Interleukin-1 receptor antagonist gene (IL-1RN) polymorphism is a predictive factor of clinical pregnancy after IVF.

BACKGROUND: Only 25% of IVF transfer cycles lead to a clinical pregnancy, calling for continued technical progress but also more in depth analysis of patients' individual characteristics. The interleukin-1 (IL-1) system and matrix metalloproteinases (MMPs) are strongly implicated in embryo implantation. The genes coding for IL-1Ra (gene symbol IL-1RN), IL-1beta, MMP2 and MMP9 bear functional polymorphisms. We analysed the maternal genetic profile at these polymorphic sites in IVF patients, to determine possible correlations with IVF outcome. METHODS: One hundred and sixty women undergoing an IVF cycle were enrolled and a buccal smear was obtained. The presence of IL-1RN variable number of tandem repeats and IL-1B + 3953, MMP2-1306 and MMP9-1562 single nucleotide substitutions were determined. Patients were divided into pregnancy failures (119), biochemical pregnancies (8) and clinical pregnancies (33). RESULTS: There was a 40% decrease in IL-1RN*2 allele frequency (P = 0.024) and a 45% decrease in IL-1RN*2 carrier status in the clinical pregnancy group as compared to the pregnancy failure group (P = 0.017). This decrease was still statistically significant after a multivariate logistic regression analysis. The likelihood of a clinical pregnancy was decreased accordingly in IL-1RN*2 carriers: odds ratio = 0.349, 95% confidence interval = 0.2-0.8, P = 0.017. The IL-1B, MMP2 and MMP9 polymorphisms showed no correlation with IVF outcome. CONCLUSIONS: IL-1RN*2 allele carriage is associated with a poor prognosis of achieving a pregnancy after IVF.

Chorioamnionitis.

Chorioamnionitis is an inflammation of the placental membranes induced by microorganisms which reach the endometrial cavity from the vagina and uterine cervix. Premature labor frequently depends on infections. In patients with premature rupture of membranes (PROM) antibiotic treatment can prevent intra-amniotic inflammation if it is absent at admission. In spite of antibiotic treatment started immediately after the PROM in 218 patients, the chorioamnionitis did not prevent delivery in 41 patients within 48 hours of PROM. In the presence of a previous chorioamnionitis, antibiotic treatment cannot prevent premature labor, whereas it can prevent infection and lead to a longer duration of pregnancy if PROM does not depend on previous infection.

[When should we treat infertility and how should we determine the degree of urgency?]. / Quand traiter l'infertilité et comment déterminer le degré d'urgence?

The successes of assisted reproductive treatments (ART) have been amply documented. Yet, there is no clear consensus as to who are the couples who need ART and with which degree of urgency, short of course of those suffering from definitive tubal infertility or severe male factor. Determining the degree of medical urgency for deploying ART approaches is of true clinical concern. In case of occult forms of ovarian failure (not symptomatic short of infertility itself), delaying treatment may lead to definitive failure. Conversely, if infertility results from ovulatory disorders brought by stress, postponing ART for a few months may bring spontaneous pregnancies. The recent introduction of anti-mullerian hormone (AMH) testing is of significant help for assessing the degree of ovarian reserve.

[Synchronisation of the menstrual cycle and ovarian follicles: interest and benefit]. / Synchronisation du cycle menstruel et des follicules ovariens: de nombreux avantages.

In the menstrual cycle, a slight elevation of plasma FSH levels, the inter-cycle FSH signal, initiates the 1st phase of follicular recruitment. In ovarian stimulation for IVF, exogenous FSH aims at increasing the amplitude of this signal while maintaining FSH levels elevated, in order to fool the natural mechanisms of single follicular dominance. Synchronization consists in maintaining plasma FSH levels low so that all recruitable follicles remain at a resting state, prior to inducing ovarian stimulation. Practically speaking, synchronization of ovarian follicles allows to optimize clinical efforts, reduces the risk of cyst formation and ultimately, helps improving IVF outcome.

Clinical study of disposable contact lens wear: Brazilian experience.

