Adaptation of care for non-communicable diseases during the COVID-19 pandemic: a global case study.

People living with non-communicable diseases (PLWNCDs) are at greater risk of severe COVID-19 illness. This case study highlights the adaptations that were made to humanitarian health programmes in five countries to reduce exposure risk for PLWNCDs during the COVID-19 pandemic. Common adaptations included facility-level administrative and engineering controls, improved triaging, change in prescribing practices, decrease in frequency of stable patient visits, shift to remote consultations and expanded scope of responsibility for existing community health workers. Despite fears of the impact on health service utilisation, PLWNCDs continued to seek services and changes in utilisation rates between the pre-COVID-19 and COVID-19 periods were attributed more to factors like population changes, COVID-19 travel restrictions, closure of other health services, and enhanced health education and community engagement. This study highlights the resilience and creativity of frontline health staff and managers, and their ability to make quick shifts in service delivery modalities in response to changes in risk for client groups in accordance with the evolving contextual reality. Other contextual changes such as infectious disease outbreaks, conflicts and natural disasters happen regularly within humanitarian settings, and specific groups are often more at risk. With more specific information about risks for different client groups, targeted approaches can be done to ensure that those most at risk of a specific threat are able to ensure access to sustained services.

Acute kidney injury as initial presentation of visceral leishmaniasis in a young patient- A case report.

Introduction: Visceral leishmaniasis is endemic in Somalia and in East Africa at large. Clinically, patients present with recurrent fever, weight loss, hepatosplenomegaly and pancytopenia. Sometimes, patients in low resource countries with no properly functioning primary healthcare facilities may present with complications. Case presentation: Here, we report a case of 19 years old male patient who presented with impaired renal function. After diagnosing with VL and starting Sodium Stibogluconate, patient developed acute pancreatitis, that compelled us to shift to liposomal amphotericin B, which he responded well and finally was discharged within a good condition. Clinical discussion: Early diagnosis and proper treatment is necessary to restore the renal function. Conclusion: This case report elaborates some of the clinical presentations of VL, complications of treatment and encouraging physicians in endemic areas to keep VL into their list of differential diagnosis in patients with fever and hepatosplenomegaly.

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.

64 slice-coronary computed tomography sensitivity and specificity in the evaluation of coronary artery bypass graft stenosis: A meta-analysis.

A non-invasive approach to define grafts patency and stenosis in the follow-up of coronary artery bypass graft (CABG) patients may be an interesting alternative to coronary angiography. 64-slice-coronary computed tomography is nowadays a diffused non-invasive method that permits an accurate evaluation of coronary stenosis, due to a high temporal and spatial resolution. However, its sensitivity and specificity in CABG evaluation has to be clearly defined, since published studies used different protocols and scanners. We collected all studies investigating patients with stable symptoms and previous CABG and reporting the comparison between diagnostic performances of invasive coronary angiography and 64-slice-coronary computed tomography. As a result, sensitivity and specificity of 64-slice-coronary computed tomography for CABG occlusion were 0.99 (95% CI 0.97-1.00) and 0.99 (95% CI: 0.99-1.00) with an area under the curve (AUC) of 0.99. 64-slice-coronary computed tomography sensitivity and specificity for the presence of any CABG stenosis >50% were 0.98 (95% CI: 0.97-0.99) and 0.98 (95% CI: 0.96-0.98), while AUC was 0.99. At meta-regression, neither the age nor the time from graft implantation had effect on sensitivity and specificity of 64-slice-coronary computed tomography detection of significant CABG stenosis or occlusion. In conclusion 64-slice-coronary computed tomography confirmed its high sensitivity and specificity in CABG stenosis or occlusion evaluation.