Indications of the mechanisms involved in improved sperm parameters by zinc therapy

To determine possible indications of the mechanisms involved in improved sperm parameters by zinc therapy in asthenozoospermic men. Forty-five men with asthenozoospermia [>/= 40% immotile sperm] were randomized into four therapy groups: zinc only: n = 11; zinc + vitamin E: n = 12 and zinc + vitamins E + C: n = 14 for 3 months, and non-therapy control group: n = 8. Semen analysis was done according to WHO guidelines. Malone dialdehyde, tumour necrosis factor-alpha [TNF-alpha], total antioxidant capacity, superoxide dismutase [SOD] and glutathione peroxidase were determined in the semen and serum. Antisperm antibodies IgG, IgM and IgA were evaluated by immunobeads. Sperm chromatin integrity was determined by acid denaturation by acridine orange and sperm apoptosis by light and electron microscopy. The effect of zinc on in vitro induced sperm oxidative stress by NADH was evaluated. Asthenozoospermia was significantly associated with oxidative stress with higher seminal malone dialdehyde [8.8 vs. 1.8 mmol/l, p < 0.001] and TNF-alpha [60 vs. 12 pg/l, p < 0.001], and low total antioxidant capacity [1.8 vs. 8.4, p < 0.01], SOD [0.8 vs. 3.1, p < 0.01] and glutathione peroxidase [1.6 vs. 4.2, p < 0.05], compared to normozoospermia. Zinc therapy alone, in combination with vitamin E or with vitamin E + C were associated with comparably improved sperm parameters with less oxidative stress, sperm apoptosis and sperm DNA fragmentation index [DFI]. On the whole, there was no difference in the outcome measures between zinc only and zinc with vitamin E and combination of vitamins E + C. In the in vitro experiment zinc supplementation resulted in significantly lower DFI [14-29%, p < 0.05] compared to zinc deficiency. Zinc therapy reduces asthenozoospermia through several mechanisms such as prevention of oxidative stress, apoptosis and sperm DNA fragmentation

Magnesium sulphate therapy in women with pre-eclampsia and eclampsia in Kuwait

To evaluate the outcome of the use of MgSO4 therapy in women with severe pre-eclampsia in Kuwait from January 2002 to December 2004. The study involved 450 women managed at the Maternity Hospital in Kuwait with a blood pressure of 160/110 mm Hg and proteinuria of >0.3-5 g/24 h. A loading dose of 4 g MgSO4 was administered intravenously over 20 min and then the maintenance dose continued at 1 g/h for 24 h postpartum. Magnesium sulphate toxicity was monitored by urine output, deep tendon reflexes and serum magnesium levels and managed with an infusion of 10 ml of 10% calcium gluconate and cessation of magnesium infusion. Adjunct therapy included intravenous hydralazine 10 mg and labetalol 100 mg. The mode of delivery was determined after stabilizing the patient. The women included Kuwaitis [n = 200, 44.4%], Asians [n = 129, 28.7%] and other Arabs [n = 116, 25.8%] with a mean age of 29.7 +/- 6.7 years [primigravida: n = 233, 51.8%; other parities: n = 217, 48.2%]. Antenatal complications included intra-uterine growth restriction [n = 136, 30.2%], oliguria [n = 39, 8.7%], haemolysis, elevated liver enzymes and low platelet count syndrome [n = 30, 6.6%], abruptio placentae [n = 20, 4.4%], eclampsia [n = 15, 3.3%], and preterm birth [n = 253, 55.2%]. Caesarean section [n = 241, 53.6%] was the main mode of delivery. The perinatal mortality rate was 27 per 1,000. Magnesium sulphate toxicity observed as reduced tendon reflexes occurred in 14 [3.1%] patients and flushing, nausea and vomiting and blocked nostrils in 86 [19.1%]. There was no association between adverse outcomes and maternal serum magnesium concentrations and no maternal mortality occurred. Magnesium sulphate was effective in preventing recurrence of eclamptic fits and safe for both mother and fetus

Prevalence of endometrial proliferation in pipelle biopsies in Tamoxifen - treated postmenopausal women with breast cancer in Kuwait