PURPOSE: The objective of this study was to analyze prospectively the continuous use of disposable contact lenses. METHODS: We conducted a clinical study of extended wear of disposable contact lenses for a period of 7 days and 6 nights by 25 patients during a 90-day period. Factors such as visual acuity, keratometry, complications, and contamination were analyzed. RESULTS: Visual acuity and keratometry measurements did not present significant alterations during the study. Complications related to the use of disposable contact lenses were not observed. Analysis of cultures did not present any significant microbiological alterations due to contact lens use. All of the patients were satisfied with the wear schedule and considered the Acuvue lenses comfortable. CONCLUSIONS: Our results may be useful in increasing the level of acceptance of extended wear of disposable contact lenses in Brazil.

Bacterial contamination in soft contact lens wearers.

We prospectively analyzed bacterial contamination in 15 soft contact lens wearing subjects. Contact lenses, cases, tips of saline solution bottles, and conjunctiva were cultured. Cultures were positive for 13 subjects (86.6%). Contamination was present in 13 contact lens cases (86.6%), 12 contact lenses (80.0%), nine saline solution bottles (60.0%), and in the conjunctiva of three patients (20.0%). Gram-negative bacteria (Pseudomonas aeruginosa and Proteus mirabilis) were the most frequently isolated organisms. Staphylococcus aureus was the only gram-positive organism isolated. We discuss the possible sources of contamination, and emphasize the importance of contact lens care instruction.

Educational program on ophthalmology.

To minimize the learning problems, related to the present teaching method, we developed the Educational Program on Ophthalmology, that offers an interactive and self-controlled way of learning, through the multimedia and hypertext (hypermedia) resources to the students. The software has 200 images (pictures and photos), 40 minutes of digitized voice (.WAV), 50 minutes of video animation (.AVI) and more than 200 links. The first evaluation demonstrated a great interest from the medical graduated students, who feel motivated with the utilization of the software.

[Double-blind cross-over comparison of flurbiprofen and indomethacin in osteoarthritis of the knee and hip]. / Confronto a doppia cecità cross-over tra flurbiprofen e indometacina nelle osteoartrosi del ginocchio e dell'anca.

A randomised double blind cross-over study was conducted in order to compare the therapeutic efficacy and tolerability of flurbiprofen and indomethacin in 16 patients with osteoarthrosis of the knee or hip. 300 mg per diem flurbiprofen and 150 mg per diem indomethacin were given for 14 days. Both treatment were very effective against pain whether spontaneous, under pressure or in movement and against functional limitations, joint mobility and on ESR. Undesirable side effects were noted in 4 flurbiprofen and 5 indomethacin cases.

[Effects of chrysotherapy on various immunological parameters in rheumatoid polyarthritis]. / Effets de la chrysothérapie sur différents paramètres immunologiques au cours de la polyarthrite rhumatoïde.

The effects of chrysotherapy on various immunological parameters were studied in 60 cases of rheumatoid arthritis, either classical or as defined by the ARA. There was a significant fall in serum immunoglobulin levels and in rheumatoid factor. The serum levels of C3 and C4 did not show any significant modifications. At the same time, the serum albumin level rose, suggesting that gold salts do not inhibit protein synthesis. There was a reduction in the total number of leukocytes, affecting lymphocytes more than polymorphs. Finally, there was no significant modification of the response to mitogenes during chrysotherapy. The increase in the lymphocyte response to PHA coincided with improvement in the disease.

Double-blind comparison of glucametacin and ketoprofen in chronic arthropathies.

A new, non-steroidal anti-inflammatory agent, glucametacin, was compared with ketoprofen in a double-blind, crossover trial. The drugs were given in total daily doses of 420 mg glucametacin and 300 mg ketoprofen for 20 days to 30 patients with chronic arthropathies of an inflammatory or degenerative nature. Both drugs were well tolerated and resulted in significant improvements in a number of criteria of disease assessment. Although there were no significant differences between results seen with the two drugs, there appeared to be trends in favour of glucametacin in respect to both efficacy and tolerance.

[Serum gastrin in rheumatoid arthritis]. / Gastrine sérique au cours de la polyarthrite rheuatoïde.

Serum gastrin concentrations under basal conditions and following stimulation were assessed in 40 patients suffering from rheumatoid arthritis (RA) and compared with healthy individuals. The RA groups showed no significant differences in comparison with the control population. These conclusions lead the authors to seek the reasons for the rare instances of confirmed hypergastrinaemia in RA.