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INTRODUCTION AND OBJECTIVES: Given the substantial burden of metabolic dysfunction-associated steatotic liver disease (MASLD), there is an urgent need to assess knowledge and awareness levels among physicians. We assessed MASLD knowledge among healthcare providers from Saudi Arabia, Egypt, and Türkiye. MATERIALS AND METHODS: Two global surveys containing 54-59 items assessed awareness and knowledge of MASLD/NAFLD- one survey for hepatologists and gastroenterologists, the second for non-specialists (e.g. endocrinologists, primary care providers (PCPs), other healthcare professionals). Data were collected using an electronic data collection form. Knowledge scores and variables associated with higher knowledge scores were compared across all specialties. RESULTS: A total of 584 physicians completed the survey (126 hepatologists, 178 gastroenterologists (GEs), 38 endocrinologists, 242 PCPs/others). Practice guidelines were the primary source for knowledge across all specialties (43-51%), then conferences (24-31%) except PCPs/others who selected internet as the second common source (25%). Adherence to societal guidelines varied by specialty (81-84% of specialists vs 38-51% of non-specialists). Hepatologists and GEs showed similar mean knowledge scores (51-72% correct answers across three knowledge domains, p>0.05); endocrinologists outperformed PCPs/others in knowledge scores in all knowledge domains including Epidemiology/Pathogenesis (72% vs. 60%), Diagnostics (73% vs. 67%), and Treatment (78% vs. 67%) (all p<0.01). Hospital-based practice and seeing a greater number of patients with MASLD/NAFLD were identified as independent predictors of higher knowledge scores among specialists (both p<0.05). CONCLUSIONS: A knowledge gap for identification, diagnosis, and management of MASLD/NAFLD was found despite the growing burden of MASLD/NAFLD in Saudi Arabia, Egypt, and Türkiye. Education to increase awareness is needed.

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Metabolic dysfunction-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD), has become the leading cause of chronic liver disease worldwide. Optimal dietary intervention strategies for MAFLD are not standardized. This study aimed to achieve consensus on prevention of MAFLD through dietary modification. A multidisciplinary panel of 55 international experts, including specialists in hepatology, gastroenterology, dietetics, endocrinology and other medical specialties from six continents collaborated in a Delphi-based consensus development process. The consensus statements covered aspects ranging from epidemiology to mechanisms, management, and dietary recommendations for MAFLD. The recommended dietary strategies emphasize adherence to a balanced diet with controlled energy intake and personalized nutritional interventions, such as calorie restriction, high-protein, or low-carbohydrate diets. Specific dietary advice encouraged increasing the consumption of whole grains, plant-based proteins, fish, seafood, low-fat or fat-free dairy products, liquid plant oils, and deeply colored fruits and vegetables. Concurrently, it advised reducing the intake of red and processed meats, saturated and trans fats, ultra-processed foods, added sugars, and alcohol. Additionally, maintaining the Mediterranean or DASH diet, minimizing sedentary behavior, and engaging in regular physical activity are recommended. These consensus statements lay the foundation for customized dietary guidelines and proposing avenues for further research on nutrition and MAFLD.

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PURPOSE: The aim of the study was to investigate the corneal and anterior segment characteristics in pseudoexfoliation syndrome (PXS), depending on the severity of the disease. MATERIALS AND METHODS: This cross-sectional study was conducted at a tertiary care hospital, in the ophthalmology department, in Turkey. Pseudoexfoliation syndrome group was classified into three groups. Pseudoexfoliative material on the part of the pupillary border was classified as group 1, on the entire pupillary border was classified as group 2, and pseudoexfoliative material on the entire pupillary border and iris surface was classified as group 3. The control group was composed of age and gender-matched individuals who had undergone a completely normal ophthalmologic examination. Scheimpflug tomography was performed to record tomographical data. RESULTS: The PXS groups 1, 2, and 3, along with the control group, consist of 29, 32, 33, and 42 participants, respectively. There was no significant difference in age-gender distribution between patients and the control group (P>0.05). Group 3 showed significant differences in central corneal thickness compared with the control group (P=0.001). In addition, anterior chamber angle was found to be significantly lower in group 3 than the control group (P<0.001). In corneal densitometry (CD) values, significant increases compared with the control group were observed in groups 2 and 3 across all anterior annuli (P<0.001). In group 1, significant increases observed in the anterior 6-10 mm and 10-12 mm annuli (P<0.001). In the middle 6-10 mm annuluses, only group 3 showed a significant increase compared with the control group (P<0.001). In the posterior 0-2, 2-6, and 6-10 mm annuli, significant increases compared with the control were observed only in groups 2 and 3 (P=0.001, P=0.001, P<0.001, respectively). CONCLUSIONS: Corneal densitometry values, even without an increase in intraocular pressure, have a tendency to increase in PXS depending on the severity of the disease. While minimal changes were observed in the middle layer, it was particularly noted that the effects of the disease were more prominent in the peripheral cornea.

