Dynnik Oleksandra
@knmu.kharkov.ua
obstetrics avd gynecology
Kharkiv National Medical University
EDUCATION
Kharkiv national medical university
PhD
RESEARCH INTERESTS
obstetrics, gynecology, perinatology
Scopus Publications
Scholar Citations
Scholar h-index
Scopus Publications
V.O. Dynnik, , О.О. Dynnik, H.О. Havenko, O.G. Verchoshanova, Yu.V. Volkova, , , , and
Group of Companies Med Expert, LLC
The pubertal period is accompanied by the tension of the adaptation system during the hormonal adjustment. Purpose - to define the hormonal determinants of stress-related menstrual disorders in adolescent girls with comorbid mental disorders and the peculiarities of adaptation reactions. Materials and methods. 150 adolescent girls with menstrual cycle disorders were examined. The levels of luteotropic hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), estradiol (E2), testosterone (T), cortisol (K), dehydroepiandrosterone sulfate (DHEA-S) were determined. They were divided into three groups depending on the examination by a psychiatrist: without mental status disorders, with anxiety-phobic disorders and depressive states. The control group included 35 girls of similar age with a normal menstrual cycle who were examined in the early follicular phase. Results. There were no significant differences in the content of gonadotropic hormones in girls with menstrual function disorders in view of the state of mental health. However, in girls with oligomenorrhea (OM), in relation to patients with abnormal uterine bleeding (AUB), elevated LH values are significantly more often registered (p<0.03). Levels of peripheral T, as well as its precursor DHEA-S and metabolite (E2), were associated with mental health status. The lowering of E2 significantly elevated in adolescents with comorbid psychopathology. The number of girls with high T values increased in the presence of psychopathology in AUB and remained unchanged in OM. Cortisol in psychopathology, regardless of the type of menstrual function disorders, was reduced in relation to the control group, however, in girls with OM, its content was significantly higher, especially in depressive states (p˂0.05). The specific gravity of girls with a reduced level of DHEA-S in patients with AUB increased with comorbid psychopathology. In case of OM, a reduced and increased content of DHEA-S was registered with the same frequency. An increase in the C/DHEA-S indicator of the functioning of the hypothalamic-pituitary-adrenal system in patients with OM was noted much less frequently than in patients with AUB (p˂0.006). Conclusions. It is believed that the hormonal relationship between cortisol and DHEA-S indicates the body’s response to stressors and can be used as one of the biomarkers of neurotic and depressive states. An increase in the C/DHEA-S ratio suggests a possible dissociation of their secretion. Adolescents with AUB, unlike girls with OM, have a decrease in the “protective” hormone DHEA-S, which can affect the deterioration of mental health. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.
V.O. Dynnik, О.О. Dynnik, H.О. Havenko, Yu.V. Volkova, and O.G. Verchoshanova
Publishing House Zaslavsky
Background. The reproductive health of girls has acquired great social significance in connection with the problem of quantitative and qualitative reproduction of the population. The purpose of the study was to determine the hormonal status of adolescent females with menstrual disorders and various somatic pathologies and to investigate the state of adaptive-compensatory capacities in these patients. Materials and methods. The hormonal background was studied in 391 girls aged 12–17 years: 175 with abnormal uterine bleeding (AUB) and 216 with oligomenorrhea (OM). All patients were examined by a multidisciplinary team. Results. A comorbid pathology was found in the absolute majority of girls with menstrual abnormalities. Endocrine disorders were noted more often (pϕ < 0.001–0.00001). Indicators of hormone concentration in patients with menstrual disorders had no significant differences depending on the type of comorbidity. Probable changes in the content of some hormones were observed depending on the type of menstrual disorders. A significant increase in the level of luteinizing hormone (pu < 0.02) and a decrease in estradiol (pu < 0.02) were observed in patients with OM compared to those with AUB. The assessment of the adjustment state revealed that in girls with menstrual disorders, the average cortisol content did not differ from that of controls, and insulin was higher than in the comparison group (pu < 0.001). However, high cortisol values (above 90 percentile) were noted in 8–13 % of patients with AUB and OM. The stress index (C/In) as a marker of a nonspecific stress response was lower than in the comparison group (pu < 0.0001), and it was probably higher in girls with OM than in adolescents with AUB (pu < 0.004). Conclusions. An interdisciplinary approach is a modern strategy in the treatment of menstrual disorders in adolescence. A decrease in the stress index was found in girls with menstrual disorders, which may indicate a decrease in adaptive capacity. Moreover, adolescents with OM are more adjusted to menstrual disorders than girls with AUB.
