The article is republished in order to expand the audience. The article was published earlier in the Akusherstvo i Ginekologiya (Russian Federation): Sukhikh GT, Serov VN, Artymuk NV, Andreeva MD, Bazina MI, Baranov II, Bashmakova NV, Bezhenar VF, Belotserkovtseva LD, Geppe NA, Dolgushina NV, Zaretskaya NV, Zakharova IN, Zubkov VV, Enkova EV, Yesayan RM, Katkova NYu, Kvashnina EV, Kogan IYu, Korsak VS, Krasnopolskaya KV, Kukarskaya II, Molchanova IV, Nazarenko TA, Pestova TI, Podzolkova NM, Saveljeva IV, Sazonova AI, Semenov YuA, Tapilskaya NI, Tetruashvili NK, Tiselko AV, Fadeev VV, Shamugia NL, Shakhova MA, Shikh EV, Yarmolinskaya MI. The safety of hormone therapy during pregnancy. Joint statement by experts in reproductive medicine, obstetrics and gynecology, endocrinology, clinical pharmacology, neonatology and pediatrics Akusherstvo i Ginekologiya (Russian Federation). 2024;(8):196–206. (In Russ.) https://doi.org/10.18565/aig.2024.201.

The article presents the experience of the «National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov» in creation of medical guidelines based on the patient’s route business process for vertically integrated medical information system for “Obstetrics and gynecology” and “Neonatology” (VIMIS “AKiNEO”), with simultaneous digitization of the document, describes the advantages of this an approach before the classical form of writing document.Aim. To conduct a comparative analysis of approaches to writing a medical guideline based on a digitized medical guideline and patient’s route business process for VIMIS “AKiNEO” and in the classical way.Materials and methods. The content of digitized medical guidelines and procedures for the provision of medical care, formed by experts on the basis of the “National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov” with the methodological support of the Center for Healthcare Quality Assessment and Control were used. The assessment of the methodological advantages of writing medical guidelines based on patient routes business processes in comparison with writing in the classical way was carried out using methods of analysis and synthesis.Results. Experts have created 17 patient routes using the content of digitized medical guidelines for immersion in the VIMIS “AKiNEO”. These routes fully reflect the amount and timing of medical interventions necessary to ensure the quality of medical care. Methodological approaches for writing medical guidelines based patient routes business processes have been developed. It has been demonstrated that digitizing the content of medical guidelines and medical care procedures, describing medical guidelines in the form of a business process diagram, identify “zones of uncertainty” that ar e not visible in the text document, and can significantly affec t the quality of medical care to the patient.Conclusion. The creation of regulatory legal acts on the organization and provision of medical care and medical guidelines in modern conditions of healthcare digital transformation should take place after digitizing the text of the document and creating a business process for the patient’s route, which will improve the quality of these documents.

Individual sexual and reproductive life management has been сonfirmed by medical and state communities since 1990s. Every citizen officially received rights for access to appropriate goods and services. Such international agreements as 1994 International Conference on Population and Development (ICPD, Cairo, Egypt) and 2004 WHO Reproductive health strategy, estimated reproductive health and family planning as priorities. Worldwide agreement on the 2005 summit declares achieving of female reproductive health before year 2015 as worldwide progress.WHO created complex of international eligibility criteria for male and female contraception with the aim of medical aid improvement. According to WHO plan, those criteria should be used by countries considering policy, needs, priorities and resources of national healthcare programs. For example, USA, United Kingdom, Russia etc. have successfully adopted medical eligibility criteria for contraception on the national level.The present review is summary product created by interdisciplinary expert group including representers of federal and regional healthcare establishments, medical universities, and international medical organizations.

To date the world community is actively working to optimize the approaches to determining chromosomal abnormalities in embryos. The study was aimed to assess the possibility of using noninvasive preimplantation genetic testing for aneuploidy (niPGT-A) through analysis of cell-free DNA in spent culture medium (SCM). We conducted niPGT-A of aneuploid embryos by analysis of cell-free DNA in SCM. All blastocysts were considered to be aneuploid based on the results of previous preimplantation genetic testing for aneuploidy (PGT-A) with trophectoderm (TE) biopsy. The study involved 11 embryos from seven couples. All the embryos were warmed and individually cultured in the 10 µL drops for 9 h. All SCM was collected and analyzed by niPGT-A. The results obtained were tested for concordance with previous PGT-A data. A total of 12 SCM samples were assessed: 11 samples, in which the embryos were cultured, and one control sample. Chaotic niPGT-A results not allowing the karyotype diagnosis were obtained in one case (9.1%) out of 11. Full concordance of the PGT-A and niPGT-A results was revealed in seven cases out of 10 (70%), while clinical concordance was found in nine cases out of 10 (90%). In one case (10%), the blastocyst was considered to have euploid karyotype based on the niPGT-A data. It has been concluded that niPGT-A can be a promising method of preimplantation embryonal chromosomal status diagnosis that requires no biopsy.

