A large systematic review and meta-regression analysis found that sperm counts all over the world appeared to be declining rather than stabilizing. The decline in male sperm counts does not necessarily translate to a decline in male fertility. The cause of declining sperm counts remains unknown; however, several potential causative factors have been identified: 1. Chronic diseases: diabetes mellitus, hypertension; hyperlipidemia, hyperuricemia and skin Diseases & metabolic syndrome. 2. Environmental factors: bisphenol a; phthalates; heavy metals and heat. 3. Lifestyle: obesity, diet, tobacco, alcohol, marijuana, stress, reduced sleep & sedentary life. Addressing these causes is required to stop or decrease male fertility decline. Action to improve semen quality such as prevention & treatment of chronic disease, decreasing unhealthy lifestyle behaviors such as smoking, poor diet, or lack of physical activity & eliminating toxic environmental chemicals.

A growing number of synthetic plastics derived from fossil fuels are produced, and improper plastic waste management has caused a lot of pollution problems. There are many microplastics in the environment, and they disintegrate slowly in soil and water. The properties of microplastics (MPs) include long residence times, high stability, high fragmentation potential, and the ability to adsorb other contaminants. Invertebrates and planktonic organisms are easily able to accumulate microplastics in aquatic species. Therefore, microplastics (MPs) must be removed from the water and other media. This paper aims to review the occurrence, raw polymers and additives, and remediation methods for removing microplastics from the environment. Several methods are available for removing contaminants, including sorption, filtration and chemical treatments. Various removal methods are discussed along with their methods, efficiency and advantages.

The Anterolateral Ligament (ALL) [1,2] is a ligamentous structure of the knee whose definition as a ligament has been disputed in the past, however in the last decade more and more anatomical studies have concluded that its definition as a separate ligament is the most accurate. In this case report we present our findings from the dissection of a formalinized cadaver which we find are consistent with the anatomical characteristics of the anterolateral ligament and with that we aim to further its morphological definition.

Lymphomas are common hematological malignancies with an increasing incidence in recent years. The main site of extranodal non-Hodgkin’s lymphoma is the gastrointestinal tract, representing 40% of cases. The most common site of gastrointestinal lymphoma is the stomach, followed by the small intestine, accounting for 25% - 50% and 20% - 30%, respectively [1,2]. Primary colorectal lymphoma is a rare disease, accounting for 0.2% to 1% of all colorectal malignancies [1]. Males are more commonly affected with a peak incidence in the sixth and seventh decades of life [3]. Non-Hodgkin’s lymphoma is the most commonly described subtype of colonic lymphoma [1]. 

Diverticula can affect all segments of the gastrointestinal tract, from the esophagus to the colon. In order of decreasing, the jejunoileal location is the least frequent location [1] and has  a prevalence of less than 2% of the population [2]. This location was first described by Sommering in 1794 [3]. More than two-thirds of small bowel diverticula occur in the jejunum. They appear mainly after the age of 60 with higher prevalence in males and rarely occur in patients under the age of 40 [4]. Jejunal diverticula are in general multiple and bigger than ileal ones [5]. Most of them are asymptomatic and do not require surgical treatment. Clinical presentations are diverse and not specific with no pathognomonic clinical symptoms.

‘Let food be thy medicine and medicine be thy food’, the age-old quote by Hippocrates is evidently proved in today’s life management as probiotics have become a valuable part of human day-to-day life [1]. 

In this article, we made a research on the subject of Time and Growth. In the life, the Growth is seen as the increase of mass which operates during a certain period. In physics, it is the same. By the Growth, a physical body gets its density increased. The goal of this article is to calculate or predict the energy and force that a physical system can have at its total Growth. To study the Growth, we have defined some equations which help to evaluate the Growth internal force and energy. By the same way, we have also discovered that all physical systems in the Universe are connected by the same interaction. This interaction leads to the loss of density or mass. The Time is the consequence of its manifestation. For studying the effect of this interaction, we have calculated the density of the Universe. We found that the density of the Universe is equal to the density of a photon. In other words, the Universe is a huge photon. That means, like a photon, the Universe does not know the Time. It also means that the Universe is eternal. Its Expansion (not its growth) is due by the fact that, at the moment small systems inside to it grow, the Universe maintains its density constant like a photon. Do not confuse Growth and Expansion. The Growth is the increase of the density; and the Expansion is the increase of the volume without the change of density. The Universe does not know the Growth, it knows the Expansion. All these conclusions are detailed in the development of this article.

