[The sociological approach to vasectomized patient trajectories at the Buenos Aires University Clinical Hospital "José de San Martín"].

According to the Argentinian Ministry of Health records the number of patients requesting vasectomy increased twelve times in public hospitals in 2015-2019. The physicians and specialists account for this change in recent years, arguing, among other reasons, cultural change when male assumes active position in contraceptive methods. The article addresses vasectomized patient trajectory at the Buenos Aires University Clinical Hospital "José de San Martín". The purpose of the study was to define from sociological point of view if we are actually witnessing cultural change. While considering last ten years (2012-2022), through diachronic analysis of patient demand at the Male Fertility Laboratory (n=1136) it was found that although main motivation is fertility, minority (6%) consulting to confirm absence of sperm in the ejaculate following vasectomy increased significantly in 2022 (Pearson's chi-squared test p<0.0001). After qualitative/quantitative interviews of former patient group (n=36) two sub-populations were distinguished: childless (42%; Median age: 30 years old; range: 24-35) and those having a family (58%; Median age: 39 years old; range: 35-54). Most of them had University degree (67%) and learned about this anti-contraceptive method by the Internet. It is remarkable that 94% of them were not aware of the the Argentinian Law № 236139 of 2006 that grants their right to vasectomy. Among all patients randomly interviewed in 2022 (n=200) condom anti-contraceptive method was the best known (67%). The conclusion was made that in the meantime developed New Trend that comprises high educational level segment of population of Argentina that in the future can become the germ of Cultural Change encompassing the whole society.

Analytical quality specifications in semen analysis according to the state of the current methodologies.

OBJECTIVES: The aim of this study was to establish analytical quality specifications for human semen measurands according to the state of the current methodologies. METHODS: Measurement errors were estimated based on data from participating laboratories in the External Quality Program (PEEC) led by the Argentine Biochemistry Foundation using the "Analytical Quality Minimum Specifications" model established in Spain for other biochemical collection parameters. Semen samples from the PEEC were analyzed according to WHO procedures. RESULTS: Analytical quality specifications were established according to the most recent results obtained by the External Quality Evaluation Program of the Fundación Bioquímica Argentina. Morphology, progressive motility, total motility and sperm concentration were 75%, 30%, 21% and 43%, respectively, for samples with assigned values between 6 and 15% of normal forms, 35-89% for progressive motility, 43-92% for total motility and for sperm count in the range of 1.8 × 106 -65 × 106 spermatozoa/mL. CONCLUSIONS: Our allowable total error specification may affect medical conduct at certain dose levels, compromising clinical test validity. The measurement system employed is closely associated with the number of elements evaluated. The use of manual methods, where the fatigue of the operator counteracts their ability to evaluate a considerable number of elements, leads to errors typical of the poisson and binomial distribution characteristics of these measurands. This work reflects the laboratory performance in our region. The proposed specifications are a statement of minimums that every laboratory should comply with to ensure analytical performance of clinical utility with the current methodology available.

Classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21-OHD) in adult males: Clinical presentation, hormone function and the detection of adrenal and testicular adrenal rest tumors (TARTs).

INTRODUCTION: 21-hydroxylase deficiency (21-OHD) is the most common form of congenital adrenal hyperplasia (CAH). In adulthood, most studies are reported in females. By contrast, data on adult males are scarce. OBJECTIVE: To describe a series of adult males with classic 21-OHD and to assess the presence of adrenal masses and testicular adrenal rest tumors (TARTs). MATERIAL AND METHODS: Eight males (21-42 years) were included. We evaluated clinical presentation, 17-Hydroxyprogesterone (17-OHP), Testosterone (T), Δ4Androstenedione (Δ4A) ACTH, LH, FSH and plasma renin activitiy (PRA) levels at consultation. Molecular studies of the CYP21A2 gene, testicular ultrasound (US), semen analysis and adrenal computed tomography (CT) scan were performed. Treatment and compliance were assessed. RESULTS: Basal 17-OHP levels were >20ng/ml in all patients. At consultation, median 17OH-P was 11.5 (2.3-81) ng/ml, FSH: 3 (0.3-4) mUI/ml, LH: 1.1 (0.1-6) mUI/ml, T: 4.3 (1.7-8) ng/ml, Δ4A: 5.7 (1.4-16) ng/ml, ACTH: 86.4 (76-334) pg/ml, PRA: 9.5 (1.3-23.6) ng/ml/h. Semen analysis was performed in 5/8 patients, showing azoospermia in two. Molecular genetic analysis was performed in 4/8 patients. TARTs were found in 5/6, being bilateral in four. Adrenal masses were found in 4/6. In the 7 patients diagnosed in childhood, their follow-up was referred to as irregular, both in their attendance at consultations and in compliance with the indicated treatment. CONCLUSIONS: To our knowledge, this is the first series on adult males with classic 21-OHD which concomitantly assesses clinical presentation, molecular biology, adrenal and testicular imaging studies, semen analysis and compliance to treatment. A high prevalence of adrenal masses and TARTs was observed, possibly associated with poor treatment compliance leading to elevated ACTH and increased proliferation. Our findings on TARTs agree with reports in international publications of CAH in males, with adrenal imaging being added in our group. Although we are aware that further studies with a larger sample size and more data are needed, we consider that our findings contribute to the clinical management of classical 21-OHD in the male population.

Classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21-OHD) in adult males: Clinical presentation, hormone function and the detection of adrenal and testicular adrenal rest tumors (TARTs).

INTRODUCTION: 21-hydroxylase deficiency (21-OHD) is the most common form of congenital adrenal hyperplasia (CAH). In adulthood, most studies are reported in females. By contrast, data on adult males are scarce. OBJECTIVE: To describe a series of adult males with classic 21-OHD and to assess the presence of adrenal masses and testicular adrenal rest tumors (TARTs). MATERIAL AND METHODS: Eight males (21-42 years) were included. We evaluated clinical presentation, 17-Hydroxyprogesterone (17-OHP), Testosterone (T), Δ4Androstenedione (Δ4A) ACTH, LH, FSH and plasma renin activitiy (PRA) levels at consultation. Molecular studies of the CYP21A2 gene, testicular ultrasound (US), semen analysis and adrenal computed tomography (CT) scan were performed. Treatment and compliance were assessed. RESULTS: Basal 17-OHP levels were >20ng/ml in all patients. At consultation, median 17OH-P was 11.5 (2.3-81) ng/ml, FSH: 3 (0.3-4) mUI/ml, LH: 1.1 (0.1-6) mUI/ml, T: 4.3 (1.7-8) ng/ml, Δ4A: 5.7 (1.4-16) ng/ml, ACTH: 86.4 (76-334) pg/ml, PRA: 9.5 (1.3-23.6) ng/ml/h. Semen analysis was performed in 5/8 patients, showing azoospermia in two. Molecular genetic analysis was performed in 4/8 patients. TARTs were found in 5/6, being bilateral in four. Adrenal masses were found in 4/6. In the 7 patients diagnosed in childhood, their follow-up was referred to as irregular, both in their attendance at consultations and in compliance with the indicated treatment. CONCLUSIONS: To our knowledge, this is the first series on adult males with classic 21-OHD which concomitantly assesses clinical presentation, molecular biology, adrenal and testicular imaging studies, semen analysis and compliance to treatment. A high prevalence of adrenal masses and TARTs was observed, possibly associated with poor treatment compliance leading to elevated ACTH and increased proliferation. Our findings on TARTs agree with reports in international publications of CAH in males, with adrenal imaging being added in our group. Although we are aware that further studies with a larger sample size and more data are needed, we consider that our findings contribute to the clinical management of classical 21-OHD in the male population.

Thyroid hormones in ovarian follicular fluid: Association with oocyte retrieval in women undergoing assisted fertilization procedures.

OBJECTIVE: Our aim was to analyze the role of thyroid hormones in follicular fluid (FF) in relation to the number of oocytes retrieved in women recruited for an assisted fertilization procedure. METHODS: Retrospective cohort study of 51 women 37.5±3.3 years, range 29-42, evaluated after a controlled ovarian stimulation protocol in a University Hospital. FF was sampled by transvaginal ultrasound-guided aspiration after ovarian hyperstimulation and we measured T3 (T3f), T4 (T4f), TSH (TSHf) and free T4 (T4ff). The oocyte maturation rate was calculated as: Number of metaphase II oocytes/Number of oocytes retrieved x 100. Statistical analysis was performed using the SPSS-19 software. RESULTS: Hormone levels in FF were: TSHf 1.3µIU/ml (0.4 - 2.7), T3f: 1.52±0.46 nmol/L, T4f 88.8±30.9nmol/L and T4ff: 15.44±2.57pmol/L. The number of oocytes recovered was dependent onT4f following the equation: Log (oocyte) = 0.379+0.042*T4f (r:0.352, p=0.012). After a logistic regression model analysis, T3f showed a tendency to be associated with the OMR: OR (95 % CI)= 0.977 (0.954 to 1.001), p=0.057. CONCLUSIONS: The correlation found between thyroid hormones and the number of oocytes retrieved suggests an interaction between thyroid and gonadal axes in relation to follicular development.

