Kidney-tonifying and blood-activating in treatment of infertility due to pelvic inflammatory disease:clinical experience of Professor MA Kun / 中国中药杂志

Pelvic inflammatory disease(PID) has become one of the leading causes of female infertility, with an increasing incidence in recent years. Modern medicine believes that risk factors of PID will affect the formation of eggs and embryo implantation, especially on the encounter of gametes, fertilization, and transport of fertilized eggs to the uterine cavity. Therapies for infertility due to PID include medication, sonographic hydrotubation, surgery, and assisted reproductive technology. Professor Ma Kun believes that the disease is located in the uterus with appendages with the main pathogenesis of kidney deficiency and blood stasis. Blood stasis is the pathological basis, and kidney deficiency is the fundamental pathogenesis, which exhibits deficiency-excess in complexity. Kidney deficiency will cause blood stasis over time, while blood stasis will aggravate kidney deficiency in turn, making PID-induced infertility refractory. In clinical practice, basic therapies follow the principles of kidney-tonifying and blood-activating, removing blood stasis, dredging collaterals, and coordinating thoroughfare and conception vessels. The oral administration of Chinese medicine combined with enema, external application, and external washing displays better efficacy in improving the pelvic microenvironment and increasing the pregnancy rate and pregnancy success rate in the treatment of PID-induced infertility.

Ascitis secundaria a chlamydia trachomatis tras procedimiento de reproducción asistida / Ascites secondary to chlamydia trachomatis after assisted reproduction procedure

El desarrollo de ascitis moderada o severa es infrecuente tras una enfermedad inflamatoria pélvica por Chlamydia trachomatis, una de las principales causas de infección de transmisión sexual a nivel mundial. Caso clínico: Paciente de 29 años que tras aborto diferido (gestación tras inseminación artificial) que inicia a las seis semanas con cuadro de dolor abdominal inespecífico y ascitis de predominio linfocitario. El diagnostico se realizo mediante PCR (Werfen®) tanto el liquido ascítico como en exudado endocervical. La paciente recibió tratamiento antibiótico con doxiciclina. Conclusión: Las enfermedades de transmisión sexual deben ser consideradas cuando se realiza un diagnóstico diferencial de una mujer sexualmente activa con dolor abdominal y ascitis, instaurar tratamiento antibiótico y evitar pruebas e intervenciones quirúrgicas innecesarias.

The development of moderate or severe ascites is infrequent after a pelvic inflammatory disease from Chlamydia trachomatis, one of the main causes of sexually transmitted infection worldwide. Clinical case: A 29-year-old patient who, after a delayed abortion (gestation after artificial insemination), started at six weeks with symptoms of non-specific abdominal pain and predominantly lymphocytic ascites. The diagnosis is made by PCR (Werfen®) both the ascitic fluid and the endocervical exudate. The patient received antibiotic treatment with doxycycline. Conclusion: Sexually transmitted diseases should be considered when making a differential diagnosis of a sexually activated woman with abdominal pain and ascites. Establishing antibiotic treatment, and avoiding unnecessary tests and surgical treatments.

Expert consensus statement on Kangfu Xiaoyan Suppository in treatment of pelvic inflammatory in clinical practice / 中国中药杂志

