Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction: A case report and review of literature.

BACKGROUND: Mycobacterium tuberculosis (TB) is the causative agent of TB, a chronic granulomatous illness. This disease is prevalent in low-income countries, posing a significant global health challenge. Gastrointestinal TB is one of the three forms. The disease can mimic other intra-abdominal conditions, leading to delayed diagnosis owing to the absence of specific symptoms. While gastric outlet obstruction (GOO) remains a frequent complication, its incidence has declined with the advent of proton pump inhibitors and Helicobacter pylori eradication therapy. Gastroduodenal TB can cause upper gastrointestinal hemorrhage, obstruction, and malignancy-like tumors. CASE SUMMARY: A 23-year-old male presented with recurrent epigastric pain, distension, nausea, vomiting, and weight loss, prompting a referral to a gastroenterologist clinic. Endoscopic examination revealed distorted gastric mucosa and signs of chronic inflammation. However, treatment was interrupted, possibly owing to vomiting or comorbidities such as human immunodeficiency virus infection or diabetes. Subsequent surgical intervention revealed a dilated stomach and diffuse thickening of the duodenal wall. Resection revealed gastric wall effacement with TB. CONCLUSION: Primary gastric TB is rare, frequently leading to GOO. Given its rarity, suspicions should be promptly raised when encountering relevant symptoms, often requiring surgical intervention for diagnosis and treatment.

Erratum to "Intra-abdominal mass with empty scrotum in adult male revealed as testicular seminoma: A case report" [Radiology Case Reports 17 (2022) 3308-3311].

[This corrects the article DOI: 10.1016/j.radcr.2022.06.038.].

Knowledge, Attitude and Practice of Toothbrush Contamination and Disinfection Among Undergraduate Students in Selected Universities in Somalia.

Background: Oral health is crucial for overall well-being and systemic health and Humans are exposed to several bacteria after birth and will causes systemic illnesses like septicemia, respiratory, gastrointestinal, and renal issues. This study aimed to evaluate undergraduate students' knowledge, attitudes, and practices regarding toothbrush contamination and disinfection. Methods: A descriptive cross-sectional study was carried out with undergraduates from seven selected universities, including public and private universities. A closed-ended questionnaire containing 24 items was distributed to A total of 490 undergraduate students. Results: The study showed that (28.6%, n=140) had knowledge about toothbrush cleaning and disinfection. A total of (350, n=71.4%) needed to gain knowledge about toothbrush cleaning and disinfection. Fifty-two percent of the students feel that bacteria are the primary mode of toothbrush contamination. Many of the students had different ways of disinfecting toothbrushes, including, boiling a small pot of normal water (51.4%, n=252), chemical agent (31.8%, n=156), ultraviolet sanitizer (0.2%, n=4), and microwave radiation (0.2%, n=1) does not know (16.1%, n=79). Most students (76.9%, n=377) felt that toothbrush disinfection was necessary. Conclusion: Fewer students have sufficient knowledge about toothbrush contamination and practice disinfection methods, whereas most students need to be made aware of the contamination of toothbrushes and the use of disinfectant methods.

Atypical perforated appendicitis secondary to schistosomiasis: a rare case report.

Introduction: Schistosomiasis is the second most common parasite disease after malaria and a rare cause of appendicitis. It has been well-documented in the literature that schistosomiasis infection can have several multisystem effects. The unusual condition known as schistosomal appendicitis was initially described by Turner. Case presentation: We present a 48-year-old man with perforated appendicitis and schistosomiasis-like radiological findings. An appendectomy was performed, and schistosomiasis was confirmed by a histological study of the excised appendix. Praziquantel was administered in a single dosage. Conclusion: Although schistosomiasis is a rare cause of appendicitis and is very prevalent in developing nations, it should be considered when managing the condition. Anti-shistosoma drugs, which are not frequently used in post-appendectomy cases, should also be considered in the management.

Isolated Inferior Sagittal Sinus Thrombosis in Young Patient: Rare Case Report.

Cerebral venous thrombosis (CVT) is a less common type of stroke, mostly in young patients. The majority of these cases are due to thrombosis of superior sagittal sinus and transverse sinus. Isolated thrombosis of the inferior sagittal sinus is very rare. Here, we report a 22-year-old male patient with no significant past medical history who presented to the emergency department of our hospital with a convulsion, decreased level of consciousness, and right side weakness. His laboratory investigations, including the coagulation profile, were normal. A non-contrast brain CT showed a 5 × 3 cm hematoma in the left parasagittal parietal lobe with no associated midline shift or intraventricular extension. The cerebral magnetic resonance (MR) angiogram did not show any underlying aneurysm or vascular lesion. However, the cranial MR venogram showed inferior sagittal sinus thrombosis, while other cranial veins and dural sinuses were patent. The patient was admitted to the hospital and managed with low-molecular-weight heparin and warfarin sequentially. He had significant improvement (consciousness and weakness have improved, and seizures are under control). This present case illustrates a rare case of isolated cerebral venous thrombosis and also reviews the known literature on this condition.

