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Objectives: The aim of this study is to determine the adaptation process of international medical school students to university life in Turkey. Methods: The mixed method design study, including all the international students (n=127) studying at Ege University School of Medicine, is employed. Qualitative data were collected from 23 students selected by purposive sampling technique. Two instruments were utilized for collecting data: Student Adaptation to College Questionnaire (SACQ) and Brief COPE. Focus group interviews were performed for qualitative data collection. Results: The mean SACQ score of the medical students was found to be 407.44 (SD=68.29). The Academic Adjustment category included the themes of educational goals, different studying habits, accommodation, academic advisor, and scholarship. The Social Adjustment category included the themes of social interaction and support, differences, longing for family, discrimination and its effects on social life. The Personal/Emotional adjustment category included themes of psychological and physiological health problems. The Goal Commitment/Institutional Attachment category included themes of academic and social adaptation as well as the student' communication with education management. Conclusions: This study identifies to light critical issues in supporting international students with adaptation problems to university life in Turkey. It is clear that revising the content of education programs to enable international exchange is not sufficient enough by itself to meet the needs of international students. [ABSTRACT FROM AUTHOR]

Two-thirds of complement C3 glomerulopathy (C3G) recur after transplantation and commonly cause graft loss. There is not a standard treatment protocol for these cases. We present a kidney transplant patient with recurrent C3G who was successfully treated with eculizumab. Nephrotic proteinuria and hematuria occurred and creatinine levels increased after transplantation. A graft biopsy revealed recurrent C3G. The patient was administered 250 mg pulse methylprednisolone for 3 days and had 9 sessions of plasmapheresis. Since elevated creatinine levels and proteinuria persisted, eculizumab was instituted. A complete remission was observed after 9-month maintenance eculizumab treatment. Eculizumab may be a potentially effective option in kidney transplant patients with recurrent C3G unresponsive to other treatment modalities. [ABSTRACT FROM AUTHOR]

BACKGROUND: Gamma-glutamyl transferase (gamma-GT) is an enzyme present in the cell membranes, which is used as a new biomarker in prediction of inflammation, myocardial infarction, stroke, and cardiac death. The objective of this study was to investigate the relationship between serum levels of gamma-GT and cardiovascular disease in subjects with COPD and the correlation between serum gamma-GT level and degree of the limitation of air flow in COPD. METHODS: A total of 70 subjects (46.1%) with Global Initiative for Chronic Obstructive Lung Disease (GOLD) A-B and normal function of the liver and biliary tract (mean age [IQR] 59 [51.75-70] y; 77.1% men) and 82 subjects (53.9%) with GOLD C-D (mean age [IQR] 59 [56-66] y; 79.3% men) participated. Serum levels of gamma-GT and C-reactive protein were measured and compared between the 2 groups. RESULTS: The serum level of gamma-GT was found to be significantly (P < .001) higher in the GOLD stage C and D group than in the GOLD stage A and B group. Mean values of C-reactive protein, aspartate aminotransferase, and alanine aminotransferase did not differ significantly between the 2 groups. The prevalence of cardiovascular disease was statistically significantly higher in subjects in the GOLD stage C and D group than in the GOLD stage A and B group (P < .001). The serum level of gamma-GT was higher in subjects with COPD with coexisting cardiovascular disease than in those without cardiovascular disease (64 units/L [interquartile range 57-72.5] vs 17.5 units/L [interquartile range 10-25]). CONCLUSIONS: Our results demonstrate that serum levels of gamma-GT may be helpful in grading the severity of COPD as the marker of oxidative stress, and there is a strong correlation between high serum levels of gamma-GT and cardiovascular events in subjects with COPD. [ABSTRACT FROM AUTHOR]

Investigations on soil and freshwater acidification are usually focused on well-aerated systems. This study deals with the role of reductive processes for the neutralization of acid soil solution within helocrene springs. Two toposequences consisting each of three profiles (forest soil, margin of fen, fen) were established to study the chemistry of the solid phase (soil pH, CEC, pedogenic Fe- and Al-oxides) and the soil solution in two small spring catchments on three dates during 1991 and 1992. Despite high acid inputs and acidified forest soils the pH of the spring outflow is near neutral, and the soil solid phases of the spring fens are not acidified. The results support the following hypothesis: Aluminum with its corresponding anion sulfate is leached with the soil solution into the water-saturated fens. Dissimilatory iron and sulfate reduction take place within the fen and generate alkalinity. Reduced iron either reacts with sulfide to form pyrite or migrates within the fen profile and precipitates in the uppermost, oxic horizons, consuming part of the generated alkalinity. Due to the higher pH values in the fens the incoming aluminum precipitates releasing acidity. The alkalinity generated exceeds the amount of acidity released by oxidation and precipitation of iron and the precipitation of aluminum. A balance of alkalinity consuming and alkalinity generating processes based on solid phases showed that iron and sulfatereduction can account for at least 67% of the neutralization of acidity entering the fen of one of the catchments. Due to shorter water retention times and higher discharge these processes are of minor importance in the other catchment. [ABSTRACT FROM AUTHOR]

