Expert survey on management of prostate cancer in India: Real?world insights into practice patterns

To gain insights on the diverse practice patterns and treatment pathways for prostate cancer (PC) in India, the Urological Cancer Foundation convened the first Indian survey to discuss all aspects of PC, with the objective of guiding clinicians on optimizing management in PC. A modified Delphi method was used, wherein a multidisciplinary panel of oncologists treating PC across India developed a questionnaire related to screening, diagnosis and management of early, locally advanced and metastatic PC and participated in a web朾ased survey (WBS) (n = 62). An expert committee meeting (CM) (n = 48, subset from WBS) reviewed the ambiguous questions for better comprehension and reanalyzed the evidence to establish a revote for specific questions. The threshold for strong agreement and agreement was ?90% and ?75% agreement, respectively. Sixty?two questions were answered in the WBS; in the CM 31 questions were revoted and 4 questions were added. The panelists selected answers based on their best opinion and closest to their practice strategy, not considering financial constraints and access challenges. Of the 66 questions, strong agreement was reached for 17 questions and agreement was achieved for 22 questions. There were heterogeneous responses for 27 questions indicative of variegated management approaches. This is one of the first Indian survey, documenting the diverse clinical practice patterns in the management of PC in India. It aims to provide guidance in the face of technological advances, resource constraints and sparse high?level evidence.

Management of Comminuited Intra/Juxta Articular Fracture of Distal Radius Using Bridging External Fixator

Background: Distal radius fractures are the third most common osteoporotic fractures and are frequently treated in emergency department. They have a trimodal peak of occurrence and there has been a significant increase in incidence of involvement in elderly females and young males. Management of these fractures comes with lots of treatment options and challenges to provide good functional outcome. This prospective study was done for the management of communited intra/juxta articular fractures of distal end radius using a bridging external fixator on 25 patients. The principle of ligamentotaxis was used for alignment of fracture fragments and wrist spanning external fixator was used to maintain the fracture reduction.Methods:25 patients of either sex with age group 16 to 80 years were taken from the orthopedic department. After proper primary care, cases were classified using Fernandez classification, and posted for surgery as soon as investigations and fitness were taken.Results:Patients involved in the study were in range of 16 to 78 years with 16 patients having dominant side with road traffic accident as leading cause.Radiological union was seen at an average of 7.3 weeks, 4 patients had superficial pin tract infection, 3 patients had stiffnes and a single case had malunion. Conclusions:Modified clinical scoring system of Green and O払rien was used to evaluate the overall functional results which showed excellent to good results in 84% of cases. Hence, properly planned and executed bridging external fixator is an easy, cost-effective and reliable treatment modality through the 揚rinciple of Ligamentotaxis�.

Product Optimization, Storage Quality and Sensory Acceptance of Low Calorie Beverage Developed from Bitter Gourd and Kiwifruit

Abstract Bitter gourd (Momordica charantia L.) fruit is good source of many nutraceutical compounds and possess antioxidant, anti-diabetic and hypoglycaemic activities. However, its utilization in the preparation of beverages is limited due to its bitter after taste. Therefore, to realize the functional and therapeutic benefits of bitter gourd, an attempt was made to optimize nutritious and low caloriebitter gourd based beverage by blending with kiwifruit (Actinidia deliciosa), a store house of bioactive compounds and substituting sugar with stevioside (steviol glycoside). The standard (sugar sweetened) bitter gourd (BG)-kiwifruit (K) blended beverage was developed by utilizing 30% fruit part of BG:K blended juice (80: 20) with 40oB TSS and 1.3% acidity. Further, to develop the low calorie beverage, sucrose (table sugar) was replaced with 25, 50, 75 and 100% equi-sweetness level of stevioside (steviol glycoside). Results revealed that 75% substitution of sucrose with stevioside resulted in shelf stable beverage with identical taste, good antioxidant potential (68.80%) and strong antimicrobial activity (26 mm ZOI) with reduced calorie values (28.5 Kcal/100g) compared to the sugar sweetened control sample (150.60 Kcal/100g). Hence, the developed beverage can be commercialized as low calorie beverage with additional health benefits of natural compounds of bitter gourd and kiwifruit with highest bioactivity.

