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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 . 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.

Background Refugees face circumstances where their health and well-being are compromised. In this qualitative study, the aim was to understand Syrian refugee women’s needs for care and the predisposing and enabling factors to healthcare access and utilisation. Methods Out of 945 Syrian mothers who gave birth in our university hospital between 2014 and 2018, 195 were reached; out of which, 47 women were included. Semi-structured in-depth interviews were conducted and were later analysed using a qualitative content analysis approach. Depression was assessed by the Patient Health Questionnaire-9 at the end of the interview. Results Social isolation and maternal depression, language barrier and challenges while navigating the healthcare system emerged as the main themes of the study. Low educational and occupational status of the women, poor social resources, limited Turkish proficiency and unfamiliarity with the host healthcare system were identified as the predisposing factors for poor healthcare services utilisation. Conclusion Recommendations include bridging language gaps, improving the navigation of the healthcare system by visual support or in-person interpretation, and psychosocial support. Providing hospital-based language courses to mothers and social integration programs for families will improve the mothers’ well-being and indirectly care of the child.

Introduction Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders characterized by deficits in social behaviors and nonverbal interactions. The disorder is believed to be multifactorial regarding etiopathology. This study aimed to investigate the possible risk factors associated with the development of autism in the prenatal and postnatal periods. Methods We conducted an unmatched case-control study composed of 56 autistic cases and 85 control children in North Cyprus. Cases recruited were previously diagnosed by a pediatric psychiatrist as being on the autistic spectrum. Parental questionnaires were distributed, and the collected data were analysed using Statistical Package for the Social Sciences (SPSS) version 24 (IBM Corp, Armonk, NY). Binary logistic regression was used to compute the adjusted odds ratios (aOR), adjusted for possible confounders. Results Our results showed increased odds of developing ASD in mothers with mental disorders such as depression and anxiety (aOR 6.99; 95% CI 1.94 - 25.24), mothers with medical conditions such as Hashimoto’s thyroiditis (aOR 2.68; 95% CI 1.06 - 6.78), mothers using aluminum-containing anti-acids (aOR 2.34; 95% CI 1.012 - 5.39), mothers exposed to loud noises during pregnancy (aOR 2.66; 95% CI 1.005 - 7.034), mothers with ≥ two previous miscarriages (aOR 4.19; 95% CI 1.17 -14.97), neonates with birth weight <2500 grams (aOR 4.19; 95% CI 1.16 - 14.84), male gender neonates (aOR 3.26; 95% CI 1.31 - 8.90), and neonates exposed to MRI or CT scan during the first year of life (aOR 6.94; 95% CI 1.15 - 42.07). Decreased odds of ASD development were observed in mothers using multivitamins during pregnancy (aOR 0.35; 95% CI 0.13 - 0.97), mothers consuming slight amounts of baking powder during pregnancy (aOR 0.235; 95% CI 0.09 - 0.60), mothers with threatened abortion (aOR 0.35; 95% CI 0.12 - 0.98), and neonates taking iron supplementation during the first six months of life (aOR 0.38; 95% 0.16 - 0.91). Conclusion There were various maternal and neonatal factors associated with ASD development in North Cyprus. Although there is some evidence to suggest that exposure to specific factors during prenatal or postnatal periods may increase the risk of ASD, there is insufficient evidence that implicates a specific factor for autism etiology. Future studies are recommended to be performed on larger scales to support further the factors associated with ASD development.

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Objective: Child abuse is defined as any deliberate or unintentional behavior by an adult that negatively affects the health and physical development of the child. Although the clinical presentation varies from case to case, non-accidental injuries that cannot be explained or are incompatible with the developmental stage of the child draw attention to the definitions of physical abuse. Material and Methods: An accurate and appropriate history is important in the diagnosis of child abuse. Especially, careful and detailed interviews should be performed with individuals who are obliged to look after the child. Complete physical examination should be performed. Results: This article was aimed to discuss the clinical approach, examinations to be performed and solutions in children with suspected physical abuse in clinical practice. Conclusion: Child abuse causes psychological, behavioral, and social effects on children. It leads to negative effects at the highest level especially if it occurs in the 1 st years. Significant responsibility falls on pediatricians on this subject.

Hasta ve aile merkezli bakım hizmeti hem hastaların hem de bakım veren ebeveynlerin sağlık ekibinin önemli bir parçası olarak kabul edilmesini içerir. Bu çalışmanın amacı, hastanemizde yatan çocukların ebeveynlerinin hasta ve aile merkezli bakım hizmetleriyle ilişkili deneyimlerini değerlendirmek, olumlu kısımları saptamak ve geliştirilme ihtiyacı olan alanları belirlemektir. Gereç ve Yöntemler: En az üç gün hastanede yatışı olan çocukların ebeveynleri çalışmaya dahil edilmiştir. Annelerin çocuklarının öncelikli bakım verenleri olması nedeniyle 27 çocuğun anneleri ile yüz yüze görüşme metodu kullanılarak veriler elde edilmiştir. İmmunsupresif kullanan çocuklar çalışma dışında bırakılmıştır. Görüşmeler oratalama 20-30 dakika sürmüştür. Görüşme çıktıları analiz edilip, tema rehberi belirlenmiştir. Bulgular: Anneler tarafında yatışları süresince olumlu ve olumsuz deneyimler bildirilmiştir. Ana bulgulardan biri; ülkemizdeki ebeveynlerin karar verme sürecinde aktif rol almayı tercih etmemesidir. Bununla birlikte ebeveynler mevcut hastalık, tanı, tedavi prosedürleri ve olası komplikasyonlarla ilgili bilgilendirilmek istedikleri belirtilmiştir. Sonuç: Daha iyi sağlık sonuçları elde edebilmek adına hasta ve aile merkezli bakım hizmetlerinin etkin bir şekilde uygulanması çok önemlidir. Sağlık çalışanlarına iletişim becerileri konusunda eğitim vermek ve hastane ortamını iyileştirmeye yönelik girişimlerde bulunulması önerilmektedir.

Objective: Trans-fatty acids (TFAs) pose several risks to human health. World Health Organization recommends the elimination of trans-fat consumption through limiting their use as less than 2g/100g fat. In line with this recommendation, Turkey recently passed a new regulation securing the content of TFAs as less than 2g/100g fat in industrially produced foods. The objective of this study was to determine the proportion of high TFA (>2 g/100g fat) in pastries among socioeconomically disadvantaged communities of Istanbul before the regulation was put into force. Materials and Methods: Eight socioeconomically disadvantaged districts were chosen from Istanbul and from each district three neighborhoods with the lowest land values were identified. Pastry samples were collected from 72 shops. TFA content was analyzed at Scientific and Technological Research Council of Turkey (TUBITAK) Marmara Research Center by the ISO 12966-2:2011 method. p<0.05 was set as the level of statistical significance. Results: The median (25th-75th percentile) value of TFAs was 0.19g/100g (0.04g/100g -0.30g/100g). None of the samples exceeded the level of 2g/100g. There was no difference in TFA content between the districts (p>0.05). Conclusion: Our findings indicate that Turkey could easily comply with the legislative limit of 2%. Still, the compliance should continuously be evaluated in diverse populations of the country.