Patients Of Reproductive Age Research Articles

Physiological characteristics of reproductive-age patients with female sexual dysfunction and endometriosis (a comparison of clinical and laboratory parameters in different study groups)

Physiological characteristics of reproductive-age patients with female sexual dysfunction and endometriosis (a comparison of clinical and laboratory parameters in different study groups)

Psychosomatic status of women of reproductive age with adenomyosis

The objective: to study the impact of adenomyosis on the psychosomatic status of women of reproductive age.Materials and methods. A complex clinical-laboratory and instrumental prospective examination for women with adenomyosis was conducted in 224 patients aged 30 to 50 years (average age – 42.0±1.8 years). These patients were included in the main group of the study. The patients of the main group were divided into two subgroups depending on the form of adenomyosis: Group I – diffuse form – 106 women, Group II – nodular form – 118 women.The control group included 84 healthy women of reproductive age with a regular ovulatory menstrual cycle and no history of gynecological diseases.To assess the psychosomatic status of patients with adenomyosis we used the Aleksandrowicz method: a questionnaire of neurotic disorders – symptomatic (QND- S).Results. The conducted studies established that the largest number of patients were 36–40 years old – 92 (41.1±3.3%) women in the main group, and 37 (44.0±5.4%) women in the control group. A total of 152 (67.9±3.1%) patients of the main group were of reproductive age, 72 (32.1±3.1%) patients were of perimenopausal age.In patients with adenomyosis disorder of the menstrual cycle in the form of hyperpolymenorrhea was found in almost every third patient, and algomenorrhea – in almost every second person. The diagnosis was established for the first time in 8.49±2.7% of patients in Group I (9 women) and 3.38±1.8% in Group II (4 women).Less than 5 years of the disease was observed in 34.91±4.6% of patients of the Group I (37 women) and in 51.69±4.6% of the Group II (61 women). From 5 to 10 years, the disease was observed in 56.60±4.8% of patients of the Group I (60 women) and in 44.93±4.6% of the Group II (53 women). Affective stress (up to 15.50%), sleep disorders (up to 20.22%), anxiety-phobic disorders (up to 11.18%) were determined most often.Conclusions. In the vast majority of patients of reproductive age who have adenomyosis with pain syndrome, the personal characteristics are dominated by symptoms such as anxiety-phobic and depressive disorders, affective tension, sexual, obsessive and anankastic disorders.

Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer.

To describe population-level utilization of fertility-sparing surgery and outcome of reproductive-aged patients with early epithelial ovarian cancer who underwent fertility-sparing surgery in the United States. This retrospective study queried the National Cancer Institute's Surveillance, Epidemiology, and End Result Program. The study included 3,027 patients younger than age 50 years with stage I epithelial ovarian cancer receiving primary surgical therapy from 2007 to 2020. Fertility-sparing surgery was defined as preservation of one ovary and the uterus for unilateral lesion and preservation of the uterus for bilateral lesions. Temporal trend of fertility-sparing surgery was assessed with linear segmented regression with log-transformation. Overall survival associated with fertility-sparing surgery was assessed with Cox proportional hazard regression model. A total of 534 patients (17.6%) underwent fertility-sparing surgery. At the cohort level, the utilization of fertility-sparing surgery was 13.4% in 2007 and 21.8% in 2020 (P for trend=.009). Non-Hispanic White individuals (2.8-fold), those with high-grade serous histology (2.2-fold), and individuals with stage IC disease (2.3-fold) had a more than twofold increase in fertility-sparing surgery utilization during the study period (all P for trend<.05). After controlling for the measured clinicopathologic characteristics, patients who received fertility-sparing surgery had overall survival comparable with that of patients who had nonsparing surgery (5-year rates 93.6% vs 92.1%, adjusted hazard ratio 0.87, 95% CI, 0.57-1.35). This survival association was consistent in high-grade serous (5-year rates 92.9% vs 92.4%), low-grade serous (100% vs 92.2%), clear cell (97.5% vs 86.1%), mucinous (92.1% vs 86.6%), low-grade endometrioid (95.7% vs 97.7%), and mixed (93.3% vs 83.7%) histology (all P>.05). In high-grade endometrioid tumor, fertility-sparing surgery was associated with decreased overall survival (5-year rates 71.9% vs 93.8%, adjusted hazard ratio 2.90, 95% CI, 1.09-7.67). Among bilateral ovarian lesions, fertility-sparing surgery was not associated with overall survival (5-year rates 95.8% vs 92.5%, P=.364). Among 41,914 patients who had epithelial ovarian cancer with any age and stage, those younger than age 50 years with stage I disease increased from 8.6% to 10.9% during the study period (P for trend=.002). Nearly one in five reproductive-aged patients with stage I epithelial ovarian cancer underwent fertility-sparing surgery in recent years in the United States. More than 90% of reproductive-aged patients with stage I epithelial ovarian cancer who underwent fertility-sparing surgery were alive at the 5-year timepoint, except for those with high-grade endometrioid tumors.

