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Sosyal hizmet bireyleri biyopsikososyal boyutlarıyla çevresi içinde değerlendirmektedir. Çevresi içinde birey yaklaşımı bireylerin sosyal çevresi kadar fiziksel çevresini de ele almaktadır. Bu bakış sosyal hizmetin dezavantajlı grupların haklarını savunurken aynı zamanda çevresel sürdürebilirliği de gözetmesini gerektirir. Çevresel felaketler ve iklim değişikliğinin en çok etkilediği gruplar sosyal hizmetin halihazırdaki müracaatçı gruplarını oluşturmaktadır. Bu gruplar çevresel felaketlere karşı daha savunmasız olması nedeniyle dezavantajlı durumları derinleşebilmektedir. Bu çalışma iklim değişikliği ve çevresel problemler sonucu dezavantajlı duruma düşen kişilere yönelik; bilgilendirme, sosyal yardım, savunuculuk ve danışmanlık hizmetleri sunmayı amaçlayan Yeşil Sosyal Hizmet Birimlerini model olarak önermektedir. Yeşil Sosyal Hizmet Birimleri çevresel sürdürülebilirliğin ve çevresel adaletin sağlanabilmesi için bütüncül bir ekososyal yaklaşımı benimsemektedir., Social work evaluates individuals in their environment with their biopsychosocial dimensions. The individual-in-environment approach deals with the physical environment of individuals as well as their social environment. This view requires social work to protect the rights of disadvantaged groups while at the same time considering environmental sustainability. The groups most affected by environmental disasters and climate change are the current client groups of social work. As these groups are more vulnerable to environmental disasters, their disadvantage may increase. This study proposes Green Social Service Units as a model, which aims to provide information, social assistance, advocacy and consultancy services to people who are disadvantaged as a result of climate change and environmental problems. Green Social Service Units adopt a holistic ecosocial approach to ensure environmental sustainability and environmental justice.

Bu araştırmanın amacı Covid-19 pandemisinin sosyal hizmet uzmanlarının yaşamlarına ve sosyal hizmet uygulamalarına yansımalarını keşfetmektir. Bu genel amaç doğrultusunda; sosyal hizmet uzmanlarının deneyimlerini görünür kılabilmek için nitel yöntem ve teknikler kullanılmıştır. Araştırmaya katılan öznelere kartopu örnekleme yöntemi ile ulaşılmıştır. Araştırma kapsamında sosyal hizmetler alanında faaliyet gösteren kamu kurum ve kuruluşlarında görev yapan 15 sosyal hizmet uzmanı ile derinlemesine görüşmeler gerçekleştirilmiştir. Fenomenolojik yaklaşım kullanılan araştırmada görüşmeler online (Google meet) ve pandemi kapsamında alınan önlemlere uygun şekilde yüz yüze gerçekleştirilmiştir. Araştırma sonucunda oluşturulan verilerin analizinde MAXQDA 20 programı kullanılmıştır. Yapılan analiz sonucunda; pandeminin kişisel yaşama yansımaları, sosyal hizmet uygulamalarına yansımaları ve sosyal hizmet uzmanlarının mesleki yaşamlarına yansımalar olmak üzere üç ana temaya ulaşılmıştır. Araştırma sonuçları pandeminin yansımalarının sosyal hizmet uzmanlarının hem kişisel hem de mesleki yaşamlarında görünür olduğunu göstermekle birlikte pandemi sonrası değişen koşulların; sosyal hizmetin farklı alanlarını ve bu alanlardaki mesleki uygulamaları doğrudan etkilediğini ve toplumun halihazırdaki dezavantajlı grubun sorunlarını derinleştirdiğini göstermektedir.

Devletler idari, ekonomik ve askeri açıdan kontrollerini kolaylaştırmak adına hakimiyetleri altında bulunan topraklarda sistematik yol ağları oluşturmuşlardır. Osmanlı İmparatorluğu’nun kontrol ettiği topraklar düşünülünce, İmparatorluk içerisinde sistematik yol ağlarının oluşturulması bir zaruriyet haline gelmiştir. Bu minvalde Anadolu ve Rumeli yol ağlarında sağ, orta ve sol kol olmak üzere toplam altı adet ana yol oluşturulmuştur. Zaman içerisinde ihtiyaca yönelik olarak ana yollara bağlı tali yollar meydana gelmiştir. Merkezin taşra ile olan irtibatı ve resmi haberleşmesi ana ve tali yollar üzerinden XIX. yüzyıla kadar; ulak hükmü, menzilhane sistemi, in’am hükmü, kiracıbaşılık ve posta teşkilatı üzerinden gerçekleştirilmiştir. Bu dönemde yollar üzerinde hem yolların güvenliğini hem de yolcuların konaklama, yeme, içme temel ihtiyaçlarının karşılanması için menziller inşa edilmiştir. Menziller; hac menzilleri, askeri menziller ve devlet görevlilerinin-ulakların kullandığı menziller olarak temelde üçe ayrılmaktadır. Bu menziller işleyiş bakımından benzer özelliklere sahip olsalar da coğrafi konum, mimari özellik gibi konularda birbirlerinden ayrılmaktadırlar. Menzillerle ilgili bilgilere resmi belgelerin yanısıra, menzilnâmeler üzerinden ulaşılmaktadır. Osmanlı İmparatorluğu’nun kuruluşundan itibaren kullanıldığı düşünülen yol ağlarının organizasyonunu sağlayan menziller ile ilgili bu döneme kadar birçok çalışma yapılmıştır. Bu nedenle bu çalışmada öncelikle Osmanlı’da bulunan Anadolu ve Rumeli yol ağlarından kısaca bahsedilecektir. Daha sonra ise menzilnâme literatüründe yapılmış olan çalışmalar; askeri menzilnâmeler, hac menzilnâmeleri, devlet görevlilerinin-ulakların kullandığı menziller ve menzilleri mimari olarak inceleyen çalışmalar olarak dört ana başlık altında incelenecektir., States have created systemic road networks in the lands under their control in order to strengthen transportation and facilitate their control. In the Ottoman Empire, roads are mainly divided into three as right, middle and left paths in Anatolia and Rumelia. In the Ottoman Empire, the center's contact and official communication with the countryside was carried out through various structures in different periods of the reign through main and secondary roads. These structures listed until the XIX. century as ulak hükmü, system of menzilhanes, in'am hükmü, kiracıbaşılık and postal organization. We can obtain informations about the menzils from the official documents, and also menzilnames are another sources that give information about menzils, settlements and roads. In this study, first of all, the Anatolian and Rumelian road networks in the Ottoman Empire will be briefly analyzed. Then, the studies in the menzilname literature will be examined under four main headings as military menzilnames, pilgrimage menzilnames, menzilnames that the states officials-ulaks used and studies that examine the menzils as an architecturally.

