Cuidados en la Cataluña rural de postguerra. José Quílez, practicante de Almenar / Cuidado na Catalunha rural do pósuerra. José Quílez, praticante de Almenar / Care in postwar rural Catalonia. José Quílez, practitioner from Alme- nar

This paper aims to present the testimony of the midwife and practitioner José Quílez, who developed his professional practice in Almenar (small town in the province of Lleida), in order to show how the professional provision of care in rural postwar Catalonia was developed by this civil servant of the local administration. A qualitative study of historical research is developed using the biographical interview as a resource, framed in the phenomenological paradigm, using direct oral sources that have been triangulated with the interviewee's own written sources, bibliographic sources, as well as documentation from the archives of the Official College of Nurses of Lleida. The testimony highlights a noble character forged by the miseries of postwar Spain, which led to his emigration for work reasons from Aragon to Catalonia, where he had the opportunity to develop a solid family project, as well as a strong professional commitment in the provision of care, which is manifested in the rigor in the application of the protocols of the time, as well as the basic principles of ethics and privacy with which he attended to patients.(AU)

Este trabajo pretende dar a conocer el testimonio del comadrón y practicante José Quílez, que desarrolló su ejercicio profesional en Almenar (pequeño pueblo de la provincia de Lleida), con el fin de dar a conocer como se desarrollaba la prestación profesional de cuidados en la Cataluña rural de postguerra por parte de este funcionario de la administración local. Se desarrolla un estudio cualitativo de investigación histórica que utiliza la entrevista biográfica como recurso, enmarcado en el paradigma fenomenológico, utilizando fuentes orales directas que se han triangulado con fuentes escritas propias del entrevistado, bibliográficas, así como documentación del archivo del Colegio Oficial de Enfermeras y Enfermeros de Lleida. Del testimonio destaca un carácter noble forjado por las miserias propias de la España de postguerra, que conllevaron a su emigración por motivos laborales desde tierras aragonesas a Cataluña, donde tuvo ocasión de desarrollar un proyecto familiar sólido, así como un fuerte compromiso profesional en la prestación de cuidados, que se manifiesta en el rigor en la aplicación de los protocolos de la época, así como los principios básicos de la ética y privacidad con la que atendía a los pacientes.(AU)

O objectivo deste estudo é apresentar o testemunho do parteiro e praticante José Quílez, que exerceu a sua actividade profissional em Almenar (uma pequena aldeia na província de Lérida), a fim de mostrar como a prestação de cuidados profissionais na Catalunha rural do pós-guerra foi realizada por este funcionário público da administração local. É realizado um estudo de investigação histórica qualitativa utilizando a entrevista biográfica como recurso, enquadrado no paradigma fenomenológico, utilizando fontes orais directas que foram trianguladas com as próprias fontes escritas do entrevistado, fontes bibliográficas, bem como documentação dos arquivos do Colégio Oficial de Enfermeiras e Enfermeiros de Lleida. O testemunho destaca um carácter nobre forjado pelas misérias da Espanha do pós-guerra, que levou à sua emigração por razões de trabalho de Aragão para a Catalunha, onde teve a oportunidade de desenvolver um sólido projecto familiar, bem como um forte empenho profissional na prestação de cuidados, que se manifesta no rigor na aplicação dos protocolos da época, bem como nos princípios básicos de ética e privacidade com que atendeu os doentes.(AU)

Effect of embryo transfer difficulty on live birth rates studied in vitrified-warmed euploid blastocyst transfers.

RESEARCH QUESTION: The aim of this study was to investigate the relationship between the different manoeuvres employed or degrees of difficulty during embryo transfer and live birth rate (LBR) in frozen euploid (blastocyst) embryo transfer (FEET). DESIGN: A retrospective, observational study of women undergoing FEET was performed. If the catheter encountered any resistance in its passage through the cervix, a stepwise approach was used. Easy embryo transfer was defined as a direct embryo transfer or use of the outer sheath of the catheter. Difficult embryo transfer was defined as when the process required the use of a Wallace Malleable Stylet (Smiths Medical International Ltd., UK) without or with additional instrumentation such as a tenaculum or uterine sound. RESULTS: The analysis involved 370 FEET. LBR was significantly lower in difficult FEET procedures compared with easy ones (54.5% versus 40.5%, P = 0.026) but significance was lost after adjustment for confounders. Use of the outer sheath use did not affect LBR. Although LBR was significantly lower when the stylet, without or with a tenaculum, was required (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.34-0.93; P < 0.05), no statistically significant reduction was observed after adjustment for confounders (OR 0.81, 95% CI 0.45-1.47). CONCLUSIONS: No significant reduction in LBR was observed after adjustment for confounders between difficult and easy FEET, or when use of stylet without or with a tenaculum was required for embryo transfer. The lack of significance may be due to factors such as the sample size or the use of array comparative genomic hybridization analysis. Further studies are needed to confirm these results.

