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Öğe Can we predict patients that will not benefit from invasive mechanical ventilation? A novel scoring system in intensive care: the IMV Mortality Prediction Score (IMPRES)(Tubitak Scientific & Technological Research Council Turkey, 2019) Özlü, Tevfik; Pehlivanlar Küçük, Mehtap; Kaya, Akın; Yarar, Esra; Kirakli, Cenk; Şengören Dikiş, Özlem; Kefeli Çelik, HaleBackground/aim: The present study aimed to define the clinical and laboratory criteria for predicting patients that will not benefit from invasive mechanical ventilation (IMV) treatment and determine the prediction of mortality and prognosis of these critical ill patients. Materials and methods: The study was designed as an observational, multicenter, prospective, and cross-sectional clinical study. It was conducted by 75 researchers at 41 centers in intensive care units (ICUs) located in various geographical areas of Turkey. It included a total of 1463 ICU patients who were receiving invasive mechanical ventilation (IMV) treatment. A total of 158 parameters were examined via logistic regression analysis to identify independent risk factors for mortality; using these data, the IMV Mortality Prediction Score (IMPRES) scoring system was developed. Results: The following cut-off scores were used to indicate mortality risk: <2, low risk; 2-5, moderate risk; 5.1-8, high risk; >8, very high risk. There was a 26.8% mortality rate among the 254 patients who had a total IMPRES score of lower than 2. The mortality rate was 93.3% for patients with total 1M PRES scores of greater than 8 (P < 0.001). Conclusion: The present study included a large number of patients from various geographical areas of the country who were admitted to various types of ICUs, had diverse diagnoses and comorbidities, were intubated with various indications in either urgent or elective settings, and were followed by physicians from various specialties. Therefore, our data are more general and can be applied to a broader population. This study devised a new scoring system for decision-making for critically ill patients as to whether they need to be intubated or not and presents a rapid and accurate prediction of mortality and prognosis prior to ICU admission using simple clinical data.Öğe Body Composition in Patients with Stable Chronic Obstructive Pulmonary Disease: Comparison with Malnutrition in Healthy Smokers(Aves, 2014) Baççıoğlu, Ayşe; Gülbay, Banu Eris; Acican, TuranObjective: Although malnutrition (body mass index (BMI)<18.5kg/m2) has been associated with impaired health status in patients with chronic obstructive pulmonary disease (COPD), the effects of body composition (body fat and protein percentage) in patients with COPD have not been clearly demonstrated. Materials and Methods: A total of 180 stable patients with COPD at the stages of moderate, severe, very severe, and 50 healthy subjects were included in this prospective study. All subjects underwent a clinical evaluation, spirometry tests, anthropometric measurements and blood analysis. Results: Frequency of underweight was higher in COPD (11.7%) patients than the control group (8%). The frequency of underweight increased as the severity of COPD worsens. There was body decomposition (protein or fat depletion) in not only all underweight patients but also some normal/overweight COPD patients, as well as in the healthy subjects. Deterioration in FEV1 (L), and FEV1/FVC was more evident in underweight patients with protein and fat depletion compared to normal/overweight patients (p=0.004, and p=0.005). Inspiratory and expiratory respiratory muscle power was lower in underweight patients with depletion than in normal/overweight patients (p=0.02, and p=0.01). DLCO and DLCO/VA were significantly lower in underweight patients than in normal/overweight patients (p=0.003, and p=0.004), they were also lower in normal/overweight patients with depletion than in normal/overweight patients with no depletion (p=0.01, and p=0.07). Normal/overweight patients with protein depletion had the most frequent number of exacerbations than others (p=0.04). Conclusion: These results show that the body decomposition is important in patients with COPD. Assessment of body composition should be a part of nutritional assessment besides BMI in patients with COPD.