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Objective: The obese-asthma phenotype has gradually increased in the last few years. We aimed to assess the differences between obese and non-obese patients with asthma., Methods: This research is a subanalysis of the Turkish Adult Asthma Registry (TAAR). Clinical presentation, disease control, severity, and demographics of obese and non-obese (normal-weight, overweight) patients were compared., Results: The obesity rate in TAAR was 32.2% ( n  = 619/1919; 18-83 years; 527 F/92 M). Patients with asthma and obesity had higher rates of childhood obesity, longer symptom duration, later onset of asthma, and more severe asthma. These patients were more likely to be female, older, less educated, and live in rural areas. Patients with obesity had more scheduled visits and emergency visits compared with non-obese patients, but similar asthma control, oral corticosteroid use, hospitalizations, intensive care unit admissions, and unscheduled visits. They also had a higher frequency of T2-high but lower frequency of possible T2-low phenotypes compared with normal-weight asthmatics. The risk of severe asthma in patients with obesity was 6.04 times higher for allergic than non-allergic patients and 3.58 times higher for the T2-high phenotype than for possible T2-low phenotypes. A one-unit increase in the asthma control test reduced the risk of severe asthma by 22%., Conclusions: A good definition of this phenotype is important to ensure that appropriate treatment strategies are implemented to achieve the control goal. We also believe that prevention of childhood obesity is an effective and pivotal strategy to achieve the goal of asthma control.

Current guidelines recommend adding long-acting muscarinic antagonists (LAMAs) in patients with uncontrolled asthma, despite the use of moderate to high doses of inhaled steroid-long-acting beta agonists (ICS/LABA). This study aims to analyze the factors related to the prescription of add-on LAMA in clinical practice for asthma patients, shedding light on physicians' preferences. This study included adult asthma patients on add-on LAMA and ICS/LABA monitored for at least one year in a national registry comprising 2053 asthmatics. Patients' characteristics and disease profiles were analyzed to identify factors associated with the prescription of add-on LAMA across the entire cohort. A comparative analysis was performed among three groups: MART (ICS/formoterol as a maintenance and reliever therapy) plus LAMA, Conventional (ICS/LABA as a maintenance and short-acting beta agonist as reliever) plus LAMA and Triple (ICS/LABA/LAMA single inhaler). LAMAs were added to ICS/LABA in 11.7 % of patients in the national registry. Logistic regression analysis revealed that older age, low FEV1 (%), Asthma Control Test (ACT) scores less than 20, and severe exacerbation were the main factors influencing the initiation of LAMA in our registry. However, demographic characteristics of asthma, control status, pulmonary function test results were similar among the three groups of LAMA users (p > 0.05). Physicians used LAMAs without phenotyping based on allergic status or eosinophil levels (p > 0.05). Mepolizumab was added after LAMA in all patients, while omalizumab was initiated before LAMA in 16.9 % of the patients receiving LAMA along with biologics. Add-on LAMAs were predominantly prescribed for older, uncontrolled, and exacerbated asthma patients with low FEV1., Competing Interests: Declaration of competing interest Gemicioglu B report honoraria to her instutition from GSK, AstraZeneca, Abdi Ibrahim, Deva and grant to her institution for being in advisory board of GSK and Abdi Ibrahim not related to the study. Oguzulgen IK report honoraria and grants from GSK, Chiesi, AstraZeneca, Abdi Ibrahim, Deva and Novartis. Not related to the study. Mungan D, Yorgancioglu A and Celik GE report honoraria from GSK nor related to the study. Other authors have no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Asthma is one of the most common causes of chronic respiratory disease, and countries with low socioeconomic status have both a high prevalence of asthma and asthma-related death., Objective: In this study, we aimed to determine socioeconomic levels of asthmatic patients according to a national database and investigate the effects of social markers on disease control in our region., Methods: This is an analysis of data from 2053 adult asthma patients from a multicentre chart study in Turkey. Socioeconomic status (SES) data were collected from questionnaires and this form was sent to the patients via e-mail. Parameters related to social status and poor disease control were analyzed., Results: Illiteracy (OR:2.687 [95% CI: 1.235-5.848]; p = 0.013) and lower household income (OR:1,76 [95% CI: 1.002-3.09]; p = 0.049) were found as independent risk factors for hospitalization in the multivariate logistic regression analysis. Therewithal, being aged between 40 and 60 (OR: 1.435 [95% CI: 1.074-1.917]; p = 0.015), illiteracy (OR: 2.188 [95% CI: 1.262-3.795]; p = 0.005) and being employed (OR: 1.466 [95% CI: 1.085-1.847]; p = 0.011) were considered as independent risk factors for systemic corticosteroid use at least 3 days within last 1 year., Conclusion: As a result of our national database, education level, household income and working status briefly socioeconomic status have impacts on asthma control. Identification of social markers in asthma and better recognition of risk factors based on the population gives us clues to provide better asthma control in the future., (© 2025 The Author(s). Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.)

