Search

The objective of this study was to identify the cause-effect relationships between various data related to vaginal dosage forms, such as composition, process parameters (condition attributes), and quality (decision attribute), by employing a mathematical data mining approach that utilizes rough set theory. The analyzed data were organized in a tabular format known as an information system. Objects were labeled as rows, and attributes as columns, with attribute-values serving as entries. Each formulation was described by its condition attributes (composition, manufacturing process, quality parameters), while the decision attribute indicated the quality of the formulation (expressed as pH after vaginal tablet or pessary application) and enabled classification as correct/incorrect or good/bad. The decision rules generated by the study provide insights into the relationships between the condition attributes and the decision attribute. They highlight the importance of LA content and LA:polymer ratios in maintaining physiological pH. Additionally, the findings confirm the favorable impact of chitosan on pH regulation while indicating that the type of formulation (pessaries or tablets) does not significantly affect the classification of objects. Decision rules with high confirmation coefficients of condition attributes can help in developing optimal formulations. These decision rules contain essential information that describes the cause-and-effect relationships and are free of redundant information. They form the basis for understanding and optimizing processes and establishing a design space. [ABSTRACT FROM AUTHOR]

Although the 2022 mpox outbreak mostly affected adults, its effect on children and adolescents was also substantial. In this report, we describe the clinical course and treatment of the first 3 known cases of mpox in children in New York City. These cases are instructive because they illustrate various routes of transmission, clinical presentations, and diagnostic challenges that differ from previous reports of mpox in endemic countries and previous mpox outbreaks. Of note is that each of the 3 patients received treatment with tecovirimat under an US Food and Drug Administration expanded access investigational new drug application and improved without exhibiting adverse reactions. [ABSTRACT FROM AUTHOR]

Problem: Overgrowth of candida species in the human vaginal mucosa causes inflammation, which could render the mucosal barrier more susceptible to HIV infection. Here, we investigated whether this condition also affects the ectocervical mucosa, a potential site of HIV entry, in women at high risk of HIV infection. Method of study: Retrospective medical data and ectocervical tissue samples were obtained from a cohort of Kenyan sex workers. Among 108 women, seven had signs of vaginal candida infection by wet smear microscopy and/or the presence of characteristic discharge. Women lacking these two criteria served as controls. Host transcriptomic profiling and quantitative in situ image analysis of epithelial barrier markers and CD4+ cell distribution were performed. Results: The candida group had 162 differentially expressed genes out of 15 435 genes as compared with the control group. Among these 162 genes, 147 were upregulated and 15 were downregulated. Gene expression pathway analysis indicated associations with an upregulated inflammatory response, defined primarily by markers of neutrophil activation. Transcription factor analysis revealed upregulation of pathways related to RELA/REL/NFKB1, JUN and STAT1 in the candida group. In situ image analysis of ectocervical tissue samples showed no differences between groups in terms of epithelial height, expression of epithelial junction proteins (E‐cadherin, claudin‐1, zonula occludens 1, and desmoglein‐1), or epithelial CD4+ cell distribution. Conclusions: Vaginal candida infection was associated with inflammation and neutrophil infiltration, but not with severe epithelial disruption or CD4+ cell infiltration, in the ectocervical mucosa. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Veterinary Journal / Revue Vétérinaire Canadienne is the property of Canadian Veterinary Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Vaginal atrophy is often underestimated in the routine practice of an obstetrician-gynecologist, as specialists expect active complaints from postmenopausal patients. At the same time, vaginal or urogenital atrophy can occur in women of any age due to temporary or permanent estrogen deficiency. Research continues to find effective and safe methods of treatment for this pathology in order to alleviate symptoms and improve the quality of life of women. The objective: to study the effectiveness of using vaginal suppositories in eliminating the manifestations of vaginal atrophy in women of reproductive age with primary ovarian insufficiency. Materials and methods. 23 women from 24 to 35 years old with primary ovarian insufficiency (POI) were involved in the study, they were divided into groups depending on the duration of the disease: I group – 8 women with POI duration up to 5 years, II group II – 8 women with POI duration from 5 to 7 years, III group – 7 patients with a duration of POI of more than 7 years. The set of examinations carried out before the start of the study and after treatment included an assessment of the patients’ complaints, speculum examination of the vagina and cervix with the determination of the vaginal health index in points, study of the condition of the vaginal microbiota (pH-metry, bacterioscopic examination of smears of vaginal secretions). Results. Despite receiving systemic menopausal hormone therapy, all patients had varying intensity of vaginal atrophy, while the frequency and severity of disorders increased with increasing duration of the course of POI. As the duration of POI increased, the frequency and severity of vaginal dryness, bloody discharge during intercourse increased, and the frequency of abnormal vaginal discharge decreased. Manifest vaginal atrophy was diagnosed in 12.5% of patients in I group, 37.5% of patients in II group and 71.4% of patients in III group, moderate atrophy in 37.5%, 37.5% and 28.6% of women, respectively. The obtained data indicate a gradual progression of the phenomena of vaginal atrophy in patients with POI. After treatment, there was a tendency to decrease the pH values of the vaginal contents from 5.6–5.8 to 4.7. The dynamics of patients’ complaints showed that the effectiveness of using vaginal suppositories is the highest for the duration of POI up to 5 years, and for a longer duration of vaginal atrophy, it is 80.0%. At the stage of inclusion in the study, no normocenosis was detected in any of the examined patients (100%), the intermediate state of the microbiota prevailed – 73.9%, nonspecific vaginitis was diagnosed in 13.0% of patients, and bacterial vaginosis in 13.0%. After a course of treatment with vaginal suppositories, vaginal normocenosis was diagnosed in 52.2% of patients, an intermediate state of microbiota in 56.5% in the absence of inflammatory and dysbiotic changes. The effectiveness of normalizing the condition of the vaginal microbiota was 73.9%. Conclusions. Vaginal suppositories are an original combination of components with a pronounced reparative, antipruritic, anti-inflammatory effect, which helps to eliminate the inflammatory process in the vulvovaginal area, support intensive regeneration of the vaginal mucosa and its moisture, restore the physiological protective barrier of the mucous membrane, improve local blood microcirculation, eliminate the itching, discomfort and dryness, normalization of the condition of the vaginal microbiota. [ABSTRACT FROM AUTHOR]

Sexually Transmitted Infection (STI) is a common condition with increased prevalence among pregnant women and can negatively affect the fetus. According to WHO, a total of 374 million new cases of STI are projected to occur in 2020, including gonorrhea (82 million), syphilis (7.1 million), and trichomoniasis (156 million). Therefore, this study aimed to determine the relationship between the characteristics of vaginal discharge (fluor albus) in pregnant women and STI. The descriptive method was used with a cross-sectional design, and the procedures were conducted in May 2023. The sample population comprised all pregnant women with ANC in Makassar during the study period. Vaginal swabs were obtained from 127 pregnant women who were willing to participate and had vaginal discharge. The results showed that 53 participants reported having physiological flour albus, while 74 had pathological symptoms. Itching and odor were reported to be the most common clinical signs associated with patients' abnormal vaginal discharge, followed by itching, pain, and odor. Furthermore, a significantly high prevalence of the condition was observed among pregnant women aged 20-30 years. Based on the results, the predominant symptom of fluor albus was itching and odor when combined with microorganisms that caused STI. Several pregnant women with clinical complaints also had microorganisms apart from those associated with STI. These results indicated the pressing need to develop additional testing in pregnant women with fluor albus, particularly those with concomitant symptoms.

