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Khodjaeva Nodira Vakhidovna, Republican Specialized Scientific and Practical Medical Center of Endocrinology under the Ministry of Health of the Republic of Uzbekistan, external degree candidate E-mail: nadira202@mail.ru Khaidarova Feruza Alimovna, M. D., Republican Specialized Scientific and Practical Medical Center of Endocrinology under the Ministry of Health of the Republic of Uzbekistan, therapeutic work director E-mail: alimovna@mail.ru
Assessment of emotional psychological status and quality of life at women with premenstrual syndrome under therapy with drospirenone
Abstract: The analysis of the conducted researches has shown that after 6 months of therapy with drospirenone more than at a half of women symptoms of PMS have completely disappeared, essential decrease in cases of subclinical anxiety and depression and improvement of quality of life were noted.
Keywords: premenstrual syndrome, emotional psychological status, quality of life.
Premenstrual syndrome (PMS) is characterized by the repeating, affective, physical and behavioural symptoms that develop during luteal phase of menstrual cycle and vanish within several days after the beginning of menstruation. The symptoms arising in luteal phase of cycle can significantly influence social relationship, quality of life and working capacity, changing and worsening a habitual way of life of the woman and her relation with people around [3; 14; 15; 17].
Though the exact etiology of PMS is unknown, there is a wide range of tested medications, for treatment of premenstrual symptoms (for example, change of the way of life, pharmacological interventions, and non-pharmacological methods oftreatment) [11].
Pathogenically a reasonable method of treatment of PMS is suppression of cyclic activity of ovaries. For the purpose of suppression of ovulation a number of medications is used: combined oral contraceptives (COC), danazol, agonists of gonadoliberin. Interest in use the COCs as a method of treatment of PMS has revived with the advent of a new gestagenic component — drospirenone (DRSP) similar in its effects to a spironolactone [1; 2; 16].
Drospirenone is the only gestagen that is synthesized on the basis of a molecule of a spironolactone. The unique mechanism of action of drospirenone besides influence on receptors of progesterone is also caused by its powerful anti-aldosterone and anti-andro-genic potential. At the same time drospirenone is void of estrogenic and glucocorticoid activity, it is as high-selective as gestagen due to activation of only progesterone receptors [4; 7; 9].
Objective: to estimate influence of drospirenone on the level of anxiety, depression and quality of life of women with PMS.
Materials and methods of research
Researchers examined 89 women of fertile age (from 18 to 40 years) with PMS (average age of 31.0 ± 6.59 years) who have addressed to advisory policlinic of Republican Specialized Scientific and Practical Medical Center of Endocrinology. The control group included 33 women (average age of 30.0 ± 5,30 years) with no PMS symptoms.
For confirmation of PMS the assessment of symptoms was carried out by filling out of a "calendar of premenstrual supervision" during 6 cycles including 12 most widespread psycho-emotional and 10 somatic symptoms of PMS [5; 8; 10]. Each patient estimates the severity of each symptom daily on a 4-mark scale, proceeding from extent of violation of a habitual way of life due to this symptom.
Existence and intensity of anxiodepressive distress were estimated by means of the Hospital scale of anxiety and depression [19]. At interpretation a total indicator on each subscale was considered, allocating three areas of its values: 0-7 — norm (no significant expressed symptoms of anxiety and depression); 8-10 — subclinically expressed anxiety/depression; 11 and more — clinically expressed anxiety/depression.
For the purpose of determination of QOL parameters ofpatients the standard version of questionnaire SF-36 was used [18], allowing to estimate the QOL within past 4 weeks. Prior to the beginning of pharmacotherapy it was recommended to all women to change lifestyle (observance of diet, change of work-rest schedule, sports).
The combined medication drospirenone/ethinylestradiol was assigned to all patients from the first day of menstrual cycle — 1 pill for 21 days. After a 7-day break the next course was assigned. Duration of therapy made 6 months. All patients have signed the informed consent to participation in research.
The obtained data was processed by means of the computer programs: Microsoft Excel, STATISTICA 6 and Biostat. The relation of chances (RC) and 95 % of confidence interval (95 % of CI) were counted with application of logistic regression. Reliability of differences of indicators was estimated by means of nonparamet-ric criterion x2 (Pearson's criterion). Quantitative indicators are presented in form M ± m, median (Me) and 25 and 75 percentiles (IQR). Distinctions between groups were considered statistically significant at P < 0.05.
