Pub Date : 2023-01-01DOI: 10.32364/2618-8430-2023-6-3-9
S.A. Khlynova, Yu.E. Dobrokhotova, S.B. Kerchelaeva, A.D. Fisenko, V.I. Dimitrova
Aim: to evaluate the efficacy of an antiseptic disinfectant containing benzyl-dimethyl-[3-(tetradecanoylamino)propyl] ammonium chloride as an active ingredient in the form of vaginal suppositories as a preoperative management for scheduled surgery in women with vaginal microbiocenosis disorder. Patients and Methods: a prospective open-label study of the prevention of postoperative complications in 58 women admitted to a gynecological short-stay unit was conducted. The initial examination included history taking, comprehensive clinical and laboratory examinations, bacterioscopy of cervical and vaginal discharge with Gram stain, and vaginal discharge pH measurement. Surgery (diagnostic dilation and curettage along with hysteroscopy for endometrial hyperplasia) was scheduled in all women. 8.0±1.0 days before surgery, preoperative treatment to prevent infectious complications was performed using benzyl-dimethyl-[3-(tetradecanoylamino)propyl] ammonium chloride monohydrate in the form of 15-mg vaginal suppositories (1 suppository), once daily for 7 days. 30 days after surgery, re-examination of vaginal microflora and microbiocenosis was performed in all women. Results: an increase in WBC count, mixed microflora, and Candida spores were detected at the first visit. Before preventive treatment, vaginal microbiocenosis was characterized by a decrease in the number of obligate microbes in the vaginal biotope. No infectious postoperative complications were reported, and the early and late postoperative period was uneventful. In 56 women (96.5%), normocenosis was revealed (19 women were previously diagnosed with bacterial vaginosis, 25 with candidiasis, and 12 with nonspecific vaginitis). Two women (3.5%) had intermediate-type vaginal microbiocenosis. In 54 women (93.1%), the preparation was well-tolerated, while 4 women (6.9%) complained of short-term burning. Conclusions: the preparation can be recommended as a preventive antiseptic agent before scheduled minor gynecological surgeries in women with vaginal microbiocenosis disorder. KEYWORDS: minor gynecological surgeries, postoperative infectious inflammatory complications, prevention, vaginal microflora, hysteroscopy, antiseptic agent. FOR CITATION: Khlynova S.A., Dobrokhotova Yu.E., Kerchelaeva S.B., Fisenko A.D., Dimitrova V.I. Prevention of infectious complications in minor gynecological surgeries. Russian Journal of Woman and Child Health. 2023;6(3):270–275 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-9.
{"title":"Prevention of infectious complications in minor gynecological surgeries","authors":"S.A. Khlynova, Yu.E. Dobrokhotova, S.B. Kerchelaeva, A.D. Fisenko, V.I. Dimitrova","doi":"10.32364/2618-8430-2023-6-3-9","DOIUrl":"https://doi.org/10.32364/2618-8430-2023-6-3-9","url":null,"abstract":"Aim: to evaluate the efficacy of an antiseptic disinfectant containing benzyl-dimethyl-[3-(tetradecanoylamino)propyl] ammonium chloride as an active ingredient in the form of vaginal suppositories as a preoperative management for scheduled surgery in women with vaginal microbiocenosis disorder. Patients and Methods: a prospective open-label study of the prevention of postoperative complications in 58 women admitted to a gynecological short-stay unit was conducted. The initial examination included history taking, comprehensive clinical and laboratory examinations, bacterioscopy of cervical and vaginal discharge with Gram stain, and vaginal discharge pH measurement. Surgery (diagnostic dilation and curettage along with hysteroscopy for endometrial hyperplasia) was scheduled in all women. 8.0±1.0 days before surgery, preoperative treatment to prevent infectious complications was performed using benzyl-dimethyl-[3-(tetradecanoylamino)propyl] ammonium chloride monohydrate in the form of 15-mg vaginal suppositories (1 suppository), once daily for 7 days. 30 days after surgery, re-examination of vaginal microflora and microbiocenosis was performed in all women. Results: an increase in WBC count, mixed microflora, and Candida spores were detected at the first visit. Before preventive treatment, vaginal microbiocenosis was characterized by a decrease in the number of obligate microbes in the vaginal biotope. No infectious postoperative complications were reported, and the early and late postoperative period was uneventful. In 56 women (96.5%), normocenosis was revealed (19 women were previously diagnosed with bacterial vaginosis, 25 with candidiasis, and 12 with nonspecific vaginitis). Two women (3.5%) had intermediate-type vaginal microbiocenosis. In 54 women (93.1%), the preparation was well-tolerated, while 4 women (6.9%) complained of short-term burning. Conclusions: the preparation can be recommended as a preventive antiseptic agent before scheduled minor gynecological surgeries in women with vaginal microbiocenosis disorder. KEYWORDS: minor gynecological surgeries, postoperative infectious inflammatory complications, prevention, vaginal microflora, hysteroscopy, antiseptic agent. FOR CITATION: Khlynova S.A., Dobrokhotova Yu.E., Kerchelaeva S.B., Fisenko A.D., Dimitrova V.I. Prevention of infectious complications in minor gynecological surgeries. Russian Journal of Woman and Child Health. 2023;6(3):270–275 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-9.","PeriodicalId":34075,"journal":{"name":"RMZh Mat'' i ditia","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135010539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: allergic rhinitis (AR) is the leading pathology in pediatric practice. Improvement of the diagnostic accuracy and preventive measures in AR is the priority task. Aim: to evaluate the efficacy of the proposed cascade algorithm of diagnosis and preventive medicated therapy for children at high risk of AR. Patients and Methods: a retrospective epidemiological analysis was conducted in five regions of the Central Federal District for 2017–2021, where the main risk factors of AR were identified. The article proposes a screening cascade and a three-step diagnostic algorithm of AR, as well as high-risk group identification with the indication of preventive medicated therapy. The efficacy of the proposed technique was evaluated in the catamnestic study. Results: during the follow-up, there was a steady increase of AR in all regions — from 1,472 to 2,684%. 28 risk factors were identified, of which 12 were controlled factors. According to the highest risk factor probability, 4 age groups were identified: from birth to 5 years, 6–7 years, 8–12 years and children 13 years and older. In the group receiving preventive therapy, AR was verified in the catamnesis 2 times less common — in 12 instead of 24%. Thus, the patients at high risk of AR require preventive medicated therapy and constant follow-up at certain age periods. Conclusion: this article presents the evaluation of the proposed diagnostic cascade efficacy, the identification of the group at high risk of AR and the justification concerning the use of preventive medicated therapy of AR in this group during acute respiratory infection. KEYWORDS: allergic rhinitis, preventive therapy, polymorphism, heart rate variability, microcirculation. FOR CITATION: Berezhanskiy P.V., Malakhov A.B., Geppe N.A., Kolosova N.G., Tataurshchikova N.S. Diagnostics and preventive therapy of allergic rhinitis in children: modern algorithm. Russian Journal of Woman and Child Health. 2023;6(3):276–282 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-11.
