Emotional Regulation as a Transdiagnostic Process of Emotional Disorders in Therapy: A Systematic Review and Meta-Analysis.

CONTEXT: Several studies have shown that emotional regulation (ER) is a transdiagnostic construct of emotional disorders. Therefore, if therapy improves ER, it would improve psychological distress. OBJECTIVE: This review assesses and compares the changes in ER due to psychological treatment in different therapies. METHODS: A systematic review and meta-analysis of RCTs published in the databases PubMed, PsycINFO and Web of Science was performed. It was registered in PROSPERO under the number CRD42023387317. Two independent experts in the field reviewed the articles. RESULTS: A total of 18 articles met the criteria for inclusion in the review. Analysis of these studies suggests that in unified protocol (UP), cognitive behaviour therapy, dialectical behaviour therapy (DBT) and mindfulness, there is evidence to support that a moderate effect occurs during treatment. Furthermore, in mindfulness and DBT, the effect was moderate in the follow-up period, while in UP, it was high. LIMITATIONS: Given the heterogeneity of the applied interventions and the methodological limitations found in the reviewed trials, the results should be interpreted with caution. CONCLUSIONS: UP, cognitive behaviour therapy, DBT and mindfulness can improve ER after therapy, while UP, DBT and mindfulness in the follow-up period. Other therapies, such as SKY or Flotation REST, require more research.

INTRODUCCIÓN: Varios estudios han demostrado que la regulación emocional es un constructo transdiagnóstico de los trastornos emocionales. Por lo tanto, si la terapia mejora la regulación emocional, también mejorará el malestar psicológico. OBJETIVO: Evaluar y comparar el cambio en la regulación emocional debido al tratamiento psicológico en diferentes terapias. MÉTODO: Se realizó una revisión sistemática y metaanálisis de ECA publicados en las bases de datos PubMed, PsycINFO y Web of Science. Se registró en PROSPERO con el número CRD42023387317. Dos expertos independientes en la materia revisaron los artículos. RESULTADOS: Un total de 18 artículos cumplieron los criterios de inclusión en la revisión. El análisis de estos estudios sugiere que en el Protocolo Unificado, la Terapia Cognitivo Conductual, la Terapia Dialéctica Conductual y terapias basadas en mindfulness existen evidencias que apoyan que se produce un efecto moderado durante el tratamiento. Además, en las terapias basadas en mindfulness y en la Terapia Dialéctica Conductual, el efecto se moduló en el periodo de seguimiento, mientras que en el Protocolo Unificado fue mayor. LIMITACIONES: Dada la heterogeneidad de las intervenciones aplicadas y las limitaciones metodológicas encontradas en los ensayos revisados, los resultados podrán interpretarse con cautela. CONCLUSIONES: UP, CBT, DBT y mindfulness pueden mejorar la ER tras la terapia, mientras que UP, DBT y mindfulness pueden mejorar la recuperación tras un tiempo de seguimiento. Otras terapias, como SKY o Flotation REST, requieren más investigación.

Clinical profile of Spanish hepatitisC virus-infected treatment-naïve patients with compensated cirrhosis in the CREST study. / Perfil clínico de los pacientes españoles con hepatitisC naïve con cirrosis compensada tratados en el estudio CREST.

BACKGROUND AND AIM OF THE STUDY: There are still patients with hepatitisC in Spain who have yet to be diagnosed, but their clinical profile is unclear. In 2021, 21.93% of patients diagnosed had cirrhosis and were mostly treatment-naïve. METHODS: This sub-analysis describes the clinical profile of the 60Spanish treatment-naïve patients with compensated cirrhosis who were included in the CREST study. MAJOR RESULTS: Sixty percent of patients were male, median age 56years, and 33% had a history of drug use. Almost three-quarters (71.3%) had more than one comorbidity and 78.3% took concomitant medication. At treatment initiation, median platelet count was 139×103/µL and FibroScan® 17kPa. No virological failure was observed and no patient discontinued treatment due to adverse events. No clinically significant changes were noted during or after treatment in the median platelet, albumin, bilirubin, and transaminase levels. CONCLUSIONS: Treatment with glecaprevir/pibrentasvir for 8weeks in this cohort of treatment-naïve patients with compensated cirrhosis in Spain was safe and effective. This information reinforces the use of this short antiviral regimen even when there is compensated cirrhosis, simplifying the approach to hepatitisC among those patients still to be diagnosed and treated in Spain.

[Improving quality of life in older adults with the decline syndrome: The role of occupational therapy in primary care]. / Mejorando la calidad de vida en personas mayores con el síndrome del declive: el rol de la terapia ocupacional en Atención Primaria.

OBJECTIVE: To evaluate the effect of an occupational therapy intervention in users recently diagnosed with the decline syndrome, who have experienced a decrease in the Barthel and/or Lawton index in the last month and susceptible to improvement based on medical opinion. DESIGN: Non-controlled, quasi-experimental longitudinal study. A pre-post intervention. LOCATION: Sant Hipòlit de Voltregà health centre. Osona, Barcelona. PARTICIPANTS: Patients referred by the centre's primary care nursing, social work or medical staff with a recent diagnosis of decline syndrome who may benefit from the intervention of an occupational therapy professional. INTERVENTION: Following the initial assessment visit, four training sessions were conducted to improve functional independence, mobility and adaptation of the home environment, providing training to primary caregivers. MAIN MEASUREMENTS: Patient autonomy was assessed using the Barthel and Lawton scales, quality of life using the EuroQol questionnaire (EQ-5D) and home suitability using the home suitability assessment questionnaire. RESULTS: Improvements were observed in autonomy in activities of daily living (p=0.003), mobility (p=0.001) and housing adaptation (p<0.001). The level of anxiety/depression was reduced (p=0.028), and the mean health status score increased markedly (p<0.001). CONCLUSIONS: This study highlights the improvement in the quality of life and autonomy in the basic activities of daily living for individuals receiving occupational therapy, emphasizing the need for home adaptation and family support.

