Application characteristics of Qugu (CV 2) in ancient and modern literature / 中国针灸

To summarize and analyze the clinical application characteristics of Qugu (CV 2) in ancient and modern literature based on data mining technology. The Chinese Medical Code (the 5th edition) was taken as the retrieval source of ancient literature, while the CNKI, Wanfang, and VIP databases were taken as the retrieval source of modern literature. The indications of Qugu (CV 2) used alone or with compatible acupoints, compatible acupoints, acupuncture-moxibustion manipulation, etc., were systematically sorted out. As a result, a total of 140 articles of ancient literature were included. The common indications of Qugu (CV 2) used alone were urinary retention, profuse vaginal discharge and hernia. The common indications of Qugu (CV 2) used with compatible acupoints were profuse vaginal discharge, stranguria and hernia. Sixty-four acupoints were concurrently used with Qugu (CV 2), Qugu (CV 2) was mainly compatible with acupoints of conception vessel, bladder meridian and liver meridian, and the high-frequency acupoints included Zhongji (CV 3), Guanyuan (CV 4) and Sanyinjiao (SP 6); five-shu points were the most used special acupoints, and moxibustion therapy was often used. A total of 73 modern articles were included. The common indications of Qugu (CV 2) used alone were urinary retention, erectile dysfunction and chronic prostatitis; the common indications of Qugu (CV 2) used with compatible scupoints were urinary retention, erectile dysfunction and prostatic hyperplasia. Thirty-six acupoints were concurrently used with Qugu (CV 2), Qugu (CV 2) was mainly compatible with acupoints of conception vessel, kidney meridian and spleen meridian, and the high-frequency acupoints included Zhongji (CV 3), Guanyuan (CV 4) and Zusanli (ST 36); front-mu points were the most used special acupoints, and acupuncture therapy was often used. Qugu (CV 2) treats a wide range of diseases in ancient times, the distant treatment effectiveness of acupoints is emphasized; and it mainly treats local diseases in modern times, the nearby treatment effectiveness of acupoints is emphasized.

Concordance Between Clinical and Laboratory Diagnosis of Abnormal Vaginal Discharge in Chilean Women / Concordância entre o diagnóstico clínico e laboratorial de corrimento vaginal anormal em mulheres chilenas

Abstract Objective To determine the concordance between the clinical diagnosis of women with abnormal vaginal discharge (AVD) and laboratory results using molecular detection and observation of the vaginal microbiota. Methods Cross-sectional study conducted in 2018 in Temuco, Chile. A total of 25 midwives from 12 health centers participated. A total of 125 women>18 years old, volunteers, were recruited. The sample of the posterior vaginal fornix was obtained by speculoscopy. Characteristics of the discharge and of the external and internal genitalia were observed. Gram staining was used to observe vaginal microbiota, blastoconidia and pseudohyphae, and polymerase chain reaction was used for the detection of Trichomonas vaginalis and Candida albicans. The Cohen kappa coefficient was used in the concordance analysis. Results Out of a total of 125 women with AVD, 85.6% consulted spontaneously and 14.4% were diagnosed clinically during a routine check-up. Absolute concordance was significant (p=0.0012), with an agreement of 13.6%. The relative concordance was significant, but fair for bacterial vaginosis (Kappa=0.21; p=0.003) and candidiasis (Kappa=0.22; p=0.001), and slight for trichomoniasis (Kappa=0.14; p=0.009). The percentage of coincidence of the diagnoses (single or mixed) by laboratory and midwives was: bacterial vaginosis 63.2% (12/19), candidiasis 36.5% (27/74), and trichomoniasis 12.5% (4/32). There was 20% coinfection. A total of 36% of the clinical diagnoses of AVD had negative laboratory tests. Conclusion The vulvovaginitis conditions candidiasis and trichomoniasis appear to be overdiagnosed, and bacterial vaginosis appears to be underdiagnosed by the clinical diagnosis when compared with the laboratory diagnosis. The low concordance obtained shows the importance of complementing the clinical diagnosis with a laboratory study of AVD, particularly in women with failed treatments and/or coinfections with unspecific and varying signs and symptoms.

Resumo Objetivo Determinar a concordância entre o diagnóstico clínico de mulheres com corrimento vaginal anormal (AVD) e os resultados laboratoriais por meio da detecção molecular e observação da microbiota vaginal. Métodos Estudo transversal realizado em 2018 em Temuco, Chile. Participaram 25 parteiras de 12 centros de saúde. Um total de 125 mulheres>18 anos, voluntárias, foramrecrutadas. A amostra do fórnice vaginal posterior foi obtida por especuloscopia. Foram observadas características da secreção e da genitália externa e interna. A coloração de Gram foi usada para observar a microbiota vaginal, blastoconídios e pseudo-hifas, e a reação em cadeia da polimerase foi usada para a detecção de Trichomonas vaginalis e Candida albicans. O coeficiente kappa de Cohen foi usado na análise de concordância. Resultados De um total de 125 mulheres com AVD, 85,6% consultaram espontaneamente e 14,4% foram diagnosticados clinicamente durante um check-up de rotina. A concordância absoluta foi significativa (p=0,0012), com concordância de 13,6%. A concordância relativa foi significativa, mas razoável para vaginose bacteriana (Kappa =0,21; p=0,003) e candidíase (Kappa=0,22; p=0,001), e leve para tricomoníase (Kappa=0,14; p=0,009). O percentual de coincidência dos diagnósticos (solteiros ou mistos) por laboratório e parteiras foi: vaginose bacteriana 63,2% (12/19), candidíase 36,5% (27/74) e tricomoníase 12,5% (4/32). Houve 20% de coinfecção. Umtotal de 36% dos diagnósticos clínicos de AVD tiveram exames laboratoriais negativos. Conclusão As condições de vulvovaginite candidíase e tricomoníase parecem ser sobrediagnosticadas, e a vaginose bacteriana parece ser subdiagnosticada pelo diagnóstico clínico quando comparado com o diagnóstico laboratorial. A baixa concordância obtida mostra a importância de complementar o diagnóstico clínico comestudo laboratorial de AVD, principalmente emmulheres com falha de tratamento e / ou coinfecções com sinais e sintomas inespecíficos e variáveis.

