The Outpatient Prescribing of Miconazole in a Tertiary Hospital in Riyadh Region

Aim: The present study aimed to describe the use of miconazole in the outpatient setting of a tertiary hospital in Riyadh Region. Methodology: This was a retrospective study that included reviewing the electronic prescriptions that contained miconazole among patients in a public hospital in Riyadh Region. Results: Most of the patients who received miconazole were females (89.29%) and the age of 51.79% of them was between 30 and 39 years. Most of the prescriptions were written by residents (96.43%) and most of the prescriptions were prescribed by emergency department (66.07%). Most of the patients received miconazole as vaginal suppository (50.00%) or as cream (39.29%). Conclusion: The present study showed that miconazole was uncommonly prescribed in in Riyadh Region. Further studies are needed to explore the frequency and pattern of miconazole use as well as to explore the frequency of prescribing other antifungal medications in different settings.

An Efficient Herbal Approach for Treating Fungal Infection in Cervical Cancer Patients by Developing and Optimizing a Vaginal Suppository

Aim. The study is aimed at developing curcumin suppositories as a promising approach for natural antifungal management of vaginal candidiasis in cervical cancer patients to eradicate side effects produced by current antifungal drugs. The objective of the study was to optimize the suppositories using optimal (custom) design employing Design-Expert 13 software to recognize the concentration of polyethylene glycols (PEG) and Poloxamer 407 and obtain a stable suppository. Methodology. Combinations of PEG 1500 (10%–40%), PEG 6000 (40%–60%), and Poloxamer 407 (5%–30%) were entered as factors, and the responses evaluated were hardness, deformation time, and % drug release. In addition, the formulation was also evaluated for visual examination, weight variation, pH determination, drug content, hardness test, disintegration time, melting zone, deformation time, in vitro drug release, antifungal activity, and stability tests. Results. Suppositories were devoid of holes and cracks, with a characteristic odor and a dark yellowish-orange color. All formulations passed the weight variation test. Formulations exhibited pH ranging from 5.5 to 6.5. Drug content was observed to be 98.65 ± 0.041 % – 99.85 ± 0.041 % . The hardness of the formulation was between 2.9 and 4.2 kg/cm2. The disintegration time ranged from 11 ± 0.052 min to 20 ± 0.011 min . The melting point was between 41 ± 0 . 31 ° C and 58 ± 0 . 62 ° C . Deformation time ranged from 10 ± 0.45 to 35 ± 0.52 min . Most of the formulations resulted in 90% of drug release at 40 min, and the zone of inhibition noted was 19.6 ± 0.4 mm . All the selected factors have a significant effect on the response chosen for the study. Conclusion. The optimized curcumin vaginal suppository formulation can be an efficient herbal treatment devoid of side effects to treat vaginal candidiasis in cervical cancer patients.

Assessment of vaginal health before and after treatment with vaginal suppository containing Lactiplantibacillus pentosus KCA1

Bacterial Vaginosis (BV) is a polymicrobial syndrome characterized by a shift in the vaginal flora from a predominant population of Lactobacilli to a replacement with anaerobes. Vaginal suppositories containing L. pentosus KCA1 were formulated using glycerol-gelatin base. A prospective and follow-up community-based study was done. Vaginal samples were collected from women of reproductive age (non-pregnant) between 18-45 years. A total of 360 women both symptomatic and asymptomatic provided High Vaginal Swabs (HVS) for BV screening using Nugent scoring method and 65 (18.1 %) participants were identified as having BV by microscopy with 45 (12.5 %) of them being consistent with BV (Nugent score of 7-10) and twenty (5.56 %) being intermediate with BV (Nugent score of 4-6). A baseline and intervention questionnaire were administered to the participants. Majority (81.5 %) of the participants affirmed that they have not heard about BV. Social burden reveals that 90.8 % affirmed that they feel frustrated, having BV symptoms recur after treatment and 83.1 % admitted that BV symptoms makes them feel embarrassed, ashamed and dirty. Majority (58.8 %) claimed that the state of their reproductive health is ‘very good’ four weeks after treatment, while 88.2 % of the participants rated their reproductive health after four weeks of treatment to be ‘somewhat better than now than a year ago’. In conclusion, it was revealed that BV has impact on the social status and quality of life of the participants except on their economic status. Knowledge on the awareness of BV among women of reproductive age is essential.

