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VOLUME 2 , ISSUE 1 ( January-March, 2018 ) > List of Articles

RESEARCH ARTICLE

Evaluation of Vyoshadi Guggulu and Haritaki Churna in the Management of Dyslipidemia: A Multicenter Prospective Clinical Study

Paravazhi Radhakrishanan, Varanasi Subose, Guru C Bhuyan

Keywords : Ayurveda, Dyslipidemia, Haritaki Churna, Medoroga, Quality of life, Vyoshadi Guggulu.

Citation Information : Radhakrishanan P, Subose V, Bhuyan GC. Evaluation of Vyoshadi Guggulu and Haritaki Churna in the Management of Dyslipidemia: A Multicenter Prospective Clinical Study. J Res Ayurvedic Sci 2018; 2 (1):12-19.

DOI: 10.5005/jp-journals-10064-0034

License: CC BY-NC 3.0

Published Online: 00-03-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Dyslipidemia (DL) is a principal risk factor in the pathophysiology of cardiovascular diseases (CVD) and diabetes mellitus (DM). It may correlate with Medoroga, which is a risk factor for diseases like Prameha, Hridroga Jwara, Bhagandara, Vrana, Vataroga, etc. Aim: To assess the clinical efficacy of Vyoshadi Guggulu (VG) and Haritaki Churna (HC) in the management of DL and changes in the quality of life of the study participants. Materials and methods: It was a prospective, multicenter, single-arm study. The Ayurvedic formulations VG (2 tablets of 500 mg each TDS) after food with lukewarm water and HC (3 gm bd) were administered for 12 weeks with a follow-up of 2 weeks without interventions. Totally, 146 participants belonging to either sex, 18 to 70 years with low-density lipoprotein (LDL) 100 to 160 mg/dL and/or serum cholesterol 200 to 250 mg/dL and/or serum triglycerides (TG) 150 to 250 mg/dL and those willing and able to participate were included in the study. The outcome measures were changes in lipid profile, clinical safety, and changes in the quality of life. Results: There was a significant reduction (p < 0.005) in the mean serum cholesterol level, i.e., 214.8 reduced to 208.3 after 84 days of treatment and (p < 0.001) in the mean high-density lipoprotein (HDL), i.e., 46.3 reduced to 44.04 after 84 days of treatment. There was no significant change in the serum TG, LDL, and very-low density lipoprotein (VLDL) value. There is also improvement in the quality of life (p < 0.001) of the participants. There are no significant changes observed in the laboratory safety parameters. This corroborated that drugs are safe to use. Conclusion: Vyoshadi Guggulu and Haritaki Churna are effective in the management of DL and are safe to use. Clinical significance: The use of these drugs may lower the complications of DL.


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  1. Enas A, Vishwanathan M, Mohan D, Sayed F, Pazhoor S, Chennikkara H. The metabolic syndrome and dyslipidemia among Asian Indians: a population with high rates of diabetes and premature coronary artery disease. J Cardiometab Syndr 2007 Sep;2(4):267-275.
  2. Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; And International Association for the Study of Obesity. Circulation 2009 Oct;120(16):1640-1645.
  3. Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, Franklin B, Kris-Etherton P, Harris WS, Howard B, et al. Diet and lifestyle recommendations revision 2006. A scientific statement from the American Heart Association Nutrition Committee. Circulation 2006 Jul;114(1):82-96.
  4. Anjana RM, Ali MK, Pradeepa R, Deepa M, Datta M, Unnikrishnan R, Rema M, Mohan V. The need for obtaining accurate nationwide estimates of diabetes prevalence in India: rationale for a national study on diabetes. Indian J Med Res 2011 Apr;133:369-380.
  5. Ramsubba Rao KV, Laxmu NM. Management of Hyperlipidaemia (Medoroga) in Ayurveda—a review. Int Res J Pharm 2011;2(11):6-10.
  6. Prasad SVLN, Rao V Prahalad, Punita V, Murali Manohar Raju Y, Sharmila UV, Anand B. Efficacy and safety of an Ayurvedic regimen in Medoroga. Indian J Traditional Knowl 2009 Jul;8(3):379-386.