Introduction: Vulvovaginal candidiasis (VVC) is considered a common gynecological problem among females of reproductive age group. 70–75% of women report having had candidal vulvovaginitis at some point in their lifetimes and 40–50% suffer recurrent candidal vulvovaginitis. Objectives: This study aims to identify the Candida species involved in VVC and to determine their antifungal susceptibility pattern. Materials and Methods: The present study was a cross-sectional study conducted on 257 females (18–55 yr) with complaints of abnormal vaginal discharge. For detection of Candida, the swab samples were subjected to Gram stain, 10% KOH mount, and culture on Sabouraud dextrose agar (SDA). Candida species identification was done by subculturing Candida isolates onto CHROMagar, corn meal agar (Himedia), and further confirmation was done by MALDI-TOF MS. Antifungal testing was done using the disk diffusion method. Results: A total of 257 females with complaints of abnormal discharge were enrolled in this study. Out of 257, C. albicans 37 (58.7%) and 26 (41.3%) isolates were identified as non-albicans Candida. Out of 63 positive cases, a maximum number of study subject belongs to the age group 26–35 years (50.8%). Along with vaginal discharge, itching (65.37%) is the most common complaint. VVC was found to be most predominant in patients with prolonged antibiotic therapy (38.1%), and in pregnant females (15.9%). Conclusion: Understanding the emerging fungal pathogens and their drug susceptibility patterns is essential for the effective management of infections. Drug resistance can lead to treatment failure and highlights the need for alternative treatment options or strategies.

Lichen planus (LP) is a chronic inflammatory disorder primarily affecting the skin and mucous membranes, characterized by pruritic, violaceous papules often exhibiting a polygonal pattern. This dermatological disorder can affect various sites of the body, including the skin, nails, hair, and mucous membranes out of which the oral mucosa is the most commonly affected. We report a case of a 40-year-old female with a unique combination of cutaneous, nail, and mucosal LP manifestations coexisting with lichen planopilaris and vulvovaginal-gingival syndrome. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This article from the Indian Dermatology Online Journal discusses a case of persistent vaginal discharge in a 32-year-old woman. Despite visiting multiple practitioners and trying various treatments, the discharge did not improve. Diagnostic tests revealed that the cause of the discharge was cytolytic vaginosis (CV) due to cervical ectropion. The patient underwent cervical conization, which successfully stopped the discharge. The article emphasizes the importance of accurate diagnosis and highlights CV as a commonly misdiagnosed condition. The Indian Dermatology Online Journal, published by Wolters Kluwer - Medknow, is a valuable resource for researchers in dermatology, with the latest issue covering topics related to dermatology in India. [Extracted from the article]

A dystociac ewe presented with the history of continuous straining, off feed and vaginal discharge had a fetal monster-monocephalus tetrabrachius tetrapus, which was managed by cesarean operation. [ABSTRACT FROM AUTHOR]

Abstract Background Genital tract infections pose a public health concern. In many low-middle-income countries, symptom-based algorithms guide treatment decisions. Advantages notwithstanding, this strategy has important limitations. We aimed to determine the infections causing lower genital tract symptoms in women, evaluated the Kenyan syndromic treatment algorithm for vaginal discharge, and proposed an improved algorithm. Methods This cross-sectional study included symptomatic non-pregnant adult women presenting with lower genital tract symptoms at seven outpatient health facilities in Nairobi. Clinical, socio-demographic information and vaginal swabs microbiological tests were obtained. Multivariate logistic regression analyses were performed to find predictive factors for the genital infections and used to develop an alternative vaginal discharge treatment algorithm (using 60% of the dataset). The other 40% of data was used to assess the performance of each algorithm compared to laboratory diagnosis. Results Of 813 women, 66% had an infection (vulvovaginal candidiasis 40%, bacterial vaginosis 17%, Neisseria gonorrhoea 14%, multiple infections 23%); 56% of women reported ≥ 3 lower genital tract symptoms episodes in the preceding 12 months. Vulvovaginal itch predicted vulvovaginal candidiasis (odds ratio (OR) 2.20, 95% CI 1.40–3.46); foul-smelling vaginal discharge predicted bacterial vaginosis (OR 3.63, 95% CI 2.17–6.07), and sexually transmitted infection (Neisseria gonorrhoea, Trichomonas vaginalis, Chlamydia trachomatis, Mycoplasma genitalium) (OR 1.64, 95% CI 1.06–2.55). Additionally, lower abdominal pain (OR 1.73, 95% CI 1.07–2.79) predicted sexually transmitted infection. Inappropriate treatment was 117% and 75% by the current and alternative algorithms respectively. Treatment specificity for bacterial vaginosis/Trichomonas vaginalis was 27% and 82% by the current and alternative algorithms, respectively. Performance by other parameters was poor to moderate and comparable between the two algorithms. Conclusion Single and multiple genital infections are common among women presenting with lower genital tract symptoms at outpatient clinics in Nairobi. The conventional vaginal discharge treatment algorithm performed poorly, while the alternative algorithm achieved only modest improvement. For optimal care of vaginal discharge syndrome, we recommend the inclusion of point-of-care diagnostics in the flowcharts.

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.

Objective: To analyze and summarize the types, incidence rates and relevant influencing factors of adverse events (AEs) after high-intensity focused ultrasound ablation of gynecological diseases and provide reference and basis for handling such events in clinical practice. Method: We searched PubMed, Cochrane Library, Web of Science and Embase databases to retrieve all literature since its establishment until February 2024. We evaluated the quality of included literature and publication bias and conducted a meta-analysis of single group rates for various AEs using Stata 17.0. Results: This systematic review finally included 41 articles. We summarized 34 kinds of AEs in 7 aspects and conducted a single group rate meta-analysis and sub-group analysis of 16 kinds of AEs. Among the common AEs of High-Intensity Focused Ultrasound (HIFU), the incidence of lower abdominal pain/pelvic pain is 36.1% (95% CI: 24.3%∼48.8%), vaginal bleeding is 20.6% (95% CI: 13.9%∼28.0%), vaginal discharge is 14.0% (95% CI: 9.6%∼19.1%), myoma discharge is 24% (95% CI: 14.6%∼34.8%), buttock pain is 10.8% (95% CI: 6.0%∼16.5%) and sacral pain is 10% (95% CI: 8.8%∼11.2%). Serious complications include uterine rupture, necrotic tissue obstruction requiring surgical intervention, third degree skin burns and persistent lower limb pain or movement disorders. Conclusion: The common AEs after HIFU surgery are mostly mild and controllable, and the incidence of serious complications is extremely low. By reasonable prevention and active intervention, these events can be further reduced, making it a safe and effective treatment method. It is a good choice for patients who crave noninvasive treatment or have other surgical contraindications. [ABSTRACT FROM AUTHOR]

Aims Female genital tuberculosis is an infrequent form of tuberculosis that is often underestimated due to its low prevalence in developed countries, difficult and delayed diagnosis, and misleading clinical presentation. This systematic review aimed to describe the epidemiology, clinical presentation, diagnosis, and treatment of female genital tuberculosis during 2000-2021. Information & Methods The current study is a systematic review that was conducted through exploration of English keywords like “female genital tuberculosis”, “vulva tuberculosis”, “tuberculosis”, and “genital system” as well as, Persian keywords. Furthermore, a similar search methodology was employed in various international databases, including PubMed, Scopus, and Web of Sciences, as well as in certain Iranian databases, like Irandoc and Magiran, between 2000 and 2021. Findings Most patients (37.5%) were from India. Upper genital tuberculosis was more common among women of reproductive age, and the most involved upper genital organs were the endometrium and fallopian tubes. In contrast, vulvar tuberculosis was more prevalent in postmenopausal women, and the vulva was the most common site involved in lower genital tuberculosis. Weight loss (31.25%) and vaginal discharge (31.25%) were the most common symptoms reported by the study participants. The main histologic finding in female genital TB was the presence of epithelioid cell granulomas (81.25%). 29 (90.6%) patients received the standard antibiotic therapy (combination of rifampicin, isoniazid, ethambutol, and pyrazinamide), all of whom responded positively. Conclusion Most patients experience prolonged vulva ulcers and inadvertently receive various antibiotics. The typical lesions are epithelioid cell granulomas, which may be accompanied by Langerhans giant cells. [ABSTRACT FROM AUTHOR]

