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Kaz&inodot;m K&inodot;ratl&inodot;,1 Muhammet Bulut,2 Mukhtar Abdullahi Ali,1 Murat Aysin,3 Ahmed Mohamed Ali,1 Ibrahim Mohamed Hirsi,4 Ahmed Muhammad Bashir5 1Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Mogadishu, Somalia; 2Sancaktepe &Scedil;ehit Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Radiology, Istanbul, Turkey; 3Balikesir University Faculty of Medicine, Department of Public Health, Balikesir, Turkey; 4Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Pediatrics, Mogadishu, Somalia; 5Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Internal Medicine, Mogadishu, SomaliaCorrespondence: Kaz&inodot;m K&inodot;ratl&inodot;, Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Mogadishu, Somalia, Email drkazimkiratli@gmail.comIntroduction: Lymphadenopathies, which can be caused by infections, malignant diseases, autoimmune disorders, and many other diseases, pose a challenge to clinicians in sub-Saharan Africa, as well as all over the world. The purpose of this research was to identify the clinical and diagnostic characteristics of Somalian patients suffering from swollen lymph nodes.Methods: Under the purview of this study, the diagnoses, patient clinical courses, and treatment outcomes were ascertained retrospectively by analyzing the biochemical, microbiological, radiological, and pathological data of the cases in all age groups who underwent therapy for lymphadenitis at Mogadishu Somali Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital between January 2016 and September 2023.Results: During the study period, 317 patients were followed up, with 53.3% of the patients as female, 46.7% as male, 28.1% as pediatric, 63.1% as adult, and 8.8% were elderly patients. With 58.7% of diagnoses, tuberculous lymphadenitis was the most common, pursued by malignant causes (21.8%). The most commonly affected lymph node was the cervical region, the symptom detected was lymph node swelling, the radiological method used was ultrasonography, and the biopsy method was fine needle aspiration biopsy. It was determined that benign conditions, including tuberculosis were more common in pediatric group and younger adults (p< 0.001), and weight loss was a significant in terms of malignancy and tuberculosis (p< 0.001). White blood cell value (p< 0.001), erythrocyte sedimentation rate (p< 0.001), and C-reactive protein (p:0.001) revealed differences across the diagnostic groups.Conclusion: Almost two-thirds of patients were diagnosed with tuberculosis lymphadenitis. Our finding revealed tuberculosis as the commonest cause of lymphadenopathy followed by malignant causes. Therefore, before screening for malignant causes, tuberculosis should be the first diagnosis considered in Somalia, particularly in a patient presenting with weight loss and swelling of the lymph nodes.Keywords: immunization, lymphadenopathy, Somalia, sub-Saharan Africa, tuberculosis

Kaz&inodot;m K&inodot;ratl&inodot;,1 Ibrahim Mohamed Hirsi,2 Burak Çelik,3 Murat Aysin,4 Ahmed Mohamed Ali,1 Selim Turfan,5 Hakan Zeybek6 1Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Mogadishu, Somalia; 2Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Pediatrics, Mogadishu, Somalia; 3Health Sciences University, Fatih Sultan Mehmet Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey; 4Balikesir University Faculty of Medicine, Department of Public Health, Balikesir, Turkey; 5Giresun Training and Research Hospital, Department of Emergency Medicine, Giresun, Turkey; 6Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Orthopedics and Traumatology, Mogadishu, SomaliaCorrespondence: Kaz&inodot;m K&inodot;ratl&inodot;, Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Mogadishu, Somalia, Tel +252 611 522 947, Email drkazimkiratli@gmail.comIntroduction: Despite the efforts and support of the World Health Organization and other international organizations to reduce the incidence of the disease, tetanus is still an acute condition with serious consequences, including death. The purpose of this study was to assess the tetanus patients we have been monitoring over the past two years in Somalia, a country with a protracted civil conflict, extreme poverty, and restricted access to hospital, social security, and public health facilities.Methods: This study includes tetanus patients who were admitted to the Recep Tayyip Erdo&gbreve;an Training and Research Hospital in Mogadishu, Somalia, Turkey between January 1, 2022, and November 1, 2023. Hospitalization, diagnosis, treatment, complications, death, and test results were all looked at in addition to the patients’ sociodemographic details.Results: The average age of the 196 patients was 10 years, with