Burnout dynamic among Ukrainian academic staff during the war

This study examined burnout dynamics among Ukrainian academic staff during the full-scale war. A cross-sectional study was conducted twice: the first wave in July 2022 and the second in January 2023. To assess the burnout syndrome as the final outcome, the self-reported Maslach Burnout Inventory-Human Services adapted for socioeconomic professions by Vodopyanova was used and correlated with different characteristics. The results showed a significant positive trend in emotional exhaustion among Ukrainian academic staff, with females being more sensitive to war-related factors. The results demonstrate that prolonged stressful situations associated with the ongoing war and constant changes in professional conditions lead to significant depersonalization dynamics among academic staff of both sexes. For male academic staff, factors such as age and academic position become less significant for depersonalization. However, university relocation and migration processes were significant factors affecting female academic staff's' perception of effectiveness and accomplishment in their professional activities. The alarming dynamic of burnout levels detected among Ukrainian academic staff urges the national and institutional levels to take prompt actions to enhance the academic staff's mental health in the workplace for preserving not only the quality of higher education, but also human capital in war times for postwar recovery in Ukraine.

Defence factors of vaginal lactobacilli

Accurate knowledge of the composition and ecology of the vaginal microbial environment in healthy women is necessary for understanding lactobacilli-dominated normal microbiota and the mechanisms by which it reduces disease risk. The vagina and its microbiota form a balanced ecosystem; any movement outside the normal range for this ecosystem of obligate and/or facultative microbes, termed dysbacteriosis, can lead to infection and disease. This review summarizes recent research on the vaginal ecosystem, the Lactobacillus species that dominate it, and the means by which they suppress the growth, development, and/or proliferation of pathogenic microbial species. Lactobacilli colonization is believed to be beneficial since it prevents other microorganisms from colonizing the vaginal epithelium via competitive adhesion, interactions with the local immunity and plasminogen-plasmin system, and the production of lactic acid, hydrogen peroxide, and antibacterial substances. In addition, lactobacilli also constitute an important part of the urogenital tract microbiota and the lactobacilli-dominated vaginal microbiome is a major determinant for female urogenital health.

[POLYHEXAMETHYLENE BIGUANID HYDROCHLORIDE (BIGUANELLE) THERAPY OF BACTERIAL VAGINOSIS]

The aim of our study was to determine the efficacy and tolerability of local therapy with polyhexamethylene biguanid hydrochloride (BIGUANELLE) in women with anaerobic vaginal infection.

MATERIAL AND METHODS

We include in our study 23 women (18-50) with established by AMSEL criteria bacterial vaginosis. In all of the women at the beginning and at the end of the survey was performed gynecological examination and microbiological research (AMSEL). The therapeutic scheme at all women is with a single vaginal application of gynecological solution BIGUANELLE. Effectiveness of the treatment was evaluated according to clinical complaints and microbiological research (Amsel criteria: Ph 4.5 >; KOH (+); "clue cells"; specific vaginal fluorine). Tolerability of patients to treatment was assessed by questionnaire.

RESULTS

Clinical complaints of patients after the therapy decreased as follows: vaginal fluorine with 73.9%; odor--75%; pruritus--50%; discomfort--90%. Microbiological research and their evaluation by AMSEL, showed the therapeutic efficacy of the therapy in 16 (69.6%) of all (n-23) patients. At 7 (30.4%) women, the treatment remained without effect. At questionnaire answers, 73.9% patients were satisfied with the application of BIGUANELLE, 95.6% of them have implemented it easily, 95.6% of women believe that BIGUANELLE is more convenient to use in comparison with similar products which have a daily application, and none of the patients (100%) have any complaints in applying this gynecological solution.

CONCLUSIONS

BIGUANELLE showed good clinical efficacy in the treatment of bacterial vaginosis. It is easily applied and well tolerated by the patients.

[Chemotherapy for Malignancy During Pregnancy - Literature Review.]

In today's dynamic development of modern life, we can unfortunately see more and more often cases of malignant diseases during pregnancy. Therapy of these conditions in pregnant women is a challenge to the doctors, due to concerns for the mother's health, but also the possible risks for the foetus. An additional difficulty is the fact that there are no common algorithms for the treatment. Of great importance is the ges'tation period, because in its different parts, the risks vary in grade. It is believed that up to 10-12th ges.tation week chemotherapy should not be included. The optimal time for the last course is 35th gestation week or three weeks to the due date. The purpose of this review is to examine the benefits and risks of the treatment of malignant diseases during pregnancy for both the mother and the fetus.

[UTERINE SCAR DEFECT IN WOMEN AFTER CESAREAN SECTION - ULTRASOUND AND HYSTEROSCOPIC DIAGNOSI.]

The aim of our study was to determine the frequency of defect scar in women with clinical complaints after Cesarean section (CS) diagnosed by transvaginal ultrasonography and diagnostic hysteroscopy as well as to determine the degree of match between the data obtained by the two methods.

MATERIALS AND METHODS

The study was retrospective and was conducted in the Department of General Oncology and Gynecology, MMA for the period from 2014 to 2016 years. Included are 25 non-pregnant premenopausal women aged 29 to 45 years with clinical symptoms. The main inclusion criteria were delivery by CS, overt clinical gynecological symptoms and positive imaging findings of a defect in the scar. The main gynecological symptoms are: postmenstrual and breakthrough bleeding, dysmenorrhea, dispaureny and idiopathic pain over the symphysis. Imaging studies were performed using two-dimensional transvaginal sonography and diagnostic hysteroscopy. The data are processed by Social statistic STAT 10. We used Chi square statistic test 12.5 (Pearson). Data were compared to two independent groups. Results were statistically significant at values of p<0. 05.

