Functional constipation during and after pregnancy

Functional constipation is a common problem in pregnancy and postpartum period and is now considered not just a medical problem but also a factor influencing the quality of life. The frequency of defecation differs in people. Recent years specialists prefer personalized evaluation of the frequency of defecation for exact diagnostics of the condition, but not the classic definition. Functional constipation in pregnancy is caused by functional and anatomy changes of gastrointestinal tract and also by hormonal changes in pregnancy. Early diagnosis and correction of this pathology is one of the main objectives when managing normal pregnancy. This review covers current information on the theme, contains recommendations about the lifestyle during pregnancy and postpartum period and treatment options. Some foreign and Russian authors note the effectiveness of sodium picosulfate which accelerates the passage of the feces in a short time. It can be used during II and III trimesters of pregnancy as well as in the postpartum period and breastfeeding. Thus, complex correction of factors causing functional constipation decreases the risk of colon diseases as well as of all gastrointestinal tract in pregnant women and in the puerperium

The role of dydrogesterone in habitual miscarriage

Habitual miscarriage is a fairly common complication of early pregnancy. In the opinion of most authors, the term habitual miscarriage is used to describe a loss of two or more pregnancies during the first 22 weeks of pregnancy. Issues of terminology and management continue to be relevant and debatable in medical professional communities and need further discussion. In addition to the medical sides of the issue, habitual miscarriage has a significant psychological impact on women and their partners. Regardless of the gestational age, the loss of pregnancy for most couples is similar in importance to the loss of a newborn and is associated with the loss of hope and plans that future parents connected with a baby who has not yet been born. After repeated losses, bereavement and emotional upheaval are further exacerbated irrespective of the term of abortion. Repeated pregnancy loss is a significant negative event in the life of a couple both from a medical and psychological point of view, that’s why the provision of adequate medical care is one of the objectives of a specialist managing pregnancy. This also involves the choice of effective disease management. Previously it was shown that luteal phase deficiency might be the cause of this phenomenon, and that hormonal deficiency had to be replenished. Many modern publications confirm that progesterone and its derivatives have an important immunomodulatory role in the habitual miscarriage. The article describes the role of progesterone in maintaining pregnancy and the results of studies devoted to the role of dydrogesterone. It also presents data of international studies on the treatment of women with habitual miscarriage

Combination therapy with ruxolitinib plus low-dose cytarabine or mercaptopurine in patients with blast-phase myelofibrosis

Patients with myelofibrosis in blast-phase commonly have a median overall survival of only 3–6 months. Given the older median age of onset and heavy pretreatment, intensive chemotherapy often is not appropriate and has low efficacy with high toxicity. Ruxolitinib (a JAK1/2 inhibitor) has provided significant clinical benefits in patients with chronic phase myelofibrosis. We report our experience of treating blastphase myelofibrosis patients with the combination therapy of ruxolitinib plus low dose mercaptopurine or low-dose cytarabine. The cases presented here demonstrated the feasibility and tolerability of combination continuous ruxolitinib treatment with mercaptopurine or low-dose cytarabine for patients with blast-phase myelofibrosis. The efficacy of these combination regimens is encouraging

THROMBOTIC AND BLEEDING RISK FACTORS IN ESSENTIAL THROMBOCYTHEMIA

Background. Thrombosis and hemorrhage are the main category of complications, that affects the overall survival (OS), quality of life and therapy option choice in essential thrombocythemia (ET). Molecular marker presence (JAK2V617F (JAK2+), MPL (MPL+), CALR (CALR1+-type 1, CALR2+-type 2) or its absence (triple-negative status (TN)) in ET supposed to impact on the clinical course, thrombosis rate and ET prognosis.The aim of this study was to investigate interactions between the presence of molecular marker, thrombosis/bleeding rates and the OS in ET.Methods. Outpatient’s charts of 240 ET patients, who had been diagnosed with ET at our institution according to WHO 2008 criteria. The following data were assessed: complete blood count, bone marrow biopsy results, bone marrow cytogenetic, the restriction fragment length polymorphism (RFLP) results used for JAK2V617F detection, in case of JAK2V617F-negative status the PCR-RFLP results (MPL detection) and the direct sequencing results (CALR detection). Different thrombotic/bleeding complications rates were analyzed. The OS in ET patients was compared according to complications and IPSET-thrombosis groups. Results. Among 240 pts 183 (76.3 %) hadn’t any thrombotic complication or bleeding event (no complications/NC), 57/240 (23.7 %) had complications: 49/57 (85.9 %) reported arterial or/and venous thrombosis, stroke or heart failure (thrombosis+) and 11/57 (19.3 %) had bleeding events (hemorrhage+). Thrombotic complications in JAK2+ had 27.4 % (50/182) pts, in TN – 30.7 % (8/26) pts, in CALR1+ – 18.2 % (2/11) pts and no cases of thrombosis were detected in CALR2+ and MPL+ subgroups (p < 0,001). There were significant statistical differences in median platelet count as follows: 742 . 10 9/L (thrombosis+) and 937 . 10 9/L (hemorrhage+) (p = 0.003). No significant statistical differences in median hemoglobin and leukocyte count (р = 0.75 and р = 0.47) were detected. There were more than a half pts older than 60 years in groups NC (51 %) and thrombosis+ (59 %) and in group hemorrhage+ only 36 % (p < 0,001). Cardiovascular risk factors were reported in 24 % pts (NC), 69 % pts (thrombosis+) and 36 % pts (hemorrhage+) (p < 0,001). There were no significant statistical differences in follows risk factors as platelets count > 1000 . 10 9/L and leukocytosis > 11 . 10 9/L (р = 0.85 and р = 0.72). No significant differences in OS among groups NC, thrombosis+ and hemorrhage+ (р = 0.21) and IPSET-thrombosis groups (р = 0,068) were found. Conclusion. Along with common thrombotic risk factors (age > 60 and cardiovascular risk factors) mutational status may help to identify ET course. Leukocytosis > 10 . 10 9/L and thrombocytosis > 1000 . 10 9/L cannot be assessed as independent thrombosis risk factors in ET. The JAK2V617F mutation was associated with increased risk of thrombotic complications in ET. CALR mutations were associated with lower thrombosis risk, comparing to JAK2+ status despite the fact of CALR+ patients had higher platelets level

