Mixed-genotypes hepatitis C virus (HCV) infections are normally ignored in chronic hemodialysis patients. The aim of this study is to investigate the prevalence of mixedgenotypes infections among hemodialysis patients in Pahang province, Malaysia. Reverse-transcription and polymerase chain reaction methods were performed using two different sets of primers, targeting the 5’ untranslated region and nonstructural 5B region. Target region base sequences were obtained by direct sequencing. Discrepancy in outcomes from phylogenetic analysis of both regions suggests double infections. Of 40 subjects in eight hemodialysis centres, evidence of mixed-genotypes infections was found in 5 subjects (12.5%) from three different centres. Four patients were infected with mixed genotypes 3 and 1 and one with genotypes 3 and 4. Cases of mixed HCV genotypes infection were considered high among hemodialysis patients in Pahang. However, further investigation is needed to confirm whether they are true mixed infections or perhaps infection with recombinant virus and also to assess the clinicopathologic characteristics of the infection.

Introduction: The culture of Nile tilapia (Oreochromis niloticus) has become wide spread because of its high productivity over a short period of time. Its production partially fulfills the demand for food in rural people in Bangladesh. However, the accumulation of toxic heavy metals in the human body through consumption of fish contaminated by it causes various diseases. The aim of this study was to evaluate the bioaccumulation of five heavy metals, namely, cadmium (Cd), chromium (Cr), lead (Pb), nickel (Ni) and copper (Cu) in cultured Nile tilapia in the Noakhali region of Bangladesh. Methods: Fish were collected from three different fish farms in the Noakhali region and samples of gill, muscles and liver of tilapia were assayed for Cd, Cr, Pb, Ni and Cu using atomic absorption spectroscopy. Proximate composition of the tilapia was also determined. Results: Metal accumulation in different tissues was as follows: liver > gill > muscle. The accumulation of metals in the muscle, gill and liver was Ni > Pb > Cr > Cu > Cd, Pb > Ni > Cu > Cr > Cd and Pb > Cu > Ni > Cr > Cd, respectively. The bioaccumulation of lead was significantly increased in liver and gill while muscle showed the lowest value. Conclusion: It can be concluded that bioaccumulation of Pb, Cr and Ni in Nile tilapia in this study exceeds the permissible limits set for heavy metals by Food and Agriculture Organization (FAO) and International Atomic Energy Agency (IAEA)-407. This is potentially risky for consumers.

Purpose: Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and Methods: An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. Results: A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4–6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. Conclusions This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians.