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Pybertygenesis progress' peculiarities of adolescent girls with gynecological pathology, born low or high to gestational weight 患有妇科病理、出生时体重低或高的青春期少女的产热进展特点
Pub Date : 2021-12-30 DOI: 10.15574/pp.2021.88.26
N. Pylypenko
The perinatal background plays one of the most important roles in the development of future mothers. The study of factors influencing the formation of puberty is an urgent issue for improving the demographic situation in the country. Purpose — to analyze the nature of the pubertogenesis's progress of adolescent girls depending on body weight at birth. Materials and methods. A retrospective analysis was made of the course of pregnancy and childbirth of mothers of girls born with low or overweight. Menstrual function and somatic status among the study groups were prospectively assessed to identify markers of start and puberty disorders. Results. The data obtained showed the reliability of the influence of body weight at birth on the development of menstrual function. Hypomenstrual syndrome was formed under the influence of fetal growth retardation syndrome, and vice versa, hypermenstrual syndrome was based on macrosomia in the antenatal period. Conclusions. The identified features provide an opportunity for further research for the timely optimization of the formation of risk groups in the fertile age. Step-by-step monitoring and predictive models for the formation and maintenance of the ovarian reserve of this cohort implement differentiated pregravid preparation at an early reproductive age. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: puberty, reproductive potential, low birth weight, macrosomia, menarche.
围产期背景对未来母亲的发展起着最重要的作用之一。研究影响青春期形成的因素是改善我国人口状况的迫切问题。目的:分析青春期女孩出生体重对青春期发育进程的影响。材料和方法。对出生时体重过轻或超重的女孩的母亲的妊娠和分娩过程进行了回顾性分析。对研究组的月经功能和躯体状态进行前瞻性评估,以确定启动和青春期障碍的标志物。结果。所获得的数据表明,出生时体重对月经功能发育的影响是可靠的。月经不足综合征是在胎儿生长迟缓综合征的影响下形成的,月经过多综合征是在产前巨大儿的基础上形成的。结论。确定的特征为进一步研究及时优化育龄期风险群体的形成提供了机会。该队列卵巢储备形成和维持的分步监测和预测模型在生育年龄早期实现了分化的妊娠前准备。这项研究是按照《赫尔辛基宣言》的原则进行的。研究方案经参与机构当地伦理委员会批准。获得患者的知情同意进行研究。作者未声明存在利益冲突。关键词:青春期,生殖潜能,低出生体重,巨大儿,初潮。
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引用次数: 0
The state of the provisional organs in the fetus with vital and lethal anomalies (literature review) 生命与致死畸形胎儿的临时器官状态(文献回顾)
Pub Date : 2021-12-30 DOI: 10.15574/pp.2021.88.44
G. Grebinichenko, I. Gordienko, I. Luk’yanova, O. M. Dzyuba, G. Medvedenko
Provisional organs (placenta, umbilical cord, amniotic membranes, amniotic fluid) play a significant role during pregnancy. Their normal morpho3functional state is an important condition for normal development and well3being of the fetus, as well as for uncomplicated course of pregnancy. Congenital malformations (CM) and chromosomal abnormalities are major causes of perinatal morbidity and mortality. For fetuses with malformations, dysfunction of the provisional organs (PO) can become critical and affect survival. Expert correct examination of PO during a comprehensive prenatal examination can become a diagnostic and prognostic tool for specialized management of fetuses as patients, and newborns to optimize the system of prenatal dispensary evaluation. Literature review has shown that there are certain patterns of the PO pathology in cases of fetal abnormal development, which require changes in the tactics of prenatal observation and delivery. The variability of morphological/ultrasound changes and clinical outcomes makes it difficult to reach definite diagnosis and make correct decisions about the management of patients in specific cases. Further research is needed to optimize the protocols of ultrasound examinations and prediction of perinatal complications in the pathology of the PO in fetuses with normal and abnormal development. No conflict of interests were declared by the authors. Key words: prenatal diagnosis, provisional organs, placenta, umbilical cord, amniotic membrane, amniotic fluid, vital and lethal congenital malformations, perinatal consequences, fetus.
