85 research outputs found
Alcoholic polyneuropathy. Clinical forms and pathogenetically based approaches to therapy
The number of cases of alcoholism in Russia is gradually decreasing, but still significantly affects the overall health indicators of the population. One of its frequent complications is alcoholic polyneuropathy. The article deals with the pathogenetic mechanisms of the occurrence and development of the disease, its forms, classification, and clinical picture. The damage to the nervous system in patients with alcoholism depends on the frequency of alcohol consumption, the dose, the type of drinks that were consumed, malnutrition, genetic predisposition and individual characteristics that determine the level of alcohol dehydrogenase and aldehyde dehydrogenase. In the clinical picture, a toxic form of alcoholic polyneuropathy is currently distinguished, associated with the direct effect of toxic alcohol metabolites on somatic and autonomic nerve fibers, thiamine deficiency, resulting from a deficiency of B vitamins, and mixed forms. According to the rate of development of clinical manifestations, there are acute forms of alcoholic polyneuropathy (thiamine deficiency) and chronic forms (toxic). The article discusses the possibilities of diagnostics using modern instrumental and laboratory methods of research, primarily electroneuromyography. With the help of this method of investigation, in alcoholic polyneuropathy, signs of axonal damage are most often detected, and in the thiamine-deficient form, it is possible to determine signs of secondary demyelination. The authors emphasize the importance of differential diagnosis with other pathologies. The article highlights the current understanding of the main therapeutic strategies, treatment options for patients with alcoholic polyneuropathy. Therapy of patients suffering from alcoholic polyneuropathy includes refusal of alcohol abuse, normalization of nutrition, medication. For drug therapy, B vitamins and antioxidants are used. The drug with a recognized antioxidant effect is alpha-lipoic acid. A clinical case was analyzed on the basis of our own clinical observation of a mixed form of alcoholic polyneuropathy
Block Copolymers of Ethylene Oxide andΒ Propylene Oxide: Prospects for Medical and Pharmaceutical Application in Russia
Block copolymers of ethylene oxide and propylene oxide (EO/PO block copolymers) are polymeric non-ionic surfactants with a high hydrophilicβlipophilic balance also referred to as pluronics, poloxamers, or proxanols. These compounds are among the most demanded modern excipients for the production of medicines. EO/PO block copolymers are used both in the production of traditional (liquid, semi-solid, and solid) dosage forms and as part of targeted delivery systems. The extensive application of EO/PO block copolymers is due to the diverse array of their properties, including not only solubilising, emulsifying, gelling, and other effects but also thermoreversibility, which is essential for developing in situ delivery systems and 3D printing technologies.The aim of the study was to evaluate the potential of EO/PO block copolymers for medicinal use and to assess the range of medicinal products approved in the Russian Federation that contain EO/PO block copolymers.This review presents