Bacterial Vaginosis (BV) and Vaginal Microbiome Disorders in Women Suffering from Polycystic Ovary Syndrome (PCOS).

Introduction: Polycystic ovary syndrome (PCOS) is a multifactorial, heterogeneous endocrine and metabolic disorder in women. Due to its association with the menstrual cycle and fertility disorders, the importance of this problem is emphasized especially in patients of reproductive age. Based on a number of analyses, the effect of PCOS on altering the diversity of the microbiome (e.g., intestinal or vaginal) is suggested. Vaginal dysbiosis can result in BV (bacterial vaginosis). The purpose of this study was to assess the prevalence of BV in patients with PCOS, as well as to determine the most reliable diagnostic factors. Material and Methods: Retrospective analysis of microbiological findings (2018-2022) of PCOS patients (n = 594) of reproductive age. The present analysis focused on the results of patients with PCOS (n = 380) and vaginal discharge with pH ≥ 4.4 and suspected BV. Biological material was a vaginal swab/vaginal secretion. The most commonly used routine methods for assessing BV were the Amsel analysis and the Nugent scoring system. Results: Patients with PCOS and vaginal fluid pH ≥ 4.4 and suspected BV (n = 380) accounted for 64% of all PCOS patients (n = 594). The relationship between pH and detection of "clue cells" showed significant dependency and increased with leukocytes. The pH measurement also showed dependency on high G. vaginalis counts. In addition, the elimination of lactic acid bacteria (LAB) in vaginal secretions was associated with an increase in the number of leukocytes with increasing pH values. A marked increase in G. vaginalis was found in more than half (56.8%) of PCOS women (n = 380) with suspected BV. No dependency was observed between the absence of LAB and the diagnosis of BV on a positive G. vaginalis culture. Of the n = 380 patients with PCOS, 191 (50%) had a Nugent score ≥ 7 positive for BV. No dependency was observed between the number of patients with Candida sp. in vaginal secretions and pH, BV (with clue cells), or elevated leukocyte levels. The LRM was adjusted and the statistical model represented by the following formula was obtained: log(p/(1 - p)) = -1.18 + 1.24 × Group4.6 + 1.08 × Group4.8 + 1.66 × Group5.4. Conclusions: Based on the present analysis, BV appears to be more common in patients with PCOS than in the non-PCOS population. Chronic inflammation in PCOS patients and abnormalities in the vaginal microbiome may predispose to the development of BV. In women with PCOS, BV may be one of the unrecognized causes of infertility or complications of pregnancy. Despite the potential link between PCOS and the development of BV, the extent to which this syndrome contributes to vaginal dysbiosis and reproductive complications requires further study.

Demodicosis in Different Age Groups and Alternative Treatment Options-A Review.

Infestation with Demodex mites is a common occurrence, especially in adults and the elderly. More recent attention has been paid to the presence of Demodex spp. mites in children, even ones without comorbidities. It causes both dermatological and ophthalmological problems. The presence of Demodex spp. is often asymptomatic, thus it is suggested to include parasitological investigation tests in dermatological diagnostics, in addition to bacteriological analysis. Literature reports show that Demodex spp. are related to the pathogenesis of numerous dermatoses, including rosacea or demodicosis gravis, and common eye pathologies reported by patients such as dry eye syndrome or ocular surface inflammatory conditions, such as blepharitis, chalazia, Meibomian gland dysfunction, and keratitis. Treatment of patients is a challenge and is usually prolonged, therefore it is important to carefully diagnose and properly select the therapy regimen for the treatment to be successful, and with minimal side effects, especially for young patients. Apart from the use of essential oils, research is ongoing for new alternative preparations active against Demodex sp. Our review was focused on the analysis of the current literature data on the available agents in the treatment of demodicosis in adults and children.

The Role of Individually Selected Diets in Obese Women with PCOS-A Review.

