A New Approach to Sea Transportation: An Application in Turkey

This study has been conducted to detect the strengths and the improvement requiring areas of sea transportation in Turkey via SWOT analysis, and the opportunities this sector brings to Turkey and the threats that might appear have been put forward in several aspects. When the necessary advances have been made considering the outcomes of this study, it can be foreseen that Turkish navigation can make a swift progress and assume its place in the top 5 mercantile fleets of the World Trade Fleet. Moreover, this new approach that can be developed through the example of Turkey, especially in the context of SWOT analysis methodology, can get to be seen as a role model before the other developing countries.Sea transportation is not merely a transportation sector. Along with goods and human transportation, ship building industry, port services, sea insurance and sea tourism are among the many naval activities. Because of all these, sea transportation has a significant place in international trade. The overall commercial value of world trade mounting up to 15 trillion US dollars, 9 trillion dollars of this has been conducted via sea transportation. In other words, 60 percent of world commerce has been done through sea transportation (GISBIR, 2013). Furthermore, the volume of the dry bulk market via sea transportation is expected to grow by 6 percent between the years 2014 and 2018 (GISBIR, 2013)

A New Approach to Sea Transportation: An Application in Turkey

This study has been conducted to detect the strengths and the improvement requiring areas of sea transportation in Turkey via SWOT analysis, and the opportunities this sector brings to Turkey and the threats that might appear have been put forward in several aspects. When the necessary advances have been made considering the outcomes of this study, it can be foreseen that Turkish navigation can make a swift progress and assume its place in the top 5 mercantile fleets of the World Trade Fleet. Moreover, this new approach that can be developed through the example of Turkey, especially in the context of SWOT analysis methodology, can get to be seen as a role model before the other developing countries.Sea transportation is not merely a transportation sector. Along with goods and human transportation, ship building industry, port services, sea insurance and sea tourism are among the many naval activities. Because of all these, sea transportation has a significant place in international trade. The overall commercial value of world trade mounting up to 15 trillion US dollars, 9 trillion dollars of this has been conducted via sea transportation. In other words, 60 percent of world commerce has been done through sea transportation (GISBIR, 2013). Furthermore, the volume of the dry bulk market via sea transportation is expected to grow by 6 percent between the years 2014 and 2018 (GISBIR, 2013)

patient-based survey

Although gout is potentially curable, the management of this disease is often suboptimal. In this study, we investigated the treatment of gout in Turkey and also compared the management approaches to gout in different clinical specialties. Three hundred and nineteen consecutive patients (mean age 58.60 +/- 12.8 years; 44 females, 275 males) were included in this multicenter study. A standardized form was generated to collect data about the patient's first admission to health care, the specialty of the doctor first diagnosed the gout, the treatment options for gout including attack management, patient referral, chronic treatment including medical treatment, and life style modifications. Forty patients were referred to another center without any treatment (12.8 %), and referral rate is most common among the primary care physicians (28.8 %). Colchicine was more commonly used for attack prophylaxis than allopurinol. Ninety-two patients had never been treated with allopurinol (28.8 %). Allopurinol prescription was less common among the primary care physicians and orthopedists, and highest among the rheumatologists. Recommendation of diet and life style modifications was less common among the primary care physicians and orthopedists, and highest among the rheumatologists. The rates of life style modification recommendation and long-term allopurinol prescription were 83.7 and 77.6 %, respectively, among the rheumatologists. Both acute and chronic management of gout is suboptimal in Turkey especially among the primary care physicians and orthopedists. Moreover, chronic treatment is even suboptimal among rheumatologists

