Results of Lucia Keratoprosthesis Implantation in Severe Corneal Disease.

PURPOSE: Describe complications, functional success, and retention of the Lucia Keratoprosthesis (KPro). DESIGN: Retrospective interventional case series METHODS: The demographic data, baseline characteristics, complications, functional success, and retention were analyzed for Lucia KPro at the Instituto de Oftalmologia Conde de Valenciana in Mexico City from 2021 to 2023. Multivariate regression analysis and Kaplan-Meier plots were performed to identify associations with functional failure. The main outcome measures were postoperative complications, functional success defined as best-corrected visual acuity (BCVA) ≥20/200 (logMAR 1.0), and device retention rate. RESULTS: Forty-eight eyes of 48 patients (56.88% male) were studied. The mean age at implantation was 57.29 ± 15.63 years (range 27-91), with a mean follow-up of 20.5 ± 8.83 months (range 3-40). Diagnostic indications for implantation included recurrent graft rejection (54.17%), autoimmune disease (20.83%), chemical injury (12.5%), and other (12.5%). At least 1 postoperative complication occurred in 75% of patients, leading to 65 additional interventions (mean number of subsequent procedures: 1.35 ± 1.3, range 0-5). The preoperative BCVA was 2.40 ± 0.36 logMAR. At the final follow-up, 62.5% had achieved functional success and 22.92% had a BCVA of 20/40 (logMAR 0.3) or better. Glaucoma (adjusted OR 469.74, 95% CI 5.02-43939.14, P = .007) and retinal pathology before KPro (adjusted OR 372.38, 95% CI 4.18-33162.11, P = .009) were associated with functional failure. The device remained in place in 95.83% of recipients over the follow-up period. CONCLUSIONS: The Lucia KPro offers functional success in severe corneal diseases and excellent retention in the short to intermediate term.

Improvement of digital Gabor holographic microscopy using a lens in plankton studies.

This work utilizes a Gabor Holographic Optical Scheme integrated with a microscope objective and a thin convex plane lens. This bi-telecentric lens system corrects spherical aberration from the objective, maintains consistent magnification across various reconstruction distances, and ensures a plane incidence on CMOS. Depending on the focal lengths of the objective and lens, the final image can be enlarged or reduced compared to the classic Gabor system, resulting in high-quality reconstructed phase images without spherical aberration. This setup was employed to capture phase distribution and intensity images of planktonic objects, such as copepods, achieving superior image quality.

Effect of Water Absorption and Stacking Sequences on the Tensile Properties and Damage Mechanisms of Hybrid Polyester/Glass/Jute Composites.

The aim of this work is to analyze the effect of water absorption on the mechanical properties and damage mechanisms of polyester/glass fiber/jute fiber hybrid composites obtained using the compression molding and vacuum-assisted resin transfer molding (VARTM) techniques with different stacking sequences. For this purpose, the mechanical behavior under tensile stress of the samples was evaluated before and after hygrothermal aging at different temperatures: TA, 50 °C, and 70 °C for a period of 696 h. The damage mechanism after the mechanical tests was evaluated using SEM analysis. The results showed a tendency for the mechanical properties of the composites to decrease with exposure to an aqueous ambient, regardless of the molding technique used to conform the composites. It was also observed that the stacking sequence had no significant influence on the dry composites. However, exposure to the aqueous ambient led to a reduction in mechanical properties, both for the molding technique and the stacking sequence. Damage such as delamination, fiber pull-out, fiber/matrix detachment, voids, and matrix removal were observed in the composites in the SEM analyses.

Examining the Features of Neuroleptic Malignant Syndrome in Anti-NMDA Receptor Encephalitis: A Case-Control Study.

