Introduction. Acute decompensation of heart failure (AHF) can cause acute kidney injury (AKI), hyponatremia, episodes of oliguria and polyuria in the treatment of furosemide. These complications lengthen the time of hospitalization, increase the economic costs of treatment and worsen the prognosis. Currently, the relationship of these manifestations in patients with CHF has not been studied. Objective. To evaluate the effect of AKI on the rate of diuresis and the level of plasma sodium during the complex therapy of AHF. Materials and methods . Kidney function was assessed in 125 patients receiving complex therapy for AHF. The glomerular filtration rate (GFR) was determined in two ways: by the level of creatinine and cystatin C in blood serum. The number of AKI, hyponatremia, episodes of oliguria and polyuria were studied. An analysis of the relationship between these events was carried out. Results. At the time of admission to the hospital, the study of GFR by the level of cystatin C showed 2.6 times more AKI than by the level of creatinine. In total, AKI was found in 22.4% of cases, hyponatremia in 24.8%, episodes of oliguria in 18.4%, episodes of polyuria in 24.8%. The analysis showed that there is a connection of violations of the rate of diuresis and hyponatremia with AKI. Conclusions. Сases of impaired urinary excretion and hyponatremia during AHF therapy are more common in patients with AKI.
{"title":"Characteristics of acute kidney injury in patients with acute decompensation of heart failure","authors":"V. V. Davydov, E. L. Arehina","doi":"10.21518/ms2023-319","DOIUrl":"https://doi.org/10.21518/ms2023-319","url":null,"abstract":"Introduction. Acute decompensation of heart failure (AHF) can cause acute kidney injury (AKI), hyponatremia, episodes of oliguria and polyuria in the treatment of furosemide. These complications lengthen the time of hospitalization, increase the economic costs of treatment and worsen the prognosis. Currently, the relationship of these manifestations in patients with CHF has not been studied. Objective. To evaluate the effect of AKI on the rate of diuresis and the level of plasma sodium during the complex therapy of AHF. Materials and methods . Kidney function was assessed in 125 patients receiving complex therapy for AHF. The glomerular filtration rate (GFR) was determined in two ways: by the level of creatinine and cystatin C in blood serum. The number of AKI, hyponatremia, episodes of oliguria and polyuria were studied. An analysis of the relationship between these events was carried out. Results. At the time of admission to the hospital, the study of GFR by the level of cystatin C showed 2.6 times more AKI than by the level of creatinine. In total, AKI was found in 22.4% of cases, hyponatremia in 24.8%, episodes of oliguria in 18.4%, episodes of polyuria in 24.8%. The analysis showed that there is a connection of violations of the rate of diuresis and hyponatremia with AKI. Conclusions. Сases of impaired urinary excretion and hyponatremia during AHF therapy are more common in patients with AKI.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"20 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135463094","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}
The presented contains the discussion about the role of echocardiography in management of patients with hypertrophic cardiomyopathy (HCM). The article provides general information about the role of echocardiography in the diagnosis of the disease, clarification of the specific etiology of hypertrophy and differential diagnosis with secondary hypertrophy and phenocopies of HCMP. The features of right and left ventricular (LV) hypertrophy, determination of its predominant localization, phenotype, and conventionally used parameters for assessing myocardial hypertrophy, including the maximum LV wall thickness, LV myocardial mass and LV myocardial mass index, are discussed in detail. Knowledge of phenotypic variants helps to diagnose HCMP, to differentiated approach the management of patients and to choose the optimal treatment strategy. Special attention is paid to the assessment of the structure and function of the mitral valve (MV), the subvalvular apparatus and the phenomenon of systolic anterior motion of the MV responsible for the development of obstruction of the LV outflow tract. The previously existing opinion that cardiac abnormality in HCMP is limited only by hypertrophy of ventricular myocardium has recently undergone changes. Approximately 60% of patients with HCMP have at least one MV anomaly as a direct consequence of genetic mutations. The most common abnormalities that can be detected with echocardiography include elongation of the valvular leaflets and chords, prolapse of the valvular leaflets, hypertrophy, disposition and change in the number of papillary muscles. The importance and significance of assessing LV systolic and diastolic functions using echocardiography is emphasized. The role of transesophageal echocardiography in visualization of hypertrophy features of the MV structure and in the perioperative period during surgical correction of hypertrophied septum and valvular defects is also discussed.