Kangfu Xiaoyan Suppository is widely used in the treatment of gynecological inflammatory diseases. Long-term clinical application and a certain amount of research evidences show that Kangfu Xiaoyan Suppository can alleviate the clinical symptoms of pelvic inflammatory diseases,reduce the recurrence rate,and relieve sequelae,with a better safety and economic characteristics. As a type of nationally protected traditional Chinese medicine and type B medicine included in medical insurance,it has been selected as a Chinese patent medicine for rectal administration. It was included in the Guidelines for diagnosis and treatment of common gynecological diseases of traditional Chinese medicine published by the Chinese Academy of Traditional Chinese Medicine in 2012,the Pelvic inflammatory diseases diagnosis and treatment guidelines issued by the Infectious Diseases Collaborative Group of the Obstetrics and Gynecology Branch of the Chinese Medical Association in 2014,and the group standard of Single use of traditional Chinese medicine/combined antibiot guidelines for clinical practice-pelvic inflammatory diseases of the Chinese Academy of Traditional Chinese Medicine in 2017. To further enhance clinicians' understanding of the drug and better guide its rational clinical use,experts from the field of gynecology of traditional Chinese and Western medicine were invited to develop and compile this expert consensus. This consensus takes full account of clinical evidences and expert clinical experience,and form recommendations for clinical problems based on evidences and consensus recommendations for clinical problems without evidence by nominal grouping method. The expert consensus is mainly formed in the consideration of six factors: quality of evidence,economy,efficacy,adverse reactions,patient acceptability and others. Based on clinical research evidences and expert experience,this consensus provides a preliminary reference for the clinical use of the drug in a concise and clear format. However,evidence-based support is still required in a large number of high-quality studies,and this consensus will be revised in the future according to new clinical problems and the update of evidence-based evidence in practical application.

Systemic evaluation and Meta-analysis of efficacy and safety of Kangfu Xiaoyan Suppository in treatment of pelvic inflammatory disease / 中国中药杂志

To evaluate the efficacy and safety of Kangfu Xiaoyan Suppository in the treatment of pelvic inflammatory disease. Four Chinese databases,namely CNKI,VIP,WanFang and SinoMed,and three English databases Cochrane Library,namely Medline,and ClinicalTrail.gov were systematically and comprehensively retrieved from the establishment of each database to June 2018. The quality of the included studies was evaluated by using the risk assessment tools developed by the Cochrane Collaboration,and RevMan 5. 3 software was used for Meta-analysis. A total of 675 articles were retrieved,and finally 56 studies were included. The total sample size was 6 228,the test group included 3 267 cases,and the control group included 2 961 cases. The overall quality of the included studies was generally low. According to the intervention measures and outcome indicators,the included studies were divided into different subgroups for analysis. The main results of Meta-analysis showed that the recurrence rate of Kangfu Xiaoyan Suppository combined with antibiotics was lower than that of antibiotics alone. Kangfu Xiaoyan Suppository combined with antibiotics was superior to antibiotics alone in terms of abdominal pain,leucorrhea abnormality relief time,mass absorption time and pain relief time. In terms of safety,Kangfu Xiaoyan Suppository combined with antibiotics had a lower incidence of adverse reactions than antibiotics alone. Based on the results of this study,it is indicated that Kangfu Xiaoyan Suppository had a certain effect on the treatment of pelvic inflammatory disease,especially with a lower recurrence rate. The long-term effect is remarkable. No serious adverse reaction was observed. Restricted by the quality of the studies included,the above conclusion need to be further verified in high-quality,largesize,multi-center clinical researches.

Mechanisms of Fuke Qianjin Capsules in treatment of pelvic inflammatory disease based on GC-MS metabolomics / 中国中药杂志

Pelvic inflammatory disease( PID) rat model was induced by the mixture of Escherichia coli,Staphylococcus aureus,and Streptococcus hemolytic-β． Gas chromatography-mass spectrometry( GC-MS) based metabolic profiling method was combined with multivariate statistical analysis,such as PCA,PLS-DA and OPLS-DA to analyze endogenous small molecule metabolites in serum of rats after treatment of Fuke Qianjin Capsules. The results showed that Fuke Qianjin Capsules could significantly improve the inflammatory pathological characteristics and tissue damages in model rats. Based on the principle of VIP>1 and P<0. 05,a total of 6 different metabolic biomarkers were identified,including L-valine,L-isoleucine,L-threonine,butanedioic acid,serine and D-glucose,respectively.The contents of these six different metabolites were significantly reversed after administration. Further analysis of the metabolite pathways through KEGG database showed that Fuke Qianjin Capsules achieved the effect possibly through glycine,serine and threonine metabolism,aminoacyl-tRNA biosynthesis and valine,leucine and isoleucine biosynthesis. Therefore,this study came to the conclusion that Fuke Qianjin Capsules can be used in the treatment of mixed bacteria induced pelvic inflammatory disease possibly by regulating amino acid and its derivative metabolism.

