Real-world efficacy and safety of Ledipasvir plus Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir +/- Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience

Background/Aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population.Material and Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)+/- ribavirin (RBV) ombitasvir/paritaprevir/ritonavir +/- dasabuvir (PrOD)+/- RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed.Results: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90 +/- 54.60 U/L to 17.00 +/- 14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51 +/- 4.54 to 7.32 +/- 3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0 +/- 16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%).Conclusion: LDV/SOF or PrOD +/- RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.Turkish Association for the Study of The Liver (TASL

Crimes of al-hudud in Zaydi fiqh and comparision with Hanafi fiqh

İslam hukukunun doğru anlaşılmasında mukayeseli çalışmalar önemli bir yere sahiptir. Çünkü çağın getirdiği koşullar içerisinde zuhur eden güncel problemler, İslâm dünyasının değişim ve gelişmelere donuk kalmamasını ve ortaya çıkan mevzuları çözüme kavuşturmak için mezheplerin bir bahis etrafında ortaya koyduğu muhtelif hükümleri iyi analiz etmesini gerektirmektedir. Bu nedenle araştırmamızda, Zeydiyye mezhebine ait Tecrîd ve Hanefi mezhebine ait Muhtasaru'l-Kudûrî adlı fıkıh kitapları esas alınarak, mukayeseli bir inceleme yapılmıştır. Kitapların tüm bölümleri incelenmemiş olup araştırma "had suçları" bölümü ile sınırlı tutulmuştur. Bu çalışmayla, had suçları çerçevesinde; Şiî fırkalarından sayılan ancak Sünnî mezheplere yakın olduğu ileri sürülen Zeydiyye fıkhı ile Hanefi fıkhın arasındaki benzerlik durumuna ilişkin bir kanaat elde edilmeye çalışılmıştır. Araştırmanın birinci bölümünde Zeydiyye fıkhıyla Hanefi fıkhının teşekkülü ile literatürü genel olarak tanıtılmıştır. İkinci bölümünde Tecrîd ve Muhtasaru'l-Kudûrî eserleri hakkında ayrıntılı bilgiler verilmiş ve eserlerin şekil ve metot açısından mukayesesi yapılmıştır. Üçüncü bölümünde ise iki eserde bulunan; zina, zina iftirası (kazf), içki içme (şürb), hırsızlık (sirkat), yol kesme (kat-ı tarik) ve dinden dönme (irtidât) suçları ile ilgili hükümlerin mukayesesi yapılıp iki mezhebin had cezaları bağlamında var olan ortak ve farklı hükümleri belirtilmiştir. Bunun dışında bir eserde yer alıp diğer eserde yer almayan hükümlere yer verilmiştir. Araştırma sonucunda esasen her iki eserde ortak hükümlerin varlığı yanında, farklıkların da var olduğu görülmüştür.Comparative studies play an important role in the proper understanding of Islamic law since it is necessary to analyze the different provisions of the sects in question. Because the current problems that emerge under the conditions of the nowadays world require the Islamic world not remaining static during changes and developments and to analyze properly the provisions put forward by sects in certain issues. For this reason, comparative analysis is the preferred method for this research. Regardingly, research was referred to the fiqh book "Tacrîd" belonging to the Hanafi sect and "Mukhtasar al-Qudûrî" belonging to Zaydiyya. Not all the chapters of the books have been examined and the work is limited to the topic of "had crimes". In this study, the researcher attempted to determine the ratio of the claim of proximity between the Zaydiyya sect which is considered to be part of the Shiite sects. In the first part of the research, the forming and the literature of Zaydiyya jurisprudence and Hanafi jurisprudence are introduced in a general framework. In the second part, detailed information about Tacrîd and Mukhtasar al-Qudûrî's works are given and their works are compared in terms of form and methods. In the third one, the common provisions regarding adultery, imorality slender (qazf), drinking (şurb), theft(sirkat), road cutting (qat-ı tariq) and liaison crimes (irtidât) are examined and compared based on the ranking of the books utilized for this research. Different provisions of both sects are are stated in the context of "had" punishments and apart from this are also examined provisions that are not included in other works. As a result, the research showed that although there is a considerable convergence of factors in the two works, there are also significant divergences

Computer aided drawing and cost estimation of civil engineering projects

Ph.D. - Doctoral Progra

Feu et archéoanthropologie au Proche-Orient (épipaléolithique et néolithique). Le lien avec les pratiques funéraires. Données nouvelles de Çayönü (Turquie)

