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Introducción: Aproximadamente el 60% de las personas con síndrome de X frágil también reciben un diagnóstico de trastorno del espectro autista. Entre estos trastornos existen tantas semejanzas como diferencias, que provocan cuadros clínicos distintos, por lo que es importante el diagnóstico diferencial temprano, de cara a conocer los déficits y fortalezas de cada niño y ajustar el tipo de intervención lo mejor posible. El presente estudio tiene como objetivo realizar una aproximación al conocimiento de la relación y las diferencias de ambas condiciones, y contribuir al diagnóstico diferencial y la posterior intervención.Materiales y métodos: Siguiendo el protocolo PRISMA-ScR, se realizaron búsquedas en las bases de datos de PsycInfo, Medline, SCOPUS y Web of Science, incluyendo los artículos científicos empíricos centrados en la etapa de los 0 a los 6 años desde 2010 a 2020.Resultados: Se seleccionaron 22 estudios en los que se trata el desarrollo inicial de estos dos trastornos y su confluencia. Los resultados se reagruparon en función de cambios morfológico-estructurales, y de las áreas cognitivas, comunicativas, socioemocionales y sensoriomotoras.Conclusiones: A nivel morfológico-estructural, parecen existir ciertos patrones de crecimiento cerebral diferenciadores entre estos trastornos. Asimismo, existen ciertas señales de alarma en las distintas áreas del desarrollo que son indicativas de comorbilidad o permiten la discriminación entre patologías, y existe cierto debate en torno a algunas de ellas, como el nivel atencional o los manierismos repetitivos.(AU)

Introduction: Nearly 60% of those diagnosed with fragile X syndrome show comorbidity with autism. Thus, there are similarities and differences between both conditions that lead to very different clinical manifestations. However, an early differential diagnosis may help professionals to detect deficits and enhance strengths to apply the best suitable intervention. The purpose of this scoping review was to provide a comprehensive overview of the relation and the differences between autism and fragile X syndrome to orientate diagnosis and intervention. Materials and methods: The research for articles was carried out in PsycInfo, Medline, SCOPUS and Web of Science, including scientific articles published from 2010 to 2020 and children aged 0-6 years. The scoping review followed the PRISMA-ScR criteria. Results: 22 studies were selected. Results were reviewed in terms of structural and morphological changes and cognitive, communicative, social-emotional and sensory-motor skills. Conclusions: Different growing cerebral patterns are observed in both conditions. Besides, there are early signs from the different developmental areas studied that show comorbidity or allow early differentiation. However, attentional function or repetitive mannerisms, among others, need further research.(AU)

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INTRODUCTION: Nearly 60% of those diagnosed with fragile X syndrome show comorbidity with autism. Thus, there are similarities and differences between both conditions that lead to very different clinical manifestations. However, an early differential diagnosis may help professionals to detect deficits and enhance strengths to apply the best suitable intervention. The purpose of this scoping review was to provide a comprehensive overview of the relation and the differences between autism and fragile X syndrome to orientate diagnosis and intervention. MATERIALS AND METHODS: The research for articles was carried out in PsycInfo, Medline, SCOPUS and Web of Science, including scientific articles published from 2010 to 2020 and children aged 0-6 years. The scoping review followed the PRISMA-ScR criteria. RESULTS: 22 studies were selected. Results were reviewed in terms of structural and morphological changes and cognitive, communicative, social-emotional and sensory-motor skills. CONCLUSIONS: Different growing cerebral patterns are observed in both conditions. Besides, there are early signs from the different developmental areas studied that show comorbidity or allow early differentiation. However, attentional function or repetitive mannerisms, among others, need further research.

