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6. Tolkacheva V.V., Villevalde S.V., Kobalava Zh.D. The state of carbohydrate metabolism and the transformation of prediabetes into type 2 diabetes mellitus depending on the diagnostic method in patients with high cardiovascular risk arterial hypertension without a history of diabetes mellitus. Arterial hypertension. Volume 18. № 2, 2012. Р. 83.
MODERN FEATURES OF PCOS TREATMENT IN WOMEN WITH
CHRONIC IOD DEFICIENCY
1 2 Ahmedova N.M. , Abdullazhonova S.A.
Email: Ahmedova17164@scientifictext.ru
1Ahmedova Nilufar Mahmudovna - Candidate of Medical Sciences, Associate Professor; 2Abdullazhonova Sayyora Azimzhonovna - Master's degree in Obstetrics and Gynecology, DEPARTMENT № 1 OF OBSTETRICS AND GYNECOLOGY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: polycystic ovary syndrome is a clinical syndrome characterized by moderate obesity, irregular periods or amenorrhea, and signs of androgen excess (eg, hirsutism, acne). Most patients have multiple ovarian cysts.
The developing hypercholesterolemia in hypothyroidism and polycystic ovary syndrome leads to the progression of atherosclerotic changes in the vessels and the occurrence of cardiovascular diseases.Diagnosis is based on pregnancy test results, hormone measurements, and imaging to rule out a virilizing tumor. Treatment is symptomatic. Keywords: polycystic ovary syndrome, infertility, ovaries, iodine deficiency, ovulation.
СОВРЕМЕННЫЕ ОСОБЕННОСТИ ЛЕЧЕНИЯ СПКЯ У ЖЕНЩИН С ХРОНИЧЕСКОМ ДЕФИЦИТОМ ЙОДА Ахмедова Н.М.1,Абдуллажонова С.А.2
1Ахмедова Нилуфар Махмудовна - кандидат медицинских наук, доцент; 2Абдуллажонова Сайёра Азимжоновна - магистр акушерства и гинекологии, кафедра № 1 акушерства и гинекологии, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: синдром поликистозных яичников - клинический синдром, характеризующийся умеренным ожирением, нерегулярными менструациями или аменореей и признаками избытка андрогенов (например, гирсутизм, угри). Большинство пациентов имеют множественные кисты яичников. Развивающаяся гиперхолестеринемия при гипотиреозе и синдроме поликистозных яичников приводит к прогрессированию атеросклеротических изменений в сосудах и возникновению сердечно-сосудистых заболеваний. Диагноз ставится на основании результатов теста на беременность, измерения уровней гормонов и визуальных методов исследования для исключения вирилизирующей опухоли. Лечение является симптоматическим.
Ключевые слова: синдром поликистозных яичников, бесплодие, яичники, йододефицит, овуляция.
УДК 618.11-006.31-07-08
Relevance. Determination of the frequency of PCOS depends on the diagnostic criteria used and the characteristics of the population sample [2, 6]. Among patients with
anovulatory infertility, its frequency is 55-91%, and in the structure of infertile marriage, this pathology takes 5-6th place, accounting for 5-22% [3, 8].
The prevalence of this pathology in the United States, when diagnosed in accordance with the criteria of the US National Institutes of Health, is approximately 4-8%. The situation is similar in Europe - about 6-7%, according to the UK National Institute for Health and Clinical Excellence guidelines for the management of PCOS patients. However, caution should be exercised when interpreting data on the epidemiology of PCOS, as prevalence rates from the new Rotterdam Diagnostic Criteria are as high as 20% [1, 5].
The incidence of type 2 diabetes mellitus (DM) among young women with PCOS in the United States is 10 times higher than in healthy women. Reduced glucose tolerance or directly type 2 diabetes develops around the age of 30 in 30-50% of obese people with PCOS. The frequency of metabolic syndrome (MS) is 2-3 times higher in patients with PCOS compared with healthy women of the same age and with a similar body mass index; at the same time, 20% of patients with PCOS under 20 years of age suffer from MS [2,10]. In addition, the risk of fatal myocardial infarction is twice as high among individuals prone to oligomenorrhea, most of whom are presumed to have PCOS [4, 7].
Purpose of the study. Determination of the optimal tactics of drug therapy for PCOS in women with hypothyroidism.
Materials and research methods. We examined 154 patients with PCOS aged 18 to 40 years. They were randomized into three groups depending on the presence / absence of thyroid pathology.
