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Navarro S, Abla H, Colmer-Hamood JA, Ventolini G, Hamood AN. Under conditions closely mimicking vaginal fluid, Lactobacillus jensenii strain 62B produces a bacteriocin-like inhibitory substance that targets and eliminates Gardnerella species. Microbiology (Reading) 2023; 169. [PMID: 37909284 DOI: 10.1099/mic.0.001409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Within the vaginal ecosystem, lactobacilli and Gardnerella spp. likely interact and influence each other's growth, yet the details of this interaction are not clearly defined. Using medium simulating vaginal fluid and a two-chamber co-culturing system to prevent cell-to-cell contact between the bacteria, we examined the possibility that Lactobacillus jensenii 62B (Lj 62B) and/or G. piotii (Gp) JCP8151B produce extracellular factors through which they influence each other's viability. By 24 h post-inoculation (hpi) in the co-culture system and under conditions similar to the vaginal environment - pH 5.0, 37 °C, and 5% CO2, Lj 62B viability was not affected but Gp JCP8151B had been eliminated. Cell-free supernatant harvested from Lj 62B cultures (Lj-CFS) at 20 hpi, but not 16 hpi, also eliminated Gp JCP8151B growth. Neither lactic acid nor H2O2 production by Lj 62B was responsible for this effect. The Lj-CFS did not affect viability of three species of lactobacilli or eight species of Gram-positive and Gram-negative uropathogens but eliminated viability of eight different strains of Gardnerella spp. Activity of the inhibitory factor within Lj-CFS was abolished by protease treatment and reduced by heat treatment suggesting it is most likely a bacteriocin-like protein; fractionation revealed that the factor has a molecular weight within the 10-30 kDa range. These results suggest that, in medium mimicking vaginal fluid and growth conditions similar to the vaginal environment, Lj 62B produces a potential bacteriocin-like inhibitory substance (Lj-BLIS) that clearly targets Gardnerella spp. strains. Once fully characterized, Lj-BLIS may be a potential treatment for Gardnerella-related BV that does not alter the vaginal microflora.
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Affiliation(s)
- Stephany Navarro
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Habib Abla
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jane A Colmer-Hamood
- Department of Medical Education, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Gary Ventolini
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center Permian Basin, Odessa, TX, USA
| | - Abdul N Hamood
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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2
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Enakpene CA, Canci ME, Ventolini G. Obstetric vascular Doppler velocimetry: clinical applications and overuses. Minerva Obstet Gynecol 2023; 75:482-490. [PMID: 37140586 DOI: 10.23736/s2724-606x.23.05164-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A safe and non-intrusive assessment of fetal health is not only crucial in low-risk gestations, but it is also the standard of care in high-risk pregnancies. Therefore, measuring blood flow across different vessels with non-invasive ultrasound methods has been accurately and painstakingly studied and published. Amongst these state-of-the-art techniques, umbilical artery (blood flow) Doppler velocimetry (UADV) has allowed for fetal well-being follow-ups and assess uteroplacental function, which obtains a more complete and clearer picture; particularly in regard to complicated pregnancies. Additionally, there are other modalities with diverse clinical applications that have emerged, including their clinical and research utilization in conditions such as fetal growth restriction (FGR), preeclampsia, fetal anemia, monochorionic twins vascular blood flow mismatch such as is in twin-to-twin transfusion syndrome, twin anemia polycythemia sequence, and twin reverse arterial perfusion sequence. Nevertheless, their applications regarding various other maternal-fetal diagnoses in the same way as premature births and/or multiple gestation surveillance have not been reported to hold strong clinical evidence. With that in regard, the purpose of this unique study was to give update of the multiple clinical applications of this very important obstetrical tool. Additionally, to review the pathophysiology as well as revisit their reported significant valid uses and occasional overuses. We also delved into quality control measures as related to the application of Doppler in obstetrics. Lastly, it is essential to look through and reflect on the future developments of this valuable, non-invasive, high-risk marvelous modern device.
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Affiliation(s)
- Christopher A Enakpene
- Maternal-Fetal Medicine, School of Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Permian Basin, TX, USA
| | - Maria E Canci
- Department of Family Medicine, Texas Tech University Health Sciences Center, Permian Basin, TX, USA
| | - Gary Ventolini
- Maternal-Fetal Medicine, School of Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Permian Basin, TX, USA -
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3
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Navarro S, Abla H, Delgado B, Colmer-Hamood JA, Ventolini G, Hamood AN. Glycogen availability and pH variation in a medium simulating vaginal fluid influence the growth of vaginal Lactobacillus species and Gardnerella vaginalis. BMC Microbiol 2023; 23:186. [PMID: 37442975 PMCID: PMC10339506 DOI: 10.1186/s12866-023-02916-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Glycogen metabolism by Lactobacillus spp. that dominate the healthy vaginal microbiome contributes to a low vaginal pH (3.5-4.5). During bacterial vaginosis (BV), strict and facultative anaerobes including Gardnerella vaginalis become predominant, leading to an increase in the vaginal pH (> 4.5). BV enhances the risk of obstetrical complications, acquisition of sexually transmitted infections, and cervical cancer. Factors critical for the maintenance of the healthy vaginal microbiome or the transition to the BV microbiome are not well defined. Vaginal pH may affect glycogen metabolism by the vaginal microflora, thus influencing the shift in the vaginal microbiome. RESULTS The medium simulating vaginal fluid (MSVF) supported growth of L. jensenii 62G, L. gasseri 63 AM, and L. crispatus JV-V01, and G. vaginalis JCP8151A at specific initial pH conditions for 30 d. L. jensenii at all three starting pH levels (pH 4.0, 4.5, and 5.0), G. vaginalis at pH 4.5 and 5.0, and L. gasseri at pH 5.0 exhibited the long-term stationary phase when grown in MSVF. L. gasseri at pH 4.5 and L. crispatus at pH 5.0 displayed an extended lag phase over 30 d suggesting inefficient glycogen metabolism. Glycogen was essential for the growth of L. jensenii, L. crispatus, and G. vaginalis; only L. gasseri was able to survive in MSVF without glycogen, and only at pH 5.0, where it used glucose. All four species were able to survive for 15 d in MSVF with half the glycogen content but only at specific starting pH levels - pH 4.5 and 5.0 for L. jensenii, L. gasseri, and G. vaginalis and pH 5.0 for L. crispatus. CONCLUSIONS These results suggest that variations in the vaginal pH critically influence the colonization of the vaginal tract by lactobacilli and G. vaginalis JCP8151A by affecting their ability to metabolize glycogen. Further, we found that L. jensenii 62G is capable of glycogen metabolism over a broader pH range (4.0-5.0) while L. crispatus JV-V01 glycogen utilization is pH sensitive (only functional at pH 5.0). Finally, our results showed that G. vaginalis JCP8151A can colonize the vaginal tract for an extended period as long as the pH remains at 4.5 or above.
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Affiliation(s)
- Stephany Navarro
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX USA
| | - Habib Abla
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX USA
| | - Betsaida Delgado
- Honors College, Texas Tech University, Lubbock, TX USA
- Woody L. Hunt School of Dental Medicine, Texas Tech University Health Sciences Center, Lubbock, TX USA
| | - Jane A. Colmer-Hamood
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX USA
- Department of Medical Education, Texas Tech University Health Sciences Center, Lubbock, TX USA
| | - Gary Ventolini
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center Permian Basin, Odessa, TX USA
| | - Abdul N. Hamood
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX USA
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX USA
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Coppedge N, Garza J, Gandhi K, Sanchez A, Galloway J, Ventolini G. Lactobacillus microbiota of the female genital tract in vaginal lactobacillosis. Arch Gynecol Obstet 2023; 307:1319-1322. [PMID: 36869938 DOI: 10.1007/s00404-023-06988-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Affiliation(s)
- Nicole Coppedge
- School of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, 301 North N Street Midland, Odessa, TX, 79701, USA
| | - John Garza
- School of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, 301 North N Street Midland, Odessa, TX, 79701, USA.,The University of Texas Permian Basin, Odessa, TX, USA
| | - Kushal Gandhi
- School of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, 301 North N Street Midland, Odessa, TX, 79701, USA
| | - Asley Sanchez
- School of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, 301 North N Street Midland, Odessa, TX, 79701, USA
| | - Josh Galloway
- School of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, 301 North N Street Midland, Odessa, TX, 79701, USA
| | - Gary Ventolini
- School of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, 301 North N Street Midland, Odessa, TX, 79701, USA.
