Introduction. Autoimmune thyroiditis (AIT) is the most prevalent among the autoimmune pathologies and multifactorial thyroid diseases; accordingly, remaining a pressing issue for investigation.

Aim: to study AIT profile in different age groups of the female population in the western region of Georgia – Adzhariya.

Materials and Methods. A prospective comparative study in parallel groups was carried out. There were examined 405 samples of venous blood obtained at «Health» Clinic from women of two groups: group 1 – 159 patients with AIT, group 2 (control) – 246 women without AIT. Blood samples were collected between the years 2017 and 2020. There were analyzed serum antibodies against thyroperoxidase (TPOAb), thyroid stimulating hormone (TSH) as well as level of free thyroxine (FT4) by using enzyme immunoassay.

Results. Patients with AIT from different age groups vs. control group were found to have decreased level of FT4, but increased amount of TSH and TPOAb. At the reproductive age (18–45 years), a significant increase in the level of TSH was found (6.12 times) compared with the control group (p < 0.0001). The level of FT4 and TSH in AIT women aged 51 to 60 years was 0.7880 ± 0.3584 ng/ml and 4.754 ± 2.433 U/ml that significantly differed from those in the control group – 1.314 ± 0.4044 ng/ml (p < 0.0001) and 2.276 ± 1.409 U/ml (p < 0.0001), respectively.

Conclusion. AIT occurs in women of all age groups, but is more common in women aged 51 to 60 years. In a number of cases, TPOAb was detected in the control group, which, apparently, is associated with increased intake of dietary iodized salt since 2005 in Georgia (the adoption of the law on universal salt iodization). A significant increase in the level of TSH, in AIT women aged 18–45 years, strongly suggests to perform diagnostics of and screening for AIT not only in females of menopausal period, but also in reproductive age. 

Introduction. Currently, virtually no data on comparative studies of efficacy and safety of drug class aromatase inhibitors vs. standard therapies used in patients with overweight and/or obesity with an initial testosterone deficiency and excessive estradiol are available.

Aim: to study and evaluate the efficacy and safety of the use of the reversible aromatase inhibitor letrozole in adult men with overdeveloped adipose tissue and/or obesity with hyperestrogenism and testosterone deficiency.

Materials and Methods. A randomized, open, interventional, comparative, single-centre clinical trial was conducted by enrolling 49 obese men. The patients were divided into 2 groups: Group 1 (n = 26) – patients received standard metformin therapy (1000 mg 2 times a day), along with letrozole (at a dose of 2.5 mg 2 times a week); Group 2 (n = 23) – patients received only standard metformin therapy. Patients were monitored for 8 weeks from the date of inclusion. Anthropometric parameters were monitored: body weight, body mass index, waist as well as hip circumference. Laboratory data were also evaluated: level of sex hormone binding globulin (SHBG), total testosterone, estradiol, glucose, uric acid, insulin. All subjects filled out questionnaires twice (before the start of the study and after its completion) – the aging symptoms questionnaire for men (Aging Males Symptoms, AMS) and IIEF (International Index of Erectile Function).

Results. Total testosterone level significantly and reliably increased only in Group 1 from 10.6 to 22.2 nmol/L. In Group 2 testosterone level increased insignificantly from 9.28 to 11.02 nmol/L, and did not reach the physiological normal range. Estradiol changes also differed markedly and significantly: in Group 1, estradiol decreased from 51.4 to 24.3 pg/ml, i.e., by 2.1-fold reaching physiological range, whereas in Group 2 estradiol level decreased insignificantly from 45.1 to 44.4 pg/ml, and remained above the range of normal values. Significant changes in SHBG were observed only in Group 2. Insulin level in Group 1 significantly decreased from 10.6 to 6.6 μIU/ml, i.e., by 1.6-fold. In Group 2, insulin also decreased, but less pronounced, from 15.8 to 13.7, i.e., by 1.2-fold, which turned out to be statistically insignificant and according to the НОМА-IR index (Homeostasis Model Assessment of Insulin Resistance), it remained within the insulin resistance range. Glucose level did not change significantly in both groups. Uric acid, on the contrary, significantly changed in both groups: in Group 1, from 0.41 to 0.35 mmol/L, and in Group 2, from 0.40 to 0.36 mmol/L.

