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Current non-hormonal therapy options for vaginal dryness and genitourinary menopausal syndrome: clinical data and practical algorithm
Background. Vaginal dryness is a prevalent condition among women of all ages and can occur not only during menopause as part of the genitourinary syndrome, but also in women of reproductive age, affecting them during the postpartum period and lactation, or due to stress, low body weight, intense physical activity, and the use of certain medications.Reduced vaginal hydration is accompanied by the disruption of the vaginal epithelial barrier, alterations in vaginal pH and microbiota composition, resulting in symptoms of vaginal dryness, burning, pruritus, and dyspareunia, thereby reducing patients' quality of life. Materials and methods. This article provides an analysis of current non-hormonal approaches to the management of vaginal dryness, including the use of moisturizers based on hyaluronic and lactic acids, and phytocomponents. The mechanisms of action of these components, their effects on restoring vaginal mucosal hydration, maintaining physiological pH, and normalizing the vaginal microbiome were reviewed. Particular attention is given to the role of lactic acid as a component of vaginal moisturizers, which promotes the maintenance of an acidic environment and the growth of Lactobacillus. Results. The summarized results of clinical trials revealed reduction in VAS scores, an increase in the vaginal health index, normalization of pH, and the an increase in lactoflora counts after non-hormonal treatment courses. Routine combined use of moisturizers promotes vaginal structural repair and functional recovery and demonstrates a favourable safety profile, including patients with contraindications to hormonal therapy. A practical algorithm for the management of patients with vaginal dryness has been proposed, including diagnosis, selection of non-hormonal therapy, treatment efficacy monitoring, and maintenance therapy to prevent symptom recurrence. Conclusion. The results obtained соnfirm that treatment with non-hormonal moisturizers is an efficient and safe therapeutic option for the improvement of vaginal dryness in women of all ages and can be considered a first-line treatment.
Experimental evaluation of the effectiveness of low molecular weight chitosan on a model of endometrial hyperplasia
Background.Currently, there is a sharp increase in gynecological diseases with pathophysiological elements of connective tissue dysplasia and proliferative processes in the uterus. In this aspect, endometrial hyperplasia occupies a leading position and is observed not only during postmenopause, but also for this pathological process there is a very negative tendency towards rejuvenation. The clinical significance of endometrial hyperplasia lies in the associated risk of endometrial cancer progression, and "atypical" forms of endometrial hyperplasia are considered as precancerous lesions. The frequency and timing of malignancy of endometrial hyperplasia are quite variable. Some authors believe that the frequency of oncotransformation of the endometrium ranges from 25 to 50%, others – up to 80%. Objective. The purpose of the work was to evaluate the therapeutic and prophylactic effect of low molecular weight chitosan on a model of endometrial hyperplasia in mice induced by hyperestrogenemia. Materials and methods. 20 outbred nonlinear laboratory ICR (CD-1) mice (female) with an average body weight of 20-22 g, they were divided into 2 groups of 10 animals in each group. Endometrial hyperplasia was modeled by subcutaneous injection of 0.1 ml of 2% synestrol oil solution, 2 times a week for 2 weeks. The animals of the experimental group received a 0.05% aqueous solution of low molecular weight chitosan as a drink throughout the experiment, and the animals of the control group received drinking water. After removing the animals from the experiment under ether anesthesia, the liver and uterus were fixed in a 10% formalin solution and subjected to standard alcohol histological wiring. The sections were stained with hematoxylin and eosin according to the usual procedure. The height of the epithelium was measured in micrometers on a cross-section of the uterus. The number of cells in adipose dystrophy was calculated as a percentage per 1 mm2. The glass sections were scanned on a histopathological micropreparation scanner KF-PRO-005 (Konfoong Biotech International Co., Ltd). Statistical processing of the results was carried out using the Statistica10.0 program. Results. As can be seen from the results obtained, low molecular weight chitosan has a pronounced therapeutic and prophylactic effect in endometrial hyperplasia. It manifests itself not only at the level of a decrease in endometrial hyperplasia, but also at the level of liver damage in a decrease in the volume density of hepatocytes in a state of fatty degeneration. Conclusion. The results obtained objectively prove that oral administration of low molecular weight chitosan effectively affects all links in the etiopathogenesis of endometrial hyperplasia and can be recommended for the prevention of not only this disease, but also for the prevention of malignancy of endometrial hyperplasia and the prevention of uterine cancer.