{"title":"Diagnostics and preventive therapy of allergic rhinitis in children: modern algorithm","authors":"P.V. Berezhanskiy, A.B. Malakhov, N.A. Geppe, N.G. Kolosova, N.S. Tataurshchikova","doi":"10.32364/2618-8430-2023-6-3-11","DOIUrl":"https://doi.org/10.32364/2618-8430-2023-6-3-11","url":null,"abstract":"Background: allergic rhinitis (AR) is the leading pathology in pediatric practice. Improvement of the diagnostic accuracy and preventive measures in AR is the priority task. Aim: to evaluate the efficacy of the proposed cascade algorithm of diagnosis and preventive medicated therapy for children at high risk of AR. Patients and Methods: a retrospective epidemiological analysis was conducted in five regions of the Central Federal District for 2017–2021, where the main risk factors of AR were identified. The article proposes a screening cascade and a three-step diagnostic algorithm of AR, as well as high-risk group identification with the indication of preventive medicated therapy. The efficacy of the proposed technique was evaluated in the catamnestic study. Results: during the follow-up, there was a steady increase of AR in all regions — from 1,472 to 2,684%. 28 risk factors were identified, of which 12 were controlled factors. According to the highest risk factor probability, 4 age groups were identified: from birth to 5 years, 6–7 years, 8–12 years and children 13 years and older. In the group receiving preventive therapy, AR was verified in the catamnesis 2 times less common — in 12 instead of 24%. Thus, the patients at high risk of AR require preventive medicated therapy and constant follow-up at certain age periods. Conclusion: this article presents the evaluation of the proposed diagnostic cascade efficacy, the identification of the group at high risk of AR and the justification concerning the use of preventive medicated therapy of AR in this group during acute respiratory infection. KEYWORDS: allergic rhinitis, preventive therapy, polymorphism, heart rate variability, microcirculation. FOR CITATION: Berezhanskiy P.V., Malakhov A.B., Geppe N.A., Kolosova N.G., Tataurshchikova N.S. Diagnostics and preventive therapy of allergic rhinitis in children: modern algorithm. Russian Journal of Woman and Child Health. 2023;6(3):276–282 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-11.","PeriodicalId":34075,"journal":{"name":"RMZh Mat'' i ditia","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135010064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32364/2618-8430-2023-6-1-34-38
D. Merzlyakova, N. R. Hafizova, G. A. Vakhitova, Z. A. Shangareeva, G. G. Gilyazova, A.I. Nazarova
Aim: to assess the status of bone mineral density (BMD) using the ultrasound densitometry as a screening technique in premature in vitro fertilization (IVF) and non-IVF infants weighing less than 1500 g at birth. Patients and Methods: the study included 189 premature babies who stayed in the department for newborns and premature infants with health problems. The infants were divided into two groups, depending on the IVF use: born through the IVF or conceived naturally. Each of the groups was divided into two subgroups based on the infant weight at birth: subgroups A consisted of very low birth weight (VLBW) babies and subgroups B consisted of extremely low birth weight (ELBW) babies. The first group (n=101) consisted of IVF-infants, 52 and 49 of them were included in subgroups 1A and 1B, respectively. The second group (comparison, n=88) consisted of the naturally conceived infants, 46 and 42 of them were included in subgroups 2A and 2B, respectively. BMD was measured using the ultrasound densitometry method. The evaluated parameters comprised the speed of sound (SOS) and Z-score, representing the difference in BMD between the studied infants and the mean BMD of other children of the same age and gender (standard deviation (SD) for the tibia). Z-score <-1 SD (SOS <10 ‰ and >3‰) was associated with a low bone density and Z-score <-2 SD (SOS <3 ‰) – with a clinically significant low bone density. Results: the normal values of bone density were found in 39 (38.6%) infants of group 1 and 58 (65.9%) infants of group 2 (p>0.05). In the group 1 infants a decrease in bone density was found more frequently than in the group 2 infants: 49 (48.5%) and 21 (23.8%), respectively, p<0.05, and the difference was statistically significant (<-1SD). A clinically significant low bone density (SOS <3‰) found in 13 (12.8%) IVF- babies. The extremely low birth weight (ELBW) in IVF-babies is a risk factor for osteopenia and osteoporosis. Conclusion: a significant decrease in the bone density values (SOS <10‰ and >3‰) was found in IVF-infants as compared to those in naturally conceived infants. A clinically significant decrease in bone density in premature IVF-infants with ELBW was reported in 12.8% of cases. The early diagnosis of osteopenia can be established by using a safe technique — the ultrasound densitometry. KEYWORDS: bone mineral density, densitometry, in vitro fertilization, IVF, premature babies, osteopenia, bone tissue, screening, very low birth weight, extremely low birth weight. FOR CITATION: Merzlyakova D.R., Hafizova N.R., Vakhitova G.A. et al. The assessment of bone strength based on the results of ultrasound densitometry in infants born after in vitro fertilization (IVF) weighing less than 1500 g. Russian Journal of Woman and Child Health. 2023;6(1):34–38 (in Russ.). DOI: 10.32364/2618-8430-2023-6-1-34-38.