Acreditación de los laboratorios de Andrología en la República Argentina / Accreditation of Andrology laboratories in Argentina / Credenciamento dos laboratórios de Andrologia na República Argentina

La acreditación de laboratorios especializados en Andrología tiene como objetivo promover, mejorar y asegurar la calidad del servicio. Las especialidades requieren de la participación de expertos que asesoren a los organismos autónomos que efectúan las auditorías de tercera parte. El objetivo del trabajo es comunicar la experiencia de trabajo cooperativo llevado a cabo por una sociedad científica, la Sociedad Argentina de Andrología (SAA) y el Programa de Acreditación de Laboratorios (PAL) de la Fundación Bioquímica Argentina (FBA) para el aseguramiento de la calidad de la prestación bioquímica en el área andrológica. Con tal fin se firmó un convenio marco y específico de colaboración para la acreditación de laboratorios especializados en Andrología. La FBA llevaría a cabo la logística del proceso, con su plantel de auditores, aplicando como instrumento el Manual de Acreditación MA3 y la SAA proveería asesoramiento científico. Junto con las autoridades del PAL se elaboró un documento que especifica los apartados correspondientes al MA3 capítulo Nº 4 Anexo Nº 4, "Estándares para la acreditación de laboratorios especializados". Se realizó capacitación para la elaboración de la documentación y formación de los auditores en la especialidad. Esta experiencia demuestra que el trabajo cooperativo entre organizaciones permite alcanzar logros a favor de la seguridad del paciente.

Laboratory accreditation aims to promote, improve and ensure the quality of the service. The specialties require the participation of experts who advise the autonomous bodies that carry out third-party audits. The objective is to communicate the experience of cooperative work carried out by a scientific society, the Sociedad Argentina de Andrología (SAA) (Argentine Society of Andrology) and the Laboratory Certification Programme (PAL for its name in Spanish) of Fundación Bioquímica Argentina (FBA) (Argentine Biochemistry Foundation) for quality assurance of the biochemical work in the andrology area. To reach this goal, a framework and specific collaboration agreement was signed for the certification of specialized laboratories in Andrology. The FBA will carry out the logistics of the process, with its auditors' staff, applying the MA3 Accreditation Manual as an instrument, and the SAA will provide scientific advice. Together with the PAL authorities, a document was drawn to specify the sections corresponding to the MA3 chapter No. 4 Annex No. 4, "Standards for the certification of specialized laboratories". Training was carried out to prepare the documentation and the auditors in the specialty were trained as well. This experience has proven that cooperative work between organizations can achieve results favouring the patient's safety.

O credenciamento dos laboratórios visa promover, melhorar e garantir a qualidade do serviço. As especialidades requerem a participação de profissionais que assessoram os órgãos autônomos que realizam auditorias de terceiros. O objetivo é comunicar a experiência do trabalho cooperativo realizado por uma sociedade científica, a Sociedade Argentina de Andrologia (SAA) e o Programa de Credenciamento (PAL) da Fundação Bioquímica Argentina (FBA) para garantir a qualidade do trabalho bioquímico na área andrológica. Para esse fim, foi assinado um acordo-quadro e específico de cooperação para o credenciamento de laboratórios especializados em Andrologia. A FBA iria executar a logística do processo, com a sua equipe de auditores, por meio do Manual de Credenciamento MA3 como instrumento e a SAA como um instrumento e a SAA forneceria assessoramento científico. Junto com as autoridades do PAL foi elaborado um documento especificando as seções relativas ao MA3 capítulo Nº 4 Anexo Nº 4, "Normas para a credenciamento de laboratórios especializados". O treinamento foi realizado para a elaboração da documentação e formação dos auditores na especialidade. Essa experiência tem demonstrado que o trabalho cooperativo entre organizações permite atingir resultados positivos para a segurança do paciente.

Computer-aided sperm analysis: a useful tool to evaluate patient's response to varicocelectomy.

Preoperative and postoperative sperm parameter values from infertile men with varicocele were analyzed by computer-aided sperm analysis (CASA) to assess if sperm characteristics improved after varicocelectomy. Semen samples of men with proven fertility (n = 38) and men with varicocele-related infertility (n = 61) were also analyzed. Conventional semen analysis was performed according to WHO (2010) criteria and a CASA system was employed to assess kinetic parameters and sperm concentration. Seminal parameters values in the fertile group were very far above from those of the patients, either before or after surgery. No significant improvement in the percentage normal sperm morphology (P = 0.10), sperm concentration (P = 0.52), total sperm count (P = 0.76), subjective motility (%) (P = 0.97) nor kinematics (P = 0.30) was observed after varicocelectomy when all groups were compared. Neither was significant improvement found in percentage normal sperm morphology (P = 0.91), sperm concentration (P = 0.10), total sperm count (P = 0.89) or percentage motility (P = 0.77) after varicocelectomy in paired comparisons of preoperative and postoperative data. Analysis of paired samples revealed that the total sperm count (P = 0.01) and most sperm kinetic parameters: curvilinear velocity (P = 0.002), straight-line velocity (P = 0.0004), average path velocity (P = 0.0005), linearity (P = 0.02), and wobble (P = 0.006) improved after surgery. CASA offers the potential for accurate quantitative assessment of each patient's response to varicocelectomy.

