The role of men in recurrent miscarriage; a Narrative Review

Background and Method: Recurrent Pregnancy Loss (RPL) is defined as the occurrence of two or more consecutive miscarriages within the first 20 weeks of pregnancy. The key challenge remains to be what it is that has to be done with couples experiencing RPL. Infections, endocrine disturbances, a suboptimal uterine environment, advanced maternal age, and genetic influences are some of the factors which may increase the chances of RPL occurrence. Despite all medical and research efforts, approximately 40 percent of RPL cases are categorized as unexplained. This is while amongst all the various factors which may lead to such condition, fathers’ genetic influences have often been ignored in the past. In fact, parental chromosomal anomalies, gene mutations such as the microdeletion of chromosome Y, and/or some polymorphism of HLA-G have shown to contribute and lead to miscarriage.Result: Furthermore, high levels of Reactive Oxygen Species (ROS) can cause DNA damage in spermatozoa. Meantime, sperm DNA damage has been closely linked with indicators such as fertilization, embryo quality, implantation, spontaneous abortion, congenital malformations, and childhood diseases. Sperm Chromatin Structure Assay (SCSA) is a test to measure DNA fragmentation. Moreover, the other SCSA parameter that needs to be considered is high DNA stainability (HDS). It is worth mentioning that HDS is associated with frequency of aneuploidy in spermatozoa. In addition, high HDS can be associated with an increased risk of early abortion in IVF and ICSI cycles.Conclusion: Additionally, increasing paternal age and varicocele can increase the risk of miscarriage. Advanced Paternal Age (APA) can also increase the relative risk of offspring neurocognitive defects. In saying that, the microsurgical varicocelectomy effectively increases the odds of natural pregnancy, the rate of high-quality embryos, and the success rate of in vitro fertilization

The Trends of Urolithiasis Therapeutic Interventions over the Last 20 Years: A Bibliographic Study

Introduction: The clinical and economic burden of kidney stones is a challenge for the healthcare system. There is a limited bibliometric project exploring the literature trends on ‘urolithiasis’ and its related management.Methods: A review was conducted to discover the related abstracts regarding each specific issue, investigated year by year from May 2000 to May 2020. To make an effective comparison, the statistics resulting from every single study were allocated to two 10-year periods: period 1 (2000 to 2010) and period 2 (2010 to 2020). We included all English language articles, all non-English articles with English abstracts, and studies in which interventions were used for stone removal, including laser technology.Results: These articles are about ureteroscopy (URS) (n=10360, 33.45%), percutaneous nephrolithotomy (PCN) (n =10790, 34.84%) and extracorporeal shockwave lithotripsy (ESWL) (n=9846, 31.76%). When evaluating the two time periods, there were 9912 studies available in period one, which increased by ×2.12 times (112.71% rise) to 21 084 studies in period two (P=0.001). The increase was 133%, 103.51%, and 70.4% for URS, PCN, and SWL respectively. A total of 855 studies on Laser application via URS were published on PubMed over a 20-year period. There was an increasing trend toward using laser applications via URS over the study period. Also, there were 230 articles published in period one, which increased by nearly 2.71 times to 625 papers in period two (P< 0.001). There was an increasing trend toward using laser application via PCN; 126 papers were published in period one, which increased by nearly 3.05 times (rise of 205.5%) to 385 papers in period two (P = 0.002).Conclusion: The minimal invasive interventions for stone removal, including URS and PCN, increased dramatically in the last decade, and the use of lasers in stone treatment increased significantly in the last decade. DOI:10.34172/jlms.2021.1

The Role of Protamine in Male Fertility

Background: Approximately 40-50% of infertilities is related to males. Abnormal sperm chromatin structure is suggested as a significant cause of infertility. Protamines constitute a significant component of the sperm chromatin, and they play a vital role in the proper packaging of chromatin. Numerous studies have shown that protamine deficiency in sperm is associated with low sperm quality and infertility. Given the importance of protamine infertility, the purpose of this article is to investigate the content of protamine and its biological importance in male fertility. Materials and Methods: In this study, data and information collected on English-language articles from PubMed and MEDLINE databases. For Persian articles, Persian-language databases, including SID Scientific Database, IranMedex Medical Articles Database, IranDoc (Iran Scientific Information and Documents Research Institute), Magiran Publication Information and MedLib investigated. Results: Based on previous studies about protamine and its role in spermatogenesis, any disruption in protamine genes, including PRM1 and PMR2, can disrupt histone/protamine ratio, leading to abnormal spermatozoa. Conclusion: Most the previous studies approved any mutation in protamine genes correlates with infertility in men. These results can be a potential subject for future researches into infertility treatment in men

