without any organic pathology. [3] The onset of primary dysmenorrhea is usually at or shortly after menarche, when ovulatory cycles are established. Women with primary dysmenorrhea have a greater endometrial production of prostaglandins compared with asymptomatic women. [4] Primary dysmenorrhea is an important clinical cause in young girls for work absenteeism, thus having negative effect on QoL. The World Health Organization defined health as being not only the absence of disease and infirmity but also the presence of physical, mental, and social well-being. [5] QoL is defined as a subjective phenomenon based on individual perception, experiences, beliefs, and expectations. [6] Nowadays, QoL has become an issue in many clinical studies. [7] Severe dysmenorrhea pain is associated with restriction of activity and absence from school/college or workplace. Participation in usual activities is adversely affected in 5-20% of the women. [8] Pain poses a unique challenge for outcomes research because of the central importance of patientcentered and patient-reported information. The diagnosis may be overlooked, and the impact of primary dysmenorrhea has been poorly studied; mainly, the studies have focused on Western populations. [9]
Our survey revealed that infected intrauterine devices (IUDs) recovered from patients suffering from reproductive tract infections (RTIs) were tainted with Candida biofi lm composed of a single or multiple species. Scanning electron microscopy (SEM) analysis of C. albicans biofi lm topography showed that it consists of a dense network of mono-or multilayer of cells embedded within the matrix of extracellular polymeric substances (EPS). Confocal scanning laser microscopy (CSLM) and atomic force microscopy (AFM) images depicted that C. albicans biofi lms have a highly heterogeneous architecture composed of cellular and noncellular elements with EPS distributed in the cell-surface periphery or at cell-cell interface. Biochemical analysis showed that EPS produced by C. albicans biofi lm contained signifi cantly reduced total carbohydrate (40%), protein (5%) and enhanced amount of hexosamine (4%) in contrast to its planktonic counterparts. The in vitro activity of antifungal agents amphotericin B, nystatin, fl uconazole and chlorhexidine against pre-formed C. albicans biofi lm, assessed using XTT (2,3-bis[2-methoxy-4-nitro-5-sulfophenyl]-2H-tetrazolium-5-carboxanilide) reduction assay revealed increased resistance of these infectious biofi lm (50% reduction in metabolic activity at a concentration of 8, 16, 64, 128 μg/ml respectively) in comparison to its planktonic form.
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