Conclusion. The use of letrozole significantly increases total testosterone level in patients with initial testosterone deficiency and hyperestrogenism. At the same time, patients with androgen deficiency and hyperestrogenism, in most cases, have excess body weight due to adipose tissue, metabolic syndrome in a combination of its various components, which underlie a need to use standard methods of therapy primarily modified lifestyle and metformin, which provide the maximum positive effect in the treatment of such patients. 

The article is devoted to investigate and interpret the contents and correlation for the concepts of "medical care" and "medical service" in the context of public healthcare. Here, we demonstrate the defective features of the Russian legislation regarding accepting the necessary legal definitions for such concepts. At the same time, while performing a comprehensive formal legal analysis and applying interpretation by analogy, we provide generalizations allowing to understand the essence of the concepts analyzed as well as their inter-relationship. We interpret two definitions for the concept of "medical service", and envision that medical care vs. medical service is an ontological unit of a more general and higher level. Understanding the differences in the definitions of "medical care" and "medical service", demonstrated in the article, will be useful to healthcare organizers. 

The success in modern biology has significantly enriched scientific understanding of the pathogenetic basis underlying some diseases, including obstetric and gynecological practice. Despite this, the etiology and pathogenesis of some conditions are not yet fully elucidated. One of the approaches is to study metalloproteinases during pregnancy, particularly concerning occurrence of formidable complication such as preeclampsia, which diagnostics and significance have been continuously revised. Preeclampsia is a disease that leads altered course of pregnancy, and sometimes even to maternal and/or fetal death. Currently, no specific treatment for preeclampsia has been proposed, but early prognosis is crucial for a more favorable maternal and fetal outcome. Given that metalloproteinase activity is able to influence trophoblast invasion and remodeling of spiral arteries, insights into such processes are of high importance. 

Aim: to analyze and summarize the available data of studies aimed at obtaining deeper insight in the field of alcohol-related effects on the course of pregnancy and potential consequences thereof; to study the prevalence of alcohol consumption by women in Russia, as well as potential preventive measures.

Materials and Methods. The results of the Russian and foreign studies on the alcohol-related effect on the fetus and pregnancy outcome, published in the international databases Scopus, Web of Science, PubMed/MEDLINE, Cochrane Library, have been analyzed. The search for scientific publications was limited to the period from the years 2012 to 2021. We used search queries in Russian and English ("alcohol", "pregnancy", "prevention", "fetus", "fetal alcohol syndrome").

Results. The presented data analysis indicates an extremely negative effect of alcohol on the body of pregnant women, as well as on the health of our future generation. This article proves the importance of the problem, the need for further research on the mechanisms of fetal alcohol syndrome (FAS) and the development of effective prevention measures, potential treatment methods, and assistance for FAS. At present, in Russia there is an acute lack of information on the real extent of the problem with maternal alcohol consumption during pregnancy. Still, no precise data on FAS prevalence in Russia are available.

Conclusion. Preventing FAS is an urgent and unexplored issue in Russia. Medical doctors able to conduct pregravid preparation of a married couple while they plan to conceive a healthy child are highly demanded. It is necessary to raise awareness and improve the quality of training for obstetricians and gynecologists in order to identify women with high risk factors for alcohol abuse and childbirth with FAS at early stages of pregnancy management. It is also necessary to identify new or use already identified maternal blood biomarkers to verify excessive alcohol consumption during pregnancy. 

Cognitive dysfunction in postmenopausal women reduces their quality of life, social and family adaptation and can lead to complications such as dementia including Alzheimer's disease. Results of the studies on the potential of hormone replacement therapy in prevention of this group of disorders are controversial and require further investigation. However, following healthy lifestyle, certain diets as well as regular physical and mental activity can minimize the risks of dementia and ensure normal mental performance in old age. 

