Push and Pull Factors of Why Medical Students Want to Leave Türkiye: A Countrywide Multicenter Study.

Phenomenon: Physician immigration from other countries is increasing as developed countries continue to be desirable destinations for physicians; however, the determinants of Turkish physicians' migration decisions are still unclear. Despite its wide coverage in the media and among physicians in Türkiye, and being the subject of much debate, there is insufficient data to justify this attention. With this study, we aimed to investigate the tendency of senior medical students in Türkiye to pursue their professional careers abroad and its related factors. Approach: This cross-sectional study involved 9881 senior medical students from 39 different medical schools in Türkiye in 2022. Besides participants' migration decision, we evaluated the push and pull factors related to working, social environment and lifestyle in Türkiye and abroad, medical school education inadequacy, and personal insufficiencies, as well as the socioeconomic variables that may affect the decision to migrate abroad. The analyses were carried out with a participation rate of at least 50%. Findings: Of the medical students, 70.7% had emigration intentions. Approximately 60% of those want to stay abroad permanently, and 61.5% of them took initiatives such as learning a foreign language abroad (54.5%) and taking relevant exams (18.9%). Those who wanted to work in the field of Research & Development were 1.37 (95% CI: 1.22-1.54) times more likely to emigrate. The push factor that was related to emigration intention was the "working conditions in the country" (OR: 1.89, 95% CI: 1.56-2.28) whereas the "social environment/lifestyle abroad" was the mere pull factor for the tendency of emigration (OR: 1.73, 95% CI: 1.45-2.06). In addition, the quality problem in medical schools also had a significant impact on students' decisions (OR: 2.20, 95% CI: 1.83-2.65). Insights: Although the percentage of those who want to emigrate "definitely" was at the same level as in the other developing countries, the tendency to migrate "permanently" was higher in Türkiye. Improving working conditions in the country and increasing the quality of medical faculties seem vital in preventing the migration of physicians.

Effect of Ramadan fasting on glycaemic parameters & body mass index in type II diabetic patients: A meta-analysis.

Background & objectives: There has been an ongoing debate about the impact of Ramadan fasting (RF) on the health of these individuals who fast during Ramadan. The aim of this meta-analysis was to evaluate the relationship between RF and glycaemic parameters in type 2 diabetes mellitus (T2DM) patients. Methods: Search terms were decided and databases such as MEDLINE EBSCO, Google Scholar and EMBASE were searched for eligible studies. Standardized mean differences and 95 per cent confidence intervals (CIs) of post-prandial plasma glucose (PPG), fasting plasma glucose (FPG), glycated haemoglobin (HbA1c) (%) and fructosamine levels were calculated for different treatment regimens. Results: Of the 40 studies, 19 were found eligible for inclusion in the meta-analysis. Based on pooled results, significant reductions in FPG were found in single oral antidiabetics (OAD) [standardized weighted mean difference (SMD)=0.47, 95% CI=(0.20-0.74)], multi-OAD [SMD=0.36, 95% CI=(0.11-0.61)] and multitreatment subgroups [SMD=0.65, 95% CI=(0.03-1.27)] and overall [SMD=0.48, 95% CI=(0.27-0.70)]. Furthermore, HbA1c(%) [SMD=0.26, 95% CI=(0.03-0.49)] and body mass index (BMI) [SMD=0.18, 95% CI=(0.04-0.31)] were significantly decreased in the multi-OAD group. Interpretation & conclusions: The meta-analysis showed that RF was not associated with any significant negative effects on PPG and fructosamine levels. However, BMI and FPG and HbA1c(%) were positively affected by RF.

A detailed assessment of high infant death rates in Gaziantep in 2013.

OBJECTIVE: To determine the causes of a relatively high infant mortality rate in a Turkish city compared to the nationwide rate. METHODS: The cross-sectional study was conducted at Gaziantep from January to March 2014, and comprised a representative sample of infant deaths that occurred between January and December 2013 in the city of Gaziantep, Turkey. Mothers of the deceased infants were interviewed using a structured questionnaire. Data was analysed using SPSS 22. RESULTS: Of the 556 deaths, 114(20.5%) cases comprised the sample and their mothers formed the study universe. Of them, 3(2.6%) were aged below 18 years; 22(19.3%) were over 35 years; 20(17.5%) had 4 or more children, and 40(35.0%) had an interval of less than 2 years between two pregnancies. Consanguineous marriage was the case with 49(43.0%) mothers. Overall, 111(97.4%) mothers had received prenatal care. Of the births, 66(57.9%) had occurred in private hospitals and 41(36%) in state hospitals. A total of 77(67.5%) infants had been delivered by caesarean section. The most frequent causes of mortality were congenital abnormalities 33(28.9%), prematurity 29(25.4%), respiratory distress syndrome 24(21.1%) and congenital heart diseases 14(12.3%). CONCLUSIONS: A high rate of consanguineous marriages seemed to be one of the most important causes of the high infant death rate in Gaziantep compared to the rest of Turkey..

