Development of Somaliland national harmonised medical curriculum.

BACKGROUND AND OBJECTIVES: The rational for the Somaliland national harmonised curriculum (NHC) was driven by shared concern about the quality of medical education. PROCESS: The Ministry of Education and Science and the Ministry of Health Development produced a Medical Education Policy 2018. Policy objectives included the development of the NHC and accreditation for medical schools that met the standards of the World Federation for Medical Education (WFME). Two bodies were asked to oversee these aims: the National Health Professions' Commission (NHPC) and the National Commission of Higher Education (NCHE). Between 2018 and 2020, a collaborative approach between the Somaliland government, medical school stakeholders, King's Global Health Partnership's (KGHP) volunteers and the Tropical Health Education Trust (THET) team was used to design the 6-years NHC. The NHC structure, content and delivery were grounded by WFME standards, health needs of the local population, student focused and active learning methods, and feasibility of implementation in medical schools. OUTCOMES: The NHC comprises details about the educational outcomes, curriculum model and framework, educational principles, instructional and learning methods, core as well as optional content, and assessment strategy. CONCLUSIONS: The approach used to develop the NHC ensured it is bespoken for Somaliland. Ongoing evaluation of patient and population needs, each medical school's review of programme implementation and outcomes will inform continuous revision and renewal.

Seroprevalence of Newcastle disease in backyard chickens in selected districts of Banadir region, Somalia.

A cross-sectional study was carried out in the period between January and April 2019 with the aim of establishing prevalence of Newcastle disease (ND) in backyard chickens in Banadir region of Somalia using indirect enzyme-linked immunosorbent assay (iELISA). A total of 373 unvaccinated free scavenging backyard chickens were sampled from five districts in Banadir region, namely Dharkenley, Hodan, Wadajir, Hawlwadag, and Daynile. The overall prevalence was found to be 39.4% (95% confidence interval: 34.6-44.4%) with a mean antibody titre of 3844.10 ± 263.3 (standard error). The seroprevalence of ND virus (NDV) antibody in Wadajir district was the highest (66.6%) followed by Hawlwadag, Daynile, Dharkenley, and Hodan with prevalence of 56%, 42.1%, 42.35%, and 10.6%, respectively, with statistically significant differences (P < 0.05). Adult chickens had significantly higher prevalence (43.8%) than growers (19.4%) (P < 0.05). The present study, which is the first of its kind in Somalia to the best of our knowledge, concluded that the disease is highly prevalent in the study area; therefore, molecular studies on the characteristics of circulating strains are to be carried out in order to develop an evidence-based control programme and minimize the economic and social impacts of ND on smallholders.

Tuberculosis Treatment Outcomes and Associated Factors in Benadir Somalia. A Multicenter Cohort Study.

Background: In low-resource countries like Somalia, tuberculosis (TB) is still a serious global health concern. Understanding the treatment outcomes of TB patients in specific regions is crucial for developing effective strategies to combat the disease. This study aimed to assess the treatment outcomes of TB patients in Benadir, Somalia. Methods: A retrospective cohort study was conducted using data from TB treatment centers in Benadir, Somalia. The study included all TB patients who initiated treatment between July 1, 2019 and June 30, 2020. Treatment outcomes, including treatment success, treatment failure, lost, death, and transfer out, were analyzed. Factors associated with treatment outcomes were also examined using chi-square test. Results: The study comprised 3165 TB patients in total. The mean age of the observations was 29.9 years, with males making up the majority (64.58%). The overall success rate of TB treatment was 80.6%, with 5.3% lost, 4.6% died, 0.5% failed, 4.6% transferred out, and 4.4% not evaluated. Factors associated with unfavorable treatment outcomes included older age and HIV co-infection. Conclusion: The treatment success rate for TB patients in Benadir, Somalia, is below the global target of 90%. Enhancing access to quality TB diagnostic and treatment services, as well as addressing social and economic barriers to treatment adherence, are essential for improving TB control in Benadir, Somalia.

Progress and experiences of implementing an integrated disease surveillance and response system in Somalia; 2016-2023.

