This guideline aims to improve diagnostic accuracy and promote evidence-based therapy for both paediatric and adult patients in both primary and secondary care. The guideline is intended for use by all healthcare professionals looking after patients with chronic cough. This guideline follows the hybrid model of the ERS Guidelines Working Group and Science Council, which combines the scientific rigour of the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework for key questions of uncertainty with a narrative component to reflect the expert consensus of the guideline task force.
Chronic cough is defined as a cough lasting for ≥8 weeks with a normal chest radiograph. The common causes of chronic cough are cough variant asthma (CVA), upper airway cough syndrome/postnasal drip syndrome (UACS/PNDs), eosinophilic bronchitis (EB), gastroesophageal reflux-related chronic cough (GERC) and atopic cough (AC). Drug induced chronic cough, a rare cause of chronic cough, refers to a chronic cough caused by certain drugs.
Cough is the most frequent complaint of patients seeking medical attention in general and hospital practice. Cough is controlled by treating the cause, however, when no cause can be found, symptomatic relief of cough must be considered. Treatment of dry cough resulting from increased sensitivity of the cough reflex remains a challenge in
some subjects. Codeine in combination with other medicines has been a mainstay for the effective short-term symptomatic relief of dry or nonproductive cough in clinical practice. This article focuses on the current status of codeine as an antitussive formulation in the treatment of dry cough.
In patients treated with azithromycin, satisfactory clinical responses (cure or improvement) were seen in 86% patients with AIECBs, 50% with acute bronchitis and 100% with pneumonia. Responses were satisfactory in 92%,100% and 100% patients, respectively, receiving co-amoxiclav.
Azithromycin is an antibiotic. Since its discovery, it has been FDA-approved for respiratory tract infections such as pneumonia, genitourinary infections such as chlamydia, and enteric infections. Patients with COVID-19 display complications of pneumonia and acute respiratory distress offers a rationale for azithromycin’s therapeutic candidacy for the current pandemic.
Acebrophylline is an airway mucus regulator with antiinflammatory action. The drug’s approach involves several points of attack in obstructive airway disease. By deviating phosphatidylcholine towards surfactant synthesis, making it no longer available for the synthesis of inflammatory mediators such as the leukotrienes, acebrophylline also exerts an inflammatory effect.
N-acetylcysteine is a classic mucolytic agent. Bronchiectasis is a chronic suppurative lung disease characterized by permanent dilation of bronchi and bronchioles. This study aimed to investigate the efficacy of N-acetylcysteine on reducing the risk of exacerbations in bronchiectasis patients.
Over the past several decades, the use of drug therapy in COPD has expanded, and provides an optimistic picture. Methyixanthines are used freely in COPD. Of them, Theophylline is an age old bronchodilator and anti-inflammatory agent while Acebrophylline is a newer one.
The aim of this study was to evaluate the efficacy and safety of a fixed-dose combination of montelukast and levocetirizine in subjects with perennial allergic rhinitis with mild-to-moderate asthma compared to montelukast alone.
To evaluate efficacy, safety and tolerability of Montelukast 10 mg+levocetirizine 5 mg FDC compared to either montelukast 10 mg or levocetirizine 5 mg given alone in seasonal allergic rhinitis (SAR) patients.
Chronic urticaria is a vexing problem for patients and treating physicians alike. The EAACI/GA2LEN/EDF/WAO guidelines advocate an increased antihistamine dosage up to four times the standard, before adding leukotriene receptor antagonists. Patients are frequently intolerant of these higher dosages.
The aim of this study was to evaluate the efficacy and safety of a fixed-dose combination of Montelukast and levocetirizine in patients with perennial allergic rhinitis with mild to moderate asthma compared with the efficacy and safety of Montelukast alone.
We investigated the effects of 6 weeks of treatment of persistent allergic rhinitis with either Montelukast alone, desloratadine alone, levocetirizine alone or the combination of Montelukast and either desloratadine or levocetirizine on patient quality of life.
Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine pathology, affecting up to 10-15% of women during the reproductive age,and constitutes one of the leading causes of infertility in industrialized areas.In fact, PCOS is characterized also by several reproductive, metabolic and cardiovascular problems, that can exert a high number of health consequences during the life span.
PCOS is the most common endocrinopathy of reproductive-aged women, affecting 6-8% of this population. Chromium picolinate is an extremely safe and highly tolerable trace mineral present in normal diet enhances gut absorption. In women with PCOS, Chromium picolinate improved glucose tolerance.
