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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

Semiha Çelik Ekinci,1 Kaz&inodot;m K&inodot;ratl&inodot;2 1University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey; 2Katip Celebi University, Ataturk Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, TurkeyCorrespondence: Kaz&inodot;m K&inodot;ratl&inodot;, Katip Celebi University Ataturk Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey, Email drkazimkiratli@gmail.comIntroduction: The most essential way to prevent the transmission of Human Immunodeficiency Virus (HIV), one of the most important communicable diseases, is to enhance public knowledge. Our study aimed to assess whether there were any changes in HIV knowledge following the onset of the Covid-19 pandemic.Methods: In Turkey, information stands were established in Izmir on 1 December 2017 and in public locations in both Istanbul and Izmir on 1 December 2021 to providing education the public about HIV/AIDS. Prior to the educational intervention, a voluntary information survey was administered to 618 people aged 18 and older (149 pre-pandemic and 469 post-pandemic) The questionnaire consisted of seven questions designed to assess participants’ knowledge about HIV. Participants were stratified by gender, marital status, and educational status, and responses were compared before and after the pandemic. Patient characteristics were reported as n (percentage) or mean ± SD (standard deviation) for categorical and continuous variables, respectively. Nominal variables were reported as percentages and compared using two-tailed Chi-square or Fisher’s test, where appropriate. A p-value of less than 0.05 was considered statistically significant.Results: Comparing responses to all questions, the correct response rates before and after the pandemic were 57.62% and 73.77%, respectively. The rates for these questions were as follows: 59.29% and 79.63% for females, 47.31% and 78.57% for males; 48.78% and 75.47% for married individuals, 52.08% and 80.89% for single individuals; 39.38% and 56.43% for primary school graduates, 58.13% and 72.24% for secondary school graduates, 52.16% and 85.11% for university graduates, and 41.56% and 83.44% for master’s degrees.Conclusion: Compared to the pre-pandemic period, the level of HIV knowledge of the participants increased in the post-pandemic period. The increase in knowledge levels was more significant in men than in women and in single individuals than in married individuals. The greatest difference in terms of education status was observed among those with a master’s degree or higher.Keywords: AIDS, COVID-19, HIV, knowledge

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

&Scedil;ükran Köse,1 Canberk Y&inodot;lmaz,2 Kaz&inodot;m K&inodot;ratl&inodot;,3 Ça&gbreve;lar Çelebi,4 P&inodot;nar Akan,5 Meltem Kumas Kulualp,6 Soner Duman,7 Osman Y&inodot;lmaz8 1Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; 2Department of Pediatrics, Faculty of Medicine, Health Sciences University, Izmir, Turkey; 3Department of Infectious Diseases and Clinical Microbiology, Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Mogadishu, Somalia; 4Department of Medical Biology, Institute of Health Sciences, Ege University, Izmir, Turkey; 5Department of Medical Biochemistry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; 6Department of Histology and Embryology, Faculty of Veterinary Medicine, Dokuz Eylul University, Izmir, Turkey; 7Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Turkey; 8Department of Laboratory Animal Science, Institute of Health Sciences, Dokuz Eylul University, 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 +252 611 522 947 ; +90 537 252 84 86, Email drkazimkiratli@gmail.comObjective: Many of the vaccines developed for COVID-19 have been approved for clinical emergency use before their safety and preclinical studies have been completed. The main aim of this study was to investigate the effects of an inactivated SARS-CoV-2 virus vaccine (Vero cells) on renal function in Balb/C Albino mice.Methods: 21 healthy, 6– 8 week old BALB/c male mice were divided into three equal groups, and 0.10 mL of intramuscular saline equal to the vaccine dose volume was administered to the first group. To the second group, a single dose of 0.10 mL 120 U of Vero cell inactive SARS COV-2 vaccine was administered intramuscularly. Group 3 received two consecutive doses of 0.10 mL 120 U intramuscular Vero cell inactive SARS COV-2 vaccine, 14 days apart. After administration, the clinical status, fecal and urine status, nutritional status and kidney histopathology of the mice were evaluated.Results: It was determined that no acute toxic symptoms were observed in the mice administered the vaccine, they were in good condition, and there was no significant stimulatory reaction related to the vaccine in the tissues of the injected local area. There was no difference in feed consumption, water consumption, and body weight gains between the control group, the groups that received a single dose of vaccine, and the groups that received two doses of vaccine (p> 0.05). No difference was found between the groups when urine and feces amounts were compared (p> 0.05). No difference was found between the groups when urinary urea, creatinine, and serum BUN, creatinine levels were compared (p> 0.05). No difference was found in the histopathological evaluation of the kidneys between the groups (p> 0.05).Conclusion: In conclusion, single or repeated injections of the SARS-CoV-2 vaccine (Vero cells) into mice were found to have no adverse effects on the animals’ overall clinical health, performance abilities and kidneys.Keywords: COVID-19, vaccine, SARS CoV-2, adverse effect, kidney