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Okwuwa I, Alam N, Wai R, Shayeb M, Sanchez A, Gandhi K, Garza J, Ventolini G. Pubic Candida Folliculitis, A Case Report in a Patient With Recurrent Vaginal Candidiasis. J Family Reprod Health 2023; 17:62-64. [PMID: 37538222 PMCID: PMC10394490 DOI: 10.18502/jfrh.v17i1.11981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Objective Folliculitis is a skin infection and inflammation that develops in the hair follicles. While most cases of folliculitis are caused by bacterial infections, here is a case of folliculitis caused by the Candida fungi in an immunocompetent host. Case report A 23-year-old non-diabetic immunocompetent female with recurrent vaginal candidiasis developed clusters of erythematous, pruritic papules in the pubic area. Upon evaluation, the clusters were determined to be folliculitis. Risk factors for folliculitis included shaving of the pubic area, hot tub use, and wearing of tight, restrictive clothing. Cultures and skin samples of the folliculitis demonstrated Candida albicans. The patient was subsequently and successfully treated with clotrimazole solution and cream. There was no recurrence of the folliculitis upon her 3-month follow-up appointment. Conclusion Candida folliculitis is a rare condition in non-diabetic patients. The patient's history, risk factors and immune status assessment, and physical examination with proper diagnostic testing, are crucial steps in attaining the correct diagnosis.
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Affiliation(s)
- Ikemefuna Okwuwa
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Nimat Alam
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Rachel Wai
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Miriam Shayeb
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Asley Sanchez
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Kushal Gandhi
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - John Garza
- The University of Texas Permian Basin (UTPB), Odessa, TX, USA
| | - Gary Ventolini
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
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Le DM, Le T, Sanchez AA, Gandhi K, Ventolini G. Cytokine levels in women with provoked vulvodynia: a pilot study. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Gandhi K, Manales NJ, Garza J, David S, Sanchez A, Ventolini G. Lactobacilli and Cytokine Modifications during Menopause and Their Relation to Vulvar and Vulvovaginal Disorders. J Menopausal Med 2022; 28:52-59. [PMID: 36070870 PMCID: PMC9452597 DOI: 10.6118/jmm.22001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 07/13/2022] [Accepted: 08/08/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Female sexual and reproductive health is heavily influenced by the levels and ratios of Lactobacilli species and vaginal cytokines. Menopause marks a profound body change as it shifts to a natural and permanent non-reproductive state. Vulvovaginal diseases encompass a broad variety of sexual health conditions. Furthermore, both menopause and vulvovaginal diseases affect vaginal Lactobacilli and cytokine levels. Thus, this study aimed to investigate the correlation between menopause, vulvovaginal diseases, and vaginal Lactobacilli and cytokine levels. METHODS Vaginal swab samples were collected as part of a prospective data bank creation to study vaginal conditions as approved by the Institutional Review Board of Texas Tech University Health Sciences Center, Lubbock, USA. This study utilized 38 samples in this database, which were assigned to the pre-menopausal with no vulvovaginal conditions (n = 20) and post-menopausal with vulvovaginal conditions (n = 18) groups. A real-time polymerase chain reaction was conducted to determine the relative concentration of Lactobacilli species, while cytokine analysis was performed using multiplex enzyme-linked immunosorbent assay immunoassay. The standardized mean difference, multivariate analysis of variance, and permutational unequal variance t test were used for the statistical analysis. RESULTS Cytokines, interleukin (IL)-6, macrophage inflammatory protein-1α, IL-8, and Lactobacillus iners expression were significantly elevated in the control group compared to the study group (P = 0.03 for the cytokines, P = 0.0194 for Lactobacilli). CONCLUSIONS The levels of vaginal cytokine and Lactobacillus profile were significantly different between the pre-menopausal and post-menopausal groups.
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Affiliation(s)
- Kushal Gandhi
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Nathan Joshua Manales
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - John Garza
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA.,Department of Mathematics, The University of Texas Permian Basin, Odessa, TX, USA
| | - Samuel David
- Department of Chemistry, Southern Oregon University, Ashland, OR, USA
| | - Asley Sanchez
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Gary Ventolini
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA.
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Eboh S, Burghul S, Galloway M, Sanchez A, Ventolini G. Preterm Complete Uterine Rupture With En Caul Expulsion. Clin Med Insights Case Rep 2022; 15:11795476221112376. [PMID: 35845355 PMCID: PMC9280791 DOI: 10.1177/11795476221112376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/17/2022] [Indexed: 12/01/2022] Open
Abstract
Spontaneous uterine rupture is a catastrophic obstetric complication for both the mother and fetus. We highlight a case of a 32-year-old G2P1A0L1 Hispanic female at 36 weeks gestation who presented to the labor and delivery unit with minimal prenatal care, complaining of abdominal pains and vaginal bleeding. An abdominopelvic ultrasound confirmed an empty uterus and fetal demise in the abdominal cavity, leading to an exploratory laparotomy to evacuate the fetus. At surgery, a preterm sized fetus “en caul” with intact amnions was floating in the abdominal cavity and a hemostatic, complete rupture of the anterior uterine wall was discovered. Uterus was repaired and the patient recovered postoperatively without complications. Despite the best evidence suggesting that a history of low-transverse Cesarean section poses a low risk for spontaneous uterine rupture, this complication should always be considered and patients should be counseled regardless of the low risk should they desire a cesarean section.
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Affiliation(s)
- Stanley Eboh
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Suna Burghul
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Michael Galloway
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Asley Sanchez
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Gary Ventolini
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
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Ventolini G, Gandhi K, Manales NJ, Garza J, Sanchez A, Martinez B. Challenging Vaginal Discharge, Lactobacillosis and Cytolytic Vaginitis. J Family Reprod Health 2022; 16:102-105. [DOI: 10.18502/jfrh.v16i2.9477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In women’s health, clinicians are often faced with diagnosing and administering treatment to patients who present with an increased vaginal discharge without much other information to work with. It’s only once a patient’s background is reviewed and lab work is completed that two common reasons behind vaginal discharge with similar symptoms, Lactobacillosis and Cytolytic Vaginitis, can be differentiated and a proper diagnosis can be reached.
Now, we understand that Lactobacillosis and Cytolytic Vaginitis are symptomatically confused by patients as well as inexperienced clinicians. Lactobacillosis involves the presence of abnormal, extremely long Lactobacilli, a keystone species for vaginal health, while Cytolytic Vaginitis mainly involves, increased Lactobacilli, pH between 3.5 and 4.5, presence of cytolysis, and a lowered white blood cell count.
Both present with similar discharge, leading to their conflation. A microscopic examination of the discharge using a wet mount with normal saline can provide 80% diagnostic sensitivity until further testing can be completed.
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Abstract
OBJECTIVE This series of articles, titled The Vaginal Microbiome (VMB), written on behalf of the International Society for the Study of Vulvovaginal Disease, aims to summarize the recent findings and understanding of the vaginal bacterial microbiota, mainly regarding areas relevant to clinicians specializing in vulvovaginal disorders. MATERIALS AND METHODS A search of PubMed database was performed, using the search terms "vaginal microbiome" with "dysbiosis," "bacterial vaginosis," "cytolytic vaginosis," "desquamative inflammatory vaginitis," and "aerobic vaginitis." Full article texts were reviewed. Reference lists were screened for additional articles. RESULTS The second article in this series focuses on vaginal dysbiotic conditions. Dysbiosis is a term describing imbalances in bacterial communities. Given that lactobacillus-dominated microbiota are thought to be the most optimal, vaginal dysbiosis is usually considered as lactobacilli-depleted VMB. Bacterial vaginosis (BV), the most common vaginal dysbiotic condition, is a polymicrobial disorder, considered the leading cause for vaginal discharge in women worldwide. In addition, we review the VMB in other vaginal conditions associated with lactobacilli depletion: desquamative inflammatory vaginitis and aerobic vaginitis. We also discuss the controversial diagnosis of cytolytic vaginosis, related with lactobacilli overgrowth. CONCLUSIONS Bacterial vaginosis displays complex microbiology. The heterogeneity and diversity within the genus Gardnerella may impact the progression of BV. Bacterial biofilms may contribute to the etiology and persistence of BV, and various bacteria may affect its clinical presentation and pathogenicity. Lack of lactobacilli is not always accompanied by an overgrowth of anaerobes.
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Affiliation(s)
- Ahinoam Lev-Sagie
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Francesco De Seta
- Institute for Maternal and Child Health “IRCCS Burlo Garofolo,” Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Hans Verstraelen
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Gary Ventolini
- Professor of Obstetrics and Gynecology, Distinguish University Professor, School of Medicine, Texas Tech University Health Sciences Center, Permian Basin, Odessa, Texas
| | - Risa Lonnee-Hoffmann
- Department of Obstetrics and Gynecology, St Olavs University Hospital, Trondheim, Norway
- Institute for Clinical and Molecular Medicine, Norwegian University for Science and Technology, Trondheim, Norway
| | - Pedro Vieira-Baptista
- Hospital Lusíadas Porto, Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
- LAP, a Unilabs Company, Porto, Portugal
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Sanchez A, Gandhi K, Lee B, Garcia JG, Ventolini G. Vulvar Neurodermatitis in a Postmenopausal African-American Patient: A Case Report. J Menopausal Med 2022; 28:42-45. [PMID: 35534430 PMCID: PMC9086344 DOI: 10.6118/jmm.21032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/19/2022] [Accepted: 02/27/2022] [Indexed: 11/25/2022] Open
Abstract
Lichen simplex chronicus commonly presents as a distressing vaginal lesion caused by severe, cyclical itch-scratch behavior. Lichen simplex chronicus is diagnosed by obtaining a detailed medical history, performing a physical exam, and recording of self-reported symptoms. Lichen simplex chronicus can be treated by corticosteroids, immunomodulators, antiepileptics, antihistamines, antidepressants, and phototherapy. Our case describes a 55-year-old female patient who presented to a clinic with recurrent vaginal itching, combined with compulsive scratching behavior that disrupted daily functioning. Physical examination revealed hypertrophic nodules located on the labia minora with scaling and hyperpigmentation. And the patient was diagnosed with lichen simplex chronicus. Empirical treatment with behavioral modifications and clobetasol propionate cream with an occlusive dressing produced significant improvements in symptoms at a six-month follow-up. Lichen simplex chronicus can have unusual presentations and; therefore, must be carefully differentiated from infectious and malignant skin lesions.
