Developmental landmarks during floral ontogeny of jalapeño chili pepper (Capsicum annuum L.) and the effect of gibberellin on ovary growth.

Pepper (Capsicum annuum L.) is an important horticultural crop in many regions of the world. The final shape and size of the fruit are known to be determined at a very early step of flower development. During flower development hormonal treatments using gibberellins seem to promote growth resulting in higher yield and fruit quality. However, the morphological changes that occur in the pepper flowers after these treatments are largely unknown. In the present study, we provide a description of floral development landmarks of jalapeño chili pepper (cultivar Huichol), divided in nine representative stages from its initiation until the opening of the bud. We established a correlation among external flower development and the time and pattern of reproductive organogenesis. Male and female gametogenesis progression was used to define specific landmarks during flower maturation. The pattern of expression of key genes involved in gibberellin metabolism and response was also evaluated in the nine flower stages. The proposed development framework was used to analyze the effect of gibberellin treatments in the development of the flower. We observed both an effect of the treatment in the histology of the ovary tissue and an increase in the level of expression of CaGA2ox1 and CaGID1b genes. The developmental stages we defined for this species are very useful to analyze the molecular and morphological changes after hormonal treatments.

Diagnóstico de la dinámica cardiaca durante 16 horas desde los sistemas dinámicos aplicable en UCI / Diagnosis of cardiac dynamics for 17 hours from dynamical systems applicable to ICU

RESUMEN Introducción: El comportamiento caótico de la dinámica cardiaca normal y aguda ha sido caracterizado en el contexto de la teoría de los sistemas dinámicos y la geometría fractal. Objetivo: Desarrollar una nueva metodología diagnóstica para la evaluación de la dinámica cardiaca en pacientes de UCI, durante 16 horas. Metodología: Este es un estudio en pacientes ingresados a Cuidados Intensivos posquirúrgicos (UCI) y sujetos sanos, tomando un total de 47 registros electrocardiográficos continuos y/o Holter, normales y con patología aguda, evaluados en 16 horas. Se desarrolló una inducción con dos dinámicas normales y tres de UCI; a partir de los valores máximos y mínimos de la frecuencia cardiaca/hora y total de latidos/hora, registrados durante 16 horas se construyeron atractores para evaluar sus espacios de ocupación y dimensión fractal, con el fin de establecer diferencias e igualdades respecto a estados normales y patológicos. Se realizaron medidas de sensibilidad y especificidad con las dinámicas restantes para comparar el diagnostico matemático con el diagnóstico clínico. Resultados: Los espacios de ocupación de los atractores cardiacos diferencian dinámicas cardiacas normales de dinámicas con enfermedad crónica y aguda, detectando además dinámicas patológicas con valores superiores a los límites de normalidad, logrando valores de sensibilidad de 0,937 y especificidad del 1. Conclusión: se estableció una nueva metodología de evaluación de la dinámica cardiaca de utilidad para el seguimiento clínico en pacientes de UCI.

ABSTRACT Introduction: The chaotic behavior of normal and acute cardiac dynamics has been characterized in the context of theory of dynamical systems and fractal geometry. Objective: to establish a new diagnostic method for assessing cardiac dynamics in ICU patients, for 16 hours. Methodology: This is a study in post-surgical patients admitted to intensive care (ICU) and in healthy subjects, taking a total of 47 continuous electrocardiographic recordings and/ or Holter, normal and acute pathology, evaluated in 16 hours. Induction with two normal and three UCI dynamics was developed; from the maximum and minimum values of the heart/time and total frequency of beats/minute for 16 hours recorded attractors they were constructed to assess their areas of occupation and fractal dimension, in order to establish differences and equalities regarding normal states and pathological. Sensitivity and specificity measurements were performed with the remaining dynamic to compare mathematical diagnosis with clinical diagnosis. Results: Space occupancy heart attractors differ dynamic normal cardiac dynamics with chronic and acute illness, in addition detecting dynamic pathological with above normal limits values, achieving sensitivity values of 0.937 and specificity of 1. Conclusion: a new methodology for evaluating cardiac dynamics useful for clinical monitoring in ICU patients was established.

Heuristic optimization for the design of plasmonic nanowires with specific resonant and scattering properties.