in Turkey: the data from TSN-GOLD Working Group

Purpose Hematuria is one of the most common laboratory findings in nephrology practice. To date, there is no enough data regarding the clinical and histopathologic characteristics of primary glomerular disease (PGD) patients with hematuria in our country. Methods Data were obtained from national multicenter (47 centers) data entered into the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) database between May 2009 and June 2019. The data of all PGD patients over the age of 16 years who were diagnosed with renal biopsy and had hematuria data were included in the study. Demographic characteristics, laboratory and biopsy findings were also recorded. Results Data of 3394 PGD patients were included in the study. While 1699 (50.1%) patients had hematuria, 1695 (49.9%) patients did not have hematuria. Patients with hematuria had statistically higher systolic blood pressure, serum blood urea nitrogen, creatinine, albumin, levels and urine pyuria. However, these patients had statistically lower age, body mass index, presence of hypertension and diabetes, eGFR, 24-h proteinuria, serum total, HDL and LDL cholesterol, and C3 levels when compared with patients without hematuria. Hematuria was present 609 of 1733 patients (35.8%) among the patients presenting with nephrotic syndrome, while it was presented in 1090 of 1661 (64.2%) patients in non-nephrotics (p < 0.001). Conclusion This is the first multicenter national report regarding the demographic and histopathologic data of PGD patients with or without hematuria. Hematuria, a feature of nephritic syndrome, was found at a higher than expected in the PGDs presenting with nephrotic syndrome in our national database.C1 [Sumnu, Abdullah] Medipol Univ, Med Fac, Dept Nephrol, Medipol Mega Hastanesi, Goztepe Mahallesi Metin Sk 4, Istanbul, Turkey.[Turkmen, Kultigin] Necmettin Erbakan Univ, Meram Med Fac, Nephrol, Konya, Turkey.[Cebeci, Egemen; Uzun, Sami; Ozturk, Savas] Haseki Training & Res Hosp, Nephrol, Istanbul, Turkey.[Turkmen, Aydin] Istanbul Univ, Istanbul Med Fac, Nephrol, Istanbul, Turkey.[Eren, Necmi; Ergul, Metin] Kocaeli Univ, Nephrol Med Fac, Kocaeli, Turkey.[Seyahi, Nurhan; Dincer, Mevlut Tamer] Istanbul Univ, Cerrahpasa Med Fac, Nephrol, Istanbul, Turkey.[Oruc, Aysegul; Gullulu, Mustafa] Uludag Univ, Med Fac, Nephrol, Bursa, Turkey.[Dede, Fatih; Piskinpasa, Serhan] Ankara Numune Training & Res Hosp, Nephrol, Ankara, Turkey.[Derici, Ulver; Akcay, Omer Faruk] Gazi Univ, Med Fac, Nephrol, Ankara, Turkey.[Basturk, Taner; Unsal, Abdulkadir] Hamidiye Sisli Etfal Training & Res Hosp, Nephrol, Istanbul, Turkey.[Sahin, Garip] Eskisehir Osmangazi Univ, Med Fac, Nephrol, Eskisehir, Turkey.[Sipahioglu, Murat; Koyuncu, Sumeyra] Erciyes Univ, Med Fac, Nephrol, Kayseri, Turkey.[Sahin, Gulizar Manga; Gok, Mahmut] Sultan Abdulhamit Han Res & Training Hosp, Nephrol, Istanbul, Turkey.[Tatar, Erhan] Bozyaka Training & Res Hosp, Nephrol, Izmir, Turkey.[Dursun, Belda] Pamukkale Univ, Med Fac, Nephrol, Denizli, Turkey.[Sipahi, Savas] Sakarya Univ, Med Fac, Nephrol, Sakarya, Turkey.[Yilmaz, Murvet] Bakirkoy Sadi Konuk Training & Res Hosp, Nephrol, Istanbul, Turkey.[Suleymanlar, Gultekin] Akdeniz Univ, Med Fac, Nephrol, Antalya, Turkey.[Ulu, Sena] Afyon Kocatepe Univ, Med Fac, Nephrol, Afyon, Turkey.[Gungor, Ozkan] Sutcu Imam Univ, Med Fac, Nephrol, Kahramanmaras, Turkey.[Kutlay, Sim] Ankara Univ, Ibni Sina Hosp, Med Fac, Nephrol, Ankara, Turkey.[Bahcebasi, Zerrin Bicik] Dr Lutfi Kirdar Kartal Training & Res Hosp, Nephrol, Istanbul, Turkey.[Sahin, Idris] Inonu Univ, Med Fac, Nephrol, Malatya, Turkey.[Kurultak, Ilhan] Trakya Univ, Med Fac, Nephrol, Edirne, Turkey.[Sevinc, Can] Ataturk Univ, Med Fac, Nephrol, Erzurum, Turkey.[Yilmaz, Zulfikar] Dicle Univ, Diyarbakir, Turkey.[Kazancioglu, Rumeyza Turan] Bezmialem Vakif Univ, Med Fac, Nephrol, Istanbul, Turkey.[Cavdar, Caner] Dokuz Eylul Univ, Med Fac, Nephrol, Izmir, Turkey.[Candan, Ferhan] Cumhuriyet Univ, Med Fac, Nephrol, Sivas, Turkey.[Aydin, Zeki] Darica Farabi Training & Res Hosp, Nephrol, Kocaeli, Turkey.[Oygar, Deren] Burhan Nalbantoglu State Hosp, Nephrol, Nicosia, Cyprus.[Gul, Bulent] Bursa Yuksek Ihtisas Training & Res Hosp, Nephrol, Bursa, Turkey.[Altun, Bulent] Hacettepe Univ, Med Fac, Nephrol, Ankara, Turkey.[Paydas, Saime] Cukurova Univ, Med Fac, Nephrol, Adana, Turkey.[Istemihan, Zulal] Istanbul Univ, Istanbul Med Fac, Internal Med, Istanbul, Turkey

