Американский Научный Журнал POSSIBLE PATHOGENETIC FACTORS IN THE DEVELOPMENT OF CERVICAL ITRAEPITITIONAL NEOPLASIA (18-20)

18 American Scientific Journal № ( 37 ) / 2020
МЕДИЦИНСКИЕ НАУКИ

POSSIBLE PATHOGENETI C FACTORS IN THE DEV ELOPMENT OF CERVICAL
ITRAEPITITIONAL NEOP LASIA

Andreeva Natalya Anatolyevna
Associate Professor in the
Department of Obstetrics and Gynecology,
Saransk
Epifanova Olga Viktorov na
Penza Institute for Advanced Medical Studies, Assistant,
Department of Obstetrics and Gynecology,
Penza, Russia
Kadhim Hussein Jawad
6th year student of Federal State Budgetary Educational Institution
of Higher Education “National Research N.P. Ogarev's Mordovia
State University”

Annotation . The analysis of factors of development of cervical intraepithelial neoplasia of the I and II degrees
was carried out. Cervical intraepithelial neoplasia is a leading pathogenetic link in the development of cervical
cancer. The relevance of the use of immunomodulators with antiviral activity in patients with CIN I and CIN II
was assessed.
Keywords: Cervical intraepithelial neoplasia, human papilloma virus infection, human papillomavirus,
colposcopy, koilocytosis, biop sy, polymerase chain reaction, immunomodulators.

The pathological condition in which there is a
violation of the differentiation of epithelial cells, the
development of atypia in them as a result of
proli feration of combinative elements and a violation o f
the histological structure is called cervical
intraepithelial neoplasia.
According to WHO, CIN is a change in which part
of the epithelium is replaced by cells, with varying
degrees of atypia and loss of stratification and polarity,
but the stroma in thi s process remains unchanged.
Depending on the intensity of cell proliferation, the
severity of cellular and structural atypia, CIN I, CIN II,
CIN III are distinguished.
Cervical intraepithelial neoplasia is a
precancerous disease of the cervix. Cervical ca ncer
occupies a leading position in the structure of obstetrics
and gynecology. In the world, it is occupied ranked 4th
among the most common types of cancer in women.
From 2014 to 2019 according to experts of the Russian
Federation, 175,427 new cases of c ervical cancer were
registered. A significant figure is that on average 275
thousand women in the world die from cervical cancer
per year, 17 Russians die daily from this pathology. The
average age of the i ncidence is 35.3 years, but recently
there has bee n an alarming trend, cervical cancer is
diagnosed in young women of reproductive age, at the
age of 27 +/ - 1.5 years [2].
More than 80% of LSIL and 100% of HSIL are
associated with high oncogenic HPV infect ion. A
common type found in both lesions is HPV ty pe
16.18.311.33. The rate of progression of the HPV -
associated disease is different in each case.
In order for HPV to initiate oncological cell
proliferation, a number of predictor factors and cascade
cytok ine reactions in the cells themselves are required .
It is worth noting that the virus in not every woman can
provoke the appearance of cervical intraepithelial
neoplasia. As a rule, from the moment of HPV infection
or its activation and ending with the app earance of CIN
and/or Carcinoma in situ, it takes about 1.5 to 5 years.
Based on the foregoing, the aim of our study is to
study the predisposing factors in the development of
cervical intraepithelial neoplasia, to develop an
algorithm for stage -by-stage diagnostic schemes and
treatment principles for wom en with CIN I and CIN II.
Materials and research methods: We examined
161 patients of reproductive age with CIN I, II
according to an oncocytological examination.
Patients included in the su rvey groups
corresponded in the age parameter from 19 to 55 years,
and on average their age was 37 +/ - 3.5 years.
According to our observations, in 35% of women who
applied, cervical pathology was visualized in the form
of ectopia, leukoplakia, and cervica l cysts.
Patients included in the survey groups
corresponded in th e age parameter from 19 to 55 years,
and on average their age was 37 +/ - 3.5 years.
According to our observations, in 35% of women who
applied, cervical pathology was visualized in the form
of ectopia, leukoplakia, and cervical cysts.
All patients underwen t a cytological study using
the liquid cytology method. The conclusion of which
was confirmation of CIN I, II. In this regard, patients
were divided into 2 groups: women with CIN I were
obse rved in group 1, and patients with CIN II were
assigned to group 2 .
Regarding the contraceptive history, we are
interested in the serious barrier method of
contraception, only 27% of the women surveyed used
the barrier method with condoms, 25.3% of the pat ients
used the hormonal method of contraception, and 47.7%
did not have contraceptive alertness during sexual
intercourse.

