CHANGES IN MALE REPRODUCTIVE HORMONES IN PATIENTS WITH COVID-19

COVID-19 is a global, highly contagious, predominantly respiratory viral illness caused by coronavirus 2 (SARS-CoV2). Although COVID-19 is mainly a respiratory disease, it can affect other organ systems causing a lot of extrapulmonary manifestations and multiple organ dysfunctions. The aim of the study is to discover if COVID-19 affects male reproductive hormones (testosterone and luteinizing hormone) or not, and whether this effect (if present) is negatively associated with the severity of the disease. In this prospective case-control study we recruited 120 reproductive-aged male patients, they represent group (A) which is subdivided into 3 groups according to the severity of the disease (mild, moderate, and severe). A control group consisting of another 120 age-matched males was randomly selected and they represent group (B). The hormone profile of the diseased group is then compared to that of the control group. The testosterone/LH ratio of both groups was calculated and compared. The age of cases had a mean of 41.96±10.18 and that of the control was 41.85±10.2 years. The age distribution of both groups did not show significant statistical differences (0.937). Patients with COVID-19 exhibited considerably lower levels of total blood testosterone (P=0.043) and T/LH ratio (P value 0.0001) compared to the control group, although serum LH levels were significantly higher in the COVID-19 group (P value 0.0001). Conclusions: In addition to the hematological, biochemical, inflammatory, and immune biomarkers abnormality in patients with COVID-19, the current study demonstrated that total testosterone level, LH level, and T/LH ratio might be affected by the disease according to severity. Recommendations: Due to the novelty of COVID-19, only a few studies about its effect on male reproductive hormones are available worldwide and no similar study in our locality. Further studies are required for a better understanding of this issue.

Tannin in Ruminant Nutrition: Review

Tannins are polyphenols characterized by different molecular weights that plants are able to synthetize during their secondary metabolism. Macromolecules (proteins, structural carbohydrates and starch) can link tannins and their digestion can decrease. Tannins can be classified into two groups: hydrolysable tannins and condensed tannins. Tannins are polyphenols, which can directly or indirectly affect intake and digestion. Their ability to bind molecules and form complexes depends on the structure of polyphenols and on the macromolecule involved. Tannins have long been known to be an "anti-nutritional agent" in monogastric and poultry animals. Using good tannins' proper application protocols helped the researchers observe positive effects on the intestinal microbial ecosystem, gut health, and animal production. Plant tannins are used as an alternative to in-feed antibiotics, and many factors have been described by researchers which contribute to the variability in their efficiencies. The objective of this study was to review the literature about tannins, their effects and use in ruminant nutrition.

Prevalence of Fascioliasis in Livestock and Humans in Pakistan: A Systematic Review and Meta-Analysis

Fascioliasis is a parasitic infection that affects both livestock and humans. Understanding the distribution of Fasciola spp. can help the development of preventive measures to control fascioliasis. This systematic review and meta-analysis aimed to estimate the status of fascioliasis among livestock and humans in Pakistan between 2000 and 2020. Based on the selection criteria, 25 articles were selected from Google Scholar, PubMed, and Scopus. This review included 76,099 animals, including 13,738 that were positive for fascioliasis. The overall prevalence was 18.1%; it was 0.3% in humans and 20.1% in livestock. Among animal hosts, the prevalence was highest in sheep (53.5%), followed by the goats (44.9%), cows (21.3%), buffaloes (16.8%), cattle (12.7%), and humans (0.3%). Sindh had the highest prevalence at 42.7%, followed by Baluchistan (25.2%), Punjab (17.7%), Khyber Pakhtunkhwa (10.7%), and Islamabad capital territory (1.5%). In the Punjab province, sheep had the highest prevalence (65.7%); in Khyber Pakhtunkhwa, it was buffalo (15.9%); and in Baluchistan, it was cows (28.5%). The prevalence of Fasciola spp. was higher in Sindh and Baluchistan than in the other provinces. The presented results are essential for developing preventive approaches for the management of human health and minimizing economic loss in the livestock industry in Pakistan. Preventive-curative treatments two times a year followed by a prophylactic treatment at the end of the dry season are crucial throughout the areas of Pakistan that serve as hotspots for infection by Fasciola sp. For humans, regular, prioritized surveys must be performed for high-risk populations so that the real situation can be assessed and addressed in a timely manner.

