Prevention and treatment of non-complicated infections of the lower urinary tract in pregnant women

Aim: to assess the efficacy of biologically active additive Cystenium II as a component of combined antimicrobial treatment of acute cystitis or exacerbation of chronic cystitis and asymptomatic bacteriuria (ASB) in pregnant women. Patients and Methods: 65 pregnant women with urinary tract infections were enrolled. Group 1 included 22 women with acute cystitis or exacerbation of chronic cystitis and group 2 included 20 women with ASB. These women received standard antimicrobial therapy (fosfomycin trometamol 3 g) and Cystenium II (1 tablet twice daily with food for 14 days). The control group included 23 women with acute cystitis or exacerbation of chronic cystitis or ASB who received standard antimicrobial therapy only. Treatment results were evaluated after 14 days and 2 months. Results: complete resolution of cystitis occurred on days 2 and 3 in group 1 and days 4 and 5 in group 2. Eradication of causative agent as demonstrated by inoculation of urine samples after 14 days was reported in 77.3% of women in group 1, 70% of women in group 2, and 61% of women in group 3. Total treatment efficacy in group 1 was 81.9%, i.e., exacerbations of chronic cystitis were diagnosed in 3 women (13.6%), acute pyelonephritis in 1 woman (4.5%). Total treatment efficacy in group 2 was 90%, i.e., recurrence of ASB was diagnosed in 2 women (10%). Meanwhile, treatment efficacy in the control group was 56.5%, i.e., clinical exacerbation of chronic cystitis was diagnosed in 6 women (26%). Moreover, in 4 women (17.4%), the disease was complicated by acute pyelonephritis. Conclusions: Cystenium II for acute cystitis or exacerbation of chronic cystitis and ASB in pregnant women improves treatment success and also maintains the effect. KEYWORDS: cystitis, asymptomatic bacteriuria, pregnancy, treatment, cranberry, prevention of recurrences. FOR CITATION: Nashivochnikova N.A., Krupin V.N., Leanovich V.E. Prevention and treatment of non-complicated infections of the lower urinary tract in pregnant women. Russian Journal of Woman and Child Health. 2021;4(2):119–123. DOI: 10.32364/2618-8430- 2021-4-2-119-123.

Novel treatment modalities for pelvic inflammatory disease using immunomodulating therapy

Pelvic inflammatory disease (PID) is a significant issue of public health due to its devastating effects on female reproductive health and fertility. Despite extensive development of medicine and the emergence of novel groups of antibacterial agents, the risks of antibacterial resistance rapidly grow, thus requiring complex treatment of infectious inflammatory disorders caused by bacterial flora. The modulation of immune response is the heart of recently developed treatment modalities for various diseases (infections, oncology etc.). A detailed understanding of molecular immunology contributes to the rational development of novel types of immunotherapy, which can be successfully introduced into clinical practice. Numerous findings demonstrate the efficacy of inosine pranobex for various diseases, in particular, in immunocompromised patients. This medication has proven itself due to good tolerability and the lack of serious side effects. Inosine pranobex being a safe drug that can be used in many treatment schedules, including complex treatment for chronic PID with antibacterial agents. KEYWORDS: inosine pranobex, pelvic inflammatory disease, salpingo-oophoritis, infertility, immunotherapy, sexually transmitted infections, bacterial vaginosis. FOR CITATION: Dobrokhotova Yu.E., Shadrova P.A. Novel treatment modalities for pelvic inflammatory disease using immunomodulating therapy. Russian Journal of Woman and Child Health. 2021;4(2):149–154. DOI: 10.32364/2618-84 30-2021-4-2-149-154.

