Men's Health Journal

Background: Radial artery spasm (RAS) is one of the most common complications of radial coronary angiography. Several demographic and clinical factors increase the risk of RAS in this procedure. We aimed to evaluate the effect of various risk factors on the incidence and severity of RAS in radial coronary angiography.  Methods: This cross-sectional study was performed on 120 patients who were randomly selected from candidates referred to Shahid Modarres Educational Medical Center for coronary angiography by the radial method. After angiography, radial arteriography was performed to diagnose spasms. The association of some demographic and clinical factors with the incidence and severity of RAS was evaluated. Results: 35 of the 120 patients (29.16%) developed RAS during angiography. Shorter height, shorter radius bone length, less radial artery diameter, longer procedure length, diabetes mellitus, more catheters used, and female sex were significantly associated with higher incidence. The predictive power of these factors for the occurrence of spasms was very good with AUC=0.88. Age, shorter height, higher body mass index, smaller radial artery diameter, longer procedure time, diabetes mellitus, failure of initial effort for puncture, number of catheters used, and female sex were significantly associated with the severity of spasms.

Conclusions: The incidence or severity of spasms during the procedure can be reduced by examining the available risk factors for every patient before deciding to perform angiography.

Introduction: Premature ejaculation (PE) is the most common male sexual dysfunction. Although its etiology is not fully understood, several organic and psychological disorders have been identified as risk factors. The main aim of this study is to find any association between religious orientation (RO) and PE.  

Methods: We designed a cross-sectional study and 80 participants with PE as the main chief complaint were enrolled. After filling informed consent, all participants have filled two questionnaires including the Premature Ejaculation Diagnostic Tool (PEDT) for PE and the Allport & Ross intrinsic-Extrinsic Religious Orientation Scale for RO assessment respectively. Spearman's rho analysis was used for assessing the association between PEDT scores and ROS scores by SPSS 22.0 version.

Results:  Out of 80 patients with mean age 35.56 ± 8.46 years, 70 patients (87.5%) had PEDT positive score. Of them, 45 (64%) had lifelong PE and 25 (36%) experienced an acquired PE. Correlation analysis was shown a reverse correlation between PEDT positive scores and Intrinsic RO (P = 0.05) with a correlation coefficient -0.311, PEDT positive and negative scores was not correlated with extrinsic RO (P= 1).

Conclusion: Patients with a lower intrinsic religious orientation score have a higher probability for PE and PEDT positive score.

Introduction: Regarding scarce knowledge about bleeding in non-valvular atrial fibrillation (AF) patients with simultaneous coronary artery disease (CAD) under triple anti-coagulant therapy, this study was carried out to recognize the risk of hemorrhage and preventive programming.

Materials and Methods: In this performed prospective, 150 consecutive patients with non-valvular atrial fibrillation and concurrent coronary disease, candidate for triple therapy with Asprin 80 mg, Clopidogrel 75 mg and Rivaroxaban 15 mg (in Shohada, Loghman, Modarres, and Labafinezhad centers, in Tehran, Iran during Jan 2019 to Jan 2020 were enrolled and the incidence rate of bleeding and compliance were evaluated for one month.

Results: The results in this study demonstrated that 87.3% had compliance and completely use three drugs. Bleeding occurred in 0.6 % (4 patients), no major bleeding , only one minor bleeding as GIB, three minimal cases (totally 4 bleeding cases), 3 cases with epistaxis, 7 patients with ecchymosis, 6 subjects with hematuria, no one required discontinuation of drug. Diabetes mellitus, hypertension, female sex, older age, higher HASBLED Score, and higher CHADS-VASC Score were related to lack of compliance (P < 0.05).

Conclusion: Incidence rate of bleeding in atrial fibrillation plus coronary concurrent patients, candidate for triple therapy with ASA, Clopidogrel and Rivaroxaban is low. Also the bleeding is minor and the compliance is high showing that majority of cases use routinely these triple therapy regimen.

Introduction:  Considering the incidence of contrast  induced  nephropathy  (CIN) as well as  its  complications  and    costs,  prevention  and  reducing  the  risk  of  CIN  is  an  essential  issue.  The  present  study  aimed  to  evaluate  the  efficacy  of  vitamin  E  and  N-acetylcysteine  (NAC)  on the prevention  of  CIN  in  diabetic  patients  undergoing  coronary  angiography.

Materials and Methods:  360  patients  with  diabetes  who  required  angiography,  including  patients  with  stable  angina  susceptible  to  acute  myocardial  infarction  and  patients  with  acute  coronary  syndrome  were  included  and  randomized  into  three  groups .  Group  1  received  serum  therapy  (Normal Saline)  plus  NAC  and  placebo  of  vitamin  E,  group  2  received  serum  therapy  plus  vitamin  E  and  placebo  of  NAC,  and  group  3  only  received  serum  therapy  with  two  placebos  of  NAC  and  vitamin  E.  The groups were compared considering CIN after angiography. Results:  A  total  of  93  patients  were  studied  in  group  1,  94  in  group  2,  and  113  in  group  3.  CIN  occurred  in  4  patients  (4.3%),  4  patients  (4.3%),  and  8  patients  (7.1%)  in  groups  1,  2,  and  3,  respectively  (P=0.58).  There was  a  significant  difference  in  mean  difference  of  creatinine  levels  before  and  after  study  in  groups  1  and  2  (both  P<0.001).  In  the  subgroup  of  patients  with  chronic  kidney  disease,  NAC  significantly  reduced  CIN  (P=0.03).

Conclusion:  The results  suggested  efficacy  of  both  interventions,  considering  reduction  of  mean  Serum creatinine ( Scr) after  the  study,  while  lack  of  significant  difference  in  the  incidence  of  CIN  could  be  because  of  the  low  number  of  CIN  in  our  study.  The second  important  finding  of  this  study,  probably the  reduced  risk  of  CIN  in  diabetic  patients  with  chronic  kidney  disease  receiving  NAC,  recommends  the  use  of  NAC  for  prevention  of  CIN,  especially  in  this  subgroup  of  patients  undergoing  angiography.

