The impact of aging on innate and adaptive immunity in the human female genital tract.

Mucosal tissues in the human female reproductive tract (FRT) are primary sites for both gynecological cancers and infections by a spectrum of sexually transmitted pathogens, including human immunodeficiency virus (HIV), that compromise women's health. While the regulation of innate and adaptive immune protection in the FRT by hormonal cyclic changes across the menstrual cycle and pregnancy are being intensely studied, little to nothing is known about the alterations in mucosal immune protection that occur throughout the FRT as women age following menopause. The immune system in the FRT has two key functions: defense against pathogens and reproduction. After menopause, natural reproductive function ends, and therefore, two overlapping processes contribute to alterations in immune protection in aging women: menopause and immunosenescence. The goal of this review is to summarize the multiple immune changes that occur in the FRT with aging, including the impact on the function of epithelial cells, immune cells, and stromal fibroblasts. These studies indicate that major aspects of innate and adaptive immunity in the FRT are compromised in a site-specific manner in the FRT as women age. Further, at some FRT sites, immunological compensation occurs. Overall, alterations in mucosal immune protection contribute to the increased risk of sexually transmitted infections (STI), urogenital infections, and gynecological cancers. Further studies are essential to provide a foundation for the development of novel therapeutic interventions to restore immune protection and reverse conditions that threaten women's lives as they age.

Proceso de enfermería a embarazada con infección de vías urinarias y amenaza de aborto / A Nursing Process for a Pregnant Woman with Urinary Tract Infection and Threatened Miscarriage

Introducción: La infección de vías urinarias es recurrente en el embarazo y generadora de complicaciones. Objetivo: Presentar un plan de cuidados enfermero a una mujer con diagnóstico infección de vías urinarias y amenaza de aborto Métodos: Caso clínico de paciente admitida en unidad de Ginecología y Obstetricia del Hospital General de Teziutlán, Puebla, México, durante 2019. Siguiendo la lógica del proceso de enfermería, la valoración se fundamentó en los patrones funcionales de salud de Marjory Gordon. Fueron utilizadas las terminologías normalizadas de enfermería: Diagnósticos (NANDA.int). Resultados (NOC) e Intervenciones (NIC). Resultados: Se identificaron cuatro diagnósticos de enfermería: deterioro de la eliminación urinaria, gestión ineficaz de la propia salud, disposición para mejorar la nutrición y riesgo de alteración de la díada materno/fetal, este último diagnóstico principal. Además, un Resultado NOC (Conocimiento: Control de Infección), cuatro indicadores y la escala de nunca a siempre demostrado; cuatro Intervenciones NIC, con 19 actividades. La evaluación transitó desde 12 (puntuación inicial) a 19 (puntuación final), de 20 como puntuación diana. Conclusión: La integración de las taxonomías NANDA, NIC, NOC y los patrones funcionales de salud de Marjory Gordon permitió diseñar el plan de cuidado de la embarazada, fueron articulados diagnósticos, resultados e intervenciones de enfermería que favorecieron la relación enfermera-paciente-contexto sociocultural, para llevar el cuidado hasta una concepción sistémica que permita el seguimiento y control de la embarazada(AU)

Introduction: Urinary tract infection is recurrent in pregnancy and causes complications. Objective: To present a nursing care plan provided to a woman with a diagnosis of urinary tract infection and threatened miscarriage. Methods: Clinical case of a patient admitted to the gynecology and obstetrics unit of General Hospital of Teziutlán (Puebla, Mexico) during 2019. Following the logic of the nursing process, the assessment was based on Marjory Gordon's functional health patterns. The standard nursing terminologies were used: diagnostics (NANDA-I), outcomes (NOC) and interventions (NIC). Results: Four nursing diagnoses were identified: deterioration of urinary elimination, ineffective self-health management, willingness to improve nutrition, and risk for alterations in maternal-fetal dyad, the latter being the main diagnosis. In addition, a NOC outcome (knowledge: infection control), four indicators and the never-to-always scale upon demonstration, as well as four NIC interventions, with nineteen activities, were obtained. Evaluation ranged from twelve (initial score) to nineteen (final score), with twenty as target score. Conclusion: The integration of the NANDA, NIC and NOC taxonomies together with the Marjory Gordon's functional health patterns allowed the design of the pregnant woman's care plan, with an articulation between nursing diagnoses, outcomes and interventions, which favored the nurse-patient-sociocultural context relationship, up to considering care based on a systemic conception that allows monitoring and control of the pregnant woman(AU)

Gonococcal Adaptation to Palmitic Acid Through farAB Expression and FadD Activity Mutations Increases In Vivo Fitness in a Murine Genital Tract Infection Model.