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-age women, affecting 11–18% of the population. Insulin resistance (IR) and the resultant hyperinsulinemia are key metabolic features in the pathogenesis of PCOS. Chromium picolinate (CrP) improves insulin sensitivity at the insulin receptor level, which should theoretically help with the IR and the obesity seen in PCOS.
Myoinositol supplementation is inadequate to improve oocyte or the embryo quality & pregnancy rates in women having polycystic ovary syndrome. The role of D-chiroinositol supplementation also remains unclear or unknown, The new combination was considered as superior if the percentage of relived patients receiving D-Chiroinositol + Myo inositol is 10 percentages higher than the percentage of relived patient who received Myo inositol + Placebo (folic acid).
Deficiency in the usage and/or tissue availability of myoinositol (MI) and/or D-chiroinositol (DCI) in PCOS patients could likely lead to insulin resistance typical of this syndrome. Recent studies have demonstrated that combined supplement containing both MI + DCI in their physiological plasma ratio 40:1 is able to improve the endocrine profile, ovarian function and the insulin resistance in PCOS patients.
Hormonal disorder common among women of reproductive age is polycystic ovarian syndrome (PCOS). Metformin by decreasing insulin resistance improves ovulation in women with PCOS.2 Myo-inositol a naturally occurring member of the vitamin B group regulates glucose transport and follicle-stimulating hormone signaling in the ovary whereas glycogen and insulin-induced androgen synthesis is mainly controlled through d-chiroinositol.
The most important factor affecting oocyte quality is a woman’s age. However, nowadays many couples choose to delay parenthood. Among the different factors identified, two have been shown to be highly predictive: myo-inositol (MI) and melatonin (M).
Metabolic disturbances are present in a majority of the women suffering from PCOS, i.e. 30–40% have impaired glucose tolerance and insulin resistance with compensatory hyperinsulinemia, and as many as 10% will develop type 2 diabetes mellitus during their fourth decade. Vitamin D deficiency has been proposed as the possible missing link between insulin resistance and PCOS.
The prevalence of infertility has increased significantly in recent decades, and it is currently estimated to affect approximately 15% of the population worldwide. Oxidative stress contributes to male infertility, and antioxidants have been recommended for treating idiopathic oligoasthenoteratozoospermia (OAT).
Carnitine is essential for energy metabolism and spermatozoa maturation. Combining L‐carnitine and L‐acetylcarnitine with micronutrients has been investigated as a treatment for infertility in men. Male fertility issues are major contributors to infertility in couples, accounting for approximately 50% of these casesThe causes of male infertility remain unknown, and are ambiguous in almost 40%–60% of these patients.
In order to be able to fertilize oocytes, human sperm must undergo a series of morphological and structural alterations, known as capacitation. It has been shown that the production of endogenous sperm reactive oxygen species (ROS) plays a key role in causing cells to undergo a massive acrosome reaction (AR).Astaxanthin (Asta), a photo-protective red pigment belonging to the carotenoid family, is recognized as having anti-oxidant, anti-cancer, anti-diabetic and anti-inflammatory properties and is present in many dietary supplements.
Infertility affects approximately 15% of couples trying to conceive, and a male factor contributes to roughly half of these cases. Oxidative stress (OS) has been identified as one of the many mediators of male infertility by causing sperm dysfunction. OS is a state related to increased cellular damage triggered by oxygen and oxygen-derived free radicals known as reactive oxygen species (ROS).
Excessive amounts of reactive oxygen species (ROS) cause a state of oxidative stress, which result in sperm membrane lipid peroxidation, DNA damage and apoptosis, leading to decreased sperm viability and motility. Elevated levels of ROS are a major cause of idiopathic male factor infertility, which is an increasingly common problem today. Lycopene, the most potent singlet oxygen quencher of all carotenoids, is a possible treatment option for male infertility because of its antioxidant properties.
Zinc (Zn) is the second most abundant trace element in human, which can't be stored in the body, thus regular dietary intake is required. This review explained the physiological and pathogenesis roles of zinc in men's health and its potentials in germination, quality of sperm, and fertilization.
Melatonin is a neuroregulatory hormone that has free radical scavenger, strong antioxidant, anti-inflammatory, and immunosuppressive actions. These major properties of melatonin can play an important role in the pathophysiological mechanisms of neurological diseases. In addition, melatonin is necessary for circadian rhythm. Studies have shown that melatonin levels are low in people with neurological diseases.