V.O. Dynnik, , О.О. Dynnik, O.G. Verchoshanova, H.О. Havenko, , , and
Group of Companies Med Expert, LLC
The duration and regularity of the menstrual cycle are influenced by many factors, including psychosocial stress, which can lead to activation of the hypothalamic-pituitary-adrenal system. Purpose - to assess the levels of stress hormones cortisol, insulin (IRI), prolactin, and the cortisol/insulin (K/In) index in adolescent girls with menstrual disorders. Materials and methods. 177 adolescent girls aged 12–17 years with menstrual disorders were examined (87 with abnormal uterine bleeding (АUB), 90 - with oligomenorrhea (OM)). The comparison group consisted of 57 girls of the same age with normal menstrual cycles examined in the early follicular phase. The level of cortisol, insulin, prolactin (PRL) was measured in blood serum on an empty stomach using the immunoenzyme method to determine the level of organism’s adaptive capabilities. All hormones were defined according to the instructions for the kits. The ratio of K/In was calculated. Results. In girls with menstrual disorders, three types of reaction from the adrenal glands were found, which were expressed in increased levels of cortisol above 75 and 90 percentile, a decrease (below 10 percentile) and its fluctuations within physiological values. At cortisol values above the 90 percentile, the average level of glucose, IRI, and HOMA in teenage girls with OM did not differ from the normative values, and in patients with AUB these indicators were significantly higher than in adolescents with OM. The K/In ratio in girls with OM by 1.8 times exceeded the similar indicator of adolescents with AUB (p<0.04) and was slightly higher than in the comparison group, which indicates a satisfactory reaction of stress tolerance. With AUB, this coefficient decreased, which may indicate exhaustion of the body’s adaptive capabilities. The same situation was observed when cortisol increased above the 75 percentile. When the cortisol level was within physiological values, the content of glucose and IRI also did not go beyond the limits of normative fluctuations. The stress ratio (K/In) had no significant difference depending on the type of violations and was significantly reduced. The absence of changes in the content of cortisol and IRI in the blood serum in response to the onset of menstrual disorders may indicate a certain instability in the development of the body's protective reactions in teenage girls with menstrual disorders. Conclusions. The revealed changes in the content of cortisol, insulin, K/In and PRL as markers of a non-specific stress reaction in the structure of the adaptive response in disorders of menstrual function carry additional information about impaired adaptation to stress and the state of compensatory capabilities of the girl's body, expand the understanding of pathogenetic mechanisms these disorders and can be used both in the assessment of the state of adaptation and in the development of appropriate preventive strategies. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.