Results and discussion
At the first stage of work the careful analysis of two menstrual calendars of patients carried out that allowed to reveal dependence
Assessment of emotional psychological status and quality of life at women with premenstrual syndrome under therapy.
of symptoms of PMS on the second phase of cycles and to estimate severity of their symptoms.
The carried-out analysis has shown that most often patients complained about soreness (33.7 %), low mood (32.6 %), headaches (27.7 %), decrease in working capacity (26.2 %).
At assessment of the family anamnesis inherited predisposition to PMS was established at 42 (47.2 %; 95 % CI 36.5-58.1 %) patients, i. e. almost at a half of surveyed women the presence of symptoms of PMS at relatives of the first generation was recorded. Twelve (13.5 %; 95 % CI 7.2-22.4 %) women have never been pregnant. Of all pregnancies 71.4 % (95 % CI 60.0 —81.2 %) ended in childbirth (n = 77), 28.6 % (95 % CI 18.8-40.0 %) in artificial and spontaneous abortion. After the restoration of menstrual cycle 36.4 % (95 % CI 23.8-50.4 %) of women, having a history of childbirth, noted that the state of the disease became more serious (n = 55). In past medical history of the patients there were: operative delivery (7.9 %; 95 % CI 3.2-15.5 %), surgeries concerning ectopic pregnancy (9.0 %; 95 % CI 4.0-16.9 %), surgeries concerning ovarian cysts (5.6 %; 95 % CI 1.8-12.6 %). The reproductive anamnesis and the analysis of surgeries hasn't shown specific violations that could be an immediate cause of PMS. At 59.6 % (95 %CI 48.6-69.8 %) of women with PMS the high infectious index was determined (5 and more infectious diseases a year).
All patients treated with drospirenone were observed until the end of research. The analysis of results of therapy with drospirenone after 3 months has shown disappearance of symptoms of PMS at 27 (30.3 %; 95 % CI 21.0-41.0 %) patients, severity of symptoms of PMS has decreased from average to easy degree at 37 (41.6 %; 95 % CI 31.2-52.5 %) women. After 6 months the symptoms of PMS have completely disappeared at 51 (57.3 %; 95 % CI 46.4-67.7 %) women, at 38 (42.7 %; 95 %DI 32.3-53.6 %) women respectively expressiveness of symptoms had easy degree.
Mean scores on anxiety (6.98 ± 1.48) and depression (6.51 ± 2.13) scales were within normal values, however anxiodepres-sive distress has been found more than at half ofwomen. Subclinically the large degree of anxiety/depression has been diagnosed in 58.4 % (95 % CI 47.5-68.8 %) of cases, the clinical norm was observed in 41.6 % (95 % CI 31.2-52.5 %) ofcases. Clinically large degree ofanxi-ety/depression wasn't noted. The obtained data confirm high prevalence ofanxiodepressive symptomatology among patients with PMS.
At the end of the course of treatment reliable decrease was established: in cases of subclinical anxiety to 31 % (OR 0.38; 95 % CI 0.21-0.70; P = 0.003) and in cases of depression to 27 % (OR 0.31; 95 % CI 0.17-0.57; P = 0.0003).
At an assessment of the psychological status of women with PMS under therapy with drospirenone-containing oral contraceptive, conducted by Lekareva T. M. [1; 2] (2007), it was found that by the end of the first cycle of therapy the clinical norm was observed at 91.4 %, subclinically 8.6 % of women had anxiety/depression of large degree. Positive influence of drospirenone on psychological state of patients is also determined by anti-edematous action of the medication [12; 13].
According to research results, at our supervision of patients with PMS the quality of life at all scales SF-36 was credibly lower than the quality of life of healthy women.
Indicators of QOL ranged from 24 to 89 points. The lowest values that aren't exceeding 50 points were noted on scales: role-physical functioning (at 67.4 % of women), amount of pain (at 41.6 %), physical activity (at 40.4 %) and general state of health (at 39.3 % of patients). Existence of clinical symptoms of PMS influenced the psychological component of health, the indicators that aren't exceeding 50 points were noted on scales: emotional functioning (at 38.2 % of women), vitality (32.6 %), mental health (25.8 %) and social activity (13.5 %).
