ASEBIR Quality Special Interest Group guidance for quality in assisted reproduction technology.

Assisted human reproduction has undergone rapid advances since its inception 45 years ago. To keep pace with these advances, assisted reproduction laboratories should adhere to a quality management system that addresses staffing and training, physical space and air quality, equipment maintenance and other operational matters, and ensures gamete and embryo handling in accordance with the latest quality and safety standards. Accordingly, this review aims to provide a reference document that highlights the critical aspects to consider when establishing and operating an ART laboratory. The review collates and expands upon published national and international guidelines and consensus documents, providing easier access to this large body of important information.

Analysis of ethoxyquin residues in animal feed using QuEChERS and gas chromatography tandem mass spectrometry and its results from Catalonian production 2018-2019.

Ethoxyquin (EQ) is a quinolone commonly used as an antioxidant additive and a fungicide. However, Regulation (EU) 2017/962 suspended its authorisation as a feed additive for all animal species and categories. The aim of this study is thus to ensure compliance with this regulation by developing a method of analysing EQ in animal feed. For analysis, EQ was extracted from animal feed by using a modified QuEChERS protocol that used an ascorbic acid buffer to minimise its degradation. The extracts were analysed by gas chromatography coupled to triple quadrupole mass spectrometry (GC-QQQ), obtaining two chromatographic peaks corresponding to EQ and its transformation products. A study of these peaks was subsequently carried out using different standards, evincing that EQ had indeed been converted into several different transformation products. Quantification required the sum of the areas of the different peaks. The method was validated according to European Commission guidelines, namely SANTE/12682/2019. The obtainment of pesticide-free samples for carrying out the validation process was a critical achievement, as EQ residues were detected in 90% of the analysed samples. This was made possible by manufacturing 20 different feed samples from a mixture of several cereals used in animal feed in the laboratory. Method validation yielded excellent results in terms of accuracy (recoveries 70-120%), precision (RSD < 20%) and linearity (r2≥ 0.99) at the studied levels, as well as excellent sensitivity and selectivity (retention time ±0.1 min; ratio < 30%) to the LoQ. Over the course of 2018 and 2019, 70 samples of various feed matrices from agricultural production in Catalonia were analysed, garnering positive results 43% of the time.

Critical appraisal of the Vienna consensus: performance indicators for assisted reproductive technology laboratories.

The Vienna consensus, based on the recommendations of an expert panel, has identified 19 performance indicators for assisted reproductive technology (ART) laboratories. Two levels of reference values are established for these performance indicators: competence and benchmark. For over 10 years, the Spanish embryology association (ASEBIR) has participated in the definition and design of ART performance indicators, seeking to establish specific guidelines for ART laboratories to enhance quality, safety and patient welfare. Four years ago, ASEBIR took part in an initiative by AENOR, the Spanish Association for Standardization and Certification, to develop a national standard in this field (UNE 17900:2013 System of quality management for assisted reproduction laboratories), extending the former requirements, based on ISO 9001, to include performance indicators. Considering the experience acquired, we discuss various aspects of the Vienna consensus and consider certain discrepancies in performance indicators between the consensus and UNE 179007:2013, and analyse the definitions, methodology and reference values used.

The pattern of recovery of ambulation after hip fracture differs with age in elderly patients.

BACKGROUND: The main objective of this study was to analyze the independent effect of increasing age on the recovery of different areas of functioning 1 year after hip fracture. METHODS: Consecutive 1-year survivors aged ≥ 65 years (n = 362) admitted to a single hospital for acute hip fracture surgery were followed prospectively for 1 year. Age was stratified as <75, 75-84, and ≥ 85 years. Basic activities of daily living and ambulation were measured by personal interview during hospitalization and phone contact at 3, 6, and 12 months. Longitudinal data of recovery in these areas were analyzed using generalized estimating equations. RESULTS: Older age was strongly associated with poor recovery in all areas of function, except eating. The pattern of recovery of ambulation differed with age, peaking at 6 months in the younger group and continuing for at least 12 months in the eldest group. The pattern of recovery of overall and individual activities of daily living was similar in the three age groups. Recovery of areas associated with upper extremity function peaked at 3 months, whereas areas associated with lower extremity function peaked at 6 months. CONCLUSIONS: The patterns of functional disability after hip fracture differ with areas of function and age with the oldest patients having a particular risk of decline and a prolonged time to recovery of ambulation.

