Manejo del dolor posoperatorio en pacientes beneficiarios de una artroplastia total de rodilla: comparación de tres técnicas analgésica / Postoperative pail management in patients underfgoing total knee arthroplaty: comparison of three analgesic techniques

Introducción: La artroplastia total de rodilla (ATR) es un procedimiento quirúrgico muy doloroso en cirugía ortopédica, siendo muy difícil su tratamiento. El objetivo del presente estudio fue comparar 3 estrategias de analgesia post operatoria en el manejo del dolor post ATR. Pacientes y Método: se estudiaron 60 pacientes, divididos en 3 grupos. Grupo 1: Bloqueo iliofascial (BIFC), Grupo 2: Analgesia epidural continua (AEPIC) y Grupo 3: Morfina intratecal (MIT). Se evaluó el dolor post operatorio (DPO) en reposo y movimiento con escala visual análoga en las primeras 24 hrs., consumo de morfina endovenosa (MEV), incidencia de efectos adversos: prurito, náuseas y vómitos (NVPO), retención urinaria (RU). Al término del tratamiento se evaluó la satisfacción del paciente. Resultados: El DPO fue significativamente menor entre las 6 y 24 hrs. en los pacientes del Grupo 3 versus los de los Grupos 1 y 2 (p<0,01). El consumo de MEV fue menor en los pacientes del grupo 3 (p< 0,01). La incidencia de prurito post operatorio y RU fue significativamente mayor en el grupo 3 versus los grupos 1 y 2 (p< 0, 001 y p< 0,008). La hipotensión arterial fue mayor en los grupos 2 y 3 versus el grupo 1 (p< 0,05), siendo más frecuente la hipotensión moderada en el grupo 3 versus a los grupos 1 y 2 (p< 0.01). La calidad de la analgesia fue considerada superior en los pacientes del grupo 3. Conclusión: Las 3 técnicas analgésicas son útiles para el manejo del DPO de una ATR. La MIT presenta menor índice de dolor, mejor calidad de la analgesia percibida por el paciente, pero una mayor incidencia de efectos adversos en relación con el BIFC y AEPIC.

Introduction: Total knee arthroplasty (TKA) is a very painful surgical procedure in orthopedic surgery, making its treatmentvery difficult. The objective of the present study was to compare 3 postoperative analgesia strategies in the management of post TKA pain. Patients and Method: 60 patients, divided into 3 groups, were studied. Group 1: Iliofascial blockade (BIFC), Group 2: Continuous epidural analgesia (AEPIC) and Group 3: Intrathecal morphine (MIT). Postoperative pain (POD) at rest and movement was evaluated with a visual analog scale (EVA) in the first 24 hours, intravenous morphine consumption (VEM), incidence of adverse effects: pruritus, nausea and vomiting (PONV), urinary retention (UR). At the end of treatment, patient satisfaction was evaluated. Results: The DPO was significantly lower between 6 and 24 hours in the patients of Group 3 versus those of Groups 1 and 2 (p<0.01). MEV consumption was lower in patients of group 3 (p<0.01). The incidence of postoperative pruritus and UR was significantly higher in group 3 versus groups 1 and 2 (p<0.001 and p<0.008). Arterial hypotension was greater in groups 2 and 3 versus group 1 (p<0.05), with moderate hypotension being more frequent in group 3 versus groups 1 and 2 (p<0.01). The quality of analgesia was considered superior in patients in group 3. Conclusion: The three analgesic techniques are useful for managing the DPO of a TKA. MIT presents a lower pain index, better quality of analgesia perceived by the patient, but a higher incidence of adverse effects in relation to BIFC and AEPIC.

