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Background:The aim of this study is to identify cutoff values for muscle ultrasound (US) to be used in Global Leadership Initiative on Malnutrition (GLIM) criteria, and to define the effect of reduced muscle mass assessment on malnutrition prevalence at hospital admission.Methods: A total of 118 inpatients were enrolled in this cross-sectional study. Six different muscles were evaluated by US. Following defining thresholds for muscle US to predict low muscle mass measured by bioelectrical impedance analysis, malnutrition was diagnosed by GLIM criteria with seven approaches, including calf circumference, mid-upper arm circumference (MAC), handgrip strength (HGS), skeletal muscle index (SMI), rectus femoris (RF) muscle thickness, and cross-sectional area (CSA) in addition to without using the reduced muscle mass criterion. Results:The median age of patients was 64 (18-93) years, 55.9% were female. RF muscle thickness had moderate positive correlations with both HGS (r = 0.572) and SMI (r = 0.405). RF CSA had moderate correlation with HGS (r = 0.567) and low correlation with SMI (r = 0.389). The cutoff thresholds were 11.3 mm (area under the curve [AUC] = 0.835) and 17 mm (AUC = 0.737) for RF muscle thickness and 4 cmš (AUC = 0.937) and 7.2 cmš (AUC = 0.755) for RF CSA in females and males, respectively. Without using the reduced muscle mass criterion, malnutrition prevalence was 46.6%; otherwise, it ranged from 47.5% (using MAC) to 65.2% (using HGS). Conclusions:Muscle US may be used in GLIM criteria. However, muscle US needs a standard measurement technique and specific cutoff values in future studies.

Background and Aim: This study aimed to determine the presence of concomitant extrahepatic autoimmune disease (EAD) in patients with autoimmune liver disease (ALD) and the efficacy of the treatment response of ALD with the presence of any EAD. Materials and Methods:Between January 2001 and November 2017, 241 patients with ALD were included in the study. Results:Of the 241 patients, 88, 134, and 19 had autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and overlap syndrome (OS), respectively. Thirty-one patients had cirrhosis: 77% and 23% had compensated and decompensated disease, respectively. The presence of at least one EAD was defined in 38.6% of the patients with ALD (n=93), and 12% of them had ≥1 EAD. EAD was most commonly seen in patients with OS and PBC compared with those with AIH (p=0.036). Autoimmune thyroid disease was the most common association (20%), followed by Sjogren syndrome (12.0%). At the end of the follow-up period, 165 patients (72%) had biochemical response. The presence of EAD did not affect the biochemical response. Conclusion:EAD is most frequently seen in patients with ALD. The presence of EAD is not associated with the treatment response.

Background:The most important disadvantage of surgical mask usage is that it can aversely affect communication. This study aimed to evaluate the possible effects of face masks on the cognitive test performance of older adults. Methods: A total of 198 geriatric patients were enrolled after applying the exclusion criteria. Within the comprehensive geriatric assessment (CGA), cognitive status assessment was performed with the Mini-Mental State Examination test (MMSE) and Quick Mild Cognitive Impairment Screening test (Q-MCI) tests. Results: The median age was 70 (66-77) years, and there were 119 female (60.7%) patients. Patients were divided into normal cognitive status (NC), mild cognitive impairment (MCI), and probable Alzheimer's disease (AD) groups. There were 129 (65.2%), 30 (15.2%), and 37 (18.7%) patients in each group, respectively. For differentiating MCI from NC, calculated optimal cut-offs for the Q-MCI and MMSE total scores were ≤50 (sensitivity 83.3%, specificity 90.7%) and ≤26 (sensitivity 63.3%, specificity 87.5%), respectively. For differentiating AD from MCI, calculated optimal cut-offs for the Q-MCI and MMSE total scores were ≤28 (sensitivity 76.8%, specificity 86.7%), and ≤24 (sensitivity 94.4%, specificity 64.5%), respectively. Conclusion: Our results revealed that screening tests are still sensitive in discriminating cognitive disorders although cut-offs are lower with mask usage than for previously validated cut-offs. This is the first study revealing the impact of surgical mask usage on cognitive test performance, indicating that cut-offs validated before the pandemic may cause overdiagnosing of cognitive disorders since the previous cut-offs are not validated for mask usage. Large sample studies are needed to determine new cut-offs validated with mask usage.

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The current study aimed to screen for delirium in hospitalized older adults and assess the validity of the Turkish version of the 4A's Test (4AT-TR) as a feasible tool to integrate in routine patient care. The point prevalence of delirium according to clinical evaluation in routine practice was detected among all patients aged ≥60 years in 12 pilot wards. Delirium screening was then conducted by two arms: (a) nurses using the 4AT-TR and (b) geriatricians according to Diagnostic and Statistical Manual of Mental Disorders, 5th edition ( DSM-5 ) criteria. Prevalence of delirium according to clinical impression was 3.3% ( n = 4), whereas prevalence was 12.4% ( n = 17) according to DSM-5 criteria and 13.8% ( n = 17) according to the 4AT-TR. The 4AT-TR performed by nurses had a sensitivity of 66.6% and specificity of 93.5%. Area under the receiver operating characteristic curve for delirium diagnosis was 0.819 ( p < 0.001). Most delirium cases remain undetected unless a routine and formal delirium assessment is integrated in hospital care of high-risk patients. The 4AT-TR performed by nurses seems to be a valid tool for determining delirium in hospitalized older adults. [ Journal of Gerontological Nursing, 48 (8), 43–51.]

Background and Aims This study aimed to investigate the potential role of shear‐wave elastography (SWE) in evaluating muscle quality and assess its association with muscle strength and mass. Methods A total of 129 patients aged 18–87 years were included. Patients aged >65 years underwent comprehensive geriatric assessment. Anthropometric measurements, assessment of physical performance, muscle strength (handgrip strength [HGS]), muscle mass (B‐mode muscle ultrasonography), and muscle quality (identified via SWE) were performed for all patients. Results The median (interquartile range) age of participants was 69 (59–76) years and 62% (n = 80) were female. According to HGS, patients were divided into normal and low HGS groups, and there were 85 (65.9%) and 44 (34.1%) patients in each group, respectively. The median average value of SWE measurement (Vmean) of the rectus femoris (RF) in passive stretching was significantly lower in the low HGS group. In regression analyses, Vmean was significantly associated with HGS independently of age, sex, and body mass index. Optimal cutoff values of the Vmean value (m/s) of RF in passive stretching for predicting low HGS were ≤2.62 for male (area under the curve [AUC], 0.882; 95% CI, 0.705–0.938; P = <0.0001), and ≤2.52 for female (AUC, 0.719; 95% CI, 0.605–0.833; P = 0.002). Conclusion To the best of our knowledge, this is the first study revealing SWE is a good predictor of muscle strength, and it could be a useful tool for evaluating muscle quality in clinical practice. Further randomized controlled studies are needed to confirm the presented cutoff values.