Background: Leucorrhoea or vaginal discharge is one of the very common problem or complaint among female of reproductive age group (15-45) attending to Gynecology and Venereology outpatient department and it is associated with STI/HIV and adverse birth out comes. Objective of the study was isolation identification and to assess the frequency of occurrence of various microbial agents. Materials and Methods: Between July 2023 to December 2023, 125 sexually active women (15-45) age were enrolled from two reproductive health clinics (Gynecology and Venereology) in Government General Hospital, Guntur. The women underwent an interview followed by physical examination. Vaginal swabs are taken and processed for confirmatory diagnosis of Bacterial vaginosis, trichomonal vaginitis and candidal vulvo vaginitis. Results: Among the study group of 125 women, majority of women belongs to urban area (70.4%), low socio-economic group 66.4%, illiterates 62.4% and 21-30 years of age (27%). Among the study group 30.4% were having bacterial vaginosis, 22.4% have vulvo vaginal candidiasis, and 10.4% have vaginal trichomoniasis. Conclusion: Microbial infections of lower genital tract are very common in sexually active women in reproductive age group. Nonspecific vaginosis mostly associated with Gardenella vaginosis, specific vaginosis with Trichomonas vaginosis, candiasis are very frequent. These infections in pregnancy cause adverse birth outcomes. Early and proper diagnosis and timely treatment of infected women including sexual partners is essential in cases of vaginal infections which requires laboratory assistance. [ABSTRACT FROM AUTHOR]

The failures in Trichomonas vaginalis (TV) infection diagnosis leave more than half of cases unidentified. In this report, urine and vaginal discharge samples were analyzed by wet mount, culture examination, and real-time PCR by Allplex™ (Seegene®) kit, in a population assisted by the Brazilian Public Health System. From 747 samples, 2.81% were positive for TV in wet mount and culture, and 3.88% by Allplex™. Samples kept at − 80 ºC for 22 months did not impair the PCR technique. The sensitivity for wet mount, culture, and Allplex™ was 72, 100, and 100%, respectively. Allplex™ technique showed highest detection of TV. [ABSTRACT FROM AUTHOR]

Background: Rural population constitutes a significant population of our country. According to the regions, the sexual behavior and pattern of sexually transmitted infections (STIs) changes because of variation in health facilities, education, and sociocultural belief. Objective: To study the sociodemographic profile, sexual behavior, and pattern of STIs based on the syndromic approach in the rural population attending STIs clinic from the east‑central zone of India. Materials and Methods: Between January 2020 and July 2022, a retrospective study was carried out in a STIs clinic at a tertiary care facility in India’s east‑central region. Data included demographics, clinical profiles (syndromic approach), and sexual behavior from all the rural population suffering from STIs. The data were corroborated using the proper statistical tools. Results: Seven hundred and twenty‑two (63.6%) of the 1135 STI cases were from the rural population. The gender ratio was 17:1, with 333 (46.1%) patients between the ages of 20 and 30 years. Four hundred and ninety‑four (68.4%) of the rural population had education qualifications below the 10th class. The predominant occupation was a homemaker (582; 80.6%). Drug abuse was noted in 13 (1.8%) cases. Lower abdominal pain was the most clinical manifestation seen in 441 (61%) cases, followed by vaginal discharge in 89 (12.3%) cases. The majority of the patients presented with the first episode of symptoms and had a single regular partner with no symptoms in a partner. In 22.9% of cases, the partner had a history of frequent travel. In 94.1% of cases, protective measures were not used. Conclusions: Young married adults, female partners, lower education, and low‑income classes were among those who had STIs, with frequent unprotected sexual activity. Lower abdominal pain is the most common symptom in this area. [ABSTRACT FROM AUTHOR]

Vaginal cancer, rarest form of gynaecological cancer (0.6%) has been found to be associated with long term use of vaginal ring pessary, which have long been used in alternative management of pelvic organ prolapse (POP) other than surgery. A survey was done in remote areas of Cox's bazar, refugee camp in 2019 where out of 52 cases of pelvic organ prolapse, 7 cases found to use vaginal ring pessary for long and out of 7, vaginal cancer developed in 4 cases. All of them were aged women above 60 and had defaulted follow up presented with vaginal bleeding, varying discharge and pain of varying intensity. One patient had only local lesion -surgical removal followed by radiotherapy and 2nd one, 68 years, received neo-adjuvant therapy and died before planned surgery. The 3rd one, aged 79, did not come for follow up once diagnosis vaginal cancer done and advised for definitive surgical treatment, family refused operation and she passed away after 2 years at 81 years. The 4th one declined further investigations and any form of treatment when diagnosed with vaginal cancer. So, all patients of pelvic organ prolapse should be informed thoroughly (both verbal and written informed consent) before inserting pessary for potential long term serious consequences where strict compliance must be ensured for subsequent regular follow up and biopsy should be mandatory for any suspicious chronic vaginal ulcers among them. [ABSTRACT FROM AUTHOR]

Purpose: To determine the relationship between genital hygiene behavior and the emergence of vaginitis, especially in female motorcycle taxi drivers at Jakarta area Patients and methods: Subjects are 50 female motorcycle taxi drivers in Jakarta area who met inclusion/ exclusion criteria. A questionnaire of genital hygiene behavior inventory (GHBI) was used to obtain the genital hygiene behavior among subjects. Vaginal examination and microbiological swab from vaginal discharge were then performed as diagnostic for any type of vaginitis. Data collected were then analyzed using SPSS application for univariate and bivariate analysis to show subjects' characteristics and to look for relationships between variables. Results: 62% of respondents are over 40 years old and most of them work more than 8 hours per day. Vaginitis was found in 42% of drivers divided into 21 subjects with bacterial vaginosis (42%) and 8 subjects with vaginal candidiasis (16%). There are more subjects with poor knowledge of general genital hygiene, menstrual hygiene management, and self-awareness of abnormal genital symptoms, but no statistically significant difference in the incidence of vaginitis and the total GHBI score (p>0,05). This study found a relationship between age and the incidence of vaginitis in female motorcycle taxi drivers in Jakarta area. Conclusion: There is no relationship between the GHBI score, duration of work, length of working experience, access to clean toilet and the incidence of vaginitis. There is a significant relationship between age and the incidence of vaginitis in female motorcycle taxi drivers. [ABSTRACT FROM AUTHOR]