Diseases Working Group

Background The largest data on the epidemiology of primary glomerular diseases (PGDs) are obtained from the databases of countries or centers. Here, we present the extended results of the Primary Glomerular Diseases Study of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) Working Group. Methods Data of patients who underwent renal biopsy and received the diagnosis of PGD were recorded in the database prepared for the study. A total of 4399 patients from 47 centers were evaluated between May 2009 and May 2019. The data obtained at the time of kidney biopsy were analyzed. After the exclusion of patients without light microscopy and immunofluorescence microscopy findings, a total of 3875 patients were included in the study. Results The mean age was 41.5 +/- 14.9 years. 1690 patients were female (43.6%) and 2185 (56.3%) were male. Nephrotic syndrome was the most common biopsy indication (51.7%). This was followed by asymptomatic urinary abnormalities (18.3%) and nephritic syndrome (17.8%). The most common PGD was IgA nephropathy (25.7%) followed by membranous nephropathy (25.6%) and focal segmental glomerulosclerosis (21.9%). The mean total number of glomeruli per biopsy was 17 +/- 10. The mean baseline systolic blood pressure was 130 +/- 20 mmHg and diastolic blood pressure was 81 +/- 12 mmHg. The median proteinuria, serum creatinine, estimated GFR, and mean albumin values were 3300 (IQR: 1467-6307) mg/day, 1.0 (IQR: 0.7-1.6) mg/dL, 82.9 (IQR: 47.0-113.0) mL/min and 3.2 +/- 0.9 g/dL, respectively. Conclusions The distribution of PGDs in Turkey has become similar to that in other European countries. IgA nephropathy diagnosed via renal biopsy has become more prevalent compared to membranous nephropathy.C1 [Turkmen, Aydin; Yazici, Halil] Istanbul Univ, Istanbul Med Fac, Nephrol, Istanbul, Turkey.[Sumnu, Abdullah] Istanbul Medipol Univ, Med Fac, Nephrol, Istanbul, Turkey.[Cebeci, Egemen; Ozturk, Savas] Haseki Training & Res Hosp, Nephrol, Istanbul, Turkey.[Eren, Necmi] Kocaeli Univ, Med Fac, Nephrol, Kocaeli, Turkey.[Seyahi, Nurhan] Istanbul Univ, Cerrahpasa Med Fac, Nephrol, Istanbul, Turkey.[Dilek, Kamil] Uludag Univ, Med Fac, Nephrol, Bursa, Turkey.[Dede, Fatih] Ankara Numune Training & Res Hosp, Nephrol, Ankara, Turkey.[Derici, Ulver] Gazi Univ, Med Fac, Nephrol, Ankara, Turkey.[Unsal, Abdulkadir] Hamidiye Sisli Etfal Training & Res Hosp, Nephrol, Istanbul, Turkey.[Sahin, Garip] Eskisehir Osmangazi Univ, Med Fac, Nephrol, Eskisehir, Turkey.