bluuebunny/crossref_metadata_2025 huggingface dataset:
PMON33 Non-Syndromic SRY Negative 46 XX Testicular Disorder of Sex Development (DSD): A Rare Cause of Infertility
Authors: Riaz Aiman , Barua Nabonita , Gordner Chelsea
Published: November 2022

Introduction

Male infertility can be categorized as endocrine and systemic disorders, primary testicular defects in spermatogenesis, sperm transport disorders and idiopathic male infertility. Chromosomal abnormalities are one of the primary testicular defects. The overall incidence of chromosome abnormalities in infertile men is estimated to be around 5.8%. XX male is a rare sex chromosomal disorder in infertile men. We present case of a young patient with infertility, azoospermia, hypergonadotropic hypogonadism and classical (46, XX) karyotype with negative FISH and SRY gene. Case report: 28-Year-old gentleman was referred to adult endocrinology clinic as part of work up for infertility. Initial work up included 2 semen analyses which were consistent with azoospermia. Examination revealed height 180 cm, weight 77 kg, a body mass index 24 kg/m2, normal phenotypic male without gynecomastia and had normal male pattern hair distribution. Genital examination showed normal male phallus without hypospadias, a hypoplastic scrotum, bilateral firm testes, with no varicocele or hydrocele. Labs were suggestive of compensated primary hypogonadism (FSH 47.9 mIU/ml, LH 20.4 mIU/ml, total testosterone 397.9 ng/dl by LC/MS, free testosterone 15.76 ng/dl by equilibrium dialysis, Inhibin B < 10 pg/ml, and anti-Mullerian hormone 0.390 ng/ml. Given normal testosterone levels, he was not started on testosterone replacement. Karyotype analysis revealed 46 XX and FISH was negative for SRY gene. CT imaging of abdomen and pelvis did not reveal any Mullerian structures, prostrate and seminal vesicles reported as normal. Patient met with a Urologist and was informed that testicular sperm extraction will not be a possibility for him. Patient had a detailed consultation with a geneticist for genetic and family counseling. Chromosome microarray analysis was obtained and was normal. Invitae Disorders of sex development (DSD) panel obtained for genetic sequencing of 53 genes including SOX-9, DHH, WNT4, WT1, was found to be non-diagnostic.

Conclusion and Discussion

SRY negative 46 XX male is a DSD and a rare genetic cause of male factor infertility, with a discrepancy between genotype and phenotypic sex. In the case presented, genetic work up for potential etiologies has been unrevealing. Further studies are needed to identify the genetic causes of the SRY negative 46 XX male phenotype. Physicians involved in care of these patients should orient with clinical management and prognosis. For Classical 46 XX Males seeking fertility, the current options include invitro-fertilization with donor sperm or adoption only. Testosterone replacement should be considered to correct hypogonadism for physical and sexual well-being. Genetic consultation should be sought in all these cases.

Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
RF30 | PSAT136 Gitelman Syndrome and Primary Hyperparathyroidism, a Case Report
Authors: Alnahas Zeinab , Markov Marko , Horani Mohamad H
Published: November 2022

Introduction

Gitelman syndrome, also known as familial hypokalemia-hypomagnesemia, is a rare autosomal recessive disorder that impairs the sodium chloride cotransporter (NCC) and magnesium channels in the renal distal convoluted tubule, causing salt-losing tubulopathy. It is characterized by hypokalemia, hypomagnesemia, hypocalciuria, and secondary hyperaldosteronism. Although hypocalciuria is a distinctive characteristic of Gitelman syndrome, it seldom can cause any change in the total plasma calcium level. Thus, the occurrence of hypercalcemia would need further investigation.

Case presentation

We reported a case of a 36-year-old normotensive man with a past medical history significant for bipolar depression disorder and a history of chronic atrial fibrillation secondary to chronic hypokalemia, hypomagnesemia, and mild hypercalcemia. He was diagnosed with Gitelman syndrome. However, he was noncompliant with spironolactone, potassium, and magnesium supplementation. He suffered a motor vehicle accident, and on presentation to the emergency room, he was found with a serum potassium of 2.5 mEq/L (reference value 3.5-5.1), serum magnesium of 0.8 mEq/L (reference value 1.6-2.6), total serum calcium of 11.3 mEq/L (reference value 8.4-10.2), and serum phosphorus of 2.7 (reference value 2.5-4.5 mg/dl). Random urine potassium was 122.1 mEq/L, and intact parathyroid hormone was 144 pg/mL (reference value 14-65). His CT neck scan showed a 1.5 cm nodule inferior to the right thyroid lobe pole consistent with an inferior parathyroid adenoma. However, a parathyroid radionuclide scan using technetium-99m MIBI showed no radiopharmaceutical localization for parathyroid adenoma.

Conclusion

Hypercalcemia is extremely rare in Gitelman syndrome, offset by the action of concomitant hypomagnesemia. Our case shows the importance of investigating other causes of hypercalcemia, such as primary hyperparathyroidism in patients with Gitelman syndrome. To our knowledge, Gitelman syndrome and primary hyperparathyroidism are an extremely rare association that is present in our case.

Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Monday, June 13, 2022 12:48 p.m. - 12:53 p.m.
LBMON137 Don't Be Fooled By Normotension Pheo Could Be The Potential
Authors: Idriss Setana , Shaikhoun Mazin , Ahmad Rehan
Published: November 2022

Introduction

Sustained or proximal hypertension is the most common sign of pheochromocytoma, but approximately 5-15% of pts present with normal blood pressure. We report a case of a patient incidentally found to have a catecholamines secreting adrenal tumor, but was normotensive on admission.

