Background/Objectives: Metabolic dysregulation has emerged as a potential modifier of disease activity and disability in multiple sclerosis (MS). However, the relationship between glycemic status and clinical outcomes in patients with MS remains incompletely understood. This study aimed to investigate the associations of glycemic regulation with disease severity, relapse activity, inflammatory markers, and metabolic characteristics in patients with MS. Methods: In this retrospective single-center observational study, 455 patients with MS aged 18–65 years were included. Patients were categorized into normoglycemia (n = 241), prediabetes (n = 98), and diabetes (n = 116) according to American Diabetes Association criteria and documented diabetes diagnosis. Demographic characteristics, Expanded Disability Status Scale (EDSS) scores, annualized relapse rate (ARR), disease-modifying therapy (DMT), hematological indices, inflammatory markers, and metabolic parameters were retrieved from electronic medical records. Associations between glycemic status and clinical outcomes were evaluated using group comparisons, Spearman correlation analyses, and multivariable linear regression models. Results: Significant differences were observed among glycemic groups for age, disease duration, EDSS score, ARR, MS phenotype, platelet count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), lipid parameters, estimated glomerular filtration rate, alanine aminotransferase, gamma-glutamyl transferase, triglyceride–glucose (TyG) index, and atherogenic index of plasma (all p < 0.05). HbA1c, FPG, TyG index, lipid parameters, CRP, and ESR were positively correlated with EDSS scores (all p < 0.05). In contrast, these markers showed inverse correlations with ARR. However, after adjustment for demographic and clinical variables, including age, sex, disease duration, MS phenotype, and disease-modifying therapy (DMT), neither prediabetes nor diabetes remained independently associated with disability, as measured by the EDSS score, or with ARR. Progressive MS phenotype, older age, and longer disease duration were independently associated with higher disability, whereas age, disease duration, and progressive phenotype were independently associated with lower ARR. Conclusions: Impaired glycemic status is associated with greater disability, unfavorable metabolic profiles, and increased systemic inflammation in patients with MS. Nevertheless, glycemic status was not independently associated with disability or relapse activity after adjustment for major clinical confounders. These findings suggest that metabolic dysregulation accompanies more severe clinical characteristics but may not independently drive disease progression in MS.

The Global Emergency and Critical Care is a peer-reviewed, open-access scientific journal of the Turkish Emergency Medicine Foundation, publishing high-quality research in emergency medicine and related fields. The journal is published quarterly in March, June, September, and December. Objective: The aim of this study was to evaluate the post-treatment change in base excess (ΔBE) in diabetic ketoacidosis (DKA) and to assess how both the magnitude of correction an...

Objective: Nutritional support products should preferably be administered orally whenever possible, with rare exceptions, one of which is gastrointestinal bleeding. In our study, we examined the effects of parenteral nutrition support, which we have recently introduced in the treatment of patients with gastrointestinal bleeding, on the hospitalization duration and mortality-morbidity of these patients. Methods: We analyzed the patients admitted to the Internal Medicine Service with non-variceal upper gastrointestinal bleeding in our study. Patients were retrospectively analyzed in two groups, based on the years in which total parenteral nutrition (TPN) was initiated (2016-2017) and not initiated (2012-2013). Hospitalization durations and discharge methods were compared between the two groups. Results: Our study included a total of 369 cases after screening and application of our exclusion criteria. 35.5% of these cases received TPN, while 64.5% did not. When evaluated based on the TPN administration status after stabilizing the Rockall score of the patients, as well as considering the need for erythrocyte suspension (ES), fresh frozen plasma (FFP) replacement, and length of hospital stay, the length of hospital stay was significantly longer in those receiving TPN compared to those who did not. Conclusion: Although TPN may be the preferred choice in patients with upper gastrointestinal bleeding for whom oral nutrition is not suitable, our study suggests that this preference not only does not lead to a reduction in the number of blood and blood product replacements but also prolongs the hospital stay. While it is believed that complications of nutritional support with TPN may contribute to this result, our retrospective study did not provide data on this. Comprehensive prospective studies are needed on this issue.