Thyroxin Is Useful to Improve Sperm Motility.

BACKGROUND: The aim of this study was to evaluate the non-genomic action of thyroxin on sperm kinetic and its probable use to improve sperm recovery after applying an en- richment method like "swim-up" in comparison with the available one, pentoxifylline. MATERIALS AND METHODS: This is an experimental study. A total of 50 patients were re- cruited, followed by infertility consultation. Conventional sperm assays were performed according to World Health Organization criteria-2010 (WHO-2010). A Computer Aided Semen Analysis System was employed to assess kinetic parameters and concentrations. Number of the motile sperm recovered after preparation technique was calculated. RESULTS: Addition of T4 (0.002 µg/ml) to semen samples increased hypermotility at 20 minutes (control: 14.18 ± 5.1% vs. 17.66 ± 8.88%, P<0.03, data expressed as mean ± SD) and remained unchanged after 40 minutes. Significant differences were found in the motile sperm recovered after swim-up (control: 8.93×10(6) ± 9.52× 06vs. 17.20×10(6) ± 21.16×10(6), P<0.03), achieving all of the tested samples a desirable threshold value for artificial insemination outcome, while adding pentoxifylline increased the number of recovered sperm after swim-up in 60% of the studied cases. No synergism between two treatments could be determined. CONCLUSION: We propose a new physiological tool to artificially improve insemination. The discussion opens windows to investigate unknown pathways involved in sperm ca- pacitation and gives innovative arguments to better understand infertility mechanisms.

Nutrition and Reproductive Health: Sperm versus Erythrocyte Lipidomic Profile and ω-3 Intake.

Fatty acid analyses of sperm and erythrocyte cell membrane phospholipids in idiopathic infertile patients evidenced that erythrocyte contents of EPA, DHA, omega-6-omega-3 ratio and arachidonic acid provide a mathematical correspondence for the prediction of EPA level in sperm cells. The erythrocyte lipidomic profile of patients was significantly altered, with signatures of typical Western pattern dietary habits and no fish intake. A supplementation with nutritional levels of EPA and DHA and antioxidants was then performed for 3 months, with the follow-up of both erythrocyte and sperm cell membranes composition as well as conventional sperm parameters. Some significant changes were found in the lipidomic membrane profile of erythrocyte but not in sperm cells, which correspondently did not show significant parameter ameliorations. This is the first report indicating that membrane lipids of different tissues do not equally metabolize the fatty acid elements upon supplementation. Molecular diagnostic tools are necessary to understand the cell metabolic turnover and monitor the success of nutraceuticals for personalized treatments.

Verificación de los valores de referencia del estudio del semen según OMS 2010 en Buenos Aires / Verification of reference values for semen analysis according to WHO 2010 in Buenos Aires / Verificação dos valores de referência da análise do sêmen de acordo com a OMS 2010 em Buenos Aires

La Organización Mundial de la Salud en su edición 2010 ha publicado valores de referencia para los parámetros seminales. Sin embargo, los laboratorios deben verificarlos en su población para transferirlos a su práctica clínica. Para cumplimentar este requerimiento se propuso verificar los intervalos de referencia OMS 2010 en la población de la provincia y Ciudad Autónoma de Buenos Aires. También se determinó el rango de resultados para: número total de espermatozoides móviles progresivos y morfología normal en el eyaculado, parámetros cinéticos y pruebas funcionales. El proceso de verificación fue llevado a cabo de acuerdo a la guía C28-A2 CLSI (Clinical and Laboratory Standards Institute). Mediante difusión se convocó a hombres (n:20) argentinos residentes en Buenos Aires, con fertilidad probada en los últimos 12 meses. Se excluyeron individuos con patología andrológica. Las muestras se procesaron de acuerdo con los criterios OMS 2010. De los resultados se establece que los intervalos de referencia publicados en la última versión han sido verificados, con excepción del volumen seminal. Los rangos de valores obtenidos para los parámetros de movilidad progresiva y morfología en número totales, como también de los parámetros cinéticos y de las pruebas funcionales contribuirán a establecer futuros valores de referencia.

WHO 2010 provided reference values for semen analysis; however clinical laboratories should verify them in healthy fertile males. In order to be able to transfer this reference interval to our unit, it was proposed to examine the available data in the Buenos Aires population. The range of data obtained in this population was also provided for the following: total number of progressively motile and morphologically normal spermatozoa in the ejaculate,nematic parameter values and functional tests, in an attempt to establish standardization in these parameters. The process of reference value verification was carried out according to C28-A2 CLSI (Clinical and Laboratory Standards Institute) guidelines; to that aim, twenty men born in Argentina who reside in Buenos Aires province or city were recruited to participate. They were of proven fertility in the last 12 months. Individuals with pathologies by andrological consultation were excluded. Samples were processed according to 2010 WHO. In Buenos Aires City, WHO reference values were confirmed whereas semen volume was not confirmed. The range of values for total progressive and morphologically normal spermatozoa as well as kinetic parameter values, enrichment by swim up and functional test results were established for the male fertile population studied in an attempt to contribute to the construction of future reference values.