BACKGROUND: Anti-N-methyl-D-aspartate receptor encephalitis (ANMDARE) is a neuroimmunological disorder that frequently improves with immunotherapy. Symptomatic treatment with antipsychotics is common in the early stages when psychiatric symptoms predominate, and their use has been associated with serious side effects including neuroleptic malignant syndrome (NMS). The observation of an adverse response to antipsychotics, raising the suspicion of NMS, has been included as a criterion for possible autoimmune psychosis. METHODS: This case-control study included patients who received antipsychotics before referral to the National Institute of Neurology and Neurosurgery of Mexico, where they were diagnosed as having definite ANMDARE, and patients with ANMDARE who did not receive antipsychotics before referral. The neurologic and systemic features that are used to measure an adverse response to antipsychotics, raising the suspicion of NMS, were measured in both groups, including akinesia, autonomic instability, generalized rigidity, elevated concentrations of creatine phosphokinase, and hyperthermia. A logistic regression analysis was used to determine the relationship between the previous use of antipsychotics and the occurrence of NMS-like reactions. RESULTS: A total sample of 112 patients with definite ANMDARE were included in the study. Fifty patients received antipsychotics before being referred to our institution. In this group, thirty-six patients (72%) were initially classified as having an adverse response, raising the suspicion of NMS, with the following features: akinesia (64%), autonomic instability (58%), generalized rigidity (52%), elevated concentrations of creatine phosphokinase (50%), and hyperthermia (14%). Six patients fulfilled the criteria for NMS (12%). The comparison with patients who did not receive antipsychotics before the clinical assessment did not show a significant difference between groups regarding the frequency of akinesia, autonomic instability, generalized rigidity, elevated concentrations of creatine phosphokinase, or hyperthermia. Among different antipsychotics, only haloperidol was significantly associated with generalized rigidity as compared to patients who did not receive antipsychotics. CONCLUSIONS: Our study supports previous observations about the high frequency of autonomic dysfunction, hyperthermia, tachycardia, rigidity, and elevated creatine phosphokinase levels in patients with anti-NMDAR encephalitis following the administration of antipsychotic medications. Nevertheless, our study does not suggest a causal link between atypical antipsychotics and the onset of these neurological symptoms, as they were equally frequent among the group of patients who did not receive antipsychotic treatment.

Importance and use of corneal biomechanics and its diagnostic utility.

The study of corneal biomechanics has become relevant in recent years due to its possible applications in the diagnosis, management, and treatment of various diseases such as glaucoma, keratorefractive surgery and different corneal diseases. The clinical biomechanical investigation has become of great importance in the setting of refractive surgery to identify patients at higher risk of developing iatrogenic ectasia. This review focuses on two of the technologies available for clinical use, the Ocular Response Analyzer (Reichert Ophthalmic Instruments, Buffalo, NY, USA) and the Corvis ST (Oculus Optikgergäte GmbH, Wetzlar, Germany). Both are non-contact tonometers that provided a clinical evaluation of corneal biomechanics. The fundamentals and main parameters of each device are described, as well as their use in eye surgery and the corneal biomechanical behavior in eye diseases. Finally, we will discuss the more recent Brillouin microscopy biomechanical analysis, and the integration Scheimpflug-based corneal tomography and biomechanical data with artificial intelligence to increase accuracy to detect risk of ectasia.

El estudio de la biomecánica corneal ha cobrado relevancia en los últimos años debido a sus posibles aplicaciones en el diagnóstico, el manejo y el tratamiento de diversas enfermedades, como glaucoma, cirugía queratorrefractiva y diferentes enfermedades corneales. La investigación de la biomecánica corneal es de mucha importancia en el contexto de cirugía refractiva, pues podría identificar pacientes en riesgo de desarrollar una ectasia corneal iatrogénica. Esta revisión se centra en dos de las tecnologías disponibles para uso clínico: el Ocular Response Analyzer (Reichert Ophthalmic Instruments, Buffalo, NY, EE. UU.) y el Corvis ST (Oculus Optikgergäte GmbH, Wetzlar, Alemania). Ambos son tonómetros de no contacto que proporcionan una evaluación clínica de la biomecánica corneal. Se describen los fundamentos y los principales parámetros de cada dispositivo, así como su uso en cirugía ocular y el comportamiento biomecánico corneal en las enfermedades oculares. Finalmente, se mencionan los dispositivos más recientes de análisis biomecánico, como la microscopía de Brillouin, así como la integración de los datos biomecánicos y topográficos basados en Scheimpflug con la inteligencia artificial para aumentar la precisión en la detección del riesgo de ectasias.

