scholarly journals Is the Death Instinct Silent or Clinically Relevant? From Freud’s Concept of a Silent Death Instinct to Understanding Its Clinical Manifestations

2021 ◽  
Author(s):  
Gertraud Diem-Wille
Keyword(s):  
Clinical Manifestations ◽  
Melanie Klein ◽  
Clinical Use ◽  
Death Instinct ◽  
Repetition Compulsion ◽  
Pleasure Principle ◽  
Clinical Vignettes ◽  
Negative Therapeutic Reaction ◽  
Drive Theory ◽  
The One

When Freud introduced his concept of the death instinct in Beyond the Pleasure Principle (1920) he solved three theoretical problems which could not be explained by the one drive theory: masochism, repetition compulsion and the negative therapeutic reaction. The concept of two inherently opposed instincts remained one of the most controversial parts of Freud’s theory. For Melanie Klein, Freud’s idea of the death instinct was a powerful instrument in solving her greatest problems of integrating her clinical evidence of an earlier, very harsh superego. In Freud’s account, the superego was the manifestation at birth of the death instinct operating in destructiveness towards the person, as he had argued. In this way, Klein put – as Hinshelwood claims – clinical “flesh on the bones of Freud’s theory of the death instinct.” I will describe the development of Freud’s theory and how this was elaborated by Klein and her followers Bion, Esther Bick, Segal and Rosenfeld. With three clinical vignettes--from an Infant Observation, a child analysis and an adult analysis--the clinical use of the concept will be illustrated.

scholarly journals POS0083 USEFUL EXPERIENCE OF RHEUMATOLOGISTS FOR UNDERSTANDING OF THE DISEASE ORIGIN AND APPROACHES TO THERAPY IN FIBRODYSPLASIA OSSIFICANS PROGRESSIVA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 249.2-250
Author(s):  
I. Nikishina ◽  
S. Arsenyeva ◽  
V. Matkava ◽  
A. Arefieva ◽  
M. Kaleda ◽  
...  
Keyword(s):  
Heterotopic Ossification ◽  
Kinase Inhibitor ◽  
Inflammatory Diseases ◽  
Clinical Manifestations ◽  
Fibrodysplasia Ossificans Progressiva ◽  
Rapid Progression ◽  
Time Duration ◽  
Long Term Follow Up ◽  
Vertebral Bodies ◽  
The One

Background:Many monogenic genetic conditions, such as auto-inflammatory diseases (AIDs), have similar clinical manifestations and immunopathogenesis to “classic” rheumatic diseases (RD). Such cases may include Fibrodysplasia ossificans progressiva (FOP), an extremely rare genetic disease, which, according to our previous study and data from other authors1, may represent an example of AID with catastrophic heterotopic ossification due to a mutation in the ACVR1 gene. it seems that the experience of rheumatologists, especially children’s ones, will be useful in the treatment of FOP.Objectives:To analyzed the dynamics of clinical manifestations and to therapy approaches including target anti-inflammatory drug Tofacitinib (TOFA) in the one of the world’s largest groups of patients (pts) with FOP.Methods:The study was based on the analysis retrospective and prospective observation of the 35 pts (17 males and 18 females) with a verified diagnosis of FOP for the period from 1998 to 2020. In 9 pts with severe course of FOP TOFA administration were evaluated.Results:In all 35 pts the diagnosis was verified by “classic” FOP phenotype: malformed great toes in 33 pts (94,3%); short malformed thumbs-8 (22.8%); peripheral osteochondromas-20 (57.1%); abnormalities of the cervical spine-32 (91.4%), multiple heterotopic ossifications-32 (91,4%). Genetic tests were done in 26, it confirmed mutation in the ACVR1 gene in 100%. Long term follow-up detected a lot of spondyloarthritis-like signs similar to the manifestation of RD: ankylosis of the facet joints and vertebral bodies (by the type of syndesmophytes) in most pts, sacroiliitis, confirmed by radiological methods (X-ray, CT, MRI), gradual ankylosis in the peripheral joints in 18 (56.4%), synovitis in large joints in 8 (25%) pts (knee and hip mostly). In 9 pts with the most difficult course with rapid progression of ossification due to continuous flares despite the NSAIDs and steroids intake, we tried to use TOFA after the approval of the local Ethic Committee. We use the similar dose to randomized trial for JIA (up to 5 mg twice a day). The first patient was 16 y.o. at the time of TOFA administration in December 2019, the age of the other pts was from 2 to 12 y.o. By present time duration of TOFA therapy is from 6 to 15 mo. For the previous 6 months before TOFA initiation the number of flares was in average 8 per patient. After 6 months of TOFA treatment the number of new flares decreased to 0-1, except youngest patient of 2 y.o. in whom the number of flares decreased from 10 to 4 per the same period. In all 9 pts we minimize the dose or completely stop the steroids. New nodes formation stopped immediately in most pts and also the significant motion improvement of large (shoulder) joints were established. Drug tolerance was good in all pts, no AE were registered. But despite the good clinical effect without new heterotopic ossification in our first patient, we found continuous intraskeletal ossification between vertebral bodies, facet and sacroiliac joints in MRI.Conclusion:We are confident that the processes of heterotopic ossification in FOP are very similar to new born formation phenomenon in spondyloarthritis and reliable suppression of inflammation can interrupt the progression of the disease. We used similar justifications to our colleagues for the use of anti-cytokine drugs, but used a JAK-kinase inhibitor, it was extremely important the oral rout of drug administration and possibility to escape any injections in FOP. TOFA demonstrated positive effect and safety in children with severe course of FOP. It showed their advantages over the use of steroids and possibility to inhibit the rate of progression.References:[1]R.Haviv et al. Is fibrodysplasia ossificans progressiva aninterleukin-1 driven auto-inflammatory syndrome? Pediatric Rheumatology (2019) 17:84 //doi.org/10.1186/s12969-019-0386-6Disclosure of Interests:None declared.

