Main Clinical Group Research Articles

Complex anti-relapse therapy of various variants of the course of the vulvar lichen sclerosus: A randomized prospective study

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.

Clinical and psychopathological characteristics of patients with pulmonar y tuberculosis and anxiety-depressive disorders treated in a phthisiological hospital

The aim of the research was to study the clinical and psychopathological characteristics of patients with pulmonary tuberculosis in the active phase and identified anxiety and depressive disorders. The study included 145 patients with anxiety-depressive disorders: 85 patients with a diagnosis of pulmonary tuberculosis who were being treated in a phthisiological hospital (the main group) and 60 patients with anxiety-depressive disorders without a history of tuberculosis, who were under follow-up and treatment in a psychoneurological dispensary (comparison group). In addition, in the main clinical group, two subgroups were identified depending on the length of hospital stay: with hospital stays of up to 2 months (44 patients) and over 2 months (41 patients). The study assessed the level of anxiety-depressive disorders, asthenia, the nature and intensity of psychosomatic complaints, and signs of vegetative changes. The study showed the presence of more intense psychosomatic complaints, asthenic disorders, and signs of autonomic disorders among the patients with pulmonary tuberculosis compared to those without tuberculosis. Furthermore, in the main clinical group, there was an increase in anxiety-depressive symptoms, asthenic manifestations, and signs of vegetative changes during a longer stay in the phthisiological hospital. The obtained results are presented in the context of the concept of «psychosomatic proportion», implying the ratio of subjective and objective components of patients» psychosomatic status (intensity and structure of psychosomatic complaints and objectively detectable somatovegetative changes in the body). It is concluded that tuberculosis determines a more severe course of affective spectrum disorders and negatively affects the general psychosomatic state of patients, while a long stay in a phthisiological hospital contributes to the chronic course and aggravation of anxiety-depressive disorders, which indicates the need for timely detection and treatment of affective pathology, as well as taking into account predictors of its development in order to elaborate an integrated approach to the therapy of tuberculosis and concomitant mental disorders.

Сучасні аспекти харчування українських підлітків з ожирінням

Purpose - to analyze the nature of nutrition and eating behavior in adolescents with obesity in order to improve the management of this category of patients. Materials and methods. A total of 140 adolescents were examined. The main clinical group included 108 adolescents aged 12-17 years with obesity (body mass index (BMI) ≥95th percentile); the control group included 32 healthy adolescents (BMI 5-85th percentile) of the same age. The survey plan included a set of standard clinical and anamnestic studies, including the study of eating behavior, and laboratory and instrumental studies. To study the nature and diet, a questionnaire developed on the basis of the «Institute of Children and Adolescent Health Care of the National Academy of Medical Sciences of Ukraine» was used. The study of eating behavior (EВ) in adolescents was carried out using the Dutch Questionnaire (DEBQ, The Dutch Eating Behavior Questionnaire). Statistical analysis was performed using the software STATISTICA 6.0. FOR WINDOWS (StatSoft Inc.). Pearson's Chi-square test (χ2) and Fisher's exact test (F) were used to compare the frequency indices of independent groups. To assess the direction, strength, and significance of the relationship between the studied characteristics, a correlation analysis was used to determine the Spearman's rank correlation coefficient. The critical level of statistical significance for testing hypotheses is p<0.05. Results. Adolescents with obesity were significantly more likely to have eating disorders, as well as the habit of snacking on sweets and sweets during the day and late dinner compared with the control group (p<0.001). It was found that obese patients significantly more often used sweets, sweets, fast food, chips, croutons every day or several times a week compared to the examined control group (p<0.05). In the course of the correlation analysis, the interdependence between the increase in the frequency of consumption of sweets, meat, sausages, sweet carbonated drinks, fast food and the increase in anthropometric indicators associated with obesity (BMI, waist circumference and hip circumference) was established; between an increase in the frequency of consumption of sugary carbonated drinks, sausages and an increase in the size of the liver, between a greater frequency of consumption of fruits and a lower level of triglycerides and very low density lipid cholesterol (p<0.05). Analysis of the results of the DEBQ survey showed that more than 70% of obese patients had a restrictive violation of the EB, with a lesser frequency of external (43.8%) and emotiogenic (39.3%) type of EB in contrast to the control group (p<0.05). Conclusions. The study revealed the problem of unbalanced nutrition in adolescents, which also manifested itself in the form of eating disorders. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

НЕКОТОРЫЕ ОСОБЕННОСТИ СТОМАТОЛОГИЧЕСКОГО СТАТУСА ПАЦИЕНТОВ С ПРОЯВЛЕНИЯМИ ТИПИЧНОЙ И ЭРОЗИВНО-ЯЗВЕННОЙ ФОРМЫ КРАСНОГО ПЛОСКОГО ЛИШАЯ СЛИЗИСТОЙ ОБОЛОЧКИ РТА

