Showing papers in "Reproductive Endocrinology in 2015"

Sexually transmitted diseases treatment guidelines (2015)

Abstract: Дані рекомендації щодо лікування осіб, які мають або піддаються ризику захворювань, що передаються статевим шляхом (ЗПСШ), були оновлені Центрами з контролю і профілактики захворювань США після консультації з групою фахівців у сфері ЗПСШ, які зустрілися в Атланті навесні 2013 р. Це оновлена версія Керівництва з лікування ЗПСШ від 2010 р. В оновленій версії керівництва обговорюються: 1) альтернативні схеми лікування Neisseria gonorrhoeae; 2) застосування методів ампліфікації нуклеїнових кислот для діагностики трихомоніазу; 3) альтернативні способи лікування гострих кондилом; 4) роль Mycoplasma genitalium у розвитку уретритів/цервіцитів і наслідки, пов’язані з лікуванням; 5) оновлені рекомендації з консультування та вакцинації проти вірусу папіломи людини; 6) менеджмент пацієнтів-транссексуалів; 7) щорічне тестування на гепатит С осіб із ВІЛ-інфекцією; 8) оновлені рекомендації з діагностичної оцінки уретриту; 9) повторне тестування з метою виявлення нового інфікування. Дане керівництво можуть використовувати лікарі та інші медичні працівники для надання допомоги з профілактики та лікування ЗПСШ.

Синдром поликистозных яичников. Официальное заявление Европейского общества эндокринологии

Abstract: Polycystic ovary syndrome (PCOS) is the most common ovarian disorder associated with androgen excess in women, which justifies the growing interest of endocrinologists. Great efforts have been made in the last 2 decades to define the syndrome. The presence of three different definitions for the diagnosis of PCOS reflects the phenotypic heterogeneity of the syndrome. Major criteria are required for the diagnosis, which in turn identifies different phenotypes according to the combination of different criteria. In addition, the relevant impact of metabolic issues, specifically insulin resistance and obesity, on the pathogenesis of PCOS, and the susceptibility to develop earlier than expected glucose intolerance states, including type 2 diabetes, has supported the notion that these aspects should be considered when defining the PCOS phenotype and planning potential therapeutic strategies in an affected subject.The NIH Experts Panel recommended the maintenance of the broad diagnostic criteria of Rotterdam, but focused on the need for specific identification of the phenotype of each patient. Four different phenotypes of PCOS are now identified: 1) hyperandrogenism (clinical or biochemical) and CA (H-CA); 2) hyperandrogenism and polycystic ovaries on ultrasound (PCOm) but with ovulatory cycles (H-PCOm); 3) CA and polycystic ovaries without hyperandrogenism (CA-PCOm); and, finally, 4) hyperandrogenism, CA and polycystic ovaries (H-CA-PCOm). This paper offers a critical endocrine on the debate on the definition of PCOS and summarises all major aspects related to aetiological factors, including early life events, potentially involved in the development of the disorder. Diagnostic tools of PCOS are also discussed, with emphasis on the laboratory evaluation of androgens and other potential biomarkers of ovarian and metabolic dysfunctions. We have also paid specific attention to the role of obesity, sleep disorders and neuropsychological aspects of PCOS and on the relevant pathogenetic aspects of cardiovascular risk factors. In addition, we have discussed how to target treatment choices based according to the phenotype and individual patient’s needs.

Гиперпластические процессы эндометрия: что нового?

