Investigating the association between various platelet indices and different clinical sub-groups of severe malaria.

Aim: To evaluate the ability of platelet count, mean platelet volume, platelet distribution width, and platelet mass index to predict the severity of malaria. Materials and Methods: This study was conducted as a retrospective cohort study at a tertiary hospital in Somali. Patients grouped as severe and non-severe malaria. We compared groups in terms of platelet count, mean platelet volume, platelet distribution width, and platelet mass index. Results: A total of 131 patients were included in the final analysis. Of the patients, 77 (58.7%) had non-severe malaria, and 54 (41.3%) had severe malaria. The multivariate analysis revealed that there was no significant difference between the groups in terms of platelet count, mean platelet volume, platelet distribution width, and platelet mass index (p: 0.183, 0.323, 0.204, and 0.139, respectively). In the receiver operating characteristic analysis, the area under the curve values for platelet count, mean platelet volume, platelet distribution width, and platelet mass index were 0.699, 0.619, 0.504, and 0.675, respectively. Conclusion: Of the platelet indices, platelet count, mean platelet volume, platelet distribution width, and platelet mass index were not clinically significant markers that could be used to predict the severity of malaria.

Terror-related injuries in Somalia: a retrospective cohort of 2426 hospitalized cases along 7 years.

Terrorism-related injuries and deaths have become a major threat to the Somalian population, as in the rest of the world. We aimed to characterize and compare firearm and explosion injuries caused by terrorist acts. This retrospective study reviewed the data of all patients injured by explosions and firearm attacks over seven years. Epidemiological characteristics, injury pattern, severity scores, hospital resource utilization parameters, length of stay, and death rates were evaluated. A total of 2426 patients were injured by 359 explosions and firearm attacks during the study period. Eighty-one percent of the patients (n = 1974) were male, while 19% of the cases were female. Multiple body site injuries occurred more frequently in explosion injuries (75%) than firearm wounds (48%) (P < 0.001). The relative frequency of internal injuries in explosion injuries was higher than in firearm wounds (46.7% vs. 36.2%). Patients injured due to the explosion have a greater rate of severe and critical injuries than those injured by firearms (30.2% vs. 21.2%, P < 0.001). About a quarter (24%) of the patients were hospitalized in the intensive care unit. The inpatient mortality rate was 11.6%. The findings of the study revealed that suicide bombings explosions are associated with multiple body site injuries, a greater rate of severe and critical internal injuries, and a higher mortality rate.

Evaluation, management, and analysis of demographic and radiological characteristics of patients with renal colic at a tertiary hospital in Somalia.

Background: Renal colic is a common emergency centre (EC) complaint worldwide, but its epidemiology and strategies for evaluation and treatment have been little reported in Africa. To the best of our knowledge, this is the first study aimed at evaluating the radiological investigations, management, and analysis of demographic characteristics of patients with urinary system stones who visited the EC. Method: A 3-year retrospective study of a total of 435 patients with acute renal colic who underwent radiologic investigations was included in this study. The overall positive stone rate, stone location, size, and hydronephrosis grade were assessed. The sensitivity and specificity of ultrasound were evaluated using patients with both an ultrasound and a non-contrast CT (NCCT). Results: The mean age of the patients was 34.7years; males accounted for 71.3% (n = 310), while females were 28.7% (n = 125). Urolithiasis was found in 63.4% of the cases, 71.3% of males and 28.7% of the females had a stone diagnosis (P < 0001). There was no statistically significant association between age and stone diagnosis (P > 0.05). The sensitivity and specificity of USG were 86.1% and 94%, respectively. Seventy-two percent of the cases had ureteral stones (29% in proximal, 25% in UVJ, 9% in mid, and 9% in distal ureter), followed by 28% having renal stones (19% calyces and 9% in renal pelvis). The mean size of the stone was 5.9±1.8, half of the cases harbour stone size <5mm, followed by 30% in 5mm-1cm. Conclusion: Due to the scarcity of well-equipped tertiary care hospitals and the low socioeconomic status of the patients living in Sub-Saharan Africa, Ultrasound can be the initial investigation of choice because it is safe, cheap, and may help guide diagnosis and the need for further imaging. However, NCCT remains the gold standard diagnosis of choice for acute flank pain.