STHANIK CHIKITSA (LOCAL THERAPIES) IN STRI ROGA: CRITICAL REVIEW

Ayurveda is one of the oldest systems of health gives a detail description of Stree Roga. Women combat with quite common gynecological problems like white discharge, itching at vulva, foul smelling vaginal discharge, burning micturition etc. Sthanik Chikitsa has given excellent results in these problems. Sthanik Chikitsa preferably includes Yonidhawan (Douching per vaginum), Yoni-Pichu (Tampooning per vaginum), Yoni Dhoopan (Fumigation of vagina), Yoni-Varti (Vaginal suppository), Yoni-Lepana (Vaginal painting), Uttarbasti (Medicated oil or decoction is pushed into the uterine cavity through vagina), Agnikarma (Cauterization) and Ksharakarma (Chemical cauterization) etc. In the present study all these local therapies are revised through ancient Samhitas, and these therapies are reviewed with their meanings, indications, procedures, application site and probable mode of actions. It is my sincere and optimistic effort to encourage most of the Ayurveda physician towards Sthanik Chikitsa in the management of Stree Rogas. Keywords: Sthanikchikitsa, Local therapies, Stree Roga.

Comparing intramuscular and vaginal suppository progesterone for luteal phase support in IUI cycle: A randomized clinical trial

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Treatment for mixed non-specific vulvovaginitis in pregnant women using combined topical preparations

Aim: to assess clinical laboratory efficacy of a combined medication (metronidazole 10 mg + clotrimazole 20 mg in 1 g of gel, M + C) for mixed non-specific vulvovaginitis in the 3rd trimester of pregnancy. Patients and Methods: this study enrolled 105 pregnant women admitted to the Obstetrical Department of Pregnancy Diseases. The study group included 53 women who received M + C (5 g, one full applicator) twice daily for five days. The comparison group included 52 women who received a vaginal suppository (metronidazole 500 mg + sodium miconazole 100 mg) twice daily for seven days. In addition, all women received peroral probiotic strains of lyophilized Lactobacilli (one capsule twice daily for seven days). Primary endpoints were changes in complaints, speculum exam findings, vaginal pH-metry, and vaginal smears. Secondary endpoints were the type of delivery beginning, overall duration and specificity of the delivery process, signs of chorioamnionitis, intraamniotic fetal infection, birth injury, Apgar score, and specificity of the postnatal period. Results: 50 women of the study group (94.3%) and 47 women of the comparison group (90.4%) presented with no complaints after the treatment course (р=0.45). Local discomfort at the time of drug administration was reported in three women of the study group (5.7%) and four women of the comparison group (7.7%) (р=0.68). Forty-seven women of the study group (88.7%) reported being highly satisfied with M + C. Normalization of WBC counts was seen in 49 women of the study group (92.4%) and 49 women of the comparison group (94.2%) (p<0.05 compared to baseline in both groups). The number of women with moderate and high gram-positive rod counts increased in the study group (n=29, 54.7%; p<0.05). No differences in delivery type, mean delivery time, and Apgar score were reported. No postnatal purulent septic complications were revealed in either group. Conclusions: combined vaginal gel containing metronidazole 10 mg and clotrimazole 20 mg is highly effective for mixed non-specific vulvovaginitis in the 3rd trimester of pregnancy. KEYWORDS: pregnancy, non-specific vulvovaginitis, topical treatment, vulvovaginitis, clotrimazole. FOR CITATION: Shaposhnikova E.V., Bazina M.I., Mentsik M.M. et al. Treatment for mixed non-specific vulvovaginitis in pregnant women using combined topical preparations. Russian Journal of Woman and Child Health. 2021;4(3):201–208 (in Russ.). DOI: 10.32364/2618-8430- 2021-4-3-201-208.

MODE OF ACTION OF STHANIK CHIKITSA IN COMMONLY USED IN STREE ROGA

Yoni Roga do not occur without vitiation of Apana Vata, thus first of all Vata should be normalized then treatment of other Doshas should be done. Sthanika Chikitsa (local therapies) prescribed by ancient Acharyas as Yoni Prakshalana (cleansing of vagina), Yoni Pichu (medication soaked tampon place in the vagina), Yoni Purana (vaginal packing), Yoni Lepa (semisolid drug applied in vaginal wall), Yoni Varti (vaginal suppository), Yoni Dhoopana (vaginal fumigation) & Uttarbasti (medicated oil/Ghrita pushed in the uterine cavity). For better result of this therapy the appropriate knowledge of mode of action of drug ought to be important. Our Acharyas very well know the mode of action of this Sthanika Chikitsa and describe the specific Sthanika Chikista according to different Yoni- Vyapada or vitiated Doshas. The reason behind for chosen the vaginal route because of the rugae of the vaginal epithelium create a invoulted surface and results in a large surface area provide, this large surface area allows the trans-epithelial absorption of medications via the vaginal route & the posterior fornix have rich blood supply so actively absorption of drug. The main objective of this literature to find out the probable mode of action of special drug in specific Sthanik Chikitsa.