Neisseria gonorrhoeae is a bacterial pathogen that colonizes mucosal epithelia that are rich in antimicrobial molecules such as long-chain fatty acids. Here we studied the mechanisms involved in palmitic acid resistance and their impact on in vivo biological fitness in a murine genital tract infection model. A stable palmitic acid-resistant derivative was obtained by serial passage with incremental palmitic acid concentrations. This derivative outcompeted its parent strain for colonization and survival in the murine infection model. Subsequent whole-genome sequencing resulted in the identification of the 3 resistance-related SNPs ihfAC5T, fadDC772T, and farAG-52T (promoter) that were verified for resistance against palmitic acid. Subsequent characterization of the associated resistance determinants showed that ihfAC5T and farAG-52T induced gene expression of the FarAB efflux pump, whereas fadDC772T increased the maximum enzyme activity of the FadD long-chain fatty acid-coenzyme A ligase. Our results highlight the mechanisms involved in gonococcal adaptation to the murine host environment.

Activity of airway antimicrobial peptides against cystic fibrosis pathogens.

Antimicrobial peptides are important players of the innate host defence against invading microorganisms. The aim of this study was to evaluate the activity of airway antimicrobial peptides against the common cystic fibrosis (CF) pathogen Pseudomonas aeruginosa, and to compare it to the emerging multi-drug resistant CF pathogens Achromobacter xylosoxidans and Stenotrophomonas maltophilia. Clinical bacterial isolates from CF patients were used, and the antimicrobial activity of human beta-defensin 2 and 3, LL37 and lysozyme was evaluated using radial diffusion assay and viable counts. The cell surface zeta potential was analysed to estimate the net charge at the bacterial surface. Of the bacterial species included in the study, A. xylosoxidans was the most resistant to antimicrobial peptides, whereas P. aeruginosa was the most susceptible. The net charge of the bacterial surface was significantly more negative for P. aeruginosa compared to A. xylosoxidans, which may in part explain the differences in susceptibility.

CD70 Deficiency Associated With Chronic Epstein-Barr Virus Infection, Recurrent Airway Infections and Severe Gingivitis in a 24-Year-Old Woman.

Most of the few patients with homozygous CD70 deficiency described to date suffered from EBV-related malignancies in early childhood. We present a woman with CD70 deficiency diagnosed in adulthood. She presented in childhood with recurrent airway infections due to encapsulated bacteria, herpes zoster and a fulminant EBV infection followed by chronic EBV infection with mild lymphoproliferation and severe gingivitis/periodontal disease with high EBV viral load in saliva and gingival plaques as an adult. Up to the age of 24 years she developed no malignancy despite constant EBV viremia since primary EBV infection 15 years previously. Immunologic evaluation in childhood showed hypogammaglobulinemia with impaired polysaccharide responsiveness. She has been stable on immunoglobulin substitution with no further severe viral infections and no bacterial airway infections in adulthood. Targeted panel sequencing at the age of 20 years revealed a homozygous CD70 missense mutation (ENST00000245903.3:c.2T>C). CD70 deficiency was confirmed by absent CD70 expression of B cells and activated T cell blasts. The patient finished high school, persues an academic career and has rarely sick days at college. The clinical course of our patient may help to counsel parents of CD70-deficient patients with regard to prognosis and therapeutic options including haematopoetic stem cell transplantation.

A study on the relationship between intrauterine device type and processing period and reproductive tract infections.

