MRI Findings in Patients with Clinical Onset Consistent with Infantile Neuroaxonal Dystrophy (INAD), Literature Review, Clinical and MRI Follow-up

Infantile neuroaxonal dystrophy (INAD) is a rare autosomal recessive neurodegenerative disorder characterized by infantile onset and rapid progression of psychomotor regression and hypotonia evolving into spasticity. The neuroradiologic hallmark of the disease is represented by progressive cerebellar atrophy. Prior to the discovery of mutations in the PLA2G6 gene in family with INAD, the clinical diagnosis of the disease had been confirmed by the presence of spheroid bodies (SB) in a peripheral nerve biopsy. Various studies have found that some patients with mutations lacked SB and some without mutations had SB, indicating incomplete detection using either pathologic or molecular methods 7. This, together with the observation that the spectrum of clinical features associated with mutations in PLA2G6 is broader than previously described, has increased the usefulness of Magnetic Resonance (MR) in INAD diagnosis, particularly in the frequent occurrence of atypical cases, especially in the early stages of the disease. We retrospectively reviewed the MR studies of eight patients in whom clinical and imaging onset met the typical criteria for INAD. Their clinical and MR imaging (MRI) onset and follow-up were evaluated together with the neuroradiological findings reported in the literature in order to identify MRI features useful in differentiating INAD from other diseases with similar clinical onset and to discuss which of them are the most important, thus suggesting INAD diagnosis. Our contribution included the use of Proton Spectroscopy (1H-MR), diffusion weighted MR imaging (DWI) and diffusion tensor imaging (DTI) in the follow-up of seven of the eight patients. The literature reviewed included attempts to correlate clinical and MR data with the genotype in the group of patients carrying PLA2G6 mutations. From the limited and inhomogeneous cohort of patients included in our study, a correlation between the MR features, phenotype and genotype was not exhaustive.

[Treatment of acne in daily clinical practice: an opinion poll among Spanish dermatologists]

BACKGROUND AND OBJECTIVES

the aim of this study was to determine the approaches used to treat acne in clinical practice by Spanish dermatologists. A secondary objective of the study was to compare the practices of Spanish dermatologists with the Acne Global Alliance treatment algorithm and develop a Spanish treatment algorithm for acne.

PATIENTS AND METHODS

a multicenter, cross-sectional survey was undertaken among 872 Spanish dermatologists. The study comprised 4 randomly distributed questionnaires. The first 3 contained the following case descriptions: severe acne associated with masculinization (case 1), mild comedonal acne (case 2), and moderate papulopustular acne (case 3). The fourth questionnaire contained 5 photographs of different types of acne and an algorithm containing various treatment options, from which dermatologists were asked to choose the most appropriate.

RESULTS

for case 1, 55% of dermatologists chose oral antiandrogens/contraceptive drugs plus topical retinoids or topical benzoyl peroxide/antibiotics. In case 2, 62% chose topical retinoids and, in case 3, 68% chose systemic antibiotics plus benzoyl peroxide. Combination therapy was considered the treatment of choice in all types of acne, with topical retinoids as the initial treatment option for mild and moderate forms and the preferred option for maintenance therapy.

CONCLUSIONS

in general, Spanish dermatologists treat acne in accordance with the Acne Global Alliance treatment algorithm. The varying opinions reported in response to open questions, however, confirm the need to unify criteria for the treatment of acne.

How much does overweight impact the adolescent developmental process?

BACKGROUND

To analyse the associations between body mass index (BMI) and health-related behaviours among Portuguese adolescents based on the three waves of the Health Behaviour in School-aged Children (HBSC) survey conducted in Portugal.

METHODS

Data were derived from the three waves (1998, 2002 and 2006) of the World Health Organization collaborative cross-national survey HBSC, including 17, 024 public school students (6th, 8th and 10th grades). Separate analyses of the variables under study were individually conducted for each of the three waves of the survey, and for the total sample according to BMI (normal-weight and overweight/obese) using Chi square. At a second step, a multivariate logistic regression model was tested using all the variables that were significantly associated with normal or excess BMI values at a bivariate level, in order to determine whether they would predict being overweight, when controlling for all the others in the model.

RESULTS

Overweight adolescents reported their health as fair or poor more often, reported a poorer perception of academic achievement, were more likely than their peers to describe themselves as 'unhappy', and reported irritability or bad temper more often. According to our findings, being overweight can be predicted by being a male, being younger, having low body satisfaction, having a perception of poor academic achievement, of poor personal health and of being unhappy. Being overweight was not significantly predicted by the year of data collection.

CONCLUSIONS

Overweight adolescents were consistently far more likely to exhibit difficulties with their physical and emotional health when compared with their non-overweight peers. Although the effects of overweight on psychosocial functioning remain incompletely defined, they may constitute important determinants of overweight persistency, as well as have a detrimental effect on the adolescent's developmental process.