[HBV pol/S gene mutations in chronic hepatitis B patients receiving nucleoside/nucleotide analogues treatment]. / Nükleozid/nükleotid analogu tedavisi alan kronik hepatit B hastalarinda hbv pol/S geni mutasyonlari.

Chronic hepatitis B (CHB) is an important public health problem affecting over 240 million people all around the world. The aim of the treatment in chronic hepatitis B is to prevent progression to cirrhosis and liver cancer. Interferons (standard and peginterferon) (Peg-IFN) and nucleoside/nucleotide analogues (NAs) are widely used in the treatment of CHB. The use of long-term therapy can however result in drug resistant mutations, which can lead to treatment failure. In patients with chronic hepatitis B, in addition to primary drug resistance mutations in the pol gene, compensatory mutations were reported. The genom of HBV polymerase (pol) gene overlaps with the envelope (S) gene. Nucleoside/nucleotide analogue (NA) resistance mutations in the pol gene of HBV, either from selection of primary or secondary resistance mutations, typically result in changes in HBsAg. Recent studies have conferred a new acronym for these HBV pol/S gene overlap mutants; ADAPVEMs, for antiviral drug-associated potential vaccine-escape mutants. The aim of this study was to investigate clinically and epidemiologically significant HBV pol/S gene mutations in NA treated CHB patients. In the study, a total of 100 patients who received nucleoside/nucleotide analogue therapy for one year or more were included. The levels of HBV DNA from serum samples were detected by the commercial real-time PCR assay and the mutations of pol/S genes by direct sequencing. Sixteen samples with low HBV DNA levels (> 200 IU/ml) could not be interpreted by sequencing due to insufficient amplification. Of the remaining 84 patients that could be sequenced HBV pol gene of HBV, 53 (63.09%) were males and 31 (36.91%) were women and the mean age was 47 ± 14.99 years (range: 20-67). Primary/secondary drug mutations (rtM204I/V, rtI169S, rtL180M, rtT184L, rtA194V, rtM204I/rtL91I, rtQ149K, rtQ215H/S, rtN238D) were detected in 38 (45.2%) of the patients. Because of the HBV pol/S gene overlapping, in 27 patients immun-selected amino acid substitutions (sI110L, sT127P, sS114A, sT123A), in nine patients HBIg selected escape mutants (sP120R, sT123N, sE164D, sY134F, sQ129H, sT118A, sP127K), in seven patients vaccine escape mutants (sT126I, sP120S, sG145A, s S193L) and in one patient misdiagnosis of HBsAg (sT131I) were detected. In addition, antiviral drug-associated potential vaccine-escape mutants were detected in 13 (15.4%) patients. In patients with chronic HBV, NAs including commonly used lamivudine were observed to have the potential for ADAPVEM to emerge during treatment. It was concluded that after determination of antiviral drug resistance and ADAPVEMs replanning of treatment should be done in the NA treatment of patients with CHB.

Waist to height ratio as a screening tool for identifying childhood obesity and associated factors.

OBJECTIVE: To investigate the prevalence of obesity and associated factors during childhood in Southeastern Turkey. Another objective was to determine the cut-off points of Waist to Height Ratio (WHtR) values for defining obesity/abdominal obesity. METHODS: The community-based descriptive cross-sectional study was conducted in Gaziantep Turkey between November 2011 and December 2011 with 2718 primary school/high schools students aged 6-17 years. The SPSS 22.00 was used for the analysis of data. RESULTS: The prevalence of overweight, obesity, abdominal obesity, was 13.2%, 4.2% ,26.4%, respectively. There was a reverse relationship between BMI/WC values and sleep durations (p<0.05). The BMI/WC values were higher in students with computer usage time ≥1 hours in a day (p<0.05). Parental obesity status has an effective role on the WC/BMI values of children (p<0.05). The WHtR was a good predictor of diagnosis on obesity and abdominal obesity (AUC=0.928, p<0.0001; AUC=0.920, p<0.0001; respectively). The optimal cut-off values for obesity and abdominal obesity were detected as 0.5077, 0.4741, respectively. CONCLUSIONS: The WHtR can be used for diagnosis of obesity/abdominal obesity. Parental obesity, short sleep duration and computer use more than one hour per day are risk factors for the development of obesity in children and adolescents.