Introduction: Male circumcision involves the partial or total removal of the prepuce (foreskin) from the penis, and it is the most common surgical procedure performed on infants in the USA. According to social convention theory, in demographic populations where male circumcision is more socially accepted, we would predict that circumcised men would be more likely to report satisfaction with their circumcision status. This exploratory study investigated the ways in which particular demographic sub-groups have differing attitudes and levels of satisfaction based on their circumcision status. Materials and Methods: The participant data used in these analyses are from a study conducted to explore the effects of false beliefs concerning circumcision and intact penises on circumcision satisfaction. After participant exclusion based on additional criteria, 902 male participants from the United States, ranging in age from 18-75 (M = 34.0, SD = 10.0), remained. A series of demographic information by circumcision status between participants Analysis of Variances (ANOVA) were conducted on circumcision status satisfaction.  Results: Results indicated that circumcision status satisfaction varied as a function of race/ethnicity, religion, relationship status, and sexual orientation. Statistically significant differences in circumcision status satisfaction were found for all of the demographic variables. Conclusion: Using social convention theory, these data suggest that circumcision satisfaction is related to endorsement of the dominant culture and its norms surrounding the masculine body. Further investigation is warranted regarding causal implications of how one’s demographic characteristics may affect one’s satisfaction with their circumcision status.

Introduction: During the last decades, frequent reports on the poor semen quality in humans have raised many researchers' concerns to study the possible impact of lifestyle or environmental factors on semen quality. The debate is continuously growing on the adverse reproductive effects of exposure to heavy and trace metals found in the environment, even at their relatively low levels. Materials and Methods: This study was carried out from July 2018 to February 2019.  A total of 40 men were divided into two groups (idiopathic oligo– and/or asthenozoospermia and normozoospermic men) to determine the correlation between arsenic (As), cadmium (Cd), copper (Cu), and manganese (Mn) levels in the seminal plasma with sperm quality parameters including concentration, total motility, progressive motility, viability, mitochondrial membrane potential (MMP), sperm plasma membrane integrity (SPMI), acrosome integrity (AI) and DNA fragmentation in Iranian men with idiopathic oligo– and/or asthenozoospermia and normozoospermic individuals.  Results: A significant positive or suggestive correlation was found between as concentrations in the seminal plasma and sperm concentration, motility, progressive motility, viability, MMP, SPMI, and DNA fragmentation. Moreover, seminal plasma Cd concentrations were also correlated negatively with sperm viability. We also found a positive correlation between the seminal plasma Mn levels and sperm concentration, motility, progressive motility, morphology, viability, acrosome integrity, and DNA fragmentation. Conclusion: We showed that the levels of As, Cd, and Mn levels in the seminal plasma are associated with the sperm functional parameters. Considering the unpleasant effects of the studied metals on semen quality, it is suggested that long-term contact with these metals be avoided, especially by people at their reproductive age.

Introduction: Urethroplasty is one of the most common and important reconstructive procedures in the field of urology. In order to improve patient’s condition, medical man needs to be acquainted with this technique.  We aimed to evaluate quality of life and satisfaction of patients with Urethroplasty in the reconstructive urology department of Shohada-e-Tajrish Hospital, during 1995-2016. Materials and Methods: This study was a retrospective cohort. Sampling was done by census method. The patients' demographic information, cause and duration of urethral stricture, type and frequency of procedures, daily fluid intake, urinary obstruction symptoms, the quality of marital relations, and the quality of life of patients before and after the surgery, were evaluated.  Results: The mean age of the patients was 36.6 years. 46.4% of the patients had moderate and more than moderate marital satisfaction after surgery, while this preoperative satisfaction was 48.2% (P>0.05). Patients' quality of work life and job satisfaction was significantly higher than before surgery (P=0.05). In 90.3% of the patients, urination status had no or little negative impact on their daily life after surgery. Also, 86.9% of the patients did not have weak urinary flow during follow-up. 88% of the patients were satisfied with the outcome of their surgery. Patients' satisfaction with their physical health after surgery was 82.1%. Conclusion: In general, it is inferred that Urethroplasty is associated with a high success rate and patient satisfaction, and also improves their quality of life.

Introduction: Assisted Reproductive Technology (ART) has been widely utilized for infertility management. Despite its low success rate, Intra-Uterine Insemination (IUI) is one of the first alternatives and most important approaches regarding many cases of infertility treatment. Given the numerous influencing factors and limitations associated with time and resources, the development of a reliable model to predict the success rate of ART methods can significantly contribute to decision-making processes. Materials and methods: We reviewed the demographic, clinical, and laboratory data regarding 157 IUI treatment cycles among 124 women using their partner’s sperm from May2017 to June2019. Primary outcome measures were clinical pregnancy and live birth. Some prediction models were constructed and compared to the logistic regression analysis. Results: Woman’s mean age was 30.1 ± 5.2 years and the infertility had a female cause in 24.3% of the cases, male cause in 32.6% of cases, and combined causes in 32.6% of the cases. Concerning the first IUI cycle, the clinical pregnancy rate per cycle was 16.9% (N= 21). Data were prepared according to cross-industry standard process for data mining (CRISP-DM) methodology, and the following models were fitted to the data: J48 Decision Tree, Perceptron Multilayer (MLP) Neural Network, Support Vector Machine (SVM) with radial basis function (RBF) kernel, K-Nearest Neighbors (KNN) with one neighborhood, and Bayesian Network. J48 Decision Tree, with a sensitivity of 95% and specificity of 98%, had the most optimal performance, and the KNN model was the weakest one. Conclusion: To predict the results of IUI as a simple and less invasive therapy for infertile couples, some models were applied based on artificial intelligence and J48 Decision Tree was recommended.

Renal cell carcinoma (RCC) is the third most common genitourinary cancer in the world, and has the highest mortality rates among these types of cancers. In the present cross-sectional assessment, the prevalence of RCC subtypes in a sample of Iranian patients diagnosed with RCC which have undergone nephrectomy surgery between years 2014 to 2019 in a referral medical center has been investigated. We have studied 68 patients, including 47 male and 21 female individuals with an average age of 55. The patients have been studied for demographic and pathologic information such as age, sex, tumor size, tumor subtype, TNM staging, Fuhrman nuclear grading, and other pathological information. The statistical analysis was done via SPSS software version 21. Quantitative data were examined by T test and qualitative data were assessed by Chi square test. As we observed in the results, the most common RCC subtype among these patients was clear cell 53%, followed by papillary 22% and chromophobe 19%, emphasizing the higher rates of chromophobe RCC compared to the statistics worldwide.