TITLE: Hacia un diagnóstico diferencial temprano en el trastorno del espectro autista y el síndrome de X frágil. Una revisión sistemática.Introducción. Aproximadamente el 60% de las personas con síndrome de X frágil también reciben un diagnóstico de trastorno del espectro autista. Entre estos trastornos existen tantas semejanzas como diferencias, que provocan cuadros clínicos distintos, por lo que es importante el diagnóstico diferencial temprano, de cara a conocer los déficits y fortalezas de cada niño y ajustar el tipo de intervención lo mejor posible. El presente estudio tiene como objetivo realizar una aproximación al conocimiento de la relación y las diferencias de ambas condiciones, y contribuir al diagnóstico diferencial y la posterior intervención. Materiales y métodos. Siguiendo el protocolo PRISMA-ScR, se realizaron búsquedas en las bases de datos de PsycInfo, Medline, SCOPUS y Web of Science, incluyendo los artículos científicos empíricos centrados en la etapa de los 0 a los 6 años desde 2010 a 2020. Resultados. Se seleccionaron 22 estudios en los que se trata el desarrollo inicial de estos dos trastornos y su confluencia. Los resultados se reagruparon en función de cambios morfológico-estructurales, y de las áreas cognitivas, comunicativas, socioemocionales y sensoriomotoras. Conclusiones. A nivel morfológico-estructural, parecen existir ciertos patrones de crecimiento cerebral diferenciadores entre estos trastornos. Asimismo, existen ciertas señales de alarma en las distintas áreas del desarrollo que son indicativas de comorbilidad o permiten la discriminación entre patologías, y existe cierto debate en torno a algunas de ellas, como el nivel atencional o los manierismos repetitivos.

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Introducción: El método de referencia para diagnosticar el síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) es la polisomnografía, esta no es diagnóstica en otros trastornos respiratorios del sueño, por lo que es necesario la implementación de puntajes predictivos para diferenciar aquellos pacientes que tienen más riesgos de padecer SAHOS y necesiten de una polisomnografía. El objetivo de este estudio fue validar el puntaje NoSAS y la escala de Berlín frente a la polisomnografía tipo 1 en pacientes con sospecha de SAHOS. Materiales y métodos: Estudio de pruebas diagnósticas. A 264 pacientes se les realizó una polisomnografía basal, la aplicación del puntaje NoSAS y la escala de Berlín; luego, se hizo el análisis de las pruebas diagnósticas y se calculó el rendimiento de cada una en relación con el índice de apnea hipopnea (IAH). Resultados: La sensibilidad del puntaje NoSAS para un IAH ≥ 20 fue 88,57% con intervalo de confianza (IC) 95% 80,4-96,74; especificidad 56,70 %; IC 95% 49,47-63,93 y valor predictivo negativo (VPN) de 93,22, IC 95% 91,70- 99,82. Para la escala de Berlín, la sensibilidad fue de 81,43%, IC 95% 71,60-91,25; especificidad de 58,76%, IC 95% 51,58-65,95 y VPN 89,76%, IC 95% 89,08-98,32. Conclusión: Se demostró que el puntaje NoSAS y la escala de Berlín tienen una buena sensibilidad para descartar a las personas con un menor riesgo de SAHOS. Un paciente clasificado de bajo riesgo probablemente está sano o tiene bajo riesgo para SAHOS moderado a severo y no requeriría de una polisomnografía inicial.

Introduction: The gold standard for diagnosing obstructive sleep apnea-hypopnea syndrome (OSAHS) is the polysomnography, and it is not a diagnostic tool for another sleep breathing disorders, so that it is necessary to implement predictive scores to differentiate those patients who have more risk of suffering OSAHS, therefore they need a polysomnography. The aim to this study was to validate the NoSAS score and Berlin scale in relation to the polysomnography type 1, in patients who have the clinical suspicion of OSAHS. Material and methods: Diagnostic tests study. 264 patients underwent polysomnography, and the NoSAS score and Berlin scale were applied to them. After that, the diagnostic tests analysis was done and the performance of each one of them was calculated in relation to the apnea- hypopnea index (AHI). Results: The sensitivity of the NoSAS score for an AHI ≥ 20 was 88.57%, confidence interval (CI) 95% (80.4-96.74), specificity 56.70 %, CI 95% (49.47-63.93), and the negative predictive value (NPV) was 93.22, CI 95% (91.70-99.82). For Berlin scale the sensitivity was 81.43%, CI 95% (71.60-91.25), specificity 58.76%, CI 95% (51.58-65.95) and NPV 89.76%, CI 95% (89.08-98.32). Conclusions: It was shown that NoSAS score and Berlin scale have a good sensitivity to rule out people who have less OSAHS risk. A patient classified as low risk, probably is healthy or at low risk for moderate to severe OSAHS and would not require an initial polysomnography.