Öğe Blood Patch Pleurodesis in the Treatment of Persistant Air Leakage in Langerhans Cell Histiocytosis; A Case Report(Derman Medical Publ, 2013) Baççıoğlu, Ayşe; Günal, Nesimi; Kalpaklıoğlu, Füsun; Dural, Koray; Özpolat, BerkantPulmonary langerhans cell histiocytosis is a rare reactive disorder with unclear pathogenesis. 16-year-old male patient complained about shortness of breath induced with exercise, non-productive cough, and intermittent chest pain for one year. Pulmonary function tests were in restrictive nature. There were multiple air cysts in lung parenchyma smaller than one cm and minimal pneumothorax on the left hemithorax in high resolution computed tomography of thorax. There was no hypoxemia in arterial blood gas analysis, and no pulmonary hypertension in echocardiography. Pulmonary langerhans cell histiocytosis was diagnosed with clinical features and typical radiographic appearance. Existence of multisystem langerhans cell histiocytosis was excluded thorough a detailed history, comprehensive physical examination, and baseline radiographic, blood and urine tests. He was recommended to quit smoking and close follow-up was planned. A tube thoracostomy was performed for left sided total pneumothorax one month later, and blood patch pleurodesis was done due to persistent air leakage with a successful outcome. As far as we know this is the first case report of pulmonary langerhans cell histiocytosis who was treated with autologous blood pleurodesis in the literature.Öğe Assessment of quality of life in patients with nonallergic rhinitis compared to allergics in relation with nasal provocation test(Bilimsel Tip Yayinevi, 2012) Kavut, Ayşe Baççıoğlu; Kalpaklıoğlu, FüsunObjective: Allergic-rhinitis (AR) is an IgE-mediated disease with negative effects on quality-of-life (QoL). Despite suggestive symptoms of AR, nonallergic-rhinitis (NAR) is a chronic condition with unclear characteristics and pathophysiology. The objective of this study was to assess the effect of exposure to allergen on rhinitis symptoms and QoL in patients with NAR. Materials and Methods: Patients with NAR (n=25), AR (n=16), and control group (n=10) were compared, regarding generic (SF-36), and specific (MiniRQLQ) QoL, Epworth-Sleepiness-Scale (ESS) and nasal-provocation-test (NPT) with house-dustmite. Results: NPTs were resulted positive in all AR, in 52% of NAR patients and none in control group (p between AR&NAR: < 0.001). Before NPT, social, physical and emotional role domains of SF-36 were lower in NAR group than control group, whereas patients with AR had impairment only in social scores. NAR group had impairment in the general, activity limitation, practical problems and nasal symptoms of MiniRQLQ, while patients with AR had impairment in the general and nasal symptom scores of MiniRQLQ. Results of EUS were similar and in normal levels in all groups. After NPTs, the only change in QoL questionnaires was the impairment in the energy score of SF-36 in NAR group compared to others (p=0.02). Conclusion: This study showed the impact of rhinitis on QoL was more prominent in NAR patients than AR. Furthermore, after exposure to allergen, rhinitis symptoms devepoed in some of the patients with NAR may be a reflection of atopy. The impact of NPT with allergen on QoL was negligible.Öğe Stepwise Approach in Asthma Revisited 2023: Expert Panel Opinion of Turkish Guideline of Asthma Diagnosis and Management Group(Aves, 2023) Çelik, Gülfem Elif; Aydın, Ömür; Damadoğlu, Ebru; Baççıoğlu, Ayşe; Özdemir, Seçil Kepil; Bavbek, Sevim; Ediger, DaneIntroduction of inhaled corticosteroids (ICS) has been the cornerstone of the long-term management of asthma. ICSs either alone or in combination with long-acting beta-2 agonists have been shown to be associated with favorable asthma outcomes. However, asthma con-trol is still reported to be below expectations all around the world. Research in the last decades focusing on the use of ICS/formoterol both as maintenance and as needed (maintenance and reliever therapy approach) showed improved asthma outcomes. As a result of recent developments, Turkish Asthma Guidelines group aimed to revise asthma treatment recommendations. In general, we recommend physi-cians to consider the risk factors for poor asthma outcomes, patients' compliance and expectations and then to determine a personalized treatment plan. Importantly, the use of short-acting beta-2 agonists alone as a symptom reliever in asthma patients not using regular ICS is no longer recommended. In stepwise treatment approach, we primarily recommend to use ICS-based controllers and initiate ICS as soon as possible. We define 2 different treatment tracks in stepwise approaches as maintenance and reliever therapy or fixed-dose therapy and equally recommend each track depending on the patient's risks as well as decision of physicians in a personalized manner. For both tracks, a strong recommendation was made in favor of using add-on treatments before initiating phenotype-specific treatment in step 5. A strong recommendation was also made in favor of using biologic agents and/or aspirin treatment after desensitization in severe asthma when indicated.