Use of low-level laser therapy as an adjuvant therapy for phlebostatic lesions.

Low-intensity laser therapy (LILT) is commonly used as an adjuvant therapy for treating injuries. This integrative literature review was carried out in the MEDLINE, LILACS, CUMED, BDENF, SPORTDiscus, Dentistry & Oral Sciences Source, Academic Source and CINAHL databases. Among the inclusion criteria were: range from 2011 to 2021, in English, Portuguese and Spanish and any study, with the exception of preprints and books. The question was answered: "What is the effectiveness described in the literature of using low-intensity laser therapy (LILT) in the treatment of venous lesions?" The wavelength used in studies varied from 635 nm of red ray to 780 nm of infrared ray, generating healing improvement at any length. LBI presented itself as a low-cost and easy-to-apply adjuvant option, alleviating pain complaints and improving healing in patients with vasculogenic lesions.

Real-World Evidence of Adjuvant Immunotherapy in Resected Stage III and IV Melanoma Patients: CADIM Trial Final Results. Experience from 2 Tertiary Referral Centers. / Evidencia en la práctica clínica del tratamiento adyuvante con inmunoterapia en pacientes con melanoma en estadios III y IV resecados: resultados finales del estudio CADIM. Experiencia de 2centros de tercer nivel.

INTRODUCTION: Clinical trials have validated the use of nivolumab and pembrolizumab as adjuvant therapies regarding relapse-free survival in patients with resected stage III and IV melanoma. Evidence in real-world patients is currently limited. MATERIAL AND METHOD: The CADIM trial (Characterization of adjuvant immunotherapy in melanoma patients) recruited a total of 81 patients with resected stage III and IV melanoma on nivolumab or pembrolizumab as adjuvant therapy from February 2018 through December 2022. RESULTS: The stage distribution rate was 81.5% (n=71) for stage III, while 15 patients (18.5%) had resected stage IV. Among stage III patients, 38 were stage IIIC (46.9%). With a median follow-up of 22.8 months, the relapse-free survival in the intention-to-treat population was 84% at one year and 81.5% at 2 years. The overall survival rate was 99% at one year and 91.4% at 2 years. Grade 3-4 treatment-related adverse events were reported in 12.3% of the patients. CONCLUSIONS: This study shows the results of resected stage III and IV melanoma patients on adjuvant therapy with anti-PD-1, and eventually confirmed the safety and efficacy profile described by clinical trials. Comparing clinical trial data with real-world evidence is necessary for a more practical, reliable, and accessible use of these drugs.

Trichotillomania Treatment Update. / Actualización en el tratamiento de la tricotilomanía.

Trichotillomania (TTM) is an obsessive-compulsive disorder in which affected individuals recurrently pull-out hair from any region of the body, causing hair loss or alopecia. The management of TTM is a therapeutic challenge for dermatologists and consists of a combination of pharmacological and non-pharmacological alternatives. Cognitive-behavioral therapy has successfully been used to treat TTM. However, not all patients are willing to follow this treatment strategy. Unconventional support tools are proposed, such as electronic devices, internet therapies and microneedling. N-acetylcysteine and memantine are considered suitable first-line therapies thanks to their favorable safety and efficacy profile, low risk of adverse effects, and significant benefits. The use of other drugs, including fluoxetine, clomipramine, olanzapine, and naltrexone has limited evidence of variable efficacy. The present review illustrates the current treatment modalities for the management of TTM.

Multicenter analysis of the surgical management and adjuvant therapy of patients with melanoma and a positive sentinel lymph node biopsy. / Análisis multicéntrico del manejo quirúrgico y tratamiento adyuvante de los pacientes con melanoma y positividad en la biopsia selectiva del ganglio centinela.

INTRODUCTION: Complete lymph node dissection (CLND) was the standard practice for patients with melanoma and a positive sentinel lymph node biopsy (SLNB) until the results of 2 clinical trials published in 2016 and 2017 demonstrated that it did not improve melanoma-specific survival (MSS). However, it continues to be performed in some scenarios. No studies have ever been published on lymph node management after a positive SLNB in the routine clinical practice in our setting. OBJECTIVES: To determine the evolution of the indication for CLND in patients with a positive SLNB, as well as the characteristics associated with its performance. MATERIAL AND METHODS: We conducted a multicenter retrospective observational study with patients with skin melanoma and positive sentinel lymph nodes diagnosed from 2017 through 2022 at 8 Spanish centers and 1 Italian center. RESULTS: A total of 430 patients were included, 54% men, with 358 (75.1%) aged between 45 and 80 years. A total of 133 cases (31%) exhibited Breslow thickness > 4mm, 206 cases (49.1%) were ulcerated, and in 213 cases (55.7%), lymph node metastasis was > 1mm. Isolated lymphadenectomy or followed by adjuvant therapy was performed in 146 patients (34.1%). After multivariate logistic regression, the factors associated with the performance of CLND were the acral lentiginous melanoma histological subtype, lymph node metastasis size > 1mm, extracapsular spread, and the participant hospital. Age > 80 years was inversely associated. CONCLUSION: While the frequency of CLND in patients with melanoma and positive SLNB has decreased, the indication for systemic adjuvant therapy in these patients has increased. However, CLND is still indicated in patients with high-risk characteristics.