Risk factors, classification, and operative choices of femur fractures at a Tertiary Hospital: first report from Somalia.

A traumatic femur fracture is a significant cause of morbidity, affecting one to three million individuals annually. The present is the first study investigated the epidemiological characteristics, risk factors, classification, mechanisms of injury, and early management of femoral fractures in Somalia. This retrospective epidemiological study included all patients with a femur fracture who were admitted for four years between November 2018 and December 2022 to the orthopedic and trauma surgery department. We reviewed patient demographic characteristics, including age and gender, the mechanism of injury, injury characteristics, and the type of fixation performed. We reviewed the radiographs and classified the fracture using the AO/OTA classification system. During the study period, a total of 402 patients were treated for femur fractures; 256 (64%) were males, and 144 (36%) were females. The mean patient age was 47.7 ± 8.5 years. Regarding the anatomical location of femur fractures, the proximal (31A, 31B) was the most common, accounting for 50% of the patients. Femur neck fracture (31B) was the most common in the proximal femur fractures. Gunshot 82 (59.42%) was the leading cause of femur shaft fractures. Most patients with femur shaft fractures were males; 150 (86.20%) and 152 (64.47%) were young patients between 19 and 40 years old. Almost half of the patients (86) with femur shaft fractures had open fractures. The distribution of the mechanism of injury significantly differed according to age (p < 0.001). Younger patients (< 40 years) were predominantly injured due to gunshot injuries compared to elderly cases (> 60 years), where falls from standing height were the primary mechanism of injuries. There was a statistically significant difference between the mechanism of injury and gender categories (p < 0.001). Male patients were injured mainly by gunshots in about 40%, while 80% of fractures in female patients were due to falls from standing height. Female fractures occurred primarily in the proximal, while the males had an equal fracture rate for proximal and shaft fractures. Femur fracture causes significant morbidity and mortality. The study findings revealed that the most common femur fracture type was femur neck fracture, and low-energy injuries were the most common mode of injury in the elderly. Proximal femur fractures occur in older age and mainly in females. Gunshots were the most common cause of femur shaft fractures in Somalia, a country that has struggled with wars for over 30 years.

Iatrogenic giant subclavian artery pseudoaneurysm following clavicle fracture repair: A case report.

Subclavian artery aneurysms are infrequently observed in clinical settings, and are divided into intrathoracic and extra-thoracic segments. Atherosclerosis, cystic necrosis of the tunica media, trauma, or infections are more common. Blunt trauma or piercing is more frequently the cause of pseudoaneurysms, and broken bones following surgery should be evaluated. A 78-year-old woman attended the vascular clinic with a closed mid-clavicular fracture due to plant trauma before 2 months. Physical examination revealed a well-healed wound and no palpable pain, but a massive pulsating mass with normal overlying skin in the superior side of the clavicle. Thoracic CT angiography and a neck ultrasound revealed a distal right subclavian artery pseudoaneurysm of 50 × 49 mm. Arterial injuries were repaired by a ligature and bypass. The recovery from surgery was successful, and a 6-month follow-up examination revealed a right upper limb that was symptom-free and well-perfused.

Spontaneous expulsion of 10 years retained intrathoracic foreign body (bullet) from left main bronchus: A case report.

A foreign body lodged in the tracheobronchial tree is a serious and common medical emergency that can have serious and perhaps lethal consequences. A few cases have been reported in the literature for the last century with gunshot wounds to the chest that were handled non-operatively and finally expelled the bullet on their own. We present a case of a hemodynamically stable 50-year-old male with a 10-year-old penetrating thoracic gunshot wound, with the bullet found in the left main bronchus on computed tomography (CT) scan upon admission. Further examination found no evident erosive injuries, such as hemoptysis, but he did have empyema and required a thoracotomy for decortication. Shortly after discharge, he coughed out a bullet into the floor, which is why our case is so intriguing. This case demonstrated that a bronchial foreign body is seldom spontaneously expelled.

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.

A rare case of septic pulmonary embolism: A case report.

Septic pulmonary embolism occurs when septic material separates from its source and infiltrates the pulmonary parenchyma, resulting in substantial clinical symptoms. Here we report a 13-year-old female patient admitted to the hospital with a fever and chest discomfort. In the past days, she had bilateral limb pain, which induced traditional cauterization in the bilateral inguinal regions. On inspection, she had edema and erythema at the cauterization site, indicating wound infection. Multiple lung nodules were discovered on computed tomography, indicating SPE. High-dose antibiotics were started immediately after debridement. SPE is frequently associated with deep tissue infections, and cases of SPE following minor traumas are uncommon.

