Untoward Azoospermia by absurd testosterone therapy

The established role of the male partner in overall infertility is almost 50%.1 The most significant cause is degraded number as well as the quality of sperms.2 Spermatogenesis is governed by gonadotropin-releasing hormone (GnRH) then follicle-stimulating hormone (FSH) and finally by testosterone, which is linked with puberty, and essentially required well controlled hypothalamic-pituitary axis leading the Leydig cells along with Sertoli cells.3 In Pakistan incidence of azoospermia is 12.32%, and another study reported it to be 16%, this incidence is comparable to infertility in the USA at 10% while 11.35% in Kenya.4 The non-obstructive azoospermia (NOA) is mostly treated with testicular sperm extraction and then intracytoplasmic sperm injection (ICSI), but only a small percentage can afford it, and mostly it requires multiple attempts. So, most couples end up with adaptation or sperm donation.5,6 One percent of all men and 10% of infertile are azoospermic. In non-obstructive azoospermia primary testicular failure occur, testosterone therapy (TTh) negative feedback mechanism can cause suppression of luteinizing hormone (LH).7 In 30% of infertile men, the cause cannot be established, but genetics, chronic infection, prostatitis, anti-sperm antibodies, and persistent obesity can lead to it.8Unfortunately, in Pakistan, most of our physicians are fond of prescribing a high dosage of testosterone for the long term, to infertile male patients. Patients become satisfied due to the positive characteristics of testosterone, but the most painful aspect is that high TTh leads to complete azoospermia. Moreover, in most such cases, it is permanent due to damage to the germinal layer. More than six-month high TTh is contraceptive.9 In 2018 the Endocrine Society and the American Urological Association recommend testosterone therapy to treat infertility and preserve fertility.10 The first management of such cases is the cessation of TTh. An integrated analysis of 1549 men on high TTh was reported as the median time to recover was 3.4 months, to a sperm concentration of 20 million/ mL and the median time to recover to baseline sperm concentration was 5.4 months.10 According to this analysis, 90% of men recovered in 12-month time after stopping TTh with 20 million/ml sperms, and 100% recovered after 24 months, all of them were on average 31.8 years of age. They were on TTh for 9.5 months.11 Hypothalamic-pituitary-gonadal (HPG) axis is almost terminated by testosterone replacement therapy (TRT) and anabolic androgenic steroids (AAS) resulting in very much suppressed or even the complete arrest of the spermatogenesis. Spontaneous cessation of such overwhelming male infertility treatments can recover spermatogenesis depending upon the length and strength of such treatments.12,13 The Prime concern is the weightage of the decision by a physician to start such therapies, which have an abusive role in treating infertility. Most physicians are unfortunately causing such azoospermia. Many very reputed international guidelines and recommendations are against such TTh, TRT, and even AAS for the treatment of male infertility. Clomiphene citrate (CC) and human chorionic gonadotropin (HCG) along with the revival of the hypothalamic-pituitary-gonadal axis can help to restore spermatogenesis in these men, after 1-2 years of the cessation of the TTh.1