V nastoyashchee vremya v mire idet aktivnaya rabota po optimizacii primeneniya podhodov k opredeleniyu hromosomnoj patologii embrionov. Cel'yu issledovaniya bylo ocenit' vozmozhnost' ispol'zovaniya neinvazivnogo preimplantacionnogo geneticheskogo testirovaniya na aneuploidii (niPGT-A) putem analiza vnekletochnoj DNK v otrabotannoj kul'tural'noj srede (OKS). Provedeno niPGT-A aneuploidnyh embrionov putem analiza vnekletochnoj DNK v OKS. Vse blastocisty byli aneuploidnymi po rezul'tatam predshestvuyushchego preimplantacionnogo geneticheskogo testirovaniya na aneuploidii (PGT-A) s biopsiej trofektodermy (TFE). V issledovanie bylo vklyucheno 11 embrionov ot semi supruzheskih par. Vse embriony razmorazhivali i kul'tivirovali v kaplyah po 10 mkl v techenie 9 ch. Ves' ob"em OKS sobirali i analizirovali putem niPGT-A. Poluchennye rezul'taty sravnivali na sootvetstvie s predshestvuyushchimi dannymi po PGT-A. Summarno vypolnili analiz 12 obrazcov OKS: 11 obrazcov, v kotoryh byli kul'tivirovany embriony, i odin kontrol'nyj obrazec. V odnom sluchae (9,1%) iz 11 byli polucheny haotichnye rezul'taty po dannym niPGT-A, ne pozvolyayushchie provesti diagnostiku sostoyaniya kariotipa. Polnoe sootvetstvie rezul'tatov PGT-A i niPGT-A polucheno v semi sluchayah iz 10 (70%), klinicheskoe sootvetstvie rezul'tatov — v devyati sluchayah iz 10 (90%). V odnom sluchae (10%) po dannym niPGT-A kariotip blastocisty byl diagnostirovan kak euploidnyj. Vyvod: niPGT-A mozhet byt' perspektivnym, ne trebuyushchim biopsii, metodom diagnostiki hromosomnogo statusa preimplantacionnyh embrionov.

COVID-19, a severe acute respiratory syndrome caused by SARS-CoV-2, may predispose to thrombotic events, especially when combined with antiphospholipid antibodies (aPL). However, there are limited data on prevalence and antigenic specificity of aPL in COVID-19. Complement activation is assumed to play an important role in pathogenesis of COVID-19-associated coagulopathy. During the SARS-CoV-2 pandemic, it is necessary to identify important biomarkers for predicting severe course of COVID-19 and risk of thrombotic complications. Our objective was to evaluate the aPL profile, quantitative content and activity of complement and its components in COVID-19 patients graded by severity in the course of time. IgM and IgG antibodies to cardiolipin (CL), phosphatidylserine (PS), β2-glycoprotein-I (β2-GP-I), prothrombin (PT), annexin V (An V), as well as C1q complement component, content of its C3 and C4 components and total complement activity were determined in blood serum using ELISA approach. 141 patients with COVID-19 were included in the study. Group 1 consisted of 39 patients with mild form, group 2 (65 patients) presented with moderate form, and group 3 included 37 patients with severe form of COVID-19. Blood samples were obtained on day 3-7 of the disease (1st point) and after 14-28 days (2nd point). The results were as follows: aPL were detected in 29.1% of the total COVID-19 cohort, frequency of aPL detection by the severity grade did not differ (33.3%, 24.6% and 32.4%). In 8.5% of the patients, aPL were detected only at the 1st time point; in 14.2%, only at the 2nd point; and in 6.4% of the cases, at the both time points. Antibodies to PT (16.3%) and An V (11.3%) were revealed more frequently. The detection frequency of antibodies to PT was significantly higher than antibodies to CL and PS (7.1%), β2-GP-I (7.8%). The prevalence of aPL in groups 1 and 3 did not differ. At the 1st point in group 3, increased levels of C4 (89.2%) and C3 (24.3%) in blood, and a decrease in complement activity (35.1%) were more often observed than in group 1. At the 2nd time point in group 3, a decrease in complement activity was often detected (59.5%). The C3 levels exceeding 720 μg/ml were found to predict a 2.6-fold increased risk of severe COVID-19, and this risk became 3.3 times higher at C4 levels of > 740 μg/ml. The antibodies to PT and An V are often detected in COVID-19 patients, along with low prevalence of antibodies to CL and β2-GP-I. These antibodies can be involved in pathogenesis of COVID-19-associated coagulopathy, being detectable at the late stage of the disease, and they may trigger APS in predisposed patients and reconvalescents. Although presence of aPL antibodies is not associated with COVID-19 severity, their persistence over the period of convalescence may be an additional risk factor for thromboembolic complications. The COVID-19 patients are characterized by activation of the complement system, which increases in severe cases, and manifests with increased or decreased levels of C3 complement component, increased levels of C4 component in blood, and a decreased total complement activity. Quantitative determination of C3 and C4 complement components over the period of COVID-19 progression is of prognostic value, with respect to severity of the disease.