Adherence to antiretroviral therapy and factors associated with non-adherence: a cohort study at two referral services in Brazil.

This cohort study evaluated non-adherence to antiretrovirals at referral services in Pernambuco, Brazil, 2016/2017, through self-report. A generalized mixed-effects model for binary outcomewas used. We assessed 542 participants with an adherence rate of 85.50%. A greater chance of non-adherence was associated with:a low/moderate level of nicotine dependence (OR = 2.79, p = 0.00, IC = 1.44-5.41); ≥7 tablets/day (OR = 6.14, p = 0.00, IC = 3.42-11.02); LPV/r (OR = 1.49, p = 0.6, IC = 0.98-2.26), ddI (OR = 3.34, p = 0.03, IC = 1.12-9.97), ABC (OR = 4.02, p = 0.05, IC = 1.01-16.03), RAL (OR = 2.49, p = 0.01, IC = 1.32-4.70) and DTG (OR = 4.65, p = 0.01, IC = 1.42-15.16); 6-10 year seropositive diagnosis (OR = 2.17, p = 0.01, IC = 1.20-3.92) and symptoms of depression (OR = 1.55, p = 0.03, IC = 1.03-2.33). Protective factors for non-adherence weres: ≥50 years (OR = 0.67, p = 0.06, IC = 0.45-1.01), secondary/higher education (OR = 0.48, p = 0.00, IC = 0.34-0.70), embarrassment at health service (OR = 0.49, p = 0.04, IC = 0.24-0.97), good understanding of antiretrovirals (OR = 0.62, p = 0.03, IC = 0.40-0.96), adverse event (OR = 0.74, p = 0,06, IC = 0.54-1.01), use of TDF (OR = 0.62, p = 0.01, IC = 0.43-0.90), NVP (OR = 0.41, p = 0.05, IC = 0.71-1.00) and EFZ (OR = 0.48, p = 0.01, IC = 0.29-0.80) and good knowledge of HIV/AIDS/ART. (OR = 0.67, p = 0.07, IC = 0.43-1.04). Variables with stronger association were those linked to ART. Systematic use of self-report adherence is recommended for priority groups.

Ancient medicine for a modern disease: traditional Amazonian medicine to treat substance use disorders.

Background: There exists an underexploited opportunity to develop innovative therapeutic approaches to SUDs based upon the complementarity between modern and traditional health systems.Objectives: Illustrate the feasibility and potentiality of such an approach through the comprehensive description of Takiwasi Center's treatment model and program, where health concepts and practices from traditional Amazonian medicine work synergistically with modern psychotherapy and medicine in an intercultural dialog to assist in the rehabilitation of people suffering from SUDs.Methods: The description was built from a review of the literature, institutional data, participatory observation and unstructured interviews with staff, researchers and patients during treatment.Results: Since the foundation of the Takiwasi Center in 1992 in the peruvian Amazon, more than a thousand patients with different socio-cultural, ethnic and religious backgrounds have received residential treatment. We present how traditional Amazonian medicine techniques and health concepts cooperate to complement modern psychology in a therapeutic community setting and propose some hypotheses about the neurobiological, psycho-emotional and spiritual healing mechanisms triggered by the program to help people identify and heal the roots of their substance misuse and addictive behavior. We also summarize quantitative outcomes during treatment showing significant improvements in a wide variety of mental health indicators.Conclusion: Takiwasi Center's program is an option for people seeking non-conventional treatment who are sensitive to traditional Amazonian medicine practices and ready to explore the roots of their addiction. From this intercultural approach, some lessons could emerge toward a broader understanding of SUDs that may result in better patient care.

High incidence of surgery and initiation of medical therapies after colectomy for ulcerative colitis or inflammatory bowel disease unclassified.

BACKGROUND AND AIMS: Despite novel medical therapies, colectomy has a role in the management of patients with ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBDU). This study aimed to determine the incidence of unplanned surgery and initiation of immunomodulatory or biologic therapy (IMBT) after colectomy in patients with UC or IBDU, and identify associated factors. METHODS: Data of patients with preoperative diagnosis of UC or IBDU who underwent colectomy and were followed up at a single tertiary centre was retrospectively collected. The primary outcome was the risk of unplanned surgery and initiation of IMBT during follow-up after colectomy. Secondary outcomes were development of Crohn's disease-like (CDL) complications and failure of reconstructive techniques. RESULTS: 68 patients were included. After a median follow-up of 9.9 years, 32.4% of patients underwent unplanned surgery and IMBT was started in 38.2%. Unplanned surgery-free survival was 85% (95% confidence interval [CI] 73.8-91.6%) at 1 year, 76% (95% CI 63.2-84.9%) at 5 years and 69.1% (95% CI 55-79.6%) at 10 years. IMBT-free survival was 96.9% (95% CI 88.2-99.2%) at 1 year, 77.6% (95% CI 64.5-86.3%) at 5 years and 63.3% (95% CI 48.8-74.7%) at 10 years. 29.4% of patients met criteria for CDL complications. CDL complications were significantly associated to IMBT (hazard ratio 4.5, 95% CI 2-10.1). CONCLUSION: In a retrospective study, we found a high incidence of unplanned surgery and IMBT therapy initiation after colectomy among patients with UC or IBDU. These results further question the historical concept of surgery as a "definitive" treatment.

