V.F.Snegirev Archives of Obstetrics and Gynecology

In Russia, according to Rosstat, approximately 2.5% of adolescents suffer from anorexia. In Moscow, according to 2015 data, at least 5% of young women suffered from anorexia; however, most experts believe that the true figures are much higher because only advanced cases are documented. The relevance of the problem of anorexia nervosa is associated with its potential threat to the lives of patients, eating disorders, concomitant mental diseases, and, in general, the deterioration of mental status. Despite the apparent simplicity of diagnosis, patients with advanced stages of anorexia nervosa that require long-term therapy are more likely to seek a doctor’s help. Anorexia requires a comprehensive treatment approach, including psychopharmacotherapy, psychological influence, diet therapy, therapy of somatic pathology, and concomitant complications. All these aspects of treatment must be implemented simultaneously. The key to success is the constant monitoring of therapy by a psychiatrist. Malnutrition will result in the deterioration of general health, particularly in girls with menstrual disorders, complications associated with conception and gestation, and a difficult pregnancy. Thus, this condition must be considered from the point of view of psychiatry, obstetrics, and gynecology.

Globally, tuberculosis (TB) is the second leading cause of death from infectious diseases after COVID-19. TB of the female genital organs is a type of extrapulmonary TB. Clinically pronounced and latent forms of TB can cause both primary and secondary infertility because of pathogenetic damage to the structure of the fallopian tubes and changes in the susceptibility of the uterine endometrium. Although the true prevalence of genital TB is unknown, it is still a very relevant problem in Russia. This assumption is based on the projected growth of indicators of extrapulmonary TB, an obvious discrepancy between the real incidence and the official figures, and increasing incidence of tubal–peritoneal infertility, which is often caused by genital TB. The diagnosis of TB of the female genital organs is challenging because it does not have specific (so-called “marker”) manifestations. Low diagnostics rates of extrapulmonary TB create a false sense of well-being, which does not reflect its true epidemiological picture. Thus, at present, an optimal diagnostic complex, which would hasten the diagnosis of genital TB in women and consequently prevent the occurrence of associated irreversible changes in the female reproductive system, must be developed. Scientific databases CyberLeninka, ELibrary, and PubMed were searched for relevant articles using the following keywords: “tuberculosis”, “genital tuberculosis”, “infertility and tuberculosis”. Articles published over the past 10 years were analyzed.

The literature review reflects the main possible gynecological pathologies and their causes in female flight attendants. These diseases are serious problems for all women; however, aviation professionals are at a higher risk. The article examined various factors that can contribute to the development of not only gynecological diseases but also breast cancer and venous thrombosis in female flight attendants. Risk factors include long-term exposure to ionizing radiation, static stress, jet lag, and chronic stress. The review also analyzed existing studies related to the effect of occupational exposure on the health of flight attendants and suggested possible measures for the prevention and treatment of emerging pathologies, which can serve as a basis for the development of effective programs to preserve the health of female flight attendants.

AIM: This study aimed to optimize the outcomes of surgical treatment of enterocele using the original model of “titanium silk” mesh implants with their transobturator-sacrospinal fixation.

MATERIALS AND METHODS: A comprehensive clinical examination and surgical treatment of 22 patients aged 53–68 years with enterocele who had undergone surgical interventions for various forms of POP, were conducted. All patients underwent surgery using the surgical technique developed for enterocele correction using an original “titanium silk” mesh implant model with transobturator-sacrospinal fastening. Outpatient monitoring of patients in the early and delayed postoperative periods was carried out after 1, 6, 12, and 24 months.

RESULTS: During dynamic follow-up, patients were satisfied with the results of the surgical treatment, POP symptoms were stable, and no signs of relapse and mesh-associated complications were observed.

CONCLUSION: The study confirmed the effectiveness and safety of a new surgical technique for enterocele correction using an original model of a mesh implant “titanium silk” with transobturator-sacrospinal fixation in patients with enterocele who had undergone surgery in the past for various forms of POP. However, further research in this direction is needed.

BACKGROUND: Despite the retentive relevance of preeclampsia (PE) among the main causes of maternal morbidity and mortality, its etiology remains unclear. Despite gaps in its pathophysiology, highly effective methods of prognosis, prevention, and treatment are still not devised yet. In recent years, the use of microRNA molecules that epigenetically control the expression of target genes at the post-transcriptional level received great interest as are they of key importance in the proliferation, differentiation, invasion, migration, and apoptosis of trophoblast cells and regulation of angiogenesis, immune response, and other processes during pregnancy

AIM: This study aimed to investigate the epigenetic mechanisms of PE development based on the evaluation of the expression of pathogenetically significant microRNAs in women’s blood plasma.

