Changes in vessel density patterns assessed with OCTA in patients with diabetic macular edema treated with anti-VEGF therapy.

AIMS: To determine the presence of sectoral changes in vessel density (VD) patterns induced by vascular endothelial growth factor inhibitors (anti-VEGF) in patients with diabetic macular edema (DME) using optical coherence tomography angiography (OCTA). METHODS: Prospective, interventional study. A total of 43 patients (63 eyes) were initially enrolled in the study. We performed swept source (SS) OCT and sectorial OCTA measurement to determine parafoveal VD at baseline and after six months of anti-VEGF treatment. In the locations with statistically significant differences in VD between baseline and month 6, we performed univariate and multivariate analyses to determine which, if any, of the baseline variables were associated with the observed changes. RESULTS: A total of 34 patients (48 eyes) were included in the final analysis. Mean VD decreased from baseline to month 6 (from 45.2 (± 3.5) to 44.6 (± 3.2) % in the SCP and from 50 (± 3.3) to 49 (± 3.9) % in the DCP). The only significant changes in VD were observed in the nasal sector of the deep capillary plexus, with a decrease of 2.9% (p = 0.001). On univariate and multivariate analyses, the only variable significantly associated with changes in VD in the nasal sector after 6 months of treatment was baseline VD in the same sector. CONCLUSIONS: Anti-VEGF therapy has a small impact on VD values over time. These variations observed after treatment seems to be related to changes over areas of vascular anomalies and displaced vessels adjacent to cystic areas, with no significant changes over ischemic areas. No correlation was observed between this trend and other clinical baseline features.

Correlation between Topographic Vessel Density and Retinal Thickness Changes in Patients with Diabetic Macular Edema Treated with Anti-VEGF Therapy: Is It a Suitable OCTA Biomarker?

The objective of this study was to determine the correlation between topographic vessel density (VD) and retinal thickness (RT) reductions induced by vascular endothelial growth factor inhibitors (anti-VEGF) in patients with diabetic macular edema (DME) using optical coherence tomography angiography (OCTA). This was a prospective, interventional case series. VD and RT measurements were separately taken in four parafoveal subfields at baseline and after six months of treatment. This correlation was statistically assessed using Spearman's rho correlation coefficient after adjustment for multiple comparisons. The study included a total of 48 eyes in the final analysis. Mean VD decreased from baseline to month 6 (from 45.2 (±3.5) to 44.6% (±3.2) in the superficial capillary plexus and from 50 (±3.3) to 49% (±3.9) in the deep capillary plexus). Statistically significant reductions in RT were observed in all ETDRS sectors (p < 0.0001). No significant association was found between RT and VD, even when analyzing responders and non-responders separately. After six months of anti-VEGF treatment, no significant correlation was observed between the topographic VD and RT values. These findings suggest that reductions in VD values may not solely result from a reduction in microaneurysms, also being affected by the repositioning of displaced vessels due to edema and a reduction in their caliber. Therefore, VD changes may not be a suitable indirect OCTA biomarker of microaneurysm turnover and treatment response.

Higher plasma levels of thymosin-α1 are associated with a lower waning of humoral response after COVID-19 vaccination: an eight months follow-up study in a nursing home.

BACKGROUND: Older people achieve lower levels of antibody titers than younger populations after Covid-19 vaccination and show a marked waning humoral immunity over time, likely due to the senescence of the immune system. Nevertheless, age-related predictive factors of the waning humoral immune response to the vaccine have been scarcely explored. In a cohort of residents and healthcare workers from a nursing home that had received two doses of the BNT162b2 vaccine, we measured specific anti-S antibodies one (T1), four (T4), and eight (T8) months after receiving the second dose. Thymic-related functional markers, including thymic output, relative telomere length, and plasma thymosin-α1 levels, as well as immune cellular subsets, and biochemical and inflammatory biomarkers, were determined at T1, and tested for their associations with the magnitude of the vaccine response (T1) and the durability of such response both, at the short- (T1-T4) and the long-term (T1-T8). We aimed to identify age-related factors potentially associated with the magnitude and persistence of specific anti-S immunoglobulin G (IgG)-antibodies after COVID-19 vaccination in older people. RESULTS: Participants (100% men, n = 98), were subdivided into three groups: young (< 50 years-old), middle-age (50-65 years-old), and older (≥65 years-old). Older participants achieved lower antibody titers at T1 and experienced higher decreases in both the short- and long-term. In the entire cohort, while the magnitude of the initial response was mainly associated with the levels of homocysteine [ß (95% CI); - 0.155 (- 0.241 to - 0.068); p = 0.001], the durability of such response at both, the short-term and the long-term were predicted by the levels of thymosin-α1 [- 0.168 (- 0.305 to - 0.031); p = 0.017, and - 0.123 (- 0.212 to - 0.034); p = 0.008, respectively]. CONCLUSIONS: Higher plasma levels of thymosin-α1 were associated with a lower waning of anti-S IgG antibodies along the time. Our results suggest that plasma levels of thymosin-α1 could be used as a biomarker for predicting the durability of the responses after COVID-19 vaccination, possibly allowing to personalize the administration of vaccine boosters.

