Effect of laparoscopic ovarian drilling on serum anti-Mullerian hormone in clomiphene citrate resistant polycystic ovarian syndrome patients

Background: PCOS (polycystic ovarian syndrome) is the most common cause of anovulatory infertility, the purpose of our study was to see the effect of laparoscopic ovarian drilling on the ovarian reserve (with AMH as an indicator of ovarian reserve) and its safety as 2nd line of treatment in patients resistant to clomiphene citrate.Methods: This was a prospective interventional study conducted on 40 clomiphene citrate resistant PCOS women attending the infertility OPD. This study was conducted over a period of 1 year May 2019 to May 2020. Laparoscopic ovarian drilling (LOD) was done and these subjects were studied preoperatively and postoperatively on day 7 and day 30 for change in AMH (anti-Mullerian hormone) levels.Results: There is a significant change in the AMH level post LOD day 7 and 30 but not so severe that it will lead to premature ovarian failure. The amount of drop in AMH (day 30) increases till 20 ng/ml beyond which it shows a decrease.Conclusions: If LOD is done in a proper manner in women with sufficient ovarian reserve (high AMH), it will not adversely affect the ovarian reserve (the fall is not enough to cause premature ovarian insufficiency).

Rare case of two siblings with complete androgen insensitivity syndrome

Androgen insensitivity syndrome (AIS) also called testicular feminizing syndrome is a rare X linked disorder of sexual differentiation caused by mutation in the androgen receptor (AR) gene, which is located on the X chromosome (Xq11-q12). In the reported cases, individuals with complete androgen insensitivity syndrome (CAIS) presented with a female appearance and normal breast development, absence of uterus and ovaries, bilateral undescended testis, and elevated testosterone levels. The syndrome is usually detected on evaluation of a phenotypic female with primary amenorrhea who presents for treatment of infertility. Here, we report 2 cases of CAIS in siblings 21 and 19 years of age who presented to us with primary amenorrhea. The elder sibling presented to us with primary amenorrhea, thelarche +, absent adrenarche, blind pouch of vagina, b/l inguinal masses suggestive of undescended testes, raised serum testosterone and absent uterus on USG. While the younger sibling also presented with similar findings but had history of b/l orchidectomy at the age of 14 years. Both the sisters were admitted in our unit and the elder sister underwent b/l orchidectomy and McIndoe’s vaginoplasty. While the younger sister underwent McIndoe’s vaginoplasty on the same day. Post-operative recovery was uneventful and they were given hormone replacement therapy (HRT). AIS is a rare X linked disease caused by mutation in the AR gene. which when diagnosed early can be treated appropriately. Precise diagnosis requires clinical, hormonal and molecular investigation and is of great importance for appropriate gender assignment and management in general. With timely gonadectomy, vaginoplasty or vaginal pouch deepening, hormone replacement and appropriate psychological support help the person live a healthy and almost normal life.

A comparative study of antenatal and fetal complications in pregnant women with and without history of polycystic ovary syndrome

Background: Polycystic ovary syndrome in the present generation is a very common reproductive disorder and the prevalence is on the rise. Aim of the current study was to compare the maternal outcome in normal and women with PCOS.Methods: This study was a case-control study conducted in Department of Obstetrics and Gynaecology, SMS Medical College and attached group of hospitals, Jaipur from May 2019 to August 2020. Pregnant women with history of PCOS were taken as cases and with no such history were controls.Results: 9.49% women developed gestational diabetes mellitus (GDM) in cases as compared to 1.61% women in control group. The difference in the incidence of GDM in the two groups was statistically significant. When hypertensive disorders of pregnancy were considered, a statistically significant difference was observed as 11.2% cases and 2.42% controls showed HDP. Mean birth weight of neonate in cases was 2.43±0.31 kg and in control group was 2.71±0.29 kg. Mean APGAR score at 1 minute in cases was 6.21±1.23 and in controls was 7.21±0.24. APGAR score at 5 minutes in PCOS group was 7.89±1.40 and in control group was 8.12±0.21. 12 neonates from the cases group were admitted in NICU. The difference was statistically significant when comparedConclusions: With a detailed comparative analysis of this case-control study, it can be concluded that many antenatal and fetal complications are per se increased in women with a history of PCOS

The combinational effect of cardiac and biochemical markers in diabetic patients with cardiovascular disease

Background: Clinicopathological correlations, as well as several angiographic studies, suggest that diabetic patients have more extensive atherosclerotic disease, affecting the coronary arteries in particular. We sought to examine the combinational effect of cardiac and biochemical markers in diabetic patients with cardiovascular disease.\ud Method: The study population constituted 50 healthy subjects, 50 cardiovascular subjects with diabetes and 50 cardiovascular subjects without diabetes. The population was subjected to biochemical and cardiac marker analysis and the results were verified.\ud Results and discussion: Studies suggest that glycated hemoglobin values in the abnormal range can identify persons at increased risk for coronary heart disease, stroke, and death before the diagnosis of diabetes, indicating that glycated hemoglobin is a useful marker of cardiovascular risk and death from any cause.\u

The role of statin drugs in combating cardiovascular diseases –A review

Statins clearly confer substantial benefit in people with established cardiovascular (CV) disease. Increased cholesterol levels have been associated with cardiovascular diseases (CVD), and statins are therefore used in the prevention of these diseases. Studies have found that the ability of a particular statin to lower or reduce LDL is proportional to the amount it can increase HDL levels. This review article will focus on the effective role of statin in cardiovascular disease and comparison was made between various classes of statin drugs

The COVID‐19 Pandemic Not Only Poses Challenges, but Also Opens Opportunities for Sustainable Transformation

