Gayane Martirosian

Is the plasma anti-Müllerian hormone (AMH) level associated with body weight and metabolic, and hormonal disturbances in women with and without polycystic ovary syndrome?

OBJECTIVE The aim of the study was to analyze interrelation between AMH levels and body weight, metabolic, and hormonal status in normal and overweight weight women with and without polycystic ovary syndrome (PCOS). STUDY DESIGN Eighty-seven women (54 normal weight and 33 overweight) diagnosed with PCOS and 50 apparently healthy women - Non-PCOS (28 normal weight and 22 overweight) were enrolled. The body weight and height were measured and BMI was calculated. In addition to serum glucose, lipids, androgens, FSH, LH, SHBG and insulin, AMH were assessed in fasting state and free androgens index (FAI) was calculated. The insulin resistance was assessed based on the homeostasis model of assessment-insulin resistance (HOMA-IR). RESULTS Plasma AMH levels were similar in normal weight and overweight PCOS groups (9.6±3.5 vs. 11.2±4.5ng/mL, respectively), and as expected markedly higher than in both Non-PCOS groups (2.5±0.8 and 2.3±0.7ng/mL, respectively). There were no correlations between BMI and AMH levels in all study groups. A significant positive correlation between HOMA-IR, free testosterone concentrations or FAI and AMH levels were found (R=0.31, p<0.001; R=0.91, p<0.001 and R=0.62, p<0.001, respectively). Moreover, there was positive correlation between total or LDL cholesterol and AMH levels (R=0.22, p<0.05 and R=0.31, p<0.05, respectively) and a negative one between HDL cholesterol and AMH levels (R=-0.17, p<0.05) in all study subjects. CONCLUSIONS The plasma AMH level is associated with insulin resistance but not with BMI per se. Increased circulating AMH level seems to reflect the disturbances of gonadotrophins release in PCOS. It seems that AMH level may be used not only as new surrogate marker of ovarian hyperandrogenism in PCOS but also as a potential new cardiovascular risk factor.

Distribution of the Serine-Aspartate Repeat Protein-Encoding sdr Genes among Nasal-Carriage and Invasive Staphylococcus aureus Strains

ABSTRACT The sdr locus was found in all 497 investigated Staphylococcus aureus strains, although in 29 strains it contained only the sdrC gene (sdrD negative, sdrE negative). The sdrC-positive, sdrD-negative, sdrE-negative gene profile was exclusive to methicillin-sensitive S. aureus (MSSA) strains (Fishers exact test; P = 0.0005) and was not found in the strains collected from bone infections (P = 0.0019). We also found a strong association between the presence of the sdrD gene and methicillin-resistant S. aureus strains (P < 0.0001). Our findings suggest that MSSA strains with the newly uncovered sdrC-positive, sdrD-negative, sdrE-negative gene profile have a substantially decreased potential to establish bone infection.

Gut microbiota, microinflammation, metabolic profile, and zonulin concentration in obese and normal weight subjects.

The association between gut microbiota and circulating zonulin level, a marker of intestinal permeability, has not been studied yet. The aim of the study is the assessment of plasma zonulin, haptoglobin and proinflammatory cytokines (TNF-α and IL-6) levels in relation to composition of gut microbiota in obese and normal weight subjects. Circulating inflammation markers, such as TNF-α, sTNFR1, sTNFR2, IL-6, zonulin, and haptoglobin levels were measured and semiquantitative analysis of gut microbiota composition was carried out in 50 obese and 30 normal weight subjects without concomitant diseases. Higher circulating zonulin, TNF-α, sTNFR1, sTNFR2, and IL-6 levels were found in the obese subjects. Plasma zonulin level correlated positively with age (r = 0.43, P < 0.001), body mass (r = 0.30, P < 0.01), BMI (r = 0.33, P < 0.01), fat mass and fat percentage (r = 0.31, P < 0.01 and r = 0.23, P < 0.05, resp.). Positive correlations between bacterial colony count and sTNFR1 (r = 0.33, P < 0.01) and plasma zonulin (r = 0.26, P < 0.05) but not haptoglobin levels were found. Additionally, plasma zonulin level was proportional to daily energy intake (r = 0.27, P < 0.05) and serum glucose concentration (r = 0.18, P < 0.05) and inversely proportional to diet protein percentage (r = −0.23, P < 0.05). Gut microbiota-related systemic microinflammation in the obese is reflected by circulating zonulin level, a potential marker of interstitial permeability.

