This document provides recommendations for managing polycystic ovary syndrome (PCOS) in India. It discusses the epidemiology and pathophysiology of PCOS, highlighting factors that contribute to its increasing prevalence in India such as genetics, lifestyle changes, and obesity. Diagnostic criteria are outlined, including signs and symptoms and recommended tests. Lifestyle modifications including diet, exercise and weight loss are recommended as first-line treatment. Pharmacotherapy and bariatric surgery are also discussed as treatment options, especially for obese patients. Specific recommendations are provided for managing PCOS-related menstrual irregularity.
PCOS (Polycystic ovary syndrome), a hormonal disorder causing enlarged ovaries with small cysts, or fluid-filled sacs. It is a condition in which a woman's hormones are out of balance. It's a health problem that affects 1 in 10 women of childbearing age. Over the years, numerous hypothesis have been proposed regarding the proximate physiological origin for PCOS. Difference between PCOD & PCOS is important to know. A common confusion among women, is understanding the difference between having PCOS & having been diagnosed with it.
Various researches have studied the prevalence of PCOS in India (Tamil Nadu, Mumbai, Karnataka & Lucknow). Maintaining a good health is essential to prevent as well as treat hormonal disturbances & conditions. Management of these both at risk for PCOS and those with a confirmed PCOS diagnosis includes education, healthy lifestyle and therapeutic interventions targeting their symptoms.
Polycystic ovarian syndrome (PCOS) is a condition
of unexplained hyperandrogenic chronic anovulation
that most likely represents a heterogenous disorder.
About 10% of women in the reproductive age group
suffer from this disorder.
PANEL DISCUSSION
MANAGEMENT OF PCOS - WOMB to TOMB
MODERATOR : Sharda Jain
PANELISTS : Dr.Chitra setia
Dr Puneet Arora
Dr. Ila Gupta
Dr. Rupam Arora
Dr. Archana Sharma
Dr. Sangeeta Gupta
Dermatologists
Dr. V.K. Upadhyay
Dr. S. Kandhari
Pcos by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine-metabolic disorder that implies various severe consequences to female health, including alarming rates of infertility. Although its exact etiology remains elusive, it is known to feature several hormonal disturbances, including hyperandrogenemia, insulin resistance (IR), and hyperinsulinemia. Insulin appears to disrupt all components of the hypothalamus-hypophysis-ovary axis, and ovarian tissue insulin resistance results in impaired metabolic signaling but intact mitogenic and steroidogenic activity, favoring hyperandrogenemia, which appears to be the main culprit of the clinical picture in PCOS. In turn, androgens may lead back to IR by increasing levels of free fatty acids and modifying muscle tissue composition and functionality, perpetuating this IR-hyperinsulinemia-hyperandrogenemia cycle. Nonobese women with PCOS showcase several differential features, with unique biochemical and hormonal profiles. Nevertheless, lean and obese patients have chronic inflammation mediating the long term cardiometabolic complications and comorbidities observed in women with PCOS, including dyslipidemia, metabolic syndrome, type 2 diabetes mellitus, and cardiovascular disease. Given these severe implications, it is important to thoroughly understand the pathophysiologic interconnections underlying PCOS, in order to provide superior therapeutic strategies and warrant improved quality of life to women with this syndrome.
PCOD occurs when a woman’s hormones are imbalanced and numerous cysts accumulate in the ovaries. The only way to identify PCOD is only through the symptoms. Because of the seriousness of the complications that can arise from PCOD, it is extremely important to seek treatment for it immediately. To know more about it, read on…
PCOS (Polycystic ovary syndrome), a hormonal disorder causing enlarged ovaries with small cysts, or fluid-filled sacs. It is a condition in which a woman's hormones are out of balance. It's a health problem that affects 1 in 10 women of childbearing age. Over the years, numerous hypothesis have been proposed regarding the proximate physiological origin for PCOS. Difference between PCOD & PCOS is important to know. A common confusion among women, is understanding the difference between having PCOS & having been diagnosed with it.
Various researches have studied the prevalence of PCOS in India (Tamil Nadu, Mumbai, Karnataka & Lucknow). Maintaining a good health is essential to prevent as well as treat hormonal disturbances & conditions. Management of these both at risk for PCOS and those with a confirmed PCOS diagnosis includes education, healthy lifestyle and therapeutic interventions targeting their symptoms.
Polycystic ovarian syndrome (PCOS) is a condition
of unexplained hyperandrogenic chronic anovulation
that most likely represents a heterogenous disorder.
About 10% of women in the reproductive age group
suffer from this disorder.