The intrauterine device (IUD) has corresponding side effects including reproductive tract infectious diseases, irregular vaginal bleeding, menoxenia, lower abdominal pain, pain in the lumbosacral region and ectopic gestation. A prior study conducted by Bhatia and Cleland reflected that contraceptive usage was one of the factors that influence the occurrence of RTIs in South India. Although many studies have been conducted in various parts of different countries with the aim to document the prevalence of RTIs and its risk factors, there remains a lack of sizable literature for Chinese women who use specific IUDs. Therefore, we conducted an analysis on the relationship of IUD type and processing period with the occurrence rate of RTI.

Sodium-Glucose Cotransporter 2 Inhibitors: A Case Study in Translational Research.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are the most recently approved class of diabetes drugs. Unlike other agents, SGLT2 inhibitors act on the kidney to promote urinary glucose excretion. SGLT2 inhibitors provide multiple benefits, including decreased HbA1c, body weight, and blood pressure. These drugs have received special attention because they decrease the risk of major adverse cardiovascular events and slow progression of diabetic kidney disease (1-3). Balanced against these impressive benefits, the U.S. Food and Drug Administration-approved prescribing information describes a long list of side effects: genitourinary infections, ketoacidosis, bone fractures, amputations, acute kidney injury, perineal necrotizing fasciitis, and hyperkalemia. This review provides a physiological perspective to understanding the multiple actions of these drugs complemented by a clinical perspective toward balancing benefits and risks.

The Prevalence of Reproductive Tract Infections in a Chinese Internal Migrant Population, and Its Correlation with Knowledge, Attitude, and Practices: A Cross-Sectional Study.

Objective: This study was designed to assess the prevalence of reproductive tract infections (RTIs) among an internal-migrant population of reproductive age in China. We also analyzed the knowledge, attitude, and practices related to these infections. Methods: A cross-sectional study using the quota-sampling method was conducted in three cities from March 2016 to February 2017. A total of 3320 participants (40.7% men and 59.3% women) were enrolled in the study, of whom, 1124, 1015, and 1181 were from Yinchuan, Urumchi, and Shanghai, respectively. Data on the included subjects were collected using a self-administered questionnaire. Results: We found that 3.2% and 22.6% of all subjects lacked knowledge regarding the identification and prevention of RTIs, respectively. More than 80% of the participants approved of developing RTI surveillance and taking RTI-related courses. While 45.1% of the respondents changed their underwear every 2⁻3 days, 49.0% cleaned their genitals daily, and 34.9% reported taking a bath daily. Among contraceptive users, 47.4% and 29.7% used condoms and IUDs (intrauterine devices), respectively. Overall, 48.2% of the participants had laboratory-confirmed sexually transmitted infections, and 19.7% of the female participants had endogenous infections. After controlling the socio-demographic variables, participants who cleaned their genitals and took a bath less frequently, as well as used condoms or pills had a lower prevalence of sexually transmitted infections, while those who were unwilling to take RTI-related courses and changed their underwear less frequently were more likely to contract sexually transmitted infections. While women who were unwilling to take RTI-related courses had a lower prevalence of endogenous infections, those with more children had a higher prevalence. Conclusion: The status of RTIs among the internal-migrant population of reproductive-age is not optimistic and is related to multiple factors. We believe this study will contribute to improving the knowledge, attitude, and practices related to RTIs.

Culture- and PCR-based detection of BV associated microbiological profile of the removed IUDs and correlation with the time period of IUD in place and the presence of the symptoms of genital tract infection.

