Prevalence and associated factors of sexual dysfunction in female hemodialysis patients: first report from Somalia.

BACKGROUND: Sexual dysfunction is frequent in female hemodialysis patients and is related to poorer quality of life. It is often a neglected topic associated with marked distress and interpersonal difficulties. OBJECTIVE: Few studies are reported from Sub-Saharan African Countries (SSA) regarding female sexual dysfunction (FSD) in (HD) patients. The study aims to explore the prevalence and associated factors of FSD in female HD at a sole dialysis centre in Somalia. METHOD: Over a one-month period, a cross-sectional study was conducted among women with end-stage renal disease aged 18-50 years who were undergoing a dialysis program for at least three months at the dialysis center of our hospital. The participants were married, and they were living with their partners. Data regarding the sociodemographic features, clinical characteristics, frequency of sexual intercourse per week, and the Female Sexual Function Index (FSFI) scores were collected using a standard face-to-face interview questionnaire. RESULTS: During the study period, a total of 115 participants were eligible for the study's inclusion criteria. The mean patient age was 38.5 ± 9.3 years. The most common cause of ESRD was diabetes, which accounted for 53%, followed by hypertension (26.1%) and glomerulonephritis (9.6%). The mean duration of dialysis was 2.9 ± 1.4 years, and approximately two-thirds of the participants (62.5%) were in the program for more than three years. Regarding the frequency of sexual intercourse, 61.7% of female participants performed sexual intercourse less than once time/a week. The prevalence of FSD was 92.2% (n = 106) of all participants. The mean FSFI score of the participants was 16.05 ± 4.48. Longer duration of dialysis program (i.e., more than four years), increasing age (i.e., > 35 years), those with diabetes had scored lower overall FSFI scores. CONCLUSION: The prevalence of female sexual dysfunction among Somali female hemodialysis patients was very high, representing a significant problem in end-stage renal disease (ESRD). Our study findings revealed that increasing age, diabetes, and duration of dialysis negatively impact female sexual function and are significantly associated with FSD.

Prevalence and Determinants of Hypothyroidism in Patients on Routine Hemodialysis in Somalia: A Cross-Sectional Study.

Introduction: In recent decades, the relationship between thyroid and kidney disease has drawn considerable attention. We aim to assess the prevalence and the determinants of hypothyroidism in hemodialysis patients in Somalia. Materials and Methods: This is a cross-sectional study which was conducted in the hemodialysis unit of Mogadishu Somalia Turkish Training and Research Hospital, between June 1 and July, 31 2022. A total of 301 patients who are routinely going to hemodialysis were included in the study. Demographic data including age, gender, and data regarding hemodialysis were extracted from hospital information system (HIS). All participants had their thyroid function test measured before hemodialysis sessions. Results: A total of 301 patients were examined. Their ages ranged from 40 to 66 years, with the median age being 54 (IQR= 40-66). Males were 167 (55.5%) compared to females 134 (44.5%). Hypertension was the most common comorbidity among the patients with 137 (45.5%). Diabetic kidney disease was the most common cause of renal failure in 138 patients (45.84%) followed by hypertensive kidney disease 100 (33.22%). The prevalence rate of hypothyroidism in hemodialysis patients in our study was 28%. In hypothyroidism patients 57.8% had subclinical hypothyroidism and 42.2% had overt hypothyroidism. 70.8% of our patients were in euthyroid status. Subclinical hypothyroidism was commonly seen in patients with diabetes, hypertension, and heart disease. We found that increasing age, decreased albumin level were related to higher risk of subclinical hypothyroidism. We also found that increasing creatinine levels were associated with lower risk of overt hypothyroidism. Conclusion: The prevalence rate of hypothyroidism in hemodialysis patients was 28%, with 57.8% showing subclinical hypothyroidism and 42.2% overt hypothyroidism. Increased age and low albumin level was associated with the prevalence of subclinical hypothyroidism in hemodialysis patients. Also low creatinine level was observed in overt hypothyroidism patients.

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.

Colorectal intussusception with rectal prolapse related to cecal lipoma in adult: A rare case report and review of the literature.

