In recent years, some new evidence on the role of Malassezia in late-onset sepsis in immunocompromised patients have been published, but there are still very few studies with special focus on newborns. The prevalence of Malassezia-associated conditions in 3519 newborn patients of general and surgical neonatal intensive care units (NICU) was assessed. All patients underwent pharyngeal and rectal swab screening for Malassezia spp. Identification of Malassezia spp. was carried out with the use of an adapted nutrient media, microscopic assessment of yeast cell morphology, and real-time PCR analysis. Malassezia furfur-induced invasive mycoses (IM) were developed 2.5 times more often in very low birth weight (VLBW) M. furfur-positive newborns, than in neonates with birth weight ≥1500 g, and affecting 15.8 % of VLBW infants. Funguria occurred 16 times more often in VLBW babies, but fungemia incidence was similar for both weight categories. Gastrointestinal (GI) colonization was found in 94.6 % of Malassezia-positive population, and in 8 % of all studied neonates. Among IM patients, death rate was 6.5 %. The specific pathogen was highly detectable by a combination of real-time PCR and an adapted nutrient media. Colonization with M. furfur in newborns was associated with low gestational age, VLBW, and long stay in NICU. The findings emphasize the need to monitor colonization and infection with M. furfur in neonates, staying in ICU for more than two weeks and to improve current diagnostic approaches by using real-time PCR and an adapted nutrient media for M. furfur isolation.

Background. Vulvovaginal infections are the most common, studied, and still causing many questions. It has been established that the disturbance of the ratio of the vaginal microbiota components does not always lead to a disorder since the development and outcome of the disorder largely depend on the state of the macroorganism, including the state of its immune system. To date, the only method for assessing the state of local immunity is smear microscopy with counting leukocytes. An alternative to leukocyte counting is the assessment of immunological parameters (e.g., the transcriptional profile of cytokine genes). An integrated approach to assessing the state of microbiocenosis (the ratio of lactobacilli and opportunistic pathogens) and local mucosal immunity, considering the individual genetic characteristics of patients and microorganisms, makes it possible to optimize treatment methods for vaginitis. One of the ways to increase the effectiveness of treatment and prevention of the recurrence of infectious and inflammatory diseases in gynecology is systemic enzyme therapy based on the complex effect of a specially selected combination of plant and animal origin enzymes on key physiological and pathophysiological processes in the body. Aim. To study the clinical effect and the effect of combined therapy with an antibiotic and a medicinal product, including a complex of enzymes of plant and animal origin (Wobenzym) on the state of the vaginal microbiota, the expression of cytokine genes, and the recurrence rate in patients with bacterial vulvovaginitis. Materials and methods. An open-label, single-center, prospective, comparative, randomized study enrolled 88 patients according to inclusion criteria. After randomization of patients into 2 groups, the main group received combination therapy (clindamycin vaginal cream 2% and Wobenzym), and patients of the comparison group received standard therapy only (clindamycin vaginal cream 2%). Short-term and long-term endpoints were defined. The primary endpoints included the assessment of symptoms, the change over time of the number of leukocytes in Gram-stained smears, and the recurrence rate; the secondary endpoints were the study of the change over time of the inflammation index, the results of the assessment of the state of the vaginal microbiota by real-time quantitative polymerase chain reaction using the Femoflor 16 reagent kit and a microbiological study. Results. When used in combination, Wobenzym potentiates the antibacterial properties of clindamycin, reduces the inflammation index, promotes the growth of the normal microbiota of the vagina (Lactobacillus spp.), prevents the growth of opportunistic microorganisms and, as a result, prevents the recurrence of vulvovaginitis. Conclusion. The results support the use of combination therapy (antibiotic + Wobenzym) to improve the effectiveness of therapy and maintain normocenosis.

