Pub Date : 2024-06-10DOI: 10.26442/20795696.2024.2.202663
Ekaterina V. Kolesnikova, A. V. Zharov, N. V. Mingaleva, M. A. Penzhoyan
Aim. To develop and evaluate the effectiveness of complex therapy of vulvar lichen sclerosus (VLS), considering the clinical and immunological variant (CIV) of the disease. Materials and methods. A randomized prospective study included 292 patients 20-70 years old with different CIVs of the VLS course: atrophic (n=101), sclerosing (n=154), scleroatrophic (n=37), as well as 35 females with VLS in the comparison group of the same age category. Based on the clinical, immunological, and morphological features of the VLS course, a complex anti-relapse therapy was developed, the effectiveness of which was evaluated after a year of follow-up in comparison with the standard of care (SoC) of patients (from the comparison group) based on the number of disease relapses and the results of the Vulvar Quality of Life Index Questionnaire (VQLI) survey of women with vulvar diseases. Results. In patients with the sclerosing variant of VLS, short courses of topical glucocorticoids during exacerbations are justified; in patients with the scleroatrophic variant – topical calcineurin inhibitors, in the atrophic variant – a protein-peptide complex from porcine blood leukocytes (vaginal suppositories and cream-balsam with lanolin) containing interleukin-1, 6, tumor necrosis factor α, transforming growth factor, macrophage migration inhibitory factor. Patients with any variant of VLS are instructed to follow household and hygienic recommendations, use emollients daily, take prophylactic doses of vitamins A, E, and D to correct its deficiency or insufficiency, as well as use local enzyme therapy, as indicated, aimed at preventing or treatment of cicatricial changes. Local estrogens were prescribed only to women with genitourinary menopausal syndrome in the peri- and postmenopausal period. The developed complex anti-relapse therapy of VLS showed greater clinical efficacy compared to SoC: 3.7-fold decrease in episodes of disease exacerbation, as well as a significant (p=0.001) 1.3-fold decrease in the negative effect of VLS on the QoL of patients in the main clinical group (15.4 points according to the VQLI assessment – a mild effect on QoL) compared to SoC with the average score of 27.6, which corresponded to a strong negative effect of the disease on QoL. Conclusion. The results of the study support the distinction of VLS CIVs and the need to consider their features when choosing an effective therapy for the disease. Properly selected complex, supportive therapy of VLS can significantly increase the QoL of patients, minimize the number of relapses, and prevent the development of complications, including, probably, the risk of malignant transformation.
{"title":"Complex anti-relapse therapy of various variants of the course of the vulvar lichen sclerosus: A randomized prospective study","authors":"Ekaterina V. Kolesnikova, A. V. Zharov, N. V. Mingaleva, M. A. Penzhoyan","doi":"10.26442/20795696.2024.2.202663","DOIUrl":"https://doi.org/10.26442/20795696.2024.2.202663","url":null,"abstract":"Aim. To develop and evaluate the effectiveness of complex therapy of vulvar lichen sclerosus (VLS), considering the clinical and immunological variant (CIV) of the disease. \u0000Materials and methods. A randomized prospective study included 292 patients 20-70 years old with different CIVs of the VLS course: atrophic (n=101), sclerosing (n=154), scleroatrophic (n=37), as well as 35 females with VLS in the comparison group of the same age category. Based on the clinical, immunological, and morphological features of the VLS course, a complex anti-relapse therapy was developed, the effectiveness of which was evaluated after a year of follow-up in comparison with the standard of care (SoC) of patients (from the comparison group) based on the number of disease relapses and the results of the Vulvar Quality of Life Index Questionnaire (VQLI) survey of women with vulvar diseases. \u0000Results. In patients with the sclerosing variant of VLS, short courses of topical glucocorticoids during exacerbations are justified; in patients with the scleroatrophic variant – topical calcineurin inhibitors, in the atrophic variant – a protein-peptide complex from porcine blood leukocytes (vaginal suppositories and cream-balsam with lanolin) containing interleukin-1, 6, tumor necrosis factor α, transforming growth factor, macrophage migration inhibitory factor. Patients with any variant of VLS are instructed to follow household and hygienic recommendations, use emollients daily, take prophylactic doses of vitamins A, E, and D to correct its deficiency or insufficiency, as well as use local enzyme therapy, as indicated, aimed at preventing or treatment of cicatricial changes. Local estrogens were prescribed only to women with genitourinary menopausal syndrome in the peri- and postmenopausal period. The developed complex anti-relapse therapy of VLS showed greater clinical efficacy compared to SoC: 3.7-fold decrease in episodes of disease exacerbation, as well as a significant (p=0.001) 1.3-fold decrease in the negative effect of VLS on the QoL of patients in the main clinical group (15.4 points according to the VQLI assessment – a mild effect on QoL) compared to SoC with the average score of 27.6, which corresponded to a strong negative effect of the disease on QoL. \u0000Conclusion. The results of the study support the distinction of VLS CIVs and the need to consider their features when choosing an effective therapy for the disease. Properly selected complex, supportive therapy of VLS can significantly increase the QoL of patients, minimize the number of relapses, and prevent the development of complications, including, probably, the risk of malignant transformation.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":" 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141363690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-10DOI: 10.26442/20795696.2024.2.202802
V. Prilepskaya, E. R. Dovletkhanova, A. V. Ledina, Aigun V. Tagieva