They conducted the first systematic review and series of meta analyses to assess the efficacy and tolerability of melatonin in children/adolescents or adults with sleep or mental health disorders, using the same set of criteria across disorders and ages.
Endogenous melatonin levels are inversely associated with age and cognitive deficits. Although melatonin can improve psychopathological behavior disturbances in clinical trials, whether melatonin may also enhance cognitive function remains elusive.
Primary sleep disorders are those not associated with a medical condition, substance use or concurrent psychological disorder. In order to be diagnosed with a primary sleep disorder, the sleep disturbance must cause significant distress or impairment in social, occupational, or other areas of functioning. Study objective - To investigate the efficacy of melatonin compared to placebo in improving sleep parameters in patients with primary sleep disorders.
Insomnia is the most commonly reported sleep problem in industrialized countries worldwide being present in about 36.8% of the general population. In Italy, such a percentage seems to be even higher. Although insomnia can be an independent disorder, it is most frequently observed as a comorbid condition and may precipitate, exacerbate, or prolong a broad range of comorbid conditions including physical and mental illnesses.
Diabetes is a major comorbidity in insomnia patients. The efficacy and safety of prolonged-release melatonin 2 mg in the treatment of glucose, lipid metabolism, and sleep was studied in 36 type 2 diabetic patients with insomnia.
Melatonin is beneficial not only in the treatment of dyssomnias, especially delayed sleep phase syndrome, but also on sleep disorders present in children with attention-deficit hyperactivity, autism spectrum disorders, and, in general, in all sleep disturbances associated with mental, neurologic, or other medical disorders. Sedative properties of melatonin have been used in diagnostic situations requiring sedation or as a premedicant in children undergoing anesthetic procedures.
The renin–angiotensin system (RAS) plays a crucial role in the conservation of extracellular volume homeostasis and blood pressure through complex molecular mechanisms. The augmented activity of circulating levels of RAS components significantly affects the pathogenesis of chronic kidney disease (CKD) and subsequently end-stage renal disease (ESRD).
Melatonin is used to treat sleep disturbances (SDs). Sleep disturbance (SD), unsatisfactory sleep, and altered sleep patterns are common among patients with cirrhosis. Up to 40–50% of patients with cirrhosis report poor and unsatisfactory sleep. The aim of this study was to investigate the safety and efficacy of low-dose melatonin for SDs in early-stage cirrhosis.
COPD is primarily the disease of the lungs; nevertheless, multiple systemic manifestations including poor sleep quality and sleep disturbances have been linked to this illness. Administration of sedative hypnotics is not recommended in COPD patients, as these drugs suppress the ventilatory response and exacerbate sleep-related disorders. Melatonin is an alternative medication that has been widely used to treat sleep disturbances caused by aging and other specific conditions.
The purpose of this investigation was to compare the effect of alprazolam and melatonin on oxidative stress, glicocalyx integrity and neurocognitive function in patients undergoing coronary artery bypass grafting (CABG)
Sleep disorders are prevalent in end-stage renal disease (ESRD) involving the majority of patients undergoing hemodialysis. The main objective of treating sleep disorders in patients of ESRD is to correct subjective and objective sleep quality, decrease fatigue and daytime sleepiness, and enhance daytime functioning.
Melatonin is the “clock factor” produced from the pineal gland dominating regular circadian rhythm in mammalians. It is an indoleamine with potent multifunctional pharmacological effects, both receptor dependent and non-receptor dependent effects, including antioxidant and anti-inflammatory activities. The aim of this review is to summarize clinical evidence related to melatonin’s effectiveness in the treatment of liver and pancreas diseases.
Melatonin, primarily secreted by the pineal gland, is an anthracemal compound. Its chemical name is N‑acetyl‑5‑methoxytryptamine. Melatonin has strong radical scavenging activity, which serves an important role in pulmonary disorders. Pulmonary disorders are among the diseases that threaten human health.
Add-on prolonged-release melatonin (PRM) in antihypertensive therapy has been shown to ameliorate nocturnal hypertension. Hypertension is a major comorbidity among insomnia patients.
Neuropathic pain (NeP) constitutes a major pain‑related disorder, which is often underdiagnosed and undertreated. Adverse physical, psychological, and economic consequences associated with NeP lead to poor quality of life. Burden of NeP in developing countries like India is colossal. Various international guidelines provide effective approaches to diagnose and manage NeP. However, differences in the genetic makeup of Indian population can result in subtle differences in clinical response, considering their low body weight, drug metabolism ability, and pain perception.
