The Effectiveness of Biological Agents on Chronic Rhinosinusitis with Nasal Polyposis in Patients with Comorbid Asthma: A Multicenter Real-Life Study from Türkiye

Background and Objectives: Real-life data on the efficacy of biologic agents (BAs) on asthma-comorbid CRSwNP are needed. Our primary goal is to investigate the effects of BAs on CRSwNP symptoms, as well as endoscopic and tomography scores. Our secondary goal is to show a reduction in the frequency of acute sinusitis exacerbations and the need for surgery. Materials and Methods: We conducted a multicenter, retrospective, real-life study. We screened the patients with asthma-comorbid CRSwNP treated with omalizumab or mepolizumab. A total of 69 patients (40 F/29 M; omalizumab n = 55, mepolizumab n = 14) were enrolled. We compared the visual analog scale (VAS), sinonasal outcome test-22 (SNOT-22), nasal congestion score (NCS), Lund-Mackay computed tomography score (LMS), and total endoscopic polyp scores (TPS) before and after BAs. We evaluated the endoscopic sinus surgery (ESS) and acute exacerbations of chronic rhinosinusitis (AECRS) frequencies separately, according to the BAs. Results: The overall median (min-max) age was 43 (21-69) years. The median (min-max) of biologic therapy duration was 35 (4-113) months for omalizumab and 13.5 (6-32) for mepolizumab. Significant improvements were seen in VAS, SNOT-22, and NCS with omalizumab and mepolizumab. A significant decrease was observed in TPS with omalizumab [95% CI: 0-4] (p < 0.001), but not with mepolizumab [95% CI: -0.5-2] (p = 0.335). The frequency of ESS and AECRS were significantly reduced with omalizumab [95% CI: 2-3] (p < 0.001) and [95% CI: 2-5] (p < 0.001); and mepolizumab [95% CI: 0-2] (p = 0.002) and [95% CI: 2-8.5] (p < 0.001), respectively. There was no significant difference in LMS with either of the BAs. Conclusions: Omalizumab and mepolizumab can provide a significant improvement in the sinonasal symptom scores. BAs are promising agents for CRSwNP patients with frequent exacerbations and multiple surgeries.

Determination of the cryoprotective effect of n-methylacetamide in rabbit semen

BACKGROUND

Amides are low molecular weight cryoprotectants. N-methylacetamide (MA) is one of the cryoprotectant agents in this group.

OBJECTIVE

To investigate the cryoprotective effect of MA in rabbit semen.

MATERIALS AND METHODS

For this purpose, six ejaculates from six New Zealand rabbits were collected and pooled using an artificial vagina. Pooled semen was divided into four equal parts and diluted with TCG+ egg yolk. CPA was added to form the following groups: Control with 6% DMSO; Group 1 with 1% MA; Group 2 with 2% MA; and Group 3 with 3% MA. After the addition of CPA, the semen eqilibration procedure was started. Sperm were then drawn into 0.25 mL straws, frozen by automatic semen freezing and stored in a liquid nitrogen container. Pipettes were thawed after 24 h and analyses were performed.

RESULTS

Total, progressive and rapid motility values of the Control group were higher than those of the MA groups (p<0.05). However, there was no statistical difference between the Control and Group 2 in terms of these parameters. While there was no statistical difference between the groups in terms of acrosome damage and mitochondrial membrane potential, the best results were observed in Control, Group 2, Group 1 and Group 3, respectively. When we compared all groups, no difference was found in terms of MDA, CAT and GSH-Px. There was a statistical difference between Group 3 and the Control in terms of GSH level (p<0.05).

CONCLUSION

DMSO appeared to be more useful for the cryopreservation of rabbit semen compared to MA. Doi.org/10.54680/fr23610110812.

Picturing asthma in Turkey: results from the Turkish adult asthma registry

INTRODUCTION

National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention.

METHODS

Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes.

RESULTS

The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3-5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions.

CONCLUSION

The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.

Can transcription factors in the intervertebral disc of lopinavir/ritonavir prevent degeneration in the nucleus pulposus by mediating the regulation of inflammation through signaling pathways?

OBJECTIVE

This study was conducted to examine whether lopinavir/ritonavir (Lop/r), an HIV protease inhibitor, can improve disc physiology and slow down intervertebral disc (IVD) degeneration through in vitro experimental methods, as well as whether it can suppress inflammation with interleukin-1 beta (IL-1β) and sex-determining region Y (SRY) protein-related high-mobility group box genes-9 (SOX9) through hypoxia-inducible factor 1-alpha (HIF-1α) and the nuclear factor kappa B (NF-κB) signaling pathway. The aim was to investigate whether Lop/r application is toxic to IVD cells and the microenvironment simultaneously.

PATIENTS AND METHODS

Human primary cell cultures were prepared using herniated IVD tissues obtained from patients with lumbar disc hernia who were unresponsive to conservative and medical treatment, and thereby, were operated on. The untreated culture samples served as control group, and the samples treated with Lop/r served as study group. Microscopic evaluations were performed simultaneously using fluorescent and supravital dyes in all groups. In addition to cell viability, toxicity, and proliferation analysis through a commercial kit, IL-1β, SOX9, HIF-1α, and NF-κB protein expressions were evaluated using Western blotting. In the statistical comparison of the obtained data, an alpha value less than 0.05 was considered significant.

RESULTS

Cell proliferation decreased in the Lop/r group, but no cell death was observed (p < 0.05). Moreover, at the end of 72 hours after Lop/r application, IL-1β and NF-kB protein expressions decreased by 40% and 52%, respectively, while HIF-1α and SOX9 protein expressions increased by 4% and 59%, respectively (p< 0.05).

CONCLUSIONS

Although these data were obtained from an in vitro experimental study, it is believed that these findings could make significant contributions to the pharmaco-regenerative treatment modalities of IVD degeneration. Lop/r suppresses the IL-1β and NF-κB and induces SOX9 and HIF-1α, since these signaling pathways may be related to human IVD degeneration.

The External Exposome and Allergies: From the Perspective of the Epithelial Barrier Hypothesis

Introduction

In the last decades, we have seen a rapid increase in the prevalence of allergic diseases such as asthma, allergic rhinitis, atopic dermatitis, and food allergies. The environmental changes caused by industrialization, urbanization and modernization, including dramatic increases in air pollutants such as particulate matter (PM), diesel exhaust, nitrogen dioxide (NO2), ozone (O3), alarming effects of global warming, change and loss of biodiversity, affect both human health and the entire ecosystem.

Objective

In this review, we aimed to discuss the effects of the external exposome on epithelial barriers and its relationship with the development of allergic diseases by considering the changes in all stakeholders of the outer exposome together, in the light of the recently proposed epithelial barrier hypothesis.

Method

To reach current, prominent, and comprehensive studies on the subject, PubMed databases were searched. We included the more resounding articles with reliable and strong results.

Results

Exposure to altered environmental factors such as increased pollution, microplastics, nanoparticles, tobacco smoke, food emulsifiers, detergents, and household cleaners, and climate change, loss and change in microbial biodiversity, modifications in the consumption of dietary fatty acids, the use of emulsifiers, preservatives and the decrease in the antioxidant content of the widely consumed western diet may disrupt the epithelial barriers of the skin, respiratory and gastrointestinal tracts, making us more vulnerable to exogeneous allergens and microbes. Epithelial cell activation, microbial dysbiosis and bacterial translocation disrupt the immune balance and a chronic Th2 inflammation ensues.

Conclusion

Dramatic increases in air pollution, worrisome effects of global warming, dysbiosis, changing dietary habits and the complex interactions of all these factors affect the epithelial barriers and local and systemic inflammation. We want to draw attention to the emerging health effects of environmental changes and to motivate the public to influence government policies for the well-being of humans and the nature of the earth and the well-being of future generations.