Introduction: In a resource-constrained situation, a clinical risk stratification system can assist in identifying individuals who are at higher risk and should be tested for COVID-19. This study aims to find a predictive scoring model to estimate the COVID-19 diagnosis.", Materials: Patients who applied to the emergency pandemic clinic between April 2020 and March 2021 were enrolled in this retrospective study. At admission, demographic characteristics, symptoms, comorbid diseases, chest computed tomography (CT), and laboratory findings were all recorded. Development and validation datasets were created. The scoring system was performed using the coefficients of the odds ratios obtained from the multivariable logistic regression analysis.", Result: Among 1187 patients admitted to the hospital, the median age was 58 years old (22-96), and 52.7% were male. In a multivariable analysis, typical radiological findings (OR= 8.47, CI= 5.48-13.10, p< 0.001) and dyspnea (OR= 2.85, CI= 1.71-4.74, p< 0.001) were found to be the two important risk actors for COVID-19 diagnosis, followed by myalgia (OR= 1.80, CI= 1.08- 2.99, p= 0.023), cough (OR= 1.65, CI= 1.16-2.26, p= 0.006) and fatigue symptoms (OR= 1.57, CI= 1.06-2.30, p= 0.023). In our scoring system, dyspnea was scored as 2 points, cough as 1 point, fatigue as 1 point, myalgia as 1 point, and typical radiological findings were scored as 5 points. This scoring system had a sensitivity of 71% and a specificity of 76.3% for a cut-off value of >2, with a total score of 10 (p< 0.001)., Conclusions: The predictive scoring system could accurately predict the diagnosis of COVID-19 infection, which gave clinicians a theoretical basis for devising immediate treatment options. An evaluation of the predictive efficacy of the scoring system necessitates a multi-center investigation.

Background/aim: Characteristics of asthma in the elderly population is not well-known. The aim of the present study was to evaluate asthma in the elderly population, to compare disease characteristics between patients diagnosed <60 (aged asthma) and ≥60 (elderly asthma) years of age., Materials and Methods: The study was a prospective, multicenter, cross-sectional type. A questionnaire was filled out to patients 60 years of age and over, that have been followed for asthma for at least 3 months. Asthma Control Test (ACT), eight-item Morisky Medication Adherence Scale (MMAS-8) was filled out, inhaler device technique was assessed., Results: A total of 399 patients were included from 17 tertiary care centers across the country. Mean age was 67.11 years and 331 (83%) were female. The age at asthma diagnosis was ≥60 in 146 (36.6%) patients. Patients diagnosed ≥60 years were older (p < 0.001), had higher education level (p < 0.001), more commonly had first-degree relative with asthma (p = 0.038), asthma related comorbidities (p = 0.009) and accompanying rhinitis/rhinosinusitis (p = 0.005), had better asthma control (p = 0.001), were using less controller medications (p = 0.014). Inhaler technique was correct in 37% of the patients with no difference in between the groups. Treatment compliance was better in elderly asthma patients (p < 0.001). In the multivariate logistic regression analysis, having well-controlled asthma (odds ratio = 1.61, CI = 1.04-2.51), and high medication adherence rate (odds ratio = 2.43, CI = 1.48-4.0) were associated with being in the elderly asthma group., Conclusion: The characteristics of asthma are different among patients aged 60 years and over which seems to be related to onset age of asthma. In our cohort, the elderly asthma patients had higher education level, and treatment adherence and asthma control was better. Patients diagnosed ≥60 years of age did not have more severe disease., Competing Interests: Conflicts of interest: None, (© TÜBİTAK.)

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 FEV 1 , 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 FEV 1, 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.

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.

Background: Hypersensitivity reactions (HSRs) to nonsteroidal anti-inflammatory drugs (NSAIDs) are a significant clinical issue. Several classifications have been proposed to categorize these reactions, including the current European Academy of Allergy and Clinical Immunology/European Network for Drug Allergy (EAACI/ENDA) classification. This study aimed to evaluate the applicability of this classification in a real-world clinical setting., Methods: We conducted a national multicenter study involving patients from nine hospitals in four major urban centers in Turkey. All patients had a suggestive clinical history of hypersensitivity reactions to NSAIDs. Researchers collected data using a structured form and classified reactions based on the EAACI/ENDA classification. Oral provocation tests with several NSAIDs were performed using a single-blind challenge per EAACI/ENDA guidelines., Results: Our retrospective study included 966 adult patients with a history of hypersensitivity to NSAIDs. The most common triggers were Acetylsalicylic Acid (ASA), paracetamol, and metamizole. The most prevalent acute NSAID hypersensitivity group was NSAID-induced urticaria/angioedema (NIUA) (34.3%). However, 17.3% of patients did not fit neatly into the current EAACI/ENDA classification. Notably, patients with underlying asthma or allergic rhinoconjunctivitis exhibited unusual reactions, such as urticaria and/or angioedema induced by multiple chemical groups of NSAIDs, blended mixed reactions, and isolated periorbital angioedema in response to multiple chemical groups of NSAIDs., Conclusions: While the EAACI/ENDA classification system stratifies NSAID-induced hypersensitivity reactions into five distinct endotypes or phenotypes, it may not fully capture the diversity of these reactions. Our findings suggest a need for further research to refine this classification system and better accommodate patients with atypical presentations.