Öğe Elderly and aged asthma have different characteristics: results of a multicenter study(Tubitak Scientific & Technological Research Council Turkey, 2024) Damadoğlu, Ebru; Öztürk Aktaş, Özge; Gemicioğlu, Bilun; Yılmaz, Nafiye; Bozkuş, Fulsen; Ayhan, Vehbi; Kalpaklıoğlu, Ayse FüsunBackground/ aim: Characteristics of asthma in the elderly population is not well-known. The aim of the present study was to evaluate asthma in the elderly population, to compare disease characteristics between patients diagnosed <60 (aged asthma) and >= 60 (elderly asthma) years of age. Materials and methods: The study was a prospective, multicenter, cross-sectional type. A questionnaire was filled out to patients 60 years of age and over, that have been followed for asthma for at least 3 months. Asthma Control Test (ACT), eight-item Morisky Medication Adherence Scale (MMAS-8) was filled out, inhaler device technique was assessed. Results: A total of 399 patients were included from 17 tertiary care centers across the country. Mean age was 67.11 years and 331 (83%) were female. The age at asthma diagnosis was >= 60 in 146 (36.6%) patients. Patients diagnosed >= 60 years were older (p < 0.001), had higher education level (p < 0.001), more commonly had first -degree relative with asthma (p = 0.038), asthma related comorbidities (p = 0.009) and accompanying rhinitis/rhinosinusitis (p = 0.005), had better asthma control (p = 0.001), were using less controller medications (p = 0.014). Inhaler technique was correct in 37% of the patients with no difference in between the groups. Treatment compliance was better in elderly asthma patients (p < 0.001). In the multivariate logistic regression analysis, having well -controlled asthma (odds ratio = 1.61, CI = 1.04-2.51), and high medication adherence rate (odds ratio = 2.43, CI = 1.48-4.0) were associated with being in the elderly asthma group. Conclusion: The characteristics of asthma are different among patients aged 60 years and over which seems to be related to onset age of asthma. In our cohort, the elderly asthma patients had higher education level, and treatment adherence and asthma control was better. Patients diagnosed >= 60 years of age did not have more severe disease.Öğe Vitamin D Levels in Patients with Allergic and Non-Allergic Rhinitis(Bilimsel Tip Yayinevi, 2022) Kalpaklıoğlu, Ayşe Füsun; Alpagat, Gülistan; Baççıoğlu, Ayşe; Alan Yalim, Sümeyra; Dumanoğlu, Betül; Poyraz, MerveObjective: Allergic and non-allergic rhinitis are quite similar from a clinical viewpoint and allergen sensitivity seems to be the important relevant difference between them. However, the role of vitamin-D (vit-D) as an immunomodulator hormone and on rhinitis phenotypes is not clear. We aimed to investigate the relation between vit-D levels and patients with rhinitis as allergic (AR) and non- allergic (NAR). Materials and Methods: This was a retrospective research of 228 patients whom were diagnosed at a tertiary hospital between 2012 and 2016. Rhinitis was diagnosed as AR if nasal symptoms were accompanied with skin prick test (SPT) positivity, and NAR if they were relevant with negative SPT. The clinical history of the patients and the symptoms were recorded. Serum total IgE tests were performed using an allergen detection system (UniCAP, Phadia, Uppsala, Sweden), and vit-D levels were measured with the 25-hydroxy-vit-D (25-OH vit-D) kit in the Elecsys 2010 analyzer (Roche Diagnostics, Germany). Results: A total of 228 patients (AR=170 and NAR=58) with a mean age of 31.06 +/- 11.58 yrs were included. The mean age and ratio of female gender were significantly higher in NAR (p=0.03), whereas obesity was significantly higher in AR patients (p=0.01). Duration of rhinitis in NAR was longer than in AR (p=NS). Serum total IgE levels were significantly higher in AR than NAR, whereas mean levels and ratio of vit-D deficiency were similar between the groups. Levels of vit-D were significantly lower in females than males only in the AR group (p<0.001). Patients with NAR had mostly severe vit-D deficiency (<10 ng/mL), and those with AR had mostly non-severe vit-D deficiency (11-19 ng/mL). There was no relationship between vit-D deficiency and allergen sensitization, but there was a negative correlation of vit-D levels and female gender in the AR group (p<0.001). Conclusion: The present study showed no association between serum vit-D level and allergen sensitization in adult patients with allergic and nonallergic rhinitis.