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AIM: To evaluate the utility of brain 18F-DOPA PET/CT in the differential diagnosis of brain lesions with inconclusive MRI. MATERIAL AND METHODS: Twelve patients were studied, with a total of 16 lesions, without definitive diagnosis after brain MRI. A double acquisition PET/CT brain scan was acquired at 20 and 90min. Visual and semiquantitative assessment was performed with SUVmax calculation of the lesions and calculation of the T/S Ratio (tumor/contralateral striatum) and T/N Ratio (contralateral healthy tumor/parenchyma) for each time. RESULTS: Based on the visual assessment scale and using T/S ratio ≥1 and T/N ratio ≥1.3 to determine malignancy, the values of sensitivity (S), specificity (E) and positive predictive value (PPV) were: visual assessment (S 100%, E 33.3%, VPP 71.4%), T/S Ratio (S 90%, E 100%, VPP 100%) and T/N Ratio (S 100%, E 16.6%, VPP 66.6 %). No lesion showed an increase in SUVmax in late acquisition. 18F-DOPA PET/CT modified treatment in 75% of the patients. CONCLUSION: 18F-DOPA PET/CT is a useful tool in the study of brain lesions with inconclusive MRI. Late imaging (dual-point) has no added value in the final diagnosis. FDOPA has an impact on patient management modifying therapeutic behavior.

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Pancreatic ductal adenocarcinoma (PDAC) is one of the most intractable and devastating malignant tumors. Epigenetic modifications such as DNA methylation and histone modification regulate tumor initiation and progression. However, the contribution of histone variants in PDAC is unknown. Here, we demonstrated that the histone variant H2A.Z is highly expressed in PDAC cell lines and PDAC patients and that its overexpression correlates with poor prognosis. Moreover, all three H2A.Z isoforms (H2A.Z.1, H2A.Z.2.1, and H2A.Z.2.2) are highly expressed in PDAC cell lines and PDAC patients. Knockdown of these H2A.Z isoforms in PDAC cell lines induces a senescent phenotype, cell cycle arrest in phase G2/M, increased expression of cyclin-dependent kinase inhibitor CDKN2A/p16, SA-ß-galactosidase activity and interleukin 8 production. Transcriptome analysis of H2A.Z-depleted PDAC cells showed altered gene expression in fatty acid biosynthesis pathways and those that regulate cell cycle and DNA damage repair. Importantly, depletion of H2A.Z isoforms reduces the tumor size in a mouse xenograft model in vivo and sensitizes PDAC cells to gemcitabine. Overexpression of H2A.Z.1 and H2A.Z.2.1 more than H2A.Z.2.2 partially restores the oncogenic phenotype. Therefore, our data suggest that overexpression of H2A.Z isoforms enables cells to overcome the oncoprotective barrier associated with senescence, favoring PDAC tumor grow and chemoresistance. These results make H2A.Z a potential candidate as a diagnostic biomarker and therapeutic target for PDAC.

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AIM: To evaluate the utility of brain 18F-DOPA PET/CT in the differential diagnosis of brain lesions with inconclusive MRI. MATERIAL AND METHODS: Twelve patients were studied, with a total of 16 lesions, without definitive diagnosis after brain MRI. A double acquisition PET/CT brain scan was acquired at 20 and 90 minutes. Visual and semiquantitative assessment was performed with SUVmax calculation of the lesions and calculation of the T/S ratio (tumor/contralateral striatum) and T/N ratio (tumor/contralateral healthy parenchyma) for each time. RESULTS: Based on the visual assessment scale and using T/S ratio ≥ 1 and T/N ratio ≥ 1.3 to determine malignancy, the values of sensitivity (S), specificity (E) and positive predictive value (PPV) were: visual assessment (S 100%, E 33.3%, VPP 71.4%), T/S ratio (S 90%, E 100%, VPP 100%) and T/N ratio (S 100%, E 16.6%, VPP 66.6%). No lesion showed an increase in SUVmax in late acquisition. 18F-DOPA PET/CT modified treatment in 75% of the patients. CONCLUSION: 18F-DOPA PET/CT is a useful tool in the study of brain lesions with inconclusive MRI. Late imaging (dual-point) has no added value in the final diagnosis. F-DOPA has an impact on patient management modifying therapeutic behavior.