[Sipahioglu, Murat] Erciyes Univ, Med Fac, Nephrol, Kayseri, Turkey.[Gok, Mahmut; Sahin, Gulizar Manga] Sultan Abdulhamit Han Training & Res Hosp, Nephrol, Istanbul, Turkey.[Tatar, Erhan] Izmir Bozyaka Training & Res Hosp, Nephrol, Izmir, Turkey.[Dursun, Belda] Pamukkale Univ, Med Fac, Nephrol, Denizli, Turkey.[Sipahi, Savas] Sakarya Univ, Med Fac, Nephrol, Adapazari, Sakarya, Turkey.[Yilmaz, Murvet] Bakirkoy Sadi Konuk Training & Res Hosp, Nephrol, Istanbul, Turkey.[Suleymanlar, Gultekin] Akdeniz Univ, Med Fac, Nephrol, Antalya, Turkey.[Ulu, Sena] Afyon Kocatepe Univ, Med Fac, Nephrol, Afyon, Turkey.[Gungor, Ozkan] Sutcu Imam Univ, Med Fac, Nephrol, Kahramanmaras, Turkey.[Kutlay, Sim] Ankara Univ, Ibni Sina Hosp, Med Fac, Nephrol, Ankara, Turkey.[Bahcebasi, Zerrin Bicik] Dr Lutfi Kirdar Kartal Training & Res Hosp, Nephrol, Istanbul, Turkey.[Sahin, Idris] Inonu Univ, Med Fac, Nephrol, Malatya, Turkey.[Kurultak, Ilhan] Trakya Univ, Med Fac, Nephrol, Edirne, Turkey.[Turkmen, Kultigin] Necmettin Erbakan Univ, Meram Med Fac, Nephrol, Konya, Turkey.[Yilmaz, Zulfikar] Dicle Univ, Med Fac, Nephrol, Diyarbakir, Turkey.[Kazancioglu, Rumeyza Turan] Bezmialem Vakif Univ, Med Fac, Nephrol, Istanbul, Turkey.[Cavdar, Caner] Dokuz Eylul Univ, Med Fac, Nephrol, Izmir, Turkey.[Candan, Ferhan] Cumhuriyet Univ, Med Fac, Nephrol, Sivas, Turkey.[Aydin, Zeki] Darica Farabi Training & Res Hosp, Nephrol, Kocaeli, Turkey.[Oygar, Duriye Deren] Doktor Burhan Nalbantoglu State Hosp, Nicosia, Cyprus.[Gul, Cuma Bulent] Bursa Yuksek Ihtisas Training & Res Hosp, Nephrol, Bursa, Turkey.[Arici, Mustafa] Hacettepe Univ, Med Fac, Nephrol, Ankara, Turkey.[Paydas, Saime] Cukurova Univ, Med Fac, Nephrol, Adana, Turkey.[Taymez, Dilek Guven] Kocaeli State Hosp, Nephrol, Kocaeli, Turkey.[Kucuk, Mehmet] Okmeydani Training & Res Hosp, Nephrol, Istanbul, Turkey.[Trablus, Sinan] Istanbul Training & Res Hosp, Nephrol, Istanbul, Turkey.[Turgutalp, Kenan] Mersin Univ, Med Fac, Nephrol, Mersin, Turkey.[Koc, Leyla] Taksim Training & Res Hosp, Nephrol, Istanbul, Turkey.[Sezer, Siren] Baskent Univ, Med Fac, Nephrol, Ankara, Turkey.[Duranay, Murat] Ankara Numune Training & Res Hosp, Nephrol, Ankara, Turkey.[Bardak, Simge] Batman State Hosp, Nephrol, Batman, Turkey.[Altintepe, Lutfullah] Selcuk Univ, Selcuk Med Fac, Nephrol, Konya, Turkey.[Arikan, Izzet Hakki] Marmara Univ, Med Fac, Nephrol, Istanbul, Turkey.[Azak, Alper] Balikesir Training & Res Hosp, Nephrol, Balikesir, Turkey.[Odabas, Ali Riza] Goztepe Training & Res Hosp, Nephrol, Istanbul, Turkey