  7. Singhal GD. Ayurvedic clinical diagnosis based on Madhava Nidana, Part II. Chowkhamba Sanskrit Pratishthan: Delhi; 1996. p. 593-594 (Chapter 34, verse 34.1-2/1, 34.2/2-4).
  8. Ware JE, Snow KK, Kosisnki M, Gandek B. SF-36 Health Survey Manual and Interpretation Guide. Boston, MA: The Health Institute; 1993.
  9. Anonymous. The Ayurvedic Pharmacopeia of India (API), Part-II, Vol-II. 1st ed. The Controller of Publications; New Delhi: Ministry of Health and Family Welfare, Govt. of India; 2007. pp. 138-140
  10. Anonymous. The Ayurvedic Pharmacopeia of India (API), Part-II, Vol-II. 1st ed. The Controller of Publications; New Delhi: Ministry of Health and Family Welfare, Govt. of India; 2007. pp. 47-48.
  11. Pooja BA, Bhatted S, Chaturvedi N, Deekshit S, Bhojani MK. Role of atorvastatin in dyslipidemia: a clinical study. Indian J Clin Practice 2013 Dec;24(7):620-622.
  12. Ragvani H, Bhatt N, Thakar AB. Clinical evaluation of Vyoshadi Guggulu and Haritaki Churna in the management of dyslipidemia. Int J Pharm Biol Arch 2013 Aug;4(4): 643-646.
  13. Bha—vami œra. Bha—vapraka—œa Nighan.t.u—Hindi Commentary by Shastri Brahmashankara Vaidhya Rupalalji. 9th ed. Vol. I. Chaukhumbha Sanskrit Bhawan: Varanasi; 1999. p. 959.
  14. Upadhyay BN. Studies on role of Commiphora mukul (Gugullu) in management of IHD. PhD Thesis, Department of Kayachikitsa, Varanasi: IMS BHU; 1979.
  15. Maruthappan V, Shree KS. Hypolipidemic activity of Haritaki (Terminalia chebula) in atherogenic diet induced hyperlipidemic rats. J Adv Pharm Technol Res 2010 Apr;1(2):229-235.
  16. Rathore HS, Soni S, Bhatnagar D. Hypocholesterolemic effect of Terminalia chebula fruit (Myrobalan) in mice. Anc Sci Life 2004 Apr;23(4):11-15.
  17. Hasani-Ranjbar S, Nayebi N, Moradi L, Mehri A, Larijani B, Abdollahi M. The efficacy and safety of herbal medicines used in the treatment of hyperlipidemia; a systematic review. Curr Pharm Des 2010;16(26):2935-2947.
  18. Saravanan S, Srikumar R, Manikandan S, Jeya Parthasarathy N, Sheela Devi R. Hypolipidemic effect of Triphala in experimentally induced hypercholesteremic rats. Yakugaku Zasshi 2007 Feb;127(2):385-358.
  19. Thakur CP, Thakur B, Singh S, Sinha PK, Sinha SK. The Ayurvedic medicines Haritaki, Amala and Bahira reduce cholesterol-induced atherosclerosis in rabbits. Int J Cardiol 1988 Nov;21(2):167-175.
  20. Kumar S, Sharma S, Vasudeva N. Screening of antidiabetic and antihyperlipidemic potential of oil from Piper longum and piperine with their possible mechanism. Expert Opin Pharmacother 2013 Sep;14(13):1723-1736.
  21. Vijayakumar RS, Nalini N. Piperine, an active principle from Piper nigrum, modulates hormonal and apo lipoprotein profiles in hyperlipidemic rats. J Basic Clin Physiol Pharmacol 2006 Jun;17(2):71-86.
  22. Bao L, Bai S, Borijihan G. Hypolipidemic effects of a new piperine derivative GB-N from Piper longum in high-fat diet-fed rats. Pharm Biol 2012 Aug;50(8):962-967.