Abstract: According to the extended today WHO classification (1994) there are simple and complex endometrial hyperplasia non-atypical; simple and complex atypical endometrial hyperplasia; adenocarcinoma. In numerous studies of the last decades it has been proven that the simple and complex non-atypical endometrial hyperplasia are the result of absolute or relative hyperestrogenism, and atypical endometrial hyperplasia is a progressive monoclonal mutational damage with the independent hormonal effects of local growth. With this in mind, it has been proposed the term “endometrial intraepithelial neoplasia” (EIN), which should be viewed as precancer. Based on this approach, EIN-classification also provides a simple and complex non-atypical endometrial hyperplasia interpreted as endometrial hyperplasia (endometrial hyperplasia), which is the result of estrogenic stimulation and, therefore, lends itself well to hormone therapy. In terms of diagnosis and treatment of endometrial hyperplastic processes the most appropriate are recommendations of the American College of Obstetrics and Gynecology (ACOG) and the Society of Gynecologic Oncology (SGO) at 2015: • preferred fencing material at hysteroscopy, separate diagnostic curettage (suspicious areas and all endometrium must be histological exanimated); • there are insufficient data on the efficacy of progestin therapy and monitoring the endometrial intraepithelial neoplasia; • in the progestin treatment it is need histological control every 3–6 months, 7–10 days after withdrawal bleeding; • supravaginal hysterectomy, morcellation, endometrial ablation are unacceptable in the case of endometrial intraepithelial neoplasia. In Ukraine, the treatment of endometrial hyperplasia regulated by the order of the Ministry of Health of Ukraine of 31.12.2004 № 676, which includes I stage – the removal of endometrial changes, followed by a morphological study. According to the recommendations of ACOG and SGO, the II stage of treatment of endometrial hyperplasia without atypia includes conservative therapy with progestins also permissible resectoscope endometrial ablation. Stage III involves the normalization of estrogen/progesterone ratio. The main method of treatment of endometrial hyperplasia with atypia, according to the ACOG and SGO recommendations, is total hysterectomy with/without adnexal.

Національний консенсус щодо ведення пацієнток із ендометріозом

Abstract: The National consensus on management patients with endometriosis includes the main issues of epidemiology, clinical manifestations, and diagnostics of this disease. The document also contained evidence-based recommendations on treatment tactics of endometriosis (medical and surgical treatment), secondary prevention of endometriosis.

Menarche, puberty and vitamin D

Abstract: Puberty is the development process - result of a complex series of molecular and physiological events, culminating in reproductive capability. Gonadotropin-releasing hormone actively released from specialized neurons of the hypothalamus stimulates gonadal activation and triggers physical changes of puberty through initiation of the hormonal cascade. Epidemiologic studies and numerous clinical trials claim that sufficient levels of vitamin D3 are essential for normal physiological growth, development and puberty, by activation of the neurohormonal multisystem in the hypothalamus-pituitary-gonadal axis. Various scientific studies investigate the role of vitamin D3 and its metabolites in specific reproductive disorders of women and men. All these data contribute to intensive research on vitamin D3 and its receptor as a potential factor, affecting the pathogenesis of a numerous diseases, connected with its non-classical function, such as diabetes, obesity, cancer, puberty disorders and infertility. In the last decade, the prevalence of vitamin D3 deficiency has been increasing in many parts of the world, that has caused an increasing number of medical research on the subject. Nevertheless, data on the vitamin D status and its association with puberty in girls are constrained. This paper was written to present different studies on vitamin D3 and its influence on puberty through the regulation of the neurohormonal system during sexual maturity

Liquid-based cytology for risk-adapted cervical screening

Abstract: В настоящее время существует три системы жидкостной цитологии (liquid based cytology, LBC), используемые в Германии: ThinPrep®, SurePath® и метод PapSpin®. Между LBC- препаратами и обычными Пап-мазками очень мало цитоморфологических различий. Основное различие заключается в чистом фоне, который обеспечивает LBC, что помогает легче идентифицировать и интерпретировать патологические клетки. Имеющийся опыт свидетельствует, что жидкостные цитологические методы обладают следующими преимуществами по сравнению с традиционными техниками исследования мазка: а) сокращение доли неадекватных образцов, б) улучшение чувствительности, в) возможность сокращения времени для интерпретации образца. В настоящее время в США 98% Пап-тестов основаны на жидкостной цитологии.

Клиническое исследование «Инициатива во имя здоровья женщин»: взаимосвязь кальция и витамина D с гормональной терапией

