Vol 30, No 4/5 (2023)

The problem of saving every desired pregnancy is relevant in our country due to the difficult demographic situation. Preterm morta-lity rates remain high. Data from studies on the prevention of preterm birth (PB) by administration of progesterone to women with risk factors (history of PB, short cervix, multiple pregnancies) are heterogeneous. Vaginal administration of micronized progesterone is preferred. Cerclage has shown an effect only in singleton pregnancies with previous spontaneous PB in combination with a short cervix. There is no evidence for prophylactic cerclage in multiple pregnancies, even in cases of short cervix. An emergency cerclage remains an indication after an individual consultation. The effect of the cervical pessary in singleton and multiple pregnancies in patients at risk of preterm birth appears to be promising compared to other secondary prevention options when therapy is initiated at the early stages of precocious cervical ripening. Approaches related to nutrition and the intake of dietary supplements for the prevention of PB (zinc, vitamin D, docosahexaenoic acid) are promising/ Smoking cessation before pregnancy is an effective measure to prevent PB. Conclusion. Decisions in favor of choosing one or another method of prevention of PB should be made individually in each case.

Currently, endothelial dysfunction (ED) is considered as an integral part of the pathogenesis of many chronic diseases. The endothelium is involved in leukocyte recruitment, permeability modulation, inflammation, coagulation, and changes in blood flow in response to disease progression or regression. The kidneys contain different types of endothelium, each with its own specific structural and functional characteristics, as well as being protected by thrombosis, inflammation, and complement regulators. Endothelial damage induced by antibodies, immune cells, or inflammatory cytokines can lead to acute or chronic kidney injury. The relevance of studying the mechanisms of ED in renal pathology is determined by the need to develop new therapeutic strategies aimed at preserving the function of the endothelium and improving the prognosis of the disease. The article provides data on the significance of ED in various kidney pathologies in children, including associated with the result of direct infection with SARS-CoV-2. The analysis included a collection of studies published in PubMed, ProQuest, GoogleScholar, Cochrane, ScienceDirect, Medline, AMED, EMBASE, CINHAL, SportDiscus, Scopus, and eLibrary for 2002–2022.

The review presents the prospects for the use of a combination of metronidazole and miconazole in the treatment of mixed vaginal infections with an emphasis on the most common pathogens of this pathology and possible complications that occur against the background of monocomponent therapy regimens. Taking into account intravaginal use, the mechanism of the pharmacological action of medicinal components that are part of combined preparations is discussed. The pharmacodynamic and pharmacokinetic mechanisms of action of metronidazole and miconazole are analyzed.

Background. Current trends in delayed motherhood dictate the search for new solutions to maintain women’s reproductive health. An increase in the average age of primiparas up to 30–40 years is unshakably accompanied by physiological aging of the ovaries and, accordingly, a decrease in the quality and number of germ cells.

Material and methods. The article highlights the results of the introduction of autologous platelet-rich plasma into the ovary. The analysis of clinical and anamnestic characteristics of patients, hormonal profile and the effectiveness of the procedure in preparation for in vitro fertilization programs was carried out.

Conclusion. The effectiveness of the autologous administration of platelet-rich plasma opens up new opportunities for patients with reduced ovarian reserve and certain hormonal profile parameters, but further research is required in this area.

Background: Vulvovaginal atrophy (VVA) is a chronic progressive disease that affects the female genital organs and lower urinary tract. This condition is associated with hypoestrogenia as a result of menopause, but can also develop in patients suffering from breast cancer after adjuvant hormonal therapy. Given the high prevalence of VVA and the expected increase in its incidence, and due to the increase in the mean age of women, it is easy to understand its significant social impact. VVA causes unpleasant disorders such as vaginal dryness, itching, burning, and dyspareunia, and requires ongoing treatment – when the therapy is stopped, the symptoms usually reappear. Currently available treatments include vaginal lubricants and moisturizers, vaginal estrogens and dehydroepiandrosterone (DHEA), and systemic hormone therapy. However, since these treatments have contraindications, lack of efficacy, and poor adherence to treatment, search for innovative, effective, and safe treatments is critical.

Objective. Evaluation of the efficacy and safety of dynamic quadripolar radiofrequency (DQRF™) therapy in the treatment of VVA in postmenopausal women.

