'Intracytoplasmic sperm injection (ICSI) paradox' and 'andrological ignorance': AI in the era of fourth industrial revolution to navigate the blind spots.

The quandary known as the Intracytoplasmic Sperm Injection (ICSI) paradox is found at the juncture of Assisted Reproductive Technology (ART) and 'andrological ignorance' - a term coined to denote the undervalued treatment and comprehension of male infertility. The prevalent use of ICSI as a solution for severe male infertility, despite its potential to propagate genetically defective sperm, consequently posing a threat to progeny health, illuminates this paradox. We posit that the meteoric rise in Industrial Revolution 4.0 (IR 4.0) and Artificial Intelligence (AI) technologies holds the potential for a transformative shift in addressing male infertility, specifically by mitigating the limitations engendered by 'andrological ignorance.' We advocate for the urgent need to transcend andrological ignorance, envisaging AI as a cornerstone in the precise diagnosis and treatment of the root causes of male infertility. This approach also incorporates the identification of potential genetic defects in descendants, the establishment of knowledge platforms dedicated to male reproductive health, and the optimization of therapeutic outcomes. Our hypothesis suggests that the assimilation of AI could streamline ICSI implementation, leading to an overall enhancement in the realm of male fertility treatments. However, it is essential to conduct further investigations to substantiate the efficacy of AI applications in a clinical setting. This article emphasizes the significance of harnessing AI technologies to optimize patient outcomes in the fast-paced domain of reproductive medicine, thereby fostering the well-being of upcoming generations.

Alcohol-associated liver disease: A review on its pathophysiology, diagnosis and drug therapy.

One of the global burdens of health care is an alcohol-associated liver disease (ALD) and liver-related death which is caused due to acute or chronic consumption of alcohol. Chronic consumption of alcohol damage the normal defense mechanism of the liver and likely to disturb the gut barrier system, mucosal immune cells, which leads to decreased nutrient absorption. Therapy of ALD depends upon the spectrum of liver injury that causes fatty liver, hepatitis, and cirrhosis. The foundation of therapy starts with abstinence from alcohol. Corticosteroids are used for the treatment of ALD but due to poor acceptance, continuing mortality, and identification of tumor necrosis factor-alpha as an integral component in pathogenesis, recent studies focus on pentoxifylline and, antitumor necrosis factor antibody to neutralize cytokines in the therapy of severe alcoholic hepatitis. Antioxidants also play a significant role in the treatment but till today there is no universally accepted therapy available for any stage of ALD. The treatment aspects need to restore the gut functions and require nutrient-based treatments to regulate the functions of the gut system and prevent liver injury. The vital action of saturated fatty acids greatly controls the gut barrier. Overall, this review mainly focuses on the mechanism of alcohol-induced metabolic dysfunction, contribution to liver pathogenesis, the effect of pregnancy, and targeted therapy of ALD.

Staphylococcal infections and infertility: mechanisms and management.

Infertility is a subject of worldwide concern as it affects approximately 15% of couples. Among the prime contributors of infertility, urogenital bacterial infections have lately gained much clinical importance. Staphylococcal species are commensal bacteria and major human pathogens mediating an array of reproductive tract infections. Emerging evidences are 'bit by bit' revealing the mechanisms by which Staphylococci strategically disrupt normal reproductive functions. Staphylococcal species can directly or through hematogenous routes can invade the reproductive tissues. In the testicular cells, epididymis as well as in various compartments of female reproductive tracts, the pathogen recognition receptors, toll-like receptors (TLRs), can recognize the pathogen-associated molecular patterns on the Staphylococci and thereby activate inflammatory signalling pathways. These elicit pro-inflammatory mediators trigger other immune cells to infiltrate and release further inflammatory agents and reactive oxygen species (ROS). Adaptive immune responses may intensify the inflammation-induced reproductive tissue damage, particularly via activation of T-helper (Th) cells, Th1 and Th17 by the innate components or by staphylococcal exotoxins. Staphylococcal surface factors binding with sperm membrane proteins can directly impair sperm functions. Although Staphylococci, being one of the most virulent bacterial species, are major contributors in infection-induced infertility in both males and females, the mechanisms of their operations remain under-discussed. The present review aims to provide a comprehensive perception of the possible mechanisms of staphylococcal infection-induced male and female infertility and aid potential interventions to address the lack of competent therapeutic measures for staphylococcal infection-induced infertility.

Caesarean section rates from Malaysian tertiary hospitals using Robson's 10-group classification.

