Clomiphene citrate plus letrozole versus clomiphene citrate alone for ovulation induction in infertile women with ovulatory dysfunction: a randomized controlled trial.

BACKGROUND: The aim of this study was to compare the efficacy of the combination of clomiphene citrate (CC) and letrozole to that of CC alone in inducing ovulation in infertile women with ovulatory dysfunction. METHODS: A randomized controlled trial was conducted at a single academic medical center between November 2020 and December 2021. Anovulatory infertility females, aged 18 to 40, were evenly distributed by a computer-generated block of four into two treatment groups. A "combination group" received a daily dose of CC (50 mg) and letrozole (2.5 mg), while a "CC-alone group" received a daily dose of CC alone (50 mg). The study medications were administered on days 3 through 7 of menstrual cycle. The primary outcome was the ovulation rate, defined by serum progesterone levels exceeding 3 ng/mL at the mid-luteal phase. The secondary outcomes were ovulation induction cycle characteristics, endometrial thickness, conception rate, and adverse events. RESULTS: One hundred women (50 per group) were enrolled in the study. The mean age was not significantly different in both groups: 31.8 years in the combination group and 32.4 years in the CC-alone groups (P = 0.54). The prevalence of polycystic ovary syndrome in the combination and CC-alone groups was 48% and 44%, respectively (P = 0.841). According to intention-to-treat analysis, the ovulation rates were 78% and 70% in the combination and CC-alone groups, respectively (P > 0.05). There was no significant difference in the mean endometrial thickness or the number of dominant follicles of the groups. No serious adverse events were observed in either group. CONCLUSIONS: Our study found no significant difference between the combination of CC and letrozole and CC alone in inducing ovulation in infertile women with ovulatory dysfunction in one cycle. The small number of live births precluded any meaningful statistical analysis. Further studies are needed to validate and extend our findings beyond the scope of the current study. TRIAL REGISTRATION: The study was registered at https://www.thaiclinicaltrials.org with the following number: TCTR20201108004 and was approved on 08/11/2020.

Rate of Spontaneous Preterm Delivery Between Pregnant Women With and Without Gestational Diabetes.

Objective The aim of this study is to compare the rate of spontaneous preterm delivery between gestational diabetes mellitus (GDM) and normal pregnancy. Pregnancy outcomes and associated risk factors for spontaneous preterm delivery were evaluated. Methods A retrospective cohort study was conducted on 120 GDM and 480 normal pregnant women. All women received GDM screening with 50-g glucose challenge test and 100-g oral glucose tolerance test at the first visit and repeated at 24-28 weeks. Data were retrieved from medical records and included baseline and obstetric characteristics, preterm risks, GDM risks, and pregnancy outcomes. Spontaneous preterm birth was defined as delivery before 37 completed weeks of gestation that had been preceded by spontaneous labor. Results GDM women were more likely to be ≥30 years (p=0.032) and have previous GDM (p=0.013). Incidence of overall preterm delivery was significantly higher in GDM women (17.5% vs. 8.5%, p=0.004), as well as the incidence of spontaneous preterm delivery (15.8% vs. 7.1%, p=0.004). GDM women had less gestational weight gain (p<0.001) and were less likely to have excessive weight gain (p=0.002). GDM women were more likely to deliver large for gestational age (LGA) (p=0.02) and macrosomic infants (p=0.027). Neonatal hypoglycemia was significantly more common among GDM women (p=0.013). Multivariate analysis showed that previous preterm birth and GDM independently increased the risk of spontaneous preterm delivery (adjusted OR: 2.56, 95% CI: 1.13-5.79, p=0.024, and adjusted OR: 2.15, 95% CI: 1.2-3.84, p = 0.010, respectively). Conclusion GDM and previous preterm birth significantly increased the risk of spontaneous preterm delivery. GDM also increased the risk of LGA, macrosomia, and neonatal hypoglycemia.

Correction to: High incidence of invasive fungal infection during acute myeloid leukemia treatment in a resource-limited country: clinical risk factors and treatment outcomes.

Incorrect family name of Warissara Jutidamrongphan.

High incidence of invasive fungal infection during acute myeloid leukemia treatment in a resource-limited country: clinical risk factors and treatment outcomes.

BACKGROUND: Invasive fungal infection (IFI) causes high morbidity and mortality during acute myeloid leukemia (AML) treatment. Interventions to prevent fungal infection, including air filtration systems and antifungal prophylaxis, may improve outcomes in this group of patients. However, they are expensive and therefore inapplicable in resource-limited countries. The benefit of antifungal therapy is also dependent on the local epidemiology. That led us to conduct the study to evaluate the characteristics and impact of IFI in AML patients without prophylaxis in our setting. METHODS: Clinical data from patients with AML who have been treated with chemotherapy without antifungal prophylaxis were retrieved during a 5-year period at Thailand's hematology referral center. Incidence and risk factors of IFI and outcomes of patients were evaluated. RESULTS: Among 292 chemotherapy courses, there were 65 (22.3%) episodes of IFI. Of those, 10 (15.4%) were proven, 19 (29.2%) were probable, and 36 (55.4%) were categorized as being possible IFI. Molds were the most commonly observed causative pathogens (93.1%). The incidence of probable/proven IFI was highest during first induction (20.5%), followed by second induction (6.1%), and consolidation (2.7%). A long duration of neutropenia, old age, and low serum albumin were the strongest predictors of IFI. Compared with patients who had no IFI, patients with probable/proven IFI had a longer length of hospital stay and higher in-hospital mortality. Patients with proven IFI had a significantly worse outcome at 1 year. CONCLUSIONS: These results suggest the change in health policy to implement IFI preventive measures to improve outcomes of AML treatment.