Is It a Coincidence or Secondary Immune Thrombocytopenic Purpura? A Case of an 11-Year-Old Male Patient at Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama, Ethiopia.

Background: Isolated thrombocytopenia with normal levels of other cell lines in the absence of other reasons is referred to as "immune thrombocytopenic purpura" (ITP). Tuberculosis has been associated with a variety of hematologic abnormalities, although severe thrombocytopenia and tuberculosis presenting as immune thrombocytopenic purpura are extremely uncommon. Case Presentation: We discuss a case of an 11-year-old male adolescent who came with epistaxis and petechial rash lasting one day, as well as severe thrombocytopenia. Following the clinical diagnosis of ITP, the patient was started on prednisone, transfused with platelets, and later started on antituberculosis (ATT) after confirmation of tuberculosis. The patient had a satisfactory response during the course of treatment, and the platelet level was fully recovered after 6 months. Conclusion: Tuberculosis (TB) should be recognized as a cause of immunological thrombocytopenia in tuberculosis-endemic areas. Our patient's platelet count improved after 1 week of ATT and 2 weeks of prednisolone, and it was entirely restored after 6 months of ATT treatment. Unfortunately, there are no clear guidelines for treating TB-related immune thrombocytopenia or determining the cause of TB-related immune thrombocytopenia. Tuberculosis-induced ITP resolves with the ATT, even though more investigation is warranted.

Experience of dolutegravir-based antiretroviral treatment and risks of diabetes mellitus.

HIV-infected people have started to live longer since the introduction of antiretroviral therapy, however various co-morbid illnesses have emerged. Three HIV-infected individuals, all at least 43 years old, reported with a new onset of type 2 diabetes after switching to dolutegravir-combined antiretroviral therapy regimen. These three people were switched to integrase strand transfer inhibitor (dolutegravir)-based first-line antiretroviral treatment after receiving non-nucleoside reverse transcriptase inhibitor-combined first-line antiretroviral treatment for at least 6 years, as recommended by the World Health Organization for Sub-Saharan African countries, including Ethiopia.All of the given cases had normal plasma fasting sugar (fasting blood sugar <100 mg/dL) at the time of switching. Polyuria, polydipsia, considerable weight loss, and fatigue were all classified as signs of diabetes mellitus in the two male cases. In addition, their laboratory results demonstrated hyperglycemia (plasma fasting blood sugar > 200 mg/dL and urine glucose level ⩾2+) with no ketonuria after switching to dolutegravir for 4-10 months. A glycemic control was achieved, and metformin medication was continued. After 6 months of dolutegravir treatment, the third female case developed diabetic ketoacidosis and severe hyperglycemia (fasting blood glucose level 600 mg/dL, urine glucose level 3+, and ketonuria 3+). To recover from diabetic ketoacidosis, the patient was given intravenous normal saline and regular insulin. Her glycemic control was then restored, and she was switched to NPH insulin. For all of the cases presented, the dolutegravir-based regimen was maintained. Antiretroviral regimens using dolutegravir have the potential to cause hyperglycemia and other side effects. As a result, blood glucose monitoring is required throughout treatment initiation and regularly throughout treatment follow-up, particularly for those on dolutegravir-combined antiretroviral therapy regimens.

The First Experience of Effective 3rd Line Antiretroviral Therapy - A Case of 40-Year-Old Female Retroviral-Infected Patient at Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama, Ethiopia.

