AYURVEDIC MANAGEMENT OF PRIMARY INFERTILITY DUE TO POLYCYSTIC OVARIAN SYNDROME ASSOCIATED WITH MULTIPLE UTERINE FIBROIDS: A CASE REPORT

Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. As one of the leading causes of anovulatory infertility, it is believed that 5-10% of the reproductive-aged female population is living with polycystic ovary syndrome. Ayurveda considers the excellence of 4 factors- Ritu (ovulatory phase), Kshetra (garbhasaya), Ambu (proper nourishment to embryo), and Bija (healthy sperm and ovum) for a successful pregnancy. Impairment to any of these factors leads to Vandhytva or pregnancy failure. This case study helps to plan a treatment protocol for the patient with PCOS having infertility. A 25 yr old female having regular cycles came to OPD of Streeroga of IPGT & RA, having the complaints of weight gain and failure to conceive since 2 year of active married life. On presentation she was a medium sized woman with android body habits and had mild hirsute and acanthosis nigricans over nape of neck. Gynaecological examination revealed a normal sized uterus with no other abnormalities. Sonography revealed bulky ovaries with multiple small follicles with no evidence of ovulation along with small fibroids on anterior wall (1.8cm×1.5cm) and posterior wall (2.7cm×2.8cm). Her husbands semen analysis was normal. Based on clinical findings and investigation, anovulatory factor infertility due to PCOS was diagnosed along with fibroid. Virechana and Samana were decided due to both of these factors and Sthanyasodhana gana kashaya was selected as Samana drug. Treatment was done for 3 months, during treatment itself ovulation occured and the patient conceived after 3 months. This case being a Krichrasadhya vyadhi, proper care was taken including correction of the lifestyle and food habits. This case will help to understand the importance of Sodhana in gynecological disorders and explore the probable mode of action of Sthanyasodhana gana kashaya which helped in menstrual regulation

PHARMACOGNOSTICAL AND PHYTO-CHEMICAL EVALUATION OF PIPPALYADI YOGA: A POLYHERBAL FORMULATION

Pippalyadi Yoga is Churna Kalpana described by Acharya Chakrapani in Vandhyatva (infertility). Ovulatory dysfunction is the prime cause of Infertility among the world, Pippalyadi Yoga is useful in patients especially having Anovulation which is known as Abeejatva in Ayurveda. So a new pharmaceutical preparation Pippalyadi Yoga in the form of Churna (powder) was tried to standardize which is economical in terms of time and machinery usage. Pharmacognostical and phyto-chemical observations revealed the specific characters of all active constituents used in the preparation. The present work was carried out to standardize the finished product of Pippalyadi Yoga to confirm its identity, quality and purity. The presence of stone cells, oil globules, olio resin cells, parenchymatous cells, oval & beaker shaped starch grains, pollen grains were the characteristic features observed in the microscopy of the prepared drug. Phyto-chemical analysis showed Loss on drying 10.07 % w/w, ash value 6.55 %w/w, water soluble extract 14 % w/w, methanol soluble 13.40 % w/w, particle consistency above 60 mesh 4.10 % w/w, between 60-85 mesh 9.20 % w/w, between 85-120 mesh 13.30 % w/w & below 120 mesh 73.37 % w/w & pH 5.0. HPTLC of Pippalyadi Yoga is the preliminary quantitative analysis which shows 8 prominent spots at Rf. 0.09, 0.61, 0.67, 0.74, 0.80, 0.86, 0.91, 1.00 in UV 254 nm and 7 prominent spots at Rf. 0.06, 0.17, 0.63, 0.67, 0.75, 0.82, 0.88 in UV 366 nm. Pippalyadi Yoga, a polyherbal formulation of 4 ingredients was prepared and HPTLC finger print profile was developed and it can be considered pharmacopial standard of Pippalyadi Yoga

Complicated left isolated internal iliac artery aneurysm (IIIAA) in a young man - An unusual presentation in a Tertiary Hospital in Ghana: Case report

Generally, an aneurysm is a disease of the elderly due to the degenerative aetiological factor. Isolated internal iliac artery aneurysm (IIIAA) is rare, representing 0.3–0.5 % of all intra-abdominal aneurysms. It is a focal dilatation of the internal iliac artery alone with a threshold for surgical intervention set at 8 mm. Herein, we present an unusual presentation of a rare condition of a huge left internal iliac artery aneurysm in a young man with no identifiable risk factor complicated by left ilio-femoral deep vein thrombosis. Even though this is an interesting case study, the lack of facilities to do anaerobic cultures remains a major limitation in our setting