Does oseltamivir protect human chondrocyte and nucleus pulposus cells from degeneration by inhibiting senescence and proinflammation mediated by the NLRP3 inflammasome and NF-κB?

OBJECTIVE

Recent drug design studies suggest that inflammation is among the most important factors in the development of both intervertebral disc (IVD) degeneration (IVDD) and osteoarthritis (OA) due to cartilage damage. This study aimed to investigate whether the anti-inflammatory drug oseltamivir has a toxic effect on IVD and cartilage tissue cells. It assessed what effect oseltamivir has on hypoxia-inducible factor (HIF)-1 alpha (HIF1α), which plays an important role in anabolic pathways in IVD and cartilage tissue. In addition, the study analyzed whether oseltamivir could inhibit the release of inflammatory interleukin-1 beta (IL-1β) via the nuclear factor kappa-B (NF-κB) signaling pathway by activating the nucleotide-binding oligomerization domain and leucine-rich repeat protein-3 (NLRP3) inflammasome.

MATERIALS AND METHODS

Human lumbar IVD (n = 8) tissues were isolated for annulus fibrosus (AF) and nucleus pulposus (NP) primary cell cultures, and human tibial and femoral cartilage tissues (n = 8) were isolated for primary chondrocyte cultures. Untreated groups served as the control and oseltamivir-treated groups as the study sample. Cell viability and cytotoxicity were evaluated at 0, 24, 48, and 72 h in all groups for changes in HIF-1α, IL-1β, NF-κB, and the NLRP3-inflammasome protein expressions using Western blotting. The α significance value was < 0.05.

RESULTS

In the oseltamivir-treated groups, cell proliferation decreased in both AF/NP cell and chondrocyte cultures obtained from IVD cartilage tissues. After Western blotting analysis, changes were observed in the protein expressions of HIF-1α, IL-1β, NF-κB, and the NLRP3 inflammasome in both AF/NP cells and chondrocytes. The results were statistically significant (p < 0.05).

CONCLUSIONS

Oseltamivir treatment may be a promising regenerative strategy to manage IVDD and osteoarthritic cartilage tissues.

The shortest distance between the skin and the peritoneal cavity is obtained with fascial elevation: a preliminary prospective laparoscopic entry study

The purpose of this study was to prospectively compare the measurement of skin-to-fascia distances in the neutral state, during manual elevation and by fascial elevation in patients who underwent laparoscopic surgery. In 53 patients, the distance between the skin and anterior wall of the rectus sheath was measured prospectively in following three different ways: (1) in neutral position, (2) during manual elevation and (3) during elevation of the fascia using forceps following an infraumbilical vertical skin incision. In all patients, subcutaneous tissue up to the fascia was dissected after a vertical skin incision. The skin-to-fascia distance of 30.9 mm (14.0-52.0 mm) in the neutral position decreased to 11.1 mm (0.0-26.0 mm) during the fascial elevation, while the mean distance increased to 40.1 mm (19-70 mm) during manual elevation (p < 0.001). In the closed laparoscopic entry technique in which a Veress needle is inserted into the peritoneum through a small incision, the needle should be introduced from the shortest distance between the skin and the peritoneum. Lifting the fascia with a proper surgical instrument in suitable patients could enable us to achieve this goal.

Effects of an acetylcholinesterase inhibitor and an N-methyl-D-aspartate receptor antagonist on inflammation and degeneration of the nucleus pulposus

OBJECTIVE

The study aimed to examine the effects of two drugs, an acetylcholinesterase inhibitor (AChEI) and an N-methyl-D-aspartate receptor (NMDAR) antagonist, on degenerated annulus fibrosus (AF) and nucleus pulposus (NP) cells and the extracellular matrix (ECM) structure in vitro.

PATIENTS AND METHODS

Tissue samples were obtained from patients with intervertebral disc herniation (four males and four females; classified as Pfirmann stage IV) and used to prepare cell cultures. Untreated cell culture samples served as the control group. Study group samples were treated with donepezil, memantine or a combination of the two drugs. Cell viability, toxicity and proliferation were evaluated in all groups. Western blotting was used to examine changes in protein expression of signal transducer and activator of transcription 3 (STAT3), phospho-STAT3 (ser727), hypoxia-inducible factor (HIF)-1 alpha (HIF-1α) and nucleotide-binding oligomerisation domain (NOD) leucine-rich repeat (LRR)-containing proteins (NLR) family pyrin domain containing 3 (NLRP3) inflammasome. The alpha significance value was < 0.05.

RESULTS

Analysis of the microscopy and commercial kit results revealed that cell proliferation was suppressed, and no cell death was observed. The protein expression levels of NLRP3, STAT3, ser727 and HIF-1α were lower in the samples treated with donepezil and memantine at 72 h (p < 0.05). The protein expression levels of NLRP3, STAT3, ser727 and HIF-1α were higher in the samples treated with the combination of donepezil and memantine (p < 0.05).

CONCLUSIONS

The combined administration of memantine a NMDAR antagonist which can prevent neurodegeneration and donepezil an AChEI used for pain relief increased the protein expression levels in the anabolic pathway. However, it did not reduce the protein expression levels in the catabolic pathway. Therefore, further studies are needed to provide extensive insight into whether it may be among the potential targets for the therapy of intervertebral disc (IVD) diseases.

Epithelial barrier hypothesis: Effect of the external exposome on the microbiome and epithelial barriers in allergic disease

Environmental exposure plays a major role in the development of allergic diseases. The exposome can be classified into internal (e.g., aging, hormones, and metabolic processes), specific external (e.g., chemical pollutants or lifestyle factors), and general external (e.g., broader socioeconomic and psychological contexts) domains, all of which are interrelated. All the factors we are exposed to, from the moment of conception to death, are part of the external exposome. Several hundreds of thousands of new chemicals have been introduced in modern life without our having a full understanding of their toxic health effects and ways to mitigate these effects. Climate change, air pollution, microplastics, tobacco smoke, changes and loss of biodiversity, alterations in dietary habits, and the microbiome due to modernization, urbanization, and globalization constitute our surrounding environment and external exposome. Some of these factors disrupt the epithelial barriers of the skin and mucosal surfaces, and these disruptions have been linked in the last few decades to the increasing prevalence and severity of allergic and inflammatory diseases such as atopic dermatitis, food allergy, allergic rhinitis, chronic rhinosinusitis, eosinophilic esophagitis, and asthma. The epithelial barrier hypothesis provides a mechanistic explanation of how these factors can explain the rapid increase in allergic and autoimmune diseases. In this review, we discuss factors affecting the planet's health in the context of the 'epithelial barrier hypothesis,' including climate change, pollution, changes and loss of biodiversity, and emphasize the changes in the external exposome in the last few decades and their effects on allergic diseases. In addition, the roles of increased dietary fatty acid consumption and environmental substances (detergents, airborne pollen, ozone, microplastics, nanoparticles, and tobacco) affecting epithelial barriers are discussed. Considering the emerging data from recent studies, we suggest stringent governmental regulations, global policy adjustments, patient education, and the establishment of individualized control measures to mitigate environmental threats and decrease allergic disease.

