Mexametric Assessment of Melanin Level in Children's Skin

Background. High predisposition to sunburn in childhood and associated increased risk of malignant skin tumors development, decrease with age. There is a likelihood of a relationship between the described trends and dynamic age related changes in functional state of melanocytes and melanin.Aim: to evaluate the level of melanin in the skin in children of different age. Materials and methods. The study involved 78 children aged from 7 to 17 years, without any disorders of skin pigmentation. Three groups of observations were formed: Group 1 - 28 children from 7 to 9 years, Group 2 - 25 children from 10 to 12 years, Group 3 - 25 children from 16 to 17years. The melanin level was evaluated in the skin of face, body and extremities using mexametry.Results. The highest level of skin melanin was observed in forearms and lower legs in all age groups (up to 28.3 ± 10.8, 23.3 ± 8.6 and 26.7 ± 10.6 c.u. in Group 1, 2 and 3 respectively), the lowest - in cheeks and chest (up to 8.0 ± 4.7, 4.4 ± 3.4 and 9.5 ± 4.1 c.u. in Group 1, 2 and 3 respectively). There were relationships between skin site and level of melanin, but no relationships between level of melanin and gender or age.Findings. The level of melanin in the skin in children aged from 7 to 17 years is individual and depends on the location of the skin area, but does not depend on gender or age. The distribution of melanin in the skin is stable and does not change over time

Традиционные и современные морфометрические характеристики нейроретинального пояска в диагностике начальной стадии глаукомы

PURPOSE:To compare the traditional morphometric characteristics of the neuroretinal rim and the new indicator «Bruch’s membrane opening – minimum rim width» (MRW) in the diagnosis of early primary-open glaucoma.METHODS: The study included 82 people (82 right eyes, 25 women and 57 men). The main group (group 1) consisted of 45 patients (45 eyes) with the mild stage of primary openangle glaucoma, the control group (group 2) consisted of 37 healthy people (37 eyes). The research was conducted: Maklakov tonometry (10 g.), standard automated perimetry (SAP), contour perimetry (Heidelberg Edge Perimetry, HEP), the Heidelberg retinotomography (HRT) and spectral optical coherence tomography (OCT). The study examined the mean/global and sectoral morphometric parameters of the optic nerve disc: area and cup, the area and volume of the neuroretinal rim, the retinal nerve fiber layer thickness (RNFL) and the new indicator — MRW.RESULTS: No statistically significant differences were found in the ONH and cup area groups. There was a ten- dency toward RNFL thinning in all sectors in group 1 patients compared to group 2, but statistically significant differences were found in the «classic» sectors: inferior and superior temporal, as well as in global values. Statistically significant differences were found in all sectors of the rim area/volume, except the temporal one. The greatest differences were found when comparing the superior temporal sector (p<0.00007; Z=3.96). The rim thinning of the in this sector are corresponded to the changes in the thickness of the RNFL detected above. The analysis of the characteristics determining the state of the minimum distance from the edge of the MRW established the reliability of differences in the superior temporal sector (p<0.04; Z=2.07), but at the same time, in other cases, statistically significant differences between the studied groups were not found.CONCLUSION:The results of the study found that in the majority of cases, changes in patients with early glaucoma are found in the analysis of traditional rim parameters (area and volume), as well as in the study of the RNFL in the specific rim sectors. The study of a new index of the rim — MRW, has established its importance in the diagnosis of the early glaucoma, but so far only in the analysis of a limited number of rim sectors.ЦЕЛЬ. Сравнить традиционные морфометрические характеристики нейроретинального пояска и нового показателя «расстояние от края мембраны Бруха до внутренней пограничной мембраны» (MRW) при диагностике глаукомы у пациентов с начальной стадией болезни.МЕТОДЫ. В исследование были включены 82 человека (82 правых глаза, 25 женщин и 57 мужчин). Основную группу (группа 1) составили 45 пациентов (45 глаз) с начальной стадией первичной открытоугольной глаукомы, группу контроля (группа 2) составили 37 здоровых человек (37 глаз). Проводились исследования: тонометрия по Маклакову грузом 10 г, статическая автоматическая периметрия, контурная периметрия, Гейдельбергская ретинотомография и спектральная оптическая когерентная томография. В исследовании были изучены средние/общие и секторальные морфометрические показатели диска зрительного нерва (ДЗН): площадь и экскавация, площадь и объем нейроретинального пояска (НРП), средняя толщина слоя нервных волокон сетчатки (СНВС) и новый показатель — MRW.РЕЗУЛЬТАТЫ. При сравнении полученных результатов площадей ДЗН и экскавации не было установлено статистически значимых различий в группе лиц с начальной стадией глаукомы и в группе контроля. Была отмечена тенденция истончения слоя СНВС во всех секторах у пациентов группы 1, по сравнению с группой 2, но статистически значимые различия были установлены в т. н. «классических» секторах: в верхне- и нижнетемпораль-ных, а также за счет этого и в целом. Были установлены статистически значимые различия во всех секторах НРП, за исключением темпорального. Наибольшие различия были обнаружены при сравнении верхнетемпорального сектора (p<0,00007; Z=3,96). Истончение НРП в этом секторе ДЗН соответствовало обнаруженным изменениям толщины СНВС. Анализ характеристик MRW установил достоверность различий в верхнетемпоральном секторе (p<0,04; Z=2,07), но вместе с тем в других случаях статистически значимых различий между исследуемыми группами установлено не было.ЗАКЛЮЧЕНИЕ. Результаты исследования установили, что в подавляющем большинстве случаев изменения у больных с начальной глаукомой обнаруживаются при анализе традиционных показателей НРП (площадь и объем), а также при исследовании толщины СНВС в патогномоничных секторах ДЗН. Изучение нового показателя НРП (MRW) установило его значимость в диагностике начальной стадии, но пока лишь при анализе ограниченного числа секторов ДЗН

