Analysis of changes in the state of vaginal microflora in women of reproductive age under conditions of a three-day "dry" immersion without the use of prophylaxis

Introduction. Currently, the participation of women in space flights is increasing. In this regard, questions about the influence of space factors on the state of the female body arise inevitably. Model experiments, in particular, "dry" immersion, are most convenient for studying the influence of individual factors of space flight on the organism. The aim of this work is a comparative assessment of the state of the vaginal microbiota of 6 female volunteers before and after three-day "dry" immersion.Materials and methods. Microbial samples of all volunteers were stained according to Gram with a sequential culture study in accordance with the medical technology. The species identification of microorganisms was performed by MALDI-TOF-MS analysis using an Autoflex III time-of-flight mass spectrometer with Maldi BioTyper software.To assess changes in the state of the vaginal microflora and microflora of the cervical canal, eubiotic index was used. It reflects the number of positive states of microbiota to the number of negative ones.Results. After 3 days of "dry" immersion volunteers, who had high titer of aerobic microorganisms before isolation, had significant increase of the amount of aerobic microorganisms, while the number of lactobacilli decreased. The other group of volunteers showed activation of colonization resistance of the vaginal microflora. Volunteers, who had a significant contamination with anaerobic opportunistic microflora before isolation, had reduction of the number of all anaerobes, including lactobacilli. The eubiotic index, calculated for the cervical canal, decreased after 3 days of immersion. The data obtained indicate that after 3 days of isolation, the state of the microflora has deteriorated.

Uterine Rupture of a Patient With Rudimentary Horn Pregnancy at 26th Gestational Weeks Diagnosed via Magnetic Resonance Imaging: a Case Report

Objective: Pregnancy of Rudimentary Horn is a type of ectopic pregnancy, that is recognized almost always during surgical treatment of a rupture of the rudimentary horn. This is an obstetric case diagnosed preoperatively by magnetic resonance imaging (MRI).Case: We report the case of a 19-years-old primigravida patient with rupture of rudimentary horn in 26th gestational week. The patient presented with sudden onset severe abdominal pain in the emergency room. Intraabdominal free fluid is detected. To evaluate the etiology of free fluid and location of the gestational sac, an abdominal magnetic resonance imaging (MRI) scan was planned. The decision of emergent laparotomy is made because of sonographic detection of abdominal excessive -concentrated- free fluid, abdominal tenderness, and 2 points decrease of hemoglobin value in the control hemogram. A rudimentary horn pregnancy and fundal rupture of the rudimentary part of the uterus are diagnosed during the surgical procedure. A baby -live- weighing 450 grams was delivered. The ruptured rudimentary horn and same-sided tuba uterina were surgically removed.Conclusion: Rudimentary horn pregnancy is a rare ectopic pregnancy. Diagnosis is difficult clinically, even with diagnostic imaging modalities. Identifying both cornuas systematically in all patients increases the detection rate. The absence of continuity between the gestational sac’s lumen and the cervical canal on imaging is an important finding. Due to the serious maternal and fetal complications, its detection at an early week may be life-saving.

Experience in the diagnosis of group B Streptococcus infections in pregnant women and newborns in a perinatal center

