Coronavirus disease 2019,treatment,hydroxychloroquine,tocilizumab,convalescent plasma

Background and Objectives: Drug provocation tests (DPTs) diagnose drug hypersensitivity reactions (DHRs) and identify safe alternatives. DHRs contribute to patient anxiety. The aim of this study was to evaluate anxiety and hopelessness levels before and after DPT and to examine patients’ avoidance characteristics of the tested drugs. Materials and Methods: Patients undergoing DPT were included. The State–Trait Anxiety Inventory (STAI) assessed anxiety, and the Beck Hopelessness Scale measured hopelessness. Demographic and clinical data, pre- and post-DPT scores, the status of using the medication provided after DPT, and the reason for not using it were analyzed. Results: Seventy-nine patients (60 female, 75.9%) participated. Patients’ Beck Hopelessness Scale, STAI–State, and STAI–Trait scores decreased significantly after the DPT compared to the initial scores. Among the patients who developed a reaction during the drug provocation test, the rate of those whose scale scores increased was significantly higher than the rate of those who did not develop a reaction. A total of 42 patients (53.2%) did not use the alternative safe drug. Of these, six (14.3%) reported that their reluctance stemmed from a fear of experiencing a reaction similar to their initial adverse event. Patients with concomitant allergic diseases were less likely to use alternative safe drugs. Conclusions: DPT reduces long-term anxiety and hopelessness. However, one in seven patients avoids the prescribed safe drug due to fear of recurrence. Effective communication, especially with patients who have allergic conditions or experience a reaction during DPT, and psychological support may improve adherence to the tested medication.

Propolis is a resinous substance produced from tree buds and bark, digested by bees, and is mainly composed of resins, wax, pollen, and essential oils. Propolis is used in traditional medicine due to its antiinflammatory, antioxidant, antiseptic, and local anesthetic properties. The increase in the use and popularity of propolis-containing products coincides with a linear increase in the incidence of propolis-related allergic contact dermatitis. In this report, we present a case of local allergic contact dermatitis that developed after local propolis application for wound care in a 69-year-old male patient.

Real-life studies are needed to evaluate the clinical outcomes of add-on tiotropium therapy in patients with asthma. The effects of adding tiotropium bromide to the treatment of asthmatic patients on pulmonary functions and asthma control using real-life data. In a retrospective study, spirometric measures and asthma control states were compared before and one year after of tiotropium treatment in asthmatic adults whose disease was not adequately controlled with a combination of inhaled corticosteroids and long-acting β2-agonists. One year after tiotropium treatment, mean FEV1, FEV1%, and FEV1/FVC ratio increased significantly compared to pretreatment values. Among 32 patients added tiotropium due to symptomatic asthma, 28 (87.5%) patients achieved well-controlled (ACT ≥ 20) end of the year and GINA treatment step-down in 4 (12.5%) patients. Monoclonal antibody therapies (mepolizumab or omalizumab) were initiated in 9 patients (28.1%). FEV1 values and FEV1/FVC ratios showed a statistically significant improvement from baseline measurements obtained prior to the initiation of tiotropium therapy, independent of monoclonal antibody use (p < 0.001 for each). The mean age of these patients was 48.78 ± 11.64 (range: 28 - 81) years, and 25 (78.1%) of them were female. Tiotropium bromide is an effective and reliable add-on therapy for symptomatic asthma when combined with ICS plus LABA, also leads to improvements in respiratory function and asthma control.

Kombine pulmoner fibrozis ve amfizem (KPFA) sendromu egzersiz dispnesi, düşük karbon monoksit difüzyon kapasitesi (DLCO) ve korunmuş akciğer hacimlerinin yanı sıra üst loblarda amfizem, alt loblarda fibrozise ait radyolojik bulgularla karakterizedir. Sigara içicisi olan 67 ve 62 yaşlarında iki erkek hasta efor dispnesi ve nonprodüktif öksürük yakınmalarıyla kliniğimize başvurdu. Bu olgularda şiddetli desatürasyona bağlı düşük efor kapasitesi, bozulmuş DLCO ve sendrom ile uyumlu radyolojik bulgularının varlığı nedeniyle KPFA sendromu tanısı kondu. Olgularin birinde ayrica fibrotik akciğer alanı üzerinde gelişen evre 4 pulmoner adenokarsinom da saptandı. Antifibrotik (pirfenidone/nintedanib) tedavi almadan, palyatif radyoterapi ve kemoterapi alan olgumuz ciddi solunum yetmezliği nedeniyle 14 ay sonunda kaybedildi. Diğer olgumuza akciğer trasplantasyonu önerisi yapıldı. Başlanan pirfenidon tedavisi ile fonksiyonel ve radyolojik stabil olan hasta halen poliklinik takibimiz altındadır. Sonuç olarak, sigara öyküsü ile birlikte mikst tipte solunum fonksiyon testi bozukluğu, şiddetli gaz değişim bozukluğu ve radyolojik olarak amfizem ve fibrozis varlığı tespit edilen hastalarda KPFA tanısı akılda tutulmalıdır. Hastalar akciğer kanseri gelişimi açısından takip edilmeli ve uygun palyatif tedavilerin yanisira mutlaka akciğer transplantasyonu önerilmelidir.

Silikoz, yer kabuğunun yapısında yaygın olarak bulunan silisyum dioksit kristallerinin inhalasyonu ile gelişen, bazen hızla ilerleyerek ölüme neden olabilen bir pnömokonyozdur. silika maruziyetinin mikobakteriyel enfeksiyonların sıklığını artırdığı bilinmektedir. Üç aydır devam eden ateş şikayeti olan 68 yaşında erkek hastada hiler ve mediastinal kalsifik lenf nodları, kaviter lezyon ve bilateral üst zonlarda progressif masif fibroz alanları tespit edildi. Balgam kültüründe Mycobacterium tuberculosis üremesi sonucunda silikotüberküloz tanısı konan hastada 9 ay standart antitüberküloz tedavi ile kür sağlandı. Tanı ve tedavisinin zor olması ve silikozda önemli bir ölüm sebebi olması nedeniyle sunuldu.