Pathway Analysis of Behavioral Determinants in Preventing Genital Infections of Santri Putri Pondok Pesantren : Application of The Integrated Behavior Model

Female students who live in Islamic boarding schools are a population at risk for genital infections. The practice of personal/vaginal hygiene or menstrual hygiene is a form of maintaining reproductive health by preventing genital infections. Some bad behavior related to vaginal hygiene is a trigger factor for female genital infections. This study aimed to examine the factors behind the behavior of preventing genital infection in female students in the Islamic boarding school environment. This study was a quantitative study with a cross-sectional design. The population in this study was all female students. Determination of the sample in this study was carried out randomly with the number of subjects determined based on the rule-of-thumb sample size for path analysis, namely a minimum of 100 subjects, a minimum of 5 subjects per parameter, and a minimum of 10 subjects per variable. So that a sample of 150 female students was determined. The independent variable in this study was the behavior of preventing genital infection, while the dependent variables was: (1) behavioral intentions, (2) correct knowledge about behavior, (3) perception of the meaning of behavior, (4) environmental barriers, (5) experiential attitudes, (6) instrumental attitudes, (7) injunctive norms, (8) descriptive norms, (9) perceived behavioral control, (10) self-efficacy. This study indicated that infection prevention behavior can be determined by the behavior of female students prevention of genital infection is not influenced by the behavior of environmental barriers. Good knowledge and skills did not affect female students in taking measures to prevent genital infections; therefore, it was necessary to develop a more heterogeneous number of respondents and a questionnaire that can be understood by respondents so that an integrated behavioral model can become a reference to change behavior, and use methods that can improve their behavior.

Acceptability and efficacy of vaginal self-sampling for genital infection and bacterial vaginosis: A cross-sectional study

Background & aim Screening for genital infection (GI) such as bacterial vaginosis (BV) and yeast infection, for sexually transmitted infection (STI), and for asymptomatic carriage of group B streptococcus (GBS) in pregnant women are common reason for medical appointments. The diagnosis and control of GIs, STIs, and GBS are major issues, for fertility and overall well-being of affected women. Conventional testing is performed using vaginal/cervical classical sampling (VCS); this procedure requires pelvic examination performed by health care professionals which raises concerns among women. Vaginal-self-sampling (VSS), as an alternative to VCS, might capture more women. The aim was first to show non-inferiority of VSS compared with VCS to screen for GIs, STIs, and GBS; second to determine the feasibility of VSS. Methods VSS and VCS from 1027 women were collected by health care professionals and simultaneously carried out on each patient. GIs, STIs, and GBS were systematically screened in both paired VSS and VCS samples. Non-inferiority of VSS compared with VCS was assessed using z statistic for binomial proportions. Results Prevalence of GIs were 39.7% using VSS and 38.1% using VCS (p = 0.0016). Prevalence of STIs was 8.5% (VSS) vs 8.1% (VCS) (p = 0.0087). Prevalence of GBS was 13.4% (VSS) and 11.5% (VCS) (p = 0.0001). Most participants (84%) recommended the use of VSS. Conclusions This study shows that VSS was not inferior to VCS for the detection of GIs, STIs, and GBS. This study provides evidence that VSS can be used as a universal specimen for detection of lower genital tract infections in women. Study identification number ID-RCB 2014-A01250-4.

СERVICAL INSUFFICIENCY AND GENITAL INFECTION

Despite the availability of diagnostics and modern methods of treatment, preterm birth with cervical insufficiency occurs in 44-57% of cases, while early preterm birth reaches 38,8%. To date, there is no doubt about the connection of premature labor and intraamnial inflammation, the frequency of which in cervical insufficiency reaches 80%. Most researchers are unanimous in the opinion that the ascending route of infection in intraamnial infection is a priority. It has been proven that a decrease in the absolute and relative amount of Lactobacillus spp., A change in the species composition of lactoflora or atypical vaginal colonization associated with premature birth and premature rupture of membranes. Conditionally pathogenic microorganisms of the vaginal biotope with an insufficient number of lactobacilli are capable of producing various proteases that destroy collagen, constituting the basis of connective tissue and determining the elasticity of the membranes, which allows us to consider cervicovaginal infections as one of the mechanisms of premature remodeling of the cervix and rupture of membranes. In that way, it is relevant to study the frequency and structure of genital infection in cervical insufficiency. The analysis of medical literature data, presented in the electronic libraries Elibrary and Pubmed for the last 10 years, devoted to the study of genital infection in cervical insufficiency. The issue of the relationship of cervicovaginal infections with premature remodeling of the cervix of the uterus was discussed, as well as studies on the role of intrauterine infection in the genesis of preterm labor. The results of scientific studies are presented, indicating both the direct influence of cervical incompetence on the risk of intraamnial infection and the root cause of genital infection in the pathogenesis of cervical insufficiency. Convincing data are given that timely diagnosis and treatment of violations of the vaginal biocenosis is one of the significant links in the prevention of premature birth. It is necessary to further study the pathogenetic relationship of cervicovaginal infections and cervical insufficiency.

