Valor diagnòstic de les lesions medul·lars a les síndromes neurològiques aïllades.

L’objectiu del treball és determinar la prevalença de lesions desmielinitzants a la medul·la espinal a les síndromes neurològiques aïllades i el valor afegit de la ressonància magnètica medul·lar. Es van incloure 113 pacients amb síndromes neurològiques aïllades a l’estudi. Els criteris diagnòstics d’esclerosi múltiple de McDonald 2005 es complien en un 43% dels pacients quan només eren valorades les lesions cerebrals, incrementant-se fins el 46% quan les lesions medul·lars eren també valorades. Aquests percentatges, en pacients amb síndromes neurològiques aïllades variaven del 47% al 53%. Com a conclusió considerem que la realització d’RM medul·lar als pacients amb síndromes neurològiques aïllades té una escassa contribució en la demostració de disseminació en l’espai, suggerint que no caldria realitzar una RM medul·lar als pacients amb síndrome neurològica aïllada no medul·lar, però es podria considerar quan les troballes cerebrals per RM no siguin concluents per a establir el diagnòstic d’Esclerosi Múltiple segons els criteris de McDonald 2005.

Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders

Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders - NICE Guidance

Thin healthy women have a similar low bone mass to women with anorexia nervosa.

An association between anorexia nerviosa (AN) and low bone mass has been demonstrated. Bone loss associated with AN involves hormonal and nutritional impairments, though their exact contribution is not clearly established. We compared bone mass in AN patients with women of similar weight with no criteria for AN, and a third group of healthy, normal-weight, age-matched women. The study included forty-eight patients with AN, twenty-two healthy eumenorrhoeic women with low weight (LW group; BMI < 18.5 kg/m2) and twenty healthy women with BMI >18.5 kg/m2 (control group), all of similar age. We measured lean body mass, percentage fat mass, total bone mineral content (BMC) and bone mineral density in lumbar spine (BMD LS) and in total (tBMD). We measured anthropometric parameters, leptin and growth hormone. The control group had greater tBMD and BMD LS than the other groups, with no differences between the AN and LW groups. No differences were found in tBMD, BMD LS and total BMC between the restrictive (n 25) and binge-purge type (n 23) in AN patients. In AN, minimum weight (P = 0.002) and percentage fat mass (P = 0.02) explained BMD LS variation (r2 0.48) and minimum weight (r2 0.42; P = 0.002) for tBMD in stepwise regression analyses. In the LW group, BMI explained BMD LS (r2 0.72; P = 0.01) and tBMD (r2 0.57; P = 0.04). We concluded that patients with AN had similar BMD to healthy thin women. Anthropometric parameters could contribute more significantly than oestrogen deficiency in the achievement of peak bone mass in AN patients.

Executive functions profile in extreme eating/weight conditions: from anorexia nervosa to obesity.

BACKGROUND Extreme weight conditions (EWC) groups along a continuum may share some biological risk factors and intermediate neurocognitive phenotypes. A core cognitive trait in EWC appears to be executive dysfunction, with a focus on decision making, response inhibition and cognitive flexibility. Differences between individuals in these areas are likely to contribute to the differences in vulnerability to EWC. The aim of the study was to investigate whether there is a common pattern of executive dysfunction in EWC while comparing anorexia nervosa patients (AN), obese subjects (OB) and healthy eating/weight controls (HC). METHODS Thirty five AN patients, fifty two OB and one hundred thirty seven HC were compared using the Wisconsin Card Sorting Test (WCST); Stroop Color and Word Test (SCWT); and Iowa Gambling Task (IGT). All participants were female, aged between 18 and 60 years. RESULTS There was a significant difference in IGT score (F(1.79); p<.001), with AN and OB groups showing the poorest performance compared to HC. On the WCST, AN and OB made significantly more errors than controls (F(25.73); p<.001), and had significantly fewer correct responses (F(2.71); p<.001). Post hoc analysis revealed that the two clinical groups were not significantly different from each other. Finally, OB showed a significant reduced performance in the inhibition response measured with the Stroop test (F(5.11); p<.001) compared with both AN and HC. CONCLUSIONS These findings suggest that EWC subjects (namely AN and OB) have similar dysfunctional executive profile that may play a role in the development and maintenance of such disorders.

Changes in Body Composition in Anorexia Nervosa: Predictors of Recovery and Treatment Outcome.