[Investigation of antinuclear antibodies in chronic hepatitis B patients]. / Kronik hepatit B hastalarinda antinükleer antikorlarin arastirilmasi.

Antinuclear antibodies (ANA) facilitate the diagnosis and evaluation of patients in many systemic autoimmune conditions. Besides, ANA may also be detected in chronic infectious diseases. Although a number of investigations associated with autoantibody positivity in patients with chronic hepatitis C were reported, autoantibody positivity in patients with chronic hepatitis B remain rarely addressed in the literature. The aim of this study was to evaluate the antinuclear antibody (ANA), antimitocondrial antibody (AMA), anti-smooth muscle antibodies (ASMA) and anti-liver-kidney microsomal antigen (LKM) antibodies in chronic hepatitis B patients. Serum samples were obtained from adult patients with chronic hepatitis B diagnosis according to "European Association for the Study of the Liver (EASL)" criteria. Samples were taken from 47 patients (22 female, 25 male) with treatment-naive, histologically-proven chronic hepatitis B. Cases co-infected with HCV and/or HIV or that also had systemic autoimmune diseases were excluded. As a control group, 30 healthy blood donors were included in the study. Autoantibodies, including ANA, AMA, ASMA and LKM were detected with indirect immunofluorescence (IIF) method (Euroimmune, Lubeck, Germany) and evaluated by fluorescence microscope (Eurostar III plus, Germany). Positive results were graded into 4 levels ( "+", "++","+++" and "++++") from weak to strong Positive samples were studied with a immunoblotting method (ANA Profile 3, Euroimmun, AG) for the detection of extractable nuclear antigen (ENA). The positive results were detected in 8 (17%) of the HBV patients while all the samples were negative in the control group. The difference between the groups was significant (p< 0.05). Among the 47 serum samples tested, none of the patients were positive for AMA, ASMA, LKM. ANA was present in eight of the serum samples in which six were female and two were male patients. Among the IIF patterns of ANA positivity, one mixed pattern (homogeneous and nucleolar) and one cytoplasmic anti-golgi antibody pattern were detected. Positivity grade was ''++''. Other positive patterns were nucleolar (two patients), granular (two patients), ribozomal (one patient) and homogeneous (one patient) and positivity grade was ''+''. ENA was detected in three samples. Two of them was granular pattern positive samples. SS-A was borderline (±) in one and SS-B was borderline (±) in one of the samples. In the mixed pattern positive sample, histon was detected as ''+''. Autoantibody positivity between the patient and control groups were statistically significant (p< 0.05). The difference between autoantibody positivity and gender/age was not statistically significant. In conclusion, autoimmune manifestations may be detected in patients with chronic hepatitis B. Low level titer of antibodies such as ANA, AMA, ASMA or LKM may be present in such patients. An increased frequency of these autoantibodies may be associated with non-autoimmune conditions such as chronic viral infection even in treatment-naive patients.

[Atypical serological profiles in hepatitis B infections: investigation of S gene mutations in cases with concurrently positive for HBsAg and anti-HBs]. / Hepatit B enfeksiyonunda atipik serolojik profiller: HBsAg ve anti-HBs birlikte pozitif olgularda S geni mutasyonlarinin arastirilmasi.

Hepatitis B virus (HBV) causes different clinical manifestations, ranging from asymptomatic carriage to fulminant or chronic hepatitis. Serological tests are widely used for the diagnosis of HBV infections to detect viral markers. However, facing with atypical serological profiles in some patients leads to problems in interpreting of the results and management of the patients. The aims of this study were to investigate the atypical serologic profiles seen in patients screened for HBV infection and the S gene mutations in patients with concurrent positivity of HBsAg and anti-HBs. A total of 592 sera from patients (332 male, 260 female; age range: 13-84 years, mean age: 43.9 years) prediagnosed as HBV infection between January to September 2013, and screened for HBV markers (HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc-IgM, anti-HBc-total and HBV-DNA) were included in the study. Of those samples 364 were screened only for HBsAg and anti-HBs markers. S gene mutations were investigated by direct sequencing method in sera which were concurrent positive for HBsAg and anti-HBs. In our study, 5.2% (31/592) of the sera yielded atypical serologic profiles. Of these 13 cases were concurrently positive for HBsAg and anti-HBs; nine were HBeAg positive, anti-HBe and HBV-DNA negative; eight were HBeAg, anti-HBe and HBV-DNA positive; and one was HBsAg and anti-HBs negative, anti-HBe and HBV-DNA positive. The rate of concurrent positivity of HBsAg and anti-HBs was 3.6% (13/364), while 76.9% (10/13) of those cases were also positive for HBV-DNA. DNA sequencing was performed for seven out of 10 samples which were positive for HBsAg, anti-HBs and HBV-DNA, however three samples were not used because of the low amounts. Sequence analysis of seven samples showed S gene mutations in two samples, one was sS143L with sS193L, a HBV vaccine escape mutation, and the other was sP120R, a HBV immune escape mutation. Of the patients 2.7% (10/364) was negative for both HBsAg and anti-HBs; in which nine were HBV-DNA negative and anti-HBe positive, while one was positive for both HBV-DNA and anti-HBe. The rate of concurrent positivity of HBeAg and anti-HBe was found as 1.4% (8/592), and all of these samples were HBV-DNA positive. No single positivity for HBsAg, anti-HBc, anti-HBs or HBV-DNA was not detected in any of the patients. In conclusion, HBsAg and anti-HBs concurrent positivity was the most frequently detected atypical profile in our study (3.6%), and in some (2/7) of these patients S gene mutations were determined.

