Reelin differentially shapes dendrite morphology of medial entorhinal cortical ocean and island cells.

The function of medial entorhinal cortex layer II (MECII) excitatory neurons has been recently explored. MECII dysfunction underlies deficits in spatial navigation and working memory. MECII neurons comprise two major excitatory neuronal populations, pyramidal island and stellate ocean cells, in addition to the inhibitory interneurons. Ocean cells express reelin and surround clusters of island cells that lack reelin expression. The influence of reelin expression by ocean cells and interneurons on their own morphological differentiation and that of MECII island cells has remained unknown. To address this, we used a conditional reelin knockout (RelncKO) mouse to induce reelin deficiency postnatally in vitro and in vivo. Reelin deficiency caused dendritic hypertrophy of ocean cells, interneurons and only proximal dendritic compartments of island cells. Ca2+ recording showed that both cell types exhibited an elevation of calcium frequencies in RelncKO, indicating that the hypertrophic effect is related to excessive Ca2+ signalling. Moreover, pharmacological receptor blockade in RelncKO mouse revealed malfunctioning of GABAB, NMDA and AMPA receptors. Collectively, this study emphasizes the significance of reelin in neuronal growth, and its absence results in dendrite hypertrophy of MECII neurons.

Unique case of successful surgical treatment of recurrent spinal epidural hematoma after lumbar disc surgery in a Glanzmann thrombasthenia patient.

We report a case of recurrent postoperative spinal hemorrhage after lumbar disc surgery in a Glanzmann thrombasthenia patient.

Factors Associated With University Students' Attitude Toward Euthanasia.

Although euthanasia has been practiced for thousands of years, a wide controversy still exists around it. This study aimed to assess the attitude of university students toward euthanasia and its associated factors. The study included an online self-administered survey. Survey questions consisted of demographic information, psychological condition, and attitude toward euthanasia. A total of 1,188 students participated in the study. Approximately only one-third of the respondents (34.1%) viewed euthanasia as a moral practice, and just one-quarter (25.3%) supported legalizing it. The main reason for not supporting euthanasia was religious considerations (72.2%), followed by moral considerations (46.5%). Factors that predicted a positive attitude toward euthanasia (p < .05) included undefined religion, being male, feeling lonely, or having suicidal thoughts. Conclusively, the negative attitude toward euthanasia is primarily driven by religious beliefs. Furthermore, gender and psychological status play critical roles in students' attitudes toward euthanasia.

Epigenetic modifications in pancreas development, diabetes, and therapeutics.

A recent International Diabetes Federation report suggests that more than 463 million people between 20 and 79 years have diabetes. Of the 20 million women affected by hyperglycemia during pregnancy, 84% have gestational diabetes. In addition, more than 1.1 million children or adolescents are affected by type 1 diabetes. Factors contributing to the increase in diabetes prevalence are complex and include contributions from genetic, environmental, and epigenetic factors. However, molecular regulatory mechanisms influencing the progression of an individual towards increased susceptibility to metabolic diseases such as diabetes are not fully understood. Recent studies suggest that the pathogenesis of diabetes involves epigenetic changes, resulting in a persistently dysregulated metabolic phenotype. This review summarizes the role of epigenetic mechanisms, mainly DNA methylation and histone modifications, in the development of the pancreas, their contribution to the development of diabetes, and the potential employment of epigenetic modulators in diabetes treatment.

Cellular and Molecular Variations in Male and Female Murine Skeletal Muscle after Long-Term Feeding with a High-Fat Diet.

Current information regarding the effects of a high-fat diet (HFD) on skeletal muscle is contradictory. This study aimed to investigate the effects of a long-term HFD on skeletal muscle in male and female mice at the morphological, cellular, and molecular levels. Adult mice of the C57BL/6 strain were fed standard chow or an HFD for 20 weeks. The tibialis anterior muscles were dissected, weighed, and processed for cellular and molecular analyses. Immunocytochemical and morphometric techniques were applied to quantify fiber size, satellite cells (SCs), and myonuclei. Additionally, PCR array and RT-qPCR tests were performed to determine the expression levels of key muscle genes. Muscles from HFD mice showed decreases in weight, SCs, and myonuclei, consistent with the atrophic phenotype. This atrophy was associated with a decrease in the percentage of oxidative fibers within the muscle. These findings were further confirmed by molecular analyses that showed significant reductions in the expression of Pax7, Myh1, and Myh2 genes and increased Mstn gene expression. Male and female mice showed similar trends in response to HFD-induced obesity. These findings indicate that the long-term effects of obesity on skeletal muscle resemble those of age-related sarcopenia.