Introduction: Omalizumab, a humanized monoclonal anti-IgE antibody, has largely demonstrated its efficacy in severe allergic asthma. There are limited data about the effectiveness of omalizumab in patients with non-atopic severe persistent asthma. In this study, we aimed to determine the effect of omalizumab in patients with non-atopic severe asthma and compare the data obtained with those in patients with allergic severe asthma., Materials and Methods: This study was an observational, retrospective, tertiary single-center study that assessed and compared the clinical outcome of adult patients with severe asthma (165 atopic and 41 non-atopic) who have been on omalizumab for one year or longer between January 2008 and January 2020. Effectiveness was assessed by considering symptom scores (GINA symptom control score), daily systemic corticosteroids (SCS) dosage, blood eosinophil counts, pulmonary function, and number of severe exacerbations and hospitalizations within the last one year., Result: Omalizumab exhibited significant improvement in the clinical status of non-atopic asthma patients as measured by GINA symptom score [decreased from 3.77 ± 0.63 to 1.36 ± 1.27 (p<0.001)], the number of emergency room visits for asthma [decreased from 11.25 ± 14.69 to 0.25 ± 0.55 (p<0.001)], and the number of hospitalizations [decreased from 1.17 ± 2.87 to 0.14 ± 0.36 (p= 0.036)]. These results were not significantly different from those obtained in allergic asthma patients. FEV1 improved significantly from 2.08 ± 0.86 to 2.14 ± 0.84 (p= 0.041) and oral corticosteroid doses decreased significantly from 1.67 ± 7.49 to 0.46 ± 2.74 (p= 0.015) in the only atopic group., Conclusions: Omalizumab, which is a proven and effective treatment option for allergic asthma, may also be an efficacious alternative option in non-atopic severe asthma.

Yield of sweet cherry ( Prunus avium L.) is determined by fruit set, a developmental stage sensitive to variable spring environmental conditions. To sustain fruit production and enhance crop climate resilience, it is important to understand the impacts of abiotic stresses and the effectiveness of horticultural mitigations in the spring on the critical developmental processes during fruit set. In this study, flowering phenology, pistil browning and percent fruit set of 'Lapins' were monitored at five sites of different elevation and frost risk in the Okanagan Valley, British Columbia, Canada, in 2019 and 2022. At Site 1 in Summerland Research and Development Centre ("SuRDC1"), where a 'Lapins' on Krymsk 5 planting was located in a frost pocket where the crops were exposed to high risk of cold damage in the spring, a series of experiments were conducted to investigate the floral organ viability and percent fruit set under low temperatures, and under the effects of four spring horticultural mitigation measures. Installation of polyethylene sleeves and FAME spray (fatty acid methyl esters-based plant growth regulator, WAIKEN, SST Australia) were implemented in 2019; boric acid spray and postponed irrigation were tested in 2022. Low fruit set at SuRDC1 in both years was associated with severe pistil browning after night temperature dropped below -4 °C in late April. In 2019, the semi-enclosure of polyethylene sleeves led to an increase in the surface temperature (T surfae ) of floral buds by 2-4 °C, which prolonged the stage of first bloom, delayed petal fall and prevented frost damage on pistils, but led to the decrease in percent fruit set by 77%, due to ovule abortion or cessation of fruitlet development. The early and late sprays of FAME had no significant influence on either abundance of germinated pollen tubes or percent fruit set; however, the potential of late spray in improving pollen abundance and reducing pistil browning requires further investigation. In 2022, the spray of 0.01% boric acid solution led to a decrease in fruit set by 6.95%. Six-week postponement of irrigation starting from full bloom decreased soil moisture, but increased soil temperature and improved fruit set by 7.61%. The results improved our understanding about the damages of adverse spring air temperatures on pistils and ovules, and suggested the potential of irrigation adjustment in regulating soil moisture and temperature and improving fruit set in the cool and moist spring.

Background: The potential role of interleukin-6 (IL-6) in coronavirus disease 2019 (COVID-19) pneumonia provides the rationale for investigating IL-6 signaling inhibitors., Objectives: To evaluate and report treatment responses to tocilizumab (TCZ) in COVID-19 patients and compare mortality outcomes with those of standard care., Material and Methods: Patients hospitalized with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, diagnosed with reverse transcription polymerase chain reaction (RT-PCR) between March 2020 and April 2021, were enrolled in this single-center retrospective cohort study. Propensity score matching was performed in order to reduce confounding effects secondary to imbalances in receiving TCZ treatment., Results: A total of 364 patients were included in this study. Two hundred thirty-six patients received standard care, while 128 patients were treated with TCZ in addition to standard care (26 (20.3%) patients received a dose of 400 mg intravenously once, while 102 (79.7%) patients received a total dose of 800 mg intravenously). In the propensity score-matched population, less noninvasive mechanical ventilation (p = 0.041) and mechanical ventilation support (p = 0.015), and fewer deaths (p = 0.008) were observed among the TCZ-treated patients. The multivariate adjusted Cox regression model showed a significantly higher survival rate among TCZ patients compared to controls (hazard ratio (HR): 0.157, 95% confidence interval (95% CI): 0.026-0.951; p = 0.044). The hazard ratio for mortality in the TCZ group was 0.098 (95% CI: 0.030-0.318; p = 0.0001 using log-rank test)., Conclusions: This study determined that TCZ treatment in COVID-19 patients was associated with better survival, reduced need for mechanical ventilation and reduced hospital-associated mortality.