Costo del tratamiento en trabajadoras con enfermedad inflamatoria pelviana / Cost of treatment in workers with pelvic inflammatory disease

Se realizó una intervención terapéutica en 39 trabajadoras con inflamación pelviana, diagnosticadas y tratadas desde hacía 5 meses, pertenecientes al área de salud "La Caoba" del municipio de San Luís, en Santiago de Cuba, de enero a mayo del 2012, con vistas a comparar el costo del tratamiento medicamentoso con el del acupuntural. En la serie se obtuvo que 51,3 % de las féminas con medicación mejorara en 2 semanas y 23,1 % requirió más de 28 días de tratamiento, mientras que 90,0 % de las que recibieron acupuntura se recuperaron en 3 semanas. Esta terapéutica alternativa constituyó un ahorro para las pacientes, al disminuir sus pérdidas económicas por gastos en medicamentos y por certificados médicos; además de reducir la estadía hospitalaria y su costo. Desde el punto de vista social se logró que las trabajadoras afectadas se incorporaran a sus quehaceres laborales y domésticos más tempranament.

A therapeutic intervention was carried out in 39 workers with pelvic inflammation, diagnosed and treated for 5 months, belonging to the health area from "La Caoba" of San Luís municipality, in Santiago de Cuba, from January to May, 2012, with the aim of comparing the cost of drug treatment with that of the acupunctural treatment. In the series it was obtained that 51.3% of the female with medication improved in 2 weeks and 23.1% required more than 28 days of treatment, while 90.0% of those who received acupuncture recovered in 3 weeks. This alternative therapy constituted a saving for the patients, as they decreased their economic losses due to expenses in medications and to medical certificates; besides reducing the hospital stay and its cost. From the social point of view it was achieved that the affected workers incorporate to their jobs and domestic work even earlier.

Doxiciclina para tratamento da doença inflamatória pélvica / Doxycycline for treatment of pelvic inflammatory disease

CONTEXTO: A Doença Inflamatória Pélvica (DIP) é uma síndrome clínica atribuída à ascensão dos microorganismos do trato genital inferior, com comprometimento do endométrio, trompas, anexos uterinos e/ou estruturas contíguas. Os microorganismos mais comumente envolvidos são Neisseria gonorrhoeae e Chlamydia trachomatis. A Organizaçao Mundial da Saúde (OMS) estima a ocorrência de 1.967.200 casos de clamídia e de 1.541.800 casos de gonorreia na população sexualmente ativa no Brasil, por ano. Dentre mulheres com infecções não tratadas por clamídia e/ou gonorreia, 10 a 40% desenvolvem doença inflamatória pélvica (DIP). A doxiciclina é um dos medicamentos recomendados pelo Ministério da Saúda para tratamento da DIP, mas ainda não é disponibilizado no SUS para essa indicação. TRATAMENTO RECOMENDADO: De acordo com o Manual de Controle das DST (2006)2, do Ministério da Saúde, os tratamentos recomendados para DIP leve, sem sinais de peritonismo ou febre (tratamento ambulatorial), deve ser realizado da seguinte forma: -Esquema 1: Ceftriaxona 250 mg, IM, dose única + Doxiciclina 100 mg, VO de 12/12 horas, por 14 dias + Metronidazol 500 mg, VO, de 12/12 horas, por 14 dias; -Esquema 2: Ofloxacina 400 mg, VO de 12/12 horas por 14 dias Ou Ciprofloxacina 500 mg 12/12horas por 14 dias + Doxiciclina 100 mg, VO de 12/12 horas por 14 dias + Metronidazol 500 mg, VO de 12/12 horas, por 14 dias. CONSIDERAÇÕES FINAIS: A doxiciclina é uma opção de tratamento para a doença inflamatória pélvica (DIP). As estimativas de impacto orçamentário anual resultante da ampliação de uso da doxiciclina no SUS, para tratamento da DIP provocada por clamídia e/ou gonorreia, variaram de R$274.528,36 até R$ 1.098.113,45. DELIBERAÇÃO FINAL: Os membros da CONITEC presentes na reunião do plenário do dia 11/06/2015 deliberaram, por unanimidade, recomendar a ampliação de uso da doxiciclina 100mg, em comprimido, para tratamento da doença inflamatória pélvica (DIP). DECISÃO: PORTARIA Nº 56, de 1 de outubro de 2015 - Torna pública a decisão de incorporar a doxiciclina 100mg comprimidos para tratamento da doença inflamatória pélvica (DIP), conforme normas técnicas definidas pelo Ministério da Saúde, no âmbito do Sistema Único de Saúde - SUS.