Nonalcoholic fatty liver disease (NAFLD) is a multisystemic clinical condition that presents with a wide spectrum of extrahepatic manifestations, such as obesity, type 2 diabetes mellitus, metabolic syndrome, cardiovascular diseases, chronic kidney disease, extrahepatic malignancies, cognitive disorders, and polycystic ovarian syndrome. Among NAFLD patients, the most common mortality etiology is cardiovascular disorders, followed by extrahepatic malignancies, diabetes mellitus, and liver-related complications. Furthermore, the severity of extrahepatic diseases is parallel to the severity of NAFLD. In clinical practice, awareness of the associations of concomitant diseases is of major importance for initiating prompt and timely screening and multidisciplinary management of the disease spectrum. In 2020, a consensus from 22 countries redefined the disease as metabolic (dysfunction)-associated fatty liver disease (MAFLD), which resulted in the redefinition of the corresponding population. Although the patients diagnosed with MAFLD and NAFLD mostly overlap, the MAFLD and NAFLD populations are not identical. In this review, we compared the associations of key extrahepatic diseases between NAFLD and MAFLD.

In recent years, epidemiological studies have consistently demonstrated that the coexistence of nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) is strongly associated with increased mortality and morbidity related to hepatic- and extrahepatic causes. Indeed, compared with the general population, patients with T2DM are more likely to be diagnosed with more severe forms of NAFLD (i.e., nonalcoholic steatohepatitis (NASH) with liver fibrosis). There is an ongoing debate whether NALFD is a consequence of diabetes or whether NAFLD is simply a component and manifestation of the metabolic syndrome, since liver fat (steatosis) and even more advanced stages of liver fibrosis can occur in the absence of diabetes. Nevertheless, insulin resistance is a key component of the mechanism of NAFLD development; furthermore, therapies that lower blood glucose concentrations also appear to be effective in the treatment of NAFLD. Here, we will discuss the pathophysiological and epidemiological associations between NAFLD and T2DM. We will also review currently available anti-diabetic agents with their regard to their efficacy of NAFLD/NASH treatment. Open Access funding enabled and organized by Projekt DEAL

Turizm hareketleri gün geçtikçe kitle turizminden alternatif turizm türlerine doğru yönelmekte, bu yönelim ise destinasyonların alternatif turizm türlerini karşılayacak potansiyellerine odaklanmalarına neden olmaktadır. İnanç turizmi, alternatif turizmin önemli ve her geçen gün daha fazla talep gören türleri arasındadır. Trabzon ilinin Maçka ilçesi sınırları içerisinde, Altındere Vadisi Milli Parkı’nda yer alan Sümela Manastırı; Hıristiyanlığın, özellikle Ortodoks mezhebinin Anadolu’daki en eski ve en önemli manastırlarından olma özelliği taşımakta, tarihi, kültürel ve dini önemi sebebiyle oldukça büyük bir turizm potansiyeli oluşturmaktadır. Çalışmanın amacı Sümela Manastırı’nın inanç turizmi bakımından potansiyelini ve Trabzon destinasyonunun gelişimine olan katkısını ortaya koymaktır. Daha önceki araştırmalar ışığında mevcut durum ortaya konmuş, potansiyelin daha etkili kullanılabilmesi için önerilerde bulunulmuştur.

Over-exploitation and sand-gravel mining affect groundwater resources in terms of both quantity and quality. Groundwater level and well yields in and around the sand-gravel pits significantly decrease. Sand-gravel mining also changes the turbidity levels and temperature of groundwater. Reduction and destruction of valuable aquifers are significant issues. In this case, the natural state of the aquifer disappears. The Kazan Plain in central Turkey is a dramatic example of these kinds of results. The productive sand-gravel aquifer in the Kazan plain has been substantially damaged due to intensive sand-gravel mining since the 1980s. Additionally, over-exploitation has caused notable declines in groundwater levels, particularly in the 2000s. This study focuses on the hydrogeochemical situation of the Kazan Plain alluvium aquifer after intensive sand-gravel mining and over-exploitation. Groundwater samples were collected seasonally in 2015, five years after the over-exploitation and heavy sand-gravel mining. The decline reached 20 m (about half of the saturated thickness of the sand-gravel aquifer) in the region where the intensive groundwater abstraction lasted until 2010. Some quarries continued to operate until 2010, but after that mining activity continued only at a minimum level. Today, groundwater quality has been significantly degraded due to the over-exploitation of sand-gravel mining and also the cessation of recharge from fresh river water.

