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Vaginal discharge is a common gynaecologic complaint in pre-menarchal girls. However, an intravaginal foreign body (FB) must be suspected when it is persistent. We report the case of a referred 4-year-old girl with a 5-month history of persistent foul-smelling vaginal discharge. Clinical examination confirmed purulent vaginal discharge, along with a vaginal granuloma. A hard, intravaginal object was felt through the anterior rectal wall on digital rectal examination. A plain pelvic X-ray revealed a radiopaque object whose intravaginal position was confirmed by ultrasonography. The patient underwent granuloma excision plus FB removal and antibiotic treatment. The 12-month follow-up was unremarkable.

Untreated vaginal discharge is a risk factor for complications. Correct diagnosis is crucial. The purpose of this study was to apply Femoflor-16 to study the vaginal microbiome in women with genital tract discharge. Material/Methods: A total of 45 women were included in the study. Vaginal/cervical swab - one for routine tests and Gram staining and another for PCR Femoflor-16, were tested. Clinical diagnosis of bacterial vaginosis (BV) was done by using Amsel's criteria. Microbiologically, BV was assessed by applying a Nugent score system and Femoflor-16. Results: A total of 45 women with genital tract discharge were included in the study. Based on Amsel's clinical criteria, 9 (20%) of them were diagnosed with BV. Based on Nugent's score system, 11(24,4%) were categorized as having BV. Only 40 samples were compared, and the results were tested using Femoflor-16 and Nugent score system. Of them, 33 (83%) were in agreement as a result of using both methods. Femoflor-16 detected species such as aerobic bacteria (Enterobacteriасeae, Streptococcus spp., Staphylococcus spp.), Mycoplasma spp., Ureaplasma spp. and yeast-like microorganisms (Candida spp.). Conclusions: A reliable, comprehensive, and on-time diagnosis of BV is needed. Nucleic acid amplification tests nowadays complement the "classic" laboratory methods. The real time multiplex PCR test Femoflor-16 can be effectively used in vaginal microbiota evaluation in women with discharge. It can identify a wide range of microorganisms, including bacteria that are difficult to culture, normal Lactobacilli microflora and complex of aerobic and anaerobic microorganisms, mycoplasmas and Candida spp. In addition, it is able to determine the number and ratio of microorganisms in the total bacterial mass, which further orients to the disease state and the role of the microorganism as an opportunistic or obligate pathogen.

Abstract Background The risk of developing tumorous diseases in the genital tract also increases with age in animals. One of the classified tumor types is genital leiomyoma. Presently, our understanding of the pathogenesis of this tumor in goats is, however, limited. This accounts also for the information regarding the presence of steroid hormone receptors and, thus, possible responsiveness to circulating steroids. Case presentation This study describes the case of a vaginal tumor in a seven-year-old Anglo-Nubian goat. The goat was presented due to blood mixed vaginal discharge. Per vaginal examination a singular pedunculated mass in the dorsum of the vagina measuring approximately 3 cm x 4 cm x 4 cm was revealed. After administering epidural anesthesia, the mass was removed electrothermally. There were no postoperative complications. The histopathological examination identified the mass as a leiomyoma. The immunohistochemical examination revealed the presence of the nuclear progesterone receptor (PGR) in the tumor tissue. One year after the surgery, during the follow-up examination, the goat was in good overall health, and the owners had not observed any recurrence of vaginal discharge. Conclusions When observing vaginal discharge in goats, it is important to consider the possibility of genital tract tumors. These tumors may express sex steroid receptors. In the future, it is worth considering the investigation of potential approaches for preventing tumorigenesis or treating the tumor, such as castration or the administration of antiprogestogens.

Background: With recent advances in gene sequencing technology, more than 60 genetic mutations associated with very early onset inflammatory bowel disease (VEO-IBD) have been reported. Most of the genes are associated with immune deficiencies. The Myosin 5B (MYO5B) gene is primarily involved in cell motility and material transport which is associated with congenital intractable diarrhea and cholestasis. No studies have examined the relationship between the MYO5B gene and VEO-IBD. We report a case of a child with a mutation in the MYO5B gene who was diagnosed with VEO-IBD, then we investigated the association between the MYO5B gene and VEO-IBD. Case presentation: A 7-month-old baby girl with a chief complaint of "blood in the stool for more than 4 months and vaginal pus and blood discharge for 3 weeks" was diagnosed with VEO-IBD, and her symptoms improved after treatment with mesalazine. The whole-exome sequencing was performed with peripheral blood. Immunohistochemistry was performed on the terminal ileal tissue. Western blotting, quantitative polymerase chain reaction (Q-PCR) and immunofluorescence were performed with cultured organoid tissue from the terminal ileum. Whole-exome sequencing identified heterozygous missense of MYO5B variant of unknown significance (p. [I769N]; [T1546M]). Immunohistochemistry revealed a significant decrease in the expression of MYO5B protein in the terminal ileum of the child with MYO5B mutation; Q-PCR revealed a decrease in the mRNA levels of occludin and ZO-1 and both the mRNA levels and protein levels of MYO5B was downregulated in the patient. Immunofluorescence images showed that MYO5B gene mutation disrupted the apical delivery of transporters SGLT1, NHE3 and AQP7. Conclusions: MYO5B gene mutation leading to the downregulation of MYO5B protein may promote the occurrence of VEO-IBD by decreasing mRNA and protein levels of intestinal tight junction genes and dislocating the apical transporters. [ABSTRACT FROM AUTHOR]

Vestibular papillomatosis (VP) is an uncommon benign condition. This condition is very rare; hence, its incidence is difficult to estimate. It has been recorded in healthy young women in the range of 1%–33%. Owing to the papillomatous appearance of the lesion, it is often misdiagnosed as condyloma acuminatum, resulting in unnecessary investigations and multitude of treatments, which adds to the physical and economical burden on patients. We present three cases of VP. [ABSTRACT FROM AUTHOR]

