ALWAYS ICSI? A SWOT analysis.

PURPOSE: Intracytroplasmatic sperm injection (ICSI) is a common procedure used to improve reproductive results, even among couples without male factor infertility. However, the evidence available is still uncertain on the possible advantages and deficiencies that this procedure may have in patients with no formal indication for ICSI. METHODS: A SWOT (strengths, weaknesses, opportunities, threats) analysis examines the possible advantages and deficiencies of performing ICSI in these patients with no formal indication. RESULTS: The evidence suggests that ICSI is not justified for non-male factor infertile couples requiring in vitro conception. One of the major strengths associated to the procedure is the virtual elimination of cases further complicated by total fertilization failure and a combination between IVF and ICSI on sibling oocytes has been advised in the literature. Greater technical difficulties, higher costs and performing an unnecessary invasive technique in some cases represent some of the weaknesses of the procedure, and questions regarding safety issues should not be ruled out. CONCLUSION: Despite the widespread use of ICSI in patients without a formal diagnosis of male factor infertility, evidence demonstrating its effectiveness in this population is still lacking. Additional large and well-designed randomized controlled trials are needed to clarify definitive indications for ICSI in non-male factor infertility.

Neurogenic bladder in the settings of congenital Zika syndrome: a confirmed and unknown condition for urologists.

INTRODUCTION: Congenital Zika syndrome (CZS) is a recently discovered condition that affects central nervous system structures that control the lower urinary tract. The first cases of neurogenic bladder (NB) were recently reported as a sequalae of CZS in neurologically impaired children. OBJECTIVE: Our goal is to further evaluate NB in the setting of CZS, identifying urological risk indicators in hopes that early diagnosis will mitigate the impact of the disease. STUDY DESIGN: Urological assessment was performed in all patients with CZS and neurological impairment who were referred to our urodynamic clinic between June 2016 and May 2018. Neurogenic bladder was confirmed by urodynamic evaluation, and urological risk was based on urodynamic results. RESULTS: Sixty-nine patients with CZS were tested. The majority (63 patients, 91.3%) presented with overactive bladder with increased pressures and reduced capacity for age (table 1). Different urodynamic patterns were observed, and the association of reduced bladder capacity for age, high bladder-filling pressure, and increased postvoid residual were frequently observed. DISCUSSION: NB continues to be consistently diagnosed in our cohort of CZS, mostly with high-risk indicators for renal impairment. When not intervened upon in a timely manner, NB can cause progressive damage to the urinary tract, but the lack of knowledge that CZS causes NB delays investigation and treatment. Parents and health professionals will need to be sensitized to the risks that ZIKV can pose to the urinary tract so that appropriate therapies are initiated to prevent irreversible renal damage. CONCLUSION: NB is a common condition among our patients with CZS and microcephaly. This is a new cause of NB, unknown to urologists. While further investigation is necessary to understand long-term disease behavior and therapeutic response, increased knowledge among urologists may help to reduce morbidity related to untreated NB and to mitigate the disease burden for patients and families.

Hysteroscopic septum resection and reproductive medicine: A SWOT analysis.

Hysteroscopic septum resection in women with unfavourable reproductive and clinical outcomes has become common practice worldwide to improve reproductive results. No clear evidence on the possible advantages and drawbacks of this procedure has been published. In this opinion paper, based on a SWOT (strengths, weaknesses, opportunities, threats) analysis, the different aspects of this strategy are evaluated. Currently, no level 1 published evidence supports uterine resection in women with septate uterus. Clinical evidence from the studies analysed matches the more recent guidelines and suggests an improvement in reproductive outcomes after hysteroscopic resection of the septum, particularly in infertile women and women who have experienced recurrent miscarriages. In a patient with no history of infertility or prior pregnancy loss, it may be reasonable to consider septum incision after counselling about the potential risks and benefits of the procedure. Published clinical data in favour of the intervention, however, are based on studies with important methodological limitations. In this situation, the clinician and patient should reach an agreement together, based on the pros and cons of this intervention. Well-designed randomized controlled trials are required to confirm the clinical benefits and cost-effectiveness of this procedure.

