Treatment methods for vulvovaginal candidiasis in pregnancy.

INTRODUCTION: Vulvovaginal candidiasis (VVC) is one of the three most common vaginal infections of women. Our goal is to check which treatment method (vaginal or vaginal combined with oral) is more effective for each trimester to treat VVC. MATERIALS AND METHOD: A retrospective analysis was performed and vaginal culture results after treatment of 61 pregnant women who were treated with vaginal or vaginal plus oral antifungals, were collected. Women were grouped according to the method were treated and the trimester they were in. Patients who had used vaginal 750 mg metronidazole + 200 mg miconazole nitrate were determined as the vaginal treatment group. Patients who had used vaginal 750 mg metronidazole + 200 mg miconazole nitrate and oral 150 mg fluconazole were determined as the vaginal plus oral treatment group. RESULTS: When the patients were grouped according to treatment method, there were no significant differences in demographic characteristics except previous antibiotic use. Previous antibiotic use was significantly higher in the vaginal treatment group (p<0.05). There were no statistically significant differences between the recurrence of VVC in the vaginal and vaginal plus oral treatment group in the first, second, and third trimesters. DISCUSSION: The results of the study showed that the efficiency of the vaginal treatment was the same as the vaginal plus oral treatment in all three trimesters in the aspect of VVC recurrence. Local treatment of VVC has several advantageous features when compared with oral therapy including a low rate of adverse events, safe utilization during pregnancy, and breastfeeding.

Do the interactions between coital frequency, cervical length, and urogenital infection affect obstetric outcomes?

OBJECTIVE: To determine whether interactions between coital frequency, cervical length, and urogenital infection affect obstetric outcomes. MATERIALS AND METHODS: A total of 268 unselected pregnant women were recruited in the study. The study population consisted of four groups of women: group 1 (n=203) screened negative for bacterial vaginosis (BV) both in the first and second trimesters; group 2 (n=18) screened negative for BV in the first trimester but positive in the second trimester; group 3 (n=33) screened positive for BV in the first trimester but negative in the second trimester; and group 4 (n=14) screened positive for BV both in the first and second trimesters. Urine culture, cervico-vaginal cultures, and bacterial vaginosis were screened between 11-14 weeks and 20-24 weeks. RESULTS: Two hundred fifty women were eligible for analysis in the study after lost-to-follow up patients were excluded. Previous abortion ≥1 and previous preterm delivery at 24-34 weeks ≥1 were statistically significantly higher in group 2. The number of patients who were diagnosed as having preterm premature rupture of membranes (PPROM) was statistically significantly higher in group 4. Sexual intercourse during the first trimester, cervical length during the second trimester, and history of preterm birth (PTB) were statistically significant risk factors for preterm birth <37 weeks (1.27; (1.12-1.44); 5.33; (1.84-15.41); 6.95; (1.58-30.54), respectively). CONCLUSION: Presence or treatment of BV did not influence rates of PTB. The probability of PPROM would be higher in patients who are BV positive both in the first and second trimesters.

Serum antiphospholipid antibody levels in pseudoexfoliation.

PURPOSE: To evaluate the levels of serum antiphospholipid antibodies in patients with pseudoexfoliation syndrome (PXS), pseudoexfoliation glaucoma (PXG), primary open-angle glaucoma, and healthy controls. MATERIALS AND METHODS: This prospective study included 17 patients with PXS, 19 patients with pseudoexfoliation glaucoma, 15 patients with primary open-angle glaucoma, and 19 normal individuals. Venous blood samples were obtained in the morning after an overnight 8-hour fasting. Anticardiolipin antibodies, isotypes IgG and IgM were measured by means of an enzyme-linked immunosorbent assay. Lupus anticoagulant antibodies were measured by dilute Russell viper venom time screen test. RESULTS: Mean±standard mean of error of anticardiolipin antibody IgG levels in patients with PXS and PEG were significantly higher than those of the controls (P<0.05). The mean lupus anticoagulant antibody levels of the controls were not statistically different from the levels of patients with PXS, pseudoexfoliation glaucoma, and primary open-angle glaucoma (P>0.05). The anticardiolipin antibody IgG concentrations above the cutoff value of 15 GPL/mL were found in 8 patients (21.05%) with pseudoexfoliation. There was no individual in the control group having anticardiolipin antibody IgG level above the cutoff value (P<0.05). CONCLUSIONS: Elevated serum antiphospholipid antibodies, a risk factor for cardiovascular and cerebrovascular disease, is more common in patients with PXS and pseudoexfoliation glaucoma than in the healthy controls and in patients with primary open-angle glaucoma.