Bacterial vaginosis (BV) is a common dysbiosis of unclear etiology but with potential consequences representing a public health problem. The diagnostic strategies vary widely. The Amsel criteria and Nugent score have obvious limitations, while molecular biology techniques are expensive and not yet widespread. We set out to evaluate different diagnostic strategies from vaginal samples using (1) a combination of abnormal vaginal discharge and vaginal pH > 4.5; (2) the Amsel-like criteria (replacing the "whiff test" with "malodorous discharge"); (3) the Nugent score; (4) the molecular quantification of Fannyhessea vaginae and Gardnerella vaginalis (qPCR); (5) and MALDI-TOF mass spectrometry (we also refer to it as "VAGI-TOF"). Overall, 54/129 patients (42%) were diagnosed with BV using the combination of vaginal discharge and pH, 46/118 (39%) using the Amsel-like criteria, 31/130 (24%) using qPCR, 32/130 (25%) using "VAGI-TOF", and 23/84 (27%) using the Nugent score (not including the 26 (31%) with intermediate flora). Of the 84 women for whom the five diagnostic strategies were performed, the diagnosis of BV was considered for 38% using the combination of vaginal discharge and pH, 34.5% using the Amsel-like criteria, 27% using the Nugent score, 25% using qPCR, and 25% using "VAGI-TOF". When qPCR was considered as the reference, the sensitivity rate for BV was 76.2% for the combination of vaginal discharge and pH, 90.5% for the Amsel-like criteria, 95.2% for the Nugent score, and 90.5% for "VAGI-TOF", while the specificity rates were 74.6%, 84.1%, 95.3%, and 95.3%, respectively. When the Nugent score was considered as the reference, the sensitivity for BV was 69.6% for the combination of vaginal discharge and pH, 82.6% for the Amsel-like criteria, 87% for qPCR, and 78.7% for "VAGI-TOF", while the specificity rates were 80%, 94.3%, 100%, and 97.1%, respectively. Overall, the use of qPCR and "VAGI-TOF" provided a consistent diagnosis of BV, followed by the Nugent score. If qPCR seems tedious and for some costly, "VAGI-TOF" could be an inexpensive, practical, and less time-consuming alternative. [ABSTRACT FROM AUTHOR]

Background and Objectives: A clean, uncontaminated wound results from a Caesarean section. Antibiotics are mostly used to lower parturition infections and associated problems. Lowering the mortality and morbidity following surgery. This study looked at the effectiveness of using a short course of antibiotics against the longer course that is typically used in a government tertiary care facility. Material and Methods: This study was conducted as a prospective interventional study. The present study involved a total of 200 individuals who were randomly assigned to two separate groups. Each group is comprised of 100 individuals. The selection of participants was conducted in accordance with predetermined inclusion and exclusion criteria. The research was carried out at Narayana Medical College, Nellore, and Andhra Pradesh, India under the department of Obstetrics and Gynaecology. The study was done from August 2022 to August 2023, spanning a duration of one year. Results: Based on the cited current research, the estimated incidence of wound infection typically ranges from 3% to 5%. The study conducted by Robinson et al. examined the association between risk factors and wound infection. The findings indicated that extremely obese individuals had a higher risk of wound infection compared to non-obese individuals. There was no significant variation in the incidence of wound infection based on the type of skin incision employed. Its primary objective was to assess infectious morbidity and the findings revealed that the collective risk of maternal infectious morbidity was 17%. Conclusion: Based on the findings of this study, it can be inferred that a shorter duration of antibiotic treatment yields comparable efficacy to a longer duration of antibiotic treatment. No statistically significant differences were observed between the two groups in relation to febrile morbidity, wound induration, serous wound discharge, purulent wound discharge, wound gaping, or atypical vaginal discharge. [ABSTRACT FROM AUTHOR]

We aimed at studying isolated Fallopian tube torsion (IFTT) in a relatively large cohort of women and to evaluate different features of IFTT in comparison to a large cohort of women with non-IFTT adnexal torsion (NIAT). This was a retrospective cohort study. We included women with surgically confirmed ovarian and/or Fallopian tube torsion between March 2011 and June 2020. Fifty-four cases of IFTT were surgically confirmed during the study period and were compared to 422 surgically confirmed NIAT. The rate of controlled ovarian hyperstimulation treatments, current pregnancy, and vomiting was lower in the IFTT group compared with the NIAT group. Cervical tenderness and vaginal discharge were more common in the IFTT group. Oedematous and enlarged ovaries were less common in the IFTT group. In multivariate regression analysis, the following factors were independently associated with IFTT: (i) vaginal discharge [adjusted odds ratio (aOR) 95% CI 8.16, 1.98–33.55]; (ii) cervical motion tenderness (aOR 95% CI 2.71, 1.01–7.29); (iii) fertility treatments (aOR 95% CI 0.26, 0.70–0.77); (iv) previous abdominal surgery (aOR 95% CI 0.46, 0.22–0.96); (v) vomiting (aOR 95% CI 0.38, 0.19–0.76); and (vi) enlarged ovary (aOR 95% CI 0.34, 0.18–0.65). In conclusion, we have identified factors positively and negatively associated with IFTT in a large cohort of women with adnexal torsion. [ABSTRACT FROM AUTHOR]

The aims of this study were (1) to evaluate potential associations between genetic traits, postpartum phenotypes, cow factors, and postpartum vaginal discharge score (VDS); and (2) to investigate possible associations between postpartum VDS, plasma progesterone (P4) after first service, and reproductive performance. First- and second-parity (n = 2,842) spring-calving lactating dairy cows from 35 dairy herds were enrolled. Farm visits were performed every 2 wk during the postpartum period and weekly during the breeding period. Cows that were at wk 3 and wk 7 postpartum and between 7 and 13 d after first artificial insemination (AI) were examined. Body condition score (BCS) was measured on all farm visits using a 1-to-5 scale (low ≤2.5; target ≥2.75). Transrectal ultrasound examinations were conducted to determine the presence or absence of a corpus luteum (CL). Vaginal discharge score was determined at wk 3 and wk 7 using a Metricheck device (Simcro) and a 1-to-4 scale (1 = clear mucus; 4 = mucopurulent with >50% purulent material ± odor). At wk 3, cows having a VDS ≤2 were considered to have normal reproductive tract health status (RTHS). At wk 7, cows having VDS = 1 were considered to have normal RTHS. Blood samples were collected at each visit, and plasma concentrations of glucose, β-hydroxybutyrate, fatty acids, and progesterone (only during breeding visit) were analyzed. Animals with target BCS at wk 3 and wk 7 had greater odds of having normal RTHS at wk 3 and wk 7, respectively, than cows with low BCS. Cows with a CL at wk 3 and wk 7 had greater prevalence of normal RTHS at wk 3 and wk 7, respectively, compared with cows without a CL. Cows with normal RTHS had a lesser plasma concentration of β-hydroxybutyrate at wk 3 and wk 7 and greater plasma concentration of glucose at wk 3 compared with animals with abnormal RTHS. More cows in the greatest quartiles for the fertility subindex of the Economic Breeding Index and genetic merit for milk production traits (milk kg and milk protein [%]) had normal RTHS at wk 3 and wk 7 compared with the other quartiles. Cows with VDS = 4 at wk 7 postpartum had lesser plasma P4 concentration after first AI (−1.2, −1.1, and −1.0 ng/mL compared with cows with VDS = 1, 2, and 3, respectively). Similarly, cows with VDS = 4 at both wk 3 and wk 7 had lesser pregnancy at first service, lesser cumulative pregnancy rates at wk 3, 6, and 12 during the breeding period, and longer interval from mating start date to conception (+3 d if VDS = 4 at wk 3; +5 d if VDS = 4 at wk 7), compared with cows having other VDS. In conclusion, cows with superior genetic merit for fertility traits and milk production traits, and favorable fertility phenotypes at wk 3 and wk 7, were all associated with greater likelihood of having normal RTHS. In turn, abnormal postpartum RTHS and greater postpartum VDS (score = 4) were associated with lesser odds of successful pregnancy establishment. [ABSTRACT FROM AUTHOR]

