Book Review: Decoding Jung\u27s Metaphysics: The Archetypal Semantics of an Experiential Universe

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Review of: The Myth of Normal-Trauma, Illness, and Healing in a Toxic Culture, by Gabor Maté and Daniel Maté

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Avaliação comparativa dos efeitos do tratamento do Hipotireoidismo primário entre pacientes mantidos com níveis de hormônio estimulador da tireóide sérico normal - alto e normal - baixo.

Orientadora: Profª Drª Gisah Amaral de CarvalhoCo-orientador: Prof. Dr. Rosana Bento RadominskiDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciencias da Saúde, Programa de Pós-Graduaçao em Medicina Interna. Defesa : Curitiba, 07/08/2009Bibliografia: fls. 120-130Resumo: Dados recentes da literatura apresentam evidências que sugerem a redução do limite superior de referência de normalidade do hormônio estimulador da tireóide (TSH) sérico. O objetivo do presente estudo foi determinar se a terapia com levotiroxina, durante o tratamento do hipotireoidismo primário em um grupo de pacientes mantidos com níveis de TSH sérico normal-baixo (0,4 – 2,0 mUI/L), estaria associada a melhores resultados clínicos do que em um outro grupo de pacientes mantidos com níveis de TSH sérico normal-alto (2,0 – 4,0 mUI/L). Conduziu-se um estudo prospectivo experimental envolvendo 42 pacientes com hipotireoidismo primário, recém-diagnosticados e sem tratamento prévio. Os pacientes foram pareados em 2 grupos de acordo com o sexo, a idade e o índice de massa corporal (IMC): Grupo 1 (n=20) – TSH alvo normal-baixo (0,4 – 2,0 mUI/L) e Grupo 2 (n=22) – TSH alvo normal-alto (2,0 – 4,0 mUI/L). O tratamento com levotiroxina foi iniciado para a obtenção e manutenção dos níveis de TSH sérico dentro do alvo adequado durante todo o estudo. Os pacientes foram avaliados no diagnóstico (basal), mensalmente até a obtenção de 2 valores consecutivos de TSH sérico dentro do alvo determinado para o grupo e trimestralmente até o término do estudo com 12 meses de seguimento. As variáveis avaliadas foram: função tireoidiana, perfil lipídico, creatino-fosfoquinase (CPK), gasto energético basal, peso, IMC, composição corporal e densidade mineral óssea (DMO). 35 pacientes completaram o estudo, sendo 19 do Grupo 1 e 16 do Grupo 2. Os efeitos do uso da levotiroxina no tratamento do hipotireoidismo foram avaliados no grupo total (n=35). A análise estatística demonstrou uma significativa redução percentual nos níveis de colesterol total (p=0,01), LDL colesterol (p=0,004), triglicerídios (p<0,001) e CPK (p=0,001). Adicionalmente, o tratamento do hipotireoidismo associou-se a uma elevação estatisticamente significativa do gasto energético basal por quilograma de massa magra corporal (p=0,001) e do percentual de gordura corporal (p=0,02). Durante o tratamento do hipotireoidismo, o grupo 1 apresentou uma menor elevação percentual dos níveis de colesterol total do que o grupo 2 (p=0,043). Demonstrou-se também que o grupo 1 apresentou uma maior elevação percentual no gasto energético basal do que o grupo 2 (p=0,02). Não foram apresentadas variações percentuais estatisticamente significativas entre os dois grupos de tratamento em relação às demais variáveis avaliadas. Apesar dos dados da literatura apresentarem evidências que tendem a recomendar a redução do limite superior de normalidade do TSH, os resultados do presente estudo não demonstram evidências clínicas significativas para corroborar com a recomendação de que pacientes com hipotireoidismo primário em tratamento com levotiroxina devam ser mantidos com níveis de TSH sérico normal-baixo.Abstract: Recent specific literature provided data that supports the recommendation to decrease the upper limit of the normal thyroid stimulating hormone (TSH) reference range. The aim of this study was to determine whether treatment with levothyroxine in a group of hypothyroid patients maintained within a low-normal TSH range (0,4 – 2,0 mUI/L) was associated with better clinical outcomes than those observed in a group of hypothyroid patients maintained within a high-normal TSH range (2,0 – 4,0 mUI/L). We conducted a prospective interventional study with 42 subjects newly-diagnosed with primary hypothyroidism, without previous treatment. Patients were paired in two groups by age, sex and body mass index (BMI): Group 1(n=20): low-normal TSH target (0,4 – 2,0 mUI/L) and Group 2 (n=22): high-normal TSH target (2,0 – 4,0 mUI/L). Levothyroxine was initiated to maintain the correct TSH target value during the study period. Patients were evaluated on baseline, monthly until they reached the target TSH and every 3 months until study termination with a 12 month follow-up. Evaluated variables were: thyroid function, serum lipid profile, CPK levels, resting energy expenditure, weight, BMI, body composition and bone mineral density. 35 patients completed the study, 19 in group 1 and 16 in group 2. The effects of levothyroxine treatment of hypothyroidism were analyzed within the whole group (n=35). Statistical analysis demonstrated a significant relative reduction in total cholesterol (p=0,01), LDL cholesterol (p=0,004), triglicerydes (p<0,001) and CPK levels (p=0,001). Also, treatment of hypothyroidism was associated with a significant relative increase in the resting energy expenditure per kilogram of lean body mass (p=0,001) and in the percentage of body fat (p=0,02). During the treatment of hypothyroidism, the group 1 presented a significant lower elevation of total cholesterol levels than the group 2 (p=0,043). Also, the group 1 presented a significant higher relative increase of the resting energy expenditure than the group 2 (p=0,02). The other evaluated variables showed no relative differences between the groups during the study period. Despite recent literature trends towards lowering the upper limit of normal TSH range, the results of the present study provided no clinical evidence to corroborate that patients on levothyroxine treatment for primary hypothyroidism should be maintained in a low-normal TSH range

