Comparison of copper IUDs and hormonal IUDs in prevalence of Candida species in cervicovaginal smears

Candidal vulvovaginitis is one of the most common genital infections that different types of diagnosis are essential for a proper treatment plan. IUD is one of the most influential and long-lasting methods of contraception that can be associated with vaginal candidiasis. This study was performed to investigate the prevalence of Candida species before and three months after IUD placement in patients referred to health centers. Also, a comparison of copper IUDs and hormonal IUDs was evaluated to consider the prevalence of Candida species in cervicovaginal smears. In this regard, cervicovaginal swabs were prepared from 160 women applying for IUDs who did not show signs of vaginal infection during the vaginal examination. These people were divided into two groups of 80 cases. The first group received copper IUDs (NT Cu380, Mona Lisa®, Canada), and the second group received hormonal IUDs (Mirena, USA). They had not used antibiotics or antifungal drugs at least two weeks before and three months after IUD placement. The provided Samples were cultured in a Saburo dextrose agar medium. The milky yeast colony was transferred to chromium agar culture medium, and fungal species were differentiated by dyeing. P <0.05 was considered significant. Three months after IUD insertion, 29.57% of people who received a copper IUD were diagnosed with candidiasis. Also, different species of Candida were observed in 22.95% of people who received hormonal IUD. Because Candida albicans is found in the vaginal microflora of 30 to 80% of asymptomatic women, the decision to treat asymptomatic cases requires further study and testing. The use of Candida chromium agar differential culture medium is easy, reproducible, and cost-effective; however, in cases such as recurrent or complicated vulvovaginal candidiasis where the accurate diagnosis is essential for successful treatment, the use of sensitive and precise molecular methods such as PCR is recommended. Finally, studies with wider dimensions and longer follow-up periods are suggested to confirm and complete the present study.

Recent Developments on Using Nanomaterials to Combat Candida albicans

Vaginal candidiasis (VC) is a common disease of women and the main pathogen is Candida albicans (C. albicans). C. albicans infection incidence especially its drug resistance have become a global health threat due to the existence of C. albicans biofilms and the low bioavailability of traditional antifungal drugs. In recent years, nanomaterials have made great progresses in the field of antifungal applications. Some researchers have treated fungal infections with inorganic nanoparticles, represented by silver nanoparticles (AgNPs) with antifungal properties. Liposomes, polymeric nanoparticles, metal-organic frameworks (MOFs), and covalent organic frameworks (COFs) were also used to improve the bioavailability of antifungal drugs. Herein, we briefly introduced the recent developments on using above nanomaterials to combat C. albicans in antifungal applications.

Novel antifungal activity of Q-Griffithsin, a broad-spectrum antiviral lectin

Background There is a rising global trend in candida strains with high resistance to fluconazole and other antifungal drugs, hence the need for novel agents. Here, we investigated the anti-Candida activity of Q-Griffithsin (Q-GRFT), a lectin naturally produced by the red-sea algae, Griffithsia spp. Methods To assess in vitro growth inhibitory activity, C. albicans was incubated with Q-GRFT on agar plates and in broth media. We investigated GFP-bound Q-GRFT’s ability to adhere to C. albicans using fluorescence microscopy and fluorescence intensity assessments. To demonstrate in vivogrowth inhibitory activity, CBA/J mice were treated per vaginam with Q-GRFT followed by challenge with C. albicans, and fungal burden determined following vaginal lavage. Results Wild type fluorescently labeled Q-GRFT displayed higher fluorescence than the lectin-binding site deficient variant following incubation with C. albicans. Q-GRFT localized around the fungal cells and bound to α-mannan in the cell wall. Q-GRFT significantly inhibited C. albicans growth in broth and on agar plates, disrupted the integrity of the cell wall, and induced ROS formation. The lectin significantly inhibited the growth of C. glabrata, C. parapsilosis and C. krusei, with modest activity against C. auris CDC388 and C. auris CDC389 strains in vitro. Topical treatment resulted in a lower fungal burden compared to the vehicle control group in vaginal candidiasis. Conclusion Q-GRFT binds to and inhibits C. albicans growth both in vitro and in vivo. Further studies are needed to establish the mechanism of growth inhibition.

