Epidemiological characteristics, etiological spectrum, and outcomes of adult patients with pericardial effusion at a Teaching Hospital in Somalia.

Background: Pericardial effusion (PE) is an abnormal fluid volume in the pericardial space and is a common clinical entity. The incidence of PE is estimated diversely and depends on risk factors, etiologies, and geographic locations. Objectives: This study aimed to assess the clinical characteristics, etiologic spectrum, echocardiographic features, and outcomes among patients with different types of PE. Method: This retrospective observational study included 93 patients with confirmed PE. Their medical records were reviewed in the hospital information system of Mogadishu Somali Turkish Training and Research Hospital between April 2022 and September 2022. Patient demographics, clinical characteristics, chest X-rays, echocardiography, laboratory findings, management approaches, and outcome reports were reviewed and recorded. Results: Out of the 3000 participants, 3.1% (n = 93/3000) met the definition of definitive PE. In this study, we included 51 females and 42 males. Among the patients, 86% (n = 80) had at least one comorbidity, with diabetes (38.7%) and hypertension (37.6%) being the most common. The most frequently reported clinical presentation findings were shortness of breath (67.7%), chest pain (49.4%), cough (47.3%), and palpitations (47.3%). Cardiac tamponade developed in 9.7% (n = 9) of the patients. Pericardial taps were performed in 64.5% of the cases. Our analysis showed that the most common cause of PE was cardiac disease (n = 33, 35.4%), followed by tuberculosis (TB) (n = 25, 26.8%), uremic pericarditis (n = 24, 25.8%), and hypothyroidism (n = 10, 10.7%). Regarding the severity of PE based on echocardiographic findings, nearly half of the patients (n = 46, 49.4%) had mild PE, whereas 26.8% (n = 25) had moderate PE, and 23.6% (n = 22) had severe PE. Two-thirds of the cases (66.6%) were managed with furosemide, 48 (51.6%) patients were treated with an anti-inflammatory, hemodialysis was performed in 24 (25.8%) patients and antituberculous medications were administered to 7 (7.5%) patients. Out of the 93 patients, 24 (25.8%) died during the hospital stay. It was determined that the mortality risk of patients with renal failure was 7.518 times higher than those without (p = 0.004), and the risk for those with TB was 5.554 times higher than those without (p = 0.011). Other variables were not influential on mortality (p > 0.050). Conclusion: Our study results demonstrate the epidemiological profile of PE in Somalia. The leading causes of PE were cardiac diseases, uremic pericarditis, TB, and hypothyroidism. PE is a significant cause of morbidity and mortality in Somalia, especially in individuals with renal failure and TB infection.

Parachute tricuspid valve unique case and the first case in Somalia.

Atrioventricular valve parachute deformity is rare and is generally seen in the mitral position, called the parachute mitral valve. It is rare to see it in the tricuspid valve and up to now, there have been approximately 14 cases of parachute abnormalities in tricuspid valves in a literature review. We present here a 21-year-old male who presented to the emergency department with progressive shortness of breath over several months. Despite the absence of chest pain, palpitations, or weight changes, examination revealed a soft, holosystolic murmur at the left lower sternal border. Further investigation through electrocardiogram and echocardiogram identified a rare structural abnormality known as parachute tricuspid valve, resulting in significant tricuspid regurgitation with mild right chamber enlargement. The patient was recommended to go abroad for further management since a cardiothoracic surgeon is not available in our country.

Exploring the prevalence, clinical spectrum, and determinants of uncontrolled hypertension in the emergency department: Insights from a hospital-based study in Somalia.