scholarly journals The Potency of Seaweed Sulfated Polysaccharides for the Correction of Hemostasis Disorders in COVID-19

Molecules ◽  
2021 ◽  
Vol 26 (9) ◽  
pp. 2618
Author(s):  
Tatyana A. Kuznetsova ◽  
Boris G. Andryukov ◽  
Ilona D. Makarenkova ◽  
Tatyana S. Zaporozhets ◽  
Natalya N. Besednova ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Therapeutic Potential ◽  
Low Cost ◽  
Clinical Manifestations ◽  
Optimal Dose ◽  
Monosaccharide Composition ◽  
Structural Features ◽  
Sulfated Polysaccharides ◽  
Clinical Use ◽  
Hemostasis System

Hemostasis disorders play an important role in the pathogenesis, clinical manifestations, and outcome of COVID-19. First of all, the hemostasis system suffers due to a complicated and severe course of COVID-19. A significant number of COVID-19 patients develop signs of hypercoagulability, thrombocytopenia, and hyperfibrinolysis. Patients with severe COVID-19 have a tendency toward thrombotic complications in the venous and arterial systems, which is the leading cause of death in this disease. Despite the success achieved in the treatment of SARS-CoV-2, the search for new effective anticoagulants, thrombolytics, and fibrinolytics, as well as their optimal dose strategies, continues to be relevant. The wide therapeutic potential of seaweed sulfated polysaccharides (PSs), including anticoagulant, thrombolytic, and fibrinolytic activities, opens up new possibilities for their study in experimental and clinical trials. These natural compounds can be important complementary drugs for the recovery from hemostasis disorders due to their natural origin, safety, and low cost compared to synthetic drugs. In this review, the authors analyze possible pathophysiological mechanisms involved in the hemostasis disorders observed in the pathological progression of COVID-19, and also focus the attention of researchers on seaweed PSs as potential drugs aimed to correction these disorders in COVID-19 patients. Modern literature data on the anticoagulant, antithrombotic, and fibrinolytic activities of seaweed PSs are presented, depending on their structural features (content and position of sulfate groups on the main chain of PSs, molecular weight, monosaccharide composition and type of glycosidic bonds, the degree of PS chain branching, etc.). The mechanisms of PS action on the hemostasis system and the issues of oral bioavailability of PSs, important for their clinical use as oral anticoagulant and antithrombotic agents, are considered. The combination of the anticoagulant, thrombolytic, and fibrinolytic properties, along with low toxicity and relative cheapness of production, open up prospects for the clinical use of PSs as alternative sources of new anticoagulant and antithrombotic compounds. However, further investigation and clinical trials are needed to confirm their efficacy.