Untoward Azoospermia by absurd testosterone therapy

The established role of the male partner in overall infertility is almost 50%.1 The most significant cause is degraded number as well as the quality of sperms.2 Spermatogenesis is governed by gonadotropin-releasing hormone (GnRH) then follicle-stimulating hormone (FSH) and finally by testosterone, which is linked with puberty, and essentially required well controlled hypothalamic-pituitary axis leading the Leydig cells along with Sertoli cells.3 In Pakistan incidence of azoospermia is 12.32%, and another study reported it to be 16%, this incidence is comparable to infertility in the USA at 10% while 11.35% in Kenya.4The non-obstructive azoospermia (NOA) is mostly treated with testicular sperm extraction and then intracytoplasmic sperm injection (ICSI), but only a small percentage can afford it, and mostly it requires multiple attempts. So, most couples end up with adaptation or sperm donation.5,6 One percent of all men and 10% of infertile are azoospermic. In non-obstructive azoospermia primary testicular failure occur, testosterone therapy (TTh) negative feedback mechanism can cause suppression of luteinizing hormone (LH).7 In 30% of infertile men, the cause cannot be established, but genetics, chronic infection, prostatitis, anti-sperm antibodies, and persistent obesity can lead to it.8Unfortunately, in Pakistan, most of our physicians are fond of prescribing a high dosage of testosterone for the long term, to infertile male patients. Patients become satisfied due to the positive characteristics of testosterone, but the most painful aspect is that high TTh leads to complete azoospermia. Moreover, in most such cases, it is permanent due to damage to the germinal layer. More than six-month high TTh is contraceptive.9 In 2018 the Endocrine Society and the American Urological Association recommend testosterone therapy to treat infertility and preserve fertility.10 The first management of such cases is the cessation of TTh. An integrated analysis of 1549 men on high TTh was reported as the median time to recover was 3.4 months, to a sperm concentration of 20 million/ mL and the median time to recover to baseline sperm concentration was 5.4 months.10 According to this analysis, 90% of men recovered in 12-month time after stopping TTh with 20 million/ml sperms, and 100% recovered after 24 months, all of them were on average 31.8 years of age. They were on TTh for 9.5 months.11 Hypothalamic-pituitary-gonadal (HPG) axis is almost terminated by testosterone replacement therapy (TRT) and anabolic androgenic steroids (AAS) resulting in very much suppressed or even the complete arrest of the spermatogenesis. Spontaneous cessation of such overwhelming male infertility treatments can recover spermatogenesis depending upon the length and strength of such treatments.12,13 The Prime concern is the weightage of the decision by a physician to start such therapies, which have an abusive role in treating infertility. Most physicians are unfortunately causing such azoospermia.Many very reputed international guidelines and recommendations are against such TTh, TRT, and even AAS for the treatment of male infertility. Clomiphene citrate (CC) and human chorionic gonadotropin (HCG) along with the revival of the hypothalamic-pituitary-gonadal axis can help to restore spermatogenesis in these men, after 1-2 years of the cessation of the TTh.1

Effect of Oral intake of Stevia Leaf Powder on Body Weight – An Experimental study

Introduction: The steviol glycosides are found  in the stevia leaf. These glycosides possess sweetening properties as well as they have antioxidant, anti-microbial, anti-inflammatory, antihyperglycemic, and anti-hypertensive effects. This study was conducted to  find out the effect of Stevia leaf on body weight in obese Sprague Dawley male rats. Materials and Methods: This experimental study was carried out on 90 Sprague Dawley male rats. Group1(normal control) was given a standard diet for the entire study period, while the remaining sixty rats were given a high-fat diet (HFD) for 8 weeks to induce obesity. The obese rats were randomly assigned to group 2 (Obese Control) and Group 3 (obese + Stevia) and given HFD for another 6 weeks. The stevia leaf powder was added to the diet of group 3. Diet intake was noted for all the groups. Rats were weighed on the first day of every week, for six weeks, and then at the end of the study period.      Results: Body weights of rats in each group, at the start and end of the 6-week intervention period, when compared, showed a significant increase in group 1 (p=0.001), and group 2 (p = 0.001), while group 3 showed a non-significant increase (p = 0.248). The percentage increase in body weight for groups 1, 2, and 3 was 4.8, 9.3, and 1.1, respectively. Graphically, the weekly increase in average body weights of the three experimental groups showed maximum values for group 2. Conclusions: Stevia leaf possesses weight-reducing effects which may be due to inhibition of appetite, reduction in food intake, and consequent weight loss. Keywords: Obesity, weight loss, Natural non-nutritive sweeteners, Stevi

Infodemics and its Effect on Mental Health of Medical Students of IMDC during COVID-19 Pandemic