Urogenital myiasis - An atypical presentation

The infestation of the human body by maggots has been reported worldwide and occurs most commonly in people of lower socioeconomic status and poor personal hygiene. Urogenital is the rarest site of myiasis presentations. Here we report the case of a 20-year-old, sexually inactive female student who presented with a necrotic growth in the paraurethral region infested with numerous maggots. The lesion involved the urethra and the bladder base. She was treated with debridement and bladder irrigation. The cystoscopy and local examination performed 2 weeks after admission, confirmed the complete healing of the urogenital lesion. Managing this patient's unique challenge was to assess the extent of the involvement and removal of all maggots from the deepest wound portion. The female internal and external urogenital myiasis is a very occasional and under-reported health hazard. Reporting such cases increases the public and physician awareness about the mode of presentation, right diagnosis, and available treatment options.

Infecciones cervicovaginales en exudados vaginales / Cervicovaginal infections in vaginal exudates

Introducción: Se desconocen las características de las infecciones cervicovaginales, diagnosticadas mediante el exudado vaginal, sobre todo en mujeres cubanas de mediana edad. En otras etapas del ciclo vital femenino, sí se han realizado estos estudios. Esta información es importante, fundamentalmente para realizar acciones de promoción de salud. Objetivo: Determinar las características de las infecciones cervicovaginales más frecuentes diagnosticadas mediante el exudado vaginal. Método: Se realizó un estudio transversal en 1118 mujeres. Se recogió la edad (agrupada en 20 - 44 años y 45 y más años), los resultados del exudado vaginal, la percepción de secreción vaginal o la ausencia de esta (asintomáticas) y los microorganismos identificados en el exudado. Resultados: El 49,9 por ciento de exudados vaginales fueron positivos a vaginosis bacteriana, Cándidas albicans, Trichomonas vaginalis y desequilibro en la ecología vaginal. El 45 por ciento de las pacientes no tenían secreción vaginal, es decir, estaban asintomáticas. Conclusión: Las infecciones cervicovaginales se caracterizaron por ser de elevada frecuencia, usualmente asintomáticas, con predominio de vaginosis bacteriana, candidiasis y trichomoniasis(AU)

ABSTRACT Introduction: The characteristics of cervicovaginal infections diagnosed by vaginal exudate are unknown, especially in middle-aged Cuban women. At other stages of the female life cycle, these studies have been done. Due to the importance of this information, to carry out health promotion actions, this research was carried out. Objective: To determine the characteristics of the most frequent cervicovaginal infections diagnosed by vaginal exudate. Method: A cross-sectional study was conducted in 1118 women. Age (grouped into 20-44 years and 45 and over), the results of positive vaginal discharge, the perception of presence or not of vaginal discharge (asymptomatic) and the microorganisms identified in the discharge were collected. Results: 49.9 percent of vaginal exudates were positive for bacterial vaginosis, Candidas albicans, Trichomonas vaginalis and imbalance in vaginal ecology. 45 percent of the patients had no vaginal discharge, that is, they were asymptomatic. Conclusion: Cervicovaginal infections were characterized by being of high frequency, usually asymptomatic, with prevalence of bacterial vaginosis, candidiasis and trichomoniasis(AU)

Usefulness Analysis of Urine Samples for Early Screening of Human Papilloma Virus Infection

Human papilloma virus (HPV) is known to be a major cause of cervical cancer. In Korea, although the mortality of cervical cancer has decreased, HPV infection rates are increasing rapidly in young women. One of the reasons for a high rate of human immunodeficiency virus (HIV) infection appears to be associated with a low frequency to visit gynecology clinics because of the uncomfortable sampling process for HPV testing. Therefore, it is necessary to develop a non-invasive method, such as urine testing to diagnose cervical cancer rather than use of the existing invasive method. This study aimed to test validity of HPV DNA detection in urine specimens that can be easily collected from women. Paired vaginal discharge and urine samples were collected prospectively from 203 women who visited the local hospital between January and August 2018 in Busan, Korea. By using the Virocheck® assay kit (Optipharm), we found that 17.2% (35/203) of vaginal discharge samples were HPV positive and 82.8% (168/203) were HPV negative. In urine samples, 15.8% (32/203) were HPV positive and 84.2% (171/203) were HPV negative. The co-incident rate for HPV DNA detection was 84.8% in both vaginal discharge and urine samples. These results suggest that the HPV DNA detection using urine samples might be an alternative way to diagnose HPV infection in a non-invasive way. This analytical approach can be utilized as a screening test to identify HIV-infected patients who need a follow-up process by using urine samples.