American Scientifi c Journal № ( 37 ) / 2020 19

Anamnesis of sexual function: 42.3% of women
noted an early onset of sexual activity, which
corresponded to 1.5 +/ - 1.5 years, 44% of patients noted
the first sexual intercourse in 19 -21, 17.7% of th e
patients noted a late onset of sexual activity - 25.5 -30
years
When assessing the history of the menstrual
function of patients: 66.4% of them had a regular
menstrual cycle, 25.3% took com bined oral
contraceptives, both for contraception and for the
regu lation of the menstrual cycle, and 8.3% of the
women examined did not have regularity cycle from 35
to 90 days, which is most likely associated with a
violation of hormonal function and can be considered
as a trigger hormonal mechanism in the development o f
cervical pathology, in the form of proliferative
reactions of stratified squamous epithelium.
Reproductive function analysis showed that 51%
of the women studied had a history of both chil dbirth
and abortion; 26.7% of patients had an abortion by
instrume ntal curettage, 22.3% of patients had no
history of birth and abortion. And this does not exclude
traumatic damage to the cervix, both during childbirth
and during termination of pregnancy. What could be a
provoking factor for the penetration of HPV into t he
deep layers of the stratified squamous epithelium.
At the second stage, a comparative analysis of
laboratory and instrumental parameters in the studied
groups was performed for patients o f both groups.
Laboratory studies revealed in the 1st group in 49% of
observations I -II the degree of purity of the vaginal
contents and in 33% of examinations the presence of
key cells, mobilunkus, leptotrix. In 18% of studies,
smears for the degree of pu rity of the vaginal contents
corresponded to the III -IV degree of purity and the
content of fungi of the genus Candida, and
microorganisms that play a key role in the development
of bacterial vaginosis. The second group was
dominated by patients with the p resence of grade III -IV
purity and the presence of pathogenic micr oflora in the
smears in various associations, which was 79.8%, and
only in 20.2% of cases the microscopic result of the
analyzes had no reason to prescribe etiotropic therapy.
Extended colpo scopy in both groups demonstrated
an unsatisfactory colposcopy end oscopy.
For the purpose of differential diagnosis, a test was
carried out with acetic acid. Both in the first and second
groups in 25.5% and 19.7% of cases, respectively, we
revealed a negat ive vascular reaction, which should not
be observed normally. Vess els, atypically altered, were
visualized in different parts of the cervix or spread over
the entire surface.
When conducting a Schiller test, in 64% of
observations in both groups, the affec ted areas of the
ectocervix were stained in the form of whitish do ts -
"semolina" which indirectly indicates viral damage to
the epithelium. In patients from the second group
(79.3%), Schiller’s test was iodine -negative zone
During cytological examination of patients from
both groups, stratified squamous epithelium prev ailed.
In 66.3%, the signs of papillomavirus infection of the
cervical epithelium are due to the presence of
coilocytosis in combination with dyskeratosis in the
cells, signs of inflammation , CIN I for the first group
and CIN II for the second group. This has become an
indisputable fact for a cervical biopsy.
In order to identify the virus, PCR was performed
- diagnosis of material from the cervical canal and
urethra. We found that the peak o f HPV infection
occurred at a young age (19 -37 years), which amoun ted
to 54%. This indicator includes young women, i.e. the
most sexually active part of the population, and 47% of
their number were single and had a frequent change of
sexual partners.
In th e first and second groups of patients, the
presence of human papil loma virus of high oncogenic
risk was detected in 34.4% and 56.2% of cases,
respectively. HPV of low oncogenic risk was detected
in 23.5% and 37.7% of cases, both in the first and
second gro ups. In 17.5 ° / o research revealed - Cl.
Trachomatis, in 11.4% - Mycoplasma urealiticum.
The choice of treatment tactics depended on the
results of the examination, the nature and location of
the papillomavirus foci.
All patients received combination the rapy, which
included: herbal antiviral agent “Solanum tuberosum
shoot polysaccharides” according to the approved
schedule (intravaginal) in combination with
symptomatic therapy and destructive therapy. The
results of the therapy were evaluated no earlier t han 3 -
4 months later.
The effectiveness of combined treatment in t he 1st
group was 86%, in 2 - according to the results of the
control cytological study 56%, respectively. In 44% of
women of the 2nd group, CIN II degree was confirmed
3 months after the tre atment.
During PCR diagnostics, after treatment with
HPV, high onc ogenic risk in the 1st group was detected
in 29.8% and low oncogenic risk in 20.5%. In the 2nd
group, HPV of low oncogenic risk was detected in
18.2%, and high oncogenic risk in 24.8% of cas es
Conclusion:
1- long time infection with HPV, especially with
its h ighly oncogenic types, the use of combined oral
contraceptives for a long period of time, the beginning
of early sexual life, the presence of mixed infections,
hormonal imbalance, the presence of bad habits,
namely smoking, cause the development of cervica l
intraepithelial neoplasia and cancer cervix.
2- In the presence of CIN I, II, especially
associated with HPV, it is necessary to apply a wide
range of diagnostic methods. Which includes : clinical -
visual method, advanced colposcopy, cytological
examination , PCR diagnostics, cervical biopsy
according to indications.
3- Adequate immunomodulatory therapy with
drugs: an antiviral agent of plant origin, symptomatic
therapy promotes elimination of virions and regression
of CIN I, and with CIN II in combination with
destructive and surgical therapy, the effectiveness of
treatment is increased.