RESULTS

The most common symptom in women included in the study was a post-menstrual bleeding - 22 (88 %). In 15 (60 %) of them we found out ultrasound signs of a defect in uterine scar (p =0, 00407). In 10 (40%) of those patients by diagnostic hysteroscopy we found defective scar (p=0, 000004). There has been no significant difference between the two methods in terms of accuracy of diagnosis (isthmocele) (p=0.1572) although the hysteroscopy there was a statistically higher one.

CONCLUSION

With increasing frequency of cesarean section (CS) increases and frequency of early and late complications of this surgery. Irregular uterine bleeding in women after CS and a lack of other organic causes are the result of a defect in uterine scar. First choice for the diagnosis of this type of pathology is ultrasonography examination followed by diagnostic hysteroscopy. It is conducting further studies on the etiology of this complication.

[COMPARISON OF LAPAROSCOPIC ASSISTED VAGINAL HYSTERECTOMY AND VAGINAL HYSTERECTOMY FOR BENIGN DISEASES AND LESIONS OF THE FEMALE GENITAL SYSTEM]

OBJECTIVE

To compare the efficacy of laparoscopic assisted vaginal hysterectomy (LAVH) and vaginal hysterectomy (VH) carried out on the occasion of non-malignant diseases and lesions of the female genital system, by assessing the: operative time, price, blood loss, hospital stay, intra and postoperative complications, satisfaction of the patient.

MATERIALS AND METHODS

The study included 187 women aged 38-71 years, with hysterectomy with or without salpingo-oophorectomy by LAVH-58 (31%) women or VH-129 (69%) women, on the occasion of non-malignant diseases and lesions of the female genital system. The patients are including in the study groups according to including and excluding criteria. Operation preparation, research and intra and postoperative follow-up of patients in both groups were the same. Standard, as performance is the surgical technique in both groups. The indicators are analyzed with the statistical program SPSS 10.1 for windows. Shi-square test, Fisher exact test were used in appropriate cases.

RESULTS

No significant difference between groups in terms of age (LAVH 48.7 ± 3.2 years; VH 52.7 ± 4.8 yrs), live births (1-3)/2 (1-2), total weight (62.6 kg/59 ± 7.2 kg) weight of the uterus (227 ±116.5/234 ±: 68.3). Most often Indications for LAVH are: CIN/CA in situ coli uteri--16.1%; myoma uteri--22.5%; ovarian tumor--15.5%, etc. Indications for VH: genital prolapse--53.5%; CIN/CA in situ--14.7%; recurrent endometrial polyp--14%, etc. Operative time: LAVH (126 ± 18.2), VH (68 ± 11.1), (p ≤ 0.05). Intraoperative blood loss: LAVH (16 ± 7 average drop in hemoglobin Hb), VH (10 ± 5 decline in Hb array) (p ≤ 0.05). We didn't find out significant differences between the patients of both groups in terms of hospital stay and satisfaction with the carried out operation. Intraoperative complications are more in the LAVH group and almos absence in VH group. Post-operative complications occur without statistical differences (we exclude urinary infections) in both groups studied.

CONCLUSIONS

In our study the VH showed better or equal results in the studied indicators in comparison with LAVH, therefore it is surgical intervention of choice compared to LAVH for removal of the uterus with or without the adnexa in non-malignant diseases and lesions of the female genital system. LAVH is the right choice in comparison with VH only in ovarian tumors and when we expected problems in women small pelvis.

[Labial fusion in postmenopausal women--a clinical case]

Labial fusion is benign genital disorder, which more frequent in children at 6 years old and less in women in reproductive and postmenopausal age. It can be congenital or acquired condition. Its etiology is unclear. The low serum estrogen concentration is the basic cause of labial fusion. As a result of physiological hypoestrogenism in the vulvar skin and mucosa come on atrophic changes, which together with the chronic inflammatory changes lead to labial adhesia with subsequent partial or total obstruction of the vagina and/or the urethra. The treatment can be conservative or surgical depending on the degree of labial fusion. We perform two clinical cases respectively of total and partial vulvarsynechiae in postmenopausal women. The clinical picture of the patient with total synechiae is represented by a difficult and prolonged micturition and urinary incontinence, while in patients with partial synechiae is represented by an inability to carry out sexual intercourse.

[NON-HODGKIN'S LYMPHOMA OF THE FEMALE GENITAL SYSTEM--A LITERATURE REVIEW]

Lymphomas are a heterogeneous group of malignant lymph proliferative diseases and represent 3-4% of all neoplastic processes. They are subdivided into Hodgkin's (15%) and non-Hodgkin's (85%). Non-Hodgkin's lymphomas (NHL), depending on their primary location are subdivided into nodal and extranodal. Extranodal forms of NHL represent 25-40% of NHL where only 2% of them concern the female genital system. They develop in the female genital organs primary or secondary invade them. Extranodal NHL genital form is extremely rare and represents 0.5% of all malignant genital diseases. All genital organs may be affected where most lymphomas are localized in the cervix, uterine body and ovary. The clinical picture is nonspecific whichcomplicates the timely diagnosis. A multidisciplinary approach is used for staging of lymph proliferative disease. Treatment of genital form of NHL is determined by the age of the patient and her reproductive intentions, clinical stage, histological variant. Due to the low occurrence there are no widely accepted protocols of behavior and treatment of genital extranodal NHL. The first method of choice is the conservative approach by chemotherapy. The most widely used and most effective is the combination Cyclophosphamide, Doxorubicin, Vincristine and Prednisone (CHOP). According to data in the literature the 5-year survival rate for cervical extranodal NHL is 80%. Surgery should not come into consideration when there are certain indications. The aim of this review is to examine rare cases of non-Hodgkin's genital lymphomas in females and to present opportunities for their diagnosis and treatment.