Antiviral therapy in hepatitis B virus-infected with immune-tolerant: A meta-analysis.

To access the efficacy of antiviral therapy in patients of HBV-infected with immune-tolerant. We conducted a meta-analysis search of the Cochrane Library, PubMed, ClinicalTrials.gov, Web of science, and EMBASE on through August 2021. We combined the data by means of a random-effect DrSimonian-Laird model and calculated risk ratios (RRs) for the outcomes of hepatitis B surface antigen (HBsAg) loss, hepatitis B e antigen (HBeAg) seroconversion, HBV deoxyribonucleic acid (DNA) negative conversion rate, and the risk for hepatocellular carcinoma (HCC) and cirrhosis. An extensive literature search identified 328 relevant publications, and five were included in the study. Antiviral therapy was in favor of HBsAg loss (RR=2.34, 95%CI 0.68-4.00, p=0.91, I2=0.00%), HBV DNA negative conversion (RR=2.08, 95%CI 0.10-4.05, p=0.07, I2=58.24%) and reduce the risk for HCC (HR=0.189, 95%CI 0.052-0.692, p=0.004) and cirrhosis (HR=0.347, 95%CI 0.095-1.270, p=0.036), but not beneficial to HBeAg seroconversion (RR=0.83, 95%CI -0.03 to 1.70, p=0.11, I2=46.99%). Subgroup-analyzed by the research type was similar results of HBsAg loss, HBV DNA negative conversion, and HBeAg seroconversion.Patients in HBV-infected with immune-tolerant responded well to antiviral therapy. The evidence from this meta-analysis supports antiviral therapy for patients with HBV in the immune tolerance stage. Well-designed, multi-center, larger sample sizes, and excellent quality prospective studies are needed to confirm our conclusion.

Safe haven in adolescence: Improving parental reflective functioning and youth attachment and mental health with the Connecting and Reflecting Experience.

Attachment security provides a well-documented protective developmental function for children exposed to individual- and community-level trauma, yet the effectiveness of prevention and intervention efforts targeting attachment during adolescence has been relatively underexplored. The Connecting and Reflecting Experience (CARE) program is a transdiagnostic, bi-generational, group-based, mentalizing-focused parenting intervention developed to dismantle the intergenerational transmission of trauma and support secure attachment relationships across the developmental spectrum within an under-resourced community. This exploratory study evaluated outcomes among caregiver-adolescent dyads (N = 32) in the CARE condition of a nonrandomized clinical trial at an outpatient mental health clinic within a diverse, urban U.S. community with disproportionate trauma exposure exacerbated by COVID-19. Caregivers predominantly identified as Black/African/African American (47%), Hispanic/Latina (38%), and/or White (19%). At pre- and post-intervention, caregivers completed questionnaires regarding parental mentalizing and their adolescents' psychosocial functioning. Adolescents completed scales regarding attachment and psychosocial functioning. Results showed a significant decrease in caregivers' prementalizing on the Parental Reflective Functioning Questionnaire, improvement in adolescent psychosocial functioning on the Youth Outcomes Questionnaire, and an increase in adolescents' reports of attachment security on the Security Scale. These preliminary findings suggest that mentalizing-focused parenting interventions may be effective in fostering improved attachment security and psychosocial functioning during adolescence.

La seguridad de la afectividad provee una bien documentada función protectora del desarrollo para niños expuestos al trauma individual y comunitario; aun así, la efectividad de los esfuerzos de prevención e intervención enfocados en la afectividad en la adolescencia ha sido relativamente poco explorada. El programa Conexión y Reflexión de la Experiencia (CARE) es una intervención de crianza transdiagnóstica, bigeneracional, con base en el grupo, enfocada en la mentalización, desarrollada para desarmar la transmisión intergeneracional de trauma y apoyar las relaciones de afectividad segura a lo largo del espectro del desarrollo dentro de una comunidad menos equipada con recursos. Este estudio exploratorio evaluó resultados entre díadas cuidador-adolescente (N = 32) bajo la condición CARE de un ensayo clínico no al azar en una clínica de salud mental ambulatoria dentro de una comunidad diversa y urbana en Estados Unidos, expuesta al trauma desproporcionadamente, lo cual fue exacerbado por COVID-19. A los cuidadores predominantemente se les identificó como negros/africanos/afroamericanos (47%), hispanos/latinas (38%), y/o blancos (19%). Antes y después de la intervención, los cuidadores completaron cuestionarios acerca de mentalización del progenitor y el funcionamiento sicosocial de sus adolescentes. Los adolescentes completaron escalas sobre la afectividad y el funcionamiento sicosocial. Los resultados mostraron una significativa disminución de la pre-mentalización en el Cuestionario del Funcionamiento con Reflexión del Progenitor, mejoras en el funcionamiento sicosocial de los adolescentes en el Cuestionario de Resultados de la Juventud, y un aumento en los reportes de los adolescentes sobre la seguridad de la afectividad en la Escala de Seguridad. Estos preliminares resultados sugieren que las intervenciones de crianza enfocadas en la mentalización pudieran ser efectivas para fomentar la mejorada seguridad de la afectividad y el funcionamiento sicosocial durante la adolescencia.