an analysis of the register of poloxamer-containing medicines approved in the Russian Federation, a list of the largest manufacturers of EO/PO block copolymers in the world, and a study of the possibility to use copolymers for medical purposes. Currently, there are more than 10 chemical manufacturers producing EO/PO block copolymers for the pharmaceutical, biotechnology, and other industries around the world. EO/PO block copolymers are included in more than 60 medicinal products present in the Russian pharmaceutical market; this observation indicates the need to phase out the import of poloxamers
ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²Π·Π°ΠΈΠΌΠΎΠ΄Π΅ΠΉΡΡΠ²ΠΈΡ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΎΠ² Π² ΠΊΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ ΠΏΡΠΎΠΌΠΎΡΠΎΡΠ°Ρ Π°Π΄Π³Π΅Π·ΠΈΠΈ ΡΠ΅Π·ΠΈΠ½Ρ ΠΊ Π»Π°ΡΡΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΌΡ ΠΌΠ΅ΡΠ°Π»Π»ΠΎΠΊΠΎΡΠ΄Ρ
Addition of active sulphur-containing component into promoter system along with the use of silica as a substrate allowed us to reduce the amount of metal in rubber. The adhesion improvement using Β«silica β metal salt β polysulfideΒ» system is a result of reciprocal activation of the system components. However, we found that polysulfide adsorption on the silica surface is accompanied by chemical interaction between the polysulfide molecules and surface reactive groups of silica. Hence, the silica is not the inert substrate for the Β«polysulfide-metal saltΒ» systemΠΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ Π°ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΡΠ΅ΡΠΎΡΠΎΠ΄Π΅ΡΠΆΠ°ΡΠ΅Π³ΠΎ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠ° ΡΠΎΠ²ΠΌΠ΅ΡΡΠ½ΠΎ Ρ ΠΠΠ, Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ Π½ΠΎΡΠΈΡΠ΅Π»Ρ, ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΡΠ½ΠΈΠ·ΠΈΡΡ ΡΠΎΠ΄Π΅ΡΠΆΠ°Π½ΠΈΠ΅ ΠΌΠ΅ΡΠ°Π»Π»Π° Π² ΠΏΡΠΎΠΌΠΎΡΠΈΡΡΡΡΠ΅ΠΉ ΡΠΈΡΡΠ΅ΠΌΠ΅. ΠΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ Π°Π΄Π³Π΅Π·ΠΈΠΎΠ½Π½ΠΎΠΉ ΠΏΡΠΎΡΠ½ΠΎΡΡΠΈ ΠΏΡΠΈ Π²Π²Π΅Π΄Π΅Π½ΠΈΠΈ Π² ΡΠ΅Π·ΠΈΠ½Ρ ΡΠΈΡΡΠ΅ΠΌΡ Β«ΠΠΠ β ΠΎΡΠ³Π°Π½ΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΠΎΠ»Ρ ΠΌΠ΅ΡΠ°Π»Π»Π° β ΡΠΈΠΎΠΊΠΎΠ»Β» ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»Π΅Π½ΠΎ Π²Π·Π°ΠΈΠΌΠ½ΠΎΠΉ Π°ΠΊΡΠΈΠ²Π°ΡΠΈΠ΅ΠΉ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΎΠ². ΠΠ΄Π½Π°ΠΊΠΎ Π½Π°ΠΌΠΈ Π±ΡΠ»ΠΎ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ, ΡΡΠΎ Π°Π΄ΡΠΎΡΠ±ΡΠΈΡ ΡΠΈΠΎΠΊΠΎΠ»Π° Π½Π° ΠΏΠΎΠ²Π΅ΡΡ
Π½ΠΎΡΡΠΈ ΠΠΠ ΡΠΎΠΏΡΠΎΠ²ΠΎΠΆΠ΄Π°Π΅ΡΡΡ Ρ
ΠΈΠΌΠΈΡΠ΅ΡΠΊΠΈΠΌ Π²Π·Π°ΠΈΠΌΠΎΠ΄Π΅ΠΉ- ΡΡΠ²ΠΈΠ΅ΠΌ ΠΌΠ΅ΠΆΠ΄Ρ ΡΡΠΈΠΌΠΈ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠ°ΠΌΠΈ ΡΠΈΡΡΠ΅ΠΌΡ, ΡΠ΅ΠΌ ΡΠ°ΠΌΡΠΌ, ΡΠ½ΠΈΠΆΠ°Ρ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΡΠΈΡΡΠ΅ΠΌΡ Π² ΡΠ΅Π»ΠΎΠΌ
ΠΠ½Π°Π»ΠΈΠ· ΡΡΠΎΠ΄ΡΡΠ²Π° Π³Π΅ΠΌΠΎΠ³Π»ΠΎΠ±ΠΈΠ½Π° ΠΊ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Ρ ΠΈ ΠΏΠΎΡΡΠ΅Π±Π»Π΅Π½ΠΈΠ΅ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Π° ΡΠΊΠ°Π½ΡΠΌΠΈ
