Successful desensitization in a patient with recurrent anaplastic oligodendroglioma presenting with procarbazine-mediated anaphylaxis.

INTRODUCTION: Procarbazine is an oral chemotherapeutic agent used in the treatment of brain malignancies and is associated with hypersensitivity reactions. In case of grade 4 reactions, rechallenge should be avoided, and the agent should be replaced, unless the treatment is curative, in which case the application of a desensitization protocol should be considered. We present a successful case of desensitization in procarbazine anaphylaxis. CASE REPORT: A 53-year-old male patient was diagnosed with recurrent anaplastic oligodendroglioblastoma. The patient received three cycles of procarbazine, lomustine, and vincristine chemotherapy for malignancy recurrence. In the fourth cycle, on the 12th day of procarbazine treatment, the patient developed anaphylaxis. Procarbazine was given together with premedication as part of the 12-step desensitization process, and the fourth cycle was successfully completed. MANAGEMENT AND OUTCOME: Procarbazine hypersensitivity reactions are observed less frequently than reactions to other chemotherapeutics. We presented a case of procarbazine-associated severe anaphylaxis that was able to continue procarbazine chemotherapy with successful desensitization. This case is important in terms of confirming the procarbazine desensitization protocol. DISCUSSION: In literature there is only one protocol developed was successfully applied in one patient with procarbazine anaphylaxis. In the current case, we took this protocol into consideration in the management of our patient. Following the use of this protocol, the patient was able to continue procarbazine chemotherapy successfully. Procarbazine anaphylaxis is rare, and more cases are needed to be reported to confirm the desensitization protocol and when to continue procarbazine treatment.

Dual biologics therapy in a patient with severe asthma and chronic urticaria: a case report and review of the literature.

INTRODUCTION: The data on the use of dual biologics are scant, but a topic of current interest. CASE STUDY: In this report, the treatment regimen of a patient with two T helper 2 pathway-related comorbidities, severe asthma, and chronic spontaneous urticaria, was presented. RESULTS: Both urticaria and asthma symptoms of the patient could not be controlled entirely with monotherapy while both diseases could be controlled after omalizumab-mepolizumab dual treatment. No adverse events were observed after 6 months of dual biologics use. CONCLUSION: This report supports other publications in the literature involving the use of dual biologics and provides a summary of the literature.

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 control 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.

Cytokine Profiles of Chronic Urticaria Patients and The Effect of Omalizumab Treatment.

INTRODUCTION: Cytokines are key mediators in immunological and inflammatory conditions, including chronic spontaneous urticaria (CSU). OBJECTIVES: To investigate Th1, Th2, and Th17 cytokine profiles in CSU and to evaluate the possible effect of omalizumab treatment. METHODS: Patients who were followed up for CSU, as well as healthy volunteers, were included in the study. To assess urticaria activity, the 7-day-Urticaria Activity Score (UAS-7), the Urticaria Control Test (UCT), and the Chronic Urticaria Quality of Life Questionnaire (CU-QoL) were filled. Serum levels of IL-6, IL-17, IL-31, eotaxin, RANTES, TNF-α, and TSLP were analyzed by ELISA and compared in CSU and control groups. The patients were analyzed in two groups as the omalizumab group and the non-omalizumab group based on their treatment status. RESULTS: Total IgE, ESR, CRP, RANTES, and TNF-a were significantly different in the overall comparison of the three groups: CSU-receiving omalizumab, CSU-not receiving omalizumab, and control groups (P <0.01, 0.015, <0.01, <0.01 and <0.01 respectively). Total IgE, CRP, RANTES, and TNF-α values were similar in those who received and did not receive omalizumab, yet these biomarkers were significantly higher in both groups than in the control group (P < 0.05). Statistical significance in ESR was observed only between the CSU-receiving omalizumab group and the control group (P = 0.01). Within the CSU patients, there was a slight but significant correlation between UCT and TNF-α (P = 0.008, r = 0.32) and IL-17 (P = 0.06, r = 0.33) levels. CONCLUSIONS: The investigated cytokine profile in CSU patients may differ from healthy controls, particularly with the higher levels of RANTES and TNF-α, and omalizumab treatment does not seem to affect that profile in CSU patients.

Evaluation of disease control after SARS-CoV-2 infection or vaccination in patients with NSAID-exacerbated airway disease.