Occurrence of Ureaplasma parvum and Ureaplasma urealyticum in Women with Cervical Dysplasia in Katowice, Poland

The aim of this study was to evaluate the occurrence of genital mycoplasmas, especially Ureaplasma parvum and Ureaplasma urealyticum, in women with atypical squamous cells of undetermined significance (ASCUS), low grade squamous intraepithelial lesions (LSIL) and high grade squamous intraepithelial lesions (HSIL), compared to women with normal cytology living in Katowice, Poland. Two sterile swabs were used to obtain material from the posterior vaginal fornix of 143 women with squamous intraepithelial lesions and 39 healthy women: first for general bacteriology, second for detection of urogenital mycoplasmas using Mycoplasma IST2 kit. From each positive Mycoplasma IST2 culture DNA was isolated and PCR was performed for identification of U. parvum and U. urealyticum. Mycoplasma IST was positive in 34.1% cases. Urogenital mycoplasmas were demonstrated in women with HSIL significantly more often compared to women with LSIL, ASCUS, and with normal cytology. DNA of U. parvum was demonstrated in majority of Mycoplasma IST2-positive cases, U. urealyticum DNA-only in 9 (4.9%). Predominance of 3/14 serovars of U. parvum was demonstrated. U. urealyticum biovar 2 was present more often in women with squamous intraepithelial lesions.

Fecal lactoferrin and Clostridium spp. in stools of autistic children

Stools from autistic and healthy children were studied for fecal lactoferrin, Clostridium difficile toxins, Clostridium perfringens enterotoxin and cultured for Clostridium spp. Elevated level of FLA was demonstrated in 24.4% stools, all from boys (31.25%). No toxins were detected. Clostridium spp. was isolated with similar frequency from all samples. C. perfringens were isolated significantly often from the autistic stools, intermediate sensitive strains to penicillin 19%, to clindamycin 11.3%, and to metronidazole 7.5% were detected. Further studies on fecal microflora and inflammatory mediators, with larger groups of patients, are required in order to explain their role in neurological deficits.

Prevalence of high-risk human papillomavirus cervical infection in female kidney graft recipients: an observational study

BackgroundImmunosuppressive therapy protects the transplanted organ but predisposes the recipient to chronic infections and malignancies. Transplant patients are at risk of cervical intraepithelial neoplasia (CIN) and cervical cancer resulting from an impaired immune response in the case of primary infection or of reactivation of a latent infection with human papillomavirus of high oncogenic potential (HR-HPV).MethodsThe aim of this study was to assess the prevalence of HR-HPV cervical infections and CIN in 60 female kidney graft recipients of reproductive age in comparison to that in healthy controls. Cervical swabs were analyzed for the presence of HR-HPV DNA. HR-HPV-positive women remained under strict observation and were re-examined after 24 months for the presence of transforming HR-HPV infection by testing for HR-HPV E6/E7 mRNA. All the HR-HPV-positive patients were scheduled for further diagnostic tests including exfoliative cytology, colposcopy and cervical biopsy.ResultsThe prevalence of HR-HPV did not differ significantly between the study group and the healthy controls (18% vs 25%, p = 0.37). There was no correlation between HR-HPV presence and the immunosuppresive regimen, underlying disease, graft function or time interval from transplantation. A higher prevalence of HR-HPV was observed in females who had had ≥2 sexual partners in the past. Among HR-HPV-positive patients, two cases of CIN2+ were diagnosed in each group. In the course of follow-up, transforming HR-HPV infections were detected in two kidney recipients and in one healthy female. Histologic examination confirmed another two cases of CIN2+ developing in the cervical canal.ConclusionsFemale kidney graft recipients of reproductive age are as exposed to HR-HPV infection as are healthy individuals. Tests detecting the presence of HR-HPV E6/E7 mRNA offer a novel diagnostic opportunity in those patients, especially in those cases where lesions have developed in the cervical canal.

