Generalized Body Weakness Research Articles

8252 Central Adrenal Insufficiency Masquerading as Syndrome of Inappropriate Antidiuretic Hormone (SIADH): A Case Report

Abstract Disclosure: J.G. Sazon: None. J.L. Reyes: None. J.V. Chua: None. S.A. Kho: None. Hyponatremia, the most common electrolyte imbalance encountered in clinical practice, has various causes and presentation. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is a frequent hospital-related cause, potentially leading to misdiagnosis with adrenal insufficiency due to shared clinical features which may cause potential deleterious effect. We present a case of a 41-year-old male hyponatremic patient with a two-month history of progressive generalized body weakness and lightheadedness, initially managed as SIADH. Upon admission, the patient persistently showed low serum sodium level (122mmol/L) (NV: 135-145mmol/L), exhibited signs of euvolemic hyponatremia despite fluid restriction, intravenous furosemide, and sodium chloride tablets. Further work-up revealed normocytic normochromic anemia (Hgb 107 g/L) (NV: 120-160g/L), elevated ESR of (31mm/hr) (NV: 0-15mm/hr), low Ft4 (2.97 pmol/L) (NV: 12-22 pmol/L) and normal TSH (2.2 uIU/mL) (NV: 0.27-4.20 uIU/mL). During hospital stay, he experienced an episode of hypotension at 80/50mmHg and hypoglycemia at 65 mg/dL. Investigation revealed adrenal insufficiency secondary to pituitary macroadenoma with apoplexy as showed in magnetic resonance imaging. Patient was started on Prednisone. Pre-operatively, hydrocortisone 100mg IV every 8 hours preoperatively. He underwent transsphenoidal surgery; excising a 2.5cm soft and grayish suprasellar mass. Post-operatively, he was given Prednisone and Levothyroxine resulting in symptom improvement and normal sodium levels.The occurrence of hyponatremia due to adrenal insufficiency is relatively uncommon, emphasizing the need for heightened suspicion when assessing patients with prolonged or recurring hyponatremia. This paper highlight the need to replace glucocorticoid prior supplementation of thyroid hormone in such cases, averting the occurrence of adrenal crisis. This case indicated a mechanism of persistent hyponatremia attributed to secondary adrenal insufficiency, with added therapeutic benefits observed through the use of glucocorticoids and transsphenoidal surgery. Presentation: 6/1/2024

Peri-Ampullary Tumour; An Unusual Cause of Upper Gastrointestinal Bleeding

Periampullary tumors are cancers that arise in the region of the around the ampulla of Vater, where the bile duct and pancreatic duct converge and empty into the small intestine. This region is very critical for digestive enzyme and bile secretions. This may be associated with slow disease progression, age related changes delayed onset of symptoms and lack of screening and diagnostic facilities. These tumours can be challenging to diagnose and manage due to their proximity to several vital structures. Upper gastrointestinal bleeding may be a rare clinical presentation following tumoral ulceration, erosion into blood vessels or nearby structures or secondary complications like pancreatitis or portal hypertension. Identifying the anatomical origin of these malignancies is usually a herculean task. This will require prompt oesophagogastroduodenoscopy and imaging to determine the source and appropriate management. This is especially true given the region's transitional character, closeness to various structures, and overlapping features among them. We present periampullary tumour an unusual cause of upper gastrointestinal bleeding in a resource limited setting. A52 year old Nigerian male was admitted at the Usmanu Danfodiyo University Teaching Hospital, Sokoto for evaluation following a 3 months history of progressive weight loss, generalized body weakness and a burning and occasionally colicky, persistent, non-radiating epigastric pain, loss of appetite, easy fatiguability, occasional dizziness and recurrent non-projectile post-prandial non-billous vomiting. Though he had no hematemesis, he had history of passage of malaena. The patient was fully conscious on admission, pale, wasted with a markedly tender epigstric region. He was tachycardic with a minimal elevation in blood pressure level of 138/94mmHg. He had an international normalized ratio (INR) of 1.0. Oesophagogastroduodenoscopy was performed which showed a polypoid fungating mass at the1st extending to the 2nd part of the duodenum. A Computerized Tomogram scan of the abdomen showed a diffuse circumferential duodenal wall thickening of 1st and 2nd parts (more in 2nd part) with reduction in luminal calibre of duodenum and mildly dilated pancreatic, common bile, common hepatic ducts. Multiple biopsies were taken for histology which showed moderately differentiated aadenocarcinoma. Surface epithelium composed of columnar epithelial cells which can be seen in the top right of the image below with an invasive tumour, seen infiltrating the lamina propria in the lower left. He went on to have an exploratory laparotomy with triple bypass involving a side to side gastrojejunal anastomosis and cholecystojejunostomy and entero-enterotomy folowing which he went on to receive chemotherapy. As of the time of this write up the patient has recuperated well following his treatment.

