Comparative characteristics of nasopharynx microbiota and vaginal biotope in women with reproductive disorders

Nasopharyngeal flora contributes much to the development of many diseases, including the urinary system diseases. The aim was to compare the vaginal microbiota biotope and nasopharynx microbiota in women with reproductive disorders (RD). The study involved 97 women with RD (infertility, miscarriage). The control group comprised women with chronic endometritis (CE), RD and chronic tonsillitis (CT) (n = 65), mean age was 31.0 ± 5.3. CE was diagnosed using histologic analysis and ultrasound studies. The comparison group consisted of 32 women with RD without CE and HT, representative by age. Endometrial sampling was conducted by endometrial pipelle biopsy taken on 5-11th days of the menstrual cycle. Nasopharyngeal swabs were taken on an empty stomach. Due to reduced indigenous microbiota in the studied habitats the number of opportunistic pathogenic microflora such as Staphylococci, Enterococci, fungi, E. coli and etiologically significant Streptococcus (in nasopharynx) was increased. Streptococci in the nasopharynx indicate that the troubles are in vaginal biotope, which leads to inflammatory diseases and reproductive disorders. Everything mentioned demonstrates common etiopathogenic mechanisms for the development of pathological processes of various localizations. Thus, it is important to pay close attention to all rehabilitation centers specializing on chronic infections, which will improve the treatment of CE

The study of the adaptation of first-year students to the university system of education

The purpose of the study is an assessment of adaptation to the university system of education and identification of its links with various factors in first-year students of the Ural state medical university.Цель исследования – оценка адаптации к вузовской системе обучения и выявление ее связей с различными факторами у студентов первого курса Уральского государственного медицинского университет

Genes of pathogenicity of Enterococcus bacteria isolated from the vaginal biotope of women with chronic endometritis and reproductive disorders

The microflora of the vagina plays an important role and should be regarded as a kind of ecological system that reacts to any changes in the state of the woman's body. Clinically expressed genital infections are etiologically associated with opportunistic microorganisms. In the pathogenesis of dysbiosis, an important role is played not only by quantitative and qualitative changes in microflora, but also by the "pathogenic potential" of microorganisms. The aim of the work was to reveal genes of pathogenicity in strains of Enterococci of the vaginal biotope of women of the studied groups. The study involved 102 women with reproductive disorders. The main group - women with chronic endometritis (CE), (n = 63), mean age - 31.0 ± 5.3. The diagnosis of chronic endometritis was made on the basis of morphological signs of histological examination of vacuum suction biopsy. The comparison group consisted of 39 women, representative by age; in this group the diagnosis was not confirmed by the results of the histological study of the endometrium. It has been established that enterococcal strains isolated only in women with reproductive disorders and chronic endometritis are a reservoir of genetic determinants of pathogenicity factors (efaA and asa1 (12.5 %) and sprE (37.5 %))

PATHOGENIC POTENTIAL AND MUTUAL INTERACTION OF MICROFLORA OF MUCOUS MEMBRANES OF OPEN CAVITIES OF DIFFERENT BIOTOPES IN WOMEN AS IMPORTANT FACTORS OF THEIR REPRODUCTIVE HEALTH

Micro-ecological interrelation between intestinal, vaginal and nasopharyngeal biocoenoses as parts of microbiome of a macroorganism was determined by the latest researches. The research included 44 women with inflammatory diseases of genital tract and reproductive disorders and 28 healthy women. Genospecies structure of enterococcus for each biotope (intestinal, vaginal and nasopharyngeal) had original differences with the most full spectrum of species in intestinal biotope. The contract between the groups is evident at the conclusion of the pathogenicity genes tests

Detection of genes of pathogenicity of symbiotic microflora in adjacent biotopes in women with chronic endometritis and reproductive disorders

Recent researches established microecological relationships between intestinal, vaginal and nasopharyngeal biocenoses in the composition of a macroorganism microbiome. This study included 57 women with chronic endometritis and 21 woman without it (control group). In women with chronic endometritis all studied pathogenicity genes (asal, cylA, stxl and stx2) were identified in representatives of symbiotic microflora in all three studied habitats - vaginal, intestinal and nasopharyngeal, which confirms the presence of a reservoir of potential pathogenicity. Studied genes of pathogenicity were diagnosed in women with CE in 8 cases of the bacteria of the species E. faecalis and E. faecium, which are "harbingers" of impending serious problem. This indicates the importance of these species in etiopathogenetic structure of microbiocenoses of studied habitats, and, possibly, their impact on the course of this disease