Background. Pelvic inflammatory disease (PID) is a significant gynecological problem. The main treatment strategy involves antibacterial drugs to eliminate the infection in combination with anti-inflammatory, infusion, transfusion, anticoagulant, and desensitization therapy. Chronic inflammatory processes can induce changes in the immune system, thus reducing the effectiveness of treatment, causing adhesions, obstruction of the fallopian tubes, and infertility. It emphasizes the importance of developing new PID treatment methods, including using agents with immunomodulatory, antioxidant, and enzymatic activity that can increase the body's overall resistance to infections. Aim. To evaluate the effectiveness of Longidase® in treating pelvic adhesions to improve the outcomes in chronic PID. Materials and methods. The study included 50 women of reproductive age with established chronic PID and adhesions aged 18 to 42 years with a mean age of 29.4±5.8 years. The subjects were randomly assigned to two groups comparable in their main prognostic features. Patients of the main group (30 people) received treatment with Longidase® 3000 IU 1 suppository rectally once every 3 days, 10 doses, then 1 suppository once every 5 days, 5 doses (the total course is 15 doses of Longidase suppositories 3000 IU). Patients in the control group (20 people) received placebo. The treatment course was 55 days. The patients were followed up for up to 140 days from the start of therapy. Results. The results show no significant changes and the negative effect of the treatment on the blood chemistry parameters in both groups. In 35% of patients in the main group, the level of peptide-bound oxyproline did not change; 46% responded to therapy with its increase and 11% with a decrease, which indicates the activation of the decomposition of collagen proteins and a decrease in their synthesis. Analysis of individual levels of circulating immune complexes (CIC) before and after treatment showed a significant decrease in CIC in the main group (Longidase) vs. control group (36.1±1.4 and 30.8±0.8, respectively), which indicates a decrease in the severity of the inflammation. The pain relief, more pronounced during treatment in the main group than in the control group (30% vs. 15%), is probably due to the resolution of the chronic inflammation and correlates with changes in CIC. The onset of pregnancy in 10 (33.3%) patients in the main group indicates the effectiveness of bovhyaluronidase azoximer (Longidase®) as an anti-inflammatory and anti-fibrotic agent. Conclusion. The study showed the possibility of using Longidase 3000 IU suppositories in the complex therapy of patients with pelvic adhesions due to chronic PID
{"title":"Clinical study (phase II) of the efficacy and safety of Longidase (suppositories) in patients with adhesions due to pelvic inflammatory disease: A blinded, placebo-controlled, randomized study","authors":"V. Prilepskaya, E. R. Dovletkhanova, A. V. Ledina, Aigun V. Tagieva","doi":"10.26442/20795696.2024.2.202802","DOIUrl":"https://doi.org/10.26442/20795696.2024.2.202802","url":null,"abstract":"Background. Pelvic inflammatory disease (PID) is a significant gynecological problem. The main treatment strategy involves antibacterial drugs to eliminate the infection in combination with anti-inflammatory, infusion, transfusion, anticoagulant, and desensitization therapy. Chronic inflammatory processes can induce changes in the immune system, thus reducing the effectiveness of treatment, causing adhesions, obstruction of the fallopian tubes, and infertility. It emphasizes the importance of developing new PID treatment methods, including using agents with immunomodulatory, antioxidant, and enzymatic activity that can increase the body's overall resistance to infections. \u0000Aim. To evaluate the effectiveness of Longidase® in treating pelvic adhesions to improve the outcomes in chronic PID. \u0000Materials and methods. The study included 50 women of reproductive age with established chronic PID and adhesions aged 18 to 42 years with a mean age of 29.4±5.8 years. The subjects were randomly assigned to two groups comparable in their main prognostic features. Patients of the main group (30 people) received treatment with Longidase® 3000 IU 1 suppository rectally once every 3 days, 10 doses, then 1 suppository once every 5 days, 5 doses (the total course is 15 doses of Longidase suppositories 3000 IU). Patients in the control group (20 people) received placebo. The treatment course was 55 days. The patients were followed up for up to 140 days from the start of therapy. \u0000Results. The results show no significant changes and the negative effect of the treatment on the blood chemistry parameters in both groups. In 35% of patients in the main group, the level of peptide-bound oxyproline did not change; 46% responded to therapy with its increase and 11% with a decrease, which indicates the activation of the decomposition of collagen proteins and a decrease in their synthesis. Analysis of individual levels of circulating immune complexes (CIC) before and after treatment showed a significant decrease in CIC in the main group (Longidase) vs. control group (36.1±1.4 and 30.8±0.8, respectively), which indicates a decrease in the severity of the inflammation. The pain relief, more pronounced during treatment in the main group than in the control group (30% vs. 15%), is probably due to the resolution of the chronic inflammation and correlates with changes in CIC. The onset of pregnancy in 10 (33.3%) patients in the main group indicates the effectiveness of bovhyaluronidase azoximer (Longidase®) as an anti-inflammatory and anti-fibrotic agent. \u0000Conclusion. The study showed the possibility of using Longidase 3000 IU suppositories in the complex therapy of patients with pelvic adhesions due to chronic PID","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":" 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141364912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-10DOI: 10.26442/20795696.2024.2.202733
Alina E. Solopova, Patimat M. Alieva, M. Dumanovskaya, G. Tabeeva, Iuliia A. Ivannikova, A. A. Smetnik, S. Pavlovich
Endometriosis affects about 10% of women of reproductive age and can negatively impact their quality of life (QoL). Due to the heterogeneity of symptoms or even their absence, early diagnosis is difficult. Therefore, it is necessary to comprehensively assess the patient's complaints, including a thorough review of medical history, the results of imaging studies, and risk factors for endometriosis. Early diagnosis enables preemptive treatment and avoids surgical intervention. The article presents data on managing patients with endometriosis in outpatient settings, describing methods for non-invasive imaging diagnosis of endometriosis. Current options of pharmacotherapy aimed at controlling the development of the disease and improving the QoL of patients in the long term are addressed. Timely initiated drug treatment improves the QoL of patients, in some cases, leads to a regression of the lesions, and improves the prognosis for the reproductive function. A shift in focus to clinical diagnosis, combined with non-invasive imaging, shortens the time between the first consultation and the final diagnosis. According to the current view of Russian and international professional societies, therapy should be long-term; therefore, selecting treatment with predictable responses and monitoring the course of the disease is necessary.