Investigation of Malaria Outbreak in Sagambe Area, Mutasa District, Zimbabwe

The burden of Malaria remains a global concern, killing millions of people annually, yet it is a preventable and curable disease.. Malaria, a mosquito-borne disease caused by a parasite, leads to fever, chills, and flu-like symptoms, and can be fatal if untreated. In Zimbabwe, the malaria incidence rate decreased from 39 cases per 1,000 people in 2014 to 25 per 1,000 in 2015, a 36% reduction. A study in Sagambe, Mutasa District aimed to identify risk factors for contracting malaria. Using a 1:1 unmatched case-control study, 88 cases and 88 controls were examined. Data were collected via interviewer-administered questionnaires for cases and controls, and self-administered questionnaires for key informants. Evening outdoor activity significantly increased the risk of malaria (AOR = 9.71, 95% CI 1.97-47.85). Other risk factors included sex (p = 0.023), not owning a mosquito net (OR = 0.26, 95% CI 0.14-0.49), not sleeping under a net the previous night (OR = 0.14, 95% CI 0.07-0.35), not closing windows after sunset (OR = 4.39, 95% CI 1.79-11.11), and not wearing long sleeves outdoors (OR = 0.08, 95% CI 0.01-0.56). The outbreak was linked to evening outdoor activities. Participants had high knowledge of malaria transmission but limited awareness of symptoms beyond headache and general body weakness. The study suggests enhancing health education campaigns in Sagambe.

Pulmonary Thromboembolism in the Intermediate PostOperative Period of Laparoscopic Adrenalectomy for an Adrenocortical Adenoma with Cushing’s Syndrome

Introduction: Cushing’s Syndrome is a constellation of clinical features resulting from chronic exposure to excess glucocorticoids. This is suggested to induce hypercoagulability, which results in a 10-fold increase in the risk for venous thromboembolic events. It results from an increased production of procoagulant factors and impaired fibrinolytic, leading to decreased activated partial thromboplastin time and increased clot lysis time. However, reported events are quite rare and majority of which occur in the post-operative setting. A systematic review done in 2009 by Zaane, et al., discussed that there is up to a 1.5% incidence of venous thromboembolism after transsphenoidal surgery and 0.3-3% after laparoscopic adrenalectomy. Despite this, it is still up to debate whether thromboprophylaxis should be instituted post-operatively among these patients. Discussion: The case is a 42-year-old Filipino, female, with Cushing’s Syndrome readmitted because of generalized body weakness, seven days after laparoscopic adrenalectomy of a left adrenocortical adenoma. After correction of electrolytes and further evaluation, findings suggested the possibility of an infection of the post-operative site. This was confirmed with a whole abdominal CT scan with contrast. She was then managed conservatively with antibiotics. The study was repeated four days after for surveillance of the abscess site. It showed incidental findings of diffuse thromboembolism on the right main pulmonary artery and its segmental branches, right common iliac vein, internal iliac vein, superior gluteal vein, and left ovarian vein. No hypotension, dyspnea, syncope, leg pain, or swelling was noted during this period. Findings were confirmed through CT Angiography of Pulmonary Arteries. Furthermore, no right ventricular dysfunction was noted on 2D echo. She was then treated with loading dose of Rivaroxaban and eventually sent home well after resolution of infection and maintained on anticoagulation

Severe Disease Burden and the Mitigation Strategy in the Arsenic-Exposed Population of Kaliprasad Village in Bhagalpur District of Bihar, India.