Background: The concurrent occurrence of acute ischemic stroke and acute myocardial infarction is an extremely rare emergency condition that can be lethal. The causes, prognosis and optimal treatment in these cases are still unclear.Methods: We conducted the literature review and 2 additional cases at Al-Shifa Hospital, we analyzed clinical presentations, risk factors, type of myocardial infarction, site of stroke, modified ranking scale and treatment options. We compare the mortality rate among patients with combination intervention treatment (both percutaneous coronary intervention for coronary arteries and mechanical thrombectomy for cerebral vessels) and medical treatment at the hospital and 90 days after stroke. Results: In addition to our cases, we identified 94 cases of concurrent cardio-cerebral infarction from case reports and series with a mean age of 62.5 ± 12.6 years. Female 36 patients (38.3%), male 58 patients (61.7%). Only 21 (22.3%) were treated with combination intervention treatment.The mortality rate at hospital discharge was (33.3%) and the mortality rate at 90 days was (49.2%). In patients with the combination intervention treatment group: the hospital mortality rate was 13.3% and the 90-day mortality rate was: 23.5% compared with the mortality rate in medical treatment (23.5% at the hospital and 59.5% at 90 days (p value 0.038 and 0.012 respectively) Conclusion: Concurrent cardio-cerebral infarction prognosis is very poor, about a third of patients died before discharge and half of the patients died 90 days after stroke. Despite only one-quarter of patients being treated by combination intervention treatment, this treatment modality significantly reduces the mortality rate compared to medical treatment.

Perineal burns are a rare finding in children that may cause severe complications. Vesicovaginal fistulas are an uncommon complication of a perineal burn that can be a tragedy for girls suffering from them. Fistula and/or its treatment are a socially debilitating problem with significant medicolegal implications. We present a rare case of a girl with a history of traumatic perineal burns who was diagnosed with a vesicovaginal fistula and repaired through a transvaginal approach.

Climate change is increasing the frequency of climate-related disasters, creating greater risks of hunger and the breakdown of food systems. The sustainability of our planet is currently a major concern for the global community and has been a central theme for a number of major global initiatives in recent years. Climate change has prevalent, multi-faceted, and temporal impacts on food security. Higher temperatures, water scarcity, extreme events like droughts and floods and greater CO2 concentrations in the atmosphere have already begun to impact staple crops around the world. The warming climate is already taking a toll on human health, causing widespread hunger and illness that will grow exponentially worse, and will pose a major threat to human well-being. In this article, an attempt has been made to discuss some critical issues relevant to the four dimensions of food security and to provide broader perspectives on climate change and its impacts on the food system, food security and human well-being.“Humanity is facing a rare challenge. But it is a common challenge. There are no sides in the fight for climate justice” (Kofi Annan’s message prior to the UN Climate Conference in Copenhagen 2009).

Hyperemesis gravidarum may prompt hypovolemia and significant electrolyte anomalies. Hypokalemia is one of the most common abnormalities. When practical, it may lead to rhabdomyolysis. We report a rare case of rhabdomyolysis in a 24 years old pregnant woman due to hyperemesis gravidarum. She had a profound weakness. Physical examination and laboratory findings showed a need for the hospital admission. Aggressive rehydration and electrolytes were the definite treatment. Her serum creatinine kinase (CK) concentration during entry was 80,01 units/L.Continuous rehydration led to complete recovery clinically. On discharge, she had normal laboratories.

Anesthesia for neurosurgery, “neuro-anesthesia”, involves techniques, drugs, monitoring and objectives as diverse as the area of surgical activity is vast (surgery for vascular alterations, tumors, craniostenosis, spine, epilepsy, etc.).

Climate change has left its traces on the planet in the last 3 decades. Most of the influenced areas were occupied in the Middle East which was degraded to desertification phenomena today. The per capita share of renewable water has been reduced to less than the poverty line of 1,000 m3/(capita) and in some Arab countries, to less than the extremepoverty line of 500 m3/(capita).