Features of pathogenetic therapy and prevention of recurrent lower urinary tract infections in postmenopausal women
Background. The incidence of urogenital disorders in women aged 55-70 years reaches 30-75%. This is a complex of vaginal and urinary symptoms, the development of which is a complication of age-related processes in estrogen-dependent tissues and structures of the lower urinary tract and reproductive tract. Objective. To study the effectiveness of the dietary supplement, containing a complex of natural plant substances – D-mannose, cranberry type A proanthocyanidins and vitamin C, in patients with recurrent lower urinary tract infections during the postmenopausal period. Materials and methods. The study included 90 postmenopausal patients with recurrent urinary tract infection. The main group consisted of 46 patients, the control group – 44 patients (average age 59.3 ± 5.3 years). Patients of the main group were prescribed antimicrobial therapy for exacerbations (fosfomycin trometamol in a dose of 3 g once) + dietary supplement Cystenium II, containing a complex of natural plant substances, which was used 1 tablet 2 times a day with meals for 3 months. Patients in the control group received standard antimicrobial therapy in case of exacerbation of urinary tract infection. The results were assessed 1 month after the start of therapy and 6 months later. Results. During the study, all patients of the main group (46 women), who used the Cystenium II dietary supplement as part of treatment, together with antimicrobial therapy during an exacerbation of infection, noted a significant improvement in both general well-being and local symptoms not only at visits 1 month after the start of taking the drug, but also during the entire observation period after 6 months. As a result of the active anti-inflammatory, protective action, and the presence of vascular effects of the components of the dietary supplement, not only the general condition of the patients improved, according to LDF data, positive dynamics were noted at the level of microcirculation of the tissues of the bladder wall and urethra and, as shown by ultrasound Dopplerography, venous congestion in the pelvic organs and paraurethral plexus is reduced. The use of the dietary supplement allowed not only to significantly reduce the rate of asymptomatic bacteriuria among women in the main group, but also the number of relapses of cystitis over 6 months of observation from the start of therapy. An important predisposing factor in the development of recurrent urinary tract infection in postmenopausal women is the state of the hormonal background, which entails metabolic, local immune changes, and disorder of pelvic hemodynamics as a whole. Adequate blood supply, including venous, is also one of the main prerequisites for the normal functional activity of the mucous membrane of the urogenital area and bladder. The active components included in the dietary supplement not only help improve the hemodynamics of the bladder and urethra, but also have a protective, anti-inflammatory effect, as evidenced by a 4-fold decrease in the number of urinary tract infection relapses in patients of the main group over 6 months of observation. Conclusion. The results obtained indicate the high therapeutic effectiveness of the dietary supplement, containing a complex of natural plant substances, both for complex therapy and for the prevention of relapses of lower urinary tract infections in patients, including during the postmenopausal period.
Management of recurrent vulvovaginal candidiasis and bacterial vaginosis: focus on maintenance therapy
Background. The high-frequency recurrence of vulvovaginal candidiasis and bacterial vaginosis, bacterial biofilm formation, and the growing resistance to azole antifungal treatment compromise the efficacy of standard therapy and necessitate the search for pathogenesisoriented strategies for relapse prevention. Intravaginal boric acid is known to maintain healthy vaginal pH, suppress Candida and anaerobic bacteria growth, and affect biofilm formation, which play a pivotal role in persistent, chronic recurrent infections. Objective. This study aims to analyze real-world data to evaluate the clinical efficacy of boric acid (600 mg) medical device when used in maintenance therapy. Long-term administration of 600 mg boric acid promoted the maintenance of a balanced vaginal pH, reduced the risk of recurrent episodes, and improved the efficacy of standard antimicrobial and antifungal therapy. Materials and methods. A retrospective medical record review allowed for the identification of the specific patterns of physician prescribing habits regarding maintenance therapy with a boric acid (600 mg) medical device in patients with recurrent vulvovaginal candidiasis and bacterial vaginosis. It was established that the integration of this medical device into comprehensive treatment regimens after an induction antifungal or antibacterial therapy promotes long-term stability of the vaginal microbiota and reduces the incidence of disease recurrence. Conclusion. The mean duration of use for the boric acid (600 mg) medical device was 13 months, reflecting an unmet clinical need for longterm maintenance therapy for persistent vaginal infections. A high level of patient satisfaction with the treatment was reported, alongside with a favorable safety profile and reduced rates of adverse events. The pooled data confirmed the clinical rationale for the integration of this medical device into comprehensive anti-relapse therapy for vaginal dysbiosis.