Abstract: This study aims to test the added value of calcium and vitamin D (CaD) in fracture prevention among women taking postmenopausal hormone therapy (HT). This is a prospective, partial-factorial, randomized, controlled, double-blind trial among Women’s Health Initiative postmenopausal participants aged 50 to 79 years at 40 centers in the United States with a mean follow-up of 7.2 years. A total of 27,347 women were randomized to HT (0.625 mg of conjugated estrogens alone, or 0.625 mg of conjugated equine estrogens plus 2.5 mg of medroxyprogesterone acetate daily), and 36,282 women were randomized to 1,000 mg of elemental calcium (carbonate) plus 400 IU of vitamin D3 daily, each compared with placebo. A total of 16,089 women participated in both arms. The predefined outcomes were adjudicated hip fractures and measured bone mineral density. Interaction between HT and CaD on hip fracture (р interaction = 0.01) was shown. The effect of CaD was stronger among women assigned to HT (hazard ratio [HR], 0.59; 95% CI, 0.38–0.93) than among women assigned to placebo (HR, 1.20; 95% CI, 0.85–1.69). The effect of HT on hip fracture was stronger among women assigned to active CaD (HR, 0.43; 95% CI, 0.28–0.66) than among women assigned to placebo (HR, 0.87; 95% CI, 0.60–1.26). CaD supplementation enhanced the antifracture effect of HT at all levels of personal calcium intake. There was no interaction between HT and CaD on change in hip or spine bone mineral density. Conclusions: Postmenopausal women at normal risk for hip fracture who are on CaD supplementation experience significantly reduced incident hip fractures beyond HT alone at all levels of personal baseline total calcium intake.

Хронический вульвовагинальный кандидоз: новый взгляд на старую проблему

Abstract: Выполнено исследование по изучению эффективности лечения фентиконазолом у 60 пациенток в возрасте от 18 до 45 лет с хроническим рецидивирующим вульвовагинальным кандидозом. Женщины были разделены на 2 равные группы по 30 пациенток. Основной группе назначался фентиконазол (препарат Ломексин®) в течение 6 дней (при этом половому партнеру женщины на аналогичный период рекомендовался крем с фентиконазолом). Группе сравнения назначался кетоконазол в течение 10 дней и лечение полового партнера согласно общепринятым рекомендациям. Результаты исследования показали высокий (96,67%) противорецидивный эффект препарата Ломексин® в местной терапии хронического вульвовагинального кандидоза в сравнении с кетоконазолом (80,0%). Эти результаты позволяют авторам рекомендовать схему местной терапии фентиконазолом для лечения хронического ВВК

Оптимизация подготовки морфофункциональной структуры эндометрия в программах вспомогательных репродуктивных технологий

Abstract: The study on the efficiency of the drug Tivortin® containing arginine in cycles of assisted reproductive technology (ART ) to restore the ability of endometrial implant and improve the effectiveness of ART was performed. The study included 31 patients in the main group (at the second stage of the complex therapy they received Tivortin®) and 40 women in the control group (receiving vitamin therapy), suffering from infertility caused chronic inflammatory diseases of the pelvic organs and unsuccessful attempts ART in the anamnesis. The study showed that the use drug Tivortin® as adjuvant therapy before ART cycles improves uterine blood flow and restores the morphofunctional state of endometrium, significantly increases the possibility of implantation endometrium, that is increases the rate of pregnancy

Микробиом и здоровье женщины (обзор литературы)

Abstract: In recent decades increased interest in natural microbiome - microbial communities colonizing the mucous membranes and skin of human. Microbiome is involved in metabolic and genetic regulatory mechanisms of human life, and also creates a powerful defense of microorganism from colonizing alien microorganisms. Mouth, upper respiratory tract, gastrointestinal and urogenital tract, skin are populated by different types of microorganisms.It was found that the breach of the vaginal microbiome associated with the development of bacterial vaginosis, nonspecific (aerobic), vaginitis and mycotic vaginitis. Numerous studies have confirmed the effectiveness of probiotic therapy in the treatment of patients with various forms of urological and obstetrical and gynecological pathology, aimed at restoring the natural microbiome.

Dysmenorrhea in adolescent population

Abstract: Виконане дослідження вивчало частоту пов'язаних із менструацією проблем у дівчат-підлітків, які проживають у міських регіонах України. У дослідження увійшли 532 дівчинки-підлітка віком 15–17 років, у яких були менструації протягом щонайменше одного року до моменту включення в дослідження. Виявлено, що близько 20% дівчат мають нерегулярні менструації. Дисменорея зустрічалася у майже 62% випадків, гармонійний розвиток у віці 15–17 років спостерігався менш ніж у 50% дівчаток. У зв'язку з цим відзначено, що лікарі загальної практики, педіатри, підліткові гінекологи повинні бути активнішими в діагностиці дисменореї у дівчаток-підлітків. Одними з основних профілактичних заходів підліткової дисменореї є зміна способу життя, відмова від паління і фізична активність.