La sécurité de l'attachement offre une fonction protectrice au développement qui est bien prouvée pour les enfants exposés à un trauma individuel et communautaire. Cependant l'efficacité de la prévention et des efforts d'intervention ciblant l'attachement durant l'adolescence a été relativement peu exploré. Le programme de Connecting and Reflecting Experience (CARE, soit Expérience de Lien et de Réflexion) est une intervention de parentage transdiagnostique, bi-générationnel, basée sur un groupe, et ciblé sur la mentalisation développé afin de démonter la transmission intergénérationnelle du trauma et de soutenir des relations d'attachement sécure au travers du spectre développemental au soin d'une communauté manquant de moyens. Cette étude exploratoire a évalué les résultats chez des dyades personne prenant soin de l'adolescent-adolescent (N = 32) dans la condition CARE d'un essai clinique non-randomisé dans une clinique de santé mentale en consultation externe au soin d'une communauté américaine urbaine et diverse avec une exposition au trauma disproportionnée exacerbée par le COVID-19. Les personnes prenant soin des adolescents se sont en grande partie identifiés comme étant Noirs/Africains/Noir Américains (47%), Hispaniques/Latina (38%), et/ou Blanches (19%). Avant et après l'intervention les personnes prenant soin des adolescents ont rempli des questionnaires concernant la mentalisation parentale et le fonctionnement psychosocial de leurs adolescents. Les adolescents ont rempli des échelles concernant l'attachement et le fonctionnement psychosocial. Les résultats montrent une baisse importante de la pré-mentalisation des personnes prenant soin des adolescents concernant le Questionnaire de Fonctionnement de Réflexion Parental, une amélioration du fonctionnement psychosocial de l'adolescent au travers du Questionnaire des Résultats de Jeunesse (Youth Outcomes Questionnaire en anglais) et une augmentation dans les rapports de sécurité d'attachement faits par les adolescents au travers de l'échelle Security Scale. Ces résultats préliminaires suggèrent que les interventions de parentage focalisées sur la mentalisation peuvent être efficaces pour favoriser une sécurité de l'attachement améliorée et le fonctionnement psychosocial durant l'adolescence.

Art at the Start: A controlled trial and close observation of parent-infant art therapy intervention.

This two-part study seeks to evidence art therapy intervention for parent-infant attachment relationships, looking at improvements to wellbeing and relationships. Study one was a controlled trial with 105 participating parent/caregivers and their infants (0-3-years), identified due to concerns about their relationship. They were quasi-randomized to attend a 12-week art therapy group or treatment as usual. Measures focused on parents' wellbeing and their perceptions of their relationship with their infant. In study 2 we analyzed video footage from the first and penultimate sessions of a sample of 37 dyads, looking for observable changes in the different channels of communication upon which attachments are predicated. The controlled trial showed intervention participants had significantly improved parental wellbeing, significant increases in attachment warmth and significant decreases in intrusion. This contrasted with the control sample who showed a significant decrease in wellbeing, stable warmth, and significant increases in intrusion. The observation study showed that there was a significant increase in the communicative behaviors from the parents to the infant which would support attachments between the first and penultimate sessions. We conclude that these results make a robust case for the inclusion of art therapy within the range of interventions available for at risk early relationships.

Este estudio en dos partes busca evidenciar la intervención terapéutica de arte para las relaciones afectivas progenitor-infante, mirando las mejoras al bienestar y las relaciones. El primer estudio se trata de un ensayo controlado con la participación de 105 progenitores/cuidadores y sus infantes (0-3 años), identificados en atención a preocupaciones acerca de su relación. Ellos fueron asignados cuasi al azar para participar en un grupo de terapia de arte o seguir el tratamiento acostumbrado. Las medidas se enfocan en el bienestar de los progenitores y sus percepciones acerca de sus relaciones con sus infantes. En el estudio 2 analizamos grabaciones de video de la primera y penúltima sesiones de un grupo muestra de 37 díadas, buscando cambios observables en los diferentes canales de comunicación sobre los cuales se fundamenta la unión afectiva. El ensayo controlado mostró que los participantes de la intervención habían mejorado significativamente su bienestar como progenitores, mejoras significativas en la calidez de la afectividad y significativas disminuciones en la intrusión. Esto contrastó con el grupo muestra de control que mostró una significativa disminución en el bienestar, una estable calidez y significativos aumentos en la intrusión. El estudio de observación mostró que había un aumento significativo en los comportamientos comunicativos de progenitores a infantes lo cual apoyaría los acoplamientos entre la primera y penúltima sesiones. Concluimos con que estos resultados formulan un caso sólido para la inclusión de la terapia de arte dentro de la gama de intervenciones disponibles para relaciones tempranas bajo riesgo.

