O. V. Yakushevskaya, M. V. Iurova, E. A. Mezhevitinova
Endometriosis is a disease characterized by a benign growth of tissue identical to the endometrium outside the uterine cavity with an accompanying inflammatory process. The exact prevalence of external genital endometriosis (EGE) is unknown. According to some data, the prevalence varies from 2% to 10% among the general female population and up to 50% among women with established infertility. Currently, there is no single theory that could fully explain the causes and mechanisms of the development of the disease. The etiopathogenesis of endometriosis is widely discussed and remains uncertain. The main clinical markers of the disease are chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility. The progressive and recurrent course of EGE with a significant deterioration in the quality of life of women is the main motivation for the scientific community in the search for radical therapeutic methods. The main goal of therapy is to reduce pain, correct reproductive dysfunction, prevent / slow down the occurrence of such long-term consequences associated with endometriosis, such as fibrosis, adhesions and malignant transformation. Available advanced technologies aimed at establishing and studying the pathophysiology of endometriosis have made it possible to optimize therapeutic strategies. However, many controversial issues still arise in routine clinical practice. This article will provide an overview of the general basic concept of disease pathogenesis and highlight the role of hormonal treatment (dienogest) in women with endometriosis.
{"title":"Dienogest therapy: a window of opportunity for endometriosis","authors":"O. V. Yakushevskaya, M. V. Iurova, E. A. Mezhevitinova","doi":"10.21518/ms2023-339","DOIUrl":"https://doi.org/10.21518/ms2023-339","url":null,"abstract":"Endometriosis is a disease characterized by a benign growth of tissue identical to the endometrium outside the uterine cavity with an accompanying inflammatory process. The exact prevalence of external genital endometriosis (EGE) is unknown. According to some data, the prevalence varies from 2% to 10% among the general female population and up to 50% among women with established infertility. Currently, there is no single theory that could fully explain the causes and mechanisms of the development of the disease. The etiopathogenesis of endometriosis is widely discussed and remains uncertain. The main clinical markers of the disease are chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility. The progressive and recurrent course of EGE with a significant deterioration in the quality of life of women is the main motivation for the scientific community in the search for radical therapeutic methods. The main goal of therapy is to reduce pain, correct reproductive dysfunction, prevent / slow down the occurrence of such long-term consequences associated with endometriosis, such as fibrosis, adhesions and malignant transformation. Available advanced technologies aimed at establishing and studying the pathophysiology of endometriosis have made it possible to optimize therapeutic strategies. However, many controversial issues still arise in routine clinical practice. This article will provide an overview of the general basic concept of disease pathogenesis and highlight the role of hormonal treatment (dienogest) in women with endometriosis.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"24 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":"135513292","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}
A. N. Arefeva, V. V. Banko, M. O. Sadovskikh, S. M. Noskov
Introduction. Diabetes mellitus is a chronic disease that can impact all aspects of metabolism. Incretin mimetics, such as semaglutide, are a promising group of drugs to treat type 2 diabetes mellitus both through the improvement of glycemic control and additional effects on the cardiovascular system and body weight. The development of a generic semaglutide-containing drug is a burning issue which settlement will increase the availability of semaglutide in the Russian Federation Aim. To study the comparative pharmacokinetics, bioequivalence, safety and tolerability of a semaglutide containing GP40221 and Ozempic® in healthy volunteers. Materials and methods . This open-label, randomized, single-dose, parallel group study assessed the bioequivalence of a single dose of 0.5 mg of the study drugs in healthy male subjects under fasting conditions. The conclusion about the bioequivalence of the brand name drug versus the generic drug was made using the classical approach based on the assessment of 90% confidence intervals of the ratios of geometric means of the primary pharmacokinetic parameters (AUC 0-t , С max ) for the active substance of the study drugs. Results. The results of the study showed that the 90% CI values of the ratios of geometric means of the primary PK parameters of semaglutide were 85.96–109.01% and 89.14–111.40% for AUC 0-t и C max , respectively, and are well within acceptable limits 80.00–125.00%. The comparable safety of the study drugs containing semaglutide has been proven. Conclusion. Thus, GP40221 (GEROPHARM LLC, Russia) and Ozempic® (Novo Nordisk A/S, Denmark) can be considered bioequivalent and equally safe based on the results of this clinical study. The results of this study allow us to recommend a drug developer to submit specific data on their study drug GP40221 to the Ministry of Health of the Russian Federation to obtain marketing authorization.
