Journal of Molecular Virology and Immunology

There is an ongoing interaction between nutrition, immune system, and infectious diseases. Inadequate and unbalanced nutrition may reduce the defense efficiency of the immune system and increase the risk of contracting infectious diseases and the severity of disease symptoms. COVID-19 (coronavirus disease-2019) outbreak, which emerged in December 2019 and was declared a pandemic by the World Health Organization (WHO) in a short time, has become the most important public health problem worldwide in the last few years. COVID-19 is asymptomatic or causes with mild symptoms in most people, however, it progresses to severe illness accompanied by serious symptoms in some people, and it is known that this difference is mainly related to the effective immune responses of individuals. There is currently any easily accessible antiviral drug with proven therapeutic efficacy for the prevention and treatment of COVID-19 disease. Therefore, there has been an increasing effort to explore immune-supportive additional therapeutic options to strengthen the immune system and reduce disease-related complaints. The innate immune response, which is responsible for preventing transmission and invasion in the early stages of viral infections, is the first line of defense to eliminate the virus, and it is critical in the effective and balanced activation of the adaptive immune response. Therefore, the use of antimicrobial and antioxidant minerals, vitamins, medicinal plants, and probiotics that will strengthen the immune response is one of the accessible, easily applicable, and effective preventive measures. In this review, the effectiveness of therapeutic and supportive nutritional supplements against COVID-19 disease, which has become a major problem worldwide, has been discussed.

Abstract Pandemics generally begin in small areas and subsequently spread widely. In order to detect an outbreak in its early stage, observation of the data for small regions is important. The aim of this study to investigate the presence of COVID-19-like pneumonia findings in computed tomography (CT) taken before the COVID-19 pandemic in Turkey. The chest CTs performed in our hospital between December 1, 2019 and March 10, 2020 (study group) and those performed between December 1, 2018 and March 10, 2019 (control group) were retrospectively analyzed. A total of 1,432 chest CT images in the study group and 1,443 chest CT images in the control group were evaluated for COVID-19. The lesion characteristics on CT, length of hospital stay (LOS), and mortality rate were investigated. Typical lung involvement defined for COVID-19 was present in 1.39% (n=20/1,432) of CTs in the study group and 0.49% (n=7/1,443) in the control group (p=0.011). Seventy-five percent (n=15/20) of the study group were male, and the mean age of the patients was 51.8 (±17.1) years. All the patients in the study group had at least one of the symptoms of COVID-19, such as fever, cough, and respiratory distress. Ninety percent (n=18/20) of the patients in the study group had ground-glass opacities that showed a predominantly peripheral distribution. Five of these had accompanying consolidation and one had a reverse halo sign. According to clinical records, in-hospital mortality developed in seven of 20 patients (35%), the LOS was 5.5±6.2 days, and the median time from the symptom onset to admission was 4 (range: 1-12) days. Our study reveals that the onset of COVID-19 or a similar disease is more likely to occur earlier than first reported in the country.

The aim of this study was to determine the spirituality (spiritual attitudes) and presenteeism (inability to be present at work) of family medicine clinic assistants who worked in many areas related to the COVID-19 (Coronavirus Disease 2019) pandemic in a pandemic hospital and to determine the factors affecting them and to investigate the relationship between them. The study is an observational and cross-sectional study and the sample consisted of family medicine residents (n=127) working in the Family Medicine Clinic of Ankara Bilkent City Hospital, which served as the largest pandemic hospital in Turkey, during the COVID-19 pandemic. The first part of the questionnaire form included the sociodemographic information of the participants, the second part included the data to determine the presenteeism status and its causes, and the Stanford presenteeism scale to devote oneself to work scale was applied. The third part included the spirituality scale. The presenteeism scale mean score of the physicians participating in the study was 18.75 points out of 30 points. The mean score of the spirituality scale was found to be 100.14 points out of 135 points, and the relationship between them was not found to be statistically significant. It has been observed that physicians who took a more active role in the pandemic had a lower level of inability to be present in their work, that is, higher job performance, compared to those who remained on passive duty for various reasons. A positive moderate correlation was found between the general health status of physicians and their job performance. It was determined that among the people with whom the physicians lived together during the pandemic period, the situation of being absent from work was higher in those who had a relative with a chronic disease compared to those who did not. It has been determined that those who have a spare person who can take care of themselves in the pandemic are less likely to be absent from their jobs than those who do not. It has been determined that among the physicians who had COVID-19, the situation of being absent from work was higher in those who required a rest report after isolation, compared to those who did not. On the other hand, physicians' mean scores of spirituality scale sub-dimensions such as "spiritual coping, transcendence, search for meaning, spiritual contentment, connection, harmony with nature" and total spirituality score were found to be high. In the study, physicians' presenteeism was found to be at a moderate level and spirituality at a high level. The awareness of physicians about the concept of presenteeism and spirituality was increased, the literature related to the conduct of this study was contributed in the field of health, and a different perspective was presented to the literature on the necessity of evaluating the human as a whole for the solution of presenteeism and the importance of addressing the regulatory role of spiritual attitudes.

