Browsing by Author "Žodžika, Jana"

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    Abnormal Vaginal Microflora: Risk Factors, Bed-Side Diagnostic Methods in Pregnancy and Efficiency of an Alternative Non-Antibacterial Treatment Modality in Pregnant and Non-Pregnant Women. Doctoral Thesis
    (Rīga Stradiņš University, 2014) Žodžika, Jana; Rezeberga, Dace
    Normal vaginal microflora is an important women`s health factor, maintained by high numbers of different Lactobacillus species. Abnormal vaginal microflora and infections ascending from the lower urogenital tract represent an important reason for abortions, preterm delivery and neonatal infections. Multiple investigators have attempted to identify the patients at risk for preterm labor, followed by the treatment in a low risk population of genital infections, but the results did not meet initial hopes. Still there is growing evidence that treatment of abnormal vaginal microflora with adequate antibiotics in early pregnancy can prevent at least some of the infections related to preterm birth. While antimicrobial agents cure infections, they can cause side effects. Furthermore, urogenital pathogen drug resistance is on the increase and disrupt protective vaginal microflora. Many pregnant women are very anxious about taking antibiotics because of potentially adverse effects on the newborn. During pregnancy treatment that restores normal vaginal flora and acidity without systemic effects would be preferable to any other treatment. The aim of the present study is to investigate the influence of vaginal application of ascorbic acid (vitamin C) on abnormal vaginal microflora during pregnancy, and also to identify risk group and assess the validity of the “bed-side” diagnostic tests during the first antenatal visit in order to detect different types of abnormal vaginal flora. There are 450 pregnant (150 with elevated and 300 with normal vaginal pH) and 55 nonpregnant (with elevated vaginal pH and abnormal microflora) women included in the study. Different socio-demographic, medical, reproductive and sexual risk factors of abnormal vaginal microflora in the first trimester of pregnancy are assessed. The results of vaginal pH, wet mounts and bacteriologic examinations are correlated. The impact of vaginal vitamin C in the treatment and then maintenance regimen on different types of abnormal vaginal microflora is analysed in the present study. The major risk factors for abnormal vaginal microflora in the first trimester of pregnancy are low education level, smoking and history of abnormal vaginal microflora before pregnancy. Increased vaginal pH is associated with both aerobic and anaerobic abnormal vaginal microflora on wet mounts and overgrowth of Mycoplasma hominis and Escherichia coli. Vaginal vitamin C treatment followed by a maintenance regimen improves vaginal microflora in pregnancy. The study is supported by European Social Fund project “Support of doctoral and postdoctoral investigations in Riga Stradins University”.
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    Abnormal Vaginal Microflora: Risk Factors, Bed-Side Diagnostic Methods in Pregnancy and Efficiency of an Alternative Non-Antibacterial Treatment Modality in Pregnant and Non-Pregnant Women. Summary of the Doctoral Thesis
    (Rīga Stradiņš University, 2014) Žodžika, Jana; Rezeberga, Dace
    Normal vaginal microflora is an important women`s health factor, maintained by high numbers of different Lactobacillus species. Abnormal vaginal microflora and infections ascending from the lower urogenital tract represent an important reason for abortions, preterm delivery and neonatal infections. Multiple investigators have attempted to identify the patients at risk for preterm labor, followed by the treatment in a low risk population of genital infections, but the results did not meet initial hopes. Still there is growing evidence that treatment of abnormal vaginal microflora with adequate antibiotics in early pregnancy can prevent at least some of the infections related to preterm birth. While antimicrobial agents cure infections, they can cause side effects. Furthermore, urogenital pathogen drug resistance is on the increase and disrupt protective vaginal microflora. Many pregnant women are very anxious about taking antibiotics because of potentially adverse effects on the newborn. During pregnancy treatment that restores normal vaginal flora and acidity without systemic effects would be preferable to any other treatment. The aim of the present study is to investigate the influence of vaginal application of ascorbic acid (vitamin C) on abnormal vaginal microflora during pregnancy, and also to identify risk group and assess the validity of the “bed-side” diagnostic tests during the first antenatal visit in order to detect different types of abnormal vaginal flora. There are 450 pregnant (150 with elevated and 300 with normal vaginal pH) and 55 nonpregnant (with elevated vaginal pH and abnormal microflora) women included in the study. Different socio-demographic, medical, reproductive and sexual risk factors of abnormal vaginal microflora in the first trimester of pregnancy are assessed. The results of vaginal pH, wet mounts and bacteriologic examinations are correlated. The impact of vaginal vitamin C in the treatment and then maintenance regimen on different types of abnormal vaginal microflora is analysed in the present study. The major risk factors for abnormal vaginal microflora in the first trimester of pregnancy are low education level, smoking and history of abnormal vaginal microflora before pregnancy. Increased vaginal pH is associated with both aerobic and anaerobic abnormal vaginal microflora on wet mounts and overgrowth of Mycoplasma hominis and Escherichia coli. Vaginal vitamin C treatment followed by a maintenance regimen improves vaginal microflora in pregnancy. The study is supported by European Social Fund project “Support of doctoral and postdoctoral investigations in Riga Stradins University”.
