Jorge Hallak | Universidade de São Paulo (original) (raw)
Jorge Hallak M.D., Ph.D. is Full- Professor of Medicine at the University of Sao Paulo Medical School - FMUSP (Pathology, 2018), Doctorate degree in Medicine – Urology (1999, FMUSP), Head, Section of Andrology – Division of Urology Department of Surgery at The University of Sao Paulo Medical School Clinical Hospital (HCFMUSP), Coordinator Reproductive Toxicology Unit – Department of Pathology – FMUSP; practising urologist at HCFMUSP. Member of Syrian-Lebanese Hospital, Albert Einstein Hospital, Oswaldo Cruz German Hospital, among others. Coordinator Men’s Health Study Group at the Institute for Advanced Studies- USP (IEA-USP); and Medical and Scientific Director, Androscience – Science and Innovation Center and High-Complexity Clinical and Research Andrology Laboratory in Sao Paulo, Brazil and Medical Director at Doctor Jorge Hallak – Men’s Health Clinic. Graduated in Medicine – FMUSP (1989), he is an active urologist, specialized in andrology, male infertility, human reproduction, hypogonadism, microsurgery and sperm cryopreservation. Obtained his PhD degree in reproductive biology involving basic research in the andrology laboratory, particularly biochemical, biophysical and physiological aspects of human spermatozoa, including cryobiology, at the Department of Urology, THE CLEVELAND CLINIC FOUNDATION, in Cleveland, Ohio, USA from 1996 to 1998, as well as clinical andrology training in andrology, male infertility and microsurgery, in the Section of Male Infertility, with renowned leader in the field, Dr Anthony J., Thomas Jr. afterwards. Dr. Hallak has published as an author or coauthor, over 130 scientific papers and book chapters in peer reviewed international journals, as well as over 450 international meeting presentations and holds over a dozen national and international prizes and awards with his students. Founder and Director of Androscience - Science and Innovation Center in Andrology. A High-Complexity Clinical and Research Andrology Laboratory, dedicated to provide cutting-edge high-quality services in male infertility evaluation and treatment as well as develop and conduct clinical and basic science translational studies in the field with clinical applicability. In 1999 the Doctorate degree was obtained with the study: “Creatine kinase as a new marker of sperm function in fresh and cryopreserved semen and its relationship with male infertility” and in 2018, the Title of Full-Professor at The University of Sao Paulo Medical School, was obtained with the 18-yearlong study: “Effects of continuous use of marijuana and cigarette smoking in testicular function and its relationship with hypogonadism and male infertility”. Areas of scientific interest include: sperm and testicular tissue cryopreservation in patients with malignant diseases, including all types of cancer and non-malignant diseases, immunologic and immunosuppressive conditions and other chronic medical conditions; pathophysiology and microsurgical treatment of obstructive and non-obstructive azoospermia and varicocele. Biochemical aspects related to oxidative stress, sperm function and dysfunction; reproductive toxicology, influence of habits, lifestyle factors and chronic diseases in hypogonadism and male fertility and genetics of male infertility. In reproductive toxicology, has identified risk factors by studying the effects of air pollution, environmental pollutants, endocrine disruptors (xenoestrogens), psychotropic drugs (marijuana, crack, antidepressants), alcohol and tobacco in human health, hypogonadism and fertility. In 2018 Prof. Hallak has been appointed as Coordinator of Men's Health Study Group at The Institute for Advanced Studies, University of Sao Paulo (IEA-USP), coordinating the project: “From Fetus to the Adult Male: A Cultural, Behavioral, Biological, Medical and Environmental Approach”, pioneering the foundation of this group within the most prestigious and emerging university-based think-thank in Brazil and Latin America, characterized by the excellence of its members, independence of the researchers of the highest scientific level, possibly one of the most creative nucleus of critical and strategical thought in Brazil and Latin America that has the full capacity of becoming an important vector and transforming agent for our Global changemaking proposals.
