Cure rates of oral contraceptive users and non-users when treated for vulvovaginal candidiasis (moniliasis) with miconazole nitrate 2% vaginal cream

Analysis of the data from a carefully conducted multi-investigator study utilizing 261 subjects with a diagnosis of vulvovaginal candidiasis determined the cure rates in oral contraceptive users as compared to the cure rates in oral contraceptive non-users when treated with miconazole nitrate 2% Vaginal Cream (MONISTAT¹). The criteria for a cure required that subjects have a negative KOH smear, negative NICKERSON'S Medium culture for $\text{Candida}$ species, and complete absence of the signs and symptoms of vulvovaginal candidiasis 30 or more days following the course of therapy. There was no significant difference in the cure rates of the oral contraceptive users when compared to the oral contraceptive non-users. It is concluded that there is no justification for routinely discontinuing oral contraceptive therapy during treatment for vulvovaginal candidiasis with miconazole nitrate 2% Vaginal Cream (MONISTAT).     

Preliminary assessment of the acute toxicity of malathion in animals

Laboratory studies were conducted to acquire information concerning the acute toxicity of malathion in animals under various conditions of exposure. The responses in rabbits and quail exposed to aerosols generated from technical grade malathion (95%) and approximating an ultra-low volume ground spray were compared with those from a 6% malathion/No. 2 fuel oil mixture simulating a high volume spray. Results indicate that technical grade malathion (95%) as an ultra-low volume spray and at effective insecticidal concentrations in particle sizes having a mass median diameter of about 12 µ is relatively nonhazardous compared to the possible toxic fuel oil effects of a 6% malathion/No. 2 fuel oil mixture with a mass median diameter of 25 µ. Based on blood plasma cholinesterase activity analyses, quail were more sensitive to equivalent malathion exposure concentrations than were rabbits. Oral administration of technical grade malathion to rabbits resulted in reduction of plasma and erythrocyte cholinesterase activity at dosages of 120, 300, and 600 mg/kg with death resulting from 1200 mg/kg.The opinions contained herein are those of the authors and should not be construed as official or reflecting the views of the Department of the Army or the Department of Defense. Mention of proprietary products is for the purpose of identification only and does not imply endorsement by the Department of the Army.The experiments reported herein were conducted according to the Guide for the Care and Use of Laboratory Animals (1972) as prepared by the Committee on Revision of the Guide for Laboratory Animal Facilities and Care, of the Institute of Laboratory Animal Resources, National Research Council.     

Differential response of human ovarian cancer cells to induction of apoptosis by vitamin E Succinate and vitamin E analogue, alpha-TEA.

A vitamin E derivative, vitamin E succinate (VES; RRR-alpha-tocopheryl succinate), and a vitamin E analogue, 2,5,7,8-tetramethyl-2R-(4R,8R,12-trimethyltridecyl)chroman-6-yloxy acetic acid (alpha-TEA), induce human breast, prostate, colon, lung, cervical, and endometrial tumor cells in culture to undergo apoptosis but not normal human mammary epithelial cells, immortalized, nontumorigenic breast cells, or normal human prostate epithelial cells. Human ovarian and cervical cancer cell lines are exceptions, with alpha-TEA exhibiting greater proapoptotic effects. Although both VES and alpha-TEA can induce A2780 and subline A2780/cp70 ovarian cancer cells to undergo DNA synthesis arrest within 24 h of treatment, only alpha-TEA is an effective inducer of apoptosis. VES or alpha-TEA treatment of cp70 cells with 5, 10, or 20 microg/ml for 3 days induced 5, 6, and 19% versus 9, 36, and 71% apoptosis, respectively. Colony formation data provide additional evidence that cp70 cells are more sensitive to growth inhibition by alpha-TEA than VES. Differences in stability of the ester-linked succinate moiety of VES versus the ether-linked acetic acid moiety of alpha-TEA were demonstrated by high-performance liquid chromatography analyses that showed alpha-TEA to remain intact, whereas VES was hydrolyzed to the free phenol, RRR-alpha-tocopherol. Pretreatment of cp70 cells with bis-(p-nitrophenyl) phosphate, an esterase inhibitor, before VES treatment, resulted in increased levels of intact VES and apoptosis. Taken together, these data show alpha-TEA to be a potent and stable proapoptotic agent for human ovarian tumor cells and suggest that endogenous ovarian esterases can hydrolyze the succinate moiety of VES, yielding RRR-alpha-tocopherol, an ineffective apoptotic-inducing agent.     

