Methicillin-Resistant Staphylococcus aureus (MRSA) Detection from the Hands of Jatinangor Community Health Center’s Health Care Providers

Background: Methicillin-resistant Staphylococcus aureus is a bacterium that is resistance towards β-lactam antibiotics, and it seems to be one of the leading causes of nosocomial infections. Hands of the health care workers are said to be the main source for the nosocomial transmission. Thus, the study aims to determine methicillin-resistant S. aureus from the hands of Jatinangor Community Health Center’s health care workers.Methods: Samples were taken from the hands of 30 Jatinangor Community Health Center’s staffs, including medical and paramedical; from October 2012 to November 2012. Then, these samples underwent further laboratory examinations, starting from culture, identification and susceptibility test towards cefoxitin, in identifying methicillin-resistant S. aureus.Results: Out of the 30 samples taken, 6 samples (20%) were positive for S. aureus isolates. In which, 4 (13.33%) of the samples were positive for methicillin-resistant S. aureus.Conclusions: Since, health care workers are the main people in contact with patients and maintaining proper hand hygiene makes a huge difference; hand hygiene should be given adequate attention for the benefit of all. [AMJ.2015;2(1):217–20

ANGIOTENSIN II TYPE-1 RECEPTOR (AT1R) DISTRIBUTION IN BPH, HIGH GRADE PIN AND ADENOCARCINOMA OF THE PROSTATE

Objective: The aim of the study was to detect the differences in number and the distribution of angiotensin II type-1 receptor (AT1R) in BPH, high grade PIN, and adenocarcinoma of the prostate. Material & method: A prospective study was performed in RSHS, in collaboration with the Department of Anatomical Pathology. Prostate samples were taken by TUR of the prostate, and then divided into 5 groups. They were BPH, high grade PIN, adenocarcinoma of the prostate in 3 difference grades (well, moderate, and poorly differentiated). Kidney tissue for control. Immunohistochemical staining was done to determine the angiotensin II type-1 (AT1R) receptor distribution as primary antibody used was mouse monoclonal antibody AT1 (TONI-1): sc-57036, Santa Cruz Biotechnology Inc., CA. Results: Angiotensin II type-1 receptor was found in material of BPH, high grade PIN and adenocarcinoma of the prostate. The number and distribution of the receptors were not different. Conclusion: There are no significant differences in number and distribution of angiotensin II type-1 receptor on BPH, high grade PIN, and adenocarcinoma of the prostate

Post-vasectomy semen analysis: Optimizing laboratory procedures and test interpretation through a clinical audit and global survey of practices

Purpose: The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice. Materials and Methods: We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory scenarios. Moreover, we conducted an analysis of 1,114 PVSA performed at the Cleveland Clinic’s Andrology Laboratory and an online survey to understand clinician responses to the PVSA results in various countries. Results: Results from our clinical experience showed that 92.1% of patients passed PVSA, with 7.9% being further tested. A total of 78 experts from 19 countries participated in the survey, and the majority reported to use time from vasectomy rather than the number of ejaculations as criterion to request PVSA. A high percentage of responders reported permitting unprotected intercourse only if PVSA samples show azoospermia while, in the presence of few non-motile sperm, the majority of responders suggested using alternative contraception, followed by another PVSA. In the presence of motile sperm, the majority of participants asked for further PVSA testing. Repeat vasectomy was mainly recommended if motile sperm were observed after multiple PVSA’s. A large percentage reported to recommend a second PVSA due to the possibility of legal actions. Conclusions: Our results highlighted varying clinical practices around the globe, with controversy over the significance of non-motile sperm in the PVSA sample. Our data suggest that less stringent AUA guidelines would help improve test compliance. A large longitudinal multi-center study would clarify various doubts related to timing and interpretation of PVSA and would also help us to understand, and perhaps predict, recanalization and the potential for future failure of a vasectomy.American Center for Reproductive Medicin

Artificial intelligence in andrology: From Semen Analysis to Image Diagnostics

Artificial intelligence (AI) in medicine has gained a lot of momentum in the last decades and has been applied to various fields of medicine. Advances in computer science, medical informatics, robotics, and the need for personalized medicine have facilitated the role of AI in modern healthcare. Similarly, as in other fields, AI applications, such as machine learning, artificial neural networks, and deep learning, have shown great potential in andrology and reproductive medicine. AI-based tools are poised to become valuable assets with abilities to support and aid in diagnosing and treating male infertility, and in improving the accuracy of patient care. These automated, AI-based predictions may offer consistency and efficiency in terms of time and cost in infertility research and clinical management. In andrology and reproductive medicine, AI has been used for objective sperm, oocyte, and embryo selection, prediction of surgical outcomes, cost-effective assessment, development of robotic surgery, and clinical decision-making systems. In the future, better integration and implementation of AI into medicine will undoubtedly lead to pioneering evidence-based breakthroughs and the reshaping of andrology and reproductive medicine

Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

Purpose: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. Materials and Methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians

Controversy and consensus on the management of elevated sperm DNA fragmentation in male infertility: A global survey, current guidelines, and expert recommendations

Purpose Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and Methods An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. Results A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4–6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. Conclusions This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians

COMPARISON OF PAIN DEGREES USING VISUAL ANALOG SCALE (VAS) IN VARICOCELE PATIENT AFTER MICROSURGERY VARICOLECTOMY COMPARED TO NON MICROSURGERY VARICOCELECTOMY PROCEDURE AT HASAN SADIKIN HOSPITAL BANDUNG IN 2014 – 2015

