ISSN / EISSN : 2309-4117 / 2411-1295
Current Publisher: Publishing Office TRILIST (10.18370)
Total articles ≅ 622
Latest articles in this journal
Reproductive Endocrinology pp 38-42; doi:10.18370/2309-4117.2020.56.38-42
Objective of the study: improvement of diagnostic methods for pregnant women with tumor-like formations and ovarian tumors.Materials and methods. 60 pregnant women were examined and divided into 3 groups: group I – 28 pregnant women with ovarian tumors who underwent surgical treatment during pregnancy; group II – 21 women with ovarian tumors who underwent surgical treatment at various times after spontaneous delivery; group III (control) – 11 women with a normal course of pregnancy without ovarian tumors.Doppler ultrasound was performed on a mandatory basis at the screening time, and as well as needed. MRI was performed in 8 diagnostically difficult cases. In the II trimester of pregnancy at 12–24 weeks in 49 women with ovarian tumors tumor markers were determined: CA-125, HE-4, β2-microglobulin, transthyretin, transferrin and apolipoprotein A-I, and combined ROMA and RMI indices.Results. The analysis showed the characteristic echographic signs of most ovarian tumors in pregnant women. The overall accuracy of ultrasound in determining the ovarian tumor structure at the outpatient level was extremely low and amounted to 21.8%, in a specialized medical institution it was 79.2%. In the diagnosis of mature teratomas were found MRI sensitivity and specificity of 100%, less diagnostic value (sensitivity 91.7%, specificity 96.9%) was typical for endometrioid ovarian cysts. MRI efficiency in detecting malignant potential (borderline and malignant tumors) was quite high (sensitivity 80.0%, specificity 97.4%).The presence of any ovarian tumor, except for mature teratomas, was accompanied by a significant increase in CA-125 level. The strongest correlation was found for RMI index and CA-125 and HE-4 tumor markers.Conclusions. Doppler ultrasound and MRI are complementary highly informative methods for diagnosing ovarian tumors in pregnant women. Tumor markers used for the differential diagnosis of benign and malignant tumors outside pregnancy (CA-125, HE-4, apolipoprotein A-I, transferrin, transthyretin, β2-microglobulin) do not have a high enough diagnostic value in ovarian tumors in pregnant women, therefore their tests should be supportive.
Reproductive Endocrinology pp 18-22; doi:10.18370/2309-4117.2020.56.18-22
On September 11–12, 2020, in Kyiv hosted the International Women's Health Summit “From Menarche to Menopause” with the participation of leading foreign and domestic experts in the field of obstetrics and gynecology. The event was devoted to such topical topics as miscarriage, infertility, menstrual irregularities, menopausal hormone therapy (MHT).The current concern in clinical practice is not overuse of MHT, but it underutilization, and the fact that only a small number of women with impaired quality of life through menopausal symptoms receive treatment, despite that they perfectly fit the patient's profile for such therapy.All types of MHT are characterized by following effects: a positive effect on the cardiovascular system if MHT was start before 60 ages or in the first 10 years after menopause onset; the mortality rate from all causes is not increased in patients on MHT. The “ideal” MHT should relieve vasomotor symptoms, influence urogenital symptoms, prevent fractures and bone loss, protect the cardiovascular system and endometrium, and should not increase the risks of breast cancer, deep vein thrombosis and pulmonary embolism. Estradiol + dydrogesterone (Femoston®) scheme fits perfectly into these criteria. Femoston® is an oral MHT preparation that is effective in relieving symptoms of estrogen deficiency with a proven safety profile on the cardiovascular system and breast. This drug helps to reduce the manifestations of symptoms of estrogen deficiency, increase bone mineral density, and has a positive effect on metabolic processes. Numerous studies have shown that combination of estradiol + dydrogesterone is not only highly effective against menopausal symptoms, but also extremely important features, in particular, a proven safety profile for breast cancer.
