Calixarene-Metal Complexes in Lactide Polymerization: The Story so Far.

Polylactide synthetic procedures have lately gained attention, possibly due to their biocompatibility and the environmental problems associated with fossil-fuel-based polymers. Polylactides can be obtained from natural sources such as cassava, corn, and sugar beet, and polylactides can be manufactured in a laboratory using a variety of processes that begin with lactic acid or lactide. One of the most effective synthetic pathways is through a Lewis acid catalyzed ring-opening polymerization of lactides to obtain a well-defined polymer. In this regard, calixarenes, because of their easy functionalization and tunable properties, have been widely considered to be a suitable 3D molecular scaffold for new metal complexes that can be used for lactide polymerization. This review summarizes the progress made in applying some metal-calixarene complexes in the ring-opening polymerization of lactide.

Fresh transfer of an average quality slow growing day-3 embryo versus frozen transfer in a poor responder: a clinical management dilemma.

A common conundrum faced by clinicians is whether to go for fresh transfer or culture the embryos for future frozen transfer in a case of slow-growing embryo. This case report describes a successful pregnancy with the fresh transfer of a single day 3- 6-cell grade B embryo in a patient with poor ovarian reserve. Although more research is needed in this context, the fresh transfer can be considered as a treatment option in patients with optimal endometrium and well-controlled progesterone levels with slow-growing embryos.

Synthesis of a Zirconium Complex of an N,O-type p-tert-Butylcalix[4]arene and Its Application in Some Multicomponent Reactions.

The synthesis and characterization of a new octahedral Zr(IV) complex of oxygen-depleted N,O-type calixarene ligand comprising two distal-functionalized pyrazole rings have been reported. The cone shape and structure of the prepared complex were confirmed univocally by single-crystal X-ray diffraction and NMR studies. The Zr metal lies at 2.091 Å from the plane of the calixarene ring. This complex has been utilized as an efficient catalyst for the synthesis of Biginelli adducts, bis(indolyl)methanes, and coumarins. This complex (Cl2Zr-calixarene) showed superior activity for these multicomponent reactions in comparison to the corresponding Ti(IV) and Zn(II) analogues. Ferrocene-appended bis(indolyl)methane, prepared using this catalyst, was also evaluated for its anticancer activity against the A-172 cell line.

A non-classical presentation of scar endometriosis during pregnancy: Case report and review of literature.

Scar endometriosis is an uncommon condition in which endometrial tissue grows in a previous surgery wound site. The triad of scar endometriosis includes the history of caesarean section or any other gynecological surgery, cyclical waxing, and waning pain accompanied by the patient's menstrual cycle and a tumor inside/near the scar site. Here, we present a case report in which the patient presented with endometriosis at the previous caesarean section scar site. She had classical clinical and imaging characteristics for scar endometriosis. However, histopathology was not diagnostic for the same. The pathogenesis, presentation, diagnosis, and management are discussed briefly. The diagnosis of scar endometriosis is based on clinical presentation and imaging. Fibrosis on histopathology is an important component of endometriosis that cannot be overlooked.

Management of peri-ovarian hematoma following oocyte retrieval in a pooling cycle IVF: Case report.

Here we report a case of peri-ovarian hematoma following ovum pick-up in a patient in a pooling cycle IVF (in vitro fertilization). We have attempted to discuss the possible mechanisms for the development of hematoma in such patients, the common clinical presentation, monitoring, and management of these cases. The decision to operate or to manage conservatively forms an important aspect of managing such patients. This case report can help to keep the clinicians alert while managing this subgroup of patients.

Efectos del tratamiento homeopático individualizado en la hipertensión esencial de estadio I: ensayo aleatorizado, simple ciego, controlado con placebo / Effects of Homeopathic Treatment Individualized in Hypertension Stage I Essential: Randomized Trial, Single Blind, Placebo controlled