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Papers by Jorge Hallak
Methods: Retrospective review of medical and laboratory results from 512 patients who underwent 1... more Methods: Retrospective review of medical and laboratory results from 512 patients who underwent 1576 cycles of IUI with partner's sperm over a 3 year period. Data were collected on 3 risk factors for IUI failure (advanced female age > 37.7 years, prior corrective pelvic surgery, and poor post-wash sperm motility), and on method of OS (none, clomiphene citrate, or gonadotropin). Results: Patients who underwent OS had significantly higher pregnancy rates (7.6%) than those who did not (4.7%, p = 0.02). However, when patients were stratified by their risk factors, OS made a significant difference only for patients without risk factors. These patients had a 15.5% per cycle pregnancy rate with OS, compared to 7.9% in unstimulated IUI cycles (p = 0.04). Conclusions: Ovulatory stimulation doubles IUI pregnancy rates among young patients without a prior pelvic surgery and with good post-wash semen quality. The benefit of OS for patients with risk factors for IUI failure is unclear The...
Fertility and Sterility
when the LN 2 was gone. The time at which the rise in temperature began was 6h45min for the 10L t... more when the LN 2 was gone. The time at which the rise in temperature began was 6h45min for the 10L tank, 8h00min for the 20L tank, and 11h45min for the 35L tank, respectively. The time it took for the temperature to reach-80 C for the 10, 20, and 35L tanks were 7h54min, 8h41min, and 14h14min, respectively. The decrease in LN 2 levels of the 10, 20, and 35L tanks for 7days without a drilled hole were 2cm, 4cm, and 4cm, respectively. The temperature remained at-196 C in all tanks without tank damage. CONCLUSIONS: In this study, the speed of LN 2 decrease of the 35L tank was slower than that of the 10 and 20L tanks when damaged. The larger the capacity of the tank, the longer it took for the temperature rise to begin and for the temperature to reach-80 C. There was a difference of 6h20min between the 10L and 35L tanks to reach-80 C. Therefore, it should be kept in mind that the rescue duration of embryos over the tank failure vary depending on each tank capacity.
Recently, a study containing data on common metabolic disorders, hospitalizations, and disease pr... more Recently, a study containing data on common metabolic disorders, hospitalizations, and disease prevalence by age, sex, and ethnicity reported that worse COVID-19 outcomes are associated with four underlying medical conditions: obesity,
International Urology and Nephrology
We report a rare case of Baggio-Yoshinari Syndrome (BYS) or Lyme disease-like illness in a health... more We report a rare case of Baggio-Yoshinari Syndrome (BYS) or Lyme disease-like illness in a healthy married couple who developed severe neurological, rheumatological, and dermatological symptoms related to the disease after sexual intercourse on three occasions.
Frontiers in Physiology, 2022
The ongoing COVID-19 pandemic represents an extra burden in the majority of public and private he... more The ongoing COVID-19 pandemic represents an extra burden in the majority of public and private health systems worldwide beyond the most pessimistic expectations, driving an urgent rush to develop effective vaccines and effective medical treatments against the SARS-CoV-2 pandemic. The Nucleocapsid structural viral protein is remarkably immunogenic and hugely expressed during infection. High IgG antibodies against Nucleocapsid protein (N protein) levels were detected in the serum of COVID-19 patients, confirming its pivotal antigen role for a T lymphocyte response in a vaccine microenvironment. Currently, adverse events associated with immunizations have raised some degree of concern, irrespective of its huge benefits in dealing with disease severity and decreasing mortality and morbidity. This hitherto study evaluates histological changes in rats’ testes, epididymis, prostate, and seminal vesicles and analyzes hormone levels after solely N protein inoculation. Therefore, we exposed a group of Lewis rats to weekly injections of the recombinant N protein for 28 days, while a control group was inoculated with a buffer solution. The N group revealed a more significant number of spermatozoa. Spermatozoa in the seminiferous tubules were counted in twenty 400 × microscopy fields (mean of 9.2 vs. 4.6 in the control group; p < 0,01), but significantly lower testosterone levels (mean of 125.70 ng/dl vs. 309,00 ng/dl in the control group; p < 0,05) were found. No other histological and biochemical changes were displayed. Conclusively, these data suggest testicular hormonal imbalance mediated by the SARS-CoV-2 N protein that could be linked to reported post-COVID-19 syndrome hypogonadism. More relevant research might be performed to confirm this viral antigen’s deleterious mechanism in the human testicular microenvironment, particular in Leydig cell function.