Case

30-year-old morbidly obese woman incidentally found to have a 4.8 cm left adrenal gland mass while being worked up for sepsis secondary to atypical pneumonia. Initially, the patient presented with dyspnea, chest pain, palpitation, nausea, and vomiting. Her past medical history is significant for preeclampsia, 200 lb wt loss in 1 year, NSTMI a few months prior to admission discharged on dual antiplatelet and metoprolol which she couldn't tolerate due to hypotensive episodes. On arrival to the ED the patient was afebrile, normotensive SBP 90-110 DBP 57-70 mmHg, HR 86 BPM, RR 20, saturating 98% on room air. Her laboratory workup was significant for leukocytosis, elevated D-dimer, hyperkalemia 5.9 mmol/L, mildly elevated liver enzymes, and mildly elevated troponin. MRI abdomen 4.8×4.4×5. 0 cm complex enhancing mass with eccentric necrosis and/or fibrosis arising from the left adrenal gland. Ur Normetanephrine 5867 mcg/24h, Ur Metanephrine 3017 Mcg/24hr, urine dopamine and norepinephrine were within normal limits. Serum Metanephrine 2.64 nmol/L normetanephrine 13.50 nmol/L, aldosterone, renin, and cortisol levels were normal.

Discussion

Sustained or proximal hypertension is the most common sign of pheochromocytoma, but approximately 5-15% of pts present with normal blood pressure. Other signs and symptoms that may occur include orthostatic hypotension, visual blurring, papilledema, weight loss, polyuria, polydipsia, constipation, increased ESR, insulin resistance, hyperglycemia, leukocytosis, psychiatric disorders, and, rarely, secondary erythrocytosis due to overproduction of erythropoietin. The beta-adrenergic blocker should never be started first because a blockade of vasodilatory peripheral beta-adrenergic receptors with unopposed alpha-adrenergic receptor stimulation can lead to a further elevation in blood pressure. Our patient was normotensive throughout the hospitalization, and before admission was on metoprolol for NSTMI, however, she was unable to tolerate it due to hypotensive episodes.

Conclusion

Most patients with pheochromocytoma present with hypertension, however, few cases could present with normotension or even hypotension.

Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
LBMON139 A Case of Adipsic Diabetes Insipidus In Patient With Third Ventricular Tumor And Right Frontal Craniotomy.
Authors: Thambuluru Sirisha Reddy , Caraccio Donald
Published: November 2022

Introduction

Adipsic diabetes insipidus (ADI) is a rare hypothalamic disorder consisting of central diabetes insipidus (CDI) and loss of thirst. In hyperosmolar state, signals from osmosensors integrate in the central thirst center resulting in stimulatory signals between subfornical-oragan, organum-vasculosm of lamina terminalis and median preoptic nucleus increasing thirst and release of vasopressin. Disruption in this mechanism leads to adipsia.

Case presentation

27 yr old male with history of prediabetes, 4.6cm third ventricular epidermoid cyst s/p endoscopic ventriculosmoy, hypogonadotropic hypogonadism, central hypothyroidism, and CDI underwent right frontal craniotomy for residual third ventricular cyst. Developed worsening DI, new onset hyperglycemia, and secondary adrenal insufficiency. Discharged with oral DDAVP 300mcg oral twice daily for CDI. 1 week later presented to ED with weakness. BP 132/112, HR 139, RR 38, SPO2 94%. Labs significant for corrected sodium of 172 (136-145mmol/L), glucose 699 (70-99mg/dl), calcium 11.8 (8.3-10.6 mg/dl). Discharged after 3 weeks with intranasal DDAVP 10mcg twice daily (BID). Again presented 1 week after for weakness. Vitals BP 105/64, HR 134, F 37.3 C, RR 31, SPO2 96%. Corrected sodium of 174 (136-145mmol/L) and glucose 708 (70-99mg/dl). Denied missing medication. Reported no increased water intake. Patient was diagnosed with adipsic DI based on subjective lack of thirst during period of significant hyperosmolar hypernatremia state. Overtime switched to 10mcg BID intranasal DDAVP and started on 4L fixed water intake. Had 5L urine output daily. Sodium levels ranged from 132-137. Discharged on intranasal DDAVP 10mcg AM/20mcg PM, 4L daily fixed water intake, and twice weekly sodium checks as outpatient. Goal sodium 135-140. DDAVP adjusted after sodium rose to 145. At recent clinic visit continued fixed 4L fluid intake with extra 500-1L intake for increased sweating/exercise, and sodium level 134. A1c 10% on insulin, and weight gain of 70lbs since surgery (8mon piror), BMI of 45. Started on GLP-1RA and sleep study. Learning points: Less than 100 cases of ADI reported worldwide and associated with increased morbidity/mortality1. This patient likely developed ADI due to disruption of central thirst center from epidermoid cyst and trans frontal craniotomy. We must be hypervigilant for ADI in patients with third ventricular tumors who undergo frontal craniotomy. Management is complex and requires patients are followed closely with weekly labs, either fixed water intake or fixed DDAVP dose and adjustment depending on labs. Important to screen these patients for obesity and sleep apnea given increased likelihood of hypothalamic dysfunction1. Reference: Cuesta, M., Hannon, M. J. & Thompson, C. J. Adipsic diabetes insipidus in adult patients. Pituitary 20, 372-380 (2017). https://doi.org/10.1007/s11102-016-0784-4

Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
LBODP072 Squamous Cell Carcinoma Or Fungal Infection? An Unusual Presentation Of Anterior Hypopituitarism
Authors: Kapoor Ashutosh , Shaikh Sheeba , Lewis Alexander
Published: November 2022

Introduction

Intracranial squamous cell carcinomas are rare tumours with a poor prognosis. Lack of specific imaging characteristics mandates a high index of clinical suspicion and ultimately histopathological confirmation. Chronic invasive fungal rhinosinusitis (CIFRS) is often difficult to distinguish from Sino nasal squamous cell carcinomas (SNSCC) in clinical practice. Our case draws attention to the fact that biopsy results are necessary in discriminating between the two entities, due to the diagnostic conundrum in context of Anterior Hypopituitarism. Case detailsWe report a case of 78-year-old lady who presented with a 3-month history of increasing headache, lethargy and confusion. There was no change in urinary habit. On examination she had right sided ptosis and restricted eye movements with a reported 4-week duration. Primary care physicians referred her for ophthalmic assessment. Past medical history was significant for absent vision in the affected eye due to Ischaemic optic neuropathy since 2018. A CT Angiogram was organised which revealed a large soft tissue mass that could not be differentiated from the optic chiasma. Differentials included chondrosarcoma, chordoma, invasive pituitary macroadenoma and skull base Plasmacytoma. Subsequent MRI imaging suggested appearances could be consistent with aggressive fungal sinusitis. Endocrine investigations showed partial anterior hypopituitarism. ManagementEmpiric treatment was started with Intravenous anti-fungals and steroids, alongside appropriate pituitary hormone replacement. Her case was discussed in the Skull Base Multi-disciplinary Team (MDT) meeting. She was then transferred to the regional tertiary centre for surgical intervention, where she underwent debridement of the Ethmoid sinus, Sphenoid Sinus and Anterior base of skull for presumed chronic invasive fungal sinusitis. Post-operative imaging displayed satisfactory debulking of the central skull base tumour. Histopathology from sphenoid sinus reported invasive squamous cell carcinoma. The post-operative imaging and histopathology results were discussed in the regional MDT and considering the advanced stage a decision was made for best supportive care. Within 2 months neurological symptoms progressed and further imaging demonstrated radiological tumour progression.

Discussion

Sinonasal Squamous cell carcinoma (SNSCC) is a rare tumour and thus pose difficulty in detection. Presentation usually occurs at an advanced stage since initial symptoms are nonspecific and the tumour remains indolent for many months to years. There is limited evidence in relation to detection and follow up of these cases. Clinical presentation and radiological appearance can be varied. This case highlights the need for histological confirmation of the diagnosis to guide appropriate treatment pathways and ensure compassionate, appropriate care.

Presentation: No date and time listed
LBODP077 The Therapeutic Potential Of Targeting Histone Deacetylase For Pituitary Neuroendocrine Tumors By High-throughout Drug Screening
Authors: Wu Zhe Bao , Cheng Yijun , Xie Jing , Xue Li , Dai Yuting
Published: November 2022

Background

A growing awareness regarding all molecular mechanisms involved in both tumor shrinkage and hormonal control might allow for medical treatment of pituitary neuroendocrine tumors (PitNETs), especially macroadenomas, rather than surgery. However, there are still no effectively therapeutic targets and corresponding drugs for all subtypes of PitNETs.

Methods

To identify druggable cell-intrinsic vulnerabilities and correspondingly promising therapeutic agents, we examined 3 PitNETs cell lines and 21 PitNETs patient-derived primary cell cultures in sequential quantitative high-throughput screens (HTS) of 2149 FDA-approved and bio-active targeted drugs. Furthermore, we verified the most effective drug which targeted the class of mechanistic vulnerabilities, histone deacetylase (HDAC) in vitro and in vivo PitNETs models. Further RNA sequencing was employed to reveal underlying molecular mechanisms following treatment with the most effective HDAC inhibitor, panobinostat.

Results

The HTS effort generated a total of 55296 single-agent dose responses which were enriched among multiple inhibitors for relevant PitNETs oncogenic targets, including HDAC, Akt/mTOR, proteasome, mitogenactivated protein kinase (MEK), and phosphoinositide-3-kinase (PI3K). Inhibitors from these mechanistic classes demonstrated a relatively wide potency-range, with HDAC inhibitors being, on average, the most potent drug class. Further in vitro and In vivo testing in PitNETs models validated HDACi, especially panobinostat as a promising therapeutic approach. Transcriptional surveys revealed substantial alterations to the oxidative redox mediated by the Akt/mTOR1/4EBP1/Nuclear factor-E2-related factor 2 (Nrf2) antioxidant signaling pathway following treatment with panobinostat.

Conclusion

The current study revealed a class of newfound anti-tumor drugs, HDACi based on the HTS technology, which may be potential drugs for the treatment of PitNETs.

Presentation: No date and time listed
Thyroglobulin Assay Interferences: Clinical Usefulness of Mass-Spectrometry Methods
Authors: Barbesino Giuseppe , Algeciras-Schimnich Alicia , Bornhorst Joshua
Published: November 2022

Context

Thyroglobulin autoantibodies (TgAbs) affect thyroglobulin immunometric assays (TgIMAs), causing falsely low results. Conversely, heterophilic antibodies (HAs) may cause falsely elevated results. Thyroglobulin (Tg) measurements by mass spectrometry (MS) resist antibody interference. The most effective use of TgIMA/TgMS in the evaluation of Tg remains unclear.