Research results. Most often, patients complained of menstrual irregularities, excessive hair growth, infertility, hyperandrogenism, dermopathy, and obesity. Women with hypothyroidism also reported drowsiness (n = 26), memory loss (n = 31), constipation (n = 16), dry skin (n = 33).
Patients with PCOS and ECD had a burdened heredity in relation to maternal endocrinopathies (p <0.05). In them, menstrual irregularities and endocrinopathies were statistically significantly more frequent. It should be noted that the second and third groups did not differ in the incidence of thyroid diseases. There was no statistically significant difference between groups regarding family history of obesity. The results obtained support the genetic etiology of the syndrome and its association with autoimmune processes.
Menarche in the examined women was between 11 and 18 years old. In 36.4% of cases, it occurred at the age of 13-14. In relation to this indicator, there was no significant statistical difference between the groups. At the same time, in the first group, the onset of menarche was noted a little later - at 14.7 ± 1.2 years. The proportion of such patients was 37.5% (p <0.05).
In the first group, the body mass index averaged 28.90 ± 0.70 kg / m2 with a maximum value of 40.00 kg / m2, in the second - 28.00 ± 0.02 kg / m2 with a maximum value of 41.00 kg / m2, in the third - 30.20 ± 0.10 kg / m2 with a maximum value of 38.60 kg / m2. The frequency of occurrence of normal and overweight, as well as obesity is presented in table. four.
When clarifying the nature of the diet, it was found that 81 women ate balanced, 73 -high-calorie foods. In the diet of the latter, there was an excess of fried and spicy foods, foods containing easily digestible carbohydrates. There were more such patients in the second group.
Of the 154 participants, 106 (69.3%) were married, 100 (94.3%) of them had a regular sex life. In 65 (42.5%) patients out of 100, primary infertility was diagnosed, in 35 (22.7%) -secondary infertility. In the first group, primary infertility was diagnosed in 17 (26.2%) women, in the second - in 22 (33.8%), in the third group - in 26 (40%) patients. The incidence of secondary infertility in all groups was practically the same - 13 (37.1%), 11 (31.4%) and 11 (31.4%) cases, respectively. Primary infertility was more often observed in urban women (p = 0.006), secondary - in those living in the districts (p = 0.016).
The general obstetric history was most favorable in women with PCOS. With combined pathology, the reproductive prognosis is more difficult.
According to the results of our study, age, social and obstetric and gynecological history, clinical manifestations of hyperandrogenism (hirsute number), as well as the presence of concomitant pathology are the most significant for the prognosis of reproductive function in patients with infertility.
The results of a biochemical study of the patients' blood are consistent with the data of other authors: metabolic disorders are characteristic of PCOS patients - dyslipidemia and hyperinsulinemia.
Analysis of the hormonal profile indicates that the highest ratio of luteinizing hormone follicle-stimulating hormone (LH / FSH) was in the third group.
This indicates deeper changes in the activity of gonadotropic hormones in women with PCOS and hypothyroidism.
Most likely, the change in these indicators is more associated with hypothyroidism than with ovarian hyperandrogenism. This is confirmed by the higher frequency of these disorders in patients with hypothyroidism than in women with PCOS and normal thyroid function.
An increase in TSH concentration by more than one and a half times in patients of the third group compared with patients in the other two groups and a concomitant decrease in St. T3 and St. T4 confirms the involvement of the pituitary gland in the pathological process. A hypothyroid state appears to exacerbate hormonal imbalances. It was found that most often in patients with hypothyroidism, the level of prolactin (PRL) is increased, which reflects the stimulating effect of thyroid hormone deficiency on its secretion.
The mechanism of impaired reproductive function with a combination of PCOS and hypothyroidism is quite complex: the concentration of PRL increases, which blocks the effect of gonadotropic hormones on the ovaries, decreases the synthesis of estradiol, increases the ratio of LH / FSH, which leads to insufficiency of the second phase of the menstrual cycle or its single-phase, decreases the synthesis of progesterone, the consequence of which may be miscarriage or infertility.
Dysfunction of the thyroid gland exacerbates the severity of metabolic and hormonal disorders in patients with PCOS. In particular, the level of SHBG significantly decreases, the free fractions of ovarian androgens, the concentration of DHEA naturally increase, which in turn increases the severity of androgenization and potentiates the development of insulin resistance, as well as dyslipidemia.