{"title":"The assessment of bone strength based on the results of ultrasound densitometry in infants born after in vitro fertilization (IVF) weighing less than 1500 g","authors":"D. Merzlyakova, N. R. Hafizova, G. A. Vakhitova, Z. A. Shangareeva, G. G. Gilyazova, A.I. Nazarova","doi":"10.32364/2618-8430-2023-6-1-34-38","DOIUrl":"https://doi.org/10.32364/2618-8430-2023-6-1-34-38","url":null,"abstract":"Aim: to assess the status of bone mineral density (BMD) using the ultrasound densitometry as a screening technique in premature in vitro fertilization (IVF) and non-IVF infants weighing less than 1500 g at birth. Patients and Methods: the study included 189 premature babies who stayed in the department for newborns and premature infants with health problems. The infants were divided into two groups, depending on the IVF use: born through the IVF or conceived naturally. Each of the groups was divided into two subgroups based on the infant weight at birth: subgroups A consisted of very low birth weight (VLBW) babies and subgroups B consisted of extremely low birth weight (ELBW) babies. The first group (n=101) consisted of IVF-infants, 52 and 49 of them were included in subgroups 1A and 1B, respectively. The second group (comparison, n=88) consisted of the naturally conceived infants, 46 and 42 of them were included in subgroups 2A and 2B, respectively. BMD was measured using the ultrasound densitometry method. The evaluated parameters comprised the speed of sound (SOS) and Z-score, representing the difference in BMD between the studied infants and the mean BMD of other children of the same age and gender (standard deviation (SD) for the tibia). Z-score <-1 SD (SOS <10 ‰ and >3‰) was associated with a low bone density and Z-score <-2 SD (SOS <3 ‰) – with a clinically significant low bone density. Results: the normal values of bone density were found in 39 (38.6%) infants of group 1 and 58 (65.9%) infants of group 2 (p>0.05). In the group 1 infants a decrease in bone density was found more frequently than in the group 2 infants: 49 (48.5%) and 21 (23.8%), respectively, p<0.05, and the difference was statistically significant (<-1SD). A clinically significant low bone density (SOS <3‰) found in 13 (12.8%) IVF- babies. The extremely low birth weight (ELBW) in IVF-babies is a risk factor for osteopenia and osteoporosis. Conclusion: a significant decrease in the bone density values (SOS <10‰ and >3‰) was found in IVF-infants as compared to those in naturally conceived infants. A clinically significant decrease in bone density in premature IVF-infants with ELBW was reported in 12.8% of cases. The early diagnosis of osteopenia can be established by using a safe technique — the ultrasound densitometry. KEYWORDS: bone mineral density, densitometry, in vitro fertilization, IVF, premature babies, osteopenia, bone tissue, screening, very low birth weight, extremely low birth weight. FOR CITATION: Merzlyakova D.R., Hafizova N.R., Vakhitova G.A. et al. The assessment of bone strength based on the results of ultrasound densitometry in infants born after in vitro fertilization (IVF) weighing less than 1500 g. Russian Journal of Woman and Child Health. 2023;6(1):34–38 (in Russ.). DOI: 10.32364/2618-8430-2023-6-1-34-38.","PeriodicalId":34075,"journal":{"name":"RMZh Mat'' i ditia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69552023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32364/2618-8430-2023-6-1-39-44
M. Savenkova, I.A. Sotnikov, A. A. Afanasieva, Ya.V. Afanasieva, R. Dushkin
Aim: to assess the prevalence of detection of confirmed herpes virus infections (HVI) in children who had a previous COVID-19 infection, characterize specific clinical manifestations of the disease under the new conditions (post-COVID syndrome), and to provide a rationale for the administration of drug therapy. Patients and Methods: of 456 patients who received medical consultations from September 2021 to July 2022, the authors selected 72 (15.8%) children (42 boys and 30 girls) who had a previous SARS-CoV-2 infection confirmed by serological tests or polymerase chain reaction and in whom herpes viruses were found during serological evaluation. Results: most of the children (81.4%) visited the polyclinic within the first six months after the COVID-19 infection. Epstein-Barr virus (EBV) was the most prevalent finding among herpesviruses detected in children with post-COVID-19 sequela — it was detected in 44 (61.1%) cases. Human herpesvirus (HHV) 6 and cytomegalovirus (CMV) were less common in this group and found in 41 (56.9%) and 30 (41.7%) children, respectively. HHV-1 and HHV-2 were detected more rarely — in 11 (15.3%) children. Monoinfection was diagnosed in 41 (56.9%) cases and a combination of viruses was found in 31 children, in 22 (71.0%) of them it comprised two viruses, in 6 (19.3%) — three viruses, and in 3 (9.7%) — four viruses. The presence of herpesvirus infections underpinned the main reasons why parents of the ill children were seeking for outpatient care, in particular: a prolonged subfebrile condition (18.0%), fatigue and sleep disorders (27.7%), rashes (16.6%), lymphadenopathy (16.7%), ENT diseases (33.3%), more frequently occurring respiratory diseases (33.3%), and the increase in seizure activity in children with epilepsy (8.3%). In addition to herpes viruses, pathogenic agents were detected in 18% of patients, including intracellular pathogens, which were found in 13.9% of 72 children. Taking into consideration the obtained results and established clinical diagnoses, the authors conducted a review and provided a rationale for the administered drug therapy, including medications for herpes treatment. Conclusion: a prior COVID-19 infection induces immunosuppression and, as a result, the activation of herpesvirus infections as long-term effects of COVID-19 (post-COVID conditions). The presence of mixed viral and bacterial pathogens is an indication for administering antivirals, immunomodulators, antibacterial agents, and probiotics. KEYWORDS: post-COVID conditions, herpesvirus infections, children, clinical symptoms, treatment. FOR CITATION: Savenkova M.S., Sotnikov I.A., Afanasieva A.A. et al. Importance of herpes viruses in children with post-COVID conditions. Russian Journal of Woman and Child Health. 2023;6(1):39–44 (in Russ.). DOI: 10.32364/2618-8430-2023-6-1-39-44.
