Effect of Modulator Therapies on Nutritional Risk Index in Adults with Cystic Fibrosis:A Prospective Cohort Study

Background: Modulator therapies improve weight and body mass index (BMI) in cystic fibrosis (CF) patients. We aimed to compare the nutritional risk index (NRI) in adult CF patients receiving modulator (MT) or only non-modulator (conventional) therapies (non-MT). Methods: A single-center prospective cohort study was conducted between June and December 2023. The NRI based on weight gain and albumin was calculated at beginning and end of a 12-week period in both groups. This design was pragmatic, since it was based on individual patient access to MT for 12 weeks. Results: In total, 107 patients were included [mean (SD) age: 23.85 (4.98) years, 54.7% male, 46.7% MT]. In the MT group, mean (SD) weight (kg) and albumin (g/dL) increased significantly [changes: +3.09 (2.74) and +0.17 (0.37); p &lt; 0.001]. In the non-MT group, weight and albumin decreased significantly [changes: -0.99 (1.73) and -0.12 (0.30); p &lt; 0.001]. Compared to the MT group, baseline mean (SD) NRI in the non-MT group was significantly higher [100.65 (11.80) vs. 104.10 (10.10); p = 0.044]. At the end of the 12 weeks, mean (SD) NRI in the MT group was higher than in the non-MT group [104.18 (10.40) vs. 102.58 (12.39); p = 0.145]. In the MT group, the NRI category improved in 22 (44%), and worsened in 3 (6%) patients (p &lt; 0.001). In the non-MT group, the NRI category improved in 2 (3.5%), and worsened in 10 (17.5%) patients (p &lt; 0.001). Conclusions: This is the first study reporting on a positive effect of MT on NRIs, based on weight gain and albumin. Personalized nutrition and routine follow-up of adults with CF based on NRI is recommended prior to MT initiation.</p

Stepwise Approach in Asthma Revisited 2023: Expert Panel Opinion of Turkish Guideline of Asthma Diagnosis and Management Group

Introduction 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 physicians 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

Patients with cystic fibrosis who could not receive the CFTR modulator treatment: What did they lose in 1 year?

Background: Cystic fibrosis (CF) is an autosomal recessive disorder caused by CF transmembrane conductance regulator (CFTR) genetic variants. CFTR modulators improve pulmonary function and reduce respiratory infections in CF. This study investigated the clinical and laboratory follow-up parameters over 1 year in patients with CF who could not receive this treatment. Methods: This retrospective cohort study included 2018 and 2019 CF patient data from the CF registry of Turkey. Demographic and clinical characteristics of 294 patients were assessed, who had modulator treatment indications in 2018 but could not reach the treatment. Results: In 2019, patients younger than 18 years had significantly lower BMI z-scores than in 2018. During the 1-year follow-up, forced expiratory volumes (FEV1) and FEV1 z-scores a trend toward a decrease. In 2019, chronic Staphylococcus aureus colonization, inhaled antipseudomonal antibiotic use for more than 3 months, oral nutritional supplement requirements, and oxygen support need increased. Conclusions: Patients who had indications for modulator treatments but were unable to obtain them worsened even after a year of follow-up. This study emphasized the importance of using modulator treatments for patients with CF in our country, as well as in many countries worldwide

The success of the Cystic Fibrosis Registry of Turkey for improvement of patient care