The present study was carried out in the village Kaliprasad of Bhagalpur district of Bihar to know the arsenic exposure effect in the exposed population. A total of n = 102 households were studied, and their water and biological samples such as urine and hair were collected and analyzed in a graphite furnace atomic absorption spectrophotometer (GF-AAS). The assessment of arsenic-exposed village population reveals that the villagers were suffering from serious health-related problems such as skin manifestations (hyperkeratosis and melanosis in their palm and soles), breathlessness, general body weakness, mental disorders, diabetes, hypertension (raised blood pressure), hormonal imbalance, neurological disorders, and few cancer cases. About 77% of household hand pump water had arsenic level more than the WHO recommended level of 10µg/L, with highest level of 523µg/L. Moreover, in 60% individual's urine samples, arsenic concentration was very high with maximum 374µg/L while in hair 64% individuals had arsenic concentration above the permissible limit with maximum arsenic concentration of 11,398µg/kg. The hazard quotient (HQ) was also calculated to know the arsenic risk percentage in children as 87.11%, in females as 83.15%, and in males as 82.27% by groundwater. This has surpassed the threshold value of for carcinogenic risk (CR) in children, female, and male population group in the village. Hence, the exposed population of Kaliprasad village are at very high risk of the disease burden.

A Case Study: Management of Hypothyroidism through Ayurveda Medication

One of the most common endocrine disorders seen in daily practise is hypothyroidism. Hypothyroidism is caused by a lack of thyroid hormone or resistance of body tissue to thyroid hormone in relation to metabolic demand. Although diagnosis and treatment of hypothyroidism are frequently thought to be simple, a large number of people with this condition receive suboptimal care. Thyroid disorders are common in India, with hypothyroidism being a condition that is currently not adequately controlled. Because of the disease's broad scope and high prevalence in society, the current issue was chosen for study and management using Ayurveda principles. 60 years old male patient on 10/03/2023 came to OPD of Shalakya Tantra, Parul Ayurved Hospital, Parul University, Vadodara with general body weakness, breathlessness, voice fatigue, dryness, difficulty in swallowing big tablet since a year. Primarily he had steroid therapy for 10 days in November, 2022 but he wanted to be on Ayurveda medication completely. In an interval of 30 days, complete Ayurveda treatment was given, patient was symptomless and TSH level reduced from 15.96 micro IU/ml to 7.77 micro IU/ml.

COVID-19 disease and vaccination in pregnancy: understanding knowledge, perceptions and experiences among pregnant women and community leaders in Uganda.

We investigated pregnant women and community leaders' knowledge, perceptions and experiences of the coronavirus disease 2019 (COVID-19) vaccination program during pregnancy in Uganda and how this changed over the course of the pandemic. We conducted 20 in-depth interviews (IDIs) and two group discussions (GDs) with pregnant women and four GDs with community leaders in Kawempe division of Kampala, Uganda. The first round of IDIs/GDs were carried out in March 2021. In July 2021, telephone IDIs were conducted with 7 pregnant women and 10 community leaders randomly selected from first-round interview participants. Themes were analysed deductively drawing codes from the topic guides. In the first round, the majority of participants thought COVID-19 was not real because of misconceptions around government messaging/motivation and beliefs that Africans would not be affected. In the second round, participants recognised COVID-19 disease, because of rising case numbers and fatalities. There was increased awareness of the benefits of the vaccine. However, pregnant women remained unsure of vaccine safety and quality, citing side effects like fevers and general body weakness. Role models and coherent public health messaging and healthcare workers were key enablers of vaccine uptake. Targeted and sustained COVID-19 communication and engagement strategies are needed, especially for pregnant women and others in their communities, to improve vaccine confidence during outbreaks.

