The impact of undernutrition and overnutrition on early brain development

In this review, we explore the effects of malnutrition on childhood neurodevelopment. Early brain development is highly sensitive to nutritional status. Both undernutrition and overnutrition can disrupt critical neurodevelopmental processes, affecting cognition, emotional regulation, and long-term mental health. Nutrient deficiencies, such as iron, iodine, folate, and vitamin B12, have been linked to impaired brain growth and function. Similarly, excessive caloric intake can also negatively impact brain development as it may contribute to neuroinflammation and altered neurocircuitry. The effects are most pronounced during prenatal life and early childhood, with lasting consequences on academic performance, behavior, and productivity. In addition to health-related outcomes, undernutrition and overnutrition can also have significant social and financial repercussions for individuals and their communities. This review synthesizes current insights on the relationship between nutrition and brain development, explores specific nutrient effects, and highlights the role of public health interventions. Addressing both undernutrition and overnutrition through early and targeted action is essential for optimizing neurodevelopment and reducing the long-term societal burden of cognitive and mental health disorders. Continuous monitoring of both existing and emerging nutritional deficiencies is necessary, particularly in marginalized communities and low- and middle-income regions, where the risk of undernutrition remains high

Household food insecurity, growth and development of preschool children: Evidence from rural Pakistan

Household food insecurity (HFI) remains a challenge globally and is recognized as a risk factor for poor child nutritional outcomes for infants and young children. However, few studies have evaluated the associations of HFI with the growth and development of preschool children. This study assessed the association of HFI with growth and development outcomes among preschool-aged children in rural Pakistan and explored potential differences in the magnitude of the associations by child gender and early childhood care and education (ECCE) intervention. Anthropometric and child development data from 2795 children aged 4.5-5.5 years enroled in a cluster-randomized stepped-wedge trial of the Youth Leaders for Early Childhood Assuring Children are Prepared for School intervention were collected across four districts in rural Sindh. HFI was assessed using the Household Food Insecurity Access Scale, and child development was measured by the International Development and Early Learning Assessment (IDELA) and a battery of executive functions tasks. Multilevel mixed-effects models were utilized to investigate the associations between HFI and height-for-age (HAZ), weight-for-age (WAZ), BMI-for-age z scores and child development scores. Increasing levels of HFI were associated with lower child WAZ, lower total IDELA scores and lower emergent literacy scores (p values for trend \u3c 0.05). No significant association was observed between HFI and executive functioning. Gender and ECCE intervention status did not modify the relationship between HFI and child growth and development outcomes (p \u3e 0.05). Future research should investigate the synergistic potential of nutrition and ECCE programmes to improve outcomes for children and families in rural Pakistan and similar resource-scarce settings. The trial is registered with ClinicalTrials.gov (NCT03764436)

Protocol for the redefining maternal anemia in pregnancy and postpartum (ReMAPP) study: A multisite, international, population-based cohort study to establish global hemoglobin thresholds for maternal anemia