We investigated whether Chest X-Ray (CXR) could replace computed tomography (CT) modality in the diagnosis and during the treatment of young adult COVID-19 patients with mild dyspnea with no comorbid diseases. This retrospective study involved an examination of the records of a total of 956 patients hospitalized between March 1, 2020, and May 15, 2020. The study included a total of sixty-four COVID-19 patients who underwent a CXR at admission and CT imaging within 24 hours, aged 21-60 years with mild dyspnea with no comorbid diseases. The diagnosis of infection was confirmed by the polymerase chain reaction test in all cases. The first CXR and CT images at the time of admission were evaluated in terms of lesions and localization. The clinical-radiological course of the disease was also statistically evaluated. CT was normal in 18/64 (28.1%) patients, all of whom also had normal CXR. The rest of the patients 46/64 (71.9%) with an abnormal CT, the CXR was normal in 18/46 (39.1%) and abnormal in 28/46 (60.9%). The time between the onset of complaints and admission to the hospital in patients with abnormal and normal CXR was 3.5±2.3 days and 2.1±1.1 days respectively and this difference was statistically significant (p=0.004). The hospital stay durations of the patients with abnormal and normal CXR was 9.6±3.5 and 9.5±3.4 days (p=0.928), respectively, and was not statistically significant. In conclusion, in the case of early admission to the hospital, there is not a significant difference between using CXR or CT in the management of young adult COVID 19 patients with mild dyspnea no comorbid disease. Therefore, the use of CXR in these patient groups will reduce the burden of CT units in pandemic conditions with limited resources.

Infectious diseases are generally preventable public health problems; however, they cause epidemics, economic losses, and deaths at all levels worldwide. Especially with the effect of globalization, it has been observed much better with the COVID-19 pandemic, where viral outbreaks can rapidly affect all stages of life. Experiences show that not only national authorities, but also international organizations should play critical roles in the control of infectious diseases. Based on this perspective, in our study, the responses of the World Health Organization (WHO), which has a decisive role in international health policies, to prevent the spread of the COVID-19 pandemic in the first three-month period were examined. In addition, the possible effects of the national measures and policies taken by Canada, Turkey, Pakistan, and Tajikistan, which are in different income groups according to the World Bank, on the number of cases and deaths were discussed. In this context, the contributions, or potential effects of the WHO on the performance of these countries against the COVID-19 were interpreted. It was understood that the countries in different income groups have developed policies based on their capability at country level independent from other countries in the fight against COVID-19 outbreak. It has been evaluated that the success of countries in the fight against the outbreaks is affected by different parameters such as average age of the country's populations, health infrastructures and income levels that greatly affect access to medical supplies and equipment. However, it can be said that international organizations with institutional power such as WHO cannot play a leading role at the expected level in the prevention of the pandemic and ineffective in directing local policies and ensuring international coordination. Especially in the COVID-19 viral pandemic environment where fast and precise decisions are required, this leading role is desperately needed. The first quarterly decisions and meeting notifications of the WHO in the COVID-19 pandemic were examined in our study and it was understood that these outcomes cannot provide a definite and effective management plan to national health policy makers, although WHO presented diagnostic tools rapidly and, in some degree maintained the supply chain of medical equipment globally. As a result, when all these elements determined in our study were considered together; the need for an integrative, proactive, and fair international health institution that produces prompt, effective and constantly updated comprehensive policies should be emphasized.