Background: There are insufficient data on changes in disease control after severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection or vaccination in patients with nonsteroidal anti-inflammatory drug exacerbated respiratory disease (N-ERD). Objective: This study aimed to investigate the history of coronavirus disease 2019 (COVID-19) in patients with N-ERD, determine whether they experienced exacerbations of asthma or rhinitis after COVID-19, and evaluate their postvaccination asthma and rhinitis control data. Methods: The demographic characteristics of patients with N-ERD and whether they had had symptoms of asthma, changes in nasal symptom scores Sino-nasal outcome test (SNOT-22), Asthma Control Test (ACT) within 1 month after SARS-CoV-2 vaccination or infection were recorded. The prevalence of COVID-19 in patients with N-ERD and in healthy controls was estimated. Results: A total of 103 patients with N-ERD and 100 healthy controls were included in the study. Thirty seven of the patients (35.9%) and 65 of the controls (65%) had a history of COVID-19. There were no significant differences in changes in the ACT and SNOT-22 scores after SARS-CoV-2 vaccination (p = 0.999). Although, the change in ACT score after infection was significant (p = 0.017; r = 0.39), there was no significant change in level of asthma control (p < 0.001). Conclusion: The history of COVID-19 was less frequent in the N-ERD group. There was no deterioration in asthma and rhinitis controls after SARS-CoV-2 vaccination. Although a significant decrease was observed in the ACT scores after COVID-19, there was no deterioration in the level of asthma control.

Artificial Intelligence Chatbots in Allergy and Immunology Practice: Where Have We Been and Where Are We Going?

Artificial intelligence (AI) is rapidly becoming a valuable tool in healthcare, providing clinicians with a new AI lens perspective for patient care, diagnosis, and treatment. This article explores the potential applications, benefits, and challenges of AI chatbots in clinical settings, with a particular emphasis on ChatGPT 4.0 (OpenAI - Chat generative pretrained transformer 4.0), especially in the field of allergy and immunology. AI chatbots have shown considerable promise in various medical domains, including radiology and dermatology, by improving patient engagement, diagnostic accuracy, and personalized treatment plans. ChatGPT 4.0, developed by OpenAI, is good at understanding and replying to prompts in a way that makes sense. However, it is critical to address the potential biases, data privacy issues, ethical considerations, and the need for verification of AI-generated findings. When used responsibly, AI chatbots can significantly enhance clinical practice in allergy and immunology. However, there are still challenges in using this technology that require ongoing research and collaboration between AI developers and medical specialists. To this end, the ChatGPT 4.0 platform has the potential to enhance patient engagement, improve diagnostic accuracy, and provide personalized treatment plans in allergy and immunology practice. However, limitations and risks must be addressed to ensure their safe and effective use in clinical practice.

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.

Thermo-SPT: A new skin prick test evaluation framework based on low-cost, portable smartphone thermography.

BACKGROUND: Although the skin prick test (SPT) is a reliable procedure to confirm IgE-dependent allergic sensitization in patients, the interpretation of the test is still performed manually, resulting in an error-prone procedure for the diagnosis of allergic diseases. OBJECTIVE: To design and implement an innovative SPT evaluation framework using a low-cost, portable smartphone thermography, named Thermo-SPT, to significantly improve the accuracy and reliability of SPT outcomes. METHODS: Thermographical images were captured every 60 s for a duration of 0 to 15 min using the FLIR One app, and then analysed with the FLIR Tool® . The definition of 'Skin Sensitization Region' area was introduced to analyse the time-lapse thermal changes in skin reactions over several time periods during the SPT. The Allergic Sensitization Index (ASI) and Min-Max Scaler Index (MMS) formulae were also developed to optimize the identification of the peak allergic response time point through the thermal assessment (TA) of allergic rhinitis patients. RESULTS: In these experimental trials, a statistically significant increase in temperature was detected from the fifth minute of TA for all tested aeroallergens (all p values < .001 ). An increase was observed in the number of false-positive cases, where patients with clinical symptoms not consistent with SPT were evaluated as positive on TA assessment, specifically for patients diagnosed with Phleum pratense and Dermatophagoides pteronyssinus. Our proposed technique, the MMS, has demonstrated improved accuracy in identifying P. pratense and D. pteronyssinus compared with other SPT evaluation metrics, specifically starting from the fifth minute. For patients diagnosed with Cat epithelium, although not statistically significant initially, an increasing trend was determined in the results at the 15 min (ΔT (T15 - T0 ), p = .07 ; ASIT15 , p < .001 ). CONCLUSIONS: This proposed SPT evaluation framework utilizing a low-cost, smartphone-based thermographical imaging technique can enhance the interpretability of allergic responses during the SPT, potentially reducing the need for extensive manual interpretation experience as standard SPTs.