The purpose of the study is to evaluation of peculiarities of complaints, symptoms and clinical manifestations of typical asymptomatic (L43.80) and erosive-ulcerative (L43.82) forms of lichen planus (LP), its manifestations on the oral mucosa, depending on the age and sex of patients.
 Material and methods. In the present study, 111 patients with OLP were divided into a main clinical group with erosive-ulcerative form of OLP (L43.82, n = 86) and a comparison group with typical asymptomatic form of OLP (L43.80, n = 25) based on the complex of dental examination and simple randomization method. Mann–Whitney and chi-square tests, including Yates' correction, were used to assess the statistical significance of differences between the groups. 
 Results. Patients with the typical asymptomatic form of OLP (L43.80) often had grayish-white, flat papules up to 2 mm in diameter on the unchanged mucosa of the cheeks and dorsal surface of the tongue in the absence of complaints. In the erosive and ulcerative form (L43.82) of OLP, the complaints of pain, intensifying at intake of hard, spicy and hot food, feeling of tightness, roughness, burning, slight dryness prevailed, papules, erosions of irregular or polygonal ulcers were simultaneously observed on swollen, hyperemic mucosa of cheeks, corners of mouth and lateral surface of tongue. The studied pathology prevailed in 81.98% of cases in persons of young working age. Depending on the form of OLP, the intensity of caries according to the CPU index corresponds to a high or very high degree of caries process, the state of oral hygiene according to the OHI-S index of poor or poor hygiene, the inflammatory process in periodontal tissues according to the PMA index of mild or medium degree of inflammation (p < 0.001). Conclusion: thus, the identified features of complaints, symptoms and manifestations of oral mucosal lichen planus should be taken into account by general practitioners when conducting outpatient appointments.

IMPROVEMENT OF CERVICAL EPITHELIUM REPAIR AND PREVENTION OF COMPLICATIONS AFTER ELECTROSURGICAL TREATMENT

The problem of optimization the management of women with cervical pathology after destructive methods of treatment is actual because of its high frequency. We used vaginal suppositories "Giaval" after loop electroexcision of the cervix to prevent complications and recurrences, accelerate the regeneration of the cervical epithelium, prevention of infectious complications.
 Aim. Study of the clinical effectiveness of the drug with hyaluronic acid to improve reparative processes in the cervical mucosa in the postoperative period.
 Materials and methods. The object for the prospective research of the clinical effect of the drug with hyaluronic acid "Giaval" were 50 women who underwent loop FOTEK E81MV loop electroexcision of the cervix with the presence of CIN I and CIN II according to cytomorphological examination and colposcopy and the presence of LSIL after histological examination. The work was carried out on the clinical basis of the Department of Obstetrics and Gynecology named after I.D. Lanovoho IFNMU. According to the principle of simple randomization, patients were divided into two equal clinical groups, depending on the prescribed treatment. The main (first) clinical group (n = 25) included patients who from 7 days after electroexcision were prescribed vaginal suppositories "Giaval" for 1 suppository in the vagina at night for 15 days. In the control (second) group, women received Methyluracil suppository twice a day for 10 days. The control examination, bacterioscopic, cytological examination and extended colposcopy were performed 6 weeks after treatment and then once every 3 months during the year. During the analysis of the effectiveness of treatment, the results of cervical epithelialization were evaluated according to the following criteria: full effect, absent or incomplete effect, recurrence. Variational and statistical processing of research results were performed using the programs SPSS Statistics 22 and StatSoft Statistica.
 Results. During examination patients of both groups, no significant difference in the anamnesis or objective data were found. In the patients of the first group already on the third day using of vaginal suppositories "Giaval" there was a sharp decrease in vaginal discharge in contrast to the control group, where the discharge was intensive and continued for about a week. Lower abdominal pain bothered 3 (12%) women in the control group. Six weeks after PEE in the main clinical group, complete epithelialization was observed in 23 women (92%) who received postoperative treatment with Giaval. At the same time, in patients of the control group complete epithelialization was observed in only 17 women (68%), in the rest incomplete epithelialization was observed on the background of inflammatory smear type. The period of complete repair of postoperative wound defects of the cervix was 39.3 ± 1.8 and 47.4 ± 2.3 days, respectively in patients of the first and second groups.
 Six months after treatment all women in the main group had normal colposcopy and cytology. Abnormal colposcopy and cytology after treatment, which was considered a relapse, was diagnosed in 2 (8%) patients of the second group. Cervical stenosis was also diagnosed in 6 (24%) patients in the same group.
 Conclusions. Using of vaginal suppositories "Giaval" improves the repair of the epithelium of the cervical mucosa, reduces the duration of vaginal discharge, normalizes the biocenosis of the vagina, which increases the effectiveness of treatment and reduces the frequency of postoperative complications, improve women's quality of life. The use of "Giaval" suppositories are safe and comfortable for women as it has no side effects.

