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Introduction: Ultra-high field MR imaging offers marked gains in signal-to-noise ratio, spatial resolution, and contrast which translate to improved pathological and anatomical sensitivity. These benefits are particularly relevant for the neonatal brain which is rapidly developing and sensitive to injury. However, experience of imaging neonates at 7T has been limited due to regulatory, safety, and practical considerations. We aimed to establish a program for safely acquiring high resolution and contrast brain images from neonates on a 7T system., Methods: Images were acquired from 35 neonates on 44 occasions (median age 39 + 6 postmenstrual weeks, range 33 + 4 to 52 + 6; median body weight 2.93 kg, range 1.57 to 5.3 kg) over a median time of 49 mins 30 s. Peripheral body temperature and physiological measures were recorded throughout scanning. Acquired sequences included T2 weighted (TSE), Actual Flip angle Imaging (AFI), functional MRI (BOLD EPI), susceptibility weighted imaging (SWI), and MR spectroscopy (STEAM)., Results: There was no significant difference between temperature before and after scanning ( p = 0.76) and image quality assessment compared favorably to state-of-the-art 3T acquisitions. Anatomical imaging demonstrated excellent sensitivity to structures which are typically hard to visualize at lower field strengths including the hippocampus, cerebellum, and vasculature. Images were also acquired with contrast mechanisms which are enhanced at ultra-high field including susceptibility weighted imaging, functional MRI, and MR spectroscopy., Discussion: We demonstrate safety and feasibility of imaging vulnerable neonates at ultra-high field and highlight the untapped potential for providing important new insights into brain development and pathological processes during this critical phase of early life., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Bridgen, Tomi-Tricot, Uus, Cromb, Quirke, Almalbis, Bonse, De la Fuente Botella, Maggioni, Cio, Cawley, Casella, Dokumaci, Thomson, Willers Moore, Bridglal, Saravia, Finck, Price, Pickles, Cordero-Grande, Egloff, O'Muircheartaigh, Counsell, Giles, Deprez, De Vita, Rutherford, Edwards, Hajnal, Malik and Arichi.)

Background The benefits of using low-field-strength fetal MRI to evaluate antenatal development include reduced image artifacts, increased comfort, larger bore size, and potentially reduced costs, but studies about fetal low-field-strength MRI are lacking. Purpose To evaluate the reliability and feasibility of low-field-strength fetal MRI to assess anatomic and functional measures in pregnant participants using a commercially available 0.55-T MRI scanner and a comprehensive 20-minute protocol. Materials and Methods This prospective study was performed at a large teaching hospital (St Thomas' Hospital; London, England) from May to November 2022 in healthy pregnant participants and participants with pregnancy-related abnormalities using a commercially available 0.55-T MRI scanner. A 20-minute protocol was acquired including anatomic T2-weighted fast-spin-echo, quantitative T2*, and diffusion sequences. Key measures like biparietal diameter, transcerebellar diameter, lung volume, and cervical length were evaluated by two radiologists and an MRI-experienced obstetrician. Functional organ-specific mean values were given. Comparison was performed with existing published values and higher-field MRI using linear regression, interobserver correlation, and Bland-Altman plots. Results A total of 79 fetal MRI examinations were performed (mean gestational age, 29.4 weeks ± 5.5 [SD] [age range, 17.6-39.3 weeks]; maternal age, 34.4 years ± 5.3 [age range, 18.4-45.5 years]) in 47 healthy pregnant participants (control participants) and in 32 participants with pregnancy-related abnormalities. The key anatomic two-dimensional measures for the 47 healthy participants agreed with large cross-sectional 1.5-T and 3-T control studies. The interobserver correlations for the biparietal diameter in the first 40 consecutive scans were 0.96 (95% CI: 0.7, 0.99; P = .002) for abnormalities and 0.93 (95% CI: 0.86, 0.97; P < .001) for control participants. Functional features, including placental and brain T2* and placental apparent diffusion coefficient values, strongly correlated with gestational age (mean placental T2* in the control participants: 5.2 msec of decay per week; R 2 = 0.66; mean T2* at 30 weeks, 176.6 msec; P < .001). Conclusion The 20-minute low-field-strength fetal MRI examination protocol was capable of producing reliable structural and functional measures of the fetus and placenta in pregnancy. Clinical trial registration no. REC 21/LO/0742 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Gowland in this issue.