  23. Parim B, Harishankar N, Balaji M, Pothana S, Sajjalaguddam RR. Effects of Piper nigrum extracts: restorative perspectives of high-fat diet-induced changes on lipid profile, body composition, and hormones in Sprague-Dawley rats. Pharm Biol 2015 Apr;53(9):1318-1328.
  24. Otunola GA, Oloyede OB, Oladiji AT, Afolayan AJ. Selected spices and their combination modulate hypercholesterolemia- induced oxidative stress in experimental rats. Biol Res 2014 Mar;47:55.
  25. El-Rokh el-S, Yassin NA, El-Shenawy SM, Ibrahim BM. Antihypercholesterolaemic effect of ginger rhizome (Zingiber officinale) in rats. Inflammopharmacology 2010 Dec;18(6): 309-315.
  26. Bhandari U, Kanojia R, Pillai KK. Effect of ethanolic extract of Zingiber officinale on dyslipidaemia in diabetic rats. J Ethnopharmacol 2005 Feb 28;97(2):227-230.
  27. Alizadeh-Navaei R, Roozbeh F, Saravi M, Pouramir M, Jalali F, Moghadamnia AA. Investigation of the effect of ginger on the lipid levels. A double blind controlled clinical trial. Saudi Med J 2008 Sep;29(9):1280-1284.
  28. Goel A, Dharurkar P, Shah A, Gore S, More S, Ranjan S. Only spinal fixation as treatment of prolapsed cervical intervertebral disc in patients presenting with myelopathy. J Craniovertebr Junction Spine. 2017 Oct-Dec;8(4):305-310.
  29. Goel A, Kaswa A, Shah A, Rai S, Gore S, Dharurkar P. Extraspinal-Interdural Surgical Approach for C2 Neurinomas-Report of an Experience with 50 Cases. World Neurosurg. 2018 Feb;110:575-582.
  30. Goel A, Jain S, Shah A, Patil A, Vutha R, Ranjan S, More S. Atlantoaxial Fixation for Odontoid Fracture: Analysis of 124 Surgically Treated Cases. World Neurosurg. 2018 Feb;110:558-567.
  31. Goel A, Jain S, Shah A.Radiological Evaluation of 510 Cases of Basilar Invagination with Evidence of Atlantoaxial Instability (Group A Basilar Invagination). World Neurosurg. 2018 Feb;110:533-543.
  32. Goel A, Bhaganagare A, Shah A, Kaswa A, Rai S, Dharurkar P, Gore S. Olfactory groove meningiomas: An analysis based on surgical experience with 129 cases. Neurol India. 2018 Jul-Aug;66(4):1081-1086.
  33. Goel A, Nadkarni T: Surgical management of giant pituitary tumours- a study of 30 cases. Acta Neurochir (Wien) 138; 1042- 1049, 1996.
  34. Goel A: The extradural approach to lesions involving cavernous sinus. Br J Neurosurg 11(2): 134-138, 1997
  35. Goel A, Muzumdar D, Desai K: Tuberculum sellae meningioma: A report on management on the basis of a surgical experience with 70 cases. Neurosurgery) 51:1358-1364,2002.
  36. Goel A, Muzumdar D, Raman C: Trigeminal neuroma: An analysis of a surgical experience with 73 cases. Neurosurgery 52:783- 790,2003.
  37. Goel A, Nadkarni T, Muzumdar D, Desai K, Phalke U, Sharma P: Giant pituitary tumors: a study based on surgical treatment of 118 cases. Surg Neurol. 2004 May;61(5):436-445.
  38. Goel A: Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation. J Neurosurg Spine. 2004 Oct;1(3):281-6.
  39. Goel A, Muzumdar, Desai K Anterior tentorium-based epidermoid tumours: Results of radical surgical treatment in 96 cases. “Br J Neurosurg. 2006 Jun;20(3):139-45.
  40. Malvankar-Mehta MS, Chen YN, Iordanous Y, Wang WW, Costella J, Hutnik CML. iStent as a solo procedure for glaucoma patients: a systematic review and meta-analysis. PLoS One2015;10(5):e0128146.
