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Aim of the Study: Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse., Material and Methods: Eighty women with asymptomatic utero-vaginal prolapse were included in this prospective study for vaginal hysterectomy after preoperative preparation and after written informed consent. Women included in this study were screened preoperatively by high vaginal swab, Pap smear, endometrial biopsy and trans-vaginal ultrasound. Surgically removed uteri and ovaries were sent for histopathological examination. Results of histopathological examination as gold standard were compared with conventional gynecological screening methods., Results: Histopathological examination of surgically removed uteri and ovaries after vaginal hysterectomy for uterovaginal prolapse showed abnormal findings in 61.25% (49/80) of studied cases (10 chronic cervicitis; 20 cervical intra-epithelial neoplasia-1 [CIN-1]; 5 CIN-2; 2 CIN-3; 10 simple endometrial hyperplasia without atypia and 2 simple serous ovarian cyst). Also, histopathological examination showed premalignant changes in 33.75% (27/80) of studied cases (20 CIN-1; 5 CIN-2 and 2 CIN-3), which mean 50% sensitivity of pre-operative Pap smear to detect premalignant cervical changes., Conclusions: Asymptomatic women with utero-vaginal prolapse may have associated premalignant lesions which may not be detected by conventional screening methods, and this should be explained preoperatively for women undergoing surgery, especially if conservative management was considered.

Introduction: The objective of this study is to investigate the molecular mechanisms underlying the effects of zinc deficiency on spermatogenesis in the Sprague-Dawley (SD) rat., Materials and Methods: Three groups of eight adult male SD rats were maintained for 4 weeks on a normal diet as control, zinc deficient diet and zinc deficient diet with zinc supplementation of 28 mg zinc/kg body weight respectively. Using standard techniques, the following parameters were compared between the three groups of experimental animals at the end of 4 weeks: (a) Serum zinc, magnesium (Mg), copper (Cu), selenium (Se) and cadmium (Cd), (b) serum sex hormones, malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GPX), (c) interleukin-4 (IL-4), tumor necrosis factor-alpha (TNF-α), Bcl-2, Bax and caspase-3 expression in the testes, (d) assessment of apoptosis of testicular cells using electron microscopy and (e) testicular volume and histology using the orchidometer and Johnsen score, respectively., Results: The zinc deficient group showed a reduction of testicular volume, serum concentrations of Zn, Cu, Se, Mg, SOD, GPX, IL-4, Bcl-2 and testosterone (P < 0.05), as well as increased levels of serum Cd, MDA and tissue TNF-α, Bax, caspase-3 and apoptosis of the germ cells (P < 0.05) compared with control and zinc supplementation groups., Conclusion: Zinc deficiency is associated with impaired spermatogenesis because of reduced testosterone production, increased oxidative stress and apoptosis. These findings suggest that zinc has a role in male reproduction.

Since the discovery of spermatozoon by Anton van Leeuwenhoek in 1677, there has been an ever increasing understanding of its role in reproduction. Many factors adversely affect sperm quality, including varicocele, accessory gland infection, immunological factors, congenital abnormalities, and iatrogenic systemic and endocrine causes, such as diabetes mellitus, obesity, metabolic syndrome, and smoking. The mechanisms responsible for the association between poor sperm parameters and ill health may include oxidative stress, low-grade inflammation, low testosterone, and low sex-hormone-binding globulin. Oxidative stress in the testicular microenvironment may result in decreased spermatogenesis and sperm DNA damage, loss of sperm motility, and abnormal sperm morphology. Low testosterone caused by advanced age, visceral obesity, and inflammation is associated with the development of cardiovascular disease. Hence, semen analysis has an important role in the routine evaluation of idiopathic male infertility, usually manifested as low sperm counts, impaired sperm motility, or absence of sperm, and remains the most common single diagnostic tool. Several studies have shown an inverse relationship between semen quality and medical disorders. This review elucidates the effect of medical disorders and social habits on sperm quality, the mechanisms that are involved in the impairment of sperm quality, and whether or not sperm quality can be used as an index of good health and longevity in a man., (© 2013 S. Karger AG, Basel.)