The tissue and blood oxygenation estimation with taking into consideration the hemoglobin affinity for oxygen with new parameter pO2-effective use was studied. The calculation algorithm and its program realization for paeO2 and estimation of the dissociation oxyhemoglobin curve (ODC) were produced.28 patients were examined with the measurement of next parameters of arterial blood: pH, gas composition (paO2 and paCO2), and blood oxygenation (SO2, ctO2). The calculation of paeO2 value and the shift of ODC was carried out. The estimation of oxygen consumption (VO2) was carried out in 11 patients.The analysis of the obtained data allowed to conclude that paeO2 reflects changes of the hemoglobin affinity for oxygen in such a way, that when affinity is decreased then ODC shift is greater than zero and when the affinity is increased then ODC shift is less than zero. The parameter paeO2Β allows to estimate more correctly the blood oxygenation than paO2 in mmHG terms. The correlation with the coefficient 0.8 was found between the value of the DOC shift and oxygen consumption. In the case of the negative ODC shift, the oxygen consumption is decreased, in the case of the positive ODC shift oxygen consumption is increased.Thus, on the basis of ODC, it is possible to estimate the blood and tissue oxygenation with taking into consideration the hemoglobin affinity for oxygen and, therefore, the respiration of organism in general.ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½Π° Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ ΠΎΡΠ΅Π½ΠΊΠΈ ΠΎΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΈΠΈ ΠΊΡΠΎΠ²ΠΈ ΠΈ ΡΠΊΠ°Π½Π΅ΠΈΜ Ρ ΡΡΠ΅ΡΠΎΠΌ ΡΡΠΎΠ΄ΡΡΠ²Π° Π³Π΅ΠΌΠΎΠ³Π»ΠΎΠ±ΠΈΠ½Π° ΠΊ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Ρ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π½ΠΎΠ²ΠΎΠ³ΠΎ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠ° ΡΠ2 ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅. Π Π°Π·ΡΠ°Π±ΠΎΡΠ°Π½Ρ Π°Π»Π³ΠΎΡΠΈΡΠΌ ΡΠ°ΡΡΠ΅ΡΠ° ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠ° ΡaeΠ2 ΠΈ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΡ ΠΊΡΠΈΠ²ΠΎΠΈΜ Π΄ΠΈΡΡΠΎΡΠΈΠ°ΡΠΈΠΈ ΠΎΠΊΡΠΈΠ³Π΅ΠΌΠΎΠ³Π»ΠΎΠ±ΠΈΠ½Π° (ΠΠΠ) ΠΈ Π΅Π³ΠΎ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠ½Π°Ρ ΡΠ΅Π°Π»ΠΈΠ·Π°ΡΠΈΡ.ΠΡΠΎΠ²Π΅Π΄Π΅Π½Π½ΠΎΠ΅ Ρ 28 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ°Π»ΠΎ ΠΈΠ·ΠΌΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ² Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΈΜ ΠΊΡΠΎΠ²ΠΈ: ΠΠ©Π‘ (pH), Π³Π°Π·ΠΎΠ²ΠΎΠ³ΠΎ ΡΠΎΡΡΠ°Π²Π° (ΡaΠ2, ΡΠ‘Π2) ΠΈ ΠΎΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΈΠΈ ΠΊΡΠΎΠ²ΠΈ (SO2, ΡtO2); ΡΠ°ΡΡΠ΅Ρ Π²Π΅Π»ΠΈΡΠΈΠ½Ρ ΡΠ°Π΅O2 ΠΈ ΡΠ΄Π²ΠΈΠ³Π° ΠΠΠ. Π£ 11 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΠΏΠΎΡΡΠ΅Π±Π»Π΅Π½ΠΈΡ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Π° (VO2).ΠΠ½Π°Π»ΠΈΠ· ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΡ
ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ» ΡΠ΄Π΅Π»Π°ΡΡ ΡΠ»Π΅Π΄ΡΡΡΠΈΠ΅ Π²ΡΠ²ΠΎΠ΄Ρ: ΡΠ°Π΅Π2 ΠΎΡΡΠ°ΠΆΠ°Π΅Ρ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΡΡΠΎΠ΄ΡΡΠ²Π° Π³Π΅ΠΌΠΎΠ³Π»ΠΎΠ±ΠΈΠ½Π° ΠΊ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Ρ, ΠΏΡΠΈ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠΈ ΡΡΠΎΠ΄ΡΡΠ²Π° ΡΠ΄Π²ΠΈΠ³ ΠΠΠ>0, ΠΏΡΠΈ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠΈ ΡΡΠΎΠ΄ΡΡΠ²Π° ΡΠ΄Π²ΠΈΠ³ ΠΠΠ<0; ΡΠ°Π΅Π2 Π΄Π°Π΅Ρ Π±ΠΎΠ»Π΅Π΅ ΡΠΎΡΠ½ΡΡ ΠΎΡΠ΅Π½ΠΊΡ ΠΎΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΈΠΈ ΠΊΡΠΎΠ²ΠΈ, ΡΠ΅ΠΌ ΡΠ°Π2 Π² ΡΠ΅ΡΠΌΠΈΠ½Π°Ρ
