Infertility was reported in approximately 15% of all heterozygous couples, with the male factor accounting for nearly half of the cases. This typically occurs due to low sperm production, sperm dysfunction, and sperm delivery obstruction. In this randomized controlled single-blind clinical trial, 90 infertile male subjects diagnosed with oligospermia, hypospermia, asthenozoospermia, or necrozoospermia were recruited. Semen samples were obtained with the masturbation method and an assessment of semen volume, sperm count, and motility was performed. Five milliamps of electrical shock was delivered to the participants through the fertility improvement device. Semen analysis was collected 4 months post-intervention from all subjects. Data were collected and an analysis of pre- and post-intervention results was performed. There was an improvement in the count, volume, and motility of the patient’s sperm after electrical shock treatment compared with the control group. By using the analysis of variance (ANOVA) test, there were statistically significant differences between the first and the second seminal analysis results (<.05). All other results were found to be independently correlated. This study demonstrated that using a painless, convenient at-home device, which is designed to contain all the testis tissue as a cup and then extend to include the scrotal roots reaching the penile root to include the epididymis, could significantly improve sperm motility and count. This device can be utilized to tackle the significant issue of infertility in a cost-effective, safe, and efficacious manner. An ultrasound was done before and after using the device as well as years after with no changes noted. Clinical Trial’s Registration Number: NCT04173052

Background: Supraventricular tachycardia (SVT) is an abnormally rapid heart rhythm that results from improper electrical activity in the upper part of the heart. Acute management of children presenting with SVT may be a challenge, as the exact tachycardia mechanism is often unknown. The strategy for treatment depends on the presentation and clinical status of the patient.Methodology: A systematic literature review was conducted to identify and select original research reports on supraventricular tachycardia management drugs in children and infants with no structural heart disease (all children from 1 hour to 17 years of age) in accordance with the PRISMA guidelines. Data were analyzed with Review manager version 5.4. P-value and I2were used to test the significance difference.Results: 26 studies out of 65 total studies assessed for eligibility were included in the review by fulfilling the inclusion criteria. There were 8103 patients from 13 countries with SVT who were treated with different antiarrhythmic drugs including (Adenosine, Dexmedetomidine) as acute management and (Amiodarone, Beta-Blockers, Flecainide, Digoxin and Ivabradine) as chronic control. There was a significant difference between the patients who took the drugs and the patients who responded to the drugs, with P-value <0.005 and I2 = 72%.Conclusion: There is not a first line treatment or second line treatment for SVT in pediatrics, and drug effectiveness can vary greatly between patients; all choices should be considered during the treatment protocol. The combination of drugs, as opposed to a single drug, is more efficient with less side effects in these patients. According to this review, the management of SVT in infants is highly dependent on the history of the patient and the probable side effects of some treatments that must be avoided.

Introduction: Irritable bowel syndrome (IBS) seems to have an unclear pathogenesis in the majority of patients. Antibodies against gonadotropin-releasing hormone (GnRH) have previously been discovered in the blood of these patients on a significant occurrence. This meta- analysis aims to assess if there is a significant association between GnRH antibodies and IBS. Methods: We defined a search strategy and implemented it to the PubMed, Ovid, Scopus and Web of Science databases for English language publications. The data were evaluated for acceptability, and controlled studies, either clinical trials, case control, cross sectional or cohort studies reporting the prevalence of GnRH antibodies in IBS patients were included. RevMan software version 5.4 was used for performing the analysis. Results: The total number of patients in the included studies was 1095 (270 patients in the IBS group, and 825 patients in the control group). By comparing IBS group and control group, we found a statistically significant association between IBS and increased prevalence of GnRH IgM antibodies (RR = 2.29, 95% CI = 1.58 to 3.31, p-value < 0.0001). No heterogeneity was observed among studies (P = 0.20, I2 = 36%). In GnRH receptor IGM antibodies outcome, we found a statistically significant association between IBS and increased prevalence of GnRH IgM antibodies compared with controls (RR = 3.80, 95% CI = 1.72 to 8.38, p-value = 0.0010). No heterogeneity was observed among studies (P = 0.85, I2 = 0%). For GnRH receptor IgM antibodies, the pooled analysis showed a statistically significant association between IBS and increased prevalence of GnRH receptor IgM antibodies compared with controls (RR = 3.80, 95% CI = 1.72 to 8.38, P = 0.0010). No heterogeneity was observed among studies (P = 0.17, I2 = 44%). Conclusion: This current meta-analysis revealed that GnRH IgM Antibodies may have an influence on the development of Irritable bowel syndrome, as Irritable bowel syndrome is related to a higher incidence of IgM antibodies against GnRH and its receptor when compared to healthy persons. More multicenter studies with higher sample sizes are needed to support our findings.