{"title":"The role of echocardiography in management of patients with hypertrophic cardiomyopathy (review)","authors":"G. G. Taradin, G. A. Ignatenko, I. V. Rakitskaya","doi":"10.21518/ms2023-265","DOIUrl":"https://doi.org/10.21518/ms2023-265","url":null,"abstract":"The presented contains the discussion about the role of echocardiography in management of patients with hypertrophic cardiomyopathy (HCM). The article provides general information about the role of echocardiography in the diagnosis of the disease, clarification of the specific etiology of hypertrophy and differential diagnosis with secondary hypertrophy and phenocopies of HCMP. The features of right and left ventricular (LV) hypertrophy, determination of its predominant localization, phenotype, and conventionally used parameters for assessing myocardial hypertrophy, including the maximum LV wall thickness, LV myocardial mass and LV myocardial mass index, are discussed in detail. Knowledge of phenotypic variants helps to diagnose HCMP, to differentiated approach the management of patients and to choose the optimal treatment strategy. Special attention is paid to the assessment of the structure and function of the mitral valve (MV), the subvalvular apparatus and the phenomenon of systolic anterior motion of the MV responsible for the development of obstruction of the LV outflow tract. The previously existing opinion that cardiac abnormality in HCMP is limited only by hypertrophy of ventricular myocardium has recently undergone changes. Approximately 60% of patients with HCMP have at least one MV anomaly as a direct consequence of genetic mutations. The most common abnormalities that can be detected with echocardiography include elongation of the valvular leaflets and chords, prolapse of the valvular leaflets, hypertrophy, disposition and change in the number of papillary muscles. The importance and significance of assessing LV systolic and diastolic functions using echocardiography is emphasized. The role of transesophageal echocardiography in visualization of hypertrophy features of the MV structure and in the perioperative period during surgical correction of hypertrophied septum and valvular defects is also discussed.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135463202","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}
Chronic heart failure (CHF) is currently a common disease and the search for new approaches to the treatment of various forms of CHF remains relevant. Sacubitril/valsartan is a member of a new class of angiotensin-neprilysin receptor inhibitors (ARNIs) that act on key neurohormonal mechanisms, including the RAAS and natriuretic peptides. Simultaneous inhibition of RAAS and neprilysin provides more effective neurohormonal modulation, preventing clinical deterioration in patients with CHF. New mechanisms of action of sacubitril/valsartan associated with the inhibition of several targets involved in cardiac hypertrophy, fibrosis, cardiac remodeling and apoptosis have been disclosed. Sacubitril/valsartan is recommended for CHF with low ejection fraction (EF) in addition to traditional therapy with ACE inhibitors, mineralocorticoid receptor antagonists, beta-blockers, and also has an independent effect. A number of studies have shown the effect of sacubitril/valsartan on heart remodeling, a decrease in the level of the NT-proBNP biomarker and an improvement in EF, and according to the PARADIGM-HF study, the drug significantly reduced the risk of cardiovascular mortality by 20% and hospitalizations for CHF by 21%, which found confirmation in three meta-analyses. The use of sacubitril/valsartan in CHF with preserved and intermediate EF showed a beneficial therapeutic effect and a decrease in the level of biomarkers, as well as a significant decrease in the frequency of hospitalizations due to CHF by 15–22%, but without a significant advantage in terms of the effect on mortality, which supported by several meta-analyses of studies. A number of large meta-analyses of studies of sacubitril/valsartan in CHF have shown reverse cardiac remodeling and a reduced risk of atrial fibrillation. Thus, the accumulated data substantiate and expand the possibilities of using sacu-bitril/valsartan in CHF.