临时器官(胎盘、脐带、羊膜、羊水)在怀孕期间起着重要作用。它们正常的形态功能状态是胎儿正常发育和健康的重要条件,也是妊娠顺利进行的重要条件。先天性畸形(CM)和染色体异常是围产期发病率和死亡率的主要原因。对于畸形胎儿,临时器官(PO)的功能障碍可能变得至关重要并影响生存。在全面产前检查中对PO进行专家正确的检查,可以成为胎儿作为患者进行专科管理和新生儿优化产前药房评价体系的诊断和预后工具。文献综述表明,在胎儿发育异常的情况下,有一定的PO病理模式,这需要改变产前观察和分娩的策略。形态学/超声变化和临床结果的多变性使得在特定病例中难以做出明确的诊断和正确的治疗决策。在正常和异常发育的胎儿中,超声检查方案的优化和围产期并发症的预测需要进一步的研究。作者未声明存在利益冲突。关键词:产前诊断,临时器官,胎盘,脐带,羊膜,羊水,生命和致命先天性畸形,围产期后果,胎儿。
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引用次数: 0
Assessment of the state of personal and situational anxiety and indicators of stress-implementing and stress-limiting systems of the organism as marker efficiency the antenatal preparation 评估个人和情境焦虑状态,以及机体压力实施和压力限制系统的指标,作为产前准备的标志效率
Pub Date : 2021-09-29 DOI: 10.15574/pp.2021.87.17
N. Skripchenko, Y. Nevyshna
As a result of research conducted on the basis of the State Institution «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova NAMS of Ukraine», the issue of the transcranial electrostimulation introduction in preparation for partnership labor was shown. Purpose — to study the features of changes in the state of personal and situational anxiety, stress-implementing and stress-limiting systems of the body in healthy women depending on the method of prenatal training. Materials and methods. 120 somatically healthy women without severe extragenital and obstetric pathology with a physiological course of singleton pregnancy were examined. In the first group — 45 women set up for partner childbirth, the second group also included 45 patients who underwent a course of transcranial electrical stimulation (TES) of mesodiencephalic structures of the brain in comprehensive preparation for partner childbirth. The control group included 30 women who did not receive prenatal training, did not have individual support in childbirth and were tuned to traditional methods of pain relief as needed. Results. Following the results of the determination of pain rate in the dynamic of the TES procedure, a progressive growth of the pain tolerance threshold was recorded with the subsequent stabilization of this value after the 5th procedure of electrical stimulation. Methods of psychophysical preparation for childbirth using transcranial electrostimulation and partner support made it possible to reduce medical induced pain relief during childbirth, which is what the data we obtained indicate. Conclusions. The use of TES in complex prenatal preparation for partner labor allows to achieve and maintain a stable psycho-emotional adaptation of pregnant women and increases the tolerance of the consonant to labor pain without additional medication load, which helps to make more physiological course of labor. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: labor, prenatal preparation, transcranial electrostimulation, pain threshold, anesthesia, partnership labor.
根据国家机构“以乌克兰院士O.M. Lukyanova NAMS命名的儿科,产科和妇科研究所”进行的研究结果,显示了为伙伴劳动准备引入经颅电刺激的问题。目的:研究产前训练方法对健康女性个体焦虑状态、情境焦虑状态、压力执行系统和压力限制系统变化的特点。材料和方法。对120名身体健康、无严重生殖外和产科病理、单胎妊娠生理过程的妇女进行了检查。在第一组中,45名妇女准备伴侣分娩,第二组也包括45名患者,她们接受了经颅电刺激(TES)大脑中间脑结构的一个疗程,为伴侣分娩做全面的准备。对照组包括30名妇女,她们没有接受产前培训,在分娩时没有个人支持,并根据需要调整到传统的镇痛方法。结果。根据TES过程中疼痛率的动态测定结果,记录疼痛耐受阈值的逐渐增长,并在第5次电刺激过程后该值趋于稳定。使用经颅电刺激和伴侣支持为分娩做心理生理准备的方法可以减少分娩时药物引起的疼痛缓解,这是我们获得的数据所表明的。结论。在复杂的伴产产前准备中使用TES,可以实现并保持孕妇稳定的心理-情绪适应,增加辅音对分娩疼痛的耐受性,而无需额外的药物负荷,有助于使分娩过程更加生理性。这项研究是按照《赫尔辛基宣言》的原则进行的。研究方案经参与机构当地伦理委员会批准。获得患者的知情同意进行研究。作者未声明存在利益冲突。关键词:产程,产前准备,经颅电刺激,痛阈,麻醉,伴产。
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引用次数: 0
Concentration of 25(OH)D in blood serum and certain aspects of the clinical course of juvenile scleroderma 血清25(OH)D浓度与少年硬皮病临床病程某些方面的关系
Pub Date : 2021-09-29 DOI: 10.15574/pp.2021.87.44
L. Omelchenko, O. Mukvich, D.L. Ismakaeva, O. Belskaya, T. A. Ludvik
Purpose — to assess the vitamin D supply in children and adolescents with systemic juvenile scleroderma (JS), taking into account its onset and clinical course at different periods of the child's development. Materials and methods. 14 children of 1 year 3 months —17 years old with systemic JS and 10 healthy children of the control group were examined. The concentration of 25(OH)D was determined in blood serum using commercial kits Vitamin D3 — Screeningkit, Switzerland, according to the manufacturer's instructions. Results. All patients with systemic JS showed a decrease in serum 25(OH)D levels — (24.55±9.32) ng/ml, compared to healthy children — (39.98±3.11) ng/ml. The lowest concentrations of the circulating form of vitamin D in the blood serum were in patients with limited form of systemic JS with Parry–Romberg hemiatrophy and «saber strike» — (14.07±3.38) ng/ml, as well as with the onset of generalized rapidly progressive JS in children at puberty — (16.31±4.6) ng/ml. Conclusions. Children with JS are shown to assess their vitamin D status by monitoring the serum concentration of 25(OH)D in order to decide whether to prescribe vitamin D supplements. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: children, juvenile scleroderma, vitamin D.