BACKGROUND AND AIM While non-invasive scores are increasingly being used to screen for advanced fibrosis in metabolic (dysfunction) associated fatty liver disease (MAFLD), the effect of BMI on their clinical utility remains uncertain. This study assessed the usefulness of the Fibrosis-4 index (FIB-4) and the non-alcoholic fatty liver disease fibrosis score (NFS) in lean, overweight, obese, severely obese, and morbidly obese patients with biopsy-proven MAFLD. METHODS A total of 560 patients (28 lean, 174 overweight, 229 obese, 89 severely obese, 40 morbidly obese) were included. Diagnostic performances and optimal cut-off values for FIB-4 and NFS were calculated using receiver operating characteristic (ROC) curve analysis. RESULTS In both lean and morbidly obese patients with MAFLD, both FIB-4 and NFS failed to discriminate advanced fibrosis. Conversely, both scores showed acceptable diagnostic performances in exclusion of advanced fibrosis in overweight, obese, and severely obese patients. FIB-4 was able to exclude advanced fibrosis with the highest diagnostic accuracy in the subgroup of overweight patients (area under the ROC curve: 0.829, 95% confidence interval: 0.738-0.919). CONCLUSION FIB-4 and NFS can confidently be used to exclude advanced fibrosis in overweight, obese, and severely obese patients. However, they do not appear clinically useful in lean and morbidly obese patients.

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BACKGROUND & AIM: Besides their physiological role in bile formation and fat digestion, bile acids (BAs) synthesized from cholesterol in hepatocytes act as signaling molecules that modulate hepatocellular carcinoma (HCC). Trafficking of cholesterol to mitochondria through steroidogenic acute regulatory protein 1 (STARD1) is the rate-limiting step in the alternative pathway of BAs generation, whose physiological relevance is not well understood. Moreover, the specific contribution of the STARD1-dependent BA synthesis pathway to HCC has not been explored. METHODS: STARD1 expression was analyzed in a cohort of human NASH derived HCC specimens. Experimental NASH-driven HCC models included MUP-uPA mice fed high fat high cholesterol diet (HFHC) and diethylnitrosamine (DEN) treatment in wild type (WT) mice fed HFHC. Molecular species of BAs and oxysterols were analyzed by mass spectrometry. Effects of NASH-derived BAs profile were investigated in tumor-initiated stem-like cells (TICs) and primary mouse hepatocytes (PMH). RESULTS: We show that patients with NASH-associated HCC exhibit increased hepatic expression of STARD1 and enhanced BAs pool. Using NASH-driven HCC models, STARD1 overexpression in WT mice increased liver tumor multiplicity, whereas hepatocyte-specific STARD1 deletion (Stard1(ΔHep)) in WT or MUP-uPA mice reduced tumor burden. These findings mirrored the levels of unconjugated primary BAs, β-muricholic acid and cholic acid, and their tauroconjugates in STARD1 overexpressing and Stard1(ΔHep) mice. Incubation of TICs or PMH with a mix of BAs mimicking this profile stimulated expression of genes involved in pluripotency, stemness and inflammation. CONCLUSIONS: We show a previously unrecognized role of STARD1 in HCC pathogenesis by promoting the synthesis of primary BAs through the mitochondrial pathway, whose products act in TICs to stimulate self-renewal, stemness and inflammation.

Hepatocellular carcinoma (HCC) accounts for some 80% of primary liver tumors. According to recent data, HCC is the sixth most common type of cancer and the third leading cause of cancer-related mortality worldwide. Risk factors for HCC include the presence of the hepatitis B virus, hepatitis C virus, non-alcoholic fatty liver disease, and exposure to noxious agents, such as alcohol, or toxins, such as aflatoxin, which are considered preventable etiologies of HCC. Monitoring strategies are needed for patients at risk of developing HCC. There is a consensus on routine monitoring of cirrhotic patients due to definitive evidence of a significantly high rate of progression to HCC; however, the appropriate surveillance of patients with advanced fibrosis remains a topic of discussion. Nevertheless, adherence to a strict observation protocol is the cornerstone of early detection and treatment with curative options for patients with a high risk of developing HCC. This review examines prevention strategies, risk factors, and surveillance based on current guidelines.

Background In metabolic associated fatty liver disease (MAFLD) vibration controlled transient elastography (VCTE) by Fibroscan has emerged as a non-invasive diagnostic tool for the measurement of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), which are surrogate markers for hepatic steatosis and fibrosis, respectively. However, obesity constitutes a limitation in terms of creating unreliable examinations due to increased skin to liver capsule distance. Here, we aimed to investigate the feasibility of VCTE in the evaluation of hepatic steatosis and fibrosis in obese individuals. Methods A total of 126 consecutive obese patients (body mass index ≥30 kg/m2) without a known history of MAFLD enrolled in the study. We performed CAP and LSM measurements and calculated Fibrosis-4 Index for each patient and included data of those patients to the analysis, from whom valid measurements were able to be taken. Results Reliable VCTE measurements were able to be obtained in 122 patients (97%), from those in 34 patients with M and 88 patients in XL probe (median age: 50 [18-75], 45 males and 77 females). In 1 patient VCTE failed to take any measurements and in 3 the measurements were classified as unreliable. The mean CAP value was 323 ± 48 dB/m and the median LSM value 5.3 [1.8-34.3] kPa. Conclusion CAP and LSM assessments by Fibroscan are reliable diagnostic tools for the early diagnosis of hepatic steatosis and fibrosis in obese individuals.

