Ilkim Deniz Toprak ilkimdenizzz@hotmail.com Pelin Korkmaz Zeynep Kılınc Derya Unal Semra Demir Aslı Gelincik Ilkim Deniz...

Amaç: Çalışmamızın amacı; bir yıllık süre içerisinde takip ettiğimiz tip 2 diyabetik hastaların tedavi, tetkik ve muayene için harcanan maliyetlerini ortaya koyup, bu maliyetlerin bir yıllık kontrolde ne kadar etkili olduğunu göstermektir. Gereç ve Yöntem: Son bir yıl içinde Tip 2 Diyabet tanısı ile polikliniğimizde ayaktan takip edilen 500 hasta çalışmaya alındı. HbA1c (%) değerlerine göre ‘iyi regüle ≤7’, ‘kötü regüle7-10’, ‘çok kötü regüle ≥10’ olmak üzere 3 gruba ayrıldı ve üç grubun ortalama yıllık tedavi, muayene ve tahlil maliyetleri hesaplanarak karşılaştırmaları yapıldı. Bulgular: Son bir yıldır poliklinikte takip edilen 500 Tip 2 Diyabet tanısı olan hastanın bir yıllık ilaç maliyeti ortalaması kişi başı 1614 TL, ortalama muayene ve tahlil maliyeti ise 250 TL olarak hesaplandı. HbA1c ≤7 olan hastalarda bir yıllık ortalama tedavi maliyeti 835 TL, HbA1c 7-10 arasında olan hastalarda 1879 TL iken, HbA1c ≥10 olan hastalarda ise 2182 TL saptandı. Sadece oral antidiyabetik (OAD) kullanan grubun bir yıllık ortalama ilaç maliyeti 449 TL iken bu değer insülin kullanan grupta: 2429 TL ve OAD+insülin grubunda ise 2376 TL saptandı. Sonuç: Tedavi maliyetleri açısından değerlendirildiğinde iyi kontrollü diyabetik hastaların tedavi maliyetleri, kötü kontrollü hastalardan anlamlı olarak daha düşük iken, iki grup arasında muayene ve tahlil harcamalarında anlamlı fark saptanmadı. OAD kullanan grup ile insülin ve OAD+insülin kullanan gruplar karşılaştırıldığında, OAD kullanan grubun tedavi maliyeti diğer iki grubun maliyetinden anlamlı olarak düşük tespit edildi. Yaş ve cinsiyet ile diyabet ilaç maliyeti arasında korelasyon yokken, diyabet yaşı ile tedavi maliyeti arasında istatiksel olarak anlamlı korelasyon saptandı.

Background/Objective: The psychological impact of in vivo diagnostic procedures remains poorly understood. We assessed changes in psychological distress and drug hypersensitivity-related quality of life (QoL) throughout a diagnostic evaluation for suspected immediate drug hypersensitivity reactions (IDHRs) and aimed to identify predictors of persistent psychological burden. Methods: This single-center prospective observational longitudinal study included 100 consecutive adults undergoing evaluation for suspected IDHRs. Psychological distress and QoL were assessed using the Depression Anxiety Stress Scale-21 (DASS-21) and the Drug Hypersensitivity Quality of Life Questionnaire (DrHy-Q). Assessments were performed before and after each diagnostic phase, including skin tests (STs), placebo, and drug provocation tests (DPTs). Results: The mean age was 44.2 ± 12.5 years, and women comprised 72% of the cohort. Depression, anxiety, stress, and DrHy-Q scores significantly decreased after ST, placebo, and DPT compared with baseline measurements. Across diagnostic stages, depression, anxiety, stress, and DrHy-Q scores were significantly lower during the DPT phase than during the ST and placebo phase in both pre-test and post-test measurements (p < 0.01 for pairwise comparisons). The number of prior HSRs showed a weak but significant positive correlation with DrHy-Q scores. In multivariable linear regression analysis, the number of prior HSRs was the only independent predictor of post-DPT DrHy-Q scores (β = 3.43, 95% CI 1.36–5.50, p = 0.001). Patients who avoided the provoked drug despite a negative DPT had higher DPT-post depression, anxiety, stress, and DrHy-Q scores. Conclusions: Psychological burden progressively decreased over the course of the stepwise diagnostic evaluation for suspected IDHRs, although patients with repeated reactions may benefit from additional support.

Introduction: Acquired angioedema due to C1 inhibitor deficiency (AAE-C1INH) is a rare bradykinin-mediated condition that may mimic hereditary angioedema (HAE). Management is largely extrapolated from HAE data. Therefore, retrospective observations in AAE-C1INH are particularly valuable for informing future approaches. This study aimed to evaluate the clinical characteristics, underlying conditions, and treatment outcomes of patients with AAE-C1INH. Methods: We conducted a retrospective cohort study of adult patients diagnosed with AAE-C1INH, with a comprehensive review of demographic and clinical features. Results: Among 587 patients with recurrent angioedema, 1.7% had AAE-C1INH. Median onset age was 56.5 years (45.5–66.75), median follow-up was 60.5 months (23.25–66.5), and 20% were female. Clonal hematologic neoplasms were present in 60% of patients and monoclonal gammopathy of undetermined significance in 30%, with angioedema preceding the diagnosis of the underlying condition in 60% of cases. Long-term prophylaxis was required in 50% of patients. Antifibrinolytic agents showed limited efficacy, whereas attenuated androgens were associated with a marked reduction in attack frequency. Rituximab-based therapy effectively controlled angioedema, although relapse occurred during extended follow-up. Complete remission under Bruton’s tyrosine kinase (BTK) inhibition was observed despite persistently low complement levels; however, concurrent withdrawal of renin–angiotensin system blockers represents a potential confounder. Complement levels were observed to parallel treatment response in most patients, whereas this association was not observed in the patient receiving a BTK inhibitor. Conclusion: In this rare, well-characterized cohort with extended follow-up, angioedema frequently represented the earliest clinical manifestation of AAE-C1INH, preceding recognition of the underlying disorder. Antifibrinolytic prophylaxis showed limited benefit, whereas attenuated androgens were associated with reduced attack frequency. Furthermore, therapies targeting the underlying lymphoproliferative condition, including rituximab-based regimens and BTK inhibition, were associated with meaningful clinical benefit. These findings support an individualized, etiology-driven management approach and provide practical insights for clinicians managing this rare condition.