To determine the prevalence of pathologic changes in the endometrium of tamoxifen-treated asymptomatic postmenopausal patients with breast cancer. Subjects and Fifty postmenopausal asymptomatic breast cancer patients with positive estrogen receptor status were treated with 20 mg of tamoxifen daily for a period of 5-60 months. The control group consisted of 30 asymptomatic postmenopausal breast cancer patients who were negative for estrogen receptor and therefore did not receive tamoxifen. Endometrial biopsies were performed using Pipelle endometrial suction curette at least 5 months after the study began. The endometrium was classified as atrophic [negative finding] and proliferative or hyperplastic [positive findings]. The study and control groups were compared for demographic characteristics, risk factors for endometrial cancer, histological findings and the duration of tamoxifen treatment. A significantly greater prevalence of endometrial abnormalities existed among the tamoxifen-treated than control patients [76 vs. 33%, p < 0.001]. The abnormal endometrial changes were further demarcated in both groups into proliferative [54 vs. 26.7%, p = 0.02] and hyperplastic [22 vs. 6.6%, p = NS]. In the study group, 63.6% of hyperplastic endometrium was simple hyperplasia and 36.4% was complex/no atypia hyperplasia, while in the control group all the cases were simple hyperplasia. No endometrial cancer was detected in either group. In addition, there was a positive association between the duration of tamoxifen exposure [<1 year vs. >/= 1 year] and the endometrial abnormalities [46.6 vs. 88.6%, p = 0.003; proliferative 57.1 vs. 74.1%, p = 0.015; hyperplastic 42.8 vs. 25.8%, p = NS]. The adjuvant use of tamoxifen is associated with significant time-dependent abnormal endometrial changes among patients with cancer of the breast

Causal factors and management options of infertility in Kuwait

To determine the main causes and management options of infertility in Kuwait. Methodology: Clinical evaluation, hormone profile of LH, FSH, prolactin and testosterone and midluteal phase progesterone, tubal patency tests, semen analysis and antisperm antibodies were assessed. Treatment included medical and surgical induction of ovulation. Male factor infertility was treated with antibiotics and immunosuppression when indicated, and empirically with antioxidants. The main cause of female infertility was ovarian dysfunction [40.7%] with predominance of polycystic ovarian syndrome [52.9%], anovulatory regular cycles [25%] and hyperprolactinaemia [14.3%]. Male factor accounted for infertility in 40.2% of the couples, with asthenozoospermia in 34.3%, oligozoospermia in 29.2% and azoospermia in 8.2%. Immuological tubal factors and endometriosis occurred in 9.8, 5.9 and 5.6%, respectively, and unexplained infertility in 8.5%. Both spouses were involved in 36.5% of the couples. Clomiphene citrate was the commonest agent for induction of ovulation with an 80% success rate. Bromocriptine, gonadotropins and laparoscopic ovarian cautery had success rates of 71, 69, and 80%, respectively. Treatment outcome in male factor infertility was variable. Ovarian dysfunction and male factor infertility are the dominant factors responsible for infertility in Kuwait. Induction of ovulation has a good prognosis of 40-80% success rate. Tubal factor infertility is uncommon in Kuwait

Fetal fibronectin membrane immunoassay in the detection of premature rupture of membranes and prediction of preterm labour

The objective of this study was to evaluate the sensitivity of fetal fibronectin membrane immunoassay in the detection of premature rupture of membranes and prediction of preterm labour. Seventy-two woman were evaluated using ROM-Check immunoassay, which utilizes a monoclonal antibody to the fetal fibronectin in the amniotic fluid drained into the vagina of 13 patients with unequivocal preterm premature rupture of membranes and in 35 patients with a previous history or features of preterm labour. Sensitivity of the fetal fibronectin immunoassay was 90.5% and the specificity was 61.0% in the detection of preterm spontaneous rupture of membranes. The positive and negative predictive values were 54.3 and 92.6%, respectively. In the patients with a previous history of preterm labour, 92% of those with positive fibronectin immunoassay had preterm delivery within 7 days of sampling; this contrasts with 87% of those with negative fibronectin immunoassay who delivered at term, defined as >/= 37 weeks of gestation, or close to term, with much better perinatal outcome [p <0.01]. In conclusion, fetal fibronectin immunoassay is a good method of detecting ruptured membranes and a strong predictor of spontaneous preterm labour

pattern of menopause in Kuwait and the need for hormone replacement therapy

To evaluate the pattern of menopausal symptoms in Kuwait and the need for hormone replacement therapy. Methodology: Two hundred and sixty-one postmenopausal women who attended the menopause clinic in a three year period form the subjects of the evaluation. This included detailed history, physical examination, and blood for hormone, lipoproteins and glucose profile, and high vaginal swabs, cervical smears and mid stream urine for urine culture. Mammography and CT scan were done for some patients. The median age for natural menopause was 49.5 years. Hot flushes were the commonest feature in 90% of the patients. Other features included night sweats, musculo-skeletal and psychological symptoms. The FSH and LH were generally high; >20 iu/L. About 14-27% of the patients had high risk lipoprotein indices concomitant with developing coronary heart disease. The CT scan revealed that 27.5% of the women had low mineral bone density in the risk range for developing osteoporosis. Menopausal symptoms in Kuwait have the same pattern as in western countries. Hormone replacement therapy is acceptable by women. Its general use among postmenopausal women is therefore recommended