Water Sorption in Hybrid Polyester/Glass/Jute Composites Processed via Compression Molding and Vacuum-Assisted Resin Transfer Molding.

The aim of this work is to analyze water sorption in hybrid polyester/glass fabric/jute fabric composites molded via compression and VARTM (Vacuum-Assisted Resin Transfer Molding). The laminates were produced with five different stacking sequences and subjected to water sorption testing at room temperature, 50 °C and 70 °C. This study consisted of two stages: experimental and theoretical stages. The composites had a fiber volume content ranging from 30% to 40%. Water absorption and diffusion coefficient in the hybrid composites were intermediate to those reinforced with a single type of fiber. There were no significant differences in these properties based on fiber arrangement once the composites reached saturation. Diffusion coefficient values were higher for specimens with jute fiber on at least one of the outer surfaces. Water sorption rates increased with higher immersion temperatures. The water sorption at saturation point was not affected by the manufacturing process. Among the hybrid composites, those with jute on the surfaces showed the highest diffusion coefficient, while those with glass on the surface had the lowest values. Higher diffusion coefficient values were observed at temperatures of 50 °C and 70 °C. The main influencing factors on the absorbed moisture content for composites are the presence and content of jute fibers in the system and the immersion temperature. The manufacturing process does not affect the water sorption at saturation point.

Influence of Bentonite Particles on the Mechanical Properties of Polyester-Sisal Fiber Composites.

As a part of the mission to create materials that are more environmentally friendly, we present the following proposal, in which a study of the mechanical properties of composite materials comprising a polyester resin with sisal fiber and bentonite particles was conducted. Sisal fiber was added to a matrix in percentages ranging from 5% to 45% in relation to the polyester resin weight, while bentonite remained fixed at 7% in relation to the polyester resin weight. The specimens were manufactured by compression molding. The mechanical properties were analyzed by tensile, bending, impact, stepped creep, and relaxation tests. In addition, energy-dispersive X-ray spectroscopy and scanning electron microscopy analyses were carried out to analyze the composition and heterogeneity of the structure of the composite material. The results obtained showed that 7% of bentonite added to the matrix affects the tensile strength. Flexural strength increased by up to 21% in the specimens with a 20% addition of sisal fiber, while the elastic modulus increased by up to 43% in the case of a 20% addition of sisal fiber. The viscoelastic behavior was improved, while the relaxation stress was affected.

Adjuvant Topical Interferon Alpha 2b for the Treatment of Monkeypox Ocular Manifestations.

PURPOSE: The aim of this study was to report a case of ocular Mpox that responded favorably to treatment with topical interferon and oral doxycycline. METHODS: This is a case report of a previously healthy 24-year-old woman who developed a pustular rash, headache, fever, arthralgia, sore throat, and asthenia 3 weeks before attending to our clinic. Her main complaint at the moment of the visit was pain, photophobia, foreign body sensation, blurred vision, red eye, and discharge on the left eye. The slit-lamp examination of the left eye showed severe conjunctival hyperemia associated with tarsal follicles, 360 degrees ciliary injection, diffuse corneal epithelial edema with white linear epithelial infiltrates, pigmented and nonpigmented keratic precipitates, and two 1-mm peripheral corneal ulcers with white infiltrates, associated with positive fluorescein staining. Anterior chamber cellularity and flare were mildly present. RESULTS: Mpox with ocular manifestations diagnosis was confirmed by real-time quantitative reverse transcription polymerase chain reaction assay (qRT-PCR) testing; samples were taken from corneal, conjunctival, and nasopharynx swab as well as a skin scab. Topical interferon alpha 2b 1 MIU/mL every 6 hours for 1 month and oral doxycycline 100 mg BID were administered along with other medications with consequent decrease of inflammation and malaise symptoms 1 week later, associated with uncorrected visual acuity improvement. CONCLUSIONS: Alternative and efficacious treatment options for Mpox ocular manifestations are needed to prevent further disease progression and sequelae in countries with no access to the gold-standard therapy. Topical interferon alpha 2b and oral doxycycline have shown adequate response as shown with this patient.