This study was undertaken to determine the prevalence of Chlamydia trachomatis, mycoplasmas, and ureaplasmas in semen samples of infertile compared with fertile men and to evaluate the seminological variables of semen from infected and noninfected men. A total of 127 infertile and 188 fertile men seen in a maternity hospital clinic were recruited into the study over a period of 14 months. Specimens were obtained by masturbation and examined for the presence of Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, and C trachomatis by polymerase chain reaction. Semen analysis was performed according to World Health Organization guidelines. U urealyticum, M hominis, M genitalium, and C trachomatis were demonstrated in the semen samples of 31 (24.4%) vs 49 (26.1%), 22 (17.1%) vs 61 (32.4%), 6 (4.7%) vs 6 (3.2%), and 5 (3.9%) vs 7 (3.7%), respectively, of infertile and control men. Mixed infections were detected in 14 (11%) of infertile and 29 (15.4%) of fertile men. The infertile men positive for M hominis had semen samples that showed statistically significant differences in the mean of sperm pH and leukocyte count between infected and uninfected men (P < .03 and P < .001, respectively). Similarly, there was statistically significant difference in the leukocyte counts of M genitalium and C trachomatis in infected compared with uninfected men. A similar trend was noted in infected fertile compared with uninfected men. The difference in prevalence of these urogenital pathogens among infertile compared with fertile men was not statistically significant. However, genital mycoplasmas and chlamydial infections appeared to influence semen quality negatively.

Purpose: To investigate the protective effect of Lithium against the toxic effect of Cadmium in the rat testes., Methods: Twenty four adult male Sprague-Dawley rats were treated with four different regimens: Cadmium only, Cadmium and lithium, lithium only and controls. Rats were sacrificed after 6 weeks and testicular levels of pro-inflammatory cytokine (IL-4), anti-inflammatory cytokine (TNF-α), Pro-apoptotic protein (Bax) and anti-apoptotic protein (Bcl-2) were measured by ELISA while serum levels of FSH, LH, Prolactin and Testosterone were measured using the Vidas parametric system. Antioxidant status (MDA, SOD) was also assessed in serum. Histopathological changes of testes were examined using light and electron microscopy. Immunohistochemical staining for Bax, Bcl-2 and Caspase 3 were performed., Results: Treatment with lithium was associated with significant reduction in the toxic effects of Cadmium as shown by reduced testicular levels of TNF-α, serum levels of Malondialdehyde and testicular level of Bax, and increased levels of IL-4, Zn-Cu SOD, Bcl-2 and Testosterone. Testicular histopathology showed that Cadmium produced an extensive germ cells apoptosis and the addition of lithium in Cadmium-treated rats significantly reduced cadmium-induced testicular damage., Conclusion(s): Lithium has a protective effect against cadmium-induced testicular apoptosis in the rat.