Methods. The study included 180 women. The mean age of the patients was 52±4.3 years. All patients underwent a course of treatment: group 1 – the impact of DQRF^TM on the vagina and vulva, 4 procedures with an interval of 2 weeks; group 2 – DQRF™ in the mode of radioporation with estriol cream 0.5 mg, 4 procedures with an interval of 2 weeks; group 3 - local hormonal therapy with estriol cream 0.5 mg according to the scheme for 8 weeks. Evaluation of the effectiveness of treatment was carried out by measuring the vaginal pH, assessing the index of vaginal health, FSFI, VSQ questionnaires. In all groups, satisfaction with the appearance of the vulva was assessed according to VAS. For the clinical data of patients in each of the groups, the parameters were compared after treatment with a zero time point using paired and unpaired Mann-Whitney test. Comparison of changes in clinical parameters of the group 1 and 2 with the control group at each time point was made using the Mann-Whitney test.

Results. Analysis of the results of the study revealed a significant decrease in the severity of VVA symptoms one month after treatment in all groups. In the group 1, an increase in the mean vaginal health index in 40 (67%) women from 21.3 to 23.1 points (P<0.001), a decrease in the mean vaginal pH in 39 (65%) women from 6.8 to 4.9 (P<0.001), an increase in mean values of satisfaction with the appearance of the vulva in 48 (80%) patients according to VAS from 6.5 to 9.2 (P<0.001) were observed. In the group 2, there was an increase in the mean index of vaginal health in 50 (87%) women from 18.1 to 24.1 points (P<0.001), a decrease in the mean vaginal pH in 49 (85%) women from 7.0 to 4.5 (P<0.001), an increase in mean values of satisfaction with the appearance of the vulva in 48 (83%) patients according to VAS from 5.5 to 9.0 (P<0.001). Analysis of the results of the group 3 revealed an increase in the mean vaginal health index in 56 (90%) women from 19.1 to 24.5 points (P<0.001), a decrease in the mean vaginal pH in 53 (87%) women from 7.0 to 4.3 (P<0.001), an increase in mean values of satisfaction with the appearance of the vulva in 12 (20%) patients according to VAS from 5.5 to 7.0 (P<0.001).

Conclusion. The article confirms the safety and efficacy of DQRF™ procedures within 12 months of follow-up after the end of treatment sessions. Vaginal health index, vaginal pH, satisfaction with vulvar appearance, and female sexual function index (FSFI) were shown to improve rapidly to near normal levels. It has been shown that it is necessary to undergo a new course of DQRF™ therapy 6–9 months after the previous cycle, and not 9–12 months after, as previously suggested. This algorithm provides maintaining the level of women’s health indicators and quality of life at a high level. This work has shown that it is possible to use only DQRF™ procedures without the use of local hormonal therapy with comparable, and sometimes even superior results. This may be especially true for patients who have had cancer and/or cardiovascular diseases, as well as for patients who refuse hormonal treatment.

Background. External genital endometriosis (EGE) is a chronic, relapsing, progressive, hormone-dependent disease characterized by a benign growth of tissue outside the uterine cavity, similar in morphological structure and functions to the endometrium. The versatility of the pathogenetic mechanisms of the development of the disease, the variability of clinical symptoms, as well as the lack of a unified concept of endometriosis therapy dictate the need to find modern methods for correcting this pathology. Retinol may be one of these areas.

Objective. Determination of the retinol level of in peripheral blood and peritoneal fluid in patients with EGE, evaluation of the effectiveness of its use on the basis of surgically induced endometriosis in Wistar rats.

Methods. The main group included 38 patients with a histologically confirmed (based on laparoscopy) diagnosis of I-IV stage EGE according to the revised classification of the American Society for Reproductive Medicine (r-ASRM); mean age of patients was 31.7±4.1 years. The control group consisted of 10 patients without endometriosis who underwent diagnostic laparoscopy before entering the protocol of assisted reproductive technologies. Determination of the blood serum and peritoneal fluid vitamin A level in was carried out using Cloud-Clone Corp kits by ELISA.

Experimental model. A surgically induced model of endometriosis was performed on 21 mature female Wistar rats. The creation of the experimental model was carried out in three stages. The first stage was the modeling of the disease, the second was the confirmation of the presence of endometriosis based on laparoscopy and the assessment of the area of endometrioid heterotopias, followed by drug therapy of the disease; the third stage was the removal of animals from the experiment, the assessment of the area of endometrioid heterotopias in dynamics, and histological examination.