Pharmacotherapy in pregnant women

Aim: to analyze the prescription of medications in pregnant women based on outpatient charts of women’s clinics. Patients and Methods: retrospective cohort study was conducted in three women’s clinics of Perm and two women’s clinics of Izhevsk. Data on the prescription of medications in 361 pregnant and postpartum women during pregnancy (2017–2018) were obtained by copying individual medical charts. Additionally, we compared our findings with the results of the Russian Pharmacoepidemiologic Study (2007). Results: pharmacotherapy was prescribed in 100% of women. On average, 12.6 medications were prescribed during gestation. Most medications were prescribed in the second trimester (on average, 5.5 medications). In the first and third trimesters, 2.4 and 4.7 medications were prescribed, respectively. The most prescribed drugs were vitamins and minerals (70.4%), feminine hygiene products (37.1%), progestogens (33.1%), herbal urinary antiseptics (29.8%), and systemic antibiotics (14.2%). Pharmacotherapy defects included medications inconsistent with diagnosis (48.6%), a combination of several drugs with similar pharmacological effects (16.5%), and polypharmacy defined as the use of five or more medications (25.8%). A two-fold reduction in drug aggression as well as an increase in the dotation of vitamin-mineral complexes compared to 2007 were reported. Conclusions: our findings illustrate positive trends for treating pregnant women in the last 9–10 years and increased safety of treatment (the lack of drugs with potential teratogenic or embryotoxic effects) but also indicate the need in the permanent audit and adjustment of prescriptions based on clinical guidelines. Pre-pregnancy preparation is a perspective way to reduce the intensity of drug therapy during pregnancy. As a result, drug burden shifts to a pre-gestational period. Pre-pregnancy preparation provides favorable conditions for developing an embryo and fetus. KEYWORDS: pharmacotherapy, pregnancy, polypharmacy, micronutrients, vaginal hygiene, progestogens, urinary antiseptics. FOR CITATION: Sandakova E.A., Zhukovskaya I.G., Semenova M.V. et al. Pharmacotherapy in pregnant women. Russian Journal of Woman and Child Health. 2021;4(2):115–118. DOI: 10.32364/2618-8430-2021-4-2-115-118.

Efficacy of normalization of vaginal microbiota after antimicrobial treatment for bacterial vaginosis and bacterial vaginosis in pregnant women (results of the multicenter prospective non-interventional comparative study)

ABSTRACT Aim: to assess the efficacy and safety of Lactogynal® to normalize vaginal microflora after antimicrobial treatment for bacterial vaginosis (BV) and to prevent recurrences of vulvovaginal candidiasis (VVC) during pregnancy. Patients and Methods: this multicenter prospective non-interventional comparative study included 100 women in the 3rd trimester of pregnancy diagnosed with acute BV (n=50) or acute VVC (n=50). 25 women of each group received standard antimicrobial treatment only. 25 women of each group received Lactogynal® as the second step of antimicrobial treatment. Women were followed up until delivery and discharge. The rate of BV and VVC recurrences before delivery was considered the key indicator of treatment efficacy. In addition, obstetrical and perinatal outcomes, compliance, the type and duration of antimicrobial treatment for BV and VVC were evaluated. Results: in women with BV and VVC who received Lactogynal®, no recurrences during the follow-up were reported (p<0.05). In women who received standard antimicrobial treatment only, the rate of recurrences of BV and VVC was 40% and 28%, respectively. As to the complications of pregnancy, delivery, and the postpartum period, women with BV who received probiotic therapy were less often diagnosed with anemia (p<0.05) while women with VVC who received probiotic therapy were less often diagnosed with the premature rupture of membranes (p<0.05). Conclusions: Lactogynal® is an effective and safe tool to normalize vaginal microflora after antimicrobial treatment for BV and to prevent VVC recurrences during the 3rd trimester of pregnancy. This drug (as a part of complex treatment for BV and VVC) reduces the risk of recurrences and promotes a more favorable pregnancy course until delivery. KEYWORDS: lactobacilli, bacterial vaginosis, vulvovaginal candidiasis, pregnancy, vaginal microflora. FOR CITATION: Radzinskiy V.E., Manukhin I.B., Ordiyants I.M. et al. Efficacy of normalization of vaginal microbiota after antimicrobial treatment for bacterial vaginosis and bacterial vaginosis in pregnant women (results of the multicenter prospective non-interventional comparative study). Russian Journal of Woman and Child Health. 2021;4(3):192–200 (in Russ.). DOI: 10.32364/2618-8430-2021-4-3-192-200.

Clinical prognostic relevance of elastin and laminin in children with undifferentiated connective tissue disease

