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
Ovarian reserve refers to the reproductive potential left within a woman's two ovaries based on number and quality of eggs. Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of the remaining eggs
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
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
Ovarian reserve refers to the reproductive potential left within a woman's two ovaries based on number and quality of eggs. Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of the remaining eggs
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
Vasundhara Hospital Jaipur is a premier specialty hospital for infertile couples, complete women care, high risk pregnancy management, located in heart of Jaipur.
Click to more info :- https://www.vasundharafertility.com/jaipur
Healthy Choices are the key!
Healthy diet including raw foods & avoiding processed food or high fat diet is the best way to eliminate toxins from your body. Toxins damage your egg follicles.
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.
Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
Vasundhara Hospital Jaipur is a premier specialty hospital for infertile couples, complete women care, high risk pregnancy management, located in heart of Jaipur.
Click to more info :- https://www.vasundharafertility.com/jaipur
Healthy Choices are the key!
Healthy diet including raw foods & avoiding processed food or high fat diet is the best way to eliminate toxins from your body. Toxins damage your egg follicles.
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.
PCOS IS THE THIEF OF WOMENHOOD........an enigmatic condition must be understood and managed according to the age it presents.......contact dr jaideep at jaideep malhotraagra@gmail.com for CME AND WORKSHOPS IN YOUR CITY
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)
Diabetes is fast gaining the status of a potential epidemic in India with more than 65 million diabetic individuals currently diagnosed with the disease. Ranked second in the world, the burden of the disease is expected to compound in the years to come. Worryingly, diabetes is now being shown to be associated with a spectrum of complications and to be occurring at a relatively younger age within the country.
It is a known fact that most of the diabetes cases in our country is managed by primary care Physicians(PCP) who have a pivotal role to play in ensuring that diabetes patients receive effective care by practicing evidence based management. This said, the sad fact is that health care providers-primary care and specialists alike are not managing our patients with diabetes as well as we should be.
The complexities of the disease and its association with lot of other medical conditions make the management of diabetes more challenging to the PCPs. Patients feeling of frustration and denial about having the chronic condition often are a challenge to the practitioners in convincing the patients for initiation of treatment. With no clear cut national policy guidelines for management of diabetes, we rely on western guidelines which have certain pitfalls and fallacies in our setting.
This seminar explores the potential connection between two inositol stereoisomers supplements and improvements in insulin sensitivity and various metabolic parameters.
power point presentation on obesity by Rajeshwaree Netha (Doctor of pharmacy).
contents included are Introduction,pathophyisiology,clinical presentation (signs and symptoms of obesity disorder) ,Treatment,goals of treatment, general approach, Pharmacological treatment, and Evaluation of therapeutic outcomes.
Similar to Treatment guid line 2018 PCOD Treatment by Dr Sharda Jain Dr Jyoti Agarwal (20)
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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
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.
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.
Follow us on: Pinterest
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
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Couples presenting to the infertility clinic- Do they really have infertility...
Treatment guid line 2018 PCOD Treatment by Dr Sharda Jain Dr Jyoti Agarwal
1. TREATMENT
+
What we have learnt in last 50 years
International Guidelines 2018
DR SHARDA JAIN
DR JYOTI AGARWAL
…Caring hearts, healing hands
2. OBJECTIVES OF PPT PRESENTATION
• How we have evolved about PCOD TREATMENT
in last 50 years.
• 2018 INTERNATIONAL EVIDENCE BASED
GUIDELINES ,s have added to few more Best
Practices in the MANAGEMENT OF PCOD..& bcz
they are evidence based
NO CONTROVERSY
NO DOUBT
3. • most common endocrine disorder diagnosed in females in Reproductive years.
• It affects 3-20% & 70 % remain undiagnosed .
• PCOS-presents with variety of symptoms that can remit or relapse over time.
• These include; irregular or no menses, menorrhagia, excess facial and/or body
hair, infertility, patches of thick darker velvety skin, Central obesity, difficulty
losing weight (due to insulin resistance).
• Associated conditions include; Type 2 Diabetes , obstructive sleep apnoea, mood
disorders, and endometrial cancer.
• Other Metabolic sequelae include; hypertension, dyslipidaemia, visceral obesity,
insulin resistance, Hyperinsulinaemia and CHD.
OVERVIEW
5. PEARLS OF WISDOM
gained in the
Treatment of PCOD
1970-2018:
What have we learned about PCOD TREATMENT over the last 50 years?