Clinical and epidemiological characteristics of fertile aged women with uterine leiomyoma, residents of industrial region of Ukraine

Abstract: Results of study provided in population of fertile aged women are showed in the article, clinical and epidemiological characteristics of women with uterine leiomyoma, which are living in the industrial region of Ukraine. Revealed frequency and structure of appearance of uterine leiomyoma and factors, that could lead to uterine leiomyoma. Thus, the incidence of uterine leiomyoma in fertile aged women at Dniprovskyi district of Kyiv was 5.1% per 1000 women, which is slightly higher than the average according to the official statistics (4.4% per 1000 women)

Features of treatment of polycystic ovary syndrome on the overweight background

Abstract: The main strategic goal of treatment of polycystic ovary syndrome (PCOS) is not only restore fertility and achieve a cosmetic effect, but also the prevention of metabolic disorders later. Lifestyle modifications with the inclusion of physical activity and a balanced diet are reasonable pathogenetic components of therapy and prevention of long-term effects of PCOS. Well pronounced antiandrogenic effect in the treatment of PCOS has a selective androgen receptor inhibitor flutamide. However, in women with PCOS often develop nonalcoholic steatosis, particularly against the background of obesity, which limits the long-term use of this drug, as it is hepatotoxic effects. Given this, it is advisable to give preference to phyto- antiandrogens, one of which is normocycle. Advantages of drugs in this group have low toxicity and the possibility of long-term use without risk of serious adverse reactions. The aim of the study was to improve the treatment of women with PCOS and excess body weight. We examined 105 women with a diagnosis of “polycystic ovary syndrome” in the background of excessive body weight and obesity aged 18 to 35 who were divided into two groups: group I consisted of 65 women who received developed treatment; II group – 40 women who received standard treatment. In the first phase (3 months) in both groups used the standard treatment: flutamide administered in the case of hyperandrogenism and in the case of insulin resistance – metformin. Patients of group I additionally used normocycle for 3 months and tivortin for 10 days. The next three months the women in both groups received advice on diet and exercises, and the patient group I continued to use normocycle for 3 months and tivortin for 14 days. The results showed that the use of herbal anti-androgen (normocycle) and antihypoxant (tivortin) in the complex treatment of women with PCOS against the backdrop of excess body weight leads to permanent reduction of clinical symptoms and improve hormonal parameters.

To the question of complex treatment of endometriosis

Abstract: Виконана робота з метою покращення якості антипроліферативного лікування при ендометріозі з урахуванням клініко-морфологічних та імуногістохімічних даних. На першому етапі дослідження проводилось вивчення активності маркерів проліферації та апоптозу у пацієнток із різними формами ендометріозу: 35 пацієнток із внутрішнім генітальним ендометріозом (аденоміозом), 52 пацієнтки із зовнішнім генітальним ендометріозом і 19 пацієнток із екстрагенітальним ендометріозом. В результаті з’ясовано, що у вогнищах ендометріозу відзначається низький апоптоз, висока проліферативна активність клітин та превалює ендометрій проліферативного типу (гіперплазія ендометрія). На ІІ етапі дослідження проводилась оцінка антипроліферативних властивостей Епігаліну при лікуванні ендометріозу. В дослідженні брали участь 38 пацієнток із аденоміозом та вираженим больовим синдромом: 18 хворих отримували дієногест, а 20 пацієнткам на фоні аналогічної терапії дієногестом призначався Епігалін. В результаті виявлено, що використання Епігаліну в комплексній терапії ендометріозу дозволяє контролювати проліферативний потенціал клітин ендометрія.

Нейроэндокринная система – терапевтическая мишень экстракта плодов витекса священного при предменструальном синдроме

Abstract: В статье обсуждаются нейроэндокринные механизмы формирования латентной гиперпролактинемии при предменструальном синдроме (ПМС) и некоторые аспекты ее влияния на водно-минеральный обмен и циклическую деятельность яичников. Автором предложена концепция взаимодействия нейромедиаторов и регуляторных пептидов в нейроэндокринной регуляции секреции пролактина при ПМС с акцентом на роль туберо-инфундибулярной дофаминергической системы гипоталамуса и галанина. Согласно этой концепции, гипоталамический дофамин является коммуникационным звеном, влияющим на секрецию пролактина в условиях стресса и действия эстрогенов. С учетом современных данных, применение препаратов Циклодинон и Мастодинон, которые содержат специальный экстракт плодов витекса священного с доказанной дофаминергической активностью, для лечения ПМС при наличии латентной гиперпролактинемии патогенетически целесообразно и безопасно