The COVID-19 pandemic has impacted social, economic, and environmental systems worldwide, slowing down and reversing the progress made in achieving the Sustainable Development Goals (SDGs). SDGs belong to the 2030 Agenda to transform our world by tackling humankind's challenges to ensure well-being, economic prosperity, and environmental protection. We explore the potential impacts of the pandemic on SDGs for Nepal. We followed a knowledge co-creation process with experts from various professional backgrounds, involving five steps: online survey, online workshop, assessment of expert's opinions, review and validation, and revision and synthesis. The pandemic has negatively impacted most SDGs in the short term. Particularly, the targets of SDG 1, 4, 5, 8, 9, 10, 11, and 13 have and will continue to have weakly to moderately restricting impacts. However, a few targets of SDG 2, 3, 6, and 11 could also have weakly promoting impacts. The negative impacts have resulted from impeding factors linked to the pandemic. Many of the negative impacts may subside in the medium and long terms. The key five impeding factors are lockdowns, underemployment and unemployment, closure of institutions and facilities, diluted focus and funds for non-COVID-19-related issues, and anticipated reduction in support from development partners. The pandemic has also opened a window of opportunity for sustainable transformation, which is short-lived and narrow. These opportunities are lessons learned for planning and action, socio-economic recovery plan, use of information and communication technologies and the digital economy, reverse migration and “brain gain,” and local governments' exercising authorities

Ustekinumab for type 1 diabetes in adolescents: a multicenter, double-blind, randomized phase 2 trial

Immunotherapy targeting the autoimmune process in type 1 diabetes (T1D) can delay the loss of β-cells but needs to have minimal adverse effects to be an adjunct to insulin in the management of T1D. Ustekinumab binds to the shared p40 subunit of interleukin (IL)-12 and IL-23, targeting development of T helper 1 cells and T helper 17 cells (TH1 and TH17 cells) implicated in the pathogenesis of T1D. We conducted a double-blind, randomized controlled trial of ustekinumab in 72 adolescents aged 12–18 years with recent-onset T1D. Treatment was well tolerated with no increase in adverse events. At 12 months, β-cell function, measured by stimulated C-peptide, was 49% higher in the intervention group (P = 0.02), meeting the prespecified primary outcome. Preservation of C-peptide correlated with the reduction of T helper cells co-secreting IL-17A and interferon-γ (TH17.1 cells, P = 0.04) and, in particular, with the reduction in a subset of TH17.1 cells co-expressing IL-2 and granulocyte–macrophage colony-stimulating factor (IL-2+ GM-CSF+ TH17.1 cells, P = 0.04). A significant fall in β-cell-targeted (proinsulin-specific) IL-17A-secreting T cells was also seen (P = 0.0003). Although exploratory, our data suggest a role for an activated subset of TH17.1 cells in T1D that can be targeted with minimal adverse effects to reduce C-peptide loss, which requires confirmation in a larger study. (International Standard Randomised Controlled Trial Number Registry: ISRCTN 14274380)

Toxicity of Imidacloprid on Peripheral Blood Lymphocytes by MTT Assay and the Ameliorative Effect of Extract of Tinospora cordifolia (Gilloe) Extract

Imidacloprid (IMI) is a widely used insecticide which has a specific affinity for insect neonicotinoid acetylcholine receptors. Like all insecticides which are used in excess it tends to bioaccumulate in the environment. So it was thought worthwhile to study its cytotoxicity to human peripheral blood lymphocytes in concentrations ranging from 1.5mM to 4mM after 2 hours and 18 hours exposure by MTT method. Trypan blue test was also used to determine the percentage of living cells. The ameliorative effect of an extract of the stem in water and ethanolic extract of leaves of Tinospora cordifolia (Thunb.) Miers, was also studied. The viability of the lymphocytes showed a fall with increasing concentrations at an exposure of 2 hours. After 18 hours exposure to the IMI only, the viability showed a significant dose dependent drop. Trypan blue test for viability was also conducted. Addition of Tinospora extract raised the viability significantly at 2 hours of incubation. In fact this increase was greatest at 3.5mM and 4mM concentration of drug. The ameliorative effect was maximum at 2 hours. Addition of Tinospora leaf extract showed a significant increase in cell viability at 18 hours of incubation as compared to values obtained with only the drug. Thus a considerable loss of viability of lymphocytes was seen after exposure to the drug in the selected concentrations but herbal extracts seem to help to make the damage less marked. The cells showed a significant rise in viability when incubated with Tinospora leaf extract only, confirming its supportive action in cell proliferation. However, taking into account the evident fall in cell viability caused by exposure to the considerably dilute concentrations tested, caution is needed to prevent over exposure to the pesticide while spraying

Antimycobacterial potential of <i>Trachyspermum ammi</i> seed essential oil via fume contact and determination of major compounds

Trachyspermum ammi (L.), commonly known as carrom seeds or Ajwain, has been extensively studied for its medicinal properties. In this study, anti-mycobacterial effect of AEO in liquid and fume form was investigated against Mycobacterium smegmatis and Mycobacterium tuberculosis (M. tb). Results showed that AEO inhibits the growth of M. smegmatis at 0.03 mg/mL and becomes bactericidal at 0.125 mg/mL. MICs were observed at 0.03, 0.125 and 0.06 mg/mL against M. tb (H37Rv), isoniazid- and rifampicin-resistant (RIF-R) strains. Inverted disc-fume assay revealed AEO and Thymol efficiently inhibit the growth of M. smegmatis and M. tb. Similarly, in fume contact AEO and Thymol demonstrated antibiofilm activity at a dose of 1.25 mg/mL air and 40 mg/mL air against M.smegmatis effectively. GC-MS analysis showed that Thymol was the dominant compound. These findings suggest that the use of AEO in fume form may serve as a promising strategy as an anti-mycobacterial activity against M. tb</p