Enfermedad inflamatoria pélvica: un reto en el diagnóstico y tratamiento precoz / Pelvic inflammatory disease: a challenge in the early diagnosis and treatment

Actualizar los datos disponibles en referencia a la enfermedad inflamatoria pélvica para poder unificar criterios diagnósticos y terapéuticos y así minimizar las complicaciones que a corto y/o largo plazo puedan derivar. Método: Revisión de la literatura en Pubmed atendiendo sobre todo a las guías clínicas más actualizadas y ensayos clínicos aleatorizados. Resultados: La enfermedad inflamatoria pélvica es un cuadro infeccioso común entre las mujeres en edad fértil. Su mecanismo de transmisión más frecuente es la vía sexual y comparte factores de riesgo con otras enfermedades de transmisión sexual. Su diagnóstico, que es clínico, puede ser complejo y las formas subclínicas pueden pasar en ocasiones inadvertidas. Generalmente se puede comenzar con un tratamiento médico ambulatorio siguiendo las pautas recomendadas, y si la paciente no mejora o presenta un cuadro grave de inicio se indicará ingreso hospitalario y tratamiento médico endovenoso, reservando la cirugía para aquellos casos rebeldes en que fracasen los pasos anteriores. Conclusión: Es imprescindible reconocer esta entidad e instaurar el tratamiento antibiótico precoz, un retraso en el tratamiento adecuado, puede incrementar las secuelas inflamatorias a corto y largo plazo.

Update the pelvic inflammatory disease to standardize diagnostic and therapeutic criteria and to minimize its complications in the short and/or long term. Method: Search in Pubmed with especial attention to clinical guidelines and randomized clinical trials. Results: Pelvic inflammatory disease is a common infectious condition among women of fertile age. Its mechanism is the most common sexually transmitted shared risk factors and other sexually transmitted disease. Its clinical diagnosis can be complex and subclinical forms can sometimes go unnoticed. Usually it's indicated to start with medical treatment following the recommended guidelines, and if the patient does not improve or has a severe case, hospitalization and intravenous medical treatment is indicated, reserving surgery for those cases in which fail the above steps. Conclusion: It is essential to recognize this entity and establish early antibiotic treatment, so that a delay in appropriate antibiotic treatment, can lead to an increase in inflammatory short and long term sequelae.

Abordagem atual da doença inflamatória pélvica / Current approaches to pelvic inflammatory disease

A doença inflamatória pélvica (DIP) é um processo inflamatório de natureza infecciosa que pode atingir estruturas e órgãos do trato genital superior. Devido à sua importância epidemiológica e de suas graves complicações, este artigo atualiza e propõe uma abordagem sistemática da DIP. Os principais agentes etiológicos são a Neisseria gonorrhoeae,Chlamydia trachomatis e outros agentes etiológicos de uretrites, cervicites, vulvovaginites e vaginoses, em geral, polimicrobiana, o que é a base de sua terapêutica. A mulher deve ser investigada para DIP quando apresenta, especialmente, desconforto abdominal, dor lombar, dispareunia e nódoas ou manchas ao exame ginecológico, previamente a procedimentos transcervicais. A classificação clínico-laparoscópica deDIP pode ser dividida em: a) estágio I (endometrite/salpingite sem peritonite); estágio II (salpingite aguda com peritonite); estágio III (salpingite aguda com oclusão tubária ou abscesso tubo-ovariano); estágio IV (abscesso tubo-ovariano roto). A definição do estágio orienta a conduta e o tratamento, pois em formas leves (estágio I) o tratamento e seguimento podem ser feitos ambulatorialmente, enquanto para os casos moderadosou graves a internação hospitalar está indicada para início do tratamento por via endovenosa e monitorização da resposta ao tratamento. O tratamento suportivo, retirada de dispositivo intrauterino (DIU), abstinência sexual e repouso também são indicados, além de orientações sobre as implicações da doença e abordagem do parceiro.