Examining the effects of HMG-CoA reductase inhibitors on anabolic and catabolic signaling pathway proteins associated with degenerative disc disease

OBJECTIVE

Recent evidence suggests that statins, among lipid-lowering drugs, can be used to lower serum cholesterol levels for reducing the risk of cardiovascular disease in individuals with high cholesterol, as well as reducing DNA damage and having anti-ageing and pleiotropic effects. Additionally, nuclear factor kappa B (NF-κB) is reported to be suppressed in statin-administered nucleus pulposus (NP) cells for the prevention of interleukin (IL) -1 beta (IL-1β)-induced apoptosis and extracellular matrix (ECM) degradation. The purpose of this study is the examine whether it is possible for pharmacological synthetic statin agents added into primary cell cultures obtained from human intervertebral disc tissue (IVD) to stop and eliminate tissue degeneration through the anabolic/catabolic signaling pathways associated with inflammation.

MATERIALS AND METHODS

Pitavastatin and rosuvastatin were added to monolayer grown human primary annulus fibrosus (AF)/NP cells. Cytotoxicity and proliferation analyses were carried out. AF/NP cells and ECM structure were also examined microscopically. In addition, changes in transcription factors and protein expressions of proinflammatory cytokines, which play important roles in anabolic and catabolic pathways associated with inflammation, were analyzed.

RESULTS

Decreased proliferation and cell necrosis were observed at the end of 72 hours in the samples, in which statins were added, compared to the samples in the control group to which no pharmacological agent was administered. In addition to this, changes were observed in the expressions of proteins. All results were statistically significant (p<0.05).

CONCLUSIONS

To better understand the regenerative effects of these two pharmacological agents on degenerated AF/NP cells, there is an urgent need for prospective studies in which different signaling pathways and receptors on these pathways are investigated, apart from IL-1β; NF-κB signaling pathway and SOX9.

Rational use of drugs in healthcare services: a sample of tertiary hospital

OBJECTIVE

This study aimed at evaluating physicians' attitudes towards the rational use of drugs (RUD) at a training and research hospital.

SUBJECTS AND METHODS

This cross-sectional study was conducted in a training and research hospital affiliated with the Ministry of Health between December 2014 and April 2015. All 424 active-duty physicians were asked to participate in the survey study. Of these physicians, 193 (45.5%) volunteered to respond to a 64-item survey. A total of 193 (45.5%) physicians volunteered to participate in the study. The chi-squared test, ANOVA, and multiple logistic regression analysis were used for the evaluation of the study data.

RESULTS

Of the physicians who participated in the study, 58.0% were male. Prescriptions were dispensed for 52.73% (± 27.44) of the patients, with a mean of 2.67±0.98 items per prescription. The rational use of drugs was defined as prescribing an effective drug for the patient (85.4%), prescribing an appropriate drug for the patient (84.9%), and prescribing a safe drug for the patient (77.2%). Compared to residents, the prescription preferences of specialists were affected 2-fold by follow-up visit (p=0.010, β 0.694, CI 1.180 3.396), 1-fold by patient examination percentage (p=0.002, β 0.022, CI 1.008 1.037), and 3.5-fold by prescribing iron supplements (p=0.001, β 1.274, CI 1.644 7.774) (R2 0.259, p=0.001).

CONCLUSIONS

The results of the study showed that tertiary hospital specialists and residents have similar attitudes towards patients, their prescribing preferences and RUD knowledge level. This study provides comprehensive information on physicians' attitudes towards RUD.

Intensive care nurses' evidence-based knowledge and experiences regarding closed suctioning system

Background

Endotracheal suctioning is a vital procedure performed by intensive care nurses to maintain airway patency and optimal gas exchange in critically ill patients under mechanical ventilation. As the procedure can cause several complications, intensive care nurses should have adequate evidence-based knowledge on how to perform the procedure.

Aims

This study aimed at examining intensive care nurses' knowledge and experience of the closed suctioning system. This study was a prospective, cross-sectional, descriptive, and multi-centered study conducted with 195 nurses working in the tertiary intensive care units in five Turkish hospitals.

Subjects and Methods

The data were collected with a questionnaire developed by the researchers in light of the literature. The data were evaluated with Kruskal-Wallis and Mann-Whitney U tests.

Results

The mean age of the nurses was 30.58 ± 6.28 years. The mean knowledge score of the nurses for the closed system was 27.35 ± 12.05 (range = 0-80) and 80.5% of them obtained scores ranging between 0 and 40. Also, 71.8% stated that they did not have any difficulty performing suctioning with the closed system catheter, and 85% said that they saved time with the closed system. However, 50.8% of the nurses said they were not able to suction viscous and sticky secretions efficiently, 44.6% stated they did not need to irrigate the inside of the catheter, and 45.1% of them were undecided whether the coude tip catheter led to hemorrhagic secretion more than straight tip catheter.

Conclusions

Almost one-fifth of the nurses had good scores on evidence-based knowledge of suctioning. Most of the nurses' experiences regarding the use and manipulation of the closed system were positive. However, almost half of the nurses pointed out that the closed system was not effective enough to suction viscous and sticky secretions. Regular in-service training sessions may help to improve nurses' current knowledge and experiences.

Stable and exacerbation period serum cytokine and periostin levels of the five distinct phenotypes of severe asthma

BACKGROUND AND AIM

The differences in molecular mechanisms during stable period and the changes in the inflammatory responses during exacerbations between distinct severe asthma phenotypes remain unclear. In this study, we aimed to characterize stable and exacerbation period serum cytokine and periostin levels of 5 different pre-defined severe asthma phenotypes with real-life data. Changes in the viral infection-induced exacerbations were also analyzed.

MATERIALS AND METHODS

Serum levels of 8 cytokines and periostin were measured from the sera obtained from the adult patients with five different severe asthma phenotypes based on the presence/absence of aeroallergen sensitivity, peripheral eosinophilia and chronic rhinosinusitis with nasal polyposis (CRSwNP) during stable and exacerbation periods, and from the matched controls.

RESULTS

Serum IL-13, IL-25, TSLP and periostin levels were similar between the patient and the control groups during stable and exacerbation periods. Serum IL-25 and TSLP levels, and peripheral eosinophil count and periostin level showed a strong correlation. Stable period periostin levels were significantly higher in eosinophilic patients and eosinophilic patients without long-term systemic steroid therapy had higher IL-13 levels. Compared to stable period, exacerbation period serum periostin levels found significantly lower [5853 (2309-8427) pg/mL vs. 4479 (2766-6495) pg/mL; p=0.05] and periostin levels were much more lower in viral infection-induced exacerbations [2913 (893-4770) pg/mL vs. 7094 (4782-9596) pg/mL; p=0.022].

CONCLUSION

Our study showed that serum periostin levels were decreased in viral infection-induced exacerbations and increased in the presence of eosinophilia independent from atopy and it can help to differentiate eosinophilia even if the patient is under long-term systemic steroid therapy. Also, serum IL-13 levels may reflect peripheral eosinophilia in patients without long term systemic steroid use.

POS1375 THE EFFECT OF M694V HOMOZYGOSITY ON THE CAROTID INTIMA-MEDIA THICKNESS AND FLOW MEDIATED DILATATION IN PATIENTS WITH FMF RELATED AMYLOIDOSIS

Background:

There are limited data in FMF associated AA amyloidosis patients regarding the vascular abnormalities including atherosclerosis and endothelial dysfunction, all of which are contributors of cardiovascular disease (CVD) risk. And, this risk assessment for future CV events have not yet been evaluated between FMF amyloidosis patients with different genotypes.

Objectives:

We aimed to compare early markers of endothelial dysfunction and atherosclerosis, mortality and other disease characteristics in FMF-related amyloidosis patients with a homozygous M694V genotype and in patients with other genotypes with this cross-sectional comparative study.

