The Influence of Follicular Fluid Metals on Assisted Reproduction Outcome.

Infertility has become more common, with an increased exposure to toxic compounds including heavy metals (HM). Follicular fluid (FF) surrounds the developing oocyte in the ovary and can be analysed to assess metal content. The levels of twenty-two metals were measured in the FF of ninety-three females in a reproduction unit, and their influence on assisted reproduction technique (ART), were examined. The metals were determined by optical emission spectrophotometry. Low values of copper, zinc, aluminium, and calcium favour polycystic ovary syndrome. The relationships between the number of oocytes and metals: iron (rs=0.303; p=0.003) and calcium (rs=-0.276; p=0.007) are significant, as well as between the number of mature oocytes with iron (rs=0.319; p=0.002), calcium (rs=-0.307; p=0.003) and sodium (rs=-0.215; p=0.039) and are near to significance in the case of aluminium (rs=-0.198; p=0.057). In the group with a fertilisation rate ≤ 75%, 36% of the women presented calcium >176.62 mg/kg compared to the group with a fertilisation rate ≥ 75% where this percentage was only 10% (p=0.011). An excess of iron and calcium reduces the good quality embryo rate, and an excess of potassium impairs the blastocyst rate. If potassium is above 237.18 mg/kg and calcium is below 147.32 mg/kg, these conditions favour embryo implantation. Pregnancy is influenced by high potassium and low copper levels. Controlling exposure to toxic elements is recommended for all couples with reduced fertility or receiving an ART.

Influence of Seminal Metals on Assisted Reproduction Outcome.

Increased levels of metal ions in human seminal fluid have a significant correlation with male fertility. Few publications explain the effect of metals in semen and their influence on assisted reproductive treatments. Semen parameters and the levels of twenty-two metals were measured in the seminal fluid of 102 men attended in a Reproductive Unit. Metals were determined by optical emission spectrophotometry. A statistical relationship was found between spermiogram and iron, which was lower than expected in pathological spermiograms (p = 0.032); zinc (p = 0.066), calcium (p = 0.047), and magnesium (p = 0.048) mean levels were higher in normozoospermics. More days of sexual abstinence correlates with higher seminal zinc (p = 0.001) and magnesium levels (p = 0.002). Lower vanadium values were found to be associated with higher fertilization rates (p = 0.039). Higher values of lead (p = 0.052) and vanadium (p = 0.032) were obtained in patients who did not reach 100% embryo cleavage rate. Aluminium (p = 0.042) and sodium (p = 0.002) were found in lower amounts associated with better blastocyst rates. The implantation rate shows an inverse association with women's age and iron and calcium content, compared to magnesium and sodium which presented a significant direct association with this percentage. A significant direct relationship was found between the positive evolution of pregnancy and the values of zinc (p = 0.004), calcium (p = 0.013), potassium (p = 0.002), and magnesium (p = 0.009). The study confirms that zinc, iron, calcium, sodium, aluminium, magnesium, vanadium, and lead have positive-negative effects on reproduction and support the analysis of metals in semen as a new line of study on male fertility with implications for reproductive outcomes.

Manejo de obesidad y diabetes mellitus

Teniendo en cuenta que la obesidad constituye un problema de salud creciente en las sociedades donde se experimentan cambios positivos en el nivel socioeconómico y se asocia frecuentemente con la diabetes mellitus, se realizó una guía para el manejo de la obesidad por el Médico de Familia(AU)

The obesity constitutes a growing health problem in the societies where positive changes are experienced in the socioeconomic level and its frequently associated with the diabetes mellitus, for that reason a guide for the handling of the obesity for the family doctor was carried out(AU)

Calidad de la atención médica a los pacientes diabéticos hospitalizados

Para evaluar la calidad en la atención al paciente diabético egresado del servicio de medicina, se realizó una investigación en servicio de salud, a través de un diseño transversal en el hospital Héroes del Baire. Para obtener los datos se revisaron 140 historias clínicas de los pacientes diabéticos egresados del servicio de Medicina en el período comprendido de enero a diciembre de 1998, aplicándose para la recolección de datos la encuesta del EPICRONI DMSEC y la base de datos del epicroni , para el análisis se utilizó el EPI-INFO. La mayoría de los pacientes acuden por decisión propia y en menor cuantía son remitidos por sus médicos de familia o por el sistema de urgencia. En cuanto a la disponibilidad de recursos fueron suficientes los medicamentos e instrumentales y dificultades con los reactivos. A todos los pacientes diabéticos ingresados no se les realizó el interrogatorio, el examen físico, ni los análisis básicos propuestos por el programa nacional de diabetes y los complementario de menos indicados fueron colesterol, creatinina y Benedict. Los medicamentos antidiabéticos más usados fueron la insulina, seguidos de los hipoglicemiantes orales CONCLUSION: La calidad de los servicios recibidos por los pacientes diabéticos egresados del Hospital Héroes del Baire en 1998 no fue buena(AU)

