Neriman Ipek Kirmizi Sonmez

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.

As COVID-19 primarily affects the respiratory system, it may have impacted utilization patterns of drugs used in obstructive airway diseases (DOADs). We examined nationwide DOAD utilization trends before, during, and after pandemic measures. We collected data on DOADs (ATC-Code: R03) between 01.01.2017–28.02.2023 from IQVIA-Turkey. National outpatient sales and prescription projections were converted into consumption data, expressed as defined daily dose per 1,000 inhabitants (DID). We compared mean monthly consumption, costs, and quarterly DOADs use across "before restrictions" (BfR), "during restrictions" (DuR), and "after restrictions" (AfR) periods. We identified 433.5 million DOAD units consumed, costing €3.3 billion; inhaled-DOADs accounted for 73.1%. Mean monthly DOAD consumption remained stable (BfR: 67.8 ± 3.1 DID; DuR: 74.2 ± 12.5 DID; AfR: 74.2 ± 14.6 DID; p > 0.05). Inhaled-DOADs exhibited a similar pattern, except the anticholinergics with a significant increase in the DuR (19.4 ± 3.3 DID) compared to the BfR (16.1 ± 2.3 DID, p < 0.001). Also inhaled-corticosteroid monotherapy rose significantly between BfR (4.1 ± 0.9 DID) and AfR (5.3 ± 1.3 DID, p < 0.05). Montelukast, constituting 76.6% of systemic-DOADs, had higher consumption in AfR (15.0 ± 2.8 DID) than in BfR (11.7 ± 2.2 DID, p < 0.001) and DuR (12.9 ± 2.4 DID, p < 0.05). Overall DOAD prescriptions declined in DuR and trended upward in AfR but didn’t reach pre-pandemic levels, except for new users of montelukast and long-acting beta agonists. Our study showed increased use of inhaled anticholinergics, glucocorticoid monotherapy, and montelukast within a generally stable overall DOAD utilization. This may reflect varied responses to bronchodilation and anti-inflammatory treatment needs during the pandemic and beyond.

We aimed to examine the cost-related prescribing performance of primary care physicians who had a higher versus lower tendency of arbitrary prescribing. In this cross-sectional study, we evaluated the prescriptions of primary care physicians in Istanbul, collected with 3:1 systematic sampling. We determined higher versus lower arbitrary prescribing by the physician’s degree of writing the solo diagnosis of “Z00- General examination without diagnosis/complaint”: those for whom such prescriptions constituted >5% were classified as Group A and those with them at P < .001, P < .001, P = .009, P = .007, and P < .001, respectively), whereas disease-specific drug costs per prescription were similar (P > .05 in all diagnoses). In myalgia, Group A had lower cost per prescription (P < .001) and higher analgesic costs per prescription (P < .001) compared to those in Group B. We found significantly higher disease-specific drug cost share in Group B for URTIs (antibiotic), gastroesophageal reflux disease (gastric acid–suppressant), hypertension (antihypertensive), anemia (iron preparations), diabetes (antidiabetic), depression (antidepressant), and conjunctivitis (corticosteroid) than those in Group A (P < .001 for each). Our study showed that physicians who had a higher tendency of prescribing for no clear indication are also more likely to produce costly prescriptions. Up to 2% of physicians may arbitrarily prescribe medications without stating any indication. Inability to determine the rationality of prescriptions may have costly implications. Physicians who practiced arbitrary prescribing for uncertain conditions tend to generate more costly prescriptions. The propensity to engage in inattentive recording behavior may accompany untraceable irrational prescribing problems, beyond the cost. The percentage of absent diagnoses in prescriptions may merit further investigation as being one of the surrogate indicators of irrational drug use.

Pediatric patients, especially with rare diseases, represents a population which has high tendency towards off-label drug use (OLDU) and needs a careful practice of pharmacotherapy than in adults. We aimed to investigate biotechnological drug use in children with rare diseases requiring OLDU. This retrospective study examined all single-diagnosed OLDU applications (n=5792) for 4992 children (<18-year) in Turkey. Applications of rare diseases were selected, and their descriptive characteristics were examined including demographic features of patients, biotechnological drug utilization status, and disease categories. The off-label status of the drugs at the end of 2020 was also examined. In total, 77.7% (n=4501) of OLDU applications were made for rare diseases. Biotechnological drug use was higher in rare disease applications than in non-rare diseases (37.9% vs. 19.2%, respectively; p<0.0001). Canakinumab was the top applied biotechnological drug (73.2%). Compared to that in small-molecule drugs, the mean age of patients was higher in biotechnological drug-containing applications (8.1±5.3 vs 9.7±4.9, respectively; p<0.0001). Biotechnological drug use was higher in non-neoplastic rare diseases (40.3%) than in neoplastic rare diseases (26.4%), (p<0.0001). At the end of the year 2020, the approval status of the off-label indications covered in 2016 was significantly higher for rare (24.4%) vs. non-rare (5.2%, p<0.0001) diseases and for biotechnological (32.3%) vs. small-molecule (13.9%, p<0.0001) drugs. In total, 87.7% of the drugs would have to be still used in the off-label setting at the end of 2020. It was seen that more than three-quarters of the pediatric OLDU applications are for rare diseases and the need for biotechnological OLDU in this group is almost 2-fold of small-molecule drug use. While further projected findings imply a higher approval tendency towards for rare diseases and biotechnological drugs, there seems to be more room for improvement for pediatric drug use.