V.O. Dynnik, , O.O. Dynnik, S.V. Novokhatska, A.E. Druzhinina, , , and
Group of Companies Med Expert, LLC
The purpose - to identify significant prognostic criteria for the development of a complicated course of oligomenorrhea. Materials and methods. A clinical and hormonal examination of 64 adolescent girls with oligomenorrhea aged 12-18 was carried out. The following were determined: physical with determination of body mass index, sexual development, parameters of the hormonal background, vitamin D status, lipid spectrum and the state of carbohydrate metabolism. Results. The most informative sings regarding the formation of metabolic complications of the course of oligomenorrhea were selected by determining the informative clinical and anamnestic signs, hormonal indicators and the status of vitamin D. The following clinical parameters, which may indicate a complicated course of oligomenorrhea with disturbances in carbohydrate metabolism, had the greatest overall informativeness: macrosomia at birth; the mother’s age is more than 35 years at the time of our patient’s birth; in a girl, the age of menarche is up to 11 years, the presence of comorbid pathology (especially cardiovascular disorders) and body weight deficiency. The greatest prognostic significance from the hormonal parameters had high levels of luteinizing hormone, testosterone, total cholesterol, and low estradiol. The clinical, anamnestic and hormonal indicators that may indicate the formation of complications from lipid spectrum disorders were found. It was: deviation of the body weight at birth in both sides, high serum levels of prolactin, cortisol, normative follicle-stimulating hormone, and a moderate decrease in the level of vitamin D. Conclusions. Significant risk factors for the formation of metabolic complications in girls with oligomenorrhea have been identified. Using them makes it possible to timely determine the prognosis of the course of oligomenorrhea in the majority of patients already at the early stages of the formation of this pathology, to decide on therapy and the implementation of therapeutic and preventive measures in the future. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the SI «Institute of Health Care of Children and Adolescents of the NAMS of Ukraine». The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.
V.O. Dynnik, , N.V. Bagatska, O.O. Dynnik, O.G. Verchoshanova, H.O. Havenko, , , , and
Group of Companies Med Expert, LLC
The problems of diagnosis, therapeutic tactics and medical prognosis in comorbid, polymorbid pathology stand out among the most actual problems of modern health care. Purpose - to study the frequency and nature of comorbid conditions in patients with pubertal abnormal uterine bleeding (PAUB). Materials and methods. The study included 342 girls aged 11-17 suffering from PAUB. All patients were examined by a multidisciplinary team of doctors. Results. It has been shown that menstrual irregularities are combined with other somatic, mental and endocrine pathologies in the vast majority of patients. Only 9.6% of the patients examined had no concomitant pathologies. More than half of girls have a combination of more than three comorbidities. The first three ranks are occupied by endocrine, mental and digestive system disorders. More than a third of patients with endocrine disorders had deviations in terms of body weight - overweight and obesity, which is much more often accompanied by changes in carbohydrate and lipid metabolism. In patients with mental disorders astheno-neurotic syndrome and vegetative-vascular dystonia syndrome prevailed. Functional disorders of the biliary tract were mainly recorded among the disorders of the digestive system, about 18% of girls suffered from gastritis, cholecystitis. The presence of comorbid pathology reduced the effectiveness of non-hormonal therapy by 1.5 times and increased the number of relapses by 3.5-4 times. The effectiveness of non-hormonal therapy was 81.8% on the absence of concomitant pathology; relapses were recorded only in 16.7%. Conclusions. Comorbid pathologies in patients with PAUB aggravate the severity of the girl’s condition, reduces adaptive capabilities, adversely affects the effectiveness of non-hormonal therapy, contributes to the recurrence of the disease and is a risk factor for the development of serious metabolic, endocrine and cardiovascular diseases in the future. The category of patients with concomitant pathology requires a special examination algorithm and the appointment of an adequate therapeutic intervention, taking into account all the identified nosological forms and drug compatibility. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.
