Gynecologic Research Articles

Особливості імунних порушень у дівчат із рецидивами хронічних неспецифічних запальних захворювань статевих органів

Nonspecific inflammatory diseases of the female genital organs (NIDFGO) affect women throughout their lives and are an important medical and social problem associated with a decrease in a woman's reproductive potential. Purpose - to study the immune status of girls with HCV in comparison with changes in adult women in order to improve algorithms for the diagnosis and treatment of inflammatory vaginal lesions depending on age. Materials and methods. In a prospective, single-center controlled and non-randomized study, 69 girls were involved: 55 patients with NIDFGO, who had a different frequency (from 1 to 4 or more) of disease recurrence during 1 year of observation, and 14 healthy girls of the control group. All study participants underwent a standard gynecological examination and laboratory screening. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the Bogomolets National Medical University. The informed consent of the children’s parents was obtained for the conducting the studies. Statistical analysis was performed using the IBM SPSS Statistics 23 package and the MedStat program. Results in groups were compared using Kruskal-Wallis, Dunn, or Mann-Whitney tests with Bonferroni correction. Results. Selective deficiencies of IgE and NKT-cells are the main immune disorders in patients with , NIDFGO of both age groups. Deficiencies of IgA, C3 component of the complement system and qualitative phagocytic disorders are registered only in girls, while in adult women, deficiency of C4 component of complement, CD8+ cytotoxic T-lymphocytes and NK cells predominate. Conclusions. The opposite direction of changes in the content of the IgE molecule and the number of NKT cells in the blood in patients with NIDFGO in different age groups, with the preservation of the ratio of results in subgroups with different frequency of relapses, indicates the need for a differentiated approach to the diagnosis, treatment and prevention of immune disorders in people with recurrent NIDFGO in different age groups. No conflict of interests was declared by the authors.

Clinical cases of an accessory spleen in the pelvic and pelvic splenosis

The article describes cases of diagnosis of an additional spleen in the pelvis and splenosis of the pelvis in women, detected by ultrasound, confirmed by MRI. The relevance of the publication of the presented observations is determined by the rarity of such localization of the spleen and splenosis in the pelvis and the low awareness of obstetricians and gynecologists, most often conducting ultrasound examination of pelvic organs, about this pathology. Cases of an accessory spleen and splenosis in the abdomen are known and written in the literature, while similar findings in the pelvis are, firstly, a rare find, and secondly, ultrasound examination in gynecology is carried out by obstetricians-gynecologists, who rarely meet with surgical pathology, thirdly, the echographic picture requires differential diagnosis with endometrioma, hemangioma, primary and metastatic cancer, and splenosis and accessory spleen should also be differentiated from each other. The article presents two of our own clinical cases of splenosis and accessory spleen with US and MRI data, discusses the reasons for difficulties in diagnosis and key criteria for differential diagnosis, and also includes a review of the literature on this topic. Based on all of the above, it was concluded that should not forget about such a rare but possible diagnosis as pelvic splenosis, and also remember about a possible congenital condition – accessory spleen.

Proximal epithelioid sarcoma of the vulva. A rare neoplasm. A clinicopathological case

Epithelioid sarcoma is a rare aggressive soft tissue sarcoma, which can be distal or proximal types. The classic form (distal-type) of epithelioid sarcoma mainly occurs in teenagers and young adults. A rarer form, called large-cell (proximal-type) epithelioid sarcoma, tends to be more aggressive and mainly affects adults. The proximal subtype mostly arises from the proximal pelvis, limbs, and genital tract. We report a case of a 59 -year-old female, presented with a progressively growing mass in the left labia majora. Gynecologic examination revealed a 2 cm mobile and painless mass that was not attached to deep planes. The histological study showed a multinodular tumor was seen comprising sheets of oval to polygonal cells with moderate amount of cytoplasm. Interspersed were larger, rhabdoid cells with abundant eosinophilic cytoplasm and prominent nucleoli. On IHC, the tumor cells showed positivity for EMA and CKAE1/AE3 and do not expressed INI-1 in the nucleus. All tumor cells were negative for S-100 protein and CD34. The histopathological diagnosis was soft tissue of the vulvar region with proximal epithelioid sarcoma. The patient received adjuvant external pelvic radiotherapy and brachytherapy in the vulvar bed. Currently, 3 years after diagnosis, the patient does not present signs of tumor recurrence in her controls. Due to its low incidence, there are no evidence-based diagnostic algorithms or published recommendations for treatment. The prognosis is generally poor. A wide excision with clear margins is imperative with options of post-operative CT/RT in individual cases during a close follow-upbehavior, as seen in our case.

