Vol 19, No 5 (2017)

The review highlights the role of endo- and exogenous estrogens and androgens in the genesis of cardiometabolic disorders in postmenopausal women and the role of menopausal hormone therapy in their prevention.

Genital herpes is a common disease diagnosed in 90% of people and is characterized by a recurring lifelong course. Clinical manifestations are diverse and manifest in 20% of infected people. The gold standard for diagnosis is the detection of virus culture and polymerase chain reaction in real time. Conducting oral antiviral therapy significantly reduces the duration, severity of the disease and the risk of infection of the sexual partner. At the initial episode of genital herpes it is necessary to carry out system antiviral therapy with its earliest start. The effectiveness of the use of acyclovir, valaciclovir and famciclovir is comparable, but only with valaciclovir the efficacy of two-fold daily dosing is proved. For patients with 6 or more episodes of exacerbations per year, suppressive therapy is indicated, the drug of choice is valaciclovir. With a relapse rate of less than 6 per year, it is sufficient to conduct episodic antiviral therapy. Clinical trials have demonstrated comparable efficacy of acyclovir, famciclovir and valaciclovir. The three-day course of valaciclovir (500 mg 2 times a day) is most suitable in view of the high bioavailability and rapid relief of viremia.

The pain syndrome after uterine artery embolization can vary from slight to very pronounced. Therefore, choosing an adequate method of anesthesia is extremely important in this method of treatment. Aim of the study: pre-operative prognosis of the severity of the pain syndrome and selection of the optimal managing tactics in postoperative period. Materials and methods. Our study includes 65 patients, the patients are divided into 2 groups depending on the method of anesthesia. For analgesia in the perioperative period, the patients of the first group underwent anesthesia by the method of epidural anesthesia (n=44). In the second group (n=21), the operation was performed under local anesthesia. Results. In group 1, the intensity of the pain syndrome was 5.38 on the 1st day, and 2.36 on the 4th day of the postoperative period. In this case, a clear relationship between fibroid size and the severity of the pain syndrome was revealed. In the second group of patients (n=21) on the 1st day of the postoperative period, the average value of the intensity of the pain syndrome was 7.72. On the 4th day of the postoperative period, the average value of the pain syndrome was 4.95. When analyzing the intensity of the pain syndrome, depending on the size of fibroids, a direct correlation was also found in the patients of this group. Conclusion. Pain syndrome depends primarily on the size of the fibroids. Epidural anesthesia can be considered to be the most effective method of anesthesia. The use of epidural anesthesia is especially justified in the presence of large-sized fibroids (>8 cm). It is advisable to discharge patients not earlier than 4 days after the operation, when a reliable control of the intensity of the pain syndrome is achieved.

Vitamin D is a precursor of calcitriol, a secosteroid hormone regulating calcium-phosphorus metabolism and a wide range of proliferative and immune responses. Solar UV radiation (290-315 nm) is an initiator of vitamin D production in the human skin. In the northern latitudes, the amount of such radiation reaching the earth's surface is less than in the southern ones, which can be the reason for the wide spread of vitamin D deficiency in the North-West region. Hypovitaminosis takes on particular urgency in women during the pregravid period and during pregnancy, therefore the study of this issue is extremely topical. Materials and methods. The study involved 178 women in the first trimester of pregnancy. The concentration of calcifediol was determined and anthropometric examination was performed. The calendar month of inclusion in the study was taken into account. Women are divided into 2 groups: Group 1 (n = 65) women with a calcifediol level above 30 ng/ml, group 2 (n=113) - below 30 ng/ml. Results. In both groups, the average concentrations of calcifediol were lower in winter. The total variability of the values of calcifediol is not due to the trend, but due to the seasonal component. The seasonal difference of calcifediol fluctuates above and below zero on the graph of the seasonal component, with the "summer vitamin D" season comprising the months from June to September, and the "winter vitamin D" season from October to May. In this period is necessary the exogenous introduction of cholecalciferol or additional irradiation of the skin with UV radiation.

Connective tissue dysplasia is a genetically determined condition characterized by a violation of the structural organization and synthesis of the main components of connective tissue. The prevalence of non-syndromic forms is extremely high and to 46.6-72.0% is due to cofactor deficiency of magnesium. Typical obstetric complications in Ehlers-Danlos syndrome are bleeding, early formation of isthmicocervical insufficiciency, premature and rapid delivery, delayed fetal growth, symphysiopathy, rupture of the pubic joint, rupture of the perineum, spontaneous ruptures of the skin, vagina and internal organs, postpartum bleeding and incompetence of the pelvic floor muscles, bladder, urethra and rectum. Marfan syndrome in 40% of cases develop premature rupture of membranes, premature birth and miscarriage at an early age. Maternal mortality is 0.74 per 100 000 births and is associated with lamination (1%) or rupture of the aortic aneurysm (3%). With nonsynthetic forms of connective tissue dysplasia at the stage of pregravid preparation and throughout pregnancy, the appointment of magnesium preparations is indicated.

The use of gynecological pneumo-vibro-massage as monotherapy, or in combination with other methods of physiotherapy helps to strengthen the entire complex of metabolic and trophic processes, improve the activity of regulatory systems, and to suspend the development of muscle atrophy and sclerotic changes. Our own experience in the application of this method for gynecological diseases, showed an improvement in tissue trophism, regeneration and restoration of functions. Gynecological pneumo-vibro-massage using MKV-01 "Ivavita" in a complex treatment of various diseases can take a significant place in restorative medicine and rehabilitation.