Systems Biology in Reproductive Medicine, 2022
ABSTRACT Standard protocols for clinical in vitro fertilization (IVF) laboratories recommend incu... more ABSTRACT Standard protocols for clinical in vitro fertilization (IVF) laboratories recommend incubating semen at 37°C in 5% CO2 without strictly specifying which medium should be used or for how long. This study aimed to test the most common different incubation media used in Latin American andrology and micromanipulation laboratories and verify which, if any, is the most appropriate medium to improve asthenozoospermic semen samples’ motility in the infertile male population. Ejaculates (136) collected from asthenozoospermic men were divided into two cohorts with similar characteristics (cohort 1; n = 28 and cohort 2; n = 108). Cohort 1 was used to evaluate the optimal incubation time with regard to unprepared asthenozoospermic sample sperm motility. After defining an optimal incubation period of 2 h, cohort 2 was used to evaluate which of the four media commonly used in IVF clinics (continuous single culture medium = CSCM®; SpermRinse medium = SR®; in vitro fertilization medium = G-IVF® and human tubal fluid medium = HTF®) was preferred for semen samples from asthenozoospermic patients. Overall, it was determined that a 2-h incubation in CSCM® medium led to the highest asthenozoospermic sperm motility. Thus, this simple, cost-effective, easily reproducible protocol could prove extremely useful for andrology laboratories working with IVF clinics dealing with asthenozoospermic semen specimens. This is particularly relevant since the incidence of the latter is on the rise as semen quality decreases around the globe. Abbreviations: ANOVA: Analysis of variance; ARTs: Assisted reproductive techniques; BWW: Biggers, Whitten, and Whittingham; CO2: Carbon dioxide; CPM: counted per minute; CSCM: Continuous Single Culture Medium; DAB: 3.3′- diaminobenzidine; DFI: DNA Fragmentation Index; DMSO: Dimethyl sulfoxide; G-IVF: In Vitro Fertilization Medium; GSH: Glutathione; GPx: glutathione peroxidase; HDS: High DNA Stainability; HSA: Human Serum Albumin; HTF: Human Tubal Fluid; HYP: Hyperactivity; ICSI: Intracytoplasmic sperm injection; IUI: Intrauterine insemination; IVF: in vitro fertilization; LIN: Linearity; ROS: Reactive Oxygen Species-level; SC: Sperm concentration; SCA: Sperm Computer Analysis; SCSA: Sperm Chromatin Structural Assay; SR: SpermRinse medium; SSS: Synthetic Serum Substitute; STR: Straightness; SOD: superoxide dismutase; TNE: Tris-Borate-EDTA; TSC: Total sperm count; VAP: Mean velocity; VCL: Curvilinear velocity; VSL: Linear velocity; WHO: World Health Organization; WOB: Wobble; spz: spermatozoa; AO: antioxidant
International braz j urol, 2021
International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology, 2021
1 Androscience Centro de Ciência e Inovação em Andrologia e Laboratório de Andrologia Clínica e d... more 1 Androscience Centro de Ciência e Inovação em Andrologia e Laboratório de Andrologia Clínica e de Pesquisa de Alta Complexidade, São Paulo, SP, Brasil; 2 Divisão de Urologia, Universidade de São Paulo – USP, São Paulo, SP, Brasil; 3 Men’s Health Study Group, Institute for Advanced Studies, Universidade de São Paulo – USP, São Paulo, SP, Brasil; 4 Unidade de Toxicologia Reprodutiva, Universidade de São Paulo – USP, São Paulo, SP, Brasil; 5 Faculdade de Medicina da Universidade Federal do Amapá UNIFAP, Macapá, AP, Brasil
International braz j urol, 2021
Asian Journal of Andrology, 2021
Viral infections have haunted humankind since times immemorial. Overpopulation, globalization, an... more Viral infections have haunted humankind since times immemorial. Overpopulation, globalization, and extensive deforestation have created an ideal environment for a viral spread with unknown and multiple shedding routes. Many viruses can infect the male reproductive tract, with potential adverse consequences to male reproductive health, including infertility and cancer. Moreover, some genital tract viral infections can be sexually transmitted, potentially impacting the resulting offspring's health. We have summarized the evidence concerning the presence and adverse effects of the relevant viruses on the reproductive tract (mumps virus, human immunodeficiency virus, herpes virus, human papillomavirus, hepatitis B and C viruses, Ebola virus, Zika virus, influenza virus, and coronaviruses), their routes of infection, target organs and cells, prevalence and pattern of virus shedding in semen, as well as diagnosis/testing and treatment strategies. The pathophysiological understanding in the male genital tract is essential to assess its clinical impact on male reproductive health and guide future research.