Risk of Periodontal Diseases in Women With Polycystic Ovary Syndrome: An Overview.

Polycystic ovary syndrome (PCOS) is the most prevalent condition seen in reproductive-aged women, which has a negative impact on their health system. There is a serious concern for women having PCOS that they may experience long-term metabolic conditions. PCOS also has a negative impact on periodontium components such as gingiva, periodontal ligament (PDL), and alveolar bone. It has been said that there may be a bidirectional link between PCOS and periodontal diseases. Moreover, PCOS and periodontal disorders both have common risk factors. Periodontal diseases are exacerbated by systemic low-grade inflammation, including obesity, constant immunological imbalance, and oxidative stress caused by PCOS. On the other hand, periodontal diseases can also increase the risk of causing PCOS. According to recent data, women with PCOS may be more likely to suffer from periodontal diseases. A PubMed and Google Scholar search was conducted for literature relating to PCOS and its relationship with different comorbidities which also included periodontal disorders. Analyses were performed, and data was synthesized and assembled in a presentable form. Therefore, the focus of this review will be on the relationship between PCOS and periodontal disorders, as well as the risk factors for both. However, in order to establish a more distinct and solid link, more studies with a large sample size need to be done.

Differences in patterns of sexual assault among female victims preceding and during the COVID-19 pandemic: an analysis of encounters in an emergency department

The aim of this study was to evaluate how the COVID-19 pandemic may have impacted the number and patterns of sexual assault victims within a German metropolitan city. A retrospective single center analysis of the gynecology examination reports of all women presenting to the emergency department of a university hospital after a sexual offense between 03/2013 and 02/2021 (n = 1167). Comparison of the first year of the pandemic 03/2000-03/2021) to previous years (03/2017-02/2020) and comparison of periods of government-imposed social distancing (03/12/2020-05/23/2020 and 10/23/2020-02/28/2021) with corresponding periods of pre-pandemic years. The overall number of sexual assault cases did not change during the first year of the COVID-19 pandemic. However, during the stay-at-home orders, the number of women presenting to the emergency department decreased by 38% (n=45 vs. 72). Fewer victims filed a police report during the pandemic (49.5% vs. 73.9%, p<0.001) and the lockdown period (50% vs. 76.5%, p<0.001). Less genital injuries after sexual assault were detected during the pandemic (14.3% vs. 25.2%, p<0.02), but there was an increase of illegal substance abuse (19.5% vs. 9.3%, p<0.003). During the stay-at-home orders fewer victims reported alcohol consumption (42.4% vs. 62.5 %, p<0.023). Despite the decrease in sexual offense related police reports, the number of sexual assault cases remained consistent, and the usage of illegal drugs increased during the COVID-19 pandemic. These findings represent the importance of providing support to sexual assault victims, as well as the implementation of preventative measures, especially in times of crisis.

Serum levels of tumor necrosis factor (TNF-α) and vaginal gene expression of toll-like receptor 2 (TLR2) & microtubule-associated protein 1 light chain 3 (LC3) after treatment of vulvovaginal candidiasis with sertaconazole nitrate spanlastics

