Aim: Lactate dehydrogenase (LDH) is a marker of cellular damage, increasingly recognized for its prognostic value in stroke. However, its role in differentiating stroke types and in predicting outcomes remains incompletely defined. Materials and Methods: In this retrospective, single-center study, 1,299 patients [1,185 acute ischemic stroke (AIS), 114 intracerebral hemorrhages (ICHs)] between 2018 and 2023 were analyzed. Admission and first-week LDH levels were compared across stroke types, etiologies, and outcomes. Functional status was assessed using the 3-month modified Rankin Scale (mRS). Multivariate stepwise linear regression was applied to determine factors independently associated with admission LDH. Results: Mean admission LDH was 329.3±176.1 U/L in AIS and 342.4±174.9 U/L in ICH (p=0.45). First-week LDH levels were 276.2±148.1 U/L in AIS and 300.1±123 U/L in ICH (p=0.19). In AIS, higher admission LDH levels were associated with unfavorable outcomes (mRS 3-6; p=0.002) and were significantly elevated in total anterior circulation infarcts (total anterior circulation infarction: 354.1±165 U/L) compared to lacunar infarcts (lacunar infarction: 312.1±141 U/L; p=0.077). First-week LDH levels were significantly higher in cardioembolic strokes compared with large-artery atherosclerosis (cholesteryl ester: 302 U/L vs. LAA: 248 U/L; p=0.006). In ICH, higher first-week LDH levels were associated with unfavorable outcomes, particularly in deep hematomas. In multivariate analysis, chronic kidney disease (B=63.1, p=0.017), female sex (B=47.9, p=0.004), and unfavorable outcome (B=58.4, p=0.008) were independently associated with elevated admission LDH. Conclusion: LDH levels alone do not distinguish between AIS and ICH, but higher admission values and sustained elevation are associated with poorer 3-month functional outcome, especially in ischemic stroke subtypes with larger infarcts or cardioembolic origin, and in deep ICH. LDH may be a marker that contributes to early risk stratification, yet the retrospective single-center design, small hemorrhagic subgroup, and exploratory multiple comparisons mean that these findings should be interpreted with caution and confirmed in prospective studies.
Aim: This school-based cross-sectional study aimed to determine the proportion of school-age children who screened positive for asthma- and allergy-related symptoms and to identify associated child- and parent-level factors. Materials and Methods: This cross-sectional study was conducted among children attending grades 2-7 at a single school in İstanbul. Data were collected using a structured Child and Parent Information Form and the School-Based Asthma and Allergy Screening Questionnaire (SBASQ), which comprises a parent/caregiver questionnaire (PQ) and a student questionnaire (SQ). SBASQ cut-off scores were used to identify screening-positive results for asthma- and allergy-related symptoms. A total of 379 children with complete questionnaires were included in the analysis. Results: The mean age of participants was 10.09±1.97 (7-14) years, and 62.8% were aged 7-10 years. Based on the PQ, 27.7% of children screened positive for asthma-related symptoms and 68.1% for allergy-related symptoms; corresponding proportions based on the SQ were 25.3% and 63.6%, respectively. Antibiotic use during the first year of life and a history of respiratory disease before the age of two years were significantly associated with higher screening-positive rates for both asthma- and allergy-related symptoms across both PQ and SQ analyses (p<0.05 for all comparisons). Positive screening for asthma-related symptoms according to the PQ was more frequent among boys (p=0.041), children with low birth weight (p=0.035), and those with a history of hospitalization due to pneumonia (p=0.018). For allergy-related symptoms, positive screening according to the PQ was significantly associated with maternal asthma/allergy (p=0.012) and frequent consumption of packaged/processed foods (p=0.017). Conclusion: This study demonstrated that a substantial proportion of school-age children screened positive for asthma- and allergy-related symptoms. Several child- and parent-level characteristics were associated with positive screening results. These findings suggest that symptom-based school screening may help identify children who could benefit from further clinical evaluation, without implying a clinical diagnosis.