Stroke is the second most common cause of global death following coronary artery disease. Time is crucial in managing stroke to reduce the rapidly progressing insult of the ischemic penumbra and the serious neurologic deficits that might follow it. Strokes are mainly either hemorrhagic or ischemic, with ischemic being the most common of all types of strokes. Thrombolytic therapy with recombinant tissue plasminogen activator and endovascular thrombectomy are the main types of management of acute ischemic stroke (AIS). In addition, there is a vital need for neuroprotection in the setting of AIS. Neuroprotective agents are important to investigate as they may reduce mortality, lessen disability, and improve quality of life after AIS. In our review, we will discuss the main types of management and the different modalities of neuroprotection, their mechanisms of action, and evidence of their effectiveness after ischemic stroke.

Cardiopulmonary resuscitation (CPR) in full‐coded patients requires effective chest compressions with minimal interruptions to maintain adequate perfusion to the brain and other vital organs. Many novel approaches have been proposed to attain better organ perfusion compared to traditional CPR techniques. The purpose of this review is to investigate the safety and efficacy of heads‐up CPR versus supine CPR.

Background: The Japanese government advised mild or asymptomatic coronavirus disease-2019 (COVID-19) cases to self-isolate at home, while more severe individuals were treated at health posts. Poor compliance with self-isolation could be a potential reason for the new outbreak. Our study aimed to find out the correlation between the rising new cases of COVID-19 and home-based patients in Japan. Methods: A secondary data analysis study was conducted with the data from COVID-19- involved databases collected from Johns Hopkins University, Japanese Ministry of Health, Labour and Welfare, and Community Mobility Reports of Google. New community cases, stringency index, number of tests, and active cases were analyzed. Using a linear regression model, an independent variable was utilized for a given date to predict the future number of community cases. Results: Research results show that outpatient cases, the stringency, and Google Mobility Trend were all significantly associated with the number of COVID-19 community cases from the sixth day to the ninth day. The model predicting community cases on the eighth day (R2=0.8906) was the most appropriate showing outpatients, residential index, grocery and pharmacy index, retail and recreation index, and workplaces index were positively related (β1=24.2, 95% CI: 20.3– 26.3, P<0.0001; β2=277.7, 95% CI: 171.8–408.2, P<0.0001; β3=112.4, 95% CI: 79.8–158.3, P<0.0001; β4=73.1, 95% CI: 53- 04.4, P<0.0001; β5=57.2, 95% CI: 25.2–96.8, P=0.001, respectively). In contrast, inpatients, park index, and adjusted stringency index were negatively related to the number of community cases (β6=-2.8, 95% CI: -3.9 – -1.6, P<0.0001; β7=-33, 95% CI: -43.6 – -27, P<0.0001; β8=-14.4, 95% CI: -20.1– -12, P<0.0001, respectively). Conclusion: Outpatient cases and indexes of Community Mobility Reports were associated with COVID-19 community cases.