PANEL DISCUSSION
MANAGEMENT OF PCOS - WOMB to TOMB
MODERATOR : Sharda Jain
PANELISTS : Dr.Chitra setia
Dr Puneet Arora
Dr. Ila Gupta
Dr. Rupam Arora
Dr. Archana Sharma
Dr. Sangeeta Gupta
Dermatologists
Dr. V.K. Upadhyay
Dr. S. Kandhari
Pcos by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine-metabolic disorder that implies various severe consequences to female health, including alarming rates of infertility. Although its exact etiology remains elusive, it is known to feature several hormonal disturbances, including hyperandrogenemia, insulin resistance (IR), and hyperinsulinemia. Insulin appears to disrupt all components of the hypothalamus-hypophysis-ovary axis, and ovarian tissue insulin resistance results in impaired metabolic signaling but intact mitogenic and steroidogenic activity, favoring hyperandrogenemia, which appears to be the main culprit of the clinical picture in PCOS. In turn, androgens may lead back to IR by increasing levels of free fatty acids and modifying muscle tissue composition and functionality, perpetuating this IR-hyperinsulinemia-hyperandrogenemia cycle. Nonobese women with PCOS showcase several differential features, with unique biochemical and hormonal profiles. Nevertheless, lean and obese patients have chronic inflammation mediating the long term cardiometabolic complications and comorbidities observed in women with PCOS, including dyslipidemia, metabolic syndrome, type 2 diabetes mellitus, and cardiovascular disease. Given these severe implications, it is important to thoroughly understand the pathophysiologic interconnections underlying PCOS, in order to provide superior therapeutic strategies and warrant improved quality of life to women with this syndrome.
PCOD occurs when a woman’s hormones are imbalanced and numerous cysts accumulate in the ovaries. The only way to identify PCOD is only through the symptoms. Because of the seriousness of the complications that can arise from PCOD, it is extremely important to seek treatment for it immediately. To know more about it, read on…
This presentation briefly discuss the polycystic ovary syndrome in terms of pathogenesis, features and management. Then, It moves on to discuss the various guidelines laid down by Endocrine Society in 2013 for the management of patients with polycystic ovary syndrome.
Treatment of Polycystic Ovary Syndrom (PCOS)Dr JP Singh
An Invented technique to treat the PCOS, Introduced by Dr JP Singh. PCOS is a leading cause of women infertility. Near about 50% women at the age group of 15-30 in Kolkata, (India) are suffering from PCOS. Polycystic ovary syndrome is a Gynecological problem that can affect woman's: Menstrual cycle, Difficulty to be pregnant, Hormonal imbalances, Skin and hair problems. It may be treated through this technique. More details logon: www.brainstup.com
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
Polycystic Ovary Syndrome (PCOS): Symptoms, Causes and TreatmentYashodaHospitals
Polycystic ovary syndrome (PCOS) is a reproductive hormonal imbalance among women of reproductive age. Know more about symptoms, causes and treatment for PCOS
PCOD,How are they different ??Difficulties & Solutions made Easy , Dr. Sharda...Lifecare Centre
Tremendous advances and extensive human studies have uncovered the complexity and management of PCOD
Global prevalence -2.2% to 26% Roughly 1 in 15 women worldwide, (Lancet, 2007)
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is an open access international journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
This presentation briefly discuss the polycystic ovary syndrome in terms of pathogenesis, features and management. Then, It moves on to discuss the various guidelines laid down by Endocrine Society in 2013 for the management of patients with polycystic ovary syndrome.
Treatment of Polycystic Ovary Syndrom (PCOS)Dr JP Singh
An Invented technique to treat the PCOS, Introduced by Dr JP Singh. PCOS is a leading cause of women infertility. Near about 50% women at the age group of 15-30 in Kolkata, (India) are suffering from PCOS. Polycystic ovary syndrome is a Gynecological problem that can affect woman's: Menstrual cycle, Difficulty to be pregnant, Hormonal imbalances, Skin and hair problems. It may be treated through this technique. More details logon: www.brainstup.com
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
Polycystic Ovary Syndrome (PCOS): Symptoms, Causes and TreatmentYashodaHospitals
Polycystic ovary syndrome (PCOS) is a reproductive hormonal imbalance among women of reproductive age. Know more about symptoms, causes and treatment for PCOS
PCOD,How are they different ??Difficulties & Solutions made Easy , Dr. Sharda...Lifecare Centre
Tremendous advances and extensive human studies have uncovered the complexity and management of PCOD
Global prevalence -2.2% to 26% Roughly 1 in 15 women worldwide, (Lancet, 2007)
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is an open access international journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Effect of Antenatal Pelvic Floor Muscle Exercise on Postnatal Stress Urinary ...Crimsonpublishers-IGRWH
Effect of Antenatal Pelvic Floor Muscle Exercise on Postnatal Stress Urinary Incontinence in Primigravida - An Comparative Experimental Study by Rejisha TR in Womens health Journal
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Explore the intricacies of ovulation induction in intrauterine insemination (IUI) with Dr Laxmi Shrikhande's informative slide share presentation. From understanding the hormonal mechanisms to the latest techniques, this presentation offers insights into optimizing fertility through IUI. Whether you're a clinician seeking to enhance patient outcomes or an individual navigating fertility treatments, this resource provides valuable knowledge for your journey towards conception.
Chief Co ordinator Dr.Maninder Ahuja
These six modules from 2-7 are on mid life health care of women and were made with intention of training general gynecologist and other speciality into care of mid life women and have Mid Life OPD cards as mainstay of care.