Andrology, 2020
The current outbreak of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, n... more The current outbreak of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, named coronavirus disease 19 (COVID‐19), is not the first well‐known spillover of an animal originated virus to infect humans. However, one of the few to make such a fast jump in a powerful evolutionary shortcut. The incredible pattern of aggressiveness worldwide since the beginning of the outbreak is that up to 20% of those infected need hospitalization and 5% evolve to critical conditions, not limited to respiratory‐related issues, but rather to systemic involvement.
International braz j urol, 2020
To the editor, Early in January 2020, we were living our regular lives. We are urologists at the ... more To the editor, Early in January 2020, we were living our regular lives. We are urologists at the "Hospital das Clínicas", University of Sao Paulo Medical School Clinical Hospital (HC-FMUSP), a 900-bed tertiary care facility inside an even wider and stronger health complex of 2.300 beds. Our Institution is responsible for about 350 highly complex monthly urological surgeries comprising all subspecialties in the field. We are inserted in the SUS (Sistema Único de Saúde), a unified health system with universal coverage created in 1990 (1). By the end of January 2020, we were attending crowded outpatient ambulatories, performing our usual surgeries, participating in the teaching of undergraduate students, teaching general surgery and urology residents, presenting scientific research in national and international scientific meetings. When the press released the first confirmed case of corona virus disease (COVID-19) in late December, 2019 by the previously named "Wuhan virus" (Hubei province in China), later renamed as SARS-CoV-2 (2), not even the most pessimistic of us could imagine the impact it would have on our lives. Not even when it was spotted that the virus spread was hidden from the World and that doctors who tried to disseminate the information out died of the disease. At worst, if the virus crossed oceans and continents to our country, the routine of clinicians working in emergency rooms and intensive care units could be affected. Important and influential individuals of our national medical and political society came to the public warning that there was nothing to fear or to worry about. They told, we believed. Those who lived to see April 2020 realized how naive we had been. Italy fell and the whole World kneeled together with the Mediterranean country. "No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less" (3). How can the wisdom of a 17th century man be so contemporary? Perhaps because true wisdom is beyond time. While Italy was bleeding, here in Brazil most of our surgeries started to be postponed and the outpatient clinics to be rescheduled based on international and national urological societies recommendations (4). Academic meetings were canceled indefinitely. One by one, all the familiar aspects of our lives were taken away from us. Whilst we could still get together in the cafes, we were astonished. What´s next? Heartbreaking videos came from all over the World: first Italy, then Spain, England, and finally the United States. Great nations with robust health care systems took a hit like they have never seen before, at least not since the World War II. The context of a locally Chinese isolated crisis was rapidly dissipated into thin air. Thunders of war were quickly moving in our direction. It was real, surreal, and we did not plan for it. On March 24, the state of Sao Paulo officially announced social isolation. Cancelation of all sports events. Empty streets. Parks with closed gates. Children and parents trapped at home. We lost freedom as we knew it.
Fertility and Sterility, 2020
JBRA Assisted Reproduction, 2020
Translational Andrology and Urology, 2019
Translational andrology and urology, 2017
Cite this article as: Hallak J. Utility of sperm DNA fragmentation testing in different clinical ... more Cite this article as: Hallak J. Utility of sperm DNA fragmentation testing in different clinical scenarios of male reproductive abnormalities and its influence in natural and assisted reproduction.
