Clinical characteristics of acute liver failure associated with hepatitis A infection in children in Mogadishu, Somalia: a hospital-based retrospective study.

BACKGROUND: Hepatitis A is one of the most common infectious causes of acute hepatitis, and currently, a neglected global public health problem necessitating an urgent response in Somalia. Hepatitis A infection and its rare complication of acute liver failure in children are largely based on very limited data. The aim of the study was therefore to investigate the Hepatitis A infection and its rare complication of acute liver failure in children in Somalia. METHODS: This retrospective study was conducted on children aged 0-18 years who were admitted to the pediatric departments of the Somalia Mogadishu-Turkey Training and Research Hospital, Somali, from June 2019 and December 2019. Patients who were tested for hepatitis A infection during the study period and had complete data were included. Children with chronic disease, primary or secondary immunodeficiency, blood transfusion history, and missing data were excluded. Abstracted data including patients' demographics, clinical presentation, laboratory results, ultrasonographic findings, length of hospital stay, clinical course and outcome were retrieved from the hospital database system. RESULTS: Of the 13,047 children, 219 were analyzed. Of the 219 Hepatitis A cases, 25 (11%) were diagnosed with pediatric acute liver failure (PALF). The mean age of children with Hepatitis A was 6.7 years. The majority of cases were reported in the 5-9 (39.7%) year age range. Hepatic encephalopathy, length of hospital stay, levels of albumin, and values of PT, aPPT, and INR were significantly higher in children with acute live failure. The presence of cholecystitis and cholecystitis with ascites in the sonographic evaluation were poor prognostic markers for acute liver failure. CONCLUSIONS: This study revealed hepatitis A virus infection and its related acute liver failure among hospitalized children in Somalia of which 11% had PALF. Hence, the introduction of Hepatitis A vaccination, which is the main public health tool, into the national immunization program, the improvement of hygiene conditions, raising awareness of the disease, and increasing health literacy are necessary to prevent the consequence of the Hepatitis A virus in children.

Clinical Characteristics of Patients with Hepatocellular Carcinoma: A Single-Center 3-Year Experience from Somalia.

Background: To evaluate the relationship between prognosticators representing tumor aggressiveness and socio-demographic, laboratory, and imaging findings in patients with hepatocellular carcinoma (HCC). Methods: We retrospectively searched patients with HCC between January 2017 and December 2019 in our tertiary referral hospital. The tumor-related factors and liver damage indicators and their relationship to indicate the value of prognosis were analyzed. Results: A total of 268 HCC patients, with a male-to-female ratio of 2.8 : 1. The mean age was 52.6 years. The patient with portal vein thrombosis (PVT) was older, had higher liver laboratory parameters (AST, ALT, total bilirubin, and direct bilirubin), and had larger tumor size. Patients with the larger tumor size had a higher AFP level, had more tumor multifocality. The majority of patients were in Child's A (73.6%) and B (17.2%) classes. The laboratory parameters of HCC patients were increased in Child's C compared to other groups of Child-Pugh classification. Conclusions: The presence of PVT and large-sized tumor in patients with HCC indicated a poorer prognosis than non-PVT group and small tumor sizes.

Spectrum and Prevalence of Thyroid Diseases at a Tertiary Referral Hospital in Mogadishu, Somalia: A Retrospective Study of 976 Cases.

BACKGROUND: Thyroid disorder is one of the most common noncommunicable diseases worldwide and neglected public health issues in Somalia. The aim of the study thus was to investigate the thyroid disorders in patients attending to the largest tertiary referral hospital in Somalia. METHODS: This retrospective study was conducted on patients admitted to the internal department of Somalia Mogadishu-Turkey Education and Research Hospital, Somali, between January 2017 and December 2019. Patients who were tested for thyroid function tests and had complete data were included. Patients with incomplete data and currently treated for any thyroid disorder were excluded from the study. Abstracted data including patients' sociodemographic characteristics, thyroid function tests, and histopathological findings were retrieved from the hospital database system. RESULTS: A total of 976 patients with thyroid disorders were enrolled, of whom 66.6% (n = 650) were female and 33.4% (n = 326) were male. The mean age of the patients was 47 ± 18.5 years. The majority of the patients were reported in the 31-50 (35.9%) age range. The most reported thyroid function disorders were 58.8% euthyroid sick syndrome followed by 15.4% hypothyroidism, 12.5% subclinical hypothyroidism, 7.6% hyperthyroidism, and 5.7% subclinical hyperthyroidism. The distribution of comorbidity indicated that 13.4% had diabetes mellitus, 10.4% had HIV, 4.9% had malaria, and 4.5% had HIV and malaria coinfection. Thyroid malignancies were detached in 22 (2.2%) patients including eleven papillary thyroid cancer, nine patients had follicular thyroid cancer, and two patients had differentiated thyroid cancer. CONCLUSIONS: Euthyroid sick syndrome was the most common type of thyroid disease in our setup. Hypothyroidism is the second most common, followed by subclinical hypothyroidism. Papillary thyroid cancer was the predominant histology among thyroid malignancies, followed by follicular thyroid cancer. This study revealed that thyroid diseases emerge as an important endocrine disorder encountered in Somali, necessitating a major public health response.

Prevalence of Anti-Toxoplasma gondii and Anti-Brucella Spp. Antibodies in Pregnant Women From Mogadishu, Somalia.

Toxoplasmosis and brucellosis are zoonotic diseases of worldwide distribution. They both cause abortion and infertility in human and animals. Limited data are available about these pathogens in Somali people and their animals. Hence, this study has evaluated the prevalence of anti-Toxoplasma gondii and anti-Brucella spp. antibodies in pregnant women in Mogadishu, Somalia. Serum samples from 307 pregnant women from Mogadishu, Somalia were tested for anti-T. gondii antibodies by Latex Agglutination Test (LAT) and anti-Brucella spp. antibodies by Rose Bengal Plate Test (RBPT) and a commercial competitive-ELISA (cELISA). A total of 119/307 (38.76%) pregnant women had a prior history of abortion. A total of 159/307 (51.79%; 95% CI: 46.2-57.35%) pregnant women were seroreactive for T. gondii by LAT at different stages of pregnancy. For Brucella spp., when RBPT and cELISA were combined 4/307 (1.30%; 95% CI: 0.36-3.30%) pregnant women were seroreactive to anti-Brucella spp. antibodies, being 2/307 (0.65%; 95% CI: 0.18-2.34%) by RBPT and 3/307 (0.98%; 95% CI: 0.33-2.83%) by cELISA. Two women were seroreactive for both agents. A high seropositivity to T. gondii and low seropositivity to Brucella spp. have been found in pregnant women from Mogadishu, Somalia. Considering the high number of abortions in the country associated to the fact that awareness on other zoonotic abortifacient pathogens in Somalis is very low, further studies should be conducted to evaluate the potential causes of abortions.