{"title":"Importance of herpes viruses in children with post-COVID conditions","authors":"M. Savenkova, I.A. Sotnikov, A. A. Afanasieva, Ya.V. Afanasieva, R. Dushkin","doi":"10.32364/2618-8430-2023-6-1-39-44","DOIUrl":"https://doi.org/10.32364/2618-8430-2023-6-1-39-44","url":null,"abstract":"Aim: to assess the prevalence of detection of confirmed herpes virus infections (HVI) in children who had a previous COVID-19 infection, characterize specific clinical manifestations of the disease under the new conditions (post-COVID syndrome), and to provide a rationale for the administration of drug therapy. Patients and Methods: of 456 patients who received medical consultations from September 2021 to July 2022, the authors selected 72 (15.8%) children (42 boys and 30 girls) who had a previous SARS-CoV-2 infection confirmed by serological tests or polymerase chain reaction and in whom herpes viruses were found during serological evaluation. Results: most of the children (81.4%) visited the polyclinic within the first six months after the COVID-19 infection. Epstein-Barr virus (EBV) was the most prevalent finding among herpesviruses detected in children with post-COVID-19 sequela — it was detected in 44 (61.1%) cases. Human herpesvirus (HHV) 6 and cytomegalovirus (CMV) were less common in this group and found in 41 (56.9%) and 30 (41.7%) children, respectively. HHV-1 and HHV-2 were detected more rarely — in 11 (15.3%) children. Monoinfection was diagnosed in 41 (56.9%) cases and a combination of viruses was found in 31 children, in 22 (71.0%) of them it comprised two viruses, in 6 (19.3%) — three viruses, and in 3 (9.7%) — four viruses. The presence of herpesvirus infections underpinned the main reasons why parents of the ill children were seeking for outpatient care, in particular: a prolonged subfebrile condition (18.0%), fatigue and sleep disorders (27.7%), rashes (16.6%), lymphadenopathy (16.7%), ENT diseases (33.3%), more frequently occurring respiratory diseases (33.3%), and the increase in seizure activity in children with epilepsy (8.3%). In addition to herpes viruses, pathogenic agents were detected in 18% of patients, including intracellular pathogens, which were found in 13.9% of 72 children. Taking into consideration the obtained results and established clinical diagnoses, the authors conducted a review and provided a rationale for the administered drug therapy, including medications for herpes treatment. Conclusion: a prior COVID-19 infection induces immunosuppression and, as a result, the activation of herpesvirus infections as long-term effects of COVID-19 (post-COVID conditions). The presence of mixed viral and bacterial pathogens is an indication for administering antivirals, immunomodulators, antibacterial agents, and probiotics. KEYWORDS: post-COVID conditions, herpesvirus infections, children, clinical symptoms, treatment. FOR CITATION: Savenkova M.S., Sotnikov I.A., Afanasieva A.A. et al. Importance of herpes viruses in children with post-COVID conditions. Russian Journal of Woman and Child Health. 2023;6(1):39–44 (in Russ.). DOI: 10.32364/2618-8430-2023-6-1-39-44.","PeriodicalId":34075,"journal":{"name":"RMZh Mat'' i ditia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69552044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32364/2618-8430-2023-6-2-130-137
E. Kudinova
Aim: to study the hemostasis indicators in female patients with hyperandrogenism (HA) and menstrual disorders (MDs) during combined oral contraceptive (COC) intake, depending on the presence of undifferentiated connective tissue displasia (UCTD). Patients and Methods: the study results of 28 female patients with HA and MDs were divided into 2 groups: group 1 — 22 patients (mean age 22.1±3.2 years) with UCTD, group 2 — 6 patients (mean age 20.5±1.8 years) without UCTD. The content of hormones in the blood (on the 2nd–3rd day of the menstrual period), the parameters of hemostasis before and after 1 month of COCs intake, and the level of homocysteine were determined in all patients. Results: the analysis revealed an increase in the levels of platelet activation markers, coagulation link and fibrinolysis. During COCs intake, an increase in the fibrinogen content was noted in patients of both groups, which, however, did not exceed the reference values. During the correlation analysis, it was found that in groups 1 and 2, the parameters of the fibrinogen baseline, D-dimer and the corresponding indicators after 1 month of COCs intake had a strong correlation with each other (r=0.845, r=0.864). However, group 1 had higher levels of fibrinogen and fibrin degradation products (D-dimer) (p<0.0001) versus those in group 2. The study on the trend of prothrombin time (PTT) and activated partial thromboplastin time (APTT) during COCs intake in female patients with HA and UCTD revealed an acceleration of indicators (p<0.01) versus those before COCs intake. At the same time, the change in blood clotting markers was not realized by episodes of thrombosis in any of the patients. Conclusion: patients with UCTD had changes that characterized the activation of thrombogenesis. When planning hormonal contraception, it is necessary to single out a group of female patients with HA and signs of UCTD as the most vulnerable in relation to an increased risk of thrombogenic events. KEYWORDS: hyperandrogenism, combined oral contraceptive, thrombosis, connective tissue dysplasia, hyperhomocysteinemia. FOR CITATION: Kudinova E.G. Hormonal contraception in terms of effect on the hemostasis system. Russian Journal of Woman and Child Health. 2023;6(2):130–137 (in Russ.). DOI: 10.32364/2618-8430-2023-6-2-130-137.