In this contribution, we propose a computational tool for the synthesis of metallic nanowires with optimized optical properties, e.g. maximal scattering cross-section at a given wavelength. For this, we employ a rigorous numerical method, based on the solution of surface integral equations, along with a heuristic optimization technique that belongs to the population-based set known as Evolutionary Algorithms. Also, we make use of a general representation scheme to model, in a more realistic manner, the arbitrary geometry of the nanowires. The performance of this approach is evaluated through some examples involving various wavelengths, materials, and optimization strategies. The results of our numerical experiments show that this hybrid technique is a suitable and versatile tool straightforwardly extensible for the design of different configurations of interest in Plasmonics.

Gold nanostars as thermoplasmonic nanoparticles for optical heating.

Gold nanostars are theoretically studied as efficient thermal heaters at their corresponding localized surface-plasmon resonances (LSPRs). Numerical calculations are performed through the 3D Green's Theorem method to obtain the absorption and scattering cross sections for Au nanoparticles with star-like shape of varying symmetry and tip number. Their unique thermoplasmonic properties, with regard to their (red-shifted) LSPR wavelentgh, (∼ 30-fold increase) steady-state temperature, and scattering/absorption cross section ratios, make them specially suitable for optical heating and in turn for cancer thermal therapy.

Estudio piloto sobre entrenamiento físico durante hemodiálisis / A pilot study on physical training of patients in hemodialysis

Background: Exercise training during the dialytical procedure may have positive cardiovascular effects and prevent or revert muscle wasting in patients undergoing chronic hemodialysis. Aim: To evaluate the effects of an exercise training program in patients undergoing chronic hemodialysis. Material and Methods: Fifteen patients on chronic hemodialysis aged 21 to 69 years (three females) were included in the study. Nine of these were included in an exercise training program. During 16 weeks, exercise sessions were carried out during each dialytical procedure that included a warm-up period, aerobic exercises done using standing cycles, and resistance exercises, performed using Thera-Band® elastic bands and loops. Borg scale was used to control the intensity of training. At baseline and at the end of the study, a blood sample prior and after the dialytical procedure was obtained to measure C reactive protein, tumor necrosis factor α and interleukin 6. Quadriceps muscle strength, six minutes´ walk and quality of life using the SF-36 questionnaire, were also measured. Results: Four experimental subjects did not complete the study period, two that withdrew before starting, one due to problems with the venous access and one that decided to withdraw after 1 month of training. Among the five patients that finished the training period, significant improvements in the six minutes´ walk and quadriceps strength were observed in the experimental group. No significant changes were observed among controls. No changes were observed in either group in C reactive protein, tumor necrosis factor and interleukin 6 levels or quality of life. Conclusions: Among patients undergoing chronic hemodialysis exercise training improves endurance and muscle strength.

[A pilot study on physical training of patients in hemodialysis]. / Estudio piloto sobre entrenamiento físico durante hemodiálisis.

BACKGROUND: Exercise training during the dialytical procedure may have positive cardiovascular effects and prevent or revert muscle wasting in patients undergoing chronic hemodialysis. AIM: To evaluate the effects of an exercise training program in patients undergoing chronic hemodialysis. MATERIAL AND METHODS: Fifteen patients on chronic hemodialysis aged 21 to 69 years (three females) were included in the study. Nine of these were included in an exercise training program. During 16 weeks, exercise sessions were carried out during each dialytical procedure that included a warm-up period, aerobic exercises done using standing cycles, and resistance exercises, performed using Thera-Band(®) elastic bands and loops. Borg scale was used to control the intensity of training. At baseline and at the end of the study, a blood sample prior and after the dialytical procedure was obtained to measure C reactive protein, tumor necrosis factor α and interleukin 6. Quadriceps muscle strength, six minutes' walk and quality of life using the SF-36 questionnaire, were also measured. RESULTS: Four experimental subjects did not complete the study period, two that withdrew before starting, one due to problems with the venous access and one that decided to withdraw after 1 month of training. Among the five patients that finished the training period, significant improvements in the six minutes' walk and quadriceps strength were observed in the experimental group. No significant changes were observed among controls. No changes were observed in either group in C reactive protein, tumor necrosis factor and interleukin 6 levels or quality of life. CONCLUSIONS: Among patients undergoing chronic hemodialysis exercise training improves endurance and muscle strength.