Genellikle iyon odaları; içi hava eşdeğeri gaz ile dolu, dış duvarın iç yüzeyi iletkenliği sağlamak amacıyla karbon veya grafitle kaplı ve merkezi iki elektrottan oluşmaktadır. Eksternal radyoterapide hedefe istenilen dozun verilebilmesi için iyon odası kullanılarak doz ölçümü yapılmalıdır. Radyoterapide kullanılan ışınların doz ölçümünde, çeşitli dozimetri protokolleri tarafından Farmer tipi silindirik iyon odası tavsiye edilmektedir. İyon odalarının duyarlı hacmi 0,01 cc ile 0,6 cc arasında değişmektedir. Bu çalışmada 0,6 cc aktif hacme sahip iyon odasının duvar materyali 0,43 mm kalınlığa sahip grafit duvar elektrotu ve alüminyum merkez elektrotu ile imal edilmiş. Sun Nuclear marka SNC 600c silindirik iyon odası kullanılmıştır. Clinac IX marka lineer hızlandırıcı cihazında 6 ve 15 MV foton ışınlarında iyon odasının çeşitli dozimetrik parametrelere bağlı yanıtı incelenmiştir. Sonuç olarak SNC 600c marka iyon odasının her iki foton enerjisinde de doza bağlı yanıtının doğrusal olduğu görülmüştür. İyon odasının voltaja bağlı değişimde, üreticinin tavsiye ettiği 300 Volt ve üzerindeki değerlerde her iki foton enerjisi için %1’in altında bir fark görülmüştür. Her iki foton enerjisi için iyon odasının yanıtı doz hızından ve enerjiden bağımsızdır. Böylece SNC 600c Farmer tipi silindirik iyon odasının yüksek enerjili fotonlar ile yapılan radyasyon ölçümünde kullanılan dedektörlerin sahip olması gereken özellikleri taşıdığından, mutlak doz ölçümünde kullanılabileceği doğrulanmıştır., Generally, ion chambers consists of an outer wall and a central two electrodes, filled with air equivalent gas, and an inner surface covered with carbon or graphite to ensure conductivity. In external radiotherapy, dose measurement using ionazation chambers is required to deliver the desired dose to the target. For dose measurement of rays used in radiotherapy, Farmer type cylindrical ionazation chamber is recommended by various dosimetry protocols. The sensitive volume of the ionazation chambers varies between 0.01 cc and 0.6 cc. In this study, the wall material of the ionazation chamber with an active volume of 0.6 cc was fabricated with a graphite wall electrode with a thickness of 0.43 mm and an aluminum center electrode. In the Clinac IX brand linear accelerator device, the response of the ionazation chamber depending on various dosimetric parameters was investigated in 6 and 15 MV photon beams. As a result, it was observed that the dose-dependent response of the SNC 600c brand ionazation chamber was linear at 6 and 15 MV photon energies. In the voltage-dependent change of the ionazation chamber, a difference of less than 1% was observed for both photon energy at the manufacturer's recommended values of 300 Volts and above. The response of the ionazation chamber for both photon energies is independent of dose rate and energy. Thus, it has been confirmed that the cylindrical ionazation chamber of the SNC 600c farmer type can be used in absolute dose measurement, as it has the characteristics that detectors used in radiation measurement with high-energy photons should have.

Non-alcoholic fatty liver disease (NAFLD) is histologically classified as either non-alcoholic fatty liver or non-alcoholic steatohepatitis (NASH). NASH is the progressive subtype of NAFLD. Individuals with NASH are at significant risk of developing hepatic fibrosis, cirrhosis, hepatocellular carcinoma, and liver-related and all-cause mortality. NAFLD is closely associated with obesity, type 2 diabetes mellitus (T2DM), metabolic syndrome, and cardiovascular events. Its prevalence is estimated to be above 30% in Turkey; and recent studies confirm this estimate. According to these studies, the prevalence of NAFLD in Turkey is between 48.3% and 60.1%. Currently, Turkey can be considered a risky region in terms of NAFLD burden as it is the most obese country in Europe with an obesity prevalence of 32.1% according to the 2016 World Health Organization data. Moreover, along with the increasing prevalence of obesity and T2DM in Turkey, the burden of NAFLD is estimated to increase in the upcoming decade. Despite the growing burden, we lack well-designed systemic studies that investigate NAFLD and its marked histological severity. In this review, we present studies on the burden of NAFLD and NASH, the natural history of NAFLD, and its association with other systemic diseases conducted with Turkish populations.