V.O. Dynnik, O.O. Dynnik, and A.E. Druzhinina
SE Dnipropetrovsk Medical Academy of Health Ministry of Ukraine
The problem of the participation of vitamin D in the pathogenesis of various diseases has been attracted the attention of scientists in recent years. Vitamin D deficiency is regarded as a global problem that increases the risk of many chronic diseases. More recently, the emphasis has shifted to the non-skeletal effects of vitamin D. A lot of literature suggests that vitamin D plays an important role in the regulation of processes in the ovaries that determine female fertility, female reproductive potential. Vitamin D receptor enzymes involved in its metabolism are expressed in both the central and peripheral reproductive organs (hypothalamic-pituitary system, ovaries, uterus, placenta). All of this suggests that vitamin D is involved in the regulation of menstrual function. The aim of the study is to identify the relationships between gonadotropic and steroid hormones with the content of vitamin D in menstrual disorders in adolescent girls by type of abnormal uterine bleeding (AUB). 167 adolescent girls with AUB were examined. The levels of Luteinizing hormone (LH), Follicle-stimulating hormone (FSH), Prolactin (PRL), total estradiol (E2), testosterone (T), cortisol (C), vitamin D were determined. It was revealed that in 92.1% of girls with AUB have a decrease in the level of vitamin D, and 53.9% of them have a sharp reduce of its. A factorial model of the relationship between pituitary-gonadal hormones and vitamin D, on the basis of which it may be assumed that vitamin D makes a significant contribution to the formation of AUB in adolescence. It participates in the mechanisms of stimulation of gonadotropins, affects the activity of sex hormones through the promoters of receptors located both in the hypothalamic-pituitary region and in the periphery in the ovaries. This is evidenced by factor weights, which serve as analogues of the correlation ratios and show the degree of interconnection between the variables in the factors selected. The changes in the content of vitamin D revealed indicate the need and expediency of its determination in the blood of patients with AUB during puberty for early diagnosis of its abnormalities and timely prevention of serious complications in the future.
Вікторія Диннік, Олександра Диннік, and Альона Дружиніна
V.Danilevsky Institute for Endocrine Pathology Problems of NAMSU
Мета роботи: з’ясувати зв'язок між рівнем вітаміну D в сироватці крові і ліпідним профілем у пацієнток з олігоменореєю (ОМ). Матеріали і методи. Обстежено 62 дівчинки-підлітка з ОМ 12-18 років. Визначали натщесерце в сироватці крові концентрації 25 (OH) D, загальний холестерин (ЗХ), холестерин ліпопротеїнів високої щільності (ХС ЛПВЩ), тригліцериди (ТГ), β-ліпопротеїди. Розрахунковим шляхом визначали ХС ЛПНЩ, ХС ЛПДНЩ і коефіцієнт атерогенності (КА). Залежно від індексу маси тіла (ІМТ) підлітки були розподілені на 2 групи. Ⅰ гр. склали пацієнтки зі зниженою масою тіла, ІІ гр. – з фізіологічними її значеннями. Результати. Тільки у 34,8 % підлітків з ОМ не визначалися будь-які зміни в ліпідному профілі. Більш ніж у третини (32,8 %) обстежених пацієнток є підвищення рівня ЗХ, причому як у дівчат з фізіологічними параметрами ІМТ, так і при його дефіциті. Майже у 60 % підлітків відзначається збільшення β-ліпопротеїдів. У 17,4 % реєструється підвищення рівня ТГ і КА, у 13,0 % виявлені підвищені значення ХС ЛПНЩ. Майже у кожної п'ятої (19,6 %) реєструвалися поєднані порушення показників ліпідного спектра крові. Більш ніж у 80 % дівчат з ОМ відзначалося зниження рівня в крові віт. D, причому у половини з них вміст віт. D був ˂20 нг/мл. Тільки 17,3 % підлітків з ОМ мали значення віт. D вище 30 нг/мл. Істотних відмінностей в залежності від того, до якої групи була віднесена дівчина, виявлено не було. На тлі зниження концентрації віт. D реєструється збільшення атерогенних фракцій ліпопротеїнів, підвищується ризик формування дисліпідемій. Побудована факторна модель асоціації ліпідів і віт. D, що підтверджує негативну залежність рівня в крові віт. D та тригліцеридів і холестерину ЛПДНЩ. Висновки. Рівень вітаміну D впливає на вміст ліпідів у дівчат з олигоменореєю. На тлі зниження рівня вітаміну D наростають зміни в ліпідному спектрі крові, збільшується кількість підлітків з атерогенними зрушеннями в ліпідограмі. Зниження рівня вітаміну D і порушення ліпідного профілю дівчат повинні бути об'єктами первинної профілактики в зв'язку з високим ризиком формування метаболічних і кардіометаболічних порушень в майбутньому.
