Randomized, single-blinded comparison of efficacy, safety and tolerability of metronidazole 750mg - miconazole 200mg vaginal suppository vs. metronidazole 500mg - nystatin 100, 000 IU vaginal suppository in the treatment of bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis, and mixed vaginal infections / Philippine Journal of Obstetrics and Gynecology

OBJECTIVE: This randomized, single-blind, two-arm controlled study compared the efficacy, safety, and tolerability of an intravaginal suppository preparation containing metronidazole 750mg + miconazole 200mg (Neopenotran Forte) with another vaginal preparation containing metronidazole 500 mg + nystatin 10000 IU (Flagystatin) in the treatment of bacterial vaginosis (BV), candidal and trichomonial vulvovaginitis (CVV, TV), mixed vaginitis and in the prevention of secondary candidal vulvovaginitis. MATERIALS AND METHODS: Women ages 18-45 years with chief complaints of abnormal vaginal discharge or vaginal/vulvar itching were examined and microbiologic confirmation of BV, VVC, TV or mixed infection was made. They were then randomly assigned to receive either treatment once daily (nightly) for 7 days. A total of 261 subjects had evaluable clinical and microbiological findings at the end of the study. Test of cure by Amsel criteria and Nugent score were performed twice after treatment. RESULTS: The overall test revealed that microbiological cure rate is significantly different between the two treatment groups. CONCLUSION: The odds of being cured microbiologically is 2.35 times more in the metronidazole 750mg + miconazole nitrate 200mg group compared to the metronidazole 500 mg + nystatin 10000 IU group. However, no significant difference in the clinical cure between the two groups was found. Both drugs are safe and convenient to use.

Hydatidiform mole and its complications: review of patient profiles and management at the university of the Philippines-Philippine General Hospital.

OBJECTIVE: To describe the clinicopathologic profile of patients diagnosed with molar pregnancy and complications associated with the disease and their management at a tertiary government hospital. STUDY DESIGN: A descriptive retrospective review of medical records of patients diagnosed with hydatidiform mole for a 5-year period was done. The demographics, clinical course, management options and complications, monitoring and progression to malignancy, and histopathologic diagnosis of these patients were reviewed. RESULTS: From January 2008-December 2012 there were 551 cases of molar pregnancies. The hospital-based incidence of hydatidiform mole was 13.38/1,000 pregnancies. The most common manifestation was vaginal bleeding, with 98% (540/551) of patients. However, 75% (405/540) had significant anemia described as hemoglobin level < 10 mg/dL, and 32% (173/540) had accompanying pallor, hypotension and tachycardia. Other medical complications included those related to increased beta-hCG titers such as preeclampsia, hyperthyroidism and pulmonary insufficiency. The most common histopathologic diagnosis (71%) was complete hydatidiform mole. Seventy percent of patients were given methotrexate chemoprophylaxis, mainly due to serum hCG > 100,000 mIU/ mL. Of the 551 patients 49 (9%) progressed to malignancy within the next 36 months. The mortality rate was 1.6% (9/551). The most common cause of mortality was hemorrhagic complication. CONCLUSION: At the Philippine General Hospital hydatidiform mole is not uncommon. The knowledge of the clinical course of the condition as well as prompt and appropriate management of complications is integral in its management for an excellent prognosis.

Vaginal metastases complicating gestational trophoblastic neoplasia.

OBJECTIVE: To evaluate the clinical experience and outcomes of patients with gestational trophoblastic neoplasia (GTN) complicated by vaginal metastases. STUDY DESIGN: A retrospective descriptive study of patients with vaginal metastases from GTN treated at the University of the Philippines-Philippine General Hospital (UP-PGH) Trophoblastic Disease Section from 1998 to 2008. RESULTS: Vaginal metastases were present in 46 (11%) of the 424 patients treated for GTN. The majority of the patients (69.6%) were stage III, 19.6% were stage II and 10.9% were stage IV. Thirty-six patients (78.3%) were high-risk patients with World Health Organization scores of > 7. Eleven patients (24%) had bleeding vaginal lesions on initial consultation, and transfusion of packed red blood cells was necessary in all of these patients. Interventions to control bleeding included vaginal packing with methotrexate solution (5/11 or 46%), ligation of bleeders with bilateral internal iliac artery ligation (4/11 or 36%), over sewing of bleeding vaginal lesions (2/11 or 18%), ligation of vaginal bleeders (3/11 or 27%), vaginal packing only (6/11 or 54%), methotrexate infiltration of vaginal mass (1/11 or 9%) and external beam radiation (1/11 or 9%). Of the 37 patients who were given chemotherapy, 26 (70%) had complete remission. CONCLUSION: Prognosis with vaginal metastasis mainly depends on disease extent. Favorable response to chemotherapy was observed in low-risk patients with pretreatment hCG of < 100,000 mIU/mL and metastases confined to the vagina and/or pelvic area only.