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BACKGROUND: Premature ventricular contractions (PVCs) are common arrhythmias with diverse clinical implications. This retrospective study aimed to evaluate the efficacy of medical treatments using various clinical, imaging, and electrocardiographic parameters in patients with idiopathic PVCs. METHODS: A total of 1051 patients with idiopathic PVCs were retrospectively analyzed. Patients were categorized into three groups based on treatment response: beta-blocker (BB) responders (479 patients), calcium-channel blocker (CCB) responders (335 patients), and class 1c antiarrhythmic (AA) responders (237 patients). Clinical, imaging, and electrocardiographic data were collected and analyzed to assess the factors influencing treatment response. RESULTS: Age, left ventricular ejection fraction (LVEF), PVC QRS duration, CI variability, and multiple PVC morphologies were identified as significant factors affecting treatment response. Older age and lower LVEF were associated with better response to BB treatment, whereas CCB responders showed narrower QRS complexes. BB responders also exhibited higher CI variability, possibly linked to automaticity mechanisms. Moreover, the BB responder group had a higher frequency of multiple PVC morphologies. CONCLUSION: These findings emphasize the importance of tailored treatment approaches based on individual patient characteristics.

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PURPOSE: Planning intraoperative fluid therapy in patients undergoing major abdominal surgery is important. It was aimed to define the difference between fluid therapy protocols for renal function, bleeding and postoperative service follow-ups. MATERIALS AND METHODS: This is an observational case-controlled prospective study. Sixty patients aged 18-65 years who had undergone pancreatic surgery between December 2023- February 2023 were included in the study. Liberal (Group 1; n = 30) and targeted fluid therapies (Group 2; n = 30) were administered to the patients. Liberal fluid therapy was planned with 8-10 ml/kg/h crystalloid infusion. The targeted fluid therapy (TFT) group (Group 2; n = 30) began with a 2 ml/kg/h crystalloid infusion at the baseline. Additional fluid boluses were given in 250 ml of colloid infused over 10 min if PVI was > 13% for at least five minutes. The patients were staged using the KDIGO (Kidney Disease: Improving Global Outcomes) criteria. The amount of bleeding during surgery was recorded for both groups. RESULTS: No significant difference was observed in postoperative renal function. A significant difference was observed in the amount of intraoperative bleeding. The amount of bleeding was greater in patients managed with liberal fluid therapy. No significant difference was observed between the groups in the oral intake (hour), drain withdrawal (hour) mobilization (hour) and discharge (day) times and there isn't any statistically significant differance between groups in cost effectivity (p>0.05). CONCLUSION: Kidney function was preserved during individualized targeted fluid therapy using non-invasive haemodynamic monitoring parameters.

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PURPOSE OF REVIEW: The approval of resmetirom brings great hope to patients with metabolic dysfunction-associated steatohepatitis (MASH). The purpose of this review is to explore its impact on the global health environment. The implementation of multidisciplinary management MASH is proposed. RECENT FINDINGS: Resmetirom has benefits in the treatment of MASH, and its safety and effectiveness have been studied. The adverse events (AEs) need to be noticed. To improve patient outcomes, a multimodal approach with medication such as resmetirom, combined with metabolic and bariatric surgery (MBS) and lifestyle interventions can be conducted. MASH, a liver disease linked with obesity, is a challenging global healthcare burden compounded by the absence of any approved pharmacotherapy. The recent conditional approval by the Food and Drug Administration (FDA) in the United States of resmetirom, an oral, liver-directed, thyroid hormone receptor beta-selective agonist, marks a significant milestone, offering a treatment option for adults with non-cirrhotic MASH and who have moderate to advanced liver fibrosis. This narrative review discusses the efficacy and safety of resmetirom and its role in the therapeutic landscape of MASH treatment. Despite the promising hepatoprotective effect of resmetirom on histological liver endpoints, its use need further research, particularly regarding ethnic differences, effectiveness and cost-effectiveness, production scalability, social acceptance and accessibility. In addition, integrating resmetirom with other multidisciplinary therapeutic approaches, including lifestyle changes and MBS, might further improve clinical liver-related and cardiometabolic outcomes of individuals with MASH. This review highlights the importance of a comprehensive treatment strategy, supporting continued innovation and collaborative research to refine treatment guidelines and consensus for managing MASH, thereby improving clinical patient outcomes in the growing global epidemic of MASH. Studies done to date have been relatively short and ongoing, the course of the disease is highly variable, the conditions of various patients vary, and given this complex clinical phenotype, it may take many years of clinical trials to show long-term benefits.

