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Abstract Background Heart failure is a rare manifestation of metastatic disease of the carcinoma of an unknown primary, malignancy that requires extensive work-up to identify the primary site. Initial consideration of rare etiologies in patients presented with a common clinical syndrome is challenging. Case presentation A 35-year-old Black woman presented with shortness of breath at rest, orthopnea, paroxysmal nocturnal dyspnea, chest pain, a blood-tinged productive cough, and fever for 2 weeks. She also had progressive body swelling, easy fatigability, loss of appetite, and abdominal pain during the same week’s duration. Body imaging revealed large pleural and pericardial effusions, metastatic liver lesions, and bilateral pulmonary vascular segmental and subsegmental filling defects. Pericardial and pleural fluid cytology suggest malignant effusion. Liver lesions and core needle biopsy indicated adenocarcinoma of unknown origin, and the carcinoembryonic antigen level also increased significantly. Conclusion Carcinoma of unknown primary origin commonly presents in an advanced stage and is often accompanied by clinical features of site metastasis. This case highlights heart failure as an unusual first manifestation of adenocarcinoma with an unknown primary origin.

Abstract Background Patients with type 2 diabetes mellitus (T2D) have an increased risk of vascular complications. Despite the rise in the prevalence of T2D and its complications throughout the globe, there is a paucity of data regarding the prevalence and determinants of vascular complications of T2D in Ethiopia. Hence, this study aimed to assess the prevalence, patterns, and determinants of the microvascular and macrovascular complications of T2D among adult patients attending a teaching hospital in Addis Ababa, Ethiopia. Methods A retrospective study was done by reviewing the electronic health records of adult patients with T2D attending the general medical and endocrine referral clinics of Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, from June 1, 2023, to November 30, 2023. Statistical Package for Social Sciences (SPSS), version 25, was used to analyze the data. Descriptive analysis was used to summarize the sociodemographic, clinical, and laboratory profiles as well as the patterns of vascular complications of T2D. Bivariate and multivariate logistic regression models were fitted, and the crude odds ratio (COR) and adjusted odds ratio (AOR), together with the 95% confidence interval (CI), were computed to identify the determinants of microvascular and macrovascular complications of T2D. Results A total of 272 patients with T2D were included in this study; 50.5% were females, and the mean (± standard deviation) age was 56.3 ± 12.8 years. The majority of patients (62.5%) had diabetes for ≥ 5 years. More than half (51.5%) had poor glycemic control with glycated haemoglobin (HbA1c) value of ≥ 7%. The overall prevalence of vascular complications was 39%. The prevalence of microvascular complications was 23.5%, the most common being neuropathy (11.8%), and the prevalence of macrovascular complications was 21%, the most common being coronary artery disease (12.1%). The determinants of microvascular complications were age ≥ 60 years (AOR = 2.25, 95% CI: 1.17, 4.33), diabetes duration of ≥ 5 years (5–10 years [AOR = 3.13, 95% CI: 1.37, 7.18], and > 10 years [AOR = 3.88, 95% CI: 1.66, 9.06], and HbA1c value of ≥ 7% (AOR = 2.21, 95% CI: 1.14, 4.28). The odds of developing macrovascular complications were higher with diabetes duration of ≥ 5 to 10 years (AOR = 2.89, 95% CI: 1.37, 6.12) as compared with diabetes duration of

Abstract Background Hypertension is a recognized risk factor that underlies the epidemic of cardiovascular diseases. Guidelines, including those from the European Society of Hypertension, recommend opportunistic screening for hypertension in all adults. However, there have been no institution-based studies on the prevalence of hypertension and its associated factors with an opportunistic screening program in Ethiopia. Hence, this study aimed to assess the prevalence of newly diagnosed hypertension and its associated factors in an opportunistic screening program in Ethiopia. Methods This was an institution-based cross-sectional study conducted on adult participants in an opportunistic hypertension screening program at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, from November 1, 2023, to February 1, 2024. Data were collected using a structured questionnaire, constructed as per the WHO STEPwise approach to non-communicable disease risk factor surveillance (STEPS). The data was analyzed using Statistical Package for Social Sciences (SPSS), version 26. Descriptive analysis was used to compile the sociodemographic and clinical characteristics of the participants, and logistic regression analyses were performed to determine the factors associated with hypertension. Results A total of 301 adult participants were included in this study. The mean age of the participants was 47.6 years (standard deviation: 13.5), and 62.5% were males. The prevalence of newly diagnosed hypertension was 36.2% (95% confidence interval [CI]: 5.6, 66.8). Male sex (adjusted odds ratio (AOR) = 2.06, 95% (CI): 1.05, 4.04), being married (AOR = 4.8, 95% CI: 1.84, 2.77) or widowed (AOR = 5.14, 95% CI: 1.23, 1.46), less frequent intake of vegetables and/or fruits [

