Роль мотивации пациента в проведении специфической вакцинации аллергии

A choice of therapy tactics and performing of specific allergy vaccination in atopic patients are greatly depended on a patient's motivation which is a conscious desire to keep preventing and therapeutic requirements. Thirty-year experience of the specific allergy vaccination in the Saratov allergological center demonstrates a significant activation of a patient’s role in the treatment and a transfer of medical practice from the paternalistic model, when a doctor has an exclusive right to decide a patient's future, to social-and-ethic partnership based on a patient's awareness of potential benefit and risk of treatment. Such decision for 98.4% of the patients is based on a positive motivation to reach future benefit of he treatment. Orientation to health without drugs and good results of the first therapy course predominate over social, occupational, emotional factors of the patients while being treated with specific allergy vaccination.Выбор тактики лечения и проведение специфической вакцинации аллергии у больных с атопическими заболеваниями в значительной степени определяется мотивацией пациента — осознанное стремление больного выполнять необходимые лечебно-профилактические действия. 30-летний опыт применения специфической вакцинации аллергии в Саратовском аллергологическом центре показывает заметную активизацию роли пациента в лечебном процессе и переход от патерналистской модели медицинской практики с монопольным правом врача решать судьбу пациента к построению социально-этичного партнерства на основе информированности больного о потенциальной пользе и возможном риске предлагаемого лечения. В основе принятия решения для 98,4% пациентов лежит позитивная мотивация достижения успеха от лечения в будущем. Ориентация на здоровье без лекарств и положительные результаты первого курса лечения доминируют над социальными, трудовыми, эмоциональными мотивами пациентов при проведении специфической вакцинации аллергии

The stationary concentrated vortex model

A new model of an axially-symmetric stationary concentrated vortex for an inviscid incompressible flow is presented as an exact solution of the Euler equations. In this new model, the vortex is exponentially localised, not only in the radial direction, but also in height. This new model of stationary concentrated vortex arises when the radial flow, which concentrates vorticity in a narrow column around the axis of symmetry, is balanced by vortex advection along the symmetry axis. Unlike previous models, vortex velocity, vorticity and pressure are characterised not only by a characteristic vortex radius, but also by a characteristic vortex height. The vortex structure in the radial direction has two distinct regions defined by the internal and external parts: in the inner part the vortex flow is directed upward, and in the outer part it is downward. The vortex structure in the vertical direction can be divided into the bottom and top regions. At the bottom of the vortex the flow is centripetal and at the top it is centrifugal. Furthermore, at the top of the vortex the previously ascending fluid starts to descend. It is shown that this new model of a vortex is in good agreement with the results of field observations of dust vortices in the Earth’s atmosphere

NEW NUTRIENT MEDIUM ON THE BASIS OF DRY FIBRIN HYDROLYSATE FOR V. CHOLERAE CULTIVATION

The data on exploration of biological properties of experimental solid and liquid media on the basis of dry enzymatic hydrolysate of fibrinobtained from production waste of anti-rabies immunoglobulin is presened here. The culture media engineered meets the requirements of normative documents and. is highly competitive with the test medium in their qualitative characteristics. Suggested media can be used for V. cholerae cultivation, including submerged cultivation, in production of cholera preventive and. diagnostic preparations

