Nemanja Radojevic

Semen analysis before and after antibiotic treatment of asymptomatic chlamydia‐ and ureaplasma‐related pyospermia

Pyospermia is the abnormally high concentration of white blood cells in human ejaculate, as caused by a bacterial infection. This study addresses the evaluation of the use of an antibiotic treatment in infertile patients who show asymptomatic pyospermia through the monitoring of semen analysis parameters. The study was carried out on 60 infertile patients who were diagnosed with asymptomatic genital infections, focused on pyospermia caused by Chlamydia trachomatis and Ureaplasma urealyticum. The volume of the ejaculate, pH, sperm concentration and progressive motility, as well as the viability of the spermatozoa and their morphology, were all observed before therapy, 10 and 30 days after. Patients were treated with antibiotics in accordance with the recommendations given by the European Urology Association. The results showed a clear effect of antibiotic therapy on the volume and pH of the seminal fluid; moreover, only 30 days after completion of the therapy sperm concentration itself significantly increased, and progressive motility greatly improved, albeit slowly. However, it must be noted that the antibiotic therapy had no significant effect on the viability of the spermatozoa within 30 days of beginning the treatment.

Forensic aspects of water intoxication: Four case reports and review of relevant literature

Water intoxication (WI) is a rare condition that originates from over-consumption of water, with a potentially fatal outcome. Increased water intake (polydipsia) is followed by urination of high amount of diluted urine (polyuria) which are the main initial symptoms of WI. We present four case reports of WI. Two of them are unusual pediatric clinical cases using medical documentation and police case files, one of which is related to child abuse, and the other to a psychiatric disorder. The other two cases are fatal adult cases submitted to autopsy from a psychiatric hospital. Also, we present a diagnostic algorithm for polydipsia and polyuria before death. WI is usually seen in patients with psychiatric disorders, victims of child abuse or torture, drug abusers or it can be iatrogenically induced.

Multiple stabbing in sex-related homicides

It is possible that sexually driven homicides are the consequence of sexual deviation, but more often than not the main cause of such homicides stems from a non-paraphilic persons emotional component. It is known that homicides which involve multiple stabbing are very often the result of the assailants highly expressed affect. This study tries to establish whether such homicides are essentially related to the sexual motives of the murderer. This paper is conducted through a retrospective autopsy study that includes 766 cases of homicides. These were reviewed and analysed according to the motive of the homicide, as well as by method, age, and gender of the victim, and the relationship between the victim and the assailant. The motives of homicides are classified as non-sexual and sexual, including homicides related to rape, jealousy, amorous affairs outside of an established relationship, deviant sexual behaviour of psychiatric patients, paraphilia, and disturbed emotional relationships between the victim and the assailant. Cases include both hetero- and homosexual relationships. Multiple stabbing occurs significantly more frequently in sex-related homicides (≥ 3 stab wounds) than in other homicide types. When the criteria for multiple stabbing are changed (≥ 4, 5, or 25 stab wounds), the percentage of sex-related homicides rises in every group in relation to the increased number of wounds. Sensitivity and specificity are represented by ROC curves for 3, 5 and 7 stab wounds. The correlation coefficients between multiple stabbing and sex-related homicides regarding gender are all near 0.9. For female victims, all homicides committed by 25 and more stab wounds were found to be sex-related. Statistically, jealousy was the most frequent motive for sex-related multiple stabbing homicides. Regardless of age, homicides involving multiple stabbings should be considered sex-related, especially when the victim is female.

A new anatomical variation of the musculocutaneous and the median nerve anastomosis.

Variations of the brachial plexus and its terminal branches are not uncommon.Therein, the anatomical variations of the musculocutaneous and the median nerve are classified into 5 types, while the communicating branches between the musculocutaneous and the median nerve are classified into 3 types, depending on their position related to the coracobrachial muscle. The case reviewed in this paper presents a variation similar to that of the second variety, but is significantly different due to the appearance of the proximal musculocutaneous nerve and its communicating branching, the site rising from the communicating branch (through the coracobrachial), and important clinical implications of this new variation. Despite the communicating branch being located in the upper third of the upper arm, it should not be considered as being a double lateral root of the median nerve.

The bilateral anatomical variation of the sural nerve and a review of relevant literature

The sural nerve is a sensory nerve, usually formed in the distal part of the leg by the union of the lateral sural cutaneous nerve or the communicating fibular branch with the medial sural cutaneous nerve. The aim of this paper is to present a case of a variant formation of the sural nerve and a review of the literature related to this case. During the dissection of an adult male cadaver, the medial sural cutaneous nerve and communicating fibular branch, after respectively deriving from the tibial and common fibular nerve, were noticed to continue their course without any formation of a unique nerve trunk on the posterior side of both lower limbs. A transverse communicating branch, connecting these two nerves, was present in both legs. As the sural nerve is of significant diagnostic and therapeutic importance, detailed knowledge of the sural nerve’s anatomy and its contributing nerves is also of great importance.

Relationship between 25-hydroxyvitamin D and newly diagnosed type 2 diabetes mellitus in postmenopausal women with osteoporosis.