Comparison of 300 mg versus 600 mg daily maintenance doses of aspirin treatment after desensitization in N-ERD: A three-year multicentre experience.

Background: Aspirin treatment after desensitization (ATAD) is effective in preventing nasal polyps recurrence as well as respiratory symptoms in patients with nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory diseases (N-ERD). However, there is no consensus on effective daily maintenance doses in ATAD. Therefore, we aimed to compare the effects of two different maintenance doses of aspirin on clinical outcomes for 1-3 years of ATAD. Methods: This was a retrospective, multicenter study that involved four tertiary centers. The maintenance doses of daily aspirin were 300 mg in one center and 600 mg in the remaining three. The data of patients who were on ATAD for 1-3 years were included. Study outcomes (nasal surgeries, sinusitis, asthma attacks, hospitalization, oral corticosteroid use, and medication uses) were assessed in a standardized way and recorded from case files. Results: The study initially included 125 subjects, 38 and 87 were receiving 300 and 600 mg daily aspirin for ATAD, respectively. Number of nasal polyp surgeries decreased after 1 -3 years compared with before ATAD in both groups (group 1, baseline: 0.44 ± 0.07 versus first year: 0.08 ± 0.05; p < 0.001 and baseline: 0.44 ± 0.07 versus 3rd year: 0.01 ± 0.01; p < 0.001; and group 2, baseline 0.42 ± 0.03 versus first year: 0.02 ± 0.02; p < 0.001 and baseline: 0.42 ± 0.03 versus 3rd year: 0.07 ± 0.03; p < 0.001). Conclusion: Given the comparable effects of 300 mg and 600 mg aspirin daily as maintenance treatment of ATAD on both asthma and sinonasal outcomes in N-ERD, our results suggest using 300 mg of aspirin daily in ATAD owing to its better safety profile.

Comparison of the clinical outcomes of patients with NSAID-exacerbated respiratory disease receiving aspirin or biologicals.

OBJECTIVE: NSAID-exacerbated respiratory disease (NERD) is characterized by exacerbation of respiratory symptoms after NSAID intake. While research for specific treatment options continues in patients who cannot tolerate or are unresponsive to aspirin treatment after aspirin desensitization (ATAD), biologicals have emerged as a new therapeutic option in NERD patients. The aim of this study was to compare the quality of life, and the sinonasal and respiratory outcomes of NERD patients treated with ATAD or biologicals. METHODS: Patients who have been followed up at a tertiary care allergy center and who have been receiving at least one of ATAD, mepolizumab or omalizumab for at least six months were included. Evaluations were made using sinonasal outcome test (SNOT-22), asthma control test (ACT), short form-36 (SF-36), blood eosinophil counts, need for recurrent functional endoscopic sinus surgeries (FESS), and asthma or rhinitis exacerbations requiring oral corticosteroids (OCS). RESULTS: A total of 59 patients comprised of 35 (59%) females and 24 (41%) males with a mean age of 46.1 (min-max, 20-70) years were included. The baseline blood eosinophil count was higher, and a significant decrease in blood eosinophil counts was observed in the mepolizumab group compared to ATAD group (p = 0.001, p < 0.001, respectively). At follow-up, the rate of recurrent FESS was lower in the group that received mepolizumab (p = 0.02). CONCLUSIONS: In NERD patients, mepolizumab significantly decreased blood eosinophil counts and recurrent FESS. There was no significant difference between the patients receiving ATAD or mepolizumab regarding other clinical parameters.

Community-acquired pneumonia - An EFIM guideline critical appraisal adaptation for internists.

