Acquired von Willebrand Syndrome in a 17-Year-Old With Essential Thrombocythemia: A Case Report With Literature Review.

Acquired von Willebrand syndrome (AVWS) is a rare bleeding disorder that is often underdiagnosed. AVWS typically occurs in adults without a family history of bleeding disorders and with associated conditions such as lymphoproliferative, myeloproliferative, and cardiovascular disorders. Here, we present a case of AVWS in a young patient with essential thrombocythemia and a literature review on AVWS in the setting of essential thrombocythemia.

A Case Report and Literature Review of Skeletal Muscle Metastasis of Non-small Cell Lung Cancer.

Non-small cell lung cancer metastasis to skeletal muscle is an uncommon occurrence. Lung cancers are more likely to spread to the brain, bone, liver, and adrenals. Here, we present a rare case of non-small cell lung cancer metastasis to the skeletal muscle in a 54-year-old male. In addition, we present a literature review on skeletal metastasis of non-small cell lung cancer. The most frequent presentation of skeletal muscle metastasis is muscular pain with or without swelling. The mechanism of metastasis to muscle is not well understood; it is theorized that hematogenous spread is the most likely route. As with our patient, the presence of skeletal muscle mass is considered an aggressive disease with poor survival, usually less than one year. The treatment for muscle metastasis is often palliative in the form of radiation therapy, chemotherapy, or surgical removal of the mass.

A Systematic Review of the Emerging Treatment for Hepatorenal Syndrome With a Principal Focus on Terlipressin: A Recent FDA-Approved Drug.

BACKGROUND:  Hepatorenal syndrome (HRS), a consequence of liver cirrhosis, is the development of renal failure, which carries a grave prognosis. Reversing acute renal failure with various vasoconstrictor therapies at an appropriate time favors a good prognosis, especially when a liver transplant is not feasible. OBJECTIVE:  This study aims to compare various treatment modalities to deduce an effective way to manage HRS. METHODS:  The authors conducted a literature search in PubMed, Google Scholar, the Cochrane Library, and Science Direct in October 2022, using regular and MeSH keywords. A total of 1072 articles were identified. The PRISMA guidelines were used, the PICO framework was addressed, and the inclusion criteria were set based on studies from the past 10 years. After quality assessment, 14 studies were included for in-depth analysis in this review.  Results: A total of 14 studies were included after quality assessment, including randomized controlled trials, systematic reviews, meta-analyses, and observational cohort studies. Nine hundred and forty-one patients represented this review's experimental and observational studies, apart from the other systematic reviews analyzed. Nine studies discovered that Terlipressin, especially when administered with albumin, was more effective than other conventional treatment modalities, including norepinephrine and midodrine, in terms of improving mortality and reversing the HRS. Four studies suggested that terlipressin exhibited similar effectiveness but found no significant difference. In contrast, one study found that norepinephrine was superior to terlipressin when particularly considering the adverse effects. CONCLUSION:  Terlipressin, one of the most widely used vasoconstrictor agents across the world, seems to be effective in reversing renal failure in HRS. Although adverse effects are seen with this agent, it is still beneficial when compared to other medications. Further studies with larger sample sizes may be warranted.

The Comorbidity of Endometriosis and Systemic Lupus Erythematosus: A Systematic Review.

Autoimmune diseases manifest in genetically predisposed individuals exposed to certain triggers that aggravate immune dysfunction and result in an exacerbated immune response in the form of hyperactivity to both the humoral and cell-mediated response. The devastating reality apart from the severity of the disease is that multiple immune diseases could co-occur, increasing the patient's physical, psychological, and financial burden. Autoimmune diseases are utterly deranging. One of the dreadful autoimmune diseases is systemic lupus erythematosus (SLE). SLE is a rheumatological disease that affects multiple systems, and there are no predictors to know which system will be affected in the future. It could affect the mucocutaneous system. It could also present with hematological, rheumatological, neuronal, renal, pulmonary, and cardiac manifestations. SLE is prevalent in females, predominantly in the childbearing age group. The pharmacological therapy and bombarding pathophysiology of the disease lead to obstetrical and gynecological complications such as infertility, abortion, miscarriage, and stillbirth. Over the past decade, the autoimmune disease comorbidity increased eminently. One of the common associations is rheumatological diseases (like rheumatoid arthritis, Sjogren syndrome, and SLE) with gynecological diseases (e.g., endometriosis and uterine fibroids). SLE and endometriosis have strong associations, and the prevalence of each condition is relatively high among the female population. Endometriosis is a chronic disease triggered by inflammation, hormonal milieu, and other predisposing factors that lead to the fibrous tissue that lines the uterus (endometrial tissue) to be implanted at sites other than the uterus, commonly in the peritoneum and mesentery. The pathogenesis of this association remains unexplained. The approved theory is that their immune dysfunction is summarized by the elevated humoral and cell-mediated response, which leads to an attack to the epithelium, mesothelium, and Serosa and leads to fibrous tissue deposition in different sites other than the uterus. Statistical evaluations have shown a remarkable association between autoimmune diseases and both gynecological and nongynecological diseases.