BACKGROUND: Uncontrolled hypertension (UH) is a significant public health issue in both developed and developing countries. This study aimed to analyze the clinical spectrum and degrees of severity of hypertension, antihypertensive use, and factors associated with UH. METHOD: Hospital-based cross-sectional study was conducted at the emergency-department of Mogadishu Somali Turkey Training and Research Hospital from September 2021 to August 2022. A total of 278 hypertensive patients were selected using a convenient sampling technique. Data was entered into and cleaned by Excel and exported to SPSS version-26.0 for analysis. A binary logistic regression model (AOR, 95 % CI and p-value<0.05) was used to determine the predictors of UH. RESULTS: The prevalence of UH was 62 %(n = 172). Of the total respondents, 144(51.8 %) were males. The predominance of the respondents(n = 147, 52.9 %) were in the age group 40-69years. Almost 65.8 %(n = 183) of the participants were married. 112(40.3 %) of the participants had no formal education. The majority of the participants (n = 192, 69.1 % %) were unemployed. 225(81 %) patients had at least one or more coexisting diseases. Diabetes was the most common comorbid(47.4 %). The most common clinical manifestations observed in the study group were headache(21 %). According to the stages of hypertension, most of the patients have a Hypertensive crisis(20.9 %). Among the participants, 50 % were on calcium channel blockers(CCBs). Additionally, the majority (53.2 %) were receiving monotherapy. Patients who have no comorbidity (AOR = 0.178, 95 % CI:0.066-0.447), not performed diet control (AOR = 15.475, 95 % CI:6.666-35.929), and non-adherence to physical-activity (AOR = 5.585, 95 % CI:2.834-12.792) are independent predictors of UH. CONCLUSION: The prevalence of UH among patients with hypertension in Somalia was high. Unhealthy lifestyles and non-adherence to physical activity were the major modifiable risk factors for UH. Regular health education during follow-up visits by nurses and physicians is crucial in preventing the issue by providing continuous information on lifestyle practices and the potential complications associated with hypertension.

A 28-year-old male with spontaneous coronary artery dissection complicated by apical thrombus and acute ischemic stroke: An interesting case.

Spontaneous coronary artery dissection is described as the intramural bleeding that separates the layers of an epicardial coronary artery wall, either with or without an intimal tear. Atherosclerosis, iatrogenic damage, or trauma are not linked to this syndrome. Here we present a 28-year-old male with 1 month history stroke but no any chronic disease as well family history of heart disease who presented with 2 days' duration of typical cardiac chest pain. Based on an emergency electrocardiogram that showed biphasic T-wave inversion with ST-elevation myocardial infarction, the patient was taken to the a  catheterization laboratory(cath-lab), with the result of spontaneous coronary artery dissection of the left anterior dissenting artery with thrombolysis in myocardial infarction flow grade 0 and normal of other vessels. Then we successfully did angioplasty, and the patient was discharged with aspirin 100 mg 1 × 1, clopidogrel 75 mg 1 × 1, and rivaroxaban 20 mg 1 × 1.

A multivessel spontaneous coronary artery dissection presented with an acute coronary syndrome that was conservatively managed. A case report.

A spontaneous coronary artery dissection (SCAD) is a tear that forms in a blood vessel in the heart without any obvious underlying etiology. It could be a single vessel or multiple vessels. We present a 48-year-old male known to be a heavy smoker without any chronic diseases or family history of heart disease who presents to the cardiology outpatient clinic with shortness of breath and chest pain on exertion. Electrocardiography demonstrated ST depression with T wave inversion of anterior leads, while echocardiography of the patient showed left ventricular systolic dysfunction with severe mitral regurgitation and mildly dilated left chambers. Based on his risks for coronary artery disease, his electrocardiography, and echocardiography, the patient was referred for elective coronary angiography to exclude the possibility of coronary artery disease. The angiography was done with the result of multivessel spontaneous coronary artery dissections involving the left anterior descending artery (LAD) and circumflex artery (CX) with a normal dominant right coronary artery (RCA). Due to the multi-vessel involvement of the dissection and the high risk of extension of the dissection, we preferred conservative management, including smoking cessation and heart failure management. The patient is doing well with regular heart failure treatment in cardiology follow-up.

A Rare Case of Apixaban-Induced Subdural Hematoma in Elderly Heart Failure Patient.

New oral anticoagulants (NOACs) have become more popular in the last few decades. Although apixaban has been proven to be safer than warfarin and causes less hemorrhage in comparison to other NOACs, it still poses a risk of spontaneous bleeding. We present here an 81-year-old male known case of heart failure with reduced ejection fraction (HFrEF) associated with an apical thrombus of 0.93×1.29 cm who presents with cognitive decline, slurred speech, and right side weakness following apixaban use for his apical thrombus. On further evaluation of non-contrast brain computerized tomography (CT), there was a large extra-axial subacute subdural hematoma with thick septations in the left parietal region, measuring 2.6 cm in thickness, causing an a mass effect, and an a midline shift of 1 mm. Following neurosurgery, cardiology, and anesthesiology discussions, the surgery was deferred due to his age and coexisting conditions with regular follow-ups. The patient has now gained full consciousness and is currently undergoing physiotherapy. This case highlights an elderly patient with apixaban-induced subdural hemorrhage, which is a rare entity in the medical literature. Although apixaban is safer than other NOACs, it may cause subdural hemorrhage.