Lactobacillus iners Cell-Free Supernatant Enhances Biofilm Formation and Hyphal/Pseudohyphal Growth by Candida albicans Vaginal Isolates

Candida albicans is a commensal fungus of the vaginal mucosa and the principal etiological agent of vaginal candidiasis. Vaginal dysbiosis has been reported during vulvovaginal candidiasis (VVC), with a progressive decrease in Lactobacillus crispatus population and an increase in L. iners population. To date, the role of L. iners in VVC pathogenesis remains scarcely explored. Herein we investigated the in vitro effect of L. iners cell-free supernatant (CFS) on the ability of C. albicans to form biofilms. Biomass and metabolic activity were measured by crystal violet and XTT assays. Further, light microscopy was performed to determine the effect of L. iners CFS on biofilm cellular morphology. We found that L. iners CFS induced a significant increase in biofilm formation by C. albicans clinical isolates which were categorized as moderate or weak biofilm producers. This effect was associated with an enhancement of hyphal/pseudohyphal growth, and the expression levels of HWP1 and ECE1, which are typical hyphae-associated genes, were upregulated. Overall, these results suggest that L. iners contributes to the pathogenesis of VVC and highlight the complexity of the interaction between C. albicans and vaginal lactobacilli. Understanding these interactions could prove essential for the development of new strategies for treating VVC.

Prevalence of vaginal candidiasis and associated factors in pregnant women with diabetes

Background/aims Vaginal candidiasis is commonly experienced by women with diabetes, but its prevalence is not well documented in Zimbabwe. This study aimed to assess the prevalence of vaginal candidiasis and factors associated with diabetic treatment adherence in pregnant women with diabetes. Methods This cross-sectional study was conducted on a consecutive sample of 157 participants from a central hospital in Harare, Zimbabwe. A structured questionnaire and physical examination of the perineum were used to collect data. All procedures were conducted in privacy. Diagnosis of vaginal candidiasis was made clinically. Data were analysed using the Chi-squared test, with P<0.05 being significant. Results The prevalence of vaginal candidiasis was 19.7%. There was a significant association between monthly family income (P=0.041), parity (P=0.029) and number of living children (P=0.049) and the presence of vaginal candidiasis. Women with poor adherence to diabetic therapy were 3.95 times more likely to have vaginal candidiasis (P=0.002). Conclusions Individualised health education on glycaemic control and good perineal hygiene remains key in the prevention of vaginal candidiasis among diabetic pregnant women.

Current opportunities for treatment and prevention of recurrent vulvovaginitis in reproductive aged women

Vulvovaginal candidiasis is an urgent medical and social problem, a common reason for women to see a doctor. This disease occurs in women of different ages, which leads to a significant decrease in the quality of life, and to more serious complications in some cases (genitourinary system diseases, miscarriage, vaginal stenosis, etc.).Research objective. Comprehensive assessment of the effectiveness of treatment and prevention of recurrent vulvovaginal candidiasis (RVVC) with Candivac (contains inactivated microorganisms in the form of frozen lyophilized 4 original strains, which are the most common causative agents of vaginal candidiasis).Materials and methods. 76 women of reproductive age with RVVC were examined and randomized into 2 groups: the main group consisted of 40 patients who received anti-candidiasis therapy with fluconazole and Candivac; the control group included 36 women who received only the standard fluconazole antifungal regimen. The duration of observation was 12 months.Criteria for evaluating treatment efficacy were no/reduction of clinical symptoms and changes in the vaginal mucosa, positive dynamics of laboratory tests (with control after 3 and 12 months) from the start of treatment. Results. Clinical efficacy of treatment (regression of complaints and normalization of objective data) in two groups was observed in the majority of patients. At the same time, clinical efficiency in the main group was 87% and exceeded that in the comparison group (63%), which was accompanied by the normalization of the vaginal microbiocenosis. However, after complex therapy with Candivac a more reliable result was observed, which was accompanied by a significant decrease in the frequency of disease recurrence.Conclusions. Study showed that Candivac in combination with antifungal therapy and probiotic promotes the elimination of systemic inflammation and the rapid return of normal intravaginal microflora, and reduces the number of RVVC recurrences.

THE EFFECT OF THE COMPLAİNTS ASSOCİATED WİTH PREGNANCY ON THE QUALİTY OF LİFE OF THE PREGNANT PATİENTS HOSPİTALİSED İN THE PERİNATOLOGY CLİNİC

