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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.)

Objectives: Numerous vaccination studies are conducted to protect against COVID-19 infection, and preclinical and clinical studies are still ongoing worldwide. During this extraordinary period, the necessity to perform COVID-19 vaccine studies and immunization programs together has emerged. Vaccine Adverse Effects (VAEs) need to be documented quickly. We aimed to determine the VAEs and to compare the frequency of VAEs between groups according to sociodemographic characteristics after the inactivated vaccine (CoronaVac) was administered to healthcare workers (HCWs) in Turkey., Methods: An online questionnaire was delivered to 4040 volunteer HCWs across the whole country who were vaccinated with CoronaVac. Sociodemographic characteristics, medical history, history of COVID-19 infection, and VAEs occurring after the first and second doses of the inactivated vaccine were evaluated., Results: The most common local and systemic VAEs after first and second doses of the COVID-19 vaccine were reported as, pain at the injection site (37.9%; 37.6%), headache (21.5%; 16.8%), fatigue (18%; 15%), drowsiness (9.6%; 8.2%), back pain (8.8%; 8.2%), nausea (6.3%; 4.8%), and joint pain (4.7%; 4.7%). Individuals with a history of allergies (generalized or vaccine-related) and females had a higher rate of VAE. Participants aged 60 and over reported less frequent VAEs., Conclusion: It is extremely important to identify and document the VAEs occurring in the early postvaccination period in different groups of the community. These initial findings may provide reassurance to healthcare providers and vaccine recipients and promote confidence in the safety of this inactive COVID-19 vaccine, however longitudinal follow-up studies are recommended.

Objectives: Our objective was to analyze characteristics, risk factors, and incidence of de novo malignancies after liver transplant., Materials and Methods: The hospital records of 557 patients who underwent liver transplant were analyzed from the point of de novo malignancy development. We evaluated the demographic features and survival of these patients retrospectively., Results: The research covered 429 patients, 9 (2%) of whom developed de novo malignancy. All of these patients were male (100%), and their mean (SD) age was 51.33 (4.69) years (range, 45-65 y). Indications for transplant included alcohol related in 4 cases, chronic hepatitis B in 2 cases, chronic hepatitis B and C in 1 case, chronic hepatitis B and D in 1 case, and chronic hepatitis C and alcohol-related cirrhosis in 1 case. The mean (SD) time from transplant to cancer diagnosis was 63.41 (37.10) months (range, 17-122 mo). The types of tumors were lung cancer, lymphoma, neuroendocrine tumor of lung, nasopharyngeal cancer, and squamous cell carcinoma of the skin. Seven cases received chemotherapy with or without radiotherapy. Two cases received surgery and radiotherapy. One patient underwent surgical treatment. One patient died before treatment was started., Conclusions: In recent years, improvements in surgical techniques and immunosuppressive therapies have helped prolong survival of patients who undergo liver transplant. However, this also has led to a rise in the incidence of long-term complications such as de novo malignancy. These patients are more likely to develop de novo malignancy than the general population, for which chronic immunosuppression is identified as a major risk factor. Early diagnosis and treatment of de novo malignancies can help obtain better prognosis and higher survival rates in these patients.

Objective: The study aimed to investigate whether there is any association of anterior knee pain and knee function with chondromalacia stage and patellofemoral alignment in patients with anterior knee pain for over a month and with chondromalacia patellae (CMP) detected by magnetic resonance imaging (MRI)., Materials and Methods: We reviewed the medical records of 38 patients who underwent a knee MRI examination and were diagnosed with chondromalacia based on the MRI. Knee MRI images were evaluated by a radiologist for chondromalacia staging. Patients were divided into two groups as early stage (stage 1-2) and advanced stage (stage 3-4) chondromalacia. Patients' demographical data (age, sex, and occupation), clinical features, physical examination findings and patellofemoral pain severity scale, kujala patellofemoral scoring system, and functional index questionnaire scores were obtained from their medical records. Trochlear sulcus angle, sulcus depth, lateral patellofemoral angle, patellar translation, and Insall-Salvati index were measured using the MRI images., Results: The mean patient age was higher in the advanced stage CMP group compared to the early stage CMP group (p=0.038). There was no statistically significant difference regarding other demographical data (p>0.05). MRI measurement parameters did not show difference between the groups (p>0.05). Patients in the advanced stage CMP group had higher patellofemoral pain severity score, lower kujala patellofemoral score, and lower functional index questionnaire score compared to the early stage CMP group. The differences were statistically significant (p=0.008, p=0.012, and p=0.026, respectively)., Conclusion: As chondromalacia stage advances, the symptom severity worsens and knee functions decline; however, MRI measurements do not show difference between early and advanced stage CMP patients., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

The objectives of this study were to assess the level of knowledge on HPV and HPV vaccination, and to determine vaccination attitude among Ege university students in Izmir, Turkey. A cross-sectional survey was conducted in first-year English preparatory class. Systematic cluster sampling was applied and 717 (72.6%) of students registered to the 54 classes in 17 different faculties/schools were contacted. Data were collected between April 30 and May 18, 2010, through a self-reported questionnaire including 40 questions. A knowledge score was calculated by summing up the number of correct answers given to the 12 knowledge questions. Analyses were done using t-test, chi-square test, univariate and multivariate logistic regression. The mean age of participants was 19.7±1.5 and 445 (62.1%) were female. Overall, 132 (18.9%) had experienced sexual intercourse, but only 7 of them were female. Among participants, 24.1% had heard of HPV and 25.1% about HPV vaccine. The knowledge item with the highest correct answer rate (32.3%) was that HPV caused cervical cancer. The mean total knowledge score was remarkably poor (1.8±2.6 over 12 items), with 59.6% of respondents having zero as their score. There was no difference in mean knowledge scores between males and females. Higher income, history of sexual intercourse and higher knowledge score were significant factors increasing HPV and vaccine awareness for the whole group, adjusted for gender. Genital cancer history in the family significantly increased awareness, but only among girls. Only three students (0.4%) had already been vaccinated, all being female. Among females, 11.6% intended to be vaccinated vs. 10.1% for males, without any significant difference. Visiting a gynaecologist/urologist in the last three years, a history of genital cancer in the family, vaccine awareness, a higher total knowledge score, and being from the East of Turkey were significant predictors of a positive vaccination attitude. HPVvaccination still remains as a 'hot medical topic' in Turkey, since it hasn't yet become a popular health issue. Based on their age of first intercourse, first year at the university seems to be appropriate timing to inform Turkish girls, whereas it is a bit late for boys. Thus, integration of HPV education into secondary/high school curricula should be considered.