Usefulness of oocyte accumulation in low ovarian response for PGS.

This is an observational study of the response to ovarian stimulation and preimplantational genetic screening (PGS) cycles of 188 patients with a foreseen high aneuploid rate, undergoing two or three stimulation cycles (2SC and 3SC) and oocyte vitrification to accumulate oocytes (Accumulation group = 112 patients) compared to patients undergoing one stimulation cycle (1SC Group= 76 patients) and fresh embryo transfer, between January 2011 and July 2014. Accumulation was performed when <10 MII oocytes were retrieved. Oocytes were vitrified for later warming and IVF, when the planned number of oocytes was achieved. After PGS, euploid embryos were transferred. Comparing 2SC Group with 3SC Group, AMH, AFC, number of oocytes retrieved per pick-up and total number of biopsied embryos were significantly higher in the 2SC Group. After chromosome analysis, 18.5% of biopsied embryos were euploid and 58.9% patients reached embryo transfer. There were no differences in pregnancy rates per patient between the 1SC, 2SC and 3SC Groups (36.8%, 34.9% and 31.0%, respectively) or per embryo transfer (59.6, 56.8 and 60%, respectively). In patients with <10 MII oocytes after ovarian stimulation undergoing PGS, accumulating oocytes can render a pregnancy rate per patient and per embryo transfer comparable to those of fresh PGS cycles.

Comparison of starting ovarian stimulation on day 2 versus day 15 of the menstrual cycle in the same oocyte donor and pregnancy rates among the corresponding recipients of vitrified oocytes.

OBJECTIVE: To assess the clinical pregnancy rate per transfer in recipients of embryos from donor oocytes obtained after ovarian stimulation initiated on day 2 (D2) or day 15 (D15) of the menstrual cycle with a secondary end point of comparing the response to stimulation. DESIGN: Prospective observational comparative study. SETTING: Private in vitro fertilization (IVF) program. PATIENT(S): Oocyte donors (OD) and recipients. INTERVENTION(S): Donors stimulated within 3 months, starting on day 2 or day 15 after bleeding, with recombinant follicle-stimulating hormone (FSH), gonadotropin-releasing hormone (GnRH) antagonist, and GnRH agonist trigger, and oocytes vitrified and later assigned to recipients, followed by routine IVF procedures one to two embryos transferred. MAIN OUTCOME MEASURE(S): Primary outcome pregnancy rate, and secondary outcome number of mature oocytes retrieved. RESULT(S): Nine D2 and nine D15 cycles were performed in nine donors. There were no differences between D2 and D15 in the number of mature oocytes obtained (14.0±6.96 vs. 16.89±7.52). To date, 20 recipients have received vitrified oocytes (8 recipients received D2 oocytes and 12 recipients received D15 oocytes). There were no differences between the groups of recipients in fertilization rate (77.3% vs. 76.5%) or number of embryos transferred (1.50±0.53 vs. 1.67±0.65). Twelve clinical pregnancies were obtained. No differences were noted in pregnancy rates (62.5% vs. 58.3%) or implantation rates (41.67% vs. 45%) between recipients of D2 oocytes and recipients of D15 oocytes. CONCLUSION(S): Donor oocytes obtained after ovarian stimulation initiated on day 15 of the cycle achieve good pregnancy rates. This information is useful for patients with cancer undergoing fertility preservation. CLINICAL TRIAL REGISTRATION NUMBER: NCT 01645241.

Live birth using vitrified--warmed oocytes in invasive ovarian cancer: case report and literature review.