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OBJECTIVE: To determine whether there are differences between subglottic pressure during swallowing with and without air insufflation via a subglottic catheter in tracheostomized patients. DESIGN: A prospective, randomized cross-over study was made. SETTING: Adult Intensive Care Units. PARTICIPANTS: Patients requiring mechanical ventilation and tracheostomy with a subglottic catheter, and with tolerance to deflation of the balloon and a speaking valve placed over the opening of the tracheostomy tube. INTERVENTIONS: Subglottic pressure was measured during swallowing of a thickened solution with and without the delivery of airflow through the subglottic catheter. MAIN VARIABLE: Subglottic pressure during swallowing. RESULTS: Twelve out of 14 patients showed higher subglottic pressure values during swallowing with air insufflation. Two patients showed no differences between both conditions. Median (Med) values of subglottic pressure for the first, second and third swallow were 5, 4 and 4.5 cmH2O (Med 4.5 cmH2O) without air insufflation, and 8, 5.5 and 7.5 cmH2O (Med 5.5 cmH2O) with air insufflation, respectively (Wilcoxon, Z=-3.078; p=.002). CONCLUSION: In a group of tracheostomized patients, air insufflation via a subglottic catheter increased subglottic pressure levels measured during swallowing.

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ObjetivoAnalizar los indicadores de actividad asistencial de una unidad de corta estancia (UCE) y comparar estos indicadores con los de otros servicios de hospitalización convencional.Material y métodosEstudio descriptivo retrospectivo de los pacientes ingresados en la UCE durante el período 2003–2007. Se analizó el número de ingresos, la estancia media, la mortalidad y el destino. Se comparó la estancia media y el número de ingresos de los principales grupos relacionados con el diagnóstico (GRD) de la UCE en relación con otros servicios de hospitalización convencional.ResultadosUn 15,3% de los enfermos que acudieron a la urgencia fue ingresado en la UCE. La estancia media fue significativamente menor en la UCE que en el resto del hospital (año 2003: UCE 3,2 días, resto del hospital 10,2 días; año 2007: UCE 3,3 días, resto del hospital 8,6 días). Los cuatro GRD más comunes (el 71,3% de todos los ingresos en la UCE) fueron enfermedad pulmonar obstructiva crónica, infección respiratoria/bronquitis/asma, neumonía simple y pleuritis en mayores de 18 años sin comorbilidad y fallo cardíaco y shock. Para los cuatro GRD, la estancia media en la UCE fue significativamente menor (p<0,01) que en Medicina Interna, Neumología y Cardiología («fallo cardíaco y shock»).ConclusionesLa UCE maneja con mayor agilidad sus patologías más prevalentes en relación con otros servicios de hospitalización convencionales(AU)

ObjectiveTo analyze the health care activity indicators of a short-stay unit (SSU) and compare them with those of other services in a Conventional Hospital.Material and methodsA descriptive, retrospective study was conducted of the patients admitted to SSU during 2003–2007. Number of admissions, mean stay (MS), mortality and destination were analyzed. Mean stay and number of admissions of the main diagnosis-related groups (DRGs) in the SSU were compared with other services of conventional hospitalization.ResultsA total of 15.3% of the patients who came to the Emergency Service were admitted to the SSU. Mean stay was significantly lower in the SSU than in the rest of the hospital (year 2003, SSU 3.2 days, rest of the hospital 10.2 days; year 2007, SSU 3.3 days, rest of the hospital 8.6 days). The 4 most common DRGs (71.3% of all those admitted to the SSU) were COPD, respiratory infection/bronchitis, simple pneumonia/pleuritis and heart failure/shock. Mean stay for the 4 DRGs in the SSU was significantly lower (p<0.01) than in Internal Medicine, Pneumology and Cardiology (heart failure/shock).ConclusionsThe SSU handles its most prevalent diseases with greater agility compared to other conventional hospitalization services(AU)