Serogroup B streptococci (Streptococcus agalactiae) are one of the main etiological agents responsible for the occurrence of severe perinatal infections in both postpartum women and newborns. The experience of microbiological diagnostics of infections caused by streptococcus serogroup B (GBS) according to the data of the microbiological laboratory of the perinatal center is generalized. In the study of biomaterial from patients, the proportion of positive cultures of Streptococcus agalactiae was 2.2% in cervical samples, 8.8% in vaginal contents, 6.6%; 2.8% and 0.7% in amniotic fluid, placenta and urine, respectively. In 57% of cases, GBS was released at a concentration of more than 5 lg / ml and in 73% of cases as part of polymicrobial associations with other opportunistic microorganisms. In the biomaterial from newborns, GBS was found in 2.5% of positive findings in blood samples, 4.6% in tracheobronchial lavages and 2.7% in detachable skin of the armpit when taking material immediately after childbirth and 1, 1% and 0.7%, respectively, during examination in the second stage of nursing. 5 cases of GBS isolation in newborns ended in early neonatal mortality with definitive diagnoses of congenital pneumonia and IUI of newborns, while there was only partial coincidence of the results of microbiological studies of the genital tract of the mother and biomaterials from the newborn. Relatively frequent findings of GBS in newborns of the high-risk group in intensive care unit indicate intrauterine infection with this pathogen. The examination of smears from the cervical canal is not informative in relation toGBS infection in comparison with the examination of the vaginal contents and recto-vaginal smears. The results of the introduction of microbiological screening and its effectiveness in real practice to prevent the development of early and late forms of GBS infections in newborns require further analysis.

Analysis of myelomalacia and posterior longitudinal Ligament ossification as prognostic factors in patients with cervical spondylotic myelopathy submitted to laminoplasty

Background: Cervical spondylotic myelopathy is a degenerative disease of the intervertebral disc and vertebral body of the spine that causes cervical spinal cord injury due to central vertebral canal stenosis. Its prevalence is higher in the elderly. Treatment is usually surgical when the spinal cord is affected either clinically with pyramidal release or radiologically with the altered spinal cord. Objective: The rationale of this study is to analyze the myelomalacia and the ossification of posterior longitudinal ligament as prognostic factors in the postoperative evolution of patients with cervical canal compression who underwent laminoplasty by open-door or french-door techniques. Methods: We performed a retrospective analysis of 18 surgical cases of spondylotic cervical myelopathy of the same senior neurosurgeon, using the chi-square test to analyze prognostic factors for patients’ postoperative evolution in the Nurick scale, after open-door or french-door laminoplasty. Results: The comparison between pre and postoperative showed an improvement of 71.43% of cases that did not have ligament ossification compared to 45.45% of cases that presented posterior longitudinal ligament ossification. Also, there was a better prognosis in patients without myelomalacia, as 71.43% of them improved their condition against only 45.45% improvement in those with myelomalacia. Conclusion: There is a need for further studies with larger samples to expressively prove that the presence of longitudinal ligament ossification and the previous presence of myelomalacia are factors of worse prognosis in the postoperative evolution of patients with cervical spondylotic myelopathy submitted to laminoplasty.

Eradication of Cervical Canal Colonization In Treatment Associated With Prophylactic Cervical Cerclage: The LOOK FURTHER Study

BACKGROUND: The perioperative management of the cervical cerclage procedure is not unified. Controlling microbiome cervical status does not affect obstetric outcomes in general population, but it can be beneficial in cervical insufficiency. Eliminating cervical pathogens in those patients may increase the effectiveness, resulting in prevention of miscarriage or preterm labor and delivery of a baby capable of normal development.METHODS: Thirty five patients undergoing cervical cerclage at the 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, were included in the study. The procedure was performed only after receiving a negative culture from the cervical canal.RESULTS: Thirty one (88.5%) patients delivered after the 34th and 28 (80%) after the 37th week of gestation. The colonization of genital tract was found in 31% of patients prior to the procedure, 42% in the subsequent course of pregnancy and 48% before delivery. Eighty five percent of patients who had miscarriage or delivered prematurely had abnormal cervical cultures. In patients with normal cervical cultures 91.67% women delivered at term. There were no abnormalities in children’s development.CONCLUSIONS: Controlling microbiological status of the cervical canal results in better or similar outcomes to those reported by other authors in terms of obstetric and neonatal outcomes. Active eradication of the reproductive tract colonization potentially increases the effectiveness of the cervical cerclage placement.