The irritating infection known as vulvovaginal candidiasis (VVC) affects women all over the world. Around 75% of women will acquire at least one attack throughout their lives. In addition to its demonstrated antifungal properties, sertaconazole nitrate (SCN) also exhibits anti-inflammatory effects, which are of significant importance in the therapeutic management of (VVC). Despite its benefits, SCN suffers from poor solubility, which affects its biological activity. This project's objective is to construct SCN spanlstics in order to enhance its solubility as well as its antifungal and anti-inflammatory activities. SCN spanlastics were created utilizing the ethanol injection technique, after which they were characterized. Chitosan (2.5%) w/w gels containing 2 % w/w of SCN in the form of spanlastics were prepared, and then the in vitro antifungal activity of the prepared chitosan gel and commercial SCN cream (Dermofix) was performed. After a complete gynecological examination, vaginal swabs were obtained from patients suspected of VVC and then cultured on Sabouraud dextrose agar for phenotypic identification. VVC was then induced in nonpregnant ovariectomized female rats using isolated and identified Candida albicans (C. albicans) species. In order to detect the difference between chitosan gel containing SCN spanlastics and the commercial (Dermofix) cream, serum levels of pro-inflammatory cytokine Tumor necrosis factor (TNF- α) were detected. After sacrificing the rats, gene expression of toll-like receptor 2 (TLR2) & microtubule-associated protein 1 light chain 3 (LC3) in vaginal tissue and immunohistochemical expression of interleukin-6 (IL-6) as an inflammatory chemokine were performed in all groups. Results revealed that SCN was successfully entrapped into spanlastics, the particle size ranged from 1.6 ± 0.050 to 5.7 ± 0.900 μm in diameter; in-vitro dissolution of SCN was significantly enhanced from chitosan gel compared to that from Dermofix cream, the inhibition zone of prepared chitosan gel containing SCN spanlastics was significantly larger compared to that of Dermofix cream. Our results revealed that the anti-inflammatory effect of SCN in the form of spanlastics was significantly greater than that of commercial (Dermofix) cream. Finally, we recommend the use of SCN spanlastics as the best antifungal and anti-inflammatory formulation in cases of vaginal candidiasis.

What do Cardiologists Expect from Imaging For Ischemic Heart Disease in Women

What do Cardiologists Expect from Imaging For Ischemic Heart Disease in Women

Differences in the referral process from general practice to resident specialists in gynaecology depending on density of specialists and patients’ socioeconomic status

Background There are significant differences in the densities of resident specialists in gynaecology (RSGs) in various regions of Denmark. It is unclear whether this disparity affects gynaecological patients’ experience of the referral process and whether it differs in terms of their socioeconomic status (SES). Objective To examine gynaecological patients’ experiences of the referral process to an RSG concerning RSG density and patients’ SES. Design Cross-sectional questionnaire and registry-based study. Setting In Denmark, general practitioners (GPs) serve as gatekeepers of secondary care and are responsible for referrals to resident specialists as well as inpatient and outpatient hospital care. Subjects A total of 2917 patients who consulted an RSG participated in this study. Main outcome measurements Patients’ experiences of referral to an RSG, waiting times, involvement, and how they experienced the referral process. Results Patients who lived in the highest density RSG region were referred to an RSG more promptly after the onset of symptoms, had to visit their GP less frequently to obtain a referral to the RSG, and rarely received a gynaecological examination by their GP compared with those living in regions with lower RSG densities. Moreover, their waiting times were shorter, and more often, the patients themselves proposed to be referred to an RSG. The findings show that RSG density had a greater impact on women’s experiences than SES. Conclusion To allow equal access to specialist care, RSG density must be equal across all regions in the country.

S1445 Increasing Mortality of Non-Alcoholic Fatty Liver Disease in Women: A Population-Based Time-Trend Analysis Using the Global Burden of Disease Database, 1990-2019

S1445 Increasing Mortality of Non-Alcoholic Fatty Liver Disease in Women: A Population-Based Time-Trend Analysis Using the Global Burden of Disease Database, 1990-2019

Common Cardiovascular Diseases in Women.

Cardiovascular disease is a leading cause of death for women in the United States. This article encompasses the epidemiology/etiology, clinical presentation, diagnostic assessment, management, and prognosis of some common cardiovascular disorders seen in women with a special focus on pregnancy.

Effect of Educational Program about Clinical Gynecological Examinations on Nurses′ Performance

Effect of Educational Program about Clinical Gynecological Examinations on Nurses′ Performance

Investigation of the Effect of Women's Breast Cancer Worry Levels on Breast Cancer Prevention Behavior.