Conversion Predictors of Clinically Isolated Syndrome to Multiple Sclerosis in Mexican Patients: A Prospective Study.

BACKGROUND: Clinically Isolated Syndrome (CIS) is the first clinical episode suggestive of Clinical Definite Multiple Sclerosis (CDMS). There are no reports on possible predictors of conversion to CDMS in Mexican mestizo patients. AIM OF THE STUDY: To investigate immunological markers, clinical and paraclinical findings, and the presence of herpesvirus DNA to predict the transition from CIS to CDMS in Mexican patients. METHODS: A single-center prospective cohort study was conducted with newly diagnosed patients with CIS in Mexico between 2006 and 2010. Clinical information, immunophenotype, serum cytokines, anti-myelin protein immunoglobulins, and herpes viral DNA were determined at the time of diagnosis. RESULTS: 273 patients diagnosed with CIS met the enrolment criteria; after 10 years of follow-up, 46% met the 2010 McDonald criteria for CDMS. Baseline parameters associated with conversion to CDMS were motor symptoms, multifocal syndromes, and alterations of somatosensory evoked potentials. The presence of at least one lesion on magnetic resonance imaging was the main factor associated with an increased risk of conversion to CDMS (RR 15.52, 95% CI 3.96-60.79, p = 0.000). Patients who converted to CDMS showed a significantly lower percentage of circulating regulatory T cells, cytotoxic T cells, and B cells, and the conversion to CDMS was associated with the presence of varicella-zoster virus and herpes simplex virus 1 DNA in cerebrospinal fluid and blood. CONCLUSION: There is scarce evidence in Mexico regarding the demographic and clinical aspects of CIS and CDMS. This study shows several predictors of conversion to CDMS to be considered in Mexican patients with CIS.

Effect of Human Adenovirus 36 on Response to Metformin Monotherapy in Obese Mexican Patients with Type 2 Diabetes: A Prospective Cohort Study.

Human adenovirus 36 (HAdV-36) has been associated with obesity and changes in glucose and lipid metabolism. The virus has been reported to increase insulin sensitivity and paradoxically promote weight gain. Because of its effects on metabolism, infection with the virus could alter the response to several drugs used to treat type 2 diabetes (DM2), such as metformin. The aim of this study was to test whether HAdV-36 affects the response to metformin in a group of obese patients with DM2. METHODS: In a prospective cohort study, 103 obese patients with newly diagnosed DM2 were divided into two groups based on their HAdV-36 seropositivity (+HAdV-36 and -HAdV-36). Weight, glucose, cholesterol, triglycerides, body mass index, body fat percentage, and waist and hip circumference were measured and compared in both groups at baseline and after 45 days of metformin treatment. RESULTS: Only glucose was significantly lower in the +HAdV-36 group at baseline, while all other variables were similar between the two study groups. After 45 days of follow-up, it was observed that the effect of metformin did not differ between the groups, but the variables improved significantly after treatment. CONCLUSIONS: In this study, we did not find that HAdV-36 had an effect on the response to metformin in obese patients with DM2.

Development of an Epoxy Matrix Hybrid Composite with Astrocaryum Aculeatum (Tucumã) Endocarp and Kaolin from the Amazonas State in Brazil.

