Adherence to reporting guidelines in observational studies concerning exposure to persistent organic pollutants and effects on semen parameters.

STUDY QUESTION: Are studies on semen quality in men exposed to persistent pesticides reported according to the 'strengthening the reporting of observational studies in epidemiology' (STROBE) recommendations and the guidelines for the appraisal of semen quality studies (SEMQUA)? SUMMARY ANSWER: Most studies of the impact of pesticides on semen quality do not follow the STROBE and SEMQUA guidelines, thus adherence is low, especially in methodological aspects. WHAT IS KNOWN ALREADY: Much of the controversy about reduced semen quality in recent decades arises from a lack of standardization in the methodology applied, despite the existence of several validated instruments for evaluating the quality of reporting. Indeed, SEMQUA was purpose-designed for the particular characteristics of semen quality studies. STUDY DESIGN, SIZE, DURATION: A structured literature search identified eligible articles reporting on persistent pesticides and human semen quality, published in English before 1 September 2012. Opinion articles and reviews were excluded. We assessed the adherence to reporting guidelines of the articles, using and comparing the STROBE statement and the SEMQUA guidelines, in both cases with indicators relevant to observational studies of semen quality. PARTICIPANTS/MATERIALS, SETTING, METHODS: A comprehensive bibliographic search in various electronic literature databases using the key words 'sperm' and 'pesticide' obtained 1179 papers, of which 46 were valid for our purposes. The papers examined occupational (26) and environmental exposure (20). Two of the present authors independently piloted the data extraction form for this review. The articles were then evaluated by two researchers using the STROBE and SEMQUA checklists. MAIN RESULTS AND THE ROLE OF CHANGE: Although no significant differences were found between the overall degree of compliance with STROBE and SEMQUA (47.0 ± 18.5% versus 43.1 ± 11.6%), there were significant differences when only methodological aspects were considered (48.4 ± 21.0% versus 39.5 ± 17.4%; P < 0.001). We observed an increase over time in the degree of compliance, for SEMQUA (r = 0.61 and P < 0.001) and STROBE (r = 0.45 and P < 0.01). The papers that reported a negative effect of exposure to persistent pesticides on sperm concentration presented a lower level of compliance to SEMQUA (42.1 ± 18.3% versus 57.6 ± 14.2%; P < 0.01) and STROBE (40.2 ± 10.3% versus 49.5 ± 11.6%; P < 0.05) than those which recorded no such influence. The year of publication and the observed effect on sperm concentration were the only candidate variables included in the model of stepwise multiple regression model for the 'degree of compliance' variables of SEMQUA and STROBE. LIMITATIONS, REASONS FOR CAUTION: Other characteristics of reporting quality, such as legibility, were not evaluated. WIDER IMPLICATIONS OF THE FINDINGS: The low degree of compliance observed is consistent with that observed in other studies of reproductive medicine and highlights the need to improve the design of studies of semen quality. SEMQUA proved to be a more specific tool than STROBE for the field of semen quality. Editors, reviewers and authors should be aware of SEMQUA and apply it when assessing papers on semen quality. STUDY FUNDING/COMPETING INTEREST(S): No research funding was received and none of the authors have any conflict of interests.

Embryologists' health: a nationwide online questionnaire.

PURPOSE: The present study evaluates health status and its relation with occupational characteristics and with burnout syndrome among embryologists. METHODS: A cross-sectional design was used to conduct an online self-assessment survey, sent to all members of the Spanish Association of Clinical Embryologists. The questionnaire contained occupational questions and two standard instruments: 'Short Form-12 Health Survey' as a measure of physical (PCS-12) and mental (MCS-12) health and the Maslach Burnout Inventory-General Survey (MBI-GS) to evaluate the degree of burnout. RESULTS: The PCS-12 obtained for the Spanish embryologists was higher than that for the reference population. However, the total MCS-12 was significantly lower than that observed in non-institutionalised males and females representative of the general Spanish population aged 35-44 years. In the linear regression model, the dependent variable PCS-12 was related indirectly with the variables number of hours worked per week, BMI, back pain, leg pain and visual discomfort. In the linear regression model, the dependent variable MCS-12 was indirectly related to the gender (male reference; female coefficient regression: -3.23), exhaustion and cynicism dimensions of the MBI-GS. A total of 87 (36.3%) embryologists presented a high score on at least one of the MBI-GS dimensions. CONCLUSION: In this sample of Spanish embryologists, a norm measure (SF-12) showed their physical health to be better than the average for the general population, but that their mental health was poorer. A significant indirect relation was observed between mental health and burnout syndrome. Strategies to reduce occupational stress and problems should form part of the training provided for clinical embryologists.

