AB0591 ASSESSMENT OF KNEE-RELATED SYMPTOMS, ACTIVITIES, AND QUALITY OF LIFE IN PATIENTS WITH POLYCYSTIC OVARY SYNDROME

Background:

Osteoarthritis (OA) is a slowly progressive disease that probably begins in young adulthood when a timely treatment would present the possibility to reverse or slow down the disease process. Obesity and sex hormones play an essential role in the pathogenesis of OA in women and their influence on joint function persists throughout the whole life [1]. Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age characterized by sex-hormonal disbalance, metabolic abnormalities, and most commonly obesity. It seems that PCOS presents the best opportunity to study the complex interactions among hormonal disbalance, obesity, and (pre)osteoarthritis.

Objectives:

Our study aims to assess the knee-related symptoms, activities, and quality of life in young women with PCOS and to compare them with healthy volunteers using Knee Injury and Osteoarthritis Outcome Score (KOOS) developed for younger and more active individuals [2].

Methods:

Fifty-four patients with PCOS who met the Rotterdam criteria were compared with 26 healthy women. Both groups were matched by age and body mass index (BMI). The exclusion criteria of the study were: the presence of inflammatory/autoimmune rheumatic disease and/or another endocrine disorder. Pregnant women and participants, who used systemic corticosteroids, antiandrogens, or insulin-sensitive drugs in the last 3 months were also excluded from the study. After written informed consent all participants filled in the questionnaire. KOOS was scored in each of its 5 domains: pain, symptoms, activities of daily living (ADL), sport and recreation function, and knee-related quality of life (QoL). Additionally, detailed anthropometric data, clinical examination, and hormonal assessment (testosterone, dehydroepiandrosterone sulfate [DHEAS], androstenedione, 17-OH-progesterone, luteinizing hormone [LH], follicle stimulating hormone [FSH], and estradiol) were carried out in all overnight-fasted participants during a follicular phase of a menstrual cycle.

Results:

Patients and healthy volunteers had similar anthropometric and demographic characteristics but PCOS women were expectedly more hyperandrogenic and hirsute than controls. Patients and controls did not differ significantly in their knee pain, knee-related QoL, and sport and recreation function. Knee-related symptoms were more prominent in the PCOS group compared to controls (p = 0.035). ADL associated with the knee joint were also more impaired in patients (p = 0.001). Obese PCOS women had a significantly lower score in the ADL domain than normal and overweight patients (p = 0.035). In the PCOS group, both knee-related ADL and sport and recreation function correlated significantly with weight (p = 0.025 and p = 0.034, respectively) and waist circumference (p = 0.011 and p = 0.016, respectively), among all studied anthropometric parameters. Sex hormones did not correlate with any of the evaluated KOOS subscales.

Conclusion:

PCOS patients may experience impaired physical function related to daily life due to knee problems. Obesity may further contribute to knee-related ADL dysfunction. Hormonal disturbances did not show any association with knee complaints in our study.

References:

[1]Georgiev T, Angelov AK. Modifiable risk factors in knee osteoarthritis: treatment implications. Rheumatol Int. 2019 Jul;39(7):1145-1157

[2]Roos EM, Toksvig-Larsen S. Knee injury and Osteoarthritis Outcome Score (KOOS) - validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes 2003;1:17.

Acknowledgements:

The study was performed with the financial support of Medical University-Sofia, Bulgaria, Young Investigator 2020, Project No 8378/20.11.2019, Contract D-85/24.06.2020.

Disclosure of Interests:

None declared.

P1271 Systolic dysfunction in obese and extreme obese patients and preliminary results after bariatric surgery

Background

Obesity is known to be associated with left ventricular (LV) diastolic dysfunction, heart failure and some risk factors for early atherosclerosis: diabetes mellitus, arterial hypertention, dyslipidemia. Very few studies investigate extremely obese patients and how this condition impairs LV systolic function.

The aim of the study is to explore the effect of obesity and extreme obesity on LV systolic function in patients without diabetes mellitus and the effect of bariatric surgery on that function.

Methods

We prospectively investigated 55 patients with obesity class 1 and 2 and 23 patients with extreme obesity who underwent bariatric surgery. The participants were grouped according to body mass index (obesity class 1 and 2 BMI ≥ 30 ≤ 40 kg/m2 and extreme obesity ≥ 40 kg/m2). Systolic function was assessed by ejection fraction by Simpson and Teicholz, global longitudinal strain, Tei index.

Results

In the studied groups statistical analysis proved the relation between all investigated echographic parameters and BMI. The mean left ventricular ejection fraction and GLS values were 55% (±10%) vs. − 17.3% (±3.3%) for obese and 51% (±8%) vs. − 16.5% (2.3%) for extreme obese (p < 0.05).

