Guia practica clinica para el manejo de parto pretermino / Clinical practice guide for the management of preterm birth

El parto pretérmino en la región centroamericana tiene variaciones en cada país, así como la mortalidad perinatal neonatal y materna que se deriva de la condición. La atención adecuada sigue siendo una barrera en las zonas con más limitaciones en los servicios y el personal sanitario disponible. El parto pretérmino es considerado un problema con implicaciones sociales y económicas que produce impacto a corto, mediano y largo plazo (Goldenberg, 2012). El 75% de las complicaciones que genera conllevan a un aumento en la mortalidad infantil. La mayoría de sus factores de riesgo son considerados como prevenibles con la implementación de medidas sencillas y económicas (WHO, 2015). La investigación clínica de esta condición, en una gran mayoría, se ha generado en países de alto ingreso (Opiyo, 2017) 1 . Algunas veces se desconocen los resultados de algunas intervenciones en condiciones de recursos limitados. Esta guía presenta y pretende abordar algunas de estas limitaciones. También alerta sobre algunas intervenciones que pueden producir más problemas y dificultades si se implementan, al considerar los recursos disponibles en los lugares donde se desarrollaron las investigaciones que generaron la evidencia y hacer la comparación con la realidad de los países de Centroamérica en donde se usará la evidencia. Por otra parte, para cada recomendación que en este instrumento se facilita, los resúmenes de evidencia consideran las efectividades clínicas y los efectos adversos cuando han estado disponibles.

Role of female intimate hygiene in vulvovaginal health: Global hygiene practices and product usage.

Women use various feminine hygiene products, often as part of their daily cleansing routine; however, there is a paucity of published medical literature related to the external vulva and how personal hygiene practices can affect it. This review article provides background information on the physiological changes that occur during women's lives and reviews the relevance of transient and resident microbiota as they relate to common vaginal and vulvar disorders. It also discusses the need for female intimate hygiene, common practices of feminine hygiene from a global perspective, and the potential benefits of using suitable external, topical feminine vulvar washes to minimize the risk of vulvovaginal disorders and to improve overall intimate health in women around the world. Supported by international guidelines, daily gentle cleansing of the vulva is an important aspect of feminine hygiene and overall intimate health. Women should be encouraged to choose a carefully formulated and clinically tested external wash that provides targeted antimicrobial and other health benefits without negatively impacting on the natural vulvovaginal microbiota.

Safety, efficacy, and tolerability of differential treatment to prevent and treat vaginal dryness and vulvovaginitis in diabetic women.

BACKGROUND: Problems affecting the vaginal tract in diabetic women are very often neglected. The efficacy and safety of three gynecological treatments in diabetic women have been assessed. MATERIALS AND METHODS: A single-blind randomized progressive trial on 48 diabetic women affected by vaginal dryness, dyspareunia, and recurrent Candida infections was carried out. The ICIQ Vaginal Symptoms (ICIQ-VS) questionnaire was administered. RESULTS: The analysis of the parameters of ICIQ-VS questionnaire among the three groups showed significant difference only for "dragging pain" (p = 0.0 19) and "soreness" (p = 0.028). In all groups and for all parameters of the questionnaire, improvement of symptoms was observed. In particular, in Group 1 for all symptoms a highly significant difference was observed, to support the already known benefits of the products and of the proposed combination. Significant improvement was also observed in Group 2. CONCLUSIONS: The proposed treatment with DermoXEN® Ultracalming Special for diabetics and DermoXEN® Vitexyl vaginal gel exert effective moisturizing and soothing action. Indeed, the aforementioned products have been proven effective for the main gynecological problems of diabetic women.