Evaluation of CD44+/CD24- and Aldehyde Dehydrogenase Enzyme Markers in Cancer Stem Cells as Prognostic Indicators for Triple-Negative Breast Cancer.

Triple-negative breast cancer (TNBC) has been extensively studied not just for its aggressive behavior but also to understand its complex molecular nature. This type of heterogeneous tumor shows no expression of estrogen receptor (ER) or progesterone receptor (PR) and does not express the HER2 gene, and often these tumors are high grade with distinct histological groups. The basal-like subtype is most commonly related to the TNBC type of neoplasms; it can be further classified according to Lehmann and Burstein expert's criteria. TNBC is related to breast stem cell markers such as CD44+/CD24- and high levels of enzyme aldehyde dehydrogenase (ALDH), which have been shown to possess stem cell features that are involved in differentiation, vascular invasion, tumorigenesis, and metastatic potential. CD44+/CD24- and high levels of ALDH have significance as markers as well as indicators of poor prognosis in TNBC. The databases used in this review are PMC, PubMed, and Google Scholar.

Dexmedetomidine in Prevention of Postoperative Delirium: A Systematic Review.

Delirium is defined by the DSM-5 as a fluctuating course of disturbance in attention, cognition, and awareness that develops over a short period without any pre-existing neurocognitive disorder. As people age, there is an increased risk of complications that may occur following a surgical procedure and one such acute complication is delirium. Studies are emerging to reduce the incidence of postoperative delirium, and one such preventive measures implemented in recent years include the administration of dexmedetomidine, a high selectivity α-2 adrenoceptor agonist. This study aims to review the efficacy of Dexmedetomidine in the prevention of postoperative delirium in randomized controlled trials in patients older than 18 years of age. The literature was explored in three online databases, namely, PubMed, Science Direct, and Scopus. Appropriate keywords and MesH terms were employed to scrutinize relevant articles that demonstrated the effects of dexmedetomidine in the prevention of postoperative delirium. The data was restricted to randomized controlled trials and clinical trials published from 2017 to 2021 in human patients older than >18 years of age undergoing non-cardiac-related procedures. The randomized clinical trials were critically assessed with the Cochrane risk of bias tool. We proceeded to screen 428 records with the assessment of the PRISMA chart and filtered out 420 papers to obtain a total of eight studies where we identified data such as sample size, types of surgeries in which the patients were involved, the delirium assessment tool, the plan of the administration of dexmedetomidine and the outcomes evaluated in each study. The Confusion Assessment Method (CAM) was the prevailing assessment tool used with the sole purpose to evaluate the incidence of postoperative delirium as the primary outcome, and assessment of inflammatory cytokines, sleep quality, and pain scales were considered as secondary outcomes. The dosage of dexmedetomidine varied among studies, and it displayed varying impacts on postoperative delirium and the secondary outcomes as well. Limitations include varying ages and ethnicities of the population. It was concluded that dexmedetomidine prevents the development of postoperative delirium in elderly patients undergoing non-cardiac surgical interventions by modulating important predisposing factors such as neuroinflammation, pain, and sleep quality. No funding was made for this study.

Evaluation of and Current Trends in the Management of Gastrointestinal Stromal Tumors: A Systematic Review.

