539 research outputs found
ADULT-ONSET STILL'S DISEASE: DIAGNOSIS AND TREATMENT
The paper describes adult-onset Still's disease (AOSD), a rare multisystemic disease of unknown etiology that is referred to as seronegative rheumatoid arthritis. It presents the major manifestations of AOSD: long-term fever, arthritis or persistent arthralgias, maculopapular eruption, seronegativity for rheumatoid factor, neutrophilic leukocytosis, and disease onset after 16 years of age, as well as additional signs: lymphadenopathy, hepatosplenomegaly, polyserositis, nasopharyngeal infection. It is noted that particular difficulties in the diagnosis of AOSD emerge when it is complicated by the hematophagocytic syndrome (HPS). The distinctive features of AOSD are the development of cutaneous and articular symptoms in practically 80% of patients and their absence in HPS. It is stated that of greater value in the diagnosis of HPS is examination of aspirate of the bone marrow than its biopsy. Most patients develop refractoriness to glucocorticoids and essential anti-inflammatory drugs. The positive results of using anakinra, rituximab, and tocilizumab are promising
Formation of the system of business processes at machine building enterprises
The article studies approaches to determination of totality of business processes of machine building enterprises of the RF within structural & functional and process-oriented model of management. It was found that in functional management, algorithm is limited by six steps, and totality of business processes is βtiedβ to technological productive processes; that in process management, there are ten steps of determination and development of business processes, and their totality is limited by flow of value creation or by quality loop (life cycle of production). The authors offer an algorithm of formation of the system of business processes of large industrial enterprises which issue a range of technologically complicated products and are on the stage of transition from linear & functional management to process management. At the stage of transition from one model to another, it is offered to found the algorithm on the functional model of management through determination of βbasic element of managementβ with further transformations of the system. Methodology of formation of the system of business processes of enterprises is developed which β within the PLM concept β allows: structuring activities in the sphere of different business processes, designing product and processes simultaneously, and integrating systems of creation of product of enterprises-members into the system of business processes of final manufacturer. Targeted indicators of evaluation of efficiency of main business processes are offered, which are received as a result of implementation of methodology in view of separate production of machine building enterprise of the RF which stipulate determination of the list of top-level processes, reflecting interests of most of external members of the system and of those processes which do not have reserves for improvement and are subject to changes in future.peer-reviewe