BackgroundThe United States Armed Forces completed their withdrawal from Afghanistan on August 30th, 2021, ending 20 years of war in Afghanistan. This rapid timeline from announcement to withdrawal and subsequent power transfer had profound consequences on the Afghan people, particularly in the domains of health and healthcare. MethodsOn 15 September 2021, we posted an anonymous online cross-sectional survey on social media (Twitter, Facebook, and WhatsApp groups) to collect data about respondents from Afghanistan. Questions focused on COVID-19 symptoms, concerns, and individual care with a focus on changes related to the United States (US) withdrawal from Afghanistan. The form was composed of 17 questions which included multiple choice, single choice, and numeric options. All questions were optional including demographic data. ResultsOur survey yielded 1,074 responses from the Farsi version and 572 responses from the Pashto version for a total of 1,646 responses. 1,286 (80%) of respondents were in Afghanistan at the time of survey submission. Concerning the US withdrawal from Afghanistan, 26% (412) respondents were extremely concerned and 12% (181) were moderately concerned. A majority of respondents report concerns regarding mental health due to the US withdrawal. 27% (418) report extreme concern, 12% (186) report moderate concern, and 15% (229) report a little concern. There is a significant difference in the proportions of concern (for US withdrawal generally, as well as physical and mental health) across gender. 49% of Female respondents report extreme concern regarding the US withdrawal compared to 22% of Male respondents (P < 0.001). With respect to physical health concerns 36% of Females report extreme concern compared to 16% of Males (P < 0.001). Finally on the mental health concerns, 54% of Females report extreme concern compared to 22% of Males (P < 0.001). ConclusionThe results from this survey are susceptible to the possibility of internal validity and/or external validity. However, we are accepting of those possibilities considering this survey wasn't designed to be bulletproof, but rather serve as a voice for those who can't be heard and to inform the public of the hardships occurring across the globe due to a steadfast retraction of the US footprint from their soil. Our findings indicate salient changes and public health concerns among Afghans following the US withdrawal from the region. These concerns varied across gender and ethnic groups. Our findings may serve as the first step in addressing the health concerns of Afghans following two decades of US military presence. The results should be understood through the limitations associated with a survey study design. Future research and policy aimed at tackling short and long-term health and social concerns in Afghanistan should consider the role of US withdrawal.

This meta-analysis assessed the association between gonadotropin hormone-releasing hormone (GnRH) antibodies and irritable bowel syndrome (IBS). We defined a search strategy and implemented it with PubMed, Ovid, Scopus, and Web of Science databases for English language publications. The data were evaluated for acceptability, and randomized controlled studies as well as case-control, cross-sectional, and cohort studies reporting the prevalence of GnRH antibodies in IBS patients were included. The total number of patients in the included studies was 1095: 270 patients in the IBS group and 825 patients in the control group. By comparing the IBS group and the control group, we found a statistically significant association between IBS and the increased prevalence of GnRH IgM antibodies (risk ratio = 2.29, 95% confidence interval = 1.58 to 3.31, P < 0.0001). We also found a statistically significant association between IBS and increased prevalence of GnRH receptor IgM antibodies compared with controls (risk ratio = 3.80, 95% confidence interval = 1.72 to 8.38, P = 0.001). The meta-analysis revealed a statistically significant association between IBS and increased prevalence of GnRH IgM and GnRH receptor IgM antibodies.