Composites with natural lignocellulosic fillers are being cited as a viable and sustainable alternative to conventional materials, as they combine lower costs with lower weight. In many tropical countries, such as Brazil, there is a considerable amount of lignocellulosic waste that is improperly discarded, which causes pollution of the environment. The Amazon region has huge deposits of clay silicate materials in the Negro River basin, such as kaolin, which can be used as fillers in polymeric composite materials. This work investigates a new composite material (ETK) made of epoxy resin (ER), powdered tucumã endocarp (PTE), and kaolin (K), without coupling agents, with the aim of producing a composite with lower environmental impact. The ETK samples, totaling 25 different compositions, were prepared by cold molding. Characterizations of the samples were performed using a scanning electron microscope (SEM) and a Fourier-transform infrared spectrometer (FTIR). In addition, the mechanical properties were determined via tensile, compressive, three-point flexural and impact tests. The FTIR and SEM results showed an interaction between ER, PTE, and K, and the incorporation of PTE and K reduced the mechanical properties of the ETK samples. Nonetheless, these composites can be considered potential materials to be used for sustainable engineering applications in which high mechanical strength is not a main requirement of the material.

Optimizing the Production of gp145, an HIV-1 Envelope Glycoprotein Vaccine Candidate and Its Encapsulation in Guanosine Microparticles.

We have developed a pipeline to express, purify, and characterize HIV envelope protein (Env) gp145 from Chinese hamster ovary cells, to accelerate the production of a promising vaccine candidate. First in shake flasks, then in bioreactors, we optimized the growth conditions. By adjusting the pH to 6.8, we increased expression levels to 101 mg/L in a 50 L bioreactor, nearly twice the previously reported titer value. A battery of analytical methods was developed in accordance with current good manufacturing practices to ensure a quality biopharmaceutical. Imaged capillary isoelectric focusing verified proper glycosylation of gp145; dynamic light scattering confirmed the trimeric arrangement; and bio-layer interferometry and circular dichroism analysis demonstrated native-like properties (i.e., antibody binding and secondary structure). MALDI-TOF mass spectrometry was used as a multi-attribute platform for accurate mass determination, glycans analysis, and protein identification. Our robust analysis demonstrates that our gp145 product is very similar to a reference standard and emphasizes the importance of accurate characterization of a highly heterogeneous immunogen for the development of an effective vaccine. Finally, we present a novel guanosine microparticle with gp145 encapsulated and displayed on its surface. The unique properties of our gp145 microparticle make it amenable to use in future preclinical and clinical trials.

Effect of Nanometric Particles of Bentonite on the Mechanical Properties of a Thermoset Polymeric Matrix Reinforced with Hemp Fibers.

The influence of the addition of bentonite nanoparticles on the tensile and flexural strength of a thermosetting polymer matrix composite material reinforced with hemp fibers was de-terminated. All composites were manufactured with 5% of bentonite in the polymer mass-weight ratios and 10 to 45 wt% of fibers with a step of 5%. For mechanical characterization, tensile and flexural tests were performed: scanning electron microscopy and energy-dispersive X-ray spectroscopy analyses were carried out. The tensile strength of the samples containing bentonite compared to the polymer samples with the fiber addition was affected for all fiber addition percentages, except for 35% while the flexural resistance improved with the addition of bentonite in the percentages of 20, 30, 35, and 45% of fiber addition. With the addition of bentonite, the maximum values of tensile and flexural strength were both obtained for the 35% addition of fibers, with values of 34.28 MPa and 98.04 MPa, respectively. The presence of bentonite favored the rigidity of the material to traction and bending, which was reflected through an increase in the elastic modulus compared to the composite that only had fiber. The maximum values obtained were 9065 MPa in tension and 8453 MPa in flexion for the 40% and 35% of addition of fiber, respectively. Microscopy showed a good distribution of fibers in the matrix, the absence of internal porosities, and a good interaction between matrix and reinforcement.

Advances in two-dimensional engineered nanomaterials applications for the agro- and food-industries.