OBJECTIVES: The long-term use of intrauterine devices (IUDs) may lead to biofilm formation on the surface. The aim of this study was to perform the culture- and PCR-based detection of bacteria/fungi from the biofilm of the removed IUDs with different time periods in place. METHODS: For a 2-year period, 100 IUD users were involved in the study. In the majority of the cases, IUDs were removed because of the patients' complaints. Beside the aerobic and anaerobic culture, species-specific PCR was carried out to detect Chlamydia trachomatis Neisseria gonorrhoeae and the "signalling" bacteria of bacterial vaginosis (BV) in the biofilm removed by vortexing. RESULTS: Sixty-eight percent of IUDs were used for more than 5 years, 32% were removed after 10 years in place. In 28% of the IUDs ≥ 3 different anaerobic species typically found in BV with or without other aerobic bacteria were found by culture method. Streptococcus agalactiae (14%) and Actinomyces spp. (18%) were also isolated frequently. The PCR detection of Gardnerella vaginalis, Atopobium vaginae, Mobiluncus spp. and Ureaplasma urealyticum were 62%, 32%, 23% and 16%, respectively. Seventy-six percent of the IUDs were PCR positive at least for one "signalling" bacterium of BV. C. trachomatis was detected by PCR only in one IUD together with other aerobic and anaerobic bacteria, while the presence of N. gonorrhoeae could not be confirmed from the biofilm of these removed devices. CONCLUSION: Sexually transmitted infections (STI)-related bacteria-except for one patient-were not detected on the IUDs removed due to different reasons including clinical symptoms of infection. Presence of any BV "signaling" anaerobic bacteria were detected in a much higher number in the biofilm of the removed IUDs by PCR-based method compared to use culture method (76 versus 28 samples). Different aerobic and anaerobic bacteria colonized an equal number of IUDs, independent of the time-period in place, which may be relevant, if the IUD is removed due to planned pregnancy or due to a fear from upper genital tract infection caused by anaerobic bacteria including Actinomyces spp.

Chlamydia muridarum Genital and Gastrointestinal Infection Tropism Is Mediated by Distinct Chromosomal Factors.

Some members of the genus Chlamydia, including the human pathogen Chlamydia trachomatis, infect multiple tissues, including the genital and gastrointestinal (GI) tracts. However, it is unknown if bacterial targeting to these sites is mediated by multifunctional or distinct chlamydial factors. We previously showed that disruption of individual large clostridial toxin homologs encoded within the Chlamydia muridarum plasticity zone were not critical for murine genital tract infection. Here, we assessed whether cytotoxin genes contribute to C. muridarum GI tropism. Infectivity and shedding of wild-type (WT) C. muridarum and three mutants containing nonsense mutations in different cytotoxin genes, tc0437, tc0438, and tc0439, were compared in mouse genital and GI infection models. One mutant, which had a nonsense mutation in tc0439, was highly attenuated for GI infection and had a GI 50% infectious dose (ID50) that was 1,000 times greater than that of the WT. GI inoculation with this mutant failed to elicit anti-chlamydial antibodies or to protect against subsequent genital tract infection. Genome sequencing of the tc0439 mutant revealed additional chromosomal mutations, and phenotyping of additional mutants suggested that the GI attenuation might be linked to a nonsense mutation in tc0600 The molecular mechanism underlying this dramatic difference in tissue-tropic virulence is not fully understood. However, isolation of these mutants demonstrates that distinct chlamydial chromosomal factors mediate chlamydial tissue tropism and provides a basis for vaccine initiatives to isolate chlamydia strains that are attenuated for genital infection but retain the ability to colonize the GI tract and elicit protective immune responses.

Profilaxis antibiótica intravaginal del absceso de cúpula en histerectomía / Intravaginal antibiotic prophylaxis of dome abscess in total hysterectomy