Introduction: Vulvovaginal candidiasis (VVC) is considered a common gynecological problem among females of reproductive age group. 70–75% of women report having had candidal vulvovaginitis at some point in their lifetimes and 40–50% suffer recurrent candidal vulvovaginitis. Objectives: This study aims to identify the Candida species involved in VVC and to determine their antifungal susceptibility pattern. Materials and Methods: The present study was a cross-sectional study conducted on 257 females (18–55 yr) with complaints of abnormal vaginal discharge. For detection of Candida, the swab samples were subjected to Gram stain, 10% KOH mount, and culture on Sabouraud dextrose agar (SDA). Candida species identification was done by subculturing Candida isolates onto CHROMagar, corn meal agar (Himedia), and further confirmation was done by MALDI-TOF MS. Antifungal testing was done using the disk diffusion method. Results: A total of 257 females with complaints of abnormal discharge were enrolled in this study. Out of 257, C. albicans 37 (58.7%) and 26 (41.3%) isolates were identified as non-albicans Candida. Out of 63 positive cases, a maximum number of study subject belongs to the age group 26–35 years (50.8%). Along with vaginal discharge, itching (65.37%) is the most common complaint. VVC was found to be most predominant in patients with prolonged antibiotic therapy (38.1%), and in pregnant females (15.9%). Conclusion: Understanding the emerging fungal pathogens and their drug susceptibility patterns is essential for the effective management of infections. Drug resistance can lead to treatment failure and highlights the need for alternative treatment options or strategies. [ABSTRACT FROM AUTHOR]

A 11 years old German Shepherd bitch with the history of abdominal distension, vomiting, and purulent vaginal discharge was presented to Veterinary Clinical Complex, DUVASU, Mathura. Haematological examination revealed increase in total erythrocyte count and total leucocyte count while decrease in platelet count. The condition was treated with ovariohysterectomy and histopathological examination revealed the condition as cystic endometrial hyperplasia with pyometra complex. [ABSTRACT FROM AUTHOR]

Background: The genotypic distribution of human papillomavirus (HPV) needs to be determined with detail as it is an important issue when it comes to public health and preparing vaccines since the HPV type may be different in various areas. Objectives: This study aimed at reporting the frequency of HPV types among women in Sari in the north of Iran. Methods: From 2018 October to 2019 April, 50 sterile swabs of vaginal and cervical discharge of women with genital warts, which were performed by a gynecologist, were examined to determine the prevalence of HPV genotyping by using polymerase chain reaction (PCR). Results: From 50 vaginal swab samples of patients with genital warts, the frequency distribution of types of HPV in women with genital warts included 5 patients (10.0%) with 2 high-risk serotypes as simultaneous serotypes 4% (16,18), 4% (18,35), 2% (66, 67), 1 patient (2%) HPV 33,1 patient (2%) HPV34,1 patient (2%) 1 patient (2%) HPV 35,2 patients (4%) HPV 66,1 patient (2%) HPV 67, and 1 patient (2%) HPV 68. Conclusions: Since HPV genotype varies in diverse areas, these results can be used for screening, management, and vaccination of the target population against the common types of virus in Sari. [ABSTRACT FROM AUTHOR]

Background: In Cambodia, stillbirths and their underlying factors have not been systematically studied. This study aimed to assess the proportion and trends in stillbirths between 2017 and 2020 in a large maternity referral hospital in the country and identify their key determinants to inform future prevention efforts. Methods: This was a retrospective cross-sectional analysis with a nested case–control study of women giving birth at the National Maternal and Child Health Centre (NMCHC) in Phnom Penh, 2017–2020. We calculated percentages of singleton births at ≥ 22 weeks' gestation resulting in stillbirth and annual stillbirth rates by timing: intrapartum (fresh) or antepartum (macerated). Multivariable logistic regression was used to explore factors associated with stillbirth, where cases were all women who gave birth to a singleton stillborn baby in the 4-year period. One singleton live birth immediately following each case served as an unmatched control. Multiple imputation was used to handle missing data for gestational age. Results: Between 2017 and 2020, 3.2% of singleton births ended in stillbirth (938/29,742). The stillbirth rate increased from 24.8 per 1000 births in 2017 to 38.1 per 1000 births in 2020, largely due to an increase in intrapartum stillbirth rates which rose from 18.8 to 27.4 per 1000 births in the same period. The case–control study included 938 cases (stillbirth) and 938 controls (livebirths). Factors independently associated with stillbirth were maternal age ≥ 35 years compared to < 20 years (aOR: 1.82, 95%CI: 1.39, 2.38), extreme (aOR: 3.29, 95%CI: 2.37, 4.55) or moderate (aOR: 2.45, 95%CI: 1.74, 3.46) prematurity compared with full term, and small-for-gestational age (SGA) (aOR: 2.32, 1.71, 3.14) compared to average size-for-age. Breech/transverse births had nearly four times greater odds of stillbirth (aOR: 3.84, 95%CI: 2.78, 5.29), while caesarean section reduced the odds by half compared with vaginal birth (aOR: 0.50, 95%CI: 0.39, 0.64). A history of abnormal vaginal discharge increased odds of stillbirth (aOR: 1.42, 95%CI: 1.11, 1.81) as did a history of stillbirth (aOR: 3.08, 95%CI: 1.5, 6.5). Conclusions: Stillbirth prevention in this maternity referral hospital in Cambodia requires strengthening preterm birth detection and management of SGA, intrapartum care, monitoring women with stillbirth history, management of breech births, and further investigation of high-risk referral cases. Plain language summary: In Cambodia, there is very little information published on stillbirths to know precisely how many there are and to understand the underlying reasons they occur so they can be prevented in the future. Our study aimed to quantify the number of stillborn babies and identify some underlying risk factors from one of the largest maternity referral hospitals in Phnom Penh, Cambodia. We examined data from almost 30,000 health facility medical files of women who gave birth between 2017 and 2020 which included 938 stillbirths. We found that about 3.2% of births ended in a stillbirth and that this percentage increased between 2017 and 2020. Women who had preterm babies, or whose babies were small in weight for their gestational age, and babies that were born breech had a higher chance of being stillborn. Women who had abnormal vaginal discharge, which can indicate a possible infection, also had a higher odds of having a stillbirth. We also found that women who had a stillbirth previously had almost three times higher chance of having another stillborn baby. Having a caesarean section reduced the likelihood of having a stillborn baby by about half. These findings suggest that efforts are needed to better identify and manage women with preterm births and monitor fetal growth as well as ensure breech births are managed adequately. [ABSTRACT FROM AUTHOR]

A healthy mother ensures a healthy family. The concept of a healthy Yoni has been discussed in both contemporary medicine and Ayurveda throughout many phases of a woman's life, from puberty to menopause. Regardless of their age or economic background, Yoni contamination is a pressing problem today. Additional signs and symptoms of infection include vaginal discharge, itching, and discomfort. These kind of signs and symptoms are seen in Kaphaja Yoni Vyapada in Ayurveda, and some of the symptoms are similar to Vulvo-Vaginal Candidiasis. Due to the fact that women have a unique characteristic of giving birth, gynaecological illnesses have come to be of great significance in the field of medicine. The majority of gynaecological problems are referred to as Yoni Vyapada in Ayurveda's section on women's fitness care. The literature of the disease must be studied before understanding the management. Therefore, an effort has been made in this study to provide a conceptual knowledge of almost all of Kaphaja Yoni Vyapada aspects according to both Ayurveda and modern science. [ABSTRACT FROM AUTHOR]