介绍。糖尿病是一种慢性疾病，可以影响新陈代谢的各个方面。肠促胰岛素模拟物，如西马鲁肽，是治疗2型糖尿病的一组有希望的药物，既可以改善血糖控制，又可以对心血管系统和体重产生额外的影响。开发含有塞马鲁肽的仿制药物是一个亟待解决的问题，解决该问题将增加塞马鲁肽在俄罗斯联邦的可得性。研究含GP40221和Ozempic®的西马鲁肽在健康志愿者体内的比较药代动力学、生物等效性、安全性和耐受性。材料和方法。这项开放标签、随机、单剂量、平行组研究评估了健康男性受试者在禁食条件下单剂量0.5 mg研究药物的生物等效性。采用经典方法对研究药物原料药的主要药代动力学参数(AUC 0-t， С max)几何均值比值的90%置信区间进行评估，得出品牌药与仿制药的生物等效性结论。结果。研究结果表明，semaglutide主要PK参数的几何平均比值的90% CI值分别为85.96 ~ 109.01%和89.14 ~ 111.40%，AUC 0-t * C max均在80.00 ~ 125.00%的可接受范围内。含有西马鲁肽的研究药物的相当安全性已被证实。结论。因此，基于该临床研究的结果，GP40221 (GEROPHARM LLC，俄罗斯)和Ozempic®(Novo Nordisk A/S，丹麦)可以被认为具有生物等效性和同等安全性。这项研究的结果使我们能够建议药物开发商向俄罗斯联邦卫生部提交其研究药物GP40221的具体数据，以获得上市许可。
{"title":"Pharmacokinetics of first semaglutid drug in Russian Federation: results of open-label randomized clinical trial","authors":"A. N. Arefeva, V. V. Banko, M. O. Sadovskikh, S. M. Noskov","doi":"10.21518/ms2023-312","DOIUrl":"https://doi.org/10.21518/ms2023-312","url":null,"abstract":"Introduction. Diabetes mellitus is a chronic disease that can impact all aspects of metabolism. Incretin mimetics, such as semaglutide, are a promising group of drugs to treat type 2 diabetes mellitus both through the improvement of glycemic control and additional effects on the cardiovascular system and body weight. The development of a generic semaglutide-containing drug is a burning issue which settlement will increase the availability of semaglutide in the Russian Federation Aim. To study the comparative pharmacokinetics, bioequivalence, safety and tolerability of a semaglutide containing GP40221 and Ozempic® in healthy volunteers. Materials and methods . This open-label, randomized, single-dose, parallel group study assessed the bioequivalence of a single dose of 0.5 mg of the study drugs in healthy male subjects under fasting conditions. The conclusion about the bioequivalence of the brand name drug versus the generic drug was made using the classical approach based on the assessment of 90% confidence intervals of the ratios of geometric means of the primary pharmacokinetic parameters (AUC 0-t , С max ) for the active substance of the study drugs. Results. The results of the study showed that the 90% CI values of the ratios of geometric means of the primary PK parameters of semaglutide were 85.96–109.01% and 89.14–111.40% for AUC 0-t и C max , respectively, and are well within acceptable limits 80.00–125.00%. The comparable safety of the study drugs containing semaglutide has been proven. Conclusion. Thus, GP40221 (GEROPHARM LLC, Russia) and Ozempic® (Novo Nordisk A/S, Denmark) can be considered bioequivalent and equally safe based on the results of this clinical study. The results of this study allow us to recommend a drug developer to submit specific data on their study drug GP40221 to the Ministry of Health of the Russian Federation to obtain marketing authorization.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"47 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135513294","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}
V. V. Gorban, E. V. Gorban, V. S. Manto, O. V. Svistun
Introduction. The study of vegetative homeostasis requires the accounting of sensitive, non-invasive parameters of multidimensional ambulatory metabolic and cardiorespiratory monitoring, including bioimedansometry, heart rate variability (HRV) and respiratory function (RF). Aim. To determine concomitant changes in HRV, RF, depending on the level of visceral fat (VF) and the presence of arterial hypertension (AH), associated with gender, age to determine the targets of preventive effects. Materials and methods . 215 boys and girls aged 18 to 30 years and 93 men and women with hypertension aged 45 to 59 years underwent, bioimpedancometry, HRV monitoring using ten-minute recordings, and the study of respiratory function. Results and discussion . In young people with a BMI over 25 kg/m 2 , a high level of HF was associated with an increase in LF/ HF and SDANN values, which reflected a reduction in parasympathetic activity and an increase in sympathetic activity, as well as changes in RF with a decrease in the Tiffno index and maximum half-expiratory flow (MHF). In middle-aged individuals with AH and BMI exceeding 25 kg/m 2 , a direct correlation was found between the value of VF and age, waist circumference, diastolic blood pressure, with a higher stress index of cardiac rhythm regulation and more pronounced sympathetic activity in terms of the LF/HF parameter. A lower total HRV, low parasympathetic activity and tension in the regulation of the heart rhythm in persons with AH were detected even with an intermediate value of VF. Conclusions. The study of autonomic homeostasis required the accounting of the individual dynamics of the parameters of HRV and the RF even within normal values. Changes in HRV associated with an intermediate increase in VF should be monitored with an emphasis on SDANN, LF/HF, stress index and vegetative index, and changes in RF – with an emphasis on the Tiffno index and MHF.