[OPEN LAPAROSCOPY--A MODIFIED HASSON TECHNIQUE]

The open technique was first described by Hasson in 1970. This technique consists of creating a small umbilical incision under direct visualization to enter the abdominal cavity followed by the introduction of a blunt trocar. Pneumoperitoneum is then rapidly created. Hasson proposed its potential benefits to be the avoidance of blind insertion of the Veress needle and bladed trocar, prevention of visceral and vascular injuries, preperitoneal insufflation and gas embolism, guaranteed pneumoperitoneum, and a more anatomical repair of the abdominal wall. Since that time, many surgeons have made some modifications to first Hasson technique. Here we described the way we do the open laparoscopy in our hospital and different positive and useful details we put to original Hasson version.

[OPEN LAPAROSCOPY--ADVANTAGES AND DISADVANTAGES]

The debate about the safety of penetrating technique in laparoscopy, persist for more than four decades and still does not approach the scientifically valid decision about what method to use: closed with a Veress needle laparoscopic surgery; open laparoscopy; direct placement of troakar without prior to insufflation, visual entry methods. We're meant to look at the advantages and disadvantages of the laparoscopic approach, which we use in the Clinic of Gynaecology of the Military Medical Academy, Sofia, Bulgaria, having conducted a search in the literature and Medline from the year in which it was introduced (1971) to present. The open laparoscopy is the only method that offers a precisely controlled entrance into the abdominal cavity, with low traumas, without serious vascular and organ injuries. The advantages of this procedure are that with proper practice, it takes less time and can be used in all possible situations with low intraoperative risk, even after previous abdominal operations.

[The primary cancer of fallopian tube--a clinical case]

The primary cancer of the fallopian tube is only 1% of all malignant diseases affecting the female genital tract. The etiology is unknown and is assessed with untypical symptomatic. It often affects women at age over 50 years old. Recently in literature are described about 1200 clinical cases. The primary carcinomaof fallopian tube resembles the epithelial ovarian cancers, which defines the similarity in the diagnosis, treatment and follow up of the patients with such type of pathology. We describe a clinical case of 66 year old woman with primary serous low graded cancer of a fallopian tube. The symptoms were presented of dull pains in the lower part of the abdomen and a little quantity of free fluid in the pelvis. The diagnosis is set after a surgical intervention, based on pathoanatomic results. After the radical hysterectomy with bilateral salpingo-oophorectomy, lymphadenectomy and omentectomy, the patient is treated with adjuvant chemotherapy with platinum and taxane.

[VAGINAL LEIOMYOMA AFTER TOTAL ABDOMINAL HYSTERECTOMY--CLINICAL CASE AND REVIEW OF LITERATURE]

Vaginal myomas are rare benign, mesenchyme, monoclonal tumors. They originate from smooth muscle cells and have a diverse and non-specific clinical feature. They are normally presented as single solid nodules localized in anterior vaginal wall in women between the ages of 35-50 years. Often times they are secondary originating from a cervical or vaginal lesion in woman who had undergone a hysterectomy on account of a myoma. We present a rare case of vaginal myoma localized in the posterior vaginal wall in a patient, who had undergone a total hysterectomy 19 years ago on account of a myoma.

[SLOW RELEASED LOCAL PROBIOTICS]

The probiotics are live microorganisms which embedded in adequate quantities have a healthy influence on the recipient. The current local probiotics get on medical practice at the beginning of the last decade and quickly become part of the current therapy of vaginal disbacteriosis and infections. A lot of studies show their microbiological and clinic effectiveness in prevention and treatment of the most met vaginal pathogens, usually together with on after pathogenetic or ethiological treatment. Slow release probiotics are the newest generation of probiotic products. Due to their limited and complicated pharmaceutical production, there are very few clinical trials on their microbiological and clinical effectiveness in the treatment of vaginal disbacteriosis and infections. Our expections for their useful application remain high, because of the already achieved good results.

[COMPLICATIONS OF DIAGNOSTIC AND OPERATIVE HYSTEROSCOPY--REVIEW]

Hysteroscopy is a diagnostic or surgical mini-Invasive gynecologic operating procedure. The complications of this standard procedure are relatively rare. According to retrospective studies they are 0.95-13.6%. They occur more often by an operative rather than a diagnostic hysteroscopy. These complications could be divided into two groups of an approximately equal occurrence--due to a dilation and passing through the cervix uteri (cervical laceration, creative a false cervix uteri, perforation, bleeding, impossibility to pass through the inner orifice of the cervical canal, insufficiency of the cervix uteri) and due to the operative technique itself (uterine perforation, fluid overload, thermal or mechanical trauma of the inner urinaiy and gastrointestinal tract, infection, rupture of the uterus during a subsequent pregnancy). The most occurring complication is namely the uterine perforation--1-9%, the most severe could indeed be the fluid overload--0.01-11%. The gynecologist performing the hysteroscopy should be well grounded in the typical complications. Unveiling and performing a quick intervention of the latter could prevent unwanted consequences for the patient and the legal issues that could follow occur.