This article reports the live birth of a healthy newborn using vitrified-warmed oocytes in a young patient with invasive mucinous ovarian carcinoma (stage Ic). Diagnosis was performed after a laparoscopic left adnexectomy. She underwent two cycles of ovarian stimulation, and 14 oocytes were vitrified before fertility-sparing surgery with uterus preservation went ahead. One year later, a transfer of two embryos was performed after insemination of warmed oocytes. Eighteen days after the transfer, she underwent a laparotomy because of abdominal pain, vaginal bleeding and haemoperitoneum. A right cornual ectopic pregnancy in the uterus was diagnosed and a wedge resection was performed to resolve it. One week later, a viable intrauterine pregnancy was confirmed under ultrasound. An elective Caesarean section was performed at week 38 of gestation, resulting in the birth of a healthy boy weighing 2650 g. As far as is known, this is the first live birth reported through vitrified-warmed oocytes in a patient with invasive ovarian cancer. Although oocyte vitrification is an alternative to be considered for fertility preservation in highly selected cases of ovarian cancer, controversial issues are discussed. Fertility preservation is a proven possibility in some cancer patients according to their age, disease and time available until the beginning of their oncological treatment. Although oocyte vitrification is an alternative to be considered for fertility preservation in highly selected cases of ovarian cancer, no live birth has been reported. We report the live birth of a healthy newborn through vitrified-warmed oocytes in a young patient with invasive mucinous ovarian carcinoma (stage Ic). Diagnosis was performed after a laparoscopic left adnexectomy. She underwent two cycles of ovarian stimulation, and 14 oocytes were vitrified before fertility-sparing surgery with uterus preservation went ahead. One year later, a transfer of two embryos was performed after the insemination of the warmed oocytes. Eighteen days after the transfer she underwent a laparotomy because of abdominal pain, vaginal bleeding and haemoperitoneum. A right cornual ectopic pregnancy in the uterus was diagnosed and a wedge resection was performed to resolve it. One week later, a viable intrauterine pregnancy was confirmed under ultrasound. An elective Caesarean section was performed at week 38 of gestation, resulting in the birth of a healthy boy weighing 2650 g. To our knowledge, this is the first live birth reported using vitrified-warmed oocytes in invasive ovarian cancer. Controversial issues are reviewed and discussed.

Antagonist rescue of agonist IVF cycle at risk of OHSS: a case series.

We describe a series of in vitro fertilisation (IVF) long protocol cycles presenting a risk of ovarian hyperstimulation syndrome (OHSS) which were rescued with an antagonist at a university-based tertiary-care fertility centre. Nineteen IVF patients presenting a risk of OHSS during treatment with long protocol, between 2009 and November 2012 were included in the present study. After discussion of available options, the agonist was stopped and a daily gonadotropin-releasing hormone (GnRH) antagonist injection was initiated ("rescue protocol") and maintained until ovulation trigger. Fourteen patients were triggered with human chorionic gonadotropin (hCG) and five with GnRH agonist bolus, yielding competent oocytes. Seventeen embryo transfers were performed in the fresh cycles. One patient developed moderate OHSS. There were eight clinical pregnancies after the fresh IVF cycle (42% per patient), and six further pregnancies after frozen-thawed cycles, resulting in a 73% cumulative clinical pregnancy rate within one year. We conclude that the "rescue protocol with antagonist" of the long IVF cycle with a high risk of OHSS allows us to carry on with the cycle, without compromising its success or the patient safety, thus broadening the possibility of applying the long protocol.

Cancer and fertility preservation: Barcelona consensus meeting.

Improvements in early diagnosis and treatment strategies in cancer patients have enabled younger women with cancer to survive. In addition to the stressful event of the diagnosis, patients with malignant diseases face the potential loss of the opportunity to have children. Preservation of fertility has become a challenging issue and it is still surrounded by controversies. On the basis of available evidence, a group of experts reached a consensus regarding the options for trying to preserve fertility in women with cancer: among established methods, in postpubertal women, oocyte cryopreservation is the preferred option, whereas ovarian tissue cryopreservation is the only possibility for prepubertal girls. Combining several strategies on an individual basis may improve the chances of success. Realistic information should be provided before any intervention is initiated. Counseling should offer support for patients and provide better care by understanding emotional needs, psychological predictors of distress and methods of coping. Early referral to the fertility specialist is essential as fertility preservation (FP) may improve quality of life in these patients. The information summarized here is intended to help specialists involved in the treatment of cancer and reproductive medicine to improve their understanding of procedures available for FP in young cancer patients.

Vitrified blastocysts from Preimplantation Genetic Diagnosis (PGD) as a source for human Embryonic Stem Cell (hESC) derivation.

