Cotton-tipped Swabs Research Articles

Prevalence of Pathogenic Bacteria and Antibiotic Susceptibility Profiles Isolated from Medical Equipment and Inanimate Surface.

The hospital environment, especially the intensive care unit, is a leading reservoir of nosocomial bacteria. Equipment and inanimate surfaces are among the most transmission vehicles for nosocomial bacteria. This study is to assess the bacterial profile and antibiotic susceptibility pattern of the isolates from medical equipment and inanimate surfaces at intensive care unit wards in Bahir Dar City government hospital, North West Ethiopia. A hospital-based, cross-sectional study was conducted between March 01/2021 and May 30/2021 at Felege Hiwot and Tibebe Gihon Compressive Specialized Hospitals. A total of 158 surface swab samples from the patient bed, table, chair, sphygmomanometer, and stethoscopes were collected. Sterile cotton-tipped swabs moistened with normal saline were used. Using standard protocols, the collected samples were processed at Bahir Dar University, Microbiology Laboratory. All isolates were cultured and identified by using routine bacterial culture, Gram staining, and biochemical tests. Phenotypic antimicrobial susceptibility testing was done on each isolate following the Kirby Bauer disk diffusion method. Data were entered and analyzed using SPSS version 26 and the results were explained by using percentages and tables. In this study, coagulase-negative Staphylococcus, S. aureus, and K. pneumoniae were the most predominant isolated bacteria, which accounted for 52.8%, 47.2%, and 43.2% respectively. Chairs, sphygmomanometers, and patient beds were the most contaminated. Imipenem and clindamycin were the most effective antibiotics for all Gram-negative and Gram-positive isolates, respectively. Among the total isolates, 84 (57.5%) were multidrug resistant and of these, 78.4% were Gram-negative isolates. Inanimate objectives and key medical devices of the hospital are heavily contaminated with potentially pathogenic bacteria. Additionally, the recovered isolates are multidrug resistant, making the control and prevention strategy more challenging. Thus, the hospital infection prevention and surveillance system must be activated and perform periodic disinfection of objects. Furthermore, large-scale surveillance is desirable.

DETERMINATION OF VULVOVAGINAL CANDIDIASIS IN TERTIARY CARE HOSPITAL

Objectives: Infections of vulva and vagina are commonly encountered in gynecology practice. These infections are predominant in the women of reproductive age group so, this study was done to determine the prevalence of vaginal candidiasis and identify, differentiate Candida species isolated from the patients. Three high vaginal swabs per patients were collected using sterile cotton-tipped swabs from Gynecology Department and processed in Department of Microbiology, MLBMC, India. Candida was identified using standard guidelines. The study was done on 350 women in reproductive age group (18–49 years), 63.4% were non-pregnant and 36.5% pregnant. One hundred and sixteen/350 (33.1%) samples showed pure growth of Candida species. Candida positivity among pregnant women (42.9%) was higher than in non-pregnant women (27.1%). Isolation of non-albican Candida was higher (26.7%) than Candida albicans, this difference was statistically significant (p<0.05) The most common isolated species by conventional methods was C. albicans (36.3%) followed by Candida glabrata (24.1%), Candida tropicalis (22.5%), Candida krusei (10.3), and Candida parapsilosis (7.7%). In case of C. albicans, Fluconazole and Amphotericin B were found to be most sensitive drugs followed by Nystatin, voriconazole and ketoconazole and among non-albicans candida, Nystatin was the highly sensitive drug. Vulvovaginal candidiasis (VCC) is the most common infection in the women reproductive age group. Several predisposing factors such as HIV, diabetes mellitus, oral contraceptive, IUCD usage, antibiotics, and immunosuppressive drug increase the VCC, C. albicans was the most prevalent species followed by C. glabrata and C. tropicalis.

Perineural 5% Dextrose Injection Treatment and Central Core Excision of the 12:00 Vestibule as Adjunctive Therapies to Complete Vestibulectomy in Select Patients with Neuroproliferative Vestibulodynia

ABSTRACT Introduction Complete vestibulectomy with vaginal advancement flap (CVVAF) for the treatment of neuroproliferative vestibulodynia (NPV) involves excision of the 1:00 to 11:00 region surrounding the urethral meatus and introitus, allowing the vagina and urethral meatus to be anastomosed to the vulva. The vestibule, however, extends above the urethral meatus and below the clitoris (12:00 region). In NPV patients, the entire vestibule including the 12:00 region contains excess mast cells/nerves, however the 12:00 region is not usually addressed during CVVAF surgery. While CVVAF surgery is associated with an approximately 80% success rate, we have observed some patients with significant pain at the 12:00 region pre-operatively who continue to have persistent entrance dyspareunia post-operatively. Objective We report on novel medical/surgical adjunctive strategies for NPV patients with pre-operative 12:00 pain implemented to reduce post-operative pain: using perineural 5% dextrose injection treatments pre-operatively; and performing a limited central core excision of the 12:00 vestibule during CVVAF. Perineural 5% dextrose injections have been shown to reduce neuropathic pain, in part by blocking the transient receptor potential vanilloid - TRPV-1 receptor. Methods In patients scheduled for CVVAF to treat suspected NPV, we performed preoperative vulvoscopy and baseline cotton-tip swab testing at the 12:00 region. In those with significant pain/tenderness at 12:00 (> 4/10 pain), we offered pre-operative perineural 5% dextrose treatments for the three days prior to CVVAF. Each day, cotton-tip swab testing of the 12:00 region was repeated prior to application of local anesthesia with 20% benzocaine, 8% lidocaine, 6% tetracaine. After anesthesia was established, betadine was applied to the region. Insulin syringes (31-gauge needle, 5/16”, 1 ml) filled with 5% dextrose were administered at six locations (total 6 ml) circling the 12:00 region, and compression applied for three minutes. The day after the final treatment, the patient underwent CVVAF including central core excision of the 12:00 region. All vestibular specimens were sent for immunohistochemical staining. Results 14 women, mean age 29 ± 9 years, had 12:00 pain > 4/10 on cotton swab testing at baseline, and confirmed immunohistochemical findings of excess mast cells/nerves consistent with NPV in all specimens. Baseline cotton-tip swab testing mean pain score prior to treatment was 7.3/10 (range 5-10/10) involving the entire 12:00 region. After three perineural 5% dextrose injection treatments, the cotton-tip swab testing mean pain score was reduced to 2.8/10 (range 0-5/10), focused on the central core region of the 12:00 vestibule. Side effects of perineural 5% dextrose injection were limited to mild bruising at injection sites in all patients. The central core excised specimens included the 12:00 minor vestibular gland ostia, and was oval-shaped, on average 2 mm thick, 6 mm wide and 7 mm long. Interrupted vertical sutures of 3-0 vicryl allowed for a horizontal closure of the defect. In patients who returned for in-person post-operative vulvoscopy at 6 months, the post-op cotton-tip swab testing mean pain score was 2.3/10 (range 0-4/10). Conclusions While more research is needed, preliminary results with these adjunctive therapies in selective NPV patients are encouraging. Disclosure No