[The use of polymerase chain reaction in laboratory diagnosis of dermatophytosis]. / Dermatofi tozlarin laboratuvar tanisinda polimeraz zincir reaksiyonunun kullanilmasi.

Dermatophytes are among the common causes of fungal infections in the community. Classical diagnostic tests for dermatophytosis have some disadvantages such as failure of direct microscopy in species differentiation and culture methods being time consuming and having low sensitivity. The aim of this study was to investigate the performance of polymerase chain reaction (PCR) in the identification of dermatophytes directly from the clinical samples and the cultures. A total of 123 samples that comprise 63 skin and 60 nail scrapings obtained from 110 patients (69 female, 41 male; age range: 4-82 years) who were prediagnosed as dermatophytosis, were included in the study. Samples were examined with routine direct microscopy, culture and two different nested PCR (nPCR) protocols. The first was a pan-dermatophyte nPCR protocol targeting chitin synthase gene (CHS-1) of dermatophytes and the second was a nPCR protocol which targets specific ITS-1 genes of Trichophyton rubrum and T.mentagrophytes. Similar PCR methods were also applied to cultivated strains. Sequence analysis was performed for the samples that yielded positive results in pan-dermatophyte nPCR and negative results in T.rubrum/T.mentagrophytes - specific nPCR. Hyphae and/or spore structures were observed in 62 (50%) samples with direct microscopic examination and dermatophytes were isolated in 30 (24%) samples. Twenty-eight of the isolates grown in culture were identified as T.rubrum, and two as T.mentagrophytes with T.rubrum/T.mentagrophytes-specific nPCR protocol. In direct application, 67 (55%) of the clinical samples were found positive with pan-dermatophyte nPCR and 65 (53%) were positive with T.rubrum/T.mentagrophytes-specific nPCR. Samples which were negative in direct microscopic examination were also negative in culture. Nine of them were found positive with pan-dermatophyte nPCR and eight were positive with T.rubrum/T.mentagrophytes-specific nPCR. Two of the 30 samples which were positive in culture were negative in direct pan-dermatophyte nPCR, and one of them was negative in T.rubrum/T. mentagrophytes-specific nPCR. Three samples which were positive by pan-dermatophyte nPCR, gave negative result with T.rubrum/T.mentagrophytes-specific nPCR. Sequence analysis was performed for these three samples and all were identified as T.rubrum. In evaluation of concordance between the methods, the agreement of direct microscopy and culture was moderate (kappa value; κ= 0.48), the agreement of direct microscopy and both protocols of nPCR was high (κ= 0.78) and the agreement of both nPCR protocols with each other was excellent (κ= 0.93). Our data indicated that two different nPCR methods used for the laboratory diagnosis of dermatophytosis yielded higher positivity in less time than the culture method. In conclusion, nPCR was considered to be useful in identification of dermatophytosis from either direct clinical samples or culture-isolated strains.

Vaccination coverage of children aged 12-23 months in Gaziantep, Turkey: comparative results of two studies carried out by lot quality technique: what changed after family medicine?

