Striatal and thalamic automatic segmentation, morphology, and clinical correlates in Parkinsonism: Parkinson's disease, multiple system atrophy and progressive supranuclear palsy.

Parkinson's disease (PD), multisystem atrophy (MSA), and progressive supranuclear palsy (PSP) present similarly with bradykinesia, tremor, rigidity, and cognitive impairments. Neuroimaging studies have found differential changes in the nigrostriatal pathway in these disorders, however whether the volume and shape of specific regions within this pathway can distinguish between atypical Parkinsonian disorders remains to be determined. This paper investigates striatal and thalamic volume and morphology as distinguishing biomarkers, and their relationship to neuropsychiatric symptoms. Automatic segmentation to calculate volume and shape analysis of the caudate nucleus, putamen, and thalamus were performed in 18 PD patients, 12 MSA, 15 PSP, and 20 healthy controls, then correlated with clinical measures. PSP bilateral thalami and right putamen were significantly smaller than controls, but not MSA or PD. The left caudate and putamen significantly correlated with the Neuropsychiatric Inventory total score. Bilateral thalamus, caudate, and left putamen had significantly different morphology between groups, driven by differences between PSP and healthy controls. This study demonstrated that PSP patient striatal and thalamic volume and shape are significantly different when compared with controls. Parkinsonian disorders could not be differentiated on volumetry or morphology, however there are trends for volumetric and morphological changes associated with PD, MSA, and PSP.

Effects of Calliandra and Sesbania supplementation on weight gain in dairy calves on smallholder farms in Kenya.

The growth rate of female calves on dairy farms is one of the crucial factors which influence age at first calving, affecting lifetime lactation productivity of a dairy cow. Diets with adequate crude protein are necessary to support calf growth. The study objective was to determine the effects of nutritional advice and diet supplementation with Calliandra calothyrsus and Sesbania sesban on average daily weight gain in dairy calves on semi-commercial smallholder dairy farms in Kenya. This trial involved 155 calves from 73 smallholder dairy farms, in Kenya, randomly selected and allocated to either intervention or control groups. The intervention group received nutritional advice and seedlings of Calliandra calothyrsus and Sesbania sesban, while the control group did not receive these interventions. Every 1-2 months for 16 months, data on farm nutritional practices and management were collected in a questionnaire, and physical examinations were done to monitor weight and health status. Descriptive and univariable statistical analyses were conducted, and multivariable mixed linear regression models were used for identification of factors associated (P < 0.05) with the natural log transformation of weight gain of calves on a given farm, controlling for clustering of visits within calves. Feeding at least 0.2 kg/day (wet weight) of Calliandra or Sesbania to calves <6 months old resulted in 33.2% increase in daily weight gain, while controlling for confounding by breed and sex of the calf. For calves ≥6 months, there was a significant interaction between amount of hay fed and if calves were also fed on Calliandra or Sesbania. When no Calliandra or Sesbania supplementation was provided, the mean weight gain was low and relatively constant even with increasing amounts of hay. When Calliandra or Sesbania supplement was added to the diet, the mean weight gain increased from 0.17 kg to 0.48 kg when hay was fed at 1 and 5 kg, respectively, while controlling for confounding by amount of maize silage fed and the prevailing season. In conclusion, supplementation of calf diets with at least 0.2 kg/calf/day of Calliandra or Sesbania is beneficial for faster weight gains.

11 beta-hydroxylase deficiency: management of a difficult case by laparoscopic bilateral adrenalectomy.

A 14-year-old girl presented with short stature and progressive virilization. She had not undergone the menarche. On investigation, she had elevated testosterone, androstenedione, dihydroepiandrosterone sulphate and 17 alpha-hydroxyprogesterone levels, which were all suppressed by overnight dexamethasone to within their normal ranges. An initial diagnosis of 21-hydroxylase deficiency was revised to 11 beta-hydroxylase deficiency after a tetracosactrin stimulation test, which showed only a modest rise in 17 alpha-hydroxyprogesterone level (from 92 nmol/l at baseline to 133 nmol/l at 60 minutes) and measurement of the basal 11-deoxycortisol, which was grossly elevated. Treatment with dexamethasone 0.5 mg nocte resulted in suppression of androgens in the daytime, but not in the evening, particularly androstenedione. Treatment with hydrocortisone 10 mg b.d. failed to suppress testosterone or androstenedione over a 24-hour period. Addition of cyproterone and oestrogen supplements had no effect and significant virilization persisted. Laparoscopic bilateral adrenalectomy was therefore performed as definitive treatment and resulted in remarkable clinical and biochemical improvement. This case illustrates difficulties in correct diagnosis, choice of appropriate steroid regimen and monitoring efficacy of treatment in congenital adrenal hyperplasia due to 11 beta-hydroxylase deficiency. More aggressive management with earlier bilateral adrenalectomy may be appropriate in selected cases.

Personalized versus usual care of previously uncontrolled hypertensive patients: an exploratory analysis.

This study was conducted to explore whether the quality of provider care may contribute to blood pressure reduction and whether other factors related to the treatment of hypertension may explain decline in blood pressure. In the study, 46 uncontrolled (greater than or equal to 140/90 mm Hg), medically treated hypertensive patients who received more personalized care differed significantly in the magnitude of blood pressure reduction from 36 usual-care patients (10/7 vs 2/2 mm Hg means for systolic and diastolic blood pressure reduction, respectively). About twice as many experimental patients as controls were reclassified as having "controlled" blood pressure, and this difference reached statistical significance. A multiple regression analysis for personalized-care subjects showed that no dynamic variables were related to blood pressure changes. It was postulated that more personalized care may have accounted for the significant difference between groups in blood pressure reduction. Similar personalized monitoring services might be important additions to usual medical care in order to control blood pressure more fully in high-risk hypertensive patients.