[THE FIRST EPIDEMIOLOGICAL DATA ABOUT THE HR-HUMAN PAPILLOMA VIRUS TYPES IN SOUTH AND NORTHERN BULGARIA]

The aim of our study were to evaluate the prevalence of HR-HPV infection in women between 15 and 55 years of age in the South and Northern Bulgaria. We have analyzed the HPV status (using DNA-sorb-AM nucleic acid extraction kit) in cervical samples collected during a 3 year period (2010-2012) from 1020 women, aged 15-55 and divided in four age groups, who attended their gynecologists for HPV-DNA cervical test. The rate of the HR-HPV infection was established to be 39.9%. HR-HPV negative were 60.1% of the evaluated subjects. The most commonly isolated genotype in all 407 (100%) infected women was HPV 16 - 190 women (46.7%), followed by HPV 56 - 78 (19.1%), HPV 31- 48 (11.8%) and HPV 33 - 45 (11.1%). To our knowledge, this is the first survey evaluating the prevalence of HR-HPV infection in the South and Northern regions of Bulgarian towns and drawing attention to the unusually high proportion of different HR-HPV.

[Hyperandrogenism in multiple pregnancy]

Hyperandrogenism caused by pregnancy is an extremely rare condition. One of the most common reasons is the hyperreactio luteinalis (LH). The literature describes 51 cases of LH where 8 of them have occurred during spontaneous multiple pregnancy. LH is a result of increased serum concentrations of human chorion gonadotropin (β-hCG) and increased receptors' sensitivity to β-hCG. It is characterized by a typical ultrasound image: most often bilaterally massively enlarged ovaries that consist of many of thin-walled small theca-lutein cysts, giving it the appearance of a "spoke wheel". We present a case of a 36 year old woman pregnant for the first time with spontaneously occurred twin pregnancy, who has hyperandrogenism and high blood pressure resistant to therapy. The conducted imaging studies showed enlarged polycystic ovaries resembling cancerous ovarian neoplasia. Recognition of this condition is important as radical surgery, resulting in removal of the ovaries is wrong and incorrect.

[VULVAR INTRAEPITHELIAL NEOPLASIA--TERMINOLOGY, SYMPTOMS AND TREATMENT]

The term vulvar intraepithelial neoplasia (VIN) was introduced for first time in 1986 year from the International Society for the Study of Vulvar Disease (ISSVD). With this term are denoted precancer vulvar conditions. According to a classification dated 1986 depending on the degree of affection of multilayered squamous epithelial vulvar precancerous lesion are subdivided into three groups: VINI, VIN2 and VIN3. Subsequently VIN1 is determinate as a lesion which there isn't oncogenic potential. These types of changes often are result from irritation or viral infection which leads to benign condylomata acuminate. Compare to lesions with VIN require histological signs for high grade intraepithelial neoplasia as nuclear pleomorphism, increased mitotic activity, atypical mitotic activity and disordered architecture of squamous cells epithelium. These fundamental morphologic characterizations lead to revision and subsequent change of the current classification. In 2004 ISSVD changed the classification. It included lesions like VIN2 and VIN3, but they are subdivided in two groups: the usual type VIN and the differentiated VIN. They have different etiology, morphology, oncogenic potential and prognosis. The usual type VIN is associated with infection of high risk types of human papilloma virus and is a more frequently met form of VIN. A very good prognosis is characteristic for it. The differentiated VIN is met in postmenopausal women of about 70 with frequency of about 2-5%. It originated from vulvar dermatosis like lichen scierosus and there is a high oncogenic potential and worse prognosis. The treatment of VIN may be surgical and by medicines. The frequency of recurrences after treatment is 30-50% which required frequently follows up. The aim of this literature review is to introduce present terminological classification of VIN, as well as basic clinical, diagnostically and curative methods in treat of the both types of this precancerous.

[Diagnosis and treatment of lichen sclerosus--review]

Lichen sclerosus (LS) is a chronic skin disease of the vulva which affects mostly women in the postmenopausal period. The disease affects also men and children. Its frequency is from 1/70 up to 1/1000, whereas for women it is 10 times more frequently. The disease has unknown etiology. Due to the high frequency of accompanying, autoimmune diseases, it is presumed that this disease is a result of immunological processes. Some of patients diagnosed with LS have vulvar intraepithelial neoplasia, while 0.3% - 4.9% of them have squamous cell carcinoma. The aim of this review is to summarize our knowledge regarding the frequency, clinical features, diagnosis and therapy of LS in view of the prevention of the complications that may occur.

MATERIAL AND METHODS

We researched the available literature and Medline on the topic for the period of 1971 until 2014 year. We summarized the most interesting, contemporary and scientifically substantiated facts regarding this disease.

DISCUSSION

Early diagnosis, the proper and timely treatment, as well as the continuous follow up the patients with LS is mandatory due to the fact that the spontaneous remission is extremely rare and the complications may lead to significant deterioration of the quality of life.