Polycystic ovarian syndrome (PCOS) is one of the most common heterogeneous endocrine and metabolic disorders in premenopausal women. It is a complex multifactorial disorder with strong epigenetic and environmental influences, including factors related to eating habits and lifestyle. There is a close relationship between obesity and PCOS. Weight gain and obesity are often clinical symptoms manifested by biochemical markers. Moreover, abdominal obesity in women with PCOS is involved in the development of inflammatory changes. A significant share of balanced therapies correcting the lifestyle of patients is suggested, e.g., with the implementation of appropriate diets to minimize exposure to inflammatory factors and prevent abnormal immune system stimulation. In the case of obese patients with PCOS, planning a diet program and supporting the motivation to change eating habits play an important role to lose weight and lower BMI. Probiotics/synbiotic supplementation may enhance weight loss during the diet program and additionally positively affect metabolic and inflammatory factors by improving the intestinal microbiome.

The Effect of Endurance and Endurance-Strength Training on Bone Mineral Density and Content in Abdominally Obese Postmenopausal Women: A Randomized Trial.

The optimal type of exercise that simultaneously decreases body weight and preserves bone health in people with obesity is unknown. This parallel randomized trial aimed to compare the effect of endurance and endurance-strength training on bone mineral density (BMD) and content (BMC) in abdominally obese postmenopausal women. A total of 101 women were recruited and randomly assigned to endurance or endurance-strength training groups. Participants trained for 60 min per day, three times per week for 12 weeks. The endurance exercises were performed at an intensity of 50-75% of the maximum heart rate, whereas the strength exercises were at 50-60% of the one-repetition maximum. Pre- and post-intervention BMD and BMC of the total body, lumbar spine, and femoral neck and physical capacity were measured. There were no differences among the densitometric parameters in the endurance group, but a significant increase in whole-body BMD in the endurance-strength group was found. Moreover, there was a significant difference between the groups in the changes in the lumbar spine BMC. Furthermore, both training programs significantly improved physical capacity with no differences between groups. Endurance training was more effective in maintaining BMC at the lumbar spine. However, both groups did not differ in effect on BMD. Further studies with a long-term follow-up should be considered to confirm these findings. The study was registered with the German Clinical Trials Register within the number DRKS00019832, and the date of registration was 26 February 2020 (retrospective registration).

Effects of Synbiotic Supplementation and Lifestyle Modifications on Women With Polycystic Ovary Syndrome.

CONTEXT: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting women of reproductive age. OBJECTIVE: This study was designed to evaluate effects of lifestyle modifications and synbiotic supplementation on PCOS. DESIGN: A randomized (1:1) double-blind, placebo-controlled trial. SETTING: Academic hospital. PATIENTS OR OTHER PARTICIPANTS: Overweight and obese women with PCOS were identified according to the Rotterdam criteria. Evaluations were performed at baseline and repeated after 3 months of treatment. INTERVENTION: Lifestyle modifications in combination with synbiotic supplementation or placebo. MAIN OUTCOME MEASURES: Change in body mass index (BMI) and testosterone level. RESULTS: In the placebo group, a 5% decrease in BMI was accompanied by significant decreases of the waist, hip, and thigh circumferences. The synbiotic group experienced an 8% decrease in BMI, which was significantly greater than that in the control group (P = 0.03) and was accompanied by decreases in the waist, hip, and thigh circumferences. Testosterone did not decrease significantly in the placebo group (decrease of 6%), whereas in the synbiotic group it decreased by 32% (P < 0.0001). The decrease of testosterone was significantly greater in the synbiotic group than in the placebo group (P = 0.016). CONCLUSIONS: Synbiotic supplementation potentiated effects of lifestyle modifications on weight loss and led to significant reduction of serum testosterone.

Elevation of markers of endotoxemia in women with polycystic ovary syndrome.

