Candida albicans causing vulvovaginitis and their clinical response to antifungal therapy

The purpose of the present study was to determine the prevalence of Candida albicans causing vulvovaginitis, also to evaluate the utility of the E-test in determining their antifungal susceptibility to some azoles and to determine if failure of recurrent Candida albicans vulvovaginitis to respond clinically to fluconazole is related to in vitro mycologic resistance. Vaginal swabs were collected from 60 women suspected clinically to suffer from vulvovaginal candidiasis. Each was examined microscopically by Gram's stain and was inoculated on the surface of plates of Sabouraud dextrose agar. All isolates proved to be Candida species by culture and microscopy were subjected to the following tests: Germ tube test, Chlamydospore production and Sucrose assimilation. Antifungal Susceptibility testing was done using E-test [AB BIODISK]. The results of this study showed that: Total number of Candida species isolated were 33/60 of which 26[86.6%] were C.albicans. The range of antifungal susceptibility to the three azoles were as follows: 0.125 - >/=256 for fluconazole, 0.008 - >/=32 for itraconazole and 0.008 - 4 for ketoconazole. Fourteen cases were non -recurrent vulvovaginitis and they responded well to fluconazole treatment and were clinically well on next visit to the clinic. While 12 cases had history of recurrent vulvovaginitis, only 8 of them were available for follow up. The most important risk factors for recurrent cases include: receiving antibiotics for prolonged duration, hormone-replacement therapy, combined Oral contraceptive pills and Diabetes mellitus. Three of the 12 cases with recurrent vulvovaginal candidiasis [RVVC] were resistant to fluconazole, one of them was also resistant to ketoconazole and another case was also resistant to itraconazole. And 4 cases were susceptible dose dependant to fluconazole. All of the 12 patients were culture positive for C.albicans and 9 of them had previously responded to fluconazole [single dose] but subsequently failed. Three of the12 patients who were fluconazole resistant were given itraconazole or ketoconazole according to the results of in-vitro susceptibility tests while the other patients were treated with fluconazole plus local antimycotic.Clinical and mycological outcomes corresponded to each other. As all patients became clinically well and mycologically free [-ve culture] after therapy except one patient who refused to take maintenance dose of fluconazole for 3 weeks and so she had recurrent signs and symptoms and positive culture for C.albicans.While 4 of the 12 patients were not available for follow up. In Conclusion: The high frequency with which C.albicans was recovered in this study and its azole susceptibility support the continued use of azole agents for empirical therapy of candidal vulvovaginitis even those with RVVC. Antifungal susceptibility tests using E-test may be an important aid in treatment and the monitoring of outcome of vulvovaginal candidiasis

Ventilatory effects with metabolic and inflammatory responses after laparoscopic and abdominal hysterectomy

This study was carried out to quantify and compare the ventilatory effects with the metabolic and inflammatory responses after laparoscopic and abdominal hysterectomy. Forty patients with no major medical disease requiring abdominal hysterectomy for benign disorders were randomly assigned to have laparoscopic hysterectomy [n = 15] and abdominal hysterectomy [n = 25]. Bed side pulmonary function tests were done preoperanvely and at 2, 4, 6 and 8 hours post operatively using portable vitalograph-compact spirometer. Venous blood samples were collected the day before operation and for each of the first 2 post operative days for estimation of serum interleukin-6, C-reactive protein, plasma glucose and white blood cell count. The results of the study showed no differences in demographic characteristics and operating time in the two groups. No major complications were also encountered. The laparoscopic hysterectomy group had a significantly lower febrile morbidity rate [16% vs 46%, P < 0.05] and shorter hospital stay [Median 4 vs 6 days, P < 0.001]. The study showed also that all measurements of pulmonary function tests that require patient effort like forced expiratory volume in one second [FEVI] and peak expiratory flow rate [PEFR] and which are influenced by the strength of the respiratory muscles are better in case of laparoscopic hysterectomy compared to the abdominal hysterectomy group. The study demonstrated a significant elevations of C-reactive protein and interleukin-6 in both groups and this elevation denotes a less intense stress response in the laparoscopic hysterectomy group compared to the abdominal hysterectomy group as the serum interleukin-6 [median 42.2 vs 83.2 pgi, P < 0.001], C-reactive protein [Median 26.1 mglL vs 45.3 mglL, P < 0.001] and white blood cell count [Median 59.5 vs 69.0 10[9]/L, P = 0.009]. No significant difference was detected in plasma glucose [median 40.5 vs 45.6 mmol /L]. So, we can conclude that laparoscopic hysterectomy is very beneficial in keeping the standard of the pulmonary function post operatively and also, it is associated with a less intense stress response than abdominal hysterectomy for benign diseases

Tumour necrosis factor-alpha in patients with severe preeclampsia with and without HELLP syndrome

Tumor necrosis factor-a [TNF- alpha], acytokine produced mainly by macro-phages, is involved in immunoregulation, the modulation of cell growth and differentiation, as well as in the induction of oxygen radicals. This study was designed to investigate whether tumor necrosis factor- alpha [TNF- alpha] is present in maternal plasma in pregnancies associated with severe preeclampsia with and without HELLP syndrome and its concentrations. Fifty patients with severe preeclampsia composed the study group. This group is further subdivided into severe preeclamptic without HELLP syndrome, [n = 37] and severe preeclampsia with HELLP syndrome [n = 13]. A control group composed of 25 pregnant women, some of them were in early labor [n = 11] and the rest [n - 14] were in late pregnancy. Maternal plasma samples for TNF- alpha were taken for all groups. Also, serum creatinine spartate aminotransferase [AST], alanine aminotransferase [ALT] and platelets count to diagnose the presence of HELLP syndrome. TNF-alpha was detected in 80% of the studied group with severe preeclampsia [n = 50], while it was detected only in 13 patients [21%] only in the control groups. Also, the maternal plasma concentration in the severe preeclamptic group was [61 +/- 17] ng/ml and [146 +/- 37] ng/ml in the severe preeclampsic group with HELLP syndrome [n = 13] respectively which were statistically highly significant when compared to maternal plasma levels in the control group [7 +/- 3] ng/ml. There were no positive or negative correlation between TNF- alpha plasma concentrations in both groups and maternal age, gestational age and parity. Also, in the severe preeclamptic group there were no positive or negative correlation between the diastolic blood pressure, the amount of protein urine, the liver enzymes or platelets count and TNF- alpha maternal serum levels. So, we can concluded that tumor necrosis factor-alpha is increased in the plasma of patients with severe pre-eclampsia especially those developing HELLP syndrome. These data are suggestive of a role for abnormal immune activation in the pathophysiologic mechanisms of severe pre-eclampsia with or without HELLP syndrome

Prognostic significance of secondary yolk sac assessment by transvaginal ultrasonography as a predictive method of pregnancy outcome

This study was designed to evaluate the prognostic significance of transvaginal ultrasonography measurement of the yolk sac in early pregnancy and its significance as a predictive method for pregnancy outcome. The study composed of 60 consecutive first trimester singleton pregnancies to evaluate size abnormalities of the secondary yolk sac [YS] vis-a-vis pregnancy outcome using transvaginal sonography [TVS]. In normal pregnancy outcome [NPO], the YS diameter showed an increase from the 5th to the 11th week, menstrual age, followed by a decrease and its disappearance after 12 weeks. A yolk sac of abnormal size was statistically significant in spontaneous abortion [SA] versus NPO with a sensitivity of 66.3%, a specificity of 99%, a positive predictive value of 91.6% and a negative predictive value of 95.2%. These preliminary results indicated that very early measurements of the YS in gestation may be a useful marker of pregnancy outcome