Vol 33, No 8 (2022)

Fertile age patients tend to have an increased prevalence of malignant neoplasms of the reproductive system. Metabolic syndrome (MS) is the main factor of endometrial hyperplasia with atypia, followed by possible tumor transformation. Obesity as part of MS supports chronic inflammation, metabolic disorders, oxidative stress, hyperestrogenemia, and persistent stimulation of endometrial cells. An integrated treatment approach should involve radical or organ-sparing surgery in reproductive-aged women, followed by hormonal therapy, as well as the comprehensive medical rehabilitation stage based on a multidisciplinary approach to prevent irreversible functional and mental disorders due to aggressive treatment methods and the disease itself.

Pelvic inflammatory diseases (PIDs) are a collective term embracing infectious and inflammatory diseases of the upper female genital tract involving the uterine (fallopian) tubes, ovaries, and surrounding tissues. The paper considers the classification, etiology, and pathogenesis of PID, describes the clinical presentation of the disease, and also provides the main methods of diagnosis and drug therapy.

Neonatal subgaleal hemorrhage (SH) is a common complication of vacuum extraction delivery. The baby’s condition after SH can progressively worsen up to death in 22% of cases. The basis for SH is a large blood accumulation volume in the subgaleal space, resulting in hemorrhagic shock and coagulopathy. The paper describes a clinical case of female patient M. who has undergone operative vaginal vacuum extraction done to deliver a baby, if clinically indicated. It analyzes the labor activity of Patient M, by providing a rationale for obstetric care tactics. The paper depicts the further worsening severity of neonatal infants condition in the presence of progressive bleeding into the subgaleal space, as well as neonatologists’ treatment policy, with a detailed description of instrumental and laboratory data up to the moment the patients discharge from hospital. An analysis of the clinical case showed that medical personnel alertness regarding the detection of SH after vacuum extraction delivery was a predetermining factor in the prognosis of the baby’s health and life. A particularly important step is to make a correct differential diagnosis of conditions similar to SH. Intensive infusion-transfusion therapy is in the first place while providing assistance and stabilizing the baby’s condition, since ongoing bleeding and hemorrhagic shock are the main causes of mortality in SH.

Objective. To assess comprehensive examination results in patients with adenomyosis. Subjects and methods. The investigation enrolled 59 reproductive-aged and premenopausal (40.5±6.2 years) patients with adenomyosis verified in 42 (71.2%) cases, with no concurrent uterine myoma, as well as 20 control group patients. The investigation used traditional methods, such as 3D ultrasound, magnetic resonance imaging, hysteroscopy and biopsy of the endometrium and myometrium, histological examination, and statistical methods. Results. The patients with adenomyosis were found to include persons who were younger than 35 years (28.8%), nulliparous (25.4%), and infertile (19.1%); those who had undergone peritoneal endometriosis (11.9%) or uterine (28.8%) surgeries; and those who had predominant dysmenorrhea (96.6%). The uterine volume was higher in 83.1% of adenomyosis patients than that in the control group (103.35±13.01 and 42.4±2.96 cm3, respectively; p=0.000); the myometrial wall asymmetry with a difference in the anterior and posterior wall thickness was 7.01±1.8 mm in 47.6% of patients; and the myometrial junctional zone thickness was >12 mm in 62.5%. There was an increased uterine radial and basal artery resistance index and reduced myometrial vascularization indices in comparison with the control (p<0.05). Conclusion. The presented diagnostic possibilities of traditional clinicomorphological studies and modern myometrial imaging techniques allow the timely detection of characteristic signs of adenomyosis.

The paper considers the role of risk factors (RFs) in the formation of low bone mineral density, starting with the prenatal period, early childhood and school age periods. An analysis has shown the characteristics of RFs in the examined children aged 9-17 years and their total negative effect on the development of osteoporosis and fractures in this category of patients. The paper also indicates a relationship of the frequency of bone fractures to the number of RFs risk factors and the presence of comorbidities. It provides a rationale for the pharmacological correction of vitamin D and calcium deficiency in children.