Management of albuminuria and dysuria through Ayurveda interventions in a patient with crossed renal ectopia

Albuminuria is one of the most typical symptoms when there are derangements in the kidney functions, which may damage the kidney’s functional units, that is, nephrons. This study presents a case of a patient suffering from albuminuria who was diagnosed with crossed renal ectopia, that is, fused right kidney to the left side. A 61-year-old male patients suffered from generalized body weakness, proteinuria, disturbed sleep, and dysuria. Because of dysuria, the patient needed catheterization every fortnight. The patient had no history of addiction to smoking and alcohol. The patient had no history of diabetes mellitus, hypertension, or systemic disease except pulmonary tuberculosis 30 years back. The kidney function test, urine routine, and microscopy examination revealed albuminuria, the presence of bacteria, and elevated serum uric acid level. Crossed renal ectopia was diagnosed through a computed tomography examination. From an Ayurveda perspective, the diagnosis of Kaphaja Meha was based on the patient’s complaints, such as increased frequency of micturition and hazy/turbid urine. The treatment plan was made according to the management of Kaphaja Meha. Chandraprabha Vati, Punarnava Asava, Punarnava capsule, and SG syrup—an Ayurvedic formulation, were prescribed along with the dietary regimen. Follow-up was done seven times within 9 months. The medications and dose were altered according to the patient’s condition. The patient’s condition improved symptomatically. After the Ayurvedic intervention for 9 months and 23 days, albumin was absent in urine; serum uric acid became 4.90 mg/dL, and the glomerular filtration rate increased to 88/mL/min/1.73 m2. The patient had normal urination without needing catheterization. The case study results indicate that Ayurveda interventions can manage albuminuria and dysuria in patients with crossed renal ectopia.

ST Segment Elevation in a Young Woman with Metaplastic Breast Carcinoma.

The 12-lead electrocardiogram (ECG) remains a key tool to diagnose ST elevation myocardial infarction (STEMI). However, a variety of other conditions aside from obstructive coronary disease, including hyperkalemia, myocarditis, pericarditis, and Takotsubo and Brugada syndrome, may also cause ST segment elevation, with an incidence rate of 3%-15% and mean age of 45 ± 14 years. A combination of a detailed past medical history, thorough physical examination, and additional imaging tests may allow physicians to make the correct diagnosis.In this report, we present a case of a 39-year-old woman with metaplastic breast cancer in the process of combined oncological treatment admitted to the emergency department because of general body weakness, chest pain, and accompanying hypotonia with an initial diagnosis of acute coronary syndrome.The ECG at presentation showed ST segment elevation, but owing to the observed neoplastic cachexia and frailty, she was medically managed and the diagnostics were extended to include transthoracic echocardiogram and computed tomography scan. The patient was found to have an external mass that infiltrated into the thoracic wall, pericardium, right ventricle, interventricular septum, and coronary arteries.In cancer patients with chest pain and ST segment elevation, STEMI should not be the only diagnosis taken into account. In our report, using a combination of available cardiac imaging methods, we were able to evaluate the stage of the lesion and coronary involvement.

Myasthenia Gravis Exacerbation Following COVID-19 Vaccine: A Case Report

Background: As of December 2021, the World Health Organization (WHO) reports that Coronavirus disease 2019 (COVID-19) led to about 5,403,662 deaths. While COVID-19 has resulted in millions of deaths worldwide to date, vaccination remains the mainstay of infection control. AZD1222 (AstraZeneca vaccine) was distributed in Sudan by the COVID-19 Vaccines Global Access facility in March 2021. It was added to the emergency use list by WHO in the middle of February 2021. However, vaccine safety among patients with autoimmune diseases, such as myasthenia gravis (MG), is yet to be established. MG is a relatively rare illness that could result in life-threatening complications. Myasthenic crisis is considered the most serious complication of MG that can lead to death due to aspiration and respiratory failure. Plasma exchange (PLEX), Immunoadsorption (IA), and intravenous Immunoglobulin (IVIG) are the first-line treatment for myasthenic crisis. It is proven that cortisone has a positive effect when used as add-on therapy with PLEX/IA and IVIG.
 
 The case: We report the case of a 37-year-old Sudanese female who presented to the emergency room with an exacerbation of her previously well-controlled MG following her second dose of AZD1222 vaccination. The exacerbation symptoms at time of presentation were severe generalized body weakness that increasing overtime and shortness of breath. Computerized tomography of the chest was performed, and it revealed no evidence of COVID-19. Management at the ER started with rehydration and IV methylprednisolone 1g, followed by IV hydrocortisone 200mg. She continued to deteriorate and was admitted to the intensive care unit where she was intubated and placed on a mechanical ventilator. IVIG was requested but couldn't be obtained due to the low-income setting, and fourteen days after admission patient died due to circulatory collapse. Our study aims to present an MG case with features of MG exacerbation following the administration of the second dose of AZD1222.
 