Background: The unfulfilled desire of millions of infertile couples worldwide to have their own biological children results in emotional distress. This study evaluated the emotional reactions of couples attending a combined infertility clinic in Kuwait and successful clients' perception of nurses., Methods: Quantitative and qualitative methods were used. The first phase was by structured interview using two standardized psychological scales: the 25-item Hopkins Symptom Checklist and Modified Fertility Adjustment Scale. Data were collected from 268 couples attending the combined infertility clinic, between October 2002 and September 2007. The second phase was a semi-structured interview of 10 clients who got pregnant following treatment. The interview explored their feelings and perception of the nurses' role. Interviews were transcribed verbatim and analyzed., Results: The average duration of infertility was 4 years; 65.7% of the women and 76.1% of men suffered from primary infertility. Emotional reactions experienced were: anxiety in women (12.7%) and men (6%), depression in women (5.2%) and men (14.9%) and reduced libido in women (6.7%) and men (29.9%). Also in men, 14.9% experienced premature ejaculation, 5.2% weak ejaculation and 7.9% had impotence although 4.9% were transient. In the semi-structured interviews, the emotions expressed were similar and in addition to anger, feelings of devastation, powerlessness, sense of failure and frustration. In the survey, 12.7% of the men were found to show more anxiety than women (6%). Although all the 10 women interviewed confirmed they were anxious; only 4 of their partners were reported to be sad or anxious. Successful clients' perception of nurses' roles included nurses carrying out basic nursing procedures, communicating, educating about investigative and treatment procedures, providing emotional support by listening, encouraging, reassuring and being empathetic., Conclusions: This study illuminates the emotional reactions of infertile clients. Fertility nurses in Kuwait can provide emotional support through communication. The need for additional and continuous training for nurses employed in fertility settings in Kuwait is paramount.

Objective: To determine possible indications of the mechanisms involved in improved sperm parameters by zinc therapy in asthenozoospermic men., Subjects and Methods: Forty-five men with asthenozoospermia (>or=40% immotile sperm) were randomized into four therapy groups: zinc only: n = 11; zinc + vitamin E: n = 12 and zinc + vitamins E + C: n = 14 for 3 months, and non-therapy control group: n = 8. Semen analysis was done according to WHO guidelines. Malone dialdehyde, tumour necrosis factor-alpha (TNF-alpha), total antioxidant capacity, superoxide dismutase (SOD) and glutathione peroxidase were determined in the semen and serum. Antisperm antibodies IgG, IgM and IgA were evaluated by immunobeads. Sperm chromatin integrity was determined by acid denaturation by acridine orange and sperm apoptosis by light and electron microscopy. The effect of zinc on in vitro induced sperm oxidative stress by NADH was evaluated., Results: Asthenozoospermia was significantly associated with oxidative stress with higher seminal malone dialdehyde (8.8 vs. 1.8 mmol/l, p < 0.001) and TNF-alpha (60 vs. 12 pg/l, p < 0.001), and low total antioxidant capacity (1.8 vs. 8.4, p < 0.01), SOD (0.8 vs. 3.1, p < 0.01) and glutathione peroxidase (1.6 vs. 4.2, p < 0.05), compared to normozoospermia. Zinc therapy alone, in combination with vitamin E or with vitamin E + C were associated with comparably improved sperm parameters with less oxidative stress, sperm apoptosis and sperm DNA fragmentation index (DFI). On the whole, there was no difference in the outcome measures between zinc only and zinc with vitamin E and combination of vitamins E + C. In the in vitro experiment zinc supplementation resulted in significantly lower DFI (14-29%, p < 0.05) compared to zinc deficiency., Conclusion: Zinc therapy reduces asthenozoospermia through several mechanisms such as prevention of oxidative stress, apoptosis and sperm DNA fragmentation., ((c) 2008 S. Karger AG, Basel.)

