Bilateral supernumerary kidney with an obstructive calculus: An extremely rare case report and literature review.

Bilateral supernumerary kidneys and associated urinary stone disease are rarely seen in clinical practice, and only three cases have been reported in the literature to date. We report a 15-year-old male patient having a bilateral supernumerary kidney with an obstructive left ureteric stone successfully managed with retrograde intrarenal surgery. Stones in such anomalous kidneys pose a challenge for the urologist, and imaging is essential for surgical intervention planning. RIRS with holmium laser lithotripsy is a safe and effective treatment with a high single-stage stone-free rate and low complication rate in experienced hands.

Rhino-Orbital Cerebral Mucormycosis in a Healthy Female Child: Case Report.

Mucormycosis is a potentially fatal condition with a high mortality rate, particularly when there is extra nasal involvement, and it is rare for patients with fungal brain disease to survive. It mostly affects patients who are metabolically or immunologically compromised, which constitutes one of the three classical stages of the progression of Rhino-Orbito-Cerebral Mucormycosis (ROCM). Stage I: infection of the nasal mucosa and paranasal sinuses; Stage II: orbital involvement; Stage III: cerebral involvement.Here, we report a case of rhino-orbital cerebral mucormycosis in a 14-year-old girl with no known risk factor who presented with periorbital edema, right eye proptosis, fever, and extreme facial pain, which progressively worsened to confusion and left leg weakness in 3 days after admission. The final diagnosis was rhino-orbital-cerebral mucormycosis. The infection was successfully treated using liposomal amphotericin and surgical debridement to remove infected orbital tissue. Mucormycosis is a potentially fatal disease that necessitates prompt diagnosis and treatment. Children are rarely infected with mucormycosis. The majority of studies show that people are typically between 40 and 50 years old. ROCM is typically diagnosed using clinical symptoms and histopathologic evaluation; however, imaging is critical in determining the presence of intracranial lesions. The standard treatment for ROCM is amphotericin B at a recommended dose of 1.0-1.5 mg/kg/day for weeks or months, depending on the clinical response and severity of adverse drug reactions, particularly nephrotoxicity.Rhino-orbital cerebral mucormycosis in a healthy female child is uncommon; early diagnosis and prompt treatment with Amphotericin B should be necessary. Devastating consequences will result from a delayed diagnosis.

A case report and treatment considerations for pyogenic liver abscess with biliary fistula.

INTRODUCTION AND IMPORTANCE: Pyogenic liver abscess (PLA) is a potentially life-threatening condition characterized by the formation of space-occupying lesions within the liver parenchyma. Despite advancements in diagnostic imaging and antibiotic therapies, complications such as biliary fistula formation can arise, posing challenges in management. CASE PRESENTATION: This case study presents a 23-year-old male patient with PLA complicated by a biliary fistula. Diagnostic imaging via CT scan and MRI confirmed a liver abscess and biliary dilation. The patient underwent a second drainage for ascitic fluid following the initial percutaneous liver catheter drainage. CLINICAL DISCUSSION: The patient responded positively to the treatment, with reduced abscess size and fistula resolution. While endoscopic interventions offer promising results, their limited availability necessitates alternative treatment strategies, such as percutaneous drainage and appropriate antibiotics. CONCLUSION: This case emphasises the importance of individualized management approaches for PLA complicated by biliary fistulas. Despite the challenges, successful outcomes can be achieved through careful management and appropriate treatment strategies.

Magnetic Resonance Imaging Findings and Their Association with Electroencephalographic Data in Children with Epilepsy at Tertiary Care Hospital in Mogadishu Somalia.

Introduction: Epilepsy is a neurological disorder characterized by abnormal, fast, synchronous neuronal discharge from the cerebral cortex. This abnormal excitation of the brain is usually short and self-limiting and can last anywhere from a few seconds to a few minutes. Neuroimaging and electroencephalography (EEG) are two widely used techniques to differentiate, verify, or exclude the diagnosis of epilepsy. The study aims to identify the frequency of EEG and MRI abnormalities in pediatric epilepsy and their correlations, aiming to improve diagnostic and treatment methods for these children. Materials and Methods: In this cross-sectional retrospective study, we evaluated pediatric patients aged 0-18 years who visited the Neurology Polyclinic between July 2022 and July 2023, were diagnosed with epilepsy in accordance with the ILAE 2014 epilepsy guidelines, and had undergone neuroimaging at the hospital's radiology department. Demographic information and clinical data, including the patient's age, gender, history of trauma, and congenital infection, were assessed. In all patients, a surface electroencephalogram (EEG) and brain magnetic resonance imaging (MRI) were performed. Results: Our study recruited 102 pediatric patients aged between 0-18 years, including 63 (61.8%) boys and 39 (37.2%) girls. An electroencephalogram (EEG) and MRI study have been done on all patients. An abnormal EEG study was seen in 79 (77.45%) participants, and an abnormal MRI was noted in 45 (44.1%) patients. The EEG and MRI were both abnormal in 34 cases (33.3%). The study found no significant correlation between magnetic resonance imaging and electroencephalographic findings (P =0.779). Conclusion: We observed multiple abnormalities on neuroimaging in pediatric epileptic patients. Even though our sample size was small, our results demonstrated that there is no statistically significant relationship between EEG and MRI results.