Normalization of Vitamin D Serum Levels in Patients with Type Two Diabetes Mellitus Reduces Levels of Branched Chain Amino Acids.

Background and Objectives: Vitamin D is involved in pancreatic beta-cell function, insulin sensitivity, and inflammation. Further, elevation in branched-chain amino acids (BCAAs) has been implicated in type 2 diabetes (T2DM) pathology. However, the relationship between vitamin D and BCAAs in T2DM remains unclear. The current study aimed to investigate the relationship between vitamin D and BCAAs in T2DM. Materials and Methods: In total, 230 participants (137 with T2DM and 93 healthy controls) were recruited in a cross-sectional study. Furthermore, an additional follow-up study was performed, including 20 T2DM patients with vitamin D deficiency. These patients were prescribed weekly vitamin D tablets (50,000 IU) for three months. The levels of several biochemical parameters were examined at the end of the vitamin D supplementation. Results: The results showed that patients with T2DM had higher serum levels of BCAAs and lower serum levels of 25-hydroxyvitamin D (25(OH)D) compared with those of the healthy controls (p < 0.01). The serum levels of vitamin D were negatively correlated with BCAA levels in T2DM patients (r = −0.1731, p < 0.05). In the follow-up study, 25(OH)D levels were significantly improved (p < 0.001) following vitamin D supplementation. Vitamin D supplementation significantly reduced the levels of BCAAs, HbA1c, total cholesterol, triglycerides, and fasting glucose (p < 0.01). Conclusion: Overall, these results suggest a role for BCAAs and vitamin D in the etiology and progression of T2DM. Thus, managing vitamin D deficiency in patients with T2DM may improve glycemic control and lower BCAA levels.

Perceptions of primary healthcare physicians in Jordan of their role in the COVID-19 pandemic: A cross-sectional study.

BACKGROUND: Following the remarkable spread of coronavirus disease 2019 (COVID-19), worldwide, it quickly became apparent that many public health systems worldwide were not prepared to manage such a pandemic. We aimed to assess the perceptions of primary care physicians (PCPs) in Jordan towards their role during COVID-19. METHODS: A cross-sectional study using a self-administered questionnaire was performed. The study participants included PCPs from the Ministry of Health, academic institutions, and the private sector in Jordan. RESULTS: A total of 221 PCPs participated in the study. Most participants reported not having received any training on infection control (59.7%) or COVID-19 (81%). More than half PCPs (53.4%) felt positive about the way patients received and/or complied with their instructions. More than half PCPs (55.7%) educated their patients on protective measures against COVID-19 infection and considered this as part of their role and responsibility. Over 80% of the participants would apply social distancing, hand sanitation, facial masks, and patient education, but only half (51.1%) reported planning to order COVID-19 test kits. CONCLUSIONS: PCPs had a positive attitude towards controlling COVID-19 infection and showed a willingness to educate patients on how to protect themselves. However, PCPs should be provided special training on COVID-19.

Cervical decompressive laminectomy and lateral mass screw-rod arthrodesis: surgical experience and analytical review of 4120 consecutive screws.

BACKGROUND: Cervical decompressive laminectomy with lateral mass arthrodesis is a common neurosurgical procedure used to address a variety of cervical spine pathologies. PURPOSE: This study aimed to determine the safety and efficacy of this neurosurgical procedure using the Anderson-Sekhon technique for screw trajectory. METHODS: The study retrospectively reviewed all clinical and radiological indicators for patients who underwent lateral mass arthrodesis between December 2005 and December 2017. All patients underwent polyaxial screw-rod implants using the Anderson-Sekhon technique for screw trajectory. It additionally reported all intra- and post-operative complications, along with short- and long-term outcomes for these patients. The follow-up period ranged from 2 months to 10 years. RESULTS: The study evaluated 695 patients who received a total of 4120 lateral mass screws. This is considered the largest reported case series up to date. No patients had neuro-vascular injuries. The main complications included 51 (7.3%) cases of screw malposition, as when the screw had breached either of foramen transversarium, neural foramen, or the facet joint; 39 (5.6%) cases of lateral mass breakdown; 29 (4.2%) cases of C5 root pain which has subsided overtime; 22 (3.2%) of incidental durotomy; and 18 (2.6%) cases of postoperative wound infection. There were only 3 cases of screw pullout leading to a stability rate of 99.5%. Most cases demonstrated very good to excellent outcomes on both short- and long-term follow-up. CONCLUSIONS: Cervical decompressive laminectomy with lateral mass arthrodesis is a safe and effective technique for the management of different cervical spine pathologies, which results in favourable short- and long-term outcomes.

