Molecular Epidemiology of HIV-1 Subtypes and Primary Antiretroviral Resistance Profiles in Northern Cyprus: First Data Series.

The distribution of human immunodeficiency virus-1 (HIV-1) subtypes indicates difference from region to region and in risk groups acquiring the disease worldwide. Although subtype C is more in terms of total cases, subtype B is dominant in certain regions, especially in western and central Europe. Molecular epidemiological studies are essential for the control, effective treatment, and understanding in transmission routes of HIV-1 infection. This study aims to determine the molecular epidemiology and antiretroviral drug resistance profiles of HIV-1 in northern Cyprus. The study involved 71 naive HIV-positive patients diagnosed in northern Cyprus between 2016 and 2022. HIV-1 subtypes and circulating recombinant forms (CRFs) were identified by phylogenetic analysis (neighbor-joining method) of pol gene sequences. Drug resistance mutations were analyzed using the World Health Organization (WHO) lists of mutations for surveillance. The Stanford University HIVdb program was used to interpret drug resistance mutations. In our study, 40 of 71 samples were successfully sequenced. Subtype B of HIV-1 was dominant with a rate of 52.5%, followed by CRF02_AG (20%) and G (7.5%) subtypes. The rate of subtype B (71.4%) in northern Cyprus was significantly higher than in the other country of origin (p = .028). Antiretroviral drug resistance was found in 15% of the sequenced serum samples. Nucleoside/nucleotide reverse transcriptase inhibitor (NRTI), non-nucleoside nucleotide reverse transcriptase inhibitor (NNRTI), and protease inhibitor (PI) resistance rates were 10% (4/40), 7.5% (3/40), and 2.5% (1/40), respectively. According to the results, it is noteworthy that the dominant subtype circulating in northern Cyprus is the B subtype, and CRFs were detected at a higher rate than expected.

The Effect of Altitude on Phenolic, Antioxidant and Fatty Acid Compositions of Some Turkish Hazelnut (Coryllus avellana L.) Cultivars.

Turkey is the leading producer and exporter of hazelnuts, producing approximately 64% of global hazelnut production. This research investigated the effects of cultivars and altitude on the phenolic, antioxidant, and fatty acid compositions of five hazelnut cultivars grown at three different altitudes, 100 m, 350 m, and 800 m, in Ordu province, one of the territories that produce the most hazelnuts. The results showed that the cultivar and location significantly affected phenolic compounds, antioxidant activity, and fatty acid (FA) content. The lowest (2.30 mg/kg-Yagli) and highest (21.11 mg/kg-Kara) gallic acids were obtained at 100 m. The highest total phenolic content and antioxidant activity were found in the nuts grown at 350 m in the Kara and Palaz cultivars, at 100 m in the Yagli and Sivri cultivars, and at 800 m in the Çakildak cultivar. Oleic acid was the predominant FA in the cultivars and possessed a diverse trend according to the altitude and cultivar, ranging from 76.04% to 84.80%, increasing with altitude in all cultivars except Çakildak. Palmitic acid was the predominant saturated FA followed by stearic acid, which significantly varied according to the elevations. This study suggests that the responses of hazelnuts to altitude depend on the cultivar; hence, a proper approach to producing nuts containing more phenolic, fatty acids, and antioxidant activity includes choosing a suitable cultivar for a specific elevation.

The Diversity in Grapes of Vitis labrusca Grown in Bolu (Türkiye) Assessed by Multivariate Approaches.

The grape is one of the most produced and processed horticultural crops. This study evaluated the grape genetic resource belonging to the Vitis labrusca species. The diversity was assessed according to morphometric, antioxidant, physicochemical, and colorimetric characteristics. The diversity was evaluated using a variation index and multivariate analyses. The bunch weight of the vines exhibited a range from 21.05 g to 162.46 g, with a coefficient of variation (CV) of 38.97%. The average bunch weight was 64.74 g. In terms of the berry properties, the highest CV was observed for the berry weight (21.95%). The peel thickness displayed a CV of 36.40%, and an average of 0.23 mm. The CVs for the juice characteristics in the berries of the studied vines were 7.11%, 16.61%, 19.41%, and 28.10% for the pH, TSS, must yield, and TA, respectively. The TPC of the accessions exhibited a notably low variation (CV = 4.63%). The color properties of the accessions displayed an immense variation, except for the L* values. The hierarchical clustering analysis divided the accessions into two main clusters, which both had two subclusters. The multivariate approaches separated individuals into different groups, and they were considered useful tools for utilization in the genetic diversity assessments. Further studies on the cultivation technique and crossbreeding with Vitis vinifera will provide more insights into the population, and this study will be a source for upcoming studies on V. labrusca in the region.