Developing Female-Genital Infection Preventive Behavior Tool (FGIPBT) for Islamic Boarding School Population Based on The Integrated Behavior Model

Female-genital infection in adolescence causes discomfort and may develop into a serious issue. Islamic boarding school female students are a population at risk of getting a female-genital infection due to the lack of hygiene practice sum up with the lack of parental control. Prevention of female-genital infection through behavioral change is mandatory but the changes in behavior are not an effortless thing. There are underlying constructs that predispose the behavior as described in the Integrated Behavior Model (IBM). Dealing with those constructs will facilitate the change of behavior. However, there was no exact tool for assessing construct that determines the female-genital infection preventive behavior, especially for Islamic boarding school female-student population. That was the major reason for the Female-genital Infection Preventive Behavior Tool (FgIPBT) development. We generated a tool based on IBM constructs and the Indonesian Society of Dermatology and Venereology (INSDV) recommendation regarding genital infection preventive behavior. A deductive method of item generation, expert judgments, and internal consistency test involved 143 female-student from 3 different Islamic boarding schools was done to generate a valid and reliable tool. Total 177 valid items composed on the first phase and two different arrangements of items has subjected the reliability on the second phase. Items that were arranged based on behavior items and assessed every IBM construct (Type 1) had higher reliability value than items that were arranged based on IBM construct for all behavior items (Type 2). Assessing different construct for each point of behavior at the same time generate more reliable data than assessing the same construct for all points of behavior.

Stroke associated with Mycoplasma hominis infection: a case report

Background Mycoplasmas are the smallest prokaryotic microorganisms in nature. Many cases of stroke post-Mycoplasma pneumoniae infection have been reported, particularly in the pediatric population. However, Mycoplasma hominis infection has not previously been associated with stroke. Case presentation We report the case of a 36-year-old Greek woman who presented with an extensive stroke with an unspecified cause. She had a concurrent genital infection with Mycoplasma hominis for an unknown duration. Conclusion An association may exist between stroke and the immune response to Mycoplasma hominis infection.

Empagliflozin Use and Fournier’s Gangrene: Case Report and Systematic Literature Review

Background: Fournier’s gangrene (FG) is a rare necrotising soft tissue infection localised in the genital areas with possible dramatic outcomes. Recently, sodium glucose co-transporter-2 (SGLT2) inhibitors were identified as a risk factor. Methods: We present a case report of a 57-year-old female patient with type 2 diabetes mellitus (T2DM) in treatment with empagliflozin which led to the development of FG. Moreover, we performed a systematic review assessing the association between empagliflozin use and FG. Results: The female patient with 15-years treated diabetes presented a massive FG after 6 months from starting empagliflozin. Over the period of two months, she was successfully treated in a low-income setting. The systematic review included two studies with a total of 9915 participants. Although no participant had FG, there was an increased rate of urinary and genital infection in patients treated with empagliflozin compared to those treated with other antidiabetics or placebo. Conclusions: FG should be considered as a possible complication in patients using SGLT2. Patients should be educated to report early signs of genital infection and healthy behaviours as well as a balanced diet should be promoted to aid in the prevention of FG.

Clinical Adverse Events Associated with Sodium-Glucose Cotransporter 2 Inhibitors: A Meta-Analysis Involving 10 Randomized Clinical Trials and 71,553 Individuals

Objectives This meta-analysis aimed to investigate the occurrence of various adverse events (AEs) associated with sodium-glucose cotransporter 2 inhibitors (SGLT2i) and to examine the level of risk of AEs in patients with different underlying diseases. Background SGLT2i are first-line antidiabetic agents with demonstrated cardiovascular benefits. Prior meta-analyses have examined AEs associated with these drugs in general, but such knowledge needs to be updated with the results of more recent trials. In addition, the occurrence of various AEs with different underlying diseases is unknown. Methods We conducted a quantitative meta-analysis of randomized controlled trials (RCTs) retrieved from the MEDLINE and EMBASE databases and the Cochrane library were searched on January 31 th, 2021. Outcomes of interest included 4 overall safety outcomes (AEs) and 12 specified safety outcomes. Further analyses were performed on various subgroups, which were defined based on the status of diabetes mellitus (DM), atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease, and congestive heart failure, and by the dosage of SGLT2i (high dose versus low dose). Results Our analysis included 10 eligible studies with a total of 71,553 participants. The meta-analysis showed that SGLT2i led to increased risks of genital infection (risk ratio [RR] 3.56, 95% confidence interval [CI] 2.84–4.46), urinary tract infection (RR 1.06, 95% CI 1.00–1.12), diabetic ketoacidosis (RR 2.23, 95% CI 1.36–3.63), and volume depletion (RR 1.14, 95% CI 1.06–1.23). However, the use of SGLT2i was associated with reduced risks of any serious AE (RR 0.92, 95% CI 0.90–0.94), acute kidney injury (AKI) (RR 0.84, 95% CI 0.77–0.91), and hyperkalemia (RR 0.84, 95% CI 0.72–0.99). Within the different subgroups, the risk of amputation was higher in patients with ASCVD than in those without (RR 1.44 vs. 0.96, P = 0.066). Conclusions The use of SGLT2i is generally safe. SGLT2i may be associated with increased risks of genital infection but is protective against AKI. Of note, the risk of amputation was higher in patients with ASCVD. The key to the safe use of SGLT2i lies in the identification of high-risk populations and close surveillance of patients after treatment.