The comparative analysis of scale indicators in dynamics (after 6 months) has revealed high rates (more than 70 points) on the following scales: vitality (at 71.9 % of patients), physical activity (at 59.6 % of patients), amount ofpain (at 56.2 %), social activity (at 55.1 %), emotional functioning (at 52.8 % ofwomen) and mental health (at 52.8 % ofwomen). It testifies to high social activity and good emotional state of respondents after therapy with drospirenone.
After the course of treatment reliable increase in indicators of all studied questionnaire components was noted. The most essential increase was noted on the following scales: role functioning (by 42.7 %), physical (by 31.7 %) and vital activity (by 29.2 %).
Conclusions:
1. On the background of administration of drospirenone (after 6 months) symptoms of PMS have completely disappeared more than at half (57.3 %) of women, at 42.7 % of patients respectively severity of symptoms was of low degree.
2. At the final stage of treatment essential decrease in cases of subclinical anxiety (to 31 %; P = 0.003) and depressions (to 27 %; P = 0.0003) was noted.
Dynamic supervision over QOL indicators after therapy with drospirenone has revealed improvement on such scale components as role-physical functioning (by 42.7 %), physical (by 31.7 %) and vitality (by 29.2 %).
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Navruzov Sarimbek Navruzovich, Kahhorov Jamal Nematovich, Khodjaeva Nazima Khayrullaevna, National Cancer Center of Uzbekistan, Ministry of Health of Uzbekistan, Tashkent E-mail: dr.bahodirova@bk.ru Kulabdullaev Gayrat Asatovich, Kim Andrey Alekseevich, Institute of Nuclear Physics, Uzbekistan Academy of Science, Tashkent
Influence of neutron capture therapy to biological subjects
Abstract: Developed for treatment of radio resistant malignant tumors the Gadolinium neutron capture therapy (GdNCT) is based on the nuclear capture and reactions that occur when 155Gd and 157Gd, which are non-radioactive constituents of natural elemental gadolinium, are irradiated by thermal neutrons with low energy 0.025 eV. In this article, results of scientific researches on development GdNCT in Uzbekistan are presented. The beam of epithermal neutrons with characteristics satisfying the all requirements of IAEA was received. Neutron kerma for biological tissues Kbtn = 1.35-10-4 Gr/s and for 1 ^g. natural gadolinium in 1 g. of biological tissues KGdn = 3.1-10-7 Gr/s for this beam was calculated. As gadolinium delivery agent the well-known pharmacological preparation Magnevist was chosen. For absorbed dose calculation, the Magnevist pharmacokinetics was studied after intratumoral injection in mice and intramuscular injection in rats. Results of researches of influence epithermal neutrons beam on binding ability of transport proteins of human blood, on tumor cells C-180 at mice are presented. Planned scientific researches with application of this beam in Uzbekistan are summarized.
Keywords: neutron capture therapy, sarcoma, gadolinium.
1. Introduction 152Gd (0.205 %), 154Gd (2.23 %), 155Gd (15.10 %), 156Gd (20.60 %),
There are a number of radio resistant malignant tumors, incur- 157Gd (15.70 %), 158Gd (24.50 %), 160Gd (21.60 %). Among them, able traditional methods of radiation therapy. One of a perspective 155Gd and 157Gd have the most excellent neutron capture proper-method of treatment of such tumors is GdNCT. Gadolinium neu- ties with thermal neutron capture cross-section of 60,800 and tron capture therapy (GdNCT) is based on the nuclear capture and 255,000 barns, consequently, which is approximately 16 and 66 times reactions that occur when 155Gd and 157Gd, which is a non-radioac- that of 10B. Nuclear reaction cross sections for other isotopes are tive constituent of natural elemental gadolinium, is irradiated with small, which can be neglected at dose calculations. Therefore, we low energy (0.025 eV) thermal neutrons. This results in the produc- are considered these isotopes doing the basic contribution to the tion ofhigh energy y-rays, internal conversion electrons, X-rays and summary dose (20 % - 155Gd and 80 % - 157Gd) [2]. Initially, Lo-Auger electrons, as shown below. cher have mentioned about suitability of gadolinium as element for
The employment GdNCT for cancer treatment is receiving NCT in 1936 [3]. Then it has not been used long time for NCT. All more and more interest owing to the efficient killing effect of the researches on NCT was realized by using of the best element for Auger electrons, which have demonstrated higher cell lethality than NCT 10B [4-17]. But for treatment of some radio resistant forms of alpha particles [1]. Natural Gd consists of 7 stable isotopes including cancer are require element having properties with the big gradient
