Clinical Pregnancy After Elimination of Embryo Fragments Before Fresh Cleavage-stage Embryo Transfer.

Objective: To determine if the elimination of fragments in cleavage-stage embryos, before fresh transfer, improves pregnancy rates in in vitro fertilization cycles. Materials and methods: This is a Prospective observational case-control study carried out at a University Reproductive Center. We included Twenty-six infertile patients divided into two groups. Group one: 13 patients with embryos classified as grade B and C (embryos with fragments) according to the Hill classification, and Group two: 13 patients with grade A embryos (embryos with no fragments). Embryo Defragmentation was performed in embryos of group one 65 to 68 hours after conventional fertilization. Fresh embryo transfer was made after two hours post fragments removal. Reproductive results were evaluated and compared between both groups. Results: The total number of clinical pregnancies was nine. In group one there were 5 (38.5 %); in group two, there were 4 (30.8%). The difference was not statistically significant (p = 0.68). Two abortions were reported in the study, both in group one; were fragment elimination was performed. This represents an abortion rate of 40% in patients who got pregnant in this group. These patients had twice the probability of suffering an abortion (OR 2.1; 95% CI 1.4-3.37). Ongoing pregnancies were similar in both groups. Conclusion: Removal of fragments in freshly transferred day three embryos could be an alternative to increase clinical pregnancy and ongoing pregnancy rates in patients who have only poor-quality embryos. Despite the relationship with a higher abortion rate, this strategy could represent a real alternative for this type of patient.

Identidad cultural, salud social y Estado Social de Derecho: el caso Tesoro Quimbaya, Quindío, Colombia / Cultural Identity, social health, and the Social State Under the rule of law: the case of The Quimbaya Treasure Quindío, Colombia

Se aborda el concepto de "identidad cultural", como elemento cohesionador al interior de un grupo, en el marco de la historia y el territorio. Se plantea la relación de esta identidad cultural con símbolos de filiación y procedencia, tales como el patrimonio arqueológico; en este caso el "Tesoro Quimbaya". Se presenta la "salud social", como la capacidad de una comunidad, inmersa en una cultura y en un territorio, de relacionarse saludablemente abrigando sentimientos de respaldo y confianza. Rudimentos de identificación como son los legados ancestrales, permiten crear una confesión de "pertenencia sociocultural" y autodeterminación de los pueblos, que concurren en la salud de una sociedad. La autonomía de los pueblos y el reconocimiento de su diversidad se manifiestan en la noción de Estado Nación y de Estado Social de Derecho. En este documento se argumenta que aunque la construcción del estado fue una tarea política, no así la edificación de la nación, la cual resultó de un trabajo cultural previo; no obstante, los derechos historiales se reflejan en las constituciones establecidas. El Tesoro Quimbaya fue donado a España como parte de la participación de Colombia en las ceremonias de conmemoración del IV centenario del "Descubrimiento de América". El presente ensayo documenta los actos jurídicos que evidencian la inconstitucionalidad de tal donación y por lo tanto la posible repatriación del mismo. Enfatiza la importancia de su repatriación, dado el valor que este representa como agente de la identidad cultural de los colombianos en general y de los quindianos en particular.(AU)

We approach the concept of "cultural identity" as a cohesive element within a group in the context of history and territory. We posit the relationship between this cultural identity with symbols of affiliation and origin, such as archeological heritage; in this case "The Quimbaya Treasure". We present "social health" as the capacity of a community, immersed in a culture and a territory, to relate healthily and cherish sentiments of support and trust. Rudiments of identity such as ancestral legacies allow for the creation of feelings of "sociocultural belonging" and self-determination of peoples that take paret in the health of a society. The autonomy of peoples and the recognition of their diversity appear in the notion of Nation State and Social State Under the Rule of Law. In this document, it is argued that, though the construction of this state was a political task, the edification of the nation was not. This edification was the result of earlier cultural labor. Nevertheless, historical rights are reflected in established constitutions. The Quimbaya Treasure was donated to Spain as part of Colombia's participation in ceremonies commemorating the 400th anniversary of the "Discovery of the Americas". This essay documents the legislative acts that prove the inconstitutionality of that donation and, as a result, the treasure's possible repatriation. It places emphasis on the importance of the repatriation given the value it possesses as an agent of cultural identity for Colombians in general and the residents of Quindío in particular.(AU)