Intra-abdominal mass with empty scrotum in adult male revealed as testicular seminoma: A case report.

During fatal development, the testes grow in the abdomen and descend into the scrotal sac. It can be stopped at any point along its path (cryptorchidism) or migrate to an atypical side (ectopic testis). A 47-year-old man from Somalia's lower Shabelle region was presented to the urology OPD, He had a history of non-tender abdominal mass for the previous four months, An examination revealed a mass in his abdomen that was firm, non-tender, and immobile, an abdominal ultrasound and a contrast enhanced CT abdomen showed a 15-cm heterogeneous bean-shaped mass above the bladder. After patient counseling and informed written consent, a laparotomy was done to remove the tumor. A seminoma of the undescended testis was identified during a histological examination. An intra-abdominal mass with empty scrotum should raise concerns about an intra-abdominal testicular tumor. To prevent/early discover these types of tumors, cryptorchidism should be treated at a young age, particularly before to the first year.

Spontaneous transvaginal small bowel evisceration secondary to vaginal cuff dehiscence after abdominal hysterectomy: A case report.

Introduction: and importance: Small intestinal evisceration through the vaginal canal is a rare surgical emergency that necessitates immediate surgery to avoid bowel necrosis, infection, and death. It was first documented in 1864. Case presentation: A 55-year-old postmenopausal woman was reported to the emergency department with an 8-h history of moderate lower abdomen pain and diarrhea. After investigation, the patient was diagnosed with transvaginal small bowel evisceration, and vaginal cuff dehiscence was repaired. Clinical discussion: Given the high death rates associated with this illness, we publish this case to promote awareness of therapeutic techniques. Second, it highlights the significance of interdisciplinary surgical collaboration in achieving the greatest possible patient outcome. Conclusion: An operation should be performed to avoid significant complications such as peritonitis, sepsis, and septic shock, considering the disease's rarity and high fatality rate if not treated early.

Clinical presentation and surgical management of perforated peptic ulcer in a tertiary hospital in Mogadishu, Somalia: a 5-year retrospective study.

BACKGROUND: Perforated peptic ulcer is a common surgical emergency condition worldwide, which is associated with significant morbidity and mortality if early diagnosis and immediate surgical management were not carried out. Perforation occurs in roughly 5% of PUD patients during their lifetime; this study aimed to explore the wide range of clinical presentations, associated risk factors, complications, and surgical management of perforated peptic ulcer patients. METHODS: A 5-year retrospective observational study on the clinical presentation and surgical management of perforated peptic ulcer is carried out in a tertiary hospital in Mogadishu, Somalia, Department of General Surgery, from January 2017 to December 2021. We included all patients undergoing operations with an intraoperative confirmed diagnosis of perforated peptic ulcer at the general surgery department. For operated patients, follow-up evaluation was performed in the outpatient department. RESULTS: Fifty-one patients underwent an emergency operation for perforated peptic ulcer during the study period. The sociodemographic distribution of patients was 45 (88.2%) males and 6 (11.8%) females, giving a male-to-female ratio of 7.5:1. The mean age of patients was 35.5 ± 16.8 years, and the peak frequency was in the third decade. The commonest presenting symptoms were sudden onset of severe epigastric pain in 42 (82.4%) patients. Patients who presented perforated peptic ulcer within 24 h of initiation of symptoms were free from complications. Age-group and delayed presentation > 48 h after onset of symptoms were linked to postoperative complications and were statistically significant (P 0.032 and P 0.005), respectively. Four patients died (mortality rate of 7.8%). Two patients were reoperated because of the failed primary repair, and 4 patients had > 5 cm intra-abdominal abscess image-guided percutaneous drainage, and the rest were given antibiotic therapy according to peritoneal fluid culture and sensitivity results. The most common microorganism isolated was E. coli 22% and Klebsiella 11%. Other rare microorganisms (pseudomonas, Staphylococcus aureus, and Candida spp.) were identified. In half (51%) of the patients with peritoneal fluid culture, no microorganism growth was seen. CONCLUSION: The distribution of perforated peptic ulcer is common in the young age-group in the third decades of life. Delayed presentation of the disease is linked because most patients arrived from remote areas where proper facilities of health care and health education are not available and the patient might come to the hospital in an advanced stage of the disease. We suggest conducting further researches, health awareness related to complications over-the-counter drugs self-medication, and bad habit including smoking, and to improve health-seeking behaviors of society.

Prevalence of Acute Kidney Injury in Covid-19 Patients- Retrospective Single-Center Study.

