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Tuberculosis: Causes, Prevention and Management

Apr 19, 2024 | Infectious diseases and outbreaks

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Written By THT Editorial Team

Sujata Shakya

Reviewed by Sujata Shakya, Public Health Practitioner, Assistant Professor, Public health (IOM)

Tuberculosis (TB) is a contagious infectious disease caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs but can also impact other parts of the body. Understanding the causes, prevention, and management of TB is essential for controlling its spread and reducing its impact on public health.

Causes of Tuberculosis:

Tuberculosis is caused by the transmission of Mycobacterium tuberculosis from an infected individual to a susceptible person. The bacteria can be spread through the air when an infected individual coughs, sneezes, or speaks, releasing respiratory droplets containing the bacteria (1). Factors such as overcrowded living conditions, poor ventilation, and compromised immune systems increase the risk of TB transmission (2).

Prevention of Tuberculosis:

Preventative measures play a crucial role in reducing the incidence of TB. Some examples of preventative measures include:

Vaccination: Bacille Calmette-Guérin (BCG) vaccine is used to prevent severe forms of TB in children. It provides partial protection against TB and reduces the risk of disseminated TB in infants and young children (3). However, the BCG vaccine’s effectiveness in preventing pulmonary TB, the most common form of the disease, varies and is generally less effective in adults.

Infection Control: Implementing effective infection control measures is crucial to prevent the spread of TB. This includes identifying and promptly isolating individuals with active TB, ensuring proper ventilation in healthcare facilities, and promoting cough etiquette (4).

Screening and Testing: Active case finding and early detection of TB cases are essential for preventing further transmission. Regular screening of high-risk populations, such as close contacts of TB patients, healthcare workers, and individuals living with HIV, is recommended. Diagnostic tests such as sputum smear microscopy, molecular tests, and chest X-rays are used to detect TB infection (5).

Treatment of Latent TB Infection: Individuals with latent TB infection, who have the TB bacteria in their bodies but do not have active disease, can progress to active TB if not treated. Treating latent TB infection with antibiotics, such as isoniazid or rifampin, can prevent the development of active TB disease (6).

Management of Tuberculosis:

TB management focuses on early diagnosis, appropriate treatment, and adherence to medication. Some key aspects of TB management include:

Directly Observed Therapy (DOT): DOT is a strategy in which healthcare providers or trained community health workers directly observe patients taking their TB medications. This approach ensures treatment adherence and helps prevent the development of drug-resistant TB (7).

Drug Therapy: TB is treated with a combination of antibiotics for a specific duration. The standard treatment regimen for drug-susceptible TB includes a combination of isoniazid, rifampin, ethambutol, and pyrazinamide. Drug-resistant TB requires more complex treatment regimens using second-line drugs (8).

Contact Investigation: Identifying and testing individuals who have had close contact with TB patients is crucial for early detection of TB cases and preventing further transmission. Contact investigation involves screening and testing close contacts to identify latent TB infection or active TB disease (9).

Adherence Support: Ensuring treatment adherence is vital for successful TB management and prevention of drug resistance. Providing patient education, counseling, and support services can improve medication adherence and treatment outcomes (10).

Conclusion:

Preventing and managing tuberculosis requires a comprehensive approach involving vaccination, infection control measures, screening and testing, treatment of latent infection, and effective management of active TB cases. By implementing evidence-based preventative measures and ensuring early diagnosis and appropriate treatment, communities can work towards reducing the burden of tuberculosis and protecting public health.

REFERENCES

Endometriosis: Understanding Its Impact and Exploring Treatment Avenues

Apr 16, 2024 | Women's Health

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Written By THT Editorial Team

Dr. Asmita Pandey

Reviewed by Dr. Asmita Pandey, Fertility Expert , M.D. (OB/GYN) 

Endometriosis is a disorder where endometrial-like tissue forms outside the uterine cavity, causing chronic pelvic discomfort, intense menstrual pain, dyspareunia, and potential infertility (Parasar et al. 2017). This ectopic endometrial tissue can adversely affect a woman’s reproductive health. While treatments focus on symptom relief and enhancing life quality, endometriosis remains incurable. (Malvezzi et al. 2020).

Symptoms of Endometriosis: Endometriosis manifests as ectopic tissue growth resembling the uterine lining, leading to symptoms that can profoundly affect a woman’s well-being. Notable symptoms include:

Dysmenorrhea: Affected women may suffer from debilitating cramps during menstruation, often radiating to the abdomen or back, surpassing typical menstrual discomfort. (Chauhan et al.2022)

Pain during Intimacy: The condition may result in pain during or following sexual activity, causing considerable distress. (Chauhan et al. 2022)

Painful Excretory Functions: Pain may occur during bowel movements or urination, especially coinciding with menstrual periods. (Mayo Clinic, 2024)

Menorrhagia or Metrorrhagia: There may be unusually heavy flows during periods or bleeding between cycles, disrupting the regular menstrual pattern. (Chauhan et al. 2022)

Infertility: Often linked to infertility, endometriosis might be identified in fertility assessments for women struggling to conceive. (Bulun et al. 2019)

Fatigue: Persistent tiredness or exhaustion can interfere with daily routines and affect overall health.

Additional Symptoms: Other possible symptoms include mood disorders, low body weight, increased pain sensitivity, and irregular spotting or bleeding outside of menstrual cycles.

Approaches to Managing Endometriosis:

Analgesics: Medications such as NSAIDs, including ibuprofen, and analgesics like paracetamol, are utilized to alleviate endometriosis-related discomfort.

Endocrine Therapy: This strategy involves reducing estrogen levels to diminish endometriosis lesions and lessen discomfort. Treatment modalities encompass oral contraceptives, progestins, and GnRH analogs.  (Bulun et al. 2019)

Operative Interventions: Selective surgery, often via laparoscopy, aims to excise endometriosis lesions while retaining reproductive organs, potentially enhancing fertility prospects. (Chauhan et al. 2022)

Reproductive Assistance: In cases of endometriosis-induced infertility, options such as surgical lesion removal, ovarian stimulation coupled with IUI, and IVF are explored. (Lee et al. 2020)

It’s crucial to recognize that treatment choices hinge on various personal factors, including age, symptom intensity, reproductive aspirations, and personal preferences. While these interventions aim to mitigate symptoms and elevate life quality, they are not curative. Engaging in a dialogue with a medical professional is vital to tailor treatment plans to one’s unique health profile.

For further information on endometriosis treatment options and considerations, please refer to the provided sources or book consultations here.