Oncofertility as an Essential Part of Comprehensive Cancer Treatment in Patients of Reproductive Age, Adolescents and Children.

The number of children, adolescents and young adults diagnosed with cancer has been rising recently. Various oncological treatments have a detrimental effect on female fertility, and childbearing becomes a major issue during surveillance after recovery. This review discusses the impact of oncological treatments on the ovarian reserve with a thorough explanation of oncologic treatments' effects and modes of oncofertility procedures. The aim of this review is to help clinicians in making an informed decision about post-treatment fertility in their patients. Ultimately, it may lead to improved overall long-term outcomes among young populations suffering from cancer.

The effect of antitumor therapy on the reproductive system, the possibility of preserving female fertility

The influence of malignant neoplasms and their treatment methods on the reproductive function of women is one of the significant problems of oncogynecology. The mechanisms of ovarian follicle loss caused by chemotherapy have their own characteristics depending on the characteristics of the cytotoxic agent and act differently on different populations of ovarian cells. The toxic effect on fertility of the main groups of antitumor drugs is considered. Reproductive dysfunction has negative consequences for a woman’s physical and mental health. The use of methods that reduce the effect of cytotoxic agents on the ovary helps to prevent premature ovarian insufficiency, leading to infertility. The article discusses modern methods of fertility preservation using assisted reproductive technologies. All cancer patients of reproductive age should receive full oncofertility counseling as early as possible, during the treatment planning process, regardless of the type and stage of the disease.

Features of the reproductive function of girls and women with rheumatoid arthritis: A review

Rheumatoid arthritis is one of the most common and severe autoimmune diseases. The prevalence of rheumatoid arthritis among adults in different geographical areas of the world ranges from 0.5 to 2%. The prevalence of juvenile rheumatoid arthritis is approximately 6 per 10 thousand children. The disease occurs 2 times more often in girls than in boys. Some studies have demonstrated a possible effect of high cumulative doses of methotrexate on ovarian function in patients with systemic lupus erythematosus, but further studies are needed to confirm this effect. The analysis of literature data allowed us to identify prognostically significant factors in the development of autoimmune ovarian failure in patients of reproductive age with rheumatic pathology, and to note the fact that there is missing information about the state of the reproductive system in female patients with juvenile arthritis.

Pregravid preparation for women with bacterial vaginosis and a history of early pregnancy loss