Many peripheral neuropathies are secondary to disease pathophysiologic conditions such as diabetes and unhealthy alcohol abuse, as well as the use of certain medications. Of the estimated 20 million people with neuropathy in the United States, at least 25% of neuropathies remain idiopathic.
Neuropathic pain (NeP) is defined by the International Association for the Study of Pain (IASP) as “Pain caused by a lesion or disease of the somatosensory nervous system”. NeP can be a result of a variety of conditions associated with impairing the functioning of the nervous system, such as diabetes, multiple sclerosis, trauma and herpes zoster infections.
Neuropathic pain is extremely distressing as it significantly hampers the performance of daily activities and impedes overall quality of life. A large number of illnesses are linked with neuropathic pain like radiculopathy, sciatica, diabetes, herpes infection, spinal injury, stroke, etc. Treating neuropathic pain is challenging as response to the treatment is at times uncertain and associated with undesirable side effects.
To evaluate the effectiveness and safety of coenzyme Q10 for patients with type 2 diabetes mellitus (T2DM). Methods - Data from randomized controlled trials were obtained to assess the effects of coenzyme Q10 versus placebo or western medicine on patients with T2DM.
Coenzyme Q10 (CoQ10) is an essential compound of the human body. There is growing evidence that CoQ10 is tightly linked to cardiometabolic disorders. Its supplementation can be useful in a variety of chronic and acute disorders. This review analyses the role of CoQ10 in hypertension, ischemic heart disease, myocardial infarction, heart failure, viral myocarditis, cardiomyopathies, cardiac toxicity, dyslipidaemia, obesity, type 2 diabetes mellitus, metabolic syndrome, cardiac procedures and resuscitation.
Spirulina or Arthrospira is a blue-green alga that became famous after it was successfully used by NASA as a dietary supplement for astronauts on space missions. It has the ability to modulate immune functions and exhibits anti-inflammatory properties by inhibiting the release of histamine by mast cells.
Spirulina with its high concentration of functional nutrients, is emerging as an important therapeutic food. This study aimed to evaluate the hypoglycemic and hypolipidemic role of Spirulina.
In recent decades, numerous scientific investigations have been conducted to study the antidiabetic effects of Annona muricata L. However, no comprehensive evidence-based systematic review regarding this topic is available. Hence,this study was conducted to systematically evaluate the studies of the efficacy of A. muricata in diabetes management. The search terms used were A. muricata/ soursop in combination with diabetes, glucose, and insulin.
Sitaphal is a yellowish green fruit of the family of plant species Annona. The species with an Amazonian origin is recently being cultivated in other countries including India. The fruit has established its medicinal properties for decades. Still it is not a fruit which is commonly consumed as this is a seasonal fruit.In this review we wish to outline the source, recipes, chemistry and medicinal values of the fruit and seek for a reemergence with an initiative both from private and Government sectors.
Evidence suggests that stress can affect diabetes, in terms of both its onset and exacerbation. Stress can have a deleterious effect on glycaemic control and can affect quality of life in diabetics. On the other hand emerging evidence strongly suggests that interventions that help individuals prevent or cope with stress can have an important positive effect on quality of life and glycaemic control.
Sea buckthorn (SB) has been indicated to have hypoglycemic potential, but its effects on glucose in people with impaired glucose regulation (IGR) are still unclear. This work presents a randomized, double-blinded, two-way crossover study.
Piper betel or Betel vine deep green heart shaped vary famous leaves belongs to the family Piperaceae called Paan leaves in India; rich in nutrients, minerals, vitamins, antioxidants, phytochemicals. Piper betel is mostly use to chew with sliced areca nut, slaked lime,coriander, aniseed, clove, cardamom, sweetener, coconut scrapings etc, but less used remedy.
Oxidative stress has been considered a key causing factor of liver damage induced by a variety of agents, including alcohol, drugs, viral infections, environmental pollutants and dietary components, which in turn results in progression of liver injury, non-alcoholic steatohepatitis, non-alcoholic liver disease, liver fibrosis and cirrhosis.
Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases worldwide. The pathogenesis of this disease is closely associated with obesity and insulin resistance. Ginger can have hypolipidemic and antioxidant effects, and act as an insulin sensitizer. The aim of this study was to evaluate the effects of ginger supplementation in NAFLD management.