REFERENCES

  1. Parasar P, Ozcan P, Terry KL. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Curr Obstet Gynecol Rep. 2017 Mar;6(1):34-41. doi: 10.1007/s13669-017-0187-1. Epub 2017 Jan 27. PMID: 29276652; PMCID: PMC5737931.
  2. Malvezzi H, Marengo EB, Podgaec S, Piccinato CA. Endometriosis: current challenges in modeling a multifactorial disease of unknown etiology. J Transl Med. 2020 Aug 12;18(1):311. doi: 10.1186/s12967-020-02471-0. PMID: 32787880; PMCID: PMC7425005.
  3. Chauhan S, More A, Chauhan V, Kathane A. Endometriosis: A Review of Clinical Diagnosis, Treatment, and Pathogenesis. Cureus. 2022 Sep 6;14(9):e28864. doi: 10.7759/cureus.28864. PMID: 36225394; PMCID: PMC9537113.
  4. Bulun SE, Yilmaz BD, Sison C, Miyazaki K, Bernardi L, Liu S, Kohlmeier A, Yin P, Milad M, Wei J. Endometriosis. Endocr Rev. 2019 Aug 1;40(4):1048-1079. doi: 10.1210/er.2018-00242. PMID: 30994890; PMCID: PMC6693056.
  5. Mayo Clinic. (2024). Endometriosis – Symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
  6. Lee D, Kim SK, Lee JR, Jee BC. Management of endometriosis-related infertility: Considerations and treatment options. Clin Exp Reprod Med. 2020 Mar;47(1):1-11. doi: 10.5653/cerm.2019.02971. Epub 2020 Feb 24. Erratum in: Clin Exp Reprod Med. 2020 Jun;47(2):153. PMID: 32088944; PMCID: PMC7127898.

Exploring CAR-T Cell Therapy in Glioblastoma Treatment

Apr 14, 2024 | News

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Written By THT Editorial Team

Dr. Prakash Paudel

Reviewed by Dr. Prakash Paudel,  Consultant Neurosurgeon – Spine Surgery,  MBBS(IOM), FCPS (Pakistan) CFSS (Canada) 

Glioblastoma (GBM), the most common primary malignant brain tumor, presents a daunting challenge in clinical management, with a meager 5-year survival rate of merely 5% [1]. Despite advancements in treatment modalities such as surgery, radiation, and chemotherapy, the prognosis remains dismal due to tumor heterogeneity and the intricate interplay between tumor cells and normal brain tissue, compounded by the impermeable blood-brain barrier.

Conventional therapies, including surgical resection, radiotherapy, and chemotherapy, have shown limited efficacy, resulting in high relapse rates and poor patient outcomes [2]. Therefore, there is an urgent need for innovative therapeutic approaches to combat GBM effectively.

Chimeric Antigen Receptor T (CAR-T) cell therapy, heralded for its success in hematological malignancies, has emerged as a promising avenue for solid tumors like GBM [3]. However, its application faces formidable challenges posed by the unique anatomical features of GBM, including the blood-brain barrier and the immunosuppressive tumor microenvironment, alongside tumor heterogeneity.

CAR-T therapy involves the extraction of T lymphocytes from the patient’s peripheral blood, genetic modification to express chimeric antigen receptors targeting specific tumor antigens, and reinfusion into the patient, thereby harnessing the immune system to target and destroy cancer cells [4].

The manufacturing process of CAR-T cells entails several meticulous steps, including T cell isolation, genetic engineering to introduce CAR genes, in vitro activation and expansion, and rigorous quality assessment before clinical administration [5].

While CAR-T therapies have demonstrated remarkable efficacy in hematologic malignancies, their application in solid tumors has been limited. The complexity of solid tumors, characterized by diverse cell populations, presents challenges in achieving sustained therapeutic responses [6].

Innovative strategies combining CAR-T therapy with bispecific antibodies, such as T-cell Engaging Antibody Molecules (TEAMs), hold promise in overcoming the hurdles posed by tumor heterogeneity [7]. These approaches aim to enhance the specificity and potency of CAR-T cells against solid tumors like GBM.

Recent clinical studies have reported encouraging outcomes with CAR-T therapy in GBM patients, demonstrating reduced tumor sizes and prolonged survival [8]. Notably, early-phase trials employing dual-target CAR-T cells, engineered to recognize multiple tumor-associated antigens, have shown promising results in shrinking tumors and extending patient survival [9].

Despite the progress, CAR-T cell therapy in GBM is not without limitations, with treatment-associated toxicities, including cytokine release syndrome and central nervous system complications, warranting careful monitoring and management [10].

In conclusion, the innovative field of CAR-T cell therapy is at the forefront of transforming the treatment paradigm for glioblastoma multiforme (GBM). The journey from preclinical studies to clinical trials has been fraught with challenges, yet these hurdles have been instrumental in uncovering and addressing the complexities of successful cancer treatment. The advent of CAR T cells equipped with multivalent receptors, combined with cutting-edge therapies, is tackling the problem of antigen escape [11]. Furthermore, the synergy of CAR T cell therapy with other treatments, such as immunotherapies, chemotherapies, or mechanical tumor ablation, is poised to foster a more inflammatory microenvironment conducive to better patient outcomes [11]. As research continues to refine these therapeutic strategies, there is a growing hope for significant advancements in the battle against this formidable disease.

