Clinical Efficacy and Psychological Mechanisms of an App-Based Digital Therapeutic for Generalized Anxiety Disorder: Randomized Controlled Trial.

BACKGROUND: Current treatments for generalized anxiety disorder (GAD) often yield suboptimal outcomes, partly because of insufficient targeting of underlying psychological mechanisms (eg, avoidance reinforcement learning). Mindfulness training (MT) has shown efficacy for anxiety; yet, widespread adoption has been limited, partly because of the difficulty in scaling in-person-based delivery. Digital therapeutics are emerging as potentially viable treatments; however, very few have been empirically validated. OBJECTIVE: The aim of this study is to test the efficacy and mechanism of an app-delivered MT that was designed to target a potential mechanism of anxiety (reinforcement learning), based on which previous studies have shown concern regarding feedback and the perpetuation of anxiety through negative reinforcement. METHODS: Individuals with GAD were recruited using social media advertisements and randomized during an in-person visit to receive treatment as usual (n=33) or treatment as usual+app-delivered MT (Unwinding Anxiety; n=32). The latter was composed of 30 modules to be completed over a 2-month period. Associated changes in outcomes were assessed using self-report questionnaires 1 and 2 months after treatment initiation. RESULTS: We randomized 65 participants in this study, and a modified intent-to-treat approach was used for analysis. The median number of modules completed by the MT group was 25.5 (IQR 17) out of 30; 46% (13/28) of the participants completed the program. In addition, the MT group demonstrated a significant reduction in anxiety (GAD-7) compared with the control group at 2 months (67% vs 14%; median change in GAD-7: -8.5 [IQR 6.5] vs -1.0 [IQR 5.0]; P<.001; 95% CI 6-10). Increases in mindfulness at 1 month (nonreactivity subscale) mediated decreases in worry at 2 months (Penn State Worry Questionnaire; P=.02) and decreases in worry at 1 month mediated reductions in anxiety at 2 months (P=.03). CONCLUSIONS: To our knowledge, this is the first report on the efficacy and mechanism of an app-delivered MT for GAD. These findings demonstrate the clinical efficacy of MT as a digital therapeutic for individuals with anxiety (number needed to treat=1.6). These results also link recent advances in our mechanistic understanding of anxiety with treatment development, showing that app-delivered MT targets key reinforcement learning pathways, resulting in tangible, clinically meaningful reductions in worry and anxiety. Evidence-based, mechanistically targeted digital therapeutics have the potential to improve health at a population level at a low cost. TRIAL REGISTRATION: ClinicalTrials.gov NCT03683472; https://clinicaltrials.gov/ct2/show/NCT03683472.

[Lithiasis of soft appearance within a calyceal diverticulum in the right kidney. Report of one case and therapeutic management]. / Litiasis de aspecto blando, alojada en un divertículo calicial del riñón derecho. Pre- sentación de un caso y conducta terapéuti- ca.

OBJECTIVES: To report the case of a 28-year-old female patient carrying a lithiasis of soft appearance located within a calyceal diverticulum in the right kidney which presented clinically during pregnancy, and to comment on therapeutic management, as well as the outcome one year after conservative treatment. METHODS AND RESULTS: 28-year-old female patient with history of renal colic during pregnancy, who presents at our clinics in the postpartum period with a recurrent abdominal and lumbar pain. Kidney-ureter-bladder (KUB) x-ray and intravenous urography (IVP) detected a lithiasis of soft appearance within a calyceal diverticulum in the right kidney. Treatment was conservative with potassium citrate/citric acid and follow-up controls with urine culture (every 3 months) and ultrasounds (every 8 months). Currently she is asymptomatic but the lithiasis persists on KUB and urine culture is positive (Escherichia coli) and receives treatment with cefuroxime 250 mg every 12 hours for 6 days and nitrofurantoin 100 mg every night for three months. CONCLUSIONS: Most urinary stones located within calyceal diverticula have an asymptomatic course, treatment not being necessary. The most frequent clinical presentations of these stones are flank pain, urinary infection demonstrated by positive urine culture, and incidental finding. IVU is an effective method for diagnosis. ESWL is not an effective treatment for them, being percutaneous techniques the most suitable for a single-surgical procedure resolution of both lithiasis and pyelocalyceal diverticulum.

