Is psychodynamic psychotherapy an effective intervention for individuals at ultra-high risk (UHR) of psychosis?: a case report

OBJECTIVE: To report a case and to discuss the use of psychodynamic psychotherapy (PD-P) to treat individuals at ultra-high risk (UHR) of psychosis. METHODS: An individual at UHR was followed up for 24 months. The baseline evaluation included a psychiatric interview, the Structured Interview for Prodromal Symptoms (SIPS), the Scale of Prodromal Symptoms (SOPS), and neuropsychological assessment. He underwent weekly sessions of PD-P for 12 months and was followed up for 12 months after the end of PD-P. The evaluations were at baseline, after 6-, 12-, and 24-month follow-up. No medication was prescribed during the 24-month follow-up. RESULTS: The prodromal symptoms remitted. The initial total score on the SIPS/SOPS was 37 points. After the first 12 months of PD-P, there was a reduction to 12 points on the SIPS/SOPS score, which stabilized in the 24-month follow-up. There was also a slight improvement in his performance on the neuropsychological evaluations. CONCLUSION: This case report suggests that PD-P can reduce prodromal symptoms; nevertheless, a better understanding of the specificity and efficacy of PD-P as an option of treatment for UHR individuals is needed.

Psychosis associated with methimazole-induced hypothyroidism: a case report

INTRODUCTION: Thyroid dysfunction has often been associated with several psychiatric manifestations. Previous case reports/series suggest the possible role played by acute alteration of thyroid status in the onset of psychotic symptoms. METHODS: Case report and literature review. RESULTS: A 45-year-old woman with no psychiatric antecedents was brought to the ER with a full-blown psychotic episode, marked by paranoid delusions, which developed gradually over two months. She had been treated elsewhere for hyperthyroidism for five years with methimazole 40 mg/d, with poor compliance. One month before the beginning of the psychotic symptoms, methimazole was raised to 60 mg/d and she started taking it correctly. Five months earlier she had TSH: 0.074 uUI/ml and free T4: 1.3 ng/dl. At admission we found a diffuse thyroid goiter, TSH: 70.9 uUI/ml and free T4: 0.03 ng/dl. Brain CT was normal. We hospitalized her with the diagnosis of a psychosis secondary to hypothyroidism, suspended methimazole, and gave her levothyroxine (up to 75 µg/d) and risperidone (2 mg/d). The patient had a quick remission and was discharged after 15 days. Within one month she had TSH: 0.7 uUI/ml and was completely recovered psychiatrically. She has been well since then, with risperidone in the first 8 months, and without it for 10 months now. CONCLUSION: This case report is a reminder of the necessity of checking thyroid status as part of clinical assessment of psychoses. It also supports the hypothesis that antithyroid drugs may have severe psychiatric consequences, especially when they lead to an acute change of thyroid status.

White-coat hypertension and normotension in the League of Hypertension of the Hospital das Clínicas, FMUSP: prevalence, clinical and demographic characteristics

OBJECTIVE: To assess the prevalence of white-coat normortension, white-coat hypertension, and white-coat effect. METHODS: We assessed 670 medical records of patients from the League of Hypertension of the Hospital das Clínicas of the Medical School of the University of São Paulo. White-coat hypertension (blood pressure at the medical office: mean of 3 measurements with the oscillometric device ³140 or ³90 mmHg, or both, and ambulatory blood pressure monitoring mean during wakefulness < 135/85) and white-coat normotension (office blood pressure < 140/90 and blood pressure during wakefulness on ambulatory blood pressure monitoring ³ 135/85) were analyzed in 183 patients taking no medication. The white-coat effect (difference between office and ambulatory blood pressure > 20 mmHg for systolic and 10 mmHg for diastolic) was analyzed in 487 patients on treatment, 374 of whom underwent multivariate analysis to identify the variables that better explain the white-coat effect. RESULTS: Prevalence of white-coat normotension was 12%, prevalence of white-coat hypertension was 20%, and prevalence of the white-coat effect was 27%. A significant correlation (p<0.05) was observed between white-coat hypertension and familial history of hypertension, and between the white-coat effect and sex, severity of the office diastolic blood pressure, and thickness of left ventricular posterior wall. CONCLUSION: White-coat hypertension, white-coat normotension, and white-coat effect should be considered in the diagnosis of hypertension.

Síndrome de Wolff-Parkinson-White associada a comunicação interatrial tipo seio venoso

A associação de comunicação interatrial (CIA) tipo seio venoso com síndrome de Wolff Parkinson White (WPW) é muito rara e ainda não descrita na literatura médica especializada. Descreve-se o caso de uma jovem portadora dessa associação de patologias tratada com ablação da via acessória por radiofreqüência, seguida de correção cirúrgica do defeito do septo interatrial.