[Secondary non-Hodgkin lymphoma of female genital tract]

Non-Hodgkin Lymphomas (NHL) are a separate group of blood diseases, which includes all types of lymphomas, without Hodgkin lymphomas. The incidence of NHL in the female genital system is 0.5% of all the NHL. They develop in the female genital organs primary or affect them secondary. Secondary development of the genital non-Hodgkin's lymphoma we have when the biopsy of a lymph node that precedes the diagnosis of the disease is before the development of a genital tumor or we can find a genital tumor--along with simultaneous involvement of the lymph nodes or extra genital authority. We present a clinical case of 56 years patient with non-Hodgkin's lymphoma with secondary genital involvement. From ultrasonography, computed axial tomography and Tu markers that were maiden we have suspicion for ovarian tumor with mechanical pressure over pyelocalix system due to left hidroureter and left hydronephrosis II degree. That was the only reason for urgent surgical treatment with intraoperative histologic diagnosis of NHL. The postoperative chemotherapy in combination with surgical treatment in our case had a good and long-lasting disease survivor effect. One year after the operation and the chemotherapy in the patient, there is no evidence of relapse.

[Efficacy of combined 5-nitroimidazole and probiotic therapy of bacterial vaginosis: randomized open trial]

The aim of the current research is to identify the clinical and microbiological effect of 5-nitroimidazol therapy for the treatment of bacterial vaginosis and in combination with probiotics and the influence of such therapy upon vaginal flora.

MATERIALS AND METHODS

Women (n = 539) with bacterial vaginosis who meet the criteria were included in the study. They were randomized into two groups with the following therapeutic regimes: in the first group (n = 242 women) the treatment included applications of 2g BID tinidazole for two days and vaginal suppositories of 1000 mg metronidazol at day 1 and 3 (T+M). In the second group (n = 297) the women were cured with the same treatment as those in the first group. In addition to it from the fifth day of the treatment was added a topical administration of vaginal probiotic which contains species of alive lactobacilli: Lactobacillus acidophilus, Lactobacillus rhamnosus (T+M+P). The efficacy from the therapy was evaluated using the clinical compliances of the women, the data from the clinical examination and the microbiological tests results.

RESULTS

The results showed expected increase of clinical therapy efficacy (Amsel - criteria) from 42.8% (T+M; n = 211/242) to 84.06% (T+M+P; n = 274/297) in groups and of microbiological efficacy (Nugent) from 44.7% (T+M; n = 211/242) to 83.3% (T+M+P; n = 274/297), in follow up 35-40 days from the beginning of treatment. The percentage of women with normal vaginal flora on 35-40 day after the therapy increase with 57% in the (T+M) first group while in the second group (T+M+P) with 94%.

CONCLUSIONS

Combining the therapies of 5-nitroimidazoles and vaginal probiotic reduce bacterial vaginosis recurrence and restores permanently normal vaginal flora.

[Vaginal disbacteriosis--social and sexual risk factors]

The vaginal microbe equilibrium could be impaired by different agents. Many of the risk factors can change the preventive mechanisms of the vagina and can lead to inflammation and disease. We even do not suppose about the role of most of them in impairing of vaginal microbe equilibrium. The exact understanding of those risk factors and mechanisms by which they disturb the vaginal microbe balance could reduce female morbidity of vaginal disbacteriosis and vaginal inflammations. The aim of this literature synopsis is to review some of the most frequent risk factors for vaginal disbacteriosis and about how they change vaginal micro-flora with dominant lactobacillus within it. The most informative and detailed articles on the theme which were found in the resent literature as well as in Medline for the period between 1990 and 2012 were selected. The risk agents for vaginal disbacteriosis are: endogenetic, social, sexual, infectious and iatrogenic. The social and sexual factors are the most frequent in our daily round. The intensity and the kind of sexual life, smoking, homosexual connections, vaginal douching and contraception methods are included in them. All these factors depend on us. Thus we hope that through their popularization and discussion will help to prevent the females' health.

[Probiotic monotherapy of bacterial vaginosis: a open, randomized trial]

The aim of the current research is to establish the clinical and microbiological efficacy of the therapy with local probiotics in the treatment of anaerobic vaginal infections and the therapy's effect upon vaginal flora.

STUDY DESIGN/METHODS

381 (100%) women with bacterial vaginitis are included in the research. They were randomized into three groups. In the first group 143 women who were treated with local (10 applications) probiotics vaginal medicine, containing live lactobacillus types Lactobacillus acidophilus, Lactobacillus rhamnosus. In the second group 126 patients were treated with five days oral administration of Clindamycin (tabl.x 600 mg) BID and local therapy of two vaginal ovules containing each 1000 mg Metronidazole, which were administered intravaginal every other day. In the third group 112 women were treated with the same therapy as the second group and in addition started from the day 5 after it were administered locally probiotic medicine containing Lactobacillus acidophilus u Lactobacillus rhamnosus. The efficacy of the therapeutic scheme was evaluated via comparison of patients' clinical complains in the different groups, of data from clinical examinations (Amsel) and microbiological tests (Nugent) for each patient.

RESULTS

Thirty five-forty days after the probiotic therapy, the clinical efficacy in this group (Amsel) is 42.7% and microbiological efficacy (Gram preparation - Nugent)--41.3%. They are lower than the results which we received in the groups where the combine nitroimidazole/incozamide treatment was performed with or without local probiotic. The second group: clinical efficacy--51.6%, microbiological (Nugent)--46.4%. The highest clinical--87.5% and microbiological--80.3% efficacy showed the combine nitroimidazole/lincozamide/probiotic treatment in the third group.