Ефективність ембріологічного етапу екстракорпорального запліднення в пацієнток із прогнозованою слабкою відповіддю яєчників

Purpose - to show the efficacy of the embryological stage of in vitro fertilisation (IVF) in women with infertility and predicted poor ovarian response to stimulation with various gonadotropins. Materials and methods. This article analyzes the embryological stage of IVF in 140 women with infertility and predicted poor ovarian response. The main clinical group included 75 women who underwent controlled ovarian superstimulation with urinary gonadotropins in the protocol along with gonadotropin-releasing hormone antagonist. Group II (comparison) included 65 women who underwent stimulation of superovulation as per the similar scheme with recombinant gonadotropins. Oocyte pickups, fertilization, cultivation, and embryo transfer were carried out as per standard techniques. Confirmation or exclusion of biochemical pregnancy was carried out by determining the level of total chorionic gonadotropin in the blood serum 14 days after embryo transfer. When calculating the results, the analysis applied methods that were adopted in medical and biological statistics and described in the Glantz Manual. Data were processed by means of StatSoft Statistica 8.0 software package. Results. Among female patients of Groups I and II - where duration of ovarian stimulation did not exceed 10 days - the average duration of using gonadotropins estimated 8.4±1.3 and 9.5±1.2 days respectively (p<0.05). In patients with a longer administration of drugs compared, the average duration of gonadotropin stimulation was definitely higher when using recombinant gonadotropins, i.e. 12.8±2.0 days versus 10.4±1.4 days (p<0.05). When evaluating the follicle-stimulating hormone (FSH) dose used as part of gonadotropin products compared, it was found that in female patients of Groups I and II - where duration of gonadotropin stimulation did not exceed 10 days - the FSH course dose averaged 2,700±300 IU respectively. With the gonadotropin stimulation lasting for more than 10 days, the FSH dose in Group I increased on average up to 3,000±300 IU; in Group II, it increased on average up to 3,300±300 IU (p<0.05). The number of viable embryos on Day 5-6 of cultivation - in the groups compared - averaged to 5.4±2.1, whereas 4.3±2.3 (p=0.014), and their percentage of the number of obtained zygotes reached 91.2±4.1% and 90.0±5.6% (p=0.041). On Day 5, the process of cultivating viable embryos in the groups decreased down to 4.2±1.5 and 3.6±1.7 (p=0.005), whereas their percentage of the number of obtained zygotes decreased down to 77.2±3.5% and 76.0±4.8% (p=0.012). When conducting the cytomorphological examination of embryos under cultivation, it was found that percentage of good quality embryos in the total pool of embryos aged 5 days was 60.4±13.6% and 54.6±14.2% (p=0.011) respectively, whereas in the total pool of embryos aged 6 days, the percentage was 72.6±14.7% and 68.7±16.4% (p=0.013). Conclusions. The conducted comparative study of the effects of human menopausal gonadotropin and the combination of recombinant FSF + recombinant luteinizing hormone at the pre-transfer stage in all examined female patients with expected poor response to gonadotropins showed that the administration of these drugs was accompanied by definitive differences within a number of parameters of stimulated cycles; in terms of statistics, significant are the conclusions as follows: reducing the stimulation period in women who had duration of gonadotropin for less than 10 days; decreasing the average dose of FSH if the gonadotropin stimulation period lasted less than and more than 10 days; improving the survival rate of embryos aged 5 and 6 days; increasing the percentage of good quality embryos among embryos aged 5 and 6 days. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author. Key words: infertility, assisted reproductive technologies, controlled ovarian stimulation, urinary gonadotropins, recombinant gonadotropins.

Ефективність використання препарату Ентроп у лікуванні астенії в пацієнтів, які перенесли черепно-мозкову травму

Мета: оцінити ефективність ноотропного препарату Ентроп (INN: Mono) у лікуванні астенії в пацієнтів, які перенесли черепно-мозкову травму (ЧМТ). Матеріали та методи. Дослідження проведено в 60 пацієнтів у проміжний та віддалений період після перенесеної ЧМТ. У 30 пацієнтів 1-ї клінічної групи (основної) в лікуванні використовували препарат Ентроп, у 30 пацієнтів 2-ї клінічної групі (контрольної) як ноотропний препарат використовували пірацетам. Застосовані методи: клініко-неврологічний; нейропсихологічне тестування з використанням шкал для оцінки когнітивних та астенічних розладів; нейрофізіологічні — когнітивні слухові викликані потенціали (КВП Р300), цифрова електроенцефалографія. Результати. Через 1–1,5 місяця від початку лікування препаратом Ентроп спостерігали вірогідне зниження (р < 0,05) частоти виявлення симптомів астенії: загальної слабкості, підвищеної втомлюваності, дратівливості, емоційної лабільності, погіршення пам’яті, невпевненості, тривоги; показники латентності та амплітуди (КВП Р300) мали чітку тенденцію до нормалізації. Висновки. Результатом застосування препарату Ентроп у пацієнтів після перенесеної ЧМТ є вагоме зменшення проявів астенічного синдрому, покращення когнітивних функцій за даними нейропсихологічного тестування та об’єктивних нейрофізіологічних показників — параметрів КВП. Позитивний антиастенічний ефект препарату Ентроп у такого контингенту хворих виявлявся раніше та в більшої кількості хворих, ніж при застосуванні препарату пірацетам.

