Prenatal diagnosis of congenital head,face, and neck malformations—Is complementary fetal MRI of value?

Objectives

The aim of this study was to evaluate the role of fetal magnetic resonance imaging (MRI) as a complement to ultrasound (US) in the prenatal diagnosis of craniofacial anomalies.

Methods

A historical cohort study including all pregnant women who were referred for fetal MRI because of antenatal diagnosis of craniofacial anomalies on screening US. Prenatal diagnostic US, MRI, and postnatal diagnosis were compared for consistencies and discrepancies.

Results

Forty-five pregnant women with 73 suspected fetal craniofacial anomalies diagnosed by US underwent MRI. In 40 out of 73 anomalies (54.8%), US and MRI findings were in complete agreement with postnatal diagnoses. MRI correctly ruled out the diagnosis of 24 anomalies suspected on US and diagnosed four additional pathologies that were not demonstrated by US. Out of the 85 anomalies (suspected by imaging or confirmed postnatally), confident diagnosis could be made by MRI in 68 anomalies (80%), not diagnosed in 10 (11.8%), and over-diagnosed in seven (8.2%). By US, confident diagnosis could be made in 44 anomalies (51.8%), not diagnosed in 11 (12.9%), and over-diagnosed in 30 (35.3%).

Conclusion

MRI is valuable in the antenatal evaluation of fetal craniofacial anomalies and may be useful as an adjunct to US in the prenatal work-up of craniofacial anomalies.     

Geographic shifts in the highland cooking banana (Musa spp., group AAA-EA) production in Uganda

Summary

Between 1970 and 1990 Uganda witnessed the decline of the highland cooking banana from traditional growing areas in the central region, coupled with crop expansion in the country's southwest. Apprehension that the factors leading to loss of sustainability in the central region may be replayed in extant production areas has raised concern about the future of the cooking banana in Uganda. Consequently, a multi-disciplinary study was conducted at nine central and six southwestern sites to document shifts in cooking banana production and to elucidate the causes behind these shifts.

Cooking banana production in central Uganda sites fell from 18% of total food crop and 7% of total cash crop production in the 1970s to 4% and 2%, respectively, in the 1990s. Farmers identified reduced labour availability and management, increasing pest pressure and declining soil nutrient status as the major causes of decline. On-farm verification confirmed farmers' observations: weevil levels were the highest yet found in Uganda, while foliar samples indicated deficiencies in magnesium, nitrogen, and potassium. Soil nutrient deficiencies, however, appear to be a direct outcome ofreduced management rather than ‘soil exhaustion’ as postulated by farmers.

In southwestern Uganda, the importance of the cooking banana as a cash crop has quadrupled since 1970. Banana first penetrated the region because of its ease of production and stability of yield. High yields attracted traders and urban market demand drove further crop expansion. With current market incentives, banana management standards have been high. Under current levels of management, it is unlikely that farmers in southwestern Uganda will experience a similar process of decline as that which occurred in the central region. However, concern remains aboqt lack of replenishment of nutrients leaving the farm in the form of fruits sold for market, a nutrient loss which may eventually lead to non-sustainability of the cropping system.