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Fulltext Intra-Abdominal Solid Organ Injury Management in Pediatrics

K Subrumaniam, Sakti, Nurdaliza, YW Yan

IIUM Medical Journal Malaysia, 2019;18(101):12-0.
MyJurnal

Abdominaltrauma is relatively uncommon in children but can leads to a significant morbidity and mortality in the pediatric population. The abdomen is the third most commonly injured anatomic region in children, after the head and the extremities. The abdomen is the most common site of initially unrecognized fatal injury in traumatized children.We are reporting a case of a child with multiple solid organ injury that was successfully treated non-operatively at our center.We presented apreviously healthy 9-month-old girl, presented with fluctuating GCS secondary to motor vehicle accident with borderline hemodynamic stability. She was intubated, blood transfusion commenced and a single inotrope support started. She subsequently diagnosedwith grade III liver injury, grade II splenic injury, right grade IV renal injury with large perinephric and retroperitoneal hematoma and moderate hemoperitoneum, a non-displaced left superior pubic rami fracture and cerebral edema on computed tomography (CT). She was admitted to pediatric intensive care unit (PICU). Her intra-abdominal injury injuries were successfully treated conservatively. She required a right chest tube on post trauma day 2, for right hemothorax. The chest tube was removed 3 days later following adequate drainage. She eventually was weaned off from ventilator on post trauma day 11. Feeding was commenced on day 7 of post trauma.She was discharge home well after 3 weeks post trauma with periodical follow up.Conclusion: Pediatric intra-abdominal solid organ injury is relatively uncommon, but a potential source of significant morbidity. Non-operative management is the standard of care for the majority of these injuries, which have shown successful rate more than 95%, although continued hemodynamic instability mandates operative intervention.
Fulltext Mining of Opinions on COVID-19 Large-Scale Social Restrictions in Indonesia: Public Sentiment and Emotion Analysis on Online Media

Tri Sakti AM, Mohamad E, Azlan AA

J Med Internet Res, 2021 08 09;23(8):e28249.
PMID: 34280116 DOI: 10.2196/28249

BACKGROUND: One of the successful measures to curb COVID-19 spread in large populations is the implementation of a movement restriction order. Globally, it was observed that countries implementing strict movement control were more successful in controlling the spread of the virus as compared with those with less stringent measures. Society's adherence to the movement control order has helped expedite the process to flatten the pandemic curve as seen in countries such as China and Malaysia. At the same time, there are countries facing challenges with society's nonconformity toward movement restriction orders due to various claims such as human rights violations as well as sociocultural and economic issues. In Indonesia, society's adherence to its large-scale social restrictions (LSSRs) order is also a challenge to achieve. Indonesia is regarded as among the worst in Southeast Asian countries in terms of managing the spread of COVID-19. It is proven by the increased number of daily confirmed cases and the total number of deaths, which was more than 6.21% (1351/21,745) of total active cases as of May 2020.
OBJECTIVE: The aim of this study was to explore public sentiments and emotions toward the LSSR and identify issues, fear, and reluctance to observe this restriction among the Indonesian public.
METHODS: This study adopts a sentiment analysis method with a supervised machine learning approach on COVID-19-related posts on selected media platforms (Twitter, Facebook, Instagram, and YouTube). The analysis was also performed on COVID-19-related news contained in more than 500 online news platforms recognized by the Indonesian Press Council. Social media posts and news originating from Indonesian online media between March 31 and May 31, 2020, were analyzed. Emotion analysis on Twitter platform was also performed to identify collective public emotions toward the LSSR.
RESULTS: The study found that positive sentiment surpasses other sentiment categories by 51.84% (n=1,002,947) of the total data (N=1,934,596) collected via the search engine. Negative sentiment was recorded at 35.51% (686,892/1,934,596) and neutral sentiment at 12.65% (244,757/1,934,596). The analysis of Twitter posts also showed that the majority of public have the emotion of "trust" toward the LSSR.
CONCLUSIONS: Public sentiment toward the LSSR appeared to be positive despite doubts on government consistency in executing the LSSR. The emotion analysis also concluded that the majority of people believe in LSSR as the best method to break the chain of COVID-19 transmission. Overall, Indonesians showed trust and expressed hope toward the government's ability to manage this current global health crisis and win against COVID-19.
Fulltext Cancer and COVID-19: economic impact on households in Southeast Asia

