Arsenic modifies the effect of folic acid in spina bifida prevention, a large hospital-based case-control study in Bangladesh.

BACKGROUND: Spina bifida, a developmental malformation of the spinal cord, is associated with high rates of mortality and disability. Although folic acid-based preventive strategies have been successful in reducing rates of spina bifida, some areas continue to be at higher risk because of chemical exposures. Bangladesh has high arsenic exposures through contaminated drinking water and high rates of spina bifida. This study examines the relationships between mother's arsenic exposure, folic acid, and spina bifida risk in Bangladesh. METHODS: We conducted a hospital-based case-control study at the National Institute of Neurosciences & Hospital (NINS&H) in Dhaka, Bangladesh, between December 2016 and December 2022. Cases were infants under age one year with spina bifida and further classified by a neurosurgeon and imaging. Controls were drawn from children seen at NINS&H and nearby Dhaka Shishu Hospital. Mothers reported folic acid use during pregnancy, and we assessed folate status with serum assays. Arsenic exposure was estimated in drinking water using graphite furnace atomic absorption spectrophotometry (GF-AAS) and in toenails using inductively coupled plasma mass spectrometry (ICP-MS). We used logistic regression to examine the associations between arsenic and spina bifida. We used stratified models to examine the associations between folic acid and spina bifida at different levels of arsenic exposure. RESULTS: We evaluated data from 294 cases of spina bifida and 163 controls. We did not find a main effect of mother's arsenic exposure on spina bifida risk. However, in stratified analyses, folic acid use was associated with lower odds of spina bifida (adjusted odds ratio [OR]: 0.50, 95% confidence interval [CI]: 0.25-1.00, p = 0.05) among women with toenail arsenic concentrations below the median value of 0.46 µg/g, and no association was seen among mothers with toenail arsenic concentrations higher than 0.46 µg/g (adjusted OR: 1.09, 95% CI: 0.52-2.29, p = 0.82). CONCLUSIONS: Mother's arsenic exposure modified the protective association of folic acid with spina bifida. Increased surveillance and additional preventive strategies, such as folic acid fortification and reduction of arsenic, are needed in areas of high arsenic exposure.

Awake brain mapping by direct cortical stimulation; technical note to get higher resection rate and low morbidity in low-grade glioma patients.

Introduction: Direct cortical stimulation has been used for brain mapping and localization of eloquent areas in awake patients. This simplified technique is to provide the positive areas, which can be preserved if the tumor or lesions are involved eloquent areas. Objective: The main objective of this study is to determine whether direct cortical stimulation in awake brain mapping for low-grade glioma patients increases the rate of resection or not. Method: The authors present a retrospective study between 2020 to 2022 that includes 35 cases in a single center, to get higher resection rate, and their consequences in awake craniotomy in low-grade glioma patients. Here, two neurosurgeons were involved and the minimum follow-up was 12 months. Results: The authors achieved 80% removal of tumors. To get higher resection rate we emphasized negative mapping with prior anatomical analysis to understand functional realignment. Stimulation-related complications will be thoroughly discussed with a potential future direction to minimize the issues. The authors used PROMIS score to measure patients physical and mental health status and kernofsky score to measure performance status before and after successful surgery. The authors found three cases of transient deficit in repetitive stimulation. Repeated stimulation to identify the eloquent areas with low voltage frequency is a good option. Numbness in the face related to stimulation may continue for 6 weeks. Conclusion: Functional realignment in shifted brain and edema can be seen while doing cortical and subcortical stimulation. Most of the stimulation from low to high for language mapping may vary from patient to patient. For safe removal of low-grade glioma a steep learning curve is needed to find out the negative areas, though the authors emphasize positive mapping of areas to secure the maximum eloquence.

Arsenic modifies the effect of folic acid in spina bifida prevention, a large hospital-based case-control study in Bangladesh.

