Metformin-letrozole in comparison with metforminclomiphene citrate in clomiphene-resistance PCOS patients undergoing IUI

Polycystic ovary syndrome [PCOS] is associated with approximately 75% of women who suffer from infertility due to anovulation. Additionally, around 20-25% of anovulatory women with PCOS do not respond at all to clomiphene citrate and are considered to be "clomiphene-resistant". Aromatase inhibitors have been suggested as an alternative treatment to clomiphene as the discrepancy between ovulation and pregnancy rates with clomiphene citrate has been attributed to its anti-estrogenic action and estrogen receptor depletion. The aim of this study is to compare results of Metformin-letrozole with Metformin-clomiphene citrate in clomiphene resistance PCOS patients undergoing IUI. In this single blind randomized trial, ovarian cycles were studied in 100 clomiphene- resistant patients with PCOS. The inclusion criteria were patients who received 150mg clomiphene citrate daily for 3 cycles and failed to become pregnant. The patients were matched for their age, body mass index [BMI], and infertility period. They were randomly allocated to a metformin-letrozole group [n=50] and a metformin-clomiphene citrate group [n=50]. Chemical and clinical pregnancies were assessed after IUI. Abortion rates were determined in both groups. Regarding pregnancy rate, there was no significant difference between the two groups. One miscarriage [2%] occurred in the metformin-clomiphene citrate group, whereas none was seen in the metformin-letrozole group. There is no significant difference in pregnancy rate between clomiphene citrate and letrozole groups although it has been 2% in the former and 5% in the latter

Hematuria in patients with beta-thalassemia major

Our information about renal involvement in beta-thalassemia major is limited. Recently, few studies have reported proteinuria, hypercalcuria, phosphaturia, and oversecretion of tubular damage markers; however, hematuria has not yet been meticulously studied in these patients. We investigated hematuria in patients with beta-thalassemia major. Urinalysis was performed in 500 patients with beta-thalassemia major under a regular blood transfusion program. In those with hematuria [at least 3 to 5 erythrocytes per high-power field] a second urinalysis was done at the next transfusion time. The patients ranged in age from 6 months to 32 years. The male-female ratio was 1.05:1. Hematuria was detected in 55 [10.6%], including 9.8% of those younger than 20 years and 20.0% of those older than 20 years. Hematuria was persistent in 79.2% of the second urinalyses. Sixty-four percent of the patients with hematuria were females. A blood transfusion program had been started during the first year of life in 81% percent of the patients with hematuria. Sterile pyuria was detected in 4% and proteinuria in 16% of the patients with hematuria, while these figures in patients without hematuria were 2.1% [P=.56] and 1.4% [P=.002], respectively. We found that in patients with beta-thalassemia major, the risk of hematuria rises with age. Moreover, proteinuria seems to be more common in those with hematuria. Further studies are needed to ascertain the importance of these findings

point mutations of mitochondrial tRNA threonine and proline in idiopathic repeated pregnancy loss

Mitochondrial transfer RNAs [tRNA] genes are essential components of protein biosynthesis. These genes are hotspots for mutations. These mutations are associated with a wide spectrum of human disease. Many genetic factors are known in assessment of repeated pregnancy loss [RPL]. The aim of this study was analysis of tRNA[Thr] and tRNA[Pro] in women with RPL. The nucleotide variations of threonine and proline were investigated in 96 women with idiopathic repeated pregnancy loss. The related mitochondrial area was amplified using a polymerase chain reaction [PCR]. The PCR products were demonstrated by 2% agarose gel electrophoresis, and all the positive samples were purified and verified by an automated DNA sequencing method. The sequence analysis revealed 4 mutations in tRNA[Thr]. These mutations were A15907G in 2 cases [2.08%], A15924G in 3 cases [3.12%], G15928A in 10 cases [10.42%] as the most common mutations and G15930A in 3 cases [3.12%] as a novel mutation. Also, the result of tRNA[pro] sequencing showed the T15972C mutation in 1 woman [1.04%] as a novel mutation. These tRNAs mutations can alter their steady state level and affect the structure of tRNAs. It results in protein synthesis defects and, in turn, mitochondrial dysfunction. The mutations of these genes may help in the assessment of RPL. Further study of an expanded series of these tRNA mutants is recommended to describe their etiologic role in idiopathic RPL