Introduction: Bacterial vaginosis is the most common outpatient clinical condition in gynecology department; globally Diagnosis of bacterial vaginosis is by amsel's criteria during clinical examination, nugents criteria of gram stain and culture analysis can help to detect the exact pathogen and to start the accurate treatment. The aim of this study is to know the aerobic bacteriology of bacterial vaginosis and their antibiotic susceptibility pattern.Materials and Methods: A total of 363 patients participated in this descriptive cross sectional study was between the age group of 15 to 55 years. Their samples were collected and processed as per guidelines by performing gram stain and culture & sensitivity testing method. Patient details such as age, socioeconomic status, relapse of bacterial vaginosis, number of partners, type of discharge, associated symptoms and signs, and microbiological details were tabulated in an excel sheet to evaluate further. Results: Gram positive cocci are highly susceptible to gentamicin(100%), high level gentam icin(100%), vancomycin(82.8%) followed by linezolid(71.4%), clindamycin(60%), amoxiclav(48.6%) and least sensitive to azithromycin(28.6%). Gram negative bacilli are highly susceptible to amikacin(88.9%), meropenem(85.7%), cefipime(69.2%), followed by piperacillin tazobactam(60%), cotrimoxazole (53.5%), ciprofloxacin (50%), ofloxacin (44.4%), cefotaxime (40.7%), doxycycline (33.3%) and they were least sensitive to ceftriaxone (27.8%). Between the age group of 15 - 28 years, E.coli and Staphylococcus aureus were the most common organism isolated, followed by klebsiella pneumonia, Enterococci, CONS, Candida, Acinetobacter and Klebsiella oxytoca. Between the age group of 29 - 55 years, E.coli was the most common organism isolated, followed by Klebsiella pneumoniae, Enterococci and Staphylococci aureus. Conclusion: This study emphasizes the need to understand the aerobic pathogens associated with vaginitis especially in the reproductive age group to prevent adverse complications seen during pregnancy and labour. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The safety and feasibility of same-day discharge (SDD) has been consistently reported across the benign and gynecologic oncology literature. However, outcomes of SDD in the urogynecology population are sparse. The objectives of this study were to describe the success of SDD following vaginal hysterectomy and native-tissue colpopexy, and to compare the incidence of postoperative adverse events in patients discharged same-day versus postoperative day 1 (POD1). Further objectives were to compare pain, quality of recovery (QoR), and satisfaction between the groups. Methods: This was a single-center, prospective cohort study of patients with planned SDD. A standardized ERAS protocol was utilized. The QoR-40 questionnaire was administered at baseline, POD2, and the 6-week postoperative visit. Pain scores were captured similarly, and a satisfaction survey was administered at 6 weeks. The primary outcome was composite adverse events defined as any postoperative adverse event and/or health care utilization, excluding telephone calls, and urinary tract infection. Results: A total of 101 patients were enrolled in the study; the primary outcome was available for 99. SDD was achieved for 76 patients (77.0%); 23 patients stayed overnight (23.2%). The overall incidence of composite adverse events was 20.2% (95% CI, 13.5–29.2), and was not different between the groups (26.1% vs 18.4%, p = 0.42). Additionally, there were no differences in the QoR-40 or pain scores on POD2 and at 6 weeks. Patient satisfaction was high and similar between the groups. Conclusions: Successful SDD was achieved in 77.0% of the patients. SDD following vaginal hysterectomy and native-tissue colpopexy appears to be safe, feasible, and associated with good QoR and a high degree of patient satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the clinical efficacy and safety of argon plasma coagulation (APC) therapy and interferon therapy in patients with grade I and II vaginal intraepithelial neoplasia (VaIN). Methods: A total of 112 patients with VaIN were diagnosed via colposcopy-induced biopsy and classified into the APC group (n = 77) and interferon group (n = 35). Clinical data including age, grade, symptoms, historical or concomitant neoplasia of the lower genital tract, indications for hysterectomy, pregnancy history, cytology, human papillomavirus (HPV) subtype, treatment modalities, and clinical outcomes were analyzed, retrospectively. Complications and clinical outcomes were assessed at 6- and 12-month follow-ups. Results: There was no significant difference in the HPV clearance rate between the APC (53.42%) and interferon (33.33%) groups at 6 months after treatment. However, the 12-month follow-up of the APC group showed a significantly higher HPV clearance rate as compared to the interferon group (87.67% vs. 51.52%, P < 0.05). The APC group exhibited a significantly higher cure rate (79.22% vs. 40.0%) and lower persistence rate (12.99% vs. 37.14%) than the interferon group (P < 0.05). Adverse reaction analysis revealed that the primary reaction in the APC group was vaginal drainage, in contrast to the increased vaginal discharge in the interferon group; though the difference was significant (68.83% vs. 28.57%, P < 0.05), no serious complications were observed. Conclusions: Treatment with APC is a safe and more effective procedure against VaIN I and II, compared to interferon. APC may serve as a viable alternative to other physiotherapies. [ABSTRACT FROM AUTHOR]

Our objective was to evaluate the accuracy of predictive models for metritis spontaneous cure (SC) and cure among ceftiofur-treated cows using farm-collected data only, and with the addition of hemogram variables and circulating concentration of metabolites, minerals, and biomarkers (BM) of inflammation measured at time of diagnosis. Data related to parity, calving-related issues, BCS, rectal temperature, and DIM at metritis diagnosis were collected from a randomized clinical trial that included 422 metritic cows from 4 herds in Texas, California, and Florida. Metritis was defined as the presence of red-brownish, watery, and fetid vaginal discharge, and cure was defined as the absence of metritis 14 d after initial diagnosis. Cows were randomly allocated to receive systemic ceftiofur therapy (2 subcutaneous doses of 6.6 mg/kg of ceftiofur crystalline-free acid on the day of diagnosis and 3 d later; CEF) or to remain untreated (control). At enrollment (day of metritis diagnosis), blood samples were collected and submitted to complete blood count (CBC) and processed for the measurement of 13 minerals and BM of metabolism and inflammation. Univariable analysis to evaluate the association of farm-collected data and blood-assessed variables with metritis cure were performed, and variables with P ≤ 0.20 were offered to multivariable logistic regression models and retained if P ≤ 0.15. The areas under the curve for models predicting SC using farm data only and farm + BM were 0.70 and 0.76, respectively. Complete blood count variables were not retained in the models for SC. For models predicting cure among CEF cows, the area under the curve was 0.75, 0.77, 0.80, and 0.80 for models using farm data only, farm + CBC, farm + BM, and farm + CBC + BM, respectively. Predictive models of metritis cure had fair accuracy, with SC models being less accurate than models predictive of cure among CEF cows. Additionally, adding BM variables marginally improved the accuracy of models using farm collected data, and CBC data did not improve the accuracy of predictive models. [ABSTRACT FROM AUTHOR]

The objective was to evaluate the performance of exploratory models containing routinely available on-farm data, behavior data, and the combination of both to predict metritis self-cure (SC) and treatment failure (TF). Holstein cows (n = 1,061) were fitted with a collar-mounted automated-health monitoring device (AHMD) from −21 ± 3 to 60 ± 3 d relative to calving to monitor rumination time and activity. Cows were examined for diagnosis of metritis at 4 ± 1, 7 ± 1, and 9 ± 1 d in milk (DIM). Cows diagnosed with metritis (n = 132), characterized by watery, fetid, reddish/brownish vaginal discharge (VD), were randomly allocated to 1 of 2 treatments: control (CON; n = 62), no treatment at the time of metritis diagnosis (d 0); or ceftiofur (CEF; n = 70), subcutaneous injection of 6.6 mg/kg of ceftiofur crystalline-free acid on d 0 and 3 relative to diagnosis. Cure was determined 12 d after diagnosis and was considered when VD became mucoid and not fetid. Cows in CON were used to determine SC, and cows in CEF were used to determine TF. Univariable analyses were performed using farm-collected data (parity, calving season, calving-related disorders, body condition score, rectal temperature, and DIM at metritis diagnosis) and behavior data (i.e., daily averages of rumination time, activity generated by AHMD, and derived variables) to assess their association with metritis SC or TF. Variables with P -values ≤0.20 were included in the multivariable logistic regression exploratory models. To predict SC, the area under the curve (AUC) for the exploratory model containing only data routinely available on-farm was 0.75. The final exploratory model to predict SC combining routinely available on-farm data and behavior data increased the AUC to 0.87, with sensitivity (Se) of 89% and specificity (Sp) of 77%. To predict TF, the AUC for the exploratory model containing only data routinely available on-farm was 0.90. The final exploratory model combining routinely available on-farm data and behavior data increased the AUC to 0.93, with Se of 93% and Sp of 87%. Cross-validation analysis revealed that generalizability of the exploratory models was poor, which indicates that the findings are applicable to the conditions of the present exploratory study. In summary, the addition of behavior data contributed to increasing the prediction of SC and TF. Developing and validating accurate prediction models for SC could lead to a reduction in antimicrobial use, whereas accurate prediction of cows that would have TF may allow for better management decisions. [ABSTRACT FROM AUTHOR]

Introduction: It is unheard of in the present day to cure prolapse without the use of medication by using plastic balls. A 70-year-old woman who has been 20 years into menopause and visited our OPD complaining of foul-smelling vaginal discharge. In addition, she occasionally had lower abdominal pain and social humiliation because of the offensive odor. There were no evident vulval/cervicovaginal growths or uterovaginal prolapses identified, and there was no history of fever or vaginal hemorrhage. On per speculum and per vaginal examination, a ring-shaped foreign body with a diameter of around 8 cm followed by a ball of 12 cm diameter was visualized and felt. She described an insertion that had been performed 20 years prior as prolapse therapy. There was no trauma associated with the removal of the foreign body. Following that, she received supportive care and a cautious approach to management. Conclusion: Gynecologist ought to be mindful of this and understand how it is extracted. [ABSTRACT FROM AUTHOR]