Kong YC, Sakti VV, Sullivan R, Bhoo-Pathy N

Ecancermedicalscience, 2020;14:1134.
PMID: 33281926 DOI: 10.3332/ecancer.2020.1134

The ongoing COVID-19 pandemic may worsen the existing financial vulnerabilities of cancer survivors who may be experiencing a double financial hit, both from cancer-induced financial toxicity as well as economic strains arising from loss of income and prolonged unemployment following the pandemic. The impact of the pandemic is likely to be more pronounced on cancer survivors living in resource-limited settings, such as in Southeast Asia. As health care systems in the region try to streamline resources and accommodate the influx of patients from COVID-19, many in the cancer community have experienced severe disruptions in their care. The delays and disruption of timely access to cancer care could lead to patients presenting with worsened conditions and at more advanced cancer stages in which treatment options tended to be costlier. Similar to countries around the world, the various forms of movement restrictions that were enforced have aggravated the rates of unemployment, loss of wages and the limited access to support from family or friends around Southeast Asia. The economic impact of COVID-19 hits even harder on the large proportion of the population in the region that works in the informal sector, who are often one paycheque or one episode of illness away from financial catastrophe. More worryingly, the lack of a robust social security system in many Southeast Asian countries, especially in terms of income protection, could ultimately force many cancer survivors to choose between paying for their treatments, or to forego treatments, and feed their families. Early identification of cancer patients experiencing financial toxicity following the pandemic will enable timely and appropriate interventions to be undertaken by various stakeholders, potentially averting a cascade of other economic fallouts that may last for years after cancer treatment.
Determination of warfarin in volumetric absorptive microsampling by liquid chromatography-tandem mass spectrometry

Harahap Y, Mulyadi CA, Muliawan HS, Wahab HA

Heliyon, 2024 Jul 30;10(14):e34500.
PMID: 39130442 DOI: 10.1016/j.heliyon.2024.e34500

OBJECTIVE: This study aims to develop and validate bioanalytical method for quantifying warfarin in VAMS samples using liquid chromatography tandem mass spectrometry (LC-MS/MS), directly implementing the method to patients receiving warfarin therapy.
METHODS: The UPLC-MS/MS method was developed and optimized, with quercetin as the internal standard. Sample preparation was carried out using protein precipitation with methanol-acetonitrile (1:3 v/v).
RESULTS: Chromatographic separation was achieved using Acquity® UPLC BEH C18 column with 0.1 % formic acid-acetonitrile-methanol (30:69:1 v/v) as mobile phase, in isocratic elution. Multiple Reaction Monitoring (MRM) detection was done using m/z values of 307.10 → 161.06 for warfarin and 301.03 → 150.98 for quercetin as internal standard, using Electrospray Ionization (ESI) negative ion source. The clinical application of the bioanalytical method was carried out on 25 patients receiving warfarin therapy at Universitas Indonesia Hospital and warfarin levels were well within the calibration range from 6.05 to 431.39 ng/mL.
CONCLUSION: A novel method has been developed to analyze warfarin in VAMS samples. This method has been fully validated according to guideline from FDA 2022 and is linear in the range of 5-500 ng/mL and the value of r ≥ 0.9977, and successfully applied for the analysis of warfarin in VAMS samples of clinical patients.
Fulltext Review of Functional Aspects of Nanocellulose-Based Pickering Emulsifier for Non-Toxic Application and Its Colloid Stabilization Mechanism