Reproductive Endocrinology pp 23-34; doi:10.18370/2309-4117.2020.56.23-34
The article presents literature data on the role of inositol and its derivatives in human body, results of the myo-inositol (MI) use in gynecological diseases, treatment of female and male infertility, including in cycles of assisted reproductive technologies, in the prevention of gestational and perinatal complications. It has been shown that the inability to adequately synthesize or metabolize inositol can contribute to disturbances in the transmission of intracellular signals, disturbances in the activity of insulin signaling cascades, development of insulin resistance and hyperinsulinemia, which cause abnormal steroidogenesis in the gonads and metabolic disorders.The concept of “D-chiro-inositol paradox” is highlighted, according to which women with polycystic ovary syndrome are characterized by increased epimerization of MI to D-chiro-inositol, depletion of MI reserves and low oocyte quality. Prescribing biologically active supplements with MI and folic acid for pregnant women reduces the likelihood of threatened abortion, preeclampsia, placental dysfunction, gestational diabetes mellitus, diabetic fetopathy, malformations, oxidative stress in the fetus.Experience has also been accumulated about myo-inositol use in andrology: it plays a decisive role in osmoregulation of seminal fluid and, as a consequence, increasing the progressive sperm motility and speed, increasing the mitochondrial sperm potential, improves libido and potency, helps to increase the endogenous testosterone, and normalizes the men’s hormonal balance. Inositol is a synergist of folates and other B vitamins and significantly potentiates their effect on the human body; it is the basis for the advantages of using combined biological supplements such as Miofolic® and Miofolic® MEN in the clinic for female and male reproduction. Harmonious use of all possible reserves of micronutrient support for the preconception and gestational period with the use of biologically active supplements of MI in combination with folic acid and vitamin B12 is a promising preventive and therapeutic agent in supporting of reproductive system, embryo development, neuroprotection of the fetal brain, ensuring the activity of signaling cascades insulin.
Reproductive Endocrinology pp 49-56; doi:10.18370/2309-4117.2020.56.49-56
Antibiotic resistance (AR) is one of the leading and still far from solving the problems of mankind. Implementation of strategies for controling AR at different levels is a priority task, since crisis of the possibilities of creating new antibiotics is obvious. Implementation of this strategy in the medical field consists in the rational use of antibacterial agents and hygienic control of the spread of multiresistant strains.One of the ways to rationalize the use of antimicrobial agents was WHO AWaRe classification, the purpose of which is to expand the use of narrow-spectrum antibiotics and limit the misuse of reserve groups and drugs with growing resistance levels. Implementation of these tasks is impossible without microbiological studies. Laboratory diagnostics of the infectious causes has undergone significant improvement – automation, availability of routine determination of resistance markers. The review presents the main mechanisms of AR development by common pathogens and possibility of their reflection in resistance markers.An important milestone in 2020 was the Infectious Diseases Society of America (IDSA) clinical guideline for treatment of infectious caused by common multi-resistant gram-negative bacteria. In contrast to previous clinical guidelines, this makes the prescription of antibacterial drugs primarily on information about resistance markers, antibiotic susceptibility, and also on the location of infection. The purpose of the IDSA-2020 clinical guidelines is to assist clinicians in making decisions in treatment of infections caused by extended-spectrum β-lactamase or carbapenemase-producing Enterobacteriaceae bacteria and Pseudomonas feruginosa multi-drug resistant. The review presents the main points of this clinical guideline.Thus, effective treatment of infections caused by antibiotic-resistant microorganisms is possible due to contemporary microbiological methods according to evidence-based clinical guidelines. Automated microbiological research systems significantly expand the clinical possibilities of effective treatment of infections and epidemiological control of resistant strains.
Reproductive Endocrinology pp 64-72; doi:10.18370/2309-4117.2020.56.64-72
Acute pancreatitis during pregnancy is a rare but extremely formidable complication and accompanied by a high level of perinatal and maternal mortality. Excessive hypertriglyceridemia is an extremely important risk factor for pancreatitis, especially during pregnancy. The secretion of cholesterol in hepatic bile increases in the second trimester and reaches a peak in the third trimester compared with bile acids and phospholipids, which leads to a supersaturation of bile. This is determines the highest incidence of acute pancreatitis in pregnant women in the third trimester. Acute onset, nature of the disease and difficulties in diagnosis and treatment of acute pancreatitis in pregnant women significantly threaten the health of mother and fetus. Although most authors argue that treating acute pancreatitis during pregnancy is similar to treating non-pregnant patients, this is actually far from the truth. Pathogenesis features of acute pancreatitis in pregnant women come to the fore, which must be taken into account when managing these patients. Medical workers (primarily obstetricians) have a question about the advisability of preserving pregnancy, fetus, timing and method of abortion, and today these are extremely controversial decisions.Management of pregnant women with acute pancreatitis is an extremely difficult task, despite the achievements of recent years, and is accompanied by high perinatal and maternal mortality, the level of which depends on the severity of acute pancreatitis.The severe course of acute pancreatitis in pregnant women is extremely dangerous for the fetus and in all cases leads to its distress and in more than half of cases to fetal loss. The average severity of pancreatitis is also unfavorable for the fetus and is accompanied by its loss in every fourth case. Emergency abortion is indicated if triglycerides are the cause of acute pancreatitis. Management of such pregnant women requires a multidisciplinary approach to predict the course of pancreatitis, determine the tactics of pregnancy and acute pancreatitis, method and timing of delivery.