Objective An inguinal hernia is a common condition associated with advanced age, male gender, smoking, connective tissue disorder, and factors responsible for increased intra-abdominal pressure. This study aimed to observe the relationship of body mass index with the development of inguinal hernia in males and females. Methodology This cross-sectional descriptive study using a non-probability convenient sampling technique was carried out at Al-Tibri medical college and hospital, Karachi, Pakistan. A total of 82 patients were selected: 78 males and four females. The ethical approval for the study was taken from Institutional Research and Ethical Committee. Inclusion criteria based on the patient age above 40 of either gender with complaints of pain in the groin region with clinical findings like swelling and tenderness. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM Inc., Armonk, USA). Results The mean age of 82 patients diagnosed with an inguinal hernia on a clinical basis was 47.41 ± 15.49 years. The mean height was 67.09 ± 3.95 inches. The mean weight was 63.5 ± 6.77 kg. The mean BMI was 22.07 ± 2.17 kg/m 2 . Seventy-eight (96.06%) were males, and four (5.9%) were females. Thirty-four (41.5%) patients were diagnosed with right inguinal hernia, 34 (41.5%) - with a left inguinal hernia, and 14 (17.1%) - with a bilateral inguinal hernia. BMI was normal in 68 (86.3%) and low in 14 (20.55%) patients. Our study indicated that patients with normal BMI were more likely to suffer from inguinal hernia than patients with low BMI. Conclusion This study concluded that the normal body mass index was associated with a high occurrence of inguinal hernia among the genders. The normal body mass index in males exhibits more inguinal hernia chances than a low body mass index. It was observed that the frequency of unilateral right inguinal hernia is higher than bilateral. Similarly, males are more affected than females., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Melwani et al.)

Prenatal detection of congenital heart disease facilitates the opportunity for potentially life-saving care immediately after the baby is born. Echocardiography is routinely used for screening of morphological malformations, but functional measurements of blood flow are scarcely used in fetal echocardiography due to technical assumptions and issues of reliability. Magnetic resonance imaging (MRI) is readily used for quantification of abnormal blood flow in adult hearts, however, existing in utero approaches are compromised by spontaneous fetal motion. Here, we present and validate a novel method of MRI velocity-encoding combined with a motion-robust reconstruction framework for four-dimensional visualization and quantification of blood flow in the human fetal heart and major vessels. We demonstrate simultaneous 4D visualization of the anatomy and circulation, which we use to quantify flow rates through various major vessels. The framework introduced here could enable new clinical opportunities for assessment of the fetal cardiovascular system in both health and disease.

Objective The aim of this study is to determine the frequency and risk factors for hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (Anti-HCV) in a preoperative screening of patients admitted at the surgical unit of Al-Tibri Medical College and Hospital and Lyari General Hospital, Karachi. Materials and methods This study was conducted at the surgical units of Al-Tibri Medical College Hospital and Lyari General Hospital, Karachi. This study was conducted for six months from 30th June 2017 to 31st December 2017. This observational study was performed using a non-probability convenient sampling technique. All patients who were undergoing elective and emergency surgical procedure were selected for the study and screened for HBsAg and anti-HCV by immunochromatographic test (ICT) method at the hospital laboratory. The risk factors identified as parenteral injections, past surgical procedure, blood transfusion, etc. along with demographic data as age, gender, and district residential status were recorded on a specially designed proforma. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23. Descriptive statistics were applied, and the qualitative data were expressed as the mean and standard deviation. Results Among a total of 360 patients included in the study, 63 (21.38%) were found with anti-HCV positive, and 14 (3.88%) were HBsAg positive with none of the patients found to have co-infection. The male-to-female ratio was 2.3:1. The mean age of patients was 32.34±4.3 years. The age range affected commonly in the study population was 21-30 years, 24(31%). The commonest risk factor for transmission of viral infection was parenteral injection abuser 31(40.2%), followed by surgical procedure 13(18.1%), blood transfusion 10(12.9%), and barber shave 7(9.1%). Conclusion It was predicted in our study that hepatitis C was more common in patients screened preoperatively for surgery. However, the most frequent risk factor in these patients was parenteral abuse history. The preoperative screening is an important investigative tool for the identification of silent cases in the community for preventive measures adoption and treatment for silent carriers., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Malik et al.)

Objective: To produce a strategic roadmap for supporting the development of dementia research in Pakistan., Background: While global research strategies for dementia research already exist, none is tailored to the specific needs and challenges of low- and middle-income countries (LMIC) like Pakistan., Methods: We undertook an iterative consensus process with lay and professional experts to develop a Theory of Change-based strategy for dementia research in Pakistan. This included Expert Reference Groups (ERGs), strategic planning techniques, a "research question" priority survey, and consultations with Key Opinion Leaders., Results: We agreed on ten principles to guide dementia research in Pakistan, emphasizing pragmatic, resource sparing, real-world approaches to support people with dementia, both locally and internationally. Goals included capacity/capability building. Priority research topics included raising awareness and understanding of dementia, and improving quality of life., Conclusion: This roadmap may be a model for other LMIC health ecosystems with emerging dementia research cultures., (© 2019 The Authors.)