STUDY QUESTION: Is polycystic ovary syndrome (PCOS) associated with an elevation of markers of endotoxemia? SUMMARY ANSWER: In women with PCOS serum levels of lipopolysaccharides (LPS), the LPS to high-density lipoprotein (HDL) ratio and LPS-binding protein (LBP) are significantly greater than those of normal control subjects. WHAT IS KNOWN ALREADY: Mononuclear cells from women with PCOS respond excessively to LPS by releasing pro-inflammatory cytokines. In rat ovarian theca-interstitial cell cultures LPS stimulates androgen production. STUDY DESIGN, SIZE, DURATION: Cross-sectional study comparing markers of endotoxemia in women with PCOS (n = 62), healthy ovulatory women with polycystic ovary morphology (PCOM, n = 39) and a control group of healthy ovulatory women without PCOM [normal (NL), n = 43]. PARTICIPANTS/MATERIALS, SETTING, METHODS: LPS was measured using a chromogenic assay. LBP was measured by ELISA. Total cholesterol and lipids were measured using a homogeneous enzyme colorimetric method. Androgens, gonadotrophins, prolactin, insulin, high-sensitivity C-reactive protein (hs-CRP) and sex hormone-binding globulin were determined by electrochemiluminescence assays. Glucose was measured using an enzymatic reference method with hexokinase. MAIN RESULTS AND THE ROLE OF CHANCE: Women with PCOS, when compared with NL subjects, had a significantly higher mean LPS (P = 0.045), LPS/HDL ratio (P = 0.007) and LBP (P = 0.01). Women with PCOM had intermediate levels of markers of endotoxemia. Comparison among all groups revealed that markers of endotoxemia correlated positively with testosterone level, ovarian volume, number of antral follicles and hirsutism score, but negatively with the number of spontaneous menses per year. In multiple regression analysis, all measures of endotoxemia correlated independently and positively with hs-CRP and with ovarian volume. LIMITATIONS, REASONS FOR CAUTION: This cross-sectional study reveals that markers of endotoxemia are associated with several clinical features observed in women with PCOS. However, responsible mechanisms and causation remain unknown. Steroid quantification was carried out by electrochemiluminescence assays and not by the current gold standard: liquid chromatography-mass spectrometry. Hence, the relationship of endotoxemia with features of PCOS and the extent to which endotoxemia contributes to reproductive and metabolic dysfunction warrants further investigation. WIDER IMPLICATIONS OF THE FINDINGS: This study reveals the novel observation that markers of endotoxemia are elevated in young and otherwise healthy women with PCOS without significant metabolic dysfunction. Moreover, the association of clinical and endocrine markers of PCOS with those of endotoxemia may represent a pathophysiologic link to reproductive dysfunction as well as metabolic and long-term cardiovascular risks associated with this disorder. STUDY FUNDING/COMPETING INTEREST(S): Intramural funding from Poznan University of Medical Sciences. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: N/A.

Conjugated linoleic acid does not affect digestion and absorption of fat and starch-a randomized, double-blinded, placebo-controlled parallel study.

OBJECTIVE: Conjugated linoleic acid (CLA) is known as a potent agent for altering body weight and composition. However, its effect on the process of digestion is still unknown. The aim of this study has been to elucidate the effect of a 3-month supplementation with CLA on starch and fat digestion and absorption in humans. APPROACH: The study included 74 obese and overweight adults who were randomized to receive 3.0 g of CLA or sunflower oil as placebo daily for 3 months. Digestion and absorption of fat and starch was assessed using non-invasive breath tests with a stable 13C isotope (cumulative percentage dose recovery, CPDR) before and after the supplementation period. To exclude the effect of oxidation, in addition total energy expenditure (TTE) was measured by a 13C bicarbonate breath test. RESULTS: The changes in CPDR values (∆CPDR median 〈interquartile range〉) were no different between subjects from the CLA group and the placebo group (fat: -0.2 〈-9.1-4.1〉 versus 0.6 〈-7.0-8.0〉, p < 0.4796; starch: -1.3 〈-9.5-2.4〉 versus -1.0 〈-5.1-1.7〉, p < 0.5520, respectively). The incidence of negative and positive values of ∆CPDR was no different between groups [for fat: 53.1% versus 46.7%, RR 1.138, (95% CI 0.689-1.882) and for starch: 67.7% versus 56.7%, RR 1.195, (95% CI 0.804-1.777)]. The changes in TTE did not differ between the CLA and the placebo group (respectively 1 〈48; 267〉 versus -8 〈-120;93〉 kcal; p < 0.2728). CONCLUSION: Supplementation with CLA for 3 months did not affect fat and starch digestion assessed by 13C mixed triglyceride breath test and 13C starch breath test.

Selected Factors of Innate Immunity in Healthy Individuals with S. aureus Nasal Carriage.