Background: The goal of this study was to assess the microbial ecology and diversity present in the uterus of post-partum dairy cows with and without metritis from 24 commercial California dairy farms using shotgun metagenomics. A set subset of 95 intrauterine swab samples, taken from a larger selection of 307 individual cow samples previously collected, were examined for α and β diversity and differential abundance associated with metritis. Cows within 21 days post-partum were categorized into one of three clinical groups during sample collection: control (CT, n = 32), defined as cows with either no vaginal discharge or a clear, non-purulent mucus vaginal discharge; metritis (MET, n = 33), defined as a cow with watery, red or brown colored, and fetid vaginal discharge; and purulent discharge cows (PUS, n = 31), defined as a non-fetid purulent or mucopurulent vaginal discharge. Results: All three clinical groups (CT, MET, and PUS) were highly diverse, with the top 12 most abundant genera accounting for 10.3%, 8.8%, and 10.1% of mean relative abundance, respectively. The α diversity indices revealed a lower diversity from samples collected from MET and PUS when compared to CT cows. PERMANOVA statistical testing revealed a significant difference (P adjusted < 0.01) in the diversity of genera between CT and MET samples (R2 = 0.112, P = 0.003) and a non-significant difference between MET and PUS samples (R2 = 0.036, P = 0.046). ANCOM-BC analysis revealed that from the top 12 most abundant genera, seven genera were increased in the natural log fold change (LFC) of abundance in MET when compared to CT samples: Bacteroides, Clostridium, Fusobacterium, Phocaeicola, Porphyromonas, Prevotella, and Streptococcus. Two genera, Dietzia and Microbacterium, were decreased in natural LFC of abundance when comparing MET (regardless of treatment) and CT, while no changes in natural LFC of abundance were observed for Escherichia, Histophilus, and Trueperella. Conclusions: The results presented here, are the current deepest shotgun metagenomic analyses conducted on the bovine uterine microbiome to date (mean of 256,425 genus-level reads per sample). Our findings support that uterine samples from cows without metritis (CT) had increased α-diversity but decreased β-diversity when compared to metritis or PUS cows, characteristic of dysbiosis. In summary, our findings highlight that MET cows have an increased abundance of Bacteroides, Porphyromonas, and Fusobacterium when compared to CT and PUS, and support the need for further studies to better understand their potential causal role in metritis pathogenesis. [ABSTRACT FROM AUTHOR]

Background: Abnormal vaginal discharge is a common complaint among women of reproductive age, affecting about one- third of all women. In resource-limited settings where access to laboratory services is limited, treatment is usually syndromic. This approach may result in ineffective treatment, with high recurrence rates and a potential of developing antibiotic resistance. This study aimed to determine the bacterial isolates and antibiotic susceptibility among women with an abnormal vaginal discharge attending the gynecology clinic at a tertiary hospital in Southwestern Uganda. Methods: We conducted a hospital based cross-sectional study among 361 women aged 15–49 years, presenting with abnormal vaginal discharge at the gynecology clinic of Mbarara Regional Referral Hospital from December 2020 to June 2021. Demographic characteristics were collected using a structured questionnaire. We collected cervical and vaginal sterile swabs and subjected them to wet preparation and gram stain. The specimens were cultured for bacterial isolates. Susceptibility testing was performed on samples with bacterial isolates using the Kirby-Bauer disc diffusion method, on the commonly prescribed antibiotics in this setting. We summarized and described the bacterial isolates and antibiotic susceptibility patterns as frequencies and percentages. Results: We enrolled 361 women with abnormal vaginal discharge. Bacteria were isolated in 29.6% (107/361) of the women, and the commonest isolates included; Staphylococcus aureus 48.6% (52/107), Klebsiella pneumoniae 29.9% (32/107) and Enterococcus faecalis 15% (16/107). Yeast cells were found in 17.7% (64/361) of the women with abnormal vaginal discharge. Cefuroxime (90.7%) and Ciprofloxacin (81.3%) had a high level of sensitivity while high levels of resistance were observed for Doxycycline (86.0%) and Azithromycin (67.0%). Conclusion: The common bacterial isolates were Staphylococcus aureus, Klebsiella pneumoniae and Enterococcus faecalis. The isolated bacteria were most sensitive to Cefuroxime and Ciprofloxacin but resistant to Doxycycline and Azithromycin. There is need for routine culture and susceptibility testing of women with abnormal vaginal discharge so as to guide treatment, minimize inappropriate antibiotic use and consequently reduce antibiotic resistance. [ABSTRACT FROM AUTHOR]

The objective of this study was to characterize the species composition and functional potential of the vaginal and uterine microbiota at 1 wk postpartum in dairy cows diagnosed with or without purulent vaginal discharge (PVD) at 3 wk postpartum. The hypothesis was that differences in the vaginal and uterine microbiota between cows diagnosed with (PVD+) or without (PVD−) PVD were dependent on parity and breed. Cytobrush samples of the vagina and uterus were collected at 1 wk postpartum from 36 Holstein-Friesian (7 primiparous and 29 multiparous) and 29 Jersey (10 primiparous and 19 multiparous) cows. Microbial DNA was isolated from each sample and processed for shotgun metagenomic sequencing. The odds of multiparous cows being diagnosed as PVD+ was less compared with primiparous cows (OR = 0.21). Neither the α-diversity nor β-diversity of the uterine and vaginal microbiota were associated with PVD but the β-diversity was different between breeds and between parities. In the vagina of primiparous cows, differences in the microbiota of PVD− and PVD+ cows were minor, but the microbiota of multiparous PVD+ cows had greater relative abundance of Fusobacterium necrophorum , Trueperella pyogenes , Porphyromonas levii, and greater functional potential for amino acid and protein synthesis, energy metabolism, and growth compared with PVD− cows. The uterus of primiparous PVD+ cows had lesser relative abundance of Bacteroides heparinolyticus compared with PVD− cows. In the uterine microbiota, differences included greater functional potential for cellulose biosynthesis and fucose catabolism in multiparous PVD+ cows compared with PVD− cows. In the uterine microbiota of primiparous PVD+ cows, the functional potential for gram-negative cell wall synthesis and for negative regulation of tumor necrosis factor signaling was lesser compared with multiparous PVD+ cows. In the vagina of Holstein-Friesian PVD+ cows, the relative abundance of Caviibacter abscessus was greater whereas in the vagina of Jersey PVD+ cows the relative abundance of Catenibacterium mitsuokai , Finegoldia magna , Klebsiella variicola , and Streptococcus anginosus was greater compared with PVD− cows. In the uterine microbiota of Holstein-Friesian cows, the functional potential for spermidine biosynthesis was reduced compared with PVD− cows. In summary, differences in the species composition and functional potential of the vaginal and uterine microbiota between PVD− and PVD+ cows were dependent on parity and breed. The findings suggest that alternative strategies may be required to treat PVD for different parities and breeds of dairy cow. [ABSTRACT FROM AUTHOR]