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    Composition of vaginal microflora in relation to vaginal pH and wet mount diagnostic tests in the first trimester of pregnancy
    (2013-12-01) Žodžika, Jana; Rezeberga, Dace; Donders, Gilbert; Vedmedovska, Natalija; Vasina, Olga; Pundure, Ināra; Bite, Ruta; Pavlova, Žanna; Zīle, Oksana; Department of Obstetrics and Gynaecology
    The aim of the study was to determine the relations between vaginal culture results, elevated vaginal pH and abnormal vaginal microflora observed in microscopy, during the first trimester of pregnancy. A cross-sectional, observational study of 100 women receiving antenatal care in five outpatient clinics was carried out in Riga from March 2010 until April 2011. Pregnant women at the first antenatal visit were submitted to a vaginal specimen collection for pH measurement, wet mount and cultures. Fifty pregnant women with vaginal pH 4.5 and 50 subsequent pregnant women with vaginal pH less than 4.5 were included. 96% of women with increased pH and 86% of women with normal vaginal pH showed positive cultures. Increased vaginal pH was significantly associated with M. hominis (P < 0.001), U. urealyticum (P = 0.017) and E. coli (P = 0.018). Abnormal vaginal microflora patterns showed similar associations with culture findings. Multivariate logistic regression analysis showed the highest risk of abnormal vaginal microflora associated with M. hominis (OR 14.4, 95% CI 1.6-124.4, P = 0.015) and E. coli (OR 8.5, 95% CI 1.6-45.9, P = 0.013). Increased vaginal pH and abnormal vaginal microflora pattern in wet mounts was associated with M. hominis and E. coli in vaginal cultures.
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    Efficacy of Topical Treatment of Low-Risk Cervical Preinvasive Lesions with Glycyrrhizinic Acid
    (2025-01) Andžāne, Diāna; Žodžika, Jana; Jermakova, Irina; Senfelde, Ilva; Utorova, Marina; Rezeberga, Dace; Department of Clinical Skills and Medical Technologies; Department of Obstetrics and Gynaecology
    Background/Objectives: The study aimed to investigate the efficacy of medication treatment with glycyrrhizinic acid for cervical intraepithelial neoplasia (CIN) 1 lesions. Methods: Women with histologically confirmed CIN 1 in cervical biopsies were included in the prospective study. Participants of the study group used glycyrrhizinic acid spray (Epigen spray) topically 10 days (Epigen 10-day subgroup) or 20 days (Epigen 20-day subgroup) per month for 6 months. Women in the control group had no treatment. There were two follow-up visits 6 months apart. All patients were screened for human papillomavirus (HPV) before enrollment and during the first follow-up visit. Results: There were 50 patients in the Epigen group and 50 patients in the control group. At the first follow-up visit, in the histological findings, progression to CIN 2+ was 6.7% in the Epigen 20-day subgroup, 31.1% in the control group, and the persistence of CIN 1 was 86.7% in the Epigen 20-day subgroup and 62.2% in the control group, p = 0.03. Large loop excision of the transformation zone (LLETZ) was statistically significantly more frequent in the control group after the first follow-up visit (10% in the Epigen 20-day subgroup vs. 30% in the control group, p = 0.032). No such relationships were found during the second follow-up visit. Conclusions: The vaginal spray of the glycyrrhizinic acid used 20 days per month appears to decrease the risk of the progression of CIN 1 lesions, with the need to perform LLETZ. However, a similar effect is not observed after stopping usage.
