Multiple system atrophy-cerebellar type: Diagnostic challenge in resource-limited settings case report.

Key Clinical Message: This case report highlights the challenges of diagnosing MSA-C in resource-limited settings. MRI findings like the "hot cross bun" sign can be supportive, but the unavailability of advanced tools like seed amplification assay may delay diagnosis. Early diagnosis is crucial for proper symptom management. Abstract: Multiple system atrophy is a rare neurodegenerative disorder affecting the pyramidal, autonomic, nigrostriatal, and cerebellar tracts. Multisystem atrophy should be considered in adults with progressive motor or autonomic dysfunctions. Clinical manifestations vary depending on the system, including bradykinesia, tremor, rigidity, cerebellar ataxia, and autonomic failure. Depending on the initial predominant manifestation, multisystem atrophy is classified as Parkinsonian (MSA-P) and cerebellar (MSA-C). Our patient presented with progressive loss of balance, rigidity, slurred speech, choking episodes, and loss of morning tumescence for 4 years, suggesting autonomic and cerebellar involvement. He was diagnosed with MSA after 4 years of initial presentation with combinations of magnetic resonant imaging findings and clinical manifestations. Diagnosing multiple system atrophy in such resource-limited areas is challenging. The unavailability of seed application tests and biomarkers significantly affected the delayed diagnosis.

Uncontrolled hypertension in Ethiopia: a systematic review and meta-analysis of institution-based observational studies.

BACKGROUND: Uncontrolled hypertension is one of the major risk factors of cardiovascular and cerebrovascular diseases. The prevalence of hypertension in Ethiopia is expected to reach up to 30%. The aim of this study was to determine the prevalence of uncontrolled hypertension among hypertensive patients on treatment in Ethiopia. METHODS: Electronic databases and search engines including EMBASE (Ovid), PubMed/Medline, and Google Scholar were searched for original records in the English language addressing hypertension control in Ethiopia from 2000 to 2018. Data were extracted using a format prepared in Microsoft Excel and exported to STATA 15.0 software for analyses. The study protocol is registered at PROSPERO with reference number ID: CRD42018116336. RESULTS: A total of 13 studies with 5226 hypertension patients were included for systematic review and meta-analysis. The pooled prevalence of uncontrolled hypertension in Ethiopia was 48% (95% confidence interval (CI): 36, 61%). The result of the sub-group analysis, based on the year of publications, revealed that the prevalence of uncontrolled BP was highest in 2016 (63%; CI: 60, 67%) and in 2015 (59%; CI: 53, 65%). Univariate meta-regression revealed that sampling distribution was not a source of heterogeneity for the pooled estimate as well as the sub group analysis. CONCLUSION: The prevalence of uncontrolled hypertension was high in Ethiopia. This alarming public health issue fuels the ever-increasing cardiovascular and cerebrovascular diseases. The ministry of health has to design a policy and implementation mechanisms to reduce uncontrolled hypertension prevalence and improve awareness on blood pressure control.

Evaluation of rational drug use based on World Health Organization core drug use indicators in selected public hospitals of eastern Ethiopia: a cross sectional study.

BACKGROUND: Despite the complexity of drug use, a number of indicators have been developed, standardized and evaluated by the World Health Organization (WHO). These indicators are grouped in to three categories namely: prescribing indicators, patient care indicators and facility indicators. The study was aimed to evaluate rational drug use based on WHO-core drug use indicators in Dilchora referral hospital, Dire Dawa; Hiwot Fana specialized university hospital, Harar and Karamara general hospital, Jigjiga, eastern Ethiopia. METHODS: Hospital based quantitative cross sectional study design was employed to evaluate rational drug use based on WHO core drug use indicators in selected hospitals. Systematic random sampling for prescribing indicators and convenient sampling for patient care indicators was employed. Taking WHO recommendations in to account, a total of 1,500 prescription papers (500 from each hospitals) were investigated. In each hospital, 200 outpatient attendants and 30 key essential drugs were also selected using the WHO recommendation. Data were collected using retrospective and prospective structured observational check list. Data were entered to EPI Data Version 3.1, exported and analyzed using SPSS version 16.0. Besides, the data were evaluated as per the WHO guidelines. Statistical significance was determined by one way analysis of variance (ANOVA) for some variables. P-value of less than 0.05 was considered statistically significant. Finally, tabular presentation was used to present the data. RESULTS: Mean, 2.34 (±1.08) drugs were prescribed in the selected hospitals. Prescriptions containing antibiotics and that of injectables were 57.87 and 10.9% respectively. The average consultation and dispensing time were 276.5 s and 61.12 s respectively. Besides, 75.77% of the prescribed drugs were actually dispensed. Only 3.3% of prescriptions were adequately labeled and 75.7% patients know about the dosage of the prescription. Not more than, 20(66.7%) key drugs were available in stock while only 19(63.3%) of key drugs had adequate labeling. On average, selected key drugs were out of stock for 30 days per year. All of the hospitals included in the study used the national drug list, formulary and standard treatment guidelines but none of them had their own drug list or guideline. CONCLUSION: Majority of WHO stated core drug use indicators were not met by the three hospitals included in the study.