Introduction: Deep vein thrombosis (DVT) is a common disease with serious risks such as pulmonary embolism and there are different anticoagulant therapies for treatment of this condition. In this study, we investigated the association between the duration of hospitalization with different treatment methods and comorbidities. Materials and methods: In this retrospective cross-sectional study, the hospital records of 213 patients with a diagnosis of acute DVT in Shohada-e-Tajrish Hospital in 2019 and 2020 were reviewed. Patients were divided into five main groups and five subgroups based on the type of treatment. Then, the association between the duration of hospitalization and different treatment methods was studied. Results: Treatment with novel oral anticoagulants (NOACs) with an average length of 2.5 days of hospitalization significantly reduces the duration of hospitalization. Combination therapy with low molecular weight heparin (LMWH) and warfarin or LMWH alone, with an average of 8.38 and 8.20 days, is preferable to treatment with unfractionated heparin (UFH) and warfarin, with an average of 9.2 days. Warfarin treatment with an average duration of hospitalization of 8.43 days is in the third place. The use of other methods has increased the duration of hospitalization. History of comorbidities including history of hospitalization, hypertension, smoking, cancer and trauma are the five comorbidities that have the greatest effect on the length of hospitalization of patients, respectively. Conclusion: According to the present study, treatment with NOACs reduces the duration of hospitalization of patients more than the other treatment methods. The second best choice is LMWH injection therapy and continuation with warfarin or starting and continuing treatment with LMWH preferable to injecting treatment with UFH and continuing with warfarin. The type of underlying disease and comorbidities had a significant effect on the duration of hospitalization.

Introduction: Recent studies suggest that the spleen has an important role as a source of multipotent stem cells and precursors of beta cells of pancreas islets. In addition, increased risk of developing hyperglycemia was reported in patients who underwent splenectomy due to trauma in long-term follow up. Therefore, there might be an association between splenectomy and an increased risk of type 2 diabetes mellitus. In this study, we evaluated the risk of type 2 diabetes and its risk factors including hyperglycemia, dyslipidemia, obesity and hypertension in trauma patients with splenectomy. Materials and methods: In this study, 221 patients who underwent splenectomy surgery due to trauma in the surgical ward of Imam Hossein Hospital 5 to 10 years ago were selected. Those with a history of diabetes, cancer, hyperthyroidism, Cushing's syndrome, pancreatitis, renal failure, and cirrhosis were excluded from the study. Then fasting plasma glucose, hemoglobin A1c (HbA1c), triglyceride, cholesterol and high density lipoprotein (HDL), body mass index and blood pressure have been evaluated in 90 patients who had had a history of splenectomy due to trauma from 2007, July 23 to 2012, July 22. Results: The results indicate that none of these patients has diabetes, 14.4 percent are in pre-diabetic stage, 56.6 percent has dyslipidemia, 57.7 percent has obesity and 20 percent has hypertension. Conclusion: The results of this study suggest that splenectomy does not increase the risk of type 2 diabetes. Prevalence of diabetes risk factors was approximately the same with those of Tehran population.

Introduction: Studying the treatment effect of subclinical hypothyroidism in decreasing metabolic syndrome risk factors and cardiovascular diseases is necessary and can be helpful to control future disorders. In spite of various studies, the relationship between subclinical hypothyroidism and cardiovascular diseases remain controversial. Studies which consider the effects of subclinical hypothyroidism treatment on metabolic control and insulin resistance have not been done in the Islamic Republic of Iran yet. Materials and methods: In this interventional study, 153 patients with subclinical hypothyroidism (thyroid stimulation hormone (TSH) >5, normal T3 and T4 at least 2 times) were selected from Labbafinejad endocrine clinic. Laboratory tests were performed at 8 a.m. after 12-14 hours fasting. Patients were then treated with levothyroxine (25-50 µg daily). To adjust the dose, thyroid function tests (TFT) were checked every 2 months for 6 months. Collected data was used for analysis by spss18 software. Results: After 6 months treatment of subclinical hypothyroidism mean values improved in factors such as insulin resistance profile (fasting blood sugar (FBS), 2 hours post prandial (2hPP), fasting insulin and homeostasis model assessment estimated insulin resistance (HOMA-IR index), lipid profile (total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL), decreased c-reactive protein (CRP) and weight (all had P value<0.05). Treatment did not have significant effect on triglycerides (TG), waist circumference, body mass index (BMI), uric acid ad systolic/diastolic blood pressure (p values>0.05). But the number of cases with high systolic/diastolic blood pressure decreased significantly after 6 months treatment (P values=0.007 and 0.01). Conclusion: Subclinical hypothyroidism treatment is suggested according to mentioned effects, especially in cases with insulin resistance, lipid profile disturbance, obesity, and high blood pressure.

Introduction: There is still controversy over the existence of a relation between hypothyroidism and fatty liver disease. The scale by which hypothyroidism can affect fatty liver disease progression is also to be determined. Therefore, our study aims to contribute in the determination of this relation. Materials and methods: This observational analytical-before and after study with 53 patients was conducted. The subjects were categorized as having either primary or subclinical hypothyroidism. The serum levels of thyroid stimulation hormone (TSH), free T3 (FT3), free T4 (FT4), alanine transaminase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were measured and liver ultrasound was done to screen nonalcoholic fatty liver disease (NAFLD). Results: The study consisted of 41 women and 12 men with the mean age of 48.3 years. The mean TSH levels decreased after hypothyroidism treatment in patients. The mean levels of FT4 did not have a significant increase after treatment, although in patients with subclinical hypothyroidism this increase was significant. T3 levels increased significantly after treatment. Statistical studies showed that there was a significant change in the degree of fatty liver before and after hypothyroidism treatment. Conclusion: There was an explicit relation between hypothyroidism and non-alcoholic fatty liver disease as Hypothyroidism treatment can prevent non-alcoholic fatty liver disease progression.

