AMH levels were significantly higher in PCOS than in controls. AMH as an independent marker could not effectively diagnose PCOS. However, AMH levels as an adjunct to existing Rotterdam criteria for diagnosis of PCOS had good diagnostic potential.
Background: Anovulatory dysfunction is a commonly encountered problem which is responsible for about 40% of female infertility. One of the leading causes of female infertility is polycystic ovarian syndrome (PCOS). Clomiphene citrate has been the drug of choice in treating women with anovulatory infertility. However, in recent years, letrozole, an aromatase inhibitor, has emerged as alternative ovulation induction agent. Aim of this study was to compare efficacy of clomiphene citrate and letrozole as first line therapy for ovulation induction in polycystic ovarian syndrome.Methods: This study was a hospital based prospective comparative study done in MVJ MC and RH involving 100 females suffering from infertility due to anovulation. They were divided into 2 groups of 50 each. One group was given clomiphene citrate 50 mg while another group was given letrozole 2.5 mg from day 3 to day 7 of menstrual cycle. Ultrasonographic follicular monitoring was done and injection beta HCG 5000 IU was given once follicle reached optimum size (≥18 mm) and endometrial thickness was adequate (≥7 mm). Patients were advised for timed intercourse after 24-36 hours of HCG administration. Ovulation was detected by sonographic findings of follicular rupture done after 48 hours. Primary outcomes measured were number of growing follicles (≥18 mm), endometrial thickness, ovulation rate and pregnancy rate.Results: In our study there was significant difference in the outcomes of ovulation induction between letrozole group and clomiphene group. Women who received letrozole showed improved endometrial growth (8.44 mm versus 7.86 mm), ovulation rate (72% versus 56%) and pregnancy rate (22.2% versus 14.3%) than those who received clomiphene. However, variation in follicular growth was negligible between the two groups (1.28 versus 1.36).Conclusions: Letrozole is a superior alternative to clomiphene citrate for ovulation induction in cases of PCOS with anovulatory menstrual cycle, and can be considered as first-line therapy for ovulation induction in such women.
Angioleiomyomas are relatively common neoplasms in skin and superficial planes of extremities (89%), head (48%) and trunk (14%). These tumours are extremely rare in uterus with very few cases described in the literature. These cases have been described with varied names like angiomyoma, angioleiomyoma, or vascular leiomyoma. There is no description of angioleiomyoma as an entity or as a variant of leiomyoma in the latest WHO classification of uterine tumours. There is a mention of vascular leiomyoma as a differential diagnosis of hemangioma under rare mesenchymal tumors but no description provided. A proposal has been made by Glenn Mc Cluggage et.al that angioleiomyoma should be included among the benign leiomyoma variants in the next WHO classification.
Early T precursor acute lymphoblastic leukemia (ETP ALL) is rare and has a characteristic phenotype. Mixed phenotype acute leukemia (MPAL), as per World Health Organization, needs to have two different lineages. On cytochemistry, myeloid lineage is designated by more than 3% blast cells positivity for cytochemical myeloperoxidase (MPO). Flow cytometric analysis of MPO an arbitrary cutoff of 10% has been described in the literature for this purpose by some authors. Many laboratories performing flow cytometric immunophenotyping of hematolymphoid neoplasms do not use cytochemical MPO. The differential diagnosis between ETP ALL with myeloid antigen expression and T/Myeloid MPAL is tricky. Here, we describe a case where in cytochemistry and morphology favor myeloid lineage and flow cytometry findings in isolation favored ETP ALL, thereby highlighting the benefits of cytochemical MPO staining of bone marrow/blood smears in the diagnostic workup for acute leukemia.
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