Andrology Department Research Articles

P-018 Serum Follicle-Stimulating Hormone (FSH) levels as a predictor of outcomes after Surgical Sperm Retrieval (SSR) for male infertility

Abstract Study question Is there an association between pre-operative FSH levels and successful outcomes following Surgical Sperm Retrieval (SSR), and subsequent fertility treatment? Summary answer Higher levels of pre-operative FSH are associated with unsuccessful SSR, and, in the cases of successful retrieval, sperm less likely to produce healthy live births. What is known already Surgical Sperm Retrieval (SSR) techniques combined with Intracytoplasmic Sperm Injection (ICSI) offer men with azoospermia a chance to father biological children. However, the variable success rates of these physically, psychologically, and financially costly procedures highlights the potential value of pre-operative predictors of success. A literature review indicated serum FSH a promising pre-operative prognostic factor. However, only very few papers investigated pregnancy outcomes as an endpoint. Study design, size, duration An extensive literature review was undertaken examining literature between 2015-2020. This led to determination of the serum cut-off level to apply to the different groups’ outcomes. The study was a retrospective clinical analysis of SSR offered by a university Hospital between 2014-2021. Sample size was 118 (mainly Testicular Sperm Aspiration (TESA) and Percutaneous Epididymal Sperm Aspiration (PESA) patients. Patients with Klinefelter’s (KF) (N = 3) were excluded from analysis due to the genetic nature of their azoospermia. Participants/materials, setting, methods Databases from the University Hospital's Theatres and Andrology Department provided data on patients who underwent SSR 2014-present. A retrospective evaluation of physical and electronic notes identified preoperative hormone profiles and other potential influencers. Pregnancy outcomes were ascertained from the ICSI and Frozen Embryo transfer (FET) databases. Using a serum FSH cut-off of 15IU/mL (chosen based on previous literature review) data was analysed for differences between the groups’ outcomes. ROC analysis generated potential alternate cut-offs. Main results and the role of chance Using the initial 15IU/mL cut-off analysis demonstrated significantly more patients had unsuccessful SSR and sperm that did not produce healthy live birth where FSH was ≥15IU/mL at a 95% confidence level. The ROC curves for both SSR and pregnancy outcomes also proved significant – suggesting various potential cut-offs from our data. One potentially valuable cut-off for identifying men unlikely to produce sperm capable of producing a healthy live birth following all treatment is 14.0IU/mL (FSH above this predicting failure in pregnancy outcomes) (sensitivity 40.8%, specificity 90.5%), i.e., above this level the model predicts 90.5% of men will not have success. The lower bound 95% CI for this curve was above 0.5, indicating the curve to be statistically significant at a 95% confidence level. Limitations, reasons for caution SSR is rare and a lack of documentation available for some patients resulted in a relatively small sample size. Our data comprises primarily TESE and PESA patients. Different surgeon technique or service standards may influence outcomes. Our findings did not consider KF patients, who may have favourable SSR outcomes. Wider implications of the findings SSR is a costly procedure financially and physically with variable success rates. Hopefully these findings can help counsel men as to their likelihood of success in having a healthy live birth following SSR and subsequent treatment, helping to reduce both a financial burden on services and emotional burden on patients. Trial registration number Not applicable