Introduction. Statistics show that about 13 to 15 in 100 pregnancies end in early miscarriage. This represents both a medical and social issue, as such outcome may be associated with maternal depression and anxiety, which inevitably affects women’s activities, performance efficiency and social inclusion. Restoration of normobiocenosis and lactobacilli pool dominance is one of the key challenges for women planning pregnancy.Aim. To evaluate the effectiveness of probiotics at the pregravid preparation stage in women with a history of early pregnancy loss and bacterial vaginosis (BV).Materials and methods. We selected 46 patients of reproductive age (24–39 years) who applied for early pregnancy loss, with complaints of vaginal discharge with an unpleasant odour, pruritus, burning, and dyspareunia, using databases of 5 medical clinics in Moscow, Tyumen and Stavropol. To treat bacterial vaginosis, two-stage therapy aimed at eliminating the increased number of anaerobic microorganisms and restoring the vaginal microbiocenosis was used.Results. The effectiveness of combination therapy was assessed at 1 month. All patients on therapy experienced clinical improvement, normalization of vaginal microbiocenosis parameters based on Femoflor-16 test findings after the end of treatment. Physiological microbiocenosis of Lactobacillus spp. &gt; 107 was detected in 43 (94.5%). In all patients, the average vaginal pH after two-stage therapy was 4.3 ± 0.7. The safety of Acilact Duo therapy was assessed in all study participants. No negative trends were recorded.Conclusion. Superlimflife (Acilact Duo), acidophilus bacteria + vitamin-mineral protein-peptide complex, quickly restores optimal vaginal acidity (pH), stimulates the growth of lactobacilli, and reduces the incidence of BV relapses.

New options for replenishing the iron stores in patients with abnormal uterine bleeding

Introduction. The high incidence of abnormal uterine bleeding (AUB) (over 30%) among patients of reproductive age is accompanied by the development of iron deficiency anaemia (IDA), which, in turn, is a social problem among global burden diseases throughout the world.Aim. To evaluate the clinical efficacy and compliance with the Vojea complex regimen to prevent IDA in women with abnormal uterine bleeding.Materials and methods. A multicentre clinical observational study was conducted in 6 health care facilities and women’s health clinics in Yekaterinburg and Moscow. The study included 52 patients with latent iron deficiency (serum ferritin level &lt; 15 ng/ml) who were diagnosed with abnormal uterine bleeding (AUB) due to ovulatory dysfunction. All patients received Vojea complex at a dose of 1 tablet QD for 3 months while taking pharmaceutical therapy for AUB. The clinical and laboratory efficacy and medication compliance were assessed at 30, 60 and 90 days after initiation of treatment.Results. Starting from the 1st month of treatment with the study complex, positive trends in clinical and laboratory findings were observed in both groups. After the three-month therapy with Vojea, ferritin levels increased 5.4 times (a clinically significant growth was reported after the two-month intake), plasma folate levels increased 4.9 times and red blood cell folate concentrations increased by 45%. The complex therapy helped reach and maintain the average red blood cell folate concentration &gt;400 ng/ml (906 nmol/l). Side effects included isolated events of gastrointestinal dyspepsia and individual intolerance. All patients reported good and excellent tolerance of the complex, which ensured high compliance with the drug regimen (92%).Conclusion. The three-month therapy with Vojea complex as part of the combination approach to the treatment of AUB in women with latent iron deficiency showed high clinical and laboratory efficacy, as well as good compliance with the drug regimen.

Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer: A Population-Based Assessment in the United States [ID 2693178

INTRODUCTION: The objective of this study was to assess population-level utilization and outcome of reproductive-aged patients with early epithelial ovarian cancer (EOC) who underwent fertility-sparing surgery (FSS) in the United States. METHODS: This population-based retrospective study queried the National Cancer Institute’s Surveillance, Epidemiology, and End Result Program. The study included 3,027 patients aged less than 50 years with stage I EOC receiving primary surgical therapy from 2007 to 2020. Fertility-sparing surgery was defined as preservation of one ovary and the uterus for unilateral lesion and preservation of the uterus for bilateral lesions. Temporal trend of FSS was assessed with linear segmented regression with log-transformation. Overall survival (OS) associated with FSS was assessed with Cox proportional hazard regression model. RESULTS: A total of 534 (17.6%) patients underwent FSS. At cohort level, the utilization of FSS was 13.4% in 2007 and 21.8% in 2020 (P-trend=.009). Non-Hispanic White individuals (2.8-fold), high-grade serous histology (2.2-fold), and stage IC disease (2.3-fold) had greater than 2-fold increase in FSS utilization during the study period (all, P-trend&lt;.05). After controlling for the measured clinico-pathological characteristics, patients who received FSS had OS comparable to those who had nonsparing surgery (5-year rates, 93.6% versus 92.1%; adjusted hazard ratio, 0.87; 95% CI, 0.57–1.35). This survival association was consistent in high-grade serous (5-year rates, 92.9% versus 92.4%), low-grade serous (100% versus 92.2%), clear cell (97.5% versus 86.1%), mucinous (92.1% versus 86.6%), low-grade endometrioid (95.7% versus 97.7%), and mixed histology (93.3% versus 83.7%) (all, P&gt;.05). In high-grade endometrioid tumor, FSS was associated with decreased OS (5-year rates, 71.9% versus 93.8%; adjusted-hazard ratio 2.90; 95% CI, 1.09–7.67). Among bilateral ovarian lesions, FSS was not associated with OS (5-year rates, 95.8% versus 92.5%; P=.364). CONCLUSION: Nearly one in five reproductive-aged patients with stage I EOC underwent FSS in recent years in the United States. The data suggest that FSS may not adversely affect OS, except for high-grade endometrioid tumors.