Streptomyces ansochromogenes Tur-10 produces a substance with antifungal bioactivity.

The increased incidence of fungal infections and the development of drug resistance have led to the search for microorganisms capable of producing bioactive metabolites with antifungal activity. Among these microorganisms, Streptomyces spp are distinguished mainly owing to their potential to secrete bioactive molecules. The aim of this study was to evaluate the production of secondary metabolites by Streptomyces sp TUR-10 against 12 fungal clinical isolates (yeast and filamentous fungi). In the preliminary screening, Streptomyces sp TUR-10 showed activity against 75% of the clinical isolates, and was selected for fermentation. In this assay, we tested three different media (MPE, M1, and ISP-4) for 96 h at pH 7.0 and 30°C for the production of bioactive metabolites. Increased production of bioactive compounds was observed when using the MPE medium for 48 h, with good activity against Candida pelliculosa. The minimum inhibitory concentration showed significant antifungal activity values ranging from 15.6 to 250 µg/mL. The actinobacterium was characterized by 16S rRNA analysis and the pattern suggested that the isolate studied belonged to the species Streptomyces ansochromogenes. The biotechnological potential of this strain was also demonstrated by the detection of the nrps and pks genes. These results indicate the production of secondary metabolites of biotechnological interest by actinobacteria from the rhizosphere, suggesting great potential for further research.

New and rare coastal fishes in the Azores islands: occasional events or tropicalization process?

Seven coastal fish species are newly reported for the remote north Atlantic archipelago of the Azores: Mediterranean sand eel Gymnammodytes cicerelus, bar jack Caranx ruber, two-banded seabream Diplodus vulgaris, bastard grunt Pomadasys incisus, unicorn leatherjacket filefish Aluterus scriptus and longspined porcupinefish Diodon holacanthus. The occurrence is also confirmed for 19 species that had been hitherto cited occasionally for the region, totalling a list of two elasmobranchs and 23 teleosts. Diplodus vulgaris, which appears to have recently colonized the islands, as well as roughtail stingray Dasyatis centroura and golden grey mullet Liza aurata, re-cited based on new records, are frequent or common coastal species in the Azores. The remaining 22 species, exceptional or rare in the region, are of tropical or subtropical affinity and find their northernmost distribution limit within the central and north-east Atlantic Ocean precisely in the Azores. This biogeographical pattern contrasts with that of the Azorean coastal fish community and suggests a tropicalization process in the region in line with previous findings of similar patterns across the north-east Atlantic Ocean and the Mediterranean Sea. These novel data from the most isolated archipelago of the North Atlantic Ocean, located in a biogeographic boundary area where colonization opportunities are reduced, reinforce the need for long-term monitoring programmes of coastal fish communities and, in particular, of indicator species groups to improve understanding of the effects of climate change on marine communities.

Ascorbic acid improves membrane fragility and decreases haemolysis during red blood cell storage.

BACKGROUND: Changes that occur to red blood cells (RBCs) during routine blood bank storage include decreased deformability, increased haemolysis and oxidative damage. Oxidative injury to the RBC membrane and haemoglobin can affect changes in shape and deformability. Ascorbic acid (AA) is an antioxidant that maintains haemoglobin in a reduced state and minimises RBC oxidative injury. We hypothesised that AA would improve membrane fragility and decrease haemolysis during storage. METHODS: Whole blood derived, AS-5 preserved, pre-storage leucoreduced RBC units were exposed to either AA or saline control solutions. Several rheological and biochemical parameters were measured serially during storage, including RBC membrane mechanical fragility, percent haemolysis and methaemoglobin levels. RESULTS: AA exposure significantly reduced mechanical fragility and haemolysis over the entire storage period. The highest two concentrations of AA affected the greatest reductions in mechanical fragility and percent haemolysis. Addition of AA to the RBCs did not significantly alter their biochemical parameters compared to control RBCs incubated with saline. CONCLUSION: AA reduced RBC membrane fragility and decreased haemolysis during storage without adversely affecting other RBC biochemical parameters. The clinical significance of these findings needs to be determined.