ΠΌΠΌ ΡΡ.ΡΡ.; ΠΌΠ΅ΠΆΠ΄Ρ Π²Π΅Π»ΠΈΡΠΈΠ½ΠΎΠΈΜ ΡΠ΄Π²ΠΈΠ³Π° ΠΠΠ ΠΈ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΏΠΎΡΡΠ΅Π±Π»Π΅Π½ΠΈΡ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Π° ΡΠΊΠ°Π½ΡΠΌΠΈ ΡΡΡΠ΅ΡΡΠ²ΡΠ΅Ρ Π»ΠΈΠ½Π΅ΠΈΜΠ½Π°Ρ Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΡ Ρ ΠΊΠΎΡΡΡΠΈΡΠΈΠ΅Π½ΡΠΎΠΌ ΠΊΠΎΡΡΠ΅Π»ΡΡΠΈΠΈ 0,8; ΠΏΡΠΈ ΠΎΡΡΠΈΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΌ Π·Π½Π°ΡΠ΅Π½ΠΈΠΈ ΡΠ΄Π²ΠΈΠ³Π° ΠΠΠ ΠΏΠΎΡΡΠ΅Π±Π»Π΅Π½ΠΈΠ΅ Π2 Π° ΡΠ½ΠΈΠΆΠ΅Π½ΠΎ, Π° ΠΏΡΠΈ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΠΌ β ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΎ.Π’Π°ΠΊΠΈΠΌ ΠΎΠ±ΡΠ°Π·ΠΎΠΌ, Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ Π°Π½Π°Π»ΠΈΠ·Π° ΠΠΠ ΠΌΠΎΠΆΠ½ΠΎ ΠΎΡΠ΅Π½ΠΈΡΡ ΠΎΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΈΡ ΠΊΡΠΎΠ²ΠΈ ΠΈ ΡΠΊΠ°Π½Π΅ΠΈΜ Ρ ΡΡΠ΅ΡΠΎΠΌ ΡΡΠΎΠ΄ΡΡΠ²Π° Π³Π΅ΠΌΠΎΠ³Π»ΠΎΠ±ΠΈΠ½Π° ΠΊ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Ρ, Π°, Π·Π½Π°ΡΠΈΡ, ΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ Π΄ΡΡ
Π°Π½ΠΈΡ ΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠ° Π² ΡΠ΅Π»ΠΎΠΌ
ΠΡΡΠΌΠ°Ρ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠ°Ρ Π΄Π΅ΡΠ΅ΠΊΡΠΈΡ Borrelia burgdorferi Π² ΠΌΡΡΠ΅ΡΠ½ΡΡ Π±ΠΈΠΎΠΏΡΠ°ΡΠ°Ρ : Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ ΡΠ²ΡΠ·ΠΈ Π½Π΅ΡΠ²Π½ΠΎ-ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ Ρ Π±ΠΎΡΡΠ΅Π»ΠΈΠΎΠ·ΠΎΠΌ
The authors examined 40 muscle biopsy specimens taken from patients with neuromuscular symptoms when the diagnosis was unestablishedΒ or presumptive. Eighteen of them exhibited foci of muscle fiber damage with the presence of spirochete-like structures in the semithin tissueΒ sections. Electron microscopy of these areas detected Borrelia as vegetative and diverse L-forms. Immunocytochemical techniques usingantibodies to Borrelia burgdorferi antigens confirmed that the spirochetes belonged to this species. This allows one to consider borreliosis asΒ an etiological or complicating factor of neuromuscular pathology and to recommend the above morphological methods for the diagnosis ofΒ neuromuscular diseases of unknown origin.ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΎ 40 Π±ΠΈΠΎΠΏΡΠ°ΡΠΎΠ² ΠΌΡΡΡ, Π²Π·ΡΡΡΡ
Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ Π½Π΅ΡΠ²Π½ΠΎ-ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΡΠΈΠΊΠΎΠΉ ΠΏΡΠΈ Π½Π΅ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π½ΠΎΠΌ ΠΈΠ»ΠΈ ΠΏΡΠ΅Π΄ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΠΌ Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π΅. Π 18 ΠΈΠ· Π½ΠΈΡ
Π² ΠΏΠΎΠ»ΡΡΠΎΠ½ΠΊΠΈΡ
ΡΡΠ΅Π·Π°Ρ
ΡΠΊΠ°Π½ΠΈ ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½Ρ ΠΎΡΠ°Π³ΠΈ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΌΡΡΠ΅ΡΠ½ΡΡ
Π²ΠΎΠ»ΠΎΠΊΠΎΠ½ Ρ Π½Π°Π»ΠΈΡΠΈΠ΅ΠΌΒ ΡΠΏΠΈΡΠΎΡ
Π΅ΡΠΎΠΏΠΎΠ΄ΠΎΠ±Π½ΡΡ
ΡΡΡΡΠΊΡΡΡ. ΠΡΠΈ ΡΠ»Π΅ΠΊΡΡΠΎΠ½Π½ΠΎΠΉ ΠΌΠΈΠΊΡΠΎΡΠΊΠΎΠΏΠΈΠΈ ΡΡΠΈΡ
ΡΡΠ°ΡΡΠΊΠΎΠ² Π±ΡΠ»ΠΈ Π²ΡΡΠ²Π»Π΅Π½Ρ Π±ΠΎΡΡΠ΅Π»ΠΈΠΈ Π² Π²ΠΈΠ΄Π΅ Π²Π΅Π³Π΅ΡΠ°ΡΠΈΠ²Π½ΡΡ
Β ΠΈ ΡΠ°Π·Π½ΠΎΠΎΠ±ΡΠ°Π·Π½ΡΡ
L-ΡΠΎΡΠΌ. ΠΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² ΠΈΠΌΠΌΡΠ½ΠΎΡΠΈΡΠΎΡ
ΠΈΠΌΠΈΠΈ Ρ Π°Π½ΡΠΈΡΠ΅Π»Π°ΠΌΠΈ ΠΊ Π°Π½ΡΠΈΠ³Π΅Π½Π°ΠΌ Borrelia burgdorferi ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠ΄ΠΈΠ»ΠΎΒ ΠΏΡΠΈΠ½Π°Π΄Π»Π΅ΠΆΠ½ΠΎΡΡΡ ΡΠΏΠΈΡΠΎΡ
Π΅Ρ ΠΊ Π΄Π°Π½Π½ΠΎΠΌΡ Π²ΠΈΠ΄Ρ. ΠΡΠΎ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ»ΠΎ ΡΡΠΈΡΠ°ΡΡ ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΈΠ»ΠΈ ΠΎΡΠ»ΠΎΠΆΠ½ΡΡΡΠΈΠΌ ΡΠ°ΠΊΡΠΎΡΠΎΠΌ Π½Π΅ΡΠ²Π½ΠΎ-ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉΒ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ Π±ΠΎΡΡΠ΅Π»ΠΈΠΎΠ·, Π° ΡΠ°ΠΊΠΆΠ΅ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΠΎΠ²Π°ΡΡ ΠΏΡΠΈΠΌΠ΅Π½ΡΡΡ ΡΠΊΠ°Π·Π°Π½Π½ΡΠ΅ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΌΠ΅ΡΠΎΠ΄Ρ ΠΊΠ°ΠΊ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π² ΡΠ»ΡΡΠ°ΡΡ
