The initial fraction of the human ejaculate mainly contains prostatic secretions and the subsequent fraction holds majority of the spermatozoa suspended in the secretions from the seminal vesicle. Apart from large series of proteins, human ejaculate also contains antioxidants and reactive oxygen species that are specific to certain accessory sexual glands; however, the influence of these components on the sperm DNA integrity has not been elucidated till date. The present investigation was conducted using split (first and second) ejaculate fractions of forty-one subjects having various semen abnormalities. Sperm DNA integrity was assessed in the individual fractions by comet assay and quantified. The amount of sperm DNA damage between the split fractions is not significantly different in normozoospermic semen samples. In contrast, split fraction-2 had significantly elevated level of DNA-damaged spermatozoa in asthenozoospermic (P < 0.01) and teratozoospermic groups (P < 0.001) when compared to whole ejaculate. The split fraction analysis using various types of ejaculates demonstrated the difference in sperm DNA integrity, which has not been reported till date. Hence, in a clinical point of view, the use of initial ejaculate fraction may be considered superior to whole ejaculate in assisted conception if the DNA integrity is a concern especially in asthenozoospermic and teratozoospermic samples.

Primary lung abscess as a complication of necrotising community-acquired pneumonia due to multidrug-resistant (MDR) Klebsiella pneumoniae is rare. A 63-year-old man with a medical history of type 2 diabetes mellitus and chronic kidney disease was diagnosed with lung abscess due to MDR Klebsiella pneumoniae, a rare organism as a causative agent for community-acquired pneumonia. This unusual case revealed therapeutic challenges faced owing to factors such as drug-resistant pathogen, longer duration of antibiotics required for lung abscess and the chronic kidney status of the patient limiting the dosage of antibiotics. The clinical nuggets discussed in this case might pave the way in the future for management guidelines to be formulated in optimising the selection and duration of therapy for lung abscesses with MDR aetiology and in early recognition of this rare but dreaded entity.

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