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Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care
Isabel Del-Cura González, Francisca García-de-Blas González, Teresa Cuesta, Jesús Fernández, Justo M Del-Alamo Rodríguez, Rosa A Escriva Ferrairo, M del Canto De-Hoyos Alonso, Laura Arenas, Ricardo Barrientos, Elisa Wiesmann, Cristina De-Alba Romero, Yolanda Díaz, Ana Rodríguez-Mo?ino, Blanca Teira, Marta del Pozo, Jesús Horcajuelo, María J Rojas Giraldo, Paulino González, Rocío A Vello Cuadrado, Beatriz Uriarte, Jeannet Yepes, Yolanda Sanz, M Iglesias Pi?eiro, Susana Hernández, Fernando Alonso, Ana I González González, Alicia Fernández, Carmen Carballo, Ana López, Fernanda Morales
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-63
Abstract: This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical) in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid.The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression).. The dependent variable being the type of treatment chosen (oral or topical) and the independent, the variables that after bivariant analysis, have been associated to the treatment preference.Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient.Vaginitis is the most frequent reason for gynecology consultation in primary health care services. It is estimated that 75% of women experience at least one episode of vulvovaginal candidiasis throughout her life and 40-50% of them have at least one recurrence [1].The most frequent cause of vulvovaginal inflammation is infective, beeing the main organisms: Gardnerella vaginalis (15-50%), Candida (C) (20-25%) and Trichomonas vaginalis (5-50%) species, with a frequency distribution that depends on the populations studied [2]. Candidal vaginitis is a generic term used for vaginal infections caused by Candida species. Candida albicans is responsible for 90% of vulvovaginal candidiasis; the remaining 10% corresponds to C. glabrata and C
Efficiency of fenticonazole for the treatment of vaginal candidiasis
?ivaljevi? Biljana,Golubovi? Ilija,Seratli? Jelena,Nikoli? Petar
Srpski Arhiv za Celokupno Lekarstvo , 2012, DOI: 10.2298/sarh1208469z
Abstract: Introduction. Uncomplicated vulvovaginal candidiasis appears in 75% women of reproductive age. The most frequent causes are Candida albicans (85-95%) or C. glabrata, and infrequently C. krusei, C. tropicalis, C. parapsilosis, C. pseudotropicalis, etc. Objective. The aim of the study was to investigate efficiency and safety of fenticonazole for vaginal candidiasis treatment. Methods. Therapeutic effect of a single 600 mg fenticonasole vaginal capsule was observed in 417 women, aged 16-67, in five centers in Serbia. In all women, before the treatment, vaginal candidiasis was confirmed by testing of vaginal smear. Based on smear findings and associated symptoms observed on the 7th and 28th day after therapy administration, treatment results were evaluated. On the next day after drug application the patients recorded by using a questionnaire their own feelings on withdrawal symptoms and possible side effects in the period prior to the first control. Results. Control after seven days showed a statistically significant decrease of symptoms. In 385 women, vaginal smear was found negative to yeast and yeast blastospores. Within the first seven days after treatment 84 women had to repeat therapy due to the persistence of symptoms or positive vaginal smear. After 28 days we recorded full recovery in 392 patients, clinical improvement in eight, no change in 16, and deterioration in one patient only. Side effects were very seldom, mostly in the form of a slight redness of the vulva and vagina, and mild itching during several days. Conclusion. Our observations confirmed good efficacy and safety of fenticonazole in the treatment of vaginal candidiasis.
Virgin Coconut Oil (VCO) Enriched with Zn as Immunostimulator for Vaginal Candidiasis Patient  [PDF]
HERY WINARSI,HERNAYANTI,AGUS PURWANTO
HAYATI Journal of Biosciences , 2008,
Abstract: Disturbance on the immune system and deficiency of Zn is two factors which often trigger vaginal candidiasis patient. The aim of the research was to study the effect of virgin coconut oil (VCO) enriched with Zn to the amount of neutrophil and lymphocyte subset cells, and the level of IL-2 and IgG in vaginal candidiasis patient. Thirty women were grouped into three (ten women in each group): A, B and C, and intervened for two months. Women in A group were intervened with two tablespoon/day; those in B group were intervened with one tablespoon/day; while those in C group served as control (placebo). Blood was sampled at baseline time, one and two months after intervention. Hematological test by Micros-OT was done on a part of blood, and the plasma was used for IL-2 and IgG level tests using ELISA. The virgin coconut oil enriched with Zn maintained the number of neutrophil and NK cells, but increased Tc cells from 521 to 649 cells/mm3, increased Th cells from 1.090 to 1.380 cells/mm3. The enriched VCO also increase level of IL-2 from 0.25313 to 0.27337 pg/ml, while the IgG level changed from equivocal to negative. The recommended dosage was one tablespoon each day.