Objective

The objective of this work was to study the usefulness of TgMS vs TgIMA in the presence of Tg measurement interference by HA and TgAb.

Methods

In 163 thyroid cancer patients, Tg was postoperatively measured by TgIMA and TgMS. When TgIMA was elevated and TgMS undetectable, HA was assessed by serial dilution and pretreatment with HA blocking reagent. TgIMA and TgMS were compared in TgAb-positive patients with well-characterized clinical status.

Results

6 out of 45 cases with TgIMA >1 ng/mL had undetectable TgMS. HA interference was confirmed by serial dilution and HA blocking reagent addition. In TgAb-positive cases, TgIMA and TgMS were highly correlated (R2 = 0.86). In patients with structural disease and TgAb, TgIMA and TgMS were detectable in 6/19 patients, and 9/19 cases, respectively. The TgMS concentration range in the 3 discrepant cases ranged from 0.5 to 2.0 ng/mL. Hence, the presence of TgAb was associated with inappropriately reduced Tg concentrations with both TgIMA and TgMS.

Conclusion

HA cause falsely elevated TgIMA with undetectable TgMS with significant frequency. TgMS can be used to rule out HA interference. Albeit resistant to TgAb in vitro, TgMS detects little Tg in patients with TgAb and structural disease. Hence, TgAb may reduce Tg concentrations in vivo. The implication is that no assay design may be able to overcome this problem. TgMS may not detect structural disease in TgAb-positive patients.
Case Report: Caecal volvulus management from diagnosis to treatment in a young patient
Authors: Abbassi Imed , Triki Wissem , Trigui Racem , Ben Salah Ramy , Itaimi Ahmed , Ayed Karim , Sebri Hajer , Baraket Oussema , Bouchoucha Sami
Published: November 2022

Caecal volvulus (CV) is a rare cause of intestinal obstruction, defined by an axial torsion of the caecum, ascending colon, and terminal ileum around the mesenteric vascular pedicles, leading to ischemia and bowel necrosis.

A 20-year-old woman, with no significant medical history, was admitted for generalized abdominal pain evolving for three days, along with constipation and abdominal distension, but with no vomiting. Physical examination showed a generalized abdominal tenderness with no rigidity or rebound tenderness, associated with abdominal distension and tympanic upon percussion. Laboratory findings were within normal limits.

An abdominal computed tomography scan revealed distension of a loop of the large bowel with its long axis extending from the right lower quadrant to the epigastrium or left upper quadrant. Colonic haustral pattern was absent. An abdominal computed tomography scan showed a rounded focal collection of air-distended bowel with haustral creases in the upper left quadrant. In addition, spiraled loops of the collapsed cecum (giving a whirl sign) were noted, along with low-attenuating fatty mesentery from the twisted bowel.

The patient underwent an emergency laparotomy and caecectomy using GEA 80 charges. The patient had no complaints post-operation.

CV is a rare cause of bowel obstruction, mainly caused by an exceedingly mobile caecum. Despite its rareness, CV represents the second most common cause of large bowel volvulus, behind sigmoid volvulus. For acute obstruction by CV, it is hard to differentiate it clinically from obstruction of the small bowel; therefore, radiological exams are needed. Surgery is the gold standard treatment for CV.

We report a rare case of CV to highlight the rarity of this pathology, specify its diagnostic and therapeutic means, and its clinical and biological evolution.
Psychosocial- and disclosure-related challenges among HIV-serodiscordant couples: an interpretative phenomenological analysis study
Authors: Lelaka Constance Matshidiso , Tshivhase Livhuwani , Moyo Idah , Ndou Nthomeni Dorah , Mavhandu-Mudzusi Azwihangwizi Hellen
Published: November 2022

Background: Serodiscordant refers to a couple where one has human immunodeficiency virus (HIV), and the other partner is HIV negative. HIV-serodiscordancy often results in diverse psychological and emotional challenges. Evidence demonstrates that the dynamics of living in an HIV-serodiscordant relationship are often stressful. This study explored the psychosocial- and disclosure-related challenges faced by couples in HIV-serodiscordant relationships in South Africa.

Methods: An interpretative phenomenological analysis (IPA) design was followed. A total of 13 HIV-serodiscordant partners were purposively sampled. Data were collected through individual face-to-face interviews and analysed using the IPA framework.

Results: The findings indicated that HIV-serodiscordant couples experienced diverse psychosocial challenges such as shock, sadness, hurt, denial and disbelief. Participants also experienced challenges such as selective disclosure and fear of further disclosure.

Conclusions: The findings have implications for public health and are critical in programming and designing couple-based HIV care interventions. Couples in HIV-serodiscordant relationships would benefit more from differentiated, client-centred psychosocial support. To contribute to the HIV epidemic control and reduction of new HIV infections, specific interventions such as couples counselling, disclosure counselling, support groups, health education and safer conception risk reduction strategies need to be implemented.
Early detection of biliary atresia in primary health care: still a problem
Authors: Setyoboedi Bagus , Prihaningtyas Rendi Aji , Utomo Martono Tri , Arief Sjamsul
Published: November 2022

Background: Biliary atresia is the leading cause of liver transplantation in children. Early detection of biliary atresia is crucial for diagnosis and disease progression. The purpose of this study was to analyze knowledge about biliary atresia and the effectiveness of health education in increasing the knowledge of primary health care providers.

