Browsing by Author "Canitez, Y"

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    A multicenter survey of childhood asthma in Turkey - II: Utilization of asthma drugs, control levels and their determinants
    Soyer, OU; Beyhun, NE; Demir, E; Yildirim, S; Boz, AB; Altinel, N; Cevit, O; Karakas, T; Anlar, Y; Sögüt, A; Altintas, D; Canitez, Y; Büyükdereli, Z; Sekerel, BE
    Many surveys worldwide have consistently demonstrated a low level of asthma control and under-utilization of preventive asthma drugs. However, these studies have been frequently criticized for using population-based samples, which include many patients with no or irregular follow-ups. Our aim, in this study, was to define the extent of asthma drug utilization, control levels, and their determinants among children with asthma attending to pediatric asthma centers in Turkey. Asthmatic children (age range: 6-18 yr) with at least 1-yr follow-up seen at 12 asthma outpatient clinics during a 1-month period with scheduled or unscheduled visits were included and were surveyed with a questionnaire-guided interview. Files from the previous year were evaluated retrospectively to document control levels and their determinants. From 618 children allocated, most were mild asthmatics (85.6%). Almost 30% and 15% of children reported current use of emergency service and hospitalization, respectively; and 51.4% and 53.1% of children with persistent and intermittent disease, respectively, were on daily preventive therapy, including inhaled corticosteroids. Disease severity [odds ratio: 12.6 (95% confidence intervals: 5.3-29.8)], hospitalization within the last year [3.4 (1.4-8.2)], no use of inhaled steroids [2.9 (1.1- 7.3)], and female gender [2.3 (1.1-5.4)] were major predictors of poor asthma control as defined by their physicians. In this national pediatric asthma study, we found a low level of disease control and discrepancies between preventive drug usage and disease severity, which shows that the expectations of guidelines have not been met even in facilitated centers, thus indicating the need to revise the severity-based approach of asthma guidelines. Efforts to implement the control-based approach of new guidelines (Global Initiative for Asthma 2006) would be worthwhile.
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    Characteristics and Prognosis of Childhood Atopic Dermatitis: A Multicenter Study in Turkey
    Yuksel, H; Can, D; Reisli, I; Uzuner, N; Orhan, F; Cevit, O; Tahan, F; Canitez, Y; Kuyucu, S; Aysen, BB; Akcay, A; Yilmaz, O
    Background: Childhood atopic dermatitis (AD) is classically accepted as initial finding of atopic march; however, non-atopic cases do not follow this course. The aim of this study was to determine the characteristics and prognosis of AD in childhood in Turkey. Methods: The study included 531 children with AD that presented to pediatric allergy departments in 11 different regions of Turkey. Age at diagnosis, total serum and inhalant-specific immunoglobulin E (IgE) levels and allergen skin prick test results were recorded retrospectively. Clinical characteristics like additional allergic diseases at presentation or during follow-up were recorded as well as duration of follow-up. Results: Mean age at diagnosis was 37.8 +/- 36.2 months. Mean IgE level was 318.3 +/- 677.8 IU/ml (median 100 IU/ml). Skin prick tests yielded positive results in 47% of children. At presentation, 31.6% of children reported additional allergic disease, while 11.7% developed allergic disease during follow-up. Among all, 46.6% had additional allergic disease at any point. IgE levels were significantly higher in children with additional allergic diseases (p = 0.001). Allergen skin prick test positivity and family history of allergic diseases increased the risk of additional allergic diseases significantly (OR = 3.90, 95% CI = 2.3-6.6 and OR = 1.89, 95% CI = 1.3-2.8, respectively). Conclusions: Allergic sensitization is not present in all cases of AD. Coexistence of additional allergic diseases is not as high as expected but more common in children who have been demonstrated to have atopic sensitization with high IgE levels and allergen skin prick test positivity. Copyright (C) 2010 S. Karger AG, Basel