Assessing the role of urban green spaces for human well-being: a systematic review

Human has been evolving in a natural environment over a long time; thus, he is habitual to adapt it. Green spaces are obligatory landscapes in an urban structure that provide a natural environment and accelerate other life events. In contrast, unplanned urbanization, and conversion from green to grey structures have damaged natural environmental resources. Studies through different angles have highlighted the importance of urban green spaces for human well-being but now need to identify their role according to the potential. The demands of urban green spaces may differ with the change of population size, types of grey structure, urban expansion, the altitude of the place, and geographical location. Therefore, this systematic review aims to analyse the significance of urban green spaces for human well-being. The study opted for a systematic process during the selection and organization of studies for this review. After analysing, 46 studies were finalized with the consensus of three review authors. Accordingly, literature was analysed under the central theme of "Urban Green Spaces for Human Well-being." Human Well-being was assessed under six sub-themes; physical, psychological, mental, social, subjective, and environmental well-being. The review concluded that urban green spaces are the primary pillar for a sustainable urban place and human well-being due to highly positive and positive correlations. Moreover, the study did not find any demarcation line between green spaces and grey structures according to any specific need. Therefore, the study suggested that the role of urban green spaces for human well-being should be analysed according to their potential and required optimal ratio under different communities' urban specific environments and social behaviour.

Community-Based Assessment of Knowledge, Attitude, Practices and Risk Factors Regarding COVID-19 Among Pakistanis Residents During a Recent Outbreak: A Cross-Sectional Survey

Exceptional precautionary measures have been adopted to stop the transmission and control of COVID-19 through the world and Pakistan is facing lockdown in this scenario. Public loyalty to precautionary measures is affected by their knowledge, attitude, risk factors and practices (KAP) towards COVID-19. The present study was conducted among the Pakistani residents to observe the knowledge, attitude, practices and risk factors towards COVID-19 outbreak in Pakistan. A questionnaire was designed, and a cross-sectional survey was conducted among participants of the study area. Participants were asked the questions regarding knowledge, attitude, practices and risk factors towards COVID-19. Data were analyzed by SPSS and t/F test and correlation was applied among the knowledge, attitude, risk factors and practices. A total of 1060 questionnaires were received. 1004 were included while 56 were excluded. The highest representation was from Punjab province (65.6%), female (63%) and age group of 21-30 years (62.1%). Most participants were single (85%), Muslim (99.4%), Urdu speaking (45.6%) and were graduates (51.5%). Most of the participants were students (52.9%) and were from economically middle-class families (40.8%). The knowledge was positively correlated with attitude and practices whereas negatively correlated with risk factors (P < 0.05). The attitude was negatively correlated with risk factor and positively correlated with practices. The risk factors and practices were positively correlated with each other. Health education program to improve the COVID-19 knowledge, attitude, practices and risk factors should be initiated to combat current health challenge.

Effects of endocrine disruptor furan on reproductive physiology of Sprague Dawley rats: An F1 Extended One-Generation Reproductive Toxicity Study (EOGRTS)

The present study investigated the reproductive toxicity of furan in an Extended One-Generation Reproductive Toxicity Study in rats. Sprague Dawley F0 weaning rats (30 per sex per group) were exposed to furan orally at 0, 1, 2.5, 5, and 10 mg kg^-1 for 10 weeks (males) and 2 weeks (females) and then mated. Results of F0 indicated that in the furan-treated groups (5 mg kg^-1 and 10 mg kg^-1), body weight (bw) gain decreased during prebreed and gestational period while increased during lactation periods. F0 animals prebreeding exposure resulted in head tilt and foot splay at 10 mg kg^-1. Number of live pups at birth were decreased (p < 0.001) at 10 mg kg^-1. At postnatal day (PND) 70, a significant (p = 0.03) decrease in testosterone levels of male rats and estrogen levels of female rats (p = 0.05) was observed in 10 mg kg^-1 furan-treated group in F1 generation. Luteinizing hormone, follicle-stimulating hormone, and progesterone levels were also reduced, but their reduction was not statistically significant in all groups. In higher dose furan group (10 mg kg^-1), testicular and ovarian weights were reduced in F1 generation at PND 70, with decreased daily sperm production (p = 0.01) and disturbed estrous cyclicity (p < 0.01). Some histopathological changes were also observed in testis and ovaries in groups whose parents were previously exposed to 10 mg kg^-1 bw of furan group. Based on the above results, it is suggested that exposure to food-based contaminant furan induced remarkable changes in the F0 (parental stage) and F1 (offspring, pubertal, and adult stage) generations of Sprague Dawley rats.