To evaluate the quality in the attention to the patient diabetic departure of the medicine service,was carried out an investigation in service of health, through a traverse design in the hospital Heroes of the Baire. To obtain the data the patients' diabetic departure of the service of Medicine 140 clinical histories they were revised in the understood period of January to December of 1998, applying stops the gathering of data the survey of the EPICRONI DMSEC and the database of the EPICRONI, for the analysis the EPI-INFO was used. Most of the patients go for own decision and in smaller quantity they are remitted by their family doctors or for the system of urgency. As for the readiness of resources they were enough the medications and instrumental and difficulties with the reagents. To all the entered diabetic patients they were not carried out the interrogation, the physical exam, neither the basic analyses proposed by the national program of diabetes and the complementary one of less suitable they were cholesterol, creatinina and Benedict. The medications antidiabético but used they were the insulin, followed by the hipoglicemiantes oral CONCLUSION: The quality of the services received by the patients diabetic departure of the Hospital Héroes of the Baire in 1998 was not good(AU)

Hipertensión arterial y diabetes mellitus / Arterial hypertension and diabetes mellitus

El tratamiento de la Hipertensión arterial debe seleccionarse según la situación del paciente. En todos los casos deben promoverse el tratamiento no farmacológico, si se usan medicamentos, hay que titularlos cuidadosamente, tratando de utilizar la dosis mínima que reduzca la tensión arterial satisfactoriamente. Los medicamentos de elección para el tratamiento de la HTA en pacientes diabéticos son los Anticálcicos y los Inhibidores de la Enzima Convertidora de Angiotensina, por no interferir en el control de la glicemia, además los últimos pueden reducir la proteinuria independientemente de su efecto en la tensión arterial(AU)

The treatment the high blood pressure it should be selected according to the situation the patient. in all the cases they should be promoted the treatment pharmacological no, if medications are used, it is necessary to title them carefully, trying to use the minimal dose that reduces the arterial tension satisfactorily. the medications election for the treatment the hta in diabetic patients they are the anticálcicos and the inhibitors the enzyme convertidora angiotensina, for not interfering in the control the glicemia, the last ones can also reduce independently the proteinuria their effect in the arterial tension(AU)

Calidad de la atención médica a los pacientes hipertensos hospitalizados / Quality of primary attention to hypertensive patients in the Isle of Youth

Se realizó una investigación en servicios de salud, a través de un diseño descriptivo transversal; con el Objetivos General de Evaluar la calidad en la atención al paciente hipertenso egresado del servicio de medicina del hospital Héroes del Baire en el período comprendido de Enero a Junio de 1999. Para obtener la información se revisaron 146 historias clínicas, aplicándose para ello la encuesta y la base de datos EPICRONI HTASEC. El procesamiento se hizo con el Programa EPI-INFO versión 6.A todos los pacientes hipertensos ingresados no se les realizó los análisis básicos propuestos por el Programa Nacional de Hipertensión. Aunque la mayoría de los pacientes fueron clasificados, no se uso la clasificación del Programa Nacional de Hipertensión. La terapéutica médica en cada paciente hipertenso no estuvo en correlación con el grado de evolución de la enfermedad y Los medicamentos antihipertensivos más usados fueron los anticálcicos, seguidos de los diuréticos. La calidad de la atención médica a los pacientes hipertensos egresados del Hospital es mala(AU)

Guía para diagnóstico y tratamiento de la diabetes mellitus / A guide to diagnose the diabetes mellitus

Se propone una guía práctica para el diagnóstico, tratamiento y seguimiento del paciente diabético en la atención primaria. Realizada a partir de revisión bibliográfica en forma de preguntas y respuestas; sobre los aspectos fundamentales de dicha enfermedad: índice de sospecha, confirmación, clasificación, uso de los distintos tipos de medicamentos, control y seguimiento del paciente diabético. Todo esto puede ser de gran utilidad para los médicos de la familia(AU)

Intends a practical guide for the diagnosis, treatment and the diabetic patient's pursuit in the primary attention. Carried out starting from bibliographical revision in form of questions and answers; on the fundamental aspects of this illness: index of suspicion, confirmation, classification, use of the different types of medications, control and the diabetic patient's pursuit. All this can be of great utility for the doctors of the family(AU)