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Affiliation(s)
- Asley Sanchez
- Department of Obstetrics and Gynecology, School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, Odessa, TX, USA
| | - Kushal Gandhi
- Department of Obstetrics and Gynecology, School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, Odessa, TX, USA
| | - Ben Lee
- Department of Obstetrics and Gynecology, School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, Odessa, TX, USA
| | - Jonathan Gomez Garcia
- Department of Podiatry, California School of Podiatric Medicine, Samuel Merritt University, Oakland, CA, USA
| | - Gary Ventolini
- Department of Obstetrics and Gynecology, School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, Odessa, TX, USA
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Vieira-Baptista P, De Seta F, Verstraelen H, Ventolini G, Lonnee-Hoffmann R, Lev-Sagie A. The Vaginal Microbiome: V. Therapeutic Modalities of Vaginal Microbiome Engineering and Research Challenges. J Low Genit Tract Dis 2022; 26:99-104. [PMID: 34928260 PMCID: PMC8719494 DOI: 10.1097/lgt.0000000000000647] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This series of articles, titled The Vaginal Microbiome (VMB), written on behalf of the International Society for the Study of Vulvovaginal Disease, aims to summarize the recent findings and understanding of the vaginal bacterial microbiota, mainly regarding areas relevant to clinicians specializing in vulvovaginal disorders. MATERIALS AND METHODS A search of PubMed database was performed, using the search terms "vaginal microbiome" with "treatment," "diagnosis," and "research." Full article texts were reviewed. Reference lists were screened for additional articles. RESULTS The currently available approaches for treating vaginitis or attempting to modulate the VMB are often insufficient. It has traditionally relied on the use of antibiotics, antiseptics, and antifungals. The fifth and last article of this series discusses the new and/or alternative therapeutic modalities. It addresses the role of probiotics, prebiotics and symbiotics, activated charcoal, biofilm disrupting agents, acidifying agents, phage therapy, and the concept of vaginal microbiome transplant. The challenges facing the research of VMB, including the clinical impact of microbiome manipulation, classification, and new diagnostic approaches are discussed. CONCLUSIONS Microbiome research has grown dramatically in recent years, motivated by innovations in technology and decrease in analysis costs. This research has yielded huge insight into the nature of microbial communities, their interactions, and effects with their hosts and other microbes. Further understanding of the bacterial, fungal, phage, and viral microbiomes in combination with host genetics, immunologic status, and environmental factors is needed to better understand and provide personalized medical diagnostics and interventions to improve women's health.
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Affiliation(s)
- Pedro Vieira-Baptista
- Hospital Lusíadas Porto, Porto
- Lower Genital Tract Unit, Centro Hospitalar de São João, Porto
- LAP, a Unilabs Company, Porto, Portugal
| | - Francesco De Seta
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health “IRCCS Burlo Garofolo”, Trieste
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Hans Verstraelen
- Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Gary Ventolini
- Professor of Obstetrics and Gynecology, Distinguish University Professor, School of Medicine, Texas Tech University Health Sciences Center, Permian Basin, Odessa, Texas, USA
| | - Risa Lonnee-Hoffmann
- Department of Obstetrics and Gynecology, St Olavs University Hospital, Trondheim
- Institute for Clinical and Molekular Medicine, Norwegian University for Science and Technology, Trondheim, Norway
| | - Ahinoam Lev-Sagie
- Faculty of Medicine, Hebrew University of Jerusalem, Israel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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13
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Verstraelen H, Vieira-Baptista P, De Seta F, Ventolini G, Lonnee-Hoffmann R, Lev-Sagie A. The Vaginal Microbiome: I. Research Development, Lexicon, Defining "Normal" and the Dynamics Throughout Women's Lives. J Low Genit Tract Dis 2022; 26:73-78. [PMID: 34928256 PMCID: PMC8719517 DOI: 10.1097/lgt.0000000000000643] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This series of articles, titled The Vaginal Microbiome, written on behalf of the International Society for the Study of Vulvovaginal Disease, aims to summarize the current findings and understanding of the vaginal bacterial microbiota, mainly regarding areas relevant to clinicians specializing in vulvovaginal disorders. MATERIALS AND METHODS A database search of PubMed was performed, using the search terms "vaginal microbiome" (VMB) with "research," "normal," "neonate," "puberty," "adolescent," "menopause," and "ethnicities," as well as "human microbiome project." Full article texts were reviewed. Reference lists were screened for additional articles. RESULTS In the last 2 decades, many studies applying molecular techniques were performed, intending to characterize the vaginal microbiota. These studies advanced our understanding of how vaginal health is defined. The first article in this series focuses on the advancement of VMB research, technical definitions, the definition of "normal" VMB, and the dynamics of VMB throughout women's lives. CONCLUSIONS Understanding how microorganisms inhabiting the vagina interact with each other and with the host is important for a more complete understanding of vaginal health. The clinical application of microbial community sequencing is in its beginning, and its interpretation regarding practical clinical aspects is yet to be determined.
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Affiliation(s)
- Hans Verstraelen
- Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Pedro Vieira-Baptista
- Hospital Lusíadas Porto, Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
- LAP, a Unilabs Company, Porto, Portugal
| | - Francesco De Seta
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Gary Ventolini
- Professor of Obstetrics and Gynecology, Distinguish University, Professor School of Medicine, Texas Tech University Health Sciences Center Permian Basin, Odessa, TX
| | - Risa Lonnee-Hoffmann
- Department of Obstetrics and Gynecology, St Olavs University Hospital, Trondheim, Norway
- Institute for Clinical and Molecular Medicine, Norwegian University for Science and Technology, Trondheim, Norway
| | - Ahinoam Lev-Sagie
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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De Seta F, Lonnee-Hoffmann R, Campisciano G, Comar M, Verstraelen H, Vieira-Baptista P, Ventolini G, Lev-Sagie A. The Vaginal Microbiome: III. The Vaginal Microbiome in Various Urogenital Disorders. J Low Genit Tract Dis 2022; 26:85-92. [PMID: 34928258 PMCID: PMC8719503 DOI: 10.1097/lgt.0000000000000645] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This series of articles, titled The Vaginal Microbiome (VMB), written on behalf of the International Society for the Study of Vulvovaginal Disease, aims to summarize the recent findings and understanding of the vaginal bacterial microbiota, mainly regarding areas relevant to clinicians specializing in vulvovaginal disorders. MATERIALS AND METHODS A search of PubMed database was performed, using the search terms "vaginal microbiome" with "Candida," "vaginitis," "urinary microbiome," "recurrent urinary tract infections," "sexually transmitted infections," "human immunodeficiency virus," "human papillomavirus," "nonspecific vaginitis," "vulvodynia," and "vulvovaginal symptoms." Full article texts were reviewed. Reference lists were screened for additional articles. The third article in this series describes VMB in various urogenital disorders. RESULTS Variable patterns of the VMB are found in patients with vulvovaginal candidiasis, challenging the idea of a protective role of lactobacilli. Highly similar strains of health-associated commensal bacteria are shared in both the bladder and vagina of the same individual and may provide protection against urinary tract infections. Dysbiotic VMB increases the risk of urinary tract infection. Loss of vaginal lactic acid-producing bacteria combined with elevated pH, increase the risk for sexually transmitted infections, although the exact protective mechanisms of the VMB against sexually transmitted infections are still unknown. CONCLUSIONS The VMB may constitute a biological barrier to pathogenic microorganisms. When the predominance of lactobacilli community is disrupted, there is an increased risk for the acquisition of various vaginal pathogents. Longitudinal studies are needed to describe the association between the host, bacterial, and fungal components of the VMB.
