Dairy farmer's perception on feeding, conservation, and constraints of brewery by-products utilization in selected districts of Ethiopia.

A survey was conducted in Ada'a, Sululta, and Debre Birhan districts. The districts are located in the vicinity of brewery factories. A semi-structured questionnaire was used to collect data from purposively selected dairy farmers (160). Data were analyzed with a statistical package for social sciences (Version 21). The majority of farmers (69.4%) used wet brewery-spent grain (WBSG), whereas 30% of them used both WBSG and wet brewery spent yeast (WBSY). Farmers obtained WBSG and WBSY only in fresh form from the distributors. The majority of farmers (66.67%) blended WBSG and WBSY with concentrate and roughage feed before feeding it to their animals, while 14.47% fed the by-products alone to their animals. Several farmers (60.1%) responded that the key reason for providing WBSG and WBSY to their livestock was higher production (increased milk and growth rates). The majority (82.78%) of farmers used common salt to extend the shelf life of WBSG and WBSY. Out of 128 (80%) farmers who reported spoilage in WBSG, 49 (38.28%) farmers observed sever mold development, while the remaining 12 (9.38%) and 28 (21.88%) saw change in colour and unpleasant odor. According to 68 (53.13%) of the farmers who experienced in WBSG spoiling, the amount of spoilt was less than 9% and 10-20% of the total purchased. The majority of farmers (87.8%) reported that storage time and storage conditions (temperature, moisture, and humidity) were the primary reasons of WBSG spoilage, whereas 12.2% of the farmers reported that inadequate sanitation of feeding troughs, transportation, and storage facilities were the primary causes of spoilage. The key restrictions of brewery by-product utilization were found as scarcity and high purchasing costs. Farmers (44.38% and 41.86%) believed that feeding WBSG and WBSY to dairy cattle have negative health effect, respectively. In conclusion, insufficient and irregular supply, rising cost of material and transport, spoilage, and health-related hazards are the main constraints of WBSG and WBSY usage. It is suggested that there is a dire need for consistent supply, staying away from the brokers, and preserving the brewery by-products through sun drying, and ensiling. Additionally, more research is required to determine the negative health impact of feeding brewer by-products for dairy cattle.

Modified Gundersen Flap Using Inferior Palpebral-Bulbar Conjunctiva.

PURPOSE: The purpose of this article was to describe a modification to the traditional Gundersen flap technique that expands eligible eyes to include those with severe conjunctival scarring and to report results from a clinical case. METHODS: A 68-year-old woman with a history of herpes simplex keratitis, multiple failed penetrating keratoplasties, lagophthalmos, persistent epithelial defect, and low visual potential in the left eye presented for the evaluation of a Gundersen flap. Severe superior bulbar conjunctival scarring precluded a traditional approach. A modified Gundersen flap technique using a contiguous flap of inferior palpebral-bulbar conjunctiva extending from the inferior tarsal border to the limbus was devised and performed. RESULTS: The modified Gundersen flap technique successfully stabilized the ocular surface, obviating the need for a cosmetically disfiguring permanent tarsorrhaphy or an evisceration. CONCLUSIONS: This modified Gundersen flap technique expands the indications to eyes with severe conjunctival scarring and can be offered in eyes with previous trabeculectomies, glaucoma drainage implants, and scleral buckles, which were previously excluded from the globe-preserving option.

Clinical outcomes of pediatric macular edema associated with non-infectious uveitis.

BACKGROUND: Macular edema (ME) is the most frequent cause of irreversible visual impairment in patients with uveitis. To date, little data exists about the clinical course of ME in pediatric patients. A retrospective, observational study was performed to examine the visual and macular thickness outcomes of ME associated with chronic, noninfectious uveitis in pediatric patients. METHODS: Pediatric patients with noninfectious uveitis complicated by ME seen in the University of California San Francisco Health System from 2012 to 2018 were identified using ICD-9 and ICD-10 codes. Data were collected from medical records including demographics, diagnoses, ocular history, OCT imaging findings, complications, and treatments at first encounter and at 3, 6, 9, and 12-month follow-up visits. Cox proportional hazards regression was used to investigate the association between different classes of treatment (steroid drops, steroid injections, oral steroids and other immunosuppressive therapies) and resolution of macular edema. RESULTS: The cohort comprised of 21 children (26 eyes) with a mean age of 10.5 years (SD 3.3). Undifferentiated uveitis was the most common diagnosis, affecting 19 eyes (73.1%). The majority of observed macular edema was unilateral (16 patients, 76.2%) and 5 patients had bilateral macular edema. The mean duration of follow-up at UCSF was 35.3 months (SD 25.7). By 12 months, 18 eyes (69.2%) had achieved resolution of ME. The median time to resolution was 3 months (IQR 3-6 months). Median best-corrected visual acuity (BCVA) at baseline was 0.54 logMAR (Snellen 20/69, IQR 20/40 to 20/200). Median BCVA at 12 months was 0.1 logMAR (Snellen 20/25, IQR 20/20 to 20/50) Corticosteroid injections were associated with a 4.0-fold higher rate of macular edema resolution (95% CI 1.3-12.2, P = 0.01). CONCLUSIONS: Although only 15% of the pediatric patients with uveitis in the study cohort had ME, it is clinically important to conduct OCTs to detect ME in this population. Treatment resulted in 69% of eyes achieving resolution of ME by 12 months, accompanied with improvement in visual acuity. Corticosteroid injections were significantly associated with resolution of macular edema.

Bilateral optic disc pits in a pediatric patient with Cobb syndrome.

PURPOSE: To describe a patient with Cobb Syndrome, a rare congenital disorder characterized by cutaneous and spinal arteriovenous malformations, who was found to have bilateral optic nerve pits. OBSERVATIONS: A 15-year-old boy diagnosed with Cobb Syndrome, manifesting as a large cutaneous port-wine stain associated with an underlying left paraspinous arteriovenous malformation resulting in severe scoliosis, presented for a screening ophthalmological exam. The patient had no visual symptoms. On examination, his visual acuity was 20/20 in each eye; however, bilateral optic disc pits were discovered on biomicroscopy and confirmed by spectral-domain optical coherence tomography. CONCLUSION AND IMPORTANCE: The unusual finding of bilateral optic disc pits in this rare congenital neurocutaneous disorder represents the first report of ophthalmic abnormalities in association with Cobb syndrome. Patients with Cobb Syndrome may be considered for screening ophthalmological exam for the detection of subclinical optic nerve abnormalities.