Reference.
1. Andreeva N.A., Epifanova O.V. "Modern
aspects of the diagnosis and treatment of cervical
ectopy against the background of human

20 American Scientific Journal № ( 37 ) / 2020
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АКТИВН ЫЙ ОБРАЗ ЖИЗНИ У ПОЖ ИЛЫХ ЛЮДЕЙ И ЗДОРОВО Е СТАРЕНИЕ НАСЕЛЕНИЯ
В ЗАКО НОДАТЕЛЬСТВЕ И ПРОГР АММАХ ЕС И РЕСПУБЛИК И БОЛГАРИЯ

Жени Стайкова 1,
Проф. д -р, дмн.
Юлия Димитрова 2
д-р
МУ - СОФИЯ, ФОЗ 1, МБАЛ АО ПИРДОП 2
DOI : 10.31618/ asj .2707 -9864.2020.1.37.1
Резюме : В статье рассмотрена законодательная база и действующие программы на территории ЕС и
Республики Болгария, поддерживающие активный образ жизни среди пожилых людей и здоровое старение
насе ления. Активный образ жизни среди стареющего населения является важн ой частью принятой
стратегии „Европа 2020“. В 2000 г. ЕС принял Директиву 2000/78/ЕС по всему миру, определяющую
основную рамку в борьбе с дискриминацией. В 1989 г была принята Европейская рамочная д иректива
относительно минимальных требований безопасности и гигиены труда на рабочем месте (Директива
89/391 EЕС). Был принят Регламент по координации системы социального страхования (883/2004). В
Республики Болгария была принята Национальная ст ратегия касательно поддержки и пропагандирования
активного обр аза жи зни среди пожилых слоев населения в Болгарии (2019 – 2030 г.) Были предоставлены
средства по линии ЕС через структурные и Когезионный фонды.
Пожилое население представляет собой важную ча сть современного европейского общества.
Болгар ия в этом смысле не ис ключение, особенно принимая во внимание демографические показатели.
Европейская Комиссия предлагает различные подходы к решению острых демографических проблем. Так,
2012 год был объявлен Е вропейским годом активного образа жизни пожилых людей. В этом смысле
реализация разного рода программ демонстрирует сильный политический импульс к поощрению
социальной активности и реализации полного объема прав пожилого населения в Европе.
Ключевые слова и понятия: законодательство, законодательная база, программы, пожил ое
население, активный образ жизни и здоровое старение населения

Введение
Демографическое старение население - одно из
самых серьезных вызовов, перед которым
оказалась Европа. Поскольку в течение
последующих 50 лет число европейцев старше 65
лет удвоится, очень важно, чтобы Европейская
комиссия и страны — члены ЕС оставили в
приоритетах вопросы поддержания и
стимулирования активного образа жизни пожилых
слоев населения, а также обеспечени я здоровой
старости. С повышением показателя с редней
продолжительности жизни все больше пожилых
людей могут быть полезны обществу даже в пост -
пенсионном возрасте. Оставаясь активными,
поддерживая медицинские показатели здоровья,
эти слои населения способны внести свой вклад в
устойчивое развитие нашег о общества. Ключ к
достижению стабильности - в поддержании у
пожилых людей активности и независимости,
интереса к жизни и возможности участвовать во
всех ее сферах - от профессиональных,
общественных проявлений , до семейных
отношений.
Цель настоящего исследования:
осуществить обзор нормативных документов и
программ в ЕС и Р. Болгария, связанных с
поддержкой и пропагандированием активного
образа жизни пожилых людей и обеспечения
здоровой старости.
Материалы и м етоды : авторы прибегают к
докум ентальной методике, рассматривая все
существующие на данный момент европейские и
национальные нормативные документы и прилагая
к ним критический анализ.
Резултаты и обсуждения:
Активный образ жизни по отношению к
пожилым люд ям означает:
1. Обеспечение воз можностей длительного
трудоустройства для мужчин и женщин
пенсионного и пост -пенсионного возраста путем
преодоления структурных преград и введения
подходящих стимулов.