Sex and ABO Blood Differences in SARS-CoV-2 Infection Susceptibility.

Data consisting of millions of cases cannot still explain the immunopathogenesis mechanism between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and host cell for ongoing coronavirus disease 2019 (COVID-19) pandemics. Epidemiological studies among different populations suggested different impacts of ABO and Rh antibodies on the COVID-19 susceptibility. Thus, the ABO blood group and the SARS-CoV-2 infection paradox remain unclear. Therefore, the present retrospective case-control study aimed to investigate the possible association between ABO blood groups and Rh blood types on SARS-CoV-2 infection in the Turkish Cypriot population. A total of 18,639 Turkish Cypriot subjects (297 SARS-CoV-2 COVID-19 patients and 18,342 healthy) were included in this study. Personal and clinical characteristics including age, gender, SARS-CoV-2 infection status, the ABO blood group and Rh blood types were evaluated and compared between two groups. As a result, ABO blood group was shown to be associated with a higher risk of SARS-CoV-2 infection as well as with male sex ( p = 0.018). There was no association between Rh blood type and COVID-19. Overall, this study is the first largest sample group study to show the distribution of ABO blood group and Rh blood types in the healthy Turkish Cypriot population. Based on the current evidence, there are insufficient data to guide public health policies regarding COVID-19 pathogenesis.

Investigation of Brucella canis and Brucella abortus Seropositivity by In-House Rapid Slide Agglutination Test and In-House ELISA in Northern Cyprus.

The incidence of Brucella canis (B. canis) in humans is unknown in Northern Cyprus. In this study, we investigated the prevalence of B. canis and Brucella abortus (B. abortus) infection in human sera and evaluated the results obtained by agglutination-based techniques using standardized antigens made from B. canis comparatively. All of the subjects were negative in terms of Rose-Bengal plate test. Undiluted serum samples were initially screened by rapid slide agglutination test (RSAT), and those which were found positive were retested in the dilution of 1/25-1/200. Confirmation of the positive results was performed by using 2-mercaptoethanol standard agglutination test (SAT). The test antigen was prepared from the less mucoid M (-) variant of B. canis, and 1/1,048 titered dog antiserum was used as positive control. In 225 serum samples, 3.6% (8/225) was positive by B. canis M (-) RSAT, 4.4 % (10/225) was positive by B. canis M (-) indirect enzyme-linked immunosorbent assay (iELISA). 5.3% (12/225) was positive by B. abortus S99 RSAT and 9.8% (22/225) was positive by B. abortus S99 iELISA. Nine samples were positive by both B. abortus S99 RSAT and B. abortus S99 iELISA. Seven samples were positive by both B. canis M (-) RSAT and B. canis M (-) iELISA. One patient was positive by all methods. It is important to evaluate patient samples with RSAT and iELISA. Until the notification system gives better results to the Ministry of Health, in order to reach the real data for Northern Cyprus, multicenter prevalence determination studies should be done for future.

Assessment of Deep Learning Models for Cutaneous Leishmania Parasite Diagnosis Using Microscopic Images.

Cutaneous leishmaniasis (CL) is a common illness that causes skin lesions, principally ulcerations, on exposed regions of the body. Although neglected tropical diseases (NTDs) are typically found in tropical areas, they have recently become more common along Africa's northern coast, particularly in Libya. The devastation of healthcare infrastructure during the 2011 war and the following conflicts, as well as governmental apathy, may be causal factors associated with this catastrophic event. The main objective of this study is to evaluate alternative diagnostic strategies for recognizing amastigotes of cutaneous leishmaniasis parasites at various stages using Convolutional Neural Networks (CNNs). The research is additionally aimed at testing different classification models employing a dataset of ultra-thin skin smear images of Leishmania parasite-infected people with cutaneous leishmaniasis. The pre-trained deep learning models including EfficientNetB0, DenseNet201, ResNet101, MobileNetv2, and Xception are used for the cutaneous leishmania parasite diagnosis task. To assess the models' effectiveness, we employed a five-fold cross-validation approach to guarantee the consistency of the models' outputs when applied to different portions of the full dataset. Following a thorough assessment and contrast of the various models, DenseNet-201 proved to be the most suitable choice. It attained a mean accuracy of 0.9914 along with outstanding results for sensitivity, specificity, positive predictive value, negative predictive value, F1-score, Matthew's correlation coefficient, and Cohen's Kappa coefficient. The DenseNet-201 model surpassed the other models based on a comprehensive evaluation of these key classification performance metrics.