Nasal carriage of Staphylococcus aureus represents a well-defined factor of risk involving community and hospital-acquired infections. Recently a significance of several host factors has been pointed out and, in particular, of immune determinants in nasal S. aureus colonization. Therefore, this study aimed at analysis of manifestation involving manifestation in the nasal secretions of important components of the host innate immunity - human beta-defensin-2 (HBD-2), lysozyme (Ly), and interferon-gamma (IFN-γ) in healthy individuals and in persons with persistent carriage of S. aureus. The studies were conducted in two groups of healthy volunteers, encompassing non-carriers (group 1) or persistent carriers of S. aureus (group 2). Elisa assays were employed to evaluate levels of HBD-2, Ly, and IFN-γ in nasal secretions of the examined donors. In S. aureus carriers a significant variability of HBD-2 levels was detected, corresponding to, respectively, the high (averaging at 1.46 ng/ml) and the low (averaging at 0.13 ng/ml) secretory response of the defensin. The level of Ly in S. aureus carriers averaged at 1.46 µg/ml and it manifested no significant difference as compared to that noted in non-carriers. In turn, concentrations of IFN-γ in nasal secretions in the group of carriers of S. aureus amounted on the average to 81.7 pg/ml and they were 1.3-fold higher that in the group of non-carriers. The obtained results allow to conclude that IFN-γ secretion by the nasal cavity-colonizing S. aureus remains quantitatively insufficient to eliminate the pathogen. Nevertheless, a significant increase in levels of this host factor may be important for restriction of the staphylococcal colonization and protection against development of an invasive infection. In turn, the role of HBD-2 and Ly in inactivation of the colonizing S. aureus remains doubtful.

Twelve weeks CLA supplementation decreases the hip circumference in overweight and obese women. A double-blind, randomized, placebo-controlled trial.

BACKGROUND: Conjugated linoleic acid (CLA) reduces body weight (BW), body fat mass (BFM), and increases or maintains lean body mass in animals. However, the results concerning the effect of CLA on weight reduction in humans are contradictory. The present study aimed to evaluate the effect of CLA supplementation on the BW and anthropometric parameters (waist and hip circumferences) in overweight and obese adult women. METHODS: A total of 74 subjects (BMI: 28-42 kg/m2) were included in a double blind, placebocontrolled trial. Subjects were randomized into two groups, those supplemented with either 3.0 g/d CLA or with placebo (sunflower oil) for 12 weeks. RESULTS: CLA significantly decreased the hip circumferences compared to placebo (p = 0.016209), but had no effect on body weight, BMI, or waist circumference. The number of subjects with a reduction in hip circumference in the CLA group was significantly larger compared to that in the placebo group (p = 0.0017;  NNT= 2.65; CI [6.27-1.685]). CONCLUSIONS: In conclusion, our findings do not support the hypothesis that 12 weeks CLA supplementation, as dosed in the present study, is effective for body weight reduction in overweight and obese women. However, its local action in decreasing the hip circumference seems to be encouraging and suggests that CLA may represent an attractive dietary supplement.

[Occurrence of Chlamydia trachomatis infections in infertile women in Poland]. / Wystepowanie zakaien Chlamydia trachomatis u kobiet z nieplodnoscia w Polsce.

INTRODUCTION: Chiamydia trachomatis represents a causal factor of sexually transmitted infections (STI), the course of which is frequently asymptomatic. Chronic and relapsing infections with Chlamydia trachomatis may result in a disturbed function of oviducts, resulting in infertility. OBJECTIVES: The aim of the study was to evaluate the relationship between manifestations of asymptomatic infections with Chlamydia trachomatis and infertility among Polish women. MATERIAL AND METHODS: The study was conducted between 2010-2013 on 543 women in two groups. Group 1 included 190 patients (aged 23-39 years), in whom control tests were performed before planned pregnancy Group 2 included 353 patients (aged 23-39 years), suffering from infertility (no pregnancy after 12 months of regular sexual intercourse). The study included all women presenting with infertility A smear was taken from the cervical canal and DNA of C. trachomatis was isolated and identified using nested-PCR. In the statistical analysis the Fisher's exact test was applied. RESULTS: Infection with C. trachomatis was detected in 18 (9.47%) controls (group 1) but as many as 81 (22.95%) patients with infertility (group 2). The obtained results were significantly different (p<0.0001) between the investigated groups. CONCLUSIONS: (1) The study indicates that chronic infection with C. trachomatis may represent a significant factor resulting in infertility of women. (2) A test for Chlamydia trachomatis infection should be routinely performed in every couple with diagnosed infertility and always before a scheduled in vitro procedure.