{"title":"Hormonal contraception in terms of effect on the hemostasis system","authors":"E. Kudinova","doi":"10.32364/2618-8430-2023-6-2-130-137","DOIUrl":"https://doi.org/10.32364/2618-8430-2023-6-2-130-137","url":null,"abstract":"Aim: to study the hemostasis indicators in female patients with hyperandrogenism (HA) and menstrual disorders (MDs) during combined oral contraceptive (COC) intake, depending on the presence of undifferentiated connective tissue displasia (UCTD). Patients and Methods: the study results of 28 female patients with HA and MDs were divided into 2 groups: group 1 — 22 patients (mean age 22.1±3.2 years) with UCTD, group 2 — 6 patients (mean age 20.5±1.8 years) without UCTD. The content of hormones in the blood (on the 2nd–3rd day of the menstrual period), the parameters of hemostasis before and after 1 month of COCs intake, and the level of homocysteine were determined in all patients. Results: the analysis revealed an increase in the levels of platelet activation markers, coagulation link and fibrinolysis. During COCs intake, an increase in the fibrinogen content was noted in patients of both groups, which, however, did not exceed the reference values. During the correlation analysis, it was found that in groups 1 and 2, the parameters of the fibrinogen baseline, D-dimer and the corresponding indicators after 1 month of COCs intake had a strong correlation with each other (r=0.845, r=0.864). However, group 1 had higher levels of fibrinogen and fibrin degradation products (D-dimer) (p<0.0001) versus those in group 2. The study on the trend of prothrombin time (PTT) and activated partial thromboplastin time (APTT) during COCs intake in female patients with HA and UCTD revealed an acceleration of indicators (p<0.01) versus those before COCs intake. At the same time, the change in blood clotting markers was not realized by episodes of thrombosis in any of the patients. Conclusion: patients with UCTD had changes that characterized the activation of thrombogenesis. When planning hormonal contraception, it is necessary to single out a group of female patients with HA and signs of UCTD as the most vulnerable in relation to an increased risk of thrombogenic events. KEYWORDS: hyperandrogenism, combined oral contraceptive, thrombosis, connective tissue dysplasia, hyperhomocysteinemia. FOR CITATION: Kudinova E.G. Hormonal contraception in terms of effect on the hemostasis system. Russian Journal of Woman and Child Health. 2023;6(2):130–137 (in Russ.). DOI: 10.32364/2618-8430-2023-6-2-130-137.","PeriodicalId":34075,"journal":{"name":"RMZh Mat'' i ditia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69552527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32364/2618-8430-2023-6-2-199-205
E. Yupatov, T. Kurmanbaev, I. G. Mustafin, R. M. Nabiullina, N. Safina, E. Frederiks, M. Leonova, A. T. Khaertdinov, N. I. Fattakhova, V. D. Starikova
Preeclampsia is one of the so-called major obstetrical syndromes and a cause of maternal and neonatal morbidity worldwide. In addition, preeclampsia increases the risk of maternal and neonatal cardiovascular disorders and cerebrovascular diseases in the future. During pregnancy, the pregnant mother undergoes significant changes in the functions of various organ systems to accommodate the developing fetus. The onset of preeclampsia can cause dysfunction of multiple organs and systems, including the homeostasis system. Its dysfunction is associated with the most serious thrombohemorrhagic complications (premature detachment of normally situated placenta, thrombosis, embolism, and bleeding). It is important to understand the relationship between the maternal and fetal homeostasis system functioning. The homeostasis system functioning in the fetus and newborn infant has specific characteristics expressed not only in the quantitative composition and the level of activity of its main links, but also in the qualitastive composition, as well as in the functioning mechanisms which differ from those in adults. The above specific characteristics help to achieve an important balance in the homeostasis system functioning. Preeclampsia, associated conditions and complications can disturb the existing balance and homeostasis system functioning in the fetus and newborn infant with the development of thrombohemorrhagic complications. KEYWORDS: homeostasis system, newborn infants, preeclampsia, specific characteristics of functioning, preterm newborn infants, pregnancy. FOR CITATION: Yupatov E.Yu., Kurmanbaev T.E., Mustafin I.G. et al. Hemostasis functioning in neonates: normal condition and condition in preeclampsia (literature review). Russian Journal of Woman and Child Health. 2023;6(2):199–205 (in Russ.). DOI: 10.32364/2618-8430- 2023-6-2-199-205.