[Investigation of Leishmania infantum Seroprevalance and Leishmaniasis Knowledge Level in Northern Cyprus]. / Kuzey Kibris'ta Leishmania infantum Seroprevalansinin ve Leysmanyaz Bilgi Düzeyinin Arastirilmasi.

Leishmaniasis is an infectious disease caused by Leishmania parasites, transmitted by sand flies and common in the Mediterranean region. Cyprus is located in the east of Mediterranean Sea and is considered endemic for Leishmaniasis. In our study, it was aimed to investigate Leishmania infantum IgG seropositivity in healthy volunteers living in different regions of Northern Cyprus and to determine the risk factors for Leishmaniasis and measure the level of public knowledge about the disease. A total of 300 healthy volunteers (farmer/livestock: 100, hunter: 100, control group: 100) from five different regions of Northern Cyprus were included in the study, including Nicosia, Kyrenia, Famagusta, Morphou/Lefka, and Trikomo/Karpasia. The participants' blood was drawn and prepared questionnaire forms were filled out. Collected blood was centrifuged and the serum samples were separated and stored at -80ºC until the day of the test. All serum samples were tested for L.infantum IgG specific antibodies using the ELISA method (NovaTec, Immundiagnostica GmbH, Germany) in accordance with the manufacturer's recommendations. L.infantum IgG positivity was found to be 4.7% (14/300). The mean ages of L.infantum IgG positive and negative participants were 43.64 ± 11.74 and 42.17 ± 14.32 respectively. There was no statistically significant relationship between seropositivity and age (p= 0.706). The positivity rate was found to be significantly higher in hunters and farmers/livestocks compared with the control group (p= 0.020). In addition, it was determined that having a dog and the number of dogs owned were significantly associated with Leishmaniasis (p= 0.017, p= 0.020, respectively). On the other hand, 77% (231/300) of the volunteers included in our study had no prior knowledge about the disease. When compared to the other study groups, it was determined that hunters had the most knowledge of the Leishmaniasis infection (p= 0.001). Moreover, it was observed that as the education level of the participants increased, the level of knowledge about the disease also increased in parallel (p≤ 0.001). According to the results in our study, L.infantum IgG seropositivity was undeniably high in the healthy population living in Northern Cyprus. It is clear that outdoor activities such as hunting or dealing with farming/livestock are risk factors for the disease. In this context, it is apparent that more clear results will be obtained about the prevalence of the disease with the conduction of large-scale epidemiological studies. As a result, we concluded that especially risk groups should be informed about the current status of Leishmaniasis infection and necessary precautions should be taken.

Detection of SARS-CoV-2 N501Y mutation among SARS-CoV-2 variants of concern circulating in Northern Cyprus.

Aim: SARS-CoV-2 variants of concern (VOCs) carry signature mutations particularly in the spike protein. Most VOCs lineages that carry N501Y substitution have been reported to evade viral diagnostic tests and have impact on vaccine effectiveness. Therefore, monitoring the circulating variants represents a major requirement for a public health response worldwide. We aimed to investigate the prevalence of N501Y bearing SARS-CoV-2 samples in Northern Cyprus. Materials & methods: Reverse transcription quantitative PCR technique was used to identify N501Y mutation from 658 samples. Results: Our results indicate that the proportion of N501Y-bearing lineages increased significantly from January through May 2021 (45.2-75.5%) in the region. Conclusion: These results indicate that VOCs are dominant lineages in the country and highlight an alarming situation which require strict governmental measures to minimize COVID-19 morbidity and mortality.

Positive Anti-HIV ELISA Results in Pregnancy: Is It Reliable?