Major lower extremity amputation: a contemporary analysis from an academic tertiary referral centre in a developing community.

BACKGROUND: We aimed to explore the surgical outcomes of major lower extremity amputation (MLEA) and influencing factors at an academic tertiary referral centre in north Jordan, optimistically providing a platform for future health care policies and initiatives to improve the outcomes of MLEA in Jordan. METHODS: Clinical records of patients who had undergone MLEA between January 2012 and December 2017 were identified and retrospectively reviewed. International Classification of Diseases codes were used to identify the study cohort from a prospectively maintained computerised database. We included adult patients of both genders who underwent amputations for ischemic lower limb (acute and chronic) and diabetic foot syndrome (DFS). We excluded patients for whom MLEA surgery was performed for other indications (trauma and tumors). Outcomes of interest included patient demographics and comorbidities, type of amputation and indications, length of hospital stay (LOS), the need for revision surgery (ipsilateral conversion to a higher level of amputation), and cumulative mortality rate at 1 year. The impact of the operating surgeon's specialty (vascular vs. non-vascular surgeon) on outcomes was evaluated. RESULTS: The study cohort comprised 140 patients who underwent MLEA (110 below-knee amputations [BKA] and 30 above-knee amputations [AKA]; ratio: 3:1; 86 men; 54 women; mean age, 62.9 ± 1.1 years). Comorbidities included diabetes, hypertension, dyslipidaemia, ischaemic heart disease, congestive heart failure, chronic kidney disease, stroke, and Buerger disease. The only associated comorbidity was chronic kidney disease, which was more prevalent among BKA patients (p = 0.047). Indications for MLEA included DFS, and lower limb ischaemia. Acute limb ischaemia was more likely to be an indication for AKA (p = 0.006). LOS was considerably longer for AKA (p = 0.035). The cumulative mortality rate at 1 year was 30.7%. Revision surgery rates and LOS improved significantly with increased rate of vascular surgeon-led MLEA. CONCLUSIONS: In developing countries, the adverse impact of MLEA is increased because of limited resources and increased prevalence of diabetes-related foot complications. Vascular surgeon-led MLEA is associated with decreased revision rates, LOS and possibly improved outcomes, particularly when it is performed for vascular insufficiency. It is important to formulate national health care policies to improve patient outcomes in these countries.

Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus: A Comprehensive Analytical Review from an Anatomical Perspective.

There have been many reports on migration of the distal catheter of the ventriculoperitoneal shunt (VPS) since this phenomenon was recognized 50 years ago. However, there have been no attempts to analyze its different patterns or to assess these patterns in terms of potential risk to patients. We comprehensively reviewed all reports of distal VPS catheter migration indexed in PubMed and identified three different anatomical patterns of migration based on catheter extension and organs involved: (1) internal, when the catheter invades any viscus inside the thoracic, abdominal, or pelvic cavity; (2) external, when the catheter penetrates through the body wall either incompletely (subcutaneously) or completely (outside the body); and (3) compound, when the catheter penetrates a hollow viscus and protrudes through a pre-existing anatomical orifice. We also analyzed the association between each migration type and several key factors. External migration occurred mostly in infants. In contrast, internal migration occurred mostly in adults. A body wall weakness was not a risk factor for catheter protrusion. Shunt duration was a critical factor in the migration pattern, as most newly-replaced shunts tended to migrate externally. Clinicians must pay close attention to cases of large bowel perforation, since they were most often associated with intracranial infections. The organ involved in compound migration could determine the route of extrusion, as the bowel was involved in all trans-anal migrations and the stomach in most trans-oral cases. Clin. Anat. 30:821-830, 2017. © 2017Wiley Periodicals, Inc.

Branching patterns of the aortic arch: a computed tomography angiography-based study.