Objective: The aim of the study was to determine a correlation between the level of 25-hydroxivitamin D (25-OHD) and the incidence of diabetes. Subjects and Methods: In this prospective observational study, 97 (out of an initial 100) Caucasian women with osteoporosis (OS) were monitored for 2 years for the incidence of diabetes. Logistic regression analysis was used to establish an association with and prognostic value of vitamin D for the onset of type 2 diabetes mellitus, as well as insulin resistance, body mass index (BMI), total cholesterol and triglyceride levels in the development of diabetes. The serum level of 25-OHD was measured using immunochemiluminescence in March and April 2011. Results: Of the 97 patients (mean age 51.64 ± 5.86 years, range 36.0-73.0), 21 (21.65%) were diagnosed with diabetes during the observational period. The study showed that the 22 patients with low levels of vitamin D were more susceptible to diabetes (odds ratio = 0.958). The cut-off value of vitamin D using a receiver operating characteristic curve was 62.36 nmol/l with a sensitivity of 39.5% and a specificity of 90.5%. With an increase in BMI and triglyceride levels, women were, respectively, 1,591 and 2,821 times more likely to get diabetes than those without an increase. Conclusion: This study showed that the patients with postmenopausal OS and hypovitaminosis D, besides a high BMI, elevated triglyceride levels and insulin resistance, had an increased risk of developing type 2 diabetes.

The therapeutic potential of royal jelly in benign prostatic hyperplasia. Comparison with contemporary literature.

Abstract The aim of this study is to establish the scientific benefit of royal jelly (RJ) on prostatic-specific antigen (PSA), post-void residual (PVR) volume and International Prostate Symptom Score (IPSS) in benign prostatic hyperplasia. For the study, a group of 40 men were administered 38 mg of RJ over a period of three months, their PSA values, prostate volumes and the volumes of their transitory prostate zones, PVR and IPPS values were measured at the end of the first month, and at the end of the third month. The results of this study confirm the potential of RJ in reducing PSA scores and improving IPSS values. Since the use of RJ did not lead to any significant reduction in PVR, prostate volume, or to any involution of the transitory zone, it appears that it may only affect the blood marker of prostatic hyperplasia and to improve quality-of-life (QoL) in those patients. Overall, in comparison to phytotherapy and conventional therapy, RJ had similar positive effects on QoL in patients with BPH, however it exhibited markedly better effects on reducing PSA levels in blood. The therapeutical use of RJ exhibited no side effects.

Comparison of the efficiency of combined extracorporeal shock-wave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS)

Abstract The aim of this study is to determine the effect of combining extracorporeal shock-wave therapy (ESWT) and triple therapy versus triple therapy alone, when treating Category III B chronic prostatitis (CPPS). Study included 60 patients, classified as having CPPS, divided into two groups: the first group numbered 30 patients, who were treated with a combination of an α-blocker, an anti-inflammatory agent and a muscle relaxant; the second group consisted of 30 patients who received a combination of ESWT and the fore-mentioned triple therapy. Patients were treated for 12 weeks. The primary criterion of a response to therapy was scoring 2 or less on the NIH-CPSI quality of life item, while the secondary criterion of a response to therapy was a greater than a 50% reduction in NIH-CPSI pain score. Patients who received triple therapy did not show a significant change neither in post void residual urine (PVR) nor in maximum flow rate (QMAX), while the second group of patients exhibited significant improvement in both PVR and QMAX values. Both groups of patients showed statistically significant improvement in all items of the NIH-CPSI score after the treatment, with significantly better results in the second group.

Correlation between nitric oxide levels, the hypo-osmotic swelling test for sperm membranes and semen analysis in patients with varicocele

Abstract Objective. Nitric oxide (NO) is a well-known oxidative stress agent that directly inhibits mitochondrial respiration and the synthesis of DNA. A case–control study of the concentration of NO in infertile patients with varicocele versus car-accident controls was performed. The concentration of NO in infertile patients with varicocele, and its correlation with the sperm fertility test named the hypo-osmotic swelling (HOS) test for sperm membranes and semen analysis, was also examined. Material and methods. A spectrophotometric method was used to measure the concentration of NO in infertile subjects, and the HOS test was carried out according to Jeyendrans original protocol. NO values from left testicular vein and left cubital vein of 19 infertile patients with left-sided varicocele were compared to 15 patients in the control group who underwent explorative laparoscopies after car accidents. Semen analysis and the HOS test were performed only in the left-sided varicocele group and compared to the NO outcomes. Results.The results indicate that the concentration of NO was significantly higher in the testicular vein than in the peripheral veins of patients with varicocele, as well as being significantly higher than in the testicular vein of control patients. An increased NO concentration in the testicular vein, higher sperm count and higher sperm motility in infertile patients with varicocele followed negative or suspicious findings of the HOS test for sperm membranes. There was also a significant correlation between NO concentration and sperm count in patients with varicocele. Conclusions. Further studies with more patients, related to NO concentrations and the HOS test are needed to verify these results.

Medicolegal characteristics of firearm homicides in Belgrade, Serbia: before, during, and after the war in the former Yugoslavia

A comparative analysis of firearm homicides committed in Belgrade was performed including four representative years: 1987 (before the civil war in the Former Yugoslavia), 1991 (beginning of the war), 1997 (end of the war), and 2007 (period of social stabilization). The increase in the number of homicides was established in 1991 and 1997 compared with 1987, with the decrease in 2007, but with the continuous increase in the percentage of firearm homicides in the total number of homicides, from 12% in 1987 up to 56% in 2007. The significant increase in firearm homicides during the last decade of the 20th century can be explained by the social disturbances and the high availability of firearms, while their reduction in 2007 could be linked to the gradual stabilization of social circumstances. The results showed that the actual social, political, and economical changes strongly influenced medicolegal characteristics of homicides and particularly firearm homicides.