The aim of this study was to investigate the extent of worry about breast cancer (BC) amongst a sample of women and to examine the effect of this on behavior to prevent BC. This cross-sectional study was conducted in 271 women aged 18 years and above who attended the Family Medicine Outpatient Clinic of a tertiary hospital and met the inclusion criteria. Data were collected using the following tools: Patient Information Form; Breast Cancer Worry Scale (BCWS); Breast Cancer Prevention Behaviors Identification Scale (BCPBIS); and Mammography Processes of Change Scale (MPCS). When evaluated according to BCWS scores (mean 8.43±3.36), the BC worry levels were found to be low. The behavior adopted for prevention was also found to be positive according to BCPBIS (mean 119±15.26) and MPCS (mean 82.38±12.81) scores. A significant correlation was found between the BCWS and both the BCPBIS and MPCS scores, and again between the BCPBIS and MPCS scores (p<0.001 for all). There was a correlation with three scale scores in those who had knowledge about BC, and those who had regular clinical breast examination (BE) (p<0.05 for all). The BCPBIS score was found to be higher in those aged between 41-65 years, those who had mammography, and performed p self-BE (p = 0.002; p<0.001; p<0.001, respectively). According to the MPCS score, mammography behaviors was found to be more positive in those who had regular gynecological examinations and those who had mammography (p = 0.08 and p = 0.011). The participants generally had low BC worry levels and had adopted positive behavior for prevention. Being informed about BC and screening and having regular BE increased BC worry. Those with high BC worry, those who had mammography before, those who had knowledge about BC and screening, and those who regularly performed BE showed more positive behaviors toward preventing BC.

Knowledge level about HPV infection and cervical cancer screening tests

Introduction: Understanding HPV and cervical cancer is vital for prevention, early diagnosis, and treatment. Nurses play a crucial role in implementing screening and are also at risk. This study examines nurses' knowledge and practices regarding HPV and cervical cancer screening in a tertiary center.&#x0D; Materials and Methods: It is a prospective survey study conducted with nurses. A total of 191 nurses participated in the three-part and 53-item survey that evaluated demographic data, HPV knowledge levels and cervical cancer screening awareness.&#x0D; Results: A total of 2895 nurses work at the hospital. The rate of participation in the research was 6.6% with 191 participants. The average age of the participants is 27.1. Majority of the participants are female (n: 171, 89.5%), only 20 (10.5%) are male. While 81.9% of the respondents had knowledge about sexually transmitted diseases, only 13.5% had gone to regular gynecological examinations. Despite 98.4% of the participants who had knowledge about cervical cancer and screening practices, only 11% (n:19) had undergone cervical cancer screening and 94.2% (n:180) had not received HPV vaccine. The most mis-answered question about HPV was whether current vaccines protect against both genital warts and cervical cancer. &#x0D; Conclusion: In conclusion, nurses' knowledge level and screening practices about HPV and cervical cancer need to be improved. It is also important to increase awareness of the HPV vaccine and encourage more people to receive it. This effort could positively impact health outcomes related to cervical cancer and HPV.

The Determination of Knowledge Levels of Women about the Prevention of Gynecological Cancers

Purpose: The aim of this research was to determine the knowledge level of women in the prevention of gynecological cancers. &#x0D; Methods: This descriptive research was conducted with 420 women from May to June 2022. Introductory Information Form and Gynecological Cancer Prevention Information Scale were used to collect of data.&#x0D; Results: The total mean score of the Gynecological Cancer Prevention Information Scale was 14.84±7.90 (min:0, max:35). As a result of this research, it was determined that women's knowledge of protection from gynecological cancers was close to the middle level. This situation was affected by variables such as age, education level, employment status, income level, alcohol use, age of first pregnancy, age of first sexual intercourse, thinking that female cancer is preventable, having regular gynecological examinations, and knowing about cancer screenings.&#x0D; Conclusion: Women's knowledge of prevention from gynecological cancer was not at the expected level. It is essential to emphasize the importance of cancer prevention and early diagnosis in order to reduce cancer-related death rates in the society.