BACKGROUND: Rising caesarean section rates is a concern worldwide. This study aimed to use Robson's ten group classification to identify which groups of women were contributing most to the rising caesarean section rates in Malaysian tertiary hospitals and to compare between hospitals, using a common standard set of variables. METHODS: A 5-year (2011-2015) cross-sectional study was conducted using data from the Malaysian National Obstetrics Registry (NOR). A total of 608,747 deliveries were recorded from 11 tertiary state hospitals and 1 tertiary hospital from the Federal territory. RESULTS: During the study period, there were 141,257 Caesarean sections (23.2%). Caesarean sections in Group 1 (nulliparous term pregnancy in spontaneous labour) and Group 3 (multiparous term pregnancy in spontaneous labour) had an increasing trend from 2011 to 2015. The group that contributed most to the overall caesarean section rates was Group 5 (multiparous, singleton, cephalic≥37 weeks with previous caesarean section) and the rates remained high during the 5-year study period. Groups 6, 7 and 9 had the highest caesarean section rates but they made the smallest contribution to the overall rates. CONCLUSIONS: Like many countries, the rate of caesarean section has risen over time, and the rise is driven by caesarean section in low-risk groups. There was an important hospital to hospital variation. The rise in caesarean section rates reflects a globally disturbing trend, and changes in policy and training that creates a uniform standard across hospitals should be considered.

Climate change and declining fertility rate in Malaysia: the possible connexions.

Climate change is an incessant global phenomenon and has turned contentious in the present century. Malaysia, a developing Asian country, has also undergone significant vicissitudes in climate, which has been projected with significant deviations in forthcoming decades. As per the available studies, climate changes may impact on the fertility, either via direct effects on the gonadal functions and neuroendocrine regulations or via several indirect effects on health, socioeconomic status, demeaning the quality of food and water. Malaysia is already observing a declining trend in the Total fertility rate (TFR) over the past few decades and is currently recorded below the replacement level of 2.1 which is insufficient to replace the present population. Moreover, climate changes reportedly play a role in the emergence and cessation of various infectious diseases. Besides its immediate effects, the long-term effects on health and fertility await to be unveiled. Despite the huge magnitude of the repercussion of climate changes in Malaysia, research that can explain the exact cause of the present reduction in fertility parameters in Malaysia or any measures to preserve the national population is surprisingly very scarce. Thus, the present review aims to elucidate the possible missing links by which climate changes are impairing fertility status in Malaysia.

Unethical behavior and professionalism among medical students in a private medical university in Malaysia.

BACKGROUND: Ethical behavior and professionalism is an ideal characteristic required of medical students and included as 'must achieve' and critical aspect of medical students' curriculum. This study proposes to determine the perceived unethical and unprofessional behavior among medical students in a private medical university from year 1 to year 5 of the medical curriculum. METHODS: A cross-sectional study was conducted among year 1 to year 5 medical students in a private medical university. A self-administered questionnaire was used with the 3 major domains of professionalism and ethics i.e. discipline plagiarism and cheating. RESULTS: A total of 464 respondents responded to the survey and they included medical students from year 1 and year 2 (pre-clinical) and years 3-5 (clinical years). Majority of the students, 275 (59.2%) answered that they had not seen any form of unethical behavior among other students. The females seem to have a larger number 172(63%) among the same gender compared to the males. Majority 352 (75%) of them had not heard of the 'Code of Professional Conduct by the Malaysian Medical Council'. About fifty three (53.1%) of the students answered that the training was sufficient. CONCLUSIONS: This study showed that the perception of unethical behavior was 58.8% in the 1st year (pre-clinical) and it increased to 65.2% in the 5th year (clinical). The 3 main discipline issues were students do not show interest in class (mean 2.9/4), they are rude to other students (mean 2.8/4) and talking during class (mean 2.6/4). Despite the existence of unethical behavior among the students majority of them (71.7%) claimed that they had adequate training in ethics and professionalism. It is proposed that not only the teaching of ethics and professionalism be reviewed but an assessment strategy be introduced to strengthen the importance of professionalism and ethics.

The MAHSA University, Malaysia's medical student oath and a comparison of various oaths.

When students enrol in a medical school, they are not introduced to any ethical issues until later in the curriculum. The Hippocratic/physician's oath is taken upon graduation. A student oath is important to introduce students to the solemnity of the education they are dedicating themselves to. This oath is analysed and compared with the doctor's oath upon graduation and a few other oaths.

Access to safe legal abortion in Malaysia: women's insights and health sector response.

Malaysia has an abortion law, which permits termination of pregnancy to save a woman's life and to preserve her physical and mental health (Penal Code Section 312, amended in 1989). However, lack of clear interpretation and understanding of the law results in women facing difficulties in accessing abortion information and services. Some health care providers were unaware of the legalities of abortion in Malaysia and influenced by their personal beliefs with regard to provision of abortion services. Accessibility to safer abortion techniques is also an issue. The development of the 2012 Guidelines on Termination of Pregnancy and Guidelines for Management of Sexual and Reproductive Health among Adolescents in Health Clinics by the Ministry of Health, Malaysia, is a step forward toward increasing women's accessibility to safe abortion services in Malaysia. This article provides an account of women's accessibility to abortion in Malaysia and the health sector response in addressing the barriers.

A qualitative exploration of contraceptive practice and decision making of Malaysian women who had induced abortion: a case study.