We aimed to determine sleep quality and anxiety levels of surgical nurses fighting the COVID-19 ‎outbreak. This study was carried out as a cross-sectional and descriptive study. The data were collected by ‎using a sociodemographic data form, Pittsburgh Sleep Quality Inventory (PSQI), and Beck Anxiety Inventory ‎‎(BAI). A total of 302 healthcare workers participated in this study. The mean age of the participants was ‎‎31.95±7.82, and 73.2% of the participants were female, 58.9% of the participants were married and 31.5% ‎of them working in the surgical intensive care and operating room services. Of all participants, 73.5% had ‎poor sleep quality and mean PSQI was 8.18±3.69. The BAI score of surgical nurses was 16.61±12.12 and ‎‎22.5% of them experienced severe anxiety. The means of PSQI and BAI were higher in women, working in ‎surgical intensive care and operating room services, working over 40 hours a week (p<0.05). BAI score was ‎responsible for 45.6% of the change on PSQI score (p<0.001). The COVID-19 outbreak dramatically ‎increased the level of anxiety and negatively affected sleep quality. The mental health of the surgical nurses ‎should be monitored closely. It is recommended to provide psychological support to the healthcare workers.

Bu çalışmada, Ulusal Kanser Tarama Programı kapsamında yetişkinlerin kanser taramasına katılma ‎sıklıkları ve katılmama nedenlerinin değerlendirilmesi amaçlanmıştır. Bu tanımlayıcı anket çalışması, ‎Türkiye'de Mart 2021 ve Haziran 2021 tarihleri arasında aile hekimliği polikliniklerinde yetişkinlerle ‎yürütülmüştür. Anket 43 soru içeriyordu; ilk bölümde katılımcılardan bazı sosyodemografik verileri ‎sağlamaları istendi; ikinci bölümde ise mevcut sigara içme durumu, kronik hastalık varlığı, herhangi bir ‎kanser türünün olup olmadığı, ailede kanser öyküsü, ülkesindeki kanser tarama programı hakkında bilgi alma ‎durumu, COVID-19 salgını öncesinde ve sırasında herhangi bir kanser taraması yaptırma öyküsü anketin ‎üçüncü bölümü ise ulusal kanser tarama programı (kolorektal kanser, serviks kanseri, meme kanseri) ile ‎ilgili sorulara odaklandı. Ankete katılan 191 kişiden %54.2'si pandeminin dışkıda gizli kan testi yaptırma ‎sıklığını etkilediğini, %47.4'ü pandeminin kolonoskopi sıklığını etkilediğini, %37.7'si pandeminin mamografi ‎çekme sıklığını etkilediğini ve %37.1'i pandeminin pap smear testi yaptırma sıklığını etkilediğini belirtti. Bu ‎gecikmelerin en çok belirtilen nedeni enfeksiyon kapma endişesiyle sağlık ocağına gitmekten korkmaktı. ‎Kanser taramasındaki kesintiler, mevcut kanserlerin geç teşhisine, kanserle ilişkili ek ölümlere yol açacaktır. ‎Tarama oranları COVID öncesi seviyelere dönene kadar bu kesintilerin büyük bir etkisi olabilir. Sonuçlarımız ‎pandeminin tarama programları üzerine olumsuz etkilerini gösterdi ve en çok vurgulanan neden enfeksiyon ‎kapma endişesiyle sağlık ocağına gitmekten korkmaktı.