Background: Waldenstrom macroglobulinemia (WM) is a rare lymphoma with an incidence rate of 3 per million people per year, with approximately 1000 to 1500 new cases diagnosed each year in the USA. It is primarily seen in Caucasian males with a median age of 70 years old. Patients are most often asymptomatic, but WM can manifest itself with constitutional symptoms such as lethargy, bleeding, organomegaly, and neurological or fundoscopic abnormalities. WM is characterized by immunoglobulin M (IgM) monoclonal gammopathy, lymphocytic infiltration of bone marrow, and normocytic anemia due to bone marrow replacement. Case presentation: Our patient is a Hispanic 67-year-old female that presents with one month of intermittent band-like bilateral headache accompanied by dizziness, light-headedness, nausea, and blurred vision. A thorough diagnostic workup was performed, including serum protein electrophoresis (SPEP) with serum immunofixation (SIFE) showing an M spike and IgM kappa. Bone marrow biopsy was significant for lymphoplasmacytic infiltration with nodular B cells (CD19+, CD20+, CD22+). Computerized Tomography (CT) imaging showed splenomegaly in the patient. Treatment was provided for hyperviscosity syndrome with plasmapheresis twice. The patient reported improvement of her symptoms and was then scheduled for chemotherapy. Throughout 7 months, our patient received multiple cycles of bortezomib, dexamethasone, and rituximab. While her symptoms improved her psychiatric status got progressively worse. Conclusion: It is important not to neglect symptoms such as a headache, which may seem small, but could serve as a clue in the diagnosis of Waldenstrom's macroglobulinemia.

Some studies found no association between Familial Mediterranean fever (FMF) patients and abnormal QT markers of arrhythmia, others found prolongation of these markers in FMF patients. The aim of this study is to perform a met-analysis to find whether there is an actual association between FMF and abnormal QT markers. We searched PUBMED, WOS, OVID and SCOPUS databases. We included in the meta-analysis any observational study that reported QT and its markers in FMF patients without any age restriction. Meanwhile reviews, case reports, editorials, and animal studies were excluded. RevMan software (5.4) was used to do the meta-analysis. After complete screening,14 studies were eligible for the meta-analysis. The total number of patients included in the analysis is 1154. The pooled analyses between FM group and control group in QT interval, corrected QT (QTc), QT dispersion (QTd) and corrected QT dispersion (QTcd) outcomes, were (MD= 2.34, 95% CI = -1.21 to 5.89, p value = 0.20), (MD= 7.06, 95% CI = 2.68 to 11.43, p value = 0.002), (MD= 6.08, 95% CI = 0.84 to 11.32, p value= 0.02), and (MD= 4.82,95% CI = -0.57 to 10.20, p value = 0.08), respectively. No heterogeneity was observed in QT interval outcome (p = 0.21) but heterogeneity was found in QTc outcome and was solved after performing leave- one out test by removing (Koca, 2011) study (p= 0.12) and the pooled analysis was significant (p= 0.005), and the heterogeneity in QTd and QTcd was not solved by leave- one out test or subgroup analysis. No publication bias was observed in each outcome. After performing subgroup analysis based on age, a significant associations were found between increased QTc and QTd markers and FMF in children and adults subgroups, p values = (0.002), (0.02), (0.04), (0.05), respectively. QTc and QTd are prolonged in FMF patients compared with healthy controls. FMF patients are at increased risk of developing arrhythmia. More multi-center clinical trials are needed to support our findings.

Introduction The Mycobacterium abscessus complex is a nontuberculous mycobacteria species that is pervasive in soil and water. Various medical equipment malfunctions, infected surfaces, and patient transmission are potential causes of Mycobacterium abscessus infection in the hospital environment. These cases have an annual prevalence that ranges from 1.4 to 6.6 per 100,000 infections, mainly increasing. Case presentation We present the case of a 23-year-old American female patient who presented to the emergency room with significant abdominal pain between low pelvic sutures and the umbilicus. She reported abdominal pain, pruritus, and boils on her back preventing her from standing upright. The symptoms occurred in the liposuction area after cosmetic surgery in the Dominican Republic. The clinical, radiological, and cultural findings helped diagnose Mycobacterium abscessus infection. We conducted a mini literature review on the published reports of Mycobacterium abscessus. Conclusion Mycobacterium abscessus infection may occur due to surgical procedures abroad. Measures are required to combat Mycobacterium abscessus and reduce its prevalence in hospital settings.

