No 6 (2015)

The correct choice of a treatment option for menopausal symptoms is of key value, by taking into account the broad spectrum of menopausal hormone therapy (MHT) drugs, including parenteral ones available in the arsenal of a modern-day physician. Objective. To consider the impact of therapy with transdermal estrogens alone or in combination with micronized progesterone on metabolic parameters and the incidence of arterial thrombosis and cholelithiasis in postmenopausal patients. Subject and methods. Proper-quality clinical and experimental studies published since 2002 on the safety of MHT for metabolic disorders, coronary heart disease, stroke, and cholelithiasis with focus on parental estradiol and m icronized progesterone were reviewed. Results. The studies given in the review show that the benefits and risks of MHT for metabolic disorders, coronary heart disease, and stroke are greatly different depending on the route of estradiol administration and the type of progestagen. The advantages of transdermal versus oral estrogens in increasing the risk of cholelithiasis are also of great importance for a population of postmenopausal women. Conclusion. The correct choice of a drug and its administration route during MHT is particularly important due to the expansion of time frames for this therapy in women having indications for this treatment.

Objective. To determine the efficiency of a cesarean section procedure with extraction of fetuses in the whole fetal bladder during twin pregnancy in relation to gestational age and the order of fetal birth. Subject and methods. Seventy cesarean sections in twins were analyzed, by determining the impact of the fetal extraction procedure on the duration of surgery, blood loss, neonatal status, and the incidence of diseases during the f irst year of life. Results. There was a statistically significant decrease in blood loss with an insignificant increase in the duration of surgery, as well as a considerable improvement of the fetal status after birth and reductions in rehabilitation measures, the length of hospital stay, neurological changes, the frequency of hospitalizations for fetuses extracted in the whole fetal bladder at any gestational age, and irrespective of the order of birth. Conclusion. The cesarean section procedure with fetal extraction in the whole fetal bladder shows its safety and efficiency for both the mother and her fetuses.

Objective. To determine the possibility of diagnosing preeclampsia from the urinary peptide profile. Subject and methods. To identify candidate peptide biomarkers for preeclampsia, a case-control study was performed in women with verified moderate to severe preeclampsia. Eight urine samples were examined in each woman with moderate to severe preeclampsia and in each control woman with physiological pregnancy. The peptide fraction was analyzed using first a MALDI-TOF mass spectrometer and then a Dionex 300 nanoflow chromatographer (USA) and a Maxis time-of-flight mass spectrometer (Bruker, Bremen, Germany). The findings were processed by bioinformatics techniques. Results. This investigation has revealed both some previously known peptide biomarkers of preeclampsia and a number of novel endogenous urinary peptides specific for severe preeclampsia. Out of them, a subgroup of 6 peptides, fragments of the α-chain of fibrinogen and collagens (types I and III), as well as uromodulin, which allow determination of the development of severe preeclampsia with 100% diagnostic value, may be identified. Conclusion. The investigation has shown the high diagnostic potential of a precision analysis of endogenous peptides in the urine of pregnant women, by applying chromatography mass spectrometry. The verification of the found marker peptides calls for investigations on a larger patient sample and for inclusion of additional comparison groups to estimate the specificity of a panel of peptides.

Objective. To study the time course of changes in the subpopulation composition of peripheral blood lymphocytes in the first trimester of pregnancy during immunocytotherapy in women with recurrent miscarriage of alloimmune genesis, including the subpopulations of killer cells with different phenotypes, those of natural regulatory T cells (Tregs) and CD200-carrying cells. Subjects and methods. The phenotype of lymphocytes was determined at 5-6 weeks before and at 8-9 and 12 weeks after immunizing 25 full-term pregnant patients and 11 control women twice with cells from their sexual partners. Results. There were no changes in CD3 +, CD4 +, and CD8 + lymphocytes, as well as killer cells (CD56 +, CD3 -CD56,16 +, CD56,16 +, CD3 +CD56,16 +, CD16 +, CD3 +CD16 +, and CD3 - CD16 +). At 12 weeks, there was an increase in Tregs and CD200-carrying cells to the values in the control group and a decrease in CD5 +CD19 + lymphocytes as compared with the control with the similar total content of B lymphocytes.

Objective. To study the local immunity of pregnant women with Candida vaginitis (CV) and to evaluate the efficiency of etiotropic therapy. Subjects and methods. A prospective cohort study of 125 women was conducted. A study group comprised 54 patients with CV; a comparison group consisted of 71 patients with vaginal normocenosis. Enzyme immunoassay was used to determine the concentrations of proinflammatory (TNF-α, IFN-γ, IL-1α, IL-2, and IL-6) and anti-inflammatory (IL-4, IL-10) cytokines in the cervical canal of women with the second and third trimesters of pregnancy; the mRNA gene expression of the above cytokines was estimated. The clinical and microbiological efficiency of topical therapy for CV was evaluated. Results. The study group, unlike the comparison one, was found to have significantly high pretreatment concentrations of the following cytokines: TNF-α, IFN-γ, IL-6, IL-1α, and IL-2. With their significant posttreatment reductions, the mean second-trimester levels of IFN-y and IL-1α were higher than those in the vaginal normocenosis group. The study group showed a strong inverse correlation in the production of IL-6 and IL-10 (r = -0.858) and no correlation between the concentrations of IL-6 and IL-4 (r = -0.02). In the pregnant women with CV, there was a statistically significantly higher pretreatment mRNA gene expression of both proinflammatory (IL-6, LIF) and anti-inflammatory (IL-10) cytokines. The clinical and microbiological efficiency of CV treatment was 92.6%; a disease recurrence was detected in 3 (5.6%) patients in the third trimester. Conclusion. In the pregnant women with CV, pretreatment local immunity is characterized by a significant increase in the higher levels of pro- and anti-inflammatory cytokines in reference with their production in those with normocenosis. The use of topical agents is pathogenetically sound as an inflammatory response becomes normal, by lowering the expression of the proinflammatory cytokines.