Influência da porcentagem de areia no solo e Meloidogyne incognita (Kofoid e White) Chitwood sobre a incidência de murcha de algodoeiro causada por Fusarium oxysporum f. vasinfectum (Atk) Snyder e Hansen

O presente trabalho teve por finalidade estudar o efeito das diferentes porcentagens de areia, em substratos artificiais sobre a severidade de murcha do algodoeiro. Para êste fim foram utilizados substratos artificiais com quantidades variáveis de areia. Como inóculo foram utilizados suspensões de Meloidogyne, Fusarium e Fusarium mais Meloidogyne. Os três inóculos foram testados em duas; variedades de algodão. Os resultados obtidos com a variedade RM2 no 1.° ensaio mostraram uma maior incidência de murcha nos substratos, com maior porcentagem de areia, isto é, 90% e 60%. Quanto ao inóculo utilizado, a maior incidência da doença ocorreu nos tratamentos que receberam inoculação conjunta de Fusarium mais Meloidogyne. No segundo ensaio, utilizando-se a variedade RM4 não foram obtidos dados que mostrassem diferenças significativas entre substratos. Isto provavelmente se deve a um aumento no potencial de inóculo e uma melhor distribuição do mesmo. No entanto, houve uma diferença significativa para os tipos de inóculo utilizados, sendo que a maior severidade de doença ocorreu quando o inóculo era constituído de fungo e de nematóide, seguindo-se o tratamento cujo inóculo era constituido só de fungo No ensaio feito com variedade RM4 foi obtida significância para a interação tipos de inóculo versus substratos. A interação mostrou que o inóculo constituído só de Fusarium comportou-se diferentemente nos diferentes, tipos de substratos, utilizados. Tendo a maior severidade da doença ocorrido no substrato contendo a maior porcentagem de areia. No entanto, não houve diferenças significativas para a severidade da doença causada pelo inóculo constituido do fungo mais nematóides nos diferentes substratos, o que mostra efeito do inóculo de Meloidogyne sôbre o inóculo em potencial de Fusarium. Os diferentes tipos de inóculo comportaram-se de modo diferentes nos substratos de terra roxa, e nos substratos contendo 60% e 90% de areia, sendo que a maior coloração dos vasos foi obtida nos tratamentos que receberam os inóculos de Fusarium e Fusarium mais Meloidogyne.

Use of tree species by White-throated treerunner (Pygarrhichas albogularis King) in a secondary native forest of southern Chile

ABSTRACT In forest ecosystems, numerous species of insectivorous birds use certain tree species as feeding and nesting substrates. Between 2009 and 2010, the use of different floristic components as feeding substrate by the Pygarrhichas albogularis King, 1831 was evaluated in a southern Chilean secondary native forest. From a total of 13 trees and bush species, six tree species were used by P. albogularis as a feeding substrate. Tree use was limited to intermediate heights (11-20 m) and, mainly, to the trunk (40% of observations) and secondary branches (26%). Pygarrhichas albogularis showed a disproportionated use of N. dombeyi and an important use of trees with a greater age structure (DBH 81-100 cm). Nothofagus dombeyi presented a significantly greater tree bark crevice depth than E. cordifolia. In turn, covariance between crevice depth and invertebrate supply in tree bark was positive and significant. We consider bark depth and invertebrate supply to be the proximate causes explaining P. albogularis disproportionated use of Nothofagus dombeyi.

Comentario ao esquema de classificação das Salmonellas de Kauffmann-White

The classification of salmonellae in accordance with the Kauffmann-White schema accepted by the presents various inconveniences and difficulties to application. Among these is the necessity of preparing, dosing and preserving a considerable number of specific sera whose validity as is well known, is limited. The criterion of Kauffmann’s classification is exclusively, for it abandoned cultural tests, leaving therefore only a unilateral criterion. By following it one might include Chromobacterium typhi-flavum in the Salmonella genus as well as other bacteria which differ completely from the Salmonella, as long as they are antigenically related. On the other hand, the chart approximates or separates in the different groups of antigen O species or types of salmonellae which are biologically close or almost indistinguishable. The chart has given rise to an excessive number of species and lypes of salmonellae which from 44 in the chart approved by the in 1934 rose ro 60 in Bergey’s Manual and everything leads one to believe that the end is not yet for every day new lypes or species are found. And perforce this must be so for new antigenic factors have been found which give rise to new structural combinations. Applying the formula of combinations (formule) to the factors already known, there are probable possibilities of having 260 different antigenic combinations in group A, or 3260 lypes or species if all the flagellate antigens of the other groups should be found, in it combined 2 and 2. Futher applying the formula of combinations to the other groups there would be possibility of so many combinations that the number of salmonellae would exceed the number of known bacterian species or perhaps the number of those existing on earth. Undoubledly Kauffmann-White’s chart is an improvement, but the bacterian analysis made with it was exaggerated and exceeded the limit of the present possibilities of the realities of life. It revealed interesting aspects of the somatic complexity of bacteria but seems untenable because of its use in pratical sense.

