Snake envenoming is a neglected, public health problem in tropical and subtropical regions. Local tissue necrosis, neurotoxic, and hemo-vasculotoxic effects are well-recognized features, whereas the endocrine and metabolic derangements are not as well known. In addition to contributing to morbidity, some of these manifestations can be potentially life-threatening if not recognized early. The most prominent endocrine manifestation is hypopituitarism (HP), which can manifest acutely or remain asymptomatic and present years later. Unexplained recurrent hypoglycemia and refractory hypotension are early clinical clues to suspect corticotroph axis involvement in acute settings. Chronic pituitary failure may present, like Sheehan’s syndrome, several years after the bite. The occurrence of acute kidney injury, capillary leak syndrome, and disseminated intravascular coagulation are predictors of HP. Adrenal hemorrhages are documented in autopsy series; however, primary adrenal insufficiency is very rare and confounded by the presence of HP. Hyponatremia, hypokalemia or hyperkalemia, and dysglycemia can occur, but the mechanisms involved are only partially understood. Awareness, a high index of suspicion, correct interpretation of hormonal parameters, and timely treatment of these abnormalities can be lifesaving.

Data comparing the clinical spectrum of COVID-19 in kidney transplant recipients (KTRs) during the first and second waves of the pandemic in India is limited. Our single-center retrospective study compared the clinical profile, mortality, and associated risk factors in KTRs with COVID-19 during the 1st wave (1^st February 2020 to 31^st January 2021) and the second wave (1^st March-31^st August 2021). 156 KTRs with PCR confirmed SARS-CoV-2 infection treated at a tertiary care hospital in New Delhi during the 1st and the second waves were analyzed. The demographics and baseline transplant characteristics of the patients diagnosed during both waves were comparable. Patients in the second wave reported less frequent hospitalization, though the intensive care unit (ICU) and ventilator requirements were similar. Strategies to modify immunosuppressants such as discontinuation of antinucleoside drugs with or without change in calcineurin inhibitors and the use of steroids were similar during both waves. Overall patient mortality was 27.5. The demographics and baseline characteristics of survivors and nonsurvivors were comparable. A higher percentage of nonsurvivors presented with breathing difficulty, low SpO₂, and altered sensorium. Both wave risk factors for mortality included older age, severe disease, ICU/ventilator requirements, acute kidney injury (AKI) needing dialysis, Chest Computerized Tomographic (CT) scan abnormalities, and higher levels of inflammatory markers particularly D-dimer and interleukin-6 levels. Conclusions. KTRs in both COVID-19 waves had similar demographics and baseline characteristics, while fewer patients during the second wave required hospitalization. The D-dimer and IL-6 levels are directly correlated with mortality.

Purpose of review: Asthma is a chronic respiratory disease prevalent among women of reproductive age and has important implications for fertility, pregnancy, and offspring health. This review summarizes current evidence on the bidirectional interactions between asthma and female reproductive physiology, with particular emphasis on fertility and pregnancy. Recent findings: Perimenstrual asthma represents a distinct phenotype associated with greater disease severity and increased healthcare utilization. Asthma impairs fertility and is associated with longer time to conception, higher rates of infertility, and greater use of fertility treatment, although appropriately controlled asthma does not appear to adversely affect fertility rates or assisted reproductive technique outcomes. During pregnancy, poor asthma control and exacerbations are the principal drivers of adverse maternal and fetal outcomes, including hypertensive disorders, preterm birth, fetal growth restriction, and neonatal morbidity. Contemporary evidence supports continuation of guideline-directed asthma therapy, including inhaled corticosteroids and selected biologics when indicated. Prenatal vitamin D supplementation has shown a reduction in early childhood asthma or recurrent wheeze in pooled analyses, while omega-3 fatty acid supplementation has demonstrated variable benefit and is being evaluated in an ongoing confirmatory trial. Summary: Asthma influences multiple aspects of female reproductive health. Optimizing disease control before conception and throughout pregnancy remains the most effective strategy for improving maternal and offspring outcomes. Although asthma has been associated with delayed conception and greater use of fertility treatment, appropriate disease control does not reduce overall fertility.