The aim of the study was to assess the role of immunological factors in the development of abnormal uterine bleeding in women of reproductive age with extragenital disorders. Materials and methods. The study involved 100 women with abnormal uterine bleeding and accompanying extragenital disorders (main group) and 50 somatically healthy women (control group). Autoimmune antibodies to platelets, phagocytic activity of neutrophil granulocytes, concentration of circulating immune complexes (CICs), total level of membranotropic cytotoxic factors, content of CD4+T-helper subpopulations and cytotoxic CD8+T-killer lymphocytes were evaluated as immunological markers. Results of the study. The study showed that thrombocytopenia, caused by the presence of autoimmune antibodies to their own platelets, can be one of the pathogenic factors of bleeding in women with AUB. In 41 % of women with AUB, phagocytic reactions were found to be intense, which was expressed by an increase in chemotaxis and adhesion functions, and in 46 % of women by an increase in the absorption capacity of phagocytes. In the main group, 48 % of the examined women had insufficient phagocyte enzymatic activity, which was evidenced by a decrease in the index of completion of phagocytosis. In 79 % of women of the main group, violations of the formation and elimination of circulating immune complexes were detected. The formation of low-molecular-weight CICs in 82 % of women of this cohort contributed to the induction of autoimmune reactions. The total content of membranotropic cytotoxic factors, which was evaluated according to the lymphocytotoxic test, exceeded the reference values in 88 % of women of the main group. In the main group, the average content of CD4+ T-helpers was 23 % lower, and the content of suppressor CD8+ T-lymphocytes was twice as low compared to the control group, resulting in a significant increase in the immunoregulatory index by 30 %. Conclusion. The women of the main group with abnormal uterine bleeding were found to have a violation of the functional activity of cellular factors of innate immunity, accompanied by changes in the absorption and digestive capacity of phagocytic cells. Assessment of secondary adaptive reactions showed induction of humoral sensitization and formation of autoimmune reactions (presence of antiplatelet autoantibodies, increase in CICs and LCT, decrease in the subpopulation of CD8+-suppressor T-lymphocytes). The detected violations indicate the pathogenic role of immunological reactions in women with abnormal uterine bleeding
In this article, the three British parties in terms of their attitudes towards the EU are analysed. British parties are not homogenous with no single position on Europe being dominant. Nevertheless, there has been a rise of Euroscepticism across all political parties regardless of their affiliation in the recent years. Brexit referendum has become a ‘point of no return’ since no political force in Britain has questioned British exit from the EU and its results. The debate has switched to the conditions on which the post-Brexit UK collaborates with the EU but there is no discussion whether Britain needs to return to the EU. It is a question of whether British interests have been taken into account and how close the relationship with the Europeans should be. The research reflects gradual evolution of the three British parties (Labour Party, the Liberal Democrats, and the Scottish National Party) and their attitudes towards European integration. It is shown that the Labour Party and the Liberal Democrats had a U-turn on key policies such as free movement of people or joining the Eurozone whereas the Scottish National Party reinvented itself and became a proponent of the European integration (with some reservations). The author tries to answer the question of whether the above parties could have prevented Brexit.
The purpose of the study was to elaborate on a prognostic model for predicting the development of abnormal uterine bleeding in women of reproductive age with accompanying extragenital disorders based on mathematical methods. Materials and methods. The study, which was in 2019-2022, involved 100 women of reproductive age with AUB and accompanying extragenital disorders under observation, who made up the main group. The control group comprised 50 women of reproductive age undergoing medical checkups. On the basis of 23 diagnostic indicators, the most informative ones were mathematically selected for the prognosis of AUB in women with extragenital abnormalities. Results and their discussion. The prognosis of the risk of developing AUB in women of reproductive age with extragenital disorders was carried out on a double scale (0 – low probability, 1 – high probability). The search for diagnostically informative factors involved a set of 23 working indicators that were investigated in the examined patients using four levels of the risk scale. In order to solve this issue, the factors that have the greatest importance in the formation of the prognosis were selected using discriminant analysis methods, and a corresponding mathematical model was created. The classification functions made it possible to enter the practical plane and form rules for assessing the presence/absence of the risk of developing AUB in patients of reproductive age with extragenital disorders. The corresponding expressions are the following equations: NP = BAS ART*75.57+FSH*2.96+prolac*0.02+estrad*0.02-40.78 PP = BAS ART*105.35+FSH*0.79+prolac*0.1+estrad*0.08-114.49, where NP is a negative prognosis, PP is a positive prognosis. If NP > PP, then the most likely prognosis is the absence of AUB in the patient; otherwise, if PP > NP – there is an increased risk of AUB. Conclusion. Pulsation index in the basal arteries of the uterus, FSH, prolactin and estrogens are prognostically significant indicators for predicting the risk of abnormal uterine bleeding in patients of reproductive age with extragenital disorders. The above formula, obtained from the conducted discriminant analysis, makes it possible to predict bleeding in a specific patient
Study objective: to determine the clinical and diagnostic features of the abnormal uterine bleeding (AUB) in women of reproductive age with extragenital pathology.Materials and methods. The study involved a retrospective assessment of 400 case histories of reproductive aged women with AUB who underwent inpatient treatment.The main clinical group (I) consisted of 300 case histories of women with AUB and concomitant extragenital disorders, control group (II) consisted of 100 case histories of somatically healthy women with AUB. An ultrasound scan with Doppler mapping was performed to assess the pelvic organs. All women underwent hysteroscopy and/or separate diagnostic curettage with further morphological assessment of the endometrium.Results. The most common extragenital disorder was diseases of the circulatory system and endocrine system, diseases of the digestive system. 123 patients (41%) had concomitant hypertension and obesity, 76 (25.3%) – obesity and varicose veins, 53 (17.6%) – somatoform autonomic dysfunction and chronic gastritis, 39 (13%) – obesity and diabetes mellitus, 24 (8%) – chronic gastritis and obesity. AUB was complicated by anemia of varying severity in 176 (58.6%) women. According to ultrasound data the most common endometrial disorder in women of group I was glandular hyperplasia of the endometrium.Conclusion. A retrospective analysis of case histories showed a high prevalence of AUB among women with extragenital pathology, which is a clinical indicator of major menstrual disorders in this category of patients and can be a serious problem for women's health in general. The need to study the prevalence and identify the main risk factors for the AUB development will make it possible to provide a general strategy for its prevention, improve the reproductive potential of women and avoid serious abnormal changes in the process of fulfilment of the reproductive function in young women.
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