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Journal of Obstetrics and Gynaecology :... Oct 2018The goal of this study was to compare the effect of Anethum graveolens (dill) vaginal suppositories and 100 mg clotrimazole vaginal tablets on vulvovaginal... (Randomized Controlled Trial)
Randomized Controlled Trial
The goal of this study was to compare the effect of Anethum graveolens (dill) vaginal suppositories and 100 mg clotrimazole vaginal tablets on vulvovaginal Candidiasis. This study was a single centre, single-blind, randomised, placebo-controlled trial, in which 60 women with microbiology-confirmed vulvovaginal candidiasis were randomly assigned to dill and clotrimazole groups. At the end of the study, the estimated prevalence of leucorrhoea, burning, and itching was 23%, 23% and 20% in dill users, respectively. This figure was 20%, 10% and 16.7% for the clotrimazole group, respectively. The difference between the two groups was not significant. 13% of suppository patients, compared with 10% of clotrimazole-treatment patients, had a positive culture, which was not significant (p = .68). According to findings, 2% dill vaginal suppositories were as effective as clotrimazole vaginal tablets in reducing both clinical and microbiological symptoms of Candidiasis. Studies with larger sample sizes are required to confirm current findings. Impact statement What is already known on the subject? Based on results from in vivo and in vitro animal studies, dill (Anethum graveolens) has anti-candida activity. What do the results of this study add? It appears that 2% dill vaginal suppositories were as effective as 100 mg clotrimazole vaginal tablets in reducing both the clinical and microbiological symptoms. What are the implications of these findings for clinical practice and further research? Obstetricians and gynaecologists can offer dill as a useful alternative to chemical drugs, especially in women who are often interested in herbal medicine, or in women who are resistant or are not allowed to use antifungal drugs.
Topics: Administration, Intravaginal; Adult; Anethum graveolens; Antifungal Agents; Candidiasis, Vulvovaginal; Clotrimazole; Female; Humans; Iran; Plant Oils; Pruritus; Single-Blind Method; Young Adult
PubMed: 29553834
DOI: 10.1080/01443615.2018.1432578 -
Journal de Mycologie Medicale Jun 2018To determine the prevalence and the associated risk factors of vulvovaginal candidiasis in pregnant women in Mauritania.
AIM
To determine the prevalence and the associated risk factors of vulvovaginal candidiasis in pregnant women in Mauritania.
PATIENTS AND METHOD
The study was carried out at the laboratory of the Mère et Enfant Center in Nouakchott, from November 1, 2016 to February 5, 2017. It concerned all pregnant women in the third trimester that came to the natal consultation at the gynecology service. These women must have given their informed consent in written form. After completing the survey to collect epidemiological and clinical data, a sample was collected to perform fresh direct examination and culture on Sabouraud-Chloramphenicol media.
RESULTS
Two hundred pregnant women were included in the study. Culture on Sabouraud-Chloramphenicol media was positive in 52 patients corresponding to a prevalence of 26%. The germ tube test was positive for 61.5% of isolated Candida. Clinical signs are dominated by leucorrhea (56%), pelvic pain (25%) and vulvar pruritus (11%). Among women with positive culture, 55.76% had received local antifungal treatment in the form of an ovula during pregnancy.
CONCLUSION
This study shows that vulvovaginal candidiasis is frequent in pregnant women attending gynecology at the Mère et Enfant Hospital Center in Nouakchott.
Topics: Candidiasis, Vulvovaginal; Female; Humans; Mauritania; Pregnancy; Pregnancy Complications, Infectious; Prevalence; Risk Factors
PubMed: 29548876
DOI: 10.1016/j.mycmed.2018.02.006 -
Journal of Medical Microbiology May 2018Group B streptococcus (GBS) is an important cause of neonatal sepsis worldwide. Data on the prevalence of maternal GBS colonization, risk factors for carriage,...