 Conclusion: Little is known about the effect of different COVID-19 vaccines on subgroups of patients with autoimmune diseases like MG. Although the safety profile of AZD1222 is generally reassuring, people with severe underlying diseases were excluded from trials. Therefore, more efforts and experimental studies may be needed, with closer vigilance in MG patients. It has not been elucidated how the COVID-19 vaccine might provoke autoimmunity, but several theories have been proposed. Molecular mimicry theory can explain how the genetic material of a virus could provoke autoimmunity, it describes the cross-reactivity of antibodies produced against proteins that are encoded by viral genetic material with the proteins located at the post-synaptic membrane. There is a debate about whether vaccine benefit outweighs the risk in MG patients or not. However, we believed that MG patients should be informed about the benefit and risks of COVID-19 vaccination.

Autopsy Pathology of Invasive Lobular Carcinoma of the Breast: A Case Report

The cause of death can be determined by performing an autopsy. This study reviewed the autopsy pathology performed on a 54 year old woman who died of invasive lobular carcinoma of the breast. The autopsy was performed at Abia State University Teaching Hospital, Aba, Nigeria. She presented with fever and generalized body weakness of one week duration and was being treated for malaria and typhoid fever. Her condition deteriorated in two days of hospitalization despite the treatment given and she later passed away. Autopsy findings revealed that the breasts were symmetrical and the overlying skin was grossly normal. There was no area of ulceration or change in the skin. The nipples were not retracted. Cut sections of both breasts showed diffuse white fibrous tissue in areas and no obvious lymphadenopathy was noted. Histologic sections of the breast tissue showed uniform small bland cells with round nuclei and inconspicuous nucleoli invading a fibrotic fibrocollagenous stroma and adipocytes in single files. There was poor attempt at tubule formation. Histological section of the lungs showed infiltration by malignant epithelial cells similar to ones seen in the breast. There were haemorrhages, congestion and edema in the alveolar interstitium, and some of the alveolar were filled with fibrinous material. Also seen were numerous mixed inflammatory cell infiltrates. The final diagnosis was invasive lobular carcinoma of the breast, with widespread metastasis to the lungs, pleural and peritoneum. The cause of death was ruled as invasive lobular carcinoma of the breast. A thorough autopsy of deaths of women of postmenopausal age was recommended in other to identify associated pathologies. Keywords: Breast cancer, Invasive lobular carcinoma, Invasive ductal carcinoma, Autopsy

The Clinical and Social Economic Profile of Patients Diagnosed with COVID-19 at Likuni Mission Hospital, Malawi.

Background: The COVID-19 pandemic has caused devastating effects on the world since its discovery in the city of Wuhan in 2019. It has claimed millions of lives and has significantly affected the economies of the world. However, the characteristics of affected populations in poorest settings in Africa are not clearly known. Aims and Objectives: The study was undertaken to evaluate common clinical presentations of patients diagnosed with COVID-19, asses the socio-economic and demographic profiles and analyze the clinical course, and comorbidities of COVID-19 positive patients at Likuni mission hospital, central region of Malawi. Methods: This was a cross sectional study, however we looked at retrospective data from for all patients diagnosed from January 2021 to January 2022. Results: Patients were predominantly female (65%), less than 40 years, without any known comorbidity and had at least 3 symptoms before being diagnosed. The most common symptoms were fever, cough, chest pains, headache, shortness of breath, and general body weakness. A significantly higher population were from low social economic status (p<0.05). Over 95% of the population suffered minor ailment and did not need hospitalization and advanced life support. All patients that required hospitalization were above the age of 60 and the results were statistically significant (p<0.05). More than 90% of the cases were locally spread and did not have traceable positive contact. Conclusion: The diversity of clinical and epidemiological characteristic of patients diagnosed with COVID-19 across gender, socio-economic status, age group and occupation is extremely important. Our results provides an understanding of the characteristics of patients in a poor setting like Malawi and will inform policy makers at local hospitals and district levels including researchers and the ministry of health.