Bacterial vaginosis (BV) is a most common microbiological syndrome. Multiplex next-generation sequencing (NGS) or molecular tests allow a complete and accurate vaginal microbiota profiling in order to determine the primary causative agent. Due to the high costs and limited availability of NGS, the multiplex real-time PCR draws more attention. The present study aimed to evaluate the microbial composition and dominant lactobacilli species in non-pregnant women with bacterial vaginosis using a multiplex RT-PCR test and determine its diagnostic significance. In total, 331 women complaining of vaginal discharge were included. BV was confirmed upon clinical examination and Nugent criteria. A real-time PCR test was carried out with a new Femoflor test, which identifies opportunistic bacteria, STD pathogens, and some viruses. According to the results, the rate of lactobacilli is significantly reduced in BV-affected patients when compared to healthy women. Moreover, the rate of L. crispatus significantly decreases, while the rate of L. iners remains high. Among obligate anaerobic bacteria, Gardnerella vaginalis was the most prevalent in women with BV. The Femoflor test demonstrated high sensitivity and specificity for diagnosing BV. Moreover, the test allows the identification of infection in women with intermediate vaginal microbiota, as well as STD pathogens, and viruses. Thus, the application of real-time PCR tests can be effectively used in vaginal microbiota evaluation in women with BV, intermediate vaginal microbiota, and healthy women. In addition, this test may be used as an alternative to the Amsel criteria and Nugent scoring method in diagnosing BV. [ABSTRACT FROM AUTHOR]

A patient in her early 20s presented with constant and progressive lower abdominal and back pain, mainly on the right side of the abdomen, purulent vaginal discharge and pyrexia. A radiological assessment revealed a possible tubo-ovarian abscess and the incidental diagnosis of ipsilateral renal agenesis. The patient was treated for pelvic inflammatory disease (PID); however, after antibiotic administration and since the symptoms did not resolve, an abdominal MRI was requested, which revealed uterus didelphys with two cervices, an obstructed haemivagina and evidence of haematocolpos. The diagnosis of Obstructed Hemi-Vagina with Ipsilateral Renal Agenesis (OHVIRA) syndrome was confirmed, and the patient underwent the excision of the vaginal septum, the drainage of the haematopyocolpos and the laparoscopic drainage of the tubo-ovarian abscess. She achieved a good recovery. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether the number and size of endometrial–leiomyoma fistulas (ELFs) change following uterine artery embolization (UAE) for leiomyoma and the correlation between ELFs and vaginal discharge (VD). Materials & Methods: This study was a retrospective analysis of 100 patients who underwent UAE at a single institution between May 2016 and March 2021. They all underwent MRI at baseline, 4 months, and 1 year after UAE. The number and size of the ELFs were compared with the MRI images each time. The ELF tumor characteristics and the correlation between the ELFs and VD were assessed. Additional gynecologic interventions due to VD associated with ELFs were evaluated. Results: No ELF was observed at baseline. Ten ELFs were noted in nine patients at 4 months, and 35 ELFs were noted in 32 patients 1 year after UAE. The ELFs significantly increased over time (p = 0.004, baseline vs. 4 months; p < 0.001, 4 months vs. 1 year). The ELF size did not significantly change over time (p = 0.941). The tumors developing ELFs after UAE were mainly located at the submucosal or intramural area contacting the endometrium at baseline, with a mean size of 7.1 (2.6) cm. Nineteen patients (19%) had VD 1 year after UAE. There was no significant correlation between VD and the number of ELFs (p = 0.80). No patients underwent additional gynecologic interventions due to VD associated with ELFs. Conclusion: ELFs increased in number and did not disappear over time after UAE in most tumors. Clinical relevance statement: Despite the MR imaging findings, within the limited data of this study, ELFs were not seemingly associated with clinical symptoms, including VD. Key Points: • Endometrial–leiomyoma fistula (ELF) is a complication of uterine artery embolization (UAE). • ELFs increased in number over time after UAE and did not disappear in most tumors. • Most tumors developing ELFs after UAE were located near/contacted the endometrium and were larger. [ABSTRACT FROM AUTHOR]

Puerperal endometritis in sows may detrimentally affect the health of sows and reduce reproductive performance in their subsequent litters. Therefore, the present study aimed to determine risk factors for puerperal endometritis in sows. In total, 139 second-parity, Yorkshire × Landrace sows from a swine farm were recruited. Information including parity number, gestation length, litter size, number of dead-born piglets per litter, use of manual extraction of foetuses, intrapartum oxytocin use, and postpartum vaginal discharge were recorded. Puerperal endometritis was defined based on the characteristics of the vaginal discharge. Logistic regression was used to determine the significant risk factors for puerperal endometritis. The incidence of puerperal endometritis was 20.1% (28/139). Manual extraction of foetuses, farrowing duration, and number of dead-born piglets per litter were determined as the most significant risk factors for puerperal endometritis. All of these factors were positively associated with the disorder. The present study showed that puerperal endometritis was common in the sow. Determination of risk factors for puerperal endometritis contributes to the understanding of the disorder and helps farm practitioners spot and treat sows at risk early. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate rates of fibroid expulsion after uterine artery embolization (UAE) and risk factors. Materials and Methods: Single-center retrospective study of UAEs for fibroids between 2016 and 2020. Preoperative UAE and patients with incomplete follow-up were excluded. Patients underwent MRI before and 3 months after UAE and/or as indicated. Medical records were reviewed, and patient demographics, fibroid characteristics and clinical events were recorded. Fibroid expulsion included fibroid exposure to the endometrial cavity on MRI, and tissue loss/passage as observed clinically or on MRI. Symptoms were considered major if requiring additional clinic visits or treatment. Statistical tests included Chi-square, Fisher's exact test, and logistic regression models. Results: One hundred ninety-nine women were included. Symptomatic fibroid expulsion occurred after 31 (16%) procedures: 16 minor and 15 major. Symptoms included vaginal discharge (n = 23), bleeding (n = 9), tissue passage (n = 9), cramping/pain (n = 3), and fever (n = 4). Fifteen women (8%) needed additional care, of whom 6 (3%) required invasive procedures (4 elective hysterectomies, 1 hysteroscopic resection, 1 transvaginal removal of passing tissue). The International Federation of Gynecology and Obstetrics (FIGO) classification was significantly associated with symptomatic fibroid expulsion (p = 0.001). Odds ratio for symptomatic expulsion and expulsion requiring additional care for FIGO 3–7 versus 0–2 fibroids was 0.32 (95% confidence interval, 0.14–0.71, p = 0.005) and 0.28 (95% confidence interval, 0.10–0.83, p = 0.02), respectively. Other factors were not consistently associated with expulsion. Conclusion: Fibroid expulsion after uterine artery embolization was more common than previously reported but mostly asymptomatic or minimally symptomatic. Women with FIGO ≤ 2 fibroids should be appropriately counseled regarding risk for expulsion. [ABSTRACT FROM AUTHOR]