Livelihood Vulnerability of Semi-Mobile Pastoral Communities to Climate Change in Arid and Semiarid of Iran

Climate change is impacting on natural resource based livelihood systems such as pastoralist communities in arid and semi-arid regions. Vulnerability to climate change refers to the potential of a system to be harmed by this external stress. The level of vulnerability of pastoral communities and the effective components determine the extent of climate change impacts on these communities and thereby help identify institutional options that have the potential to reduce their vulnerability. This study assessed climate change vulnerability of semi-mobile pastoralist communities in five main regions (Gozm, Kaht, Madan, Rochon and Jarob) of Khabr rangelands, Kerman, Iran using the Livelihood Vulnerability Index (LVI). The data comprised of primary data on seven main components including socio-demographic profile, livelihood strategies, social networks, health, food, water availability, natural disasters and climate variability which were collected through survey of 70 semi-mobile pastoral households, and secondary data on rainfall and temperature. Data were aggregated using composite LVI index and vulnerabilities of communities were compared. Results suggested that semi-mobile pastoralists in Rochon region had the highest (0.63) LVI showing relatively the greatest vulnerability to climate change impacts in terms of Socio-Demographic Profile, Livelihood Strategies and Health while Kaht region had the least (0.49) LVI showing relatively the smallest vulnerability to climate change impacts. The results of this study are useful to access pastoralist communities’ vulnerability and set risk management policies. Keywords: climate change; livelihood vulnerability index ; semi-mobile pastoralist

The Impact of the First Covid 19 Pandemic on Urology Residency Training in Iran

Background: During the pandemic, Iranian healthcare system had faced many challenges including the continuation of medical education. In this time, almost all elective surgeries have been suspended, outpatient visits have been limited to seriously ill patients, and academic meeting have been cancelled. This process has caused a significant decrease in clinical and surgical practice in the field of urology. In this article, we assess as to what extent and how this pandemic has impacted the urology residency training in Iran. Material and Methods: a 15-item-long questionnaire was designed and sent to all Iranian urology residents via social network and/or email from the 10th of MAY to the 10th of Jun 2020. This questionnaire assessed different training activities, including on-call duty, outpatient visits, diagnostic procedures such as cystoscopy, endoscopic procedures, and open major surgeries, prior and during the pandemic. The results were evaluated using t-test and ANOVA. Results: the percentage of urology resident’s involvement in each training activity, including on-call duty, outpatient visits, diagnostic procedures such as cystoscopy, endoscopic procedures, and open major surgeries, demonstrated a significant decline (p<0.001) during this time compared to the pre-COVID-19 period. Conclusion: urology residency training significantly decreased during the COVID-19 period. In order to address the second and third waves of COVID-19 outbreak, long-term action plans, such as telemedicine and stimulation, can help prepare training programs and residents during these unprecedented times

Predictors of Testis Cancer Mortality in Iran

Introduction: Testis cancer is a rare cancer that afflicts young men. although the incidence of testis cancer is increasing, the mortality rate is decreasing. This study examines the mortality of testicular cancer and its relationship with the human development index and its components in Iran during 2005-2015. Materials and Methods: Data of patients with testis cancer were collected from the Office of National Cancer Registry in the Ministry of Health and Medical Education (MOH&ME) during 2005-2015. An additional telephone survey was conducted by trained interviewers to collect data, including survival status, demographic characteristics, age of cancer diagnosis and other clinical profiles. Kaplan-Meier survival rates were calculated according to demographic characteristics, economic status, and residential area and socioeconomic status (SES). All the analyses were done using STATA software, version 14 (StataCorp. 2015). Results: From 2005 to 2015, 5886 testicular cancer cases were diagnosed among men in all age groups. Most patients (73.9%) were 15–49 years of age at the time of diagnosis, 26.1% were 50 years of age or older. Seminoma was diagnosed among 46.78% of the patients and non-seminoma among 42.28%. Factors which had impact on survival rate were age (P=0.001), tumor histology (P=0.02, hazard ratio=1.23[0.98-1.38]) and TNM stage (P=0.001, hazard ratio=1.2[0.92-1.28]). Patients who got married at the time of diagnosis more likely presented at earlier stages and had better overall testis cancer-specific survival than patients who were single, separated, widowed, or divorced (P=0.002, hazard ratio 1.27[1.09-1.49]). Testis cancer mortality rate was significantly higher in patients who did not graduate from high school and significantly higher in patients who were tenants (P=0.057, hazard ratio =1.132[0.996-1.28]). Conclusion: Testis cancer mortality is decreasing in Iran. Age, TNM stage and histology, and marital and economic status were factors influencing mortality rate