•PCOS has no cure.
•Treatment involves lifestyle changes such as weight loss and exercise.
•The OCP may help improving the regularity of periods, excess hair growth, and acne.
•Metformin and anti-androgens may also help.
•Other typical acne treatments and hair removal techniques may be used.
•Efforts to improve fertility include weight loss, ovulation induction (e.g. clomiphene),
or metformin and IVF is used by some in whom other measures are not effective.
•Laparoscopic ovarian drilling may be helpful in resistant cases or where hormonal
therapy is contra-indicated or associated with severe side effects.
•Fertility therapy with PCO is associated with an increased risk OHSS.
•Untreated patients are at higher risk fo metabolic syndrome and endometrial cancer.
9. Lifestyle &
Is All About Diet, Exercise & Attitude
Psychosocial depression, sexual and quality of life scoring ,
eating disorders if any should be evaluated and managed.
LIFE Style modifications are most important component of
Treatment .
Lifestyle intervention (including nutritious Diet, regular
exercise and good behavioural habits & strategies) should
be recommended in all those with PCOS and excess weight,
for
reductions in weight, central obesity
and insulin resistance.
10. Lifestyle
Achievable goals such as 5% to 10% weight
loss in those with excess weight yields
significant clinical improvements.
11. Daily moderate exercise for 40 – 60 min
improves body's use of insulin and can help
relieve symptoms of PCOS
Running/Jogging
Chakki Chalanasana
12. Treatment PCOS:
What we learnt so far !
• Therapeutic approaches for adult patients not seeking fertility include
COMBINED ORAL CONTRACEPTIVES (COC), ANTIANDROGENS (AA) AND/OR
INSULIN SENSITIZERS (metformin ), although these practices are supported by
limited high-quality evidence.
• METANALYSIS PUBLISHED HUMAN REPRODUCTION 2017: COC versus AA versus
Metformin alone or in combination for the treatment of PCOS. Outcome
measures included hirsutism scores, IR, BMI, menses pattern, BP, lipid profile,
GTT.
• COC and AA are more effective than METFORMIN for Hyperandrogenic
symptoms and Endometrial protection. Their combination with Metformin adds
a positive effect on BMI and glucose tolerance.
13. Menstrual disorders :Combined oral
contraceptive pill (COCP)
containing non-androgenic progesterone
For ACNE/ HIRSUITISM - Ethiny Estradiol + anti
Androgen Cyproternoe Acetate
(Diane 35 / Krimson 35) was prescribe till now.
Non-fertility indications in ADOLESCENTS
Hyperandrogenism + Irregular Periods
what we have been doing so far
14. Pharmaceutical treatment for non-fertility
indications in ADOLESCENTS
Hyperandrogenism + Irregular Periods
2018 Guidelines
• The COCP could be considered in adolescents who are deemed
“at risk” but not yet diagnosed with PCOS by ULTRASOUND,
for management of clinical Hyperandrogenism and irregular
menstrual cycles (3/2)
• The 35 microgram ethinyloestradiol plus cyproterone acetate
preparations should Not be considered first line in PCOS as per
guidelines, due to adverse effects including
VENOUS THROMBOEMBOLIC risks.
15. Non-fertility indications
In ADULT WOMEN as per 2018 Guidelines
• The COCP alone should be recommended in adult
women with PCOS for management of
hyperandrogenism and/or irregular menstrual
cycles. (4/2)
16. • The COCP alone should be considered in
adolescents with a clear diagnosis of PCOS
for management of clinical
hyperandrogenism and/or irregular
menstrual cycles. 3/2
Pharmaceutical treatment for non-fertility
indications in ADOLESCENTS
Hyperandrogenism + Irregular Periods
2018 Guidelines
17. COCPin combination with METFORMIN
in adult women
• In combination with the COCP,
metformin should be considered in
women with PCOS for management of
metabolic features where COCP and
lifestyle changes do not achieve desired
goals.( 4/2)
18. COCP in combination with Metformin
and/or Anti-androgen in ADOLESCENTS
In combination with the COCP, Metformin could be
considered in Adolescents with PCOS and BMI ≥
25kg/m2 ( OVER WEIGHT ) where COCP and lifestyle
changes do not achieve desired goals (4/2)
In combination with the COCP, Metformin may be
most beneficial in high METABOLIC risk groups
including those with DIABETES risk factors, impaired
glucose tolerance or high-risk ethnic groups ( 4/2)
19. ANTIANDROGENS
Adolescents / ADULT WOMEN
• In combination with the COCP, ANTIANDROGENS
should only be considered in PCOS to treat
HIRSUTISM, after six months or more of COCP and
cosmetic therapy have failed to adequately improve
symptoms .(2/2)
• In combination with the COCP,ANTIANDROGENS
could be considered for the treatment of Androgen-
related ALOPECIA in PCOS. 2
21. PCOS and Metformin:
Our understanding so far !