Embryos diagnosed as abnormal in Preimplantation Genetic Diagnosis (PGD) cycles are useful for the establishment of human Embryonic Stem Cells (hESC) lines with genetic disorders. These lines can be helpful for drug screening and for the development of new treatments. Vitrification has proved to be an efficient method to preserve human blastocysts. One hundred and three abnormal or undiagnosed vitrified blastocysts from the PGD programme at Institut Universitari Dexeus were donated for human embryonic stem cell derivation. The overall survival rate after warming was 70.6 %. Our results showed better survival rates when blastocysts have not started the hatching process (initial/expanded 87.8 %, hatching 68.3 % and hatched 27.3 %). Thirty-five blastocysts and 12 partially surviving embryos were seeded. One hESC line with the multiple exostoses type 2 paternal mutation was obtained.

Proposal of a new model to improve the collection of small WEEE: a pilot project for the recovery and recycling of toys.

A new collection model was designed and tested in Catalonia (Spain) to foster the separate collection and recycling of electrical and electronic toys, with the participation of selected primary and secondary schools, as well as waste collection points and municipalities. This project approach is very original and important because small household WEEE has low rates of collection (16-21% WEEE within the EU or 5-7% WEEE in Spain) and no research on new approaches to enhance the collection of small WEEE is found in the literature. The project was successful in achieving enhanced toys collection and recycling rates, which went up from the national Spanish average of 0.5% toys before the project to 1.9 and 6% toys during the two project years, respectively. The environmental benefits of the campaign were calculated through a life-cycle approach, accounting for the avoided impact afforded by the reuse of the toys and the recycling of the valuable materials contained therein (such as metals, batteries and circuit boards) and subtracting the additional environmental burdens associated with the establishment of the collection campaign.

Correlation between embryological factors and pregnancy rate: development of an embryo score in a cryopreservation programme.

PURPOSE: To establish which embryo parameters, in frozen thawed embryo transfers, have the highest prognosis value in the establishment of pregnancy. The relative importance of different embryo parameters is used to develop an embryo score. METHODS: Retrospective analysis of the implantation rate in 356 frozen/thawed single embryo transfers. A logistic regression model is used to establish an embryo score. RESULTS: A direct correlation is established between the implantation rate and fresh embryo development (number of blastomeres and their symmetry), survival rate after thawing and mitosis resumption after overnight culture. CONCLUSIONS: An embryo score is developed to determine the implantation potential of frozen/thawed embryos.

Teledermatología / Teledermatology

La teledermatología se define como la práctica de la dermatología a distancia. Para ello se emplean dos sistemas: la videoconferencia en directo y el sistema en diferido. En el primero el médico consultor, desde el centro de atención primaria, toma las imágenes con una cámara de video. El médico de familia, el paciente y el dermatólogo están conectados en directo y por tanto el dermatólogo puede interrogar al paciente. Este sistema es altamente formativo para el médico consultor ya que se comentan los detalles que definen la dermatosis, pero es un sistema que consume mucho tiempo y el equipa miento es relativamente caro. El sistema en diferido consiste en remitir al dermatólogo, por correo electrónico, una fotografía digital de las lesiones del paciente junto con un resumen de la historia clínica. Las imágenes son de mayor calidad pero el dermatólogo se siente más inseguro con el diagnóstico emitido ya que no puede interaccionar con el paciente. Se espera que los sistemas de teledermatología faciliten el acceso al dermatólogo de pacientes situados en localidades remotas, lo que mejorará el cuidado de los mismos, y que permita reducir las listas de espera, ya que se puedan seleccionar mejor los pacientes y escoger más fácilmente la prioridad de las mismas

Teledermatology is defined as the practice of the dermatology at a distance. It can be applied in one of two ways: in real-time videoconference, or by store-and-forward methods. In the first case, the consulting doctor, from the primary care center, takes the images with a camcorder. The family practitioner, the patient and the dermatologist are connected on-line and therefore the dermatologist can interrogate the patient. This system is highly educational for the consulting doctor since the details that define the dermatosis are commented. But it is more time-consuming and the equipment is relatively expensive. In the store-forward system a digital image of the patient's skin lesions along with a summary of its clinical history is send by e-mail to the dermatologist. The images are of greater quality but the dermatologist feels more uncertain with the emitted diagnosis since he cannot interact with the patient. It is hoped that the teledermatology systems facilitate the patients located in remote areas access to the dermatology care, and, since the patients can be selected better, that it will result in fewer conventional consultations, and in a reduction in the waiting lists