Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome

Study Question What is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? Summary Answer International evidence-based guidelines including 166 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of women with PCOS. What Is Known Already Previous guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Diagnosis of PCOS remains controversial and assessment and management are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist. Study Design, Size, Duration International evidence-based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Appraisal of Guidelines for Research and Evaluation (AGREE) II-compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength. Participants/Materials, Setting, Methods Governance included a six continent international advisory and a project board, five guideline development groups, and consumer and translation committees. Extensive health professional and consumer engagement informed guideline scope and priorities. Engaged international society-nominated panels included pediatrics, endocrinology, gynecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, public health and other experts, alongside consumers, project management, evidence synthesis, and translation experts. Thirty-seven societies and organizations covering 71 countries engaged in the process. Twenty face-to-face meetings over 15 months addressed 60 prioritized clinical questions involving 40 systematic and 20 narrative reviews. Evidence-based recommendations were developed and approved via consensus voting within the five guideline panels, modified based on international feedback and peer review, with final recommendations approved across all panels. Main Results and the Role of Chance The evidence in the assessment and management of PCOS is generally of low to moderate quality. The guideline provides 31 evidence based recommendations, 59 clinical consensus recommendations and 76 clinical practice points all related to assessment and management of PCOS. Key changes in this guideline include: i) considerable refinement of individual diagnostic criteria with a focus on improving accuracy of diagnosis; ii) reducing unnecessary testing; iii) increasing focus on education, lifestyle modification, emotional wellbeing and quality of life; and iv) emphasizing evidence based medical therapy and cheaper and safer fertility management. Limitations, Reasons for Caution Overall evidence is generally low to moderate quality, requiring significantly greater research in this neglected, yet common condition, especially around refining specific diagnostic features in PCOS. Regional health system variation is acknowledged and a process for guideline and translation resource adaptation is provided. Wider Implications of the Findings The international guideline for the assessment and management of PCOS provides clinicians with clear advice on best practice based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the guideline with an integrated evaluation program. Study Funding/Competing Interest(S) The guideline was primarily funded by the Australian National Health and Medical Research Council of Australia (NHMRC) supported by a partnership with ESHRE and the American Society for Reproductive Medicine. Guideline development group members did not receive payment. Travel expenses were covered by the sponsoring organizations. Disclosures of conflicts of interest were declared at the outset and updated throughout the guideline process, aligned with NHMRC guideline processes. Full details of conflicts declared across the guideline development groups are available at https://www.monash.edu/medicine/sphpm/mchri/pcos/guideline in the Register of disclosures of interest. Of named authors, Dr Costello has declared shares in Virtus Health and past sponsorship from Merck Serono for conference presentations. Prof. Laven declared grants from Ferring, Euroscreen and personal fees from Ferring, Euroscreen, Danone and Titus Healthcare. Prof. Norman has declared a minor shareholder interest in an IVF unit. The remaining authors have no conflicts of interest to declare. The guideline was peer reviewed by special interest groups across our partner and collaborating societies and consumer organizations, was independently assessed against AGREEII criteria and underwent methodological review. This guideline was approved by all members of the guideline development groups and was submitted for final approval by the NHMRC

A REVIEW ON MUCORMYCOSIS BLACK AND WHITE PHASE OF FUNGUS

Mucormycosis started during COVID 19 when patients were treated with number of steroids oxygen, that further lead to increase in diabetes mellitus which was main cause of mucormycosis increase in black fungus further caused rhino-orbito-cerebral mucormycosis and angio invasive behavior of fungal hype that is from Mucoraceae family is main cause of the infection increases rapidly also damages the facial tissues vigorously uncontrolled diabetes, immunosuppressive, steroids poor glycemic control are main causes MRI is a technique that is been used for observing the growth of fungal hype from Epidermiological data its been proven that the mucormycosis is been spreading in countries such as India, Nepal, and Bangladesh rapidly its serious health concern in future

Primary cutaneous cryptococcosis due to Cryptococcous laurentii in a renal transplant recipient

We report a patient with primary cutaneous cryptococcosis caused by Cryptococcous laurentii following renal transplantation, probably due to repeated insulin and heparin subcutaneous injections on his thigh. Although cutaneous cryptococcosis due to C. neoformans is well known, reports of skin infections due to non-neoformans cryptococci are uncommon

