TASL practice guidance on the clinical assessment and management of patients with nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is a multisystem disease and is significantly associated with obesity, insulin resistance, type 2 diabetes mellitus, metabolic syndrome, and cardiovascular disease. NAFLD has become the most prevalent chronic liver disease in Western countries, and the proportion of NAFLD-related cirrhosis among patients on liver transplantation waiting lists has increased. In light of the accumulated data about NAFLD, and to provide a common approach with multi-disciplines dealing with the subject, it has become necessary to create new guidance for diagnosing and treating NAFLD. This guidance was prepared following an interdisciplinary study under the leadership of the Turkish Association for the Study of the Liver (TASL), Fatty Liver Special Interest Group. This new TASL Guidance is a practical application guide on NAFLD and was prepared to standardize the clinical approach to diagnosing and treating NAFLD patients. This guidance reflects many advances in the field of NAFLD. The proposals in this guidance are meant to aid decision-making in clinical practice. The guidance is primar-ily intended for gastroenterology, endocrinology, metabolism diseases, cardi-ology, internal medicine, pediatric specialists, and family medicine specialists

Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis

Background: We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). Patients and methods: Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. Results: We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. Conclusion: Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH.Fil: Efe, Cumali. Harran University Hospita; TurquíaFil: Lammert, Craig. University School of Medicine Indianapolis; Estados UnidosFil: Taşçılar, Koray. Universitat Erlangen-Nuremberg; AlemaniaFil: Dhanasekaran, Renumathy. University of Stanford; Estados UnidosFil: Ebik, Berat. Gazi Yasargil Education And Research Hospital; TurquíaFil: Higuera de la Tijera, Fatima. Hospital General de México; MéxicoFil: Calışkan, Ali R.. No especifíca;Fil: Peralta, Mirta. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Gerussi, Alessio. Università degli Studi di Milano; ItaliaFil: Massoumi, Hatef. No especifíca;Fil: Catana, Andreea M.. Harvard Medical School; Estados UnidosFil: Purnak, Tugrul. University of Texas; Estados UnidosFil: Rigamonti, Cristina. Università del Piemonte Orientale ; ItaliaFil: Aldana, Andres J. G.. Fundacion Santa Fe de Bogota; ColombiaFil: Khakoo, Nidah. Miami University; Estados UnidosFil: Nazal, Leyla. Clinica Las Condes; ChileFil: Frager, Shalom. Montefiore Medical Center; Estados UnidosFil: Demir, Nurhan. Haseki Training And Research Hospital; TurquíaFil: Irak, Kader. Kanuni Sultan Suleyman Training And Research Hospital; TurquíaFil: Melekoğlu Ellik, Zeynep. Ankara University Medical Faculty; TurquíaFil: Kacmaz, Hüseyin. Adıyaman University; TurquíaFil: Balaban, Yasemin. Hacettepe University; TurquíaFil: Atay, Kadri. No especifíca;Fil: Eren, Fatih. No especifíca;Fil: Alvares da-Silva, Mario R.. Universidade Federal do Rio Grande do Sul; BrasilFil: Cristoferi, Laura. Università degli Studi di Milano; ItaliaFil: Urzua, Álvaro. Universidad de Chile; ChileFil: Eşkazan, Tuğçe. Cerrahpaşa School of Medicine; TurquíaFil: Magro, Bianca. No especifíca;Fil: Snijders, Romee. No especifíca;Fil: Barutçu, Sezgin. No especifíca;Fil: Lytvyak, Ellina. University of Alberta; CanadáFil: Zazueta, Godolfino M.. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Demirezer Bolat, Aylin. Ankara City Hospital; TurquíaFil: Aydın, Mesut. Van Yuzuncu Yil University; TurquíaFil: Amorós Martín, Alexandra Noemí. No especifíca;Fil: De Martin, Eleonora. No especifíca;Fil: Ekin, Nazım. No especifíca;Fil: Yıldırım, Sümeyra. No especifíca;Fil: Yavuz, Ahmet. No especifíca;Fil: Bıyık, Murat. Necmettin Erbakan University; TurquíaFil: Narro, Graciela C.. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Bıyık, Murat. Uludag University; TurquíaFil: Kıyıcı, Murat. No especifíca;Fil: Kahramanoğlu Aksoy, Evrim. No especifíca;Fil: Vincent, Maria. No especifíca;Fil: Carr, Rotonya M.. University of Pennsylvania; Estados UnidosFil: Günşar, Fulya. No especifíca;Fil: Reyes, Eira C.. Hepatology Unit. Hospital Militar Central de México; MéxicoFil: Harputluoğlu, Murat. Inönü University School of Medicine; TurquíaFil: Aloman, Costica. Rush University Medical Center; Estados UnidosFil: Gatselis, Nikolaos K.. University Hospital Of Larissa; GreciaFil: Üstündağ, Yücel. No especifíca;Fil: Brahm, Javier. Clinica Las Condes; ChileFil: Vargas, Nataly C. E.. Hospital Nacional Almanzor Aguinaga Asenjo; PerúFil: Güzelbulut, Fatih. No especifíca;Fil: Garcia, Sandro R.. Hospital Iv Víctor Lazarte Echegaray; PerúFil: Aguirre, Jonathan. Hospital Angeles del Pedregal; MéxicoFil: Anders, Margarita. Hospital Alemán; ArgentinaFil: Ratusnu, Natalia. Hospital Regional de Ushuaia; ArgentinaFil: Hatemi, Ibrahim. No especifíca;Fil: Mendizabal, Manuel. Universidad Austral; ArgentinaFil: Floreani, Annarosa. Università di Padova; ItaliaFil: Fagiuoli, Stefano. No especifíca;Fil: Silva, Marcelo. Universidad Austral; ArgentinaFil: Idilman, Ramazan. No especifíca;Fil: Satapathy, Sanjaya K.. No especifíca;Fil: Silveira, Marina. University of Yale. School of Medicine; Estados UnidosFil: Drenth, Joost P. H.. No especifíca;Fil: Dalekos, George N.. No especifíca;Fil: N.Assis, David. University of Yale. School of Medicine; Estados UnidosFil: Björnsson, Einar. No especifíca;Fil: Boyer, James L.. University of Yale. School of Medicine; Estados UnidosFil: Yoshida, Eric M.. University of British Columbia; CanadáFil: Invernizzi, Pietro. Università degli Studi di Milano; ItaliaFil: Levy, Cynthia. University of Miami; Estados UnidosFil: Montano Loza, Aldo J.. University of Alberta; CanadáFil: Schiano, Thomas D.. No especifíca;Fil: Ridruejo, Ezequiel. Universidad Austral; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; ArgentinaFil: Wahlin, Staffan. No especifíca

