Результаты открытого многоцентрового неинтервенционного исследования клинической эффективности и переносимости эторикоксиба при остеоартрите и неспецифической боли в спине с дополнительной оценкой влияния препарата на «центральные» проявления боли

The formation of chronic musculoskeletal pain (MSP) is a multifactorial process, in its pathogenesis mechanism of central sensitization (CS) plays an important role.Objective: to evaluate the effectiveness of etoricoxib at a dose of 60 mg per day in diseases accompanied by moderate/severe chronic MPS, with an additional analysis of the effect of this drug on the manifestations of CS.Patients and methods. An open observational study, 790 patients (71.6% women, mean age 54.5±13.0 years) with osteoarthritis and chronic nonspecific back pain received etoricoxib 60 mg/day for 2 weeks. The dynamics of pain, dysfunction, fatigue, sleep disturbances, general health assessment (GHA) on a numerical rating scale (NRS 0–10), as well as signs of CS according to part A of the CSI questionnaire were assessed.Results and discussion. After 2 weeks, the intensity of pain during movement, at rest and at night decreased on average by 58.8±24.1, 69.7±32.6 and 70.1±32.8% respectively; functional insufficiency by 58.2±22.5%, fatigue by 52.2±25.8%, GHA by 50.0±22.6%, sleep improvement by 54.3±25.8% was observed (p<0.001 for all parameters). There was a decrease in the CSI value by an average of 33.1±14.5% (p<0.001), as well as a decrease in the number of patients with highly probable CS (CSI ≥40) from 35.3 to 10.3% (p<0.001). No serious drug-related complications were recorded. The overall frequency of adverse reactions was 5.9%, with dyspepsia and hypertension being the most common.Conclusion. Etoricoxib is an effective and relatively safe treatment for chronic MSP. It reduces the severity of CS, one of the central mechanisms of the pathogenesis of chronic MSP.Формирование хронической скелетно-мышечной боли (СМБ) – многофакторный процесс, в патогенезе которого существенную роль играет механизм центральной сенситизации (ЦС).Цель исследования – оценка эффективности эторикоксиба в дозе 60 мг/сут при заболеваниях, сопровождающихся умеренно выраженной/выраженной хронической СМБ, с дополнительным анализом влияния этого препарата на проявления ЦС.Пациенты и методы. Было проведено открытое наблюдательное исследование, в котором 790 пациентов (71,6% женщин, средний возраст 54,5±13,0 лет) с остеоартритом и хронической неспецифической болью в спине в течение 2 нед получали эторикоксиб по 60 мг/сут. Оценивалась динамика боли, нарушения функции, усталости, расстройств сна, общей оценки состояния здоровья (ООСЗ) по числовой рейтинговой шкале (ЧРШ, 0–10), а также признаков ЦС по части А опросника CSI.Результаты и обсуждение. Через 2 нед интенсивность боли при движении, в покое и ночью снизилась в среднем соответственно на 58,8±24,1; 69,7±32,6 и 70,1±32,8%, функциональная недостаточность – на 58,2±22,5%, усталость – на 52,2±25,8%, ООСЗ – на 50,0±22,6%, наблюдалось улучшение сна на 54,3±25,8% (р<0,001 для всех параметров). Было отмечено снижение значения CSI в среднем на 33,1±14,5% (р<0,001), а также числа пациентов с высоковероятной ЦС (CSI≥40) с 35,3 до 10,3% (р<0,001). Не было зафиксировано серьезных лекарственных осложнений. Общая частота нежелательных реакций составила 5,9%, наиболее часто встречались диспепсия и артериальная гипертензия.Заключение. Эторикоксиб является эффективным и относительно безопасным средством для контроля хронической СМБ. Он снижает выраженность ЦС – одного из центральных механизмов патогенеза хронической СМБ

Uterine fibroids in premenopausal women

Uterine fibroids are one of the commonest benign pelvic tumours with an estimated incidence of 20–40% in women during their reproductive years. Incidence rates for uterine fibroid diagnoses were highest in premenopausal age. The gynecologists are frequently faced with need for the administration of menopausal hormone therapy (MHT) in this group of patients with the onset of symptoms associated with estrogen deficiency; however, uterine fibroids represent a relative contraindication for the administration of MHT. In the present paper, we point out the need for conservative therapy of uterine fibroids in premenopausal patients to prepare for the administration of MHT. The paper reflects the efficacy of the drug treatment of uterine fibroids using antigestagens (gynestril)