Eisenmenger syndrome: is it the same entity in adulthood and pediatric age?

Abstract Introduction Eisenmenger syndrome is the final clinical stage of different congenital heart diseases (CHD) associated with pulmonary arterial hypertension (PAH). Children born in recent years with CHD have benefited from advances in pediatric cardiac surgery that have modified their evolution compared to adults with the same pathologies. Purpose Our objective was to define and compare the characteristics and prognosis of the adult and pediatric population with Eisenmenger Syndrome. Methods REHAP and REHIPED are Spanish, voluntary, multicenter registries that include patients with PAH associated with CHD. REHAP started in 2007 and includes patients over 18 years of age. Patients diagnosed with PAH after this time were prospectively included, until 2020. Patients who were followed in the participating centres and diagnosed after January 1998 were retrospectively included in the registry. REHIPED started in 2009 and collects patients between 2 months and 18 years of age. Patients diagnosed with PAH after this time were prospectively included, until 2020. Patients who were followed and diagnosed after January 1998 were retrospectively included. The baseline characteristics, hemodynamic profile, treatment, and 10-year survival of the REHAP patients were compared to those included in the REHIPED. Results Eisenmenger syndrome is the main clinical group in adults (56% of patients with PAH associated with CHD enlisted in REHAP), 371 patients were included. On the other hand, Eisenmenger syndrome is the least frequent clinical group in childhood (21% of patients with PAH associated with CHD enlisted in REHIPED), 32 patients were included. Among adults, simple defects were significatively more common, whereas complex defects were more frequent in children (p 0.004). Half of the patients were in NYHA class III-IV, with no difference between groups. Adults presented greater hemodynamic severity, with higher mean pulmonary arterial pressure and greater pulmonary vascular resistance index. There were no differences in treatment: neither in first line therapy nor in the percentage of patients who received prostanoids at any time during follow up. The usage of prostanoids was very low in both groups. Two-thirds of the patients who died or underwent transplantation did so without taking prostanoids at any time. The 10-years survival analysis showed no significative difference between groups. Conclusions The prevalence of Eisenmenger syndrome is clearly lower in the pediatric population with CHD compared to the adult population. However, once Eisenmenger syndrome has developed, even though adults present greater hemodynamic severity, the clinical characteristics and the prognosis are similar in both groups. The usage of prostanoids is low in adulthood and in childhood, even in those with more severe forms of the disease. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Ferrer, MSD, Janssen, GSK Table 1Figure 1

Показатели цитокинов у детей с гепатобилиарной патологией в сочетании с паразитозами

Актуальность. Гепатобилиарная патология (ГБП) у детей имеет тенденцию к неуклонному росту, а сама патология характеризуется рядом особенностей, отсутствующих у взрослых. Цель: исследовать особенности цитокинового профиля у детей с гепатобилиарной патологией на фоне паразитозов. Материалы и методы. Основную клиническую группу составили 54 ребенка в возрасте от 8 до 18 лет с ГБП. Группу сравнения составили 25 практически здоровых детей, сопоставимых по возрасту и полу с основной клинической группой. Результаты. Поражение гепатобилиарного участка преобладало у детей младшего школьного возраста. У 64,8 % пациентов с ГБП были диагностированы гельминтозы или лямблиоз. Уровень интерлейкина-4 (IL-4) у детей с ГБП превышал уровень у детей группы сравнения почти в 11 раз, фактора некроза опухоли альфа (TNF-α) — в 6 раз. Самая высокая концентрация IL-4 и TNF-α зарегистрированa у пациентов с ГБП на фоне токсокароза и аскаридоза. Выводы. В структуре ГБП у детей преобладали функциональные расстройства билиарного тракта. У детей с ГБП и сопутствующими паразитозами (особенно аскаридозом и токсокарозом) уровни IL-4 и TNF-α достоверно выше показателей у детей без сопутствующего паразитоза.

Цитокіновий статус у дітей із хронічною гастродуоденальною патологією

Актуальність. Частота захворювань шлунка та дванадцятипалої кишки у дітей має тенденцію до невпинного зростання, а сама патологія характеризується групою особливостей, що відсутні у дорослих. Мета: виявити особливості цитокінового профілю сироватки крові у дітей із хронічною гастродуоденальною патологією (ХГДП). Матеріал та методи. Основну клінічну групу становили 54 дитини у віці 8–18 років із ХГДП. Групу порівняння становили 24 практично здорові дитини, порівнянні за віком та статтю з основною клінічною групою. Результати. У 88,9 % дітей із ХГДП виявлено підвищення інтерлейкіну-4 (IL-4) щодо показників у дітей групи порівняння. При приєднанні H.pylori вміст IL‑4 знижувався. Концентрація фактора некрозу пухлини альфа (TNF-α) вірогідно не відрізнялася від такої у дітей групи порівняння при всіх варіантах інфікування, але дещо вищі його значення були при паразитозах. Найвищий показник IL‑4 зареєстрований при виразковому ураженні слизової оболонки шлунка та дванадцятипалої кишки. У цих же пацієнтів відзначено максимально високий рівень TNF-α. Висновок. У дітей із виразковим ураженням слизової оболонки, підвищеною кислотоутворюючою функцією шлунка, значною поширеністю ураження (пангастрит) виявлені вірогідно вищі значення ІЛ‑4 та TNF-α.