MATERIALS AND METHODS: The study included 62 female patients divided into the main study group (n=42 with PE) and the control group (n = 20 healthy women with uncomplicated pregnancy, childbirth, and post-natal period). All patients have undergone general clinical, laboratory, and instrumental examinations. The expression levels of 15 microRNAs in the blood plasma were evaluated using a quantitative real-time polymerase chain reaction. DIANA miRPath v. 3.0 was used to evaluate the effect of differentially expressed microRNAs on the functioning of signaling pathways. Statistical data analyses were performed using Statistica 6.0.

RESULTS: Multidirectional changes in the expression levels of 13 of 15 plasma microRNAs were found in the PE group compared with the control group; however, the expression levels of the following eight microRNAs decreased significantly: hsa-miR-146a-5p (p=0.011), hsa-miR-181a-5p (p=0.015), hsa-miR-210-3p (p=0.031), hsa-miR-517a-3p (p=0.004), hsa-miR-517c-3p (p=0.007), hsa-miR-574-3p (p=0.048), hsa-miR-574-5p (p=0.003), and hsa-miR-1304-5p (p=0.001). The expression levels of hsa-miR-20a-5p (FC=0.39; p=0.049) and hsa-miR-143-3p (FC=0.71, p=0.05) significantly decreased in pregnant women with PE and symptoms of fetal growth retardation (FGR) compared with the subgroup without FGR. No significant differences in the expression level of the analyzed microRNAs were found between the subgroups with moderate and severe PE and early and late PE. The functional evaluation of differentially expressed microRNAs among women with PE, considering the identification of their potential target genes, revealed the dysregulation of >40 signaling pathways and biological processes in which these molecules are involved.

CONCLUSION: PE progresses alongside significant epigenetic changes accompanied by changes in the microRNA expression profile, which are associated with cardiovascular and cerebrovascular diseases and placental disorders. The detected differentially expressed microRNAs may be potential diagnostic markers of PE.

AIM: This study aimed to assess the reproductive health of adolescent girls with obesity living in a large industrial territory.

MATERIALS AND METHODS: A one-time study was conducted on 105 teenage girls aged 15–17 years. The main group consisted of 70 girls with overweight and obesity, who were divided into a group with menstrual irregularities (N1=42) and without disorders (N2=28). The control group included 35 girls with normal body weight and no menstrual irregularities. Morbidity was studied. Body mass index (BMI), pituitary (thyroid-stimulating hormone [TSH], follicle-stimulating hormone, and luteinizing hormone) and sex hormones (estradiol, DHEA-SO4, AMH, and testosterone), alanine aminotransferase, aspartate aminotransferase, total cholesterol, and ultrasound data of the thyroid gland and abdominal organs were determined. A quantitative assessment of treatment adherence and lifestyle modification was performed.

RESULTS: The average BMI values in the main and control groups were 31.1 (4.9) and 20.0 (1.9) kg/m², respectively (p <0.001). A statistically significant predominance of the incidence of cardiovascular pathologies was found in the main group (χ²=2.58, p=0.014; OR=5.7; 95% CI, 1.2–26.2), as well as a more frequent occurrence of urinary tract, nervous system, and endocrine diseases. In the main group, echographic signs of liver and pancreatic pathologies were detected in 22 (31.4%) girls and diffuse changes in the thyroid gland in combination with cystic formations or hypoplasia in 31 (44.0%). The number of antral follicles was normal in all patients. A statistically significant difference in TSH (p <0.001), LH (p=0.015), and DHEA-SO4 (p=0.002) was obtained between the main and control groups. Adolescents aged 15 years were more adherent to treatment (χ²=13.28; p=0.003).

CONCLUSION: Statistically significant differences in clinical and laboratory data and treatment adherence were found in adolescent girls with overweight and obesity living in a large industrial region when compared with healthy girls, which dictates the need to improve and implement personalized medical and psychological programs.

The paper presented a clinical case of organ-saving surgical treatment for giant uterine myoma with secondary changes in a 36-year-old woman with unrealized reproductive function. The case testifies to the expediency of an individual approach to each patient with such neoplasms both at examination and during intra- and postoperative management.