The ability of sperm selection techniques to remove single- or double-strand DNA damage.

A wide variety of techniques for the preparation of sperm are currently available, of which the most commonly employed are density-gradient centrifugation (DGC) and swim-up (SUP). To date, these methods appear to be effective in selecting functional sperm for assisted reproduction techniques (ART), but they may have negative effects on sperm DNA. In this study, the ability of these semen processing techniques to eliminate spermatozoa containing single- and double-strand DNA damage was assessed by the two-tailed comet assay and the sperm chromatin dispersion test in 157 semen samples from patients seeking assisted reproduction treatment. Our results indicated that SUP and DGC are equally efficient in eliminating spermatozoa containing double-strand DNA damage and sperm with highly damaged (degraded) DNA, as characterized by the presence of both single- and double-strand DNA breaks. However, DGC is more efficient than SUP in selecting spermatozoa that are free from single-strand DNA damage. Future studies should characterise the importance of the various types of DNA damage and examine the sperm processing protocols used in each laboratory to determine their ability to eliminate DNA damage and hence, prevent the potential transmission of genetic mutations via ART.

Pregnancy outcome after preimplantation genetic diagnosis in an affected couple with X-linked adrenoleukodystrophy.

OBJECTIVE: To achieve a pregnancy free of X-linked adrenoleukodystrophy (X-ALD) by intracytoplasmic sperm injection (ICSI) and preimplantation genetic diagnosis (PGD). DESIGN: Case report. SETTING: Clínica FIV Recoletos, a private IVF center. PATIENT(S): A couple in which the man had X-ALD. INTERVENTION(S): The ICSI protocol and PGD of the obtained embryos. MAIN OUTCOME MEASURE(S): Blastomeres were analyzed by fluorescence in situ hybridization using sex selection techniques. Embryos were transferred and pregnancy was diagnosed by hCG analysis and ultrasonographic examination. RESULT(S): Ten embryos were obtained by ICSI. A biopsy was taken from eight embryos to perform PGD and two male embryos were transferred resulting in a twin pregnancy. CONCLUSION(S): This is the first registered gestation in which PGD has been used to prevent X-ALD transmission.

Estilos de vida y factores de riesgo asociados a la cardiopatía isquémica / Life styles and risk factors associated with ischemic heart disease

Se realizó un estudio descriptivo en 4 consultorios del Policlínico Docente Plaza de la Revolución, durante el año 2000, en el que participaron 100 pacientes portadores de cardiopatía isquémica, a los que se les realizó una encuesta buscando la presencia de factores de riesgo coronarios; y otra para evaluar estilos de vida, las formas clínicas de presentación y tratamiento. En la muestra predominó el sexo femenino, la raza blanca, más de la mitad eran jubilados con un nivel de escolaridad que no rebasa el 9no. grado, y casi el 90 por ciento eran mayores de 60 años. Los factores de riesgo más frecuentes fueron la HTA, los APF, el sedentarismo y el hábito de fumar; e igualmente se comprobó que los medicamentos más usados fueron los antiagregantes plaquetarios y los vasodilatadores. La forma clínica que predominó fue la cardiopatía isquémica no dolorosa. Al evaluar el estilo de vida de estos pacientes encontramos que los comportamientos no promotores de salud prevalecieron en la muestra, apareciendo con peores resultados los relacionados con responsabilidad con la salud, soporte interpersonal y ejercicio físico

Comportamiento de los factores de riesgo de la enfermedad aterosclerótica en un consultorio médico / Performance of risk factors in atherosclerotic disease in a physician´s office