Results and discussion. Based on our study, it was found that patients with endometriosis have an increased blood serum vitamin A level, which significantly exceeds its level in the peritoneal fluid by 2 times, especially in the initial forms of the disease. An «artificial» increase in the level of retinol in the blood serum can be mediated by many reasons, primarily by disorders of its metabolism and changes in the retinol-binding protein 4 expression, that justifies the need for further research to study in depth the role of vitamin A in the pathogenesis of endometriosis. At the same time, the high efficiency of the use of retinol, characterized by complete resorption of endometriosis foci based on an experimental model of a surgically induced disease in Wistar rats, makes it possible to consider retinol as a promising method of treating the disease.

Background. The study of the effect of pregnancy hormones on the occurrence and course of extrasystolic arrhythmia is one of the most difficult issues in modern medicine.

Objective. Evaluation of the effect of chorionic gonadotropin, progesterone, thyroid hormones and type 1 diastolic dysfunction on the occurrence and course of ventricular extrasystole in pregnant women.

Methods. 32 pregnant women with ventricular extrasystole (Group 1) and 30 pregnant women without extrasystole (Group 2) without heart pathology, aged 19–38 years (mean age 29.8±2.4 years) were examined. Research methods included general clinical studies, electrocardiogram (ECG), echocardiography (EchoCG), 24-hour ECG monitoring, determination of the levels of chorionic gonadotropin, progesterone, and thyroid hormones.

Results. A close relationship (p<0.05) between chorionic gonadotropin and thyroid-stimulating hormone levels and extrasystole was revealed. A regression model predicting the course of extrasystolic arrhythmia in pregnant women with AF was constructed. It was found that the predictive value of the equation is 98.6%. The antiarrhythmic effect of the combined use of potassium preparations with magnesium was established.

Background. According to statistics, the frequency of recurrence of endometrial polyps (EP) is 25.9–78%. Despite the knowledge of the pathology, the diagnosis of RP is confirmed histologically only in 50–82% of cases [5, 8, 14]. One of the urgent problems of modern gynecology is to improve the efficiency of diagnosing endometrial pathology on an outpatient basis, clarifying the causes and preventing relapses.

Objective. Identification of the frequency of EP recurrence in patients of reproductive age, evaluation of the existing diagnostic methods and identification of possible causes of EP recurrence based on a retrospective analysis.

Methods. A retrospective analysis of the case histories of 1356 patients (mean age 47.8±0.6 years) with a diagnosis of EP over a three-year period, followed by an analysis of the case histories of 246 women of reproductive age (mean age 36.6±0.8) and 52 patients of reproductive age with EP recurrence was carried out.

Results. According to the data obtained from all observed patients with EP, 18.1% were women of reproductive age. At the same time, the frequency of EP recurrence in the examined women of reproductive age was 21.2% (52 patients). In 14 (26.9%) patients, a relapse occurred on the background of hormonal therapy. Also, 25% of the examined patients had a combination of relapse with a hyperplastic process of the genitals: adenomyosis, uterine myoma, endocervical polyp. At the same time, extragenital pathology, most often pathology of the thyroid gland, was revealed in all examined women.

Conclusion. In the diagnosis of EP, office hysteroscopy and ultrasound provide a high percentage of concurrence of diagnoses, in addition, office hysteroscopy is effective in diagnosing concomitant intrauterine pathology. In the presence of ultrasound diagnostics and office hysteroscopy in the diagnosis of pathology of the uterine cavity, priority should be given to office hysteroscopy due to the accuracy of diagnosis and the possibility of obtaining a biopsy for histological confirmation of the diagnosis. EP recurrence in women of reproductive age was noted in 21.2% of cases. In every fourth patient, a relapse occurred against the background of combined hyperplastic processes of the genitals, as well as against the background of hormonal therapy or hormonal contraception.

Background. The problems of women’s reproductive aging and the need to maintain and improve the quality of life and health of women during the period of age-related changes are an urgent task of modern medicine, especially in the light of existing demographic trends. Genitourinary menopausal syndrome (GUMS) is a symptom complex that occurs in women against the background of a deficiency of estrogens and other sex steroids, including physiological and anatomical changes in the vagina, urethra, bladder, vulva and perineum.

Objective. Evaluation of the effectiveness of vulva biorevitalization with preparations based on hyaluronic acid (HA) in combination with hardware methods for the relief of local symptoms of GUMS and lichen sclerosus (LS).