Pelvic inflammatory disease (PID) is an inflammatory process of infectious nature that can affect structures and organs of the upper genital tract. Considering this disease's epidemiological relevance and severe complications, this article provides an update and proposes a systematic approach to PID. The main etiological agents are Neisseria gonorrhoeae, Chlamydia trachomatis and other etiological agents of urethritis, cervicitis, vulvovaginitis and vaginoses. These are generally of polymicrobial origin, which determines the treatment basis for pelvic inflammatory diseases.Women must be checked for PID when experiencing abdominal discomfort, backache, dyspareunia, or presenting with stains during gynecological examination and prior to transcervical procedures. The clinical and laparoscopic classification of PID can be divided into: a) stage I (endometritis/salpingitis without peritonitis), stage II (acute salpingitis with peritonitis), stage III (acute salpingitis with tubal occlusion or tube-ovarian abscess), and stage IV (tube-ovarian abscess rupture). Defining the stage guides procedures and treatment, given that in mild forms (stage I) the treatment and follow-up can be performed in the ambulatory environment while moderate to severe cases require hospitalization so that intravenous treatment and treatment outcome monitoring can be started. Supportive treatment, removal of intrauterine device (IUD), sexual abstinence and rest are also indicated, as well as counseling on the implications of the disease and partner approach.

Actinomicosis pelviana: caso clínico / Pelvic actinomycosis: a case report

La actinomicosis pelviana es una enfermedad granulomatosa crónica muy infrecuente, causada por un bacilo Gram positivo, y que clínicamente suele confundirse con neoplasias pelvianas. Se presenta un caso clínico en que sospechó la infección en forma temprana, logrando resultados exitosos con tratamiento médico.

Pelvic actinomycosis is a chronic granulomatous disease quite uncommon; it is caused by positive Gram bacilli, and clinically it may appear as a pelvic neoplasia. We present a case report in which the infection was pursued actively, achieving excellent results with medical treatment.

Doença inflamatória pélvica: atualização / Inflammatory pelvic disease: updating

A doença inflamatória pélvica (DIP) consiste em espectro de infecções do trato genital superior que inclui: endometrite, salpingite, abscesso tubo-ovariano e/ou peritonite pélvica. Constitui-se em infecção polimicrobiana do trato genital superior feminino devido à sua contaminação pelos microrganismos do endocérvice e da vagina. São fatores de risco para o desenvolvimento de DIP: idade entre 15-24 anos, vida sexual ativa, múltiplos parceiros, inserção de dispositivo intra-uterino (DIU) há menos de 20 dias e história pregressa de DIP. Procedimentos e cirurgias pélvicos com manipulação de canal cervical podem predispor à infecção por alterarem a barreira cervical protetora. A DIP é um dos processos infecciosos mais frequentes nas mulheres em idade reprodutiva e é entidade de difícil diagnóstico devido às manifestações clínicas diversas. O diagnóstico é muito provável diante de dor à palpação cervical, uterina e/ou de anexos, acompanhados de febre, corrimento vaginal mucopurulento ou leucorreia, sangramento intermenstrual e pós-coito, dispareunia, disúria e polaciúria. O tratamento da DIP deve prover antibioticoterapia empírica de amplo espectro para os patógenos mais prováveis: N. gonorrhoeae e C. trachomatis, pois o rastreamento negativo para esses organismos não exclui infecção do trato reprodutivo superior. A precocidade das medidas terapêuticas é importante na prevenção de sequelas de longo prazo e a opção por tratamento ambulatorial ou hospitalar deve ser baseada no julgamento médico. Parceiros sexuais de mulheres com DIP devem ser examinados e tratados caso tenham tido relação sexual com a paciente nos 60 dias anteriores ao aparecimento dos sintomas. O rastreamento e tratamento da infecção por clamídia em mulheres sexualmente ativas diminui o risco de elas contraírem DIP. Grávidas com suspeita de DIP devem ser internadas para receber tratamento parenteral. Não foram estabelecidas diferenças nas manifestações clínicas da DIP em mulheres soropositivas e negativas para o HIV. Ambos os grupos respondem igualmente bem aos tratamentos parenteral e oral. (AU)

