Infertility is a significant reproductive health issue in which a couple is unable to conceive a child after having unprotected intercourse for one year. Various conditions contribute to male infertility, with over half of cases being idiopathic, potentially inherited, or acquired. Poor spermatogenesis is often linked to male infertility. Spermatogenesis, the transformation of immature stem cells into mature gametes, can be disrupted by harmful substances. Azoospermia, the absence of spermatozoa in two centrifuged semen samples, is a key cause of male infertility. Nonobstructive azoospermia (NOA) occurs when issues in sperm production lead to a complete absence of sperm in the semen, often due to genetic abnormalities. Male infertility is complex and depends on gene interactions, epigenetic regulation, and environmental and lifestyle factors. Genetic factors like chromosomal abnormality cause infertility in 20% of the male population, diagnosed in 5% to 7% of oligozoospermic males and 15% of azoospermic males. This review discusses environmental and genetic factors influencing male infertility, identifies knowledge gaps, and suggests areas for further research. The results showcase the critical influence of genetic mutations, endocrine disruptors, and environmental toxins in spermatogenesis, explicitly affecting the association between external stressors and genetic predispositions. Furthermore, this study provides an overview of improving diagnostic and therapeutic options for male infertility by studying region-specific risk factors, specifically the Pakistani population. Graphical Abstract

The symptoms of COVID-19 are acute and mostly people recovered from these after a specific time period. Although, a considerable percentage of patients around the globe were affected but Per our knowledge, study of post covid- 19 associated mental health symptoms found scarce. The present study was organized to inspect the frequency of long-term anosmia, parosmia, odynophagia and associated mental health issues in the Pakistani population. A 5-month study was collected via an online questionnaire and phone calls among patients infected from March 2020 to February 2021. This study included a total of 124 patients with COVID-19 RT-PCR positive test. It was recorded by this survey that almost 13% of cases were with long-term anosmia, 81% with parosmia after short-term anosmia, and 79%with odynophagia. The level of depression and anxiety among patients suffering from long-term parosmia was significantly higher in participants than in anosmia. Most shockingly, a large fraction of respondents showed self-medication during the COVID-19 infection leading to the misuse of antibiotics, especially azithromycin, as medical treatment. To summarize, anosmia, parosmia and odynophagia are prominent, persistent symptoms of COVID-19 disease in thePakistani population leading to associated mental health issues. There’s a dire need for detailed research and proper awareness campaigns through different platforms about long-covid and medical treatment to avoid further health and psychological problems.

Background: The lethal nature of obesity is the leading cause of cardiovascular diseases, hypertension, diabetes, and dyslipidemia. Since 17th-century anthropometric parameters are known as a quantitative measure of obesity, how it detects changes in the body and its effects on health. In the beginning, the classical parameters were used i.e., BMI, waist to hip ratio, waist circumference, and waist to height ratio to determine obesity but due to different ethnic backgrounds and cut-off points, they lost their reliability. To overcome their limitations new parameters were introduced which were found to be better and independent of these factors. Methods: From different databases, a total of 450 papers were reviewed and at the end 101 were finalized for this study. Results: This study found that classical parameters can be used as a basic screening tool to differentiate from the standard. Yet their effectiveness is low since ethnic backgrounds, genders, ages, and populations influence them. Newly introduced parameters i.e., BRI, ABSI, and Log of Z-Score were found to be independent of age, gender, and ethnic backgrounds also they correspond positively with classical parameters. Various studies have supported their superiority over the classical ones, but some studies showed the result of newly introduced parameters is no better than the classical ones. But even keeping that in view it is more likely that the result given by newly introduced parameters is more authentic. Conclusion: Finally, it can be concluded that every parameter has some limitations but the factors which affect the efficiency of the results must not be overlooked.

Background. Vancomycin-resistant enterococci (VRE) are critical nosocomial pathogens with limited treatment options. We investigated the prevalence of vancomycin resistance genes in enterococcus isolates from Sheikh Zayd Hospital, Lahore, focusing on the dominant vancomycin resistance mechanism. Materials and methods. A total of 9000 clinical specimens (urine, blood, pus, and other fluids) were cultured over the study period, yielding 437 enterococcus isolates. These were identified by standard microbiological methods. Vancomycin resistance was confirmed phenotypically, and all VRE isolates were subjected to polymerase chain reaction (PCR) for vancomycin resistance genes vanA, vanB, vanC, and vanD. Patient demographics and clinical source data were recorded. Statistical analyses (chi-square tests) were performed to assess associations between VRE occurrence and patient factors (age, gender, department). Results. Out of 437 enterococcus-positive cultures, 40 isolates (9.1%) were confirmed as VRE. All 40 VRE isolates (100%) carried the vanA gene, while no vanB, vanC, or vanD genes were detected. Urine was the predominant specimen source for VRE, accounting for 85% of vanA-positive isolates, with the remainder from pus, blood, and other specimens. The median patient age was 58 years (range 5–85), and VRE cases were more frequent in older patients (50% of cases in 60 age group). Males comprised 60% of VRE cases. The highest number of VRE cases came from intensive care units (37.5%) and medical wards (25%), followed by surgical units (20%) and urology/nephrology (12.5%). Statistical analysis showed that VRE isolation was significantly associated with age 50 years (p = 0.01) and ICU admission (p = 0.02), whereas gender was not significantly associated (p = 0.40). Conclusions. vanA was the exclusive vancomycin resistance determinant in this hospital’s VRE isolates, underscoring that high-level vancomycin resistance in enterococci is primarily mediated by the vanA gene in our setting. The dominance of vanA-positive VRE in urine samples highlights the urinary tract as a common site of VRE infection. Our findings emphasize the need for vigilant antimicrobial stewardship and infection control measures to prevent the spread of vanA-mediated VRE. This first report from Lahore on molecular VRE typing aligns with regional data and reinforces that continuous surveillance of resistance genes is crucial for guiding effective infection control policies.

The current global outbreak of monkeypox, a zoonotic virus that shares similarities with smallpox (such as the characteristic rash and mode of transmission, though monkeypox generally has a lower fatality rate and less severe symptoms), has raised significant interest. Vaccination is seen as a critical preventive strategy, with the emergence of JYNNEOS and ACAM2000 as key options in recent times. This study aims to critically evaluate and compare the safety, efficacy, and real-world effectiveness of the two primary monkeypox vaccines JYNNEOS and ACAM2000 to guide clinical and public health decision-making. A comparative analytical review was conducted by synthesizing evidence from peer-reviewed studies, clinical trial data, and public health reports published between 2010 and 2025. Key parameters examined include immunogenicity, adverse event profiles, storage requirements, and suitability for different population groups. The findings suggest that JYNNEOS offers a more favorable safety profile with fewer serious adverse effects and is better suited for immuno-compromised individuals, while ACAM2000 demonstrates robust efficacy but poses higher risks of complications such as myocarditis, pericarditis, and progressive vaccinia due to its replication-competent vaccinia virus. Both vaccines show protective efficacy against monkeypox; however, JYNNEOS’s superior safety and ease of administration make it a more practical choice for widespread immunization efforts. This comparative review underscores the importance of tailoring vaccine strategies based on population risk factors and health infrastructure. Future research should focus on long-term effectiveness, potential for combination vaccine strategies, and preparedness against emerging orthopoxvirus threats.