Β Π½Π΅ΡΠ²Π½ΠΎ-ΠΌΡΡΠ΅ΡΠ½ΡΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ Π½Π΅ΡΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΠΈΡΡ
ΠΎΠΆΠ΄Π΅Π½ΠΈΡ
Π‘ΠΈΠ½Π΄ΡΠΎΠΌ Π³Π΅ΠΌΠΎΡΡΠ°Π³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΊΠΎΠ»ΠΈΡΠ° Ρ Π΄Π΅ΡΠ΅ΠΉ: ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΡΡΡΠΊΡΡΡΠ° Π² ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠ΅
The range of differential diagnostic search in the development of hemorrhagic colitis (hemocolitis) is wide enough and includes infectious and non-infectious factors. Purpose: clinical, laboratory and etiological analysis of bacterial diarrhea occurring with hemorrhagic colitis in the infectious diseases department.Materials and methods: a retrospective study of 141 case histories of those hospitalized in the infectious diseases department of the2 Children's City Clinical Hospital No. 9 named after G.N. Speransky of Moscow in 2019β2021 patients with clinical picture of hemocolitis. Hemocolitis was determined on the basis of macroscopic and microscopic signs (in scatology β mucus, leukocytes, erythrocytes) signs. All patients underwent routine laboratory examinations. The etiology was verified using modern methods of laboratory diagnostics (bacteriological analysis of feces, Latex test, ICA, ELISA, PCR, IHR).Results. There were 137 patients with infectious hemocolitis. Inflammatory bowel disease was diagnosed in 3 children, anus fissure β in 1 child. Young children under 3 years of age prevailed (77%). The etiology of infectious hemocolitis was deciphered in 47 patients (34%). Salmonellosis (36%) and shigellosis (36%) prevailed. Campylobacteriosis, clostridiosis-dificile and klebsiellosis accounted for 11%, 9% and 6% of cases, respectively. Yersiniosis was detected in 1 child at the age of 5 months. The severe form was found in 5.8% of cases, in most cases with shigellosis. Symptoms of intoxication and febrile fever were expressed in all patients, vomiting β in 28.5%, abdominal pain β in 94%, mesenteric adenitis on ultrasound β in 15%, diarrhea with a frequency of more than 5 times a day β in 84%, dehydration β in 64%, intercurrent diseases (ARVI, pneumonia) β in 41.3% of cases. Inflammatory changes in infectious hemocolitis were manifested by an increase in C-reactive protein in 71% (23.91 Β± 24.17 mg/l), leukocytosis β in 69% (11.58 Β± 3.52 Ρ
103 / ΞΌl), thrombocytosis β in 26%, an increase in the relative number of stab neutrophils in the general blood test in 78% of cases (10.95 Β± 0.4%).Conclusions. Differential diagnostic search in the development of hemocolitis should include modern diagnostic methods, if necessary, additional instrumental studies and specialist consultations to exclude inflammatory bowel diseases.Π‘ΠΏΠ΅ΠΊΡΡ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎ-Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΠΎΠΈΡΠΊΠ° ΠΏΡΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΠΈ Π³Π΅ΠΌΠΎΡΡΠ°Π³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΊΠΎΠ»ΠΈΡΠ° (Π³Π΅ΠΌΠΎΠΊΠΎΠ»ΠΈΡΠ°) Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎ ΡΠΈΡΠΎΠΊ ΠΈ Π²ΠΊΠ»ΡΡΠ°Π΅Ρ Π² ΡΠ΅Π±Ρ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΠ΅ ΠΈ Π½Π΅ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΠ΅ ΡΠ°ΠΊΡΠΎΡΡ.