Many burned skeletal remains have been found in the Çayönü Skull Building. The upper layer yielded 71 skulls and some post-cranial remains which might have been burned during the intentional burning of the building. In the earlier layer BM la, there were also many burned human remains. A burned bone deposit from this layer was studied using taphonomic approach so as to reconstruct the burial phases. It appears that the bones were selected prior to their deposit in the pit ; they were then broken in situ by natural process and finally burned may be due to the burning of the building. Although burned human bones are frequently uncovered at Near Eastern Epipalaeolithic and Neolithic sites, a relation with mortuary practices can rarely be established. The earliest cremations date back to the end of the Neolithic period (Halaf culture) but burned human bones have been uncovered from a number of older sites. Most of them were probably accidentally burned. At a few sites (Kebara, Jerf el Ahmar, Dja' de el Mughara, Aşikh, Nahal Hemar), the burning of the human remains might be connected to mortuary practices. It appears that the practice of plastering skulls during the PPNB period is the only mortuary practice involving fire with certainty, even if indirectly.Le Skull Building de Çayönü a livré de nombreux ossements brûlés. Les 71 crânes et les quelques restes post-crâniens du niveau supérieur pourraient avoir été soumis au feu lors de l'incendie volontaire du bâtiment. Les os du niveau BM la (première phase du Skull Building ) ont également pu être brûlés lors d'un incendie. L'analyse, effectuée dans une perspective taphonomique, de l'un des dépôts funéraires de ce niveau montre, de plus, que les os ont été sélectionnés avant d'être placés dans la fosse, ayant ensuite été fragmentés in situ puis brûlés. Les os humains brûlés sont fréquents dans l'Épipaléolithique et le Néolithique du Proche-Orient mais un lien avec les pratiques funéraires peut rarement être établi. Si les incinérations attestées datent de la fin du Néolithique (culture Halaf), des restes humains pourraient avoir été brûlés dans le cadre de pratiques funéraires dans quelques sites plus anciens (Kebara, Jerf el Ahmar, Dja 'de el Mughara, Aşikh, Nahal Hemar). Le surmodelage des crânes, au PPNB, est la seule pratique dans laquelle le feu joue un rôle certain bien qu'indirect.Le Mort Françoise, Erim-Özdögan Asli, Özbek Metin, Yilmaz Yasemin. Feu et archéoanthropologie au Proche-Orient (épipaléolithique et néolithique). Le lien avec les pratiques funéraires. Données nouvelles de Çayönü (Turquie). In: Paléorient, 2000, vol. 26, n°2. La pyrotechnologie à ses débuts. Evolution des premières industries faisant usage du feu. pp. 37-50

The Assessment of Oncological Emergencies Of Chest Diseases

Amaç: Göğüs hastalıkları hastanesi acil servisine başvuran onkoloji hastalarının genel özelliklerini ortaya koymak amaçlandı. Yöntem: Bir aylık dönemde acil servise başvuran malignite tanılı hastaların sosyodemografik verileri ile birlikte başvuru semptomları ve acil tanıları retrospektif olarak incelendi.Bulgular: Çalışmaya alınan 118 hastanın 105 (%84.7)’si erkek, 13 (%15.3)’ü kadın ve yaş ortalaması 61.2 yıl idi. En sık başvuru yapan yaş aralığı 50-59 idi. Hastalarımızda saptanan en sık semptomlar nefes darlığı (%50), ağrı (%27.9), ateş (%14.4) ve hemoptizi (%10.1) idi. Daha az sıklıkta bulantı (%9.3), öksürük-balgam çıkarma (%7.6) ve halsizlik (%5.9) izlendi. Küçük hücreli dışı akciğer karsinomlu hastaların %87.5’i ve küçük hücreli akciğer karsinomunun %23.5’i ileri evre kansere sahip idi. En sık rastlanan acil tanı 49 (%41.5) hastada solunum yetmezliği, 14 (%11.8) hastada kemik metastazı, 13 (%11) hastada beyin metastazı idi.Sonuç: Göğüs hastalıkları acil servisine başvuran hastaların en sık yakınmaları nefes darlığı ve ağrı, en sık acil tanıları solunum yetmezliği ve metastatik hastalıktır. Genel talep palyatif tedaviler içindir, ölüm oranı düşüktür.Objective: It was aimed to reveal the general characteristics of oncology patients referred to emergency service of chest diseases training hospital. Method: A retrospective analysis was performed on the socio-demographic data, the referral symptoms and emergency diagnoses of the subjects diagnosed with malignity who referred to emergency service along one month. Results: Of 118 subjects included in the study, 13 (84.7 %) were women and 105 (84.7 %) were men and the average age was 61.2 years. Frequent age interval was between 50-59. The symptoms most often seen in our cases were dypnea (50 %), pain (27.9 %), fever (14.4 %) and hemoptysis (10.1 %), whereas nausea (9.3%), cough-expectoration (7.6%) and weakness (5.9%) were observed less frequently. 87.5% of non-small cell lung carcinoma and 23.5% of small cell lung carcinoma had advanced stage lung cancer. The most frequent encountered emergency diagnoses were respiratory insufficiency in 49 (41.5%) cases, bone metastasis in 14 (11.8%) and brain metastasis in 13 (11%). Conclusion: It was observed that the most frequent complaints for emergency deferral were dyspnea and pain and the most frequent emergency diagnoses were respiratory insufficiency and metastatic disease. General requirement was for palliative treatments and the mortality was lower