Multi-scale recruitment patterns and effects on local population size of a temperate reef fish.

Recruitment of the temperate reef fish Coris julis was studied across the Azores Archipelago (central North Atlantic), over four consecutive recruitment seasons and at three spatial scales: between islands (separated by 100s of km), sites within islands (separated by 10s of km) and transects within sites (separated by 10s of m). At the largest scale (i.e. between islands) spatial recruitment patterns were highly variable, suggesting the influence of stochastic processes. Recruitment was spatially consistent within islands, even though magnitude was unpredictable between years, indicating that processes at meso-scales are probably more deterministic. Recruits settled randomly at the transect scale, probably reflecting habitat homogeneity. It was proposed that large and island-scale patterns reflect larval availability, driven by physical and biological processes occurring in the plankton. No evidence was found for a density-dependent relationship between newly settled and 2 week settled C. julis nor between cumulative recruitment and young-of-the-year. It appears that adult density is limited by larval supply (pre-settlement regulation) at low recruitment sites, and determined by post-settlement, density-dependent processes at high recruitment sites. This work is one of few to investigate multiple spatial and temporal scales of recruitment for a coastal fish species inhabiting isolated, temperate oceanic islands and hence, provides a novel comparison to the many studies of recruitment on coral reefs and other, more connected systems.

Donación de ovocitos / Oocyte donation

Objetivo: Conocer el marco legal y científico, indicaciones, resultados, aspectos emocionales y controversias existentes relacionadas con la técnica de donación de ovocitos en reproducción asistida. Material y métodos: Revisión de las principales guías de práctica clínica publicadas en la bibliografía internacional (ESHRE, American Society for Reproductive Medicine, Royal College of Obstetricians and Gyneacologist [RCOG]). Resultados: La tasa de embarazo obtenida mediante esta técnica varía entre el 30 y 50% en función de las fuentes consultadas. La prestación asumida por el Servicio Andaluz de Salud sólo cubre el 17% de las indicaciones que se hacen en sanidad privada. Conclusiones: La donación de ovocitos es una técnica que obtiene buenos resultados en el segmento poblacional con peor pronóstico reproductivo. Su extensión difiere sustancialmente entre el sector privado y el público. Con la generalización de la técnica han aparecido nuevas controversias no del todo resueltas. El escaso número de donantes y los aspectos morales son los dos principales factores que limitan la extensión de la técnica (AU)

Objective: To determine the legal and scientific framework, indications, results, emotional issues, and current debates related to oocyte donation in assisted reproduction. Material and methods: We reviewed the main clinical practice guidelines published in the international literature (ESHRE, American Society for Reproductive Medicine, Royal College of Obstetricians and Gynecologists). Results: The pregnancy rate obtained by this technique varied between 30% and 50%, depending on the sources consulted. The services provided by the Andalusian Health Service covered only 17% of the indications covered by private health providers. Conclusions: Oocyte donation provides good results in the segment of the population with the worst reproductive prognosis. The use of this technique differs substantially between the private and public sectors. With the widespread use of this technique, new controversies have appeared that have not been entirely resolved. The two main factors limiting wider use of oocyte donation are the low number of donors and moral issues (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

Delay in hospital admission of patients with cerebral vein and dural sinus thrombosis.