Abstract Background Acute heart failure is the rapid onset of new or worsening symptoms and signs of heart failure. Despite the increasing burden of heart failure in developing countries like Ethiopia, there is a paucity of comprehensive data regarding the clinical characteristics, treatment patterns, and outcomes of acute heart failure, especially in the selected study area. Therefore, this study aimed to assess the clinical characteristics, treatment patterns, and outcomes of hospitalized patients with acute heart failure at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia. Methods This is a retrospective cross-sectional study of 303 acute heart failure patients who were admitted to the medical wards and intensive care unit of Yekatit 12 Hospital Medical College, Addis Ababa, central Ethiopia, from July 1, 2022, to July 1, 2023. A pretested data abstraction format was used for data extraction from electronic medical records, and SPSS version 26 was used for data analysis. Descriptive analysis was used to summarize sociodemographic data, clinical characteristics, treatment patterns, and outcomes of acute heart failure. Bivariate and multivariate logistic regression models were fitted to identify factors associated with in-hospital mortality. The odds ratio (OR) with the corresponding 95% confidence interval (CI) was calculated to show the strength of the association. Results Of the 303 patients, 51.5% were females, and the mean age was 56.7 years. The most frequent symptom and sign were dyspnea (98.7%) and peripheral edema (79%), respectively. The commonest underlying cause and precipitating factor of acute heart failure were cor pulmonale (22.8%) and pneumonia (35.3%), respectively. The commonest anti-remodeling medications prescribed on discharge were beta-blockers (47.9%), followed by mineralocorticoid receptor antagonists (42.8%) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (38.6%), and the least prescribed were sodium-glucose cotransporter 2 inhibitors (8.3%). The in-hospital mortality rate was 8.6%, and the median length of hospital stay was 9 days. Based on the multivariate logistic regression analysis, the most important predictors of in-hospital mortality were systolic blood pressure (SBP) 20 mg/dl (AOR = 5.48; 95% CI: 1.47, 20.49), and presence of dyslipidemia (AOR = 3.73, 95% CI: 1.15, 12.07). Conclusions This study has shown that systolic blood pressure (SBP) 20 mg/dL, chloride (Cl) level

Abstract Background Headache is a frequent symptom in coronavirus disease 2019 (COVID-19) patients, and idiopathic intracranial hypertension (pseudotumor cerebri) has been reported among patients who underwent lumbar puncture for persistent headaches. Case presentation A 45-year-old black man presented with dyspnea, cough, fever and headache for 05 days followed by blurring of vision associated with worsening of the headache. Physical examination was significant for tachypnea and oxygen desaturation and there were no abnormal neurologic findings. He tested positive for SARS-CoV-2 with nasopharyngeal swab PCR. His CSF opening pressure appeared high with normal CSF analysis and brain magnetic resonance imaging (MRI) revealed prominent subarachnoid space around the optic nerves and bilateral papilledema. He had significant improvement with medical therapy alone. Conclusion Idiopathic intracranial hypertension (IIH) may occur in association with SARS-CoV-2 infection and should be considered when making a differential diagnosis for headache and blurring of vision. COVID-19 may play a role in the development of intracranial hypertension, even in the absence of known risk factors. Early diagnosis and treatment of IIH has paramount importance to prevent vision loss and other morbidities.

