Reproductive outcome of a patient with congenital adrenal hyperplasia: case report

Congenital Adrenal Hyperplasia are a group of inherited autosomal recessive enzymatic defects of adrenal steroid biosynthesis. Low pregnancy rate has been reported in women with CAH. Several factors have been suggested to contribute to this subfertility such as androgen excess, adrenal progesterone hyper secretion, consequences of genital reconstructive surgery, secondary PCOS and psychosexual factors. In contrast to this subfertility, pregnancies are normal and uneventful. During pregnancy, maternal & fetal problems are confined to these deficiencies. Adequate glucocorticoid therapy and improvement of surgical and psychological management could contribute to optimize fertility in CAH. The interposition of the placenta on the HPA axis & other endocrine changes during pregnancy impact considerably on the clinical evaluation of CAH. A 21 years old Primigravida presented to us at 13 weeks of gestation with history of CAH on treatment and vaginoplasty done in the childhood. Endocrinologist opinion was taken, and steroids continued. Advised to meet genetist and follow up for prenatal testing. But patient denied. Antenatal period was uneventful. Patient underwent Emergency LSCS in view of CPD in labour at 36+6 weeks of gestation. Pre-op stress dose of steroid given. A girl baby of birth weight 2.13 kg was born with good Apgar scores. Perioperative period uneventful. Preconception health, including hormonal, psychosexual and anatomical barriers to fertility should be addressed early in women with CAH. This review provides fertility outcome and pregnancy issues of a woman with CAH

Peri conceptional association of the triad of hyperhomocsteinemia, hypothyroidism and impaired carbohydrate metabolism with recurrent pregnancy loss

Background: Recurrent pregnancy loss is a cause of great concern to the affected couple as well as the treating physician. We evaluated the periconceptional association of the triad of hyperhomocystienemia, hypothyroidism, and impaired carbohydrate metabolism with RPL and to identify the potential risk factors for RPL which are probably nutritional.Methods: Seven hundred ninety-six consecutive pregnancies with two or more abortions referring to our Infertility clinic were selected to be studied in a descriptive, prospective observational study in 2012-2014. All the pregnant women were subjected to routine blood tests/ examination/ imaging as per hospital protocols. All underwent TSH, FT4, GTT 75 gm (fasting and 2 h postprandial) as per routine antenatal workup. Additionally, fasting plasma homocysteine, antinuclear antibody, anti phospholipid antibody, anti- thyroid peroxidase antibody tests were performed for patients with RPL. All the patients were studied for the triad of hypothyroidism, hyperhomocysteinemia and impaired carbohydrate metabolism.Results: The incidence of RPL was found to be 5.65 %. Majority of women (51.1%) were in the age group 30-34 years. Majority of the women (55.6%) had 2 previous abortions. Majority of women (57.7%) had conceived normally. Majority of women (46.7%) had BMI<25. PCOS was reported in 28.9% women. HHcy, hypothyroidism and impaired carbohydrate metabolism was found in 78%, 73% and 73% women, respectively. The presence of two factors was reported in 60 to 65% women. 56% women reported the presence of the triad. About 7% of the patients underwent repeat abortion in second trimester of which 66.6% had the association of triad.Conclusions: Investigating these three factors in patients with RPL would help in early recognition, monitoring, and aggressive surveillance, which will help prevent obstetric complications. Simple nutritional correction may allow for better maternal and fetal programming and appropriate risk modulation

KNOWLEDGE ATTITUDE AND PRACTICE TOWARD COVID-19 DISEASE AMONG VARIOUS PROFESSIONALS: A CROSS-SECTIONAL ONLINE SURVEY

Objectives: This study aims to assess the knowledge, attitude, and practice associated with COVID-19 disease by undertaking a web-based online survey. Methods: A cross-sectional survey was conducted all over India during the initial phase of COVID-19 hit between March 19, 2020, and March 29, 2020. Anyone aged 18 years and above using social media were included in the study. The questionnaire had a section on sociodemography which had questions regarding age, gender, marital status, and occupation. This was followed by questions on knowledge, attitude, and practice regarding the COVID-19 pandemic. The knowledge scores were summarized as median with interquartile range as the data followed a non-normal distribution. Attitude and practice questions were summarized individually as proportions and its association with socio-demographic variables was established using Chi-square test. The statistical significance was set at p&lt;0.05. Results: Occupational groups, marital status, and age group had significant difference between the groups with at least one of the practices with p&lt;0.05. Conclusion: Since the study provides enhancing effect of knowledge toward protective behaviors, the awareness raising activities and health education through mass media and campaigns, this should urgently be conducted focusing on effectiveness of hand washing, cough etiquette, social distancing, and responsibility to inform suspected cases to local health authority to prevent COVID-19