Pregnancy complicated by cervical cancer: modern treatment approaches in the russian literature
Background. Cervical cancer is one of the most common forms of malignant tumors diagnosed in women of reproductive age, including during pregnancy. Due to the relative rarity of this disease in combination with pregnancy and the limited number of randomized clinical trials, the development of standardized treatment algorithms presents significant challenges. Therapeutic approaches to cervical cancer during pregnancy are extrapolated from guidelines developed for non-pregnant patients, relying heavily on expert consensus and limited clinical evidence. The lack of large-scale studies in this specific clinical context necessitates a tailored approach for each patient, based on the stage of the disease, gestational age, and overall health. Results. To compile this review, a search of the electronic libraries eLibrary.ru and PubMed was conducted using the keywords "pregnancy" and "cervical cancer". For treatment descriptions, primarily Russian articles published within the five years prior to the article were selected. Management strategies for pregnancy associated with cervical cancer remain an area of active debate in the scientific community. For pregnant women who insist on continuing their pregnancy, specialized therapy may be administered based on the stage of cervical cancer, tumor size, gestational age, fetal condition, and the extent of pelvic lymph node involvement. Conclusion. Analysis of domestic clinical data over the past five years demonstrates the use of a personalized approach to treating cervical cancer in pregnant women. Treatment strategies are determined by a panel of specialists from various fields and are based on shared decision-making with the patient. This approach takes into account all the nuances of the clinical picture and the patient's individual preferences, helping to optimize treatment outcomes and preserve reproductive function.
Ovarian apoplexy: assessment of regional characteristics, risk factors, and current approaches to organ-preserving treatment
Background. Ovarian apoplexy accounts for 0.5% to 2.5% of all gynecological pathologies and up to 10-19% of acute gynecological conditions. Recurrence rates range from 21% to 69%. Although ovarian apoplexy can occur at any age, it is most common in young patients of reproductive age. This makes the problem particularly significant, as previous ovarian apoplexy and its treatment are associated with decreased ovarian reserve and a 30-40% increased risk of reproductive loss and infertility. The relevance of this problem necessitates the development of minimally invasive hemostasis methods aimed at preserving ovarian tissue. Objective. To analyze the clinical and epidemiological characteristics of ovarian apoplexy, evaluate the diagnostic and treatment methods used, and identify regional risk factors using the example of the Republic of Karelia. Materials and methods. A retrospective cohort analysis was conducted of 121 cases of ovarian apoplexy treated at the Republican Hospital of Emergency and Urgent Medical Care (Petrozavodsk) in 2023-2024. Results. The proportion of ovarian apoplexy in the structure of gynecological patients was 3.75% (121/3224), which is statistically significantly higher than the Russian average (~1.8%). The mean age of patients was 30.5 ± 7.31 years, with a peak incidence in the 18-29 age group (66.1%). Ovarian apoplexy was diagnosed significantly more often in the second phase of the menstrual cycle (85.9%, p < 0.05). The right ovary was the most common site of involvement (62.8%, p < 0.05). The leading precipitating factor was sexual intercourse (39.7%). Only 6.6% of patients used combined oral contraceptives. Surgical treatment was required in 58.7% of patients, with laparoscopic surgery used in all cases. Organ-preserving surgery (ovarian coagulation) were performed in 88.7% of surgical interventions. Conclusion. A higher incidence of ovarian apoplexy has been established in Karelia, necessitating further investigation of the influence of regional factors (subarctic climate, photoperiodism). Key modifiable risk factors include poor adherence to effective hormonal contraception and the presence of chronic inflammatory processes. Laparoscopy with organ-preserving techniques has become established as the standard of care. To optimize management, it is necessary to implement regional preventive programs aimed at promoting effective contraception among young women.