目的-评估系统性少年硬皮病(JS)儿童和青少年的维生素D供应,考虑其在儿童发展的不同时期的发病和临床病程。材料和方法。选取14例1 ~ 3个月~ 17岁的全身性JS患儿和10例健康儿童作为对照组。根据制造商的说明,使用商业试剂盒维生素D3 - Screeningkit,瑞士测定血清中25(OH)D的浓度。结果。与健康儿童(39.98±3.11)ng/ml相比,所有系统性JS患者血清25(OH)D水平均下降(24.55±9.32)ng/ml。血液中循环形式维生素D的最低浓度出现在伴有Parry-Romberg偏瘫和“saber strike”的有限形式系统性JS患者中,为(14.07±3.38)ng/ml,以及青春期开始出现全身性快速进行性JS的儿童中,为(16.31±4.6)ng/ml。结论。患有JS的儿童可以通过监测血清25(OH)D的浓度来评估他们的维生素D状态,以决定是否开维生素D补充剂。这项研究是按照《赫尔辛基宣言》的原则进行的。研究方案经参与机构当地伦理委员会批准。获得患者的知情同意进行研究。作者未声明存在利益冲突。关键词:儿童,少年硬皮病,维生素D
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引用次数: 0
Alternative methods in the management of preeclampsia. Analytical inspection 子痫前期治疗的替代方法。分析检验
Pub Date : 2021-09-29 DOI: 10.15574/pp.2021.87.56
G. Ischenko
There are many alternative drugs for the prevention and treatment of preeclampsia in the new research. This drugs can effect on the underlying pathophysiology of the disease: oxidative stress, antiangiogenic factors, as well as angiotensin, nitric oxide and various parts of the inflammatory process. Thus, they affect the disease of the placenta or endothelium. The proposed treatments are currently undergoing preclinical and clinical trials. Pravastatin was of the greatest interest among all the proposed therapeutic agents. It has pleiotropic effect, i.e. affects multiple molecular targets against preeclampsia. Proton pump inhibitors, metformin, and sulfasalazine are other drugs that have preclinical evidence of multiple molecular actions that may address the pathophysiology of preeclampsia. Currently, these molecules are also in clinical trials. Many natural compounds for the treatment of preeclampsia, such as plant extracts and trace elements, are being researched to identify the potential in anti-inflammatory or antioxidant activity. Monoclonal antibodies are another direction is new molecular-oriented strategies. They are targeting tumor necrosis factor alpha, placental growth factor and short interfering RNA technology to inhibit the expression of soluble fms-like tyrosine kinase-1 or angiotensinogen. Folic acid, nitric oxide donors (such as L-arginine), recombinant antithrombin III, and immunogenic digoxin antigen and melatonin are other treatment approaches that have been tested in humans (ranging from single-group studies to phase III trials that have been completed or are ongoing). The series of cases demonstrated that removal of circulating soluble fms-like tyrosine kinase-1 can help stabilize the disease and prolong pregnancy. Monoclonal antibodies such as eculizumab (a complement inhibitor) may have therapeutic potential. Thus, the identified alternative drugs in the treatment and prevention of preeclampsia create the potential to improve maternal health and pregnancy. No conflict of interests was declared by the author. Key words: preeclampsia, pregnancy, pravastatin, metformin, sulfalazine
