Abstract Background Ulcerative colitis (UC) is a chronic inflammatory bowel disease with remissions and flares. Approximately 20% of UC Patients develop acute severe ulcerative colitis (ASUC), a serious condition that is refractory to standard therapies and leads to morbidity and mortality. Rescue therapy (salvage therapy) with steroids, cyclosporine, and/or infliximab is recommended by guidelines.1 The colectomy rate in ASUC remains at around 36% even in the biological millennium.2 Upadacitinib (UPA) is a JAK1 selective inhibitor used effectively to treat UC. The role of UPA as a rescue therapy in ASUC is not clear. This study aims to evaluate the outcomes of UPA as a rescue therapy in ASUC patients. Methods A total of 31 steroid- and infliximab-refractory ASUC patients from 10 IBD centers from all over Türkiye were included between April 2023 and October 2024 in our study. Demographics of the patients and disease characteristics were recorded. Stool frequency (per day), rectal bleeding scores, and C reactive protein (CRP) were assessed from the electronic database at baseline (week 0), week 1, 4, 8, and 16 retrospectively. Complete clinical response was defined as stool frequency ≤3 per day and rectal bleeding score 0-1. Results Mean age was 36±13years; 16(51.6%) were female, mean disease duration was 6.9±5.4 years, 30(96.8%) had immunomodulator experience (Table1). A total of 10 patients had ≥ 3 biologics failures. Complete clinical response at weeks, 4, 8, and 16 were in 13 (42%), 16 (64%), 12 (67%), and 10 (77%) patients respectively. Rescue therapy responses were not statistically significant between ≥3 and <3 biologics failure groups (p=0.580) at week1. CRP normalization (<3 mg/L) at week 4 was found in 9(36%) patients. By the end of the week, 6 (33%) patients had undergone colectomy. Clinical responses and surgery rates of UPA at week1,4,8, and 16 were detailed in Figure 1. Conclusion UPA provided a complete clinical response as a rescue therapy within the first week in 42% of cases in anti-TNF and steroid non-responders even with multiple biologics experience. Over half of the patients showed clinical remission by weeks 4 and 8. References 1.Raine T, Bonovas S, Burisch J, et al. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. J Crohns Colitis. 2022;16(1):2-17. doi:10.1093/ecco-jcc/jjab1782. 2.Moore AC, Bressler B. Acute Severe Ulcerative Colitis: The Oxford Criteria No Longer Predict In-Hospital Colectomy Rates. Dig Dis Sci. Feb 2020;65(2):576-80.

Abstract Background Patient-reported outcome measures (PROMs) are used to assess the effectiveness of treatments received by patients in terms of clinical response in inflammatory bowel disease (IBD). We aimed to evaluate the perceived clinical response from the patient’s perspective using PRO2, IBD Control Questionnaire (ICQ) and Visual Analogue Scale (VAS) at the end of induction therapy in patients treated with upadacitinib. We also aimed to evaluate the correlation of PROMs with biochemical response. Methods We included IBD patients who underwent upadacitinib induction therapy from 01/07/2024 to 01/10/2024 in ten centers. ICQ and VAS assessments (Higher scores are better) were used in conjunction with CRP levels and PRO2 assessments (Lower scores are better) performed at baseline and at the end of induction treatment. Results A total of 75 patients who completed the induction phase were included, 52% were female and 50.7% were treated for Crohn’s disease (CD). Treatment was switched in 54.7% of patients due to uncontrolled chronic disease, in 42.7% for loss of response and in 2.7% for drug side effects. PRO2 mean scores were changed from 4.86 ± 3.06 to 1.67 ± 1.28 (p<0.05) and 18.61 + 10.42 to 7.36 + 5.10 (p<0.05) for ulcerative colitis (UC) and CD respectively. At the end of induction treatment, 47.2% of UC group and 66.7% in the CD group were classified as in clinical remission according to PRO2 scores. The rate of patients reporting side effects was 30.7%. Acne and skin rashes were reported more frequently (13.2 %). According to the visual analog scale, 80% of the patients reported improvement in their condition (p<0.05), and the mean VAS score and IBD control score were 71.9 and 13.7 (p<0.05) for patients in remission in the UC group and 70 and 14.7 (p<0.05) in the CD group compared to active patients. ICQ scores and VAS were negatively correlated with PRO2 scores and CRP levels (p<0.05 for both pairs). On the other hand both scores were not correlated with CDAI and mayo scores (p>0.05). Conclusion In this real-life cohort of patients treated with upadacitinib, 80% report a significant improvement in their condition. ICQ and VAS can be used to understand patients’ perspective on treatment efficacy. Conventional activity scores probably not helpful for early assessment of clinical activity compared to PROMs.