[In vitro biofilm formation and relationship with antifungal resistance of Candida spp. isolated from vaginal and intrauterine device string samples of women with vaginal complaints]. / Vajinal Yakinmasi Olan Kadinlarin Vajen ve Rahim Içi Araç Ipi Örneklerinden Izole Edilen Candida Türlerinin In Vitro Biyofilm Olusturma Özellikleri ve Antifungal Direnç ile Iliskisi.

Intrauterin device (IUD) application is a widely used effective, safe and economic method for family planning. However IUD use may cause certain changes in vaginal ecosystem and may disturb microflora leading to increased colonization of various opportunistic pathogen microorganisms. The aims of this study were (i) to detect the biofilm production characteristics of Candida spp. isolated from vaginal and IUD string samples of women with IUDs, and (ii) to investigate the relationship between biofilm production and antifungal resistance. A total of 250 women (mean age: 34.4 ± 7.6 years) admitted to gynecology outpatient clinics with vaginal symptoms (discharge and itching) were included in the study. The patients have been implanted CuT380a type IUDs for a mean duration of 59.8 ± 42.4 months. Without removing IUD, string samples were obtained by cutting and simultaneous vaginal swab samples were also collected. Isolated Candida spp. were identified by conventional methods and API 20C AUX (BioMerieux, Fransa) system. Minimal inhibitory concentrations (MIC) of fluconazole, itraconazole and amphotericin B were determined by broth microdilution method according to the CLSI guidelines. Biofilm formation was evaluated by crystal violet staining and XTT-reduction assays, and the isolates which yielded positive results in both of the methods were accepted as biofilm-producers. In the study, Candida spp. were isolated from 33.2% (83/250) of the vaginal and 34% (85/250) of the IUD string samples, C.albicans being the most frequently detected species (54 and 66 strains for the samples, respectively). The total in vitro biofilm formation rate was 25% (21/83) for vaginal isolates and 44.7% (38/85) for IUD string isolates. Biofilm formation rate of vaginal C.albicans isolates was significantly lower than vaginal non-albicans Candida spp. (14.8% and 44.8%, respectively; p= 0.003). Biofilm formation rate of C.albicans strains isolated from vaginal and IUD string samples were found as 14.8% (8/54) and 45.5% (30/66), with a statistically significant importance (p< 0.001). However, no statistically significant difference was detected for biofilm formation rates of non-albicans Candida spp. when sample types were considered [44.8% (13/29) and 42.1% (8/19), respectively; p> 0.05]. Fluconazole resistance was significantly higher in biofilm-producing vaginal Candida spp. than those of nonproducers (52.4% vs. 16.1%; p= 0.001), however, itraconazole resistance was found similar in biofilmproducer and non-producer isolates (47.6% vs. 32.3%; p> 0.05). Resistance rates for both fluconazole and itraconazole were higher in biofilm-producers (39.5% and 52.6%, respectively), than those of non-producers (10.6% and 29.8%, respectively), representing a statistical significance (p= 0.002 and p= 0.03, respectively) for Candida spp. strains isolated from IUD string samples. The overall resistance rates of C.albicans and non-albicans Candida spp. against fluconazole, were determined as 15% and 54.2%, respectively, while those rates were 24.2% and 68.7%, respectively, against itraconazole. MIC value of amphotericin B for all of the Candida spp. isolates was ≤ 1.5 µg/ml. In conclusion, the data obtained from this study revealed that Candida spp. May lead to vaginal infections by inducing biofilm formation in IUD strings and these biofilms may be related to resistance to antifungal agents. Thus, women using IUDs should be followed-up periodically for the development of biofilms in their IUD strings.