Do Women With Polycystic Morphology Without Any Other Features of PCOS Benefi...Alex Swanton
Women with ovaries of polycystic morphology (PCO), without any other features of polycystic ovary syndrome(PCOS), respond similarly to women with PCOS when stimulated with exogenous gonadotrophins, and both groups share various endocrinological disturbances underlying their pathology.
Pcos & Infertility by dr alka mukherjee nagpur m.s. Indiaalka mukherjee
Polycystic ovary syndrome represents 80% of anovulatory infertility cases. Treatment initially includes preconception guidelines, such as lifestyle changes (weight loss), folic acid therapy to prevent the risk of fetal neural tube defects and halting the consumption of tobacco and alcohol. The first-line pharmacological treatment for inducing ovulation consists of a clomiphene citrate treatment for timed intercourse. The second-line pharmacological treatment includes the administration of exogenous gonadotropins or laparoscopic ovarian surgery (ovarian drilling). Ovulation induction using clomiphene citrate or gonadotropins is effective with cumulative live birth rates of approximately 70%. Ovarian drilling should be performed when laparoscopy is indicated; this procedure is typically effective in approximately 50% of cases. Finally, a high-complexity reproduction treatment (in vitro fertilization or intracytoplasmic sperm injection) is the third-line treatment and is recommended when the previous interventions fail. This option is also the first choice in cases of bilateral tubal occlusion or semen alterations that impair the occurrence of natural pregnancy. Evidence for the routine use of metformin in infertility treatment of anovulatory women with polycystic ovary syndrome is not available. Aromatase inhibitors are promising and longer term studies are necessary to prove their safety.
The Newer Concepts In Endometriosis Management : Dr Sharda JainLifecare Centre
The Newer Concepts In
Endometriosis Management
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DELEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
The Newer Concepts forReduced Surgery to preserve fertility in Endometrios...Lifecare Centre
The Newer Concepts forReduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Strategies for Improving Success Rates in ART PARTLifecare Centre
Strategies for Improving Success Rates in ART
Part - 2
Strategies for Improving Success Rates in ART
Tailoring Controlled Ovarian Stimulation
Strategies for Luteal Phase in ART cycles
Endometrial Receptivity Array
How to optimize success rates in ART? : Dr Sharda JainLifecare Centre
How to optimize success rates in ART? : Dr Sharda Jain
How to improve success rates in ART?
The big debate कार्य में आनंद
Evolution of In-vitro Fertilization (IVF)
Factors Influencing IVF Success Ist Part
Strategies for Improving Success Rates in ART Second Part
Innovations & Breakthroughs in IVF Part Three
OPEN DEBATE
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda JainLifecare Centre
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
Introduction
Social egg freezing (oocyte cryopreservation for non-medical reasons) has evolved as a proactive option for women looking to extend their reproductive possibilities past their peak childbearing years
It is the process of saving or protecting eggs, or reproductive tissues so that a person can use them to have biological children in future
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
5. Why Indian PCOS Guidelines ?
Align the mind set of Indian clinicians
towards a common management of
PCOS
These recommendations have taken into account the
evidence from the West and also published and
unpublished good clinical practices from India
6. Recommendation
‘A suggestion or proposal as to the best course of
action, especially one put forward by an
authoritative body’
Guideline
‘A general rule, principle, or piece of advice’
Oxford Dictionary
7. Grading System for Recommendations
Strength of recommendation
A Strongly recommended
B Suggested
C Unresolved
Evidence Level (EL) based scientific liteature
1 At least one RCT or meta-analysis of RCTs
2 At least one non-randomized or non-controlled, prospective
epidemiological study
3 Cross-sectional study or surveillance or pilot study
4 Existing guideline or consensus expert opinion on extensive patient
experience or review
Malik et al. Management of Polycystic Ovary Syndrome in India. Fertility Science 2014;
8. Huge Impact On Reproductive , Metabolic , And
Cardiovascular Health Of Affected
Girls And Women
10. The Indian Scenario…..
2 in every 5 adolescents 1 in every 5 adult women
Suffer from PCOS!!!
Malik et al. Management of Polycystic Ovary Syndrome in India.
Fertility Science & Research. Jan-Jun 2014
11. Drivers of the PCOS Epidemic
Earlier age of
onset of PCOS
Rise in childhood
obesity
(faulty lifestyle habits)
Genetic
Early onset of
Insulin resistance
Improved diagnostic
facilities & early
recognition
Improved patient
awareness
12. Dietary factors
Fast food culture
‘Dietary Westernization’
Carbohydrate , fat rich refined &
processed food with low dietary fibres
Mishra A & Vikram NK. Insulin Resistance Syndrome and Obesity in Asian Indians: Evidence and Implications. Nutrition. 2004
13. “Push button lifestyle”
Reduced Physical Activity:
South Asian women are particularly sedentary & are less physically
active when compared with other ethnic groups
Urbanization : Chronic stress
Hypothalamic-pituitary-adrenocortical and sympatho-adrenal
activations, precipitating insulin resistance in the long-term
Mishra A & Vikram NK. Insulin Resistance Syndrome (Metabolic Syndrome) & Obesity in Asian Indians:
Evidence and Implications. Nutrition. 2004
14. Other factors….
• Early-life adverse events:
• mostly malnutrition, results in adult-onset metabolic syndrome
• Asian Indian children born with a low birth weight showed
insulin resistance and dyslipidemia when they gained weight in
early childhood
• Role of sub-clinical inflammation as evidenced by raised C-
reactive proteins has also been postulated to trigger development of
PCOS later in life
Mishra A & Vikram NK. Insulin Resistance Syndrome (Metabolic Syndrome) & Obesity in Asian Indians: Evidence and
Implications. Nutrition. 2004
15. Role of Genetics
• No clear cut mode of inheritance
• Autosomal dominant
• Risk of developing PCOS is greater
40 % if sister is affected
10 % if mother is affected
16. Association between PCOS &
Genetic mutations
Insulin secretion & action Insulin receptor (INSR) region
Insulin variable-number-tandem repeats (VNTR)
Insulin receptor substrate 1 (IRS-1)
Insulin receptor substrate 2 (IRS-2)
Calpain 10 (CAPN10)
Peroxisome proliferator-activated receptor ᵞ (PPAR-γ)
Protein phosphatase 1 regulatory subunit (PP1R3)
Gonadotropin secretion
& action
Follistatin (FST)
Androgen biosynthesis,
secretion, transport &
metabolism
Androgen Receptor (AR)
Sex-Hormone Binding Globulin (SHBG)
Cytochrome p450c17 (CYP17), Cytochrome p45011a (CYP11a)
11β-Hydroxysteroid dehydrogenase (11β-HSD)
1. Balen A. The pathophysiology of polycystic ovary syndrome: trying to understand PCOS and its endocrinology. Best Pract Res Clin Obstet Gynaecol. 2004
2. Goodarzi MO et al. Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nat Rev Endocrinol. 2011 Apr;7(4):219-31
3. Jones MR et al. Polymorphism of the follistatin gene in polycystic ovary syndrome. Mol Hum Reprod. 2007 Apr;13(4):237-41
Follistatin gene
Strongest
association with
PCOS
17. Pathophysiology of PCOS
Jayasena CN, Franks S. The management of patients with polycystic ovary syndrome. Nat Rev Endocrinol. 2014 Oct; 10(10): 624-36
Goodarzi MO et al. Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nat Rev Endocrinol. 2011 Apr;7(4):219-31
18. PCOS: Clinical Features
Hirsutism: 44 %
Acne: 20 %
Glucose intolerance 16.3 %
Obesity: 37.5 – 62.5 %
Amongst Indian women
with PCOS
Malik et al. Management of Polycystic Ovary Syndrome in India. Fertility Science 2014
19. Associated Co-morbidities
Associated
Co-
morbidities
Depression
Cardio-
vascular
Risk
Type 2
Diabetes
Mellitus
Endometri
al Cancer
Pregnancy
Compli-
cations
Obstructiv
e Sleep
Apnoea
NASH &
NAFLD
• Depression: 54 %
• Type 2 DM: 5 – 10 fold
higher risk
• Cardiovascular disease:
Relative risk of 1.53 as
compared to normal
subjects
• Pregnancy complications:
risk of gestational DM,
pre-term births
• NASH – 67%
Malik et al. Fertility Science & Research. Jan-Jun 2014
Add To The Burden Of PCOS
21. Gold Standard Diagnostic Criteria
Malik et al. Management of Polycystic Ovary Syndrome in India. Fertility Science & Research. Jan-Jun 2014
In adult women, it is recommended that diagnosis of PCOS be made using the Rotterdam criteria,
meeting two of the following three conditions:
Androgen excess, Ovulatory dysfunction, Polycystic ovaries (Grade A, EL 4)
22. Biochemical
Characteristics
High BMI > 23 kg/m2 for
adults
> 97.5th percentile for age in
adolescents
High waist : hip ratio (> 0.85)
Acanthosis nigricans as clinical
marker of insulin resistance
Family h/o diabetes or PCOS,
Obesity and improper lifestyle,
Deranged lipid profile
Clinical symptoms
Pubertal deviations
(early or late),
Menstrual irregularity
Presence of polycystic ovaries and clinical
signs of hyperandrogenism such as:
Early acne or hirsutism,
Persistent severe acne,
Frequent relapse in acne,
Acne in facial ‘V’ area,
Persistent hirsutism , acne for > 2 yrs
Indian women showing at least one biochemical
characteristic in conjunction with one clinical symptom
should be considered for further evaluation (Grade A, EL 3)
Malik et al. Management of Polycystic Ovary Syndrome in India. Fertility Science & Research. Jan-Jun 2014
23. Additional Recommendations
Malik et al. Management of Polycystic Ovary Syndrome in India. Fertility Science & Research. Jan-Jun 2014
In adults ,
adolescents:
Presence of
ACANTHOSIS
NIGRICANS
with/ without
obesity is an
additional
diagnostic
criterion (Grade B,
EL 4)
Determination
of anti-mullerian
hormone levels
not
recommended
for diagnosis
(Grade A, EL 4)
In adolescents,
presence of
oligomenorrhea or
amenorrhea
beyond 2 years of
menarche – early
sign of PCOS
(Grade B, EL 4)
24. Minimal workup of PCOS in
Adolescents should include 5 tests
(Grade A ,EL 4 )
• Serum total testosterone (cut off 60 ng / dl )
• OGTT ( zero, two hrs after 75 gm glucose load)
• Serum 17 - hydroxy progesterone (done at 8 am)
• Serum TSH
• Serum prolactin levels
PCOS is a Diagnosis of Exclusion
27. Lifestyle modifications: Diet control
• Eat healthy, balanced diet consisting of calorie-
restricted meals (reduced by 500 Kcal/day) (Grade
B, EL 2)
Diet
• Do not STARVE … No CRASH DIET
• Foods with low glycemic index
• Eat small quantities at regular intervals
• Routinely screen for BMI and waist
circumference as an index for increasing adiposity
and development of hyperandrogenism (Grade A,
EL 3)
Malik et al. Management of Polycystic Ovary Syndrome in India. Fertility Science & Research. Jan-Jun 2014;
28. Lifestyle Modifications:
Aim to spend 1,000 - 2,000 kcal/week
EXERCISE
• Daily strict physical activity (either exercise or
yoga) for at least 30min/day or 150min/
week (to reduce at least 5% of initial body weight
(Grade A, EL 4)
ROLE OF
YOGA
• Yoga is recommended as a part of lifestyle
management work up (Grade B, EL 3)
Malik et al. Good Clinical Practice Recommendations on Management of Infertility in Patients with Polycystic Ovary Syndrome
from India. Fertility Science & Research. Article in Press.