Clitoral Dysesthesia Following Suprapubic Liposuction: A Case Report of Injury to the Nerves Adjacent to the Clitoris

ABSTRACT Introduction Clitorodynia is a bothersome genito-pelvic dysesthesia characterized by atypical sensations such as burning, stinging, and/or sharp pain confined to the glans clitoris, common clitoral shaft and/or prepucial (hood) area that may be constant, intermittent or occurring only when provoked. Clitorodynia, like other genito-pelvic dysesthesia conditions, may result from a trigger in the end organ (clitoris), pelvic/perineum (pudendal/pelvic nerve neuropathy), cauda equina (Tarlov cyst, annular tear), spine, or brain. While the primary sensory nerve of the clitoris is the dorsal nerve, there are sensory nerves adjacent to the clitoris in the suprapubic area. A 55 year old woman who presented to our sexual medicine clinic for evaluation of clitoral dysesthesia following a suprapubic liposuction in May 2016. She described a 5 year history of unusual, unwanted, unrelenting sensations that felt weird, electrical, uncomfortable, and "nervy", were located to the left side of her clitoris/upper left inner labia, were present all the time at a minimum 5/10 intensity increasing to 7-8/10 that prevented her from focusing on tasks, including sexual activity. Objective We herein describe our evaluation and management of this patient with clitoral genito-pelvic dysesthesia. Methods The evaluation involved a detailed biopsychosocial assessment including: medical history; psychologic assessment; hormone assessment; vulvoscopy with cotton-tip swap testing; neurogenital testing for assessment of the integrity of the pudendal and sciatic nerves; and left clitoral/left inner labia anesthesia testing to assess for clinically significant symptom reduction. Results History was positive for diabetes mellitus, hypercholesterolemia, hypertension, abdominoplasty surgery (2007) and L5-S1 fusion (2010). Physical examination using vulvoscopy with cotton-tip swab testing revealed a focal region of dysesthesia (∼ 4 cm long, ∼2 cm wide) to the left of the clitoris and left upper inner labia associated with significant tenderness (7/10). Pudendal nerve integrity testing was normal. Sciatic nerve integrity testing was abnormal consistent with her previous spine surgery. Cotton-tip swab testing after focal anesthesia of the region of dysesthesia with benzocaine 20%, lidocaine 8% and tetracaine 6% revealed a clinically significant symptom reduction to pain free (0/10). Conclusions Clitoral dysesthesia can occur from injury to the nerves adjacent to the clitoris. This is a case of clitoral genito-pelvic dysesthesia in the end organ following a liposuction procedure to the suprapubic area. The most likely trigger was iatrogenic neuropathic injury of the left anterior labial branch of the genital branch of the genitofemoral nerve and/or left anterior labial branch of the ilioinguinal nerve. These latter nerves course in the suprapubic area and do not innervate the clitoris itself. Nerve testing of the clitoris, innervated by the dorsal nerve branch of the pudendal nerve, was unremarkable. Proposed management of the clitoral dysesthesia will focus on treating the iatrogenic peripheral neuropathy in the end organ and include perineural 5% dextrose injections, low intensity shockwave treatments, platelet rich plasma injections, and/or steroid injections. Disclosure No

Towards environmental detection of Chagas disease vectors and pathogen

Chagas disease vector control relies on prompt, accurate identification of houses infested with triatomine bugs for targeted insecticide spraying. However, most current detection methods are laborious, lack standardization, have substantial operational costs and limited sensitivity, especially when triatomine bug densities are low or highly focal. We evaluated the use of FTA cards or cotton-tipped swabs to develop a low-technology, non-invasive method of detecting environmental DNA (eDNA) from both triatomine bugs and Trypanosoma cruzi for use in household surveillance in eastern Colombia, an endemic region for Chagas disease. Study findings demonstrated that Rhodnius prolixus eDNA, collected on FTA cards, can be detected at temperatures between 21 and 32 °C, when deposited by individual, recently blood-fed nymphs. Additionally, cotton-tipped swabs are a feasible tool for field sampling of both T. cruzi and R. prolixus eDNA in infested households and may be preferable due to their lower cost. eDNA detection should not yet replace current surveillance tools, but instead be evaluated in parallel as a more sensitive, higher-throughput, lower cost alternative. eDNA collection requires virtually no skills or resources in situ and therefore has the potential to be implemented in endemic communities as part of citizen science initiatives to control Chagas disease transmission.

