[Prognostic power of soluble urokinase plasminogen activator receptor (suPAR) for short-term mortality in patients seen in Emergency Departments due to infections]. / Poder pronóstico de mortalidad a corto plazo del receptor soluble activador del plasminógeno tipo uroquinasa (suPAR) en los pacientes atendidos en urgencias por infección.

OBJECTIVE: To analyse and compare 30-day mortality prognostic power of several biomarkers (C-reactive protein, procalcitonin, lactate and suPAR) in patients seen in emergency departments (ED) due to infections. Secondly, if these could improve the accuracy of systemic inflammatory response syndrome (SIRS) and quick Sepsis-related Organ Failure Assessment (qSOFA). METHODS: A prospective, observational and analytical study was carried out on patients who were treated in an ED of one of the eight participating hospitals. An assessment was made of 32 independent variables that could influence mortality at 30 days. They covered epidemiological, comorbidity, functional, clinical and analytical factors. RESULTS: The study included 347 consecutive patients, 54 (15.6%) of whom died within 30 days of visiting the ED. SUPAR has got the best biomarker area under the curve (AUC)-ROC to predict mortality at 30 days of 0.836 (95% CI: 0.765-0.907; P <.001) with a cut-off > 10 ng/mL who had a sensitivity of 70% and a specificity of 86%. The score qSOFA ≥ 2 had AUC-ROC of 0.707 (95% CI: 0.621-0.793; P < .001) with sensitivity of 53% and a specificity of 89%. The mixed model (suPAR > 10 ng/mL plus qSOFA ≥ 2) has improved the AUC-ROC to 0.853 [95% CI: 0.790-0.916; P < .001] with the best prognostic performance: sensitivity of 39% and a specificity of 97% with a negative predictive value of 90%. CONCLUSIONS: suPAR showed better performance for 30-day mortality prognostic power from several biomarkers in the patients seen in ED due to infections. Score qSOFA has better performance that SRIS and the mixed model (qSOFA ≥ 2 plus suPAR > 10 ng/mL) increased the ability of qSOFA.

Effect of experimental diabetes and STZ on male fertility capacity. Study in rats.

To assess the effect of experimental Type 1 diabetes on male fertility, male Sprague Dawley rats were injected with either streptozotocine (STZ) to induce diabetes or with citrate buffer as controls. Diabetic animals and 2 control groups (STZ-resistant and buffer-injected rats) were sacrificed at 2 different times after injection: 6 weeks (6W) and 20 weeks (20W). We analyzed serum testosterone (sTT), epididymal sperm parameters, and weight of testicles and epididymides, and carried out a histological evaluation of testicular tissue. Diabetic animals presented a significant increase in teratozoospermia (20W, P < .01) and a decrease in sTT (P < .01), tubular diameter (6W, P < .05), and testicular (6W, P < .01) and epididymal (P < .01) weight. STZ-resistant animals showed significantly decreased sTT (6W, P < .01), epididymal weight (6W, P < .05), and sperm count (6W, P < .01) compared with buffer-injected controls. Experimental STZ diabetes increases teratozoospermia and decreases sTT, testicular weight (reverting at medium-term), and epididymal weight.

[Evaluation of guidelines for the assessment of success after vasectomy and needed improvements]. / Evaluación de un protocolo para el control de la vasectomía y modificaciones a realizar.

OBJECTIVES: The evaluation of a recently established guidelines about the assessment of semen samples after vasectomy in the laboratory of the Hospital General of Albacete and to modify them to optimize the number of semen samples provided per patient but keeping in concordande with the international recommendations. PATIENTS AND METHODS: The records of seminal analysis results from vasectomies performed from January 2002 to December 2004 were reviewed. Our vasectomy guidelines are based upon those of the British Andrology Society (BAS) and those of the World Health Organization for seminal assessment. RESULTS: During the 3 years 984 patients underwent vasectomy. At follow up, 67% of them returned postvasectomy semen samples, but just 55.,5% of them get the clearance criteria; the other patient abandoned before getting them. A mean of 2 samples per patient were received, but 39.6% of them provided one and more than 23% brought more than 3 semen samples. We had 43 technical failures, 4 early recanalization (0.5%) and one late recanalization (0.1%), and 13 patients underwent revasectomy (1,7%). CONCLUSION: A high percentage of our patients failed to fulfill the clearance criteria recommended by the BAS and almost a quarter of them had to deliver more than 3 semen samples. So we find convenient to modify our guides and propose that our patients should receive 2 request forms from the practitioner for semen analysis in the 6th and the 7th month postoperatively and should return to global evaluation of both reports. In that moment most patients will be able to meet the applied criteria for success with just 2 semen samples. Those who fail to become sterile because of either technical failure or early recanalizatione may be advised to go to the urologist with just 2 semen analysis without unnecessary delay.