Patiets with extreme obesity, who underwent bariatric surgery increased LV ejection fraction faster and more than patients who underwent only diatry and medical treatment. 5.0 (9.0) % vs. 3.0 (10.0) % (p < 0.05).

Conclusion

Obesity and extreme obesity impair all studied parameters for LV systolic function. Bariatric surgery is treatment option for extreme obesity patients and a possibility for significant and fast improvement of LV systolic parameters.

Serum Paraoxonase-1 Levels are Significantly Decreased in the Presence of Insulin Resistance

Paraoxonase-1 (PON1) is an extracellular esterase contributing to the anti-atherogenic and anti-inflammatory properties of HDL and has a protective role in the progression of atherosclerosis. The aim of the present study was to compare serum paraoxonase-1 levels between obese subjects with prediabetes and normal glucose tolerance.

METHODS

In this study were included 76 patients with mean age 50.7±10.7 years, divided into 2 age and BMI-matched groups - group 1 with obesity without glycemic disturbances (n=38) and group 2 with prediabetes (n=38). Oral glucose tolerance test (OGTT) with measurement of immunoreactive insulin was performed in all participants and levels of PON1 were measured using ELISA method.

RESULTS

There was only a tendency towards higher PON1 levels in patients with prediabetes compared to controls. However, individuals with insulin resistance had significantly lower levels of PON1 compared to those without. The levels of PON1 showed a negative correlation with the blood glucose on 120th minute of OGTT, fasting IRI, HOMA index, BMI, WSR, WHR and particularly with waist circumference and positive with HDL-cholesterol.

CONCLUSIONS

The levels of PON1 are similar in patients with and wthout prediabetes, but are significantly decreased in patients with insulin resistance and correlate with anthropometric markers of visceral adiposity.

Irisin in the Glucose Continuum

AIM

Irisin, a novel myokine has been involved in the pathogenesis of type 2 diabetes (T2D) and metabolic syndrome. The aim of the current study was to investigate this association by comparing individuals from the whole spectrum of carbohydrate disturbances.

METHOD

A total of 160 subjects participated in the study - 50 had normal glucose tolerance (NGT), 60 had prediabetes (PreDM), 50 had T2D. Subjects in the 3 groups were age, sex and BMI-matched. Standard OGTTs were performed for the distribution of patients in each group. Circulating serum irisin was measured by ELISA method.

RESULTS

Mean age of the participants of the study was 48.8 (± 7.97) years. Circulating irisin levels were statistically different in the 3 study groups - highest in NGT - median 619 ng/ml (IQR=567), lower in PreDM - 314 ng/ml (IQR=577) and lowest in T2D - 228 ng/ml (IQR=200). In males, irisin correlated positively with BMI (r=0.475, p<0.001), negatively with fasting glucose (r=- 0.547, p<0.001) and negatively with hepatic enzymes: ALT (r=- 0.281, p<0.05), AST (r=- 0.153, p>0.05), GGT (r=- 0.293, p<0.05). Similar correlations were observed in females. ROC analyses established irisin suitable for distinguishing T2D subjects from those without the condition (AUC=0.779, p<0.001) and insulin resistance (AUC=0.679, p=0.009), but not for MetS or dyslipidaemia. In a binary logistic regression model, after adjustment for confounders, irisin of ≤658 ng/ml had an OR of 7.125 for T2D in females.

CONCLUSION

Circulating irisin levels progressively decreased with the worsening of the glucose tolerance. Irisin correlated well with traditional biochemical and anthropometric parameters of metabolic health.

NT-proBNP levels in premenopausal women with polycystic ovarian syndrome and/or obesity

According to some studies, polycystic ovarian syndrome (PCOS) patients have an increased risk for diabetes mellitus and often show an adverse cardiovascular risk profile. NT-proBNP was shown to have a high predictive value regarding cardiovascular events, especially in those without overt cardiovascular disease. The aim of this study was to investigate the levels of NT-proBNP in 70 women with PCOS and/or obesity in relation to other classical cardiovascular risk factors. There was no statistical difference between NT-proBNP levels between obese, lean PCOS and obese PCOS patients; between patients with or without metabolic syndrome; or between patients with different cardiovascular risk, according to The Androgen Excess and PCOS Society consensus. NT-proBNP does not show significant correlation to age, weight, BMI, WHR, WSR, systolic or diastolic blood pressure and results from oral glucose tolerance test (OGTT), except for immunoreactive insulin (IRI) at 120 min. NT-proBNP correlates weakly with HDL, but not with other indices of lipid metabolism.