Key Clinical Message Early detection, timely management, and exploration of alternative treatment options are crucial for patients with high‐risk pulmonary thromboembolism, particularly those with thrombus in transit. Furthermore, prophylactic measures against thromboembolic events should be highly considered for patients with predisposing conditions for venous thromboembolism, including surgical procedures. Abstract A thrombus in transit refers to a thrombus that is temporarily lodged in the right‐side chambers of the heart with a high risk of embolization to the pulmonary artery. A 75‐year‐old man presented to the emergency department with a sudden onset of retrosternal chest pain for an hour associated with shortness of breath, which developed a week after transurethral resection of the prostate was done for the indication of benign prostatic hyperplasia. The physical examination was remarkable for tachycardia, tachypnea, hypoxia, and raised jugular venous pressure. Echocardiography revealed a serpiginous echogenic density in the right atrium, protruding through the tricuspid valve and extending to the right ventricle. He was put on facemask oxygen, and he received anticoagulation with unfractionated heparin, followed by thrombolytic therapy with streptokinase. However, the patient experienced cardiac arrest during the administration of thrombolytic therapy, and he died despite all the efforts, most likely due to a massive pulmonary thromboembolism resulting from the thrombus in transit. This case report has brought attention to the rare occurrence of a thrombus in transit complicated by fatal pulmonary thromboembolism. It has also highlighted the significant mortality risk that this condition carries, even with thrombolytic therapy.

Key Clinical Message Concomitant native and prosthetic valve infective endocarditis (IE) is very rare, and both can rarely be complicated by rapidly progressive glomerulonephritis (RPGN). This diagnosis has therapeutic implications, as not all RPGN need immunosuppression therapy. Abstract Native and prosthetic valve infective endocarditis (IE) may be rarely complicated by rapidly progressive glomerulonephritis (RPGN). The diagnosis of IE as a cause of RPGN may be missed, and patients may be subjected to inappropriate immune suppressive therapy. Moreover, IE involving multi‐valves has rarely been described, and there are only few case reports of simultaneous native and prosthetic valve endocarditis. Here, we present a case of 34‐year‐old female patient who has RPGN and whose initial workup missed IE. However, further workup revealed a diagnosis of native and prosthetic valve IE and our patient, who would have been subjected to inappropriate immune suppressive therapy, was treated with intravenous antibiotics alone and discharged with improvement.

Abstract Introduction There could be misdiagnosis of coronavirus disease 2019 for malaria and vice versa because of their similar presentations, particularly when clinicians rely mainly on symptoms for diagnosis. Coinfection with coronavirus disease 2019 and malaria is associated with increased all-cause in-hospital mortality compared with isolated infection with severe acute respiratory syndrome coronavirus 2. Presentation with pleural effusion adds another challenge in the diagnosis of coronavirus disease 2019. Case presentation This is a 57-year-old black Ethiopian woman who presented with symptoms of acute febrile illness associated with shortness of breath and coughing. Physical examination was remarkable for fever, hypotension, tachycardia, tachypnea, oxygen desaturation, decreased air entry, and dullness over bilateral lower one-third of the chest. Peripheral blood smear revealed ring-form trophozoites of Plasmodium falciparum; chest X-ray showed bilateral pleural effusion and chest computed tomography revealed bilateral ground-glass opacities and consolidations involving all lung zones with bilateral moderate pleural effusion. She was managed with supportive treatments, antimalarial agents, and antibiotics. Rapid antigen test for severe acute respiratory syndrome coronavirus 2 was negative at the time of her presentation to the emergency department, but polymerase chain reaction testing for coronavirus disease 2019 turned out to be positive after admission to the medical ward. Conclusion Clinicians should be aware of the possibility of coronavirus disease 2019 and malaria coinfection in any patient who is from malaria-endemic area and presenting with acute febrile illness symptoms such as fever and headache and respiratory complaints like shortness of breath and cough. Alhough viral etiologies such as coronavirus disease 2019 are rare causes of bilateral pleural effusion, they should be considered after ruling out other common causes.

