Y Stenting in Wide-Necked Bifurcation Aneurysms: A Single-Center Experience

Stent-assisted coiling is an endovascular means of managing wide-necked bifurcation aneurysms. In spite of the wide availability of various newer devices in managing such difficult aneurysms, the Y stenting offers a safe and cost-effective alternative to treat such cases in resource poor settings. This article provides an insight of our initial six cases of Y stent-assisted coiling along with their follow-up over a period of 6 months with no recanalization in any case. It also highlights the various technical aspects involved in such cases. One case had recurrent subdural hematoma probably due to use of antiplatelets and another patient had sudden dip in level of consciousness probably due to hematoma expansion that might also have been due to antiplatelet usage. However, none of the cases had any issues regarding stent migration, malapposition, and dissection. In our experience, Neuroform Atlas stent used for Y stenting offers a safe and technically easy alternative to various newer bifurcation devices.

CT Scanning Findings in Clinically Diagnosed Cerebral Palsy

Background: Cerebral Palsy is a non-progressive disorder due to insult in the developing brain. This causes disorders in muscle tone, posture and movement. Cerebral palsy is usually diagnosed by clinical features. Though risk factors are identified in about 75% of cases, the etiology remains unclear. Magnetic resonance imaging is the standard method to detect central nervous system abnormalities; but in resource poor areas CT Scanning may be an alternative method to elucidate the underlying Central Nervous System abnormalities. Objectives: The objective was to detect CT Scanning findings in different types of Cerebral palsies. Methodology: This was a prospective and cross-sectional study conducted on 525 Children registered at Child Development Center attached to Rangpur Mother and Children Hospital. Cerebral palsy was diagnosed by using an Interview Schedule. During from 1.1.2016 to 31.12.2019 CT scanning of brain was performed purposefully to all children to detect the underlying Central Nervous System abnormalities. The purpose was explained to parents and consent was taken before performing the tests. The children were in sedation during the procedure. Result: A total of 1800 registered children, 525 (29.10%) children were suffering from Cerebral Palsy. The male and female ratio was 3:2 and age distribution was 2.6±1.5 years. Seventy nine percent (79.0%) of children came from poor families. Parental education up to class V was in 65% cases. Maximum number (63.0%) of cases was suffering from spastic type of Cerebral Palsy followed by athetoid type (18.3%) and 7.1% ataxic type. Among spastics, quadriplegia was present in 68.5% of cases followed by hemiplegia (18.5%). Perinatal asphyxia was the commonest (56.1%) risk factor of Cerebral Palsy. Among all the CTs 116 (22.0%) were with normal finding and 409 (78.0%) were with various types of abnormal findings. White Matter Injury was present in 79 (15.0%) of cases and among these volume loss in periventricular areas with ventricular dilatation and deep white matter damage was common. The next abnormalities were Focal Vascular Insults (9.0%), Malformations (5.0%) and Unclassified lesions (4.0%). Grey Matter Injury was common in spastic type of cerebral palsy but there was much overlapping of abnormal findings and most (66.3%) insults occurred in perinatal period. Conclusion: CT scanning of brain is a comparable test to detect the central nervous system abnormalities in resource poor areas. Grey matter injury is the common abnormality in Cerebral palsy but there is much overlapping between CT Scanning findings and clinical diagnosis. J Bangladesh Coll Phys Surg 2022; 40: 31-38

A polycentric food sovereignty approach to climate resilience in the Philippines

Enhancing climate resilience in agrarian communities requires improving the underlying socioecological conditions for farmers to engage in adaptation and mitigation strategies, alongside collaborative and redistributive community development to reduce vulnerabilities. To overcome barriers to climate resilience in the Philippines, a grassroots farmer-led organization comprised of resource-poor smallholders, scientists, and nongovernmental organizations have organized a polycentric network over the past 30 years to implement food sovereignty initiatives. We explore the extent to which the network’s decentralized and farmer-led organizational structure; programming and services; promotion of diversified, organic, and agroecological farming systems; and political organizing and advocacy create broadly accessible and diverse pathways for resource-poor smallholders to build climate resilience. We find that the Magsasaka at Siyentipiko para sa Pag-Unlad ng Agrikultura’s (Farmer-Scientist Partnership for Development) polycentric governance approach directly addresses the root causes of vulnerability, particularly in working to reclaim farmer rights and control over resources, connecting local and global struggles, and revitalizing agrobiodiversity and place-based knowledge.

Validation of modified sick neonatal score, a simple clinical score for assessment of severity of illness and outcome in new-borns for resource poor settings

Background: India contributes to 25% of the neonatal deaths worldwide each year. Neonatal disease severity scoring systems are needed to make standardized comparison between performances of different units and also give prognostic information. Existing scoring systems are unsuitable for resource-limited settings which lack investigations like pH, pO2/FiO2 ratio and base excess. Modified sick neonatal score (MSNS) is based on eight routinely measured clinical variables in NICUs namely respiratory effort, heart rate, axillary temperature, capillary refill time, random blood sugar, pulse oximeter saturation, gestational age and birth weight found to be useful in resource poor settings. The aim of the study was to validate MSNS score for its clinical utility in predicting mortality.Methods: This was a cross sectional study done at NICU of Mamata Medical College Hospital. The parameters required for the score were recorded immediately at admission in NICU from 1 January 2020 to 1 January 2021 and scored using Modified sick neonatal score (MSNS). The total score was calculated and outcome was noted. The data collected were coded and analzed using SPSS Statistics for Windows, v21.0 Chi square test, Mann-Whitney U test and ROC analysis.Results: Total of 355 neonates got discharged, while 45 neonates expired. For a cutoff score of ≤10, sensitivity and specificity were 85.9% and 51.1%, respectively. Positive predictive value and negative predictive value were 93.3% and 31.5%, respectively. The Area under the curve (AUC) was 0.811 (95%CI: 0.788-0.835), which indicates the accuracy of 81.1%.Conclusions: MSNS is a better suited neonatal disease severity score for resource poor settings.

Malaria: What does the RTS,S/AS01 Vaccine Mean for Children in Africa?

Malaria is an example of an infectious disease which if not diagnosed appropriately and treated promptly can devastate the life of a child. Globally it also has a major impact on quality of life, educational potential, and economic productivity, particularly in resource-poor settings.