Spinocerebellar ataxia 36 (SCA36): «Costa da Morte ataxia¼. / La ataxia espinocerebelosa 36 (SCA36): «Ataxia da Costa da Morte¼.

INTRODUCTION-OBJECTIVE: To describe the history of the discovery of SCA36 and review knowledge of this entity, which is currently the most prevalent hereditary ataxia in Galicia (Spain) owing to a founder effect. DEVELOPMENT: SCA36 is an autosomal dominant hereditary ataxia with late onset and slow progression. It presents with cerebellar ataxia, sensorineural hearing loss, and discrete motor neuron impairment (tongue atrophy with denervation, discrete pyramidal signs). SCA36 was first described in Japan (Asida River ataxia) and in Galicia(Costa da Morte ataxia). The condition is caused by a genetic mutation (intronic hexanucleotide repeat expansion) in the NOP56 gene on the short arm of chromosome 20 (20p13). Magnetic resonance image study initially shows cerebellar vermian atrophy that subsequently extends to the rest of the cerebellum and finally to the pontomedullary region of the brainstem without producing white matter lesions. Peripheral nerve conduction velocities are normal, and sensorimotor evoked potential studies show delayed conduction of stimuli to lower limbs. In patients with hearing loss, audiometric studies show a drop of >40dB in frequencies exceeding 2,500Hz. Auditory evoked potential studies may also show lack of waves I and II. CONCLUSIONS: Costa da Morte ataxia or SCA36 is the most prevalent SCA in the Spanish region of Galicia. Given the region's history of high rates of emigration, new cases may be diagnosed in numerous countries, especially in Latin America. Genetic studies are now available to patients and asymptomatic carriers. Since many people are at risk for this disease, we will continue our investigations aimed at elucidating the underlying pathogenic molecular mechanisms and discovering effective treatment.

Sleep apnea and sudden death in the non-cardiac population: A systematic review.

INTRODUCTION: Obstructive sleep apnea (OSA) is one of the main risk factors for cardiovascular diseases and is associated with both morbidity and mortality. OSA has also been linked to arrhythmias and sudden death. OBJECTIVE: To assess whether OSA increases the risk of sudden death in the non-cardiac population. METHODS: This is a systematic review of the literature. The descriptors "sudden death" and "sleep apnea" and "tachyarrhythmias" and "sleep apnea" were searched in the PubMed/Medline and SciELO databases. RESULTS: Thirteen articles that addressed the relationship between OSA and the development of tachyarrhythmias and/or sudden death with prevalence data, electrocardiographic findings, and a relationship with other comorbidities were selected. The airway obstruction observed in OSA triggers several systemic repercussions, e.g., changes in intrathoracic pressure, intermittent hypoxia, activation of the sympathetic nervous system and chemoreceptors, and release of catecholamines. These mechanisms would be implicated in the appearance of arrhythmogenic factors, which could result in sudden death. CONCLUSION: There was a cause-effect relationship between OSA and cardiac arrhythmias. In view of the pathophysiology of OSA and its arrhythmogenic role, studies have shown a higher risk of sudden death in individuals who previously had heart disease. On the other hand, there is little evidence about the occurrence of sudden death in individuals with OSA and no heart disease, and OSA is not a risk factor for sudden death in this population.

Long-term prognosis of idiopathic ventricular fibrillation: An eighteen-year experience from a tertiary center.

INTRODUCTION AND OBJECTIVES: Idiopathic ventricular fibrillation (IVF) is diagnosed in patients who survive sudden cardiac arrest (SCA), preferably with documented ventricular fibrillation (VF), without any identifiable structural or electrical abnormality. Current evidence provides limited guidance on the diagnosis and follow-up of these patients. Our aim was to assess the clinical outcomes of survivors of an aborted SCA attributed to IVF. METHODS: We retrospectively collected clinical data from all patients who survived SCA and implanted a cardiac defibrillator (ICD) between 2005 and 2023. RESULTS: A total of 38 patients, 36.8% female, with a mean age of 44±14 years old were included. Median follow-up time was 8.7 years (interquartile range (IQR) 4.7-14.7 years). All patients underwent a comprehensive diagnostic evaluation that excluded structural and coronary disease. During follow-up, underlying diagnoses were established in 34.2% of the whole cohort. Genetic testing, performed in 37.2%, revealed underlying diagnoses in 57.1% of those tested, compared to only 26.3% of patients who did not undergo genetic testing [p=0.035, OR=5.1 (95% confidence interval (CI) 1.2-21.5)]. Mortality was 10.5% (due to non-arrhythmic causes) and 36.8% patients received appropriate therapies with a median time to first ICD therapy of 39 [5.4-47.3] months. CONCLUSION(S): Etiological diagnosis and recurrence prediction in patients with IVF remains challenging, even with extensive diagnostic evaluation and long-term follow-up. In our study, genetic testing enhanced diagnostic yield. Consistent with previous findings, our cohort experienced a notable arrhythmic recurrence, with no cardiac deaths, underlining the pivotal role of ICD implantation in these patients.

Syncope in the athlete - Minor changes, major diagnosis!