Background: Hereditary angioedema (HAE) is a rare autosomal dominant disorder caused by C1-inhibitor deficiency. It is characterized by recurrent attacks of cutaneous and upper respiratory tract swelling, and abdominal pain due to mucosal edema. Early detection and treatment prevent unnecessary interventions, improves quality of life, and prevents potentially fatal attacks., Objective: The present study aims to investigate physicians level of knowledge and awareness regarding HAE., Methods: A questionnaire about HAE was applied to 393 physicians from a university hospital. Participants were requested to choose one or several answers to multiple-choice questions., Results: Seven and three tenths percent of study participants stated to have never heard of HAE. Twenty-seven physicians (7.4%) chose the exact correct answers regarding diagnostic tests, and 2 (0.8%) chose the exact correct answers regarding emergency management. A composite of internists, pediatrists and emergency medicine specialists had a significantly higher mean score than other physicians ( p = 0.047). Physicians from internal medical sciences scored significantly higher than physicians from surgical medical sciences ( p = 0.022)., Conclusion: The present study reveals that physician awareness about HAE is low, and physicians misdiagnose HAE attacks as histaminergic angioedema attacks, and therefore provide ineffective treatment. Although HAE is a rare disease, physician awareness must be increased, because early diagnosis and effective treatment are vital for the patients., Competing Interests: Conflict of Interest: The authors have no financial conflicts of interest., (Copyright © 2022. Asia Pacific Association of Allergy, Asthma and Clinical Immunology.)

Background: Laboratory biomarkers to estimate the severity of coronavirus disease 2019 (COVID-19) are crucial during the pandemic since resource allocation must be carefully planned., Aims: To evaluate the effects of basal serum total immunoglobulin E (IgE) levels and changes in inflammatory parameters on the clinical progression of patients hospitalised with COVID-19., Methods: Patients hospitalised with confirmed COVID-19 were included in the study. Laboratory data and total IgE levels were measured on admission. Lymphocyte, eosinophil, ferritin, d-dimer and C-reactive protein parameters were recorded at baseline and on the 3rd and 14th days of hospitalisation., Results: The study enrolled 202 patients, of which 102 (50.5%) were males. The average age was 50.17 ± 19.68 years. Of the COVID-19 patients, 41 (20.3%) showed clinical progression. Serum total IgE concentrations were markedly higher (172.90 (0-2124) vs 38.70 (0-912); P < 0.001) and serum eosinophil levels were significantly lower (0.015 (0-1.200) vs 0.040 (0-1.360); P = 0.002) in clinically worsened COVID-19 patients when compared with stable patients. The optimal cut-off for predicting clinical worsening was 105.2 ng/L, with 61% sensitivity, 82% specificity, 46.3% positive predictive value and 89.2% negative predictive value (area under the curve = 0.729). Multivariable analysis to define risk factors for disease progression identified higher total IgE and C-reactive protein levels as independent predictors., Conclusions: Our single-centre pilot study determined that total IgE levels may be a negative prognostic factor for clinical progression in patients hospitalised due to COVID-19 infection. Future studies are required to determine the impact of individuals' underlying immune predispositions on outcomes of COVID-19 infections., (© 2022 Royal Australasian College of Physicians.)