Comparison of effects of benidipine and amlodipine on clinical and biochemical parameters in hypertensive patients: an observational study

Background: Hypertension is a widespread public health problem and a major risk factor for cardiovascular disease. Amlodipine, a calcium channel blocker, dilates arterioles by blocking L-type calcium channels. Benidipine inhibits L, N, and T type calcium channels. We compared the efficacy of Amlodipine and benidipine on blood pressure, pulse rate, proteinuria and lipid profile in hypertensive patients.Methods: The study was an observational, prospective, open label comparison. Eligible hypertensives were given either amlodipine (5mg/d) or benidipine (4mg/d). Clinical features and laboratory parameters were recorded initially and after 3 months. Adverse events were recorded with the help of a questionnaire. Compliance was assessed by return pill count.Results: Out of 35 patients, recruited for study, 16 received amlodipine and 17 were treated with benidipine and two were lost during follow up. Both the groups were well matched in terms of age, body weight, clinical findings and laboratory values. Both the drugs significantly (P <0.05) reduced systolic (142±16 to 138±15 vs.148±16 to 134±14mmHg) and diastolic blood pressure (81±9 to 79±7). In the Amlodipine group the pulse rate after treatment tended to be higher than before (70±9 to 72±10bpm). In the Benidipine group there was decrease in pulse-rate after treatment (69±9 to 67±9). Unlike Amlodipine, Benidipine significantly (P<0.05) decreased urinary protein excretion (1.0±1.2 to 1.1±1.4 vs. 1.4±2.5 to 1.1±1.7g/g-Cr) and serum triglycerides (125±25 to 120±23 vs 130±26 to 115±21mg/dl).Conclusions: In this study, amlodipine and benidipine were found to be be equally effective anti-hypertensive in patients with stage 1 hypertension. However, there was significant reduction in proteinuria and serum triglycerides in Benidipine group as compared to Amlodipine group. Benidipine may be a better alternative to existing calcium channel blockers

DETECTION OF MALICIOUS PACKET DROPPING IN WIRELESS AD HOC NETWORKS BASED ON PRIVACY-PRESERVING PUBLIC

Security is one of the most important issues that have attracted a lot of research and development effort in past few years. In multi-hop wireless ad hoc network link error and malicious packet dropping are two sources for packet losses. Whether the losses are caused by link errors only, or by the combined effect of link errors and malicious drop are to be identified, can be known by observing a sequence of packet losses in the network. But in the insider-attack case, whereby malicious nodes that are part of the route exploit their knowledge of the communication context to selectively drop a small amount of packets critical to the network performance. Conventional algorithms that are based on detecting the packet loss rate cannot achieve satisfactory detection accuracy because the packet dropping rate in this case is comparable to the channel error rate. Hence to improve the detection accuracy, the correlations between lost packets is identified. The technique called Homomorphism linear authenticator (HLA) based public auditing architecture is developed that allows the detector to verify the truthfulness of the packet loss information reported by nodes. This technique provides privacy preserving, collusion proof, and incurs low communication and storage overheads. A packet-block based mechanism is also proposed, to reduce the computation overhead of the baseline scheme, which allows one to trade detection accuracy for lower computation complexit

Efficient allelic-drive in Drosophila.

Gene-drive systems developed in several organisms result in super-Mendelian inheritance of transgenic insertions. Here, we generalize this "active genetic" approach to preferentially transmit allelic variants (allelic-drive) resulting from only a single or a few nucleotide alterations. We test two configurations for allelic-drive: one, copy-cutting, in which a non-preferred allele is selectively targeted for Cas9/guide RNA (gRNA) cleavage, and a more general approach, copy-grafting, that permits selective inheritance of a desired allele located in close proximity to the gRNA cut site. We also characterize a phenomenon we refer to as lethal-mosaicism that dominantly eliminates NHEJ-induced mutations and favors inheritance of functional cleavage-resistant alleles. These two efficient allelic-drive methods, enhanced by lethal mosaicism and a trans-generational drive process we refer to as "shadow-drive", have broad practical applications in improving health and agriculture and greatly extend the active genetics toolbox