Experimental heteroxenous cycle of Lagochilascaris minor Leiper, 1909 (Nematoda: Ascarididae) in white mice and in cats

Reports of natural infections of sylvatic carnivores by adult worms of species similar to Lagochilascaris minor in the Neotropical region led to attempts to estabilish experimental cycles in laboratory mice and in cats. Also, larval development was seen in the skeletal muscle of an agouti (Dasyprocta leporina) infected per os with incubated eggs of the parasite obtained from a human case. In cats, adult worms develop and fertile eggs are expelled in the feces: in mice, larval stages of the parasite develop, and are encapsulate in the skeletal muscle, and in the adipose and subcutaneous connective tissue. From our observations, we conclude that the larva infective for the mouse is the early 3rd stage, while for the final host the infective form is the later 3rd stage. A single moult was seen in the mouse, giving rise to a small population of 4th stage larvae, long after the initial infection.

Community ecology of the metazoan parasites of white croaker, Micropogonias furnieri (Osteichthyes: Sciaenidae), from the coastal zone of the State of Rio de Janeiro, Brazil

One hundred specimens of white croakers, Micropogonias furnieri (Desmarest 1823) (Osteichthyes: Sciaenidae) collected from Pedra de Guaratiba (23°01'S, 43°38'W), State of Rio de Janeiro, Brazil, from September 1997 to August 1999, were necropsied to study their parasites. The majority of the fish (95%) were parasitized by metazoan. Twenty-eight species of parasites were collected. The nematodes were the 40.5% of the total number of parasites specimens collected. Dichelyne elongatus was the most dominant species. Lobatostoma ringens, Pterinotrematoides mexicanum, Corynosoma australe, D. elongatus, and Caligus haemulonis showed a positive correlation between the host's total length and parasite prevalence and abundance. The monogenean P. mexicanum had differences in the prevalence and abundance in relation to sex of the host. The mean diversity in the infracommunities of M. furnieri was H=0.499±0.411, with correlation with the host's total length and without differences in relation to sex of the host. One pair of ectoparasites showed positive covariation, and two pairs of endoparasites showed positive association and covariation between their prevalences and abundances, respectively. Negative association or covariations were not found. The dominance of endoparasites in the croakers parasite infracommunities reinforced the differences found in sciaenids from the South American Pacific Ocean, in which the ectoparasites are dominant.

Clinical and mycological study of scalp white piedra in the State of Paraíba, Brazil

White piedra is a superficial mycoses characterized by nodules on the hair shaft, caused by the basidiomycetous yeasts. In the present study, clinical and mycological findings of scalp white piedra caused by Trichosporon spp. are related. Twenty three cases of scalp white piedra were observed with a high incidence in women (87%) and preschool children from 2 to 6 (74%) years old. These groups presented a relationship of dependence with this infection. Despite the low socio-economic status, poor standards of hygiene, (48% of the patients) as well as the fact that 30.4% of the children shared the same nursery, these factors were not significant for the transmission of the mycosis. These were the first reports of scalp white piedra in João Pessoa city, Paraíba, Brazil.

Association of human leukocyte antigen DQ1 and dengue fever in a white Southern Brazilian population

Dengue is an infectious disease of viral etiology transmitted by the mosquitoes Aedes aegypti, A. albopictus, and A. scutellaris. It can develop either as a benign form or as a severe hemorrhagic form. Previous work showed an association of the hemorrhagic form with human leukocyte antigens (HLA), suggesting a role of genetic factors in disease susceptibility. Nevertheless, data on HLA association with the classical form of the disease is scarce in literature. Sixty-four patients and 667 normal individuals, living in the state of Paraná, Southern Brazil, were used as test and control group, respectively. The patients developed the disease during a virus 1 dengue outbreak either in Maringá city in 1995 (47) or in Paranavaí city in 1999 (17). The diagnostic was confirmed through serology and/or viral culture. HLA class I and II typing was performed by the classical microlynfocitotoxicity test using monoclonal antisera and fluorobeads. Qui-square statistical analysis confirmed a positive association with HLA-DQ1 (76.6% vs 57.7%; p = 0.005243; pc = 0.026215). HLA-DR1 also presented an increased frequency in the test group, not statistically significant after p correction though (32.8% vs 15.9%; p = 0.005729; pc = 0.080206). In conclusion, genetic factors may play a role on the susceptibility to the classical dengue, virus 1, in the Brazilian population. Further independent studies should be performed in the Brazilian population to confirm these preliminary data.

Morphological and biochemical characterization of the aetiological agents of white piedra

The Trichosporon genus is constituted by many species, of which Trichosporon ovoides and Trichosporon inkin are the causative agents of white piedra. They can cause nodules in genital hair or on the scalp. At present, Brazilian laboratory routines generally do not include the identification of the species of Trichosporon genus, which, although morphologically and physiologically distinct, present many similarities, making the identification difficult. The aim of this study was to identify the aetiological agents at the species level of white piedra from clinical specimens. Therefore, both the macro and micro morphology were studied, and physiological tests were performed. Trichosporon spp. was isolated from 10 clinical samples; T. ovoides was predominant, as it was found in seven samples, while T. inkin was identified just in two samples. One isolate could not be identified at the species level. T. inkin was identified for the first time as a white piedra agent in the hair shaft on child under the age of 10.