Lemierre Syndrome: Incidental Finding of Forgotten Fatal Disease as a Complication of Ludwig's Angina.

Lemierre syndrome (LS) is a rare, life-threatening complication of oropharyngeal infections associated with septicemia and internal jugular thrombosis. Internal jugular vein thrombosis is an uncommon disease associated with central vein catheterization, intravenous drug abuse, hypercoagulability, trauma to the neck, infection, ovarian hyperstimulation syndrome (OHSS), and systemic infections. Here, we highlight a case of a 62-year-old women who presented progressively worsening neck swelling for three weeks, shortness of breath, and fever for four days. Her sepsis due to Ludwig's angina was accompanied by septic pulmonary embolism and internal jugular vein thrombosis in keeping with a diagnosis of Lemierre syndrome. For this presentation of Lemierre syndrome, the treating physicians recommended surgical excision and drainage, followed by intravenous antibiotics and subcutaneous anticoagulation to treat septic emboli of the lungs and internal jugular veins. Sadly, after being informed about the procedure, the patient refused to consent, and four days later, she passed away. It is essential to remember that early detection and aggressive treatment may significantly impact prognosis and outcome.

Penetrating brain injury caused by tired bullet: First report from Somalia.

Background: Brain injuries caused by a tired bullet can range from headaches to severe brain injury and death. The question which poses a dilemma is whether extraction of retained bullets could decrease the late complications. This study aims to investigate the radiological findings, the neurological status of the patients, and different modalities of management for craniocerebral tired bullet injury. Method: This study retrospectively reviewed 21 patients with a tired bullet injury to the brain who were admitted into our hospital over five years. All patients were assessed for the Glasgow outcome scale as outpatients. Result: Of the 21 patients in the study, 11 (52.3%) were males, and 10 (47.6%) were females. The most common entry point of the bullet was frontal in 8 (38.0%) patients, followed by parietal in 7 (33.3%), and orbital in 5 (23.8%). The mortality rate was 23.8% (n = 5 patients). Bad outcomes were documented in patients with low GCS, with all patients who died having a GCS of (3-8). Bullet retrieval was performed for 7 of 21 patients, while all patients who were not candidates for emergency operation underwent local wound debridement. The GOS score was good [4 and 5] in 71.4% (15 of 21 patients). Conclusion: This study revealed that two-thirds of patients with tired bullet injury underwent conservative treatment with an excellent long-term outcome, particularly for patients with high GCS on admission. The mortality rate was high among children under 15 years and those with a GCS of 3-8.

Lemierre's syndrome with cranial epidural abscess complication: A case report.

Introduction: Lemierre's syndrome is a rare disease typically manifested by thrombophlebitis of the jugular vein and septic embolism following a history of oropharyngeal infection. Fusobacterium necrophorum is the causative agent of Lemierre syndrome, commonly known as post-anginal sepsis. Case presentation: We reported a 24-year-old male who came to the emergency department complaining of a history of a sore throat, fever, malaise, fever, and neck swelling with a normal consciousness level. A laboratory examination showed leukocytosis and high C-reactive protein serum. Radiological diagnosis reveals an anterior neck abscess with left jugular vein thrombosis and left epidural abscess. The blood culture was positive for Fusobacterium necrophorum. The patient underwent surgical drainage and, at the same time, was treated with antibiotics and anticoagulant drugs. After 45 days, the patient improved clinically and was discharged. There were no other symptoms after a one-month follow-up clinically and neck ultrasonography. Clinical discussion: Lemierre's syndrome has historically had a high mortality rate, approximately up to 90% before antibiotics. The disease's incidence has declined gradually, leading it to become recognized as the "forgotten disease." Nevertheless, the incidence of Lemierre syndrome has been increasing over the last twenty to thirty years. Primary oropharyngeal infection, bacteremia, radiographic or clinical evidence of internal jugular vein thrombosis, and septic metastatic foci are the main clinical hallmarks of Lemierre's syndrome. Surgical debridement, antibiotics, and anticoagulants are the treatments of choice. Conclusion: Lemierre's syndrome with cranial epidural abscess is very rare. It is a forgotten disease. Nowadays, the prevalence is increasing. Awareness of clinical and radiological features will aid the prompt management of patients.