• Metformin was logically introduced to establish the extent to which
hyperinsulinaemia influences the pathogenesis of PCOS.
• Early studies were very encouraging but RCTs and several meta-analyses
have changed the picture.
• In PCOS failure of the target cells to respond to normal or ordinary levels of
insulin is regarded as insulin resistance (IR).
• IR leads to a compensatory increased production of insulin by the pancreatic
beta cells to control the hyperglycaemia which ultimately fails leading to
T2DM.
• In PCOS, hyperinsulinaemia has been thought to increase
hyperandrogenaemia via a central role or by decreasing the circulating levels
of SHBG.
• IR is not considered a diagnostic criterion in PCOS. However, it is
recognized by many as a common feature in PCOS independent of obesity
22. Metformin: Our Understanding
• Metformin improves sensitivity of peripheral tissues to insulin reducing serum
levels.
• Metformin inhibits hepatic gluconeogenesis and it also increases the glucose uptake by
peripheral tissues and reduces fatty acid oxidation.
• Metformin has a positive effect on the endothelium and adipose tissue independent of
its action on insulin and glucose levels.
• Main side effects are GI; nausea, diarrhoea, flatulence, bloating, anorexia, metallic taste
and abdominal pain. These symptoms occur with variable degrees in patients and in
most cases resolve spontaneously.
• Start dose of 500 mg daily during the main meal of the day for 1–2 weeks can lessen
side effects and allow tolerance to develop. A weekly or biweekly increase by 500 mg a
day can then be pursued up to maximum 2500–2550 mg/day.
• slow release metformin can be associated with fewer side effects. Metformin can also
lead to vitamin B12 malabsorption in the distal ileum in approximately 10–30% of
patients which is an effect dependent on age, dose and duration of treatment.
23. Metformin in PCOS:Our Understanding so far
• Metformin works by reducing the circulating insulin levels.
• Conflicting evidence as to whether it can directly affect ovarian steroidogenesis.
• May restore ovulation, reduce weight, reducing circulating androgen levels, reducing the
risk of miscarriage and reducing the risk of gestational diabetes mellitus (GDM).
• Other studies have reported that the addition of metformin to the ovarian stimulation
regime in in vitro fertilization (IVF) improves the pregnancy outcome.
•
24. Metformin in PCOS:Our Understanding so far
• The lack of an emphatic or overwhelming efficacy for Metformin in females with PCOS is
largely due to the patients' variability in phenotypes and their metabolic parameters.
Some studies have tried to identify the patients that are most likely to benefit from
metformin, yet again the results have not been forthcoming.
• Metformin does not replace the need for lifestyle modification among obese and
overweight PCOS women. The evidence categorically does not encourage its use to help
weight loss either although it may be useful in redistributing adiposity according to some
evidence.
• The long-term use of Metformin to prevent remote complications of PCOS is uncertain
and a significant amount of work is needed before a decision can be made on this front.
Stipulations from studies carried out on the general population is not the same and can
be misleading given the diversity of PCOS patients with regard to their metabolic
comorbidities.
•
25. METFORMIN + Lifestyle
2018 Guidelines
• Metformin in addition to lifestyle, could be
recommended in adult women with PCOS, for the
treatment of weight, hormonal and metabolic
outcomes. 3/2
BMI ≥ 25kg /m2 ( indian -2.5)
26. METFORMIN In adolescents
2018 Guidelines
• Metformin in additional to lifestyle, could be
considered in ADOLESCENTS with a clear diagnosis
of PCOS or with symptoms of PCOS before the
diagnosis is made. 3/2
• Metformin may offer greater benefit in high
metabolic risk groups including those with diabetes
risk factors, impaired glucose tolerance or high-risk
ethnic groups
27. Prescribing METFORMIN-2018
GUIDELINES
Where metformin is prescribed the following need to be
considered:
Adverse Effects, including gastrointestinal side-effects that
are generally dose dependent and self-limiting, need to be
the subject of individualised discussion
Starting at a Low Dose, with 500mg Increments 1-2 weekly
and extended release preparations may minimise side effects
metformin use appears long-term safe, based on use in
other populations,
however ongoing requirement needs to be considered and use
may be associated with low vitamin B12 levels
28. ANTI-ANDROGEN
2018 GUIDELINES
• Where COCPs are contraindicated or poorly
tolerated, in the presence of other effective forms
of contraception, anti-androgens could be
considered to treat HIRSUTISM and androgen-
related ALOPECIA. 3/1
• Specific types or doses of Antiandrogens cannot
currently be recommended with inadequate
evidence in PCOS.