Kaya, Eda/0000-0002-9293-2811; WOS:000490571100005 PubMed ID: 31258138 Background/Aims: Nonalcoholic fatty liver disease (NAFLD), which consists of nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH), is a growing epidemic in Turkey, considering the recent alarming prevalence of 48.3%. Patients with NASH and/or liver fibrosis are more likely to progress to advanced liver disease. In this single-center study, we sought to describe the clinical and histological characteristics of a sample of Turkish patients with biopsy-proven NAFLD, who were enrolled over a 4-year period. Materials and Methods: This is a retrospective analysis of prospectively collected data from a total of 468 patients (224 males, 244 females; median age, 47 [18-71]. The study cohort consisted of patients with biopsy-proven NAFLD who were followed up at our outpatient clinic from 2009 to 2010 and from 2017 to 2018. Histological classification of the biopsies was performed according to the Steatosis, Activity and Fibrosis (SAF) scoring allowing the use of Fatty Liver Inhibition of Progression (FLIP) algorithm and the NAFLD Activity Score (NAS) scoring system. Results: Based on the SAF scoring, most patients (90.4%) had biopsy-proven NASH, whereas the NAFL was much rarer (9.6%). The prevalence of significant fibrosis (>= F2), advanced fibrosis (>= F3), and cirrhosis (F=4) was 35.0%, 17.5%, and 3.8%, respectively. The percentage of lean, overweight, and obese patients with NAFLD was 6.4%, 32.6%, and 61%, respectively. Metabolic syndrome was prevalent in 63% of the patients and Type 2 diabetes mellitus in 33.5%. Conclusion: The growing burden of NAFLD as a public health problem in Turkey is underscored by its marked histological severity in terms of NASH and fibrosis. Well-conducted clinical trials will be essential for slowing down the NASH progression.

Kaya, Eda/0000-0002-9293-2811; Demirtas, Coskun/0000-0002-0004-2740; Keklikkiran, Caglayan/0000-0001-6304-5554; Yilmaz, Yusuf/0000-0003-4518-5283; BAKIR, Alev/0000-0003-0664-5822 WOS:000550767400012 PubMed ID: 31530739 Background/Aims: Advanced fibrosis (F >= 3) indicates poor outcomes in nonalcoholic fatty liver disease (NAFLD). Here, we examined the diagnostic performance of the fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS) for detecting (or excluding) advanced fibrosis in patients with biopsy-proven NAFLD. Methods The diagnostic performance of each non-invasive test according to previously identified cutoff points indicating low and high risk for advanced fibrosis was determined in 463 patients with NAFLD. Patients who scored 2.67 on the FIB-4 were considered at low and high risk for advanced fibrosis, respectively. Patients who scored 0.676 on the NFS were considered at low and high risk for advanced fibrosis, respectively. Results: Eighty-one patients (17.5%) had biopsy-proven advanced fibrosis (F >= 3). The published FIB-4 cutoff values for low and high risk were able to exclude advanced fibrosis with negative predictive values (NPVs) of 0.907 and 0.843 and specificities of 74% and 97%, respectively. The published NFS cutoff values for low and high risk were able to exclude advanced fibrosis with NPVs of 0.913 and 0.842 and specificities of 63% and 96%, respectively. If biopsies were performed in only patients with a FIB-4 above the low cutoff point (>= 1.3), 67.1% could be avoided. Conversely, if biopsies were performed in only patients with an NFS above the low cutoff point (>=-1.455), 57.0% could be avoided. Conclusions: The main clinical utility of the FIB-4 and NFS in patients with NAFLD lies in the ability to exclude, not identify, advanced fibrosis.

Background and aim: the objective of the present study was to investigate the prevalence of metabolic-associated fatty liver disease (MAFLD) in patients with dyspepsia. Materials and methods: a total of 909 consecutive patients who presented with dyspepsia at 8 tertiary care centers in Turkey between March 2019 and December 2019 were included. Results: the median age was 47 years. Among them, 30.3% of the patients were obese, 18.8% had type 2 diabetes mellitus (T2DM), 35.1% had metabolic syndrome, 84.8% had dyslipidemia, and 23.9% had hypertension. The prevalence of MAFLD was 45.5%. Among the patients with MAFLD, the prevalence of obesity, T2DM, metabolic syndrome, dyslipidemia, and hypertension was 43.3%, 24.9%, 52.5%, 92.3%, and 31.9%, respectively. MAFLD was significantly associated with all of the metabolic comorbidities (p, Turkish Association for the Study of the Liver and Fatty Liver Diseases Special Interest Groups

Geçmişten günümüze evlilik ilişkilerinin en yaygın çatışma sebeplerinden olan aldatma olgusu, kimi zaman ilişkinin sonlanmasına kadar gidebilen yıkıcı etkilere sahiptir. Aldatma; toplumsal, kültürel ve dinsel öğretiler ile yanlış olarak etiketlense de görülme sıklığı oldukça yüksektir. Bu derleme çalışmasının amacı aldatma ve boşanma ilişkisini Bağlanma Kuramı perspektifinden değerlendirmektir. Çalışmada önce yetişkin bağlanma stilleri ve evlilik uyumu ilişkisi ele alınmış, daha sonra bağlanma stilleri ile aldatma eğilimi ve boşanma ilişkisi değerlendirilmiştir. Kuramsal açıdan bağlanma ilişkisi bebeğin bakımverenle ilişkisine bağlı olarak gelişmektedir. Bu bağlanma stilleri yetişkinlikte de etkisini korumakta ve yetişkin bağlanma stilleri romantik ilişkilerde dinamikleri, iletişim becerilerini ve çatışma çözüm stratejilerini belirlemede oldukça etkili konuma gelmektedir. Yetişkin bağlanma stilleri evlilikte aldatma eğilimini anlamlandırmada kilit noktalardan biridir. Ülkemizde aldatma konusuyla ilgili yapılan çalışmalar sınırlıdır ve bağlanma stilleri ile aldatma ve boşanma ilişkisini ele alan çalışma bulunmamaktadır. Çalışma, oldukça güncel bir konu olan aldatmayı bağlanma kuramı perspektifinden ele alması bakımından önemlidir. Çalışmada derlenen bulgular, evlilikte dinamikleri anlamlandırma ve çatışmalara çözüm bulma noktasında alanyazına ve uygulayıcılara izlenecek yollara ilişkin önemli bir perspektif kazandıracaktır.