BACKGROUND: Human immunodeficiency virus (HIV) can be transmitted from mothers to their babies during pregnancy, delivery through vaginal fluids or breastfeeding. As false positivity anti-HIV results due to pregnancy could be detected and no relevant study have been reported in Northern Cyprus so far, we aimed to estimate the false anti-HIV positivity rate in pregnant women. METHODS: A total of 11.977 women admitted to Near East University Hospital between 2015 and 2018 were involved. The fourth generation anti-HIV-1/2 ELISA test was carried out by chemiluminescence enzyme immunoassay. Positive results were confirmed by real-time polymerase chain reaction (rt-PCR). SPSS (Statistical Package for the Social Sciences) Demo Ver 22 program was used for statistical analysis and significance (p<0.05) was measured by Person Chi-Square and Fisher's Exact tests. RESULTS: Anti-HIV-1/2 ELISA test was positive in 7 (0.3%) of pregnant and 11 (0.1%) of non-pregnant women. HIV RNA was not detected in any pregnant however, was detected in 2 (0.02%) of non pregnant. S/Co titer of pregnant and non pregnant who have positive anti-HIV-test without viral load was x̄=2.68±1.64 (1.34-5.20) and x̄=8.63±7.68 (1.56-20.98) respectively. False positivity was significantly higher in pregnants compared to non-pregnants (p=0.033). CONCLUSION: False positivity can be encountered during pregnancy therefore, positive anti-HIV-1/2 ELISA results should be confirmed with molecular techniques before initiating antiretroviral treatment.

Genetic characterisation of antibiotic resistance transposons Tn6608 and Tn6609 isolated from clinical Pseudomonas strains in Cyprus.

OBJECTIVES: Antibiotic therapy for Pseudomonas infections is becoming increasingly difficult. In this study, the transposons from two multidrug-resistant (MDR) clinical Pseudomonas strains containing related transposons responsible for giving rise to resistance determinants were characterised. METHODS: Two MDR clinical Pseudomonas isolates were obtained from a medical facility in Cyprus. The strains were identified as Pseudomonas putida C54 and Pseudomonas aeruginosa C69. DNA was extracted from both strains and was sequenced. Transposons were identified, annotated and compared with DNA sequences in GenBank. RESULTS: Two related nested transposons, here named Tn6608 (from P. putida C54) and Tn6609 (from P. aeruginosa C69), were characterised. The transposons are built on an ancestral Tn1403 base element (here named Tn1403A) that contains only the transposition module (tnpA and tnpR) and the associated cargo gene module (orfA, orfB, orfC and orfD) flanked by a 38-bp inverted repeat. The nested transposons identified in this study have evolved via acquisition of multiple transposons, adding multiple resistance genes to an ancestral transposon that originally lacked any resistance determinants. CONCLUSION: Transposons related to Tn6608 and Tn6609 have evolved and are globally disseminated. Of particular interest is that most of these nested transposons are located within the same site in a genomic island, providing alternative avenues for dissemination.

Big Concern for Public Health: Microbial Contamination of Mobile Phones.

INTRODUCTION: Mobile phones are dynamic source of microorganisms in households and professional settings. The aim was to determine the prevalence of bacterial contamination of the mobile phones, identify bacterial isolates, assess their antimicrobial susceptibility patterns and define the efficiency of using disinfectant. METHODOLOGY: This study included 233 dental students from Near East University, Faculty of Dentistry. Swab samples taken from mobile phones before and after disinfection were inoculated onto 5% sheep blood medium and eosin methylene blue medium and incubated aerobically at 37°C for 24-48 hours. Mold-growing mix cultures were sub-cultured on the sabouraud dextrose medium and allowed to grow at room temperature. Conventional microbiological techniques and VITEK 2 automated identification system were used for bacterial identification and antimicrobial susceptibility testing. Antibiotic susceptibility tests were verified by Kirby-Bauer disc diffusion technique according to the European Antimicrobial Susceptibility Test Committee criteria. Mold colonies were identified macroscopic and microscopically according to their phenotypic properties using lacto-phenol cotton blue stain. RESULTS: Microbial contamination of mobile phones was 81% (120.953 cfu/ml) in swab samples taken without using alcohol-based wipes however, microbial contamination in swab samples taken after one-time disinfection was determined to be 21% (201 cfu/ml). The most common microorganisms isolated were coagulase negative Staphylococci (69%) and Aspergillus niger (13%). All of the isolated bacteria were susceptible to all antibiotics used. CONCLUSIONS: This study represents the first data on the rate of microbial contamination on mobile phones in Northern Cyprus and the efficiency of the use of alcohol to disinfect the mobile phones.