The aim of the research is to investigate the relationship between the adherence to a Mediterranean type of diet, which is an anti-inflammatory diet, and the degree of severity and symptoms of the disease in patients with COVID-19 infection. In the study, a short questionnaire form containing questions about demographic information, disease severity, and what symptoms they experienced was given to individuals who had previously had COVID-19 infection. The adaptation of individuals to the Mediterranean diet (MD) was evaluated with the Mediterranean Diet Adherence Screener (MEDAS). SPSS software program was used to analyze the effect of the MD on COVID-19 severity and symptoms. A total of 715 people, including 283 (39.6%) men and 432 (60.4%) women, were included in the study. It was determined that 33.7% (241/715) of the individuals had MD compliance, while 66.3% (474/715) did not have MD compliance. It was observed that 77.8% (556/715) of the individuals participating in the study had a mild recovery from the COVID-19 infection process. It was observed that thin and obese individuals had more difficulty recovering (p<0.05). The top 5 most common symptoms in COVID-19 patients were found to be as follows: fatigue-weakness (87%), low back-joint pain (76.4%), headache (70.5%), olfactory disorder (66%), and taste disorder (61%), respectively. No significant difference was found between adherence to a Mediterranean-type diet and COVID-19 severity and symptoms (p>0.05). In conclusion, no significant relationship was found between adherence to the MD and the severity of the COVID-19 infection. However, considering the effects of the Mediterranean-type diet, which is an anti-inflammatory diet, on obesity, it is thought that adherence to this diet will have a positive effect on decreasing the severity of COVID-19 transmission indirectly, if not directly.

COVID-19 is a highly contagious and deadly disease. It may present with neurologic symptoms as well as respiratory symptoms. In this study, the existence of different biomarkers in the development and evaluation of neurologic symptoms and complications in patients with COVID-19 and the relationship between clinical course and neurologic disorders were investigated. In this prospective randomized study, the study group included 133 patients with a diagnosis of COVID-19 who were admitted to the neurology clinic and intensive care unit managed by expert neurologists during the pandemic period. Patients were classified as those without neurological disorders associated with COVID-19, those with mild neurologic disorders, and those with severe neurological disorders. The demographic characteristics, laboratory values, lung tomography, and clinical features of these patients were examined and the relationship between them was investigated. Of the patients, 54.9% were male, 45.1% were female, and the mean age was 60.85±18.38 (min-max: 19-91) years. As the age increased, a moderately significant positive correlation was found between the presence of neurologic disorders and disease severity. Myalgia (39.1%) and headache (34.6%) were the most common neurologic symptoms. In patients with severe neurologic disorders, the most common neurologic symptom was unconsciousness (n=22, 64.7%). Hemoglobin levels, hematocrit, lymphocyte counts, and procalcitonin levels were decreased (p=0.010, p=0.018, p=0.001, and p=0.021, respectively) in patients with neurologic disorders, neutrophil count, C-reactive protein, D-dimer, and interleukin-6 levels were increased (p=0.039, p=0.020, p<0.001, and p=0.001, respectively). An increase in the presence and severity of neurologic disorders was observed in patients in parallel with an increase in lung computed tomography scores and O2 requirement (p<0.001 and p<0.001, respectively). As the severity of the neurologic disorders of the patients increased, the rate of discharge decreased (p<0.001). Our results suggested that some biomarkers associated with the severity of the disease could also be shown in patients with neurologic disorders, and patients with COVID-19 had severe disease in the presence of neurologic disorders. To define the existence of an independent biomarker, there is a need for large-scale studies in which neurologic disorders are handled separately.

Yokenella regensburgei is a fermentative, motile, oxidase-negative, gram-negative bacillus belonging to the Enterobacteriaceae family and is an opportunistic human pathogen that is caused infections mainly in immunocompromised patients and rarely in immunocompetent individuals. Y. regensburgei, which is generally found in well water, insect guts, and reptiles in nature, can cause different types of infections such as septic arthritis, soft tissue infection, and otitis externa in humans. In this article, a case of soft tissue infection caused by Y. regensburgei and due to trauma is presented.