Odin iz mekhanizmov negativnogo vliyaniya vakcin na reproduktivnoe zdorov'e zhenshchin nosit autoimmunnyj harakter. Cel'yu raboty bylo ocenit' vliyanie immunizacii otechestvennoj kombinirovannoj vektornoj vakcinoj dlya profilaktiki koronavirusnoj infekcii, vyzyvaemoj virusom SARS-CoV-2, na uroven' autoantitel i gormonov, otrazhayushchih ovarial'nyj rezerv, i svyaz' mezhdu nimi u zhenshchin reproduktivnogo vozrasta. V prospektivnoe issledovanie bylo vklyucheno 120 zhenshchin v vozraste 18–49 let, vakcinirovannyh Gam-KOVID-Vak. Ovarial'nyj rezerv opredelyali pered vakcinaciej i cherez 90 dnej posle vvedeniya pervogo komponenta. S pomoshch'yu IFA izuchali profil' antifosfolipidnyh antitel, antitel k yadernym antigenam, antigenam shchitovidnoj zhelezy, antiovarial'nyh, antitrofoblasticheskih antitel, k zone pellyucida, FSG, progesteronu. Posle vakcinacii ne obnaruzheno povysheniya urovnya autoantitel, za isklyucheniem anti-FE IgM i anti-dsDNK IgG-antitel, kotoroe nosilo tranzitornyj harakter. Dolya pozitivnyh zhenshchin do vakcinacii sostavlyala 70,8%, posle vakcinacii — 75%. Ne vyyavleno korrelyacionnoj svyazi mezhdu urovnem autoantitel i gormonov, otrazhayushchih ovarial'nyj rezerv. Soglasno rezul'tatam, vakcinaciya Gam-KOVID-Vak ne okazyvaet negativnogo vliyaniya na ovarial'nyj rezerv, ne vyzyvaet razvitiya autoimmunnyh reakcij i associirovannogo s nimi snizheniya reproduktivnogo potenciala u zhenshchin.

Issledovanie vliyaniya COVID-19, oposredovannogo autoantitelami, na reproduktivnye iskhody imeet vazhnoe znachenie. Cel'yu issledovaniya bylo ocenit' profil' antifosfolipidnyh antitel (aFL) i ih svyaz' s iskhodami programm vspomogatel'nyh reproduktivnyh tekhnologij (VRT) u pacientok s COVID-19 v anamneze. V issledovanie vklyuchili 240 pacientok: 105 iz nih ne boleli COVID-19 (gruppa 1), 135 perenesli COVID-19 (gruppa 2) v legkoj (podgruppa 2a; n = 85) ili srednetyazheloj forme (podgruppa 2b; n = 50). S ispol'zovaniem IFA opredelyali syvorotochnye antitela (M, G) k kardiolipinu, β2-glikoproteinu-I, anneksinu V (AnV), fosfatidiletanolaminu (FE), fosfatidilserinu, kompleksu fosfatidilserin/protrombin. Ocenivali pokazateli oogeneza, embriogeneza, iskhody VRT. V gruppe 2 povyshenie urovnya anti-AnV i anti-FE IgG nablyudalos' chashche (u 28 (20,7%) i 8 (5,9%) pacientok), chem v gruppe 1 (u 10 (9,5%) i 1 (0,95%); p = 0,02 i p = 0,045 sootvetstvenno). V podgruppe 2b byl otmechen bolee vysokij uroven' anti-FE IgG i bolee vysokaya chastota rannih vykidyshej (u 6 (12%) pacientok), chem v gruppe 1 (u 3 (2,9%)) (p = 0,024). Vyyavleny slabye obratnye korrelyacionnye svyazi mezhdu urovnem anti-FE IgG i chislom poluchennyh oocitov i zigot. Rezul'taty issledovaniya predpolagayut negativnoe vliyanie COVID-19, oposredovannoe aFL, na iskhody programm VRT i techenie beremennosti na rannih srokah.

