El anillo vaginal de progesterona como soporte de la fase lútea en fertilización in vitro

Objetivo. Comparar la efectividad del anillo vaginal y las cápsulas vaginales de progesterona en el soporte de la fase lútea en procedimientos de fertilización in vitro. Métodos. Estudio retrospectivo que evaluó los resultados de embarazo en mujeres receptoras de embriones logrados de donación de ambos gametos al comparar la efectividad del anillo vaginal y las cápsulas vaginales de progesterona en el soporte de la fase lútea en procedimientos de fertilización in vitro. Resultados. 38 mujeres usaron el anillo vaginal y 46 aplicaron las cápsulas vaginales como soporte de la fase lútea. Se halló tasas similares de implantación (36,5% versus 36,9%), embarazo clínico (52,6% versus 50,0%) y nacido vivo (50,0% versus 45,7%). Conclusiones. Se halló tasas similares de implantación, embarazo clínico y nacido vivo con el empleo del anillo vaginal y las cápsulas vaginales de progesterona en el soporte de la fase lútea en procedimientos de fertilización in vitro. Debido a la comodidad de su uso y a las adecuadas tasas de embarazo, el anillo vaginal de progesterona se constituye como una alternativa importante en el soporte de la fase lútea en la fertilización in vitro.

Objective: To compare the effectiveness of the vaginal ring and vaginal progesterone capsules in supporting the luteal phase in in vitro fertilization procedures. Methods: Retrospective study that evaluated pregnancy outcomes in female recipients of embryos obtained from donation of both gametes by comparing the effectiveness of the vaginal ring and vaginal progesterone capsules in supporting the luteal phase in in vitro fertilization procedures. Results: Thirty-eight women used the vaginal ring and 46 applied vaginal capsules as luteal phase support. Similar rates of implantation (36.5% versus 36.9%), clinical pregnancy (52.6% versus 50.0%) and live birth (50.0% versus 45.7%) were found. Conclusions: Similar implantation, clinical pregnancy and live birth rates were found with the use of the vaginal ring and vaginal progesterone capsules in the support of the luteal phase in in vitro fertilization procedures. Due to the convenience of its use and adequate pregnancy rates, the progesterone vaginal ring is an important alternative in the support of the luteal phase in in vitro fertilization.

Student-led curricular approaches in medical education: the educational effects of a virtual fundamentals of COVID-19 course.

BACKGROUND: As the field of education was adapting to virtual learning during the COVID-19 pandemic, a need quickly emerged for a course to prepare medical students for future clinical practice. This call to action was answered by creating an innovative Fundamentals of COVID-19 course at the Indiana University School of Medicine (IUSM). As a group of medical student leaders at IUSM, we developed this online course in order to support our fellow students and the community. METHODS: The study examined the educational effects of completing the Fundamentals of COVID-19 course. In order to examine these effects, the study asked enrolled students to complete both a pre- and post-course self-assessment survey. Students were asked an identical set of questions on each survey about their knowledge, skills, and abilities (KSA) regarding COVID-19. Composite scores were created for each KSA learning domain. Responses were provided using a five-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree. RESULTS: Out of the 724 students enrolled, 645 students completed both the pre- and post-course assessment surveys. Findings show that there were both meaningful and statistically significant differences in students' responses to the pre- and post-course surveys. Results show 1.) a significant mean increase in the knowledge composite score of 1.01, 95% CI [0.95, 1.06], t(644) = 36.4, p < .001, d = 1.43; 2.) a significant mean increase in the skills composite score of .55, 95% CI [0.50, 0.60], t(644) = 20.70, p < .001, d = 0.81. and 3.) a significant mean increase of the abilities composite score of 1.02, 95% CI [.97, 1.07], t(644) = 36.56, p < .001, d = 1.44. CONCLUSIONS: These findings demonstrate that the student-developed, online Fundamentals of COVID-19 course resulted in notable and statistically significant educational effects. The increase in students' self-reported ratings, especially in the knowledge and abilities domains, indicate that meaningful learning occurred within the course. These findings have notable implications for medical student training during healthcare emergencies, such as a pandemic, as well as within modern clerkship environments. Overall, our findings provide evidence that student-led curricular design and virtual delivery of course content can be effective tools in undergraduate medical education.

