Makale Arama

 Celiac disease is the only life-long continuing food intolerance. This intolerance, caused by gluten, endamages the structure of small intestine and prevents the absorption of nutritional elements. Celiac disease is usually related with other auto-immune diseases. Rate of this disease in our country is increasing in time. It can be seen in people of different ages and different clinical findings. In our day, the most efficient way of treatment is removal of gluten from daily diet. Gluten-free diet that step in treatment phase, affects the living of individual in a period in which growth and development is most rapid. By applying the gluten-free diet strictly, the risk of complications like low bone mineral density and intestine malignite related with the disease, can be decreased. However, it is not always easy to apply and keep track of gluten-free diet by family or child. Moreover, gluten-free diet can cause excess of some nutritional elements (saturated fat), gaining high calorie, and poorness of some nutritional elements (fiber, folic acid, vitamin B ₁₂, iron, zinc, magnesium). Particularly, gluten-free products, when compared with their gluten-including equivalents, have less magnesium, fiber, and folic acid, as well as they are far more expensive. It is determined that a lot of patient considered "resistant" to diet treatment are also eating gluten-including food. Therefore, gluten-free diet should be planned and followed well, and family and child should be educated. This editted article is about, celiac disease, diet treatment for celiac disease, principles of the diet treatment, concordance to the diet, and the factors that effects this concordance.

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Breast reconstruction is an essential part of the breast cancer threapy. The transverse rectus abdominis musculocutaneous (TRAM) flap has been widely used for reconstruction of the breast. Partial loss of the flap is still a major problem. The defficiency of flap perfusion may cause partial necrosis of the flap. Periferic vasodilatation may increases flap viability. The aim of this study is evaluation of affect of nebivolol on rat TRAM flap perfusion. Nebivolol is a selective β1 adrenergic receptor antagonist that causes a direct vasodilator effect attributed to the action on vascular nitric oxide (NO). In this study 30 male spraque–dawley rats were used. A pedicled TRAM flap based upon the the right inferior epigastric artery was elevated and reapproximated. Animals were randomly assigned to 5 treatment groups (n:6). Group 1 received no nebivolol. Groups 2 through 5 were administered 100 mg/kg nebivolol orally 24 hours preoperatif; in addition groups 2 to 4 received orally postoperatif for 7 days. Group 3 also received intraoperatively; groups 4 and 5 were given nebivolol orally for 7 days before the 24 hours preoperatif treatment. Seven days after surgery skin paddles were photographed and assessed for viability. In seventh day blood lactate levels were measured. Statically significant differences were found in all experimental groups relative to the controls. Group 4 displayed the greatest improvement in flap viability, significantly better than other nebivolol groups. This study indicates that nebivolol may provide a useful pharmacologic tool for reducing iscemia-reletad necrosis in TRAM flaps.

Aim: To assess the optimum efficacy and neurological side effect(s) of antihyperlipidemic drug regimens in dyslipidemic adult patients. Material and Method: Fotry-two male, eighty-seven female; totally 129 dyslipidemic patients, 37 to 77 years of age who admitted to neurology and cardiology out-patient clinics were eligible for our study. All of the patients were recommended to reach an ideal body weight and to maintain a standard low-lipid diet. Patients were divided into 5 subgroups and were assigned to receive commonly used antihyperlipidemic agents; low-dose atorvastatin (10 mg), pravastatin (10 mg), simvastatin (10 mg), fenofibrate (200 mg) and a combination of fenofibrate and atorvastatin regimen. Neurological examination was evaluated besides fasting plasma lipid profile and muscle enzyme levels at 0, 3, 6 and 12-month intervals. Electroneuromyography (ENMG) was performed in patients having neurological complaint(s), finding(s) and/or elevated muscle enzyme levels after drug administration. Results: According to ATP III criteria, in the second 6-month period, fenofibrate effectively improved the triglyceride profile in patients with high and borderline plasma lipid levels versus pravastatin therapy. In the first 3-month period, atorvastatin significanty improved LDL-C levels versus fenofibrate. In the first 6-month period, pravastatin caused a marked elevation of creatinine kinase levels versus atorvastatin. Among all the drugs, no other differences were observed either on lipid or on side effect profiles. No pathological findings were observed in patients who underwent ENMG. Conclusion: For the first year, low-dose antihyperlidemic agents have mostly similar efficacy profiles. Encountered side effects are; myalgia and elevated serum creatinine phosphokinase (CPK) levels at a range of 4-68 %. CPK elevations did not exceed to 3 to 10 times as reported in the literature with any of the drugs. In spite of myopathic changes in ENMG, myalgia was commonly reported. In conclusion we suggest that, patients at hig-risk, represent a suitable group for prolonged statin treatment with regular clinical follow-up.

