Epidemiology of the vestibular schwannomas in Ukraine and our experience of surgical and radiosurgical treatment

Aim: Figuring out the occurrence of vestibular schwannomas (VS) and their management tendencies in Ukraine.Materials and methods: Data about VS detection and treatment were collected among all Ukrainian neurosurgical and radiological facilities which are enrolled in providing care for these patients. Together with those who were treated overseas the total number in 2016-2018 was 903 people. There were 665 cases (73.6  %) treated surgically, 124 cases (13.8  %) irradiated and 114 (12.6  %) observed via serial imaging.Results: The prevalence of VS in Ukraine is about 7.27 per 1 million people which corresponds to data around the world (CBTRUS trial suggested VS incidence 10-20 people per 1 million during 2004-2009).Most of verified VSs were treated surgically (73.6  %), lesser part was irradiated (13.8  %) and 12.7 % were followed-up by wait-and-scan strategy. Our data regarding surgical management was higher than worldwide. At the same time, the volume of detected tumors was much larger in comparison to published data. Seventy-three per cent of all cases were Koos T4 tumors as a possible result of poor diagnosis and lack of alertness making surgical interventions more common and difficult.Total and subtotal resection rate was 79  % as the result of combined microsurgical and endoscopic techniques under intraoperative electrophysiological neuromonitoring guidance. The facial nerve was preserved in 94.2  % of cases, cochlear — in 8.5  % of cases. The average mortality rate during 2016-2018 in Ukraine was 3.1  % with 1.3  % in Subtentorial Neurooncology Department of the Romodanov Neurosurgery Institute.Conclusions: For further improvements and development of optimal management strategies for patients with VS, it is necessary to improve earlier diagnosis and reasonable to provide neurosurgical care in high-volume centers based on the profound expertise with further advances in technologies for functionally favorable outcomes

Применение препаратов половых стероидов у женщин во время пандемии COVID-19

Документ одобрен на расширенном заседании Ассоциации гинекологов-эндокринологов Украины с привлечением всех членов правления и представителей Ассоциации акушеров-гинекологов Украины, Ассоциации фармакологов Украины, Ассоциации анестезиологов Украины, а также на Третьей Украинской школе гинекологической и репродуктивной эндокринологии с международным участием ISGE 19–20.03.21. Пандемия COVID-19 существенно повлияла на медицинскую практику в организационном и клиническом аспектах, поставив перед специалистами ряд сложных и противоречивых задач. Данный документ представляет собой результат систематизации имеющихся по состоянию на март 2021 г. научных данных и рекомендаций международных медицинских и профильных профессиональных обществ по спорным клиническим вопросам в гинекологической практике, обусловленных пандемией COVID-19, а также отдельных вопросов безопасности и целесообразности применения гормональных средств. Привлечение в рабочую группу экспертов от профессиональных ассоциаций акушерско-гинекологического направления, фармакологии, анестезиологии, сосудистой хирургии и флебологии позволило сформулировать клинически обоснованные положения позиции. Позиция включает три тематических раздела: «К вопросу применения эстрогеносодержащих комбинированных гормональных контрацептивов (КГК) во время пандемии COVID-19»; «К вопросу применения менопаузальной гормональной терапии (МГТ) во время пандемии COVID-19»; «К вопросу незарегистрированных рецептурных биоидентичных гормональных препаратов». В начале каждого тематического раздела представлены основные заключения согласованной позиции профессиональных медицинских ассоциаций. По имеющимся на март 2021 г. данным, нет оснований ограничивать применение КГК или МГТ у здоровых женщин (которые сейчас не болеют COVID-19). Вопрос о прекращении или продолжении применения КГК либо МГТ или перехода на другие формы женщинами, которые болеют COVID-19, должен решаться в зависимости от степени тяжести заболевания, общей совокупности факторов риска тромбоэмболических осложнений и других индивидуальных особенностей клинической ситуации. Дальнейшие исследования позволят сформировать более подробные алгоритмы. Врачам необходимо проявлять бдительность в отношении безопасности терапии незарегистрированными рецептурными гормональными средствами (compounded Bioidentical Hormonal Therapy, сВHT) в любой лекарственной форме (включая пеллеты), особенно в период пандемии COVID-19, учитывая неисследованные системные эффекты и, соответственно, возможные риски. Следует отдавать предпочтение официально зарегистрированным лекарственным препаратам с хорошо изученными профилем безопасности и клиническими эффектами, применение которых разрешено по рецепту врача и поддерживается клиническими протоколами и рекомендациями.The document was approved at an expanded meeting of the Ukrainian Society of Gynecological Endocrinology with the involvement of all board members and representatives of the Association of Obstetricians-Gynecologists of Ukraine, the Association of Pharmacologists of Ukraine, the Association of Anesthesiologists of Ukraine, as well during the Third Ukrainian School of Gynecological and Reproductive Endocrinology with international participation ISGE 19–20.03.21. The COVID-19 pandemic has significantly impacted medical practice, in terms of organizational and clinical practices, posing a number of complex and contradictory challenges for professionals. This document is the result of the systematization of scientific data available by March 2021 and recommendations of international medical and specialized professional societies on controversial clinical issues in gynecological practice caused by the COVID-19 pandemic, as well as certain issues of safety and ratio of using hormonal drugs. The involvement of experts from professional associations of the obstetric and gynecological field, pharmacology, anesthesiology and vascular surgery and phlebology in the working group made it possible to formulate clinically justified provisions of the position. The position includes three thematic sections: “On the use of estrogen-containing combined hormonal contraceptives (CHC) during the COVID-19 pandemic”; “On the use of menopausal hormone therapy (MHT) during the COVID-19 pandemic”; “On the issue of unregistered compounded bioidentical hormones”. At the beginning of each thematic section, the main conclusions of the consensus position of professional medical associations are presented. According to the data available by March 2021, there is no reason to limit the use of CHC or MHT in healthy women (currently not having COVID-19). The question of CHC or MHT discontinuing or switching to other forms by women with COVID-19 should be decided depending on the severity of the disease, the total set of risk factors for thromboembolic complications and other individual characteristics of the clinical situation. Further research will provide elaboration of more detailed algorithms. Physicians need to be vigilant about the safety of compounded Bioidentical Hormonal Therapy (cBHT) in any dosage form (including pellets), especially during the COVID-19 pandemic, given the unexplored systemic effects and therefore the potential risks. Preference should be given to officially licensed medicinal products with a well-studied safety profile and clinical effects, the use of which is authorized by doctor's prescription and supported by clinical protocols and guidelines