Currently, as the SARS-CoV-2 pandemic evolves, there has been increasingly more attention paid to building natural and vaccine-induced immunity against SARS-CoV-2 and related disease known as COVID-19. Widespread pre-ventive vaccination plays an important role in effectively protecting people from viral infections and can reduce national economic costs. Purpose - to study peripheral blood cell subset composition and magnitude of humoral response in vac-cinated Gam-COVID-Vac subjects. The prospective study included 352 patients, of which 194 (119 women and 75 men) underwent an immunogram study and assessed level of anti-SARS-CoV-2 antibodies. In patients, the study of the lym-phocyte subset composition and estimation of anti-SARS-CoV-2 antibodies was carried out at two time points - prior to vaccination and 90 days after inoculated component 1 of the Gam-COVID-Vac vaccine. In general, vaccination was well tolerated by patients, with no serious adverse events after immunization. The reaction to the vaccine (fever, ma-laise, headache, local reactions) was short-term (1-2 days) and more often noted after inoculated vaccine component 2. Comparatively analyzed immunogram parameters in females before and after vaccination revealed increased relative level of T-lymphocytes (CD3+), T-helper cell subset (CD3+CD4+), increased absolute and relative level of activated CD3+CD25+ T-lymphocytes, but decreased absolute and relative level of natural killer (CD3-CD56+CD16+) and natural killer T-cell (CD3+CD56+CD16+) cell subsets as well as decreased CD147 receptor expression on T-lymphocytes. Similar patterns were also found while examining the immunogram in males exepting increased level of lymphocytes and lowered CD147 expression on both T-and B-lymphocytes. No changes in the parameters of the immune T-cell arm was found. The high efficacy of the vaccine was confirmed by development of SARS-CoV-2-specific class G antiviral antibodies in 97.5% and 92.3% of vaccinated females and males, respectively. The data obtained evidence that: 1) vaccination induces a specific humoral immune response determined three months post-vaccination, and 2) it caused no serious disturbances in the im-mune system functioning, which could be reflected in the peripheral blood lymphocyte subset composition. Thus, the data presented allow to conclude that Gam-COVID-Vac is effective vaccine against SARS-CoV-2 infection.

Androgeny igrayut odnu iz klyuchevyh rolej v fiziologii zhenskogo organizma i reproduktivnoj sistemy. Ekspressiya androgennyh receptorov v razlichnyh tkanyah svidetel'stvuet o vazhnoj roli androgenov v regulyacii seksual'nogo i social'nogo funkcionirovaniya zhenshchin. Cel'yu issledovaniya bylo ocenit' seksual'noe funkcionirovanie u zhenshchin s besplodiem i snizhennym ovarial'nym rezervom (SOR) po rezul'tatam oprosnika «Indeks zhenskoj seksual'noj funkcii» (Female Sexual Function Index, FSFI). V odnomomentnom issledovanii u 496 pacientok s besplodiem i SOR proveli ocenku narushenij seksual'nogo funkcionirovaniya i ih vzaimosvyazi s izmeneniyami androgennogo profilya, osnovannogo na koncentracii androstendiona v syvorotke krovi. ZHenshchiny s besplodiem pri SOR statisticheski znachimo chashche otmechali izmenenie seksual'nogo funkcionirovaniya, v tom chisle snizhenie sposobnosti i chastoty seksual'nyh otnoshenij, libido. Dlya zhenshchin s besplodiem i izmenennym ovarial'nym rezervom s normal'nym urovnem androstendiona harakteren summarno bol'shij obshchij ball (21,2 ± 7,2), chto govorit o men'shej stepeni vyrazhennosti narushenij seksual'nogo funkcionirovaniya po sravneniyu s gruppoj so snizhennym urovnem androgenov, srednij ball v kotoroj statisticheski znachimo nizhe (15,17 ± 3,0). Krome togo, nablyudayutsya snizhenie vlecheniya, vozbuzhdeniya, udovletvoreniya, orgazma, lyubrikacii i uvelichenie bolevyh oshchushchenij. Izmenenie gormonal'nogo profilya u pacientok s SOR i snizheniem urovnya androgenov vnosit znachimyj vklad v seksual'noe funkcionirovanie, i ego vyyavlenie v klinicheskoj praktike pozvolit na bolee rannem etape provesti ob"ektivizaciyu zhalob i ocenit' vyrazhennost' seksual'nyh narushenij u molodyh zhenshchin s besplodiem s cel'yu opredeleniya dal'nejshej personificirovannoj taktiki vedeniya.