Background Cystic fibrosis (CF) registries play an essential role in improving disease outcomes of people with CF. This study aimed to evaluate the association of newly established CF registry system in Turkey on follow-up, clinical, growth, treatment, and complications of people with this disease. Methods Age at diagnosis, current age, sex, z-scores of weight, height and body mass index (BMI), neonatal screening results, pulmonary function tests, history of meconium ileus, medications, presence of microorganisms, and follow-up were evaluated and compared to data of people with CF represented in both 2017 and 2019 registry data. Results There were 1170 people with CF in 2017 and 1637 in 2019 CF registry. Eight hundred and fourteen people were registered in both 2017 and 2019 of whom z-scores of heights and BMI were significantly higher in 2019 (p = 0.002, p =0.039, respectively). Inhaled hypertonic saline, bronchodilator, and azithromycin usages were significantly higher in 2019 (p =0.001, p = 0.001, p = 0.003, respectively). The percent predicted of forced expiratory volume in 1 sec and forced vital capacity were similar in 2017 and 2019 (88% and 89.5%, p = 0.248 and 84.5% and 87%, p =0.332, respectively). Liver diseases and osteoporosis were significantly higher, and pseudo-Bartter syndrome (PBS) was significantly lower in 2019 (p = 0.011, p = 0.001, p = 0.001, respectively). Conclusions The z-scores of height and BMI were higher, the use of medications that protect and improve lung functions was higher and incidence of PBS was lower in 2019. It was predicted that registry system increased the care of people with CF regarding their follow-up. The widespread use of national CF registry system across the country may be beneficial for the follow-up of people with CF

The success of the Cystic Fibrosis Registry of Turkey for improvement of patient care

Background Cystic fibrosis (CF) registries play an essential role in improving disease outcomes of people with CF. This study aimed to evaluate the association of newly established CF registry system in Turkey on follow-up, clinical, growth, treatment, and complications of people with this disease. Methods Age at diagnosis, current age, sex, z-scores of weight, height and body mass index (BMI), neonatal screening results, pulmonary function tests, history of meconium ileus, medications, presence of microorganisms, and follow-up were evaluated and compared to data of people with CF represented in both 2017 and 2019 registry data. Results There were 1170 people with CF in 2017 and 1637 in 2019 CF registry. Eight hundred and fourteen people were registered in both 2017 and 2019 of whom z-scores of heights and BMI were significantly higher in 2019 (p = 0.002, p =0.039, respectively). Inhaled hypertonic saline, bronchodilator, and azithromycin usages were significantly higher in 2019 (p =0.001, p = 0.001, p = 0.003, respectively). The percent predicted of forced expiratory volume in 1 sec and forced vital capacity were similar in 2017 and 2019 (88% and 89.5%, p = 0.248 and 84.5% and 87%, p =0.332, respectively). Liver diseases and osteoporosis were significantly higher, and pseudo-Bartter syndrome (PBS) was significantly lower in 2019 (p = 0.011, p = 0.001, p = 0.001, respectively). Conclusions The z-scores of height and BMI were higher, the use of medications that protect and improve lung functions was higher and incidence of PBS was lower in 2019. It was predicted that registry system increased the care of people with CF regarding their follow-up. The widespread use of national CF registry system across the country may be beneficial for the follow-up of people with CF

Physical activity and dietary habits in patients with asthma: How is it related to asthma control?

© 2022 Elsevier LtdAims: In this study, we aimed to determine the PA and dietary habits of patients with asthma and whether asthma control had a role in these habits. Methods: Adult patients with asthma were included. Three questionnaires were administered to the patients. and daily step counts were recorded for one week. Asthma control level and severe asthma attacks in the previous year were assessed. Results: A total of 277 patients were included. One hundred eighty-two (65.3%) of the patients were overweight/obese. According to FFQ, none of the food groups were comsumed in recommended levels. According to the IPAQ scores, 82.7% of the patients had mild physical activity. The daily step counts and the PA domain of the HLBS-II in obese patients were lower than the nonobese patients (p = 0.001 and p = 0.034,respectively). The rate of obese patients (n = 9; 50%) was higher in the uncontrolled patients. Conclusion: In our study, the majority of patients were physically inactive. Few patients consumed the recommended amount of foods. Being overweight seems to be a significant barrier to the healthy life behaviors. Although these behaviours do not seem to have an effect on asthma controlling this study, further prospective placebo-controlled studies are needed