Pneumopericardium with massive pericardial effusion in the setting of tuberculosis constrictive pericarditis: a rare case report.

Constrictive pericarditis is an uncommon complication of acute pericarditis, mainly caused by non-idiopathic sources. Pneumopericardium is the presence of air in the pericardial sac resulting from various procedures and circumstances, including trauma, iatrogenic, non-iatrogenic and natural causes. Here, we report a 16-year-old girl who came to the cardiology outpatient complaining of weakness, abdominal distention and shortness of breath while lying down and exertion. An echocardiography evaluation revealed a thickened precordium and massive pericardial effusion. Pericardiocentesis was performed for diagnosis and treatment purposes. Despite the patient's remaining symptomatic and having no improvement following the procedure, we decided to perform chest computed tomography, which revealed a thickened pericardium with pneumopericardium. Partial pericardiectomy was performed successfully, and the sample was sent to the pathology department, which confirmed tuberculous constrictive pericarditis. The patient's symptoms improved, and she was discharged on postoperative Day 5 standing on her foot.

Retrospective Analysis of Left Ventricular Thrombus Among Heart Failure Patients with Reduced Ejection Fraction at a Single Tertiary Care Hospital in Somalia.

Introduction: Left ventricular thrombus (LVT) is a common complication in patients with systolic heart failure and can cause thromboembolic consequences including stroke. In order to determine the characteristics of LV thrombus among heart failure patients with reduced ejection fraction (HFrEF), the present study was undertaken. Methods and Materials: This was retrospective cross-sectional study conducted from referral tertiary hospital in a year period. A total of 810 transthoracic echocardiograms were carried out in our center from January 2021 to December 2021. Forty participants had met the inclusion criteria of the study. Results: About 75% of the population was male and the mean age at diagnosis was 51 years (SD: 15). Ischemic cardiomyopathy and dilated cardiomyopathy (DCMP) found to be the most underlying cause of LVT represented (57.5% and 42.5% respectively). Hypertension, hypothyroidism, and atrial fibrillation were found to be the commonest associated risk factors of LVT, 45%, 12.5%, and 30% respectively. Simpson's Biplane's approach yielded a mean LVEF of 25.25 ± 6.97. 60% of the patients had a LVEF of ≤25%. The mean LV end-diastolic and end-systolic diameters were 59.2 ± 9.4 mm and 51 ± 8.3mm respectively. Warfarin was administered to 19 (47.5), Rivaroxaban to 8 (20), and Dabigatran to 10 (25). The most prevalent anticoagulant among the individuals in our study was warfarin. A stroke complication was found in 8 patients (20%), two of them were hemorrhagic stroke and they were on dabigatran. A Peripheral Arterial Disease (PAD) affected 6 of the patients (15%). One of those with PAD had also ischemic stroke. Conclusion: This study determines that Ischemic and Dilated cardiomyopathy were the most common cause of left ventricular thrombosis among HFrEF patients in Somalia.

Simultaneous acute cardio-cerebral infarction associated with isolated left ventricle non-compaction cardiomyopathy.

Introduction and importance: The co-occurrence of acute ischemic stroke and acute myocardial ischemia; cardio-cerebral infarction (CCI) has been linked to increased morbidity and mortality. The incidence of these conditions to occur simultaneously has been reported to be less than 1% according to the published data. Left Ventricular Non-Compaction (LVNC), on the other hand, is characterized by large left ventricular (LV) trabeculae, a thin compacted layer, and deep intertrabecular recesses. In the inter-trabecular recesses, where blood flow is slow, cardiac mural thrombi may form, which can lead to systemic embolization. Case presentation: In this report, we describe a 51-year-old male patient with a history of hypertension and diabetes who developed a non-ST segment elevated myocardial infraction and an acute ischemic stroke that were thought to be related to left ventricular hypertrabeculation. Clinical discussion: Although it is rare, the simultaneous occurrence of myocardial infarction and an acute ischemic stroke can be fatal. There are numerous potential mechanisms for CCI, including cardiac thrombi-embolism, hypoperfusion during AMI. Both conditions have a narrow therapeutic window and management is very crucial. Conclusion: To the best of the author's knowledge, this is the first reported case of cardiocerebral infraction (CCI) in the setting of non-compaction left ventricle. Early and precise diagnosis is critical to the successful management of these conditions.

