Pleurisy and bilateral pleural effusions after administration of atorvastatin

Atorvastatin is a widely used cholesterol-lowering agent. Although generally safe and well tolerated, a number of drug side effects have been reported. We report only the second case of atorvastatin-induced pleural effusions, presenting as pleurisy, and the first case from Ethiopia. We believe our patient had this association based on the temporal onset of symptoms, the otherwise negative evaluation, and the resolution of findings once atorvastatin was discontinued. Clinicians need to consider this relationship when evaluating unexplained pleurisy and pleural effusions in patients taking atorvastatin

SARS-CoV-2 reinfection: Two cases from Ethiopia

Reinfection with SARS-CoV-2 has infrequently been reported in the literature and never from Ethiopia or Africa. We describe two individuals with documented recurrent COVID-19 disease admitted to Eka Kotebe Hospital, Addis Ababa, Ethiopia

COVID-19 and acute ST-elevation myocardial infarction (STEMI) and ventricular thrombus in a young ethiopian man without known cardiac risk factors: A case report

Patients with coronavirus disease 2019 (COVID-19) can present with pneumonia and acute respiratory distress syndrome but rarely with acute myocardial infarction, especially in the absence of known cardiovascular disease risk factors. We present the case of a previously healthy young Ethiopian man with COVID-19 and no known cardiovascular risk factors who was diagnosed with acute ST-elevation myocardial infarction and left ventricular thrombu

Perception of asthma control among asthmatics seen inChest Clinic at Tertiary Hospital, Addis Ababa, Ethiopia

Background Patient awareness of asthma severity is important for optimal asthma management. However, there is often a discrepancy between physician assessment of asthma control based on guidelines and patient discernment of control. We compared physician and patient perception of asthma control in a clinic population seen at a tertiary hospital in Addis Ababa, Ethiopia. Methods In this cross-sectional study, 182 consecutive patients with a physician diagnosis of asthma seen in Chest Clinic at Tikur Anbessa Specialized Hospital (TASH) between July and December 2015 were studied. Demographics, asthma symptoms, medication use in the past month, and self-perception of asthma control in the past 7 days were obtained from the clinic records. Physician assessed asthma control was based on the GINA asthma symptom control assessment tool. Lung function was measured using a Diagnostic EasyOne Plus model 2001 SN spirometer. The institutional review board approved the study protocol. Results Of the 182 subjects, 68.1% were female. The mean age was 52 ± 12 years, and the mean (SD) duration of asthma was 19.4 ± 12.7 years. Forty-four (24.2%) patients had physician determined well-controlled asthma and 138 (75.8%) patients had physician determined partly controlled/uncontrolled asthma. One hundred and fifty-one (83%) patients thought their asthma control was good. However, the degree of concordance between physician evaluation and patient perception of asthma control was low (kappa index = 0.09). On multivariate analysis, self-perceived poor asthma control was associated with any activity limitation due to asthma and inconsistent inhaled corticosteroid use. Conclusion In our study, the first of its kind in Ethiopia, a high percent of patients with physician determined well-controlled asthma has appropriate perception of their disease state. However, those patients with partly controlled/uncontrolled asthma had poor self-perception of their disease, emphasizing the need for further patient education. These conclusions may be especially useful in the care of asthmatics from other low-income countries

Letter to the Editor - Resumption of pulmonary function testing (Spirometry) at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, during the COVID-19 pandemic

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Prone ventilation in COVID-19 acute respiratory distress syndrome: Case report of two patients from Ethiopia

The COVID-19 pandemic is one of the largest health crises that the world has ever seen, infecting forty million people and killing more than 1 million to date. The disease has imposed a significant demand on health care resources due to the increased number and severely ill patients visiting facilities each day. Since there is no effective cure for COVID-19, supportive management with oxygen, steroids, anticoagulation, and prone positioning remains the major interventions. Prone ventilation is known to have a mortality benefit in intubated patients with acute respiratory distress syndrome (ARDS). However, studies on its role in intubated patients with COVID-19 ARDS (CARDS) are very scarce in resource-limited settings like Africa. We describe two patients with CARDS who were successfully treated with invasive mechanical ventilation, prone ventilation, and standard supportive care

Treaty of Fort Laramie, 1868 (Kappler)

This 1904 reprint of the Sioux Treaty of 1868, also known as the Treaty of Fort Laramie, 1868, was transcribed and published in vol. II of Charles Kappler’s Indian Affairs. Laws and Treaties. This treaty, between the United States government and the Sioux and Arapaho Nations, established the Great Sioux Reservation, promised the Sioux would own the Black Hills in perpetuity, and set aside the country north of the North Platte River and east of the summits of the Big Horn Mountains as unceded Indian territory. Furthermore, the U.S. government pledged to close the Bozeman Trail forts and provide food, clothing, and annuities to the tribes, given that they agreed to relinquish all rights to live outside the reservation.https://commons.und.edu/indigenous-gov-docs/1176/thumbnail.jp

