Revisión Bibliográfica: El Microbioma Humano / Bibliographic Review: The Human Microbiome

El microbioma humano se entiende como el enorme conjunto de microorganismo que habitan de manera simbiótica en los distintos órganos de un individuo sano. Existe evidencia suficiente como para afirmar que la colonización de dichos microorganismo sucede inmediatamente después del nacimiento, e incluso algunos autores sostienen que podría suceder dentro del útero. La cantidad de publicaciones científicas que abordan el tema del microbioma han aumentado exponencialmente en los últimos 5 años dejando claro su papel preponderante en la respuesta inmune y en el equilibro salud enfermedad; afirmando que cambios en su ecosistema en términos de cantidad y calidad se asocia con el inicio o la perpetuación de diversas enfermedades.

The human microbiome is understood as the huge group of microorganisms that inhabit symbiotically in a healthy human. There is enough evidence to affirm that the colonization of microorganism happens immediately after birth, in fact some authors claim that it could happen inside the uterus. The number of scientific publications that address the issue ofthemicrobiome have increased exponentially in the last 5 years,making clearthe predominantrole in the immune response and in the health balance; affirming that changes in the ecosystem in terms of quantity and quality, are associated with the initiation or perpetuation of various diseases.

Evolución del método de fecundación in vitro en España: 1993-2010 / Evolution of in vitro fertilization in Spain: 1993-2010

Introducción: El objetivo del presente estudio fue comparar los cambios en el uso de la intracytoplasmatic sperm injection (ICSI) en España, así como discutir las posibles causas. Métodos: Se analizaron los datos del Registro de la Sociedad Española de Fertilidad (SEF) en el uso de fecundación in vitro (FIV)/ICSI entre los años 1993-2010 con ovocitos propios y donados. Además se analizaron las causas que indicaron la FIV/ICSI y el porcentaje de ciclos realizados con ovocitos propios a mujeres mayores de 40 años. Resultados: El uso de ICSI aumentó del 4% en 1993 al 89% en 2010 en ciclos de técnicas en reproducción asistida con ovocitos propios y del 59% en 1999 al 93% en 2008 en ciclos con ovocitos donados. En el periodo 1993-2001 se observa una disminución de indicaciones de FIV/ICSI por factor femenino y un aumento por factor masculino y esterilidad de origen desconocido (EOD), pero a partir de 2001 estos porcentajes permanecen estables. Una evolución similar se observa en el porcentaje de ciclos con ovocitos propios realizados a mujeres mayores de 40 años. Conclusiones: El uso de la ICSI va en aumento, pero es difícil determinar factores clínicos específicos que expliquen estas diferencias. Dado que la ICSI no proporciona mayores tasas de embarazo que la FIV convencional en parejas cuya causa de esterilidad no sea el factor masculino y además supone un incremento en los costes, algunas parejas estériles podrían beneficiarse de un uso menos frecuente de ICSI (AU)

Introduction: The aim of this study was to compare the changes in the use of intracytoplasmatic sperm injection (ICSI) in Spain and to discuss the possible causes for these changes. Methods: We analysed the data of the Spanish Fertility Society registry on the use of in vitro fertilization (IVF)/ICSI between 1993-2010 with own and donated oocytes. We also studied the reasons for indicating IVF or ICSI and the percentage of cycles performed with own oocytes in the case of women over 40 years. Results: The use of ICSI increased from 4% in 1993 to 89% in 2010 in assisted reproductive technology cycles with own oocytes, and from 59% in 1999 to 93% in 2008 for cycles with donated oocytes. In the 1993-2001 period, a decrease was observed in the indications for IVF/ICSI due to the female factor, together with an increase in these indications due to the male factor or to infertility of unknown origin. However, these percentages have remained stable since 2001. A similar trend has been observed in the percentage of cycles with own oocytes performed with women aged over 40 years. Conclusions: The use of ICSI is increasing, although it is difficult to determine the specific clinical factors that may explain these differences. Since ICSI does not produce higher pregnancy rates than conventional IVF in couples whose cause of infertility is not the male factor and it is also more costly, some infertile couples could benefit from less frequent use of ICSI (AU)

Hábito de fumar y procesos respiratorios / Smoking habit and respiratory processes

Se realizó un estudio descriptivo-prospectivo a los 62 pacientes en hospitalización crónica del Hospital Psiquiátrico Provincial Docente Comandante Manuel Fajardo Rivero, de Manzanillo con el objetivo de determinar el hábito de fumar y los procesos respiratorios en los mismos. Se aplicó una encuesta para obtener los datos del hábito de fumar y los procesos respiratorios, además se revisaron las historias clínicas. Entre los resultados obtenidos tenemos que de los 62 pacientes, 45 fuman, las edades oscilan entre los 55–64 años y 45 a 54. La esquizofrenia y las infecciones respiratorias agudas fueron las patologías más frecuentes(AU)

It was performed a descriptive -prospective research to 62 hospitalized chronic patients at the Commander Manuel Fajardo Rivero Teaching Province Psychiatric Hospital in Manzanillo in order to determine the smoking habits and respiratory processes. It was applied a survey to obtain the data of the smoking habits and respiratory processes, besides the medical records were also reviewed. Among the results obtained we could stated that from the 62 patients, 45 were smoked and the average age was between 55- 64 years and from 45 to 54. Schizophrenia and acute respiratory infections were the most frequent pathologies(EU)

Programa educativo para capacitar a los adultos mayores en torno a la depresión oculta, Manzanillo / Educative program to qualify elderly people regarding the hidden depression. Manzanillo