We report the case of a 17-year-old athlete who resorted to the emergency department for palpitations and dizziness while exercising. He mentioned two exercise-associated episodes of syncope in the last six months. He was tachycardic and hypotensive. The electrocardiogram showed regular wide complex tachycardia, left bundle branch block morphology with superior axis restored to sinus rhythm after electrical cardioversion. In sinus rhythm, it showed T-wave inversion in V1-V5. Transthoracic echocardiography revealed mild dilation and dysfunction of the right ventricle (RV) with global hypocontractility. Cardiac magnetic resonance (CMR) revealed a RV end diastolic volume indexed to body surface area of 180 ml/m2, global hypokinesia and RV dyssynchrony, subepicardial late enhancement in the distal septum and in the middle segment of the inferoseptal wall. The patient underwent a genetic study which showed a mutation in the gene that encodes the desmocolin-2 protein (DSC-2), which is involved in the pathogenesis of arrhythmogenic right ventricular cardiomyopathy (ARVC). According to the modified Task Force Criteria for this diagnosis, the patient presented four major criteria for ARVC. Thus, a subcutaneous cardioverter was implanted, and the patient was followed up at the cardiology department. Arrhythmogenic right ventricular cardiomyopathy diagnosis is based on structural, functional, electrophysiological and genetic criteria reflecting underlying histological changes. This case depicts the essential characteristics for disease recognition.

Mitral annular disjunction: Beyond mitral valve prolapse.

Mitral annular disjunction (MAD) is an easily identifiable entity on transthoracic echocardiography, but is still poorly recognized or ignored. It is often associated with mitral valve prolapse and is itself a risk marker for ventricular arrhythmias and sudden cardiac death, but the management and risk stratification of these patients is not systematized. Two clinical cases of MAD associated with mitral valve prolapse and ventricular arrhythmias are presented. The first case is of a patient with a history of surgical intervention on the mitral valve due to Barlow's disease. He presented to the emergency department with sustained monomorphic ventricular tachycardia requiring emergent electrical cardioversion. MAD with transmural fibrosis at the level of the inferolateral wall was documented. The second report is of a young woman with palpitations and frequent premature ventricular contractions on Holter with documentation of valvular prolapse and MAD, and focuses on the risk stratification approach. The present article offers a review of the literature regarding the arrhythmic risk of MAD and mitral valve prolapse, as well as a review of risk stratification in these patients.

The Black Foe: Being Towards Death.

The ontology of death is universal, hence archetypal. Nowhere do we witness any organic creature escape its talons. Analytical psychology has had an intimate relationship to death for the simple fact that it contemplates the soul, the numinous, and an afterlife. From Hegel to Heidegger, Freud and Jung, death was an existential force that sustained and transformed life, the positive significance of the negative. Rather than merely a destructive phenomenon, death informs Being, the power of nothingness that dialectically drives life. In this paper, I will introduce the notion of what I call the omega principle, the psychological orientation and trajectory of our being towards death, which we may say is a universal preoccupation and recapitulation of the collective unconscious that subsumes our personal relation to death, an eternal return of the objective psyche constellated as esse in anima.

L'ontologie de la mort est universelle, et ainsi archétypale. Nous ne voyons nulle part une créature organique échapper à son emprise. La psychologie analytique a eu une relation intime avec la mort du simple fait qu'elle contemple l'âme, le numineux et l'au-delà. De Hegel à Heidegger, Freud et Jung, la mort était une force existentielle qui soutenait et transformait la vie, la signification positive du négatif. Plutôt qu'un simple phénomène destructeur, la mort façonne l'Etre ; la puissance du néant qui conduit dialectiquement la vie. Dans cet article, je vais présenter l'idée que j'appelle le principe oméga ; l'orientation et la trajectoire psychologiques de notre être allant vers la mort, dont nous pourrions dire qu'il s'agit d'une préoccupation et d'une récapitulation universelle de l'inconscient collectif, qui englobe notre relation personnelle à la mort, un retour éternel de la psyché objective constellée en tant qu'esse in anima.

La ontología de la muerte es universal, por tanto arquetípica. Ninguna criatura orgánica escapa a sus garras. La psicología analítica ha tenido una relación íntima con la muerte por el simple hecho de que contempla el alma, lo numinoso y una vida después de la muerte. De Hegel a Heidegger, Freud y Jung, la muerte era una fuerza existencial que sostenía y transformaba la vida, el significado positivo de lo negativo. Más que un mero fenómeno destructivo, la muerte informa al Ser, el poder de la nada que impulsa dialécticamente la vida. En este artículo, introduciré la noción de lo que denomino principio omega, la orientación y trayectoria psicológica de nuestro ser hacia la muerte, que podemos decir que es una preocupación y recapitulación universal del inconsciente colectivo que subsume nuestra relación personal con la muerte, un eterno retorno de la psique objetiva constelada como esse in anima.

Social Activism's Possibility through Perspectives of Gloria Anzaldúa, Walter Benjamin and C. G. Jung.

This paper explores the vertices of Jung's, Anzaldúa's and Benjamin's distinct ontologies and the way in which they connect in the shared recognition that what has been estranged in human history is enigmatically lodged in the world's fabric today. Cultural distress, in other words, is the outcome of what has become repudiated in the self and the collective across time. From this perspective, the paper argues that we have a collective responsibility to listen to the claims of the dead laid bare in moments of contemporary real-world danger and it elaborates the psychical dimensions of being that are cultivated in times of danger. The author contends that these psychical presences are the dead of human history including our ancestral heritage that linger and possibly may penetrate our awareness. They haunt and hold a potential to animate our movement towards a sublimatory process that can be seen as a precursor to social responsiveness and action. The author explores this through her own experience with an example of the spawning of spiritual activism within the socio-political maelstrom of AIDS.

