Epidemiology of Brain and Other CNS Tumors

Purpose of Review Brain and other central nervous system (CNS) tumors, while rare, cause significant morbidity and mortality across all ages. This article summarizes the current state of the knowledge on the epidemiology of brain and other CNS tumors. Recent Findings For childhood and adolescent brain and other CNS tumors, high birth weight, non-chromosomal structural birth defects and higher socioeconomic position were shown to be risk factors. For adults, increased leukocyte telomere length, proportion of European ancestry, higher socioeconomic position, and HLA haplotypes increase risk of malignant brain tumors, while immune factors decrease risk. Summary Although no risk factor accounting for a large proportion of brain and other CNS tumors has been discovered, the use of high throughput “omics” approaches and improved detection/measurement of environmental exposures will help us refine our current understanding of these factors and discover novel risk factors for this disease.

A Healthy Lifestyle Offsets the Increased Risk of Childhood Obesity Caused by High Birth Weight: Results From a Large-Scale Cross-Sectional Study

Objective: To investigate whether a healthy lifestyle is associated with the lower childhood obesity regardless of birth weight.Methods: Participants were selected from a large-scale cross-sectional study conducted in the seven provinces across China. Birth weight and lifestyle factors were collected through a questionnaire. A weighted healthy lifestyle score was calculated and categorized into favorable, intermediate, and unfavorable lifestyles.Results: A total of 47,768 participants were enrolled in this study. Overall, 16.4% of the participants followed a favorable lifestyle, 62.8% followed an intermediate lifestyle, and 20.8% followed an unfavorable lifestyle. Compared with the participants who were born normal birth weight (NBW), participants who were born high birth weight (HBW) (OR = 1.58; 95% CI 1.48–1.77) and very high birth weight (VHBW) (OR = 1.79; 95% CI: 1.47–2.18) had higher obesity risk, however, the participants who were born low birth weight (LBW) had lower obesity risk (OR = 0.81; 95% CI: 0.68–0.96). Participants with an unfavorable lifestyle were associated with a higher risk of childhood obesity compared with the participants with favorable lifestyle (OR = 1.25; 95%CI: 1.14–1.38). Participants who were born VHBW and with an unfavorable lifestyle had 2.76 times (95% CI: 1.78–4.28) further risk of childhood obesity compared with the participants who were born NBW and with a favorable lifestyle. However, adherence to a favorable lifestyle seems to counteract the elevated risk of childhood obesity by VHBW (OR = 1.37; 95% CI: 0.84–2.24).Conclusion: Both the HBW and unfavorable lifestyle were significantly associated with risk of childhood obesity. Adherence to a favorable lifestyle decreased the risk of childhood obesity among the participants with VHBW. A more longitudinal study is required to repeat the finding to inform tailored prevention programs.

Features of childhood growth, lifestyle and environment associated with a cardiometabolic risk score in young adults

Introduction: In young adults, the metabolic syndrome is rare. To better assess the risks for future cardiovascular disease, a cardiometabolic score can be used, ranking the disease risk in each subject. The score is a continuous variable summarising the individual z-scores for waist circumference, blood pressure, blood levels of glucose, triglycerides and HDL-cholesterol. Our main aim was to assess the association between early childhood growth and the cardiometabolic score in young adults. Methods: Study participants were recruited among subjects in the longitudinal population-based GrowUp 1990 Gothenburg study. Those with information on weight and length at birth, as well as weight, height, waist circumference, and parental BMI at ten years of age were invited to participate in a health survey at 18-20 years of age. 513 young adults (female 51%) were included. Multivariable linear stepwise regression analysis was applied. Results: The mean (SD) BMI was 22.2 (3.26) in males and 21.3 (2.69) kg/m² in females; the cardiometabolic score was 0.24 (3.12) and -0.22 (3.18), respectively. A statistically significantly higher score (p<0.001) was seen in individuals with metabolic syndrome, as defined by IDF. After controlling for adult lifestyle features, BMI z-score at ten years of age was significant risk factor in both sexes for an elevated cardiometabolic score in early adulthood, mean(SE) beta 0.47(0.19), p=0.014 in males, 0.82(017) p<0.0001 in females. In males, high maternal BMI and low age at adiposity rebound and in females high birth weight were also associated with a statistically significant risk. Additionally, contraceptive use in females was a risk factor for elevated cardiometabolic score and, in males a high lifestyle related index score showed a protective association with the cardiometabolic score. Conclusion: A high BMI z-score at ten years of age is a risk factor for the cardiometabolic state in young adults, an outcome points to the preventive potential of monitoring BMI in ten-year-old schoolchildren. This finding must however be validated in a new large cohort. Moreover, in young adults in whom metabolic syndrome is rare, a cardiometabolic score seems to be a promising approach and potentially a more powerful tool to detect risks for cardiovascular disease later in life, than using metabolic syndrome categorisation.

