RESUMO
Viral infections are important causes of morbidity and mortality in patients after hematopoietic stem cell transplantation. The monitoring by PCR of Herpesviridae loads in blood samples has become a critical part of posttransplant follow-up, representing mounting costs for the laboratory. In this study, we assessed the clinical performance of the multiplex PCR DNA microarray Clart Entherpex kit for detection of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesvirus 6 (HHV-6) as a screening test for virological follow-up. Two hundred fifty-five blood samples from 16 transplanted patients, prospectively tested by routine PCR assays, were analyzed by microarray. Routine PCR detected single or multiple viruses in 42% and 10% of the samples, respectively. Microarray detected single or multiple viruses in 34% and 18% of the samples, respectively. Microarray results correlated well with CMV and EBV detections by routine PCR (kappa tests = 0.79 and 0.78, respectively), whereas a weak correlation was observed with HHV-6 (0.43). HHV-7 was also detected in 48 samples by microarray. In conclusion, the microarray is a reliable screening assay for a posttransplant virological follow-up to detect CMV and EBV infections in blood. However, positive samples must be subsequently confirmed and viral loads must be quantified by PCR assays. Limitations were identified regarding HHV-6 detection. Although it is promising, is easy to use as a first-line test, and allows a reduction in the cost of analysis without undue delay in the reporting of the final quantitative result to the clinician, some characteristics of this microarray should be improved, particularly regarding quality control and the targeted virus panel, such that it could then be used as a routine test.
Assuntos
Sangue/virologia , Citomegalovirus/isolamento & purificação , Infecções por Herpesviridae/diagnóstico , Herpesvirus Humano 4/isolamento & purificação , Herpesvirus Humano 6/isolamento & purificação , Análise em Microsséries/métodos , Reação em Cadeia da Polimerase Multiplex/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Citomegalovirus/classificação , Citomegalovirus/genética , Feminino , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Infecções por Herpesviridae/virologia , Herpesvirus Humano 4/classificação , Herpesvirus Humano 4/genética , Herpesvirus Humano 6/classificação , Herpesvirus Humano 6/genética , Humanos , Hospedeiro Imunocomprometido , Lactente , Recém-Nascido , Masculino , Programas de Rastreamento/métodos , Técnicas de Diagnóstico Molecular/métodosRESUMO
OBJECTIVE: To compare the outcomes of conventional IVF and ICSI on sibling oocytes. DESIGN: Retrospective analysis. METHODS: Performance of ICSI on part of the oocytes and IVF on the remaining portion during the same cycle (sibling oocytes). PATIENTS: 135 couples (141 cycles) with male subfertility or with idiopathic infertility. RESULTS: Globally, the fertilization rate was not different between the ICSI and IVF, however, in patients with severe teratospermia, it was higher after ICSI (56.2 vs. 44.2 %, p<0.05). The fertilization failure rate was higher in the IVF group than in the ICSI group, globally, (12.1 % vs 2.8 %, p = 0.005), as well in patients with severe teratospermia. In the latter group, a higher number of top quality embryos were obtained after ICSI than after IVF. Of 57 cycles with severe teratospermia, only ICSI-embryos were transferred in 24, while only IVF-embryos were transferred in 11, resulting respectively in 8 and 3 clinical pregnancies. CONCLUSION: This study underscores that ICSI is useful in patients with teratospermia. Nevertheless, considering the chances of obtaining a successful fertilization after IVF and lower risk of chromosomal aberrations, we recommend performing both IVF and ICSI on sibling oocytes during the first treatment cycle in patients with teratospermia.