Prospective assessment of integrating the existing emergency medical system with automated external defibrillators fully operated by volunteers and laypersons for out-of-hospital cardiac arrest: the Brescia Early Defibrillation Study (BEDS)

AIMS: There are few data on the outcomes of cardiac arrest (CA) victims when the defibrillation capability of broad rural and urban territories is fully operated by volunteers and laypersons. METHODS AND RESULTS: In this study, we investigated whether a programme based on diffuse deployment of automated external defibrillators (AEDs) operated by 2186 trained volunteers and laypersons across the County of Brescia, Italy (area: 4826 km(2); population: 1 112 628), would safely and effectively impact the current survival among victims of out-of-hospital CA. Forty-nine AEDs were added to the former emergency medical system that uses manual EDs in the emergency department of 10 county hospitals and in five medically equipped ambulances. The primary endpoint was survival free of neurological impairment at 1-year follow-up. Data were analysed in 692 victims before and in 702 victims after the deployment of the AEDs. Survival increased from 0.9% (95% CI 0.4-1.8%) in the historical cohort to 3.0% (95% CI 1.7-4.3%) (P=0.0015), despite similar intervals from dispatch to arrival at the site of collapse [median (quartile range): 7 (4) min vs. 6 (6) min]. Increase of survival was noted both in the urban [from 1.4% (95% CI 0.4-3.4 %) to 4.0% (95% CI 2.0-6.9 %), P=0.024] and in the rural territory [from 0.5% (95% CI 0.1-1.6%) to 2.5% (95% CI 1.3-4.2%), P=0.013]. The additional costs per quality-adjusted life year saved amounted to euro39 388 (95% CI euro16 731-49 329) during the start-up phase of the study and to euro23 661 (95% CI euro10 327-35 528) at steady state. CONCLUSION: Diffuse implementation of AEDs fully operated by trained volunteers and laypersons within a broad and unselected environment proved safe and was associated with a significantly higher long-term survival of CA victims

The packing of two species of polygons on the square lattice

We decorate the square lattice with two species of polygons under the constraint that every lattice edge is covered by only one polygon and every vertex is visited by both types of polygons. We end up with a 24 vertex model which is known in the literature as the fully packed double loop model. In the particular case in which the fugacities of the polygons are the same, the model admits an exact solution. The solution is obtained using coordinate Bethe ansatz and provides a closed expression for the free energy. In particular we find the free energy of the four colorings model and the double Hamiltonian walk and recover the known entropy of the Ice model. When both fugacities are set equal to two the model undergoes an infinite order phase transition.Comment: 21 pages, 4 figure

Inhibition of Sphingolipid Synthesis as a Phenotype-Modifying Therapy in Cystic Fibrosis

Cystic Fibrosis (CF) is an inherited disease associated with a variety of mutations affecting the CFTR gene. A deletion of phenylalanine 508 (F508) affects more than 70% of patients and results in unfolded proteins accumulation, originating a proteinopathy responsible for inflammation, impaired trafficking, altered metabolism, cholesterol and lipids accumulation, impaired autophagy at the cellular level. Lung inflammation has been extensively related to the accumulation of the lipotoxin ceramide. We recently proved that inhibition of ceramide synthesis by Myriocin reduces inflammation and ameliorates the defence response against pathogens infection, which is downregulated in CF. Here, we aim at demonstrating the mechanisms of Myriocin therapeutic effects in Cystic Fibrosis broncho-epithelial cells

Functional Progression in Patients with Interstitial Lung Disease Resulted Positive to Antisynthetase Antibodies: A Multicenter, Retrospective Analysis