In vitro Anti-Leishmanial Activity of Essential Oils Extracted from Plants Growing in Northern Cyprus Against Leishmania tropica

Objective: Natural plant products are considered as a source of novel and effective compounds for the treatment of leishmaniasis. In this study, the in vitro activities of essential oils obtained from Origanum dubium (OD), Origanum majorana (OM), Salvia fruticosa (SF) and Laurus nobilis (LN) plants in Northern Cyprus were investigated against Leishmania tropica. Methods: Leishmania tropica strain (MHOM/TR/2012/CBCL-LT) was obtained. RPMI-1640 was added to 96-well plates in 100 µL aliquots, 100 µg/mL essential oil was added to the first well of each row and serial 2-fold dilutions were performed. A promastigote suspension was pipetted into all wells, and the plates were incubated. The promastigotes were enumerated using a haemocytometer. Results: OD essential oil was effective at killing all promastigotes at a minimum inhibitor height (MIC)=0.2 µg/mL and had high activity at the lowest concentrations. Both SF and LN oils had MIC=1.56 µg/mL and LD50=0.78 µg/mL. SF was observed to impair promastigote morphology at the lowest concentrations, while LN did not exert any effect at concentrations <0.2 µg/mL. OM essential oil was found to have a MIC=3.13 µg/mL and a LD50=1.56 µg/mL. Conclusion: All tested essential oils inhibited promastigotes of Leishmania tropica. OD essential oil demonstrated the highest anti-leishmanial activity. Amaç: Bitkilerden elde edilen dogal ürünlerin leishmaniasis tedavisi için yeni ve etkili bilesiklerin üretilmesine öncülük edecegi düsünülmektedir. Çalismamizda, Kuzey Kibris'ta yetisen Origanum dubium (OD), Origanum majorana (OM), Salvia fruticosa (SF) ve Laurus nobilis (LN) bitkilerinden elde edilen uçucu yaglarin Leishmania tropica'ya karsi in vitro etkinlikleri arastirilmistir. Yöntemler: Çalismamizda, Leishmania tropica susu (MHOM/TR/2012/CBCL-LT) kullanildi. Düz tabanli 96'lik plaklarda, tüm kuyucuklara 100 µL RPMI-1640 ve ilk kuyucuklara 100 µg/mL uçucu yaglar eklenerek, seri dilüsyonlari yapildi. Ardindan tüm kuyucuklara Leishmania tropica promastigot süspansiyonundan pipetlendi ve inkübe edildi. Hemositometre yöntemiyle promastigotlarin sayisi incelendi. Bulgular: OD yaginin minimum inhibitör konsantrasyonu (MIK)=0,2 µg/mL'de tüm promastigotlari öldürürken, en düsük konsantrasyonlarda bile etkili oldugu görülmüstür. SF ve LN uçucu yaglarinin ikisinde de MIK=1,56 µg/mL, LD50=0,78 µg/mL olarak saptanmistir. SF'nin en düsük konsantrasyonlarinin bile promastigot morfolojisini bozdugu görülürken, Laurus nobilis'in ise 0,2 µg/mL'den sonraki konsantrasyonlarda etkisini kaybettigi belirlenmistir. OM uçucu yaginin MIK=3,13 µg/mL, LD50=1,56 µg/mL oldugu görülmüstür. Sonuç: Kullanilan tüm uçucu yaglarin Leishmania tropica promastigotlarini inhibe ettigi görülürken, en yüksek anti-leishmanial etkinlik Origanum dubium uçucu yaginda bulunmustur.

Epidemiology of Intestinal Parasites in a University Hospital in Northern Cyprus: A 4-year Retrospective Experience

Objective: Intestinal parasitic infections (IPI) are considered as one of the most important public health problems that cause morbidity and mortality. For this reason, to determine their prevalence it is critical for prevention. This study aimed to determine the prevalence of intestinal parasites. Methods: In our study, a total of 4.957 patients registered to our hospital with gastrointestinal symptoms between January 2016 and December 2019 were retrospectively analysed. Their stool samples were examined macroscopically and microscopically. In the microscopy, native-lugol and formol ethyl acetate concentration methods were used. Crypto-Giardia-Entamoeba antigen test was applied. All cases were evaluated in terms of age, gender, year and season. Results: In our study group, 239 (4.8%) patients were detected as positive for intestinal parasites. Among these patients, 129 (54%) were male and 110 (46%) were female. No statistically significant difference was found between IPI and gender (p=0.228). Blastocystis hominis (76.2%) and Giardia intestinalis (12.1%) were the most common parasites. According to age groups, most intestinal parasites are found in 16-45 years old and least in 0-15-years-old (p=0.0001). A significant increase was found in positive intestinal parasite cases especially after 2018 (p=0.0001). Our study determined that intestinal parasites were observed most frequently in autumn (p=0.033). Conclusion: The prevalence of IPI in our country is low. However, due to the increasing trend of IPI since 2018, necessary measures must be implemented to prevent further increase in the number of cases. In addition, reasons behind the rising cases of intestinal parasites during the autumn months in which rainfall begins require further investigation.

