The clinical characteristics, presentation, and treatment outcomes of prolactinomas at Groote Schuur Hospital

Background: Prolactin-secreting tumours( prolactinomas) are the commonest type of pituitary tumour, accounting for approximately 30 to 40 %% of all pituitary adenomas. Although there is ample epidemiologic and clinic data from Industrialised countries there remains sparse data from Africa. Specifically, the clinical presentation, and hormonal deficiencies and treatment outcomes in the South Africa have not been described. Methods: A retrospective study of all patients with a diagnosis of prolactinoma attending the Endocrine and Pituitary Clinics at Groote Schuur Hospital over a 12-month period, between March 2019-March 2020. Patients folders were reviewed to retrieve the following information: demographic data, clinical presentation, clinical signs, prolactinoma phenotype, hormonal deficiencies, treatment modalities and clinical outcomes. Results: Over a 12-month period 52 patients were included in this study, females 73% (n=38), mean age of all participants was 46.1 ± 14.6 years. A macroprolactinoma was present in 67.3% (n=35) of patients and 32.7% (n=17) of patients had a microprolactinoma. In the macroprolactinoma group: the common presenting symptoms were headache 88.6% (n=33), altered vision 40% (n=14) and , in females, amenorrhoea 63.6% (n=14) but a cranial nerve palsy 17.1% (n=6) and apoplexy 5.7% (n=2) were uncommon. . In the microprolactinoma group the common presenting symptoms included amenorrhoea 75% (n=12), galactorrhoea 70.6% (n=12), headache 64.7% (n=11). On presentation the majority of patients with a macroadenoma had at least one hormonal abnormality with hypogonadism 73.1% (n=19) being most common, followed by hypothyroidism 53.8% (n=14) and hypoadrenalism 30% (n=8). Over 50% of patients with a giant adenoma had panhypopituitarism with hypogonadism in 100%, hypothyroidism in 77.8% (n=7) and hypoadrenalism in 66.7% (n=6). Hormonal deficiencies in the microadenoma group on presentation included hypogonadism 64.7% (n=11), hypothyroidism 35.3 (n=6) and one patient had hypoadrenalism. All patients received medical treatment, however, in the macroadenoma group 4 patients required surgical debulking of the tumour, 3 patients required a ventriculo-peritoneal (VP) shunt for hydrocephalus and 2 patients required radiation. After a median follow-up of 46.5 months, the median prolactin level decreased from 322.5 ug/l (94.0-4282.0) at presentation to 17.5 ug/l (8.6-82.5) at follow-up. In parallel there was a reduction of 12.2 ±9.7 mm in tumour size after a mean of 59.8 ±53.3 months. There was resolution of hypogonadism in 56.4% (n=22), of hypothyroidism in 2.7% (n=2) and hypoadrenalism only resolved in 1 patient. Conclusions: Most patients with a prolactinoma are symptomatic and have at least one hormone deficiency on presentation. With medical management most patients experienced a reduction in prolactin levels and tumour size. . This was associated with the resolution of hypogonadism in the majority, however, hypothyroidism and hypoadrenalism are unlikely to resolve despite a reduction in tumour size

Heavy Metals Uptake By Chilli Plants (Capsicum Annuum L.) Planted In Rice Husk Char And Coco Peat Media

The current study investigated the uptake of Cadmium (Cd2+) and Lead (Pb2+) by chilli plant and their effect on the plant growth and fruit quality. Kajian ini mengkaji pengambilan Kadmium (Cd2+) dan Plumbum (Pb2+) oleh pokok cili merah dan kesannya terhadap pertumbuhan tanaman dan kualiti buah-buahan

Unveiling Innovations in Grasslands Productivity and Sustainability

Funding: This work is funded by the Super g project (funded under EU Horizon 2020 programme: project number 774124). Acknowledgments: I acknowledge the efforts of the authors, reviewers, and editors who significantly contributed to the success of this Special IssuePeer reviewedPublisher PD

Fuzzy Maximum Satisfiability

In this paper, we extend the Maximum Satisfiability (MaxSAT) problem to {\L}ukasiewicz logic. The MaxSAT problem for a set of formulae {\Phi} is the problem of finding an assignment to the variables in {\Phi} that satisfies the maximum number of formulae. Three possible solutions (encodings) are proposed to the new problem: (1) Disjunctive Linear Relations (DLRs), (2) Mixed Integer Linear Programming (MILP) and (3) Weighted Constraint Satisfaction Problem (WCSP). Like its Boolean counterpart, the extended fuzzy MaxSAT will have numerous applications in optimization problems that involve vagueness.Comment: 10 page

Analysis of IVAT laboratory grounding system using CDEGS software

Practical tests on grounding systems has proved very costly and pose hazards on operating personnel. Therefore, numerical methods using computers provide the m ost appropriate tool to assess the earthing systems. The research has been conducted with the utilization o f CDEGS software as a tool to simulate all necessary phenomena on the built CDEGS model o f the grounding system in IV A T’s laboratory. In particular, the ground potential rise, touch voltages, and step voltages plots are the main outputs generated. Six lightning scenarious catergorized into low, medium and hight levels are applied on the proposed grounding system to assess for the IVAT’s earthing structure safety. The IEEE 80-2000 standard is used to calculate the maximum allowable limits for surface potentials and employed as set point. Obtained results were compared to the safety lim it of the standard and proved safe only for the low level when no protective layer is in use. However, the system was completely safe and m et the standard’s limits for low, medium and high levels of lightning strikes when a protective layer is in place

Design and Simulation of a Low Frequency Electrostatic Comb-drive Energy Harvester Using 0.35μm CMOS Technology

This project is to design, model and simulate an electrostatic comb-drive energy harvester. The device harvests the vibration energy from outside source and converts it into electric energy to supply wireless node sensors. Simulation is conducted using the CoventorWare software to simulate and optimize the device. CoventorWare simulation result has obtained a resonant frequency of 5 KHz

Linear Strain Triangle Mathematics: Stiffness, Stress and Consistent Load Vector

Typically, linear strain triangle LST is widely used for elastic analysis not only due to its ease but also due to the good results it can lead to over the traditional constant strain triangle CST. In plane elastic analysis of two combined materials the LST is quite reliable and trust worthy in terms of stress results for the same element size, LST is very useful in modelling combined materials thus believed to be efficient and can easily take into consideration, self-weight of used materials, strains due to causes other than loading; such as moisture, temperature, creep and shrinkage are easily incorporated. A mathematical formulation of stiffness matrix, stress and the more rarely dealt with consistent load vector for loads distributed on element edge are proved and highlighted for young engineers who mostly dealing with readily used FE codes, the formula proved for LST element load vector is further extended and thus a consisted load vector for conical axe-symmetric shell element is introduced

Calculating Environmental Design Loads for Floating Wind Turbine

Analysis of complicated structures usually requires; choice of the commercial software as well as good formulation of elements, and loads. The LS-DYNA3D explicit finite element dynamic analysis programme is believed to be good in performing structural analysis of a floating wind turbine and in simulating a full-scale model typical for moderate deep waters. The intended model for which loads are discussed is a middle size power rated floating 3 blades wind turbine elevated at about 50 m above main sea level a top a tripod lattice steel tower firmly resting on a moored floating concrete hull buoy, positioned on a concrete circular disk. The model is intended for use in moderately deep waters of up to 500m. The knowledge of floating offshore wind structures and important features of the LS-DYNA3D code are briefly revised. The theoretical basics for service loads experienced by the floating wind turbine are explored and the environmental loads are quantified and ready for use in the analysis