Physicochemistry, microbiology, fatty acids composition and volatile profile of traditional Söğle tulum (goat’s skin bag) cheese

Abstract Söğle cheese is a type of traditional tulum (goat’s skin bag) cheese produced from goat’s milk or a mixture of goat’s and sheep’s milk in Küçük Söğle and Büyük Söğle villages, Antalya, Turkey. This is the first study that aimed to investigate the physicochemistry, microbiology, fatty acids composition and volatile profile of traditional Söğle cheeses ripened in goat’s skins for three months in wells. The pH and titratable acidity values, total solids, fat, protein and salt contents of the Söğle cheese samples ranged from 4.9 to 5.5, from 1.4 to 2.6%, from 46.5 to 55.0%, from 2.0 to 4.5%, from 34.9 and 42.2% and from 4.1 to 8.2%, respectively. The highest proportion of fatty acids in all cheese samples was palmitic acid (C16:0). The lactobacillus, lactococcus, total aerobic mesophilic bacteria and yeast and mold counts in the cheese samples were found to be between 7.1 and 8.5 log cfu/g, 7.8 and 8.7 log cfu/g, 7.6 and 8.5 log cfu/g and 1.0 and 4.8 log cfu/g, respectively. Fifty-three volatile components were identified in the cheese samples including 13 esters, 7 ketones, 5 acids, 2 aldehydes, 5 alcohols, 12 terpenes, and 9 miscellaneous compounds. Ketones and terpenes were the predominant volatile compounds

Omalizumab updosing for better disease control in chronic spontaneous urticaria patients

The recommended dose of omalizumab for the treatment of chronic spontaneous urticaria (CSU) is 300 mg every 4 weeks, but there is no recommendation for patients who do not benefit from this dose. Our aim is to present the experiences on the use of doses of omalizumab higher than those recommended for CSU patients and to propose a protocol for updosing. This was a retrospective analysis of patients treated with omalizumab for CSU from 2 urticaria centers in Istanbul and Barcelona. The weekly urticaria activity score and/or the Urticaria Control Test (UCT) were used to monitor response. In Barcelona, a stepwise updosing regimen was preferred (450 mg first, then increasing to 600 mg), while in Istanbul, direct updosing to 600 mg was chosen. In Istanbul, 81 (88%) patients were treated with 300 mg, while 11 (12%) received 600 mg of omalizumab. In Barcelona, 7 (8.8%), 45 (56.3%), 17 (21.3%), and 11 (13.8%) patients received 150, 300, 450, and 600 mg of omalizumab, respectively. Urticaria control was achieved in 82.6% of the patients with 300 mg and in 8.7% of the patients with 600 mg in Istanbul, while it was achieved with 150 mg in 10%, with 300 mg in 48.8%, with 450 mg in 16.3%, and with 600 mg in 6.3% of the patients in Barcelona. In total, 123 (71.5%) patients responded to 150-300 mg and 26 (15.1%) to 450-600 mg. When responders to 150-300 mg (n = 123) were compared with responders to 450-600 mg (n = 26), BMI was found to be higher, and pre-omalizumab UCT was found to be lower in patients receiving updosed omalizumab (p = 0.029). Baseline data of the patients, especially BMI and pre-oma UCT, might be useful to determine if the patient will require higher doses of omalizumab. We recommend a stepwise approach starting from 450 mg and then updosing to 600 mg in CSU patients who do not respond or partially respond to 300 mg of omalizumab after 3-6 months of treatment

Validation of the Turkish version of the Urticaria Control Test: Correlation with other tools and comparison between spontaneous and inducible chronic urticaria

Background: The urticaria control test (UCT) is a questionnaire designed to determine if chronic urticaria (CU) is controlled or not and to aid therapeutic decision-making. It collects retrospective information about the symptoms and quality of life impairment over the last 4 weeks. The current study aimed to investigate the validity, reliability and sensitivity to change of the Turkish version of the UCT. We also evaluated its correlation with other tools and compared the UCT results of patients with chronic spontaneous urticaria (CSU) and patients with chronic inducible urticaria (CINDU). Methods: Following forward/backward translation and cognitive debriefing, the Turkish version of the UCT was used in 81 CSU and 78 CINDU patients. Dermatology life quality index (DLQI), Chronic urticaria quality of life questionnaire (CU-Q2oL), urticaria activity score (UAS), patients' and physicians’ global assessment visual analog scores and Likert scales were used at baseline and after four weeks to assess quality of life impairment, disease activity and disease control. Statistical analysis to determine the validity and reliability of the Turkish version of the UCT as well as comparison between CINDU and CSU patients were performed. Results: Duration of disease was longer, disease control was poorer and severe complaints were more frequent in CINDU patients (duration of disease: 36.3 (24) ± 49.1 vs 31.5 (9) ± 67.9, p = .007, UCT baseline: 8.4 (8) ± 3.4 vs 10.4 (11) ± 3.9, p = .001 and patient's global assessment Likert scale severe complaints: 6 vs 15, p < .001, respectively). The UCT showed excellent internal consistency for CSU and a minimally acceptable consistency for CINDU (Cronbach's α 0.89 for CSU versus 0.68 for CINDU). It showed strong correlation with CU-Q2oL but a moderate correlation with DLQI (r = −0.649, P < .001 and r = −0.545, P < .001, respectively). It was able to discriminate between patients with different disease control and was sensitive to detect changes in the disease control in both groups. The minimally important difference of the UCT was found to be 3. Conclusions: The Turkish version of the UCT is a valid and reliable tool for the management of CU patients and can be used both in CSU and CINDU patients to determine if the treatment is sufficient and if disease activity and quality of life impairment are under control or not. Keywords: Chronic urticaria, Inducible urticaria, Urticaria control test (UCT), Minimal clinically important difference (MCID), Reliability, Validity, Quality of life, Patient reported outcome