{"title":"Influence of visceral fat on cardio-respiratory homeostasis depending on sex, age and presence of arterial hypertension","authors":"V. V. Gorban, E. V. Gorban, V. S. Manto, O. V. Svistun","doi":"10.21518/ms2023-304","DOIUrl":"https://doi.org/10.21518/ms2023-304","url":null,"abstract":"Introduction. The study of vegetative homeostasis requires the accounting of sensitive, non-invasive parameters of multidimensional ambulatory metabolic and cardiorespiratory monitoring, including bioimedansometry, heart rate variability (HRV) and respiratory function (RF). Aim. To determine concomitant changes in HRV, RF, depending on the level of visceral fat (VF) and the presence of arterial hypertension (AH), associated with gender, age to determine the targets of preventive effects. Materials and methods . 215 boys and girls aged 18 to 30 years and 93 men and women with hypertension aged 45 to 59 years underwent, bioimpedancometry, HRV monitoring using ten-minute recordings, and the study of respiratory function. Results and discussion . In young people with a BMI over 25 kg/m 2 , a high level of HF was associated with an increase in LF/ HF and SDANN values, which reflected a reduction in parasympathetic activity and an increase in sympathetic activity, as well as changes in RF with a decrease in the Tiffno index and maximum half-expiratory flow (MHF). In middle-aged individuals with AH and BMI exceeding 25 kg/m 2 , a direct correlation was found between the value of VF and age, waist circumference, diastolic blood pressure, with a higher stress index of cardiac rhythm regulation and more pronounced sympathetic activity in terms of the LF/HF parameter. A lower total HRV, low parasympathetic activity and tension in the regulation of the heart rhythm in persons with AH were detected even with an intermediate value of VF. Conclusions. The study of autonomic homeostasis required the accounting of the individual dynamics of the parameters of HRV and the RF even within normal values. Changes in HRV associated with an intermediate increase in VF should be monitored with an emphasis on SDANN, LF/HF, stress index and vegetative index, and changes in RF – with an emphasis on the Tiffno index and MHF.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"4 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135512725","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}
Metabolic syndrome (MetS) is a major global public health problem. Abdominal obesity, arterial hypertension, disorders of carbohydrate metabolism and dyslipidemia are widely recognized and the most important components of MetS. The angiopoietin-like system, which includes eight types of angiopoietin-like proteins (ANGPTLs), is recognized as an important regulator of adipose tissue function. Angiopoietin-like proteins types 3 and 4 (ANGPTL3/4) are the most studied in terms of their influence on cardiovascular risks and are of interest in terms of their function in conditions associated with MetS. This review focuses on considering the role of ANGPTL3/4 in the development of each condition from the constellation of abnormalities that characterize MetS. The key role of ANGPTL3/4 as modulators of the interaction between the liver and adipose tissue is demonstrated based on the analysis performed on the current data in the PubMed information. Their involvement in lipid homeostasis, glucose, type 2 diabetes, hypertension, non-alcoholic fatty liver disease and sleep apnea, i.e. in the maximum spectrum of conditions determining MetS, has been considered in detail. It’s been proven that ANGPTL3/4 can act as indepen dent predictors of MetS, demonstrating a potential role as prognostic biomarkers of metabolic disorders. Understanding the peculiarities of ANGPTLs functioning can offer both new diagnostic and therapeutic approaches to diseases with MetS. Close targeting of ANGPTL3/4 and the development of innovative therapies involving blockers of their action have the potential to have a significant impact on the effectiveness of treatment of metabolic disorders in humans in future.
