Lab-Based Retrospective 10-Year Analysis Shows Seasonal Variation of Vaginal Candida Infection Rates in Belgium.

Candida vulvovaginitis is a frequent condition, and although several risk factors are known, its behavior is still enigmatic. The seasonal influence of climate conditions and living habits on its prevalence was studied. In a retrospective lab-based cohort over 10 years, we studied the prevalence of Candida in 12,941 vaginal cultures taken from women attending a vulvovaginitis clinic. The prevalence of non-albicans and albicans species were compared per month to detect differences in positivity rates in summer versus winter months. Chi-square and chi-square for trend were used. Of the 2109 (16.3%) Candida spp. positive swabs, 201 (1.0%) revealed non-albicans species, varying between 1.0% and 2.0% per month, but without significant monthly differences. Over the 10 years, compared to other months, vaginal Candida was more frequent in June (19.0%, p = 0.008) and less frequent in December (14.5%, p = 0.04). The Candida prevalence was 15.5% in summer (June/July/August) versus 14.0% in the winter (Dec/Jan/Feb, p = 0.04). Change in temperature, dietary habits, and bodily adaptations due to increased amount of sunlight were discussed as potential pathophysiological mechanisms to explain the excess of Candida in summertime. Further confirmatory research would be beneficial. Women at risk for Candida vulvovaginitis should pay more attention to living habits in summertime to avoid recurrences.

Hospital mortality in COVID-19 patients in Belgium treated with statins, ACE inhibitors and/or ARBs.

The COVID-19 pandemic has disrupted life throughout the world. Newly developed vaccines promise relief to people who live in high-income countries, although vaccines and expensive new treatments are unlikely to arrive in time to help people who live in low-and middle-income countries. The pathogenesis of COVID-19 is characterized by endothelial dysfunction. Several widely available drugs like statins, ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have immunometabolic activities that (among other things) maintain or restore endothelial cell function. For this reason, we undertook an observational study in four Belgian hospitals to determine whether in-hospital treatment with these drugs could improve survival in 959 COVID-19 patients. We found that treatment with statins and ACEIs/ARBs reduced 28-day mortality in hospitalized COVID-19 patients. Moreover, combination treatment with these drugs resulted in a 3-fold reduction in the odds of hospital mortality (OR = 0.33; 95% CI 0.17-0.69). These findings were in general agreement with other published studies. Additional observational studies and clinical trials are needed to convincingly show that in-hospital treatment with statins, ACEIs/ARBs, and especially their combination saves lives.

Association between abnormal vaginal flora and cervical length as risk factors for preterm birth.

AIM.: To study the relationship between abnormal vaginal flora (AVF) in the first trimester as a risk factor for shortening cervix length (CL) at second and third trimester, and to assess the combination of these factors in predicting preterm delivery. METHODS.: 1026 unselected low risk women seen before 16 weeks of pregnancy underwent sampling of vaginal fluid for wet mount microscopy at a central laboratory blinded to clinical data. Disappearance of lactobacilli and bacterial vaginosis (BV) were scored according to standardized definitions. Specific cultures were performed for M hominis, U urealyticum, aerobic vaginitis (AV) and vaginal colonization with Candida. CL was measured by transvaginal ultrasound at 10-14, 20-24 and at 30-34 weeks, and gestational age at delivery was recorded. RESULTS.: Short cervix (CL below the lower quartile) at 10-14 weeks is related to a lower CL at 20-24 and 30-34 weeks of gestation (p=0.01, p=0.005 respectively). Short cervix at 20-24 weeks, but not at 10-14 weeks, was predictive for preterm birth. In patients with M. hominis and/or with severe AV at 10-14 weeks, the cervix appeared shorter at 20-24 and at 30-34 weeks than in other women. Increased risk for preterm birth in women with a shorter cervix at 10-14 weeks and AVF could not be proved by this study. DISCUSSION.: Presence of AV or M. hominis is associated with a shorter cervix at 20-24 and 30-34 weeks. Although a short cervix at 10-14 weeks increases the likelihood of having a short cervix later in pregnancy, it was not a prerequisite for AVF to be associated with preterm delivery. Therefore, in the pathogenesis of preterm birth, certain types of AVF may be involved directly in the process of cervical shortening, rather than being exposed to the intrauterine cavity more readily by a short cervix in the early stages of pregnancy. Copyright (c) 2010 ISUOG. Published by John Wiley & Sons, Ltd.

Impaired tolerance for glucose in women with recurrent vaginal candidiasis.

OBJECTIVE: The purpose of this study was to determine whether nondiabetic women with recurrent vaginal candidiasis have an impaired glucose metabolism. STUDY DESIGN: A case-control study of 62 otherwise healthy women who were attending a vaginitis clinic > or =3 times a year for symptoms of Candida vaginitis, positive microscopy, and at least one positive Candida culture and of 32 Candida-negative control subjects, all of whom were undergoing standardized oral glucose tolerance testing. RESULTS: Women with recurrent bacterial vaginal infections did not differ from women without infections, so both groups comprised the control group. Women with recurrent vaginal candidiasis had a greater mean body mass index than the control subjects (23.5 vs 21.4, P =.001). They had no more incidences of overt or preclinical diabetes mellitus than the control subjects (6/62 vs 0/32 incidents), but a greater proportion of them had at least one glucose concentration above the 95th percentile (36% vs 12%, P =.016). Glucose concentrations were higher in recurrent vaginal candidiasis cases than in control subjects at 0 (89 vs 85 mg/dL,P =.049), 30 (139 vs 126 mg/dL, P =.05), and 60 minutes (123 vs 102 mg/dL, P =.009) after the intake of 75 g of glucose. Fasting concentration of glycosylated hemoglobin was 25% higher in women with recurrent vaginal candidiasis (5 vs 4 g/dL, P =.0006), even after correction for body mass index. Compared with control subjects, ingestion of 75 g of glucose led to a 15% increase of serum glucose levels in women with recurrent vaginal candidiasis (P =.01). As expected, most of these differences were largely mediated by an increased body mass index. CONCLUSION: The tolerance to glucose in nondiabetic women with recurrent vaginal candidiasis is discretely impaired. Glucose tolerance testing is of value in women with recurrent vaginal candidiasis, but the interpretation of the obtained values should not be limited to the diagnosis of preclinical diabetes mellitus.