  41. Malvankar-Mehta MS, Iordanous Y, Chen YN. iStent with phacoemulsification versus phacoemulsification alone for patients with glaucoma and cataract: a meta-analysis. PLoS One2015;10(7):e0131770.
  42. Bahler CK, Smedley GT, Zhou J, Johnson DH. Trabecular bypass stents decrease intraocular pressure in cultured human anterior segments. Am J Ophthalmol2004;138(6):988-994.
  43. Gedde SJ, Herndon LW, Brandt JD, Budenz DL, Feuer WJ, Schiffman JC. Postoperative complications in the tube versus trabeculectomy (TVT) study during five years of follow-up. Am J Ophthalmol2012;153(5):804-814.
  44. Iordanous Y, Kent JS, Hutnik CML, Malvankar-Mehta MS. Projected cost comparison of Trabectome, iStent, and endoscopic cyclophotocoagulation versus glaucoma medication in the Ontario Health Insurance Plan. J Glaucoma2014;23:e112-118.
  45. Kaplowitz K, Bussel II, Honkanen R, Schuman JS, Loewen NA. Review and meta-analysis of ab-interno trabeculectomy outcomes. Br J Ophthalmol 2016;100(5):594-600.
  46. Almeida Junior GC, Arakawa L, Santi Neto DD, Cury PM, Lima Filho AA, Sousa SJ, Alves MR, Azoubel R. Preoperative tranilast as adjunctive therapy to primary pterygium surgery with a 1-year follow-up. Arq Bras Oftalmol 2015 Jan-Feb; 78(1):1-5.
  47. Bahar I, Lusky M, Gaton D, Robinson A, Avisar R, Weinberger D. The use of fibrin adhesive in trabeculectomy: a pilot study. Br J Ophthalmol 2006 Nov;90(11):1430.
  48. Bahar I, Weinberger D, Lusky M, Avisar R, Robinson A, Gaton D. Fibrin glue as a suture substitute: histological evaluation of trabeculectomy in rabbit eyes. Curr Eye Res 2006 Jan;31(1):31-36.
  49. Buschmann W, Stemberger A, Blumel G, Leydhecker W. Fibrin adhesion and postoperative anti-fibrinolytic care of conjunctival wounds. Klin Monatsbl Augenheilkd 1984 Mar;184(3):185-188.
  50. Choudhari NS, Neog A, Latka S, Srinivasan B. Fibrin sealantassisted revision of the exposed Ahmed tube. Middle East Afr J Ophthalmol 2015 Jan-Mar;22(1):115-116.
  51. Choudhari NS, Neog A, Sharma A, Iyer GK, Srinivasan B. Authors' reply. Indian J Ophthalmol 2013 Jun;61(6):312-313.
  52. Choudhari NS, Neog A, Sharma A, Iyer GK, Srinivasan B. Our experience of fibrin sealant-assisted implantation of Ahmed glaucoma valve. Indian J Ophthalmol 2013 Jan-Feb;61(1): 23-27.
  53. Dal Pizzol MM, Roggia MF, Kwitko S, Marinho DR, Rymer S. Use of fibrin glue in ocular surgery. Arq Bras Oftalmol 2009 May-Jun;72(3):308-312.
  54. Dintelmann T, Lieb WE, Grehn F. Filtering bleb revision. Techniques and outcome. Ophthalmologe 2002 Dec;99(12): 917-921.
  55. Du TT, Saffra N. Acellular dermal graft as a treatment of recurrent conjunctival wound dehiscence. Arch Ophthalmol 2009 Nov;127(11):1520-1521.
  56. Elmalem VI, Harris GJ. Occurrence and surgical management of a cerebrospinal fluid-filled cystoid space following routine enucleation. Ophthal Plast Reconstr Surg 2012 Sep-Oct;28(5):e117-e118.
  57. Esquenazi S, Rand W, Velazquez G, Grunstein L. Novel therapeutic approach in the management of band keratopathy using amniotic membrane transplantation with fibrin glue. Ophthalmic Surg Lasers Imaging 2008 Sep-Oct;39(5): 418-421.