Development and validation of a modified questionnaire for vector assessment of female sexual constitution
Background. The assessment of the sexual constitution is an important stage in the assessment of a woman's psychosexual development. Classical scales developed in the second half of the 20th century require revision and modification due to acceleration, changes in social norms and the emergence of new data on age norms of sexual debut. The modified scale excludes the vector "age of pregnancy" due to its low informative value in modern conditions: it does not correlate with hormonal status and is strongly influenced by social factors (contraception, delayed motherhood). The lack of a modern validated instrument makes it difficult to differentiate between constitutionally determined features and pathology. Objective. To develop a modified version of the scale for the vector determination of the sexual constitution in women, to carry out its psychometric validation and to prove the diagnostic significance of each of the included vectors in a clinical sample. Materials and methods. The study included 150 women aged 18-45 years (average age 29.4 ± 6.7 years), divided into two groups: the clinical group (n = 75, complaints of sexual dysfunction) and the control group (n = 75, without complaints). All were evaluated on a modified scale (6 vectors) and evaluated on the classical scale by G. S. Vasilchenko. ROC analysis, calculation of sensitivity and specificity, correlation of Pearson and criterion χ2, and evaluation of internal consistency (Cronbach's law) were performed. Results. The modified scale demonstrated high internal consistency (Cronbach's α = 0.89). The overall accuracy of the diagnosis of "weak constitution" was 92% (k = 0.88; p < 0.001). A strong correlation was found between a weak constitution and menstrual cycle disorders (p < 0.001). ROC analysis of the "Age of libido arousal" vector (AUC = 0.91) confirmed its high predictive ability in the differential diagnosis of hypolibidemia. The adjustment of the age limits (a shift towards earlier values) made it possible to increase the diagnostic accuracy by 15% compared with the classical scale. Conclusion. The modified scale for the vector determination of the sexual constitution in women has high validity and reliability. The updated normative values (threshold ages) reflect current population trends and allow for a more accurate differentiation of the constitutional norm from pathology. Each of the six vectors makes an independent and meaningful contribution to the final assessment.
MIRAGE syndrome is a long way to diagnosis (clinical case)
Background. DMIRAGE syndrome is an abbreviation which is derived from the capital letters of the main signs of a rare genetic disease caused by mutations in the NALCN and SAMD9 genes: myelodysplasia, infection, growth retardation, adrenal hypoplasia, genital phenotypes and enteropathy, or, in English, myelodysplasia (M), infection (I), growth restriction (R), adrenal hypoplasia (A), genital phenotypes (G), and enteropathy (E). It is an autosomal dominant disease, usually caused by a de novo mutation in genes. While there are currently no long-term outcome data, however, the mortality rate is known to be extremely high, with the majority of patients succumbing to the disease during childhood. This disease is primarily characterized by organ hypoplasia due to defective cell proliferation. The exact pathophysiologic mechanism of this syndrome has yet to be determined. Endosomal dysfunction is speculated to be a mechanism underlying the cell proliferation defects observed in this disease. Objective. The purpose of the publication of this clinical case was to familiarize pediatric doctors with the specifics of the clinic and diagnostic tactics in relation to an extremely rare genetic syndrome. Materials and methods. A child aged 1 year 5 months. (at the time of diagnosis) with a genetically confirmed diagnosis: MIRAGE syndrome. It has an almost complete clinical picture of this syndrome. A detailed history of the child's life, the results of clinical, instrumental and genetic examination, as well as the specifics of the selection of therapy are presented. Results. The features of the patient's medical history and clinical picture of MIRAGE syndrome stated in the article show that it is necessary to conduct a complete genetic analysis with an unclear and atypical clinical picture, including a simultaneous damage to many body systems, in order to exclude the rarest genetic diseases.
Practical recommendations for introducing complementary foods in the context of modern food allergy prevention
Background. Starting at approximately six months of age, exclusive breastfeeding and infant formula alone are no longer sufficient to meet all nutrient needs, and complementary foods should be introduced. Complementary feeding refers to the introduction of solid and soft foods, other than breast milk and infant formula. The introduction of complementary food is a critical period in a first year of life. The nutritional value, texture, and feeding method of complementary foods help to establish taste preferences and good eating habits later in life. Choosing the right age to begin complementary feeding and developing an appropriate, individualized food introduction plan are crucial for meeting the child's physiological needs for energy and nutrients, developing healthy eating behaviors, and, as recent studies have shown, for processes related to food tolerance. The successful introduction of a variety of foods into a child's diet is influenced by many factors, such as food preparation methods, the order in which foods are introduced, and the socio-psychological climate in the family. Currently, a number of studies are aimed at examining the influence of complementary foods on the development of the intestinal microbiome and the immune response in relation to the risk of developing food allergies. Results. In this review, we analyze both scientific studies and consensus documents from recent years devoted to the nuances of introducing common food allergens into the diet of children in the first year of life and the impact of complementary foods on the intestinal microbiome and the immune system. We also provide evidence-based and consensus-based practical recommendations for introducing complementary foods from the perspective of understanding preventive strategies for allergic diseases, as well as the nuances of introducing complementary foods to children with food allergies.