BACKGROUND: Health care systems in many countries are changing for a variety of reasons. Monitoring of community-based services, especially vaccination coverage, is important during transition periods to ensure program effectiveness. In 2005, Turkey began a transformation from a "socialization of health services" system to a "family medicine" system. The family medicine system was implemented in the city of Gaziantep, in December, 2010. METHODS: Two descriptive, cross-sectional studies were conducted in Gaziantep city center; the first study was before the transition to the family medicine system and the second study was one year after the transition. The Lot Quality Technique methodology was used to determine the quality of vaccination services. The population studied was children aged 12-23 months. Data from the two studies were compared in terms of vaccination coverage and lot service quality to determine whether there were any changes in these parameters after the transition to a family service system. RESULTS: A total of 93.7% of children in Gaziantep were fully vaccinated before the transition. Vaccination rates decreased significantly to 84.0% (p<0.005) after the family medicine system was implemented. The number of unacceptable vaccine lots increased from 5 lots before the transition to 21 lots after the establishment of the family medicine system. CONCLUSIONS: The number of first doses of vaccine given was higher after family medicine was implemented; however, the numbers of second, third, and booster doses, and the number of children fully vaccinated were lower than before transition. Acceptable and unacceptable lots were not the same before and after the transition. Different health care personnel were employed at the lots after family medicine was implemented. This result suggests that individual characteristics of the health care personnel working in a geographic area are as important as the socioeconomic and cultural characteristics of the community.

Epidemiological study of self-reported sleep problems in Turkish high school adolescents.

BACKGROUND: The aim of the present study was to investigate the frequency and correlates of a variety of sleep problems in adolescents. METHODS: A representative school-based sample of 3485 8th-12th graders was selected according to the cluster sampling technique. A sleep questionnaire and the Strengths and Difficulties Questionnaire were completed by the students along with their parents. Logistic regression analysis was used to identify the independent variables of insomnia, parasomnia and excessive daytime sleepiness (EDS). RESULTS: Initiation insomnia, maintenance insomnia, non-restorative sleep (NRS) and EDS were described by 12.4%, 10.7%, 9% and 9.7%, respectively. At least one parasomnia with a frequency above the median was reported by 23.4% (nightmare, 12.8%; sleep terror, 3.6%; sleepwalking, 2.5%; bruxism, 2.5%; and sleep talking, 10.9%). Insomnias and parasomnias were highly associated with each other. Female gender was related to maintenance insomnia, NRS and night terror. Emotional problems correlated with initiation insomnia, maintenance insomnia, NRS, EDS, nightmares and bruxism; hyperactivity/inattention with initiation insomnia, NRS and sleep talking. Conduct problems were associated with NRS, whereas poor school performance was associated with initiation insomnia. CONCLUSION: Self-reported sleep problems were prevalent and highly associated with each other and behavioral and emotional difficulties in Turkish adolescents.

[Seroprevalence of Bartonella henselae and Bartonella quintana in blood donors in Aydin province, Turkey]. / Aydin ili kan donörlerinde Bartonella henselae ve Bartonella quintana seroprevalansi

Bartonella species cause several diseases in humans such as cat stratch disease, bacillary angiomatosis, peliosis hepatis, endocarditis, Carrion disease and trench fever. Cat scratch disease and bacillary angiomatosis cases have already been reported in Turkey. Studies from our region, namely Aydin (a province located at Western Anatolia, Turkey) indicated that mean Bartonella henselae IgG seropositivity rate is 11.5% in risk groups and may reach to 26.5% in pet owners. The aim of this study was to determine the seroprevalence of B.henselae and B.quintana in healthy blood donors in our university hospital in Aydin, for estimating the transmission risk via transfusion. The study was designed as a cross-sectional epidemiological study. A total of 333 samples taken from blood donors (49 female, 284 male) who were sequentially admitted to the blood center of the university hospital, in January 2011 were included in the study. All sera were screened in terms of B.henselae and Bartonella quintana IgG antibodies by using two different indirect immunofluorescent antibody (IFA) commercial kits (Vircell, Spain; Focus, USA). Slides were examined at a final magnification of x400 on fluorescent microscope by two different assigned researchers. Fluorescent intensity was graded between 1+ to 4+, and the samples with fluorescence value of ≥ 2+ were considered as positive. The seropositivity rate of IgG antibodies to B.henselae was found as 3.3% (11/333) in blood donors. This rate was 4.1% in female, and 3.2% in male donors, showing no statistically significant difference between the genders (p= 0.668). B.henselae antibody titers were detected as 1/64 in 6 (1.8%), 1/128 in 4 (1.2%) and 1/1024 in 1 (0.3%) patient. All of the B.henselae IgG positive samples also yielded relatively low positivity for B.quintana IgG, possibly indicating cross reactivity. The fluorescence intensity for different kits used was found to be the same in all but one titer. The results reported by two researchers were found to differ only in the samples graded 1+ or below. However, the evaluation differences between the kits and the researchers did not affect the results. It was concluded that B.henselae infection might be found in the blood donors in our region, thus, a detailed questionnaire prior to blood donation might be helpful to prevent transmission of B.henselae by blood transfusion.

Elevated red blood cell distribution width and inflammation in printing workers.