[Polycystic ovarian syndrome and obstructive sleep apnea]

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disturbances in women of reproductive age. Recently it has been postulated that its presence is linked to increased risk for cardiovascular diseases and type 2 diabetes in affected women. This makes necessary that PCOS is accepted not only as a reproductive issue, bus as a serious metabolic disease that carries important health risks with increasing age. In the contemporary studies much attention is given to PCOS comorbidites, including cardiovascular diseases and obstructive sleep apnea (OSA). OSA is a chronic condition that is characterized by repeating collapsing of upper airways during sleep that leads to severe hypoxemia and frequent awakening. OSA is a relatively rare condition in premenopausal women without PCOS and is commonly associated with obesity. On the other hand it is thought that PCOS patients have significantly higher risk. OSA severity is directly linked to plasma glucose and insulin levels and homeostatic model assessment (HOMA)-index in PCOS patients. It appears that the progressive worsening of PCOS clinical presentation leads to OSA that in turn aggravates the metabolic disturbances, associated with the syndrome.

Quality indicators for the prevention of type 2 diabetes in Europe--IMAGE

BACKGROUND

The marked increase of type 2 diabetes necessitates active development and implementation of efficient prevention programs. A European level action has been taken by launching the IMAGE project to unify and improve the various prevention management concepts, which currently exist within the EU. This report describes the background and the methods used in the development of the IMAGE project quality indicators for diabetes primary prevention programs. It is targeted to the persons responsible for diabetes prevention at different levels of the health care systems.

METHODS

Development of the quality indicators was conducted by a group of specialists representing different professional groups from several European countries. Indicators and measurement recommendations were produced by the expert group in consensus meetings and further developed by combining evidence and expert opinion.

RESULTS

The quality indicators were developed for different prevention strategies: population level prevention strategy, screening for high risk, and high risk prevention strategy. Totally, 22 quality indicators were generated. They constitute the minimum level of quality assurance recommended for diabetes prevention programs. In addition, 20 scientific evaluation indicators with measurement standards were produced. These micro level indicators describe measurements, which should be used if evaluation, reporting, and scientific analysis are planned.

CONCLUSIONS

We hope that these quality tools together with the IMAGE guidelines will provide a useful tool for improving the quality of diabetes prevention in Europe and make different prevention approaches comparable.

Take action to prevent diabetes--the IMAGE toolkit for the prevention of type 2 diabetes in Europe

When we ask people what they value most, health is usually top of the list. While effective care is available for many chronic diseases, the fact remains that for the patient, the tax payer and the whole of society: prevention is better than cure. Diabetes and its complications are a serious threat to the survival and well-being of an increasing number of people. It is predicted that one in ten Europeans aged 20-79 will have developed diabetes by 2030. Once a disease of old age, diabetes is now common among adults of all ages and is beginning to affect adolescents and even children. Diabetes accounts for up to 18 % of total healthcare expenditure in Europe. The good news is that diabetes is preventable. Compelling evidence shows that the onset of diabetes can be prevented or delayed greatly in individuals at high risk (people with impaired glucose regulation). Clinical research has shown a reduction in risk of developing diabetes of over 50 % following relatively modest changes in lifestyle that include adopting a healthy diet, increasing physical activity, and maintaining a healthy body weight. These results have since been reproduced in real-world prevention programmes. Even a delay of a few years in the progression to diabetes is expected to reduce diabetes-related complications, such as heart, kidney and eye disease and, consequently, to reduce the cost to society. A comprehensive approach to diabetes prevention should combine population based primary prevention with programmes targeted at those who are at high risk. This approach should take account of the local circumstances and diversity within modern society (e.g. social inequalities). The challenge goes beyond the healthcare system. We need to encourage collaboration across many different sectors: education providers, non-governmental organisations, the food industry, the media, urban planners and politicians all have a very important role to play. Small changes in lifestyle will bring big changes in health. Through joint efforts, more people will be reached. The time to act is now.

A European evidence-based guideline for the prevention of type 2 diabetes

BACKGROUND

The prevalence and socioeconomic burden of type 2 diabetes (T2DM) and associated co-morbidities are rising worldwide.

AIMS

This guideline provides evidence-based recommendations for preventing T2DM.

METHODS

A European multidisciplinary consortium systematically reviewed the evidence on the effectiveness of screening and interventions for T2DM prevention using SIGN criteria.

