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EFFECTIVENESS OF THE POSITIVE RESULTS OF JUVENILE HEMORRHAGE IN ADOLESCENT GIRLS IN THE TREATMENT WITH
MICRONUTRIENT DRUGS
J. Ya.Toxirov, G. Sh. Mavlonova
Bukhara State Medical Institute named after Abu Ali ibn Sino
The article provides an overview of the success of the treatment plan for girls with juvenile hemorrhage with essential elements that retain trace elements.
Keywords: Menstrual cycle, ME, ovulation.
Juvenile juvenile dementia is one of the most common gynecological diseases among neighboring adolescent girls, and numerous studies conducted in previous years have identified high risks in the prevention and development of this disease. is focused. At the same time, the growth of pathology of gynecological diseases in adolescent girls is a sore point of the Health Organization of the Republic of Uzbekistan, while protecting the reproductive health of young people has been declared a national strategy of public policy in Uzbekistan. Given that anomalous bleeding from the uterus at a juvenile age is central to modern medicine, the study of this problem remains one of the most pressing issues today.
The aim of the study is to study the effects of micronutrients on the body in the development of abnormal bleeding from the uterus in adolescence and to develop treatment methods.
Research objectives: To study the anamnestic and anthropometric parameters of physically healthy and adolescent girls complicated by abnormal uterine bleeding;
Detection of microelement status in the blood depending on the phase of the menstrual cycle among 12-16-year-old adolescent girls who are physically healthy and complicated by abnormal bleeding from the uterus;
Evidence of the presence of micronutrients in the blood of adolescent girls with abnormal uterine bleeding at the juvenile age and the pathogenetic relationship with hormones of the pituitary-ovarian system;
Development of treatment measures by correcting the micronutrient status in the body of adolescent girls with abnormal bleeding from the uterus at the juvenile age.
In accordance with the goals and objectives, this research was carried out at the Central Polyclinic of Romitan district and the Department of Gynecology of Romitan district in 2012-2022.
ABSTRACT
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Essential and toxic micronutrients, as well as the state of the pituitary-ovarian hormones, uterus, ovaries, endometrial layer were studied in 170 adolescent girls aged 12-16 years with abnormal bleeding from the uterus who applied to the Romitan District Central Polyclinic. The main group included 115 adolescent girls with abnormal uterine bleeding, and 55 physically healthy adolescent girls. In accordance with the goals and objectives, the following research program was developed: clinical and statistical analysis; clinical research methods (general analysis of blood, Ht, platelets); biochemical examination methods.
Adolescent girls involved in the study were divided into the following age categories: 31 (18.2%) girls at the age of 12, 32 (18.8%) at the age of 13, 14 - 35 (20.5%), 15 - 37 (21.7) %), 16 - 34 (20.0%). It should be noted that no significant age difference was found in the compared groups (R> 0.05). Thus, in the group of healthy girls at the age of 12 there were 10 (18.1%), at the age of 13 - 10 (18.1%), at the age of 14 - 12 (21.8%), at the age of 15 - 12 (21.8%), 16 years - 11 (20.0%). In the group of girls with juvenile hemorrhage, the distribution was as follows: 21 (18.2%), 22 (19.1%), 23 (20.0), 25 (21.7%), 23 (20.0%), that is, no significant difference was detected (R> 0.05). In the study groups, the age of the study participants was independent of place of residence (urban / rural) (R> 0.05).
Evaluation of the effectiveness of treatment in girls with abnormal uterine bleeding at the juvenile age of the study is the result of different treatments in adolescent girls in the recorded groups.
Juvenile uterine mines treated in 35 control groups received conventional treatment, Novinet from hormonal drugs, and symptomatic treatment. Treatment of CKD was performed according to the severity of clinical symptoms and compared with clinical laboratory tests for a period of 6 months.
Girls belonging to 50 main groups were given essential microelement drugs along with hormonal drug treatment and symptomatic conservative treatment. The results of the treatment were carried out with dynamic control of the status of micronutrients in the mines, control of the amount of hormones, ultrasound and observation of clinical signs.
First of all, measures were taken to stop mining in all girls. And a treatment aimed at restoring the menstrual cycle was carried out.
Symptomatic treatment oxytocin 5ED - 2 max
Vikasol 1ml. v / m, calcium gluconate 0.5mg 3maxal drink per day. Calcium chloride 10% -5.0 ml v / v, Ditsinon 2 ml.