{"title":"Outpatient diagnosis and drug therapy of endometriosis: A review","authors":"Alina E. Solopova, Patimat M. Alieva, M. Dumanovskaya, G. Tabeeva, Iuliia A. Ivannikova, A. A. Smetnik, S. Pavlovich","doi":"10.26442/20795696.2024.2.202733","DOIUrl":"https://doi.org/10.26442/20795696.2024.2.202733","url":null,"abstract":"Endometriosis affects about 10% of women of reproductive age and can negatively impact their quality of life (QoL). Due to the heterogeneity of symptoms or even their absence, early diagnosis is difficult. Therefore, it is necessary to comprehensively assess the patient's complaints, including a thorough review of medical history, the results of imaging studies, and risk factors for endometriosis. Early diagnosis enables preemptive treatment and avoids surgical intervention. The article presents data on managing patients with endometriosis in outpatient settings, describing methods for non-invasive imaging diagnosis of endometriosis. Current options of pharmacotherapy aimed at controlling the development of the disease and improving the QoL of patients in the long term are addressed. Timely initiated drug treatment improves the QoL of patients, in some cases, leads to a regression of the lesions, and improves the prognosis for the reproductive function. A shift in focus to clinical diagnosis, combined with non-invasive imaging, shortens the time between the first consultation and the final diagnosis. According to the current view of Russian and international professional societies, therapy should be long-term; therefore, selecting treatment with predictable responses and monitoring the course of the disease is necessary.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"109 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141361526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-10DOI: 10.26442/20795696.2024.2.202799
Eugeniu Cazacu, E. Zota, Mariam A. Vardanyan, Radu Niguleanu, Ruslan Pretula, A. Asaturova, Larisa S. Ezhova, A. Badlaeva
Background. Epithelial-mesenchymal transition (EMT) is a conserved mechanism in the process of morphogenesis and organogenesis. EMT provides cells with migratory and invasive properties, which is a necessary condition for the formation of endometrioid heterotopias. Aim. To confirm the presence of EMT features in different types of endometriosis. Materials and methods. During a period of five years (2012–2017) we analyzed 43 cases of extragenital endometriosis: appendix (3 case), colon (5 cases), ileum (1 case), abdominal scar endometriosis after caesarean section (24 cases), and inguinal hernia (10 cases). The material was processed according to histological and immunohistochemical technique using monoclonal E-cadherin and polyclonal Vimentin antibodies to assess local invasiveness. Results. In peritoneal endometriosis, the ratio of E-cadherin to Vimentin expression was 10.3, in the colon = 9.1, in the appendix 8.6, in the ileum 5.5, in the hernial sac 4.2. Thus, in diffuse infiltrative forms of endometriosis, the lesion phenotype is characterized by low expression of E-cadherin, while expression of Vimentin is at a high level (p0.05). Conclusion. The results of our study confirmed involvement of the epithelial-mesenchymal transition process in the pathogenesis of extragenital endometriosis lesions, on the one hand, and they certify its invasive potential in these localizations, on the other hand.
