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Background: India reportedly has 70% of the worldwide burden of Visceral Leishmaniasis(VL), with Bihar having 90% of reported cases. With the support of the RMRI, MSF has implemented a VL treatment project in Vaishali district, endemic for Leishmania donovani, using total dose 20mg/Kg liposomal amphotericin-B(L-AmB) as the first-line drug.Methods: Intravenous L-AmB(Ambisome) has been administered in four doses of 5mg/kg/doses to a total dose of 20mg/kg to all patients identified as primary VL over a period of 5 to 10 days depending on the severity of disease. All patients are routinely given comprehensive health education regarding VL and instructed to return immediately if any recurrence of symptoms occurred. The Excel based database of the project was analysed over a 4-year period from September 2007-December 2011. All immunocompetent patients readmitted with biopsy confirmed VL who had been previously treated for primary VL within the programme were identified, described and compared to the parameters of overall admissions of immunocompetent patients with primary VL within the same period.Results: 6435 immunocompetent primary VL patients were treated during the analysis period with 20mg/Kg LAmb. 80 of these patients re-presented with parasite confirmed relapses. This constituted a minimum of 1.2% of the overall treated, however passive

Free radicals are unstable molecules that have an unpaired electron in their last orbital, which makes them highly unstable agents. In medicine, it has been discovered that they play an important role in cell signaling and without them some cells such as leukocytes or sperm could not perform their biological functions. To protect itself from these oxidizing agents, the cell has a defense system based on antioxidants; however, when this balance is lost and oxidizing agents exceed the cellular antioxidant capacity, the cell enters oxidative stress, which affects cellular components such as proteins, nucleic acids, lipids, amino acids, and carbohydrates, among others. In the case of spermatozoa, due to their high metabolic rate, they produce large quantities of oxygen reactive species (ROS), decreasing sperm motility, alterations in cytoplasmic components, modifications in genetic material, or sperm death. In this chapter, a review is made of a brief history of how the toxicity of oxygen and free radicals was discovered, the oxidative stress in cells, and the effect of oxidative stress in the cytoplasmic sperm membrane, in the spermatic mitochondria, in the spermatic acrosome, in the sperm DNA, and in the fertility of the female and the male.

During seminal freezing, sperm undergo oxidative stress, reducing their motility, viability, and acrosomal integrity. To prevent these damages, antioxidants have been added at the time of seminal freezing. The objective was to assess the antioxidant effect of the combination of α-tocopherol with quercetin, added to the diluent for the freezing of boar semen. The semen of boars of the Pietrain and York/Pietrain breeds was frozen in 0.5 ml straws, before freezing α-tocopherol in a concentration of 4 mg/ml (T1), quercetin in concentrations of 25, 50 and 100 µM (T2, T3 and T4), α-tocopherol + Quercetin in concentrations of 4 mg/ml + 25 µM, 4 mg/ml+50 µM and 4 mg/ml + 100 µM (T5, T6 and T7) and the control group (T8) without antioxidant. The straws were frozen in liquid nitrogen for 7 days and thawed at 42 °C for 12 seconds. 5 repetitions were performed analyzing motility, viability, and NAR. the results were analyzed using a completely randomized design in factorial arrangement comparing the means with a Tukey test. The best percentage of motility was for T5, T4 and T1 with 39.44, 38.06 and 37.33%, respectively, there was a significant difference with T8; the best percentage of viability were T5 with 51.41%, there was a significant difference with T3 and T8; and the best NAR percentages were for T8 with 94.90%, with a significant difference for T1. In conclusion, the addition of α-tocopherol and quercetin separately or in combination protects the motility, viability, and NAR of spermatozoa from frozen-thawed boar semen.