A vestibular examination must include the 12:00 region

ABSTRACT Introduction The vestibule is an endodermal tissue located on the skin surface between Hart's line at the inner aspect of the labia minora (ectoderm), and the hymen, at the vaginal opening (mesoderm). The vestibule contains the urethral meatus and minor and major vestibular glands. The vestibule releases mucinous lubrication during sexual arousal that is achieved, in part, by vestibular innervation, likely from somatic (pudendal branch) and autonomic (pelvic branch) nerves. As part of an evaluation of patients with entrance dyspareunia, providers should perform a cotton-tip swab test to assess pain intensity and degree of erythema. Typically, the locations assessed are the 1:00, 3:00, 5:00, 6:00, 7:00, 9:00 and 11:00 locations of the posterior and right/left anterior vestibule. This testing strategy, however, does not include the entire vestibule. The 12:00 region of the vestibule is located above the urethral meatus, just below the clitoris and medial to Hart's line. The 12:00 region can also be painful during cotton-tip swab testing. Few providers examine this region or consider it during treatment. Objective The main objective of this study was to compare the pain scores of cotton-tip swab testing and degree of erythema of the 12:00 region to those of the 1:00, 3:00, 5:00, 6:00, 7:00, 9:00 and 11:00 locations in women presenting with entrance dyspareunia. The secondary objective was to examine the 12:00 region for the presence of minor vestibular glands. Methods Women presenting to our clinic with complaints of entrance dyspareunia underwent vulvoscopy with photography and cotton-tip swab testing including the 12:00 region while using a vulvoscope (Wallach Zoomscope) with attached camera (Cannon). Pain intensity was rated by the patient (0 – 10), with pain >3 considered clinically significant. Erythema was rated by the provider (absent, mild, moderate or severe) with any erythema considered clinically significant. Results A total of 144 women (mean age 43 +/- 20, range 13-83 years) underwent vulvoscopy at the standard 1:00, 3:00, 5:00, 6:00, 7:00, 9:00 and 11:00 locations. In addition, they were tested concomitantly at the 12:00 location. Among this group of women, 26 (18%) had absent pain and absent erythema throughout all locations; 25 (18%) had positive findings of pain and erythema in at least 3 of the usual vestibular locations but not at 12:00; and 92 (64%) had pain and erythema in at least 1 of the usual vestibular locations and at 12:00. Photographs revealed 27% of those experiencing pain at the 12:00 had obvious single/multiple ostia of minor vestibular glands at that location. Conclusions Women with entrance dyspareunia commonly have pain and erythema at the 12:00 region of the vestibule. Photography reveals the presence of minor vestibular glands at the 12:00 location. Providers should examine the entire vestibule including the 12:00 region during examination. Providers should consider including the 12:00 vestibule when treating entrance dyspareunia with medication such as compounded testosterone and estradiol and/or surgery. Disclosure Work supported by industry: no.

Extent of surgical excision of the vestibule based on positive CD117 and PGP9.5 staining of mast cells in women with neuroproliferative vestibulodynia

ABSTRACT Introduction Neuroproliferative vestibulodynia (NPV) is a poorly understood chronic debilitating sexual pain condition associated with severe vestibular allodynia and hyperalgesia. In patients with NPV, histopathology of surgical specimens from the usual posterior and right and left anterior locations (1:00 - 11:00 o'clock) has shown high densities of CD117 and PGP9.5 positive staining cells consistent with excessive mast cells and nerves. Such pathologic findings have justified the excision of this usual location of the vestibule. There is, however, a lack of consensus regarding the total extent of complete surgical excision for vestibulectomy. Some of our patients demonstrated pain at the 12:00 region and underwent concomitant 12:00 excision along with the usual vestibule location. We wished to study excised vestibular tissue at the 12:00 region for the presence/absence of CD117 and PGP9.5 positive staining cells. This pathologic finding has critical clinical implications as to the extent of the surgical excision. Objective We assessed immunohistochemical densities of CD117 and PGP9.5 positive staining cells from the 12:00 region from each patient, comparing it to cells stained from posterior and left/right anterior vestibule. Methods We studied specimens from 26 women (mean age 27 +/- 12 years) with the presumptive diagnosis of NPV based on positive vestibular cotton swab testing at 12:00 as well as 1:00, 3:00, 5:00, 6:00, 7:00, 9:00 and 11:00 locations who underwent complete vestibulectomy with vaginal advancement flap including the 12:00 region. Surgical specimens from the 12:00, the posterior and left/right anterior vestibule were prepared separately in formalin and embedded in paraffin blocks. Immunohistochemical staining using antibodies to CD117 and PGP 9.5 was performed on these blocks and sections cut for slides. These stained slides from multiple locations of the vestibule were examined and photographed using a Zeiss AxioCam HR high resolution digital microscope. The density of CD117 and PGP9.5 positive cells were determined by counting the number of dark brown stained cells per high-power field (HPF = x 20 magnifications). Based on the literature, control subjects have values of 8 mast cells or less per HPF. Results All 26 patients had elevated densities of CD117-positive cells in vestibular epithelium/stroma in the 12:00 (mean density 51 +/- 19 per HPF) as well as posterior and left/right anterior vestibule (mean density 47 +/- 18 per HPF). All 26 patients had high densities of PGP9.5-positive cells noted in vestibular stroma in the 12:00 (mean density 36 +/- 23 per HPF) and posterior and left/right anterior vestibule (mean density 38 +/- 22 per HPF). Conclusions In 100% of these patients NPV, the 12:00 region of the vestibule contained an increased number of CD117 and PGP9.5 positive staining cells similar to the posterior and left/right anterior vestibule. When performing a vestibulectomy in patients with positive cotton-tip swab testing including the 12:00, excision of the 12:00 vestibule should be considered to optimize treatment. Disclosure Work supported by industry: no.