Awake prone positioning for COVID-19 patients at Eka Kotebe General Hospital, Addis Ababa, Ethiopia: A prospective cohort study

Objectives: The objectives of the study were to evaluate the benefit of awake prone positioning in COVID-19 patients hospitalized at Eka Kotebe General Hospital, Addis Ababa, Ethiopia.Materials and Methods: Consecutive patients with COVID-19 who require supplemental oxygen to maintain oxygen saturation of ≥90% during the month of October 2020 were enrolled. Structured questionnaires were employed to collect data. Admission oxygen saturation was recorded for each patient before and after their first proning session. Analysis of descriptive and comparison statistics was done using SPSS version 25.Results: A total of 61 patients were included in the study. The mean age (+SD) for the cohort was 55.4 (+16.9) years. The average duration of proning was 5+2.5 h/session and 8+6 h/day. The average oxygen saturation before proning was 89% (SD 5.2) and 93% (SD 2.8) 1 h after proning (P < 0.001); supplemental oxygen requirements significantly decreased with prone ventilation, before proning: FiO2 0.33 (+0.14) versus 1 h after prone ventilation: FiO2 0.31 (+0.13) (P < 0.001). Oxygen improvement with prone ventilation was not associated with duration of illness or total prone position hours. When assessed at 28 days after admission, 55.7% (n = 34) had been discharged home, 1.6% (n = 1) had died, and 42.6 (n = 26) were still hospitalized.Conclusion: Awake prone positioning demonstrated improved oxygen saturation in our oxygen requiring COVID-19 patients. Even though further studies are needed to support causality and determine the effect of proning on disease severity and mortality, early institution of prone ventilation in appropriate oxygen requiring COVID-19 patients should be encouraged

Maternal neurofascin-specific autoantibodies bind to structures of the fetal nervous system during pregnancy, but have no long term effect on development in the rat

Neurofascin was recently reported as a target for axopathic autoantibodies in patients with multiple sclerosis (MS), a response that will exacerbate axonal pathology and disease severity in an animal model of multiple sclerosis. As transplacental transfer of maternal autoantibodies can permanently damage the developing nervous system we investigated whether intrauterine exposure to this neurofascin-specific response had any detrimental effect on white matter tract development. To address this question we intravenously injected pregnant rats with either a pathogenic anti-neurofascin monoclonal antibody or an appropriate isotype control on days 15 and 18 of pregnancy, respectively, to mimic the physiological concentration of maternal antibodies in the circulation of the fetus towards the end of pregnancy. Pups were monitored daily with respect to litter size, birth weight, growth and motor development. Histological studies were performed on E20 embryos and pups sacrificed on days 2, 10, 21, 32 and 45 days post partum. Results: Immunohistochemistry for light and confocal microscopy confirmed passively transferred anti-neurofascin antibody had crossed the placenta to bind to distinct structures in the developing cortex and cerebellum. However, this did not result in any significant differences in litter size, birth weight, or general physical development between litters from control mothers or those treated with the neurofascin-specific antibody. Histological analysis also failed to identify any neuronal or white matter tract abnormalities induced by the neurofascin-specific antibody. Conclusions: We show that transplacental transfer of circulating anti-neurofascin antibodies can occur and targets specific structures in the CNS of the developing fetus. However, this did not result in any pre- or post-natal abnormalities in the offspring of the treated mothers. These results assure that even if anti-neurofascin responses are detected in pregnant women with multiple sclerosis these are unlikely to have a negative effect on their children

Progressive regression of left ventricular hypertrophy two years after bariatric surgery.

BACKGROUND: Obesity is a systemic disorder associated with an increase in left ventricular mass and premature death and disability from cardiovascular disease. Although bariatric surgery reverses many of the hormonal and hemodynamic derangements, the long-term collective effects on body composition and left ventricular mass have not been considered before. We hypothesized that the decrease in fat mass and lean mass after weight loss surgery is associated with a decrease in left ventricular mass. METHODS: Fifteen severely obese women (mean body mass index [BMI]: 46.7+/-1.7 kg/m(2)) with medically controlled hypertension underwent bariatric surgery. Left ventricular mass and plasma markers of systemic metabolism, together with body mass index (BMI), waist and hip circumferences, body composition (fat mass and lean mass), and resting energy expenditure were measured at 0, 3, 9, 12, and 24 months. RESULTS: Left ventricular mass continued to decrease linearly over the entire period of observation, while rates of weight loss, loss of lean mass, loss of fat mass, and resting energy expenditure all plateaued at 9 [corrected] months (P \u3c.001 for all). Parameters of systemic metabolism normalized by 9 months, and showed no further change at 24 months after surgery. CONCLUSIONS: Even though parameters of obesity, including BMI and body composition, plateau, the benefits of bariatric surgery on systemic metabolism and left ventricular mass are sustained. We propose that the progressive decrease of left ventricular mass after weight loss surgery is regulated by neurohumoral factors, and may contribute to improved long-term survival