Objective: Feeding gastrostomy is generally needed in the cases of oropharnyngeal dysphagia. The objective of this study is to analyze the use of surgical gastrostomy with mini laparatomy under local anaesthesia in situations where endoscopic procedure is not possible.

Methods: Stamm gastrostomy was performed in 62 patients in whom oral and nasogastric tube feeding could not be given and percutaneous endoscopic gastrostomy could not be performed.

Results: A mean age of 63.7 years and 83.9% of them were ASA IV. The indications for gastrostomy were tumour obstruction, neuromuscular diseases, paralysis and cerebrovascular bleeding, oesophageal injury, metastatic tumours and hypoxic encephalopathy in 51.6, 17.7, and 16.6, 1.6 and 12.9% respectively. The mean operation duration was 34 ± 12.8 minutes. Procedure-dependent hospital morbidity and mortality were low (% 16.2- % 14.5, respectively).

Conclusion: Stamm gastrostomy with mini laparatomy under local anaesthesia is an effective alternative in situations where percutaneous or endoscopic procedures cannot be done. It can be performed in high-risk patients safely due to its short operation time, low morbidity and mortality.

35 rats were divided in 3 groups and resection of 80% the small bowel was performed. First group received 1 mglkgid of famotidine and second group 0.5 mglkgld omeprazole in water and third group re-ceived only tap water. Oral feeding with standart rat food initiated on first postoperative day. The weight and stool consistency were examined everyday. On 15th postoperative day alt rats were sacnfied and liv-er, stomach and ileum biopsies and blood samples for biochemical investigation were obtained. The weight and length of villi, depth of Lieberkühn crypts and the number of villi in 0.43 square mm were compared. Despite the ellect of reducing intestinal pH by blockading gastric acide secretion of famotidine and omeprazole, intestinal adaptation was not influenced in this way or direct ellect to the villi. We esta-blished that adaptation occured not by hypertrophy bul hyperplasia and provided by oral intake in early postoperative period.

This study aimed to research dietary quality in adults and to compare using different parameters (body mass index, education statues, gender and age). The cross-sectional study was conducted on randomly selected 421 adults (275 females, 146 males) living in Ankara. Dietary intakes of individuals aging between 20 and 50 years (mean±SD, 32.7±9.096 years) were collected by using 24-hour recall method. Mean adequacy ratio scores calculated by using nutrient adequacy ratio were used for dietary quality assessment. According to mean adequacy ratio scores, 56% of individuals’ dietary nutrient content found to be inadequate. In the study, there was no significant difference in mean adequacy ratio scores according to education, age, body weight; whereas, male mean adequacy ratio scores were higher than female. There is a need for improving diets according to mean adequacy ratio scores assessment in Turkey. Dietary quality can be affected by different variables such as gender, body mass index, age and education statues. Improving dietary quality should be aimed using plan and policies, developed taking into consideration these variables by governments.

Aim: The aim of this review is to evaluate recent literature regarding effects of nutrition on fetal development. Main findings: Previous studies show that maternal factors such as age, nutrition, and stress are able to have negative effects on fetal development during pregnancy. The role of maternal nutrition on human pregnancy is still unclear but undoubtedly crucial. The dietary recommendations for pregnant women before and during pregnancy are similar to those for other adults, with a few exceptions. The main recommendation is to keep a healthy and balanced diet; however, there are some specific recommendations related to daily supplementation of minerals and vitamins during pregnancy to reduce the risk of birth defects. Maternal nutritional status during the period of conception is an important determinant of fetal growth and development. The relationship between maternal nutrition and low birth weight, intrauterine growth retardation, and spontaneous abortus are reported in the literature. Furthermore, maternal nutritional factors associated with different kinds of birth defects such as neural tube defects, oral cleft, cardiovascular, central neural, respiratory, and urinary system defects. Result: Therefore, further researchs are need for the effects of maternal nutrition on fetal growth