Local Resection in Choroidal Melanoma: A Review.

Surgical resection is widely used to treat small tumours located in the iris and the ciliary body, due to the accessibility of these sites. By contrast, surgical removal of choroidal tumours is substantially more challenging, which is why this procedure is performed only at specialised centres. In the present article, we review the literature on surgical resection of choroidal tumours, which can be performed as endoresection (ab interno) or transscleral resection (ab externo). An important aim of this review is to describe and compare the two approaches in terms of visual outcomes, survival rates, and complications. Both approaches are indicated for the removal of large tumours (thickness > 8 mm) with small base diameters. Surgical resection of the tumour allows clinicians to obtain valuable histopathologic and cytogenetic data from the specimen and eliminates the risks associated with radiotherapy. However, both of these surgical approaches are technically challenging procedures involving the risk of severe early and late postoperative complications.

Compulsive Sexual Behavior Online and Non-online in Adult Male Patients and Healthy Controls: Comparison in Sociodemographic, Clinical, and Personality Variables.

Background and Aims: Compulsive sexual behavior (CSB) is characterized by a persistent pattern of failure to control sexual impulses, resulting in repetitive sexual behavior over a prolonged period that causes marked discomfort in personal, family, social, school, work or in other functional areas. The evolution of the worldwide incidence of this disorder warrants further studies focused on examining the characteristics of the affected people. The purpose of this study was to compare online compulsive sexual behavior (when the problematic sexual practices were online) and non-online compulsive sexual behavior (when the problematic sexual practices were in-person) patients (OCSB and non-OCSB, respectively), and healthy controls in terms of sexual behavior, sociodemographic variables and psychopathology and personality characteristics. Method: A sample of 80 CSB male patients consecutively admitted to our Behavioral Addictions Unit and 25 healthy male controls, participated in the study. The CSB group was comprised by 36 online CSB patients (mean age 42.25, SD: 10.0) and 44 non-online CSB patients (mean age 43.5, SD: 11.9). Scores on the Sexual Compulsivity Scale, Temperament and Character Inventory-Revised, Symptom CheckList-90 Items-Revised, State-Trait Anxiety Index, and additional demographic, clinical, and social/family variables related to sexual behaviors between the three groups were compared. Results: When compared with healthy controls, both clinical groups showed higher psychopathology in all measures as well as higher harm avoidance and self-transcendence and lower self-directness and cooperativeness. When comparing OCSB and non-OCSB patients, results showed that non-OCSB patients exhibited higher prevalence of sexually transmitted diseases, higher percentage of homosexual and bisexual orientation and higher scores in anxiety and in sexual impulse control failure. Conclusion: Both online and non-online CSB patients may experience a variety of comorbid psychological and medical problems. Patients with non-OCSB may suffer more consequences that are negative. Therefore, these results should be considered when designing the most convenient therapeutic approach. Whether sexual orientation plays a role in treatment needs and treatment response in CSB, should be further explored in future studies.

Recurrencia de pterigión operado con autoinjerto conjuntivo-limbar por residentes en la clínica CES / Recurrence of pterygium after conjunctival limbal auto-graft by residents at the CES clinic

Introducción: El pterigión es una lesión fibrovascular, hiperplásica de tejido conjuntival, que crece sobre la córnea por alteración de las células madre que participan en la regeneración del tejido. Su manejo es quirúrgico y el éxito depende del tipo de técnica utilizada. Los reportes más bajos de recurrencia y complicaciones postoperatorias se han encontrado con la técnica de autoinjerto conjuntivo-limbar. Objetivo: Establecer la recurrencia a un año en pacientes sometidos a cirugía pterigión primario con autoinjerto conjuntivo-limbar operados por residentes de oftalmología de primer año en la Clínica CES en el periodo 2015 a 2018. Diseño del estudio: Seguimiento retrospectivo a una cohorte. Método: Se realizó un muestreo probabilístico simple del 10% (110 historias clínicas) de los registros de los pacientes intervenidos entre 2015 y 2018. Resultados: El 55.7% fue mujeres, el promedio de edad fue 45 (33-61) años y se encontró una recurrencia de pterigión del 7.6% a un año. Conclusión: La recurrencia de pterigión primario intervenidos por residentes de primer año con la técnica de autoinjerto conjuntivo-limbar está dentro de lo reportado en estudios realizados con cirujanos de mayor experiencia