Using the Minor Variant Finder software to identify and quantify the allelic burden level of somatic mutations in oncohematologic diseases

Background. There are problems related to both quantitative assessment of an allele burden level of a mutant gene and interpretation of results in DNA samples with the burden level of the mutant allele less than 15–20 %, when using Sanger sequencing for analyzing somatic mutations. Applied Biosystems (USA) has developed new software Minor Variant Finder, which allows determining mutations with the allele burden level from 5 %.The objective: to determine the allele burden level and identification of minor variants of somatic mutations in the ASXL1, JAK2 genes and BCR-ABL oncogene using Minor Variant Finder software in patients with myeloproliferative neoplasms.Materials and methods. The level of mutant allele burden for 15 patients with myeloproliferative neoplasms was determined by the identified mutations using the Minor Variant Finder software, after analysis of point somatic mutations in the ASXL1, JAK2 genes and BCR-ABL oncogene by Sanger sequencing.Results. The allele burden level in all 5 ASXL1-positive samples and BCR-ABL-positive sample was determined as higher than 20 % using the Minor Variant Finder software. The allele burden level in 2 cases was higher than 20 % and in 7 cases lower than 20 %, when we analyzed 9 JAK2-positive samples.Conclusion. Minor Variant Finder software can be used to estimate the allele burden level and to identify minor variants of somatic mutations in the ASXL, JAK2 and BCR-ABL genes

Staffing the Priority Directions of the Socio-Economic Development: Situation and Problems

The goal of this original research paper is to analyze the state and the staffing problems of the priority directions of the socio-economic development in Russia and to reveal the required directions to modify the staffing approaches within the continuous education in general and in higher education institutions in particular. We here study and generalize the contents of the state programmes, which support the priority directions of the socio-economic development in Russia in terms of staffing, consider questions of the methodological and legal aspects to support these programmes with regards to manpower training. Our research has shown that in most of cases the implementation of the programmes is not supported by the required amount of staffing of various skill levels. This fact requires revisiting and reworking of these state programmes within one framework. Based on this analysis, this article proposes the concept of such framework together with a specially designed model to monitor and assess the state of the continuous professional education system, which can form the basis for further deeper theoretical and applied research and development both in the field of continuous education and in the area of educational institution development and management. This work presents results of the unique and complex generalized analysis of the state and the staffing problems of the government programmes, the analysis being carried out for the first time in practice. These results can be implemented in practice by the government officials and management to undertake the actions of revisiting and reworking the socio-economic programmes and to take managerial decisions to further sharpen the structure and develop the system of the professional continuous education.Цель настоящей исследовательской статьи – проанализировать состояние и проблемы обеспеченности кадрами приоритетных направлений социально-экономического развития России и выявить следующие из анализа направления реструктуризации подготовки кадров в системе непрерывного образования в целом и в вузах в частности. В статье анализируется и обобщается содержание государственных программ, обеспечивающих реализацию приоритетных направлений социально-экономического развития России в части их обеспеченности подготовкой кадров, рассматриваются вопросы методологического и правового обеспечения содержания государственных программ в части подготовки кадров для их реализации. Исследование показало, что в большинстве случаев реализация государственных программ не обеспечивается необходимыми объемами подготовки кадров различной квалификации, что требует переработки государственных программ на единой методологической основе. На основе проведенного анализа предложена концепция такой переработки и возможная модель мониторинга и оценки состояния системы непрерывного профессионального образования, которые могут быть основой для последующих углубленных исследований и прикладных разработок как в сфере непрерывного профессионального образования в целом, так и в сфере управления развитием вузов. В работе представлены результаты комплексного обобщенного анализа состояния и проблем обеспеченности государственных программ кадрами соответствующей квалификации, который до настоящего времени не проводился, результаты статьи могут использоваться органами управления при переработке государственных программ и принятии управленческих решений о совершенствовании структуры и развитии системы непрерывного профессионального образования