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Affiliation(s)
- Francesco De Seta
- Institute for Maternal and Child Health “IRCCS Burlo Garofolo,” Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Risa Lonnee-Hoffmann
- Department of Obstetrics and Gynecology, St Olavs University Hospital, Trondheim, Norway
- Institute for Clinical and Molecular Medicine, Norwegian University for Science and Technology, Trondheim, Norway
| | | | - Manola Comar
- Institute for Maternal and Child Health “IRCCS Burlo Garofolo,” Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Hans Verstraelen
- Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Pedro Vieira-Baptista
- Hospital Lusíadas Porto, Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
- LAP, a Unilabs Company, Porto, Portugal
| | - Gary Ventolini
- Department of Obstetrics and Gynecology, Distinguish University Professor, School of Medicine, Texas Tech University Health Sciences Center, Permian Basin, Odessa, TX
| | - Ahinoam Lev-Sagie
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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15
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Ventolini G, Vieira-Baptista P, De Seta F, Verstraelen H, Lonnee-Hoffmann R, Lev-Sagie A. The Vaginal Microbiome: IV. The Role of Vaginal Microbiome in Reproduction and in Gynecologic Cancers. J Low Genit Tract Dis 2022; 26:93-98. [PMID: 34928259 PMCID: PMC8719507 DOI: 10.1097/lgt.0000000000000646] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This series of articles, titled The Vaginal Microbiome (VMB), written on behalf of the International Society for the Study of Vulvovaginal Disease, aims to summarize the recent findings and understanding of the vaginal bacterial microbiota, mainly regarding areas relevant to clinicians specializing in vulvovaginal disorders. MATERIALS AND METHODS A search of PubMed database was performed, using the search terms "vaginal microbiome" with "reproduction," "infertility," "fertility," "miscarriages," "pregnancy" "cervical cancer," "endometrial cancer," and "ovarian cancer." Full article texts were reviewed. Reference lists were screened for additional articles. RESULTS The fourth article of this series focuses on 2 distinct areas: the role of VMB in various aspects of human reproduction and, in sharp contrast, the association between the VMB and gynecologic malignancies. Several of the negative pregnancy outcomes have been associated with an altered VMB. Dysbiosis is remarkably linked with poor pregnancy outcomes from preconception to delivery. The associations between the microbiome and gynecologic cancers are described. CONCLUSIONS The development of the microbiome research, enabled by molecular-based techniques, has dramatically increased the detection of microorganisms and the understanding of bacterial communities that are relevant to maternal-fetal medicine in health and disease, as well as in gynecological malignancies. Proving causation in cancer is difficult because of the complex interactive nature of potential causative factors. Certain elements of the microbiota have been shown to provoke inflammatory reactions, whereas others produce anti-inflammatory reactions; this balance might be impaired with a change in microbial variety.
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Affiliation(s)
- Gary Ventolini
- Professor of Obstetrics and Gynecology, Distinguish University Professor, School of Medicine, Texas Tech University Health Sciences Center, Permian Basin, Odessa, Texas
| | - Pedro Vieira-Baptista
- Hospital Lusíadas Porto, Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
- LAP, a Unilabs Company, Porto, Portugal
| | - Francesco De Seta
- Institute for Maternal and Child Health “IRCCS Burlo Garofolo,” Trieste, Italy
- Department of Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Hans Verstraelen
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Risa Lonnee-Hoffmann
- Department of Obstetrics and Gynecology, St Olavs University Hospital, Trondheim, Norway
- Institute for Clinical and Molecular Medicine, Norwegian University for Science and Technology, Trondheim, Norway
| | - Ahinoam Lev-Sagie
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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16
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Sanchez A, Lee B, Gandhi K, Garza J, Ventolini G. A rare case report: Cutaneous Candida tropicalis infection disguised as a sacral decubitus rash in an immunocompetent individual. J Infect Public Health 2021; 14:1018-1020. [PMID: 34153726 DOI: 10.1016/j.jiph.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/18/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022] Open
Abstract
Candida infection is seen in patients with weak or disrupted host responses. Cutaneous candidiasis typically affects the intertriginous areas and presents with a red plaque surrounded by satellite lesions. Diagnosis of cutaneous candidiasis is made by visual inspection followed by potassium hydroxide normal saline microscopic preparation (wet mount) and polymerase chain reaction identification or culture of fungal organism. The following case describes a 38-year-old patient with limited mobility who presented with a peri sacral lesion that was first assumed to be a decubitus ulcer by nursing facility staff, but proved to be a cutaneous infection by Candida tropicalis, a less common Candida species. The unusual location as well as the characteristic C. tropicalis micro- and macroscopic appearance are described which ultimately led to the diagnosis of a cutaneous fungal infection in an otherwise immunocompetent individual that was resolved with fluconazole therapy. Our case report emphasizes the need for early diagnosis of cutaneous lesions in patients with limited mobility in consideration that not all Candida species thrive in similar environments and can present in unusual locations of the human body. Although rare, C. tropicalis could be found in this vulnerable population.
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Affiliation(s)
- Asley Sanchez
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, TX, USA
| | - Ben Lee
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, TX, USA
| | - Kushal Gandhi
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, TX, USA
| | - John Garza
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, TX, USA; The University of Texas Permian Basin, Odessa, TX, USA
| | - Gary Ventolini
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, TX, USA.
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Garza J, Gandhi K, Choi S, Sanchez A, Ventolini G. Cytokine profiles and Lactobacillus species presence in pre-menopausal subjects with genital Mycoplasma genitalium or Ureaplasma urealyticum colonization. ACTA ACUST UNITED AC 2021; 17:17455065211009181. [PMID: 33866885 PMCID: PMC8058796 DOI: 10.1177/17455065211009181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background and Purpose: Lactobacilli play a vital role in protecting the vagina against pathogens. Cytokines are vital components of defense against infections in women. The genital mycoplasmas, Mycoplasma genitalium and Ureaplasma urealyticum, are associated with various infectious diseases in adults and infants. The objective of our study is to identify differences in cytokine profile and Lactobacillus species dominance between a study group of non-pregnant pre-menopausal women with genital M. genitalium or U. urealyticum colonization and a control group of non-pregnant pre-menopausal women without genital M. genitalium or U. urealyticum colonization. Methods: A real-time polymerase chain reaction was performed to measure Lactobacillus species in vaginal swab samples. Cytokine analysis was performed using multiplex immunoassay techniques. Analysis of variance confirmed a significant difference in cytokine profiles between patient groups, with t-tests identifying the most significantly different cytokines. Categorical data analysis identified significant patterns of relative Lactobacillus species dominance in the study group. Results: Lactobacillus iners was the predominant Lactobacillus species in the control group (p = 0.005). There were no dominant Lactobacillus species observed in the study group. Vascular endothelial growth factor A (p = 0.002), interleukin-8 (p = 0.001), and interleukin-1β (p = 0.049) were expressed significantly higher in the study group, whereas interleukin-1 receptor antagonist (p < 0.001), interleukin-10 (p = 0.001), interleukin-12 (p = 0.002), and interferon-γ (p = 0.022) were expressed higher in the control group. Association matrices for cytokines were significantly different between two groups (p < 0.001), with mostly negative associations in the control group and mostly positive associations in the study group. Conclusion: Cytokine levels, their associations, and the patterns of Lactobacillus species dominance are observed to significantly diverge on the basis of M. genitalium and U. urealyticum colonization among non-pregnant pre-menopausal women.
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Affiliation(s)
- John Garza
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, Odessa, TX, USA.,The University of Texas Permian Basin (UTPB), Odessa, TX, USA
| | - Kushal Gandhi
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, Odessa, TX, USA
| | - Sarah Choi
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, Odessa, TX, USA
| | - Asley Sanchez
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, Odessa, TX, USA
| | - Gary Ventolini
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, Odessa, TX, USA
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18
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Gutierrez P, Gandhi K, Amakiri N, Garza J, Ventolini G. Vulvar lesion mimicking vitiligo: A case report. Case Rep Womens Health 2020; 27:e00234. [PMID: 32642448 PMCID: PMC7334793 DOI: 10.1016/j.crwh.2020.e00234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 11/01/2022] Open
Abstract
Background Post-inflammatory hypopigmentation (PIH) is an acquired partial or total loss of pigment that occurs as a result of cutaneous inflammation. Clinically, post-inflammatory hypopigmentation is recognized by a discoloration of the skin; however, proper diagnosis requires a skin biopsy. Although post-inflammatory hypopigmentation is similar in appearance to vitiligo, histopathological evaluation highlights the key differences in the presence of melanocytes and melanophages. Case presentation A 28-year-old woman presented with discoloration in the vulvovaginal area. Physical examination was within normal limits; however, a genital exam revealed a large, intensely white discoloration in an hourglass pattern involving the clitoris, labia majora, and perianal area. Pigmentation was observed at the base of the hair follicles, which is not consistent with vitiligo. The patient consented to a skin biopsy, which was performed without complication. The biopsy showed mild chronic vulvitis and pigment incontinence due to post-inflammatory hypopigmentation. The patient was prescribed a high-potency topical steroid and a significant reduction in lesion area was observed at 3-month follow-up. Discussion Proper diagnosis via clinical examination and skin biopsy is essential in the treatment of pigment deficiencies. In cases of post-inflammatory hypopigmentation, the initial cause of inflammation must first be identified in order to provide an effective treatment regimen. When facing uncommon dermatological conditions such as post-inflammatory hypopigmentation, proper histopathological diagnosis, course of treatment, and follow-up are important in order to achieve patient satisfaction.