Teo SH, Chee CY, Fahmi MZ, Wibawa Sakti SC, Lee HV

Molecules, 2022 Oct 23;27(21).
PMID: 36363998 DOI: 10.3390/molecules27217170

In the past few years, the research on particle-stabilized emulsion (Pickering emulsion) has mainly focused on the usage of inorganic particles with well-defined shapes, narrow size distributions, and chemical tunability of the surfaces such as silica, alumina, and clay. However, the presence of incompatibility of some inorganic particles that are non-safe to humans and the ecosystem and their poor sustainability has led to a shift towards the development of materials of biological origin. For this reason, nano-dimensional cellulose (nanocellulose) derived from natural plants is suitable for use as a Pickering material for liquid interface stabilization for various non-toxic product formulations (e.g., the food and beverage, cosmetic, personal care, hygiene, pharmaceutical, and biomedical fields). However, the current understanding of nanocellulose-stabilized Pickering emulsion still lacks consistency in terms of the structural, self-assembly, and physio-chemical properties of nanocellulose towards the stabilization between liquid and oil interfaces. Thus, this review aims to provide a comprehensive study of the behavior of nanocellulose-based particles and their ability as a Pickering functionality to stabilize emulsion droplets. Extensive discussion on the characteristics of nanocelluloses, morphology, and preparation methods that can potentially be applied as Pickering emulsifiers in a different range of emulsions is provided. Nanocellulose's surface modification for the purpose of altering its characteristics and provoking multifunctional roles for high-grade non-toxic applications is discussed. Subsequently, the water-oil stabilization mechanism and the criteria for effective emulsion stabilization are summarized in this review. Lastly, we discuss the toxicity profile and risk assessment guidelines for the whole life cycle of nanocellulose from the fresh feedstock to the end-life of the product.
Bio-based Pickering emulsifier from mangosteen residues-derived sodium caseinate grafted spherical cellulose nanocrystals: Stability, rheological properties and microstructure studies

Yahya M, Sakti SCW, Fahmi MZ, Chuah CH, Lee HV

Int J Biol Macromol, 2024 Feb;257(Pt 2):128696.
PMID: 38072349 DOI: 10.1016/j.ijbiomac.2023.128696

This study focuses on the preparation of mangosteen rind-derived nanocellulose via green ascorbic acid hydrolysis. Subsequently, milk protein-grafted nanocellulose particles were developed as a renewable Pickering emulsifier for water-oil stabilization. The stabilizing efficiency of modified nanocellulose (NC-S) at different caseinate (milk protein) concentrations (1.5, 3.0, and 4.0 % w/v) was tested in a water-in-oil emulsion (W/O ratio of 40:60). At a concentration 3.0 % w/v of caseinate (3.0NC-S), the emulsion exhibited a stronger network of adsorption between water, Pickering emulsifier, and oil. This resulted in reduced oil droplet flocculation, increased stability over a longer period, and favorable emulsifying properties, as depicted in the creaming index profile, oil droplet distribution, and rheology analysis. Since 3.0NC-S demonstrated the best colloidal stability, further focus will be placed on its microstructural properties, comparing them with those of mangosteen rind (MG), cellulose, and nanocellulose (NC-L). The XRD profile indicated that both NC-L and NC-S possessed a cellulose nanocrystal structure characterized as type I beta with a high crystallinity index above 60 %. Morphology investigation shown that the NC-L present in the spherical shape of particles with nanosized ranging at diameters of 11.27 ± 0.50 nm and length 11.76 ± 0.46 nm, while modified NC-S showed increase sized at 14.26 ± 4.60 nm and length 14.96 ± 4.94 nm. The increment of particle sizes from NC-L to NC-S indicated 2.82 × 10-15 mg/m2 of surface protein coverage by caseinate functional groups.
Multi-air pollution risk assessment in Southeast Asia region using integrated remote sensing and socio-economic data products

Sakti AD, Anggraini TS, Ihsan KTN, Misra P, Trang NTQ, Pradhan B, et al.

Sci Total Environ, 2023 Jan 01;854:158825.
PMID: 36116660 DOI: 10.1016/j.scitotenv.2022.158825