The knowledge and attitudes of physicians are important in continuity of the correct applications in breastfeeding and “Baby Friendly Hospital” criteria in the society. Medical education process is a chance to educate future physicians about these issues and should be monitored. The aim of this study is to determine the knowledge level of the medical school students about “breastfeeding” and “Baby Friendly Hospital” criteria and applications in different academic years. In this cross sectional study a anonymous questionnaire was applied to medical students who are in first, third and sixth academic years of education in Necmettin Erbakan University Meram Medical School. After ethical approval 26 item questionnaire consisting socio demographic features and items about breasfeeding and baby freinedly hospital declared by WHO and UNICEF, voluntarily. The data was analyzed via statistics package program. Numbers, percentages, chi-square were used and p value <0.05 accepted as significant. Two hundred and ninety five students who were in 1st (34%), 3rd (35%) and 6th (31%) academic year participated to this study. The percentage of students who could count at least 3 benefits of breastfeeding other than feeding were 8%, 25% and 51% in respect to academic years (p<0.001). The knowledge about the existence of breastfeeding policy in their hospital and “infant friendly city” status of the city they are living in were higher in 6th year students (p<0.001). Knowledge level of correct breast feeding method (p<0.05), knowledge about at least 3 contraindications of breast feeding (p<0.001), and knowledge about the milking methods (by pump and machine) were also significantly higher in 6th year students (p<0.001). In this study it can be observed that the knowledge of students about breastfeeding and infant friendly hospital issues increase by advancing years. The target should be increasing innovations in the education program in order to raise awareness of doctors about this subject during their entire careers. In current situation supporting the theoretical education by practice may contribute to the reflection of breastfeedimg and infant friendly studies to the professional skill.

\r\n 1p36 Deletion Syndrome is a rare disease characterized by a partial deletion in the short arm of chromosome 1. The first reports of cases with microdeletion of chromosome 1p36 were published in 1980s, beginning with a report by Hain et al. The first pure case of 1p36 Deletion Syndrome was identified in the 1987 by Magenis et al. Its incidence is presumed as 1:5000 to 1:10000 and prevalence among men/women is 1/2. Characteristic signs are dysmorphic facial features, developmental delay, feeding difficulties, central nervous system anomalies, seizures, microcephaly, intellectual disability, vision problems, sensorineural deafness, congenital heart defects, skeletal and renal anomalies. Congenital Cytomegalovirus infection is an intrauterine disease with persistent effects on the fetus with no specific treatment. Common clinical findings are petechiae, jaundice at birth, hepatosplenomegaly, microcephaly, hypotonia, poor suck, sensorineural hearing loss, vision abnormalities, seizures, developmental cerebral anomalies, intrauterine development delay, prematurity and stillbirth. This case has been reported due to being a unique case having both such a rare disease like 1p36 Deletion Syndrome and a corresponding clinical picture to congenital Cytomegalovirus infection which she has firstly been determined with a positive CMV-DNA level when she was 7 months old.

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Percutaneous endoscopic gastrostomy (PEG) is a minimal invasive method of enteral nutrition for the patients that the oral intake is not possible. The aim of this study is to determine the results of our PEG insertion procedure performed. We analysed the medical records of 112 patients who had an initial PEG insertion retrospectively in January 2011 and December 2012 at Selçuk University Faculty of Medicine. We inserted 20 F Abboth Flexiflo endoscopic gastrostomy tubes by the “Pull Tecnique” in all cases. No general anesthesia was needed. The records were reviewed with regard to age, gender, indications, interventional complications, the port-site leakage, periportal infection and mortality were examined. PEG was performed to 112 patients comprising 37 females (33%) and 75 (67%) males, ages ranged from 28 to 77 years with a mean age of 53±16,57 years. All patients had neurological defects that impair feeding. Average time of feeding through PEG 180±74,84 (min 10- max 295) days. After PEG, subcutaneous infection was occured at 4 (3.5%) patients, gastrointesinal intolerance was occured at 5 (4.4%) patients, leakage from gastrostomy site was occured at 6 (5.3%) patients. PEG is a simple,safe and effective feeding method for enteral nutritional deficiency in patients.

