Compliance Issues in Managing 21 Hydroxylase Deficiency and their Short/Long-Term Consequences

Objective: To report a case of untreated classic 21 hydroxylase (OH) deficiency congenital adrenal hyperplasia (CAH) in a transgender patient resulting in pulmonary embolisms (PEs) and bilateral adrenal masses. Methods: A 36-year-old male (birth sex: female) presenting with bilateral PEs in the setting of long-standing, untreated classic 21OH CAH was also found to have bilateral adrenal masses (unconfirmed myelolipomas). Results: Further history revealed a known diagnosis of CAH. The patient had been treated with glucocorticoid and mineralocorticoid replacement in childhood but stopped taking these medications against medical advice. During his hospital admission, he was noted to have elevated 17-hydroxyprogesterone, low cortisol with elevated ACTH levels, and male-level testosterone measurements. CT of the abdomen/ pelvis revealed a 23 cm mass in the left renal fossa and a 2.5 cm mass in the right renal fossa consistent with bilateral adrenal myelolipomas. The patient attended follow-up in clinic, but declined any further hormonal treatment as he identified as male and felt further treatment was unnecessary. Conclusion: This case demonstrated the unique long-term effects of untreated classic CAH due to 21OH deficiency, including bilateral adrenal myelolipoma, adrenal compensation to the point of producing male-level androgens, and possibly PEs. Treatment with hydrocortisone was recommended to suppress ACTH and it was planned that the patient would eventually start on testosterone (although this would have been complicated by his bilateral PEs). Potential aetiologies for the PEs included vascular compression of the renal artery (which could explain the elevated EPO/erythrocytosis contributing to hypercoagulability) or the renal vein by the adrenal mass.

The Effect of Communication, Resources, Disposition And Structure of Bureaucracy on Medical Participation of Men's Operations in City of Bandar Lampung (Study of George Edward III Policy Implementation Model)

The Population and Family Planning Control Office of Bandar Lampung City has implemented a Family Planning Program to reduce birth rates so that population growth in Bandar Lampung is controlled. Since 2009, men and women have had the same rights and position in achieving the success of the Family Planning Program in Bandar Lampung City. But the fact the Family Planning Program in Bandar Lampung City still seems biased to gender, this is evidenced by the achievement of family planning acceptors who are still being majority among women compared to men. KB Male Medical Surgery (MOP) is the male birth control that attains the lowest acceptor and has decreased in five years in the city of Bandar Lampung. Based on the problems obtained in the field, the study wanted to see the influence of communication variables, resources, disposition, and bureaucratic structure on KB MOP participation in Bandar Lampung City. The independent variable used in this study is the implementation model variable proposed by George Edward III. The method used in this study a descriptive and associative method with a quantitative approach. The results showed that the communication variables obtained the magnitude of influence of 4.4% and the disposition variable obtained the magnitude of influence of 4.3%, these two variables did not have a significant effect on KB MOP participation in Bandar Lampung City. While the resource variable obtained the magnitude of influence of 21.1% and the bureaucratic structure variable obtained the magnitude of influence of 25.6%, these two variables had a significant influence on KB MOP participation in Bandar Lampung City. But simultaneously the communication, resource, disposition and bureaucratic structure variables have a significant influence on KB MOP participation in Bandar Lampung City and the magnitude of the effect obtained is 25.1%.

People’s knowledge regarding impacts of air pollution on reproductive health: a self-reported study

Air pollution is a major challenge worldwide, particularly in the developing world. This study aimed to revelation people’s perceptions regarding the impacts of air pollution on reproductive health. This study was conducted among107 respondents and a google form was used to create a survey questionnaire. Purposive sampling has been used to select the respondents. A large number of respondents are male and aged less than 30 years. A large number of respondents are from the urban area and depends on Non-Government Job. A satisfactory number of the respondents know about air pollution. Both male and female respondents know smoke inhalation during pregnancy, damage reproductive organs of the male, birth defects due to air pollutions, and delayed brain development of the newborn baby. Most of the respondents gather their knowledge from television and social media. Asian J. Med. Biol. Res. 2021, 7 (2), 147-152

Reproductive indices and performance of captive reared grasscutters (Thryonomys swinderianus Temminck)

Two male and 8 female grasscutters were severally observed and paired to characterize certain indices of reproduction as important requirements for successful propagation of the animal in captivity. Observations on some of the reproductive indices are reported. Grasscutter possesses some specialized stages of courtship and coitus that were not readily available for observation. Females openly showed no receptivity to all courtship moves by male. 71% of the mating exercises were however successful, resulting in 36 youngs from 9 litters, comprising 20 females and 16 males. Mean gestation length was 163.11 + 1.58 days (Range 152-170 days). Litter size ranged from 2 to 7 (X -4.00 + 0.52, n=9). Baby grasscutters were born with eyes opened, body fully haired and teeth well developed and capable of inflicting painful bites. Mean birth weight of litters was 117.70 + 34.08g. Male birth weighis were generally heavier (X = 118.10 +27.70g) than females (x= 100.90 + 27.50g). Litter size and weight at birth were negatively correlated (r = . 0.42) and not significant (P> 0.05). Breeding occurred in January, March, April, June, July, November and December. About 67% of the parturition occurred at night. Breeding success among other things affirmed the feasibility of commercial rearing of the grasscutter to supplement the prevailing inadequate animal protein supply in the country.