Objective. To study the time course of changes in the concentrations of sex hormones in the serum and follicular fluid of patients at high risk for ovarian hyperstimulation syndrome (OHSS) when replacing an ovulation trigger and during different variants of luteal phase support. Subjects and methods. The investigation enrolled 134 patients aged 20 to 39 years at high risk for OHSS. The patients were divided into three groups according to the injected ovulation trigger: 1) gonadotropin-releasing hormone (GnRH) agonist (GnRH-α) 0.2 mg (n = 48); 2) GnRH-α 0.2 mg in combination with human chorionic gonadotropin (hCG) 1500 IU (n = 45); 3) hCG 10,000 IU (n = 41). Micronized progesterone 600 mg/day and estradiol valerate 4 mg/day were used for luteal phase support in Groups 1 and 2. In Group 1, hCG was additionally injected in a dose of 1500 IU for luteal phase support on the day of transvaginal puncture (TVP). In Group 3, micronized progesterone was administered in a dose of 600 mg/day for luteal phase support. To estimate the concentrations of luteinizing hormone (LH), estradiol, and progesterone, peripheral blood was sampled on the days of ovulation triggering and TVP and on days 3 and 5 after TVP. The follicular fluid hormonal profile was determined in 66 patients: 23 women in Group 1, 23 women in Group 2, and 20 women in Group 3. Results. Analysis of the hormonal profile of the examined groups revealed that LH concentrations were statistically higher in the GnRH-α and GnRH-α + hCG groups than those in the hCG group. Estradiol on day 3 following TVP was statistically significantly higher in the GnRH-α group than in the hCG group whereas that on day 5 statistically significantly reduced in the GnRH-α + hCG group than in Groups 1 and 3. There was a statistically significant decrease in progesterone concentrations on day 5 after TVP in the GnRH-α + hCG group than in the Groups 1 and 3. In the GnRH-α group, progesterone concentrations on days 3 and 5 following TVP were comparable with those in the hCG group. The incidence of mild OHSS was 16.7% in Group 1, 27.3% in Group 2, and 36.6% in Group 3. In the GnRH-α group, all cases belonged to late OHSS that occurred during conception. No matter what ovulation trigger was used, the embryological parameters were identical in all the examined groups. There were no statistically significant differences in the rate of conception after embryo transfer and in that of pregnancy termination in all the groups. Conclusion. Modified support of the luteal phase effectively correlates its failure after replacement of an ovulation trigger, which enables effective prevention of OHSS, without having any impact on the rate of conception.

Objective. To study lipid peroxidation (LPO) processes and the antioxidant defense (AOD) system in women with postmenopause sleep disorders. Subjects and methods. Fifty-seven postmenopausal women, including 23 and 34 without and with sleep disorders, respectively, were examined. The latter group was divided into two subgroups: patients with insomnia (n = 18) and those with insomnia and snoring (n = 16). The investigation used spectrophotometric studies of the LPO-AOD system. The intergroup differences were estimated using the nonparametric criterion. Results. The patients with insomnia had elevated levels of LPO substrates and primary products while those with insomnia and snoring had higher levels of LPO substrates and thiobarbituric acid active products than the control group. The oxidative stress coefficient was 3.2 and 4.7 times greater than the reference value in the patients with insomnia and in those with insomnia and snoring, respectively. Conclusion. The findings suggest the development of evident oxidative stress in patients with postmenopause sleep disorders.

Objective. To make a meta-analysis of clinical trials of magnerot used in obstetric/gynecological practice. Subjects and methods. The meta-analysis covered the data of 6 randomized trials including a total of 214 patients treated with magnerot (a case group) and 192 receiving standard therapy or placebo (a control group). The mean age of the patients was 26±3 years; they took an average of 2000±775 mg/day for 1.3±1.0 months. The primary outcomes of meta-analysis were the uterine hypertonus and blood pressure index (BP); secondary - headache, weakness, heart rate (HR). Results. There were significant associations between the intake of the drug and the reductions in uterine hypertonus by 68% (OR, 0.32; (95% CI, 0.19-0.54; Р = 0.00019), weakness by 67% (OR, 0.33; 95% CI, 0.17-0.60; Р = 0.0051), and headache by 76% (OR, 0.24; 95% CI, 0.14-0.41, Р = 3.3x10 -6). The meta-analysis indicated

As of now, there are high growth rates of viral infections and, particularly, a rise in the rate of papillomavirus infection. Human papillomavirus infection initiates and maintains chronic inflammatory processes in the lower genital tract. The use of isoprinosine in the combination treatment of papillomavirus infection enhances the efficiency of the performed therapy, contributes to a pronounced anti-inflammatory effect, and leads to significant elimination of human papillomavirus.

The paper describes a case of fetal situs viscerum inversus diagnosed by ultrasound. A 28-year-old woman T. at 33 weeks’ gestation went to the center. Visceral ultrasonography revealed that the heart was formed on the left side and located on the left side; its apex was deflected leftwards. In the abdomen, the liver was on the left side, the stomach, spleen, and gallbladder were on the right side. No other visceral abnormality was detected. The correctness of ultrasound diagnosis was verified after childbirth. Conclusion. The antenatal diagnosis of fetal situs viscerum inversus is of great practical importance because it makes it possible to timely identify the presence or absence of a serious comorbid disease and, based on the findings, to decide whether it is expedient to preserve or to terminate pregnancy.