Evidence, Efficasy and Safety of the Chondroprotective Parapharmaceuticals in Treatment of the Early Stages of Osteoarthritis

Osteoarthritis (OA) is the most common joint disease that significantly affects the patients’ quality of life and requires significant medical and social investments for treatment and rehabilitation. There are no therapeutic agents which would be able to regenerate lost or damaged hyaline cartilage. The objective: to assess the efficacy and safety of the chondroprotective parapharmaceutical agent Flexogial in the complex treatment of patients with initial stages of the knee ОА. Materials and methods. 12-weeks study was conducted with the participation of 60 patients with knee OA aged 53,7±2,9 years, women – 36 (60%), men – 24 (40%) with the initial stages of the disease (I–II radiological stage). The main clinical group consisted of 30 patients who took the chondroprotective complex agent Flexogial 15 ml once a day; the comparison group included 30 patients who were administered glucosamine sulfate 1500 mg in a monopreparation taken once a day. Efficacy of the treatment was evaluated using the VAS scale, Tegner’s scale, Lisholm scale at the beginning of treatment, after 6 and 12 weeks in dynamics with subsequent statistical processing of the results. Results. The study demonstrated better indicators of functional activity and less pain intensity in the affected joints in patients of the main group who took the parapharmaceutical agent Flexogial compared to the group of patients who took glucosamine monopreparation with the same number of registered adverse events in both groups of patients (5%). Conclusions. The results of the presented clinical study proved the advantage of use of the combined chondroprotective drinking complex Flexogial in comparison with the monopharmaceutical preparation glucosamine sulfate in the treatment of patients with early stages knee OA in terms of the effect on the intensity of pain and improvement in the parameters of the functional activity of patients after 6 and 12 weeks with the same frequency of registered adverse events.

Clinical and diagnostic aspects of abnormal uterine bleeding in reproductive aged women with extragenital pathology

Study objective: to determine the clinical and diagnostic features of the abnormal uterine bleeding (AUB) in women of reproductive age with extragenital pathology.Materials and methods. The study involved a retrospective assessment of 400 case histories of reproductive aged women with AUB who underwent inpatient treatment.The main clinical group (I) consisted of 300 case histories of women with AUB and concomitant extragenital disorders, control group (II) consisted of 100 case histories of somatically healthy women with AUB. An ultrasound scan with Doppler mapping was performed to assess the pelvic organs. All women underwent hysteroscopy and/or separate diagnostic curettage with further morphological assessment of the endometrium.Results. The most common extragenital disorder was diseases of the circulatory system and endocrine system, diseases of the digestive system. 123 patients (41%) had concomitant hypertension and obesity, 76 (25.3%) – obesity and varicose veins, 53 (17.6%) – somatoform autonomic dysfunction and chronic gastritis, 39 (13%) – obesity and diabetes mellitus, 24 (8%) – chronic gastritis and obesity. AUB was complicated by anemia of varying severity in 176 (58.6%) women. According to ultrasound data the most common endometrial disorder in women of group I was glandular hyperplasia of the endometrium.Conclusion. A retrospective analysis of case histories showed a high prevalence of AUB among women with extragenital pathology, which is a clinical indicator of major menstrual disorders in this category of patients and can be a serious problem for women's health in general. The need to study the prevalence and identify the main risk factors for the AUB development will make it possible to provide a general strategy for its prevention, improve the reproductive potential of women and avoid serious abnormal changes in the process of fulfilment of the reproductive function in young women.

Evaluation of clinical efficacy of preventive therapy in pregnant women with ulcerative colitis