Background: Over-reliance on short-acting β 2 -agonists (SABAs) is associated with poor asthma outcomes. However, the extent of SABA use in Turkey is unclear owing to a lack of comprehensive healthcare databases. Here, we describe the demographics, disease characteristics and treatment patterns from the Turkish cohort of the SABA use IN Asthma (SABINA) III study., Methods: This observational, cross-sectional study included patients aged ≥ 12 years with asthma from 24 centres across Turkey. Data on sociodemographics, disease characteristics and asthma treatments were collected using electronic case report forms. Patients were classified by investigator-defined asthma severity (guided by the 2017 Global Initiative for Asthma [GINA]) and practice type (primary/specialist care). The primary objective was to describe SABA prescription patterns in the 12 months prior to the study visit., Results: Overall, 579 patients were included (mean age [standard deviation; SD]: 47.4 [16.1] years; 74.3% female), all of whom were treated by specialists. Most patients had moderate-to-severe asthma (82.7%, GINA steps 3-5), were overweight or obese (70.5%), had high school or university/post-graduate education (51.8%) and reported fully reimbursed healthcare (97.1%). The mean (SD) asthma duration was 12.0 (9.9) years. Asthma was partly controlled/uncontrolled in 56.3% of patients, and 46.5% experienced ≥ 1 severe exacerbation in the preceding 12 months. Overall, 23.9% of patients were prescribed ≥ 3 SABA canisters in the previous 12 months (considered over-prescription); 42.9% received no SABA prescriptions. As few patients had mild asthma, only 5.7% were prescribed SABA monotherapy. Therefore, most patients (61.5%) were prescribed SABA in addition to maintenance therapy, with 42.8% receiving ≥ 3 SABA canisters in the previous 12 months. Inhaled corticosteroids (ICS), ICS + a long-acting β-agonist fixed-dose combination and oral corticosteroids were prescribed to 14.5%, 88.3% and 28.5% of all patients, respectively. Additionally, 10.2% of patients purchased SABA over the counter, of whom 27.1% purchased ≥ 3 canisters in the preceding 12 months., Conclusions: Despite all patients being treated by specialists and most receiving fully reimbursed healthcare, nearly a quarter of patients received prescriptions for ≥ 3 SABA canisters in the previous 12 months. This highlights a public health concern and emphasizes the need to align clinical practices with the latest evidence-based recommendations., (© 2022. The Author(s).)

The 2021 summer heat waves experienced in the Pacific Northwest led to considerable fruit damage in many apple production zones. Sunburn browning (SB) was a particularly evident symptom. To understand the mechanism underlying the damage and to facilitate the early assessment of compromised fruit quality, we conducted a study on external characteristics and internal quality attributes of SB 'Ambrosia' apple ( Malus domestica var. Ambrosia) and evaluated the fruit loss on five rootstocks. The cell integrity of the epidermal and hypodermal layers of fruit skins in the SB patch was compromised. Specifically, the number of chloroplasts and anthocyanin decreased in damaged cells, while autofluorescent stress-related compounds accumulated in dead cells. Consequently, the affected sun-exposed skin demonstrated a significant increase in differential absorbance between 670 nm and 720 nm, measured using a handheld apple DA meter, highlighting the potential of using this method as a non-destructive early indicator for sunburn damage. Sunburn browning eventually led to lower fruit weight, an increase in average dry matter content, soluble solids content, acidity, deteriorated weight retention, quicker loss of firmness, and accelerated ethylene emission during ripening. Significant inconsistency was found between the sun-exposed and shaded sides in SB apples regarding dry matter content, firmness, and tissue water potential, which implied preharvest water deficit in damaged tissues and the risk of quicker decline of postharvest quality. Geneva 935 (G.935), a large-dwarfing rootstock with more vigor and higher water transport capacity, led to a lower ratio of heat-damaged fruits and a higher yield of disorder-free fruits, suggesting rootstock selection as a long-term horticultural measure to mitigate summer heat stress.

Introduction: Our knowledge has gaps regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication levels and its association to severity of Coronavirus disease 2019 (COVID-19). The aim of this study was to investigate the association of SARS-CoV-2 viral load with disease severity and serum biomarkers in COVID-19 patients., Methodology: Viral load was determined via cycle threshold (Ct) values of SARS-CoV-2 real-time reverse transcriptase-polymerase chain reaction (RT-PCR) in 214 adult patients. Ct values were compared with clinical severity, biochemical and hematological biomarkers., Results: Clinical course of the disease was mild (49.1%), moderate (40.2%), and severe (10.7%). Median Ct value was 28.2 (IQR: 22.2-33.8) during the first week of the disease. Ct values were lower within five days after symptom onset [lowest Ct value on the third day (median: 24, IQR: 20.6-32.3)], but they increased significantly during the second and third weeks. No association was detected between admission Ct values and disease severity. Gender, age, co-morbidity, and mortality did not differ significantly in patients with low (≤ 25) and high (> 25) Ct values. White blood cell, neutrophil, platelet, and especially lymphocyte counts, were significantly lower in patients with low Ct values., Conclusions: No definitive/clear correlation between SARS-CoV-2 viral load and severity and mortality was found in the studied COVID-19 patients. However, neutrophil, platelet, and especially lymphocyte count were significantly lower in patients with a high viral load., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2022 Imran Saglik, Beyza Ener, Halis Akalin, Buşra Ozdemir, Gokhan Ocakoglu, Baris Yalcin, Ugur Onal, Ozge Aydin Guçlu, Nilufer Aylin Acet Ozturk, Ulku Tuzemen, Ezgi Demirdogen, Asli Gorek Dilektasli, Harun Agca, Esra Kazak, Funda Coskun, Yasemin Heper, Melda Payaslioglu, Dane Ediger, Ahmet Ursavas, Emel Yilmaz, Cuneyt Ozakin, Esra Uzaslan, Mehmet Karadag.)