In patients with PCOS and hypothyroidism, the values of LH, PRL, testosterone, cortisol and DHEA were significantly higher, the level of SHBG was the lowest. These indicators in women with PCOS, as well as with PCOS and ECD were not statistically significantly different.
Output. In contrast to women with PCOS, patients with combined pathology are characterized by a burdened heredity in relation to endocrinopathies, an unfavorable somatic and obstetric-gynecological history. The combination of PCOS and hypothyroidism is associated with more severe androgenization. With PCOS and thyroid pathology, hyperandrogenism and insulin resistance are more pronounced against the background of excessive weight gain.
References / Список литературы
1. Amiraslanov A.T.O., Safarova S.I.K. Risk factors and prognostic indicators of atypical endometrial hyperplasia. Bulletin of modern clinical medicine, 2019; 12 (2): 7-11.
2. Zavalko A.F., Kotelnikova N.A. Endometrial hyperplasia - pathogenetic aspects, classification and prevalence of pathology among patients of reproductive age. Bulletin of the Medical Institute "Reaviz": rehabilitation, doctor and health, 2016; 1: 22-7.
3. Mikhelson A.F., LebedenkoE.Yu., Lazareva I.P., Emelyanova T.A., Chelakh T.D., Groshilina G.S., Bogachenko S.M., Kutuzova E.A. Features of autonomic regulation of functions in women of reproductive age with endometrial hyperplastic processes. Chief physician of the South of Russia, 2018; 3: 45-8.
4. Panshina M.V., Khadartseva K.A. Experience in the prevention of endometrial pathology. Bulletin of new medical technologies. Electronic edition, 2018; 3: 61-5.
5. Suplotova L.A., Makarova O.B., Sharukho G.V., Kovalzhina L.S. The role of nutrition in the prevention and correction of iodine deficiency conditions in the endemic area. Nutrition issues, 2018; 87 (5): 27-36.
КОМПЛЕКСНАЯ ТЕРАПИЯ ПРИ МЫШЕЧНОЙ КРИВОШЕЕ Ильчибакиева Р.А.1, Мухамадеева И.С.2, Цындрина А.В.3 Email: Mukhamadeeva 17164@scientifictext.ru
1Ильчибакиева Роза Абугалимовна - студент; 2Мухамадеева Ильмира Сафировна - студент, лечебный факультет; 3Цындрина Алена Владимировна - старший преподаватель, кафедра физического воспитания, ЛФК, восстановительной и спортивной медицины, Бюджетное образовательное учреждение высшего образования Ханты-Мансийского
автономного округа-Югры Ханты-Мансийская государственная медицинская академия, г. Ханты-Мансийск
Аннотация: в нашей статье рассказывается о важности диагностики, лечения, комплексе ЛФК и массажа при мышечной кривошее. Комплексная терапия при данной патологии включает ЛФК, массаж, коррекционную гимнастику, и физиотерапевтические процедуры. В комплексе все указанные процедуры, позволяют снизить гипертонус со стороны пораженной мышцы, увеличить кровообращение и тем самым улучшаются обменные процессы и уменьшаются инфильтративные процессы. Кривошея — это стойкий наклон головы кпереди или вбок. Раннее, последовательное и комплексное лечение кривошеи у ребенка приводит к полному устранению дефекта у 80-90% детей.
Ключевые слова: кривошея, диагностика кривошеи, лечение кривошеи, комплекс упражнений ЛФК, массаж при кривошее, профилактика осложнений при мышечной кривошее.
COMPLEX THERAPY FOR MUSCULAR TORTICOLLIS Ilchibakieva R.A.1, Mukhamadeeva I.S.2, Tsyndrina A.V.3
1Ilchibakieva Roza Abugalimovna - Student; 2Mukhamadeeva Ilmira Safirovna - Student, MEDICAL FACULTY; 3Tsyndrina Alyona Vladimirovna - Senior Lecturer, BUDGETARY EDUCATIONAL INSTITUTION OF HIGHER PROFESSIONAL EDUCATION OF THE KHANTY-MANSIYSK AUTONOMOUS OKRUG-YUGRA KHANTY-MANSIYSK MEDICAL STATE MEDICAL ACADEMY, KHANTY-MANSIYSK
Abstract: ош article describes the importance of diagnosis, treatment, complex exercise therapy and massage for muscular torticollis. Complex therapy for this pathology includes physical therapy, massage, correctional gymnastics, and physiotherapy procedures. In the