Background: Although studies are investigating the perception and beliefs about treatment and adherence to treatment in different societies related to inflammatory bowel disease, there are no studies on this subject in Turkish people with different sociocultural structures. In our study, we aimed to evaluate the beliefs about treatment and its effect on adherence to treatment in the Turkish population with inflammatory bowel disease. Methods: In the study, the "Medication Adherence Report Scale" and "Beliefs about Medicines Scale" scales were used to evaluate the treatment compliance and perception and beliefs about treatment. Characteristics that could affect treatment compliance were evaluated by statistical analysis. Results: A total of 253 patients, 167 with ulcerative colitis and 86 with Crohn's disease, were included in the study. The non-adherence rate to the treatment was found as 41.9% in ulcerative colitis and 24.4% in Crohn's disease (P =.006). Intentional (29.3% in ulcerative colitis and 16.3% in Crohn's disease [P =.031] and unintentional non-adherence to treatment (28.1% in ulcerative colitis, 16.3% in Crohn's disease [P =.037] were significantly higher in ulcerative colitis than in Crohn's disease. Female gender (odds ratio = 2.59, P =.005), low education level (odds ratio = 4.8, P =.015), distal involvement in ulcerative colitis (P =.014), and thoughts about the disease would last too soon in Crohn's disease (odds ratio = 4.17, P =.049) were risk factors for non-adherence to treatment. Conclusion: The negative perception of treatment in inflammatory bowel disease affects adherence to the treatment. Considering some social factors that affect adherence to the treatment and taking measures to enhance the adherence to treatment will increase the success of treatment.

ÖZAmaç: Çalışmamızda, HBsAg pozitif hastalarda hepatit delta virüsü (HDV) seroprevalansının belirlenmesi ve anti-HDV saptanan hastalarda hepatit B serolojik belirteçleri ile çeşitli biyokimyasal parametrelerin incelenmesi amaçlandı.Yöntem: Hastanemize

Background: Patients with Crohn's disease experience major deterioration in work productivity and quality of life.We aimed to provide the long-term effects of anti-tumor necrosis factor agents on work productivity and activity impairment and quality of life in patients with Crohn's disease using the Inflammatory Bowel Disease Questionnaire and the Short-Form Health Survey-36.Methods: Patients with Crohn's disease and initiated an anti-tumor necrosis factor treatment were included and followed up for 12 months in this observational study.Results: A total of 106 patients were included in this study, and 64.2% of the patients were males.Mean [± standard deviation] age was 36.8 [± 10.9] years.At baseline, mostly perianal fistulas [65.7%] were observed [n = 23].Intestinal stenosis was detected in 34.9% of the patients [n = 37], and most of the stenosis was located in the ileum [70.6%] followed by the colon [20.6%].Extraintestinal symptoms were observed in 24 patients [22.6%].Most frequent extraintestinal symptom was arthritis with 71.4% [n = 15].Mean time from first symptom to initiation of anti-tumor necrosis factor treatment was 6.3 [± 5.0] years.Improvements in work productivity and activity impairment scores throughout 12 months were -24.1% [P = .003]for work time missed, -18.0%[P = .006]for impairment at work, -8.5% [P = .160]for overall work impairment, and -17.0%[P < .001]for daily activity impairment.Similarly, significant improvements [P < .001]were detected in all components of the Inflammatory Bowel Disease Questionnaire when compared to baseline.Statistically significant improvements [P < .05]were detected for all components of Short-Form Health Survey-36 except for mental health [P = .095].Conclusion: Our study indicates the significant improvement in work productivity and activity impairment and quality of life of patients with Crohn's disease who receive long-term anti-tumor necrosis factor treatment.