The effects of both anesthesia and surgical intervention on the defense system have gained importance for patients and anesthetists today. Most of the immune changes seen in patients after surgery are caused either by the direct effect of anesthetic agents or as a result of these drugs contributing to surgical trauma and endocrine response. While the effect of surgery varies according to the size of the operation and the individual's stress response; The effect of anesthesia may vary depending on the breakdown level of the stress response, the immune status of the individual, the time of exposure to the anesthetic agent, the chemical structure of the preparation used and the anesthesia method (1,2,3). Although it has been suggested in many studies that surgical stress may be responsible for immunodepression seen in the postoperative period, some in vitro studies have also observed that anesthetic agents have an effect. The main difficulty in in vivo studies is to distinguish the effects specific to the anesthetic agent and the effects of many intraoperative factors (type-duration of surgery, body temperature, blood and plasma infusions, other diseases, basal immunological status, nutrition) (4,5).

The effects of starvation and refeeding on intestinal mucosa nere studied in ileum of rat intestine. Forty-two adult male rats nere used in this study. Animals nere divided into three groups. First groups of twenty-one rats nere starved for 1, 2, 3, 5, 9, 11 and 14 days. Second group of fifteen rats nere refed after a period of starvation and then decapitated after 1, 2, 3, 5 and 12 days. Third groups of three rats nere used as control animals. Starved rats nere alloned to drink nater ad libitum. Control animals had free access to nater and to chon pellets until the time of killing. Animals nere neighed daily during the fasting period. Animals nere killed under ether anesthesia. Ileal sections nere stained. Ileal villi size nere measured by ocular micrometre. After 3-day fasting, villi heigth nas observed to be gradually decreased nith days of fasting. Body neigth and after 3-day-fasting villi heigth gradually decreased nith days of fasting. Lymphatics nere dilated (5, 9, 11 and 14 day fasting), blood vessels nere fulled up nith erytrocyte at the long term fasting (9, 11 and 14- day fasting). Paneth cells and their granules nere gradually increased nith days of fasting. Ileal villus nere determined to height increased after refeeding. Paneth cells and their dense granules nere persistent.

The effect of total parenteral nutrition (TPN) with fat and fat-free solutions in eight patients who had protein-energy malnutrition was investigated. All patients gained weight except one in fat-free group with recurrent bowel obstruction due ta bezoar. Some unirnportant changes in liver functions was observed in fat group. Liver functions returned to normal values, in a short time after TPN.

This study was undertaken ta determine the safety af prognostic inflammatory and nutritional index (PINI) as an indicator of metabolic response to surgical stress, and whether there is a relationship between PINI and post-operative morbidity in children. Thirty-two patients who were performed appendectomy were enrolled in the study. Of the pafients 17 had acute appendicitis (Group 1) and 15 had gangrenous or perforated appendicitis (Group 2). Serum albumin (AL), prealbumin (PA), c-reactive protein (CRP) ve alpha-1 acid glicoprotein (AGP) values were measured pre-operatively (-1), on postoperative day 1 (+1), and postoperative day 3 (+3) in all patients. Mean PIN1-1, PINI+1, and PIN1+3 values were calculated by using these parameters. In grup 1, mean PINI-1, PINI+1, and PIN1+3 values were fonud 5.6±3.9, 15.6±7.8, and 5.8±3.6, respectively (p< 0.0001). In group 2, the same values were 25.2±16.4, 47.2±-28.1, and 43.9±24.2, respectively. The difference between PIN1-1 and PINI+1 was found statistically significant (p<0.0001) while there was no significant difference between PIN1+1 and PIN1+3 (p>0.02) in group 2. Mean PINI values were fonud higher in group 2 compared with group 1, and the difference between two groups was statistically significant (p<0.001). These results suggest that PINI is a cafe and valuable index for determination of metabolic response to sur-gical stress in children, and postoperative follow-up of surgical patients.