Acceptable variability in external quality assessment programmes for basic semen analysis.

BACKGROUND: External quality assessment is essential in modern andrology laboratories. To assess the proficiency of laboratories participating in an external quality assessment programme (EQAP), limits for acceptable variability must be determined. Limits currently specified largely depend on criteria set by the organizers of individual EQAP schemes. The objective of this study was to evaluate the different criteria described in ISO 13528: 2005 for calculating acceptable variability in EQAP when applied to basic semen analysis parameters. METHODS AND RESULTS: The data used in this study were the means and standard deviations obtained for independent samples from two EQAPs, one national (Spanish) and one international (European). The acceptable variability according to ISO 13528: 2005 was calculated using four types of criteria: (i) ± 3 standard deviations of the results of all participating laboratories; (ii) ± 3 standard deviations of the results of expert laboratories; (iii) quality specifications based on biological variability, state-of-the-art and clinicians' opinions and (iv) the same quality specifications adjusted for the uncertainty of the assigned value. The first two strategies resulted in very wide ranges of acceptable variability. Conversely, the strategy based only on quality specifications resulted in very narrow ranges. For the fourth strategy, acceptable ranges were intermediate between the results produced with the other strategies. The third and fourth strategies did not produce observable differences in acceptable ranges when the model used for calculating the specifications of analytical quality was changed. CONCLUSIONS: It is essential that EQAPs for semen parameters should determine the ranges for acceptable variability in results. Moreover, these ranges must be clinically useful, i.e. the variability should have a minimal negative impact on clinical decisions. The exact definition of 'expert laboratory' is more important than the model chosen for estimating analytical quality specifications in an EQAP for semen parameters in basic semen analysis.

Sperm chromatin structure assay and classical semen parameters: systematic review.

The present study is based on a PubMed search and compares the clinical validity of classical semen parameters (CSP) and the sperm chromatin structure assay (SCSA) in different clinical contexts. The PubMed database was searched using keywords on the sperm diagnostic test for pregnancy in three clinical scenarios: (i) couples attempting to conceive; (ii) couples who had been attempting to conceive for 12months without success; and (iii) couples treated with intrauterine insemination (IUI). There was a considerable heterogeneity among the studies included. For couples attempting to conceive following a SCSA that produced an abnormal result, the likelihood of male factor infertility ranged from a pre-test value of 7.5% to a post-test value of 32.1% [95% confidence interval (CI) 15.7-54.5], while after CSP with an abnormal result, the post-test probability was 17.3% (95% CI 11.8-24.5). For a pre-test prevalence of male factor infertility of 50%, the post-test probability of male factor infertility after an abnormal test is very similar for both SCSA and CSP. In couples treated with IUI, the clinical validity of SCSA is higher than that of sperm morphology alone, but not enough to introduce SCSA as a test in male infertility work-up.

Comparison of methods to determine the assigned value in an external quality control programme for embryo evaluation.

This study set out to establish adequate assigned values for a National External Quality Control Programme of embryo evaluation. The results obtained by Spanish laboratories in this programme are compared with those of a group of national experts in embryo quality. Image-based embryo evaluation consists not only of classifying embryos as being of optimal, moderate or poor quality, but also of specifying the clinical decision to be taken regarding each embryo (transfer, cryopreservation or rejection). The proportion of embryos for which there was a high degree of agreement among the experts was 98.3% for embryo classification and 93.3% for clinical decision; for the laboratories, the respective values were 44.2 and 42.5%. With respect to the interobserver agreement among laboratories and experts, kappa coefficients were lower than 0.6 both for classification and for clinical decision. The experts recommended cryopreservation of a higher percentage of embryos classified as poor quality than did the laboratories (28 versus 4%, P = 0.05). The data obtained show that the agreement among laboratories is lower than among experts, and that the concordance among experts and laboratories is moderate. Therefore, it is recommended that an assigned value from external quality control programmes is established based on the consensus values obtained from experts.