Two-dimensional nanomaterials, such as graphene, transition metal dichalcogenides, MXenes, and other layered compounds, are the subject of intense theoretical and experimental research for applications in a wide range of advanced technological solutions, given their outstanding physical, chemical, and mechanical properties. In the context of food science and technology, their contributions are starting to appear, based on the advantages that two-dimensional nanostructures offer to agricultural- and food-related key topics, such as sustainable water use, nano-agrochemicals, novel nanosensing devices, and smart packaging technologies. These application categories facilitate the grasping of the current and potential uses of such advanced nanomaterials in the field, backed by their advantageous physical, chemical, and structural properties. Developments for water cleaning and reuse, efficient nanofertilizers and pesticides, ultrasensitive sensors for food contamination, and intelligent nanoelectronic disposable food packages are among the most promising application examples reviewed here and demonstrate the tremendous impact that further developments would have in the area as the fundamental and applied research of two-dimensional nanostructures continues. We expect this work will contribute to a better understanding of the promising characteristics of two-dimensional nanomaterials that could be used for the design of novel and feasible solutions in the agriculture and food areas. © 2023 Society of Chemical Industry.

Acute toxicity of two insecticides on two species of Chagas disease vectors.

The control of triatomine vectors of Chagas disease is mainly based on the use of pyrethroid insecticides. Because chemical control is the primary method for managing these insects, it is crucial to diversify the range of products utilized to mitigate the risk of resistance development. This study evaluated the toxicity of two insecticides with different modes of action on Triatoma dimidiata Latreille and T. pallidipennis Stal first and third instar nymphs. Our study focused on the effects of two insecticides, buprofezin (a growth regulator) and flunocamid (an anti-feeder), on the mortality rate of triatomine bugs in a laboratory setting. Moreover, we investigated how direct and indirect (film method) exposure to these insecticides impacted the survival of the insects. Flonicamid emerged as a promising insecticide for triatomine control since it caused 100% mortality in first-instar nymphs 48 h after direct exposure. While, in third instar nymphs, the maximum mortality was 88% at 72 h after exposure. Our result can be used as a basis for future triatomine control plans.

Quality of life and mental health in multiple sclerosis patients during the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic had a profound impact on mental health symptoms and quality of life (QoL) in the general population due to necessary public health restrictions such as social distancing. The psychosocial effect of the pandemic on vulnerable groups such as people living with Multiple Sclerosis (PwMS) has been scarcely explored in countries with additional socioeconomical burdens such as access to healthcare disparities METHODS: A questionnaire exploring sociodemographic variables, quality of life, mental health determinants and sleep quality was applied to 92 PwMS to explore changes prior and during the pandemic regarding these domains RESULTS: 58.8% of the subjects were female, median age was 37.1 (± 8.5) years and relapsing-remitting MS was the predominant clinical subtype (83.5%). Unemployment rate significantly increased during the pandemic (12.3% vs 27.8%; p= 0.001). Only 46.4% received medical follow-up care during the pandemic. QoL was affected predominantly due to limitations in instrumented activities of daily life (IADL). Neuropsychiatric symptoms, requiring healthcare during the pandemic, anxiety prior to the pandemic and restricted IADL were predictors of MS-related physical impact worsening, while decreased physical/emotional wellbeing selfcare, neuropsychiatric symptoms, bad sleep quality, anxiety prior to the pandemic and restricted non-instrumental ADL predicted aggravation of MS-related psychological impact measured by the MSIS-29. Curiously, specific items regarding anxiety were more prevalent prior to the pandemic (anxious mood; p=0.02, helplessness; p=0.01), sleep problems; p=0.001 and cardiovascular symptoms; p=0.001, nevertheless, stability was observed for most items. Importantly, 77.3% of PwMS reported at least one neuropsychiatric symptom CONCLUSION: The deleterious effects of the COVID-19 pandemic on psychosocial wellbeing in PwMS, QoL and mental health outcomes are frequently overseen in vulnerable populations such as PwMS. Albeit the limitations of this study, our results may help implement policies that prevent negative outcomes on psychosocial wellbeing due to public health measures (e.g., social distancing) in MS and other neurological diseases that inexorably need constant follow-up.