Introduction: To report the prevalence of various prostate lesions in the general population through cadaver prostates and to determine the interobserver variability for reporting high-grade lesions of the prostate. Materials and Methods: The cross-sectional study was carried out on 110 autopsy specimens of healthy prostate with deceased age over 40 years. The specimens were grossed, sectioned, stained and reported independently by the primary investigator resident and the senior professor. The lesions were categorized into prostatitis, benign prostate hypertrophy (BPH), prostate intraepithelial neoplasia (PIN) further graded as low grade (LGPIN) and high grade (HGPIN) and prostate cancer (PCa). Inter-rater kappa agreement was used to find the strength of agreement between the pathologists. Results: Among 110 prostate specimens, only 8(7.27%) cases had normal prostate with 72 (65.4%) having BPH and 12(10.9%) cases having prostatitis. There were 17 cases of PIN with 11 cases of HGPIN and 6 cases of LGPIN. Malignancy was seen in only a single case (95% Confidence Interval: 0% - 2.71%). The primary resident missed 4 cases of HGPIN and 2 cases of LGPIN. Interobserver agreement between the resident and senior pathologist was fair (Kappa 0.282, p value=0.335). Conclusion: In conclusion, prostate lesions remain latent and show high prevalence in general population without causing any symptoms. The study depicts a high interobserver variability of reporting the high-grade lesions of prostate since they cause a diagnostic dilemma with PCa. The consultation with uropathologists and use of molecular markers must be included in the diagnostic panel while reaching a final diagnosis.  

Introduction: Epicardial adipose tissue (EAT), as a visceral adipose tissue, is associated with various cardio-metabolic risk factors, such as fasting plasma glucose, systemic blood pressure and serum low-density lipoprotein. Using EAT thickness as a cost-efficient assessment tool for stratifying the risk of coronary artery disease (CAD) is still controversial. Methods: We enrolled 250 consecutive patients who underwent coronary angiography during 2016 and gathered their demographic. Echocardiographic examinations were performed in the left lateral decubitus position and EAT thickness was measured in standard parasternal long-axis (PLAX) and apical four chamber views. Results: 250 patients including 156 men (mean age: 57.66) and 94 women (mean age: 61.19) were enrolled. Two vessel disease (2VD) and three vessel disease (3VD) were significantly associated with hyperlipidemia (P: 0.04), CKD (Chronic Kidney Disease) (P: 0.001), diabetes mellitus (P: 0.001) and smoking habits (P: 0.001). Also, EAT thickness in PLAX view (P<0.001), and not four chamber view (P: 0.136), was significantly associated and correlated with increased involvement of coronary arteries in catheterization. Conclusion: Although EAT thickness in PLAX view was significantly correlated with 2VD and 3VD, this correlation was not strong and the accuracy of this approach needs further evaluation.

Introduction: The lifestyle and learning of trainees from different surgical specialties have been severely affected by the COVID-19 pandemic. Despite the growing body of research, the extent to which their surgical or educational performance is affected is not yet well-understood. We investigated the Iranian multi-specialty surgical residents nationwide to clarify the extent this new pandemic’s has affected their surgical and educational activities. Material and Methods: Our specialized board designed a questionnaire which was sent to residents from the 18th of May to 12th of Jun 2020. The questionnaire comprised demographic data, questions on the clinical, surgical, and educational activities during and before the pandemic. Results: Out of 700 eligible residents, 543 (77%) submitted their answers to all questions. 417 (76.8%) of the respondents declared they had spent their residency program at a hospital that was the main referral center for patients with COVID-19 infection. The weekly number of the outpatient and emergent visits decreased by one third (P<0.001) and one-half (P<0.001), respectively, following the pandemic. Also, the amount of surgeries has dramatically decreased (P<0.001). The median weekly hours devoted to face-to-face activities decreased, while the study time increased and the share of virtual education has a five-fold increase (P<0.001). Conclusion: This pandemic had a significant impact on many aspects of training in surgical specialties’ residency program in Iran. Increasing the time available to study is an opportunity, and online education, despite its challenges, has been effective.

Introduction: Defining the opacity of urinary stones by Kidney -Ureter-Bladder (KUB) imaging in the selection of treatment modality is considered necessary by many urologists. This imposes more radiation to patients and additional health costs. The objective of this study is evaluation of the capability of Computed Tomography (CT) imaging in predicting the opacity of urinary calculi. Methods: In this prospective study, the appearance of stones and the body characteristics of all our patients were recorded and analyzed. The setup for reviewing the imaging was as follows: first: CT-scout, then KUB and finally CT scan. The sensitivity and specificity of the CT-scout and Hounsfield unit in detecting stone opacity was calculated. The effect of stone size and body parameters in CT on predicting non-opaque stones were then analyzed. CT scout-negative KUB-positive urolithiasis were analyzed separately. Results: Among 197 participants, all opaque calculi in CT scout were also visible on KUB. Among scout-negative urinary stones, twenty-eight (14.21%) were KUB opaque. For predicting the opacity by CT scan parameters, the most desirable HU cut-off was 504 HU and 510 HU in KUB and CT scout, with 80.8% and 86.5% sensitivity, respectively. The overall sensitivity of CT-scout was 86.27% and specificity was 64.29%. Stone diameter ≥5mm and subcutaneous fat width of ≤25.40 mm augmented the sensitivity in our study groups. Conclusion:  All opaque calculi on scout imaging are also opaque on KUB and this could obviate the necessity of KUB imaging in this group of patients.  HU above 504 in scout-negative stones has the best sensitivity and specificity in foretelling the opacity of stones and size ≥5mm and subcutaneous fat width of ≤25.40 mm augment their predictability potential.

