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.

Associations of Semen Quality with Seminal Non-essential Heavy Metals in Males from the Canary Islands.

Semen quality and levels of non-essential metals such as strontium (Sr), aluminum (Al), lead (Pb), nickel (Ni), and vanadium (V) were measured. Metals were determined by ICP-OES (inductively coupled plasma - optical emission spectrometry) in semen samples from 102 men who were recruited in a Reproduction Unit in the Canary Islands. The presence of each metal was as follows: Sr: 56.9%, Al: 73.5%, Pb: 45.1%, Ni: 15.7%, and V: 79.4% of the samples. No significant differences were found in the relationship between the spermiogram, the sperm motility, and the concentration of spermatozoa levels of non-essential metals. It is noteworthy that Ni levels tend to be lower in patients with oligozoospermia (t (46.4) = 1.84; p = 0.070). Between lifestyle and non-essential metals, there was a significant relationship between the level of occupational exposure to metals and Ni (χ2(2) = 13.91; p = 0.001). We did not find significant differences in non-essential seminal metal content and smoking status but, there were differences between drinkers and the concentration of V in semen (t (100) = -1.99; p = 0.050). The occupational exposure to metals and place of residence have effects on Al and V levels in semen. Regarding obesity, significant differences were found in Pb levels (t (18.0) = 2.34; p = 0.031). Obese patients have a lower Pb level, and the percentage of progressive sperm motility was lower in obese men (t (98) = 2.14; p = 0.035). The detection of metals in semen opens a new field in the study of male infertility with the possibility of performing treatments aimed at correcting these possible anomalies.

Factores estresores y ansiedad en estudiantes de Enfermeria durante las practicas clínicas / Factors causing stress and anxiety in Nursing students during clinical practices

Objetivo: identificar los factores estresores percibidos por los estudiantes de Enfermería de la Universidad de Castilla La Mancha (UCLM) durante las prácticas clínicas a lo largo de la diplomatura; conocer como cambian dichos factores y determinar si existe relación entre estos y los niveles de ansiedad. Método: estudio descriptivo, longitudinal y prospectivo. Población: estudiantes de Enfermería al comienzo de las practicas clínicas en el curso2009-2010. Cuestionarios: KEZKAK (K), para identificar los factores estresores y STAI para medir los niveles de ansiedad rasgo (AR) y estado (AE). Tres mediciones: 1) el día previo al inicio de las primeras practicas clínicas, 2) dos días antes de que finalizasen dichas prácticas y 3) después de completar el periodo de prácticas clínicas en 3o curso. Resultados: el total de los estudiantes era de 398. Contestaron en las tres ocasiones 206 alumnos (51,76%). La media de AR fue de 39,53(DT= 28.11); K1 de 69,43 y AE1 48,46; K2 de 59,48 y AE2 de 29,62;K3 de 62,43 y AE3 de 35,79. Diferencias significativas entre las puntuaciones del K1 y K2 y las puntuaciones del K1 y K3 (p< 0,01 en ambos casos) y entre las puntuaciones del K2 y K3 (p= 0,01).Correlación débil entre KEZKAK y ansiedad en las tres ocasiones. Los factores que más puntuaron fueron “hacer mal mi trabajo y perjudicar al paciente”, “confundirme de medicación”, “meter la pata” y “pincharme con una aguja infectada”. Conclusiones: los factores estresores disminuyen a lo largo de las practicas, pero vuelven a aumentar al final de la carrera. Los factores percibidos como más importantes son los mismos a lo largo de la diplomatura. Se debe dotar a los alumnos de recursos para disminuir la ansiedad y afrontar las situaciones que les generen estrés (AU)

Objective: to identify those stressors perceived by the Nursing students in the Universidad de Castilla La Mancha (UCLM) during clinical practices along the course of their studies; to understand how these factors change, and to determine whether there is any connection between these and anxiety levels. Method: descriptive, longitudinal and prospective study. Population: Nursing students at the beginning of clinical practices in the 2009-2010term. Questionnaires: KEZKAK, to identify stressors, and STAI to measure levels of anxiety trait (AT) and state (AS). Three measurements: 1)the day before initiating the first clinical practices, 2) two days before the end of said practices, and 3) after completing the period of clinical practices in the 3rd year. Results: there were 398 students in total. Of these, 206 students answered in all three occasions (51.76%). The median AT was 39.53 (DT=28.11); K1 69.43 and AS1 48.46; K2 59.48 and AS2 29.62; K3 62.43and AE3 35.79. Significant differences between K1 and K2 scores, andK1 and K3 scores (p < 0.01 in both cases) and between K2 and K3 scores(p= 0.01).There was a weak correlation between KEZKAK and anxiety in all three occasions. The factors with a higher score were: “not doing my job well and harming the patient”, “administering the wrong medication”, “making mistakes” and “pricking myself with an infected needle”. Conclusions: stressors get gradually reduced along practices, but they increase again at the end of the career. Those factors perceived as most important are the same across the whole course of studies. Students must be given resources which enable them to reduce their anxiety and face those situations which generate stress(AU)

