The role of leptin in patients recovering from Anorexia Nervosa

Introduction: Anorexia nervosa (AN) is a mental disorder with the highest death rate. The characteristic feature of AN is endocrine dysregulations, including changes in adipose-tissue secreted hormones, especially adipokines. The most widely studied of them is leptin whose role in the pathophysiology and prognosis of AN is confirmed in more and more studies. The aim of the study was to summarize the role of endocrine disruptions with particular emphasis on leptin in the pathophysiology of AN. Material and methods: For the literature review, the electronic databases PubMed, Cochrane and Google Scholar search were used with the following keywords: eating disorders, adipokines, leptin, metreleptin, satiety, hunger, anorexia, obesity, for studies listed from database inception to October 2021. Results: Leptin, produced mainly by white adipose tissue, inhibits the hunger center in the hypothalamus by negative feedback with ghrelin secreted by the gastrointestinal tract. Leptin is involved in numerous biological functions, including body weight regulation, innate and adaptive immunity regulation, reproduction, and bone formation. Studies confirm decreased leptin levels in AN individuals. In recent years, extensive experience has been gained with leptin as a drug in clinical trials. The studies suggested that treatment can restore menstrual function and bone health and improve mood with unclear body weight effects. Conclusions: Focusing on leptin-related changes is a promising approach to improve AN management. Assessment of leptin levels in AN patients could be a useful tool for therapy monitoring. Treatment with leptin could reverse unfavourable changes induced by diet restriction, including mood symptoms, loss of bone mass and menstrual function. However, the results of these studies need confirmation on larger groups of patients.

Reproductive endocrinology

This chapter covers multiple aspects of reproductive endocrinology in both male and female patients. Gender dysphoria is also included. It begins with reproductive physiology, then goes on to regulation of gonadal function. Hirsuitism, PCOS, and CAH in adults are all discussed with reference to evaluation, investigation, and treatment. Menstrual function disorders are described, as is menopause and hormone replacement therapy regimens. Contraception and emergency contraception are discussed. Male hypogonadism, androgen replacement therapy, gynaecomastia, and testicular tumours are all evaluated, alongside erectile dysfunction. The investigation and management of male and female infertility are both described, alongside fertility preservation and the induction of ovulation.

Salvarsan for diseases of the urinary tract

Loeb (Derm. Ztschr. Bd. 56, H. 2/3, 29), observing the course of gonorrhea in women simultaneously suffering from syphilis and taking specific treatment, noticed that in this case gonorrhea lasts much longer than in persons free of syphilis. A. observed 421 cases over a considerable period of time and on the basis of this material he believes that uterine gonorrhea, due to the delay of As in its mucosa and the effect on menstrual function, often has an adverse effect, while gonorrhea of ​​the canal proceeds faster due to the disinfecting effect salvarsan in the urine. With cystitis and pyelitis, a positive result is reflected in 60-80% of the cure of these processes.

Application of Piracetam Electrophoresis in Complex Sanatorium-Resort Treatment of Girls with Amenorrhea

Aim. The aim of this work was to study the effectiveness of the piracetam electrophoresis application in the complex sanatoriumresorttreatment of girls with amenorrhea. Material and methods. 56 girls aged 12 to 17 years were under observation, who were treated in the gynecological department ofthe children’s clinical sanatorium “Zdravnitsa”. Primary amenorrhea was recorded in 15 girls, secondary amenorrhea in 41. Long-termresults of sanatorium-resort treatment were studied in 8 girls with secondary amenorrhea. The control group consisted of 20 healthygirls, comparable in age, who underwent hormonal studies. Results. Upon admission to the sanatorium, the main complaint of all girls was the absence of menstruation, many had chronicinflammatory pathology of the ENT organs and pathology of the musculoskeletal system. There was a decrease in ovarian steroidogenesis,while hypoestrogenism was observed in the majority of patients. Girls with amenorrhea are characterized by a high levelof vertigo, an average level of anxiety, fatigue and a fairly low level of irritability. After the sanatorium-resort treatment, an improvementin the general condition of the girls was noted; during their stay in the sanatorium, menstruation was observed in 4 girls withsecondary amenorrhea. After the treatment, a significant positive dynamics of steroid and peptide hormones was revealed in girlswith primary and secondary amenorrhea. In girls with secondary amenorrhea, the ratio of LH/FSH approached the physiological one,but remained significantly higher than normal indicators. Under the influence of sanatorium-resort treatment, the level of adrenalinein the urine normalized in all girls with primary amenorrhea, and in the majority with secondary amenorrhea. There was a positivedynamics of the girls’ psycho-emotional state. According to the long-term results data of sanatorium-resort treatment, the restorationof menstrual function was observed within a year in half of the girls with secondary amenorrhea. Conclusion. The use of the 5% piracetam solution electrophoresis in a complex sanatorium-resort treatment of girls with amenorrheaimproved the general health of girls, normalized hormonal levels and restored menstrual function in half of the girls with secondaryamenorrhea within a year after a course of treatment in the sanatorium.

