Exploring the reported adverse effects of COVID-19 vaccines among vaccinated Arab populations: a multi-national survey study.

The coronavirus disease 2019 (COVID-19) pandemic has been a major challenge worldwide for the past years with high morbidity and mortality rates. While vaccination was the cornerstone to control the pandemic and disease spread, concerns regarding safety and adverse events (AEs) have been raised lately. A cross-sectional study was conducted between January 1st and January 22nd, 2022, in six Arabic countries namely Saudi Arabia, Egypt, Syria, Libya, Iraq, and Algeria. We utilized a self-administered questionnaire validated in Arabic which encompassed two main parts. The first was regarding sociodemographic data while the second was about COVID-19 vaccination history, types, doses, and experienced AEs. A multistage sampling was employed in each country, involving the random selection of three governorates from each country, followed by the selection of one urban area and one rural area from each governorate. We included the responses of 1564 participants. The most common AEs after the first and second doses were local AEs (67.9% and 46.6%, respectively) followed by bone pain and myalgia (37.6% and 31.8%, respectively). After the third dose, the most common AEs were local AEs (45.7%) and fever (32.4%). Johnson and Johnson, Sputnik Light, and Moderna vaccines showed the highest frequency of AEs. Factors associated with AEs after the first dose included an increase in age (aOR of 61-75 years compared to the 12-18 years group: 2.60, 95% CI: 1.59-4.25, p = 0.001) and male gender (OR: 0.72, 95% CI: 0.63-0.82, p < 0.001). The cumulative post-vaccination COVID-19 disease was reported with Sinovac (16.1%), Sinopharm (15.8%), and Johnson and Johnson (14.9) vaccines. History of pre-vaccination SARS-CoV-2 infection significantly increases the risk of post-vaccination COVID-19 after the first, second, and booster doses (OR: 3.09, CI: 1.9-5.07, p < 0.0001; OR: 2.56, CI: 1.89-3.47, p < 0.0001; and OR: 2.94, CI: 1.6-5.39, p = 0.0005 respectively). In conclusion, AEs were common among our participants, especially local AEs. Further extensive studies are needed to generate more generalizable data regarding the safety of different vaccines.

Adaptive leader-follower control for nonlinear uncertain multi-agent systems with an uncertain leader and unknown tracking paths.

With unknown leader parameters and false or immeasurable tracking paths, the leader-follower tracking problem via adaptive control becomes more complex and challenging. Different from the existing work in the literature and in line with real-world applications, this challenging issue is solved in this paper for multi-agent networks with different kinds of unknown uncertainties in the followers such as partially known parameters, nonlinearities, external disturbances, communication weights, and sensor faults. The solution of this challenging issue is obtained in three steps. Firstly, the tracking path is estimated by designing distributed adaptive observers at all agents that have direct communication edges with the leader. Next, by designing local adaptive observers for all followers, the estimates of all followers' states can be obtained. Then, distributed adaptive controllers for all followers are designed using the estimated states of both followers and their neighbors in addition to the estimated tracking path. The tracking performances are provided via sufficient conditions for both the adaptive observers and the adaptive controllers. The proposed methods are evaluated through two examples that are commonly used in the literature. The obtained results prove the efficacy of the recommended adaptive approaches.

Secure control design for nonlinear cyber-physical systems under DoS, replay, and deception cyber-attacks with multiple transmission channels.

This paper introduces the state-/output-feedback control for multi-channel nonlinear cyber-physical systems (CPSs). Many cyber-attacks are considered such as Denial-of-Service (DoS), replay and deception attacks. The deception cyber-attacks can be treated as measurement additive and multiplicative uncertainties. Both time-varying state-dependent and state-independent sensor additive attacks are considered. As DoS attack makes the CPS states unavailable, the standard modeling​ and control methods cannot be applied directly. Alternatively, as attackers in the replay attack re-transmit previous data and prevent the transmission of the more recent data, a delayed model is generated. To deal with these problems, a new observer at the controller side is proposed. It is used to perform two main tasks. The first is to estimate all system states at every time instant. The second is to exclude some unsecured transmitting channels from affecting the system response. Therefore, all attacks in these channels will have no effect on the system response. Using the estimated states, an anti-cyber-attacks state-feedback controller is investigated. Meanwhile, it is verified that the suggested approach certifies the convergence of all the CPSs states under different cyber-attacks. The effectiveness of the proposed secure control approach against different kinds of cyber-attacks is confirmed through two examples with simulation results.

