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Skinmed 2023A 36-year-old woman presented to the emergency department with a 1-day history of purulent perianal and vulvar discharge. She had a 25-year history of Crohn's disease...
A 36-year-old woman presented to the emergency department with a 1-day history of purulent perianal and vulvar discharge. She had a 25-year history of Crohn's disease (CD), and 13 years prior had received a total colectomy with end ileostomy. She had vulvar biopsies 5 years prior to presentation, demonstrating noncaseating granulomas consistent with metastatic Crohn's disease (MCD). Throughout the course of her disease, she had a failed treatment with adalimumab, certolizumab, methotrexate, and 6-mercaptopurine. She had received a radical vulvectomy 1 year prior to presenting to control recurrent vulvar abscesses and MCD while receiving monthly subcutaneous infliximab 10 mg/kg body weight. Dermatology was consulted at presentation, and the physical examination revealed tender, linear ulcerations with a granulated appearance and depigmentation on the natal cleft and vulva (Figures 1 and 2). Computerized tomography (CT) scan of the abdomen and pelvis indicated thickening of soft tissue without evidence of abscesses, fluid collection, or fistulae. Given the distribution and morphology of lesions with a history of biopsy-proven MCD, the patient was diagnosed with a flare of MCD.
Topics: Female; Humans; Adult; Crohn Disease; Abscess; Infliximab; Mercaptopurine; Methotrexate; Neoplasms; Recurrence
PubMed: 37945367
DOI: No ID Found -
Safety and efficacy of topical artesunate for the treatment of vulvar intraepithelial neoplasia 2/3.Gynecologic Oncology Nov 2023To evaluate the safety, tolerability, and efficacy of topical artesunate ointment for treatment of biopsy-confirmed Human papillomavirus (HPV)-associated Vulvar...
OBJECTIVE
To evaluate the safety, tolerability, and efficacy of topical artesunate ointment for treatment of biopsy-confirmed Human papillomavirus (HPV)-associated Vulvar intraepithelial neoplasia (VIN) 2/3.
METHODS
Participants were enrolled on a prospective, IRB-approved, dose-escalation phase I trial testing either 1, 2 or 3 treatment cycles (5 days), every other week, as applicable. Clinical assessments were completed prior to each dose cycle and included exam and review of adverse event (AE) diary cards. HPV testing and colposcopy was completed at 15 and 28 weeks. AEs were assessed according to CTCAE 4.0 criteria. Complete responders (CR) underwent biopsy of the treated site at the 28-weeks while partial (PR) and non (NR)-responders underwent surgical resection or biopsy and ablation.
RESULTS
Fifteen patients consented to and began treatment. Per-protocol assessments were completed in 100% at 15- and 80% at 28-weeks. All patients completed prescribed cycles with no grade 3 or 4 AEs. Vulvovaginal burning/ was the most common AE occurring in 93.3%. AEs were grade 2 in 23.7% and included vulvovaginal pruritus (n = 3), swelling (n = 3) and candidiasis (n = 2). The highest ORR was in the 3-cycle group (88.9% with 55.6% CR). HPV-16 was detected either alone (46.7%) or with other subtypes (33.3%) in 80% of lesions and 5 of 8 (62.5%) with CR had complete viral clearance.
CONCLUSIONS
Topical artesunate for treatment of high-grade VIN shows high tolerability, low toxicity and evidence for clinical response in this initial small series. The safety and observed responses support further study in a Phase II trial.
Topics: Female; Humans; Artesunate; Papillomavirus Infections; Prospective Studies; Biopsy; Neoplasms; Vulvar Neoplasms; Carcinoma in Situ
PubMed: 37839312
DOI: 10.1016/j.ygyno.2023.10.003 -
Plant Disease Aug 2023Black nightshade () typically grows as a weed species, but it is also widely used as an herb to treat stomach ulcers and dermal infections in many countries...