Objective: To evaluate the outcome of the use of MgSO4 therapy in women with severe pre-eclampsia in Kuwait from January 2002 to December 2004., Subjects and Methods: The study involved 450 women managed at the Maternity Hospital in Kuwait with a blood pressure of 160/110 mm Hg and proteinuria of >0.3-5 g/24 h. A loading dose of 4 g MgSO4 was administered intravenously over 20 min and then the maintenance dose continued at 1 g/h for 24 h postpartum. Magnesium sulphate toxicity was monitored by urine output, deep tendon reflexes and serum magnesium levels and managed with an infusion of 10 ml of 10% calcium gluconate and cessation of magnesium infusion. Adjunct therapy included intravenous hydralazine 10 mg and labetalol 100 mg. The mode of delivery was determined after stabilizing the patient., Results: The women included Kuwaitis (n = 200, 44.4%), Asians (n = 129, 28.7%) and other Arabs (n = 116, 25.8%) with a mean age of 29.7 +/- 6.7 years (primigravida: n = 233, 51.8%; other parities: n = 217, 48.2%). Antenatal complications included intra-uterine growth restriction (n = 136, 30.2%), oliguria (n = 39, 8.7%), haemolysis, elevated liver enzymes and low platelet count syndrome (n = 30, 6.6%), abruptio placentae (n = 20, 4.4%), eclampsia (n = 15, 3.3%), and preterm birth (n = 253, 55.2%). Caesarean section (n = 241, 53.6%) was the main mode of delivery. The perinatal mortality rate was 27 per 1,000. Magnesium sulphate toxicity observed as reduced tendon reflexes occurred in 14 (3.1%) patients and flushing, nausea and vomiting and blocked nostrils in 86 (19.1%). There was no association between adverse outcomes and maternal serum magnesium concentrations and no maternal mortality occurred., Conclusion: Magnesium sulphate was effective in preventing recurrence of eclamptic fits and safe for both mother and fetus., ((c) 2008 S. Karger AG, Basel)

Introduction: Obesity has become a worldwide epidemic with ever increasing incidence and public health problems in both developing and developed countries., Objective: The objective of the study is to investigate the incidence of obesity among patients with polycystic ovarian syndrome attending infertility clinic and the effect on treatment outcome., Methodology: Two hundred and seventy women with polycystic ovarian syndrome attending the infertility clinic were evaluated clinically, biochemically, and laparoscopically. They were stratified according to their body mass index (BMI) as follows: normal weight: 18-24; overweight: 25-29, obese:30-34, and grossly obese: > or = 35. Therapy included induction of ovulation with clomiphene citrate and gonadotrophins. The patients were followed up through during induction of ovulation and pregnancy., Results: There were ethnic differences in mean BMI. Significantly more obese women had oligomenorrhoea (p<0.01) and anovulation (p<0.01) than women with normal weight. Obesity adversely affected the outcome of ovulation induction with clomiphene citrate and gonadotrophins; 79% of women with BMI 18-24 ovulated at 6 months compared to 15.3% in those with BMI 30-34 (p<0.001) and 11.8% in women with BMI > or = 35 (p<0.001). The pregnancy rate and outcome were also adversely affected by obesity., Conclusion: Obesity has a negative impact on the outcome of treatment of infertility. Weight reduction programme should be an essential component of infertility management.

Background: Preeclampsia remains a disease of theories as the real aetiology has remained elusive. Altered nitric oxide production has been associated with preeclampsia although conflicting results showing elevation, decrease or no change in nitric oxide levels have emerged from previous studies., Objective: The aim of the study was to measure the serum levels of nitrate and nitrite in normal pregnancies and pregnancies complicated by pre-eclampsia., Materials and Methods: Venous blood was extracted from 39 normal pregnant women (control) and 34 women with preeclampsia (study group). Serum concentrations of nitrate and nitrite were determined using the HPLC method. Other special investigations including renal function tests were performed. The patients were managed according to protocol and the outcome of the pregnancies evaluated., Results: There was no significant difference in the mean maternal age and gestational age at delivery between the groups. However the mean systolic and diastolic blood pressure of the study group (150.5 mmHg and 98.8 mmHg) were significantly higher than the levels in the control group, (110.86 and 85.5), p<0.0001. There was no significant difference in the mean serum nitrate levels (19.157+/-13.407 vs. 19.189+/-16.805) p=0.993. The fetal and maternal outcomes were comparable., Conclusion: Our study has demonstrated that there was no alteration in nitric oxide production in preeclampsia, thus contributing to the existing unresolved role of nitric oxide in the pathogenesis of preeclampsia. Further research is called for.