在新的研究中,有许多预防和治疗子痫前期的替代药物。这种药物可以影响疾病的潜在病理生理:氧化应激,抗血管生成因子,以及血管紧张素,一氧化氮和炎症过程的各个部分。因此,它们影响胎盘或内皮的疾病。建议的治疗方法目前正在进行临床前和临床试验。在所有提出的治疗药物中,普伐他汀是最令人感兴趣的。它具有多效性,即对子痫前期的多个分子靶点起作用。质子泵抑制剂、二甲双胍和磺胺氮嗪是其他具有临床前证据的多分子作用的药物,可能解决子痫前期的病理生理问题。目前,这些分子也在临床试验中。许多用于治疗先兆子痫的天然化合物,如植物提取物和微量元素,正在进行研究,以确定其抗炎或抗氧化活性的潜力。单克隆抗体是分子定向新策略的另一个方向。他们针对肿瘤坏死因子α、胎盘生长因子和短干扰RNA技术抑制可溶性蛋白样酪氨酸激酶-1或血管紧张素原的表达。叶酸、一氧化氮供体(如l -精氨酸)、重组抗凝血酶III、免疫原性地高辛抗原和褪黑素是其他已在人体中进行测试的治疗方法(从单组研究到已完成或正在进行的III期试验)。这一系列病例表明,去除循环可溶性蛋白如酪氨酸激酶-1可以帮助稳定疾病并延长妊娠期。单克隆抗体如eculizumab(一种补体抑制剂)可能具有治疗潜力。因此,已确定的治疗和预防先兆子痫的替代药物有可能改善孕产妇健康和妊娠。作者未声明存在利益冲突。关键词:先兆子痫,妊娠,普伐他汀,二甲双胍,磺胺嘧啶
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引用次数: 0
Optimization of pneumonia complex therapy in children with acute respiratory diseases 急性呼吸道疾病患儿肺炎综合治疗的优化
Pub Date : 2021-09-29 DOI: 10.15574/pp.2021.87.38
I.I. Pylyuk
Purpose — to improve the pathogenetic treatment of pneumonia in children with recurrent acute respiratory infections by combining of protocol therapy with a drug has antioxidant, antihypoxic and organoprotective effects. Materials and methods. The analysis of the results of clinical, laboratory and instrumental methods of examination of children with pneumonia at the age of 3–8 years which have recurrent acute respiratory infections has performed. Children have had received standard protocol treatment of pneumonia and combination with a drug has antioxidant, antihypoxic and organoprotective effects. Results. Optimization the protocol treatment of pneumonia in children with recurrent acute respiratory infections by supplementing pathogenetic therapy with this drug made possible to improve the efficiency of treatment, what confirmed by the rapid regression of clinical manifestations of pneumonia (intoxication — to 1.9±0.04 days, cough — to 2.1±0.08 days, respiratory failure — to 1.7±0.08 days, shortness of breath — to 1.3±0.04 days, disorders of microcirculation and hemodynamics — to 2.1±0.05 and 1.8, respectively ± 0.09 days). This approach calls the decrease of percentage of children with pneumonic infiltration according to the control X-ray examination of the lungs — to 30.0%, myocardial hypoxia according to the ECG results — 20.0%, which made possible to reduce the duration of the course of antibiotic therapy to 2.0±0.04 days, inpatient treatment — to 2.2±0.08 bed-days. The positive dynamics laboratories values, clinical signs and instrumental methods of examination of such children occurred due to an increasing levels of glutathione reductase and glutathione transferase in the blood serum to 4 and 3 times, respectively, and a decreasing the content of glutathione peroxidase and gamma$glutamyl transpeptidase to 2.6 and 1.6 times. Conclusions. Supplement the protocol therapy of pneumonia in children with recurrent acute respiratory infections with a drug has antioxidant, antihypoxic and organoprotective effects promoted a rapid regression of clinical manifestations due to the improvement of the functional activity of the oxidative system of glutathione, which made possible to reduce the duration of the course of antibiotic therapy and inpatient treatment. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: children with recurrent acute respiratory infections, pneumonia, treatment.