Phytocompositions of ayurvedic medicine in the restoration of menstrual health in women of early reproductive age who have survived moderate and severe form of COVID-19

Research objectives: to evaluate the effectiveness of phytotherapy in the treatment of menstrual health disorders in women of early reproductive age after a moderate and severe form of the coronavirus disease.Material and methods. 104 women of early reproductive age with menstrual health disorders that occurred 3 months later after moderate or severe COVID-19 were under observation and 34 gynecologically and somatically healthy women of the control group who did not suffer from COVID-19. Female patients with COVID-19 were randomly divided into two groups: the main group (n=53) and the comparison group (n=51). The performed examination included: study of complaints, general and gynecological anamnesis, physical and gynecological examination, ultrasound examination of pelvic organs, determination of hormonal profile. All patients with COVID-19 received a comprehensive rehabilitation program, which included diet therapy, vitamin and mineral complexes, psychotherapy. In addition to the complex rehabilitation program patients of the main group received ayurvedic phytocompositions Femicycle or Femimens for 6 months.Results. It has been established that the moderate and severe course of the coronavirus infection affects the reproductive system of early reproductive aged women and leads to menstrual health disorders, among which irregular menstruation, premenstrual syndrome and dysmenorrhea dominate. Levels of pituitary, adrenal, ovarian and thyroid serum hormones were within the reference norm in most cases, but have statistically significant deviations from similar indicators of healthy control women who did not have COVID-19. One-third of women of early reproductive age after moderate to severe COVID-19 had elevated prolactin levels. Ayurvedic phytocompositions Femicycle and Femimens in a comprehensive rehabilitation program for post-COVID menstrual health disorders led to a faster recovery of menstrual health and a full hormonal recovery.Conclusions. Ayurvedic phytocompositions Femicycle and Femimens are effective and safe naturopathic drugs for restoring menstrual health in women of early reproductive age after experiencing moderate to severe COVID-19.

A Comparative Study of Measuring Bladder Volume in Patients with Pelvic Tumor Receiving Radiotherapy Using a Portable Bladder Scanner Made in China and CT Analog Positioning Machine

The purpose of this study was to investigate whether the bladder volume of patients with pelvic tumor treated with radiotherapy (RT) can be accurately measured using the Meike Palm Bladder Scanner PBSV3.2 manufactured in China and the accuracy of its measurement under different influencing factors. One hundred and sixty-five patients with pelvic tumor radiotherapy who were positioned in our department from January 12, 2022, to July 7, 2022, were selected. All patients voided their bowels and urine one hour before positioning, had a gynecological examination, were instructed to drink 500-800 ml of water, urine volume was measured using PBSV3.2 when they felt the urge to urinate, and urine volume reached 150-350 ml given for positioning (20 minutes expected from making the film appliance to the end of positioning), and the data were measured and recorded using a cystometric device immediately after positioning. The CT bladder volume outlined by the treating physician is viewed in the planning system. The accuracy of PBSV3.2 was evaluated by comparing the bladder volume measured by the bladder scanner and CT. To investigate the accuracy of PBSV3.2 in different sex, ages, treatment purpose, and bladder volume. There was a significant positive correlation with bladder volume on CT and PBSV (r = 0.874; p<0.001). The mean difference between CT measured values and PBSV was (-0.14±50.17) ml. The results of the different variables showed that the overall mean of PBSV and CT measurements were statistically different in the age ≥65 years, bladder volumes >400ml and ≤400ml groups (p = 0.028, 0.002, 0.001). There was no statistical significance between the remaining variables. The volume difference between PBSV measurement and CT was 12.87ml in male patients, which was larger than that in female patients 3.27ml. Pearson correlation analysis showed that the correlation coefficient was 0.473 for bladder volume greater than 400ml and 0.868 for bladder volume less than 400ml; the correlation coefficient of the other variables ranged from 0.802 to 0.893. This is the first large-sample study to evaluate the accuracy of PBSV in a pelvic tumor RT population using the convenient bladder scanner PBSV3.2 made in China. PBSV provides an acceptable indicator for monitoring bladder volume in patients with pelvic RT. It is recommended to monitor bladder volume with PBSV when the planned bladder volume is 200-400ml. For male and patients ≥65 years old, at least two repeat measurements are required when using a bladder scanner and the volume should be corrected by using a modified feature to improve bladder volume consistency.