[Prevalence of house dust mite allergy in cases with atopic disease symptoms in Kocaeli province, Turkey]. / Kocaeli bölgesinde atopik hastalik semptomlari olan olgularda ev tozu akari alerji prevalansi.

The aim of this study was to investigate the prevalence of house dust mite sensitization and to detect the IgE and eosinophilic cationic protein (ECP) levels in the positive cases living in Kocaeli province (located in Northwest region of Turkey). The results of mixed house dust mite skin tests of 1279 patients (620 male, 659 female) of which 670 were children (3-14 years), 68 were adolescents (15-19 years) and 541 were adults (20-86 years) who were admitted to Kocaeli University Medical Faculty Hospital during the period of January 2003-January 2005, with symptoms of atopic disease such as upper/lower respiratory tract symptoms, asthma and/or rhinitis and/or eczema were evaluated retrospectively. Serum IgE and ECP levels of all cases were determined by enzyme immunoassay method (UniCAP 100 System, Pharmacia, Uppsala, Sweden). The allergy test performed by using mixed house dust mite panel (Dermatophogoides pteronyssinus, Dermatophagoides farinae) was found positive in 328 (25%) cases. Among those 154 (46.9%) were sensitive to D. pteronyssinus, 151 (46%) were sensitive to D. farinae, and 23 (7%) were sensitized to both mites. The mean IgE (259 +/- 25.5 kU/ml) and ECP levels (35.7 +/- 17.9 kU/ml) of house dust mite sensitized cases were found significantly higher than the non-sensitized subjects (IgE; 144 +/- 18.9 kU/ml, ECP; 33.1 +/- 18.3 kU/ml) (p < 0.001). The prevalence rates of house dust mite allergy in our region were determined as 17% (114/670), 19.1% (13/68), and 37.1% (201/541) in pediatric, adolescent and adult populations, respectively. There was no predilection for allergy prevalence in terms of sex (p = 0.7). However, the prevalence increases during autumn-winter seasons (p = 0.01 and p = 0.007, respectively). In conclusion, it was determined that the rate of the sensitization against house dust mite was high in Kocaeli, Turkey and it exhibited an increasing tendency with age.

[Distribution of intestinal parasites among patients who presented at the parasitology laboratory of the Kocaeli University School of Medicine Hospital]. / Kocaeli Universitesi Tip Fakültesi Hastanesi Parazitoloji Laboratuvarina Basvuran Hastalarda Bagirsak Parazitlerinin Dagilimi.

In this study, 5178 fecal samples collected from patients who applied to our university during May 2003 through June 2005 were examined for the presence of intestinal parasites. Out of 5178 samples, 4560 of them were collected with cellophane tape preparations. Fecal samples were examined using native- Lugol and the trichrome staining method after sedimentation by formal-ethyl acetate concentration. The prevalence of intestinal parasites was evaluated with respect to age, gender and the months in which cases were seen. One or more parasites were found in 553 (10.67%) of the 5178 stool samples. Of these, 39.8% were female and 60.2, male. The distribution of the intestinal parasites was as follows; G. intestinalis in 138 cases (24.9%), E. vermicularis in 129 cases (23.3%), D. fragilis in 10 cases (1.8%), I. bütschlii cysts in 26 cases (4.7%), Taenia spp in 17 cases (3.07%) and Chilomastix mesnili in one case (0.18%). The rate of the presence of intestinal parasites in the 0-14 age group was higher than that of other groups. The incidence of parasitic diseases was lower in this study as compared to the results previously reported from our hospital. In our region intestinal parasites were predominantly protozoan whereas a lower rate of helminth isolations was noticeable. Parasitic infections continue to be an important public health problem in our country.