Revisión de la evidencia sobre la eficacia de los probióticos en la prevención de las infecciones del tracto urinario inferior y las infecciones vaginales / Review of the evidence on the efficacy of probiotics in the prevention of lower urinary tract infections and vaginal infections

Objetivos. Identificar, evaluar la calidad y describir la evidencia científica sobre la eficacia y seguridad de los probióticos administrados por vía vaginal u oral, en la prevención de las infecciones de repetición del tracto urinario y las infecciones vaginales fúngicas y microbianas. Métodos. Se realizó una búsqueda electrónica en PubMed, CENTRAL (Cochrane Library) y en el metabuscador TRIP Database utilizando los siguientes términos: «Lactobacillus», «Probiotics» y «Female urogenital diseases» o «Urinary tract infections» o «Genitourinary infections». Resultados. De un total de 20 estudios que cumplían con los criterios de selección de esta revisión, se ha observado una tendencia favorable hacia el uso de los probióticos, especialmente en población de riesgo elevado de vaginosis bacteriana y vulvovaginitis candidiásica. Conclusiones. Los probióticos son una opción prometedora en la prevención de recurrencias de infecciones del tracto urinario y de recomendación en infecciones vaginales, segura y costo-efectiva, especialmente en la población de mayor riesgo (AU)

Objectives. To identify, critically evaluate and describe the available scientific evidence on the efficacy and safety of oral or vaginal administration of probiotics in preventing recurrent urinary tract infections and microbial or fungal vaginal infections. Methods. An electronic search was performed in PubMed Central, the Cochrane Library and the meta-searcher TRIP databases using the terms: "Lactobacillus", "probiotics", "female urogenital diseases", "urinary tract infections" and "genitourinary infections". Results. Of 20 studies that met the selection criteria for this review, a tendency to favor the use of probiotics was observed, especially in the population at high risk of bacterial vaginosis and fungal vulvovaginitis. Conclusions. Probiotics are a promising option in the prevention of recurrences of lower urinary tract infections. Their use can be recommended as a safe and cost effective option especially in high risk subgroups (AU)

Genital immunization of heifers with a glycoprotein Edeleted, recombinant bovine herpesvirus 1 strain confers protection upon challenge with a virulent isolate / Imunização genital de bezerras com uma cepa recombinante do herpesvírus bovino tipo 1 defectiva na glicoproteína E confere proteção frente a desafio com um isolado virulento

Venereal infection of seronegative heifers and cows with bovine herpesvirus type 1.2 (BoHV-1.2) frequently results in vulvovaginitis and transient infertility. Parenteral immunization with inactivated or modified live BoHV-1 vaccines often fails in conferring protection upon genital challenge. We herein report an evaluation of the immune response and protection conferred by genital vaccination of heifers with a glycoprotein E-deleted recombinant virus (SV265gE-). A group of six seronegative heifers was vaccinated with SV265gE- (0,2mL containing 10(6.9)TCID50) in the vulva submucosa (group IV); four heifers were vaccinated intramuscularly (group IM, 1mL containing 10(7.6)TCID50) and four heifers remained as non-vaccinated controls. Heifers vaccinated IV developed mild, transient local edema and hyperemia and shed low amounts of virus for a few days after vaccination, yet a sentinel heifer maintained in close contact did not seroconvert. Attempts to reactivate the vaccine virus in two IV vaccinated heifers by intravenous administration of dexamethasone (0.5mg/kg) at day 70 pv failed since no virus shedding, recrudescence of genital signs or seroconversion were observed. At day 70 pv, all vaccinated and control heifers were challenged by genital inoculation of a highly virulent BoHV-1.2 isolate (SV56/90, 10(7.1)TCID50/animal). After challenge, virus shedding was detected in genital secretions of control animals for 8.2 days (8-9); in the IM group for 6.2 days (4-8 days) and during 5.2 days (5-6 days) in the IV group. Control non-vaccinated heifers developed moderate (2/4) or severe (2/4) vulvovaginitis lasting 9 to 13 days (x: 10.7 days). The disease was characterized by vulvar edema, vulvo-vestibular congestion, vesicles progressing to coalescence and erosions, fibrino-necrotic plaques and fibrinopurulent exudate. IM vaccinated heifers developed mild (1/3) or moderate (3/4) genital lesions, lasting 10 to 12 days (x: 10.7 days); and IV vaccinated ...