The paper presents the results of a study of the relationship between the type of body composition and the course of chronic erosive gastroduodenitis (CEGD) in children. The study involved 54 patients (34 boys, 20 girls) aged 12 to 18 years with CEGD. The body composition type of a child was determined using the Pinier index according to the procedure designed by M.V. Chernorutsky. All the patients underwent esophagogastroduodenoscopy with biopsy material sampling, followed by histopathological examination, a breathing test for Helicobacter pylori (Hp), a serological test for Hp IgG and IgM, and an objective examination. Among the children with CEGD, asthenics (68.5%) prevailed; hypersthenics (18.5%) and normosthenics (13%) were less common.

Therapy for patients with asthma during pregnancy provides a combination of maximizing benefits and minimizing risks for the mother and her baby. However, the number of studies dealing with therapy with different types of inhaled drugs is extremely scarce. Objective. To analyze the nature of the course of asthma during pregnancy, the incidence of complications of pregnancy and childbirth, as well as the health status of newborns in female patients with asthma treated with a combination of formoterol and budesonide. Subjects and methods. A clinical and functional examination and a follow-up were made in 2557 pregnant asthmatic women of childbearing age, as well as in their babies under 1 year old. Results. Among the patients taking the combination drug, the degree of asthma control was significantly higher and moderate and severe preeclampsia developed significantly less frequently than in the group as a whole. There was no impact of therapy with the combination drug of formoterol and budesonide on the timeliness of delivery. The weight and height and Apgar scores of the babies born to the mothers who used the combination drug were not different from the normal values. The incidence of atopic dermatitis in babies under the age of 1 year was significantly (p=0.029) lower in the babies whose mothers received therapy with the combination of formoterol and budesonide. Conclusion. The findings suggest the absence of a negative impact of therapy with the combination of formoterol and budesonide on the development of pregnancy complications, the timeliness of delivery, weight and height, and Apgar scores of newborns, as well as the presence of a positive impact on the controllability of the disease, on a decrease in the incidence of preeclampsia in patients with asthma and in that of atopic dermatitis in their babies.

The purpose of the study: to evaluate the effectiveness of the use of the drug bovgialuronidase azoximer in the complex therapy of inflammatory diseases of the pelvic organs in women of reproductive age. Material and methods. A comprehensive prospective clinical trial «Double-blind placebo-controlled multicenter randomized comparative study of the efficacy and safety of drugs, vaginal and rectal suppositories bovgialuronidase azoximer (NPO Petrovax Pharm LLC, Russia) in the complex therapy of patients with exacerbations of chronic inflammatory diseases of the pelvic organs» was conducted on the basis of the Clinic of FSBEI at KubSMU in 2017, which included 112 patients (average age 30.1±6.2 years). The patients were divided into 2 groups: group 1 - 58 women received the drug bovgialuronidase azoximer at a dose of 3000IU according to the scheme: 1 suppository rectally 1 time in 3 days 10 injections, then 1 suppository 1 time in 5 days 5 injections (total course - 15 suppositories); patients in the control group (n=54) received placebo suppositories, which were administered according to a similar scheme. Dynamic observation of the patients was carried out over the next three years. Results. In the patients of the main group, on the background of the treatment on day 5-7, subjective improvement was statistically significantly more frequent (50% vs 16.7%, respectively, x2=12.52, p=0.04). On the 10th-12th day, statistically significantly more often in the main group, positive dynamics of laboratory data (96.6% vs 68.5%, respectively, x2=15.5, p=0.04), normalization of vaginal biocenosis (96.6% vs 66.7%, respectively, x2=17.2, p=0.025) and subjective sensations (100% vs 87%, respectively,x2=7,906, p=0.04). With dynamic follow-up, the patients of the control group compared with the main group had a statistically significantly higher frequency of relapse of exacerbation of PID (31.5% vs 5.2%, x2=13.2, p=0.01) during the first 6 months of follow-up and during the first year of follow-up (40.7% vs 8.6%, x2=15.8, p=0.025), the onset of pregnancy is statistically significantly lower (25.9% vs 55.2%, x2=9.5, p= 0.04). Conclusion. The data revealed by us indicate that in women with PID who received, along with standard methods of treatment, the drug bovgialuronidase azoximer, there was a faster (3-5 days compared to the control group) disappearance of the main clinical symptoms, the number of pregnancies that occurred.