RESULTS

Obesity and sedentary lifestyle are the main modifiable risk factors. Age and ethnicity are non-modifiable risk factors. Case-finding should follow a step-wise procedure using risk questionnaires and oral glucose tolerance testing. Persons with impaired glucose tolerance and/or fasting glucose are at high-risk and should be prioritized for intensive intervention. Interventions supporting lifestyle changes delay the onset of T2DM in high-risk adults (number-needed-to-treat: 6.4 over 1.8-4.6 years). These should be supported by inter-sectoral strategies that create health promoting environments. Sustained body weight reduction by >or= 5 % lowers risk. Currently metformin, acarbose and orlistat can be considered as second-line prevention options. The population approach should use organized measures to raise awareness and change lifestyle with specific approaches for adolescents, minorities and disadvantaged people. Interventions promoting lifestyle changes are more effective if they target both diet and physical activity, mobilize social support, involve the planned use of established behaviour change techniques, and provide frequent contacts. Cost-effectiveness analysis should take a societal perspective.

CONCLUSIONS

Prevention using lifestyle modifications in high-risk individuals is cost-effective and should be embedded in evaluated models of care. Effective prevention plans are predicated upon sustained government initiatives comprising advocacy, community support, fiscal and legislative changes, private sector engagement and continuous media communication.

Physiological characteristics of diabetic neuropathy in sucrose-fed Otsuka Long-Evans Tokushima fatty rats

Diabetic neuropathy is a very common complication of diabetes mellitus, and animal studies have contributed tremendously to its understanding. The aim of this study was to estimate the neuropathic alterations in the Otsuka Long-Evans Tokushima fatty (OLETF) rats, an animal model of human type 2 diabetes mellitus. For this purpose, four groups of animals were used: untreated OLETF rats, sucrose-fed for 2 months OLETF rats, untreated Long-Evans Tokushima Otsuka (LETO) nondiabetic rats as genetic controls of OLETF, and sucrose-fed LETO rats. All were examined at baseline, at the end of the sucrose treatment, and during a washout period. The following parameters were evaluated: motor nerve conduction velocity (MNCV), sensitivity to noxious thermal and mechanical stimuli using the tail-flick (TF) and tail-pressure (TP) tests, and blood glucose (BG) and HbA1c levels. Our results showed that BG and HbA1c were significantly higher in OLETF rats when compared with those in control LETO rats. Sucrose caused remarkable increase of BG and HbA1c in the OLETF rats, but not in the sucrose-fed LETO rats. MNCV and thermal nociception significantly decreased in OLETF rats in their 10th month, while the values of the TP test did not differ compared with those from LETO rats. Sucrose administration significantly decreased the MNCV, and increased the pain threshold evaluated by the TF and TP tests, compared with those in the control OLETF rats. The studied parameters were not significantly altered in sucrose-fed LETO rats. In conclusion, our findings show that signs of diabetic neuropathy appear late in the individual development of the OLETF rats, and MNCV and thermal nociception are selectively affected in this strain. Sucrose deteriorated the diabetic state, decreased MNCV, and caused thermal and mechanical hypoalgesia.

Inflammatory activity and anticardiolipin antibodies during tibolone treatment of healthy postmenopausal women

The aim of the study was to investigate the inflammatory activity and anticardiolipin antibodies (Acl) during tibolone administration. Twenty seven clinically healthy postmenopausal women were included in the study and were divided into two groups: 16 women (mean age 56.4 +/- 4.6 years) who received tibolone at a dose of 2.5 mg/day for 6 months and an untreated control group (n = 11, mean age 54.8 +/- 4.0 years). Acl of IgG and IgM isotype, and C-reactive protein (CRP) were determined at baseline, 1, 3, and 6 months after treatment. Acl did not change during tibolone treatment, while CRP increased significantly at the 1st, 3rd, and 6th month compared with that at the baseline values. These preliminary data indicate that tibolone administration does not induce increase in Acl. This may counterbalance the adverse influence on CRP.

[Effect of 6-month treatment with oral antiandrogen alone and in combination with insulin sensitizers on body composition, hormonal and metabolic parameters in women with polycystic ovary syndrome (PCOS) in order to determine therapeutic strategy]

PCOS is a complex disorder with variability of phenotypes, characterized by hyperandrogenic, anovulatory and metabolic components. The later is a result of specific insulin resistant state with compensatory hyperinsulinaemia. Oral hormonal contraceptives (OHC) are a treatment of first choice in hyperandrogenic PCOS women who do not desire conception. Addition of insulin sensitizers might counteract unfavourable metabolic consequences of OHC monotherapy and could result in additional benefits for treated PCOS women.

AIM

To compare the effects of 3 therapeutic regimens widely used in practice--OHC alone and in combination with metformin or rosiglitazone on body weight and anthropometric proportions, hormonal and metabolic alterations.