REFERENCES

  1. Stupp, R., Mason, W. P., van den Bent, M. J., Weller, M., Fisher, B., Taphoorn, M. J. B., … & Mirimanoff, R. O. (2005). Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. New England Journal of Medicine, 352(10), 987-996.
  2. Ostrom, Q. T., Cioffi, G., Gittleman, H., Patil, N., Waite, K., Kruchko, C., & Barnholtz-Sloan, J. S. (2019). CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2012-2016. Neuro-Oncology, 21(Supplement_5), v1-v100.
  3. June, C. H., & Sadelain, M. (2018). Chimeric antigen receptor therapy. New England Journal of Medicine, 379(1), 64-73.
  4. Maude, S. L., Frey, N., Shaw, P. A., Aplenc, R., Barrett, D. M., Bunin, N. J., … & Grupp, S. A. (2014). Chimeric antigen receptor T cells for sustained remissions in leukemia. New England Journal of Medicine, 371(16), 1507-1517.
  5. Levine, B. L., Miskin, J., Wonnacott, K., Keir, C., & Rosenblatt, J. (2017). Trial of gene-modified virus-specific T lymphocytes augmented by granulocyte-macrophage colony-stimulating factor and interleukin-2 for advanced recurrent or refractory Hodgkin lymphoma: clinical and immunologic results. Clinical Cancer Research, 23(9), 2250-2261.
  6. Jackson, H. J., Rafiq, S., & Brentjens, R. J. (2016). Driving CAR T-cells forward. Nature Reviews Clinical Oncology, 13(6), 370-383.
  7. Yu, S., Li, A., Liu, Q., Li, T., & Yuan, X. (2019). Chimeric antigen receptor T cells: A novel therapy for solid tumors. Journal of Hematology & Oncology, 12(1), 1-10. https://doi.org/10.1186/s13045-017-0444-9
  8. Brown, C. E., Alizadeh, D., Starr, R., Weng, L., Wagner, J. R., Naranjo, A., … & Badie, B. (2016). Regression of glioblastoma after chimeric antigen receptor T-cell therapy. New England Journal of Medicine, 375(26), 2561-2569. https://doi.org/10.1056/NEJMoa1610497
  9. O’Rourke, D. M., Nasrallah, M. P., Desai, A., Melenhorst, J. J., Mansfield, K., Morrissette, J. J. D., … & Zheng, Z. (2021). A single dose of peripherally infused EGFRvIII-directed CAR T cells mediates antigen loss and induces adaptive resistance in patients with recurrent glioblastoma. Science Translational Medicine, 13(593), eabf2311. https://doi.org/10.1126/scitranslmed.aaa0984
  10. Neelapu, S. S., Tummala, S., Kebriaei, P., Wierda, W., Gutierrez, C., Locke, F. L., … & Shpall, E. J. (2018). Chimeric antigen receptor T-cell therapy—assessment and management of toxicities. Nature Reviews Clinical Oncology, 15(1), 47-62. 11
  11. Luksik AS, Yazigi E, Shah P, Jackson CM. CAR T Cell Therapy in Glioblastoma: Overcoming Challenges Related to Antigen Expression. Cancers (Basel). 2023 Feb 23;15(5):1414. doi: 10.3390/cancers15051414. PMID: 36900205; PMCID: PMC10000604. 13

Licorice Root: A Simple Guide to Its Sweet Benefits

Apr 12, 2024 | Alternative and complementary medicine

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Written By THT Editorial Team

Dr. Hari Sharan Aryal

Reviewed by Dr. Hari Sharan Aryal, MD Kaya (Internal Medicine), IOM , TU,  Director Nature Care Hospital

Licorice root (जेठी मधु), from the plant Glycyrrhiza glabra, is more than just a candy flavor. It’s been used in traditional medicine for ages because of its health benefits.

Stomach Saver: This root is like a superhero for your stomach. It’s got substances—glycyrrhizin and flavonoids—that fight off ulcers by forming a protective layer on the stomach’s surface, reducing acid, and helping heal ulcers which has been supported by findings from Rahnama et al. (2013), who studied the healing effects of licorice on Helicobacter pylori infected peptic ulcers.”

Virus Fighter: Licorice root might also be a secret weapon against viruses, especially those that mess with your liver. It’s got stuff in it that stops viruses from multiplying and tweaks your immune system to help your liver stay healthy as demonstrated by Wang et al. (2015), licorice has been identified to have significant antiviral and antimicrobial properties.”

Swelling Be Gone: Got swelling? Licorice root might help with that too. It’s got anti-inflammatory powers that could take down swelling, which is great news if you’re dealing with arthritis, asthma, or skin issues which is supported by the findings of Yang et al. (2017), who investigated the anti-inflammatory properties of licorice.”

Cough Calmer: And if you’ve got a cough that won’t quit, licorice root might be your go-to. It’s been used to soothe your throat and help you get rid of mucus, making it easier to breathe and lessening coughs ( Seladi-Schulman 2022)

Stress Buster: Licorice root is also an adaptogen, which means it helps your body deal with stress. It can help keep your cortisol—your body’s stress alarm—under control, which might make you feel more chill. (Armanini et al. 2004)

But, Heads Up: Just like with anything, you can not have too much of a good thing. If you go overboard with licorice root, it can throw your body’s mineral balance out of whack, leading to high blood pressure and low potassium, which is no bueno. (Wahab et al. 2021)

Doctor Knows Best: So, it’s super important to use licorice root the right way. Talk to a healthcare pro before diving in, especially if you’ve got other health stuff going on or you’re taking meds that might not play nice with it. And keep an eye on your potassium levels to stay safe.

REFERENCES

  1. Rahnama M, Mehrabani D, Japoni S, Edjtehadi M, Saberi Firoozi M. The healing effect of licorice (Glycyrrhiza glabra) on Helicobacter pylori infected peptic ulcers. J Res Med Sci. 2013 Jun;18(6):532-3. PMID: 24250708; PMCID: PMC3818629.
  2. Wang L, Yang R, Yuan B, Liu Y, Liu C. The antiviral and antimicrobial activities of licorice, a widely-used Chinese herb. Acta Pharm Sin B. 2015 Jul;5(4):310-5. doi: 10.1016/j.apsb.2015.05.005. Epub 2015 Jun 17. PMID: 26579460; PMCID: PMC4629407.
  3. Yang R, Yuan BC, Ma YS, Zhou S, Liu Y. The anti-inflammatory activity of licorice, a widely used Chinese herb. Pharm Biol. 2017 Dec;55(1):5-18. doi: 10.1080/13880209.2016.1225775. Epub 2016 Sep 21. PMID: 27650551; PMCID: PMC7012004.
  4. Seladi-Schulman, J., Ph.D. (2022, November 10). The 7 best teas to help ease a cough. Healthline. Retrieved from https://www.healthline.com/health/tea-for-cough
  5. Armanini D, Mattarello MJ, Fiore C, Bonanni G, Scaroni C, Sartorato P, Palermo M. Licorice reduces serum testosterone in healthy women. Steroids. 2004 Oct-Nov;69(11-12):763-6. doi: 10.1016/j.steroids.2004.09.005. PMID: 15579328.
  6. Wahab S, Annadurai S, Abullais SS, Das G, Ahmad W, Ahmad MF, Kandasamy G, Vasudevan R, Ali MS, Amir M. Glycyrrhiza glabra (Licorice): A Comprehensive Review on Its Phytochemistry, Biological Activities, Clinical Evidence and Toxicology. Plants (Basel). 2021 Dec 14;10(12):2751. doi: 10.3390/plants10122751. PMID: 34961221; PMCID: PMC8703329.

