Serum lipid profile levels and semen quality: new insights and clinical perspectives for male infertility and men's health.

PURPOSE: Several clinical scenarios regulate the final ejaculated semen, which is pivotal to reproductive success. Sperm motility and plasma membrane fusogenic activity primarily rely on the peculiar sperm lipid composition, influenced by the patient's metabolism, genetics, nutritional, environmental status, and concomitant clinical entities such as varicocele. This study aimed to determine the relationship between serum lipid profile and testicular function (semen quality and testosterone levels). METHODS: This retrospective study uses medical charts of 278 infertile men who attended andrological care between 2000 and 2019. Seminal analysis data, lipid profile, and total serum testosterone were collected. A multiple linear regression analysis was performed to evaluate the influence of the lipid parameters on the seminal variables. Statistical analyses were carried out with p ≤ 0.05 considered statistically significant. RESULTS: Seminal creatine kinase activity (p = 0.024) is negatively related to HDL (p = 0.032) and triglycerides (p = 0.037), while total testosterone (p < 0.0001) and seminal volume (p = 0.046) appeared both to be negatively related to triglycerides (p = 0.030 and p = 0.033, respectively). CONCLUSION: Medical advice commonly advocated to prevent endothelial dysfunction and cardiovascular disease and improve HDL-cholesterol and triglyceride levels in dyslipidemic patients should also be given to infertile men. Physicians should give patients a thorough assessment, including the blood lipid profile, hormonal status, and routine seminal examinations. We propose a more comprehensive men´s health check-up for the infertile male population, not limited to a simple evaluation of basic sperm parameters.

Medical Students' Perception of Risk Factors for Cancer.

To evaluate the perception of risk factors for cancer among medical students and how it varies among students in different years of their medical education. Cross-sectional study was conducted in 2019. The American Institute for Cancer Research Cancer Risk Awareness Survey questionnaire was administered to medical students at the Centro Universitário Saúde ABC. Students were divided into those in their 1st to 3rd year and those in their 4th to 6th year of medical education. Qualitative variables were described by frequency and percentage, and quantitative variables were described by mean and standard deviation or median and interquartile range. The scores of the groups on the questionnaire were compared using Student's t test. The 95% confidence interval was calculated, and p values < 0.05 were considered significant. We included 196 students, with approximately 30 to 35 students in each year of medical education. The median age was 22 (18 to 31), with 74% being female. Among risk factors for cancer, smoking (100%), cancer-causing genes (99.48%), and excessive sunlight exposure (99.48%) were the most cited by students. We observed a significant difference in the number of correct answers, favoring students in their 4th to the 6th year over those in their 1st to the 3rd year (mean = 16.46 vs. mean = 13.73, p < 0.001). Perception about risk factors for cancer is greater in the later years of medical education.

IMPORTANCE trial: a provisional study-design of a single-center, phase II, double-blinded, placebo-controlled, randomized, 4-week study to compare the efficacy and safety of intranasal esketamine in chronic opioid refractory pain.

Background:  Cancer is the second leading cause of death globally. Up to 86% of advanced cancer patients experience significant pain, while 10-20% live in chronic pain. Besides, increasing prescription of opioids resulted in 33,000 deaths in the US in 2015. Both reduce patients' functional status and quality of life. While cancer survival rates are increasing, therapeutic options for chronic opioid refractory pain are still limited. Esketamine is the s-enantiomer of ketamine, with superior analgesic effect and less psychotomimetic side effects. Intranasal esketamine was approved by the FDA for treatment-resistant depression. However, its use in chronic cancer pain has never been tested. Therefore, we propose a phase II, randomized, placebo-controlled trial to evaluate the efficacy and safety of intranasal esketamine in chronic opioid refractory cancer pain. Methods and analysis: We will recruit 120 subjects with chronic opioid refractory pain, defined as pain lasting more than 3 months despite optimal therapy with high dose opioids (>60 mg morphine equivalent dose/day) and optimal adjuvant therapy. Subjects will be randomized into two groups: intranasal esketamine (56mg) and placebo. Treatment will be administered twice a week for four consecutive weeks. The primary outcome is defined as reduction in the Numeric Pain Rating Scale (NPRS) after first application. Secondary outcomes include NPRS reduction after four weeks, the number of daily morphine rescue doses, functional status and satisfaction, and depression. Conclusion: This study may extend therapeutic options in patients with chronic pain, thus improving their quality of life and reducing opioid use. Trial registration: Clinical Trials.gov, NCT04666623. Registered on 14 December 2020.

Radiological patterns of incidental epididymitis in mild-to-moderate COVID-19 patients revealed by colour Doppler ultrasound.

The testis is a potential target organ for SARS-CoV-2 infection. Our study intended to investigate any testicular involvement in mild-to-moderate COVID-19 men. We conduct a cross-sectional study in 18 to 55-year-old men hospitalised for confirmed COVID-19. A senior radiologist executed the ultrasound with multi-frequency linear probe in all participants, regardless of any scrotal complaints. Exclusion criteria involved any situation that could impair testicular function. Statistical analysis compared independent groups, classified by any pathological change. Categorical and numerical outcome hypotheses were tested by Fisher's Exact and Mann-Whitney tests, using the Excel for Mac, version 16.29 (p < .05). The sample size was 26 men (mean 33.7 ± 6.2 years; range: 21-42 years), all without scrotal complaints. No orchitis was seen. Eleven men (32.6 ± 5.8 years) had epididymitis (42.3%), bilateral in 19.2%. More than half of men with epididymitis displayed epididymal head augmentation > 1.2 cm (p = .002). Two distinct epididymitis' patterns were reported: (a) disseminated micro-abscesses (n = 6) and (b) inhomogeneous echogenicity with reactional hydrocele (n = 5). Both patterns revealed increased epididymal head, augmented Doppler flow and scrotal skin thickening. The use of colour Doppler ultrasound in mild-to-moderate COVID-19 men, even in the absence of testicular complaints, might be useful to diagnose epididymitis that could elicit fertility complications.

Fundamentos da fisioterapia dermato-funcional: revisão de literatura / Grounds of aesthetic physical therapy: a review

A fisioterapia estética, recentemente renomeada como fisioterapia dermato-funcional, está cada vez mais em evidência. Afim de melhor definir essa área de atuação profissional, procedeu-se a uma revisão bibliográfica das patologias nas quais o fisioterapeuta pode atuar, como fibroedema gelóide (celulite),estrias, linfedema, no pré e pós-operatório de cirurgia plástica, queimaduras, cicatrizes hipertróficas e quelóides, flacidez, obesidade e lipodistrofia localizada.

Aesthetic physical therapy (which in Portuguese has been renamed 'dermatho-functional') has recently gotten more attention. In view of a better definition of the area, this paper reviews related literature to list pathologies that the physical therapist can treat - such as cellulitis, streach marks, obesity, lymphedema, burn care, hypertrophic scar and keloids flaccid skin and muscles, and local fat accumulation...