  58. Freeman PD, Kahook MY, Curtis TH. Glaucoma drainage device implantation in children using fibrin glue. J AAPOS 2010 Apr;14(2):169-171.
  59. Piltz JR, Starita RJ. The use of subconjunctivally administered tissue plasminogen activator after trabeculectomy. Ophthalmic Surg 1994 Jan;25(1):51-53.
  60. Por YM, Tan YL, Mehta JS, Tan DT. Intracameral fibrin tissue sealant as an adjunct in tectonic lamellar keratoplasty for large corneal perforations. Cornea 2009 May;28(4):451-455.
  61. Sakarya Y, Sakarya R, Yildirim A. Sutureless amniotic membrane fixation with fibrin glue in symptomatic bullous keratopathy with poor visual potential. Eur J Ophthalmol 2010 Jan-Feb;20(1):249; author reply 249-250.
  62. Lee GA, Holcombe DJ. Surgical revision of dysfunctional filtration blebs with bleb preservation sliding conjunctival flap and fibrin glue. Eye (Lond) 2010 Jun;24(6):947-953.
  63. Kahook MY, Noecker RJ. Fibrin glue-assisted glaucoma drainage device surgery. Br J Ophthalmol 2006 Dec;90(12):1486-1489.
  64. Valimaki J. Fibrin glue for preventing immediate postoperative hypotony following glaucoma drainage implant surgery. Acta Ophthalmol Scand 2006 Jun;84(3):372-374.
  65. Malhotra C, Jain AK. Human amniotic membrane transplantation: different modalities of its use in ophthalmology. World J Transplant 2014 Jun;4(2):111-121.
  66. Dua HS, Gomes JA, King AJ, Maharajan VS. The amniotic membrane in ophthalmology. Surv Ophthalmol 2004 Jan-Feb;49(1):51-77.
  67. Shimmura S, Shimazaki J, Ohashi Y, Tsubota K. Antiinflammatory effects of amniotic membrane transplantation in ocular surface disorders. Cornea 2001 May;20(4):408-413.
  68. Yazdani S, Mahboobipour H, Pakravan M, Doozandeh A, Ghahari E. Adjunctive mitomycin c or amniotic membrane transplantation for Ahmed glaucoma valve implantation: a randomized clinical trial. J Glaucoma 2016 May;25(5):415-421.
  69. Sheha H, Kheirkhah A, Taha H. Amniotic membrane transplantation in trabeculectomy with mitomycin C for refractory glaucoma. J Glaucoma 2008 Jun-Jul;17(4):303-307.
  70. Khairy HA, Elsawy MF. Trabeculectomy with mitomycin-C versus trabeculectomy with amniotic membrane transplant: a medium-term randomized controlled trial. J Glaucoma 2015 Sep;24(7):556-559.
  71. Rauscher FM, Barton K, Budenz DL, Feuer WJ, Tseng SC. Long-term outcomes of amniotic membrane transplantation for repair of leaking glaucoma filtering blebs. Am J Ophthalmol 2007 Jun;143(6):1052-1054.
  72. Sethi P, Patel RN, Goldhardt R, Ayyala RS. Conjunctival advancement with subconjunctival amniotic membrane draping technique for leaking cystic blebs. J Glaucoma 2016 Feb;25(2):188-192.
  73. Kitagawa K, Yanagisawa S, Watanabe K, Yunoki T, Hayashi A, Okabe M, Nikaido T. A hyperdry amniotic membrane patch using a tissue adhesive for corneal perforations and bleb leaks. Am J Ophthalmol 2009 Sep;148(3):383-389.
  74. Nagai-Kusuhara A, Nakamura M, Fujioka M, Negi A. Longterm results of amniotic membrane transplantation-assisted bleb revision for leaking blebs. Graefes Arch Clin Exp Ophthalmol 2008 Apr;246(4):567-571.