Department of Rheumatology, Trakya University Medical School, Edirne, Turkey [email protected] Department of Gastroenterology, Trakya University Medical School, Edirne, Turkey. The authors declare no conflict of interest. Written informed consent was obtained from the patients regarding the use of personal clinical information for research and educational purposes.

The COVID-19 pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2, has resulted in high mortality and morbidity worldwide and is still a growing problem. Inflammatory bowel disease (IBD) is a chronic inflammatory disease for which a substantial number of patients are treated with immunosuppressive medications, either occasionally or long-term. Despite the accumulating evidence, there is still a lack of knowledge about the impact of COVID-19 on IBD patients, especially those who are under immunosuppressive treatment. Moreover, following the emergence of several COVID vaccines, there are concerns regarding vaccine effectiveness and possible side effects in such patients. In this context, we tried to briefly summarize the accumulating evidence and recommendations for the management of IBD in the context of the COVID-19 pandemic.

İnflamatuvar barsak hastalıkları gastrointestinal sistemi tutan kronik inflamatuvar bir hastalık grubudur. İnflamatuvar barsak hastalıklarının etiyolojisi hala aydınlatılamamışken, çevresel ve genetik faktörlerin kompleks etkileşimi sonucu, intestinal sistemde lüminal içeriğe karşı abartılı bir immün yanıtın oluştuğu düşünülmektedir. Bu reaksiyon, genetik olarak yatkın olanlarda lüminal antijenlere karşı immün-toleransın kaybolması sonucu meydana geliyor olabilir. Günümüzde, İnflamatuvar barsak hastalıkları için yatkınlık oluşturan, intestinal immün yanıtı etkileyebilecek çok sayıda gen tanımlanmıştır. Bunlar intestinal immün sistemin farklı basamaklarında etkili mekanizmalarla ilişkili olarak ortaya çıkmaktadır. İntestinal immün sistemin, lüminal mikrobiyota, intestinal epitelyal bariyer, antijen tanımlama, otofaji ve inflamazom, endoplazmik retikulum stresi, antijen sunumu ve kazanılmış bağışıklık sistemi ile JAK-STAT yolağını da içine alan birçok katmanında genetik olarak ortaya çıkabilecek değişiklikler sistemin işleyişinin etkilenmesine neden olacak, hastalığın gün yüzüne çıkmasına neden olacaktır. Ama maalesef son gelişmelerle birlikte hastalığın ortaya çıkmasında rol oynayan genetik değişikliklerin bunlarla sınırlı olmadığı, nonfonksiyone genler, epigenetik değişiklikler, metabolomikler ve bunun gibi birçok durumun da inflamatuvar barsak hastalıklarıyla ilişkisi gösterilmiştir. Bütün bu gelişmelere rağmen hala daha hastalığın patogenezi net birşekilde ortaya konulamamış olması, hastalığı multifaktöryel doğasından kaynaklanmaktadır.

Giriş ve Amaç: Asitli siroz hastalarında ortaya çıkan spontan asit enfeksiyonu, mortalitesi yüksek bir komplikasyondur. Çalışmamızda, spontan asit enfeksiyonu sırasında, proinflamatuvar sitokinler olan interlökin-6 ve tümör nekrozis faktör-alfanın asit sıvısı ve serumda, nitrik oksit ve myeloperoksidazın ise asit sıvısındaki düzeylerine bakıp, bu sonuçların asit enfeksiyonu açısından tanısal ve prediktif değeri olup olmadığını araştırdık. Gereç ve Yöntem: Çalışmaya alınan 40 hasta, steril asitli grup, kültür negatif nötrositik asitli grup ve spontan bakteriyel peritonitli grup olarak ayrıldı. Hastalardan başvuru anında asit sıvısı ve serum örnekleri alınarak saklandı. Daha sonra tüm olguların asit sıvısı ve serumunda immünoradyometrik yöntemle interlökin-6 ve tümör nekrozis faktör-alfa, asit sıvılarında ELISA ile myeloperoksidaz ve enzimatik yöntemle nitrik oksit düzeyleri çalışılarak üç grup birbiriyle ayrı ayrı karşılaştırıldı. Bulgular: Olguların asit sıvısı ve serum interlökin-6 düzeyi ortalaması kültür negatif nötrositik asit ve spontan bakteriyel peritonit grubunda steril asit grubundan anlamlı derecede yüksek bulunmuştur. Asit sıvısı tümör nekrozis faktör-alfa düzeyi ortalaması spontan bakteriyel peritonit grubunda steril asit grubuna kıyasla anlamlı derecede yüksek saptanırken, serum tümör nekrozis faktör-alfa düzeyi ortalamasında her üç grup arasında istatistiksel anlamlı fark saptanmamıştır. Asit sıvısı myeloperoksidaz düzeyi ortalaması kültür negatif nötrositik asit ve spontan bakteriyel peritonit grubunda steril asit grubundan anlamlı derecede yüksek bulunmuştur. Asit sıvısı nitrik oksit düzeyi ortalaması arasında ise her üç grup arasında istatistiksel anlamlı fark saptanmamıştır. Sonuç: Elde edilen bulgular, asitli siroz hastalarında, spontan asit enfeksiyonu tanısında, asit sıvısı ve serumdaki interlökin-6 ile asitteki myeloperoksidaz düzeylerinin, konvansiyonel yöntemlere yardımcı olabileceğini, nitrik oksit ve tümör nekrozis faktör-alfa değerlerinin ise tanısal açıdan uygun olmadığını düşündürmektedir.