Efficacy of iron sulfate with ascorbic acid in pregnant women with iron deficiency of varying degrees of severity

Iron deficiency anemia (IDA) is one of the most common diseases in the world, characterized by hemoglobin synthesis disorder due to iron deficiency and manifested by anemia. According to WHO, the rate of IDA in pregnant women in different countries ranges from 21 to 80%, judging by the level of hemoglobin, and from 49 to 99% - by serum iron. Lack of treatment of iron-deficient pregnant women with varying degrees of iron deficiency leads to an increase in the frequency of complicated pregnancy, such as the threat of termination of pregnancy, placental insufficiency, delay in intrauterine development and hypoxia of the fetus, premature delivery, poor uterine contraction strength, pathological bleeding, infectious complications. Aim of the study: study of the efficacy of the drug containing iron sulfate (Ferrous sulfate) and ascorbic acid in pregnant women with latent and manifest forms of iron deficiency. Patients and methods: 66 pregnant women were examined. Group 1 consisted of 36 pregnant women with latent iron deficiency, Group 2–30 pregnant women with manifest iron deficiency and moderate anemia. Pregnant women in the 1st group were prescribed the drug only for 1 month due to the fact that there were no manifestations of anemia in this category of patients. Blood parameters were monitored dynamically after 1 month of treatment and after 2 months, which means after 1 month of absence of the drug intake. Patients of the 2nd group received treatment during 2 months, dynamic treatment after laboratory parameters was carried out after 1 and 2 months of treatment. Results of the study. Analyzing the data obtained, it was found that all laboratory parameters differ significantly from those before treatment. Pregnant women of the 1st group have no reliable changes between the parameters after 1 and 2 months of observations, as during this period the patients did not receive iron medication. And even a slight decrease in some indicators is noted, but when compared with laboratory data before treatment, the results differ significantly. Conclusion: Ferrous sulfate and ascorbic acid can be recommended to compensate iron deficiency in pregnant women with LID to prevent the development of anemia, in patients with MID to treat anemia and prevent the development of possible complications in pregnant women associated with this condition. Thus, earlier detection and elimination of LID leads to prevention of anemia later on

Focused radiofrequency treatment of postpartum vaginal relaxation syndrome

Aim: to assess the efficacy and safety of non-ablative radiofrequency treatment in the postpartum period in patients with vaginal relaxation syndrome and other initial manifestations of pelvic floor dysfunction (PFD).Materials and Methods. 44 patients with complaints of the initial manifestations of PFD were enrolled into prospective randomized comparative study: 30 women in the main group and 14 in the control group. Diagnostic methods included medical history collection, objective examination, assessing condition of the perineum by visual inspection; standard clinical and laboratory studies; using the questionnaire for calculating the Female Sexual Function Index (FSFI-19). Staging of pelvic organ prolapse was performed according to the POP-Q classification (Pelvic Organ Prolapse Quantification system). Measurement of the pelvic floor muscle contraction strength was performed by using a perineometer. A course of 3 procedures of radiofrequency non-ablative exposure of the vulvovaginal tissues in patients from the main group was performed 2 months after delivery, with 7-day interval. Assessment of the collagenogenesis and neoangiogenesis was carried out base on measuring expression level of the mRNA specific to proteins of the vaginal connective tissue by using real-time polymerase chain reaction.Results. Our study allowed to find that anatomical and functional state of the vulvovaginal area and perineum were significantly improved as well as relief of PFD symptoms. The level of expression of decorin mRNA in patients from the main group before and after treatment were 0.1 ± 0.035 and 0.047 ± 0.002, respectively (p = 0.02, Wilcoxon t-test). The median values of mRNA expression of matrix metalloproteinase type 2 before and after treatment were 0.0177 and 0.013, respectively (p = 0.03). The expression of type III collagen mRNA before and after treatment was 0.0675 and 0.0109, respectively (p = 0.03).Conclusion. The data obtained by us demonstrate positive effects after using monopolar radiofrequency therapy on the tissues in the vulva, vagina and perineum of patients in the postpartum period. However, clinical improvement in patients with PFD represents a cumulative result of morphological and functional changes in the tissues of the perineum as well as vulvovaginal region. We believe it is irrational to associate such positive effects solely with altered magnitude of the metabolism of collagen and other extracellular matrix proteins, due to dynamic balance and genetic determinism of decay and production of connective tissue proteins. The safety and role of radiofrequency therapeutic procedures in prevention and treatment of PFD require further investigation by assessing new markers and research methods, by extending observation period as well as increasing amount and quality of clinical observations

