Autogenous transfer of intracytoplasmic sperm injection-produced equine embryos into the uterus of the oocyte donor during the same oestrous cycle.

The clinical use of intracytoplasmic sperm injection (ICSI) in horses usually involves the transfer of embryos into recipient mares, resulting in substantial cost increases. This is essential when subfertile mares are oocyte donors; but some donors are fertile, with ICSI compensating for limited or poor-quality spermatozoa. Fertile oocyte donors could carry pregnancies, eliminating the need for a recipient. We assessed the potential of using oocyte donors as recipients for their own ICSI-produced embryos during the same cycle. Donors in oestrus and with large dominant follicles were administered ovulation-inducing compounds to cause follicle and oocyte maturation. Maturing oocytes were collected, cultured and fertilised using ICSI. At 6 or 7 days after ICSI, developing blastocysts were transferred into respective donors' uteri, and pregnancy rates were determined. Twenty follicles were aspirated from nine mares and 12 oocytes were collected. After ICSI, 10 of the 12 oocytes (83%) cleaved, and eight (67% of injected oocytes) developed into blastocysts for transfer. Five pregnancies resulted from the eight transferred embryos (pregnancy rate 62% per embryo and 42% per sperm-injected oocyte). Following this synchronisation regime, ICSI-produced embryos can be transferred into oocyte donors' uteri during the same cycle, allowing donors to carry pregnancies after assisted fertilisation.

Remitting seronegative symmetrical synovitis with pitting oedema: a study of 12 cases.

Twelve patients with remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) were analysed. Eight of them had typical RS3PE without underlying disease, and four presented associated neoplasia. The first patients experienced an excellent response to low doses of prednisone, and they all achieved complete and permanent remission. The mean treatment duration was 18 months and the mean follow-up was 4.4 years. During the follow-up, none of these patients relapsed, had fever or general health deterioration, and hand and foot radiographs did not show erosion. One of them developed a panarteritis nodosa 6 years later. Four RS3PE patients had associated neoplasia. Two were with solid malignancies, and the other two presented haematological malignancies. In one of them RS3PE preceded the diagnosis of malignancy. The diagnosis of RS3PE in the other patients was subsequent to cancer. The first patients presented clinical characteristics suggestive of paraneoplastic RS3PE, and they had a poor response to corticosteroid therapy. Two patients died, and the rest of them had a complete response to surgical resection of the tumour or to chemotherapy. In general, idiopathic RS3PE patients do not show either general health deterioration or fever and they do respond to low doses of steroids (10 mg/day). We observed strong contrasts with the results obtained when treating RS3PE patients with associated neoplasia. In patients with RS3PE the presence of systemic symptoms along with resistance to low doses of corticosteroid therapy should alert the physician to the possible presence of malignancy.

Otimismo, afetos e personalidade em portadores de doença renal crônica: resultados preliminares / Optimism, affections and personality in patients with chronic kidney disease: preliminary results

Introdução: A Doença Renal Crônica (DRC) é um problema de saúde pública. Na sua fase terminal, os tratamentos propostos são a diálise e o transplante renal. O estudo apresentado tem investigado aspectos psicológicos positivos de pacientes que vivenciam essa doença. Objetivo: Investigar correlações entre afetos, otimismo e traços de personalidade em pacientes que aguardam por um transplante renal e em pacientes que já foram submetidos a esse procedimento. Casuística/Material e Método: A pesquisa conta com 40 participantes divididos em dois grupos. O primeiro grupo, pré-transplante, com vinte pessoas que fazem hemodiálise, e o grupo pós-transplante com vinte pessoas que já passaram pelo transplante renal. São utilizados quatro instrumentos de avaliação: questionário sócio-demografico, o Teste para avaliar o Otimismo (LOT-R), o Inventário dos Cinco Grandes Fatores (NEO-FFI-R) e a Escala de Afetos Positivos e Afetos Negativos (PANAS). Resultados: Até o momento, foram avaliados nove pacientes de cada grupo. As análises parciais por correlação de Spearman apontam associações negativas entre Otimismo e Afetos Negativos com ρ = -0,66 no grupo pré e ρ = -0,78 no grupo pós-transplante. Quanto aos fatores de personalidade, há relações positivas significativas entre Afetos Positivos e Extroversão no grupo pré-transplante e Afetos Positivos e Abertura à Experiência no pós-transplante. Conclusão: Os resultados obtidos quanto a Otimismo e Afetos Negativos mantêm o padrão encontrado na população geral. Os demais resultados são ainda pouco conclusivos. Os dados que serão analisados após a avaliação de todos os sujeitos podem oferecer resultados que se afastam dos encontrados até agora.