males making up 67.9% of the total (min-max: 7 days-71 years). Acute injury was the cause of 53.1% of tetanus cases, with the legs being the most frequently injured body area (28.8%). A mean duration of stay of 11 days was observed for 82.1% of the patients who were monitored in the hospital (min-max: 1– 38 days). The total fatality rate was 14.3%, and 85.7% of patients had never had a tetanus vaccination. The group with severe tetanus had higher rates of intensive care admission (p< 0.001), generalized/neonatal tetanus (p< 0.001), high non-vaccination rate (p:0.011), antibiotic usage (p< 0.001), and a positive blood culture (p< 0.001). Almost all of the complications (p< 0.001) and all of the deaths (p< 0.001) were in the severe group.Conclusion: In sub-Saharan Africa, immunization rates are regrettably still insufficient despite the tetanus vaccine’s low cost and great effectiveness. Public education and encouragement on anti-vaccination must continue alongside the enhancement of vaccination programs. Otherwise, low- and middle-income countries will still be plagued by this illness, which has been overlooked in high-income nations.Keywords: immunization, Somalia, Sub-Saharan Africa, tetanus, vaccination

Kaz&inodot;m K&inodot;ratl&inodot;,1 Murat Aysin,2 Mukhtar Abdullahi Ali,1 Ahmed Mohamed Ali,1 Hakan Zeybek,3 &Scedil;ükran Köse4 1Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Mogadishu, Somalia; 2Balikesir University Faculty of Medicine, Department of Public Health, Balikesir, Turkey; 3Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Orthopedics and Traumatology, Mogadishu, Somalia; 4Dokuz Eylul University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, TurkeyCorrespondence: Kaz&inodot;m K&inodot;ratl&inodot;, Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Mogadishu, Somalia, Tel +252611522947, Email drkazimkiratli@gmail.comIntroduction: Historically, antimicrobials have been used to treat microbial illnesses in humans and animals. But throughout this time, antibiotics that had been successful against particular microorganisms started to lose their effectiveness due to rising inappropriate use brought on by ignorance, negligent attitudes, and improper methods. Our goal in conducting this study was to ascertain the knowledge, attitudes, and practices of doctors with relation to the use of antibiotics in light of the growing global and Sub-Saharan African problem of antimicrobial resistance.Methods: In a tertiary hospital in Mogadishu, Somalia, a cross-sectional survey study was carried out to assess experts’ and research assistants’ knowledge, attitudes, behavior, awareness, and practices regarding the use of antibiotics and antibiotic resistance. A questionnaire consisting of 2 sections and 22 questions was applied to the participants on a voluntary basis.Results: Among the 202 doctors that participated in the study, 49 (24.3%) were specialists, and 153 (75.7%) were assistants. Prescriptions for one to ten antibiotic boxes per week on average were reported by 146 respondents (72.3%). Of the physicians, just 27 (13.4%) did not require assistance when prescribing an antibiotic. The most often accessed sources of support were experts in infectious diseases (43.1%) and national/international antimicrobial guidelines (32.2%). The top three factors contributing to antibiotic resistance in Somalia include misuse of antibiotics (61.4%), unnecessary prescriptions written by doctors (44.6%), and an absence of infectious disease specialists in most institutions (44.1%).Conclusion: As an alarming level of antimicrobial resistance has been observed globally in recent years, the results of our survey will help educate our doctors by gauging their perceptions, attitudes, and knowledge about rational antibiotic use in Sub-Saharan Africa. This will provide better patient outcomes.Keywords: antimicrobial resistance, Sub-Saharan Africa, microorganism, prescription, Infectious disease, knowledge

Background: So many risk factors for mobilization failure have been described so far. We aimed to identify the risk factors and search the possible effects of bone marrow fibrosis (BMF), CD56, c-myc, and cyclinD1 expression on mobilization., Methods: We evaluated 189 patients with MM who were admitted for stem cell mobilization before autologous stem cell transplantation (ASCT) between 2015 and June 2021. Clinical, laboratory, treatment features, and survival outcomes were compared in patients who were successfully mobilized and who were not., Results: Mobilization failure rate was 11.1 % (21) in our study group. Male gender, mobilization with only G-CSF, history of previous ASCT, lenalidomide exposure, and 2 lines of chemotherapy before stem cell