Costo de la atención médica en el trauma severo de mano / Cost of medical care in severe hand trauma

Resumen: Objetivo: Determinar los costos directos e indirectos en la Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia «Lomas Verdes¼ de la patología del trauma complejo de mano calificado como riesgo de trabajo. Material y métodos: Se analizaron 50 expedientes clínicos completos con diagnóstico de trauma complejo de mano de Enero de 2019 a Agosto de 2020. La perspectiva del estudio es determinar los costos de la atención médica del trauma complejo de mano en trabajadores activos. Resultados: Se revisaron 50 expedientes clínicos de pacientes con diagnóstico clínico y radiológico de trauma severo de mano, trabajadores asegurados con dictamen de riesgo de trabajo. Conclusión: La presencia de estas lesiones en la edad activa de nuestros pacientes nos habla de la gran importancia que conlleva una atención oportuna y adecuada del trauma severo de mano, que impacta de manera importante en la economía del país. De ahí de la gran necesidad de establecer métodos de prevención de dichas lesiones en las empresas y la necesidad de establecer protocolos de atención médica para estas lesiones y buscar disminuir los procedimientos quirúrgicos para resolver esta patología.

Abstract: Objective: To determine the direct and indirect costs in the High Specialty Medical Unit Hospital de Traumatology y Orthopedic «Lomas Verdes¼ of the pathology of complex hand trauma classified as occupational risk. Material and methods: 50 complete clinical records with a diagnosis of complex hand trauma were analyzed from January 2019 to August 2020. The perspective of the study is to determine the costs of medical care for complex hand trauma in active workers. Results: 50 clinical records of patients with clinical and radiological diagnosis of trauma severe de mano, insured workers with a work risk opinion, were reviewed. Conclusion: The presence of these injuries in the active age of our patients speaks to us of the great importance of timely and adequate care for severe hand trauma, which has a significant impact on the country's economy. Hence the great need to establish methods of prevention of such injuries in companies and the need to establish medical care protocols for these injuries and seek to reduce surgical procedures to resolve this pathology.

[Cost of medical care in severe hand trauma]. / Costo de la atención médica en el trauma severo de mano.

OBJECTIVE: to determine the direct and indirect costs in the High Specialty Medical Unit Hospital de Traumatology y Orthopedic "Lomas Verdes" of the pathology of complex hand trauma classified as occupational risk. MATERIAL AND METHODS: 50 complete clinical records with a diagnosis of complex hand trauma were analyzed from January 2019 to August 2020. The perspective of the study is to determine the costs of medical care for complex hand trauma in active workers. RESULTS: 50 clinical records of patients with clinical and radiological diagnosis of trauma severe de mano, insured workers with a work risk opinion, were reviewed. CONCLUSION: the presence of these injuries in the active age of our patients speaks to us of the great importance of timely and adequate care for severe hand trauma, which has a significant impact on the country's economy. Hence the great need to establish methods of prevention of such injuries in companies and the need to establish medical care protocols for these injuries and seek to reduce surgical procedures to resolve this pathology.

OBJETIVO: determinar los costos directos e indirectos en la Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia "Lomas Verdes" de la patología del trauma complejo de mano calificado como riesgo de trabajo. MATERIAL Y MÉTODOS: se analizaron 50 expedientes clínicos completos con diagnóstico de trauma complejo de mano de Enero de 2019 a Agosto de 2020. La perspectiva del estudio es determinar los costos de la atención médica del trauma complejo de mano en trabajadores activos. RESULTADOS: se revisaron 50 expedientes clínicos de pacientes con diagnóstico clínico y radiológico de trauma severo de mano, trabajadores asegurados con dictamen de riesgo de trabajo. CONCLUSIÓN: la presencia de estas lesiones en la edad activa de nuestros pacientes nos habla de la gran importancia que conlleva una atención oportuna y adecuada del trauma severo de mano, que impacta de manera importante en la economía del país. De ahí de la gran necesidad de establecer métodos de prevención de dichas lesiones en las empresas y la necesidad de establecer protocolos de atención médica para estas lesiones y buscar disminuir los procedimientos quirúrgicos para resolver esta patología.

Role of pituitary stalk and gland radiological status on endocrine function and outcome after endoscopic transsphenoidal surgery for non-functioning pituitary adenomas.