Cet article étudie les perspectives de Jung, d'Anzaldua et de Benjamin et leurs ontologies distinctes, ainsi que la manière dont elles sont connectées parce qu'elles partagent la prise de conscience que ce qui a été écarté de l'histoire humaine est mystérieusement niché dans la structure du monde d'aujourd'hui. En d'autres termes, la détresse culturelle est le produit de ce qui a été répudié et mis dans le soi et le collectif au fil du temps. De ce point de vue, l'article soutient que nous avons une responsabilité collective : écouter les requêtes des personnes mortes dans des périodes contemporaines de vrai danger pour le monde. L'article détaille les dimensions psychiques de l'être qui sont cultivées en période de danger. L'auteur soutient que ces présences psychiques sont les morts de l'histoire humaine. Cela inclut notre héritage ancestral, qui subsiste, et qui pourra peut-être pénétrer notre conscience. Ces présences psychiques hantent et contiennent le potentiel d'animer notre mouvement vers un processus de sublimation. Un tel processus peut être envisagé comme un précurseur à la réceptivité sociale et à l'action. L'auteur étudie ceci à travers sa propre expérience d'un exemple d'engendrement d'activisme spirituel dans le maelström socio-politique du sida.

El presente artículo explora los vértices de las distintas ontologías de Jung, Anzaldúa y Benjamin y la forma en que se conectan en el reconocimiento compartido de que lo que ha sido distanciado en la historia humana está enigmáticamente alojado en el tejido del mundo actual. En otras palabras, la angustia cultural es el resultado de lo que se ha repudiado en el yo y en el colectivo a lo largo del tiempo. Desde esta perspectiva, el artículo sostiene que tenemos la responsabilidad colectiva de escuchar las reivindicaciones de los muertos que quedan al descubierto en los momentos de peligro del mundo real contemporáneo y elabora las dimensiones psíquicas del ser que se cultivan en tiempos de peligro. La autora sostiene que estas presencias psíquicas son los muertos de la historia humana, incluida nuestra herencia ancestral, que perduran y posiblemente penetren en nuestra conciencia. Nos acechan y contienen el potencial de animar nuestro movimiento hacia un proceso sublimatorio que puede considerarse precursor de la respuesta y la acción sociales. La autora explora esto a través de su propia experiencia con un ejemplo del surgimiento del activismo espiritual dentro de la vorágine sociopolítica del SIDA.

Advances in hypertrophic cardiomyopathy: What the cardiologist needs to know.

Hypertrophic cardiomyopathy (HCM) is known as the most common genetic heart disease, characterized by otherwise unexplained left ventricular (LV) hypertrophy. In spite of major advances in whole genome sequence techniques, it is still not possible to identify the causal mutation in approximately half of HCM patients. Consequently, a new HCM concept, "beyond the sarcomere" is being developed, supported by data from recent HCM registries which reveal two distinct HCM subgroups: sarcomere positive HCM subgroup and nonfamilial HCM subgroup. Sarcomere positive HCM patients tend to be younger age at diagnosis, have fewer co-morbidities, present more often with reverse septal morphology, more myocardial fibrosis, less LV outflow tract obstruction, and a worse prognosis when compared to nonfamilial HCM patients. These subgroups, with different molecular basis, phenotypes and clinical profiles, will likely require specific management strategies. Important research advances have also been made concerning diagnosis, sudden cardiac death stratification and therapy. In this article, we seek to review recent relevant knowledge, summarizing the advances in this complex and heterogeneous disease.

Symbolic reading of panic disorder: experience of imminent death and self alerts.

The author proposes a symbolic reading of panic disorder as a psychopathological emergency that currently overwhelms our society, relating to an explicit process of transformation. She understands this phenomenon as resulting from the lack of the creative feminine in people's lives, which contributes to the emergence of symptoms that are understood as alerts from the Self, which decry the danger under which the person lives. She amplifies the proposition with a symbolic reading of two great mythical moments: Oedipus' encounter with the Sphinx, and the institution of the first jury court, dramatized in the tragic play The Eumenides, by Aeschylus (Ésquilo).

L'autrice propose une lecture symbolique du trouble panique comme une urgence psychopathologique qui submerge notre société actuelle, dans un franc processus de transformation. Elle comprend ce phénomène comme une réalité qui résulte du manque de féminin créatif dans la vie des personnes. Ceci contribue à l'émergence de symptômes qui sont compris comme des alertes venant du Soi parce qu'ils dénoncent le danger dans lequel la personne vit. L'autrice amplifie la proposition avec une lecture symbolique de deux grands moments mythiques: Œdipe et sa rencontre avec le Sphinx et l'institution du premier tribunal avec jury, exprimé dans la tragédie d'Eschyle, Les Euménides.

La autora propone una lectura simbólica del trastorno de pánico como una emergencia psicopatológica que abruma a nuestra sociedad actual, en franco proceso de transformación. Ella comprende este fenómeno como una realidad que es resultado de la falta de lo femenino creativo en la vida de las personas, lo cual contribuye a la emergencia de síntomas que son comprendidos como alertas del Self, debido a que denuncian el peligro en el cual la persona vive. La autora amplifica esta propuesta a partir de la lectura simbólica de dos importantes momentos míticos: Edipo: su encuentro con la Esfinge, y la institución de la primera corte de justicia, expresada en la obra trágica, Las Euménides de Esquilo.

O autor propõe a leitura simbólica do transtorno de pânico como uma emergência psicopatológica que sobrecarrega nossa sociedade atual, em um processo franco de transformação. Ela entende esse fenômeno como uma realidade resultante da falta do criativo feminino na vida das pessoas, o que contribui para o surgimento de sintomas que são entendidos como alertas do Si Mesmo, porque denunciam o perigo sob o qual a pessoa vive. Ela amplifica a proposição com uma leitura simbólica de dois grandes momentos míticos: Édipo: seu encontro com a Esfinge e a instituição da primeira corte do júri, expressa na trágica peça: Os Eumênides de Ésquilo.

Assisted dying: reflections on the psychological process.