29. Pharmaco
-therapy
• PCOS patients with subfertility who are
morbidly obese (BMI >35 kg/m2),
pharmacological methods of ovulation
induction should be avoided before
weight reduction (Grade B, EL 4)
• Treatment with orlistat is recommended
under medical supervision in an event of
unsuccessful weight reduction , diet and
exercise alone for 2-3 months in
morbidly obese patients (Grade B, EL 1)
Malik et al. Good Clinical Practice Recommendations on Management of Infertility in Patients with Polycystic Ovary Syndrome
from India. Fertility Science & Research. Article in Press.
Lifestyle Modifications:
Recommendations
30. Bariatric
Surgery
• Bariatric surgery is recommended as second-
line treatment in morbidly obese (BMI >35
kg/m2) subfertile PCOS patients who are
unsuccessful in achieving weight reduction by
lifestyle modifications (Grade B, EL 4)
• In PCOS patients with BMI >50 kg/m2,
bariatric surgery is suggested as first-line
therapy for weight reduction (Grade B, EL 4)
• It is recommended to avoid conception for at least 12
months after bariatric surgery (Grade B, EL4)
Malik et al. Good Clinical Practice Recommendations on Management of Infertility in Patients with
Polycystic Ovary Syndrome from India. Fertility Science & Research. Article in Press.
Lifestyle Modifications:
33. In Adults with Menstrual Irregularity
• Recommended to include
progesterone withdrawal
bleeds as first line therapy till
menopause to avoid the risk
of endometrial proliferative
disorders (grade A,EL 4)
• COC containing drospirenone
and desogestral are preferred
(Grade A, EL 1)
• Drospirenone is more
beneficial than desogestrel in
Indian conditions
• Metformin is not
recommended as first line
therapy (Grade A, EL 4)
• Spironolactone is not
recommended for menstrual
irregularity
34. In Adolescents with Menstrual Irregularity
• Use low dose COC,s
with or without anti –
androgenic progestins -
drospirenone &
desogestrel
• Between 12 – 16 yrs
Progesterone only pills
to be used for a short
period (upto 7 days)
• After 16 yrs low dose
COC,s to be used
(Grade A ,EL 4)
35. In Both Adults &
Adolescents
• If no impovement with COC,s or if COC,s are not
tolerated it is recommended to use insulin
sensitizers such as metformin with or without
progestins but not thiazolidnediones (Grade A ,EL 2 )
• Duration of metformin for ovulatory dysfuntions in
adolescents has not been established
37. Management Biochemical & Clinical
Hyperandrogenism requires long term
& multidimensional treatment
• Management of Acne
• Management of Hirsutism
• Management of Alopecia
38. Recommendations for management Acne
Oral COCs with anti androgen progestins as first
line therapy for all types of acne, in consultation
with a dermatologist (Grade A, EL 1)
Cyproterone acetate is more beneficial than other
progestins in Indian conditions
Topical medications can be used along with
pharmacological therapy (Grade A, EL 4)
Malik et al. Management of Polycystic Ovary Syndrome in India. Fertility Science & Research 2014;
Anti-androgen Progestins: Cyproterone acetate, Drospirenone, Desogestrel
39. Acne Management
Clinical Evidence
Significant reduction in Acne scores with Cyproterone acetate at the end of 4 months
No significant change was found in the Medroxyprogesterone acetate arm
Chung et al. A Randomized crossover study of Medroxyprogesterone acetate and Diane-35 in adolescent girls with Pcos J Pediatr Adolesc
Gynecol. 2014
40. Treatment Algorithm:Acne
Acne
• Topical retinoids: comedones alone
• Topical antibiotic + retinoids: mild to moderate severe
inflammatory acne with papules and pustules
• Oral antibiotics: moderate to severe inflammatory acne
• Oral isotretinoin: papulonodular acne
Frequent relapse of acne/scarring/severe psychological disturbances
Oral isotretinoin
Treatment failure
41. Recommendations for Management
of PCOS related Hirsutism in adults
• Use of direct hair
removal methods along
with COCs with anti
androgen progestins are
recommended as first
line therapy
(Grade A, EL 1)
• Cyproterone acetate
is more beneficial in
Indian conditions
• No improvement or
intolerance to COCs
• Spironolactone or
Finasteride suggested
(Grade A, EL 2)
• Stop 6 months before
planning pregnancy
Malik et al. Management of Polycystic Ovary Syndrome in India. Fertility Science & Research. Jan-Jun 2014
42. Adolescents With Hirsutism, Obesity