Human intestinal infection due to coccidia in Mozambique: two cases.

A case of intestinal infection by Cryptosporidium parvum and another of intestinal Isospora belli infection, both in AIDS patients, are described. The two patients presented pulmonary tuberculosis symptoms and watery diarrhoea. Modified Ziehl-Neelsen stain of stools gave a definitive diagnosis in both cases. They are the first reports of intestinal coccidia infections in AIDS patients described in Mozambique.

Genetic testing of sperm donors for cystic fibrosis and spinal muscular atrophy: evaluation of clinical utility.

OBJECTIVE: To evaluate the clinical utility of genetic testing for cystic fibrosis (CF) and spinal muscular atrophy (SMA) in sperm donors. STUDY DESIGN: We studied the results of the genetic tests for CF and SMA applied to 372 sperm donor candidates. The CF carrier screening test analysed 32 mutations on the CFTR gene. Regarding SMA, the carrier test studied possible deletions of SMN1/2 by Multiplex Ligation-dependent Probe Amplification (MLPA) methodology. RESULTS: The carrier frequency obtained was greater for SMA than for CF. After adjusting the results obtained for the sensitivity of the tests, and taking into account the prevalence of female carriers in our population, the probability of transmission of the disease to the child from a donor with a negative genetic test was about five times lower in the case of SMA than in CF, although this difference was not statistically significant. The number of donors needed to screen (NNS) to avoid the occurrence of a child being affected by CF and SMA in our population was similar in both cases (1591 vs. 1536). CONCLUSIONS: This study demonstrates the need to include SMA among the diseases for which genetic screening is performed in the process of sperm donor selection. We believe that testing donors for SMA is as important and as useful as doing so for CF.

Expression of integrin fraction and adhesion molecules on human granulosa cells and its relation with oocyte maturity and follicular steroidogenesis.

PURPOSE: To study the correlation between the expression of integrin fractions and adhesion molecules on granulosa cells (GC) and follicular development. METHODS: GC and follicular fluid (FF) were obtained at oocyte retrieval for ICSI. Expression of adhesion molecules on GC was studied by flow cytometry. Statistics were evaluated using the Student t test and simple linear regression analysis. RESULTS: alpha5 integrin fraction was significantly (p < 0.01) higher, while alpha6 fraction and CD9 were significantly (p < 0.01 and p < 0.001, respectively) lower in GC from FF with metaphase II oocytes. A direct significant correlation was observed between FF progesterone and the alpha5 expression on GC (r = 0.54). In contrast, an inverse significant correlation was observed between FF progesterone level and the expression of alpha6 and CD9 (r = -0.40 and -0.41, respectively). CONCLUSIONS: The expression pattern for integrin fractions and adhesion molecules may be of predictive value in assessing the state of differentiation of the human follicle.

Programa del asma en Atención Primaria: estudio comparativo entre dos centros de salud de Valladolid / No disponible

Introducción: el asma es la enfermedad crónica infantil más prevalente en España y en elresto de países desarrollados. En Valladolid la prevalencia según los datos de la fase III del estudioISAAC es de 7,2-9,2%. Coincidiendo con la implantación del programa de atención al niñoasmático en Castilla y León, presentamos un estudio comparativo de los resultados de dichoprograma entre una población rural y otra periurbana en Valladolid.Pacientes y métodos: estudio observacional transversal en niños de 0-14 años que cumplíancriterios de inclusión en el programa de asma infantil. Se recogieron datos demográficos,pruebas alérgicas, clasificación de la gravedad, distribución estacional y tratamiento.Resultados: las diferencias entre ambas zonas se hallaron respecto a la prevalencia (mayoren zona periurbana), sexo (70% de varones en la zona periurbana), edad (43,7% en la zona periurbanafrente al 30% en la rural), en pruebas alérgicas (46,2% positivas en menores de 2 añosen la zona periurbana y 26% en la rural), distribución estacional (predominio invernal en la zonaperiurbana y primaveral en la rural en menores de 2 años) y tratamiento (en la zona rural usode salbutamol oral, mucolíticos y antibióticos en las crisis). El resto de datos analizados son similaresentre ellos y concordantes con otros estudios.Conclusiones: al comparar las dos zonas se observan diferencias atribuibles a factores ambientales(asistencia a guarderías, infecciones, contaminación ambiental, etc.) y similitudes enuna enfermedad que tiene una importante base genética, sin olvidar factores ajenos al proceso,como es la no universalización de la asistencia por pediatras a los niños de la zona rural(AU)