{"title":"Features of epithelial-mesenchymal transition in ectopic endometrium in patients with extragenital endometriosis of various localizations. Observational study","authors":"Eugeniu Cazacu, E. Zota, Mariam A. Vardanyan, Radu Niguleanu, Ruslan Pretula, A. Asaturova, Larisa S. Ezhova, A. Badlaeva","doi":"10.26442/20795696.2024.2.202799","DOIUrl":"https://doi.org/10.26442/20795696.2024.2.202799","url":null,"abstract":"Background. Epithelial-mesenchymal transition (EMT) is a conserved mechanism in the process of morphogenesis and organogenesis. EMT provides cells with migratory and invasive properties, which is a necessary condition for the formation of endometrioid heterotopias. \u0000Aim. To confirm the presence of EMT features in different types of endometriosis. \u0000Materials and methods. During a period of five years (2012–2017) we analyzed 43 cases of extragenital endometriosis: appendix (3 case), colon (5 cases), ileum (1 case), abdominal scar endometriosis after caesarean section (24 cases), and inguinal hernia (10 cases). The material was processed according to histological and immunohistochemical technique using monoclonal E-cadherin and polyclonal Vimentin antibodies to assess local invasiveness. \u0000Results. In peritoneal endometriosis, the ratio of E-cadherin to Vimentin expression was 10.3, in the colon = 9.1, in the appendix 8.6, in the ileum 5.5, in the hernial sac 4.2. Thus, in diffuse infiltrative forms of endometriosis, the lesion phenotype is characterized by low expression of E-cadherin, while expression of Vimentin is at a high level (p0.05). \u0000Conclusion. The results of our study confirmed involvement of the epithelial-mesenchymal transition process in the pathogenesis of extragenital endometriosis lesions, on the one hand, and they certify its invasive potential in these localizations, on the other hand.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"113 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141362253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-10DOI: 10.26442/20795696.2024.2.202689
Alexander A. Pashchenko, Y. Dobrokhotova, D. Fomina
Aim. To determine the clinical significance of the level of nitric oxide in exhaled air (NOex) for optimizing the control of bronchial asthma (BA) in pregnant women in order to reduce asthma-associated obstetric complications. Materials and methods. A cohort comparative study was conducted with the participation of 80 pregnant women in the third trimester of pregnancy against the background of asthma with varying degrees of severity and level of control, with an assessment of the frequency of asthma-associated obstetric complications. The main group consisted of 40 patients with a prospective determination of the level of BA control and inflammatory activity against the background of inhaled glucocorticosteroid + long-acting b2-agonist using a study of nitric oxide levels in exhaled air. The comparison group included 40 patients undergoing therapy with inhaled glucocorticosteroids + long-acting b2-agonist or monotherapy with inhaled glucocorticosteroids with standard methods of outpatient monitoring of pregnancy against the background of asthma (without determining the level of NOex). The instrumental examination was presented by the determination of a surrogate noninvasive marker of inflammation – nitric oxide in exhaled air was determined using a portable NOex detection device (NIOX MONO; Aerocrine AB, Sweden). Results. The study of nitric oxide in exhaled air demonstrated the presence of poorly controlled inflammation of the mucous membrane of the respiratory tract in 22.5% of patients at the beginning of the third trimester, the average NOex values were – 18.75±2.86 ppb. A strong correlation was determined between the values of nitric oxide levels in exhaled air and systolic blood pressure in the third trimester in patients from the main group (Rs=0.84; Rs 0.05=0.31). Decrease in NOex averages (14.87±1.65 ppb) in pregnant women, it occurred as a result of changes in the volume of pharmacotherapy with inhaled glucocorticosteroids and measures to control the strict adherence of patients to anti-asthmatic therapy. Achieving complete control of asthma as a result of screening determination of nitric oxide in exhaled air and selection of optimal anti-asthmatic therapy was accompanied by a 2-fold decrease in the frequency of asthma-associated hypertensive disorders and surgical deliveries in pregnant women from the main group. Conclusion. Modern approaches to the monitoring and therapy of pregnant women with asthma should be based on the study of subclinical inflammation of the mucous membrane of the respiratory tract. The screening method for determining the level of a biomarker of inflammation of the bronchial tree epithelial mucosa – nitric oxide in exhaled air allows to determine the level of BA control, meets the requirements of maximum safety and minimally invasive for use in pregnant women.
{"title":"To study the level of nitric oxide in exhaled air in pregnant women with bronchial asthma as a monitoring of disease control and prediction of asthma-associated obstetric complications: Observational comparative study","authors":"Alexander A. Pashchenko, Y. Dobrokhotova, D. Fomina","doi":"10.26442/20795696.2024.2.202689","DOIUrl":"https://doi.org/10.26442/20795696.2024.2.202689","url":null,"abstract":"Aim. To determine the clinical significance of the level of nitric oxide in exhaled air (NOex) for optimizing the control of bronchial asthma (BA) in pregnant women in order to reduce asthma-associated obstetric complications. \u0000Materials and methods. A cohort comparative study was conducted with the participation of 80 pregnant women in the third trimester of pregnancy against the background of asthma with varying degrees of severity and level of control, with an assessment of the frequency of asthma-associated obstetric complications. The main group consisted of 40 patients with a prospective determination of the level of BA control and inflammatory activity against the background of inhaled glucocorticosteroid + long-acting b2-agonist using a study of nitric oxide levels in exhaled air. The comparison group included 40 patients undergoing therapy with inhaled glucocorticosteroids + long-acting b2-agonist or monotherapy