In-patient care costs of patients with bipolar I disorder: a comparison between two European centers.

BACKGROUND: Bipolar disorder (BPD) is a disabling disease with high morbidity rates. An international (Spain, France) comparative study about hospitalizations and in-patient care costs associated with BPD I was performed. Centers were included if they had access to a database of computerized patient charts exhaustively covering a defined catchment area. METHODS: Economic evaluation was performed by multiplying the average cumulated annual length of stay (LOS) of hospitalized bipolar patients by a full cost per day of hospitalization in each center to obtain the corresponding annual costs. RESULTS: Hospitalization rates per annum and per 100,000 individuals (general population aged 15+) were similar between France (43.6) and Spain (43.1). There were only slight differences in relation to length of stay (LOS) per patient hospitalized with 18.1 days in Spain and 20.4 days in France. The overall estimated annual hospitalization costs were in the same order of magnitude after adjustment to an adult population of 100,000: euro 232,000 (Spain) and euro 226,500 (France). Mixed episodes had the longest LOS followed by depressive episodes, while manic episodes had the shortest ones. Mania was the most costly disorder representing 53.7% of annual BPD in-patient care costs. CONCLUSIONS: BPD I care requires large resources and frequent hospitalizations, especially during manic episodes. Depressive and mixed episodes require longer hospital stays than manic episodes. Out-patient costs should now be evaluated.

Molecular analysis of the CLCN5 gene in Dent's disease: first mutation identified in a patient from South America.

BACKGROUND: Dent's disease is a rare renal tubular disorder characterized by low-molecular weight proteinuria, hypercalciuria, nephrocalcinosis, nephrolithiasis, rickets and eventual renal failure. The selective loss of low-molecular weight proteins points to a defect of the proximal tubule, where filtered proteins are normally reabsorbed by endocytosis. The disease tends to present in childhood or early adult life, and males are more severely affected than females. The disease is caused by mutations in CLCN5 or OCRL1, both on the X chromosome, which code for the chloride/proton exchange transporter ClC-5 and the phosphatidylinositol-4,5-biphosphate-5-phosphatase, respectively. METHODS: Mutational analysis of CLCN5 gene from 4 unrelated patients diagnosed with Dent's disease and their relatives, 3 from Spain and 1 from Bolivia, was performed by PCR and automatic DNA sequencing. RESULTS: In the current study, we report the identification of 4 mutations in CLCN5 of 1 family from Bolivia and 3 families from Spain. Two of the mutations are novel and consist of 1 nonsense mutation, Y502X, and 1 missense mutation, L225P, affecting ClC-5alpha-helix F, one of the helices involved in formation of the chloride selectivity filter. CONCLUSIONS: Our results add to the expanding spectrum of mutations in CLCN5. This is the first report of a CLCN5 mutation in a Dent's disease patient of South American origin.

Análisis costo-efectividad de las heparinas de bajo peso molecular en tromboprofilaxis temprana en pacientes médicos y quirúrgicos / Cost effectiveness analysis of low molecular weight heparines in early anti thrombotic prophilaxis in medical and surgical patients

Objetivo: evaluar la costo-efectividad de las heparinas de bajo peso molecular enoxaparina, dalteparina y nadroparina en la tromboprofilaxis temprana de los pacientes médicos y quirúrgicos.Material y métodos: revisión sistemática de la literatura e identificación de ensayos clínicos desde 1990 a 2005 en MEDLINE, EMBASE y CENTRAL en cuanto a eficacia y seguridad en la trombo-profilaxis temprana de pacientes médicos y quirúrgicos. Se realizó el análisis de costo-efectividad comparando cada una de las heparinas de bajo peso molecular con la información obtenida de los pacientes con patología médica donde se encontró información para las tres heparinas. Se optó por el punto de vista del prestador del servicio para la determinación de los costos.Resultados: fueron identificados 173 estudios para enoxaparina, 117 para dalteparina y 110 para nadroparina. Cumplieron con los criterios de inclusión 14, 4 y 5 estudios respectivamente. Se obtuvieron medidas de resúmenes para los riesgos de trombosis y de sangrado mayor realizándose estratificaciones de acuerdo con el tipo de patología y con el tipo de control de heparina no fraccionada o placebo.Conclusiones: en nuestro medio en grupos de bajo y mediano riesgo de trombosis venosa profunda, los costos derivados de la medicación tendrían un gran peso independientemente de la eficacia de la molécula. Cuando el riesgo es elevado aquellas moléculas con mayor eficacia pasarían a ser más costo-efectivas independientemente del costo de la molécula.