MATERIAL AND METHODS

The study comprised of 44 women with proven PCOS, divided in 3 therapeutic groups: 1st group--with Diane35 alone; 2nd group--with Diane35 + metformin; 3rd group--with Diane35 + rosiglitazone. Body weight, fat mass and distribution, hormonal levels, metabolic parameters (insulin and blood glucose during oGTT lipid profile) were studied before and after a 6-month treatment.

RESULTS

Monotherapy with Diane35 did not lead to changes in body weight, fat mass and distribution; had beneficial influence on some of the hormonal alterations in PCOS, but did not achieved significant antiandrogenic effect; did not induce changes in carbohydrate tolerance while having mild negative effect on insulinaemia; had an unfavourable although mild influence on lipid parameters including atherogenic indices except the HDL-cholesterol; did not show side effects on liver and vascular function. Combined treatment with Diane35 and metformin led to reduction of weight, fat mass and abdominal fat distribution; possessed significant antiandrogenic effect; did not decrease blood glucose levels; supressed glucose-stimulated insulin levels; had beneficial effect on HDL-cholesterol and neutral effect on other lipid parameters and atherogenic indices; decreased diastolic blood pressure. Combined treatment with Diane 35 and rosiglitazone did not induce changes in body weight, fat mass and abdominal fat distribution; possessed significant antiandrogenic effect; did not influence fasting and postchalange glucose levels; suppressed fasting hyperinsulinaemia and HOMA-index, respectively; had neutral effect on the levels of lipid parameters and atherogenic indices.

Ambulatory blood pressure monitoring and active renin in menopausal women treated with amlodipine and hormone replacement therapy

The aim of this study was to follow up the effect of an 8-week treatment with amlodipine given alone or in combination with hormone replacement therapy (HRT) on blood pressure and active renin in postmenopausal women with mild to moderate arterial hypertension using both conventional clinical blood pressure measurements and ambulatory blood pressure monitoring. Twenty-nine hypertensive menopausal women were divided randomly into two groups according to the treatment regimens: amlodipine and amlodipine plus HRT. The combination with HRT led to normalization of 24-h and daytime systolic and diastolic blood pressure. In contrast to the group treated with amlodipine alone, where a significant fall only of systolic night-time blood pressure was observed, in the group treated with amlodipine plus HRT both systolic and diastolic night-time blood pressure decreased significantly. Active renin did not change significantly after treatment in both groups. Triglycerides decreased significantly and high-density lipoprotein-cholesterol increased significantly only after amlodipine treatment. There were no significant differences in serum total cholesterol and low-density lipoprotein-cholesterol after HRT plus amlodipine. In conclusion, amlodipine is effective in reducing blood pressure in postmenopausal women. The maintenance of a normal circadian blood pressure pattern was influenced by HRT.

[Emergency contraception with levonorgestrel for teenagers--efficacy, tolerability, and level of information awareness]

OBJECTIVE

Assessment of efficacy and side effects of emergency contraception for teenagers with levonorgestrel (LNG) and the level of users' informedness about possibilities and practical application.

METHODS

The subjects are healthy girls (n = 49) with regular menstrual cycles at the age between 15 and 19, having had one unprotected or faultily protected sexual intercourse. All of them have administered 0.75 mg LNG within the 72nd hour, repeated after 12 hours. The data have been processed by variational analysis.

RESULTS

One pregnancy was registered of a girl with firstintake at the 67th hour - pregnancy rate - 2,0%. The most frequent side effect was nausea - 26,5%, folowed by breast tenderness - 22,4% and fatigue - 20,4%. An up to 7th day delay in menstrual cycle is non significantly more frequent - 14,3%, followed by a delay of more than 7 days breakthrough bleeding - 8,2%. No significant changes were established in the lenght of the menstrual cycle. Emergency contraception is sought for after unprotected sexual intercourse in 69,4%, and condom failure problems in 30,6%. Only 18,4% have sufficient information about the possibilities and practical use of emergency contraception.

CONCLUSION

LNG provides effective, highly tolerable contraception with a small number of side effects. Need is felt for serious popularization of the application of emergency contraception with teenagers.