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Affiliation(s)
- Paula Gutierrez
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA.,The University of Texas Permian Basin, Odessa, TX, USA
| | - Kushal Gandhi
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Nnana Amakiri
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - John Garza
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA.,The University of Texas Permian Basin, Odessa, TX, USA
| | - Gary Ventolini
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
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Gutierrez P, Garza J, Gandhi K, Voice A, Stout E, Ventolini G. Carbon dioxide (CO 2) laser ablation treatment of a peri-urethral genital wart: A case report. Case Rep Womens Health 2020; 27:e00226. [PMID: 32528860 PMCID: PMC7283141 DOI: 10.1016/j.crwh.2020.e00226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 10/25/2022] Open
Abstract
Background Visible genital warts are caused by the nearly 100 recognized strains of human papillomavirus (HPV). HPV infections caused by high-risk strains are associated with significant morbidity and mortality rates. Genital warts are diagnosed by visual inspection and treated by three major methods: topical agents, systemic agents, and surgical therapies. CO2 laser ablation is the best treatment option for warts that present as refractory, thick, extensive lesions. CO2 ablation offers benefits such as a painless procedure, increased clearance rate, lesser side-effects and decreased pain. Case Presentation An 18-year old patient was referred to the obstetric/gynecology clinic and presented with severe urinary complications. She complained of dysuria, frequency, vaginal irritation, and spraying while voiding. Physical exam was within normal limits; however, genital examination revealed a 3 cm fungating mass corresponding to a large genital wart at the urethral meatus and peri-urethral area. Due to her progressing symptomatology, CO2 laser ablation therapy was advised. Discussion HPV directly impacts the public health system, affecting 1% of the US population with an estimated 10-20% prevalence rate. Treatment options such as CO2 laser ablation offers complete removal for most patients with limited side-effects. Accurate follow-up is necessary to monitor proper recovery. Conclusion CO2 laser ablation is considered an effective form of therapy in cases where immediate removal is desired and surgical excision is not recommended. CO2 laser ablation provides high clearance rates and minimal instances of recurrence, as well as superior aesthetic outcome.
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Affiliation(s)
- Paula Gutierrez
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, TX, USA.,The University of Texas Permian Basin (UTPB), Odessa, TX, USA
| | - John Garza
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, TX, USA.,The University of Texas Permian Basin (UTPB), Odessa, TX, USA
| | - Kushal Gandhi
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, TX, USA
| | - Alesia Voice
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, TX, USA
| | - Elea Stout
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, TX, USA.,The University of Texas Permian Basin (UTPB), Odessa, TX, USA
| | - Gary Ventolini
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) at the Permian Basin, TX, USA
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Gandhi K, Gutierrez P, Garza J, Gray Wlazlo TJ, Meiser RJ, David S, Carrillo M, Narasimhan M, Galloway M, Ventolini G. Vaginal Lactobacillus species and inflammatory biomarkers in pregnancy. ACTA ACUST UNITED AC 2020; 72:299-309. [PMID: 32403915 DOI: 10.23736/s0026-4784.20.04566-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study was to identify vaginal Lactobacillus spp. and quantify vaginal inflammatory cytokines in primigravida vs. multigravida women and pregnant vs. non-pregnant women. METHODS Vaginal swabs were obtained from four groups of patients. A real-time PCR was carried out to identify the Lactobacillus spp. Multiplex immunoassays were performed to quantify a total of 27 cytokines using the Bio-Plex MAGPIX multiplex reader and MesoQuick Plex SQ 120 (Meso Scale Diagnostics LLC, Rockville, MD, USA). Inferential statistics using hypothesis tests were applied to detect differences in cytokine levels. RESULTS Significant differences in cytokines and chemokines exist among the four populations of women studied. IP-10 is significantly higher in multigravida women as compared to primigravida women. IFN-γ, MCP-1, MIP-1β, IL-2 and IL-10 are significantly higher in non-pregnant women compared to pregnant women. L. iners was the most abundant species in multigravida, pregnant and non-pregnant patients, while L. crispatus was the most abundant species in primigravida patients. Significant differences in the levels of MIP-1β, TNF-α, PDGF-BB, VEGF-A, IL-12, and IL-10 exist between women identified with Lactobacillus species and women not identified with Lactobacillus species. CONCLUSIONS There were significant differences regarding cytokines, chemokines, and Lactobacillus spp. among four groups of studied patients. With these results, we increase our understanding of the role that vaginal cytokines and Lactobacillus species have during pregnancy, with the goal that this novel research will be useful for examining vaginal biomarkers in obstetrical conditions.
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Affiliation(s)
- Kushal Gandhi
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) of the Permian Basin, Odessa, TX, USA
| | - Paula Gutierrez
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) of the Permian Basin, Odessa, TX, USA.,University of Texas Permian Basin (UTPB), Odessa, TX, USA
| | - John Garza
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) of the Permian Basin, Odessa, TX, USA.,University of Texas Permian Basin (UTPB), Odessa, TX, USA
| | - Taylor J Gray Wlazlo
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) of the Permian Basin, Odessa, TX, USA
| | - Rebecca J Meiser
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) of the Permian Basin, Odessa, TX, USA
| | | | | | - Madhusudhanan Narasimhan
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center (TTUHSC), Lubbock, TX, USA
| | - Michael Galloway
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) of the Permian Basin, Odessa, TX, USA
| | - Gary Ventolini
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC) of the Permian Basin, Odessa, TX, USA -
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21
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Martinez S, Garcia JG, Williams R, Elmassry M, West A, Hamood A, Hurtado D, Gudenkauf B, Ventolini G, Schlabritz-Loutsevitch N. Lactobacilli spp.: real-time evaluation of biofilm growth. BMC Microbiol 2020; 20:64. [PMID: 32209050 PMCID: PMC7092459 DOI: 10.1186/s12866-020-01753-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/13/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Biofilm is a fundamental bacterial survival mode which proceeds through three main generalized phases: adhesion, maturation, and dispersion. Lactobacilli spp. (LB) are critical components of gut and reproductive health and are widely used probiotics. Evaluation of time-dependent mechanisms of biofilm formation is important for understanding of host-microbial interaction and development of therapeutic interventions. Time-dependent LB biofilm growth was studied in two systems: large biofilm output in continuous flow system (microfermenter (M), Institute Pasteur, France) and electrical impedance-based real time label-free cell analyzer (C) (xCELLigence, ACEA Bioscience Inc., San Diego, CA). L. plantarum biofilm growth in M system was video-recorded, followed by analyses using IMARIS software (Bitplane, Oxford Instrument Company, Concord, MA, USA). Additionally, whole genome expression and analyses of attached (A) and dispersed (D) biofilm phases at 24 and 48 h were performed. RESULTS The dynamic of biofilm growth of L. plantarum was similar in both systems except for D phases. Comparison of the transcriptome of A and D phases revealed, that 121 transcripts differ between two phases at 24 h. and 35 transcripts - at 48 h. of M growth. The main pathways, down-regulated in A compared to D phases after 24 h. were transcriptional regulation, purine nucleotide biosynthesis, and L-aspartate biosynthesis, and the upregulated pathways were fatty acid and phospholipid metabolism as well as ABC transporters and purine nucleotide biosynthesis. Four LB species differed in the duration and amplitude of attachment phases, while growth phases were similar. CONCLUSION LB spp. biofilm growth and propagation area dynamic, time-dependent processes with species-specific and time specific characteristics. The dynamic of LB biofilm growth agrees with published pathophysiological data and points out that real time evaluation is an important tool in understanding growth of microbial communities.
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Affiliation(s)
- Stacy Martinez
- Texas Tech University Health Sciences Center at the Permian Basin, 701 W. 5th Street, Odessa, TX, 79763, USA
| | - Jonathan Gomez Garcia
- Texas Tech University Health Sciences Center at the Permian Basin, 701 W. 5th Street, Odessa, TX, 79763, USA.,University of Texas at the Permian Basin, Odessa, TX, USA
| | - Roy Williams
- Texas Tech University Health Sciences Center at the Permian Basin, 701 W. 5th Street, Odessa, TX, 79763, USA.,University of Texas at the Permian Basin, Odessa, TX, USA
| | - Moamen Elmassry
- Department of Biological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Andrew West
- Texas Tech University Health Sciences Center at the Permian Basin, 701 W. 5th Street, Odessa, TX, 79763, USA
| | - Abdul Hamood
- Department of Microbiology and Immunology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Brent Gudenkauf
- Texas Tech University Health Sciences Center at the Permian Basin, 701 W. 5th Street, Odessa, TX, 79763, USA
| | - Gary Ventolini
- Texas Tech University Health Sciences Center at the Permian Basin, 701 W. 5th Street, Odessa, TX, 79763, USA.
| | - Natalia Schlabritz-Loutsevitch
- Texas Tech University Health Sciences Center at the Permian Basin, 701 W. 5th Street, Odessa, TX, 79763, USA. .,Department of Neurobiology and Pharmacology, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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22
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Carrillo M, Chuecos M, Gandhi K, Bednov A, Moore DL, Maher J, Ventolini G, Ji G, Schlabritz-Loutsevitch N. Optical tissue clearing in combination with perfusion and immunofluorescence for placental vascular imaging. Medicine (Baltimore) 2018; 97:e12392. [PMID: 30278515 PMCID: PMC6181621 DOI: 10.1097/md.0000000000012392] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Imaging of placental tissues is a difficult task, because of specific for this organ complex multicellular and 3D tissue structure. The tissue clearing systems (X-CLARITY) system is a valuable tool for the examining the expression of molecular pathways in whole tissues and organs, originally developed for brain imaging.In the present report, we utilized this technology for the examination of placental vasculature and protein expression in perfused human placental tissue.The placental tissue was sufficiently cleared with preservation of endothelial staining and fluorescent markers, allowing visualization using confocal microscopy. The CLARITY method and X-CLARITY system is a valuable tool in placental imaging.