P714: EFFECT OF TYROSINE KINASE INHIBITORS ON MALE FERTILITY IN PATIENTS WITH CHRONIC PHASE CHRONIC MYELOID LEUKAEMIA

Background: With the current availability of 3+ generations of tyrosine kinase inhibitors (TKIs) and the resultant survival benefit, chronic phase chronic myeloid leukaemia (CP-CML) is considered a chronic disease for most patients. Consequently, haematologists are faced more with questions regarding the effects of treatment on fertility and pregnancy outcomes. Whilst the teratogenic effect of TKIs is well established, data on their effect on fertility, and especially male fertility, are scarce. Semen analysis parameters (sperm number, motility and morphology) remain the cornerstone in assessing male fertility, despite its limitations in comprehensively assessing sperm functions. Aims: To compare semen analysis parameters before and after TKI therapy in CP-CML patients treated in the haematology department of Imperial College Healthcare NHS Trust (ICHNT). Methods: In collaboration with the Andrology Department, newly diagnosed men with CP-CML are offered sperm banking before starting cytoreductive or TKI therapy, and sperm analyses are routinely undertaken. Patients treated with TKIs who had sperm banking at diagnosis were invited for repeat semen analysis. Treatment history and semen analysis parameters were collected from patients’ paper/electronic medical records. Median and range were used to summarize continuous non-parametric data. Paired sample t-test was used to compare continuous semen analysis parameters before and after TKI therapy. Double-sided p value of < 0.05 was considered as statistically significant. SPSS version 25 software was used for statistical analysis. Results: Twenty-five patients were identified to have a semen analysis performed around the time of starting TKI therapy and were approached for repeat testing. Of those, 13 refused to participate, 1 was an international patient no longer residing in the UK and 1 stopped TKI therapy for treatment free remission trial. Therefore, 10 patients were finally included. Median age at diagnosis was 35.6 years (range: 22.9-45.4) and patients were diagnosed between 2001 to 2014. Six and 2 patients received hydroxyurea and interferon α, respectively, before TKI therapy. Six patients received 1 TKI (imatinib (IM), n = 4; nilotinib (NIL), n = 1; bosutinib (BOS), n = 1), 2 received 2 TKIs (IM followed by NIL), and 2 received 3 TKIs (IM, DAS, NIL and IM, NIL, DAS). Switches were for failure and/or intolerance. Median duration of TKI therapy at the time of repeat semen analysis was 5.9 years (range: 3.3-16.5). Patients 6 and 10 had the initial semen analysis after 736 and 475 days, respectively, from commencing TKI therapy and all remaining patients had it before starting. All patients had a deep molecular response at the time of the repeat semen analysis. The differences between sperm concentration, % progressive motility and % total motility were all non-statistically significant (p = 0.457, 0.535, and 0.574, respectively). In 2 patients the semen parameters were below the reference ranges in both occasions. Morphology (% normal forms) was less than the reference 4% in the repeat samples of 5 patients (Table 1). Image:Summary/Conclusion: In our cohort, no significant differences were found in sperm concentration or motility before and after treatment with different TKIs for a prolonged period. The relevance of the finding of a low % of normal forms, in the presence of normal sperm concentration and motility, in some of the patients in the semen sample after TKI therapy is not clear. Studies with larger sample size would be needed to confirm or refute our findings.

Microvascular Doppler Assisted Microsurgical Denervation of the Spermatic Cord in Treating Chronic Orchialgia.

Chronic orchialgia is a common disease in department of urology and andrology. The etiology is complex, and the treatment is difficult. In severe cases, orchiectomy is even necessary. In recent years, microsurgical denervation of the spermatic cord (MDSC) is a minimally invasive and effective surgical method for the treatment of chronic orchialgia. Its greatest advantage is to preserve the testis and epididymis, avoid the possible organ resection. The key of the operation is to dissect all the fibrous tissues in the spermatic cord, while protecting the arteries (especially the testicular arteries) and several lymphatic vessels. Combined with the use of microvascular doppler in the operation, when separating the structure of spermatic cord under the microscope, the testicular arteries can be objectively and accurately protected (pulse "whistle" sound can be heard when the microvascular doppler probes the arterial surface), while artery injury and venous missed ligation can be avoided. The postoperative blood supply of the testis is also maximumly safeguarded. At the same time, we can be more fearless to cut the cremaster muscle, fatty and connective tissues surrounding the spermatic cord blood vessels and vas deferens after the arteries and lymphatic vessels being accurately protected under the microscope, finally achieve the spermatic cord completely "skeletonized" (only the testicular arteries, lymphatic vessels and vas deferens remained after the surgery). Thus we can better ensure the clinical curative effect (denervation thoroughly), avoid serious complications (testicular atrophy), and achieve better surgical results.

Investigating the microbial pathogens of sexually transmitted infections among heterosexual Vietnamese men with symptomatic urethritis

Objective To explore the microbial etiology of urethritis in Vietnamese men and the association with patients’ characteristics, especially their sexual behaviors. Methods This study was conducted on 349 men who presented with symptomatic urethritis and evidence of STIs (determined by multiplex PCR tests) at the Department of Andrology and Sexual Medicine—Hanoi Medical University Hospital. All information regarding medical history, sexual activities, and symptoms of urethritis was documented. Results C. trachomatis and N. gonorrhoea remained the two most common causative pathogens, followed by an unexpectedly high prevalence of Mycoplasma and Ureaplasma species. Coinfection was significant with a rate of 40.7%. Men who had sex with female sex workers (FSWs) were more likely to be positive with N. gonorrhoea but less likely to be positive with C. trachomatis and M. genitalium than those having sex with only one romantic partner. Conclusions Our findings suggested the important role of other microorganisms, especially M. genitalium, in the etiology of urethritis in men besides the previously well-known causes of STIs. Since the coinfection rate is quite high, targeted treatment with clear microbial evidence should be considered rather than empiric antimicrobial therapy.