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OBJECTIVE: To analyze the health care activity indicators of a short-stay unit (SSU) and compare them with those of other services in a Conventional Hospital. MATERIAL AND METHODS: A descriptive, retrospective study was conducted of the patients admitted to SSU during 2003-2007. Number of admissions, mean stay (MS), mortality and destination were analyzed. Mean stay and number of admissions of the main diagnosis-related groups (DRGs) in the SSU were compared with other services of conventional hospitalization. RESULTS: A total of 15.3% of the patients who came to the Emergency Service were admitted to the SSU. Mean stay was significantly lower in the SSU than in the rest of the hospital (year 2003, SSU 3.2 days, rest of the hospital 10.2 days; year 2007, SSU 3.3 days, rest of the hospital 8.6 days). The 4 most common DRGs (71.3% of all those admitted to the SSU) were COPD, respiratory infection/bronchitis, simple pneumonia/pleuritis and heart failure/shock. Mean stay for the 4 DRGs in the SSU was significantly lower (p<0.01) than in Internal Medicine, Pneumology and Cardiology (heart failure/shock). CONCLUSIONS: The SSU handles its most prevalent diseases with greater agility compared to other conventional hospitalization services.

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INTRODUCTION: There are few studies on congenital duodenal obstruction. The poor peristalsis of the proximal duodenum that causes functional obstruction is a well known problem that occurs in the immediate postoperative period. The optimum technique to address the problem is still controversial. OBJECTIVE: To compare the results obtained using two different surgical techniques to resolve congenital duodenal obstruction. PATIENTS AND METHODS: A five-year retrospective review of the neonates who underwent surgery for duodenal obstruction was undertaken. Two different surgical techniques were used: the Kimura operation and Heinecke-Mikulicz enteroplasty. The clinical characteristics, operative time, onset of oral feeding, hospital stay, complications and mortality were analyzed. The results of both groups were compared. RESULTS: Forty-one patients were included; 27 were operated on with the Kimura technique and 14 underwent Heinecke-Mikulicz duodenoplasty.Thirty-five patients had duodenal atresia (86%) and 6 (14%) an annular pancreas. All of them had post-Vater's papilla obstruction and 8 (20%) had trisomy 21. The clinical characteristics of both groups were similar. No significant difference was found in the operative time, onset of oral feeding and hospital stay. Eight patients in each group developed septicemia (30% in the Kimura group vs. 57% in the Heinecke-Mikulicz group, p = 0.16) and one patient in each group died (4% in the Kimura group vs.7% in the Heinecke-Mikulicz group, p = 0.78). CONCLUSION: The Kimura duodenal-duodenal anastomosis and Heinecke-Mikulicz duodenoplasty seem to be useful procedures to resolve congenital duodenal obstruction.

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A double-blind, placebo-controlled randomized trial of a homeopathic combination medication for dengue fever was carried out in municipal health clinics in Honduras. Sixty patients who met the case definition of dengue (fever plus two ancillary symptoms) were randomized to receive the homeopathic medication or placebo for 1 week, along with standard conventional analgesic treatment for dengue. The results showed no difference in outcomes between the two groups, including the number of days of fever and pain as well as analgesic use and complication rates. Only three subjects had laboratory confirmed dengue. An interesting sinusoidal curve in reported pain scores was seen in the verum group that might suggest a homeopathic aggravation or a proving. The small sample size makes conclusions difficult, but the results of this study do not suggest that this combination homeopathic remedy is effective for the symptoms that are characteristic of dengue fever.