Fundamentos: la hipertensión arterial es el cuarto principal factor de riesgo de muerte e incapacidad, así como el responsable de más de 1.6 millones de fallecimientos en la India. Los informes de casos clínicos, los estudios observacionales y los ECA evidencian los efectos de los medicamentos homeopáticos en la hipertensión. Objetivos: los resultados de este estudio se añaden a la evidencia de la eficacia del uso de los medicamentos homeopáticos individualizados en la hipertensión de estadio I. Materiales y métodos: Se ha realizado un ensayo aleatorizado, simple ciego y controlado por placebo entre octubre de 2013 y marzo de 2018. El parámetro primario fue evaluar los cambios en la presión sistólica (PS) y la presión diastólica (PD) mensualmente durante tres meses. 217 pacientes de los 2,127 pacientes examinados cumplieron los criterios de selección y fueron aleatorizados para recibir un medicamento en potencias Q (o potencias LM) más indicaciones para la modificación del estilo de vida (MEV) (116 pacientes) o bien placebo + MEV (101 pacientes). La modificación del estilo de vida incluyó actividad física y dieta como parte de la pauta terapéutica. El análisis fue de intención de tratamiento. Resultados: Las mediciones ANOVA repetidas entre los grupos mostraron una diferencia estadística significativa (Lambda de Wilks 0.85, F=12.12, dF=213, P=0.0001) tanto en la PS como en la PD a favor de la Homeopatía individualizada. La prueba t independiente post hoc mostró una reducción media significativa de la PS [diferencia media 7.12 mmHg, IC del 95%; CI 4.72 a 9.53, P=0.0001] y un descenso medio de la PD [diferencia media 5.76 mmHg, IC del 95%: 4.18 a 7.23, P=0.0001] a favor del grupo con Homeopatía más MEV. Los medicamentos más utilizados fueron: Sulphur (n=24), Natrium muriaticum (n=21), Lycopodium (n=16), Nux vomica (n=12) y Phosphorus (n=10). Conclusiones: Se ha constatado que la Homeopatía individualizada junto con la MEV fue más eficaz que el placebo junto con la MEV en los pacientes que sufren hipertensión en estadio I. Se precisan más ensayos en un marco estricto. (AU)

Background: Hypertension (HTN) is a leading risk factor for death and disability and responsible for over 1.6 million deaths in India. Clinical case reports, observational studies and randomised controlled trials show the effects of homoeopathic medicine in HTN. Objectives: The results of this study will add to the evidence of effectiveness of individualised homoeopathic medicine in Stage I HTN. Methods: A single-blind, randomised, placebocontrolled trial was undertaken from October 2013 to March 2018. The primary outcome measure was to evaluate the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) every month for 3 months. Of 2,127 patients screened, 217 patients who fitted the inclusion criteria were randomised to receive either homoeopathic Q potencies (or LM potencies) plus lifestyle modification (LSM)=116 or placebo + LSM=101. LSM included physical activity and diet as part of the treatment regimen. Analysis was by intention to treat. Results: Repeated-measure ANOVA between the groups showed statistically significant difference (Wilk lambda 0.85, F=12.12, df=213, P=0.0001), in both SBP and DBP favouring Individualised Homoeopathy (IH) along with LSM. Post hoc independent t-test showed a significant mean reduction in SBP (mean difference 7.12 mmHg, 95% confidence interval [CI] 4.72-9.53, P=0.0001) and DBP (mean difference 5.76 mmHg, 95% CI: 4.18-7.23, P=0.0001) favouring Homoeopathy plus LSM group. Sulphur (n=24), Natrum muriaticum (n=21), Lycopodium (n=16), Nux vomica (n=12) and Phosphorus (n=10) were the most useful medicines. Conclusion: IH in LM potency along with LSM was found effective over placebo along with LSM in the patients suffering from Stage I HTN. Further trials in rigorous setting are warranted. (AU)

Comparison of Clinical, Metabolic, Hormonal, and Ultrasound Parameters among the Clomiphene Citrate-Resistant and Clomiphene Citrate-Sensitive Polycystic Ovary Syndrome Women.

OBJECTIVE: The objective of the study is to compare the clinical, metabolic, hormonal, and ultrasound parameters among the clomiphene citrate (CC)-sensitive and CC-resistant polycystic ovary syndrome (PCOS) women. MATERIALS AND METHODS: This was a prospective observational study. SETTING: The study was conducted at the infertility outpatient department in a government hospital. SAMPLE SIZE: A total of 164 women with PCOS-related infertility were included. INTERVENTION: Incremental dose of CC from 50 mg/day to 100 mg/day to 150 mg/day over three cycles was given. RESPONSE: Ovulation was the outcome. Those who failed to ovulate with 150 mg CC were CC resistant. RESULTS: Of the total 164 PCOS women, 88 (53.7%) were CC resistant and 76 (46.3%) were CC sensitive. Of the 76 PCOS women who ovulated, maximum, i.e., 37 (22.6%) women ovulated with 100 mg CC. The most common diagnostic feature of PCOS in this study was hyperandrogenism (96.3%). CC-resistant PCOS women had significantly higher weight, waist circumference, waist-hip ratio, and body mass index (BMI). Significantly longer menstrual cycles and hyperandrogenism were significantly more common in CC-resistant group. CC-resistant group had a significantly higher ovarian reserve (ovarian volume, antral follicle count, and anti-Müllerian hormone values). Baseline luteinizing hormone (LH) values and LH-follicle stimulating hormone ratio were significantly higher in the CC-resistant group. CONCLUSION: Clomiphene-resistant PCOS women have significantly higher hyperandrogenism, longer cycles, more deranged metabolic profile, higher BMI, and ovarian reserve. These differences should be kept in mind while deciding the ovulation induction protocol.