Concordancia entre la base exceso arterial y venosa en los pacientes criticamente enfermos / Agreemente between arterial excess base and venous in critic patients

Para determinar el grado de concordancia en la medición de labase exceso proveniente de muestras arteriales y la base exceso proveniente de muestras venosas en los pacientes críticos que son monitorizados con catéteres centrales, se realizo un estudio observacional descriptivo retrospectivo, evaluándodose a 635 pacientes que ingresaron a la unidad de cuidados intesivos posquirúrgicos del Hospital Militar Central de Bogotá Colombia. Para realizar un anáalisis de concordancia entre base exceso arterial y venosa con determinación del coeficiente de Lyn y gráficos de Bland y Altman, en todos los pacientes se registraron las variables demográficas, el puntaje de severidad APACHE II y el cálculo de la base exceso arterial y venosa. Se encontró una elevada concordancia entre las mediciones venosas provenientes del cáteter de presión venosa central y las mediciones arteriales de la base exceso, en general para todos los rangos de pH con coeficiente del Linde 0,91 I.C. 95 por ciento y unos limites de acuerdo entre -48 a 5.4mEq/L. Conclusiones: La determinación de la base exceso en las muestras de sangre venosa provenieentes de catéteres centrales se constituye en una metodología alterna sufieciente valida para la evaluación del estado ácido básico en los pacientes críticos que no precisan de ser monitorizados con catéter de artería pulmonar sobre todo en los rangos de pH de acidosis y rango normal

Determination of Trichuris skrjabini by sequencing of the ITS1-5.8S-ITS2 segment of the ribosomal DNA: comparative molecular study of different species of trichurids.

Adults of Trichuris skrjahini have been isolated from the cecum of caprine hosts (Capra hircus), Trichuris ovis and Trichuris globulosa from Ovis aries (sheep) and C. hircus (goats), and Trichuris leporis from Lepus europaeus (rabbits) in Spain. Genomic DNA was isolated and the ITS1-5.8S-ITS2 segment from the ribosomal DNA (rDNA) was amplified and sequenced by polymerase chain reaction (PCR) techniques. The ITS1 of T. skrjabini, T. ovis, T. globulosa, and T. leporis was 495, 757, 757, and 536 nucleotides in length, respectively, and had G + C contents of 59.6, 58.7, 58.7, and 60.8%, respectively. Intraindividual variation was detected in the ITSI sequences of the 4 species. Furthermore, the 5.8S sequences of T. skrjabini, T. ovis, T. globulosa, and T. leporis were compared. A total of 157, 152, 153, and 157 nucleotides in length was observed in the 5.8S sequences of these 4 species, respectively. There were no sequence differences of ITS1 and 5.8S products between T. ovis and T. globulosa. Nevertheless, clear differences were detected between the ITS1 sequences of T. skrjabini, T. ovis, T. leporis, Trichuris muris, and T. arvicolae. The ITS2 fragment from the rDNA of T. skrjabini was sequenced. A comparative study of the ITS2 sequence of T. skrjabini with the previously published ITS2 sequence data of T. ovis, T. leporis, T. muris, and T. arvicolae suggested that the combined use of sequence data from both spacers would be useful in the molecular characterization of trichurid parasites.

Determination of Trichuris muris from murid hosts and T. arvicolae (Nematoda) from arvicolid rodents by amplification and sequentiation of the ITS1-5.8S-ITS2 segment of the ribosomal DNA.

