Vol 22, No 6 (2020)

Type 1 endocrine neoplasia syndrome is a genetically determined autosomal dominant disease and is manifested by the development of malignant transformation and/or hyperplasia of two or more endocrine glands. Women’s reproductive health problems are mainly caused by damage to the parathyroid glands, pituitary gland, thyroid gland and adrenal glands. Hyperparathyroidism is observed in 90-100% of patients and leads to the development of nephrocalcinosis, pyelonephritis, acute renal failure, pathological bone fractures, cardiovascular failure, increased blood pressure, preeclampsia, which are accompanied by fetal hypoxia, intrauterine growth retardation, and a lethal outcome is possible, such as death for the fetus, and for the mother. Prolactin-secreting pituitary adenoma disrupts the functioning of the hypothalamic-pituitary-ovarian system. Patients have hypogonadotropic hypogonadism, oligomenorrhea, amenorrhea, galactorrhea, decreased libido, polycystic ovary syndrome, infertility. Key words: hyperprolactinemia, hyperparathyroidism, menstrual irregularities, infertility. For citation: Petrov Yu.A., Kupina A.D. Complications of the gestational period in patients with type 1 multiple endocrine neoplasia syndrome. Consilium Medicum. 2020; 22 (6): 15-18. DOI: 10.26442/20751753.2020.6.200140

Aim. Evaluation of the effectiveness of uterine artery embolization in patients with placental increment. Material and methods. In the course of the study, a prospective multivariate analysis of 147 individual cards of pregnant women with placental increment was performed against various hemostasis methods: group 1 - embolization of the uterine arteries, group 2 - hysterectomy, group 3 - surgical hemostasis without hysterectomy. In the course of the work, the level of intraoperative blood loss, as well as the uterine vascular bed after embolization, was assessed. Statistical data processing was performed using the Statistica 6 program. Results. Minimal blood loss was noted after uterine artery embolization. When compared with patients who underwent hysterectomy and surgical hemostasis, the volume of blood loss was lower by 17,7 and 9,6%, respectively. The earliest restoration of the uterine vascular bed was registered in a group of patients who underwent uterine artery embolization, which is confirmed by vascular resistance indices in the radial and uterine arteries. Conclusion. Embolization of the uterine arteries is an effective organ-preserving technique that promotes effective hemostasis, as well as the rapid restoration of the uterine vascular bed. Key words: placental increment, uterine artery embolization, intraoperative blood loss, vascular resistance. For citation: Marchenko R.N., Kukarskaya I.I., Erbaktanova T.A. Efficiency of uterine artery embolization in patients with placenta accreta. Consilium Medicum. 2020; 22 (6): 25-27. DOI: 10.26442/20751753.2020.6.200303

Background. Abdominal obesity is the basic diagnostic criteria for metabolic syndrome. The most important method for preventing metabolic syndrome in its early stages is the effective correction of abdominal obesity. The use of a combination of drugs with different pathogenetic targets and in low doses for the treatment of obesity reduces the risk of side effects for each of them in comparison with their use as monotherapy, but at the maximum dosage. Aim. To compare the efficacy of combined treatment with sibutramine and metformin and metformin as monotherapy after 6 months in women with abdominal obesity. Materials and methods. 20 patients with abdominal obesity received monotherapy with metformin 850 mg/day, 30 patients were prescribed combination therapy (sibutramine 10 mg/day and metformin 850 mg/day). After 6 months, the efficacy and safety of this therapy were compared. Results. The combination of sibutramine and metformin in low doses (n=30) for 6 months more effectively reduces body mass index (p<0.05), waist circumference (p<0.05) than the use of metformin alone (n=20). Conclusions. Administration of sibutramine and metformin combination for 6 months, even in low doses, more effectively reduces body weight (p<0.05), waist circumference (p<0.05) than the use of metformin alone. The combination of sibutramine and metformin in low doses is safe to use. Key words: abdominal obesity, metformin, sibutramine, women of reproductive age. For citation: Batrak G.A., Zhaburina M.V. The use of sibutramine and metformin combination in women of reproductive age with abdominal obesity. Consilium Medicum. 2020; 22 (6): 32-34. DOI: 10.26442/20751753.2020.6.200302

Relevance. An insufficient level of vitamin D3 in the blood serum changes the function of metabolites, causes insulin resistance, and contributes to the development of metabolic syndrome, depression, etc. Vitamin D, being an inducer of nerve growth factor, modulates the neurotrophic factor of the brain in neurons, and its insufficiency can lead to the development of dementia, including Alzheimer's disease, and cognitive impairment Aim. To substantiate the feasibility of determining the level of 25(OH)D in the blood serum and to clarify the effectiveness of treatment of climacteric syndrome (CS) against the background of correction of vitamin D deficiency with colecalciferol. Materials and methods. The method of continuous sampling was used to determine the level of 25(OH)D in the blood serum of 307 patients aged 45-48 years, with neurovegetative and psychoemotional manifestations of menopausal syndrome in the period of early postmenopause. All patients underwent a comprehensive clinical and laboratory examination, including an assessment of the severity of menopausal syndrome based on the results of determining the modified menopausal index. Determination of the level of 25(OH)D vitamin D was carried out by the enzyme immunoassay "25(OH) Vitamin D Elisa". A personalized analysis of the results of the examination was carried out before and after the use of menopausal hormone therapy with and without colecalciferol. Results. Our results indicate that in 73.29% of cases in patients with neurovegetative and psychoemotional manifestations of CS in the early postmenopausal period, serum level 25(OH)D corresponds to hypovitaminosis D. The severity of CS with neurovegetative and psychoemotional manifestations in women in the early postmenopausal period is significantly higher (p<0.001) at a level of 25(OH)D in the blood serum of less than 20 ng/ml (modified menopausal index 49.17±1.57) compared with patients whose level 25(OH)D is in the range from 20 ng/ml to 30 ng/ml (modified menopausal index 34.27±1.79). According to our data, the use of colecalciferol in combination with menopausal hormone therapy significantly reliably reduces the main neurovegetative and psychoemotional manifestations of menopause in the early postmenopausal period, against the background of vitamin D deficiency, compared with the use of menopausal hormone therapy alone. Conclusions. Determination of the level of 25(OH)D in the blood serum of patients in the early postmenopausal period with the presence of neurovegetative and psychoemotional manifestations of menopause syndrome, as well as the correction of the revealed vitamin D deficiency with colecalciferol preparations, is promising and increases the efficiency of the correction of clinical manifestations of menopause syndrome. Key words: menopausal syndrome, menopausal hormone therapy, vitamin D deficiency, colecalciferol. For citation: Pestrikova T.Yu., Yachinskaya T.V. Opportunities and perspectives of the use of colecalciferol in therapy of climacteric syndrome in patients on the background of vitamin D deficiency. Consilium Medicum. 2020 (22); 6: 38-44. DOI: 10.26442/20751753.2020.6.200333