with inhaled glucocorticosteroids with standard methods of outpatient monitoring of pregnancy against the background of asthma (without determining the level of NOex). The instrumental examination was presented by the determination of a surrogate noninvasive marker of inflammation – nitric oxide in exhaled air was determined using a portable NOex detection device (NIOX MONO; Aerocrine AB, Sweden). \u0000Results. The study of nitric oxide in exhaled air demonstrated the presence of poorly controlled inflammation of the mucous membrane of the respiratory tract in 22.5% of patients at the beginning of the third trimester, the average NOex values were – 18.75±2.86 ppb. A strong correlation was determined between the values of nitric oxide levels in exhaled air and systolic blood pressure in the third trimester in patients from the main group (Rs=0.84; Rs 0.05=0.31). Decrease in NOex averages (14.87±1.65 ppb) in pregnant women, it occurred as a result of changes in the volume of pharmacotherapy with inhaled glucocorticosteroids and measures to control the strict adherence of patients to anti-asthmatic therapy. Achieving complete control of asthma as a result of screening determination of nitric oxide in exhaled air and selection of optimal anti-asthmatic therapy was accompanied by a 2-fold decrease in the frequency of asthma-associated hypertensive disorders and surgical deliveries in pregnant women from the main group. \u0000Conclusion. Modern approaches to the monitoring and therapy of pregnant women with asthma should be based on the study of subclinical inflammation of the mucous membrane of the respiratory tract. The screening method for determining the level of a biomarker of inflammation of the bronchial tree epithelial mucosa – nitric oxide in exhaled air allows to determine the level of BA control, meets the requirements of maximum safety and minimally invasive for use in pregnant women.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":" 80","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141365471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-10DOI: 10.26442/20795696.2024.2.202757
I. Bulatova, T. P. Shevlyukova, I. L. Gulyaeva, Alexander A. Sobol, Valentina V. Khasanova
Aim. To assess the functional state of the liver and endothelium in patients with menopausal metabolic syndrome, depending on the degree of obesity. Materials and methods. 70 patients with menopausal metabolic syndrome and obesity of varying degrees with an average age of 49.9±1.1 years and 30 practically healthy women without obesity and liver pathology with an average age of 47.3±2.6 years (comparison group) who were in the early postmenopausal period were examined. All women underwent biometric and laboratory-instrumental examination, including assessment of biometric indicators, determination of estradiol levels in the blood, biochemical markers of cytolysis and cholestasis, markers of endothelial dysfunction, assessment of microvascular tone reaction with calculation of the thermal vasodilation index, ultrasound examination of the liver and calculation of the Hepatic steatosis index (HSI). Results. All patients with menopausal metabolic syndrome had a genoid type of obesity and hypoestrogenism. The level of estradiol decreased more significantly during the transition to the 1st degree of obesity (p=0.001). According to ultrasound and the HSI index, signs of liver steatosis were found in all patients with menopausal metabolic syndrome. Functional liver tests were within the reference values, 13% had an increase in the level of alkaline phosphatase, more significant in the group with grade 3 obesity (p=0.034). Laboratory markers of endothelial dysfunction were significantly higher in patients with menopausal metabolic syndrome than in the comparison group. The muscular and neurogenic index of thermal vasodilation significantly decreased in women with grade 1 obesity compared to the group with “pre-obesity“ (p=0.041 and 0.047). The lowest endothelial response was observed at the transition to the 1st degree of obesity in comparison with women with excess body weight. Conclusion. For patients with menopausal metabolic syndrome to assess the condition of the liver, it is recommended to conduct a comprehensive instrumental laboratory examination, including ultrasound examination of the liver, biochemical parameters and calculation of the steatosis index.
{"title":"Functional state of the liver and endothelium in patients with menopausal metabolic syndrome","authors":"I. Bulatova, T. P. Shevlyukova, I. L. Gulyaeva, Alexander A. Sobol, Valentina V. Khasanova","doi":"10.26442/20795696.2024.2.202757","DOIUrl":"https://doi.org/10.26442/20795696.2024.2.202757","url":null,"abstract":"Aim. To assess the functional state of the liver and endothelium in patients with menopausal metabolic syndrome, depending on the degree of obesity. \u0000Materials and methods. 70 patients with menopausal metabolic syndrome and obesity of varying degrees with an average age of 49.9±1.1 years and 30 practically healthy women without obesity and liver pathology with an average age of 47.3±2.6 years (comparison group) who were in the early postmenopausal period were examined. All women underwent biometric and laboratory-instrumental examination, including assessment of biometric indicators, determination of estradiol levels in the blood, biochemical markers of cytolysis and cholestasis, markers of endothelial dysfunction, assessment of microvascular tone reaction with calculation of the thermal vasodilation index, ultrasound examination of the liver and calculation of the Hepatic steatosis index (HSI). \u0000Results. All patients with menopausal metabolic syndrome had a genoid type of obesity and hypoestrogenism. The level of estradiol decreased more significantly during the transition to the 1st degree of obesity (p=0.001). According to ultrasound and the HSI index, signs of liver steatosis were found in all patients with menopausal metabolic syndrome. Functional liver tests were within the reference values, 13% had an increase in the level of alkaline phosphatase, more significant in the group with grade 3 obesity (p=0.034). Laboratory markers of endothelial dysfunction were significantly higher in patients with menopausal metabolic syndrome than in the comparison group. The muscular and neurogenic index of thermal vasodilation significantly decreased in women with grade 1 obesity compared to the group with “pre-obesity“ (p=0.041 and 0.047). The lowest endothelial response was observed at the transition to the 1st degree of obesity in comparison with women with excess body weight. \u0000Conclusion. For patients with menopausal metabolic syndrome to assess the condition of the liver, it is recommended to conduct a comprehensive instrumental laboratory examination, including ultrasound examination of the liver, biochemical parameters and calculation of the steatosis index.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"108 31","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141362180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-10DOI: 10.26442/20795696.2024.2.202721