Introduction: asthma is the more prevalent infantile chronic disease in Spain and in therest of developed countries. According to the findings of ISAAC Phase Three, its prevalence inValladolid is 7.2-9.2%. Coinciding with the implementation of asthmatic children health careprogramme in Castilla y León, we present a comparative study based on the findings obtainedby this programme between a rural and periurban population in Valladolid. Subjects and methods: a cross-sectional, observational study of children 0 to14 years ofage who satisfied inclusion criteria to the infantile asthma programme. Demographic data,allergic tests, severity classification, seasonal distribution and treatment have been collected.Results: sex differences have been detected between both areas (70% for male in the periurbanarea), age differences (43.7% in periurban area vs. 30% in the rural one), in allergictests (46.2% positives for less than 2 years of age in periurban area and 26% in the rural one)seasonal distribution differences (winter prevalence in periurban area and spring prevalence inthe rural area for children less than 2 years of age) and treatment differences (use of oral salbutamol,mucolytics and antibiotics in crisis in rural area). The rest of the analysed data are similarbetween them and confirm the data of other studies.Conclusions: the findings of the comparison between the two areas of study are differencesdue to environmental factors (day care attendance, infections, environmental pollution…)and similarities due to the fact that they are diseases with an important genetic base, not forgettingsome foreign factors to the process such as the lack of universalization of pediatric assistancein the rural area(AU)

[Socioeconomic effects of human brucellosis]. / Repercusión socioeconómica de la brucelosis humana.

The socio-economic cost of human brucellosis is analyzed. One hundred and seven patients are included in this study, 75 males (70.09%) and 32 females (29.91), diagnosed of brucellosis in the Internal Medicine Department of the Regional Hospital "Carlos Haya" in Málaga from the 1st of October 1984 to the 31st of December 1986. Thirty seven patients (34.57%) presented some kind of complication. Seventy eight cases (72.89%) were admitted to the hospital resulting in a total of 1.005 hospital admissions with a mean hospital stay of 12.88 days. The total economic cost was 30.724.962 pesetas with a mean patient cost of 287.149 pesetas. The total number of work absence days was 5.291 with a mean 101.7 days per patient and with an accumulated cost in this respect of 49.053.151 pesetas. The total money loss was 84.307.488 pesetas with a mean of 787.920 pesetas per patient. This high cost, together with the high incidence of the disease throughout most of our national territory, clearly justify the need for aggressive preventive measures.

El fenotipo de inestabilidad de microsatélites (MIN) revela un patrón específico de mutaciones durante la carcinogénesis del colon / Microsatellite instability phenotype (MIN) reveals a specific pattern of mutation during colon tumorigenesis

Se ha investigado la presencia de mutaciones en genes ligados a apoptosis, crecimiento y diferenciación celular y respuesta inmunológica en 132 cánceres de colon escogidos al azar. Los tumores que presentaron alteraciones en estos genes, (BAX, TGFb-RII y b2m) parece constituir un grupo homogéneo que comparte la característica de inestabilidad de microsatélites, ya que todos ellos presentaron inestabilidad en BAT 26 y BAT40. Por el contrario, ninguno de los tumores MIN negativos presentaron alteraciones en las zonas de repetición de los genes anteriormente mencionados aún cuando algunos de ellos también tenían alteraciones en la expresión de antígenos de HLA, pero nunca asociadas a mutaciones en el gen de la b2m. El hecho de que en la mayoría de los casos, las mutaciones detectadas representan inactivaciones bialélicas, supone que estos genes están involucrados en la carcinogénesis de estos tumores, mediante un proceso de selección clonal, y probablemente a través de una ruta mutagénica diferente de la que se observa en la mayoría de los cánceres de colon esporádicos (AU)