& Signs Of Insulin Resistance
• Lifestyle modification is first-line
• Metformin is second-line therapy with a wait
period of 2 years post-menarche
(Grade A, EL 4)
• If glucose intolerance is not established by OGTT
,metformin should not be given (Grade B, EL 4)
Malik et al. Management of Polycystic Ovary Syndrome in India. Fertility Science & Research. Jan-Jun 2014
43. Hirsutism Management:
Comparison of different Progestins
0 1 2 3 4 5 6
Cyproterone acetate
Drospirenone
Desogestrel
5.29
2.12
1.69
Decrease FG Score
Cyproterone Acetate
shows the strongest anti-
androgenic activity after
12 cycles
Bhattacharya SM, Jha A. Comparative study of the therapeutic effects of oral contraceptive pills containing desogestrel, cyproterone acetate, and drospirenone
in patients with polycystic ovary syndrome. Fertil Steril. 2012 ;98(4):1053-9 a.
* FG Score: Ferrimen Gallway Score for Hirsutism
(n =58)
(n = 56)
(n =57)
171 pts
44. Hirsutism:
Role of Cyproterone acetate
0
20
40
60
80
100
Face Chest Abdomen Legs
100
62.5
81.2 81.2
45.4
9.1
40.9 40.9
%Patients
Baseline 12 cycles
2 mg cyproterone acetate + 35 mcg ethinyl estradiol
effectively reduce mean FG scores (14.3 to 5.7)
Golland IM, Elstein ME. Results of an open one-year study with Diane-35 in women with polycystic ovarian syndrome. Ann N Y Acad Sci. 1993 May 28;687:263-71.
45. Bhattacharya et al 2012
At the end of 12 months, CPA significantly decreased the
Free Androgen Index as compared to Desogestrel
0
2
4
6
8
10
12
CPA Drospirenone Desogestrel
FreeAndrogenIndex
Effect of drugs on Free Androgen Index
At start of therapy
After 12 months
Bhattacharya et al. Comparative study of therapeutic effects oral contraceptive pills containing desogestrel, cyproterone acetate and drospirenone in
patients with polycystic ovary syndrome. Fertil Steril. 2012
Current Indian Evidence
46. Recommendations
Management of Alopecia in PCOS
Alopecia
• In women with PCOS presenting with
alopecia, COCs and androgen
blockers are recommended as first line
therapy (Grade B, EL 3)
47. When to stop ???
The ideal time to stop hormonal therapy for
hyper androgenism cannot be established
with existing evidence (grade A, EL4 )
If Risk of thromboembolism , identify susceptible
patients , pause treatment for 3 months after
one year of treatment
48. Due to insufficient evidence alternative and
complimentary therapeutic options like
acupuncture , myoinositol ,omega 3 fatty acids
are not recommended (Grade B, EL4)
Alternative Therapy
50. PCOS-related Infertility
ESHRE Recommendations ACOG Recommendations
1. Obesity adversely affects reproduction and is associated with
anovulation, pregnancy loss, and late-pregnancy complications.
• Weight loss before infertility treatment improves ovulation rates in
women with PCOS, but there are limited data that it improves
fecundity or lowers pregnancy complications.
• Treatment of adverse lifestyles, including obesity and physical
inactivity, should precede ovulation induction
• The best diet and exercise regimens are unknown, but caloric
restriction and increased physical activity are recommended
2. Clomiphene citrate remains the treatment of first choice for
induction of ovulation in most anovulatory women with PCOS
3. At present, use of metformin in PCOS should be restricted to those
patients with glucose intolerance
4. Low-dose FSH protocols are effective in achieving ovulation in
women with PCOS, but further refinement is needed to better
control the safety of these regimens
5. Laparoscopic ovarian surgery is an alternative to gonadotropin
therapy for CC-resistant anovulatory PCOS
1. An increase in exercise combined with dietary change
has consistently been shown to reduce diabetes risk
comparable to or better than medication (Level A)
2. Improving insulin sensitivity with insulin-sensitizing
agents is associated with a decrease in circulating
androgen levels, improved ovulation rate, and improved
glucose tolerance (Level A)
3. The recommended first-line treatment for ovulation
induction remains the antioestrogen clomiphene citrate
(Level A)
4. If clomiphene citrate use fails to result in pregnancy, the
recommended second-line intervention is either
exogenous gonadotropins or laparoscopic ovarian
surgery (Level B)
5. A low-dose regimen is recommended when using
gonadotropins in women with PCOS (Level C)
51.