Π¦Π΅Π»Ρ: ΠΎΠΏΡΠ΅Π΄Π΅Π»ΠΈΡΡ ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΡΡ ΡΡΡΡΠΊΡΡΡΡ ΠΈ ΠΎΠΏΠΈΡΠ°ΡΡ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΠ΅ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ Π³Π΅ΠΌΠΎΠΊΠΎΠ»ΠΈΡΠΎΠ² Ρ Π΄Π΅ΡΠ΅ΠΉ Π² ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠ΅.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ: ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΡΠ΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ 141 ΠΈΡΡΠΎΡΠΈΠΈ Π±ΠΎΠ»Π΅Π·Π½ΠΈ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
Π² ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΠΎΠ΅ ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠ΅ ΠΠΠΠ β9 ΠΈΠΌ. Π.Π. Π‘ΠΏΠ΅ΡΠ°Π½ΡΠΊΠΎΠ³ΠΎ ΠΠ Π³. ΠΠΎΡΠΊΠ²Ρ Π² 2019β2021 Π³Π³. ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎΠΉ Π³Π΅ΠΌΠΎΠΊΠΎΠ»ΠΈΡΠ°. ΠΠΈΠ°Π³Π½ΠΎΠ· Β«ΠΠ΅ΠΌΠΎΠΊΠΎΠ»ΠΈΡΒ» (ΠΠ) ΡΡΠ°Π²ΠΈΠ»ΠΈ Π½Π° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ ΠΌΠ°ΠΊΡΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈ ΠΌΠΈΠΊΡΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠΈΠ·Π½Π°ΠΊΠΎΠ² (Π² ΠΊΠΎΠΏΡΠΎΠ»ΠΎΠ³ΠΈΠΈ β ΡΠ»ΠΈΠ·Ρ, Π»Π΅ΠΉΠΊΠΎΡΠΈΡΡ, ΡΡΠΈΡΡΠΎΡΠΈΡΡ). ΠΡΠ΅ΠΌ Π±ΠΎΠ»ΡΠ½ΡΠΌ Π²ΡΠΏΠΎΠ»Π½ΡΠ»ΠΎΡΡ ΡΡΡΠΈΠ½Π½ΠΎΠ΅ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΠΎΠ΅ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅. ΠΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡ ΠΠΠ Π²Π΅ΡΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π»ΠΈ Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ (Π±Π°ΠΊΡΠ΅ΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ Π°Π½Π°Π»ΠΈΠ· ΠΊΠ°Π»Π°, Latex-ΡΠ΅ΡΡ, ΠΠ₯Π, ΠΠ€Π, ΠΠ¦Π , Π ΠΠΠ). Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π‘ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΠΌ Π³Π΅ΠΌΠΎΠΊΠΎΠ»ΠΈΡΠΎΠΌ ΠΎΠΊΠ°Π·Π°Π»ΠΎΡΡ 137 Π±ΠΎΠ»ΡΠ½ΡΡ
. ΠΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅ ΠΊΠΈΡΠ΅ΡΠ½ΠΈΠΊΠ° Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΎΠ²Π°Π½ΠΎ Ρ 3 Π΄Π΅ΡΠ΅ΠΉ, ΡΡΠ΅ΡΠΈΠ½Π° Π°Π½ΡΡΠ° β Ρ 1 ΡΠ΅Π±Π΅Π½ΠΊΠ°. ΠΡΠ΅ΠΎΠ±Π»Π°Π΄Π°Π»ΠΈ Π΄Π΅ΡΠΈ ΡΠ°Π½Π½Π΅Π³ΠΎ Π²ΠΎΠ·ΡΠ°ΡΡΠ° Π΄ΠΎ 3 Π»Π΅Ρ (77%). ΠΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡ Π±ΡΠ»Π° ΡΠ°ΡΡΠΈΡΡΠΎΠ²Π°Π½Π° Ρ 47 Π±ΠΎΠ»ΡΠ½ΡΡ
(34%) Ρ ΠΠ. ΠΡΠ΅Π²Π°Π»ΠΈΡΠΎΠ²Π°Π»ΠΈ ΡΠ°Π»ΡΠΌΠΎΠ½Π΅Π»Π»Π΅Π· (36%) ΠΈ ΡΠΈΠ³Π΅Π»Π»Π΅Π· (36%). ΠΠ°ΠΌΠΏΠΈΠ»ΠΎΠ±Π°ΠΊΡΠ΅ΡΠΈΠΎΠ·, Cl. dificile-ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ ΠΈ ΠΊΠ»Π΅Π±ΡΠΈΠ΅Π»Π»Π΅Π· ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΈ 11%, 9% ΠΈ 6% ΡΠ»ΡΡΠ°Π΅Π² ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ. Π£ 1 ΡΠ΅Π±Π΅Π½ΠΊΠ° Π² Π²ΠΎΠ·ΡΠ°ΡΡΠ΅ 5 ΠΌΠ΅ΡΡΡΠ΅Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΎΠ²Π°Π½ ΠΈΠ΅ΡΡΠΈΠ½ΠΈΠΎΠ·. Π’ΡΠΆΠ΅Π»Π°Ρ ΡΠΎΡΠΌΠ° ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π° Π² 5,8% ΡΠ»ΡΡΠ°Π΅Π², Π² Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π΅ β ΠΏΡΠΈ ΡΠΈΠ³Π΅Π»Π»Π΅Π·Π΅. Π‘ΠΈΠΌΠΏΡΠΎΠΌΡ ΠΈΠ½ΡΠΎΠΊΡΠΈΠΊΠ°ΡΠΈΠΈ ΠΈ ΡΠ΅Π±ΡΠΈΠ»ΡΠ½Π°Ρ Π»ΠΈΡ