Antisynthetase syndrome (ASSD) is a rare autoimmune disease characterized by serologic positivity for antisynthetase antibodies. Anti-Jo1 is the most frequent, followed by anti PL-7, anti PL-12, anti EJ, and anti OJ antibodies. The lung is the most frequently affected organ, usually manifesting with an interstitial lung disease (ILD), which is considered the main determinant of prognosis. Some evidences suggest that non-anti-Jo-1 antibodies may be associated with more severe lung involvement and possibly with poorer outcomes, while other authors do not highlight differences between anti-Jo1 and other antisynthetase antibodies. In a multicenter, retrospective, "real life" study, we compared lung function tests (LFTs) progression in patients with ILD associated with anti-Jo1 and non-anti-Jo1 anti-synthetase antibodies to assess differences in lung function decline between these two groups. Therefore, we analyzed a population of 57 patients (56% anti-Jo1 positive), referred to the outpatient Clinic of four referral Centers in Italy (Modena, Monza, Siena, and Trieste) from 2008 to 2019, with a median follow-up of 36 months. At diagnosis, patients showed a mild ventilatory impairment and experienced an improvement of respiratory function during treatment. We did not observe statistically significant differences in LFTs at baseline or during follow-up between the two groups. Moreover, there were no differences in demographic data, respiratory symptoms onset (acute vs. chronic), extrapulmonary involvement, treatment (steroid and/or another immunosuppressant), or oxygen supplementation. Our study highlights the absence of differences in pulmonary functional progression between patients positive to anti-Jo-1 vs. non anti-Jo-1 antibodies, suggesting that the type of autoantibody detected in the framework of ASSD does not affect lung function decline

Absorption, Pharmacokinetics, and Urinary Excretion of Pyridines After Consumption of Coffee and Cocoa-Based Products Containing Coffee in a Repeated Dose, Crossover Human Intervention Study

Scope: The present study assesses the absorption, pharmacokinetics, and urinary excretion of coffee pyridines and their metabolites after daily regular exposure to specific dosages of coffee or cocoa-based products containing coffee (CBPCC), considering different patterns of consumption. Methods and results: In a three-arm, crossover, randomized trial, 21 volunteers are requested to randomly consume for 1 month: one cup of espresso coffee per day, three cups of espresso coffee per day, or one cup of espresso coffee plus two CBPCC twice per day. The last day of the one-month treatment, blood and urine samples are collected for 24 h. Trigonelline, N-methylpyridinium, N-methylnicotinamide, and N-methyl-4-pyridone-5-carboxamide are quantified. Trigonelline and N-methylpyridinium absorption curves and 24-h urinary excretion reflect the daily consumption of different servings of coffee or CBPCC, showing also significant differences in main pharmacokinetic parameters. Moreover, inter-subject variability due to sex and smoking is assessed, showing sex-related differences in the metabolism of trigonelline and smoking-related ones for N-methylpyridinium. Conclusion: The daily exposure to coffee pyridines after consumption of different coffee dosages in a real-life setting is established. This data will be useful for future studies aiming at evaluating the bioactivity of coffee-derived circulating metabolites in cell experiments, mimicking more realistic experimental conditions

Should beta-blocker therapy be reduced or withdrawn after an episode of decompensated heart failure? Results from COMET.

BACKGROUND: It is unclear whether beta-blocker therapy should be reduced or withdrawn in patients who develop acute decompensated heart failure (HF). We studied the relationship between changes in beta-blocker dose and outcome in patients surviving a HF hospitalisation in COMET. METHODS: Patients hospitalised for HF were subdivided on the basis of the beta-blocker dose administered at the visit following hospitalisation, compared to that administered before. RESULTS: In COMET, 752/3029 patients (25%, 361 carvedilol and 391 metoprolol) had a non-fatal HF hospitalisation while on study treatment. Of these, 61 patients (8%) had beta-blocker treatment withdrawn, 162 (22%) had a dose reduction and 529 (70%) were maintained on the same dose. One-and two-year cumulative mortality rates were 28.7% and 44.6% for patients withdrawn from study medication, 37.4% and 51.4% for those with a reduced dosage (n.s.) and 19.1% and 32.5% for those maintained on the same dose (HR,1.59; 95%CI, 1.28-1.98; p<0.001, compared to the others). The result remained significant in a multivariable model: (HR, 1.30; 95%CI, 1.02-1.66; p=0.0318). No interaction with the beneficial effects of carvedilol, compared to metoprolol, on outcome was observed (p=0.8436). CONCLUSIONS: HF hospitalisations are associated with a high subsequent mortality. The risk of death is higher in patients who discontinue beta-blocker therapy or have their dose reduced. The increase in mortality is only partially explained by the worse prognostic profile of these patients