Background: Anemia affects one in three pregnant women worldwide, with the greatest burden in South Asia and sub-Saharan Africa. During pregnancy, anemia has been linked to an increased risk of adverse maternal and neonatal health outcomes. Despite widespread recognition that anemia can complicate pregnancy, critical gaps persist in our understanding of the specific causes of maternal anemia and the cutoffs used to diagnose anemia in each trimester and in the postpartum period.Methods and analysis: The Redefining Maternal Anemia in Pregnancy and Postpartum (ReMAPP) study is a multisite, prospective, cohort study nested within the Pregnancy Risk, Infant Surveillance, and Measurement Alliance (PRISMA) Maternal and Newborn Health study. Research sites are located in Kenya, Ghana, Zambia, India, and Pakistan. Participants are up to 12,000 pregnant women who provide serial venous blood samples for hemoglobin assessment at five time points: at \u3c 20 weeks, 20 weeks, 28 weeks, and 36 weeks gestation and at six weeks postpartum. We will use two analytical approaches to estimate hemoglobin thresholds for defining anemia: (1) clinical decision limits for cutoffs in each trimester and at six weeks postpartum based on associations of hemoglobin levels with adverse maternal, fetal, and neonatal health outcomes and (2) reference limits for gestational-week-specific cutoffs and at six weeks postpartum for mild, moderate, and severe anemia based on tail statistical percentiles of hemoglobin values in a reference (i.e., clinically healthy) subpopulation. We will also conduct biomarker-intensive testing among a sub-sample of participants in each trimester to explore underlying contributing factors of maternal anemia.Ethics and dissemination: The study received local and national ethical approvals from all participating institutions. Findings from multisite analyses will be published among open-access, peer-reviewed journals and disseminated with local, national, and international partners.Strengths and limitations: Novel study design to allow multiple analytical approaches (clinical decision limits and reference limits) in the same population to establish hemoglobin thresholds.Use of gold standard methods and external quality assurance programs to ensure harmonized hemoglobin measurement across sites.Inclusion of biomarker-intensive study arm to examine the etiology of anemia among pregnant women.All data is contributed by populations historically underrepresented in research in low- and middle-income countries

Frequency of fast track extubation and factors affecting its success in adult cardiac surgery patients: A retrospective analysis

Objective: The primary objective is to identify how often do adult patients, who undergo elective open-heart surgeries are fast track extubated. Secondary objectives are to identify the causes of delayed extubation and to quantify the frequency of re-intubation and hospital stay in fast-track patients.Study design: Retrospective cross-sectional study.Place and duration of the study: The Cardiovascular Intensive Care Unit (CICU) at Department of Anesthesia, Aga Khan University Hospital, Karachi, Pakistan, where data was collected from January 2021 to December 2022.Methodology: Data of 419 adult patients admitted to the CICU and who underwent elective open-heart surgery, during the study period were included. Demographic and clinical information of the patients was collected using proforma eliciting details keeping anonymity and confidentiality of patients. Statistical analysis was conducted by RStudio (version 4.1.2, Boston, USA).Results: There were 58.4% (n = 245) of 419 patients extubated within the FastTrack window. No significant differences were seen in demographic and clinical characteristics (except surgery type, P \u3c 0.001). There was significant difference in intraoperative outcomes (CICU arrival time, temperature, Vasoactive-Inotropic Score [VIS], and hospital stay) between groups (P \u3c 0.001). High inotropic support, late night cases, bleeding and hypothermia were the major causes of delayed extubation.Conclusion: In patients undergoing elective open heart surgeries including elective CABG, fast track extubation is a feasible, safe, and effective option in improving resource utilization and patient outcome. Early extubation and prevention of postoperative complication can be facilitated by optimizing perioperative care protocols. Fast-track protocols should be standardized to protect patient safety. Fast track extubation requires careful patient selection and individual patient characteristics need to be considered

Long-term clinical outcomes of adults hospitalized for Covid-19 Pneumonia

We conducted a multicenter, observational, 12-month follow-up study to identify the extended health burden of severe COVID-19 pneumonia by characterizing long-term sequelae of acute infection in participants previously enrolled in clinical trials for severe COVID-19 pneumonia requiring hospitalization. Overall, 134 (77.5%) of 173 participants completed the study. At 12 months, 51 (29.5%) participants reported cough, 60 (34.7%) reported dyspnea, 56 (32.4%) had residual lung texture abnormalities on high-resolution computed tomography scans, 26 (15.0%) had impaired forced vital capacity, 52 (30.1%) had cognitive impairment, and 77 (44.5%) reported fatigue. Disease severity during acute infection and age were associated with persistent lung texture abnormalities; history of hypertension was associated with higher prevalence of fatigue and more frequent dyspnea and cough; and age and obesity were associated with long-term cognitive impairment. Our findings underscore the long-term health burden of severe COVID-19 pneumonia, reinforcing the importance of regular monitoring in older persons and those with underlying illnesses

Type 2 cesarean section scar pregnancy managed by hysteroscopic resection and methotrexate: A case report