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PURPOSE: This study aimed to assess and compare the retinal toxicity associated with silicone oil (SO) and perfluoropropane (C3F8) tamponade following vitreoretinal surgery for fresh rhegmatogenous retinal detachment (RRD), utilizing the office-based Diopsys® NOVA™ system for evaluation. METHODS: Patients who underwent vitreoretinal surgery for fresh RRD and had SO (group 1) or C3F8 (group 2) tamponade were included in a prospective analysis. Flicker full field electroretinography (ffERG) and pattern electroretinography (PERG) tests were performed at 6 months postoperatively. RESULTS: Postoperative best corrected visual acuity (logMAR) was significantly different in group 1 and group 2 patients, 0.48 ± 0.3 and 0.30 ± 0.2, respectively. No significant disparities were found in demographic variables. Flicker ffERG and PERG recordings revealed notable alterations in retinal function parameters in the group 1 compared to the group 2. CONCLUSION: Our findings suggest a correlation between SO tamponade and retinal dysfunction, evidenced by office-based ERG measurements. The Diopsys® NOVA™ protocol offers clinical ease in assessing retinal function. Further controlled studies are essential to validate these findings and guide clinical practice effectively.

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Salep, a traditional Turkish beverage, derives its name from its primary component: salep powder (SP), which is sourced from the tubers of certain orchid species. This study investigated various physicochemical attributes (including dry matter, protein content, pH, titration acidity, water activity, color, serum separation, and zeta potential), as well as rheological and sensory characteristics of salep beverages. These drinks were prepared by substituting SP with chia (Salvia hispanica L.) seed mucilage powder (MP) with different ratios (10%, 20%, 30%, and 40%). The substitution of SP with MP did not influence the dry matter and protein contents or the pH and acidity values of the drinks significantly (p > .05). The inclusion of MP in the formulation of salep drinks resulted in a decrease in lightness (L*) and a* color values while increasing the b* color values. However, consumer perception, as indicated by color difference values (∆E*), showed no distinguishable difference between drinks containing MP and control drinks. Furthermore, higher ratios of MP led to increased apparent viscosity values in the drinks and effectively prevented or significantly reduced serum separation observed in control drinks (p < .05). Remarkably, sensory evaluations revealed that substituting up to 30% of SP with MP did not negatively impact the overall sensory properties of the drinks (p > .05), suggesting that MP could be recommended as a feasible alternative. This substitution has the potential to contribute to the conservation of orchid plants, the primary source of salep, while also offering cost-saving benefits in the production of salep drinks.

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Background and aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global epidemic in Türkiye and worldwide. The aim of this study was to evaluate the prevalence and predictors of MASLD and steatohepatitis among adults who died of unnatural causes including sudden death and non-burn trauma. Method: We conducted a prospective review of all consecutive adult forensic autopsies for natural (sudden unexpected) and non-natural (Suicidal, homicidal and accidental) suspicious deaths carried out at the Istanbul Council of Forensic Medicine from February to May 2022. Four wedge biopsies were extracted from sagittal sectioned liver specimens. A liver pathologist with 20 years of experience examined each case for steatosis, ballooning, inflammation, and fibrosis. Results: Among 1797 autopsies, 62 met inclusion criteria. Overall, 43.3 % (n = 26) of autopsies showed evidence of steatotic liver disease, with a distribution of steatosis severity as: Grade I (28.3 %), Grade II (6.6 %), and Grade III (8.3 %). All these cases met at least one cardiometabolic criteria and diagnosed with MASLD. Ballooning was observed in 20.0 % of cases (5 cases grades 1 and 7 cases grade 2), and Inflammation was present in 51.7 % (9 cases with grade 0-1, 12 with 1-2, 7 with 2-3, and 3 with 5-6). Notably, 46.1 % (n = 12) of MASLD cases and 20.0 % (n = 12) of all cases were diagnosed with steatohepatitis, with three cases exhibiting delicate perisinusoidal fibrosis and one case showing portal fibrosis. Conclusion: The histopathological findings from this autopsy study confirmed the markedly high prevalence of MASLD and steatohepatitis within the general adult population, highlighting the concerning burden of steatotic liver disease in Türkiye.