scholarly journals STUDIES ON THE ETIOLOGY OF RABBIT POX

1936 ◽  
Vol 63 (3) ◽  
pp. 353-378 ◽  
Author(s):  
Ch'uan-K'uei Hu ◽  
Paul D. Rosahn ◽  
Louise Pearce
Keyword(s):  
New York ◽  
Clinical Manifestations ◽  
Vaccine Virus ◽  
Intradermal Injection ◽  
Skin Area ◽  
Cutaneous Lesions ◽  
Active Growth ◽  
Specific Relationship ◽  
Close Relationship ◽  
The One

Experiments are reported in which it was shown that rabbits which had recovered from experimental or spontaneous rabbit pox were refractory to inoculation of pox virus injected by various routes, and in addition did not develop clinical manifestations of the disease under conditions of exposure to florid cases of pox. It was found that pox recovered rabbits were susceptible to inoculation with the virus of virus III disease of rabbits and that virus III recovered rabbits could be successfully inoculated with pox virus. Furthermore, virus III recovered rabbits developed pox when subjected to room exposure in the same manner as did normal rabbits. It thus appears that there is no specific relationship between the two viruses. Rabbits which had recovered from experimental or spontaneous pox were found to be just as susceptible to inoculation with the virus of infectious myxoma of rabbits as were normal rabbits, a result which demonstrates that there is no specific relationship between these viruses. Rabbits which had recovered from experimental or spontaneous pox were refractory to inoculation with culture dermovaccine virus, but vaccine recovered rabbits were not completely refractory to inoculation with pox virus. Under conditions of exposure to clinical cases of pox, adult vaccine immune rabbits did not develop clinical manifestations of pox, but young, recently weaned vaccinated rabbits did contract mild but definite clinical pox. Experimental pox recovered rabbits were partially refractory to inoculation with neurovaccine virus and neurovaccine recovered rabbits were partially refractory to inoculation with pox virus. The refractory condition of the pox immune rabbits appeared to be more pronounced than that of the neurovaccine immunes. The cutaneous lesions which developed from the intradermal injection of pox, neurovaccine, and culture vaccine viruses showed definite differences with respect to the rate and persistence of active growth, amount of edema, hemorrhage, and necrosis, and the degree of tissue destructiveness. These features were most pronounced in the lesions of pox virus and were least marked in the lesions of culture vaccine virus. The differences were particularly apparent in normal rabbits, but they were also present in the lesions which developed in immune animals. It was found that the calf was susceptible to inoculation with pox virus applied to a scarified skin area. There were many similarities in the appearance and course of the pox lesions to those resulting from culture vaccine virus, the New York Board of Health vaccine, and neurovaccine virus similarly inoculated. But the pox lesions were most numerous, much the largest and most destructive, and by far the most persistent while next in order were those of the Board of Health dermovaccine. The results of these various experiments showed that a close relationship obtains between pox virus, on the one hand, and vaccine virus and neurovaccine virus, on the other, but it cannot be said that pox virus is identical in all respects with either one of these viruses. The findings indicated that the relationship between pox and neurovaccine viruses is closer than that between pox and culture vaccine viruses. Upon the basis of the results observed in culture (dermo) vaccine immune rabbits inoculated with or exposed to pox, it appeared that vaccination with vaccine virus offered a method of protection against rabbit pox.

scholarly journals Features of coping in patients with cerebrovascular pathology at different stages of diseases

2018 ◽  
Keyword(s):  
High Efficiency ◽  
Clinical Manifestations ◽  
Stressful Events ◽  
Psychological Help ◽  
Cerebrovascular Pathology ◽  
Ways Of Coping Questionnaire ◽  
Psychosocial Resource ◽  
Psychological Balance ◽  
The One

