Impact of Myo-Inositol on Ovary and Menstrual Cycle in Polycystic Ovarian Syndrome (PCOS) – A Therapeutic Approach

Background: Women of reproductive age develop menstrual irregularities along with infertility because of polycystic ovary syndrome (PCOS); the most common endocrine disorder. Myo-inositol (MI) is found to have a proven role in the treatment of this disorder.  The objective of this study was to determine the efficacy of Myo-inositol in regulating the menstrual cycle in women with PCOS. Methods: The study was conducted in 2019 at the Obstetrics and Gynecology Department of a tertiary care hospital with a sample of 50 women aged 18-45 years, having PCOS diagnosed with complaints of irregular menstrual cycles. Women with ovulatory dysfunction were excluded. Myo-inositol was given as 2 gm/day for 3 months. Pre- and post-trial data were collected, compared and analyzed through SPSS version 23 and a p-value <0.05 was considered statistically significant. Results: Mean±SD age of participant women was 27.68 ± 4.787 years. The menstrual cycle duration increased from Mean±SD 4.36 ± 2.22 to 4.70 ± 1.51 days after treatment with MI. The cycle flow increased from 19.10 ± 37.92 to 14.12 ± 13.34 ml (p-value < 0.001 each). Right and left ovary volume also decreased (p-value < 0.001 each) post-treatment. There were significant improvements in cycle flow severity towards normal pattern (from 14% to 80%; p-value < 0.001). The efficacy of Myo-inositol in regulating menstrual flow severity increased with decreasing age (p-value = <0.0001). Conclusion: Myo-Inositol was found efficacious in the treatment of PCOS and corrects menstrual irregularities, and menstrual flow, and normalizes ovarian volumes. Keywords: Inositol; Polycystic Ovary Syndrome (PCOS); Menstrual Irregularities; Myo-inositol

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status