Pelvic Inflammatory Disease (PID) consists in a spectrum of upper genital tract infections including: endometritis, salpingitis, tube-ovarian abscess and / or pelvic peritonitis. It constitutes polymicrobial infection of upper female genital tract because of its contamination by microrganisms from the vagina and endocervix. Risk factors for the development of PID are: aged 15-24 years, sexual activity, multiple partners, insertion of an intrauterine device (IUD) for less than 20 days and a history of PID. Procedures and pelvic surgery with manipulation of the cervical canal may predispose to infection by altering the cervical protective barrier. PID is one of the most common infectious processes in women in reproductive age and it is an entity of difficult diagnosis due to the diverse clinical manifestations. The diagnosis is most likely on painful palpation of the cervix, uterus or attachments, accompanied by fever, depurulent vaginal discharge or leukorrhea, intermenstrual and postcoital bleeding, dyspareunia, dysuria and pollakiuria. The treatment of PID should provide broad-spectrum empiric antibiotic therapy for the most likely pathogens: N. gonorrhoeae and C. trachomatis, because negative screening for these organisms does not exclude infection of the upper reproductive tract. The early therapeutic measures are important in preventing long-term sequelae and the option for outpatient or hospital treatment should be based on medical judgment. Sexual partners of women with PID should be examined and treated if they had sexual relations with the patient 60 days prior to the onset of symptoms. Screening and treatment of chlamydial infection in sexually active women decreases the risk of them contracting PID. Pregnant women with suspected PID should be hospitalized to receive parenteral treatment. No differences were found in clinical manifestations of PID in women seropositive and negative for HIV. Both groups respond equally well to parenteral and oral treatments. (AU)

Clinical Features of Fitz-Hugh-Curtis Syndrome in the Emergency Department

PURPOSE: Fitz-Hugh-Curtis Syndrome (FHCS) is a clinical entity characterized by inflammation of the liver capsule associated with genital tract infection. The aim of this study is to provide physicians with clinical suggestions for diagnostic approaches based on a series of patients who were diagnosed with FHCS. MATERIALS AND METHODS: We conducted a retrospective study of patients who were diagnosed with FHCS after presenting to the emergency department (ED). The symptoms, physical examinations, laboratory findings, radiological findings, and progress of the patients were reviewed. RESULTS: During the four-year study period, a total of 82 female patients received a final diagnosis of FHCS in the ED. Chlamydia trachomatis was identified as a pathogen in 89% of the patients. Their clinical characteristics and laboratory findings were described. Fifty-two patients (63.4%) were admitted to the hospital. All of the admitted patients improved after treatment combining antibiotic therapy with conservative care. CONCLUSION: FHCS should be considered as a differential diagnosis for female patients of childbearing age with right upper abdominal pain. Timely diagnosis using biphasic computed tomography (CT) with arterial and portal phases may help ensure adequate medical treatment as well as avoid invasive procedures.

Doença inflamatória pélvica / Pelvic inflammatory disease

Doença inflamatória pélvica é causada pela infecção polimicrobiana do trato genital superior.Os agentes patogênicos são sexualmente transmissíveis (clamídia, gonococo e micoplasmas) e endógenos (aeróbios, anaeróbios e facultativos).O envolvimento de germes sexualmente transmissíveis preceitua o rastreamento das demais doenças sexualmente transmissíveis em todas as pacientes e seus parceiros.A prevalência da forma subclínica aumenta o risco de falta de diagnóstico e subestimação.Vaginose bacteriana e instrumentação uterina aumentam o risco.Canal cervical com corrimento branco, amarelado ou sangramento induzido indicam infecção por clamídia, gonococo ou micoplasmas.O tratamento deve ser instituído quando estão presentes dores à palpação do baixo ventre ou anexial e à mobilização do colo uterino.O tratamento precoce se justifica porque a infecção experimental mostra que as lesões tubárias não revertem com antibióticos administrados 12 dias depois da inoculação de clamídia.