mobilization were observed more commonly in mobilization failure group. There is no relationship between mobilization failure and BMF, CD56, c-myc, and cyclin D1 expression status in patients who received either only G-CSF or G-CSF+ chemotherapy for mobilization. Overall survival (OS) was not different in groups of patients who were successfully mobilized and who were not. Neutrophil engraftment was faster in patients who were transfused > 5 × 10 6 /kg stem cells (p = 0.015). ECOG performance status (p = 0.004), c-myc expression (p = 0.005), lenalidomide therapy before mobilization (p = 0.032), and mobilization with G-CSF+chemotherapy was found to be predictive factors for OS., Conclusion: Even though we could not find any predictive value of CD56, c-myc, and cyclin D1 expression on mobilization, c-myc was found to be associated with low OS. Further studies with large and homogenous study population would be more informative., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aims: Individuals with a higher De Ritis ratio (aspartate transaminase/alanine transaminase) and neutrophil-to-lymphocyte ratio (NLR) have an inferior survival in varied malignancies. To our knowledge, the prognostic potential of the De Ritis ratio and NLR to predict the survival in nonmetastatic glioblastoma multiforme (GBM) patients remains unclear. In this study, we aimed to explore the prognostic power of the De Ritis ratio and NLR in patients with nonmetastatic glioblastoma multiforme., Methods: Data of 262 patients with glioblastoma multiforme have been retrospectively analyzed. Their age, gender, tumor characteristics, AST/ALT ratio, NLR and hemogram values, including age at diagnosis and date of diagnosis were recorded., Results: The median survival time of the study group was 21 months (95% CI: 19‒23 months). The first-year and second-year survival rates were 73.0% and 40.5%, respectively. The univariate analysis revealed that the correlation of survival with age, gender, left/right location of tumor, mean platelet volume and De Ritis ratio did not reach the level of significance. The univariate analysis of the prognostic potential of NLR indicated that a 1-unit increase in NLR value translates to a 1.05 times higher risk of death (95% CI: 1.01‒1.09)., Conclusion: The results of this study lead to the observation that NLR value can serve as an effective prognostic marker in predicting the outcomes of patients with glioblastoma multiforme. It can be positioned as an easily accessible and cost-effective biomarker for establishing appropriate therapeutic strategies (Tab. 2, Fig. 1, Ref. 20).

Introduction: COVID-19 pandemic has led to an increased rate of intensive care unit (ICU) stays. Intermediate care units (IMCUs) are a useful resource for the management of patients with severe COVID-19 that do not require ICU admission. In this research, we aimed to determine survival outcomes and parameters predicting mortality in patients who have been admitted to IMCU., Materials and Methods: Patients who were admitted to IMCU between April 2019 and January 2021 were analyzed retrospectively. Sociodemographics, clinical characteristics, and blood parameters on admission were compared between the patients who died in IMCU and the others. Blood parameters at discharge were compared between survived and deceased individuals. Survival analysis was performed via Kaplan-Meier analysis. Blood parameters predicting mortality were determined by univariate and multivariate Cox regression analysis., Results: A total of 140 patients were included within the scope of this study. The median age was 72.5 years, and 77 (55%) of them were male and 63 (45%) of them were female. A total of 37 (26.4%) patients deceased in IMCU, and 40 patients (28.5%) were transferred to ICU. Higher platelet count (HR 3.454; 95% CI 1.383-8.625; p =0.008), procalcitonin levels (HR 3.083; 95% CI 1.158-8.206; p =0.024), and lower oxygen saturation (HR 4.121; 95% CI 2.018-8.414; p < 0.001) were associated with an increased risk of mortality in IMCU. At discharge from IMCU, higher procalcitonin levels (HR 2.809; 95% CI 1.216-6.487; p =0.016), lower platelet count (HR 2.269; 95% CI 1.012-5.085; p =0.047), and noninvasive mechanic ventilation requirement (HR 2.363; 95% CI 1.201-4.651; p =0.013) were associated with an increased risk of mortality. Median OS was found as 41 days. The overall survival rate was found 40% while the IMCU survival rate was 73.6%., Conclusions: IMCU seems to have a positive effect on survival in patients with severe COVID-19 infection. Close monitoring of these parameters and early intervention may improve survival rates and outcomes., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Hale Bülbül et al.)