Oksana A. Gizinger, E. Andreeva
Aim. Evaluation and correction of local antimicrobial protection factors in women with type 2 diabetes mellitus (DM 2) and chronic recurrent vulvovaginal candidiasis (rVVC). Materials and methods. The study involved 100 women undergoing outpatient follow-up at the age of 40.9±5.8 years, with a body mass index of 29.8±3.5. The period was 2022–2023. The examination included anamnesis, collection of anthropometric data, calculation of body weight, microscopic examination of smears from the cervical canal and vagina, Gram-stained before treatment, in the 1st and 3rd months after its completion, identification pathogenic microorganisms using PCR, colposcopy, ultrasound of the pelvic organs. Indicators of glycosylated hemoglobin in the subjects at the control points of the study: at 1 month the average values were 5.9±2.9%, at 3 months – 5.9±3.0%, the average value was 5.9±3.1%. Candida species were identified by the bacteriological method using Sabouraud dextrose agar (growth of colonies of fungi of the genus Candida in an amount of more than 103 CFU/ml). Immunological methods for studying antimicrobial protection factors included studying the number of neutrophil granulocytes (NG) on the surface of the mucous membranes of the vulva and vagina, their phagocytic and NBT-reducing activity in a latex test. Randomization of patients into groups: group 1 included 50 (50%) women with DM 2 who, as part of complex therapy for rVVC received the drug Genferon® 1 intravaginal suppository of 500 thousand units 2 times a day for 10 days and fluconazole 150 mg orally three times with an interval of 72 hours at the first stage of treatment; group 2 included 50 (50%) women who received therapy with fluconazole 150 mg three times with an interval of 72 hours. The maintenance anti-relapse course therapy in both groups included the use of fluconazole 150 mg once a week for 6 months. In group 1st anti-relapse therapy was supplemented by the administration of the drug Genferon® 1 intravaginal suppository of 500 thousand units at night 3 times a week for 3 months, after which the vaginal microbiota was corrected for 2 weeks using vaginal suppositories, containing Lactobacillus acidophilus in an amount of at least 108 CFU. In group 2nd, basic anti-relapse antimycotic therapy was not accompanied by the prescription of any immunomodulatory or probiotic drugs. Results. The etiological agents of rVVC in women of late reproductive age in 79% (n=79) и 28% (n=28), respectively, were C. albicans and C. glabrata, which during the period of acute of the disease were detected by culture in the vaginal discharge at more than 104 CFU/ml. Chronic recurrent course of vulvovaginal candidiasis in women with DM 2 was characterized by exacerbations 4 or more times a year, accompanied by the corresponding clinical picture: white or yellowish-white cheesy discharge from the genital tract, itching or burning in the anogenital area, discomfort in the external genital area, dyspareunia, dysuria,
{"title":"Assessment and correction of local antimicrobial protection factors in women with chronic recurrent vulvovaginal candidiasis and type 2 diabetes mellitus","authors":"Oksana A. Gizinger, E. Andreeva","doi":"10.26442/20795696.2024.2.202721","DOIUrl":"https://doi.org/10.26442/20795696.2024.2.202721","url":null,"abstract":"Aim. Evaluation and correction of local antimicrobial protection factors in women with type 2 diabetes mellitus (DM 2) and chronic recurrent vulvovaginal candidiasis (rVVC). \u0000Materials and methods. The study involved 100 women undergoing outpatient follow-up at the age of 40.9±5.8 years, with a body mass index of 29.8±3.5. The period was 2022–2023. The examination included anamnesis, collection of anthropometric data, calculation of body weight, microscopic examination of smears from the cervical canal and vagina, Gram-stained before treatment, in the 1st and 3rd months after its completion, identification pathogenic microorganisms using PCR, colposcopy, ultrasound of the pelvic organs. Indicators of glycosylated hemoglobin in the subjects at the control points of the study: at 1 month the average values were 5.9±2.9%, at 3 months – 5.9±3.0%, the average value was 5.9±3.1%. Candida species were identified by the bacteriological method using Sabouraud dextrose agar (growth of colonies of fungi of the genus Candida in an amount of more than 103 CFU/ml). Immunological methods for studying antimicrobial protection factors included studying the number of neutrophil granulocytes (NG) on the surface of the mucous membranes of the vulva and vagina, their phagocytic and NBT-reducing activity in a latex test. Randomization of patients into groups: group 1 included 50 (50%) women with DM 2 who, as part of complex therapy for rVVC received the drug Genferon® 1 intravaginal suppository of 500 thousand units 2 times a day for 10 days and fluconazole 150 mg orally three times with an interval of 72 hours at the first stage of treatment; group 2 included 50 (50%) women who received therapy with fluconazole 150 mg three times with an interval of 72 hours. The maintenance anti-relapse course therapy in both groups included the use of fluconazole 150 mg once a week for 6 months. In group 1st anti-relapse therapy was supplemented by the administration of the drug Genferon® 1 intravaginal suppository of 500 thousand units at night 3 times a week for 3 months, after which the vaginal microbiota was corrected