{"title":"Metabolic syndrome: prospects for the use of angiopoetin-like proteins type 3 and 4 for the diagnosis of metabolic disorders","authors":"V. A. Aleksandrov","doi":"10.21518/ms2023-303","DOIUrl":"https://doi.org/10.21518/ms2023-303","url":null,"abstract":"Metabolic syndrome (MetS) is a major global public health problem. Abdominal obesity, arterial hypertension, disorders of carbohydrate metabolism and dyslipidemia are widely recognized and the most important components of MetS. The angiopoietin-like system, which includes eight types of angiopoietin-like proteins (ANGPTLs), is recognized as an important regulator of adipose tissue function. Angiopoietin-like proteins types 3 and 4 (ANGPTL3/4) are the most studied in terms of their influence on cardiovascular risks and are of interest in terms of their function in conditions associated with MetS. This review focuses on considering the role of ANGPTL3/4 in the development of each condition from the constellation of abnormalities that characterize MetS. The key role of ANGPTL3/4 as modulators of the interaction between the liver and adipose tissue is demonstrated based on the analysis performed on the current data in the PubMed information. Their involvement in lipid homeostasis, glucose, type 2 diabetes, hypertension, non-alcoholic fatty liver disease and sleep apnea, i.e. in the maximum spectrum of conditions determining MetS, has been considered in detail. It’s been proven that ANGPTL3/4 can act as indepen dent predictors of MetS, demonstrating a potential role as prognostic biomarkers of metabolic disorders. Understanding the peculiarities of ANGPTLs functioning can offer both new diagnostic and therapeutic approaches to diseases with MetS. Close targeting of ANGPTL3/4 and the development of innovative therapies involving blockers of their action have the potential to have a significant impact on the effectiveness of treatment of metabolic disorders in humans in future.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"29 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":"135512855","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}
N. Yu. Semigolovskii, I. S. Simutis, S. O. Mazurenko, E. M. Nikolskaya, M. O. Mazurenko
Currently, at least 5,000,000 patients with coronary artery disease undergo percutaneous coronary interventions with stent implantation every year in the world, and more than 200,000 in Russia. Dissection and perforation of the coronary artery are quite rare, but they are very dangerous complications leading to the development of hemopericardium with cardiac tamponade, cardiogenic shock, myocardial infarction, various arrhythmias and death. The frequency of cardiac tamponade in interventional cardiology, according to various authors, ranges from 0.1 to 3.0% of all interventions. The frequency of deaths cited in the literature also varies greatly (0–20–40%). At the same time, there are no special registers that accumulate data on coronary artery perforations in concrete countries and in the world as a whole. Unfortunately, today, there is still no clear algorithm for identifying high-risk patients, the necessary timing of their intensive follow-up is not clear, and the criteria for choosing between conservative, angiosurgical and operative treatment tactics are not defined. In addition to a literary review of recent sources on this topic, the article presents 3 clinical cases of hemopericardium development in elderly patients at different times after percutaneous interventions, with different symptoms and with different outcomes. The observations illustrate the variability of symptoms, the complexity of diagnosis and treatment, and also touch upon the issues of a multidisciplinary approach with the participation of specialists of different profiles (X-ray angiosurgeons, cardiac surgeons, intensive care specialists, cardiologists and doctors of functional diagnostics).
{"title":"Hemopericardium after coronary artery stenting: clinical observations and literature review","authors":"N. Yu. Semigolovskii, I. S. Simutis, S. O. Mazurenko, E. M. Nikolskaya, M. O. Mazurenko","doi":"10.21518/ms2023-349","DOIUrl":"https://doi.org/10.21518/ms2023-349","url":null,"abstract":"Currently, at least 5,000,000 patients with coronary artery disease undergo percutaneous coronary interventions with stent implantation every year in the world, and more than 200,000 in Russia. Dissection and perforation of the coronary artery are quite rare, but they are very dangerous complications leading to the development of hemopericardium with cardiac tamponade, cardiogenic shock, myocardial infarction, various arrhythmias and death. The frequency of cardiac tamponade in interventional cardiology, according to various authors, ranges from 0.1 to 3.0% of all interventions. The frequency of deaths cited in the literature also varies greatly (0–20–40%). At the same time, there are no special registers that accumulate data on coronary artery perforations in concrete countries and in the world as a whole. Unfortunately, today, there is still no clear algorithm for identifying high-risk patients, the necessary timing of their intensive follow-up is not clear, and the criteria for choosing between conservative, angiosurgical and operative treatment tactics are not defined. In addition to a literary review of recent sources on this topic, the article presents 3 clinical cases of hemopericardium development in elderly patients at different times after percutaneous interventions, with different symptoms and with different outcomes. The observations illustrate the variability of symptoms, the complexity of diagnosis and treatment, and also touch upon the issues of a multidisciplinary approach with the participation of specialists of different profiles (X-ray angiosurgeons, cardiac surgeons, intensive care specialists, cardiologists and doctors of functional diagnostics).","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"466 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":"135513295","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. A. Maylyan, D. A. Lesnichenko, E. S. Dzhelomanova, N. A. Reznichenko, A. S. Prilutskii, A. E. Bagriy, O. A. Trunova, E. V. Prokhorov
Introduction . The problem of early manifestations of menopausal syndrome is due to the high prevalence among postmenopausal women, a wide range of clinical manifestations, a sharp decrease in the quality of life, not always sufficient effectiveness of menopausal hormone therapy (MHT) in the presence of restrictions on its use. The aim . To evaluate the dynamics of clinical manifestations of menopausal syndrome and to determine the pathogenetic effects of vitamin D preparation when used in combination with menopausal hormone therapy in women of early postmenopausal age with menopausal syndrome. Materials and methods . 154 women were examined, of which 81 were characterized by the presence of clinical manifestations of menopausal syndrome. All women with menopausal syndrome received menopausal hormone therapy with estradiol and didrogesterone drug for 6 months, while 39 women additionally also took the vitamin D drug. Before and after therapy in patients with menopausal syndrome, the prevalence of symptoms of the Green scale was assessed. Concentrations of 25(OH) D, osteoprotegerin (OPG) and receptor activator of nuclear factor kappa-B ligand (RANKL) were determined in the blood serum of all women. Results and discussion . The use of MHT by women with menopausal syndrome leads to a decrease in the frequency of registration of a number of symptoms of the Green scale (p < 0.05). At the same time, a decrease in the frequency of registration of individual complaints is found only in the group of women who, along with MYT, received a vitamin D preparation (p < 0.05). Taking the vitamin D preparation is accompanied by an increase in its initially reduced serum concentrations to normal values (p < 0.001). The addition of cholecalciferol to the complex therapy of menopausal syndrome ensures the normalization of RANKL levels by reducing its production in the dynamics of treatment (p < 0.05) A decrease in the concentration of RANKL in response to the complex intake of a hormonal drug and cholecalciferol caused higher OPG/RANKL index values in the basic group by the end of therapy than in women of the comparison group (p < 0.01). Conclusions . The obtained effects of vitamin D preparation when prescribed in combination with menopausal hormone therapy (reduction of the frequency of symptoms of menopausal syndrome, reduction of initially elevated levels of RANKL) indicate the expediency of its use in the treatment of early manifestations of menopausal syndrome.