Trichuris muris has been isolated from murid hosts ( Apodemus sylvaticus and Mus musculus) and Trichuris arvicolae from arvicolid rodents in Barcelona, Spain. Genomic DNA was isolated and the ITS1-5.8S-ITS2 segment from the ribosomal DNA (rDNA) was amplified and sequenced using polymerase chain reaction techniques. The ITS2 of both populations isolated from Apodemus and Mus was 382 nucleotides in length and had a GC content of about 60.73%, while the ITS2 of T. arvicolae was 442 nucleotides in length and had a GC content of about 59.8%. Furthermore, the ITS1 of Trichuris from murids was 448 nucleotides in length and had a GC content of about 56.47%, while T. arvicolae was 446 nucleotides in length and had 57.62% of GC content. A total of 161 and 173 nucleotides were observed along the 5.8S gene of T. murisand T. arvicolae, respectively; This difference in nucleotides was due to the insertion of a DNA segment (transposon) in the 5.8S sequence of the latter species. Slight intraindividual and intraspecific variations were detected in the rDNA of both species. The presence of microsatellites was observed in all of the individuals assayed. Sequence analysis of the internal transcribed spacers and the 5.8S gene demonstrated no sequence differences between T. muris isolated from both of its murid hosts. Nevertheless, clear differences were detected between the ITS2, ITS1 and 5.8S gene of T. muris and T. arvicolae. This corroborates the existence of two separate Trichuris species in murid and arvicolid hosts. Furthermore, a phylogenetic analysis was carried out and endonucleases restriction maps were elaborated for both species.

Obstrucción intestinal en el paciente con cáncer: primera parte / Intestinal obstruction in the cancer patient: part one

Objetivos: describir la incidencia, los factores de riesgo, el pronostico, los hallazgos operatorios, la recurrencia y la supervivencia de los pacientes con obstruccion intestinal (0I) y los antecedentes de neoplasia de cualquier origen. Diseño: estudio longitudinal, descriptivo prospectivo. Lugar: hospital de tercer nivel, centro de referencia para el cancer. Pacientes: 88 pacientes con antecedente de neoplasia, con 127 episodios de 0I documentados por clinica y/o paraclínica, hospitalizados entre el 1§. de marzo de 1997 y el 28 de febrero de 1998 (1 año). Resultados: se evaluaron 88 pacientes, 35 hombres (40 por ciento) y 53 mujeres, con diagnostico de 0I. La edad promedio fue 52 años. La neoplasia asociada más frecuente fue el cancer colorrectal (38 por ciento); luego el de cervix (22 por ciento) y estomago (16 por ciento). Al ingreso los estados avanzados y metastásicos constituian en el 67 por ciento (estados 3 y 4), lo que cursa con un riesgo 6 veces mayor de que el origen de la 0I sea maligna (RR=6,1; IC=1,8 a 20,9). En 67 pacientes (76 por ciento) habia antecedente de cirugia, y en 53 (79 por ciento) esta fue por neoplasia. La escala de actividad mostro un estado avanzado (3 a 4) en el 66 por ciento de los casos, siendo uno de los factores determinantes de la posibilidad de cirugia (p<0,0001). Se practico cirugia en 60 pacientes (68 por ciento) y se encontro que en 80 por ciento la causa era maligna, destacando la presencia de carcinomatosis en el 47 por ciento. Hubo morbilidad posoperatoria en 21 pacientes (35 por ciento) y mortalidad posoperatoria en el 18,3 por ciento (11 pacientes). Durante el seguimiento se detectaron 39 episodios de recurrencia de 0I, lo que muestra un mayor numero de recurrencias por parte de los pacientes con tratamiento medico sobre los operados (Kruskal-Wallis=4,7; p=0,03...

Characterization of four species of Trichuris (Nematoda: Enoplida) by their second internal transcribed spacer ribosomal DNA sequence.

Adult worms of Trichuris ovis and T. globulosa were collected from Ovis aries (sheep) and Capra hircus (goats). T. suis was isolated from Sus scrofa domestica (swine) and T. leporis was isolated from Lepus europaeus (rabbits) in Spain. Genomic DNA was isolated and a ribosomal internal transcribed spacer (ITS2) was amplified and sequenced using polymerase-chain-reaction (PCR) techniques. The ITS2 of T. ovis and T. globulosa was 407 nucleotides in length and had a GC content of about 62%. Furthermore, the ITS2 of T. suis and T. leporis was 534 and 418 nucleotides in length and had a GC content of about 64.8% and 62.4%, respectively. There was evidence of slight variation in the sequence within individuals of all species analyzed, indicating intraindividual variation in the sequence of different copies of the ribosomal DNA. Furthermore, low-level intraspecific variation was detected. Sequence analyses of ITS2 products of T. ovis and T. globulosa demonstrated no sequence difference between them. Nevertheless, differences were detected between the ITS2 sequences of T. suis, T. leporis, and T. ovis, indicating that Trichuris species can reliably be differentiated by their ITS2 sequences and PCR-linked restriction-fragment-length polymorphism (RFLP).