目的:通过方案治疗联合具有抗氧化、抗缺氧和器官保护作用的药物,提高复发性急性呼吸道感染患儿肺炎的病原学治疗效果。材料和方法。对3 ~ 8岁肺炎患儿反复急性呼吸道感染的临床、实验室和仪器检查结果进行了分析。儿童已经接受了肺炎的标准治疗方案,并与一种具有抗氧化、抗缺氧和器官保护作用的药物联合使用。结果。优化肺炎复发性急性呼吸道感染患儿的治疗方案,辅以病机治疗,可提高治疗效率,肺炎临床表现(中毒-至1.9±0.04天,咳嗽-至2.1±0.08天,呼吸衰竭-至1.7±0.08天,呼吸短促-至1.3±0.04天,微循环和血流动力学紊乱-)迅速消退分别为2.1±0.05和1.8±0.09天)。该方法将肺部x线对照检查显示的肺浸润患儿比例降低至30.0%,心电图结果显示的心肌缺氧患儿比例降低至20.0%,从而使抗生素疗程缩短至2.0±0.04天,住院治疗时间缩短至2.2±0.08床日。由于血清谷胱甘肽还原酶和谷胱甘肽转移酶水平分别升高至4倍和3倍,谷胱甘肽过氧化物酶和谷胱甘肽转肽酶含量分别降低至2.6倍和1.6倍,这些儿童的阳性动态实验室值、临床体征和仪器检查方法均出现阳性。结论。在复发性急性呼吸道感染患儿肺炎方案治疗的基础上,补充具有抗氧化、抗缺氧和器官保护作用的药物,通过提高谷胱甘肽氧化系统的功能活性,促进临床表现的快速消退,从而缩短抗生素治疗和住院治疗的疗程。这项研究是按照《赫尔辛基宣言》的原则进行的。本研究方案经所有参与机构的当地伦理委员会批准。获得患者的知情同意进行研究。作者未声明存在利益冲突。关键词:儿童反复急性呼吸道感染,肺炎,治疗。
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引用次数: 0
Bacterial vaginosis and vulvovaginal candidiasis in women of reproductive age with overweight and obesity 超重和肥胖育龄妇女细菌性阴道病和外阴阴道念珠菌病
Pub Date : 2021-09-29 DOI: 10.15574/pp.2021.87.70
K. Gasparyan
In a review article of literary sources, domestic, foreign authors and their own research, modern views are highlighted, often problems and debatable, the prevalence of bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) among women with overweight and obesity, women of reproductive age. Vulvovaginal candidiasis (VVC) It ranks second among all vaginal infections and is one of the most common mental reasons for women to visit a gynecologist. Obesity and overweight play an important negative role in gynecological and obstetric practice. There has been a significant increase in C. albicans non-albicans in overweight women of reproductive age, and has a negative effect on the reproductive health of women. The article presents the results of a comparative study on the clinical and laboratory effectiveness of local therapy for bacterial vaginosis and IHC in overweight women. Against the background of metabolic disorders, there is an increase in the frequency of infectious pathology of the urogenital tract. Numerous literature data indicate that fungi of the city of Candida are part of various microbial associations and an important factor in their active growth is the deficiency of lactobacilli that produce H2O2. Data on bacterial vaginosis and vulvovaginal candidiasis, development and role of metabolic disorders in the pathogenesis of BV and VVC are presented. Increasing the effectiveness of local treatment of disorders of the vaginal biocenosis in women with overweight and obesity by using individualized dietary nutrition, means of correcting the intestinal biocenosis and metabolic therapy, an integrated approach to the therapy of women of reproductive age showed more effective results. It has been found that overweight and obesity negatively affect the reproductive system of women. Irregular menstrual cycles, secondary amenorrhea, infertility, endometrial hyperplastic processes are often associated with overweight and obesity. In many cases, BV is combined with intestinal dysbiosis. In this case, vaginosis can be considered as a manifestation of a systemic dysbiotic process, affects not only the microbiota of the genitourinary system, but also the endogenous microflora in various cavities of the macroorganism, provided that it is influenced by any exogenous and endogenous factors. No conflict of interest was declared by the author. Key words: bacterial vaginosis, vulvovaginal candidiasis, overweight, obesity.
在一篇综述文献来源,国内外作者和自己的研究,现代观点强调,往往存在问题和争议,细菌性阴道病(BV)和外阴阴道念珠菌病(VVC)的流行超重和肥胖妇女,育龄妇女。外阴阴道念珠菌病(VVC)在所有阴道感染中排名第二,是女性去看妇科医生最常见的心理原因之一。肥胖和超重在妇产科实践中起着重要的负面作用。在体重过重的育龄妇女中,非白色念珠菌显著增加,对妇女的生殖健康产生负面影响。本文介绍了超重妇女细菌性阴道病和免疫组化局部治疗的临床和实验室效果的比较研究结果。在代谢紊乱的背景下,泌尿生殖道感染病理的频率有所增加。大量文献资料表明,念珠菌城的真菌是各种微生物群落的一部分,其活跃生长的一个重要因素是缺乏产生H2O2的乳酸菌。在细菌性阴道病和外阴阴道念珠菌病,发展和代谢紊乱在BV和VVC的发病机制中的作用的数据。通过个体化饮食营养、肠道生物病变矫正和代谢治疗等手段,提高超重肥胖女性阴道生物病变局部治疗的有效性,综合治疗育龄女性效果更佳。研究发现,超重和肥胖会对女性的生殖系统产生负面影响。月经周期不规律、继发性闭经、不孕症、子宫内膜增生性病变常与超重和肥胖有关。在许多情况下,细菌性阴道炎合并肠道生态失调。在这种情况下,阴道病可以被认为是一种全身性的生态失调过程的表现,它不仅影响泌尿生殖系统的微生物群,而且还影响宏观生物各腔内的内源性微生物群,只要它受到任何外源性和内源性因素的影响。作者未声明存在利益冲突。关键词:细菌性阴道病,外阴阴道念珠菌病,超重,肥胖。