Annotation. “Voluntary childlessness” as a consequence of fear of infertility, doubts about the ability to cope with pregnancy in the presence of the disease, the hereditary nature of the disease and adverse effects on the fetus; improper medication; self-modification or discontinuation of therapy in patients with CIBD (chronic inflammatory bowel disease) are significant not only medical but also social problems that currently remain unresolved. The aim of this work is to provide up-to-date evidence for the optimal diagnosis and treatment of chronic inflammatory bowel disease before conception, during pregnancy and in the postpartum period. A detailed analysis of the social, somatic, gynecological and obstetric history of women with inflammatory bowel disease was performed. The examined patients were divided into the main group (ulcerative colitis) (n=40) and control groups (almost healthy women) (n=30). The first main clinical group underwent prophylactic therapy using a drug containing active folate of the 4th generation "Quatrefolic" (equivalent to 400 μg of folic acid), potassium iodide 1 table. per day and vitamin D 1000 IU per day, starting from the planning stage of pregnancy). The second major clinical group received, in addition to Quatrefolic and potassium iodide, vitamin D 4,000 IU per day during the pre-pregnancy phase and 2,000 IU per day during pregnancy and 1,000 IU per day in cases of placental dysfunction and anemia. The formation of observation groups was carried out by methods of continuous and selective analysis. Statistical processing of research results was performed using the software package Statistica 6.0. The obtained indicators were processed statistically with the determination of the arithmetic mean (M) and the error of the standard deviation (±m), at p<0,05. Risk ratio (RR) and confidence interval (CI) were determined with a given reliable probability p=95%. Comparison of groups by case frequency was performed using the exact Fisher test (two-way criterion). Pregnant women with ulcerative colitis have a better clinical efficacy of preventive therapy using the 4th generation active folate “Quatrefolic” (equivalent to 400 mcg of folic acid) and vitamin D 4000 IU at the pre-pregnancy stage and 2000 IU after pregnancy verification compared with active folate 4th generation “Quatrefolic” (equivalent to 400 mcg of folic acid) and vitamin D 1000 IU.

Ожирение и дефицит массы тела как предикторы гестационной гипертензии и сердечно-сосудистых заболеваний

Purpose of work. To reveal possible predictors of cardiovascular diseases on the basis of studying mechanisms of gestational adaptation, parameters of homeostasis in women with obesity and body weight deficiency. Material and methods. During pregnancy in 297 patients with changed body weight and 107 women of the comparison group carried out dynamic study of homeostasis parameters and adaptation mechanisms. The clinical state was assessed using morphological, electrophysiological, hormonal, biochemical and microbiological methods. Results. Analysis of anamnestic data revealed that parents of 87% of patients with obesity and weight deficit had arterial hypertension combined with atherosclerosis, obesity, diabetes mellitus, and depression. The upper distribution of subcutaneous tissue and gestational hypertension were found to be prevalent in women of the main clinical group: during the whole period, the average blood pressure was exceeded in obese women and in women with a deficit of body weight in the second trimester. General cholesterol level in the second trimester was increased due to atherogenic fractions in pregnant women of the first group up to 6.21 ± 0.13 mmol/l, in the second group – 5.95 ± 0.20 mmol/l, against the control group 4.96 ± 0.31 mmol/l. Transitor glucosuria (in case of excluded diabetes mellitus) occurred only in pregnant women with changed body weight in the 2nd trimester. Stress reactions prevailed in women with obesity and deficit of body weight on the eve of labor: 77% (1) and 88% (2), exceeding the parameters of the control group; there was also an increase in the level of norepinephrine and dioxyphenylalanine in daily excretion of urine by 4-6 times. Decrease in species landscape of intestinal and vaginal flora with increasing share of pathogenic microorganisms was registered in 91% of pregnant main groups and only in 33% of control group patients. Conclusion. In women with changed body weight, pregnancy is accompanied by excessive activation and disintegration of adaptation systems, the clinical equivalent of which is gestational hypertension, metabolic and microecology disorders. Gestational stress-test allows to estimate phylogenetic features of response systems of young women and probable ontogenetic risks of cardiovascular diseases.

CLINICAL EFFECTS OF HUMAN IMMUNOGLOBULIN ADMINISTRATION IN WOMEN WITH RHESUS SENSITIZATION AT THE PRE-GRAVID STAGE

The aim of the study – to evaluate changes in cellular immunity in rhesus-sensitized women in response to IVIG administration and the prognostic effectiveness of a method for the prevention of isoimmunization in the next pregnancy.
 Materials and Methods. The study was performed on the basis of City Maternity Hospital No. 7" (Odesa) in 2014–2019. 37 rhesus-sensitized women were randomly splited in two clinical groups: main clinical group (n=19) where patients received human immunoglobulin for intravenous administration, and control group (n=18) where patients did not receive IVIG.
 Results and Discussion. The state of cellular immunity in rhesus-sensitized women is characterized by a moderate decrease in the absolute and relative indices of T-lymphocytes while increasing the number of B-lymphocytes. The NK cell population did not differ from the control group. When analyzing subpopulations of T-lymphocytes, it can be concluded that the number of T-helper cells is increased and the number of T-suppressors is proportionally reduced. These changes explain the increase in the number of B-lymphocytes as a result of increasing antigenic load on cell receptors. In the group of women who received IVIG therapy, the ratio of chances of normalization of cellular immunity was 18.41 (95 % CI 2.62–166.74), T-helper – 14.93 (95 % CI) 2.45–107.8), T-suppressors – 14.57 (95 % CI 2.13 –127.57) and B-lymphocytes – 31.87 (95 % CI 4.1–333.41). According to the ROC analysis, the quality of the statistical model of IVIG application corresponds to AUC = 0.843 (95 % CI 0.689–0.941) According to the ROC analysis, the level of β-lymphocytes in the compared AUC groups = 0.58 (95 % CI 0.405–0.742).