Целесообразность применения дифференцированных («ступенчатых») стартовых подходов к лечению больных с разными стадиями глаукомы

The “classical” scheme of prescribing regimens to patients with newly diagnosed primary open-angle glaucoma (POAG) implies initial monotherapy treatment, which is practiced in patients with any stage of the disease. This in turn implies a consistent strengthening of regimes. Thus, the “modern” clinical algorithm practically excludes the possibility of initial treatment with combined medicines, laser treatment or conventional surgery. At the same time, differentiated («stepwise») approache used in other disciplines makes it possible to achieve control over the disease with the use of the smallest, but sufficient amount of medicines (regimens), depending on the stage of treatment, intraocular pressure (IOP) compensation and stabilization of the glaucomatous optic neuropathy.Significant research in the field of permissible IOP-level values, which against the background of the ongoing treatment would not lead to rapid negative morphofunctional changes of the visual analyzer, is still few. The analysis of the clinical and epidemiological results of the studies given in the review, the established hypotensive efficacy of different treatment regimens and the predicted terms of the active substance tolerance violation convincingly prove the feasibility of using differentiated schemes of initial treatment. «Stepwise» approach, including the choice of monotherapy with the use of a prostaglandin analogues at the «start» of treatment in patients with a newly identified mild glaucoma, mandatory use of combinations (preferably fixed) in patients with moderate stage of the disease and a minimum of triple therapy with a predicted transition to rapid surgical treatment in patients with advanced stage is another rational variant of using a limited amount of resources with which we can achieve the final result.Классическая схема режимов назначений у больных с впервые выявленной первичной открытоугольной глаукомой (ПОУГ) подразумевает «старт» лечения па- циентов с применения монотерапии, причем это практикуется у пациента с любой стадией болезни, что подразумевает последовательное усиление режимов. Таким образом, современный клинический алгоритм практически исключает возможность «старта» лечения с использованием комбинированных форм препаратов, лазерного лечения или традиционной хирургии. Вместе с тем практикуемые в других дисциплинах дифференцированные («ступенчатые») подходы позволяют достигать контроля над заболеванием с применением наименьшего, но достаточного количества препаратов (режимов) в зависимости от стадии глаукомы, компенсации уровня внутриглазного давления (ВГД) и стабилизации глаукомного процесса в целом.Значимые исследования в области допустимых значений офтальмотонуса, которые на фоне проводимого лечения не приводили бы к быстрым негативным морфофункциональным изменениям зрительного анализатора, по-прежнему немногочисленны. Анализ приведенных в обзоре клинико-эпидемиологических результатов исследований, установленной гипотензивной эффективности разных режимов лечения и прогнозируемых сроков нарушения толерантности к действующему веществу убедительно доказывают целесо- образность использования дифференцированных схем «стартового» лечения. В этом смысле дифференцированные («ступенчатые») подходы, включающие вы- бор монотерапии с использованием аналогов простагландинов на «старте» лечения у больных с впервые выявленной начальной стадией глаукомы, обязательное использование комбинаций (лучше — фиксированных) у пациентов с развитой стадией болезни и минимум тройная терапия с прогнозируемым переходом к быстрому хирургическому лечению у больных с далеко зашедшей стадией — это еще один рациональный вариант использования ограниченного количества ресурсов, при помощи которых мы сможем достигнуть оптимального результата

