Yuliya E. Dobrokhotova

Pirogov Russian National Research Medical University

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ІГ

І. Г. Кононова

Pirogov Russian National Research Medical University

Elena N. Kareva

Sechenov University

N.A. Shmakova

Urals Research Institute for the Protection of Maternity and Infancy

G. N. Chistyakova

Ministry of Health of the Russian Federation

L.V. Saprykina

Pirogov Russian National Research Medical University

АО

А.С. Оленев

City Clinical Hospital No 31

Lela S Djokhadze

Pirogov Russian National Research Medical University

Elena Yu Lysyuk

Ministry of Health of the Russian Federation

ЕИ

Е. И. Боровкова

Pirogov Russian National Research Medical University

ОВ

О. В. Макаров

Russian Medical Academy of Continuous Professional Education

Cooperative Institutions

Pirogov Russian National Research Medical University

Ministry of Health of the Russian Federation

Urals Research Institute for the Protection of Maternity and Infancy

Peoples' Friendship University of Russia

City Clinical Hospital

Sechenov University

National Research Center for Maternal and Child Health

City Clinical Hospital No 31

City Clinical Hospital No. 2

Scientific Research Institute of Healthcare Organization and Medical Management

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Role of Kagocel® in the treatment of recurrent herpes virus infections

Clinical review for general practice (2024)

Yuliya E. Dobrokhotova І. Г. Кононова T.A. Ogurtsova

The article provides a brief overview of the conceptual approach to the treatment of genital herpesvirus infections, a review of studies on the use of the interferon inducers Kagocel® in complex therapy of genital herpes, demonstrates clinical observations of a patient with recurrent genital herpesvirus infection, a patient with an exacerbation of genital herpesvirus infection that is difficult to respond to standard therapy, a patient with genital herpes, poorly controlled by acyclic nucleosides.

Herpes virus

10.47407/kr2024.5.9.00487

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Pre-eclampsia. Selection of obstetric tactics

Journal of obstetrics and women s diseases (2016)

Yuliya E. Dobrokhotova О. В. Макаров Elena Yu Lysyuk А.С. Оленев Pavel A Kouznetsov

Relevance. At the present time, despite the large number of studies, the root causes of pre-eclampsia remain unknown. In recent years, attention is paid to the study of the role of vascular growth factors in the pathogenesis of various obstetric pathologies, including pre-eclampsia. The aim of our study was to examine the features of the angiogenic imbalance in determining the severity of pre-eclampsia, and further tactics of conducting pregnant women. Matherials and Methods. 135 pregnant women were examined: I group - 50 pregnant women with preeclampsia moderate; II group - 36 pregnant women with preeclampsia-severe; Group III - 49 pregnant women with physiological pregnancy. All patients special methods of investigation have been carried out - the definition of levels of pro-angiogenic (PlGF) and anti-angiogenic (sFlt-1, sEng) factors in the serum in 28-34 weeks gestation. In our study we found significant differences in the content of vascular growth factors in patients in the three comparison groups. Results. With an increase in the severity of pre-eclampsia decrease pro-angiogenic placental vascular factors to a greater extent than other vascular factors points to the aggravation of the pathological process and can be used as an additional criterion of pre-eclampsia severity. The level of vascular growth factors and their relationship with a certain probability, reflects the extent of endothelial dysfunction that predicts the best time of prolongation of pregnancy in patients with pre-eclampsia. Conclusion. Use of vascular growth factor in the diagnosis and determining the severity pre-eclampsia, along with traditional clinical and laboratory research will optimize the obstetric tactics in these patients.