METHOD OF USING SPERMATOGONIAL STEM CELLS IN NON-OBSTRUCTIVE AZOOSPERMIA

METHOD OF USING SPERMATOGONIAL STEM CELLS IN NON-OBSTRUCTIVE AZOOSPERMIA Rano Zhankina master of Medicine, Urologist, doctoral student of the Department of Urology and Andrology of NAO &quot;Astana Medical University&quot;, Kazakhstan, Nur

Impact of childhood atopic dermatitis on family

Background Atopic dermatitis (AD) is a common skin disease that not only severely burdens patients but also their families and society. AD is a chronic inflammatory disease that is usually detected in childhood. Objectives We aim to evaluate the quality of life of parents of children with AD and to crosscheck it with the intensity of the disease. Patients and methods This is a cross-sectional study, where the data of parents of 100 children with AD were collected from the outpatient clinic of the Dermatology, Venereology, and Andrology Department, Assiut University Hospitals, from May 2017 to May 2019. Parents answered the validated Arabic version of the Dermatitis Family Impact (DFI) questionnaire. The disease severity was assessed using the SCORAD index. Results Families of children with severe dermatitis had quite high DFI scores (16.37±3.727) compared with the families of those with dermatitis of moderate intensity (12.10±3.356) and dermatitis of low intensity (8.50±0.707) (P&lt;0.001). It was observed that the impact of dermatitis on families had a positive significant correlation with the degree of intensity of AD (P&lt;0.001, r=0.658). The highest-scoring DFI domains were sleep time, followed by a feeling of tiredness, emotional stability, general life, household work, and expenditure. Conclusion AD directly affects the quality of life of patients’ parents, and the adverse effects on the quality of life are significantly correlated with the disease severity.

Epidemiological Aspect of the Activities Carried Out in the Urology and Andrology Department of the Central Hospital of Yaounde during the Covid 19 Period

Epidemiological Aspect of the Activities Carried Out in the Urology and Andrology Department of the Central Hospital of Yaounde during the Covid 19 Period

Directions of Development of Modern Genital Surgery. Features, Details, Nuances

The quality of life and self-esteem of a modern man are largely determined by the appearance and functional state of his genitals. The quite high demand for improving the morpho-functional properties of the penis is the driving force of progress in the field of penile surgery. Despite the positive meaning of the surgical arsenal diversity for meeting the needs of the patient, the latter puts additional requirements for standardization, safety assessment and development of algorithms for their selection. Under these circumstances, there is a significant need for publications that inform specialist with the practical aspects of external genital surgery in men. The objective: to analyze modern algorithms for managing patients with various pathologies / defects of the penis (penile dysmorphophobia, erectile dysfunction, Peyronie’s disease, congenital deviation, priapism, cavernous fibrosis, trauma and tumors) and methods of their surgery. Materials and methods. Bibliosemantic material that covers current aspects and trends of genital surgery over the past 10 years, and case reports of patients who applied to the Department of Sexopathology and Andrology of the Institute of Urology of the National Academy of Medical Sciences of Ukraine with penile pathology that required surgical correction. Results. It is demonstrated that the algorithm of managing a patient with anatomical defects of the penis, should include: analysis and correction of deformation based on geometric principles; increase in size and / or elongation of the short side (small curvature); minimization of complications (loss of sensitivity, hematoma, necrosis); preservation or restoration of erectile function; restoration of the urethra (length and caliber), normalization of the urination, restoration of a full sexual life with adequate psychological adaptation. It has been shown that severe erectile dysfunction, which is not amenable to therapeutic correction, requires the penile implantation. On the other hand, penile implantation is contraindicated in uncompensated diabetes mellitus, decompensation of the cardiovascular system, late-stage cancer, acute inflammatory processes of various localizations, mental illness, skin lesions of various etiologies in the area of the scrotum and penis, in patients with a high frequency of repeated endoscopic procedures, tissue defects in the area of operation with the predicted inability to stretch, hypersensitivity to silicone, the mismatch of the size of the corpora cavernosa to the size of the selected type of implant. It has been proven that ligamentotomy and corporoplasty prevent the loss of penis length after implantation, but increase the likelihood of complications. Complications of penile implantation include: prosthesis-associated infection, erosions, migration or extrusion of the prosthesis, migration of proximal tips, mechanical failure of the prosthesis, tissue and / or allergic reaction, acute urinary retention, pain, hematoma, edema, edema and lymphoma intraoperative perforation of the urethra or corpora cavernosa. Clinical cases of certain complications and methods of their elimination are given. The choice of method of correction of penile deviation is determined by the state of erectile function, the length of the penis, the angle of curvature, the wishes of the patient. Grafting (short penis, angle of curvature&gt; 60 °, presence of deformities) or plication (sufficient length of the penis, angle of curvature &lt;60 °, no deformities) can be performed if erectile function or pharmacotherapy is preserved. At erectile dysfunction at condition of inefficiency of pharmacotherapy implantation is shown. Conclusion. At the present stage, the main direction of movement in genital surgery is a combination of aesthetics and functionality. A specialist in penile surgery must have the skills of a urologist, andrologist, aesthetic surgeon and psychologist. In patients with penile dysmorphophobia, subjective assessment of the appearance of the genitals correlates with psychological status. The main psychological feature of a patient with penile dysmorphophobia is dissatisfaction with the size of the penis (length and / or thickness) at normal anatomical proportions. The modern arsenal of penile surgery is diverse and includes methods of correction of deviations / deformations, increase in size (length / thickness); axial rigidity, urethral capacity (length and caliber), during which implants can be used. Penile surgery is associated with the risk of severe complications: loss of sensitivity of the penile glans, hematoma, necrosis, prosthetic infection, rupture of the the corpora cavernosa and urethra. Further research should determine optimal algorithms for selecting certain surgical techniques taking into account aesthetic, functional criteria and safety.