Biochemical basis of resistance in laboratory selected fenazaquin resistant strain of Two-spotted spider mite, Tetranychus urticae Koch

The Two-spotted spider mite, Tetranychus urticae Koch is a serious pest in many cropping systems worldwide including fruits, vegetables and ornamental plants in both closed and open area. T. urticae has developed resistance against different groups of acaricides and no biochemical studies have been conducted to assess the basis/mechanisms of acaricide resistance in T. urticae populations of North India. Therefore, mechanism of acaricide resistance in T. urticae through enzyme assays was investigated. Field population of T. urticae showing resistance to fenazaquin (24.65 fold) was selected with fenazaquin successively for 15 generations to develop fenazaquin resistant strain leading to 6.83 fold increase in the resistance level. There was significant increase in specific activity of the MFO enzymes in resistant strain (534.65 nmol of p-nitrophenol formed min-1 mg-1 of protein) as compared to susceptible strain (166.35 nmol of p-nitrophenol formed min-1 mg-1 of protein). There was 3.21 fold higher MFO activity in resistant strain. Similarly, there was significant increase in GST activity by 1.40 fold and esterase activity by 1.13 and 1.27 fold with α-naphthyl acetate and β-naphthyl acetate as substrate in resistant population. The biochemical experiments conducted in the present study suggested that enhanced metabolic detoxification might be the major mechanism responsible for imparting resistance to fenazaquin in T. Urticae.

A cross sectional study regarding awareness of HIV/AIDS and practices of condoms among slum dwellers of Ajmer, Rajasthan, India

Background: People living in slums are often deprived of health-care facilities and it make them vulnerable to infection like HIV/AIDS. Health education and behavioural changes is pivotal for prevention of  HIV and HIV-related stigma.  Methods: It was community based cross sectional study carried among 288 slum dwellers of Ajmer, Rajasthan, India.Results: Out of 288 study subjects (male and females in the group of 15-54 years) 144 (50%) males and 144 (50%) females. Out of 288 study subjects 278 (96.53%) were heard about HIV/AIDS. Out of 249 study subject who were aware about condom, 107 (42.97%) study subjects [74 (56.06%) male and 33 (28.21%) female] were presently using of condom. out of 278 study subject who had ever heard about HIV/AIDS majority 215 (77.34%) subjects got the information regarding HIV/AIDS through TV/cinemaConclusions: Present study shows that the study subjects of slums at Ajmer has inadequate awareness regarding the HIV/AIDS and poor practice of condoms.

Prevalence, Risk Factors and Impact of Subclinical Endometritis on Reproductive Performance of Nili-Ravi Buffalo

Subclinical endometritis (SCE) is the inflammation of endometrium without systemic illness, hence remains mostly undiagnosed and untreated. The early diagnosis necessitates the evaluation of important risk factors. The objective of this study was to identify the risk factors of SCE and their effects on reproductive performance of Nili-Ravi buffalo. 100 buffaloes approaching parturition were selected. During calving, various risk factors viz., type of calving, peri-parturient disorders, sex and birth weight of calf, gestation period and season of calving were recorded. Buffaloes were subjected to endometrial cytology using cytobrush method on 45 day postpartum (DPP) and divided into 2 groups viz., buffaloes ‘with SCE’ (>5% PMN; n=38) and ‘without SCE’ (≤5% PMN; n=62). Buffaloes in estrus were artificially inseminated and fertility parameters were recorded. The occurrence of SCE was significantly affected by calving assistance (OR=11.74; P<0.001), peri-parturient disorders (OR=6.87; P<0.05) and gestation period (OR=1.16; P<0.05). Sex, birth weight of calf and season of calving were not associated with SCE. The service period of buffaloes did not vary between two groups. The median days open was significantly (P<0.05) higher in buffaloes with as compared to buffaloes without SCE (141 vs. 117 d). Buffaloes with SCE had significantly (P<0.05) lower first service conception (21.1 vs. 43.5%) and took more (P<0.05) mean number of services per conception (2.71 vs. 1.62) compared to buffaloes without the SCE. It may be concluded that risk factors around the time of calving control the onset of SCE which in turn has negative impact on reproductive performance of Nili-Ravi buffaloes