New Aspects in the Study of Lactobacillus iners.

A cultural microbiological study of the vaginal microbiota of patients of reproductive age was carried out to isolate the species Lactobacillus iners with subsequent study of phenotypic features. The presence of two phenotypically different species variants was found in patients with bacterial vaginosis.

Rates of Female Sterilization, Vasectomy, and LARC Placement Before and After the Dobbs Decision: A Retrospective Cohort Study [ID 2683404

INTRODUCTION: Immediately after the Dobbs decision in Ohio, abortion was restricted after detection of a fetal heartbeat. The objective of this study was to characterize changes in utilization of long-acting reversible contraception (LARC) and permanent sterilization (PS) after the abrupt enactment of restrictive abortion legislation. METHODS: We conducted a retrospective cohort study of female and male patients aged 15–55 who underwent permanent sterilization (tubal ligation, salpingectomy, vasectomy) or LARC placement (IUD, contraceptive implant) at a large Northeast Ohio hospital system from January 1, 2022 to December 31, 2022; 6 months before and after Dobbs. Contraception procedure volumes were compared, and patient characteristics were assessed. RESULTS: Pre-Dobbs, 4,247 procedures were identified among females, including 725 (17.1%) PS and 7,449 (81.3%) LARC. Post-Dobbs, the total number of female procedures increased by 15.5% (4,916) and there was a significant increase in the proportion of PS procedures, representing 20.1% of all female procedures (P&lt;.001). Males showed a similar trend, with vasectomies rising from 1,193 to 1,590 procedures. Post-Dobbs, patients undergoing procedures were younger (women, 30.9 years [24.5, 36.8] versus 31.5 [25.2, 36.9]; P=.011; men, 36.6 years [32.9, 39.6] versus 37.2 [34.2, 40.4]; P&lt;.001). Among patients undergoing procedures post-Dobbs, the proportion that reported single relationship status significantly increased for women (57.4% versus 55.9%; P=.028) and men (23.0% versus 18.1%; P=.002). CONCLUSION: This study demonstrates increased utilization of LARC and PS following the Dobbs decision. This rise in PS and demographic changes implies concerns about abortion access, especially among younger reproductive-aged patients. Further research is warranted to understand the driving factors behind these trends.

Экспрессия ARID1a в эндометрии женщин репродуктивного возраста с аномальными маточными кровотечениями и ожирением