  75. Rai P, Lauande-Pimentel R, Barton K. Amniotic membrane as an adjunct to donor sclera in the repair of exposed glaucoma drainage devices. Am J Ophthalmol 2005 Dec;140(6): 1148-1152.
  76. Ainsworth G, Rotchford A, Dua HS, King AJ. A novel use of amniotic membrane in the management of tube exposure following glaucoma tube shunt surgery. Br J Ophthalmol 2006 Apr;90(4):417-419.
  77. Papadaki TG, Siganos CS, Zacharopoulos IP, Panteleontidis V, Charissis SK. Human amniotic membrane transplantation for tube exposure after glaucoma drainage device implantation. J Glaucoma 2007 Jan;16(1):171-172.
  78. Mulder EJ, Leiblum DM, Visser GH. Fetal breathing movements in late diabetic pregnancy: relationship to fetal heart rate patterns and Braxton Hicks’ contractions. Early Hum Dev 1995 Nov;43(3):225-232.
  79. Schulte FJ, Michaelis R, Nolte R, Albert G, Parl U, Lasson U. Brain and behavioral maturation in newborn infants of diabetic mothers. I. Nerve conduction and EEG patterns. Neuropadiatrie 1969 Jan-Jul;1(1):24-35.
  80. Devoe LD, Youssef AA, Castillo RA, Croom CS. Fetal biophysical activities in third-trimester pregnancies complicated by diabetes mellitus. Am J Obstet Gynecol 1994 Aug;171(2):298-303.
  81. Dierker LJ Jr, Pillay S, Sorokin Y, Rosen MG. The change in fetal activity periods in diabetic and nondiabetic pregnancies. Am J Obstet Gynecol 1982 May;143(2):181-185.
  82. Doherty NN, Hepper PG. Habituation in fetuses of diabetic mothers. Early Hum Dev 2000 Aug;59(2):85-93.
  83. Kainer F, Prechtl HF, Engele H, Einspieler C. Assessment of the quality of general movements in fetuses and infants of women with type-1 diabetes mellitus. Early Hum Dev 1997 Nov;50(1):13-25.
  84. Mulder EJ, O'Brien MJ, Lems YL, Visser GH, Prechtl HF. Body and breathing movements in near-term fetuses and newborn infants of type-1 diabetic women. Early Hum Dev 1990 Nov;24(2):131-152.
  85. Mulder EJ, Visser GH. Growth and motor development in fetuses of women with type-1 diabetes. I. Early growth patterns. Early Hum Dev 1991 May;25(2):91-106.
  86. Mulder EJ, Visser GH. Growth and motor development in fetuses of women with type-1 diabetes. II. Emergence of specific movement patterns. Early Hum Dev 1991 May;25(2):107-115.
  87. Mulder EJ, Visser GH. Impact of early growth delay on subsequent fetal growth and functional development: a study on diabetic pregnancy. Early Hum Dev 1992 Dec;31(2):91-95.
  88. Mulder EJ, Visser GH, Bekedam DJ, Prechtl HF. Emergence of behavioral states in fetuses of type-1 diabetic women. Early Hum Dev 1987 Jul;15(4):231-251.
  89. Mulder EJ, Visser GH, Morssink LP, de Vries JI. Growth and motor development in fetuses of women with type-1 diabetes. III. First trimester quantity of fetal movement patterns. Early Hum Dev 1991 May;25(2):117-133.
  90. Aberg A, Westbom L, Kallen B. Congenital malformations among infants whose mothers had gestational diabetes or preexisting diabetes. Early Hum Dev 2001 Mar;61(2):85-95.
  91. Deregnier RA, Nelson CA, Thomas KM, Wewerka S, Georgieff MK. Neurophysiologic evaluation of auditory recognition memory in healthy newborn infants and infants of diabetic mothers. J Pediatr 2000 Dec;137(6):777-784.
  92. Nelson CA, Wewerka S, Thomas KM, Tribby-Walbridge S, deRegnier R, Georgieff M. Neurocognitive sequelae of infants of diabetic mothers. Behav Neurosci 2000 Oct;114(5):950-956.