The health performance of imported Boer goat (Capra hircus) and their crosses with Woito-guji goat breeds in South Omo Zone, South-Western Ethiopia.

Goat production in Ethiopia is constrained by various bottlenecks and low genetic performance of local breeds is among them. Southern Agricultural Research Institute had introduced Boer goats, for crossing, evaluate and distribute to users. This research was conducted to assess the survivability and productive and reproductive performance of Boers and its crosses, on animals managed in on-station, Jinka Research Center and Key-afer Goat Research Station from January 2011 to March 2014. The diseases affecting the imported flock were heart water, pyogenic infections/caseous lymphadenitis, and wart/orf diseases with crude mortality rate of 47.6% and case fatality rates of 40.7, 2.4, and 4.7%, respectively. Heart water was responsible for 85% of the overall deaths. The twining percentage of Boer goats was found to be 36.3%, which was by far superior to that of Woito-guji breeds. The mortality rate in 50% crosses was found to be 35.2%; 54.5 and 20.6% in Jinka and Key-afer, respectively. The survival rate of 50% cross kids was found to be associated with birth weight and location. The average birth weight and 1 month weight of 75% crosses was found to be 3.25 ± 0.43 and 7.12 ± 1.57 kg, respectively. The 75% crosses survival rate up to weaning was found to be 100%. Despite improvement in productive and reproductive performance through increased exotic blood level, the survivability was strangely questioned for pure and higher blood levels in South Omo Zone. Pure Boer and 75% crosses could better adapt and perform in intensive and semi-intensive production systems. Small holder and pastoral livestock production systems, like South Omo Zone area, should focus on managing 50 % cross sires and rearing 25% crosses for market.

Mapping of major diseases and devising prevention and control regimen to common diseases in cattle and shoats in Dassenech district of South Omo Zone, South-Western Ethiopia.

Livestock production system, particularly in pastoral areas, is mainly constrained by rampant livestock diseases and seasonal feed and water shortages. In areas like Dassenech, bordering Kenya and South Sudan, this risks are pronounced due to the unavailability of appropriate prevention and control. The research was conducted with the objectives of identifying major rampant diseases and designing appropriate prevention and control strategies. A cross-sectional study was employed, conducted using both participatory epidemiology and conventional veterinary investigation. Spatial and temporal occurrence of diseases was assessed. The major five diseases in bovine were contagious bovine pleuro pneumonia (CBPP), septicemic pasteurellosis, anthrax, foot and mouth disease (FMD), and black leg, in that order of importance. Similarly, in ovine, "unknown recent disease," pneumonic pasteurellosis, brucellosis, peste des petits ruminants (PPR), and septicemic pasteurellosis were ranked, starting from the most important whereas in caprine PPR, contagious caprine pleuro pneumonia (CCPP), goat pox, brucellosis, and pneumonic pasteurellosis were ranked in that order of importance. The seroprevalence in bovine were found to be 97, 10, 18, and 15% for septicemic pasteurelosis, CBPP, FMD, and brucellosis, respectively. The seroprevalence of septicemic pasteurelosis, PPR, and brucellosis was 86, 49, and 3%, respectively, in ovine. The seroprevalence of caprine sera for CCPP, PPR, and brucellosis were 87, 42, and 0%, respectively. The prevention and control regimen, vaccination against CBPP, should be at the beginning of wet season, whereas, for FMD, it should be at the end of wet season in bovine. Brucellosis for bovine, if has to be applied, should be at the beginning of dry season. PPR vaccination for ovine should be at the beginning of wet season whereas, for caprine, it should be just before start of dry season. Furthermore, the efficacy of aforementioned vaccines and its protocol should be verified in local context. In conclusion, this finding is an alarm and requires preparation and implementation of appropriate disease prevention and control strategy in collaborated approach. Further studies have to be conducted, with particular emphasis in determining the epidemiology, and prevention and control options of FMD and brucellosis.