Microsurgical varicocelectomy effect on sperm telomere length, DNA fragmentation and seminal parameters.

Varicocele is one of the main causes of male infertility and microsurgical varicocelectomy (MV) seems to be the best procedure for its repair and to reduce testicular oxidative stress (ROS). As ROS causes guanine modifications, we postulated that DNA damage could be more intense in telomeres due to their G-rich nature. We studied the effect of MV on sperm telomere length (TL), single- and double-strand DNA fragmentation (ssSDF and dsSDF) and seminal parameters. Sperm telomeres from 12 fertile donors and 20 varicocele patients before and nine months after MV were labelled using FITC-PNA qFISH (a new method to obtain absolute TL from relative fluorescence intensity using FITC-fluorescent spheres). Both ssSDF and dsSDF were analysed using the alkaline and neutral Comet assays, respectively. The results showed that varicocele and MV had no effect on TL. Seminal parameters, ssSDF and dsSDF of varicocele patients were altered. Although these parameters improved after MV, values did not reach those seen in fertile donors. A good estimation of absolute TL was developed based on FITC-fluorescent spheres. The results showed that TL is not affected by varicocele or surgery. However, MV is able to partially reduce altered seminal parameters, ssSDF and dsSDF values in varicocele patients.

Características demográficas, clínicas y de electromiografía en pacientes con Síndrome de Guillain-Barré

RESUMEN Introducción: el Síndrome de Guillain-Barré es una polirradiculoneuropatía aguda causante de parálisis fláccida, generalmente ascendente. Los pacientes frecuentemente tienen antecedentes de infecciones previas, usualmente de tipo respiratorio o gastrointestinal. Objetivo: describir las características demográficas, clínicas y electromiografías de los pacientes con Síndrome de Guillain-Barré en el Hospital Central del Instituto de Previsión Social (Asunción, Paraguay) en el periodo agosto 2015 a setiembre 2017, además de analizar variables potencialmente relacionadas al desenlace clínico. Metodología: diseño observacional con corte transversal. Población: 30 pacientes con diagnóstico confirmado de Síndrome de Guillain-Barré. Resultados: edad promedio de 46,6 ± 15,8 años, 53,3% sexo masculino, 26,7% con antecedentes de enfermedad respiratoria, 20,0% con antecedentes de diarrea, 10,0% con antecedentes de dengue, 53,3% con disociación albúmino-citológica en líquido cefalorraquídeo. En la electromiografía se halló patrón desmielinizante en el 46,7%, patrón axonal motor en el 26,7% y axonal motor sensitivo en el 23,3%. Semiológicamente hubo 100% con trastornos motores, 33,3% con trastornos sensitivos, 3,3% con trastornos autonómicos. Respecto al tratamiento, 60,0% fueron tratados antes de los seis días de enfermedad, 100% con inmunoglobulinas. Hubo 66,7% con mejoría clínica y 3,3% fallecidos. No se identificaron variables asociadas significativamente al desenlace clínico. Conclusiones: predominó el sexo masculino, la edad media fue 46,6 años. Los antecedentes más comunes fueron las infecciones respiratorias y diarrea. La disociación albúmino-citológica se observó en 53,3%. Por electromiografía, el patrón más frecuente fue de tipo desmielinizante, seguido por el de tipo axonal motor.

ABSTRACT Introduction: Guillain-Barre Syndrome is an acute polyradiculoneuropathy that causes flaccid paralysis, generally ascending. Patients frequently have a history of previous infections, usually respiratory or gastrointestinal infections. Objective: To describe the demographic, clinical and electromyographic characteristics of patients with Guillain-Barre Syndrome at the Central Hospital of the Social Security Institute (Instituto de Previsión Social in Spanish) (Asunción, Paraguay) in the period of August 2015 to September 2017, in addition to analyzing variables potentially related to the clinical outcome. Methodology: Observational cross-sectional design. Population: Thirty patients with a confirmed diagnosis of Guillain-Barre Syndrome. Results: Mean age of 46.6±15.8 years, 53.3% male, 26.7% with a history of respiratory disease, 20.0% with a history of diarrhea, 10.0% with a history of dengue, 53.3% with albumin-cytological dissociation in cerebrospinal fluid. Electromyography revealed a demyelinating pattern in 46.7%, a motor axonal pattern in 26.7%, and a sensory motor axonal in 23.3%. Semiologically, there were 100% patients with motor disorders, 33.3% with sensory disorders, and 3.3% with autonomic disorders. Regarding treatment, 60.0% were treated before six days of illness, 100% with immunoglobulins. There were 66.7% of the patients with clinical improvement and 3.3% deceased. No variables significantly associated with the clinical outcome were identified. Conclusions: males predominated and the mean age was 46.6 years. The most common antecedents were respiratory infections and diarrhea. Albumin-cytological dissociation was observed in 53.3%. By electromyography, the most frequent pattern was demyelinating, followed by axonal motor type.