Introduction: Determining prognostic factors in patients with coronavirus disease (COVID-19) can have great impact on treatment planning and follow-up strategies. Herein, we aimed to evaluate prognostic factors and clinical scores for confirmed COVID-19 patients in a tertiary-care hospital in the Bursa region of Turkey., Methodology: Patients who had been diagnosed with COVID-19 microbiologically and/or radiologically between March and October 2020 in a tertiary-care university hospital were enrolled retrospectively. Adult patients (≥ 18 years) with a clinical spectrum of moderate, severe, or critical illness were included. The dependent variable was 30-day mortality and logistic regression analysis was used to evaluate any variables with a significant p value (< 0.05) in univariate analysis., Results: A total of 257 patients were included in the study. The mortality rate (30-day) was 14.4%. In logistic regression analysis, higher scores on sequential organ failure assessment (SOFA) (p < 0.001, odds ratio (OR) = 1.86, 95% CI = 1.42-2.45) and CURB-65 pneumonia severity criteria (p = 0.001, OR = 2.60, 95% CI = 1.47-4.57) were found to be significant in predicting mortality at admission. In deceased patients, there were also significant differences between the baseline, day-3, day-7, and day-14 results of D-dimer (p = 0.01), ferritin (p = 0.042), leukocyte (p = 0.019), and neutrophil (p = 0.007) counts., Conclusions: In our study of COVID-19 patients, we found that high SOFA and CURB-65 scores on admission were associated with increased mortality. In addition, D-dimer, ferritin, leukocyte and neutrophil counts significantly increased after admission in patients who died., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2022 Ugur Onal, Ozge Aydin Guclu, Halis Akalin, Nilufer Aylin Acet Oztürk, Cihan Semet, Ezgi Demirdogen, Asli Gorek Dilektasli, Imran Saglik, Esra Kazak, Guven Ozkaya, Funda Coskun, Dane Ediger, Yasemin Heper, Ahmet Ursavas, Emel Yilmaz, Esra Uzaslan, Mehmet Karadag.)

Background/aim: COVID-19 patients have a wide spectrum of disease severity. Several biomarkers were evaluated as predictors for progression towards severe disease. IL-21 is a member of common γ-chain cytokine family and creates some specific effects during programming and maintenance of antiviral immunity. We aimed to assess IL-21 as a biomarker for diagnosis and outcome prediction in patients hospitalized with COVID-19., Materials and Methods: Patients with a preliminary diagnosis of COVID-19 and pneumonia other than COVID-19 admitted to a tertiary care hospital were included consecutively in this comparative study., Results: The study population consisted of 51 patients with COVID-19 and 11 patients with non-COVID-19 pneumonia. Serum IL-21 concentration was markedly higher, and serum CRP concentration was significantly lower in COVID-19 patients compared to non-COVID-19 pneumonia patients. Within COVID-19 patients, 10 patients showed radiological and clinical progression. Patients with clinical worsening had lower lymphocyte count and haemoglobin. In addition to that, deteriorating patients had higher urea, LDH levels, and elevated concentration of both IL-6 and IL-21. The cut-off value of 106 ng/L for IL-21 has 80.0% sensitivity, %60.9 specificity for discriminating patients with clinical worsening. Multivariable analysis performed to define risk factors for disease progression identified IL-6 and IL-21 as independent predictors. Odds ratio for serum IL-6 concentrations ≥ 3.2 pg/mL was 8.07 (95% CI: 1.37-47.50, p = 0.04) and odds ratio for serum IL-21 concentrations ≥ 106 ng/L was 6.24 (95% CI: 1.04 – 37.3, p = 0.02)., Conclusion: We identified specific differences in serum IL-21 between COVID-19 and non-COVID-19 pneumonia patients. Serum IL-21 measurement has promising predictive value for disease progression in COVID-19 patients. High serum IL-6 and IL-21 levels obtained upon admission are independent risk factors for clinical worsening., Competing Interests: There is no conflict of interest to declare for all authors., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Background/aim: We aimed to report outcomes of pregnant patients with asthma under omalizumab treatment and their infants in our country., Materials and Methods: Patients with asthma who received omalizumab for at least 6 months and at least one dose during their pregnancy were retrospectively evaluated using a questionnaire regarding their disease and therapy and the health of their infants., Results: Twenty pregnant patients and their 23 infant’s data were analyzed. The mean delivery age was 31.8 ± 7.4 years. They received omalizumab for 28.9 ± 21.8 months. Eight (36.4%) patients showed exacerbation of the disease during pregnancy. Forced expiratory volume in 1 s (FEV1) and asthma control test (ACT) scores at the starting time of omalizumab administration, first month of the pregnancy, and after delivery were 71 ± 18%, 83.4 ± 10.5%, and 80.5 ± 13% (FEV1), and 11.9 ± 4.9, 20.2 ± 2.6, and 20.4 ± 2.2 (ACT), respectively. One patient gave birth to twin infants, two patients to two infants each in different years, and 17 to one infant each. Three (13%) infants had low birth weight and five (21.7%) were born prematurely. No congenital anomalies were detected. Seven (30.4%) infants presented atopic diseases during their life., Conclusion: Omalizumab treatment during pregnancy seems to be safe for both patients and their infants., Competing Interests: The authors declare that they have no conflicts of interest related to the submitting work. However, they report that unrelated to the submitted work; Gemicioglu B received grants from Novartis, Deva, Abdi Ibrahim, Sanofi, Astra Zeneca, GSK, Chiesi, Sandoz. Karakaya G received grants from Novartis, Astra Zeneca, GSK, Meda. Bavbek S received grant from Astra Zeneca, Novartis, GSK. Ediger D received grant from Novartis, Sanofi, AstraZeneca, GSK, MSD. Oğuzulgen IK received grants from AstraZeneca, GSK, Deva. Özşeker ZF received grants from Novartis, Abdi İbrahim, Deva. Yorgancıoğlu A received grant from Novartis, Deva, Abdi Ibrahim, Sanofi, Astra Zeneca, GSK, Chiesi, Sandoz., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Objective: Fatigue is a common symptom frequently reported in many disorders but little is known about the prevalence of fatigue in asthma. The objective of this study was to determine the prevalence of fatigue in asthmatic patients, the effect of fatigue on asthma quality of life and the relationship between fatigue and anxiety/depression MATERIALS AND METHODS: This prospective cross-sectional study was conducted in Uludağ University Faculty of Medicine, Department of Immunology and Allergic Diseases outpatient clinic from June 2019 to December 2019. Fatigue was assessed using the Checklist Individual Strength-Fatigue (CIS-Fatigue), psychological distress was assessed using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) and quality of life were assessed using the Asthma Quality of Life Questionnaire (AQLQ)., Results: In the present study, a total of 168 patients are included with an average age of 43.8 ± 4.3 years. Nearly 64.8% of patients had controlled asthma and (35.2%) patients had uncontrolled asthma. Fatigue (CIS-Fatigue ≥ 27 points) was detected in 62.6% of patients and associated with asthma-related quality of life, asthma control, dyspnea, depression and anxiety (P < 0.05). However, the degree of lung function impairment and asthma severity were not associated with fatigue., Conclusions: Fatigue as a symptom is common in asthmatic patients and correlates with asthma-related quality of life, asthma control, dyspnea, depression and anxiety. Future studies are needed to better understand the physical, psychological, behavioural and systemic factors that precipitate or perpetuate fatigue in asthma., (© 2021 John Wiley & Sons Ltd.)