for 2 weeks using vaginal suppositories, containing Lactobacillus acidophilus in an amount of at least 108 CFU. In group 2nd, basic anti-relapse antimycotic therapy was not accompanied by the prescription of any immunomodulatory or probiotic drugs. \u0000Results. The etiological agents of rVVC in women of late reproductive age in 79% (n=79) и 28% (n=28), respectively, were C. albicans and C. glabrata, which during the period of acute of the disease were detected by culture in the vaginal discharge at more than 104 CFU/ml. Chronic recurrent course of vulvovaginal candidiasis in women with DM 2 was characterized by exacerbations 4 or more times a year, accompanied by the corresponding clinical picture: white or yellowish-white cheesy discharge from the genital tract, itching or burning in the anogenital area, discomfort in the external genital area, dyspareunia, dysuria,","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"109 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141362055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-10DOI: 10.26442/20795696.2024.2.202621
V. Prilepskaya, M. V. Iurova
The concept of the demographic policy of the Russian Federation is to increase the birth rate, preserve citizens' health, and increase life expectancy. One of the priority areas is the reproductive health of women. The pleiotropic effect of the components of combined hormonal drugs is successfully used in clinical practice by obstetricians-gynecologists not only for contraception but also for conditions requiring prophylaxis and drug therapy. Estrogens have a protective effect on the reproductive and extragenital organs; however, evidence of the effect of estrogen-containing drugs on breast tissue and hemostasis remains debatable. We analyzed the data published in the international databases PubMed, Google Scholar, and MEDLINE (search depth – 5 years). Estetrol (E4) is a native fetal estrogen produced by the fetal liver during pregnancy. The key difference from other estrogens is its highly selective and differentiated effect on various tissues and its unique antiproliferative properties. The review presents the results of studies on estrogenic and antiestrogenic effects of E4 and the combination of E4 with progestogen (Esteretta drug product approved in Russia), with particular attention paid to the oncoprotective effect of E4. Research data suggest that E4 may have different effects on breast epithelial cells and breast cancer cells compared to other estrogens. Clinical data indicate that E4 has a more selective pharmacological profile compared to other estrogens, which is reflected in a low estrogenic effect on the liver, including the production of sex hormone binding globulin, hemostasis parameters, and lipid profile.
{"title":"Estetrol: a new word in modern hormonal contraception. A review","authors":"V. Prilepskaya, M. V. Iurova","doi":"10.26442/20795696.2024.2.202621","DOIUrl":"https://doi.org/10.26442/20795696.2024.2.202621","url":null,"abstract":"The concept of the demographic policy of the Russian Federation is to increase the birth rate, preserve citizens' health, and increase life expectancy. One of the priority areas is the reproductive health of women. The pleiotropic effect of the components of combined hormonal drugs is successfully used in clinical practice by obstetricians-gynecologists not only for contraception but also for conditions requiring prophylaxis and drug therapy. Estrogens have a protective effect on the reproductive and extragenital organs; however, evidence of the effect of estrogen-containing drugs on breast tissue and hemostasis remains debatable. We analyzed the data published in the international databases PubMed, Google Scholar, and MEDLINE (search depth – 5 years). Estetrol (E4) is a native fetal estrogen produced by the fetal liver during pregnancy. The key difference from other estrogens is its highly selective and differentiated effect on various tissues and its unique antiproliferative properties. The review presents the results of studies on estrogenic and antiestrogenic effects of E4 and the combination of E4 with progestogen (Esteretta drug product approved in Russia), with particular attention paid to the oncoprotective effect of E4. Research data suggest that E4 may have different effects on breast epithelial cells and breast cancer cells compared to other estrogens. Clinical data indicate that E4 has a more selective pharmacological profile compared to other estrogens, which is reflected in a low estrogenic effect on the liver, including the production of sex hormone binding globulin, hemostasis parameters, and lipid profile.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"101 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141361408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-10DOI: 10.26442/20795696.2024.2.202716
N. Podzolkova, Anton V. Demidov, Vasilii В. Osadchev, K. Babkov, Yulia V. Denisova
The frequency of abdominal delivery in the world is steadily rising. Since the latter is associated with a lot of complications compared with vaginal delivery, the increase in the proportion of deliveries in women with a uterine scar through the natural birth canal is an important strategic goal of the obstetrics and gynecology community. In addition, it is established that every second patient after a cesarean section develops a defect in the scar area, which is often accompanied by various disorders of the menstrual cycle (in 25,5% of cases – abnormal uterine bleeding) and can cause secondary infertility. Both assessment of the risk of scar failure at the stage of preconceptional preparation and timely detection and treatment of isthmocele symptoms are still serious challenges facing obstetricians and gynecologists. Clinical guidelines devoted to the cesarean scar defect problem have not yet been developed. This review presents the quintessence of modern data on possible risk factors, clinical manifestations with a detailed consideration of pathophysiological mechanisms, diagnostic tools and correction methods of symptomatic isthmocele and uterine scar defect with a detailed description of indications and a comparative assessment of their effectiveness in order to standardize approaches to the diagnosis and treatment of these pathological conditions.