The 12:00 Region of the Vestibule: Often Overlooked during Examination and Treatment of Women with Entrance Dyspareunia

ABSTRACT Introduction The vestibule is an endodermal tissue located on the skin surface between Hart's line at the inner aspect of the labia minora (ectoderm), and the hymen, at the vaginal opening (mesoderm). The vestibule contains the urethral meatus and minor and major vestibular glands. The vestibule releases mucinous lubrication during sexual arousal that is achieved, in part, by vestibular innervation, likely from somatic (pudendal branch) and autonomic (pelvic branch) nerves. As part of an evaluation of patients with entrance dyspareunia, providers should perform a cotton-tip swab test to assess pain intensity and degree of erythema. Typically, the locations assessed are the 1:00, 3:00, 5:00, 6:00, 7:00, 9:00 and 11:00 locations of the posterior and right/left anterior vestibule. This testing strategy, however, does not include the entire vestibule. The 12:00 region of the vestibule is located above the urethral meatus, just below the clitoris and medial to Hart's line. The 12:00 region can also be painful during cotton-tip swab testing. Few providers examine this region or consider it during treatment. Objective The main objective of this study was to compare the pain scores of cotton-tip swab testing and degree of erythema of the 12:00 region to those of the 1:00, 3:00, 5:00, 6:00, 7:00, 9:00 and 11:00 locations in women presenting with entrance dyspareunia. The secondary objective was to examine the 12:00 region for the presence of minor vestibular glands. Methods Women presenting to our clinic with complaints of entrance dyspareunia underwent vulvoscopy with photography and cotton-tip swab testing including the 12:00 region while using a vulvoscope (Wallach Zoomscope) with attached camera (Cannon). Pain intensity was rated by the patient (0 – 10), with pain >3 considered clinically significant. Erythema was rated by the provider (absent, mild, moderate or severe) with any erythema considered clinically significant. Results A total of 144 women (mean age 43 +/- 20, range 13-83 years) underwent vulvoscopy at the standard 1:00, 3:00, 5:00, 6: 00, 7:00, 9:00 and 11:00 locations. In addition, they were tested concomitantly at the 12:00 location. Among this group of women, 26 (18%) had absent pain and absent erythema throughout all locations; 25 (18%) had positive findings of pain and erythema in at least 3 of the usual vestibular locations but not at 12:00; and 92 (64%) had pain and erythema in at least 1 of the usual vestibular locations and at 12:00. Photographs revealed 27% of those experiencing pain at the 12:00 had obvious single/multiple ostia of minor vestibular glands at that location. Conclusions Women with entrance dyspareunia commonly have pain and erythema at the 12:00 region of the vestibule. Photography reveals the presence of minor vestibular glands at the 12:00 location. Providers should examine the entire vestibule including the 12:00 region during examination. Providers should consider including the 12:00 vestibule when treating entrance dyspareunia with medication such as compounded testosterone and estradiol and/or surgery. Disclosure No

Methamphetamine-Induced Vaginal Lubrication & Associated Hormonal Changes

ABSTRACT Introduction Vaginal dryness is an issue that affects millions of women, creating a situation that often leads to painful sexual experiences and diminished pleasure and self-esteem. Though the physiology of vaginal lubrication in response to sexually arousing stimuli is established, no treatment, other than topical lubricants, is available for women suffering from vaginal dryness. Previous research from our lab reported that female methamphetamine (meth) users experience immediate and noticeable vaginal lubrication when they inject the drug intravenously (IV). A warming or flushing sensation spreading from the chest area down into the pelvic region accompanied this lubrication. Understanding the mechanisms mediating this previously undescribed phenomenon may reveal a potential target for future pharmaceutical development to enhance a woman's natural levels of vaginal lubrication. We have reported that injections of meth also increase vaginal lubrication in rats in a dose-dependent manner. Plasma levels of several signaling molecules known to influence vaginal lubrication, including the steroid hormones estradiol, progesterone, and testosterone, as well as the gaseous vasodilator nitric oxide, increase at specific time points following IV meth in female rats. Accordingly, we were able to decrease the amount of vaginal fluid produced by pre-treating the animals with the nitric oxide synthase inhibitor, L-NAME, prior to meth. Objective The present work expands the aforementioned findings by measuring plasma levels of vasoactive intestinal polypeptide (VIP), an established mediator of female sexual arousal, and corticosterone, a steroid hormone implicated in drug addiction, after IV injections of meth. We also determined the involvement of estradiol in meth-induced vaginal lubrication using an estrogen receptor antagonist. Methods We implanted adult female Wistar rats with chronic indwelling jugular catheters and allowed them at least one week to recover from surgery. We pre-treated the rats with fulvestrant, an estrogen receptor antagonist, and then anesthetized them with isoflurane gas before injecting them intravenously with meth via the implanted catheter. A pre-weighed cotton-tipped swab, inserted into the vaginal canal, collected fluid secreted following the administration of meth. The change in the weight of the swab before and after meth indicated the amount of fluid produced. In a separate group of rats, we used the jugular catheter to remove blood at various time points (1-60 min) following the meth injections to measure plasma levels of VIP and corticosterone. Results Although we have not yet completed these experiments, we hypothesize that the inhibition of estrogen receptors will reduce meth-induced vaginal lubrication similar to the reduction produced by L-NAME. Further, we predict that both VIP and corticosterone levels will increase between 5 and 20 min after the injections of meth, similarly to the other signaling molecules we measured previously. Conclusions These findings have far-reaching and potentially life-changing implications, as the majority of women will experience vaginal dryness a least once in their lifetimes, if not chronically. The underlying mechanisms of meth-induced vaginal lubrication may provide the necessary pharmacological target to treat vaginal dryness. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Goeders is on the Scientific Advisory Boards for Embera NeuroTherapeutics and JanOne; however, the work of these companies is unrelated to the submitted abstract.