Chemoradiotherapy-Associated Myelosuppression: A Retrospective Analysis of Risk Factors for Patients with Non-Small Cell Lung Cancer

Objective: Concomitant chemoradiotherapy (CRT) is the standard treatment for patients with stage III non-small cell lung cancer (NSCLC). Myelosuppression can be a significant problem in concomitant CRT. The aim of this study was to assess the parameters obtained before concomitant CRT to define the risk factors for myelosuppression in patients with locally advanced NSCLC. Methods: We retrospectively analyzed 81 patients with NSCLC who received concomitant platinum-based chemoradiotherapy between January 2008 and December 2012. Seventy-eight patients (96.2%) received etoposide (50 mg/m2, intravenously on days 1–5, 29–33) plus cisplatin (50 mg/m2, on days 1, 8, 29, and 36), and 3 patients (3.8%) received docetaxel (20 mg/m2/w, on weeks 1–8) plus cisplatin (20 mg/m2/w, on weeks 1–8) concurrently with thoracic radiotherapy to a total dose of 40–66.6 Gy. The risk factors were examined for their association with myelosupression (grade 3 or 4 leukopenia, neutropenia, thrombocytopenia, or anemia) by logistic regression analysis. Results: Grade 3 or higher neutropenia, leukopenia, thrombocytopenia, or anemia occurred in 51.8%, 53%, 8.6%, and 7.4% of the patients, respectively. Multivariate analysis revealed that the risk factors for neutropenia were performance status (p=0.032), white blood cell count (p=0.023), and pretreatment creatinine level (p=0.018). On multivariate analysis, white blood cell count (OR, 3.311; p=0.027; 95% CI, 1.148–9.545) was found as significant risk factor for CRT-induced leukopenia Conclusion: Patients with a poor pretreatment performance status, low white blood cell count, and high creatinine level are at a risk of myelosupression. These characteristics of the patients should be considered while making treatment decisions

Prevalence of Pancreatic Steatosis and Its Associated Factors in Turkey: A Nation-Wide Multicenter Study

Background/Aims: Pancreatic steatosis (PS) is a pathology associated with metabolic syndrome (MS), endocrin and exocrine disfunctions of the pancreas, and fatty liver. The data on the frequency of PS are very limited. We aimed to evaluate the frequency of PS detected by transabdominal ultrasonography (TAU) in gastroenterology clinics located in different geographical regions of Turkey and the factors associated with it. Materials and Methods: Volunteers were evaluated by TAU for PS and hepatosteatosis (HS), and its degree. Pancreatic stiffness was evaluated by ultrasonographic shear wave elastography (SWE). All demographic, physical, and biochemical parametres were measured. Results: A total of 1700 volunteers from 14 centers throughout Turkey were included in the study. Mean age was 48.03 ± 20.86 years (56.9% female). Prevalance of PS was detected in 68.9%. In the PS group, age, body mass index (BMI), waist circumference, systolic blood pressure, fasting blood glucose (FBG), lipid levels, insulin resistance, diabetes mellitus, hypertension, MS frequency, and pancreatic SWE score were increasing, and fecal elastase level was decreasing in correlation with the degree of PS. The frequency of HS was 55.5%. Hepatosteatosis [odds ratio (OR): 9.472], increased age (OR: 1.02), and BMI (OR: 1.089) were independent risk factors for the occurrence of PS. Lean-PS rate was 11.8%. The lean-PS group was predominantly female and younger than non-lean PS. Also it has lower blood pressure, FBG, liver enzymes, lipid levels, and HS rates. Conclusion: The frequency of PS was found 68.9% in Turkey. Its relationship was determined with age, BMI, HS, MS (and its components), pancreatic stiffness, and fecal elastase level