Spontaneous bilateral subdural hematoma in a patient with a prosthetic valve and association with plasmodium vivax malaria: A rare case report.

Introduction and importance: Bilateral subdural hematoma (SDH) is a very rare condition which can occur without any apparent etiology. It's characterized by a lower frequency of focal neurological impairments, which could delay the diagnosis and postpone treatment. The reported incidence of an acute spontaneous subdural hematoma (SSH) varies between 2% and 6.7% of all acute SDH. SDH following Plasmodium vivax (P. vivax) infection are uncommon to our knowledge, only two cases of SDH linked with P. vivax infection have been documented in the literature. Case presentation: We describe a case of a 31-year-old male with a history of mitral mechanical valve replacement on anti-coagulant presented with spontaneous bilateral subdural hematoma in the presence of malaria. The patient had a limited vague symptom, which delayed a prompt diagnosis of his disease. Clinical discussion: Spontaneous subdural hematoma has only a few documented cases. Hypertension, infections, vascular malformations, ruptured aneurysms, thrombocytopenia caused by hematological and oncological illnesses, acquired or inherited types of coagulopathies, and drug abuse are all risk factors. Also, SDH has been documented in the literature as a consequence of Plasmodium infection. In addition to that this patient was on anti-epileptic medicines which might potentiate vitamin K antagonists. Numerous factors were thought to have contributed to this significant bleeding. Conclusion: Patients on anticoagulants who exhibit nebulous symptoms, including a mild headache, should be subjected to a thorough history and examination. And any factor delaying an accurate diagnosis should be eliminated. This will complement the patient's plan and management.

Post-splenectomy native valve endocarditis caused by coagulase negative staphylococci: A rare case report.

Native valve endocarditis caused by coagulase negative staphylococci (CoNS) were a seldom condition, nevertheless there is an increasing CoNS native valve involvement. Here we present a 43 year old patient who underwent Splenectomy due to abdominal trauma he suffered a month before who encountered mitral valve endocarditis caused by coagulase negative staphylococci.

Warfarin-induced isolated spontaneous subarachnoid hemorrhage: Rare case report.

Introduction and importance: Subarachnoid hemorrhage (SAH) is mostly associated with head trauma. Non-traumatic subarachnoid hemorrhage is mostly due to vascular abnormalities: either hemorrhage from ruptured aneurysm or bleeding from arteriovenous malformation. Aneurysmal hemorrhage is the biggest cause in non-traumatic cases. Warfarin is associated with cerebral intraparenchymal hemorrhage, but it is rarely associated with SAH. Case presentation: Here, we report the case of a 45-year-old male patient who was admitted to the neurology ward of our hospital due to acute ischemic stroke. The patient was treated with a vitamin K antagonist (warfarin). However, on the third day, his condition deteriorated (his GCS regressed from 11/15 to 5/15). His pupils were anisocoric. Brain CT showed extensive subarachnoid hemorrhage without intraparenchymal involvement. Cerebral magnetic resonance angiography ruled out aneurysmal rupture. The patient was intubated and transferred to the intensive care unit. Due to his poor condition, neurosurgical intervention could not be done. The patient was managed conservatively, but the patient passed away 4 days later in the intensive care unit. Clinical discussion: Non-traumatic SAH is mostly caused by aneurysmal rupture. Warfarin increases the risk of intracranial hemorrhage and mostly causes intraparenchymal hemorrhage. Isolated warfarin-related SAH without parenchymal involvement is a rare event. Here we present a young male patient with an isolated warfarin-induced SAH. Conclusion: Warfarin is rarely associated with isolated subarachnoid hemorrhage. This case highlights a young male patient with spontaneous SAH after warfarin therapy for acute ischemic stroke. Aneurysmal rupture and trauma should be excluded before a diagnosis of warfarin-induced SAH is made.