First reports of computed tomographic colonography for the screening of colorectal polyps in acromegalic patients

*Aim:* To analyze the CTC performance for the screening of colorectal polyps in acromegalic patients. &#xd;&#xa;&#xd;&#xa;*Materials and Methods:* A prospective study of 21 acromegalic patients, 12 male and 9 female, average age 49, who underwent CTC and CC. CTC was performed with a GE Helical Multislice Computed Tomography Apparatus. The colonoscopy was performed, in the same day, without previous knowledge of the CTC diagnostics. The study evaluated the capacity of CTC to detect patients with colorectal polyps and identify each colorectal lesion described by CC. &#xd;&#xa;&#xd;&#xa;*Results:* In two patients (2/21), CC was incomplete. However, in all patients CTC was complete. In Phase I (&#x201c;Per Patient&#x201d;), CTC diagnosed 8 of the 9 patients with colorectal polyps and showed 88% sensitivity, 75% specificity and 81% accuracy. In Phase II (&#x201c;Per Polyp&#x201d;), out of the 21 acromegalic patients included in this study, 12 presented normal findings at CC. A total of 19 polyps were identified in 9 patients. 10 of the 19 polyps were smaller than 10 mm, and 9 were equal to or larger than 10. CTC identified 7 of the 9 polyps &#x2265; 10 mm described by CC and only 6 of the 10 small polyps identified at CC were detected by CTC. The histological analysis of resected lesions revealed 12 tubular adenomas, 6 hyperplastic polyps and 1 colonic tubulo-villous adenoma with an adenocarcinoma focus. &#xd;&#xa;&#xd;&#xa;*Conclusion:* In this study, CTC was performed without complications and a complete and safe colorectal evaluation was possible in all acromegalic patients. Moreover, CTC showed good sensitivity to identify acromegalic patients with colorectal polyps

Handedness Influences Intermanual Transfer in Chimpanzees (\u3cem\u3ePan troglodytes\u3c/em\u3e) But Not Rhesus Monkeys (\u3cem\u3eMacaca mulatta\u3c/em\u3e)