Öğe Characteristics of Adverse Reactions and Compliance in Patients who Underwent Allergen-Specific Subcutaneous Immunotherapy; Ten-Year Real-Life Data(Bilimsel Tip Yayinevi, 2022) Baççıoğlu, Ayşe; Kalpaklıoğlu, Ayşe Füsun; Poyraz, Merve; Alan Yalım, Sümeyra; Dumanoğlu, Betül; Alpagat, GülistanObjective: Allergen-specific subcutaneous immunotherapy (SCIT) is known as the best therapeutic method that may alter the natural course of allergic diseases, compared to pharmacological and avoidance options. However, some problems such as adverse reactions (ARs), inconvenience, and high costs of a prolonged course of therapy may prevent patients from completing the therapy. The objective of this study was to evaluate the evidence for the potential barriers against the benefits of SCIT in adult patients. Materials and Methods: An observational study between 2009 and 2019 was performed at the Allergy Clinic of a tertiary hospital. The data of 166 adult patients who underwent SCIT for allergic rhino-conjunctivitis (ARC), and/or asthma or hymenoptera venom anaphylaxis using conventional schedules with standard allergen extracts were evaluated. Results: SCIT indications were ARC (63%), ARC and asthma (19.3%), and venom anaphylaxis (17.5%). The standardized allergen extracts used were grass pollen (59%), house dust mite (19.9%), and hymenoptera venom (17.5%). The frequency of SCIT-related ARs was 7.4% per injection, and 42.2% per patient. Local ARs were more frequent than systemic ARs (SAR)s. The majority of the SARs were composed of anaphylaxis and generalized urticaria, which were mostly of moderate severity with no deaths. SARs were more common in women, in patients with high injection numbers, and in patients under SCIT with cat allergen or multiple allergens. Most of the SARs occurred immediately after injection, and in the initial phase, whereas the delayed-type of SARs was common in patients with pollen SCIT. Three patients under cat SCIT discontinued treatment due to SARs of immediate and moderate/severe type. Ratios of SARs of venoms were insignificantly higher than aeroallergens. SARs with house dust mite SCIT were rare. Rates of patients' compliance to SCIT were similar between the allergen extracts, with an average of 70%. The most common causes of non-compliance were non-adherence, leaving the current residence, difficulty in obtaining the allergen extracts, and ARs. The frequencies of local and moderate ARs were higher in compliant patients, whereas systemic and severe ARs were higher in non-compliant ones. In the regression model, it was found that ARs increased and patient compliance decreased as the number of injections increased. Conclusion: This study in the real-life setting for a decade showed that less than half of the patients that underwent SCIT had developed ARs, which were generally local and of moderate severity. In conclusion, these results indicated that each allergen of SCIT had different characteristics of ARs, and the moderate incidence of ARs was not a problem regarding compliance with SCIT. Therefore, SCIT may be preferred in indications of allergy, and has a tolerable balance of ARs and safety.Öğe The Effect of Internet Addiction on Asthma Control and Medication Adherence(Bilimsel Tip Yayinevi, 2022) Kalpaklıoğlu, Ayşe Füsun; Baccıoğlu, Ayşe; Dumanoğlu, Betül; Poyraz, Merve; Yalım, Sümeyra Alan; Alpagat, GülistanObjective: Internet addiction has recently become a prevalent health problem. Although many studies indicate a link between internet addiction and various diseases, no studies have examined its consequences on asthma control or medication adherence. The purpose of this study was to determine how internet addiction affects asthma control and medication adherence. Materials and Methods: Study participants were grouped as asthmatics and healthy controls whom were aged between 18 and 77. Asthma control test (ACT) and