Koncentraciya androgenov v obrazcah follikulyarnoj zhidkosti u pacientok v programmah vspomogatel'nyh reproduktivnyh tekhnologij (VRT) mozhet byt' svyazana s processami oogeneza i embriogeneza. Cel'yu issledovaniya bylo proanalizirovat' svyaz' urovnya androgenov v plazme krovi i follikulyarnoj zhidkosti u pacientok s besplodiem i snizhennym ovarial'nym rezervom yaichnikov v programmah VRT. Provedeno odnomomentnoe issledovanie v parallel'nyh gruppah 300 pacientok 18–42 let s besplodiem s 2019 po 2021 gg., obrativshihsya dlya provedeniya programmy EKO/IKSI i PE. Opredelyali androgennyj profil' v plazme krovi i follikulyarnoj zhidkosti metodom mass-spektrometrii zhidkostnoj hromatografii i tandemnoj massspektrometrii (VEZHKH-MS/MS). Poluchennye rezul'taty pokazali, chto androgeny v plazme krovi i follikulyarnoj zhidkosti, a imenno urovni DGEA-S, androstendiona i obshchego testosterona, mogut byt' rannimi markerami snizheniya ovarial'nogo rezerva (SOR) u zhenshchin s besplodiem. Statisticheski znachimaya korrelyacionnaya svyaz' mezhdu urovnyami androgenov v krovi i follikulyarnoj zhidkosti svidetel'stvuet ob ih vklade v formirovanie snizheniya ovarial'nogo rezerva. Takim obrazom, pri snizhennom ovarial'nom rezerve vyyavleno snizhenie koncentracii androgenov v plazme krovi i v follikulyarnoj zhidkosti, chto svidetel'stvuet o roli androgenov v processah follikulogeneza, takih kak testosteron i androstendion.

In the context of the COVID-19 pandemic, scientific interest is growing in studying the impact of the proposed vaccination on women’s reproductive health. As is known, alterations in the state of the immune system and activation of an autoimmune response can lead to reproductive failure in women and potential complications of subsequent pregnancy. Objective: to evaluate the effect of the “Gam-COVID-Vac” on the immune status parameters, the relationship of their changes and the specific immune response to vaccination with the dynamics of the level of autoantibodies in women of reproductive age.The prospective study included 120 women who were vaccinated against COVID-19 with the “Gam-COVIDVac”. The criteria for inclusion in the study were: the age from 18 to 49 years, the absence of COVID-19 in the anamnesis, a negative result of a study on SARS-CoV-2 by PCR and negative results of tests for antibodies of classes G and M to SARS-CoV-2 before vaccination, the absence of pregnancy and serious somatic diseases. The patients were examined twice: immediately before vaccination and 90-100 days after the introduction of the 1st component of the vaccine. The level of IgG antibodies to SARS-CoV-2 after vaccination was assessed using ELISA. Before and after vaccination, the levels of antiphospholipid, anti-nuclear, organ-specific and antihormonal autoantibodies were determined, peripheral blood lymphocytes were immunophenotyped to determine the main subpopulations (CD3, CD4, CD8, CD19, CD5, CD16, CD56), as well as the expression of activation markers of lymphocytes (HLA-DR, CD25, CD147) using monoclonal antibodies.The effectiveness and safety of the combined vector vaccine against COVID-19 were high. Specific IgG antibodies to SARS-CoV-2 were produced in 98.3% of vaccinated women, no serious adverse reactions were observed. After vaccination, there was an increase in the level of some autoantibodies within the reference ranges, only IgM antibodies to phosphatidylethanolamine (PE) and IgG antibodies to DNA increased above the reference values. However, this increase was transient. After vaccination, the following changes in the parameters of the immunogram were observed: an increase in the content of cells with CD3+CD25+, CD19+ phenotype in peripheral blood and a decrease in the content of cells with CD56+CD16+ phenotype within the reference ranges, a decrease in CD147+/CD3+. Weak correlations were noted between these changes in immunogram parameters and the levels of some autoantibodies. The specific antiviral immune response to vaccination did not correlate with the autoimmune response.Vaccination with “Gam-COVID-Vac” is effective and safe and does not lead to disorders in the immune system. The observed increase in the level of autoantibodies to PE and DNA is transient. Changes in the parameters of the immune status within the reference ranges may be due to vaccination and the development of a specific antiviral immune response.

