Efficacy and safety of oral multiprobiotics in the comprehensive treatment of bacterial vaginosis and vulvovaginal candidiasis: Results from a randomized placebo-controlled study

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Bacterial vaginosis (BV) is a polymicrobial, non-inflammatory syndrome that arises from the alteration of the normal vaginal microbiota, specifically the Lactobacillus spp. that produce lactic acid and hydrogen peroxide, into obligate and facultative anaerobic microorganisms, including Bacteroides/Prevotella spp., Mobiluncus spp., Veillonella spp., Gardnerella vaginalis, etc. [1].

Vulvovaginal candidiasis (VVC) is an infectious disease characterized by damage to the skin of the vulva and the vaginal mucosa, predominantly caused by Candida fungi [1]. Both BV and VVC represent the most prevalent conditions that significantly affect the quality of life for women of reproductive age [1].

Although standard treatments for BV and VVC are effective at alleviating acute symptoms, they often fail to restore the vaginal microbiota in the long term [2, 3]. The predominance of lactobacilli within the vaginal microbiota is crucial, as they maintain an acidic pH, produce antimicrobial compounds, and modulate the local immune response, thereby creating conditions unfavorable to the colonization by pathogenic microorganisms [2, 3].

The significance of oral multiprobiotics in the comprehensive management of BV and VVC is receiving growing attention from the global clinical community. Research has established the efficacy of multiprobiotics in modulating the vaginal microbiota, as evidenced by increased populations of beneficial Lactobacillus spp. and reduced BV recurrence rates [4].

A systematic review of 6 randomized controlled trials (RCTs) has also demonstrated high effectiveness of various multiprobiotics in the comprehensive treatment of VVC [5]. Similarly, the effectiveness of combined BV therapy with oral probiotics was shown to be superior to that of treatment modalities without them [6].

The inclusion of acidophilic Lactobacillus spp. strains within the treatment regimen provides an additional therapeutic benefit, facilitating the restoration of the lactobacillary flora and normalizing the vaginal microbiota [7].

An analysis of the safety profiles of probiotics, evaluated across studies with various levels of evidence, highlights their favorable tolerability and minimal side effects relative to traditional antifungal therapies, including nitroimidazole [7, 8].

However, a contemporary evaluation of research quality requires improvements in study design and methodology, as well as the establishment of standardized protocols. The considerable heterogeneity of existing studies, often limited by small sample sizes and inadequate blinding, diminishes the objectivity of the results and underscores the need for placebo-controlled studies comparing oral multiprobiotics to standard therapies without them [6, 7, 9].

Aim. To evaluate the efficacy and safety of an oral multiprobiotic initiated on the first day of comprehensive therapy for bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC).

Materials and methods

Study design. A prospective, randomized, double-blind, placebo-controlled, parallel study (Fig. 1).

 

Fig. 1. Study design.

 

Study duration. Active treatment period: 1 month.

Sample size and study groups. This study enrolled 90 patients of reproductive age, all with clinically and laboratory-confirmed BV (as per the International Classification of Diseases, 10th revision [ICD-10] code N89.0) and 90 patients with VVC (ICD-10 codes B37.3 for candidiasis of the vulva and vagina, and N77.1). Participants were randomized into four groups:

1. Group 1 (n = 50): Patients with BV receiving standard therapy for BV plus multiprobiotics from Day 1 of standard therapy for one month.
2. Group 2 (n = 40): Patients with BV receiving standard therapy for BV plus placebo from Day 1 of standard therapy for one month.
3. Group 3 (n = 50): Patients with VVC receiving standard therapy plus multiprobiotics from Day 1 of standard therapy for one month.
4. Group 4 (n = 40): Patients with VVC receiving standard therapy plus placebo from Day 1 of standard therapy for one month.

Objectives:

1. To assess the time course of clinical symptoms in BV and VVC.
2. To analyze changes in the composition of the vaginal microflora before and after treatment using Femoflor-16.
3. To evaluate the changes in the vaginal contents pH before and after treatment.
4. To assess patient satisfaction with the treatment provided.