Organização Mundial da Saúde, em sua edição de 2010, tem publicado valores de referência para os parâmetros seminais. No entanto, os laboratórios devem verificá-los em sua população para serem transferidos a sua prática clínica. Para cumprir com esse requisito, decidiu-se verificar os intervalos de referência da OMS 2010, na população da província e da cidade de Buenos Aires. Também foram definidos intervalos de resultados para o número total de espermatozoides móveis progressivos e para a morfologia normal no ejaculado, os parâmetros cinéticos e os testes funcionáis. O processo de verificação foi realizado de acordo com o guia CLSI C28 A2 (Clinical and Laboratory Standards Institute). Por meio de uma convocação, (N 20) homens argentinos residentes em Buenos Aires, com comprovada fertilidade nos últimos 12 meses foram convidados. Indivíduos com patologia andrológica foram excluídos. As amostras foram processadas de acordo com os critérios da OMS de 2010. A partir dos resultados estabeleceu-se que os intervalos de referência publicados na versão mais recente foram verificados, com exceção do volume seminal. Os intervalos de valores obtidos para os parâmetros de motilidade progressiva e morfologia em número total, bem como os parâmetros cinéticos e os dos testes funcionais ajudarão a estabelecer valores de referência futura.

Verificación de los valores de referencia del estudio del semen según OMS 2010 en Buenos Aires / Verification of reference values for semen analysis according to WHO 2010 in Buenos Aires / VerificaþÒo dos valores de referÛncia da análise do sÛmen de acordo com a OMS 2010 em Buenos Aires

La Organización Mundial de la Salud en su edición 2010 ha publicado valores de referencia para los parámetros seminales. Sin embargo, los laboratorios deben verificarlos en su población para transferirlos a su práctica clínica. Para cumplimentar este requerimiento se propuso verificar los intervalos de referencia OMS 2010 en la población de la provincia y Ciudad Autónoma de Buenos Aires. También se determinó el rango de resultados para: número total de espermatozoides móviles progresivos y morfología normal en el eyaculado, parámetros cinéticos y pruebas funcionales. El proceso de verificación fue llevado a cabo de acuerdo a la guía C28-A2 CLSI (Clinical and Laboratory Standards Institute). Mediante difusión se convocó a hombres (n:20) argentinos residentes en Buenos Aires, con fertilidad probada en los últimos 12 meses. Se excluyeron individuos con patología andrológica. Las muestras se procesaron de acuerdo con los criterios OMS 2010. De los resultados se establece que los intervalos de referencia publicados en la última versión han sido verificados, con excepción del volumen seminal. Los rangos de valores obtenidos para los parámetros de movilidad progresiva y morfología en número totales, como también de los parámetros cinéticos y de las pruebas funcionales contribuirán a establecer futuros valores de referencia.(AU)

WHO 2010 provided reference values for semen analysis; however clinical laboratories should verify them in healthy fertile males. In order to be able to transfer this reference interval to our unit, it was proposed to examine the available data in the Buenos Aires population. The range of data obtained in this population was also provided for the following: total number of progressively motile and morphologically normal spermatozoa in the ejaculate, kinematic parameter values and functional tests, in an attempt to establish standardization in these parameters. The process of reference value verification was carried out according to C28-A2 CLSI (Clinical and Laboratory Standards Institute) guidelines; to that aim, twenty men born in Argentina who reside in Buenos Aires province or city were recruited to participate. They were of proven fertility in the last 12 months. Individuals with pathologies by andrological consultation were excluded. Samples were processed according to 2010 WHO. In Buenos Aires City, WHO reference values were confirmed whereas semen volume was not confirmed. The range of values for total progressive and morphologically normal spermatozoa as well as kinetic parameter values, enrichment by swim up and functional test results were established for the male fertile population studied in an attempt to contribute to the construction of future reference values.(AU)

A OrganizaþÒo Mundial da Saúde, em sua ediþÒo de 2010, tem publicado valores de referÛncia para os parÔmetros seminais. No entanto, os laboratórios devem verificá-los em sua populaþÒo para serem transferidos a sua prática clínica. Para cumprir com esse requisito, decidiu-se verificar os intervalos de referÛncia da OMS 2010, na populaþÒo da província e da cidade de Buenos Aires. Também foram definidos intervalos de resultados para o número total de espermatozoides móveis progressivos e para a morfologia normal no ejaculado, os parÔmetros cinéticos e os testes funcionáis. O processo de verificaþÒo foi realizado de acordo com o guia CLSI C28 A2 (Clinical and Laboratory Standards Institute). Por meio de uma convocaþÒo, (N 20) homens argentinos residentes em Buenos Aires, com comprovada fertilidade nos últimos 12 meses foram convidados. Indivíduos com patologia andrológica foram excluídos. As amostras foram processadas de acordo com os critérios da OMS de 2010. A partir dos resultados estabeleceu-se que os intervalos de referÛncia publicados na versÒo mais recente foram verificados, com exceþÒo do volume seminal. Os intervalos de valores obtidos para os parÔmetros de motilidade progressiva e morfologia em número total, bem como os parÔmetros cinéticos e os dos testes funcionais ajudarÒo a estabelecer valores de referÛncia futura.(AU)

A rare case of respiratory disorders associated with two autosomal recessive diseases and male infertility.