Aim: to determine clinical prognostic relevance of elastin and laminin in children with undifferentiated connective tissue disease (UCTD). Patients and Methods: 47 children with UCTD aged 3–6 were enrolled. The diagnosis was verified by ruling out genetic disorders via analyzing family tree, genetic consultation, etc. Phenotypic and visceral signs were interpreted based on "Congenital and multifactorial connective tissue diseases in children" guidelines (2016). The results of cardiovascular and urinary tract ultrasound were analyzed. Serum levels of elastin and laminin were measured by the sandwich ELISA using high-sensitive kits. All tests were performed at admission and after two years. Results: prognostic relevance (prognostic coefficient) of individual phenotypic and visceral signs and lab tests and prognostic threshold value (the sum of prognostic coefficients indicating high, moderate, or low risk of UCTD progression) were determined. It was demonstrated that measuring elastin and laminin levels improves the efficacy of UCTD progression risk assessment. This phenomenon was supported by the values of their prognostic coefficient, which were comparable to the values of significant phenotypic and visceral signs. Furthermore, the accuracy of prognosis based on the use of a set of prognostic indicators (phenotypic, visceral, and biochemical) was supported by the escalation of dysplasia signs. After two years, disease progression was reported in 36 out of 38 children with a moderate and high risk of UCTD progression as identified by the initial evaluation. Conclusion: given the relevance of elastin and laminin in dysplasia pathogenesis, these parameters are considered informative to assess the risk of dysplasia progression in children aged 3–6. It is reasonable to use elastin and laminin levels as additional criteria to evaluate the risk of UCTD progression. KEYWORDS: undifferentiated connective tissue disease, prediction, children, phenotypic signs, laminin, elastin, risk of progression, cardiovascular system, urinary system. FOR CITATION: Cherkasov N.S., Doronina T.N., Prakhov A.V., Lutsenko Yu.A. Clinical prognostic relevance of elastin and laminin in children with undifferentiated connective tissue disease. Russian Journal of Woman and Child Health. 2021;4(4):351–354 (in Russ.). DOI: 10.32364/2618-8430-2021-4-4-351-354.

Unity of bowel-lung axis and the role of beneficial microbiota in anti-infectious protection

NIH Human Microbiome Project determined particular attention of the worldwide medical community to the study of the human microbiome and the assessment of the impact of symbiont microorganisms in the development of various (not only gastrointestinal) disorders. Potential interactions between the bowel and lungs (bowel-lung axis) via microbiota that allow for the possible involvement of microorganisms in the development of respiratory diseases are actively debated. This paper reviews studies on the pattern of interactions between bowel and lungs in infectious diseases associated with mucosal inflammation. The association between gut microbiota and the protective barrier of the respiratory tract based on known mechanisms and novel data derived from recent studies on SARS-CoV-2 is discussed. The relevance of beneficial bacteria (symbionts) in local and systemic immune responses, their disease-modifying and, eventually, therapeutic strategymodifying properties, the ability to be a resource of preventive medicine and an orchestrating tool for infections are addressed. Practitioners’ difficulties with probiotics in preventive and treatment schedules for various conditions are highlighted. Finally, the use of probiotics in children with respiratory infections and COVID-19 is uncovered. KEYWORDS: microbiota, microbiome, probiotics, children, mucosal immunity, Bifidobacterium. FOR CITATION: Taranushenko T.E. Unity of bowel-lung axis and the role of beneficial microbiota in anti-infectious protection. Russian Journal of Woman and Child Health. 2021;4(4):355–361 (in Russ.). DOI: 10.32364/2618-8430-2021-4-4-355-361.

Efficacy and tolerability of a specialized dietary therapeutic product in long-chain and very long-chain fatty acid metabolism disorders in children

Aim: to assess the efficacy and tolerability of a specialized dietary therapeutic product in long-chain and very long-chain fatty acid metabolism disorders in children. Patients and Methods: this open-label prospective uncontrolled study enrolled 5 children aged 35 ± 14 months who were diagnosed with longchain and very long-chain fatty acid metab-olism disorders. Diet therapy using the tested product (“Monogen”) was prescribed and corrected after the analysis of actual diet. Physical development and neurological status were evaluated, blood levels of specific acyl-carnitines (С16-ОН, С18-ОН, С18:1-ОН, С14:1, С14) were measured. Tolerability was assessed by the rate and severity of adverse events (including allergic reactions) and the changes in vital functions compared to baseline. Patient and doctor satisfaction was evaluated using a questionnaire. Results: children received the tested product throughout the study (30±2 days). The lev-els of acyl-carnitines were within normal ranges in all children. No dyspepsia, allergic reactions, somatic dysfunction, or neurological deviations were reported. Physical exam consistently fell in the range of normal for age. Parents and doctors were fully satisfied with the tested product (“Monogen”). Conclusions: “Monogen” is highly effective for therapeutic feeding of children with long-chain and very long-chain fatty acid metabolism disorders. KEYWORDS: long-chain fatty acid oxidation disorders, β-oxidation of fatty acids, long-chain acyl-coA dehydrogenase deficiency, biallelic mutation, therapeutic feeding. FOR CITATION: Semenova N.A., Shestopalova E.A., Kutsev S.I. Efficacy and tolerability of a specialized dietary therapeutic product in longchain and very long-chain fatty acid metabolism disorders in children. Russian Journal of Woman and Child Health. 2021;4(1):98–102. DOI: 10.32364/2618-8430-2021-4-1-98-102.

