Ahmet Akici

Aim: We aimed to examine changes in antidiabetic drug utilization associated with implementation and subsequent easing of pandemic-related restrictions. Background: The COVID-19 pandemic and associated restrictions disrupted healthcare access and glycemic regulation, affecting diabetes management. Methods: We collected nationwide outpatient antidiabetic drug sales and projected prescribing data from IQVIA Turkey between 01.03.2018 and 31.12.2022. We assessed average monthly consumption, expenditure, and quarterly prescribing trends across ‘before restrictions’ (BfR, 01.03.2018–31.03.2020), ‘during restrictions’ (DuR, 01.04.2020–31.03.2022), and ‘after restrictions’ (AfR, 01.04.2022–31.12.2022) periods. Consumption and prescribing levels were expressed as ‘defined daily doses/1,000 inhabitants/day’ (DID). Results: Antidiabetic consumption increased from 123.6 ± 12.2 DID in BfR to 156.3 ± 25.4 DID in DuR and remained elevated in AfR (151.2 ± 28.9 DID), paralleled by expenditure (€63.6 m ± 8.4 m, €85.1 m ± 14.8 m, and €83.9 m ± 19.1 m, respectively). Prescribing levels declined from BfR to DuR (56.4 ± 3.5 to 29.9 ± 3.6 DID, p < 0.001) and slightly recovered in AfR (46.0 ± 10.9 DID, p > 0.05 vs. earlier periods). Oral antidiabetic consumption rose from 71.2 ± 6.8 DID in BfR to 90.6 ± 17.2 DID in DuR ( p < 0.001) and further to 96.9 ± 19.4 DID in AfR ( p < 0.001 vs. BfR), while sodium-glucose cotransporter-2 inhibitor use increased across periods ( p < 0.001). Injectable antidiabetic consumption, mainly insulins, increased from BfR to DuR ( p < 0.001), and decreased in AfR ( p < 0.01 vs. DuR). Conclusion: We demonstrated a sustained increase in antidiabetic consumption following implementation of COVID-19-related restrictions, persisting beyond easing of most measures. Medication-access policies, panic stockpiling, improved glycemic adherence, and newer therapies might have contributed. These findings may inform strategies to strengthen family physician-community pharmacist coordination while maintaining treatment continuity and optimizing medication access during future public health emergencies.

Objective: Kounis syndrome (KS) is a rare clinical condition characterized by the concurrent occurrence of acute coronary syndromes and hypersensitivity reactions in response to various stimuli, including medications. We aimed to describe dental practice-related KS reports and compare their drug-exposure and outcome patterns with matched non-dental KS reports within the spontaneous reporting system.Methods: We retrieved FDA Adverse Event Monitoring System reports listing KS till 30.06.2025 and performed a structured deduplication process. Dental cases were identified using a prospectively curated dental term list and compared with non-dental reports in a 1:4 matched design based on age, sex, and calendar year. Descriptive analyses were performed on the deduplicated cohort, and crude disproportionality analyses were calculated for drugs reported in at least 50 KS cases.Results: We identified 1,957 KS reports, yielding 1,242 deduplicated unique cases, of which 50 (4.0%) were classified as dental. The median age was 56 years [IQR: 37-66] and men constituted 64.3% of cases. Compared to the non-dental group, dental cases were strongly enriched for antibiotic exposure (38.5% vs. 94.0%, p

Adolescence is a developmental stage characterized by significant physiological, psychological, and social changes. These changes are known to have a direct impact on medication use and adherence to treatment. Adolescents tend to have low adherence rates to treatment for chronic illnesses. When irrationally managed, this situation can lead to problems such as inadequate disease control, increased risk of complications, and increased use of healthcare services. The aim of this review is to evaluate the factors affecting medication adherence in adolescents, especially those specific to adolescents, considering the current literature and to suggest solutions. This review examines the implications of physiological and neurodevelopmental differences accompanying pubertal development on pharmacokinetic and pharmacodynamic processes. It also discusses the role of psychosocial factors such as the pursuit of autonomy, peer influence, aesthetic concerns, and performance anxieties on adherence during adolescence. Furthermore, changes in drug formulations and routes of administration, increased independence in accessing medications, and the transfer of treatment responsibility from parents to adolescents are evaluated. The potential contributions of digital health applications and mobile technologies to supporting adherence in adolescents are also addressed. Finally, recommendations aimed at increasing adherence through rational drug use in adolescents are presented. In conclusion, drug adherence in adolescents, which significantly determines the outcome of pharmacotherapy, is a complex process shaped by the interaction of numerous biological and psychosocial factors that requires holistic, developmentally appropriate approaches.

