Neonatal hypothermia and associated risk factors among newborns of southern Nepal

Background  

Neonatal hypothermia is associated with an increased mortality risk for 28 days. There are few community-based data on specific risk factors for neonatal hypothermia. Estimates of association between neonatal hypothermia in the community and risk factors are needed to guide the design of interventions to reduce exposure.     

Supplementation with micronutrients in addition to iron and folic acid does not further improve the hematologic status of pregnant women in rural Nepal

Iron deficiency is one of the main causes of anemia during pregnancy, although other micronutrient deficiencies may play a role. We examined the effects of daily antenatal and postnatal supplementation with four combinations of micronutrients on maternal hematologic indicators in a double-masked randomized controlled community trial. Communities, called sectors, were randomly assigned to supplementation with folic acid (400 microg), folic acid plus iron (60 mg), folic acid plus iron and zinc (30 mg) and folic acid plus iron, zinc and 11 other micronutrients, each at the approximate recommended daily allowance for pregnancy all given with vitamin A as retinol acetate (1000 microg retinol equivalent), or vitamin A alone as the control group. Hemoglobin (Hb) and indicators of iron status were assessed at baseline and at 32 wk of gestation. At 6-wk postpartum, Hb assessment was repeated using a finger stick. Severely anemic women (Hb < 70 g/L) were treated according to WHO recommendations. Folic acid alone had no effect on maternal anemia or iron status. Hb concentrations were 14 g/L, [95% confidence limits (CL), 8.3-19.2], 10.0 g/L (CL, 5.2-14.8) and 9.4 g/L (CL, 4.7-14.1) higher in the groups receiving folic acid plus iron, folic acid plus iron and zinc and folic acid plus iron, zinc and multiple micronutrients, respectively, relative to the control. Anemia in the third trimester was reduced by 54% with folic acid plus iron, by 48% with folic acid plus iron and zinc and by 36% with folic acid plus iron, zinc and multiple micronutrients supplementation, relative to the control (P < 0.05). Thus, the combinations of folic acid plus iron and zinc and folic acid plus iron, zinc and multiple micronutrients provided no additional benefit in improving maternal hematologic status during pregnancy compared with folic acid plus iron. The level of compliance and baseline Hb concentrations modified the effect of iron.     

Compression fracture diagnosis in lumbar: a clinical CAD system

Purpose Lower back pain affects 80–90 % of all people at some point during their life time, and it is considered as the second most neurological ailment after headache. It is caused by defects in the discs, vertebrae, or the soft tissues. Radiologists perform diagnosis mainly from X-ray radiographs, MRI, or CT depending on the target organ. Vertebra fracture is usually diagnosed from X-ray radiographs or CT depending on the available technology. In this paper, we propose a fully automated Computer-Aided Diagnosis System (CAD) for the diagnosis of vertebra wedge compression fracture from CT images that integrates within the clinical routine. Methods We perform vertebrae localization and labeling, segment the vertebrae, and then diagnose each vertebra. We perform labeling and segmentation via coordinated system that consists of an Active Shape Model and a Gradient Vector Flow Active Contours (GVF-Snake). We propose a set of clinically motivated features that distinguish the fractured vertebra. We provide two machine learning solutions that utilize our features including a supervised learner (Neural Networks (NN)) and an unsupervised learner (K-Means). Results We validate our method on a set of fifty (thirty abnormal) Computed Tomography (CT) cases obtained from our collaborating radiology center. Our diagnosis detection accuracy using NN is 93.2 % on average while we obtained 98 % diagnosis accuracy using K-Means. Our K-Means resulted in a specificity of 87.5 % and sensitivity over 99 %. Conclusions We presented a fully automated CAD system that seamlessly integrates within the clinical work flow of the radiologist. Our clinically motivated features resulted in a great performance of both the supervised and unsupervised learners that we utilize to validate our CAD system. Our CAD system results are promising to serve in clinical applications after extensive validation.     

Effects of zinc and iron supplementation fail to improve motor and language milestone scores of infants and toddlers

ObjectiveTo assess the effects of zinc and iron–folic acid supplementation on motor and language milestones in Nepali children.MethodsFive hundred forty-four children 4 to 17 mo old residing in Ishwarpur, Nepal were randomized to receive placebo, iron–folic acid, zinc, or zinc plus iron–folic acid daily. Data were collected at baseline and at 3-mo intervals for 1 y. The main effects of zinc and iron folic–acid supplementation were estimated for motor and language milestones. Crude and adjusted mean cumulative changes in scores from visits 1 to 5 and adjusted rates of change were modeled.ResultsAdjusted differences in motor milestone scores from visits 1 to 5 and rates of change were not significantly different for the zinc and non-zinc groups (adjusted β = ?0.7, 95% confidence interval [CI] ?1.4 to 0.01; adjusted β = ?0.1, 95% CI ?0.5 to 0.3, respectively). Motor milestones in children receiving and not receiving iron supplements were not significantly different (adjusted β = 0.1, 95% CI ?0.7 to 0.8, from visits 1 to 5; adjusted β = 0.1, 95% CI ?0.3 to 0.5, for rate of change). Children receiving zinc had a 0.8 lower mean crude change in language score from visits 1 to 5 compared with children not receiving zinc (95% CI ?1.3 to ?0.3), but the significance was lost after adjustment (adjusted β = ?0.2, 95% CI ?0.6 to 0.2, for visits 1 to 5; β = ?0.1, 95% CI ?0.3 to 0.2, for rate of change). No significant difference in motor or language milestone scores from iron supplementation was observed.ConclusionAfter 1 y, neither zinc nor iron–folic acid supplementation in Nepali children improved the attainment of motor or language milestones.