Gastrointestinal stromal tumors (GISTs) are soft-tissue sarcomas that can occur anywhere in the digestive tract, with the stomach and small intestine being the most common locations. Because no imaging modalities diagnose GIST unequivocally, histological and immunohistochemical confirmation is usually required. Most GISTs are discovered by chance; hence, determining this condition's actual frequency can be challenging. Since diagnosing the tumor could be difficult, including GIST in the differential diagnosis is crucial. The objective of this review is to explore the multiple treatment options for this tumor and provide clinicians with more information on the evolving treatment modalities, which in the future could be a possible solution to cure GIST ultimately. After exploring several studies, the authors conclude that early detection is critical since the treatment depends on the tumor size, mitotic rate, and location. Medical management using targeted therapy approved by the United States Food and Drug Administration (FDA) include tyrosine kinase inhibitors such as imatinib, sunitinib, and regorafenib. Surgical resection of the tumor is also done in cases with localized tumors. Standard chemotherapy and radiotherapy are not commonly used to treat GIST patients. However, radiotherapy may be used as a palliative therapy to ease pain (such as bone pain) or control bleeding. Additional research is needed to establish potential therapeutic targets that will result in higher and longer-term response rates.

The Impact of Bariatric Surgery on Cardiovascular Risk Factors and Outcomes: A Systematic Review.

Obesity and its complications are increasing in today's era, with cardiovascular health being one of the most significant obesity-related comorbidities. Hypertension in obesity is considered one of the major causes of death and disability due to their negative repercussions on cardiovascular health. Bariatric surgery is an approved therapeutic modality for obese people in classes II and III who have a body mass index (BMI) of more than 35 kg/m2 and 40 kg/m2, respectively. These weight loss surgeries are procedures that alter metabolism by causing weight reduction and altering gastrointestinal physiology, thereby considerably decreasing cardiometabolic risk factors that have been poorly understood to date. The purpose of this review is to explore the impact of bariatric surgery on reducing cardiac risk factors, in turn protecting the heart from succumbing to premature death. A literature search was done in the following databases: PubMed, Google Scholar, and PubMed Central (PMC). The studies taken into account for this review were observational studies published between 2016 and 2021 in the English language, where the quality was assessed using relevant quality appraisal methodologies. Finally, 10 reports were selected as definitive studies. Upon extensive evaluation of the final studies, it can be concluded that bariatric surgery results in significant weight loss, which lowers metabolic syndrome prevalence, cardiovascular risk factors, and major adverse cardiovascular events, particularly acute coronary events, and a favorable improvement in cardiac structure and function, altogether steering to reduced mortality due to cardiovascular diseases in obese patients. It is also worth noting that, while metabolic surgery can help patients with various metabolic comorbidities, the impact on individuals with hypertension is still debatable. Although the studies show significant effects on the cardiovascular system, these were only observational studies in geographically dispersed locations where each patient's lifestyle patterns and motivational levels could vary. Since real-world data are not fully explored due to the limited randomized controlled trials, it is suggested that further human trials on a larger scale be conducted to provide an even more factual conclusion.

A Systematic Review on the Prevention and Control of Opportunistic Infections in Patients With Chronic Lymphocytic Leukemia Complicated by Richter's Transformation.

Chronic lymphocytic leukemia (CLL) is one of the most commonly occurring types of leukemia among the elderly population, contributing to an increased vulnerability to infections that are especially prolific in the immunosuppressed and the risk of rapid progression of the disease into a more aggressive manifestation of large cell lymphoma, a process called Richter's Transformation (RT). CLL alone predisposes patients to develop infections; however, the additional complication of RT decreases survival and makes the prevention and control of infection for the CLL patient even more challenging. However, research that exists on preventing and controlling infection in CLL patients with RT is relatively limited. In most cases, studies have focused on the prevention of infection in CLL patients in general and with no reference to the progression of RT. Considering the dearth of research on infection prevention and control for patients with CLL complicated by RT specifically, the following review examines existing research in addressing the prevention and control of infection in CLL patients with RT and patients in general. The authors explored multiple databases such as PubMed, Google Scholar, and Science Direct. The ultimate focus of this study was to lay a fundamental understanding in preventing and controlling infection in CLL patients. After analyzing several studies, it can be concluded that identifying infections, even if rare, is a crucial aspect of managing CLL patients. A broad range of differential diagnoses should be sought in cases presenting with refractory CLL as well and management of infections before, during, or after CLL treatment should be considered.

A Systematic Review: Does Insulin Resistance Affect the Risk and Survival Outcome of Breast Cancer in Women?