Introduction: In 2021, a regional strategy for integrated disease surveillance was adopted by member states of the World Health Organization Eastern Mediterranean Region. But before then, member states including Somalia had made progress in integration of their disease surveillance systems. We report on the progress and experiences of implementing an integrated disease surveillance and response system in Somalia between 2016 and 2023. Methods: We reviewed 20 operational documents and identified key integrated disease surveillance and response system (IDSRS) actions/processes implemented between 2016 and 2023. We verified these through an anonymized online survey. The survey respondents also assessed Somalia's IDSRS implementation progress using a standard IDS monitoring framework Finally, we interviewed 8 key informants to explore factors to which the current IDSRS implementation progress is attributed. Results: Between 2016 and 2023, 7 key IDSRS actions/processes were implemented including: establishment of high-level commitment; development of a 3-year operational plan; development of a coordination mechanism; configuring the District Health Information Software to support implementation among others. IDSRS implementation progress ranged from 15% for financing to 78% for tools. Reasons for the progress were summarized under 6 thematic areas; understanding frustrations with the current surveillance system; the opportunity occasioned by COVID-19; mainstreaming IDSRS in strategic documents; establishment of an oversight mechanism; staggering implementation of key activities over a reasonable length of time and being flexible about pre-determined timelines. Discussion: From 2016 to 2023, Somalia registered significant progress towards implementation of IDSRS. The 15 years of EWARN implementation in Somalia (since 2008) provided a strong foundation for IDSRS implementation. If implemented comprehensively, IDSRS will accelerate country progress toward establishment of IHR core capacities. Sustainable funding is the major challenge towards IDSRS implementation in Somalia. Government and its partners need to exploit feasible options for sustainable investment in integrated disease surveillance and response.

Clarithromycin induced acute pancreatitis: A rare side effect. Case report.

•Rare side effect of clarithromycin.•Drug induced acute pancreatitis.•Macrolide induced acute pancreatitis.•Acute pancreatitis in pneumonia treatment.

The prevalence of HIV among tuberculosis patients in Benadir, Somalia. Retrospective multi-center study.

Introduction: In 2020, 8% of TB patients were con-infected with the Human Immuno Deficiency Virus (HIV) and 50% in parts of southern Africa. Due to a lack of available data, we will determine the prevalence of HIV infection among TB patients in the Benadir region. Methods: This is a record study of the HIV prevalence among TB cases in all Benadir TB centers from July 1, 2019, to June 30, 2020. All those whose HIV status had not been identified and all drug-resistant cases were excluded from this study. Data analysis was performed using IBM SPSS Statistics version 20. Results: 46 out of 3061 (1.5%) patients were HIV/TB co-infected. 63% and 37% were males and females, respectively. 78.2% of HIV-TB co-infected cases were 20-49 years old, which was statistically significant (P = 0.00048). 75.6% of TB/HIV co-infected patients were bacteriologically confirmed cases. Conclusion: The prevalence of HIV among TB patients in Benadir is very low. This may imply that the prevalence of HIV in the general population is also very low.

Spontaneous pneumorrhachis, pneumomediastinum, pneumopericardium, and subcutaneous emphysema. Rare features of Hamman Syndrome.

INTRODUCTION AND IMPORTANCE: Pneumorrhachis (air within the spinal canal), Pneumomediastinum (abnormal air in the mediastinum), Pneumopericardium (air in the pericardial space), and Subcutaneous emphysema (air trapped under the skin) are rare conditions which are rare features of Hamman Syndrome. Some of pulmonary diseases that relate to pneumorrhachis have been reported in the literature; but Hamman Syndrome with Pneumorrhachis and Pneumopericardium due to violent coughs that triggered by tongue scraping are very rare. CASE PRESENTATION: A 20-year-old male with no previous lung disease or trauma was brought to the emergency department due to acute chest pain, dyspnea, choking, syncope, and neck swelling which started after several self-induced coughs when he was brushing his tongue. Chest CT scan revealed Pneumorrhachis, pneumomediastinum, Pneumopericardium and extensive subcutaneous emphysema associated with lung contusions. CLINICAL DISCUSSION: Barotrauma due to violent coughs that triggered by tongue scraping may lead to lung injury resulting in Hamman Syndrome with rare features of pneumorrhachis and Pneumopericardium. To our knowledge this is the first case report of Hamman syndrome with pneumorrhachis and Pneumopericardium secondary to tongue brushing-induced lung injury in Somalia. CONCLUSION: Violent coughs from tongue scarping can lead to Hamman Syndrome with Pneumorrhachis and Pneumopericardium.

Localized massive staphylococcal pericardial abscess with atypical presentation.