Background: Pterygium is a fibrovascular, hyperplastic lesion of conjunctival tissue, which grows on the cornea due to alteration of the stem cells that participate in tissue regeneration. Its management is surgical, and its success depends on the type of technique used. The lowest reports of recurrence and postoperative complications have been found with the conjunctive-limbar autograft technique. Objective: To establish the one-year recurrence in patients undergoing primary pterygium surgery with limbar-conjuntival autograft operated by first-year ophthalmology residents at the CES Clinic in the period 2015 to 2018. Study design: Follow-up to a retrospective cohort. Method: A simple probability sampling of 10% (110 medical records) was carried out of the records of the patients operated between 2015 and 2018. Results: 55.7% were women, the average age was 45 (33-61) years, and it was found a recurrence of pterygium of 7.6% at one year. Conclusion: The recurrence of primary pterygium operated by first-year residents with limbar-conjunctival autograft technique is within that reported in studies carried out with more experienced surgeons

Women and gambling disorder: Assessing dropouts and relapses in cognitive behavioral group therapy.

BACKGROUND: Gender-specific literature focused on gambling disorder (GD) is scarce, and women with GD have been understudied. Therefore, the aim of this study was to estimate the short-term effectiveness in women with GD (n = 214) of a group standardized cognitive-behavioral therapy (CBT) and to identify the most relevant predictors of the primary therapy outcomes (dropout and relapse). METHODS: The manualized CBT consisted of 16 weekly outpatient group sessions. Women were provided with resources to obtain a better understanding of the GD, to improve self-control and to manage risk situations. RESULTS: The dropout risk was higher for women with lower GD severity and higher psychopathological distress. Among other factors, lower education levels were a significant predictor of the relapse risk and and the frequency of relapses was higher for divorced women with a preference for non-strategic gambling and with substances consumption. CONCLUSIONS: Our findings evidence women-specific predictors of the primary therapy outcomes. The results highlight the need to design psychological interventions that address dropout and relapse risk factors in women.

Subtyping treatment-seeking gaming disorder patients.

BACKGROUND AND AIMS: Gaming Disorder (GD) is characterized by a pattern of persistent and uncontrolled gaming behavior that causes a marked impairment in important areas of functioning. The evolution of the worldwide incidence of this disorder warrants further studies focused on examining the existence of different subtypes within clinical samples, in order to tailor treatment. This study explored the existence of different profiles of patients seeking treatment for GD through a data-driven approach. METHODS: The sample included n = 107 patients receiving treatment for GD (92% men and 8% women) ranging between 14 and 60 years old (mean age = 24.1, SD = 10). A two-step clustering analysis approach explored the existence of different underlying GD profiles based on a broad set of indicators, including sociodemographic features, clinical course of the condition (e.g., onset or evolution), psychopathological symptoms, and personality traits. RESULTS: Two GD profiles emerged. The first cluster grouped together patients who presented with a lower psychological impact (n = 72, 66.1%), whereas the second cluster comprised patients with a higher psychological impact (n = 35, 32.7%). Cluster comparisons revealed that those patients presenting the higher impact were older, with a later onset of pathological gaming patterns, and more pronounced psychopathological symptoms and dysfunctional personality profiles. CONCLUSIONS: GD severity is influenced by specific demographic, clinical, and psychopathological factors. The identification of two separate profiles provides empirical evidence that contributes to the conceptualization of this disorder, as well as to the development of reliable and valid screening tools and effective intervention plans focused on the precise characteristics of the treatment-seeking patients.