Cardiovascular Diseases (CVD) have become the leading cause of death worldwide: for no other reason as many people die every year from CVD. This problem affects low and middle-income countries to varying degrees. More than 80% of deaths from CVD occur in these countries, almost equally among men and women, however, patients who survived after Myocardial Infarction (MI) are at high risk of death. According to the main facts of the WHO, 17.9 million people died from CVD in 2016, which accounted for 31% of all deaths in the world. In this connection, it is necessary to improve medical rehabilitation and physical rehabilitation, in particular for CVD, especially on an outpatient basis. Competent physical rehabilitation and cardiac rehabilitation in patients with myocardial infarction are associated with improved survival and effectiveness of quality of life, as well as prevention of recurrent MI. There is a legislative framework FZ-No. 323 of 21.11.2011 “On the basics of health protection of citizens in the Russian Federation” concerning medical rehabilitation and “Procedure for organizing medical rehabilitation” No. 1705n of 29.12.2012.This study shows physical rehabilitation methods of health path and Nordic walking. Terrenkur is a method of sanatorium-and-spa treatment, which provides for dosed physical activity in the form of walking tours (5 km - 6 km daily at 12.00 - 13.00). Nordic walking - walking with sticks, a type of physical activity that uses a certain training methodology and walking technique with the help of specially designed sticks (5 km - 6 km daily at 12.00 - 13.00).Multiple meta-analyses showed that Cardiovascular Rehabilitation (CVR) reduces mortality in patients with coronary artery disease. Despite the recommendations and recommendations for the use of programs for patients with previous MI, patient participation in these programs remains low, which has led to the development of alternative models of medical rehabilitation.

Background: Among the different forms of ectopic pregnancy, cesarean scar pregnancy is one of the most uncommon with an estimated incidence of 1/1800 pregnancies. A major risk of massive hemorrhage, it requires active management as soon as it is diagnosed because it can affect the functional prognosis of the patient (hysterectomy) but can also be life-threatening. Different surgical techniques are generally proposed in first intention to patients who no longer wish to have children, who are hemodynamically unstable and/or in case of failure of medical treatment.Case presentation: We hereby report the case of a young 19-year-old patient with no particular medical history, gravida 2 para 1 with a live child born after a cesarean section for fetal heart rhythm abnormalities during labor 5 months earlier and who presented to the emergency room of our structure for the management of a cesarean pregnancy scar diagnosed at 6 weeks of amenorrhea. She was successfully managed with an intramuscular injection of methotrexate. The follow-up was uneventful.Conclusion: The implantation of a pregnancy on a cesarean section scar is becoming more and more frequent. With consequences that can be dramatic, ranging from hysterectomy to life-threatening hemorrhage, clinicians must be familiar with this pathological entity and be prepared for its management. The latter must be rapid and allow, if necessary, the preservation of the patient's fertility. In this sense, conservative medical treatment with methotrexate injections should be proposed as a first-line treatment in the absence of contraindication.

Background: Ovarian fibroma is a very unusual epithelial tumor representing less than 1% of all ovarian tumors. It can be asymptomatic and discovered during surgery or be associated with a pleural effusion preferentially located on the right side and a more or less abundant free ascites in the framework of the so-called Meigs syndrome. The challenge of management then lies in distinguishing benign from malignant since clinically, radiologically, and biologically everything points towards malignant which requires radical surgical treatment. We report here the case of a 69-year-old postmenopausal patient with a clinical form of Meigs' syndrome that strongly suggested ovarian cancer.Case presentation: We hereby report here the case of a 69-year-old patient, menopausal, gravida 4 para 3 with 3 live children delivered vaginally and one miscarriage. She presented with ascites, hydrothorax, and a solid tumor of the ovary. Serum CA 125 and HE 4 levels were very high. ROMA score was highly suggestive of malignancy. A hysterectomy with adnexectomy was performed. It was only the histological evidence of ovarian fibroma and the rapid resolution of its effusions that confirmed Meigs syndrome.Conclusion: Meigs syndrome is an anatomical-clinical entity that associates a benign tumor of the ovary, ascites, and hydrothorax. Highly elevated CA 125 and HE-4 tumor markers often point clinicians toward a malignant tumor and compel radical surgical treatment. This case report reminds us once again that only histology confirms the diagnosis of cancer.