Determining Borders of Surgical Excision of the Vestibule Based on Positive CD117 and PGP9.5 Staining of Mast Cells in Women with Neuroproliferative Vestibulodynia

ABSTRACT Introduction Neuroproliferative vestibulodynia (NPV) is a poorly understood chronic debilitating sexual pain condition associated with severe vestibular allodynia and hyperalgesia. In patients with NPV, histopathology of surgical specimens from the usual posterior and right and left anterior locations (1:00 - 11:00 o'clock) has shown high densities of CD117 and PGP9.5 positive staining cells consistent with excessive mast cells and nerves. Such pathologic findings have justified the excision of this usual location of the vestibule. There is, however, a lack of consensus regarding the total extent of complete surgical excision for vestibulectomy. Some of our patients demonstrated pain at the 12:00 region and underwent concomitant 12:00 excision along with the usual vestibule location. We wished to study excised vestibular tissue at the 12:00 region for the presence/absence of CD117 and PGP9.5 positive staining cells. This pathologic finding has critical clinical implications as to the extent of the surgical excision. Objective We assessed immunohistochemical densities of CD117 and PGP9.5 positive staining cells from the 12:00 region Methods We studied specimens from 26 women (mean age 27 +/- 12 years) with the presumptive diagnosis of NPV based on positive vestibular cotton swab testing at 12:00 as well as 1:00, 3:00, 5:00, 6:00, 7:00, 9:00 and 11:00 locations who underwent complete vestibulectomy with vaginal advancement flap including the 12:00 region. Surgical specimens from the 12:00, the posterior and left/right anterior vestibule were prepared separately in formalin and embedded in paraffin blocks. Immunohistochemical staining using antibodies to CD117 and PGP 9.5 was performed on these blocks and sections cut for slides. These stained slides from multiple locations of the vestibule were examined and photographed using a Zeiss AxioCam HR high resolution digital microscope. The density of CD117 and PGP9.5 positive cells were determined by counting the number of dark brown stained cells per high-power field (HPF = x 20 magnifications). Based on the literature, control subjects have values of 8 mast cells or less per HPF. Results All 26 patients had elevated densities of CD117-positive cells in vestibular epithelium/stroma in the 12:00 (mean density 51 +/- 19 per HPF) as well as posterior and left/right anterior vestibule (mean density 47 +/- 18 per HPF). All 26 patients had high densities of PGP9.5-positive cells noted in vestibular stroma in the 12:00 (mean density 36 +/- 23 per HPF) and posterior and left/right anterior vestibule (mean density 38 +/- 22 per HPF). Conclusions In 100% of these patients NPV, the 12:00 region of the vestibule contained an increased number of CD117 and PGP9.5 positive staining cells similar to the posterior and left/right anterior vestibule. When performing a vestibulectomy in patients with positive cotton-tip swab testing including the 12:00, excision of the 12:00 vestibule should be considered to optimize treatment. Disclosure No

A comparison of cotton-tipped and nylon flocked swabs for culture of Neisseria gonorrhoeae from oropharyngeal samples

Our aim was to determine if there was a difference in culture positivity for oropharyngeal gonorrhoea when sampling using a nylon-flocked versus cotton-tipped swab. We collected FLOQSwabs and cotton-tipped swabs from individuals aged ≥ 18 years who had untreated oropharyngeal gonorrhoea detected by NAAT between November 2019-June 2020.Of 78 participants, 32 (41.0%) were culture-positive for N. gonorrhoeae from either swab. Of these 32, 29 (90.6%, 95%CI: 75.0%-98.0%) were positive on both swabs, one (3.1%, 95%CI: 0.0%-16.2%) tested positive on FLOQSwab only and two (6.2%, 95%CI: 0.1%-20.8%) tested positive on cotton-tipped swabs only. There was moderate agreement between the swabs in the amount of bacterial growth (Cohen's Kappa (k)=0.745; 95%CI: 0.622-0.868, p<0.001). Our results showed that the proportion of positive results was comparable using the FLOQSwabs versus the cotton-tipped swabs for oropharyngeal gonorrhoea culture.

Utility of nasal application of lignocaine gel using cotton tip swab versus squirting with slip-tip syringe for transnasal fibreoptic bronchoscopy: a pilot randomised controlled trial

BackgroundDuring flexible fibreoptic bronchoscopy through the nasal route, anaesthesia of the nasal passage is achieved by lignocaine gel application by a slip-tip syringe or with the help of a cotton...

The Influence of Chewing Habits on the Degree of Impacted Cerumen

Abstract: Cerumen was glandular secretions at the outer one-third of the ear mixed with exfoliated squamous epithelium. The jaw's movement keeps the cerumen in the ear canal in a state of balance, so it is clean, protects and lubricates the external auditory canal. Impacted cerumen is also caused by excessive production, narrow canal anatomy, viscosity wax, and irritation due to cotton-tipped swabs habits. This study aims to determine whether chewing habits influence the degree of cerumen obstruction in patients with impacted cerumen. The study was a cross-sectional method in impacted cerumen patients at 17-80 years old in the ENT clinic of District Hospital Wates, Kulon Progo, Yogyakarta, Indonesia. Risk factors assessed were education, age, gender, chewing habits, and cotton-tipped swabs habits. The data were then analyzed by chi-square test. Of 80 respondents with the dominant age range 17-38 years (58.8 %), the number of males was 47 (58.8 %), and females were 33 (41.2 %). The significant risk factors comprised the chewing habit and the use of cotton-tipped swabs. Factors affecting the degree of cerumen in patients with impacted cerumen were the chewing habits and cotton-tipped swabs habits.