Flavonoids from Argyreia nervosa (Burm.f.) Bojer: A Ready Arsenal against Pests as Well as Diabetes

Diabetes mellitus type 2 (DM 2) has currently become one of the most challenging noninfectious diseases to treat. Enzymes such as alpha-amylase and alpha-glucosidase involved in carbohydrate metabolism are useful targets to treat the disease. Plants produce an immense variety of flavonoids with diverse biological activities. They are involved in interactions with other plants, animals, and microbes. They can act as antimicrobial toxins or as anti- or pro-oxidants. We aimed to investigate whether flavonoids from leaf extracts of Argyreia nervosa (Burm.f.) Bojer (Family: Convolvulaceae) could exhibit alpha-amylase inhibitory activity in vitro and in silico. The leaf flavonoids were extracted in chloroform by routine protocols, and their profiling was carried out using the LC-MS technique. The chloroform extract was also tested for its inhibitory activity against the commercially available porcine pancreatic alpha-amylase enzyme in vitro, where it showed excellent inhibition. The molecular docking study was performed only for flavonoids from the LC-MS compound list using AutoDock 4.2.6. The compounds were docked against porcine pancreatic alpha-amylase (PDB ID: 1OSE). This structure already contained a bound molecule of ‘acarbose’ (a prescribed drug, an amylase inhibitor, and positive control in our in vitro experiments). Out of these, the top four flavonoids, vitexin (apigenin 8-C glucoside, a flavone), rutin (a flavonol), myricetin (a flavonol), and isoquercetin (a flavonol), showed the highest binding energies of −12.4 kcal/mol, −15.04 kcal/mol, −10.71 kcal/mol and −11.89 kcal/mol, respectively. Acarbose had binding energy of −11.48 kcal/mol. Thus, all four secondary metabolites showed comparable or higher binding energies than acarbose. The ligands interacting with the amino acid residues ASP197, GLU233, and TRP59 of amylase protein seemed to show an excellent inhibitory effect among the 15 secondary metabolites studied. This is also proven by our experimental data, which will be discussed in detail

Procalcitonin as an adjunctive biomarker in sepsis

Sepsis can sometimes be difficult to substantiate, and its distinction from non-infectious conditions in critically ill patients is often a challenge. Serum procalcitonin (PCT) assay is one of the biomarkers of sepsis. The present study was aimed to assess the usefulness of PCT assay in critically ill patients with suspected sepsis. The study included 40 patients from the intensive care unit with suspected sepsis. Sepsis was confirmed clinically and/or by positive blood culture. Serum PCT was assayed semi-quantitatively by rapid immunochromatographic technique (within 2 hours of sample receipt). Among 40 critically ill patients, 21 had clinically confirmed sepsis. There were 12 patients with serum PCT ≥10 ng/ml (8, blood culture positive; 1, rickettsia; 2, post-antibiotic blood culture sterile; and 1, non-sepsis); 7 patients with PCT 2-10 ng/ml (4, blood culture positive; 1, falciparum malaria; 2, post-antibiotic blood culture sterile); 3 patients with PCT of 0.5 to 2 ng/ml (sepsis in 1 patient); and 18 patients with PCT < 0.5 ng/ml (sepsis in 2 patients). Patients with PCT ≥ 2 ng/ml had statistically significant correlation with the presence of sepsis (P<0.0001). The PCT assay revealed moderate sensitivity (86%) and high specificity (95%) at a cut-off ≥ 2 ng/ml. The PCT assay was found to be a useful biomarker of sepsis in this study. The assay could be performed and reported rapidly and provided valuable information before availability of culture results. This might assist in avoiding unwarranted antibiotic usage

AUTOMATIC CRACK DETECTION

The issue of detection is very criticalin all the manufacturing companies. Therefore we intend to aid in defect detection by bringing in an automatic crack detection using digital image processing.When vision inspection of a product is done manually, there are chances of human error taking place or lack of efficiency or irresponsibility in some cases. This may bring a faulty piece in application leading to the possibility of failure of that component. In order to avoid such a risk, we are trying to develop anautomatic crack detection syste