{"title":"Efficacy of sacubitril / valsartan in the treatment of chronic heart failure: an updated review","authors":"M. V. Leonova","doi":"10.21518/ms2023-330","DOIUrl":"https://doi.org/10.21518/ms2023-330","url":null,"abstract":"Chronic heart failure (CHF) is currently a common disease and the search for new approaches to the treatment of various forms of CHF remains relevant. Sacubitril/valsartan is a member of a new class of angiotensin-neprilysin receptor inhibitors (ARNIs) that act on key neurohormonal mechanisms, including the RAAS and natriuretic peptides. Simultaneous inhibition of RAAS and neprilysin provides more effective neurohormonal modulation, preventing clinical deterioration in patients with CHF. New mechanisms of action of sacubitril/valsartan associated with the inhibition of several targets involved in cardiac hypertrophy, fibrosis, cardiac remodeling and apoptosis have been disclosed. Sacubitril/valsartan is recommended for CHF with low ejection fraction (EF) in addition to traditional therapy with ACE inhibitors, mineralocorticoid receptor antagonists, beta-blockers, and also has an independent effect. A number of studies have shown the effect of sacubitril/valsartan on heart remodeling, a decrease in the level of the NT-proBNP biomarker and an improvement in EF, and according to the PARADIGM-HF study, the drug significantly reduced the risk of cardiovascular mortality by 20% and hospitalizations for CHF by 21%, which found confirmation in three meta-analyses. The use of sacubitril/valsartan in CHF with preserved and intermediate EF showed a beneficial therapeutic effect and a decrease in the level of biomarkers, as well as a significant decrease in the frequency of hospitalizations due to CHF by 15–22%, but without a significant advantage in terms of the effect on mortality, which supported by several meta-analyses of studies. A number of large meta-analyses of studies of sacubitril/valsartan in CHF have shown reverse cardiac remodeling and a reduced risk of atrial fibrillation. Thus, the accumulated data substantiate and expand the possibilities of using sacu-bitril/valsartan in CHF.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135462060","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}
L. V. Fedina, I. N. Sychev, N. P. Denisenko, Sh. P. Abdullaev, K. B. Mirzaev, D. A. Sychev
For the past 60 years, vitamin K antagonists (VKAs) have been the main drugs used for long-term oral anticoagulant therapy. Because of the significant limitations of AVCs, direct-acting oral anticoagulants (DOAKs) have been developed over the past decade. DOAKs have a predictable pharmacokinetic profile and lack the disadvantages of vitamin K antagonists. Apixaban is an oral direct-acting factor Xa inhibitor used for the prevention of thromboembolic complications in patients with non-valvular atrial fibrillation (AF) and deep vein thrombosis. Despite the use of recommended dosages, some patients may still experience bleeding or lack the desired anticoagulant effect. With this in mind, it is critical to explore new uses for direct oral anticoagulants and to predict their dosage when used in monotherapy or in combination with other drugs. In addition, recent studies have documented individual variability in plasma POAC levels. DOAC pharmacogenetics is a relatively new area of research. There is a need to understand the role of pharmacogenetics in adapting anticoagulant therapy according to a patient’s genetic characteristics. In this scientific review of current data, we detail the pharmacokinetics and pharmacogenetics of apixaban as well as new data concerning the clinical characteristics that predetermine the necessary dosage and risk of adverse drug reactions (ADRs). Indeed, the results obtained to date from basic and clinical studies certainly indicate an undeniable influence of genomic changes on the pharmacokinetics of POACs.
{"title":"Anticoagulant therapy with apixaban based on a pharmacogenetic approach: a course to safety","authors":"L. V. Fedina, I. N. Sychev, N. P. Denisenko, Sh. P. Abdullaev, K. B. Mirzaev, D. A. Sychev","doi":"10.21518/ms2023-332","DOIUrl":"https://doi.org/10.21518/ms2023-332","url":null,"abstract":"For the past 60 years, vitamin K antagonists (VKAs) have been the main drugs used for long-term oral anticoagulant therapy. Because of the significant limitations of AVCs, direct-acting oral anticoagulants (DOAKs) have been developed over the past decade. DOAKs have a predictable pharmacokinetic profile and lack the disadvantages of vitamin K antagonists. Apixaban is an oral direct-acting factor Xa inhibitor used for the prevention of thromboembolic complications in patients with non-valvular atrial fibrillation (AF) and deep vein thrombosis. Despite the use of recommended dosages, some patients may still experience bleeding or lack the desired anticoagulant effect. With this in mind, it is critical to explore new uses for direct oral anticoagulants and to predict their dosage when used in monotherapy or in combination with other drugs. In addition, recent studies have documented individual variability in plasma POAC levels. DOAC pharmacogenetics is a relatively new area of research. There is a need to understand the role of pharmacogenetics in adapting anticoagulant therapy according to a patient’s genetic characteristics. In this scientific review of current data, we detail the pharmacokinetics and pharmacogenetics of apixaban as well as new data concerning the clinical characteristics that predetermine the necessary dosage and risk of adverse drug reactions (ADRs). Indeed, the results obtained to date from basic and clinical studies certainly indicate an undeniable influence of genomic changes on the pharmacokinetics of POACs.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"21 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135463212","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}
S. N. Nasonova, O. Ya. Chaikovskaia, A. A. Shoshina, Yu. F. Osmolovskaya, I. V. Zhirov, S. N. Tereshchenko