• Vaginal foreign bodies represent a clinical and diagnostical challenge. • Most common symptoms are vaginal discharge and vaginal blood loss. Only 10% of patients presented with the complaint of a possible foreign object. Although a minority of patients develop complications, those with a battery as a foreign object are at a higher risk of mucosal injuries. • Ultrasonography is the most utilized diagnostic method, with a sensitivity of 79.9%. Radiography showed more false-negative than true-positive results, with a sensitivity of 33.3%. • Vaginoscopy is the gold standard for definitive diagnosis and therapy, as outpatient or under anesthesia. • A possible context of sexual violence should be considered, regardless the nature of the object. Vaginal foreign bodies represent a clinical and diagnostical challenge in pediatric gynecology. Several case reports, case series and retrospective studies have been published, highlighting rare or complex cases. A comprehensive systematic review is lacking. Published English-language articles on vaginal foreign objects in patients aged 16 years and younger, with full-text availability were included. Articles on adult patients and patients with an object migrating from the abdominal cavity into the vagina were excluded. Out of the 215 screened articles 75 were included, comprising a total of 522 patients. The age ranged from 6 months to 16 years, with an average of 6 years and 3 months. The presenting symptoms were documented in 340 patients, with the two most common being vaginal bleeding (n = 172) and vaginal discharge (n = 134). Toilet paper or tissue was the most common object, in 155 out of 447 patients. Ultrasonography was the most utilized diagnostic method, with a sensitivity of 79.9 %. Radiography showed more false-negative than true-positive results, with a sensitivity of 33.3 %. Complications were reported in 35 patients. Evidence of sexual abuse was found in a small group of 16 patients. Vaginoscopy under sedation was the most frequently used therapeutic approach. A swift and accurate diagnosis is crucial, with clinical examination and ultrasonography playing pivotal roles. Vaginoscopy is the gold standard for definitive diagnosis and therapy. Attention should be given to a potential context of sexual abuse. [ABSTRACT FROM AUTHOR]

Purpose: Studies involving minimally invasive hysterectomy and robotic sacrocolpopexy have demonstrated safety and feasibility of same-day discharge. There are limited data, however, on same-day discharge outcomes for vaginal hysterectomy and pelvic reconstruction. This study aimed to compare 30 and 90-day surgical outcomes between same-day discharge versus overnight stay following vaginal hysterectomy and apical suspension. Patients and Methods: This retrospective study evaluated surgeries performed over two time periods. Overnight stay was standard between December 2018 and February 2020. Same-day discharge was standard from December 2020 to February 2022. All patients who underwent vaginal hysterectomy with apical suspension were included. The primary outcome was to determine if there was an increase in 30-day readmission rates. Secondary outcomes included emergency department visits and reoperations within 30 days, the previous variables at 90 days, and the rate for successful same-day discharge. Results: A total of 324 patients were analyzed over the 30 months: 149 (46%) in the overnight stay group and 175 (54%) in the same-day discharge group. At 30 days, no difference was found between groups for readmissions (2.7% vs 4.0%, p = 0.56), emergency department visits (14.8% vs 14.9%, p = 1.0), or reoperations (2.0% vs.1.7%, p = 1.0). At 90 days, outcomes were also similar. Same-day discharge as standard practice was successful in 80% of patients. Conclusion: In this retrospective two cohort study, the safety of same-day discharge following vaginal hysterectomy with apical suspension was demonstrated with no increased risk of 30 or 90-day readmissions, emergency visits, or reoperation rates. The majority (80%) of patients were discharged on the day of surgery, suggesting feasibility of this model. [ABSTRACT FROM AUTHOR]

The present case report puts on record of successful management of dystocia in a jenny suffering from posterior presentation of fetus and torsion of the umbilical cord. A five-year-old pregnant jenny in its last trimester with the history of vaginal discharges followed by mild straining without any progress was reported at the farm. The vaginal examination revealed a fully dilated cervix with the presence of a fetus with breech presentation. The fetus was relieved successfully by repulsion of the fetus, extension of flexed hind legs and final traction of the fetus without any administration of anesthesia. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis (BV) is the most common cause of vaginal discharge in reproductive age women; however, little is known about it after menopause. We aimed to learn more about BV in Australian postmenopausal women. Methods: We conducted an online survey (July–September 2021). Participants were recruited via social media and professional networks and asked about demographic characteristics, sexual history and BV experiences. Outcomes of interest were the proportion who had heard of BV, had BV ever, or had BV after menopause. Factors associated with these outcomes were assessed using logistic regression. Results: Of 906 participants, 83% were included in the analysis. Overall, 37.9% had heard of BV, 11.0% reported having a BV diagnosis ever, 6.3% reported having a BV diagnosis after menopause and 4.4% reported having a BV diagnosis only after menopause. Multivariable analysis found that among all women the odds of having a BV diagnosis after menopause were increased for those who had BV before menopause, had douched in the past 12 months, or had a previous STI diagnosis. Among those in a sexual relationship, a BV diagnosis after menopause was associated with a BV diagnosis before menopause, or being in a sexual relationship of 5 years or less in duration. About half who reported BV after menopause described recurrences, distress, and a detrimental effect on sexual relationships. Conclusions: BV in postmenopausal women is associated with sexual activity, and impacts negatively on their lives. Research into BV should not be limited to reproductive age women. Bacterial vaginosis is the most common cause of vaginal discharge in reproductive age women, yet little is known about it in postmenopausal women. This survey of Australian postmenopausal women found that women continue to report bacterial vaginosis after menopause, it affects their quality of life, and it is associated with sexual activity. Women of all ages are susceptible to bacterial vaginosis, research should not be limited to younger women, and developing an appropriate testing method should be a research priority. [ABSTRACT FROM AUTHOR]

Objectives: The role of bacterial communities in the pathophysiology of canine nasal disease is still unclear. How and when to treat dogs with suspected secondary bacterial rhinitis and on which test to rely before making a decision to treat with antimicrobials has not been established. The objective is to compare the results of bacterial identification using agar‐plate cultures and 16S rRNA gene amplicon sequencing in dogs with nasal discharge suspected to be of bacterial origin. Materials and Methods: Twenty‐nine client‐owned dogs presented for investigation of nasal disease were included in the study. Paired swabs were collected from the same affected nasal cavity. One swab was streaked on 4 agar media (Columbia Blood Agar, MacConkey, Chapman and Edward's). The other swab was stored in a sterile cryotube at −80°. Extracted DNA underwent a polymerase chain reaction targeting the V1‐V3 region of the 16S rRNA gene. Results: At least one of the species detected by amplicon sequencing with a relative abundance of >10% was also identified by culture in 14 cases (48.3%), in association with marked predominance of one taxon (>80% relative abundance) in six of 14 cases. In 12 dogs (41.4%), the cultured isolates were rare or undetected components of the corresponding sequence libraries. A negative culture in the face of bacterial predominance (>50% relative abundance) of a potentially pathogenic bacteria detected by sequencing occurred in 17% (n=5) of cases; however, the use of other agar media may have decreased this percentage. Clinical Significance: Standard culture does not reliably predict the bacterial profile detected by 16S rRNA gene amplicon sequencing. [ABSTRACT FROM AUTHOR]

Background: Genital tract is the portal of entry for numerous sexually and non-sexually transmitted diseases. A number of bacterial and non-bacterial infections exist that affect the female reproductive tract and cause vaginal discharge. Candida species are among important opportunistic pathogens causing candidiasis in human worldwide. These yeast species are of public health concern nowadays. Aim: This study aimed at comparing the prevalence of candidiasis among single and married women attending Rwanda Military Hospital. The study population comprises of single and married women. Methodology: This was a retrospective study where data was collected from Rwanda Military Hospital. Results: The results of this study showed that the incidence of candidiasis was higher in married women when compared with single women. The prevalence of candidiasis in married women was 128(74.4%), while in single women is 44(25.6%). It was observed in this study that the distribution of candidiasis among married and single is statistically significant (p<0.05). Results also show that out of 172 single and married women, more cases of candidiasis were observed within the age range of 21-30 years, 66 (44.2%) were infected with candida albicans, 31-40 years had a prevalence of 55(32%) and 11-20 years had a prevalence of 13(7.6%). The overall of cases of candida other than C. albicans observed was 15.1%. Conclusion: This study showed that married and single women are predisposed to candidiasis. It is therefore important to give opportunistic pathogens like Candida species attention in women especially among married ones as they are mostly affected by this candidiasis. [ABSTRACT FROM AUTHOR]