Litiasis de aspecto blando, alojada en un divertículo calicial del riñón derecho. Presentación de un caso y conducta terapéutica / Lithiasis of soft appearance within a calyceal diverticulum in the right kidney. Report of one case and therapeutic management

OBJETIVO: Presentar un caso portador de una litiasis de aspecto blando, alojada en un divertículo calicial del riñón derecho, que debutó clínicamente durante el embarazo, en una paciente de 28 años y comentar el abordaje terapéutico, así como la evolución después de un año de tratamiento conservador. MÉTODO/RESULTADOS: Se trata de una paciente de 28 años de edad con antecedentes de cólicos nefríticos durante el embarazo, que acude a consulta ya puérpera por padecer de crisis de dolor abdominal recurrente y en región lumbar. Después de ser estudiada con Rx de Tracto Urinario Simple (Rx TUS) y Urografía Intravenosa (UIV) se detecta una litiasis de aspecto blando en el interior de un divertículo calicial del riñón derecho. Se decide tratamiento conservador con citrato potásico/ácido cítrico y controles con Urocultivos cada tres meses y Ecografía cada 8 meses. A la fecha actual persiste la litiasis en el Rx TUS y ecográficamente y presenta positividad del urocultivo (Echerichia coli) llevando tratamiento con Cefuroxima 250 mg cada 12 horas durante 6 días y Nitrofurantoina a dosis de 100mg en toma única nocturna durante tres meses, estándo asintomática. CONCLUSIONES: La mayoría de los cálculos alojados en divertículos caliciales cursan de forma asintomática no siendo necesario su tratamiento. Las formas de presentación clínica más frecuentes de estas litiasis son el dolor en flanco, infección de orina demostrada por urocultivo positivo y hallazgo casual. La UIV constituye un método eficaz para el diagnóstico de estas litiasis. La LEOC no constituye un tratamiento eficaz para este tipo de litiasis, considerándose las técnicas percutáneas las más idóneas para resolver en un mismo acto quirúrgico la litiasis y el divertículo pielocalicial (AU)

No disponible

[Calcified uterine myoma. Presentation of 3 cases]. / Mioma uterino calcificado. Presentación de tres casos.

OBJECTIVES: To report three cases of uterine myoma as cause of pelvic calcification and to establish differential diagnosis with bladder stones. METHODS/RESULTS: Three asymptomatic female patients, ages between 54 years (one patient) and more than 70 years (two patients), were fortuitously found to have calcified uterine myomas by radiological studies made for suspicion of other pathologies. CONCLUSIONS: Discovering of calcified uterine myomas is not frequent. Diagnosis is made by radiological studies in postmenopausal female patients. The significance from the urological point of view is to do differential diagnosis with bladder stones.

Mioma uterino calcificado. Presentación de tres casos / Calcified uterine myoma. Report of three cases

OBJETIVO: El propósito de este trabajo es presentar tres casos portadores de mioma uterino calcificado destacando esta patología como causa de hallazgo radiológico de imagen cálcica pélvica y hacer diagnóstico diferencial con los cálculos vesicales. MÉTODO/RESULTADOS: Se trata de tres pacientes femeninas, en edades comprendidas entre los 54 años (1 paciente) y por encima de los 70 años (2 pacientes), asintomáticas desde el punto de vista uro-ginecológico, a las que se le diagnosticó de forma fortuita mediante estudios radiológicos, por sospecha de otra patología, miomas uterinos calcificados. Se aportan figuras ilustrativas con el objetivo de colaborar en el conocimiento de esta patología. CONCLUSIONES: El hallazgo de miomas uterinos calcificados es poco frecuente en nuestro medio, el diagnóstico generalmente es casual a través de exploraciones radiológicas indicadas en el transcurso del estudio de otra patología ya que el mioma uterino calcificado en edades postmenopáusicas generalmente no da síntomas, las pacientes refieren el antecedente de haber sido tratadas por mioma uterino durante su edad premenopáusica. Desde el punto de vista urológico la importancia de esta entidad radica en el diagnóstico diferencial que hay que hacer con los cálculos vesicales (AU)