Changing trends in the management of gestational trophoblastic diseases in the Philippines.

OBJECTIVE: To describe the Philippine hospital-based prevalence rate of gestational trophoblastic disease (GTD) and to discuss changing trends in its management. STUDY DESIGN: A retrospective descriptive study was done using local hospital based epidemiologic data. Charts of diagnosed GTD patients from 2002-2008 were reviewed for data analysis including sociodemographic and clinical profile, International Federation of Obstetrics and Gynecology staging and World Health Organization prognostic scoring, chemotherapy used and remission rates. RESULTS: The national prevalence rate of hydatidiform mole is 2.4/1,000 pregnancies during the years 2002-2008. At the University of Philippines-Philippine General Hospital (UP-PGH) the prevalence rate of hydatidiform mole is 14/1,000 pregnancies. The national prevalence rate of choriocarcinomas and other gestational trophoblastic neoplasias (GTNs) has remained almost constant at 0.56/1,000 pregnancies. Again, UP-PGH showed a high prevalence for choriocarcinoma and other GTNs at 4.3/1,000 pregnancies. Because patients with GTD are invariably indigent, modifications to standard treatment practices have been adapted to bring down the cost of chemotherapy without sacrificing survival and remission rates. CONCLUSION: Current outcomes of treatment for Filipino GTN patients appear much improved. This might be due to increased efforts of trophoblast specialists to educate other physicians in the prompt recognition of the disease, initial management and appropriate referral of these patients to specialty centers.

Sexual dysfunction as a complication of treatment of gestational trophoblastic neoplasia.

OBJECTIVE: To examine the impact of gestational trophoblastic neoplasia (GTN) therapy on women's sexuality. STUDY DESIGN: A questionnaire concerning various sexual problems experienced by patients treated with chemotherapy and/or surgery for GTN and in remission for 1 year or more was completed by 47 women in the outpatient clinic of the Trophoblastic Disease Section of our institution from January to June 2007. RESULTS: Ninety-five percent of the subjects continued sexual activity after treatment, but there was an increase in the incidence of sexual problems, which resulted in a slight reduction in the quality of their sex lives. Seventy percent of the women experienced absent or low sexual desire, while 42% had dyspareunia and 45% had lubrication problems. Fifty-three percent experienced changes in the relationship with their partner within the first year after remission. CONCLUSION: Sexual dysfunction is a common complication of treatment of GTN yet is given little attention as compared to other complications. Patient education and reassurance, with early diagnosis and intervention, are essential for a better quality of life for survivors.

The role of adjuvant surgery in the management of gestational trophoblastic neoplasia.

OBJECTIVE: To evaluate the role of different surgical procedures combined with chemotherapy in the management of gestational trophoblastic neoplasia (GTN). STUDY DESIGN: A retrospective descriptive analysis of data was done using charts of diagnosed cases of GTN from 1996 to 2006. The patients were classified according to FIGO staging and WHO prognostic scoring. Surgical procedures were evaluated as to indications, hospital stay, remission rate and number of chemotherapy cycles needed to achieve remission. RESULTS: One hundred thirty-four patients underwent at least 1 major surgery in the form of hysterectomy, with uterine perforation and profuse vaginal bleeding as an indication for surgery. Common indications for adjuvant surgery are completed family size and resistance to chemotherapy. Two patients had excision of liver metastases, and 3 patients had lung resection. CONCLUSION: With the increasing use of early surgical intervention combined with chemotherapy, we feel that we are maximizing the benefit that can be derived by our patients from our treatment protocol. We are decreasing the number of chemotherapeutic cycles needed to attain remission and in effect decreasing the exposure of the patients to toxicity from the chemotherapy.