Objective. The aim of the study was to evaluate the expression of the proliferative marker ARID1a in endometrial biopsies of patients with abnormal uterine bleeding (AUB) and obesity and its role in the pathogenesis of endometrial dysfunction. Materials and methods. The study included 40 endometrial samples from patients of reproductive age with AUB-E: 20 from patients with AUB-E and obesity (group 1) and 20 from patients with normal body mass index (BMI) and AUB (group 2). 10 endometrial samples were obtained from healthy women of reproductive age, taken on the 2nd-3rd day of the menstrual cycle. All patients underwent histological examination according to the standard procedure. At the second stage, an immunohistochemical study of the ARID1a proliferation marker was performed using polyclonal rabbit antibodies to Anti-ARID1a (clone EPR13501-73) in standard dilution (1:500) according to the protocol of the manufacturer Abcam (Great Britain). The IBM SPSS Statistics v.26 program (IBM Corporation, USA) was used for statistical data analysis. To determine statistically significant differences between quantitative parameters with a normal distribution, one-factor analysis of variance (ANOVA) was used with the calculation of a 95% confidence interval followed by the post-hoc Games-Howell test for multiple comparisons. The differences were considered significant at p&lt;0.05. Results. ARID1a expression was evaluated in the glandular and stromal compartments of the endometrium. In the endometrial glands, the expression of ARID1a was statistically significantly higher in the first group of obese patients compared with the normal and control groups. In the endometrial stroma, the expression of the proliferative marker was higher in the main group compared with the control group. However, when comparing between groups within the main group, statistical significance in the level of expression was not achieved. Conclusion. The results obtained demonstrate the possible pathological effect of obesity on the structural and functional properties of the endometrium, which leads to delayed regeneration of the endometrium due to the glandular component and, consequently, to AUB-E.

Basic Characteristics and Demographic Data in Patients with Chronic Vulvar Discomfort: A Detailed Analysis of DATRIV Study

This study aims to provide a descriptive analysis of the essential characteristics and demographic profiles, including age, weight, height, body mass index, marital status, and educational background in patients with chronic vulvar discomfort. The data were collected from the study DATRIV (Diagnostic Accuracy of Three Rings Vulvoscopy), which included 328 participants divided into four groups: normal vulva, impaired vulvar skin, primary vulvar distress/vulvodynia, and secondary discomfort caused by vulvar dermatoses. The clinical data collected from the study questionnaire were analyzed using statistical software such as StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). The study was conducted with the approval of the Institutional Review Board of Polyclinic Harni, and all participants provided written informed consent. The findings from the DATRIV study shed light on several important aspects of chronic vulvar discomfort. They offered valuable insights into the demographic and reproductive characteristics of patients with chronic vulvar pain, specifically vulvar dermatosis. The study revealed that patients with vulvar dermatosis tended to be older, with a peak incidence in the 45-65 age range. They also had higher weight and BMI compared to other groups. There was a significant difference in the proportion of patients of reproductive age between the vulvar dermatosis group and other groups. Additionally, the vulvar dermatosis group had higher rates of marriage, births, and abortions and lower educational levels. The study&amp;apos;s limitations included lacking patients younger than 16 years. Future research should aim to include a broader age range, including pediatric populations, to gain a more comprehensive understanding of vulvar dermatosis across different age groups. Further investigation is needed to uncover the underlying mechanisms and establish causal relationships, enhancing diagnosis, treatment, and support for individuals affected by vulvar dermatosis.

Maternal-Fetal Compatibility in Recurrent Pregnancy Loss.

Nowadays, recurrent pregnancy loss (RPL) is an undesirable condition suffered by many patients of reproductive age. In this scenario, certain immune cell populations and molecules, involved in maternal-fetal compatibility, have emerged as factors related with the pathogenesis of RPL. Among them, uterine Natural Killer cells (uNKs) appear to be of great relevance. These cells are involved in numerous processes during pregnancy, such as the remodeling of uterine spiral arteries or the control of trophoblast invasion. These functions are regulated by the interactions that these cells establish with the extravillous trophoblast, mainly through their Killer Immunoglobulin-like Receptors (KIRs) and the Human Leukocyte Antigen-C (HLA-C) molecules expressed by the embryo. A high level of polymorphism has been reported for both molecules involved in this interaction, with some of the possible KIR-HLA-C combinations being associated with an increased risk of RPL. However, the complexity of the maternal-fetal interface goes beyond this, as other HLA molecules also appear to be related to this reproductive pathology. In this review, we will discuss the role of uNKs in pregnancy, as well as the polymorphisms and clinical implications of KIR-HLA-C binding. We will also address the involvement of other, different HLA molecules in RPL, and the current advice on the appropriate management of patients with 'immunological mismatch', thus covering the main aspects regarding the involvement of maternal-fetal compatibility in RPL.

Patient Location and Disparities in Access to Fertility Preservation for Women With Gynecologic or Breast Cancer.

