ABSTRACT
In the United States, 18.9% of the population identifies as Hispanic or Latin. The culture of these communities is as diverse, heterogenous, and rich as the history of this population. Culture shapes the perception of symptoms and psychiatric disorders. To provide culturally sensitive care, it is relevant to understand the history of these communities in the US, recognize cultural humility, and acknowledge aspects and values (eg, culturally bound syndromes, familism, paternalism, stigma of mental illness, machismo, immigration) inherent to the cultural experience and unique barriers to care. Incorporating these aspects into clinical practice is essential for positive outcomes. The purpose of this article is to give a brief historical context, encourage cultural humility, and describe cultural aspects that are essential when providing culturally sensitive care to the Hispanic and Latinx community in the US.
ABSTRACT
OBJECTIVE: To determine the impact of Zika virus (ZIKV) infection on brain structure and functional organization of severely affected adult patients with neurological complications that extend beyond Guillain-Barré Syndrome (GBS)-like manifestations and include symptoms of the central nervous system (CNS). METHODS: In this first case-control neuroimaging study, we obtained structural and functional magnetic resonance images in nine rare adult patients in the subacute phase, and healthy age- and sex-matched controls. ZIKV patients showed atypical descending and rapidly progressing peripheral nervous system (PNS) manifestations, and importantly, additional CNS presentations such as perceptual deficits. Voxel-based morphometry was utilized to evaluate gray matter volume, and resting state functional connectivity and Network Based Statistics were applied to assess the functional organization of the brain. RESULTS: Gray matter volume was decreased bilaterally in motor areas (supplementary motor cortex, specifically Frontal Eye Fields) and beyond (left inferior frontal sulcus). Additionally, gray matter volume increased in right middle frontal gyrus. Functional connectivity increased in a widespread network within and across temporal lobes. INTERPRETATION: We provide preliminary evidence for a link between ZIKV neurological complications and changes in adult human brain structure and functional organization, comprising both motor-related regions potentially secondary to prolonged PNS weakness, and nonsomatomotor regions indicative of PNS-independent alternations. The latter included the temporal lobes, particularly vulnerable in a range of neurological conditions. While future studies into the ZIKV-related neuroinflammatory mechanisms in adults are urgently needed, this study indicates that ZIKV infection can lead to an impact on the brain.
ABSTRACT
In this study, we investigated gray and white matter changes in subgroups within the larger tinnitus population related to differences in severity or duration of tinnitus symptoms. Tinnitus is the illusory perception of sound in the absence of an external source, most often experienced as a chronic condition. The psychological reaction to the sound constitutes the severity, or degree of discomfort experienced, and the duration refers to the time since onset of chronic tinnitus. We used voxel- and surface-based morphometry to investigate gray matter changes and diffusion tensor imaging (using fractional anisotropy, or FA, metrics) to assess changes in orientation of white matter tracts, using both whole brain and region of interest analyses. Whole brain analyses revealed decreased cortical thickness in the left parahippocampal gyrus in those with more severe tinnitus compared to a group with a milder reaction, and reduced gray matter volume in left anterior cingulate in those with mild tinnitus compared to a normal hearing control group without tinnitus. In the analysis based on FA, no significant differences were revealed between the subgroups or with respect to control groups in either whole brain or region of interest analyses. Our results suggest that these subgroups within the tinnitus population likely exhibit different anatomical alterations related to the disorder, which may explain the variable findings in the literature, particularly in terms of gray matter.
