Aim: to increase the effectiveness of combination therapy and reduce frequency of recurrences of inflammatory diseases in the lower genital tract of combined etiology.Materials and Мethods. There was conducted a prospective, randomized, blind, comparative clinical study. 80 women with vaginal microbiota disorders were examined randomized into 2 groups: group I (n = 40) – antibiotic therapy was carried out in combination with the preparation Superlimph, group II (n = 40) – a standalone antibacterial therapy; group III consisted of 20 patients lacking gynecological diseases considered to provide with control laboratory parameters. Clinical and laboratory methods were used: microscopy of vaginal smears, detection of viruses and sexually transmitted infections, measurement of serum cytokine levels – interleukins (IL-1â, IL-2, IL-4, IL-6, IL-8, IL-10), tumor necrosis factor alpha, (TNF-á), interferon gamma (IFN-ã).Results. It was found that clinical recovery occurred in 90.0 and 70.0 % of patients in group I and group II (р = 0.02), respectively. Microbiological recovery was observed in 100.0 and 67.5 % of patients, respectively (р = 0.003). In group I, the isolation of herpes simplex virus type 2 was found in 80.0 and 45.2 % of patients before and after treatment (p < 0.001), respectively, whereas in group II – in 82.5 and 77.5 %, respectively (p = 0.58), between groups – p < 0.001. Before treatment the level of all cytokines, excepting IFN-ã, was higher than the reference values in both groups: in group I, their magnitude decreased after treatment (p < 0.001) and corresponded to the reference values; in group II no changes occurred. Three months after treatment, no relapses were observed in group I, whereas frequency of relapses in group II was 22.5 %, within 1 year – 0 and 35.1 %, respectively. Predictors of recurrent dysbiosis (IL-2, IL-6 and TNF-á in increased concentrations after a course of treatment) were identified.Conclusion. Treatment with a combined broad-spectrum antimicrobial drug along with topical immunomodulatory agent containing exogenous cytokines is an effective strategy for treating concomitant dysbiosis and preventing relapse.

Objective: to provide an overview of modern methods for assessing the function and strength of the pelvic floor muscles in women available for clinical practice. The main provisions. Foreign and domestic sources found in free access Internet databases were analyzed. Visual observation, palpation, perineometry, electromyography, ultrasound and magnetic resonance imaging measure various aspects of the function and strength of the pelvic floor muscles. Perineometry allows you to accurately measure the force of contractions of the pelvic floor muscles and is an easy and affordable way. Oxford vaginal palpation technologies, biofeedback devices, and ultrasound can be important clinical tools in the practice of a physician to quantify dysfunction of the pelvic floor. Conclusion. The obtained data on methods for assessing the function and strength of the pelvic floor muscles indicate the need for perineometry in clinical practice for the timely diagnosis of pelvic floor insufficiency, which will allow choosing the right rehabilitation method for women of different age groups.

Objective. To study the immune response in patients with chronic endometritis (CE) of viral and bacterial etiology based on the evaluation of cytokine status as well as the efficiency of local therapy using a complex of natural exogenous cytokines. Patients and methods. A prospective randomized clinical trial, which included 76 women with CE and infertility, who received etiotropic antibacterial therapy prior to inclusion in the study, is presented. In group I (n = 36), patients were treated with a daily intravaginal administration of Superlymph 25 U for 20 days; in group II (n = 40), patients were under observation. We used a vaginal wet mount test, real-time polymerase chain reaction (RT-PCR) (to estimate virus shedding), and an analysis of serum cytokine levels (interleukins IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, and tumor necrosis factor alpha (TNF-α)). Results. The herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) (80.6% and 80.0%, respectively) was predominantly detected in both groups of patients in combination with other types of herpesviruses (50.0% and 42.5%, respectively) and/or human papillomavirus (HPV) (50%). After treatment with Superlymph, virus shedding ceased in 66.7% of patients (p < 0.001). Before treatment, the levels of all cytokines were higher than the reference values (p < 0.001) in both groups (IL-1β – 1.8 times, IL-6 – 1.6 times, IL-2 and IL-8 – 1.2 times, TNF-α – 1.4 times). After treatment, their values decreased in group I (p < 0.001 for each indicator). In group II, the changes were insignificant. Pregnancy occurred within 12 months in 30 (83.3%) patients in group I and in 24 (60.0%) patients in group II, and this result was statistically significantly higher in group I (p = 0.047). Conclusion. The role of viral and bacterial infections accompanied by an imbalance of pro- and anti-inflammatory cytokines in patients with CE was revealed, which is the basis for prescribing not only antibacterial therapy, but also local immunomodulatory agents. Key words: infertility, immunity, Superlymph, chronic endometritis, cytokines

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Introduction. Subclinical hypothyroidism occurs in 2–3% of pregnant women and is often associated with pregnancy complications, including preterm birth.Aim – to study correlations between thyroid dysfunction and pregnancy outcomes.Materials and methods. 64 clinical cases of managing pregnant women in the Perinatal Center (Tyumen) were analyzed for 2017– 2021: 28 women with thyroid-stimulating hormone (TSH) > 2.5 mU/l, 36 women with TSH ≤ 2.5 mU/l) during the entire period of pregnancy. Quantitative features are described by absolute and relative (percentage) indicators. The probability of outcome depending on the presence of a clinical-amnestic factor was assessed by determining the relative risk (RR) and 95% confidence interval (CI). The level of statistical significance in testing the null hypothesis is p < 0.05.Results. There were no differences in pregnant women with and without subclinical hypothyroidism when considering such medical and social factors as age, marital status, work, education, nicotine addiction, obesity, kidney disease. An increased risk of preterm delivery was found in patients with a TSH level > 2.5 mU/l: RR 1.41 (0.59–3.37), especially against the background of a positive test for antibodies to thyroperoxidase: RR 1.63 (0.62–4.28). In the absence of treatment, the risk of early delivery, preterm birth, preeclampsia was revealed.Conclusions. A universal approach to determining the threshold values of TSH for the diagnosis of subclinical hypothyroidism in pregnant women, to the need and tactics of its treatment has not been developed. Diseases of the thyroid gland are endemic for Western Siberia, often associated with iron deficiency anemia, their high frequency in the anamnesis of pregnant women is  noted. Establishing a  correlation between subclinical hypothyroidism, hormonal correction and pregnancy complications requires further research. An obstacle is the lack of proper diagnosis of the TSH level in women who give birth on an emergency basis in early gestational periods.