Methods:  A quasi-experimental study with pretest and posttest designs was carried out in Sidoarjo, East Java using a self-administered questionnaire. The intervention using health education was delivered by pediatrician and consultant of pediatric gastro hepatology. There were 13 questions on the questionnaire, question numbers 1 to 6 were about normal and abnormal neonatal jaundice, question numbers 7 to 13 were about biliary atresia.

Results: A total of 252 participants were involved, the mean age of the participants was 40.7 ± 9.4 years old. Most of the participants were midwives (61.9%) and 77.8% of participants have years of service in primary health care > 5 years.  A total of 40.5% participants stated that newborns may have physiological jaundice, which was characterized by icteric sclera, pale stools, and dark urine. A total of 27,4% and 24,2% participants said that all jaundice in newborn will always improve on their own and newborn with prolonged jaundice does not need further examination, respectively. There was an increase in the median value in the pretest and posttest knowledge scores

 after interventional health education (p < 0,05).

Conclusions: The primary health care provider understands about biliary atresia, however, the initial knowledge about early detection of biliary atresia is not evenly distributed in all primary health care providers. These findings suggest that improving knowledge to early detection of biliary atresia is needed. Health education can be used effectively in increasing knowledge about biliary atresia.
Intensive care nurses' knowledge of enteral nutrition at public hospitals in Sana'a, Yemen: a cross-sectional survey
Authors: Ali Hussein Al-Qalah Talal , Alrubaiee Gamil Ghaleb
Published: November 2022

Background: Nurses have a pivotal role in initiating and managing enteral nutrition (EN) and monitoring any potential complications. Yet, it is unclear whether Yemeni nurses have adequate knowledge to deliver and manage enteral nutrition safely. Therefore, the aim of this study was to assess the level of ICU nurses’ knowledge regarding the care of EN.

Methods: A descriptive cross-sectional study was conducted from February 2019 to March 2019. A probability sampling method was used to recruit 174 nurses from four public hospitals in the capital city of Yemen. A self-administered 17-item questionnaire related to ICU nurses' knowledge regarding EN intervention was used to collect the data.

Results: Based on our findings, only 10.9% of the respondents had an adequate level of knowledge about EN care, while 43.1% of them had a moderate level of knowledge, and 46.0% of them had an inadequate level of knowledge. Only 16.1% of the participants were knowledgeable of EN pre-administration care, whereas 5.80% of them were knowledgeable of EN administration care, and 9.20% were knowledgeable of EN post-administration care. There were significant associations between ICU nurses’ level of knowledge of EN care and their level of education and knowledge sources.

Conclusions: The significant gap in ICU nurses’ knowledge regarding EN care identified implies the need to upgrade and refresh of the ICU nurses' knowledge by implementing a regular training program concerning EN care.
Truthfulness of a Network Resource-Sharing Protocol
Authors: Cheng Yukun , Deng Xiaotie , Qi Qi , Yan Xiang
Published: November 2022

We consider a sharing economy over a network in which each vertex agent allocates resources to its neighbors in response to their contributions. General equilibrium theory can be applied here to solve the problem of deciding how to fairly and efficiently allocate resources among agents as resource sharing over the network can be modeled as a pure exchange economy. It is known that proportional sharing dynamics converges to a market equilibrium solution. We are particularly interested in proportional sharing dynamics as a mechanism for network resource sharing. Our focus is on the key issue in internet market design: whether an agent may manipulate its report of its own private information to gain more resources under this mechanism. This work establishes the first mathematical proof that such a practical distributed network resource-sharing protocol is truthful against the manipulative strategies of feasible weight misreporting and edge deletion applied both individually and together.

Funding: This work was supported by the National Nature Science Foundation of China [Grants 11871366, 62172012]; Beijing Outstanding Young Scientist Program [Grant BJJWZYJH012019100020098]; the Fundamental Research Funds for the Central Universities; the Research Funds of Renmin University of China [Grant 297522503709]; and the Intelligent Social Governance Platform, Major Innovation & Planning Interdisciplinary Platform for the “Double-First Class” Initiative, Renmin University of China.
DDoS – does size matter?
Authors: Stephenson Ashley
Published: November 2022

We see frequent headlines about distributed denial of service (DDoS) of ever greater volumes. But does this reflect a true image of the DDoS problem? We can look at recent history to gain some insights into this obsession with attack size.
Phytochemical and Antimicrobial Analysis of Root Extract of Aspargus Adscendens
Authors: Tripathi Rekha , Sharma Ashutosh
Published: November 2022

The aim of this study was to characterize the phytochemicals and to investigate the antimicrobial efficacy of the shade dried roots of the Asparagus adscendens. The powder roots were extracted with chloroform and after removal of solvent under reduced pressure was subjected for chromatographic separation. After column chromatography and purification five compounds i.e .hexacosanyltriacontanoate, hexatriacontanone, 2,3,5,7-tetramethoxydi hydrophenanthrene, -sitosterol and stigmasterol were characterized with the help of physical and spectral analysis(IR, 1HNMR, 13CNMR and mass). The crude extract was tested against the selected bacteria and fungi using disc diffusion method. The root extract exhibited significant antibacterial activity with maximum efficacy against E. coli (activity index 0.82 at 1000 µg/disc and 0.73 at 500 µg/disc).
Chemical Distribution, Stability and Structures of Ternary Metal Chelates in Ethylene Glycol – Water Media Involving Mercaptosuccinic Acid and Some Non-Essential Amino Acids
Authors: Swamy G. Rama , Kumar N. Vijaya , Manikandan G.
Published: November 2022