Automated detection of Mycobacterium tuberculosis using transfer learning.

INTRODUCTION: Quantitative analysis of Mycobacterium tuberculosis using microscope is very critical for diagnosing tuberculosis diseases. Microbiologist encounter several challenges which can lead to misdiagnosis. However, there are 3 main challenges: (1) The size of Mycobacterium tuberculosis is very small and difficult to identify as a result of low contrast background, heterogenous shape, irregular appearance and faint boundaries (2) Mycobacterium tuberculosis overlapped with each other making it difficult to conduct accurate diagnosis (3) Large amount of slide can be time consuming and tedious to microbiologist and which can lead to misinterpretations. METHODOLOGY: To solve these challenges and limitations, we proposed an automated-based detection method using pretrained AlexNet to trained the model in 3 sets of experiments A, B and C and adjust the protocols accordingly. We compared the detection of tuberculosis using AlexNet Models with the ground truth result provided by microbiologist and analyzed inconsistencies between network models and human. RESULTS: 98.15 % accuracy, 96.77% sensitivity and 100% specificity for experiment A, 98.09% accuracy, 98.59% sensitivity and 97.67% specificity for experiment B and 98.73% testing accuracy, 98.59 sensitivity, 98.84% specificity ofr experiment C which sound robust and promising. CONCLUSIONS: The results indicated that network performance was successful with high accuracies, sensitivities and specificities and it can be used to support microbiologist for diagnosis of tuberculosis.

Prevalence of Panton-Valentine leukocidin in methicillin-resistant Staphylococcus aureus clinical isolates at a university hospital in Northern Cyprus: a pilot study.

OBJECTIVE: Panton-Valentine leukocidin (PVL)-positive methicillin-resistant Staphylococcus aureus (MRSA) is a healthcare problem worldwide. There are no reports on the virulence characteristics of MRSA in Northern Cyprus (NC). This study aimed to determine the presence of pvl among MRSA isolates from patients admitted to a university hospital in NC using molecular methods. Fifty S. aureus strains were included in this study. BD Phoenix automated identification system was used for bacterial identification and antibiotic susceptibility testing. Methicillin resistance was confirmed by disc diffusion assay. Presence of nuc and mecA genes was tested by multiplex PCR. Detection of pvl gene was performed by single-target PCR. RESULTS: Out of 50 S. aureus isolates identified as MRSA by BD Phoenix system, 3 were susceptible to cefoxitin with disc diffusion assay and were confirmed as methicillin-sensitive S. aureus (MSSA). All isolates (n = 50, 100%) tested positive for the presence nuc gene and 68% (n = 34/50) were mecA positive. pvl was detected in 27.7% (n = 13/47) of the MRSA isolates. Among PVL-positive MRSA isolates, 69.2% (9/13) were inpatients. PVL-MRSA was more common in isolates from deep tracheal aspirate (30.8%, 4/13) and abscess/wound (23.1%, 3/13). This represents the first study of PVL presence among MRSA in hospital setting in NC.

Evaluation of Imported Malaria Cases in Northern Cyprus between 2016 and 2019: First Data Series

