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Blunt trauma is a common cause of renal injuries, usually managed conservatively unless there's hemodynamic instability, which warrants surgery. We present a case of a 22-year-old male with isolated Grade 5 renal injury, diagnosed via CT scan after blunt trauma. Despite the severity, he was successfully treated without surgery through conservative management in the ICU, with frequent monitoring and stabilization of his condition. While the best approach for hemodynamically stable Grade 5 renal injuries remains debated, our case suggests that conservative management is a viable option when patients are carefully monitored for any signs of instability.

This study investigates the perceived impact of rainfall frequency, defined as the number of rainfall events on food security in the Qulujed district, Awdal, Somalialand. Rainfall variability poses significant challenges to rain-fed agriculture, which is the primary livelihood in the region. The study employs simple linear regression analyses to examine relationships between rainfall frequency and key food security indicators including crop yield, food quality, prices, variety, crop failure rates, and fodder yield. The findings reveal a robust positive relationship between increased rainfall frequency and enhanced food security outcomes. Specifically, higher rainfall frequency correlates statistically significantly with increased crop yields (β = 0.892, p < .01), improved food quality (β = 0.777, p < .01), stable food prices (β = 1.003, p < .01), greater food variety (β = 0.831, p < .01), reduced crop failures (β = 0.881, p < .01), and increased fodder yield (β = 0.942, p < .01). These relationships underscore the critical role of consistent rainfall patterns in sustaining agricultural productivity and market stability. The study concludes that maintaining reliable rainfall patterns is crucial for mitigating agricultural risks and promoting food security in rain-fed farms like the Qulujed district. Effective climate adaptation and water management strategies are essential to ensure sustainable agricultural production and resilience against climate variability. Understanding the impact of rainfall frequency on food security variables is imperative for achieving long-term development goals and supporting global efforts to combat food insecurity amid environmental change.

Introduction: Situs inversus totalis (SIT), a rare congenital disorder, involves complete reversal of the heart's position and mirrored arrangement of visceral organs. Early diagnosis is crucial for managing complications like transposition of the great vessels and Kartagener syndrome, marked by bronchiectasis and sinusitis due to ciliary dysfunction. Case presentation: A 52-year-old male with diabetes mellitus presented with large amounts of watery diarrhea, vomiting, dizziness, and palpitations. He managed his diabetes with 70 units of insulin daily and had a history of chronic obstructive pulmonary disease. Physical examination revealed hypotension, tachycardia, and a right-sided apex beat. Investigations, including chest X-ray, ultrasound, and ECG, confirmed dextrocardia with situs inversus and hypovolemic shock secondary to acute gastroenteritis. The patient responded well to treatment and was discharged on the second day, continuing diabetic management. Discussion: SIT is a genetically determined anomaly with an incidence ranging from 1:35 000 to 1:1400, averaging 1:10 000, with a higher prevalence in males. Many patients are asymptomatic, with the condition often detected incidentally. Diagnostic imaging techniques, including chest radiography, CT scans, MRI, and ultrasonography, are crucial in confirming SIT. ECG findings, such as right-axis deviation and reversed QRS complexes, are valuable in diagnosing dextrocardia. Patient education is essential to empower individuals with SIT to navigate their healthcare, prevent complications, and reduce anxiety. Conclusion: SIT poses diagnostic challenges due to its incidental discovery. Accurate diagnosis relies on thorough imaging and clinical evaluation. Patient education is vital for informed care and anxiety reduction. Case reviews underscore the importance of healthcare providers' readiness to diagnose SIT effectively despite unrelated symptoms. Resumen: Introducción: Situs inversus totalis, un trastorno congénito raro, implica la inversión completa de la posición del corazón y la disposición en espejo de los órganos viscerales. El diagnóstico temprano es crucial para manejar complicaciones como la transposición de los grandes vasos y el síndrome de Kartagener, caracterizado por bronquiectasias y sinusitis debido a la disfunción ciliar. Presentación del Caso: Un hombre de 52 años con diabetes mellitus presentó grandes cantidades de diarrea acuosa, vómitos, mareos y palpitaciones. Controlaba su diabetes con 70 unidades de insulina diarias y tenía antecedentes de EPOC. El examen físico reveló hipotensión, taquicardia y un latido apical en el lado derecho. Las investigaciones, incluyendo radiografía de tórax, ecografía y ECG, confirmaron dextrocardia con situs inversus y choque hipovolémico secundario a gastroenteritis aguda (AGE). El paciente respondió bien al tratamiento y fue dado de alta al segundo día, continuando con el manejo de la diabetes. Discusión: SIT es una anomalía determinada genéticamente con una incidencia que varía de 1:35,000 a 1:1400, promediando 1:10,000, con una mayor prevalencia en hombres. Muchos pacientes son asintomáticos, con la condición a menudo detectada incidentalmente. Las técnicas de diagnóstico por imagen, incluyendo radiografía de tórax, tomografías computarizadas, resonancia magnética y ultrasonografía, son cruciales para confirmar SIT. Los hallazgos del ECG, como la desviación del eje derecho y los complejos QRS invertidos, son valiosos para diagnosticar la dextrocardia. La educación del paciente es esencial para empoderar a las personas con SIT a navegar su atención médica, prevenir complicaciones y reducir la ansiedad. Conclusión: Situs inversus totalis (SIT) presenta desafíos diagnósticos debido a su descubrimiento incidental. Un diagnóstico preciso depende de una evaluación clínica e imagenológica exhaustiva. La educación del paciente es vital para una atención informada y la reducción de la ansiedad. Las revisiones de casos subrayan la importancia de que los proveedores de atención médica estén preparados para diagnosticar SIT de manera efectiva a pesar de los síntomas no relacionados.

