Ana Mimic

The Correlation of Biochemical and Morphologic Parameters in the Assessment of Sperm Maturity

OBJECTIVE To examine the relationship between biochemical markers and morphologic sperm characteristics, including head, neck, and tail changes. METHODS The study evaluated 154 patients who went to the Andrology Laboratory of the Clinic of Urology, Clinical Center of Serbia. Patients were divided into 4 groups: normozoospermic, oligozoospermic, severe oligozoospermic, and asthenozoospermic, according to the sperm concentration and motility. RESULTS The differences in creatine kinase (CK) and CK-M levels between normozoospermic and the 2 groups of oligozoospermic patients were significantly different (P <.01). The CK and CK-M levels correlated negatively with sperm concentration and sperm motility, but correlated positively with the pathologic sperm form. Patients with CK values >0.093 have a total number of pathologic forms higher than 0.40 (87.5% sensitivity, 77.3% specificity, the area under the curve was 0.832, P <.001). Patients with CK values <0.09 U/L have normal spermatogenesis and pathologic disorder of the head <15%, neck <12%, and tail <10%. CONCLUSION The relation between sperm morphology and biochemical markers included in the maturation process is established during the sperm genesis process. If the results of these markers are used together with the morphology of the spermatozoa in the interpretation of infertility, it would lead us to better insight of the fertility potential of the each patient.

Psychological factors as predictors of early postoperative pain after open nephrectomy

Purpose There is an increasing interest in the identification of predictors for individual responses to analgesics and surgical pain. In this study, we aimed to determine psychological factors that might contribute to this response. We hence investigated patients undergoing a standardized surgical intervention (open nephrectomy). Patients and methods Between May 2014 and April 2015, we conducted a prospective observational cohort study. The following psychological tests were administered preoperatively: Mini-Mental State Examination, Amsterdam Preoperative Anxiety and Information Scale (APAIS), Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and Pain Catastrophizing Scale. The primary outcome, postoperative pain intensity (11-point numerical rating scale, [NRS]), was assessed in the “immediate early” (first 8 hours), “early” (12 and 24 hours), and “late early” periods (48 and 72 hours). Results A total of 196 patients were assessed, and 150 were finally included in the study. NRS scores improved from 4.9 (95% confidence interval [CI]: 4.7–5.1) in the “immediate early” to 3.1 (95% CI: 2.9–3.3) in the “early” and 2.3 (95% CI: 2.1–2.5) in the “late early” postoperative period. Most (87%) patients received intravenous opioids, while 13% received analgesics epidurally. Repeated measures analysis of variance indicated better pain management with epidural analgesia in the first two postoperative periods (F=15.01, p<0.00). Postoperative pain correlated strongly with analgesic strategy and preoperative psychological assessment. Multiple linear regression analysis showed “expected pain” was the only predictor in the “immediate early” phase, and “anxiety” was most important in the “early” postoperative period. In the “late early” phase, catastrophizing was the predominant predictor, alongside “preoperative analgesic usage” and “APAIS anxiety”. Conclusion After open nephrectomy, epidural analgesia conveys a clear advantage for pain management only within the first 24 hours. Moreover, as the psychological phenotype of patients changes distinctively in the first 72 postoperative hours, psychological variables increasingly determine pain intensity, even surpassing employed analgesic strategy as its main predictor.

Higher utilization of the pharmacologic and non-pharmacologic therapies in patients with chronic low back pain in a developing country than in the USA: Treatment of chronic low back pain