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引用次数: 0
Colposcopic and cytological parallels in pregnant women with a history of infertility of various genesis 有各种原因的不孕症史的孕妇的阴道镜检查和细胞学比较
Pub Date : 2021-09-29 DOI: 10.15574/pp.2021.87.5
Е.V. Kolomiiets
The state of the cervix was studied in pregnant women with a history of infertility of various genesis by colposcopic and cytological research methods. The data obtained indicate an increased level of precancerous pathology of the cervix in pregnant women with a history of tubo-peritoneal and concomitant infertility, compared with pregnant women who had endocrine infertility. Purpose — to determine the relationship between the nature and severity of colpocoscopic and cytological changes in the cervix in pregnant women who had a history of infertility. Materials and methods. 101 women were examined: 14 pregnant women with a history of endocrine infertility, group 1; 27 pregnant women with a history of tuboperitoneal infertility — group 2; 40 pregnant women, had combined infertility — group 3, 20 healthy pregnant women with no history of infertility — group 4. Methods for assessing the state of the cervix in pregnant women — video colposcopic and cytological (on glass). Results. Normal cytological changes (NILM) were found: in group 1–8 (57.2%), in group 2 — in 15 (55.6%), in group 3 — in 23 (57.5%), in group 4, 14 (70.0%) pregnant women. Benign cytological and ASCUS signs were: in group 1 — in 5 (35.7%), in group 2 — in 6 (22.2%), in group 3 — in 10 (25.0%), in group 4 — in 5 (25%) patients. Precancer (LSIL+HSIL): in group 1 — in 1 (7.1%), in group 2 — in 6 (22.2%), in group III — in 9 (22.5%) women, and in group 4, no precancers were found cytologically. Normal colposcopic signs (stratified squamous epithelium) were found: in group 3 — in 11 (27.5%), in group 2 — in 8 (29.6%), and in group 1 — in 7 (50.0%) pregnant women. And benign colposcopic changes (ectopia, open glands, Nabotovi cysts, deciduosis): in group 3 — in 19 (47.5%), in group 2 — in 16 (59.3%), in group 1 — in 6 (42.9%), in group 4 — in 5 (35.7%) patients. Our data indicate that precancers during colposcopy occurred: in group 3 — in 9 (22.5%), in group 2 — in 3 (11.1%), in group 1 — in 1 (7.1%), in group 4 — in 1 (5.0%) women. No colposcopic signs of invasive growth were found in any of the groups. Conclusions. The study revealed an increased level of precancerous pathology of the cervix in pregnant women with a history of tubo-peritoneal and concomitant infertility. A fairly high percentage of precancerous conditions of the cervix in group 2 — in 6 (22.2%) and in group 3 — in 9 (22.5%) women indicates that in the presence of Human papillomavirus (HPV) and other genital infections and with increasing age, the probability self-elimination of the papilloma virus is reduced. After long-term infertility treatment, all pregnant women must undergo a colposcopic examination at the first visit to the antenatal clinic, in addition to taking a cytological smear. If LSIL and HSIL are found in this category of women, colposcopic and cytological control once every 3 months during pregnancy with mandatory HPV PCR HCR. The research was carried out in accordance with the principles of the Helsinki