Coping is an important component in adapting a person to stressful events and maintaining a psychological balance. The aim of this work was to study the features of coping in patients with cerebrovascular pathology (CVP) in the dynamics of its development at different stages of the disease. At Kharkiv Regional Clinical Hospital - Emergency and Emergency Medicine Center during 2016-2018, observed 383 patients with cerebrovascular pathology on different stage of diseases. The coping assessed by using the Ways of Coping Questionnaire R. Lazarus & S. Folkman. In persons with high risk of CVP, clinical manifestations of CVP and patients after a stroke generally defined more tension of coping than in somatic healthy people. There occurred an imbalance forms of coping with low and high efficiency, dominated confrontation, distancing, avoidance versus problem solving, positive revaluation, increasing the role of social support as external psychosocial resource. Therefore, patients at various stages of CVP had unstable stress coping-profile that was on the one hand the basis for the development of stressrelated psychosomatic changes, on the other – not correctly solve the existing stress. Detection and psychological correction of ineffective coping strategies in patients with CVP is an important component of psychological help for this contingent of patients.

scholarly journals Metabolic signs of abdominal obesity in the patients presenting with acute myocardial infarction and normal or excess body weight

2012 ◽  
Vol 58 (4) ◽  
pp. 27-31
Author(s):  
L V Kvitkova ◽  
D A Borodkina ◽  
O V Gruzdeva ◽  
A A Silonova ◽  
O N Zharkova ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Insulin Resistance ◽  
Metabolic Disorders ◽  
Clinical Manifestations ◽  
Insulin Level ◽  
The Other ◽  
Excess Body Weight ◽  
The One ◽  
The Relationship ◽  
Level 2

This work was designed to study the relationship between the disturbances of carbohydrate metabolism (DCHM) and insulin resistance (IR) on the one hand and body mass index (BMI) and waist circumference (WC) on the other hand in the patients presenting with acute and cicatrical myocardial infarction (MI). It was shown that WC in all the patients exceeded the upper gender norm. The clinical manifestations of metabolic syndrome were documented in 65.6% of the patients with normal BMI, 85,7% of those with excess BMI, and in 96.3% of the patients with obesity. In all the groups the WC measures positively correlated with the glucose blood level at admittance to the hospital and on days 1 (r=0.34; p=0.01), 2 (r=0.38; p =0.0002), and 3 (r=0.68; p=0.002) after it. Similar correlation was observed with the insulin level 2 hours post-prandially on days 1 (r=0.42; p=0.01), 2 (r=0.5; p=0.0002), and 3 (r=-0.95; p=0.0003). The relationship between metabolic disorders and WC values indicates that visceral fat plays an important role in the regulation of metabolic processes and suggests the necessity of the treatment for the correction of WC.

scholarly journals Can We Harness Immune Responses to Improve Drug Treatment in Leishmaniasis?

2020 ◽  
Vol 8 (7) ◽  
pp. 1069
Author(s):  
Raphael Taiwo Aruleba ◽  
Katharine C. Carter ◽  
Frank Brombacher ◽  
Ramona Hurdayal
Keyword(s):  
Immune Responses ◽  
Economic Status ◽  
Clinical Manifestations ◽  
Steady Increase ◽  
Clinical Use ◽  
Self Healing ◽  
Cutaneous Lesions ◽  
Vector Borne ◽  
Visceral Disease ◽  
Control And Eradication

Leishmaniasis is a vector-borne parasitic disease that has been neglected in priority for control and eradication of malaria, tuberculosis, and HIV/AIDS. Collectively, over one seventh of the world’s population is at risk of being infected with 0.7–1.2 million new infections reported annually. Clinical manifestations range from self-healing cutaneous lesions to fatal visceral disease. The first anti-leishmanial drugs were introduced in the 1950′s and, despite several shortcomings, remain the mainstay for treatment. Regardless of this and the steady increase in infections over the years, particularly among populations of low economic status, research on leishmaniasis remains under funded. This review looks at the drugs currently in clinical use and how they interact with the host immune response. Employing chemoimmunotherapeutic approaches may be one viable alternative to improve the efficacy of novel/existing drugs and extend their lifespan in clinical use.

scholarly journals The clinical value of the delta finger to palm distance in systemic sclerosis

Reumatismo ◽  
2020 ◽  
Vol 72 (1) ◽  
pp. 44-51
Author(s):  
A. Javinani ◽  
S. Mostafaei ◽  
F. Gharibdoost ◽  
A.R. Jamshidi ◽  
R. Atef Yekta ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Clinical Manifestations ◽  
Digital Ulcers ◽  
Clinical Value ◽  
Prospective Longitudinal Study ◽  
Linear Effect ◽  
One Year ◽  
The One ◽  
Prospective Longitudinal

