Zinc (Zn) is the second most abundant trace element in human, which can't be stored in the body, thus regular dietary intake is required. This review explained the physiological and pathogenesis roles of zinc in men's health and its potentials in germination, quality of sperm, and fertilization. Our investigation showed that Zn contained many unique properties in human, especially males. The antioxidant quality is one of them. Also, the increased reactive oxygen species levels in the seminal plasma of men who are both infertile and smokers influence the Zn content of seminal plasma in a way that physiology of spermatozoa can be affected as well. Moreover, Zn acts as a toxic repercussionagainst heavy metals and cigarette inflammatory agents. Zinc as a hormone balancer helps hormones such as testosterone, prostate and sexual healthand functions as an antibacterial agent in men's urea system. It plays a role in epithelial integrity, showing that Zn is essential for maintaining the lining of the reproductive organs and may have a regulative role in the progress of capacitation and acrosome reaction. In contrast, Zn deficiency impedes spermatogenesis and is a reason for sperm abnormalities and has a negative effect on serum testosterone concentration. Based on these findings, Zn microelement is very essential for male fertility. It could be considered as a nutrient marker with many potentials in prevention, diagnosis, and treatment of male infertility.

Zinc is an Essential Element for Male Fertility: A Review of Zn Roles in Men's Health, Germination, Sperm Quality, and Fertilization.

Many studies have focused on male infertility. There is limited evidence about the influence of nutrition on quality of semen. Approximately, 30-80% of infertility cases are caused by oxidative stress and decreased level of seminal total antioxidant capacity. This study was aimed to review the effects of oral antioxidant supplements on improving major semen parameters such as sperm concentration, motility, morphology, DNA damage, and fertility rate. Data were extracted from PubMed and Google scholar database by using the terms "antioxidant", "multivitamin", "carnitine", "CoQ10", "vitamin C", "vitamin E", "zinc", "folic acid", "N-acetyl cysteine" and "selenium" combined with "male infertility", "semen", and "sperm" to generate a set of relevant citations. Supplements such as CoQ10 and alpha-tocopherol significantly improve sperm count. Also, carnitine has positive effects on sperm motility and morphology. Simultaneous administration of vitamin E and vitamin C reduces the sperm DNA damage. However, in some studies, one or more factors have not changed substantially. In most of the studies, antioxidant supplementation improved the number, motility, morphology and sometimes DNA integrity of sperm. The present study showed that antioxidant supplements, especially a combination of antioxidants such as vitamin C, vitamin E, and CoQ10 intake can effectively improve semen parameters in infertile men.

/pdf/antioxidant-supplements-and-semen-parameters-an-evidence-27hmcfv2ae.pdf

Antioxidant supplements and semen parameters: An evidence based review

Physiological changes that endow mammalian sperm with fertilizing capacity are known as sperm capacitation. As part of capacitation, sperm develop an asymmetrical flagellar beating known as hyperactivation and acquire the ability to undergo the acrosome reaction. Together, these processes promote fertilizing competence in sperm. At the molecular level, capacitation involves a series of signal transduction events which include activation of cAMP-dependent phosphorylation pathways, removal of cholesterol, hyperpolarization of the sperm plasma membrane, and changes in ion permeability. In recent years, new technologies have aided in the study of sperm signaling molecules with better resolution, at both spatial and temporal levels, unraveling how different cascades integrate and cooperate to render a fertilizing sperm. Despite this new information, the molecular mechanisms connecting capacitation with acrosomal exocytosis and hyperactivation are not well understood. This review brings together results obtained in mammalian species in the field of sperm capacitation with special focus on those pathways involved in the preparation to undergo the acrosomal reaction.

Sperm Capacitation and Acrosome Reaction in Mammalian Sperm.