Predominant role of Haemophilus influenzae in the association of conjunctivitis, acute otitis media and acute bacterial paranasal sinusitis in children

Haemophilus influenzae is a predominant pathogen for conjunctivitis, acute otitis media and acute bacterial paranasal sinusitis in children. We undertook this study to investigate the possible association among these diseases. Children younger than 18-year-old with a diagnosis of bacterial conjunctivitis plus acute otitis media and/or acute bacterial paranasal sinusitis during 2009–2018 were included. Sampling for bacterial cultures was obtained from the lower palpebral conjunctiva and/or ear discharge with cotton-tipped swabs. A total of 67 children were recruited and the age was 29.5 (± 22.4) months in average. Fifty-seven children had conjunctivitis–otitis media syndrome and eight of them had a concurrent diagnosis of acute paranasal sinusitis. Ten children had conjunctivitis and acute paranasal sinusitis simultaneously. Clusters in household were observed in 50.7% children. Most common isolates were Haemophilus influenzae (70%), Moraxella catarrhalis (18%), and Staphylococcus aureus (8%). Antibiotic resistance rate of H. influenzae was 80% for ampicillin, 18% for amoxicillin–clavulanate, and 11% for the second or third-generation cephalosporins. Apart from well-known conjunctivitis–otitis media syndrome, acute paranasal sinusitis may also be linked to conjunctivitis with a similar pathogenic process. Simultaneous presence of these infections may guide the choice of empiric antibiotics toward H. influenzae.

Cotton-Tipped Plastic Swabs for SARS-CoV-2 RT-qPCR Diagnosis to Prevent Supply Shortages.

CDC and WHO guidelines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis only recommend synthetic fiber swabs for nasopharyngeal (NP) sampling. We show that cotton-tipped plastic swabs do not inhibit PCR and have equivalent performance to rayon swabs. Cotton-tipped plastic swabs are massively produced worldwide and would prevent swab supply shortages under the current high SARS-CoV-2 testing demands, particularly in developing countries.

PD36-08 OPEN-LABEL PILOT, PROSPECTIVE VULVOSCOPIC STUDY OF DAILY ADMINISTRATION OF PRASTERONE VAGINAL INSERTS IN WOMEN WITH MODERATE TO SEVERE DYSPAREUNIA

You have accessJournal of UrologySexual Function/Dysfunction: Female (PD36)1 Apr 2020PD36-08 OPEN-LABEL PILOT, PROSPECTIVE VULVOSCOPIC STUDY OF DAILY ADMINISTRATION OF PRASTERONE VAGINAL INSERTS IN WOMEN WITH MODERATE TO SEVERE DYSPAREUNIA Sue Goldstein*, Julea Minton, Catherine Gagnon, Noel Kim, and Irwin Goldstein Sue Goldstein*Sue Goldstein* More articles by this author , Julea MintonJulea Minton More articles by this author , Catherine GagnonCatherine Gagnon More articles by this author , Noel KimNoel Kim More articles by this author , and Irwin GoldsteinIrwin Goldstein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000907.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prasterone (DHEA), a daily 6.5 mg vaginal insert, is FDA approved for moderate to severe dyspareunia, a symptom of vulvovaginal atrophy due to menopause. Prasterone is converted intracellularly in vaginal wall layers into active androgens and estrogens with blood values maintained within normal post-menopausal range. In Phase III clinical trials the mean pre-treatment dyspareunia score was 2.57, falling to 1.20, 0.97 and 0.87 at weeks 12, 26 and 52, respectively (0 = none, 1 = mild, 2 = moderate, 3 = severe). Although prasterone is a vaginal insert, the significant reduction of pain suggests improvement of the vestibular, endodermal genital tissue associated with dyspareunia in androgen and estrogen deficient states like menopause. The primary objective was to use vulvoscopic photographs to document changes to the vestibule and vaginal region in menopausal women with moderate to severe dyspareunia using prasterone daily for 20 weeks. Secondary objectives included changes in pain on the cotton-tipped swab test and sexual function by subject diary. METHODS: This prospective study involves photography at screening, baseline and every four weeks for twenty weeks. Blinded photographs were assessed independently using a 4-point Likert scale, with lower scores representing healthier appearance. Vestibular tissue appearance (VestTA) assessed severity of 5 items: urethral meatal prolapse, introital stenosis, pallor, erythema, mucosa inflammation. Vaginal tissue appearance (VagTA) assessed severity of loss of vaginal rugae. Changes in pain based on cotton-tipped swab test results and responses on subject diaries completed at each sexual event were examined for each visit and compared. Semi-quantitative data were analyzed by repeated measures ANOVA and mean differences between treatment visits and 95% CI of VestTA scores, VagTA scores and cotton swab test scores were calculated. Adverse events were recorded. RESULTS: Eleven subjects completed the study. VestTA and VagTA scores were significantly reduced from baseline after active treatment by week 4 (mean change from baseline = -0.53; 95% CI [-0.82, -0.24] and -0.49; 95% CI [-0.79, -0.20], respectively) and maintained through week 20 (-0.58; 95% CI [-0.87, -0.29] and -0.80; 95% CI [-1.09, -0.51], respectively), suggesting improved vestibular and vaginal tissue health. Cotton-tipped swab test scores were significantly reduced from baseline after week 8 (mean change = -0.65; 95% CI [-1.02, -0.28]) through week 20 (mean change = -1.04; 95% CI [-1.41, -0.67]), suggesting decreased pain. Diary results showed decrease in pain as well. No prasterone related adverse events were reported. CONCLUSIONS: Significant improvements were revealed in VestTA, VagTA and cotton-tipped swab test scores. This is the first prospective vulvoscopic study to show that an intravaginal hormone therapy significantly improves the photographic appearance of 5 vestibular health parameters. This observation may explain the robust effect on prasterone in lowering dyspareunia in menopausal women with moderate to severe dyspareunia. Source of Funding: This study was supported by an investigator-initiated research grant from AMAG Pharmaceuticals. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e726-e726 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sue Goldstein* More articles by this author Julea Minton More articles by this author Catherine Gagnon More articles by this author Noel Kim More articles by this author Irwin Goldstein More articles by this author Expand All Advertisement PDF downloadLoading ...