Hantaviruses are single-stranded RNA viruses. They are transmitted to humans by rodents and insectivore hosts. Some Hantavirus subtypes are the causative agents of haemorrhagic fever with renal syndrome (HFRS), which is characterized by fever, thrombocytopenia, and acute kidney injury. Hantavirus infection is difficult to diagnose due to its non-specific clinical symptoms. Causes of acalculous cholecystitis are severe trauma or burn, surgery, long-term starvation and some viral infections. It is very rare for Hantavirus to cause acute acalculous cholecystitis. The treatment of acute acalculous cholecystitis is usually directed towards its symptoms. A 22-year-old male forest worker was admitted to our emergency outpatient clinic with the complaints of fatigue, oliguria, fever, abdominal pain and vomiting. After the clinical and laboratory examinations, HFRS and acute cholecystitis secondary to Hantavirus infection were diagnosed. The patient's condition and clinical findings improved after supportive treatment. Hantavirus infection should be considered in patients with acute kidney injury, cholecystitis and thrombocytopenia (Fig. 2, Ref. 10). Keywords: Hantavirus, acute kidney injury, acalculous cholecystitis, thrombocytopeni.

Purpose: Hepatocellar carcinoma (HCC) remains a major health problem being the third leading cause of deaths due to cancer worldwide. Because HCC is known to be highly resistant to conventional systemic therapies, single-agent or combination of systemic therapies have been investigated. Today, sorafenib, a multikinase inhibitor, is the only approved systemic agent for the first line treatment of advanced HCC. In this study, we aimed to investigate the influence of different concentrations of cisplatin, doxorubicin, pegylated doxorubicin (PLD), oxaliplatin and gemcitabine by applying these agents either single or in combinations on mahlavu cell line., Methods: HCC mahlavu cell line was used for the experiments. Cell death was measured by flow cytometry at 48 hrs after incubation with various concentrations (0.1 μg/ml, 1.0 μg/ml and 10 μg/ml) of the drugs., Results: Cell death due to gemcitabine was found to be significantly higher than cell deaths caused by the other single agents including cisplatin, oxaliplatin, doxorubicin and PLD (p<0.001, p<0.001, p<0.001 and p=0.0049, respectively). There was no significant difference between gemcitabine and both the gemcitabine combination with doxorubicin and PLD (p=0.992 and p=0.441, respectively)., Conclusion: This is a preliminary analysis evaluating the effect of the conventional chemotherapeutic agents on mahlavu cell line in vitro. The findings of this study suggest that gemcitabine-based therapies keep on being the prefered therapeutic approach for the treatment of HCC.

Physicians' prescribing practices impact greatly on rational drug use and expenditure. The aim of this cross-sectional study is to determine primary health care physicians' knowledge on rational antibiotic use in Izmir. A total of 475 physicians from primary health care centres (response rate: 100%) participated in this study. Prescription information of physicians was collected with a standardized questionnaire. It was detected that 48.4% of the physicians have prescribed antibiotics in one of each three (30%) prescriptions, while 19.4% in one of each five prescriptions. The most frequent reason for antibiotic prescription was the upper respiratory tract infections (URTI). The rate of prescribing antibiotics for URTI according to the results of throat culture or blood count was 11.8%. The most commonly prescribed antibiotics were penicillins for URTI, quinolones for urinary tract infections and trimethoprim-sulphametoxazole for gastrointestinal tract infections. The rate of appropriate prescribing practices was high among physicians in the age group 25-29 in comparison to older age groups (X2: 14.855; p: 0.01). Only 32.2% of the physicians correctly indicated the antibiotics with drawbacks in newborn period. 6.5% of the participants gave no correct antibiotic choices for any of the infections indicated. It was stated by 89.6% of the participants that they would benefit from continuous education on rational antibiotic use. The data obtained revealed that primary health care physicians who had high antibiotic prescription rates, lacked information about rational antibiotic use and continuous professional education and development programmes related to this topic is a prerequisite.