استكشف المجموعة الواسعة من العناوين المتاحة.

BackgroundBacterial vaginosis (BV), a common condition among reproductive age women is associated with an imbalance of vaginal microbiota composition. It has been implicated in numerous adverse reproductive outcomes and increased risk of sexually transmitted infections. The vaginal ecology varies widely among women from various geographic and ethnic backgrounds. Our study aimed to explore the spectrum of bacterial communities in Indian women with and without BV and the association of individual species with Amsel’s clinical diagnostic criteria.Methods16S rRNA gene PCR and V3-V4 sequencing were performed on vaginal swabs from 38 women with BV (mean age= 30.84 years, Nugent score ≥7) and 16 healthy controls (mean age= 28.25 years, Nugent score≤3). BV was assessed by Amsel’s clinical criteria and confirmed by Nugent scoring of Gram stained vaginal smears. Taxonomic classification was performed using SILVA reference database.ResultsThe vaginal community composition of women with BV was highly heterogeneous and characterized by species diversity and richness. Women with BV harbored high concentrations of Gardnerella vaginalis (>99% women), Atopobium spp (81.6%), Prevotella timonensis (73.7%), Sneathia amnii (73.7%) and Sneathia sanguinegens (63.2%). On the contrary, in healthy women with no evident symptoms of vaginitis, Lactobacillus species dominated the vaginal flora wherein L iners and L gasseri were the two most frequently detected species. Interestingly, L iners was noted in all women, irrespective of their BV status. The presence of Atopobium spp., Sneathia spp., P timonensis and Eggerthella spp., were strongly associated with all four clinical signs defined by Amsel’s criteria.ConclusionLactobacillus species including L iners and L gasseri are the predominant vaginal species found in the vaginal tract of Indian women of reproductive age. A heterogeneous vaginal community marked by the presence of G vaginalis, Sneathia spp., Atopobium spp., Prevotella spp., Eggerthella spp., is associated with BV and its clinical symptoms.

Introduction/BackgroundDifferent from Uterine leiomyomas which are common benign tumor in woman, Vaginal leiomyomas are very rare, having only 350 cases reported in the medical literature. However, leiomyomas are the most common mesenchymal tumors of the vagina in adult women, and can easily be misdiagnosed due to its low incidence and diverse, nonspecific clinical features.MethodologyA 43-year-old woman, para 2, visited our OPD department with chief complaint of about 4 cm sized prolapsing soft mass through vagina. Sonographic findings and physical examinations suggested vaginal cystic mass and surgery was recommended but the patient did not visited our center since she had so symptom other than intermittent prolapse. After 4 years later, the patient visited our center again with symptom of vaginal bleeding and discharge. About 6.0 cm by 5.0 cm semisolid vaginal mass near the urethra and bladder was found by sonography, and 8.3 by 5.6 cm sized mass lesion in the vagina was shown in abdomen CT finding, suggesting leiomyoma, most likely.ResultsThe patient received vaginal mass excision and anterior repair. About 8 cm protruding solid mass was found inside the anterior vaginal wall. Excision and anterior repair was done without any significant complications, and her hospital stay was 24 hours. Clinical and sonographic examination at a follow-up consultation, after 1 month, showed healed vaginal wall without any mass like lesion.ConclusionOccurrence of leiomyoma in vagina is very rare, and its sarcomatous transformation is even rare but some case has been reported. Preoperative diagnosis is somewhat difficult and the gold standard of diagnosis is histopathological confirmation. Surgical removal with urethral protection should be done and histopathologic diagnosis should be made to rule out any possibility of malignancy.DisclosureNothing to disclose

Introduction/BackgroundThe majority of flaps used in reconstruction of the vulva are local flaps with a random blood supply and consist of the skin and subcutaneous tissue. They include the V-Y advancement flap, the transposition flap and the rhomboid flap. The lotus flap is a transpositional flap with the blood supply from the perineal branches of the internal pudendal artery. It has an axial blood supply at the base and a random blood supply at the tip. It can be 4 times longer than its width and can be rotated more than 90 degrees. The type of flap chosen is based on the size and location of the defect. The V-Y is best for lateral defects, the rhomboid is best for perineal defects and the lotus can be used for anterior lateral or posterior defects.MethodologyThe video will show the defect in the vulva and lower vagina that needs to be covered. It will show the harvesting of the flap, rotating it under the vulva tunnel, preparing the recipient graft site and sewing the graft into place.ResultsThe patient healed primarily. She received 4400 cGy of radiation postop. She did not have stricture or skin breakdown. Photos of the result are shown. She is alive without disease at 2 years.ConclusionThe lotus flap is an excellent flap for reconstruction of the vulva or the lower and mid vagina.DisclosureNothing to disclose

Introduction/BackgroundMedical treatment has gained popularity as an alternative treatment option in vaginal intraepithelial neoplasia (VaIN). The aim of this meta-analysis was to ascertain the efficacy and safety of 5-flouorouracil (5-FU) in this context.MethodologyA literature search was conducted throughout the PubMed, EMBASE, SCOPUS, ClinicalTrials.gov, and Cochrane Databases for relevant studies from inception until September 2019. We computed the summary proportions of women treated for VaIN with 5-FU for the outcomes of complete response and recurrence by random-effects meta-analysis. Sub-group analyses were performed to address heterogeneity.Results14 observational studies were included. The studies were of moderate quality. Pooled results from 14 studies enrolling 358 VaIN women rendered a summary proportion of 82.18% (95% CI 69.80% - 88.82%) for the outcome of complete response. Pooled results from six studies enrolling 184 high-grade VaIN women rendered a summary proportion of 77.53% (95% CI, 59.90% - 91.15%) for the outcome of complete response. Pooled results from five studies enrolling 26 VaIN women rendered a summary proportion of 53.92% (95% CI 34.62% - 72.61%) for the outcome of complete response amongst persistent lesions. Pooled results from six studies enrolling 98 VaIN women rendered a summary proportion of 16.42% (95% CI, 7.39% - 28.14%) for the outcome of recurrence. The agent was well tolerated by most women and only few studies reported discontinuation of the treatment owing to severe adverse effects.Conclusion5-FU is seemingly an effective and safe treatment modality in the treatment of VaIN. It can be considered as an alternative conservative treatment option, leading to less aggressive and morbid interventions, especially amongst young women with multifocal lesions. Further studies with longer follow-up will be warranted to further assess its efficacy and safety in this setting.DisclosureNothing to disclose

