Silvio Antonio Franceschini

Improved treatment of vulvovaginal candidiasis with fluconazole plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14

Aims:  To determine the ability of probiotic lactobacilli to improve the treatment of vulvovaginal candidiasis (VVC) using a randomized, double‐blind and placebo‐controlled trial.

Increased arterial stiffness in nonobese women with polycystic ovary syndrome (PCOS) without comorbidities: one more characteristic inherent to the syndrome?

Background  Polycystic ovary syndrome (PCOS) is associated with adverse metabolic effects. Some cardiovascular disease (CVD) risk markers are increased in women with PCOS. However, early markers of atherosclerosis are also associated with obesity and insulin resistance, which are related to PCOS. These markers may result either directly from PCOS or indirectly as a consequence of the comorbidities associated with the syndrome.

Both a combined oral contraceptive and depot medroxyprogesterone acetate impair endothelial function in young women.

BACKGROUND The study was conducted to determine whether the use of a combined oral contraceptive (COC) or depot medroxyprogesterone acetate (DMPA) interferes with endothelial function. STUDY DESIGN The study was conducted on 100 women between the ages of 18 and 30 years. Fifty women had not used hormonal contraception (control group) for at least 12 months, 25 were current users of a COC (ethinylestradiol 30 mcg+levonorgestrel 150 mcg) and 25 were current users of DMPA (150 mg) for at least a 6-month period. All women were evaluated for brachial flow-mediated dilation (FMD), intima-media thickness, carotid distensibility and stiffness index, arterial pressure, body mass index, waist circumference, heart rate and lipid profile. RESULTS A significant difference in FMD was observed between the COC and control groups (6.4+/-2.2% vs. 8.7+/-3.4%, p<.01) and between the DMPA and control groups (6.2+/-2.1% vs. 8.7+/-3.4%, p<.01). The DMPA group had lower values of total cholesterol (TC) and low-density lipoprotein (LDL-C) than COC users and the control group (TC: DMPA=139.9+/-21.5 mg/dL vs. controls=167.1+/-29.2 mg/dL vs. COC=168.2+/-37.5, p=.001; LDL-C: DMPA=85.3+/-20.1 mg/dL vs. controls=102+/-24.5 mg/dL vs. COC=106.7+/-33.3 mg/dL, p=.01). The control group had higher levels of high-density lipoprotein (HDL-C) than the DMPA and COC groups (controls=52.4+/-14.1 mg/dL vs. DMPA=42.2+/-7.2 mg/dL vs. COC=45.4+/-9.1 mg/dL, p=.001). No significant differences were observed regarding the other variables. CONCLUSIONS FMD was lower among COC and DMPA users, suggesting that these hormonal contraceptives may promote endothelial dysfunction.

Analysis of Vaginal Lactobacilli from Healthy and Infected Brazilian Women

ABSTRACT Culture-dependent PCR-amplified rRNA gene restriction analysis and culture-independent (PCR-denaturing gradient gel electrophoresis) methodologies were used to examine vaginal lactobacilli from Brazilian women who were healthy or had been diagnosed with vulvovaginal candidiasis (VVC) or bacterial vaginosis. Only Lactobacillus crispatus was detected accordingly by both methods, and H2O2-producing lactobacilli were not associated with protection against VVC.

Lack of effects of isoflavones on the lipid profile of Brazilian postmenopausal women