Acute effects of diets rich in almonds and walnuts on endothelial function

Objective Omega-3 fatty acids, especially alpha-linolenic acid (ALA), which are present in nuts may reduce cardiovascular disease (CVD) risk, by changing vascular inflammation and improving endothelial dysfunction. The objective of the study was to evaluate the acute effects of two different diets, one containing walnuts and the other almonds on endothelial function. Methods Twenty-seven overweight volunteers underwent a randomized 2-period, crossover, controlled intervention study. The subjects were given either walnut or almond diets which varied in monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA) content. The walnut diet provided 23.1% energy from PUFA and the almond diet provided 7.6% energy from PUFA. Endothelial function was assessed physiologically by flow-mediated dilation (FMD) and biochemically by sVCAM (soluble vascular cell adhesion molecules). Results The walnut diet significantly improved FMD (p = 0.004) and decreased sVCAM (p = 0.009) whereas the almond diet tended to improve FMD (p = 0.06) and significantly decreased sVCAM (p = 0.004). Conclusion Both walnut and almond diets improved FMD and sVCAM and there was no significant difference in physiological and biochemical markers between the two diets.

Clinicopathological profile of lung cancer at a tertiary care center

BACKGROUND: Lung cancer is one of the most common malignancies with high morbidity and mortality. Nonsmall cell lung cancer (NSCLC) accounts for majority of cases. AIMS: This study aims to study the clinical and pathological features of lung cancer patients treated at our institute between January 2011 and December 2016. SUBJECTS AND METHODS: It is a retrospective study. 446 patients of lung cancer were retrospectively analyzed for demographic data, history of smoking, histological type, and presence of epidermal growth factor receptor (EGFR) mutation/anaplastic lymphoma kinase (ALK) mutations. RESULTS: Of the 446 patients analyzed, 304 (68%) were males and 142 (32%) were females, with the ratio being 2:1. Most of our patients had a lesion localizing to the right side (45.7%) than left (37.8%). NSCLC was reported in 81.1% of our patients. EGFR mutation was found in 60 (24%) patients, the most common mutation being the deletion of exon 19 (73%) followed by L858R mutation (21.6%). CONCLUSIONS: EGFR and ALK mutation testing of all the lung cancer patients is to be encouraged as these mutations form druggable targets.

Port Site Chronic Sinuses – A Wisdom of 5 Years and 50 Cases.

Background: Laparoscopic surgery has now become an accepted method of minimal invasion of human anatomy but the dreaded problem of port site complications especially the chronic sinuses has rejuvenated the proponents of open techniques. The scope of laparoscopy widened from diagnostic purposes to resecting large tumors in almost all the systems of the body. As the time progressed, the problems associated with use of long instruments and dexterity of movements started creeping in. The vision, which was analogue, to start with, became 3D digital and with the introduction of robotic arm, the problem of dexterity was addressed to some extent. One thing that persisted right through so much of technical development was the problem of infection and sinuses and the enormity of this issue can be gauged by its evergrowing number. Methods: Although minimal invasive surgery is here to stay for all intent and purposes, we have decided to study 50 cases of chronic port site sinuses treated and followed up for 5 years in various wards of department of surgery in Guru Nanak Dev Hospital, Amritsar. In this study the authors present their experience and rationale regarding various factors like age and sex distribution, site of infection, results of microscopy and culture/sensitivity, treatment given (both surgical and non surgical), response time and prognosis. Results: In the cases where there was discharge culture of the pus yielded skin and soft tissue infections like staphylococcus, streptococcus, pseudomonas, E. coli and klebsiella. Out of 50, 20 cases were treated by appropriate antibiotics after culture sensitivity and quinolones.Conclusion: From the above discussion and flow chart, it can be safely concluded that atypical mycobacteria and some of the anaerobes remain the main offending agents.

Anthropometric Profile in Relation to Playing Position of Elite Indian Soccer Players.

Background: Previous literature has demonstrated that each specialized playing position may have unique physical and physiological requirements. Body fat is highly related to playing position of football players. Purpose: The purpose of the study was to examine differences among positions in body size and percent body fat of elite football players prior to the start of regular season. Subjects: The subjects of this study were 34 (10 forwards, 10 midfielders, 10 defenders, 4 goalkeepers) normal, healthy elite football players without any orthopedic, respiratory or cardiovascular problems. Methods: Anthropometric profiles of the subjects were determined by measuring height, weight, body mass index (BMI) and percent body fat. The prediction formula used to calculate percent body fat using BMI was: body fat % = (1.20 × BMI) + (0.23 × age) - (10.8 × gender) - 5.4 (R2 0.79, standard error estimate = 4.1% BF%), taking age and gender (male = 1, female = 0) into account. Results: The results demonstrated significant differences (p < 0.005) in the percent body fat among the players of different playing positions. Goalkeepers possessed highest values for body fat percentage followed by defenders and forwards while midfielders had the least body fat percentage. Conclusion: The study suggests that anthropometric characteristics differ in players of different playing positions. The differences found despite similar training protocol might be due to the physiological adaptations in the players.