Role of neutrophil to lymphocyte ratio as a prognostic indicator for COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a new pandemic disease, associated with substantial morbidity and mortality. Its diagnosis requires centralized facilities and time. AIMS: To describe the exposure history and clinical picture of the COVID-19 patients, to study the SARS-CoV-2 Virus load and some determinants that may correlate with its prognosis, and to evaluate the role of inflammatory index NLR as an early predictor of COVID-19 prognosis. METHODOLOGY: A prospective follow-up study included laboratory-confirmed 179 COVID-19 cases out of 660 suspected COVID-19 cases, at El-Madinah El-Monawarah General Hospital in April 2020. Confirmed cases were managed by the Saudi Protocol and followed up every 2 weeks by PCR, neutrophil to lymphocyte ratio (NLR) for 1 month. Data were collected through a validated questionnaire and by qualified infection control staff. RESULTS: The majority of the COVID-19 cases were 67 (37.4%) aged 30 to <45 years, 157 (87.7%) males, 76.0% working outside the medical field. 38.0% were asymptomatic and 26.3% had severe symptoms, while the main presenting symptoms were fever and dry cough (49.7% and 43.6%), respectively. The case fatality was 7.8%. The male, nonmedical occupation, and low level of education had a statistically significant relationship with the baseline PCR. There was an inverse significant correlation between baseline PCR readings and the recovery duration and health status outcomes. NLR was noted to be significantly higher among old age, illiterate nonmedical occupation, case with severe symptoms, MICU admission, and worst health status outcomes, but it was paradoxically higher among nonadmitted positive cases. CONCLUSION: Admitted COVID-19 cases outcomes (disease severity, ICU admission, and mortality) significantly correlated to NLR and not to the baseline PCR viral load. NLR could be a beneficial prognostic and triaging parameter especially old nonmedical COVID-19 patients.

Intra-alveolar neutrophil-derived microvesicles are associated with disease severity in COPD.

Despite advances in the pathophysiology of chronic obstructive pulmonary disease (COPD), there is a distinct lack of biochemical markers to aid clinical management. Microvesicles (MVs) have been implicated in the pathophysiology of inflammatory diseases including COPD, but their association to COPD disease severity remains unknown. We analyzed different MV populations in plasma and bronchoalveolar lavage fluid (BALF) taken from 62 patients with mild to very severe COPD (51% male; mean age: 65.9 yr). These patients underwent comprehensive clinical evaluation (symptom scores, lung function, and exercise testing), and the capacity of MVs to be clinical markers of disease severity was assessed. We successfully identified various MV subtype populations within BALF [leukocyte, polymorphonuclear leukocyte (PMN; i.e., neutrophil), monocyte, epithelial, and platelet MVs] and plasma (leukocyte, PMN, monocyte, and endothelial MVs) and compared each MV population to disease severity. BALF neutrophil MVs were the only population to significantly correlate with the clinical evaluation scores including forced expiratory volume in 1 s, modified Medical Research Council dyspnea score, 6-min walk test, hyperinflation, and gas transfer. BALF neutrophil MVs, but not neutrophil cell numbers, also strongly correlated with BODE index. We have undertaken, for the first time, a comprehensive evaluation of MV profiles within BALF/plasma of COPD patients. We demonstrate that BALF levels of neutrophil-derived MVs are unique in correlating with a number of key functional and clinically relevant disease severity indexes. Our results show the potential of BALF neutrophil MVs for a COPD biomarker that tightly links a key pathophysiological mechanism of COPD (intra-alveolar neutrophil activation) with clinical severity/outcome.

Cooperative control for cyber-physical multi-agent networked control systems with unknown false data-injection and replay cyber-attacks.