The objective of this study was to identify alterations in the vaginal discharge (VD) metabolome and potential biomarkers to predict metritis development and a cure in dairy cows. This prospective cohort study was conducted on two dairies located in CA and TX. Vaginal discharge was evaluated and collected using the Metricheck® device. Cows were examined for metritis at 4, 7, and 9 days in milk (DIM). Cows with a fetid, watery, and reddish-brown uterine discharge were classified as having metritis and randomized to receive ceftiofur (n = 10) or remain untreated (n = 7). A cure was defined as the absence of a fetid, watery, reddish-brown uterine discharge at 14 d after enrollment. Vaginal discharge samples were collected from 86 cows within 6 h after parturition, at 4 and 7 DIM, at metritis diagnosis, and at 4 and 7 days after metritis diagnosis. Cows with metritis (MET; n = 17) were paired with counterparts without metritis (HTH) of a similar DIM and parity (n = 34). The uterine metabolome was evaluated using untargeted gas chromatography time-of-flight mass spectrometry (GC-TOF-MS). Metabolomic data were analyzed using the MetaboAnalyst 5.0. Data were log-transformed and auto-scaled for normalization. Univariate analyses, including the fold-change, were performed to identify the metabolites linked to metritis development and its cure and principal component analysis and partial least squares discriminant analysis were performed to explain metabolite variance between animals developing or not developing metritis and being cured or not being cured of metritis. Comparing HTH with MET cows at calving, 12 metabolites were upregulated, and one was downregulated. At four and seven DIM, 51 and 74 metabolites, respectively, were altered between MET and HTH cows. After metritis development, three and five metabolites were upregulated in cows that were cured and in cows that received treatment and were cured, respectively. In all scenarios, the metabolites lignoceric, malic, and maleic acids, ornithine, and hypotaurine, which are associated with arginine/aminoacyl-tRNA biosynthesis and taurine/purine metabolism, were upregulated in HTH cows. Metritis was associated with changes in the uterine metabolome. Cows not being cured of metritis had changes in the uterus metabolome independent of receiving ceftiofur or remaining untreated. Metabolome analysis may be an important tool to understand the vaginal discharge changes during postpartum and the dynamics of metritis development and cures and help to identify biomarkers to predict metritis being cured. [ABSTRACT FROM AUTHOR]

Background: The hepatitis B virus (HBV) is a major public health problem worldwide. Vertical and horizontal transmission of HBV could affect neonates and partners. This transmission can vary in populations. Also, high-risk behaviors and clinical records affect the transmission of this virus. Due to the lack of information on vaginal discharge related to HBV in the north of Iran, we aimed to assess the presence of HBV in pregnant women's vaginal secretion referred to Sayyad Shirazi Hospital in Gorgan City, north of Iran. Methods: This cross-sectional study was performed on 315 cervicovaginal lavages from pregnant women. Viral DNA was extracted, and the gene fragments of the virus were checked by polymerase chain reaction (PCR). Clinical, demographic, and behavioral data were entered into SPSS version 16. The chi-square tests were used to determine any association between categorical data. Results: Hepatitis B virus DNA was detected in 2.2% (7/315) of samples. The age range of patients was from 14 to 43 years. Anal sex (P = 0.043) and not using a condom (P = 0.047) were significantly associated with HBV-positive cases. Abortion, unusual discharge, and some other clinical and demographic information showed no related statistical correlation. Conclusion: The results showed a similar rate of infection in the general Iranian population. In pregnant women, the risk of HBV transmission and chronic HBV can be critical in newborns; therefore, it is strongly recommended to conduct screening and provide management for women during pregnancy.

Patients, who are diagnosed with a cancer, have a life time risk for developing another de novo malignancy depending on various risk factors. Hereby we present an interesting case report of a 50-year-old woman with double primary malignancy--involving gastrointestinal and genitourinary tracts. [ABSTRACT FROM AUTHOR]

Foreign bodies in the genital tract are rare but can be found in females of all ages. Objects inserted vaginally may be for therapeutic purposes, accidental placement, and sometimes even for sexual gratification. Non therapeutic objects commonly seen include tampons, bottle caps, sex toys, and, rarely, metallic objects of various shapes and sizes. The authors report a case of a 40-yearold widowed woman, with no living children, presenting with foul-smelling vaginal discharge and passage of stool per vagina. Upon examination, a retained vaginal foreign body was noted intravaginally, complicating as a rectovaginal fistula, necessitating emergency laparotomy and requiring a colostomy. Long-retained objects are known to cause excessive foul-smelling discharge and can lead to serious complications such as lacerations, pelvic inflammatory disease, fistulas, fibrosis, and even death. Therefore, patients should seek medical attention and be treated promptly to prevent any complications. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: Reproductive health in adolescent girls is very important. To determine the relationship between the level of knowledge and the behavior of preventing vaginal discharge among nursing students. Methods: a quantitative, cross-sectional study, with 155 first-year female students at a private faculty of nursing. Data were collected from February to March 2022, using an electronic questionnaire. Results: 98.1% of participants have a good level of knowledge and 92.3% of participants practice good vaginal discharge prevention behavior. Conclusion: good knowledge produces appropriate prevention behavior. The result of this study can be used as a contribution of thoughts and references as a more in-depth study of the factors that influence the level of knowledge and behavior about the disease of the genitalia and the dangers of pathological vaginal discharge.

Background: Traditional Polynesian medicine for children has been poorly documented, and few data are available on their efficacy and safety. In this context, the aim of this study was to identify traditional practices used for treating children and then assess the efficacy and safety of the most cited remedies by reviewing the literature. Methods: In 2022, a semi-structured survey was carried out on five islands from the Society archipelago (Bora Bora, Huahine, Moorea, Raiatea, and Tahiti). A total of 86 participants were interviewed including 19 experts in herbalism. A thorough literature review was performed on the most cited plant species to gather the relevant ethnobotanical, pharmacological, and clinical data of each remedy. Results: Participants mentioned using 469 remedies to treat 69 health disorders. The most represented health categories were digestive system, skin disorders, infectious diseases, and respiratory system. A total of 67 plant species (representing 731 use-reports) were mentioned and Annona muricata, Gardenia taitensis, and Hibiscus rosa-sinensis were the main plants reported. Regarding the safety of cited remedies, one plant (Microsorum grossum) showed high risk of toxicity, and its use should be avoided in infants and children. Conclusion: Our survey confirms the importance of traditional medical practices for children in the Society Islands. A lack of data in children for most cited remedies demonstrate the need for more pharmacological and toxicological research on Polynesian medicinal plants. Finally, the potential risk of toxicity for some cited plant species reported calls for a better information of traditional medicine users and healers. [ABSTRACT FROM AUTHOR]

Introduction: Vulvovaginal candidiasis (VVC) is a common cause of vaginal discharge in women of reproductive age-group. It affects 75% of women at least once during their lifetime and 10% of them have recurrent episodes. Most common offending organism is Candida albicans, and Candida glabrata being the most common non albicans species. Based on clinical presentation, microbiology, host factor like immunosuppression and recurrence, VVC is classified into complicated and uncomplicated VVC. The treatment of VVC is reasonably effective with a range of oral and intravaginal agents with Azoles being the predominant antifungals used. Aim And Objective: To compare the safety and efficacy of oral tablet fluconazole 150 mg single dose with intravaginal sertaconazole 500mg in the treatment of vulvovaginal candidiasis. MATERIALS AND METHODS: After obtaining informed consent, 100 patients who were clinically and mycologically confirmed to have vulvovaginal candidiasis were included in the study. They were randomly assigned into 2 groups, containing 50 patients each. Group A was treated with single dose of oral tablet fluconazole 150mg and group B was treated with sertaconazole 500mg vaginal pessary. The patients were reviewed at day 7 and 14 after the treatment. At each visit, symptomatic and mycological improvements were assessed and recorded. Results: A total of 97 patients completed the study. The symptomatic cure rate in both the groups at day 7 was 64.58% and 81.63% and in day 14 was 95.8% and 91.8% respectively in each group. The mycological cure rate in both groups at day 7 was 54.1%and 65.3% and day 14 was 75.1% and 85.7% respectively. Conclusion: Treatment of VVC with single dose Sertaconazole 500mg vaginal pessary results in rapid symptom clearance and lesser recurrence rate than oral Fluconazole 150mg tablet in the treatment of uncomplicated VVC, in women with personal preference of vaginal route of drug administration without significant drug interactions and adverse effects. This can also be beneficial in the era of emerging fluconazole resistance. [ABSTRACT FROM AUTHOR]