Artificial Intelligence-Assisted Automated Applicator Digitization for Fully-Automated Gynecological High-Dose Rate Brachytherapy Treatment Planning

To automate the digitization of plastic and titanium applicators used in interstitial and hybrid gynecological (GYN) computed tomography (CT)-based high-dose-rate (HDR) brachytherapy procedures to accelerate the planning and reduce the potential for planning errors. Our hypothesis is that artificial intelligence can accurately automate the identification and digitization of plastic and titanium applicators used in HDR brachytherapy. Forty-eight patients who had received GYN procedures (7 tandem/ring: plastic applicators, 41 interstitial: titanium needles) were selected retrospectively. Patients were randomly split into training (n = 40) and test (n = 8) sets for this study. DICOM images and digitized needles from delivered plans were converted to 3D binary format. The points from each needle were transformed to individual contours and combined into a single binary mask using custom software. Using nnU-Net, a self-configuring deep convolutional neural network, 2D and 3D U-Net architectures were trained and ensembled. With the CT image as input, the nnU-Net model learned features to automatically segment the needle contours. Lastly, a 3D U-Net model was trained using 5 of the 7 tandem/ring cases (plastic applicators), with two reserved to evaluate this automated digitization. The models' performance was evaluated using the Dice Similarity Coefficient (DSC) and identification rate for individual needles. The model trained on 40 patients performed well on titanium needle cases [mean (+/- std. dev.) DSC = 0.738+/-0.034], but did not perform well on the tandem/ring cases [DSC = 0.408] in the test set. This model automatically identified 100% (54 out of 54) titanium needles but missed all plastic applicators from tandem/ring cases. Training a model with only a limited number of tandem/ring (plastic applicators) cases greatly improved segmentation accuracy [mean DSC = 0.646] for tandem/ring test cases. This model which was trained using only tandem/ring cases, automatically identified 7 out of 7 needles (100% vs 0% with previous model) from cases in the test set. The nnU-Net can automatically detect HDR needles with high confidence. Using applicator-specific identification models may improve digitization accuracy. Further evaluation of these tools on larger datasets will confirm the findings of this study.

Рецидивуючий бактеріальний вагіноз: варіативний підхід з урахуванням можливих патогенетичних аспектів

Purpose - to evaluate the effectiveness, duration of the clinical result, safety and tolerability of the complex treatment of recurrent bacterial vaginosis (BV) with the sequential use of an antibacterial agent and probiotic suppositories. Materials and methods. 91 women of reproductive age with a symptomatic course and a diagnosis of recurrent BV participated in the study. Primary decontamination of the vaginal tract was performed by all subjects and consisted of a 10-day intravaginal administration of the drug Terzhinan. Subsequently, the participants were randomized into three comparable groups. After primary remediation, no additional medication was prescribed to patients in the Group 1 (n=30). Subjects of the Groups 2 (n=30) and 3 (n=31) were recommended daily administration of vaginal probiotic suppositories Bifolak for a 10-day course, followed by prolongation of their use twice a week for 2 months in the Group 3. The effectiveness of BV therapy was evaluated immediately after antibacterial treatment and after a 6-month follow-up period based on the results of clinical examination, microscopic analysis of smears, and determination of vaginal pH with litmus strips. Results. At the end of the 10-day course of vaginal sanitation, subjective and objective signs of bacterial infection were not detected among all study participants, the pH of the vaginal secretion was within physiological limits and did not differ statistically between the Groups. At the stage of the sixth month of observation, data from a gynecological examination, smear microscopy and pH-metry confirmed 4 recurrences of the disease in the Group 1. In the Group 2, whose women additionally received a ten-day course of probiotic therapy, the number of episodes of repeated development of the disease was significantly lower, and amounted to 1 case for the entire observation period. Patients of the Group 3 did not notice manifestations of reinfection during the study and had no objective signs of BV. The use of a probiotic for a continuous course of 10 days in the Group 2, as well as its prolongation in a maintenance regimen (twice a week for 2 months) in the Group 3, was combined with a stable normalization of the acidity of the vaginal secretion, which was evidenced by the preservation of optimal pH until the end of the observation period (4.07±0.14 and 3.94±0.17, respectively, in the Groups 2 and 3 against 4.43±0.14 in the Group 1, p&lt;0.05). The complete absence of repeated cases of BV and the lower pH values (p&gt;0,05) in the Group 3 allowed us to consider the greater anti-relapse effectiveness of the long-term use of the probiotic at the trend level. Conclusions. Traditional schemes for the use of antibacterial agents in the treatment of BV allow to achieve a clinical and laboratory effect at the end of the course, but do not ensure its complete preservation for a long period of time. The disadvantage of the etiotropic approach to the treatment of BV is the lack of attention to the competitive properties of the indigenous flora as a factor in countering dysbiosis. Taking into account the pathogenetic essence of BV, which consists in the violation of the growth balance between conditionally pathogenic microorganisms and its own flora, classical antibacterial schemes can be successfully supplemented by the external introduction of eubiotic strains. Our study showed the benefits of complex therapy with an antibacterial agent and a probiotic, which consisted in stabilizing the acidity of the vaginal space and reducing the rate of disease recurrence, with a tendency to increase the effect in parallel with the duration of treatment. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Association Of Raised Serum Triglycerides With Incidence Of Pre-Eclampsia