Factors influencing early hospital admission have been described for several stroke types but not for cerebral vein and dural sinus thrombosis (CVT). CVT is more difficult to diagnose than arterial stroke; delay in hospital admission may postpone CVT treatment. The purposes of this study were: (1) to describe the delay between the onset of symptoms and hospital admission of patients with CVT, and (2) to identify the variables that influence that delay. We registered the interval (days) between the onset of symptoms and hospital admission in 91 consecutive patients admitted to 20 Portuguese hospitals between June 1995 and June 1998. We also studied the impact of admission delay on treatments (prescription of anticoagulants and the number of days elapsed between the onset of symptoms and start of anticoagulation and admission). Median admission delay was 4 days. Twenty-two (25%) patients were admitted within 24 h. Two thirds of the patients were admitted within 7 days and 75% within 13 days. In multiple logistic regression analysis, admission within 24 h was positively associated with mental status disorder (delirium or abulia; OR = 4.59; 95% CI = 1.41-14.89) and negatively associated with headache (OR = 0.03; 95% CI = 0.00-0.32). Presentation as isolated intracranial hypertension was associated with admission delay of more than 4 days (OR = 2.63; 95% CI = 0.97-7.14). Papilloedema was associated with an admission delay of more than 13 days (OR = 4.69; 95% CI = 1.61-13.61). There was no association between admission delay and the proportion of anticoagulated patients. The interval between onset of symptoms and start of anticoagulation was shorter in patients admitted earlier (p = 0.0001, for either admission within 24 h, 4 or 13 days). There is a considerable delay until the clinical picture associated with CVT is recognised as justifying hospital admission, especially when patients present with symptoms identical to isolated intracranial hypertension syndrome.

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.

Presencia de microorganismos oportunistas en el endocérvix y su influencia en la tasa de gestación en un programa de FIV-ICSI / Presence of opportunistic microorganisms in the endocervix and their influence on pregnancy rates in an in vitro fertilization program

Objetivos: Estudiar la asociación entre cultivos endocervicales positivos para microorganismos distintos de Lactobacillus spp. y las tasas de gestación obtenidas, en las técnicas de FIV-ICSI. Métodos: Se recogieron muestras endocervicales para estudio microbiológico de 109 mujeres sometidas a técnicas de FIV-ICSI, en el momento de la transferencia embrionaria. Resultados: Un total de 18 cultivos (16,5 por ciento) fueron positivos. El total de embarazos fue de 32 (un 29,35 por ciento por transferencia). Cinco correspondieron a mujeres con cultivo positivo (un 27,8 por ciento por transferencia) y 13 a mujeres con cultivo negativo (un 29,7 por ciento por transferencia). Las causas de esterilidad, el número de FIV e ICSI, el número de ovocitos por punción y el número de embriones transferidos fue similar en ambos grupos, sin que se hayan encontrado diferencias significativas. Conclusiones: La presencia en el endocérvix de microorganismos oportunistas, en el momento de la transferencia embrionaria no es suficiente para alterar la implantación embrionaria, y por tanto disminuir las tasas de gestación. (AU)

Efecto del tabaco sobre los resultados de un programa de fecundación in vitro / Effect of tobacco on the results of an in vitro fertilization program

Objetivo: Comprobar si existen diferencias dependientes del hábito de fumar en los resultados de nuestro programa de fecundación in vitro. Pacientes y método: Realizamos un análisis retrospectivo de 1.041 pacientes incluidas en un programa de fecundación in vitro desde el año 1998 hasta el 2001, las cuales se dividieron en tres grupos de 614 mujeres no fumadoras, 308 fumadoras de menos de 15 cigarrillos por día y 119 fumadoras de más de esta cantidad. Resultados: La tasa de implantación y de embarazos fue similar en los tres grupos de pacientes. Las muy fumadoras necesitaron más dosis de hormona foliculoestimulante para llegar a un desarrollo folicular adecuado y alcanzaron niveles menores de estradiol al final del ciclo (p < 0,05). Las no fumadoras obtuvieron un mayor número de folículos maduros y de ovocitos que las fumadoras (p < 0,05). Conclusión: Aunque la consecución del embarazo no se afecta por el hecho de fumar, otros parámetros, como el desarrollo folicular, el nivel de estradiol o el número de ovocitos recuperados, disminuyen con el consumo de tabaco. (AU)

Long-term prognosis of cerebral vein and dural sinus thrombosis. results of the VENOPORT study.

