Multidetector computed tomographic urography for evaluation of vascular and ureteric anomalies associated with ectopic kidneys

Background: The purpose of this study is to evaluate the vascular and ureteric anomalies associated with ectopic kidneys with multidetector computed tomography (MDCT). Methods: The 40 patients with pre-diagnosed ectopic kidney undergoing MDCT urography (Contrast study) and KUB (Plain study) were included in this cross-sectional observational study. The location and number of bilateral kidneys were assessed. The number and origin of the renal arteries and renal veins were noted. Their relationship with each other and possible complications in surgical handling analysed. Data collected was analysed using descriptive and inferential statistics.Results: The renal artery originated from suprarenal aorta in 2 cases, normal origin in 10 cases, infrarenal aorta in 12 cases, aortic bifurcation in 19 cases, common iliac artery in 6 cases and iliac artery bifurcation in 2 cases. The renal vein was of normal origin in 8 cases, originated from infrarenal inferior vena cava (IVC) in 16 cases, IVC bifurcation in 14 cases, common iliac vein in 9 cases, internal iliac vein in 2 cases and external iliac vein in 1 case. There was a significant correlation between the level of ectopic kidneys (abdominal, iliac and pelvis) and level of origin of arteries (p<0.001) and veins (p<0.001). In addition, significant correlation was found between the origins of arteries and veins of ectopic kidneys (p<0.001).Conclusions: A knowledge of the possible variations in renal vasculature and ureter associated with ectopic kidneys can play a key role in preventing iatrogenic hemorrhage during surgery

Neuroimaging in paediatric patients with developmental delay

Background: Aim and objectives of the study were to radiologically evaluate paediatric patients with developmental delay (DD), assess the relative prevalence of abnormal brain MRI, further categorize them based on the abnormal imaging findings and structures affected. The purpose of this study is to diagnose the underlying etiology that helps in early treatment and amelioration of the condition, parental counselling regarding the outcome of the child, providing an estimate of child’s developmental potential and the recurrence risk in siblings.Methods: 135 paediatric patients of the age 3 months to 15 years with DD referred to department of radiology were investigated with MRI scans of the brain via 1.5T Siemens scanner after making the child sleep or sedated. The sequences used were: axial T1, axial T2, axial FLAIR, axial DWI, axial ADC, axial SWI, axial PHASE, sagittal T1 and coronal FLAIR. CT scan of the brain was done only when indicated on 128 slice Siemens Somatom perspective scanner. Informed consent shall be taken from patient’s parents. Clinical and demographic details of the enrolled patients were noted in the Performa. Data collected was analysed using descriptive and inferential statistics.Results: Out of 135 children with DD, 69.1% (n=92) were male and 31.9% (n=43) were female. Majority of these children belonged to 3 months to 1 year and 2 to 5 years of age group. About 81.4% (n=110) of children with DD had abnormal findings in MRI. Among children with abnormal MRI findings, 42.9% had hypoxic ischemic changes, 6.6% had congenital malformations and non-specific causes, respectively 4.4% had neurodegenerative and occlusive neurovascular conditions, respectively 3.7% had CSF disorders and neoplasms, respectively 2.9% had infection associated changes and non-traumatic intracranial bleed, respectively 2.2% had metabolic disorders and 0.7% had demyelination. Majority of cases had ventricular abnormality, followed by the corpus callosum.Conclusions: DD presents with a wide spectrum of etiologies, clinical findings and MRI features ranging from completely normal to abnormal. The present study could establish the various morphological appearances of DD on MRI and further categorize them into various subgroups be effective in diagnosis, management and prognosis determination processes