Introduction: Deep vein thrombosis (DVT) is prevalent and challenging for physicians. Previously, the clinical symptoms of DVT are different based on the location of the thrombosis. In this study, the anatomic location of thrombosis and its relation with clinical symptoms and DVT risk factors were investigated. Methods: In this retrospective study, the hospital documents of 204 patients with acute lower extremity DVTs in Shohada-e-Tajrish hospital were reviewed from April 2020 to February 2021. The diagnosis was confirmed using Doppler ultrasound. Based on the location of the thrombosis, the patients were divided into four groups: unilateral proximal group (UPG), bilateral proximal group (BPG), unilateral distal group (UDG), and ipsilateral proximal and distal group (IPDG). Finally, the frequency of risk factors and symptoms were compared between the groups. Results: In this retrospective study, 204 patients with the diagnosis of acute lower extremity DVTs at the time of hospitalization or during hospitalization were studied. The mean±SD age of the patients was 57.1±19.2 years (range: 12-98 years). Of these, 114 (55.9%) were men and 90 (44.1%) were women. There were 174 patients in UPG, 16 in BPG, 5 in UDG and 9 in IPDG. In total, 97.5% of the patients had proximal thrombosis while only 6.9% of them had distal thrombosis. The incidence of different limb circumferences was significantly higher in UPG and IPDG compared to BPG and UDG (P<0.05). There was no statistically significant difference between groups in terms of other symptoms and risk factors. Conclusion: Most of the DVTs were found in the proximal veins of the lower extremities. It seems that these DVTs are more likely to create edema compared to others and in unilateral cases may result in different circumferences of the lower limbs. But there was no significant association between other clinical signs of DVT including limb pain, edema, erythema, palpitations, and shortness of breath with thrombosis location. Also not significant association between DVT risk factors and the location of thrombosis were found.

Introduction: Proton pump inhibitors can influence glucose-insulin homeostasis by elevating plasma gastrin. Considering the few clinical trials and contradictory results of previous studies, we aimed to evaluate the effect of omeprazole, a proton pump inhibitor, on glucose-insulin homeostasis in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: In this before-after clinical trial, 40 patients with T2DM received omeprazole treatment for 12 weeks. Patients were asked to continue their diet, lifestyle, and physical activity throughout the study period. Glycosylated hemoglobin (HbA1c), fasting plasma sugar (FBS), insulin level, C-peptide and 2 hours post prandial blood sugar (2hppBS) were measured at baseline and after 12 weeks. Homeostatic model assessment of Insulin resistance (HOMA-IR) and homeostatic model assessment of β-cell dysfunction (HOMA-B) indices were also calculated at baseline and after 12 weeks of omeprazole administration. Results: After 12 weeks of omeprazole administration, there was a clear decrease in the mean HbA1C before (8.11±0.96) and after (7.13±0.68) the treatment (P<0.001). Similarly, a decrease in mean FBS and 2HPPBS before and after treatment was observed, which was statistically significant for FBS (P=0.01) but not for 2HPPBS (P=0.1). There was a clear increase in the level of Insulin (P=0.001) and C-peptide (P=0.003). The mean activity index of HOMA-B before and after receiving omeprazole was 54.41 27.06 and 79.24 45.32, respectively (P=0.007). Also, HOMA-IR index was 5 before, and 6 after receiving omeprazole (P=0.001). Conclusion: Administration of omeprazole, increases insulin levels and decreases the levels of HbA1c, FBS, thus improving glycemic status and can be combined with other drugs used to manage DM, especially in patients with gastrointestinal problems; but more studies are needed.

Introduction: The prevalence of diabetes mellitus (DM) and its morbidity and mortality are prominent all over the world. Observational data suggest that vitamin D deficiency is associated with insulin resistance. In this study, we aimed to assess this association. Methods:  This study was a clinical trial consisting of 42 patients with type 2 DM who had vitamin D deficiency. The patients underwent vitamin D replacement with vitamin D pearls (50,000 iu) weekly for 10 weeks. The level of low-density lipoprotein (LDL), high-density lipoprotein (HDL), cholesterol (Chol), triglycerides (TG), hemoglobin A1c (HbA1C), 2 hour post prandial (2HPP), fasting blood sugar (FBS), body mass index (BMI), blood pressure (BP), and 25oHVitD3 were measured before and after the treatment in all patients. Data were analyzed with paired t test. Results:  100% of patients reached acceptable vitamin D level (above 30 mg/dl). No toxicity was reported. Changes in FBS, 2Hpp, HbA1C, Chol, SBP were significant and there was no significant change in LDL, HDL, and DBP. Conclusion:  Screening for vitamin D deficiency and its replacement may have a beneficial effect on type 2 DM management and its associated risk factors. More studies with larger sample size and use of placebo are recommended.

Background: Penile fracture is a urological emergency requiring proper diagnosis and treatment. Limited studies conducted in Iran have reported high prevalence of this problem (9.9 per 100,000 male population). In this study, we also examined the causes and symptoms, as well as the type of treatment physicians choose so that in the future, we can use this data to educate physicians and other people in the community about this disease. Methods: First, all urologists across the country were contacted and informed about the project. Then, from February 2017 to February 2018, a pre-prepared questionnaire containing the required information was sent to them and they were asked to complete and send this questionnaire in case of a penile fracture. Then, every two weeks, we reconnected all urologists in different ways (email, phone call, virtual networks, etc.) and collected relevant data. Finally, all data were analyzed using SPSS software, version 19.  Results: The incidence of penile fractures was estimated to be 2.5 per 100,000 men (from 0.38 in the age range of 69-60 years to 3.9 in the age range of 39-30 years). The most common causes of penile fractures were sexual intercourse (64.8%), followed by non-sexual trauma (16.9%) and masturbation (13.3%). Pain, edema and discoloration of the penis were the most common symptoms at the time of admission (83.6%) and most patients (84%) had referred to a physician within the first 24 hours after the accident. 78.9% of urologists believed in emergency surgical treatment, while 20.3% believed in delayed surgical treatment and 0.7% believed in supportive treatment. Conclusion: Because of the cultural diversity of Iran, the rate of penile fracture is very different in different parts of Iran, but its rate is much lower than previous studies.

Background: Radial artery spasm (RAS) is one of the most common complications of radial coronary angiography. Several demographic and clinical factors increase the risk of RAS in this procedure. We aimed to evaluate the effect of various risk factors on the incidence and severity of RAS in radial coronary angiography.  Methods: This cross-sectional study was performed on 120 patients who were randomly selected from candidates referred to Shahid Modarres Educational Medical Center for coronary angiography by the radial method. After angiography, radial arteriography was performed to diagnose spasms. The association of some demographic and clinical factors with the incidence and severity of RAS was evaluated. Results: 35 of the 120 patients (29.16%) developed RAS during angiography. Shorter height, shorter radius bone length, less radial artery diameter, longer procedure length, diabetes mellitus, more catheters used, and female sex were significantly associated with higher incidence. The predictive power of these factors for the occurrence of spasms was very good with AUC=0.88. Age, shorter height, higher body mass index, smaller radial artery diameter, longer procedure time, diabetes mellitus, failure of initial effort for puncture, number of catheters used, and female sex were significantly associated with the severity of spasms.