A infecção genital de novilhas ou vacas soronegativas pelo herpesvírus bovino tipo 1.2 (BoHV-1.2) pode resultar em vulvovaginite e infertilidade temporária. As vacinas atenuadas ou inativadas administradas pela via parenteral freqüentemente conferem proteção incompleta frente a desafio pela via genital. Este estudo relata uma avaliação da resposta imunológica e proteção conferida pela vacinação genital de bezerras soronegativas com uma cepa recombinante do BoHV-1 defectiva na glicoproteína E (SV265gE-). Um grupo de seis bezerras foi vacinado com a cepa SV265gE(0,2mL contendo 10(6,9)TCID50) na submucosa da vulva (grupo IV); quatro bezerras foram vacinadas pela via intramuscular (IM; dose 10(7,6)TCID50) e quatro bezerras permaneceram como controles não-vacinadas. As bezerras vacinadas pela via IV apresentaram edema e hiperemia leve e transitório na vulva e excretaram vírus em títulos baixos por alguns dias após a vacinação, porém uma bezerra soronegativa mantida em contato não soroconverteu. Administração de dexametasona pela via intravenosa no dia 70pv (0,5mg/kg) em duas bezerras vacinadas pela via IV não resultou em excreção viral, recrudescência clínica ou soroconversão. No dia 70pv, as bezerras vacinadas e as controle foram desafiadas pela inoculação genital da cepa de BoHV-1.2 altamente virulenta SV56/90 (10(7.1)TCID50/animal). Após o desafio, excreção viral nas secreções genitais das bezerras controle foi detectada por 8,2 dias (8-9); no grupo IM durante 6,2 dias (4-8 dias) e durante 5,2 dias (5-6) nas bezerras do grupo IN. As bezerras do grupo controle desenvolveram vulvovaginite moderada (2/4) a severa (2/4) que duraram entre 9 e 13 dias (x: 10,7 dias). A doença se caracterizou por edema vulvar, congestão vulvo-vestibular, formação de vesículas/pústulas que coalesceram, erosões, placas fibrino-necróticas e exsudato fibrino-purulento. As bezerras do grupo IM desenvolveram lesões genitais leves (1/3) a moderadas (3/4), com duração ...

[Ketoconazole and clindamycin efficacy vs oral clindamycin in premature membranes rupture prevention]. / Eficacia del ketoconazol y la clindamicina vaginal vs clindamicina oral en la prevención de la rotura prematura de membranas.

BACKGROUND: Vulvovaginitis is one of the main causes of premature membrane rupture. OBJECTIVE: To evaluate effectiveness of a combination of ketoconazole (400 mg) and clindamycin (100 mg) in vaginal tablets, compared with clindamicyn alone (600 mg/daily) orally, for six days, to prevent premature membrane rupture in patients with vulvovaginitis. PATIENTS AND METHOD: Longitudinal, prospective, comparative, randomized, double-blind, double-dummy study in patients older than 18 years, during them third trimester of normoevolutive pregnancy with symptomatic vulvovaginitis. Patients were monitored as out patient. Genital secretion culture and fresh studies were made. Signs and symptoms were evaluated in regular intervals: 4, 7 and 11 days. Pregnancy control was performed every three weeks, until childbirth or premature membrane rupture. RESULTS: 105 patients were included: 53 in the group of ketoconazole and clindamicyn (1), and 52 in the group of clindamycin alone (2). Symptoms were similar in both groups of treatment, without statistically significant differences. A case of group 2 has premature membrane rupture (p = 0.495). C. albicans was cultured in 35% of group 2 and in 11% of group 2. No adverse events with treatments were reported. CONCLUSIONS: The combination of ketoconazole and cindamycin was effective to prevent premature membrane rupture in patients with vulvovaginitis.

[Antifungal effect in selected natural compounds and probiotics and their possible use in prophylaxis of vulvovaginitis]. / Antifungální ucinek u vybraných prírodních látek a probiotik, jejich mozností pouzití v profylaxi vulvovaginitidy.