The paper discusses the cooperative tracking problem of partially known cyber-physical multi-agent networked systems. In this system, there exist two cascaded chances for cyber-attacks. The local agent is of networked system type that is subjected to unknown false data-injection and replay cyber-attacks that are dissimilar in the sensor-controller and the controller-actuator network parts. The communication between any two agents, if they are connected, is accomplished via a communication network that is subjected to false data-injection cyber-attacks. The problem of the existing two cascaded chances for cyber-attacks is solved in three steps. First, with partially known system parameters and unknown false data-injection and replay cyber-attacks, the state estimates of all the local followers are evaluated by designing local adaptive observers. Second, a new technique is designed to compensate for the unmatched terms that result from the use of local adaptive observers. After that, distributed adaptive leader-follower security controllers are proposed based on the local estimated information in addition to the infected arrived information from the neighbors. Meanwhile, it is verified that the suggested security control method guarantees that all states of the followers under the considered cyber-attacks follow the given leader asymptotically. The efficacy of the developed adaptive leader-follower security controllers is verified via an illustrative example.

A new unmatched-disturbances compensation and fault-tolerant control for partially known nonlinear singular systems.

This study investigates the challenge of designing a fault-tolerant control (FTC) for partially known nonlinear singular systems subjected to unmatched uncertainties in addition to actuator and sensor faults. The suggested technique is dependent on the neural network-based adaptive observer. The unknown system nonlinearities are approximated by making use of an adaptive neural network (NN) approximation technique. The parameters of the NN are unknown. A new methodology is proposed to transform the partially known singular system to a non-singular form with unknown uncertainties. Different from all previous work dealing with singular systems with partially known system parameters, an adaptive observer is proposed with the help of adaptive laws to obtain an estimation of the augmented states of the constructed descriptor system. Based on the estimated states, a new approach for dealing with unmatched disturbances and faults are proposed. Finally, an adaptive controller is designed to account for unmatched disturbances and faults. The asymptotic stability of the overall system is guaranteed via Lyapunov-stability functional. The designed method is applied efficiently to a satellite control system as a practical example in addition to another numerical example.

Biochemical and histological study on the effect of levetiracetam on the liver and kidney of pregnant albino rats.

BACKGROUND: Levetiracetam is a broad-spectrum antiseizure agent and one of the most commonly prescribed drugs for epilepsy. The aim of this work was to assess the effect of levetiracetam at its therapeutic range on the liver and kidney of pregnant albino rats. MATERIALS AND METHODS: Forty pregnant rats were divided equally into two groups (I-II), Rats in the group I were gavaged 1.5 mL/day distilled water in two divided doses throughout pregnancy. Rats in the group II were gavaged 1.5 mL/day distilled water (containing 36 mg levetiracetam) in two divided doses throughout pregnancy. At the end of the experiment, blood samples were taken and the sera were separated and used for biochemical analysis. The kidneys and livers of both groups were excised and used for light and electron microscopic examination. RESULTS: Treatment with levetiracetam induced undesirable histopathological changes in the liver and kidney of pregnant albino rats. These changes were in the form of distortion of the hepatic architecture, dilatation of the central and the portal veins, widening of the Bowman's spaces, thickening and disruption of the glomerular basement membrane, fusion and effacement of secondary foot processes, cytoplasmic vacuolation, and swollen mitochondria with loss of their cristae. Such changes were confirmed by alteration of certain biochemical parameters related to the liver and kidney functions. CONCLUSIONS: Levetiracetam induced deleterious effects on the liver and kidney of pregnant albino rats. Further investigations are recommended to clarify the mechanism of levetiracetam toxicity.

Effect of glycemic gap on short term outcome in critically ill patient: In zagazig university hospitals.

