Oxidative stress in male infertility and therapeutic approach: A mini-review

Growing evidence suggests that oxidative stress is a major cause of male infertility.Spermatozoa are highly sensitive cells due to the vulnerability of their membrane fatty acids and the diminished antioxidant defense.Reactive oxygen species(ROS)impact multiple signaling pathways involved in mitochondrial dysfunction,hormonal unbalance and semen quality decline.The origin of ROS is diverse,including generated normal cellular metabolism,environmental exposure,advanced paternal age and inflammation.Research has indicated that antioxidant supplementation can improve oxidative stress and reduce the risk of chronic diseases.Moreover,it is widely known that antioxidant supplementation can enhance sperm quality and increase the pregnancy rate in couples undergoing fertility treatments.The current study highlights the deleterious effect of ROS and its impact on semen function.In addition,it contributes to the development of a clinical approach for the use of antioxidants in the management of male infertility.

Symptomatic Tarlov Cysts and Occupational Outcome: A Case Report

Tarlov cysts are often asymptomatic and incidentally discovered. However, in few cases, these cysts can be symptomatic and may manifest as chronic low back pain. We report a case of a Tarlov cyst incidentally diagnosed by MRI in a wiring factory worker complaining of chronic low back pain exacerbated with the carrying of heavy loads and the hyper solicitation of the lumbar spine during his professional activity. The clinical manifestations of symptomatic Tarlov cysts can influence the life quality of patients and have enormous repercussions on their work ability, which in some cases can lead to job loss. Thus, the socio-professional aspects of symptomatic Tarlov cysts should not be underestimated and maintaining these patients in employment should be considered from the outset as an objective in its own right in the management.

Association of hepatitis C virus infection and diabetes in central Tunisia

AIM：To investigate hepatitis C virus （HCV） seroprevalence in Tunisian patients with diabetes mellitus and in a control group. METHODS： A cross-sectional study was conducted to determine the HCV seroprevalence in 1269 patients with diabetes （452 male, 817 female） and 1315 nondiabetic patients, attending health centers in Sousse, Tunisia. HCV screening was performed in both groups using a fourth-generation enzyme immunoassay. RESULTS： In the diabetic group, 17 （1.3%） were found to be HCV-infected compared with eight （0.6%） in the control group, although the difference was not significant （P = 0.057）. Quantitative PCR was performed in 20 patients. Eleven patients were positive and showed HCV genotype lb in all cases. CONCLUSION： Frequency of HCV antibodies was low in patients with diabetes and in the control group in central Tunisia, with no significant difference between the groups.

Granulocytic sarcoma of the rectum:Report of one case that presented with rectal bleeding

Granulocytic sarcoma is an uncommon and localized extramedullary tumor composed of immature granu-locytic cells.It may present in association with acute myeloid leukaemia,myelodysplastic syndrome and chronic myelogenous leukaemia.Granulocytic sarcoma may occur in any anatomical site but involvement of the gastrointestinal tract is rare,especially in the rectum.We report on the case of a 17 year old female who presented with rectal bleeding,abdominal pain and weight loss one mo prior to admission.Recto-sigmoidoscopy revealed a rectal polypoid and ulcerated mass.The histological examination of the mass showed granulocytic sarcoma.Bone marrow examination was compatible with acute promyelocytic leukaemia(FABtype M3).This case report is a reminder of this peculiar sign of tumoral syndrome in acute myeloid leukaemia.We also discuss diagnostic methods and analyze the disease course.

Liver Function and Structure in Rats Treated Simultaneously with Cadmium and Mercury

The effect of cadmium chloride (150 mg/l) and mercury (II) chloride (80 mg/l) either alone or in combination in drinking water for 4 weeks on function and structure of the liver of male rats was studied. Results indicated that the ratio of liver weight to body weight and the activities of serum alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase noted in rats co-exposed to cadmium and mercury were intermediate between those noted in the individually metal treated rats. The histopathological study showed that the individual metal and the combined metal treatments caused severe liver damage. The degree of these changes noted in rats co-exposed to cadmium and mercury was not higher than those signalized in individual treatment. The biochemical and the histological changes observed in rats co-exposed to cadmium and mercury show that there is not an additive effect between these two metals.