Acupuncture on treating angina pectoris: A systematic review.

Background:Coronary heart disease angina pectoris is a common clinical symptom in patients with coronary heart disease, due to coronary atherosclerotic stenosis or sputum leading to coronary insufficiency, myocardial transient ischemia, hypoxia caused by precordial pain as the main clinical manifestations Group syndrome. Coronary heart disease angina causes coronary blood flow insufficiency, cannot meet the normal activities of myocardial cells, leading to myocardial ischemia or necrosis. When the disease occurs, there is paroxysmal and crushing pain in the precordial area of the patient. Therefore, we recognize the importance of the disease and have paid enough attention. Clinical studies in recent years have found that the use of acupuncture in the treatment of angina pectoris has a good clinical application prospect. This study was conducted to study the effect of using acupuncture to treat angina pectoris.Methods and analysis:We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet, Nature, Science online and China Journal Full-text Database, China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to November 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of angina pectoris.Ethics and dissemination:This systematic review will evaluate the efficacy and safety of acupuncture for angina pectoris. Because all of the data used in this systematic review and meta-analysis have been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial.Registration number:PROSPERO CRD42019138003.

Clinical case of complications of inguinal node metastatic lesion in gastric cancer after surgical treatment

Objective:To study the phenomena of complications of atypical distant lymphangitic metastasis by the example of gastric cancer.Methods:Within the framework of the study “Hereditary diffuse gastric cancer and measures for its prevention”, a clinical group and a control group of patients with the most likely risk of developing this genetic disease were recruited. DNA samples were taken from 119 patients of the main clinical group and the control group. In the course of filling out statistical charts, questioning and examination of patients, cases of distant lymphangitic and hematogenous metastasis were revealed in 7 patients. As diagnostic methods for distant lymphangitic and hematogenous metastasis, we used the results of studies of computed tomography, positron emission tomography combined with computed tomography of the whole body, nuclear magnetic resonance imaging, ultrasound methods, open biopsy and trephine-biopsy of lymph nodes.Results:Krukenberg’s tumors were detected in 2 patients, Virchow’s metastases - in 2 patients, metastases in the paraumbilical region - in 2 patients, Schnitzler metastases - in 1 patient, Irish node was detected in 1 of the examined patients. There was also a metastatic lesion of the lymph nodes of inguinal region on the left in 2 patients and one case of metastasis to the right testicle in a patient with true inguinal cryptorchidism. This article reflects one case of metastatic lesion of the inguinal nodes on the left and subsequent complications in the form of lymphostasis and pain syndrome.Conclusion:According to the classification of distant metastases in case of malignant neoplasms of the stomach, classical cases of metastases of Krukenberg, Virchow, Schnitzler, Sister Mary Joseph, and Irish were revealed. There is atypical metastasis to the inguinal nodes and to the undescended (true inguinal cryptorchidism) right testicle, which does not fall under the generally accepted classification of distant metastases of gastric cancer. Further tactics of treatment in the case of metastatic lesion to the inguinal regions in gastric cancer are not entirely clear, which requires an increase in the study of the amount of these clinical cases.

FEATURES OF HEMODYNAMICS OF FETOPLACENTAL COMPLEX IN PREGNANT WITH PERINATAL INFECTIONS

Introduction: Perinatal infections are an important issue in modern obstetrics, perinatal and pediatric care and one of the main causes of perinatal morbidity and mortality. The persistence of infection in the mother's body can lead to an adverse outcome of pregnancy and childbirth, but it does not always mean the infection of the fetus and the development of an infectious disease. The presence of foci of infection in the body of a pregnant woman is only one of the reasons for the development of intrauterine infection. Dopplerometric study in IUI promotes identification of patients at risk of developmental retardation and helps to determine the initial signs of fetal distress. The aim: To study the features of hemodynamics of fetoplacental complex in pregnant with perinatal infections, depending on their implementation in newborns. Materials and methods: The study involved examination of 230 couples of pregnant-newborns, who were divided into clinical groups: Group I - 60 couples with viral infection; Group ІІ - 60 couples with bacterial infection; Group III - 60 couples with combined infection. Each clinical group was divided into 2 subgroups: with implementation of infection in newborns (1) and without it (0). Control group included 50 pregnant-newborns couples with physiological course of pregnancy and early neonatal period. Ultrasound (echographic and dopplerometric) study was performed according to the generally accepted technique on MINDRAY M7. The condition of the bloodstream was determined in the following vessels: umbilical artery, thoracic aorta, medial cerebral artery, uterine arteries. The resulting data was subject to statistical processing using the STATISTICA software. Results: Pregnant of the control and main groups underwent ultrasound somatogenic study with a syndromological analysis. Assessment of indices of RI and PI in the I-III clinical groups showed a tendency to increase. These values in the main group were significantly higher than the normative ones. More severe violations of the blood flow were observed in Group I and III. More pronounced changes in utero-placental-fetal blood flow were recorded in pregnant women with the implementation of infection. Peak systolic velocity in the medial cerebral artery was 1.3 times higher in Group II, 1.8 times higher in Group I and 1.6 times higher in Group III than in women with physiological pregnancy. Conclusions: Pregnant women of the main clinical group, in comparison with the normative indices of healthy pregnant, were found to have an increase in the indices of vascular resistance in the major vessels of the uterus-placental-fetal basin, which is likely due to the toxic effects of metabolic products of pathogens of infections that persist in the body on the endothelium of the blood vessels.