OBJECTIVE: a survey of effective natural compounds and probiotics with antifungal activity and their possible use in vulvovaginitis as a prophylactic or therapeutic drug. DESIGN: review of literature. SETTING: Charles University at Prague, Pharmaceutical Faculty at Hradec Kralove. METHODS: and review of literature and publications from medical data-bases. CONCLUSIONS: certain natural compounds were proved to exert antimycotic effects. The efficiency of garlic extract under in vitro conditions against yeast of C. albicans family becomes manifest within one hour. Essential oils present in the Cayenne pepper (Capsodum frutescens) exert considerable antifungal activity against C. albicans as well. Clove exerts lower antimycotic effects. The effects of Chinese leek are similar to garlic. Propolis also possesses antifungal properties, and sensitivity of the yeast strains decreases in the following order: C. albicans > C. tropicalis > C. crusei > C. guilliermondii. Its efficiency depends on the composition and place of origin. Tea trea oil (Melalauca alternifolia) is inhibiting strains of Candida family (genus) in minimal inhibiting concentration, higher concentrations are necessary for C. crusei and C. norvengensis. In the prophylaxis of vaginal candidoses, oral administration of the strains of Lactobacilus rhamnosus GR-1 and L. fermentum RC-14, B-54 may be recommended. Moreover there are suitable strains of L. brevis CD-2, L. salivarius FV-2, L. gasseri MB 335, L. plantarum, useful in the form of gel capsules (L. plantarum) or vaginal tablets (L. gasseri). The strains of L. acidophilus CRL 1294 and L. salivarius CRL 1328 display the capacity of self aggregation and co-aggregation with Candida. It should be pointed out that the probiotic strain of Lactobacillus (especially L. casei and L. rhamnosus) may, in exceptional cases, cause bacteriemia and sepsis, especially in immunodeficient patients and those who underwent surgery of alimentary tract. No protective effect against yeast infection was detected with vitamin E, any positive effect was not unequivocally confirmed with zinc, but adjusting zinc levels to normal may be recommended.

Ginecología infantil y juvenil en atención primaria / Infantile and adolescent gynaecology in primary care

El primer escalón del cuidado en Ginecología Infantil y Juvenil lo ofrecen los pediatras de Atención Primaria. Su integración en una Unidad de Ginecología Infantil y Juvenil es imprescindible para el funcionamiento de la misma. Nuestro objetivo en el presente artículo es repasar las principales patologías que encontramos en nuestra consulta de Pediatría en Atención Primaria y las conductas a seguir ante estos problemas

The first step in Infantile and adolescent gynaecology, is offered by Primary Care Paediatricians, so it is essential their integration in Children and Adolescent’s Gynaecology Unit. The aims of the present topic is to revise the principals pathologies that we can find in our paediatrics surgeries in Primary Care and the ways to act with this problems

Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial.

OBJECTIVE: To test whether oral or vaginal lactobacillus can prevent vulvovaginitis after antibiotic treatment. DESIGN: Randomised, placebo controlled, double blind, factorial 2x2 trial. SETTING: Fifty general practices and 16 pharmacies in Melbourne, Australia. PARTICIPANTS: Non-pregnant women aged 18-50 years who required a short course of oral antibiotics for a non-gynaecological infection: 278 were enrolled in the study, and results were available for 235. INTERVENTIONS: Lactobacillus preparations taken orally or vaginally, or both, from enrollment until four days after completion of their antibiotic course. MAIN OUTCOME MEASURES: Participants' reports of symptoms of post-antibiotic vulvovaginitis, with microbiological evidence of candidiasis provided by a self obtained vaginal swab. RESULTS: Overall, 55/235 (23% (95% confidence interval 18% to 29%)) women developed post-antibiotic vulvovaginitis. Compared with placebo, the odds ratio for developing post-antibiotic vulvovaginitis with oral lactobacillus was 1.06 (95% confidence interval 0.58 to 1.94) and with vaginal lactobacillus 1.38 (0.75 to 2.54). Compliance with antibiotics and interventions was high. The trial was terminated after the second interim analysis because of lack of effect of the interventions. Given the data at this time, the chances of detecting a significant reduction in vulvovaginitis with oral or vaginal lactobacillus treatment were less than 0.032 and 0.0006 respectively if the trial proceeded to full enrollment. CONCLUSIONS: The use of oral or vaginal forms of lactobacillus to prevent post-antibiotic vulvovaginitis is not supported by these results. Further research on this subject is unlikely to be fruitful, unless new understandings about the pathogenesis of post-antibiotic vulvovaginitis indicate a possible role for lactobacillus.