Prevalence of rotavirus diarrhea among hospitalized under-five children

Objective: To estimate the prevalence of rotavirus diarrhea among hospitalized children less than 5 years of age in Kerala State and to determine the circulating strains of rotavirus in Kerala. Desigh: Multicenter, cross-sectional study. Setting: Eight representative hospitals in Kunnathunadu Thaluk, Ernakulam district, Kerala. Participants: Children in the age group under 5 years. Methods: Hospitalized children admitted with acute diarrhea were examined and standardized case report form was used to collect demographic, clinical and health outcome. Stool specimens were collected and ELISA testing was done. ELISA rotavirus positive samples were tested by reverse transcription PCR for G and P typing (CMC Vellore). Results: Among the 1827 children, 648 (35.9%) were positive for rotavirus by the Rotaclone ELISA test. The prevalence of rotavirus diarrhea in infants less than 6 months of age was 24.7%; 6- 11 months 31.9%; 12- 23 months 41.9%; 24- 35 months 46.9%; and 33.3% in 36- 59 months. Rotavirus infections were most common during the dry months from January through May. G1P[8] (49.7%) was the most common strain identified followed by G9P[8] (26.4%), G2P[4] (5.5%), G9P[4] (2.6%) and G12P[6] (1.3%). Conclusions: The prevalence of rotavirus diarrhea among hospitalized children less than 5 years is high in Ernakulam district, Kerala State

Chronic growth faltering amongst a birth cohort of Indian children begins prior to weaning and is highly prevalent at three years of age

BACKGROUND: Poor growth of children in developing countries is a major public health problem associated with mortality, morbidity and developmental delay. We describe growth up to three years of age and investigate factors related to stunting (low height-for-age) at three years of age in a birth cohort from an urban slum. METHODS: 452 children born between March 2002 and August 2003 were followed until their third birthday in three neighbouring slums in Vellore, South India. Field workers visited homes to collect details of morbidity twice a week. Height and weight were measured monthly from one month of age in a study-run clinic. For analysis, standardised z-scores were generated using the 2006 WHO child growth standards. Risk factors for stunting at three years of age were analysed in logistic regression models. A sensitivity analysis was conducted to examine the effect of missing values. RESULTS: At age three years, of 186 boys and 187 girls still under follow-up, 109 (66%, 95% Confidence interval 58-73%) boys and 93 (56%, 95% CI 49-64%) girls were stunted, 14 (8%, 95% CI 4-13%) boys and 12 (7%, 95% CI 3-11%) girls were wasted (low weight-for-height) and 72 (43%, 95% CI 36-51) boys and 66 (39%, 95% CI 31-47%) girls were underweight (low weight-for-age). In total 224/331 (68%) children at three years had at least one growth deficiency (were stunted and/or underweight and/or wasted); even as early as one month of age 186/377 (49%) children had at least one growth deficiency. Factors associated with stunting at three years were birth weight less than 2.5 kg (OR 3.63, 95% CI 1.36-9.70) 'beedi-making' (manual production of cigarettes for a daily wage) in the household (OR 1.74, 95% CI 1.05-2.86), maternal height less than 150 cm (OR 2.02, 95% CI 1.12-3.62), being stunted, wasted or underweight at six months of age (OR 1.75, 95% CI 1.05-2.93) and having at least one older sibling (OR 2.00, 95% CI 1.14-3.51). CONCLUSION: A high proportion of urban slum dwelling children had poor growth throughout the first three years of life. Interventions are needed urgently during pregnancy, early breastfeeding and weaning in this population

Distinct Exosomal miRNA Profiles from BALF and Lung Tissue of COPD and IPF Patients

Chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are chronic, progressive lung ailments that are characterized by distinct pathologies. Early detection biomarkers and disease mechanisms for these debilitating diseases are lacking. Extracellular vesicles (EVs), including exosomes, are small, lipid-bound vesicles attributed to carry proteins, lipids, and RNA molecules to facilitate cell-to-cell communication under normal and diseased conditions. Exosomal miRNAs have been studied in relation to many diseases. However, there is little to no knowledge regarding the miRNA population of bronchoalveolar lavage fluid (BALF) or the lung-tissue-derived exosomes in COPD and IPF. Here, we determined and compared the miRNA profiles of BALF- and lung-tissue-derived exosomes of healthy non-smokers, smokers, and patients with COPD or IPF in independent cohorts. Results: Exosome characterization using NanoSight particle tracking and TEM demonstrated that the BALF-derived exosomes were ~89.85 nm in size with a yield of ~2.95 × 10(10) particles/mL in concentration. Lung-derived exosomes were larger in size (~146.04 nm) with a higher yield of ~2.38 × 10(11) particles/mL. NGS results identified three differentially expressed miRNAs in the BALF, while there was one in the lung-derived exosomes from COPD patients as compared to healthy non-smokers. Of these, miR-122-5p was three- or five-fold downregulated among the lung-tissue-derived exosomes of COPD patients as compared to healthy non-smokers and smokers, respectively. Interestingly, there were a large number (55) of differentially expressed miRNAs in the lung-tissue-derived exosomes of IPF patients compared to non-smoking controls. Conclusions: Overall, we identified lung-specific miRNAs associated with chronic lung diseases that can serve as potential biomarkers or therapeutic targets