BACKGROUND: In real-life settings, guidelines frequently cannot be followed since many patients are multimorbid and/or elderly or have other complicating conditions which carry an increased risk of drug-drug interactions. This document aimed to adapt recommendations from existing clinical practice guidelines (CPGs) to assist physicians' decision-making processes concerning specific and complex scenarios related to acute CAP. METHODS: The process for the adaptation procedure started with the identification of unsolved clinical questions (PICOs) in patients with CAP and continued with critically appraising the updated existing CPGs and choosing the recommendations, which are most applicable to these specific scenarios. RESULTS: Seventeen CPGs were appraised to address five PICOs. Twenty-seven recommendations were endorsed based on 7 high, 9 moderate, 10 low, and 1 very low-quality evidence. The most valid recommendations applicable to the clinical practice were the following ones: Respiratory virus testing is strongly recommended during periods of increased respiratory virus activity. Assessing the severity with a validated prediction rule to discriminate where to treat the patient is strongly recommended along with reassessing the patient periodically for improvement as expected. In adults with multiple comorbidities, polypharmacy, or advanced age, it is strongly recommended to check for possible drug interactions before starting treatment. Strong graded recommendations exist on antibiotic treatment and its duration. Recommendations on the use of biomarkers such as C-reactive protein or procalcitonin to improve severity assessment are reported. CONCLUSION: This document provides a simple and reliable updated guide for clinical decision-making in the management of complex patients with multimorbidity and CAP in the real-life setting.

Short- and long-term oral steroid therapy in patients with asthma exacerbation.

Steroids are frequently used for symptom control in cases of asthma exacerbation. The aim of this study was to compare the effect of short-term and long-term oral steroid therapy on symptom control in patients with asthma exacerbation. Patients that received short-term (<10 d) and long-term (≥10 d) oral steroid therapy during asthma exacerbation were compared retrospectively. A visual analog scale (VAS) for symptom severity was administered, and the asthma control test (ACT) and pulmonary function tests were performed before and after treatment. The study included 69 patients and the overall mean duration of steroid treatment was 9.57±3.58 d (range: 5-25 d). Mean duration of short-term and long-term steroid treatment was 6.54±0.99 d and 11.63±3.21 d, respectively. Serious side-effects were not observed following oral steroid therapy. Post the short- and long-term oral steroid therapy there were not any significant differences between the 2 groups in terms of ACT, FEV1 (forced expiratory volume 1), or VAS symptom scores. The findings show that in patients with mild asthma exacerbation short-term oral steroid therapy is as effective as long-term steroid therapy and can be safely used for symptom control during periods of mild asthma exacerbation.

The association of timothy grass allergy and cat ownership on cat sensitization.

Background: Pollen hypersensitivity might be a determining factor for other nonseasonal allergens because it may indicate deviation of the immune system toward T-helper type 2 activity and immunoglobulin E sensitivity. Objective: To investigate whether timothy grass pollen allergy may be a predictive factor for cat sensitization and whether there is an association between sensitivity to both allergens. Method: A retrospective review was made of patients with symptoms of rhinitis. The skin-prick test results and cat ownership status of the patients were analyzed. On the basis of the skin-prick test results with Phleum pratense (timothy grass) and other pollens, the patients were analyzed in two groups: "timothy allergic" and "non-timothy allergic." Results: A total of 383 patients with the diagnosis of rhinitis were included in the study, which comprised 213 (55.6%) in the timothy allergic group and 170 (44.4%) in the non-timothy allergic group. The frequency of cat sensitization was significantly higher in the patients in the timothy allergic group compared with those without timothy grass allergy (33.8% versus 12.3%; p < 0.001). No significant difference was determined between the two groups in terms of cat ownership (p = 0.63). In the logistic regression analysis, cat ownership (adjusted odds ratio [OR] 23.07 [95% confidence interval {CI}, 7.72-68.91]) and timothy allergy (adjusted OR 7.72 [95% CI, 3.16-18.86]) were associated with an increased risk of cat sensitization. Conclusion: Timothy grass allergy may play a role in the development of cat sensitization; however, further research is needed to clarify these associations and the underlying mechanisms.

Impact of socioeconomic factors and house cleaning on asthma control in women.