Introduction: In December 2019, a coronavirus disease 2019 (COVID-19) disease outbreak started in Wuhan, Hubei Province, China, and spread rapidly to other regions of the world. Although diffuse alveolar injury and acute respiratory failure were the most prominent characteristics, further investigation of organ involvement is essential. Aim: In this study, we aim to determine the prevalence of acute kidney injury (AKI) in covid-19 patients and also the relationship between inflammatory markers, the severity of lung involvement, and acute kidney injury in COVID-19 patients. Methods: This was a retrospective analysis of 102 COVID-19 patients presented to a tertiary teaching hospital in Mogadishu during the second wave of Covid-19 2021. Patients' age, gender, comorbidities, hemoglobin, platelet, and white blood cell counts, glucose, urea, creatinine, sodium, potassium, CRP, ferritin, real-time polymerase chain reaction (RT PCR) Covid-19 test and CT scan findings were all collected. Results: The mean age of the patients was 58 (Range 23-91 years), including 64 men and 38 women. The prevalence of acute kidney injury was 12.7%. There was a significant association between acute kidney injury, CRP and ferritin with the p values of P<0.003 and P<0.004, respectively. For severity of lung involvement with computed tomography finding, 35 (34.3%) had mild, 35 (34.3%) had moderate and 32 (31.4%) had severe lung involvement. There was significant association between the lung involvement, Ferritin and CRP levels with P values of P<0.005 and P<0.007 respectively. Conclusion: Our findings indicate that acute kidney injury is common in covid-19 patients and can increase the morbidity and mortality of these patients. As a result, clinicians in low-resource countries such as Somalia should be more vigilant about kidney injury in patients with severe COVID-19.

A case report of medically managed esophageal fistula due to complicated esophageal tuberculosis.

INTRODUCTION AND IMPORTANCE: Esophageal TB is a relatively uncommon condition. Mostly, the esophagus can be affected by tuberculosis through direct spread or from mediastinal nodes (rarely from the lungs or bloodstream). The most common symptom is dysphagia, and the diagnosis is confirmed by histology. If left untreated, esophageal tuberculosis can result in bleeding, perforation, fistula formation, aspiration pneumonia, lethal hematemesis, traction diverticula, and esophageal strictures. CASE PRESENTATION: This is a rare case report of an esophageal fistula caused by tuberculosis in a patient presenting with a cough on eating and weight loss. The patient was subjected to upper gastrointestinal endoscopy, which revealed a cervical esophagus fistula 20 cm from the upper central incisors. Histopathology revealed inflammatory lesions with epithelioid granulomas (granulomatous disease). A mycobacterium sputum examination was performed; the smear was negative. The patient was managed conservatively with anti-tuberculosis treatment (ATT). A follow-up endoscopy after two months revealed that the fistula was closed and clinically improved. CLINICAL DISCUSSION: The quick clearance of contaminated sputum by coordinated peristalsis, paired with upright posture and an intact lower esophageal sphincter, limits the organism's exposure to the esophagus. CONCLUSION: Despite the disease's rarity, if not delayed, it can be efficiently managed with ATT to avoid major complications like esophageal perforation, which necessitates surgery.

Laparoscopic management of ischemic right fallopian tube torsion mimicking perforated appendicitis.

BACKGROUND: Isolated fallopian tube torsion is a rare cause of acute lower abdominal pain in females. A history of hemosalpinx, hydrosalpinx, or ovarian or paraovarian cysts might all be risk factors. Diagnosis is frequently delayed until it's too late to salvage the tube. CASE PRESENTATION: A 32-year-old lady with no prior medical and surgical history presented to our emergency department with a four days history of severe right lower abdomen pain and tenderness accompanied by nausea. Clinically, she was feverish, with elevated C reactive protein levels, negative serum Beta HCG, and normal urine analysis. Computed tomography demonstrated a 5x3cm collection in the right lower quadrant of the abdomen. A diagnostic laparoscopy was performed upon exploration a Twice-fold twisted ischemic right fallopian tube with hydrosalpinx was found and Salpingectomy was performed. CONCLUSIONS: Torsion of the fallopian tube is an uncommon cause of acute lower abdominal pain in women. The exact process that causes isolated tubal torsion is unknown. Early diagnostic laparoscopy and surgical intervention are essential in a nulliparous young woman.

Empyema necessitans in an infant due to pseudomonas aeruginosa at a referral hospital in mogadishu, somalia: A case report.

Empyema necessitans (EN) is a rare complication of bacterial pneumonia, especially in children. It can be caused by many infectious agents, but Mycobacterium tuberculosis is the most common cause of EN. We report a 3-month-old girl who had EN on the 90th day of life, multidrug-resistant P. aeruginosa was isolated from her pleural fluid culture. We could not find another published report about EN caused by Pseudomonas aeruginosa (P. aeruginosa) in an infant. The case highlights that children presenting with fever and chest wall mass should be immediately imaged by chest computed tomography as there might be an urgent need for intervention.