First Report of Plantain Soft Rot Caused by Klebsiella variicola in Haiti

Plantain and banana, both Musa spp. hybrids, constitute a major component of domestic food production in Haiti. In response to grower reports (Faculty of Agronomy and Veterinary Medicine, Port-au-Prince, personal communication) of up to 60% incidence of “toppling disease”, we conducted a preliminary study in July 2018 at four plantain farms in Arcahaie, Haiti. Symptoms observed on up to 30% of plants (n = ∼100) included a brown necrotic soft rot lesion on pseudostems extending up to 1 m in length and several centimeters deep. Toppling occurred at fruit onset, with plants folding over at the point of the soft rot. Six plants representing the four farms were sampled: 6-cm² sections were excised from the lesion edge, surface sterilized with 0.6% sodium hypochlorite, rinsed, and macerated with sterile tap water, and then the suspension was streaked onto nutrient agar (NA) and Miller-Schroth medium agar (MSM) plates, yielding six bacterial isolates. Colonies were round, glossy, convex, translucent gray-white on NA, produced a transient red-orange color change on MSM, and were aerobic, gram-negative, oxidase-negative and hypersensitive response negative on ‘Bonnie Best’ tomato and ‘Hicks’ tobacco (Schaad et al. 2001); all the above tests were repeated twice. All six isolates were identical in initial 16S rDNA sequencing, so pathogenicity of two randomly chosen isolates (G18-1365 and G18-1376) was tested on disease‐free ‘Dwarf Cavendish’ banana plantlets by drilling a 2.5-cm hole into the pseudostem, inserting sterile cotton-tipped swabs drawn through 48-h cultures on NA (negative control was dipped in sterile water) into the drilled incision, and sealing with Parafilm. Each plant was wounded once, with five plants per isolate or control. Rotting symptoms consistent with the field observations were observed 4 weeks after inoculation for all isolate inoculations; control plants remained symptomless. Reisolation and identification to fulfill Koch’s postulates were completed with results identical to the first isolations and tests. Genomic DNA was boil-extracted as previously described (Dashti et al. 2009) from the two isolates grown 24 h on NA. The amplification and sequencing of 16S rDNA, rpoB, phoE, and infB gene targets were carried out using primers and protocols previously described (Rosenblueth et al. 2004). One sequence for each isolate’s gene target (eight total) was deposited in NCBI GenBank (accessions MK217521 to MK217522; MK235993 to MK235998). In BLAST searches, sequence fragments of 16S rDNA, rpoB, phoE, and infB from isolates G18-1365 and G18-1376 resulted in 99% identity with Klebsiella variicola strains. Multilocus sequence analysis (MEGA X, Kumar et al. 2018) of those sequences yielded a concatenated phylogenetic tree that placed both isolates within the K. variicola clade. Isolates G18-1365 and G18-1376 have been deposited at the BCCM, Ghent University (accessions LMG 31122 and LMG 31123, respectively). K. variicola has been reported to cause similar bacterial rots in banana and carrot (Chandrashekar et al. 2018; Fan et al. 2016). Before management can be prescribed, further studies are necessary to determine disease incidence and if this species is the sole cause of toppling or is part of a larger disease complex, and to understand the mode of transmission within and among plantain farms. Additionally, similarity to human pathogenic strains should be studied to determine if there is a human health risk posed by K. variicola isolates causing soft rot in plantain.

195 Retrospective Chart Review of Treatment Outcome Following Low-Intensity Shockwave Therapy for the Treatment of Vestibulodynia with Urogold 100™