Acciones tomadas durante El Morir en las UTI's del Cono Sur (Brasil, Argentina y Uruguay) / Actions taken during Dying in the UTIs of the Southern Cone (Brazil, Argentina and Uruguay)

La discusión respecto de la actitud con pacientes críticos terminales, está en aumento. Opciones sobre el límite de esfuerzo terapéutico (LET) han sido una creciente necesidad del intensivista. Objetivo. Diagnosticar y comparar las conductas tomadas durante el morir en las UTIs de los países del Cono Sur (Brasil, Argentina y Uruguay) Método. Corte transversal realizado por las AMIB, SATI y SUMI. Los miembros del grupo de estudio del final de la vida de ésas sociedades elaboraron un cuestionario donde constataban evaluaciones demográficas de los participantes y de las instituciones en que ellos trabajaban, así como las decisiones sobre el LET. El cuestionario fue respondido durante eventos científicos de UTI de los 3 países y vía on line, en un tiempo previamente estipulado. Participaron del estudio los miembros del equipo multiprofesional pertenecientes a las sociedades involucradas. Se compararon las respuestas obtenidas entre los miembros de las sociedades de los 3 países. Las variables fueron analizadas a través de los test de chi-cuadrado (χ2 ) ANOVA/Bonferroni. Se consideró significativo el valor de p <0,05. Resultados. En el estudio participaron 420 profesionales (217 de Brasil, 141 de Argentina y 62 de Uruguay). Se constata que el 29% se declara agnóstico,siendo la mayoría médicos. En Uruguay predominó el sexo masculino. En Brasil las UTI's tenían mas camas, fue mas excepcional las visitas irrestrictas, los profesionales eran mas jóvenes y hacía menos tiempo que trabajaban en las UTI's y había mas participación de personal no-médico. El número de visitas más frecuente en los tres países era de 3 por día. Los factores que más influyen en las decisiones de LET son: el pronóstico de la enfermedad, las comorbilidades y la futilidad terapéutica. Hubo diferencias significativas en las decisiones entre los 3 países, donde más del 90% ya había optado por LET. El equipo médico fue el principal responsable de las decisiones de LET, principalmente en Brasil y Argentina. Reanimación cardiorrespiratoria, administración de drogas vaso activas, métodos dialíticos y nutrición parenteral fueron las terapias más suspendidas/rechazadas en los 3 países, habiendo diferencias puntuales entre los mismos. Hubo una diferencia significativa respecto a la suspensión de la ventilación mecánica, más frecuente en Argentina, luego en Uruguay. Las terapias menos suspendidas entre los 3 países fueron la analgesia seguida de la sedación. Definiciones legales y éticas fueron señaladas como las principales barreras para la toma de decisiones. Conclusión. A pesar de que existan diferencias regionales y culturales entre los profesionales, el LET es común en los 3 países. Existe una tendencia de que sea más de forma pro-activa entre los argentinos y de que haya una mayor equidad en la distribución de las decisiones entre los uruguayos. Esta diferencia puede estar vinculada a la edad, experiencia, profesión y sexo de los participantes.(AR)

Antibody responses and reactions to the whole cell pertussis component of a combined diphtheria/tetanus/pertussis vaccine given at school entry.

To measure the clinical effect of adding a whole cell pertussis component to diphtheria/tetanus vaccine (DT) given as a pre-school booster, 190 children aged 4-5 years were randomised by a double-blind method to receive either diphtheria/tetanus/pertussis (DTP) or DT vaccine in a 1:1 ratio at selected clinics in England. The geometric mean antibody titres to each of the three pertussis antigens were at least sixfold higher in the DTP than the DT vaccine group and equalled or exceeded those in infants immediately after primary immunisation with DTP vaccine. There were no significant differences between DTP and DT vaccinated children in their diphtheria and tetanus antitoxin levels. The frequency of large local reactions and systemic symptoms such as crying and a disturbed night was 2-3-fold higher in the DTP vaccinees than in the DT vaccinees. Medication was given to 44% of DTP and 23% of DT vaccinees (p = 0.006). Although the change to whole cell DTP vaccine at school entry would result in good pertussis antibody titres, the 2-3-fold increase in reactogenicity that would be caused may be unacceptable at a time when whooping cough is not circulating widely. Evaluation of acellular DTP vaccines given as a pre-school booster in children vaccinated under the accelerated schedule is planned.