Objectives: the study of the influence of a new complex method of physical therapy with the inclusion of balance therapy with biofeedback and kinesihydrotherapy on the human balance function. Material and methods: the study included men and women aged 40 to 65 years with a body mass index >30 kg/m2. Research methods included anthropometry, stabilometry. The patients were further divided into two groups by simple randomization. Patients of both groups underwent a two-week course of medical rehabilitation. Patients of the main group received 4 methods of physical therapy: balance therapy, group classes in kinesihydrotherapy, group classes in a special complex of therapeutic exercises in the hall, aerobic exercises on a stationary bike or treadmill. The patients of the comparison group were treated only with the use of aerobic exercises and therapeutic exercises in the hall according to the same methodology and with the same number of procedures as in the main group. Dynamic observation was carried out at the beginning and after 14 days. Results: according to the data, we obtained an improvement in the balance function on the 14th day of the study in terms of spread along the front(p=0.028) and the spread along the sagittal (p=0.043). Significantly improved indicators in the main group in terms of the average speed of movement of the center of pressure (p=0.018) and the speed of movement of the statokinesiogram (p=0.028), indicators of the area of the ellipse (p=0.018). Conclusions: the new comprehensive program, including aerobic and strength physical training, kinesihydrotherapy and balance therapy, showed a more significant effect on the balance function after completion of the rehabilitation, rather than the standard rehabilitation method.

Diabetic polyneuropathy is one of the most common and significant complications of type 2 diabetes mellitus (DM2). The multicomponent pathogenesis of the development of diabetic polyneuropathy requires an integrated approach using both pharmacological and non-drug therapy. Objectives: to investigate the long-term results of the use of mesodiencephalic modulation in patients with diabetic distal polyneuropathy on the background of type 2 diabetes mellitus (DM2). Material and methods. The study included 120 patients aged 30 to 70 years with an established diagnosis of DM2, glycosylated hemoglobin level <8.5%, and diagnosed with severe or severe diabetic polyneuropathy of the lower extremities (more than 5 points on the NSS scale), who were simple randomization were divided into main and control groups. Patients of the main group received 13 procedures of mesodiencephalic modulation against the background of standard medical therapy for type 2 diabetes. In the control group, only standard therapy for DM2 was used. Examination of patients included the measurement of height, weight, body mass index, pain syndrome, severity of symptoms of diabetic polyneuropathy and fasting glycemia and was carried out at baseline, immediately after completion of therapy and dynamics after 3, 6 and 12 months after completion of treatment. Results. In patients of the main group, after a course of mesodiencephalic modulation, the achieved regression of neurological symptoms persisted for 8.04±0.27 months. Indicators of the dysfunctional score scale (NDS) 12 months after the end of treatment indicated a negative trend in patients of both groups. In patients of the control group, the manifestations of pain returned to the original (before treatment) values after 4.76±0.14 months, in the main group this period was 7.88±0.25 months. In contrast to the control, in patients of the main group, the body mass index returned to baseline after 3 months, and the level of fasting glycemia - after 6 months after completion of treatment. Conclusion. Data were obtained on the long-term preservation of the achieved effect after the use of mesodiencephalic modulation in patients with DM2 and the presence of diabetic polyneuropathy of the lower extremities.