Reproductive Outcomes of Different Sperm Selection Techniques for ICSI Patients with Abnormal Sperm DNA Fragmentation: a Randomized Controlled Trial.

The aim of the study is to compare the reproductive outcomes of different sperm selection techniques: density gradient centrifugation (DGC), testicular sperm (Testi), physiological ICSI (PICSI), and magnetic-activated cell sorting (MACS) in abnormal sperm DNA fragmentation (SDF) ICSI patients. A randomized controlled trial included 302 patients with abnormal SDF undergoing ICSI where they were randomized into 4 groups: a control group of DGC (n= 72), Testi (n=73), PICSI (n=78), and MACS (n=79). Results showed no significant differences in the male age, female age, or SDF between the four groups. Testi group had significantly lower cleavage and blastulation rates compared to PICSI, DGC, or MACS groups (p =0.001). For the high-quality blastocysts, DGC and MACS groups had significantly higher rate than the Testi group (p =0.014). The highest pregnancy rate was scored for the PICSI group (69.6%), while the lowest pregnancy rate was scored for the DGC group (51.4%) with (p =0.025). The PICSI group showed a significantly higher implantation rate compared to the other groups (p =0.003). Regarding the ongoing pregnancy rate, the significant difference was observed between the PICSI (62.8%) and MACS (62%) vs. DGC (45.8%). Besides, no significant differences were found in the miscarriage rates between the four groups. In conclusion, PICSI and MACS along with DGC showed significant improvement in embryological and clinical outcome over testicular sperm or sperm processed by DGC alone in patients with abnormal SDFRegistration number: NCT04482517.

PICSI vs. MACS for abnormal sperm DNA fragmentation ICSI cases: a prospective randomized trial.

PURPOSE: To know which sperm selection technique, physiological intracytoplasmic sperm injection (PICSI) or magnetic-activated cell sorting (MACS), is better for the selection of sperm with abnormal sperm DNA fragmentation (SDF) in patients undergoing intracytoplasmic sperm injection (ICSI). METHODS: A prospective randomized trial included 413 ICSI cases with abnormal SDF (> 20.3%) by TUNEL assay. Patients with at least 1 million total progressive motile sperm count were randomized to PICSI or MACS groups on the day of ICSI. PICSI depends on the hyaluronan binding of better SDF sperm where individual sperm was selected, while MACS selects non-apoptotic sperm population using Annexin V magnetic beads. All pre-implantation embryogenic parameters were observed and the main outcome was the ongoing pregnancy rate. RESULTS: There were no significant differences between patients allocated to PICSI and MACS in the studied parameters including pre-implantation embryological data, implantation, clinical pregnancy, and ongoing pregnancy rates. Meanwhile, sub-analysis according to the female age has shown that female patients with less than 30 years of age in the MACS group had significantly higher good-quality blastocyst, clinical pregnancy, and ongoing pregnancy rates than the PICSI group. However, the higher implantation (p = 0.051), clinical pregnancy (p = 0.078), and ongoing pregnancy (p = 0.097) rates observed in females between 30 and 35 years of age in the PICSI group did not reach significance level. CONCLUSIONS: PICSI and MACS are efficient techniques for sperm selection in cases with abnormal sperm DNA fragmentation. However, MACS is preferred when the females are younger than 30 years, while PICSI is preferred in older females. CLINICAL TRIAL REGISTRATION NUMBER: NCT03398317 (retrospectively registered).

TUNEL assay: Establishing a sperm DNA fragmentation cut-off value for Egyptian infertile men.

Male factor infertility is responsible for half of all infertility cases. Conventional semen analysis is inadequate to evaluate male fertility. Sperm DNA fragmentation (SDF) test can be done by: direct methods such as Terminal deoxynucleotidyl transferase dUTP Nick-End Labeling (TUNEL) and Comet assay, or indirect like Sperm Chromatin Structure Assay (SCSA) and Sperm Chromatin Dispersion (SCD). TUNEL assay measures both single- and double-strand breaks and is technically less demanding, while SCSA tests for the susceptibility for nuclear DNA denaturation and samples should be sent to the reference lab. Studies showed that a single cut-off value does not fit all. Therefore, this study aimed at establishing a cut-off value to discriminate between fertile and infertile Egyptian men. We enrolled 354 infertile men and 40 proven fertile volunteers.TUNEL assay was performed using Apo-Direct kit and bench top flow cytometer.The calculated SDF cut-off value was 20.3% with a sensitivity of 96.6% and specificity of 87.5%, and the overall accuracy of the test was 95.7%. Sperm DNA fragmentation Test using TUNEL assay is valuable tool for male infertility evaluation, and it assists in offering the best treatment options based on it's results.