 

Influenza: Causes, Prevention and Management

Apr 10, 2024 | Infectious diseases and outbreaks

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Written By THT Editorial Team

Sujata Shakya

Reviewed by Sujata Shakya, Public Health Practitioner, Assistant Professor, Public health (IOM)

Influenza, also known as the flu, is a contagious respiratory illness caused by influenza viruses. Influenza viruses are of different types (A, B, C) and are further classified into subtypes based on their surface antigens. Influenza is a significant public health concern, causing morbidity and mortality worldwide. This research-based article provides an overview of the causes, prevention, and management of influenza.

Causes of Influenza:

Influenza is caused by influenza viruses, which primarily target the respiratory system. The viruses spread mainly through respiratory droplets generated when an infected person talks, coughs, or sneezes. Influenza viruses can also spread by touching contaminated surfaces and then touching the mouth, nose, or eyes.

Prevention of Influenza:

Preventing influenza infections is critical to reducing the burden of illness. Several strategies can help prevent influenza, including:

Vaccination: Influenza vaccination is the most effective way to prevent influenza infections. The influenza vaccine is designed to match the circulating influenza viruses and provides immunity against the viruses. Annual vaccination is recommended for all individuals aged six months and older (1).

Non-pharmaceutical Interventions: Non-pharmaceutical interventions such as frequent hand washing, covering the nose and mouth with a tissue or sleeve while coughing or sneezing, and staying home when sick can reduce the spread of influenza viruses (2).

Antiviral Medications: Antiviral medications can be used to prevent influenza infections, especially in high-risk population, such as immunocompromised individuals, older adults, and those with underlying medical conditions. Antivirals can also be used for post-exposure prophylaxis in individuals who have been in close contact with an infected person (3).

Management of Influenza:

Influenza infections can range from mild to severe, and management approaches depend on the severity of the illness. The following management approaches are commonly used:

Symptomatic Treatment: Symptomatic treatment, such as antipyretics and analgesics, can alleviate symptoms such as fever, body aches, and headaches. Over-the-counter medications such as acetaminophen and ibuprofen can be used for the relief of symptoms (4).

Antiviral Medications: Antiviral medications can be used to treat influenza infections, especially in individuals at high risk for complications, such as older adults, young children, pregnant women, and those with underlying medical conditions. Treatment with antivirals should be started within 48 hours of onset of symptoms (3).

Hospitalization: Severe influenza infections can require hospitalization, especially in individuals at high risk for complications. Supportive care, including oxygen therapy, mechanical ventilation, and antiviral medications, may be needed (5).

Examples of Preventative Measures:

In addition to vaccination and non-pharmaceutical interventions, several examples of preventative measures can be implemented to reduce the spread of influenza, such as:

Environmental Cleaning: Regular cleaning and disinfection of frequently touched surfaces, such as doorknobs, keyboards, and countertops, can reduce the spread of influenza viruses (2).

School Closures: Closing schools during influenza outbreaks can reduce the spread of influenza viruses. School closures should be implemented early and for an extended period to be effective (6).

Social Distancing: Social distancing measures such as avoiding large gatherings, working from home, and staying home when sick can reduce the spread of influenza viruses (7).

Conclusion:

Influenza is a significant public health concern, leading to morbidity and mortality worldwide. Preventing influenza infections through vaccination, non-pharmaceutical interventions, and antiviral medications is critical to reducing the burden of illness. Environmental cleaning, school closures, and social distancing are examples of additional preventative measures that can be implemented. By adopting these preventive measures and following evidence-based management approaches, the impact of influenza can be minimized, protecting individuals and communities.

REFERENCES

  1. Centers for Disease Control and Prevention. (2022). Key facts about seasonal flu vaccine. Retrieved from https://www.cdc.gov/flu/prevent/keyfacts.htm
  2. Centers for Disease Control and Prevention. (2022). Preventing the flu: Good health habits can help stop germs. Retrieved from https://www.cdc.gov/flu/prevent/actions-prevent-flu.htm
  3. Uyeki, T. M., Bernstein, H. H., & Bradley, J. S. (2019). Clinical practice guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clinical Infectious Diseases, 68(6), e1-e47.
  4. National Institute for Health and Care Excellence. (2017). Acute respiratory tract infections: Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. Retrieved from https://www.nice.org.uk/guidance/ng109
  5. Fry, A. M., Goswami, D., Nahar, K., Sharmin, A. T., Rahman, M., Gubareva, L., … & Azim, T. (2019). Efficacy of oseltamivir treatment started within 5 days of symptom onset to reduce influenza illness duration and virus shedding in an urban setting in Bangladesh: a randomised placebo-controlled trial. The Lancet Infectious Diseases, 19(2), 209-218.
  6. Jackson, C., Vynnycky, E., Hawker, J., Olowokure, B., Mangtani, P., & The UK Influenza Pandemic Preparedness Strategy Expert Group. (2013). School closures and influenza: systematic review of epidemiological studies. BMJ Open, 3(2), e002149.
  7. Glass, R. J., Glass, L. M., Beyeler, W. E., & Min, H. J. (2006). Targeted social distancing design for pandemic influenza. Emerging Infectious Diseases, 12(11), 1671-1681.

Rezum Therapy: A Minimally Invasive Treatment for Benign Enlargement of Prostate

Apr 9, 2024 | Men's Health

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Written By THT Editorial Team

Dr. Asmita Pandey

Reviewed by Dr. Erena Pradhan, Consultant Urologist, MS, MCH

Introduction:

Benign Prostatic Enlargement (BPE) is a prevalent condition in men, characterized by bothersome urinary symptoms such as increased frequency, urgency, weak urine flow, and incomplete bladder emptying. While lifestyle modifications, dietary adjustments, and medication can help manage mild cases, individuals with more severe symptoms may find relief through surgical intervention. Among the traditional surgical options, transurethral resection of the prostate (TURP) is commonly employed, albeit with its associated risks, including bleeding, sexual dysfunction, and a prolonged recovery period [1].

A Less Invasive Option:

The Rezum System emerges as a promising alternative to conventional surgical methods. This innovative approach utilizes the application of thermal energy, in the form of steam, to target and treat the enlarged prostate tissue [2][3]. By delivering controlled bursts of steam directly to the prostate gland, Rezum therapy offers a minimally invasive solution that effectively alleviates urinary symptoms while mitigating the risks commonly associated with TURP, such as bleeding, ejaculatory dysfunction, and retrograde ejaculation [4]

How Rezum Works:

At the heart of the Rezum System lies a specialized device equipped with a small, flexible needle-like instrument. This instrument is inserted into the prostate tissue under direct visualization, allowing for precise delivery of thermal energy in the form of steam. The targeted application of steam induces localized tissue necrosis, leading to the gradual shrinkage of the enlarged prostate over time. Importantly, this targeted approach ensures the preservation of surrounding healthy tissue and structures, minimizing the risk of adverse effects commonly observed with conventional surgical methods [5].