Objective: In present times, malaria remains an infectious disease with a high mortality rate in some regions of the world. It is predicted to preserve its importance as a disease in the future because of the traveling human populations from malaria-endemic African countries into the regions where malaria has been eradicated. The objective of this study is to evaluate the increasing imported malaria cases in the Turkish Republic of Northern Cyprus. Methods: In this study, we investigated 13 patients who were diagnosed with malaria between 2016 and 2019. We clinically evaluated all the cases. More importantly, we made the diagnosis of these patients by Giemsa-stained thin and thick blood smears, rapid malaria antigen tests, and genotyping (only for five patients) by real-time polymerase chain reaction. Additionally, we evaluated patients with malaria in terms of age, gender, and seasons. Results: In the diagnosed malaria cases, 11 (84.4%) of them were male and 2 (15.6%) were female. There was no significance between malaria infection and gender (p=0.358). Plasmodium falciparum, Plasmodium vivax, and Plasmodium ovale infection were detected in ten patients (76.9%), two (15.4%) patients, and one (7.7%) patient, respectively. There was a significant increase (p=0.003) in the malaria cases in 2019 (n=9). The seasonal comparison revealed that malaria infections are most common in autumn (8/13, 61.5%). Conclusion: Despite the eradication of malaria in Turkish Republic of Northern Cyprus, the rising number of recently imported cases increases the risk of emerging local cases. Malaria infection should be immediately suspected, particularly, in foreign patients who travel from the malaria-endemic region and present with symptoms such as fever and shivering if the laboratory findings especially detect thrombocytopenia.

[An Endemic Plant of Cyprus, Origanum majorana: Is It A New Alternative Natural Product for Malaria Treatment?] / Kibris Endemik Bitkisi Origanum majorana: Sitma Tedavisinde Yeni Bir Alternatif Dogal Ürün Olabilir mi?

Malaria still remains to be a public health threat and one of the most important infectious diseases to get attention from World Health Organization. No domestic malaria cases have been reported on the island of Cyprus since 1948, as a result of successful elimination process. All of the malaria cases detected in recent years are imported cases. As known, hundreds of medicines are obtained from plants and traditional medicine are used in endemic places of malaria. The cause of malaria - Plasmodium parasites, are developing resistance to antimalarial drugs. Hence, research on plant extracts and essential oils have gained great interest in recent years to obtain new and safe agents/substances. In our study, it was aimed to investigate the in vivo antimalarial activities of essential oils obtained from Origanum dubium, Origanum majorana, Salvia fruticosa and Laurus nobilis plants which grows in Northern Cyprus against Plasmodium berghei - the rodent malaria agent. Plants were collected in appropriate seasons and were dried to obtain and analyze essential oils via Clevenger Apparatus system. L929 mouse fibroblast cell line and MTT [3-(4.5-dimethylthiazole-2-yl) -2.5-diphenyltetrazolium bromide] kit were used to determine the cytotoxic activities of the essential oils obtained. In our study, total of 36 mice (Balb/c) of 6 groups (6 mice in each group) were formed: chloroquine group (CG) (50 mg/kg) as malaria reference group, untreated control group (UTCG), O.dubium (OD) (20 mg/kg), O.majorana (OM) (20 mg/kg), S.fruticosa (SF) (20 mg/kg) and L.nobilis (LN) (20 mg/kg). The essential oils were given to mice infected with P.berghei strain orally on 0, 1, 2 and 3rd days (4 times in total). Blood was taken from the tail end of each mouse 24 hours after the last treatment and blood collection was continued every two days until the mice died. Withdrawn blood taken from the mice were prepared as a thin smear and stained with Giemsa. Then, parasitemia percentages in each smear were calculated. As a result of the cytotoxicity tests, cytotoxic activity was not found at 100 µg/ml (20 mg/kg) in all oils except OD essential oil. While the mice receiving chloroquine continued their lives with the disappearance of the parasite on the 6thday, the mice in the UTCG died on the 9th day. The parasitemia rate reached 35% in the OM group on the 23rd day, in the OD group on the 21st day and in the other groups (SF and LN) on the 14th day and the mice have died. In our study, the difference between the life span in all groups was found statistically significant (p≤ 0.001). As a result, the essential oils O.majorana (14 days increase according to UTCG) an endemic plant of Cyprus and O.dubium (12 days increase according to UTCG) which had an antimalarial effect, decreased parasitemia and increased the life span of mice more than two times, indicated that they could be a source for the acquisition of new antimalarial molecules.

Extended-spectrum ß-lactamase, plasmid-mediated AmpC ß-lactamase, fluoroquinolone resistance, and decreased susceptibility to carbapenems in Enterobacteriaceae: fecal carriage rates and associated risk factors in the community of Northern Cyprus.