ЦЕЛЬ РАБОТЫ Сравнительная оценка интегральных тестов (тест генерации тромбина, тромбоэластометрия, тест тромбодинамики) у пациентов с вирусной инфекцией COVID-19 разной степени тяжести. МАТЕРИАЛ И МЕТОДЫ В исследование были включены 141 пациент с подтвержденным диагнозом COVID-19. Пациенты были распределены по степени тяжести на три группы: 1-я — легкое течение (n=39), 2-я — среднетяжелое течение (n=65), 3-я — тяжелое течение (n=37). В 1-й группе (амбулаторное лечение) первое взятие крови на исследование было при первом обращении (точка 1), а второе — после выздоровления (через 14—28 дней) (точка 2); во 2-й и 3-й группах — в день поступления в стационар (точка 1) и через 14 дней (точка 2). В динамике лечения у пациентов оценивали параметры тромбоэластометрии, теста тромбодинамики и теста генерации тромбина. Уровень гепарина (анти-Xa активность) в крови определяли на автоматическом коагулометре ACL TOP 700 (Intrumentation Laboratory, США). РЕЗУЛЬТАТЫ В работе отмечено, что мужской пол, старший возраст, избыточная масса тела и ожирение являлись безусловным фактором риска тяжести COVID-19. Для структурных параметров (А10, А20, MCF) в тромбоэластометрии обнаружены различия для трех групп пациентов в 1-й точке. Гиперкоагуляция отмечена только в группе с тяжелым течением COVID-19 в начале заболевания. Для параметров тромбодинамики (V,Vst,Vi, CS, D) в трех группах выявлено достоверное снижение во 2-й (в конце лечения) точке по сравнению с 1-й (в начале лечения). При сравнении показателей ТГТ в начале и в конце лечения выявлены достоверные изменения для Cmax в группе с легким течением болезни. Выявлена взаимосвязь между параметрами тромбодинамики и уровнем анти-Xa активности. ВЫВОДЫ Результаты интегральных тестов (тест генерации тромбина, тромбоэластометрия, тест тромбодинамики) показывают аналогичную динамику выздоровления: нормализация параметров гемостаза в период реконвалесценции у пациентов с вирусной инфекцией COVID-19 разной степени тяжести.

The aim of the work was to determine frequency of lupus anticoagulant (LA) detection in patients at various degrees of COVID-19 severity as well as duration of LA circulation after the infectious disease. The study included 103 patients with COVID-19. The patients were observed during the hospital care and in ambulance, if required. The patients were admitted to the departments of infectious diseases arranged at the V.I.Kulakov National Medical Research Center for Obstetrics, Gynecology, and F.I. Inozemtsev City Clinical Hospital. Treatment schedules and stratification of the patients by clinical severity was carried out in accordance with Interim Guidelines issued by the Ministry of Health of the Russian Federation for the prevention, diagnosis and treatment of new coronavirus infection (version 9). The following groups were formed: mild (n = 27), moderate (n = 55) and severe (n = 20). The patients were tested for LA positivity in the course of disease: on the day of starting medical care (with outpatient observation), or on the day of hospitalization; repeated tests were made before discharge (inpatients), and later, 1-2 months and 7 months after recovery. Lupus anticoagulant was determined by two independent tests (dRVVT and SCT), i.e., as a screening test and a confirmation test. At initial examination, LA was found in 50 patients (49%). The effect of LA in 98% of cases was observed with dRVVT test, as an increase of normalized ratio (NR). The maximum median value of NR was 1.54 (0.97: 2.1) was revealed in patients with severe course of COVID-19 (p 0.0001) compared with other groups and correlated with severity of the infectious process (r = 0.491, p 0.0001). In mild cases of COVID-19, LA was detected less often (4 cases, 14.8%) than in moderate severity cases (27, 49.1%), and severe patients (19, 95%) (p 0.05). Re-examinations of the patients before discharge from the hospital and 1-2 months later revealed high frequency of LA (p 0.05). However, no LA-positive test was found 7 months after discharge. In patients with COVID-19, high frequency of circulating LA was registered, depending on severity of the infectious process. In addition, we have first shown that persistence of the circulating LA over post-infectious period does not exceed 7 months.

