Burden and consequence of birth defects in Nepal-evidence from prospective cohort study.

BACKGROUND: Every year an estimated 7.9 million babies are born with birth defect. Of these babies, more than 3 million die and 3.2 million have disability. Improving nationwide information on prevalence of birth defect, risk factor and consequence is required for better resource allocation for prevention, management and rehabilitation. In this study, we assess the prevalence of birth defect, associated risk factors and consequences in Nepal. METHOD: This is a prospective cohort study conducted in 12 hospitals of Nepal for 18 months. All the women who delivered in the hospitals during the study period was enrolled. Independent researchers collected data on the social and demographic information using semi-structured questionnaire at the time of discharge and clinical events and birth outcome information from the clinical case note. Data were analyzed on the prevalence and type of birth defect. Logistic regression was done to assess the risk factor and consequences for birth defect. RESULTS: Among the total 87,242 livebirths, the prevalence of birth defects was found to be 5.8 per 1000 live births. The commonly occurring birth defects were anencephaly (3.95%), cleft lip (2.77%), cleft lip and palate (6.13%), clubfeet (3.95%), eye abnormalities (3.95%) and meningomyelocele (3.36%). The odds of birth defect was higher among mothers with age < 20 years (adjusted Odds ratio (aOR) 1.64; 95% CI, 1.18-2.28) and disadvantaged ethnicity (aOR 1.78; 95% CI, 1.46-2.18). The odds of birth asphyxia was twice fold higher among babies with birth defect (aOR 1.88; 95% CI, 1.41-2.51) in reference with babies without birth defect. The odds of neonatal infection was twice fold higher among babies with birth defect (aOR 1.82; 95% CI, 1.12-2.96) in reference with babies without birth defect. Babies with birth defect had three-fold risk of pre-discharge mortality (aOR 3.00; 95% CI, 1.93-4.69). CONCLUSION: Maternal age younger than 20 years and advantaged ethnicity were risk factors of birth defects. Babies with birth defect have high risk for birth asphyxia, neonatal infection and pre-discharge mortality at birth. Further evaluation on the care provided to babies who have birth defect is warranted. FUNDING: Swedish Research Council (VR).

Incidence, risk factors and consequences of preterm birth - findings from a multi-centric observational study for 14 months in Nepal.

BACKGROUND: Preterm birth is a worldwide epidemic and a leading cause of neonatal mortality. In this study, we aimed to evaluate the incidence, risk factors and consequences of preterm birth in Nepal. METHODS: This was an observational study conducted in 12 public hospitals of Nepal. All the babies born during the study period were included in the study. Babies born < 37 weeks of gestation were classified as preterm births. For the association and outcomes for preterm birth, univariate followed by multiple regression analysis was conducted. RESULTS: The incidence of preterm was found to be 93 per 1000 live births. Mothers aged less than 20 years (aOR 1.26;1.15-1.39) had a high risk for preterm birth. Similarly, education of the mother was a significant predictor for preterm birth: illiterate mothers (aOR 1.41; 1.22-1.64), literate mothers (aOR 1.21; 1.08-1.35) and mothers having basic level of education (aOR 1.17; 1.07-1.27). Socio-demographic factors such as smoking (aOR 1.13; 1.01-1.26), use of polluted fuel (aOR 1.26; 1.17-1.35) and sex of baby (aOR 1.18; 1.11-1.26); obstetric factors such as nulliparity (aOR 1.33; 1.20-1.48), multiple delivery (aOR 6.63; 5.16-8.52), severe anemia during pregnancy (aOR 3.27; 2.21-4.84), antenatal visit during second trimester (aOR 1.13; 1.05-1.22) and third trimester (aOR 1.24; 1.12-1.38), < 4 antenatal visits during pregnancy (aOR 1.49; 1.38-1.61) were found to be significant risk factors of preterm birth. Preterm has a risk for pre-discharge mortality (10.60; 9.28-12.10). CONCLUSION: In this study, we found high incidence of preterm birth. Various socio-demographic, obstetric and neonatal risk factors were associated with preterm birth. Risk factor modifications and timely interventions will help in the reduction of preterm births and associated mortalities. TRIAL REGISTRATION: ISRCTN30829654.

Motor network plasticity and low-frequency oscillations abnormalities in patients with brain gliomas: a functional MRI study.

