© Bu dergide yer alan yazı, makale, fotoğraf ve illüstrasyonların elektronik ortamlarda dahil olmak üzere kullanma ve çoğaltılma hakları Türkiye Aile Hekimleri Uzmanlık Derneği'ne aittir. Yazılı ön izin olmaksızın materyallerin tamamının ya da bir bölümünün çoğaltılması yasaktır.

Objective: To evaluate the available human data to-date in order to assess whether the prenatal exposure to botulinum toxin type A (BTX-A) is associated with major congenital malformations and other adverse pregnancy outcomes. Methods: Searches were conducted in PubMed/MEDLINE and Reprotox in November  2017. Cohort and case-control studies, case series, case reports were the primary data of interest. Results: No controlled studies but case series and case reports of therapeutic BTX-A administration during pregnancy were identified. Case reports regarding pregnant women with botulism were also reviewed. Conclusions: Limited data suggests that BTX-A exposure for therapeutic indications during pregnancy does not seem to be associated with an increase in risk of major congenital malformations. Rates of fetal loss were substantially different between prospective and retrospective data. Controlled epidemiological studies are needed to refute or support our findings.

ÖzAmaç: Kırılganlık son yıllarda gittikçe önem kazanan bir durumdur. Çalışmamızda 65 yaş üzeri kişilerde kırılganlık ile ilaç kullanımı ve polifarmasi arasındaki ilişkinin incelenmesi amaçlanmıştır.Yöntemler: Çalışmaya aile hekimliği polikliniklerine başvuran 65 yaş üstü kişiler dahil edildi. Çalışmamızda Tilburg kırılganlık ölçeği, kalk ve yürü testi ve yürüme hızı testi kullanıldı. Çok değişkenli doğrusal ve lojistik regresyon modeli uygulandı. Bulgular:Beş ve üzerinde ilaç kullananlar (polifarmasi), katılımcıların %49,1'ini oluşturmaktaydı. Polifarmasi olanların %55,6'sı (n=74) kırılgandı. İlaç kullanımı olanlarda ve polifarmasi saptananlarda kronik hastalık sayısı, Tilburg kırılganlık ölçeği toplam skoru, kalk ve yürü testi skoru istatiksel anlamlı olarak daha yüksek; yürüme hızı testi skoru istatiksel anlamlı olarak daha düşük bulundu. Cinsiyet (β=-0,560, %95 Cl=-0,943;-0,177) ve kronik hastalık sayısının (β=1,496, %95 Cl=1,376; 1,616) toplam ilaç sayısı üzerine etkili olduğu saptandı. Polifarmasi üzerine yapılan lojistik regresyon analizi sonuçlarına göre; kadın cinsiyetin (aOR=3,4, %95 Cl=1,412-8,639), bekar/dul olmanın (aOR=2,8, %95 Cl=1,133-7,201), kronik hastalık sayısının (aOR=6,8, %95 Cl=4,218-11,075) polifarmasi riskini artırdığı tespit edildi.Sonuç: Çalışmamızda polifarmasi tespit edilen yaşlılarda, kırılganlık skoru ve yürüme hızlarında belirgin olarak kötüleşme tespit edilmiştir. Altmış beş yaş üstü kişilerde ilaç kullanımı daha dikkatli bir şekilde sorgulanmalı, polifarmasi olan bireylerin kırılganlığa yatkın olabileceği unutulmamalıdır. AnahtarSözcükler: Kırılganlık, polifarmasi, ilaç, yürüme hızıAim: Frailty has become an important health issue in recent years. The aim of this study was to investigate the relationship between frailty and medicine use and polypharmacy in people over 65 years of age. Methods:Patients aged 65 years and over, who were admitted to family medicine outpatient clinics, were included in the study. The Tilburg frailty indicator, timed up and go test and gait speed test were used. Multivariate linear and logistic regression model were conducted.Results: Individuals, who used five or more medicines (polypharmacy) daily, constituted 49.1% of all participants. 55.6% of patients on polypharmacy were frail. Gender (β=-0.560, 95% Cl=-0.943-0.177) and the number of chronic diseases (β=1.496, 95% Cl=1.376-1.616) were found to have an effect on the total number of medicines. According to the results of logistic regression analysis on polypharmacy; female gender (aOR=3.4, 95% Cl=1.412-8.639), living alone (single/divorced/widowed) (aOR=2.8, 95% Cl=1.133-7.201) and number of chronic diseases (aOR=6.8, 95% Cl=4.218-11.075) were significantly associated with increased risk of polypharmacy.Conclusion: A significant increase in frailty score and reduction in walking speeds were detected in patients aged 65 years and over on polypharmacy. It should be kept in mind that polypharmacy is significantly related with frailty in elderly patients.

Paroxetine is a selective serotonin reuptake inhibitor (SSRI) used in the treatment of depression and anxiety disorders. In some epidemiological studies, slightly increased risks of major malformations and cardiac malformations have been reported following paroxetine exposure in the first trimester of pregnancy. However, such findings have been inconsistent. There is only one report of any overdose of an SSRI during pregnancy, and that involved escitalopram. The aim of this case report was to describe the impact of a paroxetine overdose in the first trimester of pregnancy on the health of the foetus. A 21-year-old mother of one child who was pregnant with a second child was prescribed 20 mg/day paroxetine hydrochloride for the treatment of anxiety/depression. The patient ingested 15 or 16 20-mg tablets of paroxetine hydrochloride (300-320 mg) during the 5th week of pregnancy as a suicide attempt. Within 15 min of ingestion, she was admitted to hospital and treated for intoxication. No evidence of maternal SSRI intoxication was observed after treatment. The patient consulted our teratology information service for further risk assessment regarding possible major congenital malformations following the paroxetine overdose. We were unable to find previous reports of paroxetine overdose during pregnancy in the literature. The timely administration of the overdose treatment and the lack of maternal intoxication symptoms were considered positive for the foetal well-being, and the patient was referred for perinatology and psychiatry follow-ups. A healthy, 3 500-g male infant was born at 38 weeks' gestation, and his development at the age of 2 years was normal. This is the first reported case of paroxetine overdose during pregnancy. Comprehensive studies are needed to evaluate pregnancy outcomes after SSRI overdose. KEY POINTS• There are no reported data on paroxetine overdose during pregnancy.• The aim of this case report was to describe the impact of a maternal paroxetine overdose in the first trimester of pregnancy on the health of the foetus. No evidence of maternal SSRI intoxication was observed. • No congenital malformations or developmental disorders were observed in the child at 2 years of age. • Comprehensive studies are needed to evaluate pregnancy outcomes following SSRI overdose.