29. INOSITOL
2018 GUIDELINES
• Inositol (in any form) should currently be
considered an experimental therapy in PCOS,
with emerging evidence on efficacy highlighting
the need for further research. 1/1
31. As little as 5% of initial weight loss
over 6 months improves
fertility outcome
32. FIRST LINE
LETROZOLE
SECOND LINE
LOD/GONADOTROPINS
THIRD LINE
IVF
R
E
S
I
S
T
A
N
C
E
R
E
S
I
S
T
A
N
C
E
F
A
I
L
U
R
E
2007 ESHRE/ASRM-Sponsored PCOS Consensus
Workshop ,
2018 Guidelines are more or less the same except
very minor changes.
33. Assessment and treatment of
INFERTILITY (2018 Guidelines)
• Factors such as blood glucose, weight, blood
pressure, smoking, alcohol, diet, exercise,
sleep and mental, emotional and sexual
health need to be optimised in women with
PCOS, to improve reproductive and
obstetric outcomes, aligned with
recommendations in the general
population.
34. Assessment and treatment of infertility
(2018 Guidelines)
• Monitoring during pregnancy is important
in women with PCOS, given increased risk of
adverse maternal and offspring outcomes.
• Tubal patency testing should be considered
prior to ovulation induction in women with
PCOS where there is suspected tubal
infertility.
35. Ovulation Induction Principles
2018 Guidelines
• The use of ovulation induction agents, including
Letrozole, Metformin And Clomiphene Citrate is off
label in many countries.
• Where off label use of ovulation induction agents is
allowed, health professionals need to inform
women and discuss the evidence, possible concerns
and side effects.
36. LETROZOLE in PCOD
2018 Guideline
• Letrozole should be considered FIRST LINE
pharmacological treatment for ovulation induction
in women with PCOS with ANOVULATORY
INFERTILITY and no other infertility factors to
improve ovulation, pregnancy and live birth rates.
• Health professionals and women need to be aware
that the risk of multiple pregnancy appears to be
less with Letrozole, compared to Clomiphene
citrate.
37. Clomiphene citrate and Metformin
2018 Guidlines
• Clomiphene citrate could be used alone in women with PCOS with
anovulatory infertility and no other infertility factors to improve
ovulation and pregnancy rates.3/1
• Metformin could be used alone in women with PCOS, with
anovulatory infertility and no other infertility factors, to improve
ovulation, pregnancy and live birth rates, although women should
be informed that there are more effective ovulation induction
agents. 3/3
• Clomiphene citrate could be used in preference, when considering
clomiphene citrate or metformin for ovulation induction in women
with PCOS who are obese (BMI is ≥ 30 kg/m2) with anovulatory
infertility and no other infertility factors
38. Clomiphene citrate + metformin
2018 Guidelines
• If Metformin is being used for ovulation induction in women
with PCOS who are obese (BMI ≥ 30kg/m2) with anovulatory
infertility and no other infertility factors, clomiphene citrate
could be added to Metformin to improve ovulation,
pregnancy and live birth rates.3/2
• Clomiphene citrate could be combined with
metformin, rather than persisting with clomiphene citrate
alone, in women with PCOS who are CLOMIPHENE CITRATE-
RESISTANT, with anovulatory infertility and no other
infertility factors, to improve ovulation and pregnancy
rates.3/2
39. 2018 Guidelines
Gonadotrophins
Gonadotrophins could be used AS SECOND LINE
pharmacological agents in women with PCOS who have
failed first line oral ovulation induction therapy and are
anovulatory and infertile, with no other infertility factors.
With USG monitoring with cost and multiple pregnancies
explained.
