No 9 (2014)

A proper diet is of great importance in preserving the health of a pregnant woman and in ensuring the full development of her future child. The use of vitamin-mineral complexes and biologically active food additives is a justified method to prevent pregnancy complications and negative perinatal outcomes when considering that the pattern of nutrition and the quality of foodstuffs do not provide the intake of essential micronutrients. Among the substances that are essential to life, omega-3 polyunsaturated fatty acids involved in the morphogenesis and normal function of tissues and organs and in the control of many homeostatic parameters generate a great deal of interest. The sufficient intake of docosahexaenoic acid that determines not only the normal course of pregnancy and fetal development, but also the optimal development of the child’s higher nervous system is particularly important for the nervous and cardiovascular systems. Clinical trials have demonstrated both the negative outcomes of docosahexaenoic acid deficiency and the positive results of its compensation during pregnancy. This review deals with the current state of this problem and provides today’s international guidelines for the use of docosahexanoic acid in pregnant and breastfeeding women.

Vulvovaginal candidiasis (VVC) is a very widespread disease in women and is common in persons with immunodeficiency. According to different authors, VVC is diagnosed in 30-40% of the women complaining of genital tract discharge. Despite the fact that Candida is a commensal and colonizes the human skin and mucosae, it may result in skin and mucosal injuries and/or generalized infection and, if there are risk factors, the disease may be recurrent. However, recurrent VVC was observed in some cases without apparent risk factors, which may suggest that genetic disorders play a role in an anti- Candida immune response. The polymorphisms in different genes (STAT1, STAT3, CARD9, Dectinl, etc.), which are responsible for chronic/recurrent infection with Candida, were identified. The microorganism’s specific features, such as pathogenicity and virulence factors and antifungal drug resistance, also play an important role in the development of recurrent Candida infection. And only a comprehensive, detailed study of the problem will be able to give an insight into the pathogenesis of the disease and hence to choose an optimal and more sound treatment policy.

Ventilator-associated pneumonia (VAP) is a severe complication occurring in patients on mechanical ventilation and resulting in higher morbidity and mortality rates and longer length of intensive care unit stay. In spite of the current diagnostic and treatment methods, the incidence of VAP remains rather high and ranges from 18 to 26%. Its risk factors and pathogenesis have been inadequately studied in children, in newborn infants in particular. Also, there are no clear diagnostic criteria or unified treatment protocols in pediatric intensive care units patients. The acute urgency of the problem necessitates further investigations to identify risk factors, possible prevention, and elaboration of treatment and diagnostic algorithms. This literature review gives an update on VAP in children.

Objective. To study the expression of leukemia inhibitory factor (LIF), transforming growth factor в 1 (TGF-fi), and vascular endothelial growth factor A (VEGF-A) in the surface and glandular epithelia and in the endometrial stromal component by an immunohistochemical (IHC) assay. Subject and methods. The present paper gives the IHC features of the expression of the examined factors in the endometrial tissue obtained in the implantation window in the cycle before in vitro fertilization (IVF) from 48 infertile women treated by IVF, followed by embryo transfer. The expression of the examined factors was compared in 23 women with an IVF pregnancy and in 25 without IVF pregnancy. Results. There was a markedly high expression of LIF in the surface and glandular epithelia and that of VEGF-A in the endometrial stroma of the women who had conceived versus those who had not (p < 0.01). The determination of the expression of LIF in the surface and glandular endometria and that of VEGF-A in the endometrial stroma serves to predict a 72.92% chance of conceiving in the IVF cycles. Conclusion. The optical density of expression of LIF in the surface and glandular epithelia and that of VEGF-A in the stroma of the epithelium obtained on days 20-23 of the cycle preceding the IVF cycle were the most informative indicators of IVF outcomes.