PURPOSE: This study aimed to investigate the anatomical variations in direct branches of the aortic arch in Jordanians using the contrast Computed Tomography (CT) imaging techniques and to determine their prevalence according to sex. METHODS: This analytical, retrospective study included 500 patients (209 females, 291 males), who were referred to the Radio-Diagnostic Department at King Abdullah University Hospital for CT angiography of the aortic arch from 2010 to 2014. Patients were selected using a random sampling method. RESULTS: Six patterns of arrangement of arteries according to their origin from the aortic arch were identified in Jordanians. The most common pattern was the normal classical one and accounted for 61.2 % of cases. All other patterns were considered variations and accounted for 38.8 % of cases. Variation patterns were classified into six different types. There was no significant correlation (p > 0.05) between sex and the occurrence of different types of variations. CONCLUSION: This study provides new information regarding the prevalence of aortic arch branching variations in Jordanians. A wide range of anatomical variations in the branching pattern of the aortic arch was observed. This should be taken into consideration during angiography, aortic instrumentation, and supra-aortic thoracic, head, and neck surgery.

Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus patients.

Distal catheter migration of a ventriculoperitoneal shunt (VPS) is a rare but serious complication. It is usually asymptomatic. However, it can be further complicated by the presence of co-infections, interruption of the shunt, and/or disturbances in penetrated organ function. In this report, we presented a case of spontaneous complete extrusion of the distal end of a VPS catheter through the intact abdominal wall in a 5-year-old boy with hydrocephalus. We also reviewed and analyzed the literature for similar cases of complete extrusion of the distal end of a VPS catheter, through an intact or a potential weakness in the body wall, in the last 20 years. From the reviewed literature, we did not observe any difference (p>0.05) in the incidence of this complication between cases with an intact or a potential weakness in the body wall.

Influence of Cyperus esculentus tubers (tiger nut) on male rat copulatory behavior.

BACKGROUND: Cyperus esculentus tubers (tiger nut) are one of the ancient food sources known to humanity. It is traditionally used in the Middle East to stimulate sexual arousal in men. However, there has been no scientific evidence about its assumed aphrodisiac properties. This study aimed to investigate the influence of tiger nut on the copulatory behavior of sexually active male rats. METHODS: Two sets of sexually active male rats -highly active and moderately active- were identified depending on baseline sexual activity. Rats in each set were randomly divided into a control and treated groups. Highly active rats were treated with doses of 1 and 2 g/kg/d of raw tiger nut powder, while moderately active rats were treated with a dose of 2 g/kg/d. After 30 days' treatment, copulatory behavior and serum hormonal levels were measured and compared between the groups within each experimental set. Phytochemical analyses including liquid chromatography/mass spectrometry and atomic absorption were performed to elucidate the main constituents of tiger nut that may be responsible for altering serum hormones. RESULTS: Tiger nut stimulated sexual motivation in both highly and moderately active rats, indicated by reduced mount and intromission latencies in these rats compared to controls. Furthermore, tiger nut improved sexual performance, indicated by increased intromission frequency and ratio, in treated moderately active rats compared to controls. Serum testosterone levels increased significantly after tiger nut administration. Lastly, phytochemical analyses revealed the presence of quercetin, vitamin C, vitamin E, and mineral zinc in tiger nut. CONCLUSIONS: Tiger nut has positive effects on the copulatory behavior of adult male rats.

Successful Management of a Unique Condition of Isolated Intracranial Mucormycosis in an Immunocompetent Child.

This report describes a unique case of isolated intracranial mucormycosis of a slowly progressive nature in a healthy immunocompetent child. A 4-year-old girl with a clear medical and surgical history presented with complaints of right side facial asymmetry and unsteady gait for a period of 10 months. Clinical and radiographic investigations revealed right-sided lower motor neuron facial palsy caused by an infiltrative lesion on the right cerebellopontine angle. Initial surgical debulking was performed, a biopsy was sent for histopathological examination, and a course of prophylactic antibiotic and antifungal drugs was prescribed. The pathological report confirmed the mucormycosis fungal infection, and intravenous amphotericin B was administered for 3 weeks. One month after admission, the patient left the hospital with complete recovery. Follow-ups after 4, 8 and 12 weeks revealed no sensory or motor neurological deficits. In conclusion, this is a unique case of mucormycosis with regard to the nature and location of the infection, along with the host being a healthy child. Initial surgical exploration is a very critical step in the early diagnosis and treatment of such rare conditions.

Cervical lateral mass screw-rod fixation: Surgical experience with 2500 consecutive screws, an analytical review, and long-term outcomes.

