Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study

Background: People with epilepsy (PWE) in low- and middle-income countries may not access the health resources that are considered optimal for epilepsy diagnosis. The diagnostic yield of magnetic resonance imaging (MRI) has not been well studied in these settings. Objectives: To report the diagnostic yield of brain MRI and identify clinical associations of abnormal MRI findings among PWE in a neurocysticercosis-endemic, resource-limited setting and to identify the proportion and putative structural brain causes of drug-resistant epilepsy. Methods: PWE were prospectively enrolled at the Jigme Dorji Wangchuck National Referral Hospital in Bhutan (2014-2015). Each participant completed clinical questionnaires and a 1.5-Tesla brain MRI. Each MRI was reviewed by at least 1 radiologist and neurologist in Bhutan and the United States. A working definition of drug-resistant epilepsy for resource-limited settings was given as (a) seizures for >1 year, (b) at least 1 seizure in the prior year, and (c) presently taking 2 or more antiepileptic drugs (AEDs). Logistic regression models were constructed to test the cross-sectional association of an abnormal brain MRI with clinical variables. Findings: A total of 217 participants (125 [57%] female; 54 [25%] neurocysticercosis (n = 26, 12%, including 1 child) and congenital/perinatal abnormalities (n = 29, 14%, including 14 children). The number of AEDs (odds ratio = .59, 'P' = .03) and duration of epilepsy (odds ratio = 1.11, 'P' = .02) were significantly associated with an abnormal MRI. Seizure in the prior month was associated with the presence of mesial temporal sclerosis (odds ratio = .47, 'P' = .01). A total of 25 (12%) participants met our definition of drug-resistant epilepsy, with mesial temporal sclerosis (n = 10), congenital malformations (n = 5), and neurocysticercosis (n = 4) being the more common findings. Conclusions: The prevalence of abnormalities on brain MRI for PWE in resource-limited settings is high as a result of a diffuse range of etiologies, most commonly mesial temporal sclerosis. Drug-resistant epilepsy accounted for 12% of the referral population in a conservative estimation

Community Perspectives on the On-Farm Diversity of Six Major Cereals and Climate Change in Bhutan

Subsistence Bhutanese farmers spread across different agro-ecological zones maintain large species and varietal diversity of different crops in their farm. However, no studies have been undertaken yet to assess why farmers conserve and maintain large agro-biodiversity, the extent of agro-ecological richness, species richness, estimated loss of traditional varieties and threats to the loss of on-farm agro-biodiversity. Information on the number of varieties cultivated by the farmers for six important staple crops were collected from nine districts and twenty sub-districts spread across six different agro-ecological zones of the country to understand farmers reasons for maintaining on-farm crop diversity, estimate agro-ecological richness, species richness and the overall loss of traditional varieties, to know the famers’ level of awareness on climate change and the different threats to crop diversity. The results from this study indicated that an overwhelming 93% of the respondents manage and use agro-biodiversity for household food security and livelihood. The average agro-ecological richness ranged from 1.17 to 2.26 while the average species richness ranged from 0.50 to 2.66. The average agro-ecological richness indicates a large agro-ecological heterogeneity in terms of the different species of staple crops cultivated. The average species richness on the other hand shows that agro-ecological heterogeneity determines the type and extent of the cultivation of the six different staple cereals under consideration. The overall loss of traditional varieties in a time period of 20 years stands at 28.57%. On climate change, 94% of the farmers recognize that local climate is changing while 86% responded that they are aware of the potential impacts of climate change on their livelihoods. Climate change and associated factors was considered the most imminent threat to the management and loss of on-farm agro-biodiversity. The results from this study indicate that on-farm agro-biodiversity conservation, development and utilization programs have to be more specific to the different agro-ecological zones considering the agro-ecological heterogeneity. Attention has to be given to individual crops that have low average species richness and high percentage of loss of traditional varieties. The impact of climate change could offset the traditional seed system which primarily supports the persistence of on-farm agro-biodiversity in several ways

St. John's Daily Star, 1920-02-24

The St. John's Daily Star was published daily except Sunday between 17 April 1915 - 23 July 1921