There has been focus upon the study of stability constants of amino acids with metal ions since they processes antibacterial activities. The stability constants of ternary complexes were determined by pH metric analysis in aqueous solution at 25.0 0C between ligands (Mercaprosuccinicacid (MSA), Glycine (GLY), L-Aspartic acid (ASP) and L-Asparagine (ASN)) and some transition metal ions(Co(II), Ni(II), Cu(II) and Zn(II)) in varying Ethylene glycol – water media. The "MINIQUAD75" software tool analysed the potentiometric data to create a complexation model for each system. Based on the calculated equilibrium and stability constants, the most likely binding mechanism for each ternary species was discussed. Their relative stabilities and plausible structures were also proposed.
Na+ Ion Conducting Nano-Composite Solid Polymer Electrolyte – Application to Electrochemical Cell
Authors: K Manjula K Manjula , Reddy V John
Published: November 2022

Various concentrations of Multi Walled Carbon Nanotubes (MCNT) fillers dispersed PVDF- HFP: NaClO4 nanocomposite polymer electrolytes (NPE) were prepared by solution casting technique. The dispersion of MCNT nano fillers raised the accessibility of more ions for attaining the highest conductivity. Electrical conductivity, Ohmic resistance (RΩ), Polarisation resistanace (Rp), and Warburg impedance (W) were studied using electrochemical impedance spectroscopy (EIS), which revealed ion transport mechanics in the polymer electrolytes. The best ionic conductivity is found to be 8.46 × 10-3 Scm-1 for the 7 wt.% dispersed MCNT Nanocomposite Solid Polymer electrolyte among all polymer electrolyte samples. Electrochemical cell was made by PVDF-HFP:NaClO4 : MCNT polymer electrolyte and exhibited 1.95 V open circuit voltage and 2.5 mA short circuit current, respectively.
Synthesis of Biologically Active Peptides using Newly Designed N-Vinyl Pyrrolidone Incorporated Flexible Cross linked Polystyrene
Authors: Jacob Sunil , Harry Nissy Ann , K. K. Binoj K. K. Binoj , Thomas Preethy Soosan , Mathew Janey Mary
Published: November 2022

Synthesis of NS1 and NS2 peptide fragment of hepatitis C virus polyprotein was carried out on a terpolymer- polystyrene, N-vinylpyrrolidone, 1,6-hexanediol diacrylate resin (PS-NVP-HDDA). The radical aqueous suspension polymerisation resulted in the resin, that exhibited high swelling capacity in various solvents. The peptides were synthesized step-wise by Fmoc strategy, established with amino acid analysis and purified using HPLC. The polymer's high degree of swelling might facilitate free reagent interaction with resin-bound functional sites, resulting in an increased rate of amide bond production. The peptides yield and purity obtained from new support was high when compared to Merrifield resin. These peptides synthesis depicts the application of PS-NVP-HDDA resin developed for synthesis of long chain peptides in high homogeneity and high yield.
Therapeutic Drug Naproxen Pollution Removal by the Acid Digested Carbon of Waste Leathers
Authors: K. Veeravelan K. Veeravelan , S. Arivoli S. Arivoli , Solomon J. Samu
Published: November 2022

The adsorption characteristics study on the removal of therapeutic drug naproxen on the acid digested carbon of waste leather were analysed by varying the physico-chemical conditions. Effect of particle size, adsorbent dosage, pH, temperature, initial concentration of adsorbate and contact time were analysed carefully by batch mode. The minimum particle size gives maximum number of surface area and adsorbed more, 90.89% for 0-63 micron. Acidic pH ranges were desirable for the adsorption of naproxen on this Acid digested carbon of waste Leather (ADCL). But different adsorbates preferred different acidic pH ranges of pH from 1 – 6. Above pH 6 precipitations of drugs takes place. In this case at pH 1, 96.87% of adsorption takes place. The percentage of adsorption of naproxen is directly proportional to the adsorbent dosage and contact time and inversely proportional to the initial concentration of the adsorbate were found out from this study. Order of this adsorption is pseudo second order kinetics and it belongs to the physisorption, because of no chemical bond formation between the adsorbent and adsorbate. The fruendlich and Langmuir isotherm model is fit for these studies. The thermodynamic study reveals the negative ∆Go, positive ∆Ho and ∆So values concluded that this adsorption is spontaneous, feasible and physical in nature respectively. The spectral evidence from the FT-IR, SEM and XRD are in favour of above experimental results.
Assessment of Quercetin Content in Selected Vegetables and Fruits by Conventional Extraction and High Performance Liquid Chromatography
Authors: N. Swathi N. Swathi , Venugopal N. V. S.
Published: November 2022

One of the dietary flavonoids which can be found in a variety of vegetables and fruits is Quercetin (3,3′,4,5,7-pentahydroxyflavone).Quercetin reduce infection risk and also has unique biological property which improves the physical performance. The current research work describes the extraction and characteristic of quercetin present in carrot (Daucus carota sp. sativus) and grapes (genus vitis). A liquid – solid extraction method of quercetin contained in carrot and grapes was developed, in which Quercetin is extracted from a solid mixture using a liquid solvent (methanol). Determination of Quercetin is studied by using High performance liquid chromatography. The separation study was performed on Zodiac C18, 250mmx 4.6mm, 5µm column, detection at 280nm and flow rate applied 1mL/min. The limits of detection(LOD) and quantification(LOQ) parameters were in the ranges of 0.1–0.3 and 0.3–1.0 μ g/ mL respectively. The results of carrot and grape meet the specified specification limit. The detection of the active substance in carrot and grapes using the HPLC method has the advantage of being simple, fast, and accurate and the reported method was validated.
Microwave Assisted Synthesis Of Novel 2-Pyrazolines From Furan Based Chalcones and Study their Antimicrobial Actvity
Authors: Kumbhare Santosh Laxman , Meshram Yuvraj Khushal
Published: November 2022