Increased nasal potential difference and amiloride sensitivity in neonates with cystic fibrosis

Patients with cystic fibrosis (CF) have an increased nasal transepithelial potential difference (PD) which reflects increased sodium absorption across epithelium relatively impermeable to chloride. To evaluate nasal epithelial function in neonates with CF, the PD was recorded and the voltage response to superfusion of 10(-5M) amiloride, an inhibitor of sodium transport, measured between a Ringer perfused bridge on the nasal mucosa and a reference electrode in the subcutaneous space. We studied three neonates with CF with meconium ileus and compared the results with those in 24 term healthy neonates, including one obligate heterozygote for CF, and 27 control neonates with disease. All three CF neonates had raised sweat chloride values (mean 100 mEq/L) at 2 months. The CF neonates had higher PDs (-64.0 +/- 8.4 mV) than those in normal (-24.4 +/- 2.0 mV) or control (-25.8 +/- 2.0 mV) neonates. Superfusion with amiloride induced a 72% reduction in PD in the CF neonates as compared with healthy (37.5 +/- 1.0%) and diseased (36.0 +/- 1.3%) neonates. The PD and amiloride response in CF neonates are similar to those in CF infants (2.24 months), older CF children (greater than 6 years), and CF adults (-64.9 +/- 9.3 mV; 77.7 +/- 1.8%, n = 51). These results suggest that (1) nasal epithelial dysfunction is present in patients with CF shortly after birth, and (2) the nasal PD may be a diagnostic adjunct to the sweat test in the early diagnosis of CF.     

Blindness after confinement

Four days after an elective caesarean section, a patient went blind within a few hours, associated with a sudden rise in blood pressure. The blindness, initially thought to be caused by a cerebral infarct, was ultimately diagnosed as a result of posterior reversible leuco-encephalopathy syndrome. This rare syndrome is reviewed.     

The parent trap: desire for multifetal gestation among patients treated for infertility

ObjectiveTo evaluate predictors for patient preference regarding multifetal or singleton gestation among women presenting for infertility care.DesignCross-sectional study.SettingAcademic university hospital-based infertility clinic.Patient(s)Five hundred thirty-nine female patients with infertility who presented for their initial visit.Main outcome measure(s)Demographic characteristics, infertility history, insurance coverage, desired treatment outcome, acceptability of multifetal reduction, and knowledge of the risks of multifetal pregnancies were assessed using a previously published 41-question survey. Univariate analysis was performed to assess patient factors associated with the desire for multiple births. Independent factors associated with this desire were subsequently assessed by multivariate logistic regression analysis.Result(s)Nearly a third of women preferred multiples over a singleton gestation. Nulliparity, lower annual household income, older maternal age, marital status, larger ideal family size, openness to multifetal reduction, and lack of knowledge of the maternal/fetal risks of twin pregnancies were associated with pregnancy desire. Older age (OR (95% CI) 1.66 (1.20–2.29)), nulliparity (OR (95% CI) 0.34 (0.20–0.58)), larger ideal family size (OR (95% CI) 2.34 (1.73–3.14)), and lesser knowledge of multifetal pregnancy risk (OR (95% CI) 0.67 (0.55–0.83)) were independently associated with desire.Conclusion(s)A large number of patients undergoing fertility treatment desire multifetal gestation. Although a lack of understanding of the risks associated with higher order pregnancies contributes to this desire, additional individual specific variables also contribute to this trend. Efforts to reduce the incidence of multiples should focus not only on patient education on comparative risks of multiples vs singleton pregnancies but also account for individual specific reservations.