Semen and Spermatozoa Characteristics in Alcohol Users and Non-Users

Introduction: Increasing infertility rate worldwide raises research to investigate plausible reason health community. To find out the characteristics of semen and spermatozoa in alcohol users and compare these characteristics with that of non-users of alcohol.&#x0D; Methodology: The data on alcohol use and semen analysis were obtained from case records of patients reported to the Department of Andrology &amp; Reproductive Medicine of a tertiary care hospital for a period of one year from January 2018 to December 2018. The semen volume, sperm concentration, motility and morphology in alcohol users were compared with non-users.&#x0D; Results: A total of 231 patients had reported to the Department of Andrology &amp; Reproductive Medicine during the study period. Among them 81 (35.06%) were alcohol users and 150 (64.94%) alcohol non-users. Analysis of their semen reports revealed that the difference in semen volume and sperm morphology was not found to be statistically significant, but the sperm concentration and progressive motility of spermatozoa showed significant reduction in alcohol users compared to non – users (p&lt;0.05).&#x0D; Conclusion: The semen volume and sperm quality were found to be low in alcohol users. Among the spermatozoa characteristics, sperm concentration and motility were significantly reduced in alcohol users.

Effect of Anabolic-Androgenic Steroids on Semen Parameters and Serum Sex Hormonal Levels in Egyptian Male Bodybuilders

Abstract Background First identified in 1935, testosterone is the principal hormone controlling the development of androgenic-masculinizing effects in the male body, along with its anabolic properties that increase lean muscle mass. Objectives We aim at studying the influence of anabolic androgenic steroids on the semen parameters and serum sex hormonal levels in Egyptian male bodybuilders. Patients and Methods The type of study was cross sectional study. Study setting was conducted in Dermatology, Venereology and Andrology Department, Ain Shams University Hospitals. The study included 20 male body builders using AAS as the study group and 20 body builders who exercise only and not using AAS. 20 subjects who exercise only without androgenic anabolic steroids use. Results In the present study, there were statistical significant differences between ASS group and control group as regard semen volume, sperm concentration, total sperm count, sperm agglutination and rounded cells. Bodybuilders in ASS group had significantly lower semen volume, sperm concentration, total sperm count; and higher liquefaction, sperm agglutination, and rounded cells. Conclusion AAS has a negative impact on semen quality and sex hormone levels among male bodybuilders. In the present study, AAS users exhibited significantly lower plasma testosterone levels and increase FSH and decrease LH hormone higher frequencies of abnormal semen parameters than healthy control participants. These results should provoke concern, particularly because the use of anabolic steroids by exercising men for muscle building is based on self-designed personal schemes or is suggested by a partner, by field magazines, or by trainers at the gyms. Further, large-scale, studies are still needed to confirm our findings.

