As shown by numerous studies conducted during the pandemic, the severe course of COVID-19 is accompanied by multiple organ failure. Cytokine storm, hypercoagulation, complement hyperactivation and other arms comprise the overall picture of the pathogenesis of the severe disease course. The frequent diagnosis of multiple microvascular thrombosis in lung, heart, and kidneys, as well as the presence of platelet-fibrin thrombi there and signs of terminal organ damage, suggest a possible involvement of thrombotic microangiopathy (TMA) in the development of multiple organ failure. In this regard, it is especially important to timely diagnose TMA and start pathogenetic therapy. These measures can significantly reduce mortality due to the novel disease. Heparins and direct oral anticoagulants are the mainstay for prevention and treatment of venous thromboembolism in patients with COVID-19, but their effectiveness in the presence of TMA is questionable. It has been proven that anticoagulants use in critically ill patients with COVID-19 for prevention of large vessel thrombosis is effective, but their role in the prevention of microthrombosis is not clear. Here we review the currently available information on thrombotic microangiopathy, as well as a review of literature data describing TMA-like conditions in COVID-19, discuss potential pathophysiology of the condition development and proposed therapeutic approaches.

Aim: to assess the reproductive function of patients who underwent organ-preserving delivery using a modified method of uterine cavity suturing placenta increta.

Materials and Methods. There were retrospectively investigated 77 history cases of patients admitted for planned delivery in 2018–2020, subdivided into two groups: Group 1 (control) – 32 patients with uterine scar after previous cesarean section, Group 2 (main) – 45 patients diagnosed with placenta increta further assigned to 2 subgroups – 2A (n = 23) underwent a modified uterine cavity suturing, and subgroup 2B (n = 22) where a linear suturing was used.

Results. The groups studied were comparable on anthropometric data and reproductive history. The ultrasound examination of the uterus size 6 months later revealed more prominent changes in main group that might be due to larger volume of excised uterine tissue during surgery. Significant differences in subgroup 2A (uterus length – 54 [48; 62] mm, uterus width – 38 [29; 47] mm; p = 0.036 and p = 0.024, respectively) and subgroup 2B (uterus length – 51 [42; 60] mm, uterus width – 30 [24; 44] mm; p = 0.003 and p < 0.001) vs. control group (uterus length – 60 [55; 66] mm, uterus width – 48 [42; 54] mm) were observed. Magnitude of change in size and shape of the uterus were found in subgroup 2A vs. 2B (p = 0.022 for uterus length, p = 0.004 for uterus width). Examining intrauterine blood flow revealed no significant differences between the groups compared (p > 0.1).

Conclusion. Assessing results of the applied new method for uterine cavity suturing in patients with placenta increta showed a marked efficiency in maintaining anatomically most natural shape of the uterus and uterine cavity. Despite the results obtained, the problem of restoring female reproductive function after organ-preserving delivery remains a pressing issue relevant and requires to be further investigated.

Aim: to evaluate the efficacy of azoximer bromide along with a combined antimicrobial drug in treatment of patients with aerobic vaginitis (AV).

Materials and Methods. There was conducted a prospective, randomized, parallel group study with enrolled 60 patients diagnosed with AV and 10 apparently healthy women (control group III). Group I (n = 30) received azoximer bromide (10 vaginal insertion according to the scheme, course of 10 days) and a combined antimicrobial drug, while Group II (n = 30) received only antimicrobial drug (course of 10 days). Microscopy of vaginal discharge smears, polymerase chain reaction method was used, detection of cytokines – interleukins (IL) and tumor necrosis factor-alpha (TNF-α) in vaginal washings was performed by ELISA. The study of neutrophil extracellular traps (NETs) was performed by ELISA, and DNA-containing strands ejected by neutrophils were determined by fluorescence method.

Results. Recovery from disease was found in 100 % (30/30) and 86.7 % (26/30) in group I and group II, respectively. After treatment, serum level of IL-8 was revealed to decline in group I from 35.2 to 5.5 pg/ml (p = 0.05), in group II – from 33.4 to 5.3 pg/ml (p = 0.04), also not differ (p > 0.05) from the control values (5.2 pg/ml). The level of IL-1β also decreased after treatment in group I from 51.5 to 15.1 pg/ml (p = 0.002), in group II – from 57.9 to 20.1 pg/ml (p = 0.03), which also did not differ (p > 0.05) from the control values (16.7 pg/ml). The IL-10 level in both main groups decreased slightly (from 0.26 and 0.24 to 0.16 pg/ml in both groups), which was higher by 1.8-fold than in the control group (0.09 pg/ml; p < 0.001). The number of ejected NETs in both main groups decreased significantly after treatment, reaching control level. No side effects were observed, compliance and acceptability were 100 % in both groups. The frequency of AV relapses within 3 months was observed in 3.3 % (1/30) and 14.3 % (4/28) patients, after 6 months – in 14.3 % (4/28) and in 20.0 % (5/25) patients in groups I and II, respectively. Using the logit regression model, demonstrated that AV relapse might occur with a 50 %-probability at TNF-α level < 0.1 pg/ml after treatment (sensitivity – 67 %, specificity – 79 %). The risk of relapses in group I, in contrast to group II, showed a downward trend.