Hydatid cysts primarily affect the liver and secondary involvement may be seen in almost any anatomic location. We describe the unusual pericardial location of the Echinococcus cysts in an asymptomatic patient with suggestive cardiac magnetic resonance imaging.

Rice bakanae disease is a typical seed-borne disease caused by Fusarium fujikuroi that occurs in seedling beds and in fields. Fungicide seed treatment is an effective solution to this disease. In this study, we used a triple-fungicide suspension identified as 11% FMA, which is composed of 1.1% fludioxonil, 3.3% metalaxyl-M and 6.6% azoxystrobin to coat rice seeds for the prevention of bakanae disease. 11% FMA is water-logging resistant for rice seed treatment. Results showed that the mycelial growth of F. fujikuroi was significantly inhibited by 11% FMA in the laboratory test. Seed dressing with FMA at the rate of 1, 2, and 4 g per kg of seeds promoted seed germination and growth of seedling roots. Treatment with 11% FMA under all dose rates prevented rice bakanae disease of seedlings by more than 90%, especially by more than 95% at 4, 6 and 8 g per kg of seeds. During the subsequent maturation period, rice bakanae control efficiency reaches above 95% as well at 6 or 8 g per kg of seeds, slightly larger than about 92% at 1 or 2 g per kg of seeds. Above all, the rice yield notably improved by 11% with 1 g/kg, by around 8% with 2, 4, or 8 g/kg and by 5% with 6 g/kg treatment. 

A highly focused and highly cost-effective failure-oriented-accelerated-testing (FOAT) suggested about a decade ago as an experimental basis of the novel probabilistic design for reliability (PDfR) concept is intended to be carried out at the design stage of a new electronic packaging technology and when high operational reliability (like the one required, e.g., for aerospace, military, or long-haul communication applications) is a must. On the other hand, burn-in-testing (BIT) that is routinely conducted at the manufacturing stage of almost every IC product is also of a FOAT type: it is aimed at eliminating the infant mortality portion (IMP) of the bathtub curve (BTC) by getting rid of the low reliability “freaks” prior to shipping the “healthy” products, i.e., those that survived BIT, to the customer(s). When FOAT is conducted, a physically meaningful constitutive equation, such as the multi-parametric Boltzmann-Arrhenius-Zhurkov (BAZ) model, should be employed to predict, from the FOAT data, the probability of failure and the corresponding useful lifetime of the product in the field, and, from the BIT data, as has been recently demonstrated, - the adequate level and duration of the applied stressors, as well as the (low, of course) activation energies of the “freaks”. Both types of FOAT are addressed in this review using analytical (“mathematical”) predictive modeling. The general concepts are illustrated by numerical examples. It is concluded that predictive modeling should always be conducted prior to and during the actual testing and that analytical modeling should always complement computer simulations. Future work should be focused on the experimental verification of the obtained findings and recommendations.

Introduction: Percutaneous kidney biopsy is a necessary tool to diagnose many kidney diseases. However, major complications were reported in adults, including bleeding in the kidney or around it, creation of arteriovenous fistula, wound infection, damage to adjacent organs, or even loss of the kidney. Such complications can rapidly develop serious consequences. Exploring risk factors might help in preventing them.Objective: The current study aims to evaluate and explore the complications that happened after percutaneous kidney biopsy in children and associated risk factors.Methodology: A retrospective record-based study was conducted by reviewing the medical records of children with post-ultrasound-guided percutaneous kidney biopsy complications at King Saud Medical City, a tertiary hospital in Riyadh, Saudi Arabia during the period from May 2014 to June 2021. Data were extracted using pre-structured data collection sheet. Data collected included children’s age, gender, primary disease, laboratory findings, and kidney complications with needed management. Results: The study identified 76 children who had undergone 86 ultrasound-guided percutaneous kidney biopsies in the study period and fulfil the inclusion criteria. Children’s ages ranged from 1 years to 15 years with a mean age of 7.3 ± 4.0 years old. Most of the study children had nephrotic syndrome (61.6%; 53), followed by glomerulonephritis (25.6%; 22). Thirty-five (40.7%) children developed at least one of the complications. The most-reported complication was microscopic haematuria (32.6%; 28), followed by gross haematuria (3.5%; 3), Flank pain was reported among 3 (3.5%) children also and hematoma (1 child), only 2 children (3.9%) among those who had no complications recorded Haemoglobin drop > 2 g/dl compared to 3 of those who had complications with no statistical significance (p = .365). Prothrombin time was significantly higher among children who had renal complications than others who had not (11.7 ± 1.8 vs. 10.8 ± 1.2 seconds; p = .022).Conclusion: Suggestive by the low need to intervene in complications, ultrasound-guided percutaneous kidney biopsy is a relatively safe procedure in children. Even in the most commonly observed complication, i.e. hemorrhagic ones, blood transfusion is rarely needed.

