Acute Primary Small Bowel Volvulus in a Male With Loeys-Dietz Syndrome.

Loeys-Dietz syndrome (LDS) is a connective tissue disorder with features including, but not limited to, aortic dissections, skeletal abnormalities, and craniofacial defects. However, considering its relatively recent discovery, there are still many unknowns about LDS. The extent of a connective tissue disorder like LDS is yet to be defined throughout the various organ systems, including the gastrointestinal system. Connective tissue disorders have been found to have higher associations with certain conditions, like constipation. In a similar manner, LDS may increase the propensity for developing uncommon gastrointestinal manifestations, like primary small bowel volvulus. A volvulus is defined as an abnormal rotation of the small bowel segment along the axis of its mesentery. Primary small bowel volvulus is differentiated from secondary small bowel volvulus by its nature of origin: primary small bowel volvulus occurs as an independent spontaneous occurrence, whereas secondary small bowel volvulus is secondary to the presence of adhesions, diverticular disease, or abdominal masses. In this case report, we highlight a potential gastrointestinal manifestation of LDS with the occurrence of a primary small bowel volvulus in a young adult male diagnosed with LDS. The patient experienced acute primary small bowel volvulus 14 days into his stay, which may have been influenced by this newfound connective tissue disorder.

Disseminating clinical study results to trial participants in Ethiopia: insights and lessons learned.

International regulatory authorities and funders require that research be disseminated promptly and appropriately to all involved stakeholders. However, following completion of clinical trials participants often either do not receive any feedback or materials provided are not appropriate for the context. The investigators of a multicentre anti-malarial clinical trial (the IMPROV study) conducted a dissemination meeting at one of the study sites in Ethiopia; trial participants and medical staff were provided feedback on the study results. This report summarizes the dissemination strategies adopted by the investigators, including a plain language visual aid and simple communication techniques. Lessons learned are reported with a discussion on the operational challenges to dissemination of clinical trials in resource limited settings.

An in-vivo study of falciparum malaria sensitivity to Chloroquine in unstable malaria endemic area of central Ethiopia.

The role of Chloroquine as a first line drug to treat P. falciparum is almost universally becoming questionable. This study was conducted in one of the country's unstable malaria endemic area, North Shoa with the objective of assessing the in-vivo treatment efficacy of Chloroquine to falciparum malaria using the standard WHO 14 days treatment response monitoring guideline. A total of 427 patients were followed among which 87.8% showed treatment failure. This was more pronounced in children than in adults (Chi-square for trend = 8.16; P < 0.01). Clinical presentation with high grade fever on day 0 was found to be more predictive of treatment failure in children (OR = 2.06; 95% CI = 1.26, 3.36; P < 0.005). Tendency to remain febrile on subsequent follow up days was also more observed in children compared to adults. Treatment failure was further associated with high Parasite Density Index (PDI) on day 0 in all age groups (OR = 1.99; 95% CI = 1.04, 3.83; P < 0.05). Supplemented with large scale sensitivity studies, it is high time that switch to alternate drugs needs due consideration by policy makers.

Epidemiological pattern of leprosy in Ethiopia: a review of the control programmes.

Leprosy control started in a limited area of Ethiopia in 1956. Extended coverage of the country was achieved in the early seventies. Review of the data from the control projects since 1976 revealed that leprosy is a disease of the Ethiopian highlands where prevalence rates as high as 7 per thousand have been recorded in some provinces, while the cumulative national average for the last 13 years was 2.6 per thousand. The paucibacillary form was predominant. However, unlike other African countries, a relatively high proportion of multibacillary leprosy was found in Ethiopia. The male-to-female ratio was 2:1 with the highest prevalence in the 15-44 years age bracket. Detection rates for new cases have shown a gradual decline since 1982, a year before multiple drug therapy (MDT) was introduced into the country. For the last 5 years the number of new cases has stabilized at 4700/year. These trends probably reflect a general reduction in the prevalence of leprosy in the country, while the conspicuous decline in 1982 is most likely related to discharge of cases during screening before MDT. The new villagization policy of Ethiopia with its effective reorganization of the populations is believed to make control programmes and supervision of MDT easier and presumably more effective. Similarly, more reliable prevalence and incidence studies could be undertaken with success.