Background: Surgical antimicrobial prophylaxis (SAP) is the peri-operative administration of antimicrobial agents. Compliance rates vary worldwide from 15% to 84.3%, with studies in Turkey not exceeding 35%. The aim of this multicenter study was to determine the rate of appropriate antibiotic class, timing, and duration as well as discharge prescriptions in Turkey. Thus, we aimed to determine the rate of full compliance with SAP procedures in our country Patients and Methods: This multicenter, prospective, observational, descriptive study was conducted in 47 hospitals from 28 provinces in seven different regions of Turkey. Patients over 18 years of age in all surgical units between June 6, 2022, and June 10, 2022, were included in the study. Results: Of the 7,978 patients included in the study, 332 were excluded from further analyses because of pre-existing infection, and SAP compliance analyses were performed on the remaining 7,646 cases. The antibiotic most commonly used for SAP was cefazolin (n = 4,701; 61.5%), followed by third-generation cephalosporins (n = 596; 7.8%). The most common time to start SAP was within 30 minutes before surgery (n = 2,252; 32.5%), followed by 30 to 60 minutes before surgery (n = 1,638; 23.6%). Surgical antimicrobial prophylaxis duration was <24 hours in 3,516 (50.7%) patients and prolonged until discharge in 1,505 (21.7%) patients. Finally, the actual proportion of patients compliant with SAP was 19% (n = 1,452) after omitting 4,458 (58.3%) patients who were prescribed oral antibiotic agents at discharge as part of a prolonged SAP. Conclusions: Surgical antimicrobial prophylaxis compliance rates are still very low in Turkey. Prolonged duration of SAP and especially high rate of antibiotic prescription at discharge are the main reasons for non-compliance with SAP.

Purpose: We investigated the acute subclinical choroidal and retinal changes caused by Coronavirus Disease 2019 (COVID-19) in patients with and without pulmonary involvement, using spectral domain optic coherence tomography., Methods: This prospective case-control study included COVID-19 patients: 50 with pulmonary involvement and 118 with non-pulmonary involvement. All patients were examined 1 month after recovering from COVID-19. The changes were followed using optic coherence tomography parameters such as choroidal and macular thickness and retinal nerve fibre layer and ganglion cell complex measurements., Results: All choroidal thicknesses in the pulmonary involvement group were lower than in the non-pulmonary involvement group and the subfoveal choroidal thickness differed significantly (p=0.036). Although there were no significant differences between the central and average macular thicknesses in the two groups, they were slightly thicker in the pulmonary involvement group (p=0.152 and p=0.180, respectively). A significant decrease was detected in the pulmonary involvement group in all ganglion cell complex segments, except for the outer nasal inferior segment (p<0.05). In addition, a thinning tendency was observed in all retinal nerve fibre layer quadrants in the pulmonary involvement group compared to the non-pulmonary involvement group., Conclusion: In COVID-19 patients with pulmonary involvement, subclinical choroidal and retinal changes may occur due to hypoxia and ischemia in the acute period. These patients may be predisposed to ischemic retinal and optic nerve diseases in the future. Therefore, COVID-19 patients with pulmonary involvement should be followed for ophthalmological diseases., Competing Interests: Declaration of Competing Interest The authors report no conflicts of interest., (Copyright © 2022. Published by Elsevier B.V.)

Liver-derived paraoxonase-1 (PON1) enzyme that is found in the circulation is bound to high-density lipoproteins and reduces the amount of oxidized lipids with its antioxidant effect. Humans have at least three different PON gene regions which are adjacent to the other on the 7th chromosome. It has been shown that PON1 gene and its polymorphisms are related with various diseases. It is also known that, hepatitis C virus (HCV) is tightly associated with the cell lipoproteins in each step of its replication cycle leading to modulation of the host lipid metabolism. The aim of this study was to investigate the relationship between the response to chronic hepatitis C (CHC) therapy and aminoacid changes in 55' and 192' regions of PON1 enzyme believed to be involved in the pathophysiology of many chronic diseases. A total of 49 CHC patients (27 male, 22 female; mean age: 52.9 ± 12.6 yrs), all infected with HCV genotype 1b and positive for anti-HCV and HCV-RNA were included in the study. Patients who were HCV-RNA negative at the sixth month following at least once pegilated interferon + ribavirin treatment, were considered as therapy-responders, whereas those who were HCV-RNA positive were considered as non-responders. The genomic DNAs were isolated from patients' blood samples in their routine follow-ups and Q/R192 and L/M55 PON1 polymorphism analysis in 55. and 192. regions was performed by T-ARMS-PCR (Tetra-primer amplification refractory mutation system-polymerase chain reaction) method. In our study, the analysis of PON1 polymorphisms yielded 44.1% of LL, 44.1% of LM and 11.8% of MM genotypes at position 55 and 55.9% of QQ, 41.2% of QR, and 2.9% of RR genotypes at position 192 in therapy-responders. In the evaluation of combined genotype analysis of the patients, there was only one case who was responsive to treatment with LL/RR genotype. Of the patients, eight harbored LL/QQ genotypes and seven of them (87.5%) were responsive to treatment. However, statistical analysis indicated that there was no relationship between PON1 L/M55 and PON Q/R192 polymorphisms and response to CHC treatment (chi-square test, p> 0.05). Our data did not support a relationship between PON1 polymorphisms and response to CHC therapy, in contrast to a few studies pointing out of this correlation. This might be attributed to relatively low number of patients included. In conclusion, since antiviral agents used for CHC therapy are limited and costly, it was thought that further investigations with large numbers of patients should be conducted to establish the presence of any relationship between the response to CHC therapy and genotypes of the PON1 enzyme.