Aim: İn this study, it was aimed to determine the effect of vvorking status of mothers on breastfeeding and using additive food for feeding. Methods: The study vvas consisted of 458 mothers (302 housevvives and 156 vvorking women) having at least 12 months old children. The population samples chosen by using a formula vvere select- ed in tvvo steps. İn the first step, the cluster sampling systematically based on population localities. İn the second step, the mothers of children living in day-center vvere taken into the survey population. Data vvere obtained via çuestonnaire techniçue by intervvieving. Results: The ratio of mothers vvho continued educating after primary school vvas 25% of housevvives and 96% of vvorking mothers. The median of breastfeeding period in housevvives vvas 12 months, but in vvorking mothers it vvas 8 months. This difference vvas significant. The ratio of initiation time of using additive food for feeding before the first four month in vvorking mothers vvas tvvo-fold than that in the house- vvifes. One third of mothers started to feed their babies with commercial supplement foods. The ratio of housevvife mother, starting vvith fluid of home made meal, vvas higher than in vvorking mothers. Conclusion: VVorking moth­ ers could be supported for breastfeeding their babies for longer period. İn addition, increasing education levels of female population and education on infant feeding may encourage to positive attitudes for giving the supplement­ ed food and breastfeeding in population.

To determine the distribution and association with demographic variables of breast complaints of women in Early Diagnosis-Scanning and Education Centers (KETEM). Electronically kept data in Konya KETEM was analyzed by omitting personal information via SPSS package software in 2011. Dependent and independent variables were demographic features and breast complaints. Descriptive statistics were used, and logistic regression analysis was performed step by step to define the correlations. Mean age of women applying to KETEM between 2007 and 2010 was 44±12 years, and 92% were of social security. Median age of first menstrual cycle was 13 years, median number of living births was 3, and median total duration of breastfeeding was 36 m. The rates of OKS use, smokers, obesity and vegetative life style were 9%, 7%, 33% and 2%, respectively. The rates of mammography and self-checked breast examination were 32% and 18%, respectively. 44% had any kind of breast complaints, and 8% had a history of experienced breast disease. While the existence of complaints was associated with age, height, number of living births, total breastfeeding duration and type of nutrition, experienced breast disease was related to height and smoking (at least, p

Title : A case of cytomegalovirus infection mimicking total parenteral nutrition associated cholestasis.\r\n\r\nCongenital cytomegalovirus (CMV) infection is the most common infection that passes trough transplacentally in the early infancy period and is the most common infectious cause of the nonhereditary sensorineural hearing loss. We know that most of these cases were asymptomatic in the neonatal period. Especially among the extremely low birth weight infants, CMV prevalence is not known. We present a 29 weeks old 460 gr extremely low birth weight (ELBW) infant with congenital CMV infection mimicking total parenteral nutrition (TPN) associated cholestasis. Usually, when we see the cholestasis in the extremely low birth weight infant feeding with long time TPN, we think that it is associated with TPN. Direct hyperbilirubinemia and cholestasis are the common situations in the newborn period. Especially this is considered to be associated with sepsis, TPN, galactosemia, inborn errors of metabolism and other causes. CMV- associated cholestasis should be kept in mind, especially in cases of premature infants with cholestasis and extremely low birth weight infants have been fed for a long time TPN.

Esophageal achalasia in childhood especially in whom below one year of age is a rare lesion and difficult to diag- nose. An 11 months age female infant has been treated successfully by pneumatic dilatation, after returning of the esophagus to it’s normal calibre there was no complications seen in the barium study that performed later. After a follow up period of 12 months there was no vomiting or feeding problems or recurrence of the achalasia.

Aim: Respiratory muscle weakness is the inevitable consequence of many neuromuscular disorders. Deterioration in respiratory function contributes to significant morbidity and is responsible for high mortality rates with these diseases. The aim of this review to summarize diagnostic and therapeutic approaches for respiratory problems in patients with neuromuscular disorders. Main Findings: Usually, chronic respiratory failure develops slowly over a period of several years. Initially, it presents with disordered breathing that is apparent only during sleep, followed by continuous progression to severe hypoventilation, cor pulmonale and eventually frank respiratory failure in end-stage disease. Early detection of respiratory compromise and preventive care are likely to improve outcome and quality of life for many patients. This has led to the development of proactive monitoring and treatment programmes that include regular assessment of pulmonary functions, respiratory strength and sleep studies, home mechanical ventilation, chest physiotherapy, early antibiotic treatment and nutritional intervention. In particular, noninvasive positive pressure ventilation is effective in resolving respiratory failure and has dramatically changed the management of these patients. Conclusion: Pulmonary functions and sleep related respiratory problems should be followed up regularly in patients with neuromuscular disorders. Noninvasive mechanical ventilation is the most important therapeutic option for the management of respiratory failure in these patients group.