Combined Effects of Cd and Hg on Liver and Kidney Histology and Function in Wistar Rats

The present study was performed in order to discern the effects of combined exposure to cadmium and mercury on liver function and histopathological alterations in male adult Wistar rats. In the present investigation, cadmium (100 mg/l) and mercury (25 mg/l) were administered orally for 10 weeks separately or in combination. The rational for studying cadmium and mercury is that both of these metals are encountered frequently in the same contaminated areas. In liver, the activities of serum alanine aminotransferase (ALT) and aspartate amino tranferase (AST) increased significantly in the cadmium (Cd) and mercury (Hg) alone or in combination (Cd + Hg) compared to the control suggesting that both cadmium and mercury cause hepatotoxicity spatially when co-administrated. We noted an increase in serum lactate dehydrogenase (LDH) activity in Cd and combined Cd + Hg treated groups while it decreased in Hg treated group. There was no statistically significant change in the level of total bilirubilin. Serum urea concentration showed a significant increase in the Cd and Hg groups compared to the control group. However an increase in serum creatinine concentration was noted only in the combined treated rats showing that renal insufficiency is more serious in the co-exposed group. Light microscopic examination indicated severe histological changes in the two organs under Cd and mercury influence. Results of the present investigation clearly showed that mercury has profound effects of hepatic handling of cadmium (synergistic effect) as shown by histological and biochemical results. Moreover, we observed a antagonist effect between these two toxic metals on kidney markers such as urea.

Severe hemorrhagic colitis in a patient with chronic myeloid leukemia in the blastic phase after dasatinib use

Dasatinib is a second-line tyrosine kinase inhibitor used in patients with imatinib resistant or intolerant chronic myeloid leukemia (CML) and Philadelphia chromosomepositive acute leukemia. Gastrointestinal bleeding may occur in up to 7% of patients using dasatinib, although, severe dasatinib-related acute colitis had rarely been reported. Here, we present the case of a 36-year-old female who progressed to acute myeloid leukemia after fourteen months of receiving imatinib for CML in the chronic phase and was treated with a dasatinib-containing chemotherapy regimen. On day 34 of treatment, the patient developed moderate abdominal pain and bloody diarrhea with mucous. Analyses of stool specimens were negative for parasites, Clostridium difficile , and other pathogenic bacteria. The cytomegalovirus pp65 antigen was negative in her blood leukocytes. A colonoscopy revealed acute colitis, and a mucosal biopsy showed nonspecific colitis. The patient was treated with broad-spectrum antibiotics, bowel rest and hydration, and dasatinib treatment was stopped. Her bloody diarrhea improved within 72 h. After confirming cytological remission, the patient received initial course of consolidation, and dasatinib treatment was reinstated. However, hemorrhagic colitis recurred. After discontinuing dasatinib, herhemorrhagic colitis drastically improved and did not recur following the administration of nilotinib. The characteristics of our patient suggest that dasatinib treatment can lead to hemorrhagic colitis, which typically resolves after discontinuation of the drug.

Three Year Community Based Intervention for Chronic Disease Prevention in Epidemiological and Political Transition Context: Example of Tunisia