ΠΠ΅ΡΡΠΏΠ΅ΠΊΡΠΈΠ²Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΌΠ΅Π»ΠΎΠΊΡΠΈΠΊΠ°ΠΌΠ° Ρ Π±ΠΎΠ»ΡΠ½ΡΡ ΡΡΠ°ΡΡΠ΅ΠΉ Π²ΠΎΠ·ΡΠ°ΡΡΠ½ΠΎΠΉ Π³ΡΡΠΏΠΏΡ Ρ ΡΠ΅Π²ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΠΌΠΈ
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in complex therapy for pain syndrome in rheumatology. The paper describes the pathophysiological mechanisms responsible for the development of chronic and acute pain. It details the action of cyclooxygenase types 1 and 2 (COG 1 and COG 2), shows the key role of COG 2 in pain induction and transmission. The data of clinical trials of meloxicam that inhibits mainly COG 2 are given. The drug is highly effective in treating rheumatic diseases, particularly in old-age group patients with osteoporosis. The combined use of different meloxicam formulations makes it possible to choose adequate, maximally individualized treatment and to relieve the pain syndrome in the shortest possible time. Among NSAIDs, meloxicam shows an optimum efficacy-safety ratio.ΠΠ΅ΡΡΠ΅ΡΠΎΠΈΠ΄Π½ΡΠ΅ ΠΏΡΠΎΡΠΈΠ²ΠΎΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΡ (ΠΠΠΠ) ΡΠΈΡΠΎΠΊΠΎ ΠΏΡΠΈΠΌΠ΅Π½ΡΡΡΡΡ Π² ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π±ΠΎΠ»Π΅Π²ΠΎΠ³ΠΎ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ° Π² ΡΠ΅Π²ΠΌΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ. Π ΡΡΠ°ΡΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Ρ ΠΏΠ°ΡΠΎΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΡ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΎΡΡΡΠΎΠΉ ΠΈ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»ΠΈ. ΠΠΎΠ΄ΡΠΎΠ±Π½ΠΎ ΠΎΠΏΠΈΡΠ°Π½Ρ ΡΡΠ½ΠΊΡΠΈΠΈ ΡΠΈΠΊΠ»ΠΎΠΎΠΊΡΠΈΠ³Π΅Π½Π°Π·Ρ 1-Π³ΠΎ ΠΈ 2-Π³ΠΎ ΡΠΈΠΏΠΎΠ² - Π¦ΠΠ 1 ΠΈ Π¦ΠΠ 2, ΠΏΠΎΠΊΠ°Π·Π°Π½Π° ΠΊΠ»ΡΡΠ΅Π²Π°Ρ ΡΠΎΠ»Ρ Π¦ΠΠ 2 Π² ΠΈΠ½Π΄ΡΠΊΡΠΈΠΈ ΠΈ ΡΡΠ°Π½ΡΠΌΠΈΡΡΠΈΠΈ Π±ΠΎΠ»ΠΈ. ΠΡΠΈΠ²Π΅Π΄Π΅Π½Ρ Π΄Π°Π½Π½ΡΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ ΠΌΠ΅Π»ΠΎΠΊΡΠΈΠΊΠ°ΠΌΠ° - ΠΠΠΠ, ΠΈΠ½Π³ΠΈΠ±ΠΈΡΡΡΡΠ΅Π³ΠΎ ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ Π¦ΠΠ 2. ΠΠ΅Π»ΠΎΠΊΡΠΈΠΊΠ°ΠΌ Π²ΡΡΠΎΠΊΠΎΡΡΡΠ΅ΠΊΡΠΈΠ²Π΅Π½ Π² ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΡΠ΅Π²ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π±ΠΎΠ»Π΅Π·Π½Π΅ΠΉ, ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎ ΠΏΡΠΈ ΠΎΡΡΠ΅ΠΎΠ°ΡΡΡΠΎΠ·Π΅ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
ΡΡΠ°ΡΡΠ΅ΠΉ Π²ΠΎΠ·ΡΠ°ΡΡΠ½ΠΎΠΉ Π³ΡΡΠΏΠΏΡ. ΠΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ΅ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΡ
ΡΠΎΡΠΌ ΠΌΠ΅Π»ΠΎΠΊΡΠΈΠΊΠ°ΠΌΠ° ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΠΏΠΎΠ΄ΠΎΠ±ΡΠ°ΡΡ Π°Π΄Π΅ΠΊΠ²Π°ΡΠ½ΠΎΠ΅, ΠΌΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΠΎ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅, ΠΈ Π² ΠΊΡΠ°ΡΡΠ°ΠΉΡΠΈΠ΅ ΡΡΠΎΠΊΠΈ ΠΊΡΠΏΠΈΡΠΎΠ²Π°ΡΡ Π±ΠΎΠ»Π΅Π²ΠΎΠΉ ΡΠΈΠ½Π΄ΡΠΎΠΌ. Π‘ΡΠ΅Π΄ΠΈ ΠΠΠΠ ΠΌΠ΅Π»ΠΎΠΊΡΠΈΠΊΠ°ΠΌ Π²ΡΠ΄Π΅Π»ΡΠ΅ΡΡΡ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΡΠΌ ΡΠΎΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΈ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΠΈ
Spatial beam self-cleaning and supercontinuum generation with Yb-doped multimode graded-index fiber taper based on accelerating self-imaging and dissipative landscape
We experimentally demonstrate spatial beam self-cleaning and supercontinuum generation in a tapered Ytterbium-doped multimode optical fiber with parabolic core refractive index profile when 1064β
nm pulsed beams propagate from wider (122β
Β΅m) into smaller (37β
Β΅m) diameter. In the passive mode, increasing the input beam peak power above 20β
kW leads to a bell-shaped output beam profile. In the active configuration, gain from the pump laser diode permits to combine beam self-cleaning with supercontinuum generation between 520-2600β
nm. By taper cut-back, we observed that the dissipative landscape, i.e., a non-monotonic variation of the average beam power along the MMF, leads to modal transitions of self-cleaned beams along the taper length
ΠΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΡΡΡ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π»ΠΎΠ±ΡΠ»ΡΡΠ½ΡΠΌ ΠΏΠ°Π½Π½ΠΈΠΊΡΠ»ΠΈΡΠΎΠΌ-Π»ΠΈΠΏΠΎΠ΄Π΅ΡΠΌΠ°ΡΠΎΡΠΊΠ»Π΅ΡΠΎΠ·ΠΎΠΌ
Lipodermatosclerosis (LDS) is one of the variants of lobular panniculitis. The onset of LDS falls on the age of 50β60 years, when many patients already have comorbid pathology requiring complex therapy, which affects the course, the choice of treatment and prognosis of LDS, as well as the quality of life.Objective: to study the structure and frequency of comorbid conditions in patients with LDS.Patients and methods. 53 patients (3 men and 50 women), 18β80 years old, with a verified diagnosis of LDS were included, all of them had an average follow up of 10 years (they were observed in the V.A. Nasonova Research Institute of Rheumatology). The duration of the disease ranged from 2 weeks to 20 years. During clinical examination, the localization, prevalence, color and number of affected skin areas and sub cutaneous fat were determined. The intensity of pain on palpation of the node was assessed using a visual analogue scale (VAS). Laboratory and instrumental research included: blood and urine tests, computed tomography of the chest and ultrasound Doppler of the lower extremities with registration of the linear blood flow velocity in the affected veins (femoral, popliteal, posterior tibial, foot veins). Clinical, laboratory and instrumental examination of patients was carried out 2 times a year. The CIRS and Charlson indices were used to assess the relationship between comorbid pathology and LDS.Results and discussion. Most patients (60.3%) were women with increased body weight (91.5Β±21.8 kg). Depending on the duration of the disease, the main variants of the LDS course were: acute (<3 months), subacute (3β6 months), and chronic (>6 months). Skin changes were associated with polyarthralgia (34%) and/or myalgia (22.6%), mainly on the side of the affected limb. In 16 patients, an increase in ESR, on average 23.8Β±7.8 mm per hour, was detected, in 7 patients, including 4 with an acute