Treatment efficacy and safety of chlamydial infection in gynecologic diseases

Background: Chlamydia trachomatis is known to be the causative microorganism of multiple gynecologic diseases such as pelvic inflammatory disease (PID), tubo-ovarian abscess (T-O abscess), and Fitz-Hugh-Curtis syndrome (FHC syndrome). Due to its ability to destruct the celial lining of the fallopian tube and thereby obstructing the passage of the sperm and the egg, chlamydial infection may also result in female infertility. Therefore adequate care of the chlamydial infection is strongly advocated and the currently used treatment of choice is antibiotic coverage such as azithromycin or doxycycline.Methods: Medical records of the 50 patients who had been admitted to the department of Obstetrics and Gynecology, Ilsan hospital from May 2013 to May 2014, under the diagnosis of pelvic inflammatory disease, tubo-ovarian abscess, and Fitz-Hugh-Curtis syndrome with the confirmatory chlamydia trachomatis PCR positive result were taken into account. Patient’s characteristics, complications of the treatment, follow up results were analyzed.Results: Of the 37 patients given azithromycin 1000mg, 7 vomited completely (18.9%) requiring doxycycline to cover up. None of the patients taking doxycycline developed vomiting requiring second line of treatment. All of the patients were followed up in the outpatient clinic 4 weeks after being discharged from the hospital. 16.7% of the azithromycin taking group and 15.0% of the doxycycline taking group showed positive PCR result which showed no statistical significance.Conclusions: The advised 1000mg azithromycin single dosage to cover chlamydial infection is a convenient way of taking the medication, but as gastro-intestinal discomfort may follow, patients with a tendency to develop the complications should be advised to take doxycycline instead. Further research should focus on the test of cure evaluation method to differentiate reinfection from persisting disease

Comparison of intravaginal and oral metronidazole in patients with bacterial vaginosis

Background: Metronidazole is considered an effective treatment for bacterial vaginosis. Only oral preparations were available until 2014, but an intravaginal gel preparation recently became commercially available in South Korea. In this report, the efficacy and safety of metronidazole intravaginal gel application was compared to that of the conventional oral metronidazole preparation.Methods: Patients who were treated with either intravaginal metronidazole or oral metronidazole after diagnosis of bacterial vaginosis were included in this study. Patient characteristics, mode of treatment, recurrence rate, and complications including gastro-intestinal discomfort and concomitant vulvovaginal candidiasis were analyzed.Results: There were no differences in patient characteristics, except the mean age was older in the intravaginal group. Treatment outcomes were similar in both groups. In the oral metronidazole group, 6.3% of patients reported ongoing symptoms of bacterial vaginosis within one month of treatment and required a refill, while 7.3% of the intravaginal group required a refill. Significantly more patients on oral metronidazole treatment complained about gastro-intestinal discomfort including nausea (13.4%) and diarrhea (9.4%). Patients who took intravaginal metronidazole complained about increased watery vaginal discharge (26.8%). The comparatively high cost of metronidazole intravaginal gel was another factor that could affect patient access to this treatment versus the oral preparation. The incidence of vulvovaginal candidiasis was similar between groups (oral 3.9%, intravaginal 4.9%).Conclusions: Intravaginal metronidazole usage can be considered as an effective alternative treatment for bacterial vaginosis in patients with gastro-intestinal complications. However, the increased incidence of watery vaginal discharge and high cost remain obstacles to widespread use of the intravaginal preparation

Incidental finding of a Sertoli-Leydig cell tumor in a postmenopausal woman with complex endometrial hyperplasia

Sertoli-Leydig cell tumors (SLCTs) arise from the non-germ cell component of the ovary and typically present in young women with evidence of hyperandrogenism such as precocious puberty, amenorrhea, hirsutism and virilization. It is very rare accounting for less than 0.2% of all ovarian tumors, and because of the rarity, no standardized treatment approach has reached a consensus. The prognosis is generally good with complete reversion of symptoms after surgery, although some cases have been reported to be malignant. Recently the need for DICER1 mutations testing in paediatric patients has been emphasized for the surveillance of possible synchronous tumors and affected family members. Authors present here a case of Sertoli-Leydig cell tumor incidentally found while performing a hysterectomy with bilateral salpingo-oophorectomy in a postmenopausal woman with endometrial hyperplasia that caused intractable vaginal bleeding

Survival and reproductive outcome of childbearing age ovarian cancer patients taking fertility-sparing surgery