Генетические маркеры в прогнозировании ранних и поздних форм преэклампсии у беременных с сахарным диабетом 1-го типа

Abstract: The study compared the profile of polymorphic variants of genes that determine the basic pathogenesis of pre-eclampsia in groups of patients with type 1 diabetes. Overall, 60 female patients with type 1 diabetes were investigated: pregnancy complicated with early-onset (n = 15) and late-onset (n = 15) superimposed preeclampsia was reported in 30 subjects; no complications were detected among the rest 30 patients. Besides standard clinical investigation, each patient underwent molecular genetic testing with detection of the following polymorphic variants of genes: А1166С-AT2R1, C108T-PON1, Thr83Ala- and T138C-MGP, 4b/4a- and G894T-eNOS, as well as I/D-ACE. On completion of our study we established differential prognostic models for prediction of early-and late-onset preeclampsia development in women with pre-existing type 1 diabetes mellitus based on the data about the prevalence of polymorphic variants of genes and gene-gene interactions. The following risk factors were found to be the main contributors to early-onset (< 32 weeks) preeclampsia development: long duration of diabetes; presence of vascular complications at the time of conception (in particular, diabetic angiopathy of lower extremities and diabetic nephropathy); and ACE ID-genotype. The most significant genotype combinations associated with early-onset preeclampsia development were as follows: ACE (ID) / AT2R1 (1166АА), ACE (ID) / AT2R1 (1166АС), ACE (I/D) / eNOS (4b/4b), ACE (I/D) / eNOS (894GG). Genetic factor influenced the development of late-onset preeclampsia (≥ 32 weeks) to a much lesser extent; only one statistically significant combination of genotypes was detected to be associated with preeclampsia debut after 32 weeks of pregnancy – ACE (ID) / MGP (138TC). Genotype combination ACE (II) / PON1 (108CC) significantly reduced the risk of preeclampsia development during the entire pregnancy. Important genetic markers found in our study will allow predicting different forms of preeclampsia in type 1 diabetic pregnant women. Identification of women at high risk for early-onset preeclampsia development will let us to implement treatment and preventive measures and to provide closer monitoring, resulting in better pregnancy outcomes.

Патогенетична терапія цервікальної інтраепітеліальної неоплазії ІІ–ІІІ ступеня важкості

Abstract: The secondary prevention of cervical cancer include detection and treatment of preinvasive forms of the disease, which includes cervical intraepithelial neoplasia and atypical cervix leucoplachia. 98% cases of this pathology are associated with human papillomavirus. Traditional surgical methods of treatment of cervical intraepithelial neoplasia do not always lead to the elimination of the virus, that cannot completely exclude the possibility of recurrence. The article shows the literature data and own observations about the possibility of drug therapy in complex therapy of neoplasia. It is accentuated that the using of antiviral and immune drugs, biologically active complexes consisting of medical actions can achieve higher efficiency in comparison with surgical methods.

Reproductive health of girls in the Lviv region

Abstract: State of health of girls in childhood and adolescence is an important element in the implementation of reproductive function. This paper presents the results of a statistical analysis of gynecological diseases, labor and abortions among girls in different age groups over the last 3–6 years. It also shows the organization of Children and Adolescent Gynecology in the Lviv region. We have analyzed some extragenital diseases as factors that may influence the formation of reproductive potential in girls

Morphological characteristics of myoma and endometrial tissue in patients with uterine leiomyoma after treatment with ulipristal acetate