Investigational product: Bac-Set® Feminic is a targeted oral multiprobiotic for the urogenital tract developed by ADM Protexin Ltd. (United Kingdom).

Composition (per dose):

1. L. rhamnosus – 7.6 × 10⁸ CFU.
2. L. plantarum – 5.0 × 10⁸ CFU.
3. L. helveticus – 5.0 × 10⁸ CFU.
4. L. gasseri – 2.0 × 10⁸ CFU.
5. L. crispatus – 0.4 × 10⁸ CFU.

Dosage regimen: 2 capsules per day.

Method of administration: Orally daily for 1 month, starting from Day 1 of standard therapy.

Comparison product: Placebo identical in appearance, taste, and packaging to the investigational product. Dosage regimen: The same as for the investigational product. Method of administration: Orally 2 capsules per day (morning and evening) for 1 month.

The standard therapy was prescribed in accordance with current federal clinical guidelines (Russian Society of Obstetricians and Gynecologists [RSOG], 2024) [1].

Standard therapy for BV (n = 90):

• Metronidazole 500 mg orally twice daily for seven days, or
• Clindamycin 300 mg orally twice daily for seven days, or
• Clindamycin cream 2% intravaginally once daily for seven days.

Standard therapy for VVС (n = 90):

• Fluconazole 150 mg orally single dose, or
• Clotrimazole 1% cream intravaginally once daily for seven days, or
• Miconazole 2% cream intravaginally once daily for seven days.

Inclusion criteria:

1. Females aged 18 to 49 years.
2. A clinically and laboratory-confirmed diagnosis of BV (N89.8 according to ICD-10) or VVC (B37.3 according to ICD-10).
3. No current pregnancy and lactation.
4. Consent to utilize reliable contraceptive methods during the study period.
5. Signed informed consent for participation in the study.

Exclusion criteria:

1. Current sexually transmitted infections (STIs).
2. Use of local or systemic antibacterial, antifungal, or probiotic therapies within six months prior to the enrollment.
3. Participation in other concurrent clinical trials.
4. Hypersensitivity to any components of the investigational product.
5. Comorbidities including diabetes mellitus, immunodeficiency disorders, autoimmune diseases, and cancer.
6. Use of intrauterine devices.
7. Use of immunosuppressive drugs.
8. Menstruation at the time of screening.
9. Pregnancy, lactation, or plans for pregnancy during the study period.

Clinical assessments:

1. Recording of patient complaints and medical history.
2. Gynecological examination.
3. Assessment of the severity of clinical symptoms using a 10-point scale (considering discharge intensity, itching, burning, and unpleasant odor).

Laboratory tests:

1. pH-metry of the vaginal contents.
2. Microscopic examination of vaginal discharge (standard swabbing).
3. Molecular genetic test of vaginal microflora (Femoflor-16).
4. Identification of Candida albicans (specific to the VVC group).
5. Screening for STIs using polymerase chain reaction (PCR) for chlamydia, gonococci, trichomonads, mycoplasma, and ureaplasma.
6. Pregnancy test.

Study procedures

Screening visit (pre-treatment):

1. Informed consent.
2. Recording of medical history and demographic data.
3. Swabbing for culture; physical and gynecological examination.
4. pH-metry of the vaginal contents. Collection of samples for microscopic examination, PCR tests (Femoflor-16), and identification of Candida albicans.
5. Screening for STIs.
6. Pregnancy test.
7. Assessment of clinical symptoms.
8. Evaluation for inclusion and exclusion criteria.

Visit 1 (Day 1 – start of treatment):

1. Randomization of patients and group distribution.
2. Prescription of standard therapy according to current clinical guidelines.
3. Dispensing of study treatment (probiotic or placebo).
4. Medication briefing.
5. Hand-out of a diary for recording adverse events and compliance with the treatment regimen.