V svyazi s aktivnym izucheniem associacij mezhdu urovnyami mikroelementov, endokrinnymi zabolevaniyami i narusheniem reproduktivnoj funkcii predstavlyaetsya aktual'nym izuchenie elementnogo statusa u pacientok s besplodiem v programmah vspomogatel'nyh reproduktivnyh tekhnologij (VRT). Cel'yu raboty bylo proanalizirovat' u pacientok s besplodiem soderzhanie mikroelementov, svyaz' mezhdu urovnem mikroelementov v ih krovi i parametrami programm VRT. V issledovanie vklyucheno 30 pacientok s besplodiem v vozraste 18–39 let. Opredelyali koncentracii 31 himicheskogo elementa v krovi pacientok metodom mass-spektrometrii s induktivno-svyazannoj plazmoj. Dva elementa iz 31 (sur'ma i berillij) ne byli obnaruzheny ni v odnom obrazce krovi, 10 elementov (titan, hrom, kobal't, nikel', mysh'yak, rtut', barij, zoloto, vanadij) vyyavleny v chasti obrazcov krovi, ostavshiesya 19 elementov — vo vsekh obrazcah. Vozrast pacientok nahodilsya v otricatel'noj korrelyacionnoj svyazi s urovnem kremniya (r = –0,384; r = 0,036) i v polozhitel'noj — s urovnem molibdena (r = 0,384; r = 0,036). Uroven' antimyullerova gormona nahodilsya v znachimoj otricatel'noj korrelyacionnoj svyazi s urovnem litiya (r = –0,367; p = 0,046). Uroven' svobodnogo tiroksina nahodilsya v znachimoj otricatel'noj korrelyacionnoj svyazi s urovnem bora (r = –0,402; p = 0,028) i polozhitel'noj korrelyacionnoj svyazi s urovnem zheleza (r = 0,410; p = 0,024) i serebra (r = 0,432; p = 0,017). Pri ocenke embriologicheskogo etapa otmechena polozhitel'naya korrelyacionnaya svyaz' mezhdu urovnem kremniya i chislom poluchennyh blastocist (r = 0,387; p = 0,034). Ne vyyavleno statisticheskoj zavisimosti mezhdu elementnym sostavom krovi i chastotoj nastupleniya beremennosti v ciklah VRT.

Folic acid (vitamin B9) is a water-soluble vitamin, essential for the growth and development of the blood and immune systems. Its deficiency is a significant risk factor for fetal neural tube defects. The widespread implementation of drugs and food supplements containing folic acid in preparation for pregnancy and in its first trimester has significantly reduced the incidence of fetal neural tube defects.According to current recommendations, taking 0.4 mg of folic acid per day is indicated within 6 months before conception and in the first trimester of pregnancy. Taking folic acid at a dosage of 4 mg is indicated for patients with a history of a fetal neural tube defect.There are also other risk factors for developing fetal neural tube defects. These include family history, obesity, malabsorption syndrome, folate cycle gene polymorphisms, smoking, drug use, diabetes mellitus (pre-gestational), and other chronic diseases. Determination of the required dosage of folic acid in these categories of patients still requires discussion and clinical trials. Also, folic acid intake is associated with a decreased risk of esophageal atresia, conotruncal heart disease, cleft palate, urinary tract malformations, and omphalocele, reduces the incidence of some behavioral anomalies, in particular, hyperactivity, the need for planning a pregnancy.