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Affiliation(s)
- Maira Carrillo
- Department of Obstetrics and Gynecology, School of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa
| | - Marcel Chuecos
- Department of Obstetrics and Gynecology, School of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa
| | - Kushal Gandhi
- Department of Obstetrics and Gynecology, School of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa
| | - Andrey Bednov
- Department of Obstetrics and Gynecology, School of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa
- University of Texas of the Permian Basin
| | - David Lee Moore
- Department of Obstetrics and Gynecology, School of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa
| | - James Maher
- Department of Obstetrics and Gynecology, School of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa
- University of Texas of the Permian Basin
| | - Gary Ventolini
- Department of Obstetrics and Gynecology, School of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa
| | - Guangchen Ji
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Natalia Schlabritz-Loutsevitch
- Department of Obstetrics and Gynecology, School of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa
- University of Texas of the Permian Basin
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Gandhi K, Li C, German N, Skobowiat C, Carrillo M, Kallem RR, Larumbe E, Martinez S, Chuecos M, Ventolini G, Nathanielsz P, Schlabritz-Loutsevitch N. Effect of maternal high-fat diet on key components of the placental and hepatic endocannabinoid system. Am J Physiol Endocrinol Metab 2018; 314:E322-E333. [PMID: 29138223 PMCID: PMC5966752 DOI: 10.1152/ajpendo.00119.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 02/06/2023]
Abstract
Maternal obesity in pregnancy has been linked to a spectrum of adverse developmental changes. Involvement of eCBs in obesity is well characterized. However, information regarding eCB physiology in obesity associated with pregnancy is sparse. This study evaluated fetomaternal hepatic, systemic, and placental eCB molecular changes in response to maternal consumption of a HFD. From ≥9 mo before conception, nonpregnant baboons ( Papio spp.) were fed a diet of either 45 (HFD; n = 11) or 12% fat or a control diet (CTR; n = 11), and dietary intervention continued through pregnancy. Maternal and fetal venous plasma samples were evaluated using liquid chromatography-mass spectrometry to quantify AEA and 2-AG. Placental, maternal and fetal hepatic tissues were analyzed using RT-PCR, Western blot, and immunohistochemistry. mRNA and protein expression of endocannabinoid receptors (CB1R and CB2R), FAAH, DAGL, MAGL, and COX-2 were determined. Statistical analyses were performed with the nonparametric Scheirer-Ray-Hare extension of the Kruskal-Wallis test to analyze the effects of diet (HFD vs. CTR), fetal sex (male vs. female), and the diet × sex interaction. Fetal weight was influenced by fetal sex but not by maternal diet. The increase in maternal weight in animals fed the HFD vs. the CTR diet approached significance ( P = 0.055). Maternal circulating 2-AG concentrations increased, and fetal circulating concentrations decreased in the HFD group, independently of fetal sex. CB1R receptor expression was detected in syncytiotrophoblasts (HFD) and the fetal endothelium (CTR and HFD). Placental CB2R protein expression was higher in males and lower in female fetuses in the HFD group. Fetal hepatic CB2R, FAAH, COX-2 (for both fetal sexes), and DAGLα (in male fetuses) protein expression decreased in the HFD group compared with the CTR group. We conclude that consumption of a HFD during pregnancy results in fetal systemic 2-AG and hepatic eCB deficiency.
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Affiliation(s)
- Kushal Gandhi
- School of Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin , Odessa, Texas
| | - Cun Li
- Department of Animal Science, University of Wyoming , Laramie, Wyoming
- Texas Biomedical Research Institute and Southwest National Primate Research Center , San Antonio, Texas
| | - Nadezhda German
- School of Pharmacy, Texas Tech University Health Sciences Center , Amarillo, Texas
| | | | - Maira Carrillo
- School of Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin , Odessa, Texas
| | - Raja Reddy Kallem
- School of Pharmacy, Texas Tech University Health Sciences Center , Amarillo, Texas
| | - Eneko Larumbe
- Clinical Research Institute, Texas Tech University Health Sciences , Lubbock, Texas
| | - Stacy Martinez
- School of Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin , Odessa, Texas
| | - Marcel Chuecos
- School of Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin , Odessa, Texas
| | - Gary Ventolini
- School of Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin , Odessa, Texas
| | - Peter Nathanielsz
- Department of Animal Science, University of Wyoming , Laramie, Wyoming
- Texas Biomedical Research Institute and Southwest National Primate Research Center , San Antonio, Texas
| | - Natalia Schlabritz-Loutsevitch
- School of Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin , Odessa, Texas
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Affiliation(s)
- Hanna Kodeih
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX
| | - Vicki Burton
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX
| | - Gary Ventolini
- School of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX
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Vera Aguilera J, Perez-Torres A, Vera Aguilera C, Block MS, Duma N, Ventolini G, Martinez-Zaguilan R, Sennoune SR. In vivo effect of the parasite derived peptide GK-1, anti-PD-L1 and GK-1/anti-PD-L1 combination in experimental melanoma. Potential novel treatment pathways. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e21038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21038 Background: Several studies of advanced melanoma patients suggest that combining therapies that target tumor mechanisms of immune evasion with activation of normal immune cell functionality may provide optimal benefits for patients. The synthetic parasite derived GK1 peptide in combination with anti-PD-L1 showed significant longer survival (34 days) compared to GK1 or Anti-PD-L1 alone (23-27 days) in a murine melanoma model (p < 0.05). This means an increase survival increased in 47.82% in the mice treated with GK-1 + anti-PD-L1, 21.7% treated with GK-1, and 6.08% treated with anti-PD-L1. Methods: To elucidate the potential mechanism by which this combination treatment exerts its anti-melanoma effects, C57BL/6 mice were injected with B16-F10-luc2 cells and separated according to treatments in four groups: control, GK-1, anti-PD-L1 and GK-1/anti-PDL-1.Blood samples were collected at day 0, 14, and at euthanization or end of the experiment and monitored for serum cytokines using mice-specific V-PLEX Pro-inflammatory Panel. Results: On day 14, TNF-α levels in the Anti-PD-L1 and GK-1 therapy group was significantly lower compared to control mice. At sacrifice, the combined treatment group demonstrated significant decrease cytokine production in IL-6 and IL-10. Conclusions: The decreased cytokine levels observed in the GK-1/anti-PD-L1 group may explain the significant improved survival. GK-1 is a Th1 response inductor both in vitro and in vivo as it increases IFN-γ, IL-2 but not IL-4 and IL-10. It is noteworthy that when PD-L1 signaling is reduced in T cells these cells proliferate extensively in vitro and produce increased levels of IFN-γ and IL-17, suggesting an enhanced pro-inflammatory phenotype. It has been established that cytokines of Th2 response such as IL-4 and IL-5 and IL-6, have tumor-promoting activity. The anti-melanoma effect of the GK-1/anti-PD-L1 combination observed in the present study could be mediated by decreasing the pro-tumor Th2 response. These results provide novel alternative pathways and potential targets to enhance the clinical effect of the PD-1/PD-L1 blockade pathway.