The significance of ultrasound examination in arthropathies in patients with inflammatory bowel disease: focus on paediatric practice
Background. Inflammatory bowel disease is a chronic immune-inflammatory disease with intestinal and extraintestinal manifestations. Among the extraintestinal manifestations of inflammatory bowel disease, one of the most common is musculoskeletal involvement, which proceeds in the form of seronegative spondyloarthropathies. The involvement of joints in the pathological process affects the functional state and quality of life of the child and requires changes in the scope of therapeutic measures, therefore early diagnosis of the condition of joints and ligaments is of great importance. The non-specific nature of the symptoms and the high frequency of subclinical inflammation in the joints in inflammatory bowel disease make ultrasound examination particularly important as a method of early and safe visualisation of inflammatory changes. Objective. The aim of the study was to analyse the nature of ultrasonic changes in the joints of children with arthropathies associated with Crohn's disease. Materials and methods. The study included 28 children with Crohn's disease and inflammatory bowel disease in the form of joint damage, with a mean age of 11.77 ± 1.45 (95% confidence interval [10.12; 13.12]) years. The diagnosis of Crohn's disease was established in accordance with the Clinical Guidelines for Crohn's disease in Paediatric Patients, 2024. A clinical analysis of joint involvement options was performed; enthesitis was assessed using the MASES index. Arthrosonography was performed on 154 joints of various locations. The study was conducted using a Voluson E8 expert-class ultrasound machine with a linear transducer with a frequency of 6-15 MHz. Ultrasound signs of joint damage were assessed according to the following characteristics: reduction in hyaline cartilage thickness, effusion in the joint capsules (homogeneous/heterogeneous), thickening of the synovial membrane. Quantitative indicators are presented as M ± SD (mean ± standard deviation) with 95% confidence intervals. Qualitative variables are described using absolute and relative (%) frequencies. Student's t-distribution was used to calculate the confidence intervals of the mean values. Results. In our group of 28 children with Crohn's disease, boys predominated – 18/28 (64.3%), while girls accounted for 10/28 (35.7%). The average age of onset was 8.46 ± 1.33 (95% confidence interval [7.13; 9.79]) years. Joint syndrome in 6/28 (21.4%) children was represented by spondyloarthritis, in 14/28 (50%) by oligoarthritis, and in 8/28 (28.6%) by polyarthritis. Physical examination of 28 children revealed changes in 67 joints in the form of effusion/proliferative component. Enthesopathic syndrome was present in 12/28 (42.9%) children, with a mean MASES index of 2.21 ± 2.81 (95% confidence interval [1.12; 3.30]). Arthrosonography was performed on 154 joints of various locations. The most common joint change on ultrasound was synovitis (116/154, 75.3%), with minimal synovitis in 75/116 (64.7%) cases and significant synovitis in 37/116 (31.9%) cases. Diffuse thickening of the synovial membrane was detected in 116 joints (116/154, 75.3%). Only in 2/154 (1.3%) joints was there thinning and unevenness of the cartilage contour. Tenosynovitis was detected in 8/154 (5.2%) cases, and Achilles bursitis in 2/154 (1.3%) cases. Conclusion. In our study, the clinically detectable number of affected joints was 67, while arthrosonography revealed pathological changes in 154 joints, in most patients (65%) mainly in the form of minimal synovitis. Thus, subclinical joint inflammation in children with inflammatory bowel disease occurs much more frequently than is determined by physical examination of patients. The introduction of ultrasound as a screening tool, as well as in the complex dynamic observation of children with inflammatory bowel disease, can contribute to the early detection of inflammatory changes in the joints and the timely optimisation of treatment tactics.
Assessment of modifiable risk factors for precancerous colon diseases
Background. Precancerous diseases of the colon play a key role in intestinal oncogenesis, as about 80% of colorectal cancers are caused by colon polyps. The prevalence of colorectal epithelial neoplasms ranges from 20% at age 45 to over 50-60% by age 85. Developed countries exhibit higher incidence rates, which are driven by lifestyle factors and national screening programs. Polyps are detected in 20%-53% of screening colonoscopies in adults aged 50 and older. Adenomatous polyps (15-25%) and hyperplastic polyps (up to 30%) represent the most common histological types, the latter being more characteristic of individuals under 50 years of age. Inflammatory polyps are less common and typically occur in patients with inflammatory bowel disease. Genetic predisposition, age, gender, and height are significant determinants of the risk of developing precancerous colon diseases, but these are not modifiable risk factors. When considering the prevention of colorectal polyps, the primary focus should be on modifiable risk factors. Objective. The aim of this study was to evaluate key risk factors documented in the literature among 199 patients aged 40-75 with precancerous colorectal lesions and 100 apparently healthy controls based on questionnaire data. Results. A number of endocrine, metabolic, and behavioral factors contribute to the development of polyps and their progression to colorectal cancer. There is a proven link between a history of obesity, hyperglycemia, and type 2 diabetes mellitus and an increased risk of colon polyps. The presence of non-alcoholic (metabolic-associated) fatty liver disease also increases the likelihood of detecting precancerous diseases of the colon, especially with steatohepatitis or cirrhosis of the liver. Well-known risk factors such as smoking and alcohol consumption play an important role in the transformation of a polyp into colorectal cancer. The use of certain medications, primarily broad-spectrum antibiotics and proton pump inhibitors, has also proven its effect on the formation of precancerous colon diseases. Conclusion. Taken together, these findings highlight the need for systematic screening and the development of preventive strategies, especially in high-risk groups.