V.O. Dynnik, O.O. Dynnik, and A.Y. Druzhynina
Publishing Office TRILIST
Research objective: to determine the frequency of vitamin D deficiency and insufficiency to identify its association with reproductive hormones in adolescent girls with oligomenorrhea.Materials and methods. The work was carried out according to the results of clinical and instrumental examination of 68 adolescent girls 12–18 years old with oligomenorrhea, who were treated at the Department of Pediatric Gynecology of the State Institution “Institute for Children and Adolescents Health Care of the NAMS of Ukraine”. Patients were divided into two groups depending on the body mass index (BMI): group I – with a body weight deficit (BMI 16.31 ± 0.18 kg/m2), group II – with a BMI within physiological norm (20.0 ± 0.25 kg/m2). All patients underwent a comprehensive clinical and laboratory examination: luteinizing, follicle-stimulating hormones, prolactin, estradiol, testosterone, cortisol, 25(OH)D were determined in blood serum. Multivariate regression analysis was using for analyze the association of gonаdotropic, steroid hormones with vitamin D. The main characteristics of the object discrimination model are presented in the form of tables.Results. The article provides a comparative analysis of the hormonal profile and vitamin D level depending on BMI. It was revealed that a reduced 25(OH)D value was characteristic not only in patients with menstrual dysfunction, but also in peers with normal menstrual function. Schemes that characterize the pituitary-gonadal association with vitamin D were constructed based on the results of multiple regression analysis. Their features were determined in girls with different body weights. In patients with low energy resources there were direct associations between individual indicators of gonadotropins (follicle-stimulating hormone), steroid hormones (estradiol, cortisol) and vitamin D. An inverse association was observed between vitamin D and cortisol and prolactin in girls with balanced energy status.Conclusions. The reduced content of vitamin D is characteristically for patients with menstrual dysfunctions by the type of oligomenorrhea. Associations of gonadotropic, steroid hormones and vitamin D, depending on the energy status (nutrition) of patients with oligomenorrhea were revealed.
V. A. Dynnik and A. A Dynnik
Institute for Medical Radiology and Oncology of NAMS of Ukraine
Background. Ultrasound diagnosis (echography) is now one of the main diagnostic methods used in medical practice. Based on the results obtained by ultrasound (ultrasound), a plan for further diagnostic examination of the patient can be made and/or treatment policy can be determined for a specific patient.
 Purpose. Studying the echographic features of the internal genitalia in adolescent girls with abnormal uterine bleeding depending on the time of the disease debut and hormonal levels.
 Materials and methods. Two hundred and eighty-nine adolescent girls with abnormal uterine bleeding were examined at the age of 11–17. The patients were divided into three groups. Group I included 163 adolescents with manifestation of the disease with menarche or in the first year of menstrual function. Group 2 included 65 girls in whom AUB arose in the second and later years of the existence of menstrual function. Group 3 included 61 patients with an unsteady menstrual cycle. LH, FSH, PRL, E2, T, IRI, IPFR-1, SHPS were determined in the blood serum. The longitudinal, transverse and anteroposterior dimensions of the uterus and ovaries were measured.
 Results. The evaluation of the ultrasound data of the pelvic organs of girls with AUB was carried out. It was revealed that the parameters of the uterus within the age norm were recorded only in 35 % of patients. The least frequently in girls with previous oligomenorrhea (29.5 %). More than a third had persistent ovarian follicles or cysts and 62.8 % had an increase in the intrauterine M-echo. The dependence of the size of the uterus on the pattern of hormones was revealed. A mathematical analysis of associative relationships of the hormonal background and echographic parameters of the uterus is presented.
 Conclusions. Ultrasound examination of the pelvic organs is a useful tool in identifying the morphological features of the uterus and ovaries, complements the endocrine profile of patients, which increases the diagnostic accuracy, and its results serve
Dynnik V.A. Dynnik, Shcherbina N.A. Shcherbina, Dynnik A.A. Dynnik, , and
Bionika Media