Prevalence of cervical high-risk human papillomavirus infections in kidney graft recipients

BACKGROUND Female kidney graft recipients are regarded as a group at risk of cervical cancer development. The objective of this study was to assess the prevalence of cervical high-risk human papilloma virus (HR-HPV) infection and cervical intraepithelial neoplasia (CIN) in female kidney graft recipients in comparison to healthy controls. MATERIAL AND METHODS We assessed the prevalence of HR-HPV and CIN in 60 female kidney graft recipients of reproductive age in outpatient care of the First Department of Obstetrics and Gynecology, Medical University of Warsaw. The control group consisted of 60 healthy women. Cervical swabs were analyzed with use of Amplicor HPV Roche Molecular Systems test, detecting DNA of 13 types of high-risk HPV: 6, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68. RESULTS HR-HPV was detected in 11/60 kidney recipients and 15/60 healthy women (p=0.37). There was no correlation between HR-HPV presence and immunosuppressive regimen, underlying disease, graft function, or time interval from transplantation. In both groups, higher prevalence of HR-HPV was observed in females with ≥2 lifetime sexual partners. Abnormal Pap test results in 2 kidney recipients (2 cases of HSIL) and 2 healthy women (LSIL and HSIL) required colposcopy-guided cervical biopsy, which in all cases revealed CIN2+. CONCLUSIONS Female kidney graft recipients seem to be equally exposed to cervical infection with HPV of high oncogenic potential as the healthy population.

Prevalence of urogenital mycoplasmas and ureaplasmas in women after kidney transplantation.

Background. The prevalence of urogenital mycoplasmas and ureaplasmas in kidney transplant and hemodialyzed patients was studied. Methods. Vaginal and cervical swabs taken from 40 women of the study group and 40 women of the control group were investigated. Identification of ureaplasmas, Mycoplasma genitalium, and human papillomavirus was performed by polymerase chain reaction. Each vaginal slide was evaluated for bacterial vaginosis. Results. Urogenital mycoplasmas and ureaplasmas were significantly more common in patients from the study group (40%) compared with the control group (27.5%). Mycoplasma hominis and M. genitalium were demonstrated only in a few cases. Ureaplasma parvum was isolated predominantly, but Ureaplasma urealyticum was more common in patients from study group (10%) compared with control group (2.5%). In all U. urealyticum-positive women from the study group, human papillomavirus DNA was detected. Conclusion. Our observation showed the necessity of careful examination of possible atypical pathogens in diagnostic materials from hemodialyzed and kidney transplant patients.