Reproductive Endocrinology pp 43-46; doi:10.18370/2309-4117.2020.56.43-46
This article highlights one of the most important medical and social problems – an increase in the number of diseases of the female reproductive system caused by microorganisms and the insufficient effectiveness of modern antimicrobial medicines, absence of medicine with antibiofilm action. This prompts the authors to search for products that increase the effectiveness of antibiotic therapy, as well as medicines that can suppress film formation and disrupt the biofilm structure. The article presents the results of studying the biofilms sensitivity formed by Staphylococcus spp. to the action of the enzyme preparation Distreptasa® Distrept and its effect on the specific antibacterial activity of clindamycin.Purpose of the study: to evaluate the Distreptasa® Distrept impact on the specific effect of clindamycin against the biofilms of Staphylococcus aureus and Staphylococcus epidermidis.Materials and methods: one-day cultures of S. aureus 222 and S. epidermidis 297 were used in the experiments. Solutions of drugs and microorganisms were added simultaneously, with the action on the formed biofilms – 24 hours after the introduction of the bacterial inoculum to study the effect of medicines on film formation. Experiments were carried out according to the generally accepted technique based on the sorption of gentian violet by biofilm structures with subsequent desorption of the dye into an organic solvent.Results: the experiments showed that Distreptasa® Distrept interferes with the film formation of Staphylococcus spp. (S. aureus inhibition in 85.4%, S. epidermidis in 20.3%). Distreptasa® Distrept affects the biofilms formed by S. aureus, the biomass of S. aureus decreases by 59.5%. It was found that Distreptasa® Distrept enhances the specific activity of clindamycin, both at the stage of film formation, and on the formed biofilms.Conclusions: the medicine Distreptasa® Distrept has antibiofilm activity, increases the specific antibacterial effect of clindomycin against biofilms of gram-positive microorganisms. This allows us to talk about the prospects for this drug use as monotherapy in chronic recurrent diseases of the genital tract, as well as in combination with antimicrobial drugs.
Reproductive Endocrinology pp 88-94; doi:10.18370/2309-4117.2020.56.88-94
Progesterone is essential for the maintenance of pregnancy, and progesterone deficiency is associated with miscarriage. The subject of whether progesterone supplementation in early pregnancy can prevent miscarriage has been a long-standing research question and has been investigated and debated in the medical literature for over 70 years. During this time, several different progestogens have been synthesised and tested for the prevention of miscarriage. In this article described the prior evidence alongside the latest research using micronized natural progesterone as well as synthetic progestogens, which were used to treat both recurrent and threatened miscarriage. The totality of evidence indicates that women with a past history of miscarriage who present with bleeding in early pregnancy may benefit from the use of vaginal micronized progesterone. The clinical implications of the findings are discussed.
Reproductive Endocrinology pp 96-99; doi:10.18370/2309-4117.2020.56.96-99
Polycystic ovary syndrome (PCOS) is a symptom complex associated with increased amounts of circulating androgens in females, increased insulin resistance and obesity. The drugs, Myo-inositol, D-chiro-inositol and Metformin, which are insulin sensitizers, are very helpful in taking care of one of the key components of PCOS that is insulin resistance. Myoinositol and D-chiro-inositol are isomeric forms of inositol that have insulin-like properties, acting as second messengers in the insulin intracellular pathway; both of these molecules are involved in the increasing insulin sensitivity of different tissues to improve metabolic and ovulatory functions.This study was done to compare the effects of combination of Myo-inositol and D-chiro-inositol with the use of metformin on clinical and biochemical profile in PCOS.Methods. A prospective, randomized, comparative study was conducted on 200 patients. The patients were randomly assigned into the two groups of 100 each. Group A receiving Tab. Myoinositol 550mg twice daily and Tab. D-chiro-inositol 13.8mg twice daily and Group B receiving Tab. Metformin 500mg thrice daily. The patients were assessed by menstrual cycle regulation, hirsutism score (Ferriman Gallwey), fasting and postprandial glucose and insulin levels, serum dehydroepiandrosterone levels, serum free testosterone levels and serum luteinizing and follicle stimulating hormone ratio.Results. In both the groups there was significant improvement in all the above mentioned parameters, however the group with Combination of Myo-inositol and D-chiro-inositol had statistically significant improvement over the Metformin group.Conclusions: Combination of Myo-inositol and D-chiro-inositol and use of metformin, significantly improved insulin sensitivity in PCOS women. But combination of Myo-inositol and D-chiro-inositol was effective in controlling the hormonal profiles (luteinizing/follicle stimulating hormone ratio and free testosterone) when compared to Metformin.