BACKGROUND: Posterior lateral mass screw-rod fixation is a common procedure in patients who undergo multilevel cervical spine laminectomy. It has been widely used in the last decade due to its ease of application and better biomechanical stability when compared with other techniques. However, the main risk remains the possibility of violating the spinal nerve root, vertebral artery, and/or facet joint. PURPOSE: This study reviews the short- and long-term outcomes of patients who underwent posterior cervical screw-rod stabilisation using the Anderson-Sekhon technique. It investigates the safety and reliability of this technique in one of the largest reported case series. METHODS: Both clinical and radiological indicators were retrospectively assessed in lateral mass fixation patients who were treated with the Anderson-Sekhon technique for screw insertion and trajectory. The sample included 430 patients with different cervical spine disorders who were treated with a total of 2500 lateral mass polyaxial screws from December 2005 until January 2014. Follow-up period ranged from 4 months to 8 years. No neural or vascular injury occurred. Twelve patients had wound infection, of whom 6 had deep infection. Twenty patients had C5 radicular pain that subsided over time; 2 required C5 screw modification; and another 3 required screw repositioning at different levels. Two patients had asymptomatic screw pull-out evident only on radiographs and required no treatment. Iatrogenic dural tear occurred in 12 patients with severe spondylosis, while CSF leakage from the tear was observed in 3 patients. Symptomatic adjacent segment disease was noted in 4 patients within the follow-up period and was treated with surveillance. CONCLUSION: Lateral mass screw-rod stabilisation using the Anderson-Sekhon technique can be applied safely and effectively for various cervical spine diseases, resulting in a low complication rate and favourable short- and long-term outcomes.

Utilization of multidisciplinary surgical techniques to successfully manage 20 brain abscesses in a child.

PURPOSE: This study describes a case of multiple brain abscesses in a four-year-old boy who presented with a history of fever and disorientation. METHODS: Medical investigations revealed severe leukocytosis and the presence of 20 hypodense lesions in the boy's cerebrum. Initial medical treatment included intravenous antibiotics, antiepileptics, and dexamethasone. The boy underwent five surgical interventions within a period of 5 weeks that included frameless stereotactic craniotomies for aspiration and resection of the abscesses. RESULTS: At the 3-month follow-up, the boy displayed no neurological deficits and no lesions were detected in his brain. CONCLUSIONS: This study reveals the importance of instituting a standardized protocol to determine the urgency of surgical intervention in cases of brain abscess so that surgical treatment can be applied in the appropriate time period. This case also shows that rewarding results can be obtained in treating brain abscesses in children when the proper treatment method is initiated in the appropriate amount of time.

Vitamin D Reduces the Activity of Adenosine Deaminase and Oxidative Stress in Patients with Type Two Diabetes Mellitus.

SCOPE: Patients with Type 2 diabetes mellitus (T2DM) have lower levels of vitamin D. An elevation in uric acid (UA) contributes to T2DM via an increase in oxidative stress. Adenosine deaminase (ADA) is an enzyme of the purine degradation pathway. It is hypothesized that a reduction of ADA activity via vitamin D supplementation reduces UA and oxidative stress. METHODS AND RESULTS: A total of 162 participants (81 with T2DM and 81 controls) are enrolled in a case-control study. A follow-up interventional study is performed on 30 patients with vitamin D deficiency. These patients receive 50 000 IU (international units) of vitamin D3 on a weekly basis for 12 weeks. This intervention is followed by the measurement of several markers. T2DM patients has higher ADA activity, UA, and lipid peroxidation but lower 25-hydroxy-vitamin D (25 (OH) vitamin D) and GSH/GSSG ratio (p < 0.05). Vitamin D supplementation results in a reduction of ADA activity and UA levels (p < 0.05) along with an increase in GSH/GSSG ratio (p < 0.05). CONCLUSION: The results highlight the presence of an axis in T2DM patients between ADA, UA, and oxidative stress. Modulation of this axis can be achieved by clinically approved vitamin D supplementation protocols.

Blue Toe Syndrome in Behçet's Disease: A Case Report.