For therapeutic treatments, ascorbic acid 5% - 6.0 ml v / v, rutin 0.02 g -3 maxal for oral administration, ascarutin 2 tab 3 maxal oral administration for 1 month
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From antianemic drugs ferrum-lek (hydroxide-polymotose complex Fe3 +) 100 mg 1tab was given orally for 8 weeks, then again 1tab 1 maxal for 8 weeks.
Folic acid 0, 001 g 1 tab -3 maxal 12 weeks.
In the case of hyperplasia of the endometrial layer of the uterus in girls with anovulatory IBD, a drug novinet was recommended for menstrual regulation. The pharmacological composition is estrogen and dezegestrol. Ethinylestradiol is a synthetic estrogen, desogestrol is a synthetic progestagen. Novinet 1 tab per day to drink 1 maxal 21 days.
The girls in the main group received a micronutrient-preserving drug in addition to traditional treatment. Polygen (WORLDMEDICINE). The composition of the drug polygen is composed of essential elements and minerals, vitamins, amino acids, which are necessary for adolescents. Trace elements include iron, zinc, iodine, magnesium, selenium, copper, manganese, etc. strengthens the body's immune system, increases the body's ability to fight disease. Along with increasing physical activity, it enhances mental ability Activates the activity of restoring the hormonal capacity of the female body.
The main group of girls was given 1 capsule of polygen 1 ounce at meal time for a period of 24 days. The course of treatment was resumed within 1-2 months.
In order to restore the regulation of the menstrual cycle after the cessation of mining, the following recommendations were made:
She was taught to follow a eating routine
Girls aged 12-13 years were given cyclic vitamin treatment for 3 months.
From the 5th day of the menstrual cycle to drink folic acid 0, 001g 3 maxal,
glutamic acid 0.25 g 3 times a day for 10 days to drink,
0.5 g of fsrbic acid - 3 times a day for 10 days,
0.1 g of vitamin E from the 16th day of menstruation - 10 days,
Vitamin V1 (thiamine) 5% solution -1, peros- 10 days.
Girls aged 14-16 years were given a hormone-preserving agent (novinet) - 3 during the menstrual cycle. Drinking scheme 1 tablet 21 days a day from the 6th day of menstruation.
Hemoglobin levels did not differ significantly in the compared groups: 88.4 ± 1.86 g / l in the main group girls and 86.8 ± 3.4 g / l (P <0.05) in the control group. However, at the end of the second month, a significant increase in the dynamics of treatment was observed in the girls of the main group with a hemoglobin level of 97.2 ± 2.72 g / l, and in the girls of the control group - 94.1 ± 3.6 g / l. After 6 months, the hemoglobin level gradually increased to 108.4 ± 2.3 and 102.2 ± 4.5 g / l.
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In the first month of follow-up, the erythrocyte count was 3.2 ± 0.007 in the main group and 3.3 ± 0.12 x 1012 / l in the control group (P> 0.05). From the second month, an increase in the number of erythrocytes was observed, especially in the girls of the main group to 4.1 ± 0.10 and 3.9 ± 0.16 x 1012 / l, respectively. In the sixth month, erythrocyte levels were 4.2 ± 0.11 and 4.0 ± 0.12 x 1012 / l, respectively. However, these data are not significant (P> 0.05).
Disorders of the hemostatic system developed in all girls with GVHD, but deeper changes were observed in girls with low hemoglobin and erythrocytes (r = 0.86). Platelet counts were 291.5 ± 6.8 x 109 / l in healthy girls and 268 ± 5.9 and 264 ± 9.1 x 109 / l (P <0.05), respectively, in patients with GVHD.
In the dynamics of treatment, platelet count increased significantly in both groups of patients. However, high rates were achieved in the main group of girls receiving complex therapy, including when using drugs containing ME. At the end of the second month of treatment, the platelet count was 274 ± 6.9 and 270 ± 11.0 x 109 / l, respectively, and in the sixth month it was 286 ± 7.26 and 275 ± 10.6 x 109 / l, respectively.
In girls with UBC, the onset of blood clotting time increased to 8.8 ± 0.21 and 8.4 ± 0.36, respectively. In the dynamics of treatment, after 2 months, the clotting time was reduced to 6.5 ± 0.16 minutes in the main group and 7.0 ± 0.24 minutes in the control group, and after 6 months to 6.4 ± 0.16 and 6.9 ± 0, respectively. , 24 minutes.