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Introduction. Primary extragonadal germ cell tumors (EGCTs) are a very rare clinical encounter most commonly reported in males. Among females, the placenta, pelvis, uterus, brain, and mediastinum are the most common extragonadal sites and predominantly display nondysgerminoma histology. In this report, we present a case of a primary cervical dysgerminoma in a young female patient. Case Report. An 18-year-old nulligravid woman presented with a 12-month history of vaginal bleeding and discharge. Routine blood tests and serum levels of tumor markers were within normal limits. The chest X-ray was normal. A high-resolution pelvic MRI showed a well-defined lobulated cervicovaginal mass measuring 8 × 6 × 5 cm expanding into the vaginal canal with mild homogenous contrast enhancement. An incisional biopsy was performed vaginally under anesthesia, and histologic findings were consistent with dysgerminoma. A repeat follow-up pelvic MRI was done and showed a reduction in the size of the mass by more than 70%. The patient was treated with 4 cycles of bleomycin, etoposide, and cisplatin chemotherapy. Additional external pelvic beam radiation treatment was administered for a partial response. After 3 months of radiotherapy, a contrast abdominopelvic CT scan showed a recurrent cervicovaginal mass with extension to the pelvic sidewalls. The patient was initiated with ifosfamide, paclitaxel, and cisplatin (ITP) as second-line chemotherapy for a recurrent germ cell tumor but later died from hydronephrosis, chronic anemia, and sepsis. Conclusion. The uterine cervix is a very unusual site for primary dysgerminoma and can have a very aggressive clinical course. A high index of suspicion and an exhaustive workup are necessary to reach a diagnosis, particularly in a young patient presenting with a cervical lesion. [ABSTRACT FROM AUTHOR]

Background: Syndromic management is widely used to treat symptomatic sexually transmitted infections in settings without aetiologic diagnostics. However, underlying aetiologies and consequent treatment suitability are uncertain without regular assessment. This systematic review estimated the distribution, trends, and determinants of aetiologies for vaginal discharge, urethral discharge, and genital ulcer in sub-Saharan Africa (SSA). Methods and findings: We searched Embase, MEDLINE, Global Health, Web of Science, and grey literature from inception until December 20, 2023, for observational studies reporting aetiologic diagnoses among symptomatic populations in SSA. We adjusted observations for diagnostic test performance, used generalised linear mixed-effects meta-regressions to generate estimates, and critically appraised studies using an adapted Joanna Briggs Institute checklist. Of 4,418 identified records, 206 reports were included from 190 studies in 32 countries conducted between 1969 and 2022. In 2015, estimated primary aetiologies for vaginal discharge were candidiasis (69.4% [95% confidence interval (CI): 44.3% to 86.6%], n = 50), bacterial vaginosis (50.0% [95% CI: 32.3% to 67.8%], n = 39), chlamydia (16.2% [95% CI: 8.6% to 28.5%], n = 50), and trichomoniasis (12.9% [95% CI: 7.7% to 20.7%], n = 80); for urethral discharge were gonorrhoea (77.1% [95% CI: 68.1% to 84.1%], n = 68) and chlamydia (21.9% [95% CI: 15.4% to 30.3%], n = 48); and for genital ulcer were herpes simplex virus type 2 (HSV-2) (48.3% [95% CI: 32.9% to 64.1%], n = 47) and syphilis (9.3% [95% CI: 6.4% to 13.4%], n = 117). Temporal variation was substantial, particularly for genital ulcer where HSV-2 replaced chancroid as the primary cause. Aetiologic distributions for each symptom were largely the same across regions and population strata, despite HIV status and age being significantly associated with several infection diagnoses. Limitations of the review include the absence of studies in 16 of 48 SSA countries, substantial heterogeneity in study observations, and impeded assessment of this variability due to incomplete or inconsistent reporting across studies. Conclusions: In our study, syndrome aetiologies in SSA aligned with World Health Organization guidelines without strong evidence of geographic or demographic variation, supporting broad guideline applicability. Temporal changes underscore the importance of regular aetiologic re-assessment for effective syndromic management. PROSPERO number: CRD42022348045. Julia Michalow and colleagues estimate the aetiologies and aetiologic distributions of vaginal discharge, urethral discharge, and genital ulcer in sub-Saharan Africa. Author summary: Why was this study done?: Symptom-based case management is common for treating sexually transmitted infections (STIs) in sub-Saharan Africa (SSA). Characterising the infectious aetiologies (causes) of each syndrome is crucial to ensure adequate choice of treatment. Recent comprehensive assessments on the aetiologies for vaginal discharge, urethral discharge, and genital ulcer are lacking in SSA. What did the researchers do and find?: We conducted a systematic review that included 190 studies in 32 SSA countries spanning 1969 and 2022. We accounted for the sensitivity and specificity of different diagnostic tests used across studies and used meta-regression models to estimate the distribution of infections causing each symptom. We determined that the main aetiologies for vaginal discharge were candidiasis (69% of cases in 2015), bacterial vaginosis (50%), chlamydia (16%), and trichomoniasis (13%); for urethral discharge were gonorrhoea (77%) and chlamydia (22%); and for genital ulcer were herpes simplex virus type 2 (HSV-2) (48%) and syphilis (9%). Distributions of infectious aetiologies were similar across regions and population subgroups but changed over time. What do these findings mean?: The findings support the applicability and continued use of World Health Organization guidelines for symptomatic STI management across SSA settings. National STI programmes should re-assess aetiologies regularly due to changes over time. Limitations of the review include that no data were available in 16 of 48 SSA countries, there was large variability in results across studies identified in the review, and certain information of interest was missing or inconsistently reported across studies. [ABSTRACT FROM AUTHOR]

Background: Cleft lip and palate are common congenital anomalies that require comprehensive management to optimize clinical outcomes. This study aims to investigate the management approaches and epidemiological characteristics of non-syndromic and syndromic cleft lip and palate patients at a university center in Saudi Arabia. Methods: A retrospective chart review was conducted at a university medical center in Riyadh, Saudi Arabia. The study period spanned from May 2015 to August 2021, during which clinical data of cleft lip and palate patients admitted to the hospital were collected. The purpose of this review was to analyze the clinical outcomes and epidemiological characteristics of these patients. Results: The study included 210 patients with cleft lip and palate. Most cases were observed in patients aged 0–30 months. Male patients accounted for 58.1%. Prenatal, natal, and postnatal events were common. A positive family history of cleft lip and/or palate was reported in 28.6%, and consanguinity in 46.7%. Comorbidities included congenital heart disease, hearing problems, dental issues, and facial growth abnormalities. Cleft types were associated with age, gender, ethnicity, and comorbidities. Maternal factors showed no significant differences, except for obesity. Complications were less likely in patients with syndromes and higher treatment satisfaction. Longer hospital stays and additional treatments predicted complications. Conclusions: The findings of this study revealed that cleft lip was the most common type of cleft observed, with patients receiving early treatment and having shorter hospital stays. However, patients who underwent cleft lip correction and management reported lower satisfaction with their quality of life. Level of Evidence: Level IV, risk / prognostic study [ABSTRACT FROM AUTHOR]