Introducción: La histerectomía es uno de los procedimientos quirúrgicos que con más frecuencia se realiza en Ginecología. La frecuencia de aparición de absceso de cúpula varía desde un 0,7% a un 14%. La infección generalmente es polimicrobiana y los gérmenes implicados son los de la flora vaginal y endocervical de la mujer sana. En el Hospital Aeronáutico Central, desde el año 2007, además de la profilaxis intraoperatoria con cefalosporinas de primera generación, se realiza en las 12 horas previas a la cirugía programada, profilaxis con óvulos vaginales polivalentes. Objetivos: Evaluar la disminución de la incidencia de absceso de cúpula vaginal post cirugía ginecológica, que implique la manipulación de la vagina, con administración pre-quirúrgica de óvulos vaginales polivalentes. Material y Método: Estudio observacional, descriptivo y retrospectivo. Se incluyeron 220 pacientes que se les realizaron 220 histerectomías totales: 202 por vía abdominal, 5 laparoscópicas y 13 vaginales. Se realizó profilaxis intraoperatoria con cefalosporinas de 1º generación. Se les administró por vía vaginal un óvulo polivalente compuesto por: metronidazol 300 mg, miconazol nitrato 100 mg, neomicina sulfato 48,8 mg, polimixina b sulfato 4,4 mg, centella asiática 15 mg y excipientes. Se evaluó la aparición de absceso de cúpula vaginal en los 6 meses posteriores a la cirugía. Resultados: Se hallaron complicaciones post quirúrgicas en 10 pacientes (4.5%): 4 pacientes (1,8%) con infección del tracto urinario, 3 pacientes (1,4%) con infección de herida quirúrgica, 1 paciente (0,4%) con fístula vesico-vaginal, 1 paciente con Tromboembolismo pulmonar, 1 paciente con granuloma de cúpula vaginal y 1 paciente con absceso de cúpula vaginal. Esta paciente no recibió el óvulo vaginal polivalente. Conclusión: De los datos obtenidos de las 220 pacientes analizadas, y teniendo en cuenta la bibliografía consultada, podemos concluir que las pacientes que son sometidas a histerectomías totales con técnica de cúpula vaginal cerrada y que reciben como profilaxis preoperatoria un óvulo vaginal polivalente, presentan menor incidencia de complicaciones post operatorias, principalmente a nivel de la cúpula vaginal, y en particular abscesos de cúpula.

Introduction: Hysterectomy is one of the surgical procedures most frecuently performed in gynecology. Vault abscess frequency of appearance varies from 0.7% to 14%. The infection is usually polymicrobial and involved germs are those from vaginal and endocervical flora of the healthy woman. In the Hospital Aeronáutico Central, since 2007, in addition to intraoperative prophylaxis with first-generation cephalosporins, prophylaxis with polyvalent vaginal ovules is performed within 12 hours prior to scheduled surgery. Objectives: Evaluate the decrease in the incidence of vaginal vault abscess after gynecological surgery, involving the manipulation of the vagina, with pre-surgical administration of polyvalent vaginal ovules. Material and Method: Observational, descriptive and retrospective. 220 patients who underwent 220 total hysterectomies were included: 202 abdominal via, 5 laparoscopic and 13 vaginal. Intraoperative prophylaxis was performed with 1st generation cephalosporins. They were administered through vaginal via with Polyvalent ovule composed of: metronidazole 300 mg, miconazole nitrate 100 mg, neomycin sulfate 48.8 mg, polymyxin b sulfate 4.4 mg, gotu kola 15 mg and excipients. The appearance of vaginal dome abscess was evaluated in the 6 months following surgery. Results: Post-surgical complications were found in 10 patients (4.5%): 4 patients (1.8%) with urinary tract infection, 3 patients (1.4%) with surgical wound infection, 1 patient (0.4%) ) with vesico-vaginal fistula, 1 patient with pulmonary thromboembolism, 1 patient with vaginal vault granuloma and 1 patient with abscess of vaginal vault. This patient did not receive the polyvalent vaginal ovum. Conclusion: Data obtained from the 220 patients analyzed, and taking into account the bibliography consulted, we can conclude that patients who undergo total hysterectomies with a closed vaginal vault technique who receive a polyvalent vaginal ovum as a preoperative prophylaxis, present a lower incidence of post-operative complications, mainly at the level of the vaginal vault, and in particular dome abscesses

Does Active Oral Sex Contribute to Female Infertility?

Based on recent, historical, and circumstantial evidence, we present a multifactorial hypothesis that has potential direct implications on the epidemiology and management of chlamydial infection and disease in humans. We propose that (1) like its veterinary relatives, the oculogenital pathogen Chlamydia trachomatis evolved as a commensal organism of the human gastrointestinal (GI) tract primarily transmissible via the fecal-oral route; (2) in the modern era, C. trachomatis causes "opportunistic" infection at non-GI sites under conditions driven by improved sanitation/hygiene and reduced fecal-oral transmission; and (3) the rise in the practice of oral sex is contributing to the increased prevalence of C. trachomatis in the human GI tract. Infectious organisms produced in the GI tract and reaching the rectum may then chronically contaminate and infect the female urogenital tract, thereby potentially contributing to the most serious sequelae of chlamydial infection in women: pelvic inflammatory disease, ectopic pregnancy, and tubal factor infertility.