Currently, breast cancer is one of the insidious malignancies that evolves silently, eventually leading to mortality, and has been recorded as one of the leading causes of cancer-related deaths around the globe. It is evident from numerous research studies that the etiology of breast cancer is multifaceted, both on an individual and environmental level. Insulin resistance, commonly known as metabolic syndrome, has been related to a poor breast cancer prognosis. There is presently limited data on the clinical features of insulin-resistant breast cancer patients. The purpose of this study is to examine the association between metabolic syndrome and its components impacting the risk and the prognosis of breast cancer, including the clinicopathological variables in patients with newly diagnosed breast cancer with and without already established diabetes. The authors extracted data from PubMed, Google Scholar, Science Direct, and Embase, intending to study the connections between these two entities. Studies from worldwide were selected to analyze the association between breast cancer and insulin resistance, including mammogram screening practices in a region-wise manner. The ultimate objective is to raise awareness of this association among practitioners worldwide. After analyzing several reports that included observational studies, it is to be concluded that insulin resistance impacts breast cancer both in regards to increasing the risk as well as affecting the survival outcome.

Opioid Use in Patients With Sickle Cell Disease During a Vaso-Occlusive Crisis: A Systematic Review.

Sickle cell disease (SCD) affects the red blood cells, which become sickle-shaped, leading to their adhesion to vascular walls, impeding blood flow and causing the unpredictable, abrupt onset of intense pain episodes in the form of vaso-occlusive crises (VOC) as well as affecting multiple organ systems. The primary aim of this review is to assess the effectiveness of opioid analgesic intervention for pain management in sickle cell disease during an acute painful crisis. A literature search was done electronically on PubMed Central (PMC), PubMed, and Google Scholar databases. The reports included in the study were from 2010 to 2021, and the bibliographies of retrieved studies are included in the references. This systematic review was undertaken as per the Preferred Reporting Items for Systematic Review and Meta-Analysis. This study included reports discussing opioid analgesics in SCD patients during VOC in different settings. After extensive research, there were no clear current opioid treatment patterns described, and our conclusion suggested conducting more evidence-based research to improve the quality of VOC management and outcome.

Recent Advancements in the Management of Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Systematic Review.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a rare multisystem autoimmune condition that causes inflammation of small and medium-sized blood vessels and is more commonly seen in the geriatric population. ANCA-associated vasculitis (AAV) is typically characterized as necrotizing vasculitis and includes granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). The mortality rate remains high, with especially cardiovascular disease, infections, and malignancies being the leading causes of death. Existing treatment options depend heavily on the use of glucocorticoids (GCs), often in combination with cyclophosphamide (CYC); however, as the multitude of adverse effects associated with these agents has increased, numerous studies are being conducted to reduce not only these harmful effects but also improve remission rates. Rituximab, avacopan, corticosteroids, including intravenous pulse methylprednisolone, plasma exchange, and immunological targeting are among the emerging treatments. The purpose of this review is to emphasize the pathogenesis and traditional treatment modalities and give insights into the recent advances in managing this disorder in an attempt to spare the adverse effects of conventional therapies while achieving better remission rates with combination therapies as well. The authors explored multiple databases, employing appropriate keywords, satisfying the quality appraisal, after which a total of 14 reports were included in this review. Upon overall analysis, it can be concluded that rituximab and CYC, when used in combination, provided a safer alternative to GCs while exhibiting equal, if not superior, effectiveness and results, thus, paving the way for additional in-depth research in a larger population of interest.

A Systematic Review on the Management of Transfusion-Related Acute Lung Injury in Transfusion-Dependent Sickle Cell Disease.

The onset of respiratory distress and acute lung injury (ALI) following a blood transfusion is known as transfusion-related acute lung injury (TRALI), although its pathophysiology remains unknown. Even though sickle cell disease (SCD) has been studied for more than a century, few therapeutic and management strategies adequately address the emergence of TRALI. TRALI, an immune-mediated transfusion response that can result in life-threatening consequences, is diagnosed based on clinical signs and symptoms. Early detection and treatment increase the chances of survival and, in most cases, result in a complete recovery. Our objective is to provide a firm grasp of the present status of SCD-related TRALI care and therapy. After exploring multiple databases, this study offers evidence-based guidelines to aid clinicians and other healthcare professionals make decisions concerning transfusion assistance for SCD and the management of transfusion-related complications. Other risk factors for acute lung injury including sepsis aspiration should be ruled out throughout the diagnostic process. Several recent studies have shown that immunotherapy or immunological targets can effectively prevent these complications. Red cell transfusions, red cell antigen matching optimization, and iron chelation can also help reduce negative consequences. It is to be noted that poor clinical outcomes can be avoided by early detection and treatment of hemolytic transfusion reactions. Finally, preventing the onset of TRALI may be the most effective therapeutic strategy for SCD patients who rely on blood transfusions for survival.