Introduction and importance: Localized staphylococcal pericardial abscess (PA) is extremely rare and highly mortal complication of Staphylococcus aureus bacteremia with only a few reported cases in English-language medical literature. Clinical manifestations are fulminant, and early management is necessary. Case presentation: Here we report a case of end stage renal disease (ESRD) with isolated localized massive staphylococcal PA and had masked signs and symptoms of pericardial staphylococcal infection. Contrast-enhanced computed tomography scan suggested anterior massive localized pericardial cyst like image. Surgical drainage of the abscess with localized pericardiectomy conjugated with antibiotic therapy led to a successful management. Clinical discussion: Staphylococcus aureus is the leading cause of hemodialysis catheter-related bloodstream infections, contributing 33-80% of the organisms cultured from blood samples. Nature of staphylococcal pericardial infection is aggressive and life threatening with generalized involvement of the pericardium although our patient presented with masked signs and symptoms. Conclusion: CT image of localized pericardial lesion with masked signs and symptoms does not exclude the presence of live threating pericardial infection, especially in immunocompromised patients.

Empyema necessitans mimicking mesothelioma; unusual presentation of active pulmonary TB in immuno-competent state.

•This case presented with very rare feature of active Pulmonary TB.•It denotes that Empyema Necessitans can mimick mesothelioma.•Unusual CT findings of Empyema Necessitans.•It states importance of induced sputum for TB diagnosis.•We recommend to test induced sputum for extrapulmonary tuberculosis to halt the spread of TB in the communities.

Radial artery pseudoaneurisma due to unintentional arterial puncture during cephalic vein cannulation: A rare case report.

Introduction and importance: Radial artery pseudoaneurysm is considered as an extremely rare and serious complication that usually follows after cardiac catheterizations with incidence of less than 0.05%, but in lesser frequency with arterial cannulation, trauma, and inflammation or hemodialysis therapy. On the other hand, venous access is clinically important, as it allows for blood sampling, administration of medications, fluids, nutrition, and chemotherapy. But its usage is associated with complications like catheter-associated infections, injuries to peripheral nerves, along with thrombosis and phlebitis of the vessel involved as well as arterial injury. Clinical presentation: in this report, we present a 67 years old healthy nonsmoker male patient with proximal radial artery pseudoaneurysm following several attempts of cephalic vein cannulation for intravenous access. Clinical discussion: Radial artery pseudo-aneurisms are very rare with reported incidence of 0.048%, and mainly due to arterial puncture in an attempt of cardiac intervention procedures, but to the authors knowledge this is one of the first reported cases of radial artery pseudoaneurysm caused by arterial puncture in an attempt of cephalic vein cannulation. Conclusion: Radial artery pseudoaneurysm can occur after attempts of cephalic vein cannulation and patients can be successfully managed with surgical removal of the false aneurism and radial arteriorrhaphy.

Pattern and Sensitivity of Bacterial Colonization on the Tip of Non-Tunneled Temporary Hemodialysis Catheters: Results of a Tertiary Hospital in Somalia.

Introduction: Bacterial colonization on the tip of non-tunneled temporary hemodialysis catheters (NTHCs) and associated catheter-related infections (CRI) is a common complication in hemodialysis (HD) patients. In this study, we aimed to investigate the pattern of bacterial colonization formed on the tip of non-tunneled temporary hemodialysis catheters and their antibiotic sensitivity. Methods: This retrospective analysis was performed in the HD unit of an Education and Research Hospital that follows up a universe of approximately 300 patients, primarily from Mogadishu, Somalia. From September 2020 to September 2021, a total of 137 temporary HD catheters were removed and their tips were sent for culture after there was a suspicion of CRI and other sources of infection were excluded. HD Catheter tips were cultured semi-quantitatively, and the antibiogram of the positive cultures was studied. Results: Gram-positive cocci were found to be the most predominant bacterial organisms in positive cultures with 27 (31.0%) for Staphylococcus aureus, 9 (10.3%) for Staphylococcus haemolyticus and 5 (5.7%) for Staphylococcus epidermidis. We found Enterococci to be 5.7% of the isolated microorganisms. Gram-negative pathogens isolated included Escherichia coli 13 (14.9%) as the most common, followed by Klebsiella pneumoniae 10 (11.5%) and Acinetobacter baumannii (4.6%). Methicillin-resistant Staphylococcus aureus (MRSA) was found to be 9.4%. Gram-positive isolates showed high sensitivity (100%) to Linezolid, Daptomycin, Vancomycin, and Tigecycline, but a low sensitivity rate to Oxacillin (41.2%). Gram-negative isolates had the highest sensitivity to Tigecycline (100%), Imipenem (88.9%), and Amikacin (87%) but low sensitivity to Ampicillin (4.8%), Trimethoprim/Sulfamethoxazole (TMP-SMX) (23.1%), and Ceftazidime (7.1%). Conclusion: We conclude that each institution should have its own antibiogram in the management of HD CRIs. According to our findings in this study, we recommend intravenous Vancomycin and Imipenem as empirical therapy in patients with suspected HD CRIs.