OBJECTIVE To evaluate the effects of soy isoflavone supplementation on profile lipid and endogenous hormone levels. METHODS In this double-blind, placebo-controlled study, 47 postmenopausal women 47-66 y of age received 40 mg of isoflavone (n = 25) or 40 mg of casein placebo (n = 22). Cardiovascular risk factors were assessed by evaluating lipid profile at baseline and after 6 mo of treatment. To examine the effects of this regime on endogenous hormone levels, follicle-stimulating hormone and beta-estradiol were measured. Urinary isoflavone concentrations (genistein and daidzein) were measured as markers of both compliance and absorption using high performance liquid chromatography. Baseline characteristics were compared by the unpaired Students t-test. Within-group changes were determined by paired Students t-test and comparison between the isoflavone and casein placebo groups were determined by analysis of variance. RESULTS Lipid levels (low-density lipoprotein and total cholesterol) similarly decreased in both groups. High-density lipoprotein increased significantly in both groups and cannot thus be attributable to treatment; the reason for such variation is unknown and can be attributed to chance or to bias (even that of a real placebo effect in both groups or perhaps in spontaneous changes in exercise and dietary habits of patients after their inclusion). Furthermore, in both groups very low-density lipoprotein and triacylglycerol levels increased in a non-significant manner. CONCLUSION The results of the present study do not support any biologically significant estrogenic effects of isoflavone on the parameters assessed. Further research will be necessary to definitively assess the safety and efficacy of isoflavone.

in Vitro Activity of Antimycotic Agents Determined by e-Test Method Against Vaginal Shape Candida Species

Vaginal candidiasis continues to be a common cause of vaginal discharge, pruritus and other local complaints in women worldwide. Although numerous antimycotic agents are available for the treatment of yeast vaginitis there is little comparative data on the in vitro activity of these drugs. The objectives of this study were to isolate and identify the Candida species in the vagina and anus of patients treated in a gynaecology clinic, as well as determine the susceptibility to azolic compounds measured by the E-test method. Vaginal and rectal swabs were collected from 80 adult non-pregnant patients, seen at a gynaecological clinic, aged 18–59 years, with sexual activity, with and without vaginitis. The swabs were processed by methods routinely used for the detection of pathogenic yeasts. The susceptibility of the isolates to fluconazole, ketoconazole and itraconazole, was measured by the agar diffusion method (E-test), using RPMI 1640 medium with 2% glucose and phosphate buffer. Candida species (33) strains were isolated from 17 patients at similar proportions from both anatomical sites, and 12 patients harboured 24 strains of C. albicans in the vaginal and rectal tracts. Twenty one percent of the strains of C. albicans were resistant to ketoconazole, 54% were resistant to itraconazole and 0% were resistant to fluconazole. The sensitivity of strains isolated from the two sites were similar, indicating that these are strains of the same phenotype.

Phenotype and genotype of Candida albicans strains isolated from pregnant women with recurrent vaginitis.

Fourteen out of 80 pregnant women receiving prenatal care presented signs and symptoms of recurrent vaginal candidiasis. Candida albicans strains were isolated from 12 patients (85.7%), and these were submitted to morphotyping (morphological characteristics of the colony), antifungal typing (pattern of sensitivity to amphotericin B, 5-fluorcytosine, myconazole, ketoconazole and fluconazole) and genotyping (electrophoretic migration of DNA fragments digested with EcoRI and HinfI). Alteration of morphotype and antifungal type was observed in 50% of the patients, but the genotype of the strains isolated from the same patients at different times was identical in all subjects. The predominant morphotypes presented continuous fringes and the basic changes observed among antifungal types was the emergence of strains resistant to myconazole, which was the drug used for the treatment of the first episode of vaginitis. We conclude that recurrent vaginal candidiasis is caused by the persistence of a single yeast genotype that undergoes morphological and behavioral changes in the presence of antifungal agents due to the selective pressure to which it is submitted.