Prevalence of Oral Manifestations in Coronavirus Disease 2019-Infected and Vaccinated Geriatric Patients: A Clinical Survey

Aim: The aim of the study was to scrutinize the prevalence of oral manifestations encountered among the geriatric patients that got coronavirus disease 2019 (COVID-19) infection during the pandemic and also among the patients that were partially or fully vaccinated. Settings and Design: This study was a clinical survey. Materials and Methods: A questionnaire was prepared which consisted of patient’s generic details, personal history, previous medical and drug history, and relevant details about COVID-19 infection and vaccination that are needed to record. The questions were designed in such a manner so that a common person can easily understand and answer. The study was conducted on geriatric patients after screening from the outpatient department (OPD) and patients that visited the Department of Prosthodontics and Crown and Bridge. The patient’s approval was obtained, and consent was obtained for participation in the survey. The necessary instructions were explained to the patients in their native language. A total of 2519 patients aged 65 or above participated in this study over a duration of 121 working days. Emergency OPD cases, nongeriatric patients, uncooperative patients, and patients with poor compliance were excluded from the clinical survey. Statistical Analysis Used: Percentage evaluation and graphical representation of data. Results: The results stated that approximately 72% of participated patients suffered from COVID-19 infection, of which the majority of population had dry mouth (xerostomia) and a significant number had aphthous ulcer along with general body symptoms and weakness, whereas the other oral symptoms that happened were insignificant in number. Further, it was also observed that the patients vaccinated partially or fully, had fever, malaise, headache, as a general symptoms and in oral manifestations, only dry mouth (xerostomia) were statistically significant. Conclusion: It was concluded that almost every geriatric patient that recovered from the COVID-19 pandemic presented with one or the other oral signs and symptoms. Moreover, either partially or fully vaccinated patients had also shown a significant number of oral manifestations irrespective of whether they were COVID-19 infected or not.

Partial Empty Sella Syndrome Presenting with Panhypopituitarism and Masked Central Diabetes Insipidus

Empty sella syndrome (ESS) is an uncommon cause of hypopituitarism. It is usually detected incidentally or with neurological symptoms whereas it is rare to present with symptomatic endocrine dysfunction. A 48-year old previously healthy man presented with generalized body weakness, lethargy, fatigue and pos­tural dizziness of one month with no headache or visual disturbance. He also had features suggestive of hypo­gonadism and hypothyroidism. Panhypopitutarism secondary to partial ESS was diagnosed based on pituitary hormone testing and MRI brain. After starting glucocorticoid (GC) replacement patient developed polyuria and polydipsia and was diagnosed to have partial central diabetes insipidus (DI). He was successfully treated with hydrocortisone, thyroxin, intranasal vasopressin and testosterone. ESS causes significant pituitary dysfunction in considerable proportion of patients.

Diagnostic dilemma of celiac disease presenting with weight loss and secondary amenorrhea: A case report

Rationale:Celiac disease (CD) is autoimmune enteropathy affecting the proximal small intestinal mucosa. It is caused by insensitivity to gluten, a protein predominantly presented in wheat. CD is classically associated with gastrointestinal symptoms. The non-classic clinical presentation of CD can present with other organ involvement. Non-human leukocyte antigens genes are associated with atypical forms.Patients concern:We reported a case of 30-year-old female who presented with progressive pallor, amenorrhea, and unexplained weight loss with generalized body weakness. Her body mass index was 20. The patient was having no other systemic manifestations.Diagnosis:This paper reports a case of a female patient having CD without its typical features. Her laboratory evaluation revealed microcytic anemia. Anti-TTg IgA and Anti-TTG IgG antibodies were raised, ferritin and folate were low, and there was mild hyperbilirubinemia. However, follicle-stimulating hormone, luteinizing hormone, and serum estradiol levels were normal. She was diagnosed with a case of anemia resulting from malabsorption caused by CD.Interventions:A management plan was devised based on a strict gluten-free diet. The patient received supplements containing folates, iron, calcium, zinc, and vitamins A, D, E, B6, and B12.Outcomes:After 3 months of treatment with strict gluten-free diet patient showed remarkable improvement. Her hemoglobin level raised with weight gain. Her normal menstrual cycle was restored with complete resolution of symptoms at 1 year follow-up.Lessons:The pathogenesis of the atypical CD is multifactorial, but impaired uptake of micronutrients from the duodenum is the most likely cause, even if other common features of classical forms, such as bloating and diarrhea, are absent. Lack of awareness about atypical forms may lead to under-diagnoses of the disease. The physicians should consider the atypical presentations of CD to avoid the under-diagnoses of this multisystem disorder.