{"title":"The effect of vitamin D on the early clinical manifestations of menopausal syndrome and the production of cytokines, involved in bone remodeling","authors":"E. A. Maylyan, D. A. Lesnichenko, E. S. Dzhelomanova, N. A. Reznichenko, A. S. Prilutskii, A. E. Bagriy, O. A. Trunova, E. V. Prokhorov","doi":"10.21518/ms2023-369","DOIUrl":"https://doi.org/10.21518/ms2023-369","url":null,"abstract":"Introduction . The problem of early manifestations of menopausal syndrome is due to the high prevalence among postmenopausal women, a wide range of clinical manifestations, a sharp decrease in the quality of life, not always sufficient effectiveness of menopausal hormone therapy (MHT) in the presence of restrictions on its use. The aim . To evaluate the dynamics of clinical manifestations of menopausal syndrome and to determine the pathogenetic effects of vitamin D preparation when used in combination with menopausal hormone therapy in women of early postmenopausal age with menopausal syndrome. Materials and methods . 154 women were examined, of which 81 were characterized by the presence of clinical manifestations of menopausal syndrome. All women with menopausal syndrome received menopausal hormone therapy with estradiol and didrogesterone drug for 6 months, while 39 women additionally also took the vitamin D drug. Before and after therapy in patients with menopausal syndrome, the prevalence of symptoms of the Green scale was assessed. Concentrations of 25(OH) D, osteoprotegerin (OPG) and receptor activator of nuclear factor kappa-B ligand (RANKL) were determined in the blood serum of all women. Results and discussion . The use of MHT by women with menopausal syndrome leads to a decrease in the frequency of registration of a number of symptoms of the Green scale (p < 0.05). At the same time, a decrease in the frequency of registration of individual complaints is found only in the group of women who, along with MYT, received a vitamin D preparation (p < 0.05). Taking the vitamin D preparation is accompanied by an increase in its initially reduced serum concentrations to normal values (p < 0.001). The addition of cholecalciferol to the complex therapy of menopausal syndrome ensures the normalization of RANKL levels by reducing its production in the dynamics of treatment (p < 0.05) A decrease in the concentration of RANKL in response to the complex intake of a hormonal drug and cholecalciferol caused higher OPG/RANKL index values in the basic group by the end of therapy than in women of the comparison group (p < 0.01). Conclusions . The obtained effects of vitamin D preparation when prescribed in combination with menopausal hormone therapy (reduction of the frequency of symptoms of menopausal syndrome, reduction of initially elevated levels of RANKL) indicate the expediency of its use in the treatment of early manifestations of menopausal syndrome.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"8 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":"135513377","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}
I. O. Borovikov, I. I. Kutsenko, O. I. Borovikova, A. A. Andreeva, L. A. Filippova, V. A. Avakimyan, Ju. V. Nikogda
Introduction . The article describes the experience of treating patients with recurrent vulvovaginal candidosis combined with mixed vaginal dysbiosis using a variant of complex local therapy with drugs containing sertaconazole nitrate and benzyl-dimethyl-[3-(myristoylamino) propyl] ammonium chloride monohydrate. Aim . To evaluate the efficacy of local therapy in patients with recurrent vulvovaginal candidosis with underlying mixed non-specific vaginal dysbiosis. Materials and methods . A prospective open randomized clinical trial to evaluate the outcomes of treatment with drugs containing sertaconazole nitrate at a dose of 300 mg (Flucovag®, vaginal suppositories, two times with an interval of 7 days) and benzyl-dimethyl-[3-(myristoylamino)propyl] ammonium chloride monohydrate at a dose of 15 mg (Miramistin® vaginal suppositories once a day at bedtime for 10 days) in women with mixed nonspecific infectious vaginal diseases with underlying recurrent vulvovaginal candidosis (n = 68) was conducted. Methods: vaginal microbiota evaluation with AmpliPrime® Florocenosis/Bacterial vaginosis-FL PCR (NextBio LLC, Russian Federation), vaginal pH, Hay/Ison scoring criteria, antimycotic sensitivity evaluation against Candida spp. (NCCLS standards). Results and discussion . This kind of local complex therapy in patients with recurrent vulvovaginal candidosis combined with mixed vaginal dysbiosis using drugs containing sertaconazole nitrate (Flucovag®) and benzyl-dimethyl[3-(myristoylamino) propyl]ammonium chloride monohydrate (Miramistin®), followed by probiotic contamination showed high clinical (94.1 ± 2.3%) and microbiological (81.9 ± 2.1%) efficacy combined with safety and satisfactory compliance. Conclusion . A comprehensive approach to the treatment of mixed nonspecific vaginal dysbiosis with underlying recurrent vulvovaginal candidosis showed high clinical efficacy and satisfactory compliance.