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Non-alcoholic fatty liver disease (NAFLD), characterized by the excessive accumulation of fat within the cytoplasm of hepatocytes (exceeding 5% of liver weight) in individuals without significant alcohol consumption, has rapidly evolved into a pressing global health issue, affecting approximately 25% of the world population. This condition, closely associated with obesity, type 2 diabetes, and the metabolic syndrome, encompasses a spectrum of liver disorders ranging from simple steatosis without inflammation to non-alcoholic steatohepatitis (NASH) and cirrhotic liver disease. Recent research has illuminated the complex interplay between metabolic and immune responses in the pathogenesis of NASH, underscoring the critical role played by T and B lymphocytes. These immune cells not only contribute to necroinflammatory changes in hepatic lobules but may also drive the onset and progression of liver fibrosis. This narrative review aims to provide a comprehensive exploration of the effector mechanisms employed by T cells, B cells, and their respective subpopulations in the pathogenesis of NASH. Understanding the immunological complexity of NASH holds profound implications for the development of targeted immunotherapeutic strategies to combat this increasingly prevalent and burdensome metabolic liver disease.

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BACKGROUND: Coronary microvascular dysfunction (CMD) is a common occurrence in individuals with insulin resistance (IR). Homeostatic model assessment for insulin resistance (HOMA-IR) is a widely used surrogate marker of IR, although recent studies suggest Triglyceride-Glucose (TyG) index is a superior marker of IR that had a better accuracy to predict Type 2 Diabetes or cardiovascular outcomes than HOMA-IR. OBJECTIVES: We aimed to assess the accuracy and usefulness of TyG index and HOMA-IR for predicting CMD as assessed with echocardiographic coronary flow reserve (CFR) measurement. METHODS: All cases included in the institutional CFR registry were retrospectively reviewed, and 656 cases without epicardial coronary artery disease and without major risk factors for atherosclerosis were included. A CFR ≤2.0 was defined as CMD. RESULTS: TyG index was available in all cases, while HOMA-IR was available in 398 cases. Both TyG index and HOMA-IR were associated with CMD on univariate analyses, while after adjustment for potential confounders HOMA-IR (OR:1.38, 95 %CI:1.14-1.67, p = 0.001) but not TyG index(OR:1.48, 95 %CI:0.82-2.67, p = 0.19) was associated with CMD. The predictive accuracy of HOMA-IR (c-statistic:0.63, 95 %CI:0.54-0.72, p = 0.003) was higher than TyG index(c-statistic:0.55, 95 %CI:0.47-0.63, p = 0.13), although the difference was not statistically significant (DeLong p = 0.23). There was strong evidence favoring a true difference between CMD vs. non-CMD groups for HOMA-IR (BF10:3507) but not for TyG index(BF10:0.66). CONCLUSIONS: HOMA-IR, but not TyG index, is closely associated with CMD.

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Background & Aims: Patients with nonalcoholic fatty liver disease (NAFLD)/metabolic dysfunction-associated steatotic liver disease (MASLD) face a multifaceted disease burden which includes impaired health-related quality of life (HRQL) and potential stigmatization. We aimed to assess the burden of liver disease in patients with NAFLD and the relationship between experience of stigma and HRQL. Methods: Members of the Global NASH Council created a survey about disease burden in NAFLD. Participants completed a 35-item questionnaire to assess liver disease burden (LDB) (seven domains), the 36-item CLDQ-NASH (six domains) survey to assess HRQL and reported their experience with stigmatization and discrimination. Results: A total of 2,117 patients with NAFLD from 24 countries completed the LDB survey (48% Middle East and North Africa, 18% Europe, 16% USA, 18% Asia) and 778 competed CLDQ-NASH. Of the study group, 9% reported stigma due to NAFLD and 26% due to obesity. Participants who reported stigmatization due to NAFLD had substantially lower CLDQ-NASH scores (all p <0.0001). In multivariate analyses, experience with stigmatization or discrimination due to NAFLD was the strongest independent predictor of lower HRQL scores (beta from -5% to -8% of score range size, p <0.02). Experience with stigmatization due to obesity was associated with lower Activity, Emotional Health, Fatigue, and Worry domain scores, and being uncomfortable with the term "fatty liver disease" with lower Emotional Health scores (all p <0.05). In addition to stigma, the greatest disease burden as assessed by LDB was related to patients' self-blame for their liver disease. Conclusions: Stigmatization of patients with NAFLD, whether it is caused by obesity or NAFLD, is strongly and independently associated with a substantial impairment of their HRQL. Self-blame is an important part of disease burden among patients with NAFLD. Impact and implications: Patients with nonalcoholic fatty liver disease (NAFLD), recently renamed metabolic dysfunction-associated steatotic liver disease (MASLD), may experience impaired health-related quality of life and stigmatization. Using a specifically designed survey, we found that stigmatization of patients with NAFLD, whether it is caused by obesity or the liver disease per se, is strongly and independently associated with a substantial impairment of their quality of life. Physicians treating patients with NAFLD should be aware of the profound implications of stigma, the high prevalence of self-blame in the context of this disease burden, and that providers' perception may not adequately reflect patients' perspective and experience with the disease.