[Influence of the analytical process in the appearance and disappearance of the spermatozoa after vasectomy]. / Influencia del proceso analítico en la aparición y desaparición de los espermatozoides del semen tras la vasectomia.

OBJECTIVES: To evaluate if the analytical process might justify that in some patients rare non motile sperm might be seen in some but not all their post-vasectomy semen samples. PATIENTS AND METHODS: Post vasectomy ejaculates received in our Center from january 2002 to december 2004 were reviewed. We used our own guidelines for post vasectomy semen assessment based upon those of the British Andrology Society for the evaluation of post vasectomy semen samples and the World Health Organization guidelines for semen analysis. RESULTS: During the 3 years of follow up, 984 patients underwent vasectomy. We received 1.430 semen samples, 2 samples per patient on average. Regarding the pre analytical phase, 134 samples (9.4%) were not completely collected; ejaculate volumes of less than 2 mL were delivered by 269 patients (18.8%); in these cases, we were not sure whether the whole ejaculates were submitted: pre analytical conditions of 11 samples (0.8%) were inappropriate: incorrectly labeled, spilled, provided into inadequate containers... Regarding the analytical phase, 432 ejaculates (30.5%) were extremely viscous and sperm detection might have been affected; 62 semen samples (4.3%) contained many cells which obstructed the visualization of the entire microscopy field. Regarding the post analytical phase, 153 patients (20.9%) had alternative negative/positive results with rare non motile sperm. CONCLUSION: An elevated percentage of incidences involving both the pre analytical and the analytical phase were observed during post-vasectomy seminal analysis. Inadequate conditions may affect the results and justify that spermatozoa may be seen in some but not all the ejaculates of the same patient. We recommend that two semen samples per patient are required to ensure that he is correctly evaluated. We propose to report a negative result as a spermatozoa count bellow the detection limit of our analytical procedure similar to other laboratory magnitudes to minimize the effect of fluctuations in such a low count of rare non motile sperm.

Evaluación de un protocolo para el control de la vasectomía y modificaciones a realizar / Evaluation of a guidelines for the assessment of success after vasectomy and needed improvements

Objetivo: Revisar los resultados de la implantación de un protocolo para el control de la vasectomía en el laboratorio del Hospital General de Albacete y realizar algunas modificaciones que nos permitan reducir el número de controles que deben realizarse nuestros pacientes, pero que esté en concordancia con las recomendaciones internacionales. Material y Métodos: Se revisaron los controles de las vasectomías realizadas desde Enero de 2002 a Diciembre de 2004. Nuestro protocolo consiste en una adaptación a nuestro medio de las guías de la Sociedad Británica de Andrología (BAS) para el control de la vasectomía y de la Organización Mundial de la Salud para el análisis seminal. Resultados: Durante los 3 años del estudio se han intervenido 984 pacientes de vasectomía, de los cuales el 67% ha acudido a nuestro laboratorio a realizarse algún control, pero solamente un 55,5% de los mismos cumplió los criterios de alta establecidos; el resto, abandonó antes de conseguirlo. Se recibió una media de 2 muestras por paciente, aunque un 39.6% de los mismos sólo trajo una y más del 23% trajeron más de 3. Tuvimos 43 fallos de la cirugía (5,9%), 4 casos de recanalización precoz (0,5%) y uno de recanalización tardía (0,1%), y un total de 13 pacientes fueron reintervenidos (1,7%). Conclusiones: Un porcentaje elevado de pacientes vasectomizados no cumplió los criterios de alta recomendados por la BAS y casi la cuarta parte de los mismos debe realizar más de 3 controles. Por este motivo, creemos conveniente modificar nuestro protocolo para control de la vasectomía y proponer que los pacientes reciban en la consulta dos volantes de solicitud de espermiograma para los meses 6º y 7º tras la cirugía y que acudan de nuevo para la valoración conjunta de ambos resultados. En este momento, con tan solo 2 controles, la mayoría de los pacientes estarán en condiciones de conseguir el alta. Aquellos en los que se produjo un fallo de la cirugía o sufrieron una recanalización precoz, con una segunda muestra de confirmación, podrán ser derivados al urólogo sin mayor dilación

