Management of Kaphaja Yoni Vyapat by Panchavalkala Arka w.s.r to Vuvlovaginal Candidiasis- A Case Report

Vulvovaginal candidiasis is caused due to different candida species, most commonly C.albicans. It occurs in 1-14% of all women of reproductive age throughout the world and its prevalence in India is estimated to be 30% It may be physiological condition but when turns into pathological, produces associated symptoms such as pruritus, backache, white discharge with foul smell and alters the PH of the vaginal flora. This can be correlated to the Lakshanas of Kaphaja yoni vyapat, where there will be Kaphavrudhi all over the body. Management of this condition is by using Ruksha, Katu, Ushna dravyas. Sthanika Chikitsa such as Yoni Prakshalana (douching), Yoni Pichu (tamponing per vagina), Yoni Varti (local use of pessaries) and Yoni Dhoopana (fumigation) have been mentioned and these modalities are found effective in treating Kaphaja Yoni Vyapat. During the current era, many vaginal washes is available easily over the counter and women prefers using such preparation, when they come across vaginal itching and discomfort and abnormal vaginal discharge. Here is an effort to prepare a colorless, odorless solution, adopting the principals of Ayurveda which can be convenient for washing easily at home for women. Methodology: Here is a case report of a patient with complaints of Kaphaja Yoni Vyapat diagnosed vaginal candidiasis by swab smear test selected from outpatient department of SDM Ayurveda hospital Hassan. Panchavalkala Arka will be given to the pts and advised to wash it twice a day for 7 days. Results: Local therapies such as Sthanika Chikitsa have lot of potential in treating Yoni Vyapad and in Panchavalkala Arka the drugs with its Guna Karma helps in breaking the Samprapti of Kaphaja Yoni Vyapat. Discussion: PVQ Arka is a liquid preparation obtained using Arkayantra which contains the 5 Ksheeravrukshadravyas and indicated for Shotha. The Dravyas by its Guna Karma Vranashodana, Ropana, Yonidoshahara, Kandugna properties which helps to treatment of Kaphaja Yoni Vyapat. Hence here is an attempt to use Panchavalkala in Arka form and help the women kind as an easily available Ayurvedic vaginal wash in treating Vuvlo Vaginal Candidiasis.

Vaginal preparation with povidone iodine solution before caesarean section and its impact on the post-operative infectious morbidity

Background: A prospective randomized control trial (RCT) was conducted in the department of obstetrics and gynecology. The aim of the study was to evaluate the effect of pre-operative vaginal preparation with 1% povidone iodine solution on the post-operative caesarean infectious morbidity.Methods: 72 women were enrolled in the experimental group who received 1% povidone iodine vaginal wash and 72 in the control group who did not receive any vaginal wash. The investigators were blinded to the computer-generated random number table and to the allocation group. The clinical data was recorded and after its completion, the allocation group was revealed to the investigator. The data was tabulated and statistically analyzed using SPSS 21.Results: Age, parity, BMI, gestational age, blood loss, and operative time between the two groups was comparable. Pre-operative povidone iodine vaginal wash was more effective when membranes were intact versus ruptured. With intact membranes, statistical significance was reached for postoperative fever, seroma, endometritis, gaped incisional site, and foul discharge with p value 0.012, 0.012, 0.013, 0.027 and 0.012 respectively, between group A and B. The overall infectious morbidity in the 144 subjects showed statistical significance for endometritis, and foul-smelling lochia with p value 0.049 and 0.024 respectively; urinary tract infection, hospital stay duration, and incisional wound dehiscence were higher in group B versus group A, the difference in these parameters did not reach statistical significance.Conclusions: Pre-operative vaginal cleansing with 1% povidone iodine reduced post-operative infectious morbidity more effectively in those with intact membranes than ruptured membranes.

