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Aim: To evaluate the topical treatment of onychomycosis using a 10% hydroalcoholic propolis extract (PE) in two aleatorily chosen patients and analyze possible risk factors from hosts including some particularities of the isolated fungi that may justify the outcomes achieved., Materials and Methods: A topical treatment, with PE, was started in two cases of toe onychomycosis due to T. rubrum . The in vitro PE antifungal activity against these isolates was confirmed. Moreover, the ability of the fungi to infect the human nail was evaluated also in an ex vivo study, analyzed by histopathology., Results: Within four months, both patients showed evident improvement, but with different outcomes. The possible host-related risk factors justifying the poorer outcome in patient 1 include a longer duration time of onychomycosis (50 years). Some particularities in the T. rubrum strain isolated from this patient in relation to that found in patient 2 were observed: (1) the hypha morphology suggesting a major adaptation of the fungus to the host; (2) a 16 times greater propolis concentration was required in vitro ; and (3) a faster ability to start a growth using the nail as the only nutritional source. Additionally, this isolate was more efficient in producing a biofilm on the nail surface., Conclusions: A partial clinical and complete mycological cure for the two patients was achieved after four months of PE daily use. Despite a complete recovery, a different outcome was observed between both cases. A more persistent onychomycosis, added to greater fungal potential to produce biofilm on the nail, seems to influence greatly the success of a topical treatment with PE., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Vanessa Vasconcellos-Pontello et al.)

Onychomycosis is a chronic fungal infection of nails, commonly caused by dermatophyte fungi, primarily species of Trichophyton . Because of the limited drug arsenal available to treat general fungal infections and the frequent failure of onychomycosis treatment, the search for new therapeutic sources is essential, and topical treatment with natural products for onychomycosis has been encouraged. Propolis, an adhesive resinous compound produced by honeybees ( Apis mellifera ), has shown multiple biological properties including significant antifungal and anti-biofilm activities in vitro . In spite of promising in vitro results, in vivo results have not been reported so far. This study assessed an ethanol propolis extract (PE) as a topical therapeutic option for onychomycosis, including its characterization in vitro and its applicability as a treatment for onychomycosis (from bench to clinic). The in vitro evaluation included analysis of the cytotoxicity and the antifungal activity against the planktonic cells and biofilm formed by Trichophyton spp. We also evaluated the capacity of PE to penetrate human nails. Patients with onychomycosis received topical PE treatments, with a 6-month follow-up period. The results of the in vitro assays showed that PE was non-toxic to the cell lines tested, and efficient against both the planktonic cells and the biofilm formed by Trichophyton spp. The results also showed that PE is able to penetrate the human nail. The results for PE applied topically to treat onychomycosis were promising, with complete mycological and clinical cure of onychomycosis in 56.25% of the patients. PE is an inexpensive commercially available option, easy to obtain and monitor. Our results indicated that PE is a promising natural compound for onychomycosis treatment, due to its ability to penetrate the nail without cytotoxicity, and its good antifungal performance against species such as Trichophyton spp. that are resistant to conventional antifungals, both in vitro and in patients.

A 20-year-old woman with massive clitoral enlargement is presented to discuss the differential diagnosis and the treatment of this condition.

Objective: The objective of this multicentre, non-controlled, open-label study is the evaluation of the bleeding patterns during the use of a vaginal combined contraceptive, its safety in relation to occurrence of adverse effects, its efficacy as a contraceptive method and user compliance., Study Design: Healthy female volunteers (N=165), asking for contraception, were enrolled to participate in the study. Each subject was given seven vaginal rings, releasing an average amount of 120microg etonogestrel (ENG) and 15microg ethinylestradiol (EE) per day. Study period was 7 cycles. A total of 878 cycles was valid for statistical analysis. The primary parameter, (breakthrough bleeding and/or spotting), was recorded for each cycle. The subjects were asked to report any adverse effect experienced during the treatment period, general physical and gynaecological examinations were performed and haematological blood tests were taken., Results: Breakthrough bleeding/spotting occurred in 5.01% cycles (44 out of 878 cycles, of whom 37 were breakthrough spotting only). Absence of withdrawal bleeding during the ring-free period was reported in 1.94% cycles (17 out of 878). Forty-one subjects (24.8%) reported 66 events that were potentially drug-related. The most frequently drug-related events were weight increase (10 cases), headache (9 cases), nausea (4 cases). No pregnancy was reported during the study period. Haematology and chemical chemistry tests showed no clinically significant abnormality., Conclusions: In the present study, NuvaRing has shown to be a valid contraceptive method to ensure optimal cycle control with low incidence of irregular bleeding and altered withdrawal bleeding. The low incidence of gastrointestinal side effects (nausea, vomiting) may be related the low hormonal dose and to the vaginal delivery of hormones which avoids the gastrointestinal tract.