Objectives: The evaluation of a recently established guidelines about the assessment of semen samples after vasectomy in the laboratory of the Hospital General of Albacete and to modify them to optimize the number of semen samples provided per patient but keeping in concordande with the international recommendations. Patients and Methods: The records of seminal analysis results from vasectomies performed from January 2002 to December 2004 were reviewed. Our vasectomy guidelines are based upon those of the British Andrology Society (BAS) and those of the World Health Organization for seminal assessment. Results: During the 3 years 984 patients underwent vasectomy. At follow up, 67% of them returned postvasectomy semen samples, but just 55,5% of them get the clearance criteria; the other patient abandoned before getting them. A mean of 2 samples per patient were received, but 39,6% of them provided one and more than 23% brought more than 3 semen samples. We had 43 technical failures, 4 early recanalization (0,5%) and one late recanalization (0,1%), and 13 patients underwent revasectomy (1,7%). Conclusion: A high percentage of our patients failed to fulfill the clearance criteria recommended by the BAS and almost a quarter of them had to deliver more than 3 semen samples. So we find convenient to modify our guides and propose that our patients should receive 2 request forms from the practitioner for semen analysis in the 6th and the 7th month postoperatively and should return to global evaluation of both reports. In that moment most patients will be able to meet the applied criteria for success with just 2 semen samples. Those who fail to become sterile because of either technical failure or early recanalizatione may be advised to go to the urologist with just 2 semen analysis without unnecesary delay

Influencia del proceso analítico en la aparición y desaparición de los espermatozoides del semen tras la vasectomía / Influence of the analytical process in the appearance and disappearance of the spermatozoa after vasectomy

Objetivo: Evaluar si el proceso analítico puede justificar que en algunos pacientes se observen espermatozoides residuales en algunos de sus espermiogramas para el control de la vasectomía, pero no en todos. Material y métodos: Se revisaron los controles de las vasectomías realizadas desde enero de 2002 a diciembre de 2004. Nuestro protocolo consiste en una adaptación a nuestro medio de las recomendaciones de la Sociedad Británica de Andrología para el control de la vasectomía y de la Organización Mundial de la Salud para el análisis seminal. Resultados: Durante los 3 años del estudio se ha intervenido a 984 pacientes de vasectomía y se recibieron una media de 2 muestras por paciente. En relación a la calidad de la fase preanalítica, 134 pacientes (9,4%) refirieron no haber recogido todo el eyaculado; los volúmenes de semen fueron inferiores a 2.0 mL en 269 especímenes (18,8%) y existían dudas de que los eyaculados fueran completos; en 11 casos, las condiciones preanalíticas fueron incorrectas: contenedores mal etiquetados, derramados o inadecuados. Con respecto a la fase analítica, en 432 eyaculados (30,5%) se encontraron alteraciones de la consistencia; 62 especímenes (4,3%) contenían abundantes células y obstruían la visualización microscópica. En cuanto a la fase postanalítica, 153 pacientes (20,9%) obtuvieron informes con resultados alternativos de azoospermia y de presencia de espermatozoides residuales. Conclusiones: Se produce un elevado porcentaje de incidencias en la fase preanalítica y la analítica en los controles de los pacientes vasectomizados. Estas condiciones inadecuadas pueden afectar los resultados y justificar que los espermatozoides residuales se observen o no en los eyaculados de algunos pacientes. Recomendamos realizar un mínimo de dos espermiogramas por paciente para asegurar su correcta evaluación. Proponemos informar los resultados negativos como un recuento inferior al límite de detección de nuestra técnica de manera similar a otras magnitudes del laboratorio para minimizar el efecto de la fluctuación de los recuentos en estos niveles tan bajos