For several years, there has been a significant increase in the number of patients diagnosed with cardiac amyloidosis or amyloid cardiomyopathy (AC). The reason is the growing concern of specialists about amyloidosis and the increased accuracy of the instrumental methods of examination of patients of cardiological profile. Nowadays, more than 30 types of amyloidosis are known, however, the two main types are most commonly associated with cardiac involvement: amyloidosis of light chains (AL) and transthyretin amyloidosis (ATTR). Regardless of the underlying pathogenesis of amyloid production, cardiac involvement is the main cause of mortality in systemic amyloidosis. In addition to difficulties in early diagnosis, there are difficulties with further management of the disease. With the appearance of specific treatment, different depending on the type of amyloidosis, the problem of symptomatic therapy in these patients has become acute. Heart failure (HF) signs are usually prevalent in cardiac signs. Besides, patients with AC often have various arrhythmias and heart conduction disorders. However, the selection of heart failure therapy in patients with AC is complicated by the development of restrictive hemodynamic phenotype and concomitant autonomic dysfunction, making it impossible to manage standard heart failure therapy. The article presents a clinical case of a patient with a hereditary type of transthyretin amyloidosis with the cardiac involvement, whose main clinical manifestations were heart failure, cardiac rhythm and conductions disorders. This case demonstrates the importance of comprehensive and personalized approach in the management of ATTR-AC, the features of pathophysiology which require special approaches even to management of symptomatic therapy.
{"title":"Features of treatment of transthyretin amyloid cardiomyopathy: clinical case","authors":"S. N. Nasonova, O. Ya. Chaikovskaia, A. A. Shoshina, Yu. F. Osmolovskaya, I. V. Zhirov, S. N. Tereshchenko","doi":"10.21518/ms2023-305","DOIUrl":"https://doi.org/10.21518/ms2023-305","url":null,"abstract":"For several years, there has been a significant increase in the number of patients diagnosed with cardiac amyloidosis or amyloid cardiomyopathy (AC). The reason is the growing concern of specialists about amyloidosis and the increased accuracy of the instrumental methods of examination of patients of cardiological profile. Nowadays, more than 30 types of amyloidosis are known, however, the two main types are most commonly associated with cardiac involvement: amyloidosis of light chains (AL) and transthyretin amyloidosis (ATTR). Regardless of the underlying pathogenesis of amyloid production, cardiac involvement is the main cause of mortality in systemic amyloidosis. In addition to difficulties in early diagnosis, there are difficulties with further management of the disease. With the appearance of specific treatment, different depending on the type of amyloidosis, the problem of symptomatic therapy in these patients has become acute. Heart failure (HF) signs are usually prevalent in cardiac signs. Besides, patients with AC often have various arrhythmias and heart conduction disorders. However, the selection of heart failure therapy in patients with AC is complicated by the development of restrictive hemodynamic phenotype and concomitant autonomic dysfunction, making it impossible to manage standard heart failure therapy. The article presents a clinical case of a patient with a hereditary type of transthyretin amyloidosis with the cardiac involvement, whose main clinical manifestations were heart failure, cardiac rhythm and conductions disorders. This case demonstrates the importance of comprehensive and personalized approach in the management of ATTR-AC, the features of pathophysiology which require special approaches even to management of symptomatic therapy.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"26 1-3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135463096","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}
Introduction. An assessment of the relationship between the severity of hypertrophy and changes in the myocardial strain at which systolic disfunction is detected in children with hypertrophic cardiomyopathy (HCM) is clearly essential. Aim. To assess the relationship between hypertrophy and the myocardial strain in children with hypertrophic cardiomyopathy (HCM). Materials and methods . 61 patients aged between 7 and 17 years with a primary form of HCM underwent an ultrasound examination of the heart using standard techniques. An assessment of the left ventricular systolic function performed using of-line the two-dimensional (2D) speckle-tracking mode with analysis parameters that included global and segmental longitudinal, circumferential, and radial myocardial strains. The analysis of hypertrophy of myocardial segments carried out taking into account the absolute values of the thickness of the left ventricular myocardium in systole and diastole, depending on age, in terms of standard deviation units in the population (Z-score factor). Results. A decrease in longitudinal strain below the relevant values, an increase in radial strain, and no changes in circular strain were observed when the thickness of the left ventricular myocardium increased over 2.48Z. A further decrease in radial strain was observed when myocardial thickness was over 4.24Z, and circular strain was over 3.16Z. The relationship between myocardial hypertrophy and longitudinal strain had an inverse linear relationship: the lower the strain values, the greater the thickness of the myocardium. With increasing thickness of the myocardium, the radial strain first tended to increase in a compensatory manner, but it decreased when myocardial thickness increased over 4.24Z. The circular strain, as well as longitudinal one, has an inverse linear relationship, but with longer preservation of normal values when myocardial hypertrophy increases. Conclusion. Children with HCM demonstrate various types of relationships between hypertrophy and myocardial strain, which detection is important for the assessment of the left ventricular systolic function to improve the prognosis and therapeutic approach to the disease. A comprehensive approach to the assessment of myocardial strain in children with HCM should include not only a routine identification of global strain, but also assessment of the segmental strain to detect early signs of myocardial dysfunction. Comparison of measures of various types of strain and the thickness of the left ventricular myocardium has a very important diagnostic value for understanding the degree of changes in its kinetics.