PURPOSE: To investigate endocrine function changes after non-functioning pituitary adenomas (NFPA) transsphenoidal surgery and to search for predictors of hypopituitarism resolution and development. METHODS: We included 117 patients with NFPA who underwent endoscopic transsphenoidal surgery from 2005 to 2019 by two neurosurgeons. Twenty-one patients were excluded because of previous pituitary surgery or radiotherapy. We assessed symptoms at diagnosis, tumour volume, tumour removal, hormonal status at diagnosis, hormonal outcomes at 2- and 12-month follow-up, and complications. Pituitary stalk and gland MRI status (visible or not) were included, and it theirs association to hormonal function was studied for the first time, to our knowledge. RESULTS: Pituitary gland visualization was more frequent in those patients who showed a smaller number of axes affected at 12 months (p = 0.011). Pituitary stalk status showed no association to hormonal function. The hormonal normalization rate at 12 months was 13%. The endocrine improvement rate at 12 months was 16.7%. Worsening of hormonal function occurred in 19.8% of patients. Younger age was associated to hormonal improvement (p = 0.004). Higher preoperative tumour volume (p = 0.015) and absence of gross total resection (GTR) (p = 0.049) were associated with worsening in at least one hormonal axis after surgery. CONCLUSIONS: Pituitary gland visibility was higher in those patients who showed better hormonal outcomes. Assessment of initial hormonal function and outcome after surgery regarding pituitary stalk status showed no significant association. Higher preoperative tumour volumes and absence of GTR were associated to postoperative endocrine function worsening, while younger age was associated to its improvement.

[Giant loss of domain hernia: Preoperative treatment with botulinum toxin of the abdominal oblique muscles]. / Hernia abdominal con pérdida del domicilio: tratamiento preoperatorio con toxina botulínica de la musculatura oblicua abdominal.

In giant loss of domain hernia there is a high risk of abdominal compartment syndrome and restrictive lung disease after complete surgical repair of the fascial defect. We report the case of a 54-year-old man with a late-stage right giant mesogastric loss of domain hernia who began preoperative treatment with progressive pneumoperitoneum. After evaluation of the muscles and skin, ultrasound and electromyographic-guided infiltration of botulinum toxin type A was performed in the abdominal oblique muscles. It caused a flaccid paralysis of the wall and allowed advancement of the lateral flaps without weakening them. The patient underwent surgery one month later with complete closure of the defect and with no signs of respiratory failure or compartment syndrome. The use of botulinum toxin in the preoperative treatment of patients with loss of domain hernias seems a safe and effective therapeutic option.

Utilisation/upgrading of orange peel waste from a biological biorefinery perspective.

Orange peel waste (OPW) (peels, pulp and seeds) is an underutilised residue coming from the orange juice industry. Its classical applications are cattle feeding and composting, while they cannot ensure a total use of OPW, so landfilling is also common practice. On the other side, OPW is very rich in sugars, polysaccharides, essential oils and polyphenols, so there is a vast literature focused on the development and optimization of technologies and processes to several products from OPW. In this review, papers on OPW-based bioprocesses are visited, discovering a wide landscape that goes from the composting and biogas processes on detoxified OPW (deoiled) to bioprocesses to bioethanol, chemicals, flavours and polymers. All these processes are prone to integration within the 2nd-generation biorefinery framework.

Intravenous pulses of methylprednisolone to treat flares of immune-mediated diseases: how much, how long?

