Pattern of Neurological Disorders among Patients Evaluated in the Emergency Department; Cross-Sectional Study.

Introduction: Neurologic disorders are common reasons for emergency consultations. Most neurologic disorders seen in the emergency department (ED) are life-threatening and require urgent treatment. The goal of this study is to investigate the pattern of neurological disorders among patients evaluated in the ED. Methods: This is a cross-sectional study conducted in the ED of Mogadishu Somali Turkish Training and Research Hospital, from July 2021 to February 2022. The clinical and epidemiological characteristics of adult patients with neurologic manifestations in the ED were evaluated. Age, gender, distribution of neurological disease manifestations, neurological examination findings, and neurological diagnoses made by consultant neurologists were assessed. Results: During the study period, 321 patients were assessed (3.7 % of all ED admissions). The majority of the patients in the study were above 50 years of age (62.6% male). Hypertension was the most common comorbidity among these patients with 122 (38%) cases, followed by diabetes mellitus with 65 (20.2%), and heart diseases with 26 (8.1%) cases. The main reasons for neurology consultations were altered mental status with 141 (44%) cases, motor weakness with 102 (31.8%), seizures with 33 (10%), headache with 17 (5.3%), and vertigo with 9 (2.8%) cases. 196 (61%) had hemiplegia, 60 (18.7%) had consciousness impairment, and 38 (11.8%) had normal neurological examination. The most frequent neurological diagnoses were ischemic strokes with 125 (39%) cases, hemorrhagic strokes with 65 (20.2%), epileptic seizures with 28 (8.7%), and metabolic encephalopathies with 13 (4%) cases. The median duration of the neurology consultations was 20 minutes. 251 (78%) of the patients were admitted to the hospital, while 70 (22%) were discharged from the emergency department. After neurology consultation, the neurology department made the most admissions with 226 (90%) cases, while 25 (10%) were admitted by other departments. Of those admitted, 186 (74.2%) were admitted to the neurology ward, and 65 (25.8%) were admitted to the intensive care unit. Conclusion: In our study, neurologic emergencies accounted for 3.7% of all emergency admissions. Stroke, epileptic seizures, cerebral venous thrombosis, encephalopathies, and acute spinal cord diseases were the most common neurological disorders.  The admission rate was very high following neurologic assessment by neurologists.

Isolated Inferior Sagittal Sinus Thrombosis in Young Patient: Rare Case Report.

Cerebral venous thrombosis (CVT) is a less common type of stroke, mostly in young patients. The majority of these cases are due to thrombosis of superior sagittal sinus and transverse sinus. Isolated thrombosis of the inferior sagittal sinus is very rare. Here, we report a 22-year-old male patient with no significant past medical history who presented to the emergency department of our hospital with a convulsion, decreased level of consciousness, and right side weakness. His laboratory investigations, including the coagulation profile, were normal. A non-contrast brain CT showed a 5 × 3 cm hematoma in the left parasagittal parietal lobe with no associated midline shift or intraventricular extension. The cerebral magnetic resonance (MR) angiogram did not show any underlying aneurysm or vascular lesion. However, the cranial MR venogram showed inferior sagittal sinus thrombosis, while other cranial veins and dural sinuses were patent. The patient was admitted to the hospital and managed with low-molecular-weight heparin and warfarin sequentially. He had significant improvement (consciousness and weakness have improved, and seizures are under control). This present case illustrates a rare case of isolated cerebral venous thrombosis and also reviews the known literature on this condition.

A case of sirenomelia associated with atrial septal defect: A rare case report.

Introduction: and importance: Sirenomelia is a life-threatening condition caused by a rare developmental abnormality. According to the research, the incidence of sirenomelia is estimated to be between 1.5 and 4.2 per 100,000 newborns. Around 15% of cases of sirenomelia are related to a twin pregnancy, most commonly in monozygotic cases, with a 7% incidence. We're reporting on a mermaid syndrome case involving twins, one of whom was healthy and the other had sirenomelia. Case presentation: An 18-year-old female and her first child arrived at the hospital maternity ward, and she had never been there before, and when an ultrasound was performed, it was discovered that she had two babies in her womb and on of them has clung to each other's legs, and a by elective cesarean section was performed to remove the babies, which resulted in the extraction of two boys, one of whom is healthy and the other is clinging to each other's legs. Clinical discussion: Sirenomelia is a deadly congenital condition that affects the caudal part of the embryonic body. Although the most evident feature is the fusing of the lower limbs, Approximately 49.5 percent of pregnancies are terminated voluntarily due to fetal malformations, according to reports. The abnormality is thought to be caused by a combination of genetic predisposition and a trigger element in the environment, while the exact cause is unknown and thought to be complex. In cases of surviving sirenomelia, treatment can be administered using a multidisciplinary approach. Conclusion: Mermaid Syndrome is a fatal congenital abnormality with a bleak outlook. Sirenomelia can be diagnosed by ultrasonography. Oligohydramnios and fused lower limbs are important symptoms that aid in diagnosis during the first trimester of pregnancy, with probable termination of the pregnancy indicated if identified early.