Fathers of children conceived using ART have higher cognitive ability scores than fathers of naturally conceived children

STUDY QUESTION Does paternal cognitive ability differ for children conceived with and without assisted reproductive technology (ART)? SUMMARY ANSWER Young fathers of ART conceived children tend to score cognitively below their same-age natural conception (NC) counterparts and older (above 35) fathers of ART conceived children tend to score above. WHAT IS KNOWN ALREADY Cognitive ability is a genetically and socially transmitted trait, and If ART and NC children have parents with different levels of this trait, then this would in itself predict systematic differences in child cognitive outcomes. Research comparing cognitive outcomes of children with different modes of conception finds conflicting results, and studies may be influenced by selection and confounding. STUDY DESIGN, SIZE, DURATION This is a population-based study based on Norwegian data, combining information from the Medical Birth Registry (births through 2012), military conscription tests (birth cohorts 1955–1977) and the population registry. These data allow us to compare the cognitive ability scores of men registered as the father of an ART-conceived child to the cognitive abilities of other fathers and to average scores in the paternal birth cohorts. PARTICIPANTS/MATERIALS, SETTINGS, METHODS The population level study included 18 566 births after ART (5810 after ICSI, 12 756 after IVF), and 1 048 138 NC births. It included all Norwegian men who received a cognitive ability score after attending military conscription between 1973 and 1995. This constituted 614 827 men (89.4% of the male birth cohorts involved). An additional 77 650 unscored males were included in sensitivity analyses. MAIN RESULTS AND THE ROLE OF CHANCE Paternal cognitive level was assessed using intelligence quotients (IQ) converted from stanine scores on a three-part cognitive ability test with items measuring numeracy, vocabulary and abstract thought (Raven-like matrices). ART fathers averaged 1.95 IQ points above the average of their own birth cohort (P-value < 0.0005) and 1.83 IQ points above NC fathers in their own birth cohort (P < 0.0005). Comparisons of the IQ of ART fathers to those of NC fathers of similar age and whose children were born in the same year, however, found average scores to be more similar (point estimate 0.24, P = 0.023). These low average differences were found to differ substantially by age of fatherhood, with young ART fathers scoring below their NC counterparts and older ART fathers scoring above their NC counterparts. LIMITATIONS, REASONS FOR CAUTION We do not have information on maternal cognition. We also lack information on unsuccessful infertility treatments that did not result in a live birth. WIDER IMPLICATIONS OF THE FINDINGS Paternal cognitive ability of ART children differs from that of NC children, and this difference varies systematically with paternal age at child birth. Selection effects into ART may help explain differences between ART and NC children and need to be adequately controlled for when assessing causal effects of ART treatment on child outcomes. STUDY FUNDING/COMPETING INTEREST(S) This research has also been supported by the Research Council of Norway through its Centres of Excellence funding scheme, project number 262700 (Centre for Fertility and Health). It has also been supported by the Research Council of Norway’s Project 236992 (Egalitarianism under pressure? New perspectives on inequality and social cohesion). There are no competing interests. TRIAL REGISTRATION NUMBER N/A

SAT-074 A Rare Endocrine Cause of Pseudotumor Cerebri

Introduction: Idiopathic intracranial hypertension, also known as pseudotumor cerebri, can be associated with various medications, obesity, systemic conditions, and inherited disorders. To the best of our knowledge, this is the second pediatric case of a GnRH agonist reported to cause pseudotumor cerebri. Case presentation: Our patient, a 12 5/12-year-old transgender male (birth-assigned female), started depot leuprolide acetate to suppress puberty at 11 10/12 years of age (early Tanner 2 breast development). He received Lupron Depot® 7.5 mg intramuscularly for 4 doses, then 22.5 mg intramuscular every 13 weeks thereafter. Five months after his first injection, a routine eye examination revealed bilateral papilledema and enlarged blind spots, which was confirmed by a Pediatric Ophthalmologist. He was asymptomatic. There was no marked weight gain in the previous year with a BMI of 24.5 kg/m2 (+1.85 SD). His blood pressure was 110–123 mmHg systolic and 71–85 mmHg diastolic. Neurological examination was normal. CT head was normal. Cranial MRI showed slight flattening of the optic nerve heads, mild engorgement of optic nerve sheath fluid, and no space-occupying mass. Sedated lumbar puncture revealed elevated opening pressure of 31 cm H2O. CSF analysis, including pathology, was benign. He was managed with acetazolamide. Based on these findings, he was diagnosed with pseudotumor cerebri secondary to the GnRH agonist. Follow-up by the Ophthalmologist one month after starting acetazolamide showed significant improvement of the papilledema. Conclusion: This case highlights that patients on GnRH agonist therapy are at risk for pseudotumor cerebri, and we recommend periodic ophthalmologic surveillance.