Serum Interleukin-15 in Alopecia Areata and its correlation with dermoscopic findings

Abstract Background Alopecia areata is an autoimmune hair loss which frequently starts in childhood. Its presentation had an extreme variability not only in the time of initial onset but also in the duration, extent, and pattern of hair loss during any given episode of active loss. Moreover, the course of disease is unpredictable, with spontaneous regrowth of hair occurring in 80% of patients within the first year and sudden relapse at any given time. Due to the clinical variability and unpredictable nature of spontaneous regrowth, diagnosis and management may be difficult and challenging. Objective The aim of this study is to evaluate the serum levels of IL-15 in active alopecia areata and correlate them with disease severity and activity according to dermoscopic findings. Methods This case-control study were conducted in Dermatology, Venereology and Andrology department, Ain Shams University Hospitals included 30 patients with different clinical variants of AA, the diagnosis was made via clinical examination and dermoscopic findings. In addition, 30 apparently healthy individuals of matched age and sex as a control group were included in the study. Results Dermoscopic examination among cases showed that the most common dermoscopic findings in patients were vellus hair and yellow dots, while the least common finding was exclamation mark hairs. On comparing serum IL-15 in patients and control groups, it was found that serum levels of IL-15 in patients were significantly higher than those in the control group. There was no statistically significant difference in serum IL-15 levels between patients with negative and positive pull test, nail involvement, or body involvement. Similarly, no statistically significant difference in serum IL-15 levels in patients with various subjective disease activity was detected. However, there was a highly significant difference between serum IL-15 levels in different SALT score groups, with the highest levels being in the S3 group. There was a highly significant difference between IL-15 levels in patients with and without black dots. Also, there was significant difference between IL-15 in patients with and without broken hair, and exclamation mark hair. There was no significant difference in level of IL-15 among patients with and without yellow dots, and with and without vellus hair. Conclusion On the basis of the current study, we can conclude that IL-15 is significantly elevated in AA patients when compared to the control subjects. It is also a possible marker of AA severity. It is positively correlated with dermoscopic findings in AA patients, so dermoscopic findings can be useful in evaluating severity of alopecia areata.

Efficacy and Safety of Topical 2% Glycopyrrolate in the Treatment of Facial Hyperhidrosis

Background: Facial hyperhidrosis is a frequent complaint characterized by excessive sweating which usually affects the forehead bilaterally but can also involve other regions of the face such as the scalp, nose, chin and less frequently cheeks. The topical application of 2% glycopyrrolate is safe, efficacious, well tolerated and convenient method in the treatment of facial hyperhidrosis. Objective: The aim of this study was to evaluate the clinical efficacy, safety and tolerability of topical 2% glycopyrrolate in the treatment of facial hyperhidrosis. Patients Methods: This clinical trial was conducted in the Outpatient Clinics of Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University Hospitals. Twelve patients suffering from primary facial hyperhidrosis were included in this study. They were treated by topical glycopyrrolate gel 2%. Each patient applied the test product to the area affected in their faces once a day for 9 days. Response to treatment was evaluated by starch iodine test. Patient’s satisfaction level and adverse effects were also evaluated. Follow up evaluation was done for detection of any recurrence. Results:9 patients (75%) showed complete response and 2 patients (16.7%) showed partial response. Only one patient showed no response to topical glycopyrrolate 2% after 10 days of treatment. The improvement was lost in 8 patients (66.7%) on the 3rd day of stoppage of treatment and on the next day of stoppage of treatment among 3 patients (25%). Conclusion: Topical glycopyrrolate 2% is safe, efficacious, well tolerated and convenient method in the treatment of facial hyperhidrosis with minimal, transient and well-tolerated side effects.

