Vol 67, No 2 (2018)

Background. Pelvic inflammatory disease (PID), including chronic endometritis (CE), is a factor leading to endometrial receptivity disorder and in vitro fertilization (IVF) failures. The role of microorganisms in colonizing the endometrium, the pathogenesis of chronic inflammation, and associated infertility require further study.

Aims: To determine the taxonomic profile of the endometrial microbiota in different grades of CE in patients with a history of IVF failure.

Materials and methods. This study included 107 patients with ≥ 1 IVF failures. Depending on the severity of CE, and according to the morphological analysis of endometrial biopsy, the patients were categorized into three groups: group I (n = 14), patients without signs of CE; group II (n= 20); patients with signs of mild CE; and group III (n = 73),patients with signs of moderate and severe CE. All the patients underwent Pipelle biopsy of the endometrium according to our modified technique on days 18–23 of the menstrual cycle. Species and quantitative composition of the endometrial microbiota were investigated using real-time polymerase chain reaction (PCR).

Results. Compared to groups II and III, Lactobacillus spp. (50% and 46.6% versus 85.7%) and Eubacterium spp. (25% and 35.6% versus 78.6%) were detected significantly more frequently in the endometrial microflora of group I patients, respectively. Simultaneously, significantly more bacteria of the families Enterobacteriaceae (50% and 64.4% versus 35.7%, respectively) and Streptococcus spp. (55% and 56.2% versus 7.1%, respectively) were found in the patients of groups II and III compared to group I. The abundance of lactobacilli and Eubacterium spp. have also been shown to be significantly higher in the endometrial samples of women in group I than in those of the women in groups II and III, whereas the abundance of enterobacteria and streptococci are significantly higher in women with CE than in women without CE.

Conclusions. In patients without signs of CE, Lactobacillus spp. and Eubacterium spp. prevail in the endometrial microbiota. Chronic inflammation in the endometrium is associated with an increase in the frequency and abundance of Streptococcus spp., Staphylococcus spp., and bacteria of the family Enterobacteriaceae.

The results of the systematization of reasons for obstetric bleeding and preeclampsia near-miss opportunities established during an audit in 20 delivery homes in Tajikistan are presented in this article. The following reasons were reported: knowledge (45%), organizational problems (38%), and necessity for the correction of National Standards of obstetric bleeding and preeclampsia (13%). Therefore, determining recommendations for this country is a practical step to realize “near-miss” opportunities to prevent obstetric bleeding and preeclampsia.

Hypothesis/aims of study. Questions regarding the pathogenesis of urine incontinence and methods of treatment are acti vely discussed by gynecologists, urologists, and neuropathologists. Urine incontinence often has multifactor origins: the causes of urine incontinence are connected, as a rule, with the violation of urine continence functional mechanisms, anatomotopographical features of the lower urinary tract, or an premature ovarian failure. Simultaneously, changes in kidney function play a role in the pathogenesis of urine incontinence. In some cases, urine incontinence is combined with urine overproduction or inversion of the circadian rhythm of renal function owing to a decrease in the reabsorption of sodium ions in the thick ascending limb of the loop of Henle. In some patients, we successfully normalized ion transport, diuresis, and circadian rhythm of urine production by desmopressin or diclofenac administration. The present analysis was undertaken to evaluate the clinical efficiency of desmopressin and diclofenac in incontinent patients with nocturnal polyuria and polyuria.

Study design, materials, and methods. In total, 130 patients with complaints of urinary incontinence, polyuria (24-h urine volume of 40 mL/kg bodyweight or above), or nocturnal polyuria (nocturnal volume/24-h urine volume of 0.33 or above); 30 incontinent women without polyuria or nocturnal polyuria (comparison group); and 14 control subjects were included. The mean patient age was 43.6 ± 4.5 years (41.8 ± 3.7 years in the comparison group and 39.4 ± 6.3 years in the control group, p > 0.05). All the participants performed seven days of urine collection to determine the voided volumes. Patients with polyuria or nocturnal polyuria performed the 3-fold 24-h pad-test. Patients with polyuria and nocturnal polyuria were examined twice: in the initial state and one month after the start of treatment with the optimal dose of diclofenac or desmopressin (Minirin).

Results. The use of both diclofenac or desmopressin in patients with various types of urine incontinence, polyuria, or nocturia decreased the volume of voided urine because of the normalization of diuresis and an increase in cystometric bladder capacity.

Introduction. Cytochrome P450 aromatase is a key enzyme in the biosynthesis of estrogens from androgens. Some gynecological diseases are accompanied with changes in the activity of ovarian aromatase. Moreover, changes in the acti vity of ovarian aromatase are associated with the response to standard gonadotrophin stimulation in women undergoing in vitro fertilization. A new effective method determining the activity of ovarian aromatase without using ovarian tissue biopsy has been developed.

The purpose of the present study was to compare the detection of ovarian aromatase activity using the ratio of estradiol to AMH on the second day of the menstrual cycle through the immunocytochemical evaluation of aromatase expression in cumulus cells.

Methods. Depending on the activity of the ovarian aromatase, calculated on the second day of the menstrual cycle, 16 patients undergoing IVF protocols were categorized into three groups: eight patients with low activity, four with normal activity, and four with high activity. The patients did not differ in age and BMI. The expression of aromatase in cumulus cells obtained through transvaginal puncture was investigated by the immunocytochemical method.

Results. The fluorescence intensities in the low, normal, and high activity groups were 134 (122–161), 238 (201–251), and 259 (240–299), respectively. Differences between these groups were statistically significant (p = 0.008). There was a pronounced positive correlation between the activity of ovarian aromatase, calculated on day two of the menstrual cycle, and the intensity of aromatase fluorescence in cumulus cells (Spearman, r = 0.75, p = 0.001, n = 16).