What to Expect after Treatment:

 Patients undergoing Rezum therapy can anticipate a significant improvement in urinary symptoms, resulting in enhanced quality of life and restored urinary function. Clinical studies have demonstrated notable enhancements in urinary flow rates, reduction in post-void residual urine volume, and improvements in symptom scores following Rezum therapy. While some individuals may experience transient side effects such as temporary dysuria, urinary frequency, or urgency immediately post-treatment, these symptoms typically resolve within a few weeks and are generally milder compared to those observed following traditional surgical interventions [4].

Conclusion:

Rezum therapy represents a paradigm shift in the management of benign prostatic enlargement, offering a patient-centered, minimally invasive solution that effectively addresses bothersome urinary symptoms while minimizing the associated risks. By harnessing the therapeutic potential of steam, Rezum therapy exemplifies the advancements in medical technology and underscores the importance of individualized care in the field of urology [5][6].

REFERENCES

  1. Lee CL, Kuo HC. Pathophysiology of benign prostate enlargement and lower urinary tract symptoms: Current concepts. Ci Ji Yi Xue Za Zhi. 2017 Apr-Jun;29(2):79-83. doi: 10.4103/tcmj.tcmj_20_17. PMID: 28757771; PMCID: PMC5509197.
  2. McVary, K. T., Roehrborn, C. G., & Barkin, J. (2019). Rezūm Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia: 4-Year Results from Randomized Controlled Study. Urology, 126, 171-179.
  3. McVary, K. T., Gange, S. N., Gittelman, M. C., Goldberg, K. A., Patel, K., Shore, N. D., … & Roehrborn, C. G. (2016). Erectile and ejaculatory function preserved with convective water vapor energy treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: randomized controlled study. Journal of Sexual Medicine, 13(6), 924-933.
  4. McVary, K. T., Rogers, T., & Roehrborn, C. G. (2016). Rezūm water vapor thermal therapy: practical guide for urologists and primary care physicians treating lower urinary tract symptoms secondary to benign prostatic hyperplasia. Therapeutic Advances in Urology, 8(3), 172-181.
  5. Dixon, C.M., Cedano, E., & Mynderse, L. A. (2018). Rezūm water vapor thermal therapy for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia: A systematic review of the literature. Current Urology Reports, 19(6), 44.
  6. Roehrborn, C.G., Gange S.N., Shore N.D., et al.(2020). Five year results of the prospective randomized controlled Rezūm system study: Convective radiofrequency thermal therapy for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia.Journal of Urology ,203(5),1042-1050.

Rare Kidney Diseases: A Global Perspective on Diagnosis, Treatment, and Advocacy

Apr 1, 2024 | News

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Written By THT Editorial Team

Dr. Nabin Bahadur Basnet

Reviewed by Dr. Nabin Bahadur Basnet, Consultant Interventional Nephrologist, MBBS, PhD, FISN

Rare kidney diseases pose significant challenges to patients worldwide, often leading to chronic debilitation, morbidity, or even death. These conditions, characterized by low prevalence and genetic or metabolic origins, demand specialized care and concerted efforts to enhance awareness, diagnosis, and treatment accessibility (Iyengar et al., 2023). This article explores the landscape of rare kidney diseases, focusing on the challenges faced by children, common elements in these conditions, and the imperative need for advocacy and research initiatives.

Rare Kidney Diseases in Children: A Call for Action

Rare kidney diseases affect a substantial number of children globally, with a prevalence of 60–80 cases per 100,000 population in Europe and the United States. These diseases include over 150 different conditions, many of which manifest in childhood (Iyengar et al., 2023). Children with rare kidney diseases often face serious morbidity and require lifelong treatment. However, inequitable access to disease-modifying therapies remains a significant challenge, particularly for children from low- and middle-income countries (LMICs) (Iyengar et al., 2023).

Notable Rare Kidney Diseases:

  1. Cystinosis: A rare genetic disease causing cystine accumulation in cells, affecting various organs including the kidneys. Treatment involves cysteamine therapy to reduce cystine levels.
  2. Primary Hyperoxaluria Type 1: A genetic disorder causing oxalate buildup in the kidneys, often necessitating combined liver and kidney transplantation.
  3. Alport Syndrome: A genetic condition affecting the kidneys, ears, and eyes due to defects in specific genes. It can lead to kidney failure and other complications.
  4. Amyloidosis: Characterized by abnormal protein accumulation in organs like the kidneys, heart, brain, liver, and intestines.
  5. Polycystic Kidney Disease (PKD): Genetic mutations leading to fluid-filled cysts in the kidneys. Treatment varies based on the type of PKD.

Diagnosis of Rare Kidney Diseases:

Children suspected of having rare kidney diseases are given a thorough clinical assessment by pediatric nephrologists. Symptoms such as swelling, changes in urine output, blood in urine, fatigue, and growth issues are evaluated to determine the need for further testing (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.).

Genetic testing plays a crucial role in diagnosing rare kidney diseases with a genetic basis. Tests like the Genetic Renal Panel screen complement genes to identify genetic mutations associated with conditions like Alport syndrome, cystinosis, or polycystic kidney disease (University of Iowa Hospitals & Clinics, n.d.).

Imaging techniques such as ultrasound are used to visualize the kidneys and detect abnormalities like cysts or structural defects that may indicate specific rare kidney diseases like autosomal recessive polycystic kidney disease (ARPKD) (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.).

Laboratory tests are conducted to assess kidney function, protein levels in urine (proteinuria), blood in urine (hematuria), electrolyte imbalances, and other markers that can provide insights into the underlying condition causing the kidney disease (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.).

Specialized clinics like the Rare Renal Disease Clinic and Renal Genetics Clinic offer comprehensive evaluation and management for children with rare kidney diseases. These clinics provide state-of-the-art genetic testing and access to clinical trials for new therapies (University of Iowa Hospitals & Clinics, n.d.).

By combining these diagnostic approaches under the care of experienced specialists like pediatric nephrologists and geneticists, children with rare kidney diseases can receive accurate diagnoses leading to tailored treatment plans and improved outcomes.

Common Elements in Rare Kidney Diseases

Rare kidney diseases share common challenges such as small patient populations, unidentified disease causes, lack of biomarkers for disease monitoring, and complex care requirements (Aymé et al., 2017). Diagnostic hurdles often delay accurate identification of these conditions, necessitating advanced techniques like genetic testing for precise diagnosis (Aymé et al., 2017).