Background: Antibiotic-resistant Enterobacteriaceae in the gastrointestinal flora can lead to infections with limited therapeutic options. Also, the resistant bacteria can be transferred from colonized persons to others. The present study was conducted to search the fecal carriage rates of (i) Enterobacteriaceae that produce extended-spectrum ß-lactamase (ESBL-E) and/or (ii) plasmid-mediated AmpC ß-lactamase (pAmpC-E), (iii) ciprofloxacin-resistant Enterobacteriaceae (CIP-RE), and (iv) carbapenem-intermediate or -resistant Enterobacteriaceae (CIRE) in Northern Cyprus. Methods: A total of 500 community-dwellers were recruited from consecutive admissions to the clinical laboratories of four hospitals. One rectal swab or stool sample was collected from each participant. A questionnaire was applied to evaluate possible risk factors associated with intestinal colonization of resistant bacteria. The samples were cultured on antibiotic containing media to screen for resistant bacteria colonization. The bacterial colonies that grew on the plates were subjected to further phenotypic tests to confirm the resistance. Results: Of 500 volunteers, ESBL-E, pAmpC-E, CIP-RE and CIRE carriage were detected in 107 (21.4%), 15 (3.0%), 51 (10.2%) and six (1.2%) participants, respectively. Escherichia coli was the most commonly recovered species among Enterobacteriaceae isolates. A significant proportion of ESBL-producing E. coli isolates (n = 22/107; 20.6%) was found to be co-resistant to CIP (p = 0.000, OR 3.21, 95% CI 1.76-5.87). In this study, higher socioeconomic status (CIP-RE: p = 0.024, OR 1.96, 95% CI 1.09-3.53), presence of gastrointestinal symptoms (CIRE: p = 0.033; OR 6.79, 95% CI 1.34-34.39), antibiotic use (ESBL-E: p = 0.031; OR 1.67, 95% CI 1.04-2.67; and CIRE: p = 0.033; OR 6.40, 95% CI 1.16-35.39), and travelling abroad (pAmpC-E: p = 0.010; OR 4.12, 95% CI 1.45-11.66) were indentified as risk factors. Conclusion: The study indicates that resistant Enterobacteriaceae isolates are carried by humans in the community. To prevent further spread of resistance, rational use of antibiotics should be encouraged, and antibiotic resistance should be carefully monitored in Northern Cyprus.

[Investigation of the correlation between anti-HCV levels (S/Co) with HCV-RNA in the diagnosis of hepatitis C virus (HCV) infection]. / Hepatit C virus (HCV) enfeksiyonunun tanisinda anti-HCV düzeyi (S/Co) ile HCV-RNA arasindaki korelasyonun arastirilmasi.

Detection of borderline and/or low positive anti-HCV results by enzyme immunoassay (EIA) leads to severe problems in routine laboratories and needs confirmation with nucleic acid amplification tests which can increase the cost. In EIA tests, if the ratio of sample to cut-off (S/Co) is ≥ 1, the sample is accepted as positive according to the manufacturers' instructions. Although over the last decade the application of S/Co values have also applied to HCV-RNA readings, the current study aims to determine whether the S/Co value is adequate and applicable for the anti-HCV EIA test, and to determine whether a correlation exists between HCV-RNA and HCV infections. A total of 658 cases (402 female, 256 male; mean age: 49.4 ± 17.0 years) who were found anti-HCV positive between January 2011-July 2013 were included in the study. Anti-HCV tests were performed by chemiluminescent EIA (Architect i2000SR, Abbott, USA and LiaisonXL Murex, DiaSorin, Italy) and HCV-RNA by real-time PCR (Cobas Ampliprep/Cobas TaqMan HCV, Roche, USA). The mean S/Co value of the cases was 7.3 ± 4.8 (range: 1.00-17.59) and mean HCV-RNA value was 2.3x105 ± 2.1x106 copies/ml. When the anti-HCV S/Co value of varying ranges was compared with HCV-RNA readings a particular trend was noted. In the anti-HCV S/Co values of 1.0-4.0; 4.1-7.0; 7.1-10.0; 10.1-13.0; 13.1-16.0 and ³16.1, HCV-RNA positivity rates were detected as 1.9%, 24.7%,37.1%, 46.7%, 56.4% and 75%, respectively. Statistical analysis indicated an intermediate positive correlation (r= 0.454) between anti-HCV ve HCV-RNA readings (p= 0.000). An adequate S/Co value was accepted as 5.0 based on the ROC analysis, and this value gave a performance confidence level of 95.6% when determining whether a patient is HCV positive. Based on the data of this study it became evident that further EIA testing is not required if the S/Co value is ≥ 5.0, however if the S/Co value is less than 5.0, then further clinical analysis and revaluation of the patient is required.