In vitro/in vivo performance of different complexes of itraconazole used in the treatment of vaginal candidiasis  [cached]
Mohammad Aamir Mirza,Mohammad Akhlaquer Rahman,Sushama Talegaonkar,Zeenat Iqbal
Brazilian Journal of Pharmaceutical Sciences , 2012,
Abstract: A large majority of new chemical entities and many existing drug molecules exhibit poor aqueous solubility, which may limit their potential use in developing drug formulations, with optimum bioavailability. One of the approaches to improve the solubility of a poorly water soluble drug and eventually its bioavailability is complexation with agents like humic acid (HA), fulvic acid (FA), β-cyclodextrin (β-CD), 2-hydroxypropyl-β-cyclodextrin (HP-β-CD) and caffeine (Caff). The current work emphasized at employing these agents to prepare different complexes and their in vitro/in vivo assessment. All the complexes evaluated for their complexation efficiency and authenticated by molecular modeling; conformational analysis, differential scanning calorimetry (DSC), X-ray diffraction (XRD), nuclear magnetic resonance (NMR) and mass spectroscopy. Furthermore, the complexes were assessed in an in vivo, rat vaginal model for their efficacy in treatment of vaginal candidiasis. Amongst the five tested complexes, fulvic acid-itraconazole complex yielded better solubility as well as in vivo efficacy and therefore may further be explored for developing a commercial formulation for treating vaginal candidiasis. A maioria das novas entidades químicas e muitas moléculas de fármacos existentes apresenta fraca solubilidade em água, o que pode limitar seu uso potencial no desenvolvimento de formula es com biodisponibilidade ideal. Uma das abordagens para melhorar a solubilidade de um fármaco pouco solúvel em água e, eventualmente, a sua biodisponibilidade é a complexa o com agentes como o ácido húmico (HA), ácido fúlvico (FA), β-ciclodextrina (β-CD), 2-hidroxipropil-β-ciclodextrina (HP-β-CD) e cafeína (Caff). O presente trabalho baseia-se no uso desses agentes para preparar diferentes complexos e suas avalia es in vitro/in vivo. Todos os complexos foram avaliados quanto à eficiência de complexa o por modela o molecular, análise conformacional, calorimetria de varredura diferencial (DSC), difra o de raios-X (XRD), ressonancia magnética nuclear (RMN) e espectroscopia de massas. Além disso, os complexos foram avaliados in vivo, em ratas, no tocante à sua eficácia no tratamento de candidíase vaginal. Entre os cinco complexos testados, o complexo de ácido fúlvico-itraconazol foi o que apresentou melhor solubilidade, bem como melhor eficácia in vivo e, portanto, pode ser explorado para o desenvolvimento de uma formula o comercial para o tratamento de candidíase vaginal.
Polyhexamethylene Biguanide in Vaginal Solution Is Effective in the Treatment of Vulvovaginal Candidiasis: A Pilot Study  [PDF]
Alberto Biamonti, Angela Saracino
Open Journal of Obstetrics and Gynecology (OJOG) , 2017, DOI: 10.4236/ojog.2017.71002
Abstract: Vaginitis is one of the most recurrent conditions that afflict women and require medical care. Vulvovaginal candidiasis (VVC) is frequently related to vaginal carriage of Candida albicans, an opportunistic polymorphic fungus, which colonizes the human skin, the mucosa and the reproductive tract. Actually, standard treatments to counteract vaginitis include several topical and oral treatments. The aim of this study was to evaluate the efficacy of a new biguanide compound, polyhexamethylene biguanide (PHMB) in avaginal solution, in women affected by vaginal candidiasis. For this reason, 40 women showing the symptoms previously ascribed to vaginal candidiasis were recruited and treated with a single PHMB dose of vaginal solution. After a single dose of treatment, 80% of them had a complete resolution of the fungal infection; furthermore, all of them reported clinical benefits, statistically significant reduction in both clinical signs and symptoms of candidiasis and a score’s reduction of 50%.