Background and study aims: Cirrhosis is a multisystem disorder characterized by hyperdynamic circulation which can progress to multiple organ dysfunctions. Recent studies have demonstrated autonomic dysfunction and cirrhotic cardiomyopathy including diastolic dysfunction, systolic dysfunction with electrophysiologic abnormalities in patients with cirrhosis. Due to the long and complicated course of the disease, health related quality of life is affected. We aimed to evaluate the frequency of diastolic dysfunction and autonomic dysfunction in cirrhosis, and the effects on health-related quality of life. Patients and methods: Hundred cirrhotic patients were enrolled in the study. According to the Child-Pugh classification 35 patients were of Child A, 36 of Child B and 29 of Child C. The proportion of autonomic dysfunction was 52%, and diastolic dysfunction 51%. Autonomic dysfunction was diagnosed using bedside maneuvers and tests; diastolic dysfunction was diagnosed using the E/A ratio in echocardiographic findings. Health-related quality of life measurements was obtained from an SF-36 questionnaire. Results: Patients with advanced Child-Pugh classifications were found to have significantly lower health-related quality of life values (p < 0.05). Likewise, health-related quality of life values were observed to be significantly lower in patients with autonomic dysfunction (p < 0.05). No significant difference was found in health related quality of life measurements between patients with and without diastolic dysfunction. Conclusion: Our study showed that autonomic dysfunction and diastolic dysfunction are found in patients with cirrhosis. Further studies are needed to assess the effects of autonomic dysfunction and diastolic dysfunction on health-related quality of life. (C) 2020 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.

Background and Aims: Ulcerative colitis is an idiopathic, chronic inflammatory disease with a high relapse rate. Smoking contributes to the development and progression of ulcerative colitis. We determined total rectal wall thickness in patients with ulcerative colitis who had a smoking history. Materials and Methods: We included 19 patients with ulcerative colitis (ulcerative colitis group) and 19 controls (control group) and compared total rectal wall thickness among them. Total rectal wall thickness was significantly greater in the ulcerative colitis group. We also compared total rectal wall thickness between patients with and without smoking history in both groups. Results: Of the 19 patients with ulcerative colitis, 4 and 15 were females and males, respectively, with a mean age of 46.8±13.3 years. Of the 19 controls, 5 and 14 were females and males, respectively, with a mean age of 46.6±11.8 years. While 9 patients with ulcerative colitis were active, 10 were in remission. The median (interquartile range) total rectal wall thickness was significantly higher in the ulcerative colitis group (4.1 mm [3.1–4.6]) than in the control group (2.5 mm [2.0-3.7]) (p=0.003). The median total rectal wall thickness was significantly higher in patients with ulcerative colitis and a smoking history than in those without (4.6 mm [4.3-4.9] vs. 3.8 mm [2.6-4.1], respectively; p=0.025). Total rectal wall thickness did not differ according to smoking history in the control group. Conclusion: Smoking history is associated with total rectal wall thickness increase patients with ulcerative colitis on transrectal ultrasonography.