To assess the effect of geographic factors on fertility-sparing treatment or assisted reproductive technology (ART) utilization among women with gynecologic or breast cancers. We conducted a cohort study of reproductive-aged patients (18-45 years) with early-stage cervical, endometrial, or ovarian cancer or stage I-III breast cancer diagnosed between January 2000 and December 2015 using linked data from the California Cancer Registry, the California Office of Statewide Health Planning and Development, and the Society for Assisted Reproductive Technology. Generalized linear mixed models were used to evaluate associations between distance from fertility and gynecologic oncology clinics, as well as California Healthy Places Index score (a Census-level composite community health score), and ART or fertility-sparing treatment receipt. We identified 7,612 women with gynecologic cancer and 35,992 women with breast cancer. Among all patients, 257 (0.6%) underwent ART. Among patients with gynecologic cancer, 1,676 (22.0%) underwent fertility-sparing treatment. Stratified by quartiles, residents who lived at increasing distances from gynecologic oncology or fertility clinics had decreased odds of undergoing fertility-sparing treatment (gynecologic oncology clinics: Q2, odds ratio [OR] 0.76, 95% CI, 0.63-0.93, P =.007; Q4, OR 0.72, 95% CI, 0.56-0.94, P =.016) (fertility clinics: Q3, OR 0.79, 95% CI, 0.65-0.97, P =.025; Q4, OR 0.67, 95% CI, 0.52-0.88, P =.004), whereas this relationship was not observed among women who resided within other quartiles (gynecologic oncology clinics: Q3, OR 0.81 95% CI, 0.65-1.01, P =.07; fertility clinics: Q2, OR 0.87 95% CI, 0.73-1.05, P =.15). Individuals who lived in communities with the highest (51 st -100 th percentile) California Healthy Places Index scores had greater odds of undergoing fertility-sparing treatment (OR 1.29, 95% CI, 1.06-1.57, P =.01; OR 1.66, 95% CI, 1.35-2.04, P =.001, respectively). The relationship between California Healthy Places Index scores and ART was even more pronounced (Q2 OR 1.9, 95% CI, 0.99-3.64, P =.05; Q3 OR 2.86, 95% CI, 1.54-5.33, P <.001; Q4 OR 3.41, 95% CI, 1.83-6.35, P <.001). Geographic disparities affect fertility-sparing treatment and ART rates among women with gynecologic or breast cancer. By acknowledging geographic factors, health care systems can ensure equitable access to fertility-preservation services.

Assessment of the rehabilitation programs effectiveness in patients with painful external genital endometriosis

In patients with a painful form of external genital endometriosis (EGE), the prevailing symptom is chronic pelvic pain, which significantly reduces the quality of life (QoL). It causes disorders of the physical, psycho-emotional and sexual health of women of reproductive age, leading to distress, maladaptation, anxiety-depressive disorders, disruption of social functioning and family relationships. Objective. To evaluate the effectiveness of the rehabilitation program for women with a painful form of EGE after radical treatment in the rehabilitation period. Materials and methods. In the examined cohort were included a total of 104 patients of reproductive age 42.4±3.7 years with a painful form of EGE after radical treatment: Group 1 – 49 women with "active" rehabilitation; Group 2 – 55 patients with "passive" rehabilitation tactics in accordance with standards and National Clinical Guidelines. Integral assessment of QoL (objective) was performed using clinical, laboratory (cancer antigen-125 (CA-125), cancer antigen-19.9 (CA-19.9), interleukin-6 (IL-6), tumor necrosis factor (TNF), femoflor – 16, pH-metric titration), and instrumental studies (ultrasound, magnetic resonance imaging (MRI)). At the control points: before, in 5–9 days, 1,3,6 and 12 months after surgical treatment. Results. Patients with "active" rehabilitation tactics (Group 1) had a significantly more pronounced decrease in the levels of the assessed biomarkers in blood serum, normalization of the urogenital tract microbiocenosis and restoration of pelvic organs and structures, unlike patients in the comparison group. Conclusion. The use of comprehensive personalized rehabilitation in patients with painful form of EGE after radical treatment has demonstrated its effectiveness. Widespread introduction of rehabilitation programs into routine clinical practice is necessary.