Cette étude en deux parties s'est attachée à examinant l'intervention de thérapie artistique pour les relations d'attachement parent-nourrisson, étudiant les améliorations dans le bien-être et les relations. La première étude a consisté en un essai contrôlé avec 105 parents/personnes prenant soin des enfants et leurs bébés (0-3 ans), ayant été identifiés du fait d'inquiétudes à propos de leur relation. Ils ont été quasiment randomisés pour participer à un groupe de thérapie par l'art ou le traitement habituel. Les mesures ont mis l'accent sur le bien-être des parents et leurs perceptions de leur relation avec leur bébé. Dans la deuxième étude nous avons analysé des prises à la vidéo de la première et de la dernière session d'un échantillon de 37 dyades, cherchant des changements observables dans les différentes chaînes de communication sur lesquelles reposent les attachements. L'essai contrôlé a montré que les participants à l'intervention faisaient preuve d'améliorations importantes dans leur bien-être parental, dans la chaleur de l'attachement et de diminutions importantes dans l'intrusion. Cela a contrasté avec le groupe de contrôle qui a fait preuve d'une baisse importante du bien-être, d'une chaleur stable et d'augmentations importantes dans l'intrusion. Cette étude d'observation a montré qu'il y avait une augmentation importante des comportements communicatifs de la part des parents envers les bébés qui soutiendrait les attachements entre la première et la dernière session. Nous concluons que ces résultats présentent des arguments solides en faveur de l'inclusion de la thérapie par l'art au sein d'une éventail d'interventions disponibles pour les relations précoces à risque.

Reflective functioning and mother-infant relationships among mothers with Borderline Personality Disorder post-therapy.

The stressful nature of parenting infants exacerbates the characteristics of Borderline Personality Disorder (BPD). Consequently, mothers with BPD tend to be emotionally dysregulated, respond impulsively to their infants, and have poorer mother-infant relationships. Few parenting interventions target the specific skill deficits observed in mothers with BPD. This study explored the differences in parental reflective functioning (PRF) and mother-infant relationship quality at baseline and following a 24-week, group parenting intervention for mothers with BPD. PRF and mother-infant relationship quality were assessed from quantitative (N = 23) and qualitative (N = 32) perspectives. Quantitative data (Parental Reflective Functioning Questionnaire) showed a significant improvement in one of the three subscales, Interest and Curiosity, between baseline and post-intervention, and a significant moderate positive association between the subscale Certainty of Mental States and maternal-infant interaction quality post-intervention. Improvements in mother-infant relationship quality were not evident from the observational measure, Nursing Child Assessment Satellite Teaching scale. In contrast, semi-structured interview qualitative data found maternal improvements in parental reflection, coping strategies implemented post-intervention, and quality of mother-infant relationships. Overwhelmingly positive intervention feedback suggested perceived maternal benefits of group format and skills taught. Future studies with larger sample sizes would allow further clarification of such parenting interventions for mothers with BPD.

La naturaleza estresante de criar infantes agudiza las características del Trastorno Límite de la Personalidad (BPD). Por tanto, madres con BPD tienden a estar emocionalmente no reguladas, responder impulsivamente a sus infantes y tener relaciones madre-infante de menor calidad. Pocas intervenciones de crianza se centran en los específicos déficits de habilidades observados en madres con BPD. El presente estudio exploró diferencias en el funcionamiento con reflexión del progenitor y la calidad de la relación madre-infante al punto inicial y al del seguimiento a 24 semanas de la intervención de crianza en grupo para madres con BPD. Se evaluó el funcionamiento con reflexión del progenitor y la relación madre-infante desde la perspectiva cuantitativa (N=23) y cualitativa (N=32). Datos cuantitativos (Cuestionario del Funcionamiento con Reflexión del Progenitor) mostraron un significativo adelanto en una de tres subescalas, Interés y Curiosidad, entre el punto inicial y posterior a la intervención, y una significativa moderada asociación positiva entre la subescala Certeza de Estados Mentales y la calidad de la interacción materno-infantil al momento posterior a la intervención. Las mejoras en la calidad de la relación madre-infante no fueron evidentes con la medida de observación, la escala de la Enseñanza Satélite de Evaluación del Niño Lactante. En contraste, datos cualitativos de entrevista semiestructurada encontraron mejoras maternas en la reflexión del progenitor, estrategias de cómo arreglárselas puestas en práctica después de la intervención, y en la calidad de las relaciones madre-infante. La abrumadoramente positiva información sobre la intervención sugirió que había una percepción materna de beneficios del formato de grupo y las habilidades que se enseñaban. Estudios futuros con grupos mayores permitirán clarificaciones adicionales de tales intervenciones de crianza para madres con BPD.

La nature stressante du parentage des nourrissons exacerbe les caractéristiques du Trouble de la Personnalité Limite (TPL). Par conséquent les mères avec un TPL ont tendance à être émotionnellement dérégulées, réagissant de manière impulsive à leurs bébés et ont des relations mère-bébé moins bonnes. Peu d'interventions de parentage visent les déficits de compétence spécifiques qui sont observés chez les mères avec un TPL. Cette étude a exploré les différences qu'on trouve dans le fonctionnement de réflexion parental et la qualité de la relation mère-bébé au départ et après une intervention de groupe de parentage pour des mères avec un TPL, de 24 semaines. Le fonctionnement parental de réflexion et la qualité de la relation mère-bébé ont été évalués à partir de perspectives quantitatives (N=23) et qualitatives (N=32). Les données quantitatives (Questionnaire de Fonctionnement de Réflexion parental ont montré une amélioration importante dans l'une des trois sous-échelles, Intérêt et Curiosité, entre le départ de l'intervention et la post-intervention, ainsi qu'un lien positive modéré important entre la sous-échelles Certitude des Etats Mentaux et la qualité de l'interaction maternelle-bébé après l'intervention. On n'a pas trouvé d'améliorations de la qualité de la relation mère-bébé à partir de la mesure d'observation échelle d'Formation Satellite de l'Evaluation du Nourrisson. Par contre les données qualitatives de l'entretien semi-structuré a révélé des améliorations maternelles dans la réflexion parentale, dans des stratégies d'adaptation mises en place après l'intervention et dans la qualité des relations mère-bébé. Les retours de l'intervention extrêmement positifs ont suggéré que des bénéfices maternels perçus du format de groupe et des compétences enseignées. Des études avec des échantillons plus grands permettraient une clarification plus poussée sur de telles interventions avec des mères avec un TPL.

