Background. Hypothyroidism is very common worldwide. It is known to be associated with frailty which in turn, is associated with increased morbidity and mortality in the elderlies. Low ALT blood activity is an established marker for sarcopenia and frailty. The incidence and outcomes of the association of low ALT values and hypothyroidism, as manifested in elevated blood TSH levels, is unknown. Methods. This was a retrospective analysis of hospitalized patients in a large, tertiary hospital. Results. Over a period of 21 years, an overall population of 16,827 patients were identified as eligible to participate in this study. Within the study population 726 (4.3%) were classified as suffering from hypothyroidism (TSH values > 6 MIU/L) and 2,184 (13%) were classified as patients with sarcopenia (ALT < 12 IU/L). Within our patients’ population, hypothyroidism was associated with sarcopenia in a statistically significant manner (p = 0.011). Patients classified as suffering from both hypothyroidism and sarcopenia had significantly shorter survival: A multivariate analysis showed that the frail and hypothyroid group of patients had a statistically significant risk of mortality in the for coming 5 years (HR = 3.6; CI 2.75-4.71; p < 0.001). Conclusions. Sarcopenia and frailty are common comorbidities, bearing negative long-term clinical outcomes. Low ALT values could serve as a useful biomarker for screening of patients already diagnosed with hypothyroidism.

Background. Sarcopenia is characterized by progressive loss of muscle mass and function. It is often associated with frailty, a syndrome linked to physical disability and shortened survival in various diseases, including cancer patients. Low serum alanine aminotransferase (ALT) values, representing low muscle mass (sarcopenia), is a routine blood test that was shown to be associated with increased frailty and subsequently shortened survival in several cancers. In the current study, we aimed to test the association between low ALT and shorter survival in renal cell carcinoma (RCC) patients and survivors. Methods. This was a retrospective analysis of RCC patients and survivors, both in and out-patients. We defined patients with sarcopenia as those presenting with ALT < 17 IU/L. Results. We identified records of 3,012 patients diagnosed with RCC. The final cohort included 1,830 eligible patients (mean age 65.6 ± 13.3 years, 68% were men) of whom only 179 underwent surgical treatment. Out of the eligible cohort, 811 patients (44.3% ( had ALT < 17 IU/L. The mean ALT value of patients within the low ALT group was 11.79 IU/L while the mean value in the higher ALT level group was 24.44 IU/L (p < 0.001). Patients in the lower ALT group were older (67.9 vs. 63.7 years; p < 0.001) and had lower BMI (26.6 vs. 28; p < 0.001). In addition, patients with low ALT had lower hemoglobin values (12.14 vs. 12.91 g/dL; p < 0.001), higher serum creatinine (1.49 vs. 1.14; p < 0.001) and higher platelets to lymphocytes ratio (178 vs. 156; p < 0.001). In a univariate analysis, low ALT levels were associated with a 72% increase in mortality (95% CI 1.46-2.02, P < 0.001). In a multivariate model controlled for age, male gender, hemoglobin, platelets, LDH, neutrophil to lymphocytes ratio and platelets to lymphocytes ratio, low ALT levels were associated with a 27% increase in mortality (HR = 1.27, 95% CI 1.08 – 1.51; p = 0.005]. Conclusion. Low ALT values, indicative of sarcopenia and frailty, are associated with shortened survival of RCC patients and survivors and could potentially be applied for optimizing individual treatment decisions.

Abstract: Background: The Hospital-at-home (HAH) model is a viable alternative for conven-tional in-hospital stays worldwide. Serum electrolyte abnormalities are common in acute pa-tients, especially in those with many comorbidities. Pathologic changes in cardiac electrophysi-ology pose a potential risk during HAH stay. Periodical Electrocardiogram (ECG) tracing is therefore advised, but few studies evaluated the accuracy and efficiency of compact, self-activated ECG devices in the HAH settings. This study aimed to evaluate the reliability of such a device in comparison to a standard 12-lead ECG. Methods: We prospectively recruited consecu-tive patients admitted to the Sheba Beyond, virtual hospital, in the HAH department, during a 3-month duration. Each patient underwent a 12-lead ECG recording using the legacy device, and a consecutive recording by a compact 6-lead device. Baseline patients’ characteristics during hospi-talization were collected. Level of agreement between devices was measured by Cohen’s Kappa coefficient for inter-rater reliability (Ϗ). Results: Fifty patients were included in the study. 26 (52%) had electrolyte disturbances. Abnormal D-dimer values were observed in 33 (66%) pa-tients, and 12 (24%) patients had elevated troponin values. We found a level of 94.5% raw agreement between devices with regards to nine of the options included in the automatic read-out of the legacy device. The calculated Ϗ was 0.72, classified as substantial consensus. The rate of raw consensus regarding ECG intervals’ measurement (PR, RR, QT) was 78.5% and the calculated Ϗ was 0.42, corresponding to a moderate level of agreement. Conclusion: This is the first report to our knowledge regarding the feasibility of using a compact, 6-Lead ECG device in the setting of HAH to be safe and bearing satisfying agreement level with a legacy, 12-lead ECG device, en-abling quick, accessible arrythmia detection in this setting. Our findings bear a promise to the future development of telemedicine-based hospital at home methodology.