Genital pain disorders have devastating effects on a woman’s quality of life, including social isolation. These disorders occur with high prevalence; more than 1/3 of women report pain during sexual activity, placing a significant financial burden on women and the healthcare system. Multiple medical treatments for dyspareunia are available to improve quality of life and decrease pain, however many are invasive, involving pharmacotherapy/hormone therapy/needle insertion/surgery, and are associated with significant morbidity. Low intensity shockwave therapy (LiSWT) is a non-invasive, non-pharmacologic, non-hormonal, non-surgical, low morbidity treatment strategy. FDA-cleared for pain amelioration in the US as non-significant risk in humans, Urogold 100™ is an electrohydraulic shockwave device that generates energy levels such as 0.10-0.12 mJ/mm2 with a unique parabolic reflector. This chart review represents the first US-based treatment outcome study in women with vestibulodynia using Urogold 100™. Patients presenting with vestibulodynia were offered the opportunity to receive LiSWT as a potential treatment for their genital pain disorder. As standard of care in our practice, patients completed the Female Sexual Function Index (FSFI), Sexual Distress Scale (SDS), vulvoscopy with photography, and cotton-tipped swab (Q-tip®) test at baseline. Vulvoscopic vulvar/vestibular photographs were scored for Vulvar/Vestibular Tissue Appearance (Vul/VestTA) (0 = normal appearance, 1 = minimal, 2 = moderate, 3 = severe concerns) for the vulva, vestibule and urethral meatus, with low scores associated with healthier tissue appearance. Cotton-tipped swab testing rated pain at the 1:00, 3:00, 5:00, 6:00, 7:00, 9:00 and 11:00 positions (0 = no pain, 1 = minimal, 2 = moderate, 3 = severe). The LiSWT protocol involved 6 treatment sessions, 3000 shocks each (1000 right/left lateral vestibule, and 1000 posterior vestibule), frequency 4/sec, membrane level 1. The energy varied from 0.10 – 0.12 mJ/mm2, based on patient toleration. Patients underwent vulvoscopy with photography and cotton-tipped swab testing prior to each LiSWT, as is routine in our practice. At the end of treatment, patients recorded their treatment response by Patient Global Impression of Improvement (PGI-I), a scale of 1 – 7 with clinically relevant improvement expressed by scores of 1 – 3.

Evaluation of the Antibacterial and Antifungal Effects of ProRoot MTA and Nano-fast Cement: An In Vitro Study

One of the most vital characteristics of an ideal root filling material is the capability to inhibit the growth of the microorganisms. Mineral trioxide aggregate (MTA) is one of the most used root repair materials, with approved antibacterial effect. A newly introduced root repair material is nano-fast cement (NFC) which should be investigated. The antibacterial and antifungal activities of NFC were evaluated in the present study. Enterococcus faecalis (PTCC 1394), Escherichia coli (ATTC 15224), and Candida albicans (PTCC 5027) were employed for the antimicrobial assessment. The following were the steps used to conduct the agar diffusion test (ADT): six agar plates were used. 0.5 McFarland concentration of each strain was cultured on two plates by a sterile cotton-tipped swab. Three holes with 5mm diameter were created on each plate. Freshly mixed cement was placed in the holes of the related plate. After two hours, the plates were incubated at 37°C for 24 hours. Then, the diameter of the growth inhibition zones were measured, and the mean values were used for the analysis. Direct contact test (DCT) was done by using the following steps: Freshly mixed materials were placed in the 96-well microtiter plate. 10 μL of each bacterial suspension was added to the tested cement. After one-hour incubation at 37°C, 245 μL of BHI broth was added to each well, and the plate was vortexed for 2 minutes. About 15 μL of this bacterial suspension was added to a new well which contained 215 μL of fresh medium. The kinetics of the bacterial outgrowth were measured by the microplate spectrophotometer hourly for 12 hours. No significant differences were observed between the diameters of the growth inhibition zones of MTA and NFC groups in ADT. In DCT, the MTA inhibits E. coli more effectively than NFC (p value < 0.001). Both cements had the same inhibitory effect on E. faecalis and C. albicans. The MTA and NFC are almost equally effective against the tested microorganisms. The antibacterial characteristic of any dental material is an important matter. As well, the antibacterial efficacy of the NFC should be evaluated.

Nasal Carriage Rate, Antimicrobial Susceptibility Pattern, and Associated Factors of Staphylococcus aureus with Special Emphasis on MRSA among Urban and Rural Elementary School Children in Gondar, Northwest Ethiopia: A Comparative Cross-Sectional Study.

Introduction Staphylococcus aureus is a Gram-positive, catalase-positive, and coagulase-positive bacterial species commonly found on the skin and in the nose of most healthy individuals. The anterior nares of nose are the most frequent carriage sites for S. aureus in both adults and children. Methicillin resistance among S. aureus isolates has steadily increased worldwide. Objective The main objective of this study was to determine nasal carriage rate, antimicrobial susceptibility pattern, and associated risk factors of Staphylococcus aureus with special emphasis on MRSA among urban and rural elementary school children in Gondar, Northwest Ethiopia. Method A community based comparative cross-sectional study was conducted on 622 urban and rural elementary school children in Gondar from January 1st to March 30th, 2018. Data was collected using a questionnaire and nasal swab samples were collected by sterile cotton tip swab moistened with sterile normal saline. Collected samples were inoculated on mannitol salt agar and incubated aerobically at 37°C for 24 hrs. S. aureus was confirmed by observing colony characteristics and biochemical tests. MRSA was detected using cefoxitin disc by Modified Kirby-Bauer disk diffusion technique. Finally data was entered, cleared, and checked using Epi-info version 7 and exported to SPSS version 20 for analysis. Odds ratio and logistic regression were used for statistical association. P-value ≤ 0.05 at 95% CI was considered for statistical association. Result Of the 622 school children, the overall prevalence of S. aureus was 143/622 (23%). Of them, 14/143 (9.79%) were MRSA. The carriage rate in urban schools was 83/622 (13.3%) whereas it was 60/622 (9.6%) in rural schools. The prevalence of MRSA among urban schools, 9.1%, was higher than their urban counterparts, 0.7%. Gentamycin, clindamycin, and ciprofloxacin were the most effective whereas penicillin and tetracycline were resistant. Children's fathers' educational status and number of children in class room were significantly associated with S. aureus but only living in urban of children significantly associated with MRSA. Conclusion This study showed high prevalence of S. aureus and MRSA, 143/622 (23%) and 14/143 (9.79%), respectively. So, decolonization of nasal carriers of MRSA and reducing the number of students per classroom should be addressed. Moreover, regular large scale survey should be conducted to assess the burden and intervene accordingly.