Se realizó un estudio descriptivo transversal, en el que se exploró la presencia de factores de riesgo de aterosclerosis en la población mayor de 20 años del Consultorio No. 6 perteneciente al Policlínico Plaza de la Revolución, en el período 2001-2002. La información se recopiló mediante el método de encuestas a través de las entrevistas médicas, y la revisión de las historias clínicas individuales y familiares. A cada factor de riesgo se le otorgó un valor acorde con su intensidad, siendo el valor resultante la suma de los factores de riesgo. Se procesaron los datos de las variables objeto de estudio por el sistema SPSS/ PC - 08 mediante el cual se realizó análisis estadístico que se resumió en tablas. Se obtuvo que casi 1/3 de la población está en el grupo de mayores de 60 años con predominio del sexo femenino; y los factores de riesgo presentes con mayor frecuencia fueron el sedentarismo, la hipertensión arterial y el hábito de fumar, relacionados con la edad, no así con el sexo. El riesgo total de aterosclerosis aumentó proporcionalmente con la edad

Comportamiento de la enfermedad cerebrovascular en el adulto joven en el Hospital "General Calixto García" / Situation of cardiovascular disease in young adults in General Calixto Garcia

Se realizó un estudio descriptivo retrospectivo de los pacientes adultos menores de 45 años con diagnóstico de enfermedad cerebrovascular (ECV). Nuestro universo quedó constituido por un total de 27 pacientes. Se revisaron las historias clínicas y los datos fueron recogidos mediante una encuesta. Se procesaron estadísticamente y los resultados fueron expresados en tablas estadísticas. Se encontró que los adultos jóvenes son afectados mayoritariamente por la hemorragia subaracnoidea, que en el grupo etáreo de 31-35 años se encuentra la mayor cantidad de pacientes y que no existió predominio relevante en cuanto sexo y raza. Las complicaciones aparecen con frecuencia y el estudio imagenológico resulta importante para el diagnóstico y tratamiento

Ocurrencia de enfermedad cerebrovascular en pacientes hipertensos / Ocurrence of cerebrovascular disease in hypertensive patients

Se realizó un estudio para establecer la relación entre la hipertensión arterial esencial y la enfermedad cerebrovascular, en 19 consultorios del Médico de la Familia del Policlínico Plaza de la Revolución. Se aplicó una encuesta a pacientes reevaluados como hipertensos, confeccionándose una base de datos para tratamiento en el sistema FOXBASE versión 5.0. Aplicamos prueba de asociación entre variables cualitativas que se distribuyen en Chi cuadrado. Se identificó el comportamiento de la hipertensión arterial atendiendo a grados, los grupos etáreos, el sexo, la raza y los factores de riesgo asociados. Se estableció igualmente la relación entre el control de la hipertensión arterial y la aparición de la enfermedad cerebrovascular y encontramos un 15 por ciento de población hipertensa, predominando la moderada (36,88 por ciento), con mayor representación los grupos etáreos de 55 a 64 años (38,29 por ciento) y de 45 a 54 (23,16 por ciento), del sexo femenino (55,02 por ciento) y de la raza blanca (54,04 por ciento). La ocurrencia de enfermedad cerebrovascular estuvo representada por el 4, 35 por ciento, correspondiente a 71 pacientes, con mayor asociación a la hipertensión arterial severa. No resultó significativamente estadística la relación entre enfermedad cerebrovascular e hipertensión arterial

Prolapso de la válvula mitral / Mitral valve prolapse

Se informan 5 casos con prolapso de la válvula mitral en el Hospital Docente Clínico-quirúrgico "General Calixto García" en 1984. Los síntomas más frecuentes son: el dolor precordial, la lipotimia, los mareos, la disnea y el complejo auscultatorio de chasquido sistólico-soplo sistólico. Se señala la utilidad de la maniobra para detectar hipotensión ortostática y taquicardia. A todos los pacientes se les realizó ecocardiografía. Se hace un estudio de la edad, el sexo, la raza, el biotipo, los síntomas, los datos positivos al examen físico y exámenes complementarios diagnósticos

Tromboembolismo y/o infarto pulmonar / Pulmonary thromboembolism and/or infarction

En este estudio se encontraron 209 casos de tromboembolismo y/o infarto pulmonar entre 3 093 necropsias realizadas en el período 1982-1984. Se estudió la distribución por sexos y grupos etarios, así como enfermedades de base o asociadas, signos, exámenes complementarios, etcétera. Se indica que sólo en el 16,2