Introduction Glucocorticoids are widely used in the treatment of immune-mediated diseases. Despite their widespread use, details on dosing, effectiveness and adverse effects are yet to be determined. Objective To know the current use of methylprednisolone (MTP) in the management of immune-mediated conditions, evaluating the relationship among doses, therapeutic response and adverse effects. Methodology A multicenter retrospective cohort study was designed, including patients who received intravenous pulses of MTP between 1 January 2013 and 12 December 2015 in three different hospitals in Uruguay. The patients included received MTP to treat systemic autoimmune diseases (SADs), hematological, nephrological and neurologic diseases and others. The following variables were analyzed: age, gender, MTP cumulative dose, duration of treatment, clinical response (complete, partial and no response) and adverse effects. Results In total, 164 cases were identified, of which 118 (72%) were female. The median age was 48.4 (SD: 18) years. The indications for MTP included: neuroimmune-mediated 92 (56.1%), SADs 29 (17.5%), hematological 15 (9.1%), nephrological 12 (7.3%) and others 16 (9.9%). The median dose to achieve complete response was 3.2 g (SD: 1.5); the median dose to accomplish a partial response was 3.5 g (SD: 1.25); the median dose for non-responders was 3.3 g (SD 1.2) ( p > 0.05). The median dose in those patients with adverse effects was 3.4 g (SD 1.5) and the median dose for those who did not experience adverse effects was 3.3 g (SD: 1.3) ( p > 0.05). The most frequent adverse effects were infectious (22/164, 13.4%). Diabetics were found to have the highest incidence of adverse effects (13/16, 81%) in comparison to non-diabetics, p < 0.05. Discussion Our study suggests a wide range of doses and duration of treatments with MTP. No major associations were found between clinical response and the use of high MTP doses, but the latter was associated with a large proportion of severe infections. No severe infections were identified with MTP doses lower than 1.5 g. The diabetic population is known to be at risk of experiencing varied adverse effects to MTP. These observations reinforce the need for protocolized use of MTP in order to achieve a better relationship among doses, effectiveness and safety profile.

A simple vibrating sample magnetometer for macroscopic samples.

We here present a simple model of a vibrating sample magnetometer (VSM). The system allows recording magnetization curves at room temperature with a resolution of the order of 0.01 emu and is appropriated for macroscopic samples. The setup can be mounted with different configurations depending on the requirements of the sample to be measured (mass, saturation magnetization, saturation field, etc.). We also include here examples of curves obtained with our setup and comparison curves measured with a standard commercial VSM that confirms the reliability of our device.

Biologically important conformational features of DNA as interpreted by quantum mechanics and molecular mechanics computations of its simple fragments.

Deciphering the mechanism of functioning of DNA as the carrier of genetic information requires identifying inherent factors determining its structure and function. Following this path, our previous DFT studies attributed the origin of unique conformational characteristics of right-handed Watson-Crick duplexes (WCDs) to the conformational profile of deoxydinucleoside monophosphates (dDMPs) serving as the minimal repeating units of DNA strand. According to those findings, the directionality of the sugar-phosphate chain and the characteristic ranges of dihedral angles of energy minima combined with the geometric differences between purines and pyrimidines determine the dependence on base sequence of the three-dimensional (3D) structure of WCDs. This work extends our computational study to complementary deoxydinucleotide-monophosphates (cdDMPs) of non-standard conformation, including those of Z-family, Hoogsteen duplexes, parallel-stranded structures, and duplexes with mispaired bases. For most of these systems, except Z-conformation, computations closely reproduce experimental data within the tolerance of characteristic limits of dihedral parameters for each conformation family. Computation of cdDMPs with Z-conformation reveals that their experimental structures do not correspond to the internal energy minimum. This finding establishes the leading role of external factors in formation of the Z-conformation. Energy minima of cdDMPs of non-Watson-Crick duplexes demonstrate different sequence-dependence features than those known for WCDs. The obtained results provide evidence that the biologically important regularities of 3D structure distinguish WCDs from duplexes having non-Watson-Crick nucleotide pairing.

[Non-pneumococcal bacterial pneumonias (II). Respiratory infections by Mycoplasma and Chlamydia. Viral pneumonias]. / Neumonías bacterianas no neumocócicas (II). Infecciones respiratorias por Mycoplasma y Chlamydia. Neumonías víricas.