Estresores y ansiedad de los estudiantes de enfermería en sus primeras prácticas clínicas / Perceived stressors and anxiety of nursing students in their first clinical practice period

Los estudiantes de enfermería están sometidos a distintas situaciones que les producen estrés (académicas, clínicas y externas). Cuando los alumnos de enfermería realizan prácticas clínicas deben hacer frente a múltiples estresores (enfermedad, sufrimiento, muerte...). El objetivo principal de este estudio es conocer los estresores percibidos por los estudiantes de Enfermería antes y después de las prácticas clínicas (2009/2010). De 398 estudiantes matriculados, 264 contestaron al inicio y final de las prácticas a los cuestionarios STAI para medir la ansiedad y KEZKAK para identificar los estresores. Antes de las prácticas, 28 de 41 items del KEZKAK obtienen puntuación media mayor a 1.5 (situación generadora de estrés). Finalizadas las prácticas, 17 ítems obtuvieron esta puntuación. La puntuación media del KEZKAK y de ansiedad estado disminuyeron significativamente. Generan más estrés "confundirme de medicación", "hacer mal mi trabajo y perjudicar al paciente", "meter la pata" y "pincharme con una aguja infectada". Parece ser que los alumnos de cursos superiores, que cuentan con más conocimientos y habilidades, perciben las prácticas clínicas como menos estresantes. Se aconseja ver la evolución de estos alumnos en el tercer y último curso de la diplomatura (AU)

Nursing students are subject to different situations that cause stress (academic, clinical and external situations). When nursing students perform clinical practices they are faced with multiple stressors (disease, pain...). The aim of this study was to assess perceived stress in nursing students before and after their clinical practice period (2009/2010). Of the 398 registered students, 264 of them answered, both at the beginning and at the end of the clinical placement, the STAI questionnaire (measures anxiety) and the KEZKAK test (identifies stress factors). Before the clinical training period, 28 of the 41 items of the KEZKAK test yielded an average score greater than 1.5 (stress generating situations). At the end of the clinical training, 17 items presented this score. Furthermore, the KEZKAK average score and the anxiety state score were both significantly reduced. The most stressful situations were: "mistaking medication", "doing my job badly, endangering the patient", "making mistakes" and "pricking myself with an infected needle". It appears that the senior students, who have more knowledge and clinical skills, perceived the clinical practice as less stressful. It is advisable to follow the evolution of these students in the third and final year of the Diploma (AU)

Human zygote morphological indicators of higher rate of arrest at the first cleavage stage.

A little studied aspect of developmental arrest (DA) in ART is zygote arrest (ZA). Etiologically, blockage at the first cleavage stage includes molecular and chromosomal anomalies, some of which manifest morphologically. Given considerations on embryo culture, transfer and cryopreservation, optimal zygote selection is very important. The aim of this study was to ascertain whether zygote morphological features were indicators of increased ZA. In this study we performed a prospective, observational study of 2105 zygotes obtained from consecutive patients who were undergoing IVF/ICSI treatment, of which 43 (2%) suffered ZA. Morphological features observed under the inverted microscope were qualitatively categorized: pronuclear size, nucleolar precursor bodies (NPB) alignment, light and dark halos, polar body placement and fragmentation observed at 16-18 h post-insemination. We compared these features in blocked versus cleaved zygotes at 48 h and found significant correlations (p < 0.05) between ZA and three features: the absence of a light halo (p = 0.001), the absence of a dark halo (p < 0.005), and non-aligned NPB (p < 0.05). We can say that certain morphological features are indicators of significantly increased zygote arrest. These findings may be of utility for optimal zygote selection and culture strategies, especially in countries under restrictive conditions.

Pregnancy with frozen-thawed and fresh testicular biopsy after motile and immotile sperm microinjection, using the mechanical touch technique to assess viability.

BACKGROUND: There are few reports of pregnancy using immotile sperm, and none using a purely mechanical assessment of viability. METHODS: In this pilot study, we retrospectively analysed 66 cycles in 61 patients with determinant male factor, recording rates of fertilization, implantation, normal pregnancy and take-home babies achieved with ICSI. Sperm selection was based on morphologically normal appearance under the inverted microscope. Viability of immotile spermatozoa was assessed by the mechanical touch technique to observe tail flexibility and tail shape recovery. RESULTS: Of 17 ICSI cycles using frozen-thawed testicular sperm, six microinjected with immotile and 11 with motile sperm, we achieved fertilization rates of 65.7 and 74.3%, respectively, and five pregnancies (two and three, respectively). Of 49 ICSI cycles using fresh testicular sperm, 10 microinjected with immotile and 39 with motile sperm, we achieved fertilization rates of 73.4 and 64.4%, respectively, and 12 pregnancies (three and nine, respectively). CONCLUSIONS: Immotile (fresh and frozen-thawed) testicular sperm of normal morphological appearance can be used to achieve clinical pregnancy with ICSI. Our results strongly suggest that immotile sperm viability can be assessed by the mechanical touch technique.