The Association of Lung Cancer and Sarcoidosis: A Systematic Review.

Lung cancer has been the leading cause of cancer-associated deaths worldwide. While numerous reasons, including tobacco smoking, may lead to lung cancer, the purpose of this article was to explore the association between sarcoidosis, a multisystem granulomatous disorder, and lung neoplasms. A literature search was done on multiple databases with appropriate keywords, and the authors selected case reports where patients were diagnosed with sarcoidosis and lung cancer. These reports were analyzed in detail, and nine reports were included in this study. Each case was evaluated for the presenting symptoms, age, gender, and diagnostic procedures, including a follow-up analysis. After the evaluation, it can be concluded that sarcoidosis and lung cancer can occur simultaneously, despite being rare. Appropriate diagnostic procedures, including histopathological examination of the affected lymph nodes, showed either cancerous or non-cancerous cells (granulomas), thus altering the treatment on a case-by-case basis. Being aware of all possible associations between these two diseases could alter the clinical management, whether curative or palliative, and clinicians must rule out metastatic cancer in individuals with sarcoidosis-like clinical and radiographic features.

The Progression of Chronic Myeloid Leukemia to Myeloid Sarcoma: A Systematic Review.

Chronic myeloid leukemia (CML) is a slow-growing type of cancer that originates in the blood-forming cells of the bone marrow and is caused by a chromosomal mutation that is thought to occur spontaneously. CML could potentially lead to the development of myeloid sarcoma (MS), which is a rare neoplasm composed of immature myeloid cells that could evolve into a tumor mass at any anatomical site other than the bone marrow. MS can develop spontaneously or as a result of another form of myeloid neoplasm. Most instances of CML precede blast phase (BP) within two to three years after the first diagnosis of CML chronic phase (CP) at the age of pre-tyrosine kinase inhibitor (TKI) treatment. MS developing in CML patients during the era of TKI treatment is infrequently mentioned in the literature, primarily in single-case studies. As a result, the prognostic influence of MS in CML patients has not been well investigated. In the age of TKI treatment, it is uncertain whether MS and medullary BP have comparable clinical and prognostic relevance. The precise diagnosis of MS is critical for effective treatment, which is frequently delayed due to a high risk of misdiagnosis. This review focuses on the relationship between the development of MS from CML, and it culminates with recommendations for future hematology practice. A literature search was conducted in multiple databases, and the studies were appraised based on the inclusion and exclusion criteria. Finally, studies to date have shown that the existence of CML and its possible progression to MS in individuals map out the numerous implications this disease has in hematology practice. Though occurrences are uncommon in general, the prognosis for patients is bleak, necessitating the exploration and implementation of diagnostic and therapy advancements. Because there is limited evidence in the literature on its existence in the medullary chronic phase and outcomes in the era of TKI, it must be carefully investigated because it might be the first symptom of progressive illness prior to hematological progression.

Exploring the Current Trends of Artificial Intelligence in Stem Cell Therapy: A Systematic Review.

