Linking Cardiovascular Risk With Estradiol Level in Men.

Aim      To study the relationship between the cardiovascular risk and the level of estradiol in men of young and middle age. The main group included 71 patients with newly diagnosed hyperestrogenia (HE) (serum estradiol >41.2 pg/ ml). Using pseudorandomization, 68 men with normal estradiol level and age- and body weight index (BWI)-matched with the main group were included into the control group. Anthropometric data, bioimpedance variables, blood pressure (BP), and concentrations of estradiol, testosterone, glucose, and total cholesterol were analyzed in both groups.Results Patients of the main and control groups did not differ in age, BWI, and smoking status. Testosterone concentration was 10.18 nmol/l in the HE group and 12.18 nmol /l in the control group (p=0.006). Systolic BP was 142.0 mm Hg in the HE group and 135.2 mm Hg in the control group (p=0.011); diastolic BP was 90.3 mm Hg in the HE group and 86.2 mm Hg in the control group (p=0.008). Total cholesterol was 5.87 mmol/l in the HE group and 5.33 mmol/l in the control group (p=0.023). Blood glucose did not differ between the groups. The presence of HE in men 2.11 times (р=0.038) increased the probability of arterial hypertension. The intergroup difference by the SCORE scale did not reach statistical significance (р=0.172). BWI, waist and hip circumferences, and bioimpedance body composition parameters did not differ between the groups.Conclusion      In the studied cohort of young and middle-aged men, HE was an independent predictor for the presence of arterial hypertension. There were no significant intergroup differences in the total risk of cardiovascular diseases calculated with the SCORE scale.

[Androgenic status of men with severe COVID-19: the role of testosterone and dihydrotestosterone [within the program FOUNDER (features of a new coronavirus infection course and options therapy depending on the androgenic status)]].

PURPOSE: The aim of this study was to assess the mens androgen status influence on the severity and outcomes (transfer of patients to the ICU or death) of COVID-19 required hospital hospitalization. MATERIALS AND METHODS: The study included 151 hospitalized men with a confirmed diagnosis of COVID-19. To measure the severity of disease have been used Symptomatic Hospital and Outpatient Clinical Scale for COVID-19 (SHOCS-COVID). It includes the severity of the clinical condition (hyperthermia, shortness of breath, oxygen saturation, need for ventilation), the degree of inflammation (CRP), markers of thrombosis (D-dimer), the degree of lung damage according to CT. The patients underwent a study of full blood count, some biochemical parameters, lung CT, and a study of testosterone (T) and dihydrotestosterone (DHT) levels. RESULTS: T deficiency was observed in 46.4% of patients (70/151 men). At the same time, DHT deficiency was observed only in 14.4% of patients (18/125 men). In patients with a T level below the median, there was a significant increase in inflammatory factors (CRP, lymphocytes/CRP index), markers of thrombosis (D-dimer and fibrinogen), extensive lung damage at admission according to CT 25.75% vs. 11.95% (p<0.001), the elevated number of points for SHOCKS-COVID 7 (IQR 5-10) versus 5 (IQR 3-7) (p<0.001) and the longer duration of hospital treatment (3 days difference, p<0.001) in comparison with a group of patients with a T level above the median. At the same time, the T level had no correlation with age. The level of DHT had a weak inverse correlation with the age of patients, but not with the main markers of the severity of COVID-19, including the number of SHOCK-COVID scores. During multivariate regression analysis, it was shown that SHOCKS-COVID is the most significant predictor of admission to the ICU while no association of T and DHT levels with outcomes in COVID-19 was found. However, it was found that the concentration of T, even adjusted for age, has a significant inverse association with the severity of the course of the disease and the number of SHOCK-COVID scores (p=0.041). An analysis of the evaluation of directed acyclic graphs suggests the main role of COVID-19 severity in reducing androgenic function and T concentration, at which its anti-inflammatory effects are lost. There were no correlations between the concentration of DHT and the number of SHOCK-COVID scores and the COVID-19 prognosis. CONCLUSION: SHOCK-COVID is the most sensitive predictor of the COVID-19 outcome in hospitalized men, including adjusting to age. T and DHT do not directly affect the outcomes of the disease. The greater severity of the infection and an increase in SHOCK-COVID scores are associated with a decrease in the concentration of T, and a weakening of its anti-inflammatory and anti-cytokine effects, which indirectly worsens the prognosis of male patients with a new coronavirus infection undergoing hospital treatment. There are no such relationships for DHT.

[Features of a new corOnavirUs infection course and optioNs therapy DEpending on the andRogenic status (FOUNDER): androgenic status in men with COVID-19 and its relationship with the disease severity].

OBJECTIVE: Analysis of androgen status in men hospitalized with a moderate COVID-19 and its relationship with the severity of the disease. MATERIALS AND METHODS: The study included 152 males with a confirmed diagnosis of COVID-19 based on the results of a positive PCR for the SARS-CoV-2 virus and/or computed tomography of the lungs hospitalized at the MSU University Clinic due to the moderate and severe COVID-19. Examination of the level of biochemical blood parameters (CRP, creatinine, urea, glucose, total testosterone (T)); CT of the lungs. To objectify the severity of the clinical symptoms, the NEWS2 distress syndrome severity scales and the original scale for assessing the clinical condition of patients with COVID 19 (SHOCS-COVID) were used. RESULTS: The median T level in 152 examined patients was 2.14 [1.21; 3.40] ng/ml. In patients with a T level below the median, the CRP level was more than two times higher, and the D-dimer value was almost two times higher than in patients with T level above median. The duration of treatment in the hospital was longer in men with COVID 19 and an initial T level below the median than in patients with T about the median (13 days vs 10.5 days, p=0.003). Low T level was correlated with lung damage by lung CT. After improving the clinical condition, there was a linear increase in the level of T independent of its initial level. CONCLUSION: Among men with moderate and severe COVID-19, a decreased testosterone level is detected in 46.7% of cases. Patients with low testosterone levels on admission have more severe COVID-19. A significant increase in testosterone level was observed after successful COVID-19 treatment without any special action regarding testosterone level.