Comparison of the Different PCOS Phenotypes Based on Clinical Metabolic, and Hormonal Profile, and their Response to Clomiphene.

OBJECTIVE: To compare the different polycystic ovarian syndrome (PCOS) phenotypes based on their clinical, metabolic, hormonal profile, and their differential response to clomiphene. DESIGN: Prospective observational study. SETTING: Infertility clinic, a government hospital. SAMPLE SIZE: 164 women with PCOS-related infertility. MATERIALS AND METHODS: Sample population was divided into four phenotypes based on the NIH (National Institute of Health) consensus panel criteria. The incremental dose of clomiphene from 50 to 150 mg/day over three cycles was given. OUTCOME MEASURES: Clinical history, metabolic, hormonal profile, and ultrasound features of each phenotype. Also, the response to clomiphene citrate was studied as presence or absence of ovulation. RESULTS: The prevalence of phenotypes A, B, C, and D were 67.7%, 11%, 17.7%, and 3.6%, respectively. Phenotype A had significantly higher weight, body mass index, clinical, and biochemical hyperandrogenism, menstrual irregularities, ovarian reserve parameters, fasting insulin, HOMA-IR, and more deranged lipid profile (P < 0.05). Clomiphene resistance was significantly more common in phenotype A (P < 0.05). No significant differences were noted in the waist circumference, waist-hip ratio, blood pressure and blood sugar values (fasting, 1-hour postprandial, 2-hour postprandial). Also, the Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), LH-FSH ratio, 17-hydroxyprogesterone, and vitamin D levels were not significantly different among various PCOS phenotypes. CONCLUSION: Full-blown PCOS (phenotype A) is at a higher risk of adverse metabolic and cardiovascular outcomes as compared with the others, and phenotype D is the least severe phenotype. Thus, the phenotypic division of patients with PCOS-related infertility can help in prognosticating the patients about the severity of the disease and the fertility outcome.

Prediction of Responsiveness to Clomiphene Citrate in Infertile Women with PCOS.

BACKGROUND: The purpose of the study was to evaluate the role of clinical, metabolic, hormonal and ultrasound features of women with PCOS in predicting the response to clomiphene citrate in treatment of infertility. METHODS: A prospective observational study was done over a period of one year. A total of 164 women with PCOS related infertility were enrolled. They were treated with an incremental dose of clomiphene citrate starting with 50 mg/day to a maximum of 150 mg over 3 cycles. The response was recorded as either presence or absence of ovulation. Multiple logistic regression was used to analyze various clinical, metabolic, hormonal and ultrasound features in these women. Sensitivity and specificity of each of these parameters in predicting non-responsiveness (failure to ovulate with 150 mg clomiphene) were calculated. RESULTS: Ferriman-Gallwey score, androstenedione levels, HDL, and cholesterol were found to be the independent predictors of non-responsiveness to clomiphene citrate. The overall best predictor of non-responsiveness to clomiphene citrate is Ferriman- Gallwey score (FG). FG score, with a cut off value of 15, had 73.9% sensitivity and 86.8% specificity in predicting non-responsiveness to clomiphene. BMI was the best anthropometric predictor of the non-responsiveness to clomiphene. Fasting insulin was the best metabolic predictor of the non-responsiveness to clomiphene. AFC was the best ovarian reserve marker as the predictor of the non-responsiveness to clomiphene (cut-off value of 11.75 with 73.9% sensitivity and 73.7% specificity). CONCLUSION: Ferriman-Gallwey score, androstenedione levels, and lipid profile are clinically useful parameters to predict which groups of PCOS women are unlikely to respond to clomiphene.