Tubo-ovarian Actinomycosis: A case report with brief review of literature.

Pelvic actinomycosis is an uncommon condition, often associated with the use of intrauterine contraceptive device (IUCD). Pelvic actinomycosis is rare accounting for 3% of all human actinomycotic infections. Ovarian actinomycosis is even rarer. Here, we present a 24-year-old woman using an IUCD for 3 1 / 2 years with right-sided adnexal mass, which was diagnosed postoperatively as tubo-ovarian actinomycosis. Many times, an appropriate management is overlooked or delayed due to its non-specific and variable clinical and radiological features. Sometimes, it can even mimic an advanced pelvic malignancy. Therefore, the gynecologist should consider the possibility of this infection to spare the patient from morbidity of radical surgical procedure.

A comparative study of injection placentrex and conventional therapy in treatment of pelvic inflammatory disease.

To compare the effect of placentrex injection given along with conventional therapy, with conventional treatment alone on the symptoms and signs of pelvic inflammatory disease (PID) ie, abdominal pain, dysmenorrhoea and adnexal tenderness, 50 out of 100 women with PID were randomly assigned to receive intramuscular placentrex injection along with two-week conventional therapy and 50 received conventional treatment only. Abdominal pain, dysmenorrhoea and adnexal tenderness were evaluated at the end of 2 months. There was marked reduction in the sign of adnexal tenderness in the placentrex group as compared to conventional treatment group (p < 0.001). Subjective symptoms of lower abdominal pain and dysmenorrhoea were also relieved better in placentrex group (p < 0.01 and 0.05 respectively). This study showed significant and persistent improvement of signs and symptoms of PID in women who received injection placentrex.

Síndrome de congestión pélvica: Evaluación del dolor después del tratamiento laparoscópico con Ligasure® / Pelvic inflammatory disease: evaluation of pain after laparoscopy therapy with Ligasure(R)

Objetivo: Evaluar el dolor pélvico después de utilizar la técnica con Ligasure® de la ligadura de las venas ováricas varicosas por laparoscopia en mujeres con síndrome de congestión pélvica en una clínica de Cali, entre junio de 2002 y junio de 2003. Tipo de estudio: Ensayo clínico no controlado. Materiales y métodos: Se realizó laparoscopia operatoria a 29 pacientes con clínica de síndrome de congestión pélvica y evaluación de la intensidad del dolor con la escala visual análoga cromática, a través de una encuesta antes y 6 meses después del procedimiento. A 28 se les realizó varicocelectomía con técnica de Ligasure® por evidencia de varicocele pélvico y a una paciente se evidenció endometriosis. El promedio de edad de las pacientes fue 33.8 años. La información se procesó en Epi-Info 6.4. El análisis de la diferencia entre los valores de la intensidad del dolor antes y después del procedimiento quirúrgico fue realizado con la prueba chi cuadrado (c) con un nivel de significancia de 95/100 y el valor de p <0.05 considerado estadísticamente significante.Resultados: Después del procedimiento, los valores de la intensidad del dolor en la escala disminuyeron, siendo la mayoría <6 (26 pacientes). Al final del período de observación, ninguna de las pacientes había establecido un valor en la escala de 0 (sin dolor). Haciendo la comparación antes y después del procedimiento, hubo diferencia significativa en la disminución de la intensidad del dolor después de la cirugía (con prueba c² de 43.13 con 4 grados de libertad y valor de p<0.05).Conclusión: El presente estudio muestra que el dolor se reduce significativamente después de la ligadura de las venas ováricas varicosas por laparoscopia con técnica de Ligasure®, considerándose un método optativo efectivo en el tratamiento del síndrome de congestión pélvica

Syndromic management of sexually transmitted infections; an approach at the primary care level: Part 2

Syndromic management of transmitted infections is now a widely accepted strategy for treatment of infections and prevention of the spread of HIV in the developing world. Although STIs are caused by many different organisms, they cause only a limited number of syndromes. Syndromic management facilitates immediate diagnosis and treatment of many STIs at the same time without the need for expensive and time consuming laboratory tests

Ciprofloxacin-tinidazole combination, fluconazole- azithromicin-secnidazole-kit and doxycycline- metronidazole combination therapy in syndromic management of pelvic inflammatory disease: a prospective randomized controlled trial.