Candida transmission and sexual behaviors as risks for a repeat episode of Candida vulvovaginitis.

OBJECTIVE: To assess associations between female and male factors and the risk of recurring Candida vulvovaginitis. METHODS: A prospective cohort study of 148 women with Candida vulvovaginitis and 78 of their male sexual partners was conducted at two primary care practices in the Ann Arbor, Michigan, area. RESULTS: Thirty-three of 148 women developed at least one further episode of Candida albicans vulvovaginitis within 1 year of follow-up. Cultures of Candida species from various sites of the woman (tongue, feces, vulva, and vagina) and from her partner (tongue, feces, urine, and semen) did not predict recurrences. Female factors associated with recurrence included recent masturbating with saliva (hazard ratio 2.66 [95% CI 1.17-6.06]) or cunnilingus (hazard ratio 2.94 [95% CI 1.12-7.68]) and ingestion of two or more servings of bread per day (p

[Cesarean section in modern obstetrics and methods of prophylaxis of postoperative sepsis]. / "Tsezarizm't" v s'vremennoto akusherstvo i metod za profilaktika na postoperativniia sepsis.

The author discusses the problem Caesarean section in present day obstetrics and points out that the percentage of Caesarean births has been unnecessarily increased. This justifies the term "Caesarean epidemy". In spite of discussions and recommendations it turns out impossible to cope with this problem, i.e. reducing the rate to 15% in these countries where it is higher. Methods of infections morbidity prophylaxis are discussed too, especially the peri- and intraoperative antibiotic application (PAP, IAL) as well as the inaugurated by the author in 1987 postoperative intermittent intrauterine antibiotic lavage (PIAL). PIAL should be applied in very high risk cases, e.g. severe chorionamnionitis or vulvovaginitis combined with PAP and IAL. The use of these methods renders hysterectomy as ultra ratio prophylactic measure unnecessary. It is explicitly stressed that there is no prophylactic method to compensate defective surgical skills or flaws in aseptics and antiseptics.

[The role of vaginal pH. Importance of its normalization in the prevention of recurrent vaginitis]. / Ruolo del pH vaginale. Importanza della sua normalizzazione nella prevenzione delle vaginiti recidivanti.

BACKGROUND: A sample of 100 women was clinically examined for a very various vulvovaginal symptomatology and an individual diagnosis of vulvovaginitis of different aetiology was established. METHODS: All women were treated with antibiotic and/or antimycotic drugs on the basis of individual diagnosis. Sixty women had only this treatment, while 40 women had also a supplementary treatment with a cleanser emulsion characterized by physiologic pH value and an antiseptic activity due to a vegetable extract (Saugella Attiva, Lab. Guieu). The symptomatologic changes due to the two treatments were compared. RESULTS AND CONCLUSIONS: Combined treatment (drug + antiseptic) obtained better results mostly in subjective symptomatology; this combined treatment was very useful in the recovery of the Doderlein population.

Immune response of heifers to vaginal submucosal or subcutaneous vaccination and intravaginal challenge with Ureaplasma diversum.