Effect of the Obesity on Maternal and Fetal Outcome in Pregnant Women Presenting to Tertiary Care Hospital

Background: Obesity is well considered a well known risk factor for obstetric complications like pre eclampsia, gestational diabetes mellitus, intrauterine death, dysfunctional labour, meconium stained amniotic fluid, cesarean section, high birth weight and shoulder dystocia. The objective of this study was to determine the frequency of maternal and fetal outcome in obese pregnant women. Material and Methods: This descriptive case series study was conducted in department of obstetrics and gynaecology, FGPC, Islamabad from Aug 1, 2017 to Feb 1, 2018. A total of 250 consecutive antenatal women with BMI > 30 Kg/m2 were included in the study. BMI was calculated according to weight and height of the patient using the formula Kg/m2. RESULTS: Out of 250 primigravidas , 84.4% had BMI of 30-35 Kg/m2 and 15 % BMI of 36-40 Kg/m2 . Gestational diabetes was diagnosed in 51 (20.4%) cases. Preeclampsia was observed in 12 (4.8%) patients. Seventy pts (28%) patients ended on cesarean section, 21 (8.4%) cases had induction of labour and 9 (3.6%) had pre term birth. Apgar score (>7) was seen in 61 (24.4%) cases. Macrosomia was observed in 55 (22%) cases. 20 (8%) patients had stillbirth. Conclusions: Maternal obesity in pregnancy is associated with high maternal and fetal complications. Keywords: complications. fetal, maternal; morbidity ,Obesity, overweight-; risk factors

Obstetric Anal Sphincter Injuries – Maternal, Foetal and Sociodemographic Risk Factors: A Retrospective Register-Based Study

Objective. To determine risk and protective factors of obstetric anal sphincter injuries (OASIS). Design. A retrospective register-based observational study. Setting. Sweden. Population. A cohort of 988, 988 singleton term deliveries 2005-2016 were included. Methods. Data from the Swedish Medical Birth Registry and Statistics Sweden were extracted to identify cases of OASIS and maternal and foetal characteristics. Modified Poisson Regression analyses were performed to assess risk factors. Main outcome measures. Risk ratios for OASIS with 95% confidence interval associated with maternal and foetal risk factors were calculated. Results. The rate of OASIS was 3.5% (n=34, 583). Primiparity (aRR 3.13 95% CI 3.05–3.21), vacuum extraction (aRR 2.79 95% CI 2.73–2.86), forceps (aRR 4.27 95% CI 3.86–4.72) and high birth weight (aRR 2.61 95% CI 2.50–2.72) were associated with a significantly increased risk of OASIS. Increasing maternal age and decreasing maternal height increased the risk of OASIS. Smoking (aRR 0.74 95% CI 0.70–0.79) and low maternal education (aRR 0.87 95% CI 0.83–0.92) were associated with a decreased frequency of reported OASIS. Obesity decreased the risk of OASIS (aRR 0.90 95% CI 0.87–0.94), but only after adjusting for foetal birth weight. Previous caesarean section increased the risk of OASIS (aRR 1.41; 95% CI 1.36–1.47). Conclusion. Primiparity, instrumental delivery and high birth weight increased the risk of OASIS. Risk factors including BMI, height, age, smoking, maternal education, ethnicity and previous caesarean section also contribute to the overall risk of OASIS. Keywords. Obstetric sphincter injuries, risk factors, pregnancy.

Predictive risk factors for the development of diseases with lymphoproliferative syndrome in children

Background. Harmful environmental factors and negative social trends have an adverse effect on the adaptive resources of the child’s body, which in combination reduces the health index in the child population. An ambiguous epidemiological situation, an increase in morbidity rates in children, a variety of clinical manifestations of Epstein – Barr viral infection, recurrent respiratory diseases, adenovirus infection complicate their differential diagnosis in the early stages. In this regard, the assessment of risk factors and early prognosis of the development of primary form of Epstein – Barr viral infection (EBVI), recurrent respiratory diseases (RRD), adenovirus infection (ADVI) in children is an urgent task.The aim: to study the significance of risk factors influencing the development of diseases with lymphoproliferative syndrome in children.Materials and methods. Clinical and laboratory examination and analysis of case histories of 336 children and adolescents held with diseases with lymphoproliferative syndrome. Data from 30 apparently healthy children and adolescents of the same age were used as a comparison group. The Bayesian method with sequential Wald analysis was used to assess risk factors. ROC-analysis was used to check the adequacy of the forecasting models. The quality of the built models was evaluated by their sensitivity and specificity.Results. It has been established that predictors of diseases with lymphoproliferative syndrome in children are intrauterine fetal hypoxia, low or, on the contrary, high birth weight, neonatal jaundice, low Apgar score, as well as maternal factors (somatic pathology and SARS during pregnancy, gestosis, gestational anemias, young or mature age of the pregnant women). Additional predictors of the development of this pathology can be considered a decrease in the indicator of the cell-phagocytic potential to 337.1 ± 2.3 CU, a decrease in the immune-lymphocytic potential to 237.0 ± 8.2 CU, an increase in the load-erythrocyte coefficient to 0.67 ± 0.03 CU and a decrease in the leukocyte index of intoxication to 0.40 ± 0.05 CU.Conclusion. The combination of clinical and anamnestic factors with indicators of general reactive potential increases the integral general informative value of the prognostic model. The accounting by specialists of the general medical and preventive network of the identified predictors of the development of diseases with lymphoproliferative syndrome will contribute to the timely diagnosis of the primary form of Epstein – Barr viral infection, recurrent respiratory diseases and adenovirus infection in children.