Visit 2 (Day 30 ± 3 days – end of active therapy):

1. Physical and gynecological examination.
2. pH-metry of the vaginal contents.
3. Collection of samples for microscopic examination and PCR tests (Femoflor-16).
4. Evaluation of clinical symptoms using a questionnaire.
5. Assessment of compliance with the treatment regimen.
6. Evaluation of patient satisfaction with the treatment.

Statistical analysis

Statistical analysis was conducted using IBM SPSS Statistics v.26 (IBM Corp., USA) and R v.4.3.1 (R Foundation for Statistical Computing, Austria).

Quantitative variables are reported as the arithmetic mean ± standard deviation (M ± SD) with normal distribution. Qualitative variables are represented as absolute counts (n) and percentages (%).

The normality of quantitative variable distributions was assessed using the Shapiro-Wilk test, and the homogeneity of variances was evaluated using the Levene test. The homogeneity of the variances was assessed using the Levene's test.

One-way analysis of variance (ANOVA) was used to compare four groups of quantitative indicators with normal distributions; when deviations from normality were observed, the Kruskal-Wallis test was used. Pairwise comparisons of two independent groups based on quantitative attributes were performed using Student's t-test for independent samples (for normal distribution) or the Mann-Whitney U-test (for non-normal distribution).

Qualitative comparisons between groups employed the Pearson χ² test. When expected frequencies were less than 5, Fisher's exact test was used. The odds ratio with a 95% confidence interval was calculated to determine the strength of the association between probiotic use and recurrence rate.

The critical level of significance for testing statistical hypotheses was set at 0.05.

Results

The study included 180 participants with confirmed BV (n = 90) or VVC (n = 90). No statistically significant differences were observed between the two groups for age, anthropometric measurements, parity, and socio-demographic characteristics (p > 0.05), demonstrating comparability and homogeneity of the groups and affirming the integrity of the randomization process.

In patients with BV, there was a tendency for a more pronounced decrease in vaginal pH levels after the comprehensive therapy. However, the observed differences require a prolonged follow-up period post-treatment.

For participants with VVC, the addition of multiprobiotics to standard therapy resulted in a statistically significant and marked reduction in vaginal pH, specifically a decrease of 0.46 units compared with the placebo group (p < 0.001) (Fig. 2).

 

Fig. 2. Results of pH-metry of vaginal discharge before and after treatment.

 

Post-treatment analysis revealed a statistically significant increase in the proportion of lactobacilli (Lactobacillus spp.) in both multiprobiotic cohorts compared with the placebo group (Fig. 3).

 

Fig. 3. Proportion of Lactobacillus spp. in vaginal microbiota.

 

In the BV group receiving multiprobiotic therapy, the increase in Lactobacillus spp. was 33.3%, compared with 14.4% in the placebo group (p < 0.001). Similarly, in the VVC group, these corresponding values were 19.8% and 6.7%, respectively (p < 0.001).

According to Femoflor-16 data, the absolute increase in Lactobacillus spp. concentration in the BV + probiotic group was 1.8 times greater (+3.48 log vs. +1.94 log), and the reduction of BV-associated anaerobes was 1.8–2.3 times more significant than in the placebo group (all p < 0.001). For the VVC + probiotic group, the elimination of Candida spp. was 1.4 times more pronounced (-3.86 log vs. -2.72 log; p < 0.001), and the increase in lactobacilli was six times greater. Additionally, significant reductions in Staphylococcus spp., Streptococcus spp., and Enterobacteriaceae were documented in the probiotic group, with no similar changes observed in the placebo group.

Statistically significant intergroup differences in symptom severity were evident at baseline and after the treatment. Participants receiving comprehensive therapy that included multiprobiotics exhibited a greater decrease in the intensity of pathological discharge and unpleasant odor than those receiving a placebo (p < 0.05) (Fig. 4).