Aim: Malnutrition and inflammation are critical factors affecting the duration of hospitalization. Although the Nutritional Risk Screening 2002 (NRS-2002) is widely recommended for nutritional assessment, its predictive value for length of stay (LOS) remains controversial. The C-reactive protein to albumin ratio (CAR) has emerged as an objective inflammatory-nutritional marker. This study aimed to compare the prognostic performance of NRS-2002 and CAR in predicting prolonged hospitalization in an internal medicine cohort.Methods: This retrospective cohort study included 375 adult patients hospitalized in the internal medicine ward of a tertiary care hospital between April and October 2023. Prolonged LOS was defined as a hospitalization duration exceeding the median value (>9 days). The predictive performance of NRS-2002, albumin, CRP, and CAR was analyzed using univariate and multivariate binary logistic regression and receiver operating characteristic (ROC) curve analysis.Results: The median LOS was 9 days, and 48.8% of patients experienced prolonged hospitalization. In univariate analysis, CAR (8.5 [24.3] vs. 15 [36.9], p=0.004), albumin (3.3 [0.9] vs. 3.0 [0.8] g/dL, p=0.001) and CRP (25.9 [72.5] vs. 46.0 [104.8] mg/L, p=0.008) differed significantly between the normal and prolonged LOS groups. NRS-2002 scores did not differ between groups (3 [2] vs. 3 [2], p=0.617), and nutritional risk prevalence (NRS-2002 ≥3) was identical in both groups (68.3%). ROC analysis showed that CAR (area under the curve [AUC]=0.585) and albumin (AUC=0.604) had superior discriminative ability compared with NRS-2002 (AUC=0.515). In multivariate analysis, CAR remained an independent predictor (odds ratio [OR]=1.01, p=0.038), whereas NRS-2002 was not (p=0.598).Conclusion: CAR index outperforms the NRS-2002 screening tool in predicting prolonged hospital stay in internal medicine inpatients. While NRS-2002 remains essential for identifying patients in need of nutritional intervention, the integration of objective inflammatory-nutritional biomarkers such as CAR may improve risk stratification for hospitalization outcomes.

GİRİŞ ve AMAÇ: Malnütrisyon, kanser hastalarını hastalıklarının seyri boyunca büyük ölçüde etkileyen bir sorundur. Tanı anında kilo kaybı yaşayan hastaların oranı, kanser türüne bağlı olarak %15-40 arasında değişmektedir. Hastalık ilerledikçe malnütrisyon insidansı artar ve sonunda hastaların %80'ini etkiler. Malnütrisyon, kanserli hastaların enfeksiyon insidansını, hastanede kalış süresini ve ölüm riskini artırır. Bu çalışmayı bir eğitim ve araştırma hastanesinin genel cerrahi kliniğinde gastrointestinal sistem (GİS) malignitesi tanısı ile ameliyat olan hastalardaki malnütrisyon durumunu değerlendirmek amacıyla yaptık. YÖNTEM ve GEREÇLER: Çalışmaya hastanemiz genel cerrahi kliniğinde GİS malignitesi sebebiyle 01.06.2021-01.08.2021 tarihleri arasında ameliyat olan 60 hasta alındı. Görüşme yöntemi ile hastaların 4 ayrı dönemdeki kiloları ve BKI değerleri (sağlıklı dönem - hastaneye yatış esnasında - taburcu oldukları sırada - taburcu olduktan 1 ay sonra) not edildi. Hastaların yaş-cinsiyet bilgileri kaydedildi, çalışmaya katılmanın gönüllülük esasına bağlı olduğu bildirilerek ilgili kurumdan ve çalışmaya katılan hastalardan izin alındı. BULGULAR: Bu çalışma yaşları 20-83 arasında, 19’u (%31,7) kadın ve 41’i (%68,3) erkek olmak üzere toplam 60 hasta ile yapılmıştır. Hastaların yaşları ortalaması 50±15, boyları 150-190 (168±9) cmdir. Hastaların hastalık öncesi BKI 18,9-37,3 (27,5±4,1) bulundu. Yatışa kadar kilo kaybı 0-30 (8±8) kg saptandı. Hastaların yatış BKI 16-33,6 (24,8±3,7) bulundu. Hastane yatış sürecinde kaybedilen kilo 0-11(3±3) kg saptandı. Taburculuk BKI 14-31,9 (23,9±3,7) olduğu bulundu. Taburcu olduktan 1 ay sonraki BKI 14-31,9 (23,9±3,7) olduğu bulundu. Taburcu olduktan sonraki dönemde kaybedilen kilo 0-15 (2±4) kg arasında saptandı. Hastaların; hastalık öncesi dönemden yatış anına kadar, yatış sürecindeki ve taburculuk anından 1 ay sonraki döneme kadar BKI kayıpları değerlendirildiğinde, her üç dönemde de istatistiksel anlamlı kilo-BKI kaybı olduğu görüldü. TARTIŞMA ve SONUÇ: GİS malignitesi olan hastaların malnütre olduklarının takip eden klinisyen tarafından tespiti, hastalığın klinik seyri açısından önemlidir. Bu hastaların klinisyen ve aynı zamanda nutrisyon destek ekibi ile tıbbi beslenme tedavilerinin planlanması ve yakından takip edilerek kilo kayıplarının minimum düzeye indirilmesi, hastane yatışlarının azaltılması, tedavi başarısının artırılması ve yaşam kalitesinin iyileştirilmesi açısından oldukça önemlidir.