Objective: Our aim was to determine the effectiveness, feasibility, and necessary cultural adaptations of evidence-based interventions directed at tobacco use, unhealthy diet, and physical inactivity in adults and children in three different sectors: workplace, neighborhood and schools. Materials and Methods: We conducted in Sousse, Tunisia an interventional study through a quasi-experimental design (pre-post with intervention and control groups) to prevent non communicable disease risk factors. The intervention group included different settings and pre and post assessment concerned independent groups (schools with 1929 and 2170 participants, workplaces with 914 and 1098 participants and community with 940 and 1001 participants respectively at pre and post assessment). It was located in the delegation of Sousse Jawhara and Sousse Erriadh. The control group with similar settings (schools with 2074 and 2105 participants, workplaces with 861 and 1015 and community with 940 and 976 participants respectively at pre and post assessment) was located in the delegation of Msaken from the region of Sousse. Results: Tobacco use decreased among neighborhood (26.2% to 23.2%, p = 0.13) workplace (39.2% to 37.5%, p = 0.43) and schools (5.7% to 4.8%, p = 0.19) participants. In control group, it increased significantly in schools and neighborhood. Participants who consumed five fruits and vegetables daily increased significantly in all settings in intervention group (from 30% to 33.2% in schools, 47.5% to 52.1% in workplace and 39.4% to 58.4% in neighborhood). However in control group it increased only in schools and neighborhood. An improvement in physical activity practice was seen both in intervention and control group among adults participants but not in schools. Conclusion: The “Together in Health” project for the prevention of risk factors for NCD is an example of a loco-regional initiative. Such initiatives can only be beneficial with a structure organized by the government.

Place of Tranexamic Acid and Fibrinogen Association in the Management of Severe Postpartum Haemorrhage

Introduction: Severe postpartum hemorrhage (PPH) is the main cause of death in Tunisia. Its management is multidisciplinary and requires perfect knowledge of a regularly updated protocol and consistent with available resources. We propose an evaluation of the impact of different therapeutic attitudes, in particular the combination of tranexamic acid and fibrinogen concentrates in the management of this hemorrhage. Material and Methods: This was a retrospective, descriptive and analytical study, conducted in the departments of Gynecology-Obstetrics and Surgical Resuscitation anesthesia of the Farhat Hached University Hospital, Sousse, Tunisia. The study was conducted over six years (2009-2014), and included all parturients who were treated for severe PPH that occurred on a term greater than 24 weeks of amenorrhea. Patients were divided into two groups according to the study period: 1) Group 1 (G1): from 1 January 2009 to 31 December 2011, 2) Group 2 (G2): from January 1, 2012 to December 31, 2014, a group that benefited particularly from the combination of tranexamic acid and fibrinogen concentrates for the management of their PPH. Results: 166 patients were included: 57 in G1 and 109 in G2. The overall incidence of severe PPH was 3.15/1000 deliveries. We noted a significant decrease in the fall of hemoglobin in per and post haemorrhagic manifestations in favor of G2 with a p value of 0.003 and p = 0.025, respectively. The use of blood transfusion decreased significantly, in frequency and in number of packed red cells per patient, between the two groups;transfusion ratio was 1/1.7/1.5 for G1, and 1/2/1.8 for G2. Fluid therapy, use of macromolecules and catecholamines were less important in G2. The use of tranexamic acid, fibrinogen and the association of both increased significantly between the two groups (p 10-4). Haemostasis hysterectomies were less performed (p 10-3) in G2. Conclusion: The management of PPH has evolved over the years. The use of tranexamic acid in association with fibrinogen concentrates had proved his interest.

Embryonal Rhabdomyosarcoma of the Uterine Cervix: Two Cases Report and Literature Review

Introduction:?Embryonal rhabdomyosarcoma (RMS) of the uterine cervix is a rare and extremely aggressive malignant entity. However, prognosis seems to be improved with the use of multimodality approach treatment. Cases: We report the cases of 50- and 51-year-old women, presenting with vaginal bleeding and mass. The two patients underwent radical surgery. Histological examination revealed RMS of uterine cervix. Treatment was effective in the first case but despite the chemotherapy, the second patient died two months later. Discussion and Conclusions: The prognosis of the cervical embryonal RMS depends on clinical and histological features. The current treatment protocols are based on trials done on pediatric patients. Studies on embryonal RMS treatment and outcomes are limited in women over forty years. In patients with unfavorable prognosis characteristics, the multimodality approach including surgery, adjuvant chemo and radiotherapy can be effective. Otherwise, surgery alone can effectively be proposed.