Metabolizable energy equivalence of guanidinoacetic acid in corn soybean meal-based broiler diets

In this study, we evaluated how guanidinoacetic acid (GAA) addition in diets with various metabolizable energy (ME) contents affects the performance of broiler chickens. We also estimated the equivalence of GAA in ME. We distributed 1,280 one-day-old broilers in a completely randomized design with eight treatments, eight replicates, and twenty birds per experimental unit. Treatments were based on ME levels (2,775-2,875-2,975 kcal/kg; 2,850-2,950-3,050 kcal/kg; 2,925-3,025-3,125 kcal/kg; or 3,000-3,100-3,200 kcal/kg, from 1 to 7, 8 to 21, and 22 to 42 days of age) and the inclusion of GAA (0 or 600 mg/kg). Supplementation of GAA increased weight gain in broilers at an energy level of 2,908 kcal/kg and improved feed conversion ratio (FCR) at energy levels of 2,908 and 2,983 kcal/kg. There was a linear reduction in feed intake and an improvement in FCR of broilers with increasing levels of energy in diets, with and without GAA addition. Solving the equivalence equation, by applying each of the weighted average energy levels studied. indicates the GAA equivalence of 133, 103, 74, and 44 kcal/kg of diet. In conclusion, GAA supplementation improves broilers' efficiency of energy use; the average ME equivalence of 600 mg/kg of GAA is 88.5 kcal/kg.

Eficacia de la terapia de reentrenamiento en pacientes adultos con tinnitus: revisión sistemática de la literatura / Efficacy of retraining therapy in management of tinnitus in adults: Systematic review

Introducción: el tinnitus es una patología prevalente que se presenta en el 10 %-15 % de la población, su diagnóstico es clínico y tiene un impacto negativo en la calidad de vida. La terapia de reentrenamiento del tinnitus (TRT) busca categorizar y ofrecer un manejo adecuado integral a los pacientes para hacer una rehabilitación individualizada con una mejoría en el 80 % de los pacientes. En los últimos años, se ha supuesto que los cambios en la implementación de la TRT mejoran su efectividad global. A la fecha, no se tiene evidencia científica que resuma los hallazgos concluyentes de estos estudios, por lo cual se plantea una revisión sistemática de la literatura que reúna y sintetice de forma exhaustiva y sistemática toda la literatura con adecuada rigurosidad metodológica sobre la eficacia del manejo con TRT en pacientes adultos con diagnóstico de tinnitus, para estimar una medida combinada del tamaño del efecto de la intervención. Materiales y métodos: se plantea una revisión sistemática de la literatura en cuatro bases de datos diferentes, sin límite de idioma o tiempo; acorde con la metodología de las guías PRISMA. Resultados: se encontró un total de 24 264 artículos, de los cuales 15 fueron elegidos para la extracción de datos. De estos, 7 eran ensayos clínicos y 8 estudios de cohorte, con una media de Jadad de 1,55. Todos usaron el protocolo de Jastreboff y Hazell con una media de seguimiento de 16,15 ± 7,8 meses. Discusión: la totalidad de los artículos incluidos reportó una mejoría en los valores del Tinnitus Handicap Inventory (THI) (eficacia) que persistió durante la media de seguimiento. Adicionalmente, asociado a su uso se reportó una mejoría en la calidad de vida, sueño, desempeño laboral y socialización con el uso de TRT en dispositivos convencionales o dispositivos móviles. Conclusión: los reportes de los estudios incluidos son congruentes en determinar una reducción de la THI en pacientes con tinnitus de diferentes causas y estadios cuando son tratados con TRT bajo el protocolo Jastreboff y colaboradores, en el seguimiento a largo y corto plazo.