Thromboembolic and hemorrhagic complications in patients with prosthetic heart valves cared for in a tertiary care center. What have we learned?

BACKGROUND: Heart valve replacement surgery with mechanical or biological prostheses entails a risk of thromboembolism and bleeding complications. OBJECTIVE: To determine the complications related to complementary anticoagulation therapy and the probability of risk. METHODS: One-hundred and sixty-three patients who underwent heart valve replacement between 2002 and 2016 with either mechanical or biological prostheses, and who received vitamin K antagonists after hospital discharge, were studied. Anticoagulation therapy was categorized into optimal and non-optimal according to INR values prior to the development of complications. Patients with comorbidities and other risk factors for thrombosis and/or bleeding were excluded. RESULTS: In total, 68.7 % of patients received mechanical prostheses, and 31.3 %, biological prostheses (p ≤ 0.001); 25.2 % experienced the complications that motivated the study (p ≤ 0.001), which were hemorrhagic in 48.8 %, thromboembolic in 26.8 %, and of both types in 24.4 % (relative risk = 4.229). Among the patients with complications, 95.1 % received mechanical prostheses, and 4.9 %, biological (p = 0.005); non-optimal INR was identified in 49.7 % (p ≤ 0.001). CONCLUSIONS: Given the high risk of thromboembolic and hemorrhagic complications, valve prostheses must be carefully chosen, and care priorities should include prevention and follow-up, especially in those patients who require anticoagulation therapy.

ANTECEDENTES: El reemplazo valvular por prótesis mecánicas o biológicas implica riesgo de tromboembolismo y complicaciones hemorrágicas. OBJETIVO: Determinar las complicaciones relacionadas con la terapia de anticoagulación complementaria y la probabilidad de riesgo en pacientes portadores de prótesis valvulares del corazón. MÉTODOS: Se estudiaron 163 pacientes entre 2002 y 2016, portadores de prótesis mecánicas y biológicas, quienes recibieron antagonistas de la vitamina K posterior al egreso hospitalario. La terapia de anticoagulación se categorizó en óptima y no óptima conforme a los valores de INR previos a las complicaciones. Fueron excluidos los pacientes con comorbilidades y otros factores de riesgo de trombosis y/o sangrado. RESULTADOS: a 68.7 % de los pacientes se les colocó prótesis mecánica y a 31.3 %, biológica (p ≤ 0.001); 25.2 % presentó las complicaciones motivo de estudio (p ≤ 0.001), hemorrágicas en 48.8 %, tromboembólicas en 26.8 % y de ambos tipos en 24.4 % (riesgo relativo = 4.229); a 95.1 % de los pacientes con complicaciones se les colocó prótesis mecánica y a 4.9 %, biológica (p = 0.005); 49.7 % presentó INR no óptimo (p ≤ 0.001). CONCLUSIONES: Ante riesgo alto de complicaciones tromboembólicas y hemorrágicas, la elección de las prótesis valvulares, la prevención y el seguimiento son prioridades, principalmente en quienes requieren terapia de anticoagulación.

Sofosbuvir plus glecaprevir/pibrentasvir as salvage therapy after liver transplantation in NS5A inhibitor-experienced patients. A case series.

BACKGROUND: Treatment of chronic hepatitis C virus (HCV) infection with direct-acting antivirals achieves a sustained virologic response rate higher than 95%. However, virologic failure remains a clinical challenge, and data on retreatment are limited, especially in special populations such as liver transplant (LT) recipients. OBJECTIVES: This study evaluated the sofosbuvir plus glecaprevir-pibrentasvir (GLE/PIB) regimen in LT recipients who had failed to a nonstructural protein 5A (NS5A) inhibitor-based regimen. MATERIAL AND METHODS: Retrospective study of 111 liver transplant recipients between January 2018 and December 2020; 18 patients presented with HCV recurrent infection after LT, out of whom three had a history of at least one NS5A inhibitor-based regimen. Salvage therapy with sofosbuvir plus GLE/PIB was started for 12 weeks; baseline characteristics and outcomes were recorded. RESULTS: All three patients (100%) achieved an undetectable HCV viral load 12 weeks after treatment completion. No serious adverse events were observed. CONCLUSION: In our series, sofosbuvir plus GLE/PIB for 12 weeks is an effective and safe salvage therapy after LT in patients previously treated with NS5A inhibitors.