 

Fig. 4. Changes in the severity of bacterial vaginosis clinical symptoms before and after treatment.

 

A comparable trend was observed in patients with VVC; despite similar baseline values, there was a statistically significant decline in the severity of itching/burning and pathological discharge upon completion of the comprehensive therapy (Fig. 5).

 

Fig. 5. Changes in the severity of vulvovaginal candidiasis clinical symptoms before and after treatment.

 

The evaluation of patient satisfaction regarding treatment outcomes is illustrated in Fig. 6.

 

Fig. 6. Patient satisfaction with treatment outcomes.

 

Among those with BV, 88% of patients expressed satisfaction with treatment when multiprobiotics were used, compared with 70% in the placebo group (χ² = 4.50, p = 0.034). A similar pattern was noted in patients with VVC, with 86% reporting satisfaction in the multiprobiotic group versus 65% in the placebo group (χ² = 5.48, p = 0.019).

Consequently, adding an oral multiprobiotic to standard therapy from Day 1 of treatment significantly enhances patients' subjective satisfaction with outcomes in both clinical scenarios.

No serious adverse events or allergic reactions requiring the discontinuation of therapy were reported in either group.

Discussion

The findings of this study illustrate the efficacy of oral multiprobiotic therapy, incorporating lactobacilli alongside standard treatment protocols for BV and VVC. These results are consistent with the recognition of the vaginal microbiota's significant role in preserving women's reproductive health and affirm the practicality of integrating probiotics into treatment regimens for these conditions.

Particular emphasis should be placed on the identified impact of multiprobiotic therapy on the composition of vaginal microflora. Among patients diagnosed with BV who underwent comprehensive therapy, the proportion of Lactobacillus spp. increased by 33.3% (from 45.2 ± 18.5 to 78.5 ± 12.3%), whereas the placebo group exhibited a mere increase of 14.4% (p < 0.001). For patients with VVC, corresponding values were +19.8% and +6.7%, respectively (p < 0.001). These data corroborate the results of the study by F. Qi et al. [10], in which the oral administration of L. gasseri TM13 and L. crispatus LG55 facilitated a rapid restoration of a healthy vaginal microbiota.

A systematic review of 16 randomized controlled trials [11] revealed that the most effective strains for BV treatment included L. rhamnosus, L. crispatus, L. plantarum, L. acidophilus, L. gasseri, and L. reuteri, administered at dosages ranging from 1 × 10⁸ to 5.4 × 10⁹ CFU per day. The multiprobiotic used in our study comprised five strains of lactobacilli (L. rhamnosus, L. plantarum, L. helveticus, L. gasseri, and L. crispatus), each with specific mechanisms of pathogen antagonism [3] and synergistic interactions with the others.

A significant outcome of this study is the demonstrated effect of multiprobiotics on vaginal pH, with a statistically significant decrease of 0.46 units compared to the placebo group (p < 0.001) in patients with VVC. A notable trend toward lower pH was observed in patients with BV; however, this difference did not reach statistical significance (p = 0.058).

Probiotic lactobacilli confer protective functions through several mechanisms, including the production of lactic acid and hydrogen peroxide, synthesis of bacteriocins, disruption of biofilms, and modulation of the host immune response [12–16].

Quantification of the vaginal microbiota was performed using real-time PCR (Femoflor-16) for all participants, both before and after treatment. Initial characteristics indicate that both the probiotic and placebo groups were comparable across all analyzed markers for BV (all p > 0.2, Mann-Whitney test) and for VVC (all p > 0.05). Key results are summarized in Table 1.