In this study, it was investigated that current epidemiological situation and risk factors of community-acquired pneumonia (CAP) in pediatric patients in Türkiye, after socioeconomic changes and health system improvements in the past two decades. In total 1,488 children treated with a diagnosis of pneumonia in Gulhane Training and Research Hospital (Ankara) Pediatrics Department between 2016 to 2021 were included in the present study. The patients’ demographic data, personal and family histories, and socioeconomic status were recorded. Of the 1,488 pediatric patients (mean age; 43.20±41.04 months and 46.8% girls); 108 were aged 0-6 months (7.3%), 672 were aged >6-24 months (45.2%), 444 were aged >24-60 months (29.8%), and 264 were aged >60 months (17.7%). In total, 98.4% of patients underwent routine vaccination and the rate of seasonal influenza vaccination was 5.6%. Additionally, 444 patients (29.8%) had chronic disease; asthma and cerebral palsy were the most common chronic diseases, 276 and 84 patients respectively. A family history of asthma in first-degree relatives was present in 396 patients (26.6%). There have been substantial changes in the epidemiology of CAP in Türkiye, due to socioeconomic changes, increasing urbanization, and health system improvements and the current effects of these changes are presented in our study with comprehensive data that can be used in further comparative studies.

In this study, it was aimed to evaluate the seasonal distribution of rotavirus and enteric adenovirus prevalence and demographic data of patients of all age groups who applied to our hospital with the complaint of acute gastroenteritis. A total of 12,840 patients aged 0-90 years, who applied to our hospital (Elazığ Fethi Sekin City Hospital) with the complaint of acute gastroenteritis between 15 August 2018 and 18 October 2021, were retrospectively analyzed. The presence of rotavirus and adenovirus antigens was determined from stool samples by qualitative immunochromatographic method (Microcult-Rotavirus/Adenovirus Combo, Biotech China) in accordance with the manufacturer's recommendations. Of the patients who applied with the complaint of acute gastroenteritis, 3,507 (27.3%) were infants, 9,087 (70.8%) were children, and 246 (1.91%) were adults. Of all patients, 1,350 (10.5%) were positive for at least one viral agent. Of patients with detected viral agents, 750 (55.6%) were male and 600 (44.4%) were female. Of the samples, 1,099 (8.56%) were positive for rotavirus, 199 (1.55) were positive for adenovirus, and 52 (0.40%) were positive for both pathogens. The positivity rate in men was 10% higher than in women. The positivity rates were highest in patients admitted in 2019 (5,915) for both rotavirus and adenovirus, 10.5% (622) and 2.23% (132) respectively. In the study, rotavirus positivity was highest in winter with 12.2% (270/2,216) and adenovirus positivity was highest with 2.12% (95/4,484) in summer. In the evaluation carried out according to age, gender, and season, the period in which viral gastroenteritis was seen at the highest rate was determined as "childhood". In the evaluation of gastroenteritis cases, it is important to know that viral agents are common, especially in the childhood age group, in addition to bacteriological and parasitological agents in stool samples in acute gastroenteritis infections and considering that there may be seasonal and periodic changes in the frequency of viral gastroenteritis. It was thought that unnecessary antibiotic use would be eliminated or minimized by replacing the lost fluid and electrolytes, which are the basic treatment of viral infections, following the correct identification of the causative agent.

The aim of this study is to examine the incidence, clinical and epidemiological characteristics of ocular viral infections in consecutive patients admitted to the ophthalmology outpatient clinic of a tertiary education and research hospital located in Mogadishu-Somali. In the study, it was aimed to reach data that could be specific for the country and city where the study was conducted by examining patients in different age and gender groups with findings compatible with viral infections in their clinical examinations in terms of risk factors and complications. The study was conducted as a four-month (December 2019-March 2020) prospective follow-up study and included the analysis of data from 63 patients. Eight (12.7%) of the patients were affected bilaterally by infection and related complications, and 55 patients were affected in one eye (25 left eyes and 30 right). In this study based on clinical examination results, the frequency of viral eye infections was found as adenovirus 66.7% (42/63), herpes simplex virus 27.0% (17/63), herpes zoster virus 4.76% (3/63), and measles virus 1.59% (1/63), respectively. HIV serology was negative for all patients. The most common complications were as follows; keratitis 87.3% (55/63), conjunctivitis 84.1% (53/63), anterior uveitis 15.9% (10/63) and glaucoma 17.5% (11/63). Anterior uveitis, cataract, synechia and glaucoma occurrence rates were found to be significantly higher in patients with hypertension and/or diabetes mellitus (p<0.05). While 28 of the patients (44.4%) could not provide any information on the place of transmission where the infection was acquired, the most frequently reported possible transmission sites were 23 homes (36.5%) and 10 workplaces (15.9%). It was determined that adenovirus infections affect a wide age group (9-60 years; mean: 28.0±10.7), herpes simplex virus infections affected young and middle-aged individuals (16-52 years; mean: 31.3±11.36 years) and herpes zoster virus infections affected older age groups (45-69 years; mean: 56.3±12). Our study data show that reducing the burden of viral eye infections and related complications in Mogadishu, Somali population living in crowded families and in conditions with lack of infrastructure depends on many parameters such as access to health services, early treatment, control of chronic diseases and public health awareness, and viral eye infections and it shows that the burden of related complications can be possible with the development of socio-economic and general public health conditions together.