This paper explores the question of assisted dying from both a legal and psychological perspective within the legal parameters in place at the time of writing of this paper. Links are made between Kohut's notion of an acceptance of the finiteness of existence and of transience as one of several indicators of the maturation and transformation of archaic narcissism, and Jung's notion of the readiness and ability to 'die with life' as the goal of the second half of life. The author raises awareness of the importance of the need for clarity with regard to these issues on the part of therapists who may be required to provide an evaluation of a patient's admissibility to a service of assisted dying.

Cet article explore le sujet de l'aide à la mort, à la fois du point de vue légal et psychologique, dans les paramètres légaux en place au moment de son écriture. L'article fait des liens entre la notion de Kohut - l'acceptation de l'aspect fini de l'existence et de son caractère éphémère comme l'un des indicateurs de la maturation et de la transformation du narcissisme archaïque - et l'idée de Jung selon laquelle le but de la seconde moitié de la vie est de développer sa capacité à « mourir avec la vie ¼. L'auteur attire l'attention sur l'importance du besoin de clarté concernant ces questions chez les thérapeutes auxquels on pourrait demander de fournir une évaluation de l'admissibilité d'un patient dans un service d'aide à la mort.

El presente trabajo explora el tema del acompañar el proceso de morir desde una perspectiva legal y psicológica en el marco de los parámetros legales existentes al momento de escribir el trabajo. Se plantean conexiones entre la noción de Kohut, de aceptación de la finitud de la existencia y la de transitoriedad como uno de los muchos indicadores de maduración y transformación del narcisismo primitivo, y la noción de Jung de disponibilidad y habilidad para 'morir con vida' como meta en la segunda mitad de la vida. El autor trae a la consciencia la importancia de la necesidad de claridad con respecto a estas cuestiones por parte de terapeutas quienes pueden ser requeridos para dar una evaluación sobre la admisibilidad de un paciente a un servicio de muerte asistida.

Este artigo explora a questão da morte assistida de uma perspectiva jurídica e psicológica dentro dos parâmetros legais em vigor no momento da redação deste artigo. São feitas ligações entre a noção de Kohut de aceitação da finitude da existência e da transitoriedade como um dos vários indicadores da maturação e transformação do narcisismo arcaico, e a noção de Jung da prontidão e capacidade de "morrer com vida" como o objetivo da segunda metade da vida. O autor conscientiza sobre a importância da necessidade de clareza em relação a essas questões por parte dos terapeutas que podem ser obrigados a fornecer uma avaliação da admissibilidade de um paciente a um serviço de morte assistida.

Childhood and cultural evolution.

Already in 1912, Sabina Spielrein addressed the transforming and antagonistic movements of life that appear from conception in her work 'Destruction as the cause of coming into being'. Her writings form a bridge between Freud and Jung, as they establish the relationship between biological experiences and archetypes. In 1974 Lloyd deMause examined the intrinsic link between primary relational experiences, brain development and the system of beliefs and values of the Sapiens species. He outlined the parallel between the transformation of child education and cultural evolution. Reflecting this theoretical approach, in child psychotherapy we have the peculiar opportunity of resorting to experiences during pregnancy and birth, to gain a deeper understanding of self-expressions in spontaneous drawings, dreams and sand scenes.

Déjà en 1912, dans son article « La Destruction comme cause du devenir ¼, Sabina Spielrein s'intéressa aux mouvements de vie antagonistes et transformateurs qui apparaissent dès la conception. Ses écrits forment un pont entre Freud et Jung, parce qu'ils établissent la relation entre les expériences biologiques et les archétypes. En 1974 Lloyd deMause étudia le lien intrinsèque entre les premières expériences relationnelles, le développement du cerveau et le système de croyances et de valeurs de l'espèce Sapiens. Il souligna le parallèle entre la transformation de l'éducation de l'enfant et l'évolution culturelle. Reflétant cette approche théorique, nous trouvons dans la psychothérapie d'enfants l'étrange opportunité de recourir aux expériences de la grossesse et la naissance, pour obtenir une compréhension plus profonde des expressions de soi dans les dessins spontanés, les rêves et les scènes de thérapie par le jeu de sable.

Ya en 1912, desde el comienzo de su trabajo 'La destrucción como origen del devenir', Sabrina Spielrein abordó los movimientos antagónicos y transformadores de vida. Sus escritos forman un puente entre Freud y Jung, al establecer una relación entre experiencias biológicas y arquetipos. En 1974 Lloyd deMause examinó el vínculo intrínseco entre las experiencias relacionales tempranas, desarrollo cerebral y el sistema de creencias y valores de la especie Sapiens. Delineó el paralelismo entre la transformación de la educación infantil y la evolución cultural. A partir de este abordaje teórico en psicoterapia infantil, tenemos la peculiar oportunidad de acceder, a través de la auto expresión en dibujos espontáneos, sueños y escenas en la arena, a experiencias sucedidas durante el embarazo y el nacimiento, para ganar una comprensión más profunda.

Já em 1912, Sabina Spielrein abordou os movimentos transformadores e antagônicos da vida que aparecem desde a concepção em sua obra 'Destruição como causa do surgimento'. Seus escritos formam uma ponte entre Freud e Jung, à medida que estabelecem a relação entre experiências biológicas e arquétipos. Em 1974, Lloyd deMause examinou a ligação intrínseca entre experiências relacionais primárias, desenvolvimento cerebral e o sistema de crenças e valores das espécies Sapiens. Ele delineou o paralelo entre a transformação da educação infantil e a evolução cultural. Refletindo essa abordagem teórica, na psicoterapia infantil temos a oportunidade peculiar de recorrer a experiências durante a gravidez e o parto, para obter uma compreensão mais profunda das autoexpressões em desenhos espontâneos, sonhos e cenas de areia.