Nanostructure-based platforms-current prospective in ophthalmic drug delivery.

The topically applied drugs as drops are washed off from the eye in very short period, resulting in low ocular bioavailability of drugs. Number of approaches have been attempted to increase the bioavailability and the duration of action of ocular drugs. This review provides an insight into various novel approaches; hydrophilic nanogels, solid lipid nanoparticles, and nanosponges applied very recently in the delivery of insoluble drugs, prolonging the ocular residence time, minimize pre‑corneal drug loss and, therefore, bioavailability and therapeutic efficacy of the drugs. Despite various scientific approaches, efficient ocular drug delivery remains a challenge for pharmaceutical scientists.

Port Site Infection in Laparoscopic Surgeries.

Background/Aims: As the surgeries undertaken by laparoscope are increasing, complications are also increasing. In light of the explosive increase in laparoscopic surgery, there is concern about the effectiveness of sterilizing reusable laparoscopic instruments which might be a potential source of infection if not properly sterilized. Our study explains port site infection, its diagnosis and management with review of literature. Setting and Design: This study was carried out in a tertiary care setting and was an outcome study. Material and Methods: All five patients in the study were operated (April 2008-2010) elsewhere and came to us for management of non healing sinuses. Result: Amongst operated cases of laparoscopic cholecystectomy one healed by irrigation with superoxide, two cases healed with sinus exploration and wound debridement while one case required extensive wound debridement requiring temporary mesh repair of the abdominal wall with removal of the mesh (due to persistence of sinus) six months later following complete healing, no residual hernia. One operated case of laparoscopic incisional hernia repair with laparoscopic Cholecystectomy healed after removal of mesh with sinus exploration. Conclusion: The present study is an attempt to make surgeons aware about the complications which occur due to improper sterilisation of laparoscopic instruments ending into increased morbidity of patients.

Molecular typing of mealybug Phenacoccus solenopsis populations from different hosts and locations in Punjab, India.

True identity and existence of genetic variability in mealy bug from different regions holds immense significance for adopting appropriate control measures along with predicting the development of any biotypes. Mealy bug, Phenacoccus solenopsis adults were collected from four host plants i.e., Gossypium hirsutum – cotton (C), Abelmoschus esculentus – okra (O), Pennisetum glaucum – Napier Bajra (B) and a weed – Parthenium hysterophorus (P) in five cotton growing districts i.e., Abohar, Bathinda, Mansa, Muktsar and Faridkot of Punjab state. Variability among different populations was investigated through comparative analysis of four different RAPD markers. The genetic similarity dendrogram established that irrespective of the host plant and the collection site, 20 mealybug populations were distinguishable into two major clades that were related to each other by 68 %. Clade 1 included populations from Abohar district; it also included a single population each from Muktsar and Bathinda districts. The populations from all the other districts were grouped under Clade 2 with genetic similarity of 78 % Even under Clade 2, individual populations appeared to exist in location specific sub-clades. Thus, there is great possibility of development of biotypes which may differ in resistance to insecticides and host plant specificity.

Influenza a (H1N1) outbreak and challenges for pharmacotherapy.