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The aim of this study is to evaluate the efficacy of the eprinomectin pour-on in naturally Oestrus ovis-infested sheep. To carry out this trial, 14 naturally infected sheep from the same flock were used. The animals were randomly distributed in three groups: group 1 (non-treated sheep), group 2 treated with 0.5 mg/kg bodyweight and group 3 treated with 1 mg/kg bodyweight of eprinomectin. The sheep were slaughtered 15 days after treatment and their heads were sectioned to count and identify larvae instar. The following results were obtained: Group 1: the average was 34 live and 0.75 dead larvae per sheep. Group 2: the efficacy of the eprinomectin was 83.5% against O. ovis group 3: the efficacy of the eprinomectin pour-on was 100%. Drug analysis was made to determine plasma eprinomectin concentration 9 days after treatment and the average concentrations in groups 2 and 3 were 1.23 and 3.04 ng/ml, respectively. The statistical study showed a significant difference between the efficacy and the dose used, and there was correlation between the plasma concentration of eprinomectin and the dose. The efficacy and easy application allow us to take into account this endectocide as an alternative method in the integral control of parasites in sheep.

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As the uterus enlarges to accommodate the growing fetus during pregnancy, the cervix behaves essentially as a barrier. During ripening and delivery, it needs to become soft and distensible to allow dilation and the passage of the conceptus. As the transformations of the collagen-containing fibres are known to be essential for ripening and delivery, it has been hypothesized that the elastic system fibres, owing to their intrinsic mechanical properties (reversible extensibility), could be involved in the shape-recovering process immediately after delivery. In sections stained by Weigert's resorcin-fuchsin (with previous oxidation), we describe the elastic system fibres in the lamina propria of the rat uterine cervix. They are distributed following different patterns when in the endocervix or in the ectocervical-vaginal region. A third distinctive pattern (named the 'elastic tendon') is described here for the first time in the uterine-cervical transition. A special morphometrical protocol has been designed in order to overcome problems during the quantification process. Using the so-called intercept counting method, it was possible to demonstrate that the elastic system fibres are increased in the cervix at the end of pregnancy. They may be involved in the immediate shape-recovering of the cervix after delivery as well as in helping to strengthen the anchoring of the epithelium to the lamina propria, thus minimizing birth trauma.

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BACKGROUND: To optimise appropriate planning of services, the care needs in patients with chronic mental illness, the organisms or individuals that cover these needs, and the relationships between specific needs and sociodemographic variables should be identified. This study was designed to assess needs in a population of persons with mental illness. METHODS: The Camberwell Assessment of Need (CAN) questionnaire was used to obtain and report quantitative information on needs. A total of 246 patients diagnosed as having schizophrenic disorder and 246 staff members of public mental health services, all living and working in the province of Granada (southern Spain, n = 187) or the city of Madrid (central Spain, n = 56), completed the questionnaire. Regression analysis was used to identify correlations between needs and sociodemographic variables. RESULTS: Mean needs score was 6.5; the most frequent needs were those related with daytime activities, company, psychotic symptoms, psychological distress, basic education and money management. The sociodemographic variables most closely associated with these needs were: not living with a life partner, low educational level, and receiving state benefits. The type of help these patients received was mainly from the family (informal help); public services (formal help) covered mainly clinical needs. CONCLUSIONS: The needs of persons with schizophrenic disorder do not differ from those of members of the more marginalised groups in Spanish society. Care provided by family members often represents a considerable burden on relatives.

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UNLABELLED: The Camberwell Assessment of Needs questionnaire (CAN) was developed in the Institute of Psychiatry (London) in the 1990's and constitutes one of the most widely accepted instruments to assess needs of people suffering from long term psychotic disorders. This assessment instrument was translated into Spanish by the Andalusian Group of Research in Mental Health. This paper describes both the methods and most significant results on the reliability of the Spanish version of the CAN. METHODS: 246 patients with a diagnosis of schizophrenia were interviewed as well as staff involved in their care. Kappa index was used to study concordance among the results obtained from interviews to the patients and those obtained from the staff. We calculated both inter-rater reliability and test-retest reliability. RESULTS: the mean score of needs was 6.47 in the patients sample and 6.49 in the staff sample. The level of agreement amongst patients and staff interviewed was moderate/strong. Inter-rater agreement was high (r=0.986 (patients) / 0.976 (staff), p<0.01). Similarly, test-retest agreement was r=0.791 in the patients group and r=0.766 in the staff sample (p<0.01). CONCLUSIONS: this study suggests that the Spanish version of the CAN is a highly reliable instrument to evaluate needs of people suffering from long-term psychotic disorders. It also is easy and fast to administer. However, we believe it may have some transcultural difficulties in certain areas as responses might be dependent on socio-cultural context.