We report our experience with intracardiac administration of potassium chloride as safe and effective method for late termination of pregnancy (TOP) and to document the indications for feticide in a major tertiary unit. During the study period (January 2000 and December 2005), 239 late terminations of pregnancy were performed at a median gestational age of 22(+6) weeks (range 20(+6) to 36(+3) weeks). The most frequent indication was represented by aneuploidy (24.3%), followed by brain abnormalities (17.6%). Maternal indications were responsible for 2.9% of the total number of terminations. No maternal complications occurred and complete asystole was achieved in all cases with a median volume of potassium chloride of 4.7 ml (range 2-10 ml). Potassium chloride injected directly in the left ventricle induces immediate asystole, and it is a safe and effective method of TOP. Interestingly, despite the widespread introduction of aneuploidy screening, chromosomal abnormalities, particularly trisomy 21, still represent the major indication for late TOP.

Background: Amniocentesis in the third trimester, which reduces risks of procedure-related miscarriage but still allows termination of affected fetuses, may be applicable in some pregnancies. The implications of deferring amniocentesis include complications, delivery before the test and increased amniotic fluid culture failure rates. We investigated the indications, complications, karyotype results and laboratory failure rates of third-trimester amniocentesis., Methods: We studied all women who underwent third-trimester amniocentesis from 2000 to 2006. Data were collected from ultrasound databases, computerised records and individual chart review., Results: We reviewed 165 pregnancies that underwent amniocenteses after 28 weeks. Median maternal age at amniocentesis was 32 years and median gestation, 32(+2) weeks. Indications included malformation (60/165), soft markers (37/165), maternal request (12/165), and positive screening test (11/165). Of the 49 women(29.7%) who declined second-trimester amniocentesis, 24.5% had twins and 38.8%, malformations. Amniocentesis was not offered to 116 women: 57/116 (49.1%) third-trimester referrals, 25/116 (21.5%) diagnosed late and the remainder, low-risk indications. Fetal karyotype was abnormal in 17 cases (10.3%). Seven women who initially declined amniocentesis had abnormal results compared with one advised to have late amniocentesis. Culture failure rate was 9.7%, however results were obtained by Quantitative fluorescent polymerase chain reaction (QF-PCR) from 164/165 samples. Complication rate was 1.2%., Conclusion: For late diagnoses and for low-risk indications, third-trimester amniocentesis is an acceptable option, especially when utilising QF-PCR with cytogenetic culture.

It is well known that subjects with polycystic ovary syndrome (PCOS) show very variable clinical and biochemical aspects. Considering long-term repercussions, two main disturbances, not always strictly related, need to be countered: hyperandrogenism and insulin resistance, with compensatory hyperinsulinemia. The aim of this review is to summarize therapeutic perspectives for PCOS, starting from basic approach, such as weight reduction and changes in lifestyle. The benefits of long-term use of oral contraceptives and the criteria of choice of the estro-progestin combinations are discussed. With severe hyperandrogenism, a pure antiandrogen should be added. The experiences with insulin-sensitizing drugs, especially metformin, are reviewed; while their beneficial role as an adjuvant to treatment of ovulatory infertility has been well established, the effects of a long-term treatment, especially in very young patients, are still under debate. Current studies are testing the results of combinations of different treatments at low dosage; randomized comparative trials on the long-term efficacy of these approaches have yet to be scheduled.