In healthy girls, the prothrombin level decreased to 89.6 ± 1.9%, and in girls with UBC decreased to 77.4 ± 1.8% in the main group and 76.9 ± 2.8% in the control group (P <0.001). After 2 months, this figure rises to 79.4 ± 1.7 and 78.1 ± 3.0%, after 6 months - to 81.4 ± 1.8 and 78.6 ± 3.1% (P> 0.05 ).
Thus, erythrocyte counts in the blood improved significantly with the correction of GVHD in girls. An increase in the number of hemoglobin and erythrocytes was detected, the quality of the blood hemostasis system is improved, which reflects the effectiveness of pathogenetic treatment of UBC.
The state of microelement status depending on the method of treatment of uterine bleeding at the juvenile age
Dynamic growth is observed against the background of complex treatment with the use of drugs containing trace elements.
The most pronounced changes were in manganese (14.4 ± 0.46 mg% after 1 month, 15.6 ± 0.52 mg% after 2 months, and 18.4 ± 0.66 mg% after 6 months of treatment; P < 0.001), iron (38.6 ± 1,24,42,3 ± 1,13; P <0,05 and 46,4 ± 1,45 mg%; P <0,001, respectively), cobalt (7,9 ± 0.29.9.1 ± 0.27, 12.6 ± 0.42 ^g%; R <0.001), zinc (288 ± 10.6, 316 ± 9.5 and 422 ± 14.0 mg%; P <0.001), selenium (12.4 ± 0.44, 15.6 ±
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0.49 and 18.7 ± 0.59 mg%; P <0.001) and iodine (13.6 ± 0.43, 14.1 ± 0.59 and 15.8 ± 0.5 mg%; P <0.01).
There is a high correlation between significant ME levels in girls and clinical and laboratory readings of UBC. Thus, an increase in iron levels in the blood is directly related to high hemoglobin levels (r = 0.91), erythrocyte count (r = 0.87), and iodine concentration (r = 0.68).
The increase in zinc levels is directly related to the onset of ovulation after 6 months of treatment (r = 0.64). In addition, the concentrations of copper, zinc, iron, iodine, and selenium are directly related to clinical indicators such as ovarian and uterine enlargement, girls 'well-being, and so on (r = 0.40-0.91).
However, toxic ME levels in girls with UBQ did not differ from those in healthy girls. Furthermore, the concentration of these MEs in the treatment dynamics varied insignificantly, so we did not determine the dependence on clinical data (P <0.05).
Consequently, the administration of essential micronutrients led to an increase in the concentration of these MEs in the blood of girls with UBC.
Indications for certain hormones of the pituitary-ovarian system, depending on the method of treatment of uterine bleeding at the juvenile age
The LG level was 5.9 ± 0.7 ME / l in healthy girls, 4.0 ± 0.6 ME / l in girls with the main group, and 3.9 ± 0.5 ME / l in the control group (P <0, 05). In the dynamics of treatment, an increase in LG levels in girls with SCI, especially in the main group, up to
5.1 ± 0.2 and 4.8 ± 0.4 ME / l, respectively, after 2 months and 5.6 ± 0.2 and 5 until. 5, 2 ± 0.2 ME / l, (P <0.01) 6 months after the start of treatment.
Prior to treatment, the FSG level in the blood was 6.0 ± 0.3 in the main group of girls and 5.9 ± 0.2 ME / l in the control. From the second month of treatment, this hormone level has an upward trend: up to 6.2 ± 0.5 ME / l in the main group and up to
6.2 ± 0.1 ME / l in the control group. By the sixth month, FSG levels continued to increase, more specifically in the main group of girls: between 6.4 ± 0.1 and 6.3 ± 0.7 ME / l, respectively.
The peripheral blood estradiol concentration was 324 ± 42 pg / ml in healthy girls, 260.8 ± 23 pg / ml in the main group, and 260.8 ± 16 pg / ml in the control group (P> 0.05). In the dynamics, an increase in estradiol concentrations was observed in both groups, especially in girls receiving ME, from 328 ± 28, 303 ± 26 pg / ml to 283 ± 21 and 271 ± 18 after 2 months, 6 months after the start of treatment, respectively ( P <0.05).
Blood prolactin concentrations were 388 ± 25 nmol / l in healthy girls and 306 ± 18 and 306 ± 14 nmol / l in girls with UBC, respectively (P <0.01). In the dynamics of
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treatment in the second month, this figure increased to 345 ± 20 nmol / l in the main group and 340 ± 16 nmol / l in the control group. Six months after the start of treatment, an increase in this hormone was observed to be 367 ± 32 and 360 ± 28 nmol / l, respectively (P> 0.05).