The Self and alien self in psyche and soma.

This paper compares presentations of disorders of the sense of body ownership and agency from psychoanalytic and neurological perspectives to demonstrate similarities in symptomatology proposing these similarities arise from adjustments in Friston's generative model of self-organization and selfhood. The implications for the analytic model of the Self, for clinical practice and for neuroscience research are considered. Patients with narcissistic disorders use projective defences resulting in a disordered sense of what belongs to whom. This applies to mind and body of self and other and is central to understanding transference and countertransference. Clinical observations of this disordered sense of ownership and agency mirror findings in neurological disorders. This paper proposes that in both neurological and psychological disorders Friston's 'internal generative model' of selfhood is adjusted. Further to this whilst this adjustment may be either neurogenic or psychogenic, the final neural mechanism and symptomatic outcome are similar. On the basis of these observations the paper compares the concept of the Self from Jungian and psychoanalytic perspectives. Finally, the implications for the concept of the death instinct and Britton's concept of Xenophobia are explored along with the implications of these observations for clinical practice.

Cet article compare les présentations des troubles du sens de la propriété du corps et de la capacité d'action selon les perspectives psychanalytiques et neurologiques afin de montrer les similarités dans la symptomatologie. L'article suggère que ces similarités proviennent d'ajustements dans le modèle générateur de Friston de l'organisation et du sentiment de soi. L'article s'intéresse aux implications pour le modèle analytique du soi, pour la pratique clinique et pour la recherche en neurosciences. Les patients qui ont des troubles narcissiques utilisent des défenses projectives qui produisent un sentiment troublé de « quoi appartient à qui ¼. Ceci s'applique à l'esprit et au corps - de soi et de l'autre - et est central dans la compréhension du transfert et du contretransfert. Les observations cliniques de ce sentiment troublé d'appartenance et de capacité d'action reflètent les découvertes sur les troubles neurologiques. Cet article suggère que dans les troubles neurologiques et dans les troubles psychologiques le 'modèle générateur interne' du sentiment de soi de Friston est ajusté. De plus, bien que cet ajustement puisse être soit neurogène soit psychogène, le mécanisme neural final et le résultat symptomatique sont similaires. Sur la base de ces observations l'article compare le concept du Soi des points de vue Jungien et psychanalytique. Enfin les implications en ce qui concerne le concept de pulsion de mort et le concept de Britton de Xénophobie sont étudiées aux côtés des conséquences de ces observations pour la pratique clinique.

El presente trabajo compara presentaciones de trastornos de la sensación de agencia y posesión del propio cuerpo desde perspectivas psicoanalíticas y neurológicas para demostrar similitudes en sintomatología, proponiendo que estas similitudes emergen de ajustes según el modelo de autoorganización e identidad de Friston. Se consideran las implicancias de la práctica clínica y de investigaciones en neurociencias para un modelo analítico del self. Pacientes con trastornos narcisistas utilizan defensas proyectivas que resultan en un sentido desordenado de qué pertenece a quién. Esto aplica a la mente y al cuerpo de uno mismo y del otro y es central para la comprensión de la transferencia y contratransferencia. Las observaciones clínicas de este trastorno del sentido de agencia y posesión reflejan hallazgos en trastornos neurológicos. El artículo propone que, tanto en trastornos neurológicos como psicológicos, el 'modelo generativo interno' de la identidad de Friston es adaptativo. Además, mientras esta adaptación puede ser neurogénica o psicogénica, el resultado sintomático y el mecanismo final neural son similares. Sobre la base de estas observaciones, el trabajo compara el concepto de Self desde las perspectivas Junguiana y psicoanalítica. Finalmente, se exploran las implicaciones del concepto de instinto de muerte y el concepto de Xenofobia de Britton, junto a las consecuencias de estas observaciones para la práctica clínica.

Impact of the creation of specialized units for patients with hypertrophic cardiomyopathy.

INTRODUCTION AND OBJECTIVES: According to current international guidelines, hypertrophic cardiomyopathy (HCM) patients should be managed in specialized units. However, there is lack of data on the impact of the creation of these units in the management of HCM patients. Our goal was to assess the impact of the creation of an Inherited Inherited Diseases Cardiac Unit (ICDU) in the current management of patients with HCM. METHODS: We analyzed 114 consecutive patients (62.6±8 years old, 70.2% males) with HCM. Variables related to optimal management of HCM patients and their family study were recorded, as well as guidance on the risk of sudden death. We analyzed whether patients were assessed by the ICDU or at a general cardiology consultation (GCC). RESULTS: 50 patients were assessed in the IDCU and 64 in the GCC. Familial screening was more frequent in patients assessed by the IDCU (45.3% vs. 4%; p<0.01), requesting more genetic studies of the index case (70.3% vs. 14%; p<0.01) and cardiac magnetic resonance (53.1% vs. 18%; p<0.01). Sudden death risk score was performed more frequently in patients after the creation of an IDCU (67.2% vs. 28%; p<0.01). Treatment with beta-blockers was similar in both groups (72% vs. 78.1%; p=0.24). An implantable cardiac defibrillator was indicated similarly in both groups (12.5% in ICDU and 6% in GC; p=0.24). CONCLUSIONS: The implementation of an IDCU improved the quality of the medical care for HCM patients by performing a better study of the patients and their families.

Could the unfortunate outcome of pediatric acute myocarditis be predicted? Factors contributing to a poor outcome in myocarditis.