Non-alcoholic fatty liver disease (NAFLD) is a common liver disease characterized by excess lipid deposition in the hepatic tissue and subsequent oxidative and inflammatory damage. Curcumin is a dietary polyphenol with lipid-modifying, antioxidant and anti-inflammatory properties. This study aimed to evaluate the efficacy and safety of supplementation with phytosomal curcumin in subjects with NAFLD.
The hypolipidaemic drugs have attracted considerable attention because of their potential to prevent cardiovascular disease by retarding the accelerated atherosclerosis inhyperlipidaemic individuals. So, the present clinical study was planned to evaluate the hepatoprotective effect of Katuki (Picrorhiza kurroa) processed in Guduchi on scientific parameters.
Endothelial dysfunction (ED) has been observed in individuals with metabolic syndrome (MetS) and contributes to the initiation and progression of atherosclerosis. The primary management of MetS involves lifestyle modifications and treatment of its individual components with drugs all of which have side effects. Thus, it would be of advantageous if natural products would be used as adjuncts or substitutes for conventional drugs.
Orally administered pancreatic enzymes have been available since at least the 19th century, when many formulations were available as digestive aids. At that time it was known that orally administered enzymes were destroyed in gastric juice and that they were most effective when given in alkaline media. The goal of pancreatic enzyme therapy is to restore normal fat absorption by delivering “a sufficient amount of active lipase at the right place, i.e., duodenum and proximal jejunum, and at the right time, i.e., in parallel with gastric emptying of nutrients.
Complaints related to gastrointestinal gas are commonly encountered in clinical practice.The use of activated charcoal for adsorbing intestinal gas has been effective in healthy subjects but has not been properly investigated in patients with gas complaints. Dietary modification may be beneficial in certain cases. Additional controlled trials are necessary to clarify the issues in the treatment of this common problem.
Functional gastrointestinal disorders (FGIDs) also known as disorders of gut-brain interaction are chronic, recurrent disorders with no identifiable underlying pathology. The FGID with upper abdominal pain and discomfort is the hallmark feature of functional dyspepsia. Digestive enzymes are produced and secreted by the gastrointestinal system to break down fats, proteins, and carbohydrates, to accomplish digestion and, afterwards, the absorption of nutrients.
In this review, the vitamin C trials with military personnel and with other subjects living under conditions comparable to those of military recruits are analyzed to find out whether vitamin C supplementation affects respiratory infections. For this systematic review, we identified seven trials with military personnel, three trials with students in crowded lodgings, and two trials with marathon runners.
Zinc is an essential micronutrient, present at less than 50 mg/kg, in the human body. It is important for human health and disease due to its critical roles in growth and development, bone metabolism, the central nervous system, immune function and wound healing.
Belonging to the group of expectorants, ambroxol is an active substance with a long history that influences parameters considered to be the basis for the physiological production and the transport of the bronchial mucus. The reduction on chronic obstructive pulmonary disease exacerbations is consistent and clinically relevant. The anaesthetic effect is a new pharmacological action that could be beneficial in the management of acute respiratory tract infections
Guaifenesin, a mucoactive drug, acts by loosening mucus in the airways and making coughs more productive. It is used for relief of wet cough and chest congestion due to the common cold, and remains the only legally marketed expectorant in the US (per OTC Monograph). An ingredient in numerous over-the-counter (OTC) cough/cold medications, guaifenesin has a secondary indication for use in stable chronic bronchitis (professional indication).
Cough can be productive or unproductive. Productive cough is the cough with respiratory tract secretions and unproductive cough is the cough with no respiratory tract secretions. A productive cough produces phlegm or mucus or sputum. This study was conducted to test the safety and efficacy for the combination of bronchodialators, mucolytic agents and expectorant for the treatment of productive cough in children.
Shilajit is a herbo-mineral exudate with a long history of use in traditional folk medicine. This material is called mumie, moomiyo, or mummiyo as well as various other lesser used names.Various research studies indicate that shilajit exhibits antioxidant, anti-inflammatory, adaptogenic, immunomodulatory, and anti-dyslipidemic properties. Animal and human studies indicate that shilajit enhances spermatogenesis. Furthermore, animal and human data support its use as a ‘revitalizer’, enhancing physical performance and relieving fatigue with enhanced production of ATP.