Aims: To analyze the prevalence and risk factors for postoperative lower urinary tract symptoms (LUTS) in women submitted to robot-assisted sacrocolpopexy (RASC) for correction of pelvic organ prolapse (POP).Methods: A longitudinal prospective study was carried out on 51 consecutive women who underwent RASC to treat POP. We recorded preoperatively the presence of LUTS urgency, symptomatic stress urinary incontinence (SUI), and voiding difficulty. We also performed an urodynamic study prior to surgical intervention including an incontinence test for overt and occult stress urinary incontinence (with POP reduction). A transobturator suburethral sling (TOT) was implanted in patients with demonstrable urodynamic SUI (overt or occult). Patients' LUTS were reassessed at 6 months after the surgical intervention. McNemar test and the Fisher exact test were used to analyzing dependent variables and Student’s t - test for independent variables. Statistical significance was set at p ≤ 0.05.Results: Postoperative voiding difficulty and symptomatic SUI were significantly reduced. No significant differences were observed in the postoperative prevalence of urgency. The presence of preoperative urinary urgency was the only significant risk factor of postoperative urgency, whereas TOT placement was the only significative factor associated with postoperative symptomatic SUI. TOT placement in patients with occult SUI significantly reduced postoperative Symptomatic SUI.Conclusion: RASC reduces the prevalence of voiding difficulty but not urgency. Concomitant implantation of TOT in patients with preoperative urodynamic SUI (overt or occult) is useful to reduce symptomatic postoperative SUI.

The terms urotherapy and urotherapist are often mentioned in the literature, but their origins and meanings are less well-known. Objective: To describe the background and development of the concept of urotherapy in pediatric care and the profession of urotherapist.Methods: Data has been searched for in Medline PubMed and selection has been limited to papers important for the purpose.Results: Understanding of urinary bladder function was developed in the 1970’s, mainly due to new urodynamic methods opened up for possible treatment options. Standard urotherapy is a concept developed in the 1980’s and aims to treat dysfunction by helping the patient to learn to understand bladder function and then practice certain techniques in order to normalize it. To succeed, guidance and support are needed from a skilled urotherapist. In Scandinavian and German-speaking countries, quality-assured training for urotherapists at the university level is available.Conclusion: Urotherapy standard therapy is a non-invasive treatment recommended as the first-choice treatment for lower urinary tract disorders. However, we must have requirements as to what knowledge a urotherapist needs to have, and training has to be certified and be at the university level.

Polychlorinated dibenzo-p-dioxins, dibenzofurans and dioxin-like polychlorinated biphenyls are persistent organic pollutants (POPs), which in recent years received huge attention due to their extreme stability, high potential toxicity and bioaccumulation in food chains. The main source of human exposure to these compounds is discovered in foods of animal origin, especially foods rich in fat. The target of the present study was to set up an analytical method for the determination of PCDDs/PCDFs and DL-PCB in vegetable oils, sunflower meals, sunflower seeds, rapeseeds and milk powder. The first step consisted of a semi-automatic Soxhlet extraction for 3 hours, by using a mixture of Hexane: Acetone – 80:20, followed by acid digestion with 55% acid silica and filtration. After concentration, the extract is purified on a multilayer column (silica gel, silica-KOH, silica-H2SO4 anhydrous Na2SO4) followed by an alumina column separation in two fractions (first fraction containing PCDDs/PCDFs and second containing only PCBs). The purified extract was then analyzed by GC/MS/MS. The newly developed approach in our lab was capable to reduce the overall time of sample preparation to seven hours/ per sample. Since the method shows good mean recoveries for all labeled congeners spiked in the samples (for PCDDs/PCDFs – 80% - 110%, for DL-PCBs – 70% - 85%), we assumed the absence of overestimation or underestimation in the analyzed samples.