Introduction: Tinnitus is a prevalent pathology that occurs in 10-15% of the population, its diagnosis is clinical and has a negative impact on quality of life. Tinnitus retraining therapy seeks to categorize and offer individualized comprehensive management and rehabilitation with improvement in 80% of patients. In recent years, changes in the implementation of tinnitus retraining therapy are expected to improve its overall effectiveness. To date, there is no scientific evidence that summarizes the findings of these studies. Therefore, we performed a systematic review of the literature that gathers and synthesizes all the literature on the effectiveness of management with TRT in adult patients diagnosed with tinnitus, estimating a combined measure of the effect size of the intervention. Materials and Methods: A systematic review in 4 different databases, with no language or time limits; in accordance with the methodology of the PRISMA guidelines was undertaken. Results: A total of 24,264 articles were found, of which 15 were chosen for data extraction. Of these, seven were clinical trials and eight cohort studies: with a mean Jadad of 1.55. All used the Jastreboff and Hazell protocol with a mean follow-up of 16.15±7.8. Discussion: All the articles included report an improvement in Tinnitus Handicap Inventory values (efficacy) that persists during the mean follow-up. Additionally, associated with its use, improvements in quality of life, sleep, work performance and socialization are reported with the use of TRT in conventional devices or mobile devices. In addition, the present review sheds light on different subpopulations of tinnitus patients who could benefit from the use of TRT. Conclusion: The reports of the included studies are congruent in determining a reduction of Tinnitus Handicap Inventory in patients with tinnitus of different causes and stages when treated with TRT under the Jastreboff et al. protocol at long and short term follow- up.

Activación de Recursos durante la primera sesión de psicoterapia y su relación con el cambio terapéutico temprano / Resource Activation during the first psychotherapy session and its relation with early therapeutic change

Resumen Objetivo: determinar diferencias en el grado en que los terapeutas enfocan sus intervenciones en activar recursos de los consultantes durante la primera sesión en procesos de psicoterapia con y sin resultados terapéuticos tempranos (RT), y caracterizar dichas intervenciones. Método: se utilizó una muestra de 32 procesos de psicoterapia con pacientes ambulatorios, realizados en contextos de prestación rutinaria de servicios y conducidos por terapeutas de distintas orientaciones teóricas. Estos procesos se agruparon según la presencia o ausencia de RT, evaluada a partir de la diferencia de puntajes en el reporte de bienestar de los consultantes entre la primera y la cuarta sesión, a través del Cuestionario de Autoreporte de Resultados (Outcome Questionnaire -OQ-45.2.-). Y el grado en que la actividad de los terapeutas se enfocó en la Activación de Recursos (AR) se evaluó mediante el Wirkfaktoren-K (WIFA-K. Factores de Efectividad de Klaus Grawe) para jueces independientes. Posteriormente, se realizó una prueba t de varianzas desiguales de Welch, a partir de los promedios de puntajes de la AR en ambos grupos. Resultados: se encontraron diferencias significativas entre ambos grupos; específicamente, los terapeutas del grupo Con RT dedicaron tres veces más tiempo de la sesión a trabajar en la AR que los del grupo Sin RT. Adicionalmente, se ofrece evidencia detallada respecto de la variación del foco en la AR a lo largo de la sesión y la proporción en que distintos contenidos relacionados con la AR son abordados en ambos grupos.

Abstract Objective: the objective of this paper is to determine the differences in the degree to which therapists focus their interventions on activating clients' resources during the first session of psychotherapy processes with and without Early Therapeutic Outcomes (ETO), and to characterize these interventions. Method: a sample of 32 outpatient psychotherapy processes was collected, carried out in routine service delivery contexts and conducted by therapists with different theoretical orientations. The therapies were grouped according to the presence or absence of ETO, evaluated from the difference in well-being reported by clients between the first and fourth session, through the Outcome Questionnaire (OQ-45.2; Lambert et al.,1996). To assess the extent to which the therapists' activity focused on RA in both groups, the Wirkfaktoren-K (Klaus Grawe Effectiveness Factors; von Consbruch et al., 2013) instrument was used by independent judges. Subsequently, a Welch's t-test of unequal variances was performed, based on the averages of AR scores, between both groups. Results: significant differences were found between both groups. Specifically, therapists in the "With ETO" group spent 3 times more minutes working on RA than those in the "Without ETO" group. In addition, detailed evidence is provided on the variation of the focus on RA throughout the session and the proportion in which different RA-related content is addressed in both groups.