{"title":"Isthmocele: controversial issues of terminology, diagnosis and treatment. A review","authors":"N. Podzolkova, Anton V. Demidov, Vasilii В. Osadchev, K. Babkov, Yulia V. Denisova","doi":"10.26442/20795696.2024.2.202716","DOIUrl":"https://doi.org/10.26442/20795696.2024.2.202716","url":null,"abstract":"The frequency of abdominal delivery in the world is steadily rising. Since the latter is associated with a lot of complications compared with vaginal delivery, the increase in the proportion of deliveries in women with a uterine scar through the natural birth canal is an important strategic goal of the obstetrics and gynecology community. In addition, it is established that every second patient after a cesarean section develops a defect in the scar area, which is often accompanied by various disorders of the menstrual cycle (in 25,5% of cases – abnormal uterine bleeding) and can cause secondary infertility. Both assessment of the risk of scar failure at the stage of preconceptional preparation and timely detection and treatment of isthmocele symptoms are still serious challenges facing obstetricians and gynecologists. Clinical guidelines devoted to the cesarean scar defect problem have not yet been developed. This review presents the quintessence of modern data on possible risk factors, clinical manifestations with a detailed consideration of pathophysiological mechanisms, diagnostic tools and correction methods of symptomatic isthmocele and uterine scar defect with a detailed description of indications and a comparative assessment of their effectiveness in order to standardize approaches to the diagnosis and treatment of these pathological conditions.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"117 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141361710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-10DOI: 10.26442/20795696.2024.2.202791
Dzhemilya K. Muradova, A. E. Esedova, Ferzi S. Mamedov, Teyli S. Magomedova
Background. In recent decades, the frequency of surgical interventions on reproductive system organs has been steadily increasing. In gynecological practice, preference is given to minimally invasive surgery and precision treatments, especially involving ovaries. Despite the modern approach, it is not always possible to preserve this endocrine organ, which leads to post-surgical menopause (PSM). The relatively high incidence of total hysterectomy-associated PSM and primary hypothyroidism in late reproductive age often leads to their combination. Clinical manifestations aggravating each other form an unfavorable vicious circle. Aim. To study the features of the PSM course with concomitant primary hypothyroidism. Materials and methods. A prospective clinical study included 130 women aged 45 to 55 years with a history of PSM. The main group consisted of 70 patients with PSM with subclinical primary hypothyroidism. A control group included 60 PSM patients without thyroid disorders. We assessed the effect of hypothyroidism on the PSM course by comparing several indicators in the main and control groups. Results. It was found that in the main group patients, severe 26.5% and moderate 38.8% menopausal syndrome prevailed, while in the control group patients, such forms were twice as common. In the women of the main group, the levels of triglycerides were higher than those in the control group by 1.3 times (2.6±0.86 mmol/L and 1.43±0.33 mmol/L, respectively). The total serum alkaline phosphatase activity in patients in the study groups was 29.8% higher than in healthy women. Conclusion. It can be concluded that the severity of menopausal disorders depends on the thyroid status, with more severe in patients of the main group with hypothyroidism. In addition, in patients of the main group with hypothyroidism, dyslipidemia is more pronounced, which predisposes them to severe diseases in the future, in particular cardiovascular disorders, the unfavorable course of metabolic syndrome, and the development of postmenopausal osteoporosis.
{"title":"Features of post-surgical menopause with concomitant primary hypothyroidism: A prospective single-stage clinical study","authors":"Dzhemilya K. Muradova, A. E. Esedova, Ferzi S. Mamedov, Teyli S. Magomedova","doi":"10.26442/20795696.2024.2.202791","DOIUrl":"https://doi.org/10.26442/20795696.2024.2.202791","url":null,"abstract":"Background. In recent decades, the frequency of surgical interventions on reproductive system organs has been steadily increasing. In gynecological practice, preference is given to minimally invasive surgery and precision treatments, especially involving ovaries. Despite the modern approach, it is not always possible to preserve this endocrine organ, which leads to post-surgical menopause (PSM). The relatively high incidence of total hysterectomy-associated PSM and primary hypothyroidism in late reproductive age often leads to their combination. Clinical manifestations aggravating each other form an unfavorable vicious circle. \u0000Aim. To study the features of the PSM course with concomitant primary hypothyroidism. \u0000Materials and methods. A prospective clinical study included 130 women aged 45 to 55 years with a history of PSM. The main group consisted of 70 patients with PSM with subclinical primary hypothyroidism. A control group included 60 PSM patients without thyroid disorders. We assessed the effect of hypothyroidism on the PSM course by comparing several indicators in the main and control groups. \u0000Results. It was found that in the main group patients, severe 26.5% and moderate 38.8% menopausal syndrome prevailed, while in the control group patients, such forms were twice as common. In the women of the main group, the levels of triglycerides were higher than those in the control group by 1.3 times (2.6±0.86 mmol/L and 1.43±0.33 mmol/L, respectively). The total serum alkaline phosphatase activity in patients in the study groups was 29.8% higher than in healthy women. \u0000Conclusion. It can be concluded that the severity of menopausal disorders depends on the thyroid status, with more severe in patients of the main group with hypothyroidism. In addition, in patients of the main group with hypothyroidism, dyslipidemia is more pronounced, which predisposes them to severe diseases in the future, in particular cardiovascular disorders, the unfavorable course of metabolic syndrome, and the development of postmenopausal osteoporosis.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":" 66","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141365299","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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