Herlyn-Werner-Wunderlich Syndrome with Central Precocious Puberty: A Case Report

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital anomaly of the genitourinary tract comprising uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Patients with HWW syndrome usually present symptoms such as dysmenorrhea, abdominal pain, pelvic mass, and purulent vaginal discharge. If not treated at an appropriate time, complications such as infertility, endometriosis, pyosalpinx, and subsequent pelvic adhesions may occur. Here, we report a case of HWW syndrome in a 7-year-old-girl who was also diagnosed as having central precocious puberty. She was brought to the pediatric department with chief complaints of lump in her breast and vaginal discharge. When she was around 2 months old, she was confirmed to have a single kidney on ultrasonography. We checked her past medical history and diagnosed her as having HWW syndrome based on the results of imaging studies, including abdominal ultrasonography and pelvic magnetic resonance imaging. She underwent treatment with gonadotropin-releasing hormone analogue for 2 years. During 24 months of follow-up, she showed no serious problems or complications. If renal anomalies are identified immediately after birth or in infancy, further screening tests should be conducted prior to menstruation for determining congenital abnormalities of the reproductive tract and vice versa.

Recurrent vaginal discharge: a myth or a fact? / Corrimento vaginal recorrente: mito ou fato?

Introduction: Vaginal discharge is a frequent gynecological complaint, and may represent a disease or not. A vaginal discharge is considered recurrent when it occurs four or more episodes per year. Among the aetiologies, physiological and infectious conditions are mentioned, being the infectious ones, particularly those caused by Candida spp. fungus, the most related to the symptom. Despite the diagnostic and therapeutic resources available, empirical clinical treatments and self-treatments are very frequent and related to ineffective therapeutic results, leading this population to question what the differences regarding women with no symptoms are. Objective: To identify sociodemographic, behavioral and microbiological differences between women with recurrent vaginal discharge and asymptomatic women. Methods: Cross-sectional study involving 126 women with recurrent discharge complaints (study group) and 155 (control group), totaling 281 evaluated women. The group included women in the menacme, sexually active, and those who fit in the criteria of recurrent vaginal discharge, without definite previous diagnosis, compared with asymptomatic women, who attended an annual routine examination. Pregnant, diabetic and immunosuppressed women were excluded. The study was based on the principle of the null hypothesis, when there are no differences between the two studied groups. Results: The average age was 29.95 years, predominantly single and without children. There was no significant difference in the analysis of relationship time with the current partner, numbers of partners throughout life, gender and contraceptive method. There was predominance of normal vaginal flora (type 1) in both groups, with average prevalence of 44.9%. The alkaline vaginal pH was predominant in the study group. Conclusion: The null hypothesis was confirmed. Biological, behavioral and sociodemographic differences in the studied populations were not identified. In women with recurrent discharge group, there were no infectious etiologic factors, suggesting that clinical diagnoses are not sufficient for the most efficient management of these situations, indicating laboratory evaluation for these cases in order to improve diagnostic accuracy

Introdução: O corrimento vaginal é queixa ginecológica frequente, podendo ou não representar doença. Conceitua-se como corrimento vaginal recorrente aquele que ocorre em quatro ou mais episódios ao ano. Entre as etiologias, citam-se condições fisiológicas e infecciosas, sendo as infecciosas, particularmente as causadas por fungo Candida spp., as mais relacionadas ao sintoma. Apesar dos recursos diagnósticos e terapêuticos disponíveis, tratamentos clínicos empíricos e autotratamentos são muito frequentes e associados a resultados terapêuticos pouco efetivos, levando essa população a questionamentos sobre quais diferenças elas teriam em relação a mulheres sem sintomas. Objetivo: Identificar diferenças sociodemográficas, comportamentais e microbiológicas entre mulheres com corrimento vaginal recorrente e mulheres assintomáticas. Métodos: Estudo transversal envolvendo 126 mulheres com queixa de corrimento recorrente (grupo de estudo) mais 155 controles, totalizando 281 mulheres avaliadas. Foram incluídas no grupo de estudo mulheres no menacme, sexualmente ativas e enquadradas nos critérios de corrimento vaginal recorrente, sem diagnóstico prévio definido, comparadas a mulheres assintomáticas, que compareciam a exame de rotina anual. Foram excluídas as gestantes, diabéticas e imunossuprimidas. Partiu-se de princípio da hipótese nula, em que não há diferenças entre os dois grupos estudados. Resultados: A média de idade foi de 29,95 anos, predominando solteiras e sem filhos. Não houve diferença significativa quando analisados: tempo de relacionamento com o atual parceiro, número de parceiros ao longo da vida, sexarca e método anticoncepcional. Houve predomínio da flora vaginal normal (tipo 1) em ambos os grupos, com prevalência média de 44,9%. O pH vaginal alcalino foi predominante no grupo de estudo. Conclusão: Confirmou-se a hipótese nula, não se identificando diferenças biológicas, comportamentais e sociodemográficas nas populações estudadas. Não se observaram, no grupo de mulheres com corrimento recorrente, fatores etiológicos infecciosos, sugerindo que diagnósticos clínicos não são suficientes para o manejo mais eficiente dessas situações, indicando-se avaliação laboratorial para esses casos com o objetivo de melhorar a acurácia diagnóstica.

