Three women with diverse gynaecological medical histories (one with endometriosis, one having had an episiotomy and obstetric anal sphincter injury during a recent delivery, and one having had a recent cystectomy of the left Bartholin gland) developed acute episodes of gynaecological pelvic pain. In each case, clinical investigations (including objective tools for assessing the source, nature and severity of the pain) were conducted early on, and a multimodal approach to therapy was introduced to control the pain and avoid central sensitization or chronicity. The multimodal approach included hormone therapy, antineuropathic medications, and corticosteroid or botulinum neurotoxin infiltrations in some of the patients according to their medical conditions but consistently included behavioural adjustments, physical interventions and a nutraceutical supplement (alpha-lipoic acid, palmitoylethanolamide and myrrh). In each case, the pelvic pain and associated dyspareunia (Marinoff scale 2 or 3) were largely resolved. These clinical cases support the results of clinical trials showing the benefits of alpha-lipoic acid + palmitoylethanolamide + myrrh for the management of gynaecological pelvic pain, enabling the reduction or withdrawal of other analgesic, anti-inflammatory and antineuropathic medications.

Alpha-lipoic acid (ALA) is a natural short chain fatty acid containing sulfhydryl groups generated from octanoic acid and cysteine in the mitochondria, and is found in both the aqueous and lipid phases. The present study aimed to assess the efficacy of ALA supplementation in primary infertile males complaining of idiopathic asthenozoospermia. Eighty patients were randomly allocated to treatment group A (n = 40) and control group B (n = 40) groups, receiving daily doses of 600 mg (divided into two daily doses of 300 mg each) of alpha lipoic acid (ALA) or an identical placebo for 90 days. Semen analysis, anthropometric and total antioxidant capacity were analysed and compared before and after treatment. Daily supplementation with ALA improved total motility and progressive motility of the spermatozoa. In the ALA-treated group, sperm motility and progressive motility increased significantly, similarly, the mean percentage of sperm vitality demonstrated a significant increase among the ALA treated group (p < 0.001). Analysis revealed a statistically significant increase in semen volume and sperm concentration in the ALA supplemented group, while abnormal morphology decreased significantly (p < 0.001). ALA supplementation significantly improved sperm parameters and functional tests in group A patients. ALA supplementation in patients with idiopathic asthenozoospermic thus enhanced sperm quality and viability, which could therefore be considered as an adjunct therapy pending further verification of its association and mechanisms involved.

Alpha-lipoic acid is a widely used medication that does not need a prescription. Although it is safely used in adults, hitherto no safe dose for children has been reported, and there is no known antidote. The medical literature provides four reports of alpha-lipoic acid intoxication in the pediatric population to date. This case-report is the lowest known dose of alpha-lipoic acid intake leading to poisoning in a teenager.
Alfa-lipoik asit, reçeteleme gerektirmeyen, yaygın olarak kullanılan bir ilaçtır. Yetişkinlerde güvenle kullanılırken çocuklar için güvenli doz aralığı belirlenmemiştir ve bilinen bir antidotu yoktur. Dizinde dört adet alfa lipoik asit zehirlenmnesi olgusu sunulmuştur. Şu ana kadar çocuklarda adet alfa lipoik asit zehirlenmesine neden olan en düşük dozu olgumuzla bildirmekteyiz.

BACKGROUND: Zinc phosphide (ZnP) is the basic component of several insecticides easily accessible worldwide. Intentional or accidental intoxication may lead to severe complications and multiple organ failure, resulting in high mortality. No known antidote is currently available. The iron-chelation and the antioxidative effects are well-known features of alpha-lipoic acid (ALA), although its use in the treatment of ZnP poisoning has not been documented previously. We describe the case of a patient with serious ZnP poisoning with multiple organ failure, where ALA was also included in the patient\'s supportive therapy.
METHODS: A 65-year-old man ingested 125 g of Arvalin® (containing 5 g ZnP) and presented to the Emergency Department, with respiratory insufficiency and decreased consciousness. He developed hypokalemia, hypocalcemia, low white blood cell count, elevated C-reactive protein level, mixed acidosis, hepatic and kidney damage, thickening of the jejunal wall, and lung atelectasis, which served as a basis for the ensuing bacterial pneumonia. Antibiotics and adequate supportive therapy were provided. Laboratory tests indicated liver damage (slightly increased liver enzymes, low pseudocholinesterase levels; 706 U/L on day 2), possibly caused by the patient\'s chronic alcoholism or the ZnP poison itself, therefore, hepatoprotective agents, ALA (Thiogamma Turbo-Set®) with N-acetylcysteine were administered for six consecutive days. Pseudocholinesterase values increased sixfold until the end of the second week of care. Fifteen days after admission, the patient was relocated to the department of psychiatry with stable vital functions, clear consciousness, declining inflammatory markers, and improved liver function. He was discharged 1 month later, fully recovered.
CONCLUSIONS: Our case is the first documented voluntary and severe ZnP poisoning in Hungary. Our patient developed multiple organ failure and atelectasis, possibly resulting in the observed respiratory infection. The development of bacterial pneumonia highlighted the dangers of phosphine-induced atelectasis. The use of ALA in our patient\'s case, as an antioxidant and agent for metal chelation, suggested that this agent could be a promising tool in the prevention and treatment of ZnP-induced hepatic damage.