Methods:

For this purpose, patients with FMF-related amyloidosis were assigned according to the MEFV gene mutation to one of the two groups. Group 1: Patients homozygous for M694V (which is the most common genotype associated with the most severe clinical phenotype in FMF) Group 2: Patients homozygous (other than M694V) or compound heterozygous (including M694V) for other MEFV variants. Potential confounders were controlled by excluding the patients with untreated hypertension, diabetes mellitus, obesity, smoking, previous history of CVD low glomerular filtration rate (eGFR <70 mL/min). Flow-mediated dilatation (FMD), pentraxin-3 (PTX3) as early markers of endothelial dysfunction and carotid intima-media thickness (cIMT), fibroblast Growth Factor 23 (FGF23) as an indicator of atherosclerotic vascular disease, all of which are non-invasive tests that are also used to identify subjects at increased risk for future CV events were measured in these 2 groups.

Results:

We analyzed demographic, clinical, genetic, survival data and these non-invasive markers of endothelial dysfunction (FMD and PTX3) and atherosclerosis (cIMT and FGF23) in 76 FMF amyloidosis patients with homozygous M694V mutations (Group 1) and 93 FMF amyloidosis patients with two pathogenic mutations apart from M694V homozygosity (Group 2) (Table 1). Brachial artery FMD was significantly lower in Group 1 when compared with Group 2 subjects (6.0 vs. 6.5%, p<0.001). cIMT, FGF23 and PTX3 levels were higher in Group 1 when compared with Group 2 (cIMT: 0.84 vs. 0.67 mm, p<0.001; FGF23: 52.4 vs. 38.0 pg/dL, p=0.01; PTX3: 14.0 vs. 3.2 ng/mL, p<0.001). Time to develop amyloidosis was similar in patients homozygous for M694V (median 10.0 years, 95%CI: 8.99-11.0) and in Group 2 (median 10.0 years, 95%CI: 8.97-11.0) (p>0.05). Mortality rate was significantly higher in Group 1 compared to Group 2 (18.4% vs. 1.1%, p<0.001) over a median of 7.8 years of follow-up. FMF amyloidosis patients homozygous for M694V had reduced survival (mean survival: 97 months, 95%CI: 94.9 to 101.0 months) as compared to Group 2 (mean survival: 100.7 months, 95%CI: 100.0 to 101.3 months) (p<0.001) (Figure 1). The proportion of the clinical manifestations including fever, serositis, erysipelas-like erythema, all of which are associated with an FMF attack did not differ between two groups (p>0.05) apart from arthritis (76.3% in Group 1 and 59.1% in Group 2, p<0.05) (Table 1).

Conclusion:

In patients with FMF related amyloidosis, M694V homozygosity is associated with lower FMD values and higher cIMT, FGF23 and PTX3 levels. In summary, the data demonstrate that a genotype-phenotype association exists in terms of endothelial dysfunction and atherosclerosis in FMF patients with amyloidosis.

Table 1.Group 1 (n=76)Group 2 (n=93)Total (n=169)pClinical Findingsn (%)n (%)n (%)Dialysis2 (2.6)3 (3.2)5 (3.0) 1.00*Kidney transplantation5 (6.6)4 (4.3)9 (5.3)0.73*Kidney biopsy68 (89.5)85 (91.4)153 (90.5)0.67Median(Min-max)Median(Min-max)Median(Min-max)Age (years)36.5 (19.0-49.0)35.0 (22.0-49.0)36.0 (19.0-49.0)0.16Age of amyloidosis (years)20.0 (13.0-31.0)20.0 (15.0-26.0)20.0 (13.0-31.0)0.86BMI (kg/m2)26.0 (21.0-32.0)27.0 (19.0-32.0)26.6 (29.0-32.0)0.89HOMA2.2 (1.2-7.3)2.4 (1.1-8.4)2.4 (1.1-8.4)0.40Proteinuria (g/24h)7.64,65.4<0.001

Disclosure of Interests:

None declared

Pharmaco-molecular assessment of the effects of anandamide and its antagonists on hippocampal tissue in Wistar albino rats

OBJECTIVE

The members of the matrix metalloproteinase (MMP) family and cannabinoids (CBs) are reportedly associated with hippocampus-dependent memory functions. However, the effects of endogenously formed CBs on hippocampal long-term potentiation remain unknown. The present study aimed to investigate the changes in the gene and protein expression levels of matrix metallopeptidase 9 (MMP-9), phosphatase and tensin homolog (PTEN), and NOTCH receptor 1 (NOTCH1) in rat hippocampal tissues treated with anandamide (AEA), AM251, 6-iodopravadolin (AM630), and N-[4-{[(3,4-Dimethyl-5-isoxazolyl)amino]sulfonyl}phenyl] (ML193).

MATERIALS AND METHODS

The subjects were divided into 10 groups (n = five per group). The pharmaceuticals were administered via intraperitoneal injection once a day for seven days, except for the control group. The resected hippocampal tissues were then evaluated using a quantitative real-time polymerase chain reaction (RT-qPCR) and Western blot analysis. The data obtained were statistically analyzed, and p < 0.01 was considered statistically significant.

RESULTS

Contrary to the literature, the changes in MMP-9 expression were not statistically significant, but the changes in PTEN and NOTCH1 were. The findings of this in vivo experimental study revealed that the agonists and antagonists acting on the CB system have significant molecular effects on hippocampal tissue.

CONCLUSIONS

The changes in gene and protein expressions may be one of the reasons for the neurodegenerative processes observed in patients using these agonists and antagonists, whose effects on the CB system have not been fully explained yet. Our study can contribute to the literature as it is the first study investigating the MMP-9, PTEN and NOTCH1 gene and protein expression.

The protective effects of thymoquinone on lung damage caused by cigarette smoke

Chronic obstructive pulmonary disease (COPD) is characterized by systemic inflammation that usually is caused by exposure to noxious particles or gases. Thymoquinone (TQ) prevents the production of inflammatory mediators, such as thromboxane B2 and leukotriene, by altering arachidonic acid metabolism. We investigated the preventive and curative effects of TQ on lung damage in rats caused by cigarette smoke (CS). We used 50 adult male rats, 30 of which were exposed to CS every day for 3 months. TQ in dimethylsulfoxide (DMSO) was administered intraperitoneally (i.p.) every day to ten animals to investigate the protective effects of TQ, and to ten other animals during the last 21 days to investigate the curative effect. Ten rats received saline for the last 21 days. Ten subjects were untreated controls. Ten controls that were not exposed to CS received TQ for the last ten days. Serum IL-8, IL-6, IL-1β and MMP-9 levels were measured using ELISA. IL-1β and IL-8 levels were elevated in the group exposed to CS compared to controls. IL-8 levels were decreased in the group that received only TQ compared to controls, which indicated the anti-inflammatory effect of TQ. The apoptotic index (AI) was increased in all groups that were exposed to CS compared to controls. The AI index was decreased in the group that received TQ for the last 21 days compared to the other CS groups. AI was increased in the group that received TQ daily compared to the other CS groups. Our findings indicate that TQ exerts curative effects for the inflammation caused by CS and may prevent apoptosis if administered in appropriate doses; however, long term TQ or DMSO exposure may produce cumulative toxic effects.