ΠΎΡΠ°Π΄ΠΊΠ° Π±ΡΠ»ΠΈ Π²ΡΡΠ²Π»Π΅Π½Ρ Ρ Π²ΡΠ΅Ρ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΡΠ²ΠΎΡΠ° β Π² 28,5%, Π±ΠΎΠ»ΠΈ Π² ΠΆΠΈΠ²ΠΎΡΠ΅ β Π² 94%, ΠΌΠ΅Π·Π°Π΄Π΅Π½ΠΈΡ ΠΏΡΠΈ Π£ΠΠ β Π² 15%, ΡΡΡΠ» Ρ ΡΠ°ΡΡΠΎΡΠΎΠΉ Π±ΠΎΠ»Π΅Π΅ 5 ΡΠ°Π· Π² ΡΡΡΠΊΠΈ β Π² 84%, Π΄Π΅Π³ΠΈΠ΄ΡΠ°ΡΠ°ΡΠΈΡ β Π² 64%, ΠΈΠ½ΡΠ΅ΡΠΊΡΡΡΠ΅Π½ΡΠ½ΡΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ (ΠΠ ΠΠ, ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ) β Π² 41,3% ΡΠ»ΡΡΠ°Π΅Π². ΠΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΏΡΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΠΎΠΌ Π³Π΅ΠΌΠΎΠΊΠΎΠ»ΠΈΡΠ΅ ΠΏΡΠΎΡΠ²Π»ΡΠ»ΠΈΡΡ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΡΠΎΠ²Π½Ρ Π‘-ΡΠ΅Π°ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π±Π΅Π»ΠΊΠ° Π² 71% (23,91 Β± 24,17 ΠΌΠ³/Π»), Π»Π΅ΠΉΠΊΠΎΡΠΈΡΠΎΠ·ΠΎΠΌ β Π² 69% (11,58 Β± 3,52 Ρ
103 /ΠΌΠΊΠ»), ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠΎΠ·ΠΎΠΌ β Π² 26%, ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΎΡΠ½ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π° ΠΏΠ°Π»ΠΎΡΠΊΠΎΡΠ΄Π΅ΡΠ½ΡΡ
Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΠΎΠ² Π² ΠΎΠ±ΡΠ΅ΠΌ Π°Π½Π°Π»ΠΈΠ·Π΅ ΠΊΡΠΎΠ²ΠΈ Π² 78% ΡΠ»ΡΡΠ°Π΅Π² (10,95 Β± 0,4%).ΠΡΠ²ΠΎΠ΄Ρ. ΠΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎ-Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΏΠΎΠΈΡΠΊ ΠΏΡΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΠΈ Π³Π΅ΠΌΠΎΠΊΠΎΠ»ΠΈΡΠ° Π΄ΠΎΠ»ΠΆΠ΅Π½ Π²ΠΊΠ»ΡΡΠ°ΡΡ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ, ΠΏΡΠΈ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΠΈ Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΡΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΈ ΠΊΠΎΠ½ΡΡΠ»ΡΡΠ°ΡΠΈΠΈ ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΡΡΠΎΠ² Π΄Π»Ρ ΠΈΡΠΊΠ»ΡΡΠ΅Π½ΠΈΡ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ ΠΊΠΈΡΠ΅ΡΠ½ΠΈΠΊΠ°
ΠΡΠΎΠΌΠ°ΡΠΈΡΠΎΠ±Π°Π»ΡΠ½Π΅ΠΎΡΠ΅ΡΠ°ΠΏΠΈΡ Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΠΈ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠ΅ ΡΠ°ΡΡΡΡ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΡΡ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΉ Ρ Π΄Π΅ΡΠ΅ΠΉ Ρ Ρ ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ ΠΈ ΠΈΠ½Π²Π°Π»ΠΈΠ΄ΠΈΠ·ΠΈΡΡΡΡΠΈΠΌΠΈ Π±ΠΎΠ»Π΅Π·Π½ΡΠΌΠΈ
In children with chronic pathologies, co-occurring frequent respiratory infections of a prolonged course obstructs and reduce theΒ effectiveness of rehabilitation measures, and adversely affect the adaptation reserves. Hydrotherapeutic factors are widely used for theΒ prevention of colds in children from the first days of life. Addition to the water of medicinal and phytoaromatic preparations increasesΒ their efficiency. For patients with chronic pathology, when prescribing balneotherapeutic factors for treatment and prophylaxis ofΒ respiratory infections, it is important to take into account the potential risk of adverse effects on the symptoms of the underlyingΒ disease. Researches in patients with orthopedic, chronic gastroenterological diseases, spastic forms of cerebral palsy, with co-occurringΒ frequent respiratory infections of a prolonged course in history revealed that addition of medicinal baths based on phytoaromaticΒ preparation, containing eucalyptus oil, to the rehabilitation complex is an effective method of preventing and stopping initial symptomsΒ of respiratory infections. It also contributes to the adaptation reserves of the organism, without adversely affecting the course of theΒ underlying disease.