Obese and Non-obese Polycystic Ovarian Syndrome: Comparison of Clinical, Metabolic, Hormonal Parameters, and their Differential Response to Clomiphene.

OBJECTIVE: To study the clinical, metabolic, hormonal parameters, and differential response to clomiphene among the obese and non-obese PCOS (polycystic ovarian syndrome). DESIGN: Prospective observational study. SETTING: Infertility OPD, a government hospital. SAMPLE SIZE: About 164 women with PCOS-related infertility. STUDY GROUPS: Obese PCOS group [body mass index (BMI) ≥23 kg/m2) and non-obese PCOS group (BMI <23 kg/m2). RESULTS: Of the total 164 PCOS women, 124 (75.61%) were in the obese group with BMI ≥23 kg/m2 and 40 (24.39%) were in the non-obese PCOS group. The prevalence of menstrual irregularity, hypertension, insulin resistance (IR), metabolic syndrome, endometrial hyperplasia, and clomiphene resistance in the PCOS women were 82.34%, 3.66%, 59.76%, 24.39%, 7.93%, and 53.7%, respectively. The Ferriman-Gallwey score, menstrual irregularity, IR [fasting insulin and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)], metabolic syndrome, deranged lipid profile, and clomiphene resistance were statistically more common in the obese PCOS group (P < 0.05). Hypertension, deranged blood sugar profile, testosterone, androstenedione levels, and endometrial hyperplasia were more common in obese PCOS group but the results were not statistically significant. No significant differences were found in the luteinizing hormone (LH), follicle-stimulating hormone (FSH), LH-FSH ratio, and 17-hydroxyprogesterone (17-OHP) levels between the two groups. CONCLUSION: Obese PCOS have a higher risk of adverse outcomes like hypertension, IR, metabolic syndrome, and endometrial hyperplasia. So, targeting obesity in PCOS women will not only help to prevent adverse outcomes but also improve responsiveness to clomiphene citrate.

Effect of Adjuvant Homeopathy with Usual Care in Management of Thrombocytopenia Due to Dengue: A Comparative Cohort Study.

BACKGROUND: Dengue is an emerging threat to public health. At present, no clear modalities are available for the prevention and management of thrombocytopenia due to dengue. This article reports the clinical outcomes of integrative homeopathic care in a hospital setting during a severe outbreak of dengue in New Delhi, India, during the period September to December 2015. METHODS: Based on preference, 138 patients received a homeopathic medicine along with usual care (H+UC), and 145 patients received usual care (UC) alone. Assessment of thrombocytopenia (platelet count < 100,000/mm3) was the main outcome measure. Kaplan-Meier analysis enabled comparison of the time taken to reach a platelet count of 100,000/mm3. RESULTS: There was a statistically significantly greater rise in platelet count on day 1 of follow-up in the H+UC group compared with UC alone (mean difference = 12,337; 95% confidence interval [CI], 5,421 to 19,252; p = 0.001). This trend persisted until day 5 (mean difference = 14,809; 95% CI, 1,615 to 28,004; p = 0.02). The time taken to reach a platelet count of 100,000/mm3 was nearly 2 days earlier in the H+UC group compared with UC alone (H+UC: 3.44 days ± standard error of the mean [SEM] 0.18; 95% CI, 3.08 to 3.80; UC: 5.28 days ± SEM 0.29; 95% CI, 4.71 to 5.86; p < 0.001). CONCLUSION: These results suggest a positive role of adjuvant homeopathy in thrombocytopenia due to dengue. Randomized controlled trials may be conducted to obtain more insight into the comparative effectiveness of this integrative approach.

Evaluation of efficacy of peri-operative administration of hydrocortisone and dexamethasone in prevention of post-operative complications in oral and maxillofacial surgeries / Evaluación de la eficacia de la administración peri-operatoria de hidrocortisona y dexametasona para prevenir las complicaciones postoperatorias de la cirugía oral y maxilofacial