Assessment of the New 2012 EULAR/ACR Clinical Classification Criteria for Polymyalgia Rheumatica: A Prospective Multicenter Study.

OBJECTIVE: To assess the performance of the new 2012 provisional European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) polymyalgia rheumatica (PMR) clinical classification criteria in discriminating PMR from other mimicking conditions compared with the previous 5 diagnostic criteria in a multicenter prospective study. METHODS: Patients older than 50 years, presenting with new-onset bilateral shoulder pain with elevated acute-phase reactants (APR), were assessed for the fulfillment of the new and old classification/diagnostic criteria sets for PMR. At the end of the 1-year followup, 133 patients were diagnosed with PMR (expert opinion) and 142 with non-PMR conditions [69 rheumatoid arthritis (RA)]. Discriminating capacity, sensitivity, and specificity of the criteria sets were estimated. RESULTS: Discriminating capacity of the new clinical criteria for PMR from non-PMR conditions and RA as estimated by area under the curve (AUC) were good with AUC of 0.736 and 0.781, respectively. The new criteria had a sensitivity of 89.5% and a specificity of 57.7% when tested against all non-PMR cases. When tested against all RA, seropositive RA, seronegative RA, and non-RA control patients, specificity changed to 66.7%, 100%, 20.7%, and 49.3%, respectively. Except for the Bird criteria, the 4 previous criteria had lower sensitivity and higher specificity (ranging from 83%-93%) compared with the new clinical criteria in discriminating PMR from all other controls. CONCLUSION: The new 2012 EULAR/ACR clinical classification criteria for PMR is highly sensitive; however, its ability to discriminate PMR from other inflammatory/noninflammatory shoulder conditions, especially from seronegative RA, is not adequate. Imaging and other modifications such as cutoff values for APR might increase the specificity of the criteria

for Polymyalgia Rheumatica: A Prospective Multicenter Study

Objective. To assess the performance of the new 2012 provisional European League Against Rheumatism (EULAR)/ American College of Rheumatology (ACR) polymyalgia rheumatica (PMR) clinical classification criteria in discriminating PMR from other mimicking conditions compared with the previous 5 diagnostic criteria in a multicenter prospective study.Methods. Patients older than 50 years, presenting with new-onset bilateral shoulder pain with elevated acute-phase reactants (APR), were assessed for the fulfillment of the new and old classification/diagnostic criteria sets for PMR. At the end of the 1-year followup, 133 patients were diagnosed with PMR (expert opinion) and 142 with non-PMR conditions [69 rheumatoid arthritis (RA)]. Discriminating capacity, sensitivity, and specificity of the criteria sets were estimated.Results. Discriminating capacity of the new clinical criteria for PMR from non-PMR conditions and RA as estimated by area under the curve (AUC) were good with AUC of 0.736 and 0.781, respectively. The new criteria had a sensitivity of 89.5% and a specificity of 57.7% when tested against all non-PMR cases. When tested against all RA, seropositive RA, seronegative RA, and non-RA control patients, specificity changed to 66.7%, 100%, 20.7%, and 49.3%, respectively. Except for the Bird criteria, the 4 previous criteria had lower sensitivity and higher specificity (ranging from 83%-93%) compared with the new clinical criteria in discriminating PMR from all other controls.Conclusion. The new 2012 EULAR/ ACR clinical classification criteria for PMR is highly sensitive; however, its ability to discriminate PMR from other inflammatory/noninflammatory shoulder conditions, especially from seronegative RA, is not adequate. Imaging and other modifications such as cutoff values for APR might increase the specificity of the criteria