Intrauterine infections - challenges in the perinatal period (literature review).

The purpose of the study is to summarize the literature data on the state of intrauterine infections that cause antenatal fetal abnormalities. MATERIALS AND METHODS: This article presents the assessment of 25 world literature sources from 2000 to 2016, which discuss the etiology of infectious agents acting on the fetus and causing a variety of pathological conditions. RESULTS: During gestation many researchers refer to the infection as one of the causes of antenatal fetal abnormalities. The etiology of intrauterine infection is diverse and differs between countries with different economic conditions. Detection of an infectious agent makes it possible to promptly carry out preventive measures, to improve hygiene standards in order to reduce the rate of infection transmission from mother to fetus. CONCLUSION: Timely detection of the etiology of intrauterine infections promotes the identification of high-risk groups giving a possibility to provide treatment in order to prevent the transmission of an infectious agent having direct economic benefits, especially in resource-poor countries with low and middle income.

Infección genital masculina por virus de papiloma humano / Male genital infection by human papiloma virus

El virus del papiloma humano (VPH) es una de las enfermedades de transmisión sexual más comunes. Puede afectar tanto el aparato genital masculino y femenino, como también el área perianal, ano, y diversas áreas de cabeza y cuello y otorrinolaringológicas, ya sea como lesiones benignas o como promotor de lesiones malignas. Las lesiones benignas por VPH en genitales masculinos se caracterizan fundamentalmente por la aparición de lesiones verrugosas, aunque también puede manifestarse mediante lesiones planas atípicas. En algunos casos hay ausencia de lesiones macroscópicamente visibles que pueden hacerse evidentes con la prueba de ácido acético. La biopsia de la lesión, su evaluación anatomopatológica y, sobre todo, la determinación de la existencia y el tipo de virus involucrado mediante PCR (reacción en cadena de la polimerasa) permiten confirmar el diagnóstico. En algunas ocasiones es necesario realizar una cistoscopia para diagnosticar lesiones intrauretrales y vesicales. Los tratamientos propuestos son muy variados y de eficacia dispar, desde las topicaciones y la electrocirugía o la criocirugía, hasta el empleo de la tecnología láser. La prevención con el uso de protección durante el acto sexual así como la educación sexual son fundamentales. En los últimos 10 años se ha implementado el uso de la vacuna para el VPH en niñas con el fin de disminuir la incidencia de lesiones de alto grado y de cáncer de cuello uterino, pero su indicación en varones es menos clara y aún no ha sido consensuada. (AU)

Human papiloma virus (HPV) is one of the most common sexual transmitted diseases. It can affect the male genitalia, as well as the perianal and anal regions and multiple areas of the head and neck and otorhinolaryngological structures, as benign lesiones or as a promoter of malignant lesions. Benign male genitalia lesions are characterized mainly by verrucous lesions, although flat atypical lesions can be found, as well as the abscence of macroscopic visible lesions that in some cases can become evident using the acetic acid test. Lesion biopsy, its histological evaluation, and the determination of the existence and type of virus using PCR (Polymerase Chain Reaction) can confirm the diagnosis. In some cases is necessary to do a cistoscopy to diagnose intraurethral and vesical lesions. Proposed treatments are varied and with a wide range of efficacy, from topications to electro or cryosurgery, and the use of laser technology. Sexual education and the use of sexual protection are essential in prevention. In the last 10 years the use of VPH vaccine in girls was widely spread, in order to decrease the incidence of high grade lesions and cervix cancer. Its indication in male patients is less clear and not yet consented among specialists. (AU)

The effect of contraceptive methods on reproductive tract infections risk: a cross-sectional study having a sample of 52,481 women.