medication adherence report scale (MARS-5) were fulfilled by asthma patients, whereas short version of Young Internet Addiction Test (s-IAT) was applied to all participants. Pulmonary function test was performed to all subjects. Results: Forty-nine healthy volunteers and 54 asthmatic subjects were enrolled. Age and gender profiles within the study groups were similar. There was no significant difference in means of problematic and pathological (s-IAT >= 31) s-IAT scores between asthma and control groups (24.1% and 20.4%, p=0.41), as well as between asthma patients with controlled and uncontrolled ACT scores (24.1% and 24%, p=0.99), and those with and without medication adherence (16.7% and 27.8%, p=0.50). s-IAT scores were found to be linked to higher educational level (p=0.01, r=0.37), and better FEV1 (p=0.04, r=0.27) in asthmatic patients. In addition, MARS-5 was correlated with older age (p=0.02, r=0.29), and low FEV1 (p=0.01, r= -0.35). Conclusion: Internet addiction did not seem to directly affect asthma control or medication adherence. However, it appeared to be associated with a high level of education and FEV1.Öğe Therapeutic Treatment with Abdominal Adipose Mesenchymal Cells Does Not Prevent Elastase-Induced Emphysema in Rats(2020) Gülhan, Pınar Yıldız; Ekici, Mehmet Savaş; Ekici, Aydanur; Niyaz, Mehmet; Gülhan, Muhammet; Ercin, Mustafa Emre; Aksoy, NurkanOBJECTIVES: Emphysema and chronic bronchitis have different pathophysiologies but both are significant components of chronic obstructive lung disease (COPD). The levels of Matrix metalloproteinase (MMP)-9 in the bronchoalveloar lavage fluid (BALF) and in serum indicate the presence of emphysema. Intratracheal administration of elastase has been used to create a rat model of emphysema. Adipose tissue-derived mesenchymal stem cells (MSC) have been postulated to prevent or reverse emphysema, however, this has not been examined in the rat model of elastase-induced emphysema. MATERIALS AND METHODS: In this study, 31 Wistar albino rats aged 6–8 weeks and weighing 250–300 g were assessed. On day 1, the animals were treated intratracheally with 0.5 mL saline (control group, n=10), i.e., 0.5 mL saline solution containing 0.1 IU porcine pancreatic elastase (PPE) (Elastase group, n=12) or PPE plus MSC (Elastase-MSC group, n=9) was adminstered per animal. MSCs suspended in serum were injected via the caudal vein on day 21. At least 106 cells were injected. All animals were sacrificed on day 42 and the emphysema index (EI) was calculated, along with measuring the BALF and serum MMP-9 concentrations. RESULTS: Porcine pancreatic elastase induced a significant degree of emphysema in the PPE groups as compared to the control group, which was determined by the EI index (p=0.008). This was not reversed by MSC treatment. The EI remained significantly low in comprison with the controls (p=0.001) and measured no different from the Elastase-treated animals. There was no statistically significant difference between the BALF and serum MMP-9 levels between the control and treatment groups. CONCLUSION: Our findings suggest that therapeutic treatment with adipose tissue-derived MSC in rats has no effect on emphysema or on MMP9 expression, which is a known marker of emphysema.Öğe Mortality prediction ability of phycians in intensive care units of Turkey (MOPAP)(TURKISH ASSOC TUBERCULOSIS & THORAX, 2020) Pehlivanlar Kucuk, Mehtap; Ozlu, Tevfik; Kucuk, Ahmet Oguzhan; Kaya, Akin; Kirakli, Cenk; Sengoren Dikis, Ozlem; Kefeli Celik, HaleIntroduction: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up. Materials and Methods: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017. The clinical research was planned as observational, multicenter, cross-sectional. Results: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the "0" the worst probability "5" being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p< 0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% Cl: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively. Conclusion: In this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician's opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters.