Hypokalemic periodic paralysis as the first sign of thyrotoxicosis- a rare case report from Somalia.

BACKGROUND: Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare complication of hyperthyroidism characterized by thyrotoxicosis, hypokalemia, and paralysis. It is the most common form of acquired periodic paralysis. THPP is precipitated by strenuous exercise, a high carbohydrate diet, stress, infection, alcohol, albuterol, and corticosteroid therapy. It is most common in Asian men with hyperthyroidism and exceptionally rare in black people. CASE PRESENTATION: A 29-year-old man was admitted to the emergency department in Somalia with a sudden onset of paralysis after a high carbohydrate meal. Laboratory investigations showed low serum potassium 1.8 mEq/l (3.5-4.5), and biochemical thyrotoxicosis with TSH 0.006 miu/l (0.35-5.1), total T3 3.2 ng/ml (0.9-2.8) and total T4 13.5 ng/ml (0.6-1.2). He was successfully treated with potassium chloride infusion and an antithyroid drug, methimazole. CONCLUSION: To prevent life-threatening cardiac and respiratory complications, it is critical to consider and diagnose THPP early, even in populations where the condition is rare.

ICU-Managed Patients' Epidemiology, Characteristics, and Outcomes: A Retrospective Single-Center Study.

Background: Resources are limited, and it is exceedingly difficult to provide intensive care in developing nations. In Somalia, intensive care unit (ICU) care was introduced only a few years ago. Purpose: In this study, we aimed to determine the epidemiology, characteristics, and outcome of ICU-managed patients in a tertiary hospital in Mogadishu. Methods: We retrospectively evaluated the files of 1082 patients admitted to our ICU during the year 2021. Results: The majority (39.7%) of the patients were adults (aged between 20 and 39 years), and 67.8% were male patients. The median ICU length of stay was three days (IQR = 5 days), and nonsurvivors had shorter stays, one day. The mortality rate was 45.1%. The demand for critical care services in low-income countries is high. Conclusion: The country has a very low ICU bed capacity. Critical care remains a neglected area of health service delivery in this setting, with large numbers of patients with potentially treatable conditions not having access to such services.

Multiple Venous and Pulmonary Artery Thrombosis as a Presenting Complaint of Nephrotic Syndrome-Case Report and Challenges in Management.

Nephrotic Syndrome (NS) patients are prone to develop deep venous thrombosis as a complication. But it is unusual to present initially with multiple venous thrombosis and pulmonary artery thrombosis before the diagnosis of NS. Here, we present 60 years old female patient with a known history of diabetes mellitus who presented with shortness of breath and lower limb edema for 2 weeks. CT angiography showed thromboembolism at the right main pulmonary artery and its bronchus intermedius, lower and segmental with right lower lobe small pulmonary infarction and inferior vena cava (IVC) thrombosis extending in both renal veins, right common and left common iliac vein, moderate ascites. Her 24-hour urinary protein was 6.7g. a diagnosis of NS was reached and she was admitted to the ward. Anticoagulation with heparin and warfarin, methyl prednisone, and furosemide was initiated. After she become clinically stable, she was discharged with oral medications. Awareness of the complication of nephrotic syndrome is important not only to nephrologists but to all physicians. Using contrast-enhanced computed tomography to diagnose multiple venous and pulmonary arterial thrombosis is critical. Additionally, it is known that steroid-resistant NS, like membranous glomerulonephritis, are more susceptible to the complication of thromboembolism than steroid-sensitive NS. Contrast venography is used to diagnose DVT. CTPA is the gold standard test for pulmonary embolism.

Severe Hypercalcemia as an Initial Presentation of Advanced Hepatocellular Carcinoma: A Case Report.

Background: It is extremely rare for hypercalcemia to appear as the first symptom of hepatocellular carcinoma. Instead, it occurs primarily as a paraneoplastic manifestation after the disease is already diagnosed. Methods: In this report, we describe a 55-year-old woman who presented with symptoms of acute severe hypercalcemia and was negative for hepatitis B surface antigen and hepatitis C virus antibodies. Results: Laboratory tests confirmed hypercalcemia (serum calcium 16.2 mg/dL) with intact parathyroid hormone (2 pg/mL). Alpha-fetoprotein serum level was 3031.14 ng/mL. Abdominal ultrasonography and computed tomography revealed a big vascularized mass of 7 × 5.5cm in diameter, occupying most of the right lobe of the liver. Conclusion: Based on these findings, hepatocellular carcinoma may present late in disease progression with isolated hypercalcemia; therefore, HCC should be considered in the differential diagnosis in a hypercalcemic patient.