Antecedentes personales y familiares de los trastornos de la conducta alimentaria

El presente trabajo tuvo por objetivo buscar antecedentes personales y familiares de pacientes con trastornos de conducta alimentaria (anorexia y bulimia nerviosa) de manera de conocer posibles factores de riesgo que permitan al médico pediatra estar alerta y realizar tareas de prevención para evitar el desarrollo de dichas enfermedades. Se analizaron 39 pacientes con trastornos alimentarios que consultaron en un centro especializado de atención de adolescentes entre el 26 de octubre de 1995 y el 23 de setiembre de 1999. Se compararon con un grupo control de 39 pacientes que también consultaron en la institución con otros diagnósticos psiquiátricos. Los resultados de ambas poblaciones fueron procesados estadísticamente con la prueba del Chi cuadrado. Se concluyó que la población de pacientes con trastornos de la conducta alimentaria estuvo constituida casi exclusivamente por mujeres entre 12 y 26 años de edad. Predominó el subtipo bulimia atracón purga, seguido por la anorexia restrictiva. Las tres cuartas partes presentaban comorbilidad con trastornos del estado de ánimo y/o trastornos por ansiedad. Dichas pacientes presentaban significativamente mayor cantidad de antecedentes de desórdenes alimentarios y anomalías ponderales, tanto en el primer año de vida como en el resto de la infancia, que el grupo control. Las madres y padres presentaron mayores porcentajes de sobrepeso y preocupación por el físico que los del grupo control, aunque las diferencias no fueron significativas. Las madres presentaron mayor porcentaje de sobreprotección sobre sus hijos que las del grupo control, las diferencias no fueron significativas.

O presente trabalho teve por objetivo procurar antecedentes pessoais e familiares de pacientes com trastornos de conduta na alimentação (anorexia e bulimia nervosa) con intenção de conhecer possíveis fatores de risco que permitam ao médico pediatra estar alerta e realizar trabalhos de prevenção para evitar o desenvolvimento destas patologias. Analisaram-se 39 pacientes com trastornos na alimentação num centro de especialização em atenção de adolescentes entre 26 de outubro de 1995 e 23 de setembro de 1999. Comparam-se com um grupo controle de 39 pacientes que também consultaram na instituição com outros diagnósticos psiquiátricos. Os resultados de ambas populações foram processados estatisticamente com a prova do Chi quadrado. Concluiu-se: 1) A população de pacientes com trastornos de conduta na alimentação esteve constituída quase exclusivamente por mulheres entre 12 e 26 anos de idade. Predominou o subtipo bulimia "atracón purga" seguido pela anorexia restritiva. As três quartas partes apresentavam comorbilidade com trastornos do estado de ânimo e/o trastornos por ansiedade. 2) Estas pacientes apresentavam significativamente uma quantidade maior de antecedentes de desordens na alimentação e anomalías do peso, tanto no primeiro ano de vida como no resto da infância, que o grupo controle. 3) As mães e pais apresentaram maiores percentagens de sobrepeso e preocupação pelo físico do que os do grupo de controle, embora as diferenças não foram significativas. 4) As mães apresentaram maior percentagem de sobreproteção com seus filhos do que as do grupo de controle, as diferenças não foram significativas.

The objective of this paper was to study the personal and family history of patients with eating disorders (anorexia and bulimia nervosa) so as to identify possible risk factors that might help the pediatrician in becoming aware and carrying out prevention strategies in order to avoid the development of these disorders. Thirty-nine patients with eating disorders were studied, who consulted a specialized center for the treatment of adolescents in the period from October 26, 1995 to September 23, 1999. These were compared with a control group of 39 patients who also consulted the clinic but with different psychiatric diagnoses. The results of both populations were statistically processed with the Chi square test. It concludes that: The population with eating disorders consisted almost exclusively of women with ages ranging from 12 to 26. The predominant subtype was binge-purge bulimia, followed by restrictive anorexia. Seventy five percent had co-cormidity with mood disorders and/or anxiety disorders. Those patients had a significantly greater background of eating disorders and weight problems, both in their first year of life and in the rest of their childhood, compared with the control group. The mothers and fathers had greater percentages of overweight and concern for their physical appearance than the control group; however these were not significant differences. The mothers had a greater percentage of overprotection of their children than the control group; the differences were not significant.