Enhanced Dopamine D1 and BDNF Signaling in the Adult Dorsal Striatum but not Nucleus Accumbens of Prenatal Cocaine Treated Mice

Previous work from our group and others utilizing animal models have demonstrated long-lasting structural and functional alterations in the meso-cortico-striatal dopamine pathway following prenatal cocaine (PCOC) treatment. We have shown that PCOC treatment results in augmented D1-induced cyclic AMP (cAMP) and cocaine-induced immediate-early gene expression in the striatum of adult mice. In this study we further examined basal as well as cocaine or D1-induced activation of a set of molecules known to be mediators of neuronal plasticity following psychostimulant treatment, with emphasis in the dorsal striatum (Str) and nucleus accumbens (NAc) of adult mice exposed to cocaine in utero. Basally, in the Str of PCOC treated mice there were significantly higher levels of (1) CREB and Ser133 P-CREB (2) Thr34 P-DARPP-32 and (3) GluA1 and Ser 845 P-GluA1 when compared to prenatal saline (PSAL) treated mice. In the NAc there were significantly higher basal levels of (1) CREB and Ser133 P-CREB, (2) Thr202/Tyr204 P-ERK2, and (3) Ser845 P-GluA1. Following acute administration of cocaine (15 mg/kg, i.p.) or D1 agonist (SKF 82958; 1 mg/kg, i.p.) there were significantly higher levels of Ser133 P-CREB, Thr34 P-DARPP-32, and Thr202/Tyr204 P-ERK2 in the Str that were evident in all animals tested. However, these cocaine-induced increases in phosphorylation were significantly augmented in PCOC mice compared to PSAL mice. In sharp contrast to the observations in the Str, in the NAc, acute administration of cocaine or D1 agonist significantly increased P-CREB and P-ERK2 in PSAL mice, a response that was not evident in PCOC mice. Examination of Ser 845 P-GluA1 revealed that cocaine or D1 agonist significantly increased levels in PSAL mice, but significantly decreased levels in the PCOC mice in both the Str and NAc. We also examined changes in brain-derived neurotrophic factor (BDNF). Our studies revealed significantly higher levels of the BDNF precursor, pro-BDNF, and one of its receptors, TrkB in the Str of PCOC mice compared to PSAL mice. These results suggest a persistent up-regulation of molecules critical to D1 and BDNF signaling in the Str of adult mice exposed to cocaine in utero. These molecular adaptations may underlie components of the behavioral deficits evident in exposed animals and a subset of exposed humans, and may represent a therapeutic target for ameliorating aspects of the PCOC-induced phenotype

Association of Long-Term Exposure to Fine Particulate Matter and Cardio-Metabolic Diseases in Low- and Middle-Income Countries: A Systematic Review.