{"title":"Hemostasis functioning in neonates: normal condition and condition in preeclampsia (literature review)","authors":"E. Yupatov, T. Kurmanbaev, I. G. Mustafin, R. M. Nabiullina, N. Safina, E. Frederiks, M. Leonova, A. T. Khaertdinov, N. I. Fattakhova, V. D. Starikova","doi":"10.32364/2618-8430-2023-6-2-199-205","DOIUrl":"https://doi.org/10.32364/2618-8430-2023-6-2-199-205","url":null,"abstract":"Preeclampsia is one of the so-called major obstetrical syndromes and a cause of maternal and neonatal morbidity worldwide. In addition, preeclampsia increases the risk of maternal and neonatal cardiovascular disorders and cerebrovascular diseases in the future. During pregnancy, the pregnant mother undergoes significant changes in the functions of various organ systems to accommodate the developing fetus. The onset of preeclampsia can cause dysfunction of multiple organs and systems, including the homeostasis system. Its dysfunction is associated with the most serious thrombohemorrhagic complications (premature detachment of normally situated placenta, thrombosis, embolism, and bleeding). It is important to understand the relationship between the maternal and fetal homeostasis system functioning. The homeostasis system functioning in the fetus and newborn infant has specific characteristics expressed not only in the quantitative composition and the level of activity of its main links, but also in the qualitastive composition, as well as in the functioning mechanisms which differ from those in adults. The above specific characteristics help to achieve an important balance in the homeostasis system functioning. Preeclampsia, associated conditions and complications can disturb the existing balance and homeostasis system functioning in the fetus and newborn infant with the development of thrombohemorrhagic complications. KEYWORDS: homeostasis system, newborn infants, preeclampsia, specific characteristics of functioning, preterm newborn infants, pregnancy. FOR CITATION: Yupatov E.Yu., Kurmanbaev T.E., Mustafin I.G. et al. Hemostasis functioning in neonates: normal condition and condition in preeclampsia (literature review). Russian Journal of Woman and Child Health. 2023;6(2):199–205 (in Russ.). DOI: 10.32364/2618-8430- 2023-6-2-199-205.","PeriodicalId":34075,"journal":{"name":"RMZh Mat'' i ditia","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69553756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fetal growth restriction (FGR) is an integral term for a group of conditions in which the fetus does not reach the size potentially embedded in its genome. FGR is the main cause of perinatal mortality. Commonly, FGR develops due to placental insufficiency. At the same time, there are very few levers of control on this pathology by obstetricians and gynecologists. The authors present preclinical and clinical study review concerning drugs for the FGR prevention and its therapy, as well as the role of nitric oxide (NO). Currently, it is possible to determine the risk group based on the history and data from the first trimester screening, as well as to use acetylsalicylic acid (ASA) for the preventive measures. During the study, there are several drugs that can potentially not only prevent FGR but also improve the condition course with, when the diagnose is already established. Conducting randomized clinical trials, where the primary endpoint would be the FGR, will allow to assess the safety and efficacy of the proposed medicines and advance them into clinical practice. KEYWORDS: fetal growth restriction, prevention, acetylsalicylic acid, nitric oxide, randomized clinical trials, small for gestational age. FOR CITATION: Osipov R.S., Kuznetsov P.A., Dzhokhadze L.S., Shuginin I.O. What's new in the prevention and therapy of fetal growth restriction? Role of nitric oxide. Russian Journal of Woman and Child Health. 2023;6(3):258–264 (in Russ.). DOI: 10.32364/2618-8430- 2023-6-3-7.