Traditional, unfairly forgotten, rarely used and promising drug delivery methods in ophthalmology: a clinical interpretation (part 1)

Ocular targeted drug delivery is one of the most challenging tasks for pharmaceutical researchers and practical ophthalmologists. The possibilities of drug delivery to the eye are naturally determined by the anatomical structure of the eye and its physiological properties, which restrict the period when therapeutically required drug concentration could be maintained. Combined drug delivery schemes may, potentially, improve the patient’s acceptance of treatment, reduce side effects, increase efficacy, and eventually preserve vision

Abnormalities of Psycho-Emotional State among Patients with Excoriated Acne

The psychopathological features of patients with excoriated acne are analysed. An integrative anx-iety test among 43 patients (mean age 24.7±7.1 years) demonstrated borderline values and a high level of personal anxiety in 46.5% of cases; assessment according to the Beck Depression Inventory revealed subdepression among 25.6% and depression among 13.9% of patients; the Global Severity Index (GSI) of the Symptom Checklist-90-R (SCL-90-R) was in the zone of elevated and high val-ues among 31.1% of patients. The greatest deviations from the norm were observed in the areas of interpersonal sensitivity among 34.9% of patients; dev phobic anxiety – 30.2%; paranoia – 30.2%; while somatisation of complaints was observed among 27.9% of patients. The obsessive-compulsive subscale exceeded normative values among 21% of patients

Problems and resources of families that support children with heavy multiple disturbances in development

Introduction: The number of children with severe and multiple developmental disorders (SMDD) is increasing.  These children suffer from intelligence disorder, speech, sensory sphere problems, general and fine motor skills, behavior and communication disturbance.  A family, having a child with SMDD, faces a complex of various not only medical, but also psychological and pedagogical problems that are related to functioning of family, with parents fulfilling various roles in raising a child with disabilities.  Specialists do not pay enough attention to the needs of parents and child’s family aspects with which he is raised.  It is necessary to shift focus of attention from children rehabilitation with special educational needs (SEN) to accompanying family as a rehabilitation system.  From the point of family-centered approach view, effectiveness of accompanying children with SMDD by specialists depends on extent to which it is possible to intensify and strengthen parents’ resources.Objective: analysis for problematic areas and resources of families raising children with SMDD.Materials and methods: the theoretical and methodological basis of study are: 1) theory of ecological systems by U. Bronfenbrenner, in which he relies on thesis of L.S.  Vygotsky on  the role of development of social situation in establishment of a child’s higher functions; 2) a system-factor approach in analysis of problem areas and family resources; 3) a resource approach to improving the quality of family life, raising a child with SMDD.  We  used system analysis, comparative and analytical methods.Results: from standpoint of a family-centered approach, families having children with SMDD have identified various problematic areas and resources at the level of various ecological systems that help them overcome these problems.  The family problems and resources are interrelated and can be represented in the form of specific factors.Discussion and Conclusions: the family which has a child with a disability faces a complex of various medical, psychological, educational, informational and material problems. From the point of view of  family-centered approach,  the problems and resources of a family raising a child with SMSD are considered at the level of micro-meso-exo-macrosystems. In each system, there are factors that act as problematic  areas that have a resource potential for improving life quality of a family raising a child with SSD. The proposed system-factor approach which helps to identify problematic areas and resources of a family raising children with SMSD can be used to render early assistance effectively  and coordinate activities of specialists.Scientific novelty. It is proposed to consider the problematic areas and resource statuses for families raising children with SMDD. From standpoint of family-centered approach and ecological (micro, meso, exo, macro) systems, the specifying factors affecting the quality of family life are :  pre-school, correctional and rehabilitative and public-state factors.Practical significance.  The proposed system-factor approach to identifying problematic areas and resource statuses for families raising children with can be used to render early assistance and coordinate activities of specialists