Conclusions. The use of azoximer bromide and a combined broad-spectrum antimicrobial drug is effective in AV treatment, exerts a modulating effect on immune response parameters contributes to lowering relapse rate.

Aim: to find out the predictive value of blood serum biochemical parameters PAPP-A (pregnancy-associated plasma protein A) and β-hCG (beta subunit of human chorionic gonadotropin) in the assessment of unfavorable pregnancy outcomes in women infected by human immunodeficiency virus (HIV) as well as viral hepatitis B (HBV) and C (HCV).

Materials and Methods. A retrospective study of the medical records from 52 women was carried out, including 19 HIV-infected women, 9 women with monoinfection HBV or HCV, 11 pregnant women who were co-infected (HIV/HBV or HIV/HCV) and 13 uninfected women. PAPP-A and β-hCG levels, expressed as MoM (multiple of median), were evaluated in all women.

Results. Our study revealed that only PAPP-A was prognostically significant for developing chronic placental insufficiency in women with HIV infection and co-infection of HIV together hepatitis B and C. None of the parameters examined were significant in women with HBV or HCV monoinfection. PAPP-A and β-hCG in pregnant women without infections were effective in predicting development of chronic placental insufficiency.

Conclusion. PAPP-A can be used as a diagnostic parameter of developing chronic placental insufficiency in pregnant women with monoinfection HIV and co-infection with HIV/HBV or HIV/HCV.

Aim: to study the role of antiphospholipid antibodies (AРA) and genetic thrombophilia as a potential cause of the development or a component in the pathogenesis of early and late fetal growth retardation (FGR).

Materials and Methods. There was conducted a prospective randomized controlled trial with 118 women enrolled. The main group consisted of 83 patients, whose pregnancy was complicated by FGR degrees II and III, stratified into two groups: group 1 – 36 pregnant women with early FGR, group 2 – 47 pregnant women with late FGR. Women were subdivided into subgroups according to the FGR severity. The control group consisted of 35 pregnant women with a physiological course of pregnancy. АРА were determined according to the Sydney antiphospholipid syndrome criteria by enzyme immunoassay (ELISA): against cardiolipin, β2 -glycoprotein 1, annexin V, prothrombin, etc. (IgG/IgM isotypes); lupus anticoagulant – by the three-stage method with Russell's viper venom; antithrombin III and protein C levels – by chromogenic method; prothrombin gene polymorphisms G20210A and factor V Leiden – by polymerase chain reaction; homocysteine level – by ELISA.

Results. AРA circulation (medium and high titers), genetic thrombophilic defects and/or hyperhomocysteinemia were detected in 40 (48.2 %) patients with FGR, which was significantly higher than that in the control group (p < 0.05): in group 1 (41.7 % of women) AРA (30.6 %) and AРA with genetic thrombophilia or hyperhomocysteinemia (11.1 %) were revealed; in group 2 (51.1 % of women) AРA (21.3 %), AРA with hyperhomocysteinemia (4.3 %), genetic thrombophilia (25.5 %), and due to hyperhomocysteinemia (2.1 %) were found. No differences in prevalence of thrombophilia rate in patients were observed related to FGR severity, but a correlation between the FGR severity and AРA titers was found.

Conclusion. Testing for the presence of AРA, genetic thrombophilia and hyperhomocysteinemia should be recommended for patients with FGR (including those with FGR in medical history), especially in the case of its early onset. It is recommended to determine the full AРA spectrum.

Introduction. Currently, few epidemiological data on a relation between impaired purine and carbohydrate metabolism and testosterone deficiency in overweight men due to adipose tissue and metabolic syndrome (MS) are available.

Aim: to study relationships between disturbances in carbohydrate and purine metabolism and testosterone level in men with adipose tissue excess and MS.

Materials and Methods. There were enrolled 64 overweight men to the study. The patients were divided into 3 groups based on the body mass index (BMI): group 1 – with overweight (n = 24), group 2 – with the first degree of obesity (n = 21), group 3 – with the second and third degree of obesity (n = 19). A correlation analysis was carried out between the data on carbohydrate and purine metabolism related to testosterone level and body composition, as well as additionally assessing the level of inter-group difference.