Methods: Retrospective review of medical and laboratory results from 512 patients who underwent 1... more Methods: Retrospective review of medical and laboratory results from 512 patients who underwent 1576 cycles of IUI with partner's sperm over a 3 year period. Data were collected on 3 risk factors for IUI failure (advanced female age > 37.7 years, prior corrective pelvic surgery, and poor post-wash sperm motility), and on method of OS (none, clomiphene citrate, or gonadotropin). Results: Patients who underwent OS had significantly higher pregnancy rates (7.6%) than those who did not (4.7%, p = 0.02). However, when patients were stratified by their risk factors, OS made a significant difference only for patients without risk factors. These patients had a 15.5% per cycle pregnancy rate with OS, compared to 7.9% in unstimulated IUI cycles (p = 0.04). Conclusions: Ovulatory stimulation doubles IUI pregnancy rates among young patients without a prior pelvic surgery and with good post-wash semen quality. The benefit of OS for patients with risk factors for IUI failure is unclear The...
Fertility and Sterility
when the LN 2 was gone. The time at which the rise in temperature began was 6h45min for the 10L t... more when the LN 2 was gone. The time at which the rise in temperature began was 6h45min for the 10L tank, 8h00min for the 20L tank, and 11h45min for the 35L tank, respectively. The time it took for the temperature to reach-80 C for the 10, 20, and 35L tanks were 7h54min, 8h41min, and 14h14min, respectively. The decrease in LN 2 levels of the 10, 20, and 35L tanks for 7days without a drilled hole were 2cm, 4cm, and 4cm, respectively. The temperature remained at-196 C in all tanks without tank damage. CONCLUSIONS: In this study, the speed of LN 2 decrease of the 35L tank was slower than that of the 10 and 20L tanks when damaged. The larger the capacity of the tank, the longer it took for the temperature rise to begin and for the temperature to reach-80 C. There was a difference of 6h20min between the 10L and 35L tanks to reach-80 C. Therefore, it should be kept in mind that the rescue duration of embryos over the tank failure vary depending on each tank capacity.
Recently, a study containing data on common metabolic disorders, hospitalizations, and disease pr... more Recently, a study containing data on common metabolic disorders, hospitalizations, and disease prevalence by age, sex, and ethnicity reported that worse COVID-19 outcomes are associated with four underlying medical conditions: obesity,
International Urology and Nephrology
We report a rare case of Baggio-Yoshinari Syndrome (BYS) or Lyme disease-like illness in a health... more We report a rare case of Baggio-Yoshinari Syndrome (BYS) or Lyme disease-like illness in a healthy married couple who developed severe neurological, rheumatological, and dermatological symptoms related to the disease after sexual intercourse on three occasions.
Frontiers in Physiology, 2022
The ongoing COVID-19 pandemic represents an extra burden in the majority of public and private he... more The ongoing COVID-19 pandemic represents an extra burden in the majority of public and private health systems worldwide beyond the most pessimistic expectations, driving an urgent rush to develop effective vaccines and effective medical treatments against the SARS-CoV-2 pandemic. The Nucleocapsid structural viral protein is remarkably immunogenic and hugely expressed during infection. High IgG antibodies against Nucleocapsid protein (N protein) levels were detected in the serum of COVID-19 patients, confirming its pivotal antigen role for a T lymphocyte response in a vaccine microenvironment. Currently, adverse events associated with immunizations have raised some degree of concern, irrespective of its huge benefits in dealing with disease severity and decreasing mortality and morbidity. This hitherto study evaluates histological changes in rats’ testes, epididymis, prostate, and seminal vesicles and analyzes hormone levels after solely N protein inoculation. Therefore, we exposed a group of Lewis rats to weekly injections of the recombinant N protein for 28 days, while a control group was inoculated with a buffer solution. The N group revealed a more significant number of spermatozoa. Spermatozoa in the seminiferous tubules were counted in twenty 400 × microscopy fields (mean of 9.2 vs. 4.6 in the control group; p < 0,01), but significantly lower testosterone levels (mean of 125.70 ng/dl vs. 309,00 ng/dl in the control group; p < 0,05) were found. No other histological and biochemical changes were displayed. Conclusively, these data suggest testicular hormonal imbalance mediated by the SARS-CoV-2 N protein that could be linked to reported post-COVID-19 syndrome hypogonadism. More relevant research might be performed to confirm this viral antigen’s deleterious mechanism in the human testicular microenvironment, particular in Leydig cell function.