İş Sağlığı ve Güvenliği Meslek Hastalıkları

Ülkemizde iş sağlığı ve güvenliği ile meslek hastalıkları konularında, kapsamlı Türkçe kitap ihtiyacı bulunmaktadır. Bu saptamadan hareketle “İş Sağlığı ve Güvenliği Meslek Hastalıkları” kitabı iki yılı aşkın bir sürede tamamlanmıştır. Mezuniyet öncesi ve sonrası eğitimlere, sertifika eğitimlerine, çalışanların sağlıklı ve güvenlikli ortamda çalışmaları hakkına, saha uygulamalarına, araştırmalara katkı sağlaması amaçlanmıştır. Kaynak kitap ihtiyacı öncelikle, müfredatlarında konuya ilişkin başlıklar bulunan, Tıp, Mühendislik, Hemşirelik, Sağlık Bilimleri ve Fen fakülteleri, ilgili yüksek lisans ve doktora programları, ilgili yüksek okullar olmak üzere yüksek öğretim öğrencileri için geçerli iken aynı zamanda iş yeri hekimleri, iş güvenliği uzmanları, diğer sağlık personeli sertifika eğitimleri, çalışanların yasal olarak zorunlu olan eğitimleri için de söz konusudur.Kitabın, Hacettepe Üniversitesi Tıp Fakültesi Halk Sağlığı Anabilim Dalı öğretim üyesi Prof. Dr. İsmail TOPUZOĞLU’nun 1980’li yıllarda başlattığı, Prof. Dr. Nazmi BİLİR’in emekli olana kadar 30 yılı aşkın süre ile sürdürdüğü mezuniyet öncesi ve sonrası eğitim, araştırma, uygulama ve yayın çalışmaları ile bu alanlarda öncü rolü olan Hacettepe Üniversitesi’nin yayını olması ayrı bir mutluluk kaynağıdır, kendilerine şükranlarımızı sunarız.Kitap, sayfa dağılımları farklılık gösteren, konu başlıkları itibariyle toplam 79 bölümden oluşmaktadır. Meslek hastalıklarına ilişkin bazı bölümlerde, yazarlar ikinci baskısı yapılmış olan “Yıldız, A.N., Sandal, A. (Ed.). Meslek Hastalıkları İşle İlgili Hastalıklar (Seçilmiş Başlıklarda). Ankara: Hacettepe Üniversitesi Yayını. ISBN: 978-975-491-460-3.” kitabındaki bölümlerini güncelleyerek genişletmişlerdir.Kitabın yazarları başlıca, Hacettepe Üniversitesi öğretim elemanları, Tıp Fakültesi İş ve Meslek Hastalıkları Yan Dal Uzmanlık Eğitimi Programı eğitim kadrosu ile bu kapsamda eğitim almış veya almaya devam eden uzman hekimler, ile T.C. Aile, Çalışma ve Sosyal Hizmetler Bakanlığı yönetici ve uzmanlarıdır. Bütün yazarlara katkıları için teşekkür ederiz.Kitabın elektronik kitap olarak yayınlanması, ulaşılabilirliğinin artması, içerik arama ve güncelleme gibi hususlarda kolaylık sağlayacağı kanaatindeyiz. Ayrıca kaynakları metin içinde gösterilmiş olması da ileri incelemeler için katkı sağlayacaktır.Yoğun çalışma sürecinde gösterdikleri anlayış için ailelerimize, Hacettepe Üniversitesi Hastaneleri Basım Yayın ve Tanıtım Koordinatörlüğü ile Kütüphane ve Dokümantasyon Daire Başkanlığı yetkilileri ve çalışanlarına, kitabı yayına hazırlamada katkı sağlayan Dr. A. Kadir ATLI, Dr. Buhara ÖNAL ve Özge Rojda BENZİL’e teşekkür ederiz.Saygılarımızla,Prof. Dr. Bülent ALTUN (Hacettepe Üniversitesi Tıp Fakültesi Dekanı)Prof. Dr. Ali Naci YILDIZ (Editör)Uzm. Dr. Abdulsamet SANDAL (Editör