Air pollution has massive impacts on human life and poor air quality results in three million deaths annually. Air pollution can result from natural causes, including volcanic eruptions and extreme droughts, or human activities, including motor vehicle emissions, industry, and the burning of farmland and forests. Emission sources emit multiple pollutant types with diverse characteristics and impacts. However, there has been little research on the risk of multiple air pollutants; thus, it is difficult to identify multi-pollutant mitigation processes, particularly in Southeast Asia, where air pollution moves dynamically across national borders. In this study, the main objective was to develop a multi-air pollution risk index product for CO, NO2, and SO2 based on Sentinel-5P remote sensing data from 2019 to 2020. The risk index was developed by integrating hazard, vulnerability, and exposure analyses. Hazard analysis considers air pollution data from remote sensing, vulnerability analysis considers the air pollution sources, and exposure analysis considers the population density. The novelty of this study lies in its development of a multi-risk model that considers the weights obtained from the relationship between the hazard and vulnerability parameters. The highest air pollution risk index values were observed in urban areas, with a high exposure index that originates from pollution caused by human activity. Multi-risk analysis of the three air pollutants revealed that Singapore, Vietnam, and the Philippines had the largest percentages of high-risk areas, while Indonesia had the largest total high-risk area (4361 km2). Using the findings of this study, the patterns and characteristics of the risk distribution of multiple air pollutants in Southeast Asia can be identified, which can be used to mitigate multi-pollutant sources, particularly with respect to supporting the clean air targets in the Sustainable Development Goals.
Fulltext In vivo Study of Chalcone Loaded Carbon Dots for Enhancement of Anticancer and Bioimaging Potencies

Fahmi MZ, Aung YY, Ahmad MA, Kristanti AN, Sakti SCW, Arjasa OP, et al.

Nanotheranostics, 2023;7(3):281-298.
PMID: 37064612 DOI: 10.7150/ntno.80030

The fluorescent imaging and drug delivery utilizing carbon dots nanomaterials (CDs) have attracted tremendously due to their unique optical ability and outstanding biocompatibility. Herein, we reported a new design of chalcone-loaded carbon dots (Chalcone-APBA-CDs) to serve chalcone transport onto cancer cells and enhance the CDs bioimaging and antitumor activity. The boronic acid was directly introduced to carbon dots (CDs) via pyrolysis process to drive CDs specifically to the cancer cell, and chalcone was mediated on CDs by ultrasonication to perform facile release of the drug delivery model. The successfully synthesized Chalcone-APBA-CDs were proved by their chemical structure, fluorescent activities, in vitro and in vivo analyses, and drug release systems using different pH. In addition, flow cytometry and confocal fluorescent imaging proved CDs' cellular uptake and imaging performance. In vitro analyses further proved that the Chalcone-APBA-CDs exhibited a higher toxicity value than bare CDs and efficiently inhibited the proliferation of the HeLa cells depending on their dose-response. Finally, the performance of Chalcone-APBA-CDs on cancer healing capability was examined in vivo with fibrosarcoma cancer-bearing mice, which showed a remarkable ability to reduce the tumor volume compared with saline (control). This result strongly suggested that the Chalcone-APBA-CDs appear promising simultaneously as cancer cell imaging and drug delivery.
Fulltext Unraveling In vivo Potential of Curcumin-loaded Graphene Quantum Dots on Drug Delivery and Release Kinetics Aspects of Cancer Treatment

Fahmi MZ, Sugito SFA, Wibrianto A, Novania S, Widyastuti S, Ahmad MA, et al.

Nanotheranostics, 2024;8(4):521-534.
PMID: 39507106 DOI: 10.7150/ntno.96559

This study introduces an innovative magnetic-based multifunctional anti-cancer drug carrier aiming to enhance the efficacy of curcumin in cancer therapy. The research investigates the potential of Graphene Quantum Dots (GQDs) as a curcumin drug delivery system for inhibiting in vivo cancer growth. GQDs with a particle diameter below 10 nm were synthesized via hydrothermal and Hummers methods, exhibiting homogeneity and crystalline structure according to AFM and XRD analyses. FTIR analysis confirmed functionalization success, revealing the formation of bonds between GQDs and curcumin. The optical properties of GQDs were assessed using a UV-Vis spectrophotometer and spectrofluorometer, resulting in vigorous fluorescence with a quantum yield of 1.32%. Subsequently, loading curcumin onto GQDs (CQDs/cur) resulted in an efficient system for delivering the anti-cancer drug, demonstrating significant in vivo efficacy. It was indicated by reduced tumor diameter and increased body weight in mice. Furthermore, the release kinetics of curcumin from GQDs were analyzed using the Peppas-Sahlin equation under varying pH conditions (4, 7, and 9), revealing the highest release rate in acidic conditions. In conclusion, this study highlights the potential of GQDs as highly efficient carriers for targeted curcumin delivery, showcasing promising prospects in cancer treatment.
Fulltext Exposure to Misinformation, Risk Perception, and Confidence towards the Government as Factors Influencing Negative Attitudes towards COVID-19 Vaccination in Malaysia

Mohamad E, Tham JS, Mohd Ajis SZ, Hamzah MR, Ayub SH, Tri Sakti AM, et al.