Results. A relationship between the parameters of carbohydrate and purine metabolism and the level of total testosterone has been established along with overdeveloped adipose tissue. A weak negative correlation was found across the sample between testosterone and glucose, insulin, and the НОМА-IR (Homeostasis Model Assessment of Insulin Resistance) index. i.e., the higher the glucose level, the higher НОМА-IR index, and the lower the testosterone level. In addition, it was found that along with increasing BMI it was paralleled with higher insulin level. The number of patients with fasting blood glucose levels above 5.6 mmol/L and insulin resistance also increased. In the group with I degree of obesity, a negative correlation was found between the levels of total testosterone and uric acid.

Conclusion. Thus, the thesis is confirmed that the more significant the violation of carbohydrate and purine metabolism, the more profound could be androgenic deficiency. Thus, it is obvious that normalization of body composition and removal of excessive adipose tissue would provide a more effective solution in choosing a strategy to treat androgen deficiency and disorders of carbohydrate and purine metabolism in overweight men.

Introduction. The prevalence of andrological diseases among adolescents and young adults resulting in lowered reproductive potential has been noted to progressively increase. At the same time, the number of couples starting to manage reproductive issues after 35–40 years of age highlighting the onset of male androgen deficiency continues to rise. Therefore, the analysis of spermogram as the key element in assessing male reproductive potential is better to conduct at different age periods of man's life.

Aim: to compare spermogram parameters in different age groups of patients with reproductive pathology.

Materials and Мethods. The analysis of spermograms in adolescents with left-sided grade II–III varicocele aged 17 years and in infertile males aged 22–48 years was performed. Semen analysis was conducted in accordance with the standards of the 5 th edition of the World Health Organization and included the following parameters: semen volume (ml), sperm concentration (million/ml), total sperm count (million), acidity, viscosity, progressive motility, total motility, viability, morphology, detected mucus, leukocytes, amyloid bodies, lecithin grains as well as sperm aggregation and agglutination. The stained preparations were used to assess the morphology of spermatozoa and spermatogenesis cells. According to the spermogram data obtained, the following conclusions were drawn: normozoospermia, oligozoospermia, asthenozoospermia, teratozoospermia. Statistical analysis was performed by using Statistica 10.0 software (StatSoft Inc., USA). The normality distribution was assessed using the χ² test. Quantitative parameters were presented as arithmetic means and standard deviations (M ± SD). Assessing significance of differences was performed by using the Student's t-test, whereas inter-parameter correlation relations were analyzed by using the linear Pearson's correlation coefficient. A significance level between inter-group parameters was set at p < 0.05.

Results. It was found that adolescents with varicocele vs. adult men had significantly decreased ejaculate volume. In particular, the average ejaculate volume in adolescents and adult men was 2.32 ± 1.22 ml and 3.50 ± 1.44 ml, respectively, so that the larger number of young patients were noted to have ejaculate volume below 1.5 ml. Compared to young subjects, aged patients had decreased sperm concentration (35.88 ± 25.74 versus 72.20 ± 49.32 million/ml) and total sperm count (120.58 ± 91.72 versus 173.07 ± 163.92 million). Young patients were found to have significantly superior data in all categories of sperm motility, whereas infertile men were diagnosed with impaired sperm motility. In particular, adolescents were featured with the average number of spermatozoa displaying fast and slow translational movement comprising 17.12 ± 11.04 % and 29.30 ± 12.29 %, respectively, the proportion of progressive motility spermatozoa was 46.20 ± 19.82 %. In contrast, similar parameters in adult men were 5.10 ± 6.36 %, 19.80 ± 9.61 %, and 24.95 ± 11.23 %, respectively. In infertile men prevalence of lacked spermatozoa with rapid forward movement was 46 (46.0 %), in adolescents – 8 (8.6%), whereas rate of immotile spermatozoa in infertile men, on average, accounted for 53.10 ± 14.56 %, in adolescents – 34.40 ± 21.83 %. In addition, adolescents with varicocele had significantly fewer spermatozoa with normal morphology – 14.14 ± 8.06 % (in adult men – 30.08 ± 17.94 %), there were more abundant defects in the sperm head – 58.01 ± 12.43 % (in men – 48.83 ± 18.95 %) and flagella – 17.24 ± 6.31 % (in men – 10.29 ± 6.21 %). The data obtained showed that adolescents were more often diagnosed with normozoospermia – in 49 (52.7 %) cases, in infertile men – in 12 (12.0 %) cases, whereas in aged men asthenozoospermia was detected in 82 (82.0 %) cases, in adolescents – 5 (5.4 %) cases.