OBJECTIVE: The aim of this study was to investigate the association between specific contraceptives use and reproductive tract infections (RTIs). STUDY DESIGN: Participants consisted of 52,481 rural married women of reproductive age identified from a cross-sectional study in Anhui Province of China. The questionnaire, gynecological examination, and laboratory inspection were used to collect data. The subgroup analysis was performed to estimate the effect of the specific contraceptives on the specific RTIs. RESULTS: A total of 49,970 (95.2 %) women used contraceptive methods and 31,390 (59.8 %) women had at least one RTI. Overall, use of intrauterine device (IUD), condom, female sterilisation, rhythm method, and oral contraceptive (OC) were associated with RTIs. In the subgroup analysis, IUD use was a risk factor for endocervicitis, bacterial vaginosis (BV), and trichomoniasis; condom, rhythm method, and OC were associated with endocervicitis; female sterilisation was associated with endocervicitis and trichomoniasis. Moreover, male sterilisation was associated with endocervicitis; withdrawal was a protective factor for endocervicitis and a risk factor for trichomoniasis; subdermal implant was associated with candidiasis and pelvic inflammatory disease (PID). CONCLUSIONS: All the contraceptive methods may lead to the RTIs. A properly assessment for contraceptive methods use is needed for female reproductive health.

Intermittent catheterization in neurologic patients: Update on genitourinary tract infection and urethral trauma.

Intermittent catheterization is considered the standard of care in most neurologic patients with lower urinary tract disorders. However, in this context, genitourinary tract infection and urethral trauma represent specific challenges. Such conditions have been found to significantly deteriorate quality of life and complicate subsequent treatments. Only optimal prevention associated with appropriate treatment allows for the long-term continuation of such bladder management. Here, we discuss the diagnosis and therapeutic and preventive approaches associated with genitourinary tract infection and urethral trauma in this specific population. This "state-of-the-art" article results from a literature review (MEDLINE articles and scientific society guidelines) and the authors' experience. It was structured in a didactic way to facilitate comprehension and promote the implementation of advice and recommendations in daily practice. Genitourinary tract infection and urethral trauma associated with intermittent catheterization in neurologic patients should be managed with a global approach, including patient and caregiver education, optimal catheterization with hydrophilic-coated or pre-lubricated catheters and adequate use of antibiotic therapy.

Digging through the Obstruction: Insight into the Epithelial Cell Response to Respiratory Virus Infection in Patients with Cystic Fibrosis.

Respiratory virus infections are common but generally self-limiting infections in healthy individuals. Although early clinical studies reported low detection rates, the development of molecular diagnostic techniques by PCR has led to an increased recognition that respiratory virus infections are associated with morbidity and acute exacerbations of chronic lung diseases, such as cystic fibrosis (CF). The airway epithelium is the first barrier encountered by respiratory viruses following inhalation and the primary site of respiratory viral replication. Here, we describe how the airway epithelial response to respiratory viral infections contributes to disease progression in patients with CF and other chronic lung diseases, including the role respiratory viral infections play in bacterial acquisition in the CF patient lung.

[Urinary, infectious and digestive adverse events related to benign hysterectomy and the associated surgery on the Fallopian tube: Guidelines]. / Hystérectomies d'indication bénigne: complications viscérales et gestes associés sur les annexes: recommandations.

OBJECTIVES: To provide clinical practice guidelines from the French College of Obstetrics and Gynecology (CNGOF) based on the best evidence available, concerning the urinary, infectious and digestive adverse events related to benign hysterectomy and the associated surgery including opportunistic salpingectomy and adnexectomy. MATERIAL AND METHOD: Review of literature using following keywords: benign hysterectomy; urinary injury; bladder injury; ureteral injury; vesicovaginal fistula; infection; bowel injury; salpingectomy. RESULTS: Urinary catheter should be removed before 24h following uncomplicated hysterectomy (grade B). In case of urinary catheter during hysterectomy, immediate postoperative removal is possible (grade C). No hemostasis technics can be recommended to avoid urinary injury (grade C). There is not any evidence to recommend to perform a window in the broad ligament or an ureterolysis, to put ureteral stent or a uterine manipulator in order to avoid ureteral injury. An antibiotic prophylaxis by a cephalosporin is always recommended (grade B). Mechanical bowel preparation before hysterectomy is not recommended (grade B). If there is no ovarian cyst/disease and no familial or personal history of ovarian/breast cancer, ovarian conservation is recommended in premenopausal women (grade B). In postmenopausal women, informed consent and surgical approach should be taken in account to perform a salpingo-oophorectomy. Since the association salpingectomy and hysterectomy is not assessed in the prevention of ovarian cancer, systematic bilateral salpingectomy is not recommended (expert consensus). CONCLUSIONS: Practical application of these guidelines should decrease the prevalence of visceral complications associated with benign hysterectomy.