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    Characteristics and prognosis of childhood atopic dermatitis: a multi-center study in Turkey
    Yuksel, H; Can, D; Reisli, I; Uzuner, N; Orhan, F; Cevit, O; Tahan, F; Canitez, Y; Kuyucu, S; Boz, AB; Akcay, A; Yilmaz, O
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    Anaphylaxis in Turkish children: a multi-centre, retrospective, case study
    Orhan, F; Canitez, Y; Bakirtas, A; Yilmaz, O; Boz, AB; Can, D; Kuyucu, S; Harmanci, K; Tahan, F; Reisli, I; Karakas, T; Baki, A; Cokugras, H; Cakir, M; Yuksel, H
    Background Anaphylaxis is a serious and potentially lethal systemic reaction affecting more than one organ or system. Objective We aimed to describe the demographic characteristics, clinical features, causes, settings, and administered therapy in Turkish children. Methods This retrospective, case note study included all children referred to the outpatient clinics of the Pediatric Allergy Departments of the participating study centres from 1 July 1999 to 30 June 2009 for investigation of anaphylaxis or who were seen by us at the moment of the reaction during the same period and who met the clinical criteria of anaphylaxis. Results Two hundred and twenty-four cases of anaphylaxis were reported in 137 children (88 boys, P = 0.0001). The mean +/- SD age at the referral was 7.7 +/- 4.2 years (range: 4 months-17 years). Ninety-eight episodes (43.8%) occurred at home. The symptoms were cutaneous in 222 (99.1%) episodes, respiratory in 217 (96.9%), neuro-psychiatric in 118 (52.7%), cardiovascular in 92 (41.1%), and gastrointestinal in 88 (39.3%). Biphasic reaction was reported in seven episodes (3.1%, 95% CI: 1.5-6.3). Death occurred in one case (0.4%, 95% CI: 0.08-2.4). Treatment was available in 158 episodes (70.5%). Of them, 148 (93.7%) received antihistamines, 132 (83.5%) corticosteroids, 51 (32.3%) epinephrine, and 17 (10.8%) beta-2-mimetics. The causative agents were foods in 86 (38.4%) episodes, hymenoptera venom in 84 (37.5%), drugs and medications in 47 (21.0%), and latex in 5 (2.2%). In two episodes (0.9%), the causative agent was unidentified. Allergy to the trigger was known prior to anaphylaxis in 116 (51.8%) episodes. An epinephrine autoinjector had been prescribed for 70 children (51.1%). Conclusions and Clinical Relevance Anaphylaxis was seen significantly more in boys. Most of the reactions occurred at home. Foods were the most frequent cause. Epinephrine, the first-line treatment of anaphylaxis, was administered in only a third of the children.
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    Patients with cystic fibrosis who could not receive the CFTR modulator treatment: What did they lose in 1 year?
    Uytun, S; Cinel, G; Polat, SE; Tabakçi, SO; Kiper, N; Yalçin, E; Tural, DA; Özsezen, B; Sen, V; Sen, HS; Altintas, DU; Çokugras, H; Kilinç, AA; Baskan, AK; Yazan, H; Çollak, A; Uzuner, S; Ünal, G; Yilmaz, AI; Çaglar, HT; Damadoglu, E; Irmak, I; Demir, E; Öztürk, GK; Bingöl, A; Basaran, E; Sapan, N; Canitez, Y; Aslan, AT; Asfuroglu, P; Harmanci, K; Köse, M; Hangül, M; Özdemir, A; Çobanoglu, N; Özcan, G; Keskin, Ö; Yüksel, H; Özdogan, S; Topal, E; Çaltepe, G; Can, D; Ekren, PK; Kiliç, M; Emiralioglu, N; Eyüboglu, TS; Pekcan, S; Çakir, E; Özçelik, U; Dogru, D
    BackgroundCystic 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. MethodsThis 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. ResultsIn 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. ConclusionsPatients 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.