52. Infertility
Estrogen modulators
•Clomiphene citrate
•Letrozole
CC resistant/failure
•Low-dose gonadotropins
•Glucocorticoids
Insulin sensitizers
•Metformin + CC
• Metformin (if BMI ≥30 kg/m2 to
prevent OHSS
•Laparoscopic surgery +gonadotropins
•Bariatric surgery if BMI ≥35 kg/m2
First-line
Second-line
Third-line
No improvement
No improvement
PCOS-related Infertility: Management Algorithm
54. Management of NAFLD and NASH in PCOS
• Provide with sufficient
awareness on symptoms
and complications of
NAFLD & NASH
(Grade B, EL 4)
• Carry out screening in pts
with insulin resistance &
metabolic syndrome
(Grade B, EL 4)
• Rx with vitamin E is
preferred (GradeB,EL 1)
• Metformin is not
suggested for reduction
of metabolic syndrome
(GradeB, EL 1)
Liver Involvement Should Be Managed Aggressively
With A Multidisciplinary Approach(grade B, EL 1)
55. Metabolic Syndrome
• C e n t ra l
O b e s i t y
• H y p e r t e n s i o n
• D i a b e t e s
M e l l i t u s
• D y s l i p i d e m i a
HYPERURICEMIA
NASH
NAFLD
56. Metabolic Syndrome: Diabetes Mellitus
Malik et al. Management of Polycystic Ovary Syndrome in India. Fertility Science & Research. Jan-Jun 2014; 1(1): 23-4
Screen for
impaired
glucose
tolerance &
T2DM using 75
gm OGTT
(Grade A, EL 2)
Women with
impaired glucose
tolerance or
T2DM
Metformin alone
or in combination
with oral
contraceptives
(Grade A, EL 1)
Early referral
to specialist
for timely
management
& prevention
of its
complications
(Grade A, EL 4)
57. Management of cardiovascular risk in PCOS
Risk Factors
• Obesity
• Smoking
• Hypertension
• Dyslipidemia
• IGT
• C- reactive protein
• Homocysteine
• Family h/o CVD
High Risk Factors
• Metabolic syndrome
• T2DM
• Overt vascular disease
• Overt renal disease
Screen for cardiovascular disease by assessing risk factors
(Grade A, EL 1)
58. Management of cardiovascular risk in PCOS
Repeat lipid profile &
OGTT at 6 months for
borderline risk & one
year for normal profile
patients
(Grade B , EL 4 )
Specialist care is
needed in all patients
with risk factors
irrespective of the
severity of symptoms
(Grade A, EL 4)
59. Guidelines for management of Endometrial Cancer
Women without abnormal bleeding: routine
screening using TVS not recommended
(Grade B, EL 1)
Women with unexpected bleeding/ spotting: TVS
assess endometrial thickening (Grade B, EL 4)
India: Endometrial thickness > 4 mm using TVS is
taken as cutoff
Regular oncologic referrals for screening
(Grade A, EL 4)
Malik et al. Management of Polycystic Ovary Syndrome in India. Fertility Science & Research. Jan-Jun 2014; 1(1): 23-4
60. To reduce the risk of Endometrial Cancer
• Progestogens: Induce withdrawal bleed every 3 to 4 months
(Grade B, EL 3)
• Metformin: Reduce atypical endometrial hyperplasia
• Metformin + CPA: Showed normal epithelia with no evidence of
endometrial carcinoma
Progestogens or metformin reduce endometrial cancer risk
1. Chittenden et al. Reprod Biomed Online. 2009;19:398–
405.
2. Haoula et al. Hum Reprod. 2012;27:1327–1331.
3. Wild et al. Hum Fertil Camb. 2000;3:101-5
4. Roy et al. J Hum Reprod Sci. 2012; 5(1): 20–25
5. Saxena et al. J Endocrinol Metab. 2012;16:996–999.
6. Kar et al. J Hum Reprod Sci. 2012;5(3):262-5.
7. Cheung et al. Obstet gynaecol. 2001 ;98(2):325-31.
8. Session et al.Gynaecol Endocrinol 2003;17(5):405–7.
9. Shen et al. Obstet gynaecol 2008;112 (2 pt 2):465–7.
10. Legro et al. Am J Obstet gynaecol 2007; 196:402.
11. Li Xi et al. J Cancer. 2014 Jan 28;5(3):173-81.
61. Management of depression and
psychosocial dysfunction in PCOS
Depression
• Should be routinely
screened for depression and
anxiety with appropriate
psychological instruments
(Grade B, EL 3)
• Psychological Counseling by
appropriate professional
(Grade B, EL 4)
Other Psychosocial Dysfunction
• When positive for any
psychosocial dysfunction
more detailed counseling
(Grade B, EL 4)