{"title":"What's new in the prevention and therapy of fetal growth restriction? Role of nitric oxide","authors":"R.S. Osipov, P.A. Kuznetsov, L.S. Dzhokhadze, I.O. Shuginin","doi":"10.32364/2618-8430-2023-6-3-7","DOIUrl":"https://doi.org/10.32364/2618-8430-2023-6-3-7","url":null,"abstract":"Fetal growth restriction (FGR) is an integral term for a group of conditions in which the fetus does not reach the size potentially embedded in its genome. FGR is the main cause of perinatal mortality. Commonly, FGR develops due to placental insufficiency. At the same time, there are very few levers of control on this pathology by obstetricians and gynecologists. The authors present preclinical and clinical study review concerning drugs for the FGR prevention and its therapy, as well as the role of nitric oxide (NO). Currently, it is possible to determine the risk group based on the history and data from the first trimester screening, as well as to use acetylsalicylic acid (ASA) for the preventive measures. During the study, there are several drugs that can potentially not only prevent FGR but also improve the condition course with, when the diagnose is already established. Conducting randomized clinical trials, where the primary endpoint would be the FGR, will allow to assess the safety and efficacy of the proposed medicines and advance them into clinical practice. KEYWORDS: fetal growth restriction, prevention, acetylsalicylic acid, nitric oxide, randomized clinical trials, small for gestational age. FOR CITATION: Osipov R.S., Kuznetsov P.A., Dzhokhadze L.S., Shuginin I.O. What's new in the prevention and therapy of fetal growth restriction? Role of nitric oxide. Russian Journal of Woman and Child Health. 2023;6(3):258–264 (in Russ.). DOI: 10.32364/2618-8430- 2023-6-3-7.","PeriodicalId":34075,"journal":{"name":"RMZh Mat'' i ditia","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135009476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT In January 2023, European Society of Human Reproduction and Embryology (ESHRE) has released updated recommendations on recurrent pregnancy loss to replace the previous 2017 version. All changes and addendum to the recommendations in the guidelines were formulated after evaluating the most qualitative and relevant evidence that appeared in the literature and their discussion by an expert group. The authors of this article have analyzed the main points of the updated ESHRE recommendations. The article discusses whether new tactics have appeared in the patient management with recurrent pregnancy loss, whether they should be adopted by a practicing physician, and whether they differ from the recommendations of the Russian Society of Obstetricians and Gynecologists regulating the actions of Russian medical specialists during the work with female patients having the appropriate diagnosis. Based on the analysis, the authors concluded that the expert groups that compiled clinical recommendations on recurrent pregnancy loss are mostly in solidarity on fundamental issues. On the one hand, the Russian recommendations look more reasonable in some issues, but on the other, the recommendations are likely to be revised taking into account new data. KEYWORDS: recurrent pregnancy loss, habitual abortion, pregnancy, ESHRE, clinical recommendations, RSOG, assisted reproductive technologies. FOR CITATION: Dobrokhotova Yu.E., Kuznetsov P.A., Dzhokhadze L.S. Current discourse on recurrent pregnancy loss (ESHRE Protocol 2023, National Clinical Guidelines "Recurrent Pregnancy Loss" 2021, materials of the World Congress of ESHRE 2023). Russian Journal of Woman and Child Health. 2023;6(3):219–225 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-1.
{"title":"Current discourse on recurrent pregnancy loss (ESHRE Protocol 2023, National Clinical Guidelines \"Recurrent Pregnancy Loss\" 2021, materials of the World Congress of ESHRE 2023)","authors":"Yu.E. Dobrokhotova, P.A. Kuznetsov, L.S. Dzhokhadze","doi":"10.32364/2618-8430-2023-6-3-1","DOIUrl":"https://doi.org/10.32364/2618-8430-2023-6-3-1","url":null,"abstract":"ABSTRACT In January 2023, European Society of Human Reproduction and Embryology (ESHRE) has released updated recommendations on recurrent pregnancy loss to replace the previous 2017 version. All changes and addendum to the recommendations in the guidelines were formulated after evaluating the most qualitative and relevant evidence that appeared in the literature and their discussion by an expert group. The authors of this article have analyzed the main points of the updated ESHRE recommendations. The article discusses whether new tactics have appeared in the patient management with recurrent pregnancy loss, whether they should be adopted by a practicing physician, and whether they differ from the recommendations of the Russian Society of Obstetricians and Gynecologists regulating the actions of Russian medical specialists during the work with female patients having the appropriate diagnosis. Based on the analysis, the authors concluded that the expert groups that compiled clinical recommendations on recurrent pregnancy loss are mostly in solidarity on fundamental issues. On the one hand, the Russian recommendations look more reasonable in some issues, but on the other, the recommendations are likely to be revised taking into account new data. KEYWORDS: recurrent pregnancy loss, habitual abortion, pregnancy, ESHRE, clinical recommendations, RSOG, assisted reproductive technologies. FOR CITATION: Dobrokhotova Yu.E., Kuznetsov P.A., Dzhokhadze L.S. Current discourse on recurrent pregnancy loss (ESHRE Protocol 2023, National Clinical Guidelines \"Recurrent Pregnancy Loss\" 2021, materials of the World Congress of ESHRE 2023). Russian Journal of Woman and Child Health. 2023;6(3):219–225 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-1.","PeriodicalId":34075,"journal":{"name":"RMZh Mat'' i ditia","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135009489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32364/2618-8430-2023-6-3-5
O.E. Bryzgalova, O.V. Armashevskaya
Aim: to present a medical and social portrait of an expectant mother living in a metropolis. Patients and Methods: 400 expectant mothers underwent a sociological survey, which included several blocks of closed and open questions covering a wide range of life activities in expectant mothers who sought medical help on an outpatient basis in the profile "Obstetrics and Gynecology". Results: according to the data obtained, the portrait of the modern expectant mother in the metropolis is: 30.5 years old; officially married; has her first sexual experience before adulthood; higher or incomplete higher education; actively participates in public life; family income level is approx. 50 thousand rubles per person; leads a healthy lifestyle; uses contraceptives for protection from an unwanted pregnancy; plans to have two children. Conclusion: the following obtained data showed the need for extensive information and preventive activities in the medical care provision (according to the profile «Obstetrics and Gynecology») in outpatient settings which can bring enrichment knowledge and communication skills for medical specialists: increase in the expectant mother age up to 30 years, sexual relationship debut in half of women before adulthood, knowledge acquisition concerning STDs from medical professionals in only a third of the surveyed female patients, as well as the preference for barrier methods of contraception. KEYWORDS: medical and social portrait, expectant mother, pregnancy, reproductive health, metropolis, outpatient conditions. FOR CITATION: Bryzgalova O.E., Armashevskaya O.V. Expectant mother in the metropolis: medical and social portrait. Russian Journal of Woman and Child Health. 2023;6(3):247–252 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-5.
