An integrated multidisciplinary model of care for addressing comorbidities beyond reproductive health among women with polycystic ovary syndrome in India

Background & objectives: Polycystic Ovary Syndrome (PCOS) is becoming an area of global and national health concern. It requires a life cycle approach from adolescence to menopause. To comprehensively address the wide spectrum of this disorder, a multidisciplinary model of care was established for women with PCOS in a government setting in India with an objective to screen and manage multifaceted manifestations of PCOS and to diagnose and treat associated comorbidities such as metabolic syndrome, dermatologic manifestations and psychological issues. Methods: A model of integrated multidisciplinary PCOS clinic was implemented for services and research at ICMR-National Institute for Research in Reproductive and Child Health (NIRRCH), Mumbai Maharashtra, India. This is a one-stop holistic centre for managing menstrual, cosmetic, infertility, obesity, metabolic and psychological concerns of women affected with PCOS. Two hundred and twenty six women diagnosed with PCOS using the Rotterdam criteria were screened for metabolic comorbidities with anthropometry, ultrasonography, hormonal and biochemical tests and for psychological problems. Analysis was performed using SPSS version 19.0. Results: Mean body mass index (BMI) was 26.1 kg/m2, higher for Asians. Hirsutism was observed in 53.6 per cent of women. Metabolic syndrome was seen among 35.3 per cent and non-alcoholic fatty liver in 18.3 per cent. Psychological issues such as anxiety and depression were identified in majority of the women 31.4 per cent of women could achieve pregnancy at the end of one year of multidisciplinary management. Interpretation & conclusions: The results of the present study suggest that an integrated multidisciplinary approach led to the early identification and treatment of comorbidities of PCOS, especially metabolic syndrome. There is hence an urgent need to implement multidisciplinary PCOS clinics in government health facilities.

Can the vagus nerve serve as biomarker for vata dosha activity?

This ‘discussion paper’ raises ‘provocative questions’ to identify physiological systems underlying vatadosha and candidate biomarkers for vata activity. We explained the strong correlations between survivaland homeostatic functions of the parasympathetic vagus nerve, and functions governed by the five majorsub-types of vata dosha (Praana, Udana, Vyaana, Samaana, and Apana). Four reasons were provided tohypothesize that vagal activity is a reliable candidate biomarker of important vata dosha functions. First,normal vata dosha and the vagus maintain neural, respiratory, and digestive homeostasis, and dysfunctions in both entities cause very similar diseases. Second, vata dosha regulates higher neural functions such as mental health and behaviour, and the ‘polyvagal theory’ proposes similar functions for thevagus. Third, the similar roles of vata dosha and vagus in maintaining gut homeostasis, suggest that vagalactivity in the ‘gut-brain’ link is a candidate biomarker of pakwashaya (lower gut), a primary regulatorysite for vata dosha. Fourth, the vagus is the only vital nerve whose activity can be reliably measured andmanipulated. Indeed, vagal nerve stimulation is a USA-FDA approved therapy for certain ailmentsattributed to impaired vata dosha. No other nerve or dosha, has such multi-functional and life-sustainingproperties. These arguments position vagal activity as a suitable candidate biomarker for certain functions of vata dosha.© 2019 The Authors. Published by Elsevier B.V. on behalf of Institute of Transdisciplinary Health Sciencesand Technology and World Ayurveda Foundation. This is an open access article under the CC BY-NC-NDlicense (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Establishment of an in vitro plantlet regeneration protocol for unique varieties of brinjal (Solanum melongena L.) var. Mattu Gulla and Perampalli Gulla.

Brinjal (Solanum melongena L.) var. Mattu Gulla (MG) and var. Perampalli Gulla (PG) are unique varieties with distinct flavour cultivated in Udupi, Karnataka State, and are exposed to several biotic and abiotic stresses. An efficient and reproducible in vitro regeneration method is required to expedite the manipulation of these brinjal varieties to cope up with stress by tissue culture and gene transfer methods. The present study, reports a rapid and efficient in vitro regeneration protocol for these two varieties. The in vitro growth response was studied on Murashige and Skoog (MS) medium supplemented with 2, 4-D, BAP and IAA, and the plantlets were regenerated efficiently from callus cultures of leaf, cotyledon and hypocotyl explants. Among the three explants, the hypocotyl explants were found to have better callus induction and multiple shoot regeneration. High frequency of shoot initiation was achieved from hypocotyl derived calluses in MS media with 2.0 mg/L BAP and 0.5 mg/L IAA in MG and PG. Efficient and rapid shoot proliferation, and elongation were noted in MS medium with 1.0 mg/L BAP and 0.3 mg/L GA3. The in vitro regenerated shoots produced healthy roots when they were cultured on MS medium supplemented with 0.5 mg/L IBA. A significant difference was observed in percentage of callus induction, number of shoots per callus, shoot elongation and number of hardened plantlets of MG and PG. MG showed maximum response in all stages of culture than PG. Hardening of plantlets in tissue culture was achieved in three weeks. The hardened plantlets were grown in pots for further acclimatization in green house and finally transplanted to experimental garden where they developed into flowering plants and produced mature fruits with viable seeds.

Association of recurrent aphthous ulcers with stress among students in an Indian Dental Institution.

Background: Recurrent aphthous ulcers are painful oral lesions with no proven effective treatment. A definitive cause of these ulcerations still remains elusive. It is believed that psychological stress may be a significant contributor. Aim: The aim of the present study was to determine whether there was any significant association of Recurrentaphthous ulcers with episodes of stress by determining the prevalence of ulcers and levels of stress tolerance among dental students. Materials and methods: A cross sectional survey was carried out on 341 students of Manipal College of Dental Sciences, Manipal, India by distributing questionnaires. The questionnaire had two sections, the first part dealt with ulcers and the later part comprised of a perceived stress scale. The data collected was analyzed with Independent sample t test and ANOVA with post hoc Tukey’s test using the SPSS 16 version software. Results: Prevalence of ulcer was found to be 66.9%. Comparison of mean stress scores between the ‘ulcer-experienced’ and ulcer-free groups showed no difference. Assessment of stress among undergraduates, interns and post graduates who had reported ulcer experience revealed that interns were able to handle the stressful situations significantly better than under graduates and post graduates. Conclusion: The present study did not show any association between episodes of ulcers and stressful events.