Characterization of Chabertia ovina by isoenzyme gel electrophoresis: comparative study with Oesophagostomum venulosum.

The glucose-6-phosphate dehydrogenase (G6PD, EC.1.1.1.49), glucose phosphate isomerase (GPI, EC.5.3.1.9), and malate dehydrogenase (MDH, EC.1.1.1.37) isoenzymatic patterns of Chabertia ovina were determined by starch-gel electrophoresis. The G6PD and GPI isoenzymatic patterns were characterized by the existence of three phenotypes: (1) a single and slow anodic band, (2) a single and fast anodic band, and (3) a large spot matching its migration with bands 1 and 2. These three phenotypes may be explained as the existence of only one gene locus for the G6PD and GPI in C. ovina. Allelic frequencies and the Hardy-Weinberg test were determined. This test indicated that the population was not in Hardy-Weinberg equilibrium. The MDH isoenzymatic pattern of C. ovina was characterized by the presence of two bands with anodic and cathodic migration. Furthermore, comparative isoenzyme studies were carried out between Oesophagostomum venulosum and C. ovina. The different G6PD, GPI, and MDH isoenzymatic patterns observed for the two species allowed us to distinguish them and, therefore, to use isoenzymatic patterns as a diagnostic tool to discriminate these species.

Characterization of porcine and ovine Oesophagostomum spp. by isoenzymatic patterns and restriction-fragment-length polymorphisms (RFLPs).

Four different morphological and biometrical populations of Oesophagostomum have been identified, using classical taxonomy methods, from Sus scrofa domestica (pigs): O. dentatum (Od), O. quadrispinulatum (Oq), O. granatensis (Og), and a fourth population, including individuals with morphological and biometric parameters overlapping these three species that were clasified as Oesophagostomum sp. The G6PD and MDH isoenzymatic patterns did not discriminate between the three species, while GPI showed a diagnostic isoenzymatic pattern for Oq. Og showed identical G6PD, GPI and MDH isoenzymatic pattern as Od. Furthermore, after rDNA amplification by polymerase chain reaction (PCR), the uncut PCR product showed that the ITS2 of these three species had a similar size of 320 base pairs (bp). Restriction-fragment-length polymorphisms (RFLP) were analyzed after digestion of the ITS2 with 13 different restriction enzymes. After electrophoretic separation of the digested PCR products, only one unique differentiating pattern of bands was observed for Od and Oq. This was when Sau3AI was used, while Og showed an identical band pattern to Od. Thus, our studies provided no evidence for the existence of Og and Od as differentiated populations. O. venulosum was isolated from sheep and goat; G6PD and MDH isoenzymatic patterns discriminated this species from porcine species of Oesophagostomum. The ITS2 region appeared as a different band of 380 bp from those observed for porcine Oesophagostomum species.

Morphologic, biometric, and isoenzyme characterization of Trichuris suis.

Trichuris suis isolates were collected from the cecum of Sus scrofa domestica (pig) and S. s. scrofa (wild boar). Morphology and biometry studies were carried out. Morphology studies showed the existence of typical caudal papillae in males of T. suis from wild boars, but no other difference was observed in the biometric parameters (total length, esophageal length, posterior-portion body length, and spicular length) of T. suis isolated from either host. Individual extracts were subjected to malate dehydrogenase (MDH), malic enzyme (ME), glucose 6-phosphate dehydrogenase (G6PD), lactate dehydrogenase (LDH), and superoxide dismutase (SOD) isoenzyme analysis following starch-gel electrophoresis, and the isoenzyme patterns were compared with those obtained from other species of trichurids. MDH, ME, G6PD, LDH, and SOD isoenzyme patterns were identical for T. suis from both hosts. MDH isoenzyme patterns were characterized by the presence of one cathodic isoenzyme. ME, G6PD, and LDH isoenzyme patterns indicated the presence of three phenotypes, whereas the SOD isoenzyme pattern showed only one phenotype characterized by the existence of two (anodic and cathodic) bands. Different LDH and SOD isoenzyme patterns observed for T. suis, T. ovis, and T. skrjabini confirm once more that isoenzyme patterns have potential as a diagnostic tool for differentiation of different species of Trichuris.