: Background: Numerous epidemiological studies indicated high levels of particulate matter less than2.5 μm diameter (PM2.5) as a major cardiovascular risk factor. Most of the studies have been conducted in high-income countries (HICs), where average levels of PM2.5 are far less compared to low- and middle- income countries (LMICs), and their socio-economic profile, disease burden, and PM speciation/composition are very different. We systematically reviewed the association of long-term exposure to PM2.5 and cardio-metabolic diseases (CMDs) in LMICs. METHODS: Multiple databases were searched for English articles with date limits until March 2018. We included studies investigating the association of long-term exposure to PM2.5 (defined as an annual average/average measure for 3 more days of PM2.5 exposure) and CMDs, such as hospital admissions, prevalence, and deaths due to CMDs, conducted in LMICs as defined by World Bank. We excluded studies which employed exposure proxy measures, studies among specific occupational groups, and specific episodes of air pollution. RESULTS: A total of 5567 unique articles were identified, of which only 17 articles were included for final review, and these studies were from Brazil, Bulgaria, China, India, and Mexico. Outcome assessed were hypertension, type 2 diabetes mellitus and insulin resistance, and cardiovascular disease (CVD)-related emergency room visits/admissions, death, and mortality. Largely a positive association between exposure to PM2.5 and CMDs was found, and CVD mortality with effect estimates ranging from 0.24% to 6.11% increased per 10 μg/m3 in PM2.5. CVD-related hospitalizations and emergency room visits increased by 0.3% to 19.6%. Risk factors like hypertension had an odds ratio of 1.14, and type 2 diabetes mellitus had an odds ratio ranging from 1.14-1.32. Diversity of exposure assessment and health outcomes limited the ability to perform a meta-analysis. CONCLUSION: Limited evidence on the association of long-term exposure to PM2.5 and CMDs in the LMICs context warrants cohort studies to establish the association

Age and sex normalization of intestinal permeability measures for the improved assessment of enteropathy in infancy and early childhood: Results from the MAL-ED study

Objectives: The aim of the study was to describe changes in intestinal permeability in early childhood in diverse epidemiologic settings.Methods: In a birth cohort study, the lactulose:mannitol (L:M) test was administered to 1980 children at 4 time points in the first 24 months of life in 8 countries. Data from the Brazil site with an incidence of diarrhea similar to that seen in the United States and no growth faltering was used as an internal study reference to derive age- and sex-specific z scores for mannitol and lactulose recoveries and the L:M ratio.Results: A total of 6602 tests demonstrated mannitol recovery, lactulose recovery, and the L:M ratio were associated with country, sex, and age. There was heterogeneity in the recovery of both probes between sites with mean mannitol recovery ranging for 1.34% to 5.88%, lactulose recovery of 0.19% to 0.58%, and L:M ratios 0.10 to 0.17 in boys of 3 months of age across different sites. We observed strong sex-specific differences in both mannitol and lactulose recovery, with boys having higher recovery of both probes. Alterations in intestinal barrier function increased in most sites from 3 to 9 months of age and plateaued or diminished from 9 to 15 months of age.Conclusions: Alterations in recovery of the probes differ markedly in different epidemiologic contexts in children living in the developing world. The rate of change in the L:M-z ratio was most rapid and consistently disparate from the reference standard in the period between 6 and 9 months of age, suggesting that this is a critical period of physiologic impact of enteropathy in these populations

Burden, clinical characteristics, risk factors, and seasonality of adenovirus 40/41 diarrhea in children in eight low-resource settings

Background: The application of molecular diagnostics has identified enteric group adenovirus serotypes 40 and 41 as important causes of diarrhea in children. However, many aspects of the epidemiology of adenovirus 40/41 diarrhea have not been described.Methods: We used data from the 8-site Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project birth cohort study to describe site- and age-specific incidence, risk factors, clinical characteristics, and seasonality.Results: The incidence of adenovirus 40/41 diarrhea was substantially higher by quantitative polymerase chain reaction than enzyme immunoassay and peaked at ∼30 episodes per 100 child-years in children aged 7-15 months, with substantial variation in incidence between sites. A significant burden was also seen in children 0-6 months of age, higher than other viral etiologies with the exception of rotavirus. Children with adenovirus 40/41 diarrhea were more likely to have a fever than children with norovirus, sapovirus, and astrovirus (adjusted odds ratio [aOR], 1.62; 95% CI, 1.16-2.26) but less likely than children with rotavirus (aOR, 0.66; 95% CI, 0.49-0.91). Exclusive breastfeeding was strongly protective against adenovirus 40/41 diarrhea (hazard ratio, 0.64; 95% CI, 0.48-0.85), but no other risk factors were identified. The seasonality of adenovirus 40/41 diarrhea varied substantially between sites and did not have clear associations with seasonal variations in temperature or rainfall.Conclusions: This study supports the situation of adenovirus 40/41 as a pathogen of substantial importance, especially in infants. Fever was a distinguishing characteristic in comparison to other nonrotavirus viral etiologies, and promotion of exclusive breastfeeding may reduce the high observed burden in the first 6 months of life