ANTECEDENTES: El tratamiento del virus de la hepatitis C (VHC) crónica con antivirales de acción directa logra tasas de respuesta virológica sostenida superiores a 95 %. Sin embargo, el manejo del fracaso virológico sigue siendo un desafío clínico y la evidencia sobre el retratamiento es limitada, especialmente en poblaciones como los receptores de trasplante hepático (TH). OBJETIVO: Este estudio evaluó el régimen de sofosbuvir más glecaprevir/pibrentasvir (GLE/PIB) en receptores de TH en quienes falló el régimen basado en inhibidores de la proteína no estructural 5A (NS5A). MATERIAL Y MÉTODOS: Estudio retrospectivo de 111 pacientes trasplantados entre enero de 2018 y diciembre de 2020; 18 pacientes presentaron infección recurrente por VHC posterior al TH, tres de ellos tuvieron antecedentes de al menos un régimen basado en inhibidores de NS5A. Se inició terapia de rescate con sofosbuvir más GLE/PIB durante 12 semanas posterior al TH; se registraron las características basales de los pacientes y sus desenlaces. RESULTADOS: En los tres pacientes se logró obtener una carga viral indetectable de VHC a las 12 semanas de finalizar el tratamiento. No se observaron eventos adversos graves. CONCLUSIÓN: En nuestra serie, sofosbuvir más GLE/PIB durante 12 semanas demostró ser una terapia de rescate efectiva y segura posterior al TH en pacientes previamente tratados con inhibidores de NS5A.

The Role of Adjuvant Therapy in the Management of Chronic Urticaria.

Recent guideline on the management of urticaria recommends second-generation H1-antihistamine as the first-line therapy, with dose increases of up to fourfold if inadequately controlled. However, the treatment of chronic spontaneous urticaria (CSU) is often disappointing, so additional adjuvant therapies are needed to increase the effectiveness of first-line therapy, especially in patients who are refractory to the increase of antihistamine doses. Recent studies recommend various adjuvant therapy modalities for CSU, such as biological agents, immunosuppressants, leukotriene receptor antagonists, H2-antihistamine, sulfones, autologous serum therapy, phototherapy, vitamin D, antioxidants, and probiotics. This literature review was made to determine the effectiveness of various adjuvant therapies in managing CSU.

The Role of Adjuvant Therapy in the Management of Chronic Urticaria. / [Artículo traducido] El papel de la terapia adyuvante en el tratamiento de la urticaria crónica espontánea.

Recent guideline on the management of urticaria recommends second-generation H1-antihistamine as the first-line therapy, with dose increases of up to fourfold if inadequately controlled. However, the treatment of chronic spontaneous urticaria (CSU) is often disappointing, so additional adjuvant therapies are needed to increase the effectiveness of first-line therapy, especially in patients who are refractory to the increase of antihistamine doses. Recent studies recommend various adjuvant therapy modalities for CSU, such as biological agents, immunosuppressants, leukotriene receptor antagonists, H2-antihistamine, sulfones, autologous serum therapy, phototherapy, vitaminD, antioxidants, and probiotics. This literature review was made to determine the effectiveness of various adjuvant therapies in managing CSU.

Sonidegib as a Locally Advanced Basal Cell Carcinoma Therapy in Real-life Clinical Setting: A National Multicentre Study.

BACKGROUND: Basal cell carcinoma (BCC) is the most prevalent cancer. A minority of BCCs have an aggressive behaviour (laBCC) and may require hedgehog pathway inhibitors such as sonidegib as its treatment. OBJECTIVE: To describe the use of sonidegib in a large number of patients and provide more data on its real-life efficacy and safety profile. METHODS: We conducted a retrospective and multicentric study that included patients treated with sonidegib. Epidemiological, effectiveness and safety data were collected. RESULTS: A total of 82 patients with a mean age of 73.9 years were included. Ten patients had Gorlin syndrome. Median treatment duration was 6 months. Median follow-up duration was 34.2 months. Globally, 81.7% of the patients showed clinical improvement (52.4% partial response and 29.3% complete response), 12.2% clinical stability and 6.1% disease progression. There was no statistically significant difference in clinical improvement between the 24h and 48h sonidegib posology. After 6 months of treatment, 48.8% of the patients discontinued sonidegib. Prior vismodegib treatment and recurrent primary BCC were associated with a poorer response to sonidegib. At 6 months of treatment, 68.3% of the patients experienced at least one adverse effect. CONCLUSION: Sonidegib shows good effectiveness and acceptable safety profile in usual clinical practice.

Sonidegib as a Locally Advanced Basal Cell Carcinoma Therapy in Real-life Clinical Setting: A National Multicentre Study. / [Artículo traducido] Sonidegib para el tratamiento del carcinoma basocelular avanzado en práctica clínica real: estudio nacional multicéntrico.

BACKGROUND: Basal cell carcinoma (BCC) is the most prevalent cancer. A minority of BCCs have an aggressive behaviour (laBCC) and may require hedgehog pathway inhibitors such as sonidegib as its treatment. OBJECTIVE: To describe the use of sonidegib in a large number of patients and provide more data on its real-life efficacy and safety profile. METHODS: We conducted a retrospective and multicentric study that included patients treated with sonidegib. Epidemiological, effectiveness and safety data were collected. RESULTS: A total of 82 patients with a mean age of 73.9 years were included. Ten patients had Gorlin syndrome. Median treatment duration was 6 months. Median follow-up duration was 34.2 months. Globally, 81.7% of the patients showed clinical improvement (52.4% partial response and 29.3% complete response), 12.2% clinical stability and 6.1% disease progression. There was no statistically significant difference in clinical improvement between the 24 h and 48 h sonidegib posology. After 6 months of treatment, 48.8% of the patients discontinued sonidegib. Prior vismodegib treatment and recurrent primary BCC were associated with a poorer response to sonidegib. At 6 months of treatment, 68.3% of the patients experienced at least one adverse effect. CONCLUSION: Sonidegib shows good effectiveness and acceptable safety profile in usual clinical practice.