Short-term side effects of low dose valproate monotherapy in epileptic children: a prospective study

Objectives: Considering the common use of valproate among children, we investigated short-term side-effects of low dose valproate monotherapy in epileptic children.Materials and Methods: In this prospective study, 209 epileptic children (48.3% male, mean age: 7.02 ± 3.13 years) on low therapeutic dose of valproate monotherapy (20-30 mg/Kg/daily) were enrolled and side-effects were evaluated through frequent clinical visits and laboratory tests during 6 months.Results: Weight gain was reported in 53.1% of patients. Decreased appetite was seen in 11% of patients, more frequent in younger cases (P=0.006). Abdominal pain, nausea/vomiting, diarrhea, and constipation were reported in 16.3%, 2.4%, 1.4%, and 1% of patients, respectively. Headache, tremor, dizziness, abnormal color vision, myoclonus, and bruxism were seen in 5.7%, 1.4%, 1%, 1%, 1%, and 0.5% of patients, respectively. Enuresis, hair loss, and skin rash were reported in 8.1%, 6.7%, and 0.5% of patients, respectively. Thrombocytopenia, impaired liver function tests, and leukopenia occurred in 1%, 1%, and 0.5% of patients, respectively.Conclusions: low dose valproate monotherapy may cause numerous side-effects, mostly not life-threatening and requiring no action. Besides more reported complications, we observed decreased appetite (among younger patients), enuresis, and abnormal color vision which have been briefly discussed in the literature and need to be addressed more

Improvement of sperm function, chromatin damage, and oxidative damage by N-Acetyl cysteine in varicocelized rats model

Introduction: N-Acetylcysteine (NAC), an acetylated form of the amino acid cysteine and precursor of reduced glutathione, plays important roles in a multitude of cellular processes, such as oxidative damage and detoxification of many electrophiles. Considering the pathophysiology of oxidative stress induced infertility in varicocele, we aimed to investigate the effect of NAC on semen analysis parameters (light microscopy), chromatin structure (aniline blue and acridine orange staining), and lipid peroxidation (BODIPY probe) in varicocelized rats.Methods: In this experimental study, varicocelizing surgery was carried out on 30 Wistar rats. Ten of them were sacrificed after two months (one round spermatogenesis), together with control rats (n=10) and sham operated rats (n=10), to verify the varicocele model. Out of the remaining twenty varicocelized rats, ten received NAC while ten were treated with water (control group) for two months.Results: All the investigational parameters (sperm parameters, chromatin integrity, and lipid peroxidation) severely worsened 2 and 4 months after surgical varicocele. The administration of NAC for two months significantly improved all the investigational parameters as compared to control rats at four months (p<0.05).Conclusion: The supplementation of varicocelized rats with NAC was effective in antagonizing the damage as well as in preserving testicular structure and spermatogenetic function. These effects are likely to occur also in clinical varicocele

EVSS- electro tactile vestibular substitution system as a new vestibular rehabilitation approach: A pilot study

Introduction: Using conventional methods of vestibular rehabilitation such as adaptation and habituation exercises is a management strategy for patients with bilateral vestibular loss due to aminoglycoside ototoxicity so far. Previous studies shown EVSS- electrotactile vestibular substitution system- might have an important role in the rehabilitation process for these patients. This study investigated the effect of this therapeutic modality as a pilot study. Materials and Methods: In this study, 10 cases (6 males, 4 females) with bilateral vestibular loss were rehabilitated by EVSS. This approach was conducted in 10 sessions, 20 minutes per session (two sessions per day). Sensory organization test (SOT) and Dizziness handicap Inventory (DHI) were performed before and after treatment (at the first day of post-treatment period).  Difference between the groups before and after treatment was analyzed by t-test using SPSS software (ver. 16). Results: After 10 treatment sessions, all subjects had significant difference in score of SOT and DHI (P < 0.05). Less falling (5th stage of SOT) was seen after treatment sessions (P < 0.05). Subjects could maintain their straight posture in Romberg position, with closed eyes and on a soft surface (P < 0.05) and their movements were also more uniform and their gait was more stable (P < 0.05). Conclusion: The results show recuperation of subjects following EVSS that indicate probable sensory systems substitution in order to manage vestibular disorders. Keywords: Vestibular rehabilitation, Electrotactile vestibular substitution system (EVSS), Balance disorder

Melatonin accelerates the developmental competence and telomere elongation in ovine SCNT embryos.

SCNT embryos suffer from poor developmental competence (both in vitro and in vivo) due to various defects such as oxidative stress, incomplete epigenetic reprogramming, and flaws in telomere rejuvenation. It is very promising to ameliorate all these defects in SCNT embryos by supplementing the culture medium with a single compound. It has been demonstrated that melatonin, as a multitasking molecule, can improve the development of SCNT embryos, but its function during ovine SCNT embryos is unclear. We observed that supplementation of embryonic culture medium with 10 nM melatonin for 7 days accelerated the rate of blastocyst formation in ovine SCNT embryos. In addition, the quality of blastocysts increased in the melatonin-treated group compared with the SCNT control groups in terms of ICM, TE, total cell number, and mRNA expression of NANOG. Mechanistic studies in this study revealed that the melatonin-treated group had significantly lower ROS level, apoptotic cell ratio, and mRNA expression of CASPASE-3 and BAX/BCL2 ratio. In addition, melatonin promotes mitochondrial membrane potential and autophagy status (higher number of LC3B dots). Our results indicate that melatonin decreased the global level of 5mC and increased the level of H3K9ac in the treated blastocyst group compared with the blastocysts in the control group. More importantly, we demonstrated for the first time that melatonin treatment promoted telomere elongation in ovine SCNT embryos. This result offers the possibility of better development of ovine SCNT embryos after implantation. We concluded that melatonin can accelerate the reprogramming of telomere length in sheep SCNT embryos, in addition to its various beneficial effects such as increasing antioxidant capacity, reducing DNA damage, and improving the quality of derived blastocysts, all of which led to a higher in vitro development rate

Consensus and diversity in the management of varicocele for male infertility: Results of a global practice survey and comparison with guidelines and recommendations

Purpose: Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. Materials and Methods: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological Association [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. Results: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available. Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men