A successful surgical management and outcome for a young man with infrarenal aortoiliac occlusion: A rare case report of Leriche syndrome.

INTRODUCTION AND IMPORTANCE: Leriche syndrome, also known as aortoiliac occlusive disease, is characterized by chronic obstruction of the abdominal aorta and iliac arteries. The disease was first described by Robert Graham in 1814. Leriche syndrome was named after a French surgeon, Rene Leriche, who first operated on the condition. CLINICAL PRESENTATION: We present a 35-year-old male patient who came to our cardiovascular polyclinic in a wheelchair. He had been complaining for a year about severe back pain, leg cramps on both sides, and weakness in both legs. Associated symptoms included fatigue, lower limb tingling, and numbness. Physical examination revealed pulselessness in the popliteal-dorsalis pedis and posterior tibial arteries in both lower extremities, and coldness and ulcers in the dorsum part of the foot. CLINICAL DISCUSSION: Leriche syndrome often presents with a triad of clinical symptoms: (1) intermittent lower extremity vascular claudication, (2) impotence, and (3) weak/absent femoral pulses. This case report contributes to the current literature when any patient has lower limb weakness, pain, and ulcers. It must be considered in our differential diagnosis list for Leriche syndrome. This makes us more aware of the need for early diagnosis and intervention to decrease late complications of ischemia. CONCLUSION: Leriche syndrome, also known as aortoiliac occlusive disease, is considered because of its high morbidity and mortality. This was the first case in Somalia to be successfully managed and operated on by using extra-anatomical bypass, especially axillo-bifemoral bypass, by using it as an emergency measure to save ischemic limbs and shorten the length of time in the hospital.

Prevalence of Multidrug-Resistant TB Among Smear-Positive Pulmonary TB Patients in Banadir, Somalia: A Multicenter Study.

Background: Tuberculosis (TB) is an infectious disease that is the second most common cause of death from a single infectious agent. TB infection affects anyone, regardless of age, gender, and ethnicity. Drug-resistant TB is a serious public health problem, which needs treatment with a second-line anti-TB drug and it includes poly-drug resistance (PDR), multi-drug resistance (MDR), and extensive drug resistance (XDR). The goal of this research is to find out the prevalence of MDR TB among pulmonary TB patients in Banadir, Somalia. Methods: This was a multicenter retrospective review of data involving 1732 smear-positive pulmonary TB patients visiting Banadir TB centers between July 1, 2019 and June 30, 2020. Demographic, clinical, and drug susceptibility data were retrieved from TB treatment cards. The data were analyzed using Statistical Package for Social Sciences (SPSS) software (IBM SPSS Statistics version 26). Results: All 1732 pulmonary TB cases were previously diagnosed by the Gene Xpert MTB/RIF test. Among them, 70.4% (1219/1732) were males. The mean age was 31.77 years. Overall, the prevalence of drug resistance TB was 10.56% (183/1732). The MDR TB was 1.96%, poly-drug resistance (PDR) was 0.12%, and extensive drug resistance was 0.06%. Conclusion: This study showed a prevalence of MDR-TB among pulmonary TB patients, which is similar to some of the eastern African countries.

Isolated left ventricular non-compaction cardiomyopathy complicated by acute ischemic stroke: A rare case repor.

Introduction: and importance: Isolated left ventricular noncompaction cardiomyopathy (LVNC), uncommon type of primary hereditary cardiomyopathy. It is a spongy morphological appearance of the myocardium that occurs largely in the LV. Case presentation: We discuss here a case of 19 years old female with no known past medical history who present with Shortness of breath (SOB) and left sided weakness following delivery.Bedside Echocardiography demonstrated Left ventricular trabiculation with reduced ejection fraction. While brain Computed tomography showed acute ischemic stroke primly due to non-compaction cardiomyopathy as the embolic. Patient was discharged after successfully managed. Clinical discussion: Left ventricular non-compaction cardiomyopathy (LVNC) is characterized by progressive ventricular trabeculation and deep intratrabecular recesses caused by the functional arrest of myocardial maturation, which is a rare case of congenital cardiomyopathy. Our patient had isolated non-compaction cardiomyopathy of the type that was complicated by an acute ischemic stroke and was treated accordingly. Conclusion: It is usually associated with congenital heart disease, but isolated left ventricular non-compaction cardiomyopathy is very uncommon.