Pathogenesis

10.17816/jowd65216-23

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Vulvovaginitis and their correction in patients with cervical HPV-associated diseases in the light of the doctrine of pathomorphosis

GYNECOLOGY (2021)

І. Г. Кононова Yuliya E. Dobrokhotova Elena N. Kareva Olga E. Semioshina N.A. Shmakova

Background. Biological pathomorphosis of the leading pathogens of the vaginal microecological system with the occurrence of vulvovaginitis in human papillomavirus (HPV)-associated cervical intraepithelial neoplasia (CIN) is a fundamental prerequisite for optimizing the complex treatment of this disease. Aim. Optimization of treatment of vulvovaginitis based on the study of the pathomorphism of their pathogens in patients with HPV-associated CIN. Materials and methods. A two-stage examination of 211 patients with HPV-associated CIN I was carried out from 2013 to 2020. To study the pathomorphosis of the disease, the patients were divided into 2 groups, the 1st group was examined in 20132016, the 2nd in 20172020. The study of microbiocenosis was carried out by RT-PCR using Femoflor-16 reagents. At the second stage, a study of the clinical efficacy of treatment of vulvovaginitis with the complex drug nifuratel 500 mg + nystatin 200 thousand IU (Macmiror Complex) in comparison with metronidazole 500 mg. Results and discussion. It was revealed that patients with HPV-associated CIN I over the last 8 years have a pathomorphosis of pathogens. In particular, the change in the dominance of anaerobic dysbiosis with the highest bacterial replication of Gardnerella vaginalis in association with Clostridium, Megasphaera spp. and Fusobacterium on the mixed nature of microflora, manifested in the form of vulvaginitis with the dominance of Atopobium vaginae in association with G. vaginalis, Ureaplasma (urealyticum + parvum) and the addition of the intestinal group Enterobacteriaceae spp. and Escherichia coli. The use of the complex drug nifuratel 500 mg + nystatin 200 thousand IU (Macmiror Complex) demonstrated a higher (4 times) clinical efficacy, a 12-fold decrease in the recurrence of the inflammatory process compared with metronidazole in the treatment of vulvovaginitis in patients with CIN I. Conclusions. 1. The structure of the cervico-vaginal microbiota in HPV-associated CIN I degree is characterized by dysbiotic disorders in 68.3% of cases. During the last 8 years, there was a pathomorphosis of the microecological status from the dominant anaerobic (in 74.2% of cases, =9.39 at p=0.001) to the dominant mixed (in 60.8% of cases, =8.54 at p=0.001 ) with the addition of the intestinal group Enterobacteriaceae spp. and E. coli in 60.8% of patients (=9.59 at p=0.001), which indicated a change in the dominant causative agents of vulvovaginitis in CIN I. 2. Comparative analysis of the clinical efficacy of complex drugs has demonstrated an increase in clinical efficacy when using the drug nifuratel 500 mg + nystatin 200 thousand IU by 4 times, a decrease in the recurrence of the inflammatory process by 12 times, compared with standard therapy with metronidazole, which allows us to recommend inclusion of the drug nifuratel 500 mg + nystatin 200 thousand IU in the therapy of vulvovaginitis in patients with CIN I.

Gardnerella vaginalis

Ureaplasma

Ureaplasma urealyticum

10.26442/20795696.2021.2.200844

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The value of azoximer bromide for optimization of therapy for HPV-associated cervical precancerous diseases

GYNECOLOGY (2020)

І. Г. Кононова Yuliya E. Dobrokhotova N.A. Shmakova Elena N. Kareva G. N. Chistyakova