Background: Surgical management of ovarian cancer includes total hysterectomy and bilateral salpingo-oophorectomy which results in the loss of fertility. Fertility-sparing surgery in the reproductive aged women with early-stage ovarian cancer with favourable histology has been proposed by American College of Obstetrics and Gynecology and European Society for Medical Oncology. We sought to access the survival and fertility outcome of Korean women in their reproductive age who undertook fertility-sparing surgery.Methods: Based on the Korean National Insurance Claims Data and the National Health Information Database, 328 women with newly developed ovarian cancer in 2010 were followed up for the survival and pregnancy outcome until 2020. Patients who were diagnosed with cancer or underwent hysterectomy before 2010 were excluded. The control group consisted of 552 women matched by age, economic status and place of living.Results: Out of 120, 10 deaths occurred in the fertility-sparing surgery group showing a survival rate of 91.7%. Women undertaking fertility-sparing surgery had a lower chance of delivering a new-born compared to the control group (OR 0.46; 95% CI 0.26-0.81). Diagnosis of infertility, ectopic pregnancy, and abortion appeared higher in the fertility-sparing surgery group, but it did not reach a statistical significance.Conclusions: The pregnancy rate of the ovarian cancer patients with fertility-sparing surgery was lower than that of women without ovarian cancer. Undergoing fertility-sparing surgery per se should not deter women of trying to get pregnant as the pregnancy outcome indicators do not show statistically significant differences compared to the control group

Innovation and Internationalization of Korean SMEs in the Textile and Footwear Industries

Innovation has been recognized as one of the factors that enhances firm internationalization, a vital route for the growth and survival of small and medium enterprises. Thus, it is important to identify antecedents of firm innovation and their impacts on SME internationalization for their long-term success. Accordingly, the present study examined a model of SME internationalization in which the causal relationships among entrepreneurial orientation, absorptive capacity, innovation (product, process, and marketing innovation), and internationalization were proposed. Analyses of 156 survey data collected from Korean SMEs exporting textiles, apparel, and footwear revealed that entrepreneurial orientation and absorptive capacity appeared to function as significant antecedents of product and process innovation. Among three dimensions of innovation, only process and marketing innovation positively affected internationalization. The study provides practical implications by asserting the importance of process and marketing innovation to increase firm internationalization

Clinical characteristics and treatment modalities of vulvovaginal atrophy in genitourinary syndrome of menopause

Background: Genitourinary syndrome of menopause (GSM) causes symptoms such as vaginal dryness, dysuria, repetitive urinary tract infection and urinary urgency may affect daily activities, sexual relationships, and overall quality of life. The aim of the study was to provide the clinical characteristics of VVA patients in South Korea and the effectiveness as well as complications of the currently used low dose estrogen vaginal suppository.Methods: 52 women who has visited the outpatient gynecology clinic of the National Health Insurance Service Ilsan Hospital from January 2018 to December 2019 were recruited as study subjects. For the analysis of the clinical characteristics, subjective symptoms described by the patient’s own words such as vaginal dryness, pain, dysuria, dyspareunia, or no symptoms at all were included. Objective signs such as thinning of vaginal rugae, mucosal dryness, and mucosal fragility and the presence of petechiae were recorded.Results: Vaginal dryness was the most common complaint (92.3%). Thinning of the vaginal rugae was the most commonly noted objective sign (73.1%). Of the 52 subjects, 31 (59.6%) refrained from using the low dose estrogen vaginal suppository. The most common reason for not being able to use the suppository was the inability to insert the suppository (32.3%).Conclusions: Although patient-reported symptoms and clinical objectivity through physical examination are two components in diagnosing VVA, further study is warranted for a more objective and discriminatory diagnosis criteria for VVA. As the only available treatment modality was low dose vaginal estrogen suppository, comparison with other treatment modalities were not available

Changes of phenolic compounds in LebZIP2-overexpressing transgenic plants

484-491The bZIP gene is a transcription factor that plays various roles in relation to plant stress and hormone signaling. This gene is also involved in plant environmental stress and herbicide tolerance. We generated Nicotiana benthamiana transgenic plants with LebZIP2-encoding gene isolated from tomatoes using Agrobacterium-mediated transformation. Transgenic seeds harvested from these T0 transgenic plants were grown and examined for gene transfer and changes in phenolic compounds in the T1 generation. RT-PCR analysis using a primer specific to the LebZIP gene confirmed that the gene was transferred to the T1 generation. We analyzed the increase and decrease tendency for 30 phenolic compounds using the T1 generation-transgenic plants and investigated the mechanism between the specifically increased compound and LebZIP2 gene. Gallic acid, homogentisic acid, protocatechuic acid, myricetin, t-cinnamic acid, and b-resorcyclic acid were identified as the phenolic compounds that increased in T1 transgenic plants overexpressing the LebZIP gene. Among these, homogentisic acid at 246.75-1055.19 µg/g, was increased by 2-5 fold in the T1 transgenic plants compared to the control. Protocatechuic acid was found at 1640.54-2456.00 µg/g and was increased by 2-4 fold in T1 transgenic plants. t-Cinnamic acid was present in a small amount of 23.14 µg/g in the control, whereas it was 102.19-135.47 µg/g in T1 transgenic plants, showing an increase of 4-5 folds. These results indicated that homogentisic acid, protocatechuic acid, and t-cinnamic acid among the 30 phenolic compounds analyzed, were significantly increased in LebZIP2-overexpressing T1 transgenic plants, and support the evidence that the LebZIP2 gene is significantly involved in the increment of three phenolic compounds