One to 2-year surveillance intervals reduce risk of colorectal cancer in families with Lynch syndrome.

BACKGROUND & AIMS: Two percent to 4% of all cases of colorectal cancer (CRC) are associated with Lynch syndrome. Dominant clustering of CRC (non-Lynch syndrome) accounts for 1%-3% of the cases. Because carcinogenesis is accelerated in Lynch syndrome, an intensive colonoscopic surveillance program has been recommended since 1995. The aim of the study was to evaluate the effectiveness of this program. METHODS: The study included 205 Lynch syndrome families with identified mutations in one of the mismatch repair genes (745 mutation carriers). We also analyzed data from non-Lynch syndrome families (46 families, 344 relatives). Patients were observed from January 1, 1995, until January 1, 2009. End points of the study were CRC or date of the last colonoscopy. RESULTS: After a mean follow-up of 7.2 years, 33 patients developed CRC under surveillance. The cumulative risk of CRC was 6% after the 10-year follow-up period. The risk of CRC was higher in carriers older than 40 years and in carriers of MLH1 and MSH2 mutations. After a mean follow-up of 7.0 years, 6 cases of CRC were detected among non-Lynch syndrome families. The risk of CRC was significantly higher among families with Lynch syndrome, compared with those without. CONCLUSIONS: With surveillance intervals of 1-2 years, members of families with Lynch syndrome have a lower risk of developing CRC than with surveillance intervals of 2-3 years. Because of the low risk of CRC in non-Lynch syndrome families, a less intensive surveillance protocol can be recommended.

Prevalence of Taenia saginata cysticerci in Addis Ababa Abattoir Enterprise, Ethiopia.

An abattoir-based survey was conducted in Addis Ababa from December 2018 to April 2019 with the objectives of determining the prevalence of bovine cysticercosis and the viability of Taenia saginata cysticerci. Routine meat inspection was performed on the study animals. Palpation followed by incision of the heart, tongue, triceps muscle, masseter muscle and diaphragm were made to detect the presence of T. saginata cysts. From the detected cysts, 41 were randomly selected and subjected to viability test. From the total 500 study animals, 14(2.8%) had varying number of T. saginata cysts. The highest proportion of T. saginata cyst was observed in the triceps muscle 6(42.8%), followed by heart 3(21.4%), tongue 2(14.3%) and masseter muscle 2(14.3%). There was no cyst observed in the liver or diaphragm. Of the total randomly selected 41 cysticerci, 20(48.8%) were found to be viable while the rest 21(51.2%) cysticerci were found to be non-viable. Sex, breed, age, and body condition of the study animals were found to have no significant association with the occurrence of cysticerci (P > 0.05). Even though routine meat inspection has low sensitivity and usually under-estimates the prevalence of the disease, bovine cysticercosis was found to be prevalent in the study area. Therefore, an appropriate control program involving enforcement of meat inspection, promoting public awareness and improving personal and environmental hygiene should be designed and implemented.

Supra-Epiglottic Upper Airway Volume in Elderly Patients with Obstructive Sleep Apnea Hypopnea Syndrome.

OBJECTIVE: Small upper airway measurements areas and high body mass index are recognized risk factors for obstructive sleep apnea syndrome (OSAS) in non-elderly populations; however, there is limited information regarding elderly patients. We evaluated whether upper airway volume is associated with OSAS and OSAS treated with continuous positive airway pressure (CPAP) treatment and whether BMI is correlated with upper airway volume and measurements in elderly subjects. METHODS: In 60 volunteers aged 75.58±0.9 years: 20 OSAS, 20 OSAS chronically treated with CPAP, and 20 controls, semi-automatic segmentation, retropalatal distance and transverse diameter of the supra-epiglottic upper airway were evaluated using 3DT1-weighted magnetic resonance imaging. Anteroposterior to transverse diameter ratio was defined as retropalatar diameter/transverse diameter. RESULTS: There were no significant differences in supra-epiglottic upper airway volume between OSAS, CPAP treated patients, and controls. There were significant differences in retropalatal distance and anteroposterior to transverse diameter ratio between OSAS, CPAP treated patients, and controls (P = 0.008 and P<0.0001 respectively). There was a significant correlation between body mass index and retropalatal distance (P<0.05) but not with supra-epiglottic upper airway volume. CONCLUSION: In elderly subjects, OSAS and body mass index are not associated with changes in supra-epiglottic upper airway volume but are associated with modification of pharynx shape.