Conclusions: The incidence or severity of spasms during the procedure can be reduced by examining the available risk factors for every patient before deciding to perform angiography.

Introduction: Testis cancer is a rare cancer that afflicts young men. although the incidence of testis cancer is increasing, the mortality rate is decreasing. This study examines the mortality of testicular cancer and its relationship with the human development index and its components in Iran during 2005-2015. Materials and Methods: Data of patients with testis cancer were collected from the Office of National Cancer Registry in the Ministry of Health and Medical Education (MOH&ME) during 2005-2015. An additional telephone survey was conducted by trained interviewers to collect data, including survival status, demographic characteristics, age of cancer diagnosis and other clinical profiles. Kaplan-Meier survival rates were calculated according to demographic characteristics, economic status, and residential area and socioeconomic status (SES). All the analyses were done using STATA software, version 14 (StataCorp. 2015). Results: From 2005 to 2015, 5886 testicular cancer cases were diagnosed among men in all age groups. Most patients (73.9%) were 15–49 years of age at the time of diagnosis, 26.1% were 50 years of age or older. Seminoma was diagnosed among 46.78% of the patients and non-seminoma among 42.28%. Factors which had impact on survival rate were age (P=0.001), tumor histology (P=0.02, hazard ratio=1.23[0.98-1.38]) and TNM stage (P=0.001, hazard ratio=1.2[0.92-1.28]). Patients who got married at the time of diagnosis more likely presented at earlier stages and had better overall testis cancer-specific survival than patients who were single, separated, widowed, or divorced (P=0.002, hazard ratio 1.27[1.09-1.49]). Testis cancer mortality rate was significantly higher in patients who did not graduate from high school and significantly higher in patients who were tenants (P=0.057, hazard ratio =1.132[0.996-1.28]). Conclusion: Testis cancer mortality is decreasing in Iran. Age, TNM stage and histology, and marital and economic status were factors influencing mortality rate.

Introduction: C0VID-19 outbreak was declared as a pandemic in 2019 by the World Health Organization (WHO) with a global spread and undefined course. COVID-19 has created great fear and panic all over the world creating mental and physical distress. Looking at the adverse effects of the pandemic, we aimed to assess the psychological conditions of the general population residing in various states of India as a result of the nation-wide lockdown and quarantine in COVID-19. Materials & Methods: This study is a descriptive, cross-sectional, anonymous online survey. A self-rated structured questionnaire was made through Google form. Snowball sampling technique was used.  Results: 53.2% of the respondents were men while 46.8% were women. 92.5% resided in urban areas. A comparison between the male and female respondents was made in the various domains and we found that 28.3% of men and 30.2 % of women were affected to a greater extent by the pandemic whereas 24.6% of men were worried about the financial loss. 10.2% of the women reported to feel depressed in the last two weeks while only 7% of the men were irritated. 51.9% and 44.9% of men and women considered it important to take actions for preventing Corona Virus Disease. Conclusion: Stress, anxiety and depression among the general population was found to be moderately present although all the safety guidelines were followed along with the lockdown. The participants had a good level of awareness regarding preventive aspects as well.

Introduction: We aimed to compare the effect of nettle extract and pumpkin seed on Prostate Specific Antigen (PSA) and international prostate symptoms score (IPSS) in patients taking alfa-blocker for benign prostatic hyperplasia (BPH). Materials and Methods: For this purpose, 90 outpatients were studied in three groups, including men over 40 years of age with benign prostatic enlargement. The first group (Urtidin) contained consumers of nettle extract from Barijessence Company called Urtidin tablets with tamsulosin; the second group took tablets containing pumpkin seed extract called Prosta Barij and tamsulosin; the third group (Control) received only tamsulosin for three months. Patients were not randomly assigned to the groups PSA, IPSS, and related factors were evaluated and analyzed using SPSS software. Results: 89 patients completed the study (30/89 in Urtidin group with a mean age of 62.4±7.39 years, 29/89 in Prosta Barij group with a mean age of 65.9±7.32 years, and 30/89 in the control group with a mean age of 64.7±8.64 years). The results showed that nettle and pumpkin seed extracts affect PSA in patients taking tamsulosin for BPH. Also, after the intervention, IPSS had a significant decrease compared with baseline in both drug treatment groups. There was no significant difference in these three types of treatment. Conclusion: It seems that the desired herbal products did not have a synergistic effect with alpha blockers in the control and treatment of BPH but they can affect the serum PSA level.

There is considerable current policy debate and public discourse about the nature of health, wellbeing and suicide in boys and young men. Unfortunately, little of the discussion seems to be founded on established models of best practice for working with young males in this space. Further, arguments proffered, and decisions made regularly tend to omit the voice of young males from the process. For optimal health outcomes and suicide prevention to be achieved for young males and subsequently across their whole lifespan, substantial evidence needs to be gathered and considered in establishing benchmarks for policy, funding, and service delivery. The article will explore some of the established literature that covers this area, as well as emerging research that is adding to current knowledge as the article looks at the emerging non-medial alternative approaches such as mentoring as an early intervention, the impact of social determinants of health and collaborative group-based activities and also a change in media content from highlighting hegemonic/toxic masculinity to more positive emotional stories of men showing a resilient attitude to life’s problems.  The article discuses a growing need to move away from medical approaches especially in the case of attention-deficit hyperactivity disorder that is 3-9 times more prevalent amongst young boys who are diagnosed with it than girls. There is a need to find a more balanced physical/medical health and mental/emotional wellbeing approach for young men to deal with the transition from boyhood to manhood.   