Systems Biology in Reproductive Medicine, 2022
ABSTRACT Standard protocols for clinical in vitro fertilization (IVF) laboratories recommend incu... more ABSTRACT Standard protocols for clinical in vitro fertilization (IVF) laboratories recommend incubating semen at 37°C in 5% CO2 without strictly specifying which medium should be used or for how long. This study aimed to test the most common different incubation media used in Latin American andrology and micromanipulation laboratories and verify which, if any, is the most appropriate medium to improve asthenozoospermic semen samples’ motility in the infertile male population. Ejaculates (136) collected from asthenozoospermic men were divided into two cohorts with similar characteristics (cohort 1; n = 28 and cohort 2; n = 108). Cohort 1 was used to evaluate the optimal incubation time with regard to unprepared asthenozoospermic sample sperm motility. After defining an optimal incubation period of 2 h, cohort 2 was used to evaluate which of the four media commonly used in IVF clinics (continuous single culture medium = CSCM®; SpermRinse medium = SR®; in vitro fertilization medium = G-IVF® and human tubal fluid medium = HTF®) was preferred for semen samples from asthenozoospermic patients. Overall, it was determined that a 2-h incubation in CSCM® medium led to the highest asthenozoospermic sperm motility. Thus, this simple, cost-effective, easily reproducible protocol could prove extremely useful for andrology laboratories working with IVF clinics dealing with asthenozoospermic semen specimens. This is particularly relevant since the incidence of the latter is on the rise as semen quality decreases around the globe. Abbreviations: ANOVA: Analysis of variance; ARTs: Assisted reproductive techniques; BWW: Biggers, Whitten, and Whittingham; CO2: Carbon dioxide; CPM: counted per minute; CSCM: Continuous Single Culture Medium; DAB: 3.3′- diaminobenzidine; DFI: DNA Fragmentation Index; DMSO: Dimethyl sulfoxide; G-IVF: In Vitro Fertilization Medium; GSH: Glutathione; GPx: glutathione peroxidase; HDS: High DNA Stainability; HSA: Human Serum Albumin; HTF: Human Tubal Fluid; HYP: Hyperactivity; ICSI: Intracytoplasmic sperm injection; IUI: Intrauterine insemination; IVF: in vitro fertilization; LIN: Linearity; ROS: Reactive Oxygen Species-level; SC: Sperm concentration; SCA: Sperm Computer Analysis; SCSA: Sperm Chromatin Structural Assay; SR: SpermRinse medium; SSS: Synthetic Serum Substitute; STR: Straightness; SOD: superoxide dismutase; TNE: Tris-Borate-EDTA; TSC: Total sperm count; VAP: Mean velocity; VCL: Curvilinear velocity; VSL: Linear velocity; WHO: World Health Organization; WOB: Wobble; spz: spermatozoa; AO: antioxidant
International braz j urol, 2021
International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology, 2021
1 Androscience Centro de Ciência e Inovação em Andrologia e Laboratório de Andrologia Clínica e d... more 1 Androscience Centro de Ciência e Inovação em Andrologia e Laboratório de Andrologia Clínica e de Pesquisa de Alta Complexidade, São Paulo, SP, Brasil; 2 Divisão de Urologia, Universidade de São Paulo – USP, São Paulo, SP, Brasil; 3 Men’s Health Study Group, Institute for Advanced Studies, Universidade de São Paulo – USP, São Paulo, SP, Brasil; 4 Unidade de Toxicologia Reprodutiva, Universidade de São Paulo – USP, São Paulo, SP, Brasil; 5 Faculdade de Medicina da Universidade Federal do Amapá UNIFAP, Macapá, AP, Brasil
International braz j urol, 2021
Asian Journal of Andrology, 2021
Viral infections have haunted humankind since times immemorial. Overpopulation, globalization, an... more Viral infections have haunted humankind since times immemorial. Overpopulation, globalization, and extensive deforestation have created an ideal environment for a viral spread with unknown and multiple shedding routes. Many viruses can infect the male reproductive tract, with potential adverse consequences to male reproductive health, including infertility and cancer. Moreover, some genital tract viral infections can be sexually transmitted, potentially impacting the resulting offspring's health. We have summarized the evidence concerning the presence and adverse effects of the relevant viruses on the reproductive tract (mumps virus, human immunodeficiency virus, herpes virus, human papillomavirus, hepatitis B and C viruses, Ebola virus, Zika virus, influenza virus, and coronaviruses), their routes of infection, target organs and cells, prevalence and pattern of virus shedding in semen, as well as diagnosis/testing and treatment strategies. The pathophysiological understanding in the male genital tract is essential to assess its clinical impact on male reproductive health and guide future research.