The study of nasal ciliary beat frequency (CBF) and ultrastructure may contribute to the understanding of pathognomonic cases of male infertility associated with defects in sperm motility. This study was designed to report a particular case of male infertility, characterized by the association of two respiratory autosomal recessive genetic diseases (alpha-1-antitrypsin deficiency [AAT-D] and primary ciliary dyskinesia [PCD]). A 39-year-old patient with complete sperm immotility, AAT-D, and bronchiectasis was studied in the Laboratory of Male Fertility, the Department of Urology, the Respiratory Center of a Pediatric Hospital, and in the Department of Clinical Medicine of a Rehabilitation Respiratory Hospital. Family history, physical examination, hormonal analysis, microbial assays, semen analysis, nasal ciliary function, and structure study by digital high-speed video photography and transmission electron microscopy are described. A noninvasive nasal biopsy to retrieve ciliated epithelium lining the inferior surface of the inferior nasal turbinates was performed and CBF was determined. Beat pattern was slightly curved and rigid, not wide, and metacronic in all the observed fields analyzed. CBF was 8.2 Hz in average (reference value, 10-15 Hz) Ultrastructural assay revealed absence of the inner dynein arms in 97% of the cilia observed. The final infertility accurate diagnosis was achieved by the study of nasal CBF and ultrastructure contributing to the patient health management and genetic counseling while deciding fatherhood. Beyond this particular case, the present report may open a new field of studies in male infertility, mainly in cases of asthenozoospermia.

Estudio del semen humano: Implementación de un método objetivo / Study of human semen: implementation of an objective method / Estudo do sêmem humano: implementação de um método objetivo

El objetivo del presente trabajo fue estandarizar y validar un sistema computarizado de análisis de semen CASA, SCA (Sperm Class Analyzer) para los parámetros de concentración y movilidad espermática de acuerdo a normativas internacionales. Se estandarizó el tipo de velocidad para la clasificación en grados y la profundidad adecuada de la cámara. Para la validación se determinó precisión, límite de detección, intervalo de medición y estudio de comparación de métodos. Se halló alta correlación lineal en la clasificación del movimiento empleando Velocidad Curvilínea o Velocidad Promedio (r=0,99; p<0,001), estableciendo el uso de la primera para obtener resultados comparables con otros sistemas objetivos. También, se normatizó el empleo de cámaras de 10 µm de profundidad debido a que se obtienen mejores imágenes para el análisis sin afectar la movilidad. La imprecisión media fue 13,29%, 14,26% y 18,75% para recuento, móviles progresivos y móviles grado (a) respectivamente. Se halló alta correlación con el método manual, tanto en concentración (r=0,97, p<0,0001), móviles progresivos (r=0,84; (p<0,001) y móviles grado (a) (r=0,82; p<0,0001). Se comprobó linealidad (r=0,99; p<0,001), entre 0,98 x 106 y 125 x 106 esp/mL. Se concluye que el método propuesto cumple con los requisitos necesarios para su empleo en la clínica, siendo indispensable la edición de las imágenes por parte de un operador calificado.

Utilidad clínica de la citología espermática / Clinical usefulness of seminal cytology / Utilidade clínica da citologia espermática

En el examen del semen son importantes las determinaciones de la movilidad, el número y la morfología espermática, sin embargo no resultan suficientes. La observación de las células de la progenie espermática o de otras células epiteliales puede contribuir al mejoramiento del diagnóstico clínico. En el presente trabajo se presentan tres casos de estudios de muestras de sémenes donde la observación citológica fue el criterio más importante para la definición de la patología. Finalmente se discuten imágenes celulares publicadas en el Manual de OMS para el Examen y Procesamiento de Semen Humano, 5a edición, donde se confunden células germinales inmaduras con macrófagos. El propósito del trabajo es poner en evidencia la importancia del conocimiento citológico para una correcta interpretación de ciertas patologías seminales.