{"title":"Possibilities of local therapy of recurrent candidiasis against the background of mixed vaginal dysbiosis","authors":"I. O. Borovikov, I. I. Kutsenko, O. I. Borovikova, A. A. Andreeva, L. A. Filippova, V. A. Avakimyan, Ju. V. Nikogda","doi":"10.21518/ms2023-295","DOIUrl":"https://doi.org/10.21518/ms2023-295","url":null,"abstract":"Introduction . The article describes the experience of treating patients with recurrent vulvovaginal candidosis combined with mixed vaginal dysbiosis using a variant of complex local therapy with drugs containing sertaconazole nitrate and benzyl-dimethyl-[3-(myristoylamino) propyl] ammonium chloride monohydrate. Aim . To evaluate the efficacy of local therapy in patients with recurrent vulvovaginal candidosis with underlying mixed non-specific vaginal dysbiosis. Materials and methods . A prospective open randomized clinical trial to evaluate the outcomes of treatment with drugs containing sertaconazole nitrate at a dose of 300 mg (Flucovag®, vaginal suppositories, two times with an interval of 7 days) and benzyl-dimethyl-[3-(myristoylamino)propyl] ammonium chloride monohydrate at a dose of 15 mg (Miramistin® vaginal suppositories once a day at bedtime for 10 days) in women with mixed nonspecific infectious vaginal diseases with underlying recurrent vulvovaginal candidosis (n = 68) was conducted. Methods: vaginal microbiota evaluation with AmpliPrime® Florocenosis/Bacterial vaginosis-FL PCR (NextBio LLC, Russian Federation), vaginal pH, Hay/Ison scoring criteria, antimycotic sensitivity evaluation against Candida spp. (NCCLS standards). Results and discussion . This kind of local complex therapy in patients with recurrent vulvovaginal candidosis combined with mixed vaginal dysbiosis using drugs containing sertaconazole nitrate (Flucovag®) and benzyl-dimethyl[3-(myristoylamino) propyl]ammonium chloride monohydrate (Miramistin®), followed by probiotic contamination showed high clinical (94.1 ± 2.3%) and microbiological (81.9 ± 2.1%) efficacy combined with safety and satisfactory compliance. Conclusion . A comprehensive approach to the treatment of mixed nonspecific vaginal dysbiosis with underlying recurrent vulvovaginal candidosis showed high clinical efficacy and satisfactory compliance.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"1 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135512727","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}
A. V. Solovyeva, K. S. Ermolenko, L. T. Kulumbegova, E. Yu. Aleynikova, L. A. Chegus
Introduction . Anemia is a major health problem worldwide, increasing the risks of low birth weight, preterm birth, perinatal mortality, stillbirth, postpartum hemorrhage, and maternal mortality. Replenishing iron deficiency at the stage of preconceptional preparation reduces the incidence of IDA and can reduce the incidence of pregnancy complications and improve perinatal outcomes. Aim . To evaluate the effectiveness of ferrous sulfate 80 mg and its potential to replenish iron deficiency in women with infertility before using assisted reproductive technologies (ART). Materials and methods . A prospective clinical longitudinal study was conducted from May to September 2023 at LLC Health Clinic, Moscow. The study included women (n = 34) at the stage of pregnancy planning by IVF with a diagnosed iron deficiency. Iron deficiency was established in accordance with the following criteria: decrease in serum ferritin level less than 30 μg/l, serum iron level less than 15 μmol/l. Results . After 12 weeks of taking ferrous sulfate, the average hemoglobin level increased from 112.3 ± 6.5 (101–119) g/l to 118.5 ± 6.5 (110–133) g/l (W-Wilcoxon 9300 test, p = 0.003), mean serum iron level from 15.4 ± 4.0 (5.7–22.5) μmol/l to 34.8 ± 7.1 (20.1–46.7) μmol/l (Wilcoxon W test 602.0, p < 0.001), mean ferritin level from 8.2 ± 3.1 (4.5–17.0) μg/ml to 37.6 ± 6.7 (30.6–52.6) μg/ml (Wilcoxon W test 595.0, p < 0.001). Conclusions . Timely examination of patients for iron deficiency and iron deficiency anemia at the stage of preconceptional preparation makes it possible to prescribe an effective correction, thereby helping to reduce the risks of complications of pregnancy and childbirth.