Advocacy Efforts and Research Initiatives

Enhancing access to diagnostic testing through low-cost genetic testing initiatives and training clinicians in interpreting genetic analyses are crucial steps towards improving outcomes for individuals with rare kidney diseases (Iyengar et al., 2023). Collaborative efforts involving patient support organizations, healthcare providers, researchers, governments, and pharmaceutical industries are essential to drive advancements in diagnosis, treatment accessibility, and research innovation.

In Conclusion

Uniting stakeholders globally and prioritizing the needs of individuals with rare kidney diseases will lead to better outcomes and quality of life. Addressing the challenges posed by rare kidney diseases requires a multifaceted approach encompassing advocacy for equitable access to care, research into innovative treatments, and enhanced awareness initiatives (Rare Kidney Disease Foundation, n.d.).

REFERENCES

  1. Iyengar, A., Lanewala, A. A., Shirol, P. B., & Pais, P. (2023). Rare Kidney Diseases: Children Being Left Out in the Cold. Clinical Journal of the American Society of Nephrology. https://doi.org/10.2215/CJN.0000000000000374
  2. Aymé, S., Bockenhauer, D., Day, S., et al. (2017). Common Elements in Rare Kidney Diseases: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney International, 92(4), 796-808. https://doi.org/10.1016/j.kint.2017.06.018
  1. Wong, K., Pitcher, D., Braddon, F., Downward, L., Steenkamp, R., Annear, N., et al. (2024). Effects of rare kidney diseases on kidney failure: a longitudinal analysis of the UK National Registry of Rare Kidney Diseases (RaDaR) cohort. Retrieved March 26, 2024, from https://doi.org/10.1016/S0140-6736(23)02843-X.
  2. Deeley, M. (2024, February 29). Rare Disease Day: Rare kidney diseases you may not know about. American Kidney Fund. Retrieved March 26, 2024, from https://www.kidneyfund.org/article/rare-disease-day-rare-kidney-diseases-you-may-not-know-about.
  3. Rare Kidney Disease Foundation Website https://www.rarekidney.org
  4. National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Kidney Disease in Children. Retrieved March 26, 2024, from https://www.niddk.nih.gov/health-information/kidney-disease/children#diagnose.
  5. University of Iowa Hospitals & Clinics. (n.d.). Rare Kidney Diseases. Retrieved March 26, 2024, from https://uihc.org/services/rare-kidney-diseases.
  6. National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Autosomal Recessive Polycystic Kidney Disease. Retrieved March 26, 2024, from https://www.niddk.nih.gov/health-information/kidney-disease/polycystic-kidney-disease/autosomal-recessive-pkd.

A new hope to treat ‘Flat Tire’ in Spine: The Tension-Activated Repair Patch (TARP)

Mar 31, 2024 | News

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Written By THT Editorial Team

Dr Aayush Shrestha

Reviewed by Dr. Aayush Shrestha, Orthopaedic & Spine Surgeon, MS Ortho, FSS, 

The human spine, an architectural wonder of biology, is prone to a variety of injuries. Disc herniation is notably one of the most incapacitating conditions [1]. This condition, often compared to a ‘flat tire’ in the spine, happens when the soft, cushion-like discs between the vertebrae burst, causing the inner gel to bulge out and press against the nerves. This can result in intense pain, numbness, and even disability.

Traditional treatments have been palliative at best, focusing on alleviating pain rather than repairing the underlying damage. However, a ground-breaking study published in Science Translational Medicine heralds a new era in spinal repair with the development of the tension-activated repair patch (TARP) [1].

The TARP represents a significant advancement in the treatment of disc herniation [2]. Developed by researchers at the University of Pennsylvania and the CMC VA Medical Center, this biologic patch is designed to mimic the natural healing process of the body. The patch, which is inserted directly onto the herniated disc, is composed of nanofibers that deliver an anti-inflammatory drug, anakinra, directly to the damaged disc [1]. Anakinra, a recombinant interleukin-1 receptor antagonist, has been shown to reduce inflammation and promote tissue repair [1].

What sets TARP apart is its activation mechanism [2]. The patch is designed to respond to the natural biomechanical movements of the body, which in turn triggers the release of anakinra from microcapsules embedded within the patch. This ensures a sustained and controlled release of the medication, enhancing the disc’s ability to regain tension and integrity over time [1].

The implications of this technology are profound [2]. By providing a means to not only plug the ‘hole’ caused by herniation but also to restore the disc’s natural tension, TARP offers a potential cure for a condition that has long been considered irreversible. The researchers’ preclinical trials in large animal models have shown promising results, with discs regaining the necessary tension to reverse herniation and prevent further degeneration [2]. Moreover, the TARP could revolutionize the way we approach spinal injuries [1]. With its ability to integrate with the native tissue and reinforce the structure at the injury site, it prevents the aberrant remodeling that often follows disc detensioning. This could significantly reduce the incidence of recurrent herniations and persistent dysfunction, which are common with conventional treatments [1].

As we look to the future, the TARP presents a beacon of hope for millions suffering from spinal conditions [2]. The prospect of a treatment that not only alleviates pain but also restores spinal function is a monumental leap forward. While further research and human clinical trials are necessary, the TARP stands as a testament to the ingenuity of medical science and its relentless pursuit of solutions that restore quality of life to those afflicted by debilitating conditions.

The TARP’s innovative design is not just a theoretical concept but a tangible advancement poised to transform spinal treatment protocols. Its unique tension-activated mechanism aligns seamlessly with the body’s natural movements, promoting a more organic healing process. The use of anakinra within the TARP system exemplifies the shift towards targeted therapeutic strategies, offering a glimpse into the future of personalized medicine. This technology’s adaptability suggests it could be tailored for various orthopedic applications, potentially improving outcomes for patients with a range of degenerative conditions. As the research community continues to explore the full capabilities of TARP, it stands as a beacon of progress in the ongoing quest to address some of the most challenging medical conditions faced today.

In conclusion, the tension-activated repair patch is a pioneering solution that addresses the root cause of disc herniation. It offers a new hope for patients, potentially changing the course of spinal disease progression and opening the door to a future where ‘flat tires’ in the spine can be fully and effectively repaired. It’s important to note that the tests are still in the early stages and there are many factors to consider while treating a herniated disk, like the extent of herniation. Extruded and sequestered disc fragments need removal of disc fragments.

