Gender Differences in White Matter Microstructure

Sexual dimorphism in human brain structure is well recognised, but little is known about gender differences in white matter microstructure. We used diffusion tensor imaging to explore differences in fractional anisotropy (FA), an index of microstructural integrity.A whole brain analysis of 135 matched subjects (90 men and 45 women) using a 1.5 T scanner. A region of interest (ROI) analysis was used to confirm those results where proximity to CSF raised the possibility of partial-volume artefact.Men had higher fractional anisotropy (FA) in cerebellar white matter and in the left superior longitudinal fasciculus; women had higher FA in the corpus callosum, confirmed by ROI.The size of the differences was substantial--of the same order as that attributed to some pathology--suggesting gender may be a potentially significant confound in unbalanced clinical studies. There are several previous reports of difference in the corpus callosum, though they disagree on the direction of difference; our findings in the cerebellum and the superior longitudinal fasciculus have not previously been noted. The higher FA in women may reflect greater efficiency of a smaller corpus callosum. The relatively increased superior longitudinal fasciculus and cerebellar FA in men may reflect their increased language lateralisation and enhanced motor development, respectively

Quality-of-Life Assessment in Singaporean Children with Alopecia Areata

Introduction: Alopecia areata (AA) is an autoimmune dermatological disorder characterized by nonscarring hair loss. Its chronic and visible nature can negatively impact the quality of life (QoL) of patients with the condition. There has been a lack of studies on the QoL of pediatric patients with AA, especially from Asian countries. Objectives: This study aims to evaluate the impact of AA on the QoL of pediatric patients in Singapore. Methods: Between 2016 and 2017, 25 patients with AA were recruited to complete three questionnaires: Children’s Dermatology Life Quality Index (CDLQI), Family Dermatology Life Quality Index (FDLQI), and Pediatric Alopecia Areata Quality of Life Index. The results of these questionnaires were subsequently analyzed. Results: All three questionnaires had a broad range of responses, but scores were generally low, suggesting AA does not have a large impact on the QoL of our participants and their families. Two factors were identified to have resulted in better outcomes: the presence of comorbidity (atopic dermatitis, nail disease, food allergy, and allergic rhinitis) on the CDLQI and the presence of allergic rhinitis on the FDLQI. On the other hand, a later age of onset resulted in higher FDLQI scores. Conclusions: Similar to findings of other studies, the QoL of pediatric patients with AA is generally good, and clinical severity does not equate to worse QoL. Further studies are useful to provide more holistic care for the patient and their caregivers, involving both medical and psychosocial interventions

A retrospective analysis of melioidosis in Cambodian children, 2009-2013.

Background Melioidiosis, infection by Burkholderia pseudomallei, is an important but frequently under-recognised cause of morbidity and mortality in Southeast Asia and elsewhere in the tropics. Data on the epidemiology of paediatric melioidosis in Cambodia are extremely limited. Methods Culture-positive melioidosis cases presenting to Angkor Hospital for Children, a non-governmental paediatric hospital located in Siem Reap, Northern Cambodia, between 1st January 2009 and 31st December 2013 were identified by searches of hospital and laboratory databases and logbooks. Results One hundred seventy-three evaluable cases were identified, presenting from eight provinces. For Siem Reap province, the median commune level incidence was estimated to be 28-35 cases per 100,000 children <15 years per year. Most cases presented during the wet season, May to October. The median age at presentation was 5.7 years (range 8 days–15.9 years). Apart from undernutrition, co-morbidities were rare. Three quarters (131/173) of the children had localised infection, most commonly skin/soft tissue infection (60 cases) or suppurative parotitis (51 cases). There were 39 children with B. pseudomallei bacteraemia: 29 (74.4%) of these had clinical and/or radiological evidence of pneumonia. Overall mortality was 16.8% (29/173) with mortality in bacteraemic cases of 71.8% (28/39). At least seven children did not receive an antimicrobial with activity against B. pseudomallei prior to death. Conclusions This retrospective study demonstrated a considerable burden of melioidosis in Cambodian children. Given the high mortality associated with bacteraemic infection, there is an urgent need for greater awareness amongst healthcare professionals in Cambodia and other countries where melioidosis is known or suspected to be endemic. Empiric treatment guidelines should ensure suspected cases are treated early with appropriate antimicrobials