Kimura's disease: a case report.

BACKGROUND: Kimura's disease is a rare chronic inflammatory disorder of unknown etiology that is seen in people of Asian descent. It is characterized by head and neck subcutaneous nodules along with lymphadenopathy, which is usually solitary but can be generalized. It is diagnosed histopathologically by the proliferation of blood vessels and germinal centers in lymphoid follicles, along with variable degrees of fibrosis and extensive eosinophil infiltration. Its localized form is treated with surgical excision, while generalized lesions and those that do not respond to surgical excision can be managed with steroids or radiotherapy. CASE: In this report, we present the first case of Kimura's disease in the Ethiopian literature in a 40-year-old Ethiopian man that presented with generalized pruritic subcutaneous nodules and lymphadenopathy, which were effectively managed with a tapering course of prednisolone, and a relapse that showed good sustained response with slow steroid taper. CONCLUSION: We have demonstrated that, even though it is very rare in the African continent, Kimura's disease is to be considered as a differential diagnosis for patients that present with subcutaneous nodules and lymphadenopathy. We also have demonstrated that relapses can be effectively managed with reinitiation of the same dose of steroids but with a very slow taper.

Hypertriglyceridemic pancreatitis managed with heparin and insulin: a case report.

BACKGROUND: Alcohol and gall stones are common causes of pancreatitis. Other causes of pancreatitis include hypertriglyceridemia, trauma, congenital anomalies, and medications. Hypertriglyceridemic pancreatitis is distinguished, as it is more severe and complicated. The management of hypertriglyceridemic pancreatitis, other than the basic care given to other pancreatitis patients, is to decrease the serum triglyceride level to less than 500 mg/dl as soon as possible. Plasmapheresis, hemofiltration, and other modalities have been proven effective therapies, but, are expensive and not easily accessible. Insulin and heparin which are cheaper alternatives for treatment, have been reported in case reports along with one randomized controlled trial. The number of patients in these reports was small, so, the therapy is not well established. For most African countries like ours, the only option for management is heparin and insulin. Despite this fact, there has not been any publication regarding this issue on our continent. CASE REPORT: We report the case of a 24 years old Ethiopian male who presented with severe central abdominal pain, easy fatiguability, and vomiting of one-day duration. He was tachycardic and tachypneic with diffuse abdominal tenderness, and had tendon xanthomas. His plasma was lactescent with a serum triglyceride level of 4775 mg/dl. His abdominal CT scan showed diffuse pancreatic swelling with a peripancreatic fluid collection, and his serum lipase was elevated. With a diagnosis of hypertriglyceridemic pancreatitis, he was managed with intravenous insulin infusion along with subcutaneous heparin. His random blood sugar was checked hourly with three episodes of hypoglycemia during therapy. His serum triglyceride level dropped to less than 500 mg/dl in three days, and he was discharged with no complications. CONCLUSION: Since our findings are consistent with a prior randomized controlled trial and compilation of case reports, it would strengthen the evidence for safety and efficacy of insulin and heparin therapy. This therapy, which is the only available therapy in most countries of our continent, would decrease most of the complications of hypertriglyceridemic pancreatitis that we face. We believe, our report would be a wake-up call for researchers and clinicians in our continent to change their practice and strengthen the evidence for the treatment.

Clinical outcome of bronchoalveolar lavaged COVID ARDS patients.

Introduction: One of the biggest pandemics of the human race, Coronavirus disease, has reported mortality rates as high as 80% for critically ill patients. It has killed more than 3.9 million people worldwide with no strongly proven management options to decrease its mortality. One of the options gaining interest is fiberoptic bronchoscopy and bronchoalveolar lavage. Our study was conducted to assess the clinical outcome of intubated Coronavirus disease patients that had a fiberoptic bronchoscopy and bronchoalveolar lavage done. Methods and materials: A consecutive prospective case series of intubated patients with critical Coronavirus disease pneumonia were conducted at Bethzatha general hospital from April 20, 2021, to July 30, 2021 GC. Results: Five patients with a median age of 55 years were included in the study. The median APACHE II, SAPS II, and SOFA scores on admission were 13, 37, and 4 respectively. The difference in the mean values of; positive end-expiratory pressure, static compliance, plateau pressure, fractional inspired oxygen, and arterial oxygen tension to fractional inspired oxygen ratio between the time of intubation and the last fiberoptic bronchoscopy and bronchoalveolar lavage were 4.4 cmH2O, 11 ml/cmH2O, 6.2 cmH2O, 45%, and 76 mmHg. All patients were liberated from mechanical ventilation. Conclusion: - There was a numerically and clinically significant improvement in lung mechanics and oxygenation leading to a 100% ventilator liberation rate. Fiberoptic bronchoscopy and bronchoalveolar lavage in Coronavirus disease patients can improve lung mechanics, oxygenation, and rates of extubation.