Human semen contains several trace elements such as calcium (Ca), copper (Cu), manganese (Mn), magnesium (Mg), zinc (Zn) and selenium (Se) which are necessary for reproductive health, normal spermatogenesis, sperm maturation, motility and capacitation, as well as normal sperm function. In this review, the potential role of these trace elements in male reproductive health, normal function of spermatozoa and fertility potency were considered. We selected and reviewed articles that considered crucial roles of trace elements in human sperm function and fertility. Ca is essential for sperm motility and its hyperactivation, sperm capacitation and acrosome reaction, as well as sperm chemotaxis. Sodium (Na) and potassium (K) are involved in sperm motility and capacitation. Mg is necessary for normal ejaculation, spermatogenesis and sperm motility. Zn is one of the most significant nutrients in human semen. Seminal deficiency of Zn can be associated with delayed testicular development, impaired spermatogenesis, deficiency of sex hormones, oxidative stress and inflammation, and apoptosis. Se is another significant element which has antioxidative properties and is essential for spermatogenesis and the maintenance of male fertility. Mn is a potent stimulator for sperm motility; however, increased level of seminal plasma Se can be toxic for sperm. Like Se, Cu has antioxidative properties and has a positive effect on sperm parameters. Decreased level of these trace elements can negatively affect human reproductive health, semen quality, sperm normal function and as the result, fertility potency in men. Measurement of these trace elements in men with idiopathic infertility is necessary.

An overview on role of some trace elements in human reproductive health, sperm function and fertilization process

Zinc (Zn) is necessary for the normal function of the male reproductive system and spermatozoa. Although influences of zinc deficiency on impaired spermatogenesis and male infertility have been widely considered, the molecular and cellular mechanisms of these abnormalities are not well understood. General abnormalities, including hypogonadism, Leydig cells damage, deficiency of sex hormone production and impaired spermatogenesis, as well as inflammation, antioxidant depletion, sperm death and male infertility can be observed during zinc deficiency. However, it is not obvious which pathways are relevant to the pathogenesis of zinc deficiency. Oxidative stress (OS) induced by reactive oxygen species is likely as the main mechanism of zinc deficiency which is associated with sperm DNA fragmentation, decrease in sperm membrane integrity, apoptosis, depletion of antioxidants, and consequently poor sperm quality and male infertility. Therefore, identification of these pathways will give valuable information regarding the mechanisms of zinc deficiency on the male reproductive system and the potential way for developing a better clinical approach. In this review, we aim to discuss the proposed cellular and molecular mechanisms of zinc deficiency on the male reproductive system, the importance of OS and mechanisms by which zinc deficiency induces OS and depletion of other antioxidants.

Effects of zinc deficiency on impaired spermatogenesis and male infertility: the role of oxidative stress, inflammation and apoptosis.

Background: Male infertility is a serious problem all over the world. Nutritional deficiency of trace element Zinc (Zn) may play a role in male infertility as Zn plays an important role not only in normal testicular development, but also in spermatogenesis and sperm motility. Deficiency of Zn is associated with hypogonadism and insufficient development of secondary sex characteristics. Objective: The present study was designed to analyze the level of seminal Zn among different groups of infertile patients and to correlate it with sperm concentration, active, sluggish and immotile fractions of seminal parameters, with an objective to establish the role of Zn in male infertility. Setting and Design: The present study was carried out in five- years period from 2004 to 2009. It was a descriptive analytical study with non probability sampling. Materials and Methods: Semen examination of the patients was carried out according to the standardized method of the World Health Organization. Semen Zn was estimated by color 5 Br. PAPS method. Statistical Analysis: All statistical analyses were performed by using SPSS (Version 14.0 for windows) software, by applying student's t-test. Results: The result showed that seminal Zn was 702.92±10.60, 598.48±12.95, 617.54±9.55, 542.29±22.75, 710.36±7.87, 712.06±7.96, 789.36±21.33, and 762.06±8.99 mg/dl in azoospermic, oligozoospermic, asthenozoospermic, oligoasthenozoospermic, teratozoospermic, normozoospermic, polyzoospermic, and proven fathers group, respectively. Conclusions: Decreased concentration of seminal Zn do affect the sperm count, while increased level of seminal plasma Zn causes decreased sperm motility; so, it is suggested that administration of Zn should be very carefully monitored in such patients having low sperm count but normal sperm motility, as adequate seminal Zn is required for normal sperm function.

Assessment of the level of trace element zinc in seminal plasma of males and evaluation of its role in male infertility.