{"title":"Left ventricular myocardial hypertrophy and strain changes in children with hypertrophic cardiomyopathy","authors":"N. Yu. Chernykh, A. A. Tarasova, O. S. Groznova","doi":"10.21518/ms2023-348","DOIUrl":"https://doi.org/10.21518/ms2023-348","url":null,"abstract":"Introduction. An assessment of the relationship between the severity of hypertrophy and changes in the myocardial strain at which systolic disfunction is detected in children with hypertrophic cardiomyopathy (HCM) is clearly essential. Aim. To assess the relationship between hypertrophy and the myocardial strain in children with hypertrophic cardiomyopathy (HCM). Materials and methods . 61 patients aged between 7 and 17 years with a primary form of HCM underwent an ultrasound examination of the heart using standard techniques. An assessment of the left ventricular systolic function performed using of-line the two-dimensional (2D) speckle-tracking mode with analysis parameters that included global and segmental longitudinal, circumferential, and radial myocardial strains. The analysis of hypertrophy of myocardial segments carried out taking into account the absolute values of the thickness of the left ventricular myocardium in systole and diastole, depending on age, in terms of standard deviation units in the population (Z-score factor). Results. A decrease in longitudinal strain below the relevant values, an increase in radial strain, and no changes in circular strain were observed when the thickness of the left ventricular myocardium increased over 2.48Z. A further decrease in radial strain was observed when myocardial thickness was over 4.24Z, and circular strain was over 3.16Z. The relationship between myocardial hypertrophy and longitudinal strain had an inverse linear relationship: the lower the strain values, the greater the thickness of the myocardium. With increasing thickness of the myocardium, the radial strain first tended to increase in a compensatory manner, but it decreased when myocardial thickness increased over 4.24Z. The circular strain, as well as longitudinal one, has an inverse linear relationship, but with longer preservation of normal values when myocardial hypertrophy increases. Conclusion. Children with HCM demonstrate various types of relationships between hypertrophy and myocardial strain, which detection is important for the assessment of the left ventricular systolic function to improve the prognosis and therapeutic approach to the disease. A comprehensive approach to the assessment of myocardial strain in children with HCM should include not only a routine identification of global strain, but also assessment of the segmental strain to detect early signs of myocardial dysfunction. Comparison of measures of various types of strain and the thickness of the left ventricular myocardium has a very important diagnostic value for understanding the degree of changes in its kinetics.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135462095","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}
E. V. Dvoriankova, L. R. Sakaniya, O. M. Kantin, I. M. Korsunskaya
The vulva and vagina are a unique anatomical region, which anatomy and physiology changes throughout a woman's life. The most noticeable changes are hormone-mediated and are associated with the onset of puberty, menstrual cycle, pregnancy and menopause. The microbiome changes over time due to various factors, such as hormones, which leads to a change in pH. Various hygiene practices and habits also have a huge impact on the microflora of the vulva and vagina, and therefore on a woman’s health. Today, the market offers a huge number of care and hygiene products designed for the genital area of women. But, unfortunately, information about their correct use and safety of use is limited. For example, various health behaviours, such as vaginal douching and pubic hair removal are still widely used, although there is some evidence of their negative impacts on the health of the vulva and vagina. Despite the abundance of specialized intimate hygiene products, the use of general care products that are not intended for the genital area and therefore can cause irritation, itching and other unpleasant effects is reported. Foreign guidelines for intimate female hygiene practices resolve itself to recommendations of daily vulva cleansing with a gentle hypoallergenic liquid wash. There is a need to increase women's awareness about rational choice of feminine hygiene products and disorders of the vulva and vagina to improve their intimate health.