BACKGROUND/AIM Although weight loss is recommended for the treatment of nonalcoholic fatty liver disease (NAFLD) in overweight and obese individuals, this treatment modality remains questionable in lean individuals. In this study, we investigated the effects of medical nutrition therapy (MNT) and intensive lifestyle interventions (ILIs) for NAFLD in lean versus obese patients. METHODS In total, 35 patients (14 lean and 21 obese) were included in the study. All patients underwent transient elastography examinations, and controlled attenuation parameter (CAP) of >238 dB/m was indicative of hepatic steatosis. After 8 weeks of dietitian follow-up with MNT and ILI, the patients were compared with the baseline. RESULTS Significant weight loss was recorded in both lean (5.4%) and obese patients (5.7%) with NAFLD. The mean BMI decreased from 23.9 (20.5-24.8) to 22.4 (19.5-24.2) kg/m (P = 0.001) in lean patients and from 34.0 (30.0-42.0) to 31.6 (26.9-42.5) kg/m (P

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease, with a worldwide prevalence of 25%. NAFLD represents a spectrum of liver disease severity from simple hepatic steatosis to non-alcoholic steatohepatitis, which is a potentially progressive liver condition with ongoing liver injury. It is strongly associated with obesity, insulin resistance, metabolic syndrome, genetic factors, and lifestyle factors. However, the exact pathophysiology of NAFLD remains to be established. Moreover, the diagnosis of NASH also represents a major challenge. The reference standard in the diagnosis of NASH is considered liver biopsy. Due to its invasive nature, there is a major effort to optimize biochemical and imaging methods in terms of replacing liver biopsy. To date, a combination of noninvasive tests based on blood tests with imaging methods is recommended. Although there is no consensus about the pharmacological therapy of NASH, the international guidelines recommend achieving significant weight loss and lifestyle modification. In conclusion, the combination of high prevalence and its high burden warrant further research in that area.

Noninvasive scores are developed for the estimation of advanced fibrosis, including parameters in addition to transaminases in non-alcoholic fatty liver disease (NAFLD). In this study, we aimed to investigate the diagnostic performances of Fibrosis-4 (FIB-4) and NAFLD Fibrosis Score (NFS) in the estimation of advanced fibrosis comparing patients with normal and elevated transaminases.We retrospectively analyzed the prospectively collected data of a total of 407 consecutive patients with biopsy-proven NAFLD. FIB-4 scores of1.3 and2.67 or1.45 and3.25 indicated a low and high risk for advanced fibrosis, respectively. NFS scores of-1.455 and0.676 were used to assess low and high risk for advanced fibrosis, respectiv.FIB-4 cutoffs of1.3 and1.45 for low risk of advanced fibrosis had a sensitivity of 70% and 54% in patients with elevated transaminases and 70% and 52% in patients with normal transaminases, respectively. The specificities for the cutoffs of2.67 and3.25 were 97% and 98% in patients with elevated transaminases and 99% and 100% in patients with normal transaminases, respectively. Concerning NFS, we found similar results.FIB-4 and NFS showed acceptable diagnostic performance in the exclusion of advanced fibrosis in both populations with normal and elevated transaminases.

Resting metabolic (RMR) rate was shown to be associated with chronic inflammatory conditions. In this study, we aimed to investigate whether RMR differs significantly in patients with non-alcoholic steatohepatitis (NASH) from patients with non-alcoholic fatty liver disease (NAFLD) without evidence of inflammation.Forty-two biopsy-proven NASH were compared with 37 NAFLD patients, who had normal serum transaminases and no evidence of fibrosis based on transient elastography examination. In the interviews, patients' levels of physical activity and dietary habits were recorded, and bioimpedance analysis was performed. The RMRs were calculated using an indirect calorimeter.RMR did not significantly differ between patients with NASH and NAFLD without steatohepatitis in both genders (p=0.695 in males, p=0.256 in females). However, only in female patients RMR rate per body weight was significantly higher in patients with NASH (22.3 [17.2-26.6] cal/kg to 20.2 [12.2-26.1] cal/kg, p=0.020).In conclusion, RMR was not significantly associated with steatohepatitis in patients with NAFLD. Considering the minimizing the effects of body weight, RMR rate per body weight may be used over RMR in the evaluation of the inflammatory status of the NAFLD.