Postoperative management of patients with endometriosis

Aim: to assess the effectiveness of using dienogest in combination with postoperative interventions in patients with endometriosis.Materials and methods. There were enrolled 102 patients with signs of external endometriosis underwent examination and surgical treatment, subdivided into 2 groups: 67 – main group (after surgical treatment, received dienogest 2 mg/day for 6 months), 35 – comparison group received no hormone therapy in the postoperative period. Surgical treatment included removal of endometrioid ovarian cysts, endometriosis foci on the pelvic peritoneum and sacral uterine ligaments. Course of the early postoperative period (up to 1 month after the intervention) as well as the long-term dynamics of the disease manifestations (3, 6, 12 and 15 months later) were assessed.Results. Dienogest was administered after surgical treatment due to endometriosis that reduced the severity of dyspareunia and intensity of chronic pelvic pain by 3.5- and 2-fold, respectively. The probability of achieving control over uterine bleeding 6 month after the onset of treatment due to endometriosis manifested with metrorrhagia showed that combination treatment (consisting of dienogest) was 3.19-fold higher compared to surgical treatment alone (OR = 3.19; 95 % CI = 1.70–11,0; p < 0,05). Recovery of normal menstrual cycle in 63 (94.0%) women of the main group was established 1.5–2 months after completing of hormonal treatment, while in the comparison group pain and dysmenorrhea relapsed in some patients at the 6-month follow-up. Decreased libido as a side effect in patients who treated with dienogest was observed in 2 (3.0 %) women.Conclusion. Dienogest was highly effective in the combination treatment of patients with verified endometriosis that resulted in reduced severity of pain and metrorrhagia. The drug was featured by low level of side effects. Thus, a combination treatment of endometriosis containing dienogest at a dose of 2 mg/day applied during postoperative period allows to reduce the severity of the disease clinical manifestations and improve treatment outcome

Uterine artery embolization for large submucousal myomatous nodules

Uterine artery embolization is an advanced nonsurgical treatment for uterine fibroids. This method can be used with any size and location of nodules. UAE can be used as a standalone treatment of fibroids or as one of its stages. In particular, UAE is an alternative to hysterectomy and/or resectoscopy in the case of submucous location of the nodules. UAE can be used on larger nodules as the first stage treatment to reduce the size, allowing nodules to migrate (shrinking to type 0) and soften. Subsequently it is possible to remove them during ordinary cervical dilation

USE OF GONADOTROPIN-RELEASING HORMONE AGONISTS IN TREATMENT OF RECURRENT PRE-MENSTRUAL ENDOMETRIAL HYPERPLASIA

This article presents modern insights into the pathogenesis of endometrium hyperplastic processes, matrix metalloproteinases and their tissue inhibitors, and their role in development of endometrium hyperplasia. A pathogenetic substantiation is given for use of Lucrin Depot, which affects the key molecular mechanisms of development of hyperplastic processes, with the objective of pharmacological correction of this patholog

СASE STUDY OF OVARIAN VEIN THROMBOSIS DURING PREGNANCY AT 24 WEEKS OF GESTATION

In article the question is a case of ovarian vein thrombosis, developed in pregnant woman at 24 weeks of pregnancy, describing therapy and further treatment tactics, delivery and sorts of outcome

CLINICAL CASE OF EXTRAUTERINE PREGNANCY, LOCATED IN RUDIMENTAL UTERINE HORN AT 21-22 WEEK OF GESTATION

In article the question is a case of extrauterine pregnancy in term of 21-22 weeks in the rudimentary horn of a uterus in term of 21-22 weeks interrupted because of break of a horn with an intrabelly bleeding. The operation and tactical approaches to conducting the given case are described

THE COURSE FEATURES, DIAGNOSIS AND TREATMENT OF PLACENTAL INSUFFICIENCY IN VARICOSITY

Placental insufficiency (PI) is a major problem of modern perinatology. Chronic placental insufficiency (CPI) is observed in every third pregnant woman at high risk of perinatal pathology. Perinatal mortality reaches 60% in this group. We investigated the modern approaches to diagnosis, prevention and therapy of placental insufficiency, including during varicosity. We studied the efficacy of Phlebodia 600 in the combined therapy of patients with PI. Based on these findings we are recommend prevention of PI (by Phlebodia 600) for all pregnant women with varicose veins, on the basis of morphologically confirmed reduction of placentas compensatory reaction