REFERENCES

  1. Peredo, A. et al. (2023). Tension-activated nanofiber patches delivering an anti-inflammatory drug improve repair in a goat intervertebral disc herniation model. Science Translational Medicine, 15(2), eabcm1654. https://doi.org/10.1126/scitranslmed.abcm1654
  2. University of Pennsylvania School of Medicine. (2023). ‘Patch’ Uses Natural Body Motion to Fix Disc Herniation. Penn Medicine News. Retrieved from https://www.pennmedicine.org/news/news-releases/2023/january/patch-uses-natural-body-motion-to-fix-disc-herniation

Revolutionizing Prostate Cancer Treatment: The TULSA-Pro Procedure

Mar 31, 2024 | Men's Health

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Written By THT Editorial Team

Dr. Asmita Pandey

Reviewed by Dr. Erena Pradhan, Consultant Urologist, MS, MCH

Prostate Cancer:

Prostate cancer is the leading cause of cancer death and the second most common non-cutaneous cancer in males worldwide which is a significant health concern (Abudoubari et al., 2023). Wang et al. (2022) found in their study on global prostate cancer incidence and mortality that a total of 1 414 259 new cases of prostate cancer and 375 304 related deaths were reported in 2020 globally.  There are marked variations in the rate of prostate cancer in different populations worldwide which suggests its genetic predisposition (Tzelepi et al, 2022). Apart from that, age, family history, ethnicity, and tobacco smoking are additional risk factors (Berenguer et al.2023). Most of the prostate cancers identified currently are asymptomatic. Diagnosis in these cases is based on elevated prostate-specific antigen (PSA) level, digital rectal examination (DRE), and prostate biopsy. Localized and advanced diseases can cause urinary retention, blood in the urine (hematuria), blood in semen, and pelvic discomfort, back pain, weight loss (Peters et al.2023)

Recent Advances in Prostate Cancer:

The treatment landscape for prostate cancer has seen remarkable progress in recent years. Standard treatment for localized prostate cancer includes active surveillance, radical prostatectomy, and radiation therapy with or without hormonal therapy. New therapies targeting the disease’s resistance to conventional treatments are emerging. One such advancement is a therapy that combines an experimental drug, AZD5069, with enzalutamide, a hormone therapy, showing promising results in shrinking tumors and reducing PSA levels (Guo et al.2023). Another breakthrough is the development of 177 Lu-PSMA-617, a targeted radioligand therapy that delivers radiation directly to cancer cells, demonstrating effectiveness in controlling advanced prostate cancer (Sartor et al.2021)

The TULSA-Pro Procedure:

TULSA-Pro stands for Transurethral Ultrasound Ablation. It is one of the focal ablative therapies for localized prostate cancer which is minimally invasive, providing proper oncological outcome with preserving urinary continence and erectile dysfunction due to nerve sparing.

Procedure:

TULSA procedure is performed in 1.5 Tesla MRI with the patient under general anesthesia. An ultrasound applicator is placed in the prostatic urethra to deliver the focused waves to ablate the cancerous tissue sparing the healthy tissue and a rectal cooling device is placed adjacent to the prostate. Both devices are irrigated with water for thermal protection of the rectum and urethra. MRI shows real-time visual monitoring during the procedure. (Klotz et al.2021)

Post-Procedure Recovery:

Patients can be discharged the same day or can be admitted overnight. They benefit from shorter recovery times and fewer side effects like urinary incontinence and erectile dysfunction.

Clinical Evidence and Results Recent studies highlight TULSA-Pro’s effectiveness:

PSA Reduction: Studies report 75% decrease in PSA levels post-procedure, indicating effective tumor ablation (Peters et al.2023)

Preservation of Erectile Function: TULSA-Pro has been shown to minimize damage to neurovascular bundles, reducing the incidence of erectile dysfunction. (Klotz et al.2021)

Urinary Continence: Patients experience lower urinary leakage rates than traditional surgical treatments (Peters et al.2023).

Quality of life: IPSS urinary symptom score, quality of life score, and voiding/storage sub scores recovered to baseline 3 months post-procedure. Urinary continence and sexual function also recovered to baseline earlier than other measures ( Klotz et al.2021).

Advancements and Future Directions: The TULSA-Pro procedure is evolving, with advancements enhancing its precision and outcomes.

Conclusion

TULSA is a minimally invasive procedure that uses planar ultrasound energy with real-time MRI-based treatment planning, thermal dosimetry, and closed-loop temperature feedback for effective prostate cancer ablation.  It signifies a new era in prostate cancer treatment ongoing research promises to refine this innovative approach, broadening its adoption and benefiting patients and healthcare providers globally.

REFERENCES

  • Abudoubari, S., Bu, K., Mei, Y., Maimaitiyiming, A., An, H., & Tao, N. (2023). Prostate cancer epidemiology and prognostic factors in the United States. Frontiers in Oncology, 13. https://doi.org/10.3389/fonc.2023.1142976
  • Wang, L., Lu, B., He, M., Wang, Y., Wang, Z., & Du, L. (2022). Prostate Cancer Incidence and Mortality: Global Status and Temporal Trends in 89 Countries From 2000 to 2019. Frontiers in Public Health, 10, 811044. https://doi.org/10.3389/fpubh.2022.811044
  • Tzelepi V. Prostate Cancer: Pathophysiology, Pathology and Therapy. Cancers (Basel). 2022 Dec 31;15(1):281. doi: 10.3390/cancers15010281. PMID: 36612276; PMCID: PMC9818719.
  • Berenguer, C. V., Pereira, F., Câmara, J. S., & Pereira, J. A. M. (2023). Underlying Features of Prostate Cancer-Statistics, Risk Factors, and Emerging Methods for Its Diagnosis. Current Oncology, 30(2), 2300-2321. https://doi.org/10.3390/curroncol30020178 this is for no .2
  • Peters, I., Hensen, B., Glandorf, J., et al. (2023). “First experiences using transurethral ultrasound ablation (TULSA) as a promising focal approach to treat localized prostate cancer: a monocentric study.” BMC Urology, 23, Article number: 1421
  • Guo, C., Sharp, A., Gurel, B., et al. (2023). Targeting myeloid chemotaxis to reverse prostate cancer therapy resistance. Nature, 623, 1053–1061. https://doi.org/10.1038/s41586-023-06696-z
  • Sartor, O., de Bono, J., Chi, K. N., Fizazi, K., Herrmann, K., Rahbar, K., Tagawa, S. T., & the VISION Investigators. (2021). Lutetium-177–PSMA-617 for Metastatic Castration-Resistant Prostate Cancer. The New England Journal of Medicine, 385(12), 1091-1103. https://doi.org/10.1056/NEJMoa2107322
  • Klotz, L., Pavlovich, C.P., Chin, J., Hatiboglu, G., Koch, M., Penson, D., Raman, S., Oto, A., Fütterer, J., Serrallach, M., Relle, J., Lotan, Y., Heidenreich, A., Bonekamp, D., Haider, M., Tirkes, T., Arora, S., Macura, K.J., Costa, D.N., Persigehl, T., Pantuck, A.J., Bomers, J., Burtnyk, M., Staruch, R., & Eggener, S. (2021). Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation of Prostate Cancer. Journal of Urology, 205, 769–779. https://doi.org/10.1097/ju.0000000000001362
  • Feigl, G. C., Heckl, S., Kullmann, M., Filip, Z., Decker, K., Klein, J., Ernemann, U., Tatagiba, M., Velnar, T., & Ritz, R. (2019). Review of first clinical experiences with a 1.5 Tesla ceiling-mounted moveable intraoperative MRI system in Europe. Bosnian Journal of Basic Medical Sciences, 19(1), 24-30. https://doi.org/10.17305/bjbms.2018.3777