Öğe Asthma as a Comorbid Disease in COVID-19(BILIMSEL TIP YAYINEVI, 2020) Baccioglu, Ayse; Bavbek, SevimSevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel coronavirus that causes coronavirus disease 2019 (COVID-19). In terms of asthma and COVID-19, there is also a risk of experiencing an asthma exacerbation triggered by coronavirus infection beyond the direct risk of the infection itself. As a comorbid disease, the prevalence of COVID-19 infection in asthma patients is not clear. In addition, the influence of asthma on the severity of COVID-19 has not been reported. The aim of this review was to summarize the reported worldwide data about the prevalence and the clinical characteristics of patients with asthma during COVID-19 infection.Öğe "Whole" vs "fragmented" approach to EAACI pollen season definitions: A multicenter study in six Southern European cities(WILEY, 2020) Hoffmann, Tara Maria; Sahin, Aydan Acar; Aggelidis, Xenophon; Arasi, Stefania; Barbalace, Andrea; Bourgoin, Anne; Bregu, BlerinaBackground The adequate definition of pollen seasons is essential to facilitate a correct diagnosis, treatment choice, and outcome assessment in patients with seasonal allergic rhinitis. A position paper by the European Academy of Allergy and Clinical Immunology (EAACI) proposed season definitions for Northern and Middle Europe. Objective To test the pollen season definitions proposed by EAACI in six Mediterranean cities for seven pollen taxa. Methods As part of the @IT.2020 multi-center study, pollen counts for Poaceae, Oleaceae, Fagales, Cupressaceae, Urticaceae (Parietaria spp.), and Compositae (Ambrosia spp., Artemisia spp.) were collected from January 1 to December 31, 2018. Based on these data, pollen seasons were identified according to EAACI criteria. A unified monitoring period for patients in AIT trials was created and assessed for feasibility. Results The analysis revealed a great heterogeneity between the different locations in terms of pattern and length of the examined pollen seasons. Further, we found a fragmentation of pollen seasons in several segments (max. 8) separated by periods of low pollen counts (intercurrent periods). Potential monitoring periods included often many recording days with low pollen exposure (max. 341 days). Conclusion The Mediterranean climate leads to challenging pollen exposure times. Monitoring periods for AIT trials based on existing definitions may include many intermittent days with low pollen concentrations. Therefore, it is necessary to find an adapted pollen season definition as individual solution for each pollen and geographical area.Öğe Effect of internet addiction on asthma control and medication adherence(WILEY, 2020) Kalpaklioglu, A. F.; Baccioglu, A.; Dumanoglu, B.; Cimsir, Oksuzer D.; Poyraz, M.Objective: Internet addiction has recently become a prevalent health problem. Although many studies indicate a link between internet addiction and various diseases, no studies have examined its consequences on asthma control or medication adherence. The purpose of this study was to determine how internet addiction affects asthma control and medication adherence. Materials and Methods: Study participants were grouped as asthmatics and healthy controls whom were aged between 18 and 77. Asthma control test (ACT) and medication adherence report scale (MARS-5) were fulfilled by asthma patients, whereas short version of Young Internet Addiction Test (s-IAT) was applied to all participants. Pulmonary function test was performed to all subjects. Results: Forty-nine healthy volunteers and 54 asthmatic subjects were enrolled. Age and gender profiles within the study groups were similar. There was no significant difference in means of problematic and pathological (s-IAT ≥ 31) s-IAT scores between asthma and control groups (24.1% and 20.4%, p=0.41), as well as between asthma patients with controlled and uncontrolled ACT scores (24.1% and 24%, p=0.99), and those with and without medication adherence (16.7% and 27.8%, p=0.50). s-IAT scores were found to be linked to higher educational level (p=0.01, r=0.37), and better FEV1 (p=0.04, r=0.27) in asthmatic patients. In addition, MARS-5 was correlated with older age (p=0.02, r=0.29), and low FEV1 (p=0.01, r= -0.35). Conclusion: Internet addiction did not seem to directly affect asthma control or medication adherence. However, it appeared to be associated with a high level of education and FEV.