Turkthoracj, Turkish Thoracic Journal

Background and Objectives: Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are characterized by persistent inflammation, malnutrition, and immune dysfunction, all of which contribute to poor outcomes in hemodialysis (HD) patients. The C-reactive protein albumin lymphocyte (CALLY) index has been proposed as a novel biomarker that integrates these mechanisms. This study aimed to evaluate the prognostic value of the CALLY index together with established markers, including the C-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR) for all-cause mortality in HD patients. Materials and Methods: This retrospective cohort study was conducted on 106 patients undergoing HD. Demographic, clinical, and laboratory parameters were obtained three months after the effects of HD initiation was reviewed. Results: During a median follow-up of 24.5 months, 29 patients (27.3 percent) died. Non-survivors were significantly older (65.3 vs. 52.5 years, p < 0.001), had a higher prevalence of coronary artery disease (31 percent vs. 2.6 percent, p < 0.001), or shorter dialysis duration (14 vs. 27 months, p < 0.001). They also showed lower hemoglobin (9.2 vs. 10.1 g/dL, p = 0.007), creatinine (5.3 vs. 6.3 mg/dL, p = 0.048), and albumin levels (28 vs. 34 g/L, p = 0.001), as well as a higher MLR (0.329 vs. 0.254, p = 0.014). In multivariate analysis, age, CAR, and NLR independently predicted mortality, explaining 83.8% of the variation. ROC analysis identified age and MLR as significant predictors, with MLR showing a high negative predictive value (83.9%). The CALLY index did not demonstrate independent prognostic value. Conclusions: Age, CAR, NLR, and MLR were independent predictors of mortality in HD patients, whereas the CALLY index was not prognostic in this cohort. Among these markers, MLR may be a practical biomarker with strong negative predictive power. Larger prospective studies are needed to validate these findings.

Streptococcus pneumoniae,community-acquired pneumonia,adult

Background: Hereditary angioedema (HAE) is a rare but potentially life-threatening condition in which inappropriate medication use and delayed recognition may lead to preventable morbidity. Physicians’ awareness of HAE-related triggers, clinical features, and management strategies is therefore essential for timely diagnosis and safe clinical decision-making. This study aimed to assess physicians’ awareness of medications known to trigger HAE attacks across different medical specialties and to identify factors associated with higher levels of HAE-related knowledge. This single-center, cross-sectional survey was conducted among physicians working at a tertiary training and research hospital. A structured questionnaire assessing knowledge of HAE pathophysiology, clinical presentation, diagnostic evaluation, trigger factors, and management strategies was administered electronically. A composite HAE knowledge score (range: 0–14) was calculated and analyzed as a continuous variable Results: A total of 350 physicians participated in the study. Although self-reported familiarity with HAE was high, overall disease-specific knowledge was limited. Awareness of medication-related triggers, including angiotensin-converting enzyme inhibitors, dipeptidyl peptidase-4 inhibitors, and estrogen-containing therapies, was low across all specialty groups, with no significant differences observed. Knowledge gaps were also identified in the recognition of key clinical features, diagnostic evaluation, and acute management strategies. In multivariable analysis, prior clinical exposure to patients with HAE was the only factor independently associated with higher knowledge scores (B = 0.98, p = 0.003), whereas specialty group, gender, and years of professional experience were not significant predictors. Conclusion: Despite high general awareness of HAE, important gaps persist in clinically relevant knowledge among physicians across specialties. Awareness appears to be primarily shaped by prior clinical exposure rather than formal specialty training or professional experience. Targeted, practice-oriented educational strategies focusing on medication-related triggers and acute management may help bridge these gaps, complement experiential learning, and support safer clinical decision-making.

Background: Hereditary angioedema (HAE) is a rare, potentially life-threatening disease in which delayed recognition and inappropriate medication use may result in preventable morbidity and mortality. We aimed to assess physicians’ knowledge regarding HAE-related triggers, clinical features, and management strategies across multiple medical specialties. Methods: This single-center, cross-sectional survey was conducted among 350 physicians at a tertiary training and research hospital. A structured electronic questionnaire assessed knowledge of HAE pathophysiology, diagnosis, medication-related triggers, and management. A predefined composite knowledge score (0–14) was calculated. Results: Although self-reported familiarity with HAE was high, overall disease-specific knowledge was limited. Awareness of critical medication-related triggers—including angiotensin-converting enzyme inhibitors, dipeptidyl peptidase-4 inhibitors, and estrogen-containing therapies—was low across all specialties, with no significant between-group differences. Substantial knowledge gaps were identified in the recognition of clinical features, diagnostic evaluation, and acute management. In multivariable analysis, prior clinical exposure to HAE patients was the only independent predictor of higher knowledge scores (B = 1.097, p = 0.001), whereas specialty group, gender, and years of professional experience were not independently associated with knowledge scores. However, the regression model explained only a small proportion of the variance in knowledge scores. Conclusions: Significant gaps in clinically relevant HAE knowledge persist among physicians from multiple medical specialties. Prior clinical exposure was associated with higher knowledge scores, whereas specialty group, gender, and years of professional experience were not independently associated with physician knowledge. Targeted, practice-oriented educational interventions focusing on medication-related triggers and acute management may help bridge these knowledge gaps, complement experiential learning, and ultimately enhance patient safety.