DOI: 10.26650/cjm.2019.43.31Tramadol hydrochloride (HCl) is a syntheticanalgesic agent, which is generally safe at a low dose. Its adverse effects arereported in cases of intoxication. Here we present a 59-year-old male patientwith multiple relapsing parathyroid carcinoma-related refractory hypercalcemiaand generalized pain. Being prescribed tramadol HCl, he consumed an increaseddosage following increased pain, resulting in rhabdomyolysis, which improvedafter cessation of the drug. Nevertheless, the patient died owing to pulmonaryembolism. Rhabdomyolysis owing to tramadol HCl consumption is very rarelyreported. Rhabdomyolysis should be considered in patients consuming tramadolHCl and having generalized muscle weakness.Cite this article as: Trabulus S, ÖzbalakM, Kaya E, Apaydın T, Özkaya HM, Açbay Ö, et al. Case of rhabdomyolysis in apatient undergoing hemodialysis: a possible association with tramadol HCl.Cerrahpasa Med J 2019; 43(1): 34-36., DOI: 10.26650/cjm.2019.43.31Tramadol Hidroklorit (HCl) düşük dozlardagenellikle güvenli olan sentetik bir analjeziktir. Yan etkiler intoksikasyonvakalarında bildirilmiştir. Biz, burada nüks paratiroid kanseri tanısı bulunan59 yaşındaki erkek hastada medikal tedaviye dirençli ciddi hiperkalsemi vegeneralize ağrı olgusunu sunuyoruz. Hasta, ağrıları için Tramadol HCl reçeteedildikten sonra artan ağrılara paralel olarak ilaç dozunu arttırdı ve sonundarabdomiyoliz gelişti. Rabdomiyoliz ilacın kesilmesinden sonra tamamen geriledi,yine de hasta pulmoner emboli nedeniyle eks oldu. Tramadol HCl kullanımınabağlı rabdomiyoliz çok nadir olarak bildirilmiştir. Tramadol HCl kullanan vegeneralize kas ağrısı ile prezente olan hastalarda rabdomiyoliz düşünülmelidir.Cite this article as: Trabulus S, ÖzbalakM, Kaya E, Apaydın T, Özkaya HM, Açbay Ö, et al. Case of rhabdomyolysis in apatient undergoing hemodialysis: a possible association with tramadol HCl.Cerrahpasa Med J 2019; 43(1): 34-36.

Korkmaz, Merve/0000-0002-7710-6239; Trabulus, Sinan/0000-0003-3843-5950; Kaya, Eda/0000-0002-9293-2811; Seyahi, Nurhan/0000-0001-7427-618X WOS:000477574800014 Recurrence of glomerulonephritis (GN) is considered an important cause of allograft failure in kidney transplant recipients. It can present after transplantation with complications that are difficult to manage. In this case report, a 53-year-old woman was admitted to the hospital with abdominal pain and swelling in the right lower quadrant during the first month after kidney transplant. Following hospitalization, she complained of sudden-onset dyspnea and chest pain. Thorax computed tomography examination revealed pulmonary embolism (PE); thus, anticoagulation therapy was started. Her 24-h urine proteinuria was quantified as 16695 mg/day, and due to low albumin levels, she was diagnosed with nephrotic syndrome. However, kidney biopsy could not be performed due to the bleeding tendency of the patient. Due to a probable diagnosis of recurrent focal segmental glomerulosclerosis, plasmapheresis was performed. A total of eight plasmapheresis resulted in a complete recovery of the patient considering her proteinuria. In conclusion, recurrence of GN and development of PE due to nephrotic syndrome are well known, but difficult-to-manage. Thus, nephrology follow-up after kidney transplant is crucial.

Despite the increasing burden of nonalcoholic fatty liver disease (NAFLD) in modern societies, the optimal screening method to detect hepatic steatosis in the general population remains to be established. Controlled attenuation parameter (CAP) measured with transient elastography (TE) has recently emerged as a reliable imaging tool for the screening and diagnosis of NAFLD. Here, we sought to investigate the prevalence of TE-defined hepatic steatosis in a sample of apparently healthy medical students. We also assessed the relationships between CAP and traditional NAFLD risk factors.A total of 112 Turkish medical students (48 women and 64 men, mean age 20.5±1.1 years) underwent TE. On the basis of previous studies, a cut-off value of 238 dB/m for CAP was used for the diagnosis of hepatic steatosis.On the basis of the selected cut-off for CAP, we identified 26 students (23.2%) with TE-defined NAFLD. Univariate correlation analyses showed that CAP values were significantly associated with BMI (r=0.40, P0.001), waist circumference (r=0.39, P0.001), and hip circumference (r=0.34, P0.001). In multivariable analysis, only BMI retained its independent association with CAP (β=0.36, t=3.4, P0.001).NAFLD is highly prevalent even in apparently healthy young individuals. CAP assessment with TE may be useful for an early, noninvasive identification of hepatic steatosis.

The clinical guidelines recommend the use of nonalcoholic fatty liver disease fibrosis score and fibrosis-4 score for estimating the advanced liver fibrosis in nonalcoholic fatty liver disease. However, these scores are used confidently in eliminating advanced fibrosis, rather than detecting it. Therefore, paired combination with liver stiffness measurement by transient elastography is recommended. In this study, we aimed to validate this combined algorithm in our study population.A total of 139 consecutive biopsy-proven nonalcoholic fatty liver disease patients were enrolled in the study. We calculated the noninvasive scores and performed liver stiffness measurement examination for each patient.The optimal cutoff of liver stiffness measurement for advanced fibrosis was 11.0 kPa (area under curve: 0.856) with a sensitivity of 84% and a specificity of 78%. Using the fibrosis-4 score (1.45 for low risk of advanced fibrosis and3.25 for high risk of advanced fibrosis) in combination with the liver stiffness measurement cutoffs revealed the best diagnostic performance (8.8 kPa for low risk of advanced fibrosis and10.9 kPa for high risk of advanced fibrosis). This paired combination had the positive predictive value of 0.735 at a sensitivity of 89% and the negative predictive value of 0.932 at a specificity of 82%.A paired combination of the fibrosis-4 score and liver stiffness measurement (8.8 kPa for exclusion of advanced fibrosis and10.9 kPa for inclusion of advanced fibrosis) is able to diagnose the patients with advanced fibrosis with the highest diagnostic accuracy.