Niveles de leptina en líquido folicular de mujeres con Síndrome de Ovarios Poliquísticos ometidas a Desarrollo Folicular Múltiple / Leptin in follicular fluid from women with Polycystic Ovary Syndrome subjected to multiple follicular development

OBJETIVO: Profundizar en la fisiopatología del Síndrome deOvarios Poliquísticos (SOP) mediante el análisis del papel de laleptina a nivel folicular ovárico y en la regulación de la esteroidogénesisfolicular

OBJETIVE: To investigate the physiopathology of the PolycysticOvary Syndrome (PCOS) by analysing the role of leptin in theovarian follicle and in the regulation of follicular steroidogenesis

Regeneración del proceso alveolar: injertos óseos

Para poder conseguir un buen resultado en la rehabilitación de los pacientes edéntulos con implantes es necesario reconstruir la atrofia ósea que acompaña a la pérdida dentaria. Para la reconstrucción del proceso alveolar atrófico disponemos de dos alternativas: los injertos óseos y la distracción osteogénica. La distracción de los procesos alveolares, por lo reciente de la misma, es una técnica todavía poco conocida, practicada por pocos cirujanos, con poca casuística y seguimiento a largo plazo, tal y como se desprende de las revisiones bibliográficas. La técnica de distracción está sujeta todavía a numerosas variaciones, y se muestra muy sensible a las manos del cirujano que la realiza. Citamos como muestra de las dificultades técnicas el control del vector, el riesgo de necrosis del fragmento distraído, riesgos periodontales en dientes vecinos, y ser una técnica dependiente del comportamiento y cuidados del paciente. Por todo ello, consideramos que los injertos óseos en sus distintas modalidades, son el tratamiento de elección para la reconstrucción del proceso alveolar. Dicha reparación permitirá colocar los implantes en la posición ideal y, posteriormente, conseguir con la prótesis resultados estéticos y funcionales comparables a la dentición natural perdida (AU)

Injertos óseos en cirugía implantológica: aspectos generales. Principios y fundamentos / Bone grafts in implantologic surgery. General aspects. Principles and fundaments (Part 1)

Los injertos óseos constituyen una de las técnicas de más frecuente uso en la cirugía reconstructiva implatológica. El material de elección para el reemplazo del hueso perdido por atrofia, traumatismo, procesos patológicos congénitos o adquiridos son los injertos óseos autógenos. En la curación del injerto óseo pueden intervenir fenómenos de osteogénesis, osteoconducción y osteoinducción. Los injertos óseos esponjosos se revascularizan antes que los injertos corticales. Los injertos de hueso de origen membranoso se reabsorben menos que los de origen endocondral. Los injertos óseos pueden ser colocados como bloques (corticales o corticoesponjosos) o particulados. Los injertos en bloque deben ser fijados con tornillos de oseosíntesis. Las tasas de éxito de los implantes superan el 80 por ciento en el maxilar superior y el 90 por ciento en la mandíbula. La causa más frecuente de complicaciones con los injertos en bloque es consecuencia de la dehiscencia de la mucosa, con exposición del injerto al medio intraoral. La instalación de las fijaciones en un segundo tiempo (diferidas a la reconstrucción ósea), permite la colocación más precisa de los implantes para su posterior rehabilitación prostodóntica (AU)

Injertos óseos en cirugía implantológica: técnicas quirúrgicas en el maxilar y la mándíbula / Bone grafts in implantologic surgery. Surgical techniques in the maxilla and mandible (Part II)

Los injertos óseos constituyen una de las técnicas de más frecuente uso en la cirugía reconstructiva implantológica. El material de elección para el reemplazo del hueso perdido son los injertos óseos autógenos. En los últimos 20 años se han publicado diferentes técnicas de reconstrucción ósea combinadas con implantes. Los injertos en bloque pueden colocarse por aposición a la cresta alveolar ("onlay graft"), interposición bajo el suelo del seno, de las fosas nasales, o de la cresta alveolar desdoblada con escoplos ("inlay graft"), por vestibular de la cresta atrófica ("veneer graft") o en silla de montar ("saddle graft", para tratar simultáneamente los problemas de deficiente altura y anchura). Los injertos esponjosos pueden colocarse bajo membranas de regeneración ósea guiada (ROG), mallas de titanio, en el suelo del seno o en el interior de cavidades óseas. La causa más frecuente de complicaciones con los injertos en bloque es consecuencia de las dehiscencia de la mucosa, con exposición del injerto al medio intraoral. La instalación de las fijaciones en un segundo tiempo (diferidas a la reconstrucción ósea), permite la colocación más precisa de los implantes para su posterior rehabilitación prostodóntica. (AU)