Utilidad clínica de la citología espermática / Clinical usefulness of seminal cytology / Utilidade clínica da citologia espermática

En el examen del semen son importantes las determinaciones de la movilidad, el número y la morfología espermática, sin embargo no resultan suficientes. La observación de las células de la progenie espermática o de otras células epiteliales puede contribuir al mejoramiento del diagnóstico clínico. En el presente trabajo se presentan tres casos de estudios de muestras de sémenes donde la observación citológica fue el criterio más importante para la definición de la patología. Finalmente se discuten imágenes celulares publicadas en el Manual de OMS para el Examen y Procesamiento de Semen Humano, 5a edición, donde se confunden células germinales inmaduras con macrófagos. El propósito del trabajo es poner en evidencia la importancia del conocimiento citológico para una correcta interpretación de ciertas patologías seminales.(AU)

Motility, number and morphology of sperms are very important in semen examination. Nevertheless, observation of germ cells or other epithelial cells can contribute to the improvement of the clinical diagnosis. In the present paper three clinical cases are presented where the cytological characteristic were the most important criteria to define the pathologies. Finally, some images published by the WHO in the last edition of the "Laboratory Manual for the Examination and Processing of Human Semen" , Fifth Edition, 2010 are discussed; in these images, germ cells are erroneously diagnosed as macrophages. The objective of the present work is to underline the importance of the cytology for a correct interpretation of certain seminal pathologies.(AU)

No exame de sÛmen sÒo importantes as determinaþ§es da motilidade, o número e a morfologia espermática, mas tudo isso nÒo é suficiente. A observaþÒo das células da progÛnie espermática ou de outras células epiteliais pode contribuir para a melhoria do diagnóstico clínico. No trabalho em questÒo sÒo apresentados trÛs casos de estudo das amostras dos sÛmens onde a observaþÒo citológica foi o critério mais importante para a definiþÒo da patologia. Finalmente sÒo discutidas imagens celulares publicadas no Manual da OMS para o Exame e Processamento do SÛmen Humano, 5¬ ediþÒo, onde as células germinativas imaturas sÒo confundidas com macrófagos. O objetivo deste trabalho é destacar a importÔncia do conhecimento citológico para a correta interpretaþÒo de certas patologias seminais.(AU)

Estudio del semen humano: implementación de un método objetivo / Study of human semen: implementation of an objective method / Estudo do sÛmem humano: implementaþÒo de um método objetivo

El objetivo del presente trabajo fue estandarizar y validar un sistema computarizado de análisis de semen CASA, SCA (Sperm Class Analyzer) para los parámetros de concentración y movilidad espermática de acuerdo a normativas internacionales. Se estandarizó el tipo de velocidad para la clasificación en grados y la profundidad adecuada de la cámara. Para la validación se determinó precisión, límite de detección, intervalo de medición y estudio de comparación de métodos. Se halló alta correlación lineal en la clasificación del movimiento empleando Velocidad Curvilínea o Velocidad Promedio (r=0,99; p< 0,001), estableciendo el uso de la primera para obtener resultados comparables con otros sistemas objetivos. También, se normatizó el empleo de cámaras de 10 Am de profundidad debido a que se obtienen mejores imágenes para el análisis sin afectar la movilidad. La imprecisión media fue 13,29%, 14,26% y 18,75% para recuento, móviles progresivos y móviles grado (a) respectivamente. Se halló alta correlación con el método manual, tanto en concentración (r=0,97, p>< 0,0001), móviles progresivos (r=0,84; (p>< 0,001) y móviles grado (a) (r=0,82; p>< 0,0001). Se comprobó linealidad (r=0,99; p>< 0,001), entre 0,98 x 106 y 125 x 106 esp/mL. Se concluye que el método propuesto cumple con los requisitos necesarios para su empleo en la clínica, siendo indispensable la edición de las imágenes por parte de un operador calificado.(AU)

The aim of this study was to standardize and validate a CASA system, SCA (Sperm Class Analyzer) for the parameters of sperm concentration and motility according to international standards. The type of speed for the classification of degrees and the proper depth of the camera were standardized. For the validation, accuracy, detection limit, measuring range and method comparison study were determined. High linear correlation was found in the classification of motion using curvilinear velocity or average speed (r=0.99, p< 0.001), establishing the use of the first to obtain results comparable with other objectives. Likewise, the use of cameras 10 microns in depth was also standardized since better images are obtained for the analysis without affecting mobility. Average imprecision was 13.29%, 14.26% and 18.75% for counting, progressive and mobile grades respectively. High correlation was found with the manual method, both in concentration (r=0.97, p>< 0.0001), progressive mobiles (r=0.84, (p>< 0.001) and mobile grade a (r=0.82, p>< 0.0001). Linearity (r=0.99, p>< 0.001) was proved between 0.98 and 125 x 106 x 106 sperm/mL. It is concluded that the proposed method meets the requirements for use in the clinic, being image editing by a qualified operator indispensable.(AU)