CONCLUSIONS

Our results show that the local monotherapy with probiotics has fewer efficacies in comparison to the combine therapeutic schemes for treatment of vaginal disbacteriosis with dominant anaerobic species.

[A clinical case of young, oral combined contraceptive using women, heterozygous carrier of the Factor V (Leiden) which revealed thrombosis of the left internal jugular vein and brain ischemia with cerebral infarction and ischemic stroke]

Thrombophilia is associated with increased risks of venous thrombosis in women taking oral contraceptive preparations. Universal thrombophilia screening in women prior to prescribing oral contraceptive preparations is not supported by current evidence. The case is presented of a 23 year-old women with a personal history of interruption and on the same day started with oral contraceptive (0.03 microg ethynil estradiol - 0.075 microg gestodene), which due on a 18 pill/day to acute headache, increasing vomiting and speaking defects. Physical/neurologic/gynecologic examinations observed a normal status. The MRI and CT revealed thrombosis of the left internal jugular vein and brain ischemia with cerebral infarction and ischemic stroke. The acute therapy of thrombotic findings was accompanied with many tests. The thrombophilia PCR-Real time - test finds heterozygous carrier of the Factor V (Leiden). This case shows the need of large prospective studies that should be undertaken to refine the risks and establish the associations of thrombophilias with venous thrombosis among contraceptive users. The key to a prompt diagnosis is to know the risk factors. The relative value of a thrombophilia screening programme before contraceptive using needs to be established.

[Extra peritoneal anterior pelvic exenteration with total urethrectomy and vaginectomy for bladder and urethra cancer - clinical case and review of literature]

The anterior pelvic exenteration is technically demanding surgical intervention carried out in advanced malignant genito-urethral process origin. It is characterized by a high percentage of intra and postoperative complications. They can be reduced through new surgical techniques, such as extra peritoneal approach to perform this operation. We present a clinical case of 56 years old patient with adenocarcinoma of the urethra/bladder established histologically by TUR (Transurethral) - biopsy. Of the clinical and imaging studies - data for the invasion to the anterior vaginal wall. The patient is after Total Hysterectomy with bilateral salpingo oophorectomy on the occasion of the fibroids in the uterus. After a routine preoperative preparation, we did: extra peritoneal anterior pelvic exenteration with total urethrectomy and vaginectomy. Bilateral extra peritoneal ureterocutaneostomy with "JJ" stents. Bilateral extra peritoneal pelvic lymph dissection. Our clinical case, proves the thesis of many authors about the benefits of extra peritoneal approach for anterior pelvic exenteration. Reduce significantly the intra/post-operative complications, hospital stay and a time to follow postoperative therapy. We consider that the extra peritoneal approach for radical surgery should be applied whenever possible in the interest of the health of the patient.

[Effect of Lactobacillus casei var rhamnosus (Gynophilus) in restoring the vaginal flora by female patients with bacterial vaginosis--randomized, open clinical trial]

The vaginal probiotics can increase the clinical and microbiological efficacy of the therapeutic regimens used for the treatment of bacterial vaginosis. The Aim of our study was to evaluate the effect of the application of Lactobacillus casei var rhamnosus (Gynophilus--probiotic species Lcr 35) in restoring the vaginal flora and prevention of relapses by female patients with anaerobic vaginal infection undergoing conventional (nitroimidazole) local and main therapy.

METHODS

In the study were included 60 women with established Amsel/Nugent bacterial vaginosis who were randomized in two groups. The first group patients (n-30 beginning/n-25 controls) underwent a 5 day treatment with two daily peroral doses of metronidazole 500 mg, with local application of metronidazole ovules 1000 mg at the 1st and the 3rd day (M+M). In the second group (n-30 beginning/n-26 controls) the therapeutic regimen was the same as in the first group, with additional 7 day treatment with Lactobacillus casei var rhamnosus - Lcr 35. (Gynophilus) vaginal ovules, two daily doses (M+M+G).

RESULTS

30% to 40% was the difference/enhance of the clinical efficacy according to the clinical indicators when Lactobacillus casei var rhamnosus - Lcr 35 was added to the standard nitroimidazole therapy. Concerning the main clinical indicator: Amsel criteria, the improvement after the therapy in the first group (M+M) was 60% (n-15) and in the second group (M+M+G) 88.5% (n-23). According to the microbiological indicators the improvement in the first group (M+M) based on the vaginal flora evaluation (Nugent score) was 60% (n-15) and in the second group, after the addition of Lcr 35 it was 88.5% (n-23).

CONCLUSIONS

The application of Gynophilus after conventional 5-nitroimidazole treatment for bacterial vaginosis increased the clinical and microbiological efficacy of the therapy by 25% - 30%. The microbial balance in the vaginal ecosystem was restored in the majority of patients (88%), which is a prerequisite for low percentage of bacterial vaginosis relapses.