Intimate Partner Violence and Human Trafficking Screening and Services in Primary Care Across Underserved Communities in the United States-Initial Examination of Trends, 2020-2021.

The Health Resources and Services Administration (HRSA) began collecting data on intimate partner violence (IPV) and human trafficking (HT) in the 2020 Uniform Data System (UDS). We examined patients affected by IPV and HT served by HRSA-funded health centers in medically underserved US communities during the COVID-19 pandemic. We established a baseline and measured trends in patient care by analyzing data from the 2020 (N = 28 590 897) and 2021 (N = 30 193 278) UDS. We conducted longitudinal ordinal logistic regression analyses to assess the association of care trends and organization-level and patient characteristics using proportional odds ratios (PORs) and 95% CIs. The number of clinical visits for patients affected by IPV and HT decreased by 29.4% and 88.3%, respectively, from 2020 to 2021. Health centers serving a higher (vs lower) percentage of pediatric patients were more likely to continuously serve patients affected by IPV (POR = 2.58; 95% CI, 1.01-6.61) and HT (POR = 6.14; 95% CI, 2.06-18.29). Health centers serving (vs not serving) patients affected by IPV were associated with a higher percentage of patients who had limited English proficiency (POR = 1.77; 95% CI, 1.02-3.05) and Medicaid beneficiaries (POR = 2.88; 95% CI, 1.48-5.62), whereas health centers serving (vs not serving) patients affected by HT were associated with a higher percentage of female patients of reproductive age (POR = 15.89; 95% CI, 1.61-157.38) and urban settings (POR = 1.74; 95% CI, 1.26-2.37). The number of clinical visits for patients affected by IPV and HT during the COVID-19 pandemic declined. Delayed care will pose challenges for future health care needs of these populations.

АНАЛИЗ ВЗАИМОСВЯЗИ НИКОТИНОВОЙ ЗАВИСИМОСТИ И ПАССИВНОГО КУРЕНИЯ СО СТЕПЕНЬЮ ТЯЖЕСТИ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНИ ЛЕГКИХ У КУРЯЩИХ ЖЕНЩИН РЕПРОДУКТИВНОГО ВОЗРАСТА

Introduction. We studied the nicotine addiction stage and secondhand smoke interrelationships with the chronic obstructive pulmonary disease severity in smokers of reproductive age. Aim of the study was to research in the nicotine addiction and secondhand smoke impact upon the development of chronic obstructive pulmonary disease severity in smoking women of reproductive age. Materials and Methods. Using the questionnaire methodology developed, the nicotine addiction stage was analyzed in reproductive women with and without secondhand smoke (based on questionnaire survey outcomes). There were 107 smoking female patients of reproductive age divided into two groups: Those with secondhand smoke and those without it. Observational group consisted of 42 non-smoking women without any chronic diseases. Chronic obstructive pulmonary disease was diagnosed based on the clinical recommendations of the Russian Respiratory Society (2021). The data obtained during the study were analyzed followed by the comparison of the outcomes between the groups of smoking patients with secondhand and non-secondhand smoking, against the observational group. The outcomes led us to determine whether there is a statistically significant relationship between secondhand smoke and nicotine addiction stage in the development of chronic obstructive pulmonary disease. The reliability of the outcomes was assessed using the methods of parametric and nonparametric statistics. Before using all statistical research methods, we checked whether the sampling complied with the Gaussian (normal) distribution law. Variables that did not obey the normal distribution law or those with the uncertain distribution law were analyzed using a nonparametric statistical method, i. e., Pearson criterion. Results and Discussion. Average age of the smoking patients is 26.5 years. Average index of smokers was 6.59 pack-years. The smokers’ index exceeded the middle of the indicator contributing to the chronic obstructive pulmonary disease development (10 pack – years), which is typical for a young age and their smoking experience. It was found that the nicotine addiction stage correlates with the chronic obstructive pulmonary disease severity with a statistically significant reliability. Conclusions. Secondhand smoke in addition to active smoking, reduces the temporal characteristics of chronic obstructive pulmonary disease severity.