Frecuencia de deficiencia de vitamina D en obesos

RESUMEN Introducción: globalmente, la obesidad está en aumento y representa un desafío para la salud pública. Algunos estudios muestran que existe una asociación entre niveles bajos de vitamina D y un aumento del índice de masa corporal, pero dentro de la comunidad científica existen discrepancias acerca de este tema. Objetivo: determinar la frecuencia del déficit de vitamina D y su relación con la obesidad. Metodología: estudio descriptivo, transversal con componente analítico en pacientes obesos de edad adulta que acuden al Servicio de Endocrinología del Hospital Central del Instituto de Previsión Social (Asunción, Paraguay) durante el año 2017 Resultados: se incluyeron 67 pacientes, con edad media 41±8 años, 58 (86,6%) del sexo femenino, 40 (59,7%) presentaban obesidad mórbida, 13 (19,4%) eran hipertensos y 14 (20,9%) diabéticos. Al dosar la vitamina D, 18 (26,9%) tenían insuficiencia y 38 (56,7%) deficiencia. Las asociaciones entre el déficit de la vitamina D con el índice de masa corporal, la hipertensión y la diabetes mellitus, ninguno alcanzó niveles de significancia. Conclusión: se incluyó muestra mayoritariamente femenina, con baja frecuencia de comorbilidades. La insuficiencia vitamínica D fue 26,9%. No hubo una asociación significativa entre el déficit de vitamina D y el índice de masa corporal, la hipertensión arterial y la diabetes mellitus.

ABSTRACT Introduction: Globally, obesity is increasing and represents a challenge for public health. Some studies show that there is an association between low levels of vitamin D and an increase in body mass index, but within the scientific community there are discrepancies on this issue. Objective: To determine the frequency of vitamin D deficiency and its relationship with obesity. Methodology: Descriptive, cross-sectional study with an analytical component in obese adult patients who attend the Endocrinology Service of the Central Hospital of the Social Security Institute (Instituto de Previsión Social in Spanish) (Asunción, Paraguay) during 2017 Results: Sixty-seven patients were included, with a mean age of 41±8 years, 58 (86.6%) female, 40 (59.7%) had morbid obesity, 13 (19.4%) were hypertensive and 14 (20.9%) diabetics. When dosing vitamin D, 18 (26.9%) had insufficiency and 38 (56.7%) deficiency. The associations between vitamin D deficiency and body mass index, hypertension and diabetes mellitus did not reach significance levels. Conclusion: The sample was mainly female, with a low frequency of comorbidities. Vitamin D insufficiency was 26.9%. There was no significant association between vitamin D deficiency and body mass index, high blood pressure, and diabetes mellitus.

Leiomiosarcoma de arteria pulmonar, diagnóstico mediante resonancia magnética, PET-TC y EBUS-TBNA / Pulmonary artery leiomyosarcoma diagnosed by magnetic resonance, PET-CT and EBUS-TBNA

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Nivel de conocimiento sobre terminologías médicas en Guaraní de los profesionales de salud del Hospital Regional de Coronel Oviedo / Level of knowledge about medical terminology in Guaraní of the health professionals of the Regional Hospital of Coronel Oviedo

Introducción: según el Censo de 2002, el 50% de la población manifiesta hablar las dos lenguas "Guaraní y Castellano", el 37% monolingüe en Guaraní. El Guaraní es necesario para establecer un buen vínculo común entre pacientes y profesionales de la salud. Objetivo: evaluar el nivel de conocimiento sobre la terminología médica básica en Guaraní de los profesionales de salud del Hospital Regional de Coronel Oviedo. Método: estudio observacional, descriptivo con componente analítico de corte transversal con muestreo no probabilístico de casos consecutivos. Los datos se recogieron por medio de una encuesta auto administrado con las variables de interés. El nivel de conocimiento fue clasificado en bajo, medio y alto. Resultados: se incluyeron 100 sujetos de entre 23 a 70 años (35 ± 7,5 años), de los cuales el 54% son femeninos. Los años de servicio van de 1 a 47 años (13,15 ± 11,63 años). El 40% de los médicos y el 54% de los enfermeros tuvieron un rendimiento bueno. La correlación en los médicos entre los años de servicio y el porcentaje obtenido fue del 22% (R2= 22,94 p<0,05). Conclusión: el nivel de conocimiento sobre la terminología médica básica en Guaraní tanto de médicos como enfermeros es clasificado como bueno. Gran porcentaje de los profesionales encuestados afirma que el conocimiento de terminologías médicas es muy útil en su profesión.