Objectives: To evaluate if the analytical process might justify that in some patients rare non motile sperm might be seen in some but not all their post-vasectomy semen samples. Patients and methods: Post vasectomy ejaculates received in our Center from january 2002 to december 2004 were reviewed. We used our own guidelines for post vasectomy semen assessment based upon those of the British Andrology Society for the evaluation of post vasectomy semen samples and the World Health Organization guidelines for semen analysis. Results: During the 3 years of follow up, 984 patients underwent vasectomy. We received 1.430 semen samples, 2 samples per patient on average. Regarding the pre analytical phase, 134 samples (9.4%) were not completely collected; ejaculate volumes of less than 2 mL were delivered by 269 patients (18.8%); in these cases, we were not sure whether the whole ejaculates were submitted; pre analytical conditions of 11 samples (0.8%) were inappropriate: incorrectly labeled, spilled, provided into inadequate containers... Regarding the analytical phase, 432 ejaculates (30.5%) were extremely viscous and sperm detection might have been affected; 62 semen samples (4.3%) contained many cells which obstructed the visualization of the entire microscopy field. Regarding the post analytical phase, 153 patients (20.9%) had alternative negative/positive results with rare non motile sperm. Conclusion: An elevated percentage of incidences involving both the pre analytical and the analytical phase were observed during post-vasectomy seminal analysis. Inadequate conditions may affect the results and justify that spermatozoa may be seen in some but not all the ejaculates of the same patient. We recommend that two semen samples per patient are required to ensure that he is correctly evaluated. We propose to report a negative result as a spermatozoa count bellow the detection limit of our analytical procedure similar to other laboratory magnitudes to minimize the effect of fluctuations in such a low count of rare non motile sperm

Espermiograma para control de la vasectomía / Semen examination after vasectomy

La vasectomía está considerada como uno de los métodos más efectivos y populares para el control de la natalidad. Tiene el inconveniente de que no es efectiva de modo inmediato, ya que los espermatozoides tardan un tiempo variable en ser eliminados del tracto genitourinario masculino y, a veces, no lo hacen completamente. Además, existe un mínimo riesgo de que se recanalice el conducto seccionado y vuelvan a aparecer espermatozoides en el semen. Por estos motivos, es necesario realizar un espermiograma para comprobar que la intervención ha tenido éxito y que se ha conseguido la esterilidad. Esto ha supuesto que el análisis del semen sea muy importante a la hora de intentar asegurar el éxito de la operación y de tratar de evitar las consecuencias médico-legales de los fallos. Los diversos estudios existentes sobre el control de la vasectomía ponen de manifiesto la necesidad de implantar unos protocolos económicamente rentables, basados en la evidencia científica, que arranquen con la información exhaustiva preoperatoria y se continúen con un análisis estructurado posoperatorio del semen. En este sentido, la Sociedad Británica de Andrología ha publicado una guía de práctica clínica sobre el análisis seminal posvasectomía para ayudar a los profesionales del laboratorio en la estandarización de los espermiogramas de control y en el informe de los resultados. Para la recogida de semen, esta guía sigue las recomendaciones de la Organización Mundial de la Salud

Vasectomy is regarded as one of the most reliable and popular method of birth control. It has the disadvantage that it is not immediately effective because spermatozoa take some time to be cleared from the genitourinary tract of the male and sometimes they do not disappear completely. In addition, there is a minimal risk of recanalisation of the dissected duct and renewed patency. Because of this, it is necessary to do a spermiogram to confirm the success of the operation and that sterility has been achieved. This has produced that seminal examination becomes an important tool to document operative success and to avoid medicolegal consequences of failure. The studies about semen examination after vasectomy reveal the need of cost-efective evidence-based protocol, which begin by the adequate preoperative counselling and follow with a postoperative structurated semen analysis. The British Andrology Society guidelines about the assessment of semen samples after vasectomy were published to give guidance to laboratory staff to ensure standarisation of seminal analysis protocols and reporting of results that, for semen collection, follows the World Health Organization recommendation