Cumulative live birth rates of patients in the Peruvian Andes according to the POSEIDON criteria: a single-center retrospective analysis.

OBJECTIVE: To identify low prognosis in-vitro fertilization (IVF) patients treated at Centro de Fertilidad y Ginecología del Sur (CFGS) based on the POSEIDON criteria. METHODS: This retrospective study included 412 IVF patients and assessed them based on the POSEIDON criteria to describe the cumulative live birth rates seen in each group. RESULTS: 13.1% of patients met the POSEIDON criteria, and the proportion of cases in POSEIDON groups 1, 2, 3 and 4 were 20.4%, 31.5%, 14.8%, and 33.3%, respectively. The cumulative live birth rate for the individuals meeting the POSEIDON criteria was 25.9%, while for patients in POSEIDON groups 1, 2, 3, and 4 the rates were 45.5%, 29.4%, 25.0%, and 11%, respectively. The differences were not statistically significant due to the small number of cases. CONCLUSIONS: Patients belonging to the four POSEIDON groups were described at CFGS. Age and number of retrieved mature oocytes were determining parameters in the prognosis of pregnancy in IVF/ICSI patients.

Temporary restorative treatment in children and adolescents with amelogenesis imperfecta: scoping review

Background: amelogenesis imperfecta (AI) is a group of disorders that affect the enamel of the teeth, either in quality or quantity. this alteration causes sensitivity and is associated with factors that could affect the strength of the adhesive bond of the restorative material. aim: to review the literature regarding the most used temporary restorative treatment in children and adolescents with AI. methods: this scoping review aimed to include case reports, literature reviews and original studies that evaluated restorative materials for the teeth of children and adolescents with AI. editorials, meeting abstracts and letters to the editor were excluded. the following electronic databases were used: Medline (Ovid), PubMed, Ebsco, Scopus (Elsevier) and Web of Science (Thomson Reuters). manual searches in the reference lists of the included articles were also carried out. finally, a search in Google Scholar restricted to the first 100 hits was performed. duplicates were eliminated upon identification. the search covered a period between the years of 2011 and 2016. PRISMA guidelines were used for reporting the review. the evidence ranking was carried out by means of the Oxford criteria. results: six articles met the eligibility criteria and were included in this scoping review. three articles were case reports, one was a review and two were original studies. tor the treatment of AI, direct or indirect composite resins were the most commonly used material of choice in the retrieved studies because they demonstrate greater longevity, aesthetics and function compared to the other materials used. conclusions: among children and adolescents with AI, the temporary restorative treatment that demonstrated better long-term results in permanent teeth was the direct and indirect composite resins. however, high quality studies should be conducted to confirm the results presented herein.

Diez años de reproducción asistida de alta complejidad en los Andes del Perú / Ten years of high complexity assisted reproduction techniques in the Peruvian Andes

Introducción: La infertilidad es un diagnóstico cada vez más frecuente, tanto a nivel del mar como en las grandes alturas, y el desarrollo de técnicas de reproducción asistida de alta complejidad en los Andes del Perú es imprescindible. Objetivo: Definir los resultados de estas técnicas en una institución a 3 330 metros sobre el nivel del mar. Diseño: Estudio descriptivo y retrospectivo. Institución: Centro de Fertilidad y Ginecología del Sur, Cusco, Perú. Pacientes: 576 pacientes con infertilidad atendidas entre los años 2005 al 2015. Métodos: Se revisó los registros de los procedimientos realizados y se estableció las tasas de embarazo clínico según la edad y días de cultivo, tanto en ovocitos autólogos como en ovodonación. Lasignificancia estadística de las diferencias encontradas fue analizada por medio de la prueba exacta de Fisher. Principal medida de resultados: Tasa de embarazo clínico. Resultados: Las tasas de embarazo clínico fueron: 30,4% en ovocitos autólogos, 42,4% en ovodonación y 25,0% en maduración in vitro de ovocitos. La frecuencia de embarazo doble fue 31,6%, y triple, 7,9%. Conclusiones: Las tasas de embarazo clínico fueron similares a las observadas internacionalmente. Destaca la necesidad de estrategias para disminuir la pluralidad de los embarazos, así como para mejorar la tasa de embarazo en las mujeres ≥ 37 años.