In recent years, awareness has been raised around the benefits of diversifying rootstocks, in order to enhance tree health and sustain apple fruit production under the influence of climate change. However, performances of many rootstocks under stresses remain unclear. This study aimed to set the first step towards a much-needed comprehensive evaluation on water relationships and stress responses of scion-rootstock systems for the popular apple cultivar Ambrosia TM ( Malus domestica var. Ambrosia), because its production and horticultural knowledge had been largely limited to the Malling 9 rootstock (M.9). Five rootstocks were evaluated in a greenhouse water deficit experiment and at the onset of heat stress in a field trial in Summerland, British Columbia, Canada. Multiple stress indicators of leaves and fruits were analyzed to elucidate water use strategies and drought resistance mechanisms. The rootstocks led to differences in scion vigor, and stomatal and photosynthetic characteristics. The largest semi-dwarfing Geneva 202 (G.202) demonstrated more water use and higher stress susceptibility. Large dwarfing Geneva 935 (G.935) and Malling 26 (M.26) showed more stringent stomatal control and reduced water use under stresses, typical of a drought-avoidance strategy. The smallest large dwarfing M.9NIC29 ® and the small dwarfing Budagovsky 9 (B.9) led to smaller and denser stomata. B.9 demonstrated the most stable water status and drought tolerance. The study suggested that scion stress responses were influenced by rootstock vigor and tree water use strategies. It implied the necessity of vigor-specific irrigation management for alleviating stresses and achieving production goals of different rootstocks.

The Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) Series and Approved Instructional Resources - Professional (AIR-Pro) Series were created in 2014 and 2015, respectively, in response to the growing need to curate online educational content as well as create a nationally available curriculum that meets individualized interactive instruction criteria for emergency medicine (EM) trainees. These two online series identify high-quality educational blog and podcast content using an expert-based approach. The AIR series is a continuously building curriculum originally based on the Council of Emergency Medicine Directors (CORD) testing schedule. In September 2019, 61 blog posts and podcasts published within the previous 12 months and relevant to infectious diseases were evaluated by eight attending physicians using the ALiEM AIR scoring instrument. In this review, we summarize the accredited posts on infectious diseases meeting our a priori quality criteria per evaluation by the reviewers., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Ediger et al.)