The schizophrenia and Toxoplasma gondii connection: infectious, immune or both?

INTRODUCTION: Recent research has suggested a possible link between toxoplasmic agents and schizophrenia. We aimed to assess this by measuring Toxoplasma gondii-associated antibodies in schizophrenia patients and controls METHODS: We used a commercially available enzyme-linked immunosorbent assay (ELISA) kit to measure the level of immunoglobulin G (IgG) and IgM antibodies in serum samples from schizophrenia patients (n=40) and from a group of non-schizophrenic control subjects (n=37) RESULTS: Among schizophrenic patients, 16 (40%) showed IgG seropositivity and two (5%) showed IgM seropositivity. Among the control group, five (13.5%) were found have IgG seropositivity and one (2.7%) showed IgM seropositivity. In our study we found that IgG T gondii antibodies were significantly higher in schizophrenia patients compared with controls CONCLUSIONS: This study supports the theory that toxoplasmic agents may have a role in the aetiology of schizophrenia.

Relevance of autoantibody detection to the rapid diagnosis of brucellosis.

The rose bengal test is often used for rapid diagnosis of human brucellosis in endemic areas. However, autoantibodies have never been investigated as a reason for false-positive or false-negative results. Therefore, the aim of this study was to show the effect of autoantibody detection on the rapid diagnosis of human brucellosis in an endemic area. The study included 2 groups: antinuclear antibody (ANA)-positive and ANA-negative groups. Diagnosis of brucellosis was established by isolation of Brucella spp. from blood culture. The overall sensitivity and specificity of the rose bengal test were 100% and 90.8%, respectively. The specificity (100% versus 89%) and positive predictive value of the test (100% versus 8%) fell markedly from the ANA-negative to the ANA-positive group. As a conclusion, this study verified our suspicion about the effect of autoantibodies on rose bengal test results to the diagnosis of human brucellosis. However, to have definite decisions, extensive studies with larger populations are needed.

[Short communication: prevalence of fungal allergy in patients applied to hospital with symptoms of atopic disease in Kocaeli, Turkey]. / Kisa bildiri: kocaeli bolgesinde atopik hastalik semptomlari ile hastaneye basvuran hastalarda mantar alerji prevalansi.

The aim of this study was to investigate the prevalence of fungal sensitization and to detect the IgE and eosinophilic cationic protein (ECP) levels in the positive cases inhabiting in Kocaeli province (located in Northwest region of Turkey). The results of mixed fungus tests of 1.799 patients (870 male, 929 female) ages between 3-80 years old who were admitted to Kocaeli University Medical Faculty Hospital in the period of January 2002-January 2005, with the symptoms of atopic disease such as upper/lower respiratory tract symptoms, asthma and/or rhinitis and/or eczema, were evaluated retrospectively. Serum IgE and ECP levels of all cases were determined by a commercial enzyme immunoassay (UniCAP System, Pharmacia, Uppsala, Sweden) method. The allergy test performed by using mixed fungal panel (Penicillium notatum, Cladosporium herbarum, Aspergillus fumigatus, Candida albicans, Alternaria alternata, Helminthosporium halodes) was found positive in 68 cases (3.8%). Of those cases 7 (10.2%) were found to be sensitized to Alternaria alternata, 8 (11.7%) to Aspergillus fumigatus, 10 (14.7%) to Penicillium notatum, and 6 (8.8%) were sensitized to more than one fungus. The mean IgE (106.2+/-166.1) and ECP levels (31.7+/-18.3) of fungus sensitized cases were found significantly higher than the non-sensitized subjects (IgE; 77.8+/-95.0, ECP; 22.4+/-16.5) (p<0.001). The prevalence rates of fungal allergy in our region were determined as 1.9% (26/1.341), 4.5% (2/44) and 9.6% (40/414) in pediatric, adolescent and adult populations, respectively. In conclusion, it was determined that the rate of the sensitization against fungi was low in Kocaeli, Turkey and it exhibited a tendency towards increase with age.