Implante intramedular expandible SpineJack® para el tratamiento de fracturas vertebrales por compresión / Spinejack® Expandable Intramedullary Implant for Treating Vertebral Compression Fractures

RESUMEN Introducción: Las fracturas vertebrales por compresión han sido tratadas usando cemento óseo en su interior, con técnicas como la cifoplastia y vertebroplastia. Sin embargo, son conocidos los potenciales efectos adversos, principalmente la fuga del cemento a los tejidos aledaños y, en la mayoría de los casos, la consiguiente afección a la altura vertebral. Es importante lograr una adecuada reducción de la fractura, ya que la esta influye directamente en la calidad de vida de los pacientes. Objetivo: Describir la aplicación, por primera vez, del implante intramedular expandible SpineJack® como método para el tratamiento de fracturas vertebrales por compresión. Presentación del caso: Se presenta una paciente de 65 años que sufrió un traumatismo en su columna lumbar a nivel de L1, con fractura tipo burst, a la que, en junio de 2016, se le realizó un acceso transpedicular percutáneo con guía fluoroscópica con el propósito de insertar el dispositivo SpineJack® en el cuerpo vertebral. Se utilizaron expansores del implante especialmente diseñados para este dispositivo, los cuales abrieron los extremos y desplegaron el componente central de titanio; esto facilitó la inyección de polimetilmetacrilato, el cual finalmente envolvió a los implantes, lo que garantizó la estabilización de la fractura. Resultados: La tomografía de control permitió observar una adecuada reducción del declive central de la vértebra L1 de la paciente y una recuperación de la altura del cuerpo vertebral con valores similares a los reportados por otros investigadores que han trabajado con este método en otros países. Conclusiones: La capacidad anátomo-funcional de la vértebra fracturada, así como la mejoría clínica de la paciente. y su calidad de vida fueron notables. No se observaron complicaciones. El seguimiento del empleo de este dispositivo en otros pacientes en Ecuador, permitirá profundizar en su evaluación(AU)

ABSTRACT Introduction: Vertebral compression fractures have been treated using internal bone cement, using techniques such as kyphoplasty and vertebroplasty. However, the potential adverse effects are known, mainly the leakage of cement to the surrounding tissues and, in most cases, the consequent affection at the vertebral level. Achieving adequate reduction of the fracture is important since it directly influence on the quality of life of patients. Objective: To describe the application, for the first time, of SpineJack® expandable intramedullary implant as a method for treating vertebral compression fractures. Case report: We report a 65-year-old female patient who suffered trauma to her lumbar spine at L1 level, a burst-type fracture, who, in June 2016, underwent percutaneous transpedicular access with fluoroscopic guidance with the purpose of inserting SpineJack® device into her vertebral body. Specially designed implant expanders were used for this device, which opened the ends and deployed the central titanium component. This facilitated the injection of polymethylmethacrylate that eventually enveloped the implants, ensuring stabilization of the fracture. Results: The control tomography allowed to observe adequate reduction of the central decline of the L1 vertebra of this patient and the recovery of the vertebral body height with values similar to those reported by other researchers who have worked with this method in other countries. Conclusions: The anatomy-functional capacity of the fractured vertebra, as well as the clinical improvement of this patient, and her quality of life were remarkable. No complications were observed. Following up the use of this device in other patients in Ecuador will allow to deepen its evaluation(AU)

Internet Gaming Disorder Clustering Based on Personality Traits in Adolescents, and Its Relation with Comorbid Psychological Symptoms.

In recent years, the evidence regarding Internet Gaming Disorder (IGD) suggests that some personality traits are important risk factors for developing this problem. The heterogeneity involved in problematic online gaming and differences found in the literature regarding the comorbid psychopathology associated with the problem could be explained through different types of gamers. Clustering analysis can allow organization of a collection of personality traits into clusters based on similarity. The objectives of this study were: (1) to obtain an empirical classification of IGD patients according to personality variables and (2) to describe the resultant groups in terms of clinical and sociodemographic variables. The sample included 66 IGD adolescent patients who were consecutive referrals at a mental health center in Barcelona, Spain. A Gaussian mixture model cluster analysis was used in order to classify the subjects based on their personality. Two clusters based on personality traits were detected: type I "higher comorbid symptoms" (n = 24), and type II "lower comorbid symptoms" (n = 42). The type I included higher scores in introversive, inhibited, doleful, unruly, forceful, oppositional, self-demeaning and borderline tendency traits, and lower scores in histrionic, egotistic and conforming traits. The type I obtained higher scores on all the Symptom Check List-90 items-Revised, all the State-Trait Anxiety Index scales, and on the DSM-5 IGD criteria. Differences in personality can be useful in determining clusters with different types of dysfunctionality.