DICER1 Hotspot Mutations in Pleuropulmonary Blastoma: A Case Series From a Tertiary Center

Pleuropulmonary blastoma (PPB) is a potentially aggressive, rare childhood neoplasia. We investigated histopathological features, survival, and DICER1 hotspot mutations among PPB patients. Archive records at our institution were reviewed, covering a 20-year period. Thirteen children (6 males and 7 females) with a mean age of 30.5 (range 6-83) months were included. The tumor subtypes were type I in 6 (46%), type II in 4 (31%), and type III in 3 (23%). Only tumors with type II and type III histology showed anaplasia (4/7, 57%). Median follow-up was 28 (range 9-216) months. Three-year overall survival rate was 83.3% and 3-year progression-free survival rate was 25%. Progression was seen in 60% (3/5) of type I and 66.7% (4/6) of type II and type III cases. Two patients died of disseminated disease at 9 and 44 months. Hotspot missense mutations on DICER1 gene were detected in all 11 patients with available tumor tissue. We found an additional novel germline loss-of-function mutation (c.5436dupT; p.E1813*) in 1 case. To the best of our knowledge, this is the first study to investigate hotspot missense mutations on DICER1 gene among the largest series of Turkish children with PPB.

Efficacy of mepolizumab treatment in oral corticosteroid-dependent severe eosinophilic asthma patients with chronic rhinosinusitis with nasal polyps: single center, real life study

Background/aim

Oral corticosteroid (OCS)-dependent severe eosinophilic asthma with chronic rhinosinusitis with nasal polyps (SEA-CRSwNP) would be a suitable phenotype for mepolizumab treatment. This study evaluated the short-term efficacy of mepolizumab treatment in OCS-dependent SEA-CRSwNP.

Materials and methods

Baseline and 24th week results [daily OCS doses, asthma exacerbation frequency, asthma control test (ACT) scores, blood eosinophil levels, FEV1 values, and numerical analog scale (NAS) of CRSwNP symptoms] of patients who were treated for at least 24 weeks with mepolizumab were retrospectively evaluated and compared.

Results

A total of 16 patients were enrolled in the study. Mepolizumab was discontinued in one patient due to side effects. The daily OCS dosage was reduced from baseline in all patients, and at week 24 OCS was discontinued in 40% of the patients (baseline mean steroid dose: 9.2 ± 5.2 mg, 24th week: 1.3 ± 1.4 mg; P < 0.001). The number of asthma exacerbations within 24 weeks significantly decreased after beginning mepolizumab treatment (2.1 ± 2.7 vs. 0.07 ± 0.26; P = 0.012), and a significant increase in ACT scores (baseline mean ACT: 18 ± 5.7; 24th week mean ACT: 23.3 ± 3; P = 0.006) was observed despite the decrease in daily OCS dosages. There was no significant difference in FEV1 values between baseline and week 24. Evaluation of the general symptoms of CRSwNP, as per NAS, revealed that the baseline mean NAS was 5.6 ± 4.4, and the 24th week mean NAS was 3.2 ± 3.2 (P = 0.021).

Conclusion

This is the first real-life study evaluating the short-term efficacy of mepolizumab treatment on OCS-dependent SEA-CRSwNP. This study demonstrates that mepolizumab is an effective and safe biologic for the treatment of this severe asthma subphenotype.

Neuronal regeneration in injured rat spinal cord after human dental pulp derived neural crest stem cell transplantation

OBJECTIVE

This study aimed to analyze the effect of human Dental Pulp-Neural Crest Stem Cells (hDP-NCSCs) delivery on lesion site after spinal cord injury (SCI), and to observe the functional recovery after transplantation.

METHODS

Neural Crest Stem Cells (NCSCs) were isolated from human Dental Pulp (hDP). The experimental rat population was divided into four groups (n = 6/24). Their behavioral motility was scored regularly. After 4-weeks, rats were sacrificed, and their spinal cords were examined for Green Fluorescent Protein (GFP) labeled hDP-NCSCs by immunofluorescence (IF) staining.

RESULTS

In early post-injury (p.i) period, the ultrastructure of spinal cord tissue was preserved in Group 4. The majority of cells forming the ependymal region around the central canal were found to be hDP-NCSCs. While the grey-and-white-matter around the ependymal region was composed of e.g. GFP cells, with astrocytic-like appearance. The scores showed significant motor recovery in hind limb functions in Group 4. However, no obvious change was observed in other groups.

CONCLUSION

Cells e.g., mesenchymal (Vimentin+) which express GFP+ cells in the gray-and-white-matter around the ependymal region could indicate the potential to self-renewal and plasticity. Thus, transplantation of hDP-NCSCs might be an effective strategy to improve functional recovery following spinal cord trauma (Fig. 10, Ref. 32).

Cold-pressed pumpkin seed (

There is a growing interest in cold-pressed oils because they present high contents of bioactive compounds. These oils have the characteristic properties of seeds and are specific products of their regions. The aim of this study was to determine the compositions and contents of fatty acids, phytosterols, squalene, tocols, phenolic acids, carotenoids and phenolic bioactives, and the free radical scavenging as well as antioxidant activities of cold-pressed pumpkin (Cucurbita pepo L.) seed oils. Oil samples from raw pumpkin seeds cultivated in four different central Anatolia regions of Turkey were prepared using a laboratory screw-pressing machine. The results indicate that cold-pressed pumpkin seed oils (PSO) have excellent quality with high contents of polyunsaturated fatty acids (%ΣPUFAs) (53.60 ±0.06-53.73 ±0.05), total phytosterols (782.1±9.7–805.2 ±11.3 mg/100 g oil), squalene (591.3±10.6–632.5±11.4 mg/100 g oil), tocols (97.79 ±0.76?94.29 ±0.34 mg/100 g oil), phenolic acids (22.73 ±0.41–23.98 ±0.46 mg/100 g oil), carotenoids (6.95 ±0.03–7.60 ±0.03 mg/100 g oil), total phenolics (3.96 ±0.13 –5.82±0.15 mg GAE/100 g), free radical-scavenging activity (5.70 ±0.13?7.35 ±0.15 mg GAE/100 g) and total antioxidant activity (26.67±0.97-38.89±1.41 mg GAE/100 g) values. Thus, this study demonstrates that the cold- pressed PSOs from the central Anatolia regions of Turkey are an excellent source of natural bioactive compounds, free of chemical contaminants and nutritious.

Chondrocyte proliferation, viability and differentiation is declined following administration of methylphenidate utilized for the treatment of attention-deficit/hyperactivity disorder

PURPOSE

Methylphenidate (MPH) derivative drugs are used because of psychostimulants effects on attention-deficit hyperactivity disorder in children and adults. As far as we know, toxic or anti-proliferative effects of MPH against cartilage tissue were not studied in the literature. The present study was carried out to investigate the possible effects of MPH on the proliferation, viability and differentiation of primary human chondrocytes, in vitro.

METHODS

Monolayer primary chondrocyte cultures were prepared using osteochondral tissue obtained from patients who underwent a total knee prosthesis operation. Stock solution of MPH was prepared and aliquots having 1-1000 µM concentrations of the drug was composed. These solutions were applied to the wells containing cultured chondrocyte samples within the well plates. Control groups were composed of pure chondrocyte culture and no solution was added into them. All groups were evaluated at 24, 48 and 72 h in order to determine the possible negative effects of the drug on the chondrocytes. The data were evaluated by Tukey's honestly significantly different test following analysis of variance.

RESULTS

In the group where MPH was applied, it was found that viability, proliferation and stage-specific embryonic antigen-1 protein expression were decreased in comparison to the control group.

CONCLUSIONS

It was emphasized that clinicians should not disregard the fact that this drug might suppress chondrocyte cell proliferation and chondrogenic differentiation.