Postpartum Hemorrhage Complicated by Pan-hypopituitarism: Sheehan’s Syndrome; Case Report, 2022

Background: Sheehan’s syndrome is hypopituitarism due to postpartum ischemic necrosis of the pituitary gland. Due to its potentially life-threatening and very rare complications; it still remains important to pregnant women, clinicians, and public health services around the world. Case Report: 38 years parity three Eritrean mother from Ghone subzone of Gash Barka, Eritrea; had history of postpartum hemorrhage and blood transfusion before 10 years (2011) on her last delivery. She presented with history of failed lactation, amenorrhea and infertility of 10 years. She had also constipation, lethargy and generalized body weakness with her current complaint. Hormone analysis revealed pan-hypopituitarism of most anterior pituitary hormones and Magnetic Resonance Imaging of the brain revealed empty sella. She was started on Levothyroxine and fertility supplements based on her fertility desire, and on subsequent follow-ups, her menses was resumed and constipation had subsided and she was attached to endocrinology department for further followup and management. Conclusion: The history of failed lactation, amenorrhea and infertility following postpartum hemorrhage, hormone analysis and imaging findings were consistent with a rare complication of Sheehan’s syndrome. This case was reported for its rarity. Physicians should aware about this complication and should have high index of suspicion for cases with common manifestation of uncommon syndromes.

A case report on Kikuchi disease

<p class="abstract">Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis, is a benign and self-limited disease that mainly affects young women. Patients present with localized lymphadenopathy, fever, and leukopenia in up to half of the cases. KFD can occur in association with systemic lupus erythematosus. We present the case of a patient with KFD and systemic lupus erythematosus. A 38 years old female presented with right sided cervical lymphadenopathy, fever and a rash on the face, with a loss of apetite and generalized body weakness. After a series of investigations to rule out other conditions like tuberculosis, a diagnosis of kikuchi disease was made based on the biopsy report. There was a strong suspiscion of SLE as well pertaining to the facial rash. An ANA profile was done which strongly indicated SLE as well. The patient was started on steroids and other systematic treatment and recovered gradually. With its shared clinical features, Kikuchi-Fujimoto disease can be mistaken for other forms of lymphadenitis. A combined use of medical imaging and laboratory tests is the effective way to avoid misdiagnosis.</p>

Determining Clinical Features & Treatment Outcomes of SARSCoV-2 Infected and Hospitalized Patients in Eastern Ethiopia

Background: COVID-19 is not well studied in Ethiopia, especially in the eastern parts of the country. Determining the clinical profile and treatment outcome of COVID-19 cases will help to plan better prevention and treatment strategies considering the local context. So, this study attempted to investigate and describe the Clinical characteristics and outcomes among hospitalized COVID-19 patients. Methodology: Institutional based retrospective study design was used. The data extraction tool was prepared by using the COVID-19 log-book template and data was collected from 2091 COVID-19 confirmed patients using RT-PCR (real-time polymerase chain reaction) testing method who were admitted at three COVID-19 treatment centers from 21-May-2020 to 02-Aug-2021. Data was entered in Epi-data version 3.2 and analysis was done by SPSS version 25.0. Descriptive statistics proportions, percentages, ratios, frequency distributions, measures of central tendency, and dispersion were used. The result was presented in thefigure and table. Result: A total of 2019 patients were analyzed. In this study majority, 1309 (62.6%) of patients were male and the age ranges of patients were from 8 months up to 100 years with a mean age of 33 years and the most predominant age groups were less than 30 years. Around a quarter of 478 (22.9%) patients were symptomatic and the three most common symptoms manifested were cough 437 (20.9%), shortness of breath 210 (10%), and generalized body weakness 206 (9.9%). The prevalence of comorbidity was 105 (5%), of which DM 37 (1.8%), Hypertension 22 (1.1%) and CVD 15 (0.7%) were the most common. In this study 1992 (95.3%) of COVID-19 patients were recovered and 77 (3.7%) died. Conclusion: This institutional-based COVID-19 register review showed that the most common clinical manifestation were cough, shortness of breath, and generalized body weakness and among the admitted patients male accounts for the lion shares of the number. Majority of patients were asymptomatic this will increase asymptomatic transmission in the community, thus effort community mass screening intervention is important.