Abstract: Uterine leiomyoma is a hormone-dependent tumor of the myometrium, one of the most common benign tumors of the female genital organs. For conservative treatment of uterine leiomyoma different progesterone receptor blockers are used. One such drug is ulipristal acetate, a selective modulator of progesterone receptors, which suppress fibroid growth and may lead to its regression. The aim a selective modulator of progesterone receptors, which suppress fibroid growth and may lead to its regression. The aim of research was to conduct morphological study of myoma and endometrial tissue in patients with uterine leiomyoma after treatment with ulipristal acetate. Histological and immunohistochemical study of leiomyoma and endometrium in 9 patients after three months of ulipristal acetate treatment 5 mg per day (the main group) and 15 patients without hormone therapy (control group) was conducted. In patients treated with ulipristal acetate in smooth muscle cells of uterine noted a significant decrease of progesterone receptor expression, markers of apoptosis inhibitor Bcl-2 and proliferative activity Ki-67. Thus, in uterine smooth muscle cells under influence ulipristal acetate is a reduction amount of the progesterone receptor, i.e. decreases its action, resulting in the induction of apoptosis and reduced proliferation processes, whereby the uterine involution occurs. In the endometrium under the influence of ulipristal acetate develop reversible changes associated with the use of progesterone receptor modulators. In the study of proliferative activity marker Ki-67 in endometrium in patients receiving ulipristal acetate, we found its expression is very low compared with the group of patients without hormonal treatment of uterine leiomyoma. The changes in the endometrium under the action of ulipristal acetate must be differentiated from the estrogen-induced changes and endometrial hyperplasias, so the direction of the pathological examination must be necessary indicate that a patient received ulipristal acetate therapy. In the future, it is necessary to continue to study morphological changes, such as immunohistochemical characteristics of myoma and endometrial tissue in patients after treatment with ulipristal acetate.

Adolescence: risk factors for precancerous lesions and cervical cancer and prevention methods

Abstract: Adolescence is a time of rapid growth and huge potential, but at the same time associated with the significant risks when social context has a significant impact. Sexual behavior of young people in Ukraine has undergone significant changes and is characterized by irresponsible d attitude to matters of sex. The average age of first sexual intercourse among adolescents is on average 15,1 years for boys - 14,7 years. The prevalence of premarital sex on the one hand, is a testament to the «liberalization» of sexual attitudes of young people, and on the other actualizes the problem of prevention of unwanted pregnancies and sexually transmitted infections. In the structure of cervical diseases in sexually active adolescent girls the cervical interepithelium neoplasia diagnosed in 25,83% of patients. Vaccination provides a new opportunity for the primary prevention of cervical cancer and cervical intraepithelial neoplasia. Thus, it is necessary to conduct a proper information campaign for adolescents and their families by involving non-governmental organizations, schools, and health services

Menopausal syndrome as the first clinical manifestation of perimenopause

Abstract: A study to examine the efficacy and safety of drug Kleverol (active ingredient is a red clover) in patients with climacteric disorders of mild to moderate severity in late reproductive period was performed. 40 patients aged 36–49 years with climacteric disorders of mild to moderate severity were observed. Kleverol was administered 1 capsule a day for 3 months. The average menopausal index, according to a Menopause Rating Scale (MRS), was significantly lower after treatment (8,7 ± 0,3) than before treatment (22,2 ± 0,3). In all examined women hormone levels corresponded to perimenopausal values. Side effects and individual intolerance reactions were not observed. Authors of the study conclude that a good level of efficacy and safety Kleverol allows to use it at the earliest manifestations of menopausal disorders in women in the late reproductive period (perimenopause).

Кровопотеря в акушерстве, геморрагический шок: тактика акушера-гинеколога

Abstract: The key aspects of diagnostics and treatment of obstetric hemorrhage and hemorrhagic shock are present in this article. Treatment of obstetric hemorrhage, including hemorrhagic shock is more effective if the infusion therapy initiated as early as possible. The basic aims of infusion therapy are support of systemic circulation and recovery of tissue perfusion. Crystalloids, colloids and blood preparations are used as an infusion-transfusion therapy. To date, there is a great experience with colloidal preparations, among which the most widely used drugs are hydroxyethylated starch and gelatin preparations.

Role of local immunity factors in the development of vaginal dysbiosis in girls of prepubertal and pubertal age

Abstract: Data on the local immune reactivity in the formation of colonization resistance in girls with vaginal dysbiosis are few and contradictory. The aim of the work was to study the role of local immunity factors in the development of vaginal dysbiosis in girls of prepubertal and pubertal age. It was studied the species composition of the vaginal microbiota, the type and severity of dysbiosis, humoral and cellular immunity in vaginal swabs. The general trend in the study groups was to increase the level of white blood cells and lactoferrin, reduction of slgA, lysozyme activity and phagocytosis activity, the phagocytic index number and completeness of phagocytosis. The nature of the local immune response depended on the type and severity of vaginal dysbiosis. The greatest immunological changes were recorded in mixed forms of dysbiosis and a large number of microorganisms in associates in diagnostically significant quantities

Національний консенсус щодо ведення пацієнток із аномальними матковими кровотечами асоціації гінекологів-ендокринологів України