Background: Brugada syndrome (BrS) is a rare, inherited cardiac disorder characterized by distinctive electrocardiographic (ECG) findings, including right bundle branch block and ST-segment elevations in leads V1–V3. It poses significant risks such as ventricular arrhythmias, syncope, and sudden cardiac arrest, with many cases incidentally detected. Chest pain is present in approximately 17% of cases, presenting diagnostic challenges. Case presentation: This report presents a case of BrS in a patient with ischemic heart disease and discusses the management challenges in resource-limited settings. A 58-year-old Somali man presented with sudden-onset chest pain and associated symptoms. His history included ischemic heart disease and an appendectomy. Examination revealed restlessness and diaphoresis, with normal vital signs. Investigations showed normal troponin levels and an ECG indicating ST elevation in lead V1. Managed with acute coronary syndrome (ACS), he was referred for angiography, revealing mild coronary artery disease and normal ventricular function. Follow-up indicated recurrent headaches and financial constraints limited implantable cardioverter–defibrillator (ICD) placement. BrS is associated with an increased risk of ventricular arrhythmias. Discussion and conclusion: Diagnostic challenges include distinguishing it from ACS due to overlapping ECG patterns. Management options are limited, with ICD insertion and quinidine being primary modalities. Resource limitations, such as the lack of ICD services, complicate management. Ongoing debate surrounds the efficacy and safety of beta-blocker therapy. BrS presents diagnostic and therapeutic challenges, emphasizing the need for comprehensive management approaches. Tailored strategies are essential, particularly in resource-limited settings, necessitating further research to optimize patient outcomes. Resumen: Antecedentes: El síndrome de Brugada (BrS) es un trastorno cardíaco hereditario raro, caracterizado por hallazgos electrocardiográficos distintivos, que incluyen bloqueo de rama derecha y elevaciones del segmento ST en las derivaciones V1-V3. Plantea riesgos significativos como arritmias ventriculares, síncope y paro cardíaco súbito, con muchos casos detectados incidentalmente. El dolor torácico está presente en aproximadamente el 17% de los casos, lo que presenta desafíos diagnósticos. Presentación del caso: Este informe presenta un caso de BrS en un paciente con enfermedad cardíaca isquémica y discute los desafíos de manejo en entornos con recursos limitados. Un hombre somalí de 58 años se presentó con dolor torácico de inicio súbito y síntomas asociados. Su historial incluía enfermedad cardíaca isquémica y una apendicectomía. El examen reveló inquietud y diaforesis, con signos vitales normales. Las investigaciones mostraron niveles normales de troponina y un ECG que indicaba elevación del ST en la derivación V1. Manejado como síndrome coronario agudo (SCA), fue referido para angiografía, revelando una enfermedad coronaria leve y una función ventricular normal. El seguimiento indicó dolores de cabeza recurrentes y limitaciones financieras que impedían la colocación de un DAI. El BrS está asociado con un mayor riesgo de arritmias ventriculares. Discusión y conclusión: Los desafíos diagnósticos incluyen distinguirlo del SCA debido a patrones de ECG superpuestos. Las opciones de manejo son limitadas, siendo la inserción de DAI y la quinidina las modalidades principales. Las limitaciones de recursos, como la falta de servicios de DAI, complican el manejo. Existe un debate en curso sobre la eficacia y seguridad de la terapia con betabloqueadores. El BrS presenta desafíos diagnósticos y terapéuticos, enfatizando la necesidad de enfoques de manejo integral. Las estrategias personalizadas son esenciales, particularmente en entornos con recursos limitados, lo que requiere más investigación para optimizar los resultados de los pacientes.