  93. Reece EA, Homko CJ. Infant of the diabetic mother. Semin Perinatol 1994 Oct;18(5):459-469.
  94. Reece EA, Homko CJ. Why do diabetic women deliver malformed infants? Clin Obstet Gynecol 2000 Mar;43(1):32-45.
  95. Rizzo T, Metzger BE, Burns WJ, Burns K. Correlations between antepartum maternal metabolism and intelligence of offspring. N Engl J Med 1991 Sep;325(13):911-916.
  96. Rizzo TA, Metzger BE, Dooley SL, Cho NH. Early malnutrition and child neurobehavioral development: insights from the study of children of diabetic mothers. Child Dev 1997 Feb;68(1):26-38.
  97. Schwartz R, Teramo KA. Effects of diabetic pregnancy on the fetus and newborn. Semin Perinatol 2000 Apr;24(2):120-135.
  98. Vaarasmaki MS, Hartikainen A, Anttila M, Pramila S, Koivisto M. Factors predicting peri- and neonatal outcome in diabetic pregnancy. Early Hum Dev 2000 Jul;59(1):61-70.
  99. Robertson SS, Dierker LJ. Fetal cyclic motor activity in diabetic pregnancies: sensitivity to maternal blood glucose. Dev Psychobiol 2003 Jan;42(1):9-16.
  100. Accardo PJ, Blondis TA, Whitman BY. Disorders of attention and activity level in a referral population. Pediatrics 1990 Mar;85(3 Pt 2):426-431.
  101. Ornoy A, Uriel L, Tennenbaum A. Inattention, hyperactivity and speech delay at 2-4 years of age as a predictor for ADDADHD syndrome. Isr J Psychiatry Relat Sci 1993;30(3):155-163.
  102. Smyth TR. Impaired motor skill (clumsiness) in otherwise normal children: a review. Child Care Health Dev 1992 Sep-Oct;18(5):283-300.
  103. Petersen MB, Pedersen SA, Greisen G, Pedersen JF, Mølsted- Pedersen L. Early growth delay in diabetic pregnancy: relation to psychomotor development at age 4. Br Med J (Clin Res Ed) 1988 Feb;296(6622):598-600.
  104. Sells CJ, Robinson NM, Brown Z, Knopp RH. Long-term developmental follow-up of infants of diabetic mothers. J Pediatr 1994 Jul;125(1):S9-S17.
  105. Vladareanu R, Lebit D, Constantinescu S. Ultrasound assessment of fetal neurobehaviour in high risk pregnancies. DSJUOG 2012 Apr-Jun;6(2):132-147.
  106. Talic A, Kurjak A, Ahmed B, Stanojevic M, Predojevic M, Kadic AS, Di Renzo GC. The potential of 4D sonography in the assessment of fetal behavior in high-risk pregnancies. J Matern Fetal Neonatal Med 2011 Jul;24(7):948-954.
  107. Bekedam DJ, Visser GH, de Vries JJ, Prechtl HF. Motor behaviour in the growth retarded fetus. Early Hum Dev 1985 Nov;12(2):155-165.
  108. Cioni G, Prechtl HF. Preterm and early postterm motor behaviour in low-risk premature infants. Early Hum Dev 1990 Sep;23(3):159-191.
  109. Seme-Ciglenecki P. Predictive value of assessment of general movements for neurological development of highrisk preterm infants: comparative study. Croat Med J 2003 Dec;44(6):721-727.
  110. Abo-Yaqoub S, Kurjak A, Mohammed AB, Shadad A, Abdel-Maaboud M. The role of 4-D ultrasonography in prenatal assessment of fetal neurobehaviour and prediction of neurological outcome. J Matern Fetal Neonatal Med 2012 Mar;25(3):231-236.
  111. Athanasiadis AP, Mikos T, Tambakoudis GP, Theodoridis TD, Papastergiou M, Assimakopoulos E, Tarlatzis BC. Neurodevelopmental fetal assessment using KANET scoring system in low and high-risk pregnancies. J Matern Fetal Neonatal Med 2013 Mar;26(4):363-368.