Infertility is a global problem affecting 15% of sexually active traditional couples worldwide. Recently, male infertility has become equal in frequency to female infertility - the frequency of the "male" factor in family infertility reaches 40-50% and continues to increase. In 40-60% of cases there is a single anomaly - a pathological spermogram, and with a comprehensive objective and laboratory study of other anomalies, it is not determined. Infertility with undetected causes of impaired fertility is called unspecified or idiopathic. The use of nutraceuticals or biologically active additives, due to the active components of their composition, is a justified therapeutic approach to improving sperm and male fertility. The review discusses the influence of various components of nutraceuticals - trace elements (zinc, selenium), amino acids (L-arginine), vitamins (C, E, B8, B12, D, folic acid, L-carnitine, ubiquinone) used in the complex treatment of male infertility. All the above active components of nutraceuticals that positively affect male fertility, including vitamin D3, are part of the Virfertil® nutraceutical. Key words: male infertility, idiopathic male infertility, nutraceuticals, trace elements, vitamins, colecalciferol, amino acids, Virfertil. For citation: Makushin D.G., Belkina L.V., Trukhan D.I. The role and place of nutraceuticals in complex therapy of idiopathic male infertility. Consilium Medicum. 2020; 22 (6): 50-57. DOI: 10.26442/20751753.2020.6.200254

Introduction. Antibiotic monotherapy does not provide sufficient effectiveness in any type of prostatitis. Thus, pathogenic treatment is required, but no definite guidelines on medication choice exist nowadays. Objective. To evaluate Adenoprosin entomotherapy effectiveness in patients with chronic abacterial prostatitis with signs of inflammatory process. Materials and methods. The study included 40 patients with chronic abacterial prostatitis, mean age of the patients was 36.2 years. Inclusion criteria: diagnosed chronic prostatitis (CP) 3a category, symptoms severity evaluated by NIH-CPSI total score more than 15 points, disease duration more than 6 months, leucocyte count in prostate fluid more than 15 cells. Baseline therapy was conducted for 1 month. Control group patients received only baseline treatment. Study group patients received Adenoprosin rectal suppositories daily for 30 days in addition to baseline treatment. Treatment results were evaluated right after therapy course was complete and 2 months after. Treatment effectiveness was evaluated by decrease of prostate fluid leucocyte count decrease, symptoms questionnaires NIH-CPSI and I-PSS, and urodynamics characteristics. Results. No statistically significant differences in frequency and severity of main symptoms were found at baseline, the study groups were identical. In 1/2 cases in both groups benign prostatic hyperplasia (BPH) was found in CP patients. After treatment was complete significant differences were found in parameters “pain”, “quality of life”, “urination disorders”, and in total score. Urination in study group was also improved more significantly that was confirmed with uroflowmetry results. International Prostate Symptom Score (I-PSS) confirmed that baseline treatment combined with entomotherapy was more effective. At follow-up after 2 months clinical and laboratory results ratio did not change significantly that illustrates delayed prolonged effect of Adenoprosin. Conclusion. In 1/2 patients with CP in our study BPH was diagnosed for the first time. We suggest that CH and BPH mask and confound each other’s course and that is why it is preferable to use medication with bidirectional effects. Key words: chronic prostatitis, chronic abacterial prostatitis, pathogenic treatment, entomotherapy, Adenoprosin, benign prostatic hyperplasia. For citation: Kulchavenya E.V., Breusov A.A. Entomotherapy bidirectional effect in chronic prostatitis and benign prostatic hyperplasia management. Consilium Medicum. 2020; 22 (6): 64-67. DOI: 10.26442/20751753.2020.6.200178

2019 Novel Coronavirus Disease (COVID-19) caused by SARS-CoV-2 (Acute Respiratory Syndrome associated with Coronavirus-2) is a major public health concern worldwide. The question of whether SARS-CoV-2 can penetrate testicular tissue and/or sperm is currently unanswered. Also, does not the mere presence of viruses in semen mean that the disease can be sexually transmitted? Currently, a sufficient number of questions arise from specialists dealing with infertility. Unfortunately, there is no reliable data for today. This article analyzes the available publications on the impact of COVID-19 on male reproductive function. Key words: COVID-19, SARS-CoV-2, infertility, testicular tissue, angiotensin-converting enzyme 2. For citation: Popova A.Iu., Gamidov S.I., Ovchinnikov R.I. et al. Impact of COVID-19 on fertility. What prerequisites and risks will arise in the new reality? Consilium Medicum. 2020; 22 (6): 73-77. DOI: 10.26442/20751753.2020.6.200355