Reproductive Endocrinology pp 8-12; doi:10.18370/2309-4117.2020.56.8-12
Purpose of the study – to analyze the structure and morbidity patterns of control of sexually transmitted infections (STI) for the period from 2014 to 2019 in accordance with data collected by the Statistical Department of the MoH of Ukraine.Materials and methods. It was analyzed data on the STI incidence in entire population, namely from 15 years to 60 years and older, female and male, the prevalence of diseases depending on the place of residence (city or village) was performed. Particular attention is paid to the STI analysis in women and men of reproductive age. Data from the temporarily occupied territories of the Autonomous Republic of Crimea, Donetsk, Luhansk Oblasts and the city of Sevastopol are missing.Results. The incidence of STI over 5 years (2014–2019) changed as follows: syphilis decreased by almost 1.5 times (from 8.65 to 6.01 per 100,000), but remained significantly high at reproductive age (13.25 vs. 9.56 per 100,000), men are more susceptible. Significant reduction in the incidence of gonorrhea from 14.85 to 7.97 per 100,000, by 1.8 times, but among men and women of reproductive age 2.5 and 3 times more (37.26 and 24.12 per 100,000), men are more susceptible. Cases of chlamydial infection decreased from 53.02 to 32.54 per 100,000, and were more common in the age group of 18–39 years, men are more susceptible. The incidence of trichomoniasis decreased by 1.6 times from 128.77 to 79.79 per 100,000. The incidence of trichomoniasis was the highest at reproductive age – 320.87 in 2014 and 210.78 in 2019 per 100,000, more often found in women. The incidence of urogenital mycoplasmosis also decreased over 5 years from 71.88 to 51.94 per 100,000, by 1.3 times, women are more susceptible. The urban population suffers from STI 2.5–3 times more than the rural population.Conclusion. STI is a national health problem in Ukraine. Prevention, early diagnosis and modern adequate treatment of a couple with STI are the key to reducing the incidence of male and female infertility.
Reproductive Endocrinology pp 57-62; doi:10.18370/2309-4117.2020.56.57-62
Non-alcoholic fatty liver disease (NAFLD) is currently the most common form of chronic liver disease, affecting 10–20% of the total pediatric population, including 8% of non-obese children and 50–80% of those who are obese.Purpose of the study was to determine the characteristics of vitamin D status in Ukrainian adolescent girls with NAFLD and metabolically unhealthy obesity.Materials and methods. 120 girls aged 12–17 years with NAFLD and metabolically unhealthy obesity, as well as 180 conditionally somatically healthy girls with normal sexual development and normal body weights (control group) were under observation. The examination set included clinical and anamnestic data, anthropometry, assessment of sexual development, clinical blood test, general urinalysis, coprogram, parasitological examination of feces, electrocardiography, lipid profile, glucose, insulin, HOMA index, alanine aminotransferase, aspartate aminotransferase, total protein, amylase, blood test for markers of hepatitis B, C, autoimmunological studies, ultrasound and elastography of the hepatobiliary system, consultation with an endocrinologist, gastroenterologist, according to the indications - cardiologist, pulmonologist, allergist and other specialists.Results. A characteristic feature of vitamin D status in adolescent girls with NAFLD and metabolically unhealthy obesity was its deficiency in 65.83% of cases, while in the control deficiency was observed less often 1.5 times – in 43.89 % of patients. The average 25(OH)D level in the group without steatosis was 22.00 ± 0.56 ng/ml, while in patients with NAFLD and metabolically unhealthy obesity it was 1.34 times lower – 16.44 ± 0.73 ng/ml. Conclusion. Correlation analysis showed the role of 25(OH)D deficiency in the development of diffuse liver diseases, disorders of lipid, carbohydrate, and purine metabolism in adolescent girls with NAFLD and obesity, that is requires an adequate correction of the status of this vitamin during treatment.