Background: The prevalence of ulnar nerve mono neuropathy has increased in recent years. Upper limb involvement by ulnar neuropathy results in motor and sensory disability and this disability imposes significant physical, psychological and financial burdens on patients. We aimed to assess the prevalence and causes of ulnar neuropathy in the Electrodiagnosis clinic of Shohada-e-Tajrish medical center. Materials and Methods: In this cross-sectional study we extracted the electronic files of all patients referred to the clinic during 2009-2013. Patients with ulnar neuropathies were selected and required data were obtained. 62 patients with ulnar nerve lesions were included and their data (include age, sex, involved side, cause of lesion, severity and location of involvement) were analyzed. Results: Of the 62 patients enrolled, 42(67.7\%) were men and 20 (32.3\%) were women with a mean age of 41.63 years (range: 17-79 years). There was a significant relationship between age and disease prevalence. The highest prevalence rate of the disease was observed in the 20–39year-old age group and the lowest in the below 20-year-old age group. Trauma was a more frequent cause than entrapment. Elbow was the most frequent location of injury. Conclusion:Ulnar neuropathy was more prevalent in young and middle-aged individuals than those above 60 years. Considering the potential disability caused by this nerve damage, more attention is needed to evaluate patients and initiate proper treatment and rehabilitation in those ulnar nerve lesion.

Coronary artery disease (CAD) is among the most common cardiovascular diseases (CVDs), caused by the formation of plaques of lipids, calcium, and inflammatory cells. In Iran, CAD is responsible for about 50% of all deaths per year. There is also a probability of the role of androgens deficiency in CAD in men. We aimed to systematically review all the related original studies to achieve an overall insight into the associations of testosterone and CAD in Iranian men. 

MedLine, Web of Science, Scopus, and Google scholar databases were searched from inception to January 2021. All types of studies on Iranian men older than 40 years of age, reporting results of comparing testosterone in normal individuals and those with CAD were included. The main findings of the articles were compared to achieve an overall statement.

Ultimately, six studies were included. Most (66.7%) had directly stated that lower levels of testosterone are associated with CAD or the level of testosterone is lower in patients with proven CAD. Among them, in 3 (50%) studies, the mean age of the participants had no significant difference between patients with CAD and the normal group.

It is clear that low testosterone level is associated with increased risk of cardiovascular events but it is not definitely determined whether it is independent of age in Iranian men.  Further well-designed studies are needed to clearly exclude all confounding variables including age and show the net effect of testosterone on CAD.

Background: The need for comprehensive and more serious management of disasters and, consequently, the need for knowledge and how to use it in order to reduce the risk of disasters has increased. The importance of this issue is such that in 2016, the World Health Organization launched a research network related to health risk management in disasters. Accordingly, this study was conducted to review articles published in the field of health in emergency and disaster. Methods: In this study, the narrative review method has been used. The accessible articles published in the field of health Risk Management (health EDRM) from 2000 to 2019 were reviewed. Databases including Web of Science, PubMed, Google Scholar, Science Direct, Scopus, Medline, Magiran and SID were used. 24 studies had the inclusion criteria that were selected and analyzed. Data analysis was a qualitative content analysis in the form of components of health risk management in emergency and disasters. Results: Among the 24 studies reviewed, 21 articles were in English and 3 articles were in Persian. In addition, most of these studies were published in 2019. The articles were analyzed and reported in the form of components and functions of health risk management in emergency and disasters, published in 2019 by the World Health Organization. Conclusion: Studies show that the focus of most studies is on policies, strategies and legislation, planning and coordination, and less attention is paid to the components of risk communication and health services. Also, there are many research gaps and it is suggested that more research be done with more precise guidance.

Introduction: Mental disorders are the most prevalent health problems in the world. 23.6\% of Iranians have at least one psychological disorder. Men usually neglect their mental health issues, and their top priority mental health disorders should be determined for health planning. Methods: International databases including MedLine, Scopus, Web of Science, ProQuest, and SID national database were searched from 2015 to October 2020. The latest reported prevalence and percent of total DALY (Disability-adjusted life year), their difference between sexes as well as the expert panel’s opinion about mental disorders were gathered in a matrix based on the Three-Dimensional Combined Approach Matrix (3D-CAM). Each item got a rank and prioritization was made base on mean rank. Results: Eight studies were included. The most prevalent mental disorders among the Iranian male population were Major Anxiety Disorders (MADs, 12\%) and the highest burden belonged to Major depressive disorder (MDD) comprising 2.88\% of the total DALY. Considering all parameters, the highest priority was the Drug Use Disorders (DUD) followed by Alcohol Use disorders (AUDs), Conduct disorder, MADs, Bipolar disorder, MDD, and Schizophrenia, respectively. Conclusion: Men are extremely affected by drug and alcohol use disorders in Iran and also there is a lack of practical screening and effective interventional programs for these disorders in the primary health care system. More intensive harm reduction programs are needed for decreasing devastating consequences of any substance use disorders as well as improving mental health literacy and raising awareness toward risk perception for preventive and controlling purposes.

Introduction: Overweight and obesity is one of the most common diseases worldwide that is less considered in men. In this regard scattered studies have been conducted in Iran, and our aim was to systematically study the prevalence of overweight and obesity in Iranian men. Methods: Major international databases including: Scopus and PubMed, and Web of Science and national databases including Magiran and SID were searched for articles in Persian and English which were published from August 10, 2010 to August 10, 2020. Qualitative evaluation of the studies was performed using the Newcastle-Ottawa Scale checklist (NOS). Random effects model was used to estimate the pooled prevalence by STATA software version 14.2 with significance level of 0.05. Results: Overall, 52 studies with a total sample size of 120,440 men with age range of 20-77 years were included in this systematic review. Most studies were conducted in 2017 and almost all of them were in Tehran province. The pooled prevalence of overweight was 46% (95% CI: 46, 46) in men. The lowest prevalence of overweight was 11.1% in Fars and the highest was 57% in Tabriz. The pooled prevalence of obesity in men was 18% (95% CI: 18, 19) with the highest prevalence in Birjand (46.5%) and the lowest in Tehran (0.8%). Conclusion: Our results showed a variety of tools for measuring overweight and obesity in Iran. Based on the BMI index, we found that the prevalence of overweight and obesity was substantial among Iranian men. There seems to be an urgent need for health policy makers to develop and implement proper preventive strategies in order to control this public health problem and its serious health consequences among men, especially in the workplace.