Роль ангиогенного фактора в развитии эндометриальной дисфункции у женщин репродуктивного возраста с аномальными маточными кровотечениями и ожирением

The steady increase in the number of patients with abnormal uterine bleeding (AUB) has a negative impact on a woman's reproductive health. Obesity is defined as one of the risk factors for AUB and its role in the development of AUB-M and AUB-O has been studied to date. However, our earlier analysis of the results of histological examination of endometrial biopsies showed that in obese women with AUB, the desquamation phase (AUB-E) is significantly more common in the endometrium than in normal-weight women. One of the possible pathogenetic mechanisms may be abnormal endometrial vascularization due to systemic proinflammatory status and local tissue hypoxia. Aim. To identify the features of the expression of endothelial markers CD34+ and eNOS in endometrial biopsies of patients with AUB and obesity and their role in the pathogenesis of endometrial dysfunction. Materials and methods. A prospective randomized cohort study included 40 patients of reproductive age with AUB-E. Depending on the presence of obesity, women were stratified into 2 groups: 20 patients with AUB-E and obesity (group 1) and 20 normal-weight patients with AUB-E (group 2). 10 healthy women of reproductive age were included as a control group. All patients underwent endometrial biopsy followed by histological examination according to the standard procedure. At the second stage, an immunohistochemical study of CD34+ and eNOS angiogenesis markers was performed using monoclonal mouse antibodies in standard dilution. The IBM SPSS Statistics v.26 program (IBM Corporation, USA) was used for statistical data analysis. Results. CD34+ expression in patients with AUB and obesity was significantly higher than in normal-weight patients with AUB and healthy women (2,5±0,2, respectively; 95% CI 2,1–2,8 vs. 1,8±0,2; 95% CI 1,5–2,2 and 0,5±0,1; 95% CI 0,4–0,6; p1-2=0,03; p1-3&lt;0,001; p2-3&lt;0,001), as well as eNOS expression (respectively 8,7±0,6; 95% CI 7,3–10,0 vs. 4,0±0,5; 95% CI 3–5 and 1,3±0,2; 95% CI 0,9–1,7; p1-2&lt;0,001; p1-3&lt;0,001; p2-3&lt;0,001). Conclusion. Patients with AUB-E and obesity are characterized by increased expression of CD34+ and eNOS in endometrial tissue, which indicates pathological activation of neoangigenesis. Perhaps one of the mechanisms of pathogenesis is the formation of a proinflammatory profile against the background of obesity, which contributes to the pathological hypervascularization of the endometrium. Effective weight loss measures can probably reduce the incidence and recurrence of AUB-E.

The impact of treatment on endometrium ultrasound findings in reproductive age women with chronic endometritis

Purpose: to evaluate the dynamics of ultrasound parameter of structural changes of endometrium in B-mode before and after therapy in reproductive age women with chronic endometritis.Material and methods. A retrospective cohort study of 158 reproductive age patients (34.5 ± 6.5 years) with a established diagnosis of chronic endometritis was carried out. Ultrasound was performed twice prior and after comprehensive etiotropic therapy in the proliferative phase of the menstrual cycle with measurements of uterus volume, endometrium thickness and volume, with calculation of endometrial/uterine volume percentage ratio. Echogenicity and structure, including the presence of polyps, liquid in the uterine cavity, gas in the endometrial layer or on midline, the line of endometrial layers closure and the contour of endometrial midline were assessed.Results. There was no complete regress of any of pathological signs after treatment, but the frequency of most of them decreased significantly (p &lt; 0.05). At the same time, there was no significant changes in such signs as heterogeneous structure and increased echogenicity of the endometrium (p &gt; 0.05). In addition, a statistically significant decrease of endometrium thickness and volume, as well as endometrial/uterine volume ratio was obtained with a constant uterus volume (p &lt; 0.05).Conclusion. The dynamic decrease in the frequency of revealing of the ultrasound signs in chronic endometritis on the background of comprehensive etiotropic therapy allows to assess a positive therapeutic benefits.