BACKGROUND: Treatment failure continues to be an impediment to the efficacy of highly active antiretroviral therapy (HART) in the treatment of human immunodeficiency virus type 1 infection (HIV-1). The World Health Organization (WHO) recommends third-line antiretroviral therapy (ART) for patients who have failed second-line ART. Darunavir (DRV) boosted with ritonavir (DRV/r) has a higher genetic barrier to resistance, is active against multidrug-resistant HIV isolates, retaining virological activity even when multiple protease mutations are present, and has been shown to be cost-effective when compared to other boosted protease inhibitors (PIs). CASE SUMMARY: This is a case of a 40-year-old female known HIV/AIDS patient who has been on ART for the last 14 years with good adherence and regular follow-up, and who is now on 3rd line ART medication with TLD (tenofovir/lamivudine/dolutegravir)+DRV/r (in her 11th month) after being diagnosed with second-line treatment failure. After 6 months and 1 week of therapy, the viral load (VL) was sent, and the result was undetectable. The patient's clinical conditions had greatly improved. CONCLUSION: Third-line ART therapy, which was once thought to be a salvageable treatment, is now the primary option for second-line ART failure. TLD in combination with ritonavir-boosted darunavir is found to be effective at lowering viral loads in the blood below detectable limits. Despite a lack of data on the use of third-line ART in Ethiopia, access to third-line ART containing ritonavir-boosted darunavir is recommended because it has been shown to be an effective alternative for patients who have failed second-line ART. We recommend that more research be done with a larger sample size, and that the findings in this paper be used with caution.

Predictors of Partial Immunization Among Children Aged 12-23 Months in Yirga Cheffe District, South Ethiopia - A Community-Based Unmatched Case-Control Study.

BACKGROUND: Universal age-specific immunization is one of the areas where preventive public health policy has become successful. Despite the increase in global immunization coverage, however, many children around the world, especially in developing countries, are still left unvaccinated. The study aimed at assessing the determinants of partial immunization among children 12-23 months of age in Yirga Cheffe, Gedeo, Ethiopia. METHODOLOGY: A community-based unmatched case-control study design was conducted. Using a simple random sampling technique, 328 samples (164 cases and 164 controls) were selected. Index case was defined as a child aged 12 to 23 months who missed at least one dose of vaccine from the scheduled dose. The odds ratio (OR) and 95% confidence interval (CI) were used to calculate the association, and the level of significance was set at p 0.05. THE RESULT: The study showed that 40% of children were fully vaccinated, and the prevalence of those with partial vaccination was 46%. The likelihood of having incomplete vaccination was 45% higher in children whose mothers had no antenatal coverage (ANC) visit during pregnancy [OR=0.55, (95% CI; 0.297, 1.035)]. Lack of knowledge about the schedule of the vaccination has negatively affected the success of full vaccination (OR=2.3; 95% CI=1.01, 5.56). CONCLUSION: The study revealed that significant numbers of children are not fully vaccinated. Despite appreciable efforts by the Federal Ministry of Health to improve complete immunization coverage, there are still bottlenecks that need to be tackled in enhancing coverage. We recommend the expansion of ANC and providing education on vaccination schedule and importance to minimize the burden of partial vaccinations and its sequelae.

A Neonatal Hip Septic Arthritis Caused by Klebsiella pneumonia at Hawassa University Comprehensive Specialized Hospital Neonatal Unit, Hawassa, Sidama, Ethiopia.

BACKGROUND: Neonatal hip septic arthritis is one of the rarest clinical conditions epidemiologically but with momentous long-term sequelae. Early detection and proper intervention have a paramount role in alleviating the shattering long-term effects. The clinical presentation of neonatal hip septic arthritis is very non-specific, with limited movement of the extremities and excessive crying during manipulations such as diaper changing. Our case was a 17-day-old male newborn who presented to our hospital after a family noticed decreased left leg movement and crying while changing diapers for 5 days, with the associated complaint of holding the left leg in a flexed position. The newborn then underwent all the available investigations and the diagnosis of hip septic arthritis was made. We were stunned by the culture result, which isolated Klebsiella pneumonia from the sample that had been taken from joint fluid, which is a very unusual isolate. CONCLUSION: Hip septic arthritis is an orthopedic emergency, especially in neonates. It should be considered in newborns presenting with pseudoparalysis as the presentation is non-specific. Considering a less common microorganism with culture and sensitivity is very important, especially if the response to treatment is delayed. We endorse proper workup and timely intervention as hip arthritis has a poor prognosis when the management is delayed.