Twenty beef heifers were randomly assigned to five equal groups and vaccinated: Group 1--in vaginal submucosa (VM) with Ureaplasma diversum ultrasonicated whole cells (WC) in complete Freund's adjuvant (CFA); Group 2--in VM with U. diversum cell membranes (CM) in CFA; Group 3--subcutaneously (SC) with CM in CFA; Group 4--in VM with CM alone; and Group 5--in VM with phosphate buffered saline (PBS) in CFA. A second vaccination with the same antigens in incomplete Freund's adjuvant was given after four weeks, and three weeks later, all heifers were challenged intravaginally with 3.6 x 10(7) colony-forming units (CFU) of U. diversum strain 2312. Immunoglobulins that reacted with U. diversum were measured in serum and cervicovaginal mucus (CVM) by an enzyme-linked-immunosorbent assay. In groups 1 and 2, vaccination by the VM route with WC or CM antigens, stimulated high levels of U. diversum-reactive IgG1 and IgG2 antibodies in serum as well as CVM, but a low IgA response only in CVM. In group 4, VM vaccination with CM (no adjuvant) elicited a minimal IgG1 and IgG2 response in serum and CVM. In group 3, SC vaccination with CM antigen stimulated high IgG1 and IgG2 reactivity in both serum and CVM, but no IgA reactivity. Very little IgM reactivity was detected in the four vaccinated groups. Intravaginal challenge resulted in characteristic granular vulvitis in all vaccinated and control heifers, with all animals remaining culture-positive for the 35 day observation period. The infection stimulated a marked increase in the specific IgA response in CVM of the three groups vaccinated with either, adjuvanted antigen.(ABSTRACT TRUNCATED AT 250 WORDS)

Vulvovaginitis en niñas de 5 a 14 años / Vulvovaginitis in girl of the five at fourteen years old

En el presente trabajo se investigan los agentes etiológicos de vulvo-vaginitis mediante estudio microbiológico realizado en un grupo de 44 niñas pertenecientes a diferentes escuelas de la parroquia La Vega durante el primer trimestre del año 1991, con historia clínica sugestiva de vulvo-vaginitis y con edades comprendidas entre los 5 y 14 años de edad. En el grupo de 5-9 años se identificaron los siguientes microorganismos: Staphylococcus epidermitis (39,1 por ciento), Staphylococcus aureus (13,0 por ciento), Escherichia coli (4,3 por ciento), Candida sp. (4,3 por ciento), y no hubo desarrollo bacteriano (39,1 por ciento). En el grupo etario de 10-14 años se identificaron los siguientes microorganismos: Staphyloccus epidermidis (23,1 por ciento), Staphylococcus aureus (7,7 por ciento), Escherichia coli (11,6 por ciento), Candida sp. (23,1 por ciento), y no hubo desarrollo bacteriano (34,6 por ciento). Escherichia coli y Candida sp. fueron significativamente más frecuentes en el grupo etario de 10-14 años.

Round table on infectious bovine rhinotracheitis/infectious pustular vulvovaginitis virus infection diagnosis and control.

The current situation of infectious bovine rhinotracheitis/infectious pustular vulvovaginitis infection in various European countries is reviewed. Whilst some have a high serological prevalence and use live virus vaccines to control the disease, others have a low prevalence and two countries (Denmark and Switzerland) have national eradication schemes which are almost complete. Serology remains important for diagnosis although other tests such as delayed cutaneous hypersensitivity may have a role to play. New tests such as polymerase chain reaction may find increasing application where high sensitivity is required, such as the detection of virus in semen.

Candidiasis vaginal: diagnóstico y tratamiento en la práctica ginecológica / Candidiasis, vaginal: diagnosis and treatment in the practice

El tratamiento efectivo de las Candidiasis vaginal se ha convertido en un problema social y terapéutico, porque es una enfermedad muy molesta aunque no compromete la vida, compromete la felicidad de la vida conyugal. El uso de los conazoles en cualquiera de sus formas en el presente, es una solución. Pero el problema de las recurrencias frustran severamente los resultados, por lo que es necesario controlar, tratar los factores predisponentes para el fracaso o la recurrencia. Se debe tener en cuenta que el factor sexual en la que está envuelta la pareja, deberá ser considerado en la terapéutica paralela, así como todos los cuidados para evitar la infectación. Con el avance de la farmacología anti fungicida, deberemos considerar que mientras no consiga la forma de crear defensa en la vagina contra la Candida, ésta seguirá invadiéndola. Por lo tanto, es buena técnica de utilizar de manera profiláctica tratamiento local, de preferencia, o en el futuro, la dosis única oral para prevenir reinfecciones