 

Table 1. Changes in key indicators of Femoflor-16, Me lg (genome equivalents [GE]/sample)

Parameter	Group	At baseline	After treatment	Δ	p (intergroup)
BV (n = 50 probiotic, n = 40 placebo)
Lactobacillus spp.	Probiotic	3.24	6.72	+3.48	< 0.001***
	Placebo	3.40	5.34	+1.94
Gardnerella / Prevotella / Porphyromonas	Probiotic	7.11	3.94	-3.17	< 0.001***
	Placebo	6.99	5.27	-1.72
Atopobium vaginae	Probiotic	5.97	2.81	-3.16	< 0.001***
	Placebo	6.03	3.56	-2.47
Megasphaera / Veillonella / Dialister	Probiotic	5.04	2.31	-2.73	< 0.001***
	Placebo	5.33	3.99	-1.34
Candida spp.	Probiotic	1.41	1.48	+0.07	0.570 (NS)
	Placebo	1.59	1.60	+0.01
VVC (n = 50 probiotic, n = 40 placebo)
Lactobacillus spp.	Probiotic	5.54	6.72	+1.18	< 0.001***
	Placebo	5.67	5.87	+0.20
Candida spp.	Probiotic	5.83	1.97	-3.86	< 0.001***
	Placebo	5.81	3.09	-2.72
Enterobacteriaceae	Probiotic	2.77	1.99	-0.78	0.008**
	Placebo	2.74	2.50	-0.24
Staphylococcus spp.	Probiotic	2.49	1.46	-1.03	< 0.001***
	Placebo	2.30	1.85	-0.45
Streptococcus spp.	Probiotic	2.44	1.75	-0.69	< 0.001***
	Placebo	2.53	2.15	-0.38

Note. Δ – change in median (post-treatment – baseline), p (intergroup) – Mann-Whitney test post-treatment; ***p < 0.001, **p < 0.01, NS – nonsignificant.

 

In the multiprobiotic group with BV, the increase in Lactobacillus spp. was 3.48 log units, compared with 1.94 log units in the placebo group (a 1.8-fold difference). Concurrently, all BV-associated anaerobes exhibited significantly more pronounced reductions: Gardnerella/Prevotella/Porphyromonas decreased by 3.17 log versus 1.72 log (1.8-fold), while Megasphaera/Veillonella/Dialister showed a decrease of 2.73 log versus 1.34 log (two-fold difference). Intergroup differences post-treatment were highly significant for all markers (p < 0.001), except for Candida spp. (p = 0.570), underscoring the specificity of the probiotic effect on anaerobic dysbiosis.

In VVC, the multiprobiotic therapy yielded a six-fold greater increase in lactobacilli (+1.18 log versus +0.20 log; p < 0.001) and a more substantial reduction in Candida spp. (-3.86 log versus -2.72 log; p < 0.001). The additional normalization of opportunistic pathogens proved critical, resulting in significant reductions in Staphylococcus spp. (p < 0.001), Streptococcus spp. (p < 0.001), and Enterobacteriaceae (p = 0.008) in the probiotic group, whereas no significant changes were noted in the placebo group.

A visual comparison of the absolute changes (Δ) in Femoflor-16 results for BV and VVC is illustrated in Fig. 7.

 

Fig. 7. Changes in Femoflor-16 values from baseline: a – bacterial vaginosis, b – vulvovaginal candidiasis (Δ = after treatment – baseline).

 

Therefore, multiprobiotic therapy exhibited a multifaceted normalizing effect on vaginal microbiocenosis in both forms of dysbiosis: for BV, the restoration of lactobacillary dominance was achieved through a significantly deeper suppression of anaerobes, while in VVC, effective elimination of Candida spp. and a reduction in the concentration of significant opportunistic pathogens occurred-benefits that standard antimycotic therapy could not achieve.

An important result of this study is the statistically significant improvement in clinical symptoms among patients receiving multiprobiotics in addition to standard therapy. In patients with BV, the severity of abnormal discharge following treatment was 1.2 ± 0.8 points with combination therapy compared with 2.1 ± 1.2 points with placebo (p < 0.001), and the intensity of unpleasant odor was 0.8 ± 0.6 points with combination therapy versus 1.5 ± 0.9 points with placebo (p < 0.001). A similar trend was observed among VVC patients, with itching and burning severity reported as 0.9 ± 0.7 points, compared with 1.8 ± 1.1 points (p < 0.001), respectively. These findings are comparable to those reported in a systematic review of 11 high-quality randomized controlled trials [17].