Rotavirus, one of the viral infectious agents that is transmitted mainly through the fecal-oral route and spreads easily in regions with poor sanitation conditions, is the most common causative agent of acute gastroenteritis in children under five years of age worldwide, and enteric adenoviruses are other frequently encountered causative agents of gastroenteritis in childhood. Hepatitis A virus (HAV) is also transmitted in similar routes and is endemic in regions with poor sanitation conditions and limited access to clean water and is usually acquired in early childhood in these regions. In this study conducted in Mogadishu Somalia, rotavirus and adenovirus antigen test (immunochromatographic rapid test) results in patients admitted to a tertiary hospital in the 9-month period between February 2019 and October 2019 and ELISA based HAV antibody test results studied in 2018-2019 were retrospectively examined and it was aimed to determine the distribution of positivity rates of these viruses by age, gender, and year. During the study period, 1136 patients (mean age 6.33±12.36) were tested for rotavirus and adenovirus antigens, and 362 patients (mean age 21.26±18.45) were tested for anti-HAV IgM/IgG antibodies. The positivity rates of rotavirus and adenovirus were found as 17.8% and 5.1%, respectively. The positivity rates of anti-HAV IgM and IgG antibodies were 26.5% and 85.4%. The age group with the highest rotavirus test positivity was babies under one year old (27.3%), positivity rate was also high in children aged 1-2 years old (20.9%), and this distribution was similar for adenovirus. Although a small number of patients were tested in under five years of age, anti-HAV IgG seropositivity was 60% and above in all age groups. The highest anti-HAV IgM positivity rates were observed in children 2-<5 and 5-15 years of age, 52.9% and 44% respectively. Rotavirus antigen positivity was found at high levels in the three-month period covering June, July, and August 2019. In July (2019), it was observed that the number of rotavirus and adenovirus antigen test requests were increased, and also, at the same time the highest positivity rates for both viruses were observed; 31.2% and 9.5% for rotavirus and adenovirus. Rotavirus and enteric adenovirus co-infection was detected in 2.4% (27/1136) of the patients, and 23 (85.2%) of these were under five years of age children. Our study results show that children under the age of two are especially affected by rotavirus and adenovirus infections in Somalia and indicate that HAV infections are acquired at an early childhood. We can say that it may be useful to review vaccination programs as an important public health measure to reduce the burden of mortality and morbidity associated with HAV and rotavirus, which have a high prevalence and also have protective vaccines.