ObjectivesIn light of the LACC Trial results, we evaluated RFS and OS following RRH before and after 10 cases per surgeon.MethodsPatients with early-stage CC (4/2007–12/2017) who underwent RRH were evaluated and first 10 learning curve cases per surgeon (Group A) were compared to all subsequent cases (Group B). Inclusion criteria mirrored the LACC trial: > one-year follow-up, adenocarcinoma or squamous carcinoma, FIGO-2014 stage IA2 or IB1, and pathologic tumor size of ≤4 cm.Results144 RRH patients were identified and 90 met inclusion criteria from 6 attending surgeons. 40 patients met Group A and 50 Group B criteria. Median follow-up was 61± 34.3 months (A=71.5, B=52.5). The 5-year RFS was 92% (95 CI±4%) and the DSDR 5.5% (n=5). There were 7(7.8%) recurrences with median RFS of 12±8.3 months. Recurrence in Group A (n=6, 15%) exceeded Group B (n=1, 2%), p=0.025. DSDR was 10% Group A vs. 2% B (p=0.184). The 4.5-year RFS was 84.8% (95 CI±7%) in Group A vs. 98% (95 CI±3%) in Group B. There were no differences in risk factors for recurrence between groups A and B. (TS >2, LN (+), adjuvant therapy (AT), and LVSI p>0.05), except (+) vaginal margin status (A=10% vs B=0%, p=0.034). All recurrent cases had TS >2 cm.ConclusionsRecurrence of disease following RRH clustered in the first 10 cases per surgeon in our center and was associated with (+) vaginal margins and TS 2 cm. This data suggests an inter-surgeon variability and a possible learning curve effect.

Este trabajo pretende comprender cómo las mujeres de la Casa Cultural del Chontaduro resignifican sus experiencias de diversos hechos o situaciones de violencia a través del arte con la valoración de elementos simbólicos propios de su identidad social y cultural. De esta manera, se utilizó una metodología cualitativa donde se realizaron entrevistas semiestructuradas a tres mujeres de la Casa Cultural del Chontaduro con el fin de conocer estas experiencias desde sus propias narrativas e interpretarlas a través de la teoría de la psicología social. Se encontró que un libro, ciertas canciones, poemas, instrumentos musicales y vestuarios son elementos simbólicos para las mujeres de la Casa Cultural del Chontaduro, los cuales sirven como mediadores en el proceso de resignificación y contribuyen a una afirmación de la identidad social y cultural. 

Ibrexafungerp was well tolerated overall, and adverse events were primarily gastrointestinal and mild in severity (Table).3 VANISH 303 was followed by VANISH 306, a second phase 3 study with an identical study design that evaluated the efficacy and safety of ibrexafungerp for acute VVC treatment in an international patient population. Furthermore, fluconazole use in pregnancy has been associated with rare birth defects, although the data are conflicting about the safety of a single 150-mg oral dose.8 Based on observed fetal harm in animal studies, ibrexafungerp is contraindicated in pregnancy, so there remains a lack of systemic VVC treatment options for these patients.4 Of note, 2 pregnancies were reported in VANISH 303; both patients received ibrexafungerp, and both had live births with no reported complications. Ibrexafungerp is a promising new agent with pharmacologic advantages, including high oral bioavailability, fungicidal activity, and limited observed cross-resistance with other antifungal agents.4,9 Furthermore, studies have demonstrated that unlike fluconazole, ibrexafungerp retains activity at vaginal pH of 4.5 or less, which is a characteristic feature of VVC and may be an important consideration for treatment and susceptibility testing in patients with azole-refractory VVC.10 However, the cost of ibrexafungerp and insurance preferences may limit accessibility.

Objective: The aim of this study was to compare the efficacy, outcomes and complications of sacrospinous ligament fixation (SSLF) with native tissue repair and infracoccygeal sacropexy with transvaginal mesh (TVM) in the management of vaginal vault prolapse. Material and Methods: We recruited 63 women with stage 3, or greater prolapse, according to the pelvic organ prolapse quantification (POPQ) system, requiring surgical correction. They were randomized in two groups: SSLF (n = 31) and TVM (n = 32). The primary outcome was the absence of POP-Q stage ≥3 prolapse at 24 months, and secondary outcomes were perioperative events, complications and reoperations. The participants were followed for the next 2 years, with scheduled evaluation. Results: Clinical and demographic data did not differ significantly between the two treatment groups. Success in the TVM group was 84.3% (27/32) compared to 61% (19/31) in the SSLF group. Although there was not statistically significant differences between the groups, the prolapse recurrence trend was lower in the TVM group (RR 0.73). Recurrent prolapse occurred most frequently in the vaginal anterior wall (14.3%). The mesh exposure rate was 9.3%. Neither serious adverse events nor deaths occurred in either group. Conclusion: Our results showed that vaginal repair with mesh surgery was more successful in terms of reducing recurrent prolapse than the traditional sacrospinous colpopexy, 24 months after surgery.