Aim: Malnutrition remains a major global health challenge, particularly among older adults, where it contributes to frailty, sarcopenia, and chronic diseases. The Global Leadership Initiative on Malnutrition (GLIM) provides standardized diagnostic criteria to improve early detection. This study aimed to determine the prevalence of malnutrition among community-dwelling older adults using the GLIM criteria and to compare its diagnostic agreement with Mini Nutritional Assessment (MNA) and Geriatric Nutritional Risk index (GNRI). Materials and Methods: This cross-sectional study included 251 older adults aged 65 years or older from a university hospital’s geriatric outpatient clinic. Nutritional status was assessed using GLIM, MNA, and GNRI. Anthropometric measures, body composition (as determined by bioelectrical impedance analysis), handgrip strength, and laboratory markers were evaluated. Cognitive and functional assessments were also conducted. Concordance among tools was analyzed using kappa statistics. Results: According to GLIM, 51.2% of participants were malnourished, compared to 42.4% with MNA and 7.1% with GNRI. GLIM identified malnutrition in 12.8% of patients with normal body mass index. Agreement between GLIM and MNA was moderate (p<0.001), while agreement between GLIM and GNRI was weak (p=0.001). Malnutrition was significantly associated with advanced age, female sex, cognitive impairment, and lower physical performance. GLIM showed greater sensitivity in identifying malnutrition and its clinical correlates. Conclusion: GLIM criteria are more sensitive in detecting malnutrition compared to MNA and GNRI, particularly in identifying individuals with subtle nutritional deficits. A multidimensional approach integrating GLIM with cognitive, functional, and body composition assessments is essential for early diagnosis and prevention in geriatric populations.
Pulmonary alveolar microlithiasis (PAM) is an extremely rare autosomal recessive disorder caused by SLC34A2 mutations, leading to intra‑alveolar calcium‑phosphate microlith accumulation. To date, lung ultrasound (LUS) findings in PAM have been reported in only a single case report. We present a 35‑year‑old male with genetically confirmed stage III PAM who presented with acute hypoxemic respiratory failure. Bedside LUS revealed marked pleural irregularity and thickening (total 5.6 mm; parietal 4.4 mm, visceral 1.2 mm) and complete absence of B‑lines despite extensive ground‑glass opacities on computed tomography. Diaphragmatic ultrasound showed a thickening fraction of 31.5%, indicating preserved contractile reserve. Arterial blood gas on room air (PaO2 48 mmHg), normal infection markers, negative D‑dimer (0.3 µg/mL), and echocardiography showing no acute right heart strain effectively excluded alternative causes of acute hypoxemia. The absence of B‑lines may be attributed to an acoustic barrier created by subpleural microliths and microcysts. Preserved diaphragmatic function suggests that hypoxemia arose from gas‑exchange impairment rather than ventilatory pump failure. Given its extreme rarity, this second ever description of LUS in PAM confirms that bedside ultrasound may serve as a radiation‑free monitoring tool in this orphan disease.
Aim: Inability to perform the Five-Times Chair Stand test is frequently observed in very old adults but is often excluded from analyses, leading to an underestimation of advanced geriatric vulnerability. This study aimed to investigate whether inability to perform the Chair Stand test represents a clinically meaningful high-risk functional phenotype and to compare the associations of clinical and biochemical nutritional indices with this phenotype. Materials and Methods: This retrospective cross-sectional study included 417 geriatric outpatients who underwent comprehensive geriatric assessment. Chair Stand performance was categorized as ≤15 s, >15 s, or unable to perform. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF), prognostic nutritional index (PNI), and controlling nutritional status (CONUT). Associations with frailty, functional dependence, and physical performance were examined using correlation analyses and multivariable logistic regression. Results: Overall, 39.1% of participants were unable to perform the Chair Stand test. These individuals had significantly higher frailty and activities of daily living/instrumental activities of daily living dependency rates and poorer nutritional status. In adjusted models, higher MNA-SF and PNI scores were independently associated with lower odds of inability to perform the test, whereas CONUT was not. Conclusion: Inability to perform the Chair Stand test reflects a distinct state of advanced functional vulnerability closely linked to frailty and nutritional impairment. Inability to perform the Chair Stand test identifies a clinically relevant high-risk geriatric phenotype and should be recognized as an integral component of geriatric assessment rather than excluded from analyses.