Objective: To determine the prevalence of pathologic changes in the endometrium of tamoxifen-treated asymptomatic postmenopausal patients with breast cancer., Subjects and Methods: Fifty postmenopausal asymptomatic breast cancer patients with positive estrogen receptor status were treated with 20 mg of tamoxifen daily for a period of 5-60 months. The control group consisted of 30 asymptomatic postmenopausal breast cancer patients who were negative for estrogen receptor and therefore did not receive tamoxifen. Endometrial biopsies were performed using Pipelle endometrial suction curette at least 5 months after the study began. The endometrium was classified as atrophic (negative finding) and proliferative or hyperplastic (positive findings). The study and control groups were compared for demographic characteristics, risk factors for endometrial cancer, histological findings and the duration of tamoxifen treatment., Results: A significantly greater prevalence of endometrial abnormalities existed among the tamoxifen-treated than control patients (76 vs. 33%, p < 0.001). The abnormal endometrial changes were further demarcated in both groups into proliferative (54 vs. 26.7%, p = 0.02) and hyperplastic (22 vs. 6.6%, p = NS). In the study group, 63.6% of hyperplastic endometrium was simple hyperplasia and 36.4% was complex/no atypia hyperplasia, while in the control group all the cases were simple hyperplasia. No endometrial cancer was detected in either group. In addition, there was a positive association between the duration of tamoxifen exposure (<1 year vs. >/=1 year) and the endometrial abnormalities (46.6 vs. 88.6%, p = 0.003; proliferative 57.1 vs. 74.1%, p = 0.015; hyperplastic 42.8 vs. 25.8%, p = NS)., Conclusion: The adjuvant use of tamoxifen is associated with significant time-dependent abnormal endometrial changes among patients with cancer of the breast., (Copyright 2004 S. Karger AG, Basel)

Preeclampsia is a common and major cause of maternal and perinatal morbidity and mortality. Human leucocyte antigen (HLA) susceptibility and impaired adaptation of the T lymphocyte sub-population and a bi-directional effect of T helper cytokines on the outcome of pregnancy have been reported in patients with preeclampsia. The association between maternal HLA class II and T helper cytokines in women with preeclampsia was investigated in seventy-six preeclamptic women and normotensive controls using Terasaki microlymphocytotoxicity test. T helper cytokines interleukin (IL)-8, IL-6, IL-4, tumour necrosis factor (TNF)-alpha and interferon (IFN)-gamma were estimated in the maternal blood and placenta by enzyme-linked immunosorbent assay (ELISA). Histopathological evaluation of the placenta was also carried out. HLA class II DR2, DR4, DR5, DRw8, DRw10, DRw11, DRw18, and DQw2 had significant relative risk ratios for preeclampsia, while DQw3 was more common in the controls. DR4-DRw11-DQw2 haplotype was more common in preeclamptic women with intrauterine growth restriction, low birth weight and placental weight, increased expression of T helper cytokines IL-8, TNF-alpha and IFN-gamma and abnormal uteroplacental vasculature. These findings suggest that HLA class II DR4-DRw11 -DQw2 haplotypes may be associated with preeclampsia with intrauterine growth restriction through low placental weight from impaired placental development, as a result of increased expression of T helper 1 cytokines IL-8, TNF-alpha and IFN-gamma.

Objective: To evaluate the incidence of hyperemesis gravidarum among pregnant women in Kuwait and the status of HCG, TSH, Total T4 and Free T4 in the serum of patients with hyperemesis gravidarum compared with a control group of women., Methodology: During a 6-month period all patients admitted to Maternity Hospital with features of hyperemesis gravidarum (excessive vomiting and ketonuria) were enlisted into the study. In fifty of these patients and their fifty normal controls, the status of serum total (beta)hCG, TSH, total T4 and freeT4 were evaluated with AXSYM micro particle enzyme immunoassay., Results: The incidence of hyperemesis in the maternity population was 45 per 1000 deliveries. Total (beta)hCG and Total T4 and FreeT4 were significantly higher in the hyperemesis patients than in the normal controls (p<0.0001, p=0.004 and p=0.01 respectively). TSH levels were significantly lower in hyperemesis patients than in their normal controls (p<0.0001). There was a strong positive correlation between the total (beta)hCG and the gestational age (r=0.8)., Conclusion: There is a high incidence of hyperemesis gravidarum in the Kuwaiti population. Total (beta)hCG, Total T4 and Free T4 titers were significantly higher in patients with hyperemesis gravidarum, but none of the patients showed signs of hyperthyroidism.