The restoration of body composition (BC) parameters is considered to be one of the most important goals in the treatment of patients with anorexia nervosa (AN). However, little is known about differences between AN diagnostic subtypes [restricting (AN-R) and binge/purging (AN-BP)] and weekly changes in BC during refeeding treatment. Therefore, the main objectives of our study were twofold: 1) to assess the changes in BC throughout nutritional treatment in an AN sample and 2) to analyze predictors of BC changes during treatment, as well as predictors of treatment outcome. The whole sample comprised 261 participants [118 adult females with AN (70 AN-R vs. 48 AN-BP), and 143 healthy controls]. BC was measured weekly during 15 weeks of day-hospital treatment using bioelectrical impedance analysis (BIA). Assessment measures also included the Eating Disorders Inventory-2, as well as a number of other clinical indices. Overall, the results showed that AN-R and AN-BP patients statistically differed in all BC measures at admission. However, no significant time×group interaction was found for almost all BC parameters. Significant time×group interactions were only found for basal metabolic rate (p = .041) and body mass index (BMI) (p = .035). Multiple regression models showed that the best predictors of pre-post changes in BC parameters (namely fat-free mass, muscular mass, total body water and BMI) were the baseline values of BC parameters. Stepwise predictive logistic regressions showed that only BMI and age were significantly associated with outcome, but not with the percentage of body fat. In conclusion, these data suggest that although AN patients tended to restore all BC parameters during nutritional treatment, only AN-BP patients obtained the same fat mass values as healthy controls. Put succinctly, the best predictors of changes in BC were baseline BC values, which did not, however, seem to influence treatment outcome.

Blood levels of brain-derived neurotrophic factor correlate with several psychopathological symptoms in anorexia nervosa patients

Background: Evidence of a role of brain-derived neurotrophic factor (BDNF) in the pathophysiology of eating disorders (ED) has been provided by association studies and by murine models. BDNF plasma levels have been found altered in ED and in psychiatric disorders that show comorbidity with ED. Aims: Since the role of BDNF levels in ED-related psychopathological symptoms has not been tested, we investigatedthe correlation of BDNF plasma levels with the Symptom Checklist 90 Revised (SCL-90R) questionnaire in a total of 78 ED patients. Methods: BDNF levels, measured bythe enzyme-linked immunoassay system, and SCL-90R questionnaire, were assessed in a total of 78 ED patients. The relationship between BDNF levels and SCL-90R scales was calculated using a general linear model. Results: BDNF plasma levels correlated with the Global Severity Index and the Positive Symptom Distress Index global scales and five of the nine subscales in the anorexia nervosa patients. BDNF plasma levels were able to explain, in the case of the Psychoticism subscale, up to 17% of the variability (p = 0.006). Conclusion: Our data suggest that BDNF levels could be involved in the severity of the disease through the modulation of psychopathological traits that are associated with the ED phenotype.

Significados atribuídos por puérperas às síndromes hipertensivas da gravidez e nascimento prematuro

Este estudo objetivou compreender os significados de puérperas sobre as síndromes hipertensivas da gravidez que tiveram como consequência o parto pré-termo. Participaram 70 mulheres com idade média de 28 anos e para 85,7% delas o parto ocorreu entre 32 e 36 semanas de gestação. Foi aplicado um questionário com questões subjetivas, com a finalidade de identificar os significados das síndromes hipertensivas da gravidez e do parto prematuro para puérperas. Os resultados foram analisados com base no referencial teórico metodológico da Teoria das Representações Sociais. Evidenciou-se a construção de uma representação social de caráter negativo, que teve como núcleo central a morte e como periféricos os aspectos negativos decorrentes dos riscos aos quais estiveram expostos mãe e feto durante a gravidez e o parto e, posteriormente, no período puerperal, com a hospitalização do filho na Unidade de Terapia Intensiva Neonatal.

Association of candidate genes with phenotypic traits relevant to anorexia nervosa.

This analysis is a follow-up to an earlier investigation of 182 genes selected as likely candidate genetic variations conferring susceptibility to anorexia nervosa (AN). As those initial case-control results revealed no statistically significant differences in single nucleotide polymorphisms, herein, we investigate alternative phenotypes associated with AN. In 1762 females, using regression analyses, we examined the following: (i) lowest illness-related attained body mass index; (ii) age at menarche; (iii) drive for thinness; (iv) body dissatisfaction; (v) trait anxiety; (vi) concern over mistakes; and (vii) the anticipatory worry and pessimism versus uninhibited optimism subscale of the harm avoidance scale. After controlling for multiple comparisons, no statistically significant results emerged. Although results must be viewed in the context of limitations of statistical power, the approach illustrates a means of potentially identifying genetic variants conferring susceptibility to AN because less complex phenotypes associated with AN are more proximal to the genotype and may be influenced by fewer genes. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

Association study of 182 candidate genes in anorexia nervosa.

We performed association studies with 5,151 SNPs that were judged as likely candidate genetic variations conferring susceptibility to anorexia nervosa (AN) based on location under reported linkage peaks, previous results in the literature (182 candidate genes), brain expression, biological plausibility, and estrogen responsivity. We employed a case-control design that tested each SNP individually as well as haplotypes derived from these SNPs in 1,085 case individuals with AN diagnoses and 677 control individuals. We also performed separate association analyses using three increasingly restrictive case definitions for AN: all individuals with any subtype of AN (All AN: n = 1,085); individuals with AN with no binge eating behavior (AN with No Binge Eating: n = 687); and individuals with the restricting subtype of AN (Restricting AN: n = 421). After accounting for multiple comparisons, there were no statistically significant associations for any individual SNP or haplotype block with any definition of illness. These results underscore the importance of large samples to yield appropriate power to detect genotypic differences in individuals with AN and also motivate complementary approaches involving Genome-Wide Association (GWA) studies, Copy Number Variation (CNV) analyses, sequencing-based rare variant discovery assays, and pathway-based analysis in order to make up for deficiencies in traditional candidate gene approaches to AN.