Propuesta de nemotecnia CCETOE en el estudio de los núcleos de osificación en niños / CCETOE mnemonic proposal in the study of ossification nuclei in children

Introducción: La aplicación de nemotecnias facilita al personal de salud, los criterios necesarios para una aproximación diagnóstica oportuna, evitando realizar procedimientos inadecuados y perjudiciales en pacientes con posible lesión de codo.Objetivo:Proporcionar al personal de salud una nemotecnia adecuada y fácil de recordar, para identificar las características de los núcleos de osificación del codo, en una imagen radiográfica simple.Métodos:Se realizó un estudio transversal y descriptivo, enfocado en crear una nemotécnica fácil de acordarse y además conocer los núcleos de osificación de codo a lo largo de la edad pediátrica, esto se realizó durante el periodo Enero 2016-Junio 2017.Resultados:En el estudio y análisis radiológico correspondiente a las 120 placas seleccionadas en el RIS-PACS(Radiology Information System-Picture Archiving and Communications System), para el almacenamiento, distribución, presentación y administraciónde las imágenes radiológicas del Hospital Axxis se destacó; quela identificación de los núcleos de osificación fue adecuada y con mayor facilidad,aplicando los criterios nemotécnicos propuestos en CCETOE (Capitellium, Cabeza de radio, Epicóndilo Interno, Tróclea, Olecranon, Epicóndilo Externo).Conclusiones:Las nemotecnias proporcionan una opción adecuada para memorizar conceptos en el área de salud, facilitando la aplicación del conocimiento y disminuyendo el uso de exámenes perjudiciales para los pacientes.

Introduction:Mnemonics facilitates to the health personnel the necessary criteria for a timely diagnostic approach, avoiding inappropriate and harmful procedures in patients with possible elbow injury.Objective:To provide an adequate and easy-to-remember Spanish mnemonic, identifying the characteristics of elbow ossification centers at x-ray.Methods:A cross-sectional and descriptive study was carried out, focused on creating an easy-to-remember mnemonic and also knowing the elbow ossification centers throughout the pediatric age, the study was developed during January 2016 to June 2017.Results:In the study and radiological analysis corresponding to 120 x-ray selected in the RIS-PACS (Radiology Information System -Picture Archiving and Communications System)of the Axxis Hospital, the identification of the appropriate nuclei ossification was emphasized and easy determined applying the mnemonic criteria proposed as CCETOE(Capitellum, Radio Head, Internal Epicondyle, Trochlea, Olecranon, External Epicondyle).Conclusions:The mnemonic provide an adequate option to memorize concepts in the health area, facilitating the application of knowledge and decreasing the use of harmful tests for patients.

Internet Gaming Disorder in Adolescents: Personality, Psychopathology and Evaluation of a Psychological Intervention Combined With Parent Psychoeducation.

Internet Gaming Disorder is an increasingly prevalent disorder, which can have severe consequences in affected young people and in their families. There is an urgent need to improve existing treatment programs; these are currently hampered by the lack of research in this area. It is necessary to more carefully define the symptomatic, psychosocial and personality characterization of these patients and the interaction between treatment and relevant variables. The objectives of this study were three: (1) to analyze the symptomatic and personality profiles of young patients with Internet Gaming Disorder in comparison with healthy controls; (2) to analyze the effectiveness of a cognitive behavioral treatment on reducing symptomatology; and (3) to compare the results of that treatment with or without the addition of a psychoeducational group offered to the parents. The final sample consisted of 30 patients consecutively admitted to a specialized mental health unit in Spain, and 30 healthy controls. The experimental group received individual cognitive-behavioral therapy. The experimental group was divided into two subgroups (N = 15), depending on the addition or not of a psychoeducational group for their parents (consecutively admitted). Scores on the Millon Adolescent Personality Inventory (MACI), the Symptom Checklist-Revised (SCL-90-R), the State-Trait Anxiety Index (STAI), and other clinical and psychopathological measures were recorded. The patients were re-assessed post treatment (except for the MACI questionnaire). Compared with healthy controls, patients did not differ in symptomatology at baseline, but scored significantly higher in the personality scales: Introversive and Inhibited, and in the expressed concerns scales: Identity Confusion, Self-Devaluation, and Peer Insecurity and scored significantly lower in the Histrionic and Egotistic scale. In the experimental group, pre-post changes differed statistically on SCL-90-R scales Hostility, Psychoticism, and Global Severity Index and on the diagnostic criteria for Internet Gaming Disorder, regardless of the addition of a psychoeducational group for parents. Pre-post changes did not differ between experimental subgroups. However, the subgroup without psychoeducation for parents presented statistically higher drop-out rates during treatment. The results of this study are based on a sample of patients seeking treatment related to problems with online gaming, therefore, they may be of value for similar patients.

Association between Internet Gaming Disorder or Pathological Video-Game Use and Comorbid Psychopathology: A Comprehensive Review.