62. Management of obstructive sleep
apnea
• Routinely screen for OSA and insomnolence
• Sleep Study if required
• Refer to appropriate institution for treatment
Loud Snoring , Day Time Sleepiness , Morning Headaches
Indicates OSA
63. Indian story ends …….
GCPRs put forth by IFS
is a path breaking
effort to streamline the
management of PCOS
which will go a long
way in handling the
uniqness of our Indian
pts
64. ADDRESS
11 Gagan Vihar, Near
Karkari Morh Flyover,
Delhi - 51
CONTACT US
9650588339
9599044257
011-22414049
WEBSITE :
www.lifecareivf.in
www.lifecarecentre.in
www.lifecareabs.in
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…..Caring hearts, healing hands
ISO 9001:2008
Helpline : 9599044257
Web.www.lifecareivf.in
Helpline : 9910081484
27
Year
In
your
service
Editor's Notes
Dr.Jyoti Agarwal
Oxford Dictionary
Huge Disease Burden
Add to the burden of PCOS
PCOS is a diagnosis of exclusion
Management
31
Key Points:
In a latest randomised controlled trial conducted in Indian women with PCOS, the effects of oral contraceptive pills containing cyproterone acetate (CPA), desogestrel (deso), and drospirenone (dros) were compared.
There were three treatment groups: group A (n =58) received desogestrel (Novelon; 30/150 mg), group B (n = 56) received cyproterone acetate (Krimson 35; 35/2000 mg), and group C (n =57) received drospirenone (Yasmin; 30/3000 mg).
Every patient was advised to take a pill daily for 21 days followed by a 7-day gap, and again to start another packet and to continue cyclically for 12 months.
After 12 months of treatment, CPA showed the strongest anti-androgen activities as evident by significantly decreased modified FG score for hirsutism (change: CPA -5.29, dros -2.12, deso -1.69) .
References:
Bhattacharya SM, Jha A. Comparative study of the therapeutic effects of oral contraceptive pills containing desogestrel, cyproterone acetate, and drospirenone in patients with polycystic ovary syndrome. Fertil Steril. 2012 ;98(4):1053-9 a.
Key points:
Evidences for the management of hirsutism using COCs are abundant in literature.
Lower doses of cyproterone acetate have been demonstrated to be effective clinically in reducing hirsutism
Evidence from one of the earliest studies on EE/CPA combination is presented.
In women with PCOS, treatment with 2 mg CPA/ 35 mcg EE significantly reduced mean FG scores from 14.3 (at baseline) to 5.7 (completion of therapy)
References:
Golland IM, Elstein ME. Results of an open one-year study with Diane-35 in women with polycystic ovarian syndrome. Ann N Y Acad Sci. 1993 May 28;687:263-71.
Alternative Therapy
Important public health problem
References:
Chittenden BG, Fullerton G, Maheshwari A, Bhattacharya S. Polycystic ovary syndrome and the risk of gynaecological cancer: a systematic review. Reprod Biomed Online. 2009;19:398–405.
Haoula Z, Salman M, Atiomo W. Evaluating the association between endometrial cancer and polycystic ovary syndrome. Hum Reprod. 2012;27:1327–1331.
Wild S, Pierpoint T, Jacobs H, McKeigue P. Long-term consequences of polycystic ovary syndrome: results of a 31 year follow-up study. Hum Fertil Camb. 2000;3:101-5
Roy KK, Baruah J, Singla S, Sharma JB, Singh N, Jain SK, Goyal M. A prospective randomized trial comparing the efficacy of Letrozole and Clomiphene citrate in induction of ovulation in polycystic ovarian syndrome. J Hum Reprod Sci. 2012; 5(1): 20–25
Saxena P, Prakash A, Nigam A, Mishra A. Polycystic ovary syndrome: Is obesity a sine qua non? A clinical, hormonal, and metabolic assessment in relation to body mass index. Indian J Endocrinol Metab. 2012;16(6):996–999.
Kar S. Clomiphene citrate or letrozole as first-line ovulation induction drug in infertile PCOS women: A prospective randomized trial. J Hum Reprod Sci. 2012;5(3):262-5.
Cheung AP . Ultrasound and menstrual history in predicting endometrial hyperplasia in polycystic ovary syndrome. Obstet gynaecol. 2001 Aug;98(2):325-31.
Session DR, Kalli KR, Tummon IS, Damario MA, Dumesic DA. Treatment of atypical endometrial hyperplasia with an insulin-sensitizing agent. gynaecol Endocrinol 2003;17(5):405–7.
Shen ZQ, Zhu HT, Lin JF. Reverse of progestin-resistant atypical endometrial hyperplasia by metformin and oral contraceptives. Obstet gynaecol 2008;112 (2 pt 2):465–7.
Legro RS, Zaino RJ, Demers LM, Kunselman AR, Gnatuk CL, Williams NI, et al. The effects of metformin and rosiglitazone, alone and in combination, on the ovary and endometrium in polycystic ovary syndrome. Am J Obstet gynaecol 2007; 196:402.e1–402.e10.
Li X1, Guo YR2, Lin JF2, Feng Y3, Billig H4, Shao R4.Combination of Diane-35 and Metformin to Treat Early Endometrial Carcinoma in PCOS Women with Insulin Resistance. J Cancer. 2014 Jan 28;5(3):173-81.
Loud snoring , day time sleepiness , morning headaches indicates OSA