Π£ Π΄Π΅ΡΠ΅ΠΉ Ρ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠ΅ΠΉ ΡΠΎΠΏΡΡΡΡΠ²ΡΡΡΠΈΠ΅ ΡΠ°ΡΡΡΠ΅ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΡΠ΅ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ Ρ Π·Π°ΡΡΠΆΠ½ΡΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ Π·Π°ΡΡΡΠ΄Π½ΡΡΡΒ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ ΠΈ ΡΠ½ΠΈΠΆΠ°ΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΡΠ΅Π°Π±ΠΈΠ»ΠΈΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΌΠ΅ΡΠΎΠΏΡΠΈΡΡΠΈΠΉ, ΠΊΡΠ°ΠΉΠ½Π΅ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΠΎ Π²Π»ΠΈΡΡΡ Π½Π° Π°Π΄Π°ΠΏΡΠ°ΡΠΈΠΎΠ½Π½ΡΠ΅ ΡΠ΅Π·Π΅ΡΠ²Ρ. ΠΠΎΠ΄ΠΎΠ»Π΅ΡΠ΅Π±Π½ΡΠ΅ ΡΠ°ΠΊΡΠΎΡΡ ΡΠΈΡΠΎΠΊΠΎ ΠΈΡΠΏΠΎΠ»ΡΠ·ΡΡΡΡΡ Π΄Π»Ρ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ ΠΏΡΠΎΡΡΡΠ΄Π½ΡΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ Ρ Π΄Π΅ΡΠ΅ΠΉΒ Ρ ΠΏΠ΅ΡΠ²ΡΡ
Π΄Π½Π΅ΠΉ ΠΆΠΈΠ·Π½ΠΈ. ΠΠΎΠ²ΡΡΠ°Π΅Ρ ΠΈΡ
ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ Π΄ΠΎΠ±Π°Π²Π»Π΅Π½ΠΈΠ΅ Π² Π²ΠΎΠ΄Ρ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΡ
ΠΈ ΡΠΈΡΠΎΠ°ΡΠΎΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ². ΠΠ»Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠ΅ΠΉ ΠΏΡΠΈ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠΈ Π±Π°Π»ΡΠ½Π΅ΠΎΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠΎΡΠ΅Π΄ΡΡ Ρ ΡΠ΅Π»ΡΡ Π»Π΅ΡΠ΅Π½ΠΈΡΒ ΠΈ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΡΡ
ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΉ Π²Π°ΠΆΠ½ΠΎ ΡΡΠΈΡΡΠ²Π°ΡΡ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΡΠΉ ΡΠΈΡΠΊ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΠΎΠ³ΠΎ Π²Π»ΠΈΡΠ½ΠΈΡ Π½Π° ΡΠΈΠΌΠΏΡΠΎΠΌΡΒ ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠ³ΠΎ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ. ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ, ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π½ΡΠ΅ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΡΡΠΎΠΏΠ΅Π΄ΠΈΡΠ΅ΡΠΊΠΎΠΉ, Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠ΅ΠΉ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠ½ΠΎ-ΠΊΠΈΡΠ΅ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΠΊΡΠ°, ΡΠΏΠ°ΡΡΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ ΡΠΎΡΠΌΠ°ΠΌΠΈ Π΄Π΅ΡΡΠΊΠΎΠ³ΠΎ ΡΠ΅ΡΠ΅Π±ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΠ°ΡΠ°Π»ΠΈΡΠ°, Ρ ΡΠΎΠΏΡΡΡΡΠ²ΡΡΡΠΈΠΌΠΈ ΡΠ°ΡΡΡΠΌΠΈΒ Π·Π°ΡΡΠΆΠ½ΡΠΌΠΈ ΠΎΡΡΡΡΠΌΠΈ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΡΠΌΠΈ Π±ΠΎΠ»Π΅Π·Π½ΡΠΌΠΈ Π² Π°Π½Π°ΠΌΠ½Π΅Π·Π΅, Π²ΡΡΠ²ΠΈΠ»ΠΈ, ΡΡΠΎ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅ Π² ΡΠ΅Π°Π±ΠΈΠ»ΠΈΡΠ°ΡΠΈΠΎΠ½Π½ΡΠΉ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΒ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΡ
Π²Π°Π½Π½ Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ ΡΠΈΡΠΎΠ°ΡΠΎΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°, ΡΠΎΠ΄Π΅ΡΠΆΠ°ΡΠ΅Π³ΠΎ ΡΠ²ΠΊΠ°Π»ΠΈΠΏΡΠΎΠ²ΠΎΠ΅ ΠΌΠ°ΡΠ»ΠΎ, ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ ΠΈ ΠΊΡΠΏΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π½Π°ΡΠ°Π»ΡΠ½ΡΡ
ΡΠΈΠΌΠΏΡΠΎΠΌΠΎΠ² ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΡΡ
ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΉ, ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΡΠ΅Ρ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΡ Π°Π΄Π°ΠΏΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΡΠ΅Π·Π΅ΡΠ²ΠΎΠ² ΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠ°, Π½Π΅ ΠΎΠΊΠ°Π·ΡΠ²Π°Ρ ΠΎΡΡΠΈΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ Π²Π»ΠΈΡΠ½ΠΈΡ Π½Π° ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠ³ΠΎ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ
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