Black nightshade () typically grows as a weed species, but it is also widely used as an herb to treat stomach ulcers and dermal infections in many countries (Jabamalairaj et al. 2019). In April 2023, extensive root galls similar to those associated with by root-knot nematodes (RKNs), spp., were observed on the roots of black nightshade in several commercial fields in Lufeng county (22°55'57.44″N, 115°33'10.31″E), Guangdong Province, China. Upon inspection, there were one to several female RKN in each gall, and egg masses protruding through the root surface. The disease incidence rate was more than 90% in each field using the random sampling method. The nematode population densities in the samples ranged from 279 to 656 eggs and second-stage juveniles (J2s) per gram of fresh roots. Females and egg masses were collected from the roots, and egg masses were incubated in sterile water at 25°C to obtain J2s. Males were not collected in root galling or soil samples. The J2 tail is thin with a broad, bluntly pointed tip, and a clearly defined hyaline tail terminus. Measurements of J2 (n = 20) included: L= 440 ± 30.5 (384 to 500) µm, stylet = 12.3 ± 0.7 (11.3 to 13.7) µm, tail = 51.6 ± 2.4 (47.9 to 57.0) µm. For females (n = 15), vulval slit length = 25.5 ±1.9 (23.6 to 29.1) µm, vulval slit to anus distance = 22.1 ± 3.0 (18.2 to 27.0) µm. Stylet knobs in females are divided longitudinally by a groove so that each knob appears as two. The perineal patterns are round to ovoid, with coarse and smooth striae, moderate to high dorsal arch and mostly lacking distinct lateral lines. Morphological characteristics from J2s and perineal patterns from adult females fit the original description of (Yang and Eisenback 1983). Furthermore, species identity was explored by sequencing the D2-D3 region of the 28S rRNA gene using primers D2A/D3B (Vrain et al. 1992), and the mtDNA cytochrome c oxidase I (COI) genes using primers JB3/JB5 (Derycke et al. 2005). The sequences for the target genes were 759 bp (GenBank Accession No. OR046056) and 447 bp (GenBank Accession No. OR042802), respectively. The BLAST analysis suggested 98.17~99.78% similarities to other available sequences in GenBank. Species identity was further confirmed with the species-specific primer pair Me-F/Me-R (Long et al. 2006). An approximately 240 bp PCR product was produced, which was previously reported only for , whereas no product was obtained from control populations of or . The pathogenicity test was conducted in a greenhouse at 28°C using seedlings of maintained in pots containing 500 cm sterilized soil. Ten replicates were inoculated with 800 eggs and J2s of the original population of , while another 10 replicates of control plants were not inoculated. After 7 weeks, the inoculated plants exhibited galling symptoms similar to plants observed in the field, and females and egg masses were obtained by dissecting galls. No galling symptoms were observed on control plants. These results confirmed the nematode's pathogenicity. To our knowledge, this is the first record of parasitizing black nightshade. stands out as a highly deleterious variant among the species of RKNs owing to its extensive repertoire of host plants, pathogenicity, and proficiency in thriving and multiplying even on crops possessing resistance genes (Sikandar, 2022). In addition to being a medicinal plant, is a widespread weed found in fields throughout China. This report also showed that could play an important role as a reservoir host of aiding its survival, reproduction, spread, and increasing the potential damage for host crops.
PubMed: 37578363
DOI: 10.1094/PDIS-07-23-1316-PDN -
BMC Public Health Mar 2024Little attention has been given to the risk of high-risk human papillomavirus (hr-HPV) infection and cervical precancerous lesions among female migrant head porters...
BACKGROUND
Little attention has been given to the risk of high-risk human papillomavirus (hr-HPV) infection and cervical precancerous lesions among female migrant head porters (kayayei) in Ghana, as a vulnerable group, and to promote cervical screening in these women. This pilot study aimed to determine the prevalence of hr-HPV infection and cervical lesions among kayayei in Accra, the capital of the Greater Accra Region of Ghana and to describe our approach to triaging and treating these women.
METHODS
This descriptive cross-sectional cohort study involved the screening of 63 kayayei aged ≥ 18 years at the Tema Station and Agbogbloshie markets in March 2022 and May 2022. Concurrent hr-HPV DNA testing (with the MA-6000 platform) and visual inspection with acetic acid (VIA) was performed. We present prevalence estimates for hr-HPV DNA positivity and VIA 'positivity' as rates, together with their 95% confidence intervals (CIs). We performed univariate and multivariable nominal logistic regression to explore factors associated with hr-HPV infection.