Both admission Blood glucose and previous glycemic state may affect critically ill patients; So Glycemic gap may be a good indicator of ICU outcomes. This study investigated the effect of glycemic gap on short term outcome in critically ill patient and the value of incorporation of the Glycemic Gap into the APACHE-II on its discriminative performance. SUBJECTS AND METHODS: This cross sectional study was conducted in medical ICU of Zagazig University Hospitals, March 2018 to September 2018; total numbers of 240 critically ill patients admitted to ICU were enrolled in. All of them were subjected to: full history taking, clinical examination, routine investigations, random blood sugar, hemoglobin A1c. ADAG, Glycemic Gap and APACHE II were calculated. RESULTS: Elevated glycemic gap was associated with an increased ICU mortality and APACHE-II score was a good predictor of ICU mortality in critically ill patients. CONCLUSIONS: Elevated glycemic gap was significantly associated with an increased ICU mortality that the glycemic gap can be used to assess the severity and prognosis of critically ill patients and their incorporation into the APACHE II score has increased its performance as a predictor of mortality.

Quantitative Evaluation of Lobar Pulmonary Function of Emphysema Patients with Endobronchial Coils.

BACKGROUND: Recent advances in bronchoscopic lung volume reduction offer new therapies for patients with emphysema and hyperinflation. Pulmonary lobe segmentation with quantification of lobar volumes and emphysema severity plays a pivotal role in treatment planning and post-interventional assessment. Computed tomography (CT)-derived lobar volumes could reflect more accurate regional changes in pulmonary function. OBJECTIVES: The aim of our study is to validate the reliability of an in-house CT Lung Segmentation software (LungSeg; the Hamlyn Centre, Imperial College London, UK) for lung lobar volume and emphysema quantification for chronic obstructive pulmonary disease (COPD) patients. METHODS: A total of 108 CT scans from subjects who participated in an endobronchial coil treatment trial were included. Lobar volume and emphysema quantification were performed using the LungSeg and Syngo CT Pulmo 3D package (Siemens Healthcare GmbH, Germany). The inter-user reliability of the LungSeg program was investigated. Correlation coefficients and Bland-Altman analyses were used to quantify the inter-software variability. The agreement between CT volume analysis and plethysmography analysis was also examined. RESULTS: The high intraclass correlation coefficients (mean ICC = 0.98) of the lobar volumes and emphysema indices measured by LungSeg suggest its excellent reproducibility. The LungSeg and Syngo program have good correlation (rho ≥0.94) and agreement for both lobar volume (median difference = 94 mL and LOAnp = 214.6 mL) and emphysema index (median difference ≤1.5% and LOAnp ≤2.03%) calculations. CT analysis provides a higher estimation of total lung capacity (TLCCT) than body plethysmography (TLCpleth), while there is a fair agreement on residual volume (RVCT) by LungSeg as compared with body plethysmography (RVpleth). CONCLUSIONS: CT-derived lobar volume and emphysema quantification using the LungSeg program is efficient and reliable in allowing lobar volume assessment. LungSeg has low inter-user variability and agrees better with plethysmography for COPD assessment in our study.

Proinsulin/insulin ratio as a predictor of insulin resistance in patients with diabetic nephropathy.

Patients with Diabetic nephropathy (DN) have an increase in cardiovascular mortality, and since IR may be a contributing factor. Therefore, the aim of this study was to assess the role of pro insulin/insulin ratio as a predictor of insulin resistance in patients with diabetic nephropathy PATIENTS AND METHODS: A Case-control study was conducted in a total of 50 patients who diagnosed with type 2 diabetes mellitus from July 2017 to March 2018. The patients were divided into 2 groups according to presence of diabetic nephropathy. Demographic and clinical data were collected. RESULTS: There is a significant increase in serum pro insulin/insulin ratio in patients with diabetic nephropathy patients compared to patients without diabetic nephropathy An association was found between increase serum pro insulin/insulin ratio and increase predicting of insulin resistance. Cut-off value of serum pro insulin/insulin ratio ≥0.1145 with sensitivity and specificity of 92.3 and 60.3 respectively as a predictor for insulin resistance CONCLUSION: This study demonstrate a strong relationship between insulin resistance and CKD and this relationship was stronger in the presence of obesity. Pro insulin/insulin ratio was found to be a significant predictor for insulin resistance.