Prevalence of Thyroid Dysfunction Among Patients with Heart Failure at a Tertiary Hospital in Mogadishu, Somalia.

Introduction: Thyroid disease is an independent predictor of heart failure in patients. This study aimed to investigate the prevalence of thyroid dysfunction among patients with heart failure in Mogadishu, Somalia. Methods: From January 2019 to January 2021, a total of 250 patients diagnosed with heart failure admitted to the cardiology outpatient and emergency departments were evaluated retrospectively. The demographic characteristics, the cause of heart failure, and the kind of heart failure were recorded. Patients were categorized into subclinical hypothyroidism, hypothyroidism, low T3 syndrome, subclinical hyperthyroidism, and hyperthyroidism. Results: A total of 250 heart failure patients. The prevalence of thyroid dysfunction among heart failure patients was 35.6%. The mean age of the patients was 59.8±14 years. Males outnumbered females by 159 (63.2%). The prevalence of thyroid dysfunction was 35.6%. Out of the 250 patients that were examined, most of the patients 30(33.3%) had subclinical hypothyroidism. 23 (25.6%) had overt hypothyroidism, 15 (16.7%) had overt hyperthyroidism, 20 (22.2%) had low T3 syndrome, and two cases had subclinical hyperthyroidism. Regarding the gender status of the thyroid dysfunction, 43(48.3%) were male, and 46(51.7%) were female. Regarding heart failure types among thyroid dysfunction patients, most patients were HFrEF (n=64, 71.9%), and 25(28.1%) were HFpEF. Patients with heart failure and reduced ejection fraction (HFrEF) were more likely to have thyroid dysfunction than those with preserved ejection fraction (p = 0.012). Regarding comorbidities among heart failure patients with thyroid dysfunction, approximately half of the patients had hypertension (40.4%). Conclusion: Thyroid problems are one of the most prevalent endocrine abnormalities in our practice. Subclinical hypothyroidism was the most common type of thyroid dysfunction among this population. We suggest that thyroid function be evaluated with cardiac function in patients with heart failure and followed up and treated together with heart failure.

Magnetic resonance imaging findings of intracranial tuberculoma patients in a tertiary hospital in Mogadishu, Somalia: A retrospective study.

Introduction: Tuberculosis (TB) is a fatal disease caused by Mycobacterium tuberculosis (M.TB) with over eight million annual mortality reported worldwide attributed to the disease's direct or indirect effects. Among the most severe form of M. TB is an infection of the Central nervous system (CNS-TB). This infection is characterized by meningitis, tuberculoma, and tuberculous brain abscess. Tuberculomas are the most common variety of intracranial parenchymal tuberculosis. They occur because of conglomeration and conjugation of tubercular microgranulomas, which tend to occur at the grey-white matter junction due to the arrest of the hematogenous disseminating microbes caused by a decrease in the caliber of vessels in that region. Intracranial tuberculoma shows central hypointensity compared to grey matter, seeing this centrally on T2W images is helpful, as it is not seen in most other ring-enhancing lesions. Objectives: The purpose of this study was to evaluate the findings of the magnetic resonance imaging (MRI) scan of patients with intracranial tuberculoma using retrospective hospital records. Methodology: We conducted a retrospective data analysis of 73 patients with an age range of 3-70 years between 2018 and 2021 who were diagnosed with intracranial tuberculoma using MRI features at the Radiology Department, Somali-Turkey Recep Tayyip Erdogan Hospital. All the patients' MRI were evaluated, including conventional and contrast sequences and as well as MR diffusion. Results: This study revealed that most tuberculoma patients were female with 43 (58.9%) and 30 (41.1%) male. According to age group, the majority of patients 30 (41.1%) were 18-30 years of age. Based on the distribution of the conglomerates' tubercles, 39 (53.4%) were located in the supratentorial region, while 24 (32.9%) were found in both the supra-tentorial and infra-tentorial regions, with 10 (13.7%) residing in the infratentorial region. Interestingly, this study also discovered that the majority of the tuberculoma patients 43 (58.9%) had multifocal lesions, with 30 (41.1%) having single lesions. Also, associated abnormalities were detected in 28 (38.4%) of the patients with meningitis, while 7 (9.6%) had both hydrocephalus and meningitis, 2 (2.7%) had hydrocephalus, and one patient had cerebral infarction. Conclusion: The outcome of this investigation shows MRI as a suitable diagnostic tool for the diagnosis of intracranial tuberculoma and associated abnormalities in geographic areas where tuberculosis is endemic.