Selenium is a functional component of the female reproductive system. Its role in pregnancy complications

This paper reviews studies on selenium (Se) in human reproduction. Low Se intake is associated with the development of gestational hypertension, miscarriage, premature birth, intrauterine growth restriction, and thyroid gland dysfunction. Therefore, studies on the association between Se deficiency and impaired folliculogenesis, steroidogenesis, and infertility in women are of great interest. Unfortunately, these studies are scarce, and further studies are needed. A significant antioxidant activity of Se-containing enzymes allows for minimizing risks of obstetrical complications associated with placental insufficiency. Therefore, selenium is vital for realizing female reproductive function. However, even given potential risks of insufficient Se-containing product intake, the authors find it unacceptable to recommend Se dotation in the population since toxic effects of Se excess are yet to be fully explored. Further studies on Se biological effects will extend the scope of its use in obstetrics and gynecology in terms of a preventive approach. KEYWORDS: selenium, placental insufficiency, folliculogenesis, steroidogenesis, antioxidant, miscarriage, premature birth, intrauterine growth restriction. FOR CITATION: Sadykova G.K., Olina A.A. Selenium is a functional component of the female reproductive system. Its role in pregnancy complications. Russian Journal of Woman and Child Health. 2021;4(4):328–332 (in Russ.). DOI: 10.32364/2618-8430-2021-4-4- 328-332.

Radiological and nuclear medicine examinations in breastfeeding women. A novel protocol of the Academy of Breastfeeding

This paper discusses a particular time in woman’s life, breastfeeding, that takes from 4 months to 2 years. Mean age of pregnant women increases every year, while reproductive technologies allow for realizing childbearing function in the second period of adulthood. Many diseases those diagnosis requires multiple examinations occur with age. When the mother is forced to stop breastfeeding in view of the need for examination, it is essential for her to get a reasoned rationale and to know the duration of limitations. Unfortunately, no regulations covering the use of modern nuclear medicine and X-ray technologies in breastfeeding women are available in the Russian Federation. Foreign experience may address the existing lack of knowledge. In the future, these data may provide guidance to develop national recommendations. This review paper summarizes the studies on imaging techniques and nuclear medicine procedures in lactating women and limitations of breastfeeding in their use. KEYWORDS: lactation, breastfeeding, breast examination, nuclear medicine, mammologist. FOR CITATION: Gerashchenko Y.L. Radiological and nuclear medicine examinations in breastfeeding women. A novel protocol of the Academy of Breastfeeding. Russian Journal of Woman and Child Health. 2021;4(3):238–242 (in Russ.). DOI: 10.32364/2618-8430-2021-4-3-238-242.

Chronic endometritis. Towards the improvement of diagnostic methods

This paper reviews an important issue that significantly affects female fertility, chronic endometritis. This condition is characterized by clinical presentations of various severity and abnormalities of endometrial morphology. The rate of chronic endometritis varies greatly, mainly due to predominantly asymptomatic course and imperfect diagnostics. Pathogenic mechanisms of endometrial inflammation and different views on its effects on female reproductive potential are addressed. Further search for endometrial receptivity markers is needed as these markers will allow for assessing the severity of endometrial damage to develop the algorithm of preconception care. The authors focus on diagnostic techniques for chronic endometritis and their value. Immunohistochemistry of endometrium is a promising tool to be applied to diagnose endometrial inflammation and monitor treatment efficacy. A complex diagnostic approach to chronic endometritis that includes pelvic ultrasound, Doppler ultrasound, assessment of endometrial microbiota, diagnostic hysteroscopy and endometrial histopathology, and evaluation of endometrial receptivity is useful. KEYWORDS: chronic endometritis, termination of pregnancy, infertility, autoimmune processes, chronic inflammation, endometrial structure, immunohistochemistry. FOR CITATION: Shamilova A.M., Il’ina I.Yu., Borovkova E.I., Dobrokhotova Yu.E. Chronic endometritis. Towards the improvement of diagnostic methods. Russian Journal of Woman and Child Health. 2021;4(3):243–249 (in Russ.). DOI: 10.32364/2618-8430-2021-4-3-243-249.