Se diseña un programa de intervención educativa para capacitar a los adultos mayores del Policlínico Ángel Ortíz Vázquez del municipio Manzanillo en torno a la depresión culta, por la alta concurrencia de estos a los consultorios y cuerpos de guardia de los diferentes hospitales, aquejándose de múltiples síntomas somáticos que son consecuencias de un estado depresivo. Para el desarrollo de este trabajo, se utilizaron métodos teóricos que permitieron el desarrollo del mismo, así como arribar a las conclusiones. La posible efectividad práctica de la propuesta fue evaluada por criterio de experto. La significación práctica está en que las acciones de intervención educativa elaboradas, permiten elevar los conocimientos de los adultos mayores en torno a la depresión, así como disminuir la depresión en estos, logrando una mejor calidad de vida en esta población. El impacto económico esta dado en que permite reducir la morbilidad y mortalidad, disminuyendo los gastos hospitalarios, permitiendo una mejor distribución de los recursos y alivio de la carga económica de la familia y la sociedad(AU)

It was designed an educative program to qualify elderly people belonging to Angel Ortiz Vazquez Polyclinic in Manzanillo, in regards to the hidden depression due to the great attendance of these people to consults and emergency rooms from different hospitals, complaining of several somatic symptoms that were produced by a depressive state. For the performance of this work there were used theoric methods to favor its development and to obtain conclusions. The possible practical effectiveness of the proposal was evaluated with the expert criterion. The practical significance stated that the actions of the elaborated educative intervention permited to increase knowledge in the elderly people regarding depression, and diminished this symptom in them, obtaining a higher quality of life in these people. The economic impact reduced morbility and mortality, decreasing the hospital expenses and favoring a better distribution of resources for the relief the economic of family and society(EU)

Reducing inter-observer variability in embryo evaluation by means of training courses.

PURPOSE: To study the utility of a training session offered to junior embryologists, comparing the results obtained with those reported by a group of senior embryologists. METHODS: The 62 junior embryologists participanting were asked to decide on the quality of the embryos and theg clinical decision to be taken. RESULTS: The junior embryologists' success rate following the training course was significantly higher than before for embryo classification (48.4% ± 20.4 vs. 59.7% ±16.7) (p < 0.05) and for clinical decision (54.7% ± 19.6 vs. 68.7% ± 17.6) (p < 0.005). Comparison of the degree of agreement between the categories assigned by the junior embryologists and those assigned by consensus among the group of senior embryologists revealed kappa values of k = 0.32 before the course and of k = 0.54 after it. The comparison between pre- and post-training junior and senior embryologists also reflected an improvement in the kappa index for clinical decision, from k = 0.54 to k = 0.68. CONCLUSIONS: Training courses are shown to be an effective tool for increasing the degree of agreement between junior and senior embryologists.

PGS-FISH in reproductive medicine and perspective directions for improvement: a systematic review.

INTRODUCTION: Embryo selection can be carried out via morphological criteria or by using genetic studies based on Preimplantation Genetic Screening. In the present study, we evaluate the clinical validity of Preimplantation Genetic Screening with fluorescence in situ hybridization (PGS-FISH) compared with morphological embryo criteria. MATERIAL AND METHODS: A systematic review was made of the bibliography, with the following goals: firstly, to determine the prevalence of embryo chromosome alteration in clinical situations in which the PGS-FISH technique has been used; secondly, to calculate the statistics of diagnostic efficiency (negative Likelihood Ratio), using 2 × 2 tables, derived from PGS-FISH. The results obtained were compared with those obtained from embryo morphology. We calculated the probability of transferring at least one chromosome-normal embryo when it was selected using either morphological criteria or PGS-FISH, and considered what diagnostic performance should be expected of an embryo selection test with respect to achieving greater clinical validity than that obtained from embryo morphology. RESULTS: After an embryo morphology selection that produced a negative result (normal morphology), the likelihood of embryo aneuploidies was found to range from a pre-test value of 65% (prevalence of embryo chromosome alteration registered in all the study groups) to a post-test value of 55% (Confidence interval: 50-61), while after PGS-FISH with a negative result (euploid), the post-test probability was 42% (Confidence interval: 35-49) (p < 0.05). The probability of transferring at least one euploid embryo was the same whether 3 embryos were selected according to morphological criteria or whether 2, selected by PGS-FISH, were transferred. Any embryo selection test, if it is to provide greater clinical validity than embryo morphology, must present a LR-value of 0.40 (Confidence interval: 0.32-0.51) in single embryo transfer, and 0.06 (CI: 0.05-0.07) in double embryo transfer. DISCUSSION: With currently available technology, and taking into account the number of embryos to be transferred, the clinical validity of PGS-FISH, although superior to that of morphological criteria, does not appear to be clinically relevant.

Farmacovigilancia intensiva del factor estimulante de Colonias Granulocíticas Cubano (ior-Leukocim) en pacientes oncohematológicos pediátricos / Intensive drug surveillance of the cuban granulocyte colony-stimulating factor (ior-leukocim) in pediatric oncohematologic patients

Con el objetivo de describir y evaluar los efectos adversos relacionados con la administración del Factor Estimulante de Colonias Granulocíticas Cubano (ior-Leukocim), se analizaron las historias clínicas de cincuenta (50) pacientes incluídos, con edades comprendidas entre 1-18 años de edad, en el ensayo clínico realizado en el Servicio de Hematología del Hospital Infantil "José Luis Miranda" de Villa Clara, donde se evalúa el impacto del producto. Se incluyeron los pacientes que reportaron reacciones adversas, tipo de reacción y grado de intensidad. Se aplicó el algoritmo de Karsh y Lasagna para evaluar la fuerza de la relación de causalidad. Se observó que las reacciones adversas más frecuentes fueron: fiebre y dolores osteomusculares, en su mayoría clasificadas como efectos colaterales moderados de relación probable con la administración del producto(AU)