Nitrogen heterocyclic compounds such as2-pyrazoline showing various pharmacological activities such as antibacterial, antifungal, antioxidant, antidepressant, anti-inflammatory, anticancer, and antitubercular activities. This promotes to synthesize 2-pyrazolines by the reaction of different substituted chalcones of 2-Acetyl Furan and hydrazinehydrate in the presence alcohol. Synthesized compound was confirmed by physical data such as melting point and various spectral analysis such as FTIR, NMR spectra. Antimicrobial activity of synthesized compound was evaluated. The results indicated that some of compounds show good antibacterial and antifungal activity.
Free-space optical stealth communication based on wide-band spontaneous emission
Authors: Qi Yang , Li Jie , Wei Chengli , Wu Ben
Published: November 2022

We proposed and experimentally demonstrated a free-space optical stealth communication system that hides the stealth signal in wide-band spontaneous emission noise. Spontaneous emission light sources have been widely used for illuminations and has been recently deployed for short distance and indoor free-space optical communications, such as LiFi. Since free-space optical communication is a broadcasting network, the users’ privacy is exposed to eavesdropping attacks. In this paper, stealth communication is achieved by taking advantage of the existing properties of spontaneous emission light sources, random phase fluctuations, and protects users’ privacy in free-space communication networks. The keys to hide and recover the stealth signal are the optical delays at the transmitter and receiver. Only by matching the delay length with the pre-shared keys can the authorized receiver recover the stealth signal. Without the right key, the eavesdropper receives a constant power that is the same as illumination light sources and cannot detect the existence of the stealth signal.
Preliminary analysis of self-reported quality health indicators of patients on opioid agonist therapy at specialty and primary care clinics in Ukraine: A randomized control trial
Authors: Pashchenko Oleksandra , Bromberg Daniel J. , Dumchev Kostyantyn , LaMonaca Katherine , Pykalo Iryna , Filippovych Myroslava , Esserman Denise , Polonsky Maxim , Galvez de Leon Samy J. , Morozova Olga , Dvoriak Sergii , Altice Frederick L.
Published: November 2022

International agencies recommend integrating addiction treatment into primary care for people who inject drugs (PWID) with opioid use disorder (OUD). Empirical data supporting integration that incorporates comprehensive health outcomes, however, are not known. For this randomized controlled trial in Ukraine, adult PWID with OUD were randomized to receive opioid agonist therapy (OAT) in specialty addiction treatment clinics (SATC) or to primary care clinics (PCCs). For those randomized to PCC, they were subsequently allocated to PCCs where clinicians received pay-for-performance (P4P) incentives (PCC with P4P) or not (PCC without P4P). Participating cities had one of each of the three intervention sites to control for geographic variation. Ongoing tele-education specialty training (OAT, HIV, tuberculosis) was provided to all PCCs. While the primary outcome for the parent trial focuses on patient medical record data, this preliminary analysis focuses on assessment of self-reported achievement of nationally recommended quality health indicators (QHIs) which is summed as a composite QHI score. Secondary outcomes included specialty and primary care QHI subscores. This study occurred from 01/20/2018-11/1/2020 with 818 of 990 randomized participants having complete self-reported data for analysis. Relative to SATC (treatment as usual), the mean composite QHI score was 12.7 (95% CI: 10.1–15.3; p<0.001) percentage points higher at PCCs; similar and significantly higher scores were observed in PCCs compared to SATCs for both primary care (PCC vs SATC: 18.4 [95% CI: 14.8–22.0; p<0.001] and specialty (PCC vs SATC: 5.9 [95% CI: 2.6–9.2; p<0.001] QHI scores. Additionally, the mean composite QHI score was 4.6 (95% CI: 2.0–7.2; p<0.001) points higher in participants with long term (>3 months) experience with OAT compared to participants newly initiating OAT. In summary, PWID with OUD receive greater primary care and specialty healthcare services when receiving OAT at PCCs supported by tele-education relative to treatment as usual provided in SATCs.

Clinical trial registration: This trial was registered at clinicaltrials.gov and can be found using the following registration number: NCT04927091.
Direct estimates of absolute ventilation and estimated Mycobacterium tuberculosis transmission risk in clinics in South Africa
Authors: Beckwith Peter G. , Karat Aaron S. , Govender Indira , Deol Arminder K. , McCreesh Nicky , Kielmann Karina , Baisley Kathy , Grant Alison D. , Yates Tom A.
Published: November 2022