Proinsulin/insulin ratio as a predictor of insulin resistance and B-cell dysfunction in obese Egyptians ((insulin resistance & B-cell dysfunction in obese Egyptians)).

Insulin resistance (IR) and ß-cell dysfunction are key pathological features of type 2 diabetes mellitus, the aim of this study was to investigate the role of proinsulin level and proinsulin/insulin ratio in early prediction of beta cell dysfunction and insulin resistance in obese Egyptian adolescent. PATIENTS AND METHODS: This Case control study was conducted from June 2017 to March 2018. Total of 60 patients were divided into 2 groups after exclusion of patients with diabetes: normal body weight group and Obese group. Demographic, clinical data were collected. Laboratory investigation included fasting insulin, proinsulin, and estimation of HOMA IR and HOMA-B were done. RESULTS: There are highly statistically significant increase in obese group regarding insulin, proinsulin, proinsulin/insulin ratio and HOMA-IR while there is significant decrease in HOMA-B in this group. The best cutoff value of Proinsulin in prediction of beta cell function was ≥7.829 pmol/L with sensitivity 95.8, specificity 72.2. The best cutoff value of Proinsulin/insulin ratio in prediction of insulin resistance was ≥0.1545 with sensitivity 87.5, specificity 61.1. CONCLUSION: both beta cell dysfunction and insulin resistance increased in obese group and so increased risk of type 2 diabetes. We found that Pro insulin/insulin ratio is a significant predictor for insulin resistance and Proinsulin is good predictor for beta cell dysfunction.

Comprehensive evaluation of grafting the preservable narrow plates with consideration of native plate width at primary hypospadias surgery.

INTRODUCTION: Dorsal inlay graft urethroplasty using inner-face preputial graft was described as an adjunct method to the classic tubularized incised plate (TIP) urethroplasty, aiming at reducing the risk of neourethral stenosis. OBJECTIVES: To evaluate the impact of dorsal inlay grafting of preservable narrow plates, in relation to native plate width. METHODS: Consecutive children with penile hypospadias with narrow plate (width < 8 mm) were evaluated prospectively between Jan 2014 and Jun 2018. Included cases were stratified into two groups: group A (plate width: 4 to <8 mm) and group B (plate width: < 4 mm). All cases were approached by TIP urethroplasty, with dorsal inlay grafting (inner-face prepuce). Cases with significant chordee (non-preservable plates), circumcised cases, and redo cases were excluded. RESULTS: A total of 104 hypospadias cases with narrow plates were included in this study. Among group A (n = 81), the need for postrepair urethral dilations was reported in two cases (2.5%) vs seven cases (30%) in group B (n = 23) (P-value < 0.001). Another two cases (2.5%) in group A developed urethrocutaneous fistulae vs three cases (13%) in group B (P-value = 0.0624). Surgical repair of the reported five cases with fistulae, revealed an ample neourethral wall; disclosing well-taken grafts in both groups. DISCUSSION: Few published studies evaluated grafting the incised plate in penile hypospadias. To the authors knowledge, this is the first study that selectively evaluated the impact of grafting narrow plates in relation to its native pre-incision width. CONCLUSIONS: According to the presented authors' experience, 4 mm width is the border line of clinical relevance that defines poor urethral plate. Grafting that plate failed to compensate for its native poor characteristics; however, it offered a valuable neourethral wall that proved indispensable when redo surgery deemed necessary, without adding grafting-related problems. Nevertheless, further extended comparative studies came across as a necessity to verify the long-term outcomes of grafting the incised poor plates.

Expression of CD133 as a cancer stem cell marker in invasive gastric carcinoma.