Prevalence of Metabolic Syndrome in Men with Erectile Dysfunction

Abstract Background Erectile dysfunction, as defined by the International Consultation on Sexual Medicine, is the consistent and recurrent inability to acquire or sustain an erection of sufficient rigidity and duration to engage in satisfactory sexual intercourse. Objectives The aim of this study was to identify the prevalence of MetS among patients with ED. Patients and Methods This was a cross sectional study conducted on 200 patients attending the Andrology clinic of Dermatology, Venereology and Andrology department, Ain-Shams University starting from March 2019 till December 2019. The 15-question IIEF Questionnaire is a validated, multi- dimensional, self-administered investigation that has been found useful in the clinical assessment of ED and treatment outcomes in clinical trials. Results The mean ± SD of age of patients with ED in our study was 58.3 ± 20.1 years. Out of the 200 patients, 110(55%) of them had BMI (25-29.9). and over 30 in 35(17.5%) patients. The mean ± SD of WC was 41.4±4.9 inches. Among the 200 patients, hypertension was present in 125(62.5%) and smoking in 165 (82.5%) patients. Among the 200 patients, 96 (48%) patients had MetS. Among 200 patients, 90 (45 %) had mild, 54 (27.0 %) had moderate. and 56 (28 %) had severe ED. A significant association was determined between the presence of MetS and severity of ED. The prevalence of moderate and severe ED was significantly higher in patients with MetS than patients without MetS. There was a negative significant correlation between IIEF scores and age, systolic BP, and diastolic BP. Conclusion Among the 200 patients, 96 (48%) patients had MetS. Incidence of moderate to severe ED was higher among patients with MetS versus those without. There was a negative significant correlation between IIEF scores and age, systolic BP, and diastolic BP.

Split face comparative study of microneedling with platelet rich plasma versus Fractional carbon dioxide laser with platelet rich plasma in treatment of atrophic post acne scars

Abstract Background Acne scars, is a challenge for dermatologists, despite having multiple treatment modalities like microneedling, dermabrasion, Fractional CO2 Laser, dermal fillers, etc. However, monotherapy has been hardly satisfactory because of the polymorphism seen with the scars. Objective Comparison between microneedling with platelet rich plasma versus Fractional carbon dioxide laser with platelet rich plasma in treatment of atrophic post acne scars. Patients and methods This study was carried out in department of dermatology, venereology and andrology, in Kobry El-Kobba Military complex during the period (from September 2018 to July 2020 ) on 20 patients of both sexes aged from 20 to 60 years old presenting with Goodman and Baron Grade II, III, IV acne scars . Results The study revealed a statistically significant difference (p = 0.017) between Goodman and Baron scar grades on the right side of the face before and after treatment indicating that microneedling with platelet rich plasma was effective in improving acne scars. Also, there is a statistically significant difference (p = 0.010) between Goodman and Baron scar grades on the left side of the face before and after treatment, indicating that fractional CO2 laser with platelet rich plasma was effective in improving acne scars. Conclusion and recommendation Further controlled and randomized studies are needed to validate our findings in a larger cohort of patients and longer follow up. Also, number of sessions might be more than 3 sessions.

Serum level of interleukin-17A in patients with alopecia areata and its relationship to age of patients and disease recurrence

Introduction Alopecia areata (AA) is a relatively common reversible patchy hair loss of the scalp. It is usually manifested as patchy areas of complete hair loss on the scalp and sometimes with or without other body parts that can progress to complete loss of all body hair. This disorder affects all age groups, with a higher incidence in children and adolescents. AA is an autoimmune disorder characterized by hair cycle dysfunction with peribulbar and perifollicular mononuclear cell infiltrates. Aim To estimate interleukin-17A (IL-17A) serum level in patients with AA as well as study its relationship with the age of the patients, severity, and recurrence of disease. Patients and method s The study was carried out in Outpatient Clinic of Dermatology, Venerology, and Andrology Department, Zagazig University Hospitals, on 45 patients with AA of both sexes. Results were compared with 45 healthy participants with matched age (5–50 years). Results The present study included two groups: patient group included 45 patients diagnosed clinically with AA and control group included 45 age-matched and sex-matched healthy individuals. Conclusion The significantly higher levels of serum IL-17A in patients with AA suggest a possible role of IL-17A as a proinflammatory cytokine in the pathogenesis of AA and that IL-17A level may be influenced by age and disease recurrence in patients with AA.

Serum Adiponectin Level in Patients with Psoriasis and its Correlation with the Clinical Severity

Background: Psoriasis is a common chronic immune mediated papulosquamous disease that affects 2-3% of the population. The exact cause of psoriasis is still unclear, but it is considered a disease of dysregulated inflammation which is driven and maintained by interaction among multiple components of immune system in genetically predisposed individuals. Adipose tissue is an active endocrine organ contributing to the regulation of multiple metabolic pathways via self-produced bioactive products called adipokine. Adiponectin of adipose origin has the highest circulating concentration among the known adipokines. Adiponectin regulates skin inflammation especially IL-17-related psoriasiform dermatitis. Objective: This study was aimedto estimate the serum level of Adiponectin and detect its correlation with activity of psoriatic patients. Patients and Methods: This case control study included a total of 50 patients with psoriasis and 50 healthy individuals, attending at Outpatient Clinic, Department of Dermatology, Venereology and Andrology in collaboration with Department of Clinical Pathology, Faculty of Medicine, Zagazig University Hospitals. This study was conducted between November 2019 to November 2020. Psoriasis severity was classified according to psoriatic area and severity index (PASI) score. Serum level of adiponectin was determined by ELISA for both groups. Results: The results revealed that control group had significantly higher level of adiponectin than psoriasis patients. There was a negative significant correlation between adiponectin and Psoriasis Area and Severity Index (PASI score) (p <0.001**). Sensitivity of adiponectin in diagnosis of psoriasis was 94%, specificity was 90% and accuracy was 92%. Conclusion: Adiponectin measurement in serum of patients with psoriasis provides a tool for monitoring disease activity.