Primary malignant melanoma of the uterine cervix treated with pembrolizumab after radical surgery: a case report and literature review

Malignant melanoma of the genital tract is a rare disease that is usually diagnosed by chance. When a definite diagnosis is delayed, the prognosis is very poor without standardized treatment. Herein, we describe a 40-year-old patient who presented with a history of bloody vaginal discharge for 7 months. Gynecological examination showed an exophytic, hard and pigmented cervical mass involving the upper vagina. The patient was diagnosed with cervical melanoma after a punch biopsy and underwent a radical hysterectomy, upper vaginectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. After surgeries, the patient underwent 2-cycles of adjuvant immunotherapy with pembrolizumab, but died within 8 months. In this report, treatment with pembrolizumab after radical surgery was not effective for this patient who had a primary cervical melanoma that metastasized to bone and lung tissue. We do not know why pembrolizumab was ineffective for this patient, but there are several possible explanations; further research is needed.

The demographic and clinical profiles of women presenting with vaginal discharge syndrome at primary care facilities in South Africa: Associations with age and implications for management

Background. Current South African guidelines for the management of vaginal discharge syndrome (VDS) do not recommend treatment for sexually transmitted infection (STI) pathogens for women aged ≥35 years whose partners do not have male urethritis syndrome. The guideline assumes that older women are unlikely to have an STI and that their partners do not have asymptomatic infections.Objectives. To describe the demographic, behavioural and clinical characteristics of women with VDS, comparing older women (≥35 years) with younger women, and to determine the performance of age alone as a criterion for predicting the presence of STI.Methods. This was a cross-sectional study at seven primary healthcare centres taking part in the aetiological surveillance of STIs between January 2015 and December 2016. Eligible women presenting with VDS were enrolled and completed a nurse-administered questionnaire. Genital swabs and blood specimens were collected for laboratory testing. Data were entered into surveillance-specific databases and exported into Stata 14 for analysis. Descriptive statistics were used to compare demographic and clinical profiles of older with younger women. A receiver operator curve (ROC) was used to determine the age cut-off that would best differentiate between women who had infection with STI pathogens and those without.Results. Of 757 women enrolled, 157 (20.7%) were aged ≥35 years. HIV positivity was 46.6%, and higher in older than younger women (54.9% v. 44.5%; p=0.02). Of those enrolled, 283 (37.4%) had bacterial vaginosis (BV) and/or Candida infection only, 232 (30.7%) had BV or Candida with STI pathogens detected, 98 (13%) were infected with STI pathogens only, and 144 (19.0%) did not have any detectable STI or non-STI causes. Although older women were less likely than younger women to have Neisseria gonorrhoeae, Chlamydia trachomatis or Mycoplasma genitalium infection (23.6% v. 38.2%; p<0.01), the burden in older women was not negligible. The area under the ROC for age was 57.5% (95% confidence interval 53.2 - 61.8%), which implies suboptimal performance.Conclusions. Although older women with VDS were less likely than younger women to have STIs, a significant proportion of them did have an infection with STI pathogens. Age alone was not a good criterion for discriminating between women with and without infection with STI pathogens. Other ways of improving the VDS algorithm performance are needed, as is better integration of HIV and STI prevention and treatment

Effects of Module Development and Role Play Course on Clinical Practice Examination Scores during a 4th Year Clerkship / 가정의학회지

BACKGROUND: After introduction of clinical skills assessment in the Korean Medical Licensing Examination, medical schools have reinforced both experiential learning with real patients and preparatory programs. This study was conducted to investigate whether a clinical practice examination (CPX) preparation program improves students' CPX score in terms of case specificity. METHODS: One hundred and thirteen senior students in a medical school participated in this study. During the fourth-year clerkship, 28 students (24.8%) from three rotation groups took a 3-day CPX preparation course consisting of module development, role play, and comprehensive physical exam skills training. Eleven rotation groups (n=85) were compared as control. Both the intervention and control group took two comprehensive CPXs before and after the clerkship was completed. RESULTS: There was no significant difference in age, sex, and school type between the two groups. On pre-test CPX, there was no significant difference in total and sectional scores between the two groups. On post-test CPX, total scores of the intervention group were higher than those of the control groups (69.5±4.3 vs. 67.5±4.4, P < 0.05). History taking scores were higher in intervention groups (70.0±6.0 vs. 66.0±6.6, P=0.01). The station scores of vaginal discharge with case similarity were higher in the intervention groups (73.0±6.3 vs. 68.9±9.3, P=0.03). CONCLUSION: A short CPX preparation course improved history taking ability, but its effect was greater only in a specific case, similar to the pre-course case. Whether this effect was due to the test experience or true improvement in competency requires further investigation.