The results of our study align with the meta-analysis conducted by T. Zahedifard et al. [5], which indicates that probiotics significantly mitigate the severity of clinical manifestations and the recurrence frequency of VVC (odds ratio 0.14; p = 0.01). Probiotics derived from the Limosilactobacillus fermentum LF5 strain are particularly promising, as they create an environment unfavorable to Candida spp. colonization, thereby potentially reducing the recurrence rate [18, 19]. A critical practical consideration is the route of administration of probiotics. Systemic effects mediate the mechanism of action of oral probiotics through the intestinal microbiota [10]. Our study employed the oral route of administration, which offers several advantages, including convenience and the modulation of the gut microbiome. Our findings are consistent with those of studies [20], which demonstrated the effectiveness of oral probiotics in decreasing the BV recurrence, thus supporting the selected route of administration [21–23].

Notably, high patient satisfaction with the treatment was observed (88% vs. 70% in the BV + multiprobiotic group compared to placebo; p = 0.034, and 86% vs. 65% for VVC, respectively; p = 0.019), indicating a clinically significant improvement in patients' subjective health, which may enhance compliance to therapy. This metric has substantial practical significance, as low compliance is one of the primary reasons for the high recurrence rates of vaginitis. The present study established a favorable safety profile of multiprobiotic therapy.

Systematic reviews highlight considerable heterogeneity among studies in this area, attributed to variations in probiotic strains, dosages, intervention durations, and population characteristics [11, 17, 24]. Therefore, further multicenter trials with larger sample sizes and standardized protocols are required to validate outcomes and establish optimal probiotic regimens.

The exploration of individualized approaches to probiotic therapy appears promising.

Conclusion

The outcomes of this prospective, randomized, double-blind, placebo-controlled study demonstrate the effectiveness and safety of oral multiprobiotic therapy when combined with standard treatment for BV and VVC.

Initiating multiprobiotic therapy from Day 1 of standard treatment demonstrated a robust normalizing effect on vaginal microbiocenosis across both types of dysbiosis. In cases of BV, this was evidenced by significantly greater suppression of anaerobes and a restoration of lactobacillary dominance, with an increase in Lactobacillus spp. of 3.48 log compared to 1.94 log in the placebo group (a 1.8-fold difference). Concurrently, all BV-associated anaerobes exhibited significantly more pronounced reductions: Gardnerella/Prevotella/Porphyromonas decreased by 3.17 log versus 1.72 log (1.8-fold), while Megasphaera/Veillonella/Dialister showed a decrease of 2.73 log versus 1.34 log (two-fold difference). For VVC, this intervention facilitated a more effective elimination of Candida spp. and a correction of associated opportunistic flora, which standard antifungal therapy did not achieve. In the group receiving complex therapy with multiprobiotics, a statistically significant increase in Lactobacillus spp. of 1.18 log was observed, corresponding to approximately a 15-fold increase in bacterial load (p < 0.001), whereas the placebo group showed an increase of only 0.20 log (~ 1.6-fold; p = 0.241).

While the concentration of Candida spp. decreased in both treatment groups, in patients receiving complex therapy with multiprobiotics, the decrease was 3.86 log (~ 7200-fold elimination), compared with 2.72 log (~ 525-fold) in the placebo group, reflecting an absolute delta of 1.4-fold. In patients with VVC, comprehensive therapy incorporating multiprobiotics enhanced the elimination of Candida spp., improved clinical outcomes (post-treatment concentration was approximately 13 times lower; p < 0.001), and facilitated the normalization of concomitant opportunistic flora (Enterobacteriaceae, Streptococcus, Staphylococcus), which standard antifungal therapy failed to correct.