VAGINAL MICROECOLOGY IN WOMEN WITH THE NON-SPECIFIC GENITAL INFLAMMATORY DISEASES AND REPRODUCTIVE FUNCTION DISORDERS

We conducted the microbiological examination of vaginal microbiota in 324 women with non-specific inflammatory diseases of the genital tract and with reproductive dysfunction. According the condition of microecological balance of indigenous microflora (lactobacilli concentration) of women we have identified three types of vaginal microbiota: "normocenosis", " dysbiosis", "deep dysbiosis" We marked deficiency oflactobacilli in every fourth women (28%) with infertility and miscarriage, and deep deficit in every second (53% in the third group) - sharp depression of the indigenous microbiota and its replacement by opportunistic (facultative anaerobic and obligate anaerobic), what indicates microecological trouble in the vaginal biotope and can be one of the causes of infectious and inflammatory diseases of genitals and other reproductive disorders. It was shown that the dominant microorganisms of pathogenic microbiota (UPM) of inflammatory diseases in women are coagulase-negative staphylococci (CNS), fungi of genus Candida, Escherihia coli and Enterococcus spp. During the analysis of UPM representatives material of groups with "normocenosis", "dysbiosis" and "deep dysbiosis" an important microecological indicator was calculated which characterizing microbiocaenosis as a whole - index of species richness (ISR) - the average number of species in the composition

Characteristics of Nasopharyngeal Microbiocenosis and Evaluation of the Interaction of its Associates in Women with Chronic Endometritis

The upper respiratory tract is one of the most important biotopes in the human body. Therefore, in order to understand the cause-effect relationships between the microbial world and the pathological state of a person, it is crucial to clarify the relationship of the microbes-associates.The study involved 74 women with reproductive disorders. The main group – women with chronic endometritis (n = 47). The diagnosis of chronic endometritis was revealed on the basis of morphological signs of histological examination of aspirates from the uterine cavity. The comparison group consisted of 27 women, in whom the chronic endometritis was not confirmed. When applying, women complained more often of infertility and (or) miscarriage. Of the accompanying extragenital diseases, chronic tonsillitis in women of the studied groups was most often diagnosed. Therefore, it was important to give a microbiological description of the nasopharyngeal biotope of these women, as one of the factors that influences the reserves of confrontation of the reproductive function of the body to infections. Nasopharyngeal microbiocenosis of women with chronic endometritis was characterized by deficiency of the indigenous microbiota and a permanent presence in the microbiocenosis of the absolute pathogen (S. aureus) and transient species (enterococci, CNS). Between the representatives of normoflora antagonistic relations were established. The obtained results indicate violations in the nasopharyngeal biotope of these women, which can cause immunodeficiency and, as a consequence, the development and flow of chronic endometritis

Identification of Infectious Diseases Patterns in the Combined Use of Bacteriological Diagnostics and MALDI Biotyper

In multidisciplinary hospitals, there are conditions conducive to the emergence of healthcare-associated infections: high concentration of people with reduced immunity in a limited area, the presence of a significant number of sources of contagion (patients and carriers), a change in the biocenosis of the mucous membranes and skin of patients and medical personnel under the influence of widespread use of antibiotics and cytostatics. The aim of the research was in the intercomparison of the standardized bacteriological algorithms and the MALDI Biotyper system in the microbiological diagnosis of pathogens as illustrated by the healthcare-associated diseases.Materials and methods. Seventy-eight patients of a multidisciplinary hospital of a regional level (Irkutsk) in 2018–2019 were examined. The age of patients ranged from 1 to 15 years. The material for the study was blood, sputum, swabs from the tracheobronchial tree, throat, nose, wound, abdominal fluid, cerebrospinal fluid, and swabs from environmental objects. Identification of the isolated cultures (78 bacterial strains) was  carried out using generally accepted bacteriological methods, as well as using the MALDI Biotyper system.Results and discussions. In the structure of healthcare-associated infections, Pseudomonas aeruginosa occupied a leading position. Not all isolates of microorganisms were identified by standardized bacteriological methods. The identification of strains with characteristic manifestations of physiological and biochemical characteristics was more reliable. Identification difficulties arose in the presence of atypical properties of microorganisms when the use of MALDI Biotyper would be crucial.Conclusion. It is necessary to apply an integrated approach to conduct reliable diagnostics of pathogens. It includes standardized bacteriological methods and methods for identifying microorganisms using mass spectrometry in the subsequent stages

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)