Andrology, 2020
The current outbreak of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, n... more The current outbreak of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, named coronavirus disease 19 (COVID‐19), is not the first well‐known spillover of an animal originated virus to infect humans. However, one of the few to make such a fast jump in a powerful evolutionary shortcut. The incredible pattern of aggressiveness worldwide since the beginning of the outbreak is that up to 20% of those infected need hospitalization and 5% evolve to critical conditions, not limited to respiratory‐related issues, but rather to systemic involvement.
International braz j urol, 2020
To the editor, Early in January 2020, we were living our regular lives. We are urologists at the ... more To the editor, Early in January 2020, we were living our regular lives. We are urologists at the "Hospital das Clínicas", University of Sao Paulo Medical School Clinical Hospital (HC-FMUSP), a 900-bed tertiary care facility inside an even wider and stronger health complex of 2.300 beds. Our Institution is responsible for about 350 highly complex monthly urological surgeries comprising all subspecialties in the field. We are inserted in the SUS (Sistema Único de Saúde), a unified health system with universal coverage created in 1990 (1). By the end of January 2020, we were attending crowded outpatient ambulatories, performing our usual surgeries, participating in the teaching of undergraduate students, teaching general surgery and urology residents, presenting scientific research in national and international scientific meetings. When the press released the first confirmed case of corona virus disease (COVID-19) in late December, 2019 by the previously named "Wuhan virus" (Hubei province in China), later renamed as SARS-CoV-2 (2), not even the most pessimistic of us could imagine the impact it would have on our lives. Not even when it was spotted that the virus spread was hidden from the World and that doctors who tried to disseminate the information out died of the disease. At worst, if the virus crossed oceans and continents to our country, the routine of clinicians working in emergency rooms and intensive care units could be affected. Important and influential individuals of our national medical and political society came to the public warning that there was nothing to fear or to worry about. They told, we believed. Those who lived to see April 2020 realized how naive we had been. Italy fell and the whole World kneeled together with the Mediterranean country. "No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less" (3). How can the wisdom of a 17th century man be so contemporary? Perhaps because true wisdom is beyond time. While Italy was bleeding, here in Brazil most of our surgeries started to be postponed and the outpatient clinics to be rescheduled based on international and national urological societies recommendations (4). Academic meetings were canceled indefinitely. One by one, all the familiar aspects of our lives were taken away from us. Whilst we could still get together in the cafes, we were astonished. What´s next? Heartbreaking videos came from all over the World: first Italy, then Spain, England, and finally the United States. Great nations with robust health care systems took a hit like they have never seen before, at least not since the World War II. The context of a locally Chinese isolated crisis was rapidly dissipated into thin air. Thunders of war were quickly moving in our direction. It was real, surreal, and we did not plan for it. On March 24, the state of Sao Paulo officially announced social isolation. Cancelation of all sports events. Empty streets. Parks with closed gates. Children and parents trapped at home. We lost freedom as we knew it.
Fertility and Sterility, 2020
JBRA Assisted Reproduction, 2020
Translational Andrology and Urology, 2019
Translational andrology and urology, 2017
Cite this article as: Hallak J. Utility of sperm DNA fragmentation testing in different clinical ... more Cite this article as: Hallak J. Utility of sperm DNA fragmentation testing in different clinical scenarios of male reproductive abnormalities and its influence in natural and assisted reproduction.
UROLOGY - LETTER TO THE EDITOR, 2022
We report a rare case of Baggio–Yoshinari Syndrome (BYS) or Lyme disease-like illness in a health... more We report a rare case of Baggio–Yoshinari Syndrome (BYS) or Lyme disease-like illness in a healthy married couple who developed severe neurological, rheumatological, and dermatological symptoms related to the disease after sexual intercourse on three occasions.