Analysis of the demographic characteristics and clinical profile of acute ischemic strokes admitted to the emergency centre in the Somalia population.

Background: Stroke is a leading cause of death and chronic disability worldwide. In Sub-Saharan Africa (SSA), which includes Somalia, stroke represents a significant part of the chronic disease burden. However, there is relatively little data on risk factors, demographics, and clinical profiles. This study aimed to define the etiological, demographic characteristics, classification of stroke and functional status of patients with acute ischemic stroke (AIS) admitted to the emergency centre, and to create projections to evaluate the incidence and genetic aspects of stroke. Methods: The study population consisted of patients who applied to the emergency centre between 1 May 2017 and 1 May 2021 and were diagnosed with acute ischemic stroke (AIS). Patient demographics, season of onset, risk factors, laboratory data, imaging results, infarct location, AIS subtype and treatment outcomes were collected, and compared. Results: A total of 3,968 patients diagnosed with ischemia stroke were included in the study. The mean age was 51.12 ± 16.43 years, and we reported male predominance (65.7%). While hypertension, hyperlipidaemia, Diabetes mellitus (DM) were more frequent among the risk factors, smoking history and alcohol consumption history were very low. HIV-infected ischemic stroke was detected at a high rate (20.9%) and was common in a relatively young age group (31.8 ± 14.3). Large-artery atherosclerosis (LAA) subtype was detected with a high rate of 67.7%. The most common clot localization was in Supratentorial location (74.3%), and according to OSCP classification, partial anterior circulation infarcts (PACI) subtype (56.3%) was the most common. And these results were again different from other studies. Discussion: While the incidence of stroke and especially HIV-associated youthful ischemic stroke continues to increase rapidly in developing countries such as Somalia, with the addition of inadequate primary health care services, stroke has become a major public health problem in African countries regarding its costs at social, psychological, and economic levels.

ABO and Rhesus Blood Group Distribution in Mogadishu, Somalia.

Purpose: Our aim in this study is to reveal the blood group distribution by investigating retrospectively the blood types of around 60 thousand patients and donors who applied to Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital between 2018 and 2021. Patients and Methods: The blood group data of 59,442 people were included in this study. 20,414 (34.35%) of the study's participants were female, 39,023 (65.65%) were male. The blood groups of participants were determined using the slide method and the gel column technique. The frequencies and percentages of O, A, B, AB and Rh blood groups were calculated. Results: The frequencies of ABO blood group distribution indicated that blood group O and Rh+ were predominant in Mogadishu O group: 60.30%, A group: 26.50%, B group: 11.27%, AB group: 1.93%, Rh+ group: 96.49%, Rh- group: 3.43%. Conclusion: This is the first study about blood group distribution in Mogadishu based on a large number of blood type tests and hospital data. The findings of our study can guide the blood center administrators make decisions concerning blood stocking and supply. This study can give an idea about how much fluctuations may occur in the frequency of blood group types in emigrant populations over many years.

COVID-19: A Cause of HELLP Syndrome? A Case Report.

Purpose: There are still many unexplained points about how COVID-19 affects pregnant women and what kind of clinical and laboratory findings it reveals. These findings can become clinical conun drums when there is significant overlap with known and serious syndromes in pregnancy. The aim of this study is to report a case with a laboratory-proven diagnosis of COVID-19 and HELLP syndrome hypothesis. Case Presentation: A 30-year-old multigravida (g3p2, repeated cesarean section) 32-week pregnant patient reported to the emergency service with complaints of chills, cough and shortness of breath that started 6 days ago. Following comprehensive screening tests for the differential diagnosis of lymphopenia, high liver enzymes, low platelets, abnormal coagulation panel, high D-dimer, high total bilirubin, high LDH and HELLP syndrome in the laboratory examinations of the patient, the patient's laboratory findings were evaluated as compatible with HELLP syndrome. Emergency cesarean section was performed on the patient because of maternal hypoxemia. The finalization of the microbiological diagnosis of COVID-19 resulted to start conventional COVID-19 treatment. The fetus was also confirmed to be positive for COVID-19, and the newborn died on the 5th postnatal day. Unfortunately, our mother patient died on the 10th day of her hospitalization. Conclusion: This report describes a case of multigravida, 30 years old, who presented with respiratory tract infection symptoms and hypothesized HELLP syndrome, who later tested positive for the novel coronavirus. The distinction between these two etiologies and onset times is extremely difficult. However, given the sequence of events in this case, it is reasonable to consider that COVID-19 may be an etiological factor associated with the pathophysiology of HELLP, despite the lack of conclusive evidence.