Group B streptococcus (GBS) is an important cause of neonatal sepsis worldwide. Data on the prevalence of maternal GBS colonization, risk factors for carriage, antibiotic susceptibility and circulating serotypes are necessary to tailor adequate locally relevant public health policies. A prospective study including pregnant women and their newborns was conducted between March and July 2013 in Morocco. We collected clinical data and vagino-rectal and urine samples from the recruited pregnant women, together with the clinical characteristics of, and body surface samples from, their newborns. Additionally, the first three newborns admitted every day with suspected invasive infection were recruited for a thorough screening for neonatal sepsis. Serotypes were characterized by molecular testing. A total of 350 pregnant women and 139 of their newborns were recruited. The prevalence of pregnant women colonized by GBS was 24 %. In 5/160 additional sick newborns recruited with suspected sepsis, the blood cultures were positive for GBS. Gestational hypertension and vaginal pruritus were significantly associated with a vagino-rectal GBS colonization in univariate analyses. All of the strains were susceptible to penicillin, while 7 % were resistant to clindamycin and 12 % were resistant to erythromycin. The most common GBS serotypes detected included V, II and III. In Morocco, maternal GBS colonization is high. Penicillin can continue to be the cornerstone of intrapartum antibiotic prophylaxis. A pentavalent GBS vaccine (Ia, Ib, II, III and V) would have been effective against the majority of the colonizing cases in this setting, but a trivalent one (Ia, Ib and III) would only prevent 28 % of the cases.
PubMed: 29543148
DOI: 10.1099/jmm.0.000720 -
Facts, Views & Vision in ObGyn Sep 2017Lichen sclerosus most commonly affects the genital area. Contrarily to lichen planus, the involvement of the oral or vaginal mucosa is rare. Only four cases of vaginal...
BACKGROUND
Lichen sclerosus most commonly affects the genital area. Contrarily to lichen planus, the involvement of the oral or vaginal mucosa is rare. Only four cases of vaginal lichen sclerosus have been described in the literature.
CASE REPORT
The authors report two cases of postmenopausal women with a history of vulvar pruritus and burning. Both presented with lesions of the vaginal mucosa compatible with lichen sclerosus, and genital prolapse. Vaginal biopsies confirmed the diagnosis. Initial treatment with topical clobetasol was effective in one of the patients, but in the other patient line therapy with pimecrolimus, triamcinolone, and retinoids was needed.
CONCLUSION
Vaginal lichen sclerosus may be underdiagnosed and genital prolapse may favour the development of vaginal lesions.
PubMed: 29479404
DOI: No ID Found -
Taiwanese Journal of Obstetrics &... Feb 2018
Topics: Child; Female; Foreign Bodies; Humans; Magnetic Resonance Imaging; Pruritus Vulvae; Tissue Adhesions; Vagina; Vaginal Discharge
PubMed: 29458893
DOI: 10.1016/j.tjog.2017.12.030 -
Clinical Obstetrics and Gynecology Jun 2018For women at elevated risk of thrombosis, clinicians are challenged to relieve menopausal symptoms without increasing the risk of thrombosis. Oral menopausal hormone... (Review)
Review
For women at elevated risk of thrombosis, clinicians are challenged to relieve menopausal symptoms without increasing the risk of thrombosis. Oral menopausal hormone therapy increases the risk of venous thromboembolism by 2-fold to 3-fold. Observational studies suggest less thrombotic risk with transdermal therapies and with progesterone over synthetic progestogens (progestins), but the data are limited. Beneficial nonpharmacologic therapies include cognitive behavioral therapy and clinical hypnosis, whereas beneficial nonhormonal pharmacologic therapies include selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. For treatment of the genitourinary syndrome of menopause, vaginal lubricants and moisturizers, low-dose vaginal estrogen, and intravaginal dehydroepiandrosterone are options.