Influenza A (H1N1) virus, a genetic reassortment of endemic strain of human, avian flu and swine flu, with an inherent ability to mutate continuously has developed a subtype which is causing present flu in humans. As on 10th May, 2009, twenty nine countries are affected with officially reported 4379 cases with Mexico – 1626 affected (45 deaths), US 2254 affected (02 deaths); Canada 280 (01 deaths) and Costa Ricia -8 cases (01 death) respectively. Rest of 15 countries have reported less than 100 officially confirmed cases of H1N1 infection. WHO has already declared Pandemic Alert V on 29th April, 2009. If the present flu achieves equivalent virulence to that of 1918-19 pandemic flu, expected deaths will be 62 million people. Travel advisory, stockpiling of antiviral drugs – Tamiflu & Relenza; vaccine development, activation of business continuity planning for maintenance of essential serives etc., are some of the important mitigation approaches, being followed all over the world. WHO has a regional reserve of 10,000 million doses of anti-viral drugs. National Disaster Management Authority (NDMA), Government of India, an apex body for disaster management, in active coordination with Ministry of Health & other stakeholders/service providers is maintaining a constant state of vigil on the present Influenza A (H1N1) outbreak. In collaboration with UNDMT, NDMA has outlined a strategy for Pandemic Preparedness beyond Health in April, 2008. Various non-pharmaceutical interventions like detection, isolation and quarantine are required to contain the situation. Accordingly, stockpiling of 10 million doses of anti viral drugs, surveillance at airports, isolation with strict enforcement of quarantine procedures, sustained supply of respiratory masks & other personal protective equipment; deployment of rapid response teams are some of the activities being undertaken by Indian Government proactively. As situation goes to Phase VI, there will be a shift in strategy from active surveillance, detection and quarantine to containment, treatment, prevention of spread of disease and maintenance of business continuity beyond health sectors. The major concern is to utilise this latency period, between phase V and VI, to fill the gaps in state of preparedness. It is also essential to focus on development/procurement of appropriate vaccine to manage the situation arising from any further mutation of the existing causative virus to be resistant against existing anti viral therapies. It is a continued effort which can save many lives around the world and everyone has to play its assigned role effectively.

Oxidative stress & male infertility.

The male factor is considered a major contributory factor to infertility. Apart from the conventional causes for male infertility such as varicocoele, cryptorchidism, infections, obstructive lesions, cystic fibrosis, trauma, and tumours, a new and important cause has been identified: oxidative stress. Oxidative stress is a result of the imbalance between reactive oxygen species (ROS) and antioxidants in the body. It is a powerful mechanism that can lead to sperm damage, deformity and eventually, male infertility. This review discusses the physiological need for ROS and their role in normal sperm function. It also highlights the mechanism of production and the pathophysiology of ROS in relation to the male reproductive system and enumerate the benefits of incorporating antioxidants in clinical and experimental settings.

Berardinelli-Seip syndrome in a 6-year-old boy.

A 6-year-old boy presented with abnormal habitus since birth, delayed language development, history of frequent falls since 9 months, and fever since 1 week. He was found to have hyperandrogenic features, generalized paucity of fat, generalized muscular overdevelopment, and brownish pigmentation over the flexural creases. Skin biopsy demonstrated features suggestive of acanthosis nigricans with an absence of subcutaneous tissue. After further investigation, a diagnosis of Berardinelli-Seip syndrome with bilateral pneumonia and generalized tonic clonic seizures was made. Clinical features, histopathology, differential diagnosis, and prognosis of this rare disorder have been discussed.

Magnetic activated cell sorting (MACS): utility in assisted reproduction.

Assisted reproductive techniques (ART) have now been extensively incorporated in the management of infertile couples. But even after rapid methodological and technological advances the success rates of these procedures have been below expectations. This has led to development of many sperm preparation protocols to obtain an ideal semen sample for artificial reproduction. Sperm apoptosis has been heavily linked to failures in reproductive techniques. One of the earliest changes shown by apoptotic spermatozoa is externalization of phosphatidyl serine. Magnetic activated cell sorting (MACS) is a novel sperm preparation technique that separates apoptotic and non-apoptotic spermatozoa based on the expression of phosphatidylserine. This has led to the incorporation of MACS as a sperm preparation technique. The review highlights the principle and mechanism of this novel technique and enumerates its advantages as a sperm preparation technique. Its utility in ART as an efficient tool for sperm recovery and its application in cryopreservation of semen samples is also explained.