RESULTS
Gross vulvovaginal inspection revealed vulval warts in 3 (5.0%) and vaginal warts in 2 (3.3%) women. Overall, the rate of hr-HPV positivity was 33.3% (95% CI, 21.7-46.7), whereas the VIA 'positivity' rate was 8.3% (95% CI, 2.8-18.4). In the univariate logistic regression analysis, none of the sociodemographic and clinical variables assessed, including age, number of prior pregnancies, parity, past contraceptive use, or the presence of abnormal vaginal discharge showed statistically significant association with hr-HPV positivity. After controlling for age and past contraceptive use, only having fewer than two prior pregnancies (compared to having ≥ 2) was independently associated with reduced odds of hr-HPV infection (adjusted odds ratio, 0.11; 95% CI, 0.02-0.69).
CONCLUSION
In this relatively young cohort with a high hr-HPV positivity rate of 33.3% and 8.3% of women showing cervical lesions on visual inspection, we posit that kayayei may have an increased risk of developing cervical cancer if their accessibility to cervical precancer screening services is not increased.
Topics: Pregnancy; Female; Humans; Male; Uterine Cervical Neoplasms; Papillomavirus Infections; Cross-Sectional Studies; Prevalence; Ghana; Early Detection of Cancer; Pilot Projects; Transients and Migrants; Risk Factors; Condylomata Acuminata; Acetic Acid; DNA, Viral; Contraceptive Agents
PubMed: 38429784
DOI: 10.1186/s12889-024-18094-9 -
Archives of Pathology & Laboratory... Jan 2024There have been exceedingly few reports of epidermodysplasia verruciformis (EV) or EV-like lesions in the vulva. We describe the first observation of vulvar lesions...
Synchronous Epidermodysplasia Verruciformis and Intraepithelial Lesion of the Vulva Is Caused by Coinfection With Alpha-Human Papillomavirus and Beta-Human Papillomavirus Genotypes and Facilitated by Mutations in Cell-Mediated Immunity Genes.
CONTEXT.—
There have been exceedingly few reports of epidermodysplasia verruciformis (EV) or EV-like lesions in the vulva. We describe the first observation of vulvar lesions displaying synchronous EV-like histology and conventional high-grade squamous intraepithelial lesion (HSIL), a finding hitherto unreported in medical literature.
OBJECTIVES.—
To describe this novel vulvar lesion with hybrid features of HSIL and EV, attempt to confirm the hypothesis of coinfection with α and β human papillomavirus (α-HPV and β-HPV) genotypes, and describe relevant underlying genetic mutations.
DESIGN.—
Cases were retrospectively selected from our institutional archive. Detailed review of clinical information, histologic examination, and whole genome sequencing (WGS) were performed.
RESULTS.—
Five samples from 4 different patients were included. Three of 4 patients had a history of either iatrogenic immune suppression or prior immune deficiency, and all 3 featured classic HSIL and EV changes within the same lesion. One patient had no history of immune disorders, presented with EV-like changes and multinucleated atypia of the vulva, and was the sole patient without conventional HSIL. By WGS, several uniquely mappable reads pointed toward infection with multiple HPV genotypes, including both α-HPVs and β-HPVs. Mutations in genes implicated in cell-mediated immunity, such as DOCK8, CARMIL2, MST1, and others, were also found.
CONCLUSIONS.—
We provide the first description of vulvar lesions harboring simultaneous HSIL and EV features in the English-language literature, a phenomenon explained by coinfection with α-HPV and β-HPV genotypes. The finding of EV-like changes in a vulvar specimen should prompt assessment of the patient's immune status.
PubMed: 38180082
DOI: 10.5858/arpa.2023-0193-OA -
BMJ Open Sep 2023To systematically assess the associations between various immune-mediated diseases (IMDs) and human papillomavirus (HPV)-associated diseases.
OBJECTIVES
To systematically assess the associations between various immune-mediated diseases (IMDs) and human papillomavirus (HPV)-associated diseases.
DESIGN
Retrospective cohort study.
SETTING
UK Biobank.
PARTICIPANTS
A total of 500 371 subjects aged 40-69 years were eligible for the analysis, after excluding those with prevalent HPV-associated diseases at baseline and those who had withdrawn their informed consent or lacked information on sex.