Objective. To study the detection rate of endometrioid adenocarcinoma (EAC) in womenpreoperatively diagnosed as having atypical endometrial hyperplasia (EH) by an immunohistochemical examination of Ki-67 and phosphatase and tensin homolog (PTEN). Subject and methods. Fifty patients who had undergone total hysterectomy with appendages for the histological diagnosis of EAC were retrospectively selected. The expression of Ki-67 and PTEN were immunohistochemically estimated. Results. Out of the 50 patients undergoing hysterectomy for endometrial cancer (EC) and complex atypical EH, 9 (18%) patients were not diagnosed as having the cancer by preoperative transvaginal ultrasonography (USG) of small pelvic organs (SPO). Preoperative SPO magnetic resonance imaging (MRI) did not diagnosed cancer in 6 (12.5%) patients. Thus, there were no great difference in the diagnostic data obtained by both SPO USG and SPO MRI. The preoperative diagnosis of atypical endometrial hyperplasia from the results of histological examination of scrapes of the endometrium revealed its cancer after total hysterectomy in 5 of the 50 cases. Moreover, EAC tissues were found in the basal endometrial layer that was absent in the endometrial scrapes (Fig. 1d). Immunohistochemical examinations of endometrial scrapes showed that it was these 5 cases that had the highest Ki-67values up to 47% and PTENloss up to 50%. Conclusion. The data of SPO USG, SPO MRI, and histological examination of endometrial scrapes are of limited value for the differential diagnosis of atypical endometrial hyperplasia and EAC. SPO USG and SPO MR did not diagnose EAC in 18 and 12.5%, respectively. Furthermore, 5 cases of endometrial cancer were detected by the preoperative diagnosis of complex atypical EH. When endometrial scraping data are used to determine treatment policy in patients diagnosed with atypical endometrial hyperplasia, it is necessary to take into account the fact that EAC may be present in the basal layer that is absent in the examined material in a number of cases. The high values of Ki-67 and partial PTEN loss in the endometrial scrapes are poor prognostic factors and may testify to the development of EAC in the deeper endometrial layers. The use of the proliferation marker Ki-67 and the PTEN tumor suppressor gene allows the timely diagnosis of the possible development of a malignant process and the substantiation of a differential approach to choosing treatment policy in patients with complex atypical EH and EAC.

Objective. To improve methods to prevent air embolism (AE) during hysteroscopy with consideration for accumulated clinical experience. Subject and methods. A longitudinal observational retrospective case-control study was conducted at the S.P. Botkin City Clinical Hospital. The course of hysteroscopic interventions and the development of AE were analyzed examining the case histories of 4590 women aged 19 to 85 years with intrauterine pathology (IUP) who had undergone hysteroscopy in January 2010 to January 2013, including 815 (17.8%) who had hysteroresectoscopy. The findings were processed using a package of Statistica programs for Windows 6.0 Stat-Soft. Results. During the study, the development of AE was not observed in the patients with IUP during hysteroscopy. Owing to the fact that that the technology of liquid hysteroscopy was strictly observed, there were even no conditions for AE occurrence in 3750 (81.7%) women with IUP without electrosurgical interventions. To rule out AE requires that a delivery hose system and a hysteroscope should be freed of air bubbles and, where possible, liquid feeding systems using air pressure be abandoned. Where resected tissue segments must be removed from the uterine cavity, the prevention of AE involves the creation of conditions for free evacuation of air bubbles from the uterine cavity. The hysteroscope is inserted assembled with pre-supplied liquid and the tap of the outflow system being fully open. Environmental air aspirations are possible when Trendelenburg’s position is used in combination with the open outer resectoscope barrel left in the cervical canal (for example, electrode replacement); the prevention is to close the lumen of the outer barrel with a mandrin.

Objective. To analyze the pattern of abortion-related maternal deaths in the Ural Federal District (UFD) and to define ways of improving the quality of health care when pregnancy is terminated. Subject and methods. The statistical data of the Ministry of Health of the Russian Federation during 2011-2012 and those of UFD during 2012-2013, the medical records of patients who had died from abortion, as well as the annual reports of Crisis Pregnancy Centers and health care facilities were analyzed. Results. The pattern of pregnancy termination showed a preponderance of medically indicated (63%), spontaneous and unspecified (25%), and criminal (12%) abortions among the deceased in the UFD. The leading causes of maternal deaths were septic complications (50%) and extragenital diseases (25%). In the abortion technology, there was a predominance of aggressive techniques (uterine cavity curettage) (25%), hysterectomy (12%), small cesarean section (12%), criminal interventions (13%), vacuum aspiration (13%), and no interventions (13%). Conclusion. A comprehensive, commanding approach involving the attraction of allied specialists (psychologists, social workers, and lawyers) and the wide introduction of available safe abortion techniques in all UFD areas are needed to reduce maternal losses from abortion.

