Vol 29, No 6 (2022)

Background. Primary dysmenorrhea (PD) is common, but patients rarely seek medical attention. In recent years, the literature has been replenished with new information about the pathogenesis and approaches to treatment. Basic provisions. The prevalence of PD varies widely in different regions, ranging from 16 to 91%. The clinical picture of PD, in addition to menstrual pain, is represented by a wide range of other symptoms, the frequency of which is individual. In pathogenesis, the theory of the leading role of prostaglandins, impaired contractile activity of the myometrium, it's ischemia and inflammatory reaction of the endometrium has been established. Treatment with non-steroidal anti-inflammatory drugs is pathogenetically justified, the effectiveness of which reaches 80-87.5%, combined oral contraceptives are considered as second-line aid with an efficiency of 62.5-72%. Certain foods, exercise, nutritional supplements, herbal medicines, and acupuncture have been shown to reduce pain and are recommended as adjunctive therapy. Conclusion. PD responds well to treatment with the use of modern drugs with proven efficacy, as well as methods of complementary and alternative therapy. Of the group of NSAIDs, naproxen (nexemezin) is highly effective and has a better safety profile (especially with regard to the cardiovascular system).

Kidney stone disease (KSD) is a significant problem in clinical practice. The frequency of stone formation in the population is steadily increasing, and there is currently no evidence of the effectiveness of drug therapy in the prevention of this nosology. In addition, KSD is one of the leading reasons for hospital visits, which is associated with an extremely pronounced pain syndrome. In this regard, special attention should be paid to the modifiable etiological factors of this disease. One of these factors is drugs, in this case, the term «drug-induced» (DI) KSD is used. The drugs lead to KSD through two main mechanisms: crystallization in the urine and the effect on metabolism. The main culprit medications of this disease, include antiviral, antibacterial drugs and triamterene which crystallize in the urine. Medicines such as antiepileptic drugs, calcium and vitamin D supplements, and vitamin C lead to lithogenesis, affecting metabolic processes. The mainstay of treatment is the withdrawal of the culprit medication, an increase in fluid intake and modification of the diet. The same measures, as well as the correction of modifiable risk factors, are necessary for prevention. The uniqueness of the work carried out is that a comprehensive analysis of the DI KSD problem was carried out, a single table was created that includes the prevalence of this disorder against the background of taking various drugs, the mechanism of lithogenesis and the levels of evidence for each drug. In addition, this article is distinguished by a combination of analysis of the pharmacological and clinical aspects of the DI KSD problem.

The article discusses the issues of cardiovascular safety of testosterone replacement therapy (TRT) in age-related androgen deficiency in men. TRT may exacerbate cardiovascular disease in some patients with suboptimal testosterone levels. In general, the risk of CVD with TRT is low. There are individual differences in the timing of the onset of age-related androgen deficiency in men, mainly due to the sexual constitution. Accordingly, the rate of progression of atherosclerosis will vary in different men of the same age, depending on the severity of testosterone deficiency and genetic factors. At the same time, the greatest risks, according to the data available to date, were noted in men over 60-65 years of age.

Background. Pelvic floor insufficiency (PPF), characterized by damage or weakness of the pelvic muscles, affects women of all ages, with an average prevalence of 50% and a peak in the older age group (77%). Main points. Among the conservative treatments for NTD, pelvic floor muscle training (PFMT) is recognized as the first line of therapy. An important condition for performing exercises is the use of a special device - iEASE XFT-0010 perineometer (a modern digital analogue of the perineometer invented by A. Kegel), which allows you to assess the strength of contractions, select an individual simulator, control the correctness of the exercises and the effectiveness of training in dynamics. PFMT is an effective treatment for pelvic organ prolapse and stress urinary incontinence. Numerous studies and meta-analyses have shown a decrease in the frequency and severity of symptoms, a decrease in the degree of prolapse and satisfaction with the results of treatment in 70% of patients who refused surgical treatment. Conclusion. PFMT are effective in the treatment and prevention of symptoms associated with pelvic floor dysfunction with patient education, regular exercise, and use of a perineometer.

Obesity is a risk factor for the development of gestational diabetes mellitus (GDM) and related adverse perinatal outcomes and maternal complications. To date, the role of genetic markers for the development of GDM, such as adiponectin, as well as hypovitaminosis D, is being actively studied. Relationships between obesity and GDM with adiponectin and vitamin D levels and pregnancy outcomes are described. GDM predictors include low adiponectin levels and hypovitaminosis D. It is necessary to determine the blood serum vitamin D level in pregnant women with obesity and GDM and maintain its optimal level by administration of vitamin D preparations to prevent complications in both the mother and the fetus.

Background. The prevalence of chronic endometritis (CE) in the population is recorded at the level of 14.1 to 24.4% but is significantly higher in patients with impaired reproductive function. CE is accompanied by increased production of cytokines and chemokines at the local level, the normalization of the secretion of which can contribute to the restoration of endometrial receptivity in infertile patients. Objective. Evaluation of the effectiveness of local immunotherapy using a complex of exogenous natural cytokines in patients with infertility caused by CE, according to follow-up data. Methods. A prospective randomized clinical trial was carried out. 76 women with CE (confirmed histologically) and infertility who underwent causal antibiotic therapy were examined. Further, group I (n=36) received Superlymph 25 IU vaginally daily for 20 days; group II (n=40) - no additional treatments. Treated patients were followed-up for 12 months. Data were available for 30 patients in group I and 24 in group II who became pregnant during this period. The data of history of childbirth, developmental histories of newborns and personal interviews were used. Results. Treatment with Superlymph had high clinical efficacy and the onset of pregnancy in 83.3% of patients within 12 months of follow-up versus 60% in patients who received only antibiotic therapy, and improved pregnancy outcomes - a 2-fold reduction in the frequency of preterm birth (60 versus 29 %, respectively; P=0.02) and spontaneous miscarriages by 2.5 times (17 vs. 42% at the early stages and 7 vs. 13% at the late ones, respectively; P=0.04). There was no effect of the drug on the course of pregnancy and the condition of the newborn. Conclusion. The use of Superlymph, which modulates the activity of cytokines, increases the body’s resistance and improves the results of treatment of patients with infertility in CE of a viral-bacterial nature.

Background. Currently, despite the wide possibilities for diagnosing adenomyosis, each method has its limitations and cannot be offered for a non-invasive, accurate, non-subjective diagnosis of the disease. Ultrasound examination according to the standard technique also does not have strict and unambiguous criteria for assessing the severity of internal endometriosis. The complex method proposed by us for performing ultrasound with assessment of the transition zone, vascularization and elastography, with a consistent assessment of all criteria by points, allows to unify ultrasound criteria and create uniform standards for consistent diagnosis of the disease. Description of the clinical case. The clinical case of a patient with adenomyosis presented in the article clearly demonstrates the diagnosis using the proposed ultrasound method before and 6 months after treatment, justifies the choice of drug therapy using dienogest 2 mg with positive dynamics. Conclusion. Thus, an objective diagnosis and determination of adenomyosis severity based on the new combined method of ultrasound assessment developed by us, the appointment of pathogenetically substantiated and effective drug therapy, as well as an individual approach, can eliminate the clinical manifestations of the disease, increase fertility and improve pregnancy outcomes.