Background: The risk of developing tumorous diseases in the genital tract also increases with age in animals. One of the classified tumor types is genital leiomyoma. Presently, our understanding of the pathogenesis of this tumor in goats is, however, limited. This accounts also for the information regarding the presence of steroid hormone receptors and, thus, possible responsiveness to circulating steroids. Case presentation: This study describes the case of a vaginal tumor in a seven-year-old Anglo-Nubian goat. The goat was presented due to blood mixed vaginal discharge. Per vaginal examination a singular pedunculated mass in the dorsum of the vagina measuring approximately 3 cm x 4 cm x 4 cm was revealed. After administering epidural anesthesia, the mass was removed electrothermally. There were no postoperative complications. The histopathological examination identified the mass as a leiomyoma. The immunohistochemical examination revealed the presence of the nuclear progesterone receptor (PGR) in the tumor tissue. One year after the surgery, during the follow-up examination, the goat was in good overall health, and the owners had not observed any recurrence of vaginal discharge. Conclusions: When observing vaginal discharge in goats, it is important to consider the possibility of genital tract tumors. These tumors may express sex steroid receptors. In the future, it is worth considering the investigation of potential approaches for preventing tumorigenesis or treating the tumor, such as castration or the administration of antiprogestogens. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis is a common vaginal syndrome among females, which leads to significant morbidity and complications, if left untreated. The association of bacterial vaginosis with various sexually transmitted infections has been mentioned in previous literature. However, studies on the intermediate Nugent Score are lacking. This study was planned to examine the association of sexually transmitted infections with the intermediate Nugent Score. Materials and Methods: The study included was conducted to include females presenting with vaginal discharge, burning micturition, itching, lower abdominal pain and infertility. The Nugent scoring was used to categorize patients into those having normal flora, intermediate or bacterial vaginosis. Conventional and molecular techniques targeting Trichomonas vaginalis, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Syphilis, Neisseria gonorrhoeae and vulvovaginal candidiasis were performed. Results: A total of 3,531 clinical samples were collected from females with a median age of 28.0 years. The number of patients with bacterial vaginosis and intermediate Nugent Score and positive cases were significantly higher in the 21–35 years age group (P < 0.0001). We observed that the likelihood of test results being positive for Trichomonas vaginalis was higher (P < 0.05), as the abnormality of the vaginal flora increased. Mycoplasma hominis was observed to be significantly higher in the intermediate Nugent Score group than the BV-positive patients (0.6 vs 0.2, P = 0.002). The number of vulvovaginal candidiasis cases in both the bacterial vaginosis-negative and bacterial vaginosis-positive groups were nearly the same (9.3 vs 9.8%). Limitations: Individual follow-up couldn’t be performed on the patients. Conclusions: We observed that the dysbiosis in vaginal microbiota, with an increase in Nugent scoring, was significantly associated with an increased risk for the acquisition of sexually transmitted infections and vulvovaginal candidiasis. [ABSTRACT FROM AUTHOR]

Vaginal squirting is a phenomenon in which women expel fluid during the sexual response process, but it remains poorly understood in the extant literature. The study purpose was to use nationally representative data to investigate adult women's experiences with vaginal squirting. We assessed the prevalence of women who have ever squirted in their lifetime, the level of pleasure and concurrency of orgasm women reported during squirting, the ways in which women discovered squirting, and the challenges and/or concerns women experience with squirting. Forty percent of U.S. adult women (M = 47.6 years, SD = 16.8; Md = 24 years) had ever squirted in their lifetime (Md frequency = three to five times). Two thirds of women reported unintentional discovery of squirting, and most (75%) used specific techniques to promote build up and release of squirting versus squirting spontaneously. About 60% of participants reported squirting to be very or somewhat pleasurable, but only 20% "always" experienced squirting and orgasm together. Women reported different challenges with squirting, such as the time required to reach squirting or the experience being too emotionally intense. Our findings contribute to the growth of much needed, detailed literature on the ways in which women discover and enjoy squirting as part of their sexual lives. Knowledge of these techniques can enable women to better identify their own preferences, communicate about them with their partners, and advocate for their sexual pleasure. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate long-term continuation rates, adverse events of ring pessary use at a minimum of 5 years follow-up, and factors associated with discontinuation in symptomatic pelvic organ prolapse (POP). Methods: Women with symptomatic POP who were treated with vaginal ring pessary and had successful fittings were included. Adverse events and reasons for discontinuation of pessary use were recorded. Patients who were lost to follow-up were defined as discontinuation. Results: During 12 year-period, 239 of 329 POP patients (72.6%) had successful fittings with ring pessary. The mean age was 67.8 ± 8.9 years (range 27–86) and 70% of patients had advanced stage. The cumulative probability of continued ring pessary use was 84.1%, 64.4%, 49.3%, and 33.5%, at 1, 3, 5, and 10 years, respectively. Most common reason for discontinuation was frequent expulsion (21.6%), followed by vaginal erosion (16.5%), no prolapse improvement (12.4%), and inability or inconvenience to do self-care (9.3%). However, 9 patients (9.3%) had improvement of prolapse and were able to discontinue pessary insertion. Age above 70 years, wide introitus, and incapability of self-care are independent factors associated with long-term discontinuation. Adverse events occurred in 23.4% of patients, 18.8% of them had vaginal erosion, 11.7% vaginal discharge/infection, and 18.4% de novo SUI. However, no statistical significance existed between those who continued and discontinued pessary use due to these adverse events. Conclusion: Ring pessary is an effective treatment in symptomatic POP, with acceptable long-term continuation rates and minor adverse events. Self-care of pessary is very important aiming to minimize adverse events. Advanced age, wide introitus and incapability of self-care were associated factors for long-term discontinuation. [ABSTRACT FROM AUTHOR]

Rumen-protected choline (RPC) promotes benefits in milk production, immunity, and health in dairy cows by optimizing lipid metabolism during transition period management and early lactation. However, the RPC success in dairy cows depends on choline bioavailability, which is affected by the type of protection used in rumen-protected choline. Therefore, our objectives were to determine the effects of a novel RPC on dry matter intake (DMI), identify markers of metabolism and immunity, and evaluate lactation performance. Dry Holstein (n = 48) cows at 245 ± 3 d of gestation were blocked by parity and assigned to control or RPC treatment within each block. Cows enrolled in the RPC treatment received 15 g/d of CholiGEM (Kemin Industries, Cavriago RE, Italy) from 21 d prepartum and 30 g/d of CholiGEM from calving to 21 d postpartum. During the transition period, DMI was measured daily, and blood was sampled weekly for energy-related metabolites such as β-hydroxybutyrate (BHB), glucose, and nonesterified fatty acids (NEFA), as well as immune function markers such as haptoglobin (Hp) and lipopolysaccharide-binding protein (LPB). Vaginal discharge samples were collected at the calving and 7 d postpartum and stored in microcentrifuge tubes at −80°C until 16S rRNA sequencing. The main responses of body condition score, body weight, DMI, milk yield, milk components, and immune function markers were analyzed using the GLIMMIX procedure of SAS with the effects of treatment, time, parity, and relevant covariates added to the models. The relative abundance of microbiome α-diversity was evaluated by 3 indexes (Chao1, Shannon, and Simpson) and β-diversity by principal coordinate analysis and permutational multivariate ANOVA. We found no differences in DMI in the pre- and postpartum periods. Cows fed RPC increased the yields of energy- and 3.5% fat-corrected milk and fat yield in primiparous and multiparous cows, with an interaction between treatment and parity for these lactation variables. However, we found no differences in milk protein and lactose up to 150 DIM between treatments. Glucose, NEFA, and BHB had no differences between the treatments. However, RPC decreased BHB numerically (control = 1.07 ± 0.13 vs. RPC = 0.63 ± 0.13) in multiparous on the third week postpartum and tended to reduce the incidence of subclinical ketosis (12.7% vs. 4.2%). No effects for Hp and LPB were found in cows fed RPC. Chao1, Shannon, and Simpson indexes were lower at calving in the RPC treatment than in the Control. However, no differences were found 7 d later for Chao1, Shannon, and Simpson indexes. The vaginal discharge microbiome was altered in cows fed RPC at 7 d postpartum. Fusobacterium , a common pathogen associated with metritis, was reduced in cows fed RPC. Rumen-protected choline enhanced lactation performance and health and altered the vaginal discharge microbiome which is a potential proxy for uterine healthy in dairy cows. The current study's findings corroborate that RPC is a tool to support adaptation to lactation and shed light on opportunities for further research in reproductive health. [ABSTRACT FROM AUTHOR]