Changes in pupil size following panretinal retinal photocoagulation: conventional laser vs pattern scan laser (PASCAL)

PurposeTo evaluate and compare the possible changes in pupil size subsequent to panretinal laser photocoagulation (PRP) via conventional laser and pattern scan laser (PASCAL).Patients and methodsForty eyes of 40 patients with diabetic retinopathy were included. 20 eyes had a PRP via conventional laser and formed Group 1. 20 eyes had a PRP via PASCAL laser and formed Group 2. The participants underwent standard ophthalmologic examination at baseline. Automated infrared pupillometry were performed at baseline and month 1.ResultsThe mean pupillary measurements (mm) for Group 1 (in the order photopic, mesopic, and scotopic conditions) were 2.88±0.34, 3.38±0.40, and 3.95±0.38, and changed to 3.64±0.42, 4.18±0.42, and 4.58±0.48, respectively. There was significant increase in pupil size at month 1 (P<0.001, P<0.001, and P<0.00, respectively). For Group 2, they were 2.90±0.38, 3.43±0.36, and 3.90±0.40, and changed to 3.18±0.42, 3.74±0.36, and 4.10±0.38, respectively. There was significant increase in pupil size at month 1 (P=0.018, P=0.014, and P=0.014, respectively). The pupil size increased significantly in both groups in all illumination conditions.ConclusıonWe have demonstrated via automated infrared pupillary measurements that PRP may significantly increase pupil size whether it is performed with conventional laser or PASCAL laser.

Association of apelin, endoglin and endocan with diabetic peripheral neuropathy in type 2 diabetic patients

OBJECTIVE

Diabetic peripheral neuropathy is a common complication of type-2 diabetes mellitus. Endocan, apelin and endoglin are thought to be associated with endothelial dysfunction, angiogenesis and inflammation. In this study, we planned to evaluate these markers in diabetic peripheral neuropathy patients.

PATIENTS AND METHODS

This single-blind, controlled clinical study was conducted on 99 type 2 diabetic patients with or without diabetic peripheral neuropathy and 53 healthy volunteer controls. Physical and laboratory examinations were done in all groups. In these groups, Endoglin, apelin and endocan levels were measured with ELISA method.

RESULTS

Endoglin, apelin and endocan concentrations in diabetic peripheral neuropathy patients were higher than other diabetes mellitus patients and healthy controls. Similarly, diabetes mellitus patient's endoglin, apelin and endocan levels were higher than healthy controls. The differences were statistically significant. We detected a significant positive correlation between endoglin, apelin and endocan levels in all groups.

CONCLUSIONS

Endoglin, apelin and endocan may reflect angiogenesis and endothelial dysfunction in diabetic peripheral neuropathy and they may be used as a marker in the future.

Evaluation of SCUBE-1 and sCD40L biomarkers in patients with hypothyroidism due to Hashimoto's thyroiditis: a single-blind, controlled clinical study

OBJECTIVE

This study was performed to investigate the levels of platelet activation marker SCUBE-1 and sCD40L which plays some role in the progression of atherosclerosis, in patients with hypothyroidism due to Hashimoto's thyroiditis.

PATIENTS AND METHODS

The cohort of this study includes 90 patients and 35 healthy volunteers, who admitted to the internal medicine out-patient. Simultaneously in the same samples; SCUBE-1 and sCD40L measurements were accomplished by enzyme-linked immunosorbent assay (ELISA). The data obtained were analyzed statistically.

RESULTS

Hypothyroidism due to Hashimoto's thyroiditis in comparison to the control group that includes healthy volunteers; SCUBE-1 and sCD40L, were increased. And these results were statistically significant (p < 0.05).

CONCLUSIONS

SCUBE-1 and sCD40L levels were increased in Hashimoto's hypothyroidism patients. This may indicate an increased endothelial dysfunction, platelet activation and cardiovascular risk in hypothyroidism. SCUBE-1 and sCD40L may be helpful in cardiovascular risk assessment of hypothyroid patients.

Effects of Lycium barbarum on bacterial translocation in thioacetamide-induced liver injury in rats

Background and study aim:

The aim of the present study was to investigate the effects of Lycium barbarum (LB) on bacterial translocation (BT) frequency in thioacetamide (TAA)-induced liver injury in rats.

Materials and methods:

Group 1 was the control. In group 2 (TAA), rats received TAA daily for 3 days. In group 3 (TAA+LB), Lycium barbarum was administered orally 25 mg/kg for 21 days prior to the first TAA injection. In group 4 (LB), rats received only Lycium barbarum.

Results:

In our study, Lycium barbarum treatment did not attenuate liver damage. Lycium barbarum treatment decreased ileal E. coli counts and intestinal damage but it did not alter BT frequency.

Conclusions:

In conclusion, the effects of Lycium barbarum on BT may be related to ongoing severe liver damage in this model.

Differentiation Potential of Mouse Embryonic Stem Cells into Insulin Producing Cells in Pancreatic Islet Microenvironment

BACKGROUND

The differentiation capacity of embryonic stem cells (ESCs) has great promise for type-1 diabetes for cellular treatment. Therefore, different strategies have been reported so far for derivation of insulin producing cells (IPCs) from ESCs. Providing similar microenvironmental conditions as in vivo, functional differentiation of stem cells into desired cell types could be obtained in vitro. The aim of the present research was to utilize differentiation potential of ESCs to IPCs by co-culture with mouse pancreatic islets (mPIs) for the first time.

METHODS

We present an in-direct differentiation protocol which compared with a conventional differentiation protocol. Novel in-direct co-culture differentiation protocol in which mPIs induced differentiation of ESCs into IPCs was used. This technique was compared with the chemical differentiation protocol that involved supplementing the differentiation media with specific growth factors. We analyzed differentiated cells in both groups by immune labelling, gene expression and protein secretion.

RESULTS

IPCs were obtained with in-direct co-culture within 30 days. Differentiated ESCs were found to be positive for IPC specific markers, Pdx1, Insulin, C-peptide, Glut2 and MafA. The results of immunocytochemical and gene expression analysis showed higher differentiation efficiency in co-culture group than chemical differentiation group. These results were confirmed by the response assay to high glucose levels with ELISA for insulin.

DISCUSSION

Our findings illustrate the significant effect of co-culture in different stages of differentiation and maturation of ESCs in vitro. We have developed an efficient and easy way to differentiate ESCs into IPCs, which possess similar characters of mature insulin positive cells.

The effects of thiamine and thiamine pyrophosphate on alcohol-induced hepatic damage biomarkers in rats

OBJECTIVE

This study examined the effects of thiamine and thiamine pyrophosphate on oxidative damage developing in association with hepatic injury caused by alcohol toxicity in rats and on hepatic injury markers.

MATERIALS AND METHODS

Four groups of rats were used; control, a group receiving thiamine+ethanol, a group receiving thiamine pyrophosphate+ethanol and a healthy group. The experimental protocol was repeated over 30 days. Malondialdehyde, glutathione and DNA damage product levels in liver tissue were measured at the end of the study. Alanine amino transferase and aspartate amino transferase, markers of liver damage, levels were determined. The results were then compared among the groups.

RESULTS

A statistically significant difference between antioxidant markers and markers of liver damage was determined between the group given thiamine pyrophosphate ethanol and the group given ethanol alone (p < 0.01) No statistically significant difference was observed between the group given thiamine and ethanol and the group given ethanol alone (p > 0.01).

CONCLUSIONS

Our results suggest that thiamine pyrophosphate may have a protective effect against liver damage caused by alcohol toxicity.

How do patients with asthma and COPD behave during fasting?

BACKGROUND-OBJECTIVE

Several factors might affect the adherence to treatment in patients with asthma and COPD. Among these factors, the effect of religious beliefs and behaviours has been less studied so far. In this study, the effect of fasting on drug use behaviours of patients with asthma and COPD were comparatively analysed.

METHODS

A total of 150 adult patients with asthma and 150 adult patients with COPD were consecutively enrolled into this cross-sectional study. The patients were asked whether they fast during Ramadan and if the answer was yes, they were kindly asked to respond to further questions related to use of inhaled medications during that particular time.