Topics: Administration, Intravaginal; Adrenergic alpha-2 Receptor Agonists; Atrophy; Dyspareunia; Estrogens; Excitatory Amino Acid Antagonists; Female; Hormone Replacement Therapy; Hot Flashes; Humans; Laser Therapy; Lubricants; Menopause; Phytotherapy; Pruritus; Risk; Selective Serotonin Reuptake Inhibitors; Sweating; Thrombosis; Vaginal Diseases; Vulvar Diseases
PubMed: 29419532
DOI: 10.1097/GRF.0000000000000358 -
The Journal of Family Practice Feb 2018A 34-year-old woman was referred to the hepatology clinic for evaluation of an increased serum alkaline phosphatase (ALP) level. She was gravida 5 and in her 38th week...
A 34-year-old woman was referred to the hepatology clinic for evaluation of an increased serum alkaline phosphatase (ALP) level. She was gravida 5 and in her 38th week of gestation. Her obstetric history was significant for 2 uncomplicated spontaneous term vaginal deliveries resulting in live births and 2 spontaneous abortions. The patient reported generalized pruritus for 2 months prior to the visit. She had no comorbidities and denied any other symptoms. She reported no family history of liver disease or complications during pregnancy in relatives. The patient did not smoke or drink, and had come to our hospital for her prenatal care visits. The physical exam revealed normal vital signs, no jaundice, a gravid uterus, and acanthosis nigricans on the neck and axilla with scattered excoriations on the arms, legs, and abdomen. Her serum ALP level was 1093 U/L (normal: 50-136 U/L). Immediately before this pregnancy, her serum ALP had been normal at 95 U/L, but it had since been increasing with a peak value of 1134 U/L by 37 weeks' gestation. Serum transaminase activities and albumin and bilirubin concentrations were normal, as was her prothrombin time. The rest of her lab tests were also normal, including her fasting serum bile acid concentration, which was 9 mcmol/L (normal: 4.5-19.2 mcmol/L).
Topics: Adult; Alkaline Phosphatase; Biomarkers; Biopsy; Diagnosis, Differential; Female; Humans; Liver Cirrhosis, Biliary; Liver Function Tests; Pregnancy; Pregnancy Complications; Pruritus
PubMed: 29400905
DOI: No ID Found -
CytoJournal 2017Large cell neuroendocrine carcinoma (LCNEC) of uterine cervix is a rare malignancy with aggressive behavior and poor clinical outcome even in its early stage. Few...
Large cell neuroendocrine carcinoma (LCNEC) of uterine cervix is a rare malignancy with aggressive behavior and poor clinical outcome even in its early stage. Few cytopathologic features of cervical LCNEC have been reported previously. A 57-year-old postmenopausal African American female, presented to the local health department with a chief complaint of heavy vaginal bleeding. A 45-year-old female presented with 20 months of vaginal pruritus and foul odor. Cervical malignancy was suspected by pelvis magnetic resonance imaging. Thinprep cytology test demonstrated ball-like tumor cell clusters in a necrotic background. Cytologic diagnosis of adenocarcinoma was rendered. However, the histologic and immunohistochemical examination of cervical biopsy revealed the LCNEC of the uterine cervix. Due to its rarity, LCNEC may pose a diagnostic challenge in cervical cytology. Cytopathologists should pay attention to the cytological features of cervical LCNEC, such as rosettoid pattern, nuclear molding, and thin nuclear membrane for differentiation from other mimics.
PubMed: 29259654
DOI: 10.4103/cytojournal.cytojournal_17_17 -
Journal of Cosmetic Dermatology Oct 2018Keratoderma climatericum affects menopausal women, and the diagnosis relies on typical clinical findings and exclusion of other potential causes of acquired keratoderma.... (Review)
Review
Keratoderma climatericum affects menopausal women, and the diagnosis relies on typical clinical findings and exclusion of other potential causes of acquired keratoderma. Although its pathophysiology is still unknown, there has been speculation about its relation to hormonal dysregulation (possibly a local estrogen deficiency) since the 1930s. A female patient with long-lasting keratoderma climatericum was initially prescribed a topical 50% urea ointment and clobetasol propionate 0.05% ointment, with just a slight improvement after 2 months of daily use. The patient was started on topical estriol 0.125 mg/g vaginal cream applied on the plantar surface after her daily shower and application of the same topical 50% urea ointment and clobetasol propionate 0.05% ointment on alternate nights. There was a marked improvement under this regimen with total and fast control of the pruritus. At 6-month follow-up the patient retained total symptomatic control and was just applying the estriol cream and the 50% urea containing ointment. We report a case of a difficult to treat plantar keratoderma that markedly improved after adding a daily topical application of a vaginal cream containing estriol 0.125 mg/g. Trials that determine the efficacy and safety of topical estrogens for keratoderma climatericum are warranted.