Patient preferences in the treatment of diabetic retinopathy
Wirostko B, Beusterien K, Grinspan J, Ciulla T, Gonder J, Barsdorf A, Pleil A
Patient Preference and Adherence , 2011, DOI: http://dx.doi.org/10.2147/PPA.S11972
Abstract: tient preferences in the treatment of diabetic retinopathy Original Research (3326) Total Article Views Authors: Wirostko B, Beusterien K, Grinspan J, Ciulla T, Gonder J, Barsdorf A, Pleil A Published Date May 2011 Volume 2011:5 Pages 229 - 237 DOI: http://dx.doi.org/10.2147/PPA.S11972 Barbara Wirostko1, Kathleen Beusterien2, Jessica Grinspan2, Thomas Ciulla3, John Gonder4, Alexandra Barsdorf1, Andreas Pleil5 1Pfizer, New York, NY, USA; 2Oxford Outcomes, Bethesda, MD, USA; 3Midwest Eye Institute, Indianapolis, IN, USA; 4Ivey Eye Institute, London, Ontario, Canada; 5Pfizer Inc, San Diego, CA, USA Objective: Accounting for patient preferences may be especially important in diabetes mellitus, given the challenge in identifying factors associated with treatment adherence. Although preference studies have been performed in diabetes, none have examined treatments used in diabetic retinopathy (DR). The objective of this study was to elicit patient preferences for attributes associated with antivascular endothelial growth factor, focal and panretinal laser, and steroid therapy used in DR management. Methods: A cross-sectional conjoint survey was administered to DR patients at three Canadian eye centers. The survey involved making tradeoffs among 11 DR treatment attributes, including the chance of improving vision and risks of adverse events over a 1-year treatment period. Attribute utilities were summed for each product profile to determine the most preferred treatment. Results: Based on the results from 161 patients, attributes affecting visual functioning, including improving visual acuity and reducing adverse events (eg, chance of cataracts), were more important than those not directly affecting vision (eg, administration). Overall, 52%, 20%, 17%, and 11% preferred the product profiles matching to the antivascular endothelial growth factor, steroid, focal laser, and panretinal laser therapies. Preferences did not vary substantially by previous treatment experience, age, or type of DR (macular edema, proliferative DR, both or neither), with the exception that more macular edema only patients preferred focal laser over steroid treatment (19% versus 14%, respectively). Conclusions: When considering the potential effects of treatment over a 1-year period, treatment preferences in DR are most influenced by those that may positively or negatively affect visual functioning.
Patient preferences in the treatment of diabetic retinopathy  [cached]
Wirostko B,Beusterien K,Grinspan J,Ciulla T
Patient Preference and Adherence , 2011,
Abstract: Barbara Wirostko1, Kathleen Beusterien2, Jessica Grinspan2, Thomas Ciulla3, John Gonder4, Alexandra Barsdorf1, Andreas Pleil51Pfizer, New York, NY, USA; 2Oxford Outcomes, Bethesda, MD, USA; 3Midwest Eye Institute, Indianapolis, IN, USA; 4Ivey Eye Institute, London, Ontario, Canada; 5Pfizer Inc, San Diego, CA, USAObjective: Accounting for patient preferences may be especially important in diabetes mellitus, given the challenge in identifying factors associated with treatment adherence. Although preference studies have been performed in diabetes, none have examined treatments used in diabetic retinopathy (DR). The objective of this study was to elicit patient preferences for attributes associated with antivascular endothelial growth factor, focal and panretinal laser, and steroid therapy used in DR management.Methods: A cross-sectional conjoint survey was administered to DR patients at three Canadian eye centers. The survey involved making tradeoffs among 11 DR treatment attributes, including the chance of improving vision and risks of adverse events over a 1-year treatment period. Attribute utilities were summed for each product profile to determine the most preferred treatment.Results: Based on the results from 161 patients, attributes affecting visual functioning, including improving visual acuity and reducing adverse events (eg, chance of cataracts), were more important than those not directly affecting vision (eg, administration). Overall, 52%, 20%, 17%, and 11% preferred the product profiles matching to the antivascular endothelial growth factor, steroid, focal laser, and panretinal laser therapies. Preferences did not vary substantially by previous treatment experience, age, or type of DR (macular edema, proliferative DR, both or neither), with the exception that more macular edema only patients preferred focal laser over steroid treatment (19% versus 14%, respectively).Conclusions: When considering the potential effects of treatment over a 1-year period, treatment preferences in DR are most influenced by those that may positively or negatively affect visual functioning.Keywords: diabetes, retinopathy, patient preference, ophthalmology, conjoint analysis
Treatment of asymptomatic vaginal candidiasis in pregnancy to prevent preterm birth: an open-label pilot randomized controlled trial
Christine L Roberts, Kristen Rickard, George Kotsiou, Jonathan M Morris
BMC Pregnancy and Childbirth , 2011, DOI: 10.1186/1471-2393-11-18