COMPARISON OF INTRALESIONAL METHOTREXATE WITH TRIAMCINOLONE ACETONIDE IN TREATMENT OF HYPERTROPHIC SCARS

Background: Keloid and hypertrophic scars are common dermatological complaints produced by disruption of the normal wound-healing process. Since their earliest description, keloids have beleaguered patients and clinicians alike. These scars can be aesthetically disfiguring, functionally debilitating, and emotionally distressing. Objective: Our study was carried out on 40 patients complaining of keloids divided into two equal groups A and B from November 2019 to June 2020: Group A: treated by triamcinolone acetinoid (TAC) every three weeks, and Group B treated by methotrexate (MTX) every three weeks for maximum eight sessions, We used multiple intralesional injections until the lesion was blanched. Patients were selected from out-patient clinic of Dermatology, Venereology and Andrology Department of Al-Azhar University Hospitals. Results: The present study showed that the vascularity became normal (score 0) in 14 patients (70%), pink (score 1) in 6 patients (30%) in group A. Twelve patients (60%) became with normal vascularity (score 0), pink (score 1) in 8 patients (40%) in group B. Flatting of lesions (score 0) occurred in 14 patients (70%), while reduction to 2mm (score 1) documented in 6 patients (30%) in group A, and flattening (score 0) occurred in 10 patients (50%), reduction of the lesions to 2mm (score 1) occurred in 8 patient (40%) and 2 patient (10%) had score (2) height 2-5 mm in group B. Normal pigmentation (score 0) occurred in 16 patients (80%), mixed pigmentation (score 2) in 2 patients (10%) and hyperpigmentation (score 3) in 2 patients (10%) in group A and 6 patients (30%) showed normal pigmentation (score 0), 2 patients (10%) showed mixed pigmentation (score 2), 4 patients (10%) showed hypopigmentation(score 1) and 8 patients (40%) showed hyperpigmentation (score 3) in group B. Normal pliability in 16 patients (80%) (Score 0), 4 patients (20%) showed supple pliability (score 1) in group A. Normal pliability (score 0) was in 10 patients (50%), 2 patients (10%) showed yielding pliability (score 2), and 8 patients (40%) supple pliability (score 1) in group B. Assessment of the scar was based on Vancouver scar scale. Conclusion: Triamcinolone acetinoid (TAC) was effective in treatment of hypertrophic scars than methotrexate with statistically significant difference at end of treatment period and follow up.

Influence of Radioactive Background on an Idiopathic Form of Infertility Incidence in Men from Different Regions of Ukraine

There are 143 men (group I) with idiopathic infertility in the form of asthenozoospermia of the II degree living in the territories of the Kiev region (Poles’ky, Chernobylsky, Ivan’kovsky, Borodyansky, Vyshgorodsky districts) were investigated in the Department of Sexual Pathology and Andrology of the SI «Institute of Urology of the National Academy of Medical Sciences of Ukraine» and exposed to ionizing radiation due to the Chernobyl accident in 1986. All individuals in the I group were born from parents who were in the accident at the Chernobyl nuclear power station in the area of radioactive contamination and permanently resided in areas with a high level of radioactivity. The control group was made up of persons born and living in the Ivano-Frankivsk region with a similar condition (group II, n=57). The mean age of the studied group I was 28,3±2,4 years, and persons of the II group were 30,1±2,8 years. Diagnosis of II was performed ambulatory in accordance with WHO and Ministry of Health of Ukraine standards. The study was to study and compare spermogram parameters in patients from both groups.&#x0D; It has been established that the reproductive problems of men with idiopathic infertility living in radiation-polluted areas of the Kiev region of Ukraine consist in a significant violation of the quality indicators of ejaculate (mobility by the pool A+B is less than 1,6 times, p&lt;0,05) correlating with modifications of physicochemicals (the average time of liquefaction is 1,4 times greater, p&lt;0,05) and biochemical (decrease of levels of fructose by 2,2 times, citrate – by 1,6 times, p&lt;0,01–0,05) data characterizing the effect of ionizing radiation, as one one of the leading factors of male genital function violation. The study found that the level of general indicators of spermogramm is significantly worse in the regions of Ukraine who were exposed to radioactive contamination due to the Chernobyl accident, in contrast to the indicators of persons from conditionally pure regions.