Guía para la interpretación de los resultados del estudio serológico frente VHB y VHC en donantes de gametos / Guideline for the interpretation of the results of serologic study front HBV and HCV in gametes donors

El estudio de enfermedades infecciosas de transmisión en donantes de gametos está regulado por el RD 412/96. Entre las enfermedades de estudio obligatorio se encuentran las hepatitis B y C con repeticiones del estudio serológico cada seis meses para los donantes de semen. En este trabajo presentamos un protocolo de actuación ante los resultados de los estudios serológicos de hepatitis B y C y su interpretación en función de los valores de transaminasas y antecedentes personales. Las pruebas serológicas recomendadas para descartar infección por VHB son antígeno HBs y anticuerpos anti-HBc y para descartar infección por VHC son los anticuerpos anti-VHC (AU)

The study of the transmission infectious diseases in gametes donors is regulated by BD 4l2/BB. Between the diseases of obligatory study are present hepatitis B and B with repetitions of the serological study each 6 months for semen donors. In this work we show a protocol of performance before the results of the serological study of hepatitis B and E and their interpretation depending on the transaminasas value and personal antecedents. The tests recommended to discard an infection by HBV are HBs antigen and anti-HBc antibodies and to discard infection by HCV are anti-HVC antibodies (AU)

Bacteriuria e infección urinaria en el medio residencial. Análisis de la evolución de la situación de bacteriuria y de los datos microbiológicos / Bacteriuria and urinary infection in the nursing home environment. Analysis of the evolution of the bacteriuria situation and of the microbiological data

INTRODUCCION: Estudio de la prevalencia, evolución, manifestaciones clínicas, microorganismos y antibióticos activos en bacteriurias asintomáticas no significativas (BANS), bacteriurias sintomatológicas significativas (BAS) e infecciones del tracto urinario (ITU) y sus relaciones con determinadas variables. MATERIAL Y MÉTODOS: Estudio longitudinal descriptivo con una muestra de 75 pacientes, 65 mujeres y 10 hombres, promedio de edad de 83,7 años, durante un año en una residencia de ancianos. Se excluyeron a 39 enfermos de los 114 iniciales. Las BAS o BANS no se trataban. Se hacía control analítico quincenalmente en las BAS; cada dos meses si era negativa o si había BANS. En las ITU se hacía otro cultivo a las 48 horas de terminar el tratamiento con cefuroxima o ciprofloxacino. RESULTADOS: El 49,2 por ciento de los cultivos fueron BAS; el 15 por ciento de los mismos evolucionaron espontáneamente a cultivos negativos, un 6 por ciento a BANS y otro 9 por ciento a ITU. Un 40,2 por ciento de las analíticas fueron negativas. El 20 por ciento de los cultivos negativos evolucionaron a BAS. Hubo relación significativa de bacteriuria con el sexo, incapacidad funcional, mental e incontinencia. Los signos más frecuentes de la infección de orina fueron la orina maloliente y la hematuria. Escherichia coli fue la bacteria más frecuente, siendo más sensible a la cefuroxima y coamoxiclav que a al ciprofloxacino. DISCUSION: Se confirma la alta prevalencia de BAS en este tipo de ancianos y la remisión espontánea en un porcentaje elevado de casos. No se observó relación entre BAS persistente con aumento de mortalidad o morbilidad. CONCLUSIONES: Se concluye la bacteriuria como un marcador del estado funcional y mental del anciano. La ITU presenta manifestaciones clínicas diferentes a las de la población más joven. Se demuestra la conveniencia de no tratar a las BAS con antibióticos excepto en casos concretos (AU)

Patogenia de la esterilidad asociada a endometriosis / The pathogenesis of sterility associated with endometriosis

No disponible