Психологические дисфункции у женщин с бронхиальной астмой

Background. The importance of psychosocial factors in the management of bronchial asthma (BA) is discussed in clinical guidelines, including in international and national clinical guidelines. However, a specific evaluation of their role as a cause of poor asthma control in susceptible patients is required. Aim. Assessment of psychological health of women with different levels of asthma control.Materials and methods. The study included 108 women with asthma observed in Saratov center for Allergology who were stratified into 3 groups according to the control level (good, partial, uncontrolled, according to GINA). In establishing a diagnosis of asthma, standard methods were used (medical history, symptoms, spirography). To assess the level of control, ACQ-5 (Asthma Control Questionnaire 5 items-self-administered) was used, to assess the quality of life, questionnaires AQLQ-S (Asthma Quality of Life Questionnaire S); SF-36 (36-ltem MOS Short-Form Health Survey), a standardized and validated Russian version of the women’s health questionnaire WHQ (Women’s Health Questionnaire) were used; for psychological diagnosis and evaluation of social and personal competencies that contribute to the preservation and improvement of human health (the intellectual, personal, emotional, physical, social, creative, spiritual aspects), integrated multimodal questionnaire was used. The comparison was conducted with a control group of men with bronchial asthma, comparable in age and level of control.Results. Women with poorly controlled asthma had worse performance of AQLQ-S (combined median score of 3,43 instead of 5,13 in the group of good control; p < 0,05); all scales of the SF-36, including the general condition (43,48 against 55,07), role of physical (25,93 against 57,76) and emotional problems (43,83 against 64,37); at p < 0.05. According to the WHQ questionnaire (the inverse relationship: the higher the score, the lower the quality of life) in the group with poor control there is a high level of depression (mean 0,36 versus 0,24; p < 0,05); physical health problems are marked (0,47 against 0,27; p < 0,05). There is a very low selfestimation of their attractiveness in BA (0,71 and 0,64 for bad and good control, respectively). According to the integrated multimodal questionnaire, in both men and women with asthma almost identical results were obtained on the scales sensitive to manifestations of anxiety-depressive symptoms, emotional balance, scales of emotional skills, correlating with severe alexithymia and low capacity for reflection. Among women the proportion of individuals with high scores of intellectual functioning, strong-willed competence, goal-setting, and ability of making contacts was higher.Conclusion. The severity of asthma and disease control are closely linked with the psychological condition of the patient. Psychological dysfunctions are correlated with suboptimal BA control. It is important to understand psychological differences in women and to educate patients in both effective BA control and in establishing individualized asthma management strategies.There is a need for a multidisciplinary approach aimed at the identification and effective correction of asthma. The study of the psychological characteristics of personality and motivational sphere of the patient can help to optimize therapy, improve monitoring and prognosis of the disease. Введение. Важность психосоциальных факторов в управлении бронхиальной астмой (БА) обсуждается в клинических руководствах, включая международные и национальные клинические рекомендации, однако требуется конкретная оценка их роли в качестве причин плохого контроля астмы в уязвимых группах пациентов.Цель исследования. Оценка психологического здоровья женщин с разным уровнем контроля бронхиальной астмы.Материал и методы. В исследование включены 108 женщин с бронхиальной астмой, наблюдающихся в Саратовском аллергологическом центре, которые были стратифицированы на три группы в соответствии с уровнем контроля (хороший, частичный, неконтролируемый (GINA)). При постановке диагноза бронхиальной астмы использованы стандартные методы (анамнез, симптомы, спирография). Для оценки уровня контроля использовались Asthma Control Questionnaire 5 items-self-administered (ACQ-5), качества жизни – опросники Asthma Quality of Life Questionnaire S (AQLQ-S), 36-ltem MOS Short-Form Health Survey (SF-36), стандартизированная и валидизированная русскоязычная версия опросника женского здоровья Women’s Health Questionnaire (WHQ). Для психологической диагностики и оценки социально-личностных компетенций, способствующих сохранению и развитию здоровья человека (интеллектуальный, личностный, эмоциональный, физический, социальный, творческий, духовный аспекты), применялся мультимодальный интегрированный опросник (МИО). Сравнение проводилось с контрольной группой мужчин с бронхиальной астмой, сопоставимых по возрасту и уровню контроля.Результаты. Женщины с плохо контролируемой астмой имели худшие показатели AQLQ-S (суммарная медиана баллов 3,43 вместо 5,13 в группе хорошего контроля; p < 0,05); всех шкал SF-36, включая общее состояние (43,48 против 55,07), роль физических (25,93 против 57,76) и эмоциональных проблем (43,83 против 64,37); р < 0,05. По опроснику WHQ (обратная зависимость: чем выше балл, тем ниже качество жизни) при плохом контроле отмечается высокая выраженность депрессии (среднее значение 0,36 против 0,24; p < 0,05), проблем физического здоровья (0,47 против 0,27; p < 0,05). Отмечена чрезвычайно низкая оценка собственной привлекательности при БА (0,71 и 0,64 соответственно при плохом и хорошем контроле). По опроснику МИО у мужчин и женщин с БА получены практически одинаковые показатели по шкалам, чувствительным к проявлениям тревожно-депрессивной симптоматики, эмоциональной уравновешенности, шкалам эмотивных навыков, коррелирующих с выраженной алекситимией и низкой способностью к рефлексии. Среди женщин была выше доля индивидуумов с высокими шкалами интеллектуального функционирования, волевой компетенции, целеполагания, контактности.Заключение. Тяжесть астмы, контроль заболевания тесно связаны с психологическим состоянием больного. Существует необходимость в междисциплинарном подходе, направленном на выявление и эффективную коррекцию психофункциональных расстройств при БА. Изучение психологических особенностей личности и мотивационной сферы пациента может способствовать оптимизации терапии, улучшению контроля и прогноза заболевания.

Side Chain Hydrophobicity Modulates Therapeutic Activity and Membrane Selectivity of Antimicrobial Peptide Mastoparan-X

The discovery of new anti-infective compounds is stagnating and multi-resistant bacteria continue to emerge, threatening to end the "antibiotic era". Antimicrobial peptides (AMPs) and lipo-peptides such as daptomycin offer themselves as a new potential class of antibiotics; however, further optimization is needed if AMPs are to find broad use as antibiotics. In the present work, eight analogues of mastoparan-X (MPX) were investigated, having side chain modifications in position 1, 8 and 14 to modulate peptide hydrophobicity. The self-association properties of the peptides were characterized, and the peptide-membrane interactions in model membranes were compared with the bactericidal and haemolytic properties. Alanine substitution at position 1 and 14 resulted in higher target selectivity (red blood cells versus bacteria), but also decreased bactericidal potency. For these analogues, the gain in target selectivity correlated to biophysical parameters showing an increased effective charge and reduction in the partitioning coefficient for membrane insertion. Introduction of an unnatural amino acid, with an octyl side chain by amino acid substitution, at positions 1, 8 and 14 resulted in increased bactericidal potency at the expense of radically reduced membrane target selectivity. Overall, optimized membrane selectivity or bactericidal potency was achieved by changes in side chain hydrophobicity of MPX. However, enhanced potency was achieved at the expense of selectivity and vice versa in all cases