Background: It is known that socioeconomic factors affect various chronic diseases and also might affect asthma control. Exposure to house-cleaning products has been shown to impact both the onset and control of asthma. Objective: This study aimed to determine the effect of socioeconomic factors and house cleaning on asthma control of women with asthma. Methods: Adult women with asthma (N = 204) with informed consent were included in this single-center, cross-sectional observational study. A questionnaire, including items related to demographic, clinical, and socioeconomic features of the patients, was administered with a face-to-face interview by an investigator. A test to assess the level of asthma control was used to classify the patients as uncontrolled, partially controlled, and fully controlled. Wealth perception was measured with a visual analog scale. Investigated socioeconomic features were household size, monthly household income, education status, working status, occupation, and education status of the mothers of the patients. Results: Of the 204 adult female patients, 68.6% had uncontrolled, 14.7% had partially controlled, and 16.7% had fully controlled asthma. Partially or fully controlled asthma was higher (odds ratio [OR] 2.6 [95% confidence interval [CI], 1.09-6.22]) in the highest income quantile compared with the lowest income quantile. Asthma was better controlled in women with a visual analog scale score of wealth perception ≥ 7 (OR 1.93 [95% CI, 1.04-3.59]) and, in those who cleaned their houses, one to two times per week compared with zero times per week (OR 2.94 [95% CI, 1.19-7.26]). Conclusion: Having a higher household income was the only socioeconomic factor associated with better asthma control. After adjusting for age, duration of asthma, and comorbidities, better asthma control was significantly associated with cleaning the house one to two times a week.

Clinical Validation of the Spirohome Clinic Ultrasonic Spirometer in Child and Adolescent Patients.

BACKGROUND: Spirometers are critical devices that reveal the respiratory dynamics caused by respiratory problems and their severity and facilitate their diagnosis and follow-up. Hand-held spirometers have emerged relatively recently and offer several advantages over conventional desktop systems. There remains, however, a need for reassurance of high-quality spirometry testing with next-generation portable spirometers that connect over Bluetooth® to smart device applications. In this study, we examine the accuracy and repeatability of lung function measurements of a novel hand-held ultrasonic spirometer, the Spirohome Clinic and compare its clinical performance to a reference device, the EasyOne Air. METHODS: Benchtop validation of the spirometers was conducted using a lung simulator device according to ATS/ERS guidelines and the ISO 26782 standard waveforms. Subsequently, 48 volunteers (pediatric patients between 6 and 11 years of age and adolescent patients between 12 and 18 years of age) performed spirometry with both the Spirohome Clinic and the EasyOne Air spirometer during their clinic visits. Spirometric data including repeated FEV1, FVC, FEV6, FEF25-75, and PEF measurements were collected. RESULTS: Both the Spirohome Clinic and the EasyOne Air successfully passed requirements for accuracy stated in relevant guidelines and standards for spirometry. The only statistically significant (p<0.05) difference was for FVC measurement accuracy. Clinical comparisons revealed strong correlation between spirometers in the measurement of key pulmonary function parameters including FEV1 and FVC with a Pearson's correlation coefficient of 0.99. Bland-Altman plots showed good agreement between mean differences of FEV1 and FVC with the majority measurements remaining between the limits of 95% agreement for both the entire patient cohort and also in age and gender subsets. CONCLUSION: The present study demonstrated that the Spirohome Clinic spirometer conforms to ATS/ERS performance requirements and validates the clinical comparability of its measurement accuracy and repeatability to the EasyOne Air. These findings support the indicated use of the Spirohome Clinic for high-quality lung function testing in clinical settings.

The course of COVID-19 in patients with severe asthma receiving biological treatment.

OBJECTIVE: In order to decrease the use of systemic corticosteroids and prevent asthma exacerbations, EAACI and GINA made recommendations in favor of severe asthma patients continuing the use of biologicals during the pandemic. However, the course of SARS-CoV-2 infection remains uncertain, especially in patients taking biological therapy for severe asthma. The aim of this study was to demonstrate the clinical course of COVID-19 in severe asthmatic patients receiving biological treatment. METHODS: A total of 75 patients under the care of a tertiary level allergy clinic and receiving omalizumab or mepolizumab, which are the approved biologicals for severe asthma in Turkey, were included in the survey between April 1 and December 31, 2020. A questionnaire was administered via a telephone call by one of the treating physicians. RESULTS: Of the total patients, 46 (61%) were receiving mepolizumab and 29 (39%) omalizumab. Of the patients, 14 (19%) had COVID-19, 9 (64%) had pneumonia, 4 (29%) were hospitalized. A total of 12 (16%) patients interrupted biological treatments because they did not want to attend hospital for injections during the pandemic. The incidence of COVID-19 was higher in patients who have interrupted biological treatment (p < 0.001). In addition, the risk of having COVID-19 was higher in the ones who have interrupted their biological treatment (Relative risk:2.71; 95% Confidence interval:1.21-6.06). Asthma control was better in patients attending regular injections (p = 0.006). CONCLUSION: Severe asthma itself seems to be a risk factor for COVID-19, whether biological treatment has a role in the disease course needs further research.