CORRECTION OF MENSTRUAL FUNCTION DISORDERS IN GIRLS WITH OBESITY

Based on the literature datа and the results of our studies, menstrual dysfunction in teen girls leads to disorders of the reproductive system in fertile age. Establishment of normal menstrual function in teen girls is an eff ective measure for the prevention of future reproductive health disorders, which leads to improved methods of menstrual disorders diagnostics in overweight girls by analyzing clinical and anamnestic data, biochemical markers, development of diagnostic algorithm and pathogenetically based correction of menstrual disorders. To gain this aim, it was proposed to include to the complex of conventional therapy, diet therapy and drugs myo-inositol (inofolic softgel) and metformin. Evaluation of the treatment eff ectiveness was performed on the regression dynamics of the disease main clinical symptom and the normalization of hormonal status indicators. The result of treatment was considered satisfactory when the patient had regular menstruation for 12 months on the background of the therapy, and the maintenance of irregular menstruation with a cycle duration of more than 38 days was unsatisfactory. As a result of treatment the body mass index has decreased in all the patients which received our complex of therapeutic measures, especially for obesity of the second and third degree what proves the eff ectiveness of complex treatment. The appointment of proposed complex of treatment measures for patients is pathogenetically based, because after treatment, previously detected insulin resistance decreased signifi cantly in all groups, but most and reliably in groups with obesity of the second and third degree and became almost within normal limits.

ОСОБЛИВОСТІ МЕНСТРУАЛЬНОГО ЦИКЛУ ЖІНОК ФЕРТИЛЬНОГО ВІКУ, ЩО ЗАЗНАЛИ КОНТУЗІЇ ПІД ЧАС БОЙОВИХ ДІЙ

The article presents an analysis of literature data and the results of our own retrospective studies of the characteristics of the menstrual cycle in female combatants who have undergone concussion. Clinical and anamnestic factors have been identified that negatively affect the menstrual function of women of reproductive age, who received contusions during hostilities. The relationship between the state of mental health of women and menstrual irregularities has been established. Aim: to identify and evaluate changes in the menstrual function of women - veterans of reproductive age. Also, to establish the relationship between menstrual irregularities in women - veterans of reproductive age who have undergone contusion, and the state of their somatic and mental health.Materials and method: The research was conducted at the Department of Obstetrics, Gynecology and Reproductology of the National University of Health of Ukraine named after P.L. Shupika. To achieve this goal, a comprehensive clinical and laboratory examination was performed in 567 women of reproductive age (main group and comparison group) who participated in hostilities and suffered contusions, the average age of the subjects was 27.08 ± 4.23 years.The period of stay in the combat zone is 29.34 ± 9.21 months, the time from the moment of receiving a mild traumatic brain injury (contusion) is 18.8 ± 9.2 months. Group I - 399 fertile women who suffered contusions during the fighting with PKS. Group II - 168 women of childbearing age who suffered contusions during hostilities without PKS (mean age 32.21 ± 7.32 years).Results: The results of the studies revealed statistically significant deviations in the characteristics of the menstrual cycle of women who participated in hostilities who were injured with PKS, compared with women without PKS. It has been proven that women-viskovosluzhvits more often develop menstrual irregularities, namely a decrease or increase in the number, lengthening or shortening of the menstrual cycle by 7 days. Taking into account the revealed menstrual irregularities in the women under study, it can be argued that the detected changes are due to the influence of both craniocerebral trauma and stress factors associated with military service. This justifies the need to develop a program for monitoring and supporting the reproductive health of women-viyskovoservices, as well as medical and psychological rehabilitation of veterans, aimed at their full adaptation to a peaceful life.