The aim of this study was to determine the complaints associated with pregnancy and how these affect the quality of life of the pregnant patients hospitalized in the perinatology clinic. The study was carried out as descriptive with 330 pregnant women in Diyarbakır Gazi Yaşargil Training and Research Hospital Gynecology and Pediatric Hospital Supplementary Service Building between 1 February - 5 May 2019. Data were collected using the “Introductory Information Form” and “RBWH Pregnancy Symptoms Inventory” developed by the researcher. The data were evaluated by SPSS 20 statistical package program. All of the patients reported fatigue, the percentage of other complaints were 55,8% dizziness, 57,0% palpitations, 61,5% carpel tunnel (numb hands), 66,1% vaginal candidiasis, 66,7% varicose veins, 67,9% nausea, 72,1% feeling depressed, 75,5% itchy skin, 76,7% constipation, 80,3% headache, 80,9% restless legs, 83,9% taste/smell changes, 84,5% dry mouth, 86.4% swollen/hands or feet, 86,7% altered body image, 87,0% leg cramps, 87,0% shortness of breath, 87,3% forgetfulness, 87.6% sciatica/pain at the back of legs, 87,9% stretch marks, 90,3% changes in libido, 92,4% increased vaginal discharge, 94,2% poor sleep, 95,2% anxiety, 97,3% urinary frequency, 98,2% back pain, 99,1% hip or pelvic pain and 99,4% reflux, In this study, a statistically significant relationship was found between socio-demographic and obstetric characteristics and SCPEQL of the patients. Aside from that, it was found that all complaints, except for snoring and food cravings, affected the daily life of pregnant women. As a conclusion, it was found that complaints associated with pregnancy of the patients with high risk pregnancy are much more common, and negatively affect their quality of life.

Vaginal delivery of clotrimazole by mucoadhesion for treatment of candidiasis

The aim of this study was to prepare mucoadhesive vaginal tablets of clotrimazole for treatment of vaginal candidiasis. A combination of mucoadhesive polymers like HPMC K100M, Sodium CMC, and Eudragit L100 were used in different ratios prepare solid dispersions to enhance its solubility. Tablets were prepared by the wet granulation method. Solid dispersions were evaluated for saturation solubility. All tablet batches were evaluated for weight variation, hardness, friability, drug content, swelling index, in vitro drug release study, ex vivo diffusion and mucoadhesive strength. FTIR spectra showed there was no interaction between the drug and the excipients. HPMC K100 M increased the solubility of clotrimazole in simulated vaginal fluid at pH 4.5. Eudragit L100 was shown to increase the swelling and mucoadhesive strength of the tablet, i.e., 3.03 and 3.29 g. The in vitro and ex vivo release of all 9 batches showed between 61 to 78% release in 8h. Ex vivo diffusion studies using sheep vaginal membrane showed 43 to 59% in 6h in simulated vaginal fluid. The release and flux were nearly comparable to marketed tablet i.e., Candid-V6. The drug release of all batches followed the Korsmeyer-Peppas kinetic model, and the mechanism was found to be non‐Fickian/anomalous. Keywords: Clotrimazole, solid dispersion, HPMC K100M, Eudragit L100, Sodium CMC.

Comparing the Effects of Two Cream Formulations, Henna (Lawsonia inermis) and Clotrimazole, on Vaginal Candidiasis: A Randomized Controlled Trial

Background: Vaginal candidiasis is the most prevalent infection among reproductive-aged women. The current treatment for this disorder includes azole compounds. Objectives: The aim of this study was to compare the effects of two creams, henna (Lawsonia inermis) and clotrimazole, on vaginal candidiasis. Methods: In this trial, 80 women with vaginal candidiasis were recruited and randomly assigned into two groups to receive either henna (n = 40) or clotrimazole (n = 40) for one week. The ethanol extract of henna was prepared. Vaginal discharge was cultured, and vaginal pH, colony formation, lactobacillus formation, and vaginitis subjective symptoms were evaluated before and one, two, and four weeks after the intervention. The chi-square test, independent t-test, and Generalized Estimating Equations were were used for analyzing the data using SPSS version 22. Results: After four weeks of the intervention, almost 90% of the women in the henna group declared no burning sensation, itching, discharge, irritation, or dyspareunia, while only 45%, 5%, 37.5%, 52.5%, and 27.5% of the participants in the clotrimazole group did not have these symptoms, respectively (P < 0.001). The means (SD) of colony formation were 290.85 (47.35) and 265.12 (37.46) in the henna and clotrimazole groups, respectively, at the baseline, which reduced to zero and 25.45 (25.09) in the 4th week of the intervention (P = 0.001). Compared with the clotrimazole group, there was a significant increase in the mean of lactobacillus formation and a significant decrease in vaginal pH in the henna group (P < 0.001). Conclusions: Henna vaginal cream could significantly reduce the symptoms of vaginal candidiasis, such as burning sensation, itching, discharge, irritation, and dyspareunia. Also, it could decrease colony formation and vaginal pH and increase lactobacillus formation.