Objective: Serum biomarkers are frequently used to assess disease activities in ulcerative colitis (UC) and Crohn disease (CD).But none of them are specific for intestinal inflammation.There are studies showing that hematological parameters predict inflammation in the body.Although previous studies have shown that the neutrophil/lymphocyte ratio (NLR) is associated with disease activity in UC, this relationship has not been shown in CD.In our study, the relationship of NLR and other hematological parameters to disease activity in UC and CD was evaluated. Material and Method:A total of 197 UC (107 active, 90 remission), 97 CD (50 active, 47 remission) and 26 age and sex matched healthy control groups were included in the study.The disease activity and CRP, ESR, hemogram parameters were recorded.NLR, Platelet/lymphocyte (PLR), MPV/platelet and RDW/platelet ratios were calculated.Parameters were compared between UC, CD and control groups according to activity status. Results:In UC, leukocyte, neutrophil, monocyte, platelet, plateletcrit (Pct), PLR, ESR, CRP values were found to increase significantly in the control, remission and active groups with a certain trend, respectively.Hemoglobin (Hb), hematocrit (HCT) and RDW/platelet were shown to decrease respectively.NLR and MPV/platelets were significantly different between the groups of active UC, UC in remission and control.Other parameters were not statistically significant.In CH, ESR, CRP, platelet, Pct, PLR were found to increase significantly with a certain trend in control, remission and active groups, respectively.Hb, HCT, MCV, MCH and RDW/platelets were found to decrease with a certain trend.Leukocyte, neutrophil, lymphocyte, monocyte count, MCHC, NLR and MPV/platelet were significantly different between the CD and control groups.In CD, eosinophil count and RDW were not statistically significant.ESR, CRP, NLR and PLR had acceptable sensitivity-specificity in predicting active patients in CD and UC.ESR, CRP, WBC, neutrophil, monocyte, platelet, Pct, NLR, PLR, MPV/platelet and RDW/platelet parameters were significant factors in predicting active disease in UC and CD. Conclusion:Many hemogram parameters change with activity in IBD.Although not specific for IBD, NLR and PLR are as effective as CRP and ESR in detecting active patients in IBD and can be used as markers to demonstrate activity.

BACKGROUND:Recent advances in next-generation sequencing (NGS) technology have enabled multigene testing and changed the diagnostic approach to hereditary gastrointestinal cancer/polyposis syndromes. The aim of this study was to analyze different cancer predisposition genes in hereditary/sporadic gastrointestinal cancer/polyposis.METHODS:Cancer predisposition genes were analyzed with an Illumina MiSeq NGS system in 80 patients with gastrointestinal cancer/polyposis who were examined between the years 2016 and 2019. Deletion/duplication analysis of MLH1, MSH2, and EPCAM genes was performed by using the multiplex ligation-dependent probe amplification method.RESULTS:Germline testing of hereditary cancer-related genes was performed in 80 patients with gastrointestinal cancer/polyposis. A total of 30 variants in 30 cases (37.5%) were assessed as pathogenic/likely pathogenic. A total of 19 heterozygous variants were assessed as variants of uncertain clinical significance in 17 cases (21.25%) and 18 (22.5%) novel variations (9 pathogenic/likely pathogenic, 9 variants of uncertain significance) were determined. In 4 (5%) cases, multiplex ligation-dependent probe amplification detected deletions in MLH1, MSH2, and EPCAM genes.CONCLUSION:The accumulation of analyses with multigene testing will increase the available data for cancer predisposition genes in hereditary gastrointestinal cancer/polyposis. Educational campaigns for prevention, efficient screening programs, and more personalized care based on the profile of individual patients are necessary.