Persistent HPV infections may cause cervical and vaginal intraepithelial neoplasia (CIN and VaIN). Traditional methods might destroy the structure and function of the cervix. 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a non-invasive targeted therapy. This study aims to evaluate the efficacy and safety of ALA-PDT for CIN and VaIN and the clearance of HPV. A retrospective study of 303 patients who confirmed CIN or VaIN and received ALA-PDT was conducted. All the patients were followed up at six and twelve months after treatment and then annually thereafter. The effect was evaluated through HPV genotyping, a cytology test, and colposcopy-directed biopsy if necessary. After ALA-PDT, the remission rates for CIN 2, CIN 3, VaIN 2, and VaIN 3 were 90.6%, 88.5%, 87.3%, and 77.8%. For CIN 1, the remission rate at the six-month follow-up was 93.1%. The total HPV clearance rates were 72.5% at the six-month follow-up and 85.7% at the 12-month follow-up. The most common adverse event was vaginal discharge. No severe adverse effect was observed. ALA-PDT is an effective and safe treatment for all grades of CIN and VaIN and is helpful in clearing HPV with minimal side effects. This treatment may not influence fertility and delivery. [ABSTRACT FROM AUTHOR]

In postpartum patients, necrotizing myositis may present with fever, abdominal pain, severe infection, and abnormal vaginal discharge; culture and sensitivity testing are recommended to direct antibiotic therapy. BACKGROUND: Postpartum necrotizing myositis is a rare condition, typically presenting as a complication after uterine artery embolization or uterine compression suturing. Uterine ischemia can cause endometrial necrosis and even myometrial necrosis, which can lead to systemic infection. If a systemic infection is not promptly and actively treated, it may pose significant risk. CASE: A 35-year-old patient who had undergone bilateral uterine artery ligation, modified B-Lynch suture, and multiple compression sutures due to refractory postpartum hemorrhage frequently presented to clinic after postpartum discharge due to persistent fever and vaginal discharge. A bag-like prolapse from the vagina measuring 10×5 cm, accompanied by purulent discharge, was noted 78 days postsurgery. Subsequent pelvic magnetic resonance imaging revealed a uterine basal abscess and postpartum necrotizing myositis; an emergency laparoscopic supracervical hysterectomy was performed, with postoperative pathology confirming the diagnosis. After the patient's discharge, she was readmitted for inpatient treatment of a pelvic abscess. CONCLUSIONS: Although rare, postpartum necrotizing myositis should be considered in postpartum patients presenting with fever, abdominal pain, severe infection symptoms, and abnormal vaginal discharge. Culture and sensitivity testing are recommended to direct appropriate antibiotic therapy. [ABSTRACT FROM AUTHOR]

In Mozambique, sexually transmitted infections (STIs) are estimated to be prevalent, but diagnosis and treatment of curable STIs rely only on syndromic management. We examined the prevalence of four non-viral STIs and HIV-1/2, based on etiological diagnosis, associations with sociodemographic and behavioural factors, and the STI diagnostic accuracy of the vaginal discharge syndromic management in women with urogenital complaints in Maputo, Mozambique. A cross-sectional study was performed in Maputo, Mozambique, February 2018-January 2019, enrolling 924 women of reproductive age with urogenital complaints. Endocervical/vaginal swabs were sampled and chlamydia, gonorrhoea, trichomoniasis and Mycoplasma genitalium infections were diagnosed using a multiplex real-time PCR (AmpliSens; InterLabServices). Serological testing was performed for HIV-1/2. A structured questionnaire collected metadata. All data were analyzed in STATA/IC 12.1 using descriptive statistics, chi-square tests and logistic regression model. About 40% of the women were less than 24 years old, 50.8% were single, 62.1% had their sexual debut between 12 and 17 years of age, and the main complaint was vaginal discharge syndrome (85%). The prevalence of chlamydia was 15.5%, trichomoniasis 12.1%, gonorrhoea 4.0%, M. genitalium 2.1%, and HIV-1/2 22.3%. The vaginal discharge syndrome flowchart had a sensitivity of 73.0%-82.5% and a specificity of 14%-15% for the detection of any individual non-viral STI in women with urogenital complaints. In total, 19.2% of the symptomatic women with chlamydia, trichomoniasis or gonorrhoea would not be detected and accordingly treated using the vaginal discharge syndromic management (missed treatment) and 70.0% of the women would be treated despite not being infected with any of these three STIs (overtreatment). In conclusion, a high prevalence of especially chlamydia, trichomoniasis, and HIV-1/2 was found in women of childbearing age with urogenital complaints in Maputo, Mozambique. Syndromic management of vaginal discharge revealed low accuracy in the detection of STIs in symptomatic women, especially low specificity, which resulted in under-treatment of STI-positive cases and incorrect or over-treatment of women with urogenital complaints, many of whom were negative for all the non-viral STIs. Etiological diagnosis is imperative for effective management of STIs in symptomatic and asymptomatic women. [ABSTRACT FROM AUTHOR]

Background: The adult human vagina hosts a complex biota containing diverse communities of microorganisms. The occurrence of multi-drug-resistant strains of these microorganisms has persistently increased due to poor hygiene and misuse or abuse of antibiotics. The vaginal microflora may exhibit patterns of growth, biochemical expression, or response to the standard drugs which consequently lead to answer the complex questions of antimicrobial resistance. Aim: The study aimed to quantify the susceptibility profile of microorganisms isolated from vaginal discharge and evaluate the minimum inhibitory concentration of diverse antimicrobial drugs. Methods: Fifty vaginal swabs were collected from female students of Madonna University, Nigeria while two samples were collected each from a pregnant and a non-pregnant woman at the university’s tertiary care teaching hospital. The isolates were grown in selective media and identified through Gram-staining and biochemical physiology for identification. The Kirby-Bauer disc diffusion method was used for microbial susceptibility testing, and the agar dilution method was used to determine the minimum inhibitory concentration of commonly prescribed antibiotics at the teaching hospital. Results: Sixty-eight microorganisms comprising 17 Gram-positive (Staphylococcus sp.) and 31 Gram-negative (Escherichia coli and others) bacteria and 20 fungi (Candida sp.) were isolated. The bacteria showed a high resistance (>80%) to amoxicillin, cefuroxime, and cefixime but were relatively susceptible (35–100%) to levofloxacin and ofloxacin. Cefepime showed high activity with a minimum inhibitory concentration range of 25–50 µg/mL against the studied bacteria. The isolated fungi were susceptible to amphotericin B (35–40%) but resistant (>85%) to other antifungal drugs tested. Conclusion: The study suggests that bacterial vaginosis prevalence at the university could best be treated with ofloxacin (second generation- fluoroquinlone), levofloxacin (third generation- fluoroquinolone), and cefepime (fourth generation- cephalosporin) due to their greater sensitivity, while candidiasis could best be treated with amphotericin B (a pyolene).

Abstract Background Predicting the periovulatory period is very important for conception. Current approaches to predicting the periovulatory period include monitoring of basal body temperature and urine luteinizing hormone (LH) concentration; however, these methods are time-consuming. Here, we examined the potential of using vaginal discharge (VD) as a non-invasive means of sample collection for determining the LH surge that indicates ovulation. Methods Urine and VD samples were collected from 35 healthy women aged 20–39 years. VD samples were collected with panty liners to reduce the burden on participants. Daily first urine samples and used panty liners were collected from the 10th through 19th days of the menstrual cycle. Urine and VD LH (uLH and vLH) levels in the samples were measured by enzyme-linked immunosorbent assay. Measured vLH baseline and first surge values were analyzed using Student's t-test and ROC curves. Results Samples for a total of 55 menstrual cycles were collected. We used uLH surge to establish the date of ovulation. uLH surges were observed in 49 cycles, 34 of which had corresponding VD samples that qualified for measurement. Five cycles were excluded due to a lack of vLH data. In the remaining 29 cycles, the vLH surge appeared within the fertile window 90% of the time, and the sensitivity and specificity of the test were 86% and 83%, respectively. Conclusions VD has potential for use as a sample for predicting the periovulatory period by measuring LH content.