Introduction: Infertility is currently a more frequent diagnosis, at sea level and at high altitudes, and development of high complexity assisted reproduction techniques in the Andes of Peru is essential. Objective: To define the results of the application of these techniques in an institution at 3 330 meters above sea level. Design: Descriptive and retrospective study. Setting: Centro de Fertilidad y Ginecología del Sur, Cusco, Peru. Patients: 576 patients with infertility attended between years 2005-2015. Methods: Records of the procedures performed were reviewed and rates of clinical pregnancy according to age and days of culture were established for both autologous oocytes and ovodonation. Statistical significance of differences found was analyzed by Fisher exact test. Main outcome measure: Rate of clinical pregnancy. Results: Rates of clinical pregnancy were: 30.4% in autologous oocytes, 42.4% in ovodonation, and 25% in in vitro maturation oocytes. Frequency of twin pregnancy was 31.6%, and of triple pregnancy, 7.9%. Conclusions: Rates of clinical pregnancy were similar to those observed internationally. This emphasizes the need of strategies to diminish the plurality of pregnancies, as well as to improve the rate of pregnancy in women ≥ 37 years old.

First web-based database on total phenolics and oxygen radical absorbance capacity (ORAC) of fruits produced and consumed within the south Andes region of South America.

This paper reports the first database on antioxidants contained in fruits produced and consumed within the south Andes region of South America. The database ( www.portalantioxidantes.com ) contains over 500 total phenolics (TP) and ORAC values for more than 120 species/varieties of fruits. All analyses were conducted by a single ISO/IEC 17025-certified laboratory. The characterization comprised native berries such as maqui ( Aristotelia chilensis ), murtilla ( Ugni molinae ), and calafate ( Barberis microphylla ), which largely outscored all other studied fruits. Major differences in TP and ORAC were observed as a function of the fruit variety in berries, avocado, cherries, and apples. In fruits such as pears, apples, apricots, and peaches, a significant part of the TP and ORAC was accounted for by the antioxidants present in the peel. These data should be useful to estimate the fruit-based intake of TP and, through the ORAC data, their antioxidant-related contribution to the diet of south Andes populations.

Time-dependence of Ferric Reducing Antioxidant Power (FRAP) index in Chilean apples and berries / Influencia del tiempo de incubación sobre la capacidad antioxidante medida según FRAP, en manzanas y berries chilenos

We hypothesize that the Ferric Reducing Antioxidant Power (FRAP) assay that follows the reaction of Fe3+-TPTZ at 593 nm underestimates the antioxidant capacity of fruits, since the standardized time of the reaction (4 min) is not enough to titrate all the reducing compounds available. We measured FRAP, total phenolics and anthocyanins content in a variety of Chilean berry fruits (blueberries, blackberries, raspberries and strawberries) and apples (cv. Fuji, Granny Smith, Pink Lady, Red Delicious and Royal Gala). Taking into account the dependence of FRAP on the time course of the reaction, we propose to measure FRAP indexes after 1 min (FRAP-1), 30 min (FRAP-30) and 120 min (FRAP-120) of incubation. Most fruit extracts showed significant correlations between the antioxidant capacity and the incubation time, although in some cases the FRAP indexes did not correlate with the total phenolics and/or anthocyanins content. In fact, in apples and berries the correlation between anthocyanins content and FRAP indexes decreased with the incubation time. It is concluded that the fruit extracts analyzed require an incubation period higher than the established in the original experimental protocol to reach the equilibrium, due to the presence of a complex mixture of antioxidant compounds. In addition, a kinetic profile should be realized in each sample studied to establish the most suitable incubation period to titrate all the reactive antioxidant species.