Objective: This study aimed to report the demographic, presentation, and compare the pain degree after varicocelectomy procedure at Hasan Sadikin Hospital Bandung from 2014 until 2015. Material & Methods: We study the demographic, presentation, and outcome of varicocelectomy to pain degree in patient who came to Hasan Sadikin Hospital Bandung from 2014 until 2015. Results: The mean age of patients was 29.43  years old. Patient consist of 2 (2.89%) patients with varicocele grade I,  32 (46.37 %) patients with varicocele grade II, 33 (47.82%) patients with varicocele grade III, and 2 (2.89 %) with varicocele grade IV. We found incidences of varicocele at the right side in 1 (1.44 %) patient, at the left side in 34 (49.27%) patients, and at bilateral in 34 (49.27%) patients. Thirty eight patients (55%) patients underwent non-microsurgical varicocelectomy and 31 (45%) patients underwent microsurgical varicocelectomy. 22 (57.89%) patients still had pain after non microsurgical varicocelectomy and 30 (96.77%) patients had no pain after microsurgical varicocelectomy. Only one (4.34%) patient experienced scrotal pain after microsurgical varicocelectomy but the pain relieves after 6 months postoperative. Conclusion: Microsurgical varicocelectomy is an effective treatment of varicocele. Our comparative study among open surgical and microsurgical varicocelectomy has confirmed microsurgical varicocelectomy has a better postoperative outcome

COMPARISON BETWEEN GLYCOGEN LEVEL OF KIDNEY TUBULAR CELLS IN DIABETIC KIDNEY STONE PATIENTS AND NON DIABETIC KIDNEY STONE PATIENTS

Objective: To compare glycogen level of kidney tubular cells in diabetic kidney stone patients with nondiabetic kidney stone patients. Material & method: We reviewed kidney stone patients who underwent nephrectomy in Hasan Sadikin Hospital from February 2008 to January 2009. Age, gender, type of DM, and urine pH were recorded. Glycogen level of kidney tubular cells were evaluated histochemically using HE, PAS, and PAS diastase. The results were categorized into 3 grades, based on the staining appearance compared to liver cells as controls. The results of diabetic group were compared to non diabetic patients. Results: There were 30 patients eligible for this study, 15 in diabetic group and 15 non diabetic patients. In the diabetic group, there were 10 patients with urine pH 6,5. Examination revealed that glycogen level of kidney tubular cells in diabetic group was higher than in non diabetic group. Conclusion: Glycogen level of kidney tubular cells in diabetic kidney stone patients was higher than in non diabetic kidney stone patients. Keywords: Tubular cell, kidney stone, diabetes mellitus

ESTROGEN EFFECT ON WISTAR'S VAGINAL EPITHELIUM

Objective: To evaluate the effect of estrogen on wistar’s vaginal epithelium. Material & method: We divided 30 female wistars into three groups, ten wistars underwent bilateral ovariectomy, 10 wistars underwent bilateral ovariectomy, and estrogen replacement and 10 wistars as control. The second group received estradiol 1 mg/kg/day, directly after ovariectomy. After 4 weeks the vagina was then harvested and stained with hematoxylin-eosin to evaluate the thickness of epithelial layer of vagina. A pair T-test was use for statistical analysis. Results: Estrogen ablation decreased the thickness of epithelial layer in wistar’s vagina. The mean thickness of epithelial layer in vagina were 3, 5, and 10 for each group respectively. The mean epithelial layer of the first group as well as the second group showed significant difference compared to control group (p>0,05), while the first group showed insignificant difference compared to the second group. Conclusion: Estrogen ablation seems to decrease the thickness of vaginal epithelium, while estrogen replacement revealed insignificant effect

The Renaissance of Male Infertility Management in the Golden Age of Andrology

Infertility affects nearly 186 million people worldwide and the male partner is the cause in about half of the cases. Meta-regression data indicate an unexplained decline in sperm concentration and total sperm count over the last four decades, with an increasing prevalence of male infertility. This suggests an urgent need to implement further basic and clinical research in Andrology. Andrology developed as a branch of urology, gynecology, endocrinology, and, dermatology. The first scientific journal devoted to andrological sciences was founded in 1969. Since then, despite great advancements, andrology has encountered several obstacles in its growth. In fact, for cultural reasons, the male partner has often been neglected in the diagnostic and therapeutic workup of the infertile couple. Furthermore, the development of assisted reproductive techniques (ART) has driven a strong impression that this biotechnology can overcome all forms of infertility, with a common belief that having a spermatozoon from a male partner (a sort of sperm donor) is all that is needed to achieve pregnancy. However, clinical practice has shown that the quality of the male gamete is important for a successful ART outcome. Furthermore, the safety of ART has been questioned because of the high prevalence of comorbidities in the offspring of ART conceptions compared to spontaneous conceptions. These issues have paved the way for more research and a greater understanding of the mechanisms of spermatogenesis and male infertility. Consequently, numerous discoveries have been made in the field of andrology, ranging from genetics to several “omics” technologies, oxidative stress and sperm DNA fragmentation, the sixth edition of the WHO manual, artificial intelligence, management of azoospermia, fertility in cancers survivors, artificial testis, 3D printing, gene engineering, stem cells therapy for spermatogenesis, and reconstructive microsurgery and seminal microbiome. Nevertheless, as many cases of male infertility remain idiopathic, further studies are required to improve the clinical management of infertile males. A multidisciplinary strategy involving both clinicians and scientists in basic, translational, and clinical research is the core principle that will allow andrology to overcome its limits and reach further goals. This state-of-the-art article aims to present a historical review of andrology, and, particularly, male infertility, from its “Middle Ages” to its “Renaissance”, a golden age of andrology