Background/Purpose: Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disease most common in patients of childbearing age. This pathology is associated with clinical, metabolic, and reproductive complications. We evaluated the diversity of the vaginal microbiota (VM), the vaginal inflammatory reaction (VIR), the proinflammatory state, and the activation of polymorphonuclear neutrophils (PMN) with the production of neutrophil extracellular traps (NETs). Methods: Thirty-three patients who attended a consultation at the Hospital UTPL-Santa Inés, Loja, Ecuador, from May to August 2023 who were diagnosed with PCOS participated in this study. Blood samples, vaginal discharge, and a survey were obtained. Results: A high number of patients, 23/33 (69.7%), presented altered microbiota in clinical variables associated with PCOS phenotypes A and B, sexual partners (>2), and oligomenorrhoea. A significant statistical association was only observed for sexually transmitted infections at sampling (p = 0.023) and insulin (p = 0.002). All eight cases studied with VIR had PMN/NETotic activity. A high frequency of proinflammatory states was observed in all vaginal microbiota states. Conclusions: These results suggest that the PCOS could trigger a proinflammatory state in the vaginal epithelium independently of the state of the vaginal microbiota. Furthermore, the presence of NETs observed in the cases studied could decrease fertility in these PCOS patients. [ABSTRACT FROM AUTHOR]

Out of the total cases of cervical cancer, brain metastases (BMs) are relatively rare, with an estimated incidence rate of 0.63% (range: 0.1%–2.2%). Additionally, BMs prognosis remains poor, and the average patient survival time following a BM diagnosis is 3 to 5 months. Few studies have addressed the effect of programmed cell death‐1 inhibitors against BMs in cervical cancer, although they are an established option for recurrent/metastatic disease. Hence, we report a case involving a 54‐year‐old post‐surgery patient with cervical cancer with a body mass index of 19.5 kg/m2 and Eastern Collaborative Oncology Group (ECOG) performance status of 3; the disease recurred with BMs 1 year later. Intensity‐modulated radiation therapy concurrent with temozolomide and bevacizumab was initiated, following which zimberelimab immunotherapy combined with anlotinib was administered to extend tumor control. The patient had a progression‐free survival duration of 10 months, the tumor response was assessed as a partial response based on the evaluation criteria for solid tumors (RECIST1.1), and the ECOG status improved to 1 after therapy. These findings suggest that immunotherapy‐based combination therapy following radiotherapy may be a good choice for patients with cervical cancer and BMs. [ABSTRACT FROM AUTHOR]

Background: Cervicitis is a prevalent gynecologic disease, which does not usually respond to conventional treatments. Long-term cervicitis can cause serious health problems such as inflammation, infertility, and cancer. Henna oil, an herbal product in Persian medicine, is recommended for uterine diseases like cervicitis. Objective: This study aims to evaluate the efficacy of Henna oil as a vaginal suppository in combination with an antibiotic regimen in the treatment of cervicitis. Materials and Methods: This randomized placebo-controlled trial, included 92 nonmenopausal women with cervicitis at the Baqaipur Clinic of Shahid Sadoughi hospital in Yazd and the Persian Medicine Health Center in Ardakan, Yazd, Iran. Participants were further divided into either the Henna oil vaginal suppository group or the placebo group (n = 46/each group). During the study, the antibiotic treatment was administered to both groups. Cervicitis symptoms were compared between the groups and within each group. Results: Of 92 included individuals, 41 in each group completed the study. Results revealed that significant differences were observed in some outcomes, including vaginal discharge (p < 0.001), cervical ulcer size (p < 0.001), dyspareunia (p = 0.046), and postcoital bleeding (p < 0.001), indicating that the treatment was more effective in the henna group compared to the placebo group. Conclusion: Findings supported that the vaginal suppository of Henna oil in combination with antibiotic therapy could be effective in the improvement of clinical symptoms of cervicitis regardless of its pathology. [ABSTRACT FROM AUTHOR]

Clinical endometritis is one of the most common causes of declining reproductive performance in dairy cows. The purpose of this study was to investigate the effects of some risk factors including cow's parity, milk yield, dystocia, retained placenta, calf sex, calving season, abortion, and stillbirth on the incidence of clinical endometritis and the effect of clinical endometritis on open days in an Iranian dairy farm. The uterine health of 557 dairy cows was evaluated by rectal palpation and ultrasonography during 30--35 days after calving. The presence of mucopurulent secretions in the vagina and vulva as well as the ultrasonographic observation of echogenic secretions in the uterine lumen were considered endometritis. The effect of the mentioned factors on the incidence of clinical endometritis was then analyzed in univariate and multivariate logistic regression models. The chance of developing clinical endometritis in the low-producing cows was 27.2% higher than that of the high-producing cows (p=0.06). Other parameters had no significant effect on the incidence of endometritis. The incidence of clinical endometritis in the studied herd was 49.5%. Based on the results of this study, the low milk yield may be a risk factor for developing clinical endometritis in the studied herd's condition. Parameters of parity, dystocia, retained placenta, calf sex, calving season, abortion, and stillbirth were not effective in the occurrence rate of endometritis. There was no association between clinical endometritis and days open in the studied herd. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the effects of rumen-protected lysine (RPL) supplementation during the close-up period on uterine involution and the resumption of ovarian function in dairy cows. Fifty-two multiparous Holstein cows were categorized based on parity and expected calving date and randomly assigned to the RPL or control (CON) groups. The RPL group received 80 g of RPL daily from day 21 before the expected calving date until parturition. Blood samples were obtained twice weekly from pre-supplementation to 6 weeks postpartum. The onset of luteal activity postpartum was determined via ultrasonography twice weekly for up to 6 weeks postpartum. Uterine involution was tracked at 3 and 5 weeks postpartum through the vaginal discharge score, percentage of polymorphonuclear cells (PMN) in endometrial cytology samples, presence of intrauterine fluid, and gravid horn diameter via ultrasonography. Before supplementation, the RPL group showed amino acid imbalance, which was improved by RPL supplementation. There were no significant differences in the onset of luteal activity, percentage of PMN, intrauterine fluid, or the diameter of the uterine horn between the two groups. The vaginal discharge score in the RPL group decreased from 3 to 5 weeks postpartum, whereas that in the CON groups did not decrease. The number of cows with clinical endometritis was lower in the RPL group. Overall, RPL supplementation during the close-up period enhanced vaginal discharge clearance, potentially averting clinical endometritis, but did not affect the first ovulation in dairy cows. [ABSTRACT FROM AUTHOR]

Background: As rare as it is, primary fallopian tube carcinoma presents with a varied range of nonspecific signs and symptoms making its preoperative diagnosis a clinical challenge. It is often missed and is usually recognized later by histopathology. This paper aims to present four cases of fallopian tube cancer managed in our institution in a 5-year period with varied presentation and to discuss updates in diagnosis, management and prognosis in the light of recent literature. Methods and Results: All of the four cases were of different age group, presented differently and were diagnosed preoperatively to be of another etiology. The first case, 44 year old, initially presented with recurrent vaginal discharge. The patient then presented with supraclavicular nodes to be of metastatic origin. The second case, 58 year old, presented with vaginal spotting and on imaging, a pelvic mass that may represent ovarian new growth. The third and fourth case, 71 and 66 year old respectively, presented with a history of gradually enlarging abdominal mass with an imaging showing an adnexal mass. Intraoperatively, the first and third case revealed a fallopian tube that was thinned out and dilated to a granular and friable tissue. The second case had a right fallopian tube that cannot be grossly identified but an adnexal mass was noted. The fourth case showed a left fallopian tube that was converted to a tan irregular mass. Histopathology revelaed all of these cases as high grade fallopian tube serous carcinoma. Conclusion: To raise suspicion in the diagnosis of this rare carcinoma preoperatively should be given more importance so that a prompt investigation would be made and catching this disease in an early stage would be achieved. This paper showcased the varied presentation of this disease so as to avoid preoperative misdiagnosis and have a better head start on proper management. [ABSTRACT FROM AUTHOR]