This study explores contraceptive practice and decision making of women who have experienced abortion in Malaysia. In-depth interviews were carried out with 31 women who had abortions. Women in this study did adopt some method of modern contraception prior their abortion episodes. However, challenges to use a method consistently were experiences and fear of side effects, contraceptive failure, partner's influence, lack of confidence, and cost. The decision to adopt contraception was theirs but the types of contraceptive methods to adopt were influenced by their spouses/partners. The women wanted to use modern contraception but were faced with challenges that hampered its use. More proactive contraceptive promotion is needed to educate people on the array of contraceptive methods available and made accessible to them, to correct misconceptions on safety of modern contraception, to increase men's involvement in contraceptive choices, and to encourage consistent contraceptive use to prevent unintended pregnancies.

Exploring pregnancy termination experiences and needs among Malaysian women: a qualitative study.

BACKGROUND: Malaysia has relatively liberal abortion laws in that they permit abortions for both physical and mental health cases. However, abortion remains a taboo subject. The stagnating contraceptive prevalence rate combined with the plunging fertility rate suggests that abortion might be occurring clandestinely. This qualitative study aimed to explore the experiences of women and their needs with regard to abortion. METHODS: Women from diverse backgrounds were purposively selected from an urban family planning clinic in Penang, Malaysia based on inclusion criteria of being aged 21 and above and having experienced an induced abortion. A semi-structured interview guide consisting of open ended questions eliciting women's experiences and needs with regard to abortion were utilized to facilitate the interviews. Audio recordings were transcribed verbatim and analyzed thematically. RESULTS: Thirty-one women, with ages ranging from 21-43 years (mean 30.16 ± 6.41), who had induced surgical/medical abortions were recruited from an urban family planning clinic. Ten women reported only to have had one previous abortion while the remaining had multiple abortions ranging from 2-8 times. The findings revealed that although women had abortions, nevertheless they faced problems in seeking for abortion information and services. They also had fears about the consequences and side effects of abortion and wish to receive more information on abortion. Women with post-abortion feelings ranged from no feelings to not wanting to think about the abortion, relief, feeling of sadness and loss. Abortion decisions were primarily theirs but would seek partner/husband's agreement. In terms of the women's needs for abortion, or if they wished for more information on abortion, pre and post abortion counseling and post-abortion follow up. CONCLUSIONS: The existing abortion laws in Malaysia should enable the government to provide abortion services within the law. Unfortunately, the study findings show that this is generally not so, most probably due to social stigma. There is an urgent need for the government to review its responsibility in providing accessible abortion services within the scope of the law and to look into the regulatory requirements for such services in Malaysia. This study also highlighted the need for educational efforts to make women aware of their reproductive rights and also to increase their reproductive knowledge pertaining to abortion. Besides the government, public education on abortion may also be improved by efforts from abortion providers, advocacy groups and related NGOs.

Maternal plasma soluble fms-like tyrosine kinase-1 and placental growth factor levels as biochemical markers of gestational hypertension for Malaysian mothers.

AIMS: To establish baseline levels of maternal plasma soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) among normotensive Malaysian mothers and to compare the marker levels between normotensives and mothers with gestational hypertension (GH). METHODS: Plasma sFlt-1 and PlGF were measured by enzyme-linked immunosorbent assay in an unmatched, case-control study. The results were subjected to normality testing and analyzed by Mann-Whitney U-tests. RESULTS: Among normotensive mothers, both sFlt-1and PlGF showed a general increase in levels from the 24th to 32nd weeks of pregnancy. PlGF levels in normotensive mothers with gestational diabetes mellitus were reduced compared to those without the disease, while levels of sFlt-1 were elevated. Mothers with GH had reduced levels of PlGF with increased levels of sFlt-1 when compared to normotensive mothers. Among the normotensive mothers followed up until delivery, the inversed pattern of reduced PlGF and increased sFlt-1 marker levels was found in 40% of those who developed GH later in pregnancy. CONCLUSIONS: Plasma levels of sFlt-1and PlGF in normotensive mothers may be influenced by gestational diabetes mellitus and GH. GH mothers show an inversed pattern of marker levels compared to normotensive mothers.

Sudden maternal deaths in Malaysia: a case report.

We report on a retrospective study of maternal deaths in Malaysia that occurred within 24 hours of delivery, abortion or operative termination of the pregnancy (defined as sudden deaths) in the years 1995-1996. There were 131 sudden maternal deaths (20.6% of all maternal deaths); postpartum hemorrhage, obstetric embolisms, trauma and hypertensive disorders of pregnancy were the main causes. There was a disproportionately increased risk of sudden maternal deaths in the Chinese and the 'other bumiputra' racial groups. The proportion of mothers who had no obstetric risk factors in the pregnancy that led to death was 16.8%. Fourteen mothers died in transit Twenty mothers died after a cesarean section. The findings of this review emphasize the fact that caregivers in obstetrics need to be forever vigilant. All maternity staff need to be well trained in emergency care and there needs to be quick referral to centers that can provide expertise in handling these emergencies.