本文采用阴道镜和细胞学研究方法,对有多种原因的不孕症的孕妇进行宫颈状态的研究。获得的数据表明,与内分泌不孕症的孕妇相比,有输卵管-腹膜合并不孕症病史的孕妇子宫颈癌前病变水平增加。目的:探讨有不孕史的孕妇阴道镜检查的性质和严重程度与宫颈细胞学变化的关系。材料和方法。101例:1组有内分泌不孕症史的孕妇14例;有输卵管性不孕症史的孕妇27例- 2组;合并不孕症的孕妇40例(第三组),无不孕症史的健康孕妇20例(第四组)。评估孕妇子宫颈状况的方法——视频阴道镜和细胞学检查(在玻璃上)。结果。细胞学改变(NILM)正常:1 ~ 8组(57.2%),2 ~ 15组(55.6%),3 ~ 23组(57.5%),4、14组(70.0%)孕妇。良性细胞学和ASCUS征象:1组5例(35.7%),2组6例(22.2%),3组10例(25.0%),4组5例(25%)。癌前病变(LSIL+HSIL): 1组1例(7.1%),2组6例(22.2%),III组9例(22.5%),4组未发现细胞学上的癌前病变。正常阴道镜征象(分层鳞状上皮):3组11例(27.5%),2组8例(29.6%),1组7例(50.0%)孕妇。阴道镜下良性改变(异位、腺体开放、纳博托维囊肿、蜕膜):3组19例(47.5%),2组16例(59.3%),1组6例(42.9%),4组5例(35.7%)。我们的数据显示,阴道镜检查期间发生癌前病变的女性:3组9例(22.5%),2组3例(11.1%),1组1例(7.1%),4组1例(5.0%)。两组患者均未发现阴道镜下浸润性生长的迹象。结论。该研究显示,宫颈癌前病变水平增加的孕妇与输卵管-腹膜和伴随不孕的历史。第2组6名(22.2%)和第3组9名(22.5%)妇女的子宫颈癌前病变比例相当高,这表明,在存在人类乳头瘤病毒(HPV)和其他生殖器感染的情况下,随着年龄的增长,乳头瘤病毒自我消除的可能性降低。在长期治疗不孕症后,除了细胞学涂片外,所有孕妇在第一次去产前诊所时都必须进行阴道镜检查。如果在这类女性中发现LSIL和HSIL,在怀孕期间每3个月进行一次阴道镜检查和细胞学控制,并强制进行HPV PCR HCR。这项研究是按照《赫尔辛基宣言》的原则进行的。本研究方案经所有参与机构的当地伦理委员会批准。获得患者的知情同意进行研究。作者未声明存在利益冲突。关键词:宫颈病理,不孕症后妊娠,阴道镜,细胞学。
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引用次数: 0
Modern approaches for perinatal management in thrombocytopenia during pregnancy 妊娠期血小板减少症围产期管理的现代方法
Pub Date : 2021-09-29 DOI: 10.15574/pp.2021.87.64
О.М. Naumchik, I. Davydova, A. Limanska
The most common diseases of the blood system in pregnant women are anemia and thrombocytopenia (TP). There is a general tendency to significantly reducing of the number of platelets during pregnancy, starting from the first trimester with a minimum number of them during childbirth. Purpose — to learn the features of motion of pregnancy, diagnostic and curative tactician at the thrombocytopenia during pregnancy. The causes of TP during pregnancy are three groups of conditions — conditions for which TP is characteristic outside of pregnancy and conditions associated with pregnancy: gestational thrombocytopenia (GTP), pregnancy-specific complications, manifestations of diseases characterized by TP, with the chief reason among them — immune thrombocytopenia (ITP). The most common cause of TP during pregnancy is GTP, which, like ITP, is diagnose of exclusion that require differential diagnosis. The goal of treating TP during pregnancy is to achieve a safe platelet count that is different for each trimester, not target values. If the treatment of ITP is need lines of therapy with control of efficiency are consistently applied. Pregnant women with moderate and severe TP are a group of high perinatal risk, requiring careful differential diagnosis of the causes of TP, calculation of maternal and fetal risks, choice of tactics of such pregnancy, method and time of delivery, formation of postnatal care plan. No conflict of interest was declared by the authors. Key words: pregnancy, thrombocytopenia, immune thrombocytopenia, gestational thromocytopenia.
孕妇血液系统最常见的疾病是贫血和血小板减少症(TP)。妊娠期间血小板数量有显著减少的普遍趋势,从妊娠早期开始,分娩时血小板数量最少。目的:了解妊娠期血小板减少症的运动特点,为妊娠期血小板减少症的诊断和治疗提供参考。妊娠期TP的病因有三组情况——TP在妊娠期外的特征性情况和与妊娠相关的情况:妊娠血小板减少症(GTP)、妊娠特异性并发症、以TP为特征的疾病表现,其中主要原因是免疫性血小板减少症(ITP)。妊娠期TP最常见的病因是GTP,与ITP一样,GTP是排除性诊断,需要鉴别诊断。妊娠期治疗TP的目的是达到每个妊娠期不同的安全血小板计数,而不是目标值。如果对ITP的治疗是必要的,则持续应用具有疗效控制的治疗方法。中重度TP孕妇是围产期高危人群,需要仔细鉴别诊断TP的病因,计算母胎风险,选择该类妊娠的策略、分娩方式和时间,制定产后护理计划。作者未声明存在利益冲突。关键词:妊娠,血小板减少,免疫性血小板减少,妊娠期血小板减少
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引用次数: 0
Functional capabilities of the heart rate depending on the characteristics of homeostasis among primary-school-age children 小学学龄儿童体内平衡特征对心率功能的影响
Pub Date : 2021-09-29 DOI: 10.15574/pp.2021.87.30
T. Ihnatova, I. Maidan