Evaluation of acrosomal status and sperm viability in fresh and cryopreserved specimens by the use of fluorescent peanut agglutinin lectin in conjunction with hypo-osmotic swelling test

OBJECTIVE: In this study, we evaluated whether the hypo-osmotic swelling test (HOST) can be used as a vital marker in combination with peanut agglutinin (PNA) - labeling in fresh and cryopreserved spermatozoa. MATERIALS AND METHODS: Human sperm populations were exposed to a hypo-osmotic medium for 60 minutes, and then incubated in a 1 µg/mL solution of the fluorescent dye Hoescht 33258 (H33258) for 10 minutes. Excess stain was removed by washing in phosphate-buffered saline (PBS) solution, and the pellet was resuspended in 100 µL of culture medium. Twenty microliters of this solution were subsequently smeared on a microscope slide, and fixed in ice-cold methanol to permeabilize the sperm membranes. The fixed smears were finally incubated in a 40-µg/mL FITC-PNA solution for 20 minutes. Simultaneous assessment of acrosome and viability scores was done in a fluorescent microscope equipped with appropriate filters and phase contrast illumination. The same slide was examined for FITC-PNA labeling, tail swelling, and for Hoechst-33258 staining by interchanging the filters and phase contrast optics. RESULTS: In fresh specimens, HOST was found to provide viability assessments comparable to those obtained using the H33258 method (r = 0.95). However, the results of HOST and H33258 were not correlated in cryopreserved specimens (r = 0.22). There was no alteration of PNA-labeling due to the HOST or H33258. CONCLUSIONS: FITC-PNA labeling in conjunction with the visualization of the morphological change induced by exposure to hypo-osmotic solution provides a simple but effective method for establishing the state of acrosomal membrane and viability in fresh human spermatozoa, but this technique is not reliable for cryopreserved ones.

Pseudologia Fantastica.

Pseudologia Fantastica is a disorder wherein the person tells lies incessantly. It is usually encountered in forensic practice in those accused of fraud, swindling, making false accusations or false confessions. Their lies are mostly aimed at attracting notice and inflating their importance, in contrast to carefully planned typical frauds. A case presenting with features of Pseudologia Fantastica is described. Although this patient had no legal problems because of his lying habits, he had most of the features of Pseudologia Fantastica. He has shown good response with combined pharmacotherapy and behaviour therapy. As these patients are at high risk of committing various types of frauds, it is very important to diagnose such patients at an early stage so that legal implications of this disorder can be avoided.

Identification of male factor infertility using a novel semen quality score and reactive oxygen species levels

OBJETIVO: Determinar se pacientes portadores do fator de infertilidade masculina podem ser precisamente identificados através do cálculo de um novo escore de qualidade de sêmen e pela medida de espécies reativas de oxigênio durante uma avaliação rotineira de infertilidade. MÉTODOS: Amostras de sêmen de 133 pacientes e de 91 doadores saudáveis foram avaliadas através de análise manual e computadorizada de sêmen. Um modelo de análise do componente principal foi empregado para calcular o escore de qualidade de sêmen, utilizando logaritmos base 10, multiplicados por ponderações variáveis de 9 parâmetros espermáticos. Os níveis de espécies reativas de oxigênio foram medidos através de testes de quimiluminescência. RESULTADOS: O escore de qualidade de sêmen apresentou sensibilidade de 80.45% e precisão de 77% para um "cutoff" de 93.1 na identificação do fator de infertilidade masculina. A área sob a curva "receiver operating characteristic" para o escore de qualidade de sêmen foi de 84.28% (95% intervalo de confiança: 65.22%-100%). Os níveis de espécies reativas de oxigênio [log10 (espécies reativas de oxigênio +1)] foram siginificativamente mais elevados nos pacientes portadores de fator de infertilidade masculina. A medica de espécies reativas de oxigênio apresentou sensibilidade de 83.47% e especificidade de 60.52% com uma precisão (definida como pacientes portadores do fator de infertilidade masculina com diagnóstico positivo e doadores corretamente excluídos) de 75% para um "cutoff" de 1.25 na identificação de pacientes portadores do fator de infertilidade masculina. A área sob a curva "receiver operating characteristic" para níveis de espécies reativas de oxigênio foi de 78.92% (95% intervalo de confiança: 72.60%-85.23%). Os escores de qualidade de sêmen correlacionaram negativamente com os níveis de espécies reativas de oxigênio tanto nos doadores e nos pacientes portadores do fator de infertilidade masculina. CONCLUSÕES: O escore de qualidade de sêmen e os níveis espécies reativas de oxigênio nas amostras de sêmen parecem associar-se fortemente com o fator de infertilidade masculina. Na medida em que os dois parâmetros mostraram-se mais sensíveis que parâmetros espermáticos individuais na identificação do fator de infertilidade masculina, deveriam ser incluídos na avaliação rotineira de infertilidade.