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Background: Sarcopenic obesity (SO) is the coexistence of sarcopenia and obesity in an individual. The present study is designed to define the usefulness of skeletal muscle ultrasonography (US) in the definition of SO. Methods: Eighty-nine participants aged ≥65 whose body mass index (BMI, kg/m 2) was ≥30 were consecutively enrolled in an outpatient clinic of geriatric medicine. All underwent comprehensive geriatric assessment. US measurements were obtained in 6 different muscles consisting of core and limb muscles. We defined SO as the presence of low muscle function (defined by a handgrip strength < 27 kg in males and <16 kg in females) and high BMI (≥30). Results: The median age of the participants was 72 (65-85) years; 81% were female, and 35% (n = 31) had SO. Anthropometric parameters that estimate muscle mass were lower in the sarcopenic group, but estimations of muscle mass with bioelectrical impedance analysis (BIA) did not differ between groups. All US estimations of muscle mass were lower in sarcopenic obese participants, albeit not all significantly. RF muscle cross-sectional area (RF CSA) and abdominal subcutaneous fat thickness were most strongly correlated with grip strength (r = 0.477 and r = −508, respectively). Receiver operating characteristic analysis suggested that the optimum cutoff point of RF CSA for SO was ≤5.22 cm 2 , with 95.8% sensitivity and 46.7% specificity (area under the curve: 0.686). Conclusions: US evaluation of muscle mass may be more accurate than BIA-derived skeletal muscle index assessment for the diagnosis of SO.

Background Diagnostic accuracy of fine‐needle aspiration cytology (FNAC) in large and subcentimeter nodules is still debated. We aimed to evaluate the impact of nodule size on efficacy of the ultrasound‐guided FNAC. Methods B‐mode grayscale ultrasound (US), US‐guided FNAC according to Bethesda system and histopathological data of 514 nodules from 371 patients, who underwent thyroidectomy were examined retrospectively. Nodules were grouped by maximal diameter; group A nodules were smaller than 10 mm (n = 59), group B nodules were between 10 and 29 mm (n = 218), and group C nodules were 30 mm or greater (n = 130). Results Sensitivity, specificity, and accuracy of FNAC was 92.0%, 100%, and 95.1% in group A, 80.7%, 99.1%, and %92.9 in group B, 70.0%, 98.9%, and 95.8% in group C nodules, respectively. The prevalence of papillary thyroid cancer (PTC) and incidental PTC were 44.2% (n = 164) and 6.4% (n = 24), respectively. Malignancy rate was more frequent in group A when compared to groups B and C (P < 0.01). Nodule size was positively associated with follicular cancer risk (P = 0.009). The thyroid stimulating hormone level was positively associated with malignancy (P = 0.02) and optimal cut‐off value was 0.96 mIU/L. False‐negative rate was 8.0%, 19.3%, and 30.0% in groups A, B, and C nodules, respectively. Conclusions Although the malignancy rate was low in nodules ≥30 mm, diagnostic surgery for large nodules should be considered because of decreased reliability of FNAC, ineffectiveness of clinical and sonographic criteria. False‐negative rate was relatively low and malignancy rate was high in subcentimeter nodules, supporting the accuracy of FNAC.

Background: Cutoff values of cognitive screen tests vary according to age and educational levels. Objective: The objective of this study was to compare the accuracy and determine cutoffs for 3 short cognitive screening instruments: the Mini-Mental State Examination, Montreal Cognitive Assessment (MoCA), and Quick Mild Cognitive Impairment Screen-Turkish version (Qmci-TR), in older adults with low literacy in Turkey. Methods: In all 321 patients, 133 with subjective cognitive complaints (SCC), 88 amnestic-type mild cognitive impairment (aMCI), and 100 with probable Alzheimer disease (AD) with a median of 5 years education were included. Education and age-specific cutoffs were determined. Results: For the overall population, the Qmci-TR was more accurate than the MoCA in distinguishing between aMCI and AD (area under the curve=0.83 vs. 0.76, P=0.004) and the Qmci-TR and Mini-Mental State Examination were superior to the MoCA in discriminating SCC from aMCI and AD. All instruments had similar accuracy among those with low literacy (primary school and lower educational level or illiterate). Conclusions: To distinguish between SCC, aMCI, and AD in a sample of older Turkish adults, the Qmci-TR may be preferable. In very low literacy, the choice of the instrument appears less important.

Background/aim: Sleep disorders and frailty increase with advancing age, along with physical disabilities, cognitive dysfunction, mood disorders, and social vulnerability. Thus, the study objective was to evaluate the relationship between frailty and sleep quality in the oldest old patients. Materials and methods: One hundred patients aged ≥ 80 years were included and assessed using comprehensive geriatric assessment (CGA) including basic activities of daily living (ADL), instrumental ADL, handgrip strength, geriatric depression scale-15, mini-mental state examination, and mini-nutritional assessment-short form. The patients' sleep quality and frailty status were evaluated using the Pittsburgh sleep quality index (PSQI) and Fried frailty index, respectively. Results: The median age of the participants was 84 years (80-92); 55% of them were women, and 41% of them were frail. There was no statistically significant difference between frail and non-frail groups in terms of age, gender, and co-morbidities (p-value > 0.050). Frail patients scored poorly according to the CGA tests when compared to the non-frail ones (p-value <0.050). The median score for the PSQI was significantly higher in the frail group 12 points (3-19) versus 6 points (1-19) in non-frail patients (p-value < 0.001). The PSQI score (odds ratio [OR] of 1.308, 95% confidence interval [CI]: 1.092-1.566, p-value = 0.004), female gender (OR of 5.489, 95% CI: 1.063-28.337; p-value = 0.042), and basic ADL score (OR of 0.383; 95% CI: 0.207-0.706; p-value = 0.002) were found to be independently associated with frailty using multivariate analysis. 2 Conclusion: Sleep quality was significantly decreased in the oldest old frail patients compared to non-frail ones, and poor sleep quality was independently associated with frailty. Evaluating the sleep patterns of the oldest old patients with CGA in daily geriatric practice might help to improve the quality of life of frail patients.

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See the Reply by https://doi.org/10.1111/jgs.15805.