Hyperandrogenism-insulin resistance-acanthosis nigricans syndrome with PCOS and Hashimoto’s thyroiditis: case report

Female hyperandrogenism is a frequent motive of consultation. It is revealed by hirsutism, acne or seborrhea, and disorders in menstruation cycle combined or not with virilisation signs. Several etiologies are incriminated but the hyperandrogenism-insulin resistance-acanthosis nigricans syndrome is rare. A 21-year female, having had a three-year-old secondary amenorrhea, known case of hypothyroidism since 4 years on medication. The exam revealed a patient, hypertensive with blood pressure at 170/110 mmHg with a Body Mass Index (BMI) at 40.08 (Obese Class-3, as per WHO 2004) and a waist measurement of 106cm, a severe hirsutism assessed to be 27 according to Ferriman and Gallwey scale, acanthosis nigricans behind the neck and elbows. The assessment carried out revealed testosteronemia at 1.07 ng/mL, which is more than twice the upper normal of the laboratory. Imaging studies revealed enlarged right adrenal gland, hepatomegaly with fatty infiltration of grade-1 also bilateral polycystic ovaries. The retained diagnosis is HAIR-AN syndrome with polycystic ovaries, hypertension, type-II diabetes mellitus, hypothyroidism since last 4-years and dyslipidemia and was provided with metformin 500 mg thrice daily, spironolactone 25 mg twice daily, atorvastatin 20 mg once daily, telmisartan 20 mg once daily with continuation of eltroxin 50 Mcg for hypothyroidism. To our knowledge this is the first case report of HAIR-AN syndrome in 21 year old female associated with Hashimoto’s thyroiditis, dyslipidaemia, hypertension and type-2-diabetes and this case also highlights about early diagnosis and management of HAIR-AN Syndrome with PCOS and Hashimoto’s thyroiditis  which could help prevent long-term sequalae such as cardiovascular disease and endometrial cancer and with the advent of knowledge and availability of health resources we can prevent long-term adverse effects (threefold) on health of women. This woman should be observed for these ailments in later life. 

Acoustic Diagnostics of Electrical Origin Fault Modes with Readily Available Consumer-Grade Sensors

Acoustic diagnostics, traditionally associated with mechanical fault modes, can potentially solve a wider range of monitoring applications. Typically, fault modes are induced purposefully by the researcher through physical component damage whilst the system is shutdown. This paper presents low-cost real-time fault diagnostics of a previously unreported acute electrical origin fault that manifests sporadically during system operation with no triggering intervention. A suitability study into acoustic measurements from readily available consumer-grade sensors for low-cost real-time diagnostics of audible faults, and a brief overview of the theory and configuration of the wavelet packet transform (including optimal wavelet selection methods) and empirical mode decomposition processing algorithms is also included. The example electrical origin fault studied here is an unpredictable current instability arising with the PWM-controller of a BrushLess DC motor. Experimental trials positively detect 99.9 % of the 1160 resultant high-bandwidth torque transients using acoustic measurements from a USB microphone and a smartphone. While the use of acoustic techniques for detecting emerging electrical origin faults remains largely unexplored, the techniques demonstrated here can be readily adopted for the prevention of catastrophic failure of drive and power electronic components

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Dielectric relaxation in Ba(Y1/2Nb1/2)O-3-BaTiO3 ceramics

Lead-free (1 - x)Ba(Y1/2Nb1/2)O-3-xBaTiO(3); (0 <= x <= 1) ceramics have been synthesized using solid-state reaction method and characterized by X-ray diffraction, scanning electron microscopy, dielectric and impedance studies. The crystal-structure of the compounds is found to be cubic with the space group Pm3m(221) except for BaTiO3 for which it is tetragonal (P4/mmm). Complex impedance spectroscopy analysis indicated the presence of non-Debye type dielectric relaxation in Ba(Y1/2Nb1/2)O-3-BaTiO3 system. Compound 0.25Ba(Y1/2Nb1/2)O-3-0.75BaTiO(3) exhibited a low value of temperature coefficient of capacitance (<+/- 8 %) in the working temperature range (up to + 100 degrees C), room temperature dielectric constant equal to 295 and low loss tangent (0.039) which meets the specifications for "Z5F" of Class I dielectrics of Electronic Industries Association. Hence, this composition might be a suitable candidate for capacitor applications. Ac conductivity and electric modulus studies supported the hopping type of conduction in the system and frequency dependent ac conductivity data obeyed Jonscher's power law

Electrical properties of BaY(0.5)Nb(0.5)O(3) ceramic: Impedance spectroscopy analysis

Lead-free perovskite BaY(0.5)Nb(0.5)O(3) was prepared by conventional ceramic technique at 1375 degrees C/7 h in air atmosphere. The crystal symmetry, space group and unit cell dimensions were derived from the experimental results using FullProf software. XRD analysis of the compound indicated the formation of a single-phase cubic structure with the space group Pm (3) over barm. EDAX, X-ray mapping and SEM studies were carried to study the quality and purity of the compound. Complex impedance analyses suggested the dielectric relaxation to be of non-Debye type. To find a correlation between the response of the real system and idealized model circuit composed of discrete electrical components, the model fittings were presented using the impedance data. Electric modulus studies supported the hopping type of conduction in BaY(0.5)Nb(0.5)O(3). The correlated barrier hopping model was employed to successfully explain the mechanism of charge transport in BaY(0.5)Nb(0.5)O(3). The ac conductivity data were used to evaluate the density of states at Fermi level, minimum hopping length and apparent activation energy of the compound.

Ancient schwannoma of the orbit

The ancient schwannoma is a rare variant of a neurilemoma with a course typical of a slow-growing benign neoplasm. Histologically, it can be confused with a malignant mesenchymal tumor because of increased cellularity, nuclear pleomorphism, and hyperchromatism. Despite the degree of nuclear atypia, mitotic figures are absent. We describe the clinical and histopathologic features of an ancient schwannoma of the orbit. A need for early removal of such tumors is recommended to prevent complications

Disruption of leptin receptor expression in the pancreas directly affects β cell growth and function in mice

Obesity is characterized by hyperinsulinemia, hyperleptinemia, and an increase in islet volume. While the mechanisms that hasten the onset of diabetes in obese individuals are not known, it is possible that the adipose-derived hormone leptin plays a role. In addition to its central actions, leptin exerts biological effects by acting in peripheral tissues including the endocrine pancreas. To explore the impact of disrupting leptin signaling in the pancreas on β cell growth and/or function, we created pancreas-specific leptin receptor (ObR) KOs using mice expressing Cre recombinase under the control of the pancreatic and duodenal homeobox 1 (Pdx1) promoter. The KOs exhibited improved glucose tolerance due to enhanced early-phase insulin secretion, and a greater β cell mass secondary to increased β cell size and enhanced expression and phosphorylation of p70S6K. Similar effects on p70S6K were observed in MIN6 β cells with knockdown of the ObR gene, suggesting crosstalk between leptin and insulin signaling pathways. Surprisingly, challenging the KOs with a high-fat diet led to attenuated acute insulin secretory response to glucose, poor compensatory islet growth, and glucose intolerance. Together, these data provide direct genetic evidence, from a unique mouse model lacking ObRs only in the pancreas, for a critical role for leptin signaling in islet biology and suggest that altered leptin action in islets is one factor that contributes to obesity-associated diabetes