Either gonadotrophins or laparoscopic ovarian surgery could
be used in women with PCOS with Anovulatory infertility,
clomiphene citrate-resistance and no other infertility
factors, following counselling on benefits and risks of each
therapy
40. LOD :HISTORY /Rationale:
• Laparoscopic drilling for PCOS was first used 1984 involving
multiple micro-perforations of the ovarian surface via diathermy
or LASER destroying ovarian stroma and peripheral follicles of
PCOS.
• Punctures ovarian cortex 4–10 mm deep/3 mm wide and number
of punctures related to subsequent ability to conceive. 5-10
punctures more likely to produce conception.
• Use monopolar needle/hook and electrocoagulation at 40 W,
(range from 30-400 W). Laparoscopic approach < morbidity then
ovarian wedge resection.
• Aims to reduce the amount of androgen producing tissue, may
reduce circulating E2 levels, LH level/pulsations, and inhibin B.
• The most plausible theory is that reduction of these leads to an
increase in the secretion of FSH and SHBG leading to effective
follicular maturation and ovulation.
• Low serum E2 associated with <aromatase activity. IGF-1
produced with injury aids effects of FSH through greater blood
flow GnRH delivery. AMH levels fall after drilling
• Goal of drilling treatment is induction of mono-ovulatory cycles.
THEN
NOW
41. • Weight loss and Clomiphene Citrate (CC) first line therapy.
• CC is a Selective Estrogen Receptor Modulator (SERM) with;
49% ovulation rate, 30% pregnancy rate, 23% live birth rate at
6 months, and 8% rate of multiple gestation.
• Other non-surgical PCOS medical therapy options include; the
SERM Tamoxifen or aromatase inhibitors, insulin sensitising
drugs, and hormonal ovarian stimulation.
• 25% women are resistant to CC therapy
• CC therapy is followed by GnRH therapy but >risk OHSS
• Laparoscopic drilling may reduce the risk of OHSS
• The effectiveness of the surgical procedure is similar to CC but
results in fewer multiple pregnancies per ongoing pregnancy
regardless if the technique is unilaterally or bilaterally
performed
• If patients do not become pregnant 6 months after ovulation is
induced by ovarian drilling then GnRH therapy and IVF
warranted
LOD :HISTORY /Rationale:
A strategy of
minimizing
the number
of diathermy
points to:
4/ovary
For 4 s
At 40 W
(Armar et al. Fertil Steril
1990;53:45–9
Rule of 4
42. Laparoscopic ovarian drilling
2018 Guidlines
Laparoscopic ovarian surgery could be second line therapy
for women with PCOS, who are clomiphene citrate resistant,
with anovulatory infertility and no other infertility
factors.3/2
Laparoscopic ovarian surgery could potentially be offered as
FIRST LINE TREATMENT if laparoscopy is indicated for
another reason in women with PCOS with Anovulatory
infertility and no other infertility factors.
43. Laparoscopic ovarian drilling
2018 Guideline
intra-operative and post-operative risks are
higher in women who are overweight and
obese
there may be a small associated risk of lower
ovarian reserve or loss of ovarian function
Periadnexal adhesion formation may be an
associated risk.
44. In-vitro fertilisation (IVF)
2018 Guideline
• In the absence of an absolute indication for IVF ±
intracytoplasmic sperm injection (ICSI), women with PCOS
and Anovulatory infertility could be offered IVF as third line
therapy where first or second line ovulation induction
therapies have failed.
• In women with ANOVULATORY PCOS, the use of IVF is
effective and when elective single embryo transfer is used
multiple pregnancies can be minimised.
45. In-vitro fertilisation (IVF)
2018 Guideline
Women with PCOS undergoing IVF ± ICSI therapy need to be
counselled prior to starting treatment including on:
● Availability, cost and convenience
● Increased risk of ovarian hyperstimulation syndrome
● options to reduce the risk of ovarian hyperstimulation.
46. FIRST LINE
Letrozole
SECOND LINE
LOD/GONADOTROPINS
THIRD LINE
IVF
R
E
S
I
S
T
A
N
C
E
R
E
S
I
S
T
A
N
C
E
F
A
I
L
U
R
E
TAKE HOME MESSAGES
2018 GUIDELINES ON PCOD .
INFERTILITY GUIDELINE TO BE FOLLOWED WORLD OVER
CC
Metformin
47. 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
ISO 14001:2004 (EMS)
…..Caring hearts, healing hands
ISO 9001:2008
Helpline : 9599044257
Web.www.lifecareivf.in
Helpline : 9910081484
29
Year
In
your
service