{"title":"Vital issue of intimate care for women","authors":"E. V. Dvoriankova, L. R. Sakaniya, O. M. Kantin, I. M. Korsunskaya","doi":"10.21518/ms2023-327","DOIUrl":"https://doi.org/10.21518/ms2023-327","url":null,"abstract":"The vulva and vagina are a unique anatomical region, which anatomy and physiology changes throughout a woman's life. The most noticeable changes are hormone-mediated and are associated with the onset of puberty, menstrual cycle, pregnancy and menopause. The microbiome changes over time due to various factors, such as hormones, which leads to a change in pH. Various hygiene practices and habits also have a huge impact on the microflora of the vulva and vagina, and therefore on a woman’s health. Today, the market offers a huge number of care and hygiene products designed for the genital area of women. But, unfortunately, information about their correct use and safety of use is limited. For example, various health behaviours, such as vaginal douching and pubic hair removal are still widely used, although there is some evidence of their negative impacts on the health of the vulva and vagina. Despite the abundance of specialized intimate hygiene products, the use of general care products that are not intended for the genital area and therefore can cause irritation, itching and other unpleasant effects is reported. Foreign guidelines for intimate female hygiene practices resolve itself to recommendations of daily vulva cleansing with a gentle hypoallergenic liquid wash. There is a need to increase women's awareness about rational choice of feminine hygiene products and disorders of the vulva and vagina to improve their intimate health.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135512723","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}
The menopause in a woman’s life is one of the most significant events indicating the large-scale changes in the hypothalamus-pituitary-ovarian axis function. Gonadal steroid hormones are actively involved in the central nervous system (CNS) growth, differentiation, physiology and ageing processes. Sleep provides restoration of the central nervous system, and also contributes to memory consolidation. Sleep influences the two primary effector systems, the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS), which in turn regulate adaptive and innate immune responses. During sleep, blood levels of cortisol, adrenaline and norepinephrine drop, whereas the levels of neurotransmitters such as growth hormone, prolactin and melatonin show a steep increase. We get more and more facts showing the role of sleep in the processes of immunogenesis and metabolism, in particular fat metabolism. A systematic modern literature analysis on the prevalence and structure of sleep disturbances in women during pre-, peri- and postmenopause was carried out. The results of individual studies revealing the relationship between sleep disturbances and hormone levels including levels of sex steroids are presented. A review of current scientific evidence shows conclusively that the neuroendocrine system significantly determines the sleep quality. Sleep disturbances associated with RLS, COAC are highly prevalent, especially among postmenopausal women, due to declining ovarian function and deficiency of sex steroids. The results of conducted studies support the continued study and analysis of the relationships between gender, neuroendocrine factors, sleep disorders and the search for effective methods for their treatment. SonNorm Duo containing melatonin, peppermint leaf oil, and motherwort herb extract is one of the drugs used to manage sleep disturbances. SonNorm Duo is an adaptogenic sedative drug that is indicated for sleep disturbances, circadian rhythm sleep-wake disorders associated with rapid travel across multiple time zones.