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    Evaluation of respiratory function at 6 years of age in patients with cystic fibrosis with frequent pulmonary exacerbations in the first 2 years of life
    Tabakci, SO; Cinel, G; Uytun, S; Polat, SE; Yalçin, E; Kiper, N; Erdal, MA; Sen, V; Savas, S; Çelebi, Ö; Altintas, DU; Serbes, M; Kilinç, AA; Çokugras, H; Arslan, H; Yazan, H; Kafi, HM; Çollak, A; Ünal, G; Yilmaz, AI; Çaglar, HT; Irmak, I; Damadoglu, E; Öztürk, GK; Demir, E; Basaran, E; Bingöl, A; Canitez, Y; Çekiç, S; Asfuroglu, P; Aslan, AT; Harmanci, K; Kiliç, G; Köse, M; Ersoy, A; Hangül, M; Özdemir, A; Özcan, G; Çobanoglu, N; Aydin, ZGG; Keskin, Ö; Yüksel, H; Özdogan, S; Topal, E; Çaltepe, G; Can, D; Ekren, PK; Kiliç, M; Eyüboglu, TS; Pecan, S; Çakir, E; Emiralioglu, N; Özçelik, U; Ersöz, DD
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    The reliability and validity of Turkish version of Childhood Asthma Control Test
    Sekerel, BE; Soyer, OU; Keskin, O; Uzuner, N; Yazicioglu, M; Kiliç, M; Artaç, H; Ozmen, S; Can, D; Zeyrek, D; Cokugras, H; Canitez, Y; Aydogan, M; Kuyucu, S; Inal, A; Gurkan, F; Orhan, F; Yilmaz, O; Boz, AB; Tahan, F; Cevit, O
    Introduction The reliability and validity of Turkish version of Childhood Asthma Control Test (C-ACT). Purpose The management of asthma is an important as well as difficult issue of physician's daily practice particularly in busy clinical settings. C-ACT was created to identify asthma control levels in children aged 4-11 years. Our aim was to evaluate the reliability, validity and responsiveness of C-ACT in a Turkish sample of children with asthma. Method In this multicenter study, 368 children were enrolled. C-ACT was completed every month by parents and patients who were evaluated in 3 visits within 2 month intervals. At each visit, physicians interpret the control level and decided for the treatment step as established in GINA guidelines. Results The internal consistency reliability of the Turkish version of C-ACT (C-ACT1 to C-ACT5) was found to be 0.82, 0.83, 0.82, 0.82 and 0.80, respectively (reliability statistics, Cronbach's alpha). Test-retest reliability was 0.71. There was significant correlation between C-ACT and physician's assessment of asthma control at visit 1 (r = 0.65, P < 0.001). Conclusions Turkish version of C-ACT is an accurate and reliable tool to evaluate asthma control in children aged 4-11 years. Its widespread use may facilitate appropriate assessment of asthma control and may lead to decrease the number of uncontrolled patients.
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    Eligibility of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulator therapies: cohort of cystic fibrosis registry of Türkiye
    Erdal, MA; Büyüksahin, HN; Sen, V; Kilinç, AA; Çokugras, H; Dogan, G; Yilmaz, AI; Ünal, G; Serbes, M; Altintas, DU; Arik, E; Keskin,Ö; Özaslan, MM; Karcioglu, O; Köse, M; Basaran, AE; Çakir, EP; Canitez, Y; Özdemir, A; Harmanci, K; Uytun, S; Polat, SE; Hangül, M; Yüksel, H; Özcan, G; Korkmaz, P; Kiliç, M; Aydin, ZGG; Çaltepe, G; Can, D; Dogru, S; Öztürk, GK; Süleyman, A; Topal, E; Özsezen, B; Hizal, M; Demirdögen, E; Ogun, H; Börekçi, S; Yazan, H; Sen, HS; Demir, AD; Çakir, E; Eyüboglu, TS; Emiralioglu, N; Pekcan, S; Özçelik, U; Dogru, D
    Background. Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) variants are essential for determining eligibility for CFTR modulator drugs (CFTRms). In contrast to Europe and the USA, the treatment eligibility profile of cystic fibrosis (CF) patients in T & uuml;rkiye is not known. In this study we aimed to determine the eligibility of CF patients in T & uuml;rkiye for the CFTRms. Methods. The Cystic Fibrosis Registry of T & uuml;rkiye (CFrT) data was used to determine the age of patients in the year 2021 and the genetic variants they were carrying. Age- and CFTR-variant appropriate modulator therapies were determined using the Vertex (R) algorithm. Results. Among a total of 1930 registered patients, CTFR gene analysis was performed on a total of 1841 (95.4%) patients. Mutations were detected in one allele in 10.7% (198 patients), and in both alleles in 79% (1455 patients) of patients. A total of 855 patients (51.7% for whom at least 1 mutation was detected) were eligible for the drugs. The most appropriate drug among genotyped patients was found to be elexacaftor/tezacaftor/ivacaftor for 486 patients (26.4%), followed by ivacaftor for 327 patients (17.7%) and lumacaftor/ivacaftor for 42 patients (2%). Conclusions. Only half of patients registered in CFrT were eligible for CFTRms, which is a significant difference from the CFTR variant profile seen in USA and Europe. However, access to treatment is hampered for some patients whose genes are not analysed. Further studies in CF populations, where rare mutations are relatively more common, will contribute to the field of CFTR modulator treatments for such rare mutations.