Background. Antimicrobial resistance poses a significant global threat to the treatment of bacterial infections, particularly in low- and middle-income regions such as Africa. This study is aimed at analyzing antimicrobial resistance patterns in vaginal swab samples from patients at the National Health Laboratory from 2019 to 2022. Methods. This retrospective study examined patient records from vaginal swab analyses performed at the National Health Laboratory between January 1, 2019, and December 31, 2022. Ethical approval was obtained from the Ministry of Health Research Ethical Approval and Clearance Committee on 15/02/2023. Results. Of the 622 samples, 83% underwent microbial isolation and identification. Citrobacter spp. exhibited high resistance (>43%) to antibiotics such as cephalexin, ceftazidime, nalidixic acid, ampicillin, gentamicin, and tetracycline. E. coli showed resistance rates of more than 50% to ampicillin, trimethoprim-sulfamethoxazole, and tetracycline. Klebsiella spp. and Proteus spp. exhibited resistance rates that exceeded 47% to specific antibiotics. Gram-positive bacteria have resistance rates of more than 49% with ampicillin, trimethoprim-sulfamethoxazole, tetracycline, oxacillin, vancomycin, and penicillin G. In particular, S. aureus demonstrated no resistance to rifampicin or clindamycin, while Streptococcus spp. showed 100% resistance to rifampicin and vancomycin. Several species, including Proteus species, Streptococcus spp., S. aureus, and Klebsiella spp. exhibited multidrug resistance. Conclusion. Most gram-negative bacteria displayed higher resistance of >45% to ampicillin, trimethoprim-sulfamethoxazole, and tetracycline. Among gram-positive bacteria, a higher resistance rate with ampicillin, trimethoprim-sulfamethoxazole, tetracycline, oxacillin, vancomycin, and penicillin G was recorded. S. aureus showed no resistance to rifampicin and clindamycin, and Strep. spp. indicated 100% resistance to rifampicin and vancomycin. This study highlights critical gaps and areas for further exploration. Expanding the spectrum of antibiotics tested and investigating underlying multidrug resistance mechanisms would provide a more comprehensive understanding of resistance patterns. [ABSTRACT FROM AUTHOR]

Introduction: This study used an unsupervised machine learning algorithm, sidClustering and random forests, to identify clusters of risk behaviors of Bacterial Vaginosis (BV), the most common cause of abnormal vaginal discharge linked to STI and HIV acquisition. Methods: Participants were 391 cisgender women in Miami, Florida, with a mean of 30.8 (SD = 7.81) years of age; 41.7% identified as Hispanic; 41.7% as Black and 44.8% as White. Participants completed measures of demographics, risk behaviors [sexual, medical, and reproductive history, substance use, and intravaginal practices (IVP)], and underwent collection of vaginal samples; 135 behavioral variables were analyzed. BV was diagnosed using Nugent criteria. Results: We identified four clusters, and variables were ranked by importance in distinguishing clusters: Cluster 1: nulliparous women who engaged in IVPs to clean themselves and please sexual partners, and used substances frequently [n = 118 (30.2%)]; Cluster 2: primiparous women who engaged in IVPs using vaginal douches to clean themselves (n = 112 (28.6%)]; Cluster 3: primiparous women who did not use IVPs or substances [n = 87 (22.3%)]; and Cluster 4: nulliparous women who did not use IVPs but used substances [n = 74 (18.9%)]. Clusters were related to BV (p < 0.001). Cluster 2, the cluster of women who used vaginal douches as IVPs, had the highest prevalence of BV (52.7%). Conclusions: Machine learning methods may be particularly useful in identifying specific clusters of high-risk behaviors, in developing interventions intended to reduce BV and IVP, and ultimately in reducing the risk of HIV infection among women. [ABSTRACT FROM AUTHOR]

Background: Women living with HIV (WLWH) are often coinfected with Trichomonas vaginalis (TV), and annual screening is recommended. Our goal was to assess differences in TV prevalence at study entry and over time in enrollment cohorts of the Women's Interagency HIV Study. Methods: In a multisite study, TV was diagnosed by wet mount microscopy. Prevalence was determined across four enrollment waves: 1994–1995, 2001–2002, 2011–2012, and 2013–2015. Generalized estimating equation multivariable logistic regression models assessed changes in visit prevalence across waves after controlling for HIV disease severity and other risks. Results: At 63,824 person-visits (3,508 WLWH and 1,262 women without HIV), TV was diagnosed by wet mount at 1979 visits (3.1%). After multivariable adjustment, HIV status was not associated with TV detection, which was more common among younger women, women with multiple partners, and irregular condom use. All enrollment waves showed a decline in TV detection over time, although p-value for trend did not reach significance for most recent waves. To explore the potential utility of screening among WLWH, we assessed rates of TV detection among women without appreciable vaginal discharge on examination. Initial TV prevalence among asymptomatic women was 3.5%, and prevalence decreased to 0.5%–1% in the most recent wave (2013–2015) (p-trend <0.0001). Conclusions: In this cohort, TV rates are low among WLWH, and HIV does not increase TV risk. Screening may benefit newly diagnosed WLWH, women with risk factors, or those receiving care sporadically but is unlikely to further reduce the low rate of TV among women in care, especially older women without multiple partners. The clinical trials registration number for WIHS is NCT00000797. [ABSTRACT FROM AUTHOR]

Introduction: Human papilloma virus is a dominant factor for cervical carcinogenesis. First coitus at a younger age, having a high number of pregnancies, and marrying at an early age are identified as significant risk factors for HPV infection. Objective: The current study was initiated to evaluate the overall prevalence of HPV in women from the northern state of India. Materials and method: This cross-sectional study was conducted on 120 married women within the age group of 21 to 65 years, who reported specific complaints such as vaginal discharge or bleeding per vaginum. Already diagnosed with cervical cancer, received HPV vaccination, and confirmed cases of tuberculosis or any other carcinoma were excluded from the study. Cervical smears were taken by trained technician using modified AYRE'S SPATULA. Ethical approval for the study was obtained from the Institutional Ethical Committee. Result: Prevalence of HPV among women patients, who reported specific complaints, such as vaginal discharge or bleeding per vaginum, 82.50% were tested positive, while 17.50% were tested negative. The study also contributes valuable insights into age-specific trends of HPV infection, indicating an increased risk among women aged 25 to 34 years. Conclusion: The Study reveals a higher prevalence of HPV among women with normal cytology, but minor gynecological complaints and the complex relationship between HPV and biomarkers, suggests the need for further research. [ABSTRACT FROM AUTHOR]

Scientific information is incomplete regarding the genitourinary syndrome of menopause. Both the lower genital and urinary tracts are rich in receptors for reproductive hormones and are highly susceptible to waning ovarian hormones at menopause. Symptoms of dryness and pain emerge in late perimenopause, but they can also result earlier from cancer therapies or bilateral oophorectomy. Lower urinary tract symptoms rise in prevalence at midlife and increase further with advancing age. Because ovarian senescence is typically followed by years of aging, some postmenopausal complaints may be attributable to increasing longevity. [ABSTRACT FROM AUTHOR]

This study evaluated the probability of pregnancy and associated factors for two times artificial inseminations (AI), 8 or 10 hours after automated activity monitoring (AAM) alarm on the first postpartum AI of 1,054 Holstein dairy cows. The estrus was synchronized by prostaglandin or estradiol-progesterone program. Stepwise logistic regression was performed to analyze the probability of pregnancy, and associated factors (activity, estrus intensity, parity, peripartum health, retained placenta, postpartum vaginal discharge, and season). The highest pregnancy rates were obtained with multiparous animals, inseminated ten hours after the AAM alarm, in the fall or winter season, with a high activity peak and estrus intensity (P < 0.05). Peripartum diseases, retained placenta, and postpartum vaginal discharge negatively influenced the pregnancy rate, regardless of parity. Thus, the optimization of AAM models by including on-farm measures like parity, peripartum health history, and environmental conditions may favor the correct identification of estrus and improve the AAM alarm regarding the ideal moment for AI, increasing the reproductive performance in dairy cows. [ABSTRACT FROM AUTHOR]