Multimodal management of chronic lower extremity ischemia
Background. Chronic ischemia of the lower extremities, which represents the predominant manifestation of peripheral artery disease, undoubtedly represents a significant public health challenge in contemporary society due to its high prevalence, progressive course, risk of critical ischemia and major amputations, and the associated increased short-term mortality risk. The prevalence of chronic lower extremity ischemia demonstrates sex-specific patterns with an earlier onset and a slightly higher prevalence in men. However, after the age of 75, these sex differences diminish, and the prevalence of this pathology becomes higher in women. Objective. The current review aimed to outline current approaches to the comprehensive multimodal management of peripheral arterial disease, in accordance with the level of evidence in international and national clinical guidelines. Results. An analysis of epidemiological data, etiology, and pathogenesis of chronic lower extremity ischemia was performed, as well as its most hallmark symptom, intermittent claudication. Underlying mechanisms of disease development are described. This review evaluates a multimodal approach and current treatment trends for patients with chronic lower extremity ischemia and intermittent claudication. The review outlines the mechanisms of action, efficacy, and future therapeutic applications of cilostazol for managing patients with chronic lower extremity ischemia, as well as those with other pathologies. Conclusion. Representing one of the manifestations of systemic cardiovascular disease, requires a personalized yet comprehensive approach involving the prescription of maintenance therapy and peripheral perfusion enhancers. Cilostazol, with the highest level of evidence, is the first-line agent for increasing pain-free walking distance in patients with intermittent claudication. The efficacy and safety of cilostazol have been demonstrated in a series of placebo-controlled studies, thereby underlying the clinical efficacy and improved quality of life in the patient cohort.
Type 2 diabetes mellitus and comorbid conditions: from clinical recommendations to daily practice
Background. Managing patients with type 2 diabetes mellitus with comorbidities remains a major challenge in real clinical practice. Cardiovascular disease and progressive decline in glomerular filtration rate are the leading causes of mortality in type 2 diabetes. According to international and Russian guidelines, glucagon-like peptide-1 receptor agonists or type 2 sodium-glucose cotransporter inhibitors are preferred for patients with established atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease, regardless of baseline HbA1c. Semaglutide, a glucagon-like peptide-1 receptor agonist, has been proven highly effective for the treatment of type 2 diabetes and obesity. Clinical trials have shown that semaglutide reduces major adverse cardiovascular events, lowers hospitalization rates for heart failure, and slows chronic kidney disease progression, making it an essential tool for managing cardiorenal-metabolic risk in patients with type 2 diabetes. Results. Semaglutide exerts a wide range of effects because of the varied expression of the glucagon-like peptide-1 receptors not only in pancreatic β-cells, but also in vascular endothelium, cardiomyocytes, renal tubular cells, smooth muscle cells, and hypothalamic neurons. In daily clinical practice, physicians routinely face inherent challenges, such as economic constraints, a lack of awareness of updated therapeutic strategies among some clinicians, therapeutic inertia, and poor treatment adherence. Population clinical heterogeneity plays a crucial role, ranging from young adults with newly diagnosed diabetes and concomitant obesity to elderly patients with frailty syndrome and multiple comorbidities, who require diametrically opposed therapeutic strategies. The introduction of domestic semaglutide to the Russian market has significantly enhanced access to this treatment in the Russian Federation.
