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.

Comparative study of fine needle aspiration cytology and histopathology in thyroid nodules at a tertiary care hospital: First report from Somalia.

BACKGROUND: FNAC is a minimally invasive procedure and cost-effective, especially in developing countries where patients are mostly poor and surgery is not affordable. The present is the first study that examines the correlation between FNAC and histopathology in diagnosing thyroid cancers at a tertiary hospital in Somalia. METHOD: This study included 231 patients with thyroid lesions who underwent pre-operative FNACs and histopathologic examination over five years. Investigated clinical parameters include sociodemographic and clinical features and cyto-histopathological findings. RESULTS: The mean patient age was 39.3 ± 15.5 years, and there was a significant female predominance (n = 194; 84%), with a female to male ratio of 5.2:1. The overall sensitivity, specificity, and accuracy rate of cyto-histopathology correlation was 91.1%, 96.6%, and 94.9%, respectively. According to the Bethesda classification system of thyroid FNACs, (n = 141, 61%) of cases were Bethesda II (Benign), of which 95.7% of patients had a benign final histological diagnosis, while 4.3% had malignancy (6 false-negative results). Twenty-two patients (9.5%) were Bethesda III, (n = 3,1.3%) were Bethesda IV (suspicious for neoplasm), and all cases had a follicular adenoma on their final histological diagnosis. Forty-four of the patients were Bethesda V, found in 88.6% of its final histological diagnosis, while 11.4% were benign. Bethesda IV accounted for 9.1%, and all patients in this group were papillary thyroid carcinoma on its final histological confirmation. CONCLUSION: Our study findings revealed that FNAC of thyroid lesions has a high accuracy rate, sensitivity, and specificity, allowing appropriate initial diagnostic management. It should be applied as the first investigative tool for thyroid lesions.

Incidence and associated factors for incidental prostate cancer among patients who underwent surgery for benign prostatic hyperplasia: first report from Somalia.

BACKGROUND: The incidence rate of incidental prostate cancer (IPC) differs significantly among the reported studies in the relevant literature. There is a scarcity of studies regarding IPC reported from Sub-Saharan African Countries, including Somalia. The present is the first study that evaluates the incidence and associated factors for IPC among patients who had surgery for benign prostatic hyperplasia at a tertiary hospital in Somalia. METHOD: This retrospective study reviewed the data of 538 patients with benign prostate hyperplasia, 464 patients who underwent transurethral resection of the prostate (TURP), and 74 patients with open prostatectomy (OP) over 5 years. A binary logistic regression model was used to investigate the association between perioperative factors such as age, prostate volume, total prostate-specific antigen (TPSA) levels, type of surgery, specimen weight, and the finding of IPC. RESULTS: IPC was detected in 17.6%, 18.3% of TURP, and 13.5% of OP patients (p = 0.002). The mean age of the patients was 71.82 ± 7.4; IPC patients had a significantly higher mean age than the BPH group (74 ± 10.9 vs. 71.3 ± 10.8, p < 0.001). Sixty-two percent of the patients were T1b, while 57.8% had ISUP grade groups 1 and 2. Patients with T1a had significantly higher International Society of Urological Pathology (ISUP) grades 1 and 2 than those with T1b (69.4% in T1a vs. 50.8% in T1b, p < 0.001). Increased age, higher TPSA levels, low prostate volume, and specimen weight were independently associated with the finding of incidental prostate carcinoma (OR 1.978, 95% CI 0.95-1.60, P < 0.04; OR 1.839, 95% CI 0.99-2.02, P < 0.001; OR 1.457, 95% CI 0.7102.99, P < 0.001, OR 0.989, 95% CI 1.07-2.94, P = 0.01). IPC was most commonly managed by active surveillance (54.7%), followed by androgen deprivation therapy in 28.4%. The overall survival rate for a 5-year follow-up in the entire cohort was 79%. The cancer-specific mortality was 8.4%. CONCLUSION: The study findings revealed a higher incidence and cancer-specific mortality rate of incidental prostate carcinoma. T1b stage, higher ISUP grade, older age, and higher preoperative TPSA were significantly associated with the overall mortality and cancer-specific mortality rate. More than half of the cases were managed by active surveillance, and it is a safe management strategy, particularly in low-income countries like Somalia.

Epidemiological and Histopathological Characteristics of Renal Cell Carcinoma in Somalia.

Background: There is a scarcity of studies regarding renal cell carcinoma (RCC) reported from Sub-Saharan Africa. Objective: The present study is the first report evaluating the prevalence and clinical and histopathological features of RCC at a tertiary hospital in Somalia. Methods: This retrospective study included 84 patients with histologically confirmed RCC over 5-years. The investigated parameters were sociodemographic features, radiological and histopathological characteristics, mortality, and overall 5-year survival rate. Results: The prevalence of RCC in our study was 0.7%. The mean age of the patients was 53.74±5.5 years, 67.9% were male, and 32.1% were female, with a 2:1 male-to-female ratio. The mean tumor size was 6.38±2.4 cm. Clear cell RCC was the most common histological type in 67.8%, followed by papillary RCC (15.6%), unclassified RCC (9.5%), and chromophobe RCC was the least common in 7.1% of the cases. About one-third of the case had locally advanced RCC with positive nodal involvement, 26.2% of the patients had metastatic disease, and a further 6% progressed to metastatic cancer despite surgical resection. Eight percent of our cases returned with local recurrence. The mortality rate was 37.2%. More than eighty percent of females had a low-stage and a low-grade RCC, while males held higher stages and higher grades RCC in 37% and 63%, respectively (p<0.001). Smokers were male-only, while obesity was common in female patients (p=0.02). Conclusion: The study findings showed a satisfactory outcome, 71.4% of our patients presented with localized RCC, the five-year survival rate of the patients was 62.8%, and the mortality rate was substantially higher for patients with a higher stage, a higher grade tumor, and metastatic disease at the time of diagnosis.