Sosyal Ağların Eğitim Bağlamında Kullanımı

Günümüzde sosyal ağlar, içerisinde barındırdığı etkileşim ve iletişim araçları, yaygın kullanım oranı ile eğitimsel anlamda önemli bir potansiyele sahiptir. Bu bağlamda, ülkemizde de özellikle 18-24 yaş arası öğrencilerin en çok kullandığı sosyal yazılım olan Facebook üzerinde çalışan bir uygulama geliştirilerek sosyal ağların öğrenme üzerindeki etkisi incelenmiştir. Uşak Üniversitesi Eğitim Fakültesi Sosyal Bilgiler Öğretmenliği bölümü 2. Sınıf öğrencilerinden oluşan 102 katılımcı ile gerçekleştirilen çalışma, öntest-sontest kontrol gruplu desende modellenmiştir. Katılımcılardan deney ve kontrol grubu olmak üzere iki grup oluşturulmuş, deney grubu Öğretim ilke ve Yöntemleri dersi için geliştirilen Facebook uygulamasını kullanırken, kontrol grubu ise geleneksel yöntemle ders işlemiştir. Ölçümler araştırmacılar tarafından geliştirilen başarı testi aracılığıyla yapılmıştır. 4 haftalık uygulama sonucunda sosyal ağ tabanlı uygulamayı kullanan deney grubu öğrencilerinin akademik olarak geleneksel yöntemli öğrenim gören kontrol grubu öğrencilerine göre başarılı oldukları gözlenmiştir

S-39: Erzurum 2017 Avrupa Gençlik Kış Olimpik Festivalindeki (Eyof) Spor Sakatlık ve Hastalıkları