It is known that different factors, not a single one, play a role in the formation of cancer, which is accepted to develop as a result of a "mutation" in a normal cell. These factors also differ for the tissue or organ in which the cancer develops. Determining the factors that affect the etiology of a cancer requires complex approaches and studies. However, in general, it is possible to group cancer-related factors as those that increase the risk of cancer, those that reduce the risk of cancer, and those that cause cancer. Diet constitutes a "community of factors" associated with all three groups. This review has been prepared to investigate the effect of diet on various organ cancers and to reveal the measures that can be taken in the light of the information obtained.

This study was aimed to compare the knowledge levels of health education teachers with others in basic health subjects. This crosssectional study was performed in all high schools in Konya city center in 2011. The sample consisted of teachers who taught health education or counseled in health related clubs and same number of teachers of other lessons. Data were obtained by a questionnaire filled by teachers themselves under the supervision of interviewer. First part of the questionnaire was about demographic information while the second consisted of 35 questions evaluating the knowledge about protection, improvement, vaccines, contagion, diet, healthy behavior, adolescent health, first approach to frequently encountered health problems, etc. Overall level of health knowledge was assessed by summing the points for each subject, 2 for known, 1 for partially known and 0 for unknown/blank, and converting them to percentage. T test and variation analysis were used for data analysis. The mean age of 314 teachers participated in the study was 39±8, 55% of them were males, 45% were females and 90% were married. 39% of the participants consisted of health education teachers and guide teachers of health related clubs, 61% were the teachers of other lessons. The average score was higher in health education group (56±16) than the other teachers (43±14). The knowledge score was also higher in female teachers and graduates of health related faculties (biology, physical education, child development). Teaching health education or counseling in a health related club increases the general knowledge level of teachers. In writers’ opinion, improving the knowledge level of teachers in health might help students to acquire positive behaviors about health as the current level is not adequate and significant number of wrong answers was present.

Bilirübin encephalopathy or kernicterus is a neurologic syndrome resulting from the deposition of uncongugated bilirübin in brain celis. Features of kernicterus may include cerebral palsy and deafness. The purpose of this research was to investigate the effects of kernicterus on grovvth and grovvth hormone. Our research included 22 patients with kernicterus, 18 patients vvho had exchange transfusions but having no features of kernicterus, 14 patients who had only phototherapy, and 15 patients vvho had no jaundice during neonatal period vvho vvere inves- tigated at 21 months old (mean age). Ali patients had complete blood count, urine analysis, glucose, and grovvth hormone. We observed overt neurologic abnormalities in 6 patients vvith kernicterus. There vvas grovvth retardation in 5 of 6 infants vvith neurologic abnormalities. There vvas no grovvth retardation in other patients. Our research has indi- cated that there may be grovvth retardation in patients vvith kernicterus and the reason for this may be nutritional disorders. More investigations must be done in order to understand the abnormalities in grovvth hormone in patients vvith kernicterus.

\r\n A decrease in retinal nerve fiber layer thickness can be secondary to glaucoma, several neurologic diseases, optic nerve diseases other than glaucoma, retinal diseases, toxic, nutritional or vascular causes such as shock optic neuropathy. Glaucoma, which is among the commonest causes of blindness worldwide, is a progressive optic neuropathy characterized by a decrease in retinal nerve fiber layer thickness secondary to retinal ganglion cell death, cupping of optic nerve head and visual field loss. Although the best known risk factor associated with glaucoma is high intraocular pressure, it is thought that systemic vascular disorders, which are among the risk factors of glaucoma, play role especially in the pathogenesis of normotensive glaucoma where intraocular pressure is low. In our study, we described a patient with decreased retinal nerve fiber layer thickness and thought normotensive glaucoma as the most probable diagnosis, who also had multiple systemic vascular diseases. 