Shilajit is one of the Maharasa (classified drug) mentioned in classical texts. The first reference of Shilajit in classified text Charaka Samhita states that "metals like gold and others present in the rocks which receive heat and exudate is called Shilajit ". It is most important drug of Ayurveda and Folk medicine system. The primary component of Shilajit is fulvic acid which contribute to congnitive health. It has been used as rejuvenator and adaptogen for thousands of years as a part of traditional system of medicine in a number of countries. Many therpeutic properties are attributed due to presence of various compounds present in Shilajit which have been verified by modern scientific evaluation. It has been proved that Shilajit is truly a panacea of traditional medicine.
Shilajit is a safe, fluvic mineral complex exudate that is common to Ayurvedic medicine and is composed of fulvic acids, dibenzo-α-pyrones, proteins, and minerals.Shilajit supplementation may have a beneficial effect on exercise performance by enhancing fatigue-related metabolic characteristics and, potentially, increasing muscle mass and strength.
Purified Shilajit (PS) is used in Ayurveda, indigenous system of Indian medicine, as a remedy for several diseases, particularly chronic diseases. Shilajit is a pale-brown to blackish-brown exudate that oozes from sedimentary rocks worldwide, largely in the Himalayas.Traditional uses of Shilajit primarily focus not only on diabetes and diseases of the urinary tract, but also on oedema, tumours, muscle wasting, epilepsy and even insanity. Modern indications extend to all systems of the human body with a significant number of additions in the reproductive and nervous system.
Stress is the biological response which is controlled by the brain as a result to a challenging stimulation of a physical or mental nature. Stress as defined by Hans Selye is “the nonspecific response of the body to a stimulus or event, whether it is caused by the pleasant or unpleasant condition.”Stressor is any agent which produces stress. All stressors, whether physical or emotional, would provoke the same physiological reaction.
Erectile dysfunction (ED) has been defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. ED is a benign disorder, it affects physical and psychosocial health and has a significant impact on the quality of life of sufferers and their partners and families. ED can disrupt existing marital or sexual relationships and may be the cause of unconsummated marriages and infertility.
The use of plant or plant-based products to stimulate sexual desire and to enhance performance and enjoyment is almost as old as the human race itself. The present paper reviews the active, natural principles, and crude extracts of plants, which have been useful in sexual disorders, have potential for improving sexual behaviour and performance, and are helpful in spermatogenesis and reproduction. Review of refereed journals and scientific literature available in electronic databases and traditional literature available in India was extensively performed.
Mucuna pruriens (Fabaceae) is an established herbal drug used for the management of male infertility, nervous disorders, and also as an aphrodisiac. It has been shown that its seeds are potentially of substantial medicinal importance. The ancient Indian medical system, Ayurveda, traditionally used M. pruriens, even to treat such things as Parkinson’s disease. M. pruriens has been shown to have anti-parkinson and neuroprotective effects, which may be related to its anti-oxidant activity
Shilajit (mumie), a natural multi-component herbomineral ethnomedicinal food, is used as a traditional medicine for enhancing the quality of life and for management of health ailments in many countries of the world. Use of Shilajit as an adaptogen, aphrodisiac, rejuvenator and anti-aging substance is mentioned in many ancient texts. This review aims to provide comprehensive insights into its biochemical aspects, microbial role in biosynthesis, bioactivities and to establish correlation between traditional uses and scientifically validated research findings.
Melatonin is a lipophilic hormone synthesized and secreted mainly in the pineal gland, acting as a neuroendocrine transducer of photoperiodic information during the night. In addition to this activity, melatonin has shown an antioxidant function and a key role as regulator of physiological processes related to human reproduction.
Melatonin regulates biological rhythms via its receptors located in the suprachiasmatic nuclei of the hypothalamus. Melatonin also has strong antioxidant activities to scavenge free radicals such as reactive oxygen species (ROS). The direct free radical scavenging actions are receptor independent. ROS play an important role in reproductive function including in the ovulatory process. However, excessive ROS can also have an adverse effect on oocytes because of oxidative stress, thereby causing infertility. It is becoming clear that melatonin is located in the ovarian follicular fluid and in the oocytes themselves, which protects these cells from oxidative damage as well as having other beneficial actions in oocyte maturation, fertilization, and embryo development.
The central circadian regulatory system is located in the suprachiasmatic nucleus (SCN). The output of this master clock is synchronized to 24 hours by the prevailing light-dark cycle. The SCN regulates rhythms in peripheral cells via the autonomic nervous system and it sends a neural message to the pineal gland where it controls the cyclic production of melatonin; after its release, the melatonin rhythm strengthens peripheral oscillators. Melatonin is also produced in the peripheral reproductive organs, including granulosa cells, the cumulus oophorus, and the oocyte. These cells, along with the blood, may contribute melatonin to the follicular fluid, which has melatonin levels higher than those in the blood.