Comparative study regarding effect of pH on Misoprostol in induction of labor in full term primigravida pregnant women, a double blind randomized controlled trial

ObjectivesTo evaluate the effect of altering vaginal pH on induction of labor in full-term pregnancies using Misoprostol.MethodsThis randomized controlled trial was conducted at Kasralainy Hospital, Cairo University, Egypt and Algezeera Hospital, Egypt. A total of 218 healthy term primigravida pregnant women who were scheduled for pregnancy termination were recruited in the study. The included patients were divided into three groups; Group A: Those who received normal saline vaginal wash (0.9% NaCl), Group B: those who received alkaline vaginal wash (5% sodium bicarbonate) and Group C: those who received acidic vaginal wash (5% acetic acid). Patients received 25 μg of Misoprostol E1 (Vagiprost® Adwia Pharmaceuticals, Egypt) every 6 h for a maximum of 24 h (total of four potential doses).ResultsThe ‘acid’ group participants took a mean time of 20.46 h to reach active stage of labor, followed by the ‘normal saline’ group with 21.45 h and the ‘alkaline’ group with 22.59 h. The difference between the groups was statistically significant, with a p-value of 0.013.ConclusionsDouching the vagina with acidic solution seems to supplement the effect of Misoprostol on inducing labor in full-term pregnancies, as evidenced by having the shortest mean time needed to reach active stage of labor.

COMPARATIVE STUDY OF PRE-CAESAREAN VAGINAL WASH WITH 5% POVIDONE – IODINE SOLUTION VERSUS NO WASH IN PREVENTING POSTOPERATIVE INFECTION.

Objective: To evaluate the efficacy of pre-cesarean vaginal wash using 5% Povidone Iodine solution on rate of post-cesarean section (CS) surgical site infection and compared with No swabbing. Method: A Prospective Randomized controlled Trial was conducted in department of Obstetrics and Gynecology in Government medical college, Aurangabad. In interventional group, vaginal swabbing with a gauze pieces impregnated with 5% Povidone Iodine solution was done for 30 seconds. The swabbing of vagina was not performed in cases assigned to control group, however the standard surgical preparation of abdomen was done in a usual manner for both group. All subject received prophylactic antibiotic cover. Collected data was complied in pre-designed proforma and analysis was done using SPSS 15. Result: The risk of post operative fever and wound infection was significantly reduced in interventional group. No measure difference was noted in seroma and composite wound infection. Also less duration of hospital stay in interventional group was noted. No adverse effect of use of Povidone iodine was reported in the interventional group. Conclusion: Vaginal swabbing with 5% Povidone-iodine pre- LSCS is inexpensive and simple intervention even for low resource setting to decrease surgical site infection.

Evaluation of urea and creatinine levels in vaginal wash fluid for the diagnosis of premature rupture of membranes

Background: Evaluation of urea and creatinine levels in vaginal wash fluid for the diagnosis of premature rupture of membranes.Methods: The study was conducted on150 pregnant patients, 50 in each group. Confirmed PROM and unconfirmed PROM. Per speculum examination was done to look for pooling, pH tested using the Pehanon paper and vaginal wash fluid was collected. Vaginal wash fluid urea and creatinine levels were tested by a kit based on spectrophotometry.Results: The mean urea levels were 26.35 mg/dl in the study Group 1 and 3.12 mg/dl in the control group. ROC curve was plotted and the cut off value of vaginal wash fluid urea was found to be 8.55 mg/dl. The vaginal wash fluid urea levels of >8.55 mg/dl detected PROM with a sensitivity, specificity, negative and positive predictive value of 100%. The mean creatinine levels were 0.62 mg/dl in study Group 1 and 0.20 mg/dl in the control group. ROC curve was plotted and the cut off value of vaginal wash fluid creatinine was found to be 0.405 mg/dl. Vaginal wash fluid creatinine levels detected PROM with a sensitivity of 76% and specificity of 100%. The negative predictive value and positive predictive values were 80.4% and 100%.Conclusions: Urea can be used as a definite marker of PROM and creatinine can be used as a supportive marker.