Healthcare facilities are important sites for the transmission of pathogens spread via bioaerosols, such as Mycobacterium tuberculosis. Natural ventilation can play an important role in reducing this transmission. We aimed to measure rates of natural ventilation in clinics in KwaZulu-Natal and Western Cape provinces, South Africa, then use these measurements to estimate Mycobacterium tuberculosis transmission risk. We measured ventilation in clinic spaces using a tracer-gas release method. In spaces where this was not possible, we estimated ventilation using data on indoor and outdoor carbon dioxide levels. Ventilation was measured i) under usual conditions and ii) with all windows and doors fully open. Under various assumptions about infectiousness and duration of exposure, measured absolute ventilation rates were related to risk of Mycobacterium tuberculosis transmission using the Wells-Riley Equation. In 2019, we obtained ventilation measurements in 33 clinical spaces in 10 clinics: 13 consultation rooms, 16 waiting areas and 4 other clinical spaces. Under usual conditions, the absolute ventilation rate was much higher in waiting rooms (median 1769 m3/hr, range 338–4815 m3/hr) than in consultation rooms (median 197 m3/hr, range 0–1451 m3/hr). When compared with usual conditions, fully opening existing doors and windows resulted in a median two-fold increase in ventilation. Using standard assumptions about infectiousness, we estimated that a health worker would have a 24.8% annual risk of becoming infected with Mycobacterium tuberculosis, and that a patient would have an 0.1% risk of becoming infected per visit. Opening existing doors and windows and rearranging patient pathways to preferentially use better ventilated clinic spaces result in important reductions in Mycobacterium tuberculosis transmission risk. However, unless combined with other tuberculosis infection prevention and control interventions, these changes are insufficient to reduce risk to health workers, and other highly exposed individuals, to acceptable levels.
Depressive symptoms and violence exposure in a population-based sample of adult women in South Africa
Authors: Hatcher Abigail M. , Mkhize Sthembiso Pollen , Parker Alexandra , de Kadt Julia
Published: November 2022

Depressive symptoms are a major burden of disease globally and is associated with violence and poverty. However, much of the research linking these conditions is from resource-rich settings and among smaller, clinical samples. Secondary data from a household survey in Gauteng Province of South Africa examines the cross-sectional association between adult women’s elevated depressive symptoms and markers of violence. Using tablet computers, participants self-completed interview modules to screen for depressive symptoms (Patient Health Questionnaire 2-item screener), childhood exposure to physical and sexual abuse (Childhood Trauma Questionnaire 4-item index), as well as past-year exposure to sexual or intimate partner violence (SIPV; WHO Multicountry Study instrument 4-item index). Socio-economic status, food security, education, and income were self-reported. Representative data at the ward level allows for modeling of results using survey commands and mixed-level modeling. Of the 7,276 adult women participating in the household survey, 42.1% reported elevated depressive symptoms. A total of 63.9% reported childhood violence exposure and 5.3% had past-year SIPV. Multi-level modeling suggests that violence is a strong predictor of depressive symptoms. Childhood abuse alone increases the odds of high depressive symptomology, after controlling for individual-level markers of poverty and neighborhood of residence (aOR 1.31, 95%, CI 1.17–1.37). Combined exposure to childhood abuse and past-year SIPV increased odds of reporting elevated depressive symptoms (aOR 2.05, 95%, CI 1.54–2.71). Ward characteristics account for 6% of the variance in depressive symptoms, over and above the contributions of household food security and socio-economic status. Exposure to violence in childhood and past-year SIPV were associated with depressive symptoms among women. These associations persist after controlling for socio-economic markers and latent neighborhood characteristics, which also had significant association with elevated depressive symptoms. These data suggest that efforts to reduce the burden of depressive symptoms may benefit from approaches that prevent violence against women and children.
Linkage to HIV care and hypertension and diabetes control in rural South Africa: Results from the population-based Vukuzazi Study
Authors: Magodoro Itai M. , Olivier Stephen , Gareta Dickman , Koole Olivier , Modise Tshwaraganang H. , Gunda Resign , Herbst Kobus , Pillay Deenan , Wong Emily B. , Siedner Mark J.
Published: November 2022

Non-communicable diseases (NCDs) account for half of all deaths in South Africa, partly reflecting unmet NCDs healthcare needs. Leveraging existing HIV infrastructure is touted as a strategy to alleviate this chronic care gap. We evaluated whether HIV care platforms are associated with improved NCDs care. We conducted a community-based screening of adults in rural KwaZulu-Natal, collecting BP, HbA1c, and health services utilization data. Care cascade indicators for hypertension and diabetes mellitus were defined as: 1) aware, if previously diagnosed, 2) in care, if seeing a provider within last 6 months; 3) treated, if reporting medication use within preceding 2 weeks; and 4) controlled, if BP<140/90mmHg or HbA1c<6.5%. We fit multivariable adjusted logistic regression models to compare successful completion of each step of the care cascade for hypertension and diabetes between people with virally suppressed HIV and HIV-negative comparators. Inverse probability sampling weights were applied to derive population-level estimates. The analytic sample included 4,933 individuals [mean age 58.4 years; 77% female]. Compared to being HIV-negative, having suppressed HIV was associated with lower adjusted prevalence of being aware (-6.0% [95% CI: -11.0, -1.1%]), in care (-5.7% [-10.6, -0.8%]), and in treatment (-4.8% [-9.7, 0.1%]) for diabetes; but higher adjusted prevalence of controlled diabetes (3.2% [0.2–6.2%]). In contrast, having suppressed HIV was associated with higher adjusted prevalence of being aware (7.4% [5.3–9.6%]), in care (8.0% [5.9–10.2%]), in treatment (8.4% [6.1–10.6%]) and controlled (9.0% [6.2–11.8%]), for hypertension. Overall, disease control was achieved for 40.0% (38.6–40.8%) and 6.8% (5.9–7.8%) of individuals with hypertension and diabetes, respectively. Engagement in HIV care in rural KwaZulu-Natal was generally associated with worse diabetes care and improved hypertension care. While further work should explore how success of HIV programs can be translated to NCD care, strengthening of primary healthcare will also be needed to respond to the growing NCDs epidemic.