RESUMO
Aim:This study aimed to compare between the effect ofpharmacoinvasive strategy (PI)& primary percutaneous coronary intervention (P-PCI) according to PCIrelated delay (door to ballon) on the mortality and morbidityduring in-hospital stay and after 30-day follow up. Moreover, leftventricular systolic function was assessed by two-dimensional echocardiography at cardiology department, Tanta University. Patients and Methods:The study was conducted on 300 patients that were dividedinto 2 main groups. Group A consisted of patients had primaryPCI as reperfusion therapy and further divided into threegroups according to PCI related delay (door toballon). Group A1, PCI-related delay is ≤60 minute(92patients). Group A2, PCI-related delay is >60 to ≤ 90 minute. (54patients). Group A3, PCI-related delay is >90minute (78 patients). The second group (group B), include patients who undergopharmaco-invasive strategy, PCI within 24 hour afterthrombolysis (76 patients). the second group, coronary angiography was done immediately in cases of failedthrombolysis and for successful thrombolysis; coronaryangiography was performed within 3 –24 hours. Results:During hospital stay, more patients in group A3 died than those of group B orgroup A1, A2 with no statistical significance.In addition, morepatients in group A3 showed heart failure symptoms withstatistical significance than those of group B, A1 and A2. Bleeding complications occurred significantly moreingroupB. Duringfollowupvisits more patients in group A3 complained ofheart failure symptoms with statistical significance than those of group B, A1, A2 patients. Conclusion:Primary PCIwithout door to balloon time delay (≤90 minutes)was encouraged and hadthebest results on morbidity and mortality. Also, pharmacoinvasive strategy was encouraged as being better than primary PCIwhen door to balloon time showed marked delay( <90 minutes)
RESUMO
Objective: the aim of this study was to see the effect of adding aromatase inhibitor, letrozole to a high doses of rFSH/hMG-antagonist regimen on the number of the mature follicles, retrieved oocytes, egg's quality, clinical pregnancy rate, and rate of cycle cancellation in poor responder patients with a previous history of at least 2 cancelled IVF cycles
Study Design: this study included 83 infertile couples who had at least two cancelled IVF trials due to poor ovarian response. Those patients were divided into two groups, letrozole group, included 41 infertile couples, and control group included 43 infertile couples, and compared
Results: patients.in both groups were comparable in terms of age [37.3 +/- 1.2 versus 35.7 +/- 2.4 years], .day 3 FSH, LH, and E2 serum levels as shown in table 1. There was no significant differences among both groups regarding the number of stimulation days [10.3 +/- 0.6 versus 9.6 +/- 0.4], mean FSH/hMG dose administered [4,236 +/- 219 versus 4,463 +/- 238], and endometrial thickness [8.6 +/- 1.3 versus 9.8 +/- 0.9]. However, there were significant differences between both groups in terms of cancellation rate due to poor response [12.2% versus 34.9, p < 0.001], number of mature follicles [5.8 +/- 1.2 versus 3.4 +/- 0.6, p = 0.039], and in the number of retrieved oocytes [8.3 +/- 1.6 versus 4.2 +/- 0.6, p < 0.001]. In addition, there were significant differences in the terms of fertilization rate [86.4% versus 64.9%, p = 0.038], and in the clinical pregnancy rate [44.4% versus 25%, p = 0.36] between the two groups, however, there is no significant difference between them regarding the percentage of the multiple pregnancies [25% versus 28.6%, p = 0.43]
Conclusion: in conclusion, addition of aromatase inhibitors, letrozole in the first 10 days of the stimulation induction using a high doses of rFSH/hMG antagonist regimen, were associated with a higher number of mature follicles, less cancellation rate, more retrieved mature oocytes, and higher clinical· pregnancy rate in low responder patients with a previous history of at least 2 cancelled IVF cycles