ABSTRACT
Background: Bacterial vaginosis [BV] is a relatively complex yet extremely common condition characterized by alteration of the vaginal ecology in which the normal flora, dominated by lactobacilli, is replaced by a mixed bacterial flora. BV is associated with adverse pregnancy outcome, increased risk for pelvic inflammatory disease and abnormal cervical cytology. BV can be treated with antibiotics such as metronidazole or clindamycin, either orally or vaginally. However, there is usually a high rate of recurrence. Probiotics are defined as live micro-organisms which, when administered in an adequate amount, confer a health benefit on the host. The aim of this study was to investigate the efficacy of vaginally administered Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 as probiotics in comparison to the standard oral metronidazole therapy in the treatment of symptomatic bacterial vaginosis
Patients and Methods: The study enrolled 60 women with BV. They were divided into two groups: Group [1] included 30 patients who received oral metronidazole tablets 500mg twice daily for one week and placebo vaginal capsules twice daily for five days. Group [II]: included 30 patients who received oral placebo tablets twice daily for one week and vaginal capsules containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14] twice daily for five days. All participants were evaluated before initiation of treatment then 1 and 4 weeks thereafter. Follow up was based on clinical improvement, pH of vagina, whiff test, absence of clue cells in vaginal smears and Nugent score which is considered the standard for research
Results: After 4 weeks of follow up, the probiotic group had a significantly higher cure rate of BV [88%] than the metronidazole group [51%] [p = 0.01]. In addition, according to the Gram-stain Nugent score more women were assessed with "normal: vaginal micrbiota in the Probiotic group both after 1 week [p=0.05] and after 4 weeks [p=0.01]. Relapse was higher in the metronidazole treated group [4 out of 29 cases, who completed the study accounting for 13.8%] while there was no relapse in the probiotic treated group. Failure of cure was higher in metronidazole treated group [10 cases accounting for 34.4%] than probiotic treated group [3 cases accounting for 12%]
Conclusion: The results of the present study showed that Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14, taken vaginally, were effective in treatment, relapse prevention and normalization of the vaginal flora in women with bacterial vaginosis for which we recommend the use of Probiotics as an effective treatment option. Furthermore, testing sensitivity of isolates of BV for metronidazole resistance is recommended to find reasons of less efficacious metronidazole treatment
ABSTRACT
Background: Systemic sclerosis [SSc] is a distinctive idiopathic autoimmune connective tissue disease characterized by widespread vasculopathy and excessive fibrosis in the skin and internal organs, including the heart, lungs, and gastrointestinal tract. The etiology of SSc is unknown. Viruses, including human parvovirus B19 [B19] and human cytomegalovirus, have been implicated as potential causative agents. The demonstration of B19 in a high percentage of bone marrow biopsies from SSc patients, in the absence of demonstrable viremia, suggests a possible role for B19 infection in the evolution of the disease. Circulating tumor necrosis factor-alpha [TNF-alpha] is detectable during acute and convalescent parvovirus B19 infection
Objective: This study aimed to determine whether B19 DNA can be detected in the skin lesions of SSc, in an attempt to investigate a possible role of this virus in the pathogenesis of this disease, and whether this role, if present, is mediated via TNF-alpha
Patients and Methods: This study included 26 cases of SSc and 10 age and sex matched apparently healthy subjects as the control group. Skin biopsies were obtained from the lesional skin of SSc patients and from the healthy controls. Purified DNA and RNA were extracted from the skin samples for detection of B19 DNA using nested PCR and TNF-alpha mRNA gene expression by reverse transcriptase [RT]-PCR
Results: B19 DNA was detected in the skin biopsy samples of 15 patients [57.7%] with SSc. On the other hand, it was absent in all the control biopsies. A highly statistically significant [p<0.001] increase in TNF-alpha expression was detected in the skin of SSc patients as compared to the skin of control subjects. TNF-alpha was also significantly [p<0.05] expressed in the B19 negative skin samples as compared to B19 positive skin of SSc patients
Conclusion: The findings of the current study support the presence of a role for B19 in the pathogenesis of skin lesion in SSc