Identificación y características de Candida spp en secreción vaginal de pacientes embarazadas y no embarazadas / Identification and characteristics of Candida spp in vaginal secretion of pregnant and non-pregnant patients

El objetivo de este estudio fue identificar las especies de Candida spp. aisladas de secreción vaginal de pacientes embarazadas y no embarazadas y relacionarlas con la microscopía, síntomas y signos característicos de la vaginitis causada por esta levadura. Se estudiaron 743 muestras de secreción vaginal de pacientes que acudieron al Departamento de Bacteriología y Micología del Laboratorio Central en el 2015. Las muestras fueron sembradas en CHROM agar Candida y agar Sabouraud. La identificación se hizo por macro y micromorfología, pruebas bioquímicas, auxonograma y método comercial. En las 522 pacientes embarazadas se aislaron 536 Candida spp.: C. albicans 463 (86,4%), C. glabrata 46 (8,6%), C. krusei 9 (1,7%), C. parapsilosis 9 (1,7%), C. tropicalis 8 (1,5%), C. lusitaniae 1 (0,1%).En las 221 pacientes no embarazadasse aislaron 222 Candida spp.: C. albicans 163 (73,4%), C. glabrata 31 (14%), C. krusei 10 (4,6%), C. parapsilosis 9 (4,1%), C. tropicalis 6 (2,7%), C. guilliermondii 1 (0,4%), C. kefyr 1 (0,4%) y C. novergensis 1 (0,4%). Se observó un mayor porcentaje de aislamiento de Candida no albicansen las no embarazadas (26,6% vs 13,6%). En 15 pacientes (2%) se aislaron dos especies de Candida.Tanto en embarazadas como no embarazadas el prurito, la reacción inflamatoria y la presencia de pseudohifas fueron más frecuentes cuando el aislamiento era C. albicans. Enfatizamos la importancia de la siembra de las muestras en agar cromogénico para identificar y diferenciar especies de Candida para la epidemiología y un tratamiento eficazde la vaginitis causada por esta levadura.

The objective of this study was to identify Candida spp. isolated from vaginal secretion of pregnant and non-pregnant women and relate them with microscopy, symptoms and signs characteristic of vaginitis caused by this yeast. A total of 743 vaginal secretion samples wasstudied from patients consulting at the Department of Bacteriology and Mycology of the Central Laboratory in 2015. All samples were cultured on CHROM agar Candida and Sabouraud agar. The identification was made by macro and micromorphology, biochemical tests, auxonogram and commercial method. In pregnant patients (n = 522), 536 Candida spp. were isolated: C. albicans 463 (86.4%), C. glabrata 46 (8.6%), C. krusei 9 (1,7%), C. parapsilosis 9 (1.7%), C. tropicalis 8 (1.5%), C. lusitaniae 1 (0.1%). In no-pregnant patients (n = 221),222 Candida spp.were isolated: C. albicans 163 (73.4%), C. glabrata 31 (14%), C. krusei 10 (4.6%), C. parapsilosis 9 (4.1%), C. tropicalis 6 (2.7%), C. guilliermondii 1 (0.4%), C. kefyr 1 (0.4%) and C. novergensis 1 (0.4%).In the non-pregnant women, a higher percentage of non-albicans Candida species isolation was observed (26.6% vs 13.6%). Fifteen patients (2%) with two Candida species were detected. In pregnant as well non pregnant women, presence of pruritus, inflammatory reactions and and presence of pseudohifas were more frequent when Candida albicans was isolated.We emphasize the importance of culturing samples in chromogenic agar to identify and differentiate Candida species for epidemiology and an effective treatment of the vaginitis caused by this yeast.

Capacidad de formación de biopelículas en especies del género Candida de procedencia clínica / Capability of biofilm formation in Candida genus species of clinical origin

El objetivo de la investigación fue evaluar la capacidad de formación de biopelículas en especies del género Candida provenientes de muestras clínicas con procesos infecciosos. La muestra estuvo constituida por 70 aislados obtenidos de laboratorios clínicos privados. Para la identificación de las especies se utilizó la Prueba de tubo germinativo y la técnica de microcultivo en agar harina de maíz con tween 80, mientras que la cuantificación de la capacidad de formación de biopelículas se realizó por la técnica de microplaca de poliestireno. Entre los resultados obtenidos en la investigación las especies aisladas fueron: Candida glabrata (34%), Complejo Candida albicans (30%), Complejo Candida parapsilosis (27%) y Candida tropicalis (9%), de las cuales 41 aislados (59%) formaron biopelículas, resultando el Complejo Candida albicans y Candida glabrata las especies con mayor grado de formación de biopelículas con 29% cada una, seguida de Complejo Candida parapsilosis con 27% y Candida tropicalis con 15%. Las cepas que tuvieron mayor formación de biopelículas provenían de orina, seguidas de secreción ótica, secreción vaginal y sangre, sin embargo al aplicar la prueba de Chi-cuadrado (x2) de Pearson se determinó que no existe asociación estadísticamente significativa entre la capacidad de formación de biopelículas y el grado de formación con la procedencia clínica así como tampoco hay asociación entre la capacidad de formación de biopelículas y grado de formación con la especie involucrada (p > 0,05)

