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Aim of the study. Comparative analysis of the results of cervical epithelial neoplasia (CIN) I and II levels (p16ink4a-negative) (LSIL in LAST terminology) treatment against the background of highly oncogenic HPV infection using cold plasma ablation and immunomodulatory therapy with Аllokin-alpha.Materials and methods. We examined 60 women who received treatment for CIN I and CIN II (p16ink 4A negative) at the Multidisciplinary Medical Center of Odessa National Medical University. All women were of reproductive age, had mild dysplasia, high-risk HPV infection (HPV 16, 18, 31, 45) and histological confirmation of CIN I and CIN II (p16ink 4A negative). The patients were divided into 2 groups: 1 (main) group consisted of 30 women who received cold plasma ablation of cervical dysplasia in combination with immunomodulatory therapy with Аllokin-alpha (1 mg subcutaneously every other day, 3 injections before surgery and 3 injections after ablation), Group 2 (control) consisted of 30 patients who received standard cold plasma ablative treatment without prescribing immunomodulators. All women underwent cytomorphological examination of the cervical epithelium, HPV testing by RealTime PCR and colposcopy with mandatory targeted biopsy at the preoperative stage.Results. The use of combined cold plasma ablative treatment of CIN I and CIN II (p16ink 4A negative) in combination with the administration of the immunomodulator Аllokin-alpha significantly reduced the duration of discharge after ablation to 5.44 ± 1.03 days (95% CI: 4.96–6.05), the timing of epithelialization is up to 29.31 ± 1.12 days (95% CI: 26.81–32.32), and to exclude cases of recurrence of genital warts and cervical keratosis. Chances of HPV elimination 6 months after treatment (OR – 5.48; 95% CI: 1.56–29.03; p = 0.0075) and 12 months after treatment (OR – 15.48; 95% CI : 2.05–136.45; p = 0.0094), significantly higher with the combined with immunomodulation method of treatment, in contrast to only cold plasma ablation.Conclusion. Combined, with the use of cold plasma ablation and immunomodulation by perioperative management of Аllokin-alpha, LSIL treatment against the background of highly oncogenic HPV infection in women of reproductive age is accompanied by better functional results, compared with the use of cold plasma ablation alone: reduction in the duration of discharge, acceleration of epithelialization, normalization of the colposcopic and cytologic picture, decrease in the frequency of relapses, a significant increase in the frequency of HPV elimination.
Aim of the study. Comparative analysis of the results of cervical epithelial neoplasia (CIN) I and II levels (p16ink4a-negative) (LSIL in LAST terminology) treatment against the background of highly oncogenic HPV infection using cold plasma ablation and immunomodulatory therapy with Аllokin-alpha.Materials and methods. We examined 60 women who received treatment for CIN I and CIN II (p16ink 4A negative) at the Multidisciplinary Medical Center of Odessa National Medical University. All women were of reproductive age, had mild dysplasia, high-risk HPV infection (HPV 16, 18, 31, 45) and histological confirmation of CIN I and CIN II (p16ink 4A negative). The patients were divided into 2 groups: 1 (main) group consisted of 30 women who received cold plasma ablation of cervical dysplasia in combination with immunomodulatory therapy with Аllokin-alpha (1 mg subcutaneously every other day, 3 injections before surgery and 3 injections after ablation), Group 2 (control) consisted of 30 patients who received standard cold plasma ablative treatment without prescribing immunomodulators. All women underwent cytomorphological examination of the cervical epithelium, HPV testing by RealTime PCR and colposcopy with mandatory targeted biopsy at the preoperative stage.Results. The use of combined cold plasma ablative treatment of CIN I and CIN II (p16ink 4A negative) in combination with the administration of the immunomodulator Аllokin-alpha significantly reduced the duration of discharge after ablation to 5.44 ± 1.03 days (95% CI: 4.96–6.05), the timing of epithelialization is up to 29.31 ± 1.12 days (95% CI: 26.81–32.32), and to exclude cases of recurrence of genital warts and cervical keratosis. Chances of HPV elimination 6 months after treatment (OR – 5.48; 95% CI: 1.56–29.03; p = 0.0075) and 12 months after treatment (OR – 15.48; 95% CI : 2.05–136.45; p = 0.0094), significantly higher with the combined with immunomodulation method of treatment, in contrast to only cold plasma ablation.Conclusion. Combined, with the use of cold plasma ablation and immunomodulation by perioperative management of Аllokin-alpha, LSIL treatment against the background of highly oncogenic HPV infection in women of reproductive age is accompanied by better functional results, compared with the use of cold plasma ablation alone: reduction in the duration of discharge, acceleration of epithelialization, normalization of the colposcopic and cytologic picture, decrease in the frequency of relapses, a significant increase in the frequency of HPV elimination.
Research objective: to evaluate the effectiveness of vaginal decametoxinum in preparation for cervix excision (conization) in women with HSIL (cervical intraepithelial neoplasia (CIN) II) against the background of infection with high-risk human papilloma virus (HPV) in bacterial vaginosis (BV) and effectiveness of vaginal gel with decametoxinum and hyaluronic acid to improve repair in the postoperative period.Materials and methods. 60 women with HSIL (CIN II) were examined against the background of high-risk oncogenic HPV infection and BV, who underwent loop cervix excision (conization). The main group (n = 30) on the eve of surgery was prescribed BV therapy with decametoxinum solution and oral metronidazole for up to 7 days, after cervical excision used vaginal gel with decametoxinum and hyaluronic acid for 14 days. The control group (30 patients) used oral metronidazole for 7 days for the BV treatment.Visual cervix inspection was performed by colposcopy. Vaginal biocenosis was assessed by PCR. Elimination of oncogenic HPV strains was assessed by PCR.Results. Decametoxinum in the combination therapy of HSIL (CIN II) caused faster and complete epithelialization of the wound surface than standard therapy (relative risk (RR) 0.27, 95% CI 0.10 – 0.71, p = 0.008). 3 months after decametoxinum use was determined by a significant increase in cases of vaginal microbiota normalization (RR 0.30, 95% CI 0.09 – 0.98, p = 0.047), an increase in the lactobacilli number in vaginal secretions (RR 0.31, 95% CI 0.11 – 0.84, p = 0.02). There was a statistically significant effect of decametoxinum on the oncogenic HPV elimination (RR 0.22, 95% CI 0.05 – 0.94, p = 0.04) after 6 months of combination therapy. No side effects of decametoxinum were noted either during therapy or at a later date.Conclusions. Vaginal use of decametoxinum before and after loop cervix excision in women with HSIL (CIN II) on the background of high-risk HPV and BV showed acceleration of cervical reparative processes, pronounced antimicrobial effect, elimination of oncogenic HPV and safety.
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