Automatic Crack Detection

The issue of detection is very criticalin all the manufacturing companies. Therefore we intend to aid in defect detection by bringing in an automatic crack detection using digital image processing.When vision inspection of a product is done manually, there are chances of human error taking place or lack of efficiency or irresponsibility in some cases. This may bring a faulty piece in application leading to the possibility of failure of that component. In order to avoid such a risk, we are trying to develop anautomatic crack detection syste

<i style="mso-bidi-font-style:normal"><span style="font-size:13.0pt;font-family:"Times New Roman";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:Mangal;mso-ansi-language:EN-GB; mso-fareast-language:EN-US;mso-bidi-language:HI;mso-bidi-font-weight:bold" lang="EN-GB">In situ</span></i><span style="font-size:13.0pt;font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Mangal; mso-ansi-language:EN-GB;mso-fareast-language:EN-US;mso-bidi-language:HI; mso-bidi-font-weight:bold" lang="EN-GB"> formation of silver nanoparticles in thermosensitive glycogels and <span style="font-size:13.0pt; font-family:"Times New Roman";mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:Mangal;mso-ansi-language:EN-GB;mso-fareast-language:EN-US; mso-bidi-language:HI" lang="EN-GB">evaluation of its antibacterial activity</span></span>

441-446<span style="font-size:9.0pt;font-family: " times="" new="" roman";mso-fareast-font-family:theserif-b5plain;mso-bidi-font-family:="" mangal;mso-ansi-language:en-gb;mso-fareast-language:en-us;mso-bidi-language:="" hi"="" lang="EN-GB">Copolymeric thermosensitive hydrogel, N-isopropylacrylamide and glycomonomer based on D-galactose have been synthesized by free radical polymerization using <span style="font-size:9.0pt;font-family: " times="" new="" roman";mso-fareast-font-family:"times="" roman";mso-bidi-font-family:="" mangal;mso-ansi-language:en-gb;mso-fareast-language:en-us;mso-bidi-language:="" hi"="" lang="EN-GB">2,2′-azobis-isobutyronitrile<span style="font-size:9.0pt; font-family:" times="" new="" roman";mso-fareast-font-family:theserif-b5plain;="" mso-bidi-font-family:mangal;mso-ansi-language:en-gb;mso-fareast-language:en-us;="" mso-bidi-language:hi"="" lang="EN-GB"> as initiator and ethylene glycol dimethacrylate as crosslinker. This hydrogel has been further used as template to synthesize AgNPs. The composite glycogel containing AgNPs has been characterized by different techniques and tested for antibacterial activity against E. coli and P. aeruginosa.</span

Identification and Characterization of IgE-Reactive Proteins and a New Allergen (Cic\ua0a\ua01.01) from Chickpea (Cicer arietinum)

Scope Chickpea (Cicer arietinum) allergy has frequently been reported particularly in Spain and India. Nevertheless, chickpea allergens are poorly characterized. The authors aim to identify and characterize potential allergens from chickpea. Methods and Results Candidate proteins are selected by an in silico approach or immunoglobuline E (IgE)-testing. Potential allergens are prepared as recombinant or natural proteins and characterized for structural integrity by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), circular dichroism (CD)-spectroscopy, and mass spectrometry (MS) analysis. IgE-sensitization pattern of Spanish chickpea allergic and German peanut and birch pollen sensitized patients are investigated using chickpea extracts and purified proteins. Chickpea allergic patients show individual and heterogeneous IgE-sensitization profiles with extracts from raw and boiled chickpeas. Chickpea proteins pathogenesis related protein family 10 (PR-10), a late embryogenesis abundant protein (LEA/DC-8), and a vicilin-containing fraction, but not 2S albumin, shows IgE reactivity with sera from chickpea, birch pollen, and peanut sensitized patients. Remarkably, allergenic vicilin, DC-8, and PR-10 are detected in the extract of boiled chickpeas. Conclusion Several IgE-reactive chickpea allergens are identified. For the first time a yet not classified DC-8 protein is characterized as minor allergen (Cic a 1). Finally, the data suggest a potential risk for peanut allergic patients by IgE cross-reactivity with homologous chickpea proteins