BACKGROUND: The aim of this study was to estimate the effects of exposure to chemical compounds on systemic biochemical inflammatory markers in printing industry workers. MATERIAL/METHODS: Fifty-eight printing workers from 19 different small- and medium-sized enterprises in the printing sector were investigated. For comparison, 80 healthy workers not subjected to workplace chemicals served as control subjects. RESULTS: No significant differences were observed between the printing workers and control subjects with respect to age, BMI, waist circumference/hip circumference ratio, smoking, and alcohol consumption. Printing workers had significantly higher serum TNF-alpha levels (11.02 ± 5.34 vs. 9.26 ± 3.87 pg/ml, p=0.039), plasma fibrinogen levels (1.74 ± 0.49 vs. 1.38 ± 0.5 mg/dl, p=0.012), and red blood cell distribution width (RDW-SD) (49.77 ± 3.09 vs. 47.3 ± 2.88 p<0.01) compared to control subjects. CONCLUSIONS: Elevation of RDW, serum TNF-alpha, and plasma fibrinogen levels in printing workers may be due to systemic toxic effects of chemical compounds used in this sector. TNF-alpha is an inflammatory cytokine that has a wide spectrum of biological activities, and fibrinogen plays an important role in pathological processes. Some compounds may be carcinogenic or mutagenic. Better designed workplaces and working conditions will help to reduce the hazardous effects of chemical compounds.

Comparison of metabolic syndrome with growing epidemic syndrome Z in terms of risk factors and gender differences.

PURPOSE: The aim of this study is to compare metabolic syndrome with syndrome Z growing epidemic in terms of risk factors, demographic variables, and gender differences in our large cohort at southeastern area in Turkey. METHODS: Data of patients admitted to sleep clinic in University of Gaziantep from January 2006 to January 2011 were retrospectively evaluated. ATP III and JNC 7 were used for defining metabolic syndrome and hypertension. RESULTS: Data of 761 patients were evaluated. Hypertension, diabetes mellitus, coronary artery disease, pulmonary hypertension, and left ventricular hypertrophy were more common in patients with syndrome Z than in patients without metabolic syndrome. Age, waist/neck circumferences, BMI, triglyceride, glucose, and Epworth sleepiness scale score were detected higher, whereas the minimum oxygen saturation during sleep was lower in patients with syndrome Z. Metabolic syndrome was more common in sleep apneic subjects than in controls (58 versus 30 %). Female sleep apneics showed higher rate of metabolic syndrome than those of males (74 versus 52 %). Hypertension, diabetes mellitus, coronary artery disease, and left ventricular hypertrophy were detected higher in males with syndrome Z than in males without metabolic syndrome. Snoring and excessive daytime sleepiness were detected higher in females with syndrome Z than in females without metabolic syndrome. Systemic/pulmonary hypertension, diabetes mellitus, and left ventricular hypertrophy were more common in females with syndrome Z than in females without metabolic syndrome. Complaints of headache and systemic/pulmonary hypertension were more common among females than males with syndrome Z. Female syndrome Z patients had lower minimum oxygen saturation than male patients with syndrome Z. CONCLUSIONS: Metabolic syndrome in sleep apneic patients is more prevalent than in controls. All metabolic syndrome parameters were significantly different among obstructive sleep apneic patients with respect to gender with more severe coronary risk factors in males.

Global Health Professions Student Survey--Turkey: second-hand smoke exposure and opinions of medical students on anti-tobacco law.

AIM: This study, as a part of "the Global Health Professions Student Survey" (GHPSS), aimed to assess medical students' tobacco use, exposure to second-hand tobacco smoke (SHS), and opinions as well as smoking policies at medical faculties in Turkey. METHODS: The study was conducted in 2010 as a school-based survey of third-year students in 12 medical schools. GHPSS uses a standardised methodology for selecting schools (probability proportional to student enrolment size) and data processing. In total, data from 1,217 of third year medical students were analysed. RESULTS: Prevalence of current tobacco use among participating students was 28.5%. Exposure to SHS in the last seven days was 46.9% at home, and 42.2% in other places. Among smokers, over 7 in 10 students reported smoking on medical school premises during the past 30 days and the past year. CONCLUSION: Medical students' exposure to SHS is common and smoking on medical school premises/buildings constitutes a problem. Turkey passed an anti-tobacco law in 2008, yet enforcement of the law must be stronger. In addition, medical schools must evaluate, and likely revise their education curricula to better prepare medical students to advocate tobacco control.