GİRİŞ: Spor müsabakalarındaki sakatlıklarla ve hastalık ilgili yapılan araştırmalar, sonraki müsabakalarda bu tür olayların önlenmesinde önemli bir basamaktır. Yapılan araştırmalarla hangi spor branşında ne tür sakatlıkların meydana geldiği tespit edilerek gelecekte ilgili branşta bu tür sakatlıkları önleyecek “koruyucu tedbirler” alınabilmektedir.AMAÇ: Erzurum EYOF 2017’ de 8 günlük yarışmalar boyunca sporcularda meydana gelen sakatlık ve hastalık oranlarını analiz etmek.GEREÇ-YÖNTEM: Avrupa Olimpiyat Komitesinden gerekli izinler alınarak Organizasyon Komitesine bağlı olan Sağlık Hizmetleri Direktörlüğünce sporcularda “Günlük Sakatlık ve Hastalık Bilgi Formu” dağıtılarak meydana gelen vakaların bu formlara kaydedilmesi istendi. 8 günlük yarışma süreci sonrasında bu verilere dijital ortama aktarılarak Spss programıyla veriler analiz edildi.BULGULAR: Bu çalışmaya toplam 34 ülkeden 392’si erkek (%60.6) 254’ü kadın (%39.4) olmak üzere toplam 646 sporcu katılmıştır. Bu sporcuların yaşları 15 ile 18 arasındadır. Elde edilen verilere göre festival süresince 25 sakatlanma, 25 ise hastalanma olmak üzere toplam 50 vaka meydana geldiği görüldü. Bu vakaların %10’u antrenman ve müsabaka öncesi, %90’ı ise antrenman veya müsabaka sırasında meydana gelmiştir. Branş bazında en fazla sakatlanmanın yaşandığı snowboard olurken biathlon, kayaklı koşu, curling ve artistik paten branşlarında herhangi bir sakatlanma vakasına rastlanmadı. Alp disiplini ise en fazla hastalanma vakasının görüldüğü branş olmuştur. Sakatlık ve hastalanma gibi vakaların en fazla yaşandığı branş alp disiplini iken (n=17) en az vaka yaşanan branşlar curling ve artistik patinaj (n=1) olduğu yapılan istatistik çalışmaları sonucu bulundu.TARTIŞMA/SONUÇ: Erzurum EYOF 2017’de sporcuların %3,8’ sı sakatlanma vakasıyla karşılaşmıştır. Bu oran Lillehammer 2016 Gençlik Olimpik Kış Oyunlarında (YOG) % 9.0, Innsbruck 2012 YOG’ta ise %11.0’dir. Buna ek olarak organizasyondaki hastalanma oranı %3,8 iken, bu oran Lillehammer 2016 YOG’ ta % 7.0, Innsbruck 2012 YOG’ta ise %9.0’dur

Our experience on feeding ostomies

Purpose: The aim of the present study is to assess patient's profiles and complications related to the tube placement in patients undergoing Percutaneous Endoscopic Gastrostomy and surgical feeding ostomies.Materials and Methods: The retrospective data of 114 consecutive hospitalized patients who underwent enteral feeding ostomy procedures was evaluated by dividing patients into two separate groups as Percutaneous Endoscopic Gastrostomy Group and Surgery Group.Results: Of the 114 patients, 57 patients underwent surgical feeding ostomy procedures, and other 57 underwent Percutaneous Endoscopic Gastrostomy. The mean age of the patients requiring surgical ostomy was greater than that of the patients with Percutaneous Endoscopic Gastrostomy. All procedures in the surgical group were performed in the operating theater, but procedures in the endoscopy group were performed in intensive care unit (61.5 %), endoscopy suit (34.6 %), or patient wards (3.8 %). The number of patients having cancer in the surgical ostomy group was higher than the Endoscopy group significantly, p<0.001. On the contrary, 93 % of the patients in the Endoscopy group had neurologic problems. Total complication rates in PEG group, surgical gastrostomy and jejunostomy groups were 26.3 %, 25 % and 24.3 %, respectively.Conclusion: In conclusion, PEG procedure has some advantages such as simplicity, low complication rates, lower cost, long term enteral nutrition. For that reason, recently, there is an increase in use of PEG procedure. However, the situation in which the use of PEG is impossible, surgical enteral tube placement techniques are still valid alternatives

Recommendations for hepatitis B immunoglobulin and antiviral prophylaxis against hepatitis B recurrence after liver transplantation

The combination of hepatitis B immunoglobulin and potent nucleos(t)ide analogs after liver transplantation is considered as the standard of care for prophylaxis against hepatitis B virus recurrence. However, the recommended doses, route of administration, and duration of HBIG administration remain unclear. Moreover, hepatitis B immunoglobulin-free prophylaxis with potent nucleos(t)ide analogs has shown promising disease outcomes in preventing hepatitis B virus recurrence. The current recommendations, produced by the Turkish Association for the Study of the Liver, Acute Liver Failure and Liver Transplantation Special Interest Group, suggest a reduced need for hepatitis B immunoglobulin administration with effective long-term suppression of hepatitis B virus replication using potent nucleos(t) ide analogs after liver transplantation

Recommendations for hepatitis B immunoglobulin and antiviral prophylaxis against hepatitis B recurrence after liver transplantation

The combination of hepatitis B immunoglobulin and potent nucleos(t)ide analogs after liver transplantation is considered as the standard of care for prophylaxis against hepatitis B virus recurrence. However, the recommended doses, route of administration, and duration of HBIG administration remain unclear. Moreover, hepatitis B immunoglobulin-free prophylaxis with potent nucleos(t)ide analogs has shown promising disease outcomes in preventing hepatitis B virus recurrence. The current recommendations, produced by the Turkish Association for the Study of the Liver, Acute Liver Failure and Liver Transplantation Special Interest Group, suggest a reduced need for hepatitis B immunoglobulin administration with effective long-term suppression of hepatitis B virus replication using potent nucleos(t)ide analogs after liver transplantation