EXPOSURE
Eighty IMDs (involving allergic/atopic diseases, autoimmune diseases, immunodeficiency diseases, etc) were identified in the UK Biobank.
PRIMARY AND SECONDARY OUTCOME MEASURES
The main outcome was the incidence of HPV-associated diseases (including warts and malignancies of the cervix, oropharynx, anus, penis, vulva and vagina). Cox proportional hazards model was used to estimate HRs and 95% CIs with particular adjustment for sexual behaviours. We also conducted subgroup analyses based on benign and malignant status, and anatomical sites of HPV-associated diseases, respectively.
RESULTS
During a median of 12.0 years of follow-up, 2244 cases out of 500 371 subjects developed HPV-associated diseases. Overall, participants with IMDs had a higher risk of HPV-associated diseases than their controls after adjustment for sexual behaviours and other potential confounders (female: HR=1.90, 95% CI=1.66 to 2.17, p0.001; male: HR=1.66, 95% CI=1.41 to 1.97, p0.001). Additionally, eight individual IMDs in women (eg, asthma: HR=1.76, 95% CI=1.47 to 2.11, p0.001) and three in men (eg, chronic nephritic syndrome: HR=6.05, 95% CI=3.32 to 11.04, p0.001) were associated with increased risk of HPV-associated diseases. Subgroup analyses revealed significant IMD differences between benign and malignant subgroups as well as between oropharyngeal and anogenital subgroups.
CONCLUSION
In this large retrospective cohort study, IMDs were significantly associated with an elevated risk of HPV-associated diseases. Besides, gender-specific and region-specific associations were also observed between individual IMDs and HPV-associated diseases.
Topics: Female; Male; Humans; Papillomavirus Infections; Biological Specimen Banks; Retrospective Studies; Human Papillomavirus Viruses; Hypersensitivity; United Kingdom
PubMed: 37730406
DOI: 10.1136/bmjopen-2023-072249 -
Microbiological Research Apr 2024Vaginal infectious diseases caused by viruses and bacteria have been linked to the occurrence of dysbiosis, that is, a reduction in the abundance of the normally... (Review)
Review
A molecular view on the interference established between vaginal Lactobacilli and pathogenic Candida species: Challenges and opportunities for the development of new therapies.
Vaginal infectious diseases caused by viruses and bacteria have been linked to the occurrence of dysbiosis, that is, a reduction in the abundance of the normally dominating vaginal Lactobacillus species. Mucosal infections in the vagina and/or vulva caused by Candida species, usually known as vulvovaginal candidiasis (or VVC), are among the leading causes of diseases in the vaginal tract. The existence of a clear link between the occurrence of dysbiosis and the development of VVC is still unclear, although multiple observations point in that direction. Based on the idea that vaginal health is linked to a microbiota dominated by lactobacilli, several probiotics have been used in management of VVC, either alone or in combination with antifungals, having obtained different degrees of success. In most cases, the undertaken trials resorted to lactobacilli species other than those indigenous to the vaginal tract, although in vitro these vaginal species were shown to reduce growth, viability and virulence of Candida. In this paper we overview the role of lactobacilli and Candida in the vaginal micro- and myco-biomes, while discussing the results obtained in what concerns the establishment of interference mechanisms in vivo and the environmental factors that could determine that. We also overview the molecular mechanisms by which lactobacilli species have been shown to inhibit pathophysiology of Candida, including the description of the genes and pathways determining their ability to thrive in the presence of each other. In a time where concerns are increasing with the emergence of antifungal resistance and the slow pace of discovery of new antifungals, a thorough understanding of the molecular mechanisms underneath the anti-Candida effect prompted by vaginal lactobacilli is of utmost importance to assure a knowledge-based design of what can be a new generation of pharmaceuticals, eventually focusing therapeutic targets other than the usual ones.
Topics: Female; Humans; Candida; Lactobacillus; Antifungal Agents; Dysbiosis; Vagina; Candidiasis, Vulvovaginal; Candida albicans
PubMed: 38246122
DOI: 10.1016/j.micres.2024.127628 -
Journal of Clinical Research in... Aug 2023Clitoromegaly usually develops due to hyperandrogenism. There are a few cases of clitoromegaly described without clinical and biochemical hyperandrogenism. Clitoromegaly...