BACKGROUND Vascular Behçet's disease (VBD) is a rare but potentially life-threatening subtype of Behçet's disease that is characterized by multisystemic vasculitis. It primarily affects males with ancestry traced back to regions along the ancient Silk Road. Both arteries and veins, regardless of size, may exhibit complications, including aneurysmal degeneration or occlusion. While venous involvement is observed in two-thirds of VBD cases, arterial complications are notably the most severe and lethal. Arterial aneurysmal degeneration is more common than occlusive complications, with larger arteries being predominantly affected in VBD. Data regarding isolated small-vessel arterial occlusive disease in VBD are limited. Given the rarity of this presentation in this patient population, it becomes mandatory to thoroughly evaluate such patients to differentiate small-vessel vasculitis from other similar diseases, such as Raynaud's phenomenon, which has a different etiology and management and generally has a more benign course. Here, we delineate the concept of isolated small-vessel vasculitis as a cause of blue toe syndrome in patients with VBD. CASE REPORT This report describes a distinctive case of vascular Behçet's disease in a 51-year-old man who initially exhibited unilateral blue toe syndrome, which swiftly progressed to dry gangrene of the toes. Despite reports of large-vessel involvement, there is a paucity of data on isolated small-vessel vasculitis-induced digital ischemia in VBD. CONCLUSIONS This atypical case underscores the necessity of clinical discernment in differentiating inflammatory microvascular occlusive disease from vasospastic Raynaud's syndrome, both of which can complicate Behçet's disease.

Perioperative Vascular Access Mapping in Patients with Hemodialysis: A Comparative Study of Access Navigation and Selection in Jordan.

Purpose: This study aimed to elucidate the impact of three different mapping methods on the outcomes of arteriovenous fistula (AVF), including the traditional physical examination (PE) method, color duplex ultrasonography (CDU) mapping conducted by a radiologist (CDU-R), and CDU mapping performed by the operating surgeon (CDU-S). Patients and Methods: This retrospective study was conducted at a tertiary center in Jordan. Patients were divided into three groups based on the venous mapping method: PE, CDU-R, and CDU-S. Various outcomes were analyzed, including immediate technical success, clinical adequacy at 3 months, and 1-year patency rates. Additional demographic and clinical factors influencing access patency or contributing to early failure were also examined. Results: The study included 303 eligible patients: 100 in the PE group, 103 in the CDU-R group, and 100 in the CDU-S group. The overall immediate technical success rate was 72%, which was highest in the CDU-S group (95%, p < 0.001). Additionally, the CDU-S group had the highest clinical access adequacy rate (78%, p < 0.01). Notably, the mapping method also influenced the anatomical location of the AVF, as none of the patients in the radiologist group had a forearm AVF. CDU-R, forearm location, intraoperative arterial calcifications, and operative duration were identified as predictors of AVF failure. Conclusion: The results suggest that perioperative vascular mapping by the operating surgeon not only results in a higher rate of immediate success but also improves access adequacy and prevents unnecessary delays in providing an effective lifeline for hemodialysis patients. The present study highlights the burden of access failure in these patients and the evolving evidence surrounding preoperative vein mapping.

Testicular histopathology and follicular stimulating hormone to predict fertility in nonobstructive azoospermia.

PURPOSE: To examine the ability of testicular histopathology in Non-obstructive azoospermia (NOA) in predicting sperm retrieval rate (SR), sperm quality and assisted reproductive technology success. METHODS: A retrospective study recruited clinically diagnosed NOA patients between 2007 and 2015. Testicular biopsy and conventional sperm extraction (TESE) were done concomitantly. Correlation between pathological categories, SR rate, sperm quality and success of intracytoplasmic sperm injection (ICSI) was studied. FSH was measured as a predictor of fertility. RESULTS: One hundred eighteen patients were recruited. Histopathological classification was hypospermatogenesis (HS) 45 (38%), maturation arrest (MA) 22(19%), Sertoli cell only syndrome (SCOS) 34 (29%) and normal spermatogenesis (NS) 17 (14%). FSH value was above normal level in 34 (76%) of HS, 19 (86%) of MA, 32 (94%) of SCOS and 5 (29%) of NS. Positive SR was obtained in 108 (92%) patients. The highest SR rate was seen in NS group 100% and the lowest was in SCOS 26 (77%). The worst sperm quality was found in SCOS as type C represents 46%, followed by MA 40% and HS 24%. Patients had ICSI following TESE had variable success rate as success of ICSI was seen (9/15) for HS, (0/7) for MA, (5/15) for SCOS and (8/9) for NS. FSH is strongly correlated to SR, quality of sperm and success of ICSI as positive SR in normal FSH patients was obtained in 28 (100%) of normal FSH, 70 (97%) of high FSH and 10 (56%) of double high FSH (p value < 001). The success of ICSI significantly correlates with FSH value as normal FSH has 77% success ICSI rate, high FSH (52%) and double high FSH (0%) (p value < 0.001). CONCLUSIONS: Testicular biopsy and histopathology findings in NOA are strongly correlated SR rate, quality of sperms, and success of ICSI. FSH is a strong noninvasive predictor of fertility in NOA patients.