Introduction: According to a nationwide study, one-third of the Iranian population suffer from metabolic syndrome (MetS). The most controversial criteria for the diagnosis of MetS is central obesity which would be defined by waist circumference (WC) and needed to be gender and ethnic-specific. There are several national studies that reported different cut-offs for WC so the present study aimed to do a systematic review and meta-analysis to achieve an overall statistical estimate of WC for the Iranian population. Method: A comprehensive search was conducted in international databases from inception to June 2020. The search keywords were waist circumference AND metabolic syndrome AND cut AND Iran. We used the QUADAS-2 tool for quality assessment and the HSROC model for estimating pooled specificity, sensitivity, and the cut-off point from included studies in R software. Results: A total of 3571 studies were evaluated and 24 studies fulfilled the inclusion criteria. Finally, 8 studies were included. All the studies were cross-sectional. Studies with missing MetS prevalence were excluded. Most of the studies had an unclear risk of bias in patient selection. There was a wide variation among reported cut-offs for WC from national and original studies. The Pooled cut-off points of WC for the diagnosis of MetS was 90.55 cm (95%CI: 90.51-90.60) in men and 89.24 cm (95%CI: 89.13-89.36) in women. The pooled sensitivity and specificity in men were 0.67 and 0.68, respectively and the pooled sensitivity and specificity in women were 0.61 and 0.57, respectively. Conclusion:  Our results were highly consistent with the only national study and the only consensus about WC cut-off. Further nationwide studies are suggested to be involved in a Mata-analysis for calculating more precise WC cut-off.

Introduction: The typical sexual function involves the integrity and harmonious interaction of psychological, endocrine, vascular, and nervous systems. We aimed to determine the prevalence of sexual dysfunction (SD), more specifically erectile dysfunction in Iranian men with diabetes. Method: Using keywords including: “sexual function,” “erectile dysfunction,” “diabetes,” and “Iran”, an electronic search was done on national and international databases. All cross-sectional or baseline data in cohort studies were included. The prevalence of SD and its related risk factors were extracted and summarized. The random effect model was used for estimating the pooled prevalence.   Results: Ultimately, 16 studies were included in the qualitative synthesis, amongst which 6 were included for quantitative synthesis. The pooled prevalence of SD across included studies was 50.7%. with a total sample size of 1513. Two main correlated factors with SD were advanced age and depression. Conclusion: Our analysis showed that more than half of the Iranian men with diabetes suffer from SD. Apart from advanced age, the most important attributes for comorbidity of diabetes and SD in these patients were found to be chronic uncontrolled high blood sugar and depression.  More advanced epidemiological studies are needed to assess the temporality of the relationship between SD and its related comorbidities and to develop proper preventive programs.

Introduction: Primary infertility (PI) is one of the most common problems with an increasing incidence globally. Studies conducted in several parts of Iran have reported different a prevalence for this infertility type, so we investigated PI prevalence in the Iranian male population. Material and methods: This study was performed using the keywords "primary", "infertility", "prevalence", "men", "male", and "Iran" in international databases, including MedLine, Scopus, Web of Science, ProQuest, as well as domestic databases, including scientific information database (SID) and Magiran. We included original articles estimating PI prevalence and the cause of infertility in the general population and infertile Iranian couples referred to infertility centers. PI prevalence in men was not reported in any included studies, so using weighting based on sample size, the average PI prevalence in the studied couples and any male factors ("male" factors plus "both" factors) was estimated. Results: Thirty-two studies were obtained in the initial search. Ultimately, seven studies (five studies on infertile couples and two studies on the general population) were selected. The weighted average prevalence of PI was 81.26% (81.1-81.43) in referred infertile couples and 5.76% (5.63-5.89) in the general population. The overall estimate of PI prevalence in these groups was 46.35% (46.15-46.54) and 1.93% (1.89-1.97), respectively. Conclusion: Although the PI prevalence in different parts of Iran has been reported in the mentioned population, there was no domestic study on PI prevalence in men, so further studies to validate our results are needed.

Background: In the process of human reproduction, spermatogenesis is one of the most important stages, which is controled by special genes on Y chromosome. Previous studies show that some infertile men have microdeletions on Y chromosome, which cause the reduction of sperm count. Three prominent spermatogenesis loci have been identified on the Y chromosome and entitled “azoospermia factors” (AZFa, b, and c). Hereby, this review article aimed to investigate the content of the Y chromosome microdeletions and their importance in male fertility. Methods: Data and information were collected on English-language articles from PubMed and MEDLINE databases. For Persian articles, Persian-language databases, including SID Scientific Database, IranMedex Medical Articles Database, IranDoc (Iran Scientific Information and Documents Research Institute), Magiran Publication Information, and MedLib were investigated. More than 50 articles on Y chromosome microdeletions and infertility published during 2000-2020 were studied. Results: Previous studies implicated that Y chromosome microdeletions in AZFa, AZFb, and AZFc regions are accompanied by defect in spermatogenesis, leading to oligo / azoospermia. Patients with AZFa and AZFb microdeletions present secretory azoospermia and do not have sperm in their seminiferous tubules. Complete AZFc deletion involves region b2/b4, which contains a total of 12 genes. Incomplete deletion of AZFc includes b1/b3, b2/b3 and gr/gr. The most common of which are gr/gr. In men with gr/gr deletion, sperm count and motility were lower than control group. Conclusion: Y chromosomal microdeletions emerged as the most frequent structural chromosome anomaly associated with the quantitative reduction of sperm. The development of assisted reproductive techniques (ART) like intra-cytoplasmic sperm injection (ICSI) and testicular sperm extraction (TESE) helps to bypass the natural barriers of fertilization.

A posterior urethral valve (PUV) is a congenital obstructive defect of the male urethra, and sometimes maybe life threatening. The diagnosis of PUV is usually made early because of its symptoms and has rarely been diagnosed in adults for the first time in life. Here we report a rare case of an adult PUV in a 67 year-old man with 40 years history of urinary obstruction complaints with coincidence type 1 and 2 of PUV who underwent transurethral resection of the bladder neck and valve ablation. After 6 months follow-up, no evidence of urinary obstruction observed.

Leiomyomas are the most common benign mesenchymal tumors arising from smooth muscle cells. Cutaneous leiomyoma constitutes small percentage of all the leiomyomas. However, genital leiomyomas, such as those of the scrotum have an even lower incidence rate. A 43-year-old man presented with complaints of a painless swelling in the left side of the scrotum. A clinical diagnosis of scrotal wall fibroma was made and the swelling was excised which had homogenous, grey-white areas with whorling and histologically showed features of leiomyoma. Here we present a rare cause of scrotal mass in a middle-aged man.