RESULTS

The majority of the cases from both groups [98 (65.3%) of asthma patients and 139 (92.6%) of COPD] were fasting during Ramadan. The majority of the patients with COPD (n=126; 90.6%) reported that they quitted their regular therapy basis during Ramadan. On the other hand, the majority of asthma patients used their controller inhaled medications during Ramadan and preferred to use them on iftar and sahur times (n=81, 82.6%).

CONCLUSION

Our results showed that in a Muslim population, the patients with asthma and COPD do not feel their diseases to be an inhibitory factor for fasting during Ramadan. However, fasting seems to be an important determining factor in medication compliance by modifying the drug use behaviours in each group in a different way. Therefore, the patients should be informed about the effects of fasting on their disease and the allowed drugs during fasting.

En-bloc pelvic resection with concomitant rectosigmoid colectomy and immediate anastomosis as part of primary cytoreductive surgery for patients with advanced ovarian cancer

OBJECTIVE

To assess the authors' experiences in en bloc pelvic resection with concomitant rectosigmoid colectomy and primary anastomosis as a part of primary cytoreductive surgery for patients with advanced ovarian cancer.

MATERIALS AND METHODS

Atotal of 22 patients with FIGO Stage IIB-IV epithelial ovarian cancer who underwent en bloc pelvic resection with anastomosis were retrospectively reviewed. Data analyses were carried out using SPSS 10.0 and descriptive statistics, Kaplan-Meier survival curves, and Log Rank (Mantel-Cox) test were used for statistical estimations.

RESULTS

Median age was 58.8 years. FIGO stage distribution of the patients was; one (4.5%) IIB, three (13.7%) IIC, three (13.7%) IIIA, six (27.3%) IIIB, and nine (40.9%) IIIC. Median peritoneal cancer index (PCI) was 8 (range 5-22) and optimal cytoreduction was achieved in 18 patients (81.8%) of whom 13 (59.1%) had no macroscopic residual disease (complete cytoreduction). There was no perioperative mortality. A total of nine complications occurred in seven (31.8%) patients. Anastomotic leakage was observed in one (4.5%) patient. There was no re-laparotomy. Mean follow-up time was 60 months. There were 15 (68.2%) recurrences of which 12 (80%) presented in extra-pelvic localizations. Mean disease-free survival (DFS) and overall survival (OVS) were estimated as 43.6 and 50.5 months, respectively. Patients with complete cytoreduction had a better DFS (p = 0.006) and OVS (p = 0.003) than those with incomplete cytoreduction.

CONCLUSION

En bloc pelvic resection, as a part of surgical cytoreduction, seems to be a safe and effective procedure in many patients with advanced ovarian cancer if required. Despite relatively high general complication rate, anastomosis-related morbidity of this procedure is low as 0.8%. Nevertheless, surgical plan and perioperative care should be personalized according to medical and surgical conditions of the patient.

Cat and dog sensitization in pet shop workers

BACKGROUND

Sensitivity and symptoms related to animal proteins have been investigated in various occupational groups. However, data from pet shops are limited.

AIMS

To investigate rates of sensitivity to cats and dogs among pet shop workers, to assess the relationship between sensitivity, allergen levels and symptoms and to investigate whether passive transport from pet shops to homes is possible.

METHODS

Pet shop workers underwent interviews with a questionnaire adapted from the European Community Respiratory Health Survey. Dust samples for allergen detection were collected from pet shops using a vacuum cleaner. Skin tests were performed with common allergens. Dust samples were also obtained from the houses of 7 workers and 12 control subjects.

RESULTS

Fifty-one workers from 20 pet shops were included in the study. Thirteen (25%) workers reported work-related symptoms. Four workers had sensitivity to animal allergens. The mean cat/dog allergen levels from pet shops were 15.7 and 3.2 µg/g, respectively. There was no significant relationship between cat/dog allergen levels and work-related symptoms and sensitivity to pets. None of the dust samples collected from the homes of pet shop workers contained cat allergens. Dog allergen was detected in only one house (0.58 µg/g). Neither cat nor dog allergens were found in the homes of the 12 control subjects.

CONCLUSIONS

Although a quarter of pet shop workers reported work-related symptoms, sensitivity to cat and dog was low. These findings suggest that work-related symptoms may be due to other factors than cat and dog sensitivity.

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

Background

Invasive pulmonary aspergillosis (IPA) is an infection often occurring in neutropenic patients and has high mortality rates. In recent years, it has been reported that the incidence of IPA has also increased in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study is to investigate the clinical and demographic characteristics and treatment responses of IPA in patients with COPD.

Methods

Seventy-one patients with a positive culture of Aspergillus from lower respiratory tract samples were examined retrospectively. Eleven (15.4%) of these patients, affected with grade 3 or 4 COPD, had IPA.

Results

Aspergillus hyphae were detected in lung biopsy in three (27.3%) out of 11 patients and defined as proven IPA; a pathological sample was not taken in the other eight (72.7%) patients, and these were defined as probable IPA. Aspergillus isolates were identified as six cases of Aspergillusfumigatus and three of Aspergillusniger in nine patients, while two isolates were not identified at species level. While five patients required intensive care unit admission, four of them received mechanical ventilation. The most common finding on chest X-ray and computed tomography (CT) (respectively 63.6%, 72.7%) was infiltration. Amphotericin B was the initial drug of choice in all patients and five patients were discharged with oral voriconazole after amphotericin B therapy. Six patients (54.5%) died before treatment was completed.

Conclusions

IPA should be taken into account in the differential diagnosis particularly in patients with severe and very severe COPD presenting with dyspnea exacerbation, poor clinical status, and a new pulmonary infiltrate under treatment with broad-spectrum antibiotics and steroids.

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

Background: Invasive pulmonary aspergillosis (IPA) is an infection often occurring in neutropenic patients and has high mortality rates. In recent years, it has been reported that the incidence of IPA has also increased in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study is to investigate the clinical and demographic characteristics and treatment responses of IPA in patients with COPD. Methods: Seventy-one patients with a positive culture of Aspergillus from lower respiratory tract samples were examined retrospectively. Eleven (15.4%) of these patients, affected with grade 3 or 4 COPD, had IPA. Results: Aspergillus hyphae were detected in lung biopsy in three (27.3%) out of 11 patients and defined as proven IPA; a pathological sample was not taken in the other eight (72.7%) patients, and these were defined as probable IPA. Aspergillus isolates were identified as six cases of Aspergillusfumigatus and three of Aspergillusniger in nine patients, while two isolates were not identified at species level. While five patients required intensive care unit admission, four of them received mechanical ventilation. The most common finding on chest X-ray and computed tomography (CT) (respectively 63.6%, 72.7%) was infiltration. Amphotericin B was the initial drug of choice in all patients and five patients were discharged with oral voriconazole after amphotericin B therapy. Six patients (54.5%) died before treatment was completed. Conclusions: IPA should be taken into account in the differential diagnosis particularly in patients with severe and very severe COPD presenting with dyspnea exacerbation, poor clinical status, and a new pulmonary infiltrate under treatment with broad-spectrum antibiotics and steroids.

Does drug compliance change in asthmatic patients during pregnancy?