  112. Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, Carmina E, Chang J, Yildiz BO, Laven JS, et al. Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril 2012 Jan;97(1):28-38.e25
  113. Sirmans SM, Pate KA. Epidemiology, diagnosis and management of polycystic ovary syndrome. Clin Epidemiol 2014; 6:1-13.
  114. Fauser BC, Diedrich K, Bouchard P, Domínguez F, Matzuk M, Franks S, Hamamah S, Simón C, Devroey P, Ezcurra D, et al. Contemporary genetic technologies and female reproduction. Human Reproduction Update 2011 Nov;17(6):829-847.
  115. Balen A, Conway G, Kaltsas G. Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod 1995 Aug;10(8):2107-2111.
  116. Azziz R, Sanchez L, Knochenhauer ES, Moran C, Lazenby J, Stephens KC, Taylor K, Boots LR. Androgen excess in women: experience with over 1000 consecutive patients. J Clin Endocrinol Metab 2004 Feb;89(2):453-462.
  117. Wild S, Pierpoint T, McKeigue P, Jacobs H. Cardiovascular disease in women with polycystic ovary syndrome at longterm follow-up: a retrospective cohort study. Clin Endocrinol (Oxf) 2000 May;52(5):595-600.
  118. Hollinrake E, Abreu A, Maifeld M, Van Voorhis BJ, Dokras A. Increased risk of depressive disorders in women with polycystic ovary syndrome. Fertil Steril 2007 Jun;87(6): 1369-1376.
  119. Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome. In: Givens JHF, Merriman G, editors. The polycystic ovary syndrome. Cambridge, MA: Blackwell Scientific; 1992. p. 377-384.
  120. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004 Jan;81(1):19-25.
  121. Azziz R, Carmina E, DeWailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, et al. Position statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab 2006 Nov;91(11):4237-4245.
  122. Lujan ME, Jarrett BY, Brooks ED, Reines JK, Peppin AK, Muhn N, Haider E, Pierson RA, Chizen DR. Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume. Hum Reprod 2013 May;28(5):1361-1368.
  123. Badawy A, Elnashar A. Treatment options for polycystic ovary syndrome. Int J Womens Health 2011 Feb;3:25-35.
  124. ACOG Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No 108: Polycystic ovary syndrome. Obstet Gynecol 2009 Oct;114(4):936-949.
  125. Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril 2008 Mar;89(3): 505-522.
  126. Balen AH. Ovulation induction in the management of anovulatory polycystic ovary syndrome. Mol Cell Endocrinol 2013 Jul;373(1-2):77-82.
  127. Berridge DL, Winter TC. Saline infusion sonohysterography: technique, indications, and imaging findings. J Ultrasound Med 2004 Jan;23(1):97-112.
  128. Allison SJ, Horrow MM, Kim HY, Lev-Toaff AS. Salineinfused sonohysterography: tips for achieving greater success. Radiographics 2011 Nov-Dec;31(7):1991-2004.
  129. O'Neill MJ. Sonohysterography. Radiol Clin North Am 2003 Jul;41(4):781-797.
  130. Bonnamy L, Marret H, Perrotin F, Body G, Berger C, Lansac J. Sonohysterography: a prospective survey of results and complications in 81 patients. Eur J Obstet Gynecol Reprod Biol 2002 Apr;102(1):42-47.
  131. Lindheim SR, Adsuar N, Kushner DM, Pritts EA, Olive DL. Sonohysterography: a valuable tool in evaluating the female pelvis. Obstet Gynecol Surv 2003 Nov;58(11):770-784.
  132. Lindheim SR, Sprague C, Winter TC. Hysterosalpingography and sonohysterography: lessons in technique. AJR Am J Roentgenol 2006 Jan;186(1):24-29.
  133. Jeanty P, Besnard S, Arnold A, Turner C, Crum P. Air-contrast sonohysterography as a first step assessment of tubal patency. J Ultrasound Med 2000 Aug;19(8):519-527.
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