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.

Rare case cystic scrotal lymphangioma presented as a hydrocele.

INTRODUCTION AND IMPORTANCE: Cystic scrotal lymphangiomas are very uncommon lesions caused by congenital lymphatic malformation. These tumors are usually located in the neck and axilla, occasionally in the mediastinum, retroperitoneum, and thigh. The scrotum and perineum are the least frequented sites. They present as painless scrotal swelling and are easily misdiagnosed as hydrocele. We present here a case of cystic scrotal lymphangioma in a school-aged child who presented to us with a massive scrotal swelling. CASE PRESENTATION: We present here a case of a 6-year-old child who presented with scrotal swelling, which was sonographically identified as chronic hydrocele. The right testis could be felt separately from the mass, and the left scrotum was normal. Scrotal ultrasound reveals multiple cystic lesions with septa in the right hemiscrotum extending to the proximal inguinal canal. Median raphe incision and excision of the lobulated mass Cyst testicular lymphangioma was confirmed histopathologically. CLINICAL DISCUSSION: Cystic lymphangiomas are benign congenital tumors with no identifiable cause. The majority of lymphangiomas (90%) appear during the first two years of life, and half of them are present at birth. Lymphangiomas are categorized into three types: capillary, cavernous lymphangiomas, and cystic hygromas. A scrotal lymphangioma is frequently misdiagnosed as a hydrocele, inguinal hernia, hematocele, varicocele, or even testis torsion. In our case, the diagnosis was made by ultrasonography with Doppler and confirmed by a biopsy of an excised mass lesion. The scrotum is a very uncommon site for cystic lymphangioma. CONCLUSION: A cystic or septate cystic mass discovered intra-operatively should not be dismissed as a complex hydrocele, since cystic lymphangiomas predictably recur if incompletely resected. A proper diagnosis of the scrotal lymphangioma and its extent using the US is essential for planning an appropriate surgical approach.

Infrequent cause of small bowel obstruction in a child: A lemon.

Introduction: Small bowel obstruction in children induced by phytobezoar impaction is reported here. Bezoars are classified into four types: phytobezoars, trichobezoars, pharmacobezoars, and lactobezoars. We present here the first case of lemon shelves induced by small intestinal obstruction without previous gastrointestinal surgery and diagnosis was made erect abdominal x-ray. Case presentation: We present a case of a three-year-old boy who presented with a history of abdominal pain, distension, and bilious vomiting, for the preceding one week. The child had no previous history of gastric or intra-abdominal surgery. The definitive diagnosis was not known before the operation. The case was diagnosed at laparotomy and removed through a distal enterotomy. Clinical discusion: In surgical practice, small bowel obstruction is a prevalent problem. Phytobezoar is a rarely mentioned cause of mechanical small intestine obstruction, accounting for only 0.4-4% of all cases. The lemon shelves measuring 35 cm and 75 cm had impacted the terminal ileum of our patient, causing an obstruction that could only be discovered after an enterotomy as it was not feasible to be fragmented and milked into the cecum and an open appendectomy was performed because of the socio-economic reason. Conclusion: The total bowel obstruction is treated with both laparotomies and milking through the ileocecal junction or enterotomy and direct extraction.

An unusual combination of persistent silent truncus arteriosus Type-II with ascending aortic aneurysm.

Truncus arteriosus (TA) is a relatively uncommon cyanotic congenital cardiac anomaly accounting for 1.3% of all congenital cardiac malformations. TA associated with an ascending aortic aneurysm is an extremely rare congenital cardiovascular abnormality. A 15-year-old male presented with shortness of breath and cough for 2 weeks. Radiological examinations showed that the ascending aorta and main pulmonary arteries originate from a single truncus with ascending aortic aneurysm. TA has a poor prognosis if remain unrepaired and surgical intervention is necessary to avoid severe pulmonary vascular occlusive disease.