Vol 19, No 3 (2017)

Articles
Clinical-economic rational of using of prolonged gonadotropin in IVF programs in according to the new opportunities of corifollitropin alfa
Nazarenko T.A.
Abstract
Purpose. To define the schemes of induction of superovulation, what are the most pharmacoeconomical founded. Methods. Pharmacoeconomic analysis was performed using the cost minimization analysis on the assumption of equal effectiveness compared schemes of hormonal stimulation, which was confirmed in the review of clinical trials and meta-analysis. To estimate the cost of drugs for ovulation induction we used registered VED rates and recommended in the instructions for medical use and the standard of care for infertility using assisted reproductive technologies dosing regimens. Results. The results of the pharmacoeconomic analysis in according to all scenarios of the initial data, confirmed the pharmacoeconomic advantage of using corifollitropin alfa in comparison with the rFSH (follitropin alfa): 1) 1 732.22 rubles, approximately 5%; 2) 3 269.44 rubles, approximately 7%; 3) 14 955.83 rubles, approximately 30%. Conclusions. The scheme of hormonal stimulation using corifollitropin alfa in according to all scenarios of the initial data is more pharmacoeconomical reasonable, since it economizes the direct of medical costs with comparable efficacy, fewer subcutaneous injections, and the possibility to decrease the duration of stimulation cycle as compared with daily rFSH.
Gynecology. 2017;19(3):4-11
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Menopausal hormone therapy and risk factors of breast cancer development
Protasova A.E., Yureneva S.V., Vandeeva E.N.
Abstract
The article reviews the literature data of the latest studies and expert conclusions on the relationship between menopausal hormone therapy and the risk of developing breast cancer.
Gynecology. 2017;19(3):23-29
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Potassium, magnesium and pyridoxine in the context of the biological effects of estrogens
Gromova O.A., Torshin I.Y., Tomilova I.K., Dzhidzhikhiya L.K., Kerimkulova N.V.
Abstract
Potassium and magnesium ions are essential for realizing the biological effects of estrogens. Magnesium ions promote the translocation of the estrogen receptors into the nucleus of the cell and regulate the potassium channels that are involved in the regulation of arterial pressure by means of estrogens. In the central nervous system, potassium and magnesium ions interact with the neurosteroids of estrogens and various neurotransmitters (g-aminobutyric acid, epinephrine, opioids, acetylcholine). Vitamin B6 (pyridoxine) increases the bioavailability of magnesium and is a pharmacodynamic synergistic of magnesium and potassium. Therefore, hormone replacement therapy with estrogens (which contributes in part to the formation of magnesium and pyridoxine deficiencies) should be accompanied by an adequate combination of potassium, magnesium and pyridoxine.
Gynecology. 2017;19(3):30-39
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The personalized approach to choosing a contraceptive: weighing the pros and cons
Dobrokhotova Y.E., Borovkova E.I.
Abstract
The article presents the latest data on the risks of complications development on the background of the use of combined oral contraceptives, as well as the treatment effects of the use of hormonal contraceptives.
Gynecology. 2017;19(3):40-44
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Assessment of viral load in patients with HPV-associated cervicitis during the course of complex treatment
Pestrikova T.Y., Panfilova Y.O., Yurasova E.A., Kotelnikova A.V.
Abstract
The article presents information about examination and treatment of the 39 women with chronic cervicitis associated with papillomavirus infection (HPV). Inosine pranobex is a drug with immunostimulating and anti-inflammatory action. It was used in the complex treatment of the patients. Patients were given 3 courses of inosine pranobex in a daily dose of 3000 mg with an interval of 10 days. Efficacy of the therapy was evaluated on the basis of clinical data, PAP-test, colposcopy, PCR - determination of HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 types, as well as viral load of HPV before and after treatment. In 41.03±7.88% of patients who had a cytological picture of ASCUS, LSIL, HSIL, the concentration of HPV was clinically significant. Among the different types of HPV with high oncological risk, HPV types 16 and associations of different types of HPV prevailed in patients (p<0.05, p1<0.05). As a result of the use inosine pranobex in the complex treatment the viral load decreased to a clinically insignificant virus concentration in 17.95% of women, and HPV elimination occurred in 74.36% of patients.
Gynecology. 2017;19(3):45-48
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The profile of the expression of the immune response genes in the vagina of women in the complex therapy of recurrent vulvovaginal candidiasis
Pogosyan S.M., Mezhevitinova E.A., Abakarova P.R., Donnikov A.E., Muravyova V.V.