[Testosterone replacement therapy and its relationship with hyperestrogenism and obesity. Problems of laboratory diagnostics of hyperestrogenism].

Testosterone replacement therapy (TRT) is one of the most effective and common treatments for testosterone deficiency today. It is often prescribed, focusing only on the level of testosterone and the presence of patient complaints about a decrease in sexual function. Quite rarely, doctors additionally assess the level of estradiol and, as a consequence, the initial presence of a symptom of hyperestrogenism. One of the likely consequences of the appointment of TRT may be an excess of estradiol, the excess formation of which is associated with the enzyme aromatase, which converts testosterone into estradiol. Despite the availability of laboratory determination of the level of estradiol, the result may not always coincide with the clinical picture, one of the reasons is the difference in the methods for determining the level of estradiol in each laboratory, there is no single standard or «reference¼ today. This article describes the evolution of TRT, and also focuses on the variability of estradiol levels from laboratory to laboratory, and explains in detail why the assessment of estradiol over time should be carried out in only one laboratory. A systematic literature search was carried out in the databases Medline, Scopus, Web of Science and Elibrary, CyberLeninka.The purpose of our review was the need to engage the attention of specialists to the problem of hyperestrogenism, the not always justified prescription of TRT in patients with obesity, hypogonadism and hyperestrogenism, as well as to the problem of laboratory diagnosis of hyperestrogenism, which is acute not only in our country, but all over the world.

[A role of fructose in urinary stone formation].

Obesity is one of the actual problems of modern medicine. The comorbid conditions in patients with obesity and metabolic syndrome have no less important value, attracting the attention of scientists and clinicians. Renal stone disease is one these diseases. We are interested in its development, which is directly related to the effect of excess amounts of such a monosaccharide, as fructose. For quite a long time, this carbohydrate was considered to have only positive properties, including its role in carbohydrate metabolism in general, and, in particular, in diabetes mellitus. Over the years, a pathological effect of excess fructose was detected. Since fructose was used to replace glucose, and accordingly, its amount in food, and especially in diabetic foods, was growing. In addition, the industrial production of corn-based fructose has become much less expensive than the production of sucrose, which has also contributed to the increased use of this monosaccharide in the food industry. In this article, the mechanisms leading to the development of pathologies which are associated with the excessive use of fructose, increase in the level of uric acid with subsequent formation of uric acid stones, are reviewed. Thus, the study of the effect of fructose on the pathogenesis of renal stone disease is interesting and extremely relevant, since for many specialists, it is animal protein that is associated with the development of kidney stone disease and the role of fructose is not only unobvious, but is also a revelation.

[Prevention and treatment of postoperative nausea and vomiting (results of a multicenter study)]. / Profilaktika i lechenie posleoperatsionnoi toshnoty i rvoty (analiz rezul'tatov mul'titsentrovogo issledovaniia).

Described in the paper are the results of a multicenter study that was conducted at 11 health-care facilities of the Russian Federation and that was based on an analysis of 623 medical records of adult patients operated on with general anesthesia of different variations. There were 154 (24.7%) males and 469 (75.3%) females, aged 16 to 90. The study denoted the need in and possibility of preventing and arresting the PONV; it also outlined those forms of ondansetron (Zofran) that can be used for the purpose, they are: parenteral and lingual pills and rectal suppositories. An assumption was put forward on the significance of PONV conductive factors and on the most effective forms of ondansetron from among the mentioned above. An understanding, resulting from the study, on that PONV is of the multietiology nature and on that its probability increases in proportion to a compatibility of provoking factors, like sex, surgery technique as well as duration of anesthesia and its variation is of importance. The efficiency of medicamental prevention of PONV by a blocker of HT3-receptors, i.e. by ondansetron (Zofran), is to a great extent predetermined by that if the form and, probably, dose of the drug is in line with a combination of the above factors, which needs further research.

[Pharmacoeconomic assessment of prevention of the postoperative nausea and vomiting syndrome in plastic (esthetic and reconstructive) surgery]. / Farmakoékonomicheskaia otsenka profilaktiki sindroma posleoperatsionnoi toshnoty i rvoty v plasticheskoi (ésteticheskoi i rekonstruktivnoi) khirurgii.

A comparative "cost-efficiency" pharmacoeconomic analysis was made for 5 different anti-emitting drugs, i.e. for "Navoban", "Zofran" (intravenous administration, 8 mg; and suppositories, 16 mg) and for "Metipred" (methylprednisolone) used in aesthetic and reconstructive surgeries of 86 patients. All the drugs were found to be effective for the prevention of PONV. Clinically, the efficiency decreased in the following order: "Novoban" and "Zofran" suppositories 16 mg, "Metiored" and "Zofran" intravenous administration 8 mg. As for "cost-efficiency", preference should be given to "Metipred".