Undiagnosed Uterine Didelphys in a Multiparous Somali Woman with Two Previous Cesarean Sections.

Background: Uterine didelphys (UD) develops from failure of fusion of the paired Müllerian ducts, resulting in two noncommunicating uteri. We present a 31-year-old pregnant woman whose UD anomaly had not been detected during two previous cesarean sections and her presentation to a health-care clinic for her fifth pregnancy. Case Presentation: She was referred to our obstetrics clinic due to suspicion of abdominal pregnancy and a complaint of severe lower abdominal pain. On ultrasonography, UD was detected with two adjacent uteri, one of which was empty and the other with a fetus of approximately 1100 g at 28 weeks and 1 day of gestational age. Magnetic resonance imaging confirmed the presence of UD. Due to severe lower abdominal pain of the patient and severe oligohydramnios of the fetus, emergency cesarean section was performed, and a 980 g male baby was delivered. Conclusion: This case exemplifies how difficult life is for women living in an underdeveloped and resource-limited country like Somalia.

Etiology, Risk Factors and Outcome of Spontaneous Intracerebral Hemorrhage in Young Adults Admitted to Tertiary Care Hospital in Mogadishu, Somalia.

Introduction: Spontaneous Intracerebral hemorrhage (ICH) in young patients is less common and not well studied compared to ICH in older patients. The etiology, risk factors and outcome of ICH in young patients may have regional and ethnic differences. The study aims to investigate the clinical characteristics, risk factors, etiology and outcome of spontaneous intracerebral hemorrhage in young adults in Somalia. Methods: The study enrolled 168 young patients with ICH (16-50 years) admitted to the neurology department of a tertiary hospital from 2019 to 2022. The information about the demographic details, documented ICH risk factors, etiology and patients' clinical status were retrieved. The etiology of ICH was determined based on clinical, laboratory and radiological findings. Intra-hospital survival status and associated factors were assessed. Results: The mean age of the patients was 35±8.6 years. 99 (59%) of patients were male while 69 (41%) were females. Hypertension 48 (29%) was the most common risk factor, followed by substance abuse. Hypertensive hemorrhage was the most common etiology of ICH 60 (35.7%), followed by cerebral venous thrombosis (CVT) 5(15%), substance abuse 23 (13.7%) and arteriovenous malformation (AVM) in 10 (6%). AVM, CVT, cavernoma, eclampsia, substance abuse and cryptogenic etiology were more common in the 2nd and 3rd decades whereas hypertension was more common in the 4th and 5th decade. Intrahospital mortality was 28% in this study. Factors predicting intrahospital mortality were hematoma volume of greater than 30mL, thrombolytic etiology, brainstem ICH location, substance abuse related etiology, presence of associated mass effect, low GCS score on admission, high systolic blood pressure on admission, and the presence of chronic renal failure. Conclusion: In this study, hypertension, substance abuse, CVT and vascular malformation are the leading causes of ICH in young adults. Intracerebral hemorrhage in the young has different spectrum of etiologies and factors associated with short-term mortality compared to older patients.

Age at Natural Menopause and Influencing Factors in Women Attending the Gynecological Outpatient Clinic at a Tertiary Care Hospital.

Background: Menopause is the irreversible cessation of menstruation that results from the lack of ovarian follicular function and is diagnosed after 12 consecutive months of amenorrhea without reasonable cause. This study aims to determine the average age at natural menopause and identify its associated factors among Somali women. Methods: This is a cross-sectional study conducted at the Mogadishu Somalia Türkiye Recep Tayyip Erdogan research and training hospital's Obstetrics and Gynecology outpatient clinic between June 1 and July 1, 2023. Data was collected from subjects during the data collection period using face-to-face interviews with structured questionnaires consisting of sociodemographic, lifestyle, dietary, and reproductive characteristics. A multivariate logistic regression analysis was conducted to find the association between menopause age and target variables. Results: Out of the 188 participants recruited for the study, the median age of menopause was 45.00 (95% CI = 44.50-45.62), and 48.9% had either premature or early menopause. The majority (53.7%) of the participants had a minimum of eight children. In Spearman's rank correlation analysis, we found a significantly positive correlation between menopausal age and age at first (p<0.01), last childbirth (p<0.01), number of parities (p<0.05), and age at marriage (p<0.05). In multivariate logistic regression, we found that the odds of developing premature or early menopause among unemployed women were 59% lower than those of employed women (AOR = 0.41, 95% CI = 0.18-0.93). Conclusion: In this study, we established that the age of natural menopause was lower than the findings reported by previous authors. We also found that employment status, education, history of contraceptive use, BMI, age at first and last childbirth, and parity were associated with age at natural menopause, suggesting that social, lifestyle, and reproductive factors may have an impact on menopausal age.