Öğe Pulmonary embolism in obesity-hypoventilation syndrome(WILEY, 2020) Ekici, Aydanur; Ekici, Mehmet; Ileri, Sule; Cimen, Asiye Busra; Aslan, HabibeIntroduction Obesity-hypoventilation syndrome occurs with alveolar hypoventilation during sleeping and daytime. Obesity may be a risk factor for venous thromboembolism. However, the venous thromboembolism in the obesity-hypoventilation syndrome is not well characterized. Objective This case series aimed to investigate the presence and clinical features of venous thromboembolism in patients with the obesity-hypoventilation syndrome. Methods Data of eight case reports were collected. Ages ranged from 36 to 73 years. Results All patients had mosaic perfusion and enlarged main pulmonary artery, two had signs of infarction and mostly segmental and subsegmental filling defects. On the basis of this information some conclusions can be drawn carefully. Conclusion Present cases indicate that pulmonary embolism are also very common in patients with obesity-hypoventilation syndrome, anticoagulant therapy is at least as important as the treatment of the current disease. Clinicians will frequently be faced with patients with obesity-hypoventilation syndrome suspected of PE.Öğe In-vivo diagnostic test allergens in Europe: A call to action and proposal for recovery plan-An EAACI position paper(WILEY, 2020) Klimek, Ludger; Hoffmann, Hans J.; Kalpaklioglu, Ayse F.; Demoly, Pascal; Agache, Ioana; Popov, Todor A.; Muraro, AntonellaDiagnostic allergens are defined as medicinal products in the EU. Marketing authorization by national authorities is necessary; however, diagnostic allergens are not homogeneously regulated in different EU member states. Allergen manufacturers argue with increasing costs forcing them to continuously reduce the diagnostic allergen portfolios offered to allergists. In contrast, EAACI and national European Allergy Societies see the need for the availability of a wide range of high-quality diagnostic allergens for in vivo diagnosis of IgE-mediated allergies not only covering predominant but also less frequent allergen sources. In a recent EAACI task force survey, the current practice of allergy diagnosis was shown to rely on skin tests as first option in almost 2/3 of all types of allergic diseases and in 90% regarding respiratory allergies. With the need to ensure the availability of high-quality diagnostic allergens in the EU, an action plan has been set up by EAACI to analyse the current regulatory demands in EU member states and to define possible solutions stated in this document: (a) simplification of authorization for diagnostic allergens; (b) specific regulation of special types of diagnostic allergens; (c) new models beyond the current model of homologous groups; (d) simplification of pharmacovigilance reporting; (e) reduction of regulation fees for diagnostic allergens; (f) reimbursement for diagnostic allergens. Joining forces of allergists, manufacturers and authorities are of high importance to ensure remaining relevant allergens in the EU markets to facilitate a sustainable and comprehensive service for the diagnosis and treatment of allergic diseases.Öğe IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper(Elsevier, 2020) Ansotegui, Ignacio J.; Melioli, Giovanni; Canonica, Giorgio Walter; Caraballo, Luis; Villa, Elisa; Ebisawa, Motohiro; Zuberbier, TorstenCurrently, testing for immunoglobulin E (IgE) sensitization is the cornerstone of diagnostic evaluation in suspected allergic conditions. This review provides a thorough and updated critical appraisal of the most frequently used diagnostic tests, both in vivo and in vitro. It discusses skin tests, challenges, and serological and cellular in vitro tests, and provides an overview of indications, advantages and disadvantages of each in conditions such as respiratory, food, venom, drug, and occupational allergy. Skin prick testing remains the first line approach in most instances; the added value of serum specific IgE to whole allergen extracts or components, as well as the role of basophil activation tests, is evaluated. Unproven, non-validated, diagnostic tests are also discussed. Throughout the review, the reader must bear in mind the relevance of differentiating between sensitization and allergy; the latter entails not only allergic sensitization, but also clinically relevant symptoms triggered by the culprit allergen.