Simple noninvasive fibrosis scores based on routine blood tests have been increasingly investigated as screening tools in different clinical settings. Here, we sought to examine whether the Fibrosis-4 Index (FIB-4) and the non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) could perform differently in diabetic versus non-diabetic patients with biopsy-proven NAFLD.We examined 349 patients with biopsy-proven NAFLD (166 with type 2 diabetes and 183 without). Patients with FIB-4 scores 1.3 and 2.67 or NFS scores - 1.455 and 0.676 were considered at low and high risk of advanced fibrosis, respectively.A FIB-4 cutoff value of 1.3-which denotes a low risk of advanced fibrosis-had a specificity of 67% in patients with diabetes and 69% in those without. Conversely, a FIB-4 cutoff value of 2.67-which denotes a high risk of advanced fibrosis-had a sensitivity of 22% in patients with diabetes and 0% in those without. NFS performed similar to FIB-4.Both FIB-4 and NFS scores have an acceptable clinical utility in the exclusion of advanced fibrosis in patients with NAFLD, regardless of the presence of type 2 diabetes. However, their usefulness in identifying advanced fibrosis is limited-especially in the absence of diabetes.

Background: Phase angle is a bioimpedance analysis parameter that indirectly shows body cell mass. Its association with mortality has been shown in patients receiving dialysis treatment. However, assessment with mortality in kidney transplant recipients has not been studied previously. Methods: We examined 158 kidney transplant recipients who underwent bioimpedance analysis 8 years ago in a cross-sectional study. We contacted them again and investigated the presence of cardiovascular events, cancer, angina pectoris, and claudication. Data regarding mortality, graft failure, and creatinine values were collected from recipients’ files. Findings: During the follow-up period, 15 recipients died, 26 lost graft function, 36 experienced cardiovascular events, and 4 developed cancer. Phase angle was significantly associated with mortality during the 8-year follow-up period of kidney transplant recipients ( P < .001). The cutoff value for phase angle as a predictor of mortality was ≤5.85. Moreover, a phase angle value lower than 5.85 indicated 5.33 times higher risk of mortality. Discussion: Phase angle was a predictor of mortality in kidney transplant recipients. Since phase angle is an inexpensive, easy-to-perform, and noninvasive method, it might be considered as an additional tool to assess survival in kidney transplant recipients.

Trabulus, Sinan/0000-0003-3843-5950; Kaya, Eda/0000-0002-9293-2811; Seyahi, Nurhan/0000-0001-7427-618X; WOS:000467244700007 Objective: The extent of bone mineral disorders in predialysis patients is not well defined. This study aimed to detect the prevalence of both 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) deficiency in patients with stage 3-4 chronic kidney disease (CKD) and its relation to secondary hyperparathyroidism. Materials and Methods: In this study, 113 patients with stage 3-4 CKD admitted to our outpatient clinic were included. Clinical, demographic, and lifestyle characteristics of patients were recorded. Patients' serum creatinine, calcium, phosphorus, 25(OH)D, 1,25(OH)2D, and parathormone (PTH) levels were measured. Results: We found that 85 patients (75.2%) had stage 3 CKD, and 28 patients (24.8%) had stage 4 CKD. A low 25(OH)D level was detected in 89.4% of the patients (stage 3 CKD 89.4%, stage 4 CKD 89.3%). The PTH level was higher in patients with low 25(OH) D level with a borderline statistical significance (p= 0.057). The number of patients with 1,25(OH)2D level lower than 54.53 pg/ml was 28 (24.77%), which was accepted as a cut-off value. The mean PTH level was significantly higher in the group with lower 1,25(OH)2D (P= 0.048). The prevalence of secondary hyperparathyroidism was found as 57.5%. Conclusion: We found a high prevalence of bone mineral disorders among patients with stage 3-4 CKD. These results point out the importance of timely diagnosis and appropriate treatment. Istanbul University Scientific Research Projects DepartmentIstanbul University [38932] The financial support was provided by Istanbul University Scientific Research Projects Department under grant Project No: 38932.

Background: Historically, sexual assault is a common issue in Turkey. As doctors are one of the steps to help sexually assaulted women, medical students should have basic knowledge of and sensitivity regarding this subject. Another common women’s public health issue is induced abortion. In countries where access to abortion is restricted, there is a tendency towards unhealthy abortion. Aims: The aims of this study are: (1) to determine the attitudes and opinions of Marmara University Medical Faculty students about sexual assault against women and induced abortion and (2) to propose an educational program for medical students about sexual assault and abortion. Study Design: Cross-sectional study. Methods: The questionnaires were self-administered and the data were analyzed using SPSS v.15.0. First, the descriptive statistics were analyzed, followed by Chi-square for contingency tests assessing differences in attitudes toward sexual assault and induced abortion by factors such as gender and educational term. Differences were considered statistically significant at p0.05). Although there was no significant difference regarding the extent of punishment by victim’s status as a virgin, 21.3% (n=63) agreed that punishment should be more severe when the victim was a virgin. About 40.7% (n=120) agreed that the legal period of abortion in Turkey (10 weeks) should be longer. The majority (86.1%, n=255) agreed that legally prohibiting abortions causes an increase in unhealthy abortions. Conclusion: An educational program on these issues should be developed for medical students.