INTRODUCTION: Gastric cancer is considered to be the fourth most common malignancy worldwide and the second cause of cancer deaths. Regarding the cancer stem cells (CSCs) theory, they are a small group of tumor cells with unrestricted self-renewal and differentiation abilities that help tumor formation. There is an interest in the utility of CD133 as a promising marker to detect the tumor stem cell population for a variety of solid malignancies including gastric cancer. Tumors that express stem cell markers such as CD133 are found to be more aggressive tumors with poor prognosis and high liability for recurrence. This study aimed to evaluate the immunohistochemical expression of CD133 in invasive gastric carcinoma and study the relation between CD133 immunohistochemical expression and different clinicopathological parameters. MATERIAL AND METHODS: 77 cases of gastric carcinoma were collected from the surgical pathology unit at the Gastroenterology Center, Mansoura University, Egypt. CD133 expression in tumor tissue was evaluated by immunohistochemistry. RESULTS: CD133 expression positively correlated with tumor metastasis and recurrence. Multivariate analysis revealed CD133 positivity to be an independent prognostic factor for tumor recurrence (P = 0.03). CONCLUSION: CD133 is a good marker that can predict tumor recurrence and metastasis in gastric carcinoma. Even though, studies regarding CSCs are still in their initial stages especially those related to CD133 in gastric cancer.

Genetic variants of XRCC1 and risk of hepatocellular carcinoma in chronic hepatitis C patients.

BACKGROUND: Hepatitis C virus (HCV) related liver cirrhosis occurs in about 20% of chronically infected patients over a duration of 10-20 years, and within 5 years approximately 10-20% of these cirrhotic patients will develop hepatocellular carcinoma (HCC). Previous studies report that the X-ray repair cross-complementing group1 gene (XRCC1) is important in the risk of HCC development; however, results obtained from these studies are conflicting rather than conclusive. We hypothesised an association between single nucleotide polymorphisms (SNPs) in XRCC1 with the HCC risk on a background of chronic hepatitis C. MATERIALS AND METHODS: We recruited 210 subjects, 70 with HCC, 70 with cirrhosis and 70 healthy controls. Two SNPs [c.1254C>T(rs2293035) and c.1517G>C(rs139599857)] in XRCC1 were genotyped using created restriction site-polymerase chain reaction (CRS-PCR) and PCR-restriction fragment length polymorphism (PCR-RFLP) methods. RESULTS: The TT genotype, CT genotype and T-allele in c.1254C>T (rs2293035) were linked to risk of HCC compared to the CC genotype: OR 3.58 [confidence interval (CI) 95%: 1.19-10.7] p = 0.019; OR 2.16 (CI 95%: 1.04-4.47) p = 0.037 and OR 2.10 (CI 95%: 1.2-3.3) p = 0.006, respectively. Regarding c.1517G>C (rs139599857), the CC genotype, GC genotype and C-allele were linked with higher risk of developing HCC compared to GG genotype: OR 4.77 (CI 95%: 1.3-16.9), p = 0.016; OR 3.02 (CI 95%: 1.46-6.2), p = 0.002 and OR 2.4 (CI 95%: 1.4-4.0), p = 0.001, respectively. CONCLUSION: We conclude that the T-allele of c.1254C>T (rs2293035) and the C allele of c.1517G>C (rs139599857) genetic variants may be associated with increased HCC risk among chronic hepatitis C patients.

Effect of Ramadan fasting on incidence of cerebrovascular stroke in Egyptian patients with Type 2 Diabetes Mellitus.

Diabetes is an independent risk factor for stroke disease. Fasting during Ramadan, Muslims must abstain from eating, drinking, taking oral medications, and smoking from the exact time of dawn until time of sunset; in this study we investigated if there is impact of Ramadan Fasting on incidence of Cerebrovascular stroke among Patients with Type 2 Diabetes Mellitus. This cross sectional study was conducted in medical ICU of Zagazig University Hospitals, in months of Sha'ban, Ramadan and Shawwal, in 1436; total numbers of 220 patients diagnosed as cerebrovascular stroke were enrolled in. All of them were subjected to: full history taking and clinical examination, routine investigations and special investigations (CT brain & MRI brain). RESULTS: There was no significant difference in total frequency of Cerebrovascular stroke (ischemic, hemorrhagic) between patients with diabetes admitted during the month of Ramadan and other months before or after. However, during Ramadan, there was numerical but statistically not significant increase in number of patients with ischemic stroke than hemorrhagic stroke. CONCLUSION: Fasting during Ramadan does not increase the frequency of hospitalization for stroke as whole. Although; there is numerical increase in frequency of ischemic stroke than hemorrhagic stroke.