Background: Pregnant women with asthma are recommended to maintain optimal therapeutic management during pregnancy. Uncontrolled, symptomatic asthma may increase the risk of adverse peri-natal outcomes; thus adequate regular anti-asthmatic treatment must be given to provide optimal asthma control during pregnancy. However, doubts about the safety of asthmatic drugs can affect pregnant asthmatic patients’ drug compliance. The aim of this study was to assess behavioral differences in drug compliance among pregnant asthmatic patients. Methods: Thirty two asthmatic and 121 healthy pregnant women were enrolled in the study. Structured face-to-face interviews were conducted after delivery. The interviews included disease characteristics, drug compliance and patients’ own perspective for asthma status prior to and during pregnancy. In addition, medical and pregnancy history, pregnancy complications and outcomes, and newborn characteristics were recorded. Results: In our study group the rates of hospitalization, emergency room visits and systemic steroid use in the year before pregnancy were 13%, 46.9% and 18.8%, respectively. The rate of regular asthma medication use was only 32% at that period and increased to 44% during pregnancy. However, hospitalization, emergency room visits, systemic steroid usage rates remained unchanged and according to patients’ own evaluations, 44% of asthmatics pointed out that their asthma had worsened during pregnancy. No statistically significant difference was detected in terms of pregnancy/labour complication between asthmatic and non-asthmatics. Conclusions: Contrary to some previous studies, in our study regular use of asthma drugs increased during pregnancy. The uncontrolled condition of their asthma before and during pregnancy and the idea that their asthma worsened during pregnancy might force the patients to use medication more regularly.

Self-reported knowledge and approaches toward complementary and alternative medicine among physicians dealing with allergic diseases

Considering the popularity of Complementary and Alternative Medicine (CAM) in allergic patients, physicians involved in allergic patients' care need to be aware of CAM. To assess self-reported knowledge, attitude and approach to CAM of physicians who deal with allergic patients, a total of 500 structured questionnaires were distributed to physicians who participated in "Turkish National Society of Allergy and Clinical Immunology Congress-2009". For the questionnaires handed out, 242 (48.4%) physicians (median age 36.0 years, range 25-64 years) responded; 22.4% were fellows in training and 48.5% were residents. The main specialties were pediatrics (49.3%), and pulmonology (36.8%); half were either specialists or training in allergy and one-quarter (25.6%) referred patients to CAM. Asthma (42.1%) and chronic urticaria (28.9%) were the most common CAM referral diseases. Referred therapies were herbal (10.3%) and diet-based medicine (7.4%). The differences between physicians in terms of age, gender, experience in medicine, and specialty/allergy subspecialty were not statistically significant (p = 0.01). Affiliation to a university hospital was significantly associated with no CAM referral vs. affiliation in a state/private hospital or private practice. Academic degree and reported level of knowledge negatively/positively affected attitudes toward CAM, respectively. More than half of the respondents (68.8%) reported lack of or insufficient information about CAM, while 58.7% of physicians desired CAM education. This first report on physicians involved in allergic patients' care shows that they are reluctant to refer for CAM therapies. A minority believes that they have enough knowledge, and most are interested in continuing medical education on CAM. Considering physicians' interest and tendency to communicate significantly with their patients about CAM when they feel that they have sufficient knowledge and popularity of CAM among patients, training possibilities should be created to improve physicians' education in this field.

Biphasic anaphylaxis to gemifloxacin

Anaphylaxis have been documented as adverse effects of ciprofloxacin, ofloxacin, norfloxacin, levofloxacin, and moxifloxacin. However resistant and biphasic anaphlylactic reactions to gemifloxacin have not been reported to date. Management of severe anaphylaxis in the elderly can be complicated by concurrent medications such as beta (β) adrenergic, alpha (α) adrenergic blockers and angiotensin-converting enzyme (ACE) inhibitors. We report here in the case of a 60-year-old male who was taking on ACE inhibitor, α and β blockers and experienced a severe, resistant and biphasic anaphlylactic reaction to gemifloxacin mesylate.

Prevalence of aspirin-exacerbated respiratory disease in patients with asthma in Turkey: a cross-sectional survey

BACKGROUND

There are no country-based data focused on aspirin (ASA)-exacerbated respiratory disease (AERD) in Turkey.

OBJECTIVE

To assess the prevalence of AERD in adult patients with asthma.

METHODS

A structured questionnaire was administered via face-to-face interview by a specialist in pulmonology/allergy at seven centres across Turkey.

RESULTS

A total of 1344 asthma patients (F/M: 1081/263: 80.5%/19.5%, mean age: 45.7 ± 14.2 years) were enrolled. Atopy rate was 47%. Prevalence of allergic rhinitis, chronic rhinosinusitis/rhinitis, and nasal polyposis (NP) were 49%, 69% and 20%, respectively. Of 270 patients with NP, 171 (63.3%) reported previous nasal polypectomy and 40 (25%) had a history of more than three nasal polypectomies. Aspirin hypersensitivity was diagnosed in 180 (13.6%) asthmatic patients, with a reliable history in 145 (80.5%), and oral ASA provocation test in 35 (19.5%) patients. Clinical presentations of ASA hypersensitivity were respiratory in 76% (n=137), respiratory/cutaneous in 15% (n=27), and systemic in 9% (n=16) of the patients. Multivariate analysis indicated that a family history of ASA hypersensitivity (p: 0.001, OR: 3.746, 95% CI: 1.769-7.929), history of chronic rhinosinusitis/rhinitis (p: 0.025, OR: 1.713, 95% CI: 1.069-2.746) and presence of NP (p<0.001, OR: 7.036, 95% CI: 4.831-10.247) were independent predictors for AERD.

CONCLUSION

This cross-sectional survey showed that AERD is highly prevalent among adult asthmatics and its prevalence seems to be affected by family history of ASA hypersensitivity, history of rhinosinusitis and presence of NP.

Seasonal variation of secondary post tonsillectomy hemorrhage rates

OBJECTIVE

To investigate the seasonal variation of secondary post-tonsillectomy hemorrhage.

MATERIALS AND METHODS

Tonsillectomy cases performed using the cold dissection method between 1998 and 2008 at 5 distinct health centers affiliated with the Baskent University were retrospectively reviewed.The seasonal distribution of hemorrhage cases was assessed and the rates of hemorrhage were compared with average air temperature in each region.

RESULTS

A total of 4118 patients who underwent tonsillectomy the cold dissection method were included in this study. Post-tonsillectomy hemorrhage occurred in 71 (1.7%) patients. Intraoperative bleeding control was provided with bipolar cautery in 65 (91.5%) cases and bipolar cautery and suture in 6 (8.5%) cases. The season and air temperature had a significant influence on secondary post-tonsillectomy hemorrhage with a significant increase in secondary post-tonsillectomy hemorrhage cases during the winter months (p < 0.05).

CONCLUSION

In our study, we found an overall of secondary hemorrhage of 1.7%. Secondary post tonsillectomy hemorrhage showed seasonal variations. In patient at high risk of bleeding, avoiding from tonsillectomy during winter months my reduce the probability of secondary hemorrhage.

Effect of Different Packaging Methods and Storage Temperature on Microbiological and Physicochemical Quality Characteristics of Meatball

The objective of this research was to determine physicochemical changes and microbiological quality of the different packaged meatball samples. Meatball samples in polystyrene tray were closed with polyethylene film (PS packs), vacuumed and modified atmosphere packaged, (MAP) (65% N2, 35% CO2), and held under refrigerated display (4 °C) for 8, 16 and 16 days for PS packs, vacuum and MAP, respectively. Microbial load, free fatty acids and thiobarbituric acid values of the samples tended to increase with storage time. Bacteria counts of the raw meatball samples increased 2 log cycles at the end of storage compared with initial values. Meatball samples can be stored without any microbiological problem for 7 days at 4 °C. Results from this study suggested that shelf-life assigned to modified-MAP and vacuum-packed meatballs may be appropriate. Meatball samples underwent physical deformation when they were packed before vacuum process. With these negative factors considered, MAP is superior to other two packs methods.