The aim of this research was to evaluate the capability of biofilm formation in Candida genus species from clinical samples with infectious conditions. The sample consisted of 70 isolates obtained from private clinical laboratories. Germ tube test and agar cornmeal with tween 80 microculture technique were used as species identification, meanwhile, quantification of biofilm formation capacity was performed by the polystyrene microplate technique. Among the results obtained in the research, isolated species were: Candida glabrata (34%), Candida albicans Complex (30%), Candidaparapsilosis Complex (27%) and Candida tropicalis (9%), of which 41 isolates (59%) formed biofilms, resulting Candida albicans and Candida glabrata Complex species with the highest degree of biofilms with 29% each, followed by Candida parapsilosis Complex with 27% and Candida tropicalis with 15%. Strains with more biofilm formation came from urine, followed by ear discharge, vaginal secretion and blood. However, by applying the Chi squaretest the Pearson, it was determined that there was no statistically significant association between thecapability of biofilm formation and the formation degree with clinical origin, neither there is association between the ability of biofilm formation and the formation degree with the species involved (p> 0.05).

Avaliação da abordagem sindrômica do corrimento vaginal para o diagnóstico de tricomoníase / Evaluation of syndromic approach of vaginal discharge flowchart to diagnosis of trichomoniasis

A infecção por Trichomonas vaginalis é a doença sexualmente transmissível não viral mais prevalente no mundo. Entre os diferentes métodos para seu diagnóstico, estão os fluxogramas previstos pela abordagem sindrômica. Objetivo: Avaliar o fluxograma de corrimento vaginal para o diagnóstico de tricomoníase em mulheres atendidas em equipe de saúde da família. Métodos: Estudo transversal feito com amostra consecutiva de população ambulatorial, composta por mulheres em idade fértil, exceto gestantes e menores de idade. As participantes responderam a um questionário onde foram registradas as queixas ocorridas nas últimas quatro semanas. Também foram examinadas e submetidas à medição do pH vaginal e teste das aminas. A cultura em meio específico foi considerada como padrão-ouro. Resultados: Dez por cento das mulheres infectadas pela T. vaginalis estavam assintomáticas; entre as infectadas, a dispareunia foi significativamente maior do que entre as mulheres negativas. O esquema proposto pela abordagem sindrômica tem baixa especificidade e acurácia. Conclusão: O diagnóstico de tricomoníase embasado apenas na queixa de corrimento tem baixa acurácia; o resultado do teste das aminas melhora a especificidade do diagnóstico da infecção por Trichomonas vaginalis, independentemente do valor do pH vaginal.

Trichomonas vaginalis infection is the most prevalent non-viral sexually transmitted disease in the world. Among the different methods for diagnosis, the World Health Organization and Ministry of Health of Brazil proposes the use of flowcharts in the syndromic approach. Objective: To evaluate the syndromic approach of vaginal discharge to diagnosis of T. vaginalis infection. Methods: Transversal study with sample of outpatient population consisting of women in reproductive age. After exclusion of pregnant women and minor girls, the final sample consisted of women between 18 and 49 years old. The participants answered a questionnaire where the complaints were registered. They were examined, had the vaginal pH assessed and sample tested with 10% KOH solution to verify the exhalation of amine odor (whiff test). After this proceeding, a vaginal secretion sample was inoculated in a specific T. vaginalis culture medium. The culture results were used as the gold standard to evaluate the syndromic approach flowchart. The algorithm was evaluated according sensitivity, specificity, accuracy, and predictive values. Results: Among women with T. vaginalis infection, 10% were asymptomatic; among them, dyspareunia was significantly higher, if compared to women with no infection. Flowchart proposed by the syndromic approach had low specificity and accuracy, leading to unnecessary treatment in two-third of women. Conclusion: The diagnosis of trichomoniasis based only on the discharge complaint had low accuracy; the whiff test result improves the specificity of diagnosis of T. vaginalis infection, regardless of the vaginal pH value

Comparative efficacy of oral Lactobacillus rhamnosus (protexin) against metronidazole (flagyl) in the treatment of bacterial vaginosis: A randomized clinical trial / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Bacterial vaginosis (BV) is a very common gynecologic infection associated with a vast number of complications both in gynecologic and obstetric patients. One of the major concerns in its treatment is a high recurrence rate which was multifactorial and the choice of the suitable antimicrobial is important to decrease the treatment failure.METHODS: All gynecologic patients aged 18 years old and above in a tertiary hospital diagnosed with bacterial vaginosis according to Amsel's criteria. A total of 80 patients were randomly assigned into two groups; one group to receive oral Probiotics (Protexin) while the other group to receive Metronidazole. The patients will be followed up accordingly on Days 1, 3, 7 and 30 and will be graded according to Amsel's criteria. The primary endpoint of the study is the treatment of bacterial vaginosis based on the mentioned criteria. (Anukam, 2006)RESULTS: The results showed that there was a significant improvement in the character of the vaginal discharge based on the Amsels criteria on Day 1 of treatment for the Metronidazole group (0/40; 100%, p value CONCLUSION: The Metronidazole remains to be the standard treatment for Bacterial vaginosis. There was also faster recovery and clinical improvement in the character of the vaginal discharge, amount and smell based on the Amsel's criteria as early as Day 1 of follow-up; however, there was a small number of population with poor compliance resulting to higher recurrence rate which was evident on the 30 th day of follow-up. The oral lactobacillus rhamnosus showed advantage over Metronidazole due to lower recurrence rate of BV as noted on Day 30 of follow up.