Objective. To evaluate the efficiency of combination therapy using allokin-alpha for genital diseases concurrent with HPV and HSV infections, to compare the medical therapy with allokin-alpha versus destructive treatment without this drug, and to assess the tolerability and safety on the basis of an analysis of adverse events. Design. A comparative randomized controlled clinical trial. Subject and methods. After obtaining informed consent, 60 reproductive-aged patients with HPV and HSV infection and cytological and colposcopic signs of flat and exophytic condylomas and low-grade cervical intraepithelial neoplasia (CIN I) were randomized to two groups: 1) 31 patients were given allokin-alpha injections (n = 6) 1 mg/day subcutaneously every other day during argon plasma ablation (APA) treatment; 2) 29 patients received conventional APA treatment (acyclovir 1 g daily for 7 days). All the patients included in the study underwent colposcopy, bacterioscopy, PCR diagnosis of infections (with HPV, HSVII-I, cytomegalovirus (CMV), M. genitalium, or Chl. trachomatis) in the cervical canal epithelial scrape. The follow-up was 6 months. During the investigation, the patients kept a diary where they wrote down the specific features of the course of the infections and therapy-related side effects, their magnitude and duration. Diary data were assessed and PAP test, colposcopy, PCR test for HPV and HSV types I-II, and bacterioscopy were carried out 3 and 6 months after cervical APA. During their participation in the investigation, all the patients used barrier methods of contraception. Results. Since colposcopy is a somewhat subjective test to evaluate the efficiency of therapy with the basic emphasis laid on the data of PAP test and PCR for HPV and HSV. Comparison of 3- and 6-month follow-up results revealed a significant difference in the number of cases of CU epithelial normalization in Groups 1 and 2patients, which was evidenced by the PAP test in 22 (77.4%) and 19 (65.5%) patients after 3 months and in 28 (90.3%) and 20 (68.9%) patients after 6 months, respectively (P < 0.05). In Groups 1 and 2, PCR for HPV became negative in 17(54.8%) and 12 (41.1%) cases following 3 months and in 24 (77.4%) and 17(58.6%) cases following 6 months, respectively (P < 0.05). In these groups, 6-month colposcopy showed positive cervical changes in 29 (93.5%) patients in Group 1 and in 26 (89.6%) patients in Group 2, respectively (P > 0.05). During the follow-up, there were significantly fewer HSV infection recurrences in Group 1. None of the patients in the groups had any serious adverse reactions. Conclusion. Allokin-alpha enhances the efficiency of treatment for CINI and exophytic cervical condylomas concurrent with HPV and recurrent HSV infections, favors their regression, and declines the number of herpesvirus infection recurrences. The drug is safe and well tolerated in the treatment using the above regimen.

Objective. To assess clinical, immunological, cytological, and colposcopic data in women with urogenital Mycoplasma infection during combination therapy using the immunomodulatory agent aminodihydrophthalazin-edione sodium (galavit). Subject and methods. One hundred and fifteen patients with urogenital Mycoplasma infection were followed up and divided into two groups: a study group (n = 60) that received standard therapy and the immunomodulatory drug (galavit) and a comparison group (n = 55) that had standard treatment only. Polymerase chain reaction was used to investigate samples for Mycoplasma genitalium, Mycoplasma hominis, and Ureaplasma parvum and urealyticum; and a bacteriological study for Mycoplasma hominis and Ureaplasma spp. was additionally performed, by determining their antibiotic susceptibility. All the patients underwent extended colposcopy and oncocytological and immunological examinations. Results. Combination treatment including the immunomodulator galavit as rectal suppositories for urogenital Mycoplasma infection showed high clinical efficiency (the high rate of pathogen eradication in the study group, a reduction in urogenital tract inflammatory processes, and restoration of immunological parameters). Galavit suppositories showed high patient compliance. Conclusion. Combination treatment incorporating the immunomodulator aminodihydrophthalazinedione sodium (galavit) that had anti-inflammatory activity permitted Mycoplasma infection to be clinically and laboratory cured in 92% of cases and immunological parameters to be improved

Myxoma is a primary intracavitary benign tumor of the heart, which may not have clinical manifestations in its small sizes. However, when the tumor grows or is at the site that disturbs the normal function of the heart, there may be serious complications and even sudden death. The literature describes single cases of detection of cardiac myxomas in pregnant women. The paper considers a case of pregnancy and labor in a 37-year-old woman with left atrial myxoma.