD patients. Methods: This is a cross-sectional study of 129 patients aged 65 years and older (female=61 (47.3%) and male=68 (52.7%), 68.88 ?? 7.24 years) receiving maintenance HD therapy. Malnutrition was diagnosed with MNA-SF. GNRI and CI were calculated using existing formulas. Results: Of the participants, 26 (20.15%) were diagnosed with severe malnutrition, 25 patients (19.4%) were at risk of malnutrition and 78 (60.45%) were diagnosed with normal nutritional status. The optimal cut-off value for GNRI <95 was determined in predicting malnutrition with GNRI, sensitivity and specificity 85.4% and 88.6%, respectively. CI (< 20) was not found effective in determining malnutrition patients due to its low sensitivity and specificity (sensitivity and specificity of 35.9% and 45.0%, respectively). GNRI (<95) is a better predictor of malnutrition screening than CI (<20). Conclusions: In the evaluation of undernourished elderly HD patients, GNRI was as effective as MNA-SF, but CI was insufficient in detecting malnutrition individuals.Öğe Lercanidipine-induced Chyloperitoneum in a Geriatric Patient with Peritoneal Dialysis(Galenos Publ House, 2023) Pembegul, Irem; Yakaryilmaz, Funda Datli; Balseven, OzgulPeritoneal dialysis is one of the renal replacement therapy modality for patients with end-stage renal disease. Hypertension is a common comorbidity in these patients and calcium channel blockers are the most commonly prescribed drugs. Chyloperitoneum is a non-infectious cause of cloudy peritoneal effluent. Lercanidipine is a lipophilic, third generation calcium channel blocker and a widely used antihypertensive agent. Herein, we presented a case of geriatric peritoneal dialysis patient admitted to hospital cloudy effluent after the use of lercanidipine for hypertension. The peritoneal effluent returned to normal after after the cessation of lercanidipine.Öğe The Relationship of Cognitive Performance with Oxidative Stress in Alzheimer's Disease(Taiwan Soc Geriatric Emergency & Critical Care Medicine-Tsgecm, 2022) Yakaryilmaz, Funda Datli; Ozturk, Zeynel Abidin; Ulusal, Hasan; Tarakicoglu, MehmetAims: Alzheimer's disease (AD) has a complex neurodegenerative etiology and pathogenesis. In addition to oxidative stress, inflammation also plays an important role in the development of AD. In this study, we aimed to determine the total antioxidant status (TAS), total oxidation status (TOS) and oxidative stress index (OSI) levels in AD patients. We also planned to evaluate the relationship of OSI with interleukin-1 beta (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha). Methods: A total of 33 subjects with AD (mean age 78.9 +/- 7.8) and 33 subjects as control (mean age 72.3 +/- 2.6) were enrolled in this cross-sectional study. TAS and TOS were assessed with commercial kits using an autoanalyzer. TNF-alpha and IL-1 beta were measured with commercial ELISA kits. Results: The AD group demonstrated significantly higher TNF-alpha, IL-1 beta, and TOS levels compared to the control group (p = 0.001, p = 0.029, p = 0.005). The mean TAS level was significantly lower in the AD group than in the control group (p = 0.007). There was a statistically significant negative correlation between TNF-alpha and ADL, IADL, MMSE (p = 0.001, p =0.003, p = 0.003). There was a statistically significant negative correlation between IL-1 beta and AIDL, as well as a positive correlation between IL-1 beta and GDS (p = 0.029, p = 0.016). Conclusion: Our study contributes to the understanding of the situation by showing that the oxidative balance is impaired in favor of oxidants in AD. A negative correlation was found between functional capacity and TNF-alpha and IL-1 beta levels in AD patients. Different therapeutic interventions that reduce the oxidant load can be considered in the treatment of AD. Copyright (C) 2022, Taiwan Society of Geriatric Emergency & Critical Care Medicine.
