randomized trial of combined letrozole with metformin versus clomiphene citrate with metformin in polycystic ovary [PCOS] patients

Background: Polycystic Ovary Syndrome [PCOS] is one of the most common causes of anovulatory infertility. Currently, clomiphene citrate [CC] is considered the first-line therapy for ovulation induction for women with PCOS and infertility. Aromatase inhibitors [AIs] have been introduced as a new treatment option that could challenge CC for ovulation induction

Aim of the Work: The present study was designed to compare the efficacy of combined aromatase inhibitor [Letrozole] with metformin versus CC with metformin in PCOS patients

Patients and Methods: This study was done on 100 documented PCOS cases. They were divided into two groups, The 1st group received CC 50 mg twice daily from the 3rd day of cycle for 5 days and repeated for 3 cycles with metformin 500 mg 3 times daily as an adjunct with CC and continued for 3 cycles. The 2nd group received aromatase inhibitor [Letrozole] 2.5 mg twice daily from 3rd day of cycle for 5 days and repeated for 3 cycles with metformin 500 mg 3 times daily as an adjunct with letrozole and continued for 3 cycles. These cases were followed up for three cycles by transvaginal ultrasound folliculometry to document ovulation [size and number of follicles]

Results: The results of the present study revealed both lines of treatment were effective in treatment of PCOS patients, with slight favorability in letrozole group but without statistically significant difference founded between CC group and letrozole group as regard ovulation rate, number of follicles at the end of first, second or third cycles, or as regard the diameter of follicles, i.e., both regimens showed efficacy to the same extent

Conclusion: both CC and letrozole are equally effective in treatment of infertility in PCOS patients, when combined with metformin treatment

Assessment of t-cell immunity in women suffering from chronic toxoplasmosis

This study was performed to evaluate the effect of Toxoplasma gondii [T. gondii]on chosen indices of the immune response. This study involved 50 women infected with T. gondii[aged 20-45 years] proven have a chronic Toxoplasmosis [IgG positive and IgM negative]. The control group composed of 25 healthy women [aged 19 - 41 years][IgG and IgM negative] . All cases were subjected to the following :Full history taking, general and local Obstetrical and Gynecological examination, Complete blood picture, Erythrocyte Sedimentation rate [E.S.R],Renal function tests including blood urea and serum creatinine, Fasting and postprandial blood sugar, complete Liver function tests, abdominal ultrasonography and assess the rhesus factor[Rh] by agglutination test,Treponema palladium [Syphilis] by VDRLand by IHAT and agglutination test for Brucella abortus. Detection of specific anti-toxoplasma antibodies were assessed by IgG and IgM . Serum cytokines were quantitated using Sunrise ELISA reader M. code by commercially available ELISA kits for IFN y and for TNF-alpha, IL-4 and IL:10 . The results of this study showed that patients infected with T. gondii had increased production of the Th-1 cytokines involved IFN y and TNF-alpha ,The mean level +/-SD of IFN y in T. gondii infection was 134.2 +/- 6.98 pg/ml.,on the other hand the mean level in healthy subjects was 24 +/- 2.99 pg/ml. [P < 0.0001] The mean level +/- SD of TNF-a in T .gondii infection was 49.1 +/- 4.1 pg/ml and in healthy subjects was 13.2 +/- 2.00 pg/ml.[P < 0 .001]. Also there is increased production of Th2 cytokines involved IL-4 and IL-10 that responsible for humoral response as compared to controls. The mean level +/- SD of IL-4 in T. gondii infection was 28.6 +/- 3.82 pg/ml and the mean level in healthy subjects was 16.1 +/- 2.4.5pg/ml. [P < 0.01]. The mean level +/- SD of IL-10 in T. gondii infection was 23.2 +/- 3.38 pg/ml .,on the other the mean level of IL-10 in healthy subjects was 11.8 +/- 2.1 pg/ml [P < 0.01] .,that responsible for the cellular response'as compared to controls group. All these subjects were living in the same geographical area with more or less similar social and economical standard

Renal and ocular complications and it's relationship to glycemic control, CD95 and soluble fas [s Fas] in type 1 diabetes mellitus [DM]

Type 1 diabetes mellitus [DM] is an autoimmune disease that results from the destruction of insulin-secreting pancreatic islet beta cells by autoreactive cells and their mediators. The aim of this study was to analyze the expression of Fas receptors [CD[95]] on T and B lymphocytes from patients with type 1 DM and to assess the role of soluble Fas [s-Fas] in Fas mediated apoptosis of T and B lymphocytes, and to assess the role of glycemic control in renal and ocular complications. This study was carried out on three groups: Group I: consist of 16 patients with type 1 DM. Their age ranged from [11-18] years old with mean duration of illness 6 +/- 4 months. Group II: consist of 16 patients with long standing type 1 DM, their age ranged from 10 19 years old, with mean duration of illness 30 +/- 10 months. Group III: consist of 16 healthy persons their age ranged from 10.5 -19.5 years old. Results can be summarized as follows: The incidence of positive microalbuminuria as well as incidence of retinopathy were significantly higher in group II [long standing DM] than newly diagnosed case [group I]. Microalbuminuric patients had significantly higher HbA[1]C than others. Newly diagnosed cases [group I] as well as [group II] long standing DM type 1 had significantly higher percentage of T and B lymphocyte bearing Fas receptors [CD[95]] as compared to control group. Mean plasma level of s-Fas showed a significant increase in both DM groups as compared to control group. There is no significant difference in the percentage of lymphocytes expressing CD95, and plasma s-Fas levels when compared microalbuminuric to normoalbuminuric patients. There was positive correlation between HbA[1]C and microalbuminuria in diabetic patients, there was positive correlation between HBA[1]C and% of lymphocyte expressing the Fas receptors [CD95]. In both diabetic groups, positive correlation was found between HbA[1]C and s-Fas in DM type 1. Also, positive correlation was found between% of cells expressing CD[95] and s-Fas. In conclusion, the study of the possible role of apoptosis of autoreactive lymphocytes and its regulation, in the pathogenesis of type 1 DM may provide new therapeutic tools for the prevention of the disease. Further analysis, is necessary to finally settle this point, to elucidate the roles played by distinct immunological pathway in diabetes pathogenesis, this can lead to more effective and targeted therapies for the disease. Poor glycemic control is an essential initiating factor of defective apoptosis in type 1DM