Alaa Mosbah

Extended letrozole therapy for ovulation induction in clomiphene-resistant women with polycystic ovary syndrome: a novel protocol

OBJECTIVE To evaluate the outcome of long letrozole therapy for induction of ovulation in patients with clomiphene-resistant polycystic ovary syndrome (PCOS). DESIGN Prospective randomized controlled study. SETTING University teaching hospital and a private practice. PATIENT(S) The study comprised 218 patients with clomiphene-resistant PCOS. INTERVENTION(S) Patients were randomly allocated to treatment with either long letrozole therapy (n = 108; 219 cycles) or short letrozole therapy (n = 110; 225 cycles). MAIN OUTCOME MEASURE(S) Number of growing and mature follicles, serum E(2) (pg/mL), serum P (ng/mL), endometrial thickness, occurrence of pregnancy and miscarriage. RESULT(S) The number of ovulating patients was greater in the long letrozole group (65.7% vs. 61.8%), but without statistical differences. The total numbers of follicles during stimulation was significantly greater in the long letrozole group (6.7 +/- 0.3 vs. 3.9 +/- 0.4). The numbers of follicles > or =14 mm and > or =18 mm were significantly greater in the long letrozole group. There was no significant difference in the pretreatment endometrial thickness or endometrial thickness at the time of hCG administration between the two groups. Pregnancy occurred in 28 of 225 cycles in the short group (12.4%) and 38 of 219 cycles (17.4%) in the long letrozole group, and the difference was statistically significant. CONCLUSION(S) The long letrozole protocol (10 days) can produce more mature follicles and subsequently more pregnancies than the short letrozole therapy (5 days).

Aromatase inhibitors or gonadotropin-releasing hormone agonists for the management of uterine adenomyosis: a randomized controlled trial

Objective. To compare the efficacy of aromatase inhibitor vs. gonadotrophin‐releasing hormone agonists in treating premenopausal women with uterine adenomyosis. Design. A prospective randomized controlled study. Setting. A university hospital and a private practice setting. Population. Thirty‐two patients with uterine adenomyosis. Methods. Patients were randomly allocated to receive oral letrozole (2.5mg/day) or a subcutaneous gonadotropin‐releasing hormone agonist (goserelin, 3.6mg) for 12 weeks. Uterine and adenomyoma volumes were determined at baseline and during treatment at four, eight and 12 weeks. Outcome measures. Measurements were performed at baseline and during treatment at four, eight 8 and 12 weeks, and mean values were calculated. Symptoms at the start and after 12 weeks were evaluated. Results. No significant differences in the total uterine size between the post treatment uterine volumes in the two groups (20.1, 15.4 and 13.0cm3 vs. 21.7, 15.1 and 11.7cm3, at four, eight and 12 weeks, respectively). Total adenomyoma volume decreased by 8.6, 29.7 and 40.9% vs. 5.7, 34.6 and 49.1% after four, eight and 12 weeks of treatment, in group A and B, respectively. Two patients became pregnant in group A during treatment. Conclusions. Aromatase inhibitors are as effective as gonadotropin‐releasing hormone agonists in reducing adenomyoma volume and improving symptoms.

Interleukin-6, intracellular adhesion molecule-1, and glycodelin A levels in serum and peritoneal fluid as biomarkers for endometriosis

To compare levels of interleukin‐6 (IL‐6), intracellular adhesion molecule‐1 (ICAM‐1), and glycodelin A in serum and peritoneal fluid of patients with and without endometriosis, and to correlate levels with disease stage.

Helicobacter pylori, Chlamydiae pneumoniae and trachomatis as probable etiological agents of preeclampsia

Abstract Objectives: The aim of this study was to evaluate the evidence for Helicobacter pylori, Chlamydiae pneumoniae and trachomatis to act as a probable etiology for preeclampsia (PE), together with estimating the prevalence of such infections in pregnant women with PE. Methods: We performed a prospective study in Mansoura University Hospitals, Egypt, for detecting H. pylori infection by estimating H. pylori IgG and IgM, in addition to detection of Chlamydiae infections by PCR in 90 pregnant women with PE and 90 normotensive pregnant women of the same age and body mass index who were studied as control. Results: The prevalence of H. pylori infection in preeclamptic pregnant women was 54.4% with a statistically significant association to PE. The prevalence of C. pneumonia was 27.8% whereas that of C. trachomatis was 4.44%. The infected preeclamptic cases showed high levels of leucocytes besides elevated C-reactive protein concentrations. Conclusion: Helicobacter pylori was found to act as a cofactor in the development of PE. Occurrence of C. trachomatis was low in pregnant women in our community; however, it showed that it may act as a cofactor in PE, whereas C. pneumoniae was attributed to have no role in PE pathogenesis until supported by further studies.

High-risk and low-risk human papilloma virus in association to spontaneous preterm labor: a case-control study in a tertiary center, Egypt

Abstract Introduction: This study aimed to detect the correlation between human papillomavirus (HPV) and spontaneous preterm labor in Egyptian women and its association to the human papilloma viral load and MPP2 gene expression. Material and methods: We performed an observational comparative case-control study in Department of Obstetric and Gynecology, Mansoura University Hospitals over women presented with spontaneous preterm labor, besides females admitted for giving birth at full term to detect conserved sequence in HPV-L1 gene (GP5/GP6) followed by genotype detection of high- and low-risk HPVs with quantification of the viral load and the MMP2 gene expression using real-time polymerase chain reaction (PCR). Results: The prevalence of HPV was 18.1% in preterm females, but only 4% in full-term women (p value = 0.019*). Twenty percent were PCR positive for HPV 16 and 40% for HPV 18 whereas none of the control was positive for any of the studied high-risk genotypes. Thirty percent were PCR positive for HPV 6 and 10% were positive for HPV 11. MMP2 gene expression was significantly higher in preterm than full term. Human papilloma viral load was found to be positively correlated to the rate of MMP2 expression and the gestational age was significantly related to the viral load and the rate of expression of MMP2 gene. Conclusion: Human pabilloma virus especially high-risk genotypes was correlated to spontaneous preterm labor in Egyptian females through increasing early expression of MMP2 gene. The time of occurrence of preterm labor was affected by the viral load and so the rate of expression of MMP2 gene.