Intestinal obstruction in a child with massive ascariasis and associated acute appendicitis: A case report.

Introduction and importance: Ascaris lumbricoides is a parasitic roundworm that spread through feces-oral routes and is endemic in many nations with poor sanitation. Case presentation: We present a case of a 6-year-old boy who arrived in the emergency room with abdominal pain, constipation, and vomiting. Physical examination revealed abdominal distension, absence of bowel sounds, and abdominal tenderness. Abdominal radiographs, ultrasonography, and computed tomography established the diagnosis of intestinal obstruction by A. lumbricoides with associated acute appendicitis and surgical approach scheduled. A massive intraluminal nematode from the jejunum to the ileocecal valve was observed during an exploratory laparotomy. An ileal enterotomy was performed and the worms were removed. The patient was discharged without incident on the 12th day. Clinical discussion: Ascariasis is the most common helminthic infection worldwide; reaching peak prevalence in children aged 2 to 10. The disease is prevalent in children with environmental and socioeconomic risk factors, causing serious problems such as intestinal obstruction (IO), volvulus, intussusception, and intestinal necrosis. Conclusion: Ascaris lumbricoid is very prevalent in developing countries and should be kept in mind in preschool children with symptoms of sudden acute intestinal obstruction. The diagnosis of intestinal ascariasis can usually be made with plain radiography, barium examinations, and ultrasonography of the abdomen. Other modalities, such as CT, can also be used. Medical treatment of Ascaris infestation is usually successful; however, bowel obstruction may require surgery.

Ovarian Torsion Due to Mature Cystic Teratoma During the Early Postpartum Period: A Rare Case Report.

Mature cystic teratoma (MCT) is a benign and unilateral ovarian neoplasm usually seen in premenopausal women. Its most common complication, torsion, is a well-known cause of acute abdominal pain. However, it is rare in the early postpartum period. In this paper, we present a case of ovarian torsion due to MCT, which was diagnosed radiologically in the early postnatal period and surgically confirmed. A 25-year-old woman vaginally delivered a healthy baby on time and without any problems. She presented with acute abdominal pain in the right lower quadrant on the postpartum 5th day. Abdominal ultrasound (US) and computed tomography (CT) demonstrated an ovarian mass containing fat and calcification in the right adnexa and non-enhancing ovarian parenchyma. The patient was discharged on the 5th day after the salpingo-oophorectomy operation without any complications. US and CT provided crucial information to make an accurate and rapid management decision in ovarian torsion due to MCT.

Doppler ultrasound diagnosis of brachial artery injury due to blunt trauma: A Case Report.

The brachial artery is the most common injured vessel in the upper extremity. Although vascular injury following blunt trauma is rare, it is a condition to be considered because it can easily be overlooked unless the clinician has a high suspicion. In this paper, we present a blunt trauma case with brachial arterial injury, upper extremity ischemia, and the need for urgent management to salvage the limb. A 28-year-old male had a right arm swelling, pain, and paleness accompanied by a weak pulse in the right radial artery and right-hand numbness. Following resuscitation, preoperative Doppler ultrasound revealed to the brachial artery injury. The right brachial artery had an occlusion with a thrombus. In spectral Doppler analysis, there were demonstrated parvus et tardus waveform in the distal arteries. Doppler ultrasound provided crucial information to make an accurate and rapid management decision.

Cancer Incidence and Distribution at a Tertiary Care Hospital in Somalia from 2017 to 2020: An Initial Report of 1306 Cases.

PURPOSE: To determine the type, frequency and distribution of all cancers in Somalia from 2017 to 2020. PATIENTS AND METHODS: This retrospective and descriptive study included the review of a total of 5238 pathology reports obtained from the medical records of the Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital. Patient characteristics, lesion localization, and histopathology were recorded. Patients with an unconfirmed cancer diagnosis, borderline tumors, intraepithelial neoplasms and metastatic cancers were excluded from the study. The cases were classified according to gender, age, and organ involvement. RESULTS: Of the 1306 patients included in the study, 50.9% (n=666) were female and 49.1% (n=640) were male, and the mean age was 51.1±19.4 years. Of the cases, 5.1% (n=67) were pediatric (0-17 years) and 35.8% (n=468) were in the 18-50 years range. The most common cancer was esophageal cancer (EC) for the overall data (n=284; 21.7%) and in both genders. EC peaked in the fifth decade, and the most common histological type was squamous cell carcinoma (n=256; 91.1%). Liver cancer was the second most common cancer overall (n=99; 7.6%) and in men (n=67; 10.5%). Cervical cancer was the second most common cancer among women (n=88; 13.3%) and ranked fourth in terms of overall incidence (n=88; 6.7%). Breast cancer was the third most common overall (n=95; 7.3%) and in women (n= 87; 13.1%). CONCLUSION: This study shows that in Somalia, EC is the most common cancer in both genders. These high rates in Somalia suggest that environmental factors and dietary habits may have an effect. To reduce the incidence of EC and prevent its development, the population of Somalia should be educated and effective planning should be undertaken.