Non-pneumococcal and viral pneumonias are included in the group termed atypical pneumonias. They are caused by a wide range of bacteria and viruses; in most cases an aetiological diagnosis is not reached. Their clinical presentation is usually mild, although fatal cases have been described, principally in immunocompromised patients. Occasionally, extrapulmonary symptoms are associated, which makes diagnosis difficult. Microbiological tests are not indicated for diagnosis, except in the event of therapeutic failure or if the patient needs to be hospitalised. Early, empirical antibiotic treatment should be started as promptly as possible, since this has proven to reduce morbidity and mortality. Modifications to the treatment or associated viral treatment are only indicated according to the clinical progression or severity of the disease. Other treatments, such as corticotherapy, remain controversial.

Note: On the study of metal/oxide hybrid ferromagnets with magneto-optical techniques.

We analyze here the magneto-optical measurements of hybrid materials containing metallic and oxide ferromagnetic phases. We show that the magnetization curves obtained with this technique can be fairly different to those obtained with standard magnetometry techniques and cannot be representative of the contribution of each phase to the magnetization of the material, due to the very different optical properties of metals and oxides. However, a proper numerical analysis of the magneto-optical measurements allows estimating the fraction of each phase present in the material.

Tuning Metamaterials by using Amorphous Magnetic Microwires.

In this work, we demonstrate theoretically and experimentally the possibility of tuning the electromagnetic properties of metamaterials with magnetic fields by incorporating amorphous magnetic microwires. The large permeability of these wires at microwave frequencies allows tuning the resonance of the metamaterial by using magnetic fields of the order of tens of Oe. We describe here the physical basis of the interaction between a prototypical magnetic metamaterial with magnetic microwires and electromagnetic waves plus providing detailed calculations and experimental results for the case of an array of Split Ring Resonators with Co-based microwires.

Fetal laser ablation of feeding artery of cystic lung lesions with systemic arterial blood supply.

OBJECTIVE: To assess the effectiveness of laser surgery in fetuses with a cystic lung lesion with systemic arterial blood supply (hybrid lung lesion) at risk of perinatal death. METHODS: A cohort of five consecutive fetuses with a large hybrid lung lesion associated with hydrops and/or pleural effusion with severe lung compression was selected for percutaneous ultrasound-guided fetal laser ablation of the feeding artery (FLAFA) before 32 weeks' gestation in a single tertiary national referral center in Queretaro, Mexico. The primary outcomes were survival and need for postnatal surgery. RESULTS: FLAFA was performed successfully in all cases at a median gestational age of 24.9 (range, 24.4-31.7) weeks. After fetal intervention, dimensions in both lungs increased and fluid effusions resolved in all cases. All cases were delivered liveborn at term at a median gestational age of 39.6 (range, 38.0-39.7) weeks, without respiratory morbidity or need for oxygen support, resulting in perinatal survival of 100%. During follow-up, three (60%) cases showed progressive regression of the entire lung mass and did not require postnatal surgery, whereas in two (40%) cases a progressive decrease in size of the mass was observed but a cystic portion of the lung mass persisted and postnatal lobectomy was required. CONCLUSION: In fetuses with large hybrid lung lesions at risk of perinatal death, FLAFA is feasible and could improve survival and decrease the need for postnatal surgery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Measurement of the magnetic permeability of amorphous magnetic microwires by using their antenna resonance.

We present here a new free space method to measure the magnetic permeability of a single amorphous magnetic microwire (AMM) at microwave frequencies. The technique consists in inducing a high frequency electric current along the AMM axis by illumination with an electromagnetic wave at antenna resonance conditions. Fitting the induced electric current to the Hallen-Pocklington equation allows computing the relative magnetic permeability of the microwire as a function of the wave frequency. The method results particularly useful for the study of the giant magnetoimpedance effect of AMM by measuring the magnetic permeability upon the application of DC magnetic fields.

Analysis of uni and bi-parental markers in mixture samples: Lessons from the 22nd GHEP-ISFG Intercomparison Exercise.