Endometriosis is a common benign and chronic inflammatory gynaecological disease due to functional endometrial glands and stroma in an ectopic location outside the uterine cavity. It affects 5-10% of reproductive age group women in the peak age of 24-29 years. However, women with infertility and chronic pelvic pain have an even greater prevalence, accounting for 30-50% and 90% of cases, respectively. Although it is a common entity, patients often get a delayed diagnosis because it is often subtle (hidden), missed, or confused with mimics, leading to misdiagnosis, which significantly affects patients’ quality of life because they live in constant pain from undiagnosed endometriosis. Laparoscopy followed by histopathological confirmation is the gold standard for diagnosis, but it is an invasive procedure. MRI is an excellent non-invasive modality that helps in non-invasive diagnosis, with excellent delineation of the disease extent, and thus provides a presurgical mapping of the disease, which is helpful for the operating surgeon. Radiologists should be aware of all possible spectrum and diagnose this early and provide a detailed structured report mapping the entire extent of the disease process, which helps in effective treatment planning and successful outcomes in improving patients’ quality of life.

https://www.termedia.pl/Journal/-126/pdf-47701-10?filename=Magnetic%20resonance.pdf

Magnetic resonance imaging of endometriosis: a common but often hidden, missed, and misdiagnosed entity

Background: The clinical presentation of acute leukemias is quite variable. The present study was designed to assess the hematological and clinical presentation of acute leukemias in our setup.
 Methodology: This comparative study was conducted in medical and paedriatic wards of Lady Reading Hospital Peshawar, IRNUM Hospital Peshawar and DHQ Hospital Bannu from 2000 to 2006. A total of 50 patients of acute leukemias were included in the study. These patients belonged to all age groups, both sexes and mixed socio-economic status. The diagnosis was made on clinical history, physical examination and peripheral blood and bone marrow examination.
 Results: Out of 50 cases, 28 (56%) were of acute lymphoblastic (ALL), 20 cases (40%) acute myeloid leukemias (AML), while 2 (4%) were of undefferianted type. All patients were anemic at the time of diagnosis, their hemoglobin mm3 was 2.8 -12 g /dl. The TLC was quite variable ranged from 6,30,000/ mm3. Similarly the platelet count was 100000/mm3. The majority (90%) presented with fever and malaise. Abnormal bleeding was present in 20 cases (40%) at the time of presentation. Chest infection was the most common type of infection (38%). Bone and joint pain was present in 12 cases (24%). Vomiting diarrhea were present in 10 cases (20%). Disturbance of vision and hearing was also present in 5 cases (10%). Signs symptoms of mediastinal obstruction were present in only 3 cases (10.7%) of ALL. Skin rash was present in 2 cases (4%). Proptosis of eye was significant clinical feature in one child with ALL at presentation. One Child with ALL had multiple soft swellings at presentation. Two cases (4%) presented with jaundice while 2 (4%) had signs and symptoms of fracture L1 vertebra at presentation and one case presented with weakness of right side of the body.
 Conclusion: The clinical presentation of acute leukemias is so variable and atypical that in most of the cases the diagnosis is delayed for a quite long time, due to which the prognosis becomes poor in our setup.

Hematological and Clinical Presentation of Acute Leukemiasat Khyber Pakhtoonkhwa

Hijama is an Arabic word that means to suck, it is an ancient traditional healing method that is practiced since antiquity and in today’s scenario, and there is growing evidence of its potential benefits in the management of lifestyle and pain-related disorders. Its use has been documented in early Egyptian and Chinese medical practices. Diverse human civilizations have contributed too much to the development of Hijama (wet cupping). Hijama is one of the important regimens (procedures) of Ilaj Bit Tadbeer (Regimental therapy) to prevent and treat the diseases by diverting (Imala-e-mawad) and evacuating (Istefragh-e-mawad) the disease-causing substances (morbid matter) from the site of application of cups on the body. Ilaj Bit Tadbeer is one of the important modes of treatment of Unani medicine. Unani Medicine is based on the four humoral theory of Akhlate Arba (four-body humor) viz Balgham, Safra, Dam & Sauda (Phlegm, bile, blood & black bile). The imbalance in the quality and quantity of these humor leads an individual prone to diseases whereas restoration of this balance maintains the health of a person. Restoration of the equilibrium and balance of natural body humor is done through evacuation and diversion of morbid matter from the site of the disease. Hijama (wet Cupping) is an Unani mode of treatment which is carried out by application of cup-shaped glass vessels on the skin, from which air has been exhausted by heat or special suction apparatus, to divert and evacuate the morbid humor, from the diseased part of the body, to return a displaced organ to its natural position or to encourage the blood flow to the site of Hijama. In Islamic Prophetic medicine an emphasis was given to go for Hijama for the prevention and management of lifestyle and pain-related disorders. In this paper, a detailed review of Hijama will be discussed. 

Hijama (Wet cupping) an ancient traditional healing: A review

Unusual Presentation of Falciparum Malaria as generalized Anxiety Disorder at DHQTH Bannu

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