Introduction: Pain is a highly subjective experience and different studies have shown that the perception of the pain intensity depends on multiple factors, such as: gender, race, age, eye or hair color, socio-economic status, education, as well as psychological status of the person, etc. Despite those determinants there is an discrepancy in pain treating approach between the USA and the European countries. Low back pain has become a major socio-economic problem in the USA, with 70-85% of people in the North America being affected throughout their lifes compared with the average prevalence of back pain In Western Europe as 15%. Overall, NSAIDs are the most commonly prescribed medication for low back pain worldwide, however with liberalization of the law in the USA within past 20 years, and with the promotion of opioids as highly effective and safe treatment, they are getting prescribed widely and readily for different chronic pain conditions including chronic low back pain. Low back pain has become a major socio-economic problem in the USA, and Western Europe. The purpose of this prospective study was to determine the utilization of pharmacological and non-pharmacological treatments for chronic low back pain in developing countries. Methods: After approval of the ethics committee Medical School University of Belgrade we enrolled 185 patients. Any patients who were > 18 years, diagnosed with chronic low back pain and did not have a history of malignancy are included in the study. All of them completed the study. Results: Patients were between 21 and 91 years old (average age 61.2 ± 14.7), 43.5% of them were males and 56.5% females. The pain duration for these patients ranged from 2 months up to 20 years. Average VAS pain scores in rest 4.7 ± 2.3 and in movement 5.2 ± 2.1. All of these patients exploited different types of non-pharmacological treatments for their painful condition. The average improvements after these treatments were: physical therapy (52.2 ± 4.9%), massage (50.8 ± 4.8%), chiropractic manipulation (69.1 ± 10.4%) and acupuncture treatment (50 ± 11.6%). All patients used NSAIDs, with the average duration of therapy 24.2 ± 11.9 months, and the average effectiveness 61.6 ± 2.8%. These patients used compounding topical creams for 7.5 ± 2.3 months on average with effectiveness of 41.1 ± 3.5%. None of the patients used opioids. Majority of them - 72.8% never missed any day of work while 8.6% missed 10-30 days, and only 4.3% missed more than 30 days of work even though 79.6% patients had an active type of job (walking, bending, heavy lifting, etc). Discussion: Administration of opioids, epidural steroid injection, facet joint block in the treatment of chronic low back pain became extremly frequent in the USA in the last 15 years. Multimodal therapy approach of back pain is the main characteristic of the treatment strategies in the USA. Opposite to the USA, European strategy concern non-invasive, non-pharmacologic and pharmacologic approaches. Conclusion: Results of this study showed higher utilization of pharmacologic and non-pharmacological therapies in patients with chronic low back pain prior to opioids and interventional procedures than in the USA.

Pre-emptive tramadol could reduce pain after ureteroscopic lithotripsy.

Purpose Optimal analgesia in ambulatory urology patients still remains a challenge. The aim of this study was to examine if the pre-emptive use of intravenous tramadol can reduce pain after ureteroscopic lithotripsy in patients diagnosed with unilateral ureteral stones. Materials and Methods This prospective pilot cohort study included 74 patients diagnosed with unilateral ureteral stones who underwent ureteroscopic lithotripsy under general anesthesia in the Urology Clinic at the Clinical Center of Serbia from March to June 2012. All patients were randomly allocated to two groups: one group (38 patients) received intravenous infusion of tramadol 100 mg in 500 mL 0.9%NaCl one hour before the procedure, while the other group (36 patients) received 500 mL 0.9%NaCl at the same time. Visual analogue scale (VAS) scores were recorded once prior to surgery and two times after the surgery (1 h and 6 h, respectively). The patients were prescribed additional postoperative analgesia (diclofenac 75 mg i.m.) when required. Pre-emptive effects of tramadol were assessed measuring pain scores, VAS1 and VAS2, intraoperative fentanyl consumption, and postoperative analgesic requirement. Results The average VAS1 score in the tramadol group was significantly lower than that in the non-tramadol group. The difference in average VAS2 score values between the two groups was not statistically significant; however, there were more patients who experienced severe pain in the non-tramadol group (p<0.01). The number of patients that required postoperative analgesia was not statistically different between the groups. Conclusion Pre-emptive tramadol did reduce early postoperative pain. The patients who received pre-emptive tramadol were less likely to experience severe post-operative pain.