Neurogenic urogenital disorders in inflammatory bowel disease
Background. Experimental studies demonstrate shared afferent organization of the colon and urinary bladder, the presence of dichotomized neurons in dorsal root ganglia, and the development of cross-organ sensitization in colitis. TRPV1-positive visceral afferents, microglia, purinergic signalling, NK1/MAPK-p38 cascades, and brain-derived neurotrophic factor contribute to persistent neuroplasticity in spinal circuits. Clinical data confirm a high prevalence of urinary and sexual complaints in inflammatory bowel disease: the median BFLUTS score in women is 6, chronic prostatitis-like symptoms are present in 26.8% of men, and pooled prevalence of sexual dysfunction reaches 50.6%. At the same time, urinary symptoms in inflammatory bowel disease are heterogeneous and require differential assessment against urolithiasis, drug-related nephrotoxicity, pelvic floor dysfunction, chronic pelvic pain, and psychosocial factors. Current ECCO guidelines on extraintestinal manifestations and reproductive health do not define neurogenic urogenital disorders as a separate phenotype, and direct neurophysiological confirmation of neurogenic lower urinary tract symptoms in inflammatory bowel disease is still lacking. Objective. To analyze current data on neurogenic mechanisms of urogenital disorders in inflammatory bowel disease, evaluate the clinical phenotype of lower urinary tract symptoms and sexual dysfunction, and define key evidence gaps. Conclusion. A neurogenic mechanism of urogenital disorders in inflammatory bowel disease is biologically plausible and well supported by experimental evidence, but it has not yet been proven in humans by direct functional studies. Prospective studies incorporating urodynamics, pelvic floor electromyography, and neurophysiological testing are required; in current practice, active screening for urinary and sexual symptoms in patients with inflammatory bowel disease is warranted.
The current state of the issue of pressure ulcers: relevant pathophysiological and clinical aspects
Background. Pressure ulcers remain one of the most pressing problems in patients in a prolonged unconscious state, leading to significant medical and social consequences. The prevalence of the condition among hospitalized patients reaches 18%. At the same time, in intensive care unit patients, the risk of developing pressure ulcers rises to 40-60% depending on the duration of immobilization. Objective. To provide a review of current literature on the pathogenesis, diagnosis, treatment and prevention of pressure ulcers, as well as to examine the morphofunctional features of the skin underlying the development of ischemic necrotic changes and key risk factors. Additionally, it is planned to systematize data on the effectiveness of preventive measures in different clinical groups. Materials and methods. The study analyzed 55 literature sources from various databases. The influence of mechanical pressure, various physical factors, chemicals, microorganisms, sleep disturbances, stress, systemic diseases and post intensive care syndrome on skin barrier function was studied. Risk factors for pressure ulcer development (reversible – hypotension, hypovolemia, hypoproteinemia; irreversible – age) and their mechanisms of action (impaired microcirculation, trophism and innervation due to vascular obstruction, hypoxia under prolonged pressure – more than 1-2 hours) were considered. To assess data reliability, a meta analysis method was applied to individual studies with a high level of evidence. Results. Depending on the disease stage, pressure ulcers are treated with hydrocolloid, hydrogel, alginate, gel forming foam dressings, as well as surgical (including removal of necrotic tissue) and physiotherapeutic methods. The prospects for using innovative methods were discussed. It was concluded that timely diagnosis and treatment of pressure ulcers is a multidisciplinary task that remains highly relevant. The implementation of comprehensive preventive programs has reduced the incidence of severe pressure ulcer forms by 22% in the observed patient cohorts.
The effect of citalopram on the psychophysiological parameters of patients with nonpsychotic depressive disorders
Background. There is no systematic data on the effect of antidepressant therapy on the indicators of the psychophysiological state of patients with nonpsychotic depressive disorders. The role of emotional changes in the regulation of mental and physiological processes and adaptive behavior has not been sufficiently studied. Consideration of psychophysiological parameters during the course of antidepressant therapy, based on the example of an analysis of the effect of citalopram, allows us to refine a personalized treatment plan for patients. Objective. To establish the clinical, psychophysiological and therapeutic interdependence of the characteristics of manifestations of stressfrustration reactions, aggression and aggressiveness in patients with non-psychotic depressive disorders on the background of course therapy with citalopram, which is one of the most effective "model" antidepressants from the group of selective serotonin reuptake inhibitors. Materials and methods. A two-fold comprehensive systemic clinical and psychophysiological study of the condition of 107 patients with nonpsychotic depressive disorders with a predominance of anxiety, asthenic and hysterical clinical variants was conducted before the start of treatment (background) and upon the onset of a pronounced clinical effect (after 6-8 weeks of therapy). The traditional clinical and psychopathological analysis was used, supplemented by the method of multivector analysis (Yu. A. Alexandrovsky). The psychophysiological status of the patients was assessed using the automated diagnostic system "Multipsychometer" (MPM-05), taking into account the standardized population indicators of each of the methods. The battery of tests included: a set of methods for evaluating thinking, tests of verbal and nonverbal intelligence, nonverbal and mathematical intelligence, frustration, the Bass – Darkey aggression and aggression questionnaire, and the MMPI clinical and typological personality test. Conclusion. Course therapy with citalopram in the studied group of patients with nonpsychotic depressive disorders leads to a positive transformation of psychophysiological indicators of aggression and aggressiveness with its positive therapeutic effect on clinical, pathopsychological and pathological symptom complexes of depressive disorders of the neurotic level. During citalopram therapy, a group of patients with negative therapeutic dynamics of psychopathological manifestations and an increase in stress-frustration reactions of an impunitive nature were identified. There is no systematic data on the effect of antidepressant therapy on the indicators of the psychophysiological state of patients with nonpsychotic depressive disorders. Their violations of perception and evaluation of incoming information, the role of emotions in the regulation of mental and physiological processes and adaptive behavior have not been sufficiently studied. Consideration of psychophysiological parameters during the course of antidepressant therapy, based on the example of an analysis of the effect of citalopram, allows us to justify a personalized treatment plan for patients.