Immunogenicity of Exosomes from Dendritic Cells Stimulated with Toxoplasma gondii Lysates in Ocularly Immunized Mice

Immunogenicity of dendritic cell-derived exosomes stimulated with <i>Toxoplasma gondii</i> lysates (TLA exo), mixed with cholera toxin as an adjuvant, was investigated in mice immunized via 2 mucosal routes (ocular vs intranasal). BALB/c mice were injected 3 times with TLA exo vaccine at 2 week interval, and the levels of IgG in serum and IgA in tear, saliva, feces, and vaginal wash were measured. To observe the expression of <i>T. gondii</i>-specific B1 gene, mice infected with ME49 <i>T. gondii</i> cysts were immunized with TLA exo or PBS exo (not stimulated with TLA), and their brain tissues were examined. The mice vaccinated via intranasal route elicited significantly higher humoral and mucosal immune responses compared with mice treated with PBS alone. Also, mice immunized via ocular route (by eyedrop) induced significantly higher <i>T. gondii</i>-specific IgG in serum and IgA in tear and feces in comparison with PBS controls. B1 gene expression was significantly lower in TLA exo vaccinated mice than in PBS or PBS exo vaccinated mice. These results demonstrated that ocular immunization of mice with TLA exo vaccine has the potential to stimulate systemic or local antibody responses. This study also highlighted an advantage of an eyedrop vaccine as an alternative for <i>T. gondii</i> intranasal vaccines.

Comparison Among Fern, Amnisure, Creatinine and Urea Tests in Vaginal Wash for Detection of Rupture of Membrane in Iraqi Women

Prelabour rupture of membrane (PROM) is a cause for 85% of the neonatal period morbidities and fatalities. PROM is the main cause of preterm deliveries and accounts for 30-40% of these cases, indeed it complicates three percent of all pregnancies. The fetal and maternal mortality and morbidity risks of PROM, increases when the rupture occurs early in the course of pregnancy. In this study we sought to compare the detection efficiency of the standard diagnostic test of PROM with other new methods such as urea and Creatinine of vaginal fluid and Amnisure tests. The study sample is composed of 90 women divided into three groups; each woman had informed consent, questionnaire with full history, clinical examination (general and abdominal and sterile speculum examination to detect cervical dilatation, amniotic fluid leakage for sample collection to do Fern, Amnisure, Creatinine and urea tests. General investigations and ultrasound were done for each patient. Mean vaginal fluid Creatinine level among the group (1) were 0.44±0.14, versus 0.38±0.12, and 0.24±0.08 among group (2) and (3) respectively. When the results of the tests compared with the standard method of diagnosis, the specificity was 100% for Amnisure, vaginal fluid Creatinine and urea, while it was 80% for fern test. The sensitivity was 97% for Amnisure, 95% for vaginal fluid urea, 91% for vaginal fluid Creatinine and 60% for fern test. Amnisure is superior for other tests followed by vaginal fluid urea level, Creatinine and lastly Fern test.

FORMULATION AND IN VITRO EVALUATION OF GEL BASED POLYHERBAL VAGINAL WASH

Vaginal Infection is quite common in India, a multi-city study estimated that more than 90% of women between the ages 25 and 35 suffer with vaginal infection and 93% do not follow the best personal hygiene practices. The vaginal yeast infection is caused by Candida albicans. Which is characterized by Itching, irritation in tissues at the vaginal opening (vulva), burning sensation, redness /swelling of the vulva, vaginal pain ,soreness, vaginal rash, watery vaginal discharge . The objective of the present study was to develop poly-herbal vaginal wash for prevention of Candida albicans infection. Aqueous extracts of Azadirachtaindica leaf, Ocimum Sanctum leaf and Sapindus emarginatus were formulated in an aqueous based carbopol-940 (1%w/w) gel system. Prepared poly herbal vaginal wash formulation was evaluated for their physicochemical properties like texture evaluation, pH determination, viscosity and in vitro Antifungal activity were determined along with short term stability studies. The formulated gel based poly-herbal vaginal wash had acceptable physical parameters that showed that they were compatible and in addition to this, these formulations passed the short-term stability studies. The in vitro antifungal activity studies showed that the formulated gel based vaginal wash showed significantly strong activity against C. albicans. Thus, the present study concludes that the formulated herbal vaginal wash is efficient antifungal formulations for the C. albicans vaginal infection.