Role of adjuvant hormonal therapy in restoring reproductive function in women after endosurgical treatment of ovarian follicular cysts

In the structure of the causes of female infertility, follicular ovarian cysts make up 710% of cases. Despite the studies on the reproductive health of women undergoing endosurgical treatment of follicular ovarian cysts, the problem of restoring reproductive function has not yet been resolved. Aim. To assess the effectiveness of a preparation containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate in the restoration of reproductive function in women after endosurgical treatment of follicular ovarian cysts. Materials and methods. The study group included 100 women, of whom 70 patients (the main group) received adjuvant therapy with a drug containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate after endosurgery, and a comparison group of 30 patients who did not receive adjuvant therapy. The diagnosis of follicular ovarian cysts was established on the basis of hormonal, ultrasound, endoscopic and immunohistochemical studies. The levels of gonadotropic hormones (LH, FSH), steroid hormones estradiol and progesterone were determined twice at the beginning of the follicular (35 day) and secretory phase (2022 day) of the menstrual cycle. An ovarian ultrasound was performed at the beginning of the follicular phase and on days 2022 of the menstrual cycle. Immunohistochemical studies of estrogen and progesterone receptors in the ovaries were carried out using a Bond-max immunostimulator from Leica (Germany) using monoclonal antibodies: clone 1D5 and clone 1A6 Dako (USA). Results. Menstrual irregularities were detected in 36 (51.4%) patients, of which: irregular menstruation in 18.0%, algomenorrhea in 15.1%, polymenorrhea in 11.0%, and menorrhea in 7.3% of patients, infertility was observed in 34 (48.6%) patients. Endosurgical treatment of follicular ovarian cysts was performed for all examined patients. Adjuvant hormone therapy with a drug containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate was received by 70 patients. Menstrual function was restored in 70 (100%) patients. Pregnancy occurred in 60 (86.0%) of them. Conclusion. Adjuvant hormone therapy with a drug containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate allowed to restore menstrual function (100% of cases), pregnancy at 4.3 times (86.0% of cases), which confirms its high efficiency in the restoration of reproductive function in women after endosurgical treatment of follicular ovarian cysts.

RELATIONSHIP BETWEEN PATHOLOGICAL MENSTRUAL SYMPTOMS AND THE DEVELOPMENT OF EXTRAGENITAL FORMS OF LOCAL INFLAMMATION

The aim: To evaluate the parameters of menstrual function in 1015 women of reproductive age and to establish the relationship between the detected menstrual disorders and the development of migraine and/or irritable bowel syndrome (IBS). Materials and methods: During 2018–2020, a survey of women of reproductive age in the Ternopil region (Ukraine) was conducted. To interview the study respondents, we developed a questionnaire that assessed the parameters of menstrual function (age of menarche; regularity and cyclicity of menstrual changes; duration of the menstrual cycle and menstruation itself; the amount of blood loss with the pictogram, the presence of clots and their size) identify characteristic changes in health, symptoms of irritable bowel syndrome and migraine associated with the menstrual cycle. Data analysis was performed by statistical and mathematical method. Results and conclusions: In 72.2 % of respondents, the study revealed deviations from the normal course of the menstrual cycle. In particular, an increase in blood loss during menstruation and the appearance of clots larger than 1 cm were observed in 40.8 % of women. Among patients with menstrual dysfunction, 51.8 % of patients had symptoms of irritable bowel syndrome, and 44.1 % had signs of migraine. Thus, the relationship between cyclic menstrual disorders and the formation of IBS and migraine, which significantly affects the deterioration of health, performance of women of childbearing age.