[GynOphilus--a winning relay]

The vagina is a complex biocenosis where many micro-organisms coexist and colonize it. The dominant colonizing bacteria of a healthy individual is of the genus "lactobacillus". It is also called Doderlein's bacillus and determines the vaginal microbial balance through the production of lactic acid, hydrogen peroxide, biosurfactants, bacteriocines and modify the competition of pathogens for adhesion to the vaginal epithelial cells. Through these mechanisms the lactobacilli block the growth and development of other vaginal pathogenic microbial species and also inhibit the colonization of some other microorganisms imported from outside. Because of these potential therapeutic properties, the lactobacilli are used as effective medical agents for prophylaxys and therapy to restore the physiological balance in the vaginal eco-system. According to our studies and gained clinical experience the etiological antibacterial treatment is not always sufficient to restore the normal vaginal flora. The complete recovery of the vaginal flora could be reached using probiotics that are applied locally and per os. GynOphilus is a new vaginal probiotic product containing one type of the genus "Lactobacillus": Lactobacillus casei var rhamnosus. GynOphilus restores the physiological balance of the vaginal flora and reduces the risk of recurrent infection. The product is applied intravaginal and interacts locally, inhibits the growth of the most common vaginal pathogens: Gardnerella vaginalis u Candida albicans.

[Surgery for isolated, pelvic nodal metastasis in surgically staged (G1, FIGO -1) endometrial cancer patient]

A case of surgically staged G1, FIGO 1 endometrial cancer patient with isolated, pelvic nodal metastasis after radical hysterectomy with bilateral salpingo-oophorectomy and selective lymph node dissection. No adjuvant radiotherapy passed. Pre surgery diagnosis was made by Doppler Ultrasound, Angiography, MRI, and PET-CT. A high risk surgery was performed with pelvic lymphonodectomy and resection of big pelvic blood vessels. Aggressive intraoperative infusion therapy was leaded for patient restitution. This particular case raised again the questions about routine systematic pelvic lymphonodectomy and postoperative radiotherapy for first stage (G1, G2) endometrial cancer patients.

[Vaginal ecosystem]

Vaginal flora plays an important role in preventing genital and urinary tract infections in women. In fact every little movement of obligate and/or facultative vaginal micro flora over the normal limits for this ecosystem causes vaginal disbacteriosis. Vaginal disbacteriosis is a risk condition which can cause infection. Thus an accurate understanding of the composition and ecology of the ecosystem is important to understanding the etiology of urogenital diseases. The aim of this review is to update knowledge about vaginal micro biota, the Lactobacillus species that dominate normal vaginal flora and the way they suppressed infectivity and/or proliferation of pathogenic bacteria. A Medline (Pub med) and medical literature search from 1990-2010 for relevant articles was performed and the most informative articles were selected. Lactic acid bacteria determinate the most of defense mechanisms of women vagina by concurrent adhesion, producing lactic acid, antimicrobial products, hydrogen peroxide and by local interactions with the innate and cell-mediated immune systems and plasminogen-plasmin system. All this mechanisms promotes the stability of the normal vaginal micro flora. Every Lactobacillus species play a different role in host--defense vaginal system. The presence of different Lactobacillus species with the normal vaginal micro flora is a major determinant to the stability of this micro flora and for urogenital health.

[Short - term combined 5-nitroimidazole treatment in vaginal dysbacteriosis with dominant anaerobic species]

The aim of this study is to investigate the effectiveness of short-term, combined 5-nitroimidazole treatment in vaginal dysbacteriosis with dominant anaerobic species. The presence of infection was proven by microscopic examination of vaginal fluid (Nugent, modified by Ison-Hay-Keane scale), microbiological culture, and by clinical symptoms (Amsel). 179 patients were included in our study. Clinical and microbiological examinations were performed prior to the treatment and at the end of the study (day 8 after the first dose of short- term combined 5-nitroimidazole treatment). The treatment included applications of 1 g BID tinidazole for two days and vaginal suppositories of 1000mg metronidazol at day 1 and 3. Based on the microbiological tests prior to the treatment Gardnerella vaginalis alone was present in 132 patients (73.7%). The rest of the patients, 47 or 26.3% of the treatment group, the infection was present by mixture of several anaerobic species. At the end of the treatment 83.2% of the treated population showed no clinical symptoms of dysbacteriosis, and 73.7% of the treated patients showed no dysbacteriosis in microbiological test results. Based on the results mentioned above it was determined that the short-term combined 5-nitroimidazole therapy was effective in treatment of vaginal dysbacteriosis with dominant anaerobic species.

[Prevalence of human papillomavirus genotypes in Bulgarian women with atypical cervical lesions examined by colposcopy]

INTRODUCTION

For the first time three studies describing human papillomavirus (HPV) genotype distribution in Bulgaria was presented at 15th National Conference of Oncogynecology (22-25.04.2010; V. Turnovo). Such studies are needed to predict how HPV vaccination and HPV-based screening will influence cervical cancer prevention.

AIM

The aim of this study was to determine the types of human papillomavirus (HPV) distribution in Bulgarian women's population (age 16-40 years) with atypical cervical lesions examined by colposcopy.

METHODS

The prevalence of type-specific HPV was searched by PCR-DNA in 176 women with positive colposcopic findings (results).

RESULTS

Human papillomavirus was found in 105 (59.7%) of the women, while 71 (40.3%) were negative for this virus. From 105 positive for HPV women, 95 (90.5%) were infected with high- risk genotypes and 10 (9.5%) with low-risk genotypes. Among high-risk types, a predominance of HPV-16 (39% of infected women) was shown followed by HPV-56 (17.1%) and HPV-33 (15.2%). 45.7 percent of our patients were infected with single HPV genotype, whereas 54.3% were infected with mixtures of HPV genotypes.

CONCLUSIONS

The presence of relatively high percentage of HPV types 33 and 56 and the relatively high incidence of infections with mixture of genotypes are the reasons for obligatory secondary prophylactic procedures (cytology, colposcopy and HPV detection), never.mind HPV vaccination. We find that, there is strong connection between HPV infection and positive colposcopic results.