Abstract Background and Aims The patients with gastro-esophageal reflux disease (GERD) have distortion of sympathetic and parasympathetic components of the autonomic nervous system. The increase in sympathetic activity results in hyperkinetic circulation with peripheral vasoconstrictor and tachycardia and also regulates blood pressure with increase of renin in kidneys. We aimed to elucidate the patterns of pulse pressure in GERD patients, and also to investigate possible relationship between patterns of pulse pressure and laboratory/urinary parameters in adults Method The ambulatory blood pressure measuring was performed in all cases. Fifty patients in the reflux group and fifty individuals in the control group were included. Blood and urine specimens were examined. The individuals with cardiovascular disease, hypertension, malignancy, asthma disease, gastric peptic ulcer, hepatitis disease, tuberculosis, gastrointestinal disease excluding reflux, cerebrovascular disease, vasculitic disease, chronic alcohol usage, drugs with affect on autonomic system usage were excluded from study. Results We found lower diastolic blood pressure and increased pulse pressure values in reflux group and these were significant statistically. When patients were evaluated separately as men and women, this situation was found to be more pronounced in women. The decrease in serum potassium, chloride levels and the increase in serum LDL cholesterol, triglyceride levels in reflux group considered as statistically significant. Urinary parameters were similar in both groups. Non-dipper pattern found more common in reflux group, but considered as insignificant. The results were summarized in Table 1 and Table 2. Conclusion This study supports the hypothesis that increased vascular risk may be present in patients with GERD. Thus, perhaps a new population at risk for cardiovascular disease will be identified and mortality rates will able to decrease with early clinical evaluation.

Gingival Overgrowth (GO), increase in size, is a common problem in the periodontology clinics, and is very important for the therapy of gingival diseases [1,2]. The studies about the pathogenesis and etiologic factors of GO showed that GO was related to systemic diseases, certain conditions (vitamin C deficiency, pregnancy, puberty), local factors, genetic factors, and side effects produced by some medications (phenytoin-cyclosporine-nifedipine). However, a greater incidence of GO is frequently seen during puberty, and the severity of GO is more intense in children than in adults [3], and age has been considered an important risk factor for drug-induced GO with reference to phenytoin and cyclosporine [4]. Abstract

Cite this article as: Törüner M, Akpınar H, Akyüz F, et al. 2019 Expert opinion on biological treatment use in inflammatory bowel disease management. Turk J Gastroenterol 2019; 30(Suppl 4): S913-46.

Background Management of enteropathic arthritis may be challenging due to differences in treatment response of inflammatory bowel diseases and arthritis to different therapeutic modalities, which may even cause worsening of some manifestations while improving others. Enteropathic arthritis was not addressed in the management recommendations for spondyloarthritis. Objectives The aim of this project was to develop a set of evidence based recommendations for the management of patients with enteropathic arthritis. Methods A task force was formed that included ten rheumatologists and 8 gastroenterologists. Research questions were determined using a Delphi approach. A systematic literature search, data extraction, and statistical analyses were performed according to a pre-specified protocol. Studies that assessed the efficacy of an intervention on inflammatory bowel disease related outcomes and/or spondyloarthritis relates outcomes in patients with enteropathic arthritis were included. Risk ratios were calculated for binary outcomes and mean difference for continuous outcomes, whenever possible. Results of the systematic literature review were presented to the experts and recommendations were formulated after thorough discussions and voting. Results A total of 4 overarching principles and 10 recommendations were formulated. The recommendations addressed the use of NSAIDs, corticosteroids, sulfasalazine and 5-ASA derivatives, TNF inhibitors, tofacitinib, secukinumab, ustekinumab and vedolizumab among patients with active inflammatory bowel disease, active arthritis, active disease regarding both inflammatory bowel disease and arthritis, and among patients in remission. Final voting showed good agreement among the group on all recommendations. Conclusion These recommendations are intended to help rheumatologists, gastroenterologists and other clinicians dealing with enteropathic arthritis and to point out to the shortcomings of the available data on the management of this challenging condition. Disclosure of Interests Gulen Hatemi Consultant for: Abbvie, Amgen, BMS, Janssen, MSD, Pfizer, UCB, Speakers bureau: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer, Hale Akpinar: None declared, Pamir Atagündüz: None declared, Goksel Bengi: None declared, Gerçek Can: None declared, Aykut Ferhat Celik: None declared, Sinem Nihal Esatoglu: None declared, Önay Gerçik: None declared, Hulya Hamzaoglu: None declared, Murat Inanc: None declared, Gokhan Kabacam: None declared, Ismail Hakkı Kalkan: None declared, Levent Kılıç: None declared, Fatos Onen: None declared, Ahmet Tezel: None declared, Murat Toruner: None declared, Sedat Kiraz: None declared