The concept of healing in medicine has been taking a new form where scientists and researchers are in pursuance of regenerative medicine. Until now, doctors have "reacted" to disease by treating the symptoms; however, modern medicine is transforming toward regeneration rather than reactive treatment, which is where stem cell therapy comes into the play-the concept of replacing damaged cells with brand new cells that perform the same function better. Stem cell treatment is currently being used to treat autoimmune, inflammatory, neurological, orthopedic, and traumatic disorders, with various research being undertaken for a wide range of diseases. It could also be the answer to anti-aging and a disease-free state. Despite the benefits, numerous errors could prevail in treating patients with stem cells. With the advancement of technology and research in the modern period, medicine is beginning to turn to artificial intelligence (AI) to address the complicated errors that could occur in regenerative medicine. For successful treatment, one must achieve precision and accuracy when analyzing healthy and productive stem cells that possess all the properties of a native cell. This review intends to discuss and study the application of AI in stem cell therapy and how it influences how medicine is practiced, thus creating a path to a regenerative future with negligible adverse effects. The following databases were used for a literature search: PubMed, Google Scholar, PubMed Central, and Institute of Electrical and Electronics Engineers (IEEE) Xplore. After a thorough analysis, studies were chosen, keeping in mind the inclusion and exclusion criteria set by the authors of this review, which comprised reports published within the last six years in the English language. The authors also made sure to include studies that sufficed the quality of each report assessed using appropriate quality appraisal tools, after which eight reports were found to be eligible and were included in this review. This research mainly revolves around machine learning, deep neural networks (DNN), and other subclasses of AI encompassed in these categories. While there are concerns and limitations in implementing various mediums of AI in stem cell therapy, the analysis of the eligible studies concluded that artificial intelligence provides significant benefits to the global healthcare ecosystem in numerous ways, such as determining the viability, functionality, biosafety, and bioefficacy of stem cells, as well as appropriate patient selection. Applying AI to this novelty brings out the precision, accuracy, and a revolution in regenerative medicine. In addition, stem cell therapy is not currently FDA approved (except for the blood-forming stem cells) and, to date, is considered experimental with no clear outline of risks and benefits. Given this limitation, studies are conducted regularly around the world in hopes for a concrete conclusion where technological advances such as AI could help in shaping the future of regenerative medicine.

Gene Therapy - Can it Cure Type 1 Diabetes?

Type 1 diabetes (T1D) is one of the most prevalent early-onset autoimmune diseases, and numerous treatment regimens have been developed over the years with a mainstay focus on insulin injections, infusions, and pumps. However, with the evolution of modern medicine in the recent decade, can gene therapy be a possible solution to prevent and even cure this autoimmune diabetes? In this review, the authors discuss the present-day advancements around the globe where gene therapy is implemented in different techniques to halt and even reverse T1D. The main focus of the final included studies for this review was to regenerate or preserve pancreatic ß cells from other cell types in order to optimize insulin secretions in non-obese autoimmune diabetic patients. A literature search was done in various databases such as PubMed, ScienceDirect, and Google Scholar, and a final of eight studies were included. On the whole, the studies reviewed suggested favorable results of gene therapy, although these researches were done mainly in vitro or as animal studies. The application of different virus vector encoding gene transfer through transcription factors, mRNA electroporation, insulin-like growth factor gene expression as well as combination gene transfer concluded beneficial effects on normalizing insulin production, which could pave the path to perfecting gene therapy, and may even find a permanent cure for T1D in the near future.

The Effect of Marijuana on the Incidence and Evolution of Male Infertility: A Systematic Review.

Over the past decade, the consumption of marijuana or any other form of cannabis, whether medically, recreationally, or illegally, has been escalating worldwide. The additive effect of marijuana and the easy availability could make this increasing trend possible for imperceptible outcomes affecting one's physiology on multiple levels. The rationale of this review is to study and enumerate several effects marijuana may have on male reproductive organs, especially in men who are dealing with subfertility or infertility issues. A literature search was done from September 1, 2021, to September 14, 2021, using the following databases: PubMed, Google Scholar, Bielefeld Academic Search Engine (BASE), University of California, Santa Barbara Library, and PubMed Central. The studies included in this review comprised systematic reviews, cross-sectional, case-control, cohort, and longitudinal studies published during 2010-2021 in the English language. After an extensive review of all studies, the quality was assessed using appropriate quality appraisal tools, and 15 eligible reports were identified and included. In-depth research on the final studies concluded that marijuana seems to have specific adverse effects on the sperm parameters, namely, sperm count, concentration, motility, morphology, capacitation, and viability, thus affecting fertility in men. Certain hormone levels, including testosterone, luteinizing hormone, and follicle-stimulating hormone, also drew attention, potentially impacting men's fertility; however, a finite inference could not be substantiated by the studies. Although the studies show significant effects in sperm parameters and organic sexual dysfunction, it is also to be noted that these studies are observational only and are conducted in small groups in multicenter geographical locations where other lifestyle patterns could be confounding. Given this restriction, it is suggested that further human trials on a larger scale be conducted to provide an even more concrete conclusion, especially after considering other factors that may affect the generalization of these trials.