Objective: In Turkish folk medicine, different species of Scorzonera (Asteraceae) have been used in the treatment of various disorders. The study aimed to investigate antidiabetic activity of Scorzonera species and if rutin is the primary component responsible of this activity. Methods: The extracts of aerial parts of Scorzonera tomentosa, S. mollis ssp. szowitsii, S. suberosa ssp. suberosa, S. eriophora, S. acuminata, S. sublanata and S. cana var. jacquiniana were used in the experiment. Additionally, rutin, which has been analysed and detected by using HPLC qualitatively and quantitatively in some Scorzonera species, was also tested for its antidiabetic activity in the same conditions. An alloxaninduced diabetic mice test model was used in order to verify antidiabetic activity. Antidiabetic activities of the 9 groups (n=5; each) were measured at four different times: before Scorzonera extracts and rutin treatment and after 1, 2 and 4 hours of treatments. Results: S. sublanata extract exhibited the highest antidiabetic activity and at 100 mg/kg dose, it significantly reduced blood glucose levels measured after 1, 2 and 4 hours of treatments when compared to isotonic saline solution group (diabetic control group). S. cana var. jacquiniana extract also displayed notable decrease after 4 hours of treatment. Significant lowering effect on blood glucose level was also observed by treatment with rutin in all tested times at 100 mg/kg i.p. injection. According to the HPLC analyses the highest rutin content was determined in the S. acuminata aerial parts. Conclusion: Rutin content and the antidiabetic activity of the plant extracts were not correlated as displayed in this present study. Further studies should be performed to reveal responsible compunds for antidiabetic activity.

In the current study, four Onobrychis species, O. albiflora Hub.-Mor., O. argyrea Boiss. subsp. argyrea Boiss., O. galegifolia Boiss., and O. tournefortii (Willd.) Desv. were collected from Anatolia to be evaluated for their antidiabetic activities. Methanol water extracts of the aerial parts were used for experiments. An alloxan-induced diabetic mice test model was used. Phytochemical analysis of the tested extracts was investigated using the HPLC method. The highest activity was observed with treatment of O. albiflora aerial part extract. Significant decrements were detected in the blood glucose levels as follows: 180.83±47.48 and 252.83±50.47mg/dL at 100 mg/kg and 200 mg/kg doses of O. albiflora, respectively, when compared to the isotonic saline solution control group, eliciting a blood glucose level of 494.20±27.32. Among the tested standard compounds, rutin and isoquercetin were detected in the examined species. The highest amount of rutin (1.1981±0.0017%) and isoquercetin (0.7318±0.0197%) were found in O. albiflora and O. argyrea subsp. argyrea, respectively. Antidiabetic activities of the tested Onobrychis species seem to indicate a possible correlation with their rutin and isoquercetin contents. Therefore, rutin and isoquercetin may be the antidiabetic compounds that contribute to the antidiabetic activity of the tested Onobrychis species.

Hastaların yaklaşımları, akılcı ilaç kullanımının (AİK) belirleyici unsurlarından biridir. Türkiye’de ve dünya genelinde akılcı olmayan ilaç kullanımı (AOİK) yaygın bir sorundur. Diş hekimliğiyle ilgili uygulamalarda ilaçların ne ölçüde akılcı kullanıldığına dair yeterli bilimsel araştırma bulunmamaktadır. Bu çalışmada çeşitli nedenlerle diş hekimliği kliniklerine başvuran hastaların ilaç kullanımı ile ilgili tutumlarının araştırılması amaçlandı. Araştırmada, biri Sağlık Bakanlığı’na bağlı ağız ve diş sağlığı merkezi (ADSM), diğeri üniversite diş hekimliği fakültesi hastanesi (DHFH) olmak üzere iki ayrı merkezin kliniklerine başvuran toplam 139 hasta ile görüşülerek anket uygulandı. ADSM ve DHFH’deki katılımcıların verdiği yanıtlar karşılaştırıldı. Katılımcıların %29,3’ü diş kliniğine başvuru öncesi ilaç kullandığını belirtti. Bu kişilerin %77,5‘i analjezik, %15,0’ü ise antibiyotik kullandığını beyan etti. Dental nedenlerle evde bulundurduğu ilaçları kullanmadan önce, katılımcıların %47,3’ü kimseye danışmadığını, %25,0’i diş hekimine danıştığını beyan etti. Periodontal problemleriyle birlikte ateş gibi şikayetleri bulunması halinde, katılımcıların %14,2’si “muayene olmadan da antibiyotik kullanacağını”, %11,7’si ise “antibiyotiğe başlayacağını ancak iyi hissettiğinde bırakacağını” belirtti. Başvuru öncesi ilaç kullanmış olanların ADSM grubunda; son bir yılda dental nedenle ilaç dışı tedavi almış olanların ise DHFH grubunda daha fazla olduğu saptandı (p<0,05). Ayrı sağlık kuruluşlarına başvuranlar arasında bir takım farklılıklar bulunmakla birlikte, genel olarak dental problemlerle kliniklere başvuran hastaların AOİK olarak nitelendirilecek bazı olumsuz tutumlara sahip oldukları belirlendi. İçerisinde antibiyotiklerinde bulunduğu bazı ilaçların kendi kendine kullanımı, bu olumsuzluklar arasında oldukça dikkati çekmektedir. Diş hekimliğinde AİK’in yaygınlaştırılması faaliyetleri planlanırken araştırmada öne çıkan hastaların tutumları ile ilgili bu tespitler göz önünde bulundurulmalıdır.