Background: Diagnosis and management of cesarean scar ectopic pregnancy (CSP) remain challenging. We describe ultrasound diagnosis followed by hysteroscopic resection and methotrexate administration. Case presentation: A 42-year-old woman, para 2+1, presented with 8 weeks of amenorrhea and vaginal bleeding. She had two previous cesarean deliveries. Initial ultrasound suggested an incomplete miscarriage and beta human chorionic gonadotropin (β-HCG) was 46,129 mIU/ml. After failed medical management, repeat ultrasound diagnosed CSP. Hysteroscopic resection was performed, and she received methotrexate, resulting ß-HCG resolution. Conclusion: Though rare, CSP should be entertained in any woman presenting with vaginal bleeding with a history of cesarean delivery. Hysteroscopic resection with methotrexate provides good fertility-preserving modality for management

Patients’ experiences and management practices of hypertension among the pastoralist community of Marsabit County

Hypertension is a global public health challenge and a leading cause of morbidity and mortality, particularly in low- and middle-income countries, where it accounts for 86% of deaths from non-communicable diseases. With over 1.5 billion cases projected by 2025, hypertension significantly increases the risk of heart disease and stroke. Despite this, little is known about the experiences and self-care practices of pastoralist communities living with hypertension. This study employed a descriptive, exploratory, cross-sectional design to investigate the experiences and self-care practices of individuals managing hypertension among the pastoralist of Marsabit County. Twelve participants receiving follow-up care at Uran and Sololo Ramata health centres were recruited through purposive sampling. Data were collected through, semi-structured interviews which lasted 30 minutes to one hour, conducted in private rooms within the health facilities. Using Colaizzi’s method of open coding, 18 codes were identified, which were further grouped into 14 sub-themes and five overarching themes. The themes were 1) Experiences with the diagnosis of hypertension which included the journey to diagnosis, reactions to the condition, and their understanding and interpretation of the disease. 2) Experiences living with hypertension was characterized by acceptance and adjustment, reliance on social support and coping strategies, and functional and emotional challenges. 3) Medication management and adherence emerged as a significant theme, highlighting participants\u27 struggles with medication regimens and scheduling, their perceptions of medication effectiveness, and the integration of traditional healing practices. 4) Dietary and lifestyle modifications also featured prominently, encompassing typical meals and dietary restrictions, fruit and vegetable intake, engagement in physical activity, substance use such as alcohol and tobacco, and efforts in weight management. Lastly, the study uncovered 5) Challenges related to accessing healthcare services, including limited drug availability and barriers to healthcare accessibility. Most participants demonstrated poor knowledge of the causes and effects of hypertension. Adherence to prescribed medications and lifestyle modifications was often hindered by side effects and economic challenges. These findings enhance the understanding of the experiences of pastoralists living with hypertension and the factors affecting their self-care practices. The study recommends research on healthcare strategies and policies to support improved self-care among pastoralist populations managing hypertension

What do they love? A study of digital media consumption by young university audiences in Uganda

The proliferation of computers, smartphones, the Internet, social media, and streaming platforms has led to a surge in digital media consumption. Young audiences, especially those aged between 18 and 34, are increasingly turning to digital platforms for entertainment, information, and social interaction, much to the disadvantage of traditional media platforms such as the newspaper, radio and television. As a result, many media players are concerned about what young people consume, especially if they follow any news. Consequently, the desire to understand their news consumption habits on these digital platforms is paramount. Using a quantitative approach, this study got responses from 128 university students in Uganda aged between 18 and 34. It established that they prefer to consume news mostly in the morning and at night. The study also found that these young audiences prefer videos, and then text comes second, and that they spend anywhere between 30 minutes and two hours on digital platforms. With this information, the study discusses the implications of the findings for the current media dispensation for media scholars and policymakers. With the popularity of videos, social media, and mainstream media websites, the study proposes the formation of a youth-centred multimedia platform that emphasises videos and recruits consumers from social media sites