Non-Modifiable Risk Factors for Stress Fractures in Military Personnel Undergoing Training: A Systematic Review

A fracture, being an acquired rupture or break of the bone, is a significant and debilitating injury commonly seen among athletes and military personnel. Stress fractures, which have a repetitive stress aetiology, are highly prevalent among military populations, especially those undergoing training. The primary aim of this review is to identify non-modifiable risk factors for stress fractures in military personnel undergoing training. A systematic search was conducted of three major databases to identify studies that explored risk factors for stress fractures in military trainees. Critical appraisal, data extraction, and a narrative synthesis were conducted. Sixteen articles met the eligibility criteria for the study. Key non-modifiable risk factors identified were prior stress fracture and menstrual dysfunction, while advancing age and race other than black race may be a risk factor. To reduce the incidence of stress fractures in military trainees, mitigating modifiable risk factors among individuals with non-modifiable risk factors (e.g., optimising conditioning for older trainees) or better accommodating non-modifiable factors (for example, extending training periods and reducing intensity to facilitate recovery and adaptation) are suggested, with focus on groups at increased risk identified in this review.

Vitamin D level and hormonal status association in adolescent girls with oligomenorrhea

Research objective: to determine the frequency of vitamin D deficiency and insufficiency to identify its association with reproductive hormones in adolescent girls with oligomenorrhea.Materials and methods. The work was carried out according to the results of clinical and instrumental examination of 68 adolescent girls 12–18 years old with oligomenorrhea, who were treated at the Department of Pediatric Gynecology of the State Institution “Institute for Children and Adolescents Health Care of the NAMS of Ukraine”. Patients were divided into two groups depending on the body mass index (BMI): group I – with a body weight deficit (BMI 16.31 ± 0.18 kg/m2), group II – with a BMI within physiological norm (20.0 ± 0.25 kg/m2). All patients underwent a comprehensive clinical and laboratory examination: luteinizing, follicle-stimulating hormones, prolactin, estradiol, testosterone, cortisol, 25(OH)D were determined in blood serum. Multivariate regression analysis was using for analyze the association of gonаdotropic, steroid hormones with vitamin D. The main characteristics of the object discrimination model are presented in the form of tables.Results. The article provides a comparative analysis of the hormonal profile and vitamin D level depending on BMI. It was revealed that a reduced 25(OH)D value was characteristic not only in patients with menstrual dysfunction, but also in peers with normal menstrual function. Schemes that characterize the pituitary-gonadal association with vitamin D were constructed based on the results of multiple regression analysis. Their features were determined in girls with different body weights. In patients with low energy resources there were direct associations between individual indicators of gonadotropins (follicle-stimulating hormone), steroid hormones (estradiol, cortisol) and vitamin D. An inverse association was observed between vitamin D and cortisol and prolactin in girls with balanced energy status.Conclusions. The reduced content of vitamin D is characteristically for patients with menstrual dysfunctions by the type of oligomenorrhea. Associations of gonadotropic, steroid hormones and vitamin D, depending on the energy status (nutrition) of patients with oligomenorrhea were revealed.

CHARACTERISTICS OF METABOLIC PROCESSES IN THE FORMATION OF MENSTRUAL FUNCTION DISORDERS IN ADOLESCENT GIRLS WITH OBESITY

Іntroduction. Today, a quarter of the population of economically developed countries has a body weight that is 15% larger than the norm. According to various authors, the timely onset of menarche in women with various forms of obesity and reproductive dysfunction is observed in 31% of cases only. Obesity results in insulin resistance, which in its turn results in hyperinsulinemia. The main reason of the connection of insulin resistance with reproductive function disorders consists in the specific influence of insulin on ovaries. Insulin suppresses apoptosis, binding to receptors of various growth factors that promotes long existence of atresizing follicles. In the pathogenesis of the metabolic syndrome, along with the development of hyperinsulinemia and insulin resistance, a significant role belongs to the imbalance of adipocytokines, one of which is adiponectin. The aim is to analyze metabolic processes in the formation of menstrual dysfunction in adolescent girls with obesity to improve diagnostic methods of menstrual disorders. Material and methods. Clinical and laboratory examination of adolescent girls aged 12-18 years was held, among which 79 had obesity and complaints about menstrual dysfunction (the main group); 31 with normal body weight and regular menstrual cycle (the control group). Research methods: general clinical, biochemical (indicators of lipid and carbohydrate metabolism were determined), instrumental (ultrasound), statistical. Results. It was found that 53.3% of the girls from the main group had the beginning of the first menstruation after 14 years, delayed menstruation from 42 days to 6 days, duration 2.1 ± 0.05 days, which was significantly shorter, the volume of 10.2 ± 0.05; 0.4 points (average 1-2 pads per day) was significantly lower (p <0.05). Ultrasound showed uterine hypoplasia in almost every second girl in the main group - 36 (45.46%). Hyperleptinemia and leptin resistance was found in obesity of the first degree 34.8 ± 1.75, in obesity of the second degree 37.15 ± 2.12, in obesity of the third degree 40.64 ± 2.0. It was 14.35 ng / ml in the control group, p<0,01. Hyperleptinemia in the main group was accompanied by hyperinsulinemia in 26% of cases and insulin resistance. The relationship between low values of adiponectin and elevated body mass index in patients of the main group was established, which was confirmed by the results of correlation analysis (adiponectin & body mass index: ρ = -0.74). Analysis of the results revealed a decrease of A/L level in the main group by 4.3 times. Based on our own results, the A/L and HOMA-AD models can be considered more accurate for determining insulin resistance. Conclusions. 1. Changes of the menstrual cycle in overweight girls were found. The association of adipokines secretion disorders is characterized by hyperleptinemia, leptin resistance, decreased Adiponectin / Leptin index and hypoadiponectinemia, which, in combination with insulin resistance, indicates the participation of adipokines in the genesis of oligomenorrhea. The algorithm of adolescents’ treatment with menstrual dysfunction on the background of obesity must include the calculation of Adiponectin/Leptin and HOMA-AD, which will make it possible to avoid overdiagnosis of insulin resistance.