Brain plasticity is often associated with the process of slow-growing tumor formation, which remodels neural organization and optimizes brain network function. In this study, we aimed to investigate whether motor function plasticity would display deficits in patients with slow-growing brain tumors located in or near motor areas, but who were without motor neurological deficits. We used resting-state functional magnetic resonance imaging to probe motor networks in 15 patients with histopathologically confirmed brain gliomas and 15 age-matched healthy controls. All subjects performed a motor task to help identify individual motor activity in the bilateral primary motor cortex (PMC) and supplementary motor area (SMA). Frequency-based analysis at three different frequencies was then used to investigate possible alterations in the power spectral density (PSD) of low-frequency oscillations. For each group, the average PSD was determined for each brain region and a nonparametric test was performed to determine the difference in power between the two groups. Significantly reduced inter-hemispheric functional connectivity between the left and right PMC was observed in patients compared with controls (P<0.05). We also found significantly decreased PSD in patients compared to that in controls, in all three frequency bands (low: 0.01-0.02 Hz; middle: 0.02-0.06 Hz; and high: 0.06-0.1 Hz), at three key motor regions. These findings suggest that in asymptomatic patients with brain tumors located in eloquent regions, inter-hemispheric connection may be more vulnerable. A comparison of the two approaches indicated that power spectral analysis is more sensitive than functional connectivity analysis for identifying the neurological abnormalities underlying motor function plasticity induced by slow-growing tumors.

Does diffusion tensor tractography of the corticospinal tract correctly reflect motor function?

OBJECTIVE: To investigate the consistency of diffusion tensor tractography of the corticospinal tract on motor function. CLINICAL PRESENTATIONS AND INTERVENTION: Three patients with brain tumor were admitted to our hospital with impaired motor function. Diffusion tensor imaging (DTI) and tractography were performed in these patients to assess their affected corticospinal tract. The corticospinal tract showed interruption with moderately impaired motor function in 2 patients. The third case had significantly weakened muscle strength on the left upper limb but an intact right corticospinal tract. CONCLUSION: These cases showed that the corticospinal tracts obtained by DTI with tractography were inconsistent with motor function. Hence, DTI should be interpreted with caution.

Atypical presentation of tracheobronchopathia osteochondroplastica: is chronic inflammation a perpetrator?

OBJECTIVE: To report an atypical presentation of tracheobronchopathia osteochondroplastica (TO). CLINICAL PRESENTATION AND INTERVENTION: A 59-year-old man was investigated for productive cough of 1 month. An antimycobacterial combination regime was initiated with a misdiagnosis of endobronchial tuberculosis. At follow-up, the patient reported worsening of his symptoms. CT revealed an increased intensity of the cartilage ring surrounding the trachea, and bronchoscopy showed tracheal stenosis with white, hard nodules on the airway submucosa. Histopathology confirmed the diagnosis of TO. CONCLUSION: This case showed that TO should be considered in patients with cough not explained by noninvasive testing and not responsive to empiric medications.

Differentiation of pure vasogenic edema and tumor-infiltrated edema in patients with peritumoral edema by analyzing the relationship of axial and radial diffusivities on 3.0T MRI.

OBJECT: The purpose of this study was to analyze the relationship of axial diffusivity (AD) and radial diffusivity (RD) in peritumoral edema of high grade glioma, metastasis, and meningioma, and to differentiate tumor-infiltrated edema from pure vasogenic edema. MATERIALS AND METHODS: Twenty patients with high-grade glioma and 16 with meningioma or metastatic tumor were enrolled in our study. All cases were confirmed by histopathological study. Diffusion tensor imaging (DTI) was performed in all patients. Peritumoral edema of high-grade glioma was considered tumor-infiltrated edema, and edema of meningioma or metastasis was considered pure vasogenic edema. Fractional anisotropy (FA), mean diffusivity (MD), AD, RD, regression coefficient of RD to AD (RCRD-AD), and tumor infiltration index (TII) in tumor-infiltrated edema and pure vasogenic edema were analyzed and compared. Receiver operating characteristic (ROC) curve analysis was conducted to demonstrate their differential effectiveness. RESULTS: RCRD-AD in tumor-infiltrated edema (0.724±0.125) was significantly higher than that in pure vasogenic edema (0.571±0.111) (P=0.001). FA of tumor-infiltrated edema (0.175±0.025) was significantly lower than that of pure vasogenic edema (0.203±0.035) (P=0.007). Other parameters showed no significant difference between the 2 types of edema. ROC curve analysis showed RCRD-AD was the most effective parameter in distinguishing tumor-infiltrated edema from pure vasogenic edema. Using a threshold of 0.6, a sensitivity of 0.85 and specificity of 0.69 can be achieved with RCRD-AD. CONCLUSION: Analysis of the AD and RD relationship may reflect differences in diffusion characteristics of edema surrounding high-grade glioma and meningioma or metastasis, and may be helpful in detecting peritumoral infiltration in high-grade glioma.

Accuracy of magnetic resonance imaging in grading knee chondral defects.