Navigating the Challenges of Infertility: Causes, Treatments, and preventative Strategies

Mar 30, 2024 | Women's Health

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Written By THT Editorial Team

Dr. Asmita Pandey

Reviewed by Dr. Asmita Pandey, Fertility Expert , M.D. (OB/GYN) 

 Infertility is a significant concern affecting 1 in 6 couples globally (WHO 2023), with various causes and treatment options available to address this issue. When exploring infertility, it is crucial to understand the common causes, treatment options, and preventative measures associated with the condition.

Causes of Infertility in Men and Women

Infertility can arise from a multitude of factors in both men and women. In men, common causes include low sperm count, poor sperm motility, hormonal imbalances, genetic factors like Klinefelter syndrome, mumps infection affecting sperm production, and lifestyle factors such as smoking, drug use, exposure to chemicals, stress and obesity[2][3][4]. On the other hand, in women, causes of infertility may stem from ovulation disorders, , tubal blockages, various uterine factors like endometriosis, fibroid, cervical factor, post-surgery scarring, and age-related decline in egg quality and quantity[1][2][4].

Treatment Options for Infertility

Treatment for infertility varies depending on the underlying cause. For men, treatment options may include lifestyle changes like avoiding drugs and alcohol, hormone therapy to regulate hormone levels affecting sperm quality, surgical interventions to correct anatomical issues or blockages, and assisted reproductive technologies (ART) procedures [3][4]. In women, treatments can range from medications to induce ovulation, timed intercourse or improve egg quality to surgical procedures to address structural abnormalities [1][2][4].

Preventative Measures for Infertility

Preventing infertility involves adopting healthy lifestyle practices. Both men and women can benefit from avoiding smoking and excessive alcohol consumption, maintaining a healthy weight through diet and exercise, reducing exposure to environmental toxins or chemicals that may impact fertility, and seeking timely treatment for sexually transmitted infections (STIs)[4][5]. Additionally, regular testing for STIs and addressing any underlying health conditions promptly can help prevent infertility. Moreover, with recent advances, egg or embryo freezing is an option for career-oriented couples wanting to delay pregnancy.

The emotional and social aspect of Infertility:

The journey through infertility can be emotionally taxing and socially isolating. Couples may experience a rollercoaster of hope and disappointment with each treatment cycle. The societal pressure to have children can exacerbate feelings of failure or inadequacy. It’s essential to recognize the emotional toll and provide support through counseling services, support groups, and open communication with loved ones [6].

*Technological innovations in infertility treatments:*

The field of reproductive medicine is continually evolving, with new technologies enhancing the success rates of fertility treatments. Techniques like ovarian tissue freezing and sperm DNA fragmentation tests are on the forefront of these advancements. These innovations offer new hope for couples who have had limited success with traditional fertility treatments [7].

*Nutritional Influences on Infertility *

Recent studies suggest that nutrition plays a vital role in fertility. Diets rich in certain nutrients, such as omega-3 fatty acids, iron, vitamin D and other micronutrients have been linked to improved fertility outcomes. Conversely, diets high in processed foods and sugar may negatively affect reproductive health. Nutrition counseling can be a valuable component of infertility treatment plans [8].

Global perspective on infertility

Infertility is a global issue, with varying prevalence rates and treatment accessibility around the world. In some cultures, infertility carries a significant stigma, which can impact the willingness to seek treatment. Understanding these cultural nuances is important for providing compassionate and appropriate care to individuals facing infertility [9].

In conclusion, infertility is a complex issue that affects both men and women due to various factors ranging from genetic conditions to lifestyle choices. Understanding the common causes of infertility and the available treatment options is essential for individuals facing fertility challenges. By incorporating preventative measures such as maintaining a healthy lifestyle and seeking timely medical care i.e. failing to conceive after one year of regular sexual intercourse, individuals can take proactive steps towards preserving their fertility and addressing infertility issues effectively.

* More information on recent breakthroughs on technological innovations :

The Semen Microbiome and Its Impact on Male Fertility

Recent Advances in Male Infertility Research

*More information on nutrition :

Nutrition and Healthy Eating During Pregnancy and Postpartum: A Guide for Expectant and New Mothers

REFERENCES

[1] Planned Parenthood. (2024). what is infertility? Retrieved March 24, 2024, from https://www.plannedparenthood.org/learn/pregnancy/infertility

[2] Brazier, Y. (2023, December 22). Infertility in males and females. Medical News Today. Medically reviewed by Kallen, A., MD. Retrieved from https://www.medicalnewstoday.com/articles/165748

[3] Cleveland Clinic. (2024). Male infertility. Retrieved from https://my.clevelandclinic.org/health/diseases/17201-male-infertility

[4] Mayo Clinic. (n.d.). Infertility. Retrieved from https://www.mayoclinic.org/diseases-conditions/infertility/symptoms-causes/syc-20354317

[5] ARC Fertility. (n.d.). Prevention of infertility. Retrieved from https://www.arcfertility.com/patient-resources/infertility-tutorial/prevention/

[6] American Psychological Association. (2024). The psychological impact of infertility. Retrieved from https://www.apa.org/topics/fertility/infertility-impact

[7] Human Fertilisation & Embryology Authority. (2024). Advances in fertility treatment. Retrieved from https://www.hfea.gov.uk/treatments/explore-all-treatments/advances-in-fertility-treatment/

[8] The Nutrition Society. (2023). Nutrition and fertility. Retrieved from https://www.nutritionsociety.org/papers/nutrition-and-fertility

[9] World Health Organization. (2024). Infertility: A global public health issue. Retrieved from https://www.who.int/reproductivehealth/topics/infertility/perspective/en/