The addictive use of video games is recognized as a problem with clinical relevance and is included in international diagnostic manuals and classifications of diseases. The association between "Internet addiction" and mental health has been well documented across a range of investigations. However, a major drawback of these studies is that no controls have been placed on the type of Internet use investigated. The aim of this study is to review systematically the current literature in order to explore the association between Internet Gaming Disorder (IGD) and psychopathology. An electronic literature search was conducted using PubMed, PsychINFO, ScienceDirect, Web of Science and Google Scholar (r.n. CRD42018082398). The effect sizes for the observed correlations were identified or computed. Twenty-four articles met the eligibility criteria. The studies included comprised 21 cross-sectional and three prospective designs. Most of the research was conducted in Europe. The significant correlations reported comprised: 92% between IGD and anxiety, 89% with depression, 85% with symptoms of attention deficit hyperactivity disorder (ADHD), and 75% with social phobia/anxiety and obsessive-compulsive symptoms. Most of the studies reported higher rates of IGD in males. The lack of longitudinal studies and the contradictory results obtained prevent detection of the directionality of the associations and, furthermore, show the complex relationship between both phenomena.

Crystal structure of 2,2'-(ethane-1,2-di-yl)bis-(2,3-di-hydro-1H-naphtho-[1,2-e][1,3]oxazine): a prospective raw material for polybenzoxazines.

In the title compound, C26H24N2O2, the oxazine moiety is fused to a naphthalene ring system. The asymmetric unit consists of one half of the mol-ecule, which lies about an inversion centre. The C atoms of the ethyl-ene spacer group adopt an anti-periplanar arrangement. The oxazine ring adopts a half-chair conformation. In the crystal, supra-molecular chains running along the b axis are formed via short C-H⋯π contacts. The crystal studied was a non-merohedral twin with a fractional contribution of 0.168 (2) of the minor twin component.

Comparison of 4 techniques for limbal-conjunctival autograft fixation in primary pterygium surgery.

PURPOSE: To compare 4 limbal-conjunctival autograft fixation techniques-conventional suture, commercial fibrin glue, autologous fibrin glue, and cautery-in primary nasal pterygium surgery. METHODS: This is a retrospective and descriptive study. The postoperative patient discomfort, graft edema, ocular inflammation, and other complications of 4 limbal-conjunctival autograft fixation techniques in primary nasal pterygium surgery were evaluated. RESULTS: Postoperative patient discomfort was significantly lower with the sutureless techniques (p<0.001), with fixation with cautery having the lowest rate of discomfort. Graft edema and ocular inflammation during the early postoperative period were significantly higher when fibrin glue techniques were used (p<0.001). The recurrence rate did not show a statistically significant difference (p = 0.682) among the 4 groups. CONCLUSION: In primary nasal pterygium surgery, limbal-conjunctival autograft fixation using cautery is the technique with the lowest postoperative discomfort rate and without a statistically significant increase in recurrence rate when compared to conventional suture and fibrin glue techniques.

Aproximación fenomenológica al significado e impacto de la donación de órganos en la familia / Phenomenological Approach to the Meaning and Impact of Organ Donation in the Family / Aproximação fenomenológica ao significado e ao impacto da doação de órgãos na familia

RESUMEN La donación de órganos es un acontecimiento crítico tras la pérdida de un ser querido. España, a pesar de ser el país del mundo con mayor tasa de donantes, todavía mantiene una negativa familiar del 15,56%. Objetivos: conocer y analizar el impacto de la donación de órganos a través de los significados que tiene para la familia en el contexto español. Materiales y método: estudio cualitativo fenomenológico según el marco conceptual y método de Giorgi. Luego de respetar, al menos, tres años de duelo desde la pérdida de un ser querido, se entrevistaron en profundidad a once familias que donaron órganos en el Hospital La Fe en Valencia. Resultados: tras el análisis de los resultados, se describieron veintisiete unidades de significado que fueron clasificadas en relativos a la pérdida y relativos a la donación de órganos y, posteriormente, correlacionadas. Conclusiones: la donación aparece como mecanismo de alivio o compensación del fallecimiento del familiar.

ABSTRACT Organ donation is a critical event after the loss of a loved one. Spain, despite being the country with the highest donor rate in the world, still maintains a family negative rate of 15.56%. Objective: Know and analyze the impact of organ donation based on its meaning for the family in the Spanish context. Materials and method: This is a phenomenological qualitative study based on Giorgi's conceptual framework and method. Eleven families who had donated organs at the Hospital La Fe in Valencia were interviewed in depth, following at least three years of mourning since the loss of a loved one. Results: After the results were analyzed, twenty-seven units of meaning were described and classified as relative to the loss and relative to the organ donation. They were then correlated. Conclusion: Organ donation appears to be a relief mechanism or a kind of compensation for the death of a family member.