Int J Environ Res Public Health, 2022 Nov 08;19(22).
PMID: 36429342 DOI: 10.3390/ijerph192214623

INTRODUCTION: This study explored exposure to misinformation, COVID-19 risk perception, and confidence towards the government as predictors of negative attitudes toward the COVID-19 vaccine.
METHODS: A cross-sectional survey was carried out from 30 June to 30 August 2021 involving 775 respondents. The survey instrument for the questionnaire was an adaptation from various different studies consisting of five main variables: (1) misinformation about vaccination; (2) risk perception toward COVID-19; (3) attitudes toward the vaccination programme; (4) intention to get vaccinated; and (5) public confidence in the government in executing the vaccination programme.
RESULTS: The results of this study indicate that higher exposure to misinformation led to higher levels of negative attitudes toward the COVID-19 vaccine. When the perceived risk of COVID-19 infection was high, mistrust of vaccine benefits was low but there were also higher worries about the future effects of the vaccine. Confidence in the government was associated with lower negative attitudes toward the COVID-19 vaccine.
CONCLUSION: The results of this study may help develop an understanding of negative attitudes toward vaccinations in Malaysia and its contributing factors.
Three-dimensional Au-MnO2 nanostructure as an agent of synergistic cancer therapy: chemo-/photodynamic and photothermal approaches

Sugito SFA, Wibrianto A, Chang JY, Fahmi MZ, Khairunisa SQ, Sakti SCW, et al.

Dalton Trans, 2024 Jul 09;53(27):11368-11379.
PMID: 38896134 DOI: 10.1039/d4dt01123f

The design of multimodal cancer therapy was focused on reaching an efficient process and minimizing harmful effects on patients. In the present study, the Au-MnO2 nanostructures have been successfully constructed and produced as novel multipurpose photosensitive agents simultaneously for photodynamic therapy (PDT), photothermal therapy (PTT), and chemodynamic therapy (CDT). The prepared AuNPs were conjugated with MnO2 NPs by its participation in the thermal decomposition process of KMnO4 confirmed by X-ray diffraction (XRD), transmission electron microscopy (TEM), and Fourier transform infrared (FTIR) spectroscopy (FT-IR). The 16.5 nm Au-MnO2 nanostructure exhibited an absorbance at 438 nm, which is beneficial for application in light induction therapy due to the NIR band, as well as its properties of generating reactive oxygen species (ROS) associated with the 808 nm laser light for PDT. The photothermal transduction efficiency was calculated and compared with that of the non-irradiated nanostructure, in which it was found that the 808 nm laser induced a high efficiency of 83%, 41.5%, and 37.5% for PDT, PTT, and CDT, respectively. The results of DPBF and TMB assays showed that the efficiency of PDT and PTT was higher than that of CDT. The nanostructure also confirmed the time-dependent peroxidase properties at different H2O2, TMB, and H2TMB concentrations, promising good potency in applying nanomedicine in clinical cancer therapy.
Fulltext Effects of Freezing Time on Degradation of Durian (Durio Zibethinus Murr.) Fruit's Attributes During the Frozen Storage

Prasetia HA, Budiawan S, Syahputra A, Umiarsih R, Pangastuweni R, Fauzidanty MR, et al.

Trop Life Sci Res, 2023 Mar;34(1):19-39.
PMID: 37065793 DOI: 10.21315/tlsr2023.34.1.2

Freeze-process has been applied in preserving many fresh horticultural commodities addressed to the medium-distancing distribution. In this study, effect of freezing process and storage time on durian's attributes degradation was observed. 100 durian fruits were treated with two-level combinations of freezing process. The first level involves the freezing of the said fruit at -15°C for two different freezing times, that is 10 min (treatment A) and 20 min (treatment B). Followed by frozen-storage for -10°C for 0, 10, 20 and 30 days. At different interval time, the frozen samples were thawed at 4°C for 24h. Then, physical, chemical, and sensory parameters were periodically assessed. The result showed that treatment B provide a significantly better output than treatment A. This is proven through a lower weight loss, brighter and lighter yellow of the pulp, softer pulp, lower value of moisture content on the pulp, and a remained stable of succinate acid's profile. Furthermore, based on the preference evaluation test, the fruits were accepted by respondents.
Fulltext Does Varicocele Repair Improve Conventional Semen Parameters? A Meta-Analytic Study of Before-After Data

Cannarella R, Shah R, Hamoda TAA, Boitrelle F, Saleh R, Gul M, et al.