Three Years Community-Based Intervention Program to Prevent Non-communicable Disease Risk Factors in Sousse, Tunisia

Aim： To evaluate the effectiveness of a community-based intervention program for NCD （non-communicable disease） risk factors prevention. Materials and methods： The authors conducted a quasi experimental study with a control group over five years between 2009 and 2014 in the region of Sousse, Tunisia. In each group, the sample size required was 1,000 participants. For this, the authors randomly selected 500 households from two areas and they included all adults aged 18 years and older in these households. They evaluated the habits of participants from both intervention and control groups at baseline in 2009-2010 and after three years of intervention in 2013-2014. They focused on the main lifestyle risk factors represented by poor diet, physical inactivity, and tobacco use. Results： Tobacco use decreased significantly among men by 7.3% （/9 = 0.03） in the intervention group, versus an increase of 3.5% in the control group （p = 0.4）. Physical activity and fruits and vegetables intake increased significantly respectively by 25% （p 〈 0.001） and 19% （p 〈 0.001） in intervention group. Conclusion： The results suggest that a combined community-based lifestyle intervention in a developing country, can significantly improve some NCD risk factors. However, a supportive environment or a gender approach is required to maximize the effectiveness and maintain the sustainability of the health intervention.

Yolk Sac Tumor and Fanconi Anemia: Case Report

Yolk sac tumor (YST), which most frequently arises in the gonads as a type of germ cell tumor, is rare in children but is highly malignant. The common age group affected by yolk sac tumours is 11 to 24 years. In this study, we described a rare case of YST in terms of the clinical manifestation, imaging, and histopathology findings, diagnosis and treatment in a 12-year-old girl who was followed since birth for Fanconi-like syndrome. This is a rare clinical association that also limits chemotherapy.

Buerger’s Disease and Fitness for Work in a Flight Personnel: A Case Report

Buerger’s disease, also called thromboangiitis obliterans (TAO), is an inflammatory disease affecting small and medium size blood vessels of the limbs. Several risk factors are strongly associated with this disease. In fact, heavy smokers represent 99% of patients diagnosed with Buerger’s disease and smoking cessation can slow down the progression of the pathology. Ulcers and gangrene are very common complications and TAO may also cause a vasculitis as well as ischemic damage to the distal part of the limbs that can eventually lead to limb amputation. Here, we report the case of a 43 years old patient, a flight personnel working in a Tunisian airline company who consults for a lesion of the left toe that appeared 2 weeks ago. He is a chronic inveterate smoker with 36 pack-years. The diagnosis of TAO was made based on the clinical presentation and the results of the Doppler Ultrasound of the left toe. This disease has a major impact on the quality of life due to the risk of necrotic ulcers and amputation. Navigation is a profession that requires a high level of physical and mental fitness. According to the international and Tunisian standards, the applicant or the holder of medical certificate must not have a cardiovascular condition that may affect the safety of the exercise.

Primary Synovial Sarcoma of the Kidney: A Case Report

Synovial sarcoma originating from the kidney is extremely rare. A 13-year-old girl presented with a mild left flank pain of one-week duration, with no associated history of hematuria or any other systemic symptoms. Computed tomography (CT) demonstrated a 6 × 13 × 9 cm mass in the left kidney. No soft tissue or extrarenal masses were identified. The patient received a combined of treatment with doxorubicin and ifosfamide. A radical nephrectomy was performed in the left kidney with no complications. Postoperative pathology revealed post-chemotherapy residue of monophasic spindle cell synovialosarcoma of the left kidney. She received a combined treatment with doxorubicin and ifosfamide in concomittance with external radiation therapy. The patient was re-examined 4 months after surgery. An abdominal and pulmonary CT found no recurrence or metastasis.