RESUMO A doação de órgãos é um acontecimento crítico após a perda de um ser querido. A Espanha, embora seja o país do mundo com maior taxa de doadores, ainda mantém uma negativa familiar de 15,56 %. Objetivos: conhecer e analisar o impacto da doação de órgãos por meio dos significados que tem para a família no contexto espanhol. Materiais e método: estudo qualitativo fenomenológico de acordo com o referencial conceitual e o método de Giorgi. Depois de respeitar, pelo menos, três anos de luto desde a perda de um ser querido, foram entrevistadas em profundidade 11 famílias que doaram órgãos no Hospital La Fe em Valencia. Resultados: após a análise de resultados, descreveram-se 27 unidades de significado que foram classificadas em relativos à perda e relativos à doação de órgãos; em seguida, correlacionadas. Conclusões: a doação aparece como mecanismo de alívio ou compensação do falecimento do familiar.

Resección de Pterigion nasal primario con autoinjerto limbo-conjuntival sin suturas / Sutureless limbal-conjunctival autograft for nasal pterygium surgery

Objetivo: Evaluar la efectividad y los síntomas en el postoperatorio de la resección de pterigion nasal primario con autoinjerto limbo-conjuntival sin suturas. Diseño del estudio: Estudio prospectivo e intervencional. Métodos: Se incluyeron 58 ojos de 58 pacientes con pterigion nasal primario que fueron llevados a resección con autoinjerto limbo-conjuntival; la fi jación del autoinjerto se realizó con cauterio en 29 pacientes y con sutura en 29 pacientes. Se realizó un seguimiento periódico de los casos por 24 meses y variables como el tiempo quirúrgico, el discomfort en el postoperatorio, el edema de la plastia, la inflamación ocular y las complicaciones fueron evaluadas y comparadas entre los subgrupos. Resultados: El tiempo quirúrgico promedio fue de 16 minutos para el grupo de fijación con cauterio y de 40 minutos en el grupo de fijación con suturas. El discomfort postoperatorio durante los primeros 15 días fue menor en el grupo de fijación con cauterio (p<0.001). No hubo diferencias entre los subgrupos en la tasa de recurrencia, pero el grupo de fijación con cauterio presentó una tasa mayor de dehiscencia de los bordes de la plastia (p<0.001) y del descenso conjuntival (p<0.001). Conclusiones: La resección del pterigion nasal primario con autoinjerto limbo-conjuntival fijado con cauterio es una técnica prometedora que lleva a un menor discomfort postoperatorio que la técnica convencional con suturas, tiene una baja tasa de recurrencias y requiere de un menor tiempo quirúrgico.

Objective: To evaluate the eff ectiveness and postoperative symptomatology of sutureless limbal-conjunctival autograft for pterygium surgery. Study design: Prospective and interventional study. Methods: 58 eyes of 58 patients with primary nasal pterygium that underwent pterygium resection with limbal-conjunctival autograft were included. Graft fi xation was done with cautery in 29 patients and with sutures in 29 patients. The patients were followed with periodic evaluations during 24 months. Surgical time, postoperative discomfort, graft edema, ocular inflammation, and complications were evaluated and compared between groups. Results: The average surgical time was 16 minutes for the cautery group and 40 minutes for the suture group. Postoperative discomfort during the first 15 days was statistically significant lesser for the cautery group (p<0.001). There was no difference in recurrence rate among groups; however, the cautery-fi xation group presented a significantly greater incidence of graft´s edges dehiscence (p<0.001), and superior conjunctiva dehiscence (p<0.001). Conclusions: Primary nasal pterygium resection with cautery-fi xated limbal-conjunctival autograft is a promising technique that causes less postoperative discomfort than conventional sutures, has a low recurrence rate and requires less surgical time.

A Serious Videogame as an Additional Therapy Tool for Training Emotional Regulation and Impulsivity Control in Severe Gambling Disorder.