Introduction: according to the 2002 Census, 50% of the population speak the two languages "Guaraní and Castellano", 37% monolingual in Guaraní. Guaraní is necessary to establish a good common bond between patients and health professionals. Objective: to evaluate the level of knowledge about the basic medical terminology in Guaraní of the health professionals of the Regional Hospital of Coronel Oviedo. Method: observational, descriptive study with cross - sectional analytical component with non - probabilistic sampling of consecutive cases. The data were collected through a self-administered survey with the variables of interest. The level of knowledge was classified as low, medium and high. Results: 100 subjects aged 23-70 years (35 ± 7.5 years) were included, of whom 54% were female. The years of service range from 1 to 47 years (13.15 ± 11.63 years). 40% of the doctors and 54% of the nurses performed well. The correlation among the doctors between the years of service and the percentage obtained was 22% (R2 = 22.94 p <0.05). Conclusion: The level of knowledge about basic medical terminology in Guaraní of both physicians and nurses is classified as good. A large percentage of professionals surveyed said that knowledge of medical terminology is very useful in their profession.

Oral antioxidant treatment partly improves integrity of human sperm DNA in infertile grade I varicocele patients.

Infertile males with varicocele have the highest percentage of sperm cells with damaged DNA, compared to other infertile groups. Antioxidant treatment is known to enhance the integrity of sperm DNA; however, there are no data on the effects in varicocele patients. We thus investigated the potential benefits of antioxidant treatment specifically in grade I varicocele males. Twenty infertile patients with grade I varicocele were given multivitamins (1500 mg L-Carnitine, 60 mg vitamin C, 20 mg coenzyme Q10, 10 mg vitamin E, 200 µg vitamin B9, 1 µg vitamin B12, 10 mg zinc, 50 µg selenium) daily for three months. Semen parameters including total sperm count, concentration, progressive motility, vitality, and morphology were determined before and after treatment. In addition, sperm DNA fragmentation and the amount of highly degraded sperm cells were analyzed by Sperm Chromatin Dispersion. After treatment, patients showed an average relative reduction of 22.1% in sperm DNA fragmentation (p = 0.02) and had 31.3% fewer highly degraded sperm cells (p = 0.07). Total numbers of sperm cells were increased (p = 0.04), but other semen parameters were unaffected. These data suggest that sperm DNA integrity in grade I varicocele patients may be improved by oral antioxidant treatment.

Human cornea before and after refractive surgery using a new device: VCH-1.

PURPOSE: To test and measure the refractive index (RI) and to estimate the equivalent percentage of water content (%WC) of the anterior layers of the human cornea before and after excimer laser photoablation using a novel contact device, the VCH-1. METHODS: (1) Repeatability was estimated by sequential measurement of the RI of 4 separate hydrogel contact lenses on 2 occasions, 5 and 10 minutes after insertion. (2) Patients preselected for photorefractive keratectomy, laser assisted sub-epithelial keratomileusis, laser assisted in situ keratomileusis, and laser assisted in situ keratomileusis with epithelial flap were enrolled. RI was measured for (a) corneal epithelium after topical anesthesia, (b) Bowman layer where appropriate after either removing epithelium or lifting the epithelial flap and remeasured immediately after excimer laser photoablation, and (c) midstroma after lifting the flap (created using mechanical microkeratome) and immediately after photoablation. RESULTS: (1) Average repeatability of RI measurement was +/-0.001 (range 0.000 to +/-0.002). (2) Mean RI (+/-SD) and estimated mean %WC of (a) epithelium were 1.382 (0.006) and 75% (n = 8, age 28-63 years), (b) Bowman layer 1.380 (0.011) and 77% changing to 1.392 (0.010) and 69% after photoablation (n = 11, age 26-40 years, P = 0.005), and (c) midstroma 1.369 (0.007) and 83% changing to 1.385 (0.006) and 74% after photoablation (n = 30, age 22-56 years, P < 0.0001). RI of corneal epithelium and Bowman layer was significantly greater than that of midstroma before photoablation (P < 0.001). CONCLUSIONS: (1) VCH-1 can reliably measure RI to within +/-0.001 units. This is equivalent to an error in water content estimation of +/-0.6%. (2) RI and %WC of the human cornea are not uniform. Intersubject and intracorneal variations in RI and %WC should be considered because these factors will affect optical performance of the eye and photoablation increases RI, presumably by way of tissue dehydration.