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    Comparison of clinical features of cystic fibrosis patients eligible but not on CFTR modulators to ineligible for CFTR modulators
    Büyüksahin, HN; Emiralioglu, N; Yalçin, E; Sen, V; Sen, HS; Arslan, H; Baskan, AK; Çakir, FB; Koray, CF; Yilmaz, AI; Ercan, F; Altintas, DU; Serbes, M; Keskin, Ö; Arik, E; Gülen, F; Barlik, M; Karcioglu, O; Damadoglu, E; Köse, M; Ersoy, A; Bingöl, A; Basaran, E; Çakir, EP; Aslan, AT; Canitez, Y; Korkmaz, M; Özdemir, A; Harmanci, K; Soydas, SS; Hangül, M; Yüksel, H; Özcan, G; Korkmaz, P; Kiliç, M; Aydin, ZGG; Çaltepe, G; Can, D; Dogru, S; Öztürk, GK; Süleyman, A; Topal, E; Özsezen, B; Hizal, M; Demirdögen, E; Ogun, H; Börekçi, S; Yazan, H; Çakir, E; Eyüboglu, TS; Çobanoglu, N; Cinel, G; Pekcan, S; Özçelik, U; Dogru, D
    Introduction: Cystic fibrosis transmembrane conductance regulator (CFTR) modulator drugs target the underlying defect and improve CFTR function. They are a part of standard care in many countries, but not all patients are eligible for these drugs due to age and genotype. Here, we aimed to determine the characteristics of non-eligible patients for CFTR modulators in the CF registry of Turkey (CFRT) to highlight their clinical needs. Methods: This retrospective cohort study included CF patient data from the CFRT in 2021. The decision of eligibility for the CFTR modulator was determined according to the 'Vertex treatment-Finder' on the Vertex (R) website. Demographic and clinical characteristics of patients were compared between eligible (group 1) and ineligible (group 2) groups for CFTR modulators. Results: Among the study population (N = 1527), 873 (57.2%) were in group 1 and 654 (42.8%) were in group 2. There was no statistical difference between groups regarding sex, meconium ileus history, diagnoses via newborn screening, FEV1 z-score, CF-associated complications, organ transplant history, and death. Patients in group 2 had a higher incidence of pancreatic insufficiency (87.7% vs. 83.2%, p = .010), lower median height z-scores (-0.87 vs. -0.55, p < .001), lower median body mass index z-scores (-0.65 vs. -0.50, p < .001), longer days receiving antibiotics due to pulmonary exacerbation (0 [interquartile range, IQR: 0-2] vs. 0 [IQR: 0-7], p = 0.001), and more non-invasive ventilation support (2.6% vs. 0.9%, p = 0.008) than patients in group 1. Conclusion: The ineligible group had worse clinical outcomes than the eligible group. This highlights their need for life-changing drugs to improve clinical outcomes.