The purpose of this study was to analyze the long-term mortality, functional recovery and long-term complications of cerebral vein and dural sinus thrombosis (CVDST) admitted to Portuguese hospitals. A follow-up of symptomatic CVDST admitted to Portuguese hospitals since 1980 was performed. Fifty-one patients (retrospective cases) were re-evaluated during 1996; 91 consecutively admitted patients from 6/1995 to 6/1998 were followed up to 1999. In 1996, 4 (8%) of the retrospective cases had died (3 patients died in the acute phase), 4 (8%) could not be reached, 33 (64%) had recovered completely (Rankin 0 or 1) and 3 (6%) were dependent. The prospective cases had a mean follow-up of 1 year: 6 (7%) patients died in the acute phase, one (1%) died during follow-up, 75 (82%) recovered completely, and only 1 (1%) was dependent. For the prospective cases, worsening after admission (OR = 18.2; 95% CI = 2.9-112.4) and encephalopathy as the presenting syndrome (OR = 7.1; 95% CI = 1.2-40.9) predicted death or dependency, while absence of aphasia (OR 6.7, 95% CI = 1.6-33) and no worsening after admission (OR = 5.9; 95% CI = 1.6-20) predicted total recovery. During follow-up of the prospective cases, 4 (5%) patients had thrombotic events, 8 (10%) patients experienced seizures, 9 (11%) complained of severe headaches and 1 patient suffered severe visual loss. The long-term functional prognosis of patients with CVDST was fairly good with complete recovery in the majority of cases. However, these patients had a moderate risk of further thrombotic events and seizures.

Esterilidad masculina y microdeleciones en el cromosoma Y / Male sterility and Y-chromosome microdeletions

No disponible

Chromatin status in human ejaculated spermatozoa from infertile patients and relationship to seminal parameters.

The aim of this study was to evaluate the chromatin status in different groups of patients. Five groups of men were selected: pre-vasectomy; male factor infertility; varicocele; immunological male infertility; and idiopathic infertility. Chromatin status was evaluated using flow cytometry after staining the DNA with the fluorochrome propidium iodide. Differences were observed in the state of sperm chromatin between the male factor and varicocele groups with respect to the others. These two groups presented poorer quality chromatin, as evidenced fundamentally by a lower degree of condensation. These deficiencies in chromatin status were usually accompanied by alterations in the other standard parameters of semen analysis. Individuals who are infertile due to male factor and those presenting varicocele have spermatozoa with less condensed chromatin which might, in part, explain their sterility.

Nuevas líneas de estudio en el aborto habitual. Consejo reproductivo a la abortadora sin causa / New lines of research in recurrent miscarriage. Advice on reproduction to women with unexplained fetal loss

Objetivo: Revisión de las nuevas líneas de estudio en el aborto de repetición sin causa tras un estudio de abortabilidad. Sujetos y método: Revisión de la literatura más reciente sobre el tema. Resultados: La abortadora sin causa necesita una atención individualizada. Conclusiones: Sólo el diagnóstico etiológico permitirán individualizar a cada paciente y someterla al tratamiento específico necesario en cada caso. Mientras esto no suceda sólo se podrá ofrecer tratamientos empíricos, mejoras de sus hábitos de vida y cuidados especiales de seguimiento que disminuyan el grado de ansiedad de estas pacientes (AU)

[Recommendations for the diagnosis and treatment of unstable angina and non-Q-wave myocardial infarction (proposed revision)]. / Recomendações para o diagnóstico e tratamento da angina instável e do enfarte do miocárdio sem onda Q (proposta de revisões).

The optimal diagnostic and treatment strategies for unstable angina/non-Q-wave myocardial infarction patients will continue to be redefined as rapid progress is made in the understanding, and treatment of this syndrome. The recommendations presented here reflect, in part, discussions at the International Cardiology Forum in September 1998. Although areas of controversy remain, we have summarized major points on which a consensus could be reached and for which the weight of the clinical evidence supports a change in practice.