Background: Pre-eclampsia, a serious multi-systemic pregnancy complication is estimated to occur in 5-10% of pregnancies worldwide. Objective: To determine the frequency of pre-eclampsia in pregnant females with hyper-triglyceridemia and to study its associations. Methodology: This Cross-sectional study was conducted at Gynecology Dept. Poly Clinic Hospital, Islamabad (March - Sept. 2022). Pregnant females of age 15-40 years, gestational age 13-20th weeks and singleton pregnancy were included. Known hypertensives, receiving lipid-lowering or anti-hypertensives, chronic kidney or liver disease, teenage pregnancies, primigravida, history of CVA, IHD, epilepsy or endocrine disorders were excluded. After the detailed clinical evaluation, fasting serum triglyceride levels were checked. A total of 225 cases with elevated serum triglycerides were finally selected and evaluated for the presence of pre-eclampsia by monitoring the blood pressure, cardiovascular, gynaecological examination and urine for the presence of proteinuria. Patients were followed till the development of pre-eclampsia or completion of pregnancy. Results: Among 225 pregnant females with raised serum triglycerides, the mean age was 24.28+5.5 years. Pre-eclampsia was observed in 47(20.89%) of patients. The Chi-square tests of association between pre-eclampsia and each of parity, residential status, and socio-economic status were insignificant while BMI and Gestational age were significant. Conclusion: There is a high prevalence of pre-eclampsia in pregnant women with hypertriglyceridemia. Serum triglyceride levels may predict the women at risk for pre-eclampsia. The risk of preeclampsia in women with hyper-triglyceridemia is independent of parity, and socioeconomic or residential status. Hypertriglyceridemia may predispose to pre-eclampsia even at lower BMI levels. The development of hypertriglyceridemia in early gestation may be an additional risk factor. Early screening of women at risk may lead to better outcomes.

Determination of Prostaglandins (Carboprost, Cloprostenol, Dinoprost, Dinoprostone, Misoprostol, Sulprostone) by UHPLC-MS/MS in Toxicological Investigations.

Prostaglandins have stimulative influence on the human uterus and therefore were introduced to medical treatment in reproductive healthcare as labor inductors or abortifacients. The UHPLC-ESI-QqQ-MS/MS method was developed for six prostaglandins: carboprost, cloprostenol, dinoprost (PGF2α), dinoprostone (PGE2), misoprostol and sulprostone (substances for pregnancy termination) in pharmaceutical samples and was applied for the toxicological examination of pills containing misoprostol (collected during gynecological examination). There were used two internal standards: misoprostol-d5 and PGF2α-d4. The quantification of analytes was performed in the MRM mode. The linearity of method was in the range from 0.1 to 10 µg/mL, with a coefficient of determination above 0.997 (R2) for each compound. The precision and accuracy values did not exceed ±5.0%. Analysis of the pills revealed the presence of two substances: misoprostol and diclofenac. Misoprostol and diclofenac dose per sample were as follows: 608.8 ng (sample 1), 708.4 ng (sample 2), 618.8 ng (sample 3) and 67.7 mg (sample 1), 65.3 mg (sample 2) 67.3 mg (sample 3), respectively. A simple, precise and reliable method can be applied for routine examinations in terms of clinical and forensic toxicology examinations as well as in quality control of drugs for pharmaceutical purposes (original drugs and counterfeit medications).