Clitoromegaly usually develops due to hyperandrogenism. There are a few cases of clitoromegaly described without clinical and biochemical hyperandrogenism. Clitoromegaly due to clitoral priapism and clitoral priapism after appendectomy have not been reported previously. A 7-year-old girl was referred for enlargement of the clitoris. She reported having a mild, pulsating clitoral pain starting three days after an appendectomy operation. Subsequently, painful swelling and an increase in the size of the clitoris was observed. Her growth and physical examination were otherwise normal. Causes of the clitoromegaly due to androgen excess were excluded after a comprehensive work-up. Color Doppler ultrasound revealed a high peak systolic velocity and resistance in the cavernosal artery, consistent with clitoral priapism. The clitoromegaly and associated symptoms improved significantly with oral pseudoephedrine and intracavernosal aspiration. This unique case illustrates that clitoral priapism is a rare, non-hormonal cause of clitoromegaly and may occur after appendectomy. Pseudoephedrine treatment is helpful in alleviating the symptoms.
Topics: Male; Female; Humans; Child; Hyperandrogenism; Clitoris; Priapism; Pseudoephedrine; Appendectomy; Appendicitis
PubMed: 34866370
DOI: 10.4274/jcrpe.galenos.2021.2021-8-4 -
Frontiers in Oncology 2023A large-sample study focusing on VIN lesions of a more precise thickness is needed to help guide clinical treatment. This study aimed to investigate the depth of vulvar...
INTRODUCTION
A large-sample study focusing on VIN lesions of a more precise thickness is needed to help guide clinical treatment. This study aimed to investigate the depth of vulvar intraepithelial neoplasia (VIN) and involved skin appendages to provide evidence for laser surgery.
METHODS
The study retrospectively enrolled and analyzed the clinical characteristics of VIN patients in the obstetrics and gynecology department of a university hospital between January 1, 2019 and December 30, 2021. The study further explored the thickness of epithelium and skin appendages of 285 women with low-grade VIN (VIN1) and 285 women with high-grade VIN (VIN2/3).
RESULTS
The study included 1,139 (80%) VIN1 and 335 (20%) VIN2/3 cases. The VIN1 and VIN2/3 groups showed a significant difference in human papillomavirus infection (P<0.01) but not in cytology (P = 0.499). Most (89.90%, 1,325) cases occurred in one area of the vulva, whereas 10.11% were multifocal. VIN commonly occurred on the posterior fourchette (76.85%), labia majora (11.61%), and labia minora (9.92%). The VIN2/3 group reported a significantly higher positive rate for concurrent cervical and vaginal intraepithelial neoplasia (160 of 285) than the VIN1 group (321 of 953) (P=0.000). The involved epithelial thicknesses in VIN2/3 and VIN1 were 0.69 ± 0.44 and 0.49 ± 0.23 mm, respectively, both of which were greater than the corresponding noninvolved epithelial thickness (0.31 ± 0.19 and 0.32 ± 0.10 mm, P<0.001 and P<0.001, respectively). In cases of appendage involvement, the VIN thickness was 1.98 ± 0.64 mm.
CONCLUSIONS
VIN thickness was generally ≤1 mm for the superficial lesions in non-hairy areas. However, for lesions extending onto hairy areas, the thickness was approximately 3 mm, leading to the destruction of involved skin appendages.
PubMed: 37854683
DOI: 10.3389/fonc.2023.1254820 -
Climacteric : the Journal of the... Aug 2023Genitourinary syndrome of menopause (GSM) has a variety of effects on the urinary system and is an important consideration in the care provided to perimenopausal and...
Genitourinary syndrome of menopause (GSM) has a variety of effects on the urinary system and is an important consideration in the care provided to perimenopausal and postmenopausal patients when addressing urinary pathology. Here we discuss the common pathologies of the urinary system related to GSM including lower urinary tract symptoms and recurrent urinary tract infections. Female sexual dysfunction is not to be excluded as a critical part of a urologist's management of GSM but will be discussed elsewhere in this issue.
Topics: Female; Humans; Vagina; Menopause; Vulva; Urinary Tract Infections; Syndrome
PubMed: 37104711
DOI: 10.1080/13697137.2023.2202811