A significant increase in human papillomavirus-associated cervical oncological diseases, a high rate of recurrence of the process (4862.4%) after surgical treatment, changes in the local immune microenvironment in cervical biopsy specimens with (HSIL) created the prerequisites for studying the clinical efficacy of local immunocorrection in complex HSIL therapy. Aim. To study the clinical efficacy of local immunocorrection of azoximer with bromide in the complex therapy of cervical intraepithelial neoplasias. Materials and methods. Examination and treatment of 40 patients with HSIL was carried out. The study of the effectiveness of azoximer bromide in complex therapy in patients with cervical intraepithelial neoplasias of a high degree of oncogenic risk was carried out on the basis of an immunohistochemical study of cervicobioptates to markers CD3, CD56, CD20, CD138, M-CSF. Results and discussion. It was revealed that cervical intraepithelial neoplasias of a high degree of oncogenic risk are accompanied by changes in the local immune microenvironment in the epithelium and stroma of neoplastic altered tissues, which may contribute to the development of neoplasia progression. The inclusion of a local immunomodulator azoximer bromide in the complex therapy helped to reduce the recurrence of the process by 2 times, the elimination of the human papillomavirus by 3.5 times relative to the comparison group. Conclusion. 1. In cervico-biopsy specimens of patients with HSIL, there is an increase in the proportion of cells with expression of receptors CD20, CD3, CD138 (in stromal cells) and a decrease in epithelial infiltration with M-CSF, which indicates significant changes in immune homeostasis in cells of the affected epithelium. Based on the results obtained, at the stage of preparation for surgical treatment of patients with HSIL, it is advisable to include local immunocorrection to improve the outcome of therapy. 2. The inclusion of a local immunomodulator azoximer bromide in the complex therapy helped to reduce the recurrence of the process by 2 times, the elimination of the human papillomavirus by 3.5 times, which dictates the need for complex immunomodulation in the treatment of HSIL at the stage of preparation for surgery.

10.26442/20795696.2020.6.200463

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Human papillomavirus vaccination: evidence base for efficacy and safety

GYNECOLOGY (2021)

Yuliya E. Dobrokhotova Е. И. Боровкова

The article provides a literature review on the prevention of cervical cancer by human papillomavirus (HPV) vaccination. Currently, 3 vaccines are available: the 4-valent vaccine against HPV types 6, 11, 16 and 18, the 9-valent vaccine against HPV types 6, 11, 16, 18, 31, 33, 45, 52, 58 and the bivalent vaccine against HPV types 16 and 18. Vaccination provides protection for women and men against infection with HPV and further development of HPV-associated diseases. Following immunization, seroconversion develops in 93-100% of women and in 99-100% of men and is effective in preventing incident and persistent HPV infection as well as cervical intraepithelial neoplasia. HPV immunization is ineffective in treating an existing HPV infection, genital warts, or anogenital intraepithelial neoplasia. HPV vaccination status does not affect recommendations for cervical cancer screening.

Seroconversion

Genital warts

HPV vaccines

10.26442/20795696.2021.2.200742

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Post-abortion contraception: how to make the right choice?

GYNECOLOGY (2021)

Yuliya E. Dobrokhotova M.R. Narimanova S. A. Khlynova L.V. Saprykina I Ilina

More than 600 thousands abortions are performed annually in Russia. Women presenting for abortion care are often motivated by the pregnancy to use effective contraception; they are also at high risk for repeat unintended pregnancy. Contraceptive counseling and the supply of contraceptive methods are part of post-abortion care and positively influence the subsequent use of contraceptive methods. Oral contraceptives (OCs) following induced abortion offer a reliable method to avoid repeated abortion. Immediate administration of combined OCs after abortion may reduce vaginal bleeding time and amount, shorten the menstruation recovery period, and reduce the risk of complications and unintended pregnancies. Сombination of ethinylestradiol 30 g + drospirenone 3 mg demonstrates the advantages of a low estrogen dose with the antimineralocorticoid activity of drospirenone that is responsible for the drugs significant antiandrogenic and antimineralocorticoid effects, reflected clinically in lower rates of adverse events including less fluid retention. Сombination of ethinylestradiol 30 g + drospirenone 3 mg and Metafolin has similar contraceptive efficacy, side effect, safety and benefits profile to other drospirenone-containing contraceptives. The article presents the results of the latest studies about using of combined OCs (ethinylestradiol 30 g + drosperinone 3 mg and Metafolin) after abortion.

Drospirenone

Ethinylestradiol

Unintended Pregnancy

Levonorgestrel

10.26442/20795696.2021.2.200833

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