The addition of multiprobiotics to standard therapy from Day 1 results in a more pronounced alleviation of clinical symptoms (pathological discharge, unpleasant odor, itching, and burning) compared with placebo (p < 0.001). It promotes the restoration of normal vaginal microbiota composition with a significant increase in the proportion of Lactobacillus spp. (p < 0.001), normalizes vaginal pH (statistically significant in VVC; p < 0.001), and enhances patient satisfaction with treatment outcomes (p < 0.05).

These findings support the incorporation of an oral multiprobiotic containing combinations of L. rhamnosus, L. plantarum, L. helveticus, L. gasseri, and L. crispatus into comprehensive treatment regimens starting from Day 1 of therapy for BV and VVC, as this approach improves treatment efficacy and may reduce the risk of relapse.

Future multicenter studies with extended follow-up periods are necessary to evaluate the impact of multiprobiotic therapy on recurrence rates and to establish optimal dosing regimens and treatment durations.

Disclosure of interest. The authors declare no personal, professional, or financial relationships that could be regarded as a conflict of interest for this study. The independence of the scientific assessment, data interpretation, and manuscript writing was maintained at all stages of work, including the stage of financing by the company PharmaMed.

Authors' contribution. The authors declare the compliance of their authorship according to the international ICMJE criteria. V.E. Radzinsky – conceptualization, writing (review and editing); M.R. Orazov – conceptualization, methodology, project management, resources, draft writing, writing (review and editing); R.E. Orekhov – resources, visualization, draft writing; I.A. Mullina – resources; V.A. Timchenko – resources; G.H. Husyainova – resources; L.K. Barsegian – resources.

Funding source. The paper was prepared with the financial support of the company PharmaMed. The sponsor was not involved in the data collection and analysis and the interpretation of results. In preparing the manuscript, the authors maintained the independence of opinion.

Disclosing the use of AI. No AI was used when writing the article.

Compliance with the principles of ethics. The study protocol was approved by the local ethics committee (Peoples' Friendship University of Russia named after Patrice Lumumba, Minutes No. 9, 21.10.2025). Approval and protocol procedure was obtained according to the principles of the Declaration of Helsinki.

Consent for publication. Written consent was obtained from the patients for publication of relevant medical information and all of accompanying images within the manuscript.

About the authors

Viktor E. Radzinsky

Peoples' Friendship University of Russia named after Patrice Lumumba

Email: omekan@mail.ru
ORCID iD: 0000-0003-4956-0466

D. Sci. (Med.), Prof., Acad. RAS

Russian Federation, Moscow

Mekan R. Orazov

Peoples' Friendship University of Russia named after Patrice Lumumba

Author for correspondence.
Email: omekan@mail.ru
ORCID iD: 0000-0002-5342-8129

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Roman E. Orekhov

Peoples' Friendship University of Russia named after Patrice Lumumba

Email: omekan@mail.ru
ORCID iD: 0000-0002-2775-9266

Cand. Sci. (Med.)

Russian Federation, Moscow

Irina A. Mullina

Semashko Clinical Hospital RZhD-Medicine

Email: omekan@mail.ru
ORCID iD: 0000-0002-5773-6399

Cand. Sci. (Med.)

Russian Federation, Moscow

Victoria A. Timchenko

Semashko Clinical Hospital RZhD-Medicine

Email: omekan@mail.ru
ORCID iD: 0009-0009-9249-7598

Cand. Sci. (Med.)

Russian Federation, Moscow

Galiya H. Husyainova

Semashko Clinical Hospital RZhD-Medicine

Email: omekan@mail.ru
ORCID iD: 0009-0003-3284-3440

MD, Obst./Gyn.

Russian Federation, Moscow

Lilit K. Barsegian

Central Clinical Hospital with Polyclinic, Moscow

Email: omekan@mail.ru
ORCID iD: 0000-0002-4426-3334

Cand. Sci. (Med.)

Russian Federation, Moscow

References

Supplementary files