{"title":"Menopause and sleep disturbances","authors":"N. N. Stenyaeva, D. F. Khritinin, E. Yu. Stenyaev","doi":"10.21518/ms2023-333","DOIUrl":"https://doi.org/10.21518/ms2023-333","url":null,"abstract":"The menopause in a woman’s life is one of the most significant events indicating the large-scale changes in the hypothalamus-pituitary-ovarian axis function. Gonadal steroid hormones are actively involved in the central nervous system (CNS) growth, differentiation, physiology and ageing processes. Sleep provides restoration of the central nervous system, and also contributes to memory consolidation. Sleep influences the two primary effector systems, the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS), which in turn regulate adaptive and innate immune responses. During sleep, blood levels of cortisol, adrenaline and norepinephrine drop, whereas the levels of neurotransmitters such as growth hormone, prolactin and melatonin show a steep increase. We get more and more facts showing the role of sleep in the processes of immunogenesis and metabolism, in particular fat metabolism. A systematic modern literature analysis on the prevalence and structure of sleep disturbances in women during pre-, peri- and postmenopause was carried out. The results of individual studies revealing the relationship between sleep disturbances and hormone levels including levels of sex steroids are presented. A review of current scientific evidence shows conclusively that the neuroendocrine system significantly determines the sleep quality. Sleep disturbances associated with RLS, COAC are highly prevalent, especially among postmenopausal women, due to declining ovarian function and deficiency of sex steroids. The results of conducted studies support the continued study and analysis of the relationships between gender, neuroendocrine factors, sleep disorders and the search for effective methods for their treatment. SonNorm Duo containing melatonin, peppermint leaf oil, and motherwort herb extract is one of the drugs used to manage sleep disturbances. SonNorm Duo is an adaptogenic sedative drug that is indicated for sleep disturbances, circadian rhythm sleep-wake disorders associated with rapid travel across multiple time zones.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135512724","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}
Ju. S. Drapkina, N. Р. Makarova, P. D. Tataurova, E. A. Kalinina
Introduction . Machine learning (ML) applied to data analysis allows to more accurately and targetedly determine the most significant correctable and non-correctable predictors of onset of pregnancy in assisted reproductive technology (ART) programs in patients of different age groups. Analysis of data using various techniques and comparison of results obtained via two models will determine the most significant factors for onset of pregnancy in the ART program. Aim . To determine the most significant clinical and embryological predictors of onset of pregnancy using standard regression analysis and a decision tree algorithm to predict pregnancy in the ART program. Materials and methods . A total of 1,021 married couples were included in the retrospective study. The study analysed clinical and laboratory test findings and stimulated cycle parameters depending on the effectiveness of the ART program. A regression analysis was carried out and a decision tree algorithm was built using the Gini criterion to determine the most significant factors. Results . We identified “general” signs that require further validation on other models, including ML: the presence/absence of a history of pregnancies, stimulated cycle parameters (oocyte cumulus complex, number of metaphase II (MII) oocytes, number of zygotes), spermogram indicators on the day of puncture, number of high and good quality embryos, as well as the embryo grading. Conclusion . rFSH (follitropin-alpha, Gonal-f) gives a significant result in two of the five available age groups, follitropin-beta, corifollitropin alfa – in one of the five groups only. Building a model that includes not only the couple’s medical history data, but also molecular markers using machine learning methods will not only allow us to most accurately determine the most promising groups of patients for in vitro fertilization (IVF) programs, but also increase the efficiency of ART programs by selecting the highest quality embryo to be transferred.
{"title":"Deep machine learning applied to support clinical decision-making in the treatment of infertility using assisted reproductive technologies","authors":"Ju. S. Drapkina, N. Р. Makarova, P. D. Tataurova, E. A. Kalinina","doi":"10.21518/ms2023-368","DOIUrl":"https://doi.org/10.21518/ms2023-368","url":null,"abstract":"Introduction . Machine learning (ML) applied to data analysis allows to more accurately and targetedly determine the most significant correctable and non-correctable predictors of onset of pregnancy in assisted reproductive technology (ART) programs in patients of different age groups. Analysis of data using various techniques and comparison of results obtained via two models will determine the most significant factors for onset of pregnancy in the ART program. Aim . To determine the most significant clinical and embryological predictors of onset of pregnancy using standard regression analysis and a decision tree algorithm to predict pregnancy in the ART program. Materials and methods . A total of 1,021 married couples were included in the retrospective study. The study analysed clinical and laboratory test findings and stimulated cycle parameters depending on the effectiveness of the ART program. A regression analysis was carried out and a decision tree algorithm was built using the Gini criterion to determine the most significant factors. Results . We identified “general” signs that require further validation on other models, including ML: the presence/absence of a history of pregnancies, stimulated cycle parameters (oocyte cumulus complex, number of metaphase II (MII) oocytes, number of zygotes), spermogram indicators on the day of puncture, number of high and good quality embryos, as well as the embryo grading. Conclusion . rFSH (follitropin-alpha, Gonal-f) gives a significant result in two of the five available age groups, follitropin-beta, corifollitropin alfa – in one of the five groups only. Building a model that includes not only the couple’s medical history data, but also molecular markers using machine learning methods will not only allow us to most accurately determine the most promising groups of patients for in vitro fertilization (IVF) programs, but also increase the efficiency of ART programs by selecting the highest quality embryo to be transferred.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135512728","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}
E. S. Mazur, V. V. Mazur, N. D. Bazhenov, Yu. A. Orlov
Introduction. The clinical significance of atrial fibrillation (AF) is associated with the development of thromboembolic complications that occur when thrombus from the left atrial appendage enter the systemic circulation. Transesophageal echocardiography can detect the left atrial appendage thrombus, but due to lack of availability, high cost and complexity of performing such a routine examination is unlikely. Therefore, the search for predictors of the left atrial appendage thrombosis is relevant, the presence of which may become the basis for a more in-depth instrumental examination of patients with AF.Aim. To identify predictors of atrial thrombosis in patients with persistent nonvalvular atrial fibrillation.Materials and methods. The 551 patients with persistent nonvalvular atrial fibrillation underwent transesophageal echocardiography before cardioversion, thrombus in the left atrial appendage was detected in 74 (13.4%) patients. All patients were selected into training (400 people) and validation (151 people) cohorts randomly. Multivariate logistic regression analysis was performed to identify predictors of atrial thrombosis in the derivation cohort.Results. Five factors influenced the atrial thrombosis independently. They are the ratio of the transmitral velocity to the mitral annulus early Diastolic velocity (E/e’) ≥ 12 (D), the absence or inadequate Anticoagulant therapy (A), atrial Fibrillation, not flutter (F), left atrial volume Index (I), and age ≥ 75 years (DAFI75 scale). The number of predictors corresponds the risk of detecting atrial thrombosis: the area under the characteristic curve was 0.818 (0.768–0.868) in the derivation cohort and 0.847 (0.761–0.934) in the validation cohort. The sensitivity of the DAFI75 criterion ≥ 3 in the derivation and validation cohorts is 91.7 and 92.9%, the specificity is 58.8 and 65.7%, the predictive value of a positive result is 28.2 and 21.7%, and the predictive value of a negative result is 97.6 and 98.9%.Conclusion. The presence of three or more predictors score DAFI75 allows predicting the absence of atrial thrombosis more than in 97% of case.
{"title":"Predictors of atrial thrombosis of persistent nonvalvular atrial fibrillation","authors":"E. S. Mazur, V. V. Mazur, N. D. Bazhenov, Yu. A. Orlov","doi":"10.21518/ms2023-297","DOIUrl":"https://doi.org/10.21518/ms2023-297","url":null,"abstract":"Introduction. The clinical significance of atrial fibrillation (AF) is associated with the development of thromboembolic complications that occur when thrombus from the left atrial appendage enter the systemic circulation. Transesophageal echocardiography can detect the left atrial appendage thrombus, but due to lack of availability, high cost and complexity of performing such a routine examination is unlikely. Therefore, the search for predictors of the left atrial appendage thrombosis is relevant, the presence of which may become the basis for a more in-depth instrumental examination of patients with AF.Aim. To identify predictors of atrial thrombosis in patients with persistent nonvalvular atrial fibrillation.Materials and methods. The 551 patients with persistent nonvalvular atrial fibrillation underwent transesophageal echocardiography before cardioversion, thrombus in the left atrial appendage was detected in 74 (13.4%) patients. All patients were selected into training (400 people) and validation (151 people) cohorts randomly. Multivariate logistic regression analysis was performed to identify predictors of atrial thrombosis in the derivation cohort.Results. Five factors influenced the atrial thrombosis independently. They are the ratio of the transmitral velocity to the mitral annulus early Diastolic velocity (E/e’) ≥ 12 (D), the absence or inadequate Anticoagulant therapy (A), atrial Fibrillation, not flutter (F), left atrial volume Index (I), and age ≥ 75 years (DAFI75 scale). The number of predictors corresponds the risk of detecting atrial thrombosis: the area under the characteristic curve was 0.818 (0.768–0.868) in the derivation cohort and 0.847 (0.761–0.934) in the validation cohort. The sensitivity of the DAFI75 criterion ≥ 3 in the derivation and validation cohorts is 91.7 and 92.9%, the specificity is 58.8 and 65.7%, the predictive value of a positive result is 28.2 and 21.7%, and the predictive value of a negative result is 97.6 and 98.9%.Conclusion. The presence of three or more predictors score DAFI75 allows predicting the absence of atrial thrombosis more than in 97% of case.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"113 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135513164","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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