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Metabolic dysfunction associated fatty liver disease (MAFLD) is an increasing public health problem, affecting one third of the global population. Contrary to conventional wisdom, MAFLD is not exclusive to obese or overweight individuals. Epidemiological studies have revealed a remarkable prevalence among healthy weight individuals, leading investigations into the genetic, lifestyle, and dietary factors that contribute to the development of MAFLD in this population. This shift in perspective requires reconsideration of preventive strategies, diagnostic criteria and therapeutic approaches tailored to address the unique characteristics of MAFLD healthy weight individuals. It also underscores the importance of widespread awareness and education, within the medical community and among the general population, to promote a more inclusive understanding of liver metabolic disorders. With this review, we aim to provide a comprehensive exploration of MAFLD in healthy weight individuals, encompassing epidemiological, pathophysiological, and clinical aspects.

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This study involved fortifying pumpkin slices with calcium and vitamin D3 using vacuum impregnation (VI) pre-treatment and assessing the quality characteristics of the resulting desserts/jams. Slices were subjected to immersion or VI pre-treatments for 30, 60, and 90 min in a solution containing calcium oxide and vitamin D3. Calcium ions contributed to the hardness of desserts, with VI reducing processing time. The highest impregnated calcium (58.17 mg/100 g fw) and vitamin D3 contents (6.02 mg/100 g dm) were determined in slices pre-treated by VI for 90 min. VI was more effective than immersion in terms of calcium and vitamin D3 transition into pumpkin tissues. Scanning electron microscope (SEM) images indicated that calcium oxide particles were noticeable in slices pre-treated by VI. Immersing fruit slices for 90 min produced desserts with a textural hardness of 11.04 N, while VI pre-treatment for the same duration increased their hardness value to 18.92 N. Desserts produced with VI-pre-treated slices exhibited superior texture and sensory attributes, with no adverse taste resulting from calcium oxide. In conclusion, VI pre-treatment shows significant potential for the industrial production of desserts/jams with enhanced structural integrity for fruits.

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BACKGROUND: With the implementation of the 11th edition of the International Classification of Diseases (ICD-11) and the publication of the metabolic dysfunction-associated fatty liver disease (MAFLD) nomenclature in 2020, it is important to establish consensus for the coding of MAFLD in ICD-11. This will inform subsequent revisions of ICD-11. METHODS: Using the Qualtrics XM and WJX platforms, questionnaires were sent online to MAFLD-ICD-11 coding collaborators, authors of papers, and relevant association members. RESULTS: A total of 890 international experts in various fields from 61 countries responded to the survey. We also achieved full coverage of provincial-level administrative regions in China. 77.1% of respondents agreed that MAFLD should be represented in ICD-11 by updating NAFLD, with no significant regional differences (77.3% in Asia and 76.6% in non-Asia, p = 0.819). Over 80% of respondents agreed or somewhat agreed with the need to assign specific codes for progressive stages of MAFLD (i.e. steatohepatitis) (92.2%), MAFLD combined with comorbidities (84.1%), or MAFLD subtypes (i.e., lean, overweight/obese, and diabetic) (86.1%). CONCLUSIONS: This global survey by a collaborative panel of clinical, coding, health management and policy experts, indicates agreement that MAFLD should be coded in ICD-11. The data serves as a foundation for corresponding adjustments in the ICD-11 revision.

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