BACKGROUND: Gambling disorder (GD) is characterized by a significant lack of self-control and is associated with impulsivity-related personality traits. It is also linked to deficits in emotional regulation and frequently co-occurs with anxiety and depression symptoms. There is also evidence that emotional dysregulation may play a mediatory role between GD and psychopathological symptomatology. Few studies have reported the outcomes of psychological interventions that specifically address these underlying processes. OBJECTIVES: To assess the utility of the Playmancer platform, a serious video game, as an additional therapy tool in a CBT intervention for GD, and to estimate pre-post changes in measures of impulsivity, anger expression and psychopathological symptomatology. METHOD: The sample comprised a single group of 16 male treatment-seeking individuals with severe GD diagnosis. Therapy intervention consisted of 16 group weekly CBT sessions and, concurrently, 10 additional weekly sessions of a serious video game. Pre-post treatment scores on South Oaks Gambling Screen (SOGS), Barratt Impulsiveness Scale (BIS-11), I7 Impulsiveness Questionnaire (I7), State-Trait Anger Expression Inventory 2 (STAXI-2), Symptom Checklist-Revised (SCL-90-R), State-Trait Anxiety Inventory (STAI-S-T), and Novelty Seeking from the Temperament and Character Inventory-Revised (TCI-R) were compared. RESULTS: After the intervention, significant changes were observed in several measures of impulsivity, anger expression and other psychopathological symptoms. Dropout and relapse rates during treatment were similar to those described in the literature for CBT. CONCLUSION: Complementing CBT interventions for GD with a specific therapy approach like a serious video game might be helpful in addressing certain underlying factors which are usually difficult to change, including impulsivity and anger expression.

The Use of Videogames as Complementary Therapeutic Tool for Cognitive Behavioral Therapy in Bulimia Nervosa Patients.

Although cognitive behavioral therapy (CBT) has been demonstrated to be the most effective approach for the treatment of bulimia nervosa (BN), there is lack of studies showing whether a combination with a serious video game (SVG) might be useful to enhance patients' emotional regulation capacities and general outcome. The aims of this study were (a) to analyze whether outpatient CBT + SVG, when compared with outpatient CBT - SVG, shows better short-term outcome; (b) to examine whether the CBT + SVG group is more effective in reducing emotional expression and levels of anxiety than CBT - SVG. Thirty-eight patients diagnosed as having BN according to DSM-5 criteria were consecutively assigned to two outpatient group therapy conditions (that lasted for 16 weekly sessions): 20 CBT + SVG versus 18 CBT - SVG. Patients were assessed before and after treatment using not only a food and binging/purging diary and clinical questionnaires in the field of eating disorders but also additional indexes for measuring anger expression and anxiety. Regarding the post-treatment psychometric measures, most of the mean differences (Eating Disorder Inventory-2, Symptom Checklist-Revised, State-Trait Anxiety Index, and partially State-Trait Anger Expression Inventory) achieved moderate to high effect size (d > 0.5), in the sense that CBT + SVG obtained the best results compared with the CBT - SVG group. Regarding therapy outcome (dropout, partial remission, and total remission), CBT + SVG showed better results and a moderate effect size emerged for the comparison of the risk of dropout during the treatment, being higher for CBT - SVG compared with CBT + SVG (44.1 percent versus 20.0 percent, d = 0.54). Although the sample size in our study was low, and consequently results should be considered with caution, we have obtained promising findings suggesting that in the short-term CBT + SVG might be a good option not only for improving emotional dysregulation and approaching the current limitations of CBT - SVG in BN but also for enhancing the therapy adherence of patients.

Can an intervention based on a serious videogame prior to cognitive behavioral therapy be helpful in bulimia nervosa? A clinical case study.

BACKGROUND: Several studies have highlighted the implications of impulsivity and novelty seeking for both the maintenance and the process of recovery from bulimia nervosa (BN). Cognitive behavioral therapy (CBT) is the treatment of choice for BN, but for some cases, this treatment alone might not be sufficient for reducing the high levels of impulsivity. The paper presents a case report of a patient with BN, examining the effectiveness of using a videogame (VG; Playmancer) as an additional intervention designed to address impulsivity. DESIGN: Psychometric and neuropsychological measures were collected at baseline. After this assessment, Playmancer was applied prior to CBT, following an "A-B-A-C-A" single case experimental design. Impulsivity levels were assessed with the Conner's Continuous Performance Test II (CPT-II). After the Playmancer treatment, the patient started CBT, and the levels of impulsivity were recorded again. Finally, psychometric and neuropsychological measures were collected after treatment. Weekly frequency of binges and vomiting were also recorded during the entire procedure. RESULTS: After the VG intervention, psychometric measures such as anxiety levels, impulsivity and novelty seeking decreased. Regarding the neuropsychological measures, impulsivity levels (measured with the CPT-II) progressively decreased throughout the intervention, and an improvement in decision making capacities was observed. Furthermore, the frequency of binges also decreased during and after the VG intervention. DISCUSSION: This case report suggests that using the Playmancer VG to reduce impulsivity prior to CBT may enhance the final results of the treatment for BN.