Abstract
Host immunity against Candida albicans is crucial in controlling C. albicans infection. The innate immunity is believed to be the first line of host defense, such as the direct killing of yeasts through phagocytosis by neutrophils and macrophages. In addition to innate immune cells, an adjunctive protective effect is played by cellular adaptive immunity represented by Th lymphocytes. The balance of various Th cell subpopulations plays a crucial role in regulating the prognosis of C. albicans infection. Yeasts cell recognition by pattern recognition receptors leads to proinflammatory cytokines synthesis, cause immune system activation and yeast cells killing. However it was demonstrated that C. albicans inhibits immune response which cause infection. Aim - studying vaginal microbiota and the local immune response in women with recurrent vulvovaginal candidiasis for improving the tactics of their management. Results. Our date demonstrates that vaginal disbiosis are risk factor for RVVC and leads to more active innate immune system response.
Gynecology. 2017;19(3):49-54
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Spontaneous clearance of the human papilloma virus as a result of suppressive therapy with acyclic nucleosides of a recurrent herpes-viral infection
Tapilskaya N.I., Vorobtsova I.N., Glushakov R.I.
Abstract
Background. Genital human papillomavirus (HPV) infection is not effectively controlled and treated. Current dates suggest that 80% cases of HPV infections are transient and clear spontaneously, it is connected with the deterministic immune response. Results of several independent studies suggest that HSV-2 infections correlate with a higher than normal incidence of cervical cancer. Objectives. This study demonstrated a spontaneous clearance of the HPV follow the suppressive therapy of a recurrent HSV infection with acyclic nucleosides. Study design. We carried out a parallel observational study from 2015 to 2017. Herpes suppressive therapy with acyclic nucleosides (valacyclovir of 500 mg per day) during a 6 months is used to treat patients (n=32) aged 28 to 34 years (mean age 30.4±2.1 years) who have recurrent genital HSV infection and HPV infection both. The detection of HPV by RT-PCR before and after ant-herpetic therapy was investigated. Results. After treatment of HSV infection eradication of the one types of HPV was achieved in 43.75% cases, eradication of HPV-16 was achieved only in 15.4% (in 2 out of 13 patients) of cases, eradication HPV-18 was achieved in 25% (in 4 out of 16 patients) of cases. Decreasing of viral load occurred in 62.5% patients, full HPV-clearance was recorded in 15.6% of patients, but the high viral-load of HPV infection was preserved in 37.5% of the cases.
Gynecology. 2017;19(3):55-61
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Chronic pelvic pain as a female problem
Kuznetsova I.V.
Abstract
Chronic pelvic pain occurs mainly in women, and is therefore often regarded as a symptom of a gynecological disease. Meanwhile, the causes of chronic pelvic pain are usually multiple, and its formation is associated primarily with the persistence of estrogen-dependent inflammation and the development of peripheral and central sensitization of the nervous system. The presence of estrogen-dependent inflammation explains, on the one hand, the female privilege of pain, and, on the other hand, the frequent detection of endometriosis in patients with chronic pelvic pain. At the same time, the actualization of the problem of chronic pelvic pain as the main goal of treatment allows us to make a reasonable choice of means to improve the quality of life of patients.
Gynecology. 2017;19(3):62-67
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Teratomas of the ovaries in girls from the position of a surgeon
Buralkina N.A., Chuprynin V.D., Golitsina Y.S., Uvarova E.V., Zhurba A.Y., Kuzemin A.A., Asaturova A.V., Zaitsev N.V., Kometova V.V., Lunkov S.S.
Abstract
Among ovarian tumors, germinogenic tumors occur in 25.9% of cases, develop from the polypotent highly specialized germinogenic epithelium of the gonads. Most germinogenic tumors are mature (benign) cystic teratomas (95%), malignant germinogenic tumors occur in only 3-5% of cases. The only reasonable method of treating these tumors is surgery, which is associated with losses of the ovarian reserve. The article presents the clinical and anamnestic characteristics of girls aged 7 to 17 years with ovarian teratomas, describes the structure of the surgical interventions (access, volume of operations) with the analysis of the histological conclusion of the remote formations.
Gynecology. 2017;19(3):68-72
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Pregnancy and genital mycoplasma outcomes
Karapetyan T.E.