Introduction: The extraordinary circumstances due to the COVID‐19 pandemic and related restrictions altered the management of mental health disorders, including the use of antipsychotics. We aimed to examine the changes in antipsychotic utilization and expenditure in Turkey throughout pandemic‐associated restriction periods. Methods: Nationwide drug sales and projected prescribing data from 01.03.2018 to 31.12.2022 were obtained from IQVIA Turkey. We assessed average monthly consumption, expenditure, and quarterly prescribing levels across three periods: “before restrictions” (BfR, 01.03.2018–31.03.2020), “during restrictions” (DuR, 01.04.2020–31.03.2022), and “after restrictions” (AfR, 01.04.2022–31.12.2022). Consumption and prescribing levels were measured using “defined daily dose/1000 inhabitants/day” (DID) parameter. Results: Antipsychotic consumption throughout periods increased from 8.4 ± 0.6 DID in BfR to 9.9 ± 1.6 DID in DuR ( p < 0.001), and to 10.1 ± 0.9 DID in AfR ( p < 0.001 vs. BfR). Atypical antipsychotics followed the overall trend, whereas typical antipsychotics remained stable from DuR to AfR, deviating from this pattern. Antipsychotic expenditure rose from €16.7 m ± 1.1 m in BfR to €19.0 m ± 2.7 m in DuR ( p < 0.001), then shifted to €18.3 m ± 1.9 m in AfR ( p > 0.05 vs. BfR and DuR). High‐cost antipsychotic use increased after the pandemic onset ( p < 0.001) and remained elevated in AfR ( p < 0.001). Prescribing for schizophrenia declined from 2.2 ± 0.3 DID in BfR to 1.3 ± 0.2 DID in DuR ( p < 0.001), then escalated to 1.8 ± 0.3 DID in AfR ( p = 0.015 vs. DuR). Conclusions: Our study revealed an upsurge in antipsychotic utilization in Turkey with the start of the pandemic. A range of factors may have contributed, notably the impact of policies facilitating the dispensing of chronic medications without prescription or a tendency towards polypharmacy.

Background: The COVID-19 pandemic resulted in people working from home (WFH), which is associated with negative mental and social effects. However, the cardiovascular effects are not well established. We aimed to assess the effects of WFH on cardiovascular risk factors and health behaviors during the COVID-19 pandemic. Methodology: Companies that employ WFH were invited to study via occupational health specialists. WFH employees were sent an online self-reported questionnaire, which included demographics, WFH conditions, medical history, new-onset complaints, and health behaviors. Participants were asked to provide data on blood pressure, glucose, and lipid levels before and during the pandemic. Results: 208 participants completed the questionnaire, and 61 provided biological data. 72 participants reported to have undergone training for WFH conditions, and 87 were able to provide regular breaks. Weekly working hours have increased by 6 hours during the pandemic (49.6±13.8 vs. 43.8±12.1, p=0.001). Participants reported a median 7.5/10 satisfaction regarding WFH. 112 (53.8%) participants had a new complaint; the most common complaints were body weight gain/increased appetite (35.1%), insomnia/anxiety (27.9%), and physical inactivity/ musculoskeletal pain (18.3%). 120 (57.6%) participants had a weight increase. Most participants did not have changes in tobacco or alcohol consumption or exercise habits during the pandemic. Data from the biological data subgroup did not show significant changes in blood pressure, blood glucose, or lipid levels. Conclusion: WFH adversely affected modifiable cardiovascular risk factors and was associated with weight gain, increased work hours, a lack of workload planning, and increased anxiety. Although risk factors are adversely affected by WFH conditions, workers were satisfied with WFH. The training rate regarding WFH conditions was low; training about WFH should be provided to related employees, and occupational health specialists should focus on reducing specific risk factors that exist during WFH.

Fenofibrate is a fibric acid derivative used in the management of severe hypertriglyceridemia, a condition that may lead to serious maternal and fetal complications during pregnancy. However, evidence regarding the safety of fenofibrate exposure in pregnancy remains extremely limited, and the available human data are largely restricted to isolated case reports. The aim of this study was to evaluate pregnancy outcomes of women who consulted a university teratology information service (TIS) due to fenofibrate exposure during pregnancy. The data for this retrospective case series include consultation records and follow‐up interviews of pregnant women who consulted the TIS at Marmara University Hospital due to fenofibrate exposure between 2012 and 2025. Eleven pregnancies with fenofibrate exposure were identified, and pregnancy outcomes were available for 10 pregnancies. Six pregnancies resulted in live births and four resulted in stillbirth. Due to one twin pregnancy, a total of 11 infants were recorded, including seven live‐born and four stillborn infants. No major congenital malformations were identified among live‐born infants. One child was reported to have been diagnosed with autism during follow‐up. Although the proportion of stillbirths in this series appears higher than expected, most affected pregnancies were complicated by significant maternal comorbidities, including severe hypertriglyceridemia, diabetes mellitus, hypertension, and acute pancreatitis, which are known risk factors for adverse pregnancy outcomes. Therefore, the observed stillbirths may be related to underlying maternal disease rather than fenofibrate exposure. Overall, the findings of this case series do not suggest a clear teratogenic signal associated with maternal fenofibrate exposure during pregnancy.