Osteomyelitis calcaneum due to a scorpion sting.

Children are susceptible to various injuries, including insect bites, and scorpion bites are common in the lower extremity of children in Middle East countries. In most cases, the sting will produce just a local reaction; however, serious complications that can result in death have occurred. In this case report, we describe a case of osteomyelitis of the calcaneum after a scorpion sting.

Isolated Carpo-Metacarpal Dislocation of the Thumb.

INTRODUCTION: Isolated dislocations of the trapezio metacarpal joint without associated fracture has been reported very rarely in the literature. There are reports of associated injuries like fracture of the trapezium, dislocation of the metacarpophalangeal joint and fractures of the base of the thumb metacarpal. CASE REPORT: Authors report a case of isolated carpometacarpal dislocation of the right thumb, in an adult, successfully managed conservatively. At 15 months follow up the patient had full function of the hand without any clinical or radiological evidence of instability or posttraumatic arthritis. CONCLUSION: Isolated dislocations can be successfully managed by closed reduction and immobilization in a back slab, with unstable dislocations requiring surgical intervention.

Giant cell tumor of tendon sheath: case series and review of literature.

Recurrence of Giant cell tumor of the tendon sheath (GCTTS) is an unresolved issue, though it is a non malignant condition. The authors operated on fourteen cases of GCTTS, after fine needle aspiration cytology confirmation and using a magnifying loupe for complete excision of the lesion including the satellite nodules. In only one case recurrence was noted which was successfully managed by a second wide excision. Preoperative diagnosis and meticulous surgical technique were found the only predictive factor of recurrence. During the 5 year period from 2002, 12 patients [11 females, 1 male, mean age 29.5, ranging from 10-53 years] underwent excision of giant cell tumor of tendon sheath of the hand. The lesions were found over the thumb [n = 7], ring finger [n = 1], index finger [n = 1], and over the hand [n = 2]. The lesions were classified using the Al-Qattan classification. The most common presentation was with a mass over the hand, with a predilection to the thumb [n = 7]. Radiological changes in the form of bony indentation was seen in only 2 cases. FNAC was inconclusive in 2 out of the 12 cases. Due to the high incidence of recurrence, pre-operative planning aided by a tissue diagnosis with fine needle aspiration cytology, wide surgical exposure, and meticulous dissection with help of magnification are imperative for a successful outcome in GCTTS.

Does Radial Styloid Abnormality in de Quervain's Disease Affect the Outcome of Management?

Radiological changes have been described in de Quervain's disease of the wrist. The author analyzed the clinical data of 114 patients who reported to the orthopedic clinic of a Regional Referral Hospital for a period of 4 years [2003 to 2007]. Radiographs of the wrist were available for 39 cases, of which 14 [35.89%] were found abnormal. Two patients with abnormal radiographs [14.28%] required surgery where as 7 out of 25 [28%] with normal radiographs were managed surgically. Radial styloid abnormality was not found statistically significant [p < 0.05], and the outcome of management was irrespective of the changes in the radial styloid.

De quervain disease: Ibri technique to avoid superficial radial nerve injury.

Tenosynovitis of the first dorsal compartment of the wrist, commonly known as de Quervain disease, is most of the time amenable to conservative treatment in form of splinting and injection of steroids into the compartment. Resistant cases need surgical release of the compartment but with high incidence of incomplete release owing to tendon anomalies and damage to the superficial branch of the radial nerve (SBRN). Many techniques evolved for a period of years, techniques using longitudinal, transverse, and oblique incisions, but damage to SBRN still remains unsolved. The authors describe a technique they have been using since 2004 and, so far, operated on 17 wrists without a single incidence of damage to the SBRN.