The Frequency Detection of Opportunistic Sexually Transmitted Infections among HIV-Infected Women Planning Pregnancy

The purpose of our study was to determine the frequency of detection of opportunistic sexually transmitted infections (Chlamydia trachomatis, Trichomonas vaginalis, Ureaplasma spp, Human papillomavirus) in HIV-infected women planning pregnancy. Methods and Results: We examined 31 HIV-positive Caucasian women. They sought pregnancy planning advice at the Scientific Center for Family Health and Human Reproduction Problems in Irkutsk during 2014-2015. The average age of the women was 30.9±4.5 years (20-39 years). A clinical diagnosis of HIV was made at Irkutsk Regional AIDS Center. All HIV-infected women were tested for the presence of DNA of pathogens of bacterial and viral sexually transmitted infections in the epithelium of the cervical canal. Chlamydia trachomatis was detected in 1(3.2%) participant, Trichomonas vaginalis in 1(3.2%), Ureaplasma spp. in 14(45.2%), and HPV in 22(71%). Co-infection of HPV and Ureaplasma spp. was observed in 35.5% of HIV-positive women. Conclusion: the prevention and detection of sexually transmitted infections in HIV-infected individuals remain a public health priority and an integral component of HIV primary care.

Significance of analysis of lipid extracts in cervical canal secretion for diagnosing of placenta-associated complications of pregnancy

Omics technologies hold great potential as the basis for development of the new diagnostic approaches in obstetrics. Cervicovaginal fluid (CVF) as part of the mother-placenta-fetus system can be used to diagnose obstetric complications. This study aimed to identify the features of lipid composition of the cervical canal secretion peculiar to Intrauterine Growth Restriction (IUGR) and preeclampsia (PE). We took CVF samples from 57 pregnant women and subjected them to an in-depth clinical-anamnestic and mass-spectrometric analysis. Lipid extracts of CVF were analyzed with a liquid chromatography system coupled with a mass analyzer. As a result, we identified 239 lipid compounds. In case of 17 lipids, mathematical analysis revealed significant differences between samples from women with normal pregnancy indicator values (normal group) and patients from the IUGR group (p < 0.05). As for the normal group and PE group patients, there were significant differences identified for 3 lipids (p < 0.05). Comparison of samples from the PE and IUGR groups yielded statistically significant differences in levels of two lipids (p < 0.05). Mainly, the lipids were oxylipins, sphingomyelins, triglycerides, and cardiolipins. The developed diagnostic model had the sensitivity of 0.81 and specificity of 0.91 (cut-off level — 0.50; AUC — 0.85). The data obtained are valuable in the context of development of the new methods of diagnosing placentaassociated complications of pregnancy and for understanding new mechanisms of pathogenesis of these complications.

Imaging findings of uterine adenosarcoma with sarcomatous overgrowth: two case reports, emphasizing restricted diffusion on diffusion weighted imaging

Background Adenosarcoma is classified as a mixed epithelial and mesenchymal tumor composed of a benign epithelial component and a malignant stromal component. The stromal component in adenosarcoma is usually low grade, and consequently the prognosis is relatively favorable. While, adenosarcoma with sarcomatous overgrowth (SO) is defined as an adenosarcoma in which the sarcomatous component constitutes more than 25% of the tumor. The stromal component is also high-grade sarcoma showing greater nuclear pleomorphism and mitotic activity, thus, it is associated with worse prognosis. MRI findings of adenosarcoma without SO have been described in previous literatures but the imaging findings in adenosarcoma with SO may be poorly defined. Therefore we present two cases of uterine adenosarcoma with SO. Case presentation Patient 1 was a 76-year-old woman referred to our hospital with complaint of abdominal distension and postmenopausal bleeding. Patient 2 was a 57-year-old woman with complaint of lower abdominal pain and abnormal uterine bleeding. On magnetic resonance imaging (MRI), T2 weighted imaging showed a large, heterogeneous high-intensity mass with hyperintense tiny cysts that expanded the uterine cavity and extended into the cervical canal for both patients. On diffusion-weighted imaging (DWI), both masses appeared as high signal intensity. Patient 2 also had a right ovarian adult granulosa cell tumor that may have contributed to development of the adenosarcoma. Patient 1 recurred with peritoneal sarcomatosis 6 months after surgery and died of the disease. Patient 2 also recurred with a left upper lung metastasis 3 months after surgery. Conclusions DWI may depict pathological changes produced by SO of adenosarcoma as high signal intensity, even though SO does not seem to change MRI findings of adenosarcoma on other sequences. Therefore, DWI could potentially predict SO in presumptive adenosarcoma on MRI and the patient’s prognosis. It is also important for pathologists to know if SO can arise in adenosarcoma because they need to examine the tumor thoroughly to determine the percentage of SO component in the tumor volume when SO is present.