Objective: To investigate the association between maternal HLA class II and intrauterine growth retardation with associated birthweight of the newborn, in women with preeclampsia., Methodology: Thirty preeclamptics and 30 normotensive matched for age, parity and gestation were investigated for HLA class II profile using Terasaki microlymphocytotoxicity test as the typing technique. The outcome of the pregnancy in terms of intrauterine growth retardation, birthweight and placental weight, were investigated to elucidate a susceptibility factor in the HLA Class II profile of the preeclamptic women., Results: HLA class II DR2, DR4, DRw11, DRw14 and DQw2 were more common in the preeclamptic women (p < 0.04, 0.03, 0.05, 0.03, 0.05), while DQw3 was more common in the controls (p < 0.05). Mean birthweight was 2.71 +/- 0.73 kg with preeclampsia compared to 3.4 +/- 0.4 kg for controls (p < O.01). Low birthweight was 56.7% versus 6.1% (p < 0.001) and mean placental weight was 474.8 +/- 100.8 gm versus 692.1 +/- 107.3 gm (p < 0.01). DR4 and DQW2 were significantly associated with intrauterine growth retardation with associated low birthweight and placental weight (p < 0.01)., Conclusion: HLA class II hyaplotypes DR4, and DQw2 are associated with intrauterine growth retardation with associated low birthweight and placental weight through preeclampsia. The association between intrauterine growth retardation and HLA may be a direct susceptibility factor. This needs further elucidation.

Oxygen utilisation at the tissue level was investigated by the use of lactate-pyruvate (LP) ratio in forty women; twenty with term twin pregnancy, with a matched controlled group of twenty women with term singleton pregnancy. The lactate-pyruvate ratio in twin pregnancy was significantly higher than in singleton pregnancy at term (p < 0.05). There was also significantly higher LP ratio in advanced labour in twin pregnancy than in singleton pregnancy (p < 0.001). Similarly, the venous cord blood LP ratio of twin II was higher than in twin I. Our findings have thus demonstrated more marked anaerobic metabolism in twin pregnancy than in singleton pregnancy. Secondly, the second twin is more involved in anaerobic metabolism as a result of relative oxygen deficiency, than twin I. This may to some extent account for the higher morbidity and mortality in twin pregnancy, compared to singleton pregnancy, and in twin II compared to twin I.

The aim of this study was to evaluate the sequelae of menopause and how this can be managed in a primary health care setting. Between June 1992 and June 1994, 261 postmenopausal females who attended the menopause clinic at the Kuwait Maternity Hospital were evaluated clinically and with laboratory investigations; mammography, bone density assessment with quantitative computed tomography (QCT) scan and colposcopy were done for some patients. Ninety percent of the patients attended the clinic because of distressing vasomotor symptoms of hot flushes, night sweats and palpitations, and others because of psychological and/or psychiatric problems and secondary amenorrhea and infertility. About 21.5% of the patients were hypertensive, while 13.8% were diabetic. Nonspecific inflammatory bacterial vaginal infection occurred in 18.4% of the patients. High total cholesterol was found in 26%, high LDL in 20% and low HDL in 17% of the patients. Thirty-one percent of females who had bone density measurement had low bone density, while in 7.7%, mammography was abnormal. The authors conclude that the evaluation of patients prior to beginning estrogen therapy, as well as the follow-up, can be done in the primary health care centers.