BACKGROUND: Pelvic inflammatory disease is a common problem faced by the gynecologists in there out patient department. AIM: The aim of the study was to evaluate the efficacy of three treatment combinations in the syndromic management of pelvic inflammatory disease in the out patient setting. SETTING DESIGN: In the medical college hospital patients presenting in gynecology out patient department were enrolled. MATERIAL AND METHODS: One hundred and sixty five women with diagnosis of pelvic inflammatory disease were randomized into three equal groups getting ciprofloxacin (500 mg) and tinidazole (600 mg) combination twice daily for 7 days (Group 1), a kit containing fluconazole (150 mg), azithromycin (1 gm) and secnidazole (2 mg) as one time dose (Group 2) and Doxycycline 100mg twice daily and metronidazole 200 mg thrice daily for seven days (Group 3). Severity score was determined on first visit and after 1 week and 4 weeks when patients were called for follow up. Statistical Analysis: Chisqare test, Krusker wallis test and Mann Whitney test. RESULTS: There was significant reduction in severity score after 1 week of treatment, which was further reduced after 4 weeks in all the three groups. Cure rate was highest in-group 1 (96%) followed by group 2 (93.5) and group 3 (91.3%) but the difference was not statistically significant. Resolution of inflammatory mass was highest in group 1. The incidence of side effects was highest and compliance was lowest in the doxycycline -metronidazole group, but the difference was not statistically significant. CONCLUSION: All the three treatment combinations were found to be equally effective in the syndromic management of pelvic inflammatory disease.

Infección cervical por chlamydia trachomatis en mujeres embarazadas HEODRA, León noviembre- diciembre 2002 / Cervical infection for chlamydia trachomatis in women pregnant HEODRA- Leon, november- december 2002

El documento presenta un estudio de corte transversal, del total de pacientes embarazadas atendidas en el servicio de emergencia de gineco- obstetricia del Hospital Escuela Oscar Danilo Rosales , en el período comprendido de noviembre y diciembre del 2002. El universo de estudio estuvo constituido por 100 pacientes que fueron escogidas por cumplir con los critrios de inclusión como fue: no sangrado transvaginal activo. no uso de antibióticos en los últimos 7 días, no uso de duchas vaginales en los últimos 7 días, membranas integras, sin examen ginecológico en las últimas 24 horas. Al realizar la prueba de inmunocromatografía utilizando anticuerpos monoclonales, se encontró una frecuencia de 25 porciento (0.25) de infección cervical por Chlamydia Trachomatis. En la prueba de hipótesis, a un valor de referencia promedio del 12 porciento

Enfermedad inflamatoria pélvica tumoral en adolescentes / Imflammatory pelvic tumoral disease in adolescents

Se realizó un estudio descriptivo, longitudinal y prospectivo en el hospital materno de Guanabacoa durante el período de 1995 al 2000 con el objetivo de estudiar el comportamiento de la enfermedad pélvica inflamatoria tumoral en las pacientes adolescentes. La muestra estuvo constituida por 40 pacientes que fueron atendidas en nuestro centro a las que se le realizó una encuesta de donde se obtuvieron los datos para el estudio. El antecedente de enfermedad pélvica inflamatoria, el DIU como método anticonceptivo y el aborto fueron los factores epidemiológicos más sobresalientes; de igual forma el dolor, fiebre, trastorno menstrual y leucocitosis, así como eritrosedimentación fueron los elementos clínicos más destacados. El tratamiento que más se realizó fue el médico y la obstrucción tubaria fue la secuela principal. Se concluyó que el pronóstico es desfavorable para la fertilidad aún en los casos en el que el tratamiento médico fue eficaz