Abstract: Current classification of abnormal uterine bleeding, review of diagnostic methods and treatment strategies of the condition are presented in the article. Moreover, evidence based algorithms of the diagnosis and treatment of this condition considering the features of the health care system in Ukraine are given

Фармакологічна характеристика та використання міо-інозитолу в гінекологічній практиці

Abstract: Inositol is a six atom cyclohexane alcohol, which has 9 isomers, one of which (myo-inositol) has a vitamin activity and has been classified as B vitamins (B8). The biological function of myo-inositol is an intracellular signaling. Signal molecules that are synthesized from or by using myo-inositol, participate in functioning of the reproductive, central nervous system, metabolism of carbohydrates. More than 120 inositol-dependent proteins are involved in various physiological processes, including the implementation of reproductive function. Through participation GNRHR and KISS1R genes in the synthesis of proteins that includes receptors of the gonadotropin-releasing hormone, myo-inositol participates in the production of luteinizing hormone and follicle stimulating hormone, steroidogenesis, including the synthesis of several key hormones of the female reproductive system such as estriol and estradiol. Inozitol-depending proteins play an important role in the regulation of carbohydrate and lipid metabolism. They participate in transmits the signal from the insulin receptor to the cytoplasm of cells that is increase expression of glucose transporter and thus stimulates the metabolism of carbohydrates and fats. In the end, this is leads to a decrease of insulin resistance, prevents the development of overweight, obesity, diabetes. It is equally important that myo-inositol helps to reduce elevated levels of triglycerides and cholesterol, especially low density lipoprotein. In turn, disruption of lipid and cholesterol metabolism often caused by reduced production of key hormones (luteinizing hormone and follicle stimulating hormone) that regulate processes of folliculogenesis and oogenesis. Myo-inositol level in follicular fluid of mature fertilized oocytes significantly higher than that in the liquid of immature unfertilized oocytes, and its level correlates with the estriol level in follicular fluid. This is indicates that myo-inositol play role in the process of oocytes maturing. A number of studies confirming the efficiency of myo-inositol in the complex treatment of a frequent complication of this disease - polycystic ovary syndrome and infertility.

Применение пероральных и парентеральных препаратов железа у пациентов с тяжелыми формами железодефицитной анемии

Abstract: Treatment of iron deficiency anemia include the elimination of the root causes of iron loss (liquidation hemorrhage, treatment of major diseases), diet rich in heme and iron, and use of mono- or combination preparations of iron. For initial treatment of iron deficiency are used oral ferrous drugs, which contain iron in the bivalent (ionic) or trivalent (non-ionic) form. In emergency conditions where oral iron preparations cannot quickly recover iron deficiency, iron preparations are administered parenteral, and preferred dosage form is intravenous administration. Numerous clinical studies have shown that the drug Venofer® (iron sucrose (III)) for intravenous administration is more effectively restore hematocrit level, serum ferritin and erythropoiesis than other parenteral and oral iron preparations.

Епігенетичні фактори як предиктори змін репродуктивного здоров’я у жінок фертильного віку з порушеннями вегетативного гомеостазу

Abstract: Epigenetic factors of beginning or exacerbation of autonomic homeostasis violations in women of fertile age that may be considered as predictors of changes in reproductive health were studied. In particular, epigenetic risk factors of such violations in women with impaired autonomic homeostasis include smoking, excessive drinking, excessive drugs and psychotropic substances use and other factors that may be taken into account at health-care measures