Background. Fisher – Evans syndrome is a rare autoimmune disorder characterized by the combination of autoimmune hemolytic anemia and immune thrombocytopenia, often accompanied by leukopenia and signs of bone marrow failure. The disease is notable for its diagnostic complexity, variability of clinical manifestations, and frequent resistance to standard immunosuppressive therapy, necessitating an individualized approach to treatment selection. A comprehensive laboratory and instrumental evaluation plays a crucial role in confirming the diagnosis, including immunological assays as well as molecular genetic testing, which allows for the identification of possible primary immunodeficiencies and hereditary disorders of hematopoiesis. Results. This article presents a clinical case of a pediatric patient with Fisher – Evans syndrome in whom whole-exome sequencing revealed a mutation in the CDAN1 gene associated with congenital dyserythropoietic anemia type I. The presence of this mutation likely had a significant impact on the clinical course of the disease, contributing to pronounced cytopenia and resistance to ongoing therapy. Particular attention is given to the staged treatment approach, including the use of glucocorticosteroids, immunosuppressive agents, and thrombopoiesis stimulators, as well as the need for multiple blood transfusions. Due to the absence of a sustained therapeutic response to conservative treatment, the patient underwent allogeneic hematopoietic stem cell transplantation from a related HLA-identical donor. The features of the early post-transplant period are discussed, including the prevention of infectious complications, monitoring of viral infections, and assessment of immune status. The dynamics of hematopoietic recovery are presented, along with changes in chimerism parameters reflecting engraftment. It is noted that an increase in the proportion of recipient cells requires intensified monitoring and may serve as a basis for treatment adjustment. This clinical case highlights the importance of early genetic testing in patients with atypical courses of autoimmune cytopenias and demonstrates the effectiveness of hematopoietic stem cell transplantation as a treatment modality in cases involving a combination of autoimmune and genetically determined hematopoietic disorders.
A complication of acute suppurative otitis media in the form of atypical apical cervical mastoiditis: treatment experience
Background. Acute suppurative otitis media is a common form of otitis media, involving all the compartments of the middle ear. Without appropriate management, acute suppurative otitis media extends to adjacent anatomical structures, resulting in complications such as facial nerve palsy, mastoiditis, labyrinthitis, petrositis, meningitis, brain abscess, lateral and cavernous sinus thrombosis and hearing loss. Since the advent of antibiotic therapy, which has become a cornerstone of management of acute otitis media, the incidence of complications has markedly declined. However, complications of acute suppurative otitis media may present atypically, without exhibiting classic clinical signs. Apical cervical mastoiditis is a rare complication of acute suppurative otitis media, which can have an atypical and unique course without developing classic manifestations. Objective. The aim of this study was to describe the experience of treating patients with acute suppurative otitis media complicated by atypical apical cervical mastoiditis. Results. A retrospective analysis of the medical records of patients with ASO from 2022 to 2024 was conducted. Over a three-year period, 144 of 470 patients with ASO were diagnosed with atypical apical cervical mastoiditis, confirmed by CT of the temporal region. Moreover, characteristic pain and induration upon palpation of the mastoid process were detected in only 16% of patients. Conclusion. Apical cervical mastoiditis requires a thorough medical history and daily monitoring of the patient's condition and otoscopic findings. A combination of predisposing factors, such as advanced age and comorbidities, along with poor otoscopic progression, should prompt a more extensive laboratory and instrumental examination, despite the absence of pronounced clinical symptoms of apical cervical mastoiditis.