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Pregnancy habits of motIzers and their relation to child ınortality have been studied between March and May of 1991. Mothers between 15-24 years of age, consanquinity, the intervals less than 2 years betwe-en pregnancies, pregnancy less than 38 weeks, igno-rance of tetanus immunization, meals largely related cereal nutrition and lackiness of nutritive balance, weight gain less than 9 kg, lack of prenatal health care, multiple pregnancy increased infant and child monality rate and this increase was statistically me-aningffil (p<0.05). Unspecified illnesses during pregnancy and vomiting, increase in food intake pa-rallel pregnx2ncy, and undesirable pregnancy diri not affect infant and child monality significantly.

Background: The aim of this study was to develop a fructose- and iron-mediated model of steatohepatitis, which is similar to the human phenotype.

Methods: We randomly divided ninety 1.5 months old female Wistar-Albino rats into three groups. All three groups contained 30 rats in each group and 5 subgroups per group. While the control group was fed ad libitum, the fructose group’s feed consisted of 60% fructose in drinking water and that of the fructose-iron group consisted of 60% fructose in drinking water along with intraperitoneal administration of iron every 2 weeks. We performed laparotomies at 2-week intervals (at 2, 4, 6, 8, and 10 weeks) in all subgroups.

Results: None of the groups had hepatosteatosis or fibrosis at the end of the 10th week. Hepatocellular ballooning scores were significantly higher in the fructose-fed groups than in the control group (p<0.001). At 10th week serum ferritin levels in the fructose-iron group were significantly higher than those in the control and fructose groups (p<0.001). Iron accumulation in the rat liver was observed in the fructose-iron group histopathologically by the 4th week.

Conclusion: Chemically and histopathologically, a model of steatohepatitis can not be developed in young and female rats with 60% concentrated fructose feeding and administration of iron for 10 weeks. To develop a model of steatohepatitis resembling the human phenotype, it is more advisable and feasible to use adult male rats fed meals combined with fructose in order to maintain adequate hydration and nutrition for at least 16 weeks.

 Today an increasing prevalence of obesity, which is one of major health problems is associated with many chronic diseases such as diabetes, cardiovascular disease, stroke, cancer, asthma obstructive sleep apnea syndrome. Therefore, treatment of obesity contribute to  prevention of many chronic diseases risk. Recent years, it has started to consider on effects on the gastrointestinal system in treatment of obesity as well as adequate and balanced diet, increasing  physical activity and lifestyle changes. Especially it was seen that gut microbiota has been associated with obesity. Many studies showed that gut microbiota may be vary with eating habits and obesity. It is discussed changed microbiota might be associated with obesity and many obesity-related diseases. It is thought that long term-controlled studies in this area   will create a new approach to the treatment of obesity and come into prominence in the fight against obesity. In this review,it was aimed to evaluate the relationship between body weight and the gut microbiota.
\r\n amaçlanmıştır.

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Aim: The aim of this study was to determine pressure ulcer prevention knowledge and attitudes among nurses who cared for surgical patients that were exposed to pressure ulcer risk factors such as immobilization and nutritional problems.

Materials and Method: This descriptive study was carried out with 150 nurses who were working in the surgical clinics and surgical intensive care units of a medical faculty hospital in XXXX and who had at least one year’s professional experience. Necessary permissions were obtained from the ethics committee and the institution prior to the research. Data were collected with a patient information form, the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI) and the Attitude towards Pressure ulcer Prevention instrument (APuP) between October 1, 2018 and February 1, 2019.  Data were analyzed with the independent-samples t-test, the Mann-Whitney U test, the Kruskal-Wallis test, the correlation analysis and the multiple regression analysis.

Results: The mean age of the nurses was 29.91±6.48 years, 65.3% were female and half of them had undergraduate degrees. According to the PUPKAI total mean score (<60%), the pressure ulcer prevention knowledge of the nurses was inadequate and only 24% had a knowledge score ≥60%. Regression analysis results showed that, nurses' professional experience duration, working style, number of patients per shift and the experiences of giving care to patients with pressure ulcers were found to have a significant effect on the PUPKAI total mean score (p<0.05). According to the APuP total mean score (≥75%), the nurses had positive attitudes towards pressure ulcer prevention. It was also determined that the descriptive characteristics of the nurses did not significantly affect the APuP total mean score (p>0.05). There was no significant relationship between the total mean scores of the PUPKAI and APuP (p>0.05).