Since 1992, the Spanish and Portuguese-Speaking Working Group of the ISFG (GHEP-ISFG) has been organizing annual Intercomparison Exercises (IEs) coordinated by the Quality Service at the National Institute of Toxicology and Forensic Sciences (INTCF) from Madrid, aiming to provide proficiency tests for forensic DNA laboratories. Each annual exercise comprises a Basic (recently accredited under ISO/IEC 17043: 2010) and an Advanced Level, both including a kinship and a forensic module. Here, we show the results for both autosomal and sex-chromosomal STRs, and for mitochondrial DNA (mtDNA) in two samples included in the forensic modules, namely a mixture 2:1 (v/v) saliva/blood (M4) and a mixture 4:1 (v/v) saliva/semen (M8) out of the five items provided in the 2014 GHEP-ISFG IE. Discrepancies, other than typos or nomenclature errors (over the total allele calls), represented 6.5% (M4) and 4.7% (M8) for autosomal STRs, 15.4% (M4) and 7.8% (M8) for X-STRs, and 1.2% (M4) and 0.0% (M8) for Y-STRs. Drop-out and drop-in alleles were the main cause of errors, with laboratories using different criteria regarding inclusion of minor peaks and stutter bands. Commonly used commercial kits yielded different results for a micro-variant detected at locus D12S391. In addition, the analysis of electropherograms revealed that the proportions of the contributors detected in the mixtures varied among the participants. In regards to mtDNA analysis, besides important discrepancies in reporting heteroplasmies, there was no agreement for the results of sample M4. Thus, while some laboratories documented a single control region haplotype, a few reported unexpected profiles (suggesting contamination problems). For M8, most laboratories detected only the haplotype corresponding to the saliva. Although the GHEP-ISFG has already a large experience in IEs, the present multi-centric study revealed challenges that still exist related to DNA mixtures interpretation. Overall, the results emphasize the need for further research and training actions in order to improve the analysis of mixtures among the forensic practitioners.

Goya's artwork imaging with Terahertz waves.

In this paper we use a Terahertz (THz) time-domain system to image and analyze the structure of an artwork attributed to the Spanish artist Goya painted in 1771. The THz images show features that cannot be seen with optical inspection and complement data obtained with X-ray imaging that provide evidence of its authenticity, which is validated by other independent studies. For instance, a feature with a strong resemblance with one of Goya's known signatures is seen in the THz images. In particular, this paper demonstrates the potential of THz imaging as a complementary technique along with X-ray for the verification and authentication of artwork pieces through the detection of features that remain hidden to optical inspection.

[Efficacy of the fascia iliaca compartment block vs continuous epidural infusion for analgesia following total knee replacement surgery]. / Utilidad del bloqueo iliofascial continuo versus la analgesia epidural continua para la analgesia postoperatoria en artroplastia total de rodilla.

BACKGROUND AND OBJECTIVE: Total knee replacement causes moderate to severe postoperative pain. The aim of this trial was to compare postoperative analgesia from a fascia iliaca compartment block to continuous epidural analgesia following knee arthroplasty. PATIENTS AND METHODS: Clinical trial enrolling patients in American Society of Anesthesiologists (ASA) classes 1 to 3 randomized to 2 groups. One group received spinal anesthesia plus a fascia iliaca compartment block with 0.1% bupivacaine at a rate of 10 mL/h. The second group received combined spinal-epidural anesthesia plus epidural analgesia with 0.1% bupivacaine in continuous infusion at a rate of 8 mL/h. Postoperative pain on a visual analog scale (VAS) at rest and on movement was recorded every 3 hours for the first 24 hours. Use of intravenous morphine and the adverse events were also recorded. RESULTS: Forty patients (20 for each group) were enrolled. The distribution of age, weight, body mass index, sex, ASA class, duration of surgery, use of morphine, and the incidence of adverse effects were similar in the 2 groups. Postoperative VAS scores at rest and on movement were also similar. The incidence of arterial hypotension was higher in the epidural analgesia group. CONCLUSIONS: The fascia iliaca compartment block and continuous epidural infusion are similarly efficient in providing postoperative analgesia for patients after total knee replacement. The fascia iliaca compartment block is associated with a lower incidence of postoperative hemodynamic complications. Early, safe rehabilitation is facilitated by both analgesic techniques.