Background: The prevalence of mental health disorders rose when the impact of the COVID-19 pandemic was most pronounced, potentially altering the consumption of antidepressants and anxiolytics. We aimed to evaluate changes in antidepressant and anxiolytic utilization throughout the COVID-19 pandemic era. Methods: Nationwide drug sales and prescribing data through 01.03.2018–31.12.2022 were sourced from IQVIA Turkey. We assessed mean monthly consumption and expenditure trends of antidepressants and anxiolytics, along with quarterly prescribing levels, across three periods: “before restrictions” (BfR, 01.03.2018–31.03.2020), “during restrictions” (DuR, 01.04.2020–31.03.2022), and “after restrictions” (AfR, 01.04.2022–31.12.2022), using “defined daily dose per 1000 inhabitants per day” (DID) measure. Results: Antidepressant consumption escalated from 47.9 ± 4.3 DID in BfR to 56.2 ± 8.9 DID in DuR (P < .001), reaching 60.5 ± 8.9 DID in AfR (P < .001 vs. BfR). Anxiolytic use increased from 2.0 ± 0.3 DID in BfR to 2.5 ± 0.3 DID in DuR (P < .001), and to 2.7 ± 0.3 DID in AfR (P < .001 vs. BfR). Expenditure also rose in DuR and AfR for both drug groups (P < .01). Prescribing trends for antidepressants decreased in DuR (P < .001) and showed an insignificant rebound in AfR (P > .05 vs. BfR and DuR), while anxiolytic prescribing surged in DuR (P = .001 vs. BfR) and subsequently reverted in AfR (P > .05 vs. BfR and DuR). These patterns were consistent across both new and ongoing users. Conclusions: This study showed a sustained increase in the use of antidepressants and anxiolytics following the onset of pandemic despite fluctuations in prescribing, implying a heightened need for pharmacotherapy and greater burden of depressive and anxiety disorders, especially for the latter.

The COVID-19 pandemic and associated measures have had significant impacts on healthcare services, including medication use. We aimed to investigate the nationwide changes in thyroid hormone preparation (THP) utilization before, during, and after the COVID-19 restrictions. We obtained nationwide outpatient THP sales and projected prescribing data for the period between 01.03.2018 and 31.12.2022 from IQVIA Turkey. The average monthly THP consumption, cost, and quarterly projected prescribing levels were analyzed across three periods: “before restrictions” (BfR, 01.03.2018–31.03.2020), “during restrictions” (DuR, 01.04.2020–31.03.2022), and “after restrictions” (AfR, 01.04.2022–31.12.2022). Drug consumption levels were calculated using DID (defined daily dose per 1000 inhabitants per day) parameter. Mean monthly consumption of THPs across BfR, DuR, and AfR was 15.8 ± 3.0, 18.2 ± 4.0 ( p > 0.05), and 21.1 ± 3.7 DID ( p = 0.001 vs. BfR), respectively. Cost of THPs increased from €2.5 m ± 0.4 m in BfR to €2.8 m ± 0.6 m in DuR ( p > 0.05), and €3.5 m ± 0.7 m in AfR ( p < 0.001 vs. BfR, p = 0.009 vs. DuR). Projected prescribing levels of these drugs declined from 6.9 ± 0.4 DID in BfR to 6.2 ± 0.5 DID in DuR ( p = 0.005), then rose to 7.3 ± 0.03 DID in AfR ( p = 0.003 vs. DuR). Ongoing THP users accounted for 89.4% of all projected THP prescriptions and followed the overall trend. Projected prescribing for new users remained stable across three periods ( p > 0.05). This study demonstrated that THP utilization showed a modest upward trend since the onset of the COVID-19 pandemic. The increase in consumption following the relaxation of restrictions might be associated with a potentially elevated need for pharmacotherapy, likely due to reduced healthcare access during the extraordinary conditions.