course of LDS, β more than a threefold increase in the level of CRP. No comorbid diseases had 17 patients, 64.7% of them were under 50 years and had an acute course of LDS (p=0.02). In 68% of patients, mainly with chronic LDS, the following concomitant diseases was recorded: chronic venous insufficiency (CVI; in 67.9%); exogenous constitutional obesity (in 60.3%); rheumatic diseases (45.2%), including osteoarthritis (75%), rheumatoid arthritis (17%), antiphospholipid syndrome (8%), and arterial hypertension (39.6%). Most patients had 1 concomitant disease, and almost one fifth of patients had 2 concomitant diseases. The proportion of patients with 3 comorbid pathologies was 11.1%, with 4 β 8.3% and with 5 β 5.5%. When assessing the Charlson index, a 10-year survival rate of >90% (index values from 0 to 2 points) was observed in 66% of patients, 53β77% (3β4 points) β in 26.4% and <21% (β₯5 points) β in 7.5%. There was correlation between the comorbidity index and the age of patients (r=0.8, p<0.05); no association with the duration of LDS was found (r=0.3, p=0.2). Patients over 61 years had β₯1 comorbid disease. The average CIRS index for this group was 4.2Β±0.3 points (0β10), in most patients (45.2%) it was <5 points. Analysis of the Charlson and CIRS scales confirmed their statistically significant relationship (r=0.5, p=0.0000001).Conclusion. In patients with LDS, a high incidence of comorbid pathology was noted. Interdisciplinary approach with interaction between doctors of different specialties is required for treatment of these patients.ΠΠΈΠΏΠΎΠ΄Π΅ΡΠΌΠ°ΡΠΎΡΠΊΠ»Π΅ΡΠΎΠ· (ΠΠΠ‘) β ΠΎΠ΄ΠΈΠ½ ΠΈΠ· Π²Π°ΡΠΈΠ°Π½ΡΠΎΠ² Π»ΠΎΠ±ΡΠ»ΡΡΠ½ΠΎΠ³ΠΎ ΠΏΠ°Π½Π½ΠΈΠΊΡΠ»ΠΈΡΠ°. ΠΠ΅Π±ΡΡ ΠΠΠ‘ ΠΏΡΠΈΡ
ΠΎΠ΄ΠΈΡΡΡ Π½Π° Π²ΠΎΠ·ΡΠ°ΡΡ 50β60 Π»Π΅Ρ, ΠΊΠΎΠ³Π΄Π° Ρ ΠΌΠ½ΠΎΠ³ΠΈΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΆΠ΅ ΠΈΠΌΠ΅Π΅ΡΡΡ ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½Π°Ρ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡ, ΡΡΠ΅Π±ΡΡΡΠ°Ρ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, ΡΡΠΎ ΠΎΠΊΠ°Π·ΡΠ²Π°Π΅Ρ Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π½Π° ΡΠ΅ΡΠ΅Π½ΠΈΠ΅, Π²ΡΠ±ΠΎΡ ΡΠ°ΠΊΡΠΈΠΊΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΠ· ΠΠΠ‘, Π° ΡΠ°ΠΊΠΆΠ΅ Π½Π° ΠΊΠ°ΡΠ΅ΡΡΠ²ΠΎ ΠΆΠΈΠ·Π½ΠΈ.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΈΠ·ΡΡΠ΅Π½ΠΈΠ΅ ΡΡΡΡΠΊΡΡΡΡ ΠΈ ΡΠ°ΡΡΠΎΡΡ ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΡΡ
ΡΠΎΡΡΠΎΡΠ½ΠΈΠΉ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠ‘.ΠΠ°ΡΠΈΠ΅Π½ΡΡ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΎ 53 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° (3 ΠΌΡΠΆΡΠΈΠ½ ΠΈ 50 ΠΆΠ΅Π½ΡΠΈΠ½) 18β80 Π»Π΅Ρ Ρ Π²Π΅ΡΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ ΠΠΠ‘, Π½Π°Π±Π»ΡΠ΄Π°Π²ΡΠΈΡ
ΡΡ Π² Π€ΠΠΠΠ£ Β«ΠΠ°ΡΡΠ½ΠΎ-ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΡΡΠΊΠΈΠΉ ΠΈΠ½ΡΡΠΈΡΡΡ ΡΠ΅Π²ΠΌΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΈΠΌ. Π.Π. ΠΠ°ΡΠΎΠ½ΠΎΠ²ΠΎΠΉΒ» Π² ΡΡΠ΅Π΄Π½Π΅ΠΌ 10 Π»Π΅Ρ. ΠΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ Π²Π°ΡΡΠΈΡΠΎΠ²Π°Π»Π°ΡΡ ΠΎΡ 2 Π½Π΅Π΄ Π΄ΠΎ 20 Π»Π΅Ρ. ΠΡΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΌ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ»ΠΈ Π»ΠΎΠΊΠ°Π»ΠΈΠ·Π°ΡΠΈΡ, ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΡΡΡ, ΠΎΠΊΡΠ°ΡΠΊΡ ΠΈ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΠΏΠΎΡΠ°ΠΆΠ΅Π½Π½ΡΡ