[Clinical efficacy of a new method for LEEP conization with pistol-shaped electroknife]

The aim of this study is to establish clinical efficacy of a new method for LEEP conization of uterine cervix. The study is open, retrospective, performed at Department of General and Oncogynecology - Military Medical Academy (Sofia, Bulgaria) for the duration from 2007 till Mar 2010. The study includes 37 women at age from 19-50 years with proved high grade CIN (included Ca coil uteri in situ) by abrasion or biopsy. Medical history was collected from all patients enrolled in the study as well as gynecological examination and colposcopy was performed to them. A LEEP with short intra venues anesthesia was performed to the patients. An innovation system for LEEP conization and generator for monopolar currency ERBE VIO 300D was used. The follow up visit was performed one month after the treatment procedure and included gynecological examination and colposcopy (positive/negative atypical colposcopy results). The clinical efficacy of the method was evaluated on the base of histological results. The patients whose histological results show negative endocervical margins were accepted for cured. From 37 patients in total with different stage of dysplasia and carcinoma in situ hospitalized at Clinic of surgical gynecology for surgical treatment, in 33 (89%) there are negative endocervical margins. These patients formed the cured group. In four patients (10.8%) were discovered histological evidences for positive endocervical margins. The LEEP was not the final operative procedure for them. They were included in the uncured group. The final results achieved from the study about the efficacy of the used method LEEP has statistical significance (d.f .= 1, X2 = 2.82, p < 0.05). The data shows that the LEEP eliminate completely the affected by malignant process areas of cervix uteri. The LEEP can be used as a common surgical method in the treatment of the women with high stage of pre-carcinoma and carcinoma in situ coli uteri.

[Comparative study of itraconazole and fluconazole therapy in vaginal candidosis]

Women who had symptomatic acute vulvovaginal candidiasis are include in this study. Micological investigation is realized by microscopy, culture method (CHROM agar, BD, USA) and ID 32 C (Fungus), Mini API Bio Merieux, France. Most frequent isolates are Candida albicans (82.67%), followed by C. glabrata (7.8%) and C. parapsilosis (5.51%). We compare two groups of patients: received itraconazole (200 mg bd oral dose for 1 day) and fluconazole (150 mg single oral dose). The rate of mycological cure is 93.8% in the itraconazole group and 79.03% in the fluconazole group (p = 0.008). Clinical response rate for women receiving itraconazole (80%) is significantly higher than fluconazole group (59.7%). These results suggests that itraconazole is more effective than fluconazole in the treatment of acute vulvovaginal candidiasis.

[Spontaneous stercoral perforation of colon and rectum with contribution of five cases]

The authors report five cases of spontaneous perforation of the large bowel for a five year period. The clinical symptoms were dominated by the feculent peritonitis. There were found no data of previous diseases of the colon during the operations and hystologically. By all five patients was manifested severe constipation before the incident. During the operation the recto sigmoid and the left colon were found plugged by stercolithes with "stone density". A hypothesis of stercoral pathogenesis of the perforations is suggested. Conclusions for the surgical tactics in the conditions of large bowel peritonitis due to benign perforation are done.

[Treatment of bacterial vaginosis with high dosage metronidazole and lactic acid]

INTRODUCTION

Bacterial vaginosis (BV) is one of the most frequent vaginal infections in women of reproductive age. This condition is a disbalance of vaginal flora that is expressed in a considerable displacement of normal lactobacilli flora by opportunistic and facultative microorganisms. Despite the moderate or missing clinical manifestation this dysbacteriosis is linked with many complications in obstetrics and gynecology.

AIM

To evaluate the effect of treatment of bacterial vaginosis with the product Arilin rapid containing vaginal Metronidazole in high doses and a following vaginal application of lactic acid in a part of the patients.

MATERIALS AND METHODS

For the period May 2001-August 2001, bacterial vaginosis was established in 45 patients of the Specialized hospital for active treatment in obstetrics and gynecology "Maichin Dom", Sofia and the Military medical academy-Sofia, gynecology ward. The diagnosis of bacterial vaginosis was established in accordance to Amsel's criteria and the results that were obtained from samples colored by Gram. For the treatment of BV were used local Metronidazole (Arilin rapid) and vaginal tablets containing lactic acid. The patients were divided into 3 groups. In the first group (18 women) vaginal suppositoria of 100 mg Metronidazole (Arilin rapid) were used for 2 days, in the second (20 women)--Arilin rapid x 1 glob./2 days and a following therapy with vaginal tablets containing lactic acid x 1 glob. for 7 days. The third group (7 women) was the control receiving placebo therapy--shampoo Dercome Femme containing lactic acid for external application.

RESULTS

In the group receiving Arilin rapid we observed a normalization of vaginal flora in 71.43% (5/7), intermediate vaginal flora in 14.3% (1/7) and no change caused by therapy in 14.3% (1/7). In the second group, where lactic acid was included, cure was established in 94.1% (16/17) and in only one (5.9%) case was established intermediate vaginal flora. In the control group in 85.7% (6/7) of the cases was registered a lack of effect.

CONCLUSION

Treatment with Arilin rapid showed good results in 71% of cases. Adding lactate to therapy improved the therapeutic effect and achieved cure in over 94%. The following application of vaginal lactate is an additional step helping the recolonisation of the vagina with lactobacilli and is a contribution to the struggle with recurrent forms.