Melatonin (N-acetyl-5-methoxytryptamine) is secreted during the dark hours at night by pineal gland, and it regulates a variety of important central and peripheral actions related to circadian rhythms and reproduction. It has been believed that melatonin regulates ovarian function by the regulation of gonadotropin release in the hypothalamus-pituitary gland axis via its specific receptors. In addition to the receptor mediated action, the discovery of melatonin as a direct free radical scavenger has greatly broadened the understanding of melatonin’s mechanisms which benefit reproductive physiology.
Melatonin, secreted by the pineal gland, is taken up into the follicular fluid from the blood. Reactive oxygen species (ROS) are produced within the follicles, during the ovulatory process. Melatonin reduces oxidative stress as an antioxidant, and contribute to oocyte maturation, embryo development and luteinization of granulosa cells. Our clinical study demonstrated that melatonin treatment for infertile women increases intra-follicular melatonin concentrations, reduces intra-follicular oxidative damage, and elevates fertilization and pregnancy rates.
Infertility is defined as the inability to conceive for at least 1 year. Infertility is a common condition affecting 10–20% of women at the reproductive age across different countries. Assisted reproductive technology (ART) has allowed millions of infertile couples in the world to conceive successfully since 1978. Although substantial advance has been made in the past.decades, the chance of achieving a live birth through ART is not high. Several strategies aiming to increase the live birth rate are currently being used, such as endometrial scratching, assisted hatching of human embryos, the addition of drugs to improve successful rate.
Melatonin regulates biological rhythms via its receptors located in the suprachiasmatic nuclei of the hypothalamus. Melatonin also has strong antioxidant activities to scavenge free radicals such as reactive oxygen species (ROS). The direct free radical scavenging actions are receptor independent. ROS play an important role in reproductive function including in the ovulatory process. However, excessive ROS can also have an adverse effect on oocytes because of oxidative stress, thereby causing infertility. It is becoming clear that melatonin is located in the ovarian follicular fluid and in the oocytes themselves, which protects these cells from oxidative damage as well as having other beneficial actions in oocyte maturation, fertilization, and embryo development.
Subfertility is defined as not being able to conceive after 1 year, which means being less fertile than a typical couple. Subfertility is a very common condition, affecting approximately 15% of reproductive age women, and assisted reproductive technology (ART) is widely used to treat this condition. Currently, the chance of achieving a live birth after an ART cycle is close to 30%, and several strategies aiming to improve this rate are currently being tested. Oxidative stress is indicated as a possible cause of poor oocyte quality, which can affect female reproduction. Several antioxidant enzymes (e.g., catalase, glutathione peroxidase, superoxide dismutase) protect oocytes and embryos from oxidative stress.
Melatonin plays an essential role in the pathogenesis of many reproductive processes. Human preovulatory follicular fluid (FF) contains higher concentrations of melatonin than does plasma, and melatonin receptors are present in ovarian granulosa cells (GC). Melatonin has been shown to have direct effects on ovarian function. Reactive oxygen species and apoptosis are involved in a number of reproductive events including folliculogenesis, follicular atresia, ovulation, oocyte maturation, and corpus luteum (CL) formation.
Leiomyoma is very commonly seen in the present times in Gynecological practice. The incidence is high in women in active reproductive age, especially in nulliparous women. These are commonly known as Fibroids and are composed of fibrous connective tissue.
Ashoka (Saraca indica or Saraca asoca (Roxb.), belonging to the family Caesalpinioideae, is one of the most important herb extensively used in bleeding disorders in women throughout her active reproductive period. Ashoka means no grief in Sanskrit language. So it is also called as “friend of women” because it has reputation of its bark for retaining a woman healthy and youthful. Chemically, it contains glycosides, flavonoids, tannins and saponins. Its actions are spasmogenic, uterotonic, oxytocic, antibacterial, antit-umour, anti-implantations, anti-progestational and antiestrogenic to fight against menorrhagia, leucorrhoea and anticancer.
Ashoka is the most ancient tree of India, generally known as a “ashok briksh”, botanist known as a Saraca asoca (Roxb.), De.wild or Saraca indica belonging family Caesalpinaceae. Medicinal herbs are moving from fringe to mainstream use with a great number of people seeking remedies and health approaches free from side effects caused by synthetic chemicals. Saraca asoca is reported to contain glycoside, flavanoids, tannins and saponins.