Key Clinical Message Low threshold is required to suspect complications of Plasmodium vivax malaria. Pulmonary thromboembolism, though rare, should be considered as its complication in the presence of unexplained and sudden onset shortness of breath. Abstract The hypercoagulable complications of malaria typically manifest in the microvasculature. However, there are several cases of intracranial venous thrombosis caused by Plasmodium falciparum and Plasmodium vivax malaria, and there was one case report of pulmonary thromboembolism (PTE) due to P. falciparum. A 30‐year‐old Ethiopian male patient presented with sudden onset of shortness of breath for 3 days. He had also high‐grade fever, chills, and rigors associated with loss of appetite and fatigue of similar duration. He was from malaria endemic area. He had a pulse rate of 108 beats per minutes, respiratory rate of 32 breaths per minute, oxygen saturation of 82% with atmospheric air and temperature of 38.9°C. Further examination revealed accentuation of pulmonary component of second heart sound. Complete blood count revealed mild anemia and peripheral blood film showed trophozoites of P. vivax. Pulmonary CT angiography showed filling defects in the right and left pulmonary arteries. The patient was diagnosed to have P. vivax malaria complicated by PTE. He was managed with intranasal oxygen, antimalarial agent, and anticoagulation. Upon serial evaluations on the third week and second month of follow up, he did not have complaints and physical examination was non‐remarkable. Malaria is a protozoan disease with high mortality and morbidity. For a long time, severe cases of malaria were thought to be mostly caused by P. falciparum. However, recent evidences have shown a paradigm shift and we should remember that P. vivax can also cause severe malaria and this can be complicated by hypercoagulable conditions including PTE.

Key Clinical Messages The diagnosis of polyserositis due to tuberculosis (TB) is complex and challenging, which may cause delays in treatment. TB should be ruled out first before attributing polyserositis to any other cause like hypothyroidism, particularly in high TB burden countries. Abstract Polyserositis has numerous causes and frequently occurs in neoplasia, autoimmune disorders, endocrine conditions like hypothyroidism, and infectious diseases like tuberculosis (TB). The diagnosis of TB polyserositis is complex and challenging, which may cause the start of definitive therapy to be delayed. Here, we report the case of a 32‐year‐old female patient who presented with abdominal distension for 3 weeks associated with shortness of breath, cough, excessive fatigue, and loss of appetite. Thyroid function tests were suggestive of primary hypothyroidism, and later on, sputum GeneXpert MTB/RIF test turned out to be positive. She was initially started on oral levothyroxine and then anti‐TB medications. The polyserositis resolved a month after the initiation of anti‐TB drugs. TB should be ruled out first before attributing polyserositis to any other cause like hypothyroidism, particularly in high TB burden countries. Microbiologic tests, such as GeneXpert, remain the most important tools to make a diagnosis of TB and start anti‐TB medications early.

Key Clinical Messages Hereditary hemorrhagic telangiectasia (HHT), a rare hereditary disorder, can cause recurrent massive epistaxis and gastrointestinal bleeding leading to severe anemia. Early diagnosis of HHT is essential to provide timely interventional therapies. Abstract HHT is a rare autosomal dominant hereditary disease that results in abnormal vasculogenesis in the skin, mucous membranes, and visceral organs such as the liver, lungs, and brain. Clinical diagnosis of HHT is made using the Curacao criteria, which include recurrent spontaneous nosebleeds, mucocutaneous telangiectasias, visceral organ involvement, and first‐degree family history of HHT. Here, we report a patient with HHT from Ethiopia, who presented with recurrent epistaxis and gastrointestinal bleeding, and severe anemia requiring frequent blood transfusions as well as cauterization. The presented case is a 42‐year‐old Black Ethiopian man with frequent hospitalization for severe anemia and high‐output heart failure requiring frequent blood transfusions. His mother had bilateral epistaxis since her early adulthood. Physical examination was significant for tachycardia, pale conjunctivae, and tiny erythematous lesions over his tongue, ejection systolic murmur and peripheral edema. Laboratory investigations revealed severe anemia with iron deficiency picture. Upper gastrointestinal endoscopy showed multiple telangiectasia spots and abdominal Doppler ultrasound showed hepatic arterio‐venous malformations. He received supportive management and electrocauterization of nasal, gastric, and duodenal telangiectasias. To the best of our knowledge, this is the first case of HHT to be reported from Ethiopia. High degree of suspicion and early diagnosis of HHT is essential to start preventive screening and surveillance and provide timely interventional therapies. HHT can cause recurrent massive epistaxis and gastrointestinal bleeding leading to severe anemia and high‐output heart failure. In resource limited settings, selective cauterization of telangiectasia will help to control bleeding, although it does not avoid recurrent bleeding.