[Psychotropic treatment of psychodermatologic disorders]

Psychotropic drugs act by correcting the chemical changes associated with mental disorders and their symptoms. The use of such drugs in medical specialties other than psychiatry is not new and has been growing since a relationship has been demonstrated between mental states and the skin. Besides the so-called psychodermatoses, there are many skin diseases directly related to stress. For this reason, and in view of the reluctance of many patients to consult a psychiatrist, all dermatologists should have a basic understanding of the pharmacology and use of psychotropic drugs.

Sperm ultrastructure of the hydrothermal vent octopod Vulcanoctopus hydrothermalis

Sperm ultrastructure of the deep-sea hydrothermal vent octopod Vulcanoctopus hydrothermalis has been carried out by transmission electron microscopy. Spermatozoa of this species have the shortest head observed so far in octopodids. The acrosome possesses a helix with six gyres. The rod-shaped nucleus is short and wide in relation with other octopodids. Noteworthy features along the nucleus are the regularly disposed dense bands of cytoplasm, which have not been observed before in octopodids. The nuclear fossa is very short and wavy. Mitochondrial sheath has 10 elongated mitochondria running parallel to the axoneme-coarse fibers complex. Sperm morphology of V. hydrothermalis resembles that of Enteroctopus dofleini, suggesting a close phylogenetic relationship.

Validity of BMI based on self-reported weight and height in adolescents

AIM

To assess in a subset of a nationally representative sample of Portuguese adolescents, the validity of Body Mass Index (BMI) based on self-reported weight and height.

METHODS

This study included 462 students in grades 6, 8 and 10 (mean age 14.0 +/- 1.9 years) from 12 public schools randomly selected from the list of schools which took part in the 2006 Health Behaviour in School Aged Children Portuguese survey, corresponding to approximately 10% of the sample. Self-reported weight and height were recorded and then measured.

RESULTS

Prevalence of normal weight, overweight and obesity based on self-report compared with that of measured values was not significantly different for boys and girls, and among age groups. BMI based on measured weight and height was underestimated compared with BMI based on self-reported data, both among girls and boys. Larger limits of agreement were found for boys, indicating a higher variability of self-reported BMI in estimating measured BMI, specifically below the age of 14 years.

CONCLUSION

These data suggest that BMI based on self-reported weight and height is not accurate for BMI prediction at an individual level. However, self-reported BMI may be used as a simple and valid tool for BMI estimates of overweight and obesity in epidemiological studies.

Emotional, behavioural and social correlates of missing values for BMI

OBJECTIVE

To examine the emotional, behavioural and social correlates of missing values for body mass index (BMI) in a nationally representative sample of Portuguese youth.

DESIGN AND METHODS

6131 Portuguese public school students aged 11-16 years in 6th, 8th and 10th grades who participated in the 2002 HBSC/WHO survey of adolescent health were included. Those not reporting their weight and/or height were compared with their peers. Bivariate analyses of psychosocial and behavioural variables were conducted to compare the two groups. Multivariate logistic regression was used to determine if variables significantly associated with missing values for BMI at a bivariate level predicted missing BMI when controlling for all other variables in the model.

RESULTS

Of 6131 adolescents answering the questionnaire, 661 (10.8%) did not report their weight and/or height. Gender was not associated with missing BMI. Missing values were significantly predicted by younger age (adjusted odds ratio (aOR) = 2.56, 95% CI 1.99 to 3.29, p<0.001), sedentary lifestyle (aOR = 1.53, 95% CI 1.16 to 2.01, p<0.01), poor body satisfaction (aOR = 1.34, 95% CI 1.19 to 1.51, p<0.001), absence of father (aOR = 1.62, 95% CI 1.14 to 2.30, p<0.01), lack of friends of the opposite sex (aOR = 1.65, 95% CI 1.03 to 2.66, p<0.05) and poor perception of academic achievement (aOR = 1.23, 95% CI 1.06 to 1.42, p<0.01).

DISCUSSION

Our findings suggest that those with missing values for BMI tend to have poorer body image, poorer health behaviours and poorer social networks. These results have implications for potential bias in the results of studies that do not account for missing BMI.

[Management of acne in women over 25 years of age]

Acne is one of the most widespread skin diseases in the general population and among adolescents in particular. However, it is becoming increasingly common in patients over 25 years of age, and particularly in women. We distinguish 2 types of post adolescent acne: persistent acne--the most frequent such acne--is an extension of acne that began in adolescence and continues into adulthood, and late-onset acne, which first appears in those over 25 years. We review the clinical characteristics of these types of acne in women, the causes, the recommended complementary tests, and the particulars of treatment in order to adequately manage this condition.