[Predictors of rehospitalization in schizophrenia]. / Predictores de rehospitalización en la esquizofrenia.

OBJECTIVES: The aim of this study is to determine the predictive value on rehospitalization of sociodemographic variables, positive/negative symptoms and thought disorders. The results are part of research project founded by the Basque Health Department. METHODS: A 18 month follow-up study of a cohort of 60 patients with acute exacerbation of schizophrenia was carried out. The assessment was performed with DSM III-R diagnostic criteria, PANSS and CGI rating scales, and SCID-P semistructured interview. All patients received antipsychotic treatment. The sociodemographic and disease data, the dimensional score of the PANSS subscales, the score of CGI scale, the items 2, 12, 13 and 14 of the PANSS as indicators of formal thought disorders; and the items 1, 5, 6, 17 and 23 of the PANSS as content thought disorders were established as predictors. The predictive value was determined by the Cox regression test (Lee 1992). RESULTS: We did not find predictive value either in the PANSS scores or in the 9 thought disorders evaluated (Wald and RR tests were not significative). Nevertheless, considering the values of standard error obtained in the Cox regression we were not in a position to assure that they did not have an incidence in the hospitalizations. The CGI was the only scale that showed prognostic value (Wald test = 1.9945; RR = 1.7499). Our results indicated that the lower number of previous hospitalizations (Wald test = 1.1437; RR = 1.1437) and the high level of studies (Wald test = 2.4258; RR = 1.8052) diminished the risk of rehospitalization. CONCLUSIONS: 1 o The predictive value on rehospitalization for the positive/negative symptoms and thought disorders was not confirmed. 2 o CGI is the only scale with predictive value. That fact makes us consider the importance of what German psychiatrists called "smelling the schizophrenia" or "The smell of schizophrenia". 3 o Our results indicate that the lower number of previous hospitalizations, and the high level of studies diminish the risk of rehospitalization.

[Positive and negative symptoms in schizophrenia: standards of change during acute exacerbation]. / Síntomas positivos y negativos en la esquizofrenia: patrones de cambio durante la exacerbación aguda.

INTRODUCTION AND OBJECTIVES: The temporal stability of the positive and negative symptoms in schizophrenia deserves a special interest due to its consequences in the outcome and the treatment of the disease. This study determines the temporal stability of positive/negative subtypes in schizophrenia during the acute phase. MATERIAL AND METHODS: This is a clinical, observational and prospective study of a dynamic cohort of patients with acute exacerbation of schizophrenia defined by DSM III-R criteria. Patients with severe and unstable organic pathology, substance dependence, mental organic disorder, mental retardation, depression, or medicamentous parkinsonism were excluded. Clinical assessment was performed with the PANSS scale. Schizophrenic subtypes were established according to inclusive and restrictive criteria of PANSS. All patients were treated with new antipsycotics and biperiden if necessary. RESULTS: 51 patients were assessed for 8 weeks. In the baseline, the negative subtype (63.3% and 52.5% by inclusive and restrictive system respectively) and paranoid form (45.1%) were predominant. Three types of analysis were performed to determine the temporal stability: 1. Concordance (Kappa index). The concordance of the inclusive and restrictive System, regarding to the baseline assessment, indicated that both criteria had a low temporal stability. 2. Mc Nemar Ji Square. This test showed that these changes were bi-directional except for the first visit, which was significant through the restrictive system (higher change from the negative to other subtypes). 3. Transition analysis among groups by First Order Morkov Chains analysis indicated that this change was stationary (the change was the same in all phases). CONCLUSIONS: 1o The variable "time" has to be considered for the definition of subtypes in schizophrenia. 2o The restrictive system is more specific. It allows to identify a subgroup of patients with "Negative" schizophrenia with a high specificity and validity in clinical and epidemiological studies. 3o The use of the baseline visit as a reference (gold standard) is recommended because it exits a higher concordance among criteria and a more florid psychopathology.