Effect of amlodipine and hormone replacement therapy on blood pressure and bone markers in menopause

The aim of this study was to observe the effect of an 8-week treatment with amlodipine, alone or in combination with hormone replacement therapy (HRT), on blood pressure (BP), serum osteocalcin, bone-specific alkaline phosphatase (B-ALP) and urine deoxypiridinoline in postmenopausal osteoporotic women with mild-to-moderate arterial hypertension. Both conventional clinical BP measurements and ambulatory blood pressure monitoring (ABPM) were used. Twenty hypertensive menopausal women with osteoporosis were randomly divided in two groups according to the treatment regimens: amlodipine and amlodipine + HRT. Neither treatment regimen significantly changed bone formation or bone resorption markers. There were no significant differences in levels of serum and urinary calcium and phosphorous or serum cholesterol and low-density lipoprotein (LDL)-cholesterol after treatment with amlodipine alone or in combination with HRT. Triglycerides were significantly decreased and high-density lipoprotein (HDL)-cholesterol was significantly increased after amlodipine treatment. Both treatment regimens significantly decreased conventionally measured BP to a similar extent. Amlodipine given alone lowered the midline estimating statistic of rhythm (MESOR; mean 24-level) of systolic BP and induced phase advances of the circadian rhythms of systolic, diastolic and mean BP. When combined with HRT, amlodipine lowered the MESOR and reduced the amplitude of systolic BP without any phase change. In conclusion, amlodipine is effective in reducing BP in postmenopausal women. The maintenance of a normal circadian BP pattern is also influenced by supplementation with 17beta-estradiol. The 8-week treatment with amlodipine alone and in combination with HRT is not associated with a marked influence on bone metabolism.

Hematological alterations in the Otsuka Long-Evans Tokushima fatty (OLETF) rats--a model of type 2 diabetes mellitus

The OLETF rat develops microangiopathic complications similar to human diabetes and is considered a useful model of Type 2 DM. Erythrocyte, platelet and leucocyte abnormalities described in diabetic patients are thought to play a role in the development of diabetic microangiopathy. This study was designed to investigate whether OLETF rats show hematological alterations and the effect of sucrose treatment on metabolic and blood parameters. Hematological parameters, body weight, food and water intake, fasting and non-fasting blood glucose (BG) and HbA1c were measured in OLETF rats treated for two months with 30% sucrose added to drinking water. Non-treated OLETF rats and non-diabetic Long-Evans Tokushima Otsuka (LETO) rats were used as controls. In the control OLETF rats the number of platelets (Plt) and red blood cells (RBC) was higher, while the mean cell volume (MCV) and the mean cell hemoglobin content (MCH) were lower compared with LETO. Mean cell hemoglobin concentration (MCHC) was significantly higher in the diabetic rats. Sucrose administration decreased food intake and body weight and increased fasting blood glucose and HbA1c. It resulted in a decrease of RBC, Hb, Hct, MCV and MCH compared with control OLETF, while Plt count increased significantly. Our results point to significant alterations in erythrocyte count and morphology and Plt count in diabetic OLETF rats compared with non-diabetic LETO. Sucrose administration accelerated the development of diabetes, affected blood cells inducing the suppression of RBC and an increase in Plt count and some of its effects persisted after sucrose withdrawal.

[Comparative diagnostic characteristics of carbohydrate metabolism disorders in women with polycystic ovary syndrome (PCOS)]

The aim of the study was to compare the information provided by both fasting and stimulated during a standard oral glucose tolerance test (oGTT) levels of glucose and insulin as regards glucose tolerance and insulin resistance in women with PCOS. Few criteria are used in practice to verify insulin resistance in PCOS--elevated fasting insulin, decreased basal glucose/insulin ratio (< 6 for glucose in mg/dl or < 0.333 for glucose in mmol/l), insulin increase of more than 100 lul during an oGTT, and HOMA index > 2. The study comprised of 94 women (mean age 21.8 +/- 5 = 8 ys, mean BMI-30.38 +/- 7 = 7 kg/m2), divided in 4 groups according to BMI--group with BMI < 25, n = 21; group with BMI25-30, n = 27; group with BMI = 30-35, n = 23 and group with BMI > 35, n = 23. An oGTT with parallel determination of blood glucose and insulin was performed in all patients. The ratio basal glucose/insulin and HOMA index were calculated. Glucose levels on the 2 md hour during the oGTT pointed at IGT (impaired glucose tolerance) and/or diabetes in 8.5% of the investigated patients while the fasting levels indicated disturbances in only 2.2% of them. Fasting insulin levels were in the normal range in a considerable part of PCOSE women, mainly those with normal weight, and were not predictive for the response of insulin to glucose load. Relative percent of patients with elevated fasting insulin rose with the increasing of BMI. Decreased glucose/insulin ratio, elevated HOMA index, and abnormal stimulation of insulin were seen in more than 2/3 of the PCOS women including nonobese ones. Information provided by the above three markers was similar and they could be used alternatively according to the particular case and assessment of the cost/benefit ratio.