[Investigation of Coxiella burnetii prevalence in women who had miscarriage and their spouses by serological and molecular methods]. / Düsük yapmis kadinlarda ve eslerinde Coxiella burnetii prevalansinin serolojik ve moleküler yöntemlerle arastirilmasi

Coxiella burnetii is the causative agent of the common zoonotic disease known as Q fever. Human infection is mostly maintained by inhalation of contaminated aerosols that originate from infected birth products, milk and urine. Sexual transmission has also been reported. In pregnant women the disease causes abortion during the first trimester, while at later stages it tends to become chronic causing low birth weight babies and premature birth. The aim of this study was to investigate the prevalence of C.burnetii in women who had miscarriages, their spouses and in a control group composed of women with normal delivery by using serological and molecular methods. A total of 89 cases (58 female, 31 male; age range: 21-64 years, mean age: 33.1 ± 7.6 years) were included in the study. Women who had abortion (n= 36) were recruited along with their husbands (n= 31), and 22 women who had normal pregnancy were accepted as controls. Blood and placental tissue samples (after abortion or normal delivery) were collected from all of the female subjects, while blood samples were collected from the males. C.burnetii IgG and IgM antibodies in the sera of patients and controls were analysed by ELISA and indirect fluorescein antibody (IFA) methods, and the presence of C.burnetii DNA was searched in whole blood and placenta samples by using polymerase chain reaction (PCR). In our study, C.burnetii Phase II IgG antibody positivity rates in women who had miscarriages, their spouses and in women with normal delivery were found as 27.8% (10/36), 38.7% (12/31) and 4.5% (1/22), respectively by ELISA, while those rates were detected as 27.8% (10/36), 41.9% (13/31) and 9.1% (2/22), respectively by IFA which was accepted as the reference method. However C.burnetii Phase I IgM, Phase I IgG and Phase II IgM antibodies were not detected in none of the subjects by both methods. The relatively high seropositivity rate in our study group (25/89; 28.1%) was thought to be associated with high rates of livestock breeding in our region. Although C.burnetii IgG seropositivity rate in in women who had miscarriages was higher than women with normal delivery, the difference was not found to be statistically significant (x2= 2.906, p= 0.088). When the results of the women with miscarriages and their spouses were evaluated together, it was detected that C.burnetii IgG antibodies were not determined in the spouses of four seropositive women (two positive with 1/64, two with 1/128 titer); titer was 1/64 in four women and their spouses and two women with 1/128 titer had spouses with 1/64 titer. The determination of high titer phase II IgG positivity in 13% (4/31) of the spouses of women who had miscarriages was of notice. All of the blood (n= 89) and placenta samples (n= 51, 29 were from aborted and 22 from normal delivered women) were negative for C.burnetii DNA by PCR. In conclusion, since livestock breeding is common in our region, in cases with recurrent abortion and premature births, women and their husbands should be screened for C.burnetii.

[Blastoschizomyces capitatus fungemia: three case reports and review of the literature]. / Blastoschizomyces capitatus'un Etken Oldugu Fungemi: Üç Olgu Sunumu ve Literatürün Gözden Geçirilmesi.

Blastoschizomyces capitatus is a rare fungal pathogen that may lead to fatal infections especially in immunosuppressive individuals. In this report, three cases of B.capitatus were presented. The patients were under treatment for acute myeloid leukemia and their blood cultures yielded B.capitatus. The patients clinical conditions deteriorated and they died despite amphotericin B treatment. The isolates were identified by conventional mycological methods and API 20C AUX (Bio-Mérieux, France) system. Antifungal susceptibility test of the strains was performed with Sensititre Yeast One Panel (Trek Diagnostic Systems, USA) and minimum inhibitory concentration (MIC) ranges for amphotericin B, caspofungin, fluconazole, itraconazole, voriconazole, posaconazole, and flucytosine were found as 0.5-1; > 16; 8-16; 0.5; 0.25; 0.5-1 and 0.06-0.25 µg/ml, respectively. Isolated strains were genotyped with RAPD-PCR (Random Amplified Polymorphic DNA-Polymerase Chain Reaction) using Cnd-3, Cnd-4, OPE-03, OPE-18 primers. The strains isolated from the first two cases were found to be genotypically identical, while the strain isolated from the third case was different. Genotypically identical isolates belonged to two patients who were admitted to the hospital with approximately 18 months interval. The other strain with a unique genotype, was isolated from a patient who was admitted to the hospital about two years later than the other two patients. In conclusion, B.capitatus should be considered as an important opportunistic pathogen especially in patients with hematologic malignancies. The data of this study demonstrated that the lowest MIC values for B.capitatus strains were with voriconazole.

Prevalence and correlates of restless legs syndrome in adolescents.