Some studies have suggested that earlier initiation of antibiotics has shown positive outcomes in sepsis patients. We aimed to do a systematic review and meta‐analysis to evaluate the effect of prehospital administration of antibiotics on 28 days mortality and length of stay in hospital and intensive care unit for sepsis patients.

BACKGROUND:In cardiac transplant recipients, the electrocardiogram (ECG) is a noninvasive measure of early allograft rejection. The ECG can predict an acute cellular rejection, thus shortening the time to recognition of rejection. Earlier diagnosis has the potential to reduce the number and severity of rejection episodes. METHODOLOGY:A systematic literature review was conducted to identify and select the original research reports on using electrocardiography in diagnosing cardiac transplant rejection in accordance with the PRISMA guidelines. Studies included reported sensitivity and specificity of ECG readings in heart transplant recipients during the first post-transplant year. Data were analyzed with Review manager version 5.4. p-value was used in testing the significant difference. RESULTS:After the removal of duplicates, 98 articles were eligible for screening. After the full-text screening, a total of 17 papers were included in the review based on the above criteria. A meta-analysis of five studies was done. CONCLUSION:In heart transplant recipients, a noninvasive measure of early allograft rejection has the potential to reduce the number and severity of rejection episodes by reducing the time and cost of surveillance of rejection and shortening the time to recognition of rejection.

Traumatic brain injury (TBI) places a heavy load on healthcare systems worldwide. Despite significant advancements in care, the TBI-related mortality is 30-50% and in most cases involves adolescents or young adults. Previous literature has suggested that neutrophil-to-lymphocyte ratio (NLR) may serve as a sensitive biomarker in predicting clinical outcomes following TBI. With conclusive evidence in this regard lacking, this study aimed to systematically review all original studies reporting the effectiveness of NLR as a predictor of TBI outcomes. A systematic search of eight databases was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement (PRISMA) recommendations. The risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool. Eight studies were ultimately included in the study. In most of the studies interrogated, severity outcomes were successfully predicted by NLR in both univariate and multivariate prediction models, in different follow-up durations up to 6 months. A high NLR at 24 and 48 h after TBI in pediatric patients was associated with worse clinical outcomes. On pooling the NLR values within studies assessing its association with the outcome severity (favorable or not), patients with favorable outcomes had 37% lower NLR values than those with unfavorable ones (RoM= 0.63; 95% CI = 0.44-0.88; p = 0.007). However, there were considerable heterogeneity in effect estimates (I-2 = 99%; p < 0.001). Moreover, NLR was a useful indicator of mortality at both 6-month and 1-year intervals. In conjunction with clinical and radiographic parameters, NLR might be a useful, inexpensive marker in predicting clinical outcomes in patients with TBI. However, the considerable heterogeneity in current literature keeps it under investigation with further studies are warranted to confirm the reliability of NLR in predicting TBI outcomes.

AbstractBackground and AimSome studies reported a positive link between familial Mediterranean fever (FMF) and epicardial adipose tissue. Our meta‐analysis aimed to evaluate whether there is a significant association between FMF and increased epicardial adipose tissue thickness.MethodsWe searched the following databases: PUBMED, WOS, OVID, SCOPUS, and EMBASE. Inclusion criteria were any original articles that reported epicardial adipose tissue in FMF patients with no age restriction, excluding reviews, case reports, editorials, animal studies, and non‐English studies. Thirty eligible studies were screened full text but only five studies were suitable. We used RevMan software (5.4) for the meta‐analysis.ResultsThe total number of patients included in the meta‐analysis in the FMF patients group is 256 (mean age = 24.3), and the total number in the control group is 188 (mean age = 24.98). The pooled analysis between FMF patients and controls was [mean difference = 0.82 (95% CI = 0.25–1.39), p‐value = 0.005]. We observed heterogeneity that was not solved by random effects (p > 0.00001). We performed leave one out test by removing the Kozan et al. study, and the heterogeneity was solved (p = 0.07), and the results were (MD = 0.98, 95% CI = 0.52–1.43, p‐value < 0.0001).ConclusionFMF patients are at increased risk of developing epicardial adipose tissue compared to controls. More multicenter studies with higher sample sizes are needed to support our results.