Conclusion: This study revealed that the surgical nurses had positive attitudes towards pressure ulcer prevention but they had inadequate knowledge about it. These findings highlight the need for institutional arrangements to ensure that nurses have access to evidence-based knowledge about pressure ulcer prevention.

Le mangue de Vitamin B12 se produisent surtout dans mes cas suivants; Mangue de nourriture, action de manger de folat rnsuffisamment, du N.70tarien et celui des autres alimentations, le d«ant de l'estomac caus6par le bouillonnement des legumes aux feuilles vertes et celui de l'absorption d6rivant de l'intestin grle, le mangue du facteur intrinsque l'&troitement de la surface de l'absorption, les dUauts mfrtaboliques. A la fin de tous ces cas, rtıgaloblastique se produit, commoneus en avons mentionne" les preuves cidessus.

It was been presented 6 massive intestinal resection cases due to acute mesenteric vasculary occlusion in 3 cases strangulated small bowel obstruction in one case, perforated Mediterranean lymphoma in one case and ascariasis in one case between 1983-1987 in Selçuk University Medicine Faculty Alt of them developed short bowel syndrome. Total parenteral nutrition (TPN) was applied up to adaptation for new condi-tion and prevention of and treat the early complications. Five cases were successful, one case died after two months postoperation. The highy early mortality and morbidity rate can be decreased by TPN in short bowel syndrome cases.

Sustainability is satisfying the needs of present generation by pro tecting presence and quality of resources that future generations will need. A sustainable nutrition system refers to a diet with low environmental impacts which contribute to food and nutrition security for healthy life for present and future generations. Nutrition systems has changed as a result of growing global population, developing the technology, urbanization and industrialization. This situation result in environmental problems as water resources and land uses and increasing greenhouse gases emissions in addition to several health problems notably increasing cronic diseases incidence. Environmental changes and nutrition systems are interrelated. A nutrition model which is containing animal based food enough and plant based can supply sustainability of health and environment.

Divorce is the legal end of the marriage union. The divorcee is the one who could not make a good marriage and maintain a bad marriage. It reveals that in societies where the family, which forms the basis of the society, continues its existence as an institution, sleep and nutritional disorders occur in people in the divorce process, which is defined negatively, increased drinking and smoking, decreased work efficiency, negative moods such as finding themselves incompetent, feeling lonely and anxiety increase.

The pre vtant rats were fed with diphenylamine derivatives (. tmilorid dihidrat + hid-roelorothiafid) clurin,,? the last week of gestation ins-pired by phanesetin and its major metabolic bre-akdown products are similar chemically diphenvlamine. The di (frrence., that reminded glomerulocystic kidney were -determined with histopathologie exa-mination in kidneys of offvpriti;,- However this dif-frrenees were not noted in olIcpi-inf;s or rats that led normally. We conclude that fetal kidney is susceptible to the interstitial intiantatory elkcts of phanacetin lie-rivairives and the resultmz tubular obstruction pro-duced the cystic changes.

ln order to determine whether healty obese people with habit of much eating are susceptile io D.M.; Serum insülin and cortisol levels of nonobese healthy subjects (52 .female, 44 male) and 29 healthy obese (19 fentale, 10 male) were investigated. Serum insulin and corti-sol levels are as follows: Non-obese women .52±2.43 pIUlml. and 17.61±5.40 1tgldl, non-obese men 11.22±3.73 AILliml and 16.37.38 obese women 19.988.25 plUlml and 18.43±6.32 ltgrlctl, obese inen; 22.75-1-6.82 p1(11m1 and 17.08-1-6.73 ,ugldl respectivelvly. lnsulin levels of obese healthy subjects were significantly (p<0.001) higher 'han those of non-obese healthy subjects. Also, there were and important correlation between body ma.s-s index and serum insulin levels (r=0.836, p<0.001). The direct relationship between obesity and hyperisulinism and incrcased levels of cortisol together with increased iitslifirt resistance in obese people suggest that these people are potentially diabetics.