Aim. To analyze the outcomes of assisted reproductive technology (ART) cycles in patients with different levels of vitamin D. Materials and methods. The study included 100 infertile patients who applied for ART. Vitamin D levels were determined by mass spectrometry. The VDR polymorphism was evaluated using real-time PCR. Results. 50% of patients (n=50) had a sufficient level of vitamin D (group 3), 36% of patients (n=36) had an insufficient level of vitamin D (group 2), 14% of patients (n=14) had a deficiency of vitamin D (group 1). The level of vitamin D was not associated neither with baseline patients characteristics nor with embryological stage of the cycle. The clinical pregnancy rate was lower in the group 1 (vitamin D deficiency), but the difference was not significant. There was a trend to an increase of miscarriage rate in the groups of patients with vitamin D insufficiency and deficiency: 66.7% in group 1, 26.3% in group 2, and 13.6% in group 3. The live birth rate was higher in the groups of patients with normal and insufficient levels of vitamin D compared with the group of vitamin D deficiency: 46.0 and 38.9% compared to 7.1%, p=0.0821. In multivariate analysis clinical pregnancy rate was influenced by vitamin D deficiency and the genetic characteristics of the VDR gene: the presence of the G allele (FOKI-rs2228570). Conclusion. The vitamin D deficiency impairs the effectiveness of ART cycles.

The article is devoted to the problems of gynecology of children and adolescents. The historical information about the formation of specialized gynecological medical care for girls in Russia from the first thematic publications at the end of the XIX Century to modern days is given. The achievements of gynecologists in diagnostics and treatment of main diseases of reproductive system that represent major problematics within the medical community are observed as well, such as: the norm and the pathology of vaginal and vulva microbiocenosis; eligibility of establishing of a diagnoses of polycystic ovary syndrome and genital endometriosis in menstruating adolescent girls; relapses of abnormal uterine bleeding in adolescents; the quality of life and the prevention of surgical complications in adolescent girls with defects in the development of uterus and vagina; the possibility of rehabilitation of a follicular reserve in girls with premature ovarian exhaustion.

Relevance. Acute respiratory infections (ARI) are a serious health problem not only because of the high frequency of their occurrence, but also because of the economic damage they cause both in the form of direct costs (the cost of diagnosis and treatment) and indirect costs (disability, reduced labor productivity, etc.). Pregnant women and children under 5 years of age are included in the group of patients with risk factors for complications of influenza and other ARI, therefore, an analysis of the etiological structure of ARI and influenza in obstetric hospitals is an urgent task. In recent years, there has been an urgent need to create a national complex diagnostic test system based on molecular genetic methods for detecting infectious agents that cause ARI. Aims. The aim of the study is to analyze the etiological structure of ARI and influenza in patients with clinical symptoms and to develop and implement a new test system for rapid screening and diagnosis of infections that cause ARI. Materials & methods. When studying the etiological structure of ARI and influenza, cultural studies of the nasal and pharyngeal mucosa were carried out, followed by identification of microorganisms using MALDI-TOF mass spectrometry and molecular genetic study (real-time PCR) using an experimental test panel containing primers that allow detecting the following viruses: influenza A, B viruses, parainfluenza viruses of the 1st, 2nd, 3rd and 4th types, coronaviruses OS43, HKU1, NL63, E229, respiratory syncytial virus, metapneumovirus, rhinovirus and adenovirus, as well as bacterial pathogens of ARI: Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus pyogenes, Moraxella catarrhalis, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa. The test system was developed using the following methods: real-time PCR, a combination of reverse transcription and real-time PCR (RT-PCR) and the next generation sequencing (NGS) method. Results. The etiological structure of ARI and influenza was analyzed in patients with clinical manifestations (cough, tickling/sore throat/hyperemia of the mucous membrane of the palate and the back wall of the pharynx, shortness of breath/difficulty breathing, acute runny nose/nasal congestion). The species spectrum of bacterial and viral pathogens was revealed. A new test system based on PCR, real-time RT-PCR and NGS has been created for complex diagnostics of both viral and bacterial pathogens of ARI, consisting of three separate components: the main test system «ARI», which detects the main viral and bacterial pathogens of ARI, and two additional sets of reagents: «Oseltamivir resistance» and «Oseltamivir/ Zanamivir resistance». Conclusions. The new test system can be used to detect and differentiate nucleic acids of pathogens of ARI of humans. The test system seems to us promising for further use. As a result of the analysis of the etiological structure of acute respiratory infections and influenza, attention is drawn to a significantly smaller variety of identified pathogens in 2020 and a much more pronounced dominance of rhinovirus infection compared to our previous study in 2019.

