Lactobacillus plantarum P17630 for preventing Candida vaginitis recurrence: a retrospective comparative study.

BACKGROUND: Recurrence is a frequent complaint of patients with vulvovaginal candidiasis (VVC). Although the pathogenesis of VVC remains a controversial issue, disruption of the balance between the vaginal microbiota may facilitate overgrowth by Candida. Some probiotic bacterial strains can suppress Candida albicans; Lactobacillus plantarum P17630 is able to attach to vaginal epithelial cells and significantly reduce the adhesion of C. albicans. OBJECTIVE: To evaluate the effect of the application of Lactobacillus plantarum P17630 in restoring the vaginal microbiota and prevention of relapses among women with acute VVC undergoing conventional (azole) local and main therapy. METHODS: Retrospective comparative study. We recruited 89 women with a diagnosis of VVC, who were placed into two groups on the basis of reported treatment. The control group was treated with a daily dose of 2% clotrimazole vaginal cream at bedtime for 3 days, followed by vaginal application of a capsule containing lubricant once a day for 6 days and then once a week for another 4 weeks. The probiotic group was treated with the same azole-based protocol but followed by vaginal application of a capsule containing Lactobacillus plantarum P17630 (>108 CFU) once a day for 6 days and then once a week for another 4 weeks beginning the day following clotrimazole discontinuation. Clinical and diagnostic patterns were monitored for three months of follow-up. RESULTS: At the end of study the probiotic-treated women showed a statistically significant increase in Lactobacillus values "+++" (80% versus 40%, p<0.001) and a better subjective resolution of symptoms such as vaginal discomfort described as burning or itching (90% versus 67.5%, p<0.03). Among controls there was a non-significant increase at 3 months of recurrence of infection, but a significant increase of women with value of pH=5 or >5. CONCLUSION: Although the results of different studies are controversial, most have suggested use of probiotics in the prevention or treatment of VVC, and no adverse effects have been reported. Our data with L. plantarum P17630 (Gyno-Canesflor - Bayer) confirm the role of this specific strain as a potential empirical preventive agent for reducing vaginal discomfort after conventional treatment of acute VVC and shifting the vaginal milieu toward a predominance of lactobacilli with an improvement of the vaginal pH value.

[Pregnancy in HIV-positive women: 6 years of activity of the Regional Reference Center]. / La gravidanza in donna HIV positiva: 6 anni di attività del Centro di Riferimento Regionale.

AIM: With this study, we wanted to evaluate HIV-positive pregnant mothers followed at the HIV Reference Center of Friuli Venezia Giulia and to describe obstetric treatment aimed at identifying vertical transmission factors and at undertaking a correct diagnostic-therapeutic approach to this patient group. The data include a large case series from the European Collaborative Study on HIV in Pregnancy, in which our facility is a collaborating center. METHODS: The protocol includes the administration of personalized antiretroviral therapy to seropositive patients at the first visit. An elective caesarean section is performed at 38 weeks gestation. Antiretroviral therapy is continued in the neonate. Breastfeeding is prohibited. RESULTS: From 1998 to 2002, 28 pregnant mothers with HIV infection were followed. Most patients came from out of region and had acquired the infection through heterosexual intercourse with a serodiscordant partner. In 1 in 3 patients, a diagnosis of seropositivity was made during pregnancy. One case of vertical transmission was observed. CONCLUSIONS: When appropriate prevention measures are instituted, the percentage of vertical transmission of infection can be reduced to less than 1% in Europe today. An important part of this effort is early screening for HIV infection in pregnancy. Other fundamental measures are the institution of antiretroviral therapy starting from the first weeks of pregnancy, monitoring of pregnancy at a tertiary reference center, intravenous administration of therapies before caesarean section, possibly not during labor and with the membrane intact. Equally important factors are neonatal therapy, adequate pediatric monitoring after the infant is born and discontinuation of breastfeeding.

[The use of ultrasonography in the prediction of first-trimester abortion]. / Utilizzo dell'ultrasonografia nella predittività abortiva del primo trimestre.

The prediction of spontaneous abortion in the first trimester is made possible owing to the use of two diagnostic procedures: maternal assay of some biochemical parameters and ultrasonography. However, the diagnostic value of ultrasound is greater than the former procedure since it enables the embryo to be visualized directly, measuring crown-rump length (CRL), together with the gestational sac whose diameter can also be measured (DSG). The present study aimed to verify the prediction of abortion given by the ratio between DSG and CRL measured using ultrasound in the first trimester of pregnancy, namely with signs of embryonic vitality already present. A prospective longitudinal study was performed in a population of 59 pregnant women attending the Obstetric and Gynecology Clinic of Trieste University during the period between April 1990 and April 1991. On enrollment in the study all patients had a gestational age of 8 +/- 2 weeks of amenorrhea. A preliminary measurement of DSG and CRL (t0) was then obtained and these measurements were repeated after four weeks (t1). The data obtained were first compared to each other for the same time (DSG0/CRL0 and DSG1/CRL1) and the relationship between the two ratios was then calculated ((DSG1/CRL1)/(DSG0/CRL0)). This method provides a sensitive method of analysing variations in the ratio between the two measurements taken at different moments. Inferential statistical principles were then applied. At the end of the first trimester the evolution or otherwise of pregnancy was assessed by examining and separating two groups of women: those who had had spontaneous abortions and those who had continued their pregnancies.(ABSTRACT TRUNCATED AT 250 WORDS)