Se plantea que el ensayo de la capacidad antioxidante de frutas, medido según el poder reductor de hierro (FRAP), que sigue la reacción de Fe3+-TPTZ a 593 nm, subestima la capacidad antioxidante, debido a que el tiempo de reacción (4 min) no sería suficiente para que reaccionen todos los compuestos reductores disponibles en las muestras. Se analizó la capacidad antioxidante FRAP, el contenido de fenoles y de antocianinas en diversos berries (arándano, mora, frambuesa y frutilla) y manzanas (cv. Fuji, Granny Smith, Pink Lady, Red Delicious y Royal Gala). Tomando en cuenta la dependencia del tiempo de incubación en el valor FRAP, se propone medir los índices FRAP después de 1 min (FRAP-1), 30 min (FRAP-30) y 120 min (FRAP-120). Diversos extractos de las frutas analizadas mostraron una correlación significativa entre la capacidad antioxidante y el tiempo de incubación; sin embargo, en algunos casos los índices FRAP no se correlacionaron con el contenido de fenoles totales y/o antocianinas. En efecto, en manzanas y berries la correlación entre el contenido de antocianinas e índices FRAP disminuyó con el tiempo de incubación. Se concluye que los extractos analizados requieren un tiempo de incubación mayor al que establece el protocolo analítico original para alcanzar el equilibrio, debido a la presencia de una compleja mezcla de compuestos antioxidantes. Además, el perfil cinético de cada muestra debería ser estudiado para establecer el periodo de incubación más adecuado para titular todas las especies antioxidantes reactivas.

Time-dependence of ferric reducing antioxidant power (FRAP) index in Chilean apples and berries.

We hypothesize that the Ferric Reducing Antioxidant Power (FRAP) assay that follows the reaction of Fe(3+)-TPTZ at 593 nm underestimates the antioxidant capacity of fruits, since the standardized time of the reaction (4 min) is not enough to titrate all the reducing compounds available. We measured FRAP, total phenolics and anthocyanins content in a variety of Chilean berry fruits (blueberries, blackberries, raspberries and strawberries) and apples (cv. Fuji, Granny Smith, Pink Lady, Red Delicious and Royal Gala). Taking into account the dependence of FRAP on the time course of the reaction, we propose to measure FRAP indexes after 1 min (FRAP-1), 30 min (FRAP-30) and 120 min (FRAP-120) of incubation. Most fruit extracts showed significant correlations between the antioxidant capacity and the incubation time, although in some cases the FRAP indexes did not correlate with the total phenolics and/or anthocyanins content. In fact, in apples and berries the correlation between anthocyanins content and FRAP indexes decreased with the incubation time. It is concluded that the fruit extracts analyzed require an incubation period higher than the established in the original experimental protocol to reach the equilibrium, due to the presence of a complex mixture of antioxidant compounds. In addition, a kinetic profile should be realized in each sample studied to establish the most suitable incubation period to titrate all the reactive antioxidant species.

Encuesta de calidad de vida realizada a pacientes adultos de la clínica de dolor del hospital el tunal, en tratamiento con acupuntura y sin ella / Quality of life survey made to adult patients in pain clinic in hospital tunal with acupuncture treatment and without it