Hepatitis A Seroprevalence in Mogadishu, Somalia.

BACKGROUND: The hepatitis A virus (HAV) is the most frequent global causes of vaccine-preventable viral hepatitis. Since Somalia is regarded as highly endemic for hepatitis A, the hepatitis A vaccine was not included in the World Health Organization's expanded immunization program. The purpose of this study was to determine the prevalence of hepatitis A infection in the Somalia capital, Mogadishu. METHODS: The serological results of 1153 individuals presenting to the Mogadishu Training and Research Hospital between January 2019 and January 2021 were examined retrospectively to evaluate the presence of anti-HAV IgG and IgM. The seroprevalence of anti-HAV IgG and IgM was analyzed on the basis of age and sex. The seroprevalence of anti-HAV IgG was also compared among the 11-year age group. FINDINGS: The seroprevalence of anti-HAV IgG and IgM did not vary significantly between the sexes. Overall, the seroprevalence of anti-HAV IgG was 67.6%. The percentage of seropositivity for anti-HAV IgG was highest in adults aged ≥41 years (88.9%) and lowest in children aged 1-2 years (29.4%). Estimated age at midpoint of population immunity was 5 years which is compatible high endemicity. In addition, a significant rate of hepatitis A infection was also observed in the adolescent age group. CONCLUSIONS: This study confirms the high HAV endemicity in Mogadishu. These data will be useful towards planning preventive and control measures by improving the sanitation programs in Mogadishu. Furthermore, prospective studies are needed to confirm these findings and evaluate urban-rural heterogeneity.

Epidemiological Characteristics and Predisposing Factors for Surgical Site Infections Caused by Bacterial Pathogens Exhibiting Multidrug-Resistant Patterns.

BACKGROUND: Surgical site infection is the most common kind of nosocomial infection in developed and developing countries. OBJECTIVES: Our aim was to identify the prevalence of factors predisposing to multidrug resistance and the antimicrobial susceptibility profile of pathogens. METHOD: This retrospective study enrolled 10,878 patients who underwent operations in 2018-2020. Pathogens were identified using eosin methylene blue agar. Mueller-Hinton agar was used to assess antimicrobial sensitivity and resistance. In total, 382 patients with confirmed surgical site infection (SSI), whose culture showed growth, were included in the study. RESULTS: The prevalence of SSI in the current study was 3.5%. Escherichia coli was the predominant pathogen (35.8%), followed by Staphylococcus aureus (21.8%). Antibiotic use, chronic renal failure, diabetes, and emergency operations were found to increase the likelihood of multidrug resistance (OR = 6.23, CI = 1.443-26.881, p = 0.014; OR = 5.67, CI = 1.837-19.64, p = 0.02; OR = 2.54, CI = 1.46-7.35, p = 0.03; OR = 1.885, CI = 1.067-3.332, p = 0.002, respectively). The pathogens showed different levels of antimicrobial resistance against ceftriaxone (72.7%), ciprofloxacin (46.6%), and gentamicin (34%). Antimicrobial resistance of about 1-3.4% was exhibited by linezolid, tigecycline, and teicoplanin. CONCLUSION: The study presented significantly increased multidrug-resistant (MDR) Enterobacteriaceae pathogens isolated from surgical sites. They involve significant morbidity and mortality rates and increased health-related costs.