Menstrual hygiene practices and its association with reproductive tract infections and abnormal vaginal discharge among women in India.

OBJECTIVE: The objective was to explore the determinants of menstrual hygienic practices and its effect on Reproductive Tract Infections (RTI) among ever married women in India. METHODS: District Level Household and Facility Survey-3 (DLHS) India data have been used in the study. The respondents constituted ever married women (N = 577,758) in the age group of 15-49. Bivariate and multivariate techniques were employed using IBM SPSS statistics 20. Individual effects of socio economic, demographic and gynecological factors on menstrual hygienic practices, RTIs and abnormal vaginal discharged respectively were calculated using binary logistic regression. RESULTS: A meager 15% of women used sanitary pad/locally prepared napkins during menstruation in India. Both RTI and Vaginal discharge were positively related with non-use of hygienic methods. The women who used unhygienic method during menstruation were more likely to have any symptom of RTI (OR = 1.046, p < 0.001, CI = 1.021-1.071) and vaginal discharge (OR = 1.303, p < 0.001, CI = 1.266-1.341). CONCLUSION: The reason for the symptoms of RTI may be diverse and not only limited to the unhygienic menstrual practices although this may be one of the reasons causing reproductive morbidity. Awareness, affordability and privacy are some of the major concerns that need immediate attention to promote the use of sanitary pad during the time of menstruation. Establishing relation between menstrual practices and RTI is in its initial stage of investigation and hence needs further research.

Human papilloma virus in oral mucosa and its association with periodontal status of gynecologically infected women

El objetivo del estudio fue identificar la presencia del virus Papiloma Humano en lengua y periodonto de mujeres sanas y enfermas periodontales con lesiones genitales del mismo. Se evaluarontreinta mujeres, no menopáusicas, de entre 18 y 50 años de edad, derivadas del Servicio de Ginecología del Hospital Universitario Materno Neonatal de la ciudad de Córdoba, sistémicamentesanas y con diagnóstico gineco lógico de lesiones por HPV. Se realizó, anamnesis, inspec ción de mucosas bucales, examen clínico periodontal y la toma de tres escobillados por paciente, dos de un mismo sitio periodontal (epitelio externo de encía y epitelio interno del surco/bolsa periodontal) y el otro de lengua. Las 90 muestras obtenidas fueron sometidas a estudios citológicos de Papanicolau y a estudios moleculares de amplificación de ácidos nucleicos por Reacción en Cadena de la Polimerasa. Los datos fueron agrupados y analizados por el “Test Chi Cuadrado” (χ2)y el “Índice de Kappa” (κ). Fue demostrada la alta prevalencia de la presencia del virus papiloma tanto en lengua (30 por ciento), como en tejidos periodontales (15 por ciento). El genotipo -16 de alto riesgo (HR) fue identificado en mayores porcentajes (67 por ciento) encontrando, también, el genotipo -52 y el -6. Siempre que el HPV estuvo presente en los sitios periodontales fue detectado, también, en la lengua de las mismas pacientes, de las cuáles el 88,89 por ciento practicabasexo oral. Se destaca el hallazgo clínico de lesiones estomatológicas compatibles con papilitis foliada en las pacientes HPVintrabucales positivas. Se señala en la población femenina de Córdoba, Argentina, la alta prevalencia de la presencia de HPV donde el genotipo -16 fue detectado en mayor porcentaje. En lamuestra analizada No fueron positivamente correlacionados lapresencia de HPV y la mayor incidencia y severidad de lesiones periodontales...