Methods. The study included 40 patients: 20 with GUMS (group 1) and 20 with LS (group 2). The follow-up period was up to 6 months. Patients aged 24–65 years were included, the median age of patients in both groups was 42 years. Injections with MesoHydral or Hydro Line Extra (in both groups) or Nucleospire DNA-RNA 2% (only in the LS group) were administered. All patients tolerated the procedures well, there were no side effects, and the patients were satisfied with the treatment.

Conclusion. Thus, preparations of this type can be recommended not only for practical use, but also for further, possibly more detailed and broad study of the spectrum of their capabilities.

Background. Among all functional gastrointestinal disorder, the most common nosological form is functional constipation (FC). In Western countries, it is estimated to be diagnosed in 2–27% of the population. The expansion of ideas about the mechanisms of the formation of FC contributes to the expansion of the possibilities of treating this condition.

Objective. Evaluation of the effectiveness of various treatment regimens for FC in children.

Methods. The study included 106 patients aged 4 to 17 years, 51 (48.1%) were boys and 55 (51 .9%) girls, who underwent outpatient treatment due to FC at the Consultative and Diagnostic Center of the Children’s Scientific and Clinical Center for Infectious Diseases of the Federal Medical and Biological Agency. Rome IV criteria were used for the diagnosis of FC. Drug treatment of FC was carried out in three groups formed in accordance with the treatment regimen: group 1 – lactulose (n=39), group 2 – functional food product (FPP) “multi-grain protein-spelled” bread (n=33), group 3 – lactulose+FPP functional “multi-grain protein-spelled” bread (n=34). Intestinal microbiocenosis in children was assessed at the beginning of treatment and on the 21st day by examining fecal samples by real-time PCR, which was performed at the Department of Molecular Microbiology, Institute of Experimental Medicine.

Results. Complete pain relief after the course of treatment was achieved in 64 children (60.4%). Depending on the chosen drug regimen, there were significant differences in the frequency of complete long-term relief of FC symptoms: in group 1 – in 21 (53.8%), in group 2 – in 19 (57.6%), in group 3 – in 24 (70, 6%). Decrease in the Lactobacillus spp. and Bifidobacterium spp. level was most typical. This indicator was lower than the reference values by 2 lg CFU/g in 22 children from group 3 (64.7.7%) and 24 children from group 2 (72.7%). It should also be noted that the use of functional bread “protein spelled many grains” contributed to the restoration of normal levels of these parameters.

Conclusion. Combination therapy of FC using functional bread “protein spelled many grains” in combination with laxatives increases the effectiveness of treatment, providing a significantly more effective restoration of microbiocenosis parameters and a reduction in the duration of clinical symptoms. The use of functional bread “protein spelled many grains” as monotherapy also had an effect on the symptoms of the disease, contributing to the normalization of the frequency of bowel movements and the reduction of symptoms associated with stool retention.

Background. Pharmacogenetic testing is an effective method of predicting the safety of pharmacotherapy. Some antipsychotics can now be prescribed based on genotyping results - for example, haloperidol. The pharmacogenetics of haloperidol safety in adolescents with an acute psychotic episode are poorly understood at this time.

Objective. To identify pharmacogenetic predictors of adverse reactions to haloperidol in adolescents with an acute psychotic episode.

Methods. A prospective observational study included 56 adolescents diagnosed with acute polymorphic psychotic disorder. Patients were followed up for 14 days. All patients received haloperidol as their primary pharmacotherapy. Safety of psychopharmacotherapy was assessed using UKU Side Effects Rating Scale (UKU SERS), Sympson-Angus Scale (SAS), Barnes Akathisia rating scale (BARS). CYP3A4*22 (rs2740574), CYP3A5*3 (6986A>G, rs7776746), CYP2D6*4,*9 gene polymorphisms,*10 (rs3892097, rs1065852), ABCB1 1236C>T (rs1128503), 2677G>T/A (rs2032582), 3435C>T (rs1045642), COMT rs4680 (G>A - Val158Met), DRD3 rs6280 (C>T), DRD3 rs324026 (C>T), HTR2A rs6313 (T102C), ZNF804A rs1344706 (G>T), ANKS1B rs7968606 (C>T) were determined by real-time polymerase chain reaction (PCR). Results. Carriage of the COMT rs4680 polymorphism (Met allele) was associated with a lower severity of adverse psychiatric reactions. The presence of the HTR2A rs6313 and ZNF804A rs1344706 polymorphisms was significantly associated with a higher UKU SERS scale score. Carriers of the HTR2A rs6313 polymorphism variant (TC+CC genotypes) complained more frequently about the development of tremor (37.2 vs. 0%, p=0.009). Carriage of ABCB1 1236C>T and 2677G>T/A was more frequently associated with the presence of orthostatic vertigo (35 vs. 6.3%, p=0.028, due to nonequilibrium linkage, the data were the same for both polymorphic variants). The incidence of orthostatic vertigo was significantly higher in carriers of the ZNF804A rs1344706 polymorphism (37.5 vs. 12.5%; p=0.037). Carriers of the DRD3 rs6280 and rs324026 polymorphisms were less likely to develop «increased dream intensity.»