Objetivo: Identificar si existe asociación entre la percepción de mejoría con respecto a la calidad de vida de los pacientes de clínica de dolor que están siendo manejados con acupuntura y describir sus características. Diseño: observacional de cohortes. Población: se realizó la encuesta a 93 pacientes en manejo por clínica del dolor con acupuntura y sin ella. Resultados: La calidad de vida se midió mediante el cuestionario de salud SF- 36 obteniendo los siguientes resultados se usó el paquete estadístico STATA el 27(29%) eran hombres y mujeres 66 (71%), la media de edad fue 48.7. El 57% estaban en tratamiento de dolor con acupuntura y el 43% en clínica de dolor sin acupuntura. El 34% de los pacientes estaban en el rango de edad de 45 a 54 años y 28% en el rango de 35 a 44 años. El cuestionario contiene 36 preguntas y 8 dimensiones estando todas con diferencia significativa en la asociación de mejor calidad de vida con tratamiento usando acupuntura. Función física: RR de 2.2, IC de 95%(1.5 - 3.3) p< 0.00001, Rol físico RR 30.9, IC de 95%(4.4 - 215.) p< 0.00001, Dolor corporal y acupuntura RR 3.6,IC de 95%(2.04- 6.6) p< 0.00001, Salud general RR 2,3, IC de 95%(1.4 - 3.8) p< 0.0001, Vitalidad RR 2.06, IC de 95%(1.3 - 3.1) p< 0.0001, Función social RR 1.6, IC de 95%(1.2 - 2.1) p< 0.00001, Rol emocional RR 4.0, IC de 95%(2.2 - 7.2) p< 0.00001, Salud mental RR 1, 96, IC de 95%(1,4 - 2.6) p< 0.00001. Conclusiones: El resultado global obtenido de las encuestas fue una mejoría en los aspectos evaluados de calidad de vida en los pacientes manejados con acupuntura. Los resultados sugieren que existe diferencia estadísticamente significativa entre la distribución de la exposición (acupuntura vs medicamento) de hombres y de mujeres (z = -3.849, p = 0.0001). Como Variables de confusión se contemplaron la no inclusión de las comorbilidades, etiología del dolor, antigüedad del proceso de dolor o el número de sesiones de acupuntura o de consultas de dolor que se llevaban hasta el momento de la encuesta. Es necesario realizar estudios donde se incluyan las patologías de base y comorbilidades de los pacientes para determinar con mayor validez esta prevalencia.

Generation of superoxide radicals by copper-glutathione complexes: redox-consequences associated with their interaction with reduced glutathione.

The interaction between Cu(2+) ions and GSH molecules leads to the swift formation of the physiologically occurring Cu(I)-[GSH](2) complex. Recently, we reported that this complex is able to reduce molecular oxygen into superoxide in a reversible reaction. In the present study, by means of fluorescence, luminescence, EPR and NMR techniques, we investigated the superoxide-generating capacity of the Cu(I)-[GSH](2) complex, demonstrated the occurrence and characterized the chemical nature of the oxidized complex which is formed upon removing of superoxide radicals from the former reaction, and addressed some of the redox consequences associated with the interaction between the Cu(I)-[GSH](2) complex, its oxidized complex form, and an in-excess of GSH molecules. The interaction between Cu(I)-[GSH](2) and added GSH molecules led to an substantial exacerbation of the ability of the former to generate superoxide anions. Removal of superoxide from a solution containing the Cu(I)-[GSH](2) complex, by addition of Tempol, led to the formation and accumulation of Cu(II)-GSSG. Interaction between the latter complex and GSH molecules permitted the re-generation of the Cu(I)-[GSH](2) complex and led to a concomitant recovery of its superoxide-generating capacity. Some of the potential redox and biological implications arising from these interactions are discussed.

Cu(I)-glutathione complex: a potential source of superoxide radicals generation.

Cu(2+) ions and GSH molecules interact swiftly to form the complex Cu(I)-glutathione. We investigated the potential capacity of such complex to reduce molecular oxygen. The addition of SOD to a solution containing Cu(I)-glutathione led to a sustained decline of the basal oxygen level. Such effect was partially reverted by the addition of catalase. The complex was able to induce the reduction of cytochrome c and the oxidation of dyhydroethidium into 2-hydroxyethidium. Both effects were totally blocked by SOD. The ability of the complex to generate superoxide radicals was confirmed by EPR spin-trapping. Cu(I)-glutathione induces no oxidation of fluorescein, a hydroxyl radical-sensitive probe. We conclude that in solutions containing the complex, oxygen is continually reduced into superoxide, and that-in absence of interceptors-the latter radicals are quantitatively re-oxidized into molecular oxygen. We suggest that, by functioning as a continuous source of superoxide, the complex could potentially affect a broad range of susceptible biological targets.