{"title":"Replenishment of iron deficiency in women before the use of assisted reproductive technologies","authors":"A. V. Solovyeva, K. S. Ermolenko, L. T. Kulumbegova, E. Yu. Aleynikova, L. A. Chegus","doi":"10.21518/ms2023-324","DOIUrl":"https://doi.org/10.21518/ms2023-324","url":null,"abstract":"Introduction . Anemia is a major health problem worldwide, increasing the risks of low birth weight, preterm birth, perinatal mortality, stillbirth, postpartum hemorrhage, and maternal mortality. Replenishing iron deficiency at the stage of preconceptional preparation reduces the incidence of IDA and can reduce the incidence of pregnancy complications and improve perinatal outcomes. Aim . To evaluate the effectiveness of ferrous sulfate 80 mg and its potential to replenish iron deficiency in women with infertility before using assisted reproductive technologies (ART). Materials and methods . A prospective clinical longitudinal study was conducted from May to September 2023 at LLC Health Clinic, Moscow. The study included women (n = 34) at the stage of pregnancy planning by IVF with a diagnosed iron deficiency. Iron deficiency was established in accordance with the following criteria: decrease in serum ferritin level less than 30 μg/l, serum iron level less than 15 μmol/l. Results . After 12 weeks of taking ferrous sulfate, the average hemoglobin level increased from 112.3 ± 6.5 (101–119) g/l to 118.5 ± 6.5 (110–133) g/l (W-Wilcoxon 9300 test, p = 0.003), mean serum iron level from 15.4 ± 4.0 (5.7–22.5) μmol/l to 34.8 ± 7.1 (20.1–46.7) μmol/l (Wilcoxon W test 602.0, p < 0.001), mean ferritin level from 8.2 ± 3.1 (4.5–17.0) μg/ml to 37.6 ± 6.7 (30.6–52.6) μg/ml (Wilcoxon W test 595.0, p < 0.001). Conclusions . Timely examination of patients for iron deficiency and iron deficiency anemia at the stage of preconceptional preparation makes it possible to prescribe an effective correction, thereby helping to reduce the risks of complications of pregnancy and childbirth.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"8 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135513896","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}
N. A. Rakhimi, E. V. Konstantinova, A. A. Velikotskiy, E. V. Ploshchenkov, O. N. Svetlova, А. P. Nesterov
There has been an increase in the population of elderly patients with coronary artery disease (CAD) in recent years. Elderly and, especially, senile patients typically have comorbid conditions, multivessel coronary artery disease and coronary calcification, which make treatment more challenging. The available data from evidence-based medicine is not enough to determine the best treatment strategies for elderly patients, because large randomized clinical trials usually do not include elderly individuals with severe comorbidities. In the presented case, an 80-year-old patient with severe calcification and multivessel coronary artery disease experienced recurrent dissection of the left anterior descending artery (LAD) and stent thrombosis of the left main coronary artery (LMCA) during the second phase of percutaneous coronary intervention, which required the implantation of 8 stents and administration of glycoprotein IIb/IIIa inhibitors, leading to the clinical manifestation of gastrointestinal bleeding. An important feature of the presented case was the necessity to implant a large number of stents, which is a risk factor for restenosis. Various issues are discussed in this case, including the choice of optimal management strategy for an 80-year-old patient with multivessel coronary artery disease. Physicians had to make difficult decisions to achieve a balance between potential benefit and risk. In order to improve the management of elderly patients, further research is needed, as well as the accumulation and discussion of clinical data.