Effect of COVID-19 on hereditary angioedema activity and quality of life.

Background: The demonstration that severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) enters the cell via the angiotensin-converting enzyme 2 receptor has raised concerns that, in hereditary angioedema (HAE), a disease characterized by bradykinin-mediated angioedema attacks, coronavirus disease 2019 (COVID-19) may trigger angioedema attacks, increase the frequency and/or severity of attacks, or cause more severe symptoms of COVID-19. Objective: The objective was to evaluate the severity of COVID-19 in patients with HAE, the course of HAE attacks, angioedema activity, and the quality-of-life scores during COVID-19 pandemic. Methods: Patients diagnosed with HAE for at least 6 months were included in the study. The 7-day Angioedema Activity Score and the Angioedema Quality of Life (AE-QoL) Questionnaire were first completed at the onset of the pandemic between March 12 and June 1, 2020, then during SARS-CoV-2 infection, and in the third month after recovering from COVID-19. Results: Ten of 67 patients with HAE (14.9%) were diagnosed with COVID-19. The median (interquartile range) age of the 10 patients diagnosed with COVID-19 was 35.5 years (28.0-55.0 years). Six of the 10 patients (60%) were women. During COVID-19, five of the 10 patients (50%) had no angioedema attack. Two patients with severe HAE experienced a significant increase in angioedema activity during COVID-19 compared with their basal activity scores. The remaining three patients had a similar or lower attack frequency than their basal level. Four (40%) of the 10 patients had a relative increase in their attacks during the convalescence period. There was no statistically significant difference among pre-COVID-19, during COVID-19 and post-COVID-19 periods in function, mood, fear and/or shame, nutrition, and total scores of the AE-QoL Questionnaire although the fear dimension was relatively more affected (p = 0.06). Conclusion: Although the sample size was small, analysis of our data supported that the symptoms of COVID-19 were not more severe in HAE. Also, there was no significant difference in the AE-QoL Questionnaire scores, the frequency, and severity of angioedema attacks during the course of COVID-19 in the patients with HAE.

Clinical implications of fungal isolation from sputum in adult patients with cystic fibrosis

Background/aim: Cystic fibrosis is an autosomal recessive disease with a defect in mucociliary activity that is characterized by recurrent pulmonary infections. Bacterial agents frequently implicated in airway colonization are Haemophilus influenzae, Staphylococcus spp., and Pseudomonas spp. Fungal isolation from sputum is common in adults. However, growth of fungal agent only in sputum culture in patients with cystic fibrosis is insufficient for the diagnosis of fungal diseases. There is limited data about the clinical significance of fungal isolation in sputum cultures. The aim of the study was to investigate the clinical outcomes andsignificance of fungal isolation from sputum samples in adult CF. Materials and methods: This retrospective study included patients who have been admitted between October 2017 and January 2019 in an adult cystic fibrosis unit. Patients were grouped according to fungal pathogenicity as; fungal disease group, colonization group, and nonisolated group. The data of the last one year, including demographics, clinical data, laboratory, treatment modalities, results of cultured bacteria and fungus from sputum samples, respiratory function parameters, frequency of exacerbation, and hospitalizationwere compared between groups. Results: A total of 330 sputum samples from 88 adult patients with CF were collected. Patients were divided into 3 groups, the fungal disease group (n = 10, 11.4%), colonization group (n = 49, 55.7%), and nonisolated group (n = 29, 32.9%). Presence of pulmonary exacerbation, number of admissions to emergency department, and the number of positive cultures for bacteria from sputum were higher in the fungal disease group (p = 0.03, p = 0.01 and p < 0.001). The fungal disease group had higher rate of antibiotics by parenteral routethan other groups (p = 0.001) whereas lung functions were similar. Use of nutritional supplementation and parenteral antibiotherapy were the factors associated with elevated risk of fungal isolation. Conclusion: Frequent use of parenteral antibiotics and use of nutritional supplementation were found to be independent risk factors for fungal isolation from sputum in adult CF.