Early life factors in relation to albuminuria and estimated glomerular filtration rate based on cystatin C and creatinine in adults from a Swedish population-based cohort study

Background Early life factors influence the number of nephrons a person starts life with and a consequence of that is believed to be premature kidney ageing. Thus, we aimed to identify early life factors associated with cystatin C and creatinine-based estimated glomerular filtration (eGFR) rate equations and urine -albumin-to-creatinine ratio after a follow-up of 46–67 years. Methods The study included 593 Swedish subjects without diabetes mellitus from the Malmo Diet Cancer Cohort. Perinatal data records including birth weight, gestational age, placenta weight and maternal related risk factors were analysed. eGFR was determined by Chronic Kidney Disease Epidemiology (CKD-EPI), the Lund-Malmö revised and Caucasian, Asian, Paediatric, and Adult (CAPA) equations. Postnatal growth phenotypes were defined as low (≤ 0) or high (> 0) birth weight z-score, or low (≤ median) or high (> median) body mass index at 20 years of age. Results In women, lower birth weight was associated with lower eGFR (CAPA; CKD-EPI cystatin C). Birth weight z-score predicted adult albuminuria specifically in men (OR 0.75, 95% CI [0.58; 0.96]). Women with high birth weight z-score and low BMI at 20 years had lower eGFR (CAPA; CKD-EPI cystatin C; p = 0.04). Men with high birth weight z-score and high BMI at 20 years had lower risk for albuminuria (OR 0.35, 95% CI [0.12; 0.93]). Conclusions Lower birth weight, prematurity and postnatal growth curve have a potential sex- specific effect of early exposure to an adverse environment on lower cystatin C-based eGFR and albuminuria later in life. Cystatin C compared to creatinine -eGFR equations shows a higher ability to detect these findings. Graphic abstract

High Birth Weight Increases the Chance of Mortality in Girolando Calves 2 Conceived Through in Vitro Fertilization

The aim of this study was to determine zootechnical and health performance of Girolando calves born with high or low birth weight, and compare metabolic parameters between groups. The study was carried out on a commercial dairy farm located in Passos, Minas Gerais, Brazil. In this sense, a hundred Girolando calves were divided into 2 groups: Control, which consisted of calves that were born weighing ≤ 35 kg; and HBW, calves that were born weighing > 35 kg. Calves were monitored for zootechnical parameters; epidemiological indexes such as morbidity, mortality, recurrence of diarrhea, pneumonia; as well as serum concentrations of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, cholesterol, triglycerides, paraoxonase1, albumin, urea and globulin). Calves from the HBW group had a higher mortality rate as well as a tendency to more cases of pneumonia, but no effect on zootechnical performance was seen. The reasons for the differences in mortality need to be clarified since our study found no changes in biochemical parameters between the groups. The results allow us to conclude that Girolando calves from in vitro fertilization that are born heavier have a greater chance of clinical complications and a higher mortality rate, but the birth weight does not influence the zootechnical performance.

Prevalence of Low Birth Weight Neonates during COVID-19 Pandemic in a Tertiary Care Hospital at Larkana, Sindh, Pakistan

In comparison to other middle-income countries, Pakistan has a high prevalence of low birth weight. Currently the situation has worsened because of the COVID-19 pandemic where stress can have a negative impact on intrauterine development, leading to a rise in preterm birth rates and the incidence of low birth weight babies. The goal of this study is to estimate the prevalence of low birth weight in a tertiary care hospital in Larkana, Sindh, Pakistan, during the COVID-19 pandemic. In this cross-sectional study, the hospital records of two thousand, two hundred and seventy eight neonates were analyzed from patients’ data register for the year 2020. Data were analyzed using Microsoft Excel spread sheet. Of 2278 children admitted to the neonatal ward, only 29.2% babies had birth weight within normal range, 0.7% neonates were high birth weight, and the rest of the admitted babies (70.1%) during the year 2020 had birth weight below 2500 grams. Smallest birth weight observed in the study was 0.9 kg and 4.8 kg was highest birth weight (mean 2.35 kg, SD 0.88, SE 0.012). Female neonates were 895 (39.3%) and the rest of the 1383 (60.7%) babies were male. This study revealed that in Sindh province of Pakistan, the prevalence of low birth weight is extremely high during COVID-19 pandemic. Therefore, the findings suggest that there is need for a lot more emphasis on improving maternal mental health, nutrition and several other relevant factors to reduce the prevalence of low birth weight.