AIM: The aim of this study was to determine the prevalence and correlates of restless legs syndrome (RLS) in adolescents. METHOD: A sleep questionnaire aimed at identifying 'definite' RLS criteria (also including the Strengths and Difficulties Questionnaire and the Epworth Sleepiness Scale) was completed by 3304 high school adolescents aged 15 to 18 years (49% male; 51% female) in Gaziantep, Turkey. The diagnosis of RLS was confirmed by face-to-face or phone interviewing. The χ² or Student's t-test and logistic regression tests were used for statistical evaluation. RESULTS: 'Definite' RLS was diagnosed in 3.6% of participants. RLS symptoms were reported to occur on more than one occasion per week (frequent RLS) in 2% of participants and to make it to difficult to fall asleep or stay asleep (RLS with sleeping difficulty) in 1.7%. The prevalence of the combination of frequent symptoms and sleeping difficulty was 0.8%. Logistic regression analysis revealed that RLS was independently associated with nocturnal bed-wetting (4.2% vs 0.8%; p=0.004), sleeping difficulty (47% vs 32%; p=0.011), Epworth Sleepiness Scale score (4.9 vs 3.9; p=0.036), hyperactivity/inattention (25% vs 14%; p=0.049), awakening with discomfort in the legs (51% vs 30%; p<0.001), and parents with RLS-implying symptoms (56% vs 38%; p=0.006). RLS with sleeping difficulty was associated with hyperactivity/inattention (p=0.007); frequent RLS was associated with arm restlessness (p=0.006). INTERPRETATION: 'Definite' RLS is not rare in adolescents; furthermore, it may be accompanied by several comorbid conditions that can impair quality of life in adolescents.

Evaluation of resistance mechanisms and serotype and genotype distributions of macrolide-resistant strains in clinical isolates of Streptococcus pneumoniae [corrected] in Aydin, Turkey.

Macrolide resistance mechanisms in 89 Streptococcus pneumoniae strains isolated from several clinical samples between February 2007 and May 2009 were investigated. Erythromycin resistance was noted in 35 (40%) S. pneumoniae strains. In these strains, the most frequent resistance phenotype was cMLS(B) (74%), and the most frequent resistance genotype was ermB (82%). Both ermB and mefA genes were positive in 20% of macrolide-resistant strains. While no resistance to vancomycin, linezolid and telithromycin was noted in 89 S. pneumoniae strains, 12 (13%) strains were penicillin resistant, 26 (30%) strains were clindamycin resistant, 35 (40%) were azithromycin resistant, 32 (36%) strains were tetracycline resistant, and 1 (1%) strain was levofloxacin resistant. The serotype distribution of 35 macrolide-resistant S. pneumoniae strains revealed that the most frequent serotype was serogroup 19 (45%). Multidrug resistance was present in 19 (86%) of 22 strains carrying only the ermB resistance gene. No clonal dissemination was noted in the macrolide-resistant pneumococcal strains. These findings suggest that macrolide resistance rates, resistance phenotype and genotype, as well as resistant serotypes of S. pneumoniae strains should be continuously monitored in our country.

Understanding sleep habits and associated factors can help to improve sleep in high school adolescents.

We aimed to describe the sleep profiles and associated factors of poor sleep in adolescents. We gave a sleep questionnaire and Strengths and Difficulties Questionnaire to 3,441 high school adolescents (15-18 years) in Gaziantep, Turkey. Adolescents reported a requirement of 10.4 hours of sleep on average to feel their best during the day. However, total night sleep time (TNST) was 7.42 +/- 1.48 hours on school nights and 9.40 +/- 1.37 on non-school nights. TNST of > or =9 hours on both school nights and non-school nights was detected in 8.2%. Average bedtime and wake-up time were 23:16 and 06:41 on school nights. Bedtime was approximately 30 minutes later on non-school nights. The shift in wake-up time was nearly 2.5 hours. Statistical analysis by logistic regression model showed that TNST was most significantly correlated with school start time (morning versus afternoon) irrespective of school or non-school nights. TNST on school nights was negatively correlated with age, passive smoking at home, drinking tea/coffee, and conduct problem, whereas TNST on non-school nights was negatively correlated with the mother's education, male gender, body mass index, number of household members, and having a television in the bedroom. Daytime napping (21.3%) was associated with morning start time, age, female gender, and mother's education. Sleep-onset insomnia with sleep latency >30 minutes (21%) was not related to age or gender; however, it was associated with abnormal breathing during sleep. The findings revealed that inadequate sleep is quite prevalent among high school adolescents. Given the fact that most of the associated factors are modifiable, inadequate sleep is not inevitable for adolescents.