Comparison of the efficacy of metronidazole and metronidazole plus probiotics capsule in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary hospital: A single blind randomized controlled trial / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Bacterial vaginosis (BV) is the most prevalent cause of symptomatic vaginitis. In the Philippines, prevalence of BV is at 28.16%. The mainstay for the treatment of BV is Metronidazole. Although antibiotic therapy has been shown to eliminate BV associated organisms, there is extremely high recurrence rate.OBJECTIVE: To compare the efficacy of metronidazole and metronidazole plus lactobacilli tablet in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary medical center.METHODOLOGY: The population included non-pregnant women ages 15 t0 44 years old, with bacterial vaginosis diagnosed by Amsel's criteria and Nugent's scoring. The participants were randomly assigned to their treatment group, one is Metronidazole only and other received Metronidazole plus Lactobacillus tablet. All participants followed up on day 8,15,22 and 56 from initiation of treatment resolution or persistence of symptoms and collection of vaginal specimen for gram stain and inquire on adverse effects.RESULTS: On day 8 treatment, there were significantly more participant in the metronidazole plus probiotic arm with an estimated lactobacilli count of more than 30/hpf as comapred to metronidazole alone. On day 15 post treatment, there was no statistically significant difference with the estimated Gardnerella vaginalis count, lactobacilli count, presence or absence of malodorous vaginal discharge between the metronidazole plus probiotic and the metronidazole alone arm. With metronidazole plus probiotic group, the proportion of women with less than 30 per hpf Gardnella vaginalis count and absent foul smelling vaginal discharge were accounted among 100% of the participants from day 8 to 56 post treatment. The early reduction in the causative agent and symptoms can be attributed to an increase in the estimated lactobacilli count sustained until 56 days post treatment metronidazole plus probiotic. However, from day 15 to 22 and 56 post- treatment, the proportion of participants who had a nugent's score of less than 4 were greater for both the metronidazole plus probiotic (100%) and metronidazole alone (95%) arm, when compared to day 8 post-treatment. This finding for the metronidazole plus probiotic group is due to sustained reduction in the Gardnella vaginalis count and increase in lactobacilli counts. Potentially , the metronidazole plus probiotic treatment was found to be more favorable in sustaining the normal flora and probiotic can be used as an adjunct may enhance the efficacy of metronidazole in the treatment of BV.CONCLUSION: Metronidazole plus probiotic and metronidazole only treatment are comparable in treating bacterial vaginosis. In terms of restoring and maintaining the normal flora, metronidazole plus probiotic appears to be more significantly efficacious. Probiotic in the form of lactobacilli is a promising adjunct to enhance the efficacy of metronidazole in the treatment of bacterial vaginosis.

Comparative efficacy of oral Lactobacillus rhamnosus (protexin) against metronidazole (flagyl) in the treatment of bacterial vaginosis: A randomized clinical trial / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Bacterial vaginosis (BV) is a very common gynecologic infection associated with a vast number of complications both in gynecologic and obstetric patients. One of the major concerns in its treatment is a high recurrence rate which was multifactorial and the choice of the suitable antimicrobial is important to decrease the treatment failure. METHODS: All gynecologic patients aged 18 years old and above in a tertiary hospital diagnosed with bacterial vaginosis according to Amsel's criteria. A total of 80 patients were randomly assigned into two groups; one group to receive oral Probiotics (Protexin) while the other group to receive Metronidazole. The patients will be followed up accordingly on Days 1, 3, 7 and 30 and will be graded according to Amsel's criteria. The primary endpoint of the study is the treatment of bacterial vaginosis based on the mentioned criteria. (Anukam, 2006) RESULTS: The results showed that there was a significant improvement in the character of the vaginal discharge based on the Amsels criteria on Day 1 of treatment for the Metronidazole group (0/40; 100%, p value CONCLUSION: The Metronidazole remains to be the standard treatment for Bacterial vaginosis. There was also faster recovery and clinical improvement in the character of the vaginal discharge, amount and smell based on the Amsel's criteria as early as Day 1 of follow-up; however, there was a small number of population with poor compliance resulting to higher recurrence rate which was evident on the 30 th day of follow-up. The oral lactobacillus rhamnosus showed advantage over Metronidazole due to lower recurrence rate of BV as noted on Day 30 of follow up.