Arrhythmias in COVID-19 patients are associated with hypoxia, myocardial ischemia, cytokines, inflammation, electrolyte abnormalities, pro-arrhythmic or QT-prolonging medications, and underlying heart conditions such as severe congestive heart failure, inherited arrhythmia syndromes, or congenital heart conditions. In the pediatric population, multisystem inflammatory syndrome can lead to cardiac injury and arrhythmias. In addition, arrhythmias and cardiac arrests are most prevalent in the critically ill intensive care unit COVID-19 patient population. This review presents an overview of the association between COVID-19 and arrhythmias by detailing possible pathophysiological mechanisms, existing knowledge of pro-arrhythmic factors, and results from studies in adult and pediatric COVID-19 populations, and the clinical implications.

Eight elderly confirmed SARS-CoV-2 patients who had severe course of COVID-19 and admitted to ICU expressed high lactate dehydrogenase (LDH) above normal level. The mean value of LDH was 440.40 U/L with 84.52 standard deviation (normal range = 100 – 190 U/L). The mean age of patients was 73.63 years (standard deviation = 3.34). The patients were 4 males (50%) and 4 females (50%). The median of stay duration at ICU was 2 days (range = 1-32 days). Four patients died (50%) and four patients survived (50%). All the patients were at the same ICU and received the same treatment course for COVID-19. It has been shown that LDH is a potential marker of vascular permeability in immune-mediated lung injury. Areas within the body where LDH are most active include the liver, striated muscles, heart, kidneys, lungs, brain, and red blood cells. LDH is a known marker for different inflammatory states, sepsis, myocardial infarctions, infections, and malignancies. One study showed that LDH elevation was associated with a 6-fold increase in the odds of developing a severe COVID-19 disease. Furthermore elevated LDH was associated with a 16 fold increase in patient mortality. Elevated LDH levels seem to reflect that the multiple organ injury and failure may play a more prominent role in influencing the clinical outcomes in patients with COVID-19. This study is a report of 8 elderly critically ill COVID-19 patients who expressed high lactate dehydrogenase above normal level. This indicates that lactate dehydrogenase can predict the outcome of elderly COVID-19 patients. All the eight patients developed severe course of COVID-19, four of them died. High levels of lactate dehydrogenase can predict the severity and mortality of COVID-19 in elderly patients. LDH levels could be considered for inclusion in future risk stratification models for COVID-19 severity and mortality. More observational studies

The aim of this study is to perform a meta-analysis to evaluate the possible association betweenQT markers and familial Mediterranean fever (FMF). PUBMED, Web of Science, OVID, and SCOPUS databases were searched. Inclusion criteria were randomized control trials or observational studies that compared measurement of the QT markers in FMF patients and healthy controls in both males and females without any age restriction or other comorbidities. RevMan software (5.4) was used to perform the analysis. A total of 14 studies with 1,154 individuals were included in the study. The pooled effect estimate showed a statistically significant association between FMF group and prolonged corrected QT (QTc) and QT dispersion (QTd) (MD= 7.06, 95% CI = 2.68 to 11.43, p-value = 0.002) and (MD= 6.08, 95% CI = 0.84 to 11.32, p-value= 0.02), respectively. No statistically significant difference between FMF group and QT interval and corrected QT dispersion (QTcd) (MD= 2.34, 95% CI = -1.21 to 5.89, p-value = 0.20) and (MD= 4.82, 95% CI = -0.57 to 10.20, p-value = 0.08), respectively. Our findings revealed a statistically significant relationship between FMF and extended QTc and QTd. More randomized multicenter trials are required to confirm our findings.