World J Mens Health, 2024 Jan;42(1):92-132.
PMID: 37382284 DOI: 10.5534/wjmh.230034

PURPOSE: The purpose of this meta-analysis is to study the impact of varicocele repair in the largest cohort of infertile males with clinical varicocele by including all available studies, with no language restrictions, comparing intra-person conventional semen parameters before and after the repair of varicoceles.
MATERIALS AND METHODS: The meta-analysis was performed according to PRISMA-P and MOOSE guidelines. A systematic search was performed in Scopus, PubMed, Cochrane, and Embase databases. Eligible studies were selected according to the PICOS model (Population: infertile male patients with clinical varicocele; Intervention: varicocele repair; Comparison: intra-person before-after varicocele repair; Outcome: conventional semen parameters; Study type: randomized controlled trials [RCTs], observational and case-control studies).
RESULTS: Out of 1,632 screened abstracts, 351 articles (23 RCTs, 292 observational, and 36 case-control studies) were included in the quantitative analysis. The before-and-after analysis showed significant improvements in all semen parameters after varicocele repair (except sperm vitality); semen volume: standardized mean difference (SMD) 0.203, 95% CI: 0.129-0.278; p<0.001; I²=83.62%, Egger's p=0.3329; sperm concentration: SMD 1.590, 95% CI: 1.474-1.706; p<0.001; I²=97.86%, Egger's p<0.0001; total sperm count: SMD 1.824, 95% CI: 1.526-2.121; p<0.001; I²=97.88%, Egger's p=0.0063; total motile sperm count: SMD 1.643, 95% CI: 1.318-1.968; p<0.001; I²=98.65%, Egger's p=0.0003; progressive sperm motility: SMD 1.845, 95% CI: 1.537%-2.153%; p<0.001; I²=98.97%, Egger's p<0.0001; total sperm motility: SMD 1.613, 95% CI 1.467%-1.759%; p<0.001; l2=97.98%, Egger's p<0.001; sperm morphology: SMD 1.066, 95% CI 0.992%-1.211%; p<0.001; I²=97.87%, Egger's p=0.1864.
CONCLUSIONS: The current meta-analysis is the largest to date using paired analysis on varicocele patients. In the current meta-analysis, almost all conventional semen parameters improved significantly following varicocele repair in infertile patients with clinical varicocele.
Fulltext Global Practice Patterns in the Evaluation of Non-Obstructive Azoospermia: Results of a World-Wide Survey and Expert Recommendations

Shah R, Rambhatla A, Atmoko W, Martinez M, Ziouziou I, Kothari P, et al.

World J Mens Health, 2024 Apr 03.
PMID: 38606865 DOI: 10.5534/wjmh.230333

PURPOSE: Non-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction, stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with guidelines and offering expert recommendations.
MATERIALS AND METHODS: A 56-item questionnaire survey on NOA diagnosis and management was conducted globally from July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 countries were analyzed descriptively, with a Delphi process used for expert recommendations.
RESULTS: Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoospermia definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by 66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy, distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differentiation relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate.
CONCLUSIONS: This expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations.
Fulltext Global Practice Patterns and Variations in the Medical and Surgical Management of Non-Obstructive Azoospermia: Results of a World-Wide Survey, Guidelines and Expert Recommendations

Rambhatla A, Shah R, Ziouziou I, Kothari P, Salvio G, Gul M, et al.

World J Mens Health, 2025 Jan;43(1):92-122.
PMID: 38606867 DOI: 10.5534/wjmh.230339

PURPOSE: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA.
MATERIALS AND METHODS: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process.
RESULTS: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit.
CONCLUSIONS: This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines.

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