OBJECTIVE: Myocarditis has spontaneous resolution in 50% of patients. Our study aimed to define risk factors for developing dilated cardiomyopathy (DCM) and death in pediatric patients with acute myocarditis (AM). METHODS: The retrospective cohort study included all patients with treated AM. The Mother and Child Health Institute from January 2011 to March 2019. RESULTS: In the study, 62 patients were included, 40 boys and 22 girls (11.15±5.86 years) with AM. Twelve out of sixty-two children had acute fulminant myocarditis. Four patients died in the acute phase of AM, and 11 developed DCM. Follow up was 27.14±36.52 months. Patients with poor outcome (DCM development) were under the age of seven (odds ratio [OR] 10.1; p=0.003), more likely to be girls (OR 4.6; p=0.03), and had fulminant myocarditis (OR 27.0; <0.001). An ejection fraction (EF) <55% and fractional shortening (FS) <30% increased risk of DCM 13- and 5-fold, respectively, but patients with EF between 40 and 55% remain at highest risk of developing DCM. There was a 12-fold increased risk for DCM in patients with left ventricular end-diastolic diameter Z score >2+. The receiver operator curve showed that the lactate dehydrogenase (LDH) cut-off value for developing DCM was 1780 mmol/l (sensitivity 80%, specificity 100%). CONCLUSION: Acute fulminant myocarditis was an independent risk factor for DCM. Children with EF between 40 and 50% at admission were at highest risk of developing DCM. Lactate dehydrogenase value could be a significant prognostic value for the outcome of pediatric myocarditis.

The Nocturnal Ovipositon Behavior of Chrysomya megacephala (Diptera: Calliphoridae) in Brazil and Its Forensic Implications.

Chrysomya megacephala (Fab. 1794) (Diptera: Calliphoridae) is a very important species for forensic entomology, mainly contributing estimations of the postmortem interval (PMI) in judicial investigations. There are some doubts about the nocturnal oviposition of these flies, which could lead to errors in the PMI calculation. This study aimed to monitor the nocturnal oviposition behavior of this species through four experimental conditions carried out in laboratory. Ten cages, each containing five males and females (n = 100), were kept in a fume hood and subjected to total darkness or to artificial light for 11 consecutive hours. Two verifications were performed to determine whether the females deposited eggs on the substrate of ~20 g of chicken gizzards per cage. The first verification occurred at 9:00 pm in nocturnal experiments and at 09:00 am in diurnal experiments. The second verification occurred at 05:00 am in nocturnal experiments and at 05:00 pm in diurnal experiments. Each experiment lasted 5 d. Chrysomya megacephala deposited eggs at night under artificial light and in total darkness, but the amount of eggs was significantly lower when compared with the daytime experiments in dark conditions and under natural light. Oviposition occurred when the average temperature was around 25°C (± 2°C) and relative humidity around 73% (± 6%). Night oviposition is a possibility which should not be ruled out. Thus, future experiments are recommended.

Intersections of personal vs. collective trauma during the COVID-19 pandemic: the hijacking of the human imagination.

This paper explores how the deadly shadow of COVID-19 passing over the Earth constitutes a collective trauma that frequently opens up or 'triggers' un-remembered personal trauma, and it provides clinical examples of these intersections. The paper further explores how the human imagination, which we normally utilize to make meaning out of traumatic experience, can be hijacked by fear - leading to avoidance of suffering and to illusory formulations and alternative realities such as conspiracy theories. Alternatively, the imagination can be employed in more realistic and creative ways - leading through conscious suffering to healing and wholeness. Which path the imagination takes is shown to depend on the capacity of individuals to feel the full reality of the human condition in general and the exquisite vulnerability of our existence as fragile human beings at this moment in history. Ernest Becker's analysis of our 'denial of death' and his urgency to embrace our common human vulnerability is explored in relation to Jung's early tendency to deny the body. The author proposes that the more creative uses of the imagination, connected to a more humble and realistic apprehension of our common destiny, may be seen in the 'Black Lives Matter' movement that swept the world in the aftermath of the COVID-19 outbreak.

Cet article explore comment l'ombre de mort de la COVID-19, passant sur la terre, constitue un traumatisme collectif qui souvent ouvre ou ravive un traumatisme personnel non-remémoré. L'article fournit des exemples cliniques de telles intersections. Il explore comment l'imagination humaine, que nous utilisons normalement pour donner du sens à nos expériences traumatiques, peut être détournée par la peur. Ceci mène à l'évitement de la souffrance et à des formulations illusoires ou réalités alternatives telles que les théories du complot. Mais l'imagination peut aussi être employée de manières plus réalistes et créatives, nous guidant à travers une souffrance consciente à la guérison et la complétude. Nous montrerons que le choix du chemin que l'imagination emploie dépend de la capacité des personnes à éprouver la pleine réalité de la condition humaine en général et la vulnérabilité magnifique de notre existence en tant qu'êtres humains fragiles à ce moment de l'histoire. L'analyse que fait Ernest Becker de notre 'déni de la mort' et son insistance à épouser notre vulnérabilité humaine commune est étudiée et mise en relation avec la tendance de Jung, au début de son œuvre, à renier le corps. L'auteur propose que les utilisations plus créatives de l'imagination, reliées à une appréhension plus humble et plus réaliste de notre destinée commune, peuvent se retrouver dans le mouvement Black Lives Matter, mouvement qui a balayé le monde à la suite de la flambée de COVID-19.