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Vera-Aguilera J, Perez-Torres A, Beltran D, Villanueva-Ramos C, Wachtel M, Moreno-Aguilera E, Vera-Aguilera C, Ventolini G, Martínez-Zaguilán R, Sennoune SR. Novel Treatment of Melanoma: Combined Parasite-Derived Peptide GK-1 and Anti-Programmed Death Ligand 1 Therapy. Cancer Biother Radiopharm 2017; 32:49-56. [DOI: 10.1089/cbr.2016.2123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jesus Vera-Aguilera
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
- Division of Oncology, Mayo Clinic, Rochester, Minnesota
- Internal Medicine, School of Medicine at the Permian Basin, Texas Tech University Health Sciences Center, Odessa, Texas
| | - Armando Perez-Torres
- Departamento de Biología Celular y Tisular, Facultad de Medicina, Universidad Nacional Autónoma de México, México City, Mexico
| | - Diego Beltran
- Internal Medicine, School of Medicine at the Permian Basin, Texas Tech University Health Sciences Center, Odessa, Texas
| | - Cynthia Villanueva-Ramos
- Family Medicine, School of Medicine at the Permian Basin, Texas Tech University Health Sciences Center, Odessa, Texas
| | - Mitchell Wachtel
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Eduardo Moreno-Aguilera
- Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Carlos Vera-Aguilera
- Departamento de Biología Celular y Tisular, Facultad de Medicina, Universidad Nacional Autónoma de México, México City, Mexico
| | - Gary Ventolini
- Internal Medicine, School of Medicine at the Permian Basin, Texas Tech University Health Sciences Center, Odessa, Texas
| | - Raul Martínez-Zaguilán
- Department of Cell Physiology and Molecular Biophysics, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Souad R. Sennoune
- Department of Cell Physiology and Molecular Biophysics, Texas Tech University Health Sciences Center, Lubbock, Texas
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Ventolini G, Khandelwal N, Hutton K, Lugo J, Gygax SE, Schlabritz-Loutsevitch N. Obesity and recurrent vulvovaginal bacterial infections in women of reproductive age. Postgrad Med J 2017; 93:297. [PMID: 28057837 PMCID: PMC5520277 DOI: 10.1136/postgradmedj-2016-134638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Gary Ventolini
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas, USA
| | - Nuvneet Khandelwal
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas, USA
| | - Kathryn Hutton
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas, USA
| | - Jonathan Lugo
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas, USA
| | - Scott E Gygax
- Genesis Biotechnology Group, Femeris Women's Health Research Center, Hamilton, New Jersey, USA
| | - Natalia Schlabritz-Loutsevitch
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas, USA
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Ventolini G, Tsai P, Moore LD. C. dubliniensis in an immunocompetent patient with metal lingual frenulum piercing. Med Mycol Case Rep 2016; 14:27-29. [PMID: 28018842 PMCID: PMC5176124 DOI: 10.1016/j.mmcr.2016.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 11/25/2022] Open
Abstract
Candida spp. are opportunistic unicellular fungi, known to cause oral, vaginal, lung and occasionally systemic infections. Characteristically, they colonize the oral cavity, the mucosal surfaces of the cheek, palate, and tongue. Usually harmless, oral Candidas may become pathogenic under immunosuppressive conditions, dentures presence, or salivary flow impairment. Accurate species identification is important because C. dubliniensis can rapidly develop fluconazole resistance. We report C. dubliniensis in an immunocompetent patient with a metal lingual frenulum piercing.
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Affiliation(s)
- Gary Ventolini
- Texas Tech University Health Sciences Center at the Permian Basin, 701 W 5th Street, Odessa, TX 79763, USA
| | - Peihsuan Tsai
- Texas Tech University Health Sciences Center at the Permian Basin, 701 W 5th Street, Odessa, TX 79763, USA
| | - Lee David Moore
- Texas Tech University Health Sciences Center at the Permian Basin, 701 W 5th Street, Odessa, TX 79763, USA
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Ventolini G. A New Line of Attack in Provoked Vulvodynia Management: Pain Neuromodulation? J Gynecol Surg 2016. [DOI: 10.1089/gyn.2016.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gary Ventolini
- School of Medicine, Texas Tech University and Health Sciences Center Permian Basin, Odessa, TX
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Schlabritz-Loutsevitch N, German N, Ventolini G, Larumbe E, Samson J. Fetal Syndrome of Endocannabinoid Deficiency (FSECD) In Maternal Obesity. Med Hypotheses 2016; 96:35-38. [PMID: 27959272 DOI: 10.1016/j.mehy.2016.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/23/2016] [Indexed: 12/15/2022]
Abstract
The theory of a fetal origin of adult diseases links many pathological conditions to very early life events and is known as a "developmental programming" phenomenon. The mechanisms of this phenomenon are not quite understood and have been explained by inflammation, stress, etc. In particular the epidemic of obesity, with more than 64% of women being overweight or obese, has been associated with conditions in later life such as mental disorders, diabetes, asthma, and irritable bowel syndrome. Interestingly, these diseases were classified a decade ago as Clinical Syndrome of Endocannabinoid Deficiency (CECD), which was first described by Russo in 2004. Cannabinoids have been used for the treatment of chronic pain for millenniums and act through the mechanism of "kick-starting" the components of the endogenous cannabinoid system (ECS). ECS is a pharmacological target for the treatment of obesity, inflammation, cardiovascular and neuronal damage, and pain. We hypothesize that the deteriorating effect of maternal obesity on offspring health is explained by the mechanism of Fetal Syndrome of Endocannabinoid Deficiency (FSECD), which accompanies maternal obesity. Here we provide support for this hypothesis.
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Affiliation(s)
- Natalia Schlabritz-Loutsevitch
- Department of Obstetrics and Gynecology, College of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA.
| | - Nadezhda German
- Department of Pharmacology, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Gary Ventolini
- Department of Obstetrics and Gynecology, College of Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Eneko Larumbe
- Clinical Research Institute, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jacques Samson
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
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Carrillo M, Li C, Skobowiat C, Ventolini G, Chuecos M, Joseph P, Dick E, Hubbard G, Nathanielsz P, Schlabritz-Loutsevitch N. Gender-specific placental expression of cannabinoid receptor one (CB1R) in baboon model of obesity. Placenta 2016. [DOI: 10.1016/j.placenta.2016.06.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schlabritz-Loutsevitch N, Gygax SE, Dick E, Smith WL, Snider C, Hubbard G, Ventolini G. Vaginal Dysbiosis from an Evolutionary Perspective. Sci Rep 2016; 6:26817. [PMID: 27226349 PMCID: PMC4880931 DOI: 10.1038/srep26817] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 05/09/2016] [Indexed: 12/11/2022] Open
Abstract
Evolutionary approaches are powerful tools for understanding human disorders. The composition of vaginal microbiome is important for reproductive success and has not yet been characterized in the contexts of social structure and vaginal pathology in non-human primates (NHPs). We investigated vaginal size, vulvovaginal pathology and the presence of the main human subtypes of Lactobacillus spp./ BV-related species in the vaginal microflora of baboons (Papio spp.). We performed morphometric measurements of external and internal genitalia (group I, n = 47), analyzed pathology records of animals from 1999–2015 (group II, n = 64 from a total of 12,776), and evaluated vaginal swabs using polymerase chain reaction (PCR) (group III, n = 14). A total of 68 lesions were identified in 64 baboons. Lactobacillus iners, Gardnerella vaginalis, Atopobium vaginae, Megasphaera I, and Megasphaera II were not detected. L. jensenii, L. crispatus, and L. gasseri were detected in 2/14 (14.2%), 1/14 (7.1%), and 1/14 (7.1%) samples, respectively. BVAB2 was detected in 5/14 (35.7%) samples. The differences in the vaginal milieu between NHP and humans might be the factor associated with human-specific pattern of placental development and should be taken in consideration in NHP models of human pharmacology and microbiology.
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Affiliation(s)
| | - Scott E Gygax
- Femeris Women's Health Research Center, Genesis Biotechnology Group - Hamilton, New Jersey, USA
| | - Edward Dick
- Southwest National Primate Research Center, San Antonio, Texas, USA
| | - William L Smith
- Femeris Women's Health Research Center, Genesis Biotechnology Group - Hamilton, New Jersey, USA
| | - Cathy Snider
- Southwest National Primate Research Center, San Antonio, Texas, USA
| | - Gene Hubbard
- University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Gary Ventolini
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas, USA
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Affiliation(s)
- Gary Ventolini
- School of Medicine at Texas Tech. University Health Sciences Center, 800 W 4th Street, Odessa, TX 79763, USA
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Schlabritz-Loutsevitch N, Li XJ, Rensing C, Taylor B, Costelle C, Hubbard G, Ventolini G, Dick E. Microbiota and the gut-placenta axis in non-human primates (PAPIO SPP.). Placenta 2015. [DOI: 10.1016/j.placenta.2015.07.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ventolini G. Wet Mount Appearance of Candida dubliniensis: A Resistant Fungus That Colonizes Vagina. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2015.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gary Ventolini
- School of Medicine, Texas Tech University Health Sciences Center Permian Basin, Odessa, TX
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Abstract
Objective Lichen sclerosus (LS) is a chronic progressive inflammatory autoimmune-induced disease that primarily affects the epidermis and dermis of the external genital-anal region. Intense and recalcitrant pruritus is the hallmark of LS. Physical exam reveals thinning, hyperkeratosis, and parchment-like appearance. However, the classic symptom and signs of LS may not always be present and patients may be asymptomatic for pruritus. Hence, we describe 15 misdiagnosed cases with atypical clinical presentations. We believe that the absence of pruritus contributed to their initial misdiagnosis. The purpose of this paper is to increase awareness of atypical presentations of LS. Methods Data base review of de-identified clinical case pictures was performed. All patients had histopathology-confirmed diagnoses of LS. The data base file contains 800 cases of vulvovaginal disorders. The Institutional Review Board (IRB) considered that searching a de-identified data base of pictures did not require IRB approval. Results We identified 15 different atypical clinical cases. Patient ages were 18–75 years old. These patients were asymptomatic for pruritus and were misdiagnosed before they presented to the vulvovaginal specialized clinic. Conclusion Fifteen patients asymptomatic for pruritus with histopathology-confirmed diagnosis of LS were identified. They illustrate atypical clinical presentations that LS may have.