[Cultural Identity, social health, and the Social State Under the rule of law. The case of "The Quimbaya Treasure". Quindío, Colombia]. / Identidad cultural, salud social y Estado Social de Derecho. El caso "Tesoro Quimbaya" Quindío, Colombia.

We approach the concept of "cultural identity" as a cohesive element within a group in the context of history and territory. We posit the relationship between this cultural identity with symbols of affiliation and origin, such as archeological heritage; in this case "The Quimbaya Treasure". We present "social health" as the capacity of a community, immersed in a culture and a territory, to relate healthily and cherish sentiments of support and trust. Rudiments of identity such as ancestral legacies allow for the creation of feelings of "sociocultural belonging" and self-determination of peoples that take paret in the health of a society. The autonomy of peoples and the recognition of their diversity appear in the notion of Nation State and Social State Under the Rule of Law. In this document, it is argued that, though the construction of this state was a political task, the edification of the nation was not. This edification was the result of earlier cultural labor. Nevertheless, historical rights are reflected in established constitutions. The Quimbaya Treasure was donated to Spain as part of Colombia's participation in ceremonies commemorating the 400th anniversary of the "Discovery of the Americas". This essay documents the legislative acts that prove the inconstitutionality of that donation and, as a result, the treasure's possible repatriation. It places emphasis on the importance of the repatriation given the value it possesses as an agent of cultural identity for Colombians in general and the residents of Quindío in particular.

Aldosterone inhibition and cardiovascular protection: more important than it once appeared.

Aldosterone is present and active all along the cardiovascular continuum. Excessive tissue production occurs in cardiovascular diseases including myocardial infarction (MI) and heart failure, resulting in a multitude of adverse effects in the cardiovascular system necessitating pharmacologic blockade of this neurohormone. Both human and animal studies have consistently proven the beneficial effects of antialdosteronics in the improvement of: 1) endothelial function, 2) modulation of inflammatory mechanisms between blood and the vascular wall and 3) reduction of tissue proliferation and cardiovascular remodeling leading to different severities of cardiovascular damage. These basic mechanisms of anti-aldosterone therapy strongly support the promising data observed in major clinical trials with aldosterone blockers in cardiovascular diseases, specially in heart failure patients. Whereas aldosterone receptor blockers were initially viewed as potassium-sparing diuretics there has been a clear change of concept in the past 10 years, mainly following the positive results of RALES with spironolactone in chronic heart failure, followed by EPHESUS using eplerenone in patients with systolic dysfunction post MI. The significant positive results in both studies were a clear support for the inclusion of this pharmacologic intervention as first line treatment in most international guidelines for the management of heart failure. More recent and ongoing studies are exploring the usefulness of this type of intervention in preventing vascular and myocardial hypertrophy and remodeling in refractory hypertensive and some hyperfibrotic syndromes. There are also provocative studies investigating in the possibility of inhibiting atherosclerosis. More recently, some studies are suggesting the benefit of aldosterone blockade in sleep apnea. In addition, two large multicentric trials, TOPCAT and EMPHASIS are analyzing the potential use of antialdosteronics in patients with cardiac insufficiency and preserved systolic function and the possibility of extending their indication in systolic heart failure to Phase II respectively. New compounds, blocking the synthesis of aldosterone instead of blocking its receptor are being developed, and initial Phase 2 studies are positive. All of the above results are very interesting, show an optimistic future and are consolidating and enlarging the spectrum of aldosterone blockade in cardiovascular disorders every day.