Colonic intussusception due to lipoma is extremely rare. Very few cases were reported in the literature of cecal lipoma leading to the intussusception of the whole proximal colon till the rectum. We report a rare case of a 39-year-old female patient with cecal lipoma causing colo-colonic intussusception involving the entire length of the proximal colon and the overall mass prolapsed into the pelvis that could be palpated in rectal examination. The case presented with a giant mass with clinical manifestations of obstruction. An extended right hemicolectomy and end ileostomy were performed due to intestinal dilation and intra-abdominal contamination. To the best of our knowledge, this is the second case of cecal lipoma leading to intussusception of the whole proximal colon till to the rectum reported in the relevant literature. Whenever a colonic mass results in intussusception, the incidence of malignancy is slightly higher (60%), so a proper oncological resection should be performed if the pathology is not known preoperatively.

Sheehan syndrome presenting as acute renal failure: A rare case report from Somalia.

Sheehan syndrome (SS) is one of the most common causes of pituitary gland dysfunction in childbearing women and occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. Rhabdomyolysis is a pathological condition of the skeletal muscles that can be present in the setting of adrenal insufficiency. It can cause serious end-organ complications such as acute renal failure. The combination of adrenal insufficiency due to Sheehan syndrome, rhabdomyolysis, and acute renal failure is extremely rare in the literature. In this case report, we present a 35-year-old female patient who presented with acute renal failure and was later diagnosed with Sheehan syndrome. She was put on Intravenous fluids, methylprednisolone, and levothyroxine treatment. The patient was hospitalized for 10 days and was discharged in good health.

Acute Renal Injury Due to Rhabdomyolysis Induced by Severe Hypothyroidism: First Case Report from Somalia.

Rhabdomyolysis is a life-threatening condition which is characterized by muscle injury and leakage of muscle contents into the systemic circulation. It has been known that hypothyroidism is associated with some degree of myalgia and muscle stiffness, but it can also be a cause of life-threatening rhabdomyolysis with end-organ damage. A combination of acute renal impairment due to rhabdomyolysis in patients with hypothyroidism, especially those who have no precipitating factors, is extremely rare. Here, we report a case of a 27-year-old male patient with severe hypothyroidism who presented to the emergency department with acute renal impairment due to rhabdomyolysis induced by severe hypothyroidism. The patient was admitted for 5 days and after levothyroxine 100 µg, intravenous fluid rehydration, input and output follow-up and close monitoring, the patient improved and was discharged in good condition.

Superior alternating hemiplegia (Weber's syndrome)- Case report.

Introduction: and importance: Weber's syndrome is a rare type of brain stem stroke syndrome that is characterized by ipsilateral oculomotor nerve palsy and contralateral hemiparesis. The most common etiology is a midbrain infarction caused by occlusion of the paramedian branches of the posterior cerebral artery or the perforating branches of the basilar bifurcation. Although there are many multiple brainstem strokes, it is uncommon to see this syndrome. Case presentation: Here we present a case of a 62-year-old male hypertensive patient who presented with a one-week history of cognitive dysfunction, left hemiparesis, right eye ptosis, and right medial gaze palsy (oculomotor nerve palsy). Diffusion MRI showed milimetric diffusion restriction in the right side of the mesencephalon, consistent with an acute infarct. Based on the clinical and radiological findings, a diagnosis of Weber's syndrome was made. The patient was treated with antiplatelet and Piracetam along with strict blood pressure control. There was a massive improvement in the patient's condition on the follow-up visit three weeks later. Clinical discussion: Weber's syndrome is a rare brainstem stroke due to midbrain infarction and is characterized by crossing hemiplegia consisting of ipsilateral occulomotor nerve palsy and contralateral limb weakness due to damage to the corticospinal tract. Despite it being a brainstem stroke infarct, it carries a good prognosis if it is early treated along with strict control of the risk factors such as hypertension in this case. Our case had massive clinical improvement within three weeks of medical treatment and risk factor control. Conclusion: This case highlights the classic rare syndrome of brainstem stroke presenting with crossing hemiparesis due to midbrain infarction. This syndrome has a favorable prognosis.

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.