Intermanual transfer refers to an effect whereby training one hand to perform a motor task improves performance in the opposite untrained hand. We tested the hypothesis that handedness facilitates intermanual transfer in two nonhuman primate species: rhesus monkeys (N = 13) and chimpanzees (N = 52). Subjects were grouped into one of four conditions: (1) left-handers trained with the left (dominant) hand; (2) left-handers trained with the right (non-dominant) hand; (3) right-handers trained with the left (non-dominant) hand; and (4) right-handers trained with the right (dominant) hand. Intermanual transfer was measured using a task where subjects removed a Life Savers® candy (monkeys) or a washer (chimpanzees) from metal shapes. Transfer was measured with latency by comparing the average time taken to solve the task in the first session with the trained hand compared to the first session with the untrained hand. Hypotheses and predictions were derived from three models of transfer: access: benefit training with non-dominant hand; proficiency: benefit training with dominant hand; and cross-activation: benefit irrespective of trained hand. Intermanual transfer (i.e., shorter latency in untrained hand) occurred regardless of whether monkeys trained with the dominant hand or non-dominant hand, supporting the cross-activation model. However, transfer was only observed in chimpanzees that trained with the dominant hand. When handedness groups were examined separately, the transfer effect was only significant for right-handed chimpanzees, partially supporting the proficiency model. Findings may be related to neurophysiological differences in motor control as well as differences in handedness patterning between rhesus monkeys and chimpanzees

Development and piloting of a mother and child intervention to promote resilience in young children of HIV-infected mothers in South Africa

This paper describes the process of developing a parallel intervention for HIV-positive mothers and their youngchildren (6–10 years) with a view to strengthening the relationship between them. Strong mother–child relationships can contribute to enhanced psychological resilience in children. The intervention was developed through action research, involving a situation analysis based on focus group discussions; intervention planning, piloting the intervention and a formative evaluation of the intervention. Participants supplied feedback regarding the value of the intervention in mother–child relationships. The findings obtained from the formative evaluation were used to refine the intervention. Two parallel programmes for mothers and children (15 sessions each) were followed by 10 joint sessions. The intervention for mothers focused on maternal mental health and the strengthening of their capacity to protect and care for their youngchildren. The intervention for children addressed the development of their self-esteem, interpersonal relationships and survival skills. The formative evaluation provided evidence of good participation, support and group cohesion. Qualitative feedback indicated that the activities stimulated mother–child interaction. A similar intervention can easily be applied elsewhere using the detailed manual. The insights gained and lessons learnt related to mother and child interaction within an HIV-context that emerged from this research, can be valuable in other settings, both in Sub-Saharan Africa and elsewhere.The National Institute of Mental Health (NIMH) grant R01 MH076442-01.http://www.elsevier.com/locate/evalprogplangv201

Neural Systems Underlying RDoC Social Constructs: An Activation Likelihood Estimation Meta-Analysis

Neuroscientists have sought to identify the underlying neural systems supporting social processing that allow interaction and communication, forming social relationships, and navigating the social world. Through the use of NIMH’s Research Domain Criteria (RDoC) framework, we evaluated consensus among studies that examined brain activity during social tasks to elucidate regions comprising the “social brain”. We examined convergence across tasks corresponding to the four RDoC social constructs, including Affiliation and Attachment, Social Communication, Perception and Understanding of Self, and Perception and Understanding of Others. We performed a series of coordinate-based meta-analyses using the activation likelihood estimate (ALE) method. Meta-analysis was performed on whole-brain coordinates reported from 864 fMRI contrasts using the NiMARE Python package, revealing convergence in medial prefrontal cortex, anterior cingulate cortex, posterior cingulate cortex, temporoparietal junction, bilateral insula, amygdala, fusiform gyrus, precuneus, and thalamus. Additionally, four separate RDoC-based meta-analyses revealed differential convergence associated with the four social constructs. These outcomes highlight the neural support underlying these social constructs and inform future research on alterations among neurotypical and atypical populations

The role of parenting in affecting the behavior and adaptive functioning of young children of HIV-infected mothers in South Africa

Prior investigations suggest that maternal HIV/ AIDS poses significant challenges to young children. This study investigates the relationships between mothers’ psychological functioning, parenting, and children’s behavioral outcomes and functioning in a population of women living with HIV (N = 361) with a child between the ages of 6 and 10 years in Tshwane, South Africa. Utilizing path analysis, findings revealed that maternal depression is related to increased parenting stress and parent–child dysfunction, maternal coping is related to parenting style, and maternal coping, parenting style and stress, and parent–child dysfunction are associated with children’s behavior and functioning, with parenting emerging as an important mediator. These findings suggest that interventions for women living with HIV and their children should not only address maternal psychological functioning (depression and coping), but should also focus on parenting, promoting a positive approach.http://link.springer.com/journal/10461hb2014gv201

Depressive Symptoms Among Immigrant Latino Sexual Minorities

To estimate the prevalence and identify correlates of depressive symptoms among immigrant Latino sexual minorities