Conclusion. The abnormalities in the spermogram revealed in adolescents may be associated with unestablished spermatogenesis. Normozoospermia more common in adolescents with varicocele may evidence about preserved reproductive potential. Impaired sperm motility in aged patients seems to be related to the formation of oxidative stress and damage to spermatozoa by reactive oxygen species due to combined age-related changes, cumulation of the negative effects of environmental and lifestyle factors, as well as comorbidities.

A novel coronavirus (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) is largely associated with various coagulopathies, which can lead to either bleeding and thrombocytopenia or hypercoagulation and thrombosis. Thrombohemorrhagic complications also could accompany the development of cancer process. In addition, circulating inflammatory biomarkers such as fibrin, D-dimer, P-selectin and von Willebrand factor (vWF) typical to both coronavirus infection and malignancy process are of special interest. In this review, we discuss potential interplay between COVID-19 and cancer related to endothelial dysfunction, platelets, and systemic inflammatory response syndrome. Most importantly, patients should be treated in early stage of the disease process when elevated levels of fibrinogen, D-dimer, vWF, and P-selectin are observed. The level of these markers will rise rapidly upon disease progression, followed by a cytokine storm, would evidence about a poor prognosis.

Surgical and natural menopause is often associated with depression symptoms. Along with the postpartum period, perimenopause is a “window of vulnerability” for depression development, because decline in estrogen level accounts for extinction of reproductive function, emotional disorders, genitourinary menopausal syndrome, which are combined with non-endocrine risk factors, such as decreasing income levels, low social support, and stress. Although a direct relationship between blood estrogens level and depression has not been demonstrated, the relation between menopause symptoms and depression has been proven, i.e., the symptoms of menopause can be considered as risk factors. Here, we summarizes the current view on the correct counseling and routing of menopausal women with depression symptoms in primary health care facilities, the principles of managing patients with risk factors, including genitourinary menopausal syndrome, as well as methods of rehabilitation and informational support. This will aid to improve the quality of medical care for such patients.

It has long been recognized a crucial role played by platelets in thrombosis and hemostasis. Along with that, laboratory and clinical data suggest that platelets contribute to tumor progression and metastasis through a variety of interactions with cancer cells. During oncological process, the platelet function becomes modulated via their activation and increased aggregation being one of the risk factors for developing thrombosis in cancer patients. The platelets per se enhance tumor cell dissemination, activate endothelial cells, and attract immune cells to the primary and metastatic tumor sites. In this review, we summarize the current knowledge about the complex interactions between platelets and tumor cells, as well as cells of the microenvironment, and discuss the development of new antitumor agents aimed at various arms in platelet functioning.

Hormonal contraception is the most popular and effective reversible method for preventing unwanted pregnancy exerting multiple prophylactic and therapeutic effect along with contraceptive activity. The main adverse coupled to combined oral contraceptives (COCs) is its impact on the hemostasis and increased risk of venous thromboembolic complications. A great evolutionary path has been travelled after beginning application of hormonal contraception to reduce dose of its estrogen component and improving quality of gestagen component. Nevertheless, thrombotic complications related to COCs use still remain a pressing issue not only due to disease severity and high mortality rate from pulmonary embolism (PE), but also due to the difficulties in its timely diagnostics. Here we describe a clinical case of a 19-year-old patient suffering from vena cava inferior thrombosis complicated by PE after using COCs.

Currently, the number of judicial proceedings on real and alleged offenses and disputes in area of provision of medical care has been exponentially increased. Some of such proceedings become publicly disclosed, but many more of them remain unnoted in mass media and civilian society as a whole. Increasing number of medical doctors has been accused of criminal offenses, being more often sentenced to real terms of imprisonment, showing a clear tendency to increase gravity of responsibility applied to medical doctors. This publication represents a peer-reviewed response of paramount importance to the book by A.A. Ponkina and I.V. Ponkin «Defects in the provision of medical care» raising ontological, value and technical issues for negative outcome of medical care – by the fault or in the absence of the fault of the doctor. The book puts the scientific basis beneath changes so much awaited by the Russian public health in relation to medical doctors, their social importance, objective limitlessness of their opportunities and capabilities in curing sick people and saving their lives.

The date of the expected birth is important not just for future parents but rather for obstetricians and gynecologists. Midwives and doctors of all generations know and apply the Naegele rule, based on the dates of menstruation for determining duration of pregnancy. Despite the advent of ultrasound diagnostics that provides a more accurate method to calculate an expected date of birth, up until now the Naegele rule remains relevant.