Significantly lower levels of progesterone (13.8 ± 2.9 and 13.4 ± 2.5 ng / ml, respectively) were observed in girls with UBC (20.8 ± 1.2 in healthy girls; P <0.05). However, a negative correlation between progesterone and absence of ovulation was found (r = -0.66). In the dynamics of treatment, the increase in progesterone levels after 16 months to 16.0 ± 2.1 and 16.5 ± 1.8, and after 6 months from the beginning to 18.5 ± 1.8 and 16.8 ± 0.9 ng / ml observed (P <0.05).
Thus, the complex treatment of YBQ in girls aged 12-16 years contributed to the normalization of hormonal parameters, especially in the group of patients receiving ME drugs. However, the increase in the content of important MEs such as iodine, zinc, iron, etc. was naturally directly related to hormonal indices, which showed that MEs are undoubtedly involved in the formation of hormones and in the pathogenetic treatment of SCI in girls.
Indications of the uterus and ovaries, depending on the method of treatment of uterine bleeding at the juvenile age
Ovarian length was 3.6 ± 0.4 cm in healthy girls aged 12-16 years, and 3.4 ± 0.6 and 3.4 ± 0.5 cm in girls with UBC, respectively. in the dynamics after treatment, ovarian enlargement was observed: between 2 months to 3.6 ± 0.2 and 3.5 ± 0.4, and 6 months after the start of treatment, 3.6 ± 0.1 and 3.5 ± 0.2 cm (P> 0.05).
The length of the uterus was 6.4 ± 0.2 cm in healthy girls and 6.0 ± 0.3 and 5.9 ± 0.2 cm (P <0.05), respectively, in girls with UBC. In the dynamics of treatment, as well as an increase in uterine length, respectively, in the second phase to 6.2 ± 0.5 and 6.2 ± 0.4 cm, and in the sixth month of treatment 6.4 ± 0.1 and 6.3 ± 0, Made up to 7 cm.
Depending on the method of treatment, the results of ultrasound examinations of the endometrium showed that. In the second stage of the menstrual cycle, the thickness of the endometrium was 0.9 ± 0.09 cm in healthy girls, and 1.2 ± 0.1 and 1.2 ± 0.09 cm (P> 0.05), respectively, in girls with IBD. atresia of the follicle and, accordingly, the absence of a second phase. However, on UTT, some patients showed that the surface of the uterine endometrial layer was uneven and had hyperplasia.
From the second month of treatment, a decrease in endometrial thickness was observed between 1.0 ± 0.09 and 1.1 ± 0.1 cm, but these data were not reliable (P> 0.05). By the sixth month of follow-up of girls with UBC, the thickness of the endometrium was almost the same as the endometrial thickness of healthy girls: 0.9 ± 0.1 and 0.86 ± 0.4 cm, respectively.
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Consequently, the results of the study show a high efficacy of ME-containing drugs in girls with IBD, which is characterized by an increase in anthropometric size of the ovaries and uterus, significant improvement in endometrial exography and onset of ovulation. fatigue, dizziness disappeared, intellectual memory improved, etc.
These data are directly related to the positive dynamics of decreased or stopped bleeding and erythrocyte counts (r = 0.51-0.91).
Thus, a study by the authors showed that the treatment of bleeding girls at the juvenile age normalized clinical and laboratory parameters, stopped bleeding as soon as possible, improved girls' health and achieved high clinical efficacy. best results were obtained.
Positive dynamics of hormonal status, anthropometric data of the genitals, as well as the presence of high parallelism in the normalization of microelementosis in the body with clinical signs of uterine bleeding at a juvenile age, generally require treatment aimed at normalizing the microelement balance of the organism. The results of our studies have shown that this tactic is more expedient and reasonable in the management of sick girls, because even almost healthy girls have conditioned physiological microelementosis of the organism against the background of a rapidly developing organism at the age of 12-16 years.
The inclusion of drugs containing ME in the complex therapy significantly improves the level of micronutrient deficiency in the body, significantly improves clinical and laboratory parameters and contributes to the establishment of a regular ovulatory menstrual cycle.
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CENTRAL ASIAN ACADEMIC JOURNAL ISSN: 2181-2489
OF SCIENTIFIC RESEARCH VOLUME 2 I ISSUE 5 I 2022
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