Лечение и профилактика пролиферативных заболеваний молочной железы

Abstract: Benign breast hyperplasia is a diseases of civilization associated in women with hormonal disorders, estrogen dominance syndrome. Risk of developing breast cancer for women with proliferative forms of benign breast disease increased tenfold. Absolutely all patients seek medical attention, regardless of pathology, must undergo breast examination and obtain recommendations for the prevention and the multiplicity of diagnostic tests. An important role in the pathogenesis of benign breast hyperplasia plays an increase prolactin levels. Hyperprolactinemia is a frequent cause of menstrual and generative dysfunctions, as well as benign breast hyperplasia, which negatively affects the quality of women life. Quite often there is not a permanent but temporary (latent or hidden) increase prolactin secretion. Occasional bursts of prolactin levels, combined with hyperestrogenemia cause bloating, breast tenderness (mastalgia). Hyperprolactinemia induced menstrual dysfunction causes abnormal steroidogenesis in the ovaries, which also exacerbates the morphological and functional abnormalities in the mammary glands, promotes dishormonal breast diseases and increases the risk of breast cancer. Due to the increase of cancer incidence in all countries is increased emphasis on early tumors diagnosis and prevention. Special nutrition and various diets are considered as one of the variants of the anti-tumor protection. Numerous studies in recent years devoted phytonutrients – substances of plant origin. Phytopreparation that can be used in these disorders is Epigalin Brest® that contained indole-3-carbinol, epigallocatechin-3-gallate and Vitex agnus castus extract. Indole-3-carbinol and epigallocatechin-3-gallate are biologically active substances with a well-deserved popularity among clinicians in Europe and the United States. Herbal drug Epigalin Brest® regulates the metabolism of estrogen by blocking the synthesis of its “aggressive” forms, reduces the level of prolactin, inhibits the abnormal proliferation in hormone-dependent organs (mammary gland) and tissues of the reproductive system. Also Epigalin Brest® has antiproliferative effects.

Proinflammatory cytokines and polycystic ovary syndrome

Abstract: Polycystic ovary syndrome (PCOS) is a common disease, with a detection rate from 6 to 20% depending on the used criteria. Today patients with obesity have been often diagnosed with PCOS, but also it diagnoses in women with normal body weight. So the population studies shows that between 30% and 70% of women with PCOS has a normal body weight. And if today find many of the mechanisms of its formation in patients who are overweight, the pathogenesis of PCOS in women with normal body weight at the present stage is completely unclear. Research took part in 120 women with normal weight, who was diagnosed polycystic syndrome ovary on the basis of clinical practice guidelines of Endocrine Society USA (2013), of them 80 women with PCOS run on the background of pelvic inflammatory diseases (PID). Participants were comparable in age and body mass index. Status of the system mediators inflammation studied on the determining level of interleukin-18 and myeloperoxidase in blood serum in first phase menstrual cycle. An analysis of the average pro-inflammatory cytokines in the serum of women with normal body weight and PCOS, which occurs on the background of PID found elevated levels of interleukin-18 – 262.87 ± 40.57 pg/ml and myeloperoxidase – 63.29 ± 4.13 ng/ml. A positive correlative relationship between the level of interleukin-18, and the index of free testosterone in women with PCOS on the background of PID (r = 0.7) (p < 0.05). It can be assumed that the inflammatory diseases of the genitalia play an important role in the formation of the PCOS manifestations in women with normal body weight due to increased production of proinflammatory cytokine interleukin-18 and myeloperoxidase, which may be a prerequisite for circulatory disorders in ovarian, folliculogenesis processes and hormone production.

Імуно-морфологічні особливості розвитку гіперпластичних процесів ендометрія

Abstract: The aim of the study was to evaluate the immuno-morphological features of endometrial hyperplastic processes by determining the expression of dendritic cells (CD56+, CD83+, CD1a+) and apoptotic factors (Bcl-2 and Вах) in simple and atypical endometrial hyperplasia. Materials and methods. The study involved 25 women with simple hyperplasia (group I), 25 – atypical hyperplasia (group II), control group consisted of 20 healthy women. Determination of dendritic cells in the endometrial biopsies performed by immunohistochemical method using monoclonal antibodies LIR, Dardilly (France) to CD56+, CD83+, CD1a+. Expression of the antiapoptosis protein Bcl-2 and proapoptosis protein Вах was observed in the cytoplasm of cells and differed in intensity staining. Results. Immunohistochemical study of endometrial biopsies found that dendritic cells that expressed antigens CD56+, CD83+, CD1a+, showed a high level of expression. In this case, the severity and nature of immune disorders that accompany pathological endometrial transformation depends not only on the severity of its morphological changes, but also on the duration of the procedure (r = 0,61) and the presence of comorbidity (rA = 0,66). At the same time we found that the degree of expression of factors Bcl-2 and Вах was weak to moderate in women with simple and atypical hyperplasia of the endometrium and negative – in healthy women. The level of expression of markers of apoptosis in group II patients correlated (r = 0,54) with the severity of expression of immature dendritic cells CD1a+. This demonstrates the important role of the functional state of dendritic cells in the regulation of cell proliferation and apoptosis activity in women with endometrial hyperplasia.