One of the most common diseases of the cardiovascular system is cardiac arrhythmias. Assessment of the heart rate is one of the obligatory methods of pediatric examination and its deviation from the age norm may indicate a change in the child's health and be one of the first manifestations of the disease. Heart rhythm disturbances accompany various diseases, namely: congenital heart defects, cardiomyopathies, rheumatic and infectious diseases, intoxication, vegetative crises, endocrine diseases, diseases of the nervous system and others. Most often, in children's practice, it is not always possible to establish the cause of heart rhythm disturbances, as well as to classify the presence of organic or functional disorders without conducting morphological studies. Purpose — to study the features of heart rhythm and the state of the autonomic nervous system (ANS) among the children of primary school age with sinus bradycardia. Materials and methods. Children of primary school age with sinus bradycardia were examined (210 children). All children underwent: clinical examination, ECG at rest and after exercise, daily monitoring of ECG and heart rate, echocardiography, cardiointervalography with spectral analysis of heart rate. Results. Assessment of the cardiovascular system among children with bradycardia revealed the following features: 80.0% of children had no complaints, 68.0% of children at the age of 6–7 years and 55.0% of children at the age of 8–10 years had moderate bradycardia, 32.0% of children at the age of 6–7 years and 45.0% of children at the age of 8–10 years had significant bradycardia. After the exercise test, 71.0% of children still had bradycardia, which is typical for children at the age of 9–10 years and 29.0% of children had an acceleration of heart rate above the age norm. Holter monitoring revealed the following cardiac arrhythmias: sinus rhythm driver migration, ectopic rhythm, sinoatrial block, 2 grade atrioventricular block, atrial extrasystole and ventricular extrasystole. Different duration of sinoatrial pauses was detected: in the range from 1300–1400 ms among the most children (78.0%) to 1700–1800 ms among 1.8% of children. Data from spectral analysis of sinus rhythm showed the predominance of parasympathetic nervous system tone among the 84.0% of children, asympathicotonic (40.5%) and normal (44.9%) autonomic reactivity. Conclusions. Examination of the children of the primary school age revealed sinus bradycardia and bradyarrhythmia among the 80.7% of children. Bradyarrhythmia is typical for children at the age of 6–7 years, bradycardia — for children at the age of 9–10 years. Spectral analysis of the ANS showed an imbalance in the regulation of sinus rhythm: the predominance of the parasympathetic link, regardless of the initial state of the ANS and the violation of adaptive mechanisms. According to Holter monitoring, the duration of pauses is longer than normal for the given age (more than 1300 ms) indicates sinus node
心律失常是心血管系统最常见的疾病之一。心率的评估是儿科检查的强制性方法之一,其偏离年龄标准可能表明儿童的健康状况发生了变化,是疾病的早期表现之一。心律紊乱伴随着各种疾病,即:先天性心脏缺陷、心肌病、风湿病和传染病、中毒、营养危机、内分泌疾病、神经系统疾病等。大多数情况下,在儿童的实践中,如果不进行形态学研究,就不可能确定心律紊乱的原因,也不可能对器质性或功能性障碍进行分类。目的:探讨小学学龄窦性心动过缓患儿的心律特点及自主神经系统(ANS)状态。材料和方法。对210名患有窦性心动过缓的小学学龄儿童进行了检查。所有患儿均接受:临床检查、静息及运动后心电图、每日心电图及心率监测、超声心动图、心间期图及心率谱分析。结果。心动过缓儿童的心血管系统评估显示:80.0%的儿童无主诉,68.0%的6-7岁儿童和55.0%的8-10岁儿童有中度心动过缓,32.0%的6-7岁儿童和45.0%的8-10岁儿童有明显心动过缓。运动试验结束后,71.0%的儿童仍有心动过缓,这是9-10岁儿童的典型症状,29.0%的儿童心率加速高于年龄标准。动态心电图显示以下心律失常:窦性心律驱动迁移、异位心律、窦房传导阻滞、2级房室传导阻滞、房性心动过速和室性心动过速。检测到不同的窦房暂停持续时间:大多数儿童(78.0%)在1300-1400 ms之间,1.8%的儿童在1700-1800 ms之间。窦性心律频谱分析数据显示,84.0%的儿童以副交感神经系统张力为主,40.5%为交感压迫性,44.9%为正常自主神经反应性。结论。对小学学龄儿童的检查显示80.7%的儿童存在窦性心动过缓和慢性心律失常。慢速心律失常在6-7岁的儿童中是典型的,而在9-10岁的儿童中则是心动过缓。神经旁系的频谱分析显示窦性心律的调节不平衡:不管神经旁系的初始状态和适应性机制的违反,副交感神经联系占主导地位。根据霍尔特监测,停顿的持续时间比给定年龄的正常时间长(超过1300毫秒),表明窦结功能障碍,需要更密切的监测,因为在以后的生活中有发生窦结无力综合征和其他威胁疾病的风险。这项研究是按照《赫尔辛基宣言》的原则进行的。本研究方案经所有参与机构的当地伦理委员会批准。获得患者的知情同意进行研究。作者未声明存在利益冲突。关键词:儿童,心动过缓,慢速心律失常,植物体内平衡。
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