Testosterone Level and Coronary Artery Disease in Iranian Men; a Systematic Review

Coronary artery disease (CAD) is among the most common cardiovascular diseases (CVDs), caused by the formation of plaques of lipids, calcium, and inflammatory cells. In Iran, CAD is responsible for about 50% of all deaths per year. There is also a probability of the role of androgens deficiency in CAD in men. We aimed to systematically review all the related original studies to achieve an overall insight into the associations of testosterone and CAD in Iranian men.  MedLine, Web of Science, Scopus, and Google scholar databases were searched from inception to January 2021. All types of studies on Iranian men older than 40 years of age, reporting results of comparing testosterone in normal individuals and those with CAD were included. The main findings of the articles were compared to achieve an overall statement. Ultimately, six studies were included. Most (66.7%) had directly stated that lower levels of testosterone are associated with CAD or the level of testosterone is lower in patients with proven CAD. Among them, in 3 (50%) studies, the mean age of the participants had no significant difference between patients with CAD and the normal group. It is clear that low testosterone level is associated with increased risk of cardiovascular events but it is not definitely determined whether it is independent of age in Iranian men.  Further well-designed studies are needed to clearly exclude all confounding variables including age and show the net effect of testosterone on CAD

Assessing the Relationship between Serum Testosterone Levels and COVID-19 Outcomes in Admitted Patients

Introduction: With the emergence of the worldwide COVID-19 pandemic, a high toll of mortality and morbidity was imposed on Iran. Despite endeavors to control the disease using the social distancing protocols, isolations, quarantine and vaccination, COVID-19 is still afflicting individuals by mutation and development of new variants. Studies suggest higher morbidity and mortality among men compared to women, and in men with underlying diseases. Studies suggest low serum testosterone level as a risk factor for more severe diseases. We aimed to assess the relation of testosterone level with laboratory investigation and its effect on COVID-19 disease outcomes. Materials and Methods: Seventy patients were selected from those referred to Shohada-e-Tajrish hospital during February 2022 till July 2022. The patients were further categorized in two groups regarding their need for respiratory support: patients who did not need invasive respiratory support and patients who needed invasive respiratory support and were admitted to the intensive care unit. Blood samples were collected for laboratory examination. Each patient was followed for one month, and the outcomes were recorded. Results: The mean age of the participants was 64.44 years including 33 men and 37 women. Mean serum total and free testosterone level was 0.45 nmol/L and 1.22 nmol/L, respectively. Demised patients were significantly older and had significantly lower total testosterone levels. D-dimer was significantly higher in demised patients. Conclusion: Serum total testosterone levels can be used as a prognostic factor to predict COVID-19 patients’ prognosis. Serum total testosterone is inversely associated with disease severity, and lower serum total testosterone level is significantly associated with higher mortality. Moreover, inflammatory markers such as D-dimer can be used to determine prognosis and severity

Efficacy and Safety of Laser Lithotripsy in Pregnancy

Introduction: The aim of our study was to assess the efficacy and safety of laser lithotripsy in pregnant patients.Methods: In this retrospective study, we reviewed the 15 pregnant women who have been treated for ureteral stones with semi-rigid ureteroscope and holmium laser at our center between Januarys 2007and April 2015.Results: The mean age of patients and mean gestational age was 29.3 years old 27.3 weeks respectively. Mean size of stones was 7.84 mm. Twelve patients had renal colic, and hematuria was found in 3 cases. Irritative urinary symptoms such as frequency and urgency detected in 6 ones and 2 patients had fever. The stone of all patients were fragmented by using holmium laser lithotripter. In 5 patients stone residual fragments were removed by grasper while other 10 patients were left to pass fragments spontaneously. No intraoperative and postoperative urological or obstetric complication was seen.Conclusion: Laser lithotripsy is safe and efficacious in pregnant patients who have ureteral stone that does not respond to conservative management