ADDITIVE AND COMBINED GLAUCOMA THERAPY: PRINCIPLES AND PRACTICE

The review summarizes the results of modern clinical practice of glaucoma treatment, in which diverse combinations of drugs are used. The search for new combinations of treatment of glaucoma patients is directed to the individual characteristics of the disease, but at the same time it should follow a uniform pattern of prescription sequence. Lifelong monitoring of glaucoma patients and prescriptions of medication are faced with a gradual decrease in drug effectiveness. Attention should be given to a falling tolerance to drugs, or reduced reaction to habitual administration of drugs and addiction, which requires increasing doses to achieve the expected effect of the drug. Clinical and organizational aspects of the situation are considered. For citation: Kuroyedov A.V., Nagornova Z.M., Tibieva Z.U., Krinitsyna E.A., Sergeeva V.M. Additive and combined glaucoma therapy: principles and practice. Russian ophthalmological journal. 2018; 11 (2): 71-81. doi: 10.21516/2072-0076-2018-11-2-71-81 (In Russian)

Ultrasonic Patterns of Benign Skin Formations

Objective: to reveal ultrasonic features of of epithelial, dermal and vascular benign skin formations. Materials and methods. An ultrasonic study of 50 acantholytic nevuses, 50 acrochordons and 30 hemangiomas, which have an unambiguous clinical and dermatoscopic pattern and do not require differential diagnosis, was carried out. For the comparative evaluation of ultrasonic thickness and density of skin the ratio of scan indices in the lesion area relative to the indices in the adjacent healthy area of the skin was introduced. Results. On the scans of acantholytic nevus the formations that rose above the skin surface, with a nonuniform thickened, hyperechoic epidermis were visualized, in which hypoechoic round-shaped patches occur. A hypoechoic acoustic shadow was determined under the epidermis. On the scans of acrochordons the formations on a narrow base, which were located above the skin surface were visualized. In the region of formations, a discontinuous contour of epidermis with predominantly hyperechogenic areas was determined. Within the formations, the structure of the dermis is heterogeneous with the alternation of normoechoic and hypoechoic areas. Beneath the formation an epidermis structurally similar to the healthy skin epidermis is determined on the level of skin surface under which hypoechoic zone is visualized, which is an acoustic shadow. On the scans of hemangiomas the formations were visualized that rose above the skin surface, with a distinct lateral delimitation from the surrounding tissues. In the area of formations, the epidermis is non-uniformly thickened than healthy skin, hyperechoic round-shaped areas are visualized. Non-uniformly hypoechoic irregulary-shaped regions were determined in the dermis. Conclusion. All examined formations differ from healthy skin by increasing the thickness of the epidermis and dermis, as well as strengthening the overall acoustic solidity of the epidermis and decreasing the acoustic solidity of the dermis. The introduction of the ratio into practice makes it possible to quantify these changes. Moreover, each formation has a peculiar ultrasonic characteristic, allowing the use of pattern analysis for differential diagnosis between epithelial, dermal and vascular forms of benign skin formations