1.Antimicrobial Management of Complicated Skin and Soft Tissue Infections in an Era of Emerging Multi-Drug Resistance: Perspectives from 5 Gulf Countries
Wadha ALFOUZAN ; Zainab AL-BALUSHI ; Muna AL-MASLAMANI ; Asmaa AL-RASHED ; Salman AL-SABAH ; Jameela AL-SALMAN ; Mohamed BAGUNEID ; Faryal KHAMIS ; Nervana HABASHY ; Ayman KURDI ; Christian ECKMANN
Journal of Acute Care Surgery 2021;11(3):89-101
The number of complicated skin and soft tissue infections (cSSTIs) in the Arabian Gulf region has risen in recent years, particularly those caused by multi-drug resistant (MDR) pathogens. The high prevalence of diabetes, obesity, and associated cardio-metabolic comorbidities in the region renders medical and surgical management of cSSTI patients with MDR infections challenging. An experienced panel of international and regional cSSTI experts (consensus group on cSSTIs) was convened to discuss clinical considerations for MDR infections from societal, antimicrobial stewardship, and cost perspectives, to develop best practice recommendations. This article discusses antibiotic therapies suitable for treating MDR cSSTIs in patients from the Gulf region and recommends that these should be tailored according to the local bacterial ecology by country and region. The article highlights the need for a comprehensive patient treatment pathway and defined roles of each of the multidisciplinary teams involved with managing patients with MDR cSSTIs. Aligned and inclusive definitions of cSSTIs for clinical and research purposes, thorough and updated epidemiological data on cSSTIs and methicillin-resistant Staphylococcus aureus in the region, clearcut indications of novel agents and comprehensive assessment of comparative data should be factored into decision-making are necessary.
2.Effects of Varicocele Repair on Sperm DNA Fragmentation and Seminal Malondialdehyde Levels in Infertile Men with Clinical Varicocele:A Systematic Review and Meta-Analysis
Rossella CANNARELLA ; Rupin SHAH ; Ramadan SALEH ; Florence BOITRELLE ; Taha Abo-Almagd Abdel-Meguid HAMODA ; Rajender SINGH ; Gianmaria SALVIO ; Tuncay TOPRAK ; Marco FALCONE ; Murat GUL ; Fotios DIMITRIADIS ; Amarnath RAMBHATLA ; Giorgio I. RUSSO ; Edmund KO ; Armand ZINI ; Parviz KAVOUSSI ; Nguyen Ho Vinh PHUOC ; Hussein KANDIL ; Ramy Abou GHAYDA ; Ponco BIROWO ; Nazim GHERABI ; Erman CEYHAN ; Jie DONG ; Vineet MALHOTRA ; Damayanthi DURAIRAJANAYAGAM ; Bircan KOLBASI ; Fahmi BAHAR ; Gokhan CALIK ; Selahittin ÇAYAN ; Germar-Michael PINGGERA ; Aldo E. CALOGERO ; Osvaldo RAJMIL ; Taymour MOSTAFA ; Widi ATMOKO ; Ahmed M. HARRAZ ; Tan V. LE ; Jean de la ROSETTE ; Lukman HAKIM ; Edoardo PESCATORI ; Oleg SERGEYEV ; Ayman RASHED ; Pallavi SAINI ; Ashok AGARWAL
The World Journal of Men's Health 2024;42(2):321-337
Purpose:
Varicoceles can be a source of elevated seminal oxidative stress (OS) and sperm DNA fragmentation (SDF). However, it remains unclear whether varicocele repair (VR) could reduce these parameters. This systematic review and meta-analysis (SRMA) aims to investigate the impact of VR on SDF and seminal malondialdehyde (MDA).
Materials and Methods:
A literature search was performed in Scopus, PubMed, Ovid, Embase, and Cochrane databases. This SRMA included randomized controlled trials and observational studies reporting the pre- and postoperative levels of SDF and seminal OS in infertile men with clinical varicocele that underwent VR. Subgroup analyses included techniques of VR and SDF testing. The effect size was expressed as standardized mean difference (SMD).
Results:
Out of 1,632 abstracts assessed for eligibility, 29 studies with 1,491 infertile men were included. The analysis showed a significant reduction in SDF after VR, compared to preoperative values (SMD −1.125, 95% confidence interval [CI] −1.410, −0.840; p<0.0001) with high inter-study heterogeneity (I2=90.965%). Reduction in SDF was evident with microsurgical technique and non-microsurgical inguinal approaches (SMD −1.014, 95% CI −1.263, −0.765; p<0.0001, and SMD −1.495, 95% CI −2.116, −0.873; p<0.0001), respectively. Reduction in SDF was significant irrespective of testing was done by sperm chromatin dispersion (SMD −2.197, 95% CI −3.187, −1.207; p<0.0001), sperm chromatin structure assay (SMD −0.857, 95% CI −1.156, −0.559; p<0.0001) or TUNEL (SMD −1.599, 95% CI −2.478, −0.719; p<0.0001). A significant decrease in seminal MDA levels was observed following VR (SMD −2.450, 95% CI −3.903 to −0.997, p=0.001) with high inter-study heterogeneity (I2=93.7%).
Conclusions
Using pre- and post-intervention data, this SRMA indicates a significant reduction in SDF and seminal MDA levels in infertile men with clinical varicocele treated with VR. These findings may have important implications for the future management of this selected group of infertile patients.