[Possibilities for an individualized approach to the treatment of climacteric symptoms with phytoestrogens]

In climacteric women with contraindications and fear or lack of compliance for taking hormonal replacement therapy as well as in those cases where risks exceed benefits, the use of phytoestrogens is appropriate having in mind their especially good effect on neurovegetative symptoms.

AIM

The present randomized prospective study is aimed at estimating the possibility for ameliorating climacteric symptoms with Melbrosia and at assessment of its effect on different symptoms in order to individualize the therapeutical approach.

PATIENTS AND METHODS

Two groups of women with climacteric complaints were followed-up--control group (n = 32) and treatment group (n = 34). Climateric symptoms were assessed in the beginning and at the end of the study using Kupperman menopausal index. The levels of FSH, LH, oestradiol as well as some parameters of lipid metabolism were determined.

RESULTS

A significant decrease of Kupperman index was observed in Melbrosia treatment group in contrast to the control group. No significant changes in gonadotropins, oestradiol and lipid parameters were found in both groups.

CONCLUSION

The preparation Melbrosia, consisting of phytoestrogens and amino acids exerts a good therapeutic effect on climacteric symptoms mainly on the nervousness, anxiety, irritability, headache, and hot flashes.

[Prostate-specific antigen (PSA) in women]

Prostate-specific antigen (PSA) is a serine protease with chymotrypsin-like enzymatic activity. In males PSA is produced by the prostatic gland and it is present in prostatic tissue, seminal plasma and male serum. Initially, PSA was believed to be absent from all female tissues and fluids. However PSA has been detected recently in some female tissues (including breast, ovarian and endometrial tissues) and body fluids (serum, milk, amniotic fluid). The presence of PSA in these female tissues seems to be closely associated with steroid hormone regulation, especially androgens and progestins. Estrogen by itself seems to have no effect on PSA regulation, but it can impair androgen induced PSA production. In the tissues and fluids examined PSA is found in two molecular forms: free PSA is the enzymatically active form and in a complexed form bound to protease inhibitors. The data presented suggest that PSA can no longer be regarded as a specific prostatic marker, but as a protein that could be produced by cells bearing steroid hormone receptors under conditions of steroid hormone stimulation. Its biological role is not fully clarified, but PSA may be a candidate growth factor in normal tissues, pregnancy and tumors. At this point, PSA shows promise of being routinely used as a favorable prognostic indicator in female breast cancer.

[Complex effects of cavinton on climacteric symptoms]

The use of nonhormonal drugs in order to ameliorate climacteric symptoms makes it possible to treat also those women in whom there are some contraindications or lack of compliance for taking hormonal replacement therapy. The drugs with complex effects on the whole body functions are more widely used recently. The aim of the present study is to assess the therapeutic effect of Cavinton (vinpocetin) on the degree of climacteric symptoms and to verify its complex beneficial influence. The study comprises of three groups of women in early menopause--control group (n = 30), treatment groups with normolipidaemia (n = 32) and with hyperlipidaemia (n = 29). All women presented with moderately expressed climacteric symptoms as assessed by Kupperman menopausal index and Hamilton-Anxiety-Skala (HAMA). The women in the 2nd and 3rd groups have been taking Cavinton in an oral dose of 5 mg three times daily for 3 months. The following parameters of lipid metabolism were determined in the beginning and at the end of the study: total, HDL- and LDL-cholesterol, triglycerides, and two indexes of lipid atherogenic risk--total/HDL-cholesterol ratio and atherogenic index (AI) = total--HDL/LDL-cholesterol. The menopausal complaints were assessed by Kupperman index and HAMA. Blood vessels reactivity was determined by pulsation index (PI). Statistically significant decrease in total cholesterol and LDL-cholesterol levels as well as amelioration of atherogenic indexes was observed in the 3rd group. Kupperman index and HAMA decreased significantly on the 45th day and the 3rd month in the women under treatment. No significant changes in PI were observed but a tendency towards a decrease was seen in the 3rd group. Our data suggest that Cavinton possesses complex beneficial effects in climacteric women significantly ameliorating climacteric symptoms as well as some parameters of lipid metabolism in women with hyperlipidaemia.

Anticardiolipin antibodies in spontaneously hypertensive rats (SHR), stroke-prone SHR and normal Wistar rats

1. Anticardiolipin antibodies (ACA) can be detected in the serum of patients with autoimmune disturbances, ischaemic heart disease, myocardial infarction, neurological disorders and other medical conditions. Elevated values of these autoantibodies can be associated with recurrent fetal loss, arterial and venous thrombosis and thrombocytopenia. 2. In the present study, we investigated the presence of ACA in three rat strains, namely normal Wistar rats (WR), spontaneously hypertensive rats Okamoto-Aoki (SHR) and stroke-prone SHR (SHRSP). All animals were examined at four ages: 1, 4, 10 and 12 months of age. Anticardiolipin antibodies were determined by ELISA. 3. Anticardiolipin antibody levels in normal WR, which were used as controls, were lowest at 1 month and increased significantly from the 4th month on. At the prehypertensive age (1 month), ACA levels in SHR and SHRSP were significantly higher compared with control WR, decreased with age and were significantly lower at 4, 10 and 12 months compared with age-matched WR. 4. These differences may be a result of immunological disorders in SHR.

[The use of the preparation Anteovin in dysfunctional uterine hemorrhages and PCOS]

The present prospective study is aimed at estimating the therapeutic effect of a biphasic oestrogen dominated contraceptive pill Anteovin in certain forms of dysfunctional uterine bleeding (DUB) and in polycystic ovary syndrome (PCOS) which is associated with dysfunctional bleeding. Two groups of women were studied--the first group (n = 34) consisted of women with DUB; the second group (n = 31) comprised PCOS. The nature and dynamics of uterine bleeding, contraceptive effectiveness and occurrence of side effects were followed up. In the second group the changes in the levels of testosterone (T), dehydroepiandrosterone sulfate (DHEA-S) and prolactin (Prl) were additionally investigated.

RESULTS

A significant decrease in bleeding was observed in both groups. In the second group it is in parallel with a significant decrease of T even as early as on the third month and of DHEA-S on the sixth month of treatment. No significant changes in prolactin levels were found out during the treatment.

CONCLUSION

The biphasic contraceptive pill Anteovin has a very good therapeutic effect in DUB and metrorrhagic forms of PCOS while at the same time the side effects are slightly expressed and transitory and an excellent contraception is achieved.

[Low-dose estrogens in the treatment of the climacteric syndrome]

The present prospective study is aimed to estimate the effect of a low-dose combined oestrogen drug Cyclo-Menorette on climacteric syndrome in women with early menopause.

MATERIAL AND METHODS

The criteria for inclusion in the study were ac follows: 9-12 months of menopause, increased FSH levels, moderately expressed climacteric syndrome confirmed by the menopausal index of Kupperman and Hamilton-Anxiety-Scale /HAMA/. According to acceptance of hormone replacement therapy /HRT/ the women were divided into 2 groups--control T /n = 31/ and Cunder treatment T /n = 35/. The degree of climacteric syndrome expression after Kupperman and HAMA was estimated in all patients at the beginning as well as on the 3-d, 6-th 12-d months. The presence and dynamics of side effects were followed in the patients treated with HRT.

RESULTS

Spontaneous improvement of complaints was found out in the control group with an increase of intragroup differences during the follow-up period. Most expressed improvement in the group under treatment was established during the first 3-6 months, the beneficial effect being preserved until the end of the study.

CONCLUSION

The use of 1 mg oestradiol valerat in combination with 2 mg oestriol results in a significant decrease of climacteric syndrome manifestation with slightly expressed and transient side effects.

Congenital cataracts facial dysmorphism neuropathy syndrome, a novel complex genetic disease in Balkan Gypsies: clinical and electrophysiological observations

During a study of hereditary motor and sensory neuropathy-Lom in Bulgaria, a previously unrecognized neurological disorder was encountered, mainly in Wallachian Gypsies, who represent a relatively recent genetic isolate. The disorder has been termed the congenital cataracts facial dysmorphism neuropathy (CCFDN) syndrome to emphasize its salient features. Fifty individuals from 19 extended pedigrees were identified and examined clinically and electrophysiologically. At least 1 patient from each family was admitted to the hospital in Sofia for full investigation. Pedigree analysis indicates autosomal recessive inheritance. The disorder is recognized in infancy by the presence of congenital cataracts and microcorneas. A predominantly motor neuropathy beginning in the lower limbs and later affecting the upper limbs develops during childhood and leads to severe disability by the third decade. Associated neurological features are a moderate nonprogressive cognitive deficit in most affected individuals together with pyramidal signs and mild chorea in some. Accompanying nonneurological features include short stature, characteristic facial dysmorphism, and hypogonadotrophic hypogonadism. Nerve conduction studies suggest a hypomyelinating/demyelinating neuropathy, confirmed by nerve biopsy. The CCFDN syndrome is thus a pleomorphic autosomal recessive disorder displaying a combination of neurological and nonneurological features.