Türkiye's first SARS-CoV-2 vaccination campaign started with an inactivated vaccine (Sinovac Life Sciences Co., Ltd., Beijing, China) mid-January 2021 for healthcare workers. The second dose was administered at an interval of 21 days-one month. As of July 2021 (4-4.5 months after the second dose), the Republic of Türkiye Ministry of Health suggested the third vaccination dose for healthcare workers and people over 50. The individuals could select between the choice of CoronaVac or an mRNA vaccine BNT162b2 (Pfizer‐BioNTech, Inc) for the third dose vaccination. Thus, a heterogeneous immunization emerged in society. This study is aimed to investigate the humoral response (IgG and IgM) after two doses of the SARS-CoV-2 vaccine and the possible effects of factors for this response, as well as to compare the third dose of homogeneous and heterogeneous vaccine administration. The study included 512 volunteers who are 21-65 years old that have been immunized against SARS-CoV-2 in at least two doses, working at Bursa Uludag University Faculty of Medicine Health Application and Research Center. The demographic characteristics of the participants (such as age, gender, and place of duty), background (presence of chronic disease, risky contact for SARS-CoV-2 transmission, and history of COVID-19 infection), and immunization characteristics were obtained with a questionnaire. Participants were divided into five main groups regarding the time elapsed months after the second dose and the type of vaccine administered (CoronaVac or BNT162b2). Group 1b (n=11); (blood samples were taken) one month after the second dose of BNT162b2 vaccine, group1c (n=12); one month after the second dose of CoronaVac, group 2 (n=9); two months after the second dose of CoronaVac vaccine, group 3 (n=27); three months after of CoronaVac vaccine, group 4 (n=418); four months after the second dose of CoronaVac vaccine and group 5 (n=35); five months after the second dose of CoronaVac vaccine. One month later, blood samples were taken from 52 participants in group 4 who received the third dose of the vaccine. In these participants, IgG levels were compared after two different third-dose vaccines [BNT162b2; group 4b (n=30) and CoronaVac; group 4c (n=22)]. SARS-CoV-2 IgM and IgG responses were evaluated by SARS-CoV-2 IgM (Abbott, USA) and IgG Quant II (Abbott, USA) kits on Architect i2000SR (Abbott, USA) autoanalyzer with a chemiluminescent based method at Bursa Uludag University Faculty of Medicine Medical Microbiology Laboratory. In this study, a high rate (>80%) of anti-S IgG seroconversion was observed in all groups given two doses of the SARS-CoV-2 vaccine. The median IgG levels in groups 1b, 1c, 2, 3, 4, and 5 were 4315.3 AU/mL (24-10337), 721.5 AU/mL (154-1430), 842.5 AU/mL (365-4447), 183.0 AU/mL (14-1635), 165.0 AU/mL (4-31796) and 110.0 AU/mL (28-8757), respectively. After CoronaVac vaccination with two doses, groups 3, 4, and 5 had low levels of anti-SARS-CoV-2 IgG compared to group 1c (p values: 0.034, 0.006, and 0.001, respectively). IgM positivity was between 12.5-33.5% in the participants whose blood samples were obtained at one, two, and three months after the vaccination and 3.2-4.3% in the participants after four and five months (p=0.001). The heterogeneous immunization [two doses of CoronaVac and one dose of BNT162b2: median 11084.5 AU/mL (2948-40000)] has provided higher SARS-CoV-2 IgG levels compared to homogeneous immunization [three doses of CoronaVac: median 1707.0 AU/mL (304-8322)] (p<0.001). When the factors that affect the vaccine response were examined four months after two doses of the CoronaVac vaccine, IgM and IgG responses were higher in participants who also had past COVID-19 infection history (p=0.001). Advanced age (>60) was the most critical negative factor in IgG levels (p=0.001). Unlike previous research, it was found that the presence of comorbidity and gender did not affect the vaccine response after four months. Having a high-risk contact history and working in high-risk areas (pandemic ward) did not affect the antibody response. Among the factors evaluated, the only factor affecting IgM positivity was the combination of vaccine and natural immunity. Decreased levels of anti-S IgG antibody three months after the CoronaVac vaccine may affect the protection, especially in advanced age groups. Although this situation creates a guide for the planning of booster doses, the neutralizing antibody and T-cell response are important for protection.