Background/aim: Allergic rhinitis (AR) and asthma are the most common allergic disorders worldwide. Aeroallergens are critical causative factors in the pathogenesis of these disorders and sensitization to aeroallergens differs in various countries and regions. Identification of the most common aeroallergen sensitization is crucial in the diagnosis and management of AR and asthma. We examined the distribution of aeroallergen sensitizations detected by skin prick tests (SPTs) in adult patients with AR and/or asthma in the city of Bursa., Materials and Methods: Five hundred forty-five patients who underwent a SPT and were diagnosed with rhinitis and/or asthma in the Uludağ University Faculty of Medicine’s Department of Immunology and Allergic Diseases Outpatient Clinic from March 2018 to August 2018 were retrospectively evaluated. SPTs with standard extracts including house dust mites, pollens, molds, animal dander, and latex were performed for patients., Results: A total of 545 patients were included and most of the patients (270; 49.5%) were between 30 and 49 years of age. The prevalence of atopy was 57.9%. The most common aeroallergens detected in SPTs were Dermatophagoides farinae (50%) and D. pteronyssinus (44%), followed by grass-rye mix (43%), grass mix (38.6%), olive (33.2%), and wheat (32.3%). The sensitization to olive pollen was higher in cases of mild asthma (52%), while sensitization to D. farinae was higher in patients with mild and moderate asthma (54.5%, 54.2%) (P < 0.05) ., Conclusions: Our study revealed that house dust mite was the most common sensitizing aeroallergen in patients with AR and asthma while pollens were the most common allergen in patients with only AR. The sensitization to grass and olive pollen was higher in cases of mild asthma than moderate and severe. Regional allergy panels may provide important clinical clues for characteristics and courses of allergic diseases., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Introduction: The purpose of this study was to elucidate the asthma knowledge level of primary-secondary school teachers in Bursa, and factors associated with this subject., Materials and Methods: In our study 1812 teachers from 64 randomly selected primary schools in Bursa were included., Result: It was known by the vast majority of participants that asthma symptoms, asthma is not a contagious disease and may be familial, medications taken by inhalation. It was known by 64.1% of the teachers that asthmatic children do not mind doing sports. Approximately one of the two teachers knew that the medication were not addictive., Conclusions: The knowledge level of the teachers was related to female gender and age. We think that an asthma education program is needed for Turkish teachers to increase their understanding about what asthma is, its impact and how to meet the needs of a child with asthma to achieve improved wellbeing and school attendance.

Background: Allergic reactions developing after bee sting can be severe and life-threatening. According to epidemiological data, serious systemic reactions range between 1.2%-3%, and this is 2-3 times higher (6%) in beekeeping. In different beekeepers' populations, risk factors of systemic reactions have been investigated and diverse results have been found., Objective: The aim of this study is to evaluate the level of knowledge of beekeepers about venom allergy, epidemiological data, systemic reaction rates, risk factors for systemic reactions, and the rate of emergency admissions after bee sting., Methods: With the collaboration of Uludağ University Beekeeping Development Research Center and Beekeepers Association, a questionnaire consisting of 19 questions was applied to 242 beekeepers in Bursa and Yalova. Two hundred twenty-one beekeepers who completed the questionnaire were involved in the study., Results: The mean age of the beekeepers was 49.9 years (range, 18-75 years). The systemic reaction to bee sting in beekeepers was 37.6%. Allergic rhinitis was found to be a risk factor for systemic reaction. Although 80% of the beekeepers recognized that bee venom could be lethal, only 60% of the beekeepers were aware of immunotherapy, and only 30% were aware of the adrenaline auto-injector drug., Conclusion: Similar to previous studies, we found that the systemic response to the bee sting in beekeepers was higher compared to normal population. Considering the occupational exposure to bee venom and thus higher risk, the awareness of venom allergy in this high risk population was low, and they were poorly informed about the treatment options.

Background: Omalizumab has demonstrated therapeutic benefits both in controlled clinical trials and real-life studies. However, research concerning the long-term effects and tolerability of omalizumab is needed. The main objective of this study was to evaluate the effectiveness and tolerability of treatment with omalizumab for up to 5 years., Methods: A multicenter, retrospective, chart-based study was carried out to compare documented exacerbations, hospitalizations, systemic steroid requirement, FEV1, and asthma control test (ACT) results during 1 year prior to omalizumab treatment versus at 1, 3, and 5 years of treatment. Adverse events and reasons for discontinuation were also recorded at each time point., Results: Four hundred and sixty-five patients were enrolled in the study. Outcome variables had improved after the 1st year and were sustained after the 3rd and 5th years of treatment with omalizumab. Omalizumab treatment reduced the asthma exacerbation rate by 71.3% (p < 0.001) at 1 year, 64.3% (p < 0.001) at 3 years, and 54.8% (p = 0.002) at 5 years. The hospitalization rate also decreased; by the 5th year of the treatment no patients were hospitalized. ACT results had also improved significantly: 12 (p < 0.001) at 1 year, 12 (p < 0.001) at 3 years, and 12 (p = 0.002) at 5 years. Overall, 12.7% of patients reported adverse events (most of these were mild-to-moderate) and the overall dropout rate was 9.0%., Conclusion: Omalizumab had a significant effect on asthma outcomes and this effect was maintained over 5 years. The drug was found to be generally safe and treatment compliance was good., (© 2018 S. Karger AG, Basel.)