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The aim of this review is to elaborate the management of biologic therapy from initial selection to switching biologics in severe asthma. A nonsystematic review was performed for biological therapy management in severe asthma. Depending on clinical characteristics and biomarkers, selecting the preferred biologic based on super-responder criteria from previous studies may result in adequate clinical efficacy in most patients. On the other hand, no matter how carefully the choice is made, in some patients, it may be necessary to discontinue the drug due to suboptimal clinical response or even no response. This may result in the need to switch to a different biological therapy. How long the biological treatment of patients whose asthma is controlled with biologics will be continued and according to which criteria they will be terminated remains unclear. It has been shown that in patients with a long history of good response to biologics, asthma control may be impaired when biologics are discontinued, while it may persist in others. Therefore, discontinuation of biologics may be a viable strategy in a particular patient group. Clinicians should make the best use of all predictive factors to identify patients who will most benefit from each biologic. Patients who do not meet a predefined response criterion after sufficient time for response evaluation and who are eligible for one or more alternative biological agents should be offered the opportunity to switch to another biologic. There is no consensus on when the biologics used in severe asthma that produce favorable results should be discontinued. In our opinion, treatment should continue for at least five years, as premature termination may potentially deteriorate asthma control.

Background: The aim of the present study was to evaluate whether different Nd:YAG laser applications as an adjunct to scaling and root planning (SRP) improve the healing response to periodontal therapy in smokers with periodontitis., Methods: This clinical trial included eighty systemically healthy smokers with periodontitis. Patients were randomly allocated to a treatment group: SRP alone (group 1), SRP+low-level laser therapy (LLLT) with Nd:YAG laser (group 2), SRP+pocket debridement with ND:YAG laser (group 3), and SRP+combined pocket debridement and LLLT with Nd:YAG laser (group 4). Gingival index (GI), plaque index (PI), bleeding on probing (%), probing depth (PD), and clinical attachment level (CAL) were recorded, and gingival crevicular fluid (GCF) samples for metalloproteinase-8 (MMP-8) levels were collected at baseline, 1 month and 3 months after treatment., Results: There were no significant differences between the treatment groups for the GI, PI, and BOP (%) parameters and MMP-8 levels at any time points (p > 0.05). For moderately deep pockets, PD and CAL reductions were significantly greater in all test groups compared to group 1 (p ˂ 0.05). For deep pockets, these reductions were significantly greater in group 2 and group 4 compared to group 1 (p ˂ 0.05). PD and CAL reductions were generally similar between test groups (p > 0.05) except PD reduction between baseline and 3 months in deep pockets (p ˂ 0.05)., Conclusions: The findings of this clinical trial suggest that Nd:YAG laser applications may be beneficial on the healing response of smokers to non-surgical therapy compared to SRP alone., (© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Aim: Sarcopenia is a progressive and generalized syndrome that can be linked to many causes such as cancers, and is caused by a quantitative and qualitative disorder (loss of muscle strength and/or physical performance) of skeletal muscle mass. Although sarcopenia has some hypothetical explanation in clinical practice, the mechanisms underlying this condition have not been clearly differentiated in patients with cancer. We aimed to investigate the relationship between irisin, FGF21 and CRP in detecting sarcopenia in colorectal cancer patients., Material and Methods: Current prospectively study included non-metastatic newly diagnosed colorectal cancer patients. Patients were divided into 2 groups of 25 people, those with and without sarcopenia. Body composition measurements by examined by BIA. To measure the level of iris and FGF21 from patients, blood samples were taken into the biochemistry tube and their levels were measured., Results: The median age of the patients included in the study was 60 years (range: 21-81), 68% were men. It was found that there was a significant relationship between sarcopenia and gender and BMI measurement. When Spearman correlation analysis was performed between skeletal muscle mass index and FGF21, irisin and CRP, there was a positive correlation between skeletal muscle mass index and irisin and FGF21, while there was a negative correlation between skeletal muscle mass index and CRP. [respectively: (r: 0.282, p: 0.048), (r: 0.564, p: < 0.001) and (r: - 0.360, p: 0.010)]. Similar results were found between hand-grip strength and FGF21, irisin and CRP. [respectively: (r: 0.342, p: 0.015), (r: 0.290, p: 0.041) and (r: - 0.476, p < 0.001)]. When sarcopenia was treated as the dependent variable in the logistic regression analysis, and FGF21, irisin, CRP, gender and BMI were treated as the independent variables, irisin and CRP levels were determined as independent predictors., Conclusion: This study was revealed that there is a negative relationship between sarcopenia and irisin and FGF-21 in operated non-metastatic colorectal cancer patients and there may be a relationship between sarcopenia and inflammation. It suggests that these biomarkers may play a role in the pathophysiology of sarcopenia. However, our results need to be validated in different types of cancer and with more patients., (© 2022. The Author(s), under exclusive licence to European Geriatric Medicine Society.)