Conclusion. An increased risk of adverse reactions was observed in carriers of HTR2A rs6313 polymorphisms (TC+CC genotypes), ABCB1 1236C>T and 2677G>T/A, ZNF804A rs1344706. Carriage of COMT rs4680 (Met allele), DRD3 rs6280 and rs324026 was found to be associated with a lower severity of adverse reactions compared to «wild-type» genotypes.

This article discusses the immune status of the mother in gestational diabetes mellitus (GDM). Normal pregnancy is characterized by a controlled state of the immune system at the early stages of pregnancy. Various immunological mediators adapt to the state of pregnancy, all of which affect maternal and fetal health. GDM, defined as impaired glucose tolerance of any degree during pregnancy, is a serious obstetric complication affecting approximately 5–10% of pregnant women worldwide. Hyperglycemia causes immune dysfunction by negatively affecting neutrophil chemotaxis, macrophage function, and phagocytic responses, making diabetic patients more susceptible to infections and associated comorbidities. The state of pregnancy along with immunological changes, imbalances of innate and adaptive cellular responses present additional health risks. Insulin plays an indispensable role in the treatment of hyperglycemia that occurs in various conditions, including in type I and type II diabetes; insulin has an anti-apoptotic effect and reduces the expression of pro-inflammatory cytokines in human endotoxemic macrophages. Metformin or sulfonylurea derivatives may also be used for the treatment of GDM. Metformin suppresses immune responses mainly through its direct effect on the cellular functions of various types of immune cells. Glyburide enhances the anti-inflammatory response and synergizes with retinoic acid. A better understanding of development if immune dysfunctions during hyperglycemia could lead to new treatments and prevention for infectious diseases and DM2 comorbidities, thereby improving infectious disease outcomes in DM2 patients. These results require further study of the role of drugs such as insulin, metformin, and glyburide in the immunoregulation of the pathophysiology of GDM.

Surgical treatment in gynecological practice is characterized by a relatively high incidence of postoperative complications, including pain, inflammation, infections, adhesions, etc. Systemic oral enzyme therapy can contribute to the prevention of complications and their effective relief. The drug Flogenzym has the necessary anti-inflammatory, analgesic and antiplatelet effects due to the complex action of its components, successfully prevents and reduces the intensity of possible negative consequences of surgical treatment.

This article provides an analysis of the data presented in the world literature regarding the role of the endometrium in terms of reproductive failures, as well as modern methods of treating infertility caused by uterine factor. The review includes the results of studies and meta-analyses published in PubMed journals on this topic. The combination of many factors that affect the effectiveness of the interaction between the embryo and endometrial tissue makes it difficult to identify the true causes of reproductive failure in patients with uterine factor infertility. To date, the main methods of treating infertility associated with thinning of the endometrium are aimed at stimulating its growth and improving the blood supply to the uterus. A relatively new, but very promising direction in modern regenerative and reproductive medicine is the use of autologous platelet-rich plasma (Platelet-Rich Plasma – PRP) in patients with reproductive failures.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, with up to 70% of cases remaining undiagnosed as a result of significant clinical heterogeneity. This review describes in detail the diagnostic criteria for PCOS, analyzes the existing phenotypes of the disease, and also describes the etiopathogenetic significance of insulin resistance (IR) in the development of hyperandrogenism and reproductive disorders. For the choice of treatment tactics, the importance not only of accurate diagnosis of PCOS, but also of determining the clinical phenotype of the disease with a detailed analysis of the morphological structure of the ovaries and an additional study of metabolic parameters, such as body weight and IR index, is emphasized. A differentiated approach to the prescription of insulin sensitizers for various PCOS phenotypes has been substantiated.

The article is devoted to the formation of the dominant of motherhood and breastfeeding in women. A course of classes and lectures has been developed, including issues of nutrition during pregnancy, breastfeeding, care, nutrition of a child in the first year of life. The effectiveness of the developed course was evaluated.