Abstract
The aim of the study was to determine the possible association of adverse pregnancy outcomes and genital mycoplasmas colonizing the vagina of women during pregnancy. Materials and methods. The results of a survey of 312 pregnant women from the group at increased risk of developing inflammatory complications were subjected to multifactorial analysis. The state of the vaginal biotope was determined on the basis of an integrated assessment of the results of the microscopy of vaginal grammy-smears and the sowing of the vaginal discharge to be facultative-anaerobic and microaerophilic groups of microorganisms. 5% of blood agar was used as the most universal medium, as well as Saburo agar (for selective isolation of fungi) and MRS agar (for isolating lactobacilli) to seed the vaginal discharge with a quantitative estimate of the growth of microorganisms. To isolate, identify, differentiate and quantify the growth of genital mycoplasmas, the Mycoplasma DUO test kits ("BioRad") were used. The analysis of clinical parameters - parameters of obstetric-gynecological history, current of pregnancy, childbirth, postpartum inflammatory complications and the state of newborns was carried out. Results. The analysis of the frequency of mycoplasma release depending on the state of the microcenosis of the vagina showed that the frequency of mycoplasma release was statistically significantly higher for bacterial vaginosis (74.6%) and its combination with candidal vaginitis (73.7%) compared with normocenosis (46, 8%, p<0.05, p>0.01). The conducted study allows to consider as inconsistent the examination of women with unfavorable outcomes of previous pregnancies to identify foci of chronic bacterial infections and / or antiphospholipid antibodies.
Gynecology. 2017;19(3):73-76
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Modern aspects of diagnosis and pathogenesis of oligohydramnios
Voevodin S.M., Shemanaeva T.V., Serova A.V.
Abstract
The identification of oligohydramnios during the second trimester of pregnancy is a high risk of death in the fetus and newborn. Known growth of volume amnion with increasing gestation of pregnancy is normal. At the present stage oligohydramnios diagnosis is carried out using ultrasound. Measurement of the vertical pockets of amniotic fluid is the basis for calculating the index of amniotic fluid. There are technical problems in accurate estimation of the amount of amniotic fluid especially in the II trimester. Show the assumption on the prospects of using 3D/4D ultrasound such cases.
Gynecology. 2017;19(3):77-80
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Endometriosis in the postmanopasual period (clinical case)
Zakharov I.S., Petrich L.N., Demyanova T.N., Vasyutinskaya Y.V., Fetischeva L.E., Bolotova S.N., Rykova M.S., Dodonova G.H.
Abstract
The presented material describes the clinical case of newly diagnosed endometriosis in a woman who is in the postmenopausal period. The prevalence of this pathology in individuals after the onset of menopause is 2-5% with a malignancy probability of 0.9%. However, in spite of the low risk of malignancy, according to existing recommendations it is necessary to conduct operative treatment. In the presented case, a histological study confirmed the presence of endometrioid tissue in the macro preparation.
Gynecology. 2017;19(3):81-83
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Dysmenorrhea: effectiveness and acceptability of treatment with a drug containing 2 mg of chloromadinone acetate and 0.03 mg of ethinyl estradiol
Prilepskaia V.N., Mgerian A.N., Mezhevitinova E.A.
Abstract
According to various researchers, primary dysmenorrhea affects between 20% and 91% of women. Combined oral contraceptives (COCs) are the first choice drugs in young women with primary dysmenorrhea. They have high efficiency, therapeutic and protective effects. In order to assess the acceptability of a drug containing ethinylestradiol and chloromadinone acetate in women with symptoms of dysmenorrhea, 75 women aged 75 years were monitored at V.I.Kulakov Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation. at the age of 18 to 40 years. The average age was 23.4±4.1 years. The average duration of the menstrual cycle is 27.4±1.3 years. The duration of dysmenorrhea averaged 6.3 years. All patients were prescribed the drug Belara in the classical mode (21+7). 54 (72%) patients noted the disappearance of symptoms already on the 3rd cycle of drug use and another 15-20% of patients in 12 months. Subjective evaluation, obtained with the help of visual analogue scale, showed that after 3, 6 and 12 months of using the drug Belara, 72, 80 and 92% of patients were respectively satisfied or very satisfied with the effect of therapy. Analysis of individual BP parameters before and during contraception testified to the lack of influence of this drug on these parameters. Analysis of the dynamics of biochemical parameters, lipid spectrum of blood and some parameters of hemostasis did not reveal clinically and statistically significant changes that go beyond the limits of normative values. Analyzed are also the side effects that arose on the background of using the drug Belara, which were observed mainly in the first 2 months use of COCs. Six patients noted meager intermenstrual bleeding, 3 women reported nausea, tension and heaviness in the mammary glands - 5 (6.7%), one woman complained of insignificant dizziness during 1 course of treatment. Allergic reactions were not identified. All the side effects disappeared on their own and did not require additional therapy. Contraceptive effectiveness of the drug Belara was 100%. Thus, literature data and our experience have shown that a combined oral contraceptive containing 2 mg of chloromadinone acetate and 0.03 mg of ethinyl estradiol (Belara) is a highly effective, safe and pathogenetically valid drug in the therapy of dysmenorrhea. With long-term use it does not have a negative effect on the cardiovascular system, parameters of hemostasis and metabolic metabolic rates. All women were from 18 to 39 years old with dysmenorrhea of varying severity.
Gynecology. 2017;19(3):84-89
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