IntroductionGlobally rising the number of daily COVID-19 cases has triggered the incredible surge in the information (and misinformation) regarding COVID-19. This misinformation was about numbers of cases, inaccurate guidelines, advertisement of unapproved treatments, and remedies as cures. The increasing prevalence of depression and anxiety was found to be linked directly to the misinformation catered from social media. The study aims to explore the mental health of medical students due to a surge in information and misinformation regarding Covid-19.Materials and MethodsThis cross-sectional study was conducted online from August 2020 to January, 2021. 227 MBBS students of IMDC (1st year to final year with age range 19-25 years) were invited to participate in an online survey through Google docs. Those who were on medication for anxiety and depression were excluded from the study. The use of the data for research purposes was explained and written consent in the first section of the online survey was given to all participants before filling the questionnaire which was divided into 3 sections. The first part was about Demographic information. The second part consisted of 5 questions about info-media use and the third part consisting of 12 questions about mental health including stress-related and behavioral changes, somatic symptoms, emotional disturbance, and cognitive functioning during the covid-19 pandemic. Ethical Approval was taken from the ethical committee of IMDC. A Chi-square test was applied to calculate the significance of qualitative variables and determine the prevalence of mental health.ResultsThe total number of students who participated in this survey were 227 (28.2% males and 71.8% females). Among types of info-media, Whats-app was used most frequently by MBBS students. Different questions were asked regarding Info-media usage and mental health. A significant association was found between gender (Both males and females) and feelings of fear and worry (p-value 0.004**), feeling socially isolated(p= 0.005**), difficulty in communicating with people (p = 0.021*), feeling confused in decision making as time progressed( 0.008**), lack of interest in studying or difficulty in concentration during this time (p 0.037*) and effect on memorizing ability (0.000)**.MBBS students who were regularly using Info-media showed a significant disturbance in mental health problems including stress-related and behavioral changes and somatic symptoms. They were found to be significantly fearful and worried (p-value 0.010*), had difficulty in communicating with people regarding covid-19(p-value 0.021*), and also felt a change in appetite-valuable 0.030*). No serious mental health problem was found related to cognitive functioning. ConclusionIn conclusion, our findings show that there is a high prevalence of mental health problems, which were positively associated with frequent use of info-media during the COVID-19 outbreak

Alanine Transaminase levels in Patients of Dengue Fever in the Suburbs of Islamabad

Introduction: Hepatic dysfunction is a highly varied condition that can show up as minor damage with elevated levels of transaminases, or appear as extensive damage and failure of liver cells. Thus, in order to reduce associated morbidity and mortality, this ailment should be diagnosed at the earliest possible so that appropriate therapy can be instituted. Our study was carried out to observe hepatic damage in patients with dengue fever (DF) by measuring alanine transaminase levels. Materials and Methods: A cross-sectional study of three months duration was carried out in the Department of Medicine, Dr. Akbar Niazi Teaching Hospital affiliated with Islamabad Medical & Dental College, Pakistan. The sampling technique was Non-Random consecutive sampling and 118 patients were included in our study. Serum Alanine Transaminase (ALT) (normal = 7-56 IU/L), serum Aspartate Transaminase (AST) (normal = 10-40 IU/L) were determined and ultra-sound abdomen was performed. Statistical analysis was done using SPSS Version 24. The Chi-square test was used to observe the relationship between categorical variables. Phi, Cramer’s V, Pearson’s, and Spearman’s Correlation tests were used to study the association of age and gender with ALT levels. Results: There were 72% males (n=85) and 28% females (n=33). Patients were grouped according to age and mean ALT (95+86 IU/L) and AST (134.7+ 98 IU/L) levels were calculated in the different age groups. These levels were found to be significantly raised (P=0.00) in the age groups of 9-18 years and 19-25 years as compared to the other age groups. Moreover, males had high ALT levels as compared to females, however, a significant difference was not observed. There was also no association seen of gender with raised ALT levels (P=0.564), Phi & Cramer’s V=0.56, and Spearman’s correlation coefficient=0.320.Conclusions: ALT and AST levels were elevated above the normal in our sample indicating hepatic involvement

Effect of chronic restraint stress on body weight of male Sprague Dawley rats

Background:  Stress disturbs body weight and food intake, but the core mechanisms are not well understood.    Study design:  Experimental     Materials and Methods:  The study was conducted in  National  Institute  of  Health  (NIH),  Islamabad Sixty male Sprague Dawley rats (mean wt 250 ± 50 grams) were used and divided into 2 groups.   Each group comprised of 30 rats.   Group I was taken as control. Group II was exposed to chronic stress.  Results:  The comparison of weight gain by the different groups disclosed that there was a significant decrease in weight gain of rats exposed to the chronic stress as compared to control group.     Conclusion:  Chronic restraint stress has a detrimental effect on body weight.