56 Репродуктивное здоровье детей и подростков / Том 18. № 1, 2022 Особенности микроценоза половых органов у девушек с аномальными маточными кровотечениямиВ статье на основании результатов проведенного исследования представлена роль дисбиотических нарушений вагинальной микробиоты в качестве одного из триггерных механизмов развития рецидивов аномального маточного кровотечения.Целью проспективного исследования, включившего 76 пациенток с маточным кровотечением в возрасте до 18 лет, стала сравнительная оценка эффективности лечения после остановки маточного кровотечения в зависимости от состояния микробиоценоза влагалища.Результаты.Выявлено, что вне зависимости от вида лечения (витаминотерапия, комбинированные оральные контрацептивы, гестагены) микроценоз влагалища пациенток с возникшим впоследствии рецидивом кровотечения на момент отмены лечения и вне кровяных выделений из влагалища характеризовался меньшим количеством нормофлоры (Lactobacillus spp. 10 5,5 , р0,01) и увеличением количества Gardnerella vaginalis + Prevotella bivia + Porphyromonas (до 10 5,3 КОЕ/мл) по сравнению с числом лактобацилл (10 7,2 ) и полным отсутствием Gardnerella vaginalis (10) во влагалищном биотопе девушек с установившимся после лечения регулярным ритмом менструаций.У 65,79% пациенток с возникшим рецидивом кровотечения обнаружены снижение количества лактобацилл (<10 6 у 95%), увеличение количества условно-патогенной флоры (<10 4 у 70%), Ureaplasma parvum (<10 4 у 20%) и Atopobium vaginae (<10 4 у 12,5%) и значимое превышение титра Candida albicans (>10 3 у 30%) при отсутствии лейкоцитарной реакции по данным микроскопии влагалищного мазка, что указывает на состояние дисбиоза влагалищной микрофлоры как одного из факторов риска развития рецидива маточного кровотечения.Ключевые слова:

Aim. To analyze the outcomes of assisted reproductive technology (ART) cycles in patients with different levels of vitamin D. Materials and methods. The study included 100 infertile patients who applied for ART. Vitamin D levels were determined by mass spectrometry. The VDR polymorphism was evaluated using real-time PCR. Results. 50% of patients (n=50) had a sufficient level of vitamin D (group 3), 36% of patients (n=36) had an insufficient level of vitamin D (group 2), 14% of patients (n=14) had a deficiency of vitamin D (group 1). The level of vitamin D was not associated neither with baseline patients characteristics nor with embryological stage of the cycle. The clinical pregnancy rate was lower in the group 1 (vitamin D deficiency), but the difference was not significant. There was a trend to an increase of miscarriage rate in the groups of patients with vitamin D insufficiency and deficiency: 66.7% in group 1, 26.3% in group 2, and 13.6% in group 3. The live birth rate was higher in the groups of patients with normal and insufficient levels of vitamin D compared with the group of vitamin D deficiency: 46.0 and 38.9% compared to 7.1%, p=0.0821. In multivariate analysis clinical pregnancy rate was influenced by vitamin D deficiency and the genetic characteristics of the VDR gene: the presence of the G allele (FOKI-rs2228570). Conclusion. The vitamin D deficiency impairs the effectiveness of ART cycles.