Background: Spina bifida, a developmental malformation of the spinal cord, is associated with high rates of mortality and disability. Although folic acid-based preventive strategies have been successful in reducing rates of spina bifida, some areas continue to be at higher risk because of chemical exposures. Bangladesh has high arsenic exposures through contaminated drinking water and high rates of spina bifida. Methods: We conducted a hospital-based case-control study at the National Institute of Neurosciences & Hospital (NINS&H) in Dhaka, Bangladesh, between December 2016 and December 2022. Cases were infants under age one year with spina bifida and further classified using data from observations by neurosurgeons and available imaging. Controls were drawn from children who presented to NINS&H or Dhaka Shishu Hospital (DSH) during the same study period. Mothers reported folic acid use during pregnancy, and we assessed folate status with serum assays. Arsenic exposure was estimated in drinking water using graphite furnace atomic absorption spectrophotometry (GF-AAS) and in toenails using inductively coupled plasma mass spectrometry (ICP-MS). Results: We evaluated data from 294 cases of spina bifida and 163 controls. We did not find a main effect of mother's arsenic exposure on spina bifida risk. However, in stratified analyses, folic acid use was associated with lower odds of spina bifida (adjusted odds ratio [OR]: 0.50, 95% confidence interval [CI]: 0.25-1.00, p = 0.05) among women with toenail arsenic concentrations below the median, and no association was seen among mothers with toenail arsenic concentrations higher than median (adjusted OR: 1.09, 95% CI: 0.52-2.29, p = 0.82). Conclusions: Mother's arsenic exposure modified the protective association of folic acid with spina bifida. Increased surveillance and additional preventive strategies, such as folic acid fortification and reduction of arsenic, are needed in areas of high arsenic exposure.

Reduced tillage and crop diversification can improve productivity and profitability of rice-based rotations of the Eastern Gangetic Plains.

Intensive rice (Oryza sativa)-based cropping systems in south Asia provide much of the calorie and protein requirements of low to middle-income rural and urban populations. Intensive tillage practices demand more resources, damage soil quality, and reduce crop yields and profit margins. Crop diversification along with conservation agriculture (CA)-based management practices may reduce external input use, improve resource-use efficiency, and increase the productivity and profitability of intensive cropping systems. A field study was conducted on loamy soil in a sub-tropical climate in northern Bangladesh to evaluate the effects of three tillage options and six rice-based cropping sequences on grain, calorie, and protein yields and gross margins (GM) for different crops and cropping sequences. The three tillage options were: (1) conservation agriculture (CA) with all crops in sequences untilled, (2) alternating tillage (AT) with the monsoon season rice crop tilled but winter season crops untilled, and (3) conventional tillage (CT) with all crops in sequences tilled. The six cropping sequences were: rice-rice (R-R), rice-mung bean (Vigna radiata) (R-MB), rice-wheat (Triticum aestivum) (R-W), rice-maize (Zea mays) (R-M), rice-wheat-mung bean (R-W-MB), and rice-maize-mung bean (R-M-MB). Over three years of experimentation, the average monsoon rice yield was 8% lower for CA than CT, but the average winter crops yield was 13% higher for CA than CT. Systems rice equivalent yield (SREY) and systems calorie and protein yields were about 5%, 3% and 6%, respectively, higher under CA than CT; additionally, AT added approximately 1% more to these benefits. The systems productivity gain under CA and AT resulted in higher GM by 16% while reducing the labor and total production cost under CA than CT. The R-M rotation had higher SREY, calorie, protein yields, and GM by 24%, 26%, 66%, and 148%, respectively, than the predominantly practiced R-R rotation. The R-W-MB rotation had the highest SREY (30%) and second highest (118%) GM. Considering the combined effect of tillage and cropping system, CA with R-M rotation showed superior performance in terms of SREY, protein yield, and GM. The distribution of labor use and GM across rotations was grouped into four categories: R-W in low-low (low labor use and low GM), R-M in low-high (low labor use and high GM), R-W-MB and R-M-MB in high-high (high labor use and high GM) and R-R and R-MB in high-low (high labor use and low GM). In conclusion, CA performed better than CT in different winter crops and cropping systems but not in monsoon rice. Our results demonstrate the multiple benefits of partial and full CA-based tillage practices employed with appropriate crop diversification to achieve sustainable food security with greater calorie and protein intake while maximizing farm profitability of intensive rice-based rotational systems.