The biological diversity of the Horn of Africa is one of the least studied in the world. Yet the Horn supports rich communities of species that are mostly endemic to the region. Here we study the diversity of Sand Snakes (Psammophis) in East Africa, their phylogeny and systematics. Previous studies have unveiled several cryptic and potentially undescribed species of Psammophis that occur in the Horn and their taxonomic status has remained unclear to this day. We used sequence data from two mitochondrial and one nuclear genes to reconstruct the phylogeny of the genus, in which we included newly obtained samples of six different Psammophis species from Somalia, Ethiopia, Eritrea, Sudan, and Egypt. Our aim was to assess the status of some of the undescribed species, examine the level of intraspecific genetic variation within individual species, improve our understanding of the species distributions, and contribute to the taxonomy of the genus. Our results confirm the existence of two undescribed species, one in eastern Somalia, which we formally describe as new, and one in southern Ethiopia that we refer to as Psammophis cf. sudanensis in accordance with previous studies. Further, we provide first genetic data for the nominotypical subspecies of P. punctulatus and confirm the species status for its subspecies P. trivirgatus. In addition, we provide new genetic data for P. tanganicus from Ethiopia and Somalia, and range extension records for P. rukwae from Eritrea and Ethiopia and for P. aegyptius from Somalia. Our findings contribute considerably to our understanding of the diversity and distribution of Psammophis in East Africa.

Snakes are known as highly fear-evoking animals, eliciting preferential attention and fast detection in humans. We examined the human fear response to snakes in the context of both current and evolutionary experiences, conducting our research in the cradle of humankind, the Horn of Africa. This region is characterized by the frequent occurrence of various snake species, including deadly venomous viperids (adders) and elapids (cobras and mambas). We conducted experiments in Somaliland and compared the results with data from Czech respondents to address the still unresolved questions: To which extent is human fear of snakes affected by evolutionary or current experience and local culture? Can people of both nationalities recognize venomous snakes as a category, or are they only afraid of certain species that are most dangerous in a given area? Are respondents of both nationalities equally afraid of deadly snakes from both families (Viperidae, Elapidae)? We employed a well-established picture-sorting approach, consisting of 48 snake species belonging to four distinct groups. Our results revealed significant agreement among Somali as well as Czech respondents. We found a highly significant effect of the stimulus on perceived fear in both populations. Vipers appeared to be the most salient stimuli in both populations, as they occupied the highest positions according to the reported level of subjectively perceived fear. The position of vipers strongly contrasts with the fear ranking of deadly venomous elapids, which were in lower positions. Fear scores of vipers were significantly higher in both populations, and their best predictor was the body width of the snake. The evolutionary, cultural, and cognitive aspects of this phenomenon are discussed.