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Objetivo. Conocer las necesidades de los enfermos mentales crónicos y quién cubre estas necesidades, así como su relación con variables sociodemográficas, hechos fundamentales para la planificación de servicios. Método. Se utilizó como herramienta el Cuestionario de Evaluación de Necesidades de Camberwell (CAN) que permite objetivar y expresar de forma cuantitativa dichas necesidades. Se entrevistaron 246 pacientes diagnosticados de esquizofrenia y a los profesionales que les atienden. Estas necesidades fueron relacionadas con variables sociodemográficas. Resultados. La media de necesidades obtenidas fue de 6,5 siendo las más frecuentes las relacionadas con actividades de la vida diaria, compañía, síntomas psicóticos, angustia, educación básica y administración de su dinero. Las variables sociodemográficas más asociadas a estas necesidades fueron: no tener pareja, nivel educacional bajo, y ser pensionista. El tipo de ayuda que reciben estos pacientes viene fundamentalmente de la familia, mientras que los servicios públicos ayudan a solventar necesidades preferentemente de tipo clínico. Conclusiones. Las necesidades que presentan las personas con enfermedad esquizofrénica no difieren de las necesidades que tienen los grupos más desfavorecidos y marginales de nuestra sociedad. Por otro lado habría que destacar la excesiva carga familiar que supone este tipo de enfermos (AU)

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El cuestionario de evaluación de necesidades de Camberwell (Camberwell Assessment of Needs [CAN]), desarrollado por el Instituto de Psiquiatría de Londres en la década de los noventa, constituye uno de los instrumentos más generalizado para evaluar las necesidades de las personas con trastornos psicóticos de larga evolución. Este instrumento ha sido traducido al español por el Grupo Andaluz de Investigación en Salud Mental. Se analiza en este trabajo la metodología y resultados más significativos sobre la fiabilidad de este cuestionario en nuestro país. Metodología: se entrevistaron 246 pacientes (diagnosticados de esquizofrenia) y al personal que les atiende, utilizando el índice de kappa para estudiar la concordancia entre los resultados de las entrevistas a los pacientes y a los profesionales. Para la fiabilidad del instrumento, (n=56) se realizó un análisis de concordancia entre-jueces y un test-retest. Resultados: la media de necesidades identificadas por el paciente fue de 6,47 y por el profesional 6,49. El nivel de acuerdo entre paciente y profesional entrevistado resultó entre moderado y fuerte. El nivel de acuerdo entre entrevistadores resultó alto (r= 0,986 y 0,976 para el paciente y el profesional respectivamente, p<0,01) y el test- retest fue de r= 0,791 y 0,766 para el paciente y el profesional, p< 0,01). Conclusiones: el estudio realizado nos sugiere que el CAN es un instrumento con una alta fiabilidad para evaluar las necesidades de las personas con trastornos psicóticos de larga evolución. Es un instrumento fácil y rápido de aplicar, pero creemos que tiene ciertos problemas transculturales en algunas áreas, ya que su respuesta dependerá del contexto sociocultural en el que estemos operando. (AU)

