Clinical challenges in elderly asthma Introduction: Understanding the difference of elderly asthma is essential to provide better healthcare for this vulnerable population. The aim of this study was to evaluate the differences between young and elderly asthma patients. Materials and Methods: This real-life study was designed as a cross-sectional analysis. All data collected with structured web based asthma program. In sum, 373 (89.9%) young asthma (YA, age < 65) and 42 (10.1%) elderly asthma (EA, age ≥ 65) patients followed at least one year and compared statistically. results: Cough is found higher in EA (p< 0.01) despite lower smoking rate in EA (p< 0.001). Allergic rhinitis and allergic conjunctivitis were more common in YA (p< 0.05, p< 0.01) which is consistent with higher allergy rate in YA (p< 0.05). On the other hand, diabetes and hypertension were determined significantly higher in EA (p< 0.01, p< 0.01). 52.4% of EA patients were found to have low diffusion capacity (DLCO < 80%). Although EA patients use combined therapies with inhaled corticosteroids and long acting beta agonists more than YA patients (p< 0.01), both emergency room visit (ERV) and hospitalization ratios are founded significantly higher in EA (p< 0.001, p< 0.001). Conclusion: EA patients were presented with cough in general. They possess an increased risk of hypertension, diabetes and low levels of diffusion capacity. ERV and hospitalization ratios have founded higher despite higher usage of combined therapies.

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Aim:The relationship between various clinical scoring systems and clinical outcomes has been evaluated in the emergency department and intensive care unit. This study aimed to evaluate the capacity of the Acute Physiology and Chronic Health Evaluation (APACHE II) score and the Modified Early Warning Score (MEWS) in predicting the mortality of patients admitted to the intensive care unit. Material and Methods:All patients (aged >18 years) admitted to the intensive care unit between September 1, 2017 and December 31, 2018 were included in this study. Laboratory data and vital signs at the time of hospitalization were used to calculate the MEWS and APACHE II scores. The primary goal of the study was to evaluate the relationship between these scoring systems and mortality. Results:In total, 665 patients were included in the study. The mortality rate was 34.2%. The area under the receiver operating characteristic curve for the APACHE II score was 0.783, whereas that for the MEWS was 0.924 (95% confidence interval: 0.750-0.814 vs 0.901-0.943, respectively, p = 0.0001 for both). The APACHE II score cutoff value for mortality was 18, whereas that for the MEWS was 5 (sensitivity: 87.89% vs 88.99%, 95% confidence interval: 68.7-80.4 vs 84.2-92.7; specificity: 68.49% vs 83.33%, 95% confidence interval: 63.9-72.8 vs 79.5-86.7). Conclusion:Although the MEWS was superior to the APACHE II score, both systems were significantly effective in predicting mortality. ÖZ Amaç: Çeşitli klinik skorlama sistemlerinin acil serviste ve yoğun bakım ünitesinde (YBÜ) klinik sonuçlarla ilişkisi değerlendirilmiştir. Çalışmamızda YBÜ'ye yatan hastalarda ''Akut Fizyolojik ve Kronik Sağlık Değerlendirme'' (APACHE II) ve ''Modifiye Erken Uyarı Skor'' (MEWS) skorlarının mortaliteyi değerlendirmedeki kapasitelerinin ortaya konması planlandı. Gereç ve Yöntemler: Çalışmamıza 1 Eylül 2017 ile 31 Aralık 2018 tarihleri arasında YBÜ'ye yatan tüm hastalar (>18 yaş) dahil edildi. APACHE II ve MEWS skorlarını hesaplamak için yatış anında laboratuvar ve vital bulgular kullanıldı. Çalışmanın ana amacı skorlama sistemleri ile mortalite ilişkisinin değerlendirilmesiydi.Bulgular: Çalışmaya 665 hasta dahil edildi. Yatan hastaların mortalitesi %34,2 olarak bulundu. APACHE II için ROC eğrisi altındaki alan 0,783'tü. (%95 güven aralığı (GA): 0,750-0,814, p = 0,0001). Mortalite için APACHE II skoru eşik değeri 18 (duyarlılık: %87,89, %95 GA: 68,7 -80,4 ve özgüllük: %6849, %95 GA: 63,8). MEWS skoru için ROC eğrisi altındaki alan 0,924'tü. (%95 GA =0,901-0,943, p = 0,0001). Mortalite için MEWS skoru eşik değeri 5 (duyarlılık: %88,99, %95 GA:84,2-92,7 ve özgüllük: %83,33, %95 GA:79,5-86,7) olarak bulundu.Sonuç: Çalışmamızda MEWS skoru APACHE II skoruna daha üstün olmakla birlikte her ikisinin de mortalite tahmininde anlamlı olduğu tespit edildi.

Sarcopenia is defined as decreased muscle mass, muscle strength and physical performance. In geriatric patients, secondary sarcopenia may also develop due to underlying diseases in addition to the known primary sarcopenia. Computed tomography and magnetic resonance imaging are the gold standard to calculate skeletal muscle index in the diagnosis of sarcopenia. The diagnostic approach is easier in mobilized, outpatient and hospitalized patient. However, it is difficult to perform a gold standard computed tomography and magnetic resonance imaging for the diagnosis of sarcopenia and evaluate muscle strength and physical performance in patients who cannot be mobilized and stay in the intensive care unit. In this case report, we aimed to present the case in order to raise the awareness of clinicians considering the difficulty of application of diagnostic criteria of secondary sarcopenia in the course of prolonged intensive care unit hospitalization and difficulty of performing computed tomography and the lack of consensus on prevention and treatment of sarcopenia.