Inflammatory bowel disease - is there something new in the immunological background?

In the present paper we correlate clinical data, as well as histopathological, immunohistochemical and molecular biology methods, with the occurrence of both forms of inflammatory bowel disease (IBD) i.e. ulcerative colitis and Crohn's disease. We found that patients with a history of Epstein-Barr virus (EBV) or cytomegalovirus (CMV) infections, as well as steroid treatment, had increased susceptibility to the development of IBD. The diagnosis of IBD was confirmed by histopathology. Previous infections by EBV and CMV, as well as M. tuberculosis, were proved by PCR-based techniques and in situ hybridization. We found PCR-proved latent viral infections in 30-50% of the IBD patients we studied. However, we were unable to prove the presence of viral antigens by immunohistochemistry for EBV or CMV. We found positive correlations between the presence of anti-CMV IgG, as well as PCR-positive results for M. tuberculosis with an ulcerative colitis diagnosis. Additionally, up to 80% of IBD patients used steroids, which was found to be correlated with a diagnosis of Crohn's disease. Our data may support the theory that IBD could be related to previous viral infections and the use of steroids.

Proinflammatory cytokines and IL-10 in inflammatory bowel disease and colorectal cancer patients.

INTRODUCTION: The aim of the study was to describe the levels of circulating monocyte/macrophage pro-inflammatory cytokines (TNF-alpha, IL-1beta IL-6, and IL-8) and an anti-inflammatory cytokine (IL-10) in inflammatory bowel disease (IBD) and colorectal cancer (CRC) patients and healthy controls. MATERIALS AND METHODS: The study was conducted on 15 healthy individuals, 20 patients with ulcerative colitis (UC), 12 with Crohn's disease (CD), and 15 with CRC (Dukes' stage B). Blood serum cytokine levels were measured by ELISA. RESULTS: The patients with UC had significantly higher levels of the pro-inflammatory cytokines and of circulating IL-10 than the healthy controls. The patients with CD and CRC had the same specific pattern of serum cytokines of significantly elevated levels of the pro-inflammatory cytokines, but the IL-10 levels were within the range found in the healthy individuals. CONCLUSIONS: Thus our results demonstrate that both IBD and CRC are linked with an intensified production of a wide array of monocyte/macrophage pro-inflammatory cytokines which is not accompanied by elevated levels of circulating IL-10, except for its insufficiently inhibitory elevation in UC patients.

[Mycobacterium avium subsp. paratuberculosis in inflammatory bowel diseases]. / Mycobacterium avium subsp. paratuberculosis w nieswoistych chorobach zapalnych jelit.

In the paper results were presented of a study on manifestation of infection with Mycobacterium avium subsp.paratuberculosis in 16 patients aged 15-42 years with Lesniowski-Crohn disease (group 1), in 20 patients aged 21-50 years with ulcerative colitis (group 2) and in 12 healthy individuals aged 23-60 years (group 3, control). All the ill patients were subjected to surgery, involving partial or total resection of large intestine, while individuals in group 3 (control) were subjected to colonoscopy with sampling of large intestine. Using mechanical/enzymatic technique DNA was extracted from the tissue material and was identified using PCR-ELISA technique (Mycobacterium paratuberculosis PCR; Institut Pourquier-France). Colour reaction was evoked using the TMB substrate. In the studies presence of Mycobacterium avium subsp. paratuberculosis was noted in 10 (62.5%) patients with Lesniowski-Crohn disease, in 5 (25%) patients with ulcerative colitis and in 1 patient 1 (8.3%) patient of the control group. The obtained results permit to suggest that Mycobacterium avium subsp. paratuberculosis bacteria participate in etiopathogenesis of Lesniowski-Crohn disease.