Conocimientos, opiniones y prácticas sobre Aedes aegypti / Knowledge, opinions and practices on Aedes aegypti

Para disminuir la población de mosquitos Aedes aegypti es imprescindible la participación activa de la comunicad, por lo que se exploraron las causas a que atribuye su incremento, apreciaciones de acciones emprendidas, efectos en la salud y a quiénes considera responsables de controlarlos. Se entrevistaron 210 personas del 25 al 27 de junio de 1997. Las causas por las que se explicó su aumento fueron: exceso de basura (59 por ciento), aguas sucias (58 por ciento), depósitos de agua descubiertos (50 por ciento) y falta de fumigación (21 por ciento). Un 40 por ciento desconocía que estos vectores crían en aguas limpias. Todos los implicados mencionaron alguna afectación a la salud por su picada. El 51 por ciento opinó que debía controlarse conjuntamente por el Estado y la comunidad, pero el 35 por ciento responsabilizó sólo al Estado. Estas opiniones pueden condicionar que no se tomen medidas para evitar su proliferación y no se comprenda el trabajo antivectorial al no corresponder sus actividades con las expectativas que se tienen(AU)

Conocimientos, opiniones y prácticas sobre Aedes aegypti / Knowledge, opinions, and practices regarding Aedes aegypti

The active participation of the community is indispensable for reducing Aedes aegypti mosquito populations so causes leading to their growth, actions taken, effects on the health and the people in charge of controlling such mosquitoes are all dealt with in this paper. 210 persons were interviewed from June 25 to 27, 1997. The causes of the growth of the mosquito population were: excessive garbage (59), dirty waters (58), open water reservoirs (50) and lack of fumigation (21). 40 of interviewed people did not know that these vectors can breed even in clean waters. They mentioned some effects on the health due to the mosquito bites. 51 said that mosquitoes should be jointly controlled by the State and the community but 35 believed that the State should be the sole responsible for this task. These opinions may determine that steps are not properly taken to avoid proliferation of vector and that the activities of the anti-vector program are not really understood since they do not meet the expectations.

Resonancia magnética nuclear protónica (RMN'H) en el diagnóstico de desordenes metabólicos / proton nuclear magnetic resonance (H NMR) for the diagnosisi of metabolic disorders

La resonancia magnética nuclear protónica (RMN`H) es un método adecuado para la detección de metabolitos de orina humana, especialmente en casos de desórdenes metabólicos. La aplicación en el análisis clínico es de gran importancia, pues se pueden identificar los diferentes metabolitos de forma simultánea, de una manera rápida y simple, sin pretratamiento de la muestra. En este trabajo se reportan los espectros de RMN`H de la orina de niños aparentemente sanos y de 5 años que presentan diferentes desórdenes metabòlicos, en los cuales fue posible confirmar el diagnóstico mediante la identificación de los metabolitos anómalos específicos de cada enfermedad. Se demuestra mediante estos ejemplos ilustrativos que la aplicación de la RMN`H al estudio de errores congénitos del metabolismo, incluso con instrumentos de campo bajo (90 MHZ), puede ser de mucha utilidad para el reconocimiento rápido de un número de estas enfermedades

Resonancia magnética nuclear protónica (RMN'H) en el diagnóstico de desordenes metabólicos / proton nuclear magnetic resonance (H NMR) for the diagnosisi of metabolic disorders

La resonancia magnética nuclear protónica (RMN`H) es un método adecuado para la detección de metabolitos de orina humana, especialmente en casos de desórdenes metabólicos. La aplicación en el análisis clínico es de gran importancia, pues se pueden identificar los diferentes metabolitos de forma simultánea, de una manera rápida y simple, sin pretratamiento de la muestra. En este trabajo se reportan los espectros de RMN`H de la orina de niños aparentemente sanos y de 5 años que presentan diferentes desórdenes metabòlicos, en los cuales fue posible confirmar el diagnóstico mediante la identificación de los metabolitos anómalos específicos de cada enfermedad. Se demuestra mediante estos ejemplos ilustrativos que la aplicación de la RMN`H al estudio de errores congénitos del metabolismo, incluso con instrumentos de campo bajo (90 MHZ), puede ser de mucha utilidad para el reconocimiento rápido de un número de estas enfermedades