{"title":"Benefits and risks of revascularization in senile coronary artery disease patients: is there any optimal choice?","authors":"N. A. Rakhimi, E. V. Konstantinova, A. A. Velikotskiy, E. V. Ploshchenkov, O. N. Svetlova, А. P. Nesterov","doi":"10.21518/ms2023-326","DOIUrl":"https://doi.org/10.21518/ms2023-326","url":null,"abstract":"There has been an increase in the population of elderly patients with coronary artery disease (CAD) in recent years. Elderly and, especially, senile patients typically have comorbid conditions, multivessel coronary artery disease and coronary calcification, which make treatment more challenging. The available data from evidence-based medicine is not enough to determine the best treatment strategies for elderly patients, because large randomized clinical trials usually do not include elderly individuals with severe comorbidities. In the presented case, an 80-year-old patient with severe calcification and multivessel coronary artery disease experienced recurrent dissection of the left anterior descending artery (LAD) and stent thrombosis of the left main coronary artery (LMCA) during the second phase of percutaneous coronary intervention, which required the implantation of 8 stents and administration of glycoprotein IIb/IIIa inhibitors, leading to the clinical manifestation of gastrointestinal bleeding. An important feature of the presented case was the necessity to implant a large number of stents, which is a risk factor for restenosis. Various issues are discussed in this case, including the choice of optimal management strategy for an 80-year-old patient with multivessel coronary artery disease. Physicians had to make difficult decisions to achieve a balance between potential benefit and risk. In order to improve the management of elderly patients, further research is needed, as well as the accumulation and discussion of clinical data.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"99 23","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135513287","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. P. Khashchenko, M. N. Alekseeva, E. V. Uvarova, A. S. Sivirinova, I. A. Salnikova, S. O. Kyurdzidi
Introduction . Delayed diagnosis and treatment of endometriosis lead to impaired quality of life and pain chronification in young female patients. Aim . To study indicators of quality of life, anxiety, depression and pain syndrome in adolescents with peritoneal endometriosis (PE) over a one-year period of conservative therapy. Materials and methods . A total of 45 girls aged 13 to 17 years with a confirmed diagnosis of PE were enrolled in a prospective longitudinal study. Pain syndrome (VAS, McGill Pain Questionnaire), anxiety-depressive symptoms (Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Spielberger State-Trait Anxiety Inventory (STAI)), quality of life indicators (SF-36) were assessed before and after one year of treatment in female patients (dienogest administered continuously, NSAIDs and drotaverine for immediate pain relief only). Results . One year of therapy resulted in a significant decrease in the severity of dysmenorrhea and chronic pelvic pain, gastrointestinal symptoms and dysuria, daily activity and productivity impairment (p < 0.001) in girls with PE. In addition, the study demonstrated decreased indicators of anxiety and depressive disorders (BDI depression, HADS anxiety and depression, STAI reactive and personal anxiety (p < 0.001)) and an improvement in quality-of-life indicators (physical and psychological component, average index (p < 0.001)). There was a declining trend in blood hormone and inflammation test results within the reference range during treatment. The estradiol level has been shown to be a risk factor for high levels of affective disorder symptoms in adolescents with PE: STAI reactive anxiety (p = 0.046), HADS anxiety and depression (p = 0.044 and 0.033, respectively). Conclusion . The one-year therapy of PE in adolescents (dienogest administered continuously, a combination of NSAIDs and drotaverine in pain syndrome only) was associated with significantly improved quality of life, decreased severity of anxietydepressive disorders and pain, which confirms the need to start therapy when symptoms of the disease begin to show them-selves in adolescence.
{"title":"Indicators of quality of life, anxiety-depressive symptoms and severity of dysmenorrhea in adolescent girls with peritoneal endometriosis during conservative therapy for a year","authors":"E. P. Khashchenko, M. N. Alekseeva, E. V. Uvarova, A. S. Sivirinova, I. A. Salnikova, S. O. Kyurdzidi","doi":"10.21518/ms2023-345","DOIUrl":"https://doi.org/10.21518/ms2023-345","url":null,"abstract":"Introduction . Delayed diagnosis and treatment of endometriosis lead to impaired quality of life and pain chronification in young female patients. Aim . To study indicators of quality of life, anxiety, depression and pain syndrome in adolescents with peritoneal endometriosis (PE) over a one-year period of conservative therapy. Materials and methods . A total of 45 girls aged 13 to 17 years with a confirmed diagnosis of PE were enrolled in a prospective longitudinal study. Pain syndrome (VAS, McGill Pain Questionnaire), anxiety-depressive symptoms (Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Spielberger State-Trait Anxiety Inventory (STAI)), quality of life indicators (SF-36) were assessed before and after one year of treatment in female patients (dienogest administered continuously, NSAIDs and drotaverine for immediate pain relief only). Results . One year of therapy resulted in a significant decrease in the severity of dysmenorrhea and chronic pelvic pain, gastrointestinal symptoms and dysuria, daily activity and productivity impairment (p < 0.001) in girls with PE. In addition, the study demonstrated decreased indicators of anxiety and depressive disorders (BDI depression, HADS anxiety and depression, STAI reactive and personal anxiety (p < 0.001)) and an improvement in quality-of-life indicators (physical and psychological component, average index (p < 0.001)). There was a declining trend in blood hormone and inflammation test results within the reference range during treatment. The estradiol level has been shown to be a risk factor for high levels of affective disorder symptoms in adolescents with PE: STAI reactive anxiety (p = 0.046), HADS anxiety and depression (p = 0.044 and 0.033, respectively). Conclusion . The one-year therapy of PE in adolescents (dienogest administered continuously, a combination of NSAIDs and drotaverine in pain syndrome only) was associated with significantly improved quality of life, decreased severity of anxietydepressive disorders and pain, which confirms the need to start therapy when symptoms of the disease begin to show them-selves in adolescence.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"100 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135512731","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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