High fear reaction, preferential attention, or fast detection are only a few of the specific responses which snakes evoke in humans. Previous research has shown that these responses are shared amongst several distinct cultures suggesting the evolutionary origin of the response. However, populations from sub-Saharan Africa have been largely missing in experimental research focused on this issue. In this paper, we focus on the effect of snake threat display on human spontaneous attention. We performed an eye-tracking experiment with participants from Somaliland and the Czechia and investigated whether human attention is swayed towards snakes in a threatening posture. Seventy-one Somalis and 71 Czechs were tested; the samples were matched for gender and comparable in age structure and education level. We also investigated the effect of snake morphotype as snakes differ in their threat display. We found that snakes in a threatening posture were indeed gazed upon more than snakes in a relaxed (non-threatening) posture. Further, we found a large effect of snake morphotype as this was especially prominent in cobras, less in vipers, and mostly non-significant in other morphotypes. Finally, despite highly different cultural and environmental backgrounds, the overall pattern of reaction towards snakes was similar in Somalis and Czechs supporting the evolutionary origin of the phenomenon. We concluded that human attention is preferentially directed towards snakes, especially cobras and vipers, in threatening postures.

Introduction: A tumor refers to an abnormal mass of cells in the body, which can be either benign or malignant. Among cancers, breast cancer is the most frequently diagnosed in females, followed by lung cancer and prostate cancer. Sarcomas, comprising over 70 different subtypes, represent approximately 1% of all cancers. Case presentation: A 21-year-old from Borama, Somaliland/Somalia, presented with a 5-day fever, along with other symptoms. Past surgical history revealed a thyroid lesion diagnosed as round cell sarcoma. Imaging showed thyroid carcinoma with metastases. Discussion: The rising cancer incidence in sub-Saharan Africa is attributed to factors like increased life expectancy and lifestyle changes. Challenges in rare cancer cases include late-stage diagnosis and limited treatment options. Efforts to persuade the patient for treatment are ongoing. Conclusion: Improvements in healthcare infrastructure, access to imaging, and pathology services, along with cultural sensitivity, are crucial in managing rare cancers like round cell sarcoma in sub-Saharan Africa. Resumen: Introducción: Un tumor se refiere a una masa anormal de células en el cuerpo, que puede ser benigna o maligna. Entre los cánceres, el cáncer de mama es el más frecuentemente diagnosticado en mujeres, seguido por el cáncer de pulmón y el cáncer de próstata. Los sarcomas, que comprenden más de 70 subtipos diferentes, representan aproximadamente el 1% de todos los cánceres. Presentación del caso: Joven de 21 años de Borama, Somalilandia/Somalia, que presentó fiebre de cinco días, junto con otros síntomas. Los antecedentes quirúrgicos revelaron una lesión tiroidea diagnosticada como sarcoma de células redondas. Las imágenes mostraron carcinoma tiroideo con metástasis. Discusión: El aumento de la incidencia de cáncer en el África subsahariana se atribuye a factores como el aumento de la esperanza de vida y los cambios en el estilo de vida. Los desafíos en los casos raros de cáncer incluyen el diagnóstico en etapa tardía y las opciones de tratamiento limitadas. Los esfuerzos para persuadir al paciente para que reciba tratamiento están en curso. Conclusión: Las mejoras en la infraestructura sanitaria, el acceso a los servicios de diagnóstico por imágenes y patología, junto con la sensibilidad cultural, son cruciales en el tratamiento de cánceres raros como el sarcoma de células redondas en el África subsahariana.