Özet Lökosit sayısının 3500/μL seviyesinin altında olması lökopeni olarak tanımlanmaktadır. Çoğunlukla sekonder sebeplerle ilişkili olan ve immün sistem görevlerini etkileyebilmesi nedeniyle klinik önem taşıyan lökopeni çocuklarda farklı etiyolojik sebeplere bağlı olarak gelişebilmektedir. Çalışmamızın amacı çocuk hematoloji polikliniğine başvuran hastalarda benign lökopeni sıklığını ve etiyolojik sebeplerini belirlemektir. Bu retrospektif çalışmada 2019-2021 yılları arasında Elazığ Fethi Sekin Şehir Hastanesi Çocuk Hematoloji polikliniğine başvuran ve lökosit sayıları 3500/μL'nin altında olan hastalara ait veriler incelendi. Otoimmün hastalık, malignite, aplastik anemi ve kronik nötropenisi olan hastalar çalışmaya dahil edilmedi. Polikliniğimize başvuran 2500 hasta incelendi ve lökopeni insidansı %3.32 olarak bulundu. Lökopeni tespit edilen 83 hastanın 44'ü erkek (%53) ve 39'u kız (%47) hastalar olup, hastaların ortalama yaşı 8.5±4.5 yıl idi. Hastaların ortalama lökosit sayısı 2950±450/μL, ortalama lökopeni süresi 7.5±2.5 gün, ortalama takip süreleri 14±5 gün olarak tespit edildi ve tüm hastalarda lökopeninin düzeldiği gözlemlendi. Lökopeninin en sık nedenleri sırasıyla enfeksiyonlar %68.7 (57/83), vitamin B12 eksikliği %14.5 (12/83) ve ilaç kullanımı %10.8 (9/83) olarak tespit edildi. Çalışmamızda çocukluk çağında akut geçici lökopeni nedenleri arasında en sık sebebin enfeksiyon kaynaklı olduğu tespit edilirken, vitamin B12 eksikliğinin de lökopeniye sebep olabileceği gözlemlenmiş olup, bu olgularda lökopeninin tedavi ile düzeldiği saptanmıştır.

Hemodialysis (HD) patients are a special group of patients who are at high risk for infection and related complications. Blood-borne viruses associated with chronic diseases such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are important causes of morbidity and mortality in HD patients. Immunodeficiency of the patients, weak protective efficacy of vaccines (HBV etc.), invasive vascular procedures, long-term dialysis applications and device-related contaminated blood contact risk, need for blood transfusion, medical practices associated with the risk of nosocomial transmission are some of the factors associated with an increased risk of infection transmission in HD patients. In addition to standard precautions to prevent infection transmission, some additional practices specific to HD patients have been recommended. HBV vaccination, patient isolation (special staff and use of separated rooms, devices, and equipment) in case of indication, precautions to be taken during catheter application (selection of catheter location, catheter care, skin antisepsis, and performing the procedures under appropriate and sterile conditions), monitoring patients for infection markers (before dialysis and at recommended intervals), taking into account inadequate antibody production and the long incubation period of viral infections are some examples of preventive procedures specific to HD patients. In this study, the prevalence of HBV, HCV and HIV infections in HD patients treated in a tertiary care hospital in Somalia was investigated. A total of 744 HD patients, 419 (56.3%) males and 325 (43.7%) females, were included in the study. The mean age of the patients was 50.81±17.62 (range 7-91) and the median age was 53. 660 of the patients were tested for anti-HBs (386 positive patients; 58.5%), 718 for HBsAg (63 positive patients, 8.8%), 720 for anti-HCV (19 positive patients, 2.6%), and 599 for anti-HIV (one positive patient 0.17%). Seropositivity rates were found to increase with age in HD patients, in line with the prevalence of viral agents in the population. In 718 patients tested for HBsAg, the positivity rates in men and women were 10.8% (44/406) and 6.1% (19/312), respectively, and the seropositivity rate was significantly higher in men (p=0.026). Anti-HCV seropositivity (2.6%) was approximately twice and significantly higher in HD patients than the hospital general prevalence (1.41%) (p=0.005). Emergency responses to injuries related to ongoing conflict across the country, invasive procedures performed outside the hospital and under unsuitable conditions, lack of molecular diagnostic tests for viral infections in identifying seronegative cases, patients apply to various centers with different capabilities for dialysis procedures and irregular patient follow-up records, missing hemodialysis sessions due to economic or other reasons, high prevalence of HBV, and lack of trained and specialized personnel draw attention as problems specific to the region.