Geometric distortion induced by the main B0 field disrupts the consistency of fetal echo planar imaging (EPI) data, on which diffusion and functional magnetic resonance imaging is based. In this paper, we present a novel data-driven method for simultaneous motion and distortion correction of fetal EPI. A motion-corrected and reconstructed T2 weighted single shot fast spin echo (ssFSE) volume is used as a model of undistorted fetal brain anatomy. Our algorithm interleaves two registration steps: estimation of fetal motion parameters by aligning EPI slices to the model; and deformable registration of EPI slices to slices simulated from the undistorted model to estimate the distortion field. The deformable registration is regularized by a physically inspired Laplacian constraint, to model distortion induced by a source-free background B0 field. Our experiments show that distortion correction significantly improves consistency of reconstructed EPI volumes with ssFSE volumes. In addition, the estimated distortion fields are consistent with fields calculated from acquired field maps, and the Laplacian constraint is essential for estimation of plausible distortion fields. The EPI volumes reconstructed from different scans of the same subject were more consistent when the proposed method was used in comparison with EPI volumes reconstructed from data distortion corrected using a separately acquired B0 field map.

Summary: Fetal and neonatal MR imaging is increasingly used as a complementary diagnostic tool to sonography. MR imaging is an ideal technique for imaging fetuses and neonates because of the absence of ionizing radiation, the superior contrast of soft tissues compared with sonography, the availability of different contrast options, and the increased FOV. Motion in the normally mobile fetus and the unsettled, sleeping, or sedated neonate during a long acquisition will decrease image quality in the form of motion artifacts, hamper image interpretation, and often necessitate a repeat MR imaging to establish a diagnosis. This article reviews current techniques of motion compensation in fetal and neonatal MR imaging, including the following: 1) motion-prevention strategies (such as adequate patient preparation, patient coaching, and sedation, when required), 2) motion-artifacts minimization methods (such as fast imaging protocols, data undersampling, and motion-resistant sequences), and 3) motion-detection/correction schemes (such as navigators and self-navigated sequences, external motion-tracking devices, and postprocessing approaches) and their application in fetal and neonatal brain MR imaging. Additionally some background on the repertoire of motion of the fetal and neonatal patient and the resulting artifacts will be presented, as well as insights into future developments and emerging techniques of motion compensation.

We use data from the 1931, 1941, and 1951 censuses of India and the 1951 census of Pakistan to examine the demographic consequences of Partition in the Punjab in 1947. Had growth rates for the period 1931-41 for the Punjab as a whole continued to 1951, the population of the Punjab would have been 2.9 million larger than that recorded in 1951. Population losses from migration and mortality above age 20 were approximately 2.7 million greater between 1941 and 1951 than would have been predicted by loss rates between 1931 and 1941. We estimate a net Partition-related population movement out of the combined Punjab of about 400,000. We conclude from several lines of analysis that Partition-related population losses in the Punjab, either from deaths or unrecorded migration, were in the range 2.3-3.2 million. Partition was also marked by a dramatic religious homogenization at the district level.

Objectives: To document the circumstances and care of patients with schizophrenia who had recently been discharged from local psychiatric inpatient services, and to establish the extent to which misgivings about community care might be justified., Design: Cross sectional surveys with review of case notes. Follow up interviews with questionnaires administered one year after discharge., Setting: Two inner London districts (West Lambeth and Lewisham) with high levels of social deprivation and at different stages of developing community services., Patients: 90 and 50 patients in the two services respectively, aged 18 to 65, who satisfied the Research Diagnostic Criteria for schizophrenia and who were discharged from inpatient services., Main Outcome Measures: Diagnosis elicited by present state examination, global social disability rating, use of services during the three months before interview., Results: 89 of the 140 patients (64%) had been ill for five or more years, yet few were former long stay inpatients. 55% (50/91; 95% confidence interval 45% to 65%) of those interviewed had current psychotic mental states and 22% (27/124; 16% to 31%) were functioning socially at very poor or severely maladjusted levels. 86% (107/124) were unemployed. The majority of patients had seen a mental health or social service professional, yet only 16% (20/124) were in specialised accomodation (excluding hospitals) and only 23% (17/73) of those eligible had used day care. Small numbers of people had experienced homelessness (two) or imprisonment (four over six months)., Conclusions: Many schizophrenic patients leaving local psychiatric inpatient care have active symptomatology and profound social disabilities. Community care was characterised by high rates of contact with service professionals but little supported accommodation or day activity. This group of clients may require dedicated provision, which would actively encourage them to use services protected from the demands of those with less severe illness.