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The uterine cervix is a dynamic structure with a high capacity to adapt to different, even opposing, roles during the sequence of physiological events of gestation (for example, acting as a barrier to retain the fetus during pregnancy and dilating to allow delivery at term). Histoarchitectural changes of the uterine cervix allow its successful adaptation. The aim of this study was to investigate whether fibroblastic cell plasticity, described in the lamina propria of the rat uterine cervix at term, could be observed in women too. Biopsy specimens of non-pregnant and intrapartum human cervices were studied under the transmission electron microscope, and cytoskeletal differentiation markers were identified by immunohistochemistry under the light microscope. Desmin-positive cells were present in the mucous layer of the cervix during labour. These cells displayed cytoplasmic processes (typical of myofibroblasts) that also stained positively for vimentin. The main ultrastructural features for defining the myofibroblast under the electron microscope were also observed in these cells. However, cervices of non-pregnant women contained resident fibroblasts at the same location. Examination of the differentiation repertoire of fibroblastic cells in the mucous layer of the uterine cervix resulted in the characterization of myofibroblasts at term. The implications of the plasticity of fibroblastic-myofibroblastic cells in the physiological changes displayed in the uterine cervix during pregnancy, labour and postpartum involution require further investigation.

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Different organs contain fibroblasts with specific features and functions, indicating the complexity of fibroblast biology. In the rat cervical stroma, fibroblasts are preferentially located in the fibrous ring that surrounds the mucous layer. The purpose of this study was to investigate the morphological features and immunophenotype of fibroblastic cells of the uterine cervix in cycling, pregnant, and postpartum rats. Expression of the cytoskeletal proteins desmin, vimentin, and alpha-smooth muscle actin (alpha-SMA) were studied by immunohistochemistry. The optical density of immunohistochemical staining was quantified by image analysis. The ultrastructural features of fibroblastic cells were observed under transmission electron microscopy. Cervical fibroblastic cells always expressed vimentin and desmin but never alpha-SMA. During the first half of pregnancy (Day 5 [D5] to D14), desmin intensity values were similar to those of cycling and postpartum fibroblasts. In contrast, a strong expression of desmin was found from D15 to D22, with maximal expression at term (D23). Immunohistochemical expression for vimentin was constant throughout pregnancy and showed no differences with cycling and postpartum uterine cervices. Stromal cells from cycling and early pregnant rats displayed ultrastructural features characteristic of typical fibroblasts. In contrast, at the end of pregnancy, fibroblasts differentiated and showed increased secretory characteristics, reaching the ultrastructural features of a myofibroblast. Based on the differential expression of desmin and the electron microscopic observations, the foregoing results showed a modulation of the fibroblastic phenotype in the uterine cervix during pregnancy. To our knowledge, this is the first report that addresses the presence of myofibroblasts derived from resident fibroblasts in the fibrous ring of the rat uterine cervix. Fibroblastic-myofibroblastic cell plasticity may have implications in the physiological changes displayed in the uterine cervix during pregnancy, parturition, and postpartum involution.

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Growth and differentiation of mammary gland is associated with numerous hormones and a variety of cell-cell, cell-matrix interactions. This study addressed the role of relaxin (Rlx) on these processes. Morphologic and biochemical changes that occur throughout the second half of pregnancy are reported. Temporal patterns and spatial distributions of markers useful to evaluate proliferation, secretion, and collagen remodeling were established. To evaluate the role of Rlx, an ablation/replacement animal model was used. Considering Rlx secretion pattern, two periods were selected: d 11 through d 13, and d 20 through d 23. In the stroma, the extracellular compartment showed changes associated with the lack of Rlx. Collagen remodeling within the lobuloalveolar structure, measured by a significant increase in collagen birefringence, decreased at d 12, d 21, and d 22. Parenchymal structures were less sensitive to the absence of Rlx than stroma. Epithelial cell proliferation was lower in Rlx-deficient rats only at d 12, and alpha-lactalbumin expression decreased at d 21 and d 22. Both lobuloalveolar diameter and percentage of area occupied by these structures showed no changes. In the absence of Rlx, some of the studied markers showed statistically significant differences in scattered days; these do not make clear trends. No differences were found on d 23 on any of the studied parameters suggesting that compensatory mechanisms might be activated to overcome the effects of the absence of Rlx. Unlike the critical role of Rlx either in uterine cervix dilation or in nipple development during rat pregnancy, Rlx had a minor role in growth and differentiation of rat mammary gland.

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