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Rare Association of Plasmodium Vivax Malaria with Pulmonary Thromboembolism: A Case Report Gashaw Solela1 Merga Daba2 Zerubabel Getahun2 Yared Getachew2 Dejene Girma31Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia2Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia3Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Polyserositis Caused by Tuberculosis in a Young Female Patient with Hypothyroidism: A Diagnostic ChallengeGashaw Solela1 Ferhan Kedir1 Merga Daba21Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.2Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.Correspondence: Gashaw Solela, Department of Internal Medicine, Yekatit 12 Hospital Medical College, [email protected], +251-921562995, ORCiD ID - 0000-0002-2233-9270

IntroductionHereditary hemorrhagic telangiectasia (HHT), also referred to as the Osler-Weber-Rendu syndrome, 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 [1]. The prevalence of HHT ranges from one in every 5,000 people to one in every 8,000 people with an estimated 85,000 cases in Europe [2, 3] and the rate of diagnosis is lower in lower socioeconomic groups [4].Four important genes, including ENG (endoglin), ACVRL1 (activin receptor-like kinase 1), SMAD4 (mothers against decapentaplegic homolog 4), and GDF2 (growth differentiation factor 2), have recently been linked to the underlying mechanism of HHT [5]. Arterio-venous malformations (AVMs) are caused by mutations in these genes that interfere with the TGF-β (transforming growth factor)-beta signaling pathways in vascular endothelial cells, which impair cell division [5]. Heterozygous mutations are the common cause of the two primary kinds of HHT. Endoglin (ENG) is mutated in HHT1. Patients, especially women, with this type are more likely to develop pulmonary and cerebral AVMs. Activin A receptor-like type 1 (ACVRL1), commonly referred to as ALK1, is mutated in HHT2. Of the mutations known to cause HHT, ENG makes up around 61% and ACVRL1 makes up about 37% [7, 8].About 90% of those with the condition experience recurrent nosebleeds, which usually begin in childhood. Other symptoms include gastrointestinal bleeding (25–30%), which can cause melena and severe symptomatic microcytic anemia; pulmonary AVMs (50%) that can cause dyspnea, hemoptysis, paradoxical emboli, and cerebral abscesses; cerebral AVMs (10%) that can cause headache, seizures, and focal neurological deficits; and hepatic AVM (40–70%), which are typically asymptomatic but might show signs of high output cardiac failure and hepatic decompensation, ultimately necessitating liver transplantation [9].Clinical diagnosis of HHT is made using the Curacao criteria, which include first-degree family history of HHT, visceral involvement, recurrent spontaneous nosebleeds, and mucocutaneous telangiectasias. If three or more criteria are met, the diagnosis is considered to be conclusive; if only two criteria are met, the diagnosis is considered to be suspected HHT [10] [Table 1]. If less than two criteria are met, the diagnosis is considered to be unlikely HHT.Table 1 Curaçao diagnostic criteria for hereditary hemorrhagic telangiectasias