My tummy hurts – a case report of abdominal pain and macrocytic anemia caused by hypothyroidism

A 6-year-old female presented with chronic intermittent abdominal pain for 1 year. She underwent extensive investigation, imaging and invasive procedures with multiple emergency room visits. It caused a significant distress to the patient and the family with multiple missing days at school in addition to financial burden and emotional stress the child endured. When clinical picture was combined with laboratory finding of macrocytic anemia, a diagnosis of hypothyroidism was made. Although chronic abdominal pain in pediatric population is usually due to functional causes such as irritable bowel syndrome, abdominal migraine and functional abdominal pain. Hypothyroidism can have unusual presentation including abdominal pain. The literature on abdominal pain as the main presentation of thyroid disorder is limited. Pediatricians should exclude hypothyroidism in a patient who presents with chronic abdominal pain. Contrast to its treatment, clinical presentation of hypothyroidism can be diverse and challenging, leading to a delay in diagnosis and causing significant morbidity.

Severe hypoglycemia secondary to methimazole-induced insulin autoimmune syndrome in a 16 year old African-American male

Insulin autoimmune syndrome (IAS) or Hirata's disease is a rare disorder characterized by hypoglycemia secondary to insulin autoantibodies (IAb). Over 200 patients have been described from Japan with significantly less numbers being reported from outside the Orient. IAS is more common in patients older than 40 yr of age with reports in the pediatric age group being notably rarer. Exposure to sulfhydryl group containing medications is implicated in the pathogenesis of this syndrome. In this report, we describe a case of IAS in an African-American adolescent. A 16-yr-old healthy African-American male was diagnosed with Graves' disease and started on Methimazole. Four weeks later, he was found unconscious and hypoglycemic (blood sugar 1.5 mmol/L). Evaluation was negative for insulinoma. Insulin antibodies were positive. Oral glucose tolerance test revealed elevated free insulin concentrations with disproportionately elevated total insulin levels. The patient was started on prednisone, diazoxide, and propranolol for management of IAS and hyperthyroidism. Thyroid radio-ablation was subsequently undertaken. The doses of prednisone and diazoxide were tapered and these medications discontinued after 9 months. The insulin antibody levels decreased gradually and became undetectable in 6 months with resolution of the hypoglycemia.

Excess weight and precocious pubarche in children: alterations of the adrenocortical hormones

In this paper we assess the qualitative and quantitative differences in adrenal function before and after adrenocorticotropic hormone (ACTH) stimulation between normal weight and overweight precocious pubarche (PP) patients. Twelve of the 22 PP patients had a normal body weight for height with linear growth and bone ages (BAs) that were appropriate for chronological age. The remaining 10 PP patients had body weights which were greater than 120% of ideal weight for height and body mass indices (BMIs), which were more than 125% of the ideal for age and sex. In six overweight patients, linear growth was accelerated and BAs were advanced beyond chronological age. All patients underwent an ACTH stimulation test where they received an intravenous bolus of 250 micrograms Cortrosyn. Blood samples were obtained at 0' and 60' for 17-OHProgesterone (17-OHP), 17-OHPregnenolone (17-OHPG), dehydroepiandrosterone (DHEA), androstenedione (A-dione), and cortisol levels. Results of the baseline and stimulated adrenal hormones in the normal weight children were found to be within reference range for normal Tanner I children. In contrast, two of the 10 overweight children were suspected of having congenital adrenal hyperplasia [one with 21-hydroxylase (21-OHase) deficiency, another with 3-betahydroxysteroid (3 beta ol) deficiency]. These two children were indistinguishable in their linear growth rate and degree of skeletal maturation from the other overweight children. In both patients the BA/chronological age and BA/height age (HA) ratios were within two standard deviations of the mean for the overweight patients.(ABSTRACT TRUNCATED AT 250 WORDS)