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    Izmainīta maksts mikroflora: riska faktori un klātienes diagnostikas metodes grūtniecēm, kā arī alternatīvas ārstēšanas efektivitāte, nelietojot antibakteriālus līdzekļus, grūtniecēm un pārējām sievietēm. Promocijas darba kopsavilkums
    (Rīgas Stradiņa universitāte, 2014) Žodžika, Jana; Rezeberga, Dace
    Normāla maksts mikroflora is svarīgs sievietes veselības faktors, kuru nodrošina pienskābo baktēriju pārsvars. Izmainīta maksts mikroflora var būt par iemeslu spontāniem abortiem, priekšlaicīgām dzemdībām un jaundzimušo infekcijām. Daudzi pētnieki ir mēģinājuši samazināt šo faktoru izraisītos sarežģījumus, identificējot un ārstējot vispārējā populācijā tās grūtnieces, kurām varētu būt paaugstināts, ar infekcijām saistīts, priekšlaicīgu dzemdību risks, taču iegūtie rezultāti nebija efektīvi. Arvien vairāk ir pierādījumi, ka, uzsākot adekvātu antibakteriālo terapiju agrīnā grūtniecības laikā, tiek novērsta vismaz daļa no infekciju izraisītiem sarežģījumiem. Lai gan antibakteriālie līdzekļi nodrošina izārstēšanos no infekcijām, to lietošana rada uroģenitālo mikrobu rezistenci, var izraisīt blaknes un izjaukt maksts normālo ekosistēmu. Daudzas grūtnieces, baidoties no nelabvēlīga iespaida uz bērnu, nevēlas lietot antibiotikas. Ideāli grūtniecības laikā būtu izmantot tādu maksts mikrofloru uzlabojošu terapiju, kas saudzē aizsargājošo maksts vidi un neizraisa vispārējas blakus parādības. Šī pētījuma mērķis ir izpētīt alternatīvas, “ne-antibakteriālas” terapijas – vaginālā vitamīna C, ietekmi uz izmainītu maksts vidi grūtniecēm un sievietēm, kas nav grūtnieces, kā arī izanalizēt riska grupas un izvērtēt klātienes diagnostikas testu pielietojamību dažādu maksts mikrofloras izmaiņu diagnostikā grūtniecēm pirmajā trimestrī. Pētījumā ir iekļautas 150 grūtnieces ar palielinātu un 300 ar normālu maksts pH, kā arī 55 sievietes ar izmainītu maksts mikrofloru, kas nav grūtnieces. Šajā pētījumā ir izanalizēti dažādi sociāli, demogrāfiski, reproduktīvie, seksuālās uzvedības izmainītas maksts mikrofloras riska faktori grūtniecēm pirmajā trimestrī, kā arī korelācijas starp maksts pH, natīvo mikroskopiju un uzsējumu rezultātiem. Tika arī izpētīta vaginālā vitamīna C ietekme uz maksts vidi, nozīmējot to agrīnā grūtniecības laikā ārstēšanas, kā arī uzturošā režīmā. Galvenie izmainītas maksts vides riska faktori grūtniecēm pirmajā trimestrī ir zems izglītības līmenis, smēķēšana un izmainīta maksts mikroflora pirms grūtniecības. Palielināts maksts pH ir saistīts ar izmainītu maksts mikrofloru – gan aerobisko, gan anaerobisko, kā arī ar Mycoplasma hominis, Escherichia coli savairošanos makstī. Vaginālais vitamīns C ārstnieciskā, kā arī uzturošā režīmā uzlabo maksts vidi grūtniecēm, taču nav efektīvs sievietēm, kas nav grūtnieces. Pētījums ir veikts ar Eiropas Sociālā fonda programmas “Atbalsts doktorantūras un pēcdoktorantūras pētījumiem medicīnas zinātnēs” atbalstu.