Complement c1q tumor necrosis factor-related protein 3 a novel adipokine, protect against diabetes mellitus in young adult Egyptians.

C1q/TNF-related protein-3 (CTRP3) is a novel adipokine with anti-inflammatory and a multitude of biological effects on glucose and lipid metabolism however, the influence of CTRP3 on incidence of diabetes mellitus remain unclear. This study investigated the effects of CTRP3 levels in obese and normal body weight young adults on insulin resistance and occurrence of diabetes mellitus. SUBJECTS AND METHODS: In this case control study, Serum levels of CTRP3, HbA1c, Lipid profile, glucose and insulin levels were determined in 75 obese and 68 normal body weight individuals. RESULTS: In obese young adults CTRP3 concentrations were decreased compared to normal body weight young adults (NBW). The association between reduction of CTRP3 concentrations and the presence of diabetes is statistically significant. CTRP3 showed significant negative correlation with BMI, HOMA-IR and triglycerides as well as positive correlations with HDL - cholesterol while there is no association between CTRP3 and BMI within the NBW group. Higher HbA1C, HOMA-IR, and risk of diabetes development within obese subjects were related to lower CTRP3 concentration. CONCLUSIONS: This study shows that reduction of CTRP3 concentrations is likely to bring a concomitant increase in risk of diabetes in obese and normal body weight young adults. Decrease in CTRP3 concentration may have an essential role in the pathophysiology of metabolic disorders concomitant to obesity.

Semen quality and infertility status can be identified through measures of oxidation-reduction potential.

Standard analyses for evaluating semen quality require technical expertise and are interpretive in nature. Oxidative stress (OS) alters many of the semen parameters; thus, a measure of OS could be an indicator of semen quality. Static oxidation-reduction potential (sORP) is a universal measure of OS traditionally used in environmental applications but is increasingly used in biomedical studies. sORP was measured to determine how well it associates with semen quality and if it differentiates semen from infertile patients and fertile donors. All study participants (Infertile, n = 365 and Fertile, n = 50) underwent standard semen analyses, and sORP was measured in unprocessed semen. In infertile patients, sORP increased with decreased total sperm number, motility and morphology. sORP values were higher in samples with abnormal quality (low number, motility and/or normal morphology) compared with those of normal quality. Infertile patients had higher sOPR values compared to fertile donors. A sORP cut-off value of 1.38 mV/106  sperm/ml can differentiate normal from abnormal semen samples, while a cut-off value of 1.41 mV/106 sperm/ml, can differentiate between infertile and fertile semen samples. In conclusion, sORP provides a quick and unbiased indicator of semen quality that can be a beneficial addition to semen analysis to determine semen quality and fertility status.

ICSI outcome in patients with high DNA fragmentation: Testicular versus ejaculated spermatozoa.

Sperm DNA fragmentation (SDF) has emerged as an important biomarker in the assessment of male fertility potential with contradictory results regarding its effect on ICSI. The aim of this study was to evaluate intracytoplasmic sperm injection (ICSI) outcomes in male patients with high SDF using testicular versus ejaculated spermatozoa. This is a prospective study on 36 men with high-SDF levels who had a previous ICSI cycle from their ejaculates. A subsequent ICSI cycle was performed using spermatozoa retrieved through testicular sperm aspiration. Results of the prior ejaculate ICSI were compared with those of the TESA-ICSI. The mean (SD) SDF level was 56.36% (15.3%). Overall, there was no difference in the fertilization rate and embryo grading using ejaculate and testicular spermatozoa (46.4% vs. 47.8%, 50.2% vs. 53.4% respectively). However, clinical pregnancy was significantly higher in TESA group compared to ejaculated group (38.89% [14 of 36] vs. 13.8% [five of 36]). Moreover, 17 live births were documented in TESA group, and only three live births were documented in ejaculate group (p < .0001). We concluded that the use of testicular spermatozoa for ICSI significantly increases clinical pregnancy rate as well as live-birth rate in patients with high SDF.