Sars-Cov-2 B.1.1.529 (Omicron) variant outbreak: case series presentations and response to treatment at the Islamic University in Uganda health facility

The object of research: The study, investigated the clinical presentations of patients who tested Positive for Covid-19 (Omicron Variant), their response to treatment, and the levels of transmissibility of the infection.
 Investigated problem: As the globe, continent, and nation are struggling with the emergency of the new COVID-19 omicron Virant outbreak there’s not much information known about the behavior of this new threat to enable clinicians, and public health specialists, and policymakers to curb the problem.
 The main scientific results: The study found that headache, cough, fevers and, general body weakness was the commonest presenting complaints, 3 of the cases reported difficulties in breathing. None of the cases required admission. There was no difference in the severity of the illness and the response to treatment between the vaccinated and the non-vaccinated cases. Cases that did steaming as an adjuvant/supplementary treatment reported a shorter duration of symptomatic relief than those that did not.
 The area of practical use of the research results: The findings will act as a practical guide to clinicians, public health specialists, and policymakers in the management of the COVID-19 Omicron Variant.
 Innovative technological product: The use of steaming as an adjuvant to symptomatic relief management of respiratory tract infections.
 Scope of the innovative technological product: Omicron Variant produces a less severe illness than earlier variants of COVID-19. The study also reveals that vaccination alone was not effective in the prevention of contraction of the Omicron Variant and other newer variants. However, vaccination may have been advantageous in protecting the cases from progressing to severe disease. Thus, other IPCs measures must be maintained and booster doses of COVID-19 vaccinations should be encouraged. Large-scale on the effectiveness of steaming and other locally made remedies for symptomatic management of respiratory tract infections should be done.

Evaluation of cardiotoxicity and other adverse effects associated with concomitant administration of artemether/lumefantrine and atazanavir/ritonavir-based antiretroviral regimen in patients living with HIV

The interplay of artemether-lumefantrine (AL) and atazanavir-ritonavir (ATVr) with Cytochrome P (CYP) 3A4 isoenzyme and QTc-interval may spawn clinically significant drug interactions when administered concomitantly. Cardiotoxicity and other adverse effects associated with interaction between AL and ATVr were evaluated in patients with HIV infection and malaria comorbidity. In a two-arm parallel study design, six doses of AL 80/480 mg were administered to 20 participants [control-arm (n = 10) and ATVr-arm (n = 10)], having uncomplicated Falciparum malaria, at intervals of 0, 8, 24, 36, 48 and 60 h respectively. Participants in the control arm took only AL while those in ATVr-arm took both AL and ATVr-based ART regimen. Electrocardiography, adverse events monitoring and blood tests were carried out for each of them at pre and post doses of AL. Data obtained were analyzed. QTc-interval was significantly increased in the ATVr-arm (0.4079 ± 0.008 to 0.4215 ± 0.007 s, p = 0.008) but not in the control-arm (0.4016 ± 0.018 to 0.4024 ± 0.014 s, p = 0.962). All values were, however, within normal range [0.36 – 0.44 / 0.46 s (male/female)]. General body weakness and chest pain were new adverse events reported, at post-dose of AL, in the ATVr-arm but not in the control-arm. There was no significant change (p > 0.05) in the plasma levels of creatinine, alanine aminotransferase, aspartate aminotransferase and hemoglobin at post-dose compared to pre-dose of AL in both arms of study. Concomitant administration of artemether-lumefantrine with atazanavir-ritonavir-based regimen is potentially cardiotoxic but not associated with clinically significant renal, blood nor liver toxicities. They must be used with caution.