Cancer is a disease that implies several different genotypic and phenotypic traits in its whole process of development: tumorigenesis.

Introduction: Diabetes mellitus and diabetic nephropathy are the most common causes of end-stage renal disease (ESRD) in developed countries, accounting for about 30% of these cases. Up to 40% of patients with type 2 diabetes with micro albumin uria progress to overt nephropathy and develop ESRD after one to two decades. Albumin uria is the most important indicator of diabetic nephropathy and its progression. Also, hyperuricemia has been suggested as a risk factor for kidney damage, this study was designed to determine the relationship between serum uric acid level and proteinuria in patients with type 2 diabetes.Materials and methods: In this descriptive-analytical and cross-sectional study, data collection was performed among patients with type 2 diabetes referred to the diabetic Center in Gorgan from the years 2015 to 2018. The data collection tool was a two-part questionnaire including demographic and anthropometric characteristics and information about the disease. Serum levels of Uric Acid, Blood Urea Nitrogen (BUN), Creatinine (Cr), Fasting Blood Sugar (FBS) and Hemoglobin A1C (HbA1C) were measured in all patients. 24-hour urine collection was performed for proteinuria, albuminuria, urinary volume, and Cr volume. Patients’ GFR was also calculated using the CKD-EPI formula. Patients were re-evaluated 1 year after the initial evaluation in terms of measured factors and the relationship between serum uric acid and albuminuria, proteinuria, kidney function, and other serum factors were evaluated.Results: Among 823 diabetic patients that were referred to the nephrology center in this study, 90 patients were included. 34 (37.8%) of these patients were men. The age range of patients was between 32 years to 70 years with a mean of 56.31 and a standard deviation of 7.84 years. According to the Pearson correlation coefficient, a direct correlation was observed between uric acid with proteinuria and creatinine levels, and an inverse correlation was observed between uric acid and GFR. But we didn’t find any correlation between uric acid and microalbuminuria.Conclusion: According to the results of this study, the relationship between uric acid level and the severity of nephropathy (based on proteinuria) is proven. It seems that maintaining serum uric acid levels in patients with type 2 diabetes within the normal range and treatment with serum uric acid-lowering drugs may be possible to reduce the progression of diabetic nephropathy and proteinuria.

Aim: The current paper presents a subjective symptom survey regarding postpartum discomfort (Study 1) and a case study on postpartum care using the program developed based on the survey results (Study 2). Thereafter, health care during the postpartum period is discussed.Methods: Study 1 analyzed 1638 postpartum women who completed the Subjective Fatigue Symptom Scale (SFSS) over the period from June 2012 to December 2019. Study 2 detailed the case of a 33-year-old primiparous woman who answered questions regarding the rehabilitation care program.Results: The 1638 subjects included in Study 1 had a mean age of 32.4 ± 8.2 years and a mean postpartum duration of 4.3 ± 2.3 months. Subjective symptoms included lower back pain, shoulder stiffness, sleepiness, wanting to lie down, yawing, and eye strain. The case included in Study 2 showed certain psychological and physical changes following the exercise program. The results of Study 1 showed that motor system discomfort, such as stiff shoulders and lower back pain, occurred in women across all postpartum stages. Our results demonstrated that care and exercise geared toward improving motor system function are imperative after childbirth. Meanwhile, the results of Study 2 imply that our rehabilitation program based on postpartum physical conditions had positive psychological and physical effects.Conclusion: Taken together, our results suggest that continuing rehabilitative care based on the physical condition during each postpartum stage facilitates improvement in mothers’ physical and psychological discomfort.