El presente trabajo explora como la sombra mortal del COVID-19 pasando sobre la tierra constituye un trauma colectivo que frecuentemente abre o 'activa' trauma personal no recordado. Se proveen ejemplos clínicos de estas intersecciones. El escrito además explora cómo la imaginación humana, la cual normalmente utilizamos para encontrar sentido a partir de experiencias traumáticas, puede ser apropiada por el miedo - conduciendo a la evitación del sufrimiento y a formulaciones ilusorias y realidades alternativas tales como las teorías conspirativas. Alternativamente, la imaginación puede ser empleada en modos más realistas y creativos - conduciendo a través del sufrimiento consciente a la sanación y a la integridad. Cual camino toma la imaginación, se muestra que depende de la capacidad de los individuos para sentir la realidad plena de la condición humana en general y la exquisita vulnerabilidad de nuestra existencia como frágiles seres humanos en este momento de la historia. El análisis de nuestra 'negación de la muerte' de Ernest Becker y su urgencia por acoger nuestra común vulnerabilidad humana es explorada con relación a la temprana tendencia en Jung de negar el cuerpo. El autor propone que los usos más creativos de la imaginación, conectados a una aprehensión más humilde y realista de nuestro destino común, puede ser vista en el movimiento Black Lives Matter que recorrió el mundo en las postrimerías del estallido del COVID-19.

Cultural complex, death anxiety and individuation during times of populism: a dialogue between Jungian psychology and social psychology.

A trend towards political polarization and radicalization is observable in many countries across the world. The rise of populist movements and an increasingly heated polarized discourse in the face of mounting environmental and cultural challenges calls for a multifaceted psychological engagement with these phenomena. C.G. Jung's vision of individuation remains crucial for understanding, and possibly mitigating, developments towards radicalization and division within and between cultures. This paper considers classic and contemporary depth psychological ideas regarding individuation, shadow work and cultural complexes, and applies these ideas to current socio-political developments. To further elucidate, Jungian thought is brought into conversation with the findings of a body of literature within social psychology called Terror Management Theory (TMT) which points to unconscious death anxiety as amplifying a sense of separation and otherness, as well as judgment and conflict between individuals and groups. This paper aims to deepen the understanding of current cultural polarization phenomena as well as to collective healing and growth by synthesizing ideas from Jung and TMT research, and to rekindle the fire of individuation as a counter to the trend of polarization, alienation and conflict.

Une tendance à la radicalisation et la polarisation politique est notable dans un grand nombre de pays dans le monde entier. La montée des mouvements populistes et un discours de plus en plus tendu devant les défis environnementaux et culturels croissants appellent à une implication psychologique à diverses facettes par rapport à ces phénomènes. La vision de C.G. Jung concernant l'individuation reste cruciale pour comprendre et peut-être même mitiger les évolutions vers la radicalisation et la division entre les cultures et au sein de la même culture. Cet article examine les idées classiques et contemporaines de la psychologie des profondeurs en ce qui concerne l'individuation, le travail sur l'ombre et les complexes culturels, et applique ces idées aux évolutions socio-politiques actuelles. Pour aller plus loin, la pensée Jungienne est mise en conversation avec les découvertes d'un corpus de travail de la Psychologie Sociale, appelé TMT (Théorie du Management de la Terreur). Ce corpus indique que l'angoisse inconsciente de mort vient amplifier le sentiment de séparation et d'altérité, ainsi que le jugement et le conflit entre les individus et entre les groupes. L'article s'emploie à approfondir la compréhension du phénomène actuel de polarisation culturelle mais aussi de la guérison et de la croissance collective, en synthétisant des idées venant de Jung et de la recherche sur la TMT. Il vise aussi à rallumer la flamme du feu de l'individuation comme une butée à la tendance à la polarisation, l'aliénation et au conflit.

En muchos países a través del mundo, se observa una tendencia hacia la polarización y la radicalización política. El crecimiento de movimientos populistas y un discurso crecientemente acalorado y polarizado ante los desafíos culturales y del medio ambiente demanda un involucramiento psicológico multifacético con estos fenómenos. La visión de la individuación de C. G. Jung permanece crucial para comprender, y posiblemente mitigar, desarrollos hacia la radicalización y a la división dentro y entre culturas. El presente trabajo considera ideas de la psicología profunda clásica y contemporánea sobre individuación, trabajo con la sombra y complejos culturales, y aplica estas ideas a desarrollos socio-políticos actuales. Para una mayor elucidación, se propone un diálogo entre el pensamiento Junguiano y hallazgos de un campo dentro de la Psicología Social, llamado Teoría de la Gestión del Terror (TGT) la cual se focaliza en el miedo a la muerte inconsciente, como forma amplificada de un sentimiento de separación y otredad, así como en el juicio y conflicto entre individuos y grupos. El presente trabajo tiene como objetivo profundizar en la comprensión del fenómeno actual de polarización cultural, y también contribuir a la sanación y al crecimiento colectivo al sintetizar ideas de C. G. Jung y de investigación en TGT, y reavivar la llama de la individuación como contraposición a la tendencia hacia la polarización, alienación y conflicto.

QT interval greater than 460 ms in multiple electrocardiograms during follow-up in patients with Brugada syndrome: What does it contribute?

INTRODUCTION: Corrected QT interval (QTc) >460 ms in the right precordial leads has been described as a predictor of malignant ventricular arrhythmias (MVA) in patients with Brugada syndrome (BrS). OBJECTIVE: To assess the presence of QTc>460 ms in multiple electrocardiograms (ECGs) during follow-up as a predictor of recurrence of MVA in patients with BrS. METHODS: The study group included 43 patients with BrS and an implantable cardioverter-defibrillator. ECGs were performed serially between June 2000 and January 2017. QT interval was measured and QTc was obtained by Bazett's formula. The sample was divided into three groups: Group 1 (patients with no ECGs with QTc>460 ms); Group 2 (patients with only one ECG with QTc>460 ms); and Group 3 (patients with two or more ECGs with QTc>460 ms). RESULTS: The following variables were more frequently observed in Group 3: family history of sudden death (p=0.023), previous history of cardiorespiratory arrest (p=0.032), syncope (p=0.039), documented MVA (p=0.002), and proportion of ECGs with coved-type ST interval during follow-up (p=0.002). In Group 3, 67% of BrS patients had events during follow-up, as opposed to only 22% of Group 1 and 14% of Group 2 (Group 1 vs. Group 2, p=0.33015; Group 1 vs. Group 3, p=0.04295; and Group 2 vs. Group 3, p=0.04155). CONCLUSIONS: QTc>460 ms in more than one ECG during follow-up increases the risk of MVA events in patients with BrS.