Disease spectrum and mortality in hospitalized children of southern Iran

In medicine, especially in the field of pediatrics, it is necessary to perform regular epidemiologic studies in each geographic region. We designed this study in Nemazee Hospital, Shiraz [the major referral pediatric center in Southern Iran], to determine the disease spectrum, the mortality and also the rate of matching final diagnosis with the initial impression in pediatric wards. All children older than 1 month [2731] who were admitted in Nemazee Hospital [except for surgical wards], from November 2005 to October 2006, were studied through questionnaire interviewing on admission and were followed till discharge or expire time. In some instances that final diagnosis or cause of death was unclear; we followed them through their files in clinics up to 1 year. Among 3057 admissions [related to 2731 patients], 56.8% were males [male to female ratio: 1.31]. Patients' age was 31 days to 25 years [mean: 5.16 years, SD: 4.98 years] and the significant portion was less than 2 years [1210= 44.2%]. Admission duration varied from 1 to 62 days [mean: 5 days, SD: 5.13 days]. The most common diseases were seizure disorder [315=11.1%], pneumonia [235=7.7%], febrile convulsion [136=4.79%] and gastroenteritis [128=4.18%]. 17.93% of admissions came out of Pars Province [18 Provinces] with digestive system [19.1%], infectious [18.5%] and nervous system diseases [15.0%] as the most frequent referred patients. In 90.6% of admissions final diagnosis was clarified in the hospital [ranged from 86.45% in infectious ward to 93.4% in cardiology ward] [P=0.01]. The total mortality rate was 5.30%; this rate was 9.49% for patients younger than 1 year and 5.0% in older patients [P<0.001]. The most common age of admission in pediatric wards was less than one year. The most common diseases were seizure disorder, pneumonia and gastroenteritis. Congenital heart disease, sepsis and pneumonia were the most common diseases leading to death

Tumor markers in patients undergoing hemodialysis and kidney transplantation

Objective: To evaluate the effect of dialysis and kidney transplantation on serum levels of several tumor markers such as PSA, AFP, CA125, CA19-9, CA15-3, CEA and to compare with normal age matched controls

Methods: Between September of 2000 and July of 2001, the following tumor markers: PSA, AFP, CA125, CA19-9, CA15-3 and CEA were measured by ELISA Method in 29 hemodialyzed patients [group A] in 30 successfully transplanted patients [group B] and in 30 normal volunteers who did not present any clinical symptoms or signs of neoplasia

Results: The serum level of CEA was above the cutoff limit in 6.7% of hemodialyzed patients [group A] but was in the normal range in transplanted and control groups. The level of CEA were significantly higher in hemodialyzed patients in comparison to other groups [p<0.003]. Serum levels of AFP and PSA were not significantly different between the three groups [p=0.595 and p=0.545, respectively]. Although serum level of CA 19-9 was elevated in 3.3% of hemodialyzed and control group the differences between the three groups were not significant [p=0.507]. Serum level of CA 125 was elevated in 13.3% of group A, 13.8% of group B and 6.7% of control group [p=0.347]. Serum level of CA15-3 was elevated in 13.3%, 6.9% of group A, B and control group, respectively and the differences were not significant [p=0.156]

Conclusion: Hemodialyzed and transplanted patients show a high false positive rate of CEA, CA125 and CA15-3 and may be unreliable for monitoring of malignancies in these patients while other markers evaluated [AFP, PSA and CA 19.9] appear to maintain their specificity in these situations