Abstract: We used a prospective, randomized, open-label, blinded-endpoint (PROBE) study design. Pregnant women presenting at <20 weeks gestation with singleton pregnancies self-collected a vaginal swab. Those who were asymptomatic and culture positive for Candida were randomized to 6-days of clotrimazole vaginal pessaries (100mg) or usual care (screening result is not revealed, no treatment). The primary outcomes were the rate of asymptomatic vaginal candidiasis, participation and follow-up. The proposed primary trial outcome of spontaneous preterm birth <37 weeks gestation was also assessed.Of 779 women approached, 500 (64%) participated in candidiasis screening, and 98 (19.6%) had asymptomatic vaginal candidiasis and were randomized to clotrimazole or usual care. Women were not inconvenienced by participation in the study, laboratory testing and medication dispensing were problem-free, and the follow-up rate was 99%. There was a tendency towards a reduction in spontaneous preterm birth among women with asymptomatic candidiasis who were treated with clotrimazole RR = 0.33, 95%CI 0.04-3.03.A large, adequately powered, randomized trial of clotrimazole to prevent preterm birth in women with asymptomatic candidiasis is both feasible and warranted.Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12609001052224Prevention of spontaneous preterm birth remains one of the most important challenges in modern maternity care. Whilst an association between ascending infection and preterm birth is undisputed, research focussed on finding effective preventive treatments has been disappointing[1]. To date, most treatment trials (e.g. for bacterial vaginosis, Ureaplasma urealyticum, Chlamydia trachomatis, trichomoniasis) have found little effect on the rate of preterm birth[2]. In contrast, in a randomized controlled trial of early antenatal screening (15-19 weeks) and treatment for asymptomatic bacterial vaginosis, candidiasis and/or trichomoniasis in early pregnancy, Kiss a
Long Term Vaginal Azoles Versus Prophylactic Oral Fluconazole in Treatment of Recurrent Vulvovaginal Candidiasis
Zahra Fardy Azar,Shahram Habib Zadeh
Research Journal of Biological Sciences , 2012,
Abstract: Recurrent Vulvovaginal Candidiasis (RVVC) is a fungal infection of the vagina and vulva that occur usually = 4 episodes in a year. Our object was to compare the efficacy and safety of a single oral dose of fluconazole (150 mg) weekly with clotrimazole vaginal cream 150 mg twice weekly for 6 months as treatment of recurrent VVC. We conducted a clinical trial study among 124 women with Recurrent Vulvovaginal Candidiasis (RVVC) among patients presenting to the Obstetrics and Gynecology Clinics of Tabriz University of Medical Sciences from 2002-2004. There was no significant difference in the therapeutic response as the recurrence rate during 12 months between the two groups. The drug side effects in the fluconazole group were significantly more than clotrimazole group. The satisfactory from the drug in the fluconazole group was significantly less than clotrimazole group. Due to the fewer side effects and more satisfactory of local treatment, we recommend profilactic use of Azole vaginal creams for treatment of RVVC especially in women who are pregnant or have systemic problems.
Beneficial effect of Mentha suaveolens essential oil in the treatment of vaginal candidiasis assessed by real-time monitoring of infection
Donatella Pietrella, Letizia Angiolella, Elisabetta Vavala, Anna Rachini, Francesca Mondello, Rino Ragno, Francesco Bistoni, Anna Vecchiarelli
BMC Complementary and Alternative Medicine , 2011, DOI: 10.1186/1472-6882-11-18
Abstract: The in vitro and in vivo activity of EOMS was assessed. The in vitro activity was evaluated under standard CLSI methods, and the in vivo analysis was carried out by exploiting a novel, non-invasive model of vaginal candidiasis in mice based on an in vivo imaging technique.Differences between essential oil treated and saline treated mice were evaluated by the non-parametric Mann-Whitney U-test. Viable count data from a time kill assay and yeast and hyphae survival test were compared using the Student's t-test (two-tailed).Our main findings were: i) EOMS shows potent candidastatic and candidacidal activity in an in vitro experimental system; ii) EOMS gives a degree of protection against vaginal candidiasis in an in vivo experimental system.This study shows for the first time that the essential oil of a Moroccan plant Mentha suaveolens is candidastatic and candidacidal in vitro, and has a degree of anticandidal activity in a model of vaginal infection, as demonstrated in an in vivo monitoring imaging system. We conclude that our findings lay the ground for further, more extensive investigations to identify the active EOMS component(s), promising in the therapeutically problematic setting of chronic vaginal candidiasis in humans.Candida albicans is a major fungal pathogen of humans [1,2] and a commensal organism of the gastrointestinal tract. In severely immunocompromised patients this fungus causes high morbidity and mortality. C. albicans is also the etiological agent of vulvovaginal candidiasis, a common pathological condition, afflicting normal women of fertile age, which frequently develops into a chronic, substantially incurable, disease [3].Different classes of antimycotic drugs are available to treat fungal infections. The azoles, particularly fluconazole, remain among the most common antifungal drugs, but their intensive clinical use for both therapy and prophylaxis has favoured the emergence of resistant strains [4]. The phenomenon of drug resistance has raise
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