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Affiliation(s)
- Gary Ventolini
- Texas Tech University Health Sciences Center Permian Basin, Odessa, TX, USA
- Correspondence: Gary Ventolini, Texas Tech University Health Sciences Center Permian Basin, 800 West Street, Odessa, TX 79763, USA, Tel +1 432 703 5134, Email
| | - Ravi Patel
- Texas Tech University Health Sciences Center Permian Basin, Odessa, TX, USA
| | - Robert Vasquez
- Texas Tech University Health Sciences Center Permian Basin, Odessa, TX, USA
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Ventolini G, Mitchell E, Salazar M. Biofilm formation by vaginal Lactobacillus in vivo. Med Hypotheses 2015; 84:417-20. [DOI: 10.1016/j.mehy.2014.12.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 12/28/2014] [Indexed: 11/29/2022]
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Abstract
Vaginal lactobacilli provide protection against intrusive pathogenic bacteria. Some Lactobacillus spp. produce in vitro a thick, protective biofilm. We report in vivo formation of biofilm by vaginal Lactobacillus jensenii. The biofilm formation was captured in fresh wet-mount microscopic samples from asymptomatic patients after treatment for recurrent bacterial vaginitis. In vivo documentation of biofilm formation is in our opinion noteworthy, and has significant clinical implications, among which are the possibility to isolate, grow, and therapeutically utilize lactobacilli to prevent recurrent vaginal infections and preterm labor associated with vaginal microbial pathogens.
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Affiliation(s)
- Gary Ventolini
- School of Medicine, Texas Tech University Health Sciences Center - Permian Basin, Odessa, TX, USA
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Ventolini G, Goodwin B, Woody C. Patient perceptions on the subject of medical research. Drug Healthc Patient Saf 2014; 6:151-3. [PMID: 25378954 PMCID: PMC4207541 DOI: 10.2147/dhps.s71757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
While performing medical research we often spend little time addressing patient’s views on how research participants perceive the trial will affect their own condition. This manuscript identifies various ways in which the field of medicine must approach the important subject of patient’s outlook. The described approach is vital to succeed at achieving meaningful patient’s involvement in research.
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Affiliation(s)
| | | | - Courtney Woody
- Texas Tech University Health Sciences Center, Odessa, TX, USA
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Ventolini G, Yaklic JL, Galloway ML, Hampton M, Maher JE. Obstetric vulvar lacerations and postpartum dyspareunia. J Reprod Med 2014; 59:560-565. [PMID: 25552128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To report the type and prevalence of obstetric lacerations in a primigravid patient population after term spontaneous vaginal delivery without episiotomy. We examined the characteristics of lacerations in patients with postpartum dyspareunia or vulvodynia. STUDY DESIGN This was a retrospective cohort of primiparous patients who spontaneously delivered in the residents' service at a large urban hospital under the supervision of Ob/Gyn faculty. Data was extracted from medical records using discharge diagnosis codes. Postpartum medical records and diagnostic codes of all patients with lacerations and postpartum dyspareunia were reviewed. The study was IRB approved. RESULTS A cohort of 1617 primiparous patients with spontaneous vaginal delivery met the inclusion criteria. No tears were recorded in 836 patients (51.7%), first-degree tears in 413 cases (25.5%), second-degree tears in 271 cases (16.8%), third-degree tears in 58 cases (3.6%), fourth-degree in 21 cases (1.3%), and 18 cases (1.1%) were not further classified. Only 51 patients (3.2%) with first- and second-degree lacerations had postpartum complications, and merely 6 (0.4%) had vulvar pain and 6 (0.4%) had dyspareunia. However, 4 of those patients (33.3%) required vulvoplasty for complete dyspareunia remission. CONCLUSION Almost half of patients with spontaneous vaginal delivery without episiotomy experienced some type of vaginal laceration. A first degree was documented in >25% of cases; however, <10% of those subsequently had complaints of vulvar pain or dyspareunia.
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Affiliation(s)
- Gary Ventolini
- Texas Tech University Health Sciences Center, Odessa, Texas, USA.
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Ventolini G, Barhan S, Haas J. Breast Abscess and Community-Acquired Resistant Staphylococcus aureus: Case Report and Literature Review. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2013.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Sheela Barhan
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Jennifer Haas
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, OH
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Ventolini G, Gygax S, Adelson M, Cool D. Vulvodynia and fungal association: A preliminary report. Med Hypotheses 2013; 81:228-30. [DOI: 10.1016/j.mehy.2013.04.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
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Ventolini G, Chupp L, Kline M, Hampton M. Correlating Microscopic Images with Vaginal Fungal Cultures in Recurrent Candida Colonization. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2012.0127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gary Ventolini
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC), Odessa, TX
| | - Leslie Chupp
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center (TTUHSC), Odessa, TX
| | - Michelle Kline
- Department of Obstetrics and Gynecology, Riverside Methodist Hospital, Columbus, OH
| | - Moss Hampton
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC), Odessa, TX
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Ventolini G, Bolivar B. W251 GESTATIONAL TROPHOBLASTIC DISEASE IN AFRICA. A CASE REPORT AND A BRIEF REVIEW. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61975-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ventolini G. Vulvar pain: Anatomic and recent pathophysiologic considerations. Clin Anat 2012; 26:130-3. [DOI: 10.1002/ca.22160] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 08/04/2012] [Indexed: 12/12/2022]
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Galloway ML, Dhanraj DN, Ventolini G. Residency Training in Robotic-Assisted Gynecologic Surgery. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2011.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - David N. Dhanraj
- Wright State University, Boonshoft School of Medicine, Dayton, Ohio
| | - Gary Ventolini
- Wright State University, Boonshoft School of Medicine, Dayton, Ohio
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Ventolini G, Galloway M, Barhan S, Hood D. Recurrent Colonization by Group B Streptococcus Causing Vulvovaginitis: Short Communications. J Gynecol Surg 2011. [DOI: 10.1089/gyn.2011.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gary Ventolini
- Department of Obstetrics and Gynecology, Wright State University, and Boonshoft School of Medicine, Dayton, OH
| | - Michael Galloway
- Department of Obstetrics and Gynecology, Wright State University, and Boonshoft School of Medicine, Dayton, OH
| | - Sheela Barhan
- Department of Obstetrics and Gynecology, Wright State University, and Boonshoft School of Medicine, Dayton, OH
| | - Daniel Hood
- Pathology Department, Miami Valley Hospital, Dayton, OH
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Abstract
UNLABELLED Vulvodynia or vulvar pain syndrome is a chronic, heterogeneous, and multifactorial gynecological condition with an estimated prevalence of 9 - 12%, broad and substantial effect on quality of life due to physical disabilities, psychological distress and sexual dysfunction. A rationale therapeutic approach for the treatment of vulvodynia is still under investigation. A review of treatment modalities proposed by most of the clinicians involved in managing these patients advocated initially utilizing non-invasive therapies and then to proceed gradually to more aggressive therapies. A multidisciplinary approach that includes behavioral science and neuroimaging is required and recommended. Additionally a team approach should be utilized to test and evaluate therapies including pelvic floor physiotheraphy, psychotherapy, microbiology and pharmacology. It is my hope that this review will assist in the understanding of vulvodynia and its measuring treatment outcomes and will provide a thrust in the right direction to once and for all clarify this complex multifactorial disorder affecting women. KEYWORDS Treatment; Vulvodynia; Women.
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Affiliation(s)
- Gary Ventolini
- Department of Obstetrics and Gynecology, Wright State University Boonshoft School of Medicine, USA.
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Ventolini G. Conditions associated with placental dysfunction. Minerva Ginecol 2011; 63:459-464. [PMID: 21712767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Placental dysfunction is a term to describe suboptimal placental function leading to variations in the fetal supply of all its necessary required nutrients as well as the disruption in the cleansing of fetal catabolic products. The dysfunctional placenta may interrupt the manufacturing of other essential factors involved in pregnancy conservation, can compromise the fetal appropriate, atraumatic and sterile medium to grow, the immunologic shield from maternal antibodies and the normal amniotic fluid levels. Placental dysfunction can lead to a group of disorders representing a diverse and important category of pathological processes conducting to fetal and neonatal morbidity and mortality. The mechanisms by which these inflammatory processes cause death and disability are diverse and can be separated into four distinct classes: first, placental damage with loss of function; second, induction of premature labor; third, release of inflammatory mediators; fourth, transplacental infection. Several conditions have been associated with placental dysfunction: IUGR, hypertension, hypoxic-ischemic injury, preterm labor, and fetal death.
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Affiliation(s)
- G Ventolini
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45409, USA.
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