Can chlamydial cervicitis influence diagnosis of bacterial vaginosis

In the paper entitled “Evaluation of a Point-of-Care Test, BVBlue, and Clinical and Laboratory Criteria for Diagnosis of Bacterial Vaginosis,” by Bradshaw et al., published in the March 2005 issue of the Journal of Clinical Microbiology (2), the authors concluded that because a majority of women at greater risk of the sequelae of bacterial vaginosis (BV) are not in settings where conventional diagnostic methods are either practical or possible, they would greatly benefit from access to rapid and reliable point-of-care tests to improve the diagnosis and management of BV. This conclusion was based on an analysis of results of several clinical (Amsel [1]) and laboratory (Nugent [6]) criteria routinely recommended for diagnosis of BV with results of rapid tests. In our opinion, this conclusion does not apply to women with chlamydial cervicitis. The use of both Nugent and Amsel criteria simultaneously appears to be important for correct diagnosing of BV in this group of patients. To estimate the prevalence of BV by Amsel and Nugent criteria, we studied a group of 60 (mean age, 31.7 ± 6.82 years) nonpregnant women suspected for cervicitis. Patients with Neisseria gonorrhoeae, Trichomonas vaginalis, yeast infection, and human immunodeficiency virus infection were excluded from this study. The vaginal pH was measured using color strips. Three sterile cotton swabs (the first for Gram staining, the second for the KOH test, and the third for culturing of genital mycoplasmas) were used to obtain material from the posterior vaginal fornix, and one Dacron swab was used to obtain material from the endocervical canal for detection of Chlamydia trachomatis antigen by Chlamydia Direct IF (bioMerieux) (3). Evaluations of the vaginal Gram-stained smear and other criteria were performed by persons with more than 5 years of experience. C. trachomatis was confirmed in 31 (51.6%) cases, and genital mycoplasmas were cultured in 17 (28.3%) cases. BV was diagnosed in 14 (23.4%) of 60 examined women based on threeor four Amsel criteria (pH ≥4.5, thin milky homogenous discharge, presence of “clue cells,” and amine odor upon mixing vaginal fluid with 10% KOH) and was diagnosed in 6 of them (10%) according to Nugent scores (0 to 3, negative; 4 to 6, intermediate; 7 to 10, positive) (1, 6) (Table ​(Table1).1). In five out of the remaining eight women with Amsel-positive, Nugent-negative scores, coinfection with C. trachomatis was observed (Table ​(Table2).2). Interestingly, three or four Amsel criteria were positive among 57.1% of patients with intermediate Nugent scores and in 8.5% with Nugent negative scores. BV was diagnosed by Amsel criteria in four cases out of 47 women with normal flora (Nugent score, 0 to 3). In all four cases, coinfection with C. trachomatis (in one case, also with genital mycoplasmas) and absence of “clue cells” were detected, although another three Amsel criteria were positive (Table ​(Table2).2). Nugent-negative, Amsel-positive scores (based on positive Amsel criteria other than “clue cells”) very often resulted from contact bleeding and the presence of cervical mucopurulent contents, especially during chlamydial or mycoplasmal infection. Thats why observation of “clue cells” in our opinion must be the main characteristic when Amsel criteria are used. This is confirmed by the next observation: among seven women with intermediate Nugent scores, in four cases BV was diagnosed by using Amsel criteria, in three cases the presence of “clue cells” was found, and in one case coinfection with C. trachomatis was found. Nugent intermediate scores are reported by many authors as abnormal vaginal flora and very often are accompanied by the presence of “clue cells” (2, 6). TABLE 1. Clinical and laboratory data of studied women TABLE 2. Characteristics of 14 women with BV, based on Amsel criteria It is a well-known fact that abnormal vaginal discharge is a symptom of many different pathological processes in womens genital tracts. Changing (increasing) vaginal pH may follow for many reasons, especially with chlamydial infection (4, 5, 7), the presence of cervical ectopia, contact bleeding, and others. Taking into account that chlamydial cervicitis can influence Amsel criteria, avoiding false-positive results and correct diag-nosing of BV using both Nugent and Amsel criteria (mainly “clue cells”) simultaneously is important for patients with cervicitis.

Occurrence of Clostridium difficile in fecal samples of HIV-infected children in Poland.

The prevalence of Clostridium difficile and its toxins (A and B) in HIV-positive children in Poland was investigated in a group of 18 children, aged 6 months to 8 1/2 years. Stool samples were tested using an antigen detection method for toxin A/B, cytotoxicity-neutralization and culture. In 3 cases (17%) C. difficile toxins were detected in both stool samples and strains recovered from culture. The three strains isolated were shown by PCR methods to contain toxins A and B genes. All children had been treated previously with antimicrobial and antiviral agents. All three C. difficile-positive children had mild diarrhea that resolved without specific therapy. Further studies involving a large number of children and molecular analyses of isolated C. difficile strains are necessary to determine the frequency and rate of carriage of C. difficile strains among HIV-positive children in Poland.