Клінічний досвід в оптимізації репаративних процесів шийки матки після деструктивно-хірургічних втручань

The objective: to evaluate the therapeutic approach in order to improve regenerate the epithelium of the cervical mucosa and restore of the vaginal biocenosis after laser vaporization in women of reproductive age with CIN I with including the vaginal gel which consist of decametoxinum and hyaluronic acid. Materials and methods. 60 women of reproductive age were examined with CIN І, confirmed by histological examination, which underwent laser vaporization. The main clinical group (n=30), for patients were prescribed 5 ml vaginal gel which consist of decametoxinum and hyaluronic acid (Ginodek®) for 7–10 days after laser vaporization with a course of 14 days. The comparison group were consisted of 30 patients who, after laser destruction of the cervix, were prescribed standard therapy. We were used colposcopy for visual inspection of the cervical reparative processes. According to the results of a microbiological study, the vaginal biocenosis was evaluated. The side effects that were associated with the use of Ginodek® vaginal gel were evaluated. Results. It was proved that the use of vaginal gel Ginodek® in patients with CIN I after laser vaporization resulted in faster and more complete epithelialization of the wound surface than the standard therapy (RR 1.56; 95% CI: 1.08–2.26; p=0.02). 2 months after the application of vaginal gel Ginodek®, we found significant increasing cases of normalization of vaginal microbiota (RR 1.44; 95% CI: 1.04–2.00; p=0.03), increase in the number of lactobacilli in the vaginal secretion (RR 1.50; 95% CI: 1.03–2.19; p=0.04) and a decrease in the number of cases of vaginal candidiasis (RR 1.27; 95% CI: 1.005–1.61; p=0.045). Not a single adverse effects on were noted when using vaginal gel Ginodek®, both during the course of therapy and at a later date. Conclusion. The obtained results were testified to the acceleration of the reparative processes of the cervix, the reduction of the microbial effect and safety when using vaginal gel Ginodek® after laser vaporization in women with CIN І. Key words: cervical neoplasia, laser vaporization, vaginal microbiota, epithelization, Ginodek®.

Діагностичні резерви деталізації гострого апендициту у вагітних

Мета роботи: встановити додаткові діагностичні критерії діагностики гострого апендициту у вагітних для оптимізації лікування даної патології.Матеріали і методи. В період із 2004 до 2012 р. у хірургічне відділення міської клінічної лікарні № 1, № 3 м. Києва було госпіталізовано 864 вагітні жінки, які були розділені на досліджувану (n=473) та контрольну (n=391) групи. Найчастіше зустрічався ГА – 258 (29,8 %) від усіх випадків госпіталізації. В процесі обстеження поряд із загальноприйнятими дослідженнями вивчалися гематологічні, цитологічні та імунологічні показники у вагітних із діагнозом гострий апендицит. Для оцінки патогенетичних механізмів формування запальної реакції у вагітних досліджуваної групи, а також для можливості проведення диференційної діагностики та проведення раннього прогнозування ускладнень проводили дослідження активності функціонування неспецифічної резистентності та імунологічної реактивності: НСТ-тест, визначення рівнів Ig M, Ig G, Ig E, Ig A, ПРК (прокальцитоніну), Il β-1, ФНП (фактор некрозу пухлини).Результати досліджень та їх обговорення. При проведенні біохімічних досліджень для встановлення типових додаткових маркерів ГА у вагітних ми встановили, що у пацієнтів спостерігаються ознаки розвитку ендотоксикозу, пов’язані з накопиченням токсинів мікробного походження (ТЗН), декомпенсацією функціональної активності фагоцитуючих клітин – нейтрофільних гранулоцитів (індекс стимуляції) та токсинозв’язуючої та біосентизуючої здатності печінки, коефіцієнт де Рітіса, наявність кріоглобулінів. При цьому встановлено, що у пацієнтів другої клінічною групи дані тенденції були більш виразні. Визначено, що у пацієнтів обох клінічних груп проявляють такі ознаки запальної відповіді, як підвищення концентрації основних запальних медіаторів – Іл-1 та ФНП відносно значень здорових осіб. Встановлено, що в другій основній клінічній групі данні зміни були більш виразні, що свідчить про значну активність запальних реакцій. При цьому компенсуюча дія протизапальних медіаторів була знижена, що може бути причиною декомпенсованої реакції та причиною розвитку ризику системної запальної відповіді.