Influência da adição de fósforo no índice de compressão e parâmetros de consistência de um Latossolo Vermelho-Escuro

A adsorção de fosfato pelo solo pode causar a dispersão de partículas, alterando sua porosidade e a relação solo-água, especialmente em solos oxídicos. Portanto, parâmetros do solo variáveis com o conteúdo de água, como os limites de consistência e índices de compressão, podem, indiretamente, ser influenciados pela adsorção desse íon. Este trabalho teve como objetivo avaliar o efeito da adsorção de fosfato no índice de compressão e nos limites de consistência de um Latossolo Vermelho-Escuro da microrregião dos Campos da Mantiqueira (MG), Brasil. Amostras do solo foram coletadas nas camadas de 0-0,03 m e 0,27-0,30 m. Metade das amostras recebeu fosfato durante a fase de pré-umedecimento no laboratório, com P suficiente para atingir a capacidade de adsorção. Foram determinados os limites de consistência e o índice de compressão, este representado pela inclinação da reta de compressão virgem da curva de compressão. Os valores do índice de compressão foram mais elevados para a camada superficial, tanto na condição com P quanto na sem P, significando maior predisposição à compactação. Os limites de consistência e o índice de compressão foram mais elevados para condição com P. Embora o teor de água ótimo para a maior resposta à compactação esteja dentro da faixa de plasticidade na camada superficial, o que significa menor risco de compactação com o solo preparado na faixa de friável, o solo ainda seria susceptível à compactação, uma vez que esses valores estão na faixa de friabilidade para a camada de 0,27-0,30 m; camada esta que coincide com a profundidade de corte de alguns dos implementos de preparo do solo.

PROPRIEDADES MECÂNICAS E PERMEABILIDADE AO AR EM TOPOSSEQUÊNCIA ARGISSOLO-GLEISSOLO: VARIAÇÃO NO PERFIL E EFEITO DE COMPRESSÃO

Uma topossequência apresenta solos com características estruturais e morfológicas distintas que podem alterar a susceptibilidade à deformação estrutural em curtas distâncias espaciais. Os objetivos deste estudo foram avaliar a capacidade de suporte de carga e a suscetibilidade à compactação e mensurar o efeito que cargas acima e abaixo da pressão de preconsolidação causam na permeabilidade ao ar de solos numa topossequência da Depressão Central do Rio Grande do Sul, Brasil. Amostras indeformadas foram coletadas nos horizontes de três perfis de Argissolos (Ap, A1, AB, BA, Bt1 e Bt2; Ap, A1, A2, AB, BA, Bt1 e Bt2; e Ap, A1, BA, Bt1 e Bt2) e dois de Gleissolos (A1, A2, Bg; A, Bg e Cg), no longo de uma topossequência. Essas amostras foram submetidas ao teste de compressão uniaxial, sendo avaliada a permeabilidade ao ar antes e após compressão. Na condição de capacidade de campo, os Gleissolos apresentaram menor suscetibilidade à compactação e maior capacidade de suporte de carga que os Argissolos. O teor de argila esteve diretamente correlacionado com a capacidade de suporte de carga. Portanto, foi inversamente proporcional à suscetibilidade à compactação, exceto em condições de elevada umidade do solo quando a água lubrificou as superfícies aumentando a susceptibilidade à compactação de quaisquer solos. Até 25 kPa de carga ao solo não resultou degradação física do solo, mas quando foram aplicadas cargas de 200 kPa, mesmo na condição de capacidade de campo, houve redução significativa do volume de macroporos e porosidade total em níveis inferiores ao limite crítico (0,10 m3 m-3).

Self construction, cognitive conflicts and polarization in bulimia nervosa

This study explores the cognitive structures, understood as construct systems, of patients suffering from bulimia nervosa (BN). Previous studies investigated the construct systems of disordered eaters suggesting that they had a higher distance between their construction of the self and the «ideal self», and also more rigidity. In addition to these aspects, this study explored the presence of implicative dilemmas (ID). Thirty two women who met criteria for BN and were treated in a specialized center were compared to a non clinical group composed by 32 women matched by age. All participants were assessed using Repertory Grid Technique (RGT). In BN patients it was more common (71.9%) to find IDs than in controls (18.8%). They also showed higher polarization and higher self-ideal discrepancies (even more for those with a long history of BN). The measures provided by the RGT can be useful for the assessment of self-construction and cognitive conflicts in BN patients and to appreciate their role in this disorder. In addition, this technique could be helpful for clinicians to explore the patient"s constructs system, and specially to identify IDs that could be maintaining the symptoms or hindering change in order to focus on them to facilitate improvement.