It has been increasingly recognized that structural abnormalities and functional changes in the placenta can adversely affect developing fetal heart. In this article, we examine a role of the placenta as well as potential impact of placental insufficiency on a fetus with congenital heart disease (CHD). The fetal heart and placenta are directly connected because they develop simultaneously with common regulatory and signaling pathways. Moreover, placenta-associated complications are more common in pregnant women carrying fetus with CHD, and the fetal response to placental insufficiency may lead to postnatal preservation of remodeled heart. The mechanisms underlying this placenta–fetus axis potentially consists of genetic factors, oxidative stress, chronic hypoxia, and/or angiogenic imbalance. Thus, the mother–placenta–fetus circulation is critical in understanding the CHD formation. It is necessary to study the changing factors involved in these processes for early identification, imaging, quantification of placental insufficiency, and development of new prenatal therapies in the CHD patient population. 

The problem of premature ovarian failure (POF) is currently in the spotlight of obstetricians and gynecologists worldwide. Early diagnosis of this pathology is necessary to prevent the development of serious pathological conditions. The systematization of modern ideas about laboratory and instrumental methods for POF diagnosing, assessing diagnostic value of parameters such as follicle stimulating hormone, anti-Mullerian hormone as well as the count of antral ovarian follicles, intraovarian blood flow and ovarian volume using ultrasound techniques, which can then be used as prognostic criteria for POF comprise a very important modality. Based on the findings obtained, early detection may lead to proposing new prognostic strategies. 

Thrombosis of the umbilical cord vessels is a rare complication of pregnancy, combined with a high level of perinatal morbidity and mortality. Anomalies of vascular attachment (velamentous attachment), pathology of the umbilical cord (hyperspiralization, short or long umbilical cord), intrauterine infections, maternal diabetes mellitus and preeclampsia as well as meconium found in the amniotic fluid are among the risk factors of developing thrombosis in the umbilical cord vessels. Here we present two clinical observations of umbilical vein thrombosis at full-term pregnancy. In both cases, during pregnancy and childbirth, no signs of umbilical cord pathology were found according to cardiotocography and Doppler ultrasound; despite this, the children were born in hypoxic state. Both newborns were transferred to the second stage of treatment due to suspected intrauterine pneumonia. Velamentous attachment, intrauterine infections as well as meconium found in the amniotic fluid were the risk factors of developing umbilical vein thrombosis described in case 1 and case 2, respectively. During pregnancy, both female patients suffered from clinically confirmed novel coronavirus infection (COVID-19) and contacted patients with COVID-19 in the third trimester of gestation. It is likely that endothelial damage caused by the novel coronavirus SARS-CoV-2 was one of the risk factors for the development of umbilical vein thrombosis, but this issue requires to be further explored. 

Assisted reproductive technologies (ART) have been progressively recognized as a widely applied means to fight against infertility. Women after ART were shown to have higher risk of developing venous thromboembolism (VTE) that might be related to using some drugs, particularly gonadotropins. VTE risk emerges at relatively early time points after ovulation induction being sustained virtually until pregnancy is complete. According to the multi-center RIETE Registry (Spanish, Registro Informatizado de la Enfermedad TromboEmbolica), a risk of developing isolated pulmonary embolism (PE) is elevated in women after ART compared to those receiving hormonal contraceptives as well as women having spontaneous pregnancy. Low-molecular-weight heparins (LMWH) are justified to be used as a preventive means. However, commonly recommended preventive LMWH dose in such patient cohort may not always be sufficient. On the other hand, escalating dose for some LMWH results in increased rate of developing hemorrhages. Hence, it is important to take into consideration what exact type of LMWH as well as its dose and duration of therapy should be prescribed to women after ART that requires to be further investigated. 

Here, the historical aspects of the life and scientific work of the physiologist Alexander Schmidt are considered. His contribution to the study of blood coagulation is described.