Menstrual abnormalities are common problems associated with women especially belongs from age of puberty. The modern pattern of life style also created these types of problems. The menstrual abnormalities possess some specific features i.e.; irregular menstrual bleeding, cramping, profuse bleeding, painful discharge and absence of menstruation, etc. As per Ayurveda aggravation of Vata Dosha and vitiation of Rakta Dhatu mainly initiates pathogenesis of menstrual abnormalities.
Herbal drugs are cheaper, easily available and with a meager fear of any side effects. Many herbs effective for infertility are also used in folk practice which often goes unnoticed. Shivlingi beej is one such unnoticed folk medicine that shows good results for counteracting infertility. It is a uterine tonic and improves the chances of conception in women suffering from infertility. An effort has been made in this paper to scientifically review and explain the role of Shivlingi seeds in infertility of either sex hypothetically.
Bryonia laciniosa is one such plant that is also known by the name of shivlingi as its seeds resemble the 'shivling' icon of Lord Shiva. This plant is mainly known for its seeds and is used in various ayurvedic drug formulations as an important ingredient. In Ayurveda and the folklore culture, shivlingi plant is used to treat various types of diseases such as cholera, bronchitis, constipation, diabetes, inflammation, paralysis, snake bites, abdominal diseases and mainly used as an aphrodisiac agent.
Primary dysmenorrhea is a common gynecologic problem in teenage girls and women of reproductive age that has an adverse impact on women's quality of life. The aim of the present study was to determine the effects of oral Aloe vera gel on the intensity of primary dysmenorrhea in students of Zahedan University of Medical Sciences
Despite the advanced technology and development, Anemia has remained as a major health problem of rural as well as urban areas for different nutritional reasons. Many ayurvedic research scholars have taken efforts to establish a satisfactory line of treatment for it. From the review of ayurvedic research works, it is evident that they tried various single or compound drugs to counter anemia. ‘Kasisa (Ferrous sulphate)’ which is an iron compound is presented in this article in two forms i.e Kasisa bhasma (Rasashastra preparation) and Annabhedi chenduram (Siddha preparation).
Polycystic ovary syndrome (PCOS) is one of the most prevalent hormonal disorders among women of reproductive age causing irregular menstrual cycles, excessive body or facial hair, miscarriage and infertility. The latter being a most common PCOS symptoms. Because the symptoms are seemingly unrelated to one another, PCOS is often overlooked and undiagnosed. Furocyst caused significant decrease in both ovarian volume and the number of ovarian cysts. Serum ALT, BUN and CK were assessed to demonstrate the broad-spectrum safety of Furocyst. No significant adverse effects were observed. In summary, Furocyst was efficacious in ameliorating the symptoms of PCOS.
Hemidesmus indicus is a well known medicinal plant used in Ayurveda for treating many diseases. But there are fewer reports on the uroprotective activity of H. indicus root extract. So, the present study was carried out to investigate the effect of the methanolic extract of H. indicus root (MHI) against uropathogenic bacteria i.e. Escherichia coli and Klebsiella pneumoniae.Antibacterial activity of MHI was tested against the above-mentioned bacteria by using four methods, viz; disc diffusion, agar well diffusion, modified agar well diffusion and cfu/ml determination in control and MHI treated bacteria by using spread plate and absorbance methods. In disc diffusion method, MHI was more effective against K. pneumoniae in comparison to E. coli whereas, in agar well and modified agar well diffusion method, MHI was comparatively more effective against E. coli than K. pneumoniae.
Kasis Bhasma and Phaltrikadi Kwath are the two famous ayurvedic preparation that are described in ayurvedic classics for the management in panduroga (Anemia). Both drugs provided significant effect on the signs and symptoms of shrama (fatigue), daurbalya (weakness), hrudrava (palpitation), shwasa (exertional dyspnoea), aruchi (anorexia), Kati paad shool (pain in back and lower limbs).
Anaemia is a major global public health problem with consequences on human health, social and economical development. Anaemia can be caused due to multiple factors but one of the major factors is nutritional deficiency. IDA is the most significant contributor of all anaemias and hence IDA and anaemia are often used synonymously.Kasīsa bhasma produced significant improvement than Dhātrī avaleha in primary outcome measure and a few of the secondary outcome measures also. Study shows that a noniron, herbal formulation viz. Dhātrī avaleha produces significant improvement during both intervention and sustainability period.