Comparison of the efficacy of metronidazole and metronidazole plus probiotics capsule in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary hospital: A single blind randomized controlled trial / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Bacterial vaginosis (BV) is the most prevalent cause of symptomatic vaginitis. In the Philippines, prevalence of BV is at 28.16%. The mainstay for the treatment of BV is Metronidazole. Although antibiotic therapy has been shown to eliminate BV associated organisms, there is extremely high recurrence rate.OBJECTIVE: To compare the efficacy of metronidazole and metronidazole plus lactobacilli tablet in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary medical center.METHODOLOGY: The population included non-pregnant women ages 15 t0 44 years old, with bacterial vaginosis diagnosed by Amsel's criteria and Nugent's scoring. The participants were randomly assigned to their treatment group, one is Metronidazole only and other received Metronidazole plus Lactobacillus tablet. All participants followed up on day 8,15,22 and 56 from initiation of treatment resolution or persistence of symptoms and collection of vaginal specimen for gram stain and inquire on adverse effects.RESULTS: On day 8 treatment, there were significantly more participant in the metronidazole plus probiotic arm with an estimated lactobacilli count of more than 30/hpf as comapred to metronidazole alone. On day 15 post treatment, there was no statistically significant difference with the estimated Gardnerella vaginalis count, lactobacilli count, presence or absence of malodorous vaginal discharge between the metronidazole plus probiotic and the metronidazole alone arm. With metronidazole plus probiotic group, the proportion of women with less than 30 per hpf Gardnella vaginalis count and absent foul smelling vaginal discharge were accounted among 100% of the participants from day 8 to 56 post treatment. The early reduction in the causative agent and symptoms can be attributed to an increase in the estimated lactobacilli count sustained until 56 days post treatment metronidazole plus probiotic. However, from day 15 to 22 and 56 post- treatment, the proportion of participants who had a nugent's score of less than 4 were greater for both the metronidazole plus probiotic (100%) and metronidazole alone (95%) arm, when compared to day 8 post-treatment. This finding for the metronidazole plus probiotic group is due to sustained reduction in the Gardnella vaginalis count and increase in lactobacilli counts. Potentially , the metronidazole plus probiotic treatment was found to be more favorable in sustaining the normal flora and probiotic can be used as an adjunct may enhance the efficacy of metronidazole in the treatment of BV.CONCLUSION: Metronidazole plus probiotic and metronidazole only treatment are comparable in treating bacterial vaginosis. In terms of restoring and maintaining the normal flora, metronidazole plus probiotic appears to be more significantly efficacious. Probiotic in the form of lactobacilli is a promising adjunct to enhance the efficacy of metronidazole in the treatment of bacterial vaginosis.

Herlyn-Werner-Wunderlich syndrome: An unusual presentation with pyocolpos

Herlyn-Werner-Wunderlich syndrome is a rare congenital anomaly of the urogenital tract, which is characterized by the triad of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. It usually presents at puberty with pelvic pain, dysmenorrhea, and a vaginal or pelvic mass. Although rare, it may present with purulent vaginal discharge due to secondary infection of the obstructed hemivagina, making diagnosis difficult. A careful pelvic examination to identify the cervix and vagina is the key to the diagnosis of Müllerian duct anomalies and magnetic resonance imaging can provide additional useful information. The optimal treatment is full excision and marsupialization of the obstructing vaginal septum so that both uteri can drain through the patent vagina. The authors report a case of a 22-year-old female with an unusual presentation of Herlyn-Werner-Wunderlich syndrome complicated by pyocolpos, which was successfully managed by vaginal septum resection and drainage of pus.

Sterile Pyometra in Two Dogs

Two young dogs were referred to the Veterinary Medical Teaching Hospital of Konkuk University, one for examination of vaginal discharge and the other after being hit by a car. Dog 1 exhibited a high neutrophil count on Gram-stained vaginal smears, marked leukocytosis on a complete blood count, and uterine enlargement on ultrasonography. In dog 2, a markedly enlarged right uterine horn containing echogenic debris was found incidentally on ultrasonography. A tentative diagnosis of pyometra was made in both cases and ovariohysterectomy was performed. Purulent material was collected from each uterine horn and submitted separately for aerobic and anaerobic bacterial culture; all culture results were negative. The white blood cell count revealed normal limits 2 days post operation in dog 1 and 4 days post operation in dog 2. Positive bacterial cultures are usually obtained from dogs with pyometra, and antibiotic selection is based on the results of culture and sensitivity testing in the event of failure of empiric antibiotic therapy. However, in the cases reported here, no bacterial growth was identified from the uterine samples despite the presence of purulent material. A short course of empiric antibiotic therapy was administered. This is the first known report describing sterile pyometra in dogs.

Probiotics in the Prevention and Treatment of Postmenopausal Vaginal Infections: Review Article

Bacterial vaginosis (BV) and complicated vulvovaginal candidiasis (VVC) are frequently occurring vaginal infections in postmenopausal women, caused by an imbalance in vaginal microflora. Postmenopausal women suffer from decreased ovarian hormones estrogen and progesterone. A normal, healthy vaginal microflora mainly comprises Lactobacillus species (spp.), which act beneficially as a bacterial barrier in the vagina, interfering with uropathogens. During premenopausal period, estrogen promotes vaginal colonization by lactobacilli that metabolizing glycogen and producing lactic acid, and maintains intravaginal health by lowering the intravaginal pH level. A lower vaginal pH inhibits uropathogen growth, preventing vaginal infections. Decreased estrogen secretion in postmenopausal women depletes lactobacilli and increases intravaginal pH, resulting in increased vaginal colonization by harmful microorganisms (e.g., Enterobacter, Escherichia coli, Candida, and Gardnerella). Probiotics positively effects on vaginal microflora composition by promoting the proliferation of beneficial microorganisms, alters the intravaginal microbiota composition, prevents vaginal infections in postmenopausal. Probiotics also reduce the symptoms of vaginal infections (e.g., vaginal discharge, odor, etc.), and are thus helpful for the treatment and prevention of BV and VVC. In this review article, we provide information on the intravaginal mechanism of postmenopausal vaginal infections, and describes the effectiveness of probiotics in the treatment and prevention of BV and VVC.