Performance of Selective and Differential Media in the Primary Isolation of Yeasts from Different Biological Samples

In view of the increase in yeast infections, especiallypolymicrobial ones, differential culture media have acquired increasing importance. The presentstudy evaluated the Sabouraud chloramphenicol, Biggy agar, Pagano Levin agar and CHROMagarCandida media in terms of isolation, number of yeast colony forming units per plate,and inhibition of bacteria and filamentous fungi. To this end, we used 223 biological samples,including feces, and oral, vaginal and anal mucosae from 86 patients presenting or notsymptoms of fungal infections. The four media did not differ significantly in terms of detectionof yeast-positive cultures. The number of colony forming units per plate ranged from zero to 2.380,with a predominance of counts of 1 to 9 colonies per plate. No significant differences wereobserved among the four culture media in terms of number of colonies counted, for each kind ofbiological material.Fifteen species belonging to the genera Candida, Saccharomyces,Cryptococcus, Trichosporon and Rhodotorula were isolated,with C. albicans being the predominant species, followed by C. parapsilosis and R. rubra. CHROMagar Candidaand Biggy agar were complementary in the isolation of the different species and favored a greater recoveryof polymicrobial cultures. Pagano Levin agar isolated the smallest variety of species. Sabouraud chloramphenicolagar was the least effective in terms of bacterial inhibition and favored a greater development of filamentous fungi. The results suggest that more than one culture medium should be used for an adequate primary isolation.

Ethinylestradiol and estradiol have different effects on oxidative stress and nitric oxide synthesis in human endothelial cell cultures

STUDY OBJECTIVE To compare the effects of ethinylestradiol (EE) and 17β-estradiol (E(2)) on nitric oxide (NO) production and protection against oxidative stress in human endothelial cell cultures. DESIGN Experimental study. SETTINGS Research laboratory. MATERIAL Human ECV304 endothelial cell cultures. INTERVENTION(S) The NO synthesis was determined by flow cytometry, and oxidative stress was determined by a cell viability assay, after exposure to hydrogen peroxide (H(2)O(2)) and stimulation of endothelial cells with EE at concentrations similar to those of a contraceptive containing 30 μg EE. MAIN OUTCOME MEASURE(S) The effects of EE were compared with those of E(2) at concentrations similar to those occurring during the follicular phase. RESULT(S) Ethinylestradiol did not increase NO synthesis and did not protect cells against oxidative stress. The viability of the cells incubated with E(2) in combination with H(2)O(2) was greater than the viability obtained with H(2)O(2) only or with H(2)O(2) in combination with EE. The cells stimulated with E(2) presented a significant increase in NO production compared with control. CONCLUSION(S) In contrast to the effects of E(2), EE did not protect human ECV304 endothelial cells against oxidative stress and did not increase their production of NO.

Comparative study of the effects of combined oral contraceptives in hemostatic variables: an observational preliminary study.

AbstractThrombotic risk is associated with the estrogen dose and type of progestin in combined oral contraceptives. Studies published since 1990 showed that third-generation progestins have larger risk to contribute to thrombosis development than the second-generation. However, there are conflicts in the literature regarding the thrombotic risk associated to the drospirenone progestin. So, this study aimed to evaluate the effects of 3 formulations of contraceptives containing ethinylestradiol (EE) (20 and 30 &mgr;g) combined with drospirenone versus levonorgestrel combined with EE (30 &mgr;g) in hemostatic parameters.This cross-sectional study included 70 healthy women between 18 and 30 years, BMI 19 to 30 kg/m2, not pregnant, non-smokers, and users or non-users (control) of contraceptives for a minimum period of 6 months. The following parameters were assessed: prothrombin time (PT), Factor VII, activated partial thromboplastin time (aPTT), Factor XII, fibrinogen, Factor 1 + 2, Protein C, Protein S, antithrombin, D-dimers, and plasminogen activator inhibitor-1.Significant alterations were found in PT, aPTT, fibrinogen, D-dimers, and protein S, all favoring a state of hypercoagulation for contraceptive containing DRSP/20EE. Both contraceptives containing DRSP/30EE and LNG/30EE promoted changes that favor the hypercoagulability in the coagulant variable PT and in the anticoagulant variables Protein S and Protein C, respectively.We suggest that the progestin drospirenone can contribute to an inadequate balance among procoagulant, anticoagulant, and fibrinolytic factors, since that the contraceptive containing the lowest dose of estrogen and drospirenone (DRSP/20EE) caused a higher number of hemostatic changes.