Öğe Immunization status in chronic obstructive pulmonary disease: A multicenter study from Turkey(Wolters Kluwer Medknow Publications, 2019) Ozlu, Tevfik; Bulbul, Yilmaz; Aydin, Derya; Tatar, Dursun; Kuyucu, Tulin; Erboy, Fatma; Nizam, M.OBJECTIVE: The purpose of this study is to detect the prevalence and the factors associated with influenza and pneumococcal vaccination and outcomes of vaccination during 2013-2014 season in patients with chronic obstructive pulmonary disease (COPD) in Turkey. METHODS: This was a multicenter retrospective cohort study performed in 53 different centers in Turkey. RESULTS: During the study period, 4968 patients were included. COPD was staged as GOLD 1-2-3-4 in 9.0%, 42.8%, 35.0%, and 13.2% of the patients, respectively. Influenza vaccination rate in the previous year was 37.9%; and pneumococcus vaccination rate, at least once during in a life time, was 13.3%. Patients with older age, higher level of education, more severe COPD, and comorbidities, ex-smokers, and patients residing in urban areas had higher rates of influenza vaccination. Multivariate logistic regression analysis showed that advanced age, higher education levels, presence of comorbidities, higher COPD stages, and exacerbation rates were associated with both influenza and pneumococcal vaccination. The number of annual physician/outpatient visits and hospitalizations due to COPD exacerbation was 2.73 +/- 2.85 and 0.92 +/- 1.58 per year, respectively. Patients with older age, lower education levels, more severe COPD, comorbid diseases, and lower body mass index and patients who are male and are residing in rural areas and vaccinated for influenza had significantly higher rates of COPD exacerbation. CONCLUSIONS: The rates of influenza and pneumococcal vaccination in COPD patients were quite low, and the number of annual physician/outpatient visits and hospitalizations due to COPD exacerbation was high in Turkey. Advanced age, higher education levels, comorbidities, and higher COPD stages were associated with both influenza and pneumococcal vaccination.Öğe Rationale for the autologous serum skin test in acute versus chronic urticaria(Termedia Publishing House Ltd, 2019) Demirkan, Serkan; Baccioglu, AyseIntroduction: Autologous serum skin test (ASST) is a rapid, in-vivo clinical test to detect functional autoantibodies in patients with chronic spontaneous urticaria (CSU), but the rationale for its use in acute urticaria (AU) is unknown. Aim: To evaluate the efficacy of ASST among patients with AU or CSU. Material and methods: Treatment-naIve adult (age >= 18 years) patients with a diagnosis of AU (< 6 weeks' duration) and CSU were enrolled prospectively in a cross-sectional study. Healthy age- and sex-matched subjects served as controls. Besides a detailed history and physical examination, ASST, total immunoglobulin E (IgE), freeT3 (fT3), freeT4 (fT4), anti-thyroglobulin, and anti-TPO levels were assessed in all subjects. Results: Of 101 subjects, mean age was 34.35 +/- 12.68 years and the study comprised 58.4% of females with no difference between AU (n = 27), CSU (n = 46), and control groups (n = 28). The ratio of positivity in ASST was similar between AU (25.9%) and CSU groups (21.7%), but higher than in controls (10.7%, p = 0.33 for all). The ratio of patients with high total IgE levels (> 100 IU/ml) in AU (85.2%) and CSU (65.2%) groups was similar (p = 0.06), but significantly higher than in the control group (10.7%) (p < 0.001 and p < 0.001). The CSU group had significantly higher abnormal thyroid test results (45.7%) than AU (14.8%) and control groups (3.6%) (p = 0.01 and p < 0.001), whereas patients with clinically diagnosed thyroiditis were only in the CSU group (6.5%). In logistic regression analysis, there was no relation found among the possible risk factors for ASST, even if analysed separately as AU, CSU and control groups. Conclusions: Even though thyroid function test levels were found to be related with CSU, and total IgE was associated with urticaria, ASST was found to be of importance. This study confirms that ASST was insufficient to demonstrate autoimmunity and acute-chronic urticaria nature. Further tests indicating auto-antibodies in AU and CSU are needed.Öğe Troublesome cough as the sole manifestation of pulmonary embolism(Elsevier, 2019) Ekici, Aydanur; Aslan, Habibe; Ekici, MehmetEarly diagnosis and effective treatment to reduce mortality is the basis of pulmonary embolism. However, the diagnosis can be easily overlooked due to nonspecific clinical presentation. We present 9 cases of pulmonary embolism manifested by a symptom suggestive of an irritating cough due to viral upper respiratory tract infection (patients with no risk factors for PE). Pulmonary embolism should be considered in cases of irritating cough that does not respond to inhaler treatment, d-dimer positive and normal chest X-ray.