Objective: To evaluate the role of intra-operative hydrocortisone and post-operative dexamethasone on reducing post-operative complications following major surgeries involving oral cavity as in oral and maxillofacial surgeries performed under general anesthesia. Methodology: The post-surgical stress induces changes in metabolic and endocrinal pathways and also results in activation of inflammatory pathways. Post-operative administration of steroids helps in blocking all the stages of inflammatory process. This study was conducted on a group of 20 patients undergoing major surgical procedures. These patients were administered a combination of intra-operative hydrocortisone and post-operative dexamethasone therapy. Efficacy of these drugs in reducing post-operative complications was evaluated, using parameters like post-operative pain, number of analgesic injections, edema, sore throat, nausea and vomiting. Results: A 70% mean reduction in pain was seen on 2nd post-operative day and a drastic 97% pain reduction was noted on 4 th post-operative day. An overall 12 mm reduction in swelling was noted over the span of 4 days of hospital stay. Post-operative administration of dexamethasone helped in reduction of sore throat up to 95% on 2nd post-operative day. A remarkable finding noted was, that, none of the patients developed nausea and vomiting post-operatively. Conclusion: Surgeries done in and around the oral cavity are mostly prone to contamination as presence of saliva, bacteria, contaminants from stomach flora through acid reflux and post-operative events like vomiting, pollute the surgical site. A single intra-operative dose of hydrocortisone followed by post-operative tapered administration of dexamethasone helps in combating almost all of the post-operative complications after major oral and maxillofacial surgical procedures and hence hastens healing of surgical site

Objetivo: Evaluar el papel de la administración intraoperatoria de hidrocortisona, y postoperatoria de dexametasona, para reducir las complicaciones postoperatorias tras las cirugías mayores de la cavidad oral y la cirugía oral y maxilofacial realizadas bajo anestesia general. Metodología: El estrés postquirúrgico induce cambios en las vías metabólica y endocrina, y origina también la activación de las vías inflamatorias. La administración postoperatoria de esteroides ayuda a bloquear todas las etapas del proceso inflamatorio. Este estudio se realizó en un grupo de 20 pacientes sometidos a intervenciones quirúrgicas mayores. A dichos pacientes se les administró una combinación de hidrocortisona intra-operatoria y dexametasona postoperatoria. Se evaluó la eficacia de dichos fármacos para reducir las complicaciones postoperatorias, utilizando parámetros tales como dolor postoperatorio, número de inyecciones analgésicas, edema, dolor de garganta, náuseas y vómitos. Resultados: Se observó un 70% de reducción media del dolor al segundo día postoperatorio y un 97% de reducción drástica del dolor al cuarto día postoperatorio. Se observó una reducción general de 12 mm del edema durante el transcurso de la estancia hospitalaria de 4 días. La administración postoperatoria de dexametasona ayudó a reducir el dolor de garganta en un 95% durante el segundo día postoperatorio. Un hallazgo destacable fue que ninguno de los pacientes desarrolló náuseas ni vómitos a nivel postoperatorio. Conclusión: Las cirugías practicadas en y alrededor de la cavidad oral son más propensas a la contaminación, ya que la presencia de saliva, bacterias, contaminantes de la flora estomacal a través del reflujo ácido, y los acontecimientos post-operatorios tales como vómitos, contaminan el sitio quirúrgico. La administración de una única dosis intra-operatoria de hidrocortisona y postoperatoria de dexametasona ajustada ayuda a combatir la mayoría de las complicaciones postoperatorias tras las intervenciones quirúrgicas mayores orales y maxilofaciales y, por tanto, contribuye a la curación del sitio quirúrgico

Reliability of intra-oral camera using teledentistry in screening of oral diseases - Pilot study.

OBJECTIVE: Reliability of intra-oral camera using teledentistry in screening of oral diseases. METHODOLOGY: A trained and calibrated examiner used intra-oral camera to capture videos of oral cavity along with clinical examination to evaluate caries, plaque, calculus, tooth wear and fluorosis, stains in children. RESULTS: The mean DT and DMFT were significantly higher with use of intra-oral camera than with clinical examination (p = 0.001 and 0.001) respectively. A positive strong significant correlation was seen between intra-oral camera and clinical examination with respect to DT, MT, FT and DMFT (r = 0.721, p < 0.001; r = 0.908, p < 0.001; r = 0.869, p < 0.001; r = 0.876, p < 0.001) respectively. Reliability of intra-oral camera when compared with clinical examination varied from substantial to almost perfect agreement various oral conditions. Disclosed immature plaque was not clear while mature plaque was clearly demonstrated. CONCLUSION/RECOMMENDATIONS: Intra-oral camera was shown to be a reliable tool to identify common oral diseases. Further studies involving applications like sealant retention, pre-malignant lesions, recurrent apthae, gingival recession and dental malocclusion and effectiveness in regular screening are needed.