Effectiveness and use of linezolid in hospitalisation wards.

OBJECTIVE: To describe the use and effectiveness of linezolid as an alternative treatment for methicillin-resistant Staphylococcus aureus. METHOD: Demographic, clinical and safety data were collected from hospitalised patients. The information sources were the clinical records and the pharmacy programme. RESULTS: Thirty patients were treated with linezolid (median age 69.3, 63% male). The median duration of treatment was 8 days. The most prevalent indication was soft tissues and skin infections (46.7%). The indications were off-label in 40% of cases. Linezolid was used as a targeted therapy in 53%, especially for coagulase-negative Staphylococcus. Clinical healing occurred in 83.3%, and microbiological healing in 40%. Three patients (10%) experienced side effects from using linezolid. CONCLUSION: The effectiveness and safety of linezolid is similar to that described in the trials. Its off-label use and the high number of empirical treatments mean that new strategies must be developed.

¿Qué sabemos hoy sobre las relaciones entre estrés e infertilidad? / What we know today about the relationship between stress and infertility?

El objetivo de este artículo es sintetizar los resultados de la investigación acerca de la relación entre factores psicológicos, particularmente el estrés, e infertilidad. Los primeros estudios basados en casos clínicos, exploraron las características psicológicas o conflictos intrapsíquicos que pueden ser causa de infertilidad. Posteriormente la investigación puso el acento en describir las consecuencias emocionales más frecuentes de la infertilidad y sus tratamientos. Además se describieron las diferencias en la respuesta emocional de hombres y mujeres. Estos estudios aportaron a relevar la importancia de un abordaje integral de la infertilidad que integre los aspectos emocionales.En base a las teorías sobre el estrés y la incidencia de los estilos psicológicos de enfrentamiento del estrés, se caracterizó el estrés específico asociado a la infertilidad y los tratamientos (ámbito personal, de relación de pareja y social) y se desarrollaron instrumentos de evaluación. Se estudió qué tipo de enfrentamiento produce una mejor adaptación tanto en hombres como en mujeres. En los años 90 se han realizaron varias investigaciones siguiendo parejas infértiles, que demostraron que el nivel de estrés experimentado afecta significativamente la calidad de la relación de pareja, la adherenciaa los tratamientos y la respuesta a los mismos expresada en tasa de embarazo y número de ciclos de tratamiento para lograr una gestación. De la investigación surgen conclusiones que orientan la metodología y el contenido de la intervención psicosocial para que ésta sea una contribución efectiva en la salud mental de las personas, su adherencia al tratamiento y el resultado de los mismos.

The aim of this article is to summarize the results of research concerning psychological factors, particularly stress, in relation to infertility. The first studies based on clinical cases, explored the psychological characteristics or intrapsychic conflicts associated to infertility. Subsequently, studies placed emphasis on describing the most frequent emotional consequences and their treatment. The differences in the emotional response from men and women were also described. These studies contributed to highlight the importance of an integral approach to infertility which includes emotional aspects. Based on the stress theories and the incidence of psychological coping styles, it was possible to characterize stress associated specifically to infertility and its treatment (personal, for couple and social relationships), the type of approach which produces better adaptation, both in women and men, and also to develop methods of evaluation. In the 90´s various studies involving infertile couples, demonstrated that the level of stress experienced has considerable effect on the quality of couple relationships, adherence to treatment and the efficacy of the treatments themselves, expressed in terms of pregnancy rates and the number of cycles needed to achieve a pregnancy. Findings from these studies have helped to orient the methodology and content of psychosocial intervention, thus helping to contribute positively to the mental health of couples, their adherence to infertility treatment and the results, themselves.