ΡΡΠ°ΡΡΠΊΠΎΠ² ΠΊΠΎΠΆΠΈ ΠΈ ΠΏΠΎΠ΄ΠΊΠΎΠΆΠ½ΠΎΠΉ ΠΆΠΈΡΠΎΠ²ΠΎΠΉ ΠΊΠ»Π΅ΡΡΠ°ΡΠΊΠΈ. ΠΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΡΡΡ Π±ΠΎΠ»ΠΈ ΠΏΡΠΈ ΠΏΠ°Π»ΡΠΏΠ°ΡΠΈΠΈ ΡΠ·Π»Π° ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ ΠΏΠΎ Π²ΠΈΠ·ΡΠ°Π»ΡΠ½ΠΎΠΉ Π°Π½Π°Π»ΠΎΠ³ΠΎΠ²ΠΎΠΉ ΡΠΊΠ°Π»Π΅ (ΠΠΠ¨). ΠΠ°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΠΎ-ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ°Π»ΠΎ: Π°Π½Π°Π»ΠΈΠ·Ρ ΠΊΡΠΎΠ²ΠΈ ΠΈ ΠΌΠΎΡΠΈ, ΠΊΠΎΠΌΠΏΡΡΡΠ΅ΡΠ½ΡΡ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΡ ΠΎΡΠ³Π°Π½ΠΎΠ² Π³ΡΡΠ΄Π½ΠΎΠΉ ΠΊΠ»Π΅ΡΠΊΠΈ ΠΈ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΡΡ Π΄ΠΎΠΏΠΏΠ»Π΅ΡΠΎΠ³ΡΠ°ΡΠΈΡ Π½ΠΈΠΆΠ½ΠΈΡ
ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠ΅ΠΉ Ρ ΡΠ΅Π³ΠΈΡΡΡΠ°ΡΠΈΠ΅ΠΉ Π»ΠΈΠ½Π΅ΠΉΠ½ΠΎΠΉ ΡΠΊΠΎΡΠΎΡΡΠΈ ΠΊΡΠΎΠ²ΠΎΡΠΎΠΊΠ° Π² Π·Π°ΠΈΠ½ΡΠ΅ΡΠ΅ΡΠΎΠ²Π°Π½Π½ΡΡ
Π²Π΅Π½Π°Ρ
(Π±Π΅Π΄ΡΠ΅Π½Π½ΡΡ
, ΠΏΠΎΠ΄ΠΊΠΎΠ»Π΅Π½Π½ΡΡ
, Π·Π°Π΄Π½ΠΈΡ
Π±ΠΎΠ»ΡΡΠ΅Π±Π΅ΡΡΠΎΠ²ΡΡ
, ΡΡΠΎΠΏΡ). ΠΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅, Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΠΎΠ΅ ΠΈ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΠΎΠ΅ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΎΡΡΡΠ΅ΡΡΠ²Π»ΡΠ»ΠΈ 2 ΡΠ°Π·Π° Π² Π³ΠΎΠ΄. ΠΠ»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ Π²Π·Π°ΠΈΠΌΠΎΡΠ²ΡΠ·ΠΈ ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠ΅ΠΉ Ρ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΠΠ‘ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈ ΠΈΠ½Π΄Π΅ΠΊΡΡ CIRS ΠΈ Charlson.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈ ΠΎΠ±ΡΡΠΆΠ΄Π΅Π½ΠΈΠ΅. Π‘ΡΠ΅Π΄ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΡΠ΅ΠΎΠ±Π»Π°Π΄Π°Π»ΠΈ ΠΆΠ΅Π½ΡΠΈΠ½Ρ (60,3%) Ρ ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΠΎΠΉ ΠΌΠ°ΡΡΠΎΠΉ ΡΠ΅Π»Π° (91,5Β±21,8 ΠΊΠ³). Π Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ Π±ΡΠ»ΠΈ Π²ΡΠ΄Π΅Π»Π΅Π½Ρ ΠΎΡΠ½ΠΎΠ²Π½ΡΠ΅ Π²Π°ΡΠΈΠ°Π½ΡΡ ΡΠ΅ΡΠ΅Π½ΠΈΡ ΠΠΠ‘: ΠΎΡΡΡΠΎΠ΅ (<3 ΠΌΠ΅Ρ), ΠΏΠΎΠ΄ΠΎΡΡΡΠΎΠ΅ (3β6 ΠΌΠ΅Ρ) ΠΈ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅ (>6 ΠΌΠ΅Ρ). ΠΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΊΠΎΠΆΠΈ Π°ΡΡΠΎΡΠΈΠΈΡΠΎΠ²Π°Π»ΠΎΡΡ Ρ ΠΏΠΎΠ»ΠΈΠ°ΡΡΡΠ°Π»Π³ΠΈΡΠΌΠΈ (34%) ΠΈ/ΠΈΠ»ΠΈ ΠΌΠΈΠ°Π»Π³ΠΈΡΠΌΠΈ (22,6%), ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ Π½Π° ΡΡΠΎΡΠΎΠ½Π΅ ΠΏΠΎΡΠ°ΠΆΠ΅Π½Π½ΠΎΠΉ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠΈ. Π£ 16 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π·Π°ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π½ΠΎ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ Π‘ΠΠ Π² ΡΡΠ΅Π΄Π½Π΅ΠΌ Π΄ΠΎ 23,8Β±7,8 ΠΌΠΌ/Ρ, Ρ 7 Π±ΠΎΠ»ΡΠ½ΡΡ
Π² (ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ Ρ 4 Ρ ΠΎΡΡΡΡΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΠΠ‘) β Π±ΠΎΠ»Π΅Π΅ ΡΠ΅ΠΌ ΡΡΠ΅Ρ
ΠΊΡΠ°ΡΠ½ΠΎΠ΅ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ ΡΡΠΎΠ²Π½Ρ Π‘Π Π. Π£ 17 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΡΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ Π½Π΅ Π²ΡΡΠ²Π»Π΅Π½ΠΎ, 64,7% ΠΈΠ· Π½ΠΈΡ