Бронхиальная астма: федеральные клинические рекомендации по диагностике и лечению

Bronchial asthma is a heterogeneous disease that requires identification of its phenotype and a personalized approach to therapy. At the same time, despite a wide range of therapeutic options, many patients with asthma cannot achieve control over the disease.Methodology. The target audience of these clinical recommendations are general practitioners, therapists, pediatricians, allergologists-immunologists, pulmonologists, and functional diagnostics doctors. Each thesis-recommendation about diagnostic and therapeutic procedures has been scored according to the scales of classes of recommendations from 1 to 5 and A, B, C scale of the levels of evidence. The clinical recommendations also contain comments and explanations to the theses, algorithms for the diagnosis and treatment of bronchial asthma, and reference materials.Conclusion. The presented clinical guidelines cover current information about the etiology and pathogenesis, classification, clinical manifestations, diagnosis, treatment, and prevention of bronchial asthma. These guidelines were approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation in 2021. Бронхиальная астма (БА) является гетерогенным заболеванием, при котором требуется выделение различных фенотипов и персонифицированный подход к терапии. При этом несмотря на широкий выбор терапевтических возможностей, у многих пациентов с БА не удается достичь контроля над заболеванием.Методы. Целевой аудиторией данных клинических рекомендаций являются врачи общей практики, терапевты, педиатры, аллергологи-иммунологи, пульмонологи и врачи функциональной диагностики. Каждый тезис-рекомендация по проведению диагностических и лечебных мероприятий оценивается по шкалам уровней достоверности доказательств от 1 до 5 и шкале оценки уровней убедительности рекомендаций по категориям А, В, С. Клинические рекомендации содержат также комментарии и разъяснения к указанным тезисам-рекомендациям, алгоритмы по диагностике и лечению БА, справочные материалы.Заключение. По данным представленных клинических рекомендаций освещаются современные сведения об этиологии и патогенезе, классификации, клинических проявлениях, диагностике, лечении и профилактике БА. Клинические рекомендации одобрены Научно-практическим Советом Министерства здравоохранения Российской Федерации (2021).

Psychological dysfunctions in women with bronchial asthma:Психологические дисфункции у женщин с бронхиальной астмой

Background. The importance of psychosocial factors in the management of bronchial asthma (BA) is discussed in clinical guidelines, including in international and national clinical guidelines. However, a specific evaluation of their role as a cause of poor asthma control in susceptible patients is required. Aim. Assessment of psychological health of women with different levels of asthma control.Materials and methods. The study included 108 women with asthma observed in Saratov center for Allergology who were stratified into 3 groups according to the control level (good, partial, uncontrolled, according to GINA). In establishing a diagnosis of asthma, standard methods were used (medical history, symptoms, spirography). To assess the level of control, ACQ-5 (Asthma Control Questionnaire 5 items-self-administered) was used, to assess the quality of life, questionnaires AQLQ-S (Asthma Quality of Life Questionnaire S); SF-36 (36-ltem MOS Short-Form Health Survey), a standardized and validated Russian version of the women’s health questionnaire WHQ (Women’s Health Questionnaire) were used; for psychological diagnosis and evaluation of social and personal competencies that contribute to the preservation and improvement of human health (the intellectual, personal, emotional, physical, social, creative, spiritual aspects), integrated multimodal questionnaire was used. The comparison was conducted with a control group of men with bronchial asthma, comparable in age and level of control.Results. Women with poorly controlled asthma had worse performance of AQLQ-S (combined median score of 3,43 instead of 5,13 in the group of good control; p < 0,05); all scales of the SF-36, including the general condition (43,48 against 55,07), role of physical (25,93 against 57,76) and emotional problems (43,83 against 64,37); at p < 0.05. According to the WHQ questionnaire (the inverse relationship: the higher the score, the lower the quality of life) in the group with poor control there is a high level of depression (mean 0,36 versus 0,24; p < 0,05); physical health problems are marked (0,47 against 0,27; p < 0,05). There is a very low selfestimation of their attractiveness in BA (0,71 and 0,64 for bad and good control, respectively). According to the integrated multimodal questionnaire, in both men and women with asthma almost identical results were obtained on the scales sensitive to manifestations of anxiety-depressive symptoms, emotional balance, scales of emotional skills, correlating with severe alexithymia and low capacity for reflection. Among women the proportion of individuals with high scores of intellectual functioning, strong-willed competence, goal-setting, and ability of making contacts was higher.Conclusion. The severity of asthma and disease control are closely linked with the psychological condition of the patient. Psychological dysfunctions are correlated with suboptimal BA control. It is important to understand psychological differences in women and to educate patients in both effective BA control and in establishing individualized asthma management strategies.There is a need for a multidisciplinary approach aimed at the identification and effective correction of asthma. The study of the psychological characteristics of personality and motivational sphere of the patient can help to optimize therapy, improve monitoring and prognosis of the disease