PURPOSE: To determine the accuracy of routine magnetic resonance imaging (MRI) in the grading of knee cartilage lesions through a meta-analysis. METHODS: A search of English-language literature published before February 2012 was carried out in PubMed. Articles using arthroscopy as a gold standard, a 6-knee region dividing method, and a 5-level grading system were included in our meta-analysis. After data extraction, a bivariate mixed-effects model and hierarchical weighted symmetric summary receiver operating curve were used to pool the results of diagnostic tests. A sensitivity analysis was conducted to explore the potential sources of heterogeneity. RESULTS: Overall, 8 studies were included in the meta-analysis. The overall sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio were 75% (95% confidence interval [CI], 62% to 84%), 94% (95% CI, 89% to 97%), 47 (95% CI, 18 to 122), 12.5 (95% CI, 6.5 to 24.2), and 0.27 (95% CI, 0.17 to 0.42), respectively. There was substantial heterogeneity among the results. Sensitivity analysis showed the inconsistency of 2 studies. However, eliminating the 2 studies had no significant impact on the overall results. CONCLUSIONS: Our results showed that MRI was effective in discriminating normal morphologic cartilage from disease but was less sensitive in detecting knee chondral lesions (higher than grade 1). The negative results of MRI should not prevent a diagnostic arthroscopy. LEVEL OF EVIDENCE: Level II, meta-analysis of Level I and II studies.

Diffusion tensor imaging and proton magnetic resonance spectroscopy in brain tumor: Correlation between structure and metabolism.

Proton magnetic resonance spectroscopy and diffusion tensor imaging are non-invasive techniques used to detect metabolites and water diffusion in vivo. Previous studies have confirmed a positive correlation of individual fractional anisotropy values with N-acetylaspartate/creatine and N-acetylaspartate/choline ratios in tumors, edema, and normal white matter. This study divided the brain parenchyma into tumor, peritumoral edema, and normal-appearing white matter according to MRI data, and analyzed the correlation of metabolites with water molecular diffusion. Results demonstrated that in normal-appearing white matter, N-acetylaspartate/creatine ratios were positively correlated with fractional anisotropy values, negatively correlated with radial diffusivities, and positively correlated with maximum eigenvalues. Maximum eigenvalues and radial diffusivities in peritumoral edema showed a negative correlation with choline, N-acetylaspartate, and creatine. Radial diffusivities in tumor demonstrated a negative correlation with choline. These data suggest that the relationship between metabolism and structure is markedly changed from normal white matter to peritumoral edema and tumor. Neural metabolism in the peritumoral edema area decreased with expanding extracellular space. The normal relationship of neural function and microstructure disappeared in the tumor region.

A functional magnetic resonance imaging study of human brain in pain-related areas induced by electrical stimulation with different intensities.

BACKGROUND: Pain-related studies have mainly been performed through traditional methods, which lack the rigorous analysis of anatomical locations. Functional magnetic resonance imaging (fMRI) is a noninvasive method detecting neural activity, and has the ability to precisely locate related activations in vivo. Moreover, few studies have used painful stimulation of changed intensity to investigate relevant functioning nuclei in the human brain. AIM: This study mainly focused on the pain-related activations induced by electrical stimulation with different intensities using fMRI. Furthermore, the electrophysiological characteristics of different pain-susceptible-neurons were analyzed to construct the pain modulatory network, which was corresponding to painful stimulus of changed intensity. MATERIALS AND METHODS: Twelve volunteers underwent functional scanning receiving different electrical stimulation. The data were collected and analyzed to generate the corresponding functional activation maps and response time curves related to pain. RESULTS: The common activations were mainly located in several specific regions, including the secondary somatosensory cortex (SII), insula, anterior cingulate cortex (ACC), thalamus, and other cerebral regions. Moreover, innocuous electrical stimulation primarily activated the lateral portions of SII and thalamus, as well as the posterior insula, anterior ACC, whereas noxious electrical stimulation primarily activated the medial portions of SII and thalamus, as well as the anterior insula, the posterior ACC, with larger extensions and greater intensities. CONCLUSION: Several specified cerebral regions displayed different response patterns during electrical stimulation by means of fMRI, which implied that the corresponding pain-susceptible-neurons might process specific aspects of pain. Elucidation of functions on pain-related regions will help to understand the delicate pain modulation of human brain.

Alveolar soft part sarcoma of the retro peritoneum.

Alveolar Soft Part Sarcoma (ASPS), also called Alveolar Soft-Tissue Sarcoma, is a rare type of soft-tissue neoplasm with a poor long term prognosis. Such tumors originating in the retro peritoneal space are extremely rare. In this article we discuss a 34-year-old woman who was referred to our hospital with an increasing mass in her left lower abdomen. Ultrasonography and conventional Computed Tomography revealed a large hard mass occupying the left retroperitoneal space with a clear border. The pathological diagnosis was ASPS.

Case Report: Littoral cell angioma of spleen.

Littoral cell angioma is a rare primary vascular neoplasm of the spleen, composed of littoral cells that line the splenic sinuses of the red pulp. It was thought to be a benign, incidental lesion. However, many recent reports have described it to be a malignant lesion with congenital and immunological associations. The definitive diagnosis can only be made after histology and immunohistochemistry studies.