ARGONOPLASMIC COAGULATION IN THE TREATMENT OF EXTERNAL GENITAL ENDOMETRIOSIS IN WOMEN

Aim: to evaluate the effectiveness of the argonoplasmic coagulation method in the treatment of external genital endometriosis (GE) in women. Materials and methods. An open, prospective, controlled, clinical and experimental study was conducted. 50 women with genital endometriosis aged 20 to 50 years and older were examined (the average age was 35±15 years). The following forms of GE were identified: peritoneal endometriosis - in 21 (42%) patients; extraperitoneal endometriosis - in 15 (30%); uterine body endometriosis - in 9 (18%); retrocervical endometriosis - in 5 (10%) patients. Clinical, laboratory (blood test, urinalysis, biochemical studies, hemostasiogram, bacteriological and microscopic studies of the cervical canal and vagina, cytological studies); instrumental and special research methods were used. By the method of enzyme immunoassay (ELISA), studies were conducted for the presence of infections: toxoplasmosis, herpes and cytomegalovirus, chlamydia, mycoplasma, ureaplasma infections, rubella. Results. For the treatment of external genital endometriosis, a combined treatment regimen was applied: argonoplasmic coagulation of endometrioid heteropathies using the FOTEK EA 141M apparatus, followed by the prescription of a course of hormone therapy including dienogest (visanna), which contributed to improving the general condition and quality of life, relieving clinical symptoms, reducing the frequency of relapses, improving the hormonal status of the women. With a mild form of external genital endometriosis, argonoplasmic coagulation of endometrioid heteropathies was carried out in the "spray" mode at a power of 37-42 W, at a depth of 0.1-1 mm with a time interval of exposure of 2-4 seconds. In the moderate-severe form of external genital endometriosis, argonoplasmic coagulation of endometrioid foci located at a depth of 1-2 mm was carried out in the "spray" mode at a given power of 42-50W, with a time interval of exposure to an argon torch of 3-5 seconds. In severe external genital endometriosis, argonoplasmic coagulation was performed in the "filgur" mode at a given power of 57-64 watts with a time interval of exposure of 4-7 seconds, at a distance of no more than 2.5-3.0 mm. Conclusions. The use of APC using the FOTEK EA 141M device ensures the effectiveness of treatment that enables to avoid the formation of rough scars, adverse reactions and / or complications, shortening of the time interval, absence of pain syndrome, microbial contamination, risk of massive bleeding. The use of dienogest group is effective in preventing relapses after surgical treatment of severe forms of genital endometriosis.

Treatment of Cervical Pregnancy with Ultrasound-Guided Intragestational Injection of Methotrexate: A Case Report

This study is aimed at describing a noninvasive conservative strategy to the treatment of cervical pregnancy and highlighting the success of ultrasound-guided therapeutic techniques. A 43-year-old woman with a history of one previous cesarean section presented in our unit with vaginal spotting and a positive urine pregnancy test. She was diagnosed with a cervical pregnancy, and she was successfully treated conservatively with the administration of intragestational sac methotrexate under ultrasound guidance. Cervical pregnancy is a rare form of ectopic pregnancy that results from conceptus implantation in the cervical canal. The main concern is the associated life-threatening hemorrhage and subsequent need for urgent hysterectomy. The evolution of ultrasound over the past decades has enabled early diagnosis and has shifted the management from a radical surgical approach towards a stepwise conservative therapeutic approach, when possible.