{"title":"Expectant mother in the metropolis: medical and social portrait","authors":"O.E. Bryzgalova, O.V. Armashevskaya","doi":"10.32364/2618-8430-2023-6-3-5","DOIUrl":"https://doi.org/10.32364/2618-8430-2023-6-3-5","url":null,"abstract":"Aim: to present a medical and social portrait of an expectant mother living in a metropolis. Patients and Methods: 400 expectant mothers underwent a sociological survey, which included several blocks of closed and open questions covering a wide range of life activities in expectant mothers who sought medical help on an outpatient basis in the profile \"Obstetrics and Gynecology\". Results: according to the data obtained, the portrait of the modern expectant mother in the metropolis is: 30.5 years old; officially married; has her first sexual experience before adulthood; higher or incomplete higher education; actively participates in public life; family income level is approx. 50 thousand rubles per person; leads a healthy lifestyle; uses contraceptives for protection from an unwanted pregnancy; plans to have two children. Conclusion: the following obtained data showed the need for extensive information and preventive activities in the medical care provision (according to the profile «Obstetrics and Gynecology») in outpatient settings which can bring enrichment knowledge and communication skills for medical specialists: increase in the expectant mother age up to 30 years, sexual relationship debut in half of women before adulthood, knowledge acquisition concerning STDs from medical professionals in only a third of the surveyed female patients, as well as the preference for barrier methods of contraception. KEYWORDS: medical and social portrait, expectant mother, pregnancy, reproductive health, metropolis, outpatient conditions. FOR CITATION: Bryzgalova O.E., Armashevskaya O.V. Expectant mother in the metropolis: medical and social portrait. Russian Journal of Woman and Child Health. 2023;6(3):247–252 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-5.","PeriodicalId":34075,"journal":{"name":"RMZh Mat'' i ditia","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135009137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32364/2618-8430-2023-6-1-26-30
E. A. Sandakova, I. G. Zhukovskaya
Sexuality is defined as a physical, emotional, psychological, and social welfare state associated with sexual desires. The prevalence of sexual dysfunction among postmenopausal women is estimated to be 68% to 87%. The most significant causes of sexual disorders in this period are physiological changes of female body, psychological problems, lack of special knowledge, and male health status. Sexual function is linked to the complex neurotransmitter-hormone interaction both at the central and peripheral levels. The major cause of sexual dysfunction in postmenopausal women is genitourinary menopausal syndrome. Most commonly, gynecologist becomes a first contact physician dealing with female sexual disorders. Sexual dysfunction diagnosis in postmenopause includes the use of validated questionnaires, the assessment of the type and severity of menopausal disorders, the impact of somatic diseases and psychological issues, as well as a thorough physical examination. As sexual dysfunction in postmenopausal women is caused by multiple factors and has a complex pathogenesis, it is necessary to set up a multidisciplinary approach to problem solving. According to the biopsychosocial model, gynecologist has a wide range of therapeutic options for dealing with sexual disorders — pharmacotherapy (hormonal and non-hormonal agents), rational psychotherapy, and multimodal treatment methods. KEYWORDS: sexual dysfunction, postmenopause, sexual hormones, estrogens, androgens, genitourinary menopausal syndrome, biopsychosocial model of healthcare. FOR CITATION: Sandakova E.A., Zhukovskaya I.G. Gynecological aspects of sexual dysfunction in the postmenopausal women. Russian Journal of Woman and Child Health. 2023;6(1):26–30 (in Russ.). DOI: 10.32364/2618-8430-2023-6-1-26-30.
{"title":"Gynecological aspects of sexual dysfunction in the postmenopausal women","authors":"E. A. Sandakova, I. G. Zhukovskaya","doi":"10.32364/2618-8430-2023-6-1-26-30","DOIUrl":"https://doi.org/10.32364/2618-8430-2023-6-1-26-30","url":null,"abstract":"Sexuality is defined as a physical, emotional, psychological, and social welfare state associated with sexual desires. The prevalence of sexual dysfunction among postmenopausal women is estimated to be 68% to 87%. The most significant causes of sexual disorders in this period are physiological changes of female body, psychological problems, lack of special knowledge, and male health status. Sexual function is linked to the complex neurotransmitter-hormone interaction both at the central and peripheral levels. The major cause of sexual dysfunction in postmenopausal women is genitourinary menopausal syndrome. Most commonly, gynecologist becomes a first contact physician dealing with female sexual disorders. Sexual dysfunction diagnosis in postmenopause includes the use of validated questionnaires, the assessment of the type and severity of menopausal disorders, the impact of somatic diseases and psychological issues, as well as a thorough physical examination. As sexual dysfunction in postmenopausal women is caused by multiple factors and has a complex pathogenesis, it is necessary to set up a multidisciplinary approach to problem solving. According to the biopsychosocial model, gynecologist has a wide range of therapeutic options for dealing with sexual disorders — pharmacotherapy (hormonal and non-hormonal agents), rational psychotherapy, and multimodal treatment methods. KEYWORDS: sexual dysfunction, postmenopause, sexual hormones, estrogens, androgens, genitourinary menopausal syndrome, biopsychosocial model of healthcare. FOR CITATION: Sandakova E.A., Zhukovskaya I.G. Gynecological aspects of sexual dysfunction in the postmenopausal women. Russian Journal of Woman and Child Health. 2023;6(1):26–30 (in Russ.). DOI: 10.32364/2618-8430-2023-6-1-26-30.","PeriodicalId":34075,"journal":{"name":"RMZh Mat'' i ditia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69551942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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