Assessment of the Algorithms for Diagnostics and the Possibilities of Treating Patients with a Penile Dysmorphie Disorder

The article discusses issues related to the choice of diagnostic algorithms and planning tactics for treating patients with penile dysmorphophobia. The psychological characteristics of this group of patients, methods of diagnosis, psychotherapy correction and the choice of surgical tactics are sounded.&#x0D; The manifestations of penile dysmorphophobia and dysmorphomania, as disorders of a deeper level, are considered as an integrative problem solved from the standpoint of urology, psychotherapy, and aesthetic surgery. In conjunction with an andrologist, the involvement of a psychotherapist and, if necessary, a psychiatrist is required. At the initial stages of working with a patient, narrowly focused psychotherapy is used. The next level of correction is cognitive behavioral psychotherapy (CBT) with the technique of “exposure and prevention of reactions” or “cognitive restructuring”. The “mindfulness CBT” technique is considered important for teaching the patient the ability to stop subjective perception of personal experiences.&#x0D; To consolidate the result, individual hypnosuggestational therapy and group (family) psychotherapy are used. The indications for surgical enlargement of the penis are divided into medical, functional and aesthetic. Penile dysmorphophobia is an aesthetic indication for surgery. Contradictions in carrying out such interventions include the lack of standardized methods with a high positive prognosis, overestimated patient expectations, and the lack of a result to improve a man’s self-esteem even with a positive result of the operation.&#x0D; The clinic of the Department of Sexopathology and Andrology of the State Institution «Institute of Urology of the National Academy of Medical Sciences of Ukraine» uses a ligamentotomy technique to lengthen the penis and implant a polypropylene mesh under the superficial fascia of the penis to thicken it. For patients with manifestations of penile dysmorphophobia simultaneously with severe forms of erectile dysfunction, a number of operations have been proposed for the simultaneous installation of penile implants and augmentation of the tunica albuginea using a graft: corporoplasty with a circular graft, Sliding Technique, modification of the sliding technique (MoST), Multiple-slid-Technique (MuST) augmentation technique.&#x0D; These techniques are not included in the list of recommendations offered by the urological community; they have high predictable risks of complications requiring urgent explantation of the prosthesis and irreversible loss of penile length.

Evaluation of serum and urinary orsomucoid protein A in psoriatic patients and their relation to severity of disease.

Orsomucoid protein A (ORM) is a major acute-phase protein. Serum ORM (se-ORM) protein A elevates in infections, malignancies, and autoimmune diseases. Urinary ORM (u-ORM) protein A is more accurate and less invasive marker of inflammation. Elevated u-ORM was associated with pathomechanism factors related to psoriasis such as endothelial dysfunction; however, the clinical significance of it has not been explored yet. To evaluate se-ORM/u-ORM protein A and urinary orsomucoid protein A/urinary creatinine (u-ORM/u-CREAT) in patient with psoriasis and their relations to severity of the disease. This case-control study was conducted at Dermatology and Andrology Department; 35 psoriasis patients and 35 age- and sex-matched healthy controls were included. They were subjected to history taking and general and dermatological examination. Psoriasis severity was assessed by Psoriasis Area and Severity Index (PASI) score. Measurement of se-ORM/u-ORM protein A using ELISA and u-ORM/u-CREAT using colorimetric method. Highly significant difference between psoriasis patients and controls regarding u-ORM protein A level (p value=0.01). It was also higher in severe cases than moderate and mild ones and higher in moderate than mild cases (p value 0.001, 0.001, and 0.004, respectively). There were significantly higher u-ORM/u-CREAT (p˂0.001) levels in psoriasis patients than in controls. Also, significantly higher U-ORM/u-CREAT levels were found in severe psoriasis cases than in mild and moderate cases (p=0.003 and 0.006, respectively). While the se-ORM levels showed no significant differences between the studied groups. u-ORM/u-CREAT is a highly sensitive, easily available, and new inflammatory biomarker of psoriasis which correlates to the disease severity.