Retained fetal bone post abortion causing infertility

Fetal bone retention is a rare but under-diagnosed complication after abortion. If left untreated, it can cause menstrual dysfunction and secondary infertility. We present a case of a 39 year old woman who undergone abortion 20 years ago but suffered with secondary infertility due to retained fetal bone.

IMPORTANCE OF HAIR GROWTH IN HISUTISM: DIAGNOSIS AND TREATMENT

The objective of the review is to explain the pathogenesis, causes and various treatment involved in hirsutism. This article discusses the disease’s pathogenesis, causes and diagnosis. This review looks at the main significant type of hairs and clinical studies on the role of several lifestyle therapies in hirsutism development. This review examines the numerous methods that causes hirsutism in order to discover new medicaments. In addition, it covers the various type of hirsutism therapy. Hirsutism, is reported to have the strongest impact on patients’ health-related quality of life, following in descending order by body mass index, irregular menses, and infertility. To assess the types of hairs and pathogenesis, sign and symptoms, as well as causes of hirsutism. Moreover, we studied the management of hirsutism and how to treat this. At least six to nine months of therapy are required to produce improvement in hirsutism. We suggest testing for elevated androgen levels in women with moderate or severe hirsutism or hirsutism of any degree when it is sudden in onset, rapidly progressive, or associated with other abnormalities such as menstrual dysfunction, obesity, or macroclitoris. For women with patient-important hirsutism despite cosmetic measures, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral contraceptives for the majority of women, adding an Antiandrogens after 6 mo if the response is suboptimal. We recommend against androgen antagonist monotherapy unless adequate contraception is used. We suggest against using insulin-lowering drugs. For women who choose hair removal therapy, we suggest laser/photo epilation.

Micronutrient deficiency in menstrual dysfunction among women of reproductive age

Objective. To determine whether inorganic menstrual dysfunction (MD) is associated with magnesium, iron and vitamin D deficiency in women of reproductive age. Materials and methods. The study group I consisted of 50 women with MD: dysmenorrhea (16 women), oligomenorrhea (12 women), functional hypothalamic amenorrhea (3 patients) and acyclic abnormal uterine bleeding (19 women), the comparison group II was composed of 30 patients with normal menstrual function. The methods of study included history taking using a questionnaire to detect the signs of magnesium deficiency, physical examination, echography of pelvic organs, full blood count, blood tests to determine the concentration of magnesium, vitamin D and ferritin as well as consulting a therapeutist. Results. Magnesium deficiency was registered significantly more often in patients with MD (93.0 3.6 %, 73.0 8.1 %, respectively; p 0.05). The most typical signs of magnesium deficiency were the central symptoms: headache (58.0 7.1 %, 22.0 7.6 %; p 0.001), irritability (53.0 7.1 %, 26.0 8.0 %; p 0.01), dyssomnia (45.0 7.0 %, 17.0 6.9 %; p 0.01), dizziness (42.5 7.0 %, 22.0 7.6 %; p 0.05), a decrease in libido (34.0 6.7 %, 13.0 6.1 %; p 0.05), as well as trophic disturbances including hair loss (38.0 6.9 %, 13.0 6.9 %; p 0.01). Similar findings were obtained when we studied the iron supply: the frequency of latent iron deficiency (according to ferritin concentration) was 77.0 5.9 and 35.7 8.4 % respectively; p 0.001. Deficiency or insufficient supply of 25(ОH)D was registered significantly more often in women with MD in comparison with healthy women (45.0 7.0 %, 20.0 7.3 %; p 0.05). Conclusions. In summary, determination of the level of micronutrients and adequate compensation of their deficiency can be important factors in physiological correction of endocrine imbalance leading to functional disorders in the reproductive system and a decrease in fertility.

CAN PROLACTIN BE A MARKER FOR DEVELOPMENT AND PROGRESSION OF PCOS?

Background: Polycystic ovarian syndrome has been one of a major public health problem. It causes multifactorial in etiology such as menstrual dysfunction, hyperandrogenism, hirsutism, insulin resistance, dyslipidemia and obesity which increased risk of diabetes mellitus and cardiovascular disease. Prolactin has been reported as a potent lipogenic and diabetogenic factor, that affecting energy balance and fuel metabolism. The present study was designed to assess serum prolactin and insulin resistance in PCOS women and to compare them with healthy women as controls. Material And Methods: A comparative study including 50 women newly diagnosed as PCOS and 50 healthy women as controls was conducted. The age group for the study was 18-35 years. Fasting blood samples were drawn to assess serum prolactin, serum insulin and fasting blood sugar. Insulin resistance was calculated by homeostasis model assessment. Results: A signicant increase in fasting serum insulin (p<0.001) and HOMA – IR (p<0.001) were found in patients with PCOS in comparison with controls. Prolactin and FPG were found elevated in the PCOS women and were statistically signicant. Conclusions: The current study provides further evidence that signicantly higher fasting insulin and HOMA in PCOS group indicates presence of IR. IR in PCOS group may have a potential role in the prediction of dysglycemic disease in women with PCOS. This study found signicant correlation between serum prolactin and serum insulin