Systemic sclerosis (SSc) is a collagen-vascular disorder characterized by fibrosis and vasculopathy. Delta finger to palm distance (delta FTP) is an index measuring the distance between the tip of the third finger to the distal palmar crease in the flexed and extended position. The present study aimed to evaluate the clinical value of delta FTP and to assess the correlation of delta FTP with modified Rodnan skin score (mRSS) and forced vital capacity (FVC) over the 12-month follow-up. This prospective longitudinal study began with 50 participants who were followed for twelve months. Lowess smoothing and linear regression were applied to detect and assess the relationship between delta FTP and mRSS. p-values were adjusted by the Benjamini-Hochberg method (BHM) as a control for false discovery rate. Delta FTP was lower among patients with higher disease duration (p-valueadj: 0.008), diffuse cutaneous SSc (p-valueadj: 0.006), digital ulcers (p-valueadj: 0.003), telangiectasia (p-valueadj: 0.006) and dysphagia (p-valueadj: 0.036). The mRSS has a significant negative linear effect on the delta FTP at the baseline and the end of the follow-up (r: -0.31 and -0.40, respectively). Moreover, changes of mRSS and delta FTP showed a negative linear association over time (r: -0.22). These linear effects remained significant after regrouping the patients based on their SSc subtype. Delta FTP and FVC were not correlated either at the baseline or at the end. It seems that the delta FTP can be a valuable clinical index, supported by its correlated changes with mRSS and other SSc clinical manifestations over the one-year follow-up.

Listening to the Moving Body

2017 ◽  
pp. 128-148
Author(s):  
Laura-Hope Steckler
Keyword(s):  
Psychological Functioning ◽  
The Body ◽  
The Unconscious ◽  
Practical Applications ◽  
Body Psychotherapy ◽  
Clinical Vignettes ◽  
Diverse Field ◽  
Moving Body ◽  
The One ◽  
Unconscious Mind

This chapter describes various ways in which movement may be used in the field of body psychotherapy to promote psychological wellbeing. Body-oriented psychotherapy refers to those types of psychotherapy which are based on the belief that working on a bodily level has a direct impact on psychological functioning, since all experiences are stored in the body in various ways. As a body psychotherapist and a dancer, the author draws upon the diverse field of body psychotherapy on the one hand, and on the other, dance practices such as Butoh dance. These can be applied in trauma work, when movement is seen as an expression of the unconscious mind. There are also references to the use of stillness, very slow movement, and the use of ‘movement prescriptions’. All these movement interventions are discussed with relevant theoretical underpinnings, while clinical vignettes illustrate the concepts presented and their practical applications.

scholarly journals Clinical use of the III generation calcium antagonist Amlotopin the treatment of patients with cardiovascular disease

2013 ◽  
Vol 4 (4) ◽  
pp. 25-32
Author(s):  
V. S Zadionchenko ◽  
G. G Shehyan ◽  
A. A Yalymov
Keyword(s):  
Cardiovascular Disease ◽  
Calcium Current ◽  
Developed Countries ◽  
The Other ◽  
Prescription Rate ◽  
Clinical Use ◽  
Tissue Selectivity ◽  
The 1960S ◽  
The One ◽  
New Treatments

Despite the facts, revealing the mechanisms of pathogenesis and enhancing the effectiveness of the treatment of cardiovascular disease (CVD), the latter continues to be the leading cause of death and disability in the population. In this regard, the search for new treatments for CVD remains the most relevant in modern cardiology. In the treatment of CVD many classes of drugs are used, among which are calcium antagonists (AA). This class of drugs has been successfully used in the treatment of patients with arterial hypertension (AH) and coronary heart disease [1-3, 5].CA are a heterogeneous group of drugs that have the similar actionmechanism, but differ in a number of properties, including pharmacokinetics, tissue selectivity, effect on heart rate, etc. The main feature of all is the ability of CA to reversibly inhibit calcium current through the slow calcium channels. These funds are used in cardiology from the end of the 1960s and have since become so widely popular that in most developed countries they hold one of the first places on the prescription rate of drugs used for the treatment of cardiovascular disease. This is due, on the one hand, to the CA high clinical efficacy, and on the other to a relatively small number of contraindications to their purpose and the comparatively small number of side effects. [1, 2, 4, 5].

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