Chagas cardiomyopathy and heart failure: From epidemiology to treatment.

Chagas disease is among the neglected tropical diseases recognized by the World Health Organization that have received insufficient attention from governments and health agencies. Chagas disease is endemic in 21 Latin America regions. Due to globalization and increased migration, it has crossed borders and reached other regions including North America and Europe. The clinical presentation of the disease is highly variable, from general symptoms to severe cardiac involvement that can culminate in heart failure. Chagas heart disease is multifactorial, and can include dilated cardiomyopathy, thromboembolic phenomena, and arrhythmias that may lead to sudden death. Diagnosis is by methods such as enzyme-linked immunosorbent assay (ELISA) and the degree of cardiac involvement should be investigated with complementary exams including ECG, chest radiography and electrophysiological study. There have been insufficient studies on which to base specific treatment for heart failure due to Chagas disease. Treatment should therefore be derived from guidelines for heart failure that are not specific for this disease. Heart transplantation is a viable option with satisfactory success rates that has improved survival.

[Cutaneous Toxicity of Immune Checkpoint Inhibitors: A Narrative Review]. / Toxicidade Cutânea dos Inibidores de Checkpoint Imunológico: Uma Revisão Narrativa.

INTRODUCTION: Immune checkpoint inhibitors revolutionized anti-neoplastic treatment. Recently, the European Medicines Agency and the United States Food and Drug Administration approved inhibitors of various immune checkpoints, namely the cytotoxic T-lymphocyte-associated protein 4, programmed cell death protein 1 and its ligand. Despite the added benefits in the treatment of several neoplasms, immune checkpoint blockade may also be associated with multiple immune-related adverse events. MATERIAL AND METHODS: A literature review in PubMed database on the cutaneous toxicity of immune checkpoint inhibitors was performed until April 30, 2019. RESULTS AND DISCUSSION: A total of 380 articles were initially screened, of which 75 are the basis of this bibliographic review. The immune checkpoint inhibitors monoclonal antibodies produce their beneficial effects by activating the patient's immune system. This activation also results in adverse events that can affect any organ, whereas cutaneous toxicity is the most frequent and precocious. The adverse events of the programmed cell death protein 1 and its ligand and of the cytotoxic T-lymphocyte-associated protein 4 are similar (class effect), despite the apparent higher skin toxicity of inhibitors of the cytotoxic T-lymphocyte-associated protein 4 (or its use in combination with inhibitors of programmed cell death protein 1 and its ligand). The most common cutaneous toxicities are maculopapular exanthema and pruritus, but other more specific adverse effects (e.g. lichenoid or psoriasiform reaction, vitiligo, sarcoidosis, among others) or located in the oral mucosa and/or adnexa are underreported. CONCLUSION: Given the high rate of cutaneous toxicity associated with new immune checkpoint inhibitors and their impact on quality of life, their early recognition and appropriate approach are crucial in the treatment of cancer patients. Observation by a dermatologist should be provided in patients with certain toxicities.

Introdução: Os inibidores de checkpoint imunológico revolucionaram o tratamento anti-neoplásico. Nos últimos anos, a European Medicines Agency e a United States Food and Drug Administration aprovaram inibidores de vários checkpoint imunológicos, nomeadamente do antigénio 4 associado aos linfócitos T citotóxicos e da proteína 1 de morte celular programada ou o seu ligante. Apesar dos benefícios que acrescentam no tratamento de várias neoplasias, o bloqueio dos checkpoint imunológicos também se pode associar a múltiplos efeitos adversos imunorrelacionados. Material e Métodos: Foi efetuada uma pesquisa da literatura da base de dados PubMed sobre a toxicidade cutânea dos inibidores de checkpoint imunológico até 30 de abril de 2019. Resultados e Discussão: Foram triados 380 artigos em primeira análise, dos quais 75 constituem a base desta revisão bibliográfica. Os anticorpos monoclonais inibidores de checkpoint imunológico produzem os seus efeitos benéficos através da ativação do sistema imunológico. Desta ativação resultam também efeitos adversos que podem afetar qualquer órgão, sendo a toxicidade cutânea a mais frequente e precoce. Os efeitos adversos imunorrelacionados dos inibidores da proteína 1 de morte celular programada ou o seu ligante e inibidores do antigénio 4 associado aos linfócitos T citotóxicos são similares (efeito de classe), apesar da aparente maior toxicidade cutânea dos inibidores do antigénio 4 associado aos linfócitos T citotóxicos (ou do seu uso em combinação com os inibidores da proteína 1 de morte celular programada ou o seu ligante). Os efeitos adversos cutâneos mais comuns são o exantema maculopapular e o prurido, mas estão descritos outros mais característicos (reação liquenóide ou psoriasiforme, vitiligo e sarcoidose, entre outros) ou localizados às faneras e/ou mucosa oral, que estão aparentemente subestimados. Conclusão: Dada a elevada frequência da toxicidade cutânea associada aos novos inibidores de checkpoint imunológico e respetivo impacto na qualidade de vida, o seu reconhecimento precoce e a abordagem adequada são cruciais no tratamento do doente oncológico. A observação pelo dermatologista deve ser providenciada em doentes com determinadas toxicidades.