O objetivo do presente trabalho foi padronizar e validar um sistema computadorizado de análise de sÛmen CASA, SCA (Sperm Class Analyzer) para os parÔmetros de concentraþÒo e motilidade espermática de acordo com normativas internacionais. Foi padronizado o tipo de velocidade para a classificaþÒo em graus e a profundidade adequada da cÔmara. Para a validaþÒo se determinou precisÒo, limite de detecþÒo, intervalo de mediþÒo e estudo de comparaþÒo de métodos. Foi encontrada alta correlaþÒo linear na classificaþÒo do movimento utilizando Velocidade Curvilínea ou Velocidade Média (r=0,99; p< 0,001), estabelecendo o uso da primeira para obter resultados comparáveis com outros sistemas objetivos. Também, foi normatizado o uso de cÔmaras de 10 Am de profundidade visto que se obtÛm melhores imagens para a análise sem afetar a mobilidade. A imprecisÒo média foi de 13,29%, 14,26% e 18,75% para recontagem, móveis progressivos e móveis grau (A) respectivamente. Achou-se alta correlaþÒo com o método manual, tanto em concentraþÒo (r=0,97; p>< 0,0001), móveis progressivos (r=0,84; (p>< 0,001) e móveis grau (A) (r=0,82; p>< 0,0001). Foi comprovada linearidade (r=0,99; p>< 0,001), entre 0,98 x 106 e 125 x 106 esp/mL. Conclui-se que o método proposto cumpre com os requisitos necessários para sua utilizaþÒo na clínica, sendo indispensável a ediþÒo das imagens por parte de um operador qualificado.(AU)

Estudio del semen humano: Implementación de un método objetivo / Study of human semen: implementation of an objective method

El objetivo del presente trabajo fue estandarizar y validar un sistema computarizado de análisis de semen CASA, SCA (Sperm Class Analyzer) para los parámetros de concentración y movilidad espermática de acuerdo a normativas internacionales. Se estandarizó el tipo de velocidad para la clasificación en grados y la profundidad adecuada de la cámara. Para la validación se determinó precisión, límite de detección, intervalo de medición y estudio de comparación de métodos. Se halló alta correlación lineal en la clasificación del movimiento empleando Velocidad Curvilínea o Velocidad Promedio (r=0,99; p<0,001), estableciendo el uso de la primera para obtener resultados comparables con otros sistemas objetivos. También, se normatizó el empleo de cámaras de 10 Am de profundidad debido a que se obtienen mejores imágenes para el análisis sin afectar la movilidad. La imprecisión media fue 13,29%, 14,26% y 18,75% para recuento, móviles progresivos y móviles grado (a) respectivamente. Se halló alta correlación con el método manual, tanto en concentración (r=0,97, p<0,0001), móviles progresivos (r=0,84; (p<0,001) y móviles grado (a) (r=0,82; p<0,0001). Se comprobó linealidad (r=0,99; p<0,001), entre 0,98 x 106 y 125 x 106 esp/mL. Se concluye que el método propuesto cumple con los requisitos necesarios para su empleo en la clínica, siendo indispensable la edición de las imágenes por parte de un operador calificado.(AU)

Utilidad clínica de la citología espermática / Clinical usefulness of seminal cytology

En el examen del semen son importantes las determinaciones de la movilidad, el número y la morfología espermática, sin embargo no resultan suficientes. La observación de las células de la progenie espermática o de otras células epiteliales puede contribuir al mejoramiento del diagnóstico clínico. En el presente trabajo se presentan tres casos de estudios de muestras de sémenes donde la observación citológica fue el criterio más importante para la definición de la patología. Finalmente se discuten imágenes celulares publicadas en el Manual de OMS para el Examen y Procesamiento de Semen Humano, 5a edición, donde se confunden células germinales inmaduras con macrófagos. El propósito del trabajo es poner en evidencia la importancia del conocimiento citológico para una correcta interpretación de ciertas patologías seminales.(AU)

In vivo antigenotoxic activity of watercress juice (Nasturtium officinale) against induced DNA damage.

The present study was carried out to investigate the genotoxicity as well as possible protective activity against damage induced by cyclophosphamide (CP) of the aqueous juice of watercress (Nasturtium officinale, W.T. Aiton) in vivo. Male and female Swiss mice 7-8 weeks old (N = 48) were treated by gavage with 1 g kg(-1) body weight and 0.5 g kg(-1) body weight of watercress juice during 15 consecutive days. Genotoxicity and its possible protective effect were tested by the comet assay in peripheral blood cells and the micronucleus test in bone marrow. In addition, biopsies of the bladder, epididymis and testicles of mice were performed to extend the experimental design. Watercress juice per se did not induce genetic damage according to the comet assay and micronucleus study, exhibiting a protective activity against CP (P < 0.05 and P < 0.001, respectively). The comparative analysis of bladder histological changes obtained in the watercress plus CP group against those treated with CP alone suggests a probable protective effect. Further studies are needed in order to establish the protective role of watercress juice against DNA damage.