Topics: Administration, Topical; Estriol; Female; Foot Dermatoses; Humans; Keratosis; Menopause; Middle Aged; Ointments; Prognosis; Severity of Illness Index; Treatment Outcome
PubMed: 28929614
DOI: 10.1111/jocd.12422 -
Menopause (New York, N.Y.) Feb 2018Vulvovaginal atrophy (VVA) is characterized by vaginal changes, dyspareunia, and itching/irritation. Efficacy and safety of a lower-dose estradiol vaginal cream (0.003%)... (Randomized Controlled Trial)
Randomized Controlled Trial
A randomized, multicenter, double-blind study to evaluate the safety and efficacy of estradiol vaginal cream 0.003% in postmenopausal women with dyspareunia as the most bothersome symptom.
OBJECTIVE
Vulvovaginal atrophy (VVA) is characterized by vaginal changes, dyspareunia, and itching/irritation. Efficacy and safety of a lower-dose estradiol vaginal cream (0.003%) were evaluated in postmenopausal women with VVA-related dyspareunia.
METHODS
This was a phase 3, randomized, double-blind, placebo-controlled study. Sexually active postmenopausal women with moderate-severe dyspareunia as the most bothersome symptom, ≤5% vaginal superficial cells, and vaginal pH >5.0 were randomized (1:1) to 0.003% estradiol vaginal cream (15 μg estradiol; 0.5 g cream) or placebo (0.5 g cream) applied daily for 2 weeks followed by three applications/week for 10 weeks. Coprimary outcomes were changes in dyspareunia severity, vaginal cytology, and vaginal pH from baseline to final assessment. Additional efficacy outcomes and safety were assessed.
RESULTS
A total of 550 participants (average age, 58 y) were randomized. Compared with placebo, estradiol reduced dyspareunia severity (mean change from baseline ± SD: -1.5 ± 1.0 estradiol vs -1.2 ± 0.9 placebo), decreased vaginal pH (-1.36 ± 0.89 vs -0.53 ± 0.92), and improved vaginal cytology (percentage superficial and parabasal cells 10.1 ± 16.7 vs 1.4 ± 6.1 and -48.5 ± 45.1 vs -14.6 ± 39.6; P < 0.001, all) at the final assessment. In addition, estradiol decreased dyspareunia severity at weeks 8 and 12, vaginal/vulvar irritation/itching at weeks 4 and 12, and dryness at week 12 versus placebo (P < 0.01, all). VVA severity, pH, and cytology improved at week 12 with estradiol versus placebo (P < 0.001, all). Vulvovaginal mycotic infections were more frequent with estradiol. One serious event leading to discontinuation occurred with estradiol. No deaths occurred.
CONCLUSIONS
Lower-dose estradiol vaginal cream (0.003%) dosed three applications/week is an effective and well-tolerated treatment for VVA-related dyspareunia.
Topics: Administration, Topical; Aged; Atrophy; Candidiasis, Vulvovaginal; Double-Blind Method; Dyspareunia; Estradiol; Estrogens; Female; Humans; Hydrogen-Ion Concentration; Middle Aged; Postmenopause; Pruritus Vulvae; Severity of Illness Index; Vagina; Vaginal Creams, Foams, and Jellies; Vulva
PubMed: 28926514
DOI: 10.1097/GME.0000000000000985