Π±ΡΠ»ΠΈ ΠΌΠΎΠ»ΠΎΠΆΠ΅ 50 Π»Π΅Ρ ΠΈ ΠΈΠΌΠ΅Π»ΠΈ ΠΎΡΡΡΠΎΠ΅ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΠΠ‘ (Ρ=0,02). Π£ 68% Π±ΠΎΠ»ΡΠ½ΡΡ
, ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ Ρ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΠΠ‘, Π·Π°ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½Π° ΡΠ»Π΅Π΄ΡΡΡΠ°Ρ ΡΠΎΠΏΡΡΡΡΠ²ΡΡΡΠ°Ρ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡ: Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠ°Ρ Π²Π΅Π½ΠΎΠ·Π½Π°Ρ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΡ (Π₯ΠΠ; Ρ 67,9%), ΡΠΊΠ·ΠΎΠ³Π΅Π½Π½ΠΎ-ΠΊΠΎΠ½ΡΡΠΈΡΡΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ΅ ΠΎΠΆΠΈΡΠ΅Π½ΠΈΠ΅ (Ρ 60,3%); ΡΠ΅Π²ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ (Ρ 45,2%), Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ ΠΎΡΡΠ΅ΠΎΠ°ΡΡΡΠΈΡ (Ρ 75%), ΡΠ΅Π²ΠΌΠ°ΡΠΎΠΈΠ΄Π½ΡΠΉ Π°ΡΡΡΠΈΡ (Ρ 17%), Π°Π½ΡΠΈΡΠΎΡΡΠΎΠ»ΠΈΠΏΠΈΠ΄Π½ΡΠΉ ΡΠΈΠ½Π΄ΡΠΎΠΌ (Ρ 8%), Π° ΡΠ°ΠΊΠΆΠ΅ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½Π°Ρ Π³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΡ (Ρ 39,6%). Π£ Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΈΠΌΠ΅Π»ΠΎΡΡ 1 ΡΠΎΠΏΡΡΡΡΠ²ΡΡΡΠ΅Π΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅, ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈ Ρ ΠΏΡΡΠΎΠΉ ΡΠ°ΡΡΠΈ β 2. ΠΠΎΠ»Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ 3 ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΡΠΌΠΈ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡΠΌΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 11,1%, Ρ 4 β 8,3% ΠΈ 5 β 5,5%. ΠΡΠΈ ΠΎΡΠ΅Π½ΠΊΠ΅ ΠΈΠ½Π΄Π΅ΠΊΡΠ° Charlson ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ 10-Π»Π΅ΡΠ½Π΅ΠΉ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ >90% (Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΠΈΠ½Π΄Π΅ΠΊΡΠ° ΠΎΡ 0 Π΄ΠΎ 2 Π±Π°Π»Π»ΠΎΠ²) ΠΎΡΠΌΠ΅ΡΠ΅Π½ Ρ 66% Π±ΠΎΠ»ΡΠ½ΡΡ
, 53β77% (3β4 Π±Π°Π»Π»Π°) β Ρ 26,4% ΠΈ <21% (β₯5 Π±Π°Π»Π»ΠΎΠ²) β Ρ 7,5%. ΠΠ±Π½Π°ΡΡΠΆΠ΅Π½Π° Π²Π·Π°ΠΈΠΌΠΎΡΠ²ΡΠ·Ρ ΠΈΠ½Π΄Π΅ΠΊΡΠ° ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΡΡΠΈ Ρ Π²ΠΎΠ·ΡΠ°ΡΡΠΎΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (r=0,8, p<0,05), Π°ΡΡΠΎΡΠΈΠ°ΡΠΈΠΈ Ρ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡΡ ΠΠΠ‘ Π½Π΅ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ (r=0,3, p=0,2). Π£ Π±ΠΎΠ»ΡΠ½ΡΡ
ΡΡΠ°ΡΡΠ΅ 61 Π³ΠΎΠ΄Π° Π·Π°ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½ΠΎ β₯1 ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΠ΅ ΡΠΎΡΡΠΎΡΠ½ΠΈΠ΅. ΠΠ½Π΄Π΅ΠΊΡ CIRS Π΄Π»Ρ Π΄Π°Π½Π½ΠΎΠΉ Π³ΡΡΠΏΠΏΡ ΡΠΎΡΡΠ°Π²Π»ΡΠ» Π² ΡΡΠ΅Π΄Π½Π΅ΠΌ 4,2Β±0,3 Π±Π°Π»Π»Π° (0β10), Ρ Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π° Π±ΠΎΠ»ΡΠ½ΡΡ
(45,2%) ΠΎΠ½ Π±ΡΠ» <5 Π±Π°Π»Π»ΠΎΠ². ΠΡΠΈ Π°Π½Π°Π»ΠΈΠ·Π΅ ΡΠΊΠ°Π» Charlson ΠΈ CIRS ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π΅Π½Π° ΠΈΡ
ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠ°Ρ ΡΠ²ΡΠ·Ρ (r=0,5, Ρ=0,0000001).ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π£ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΠΠ‘ ΠΎΡΠΌΠ΅ΡΠ΅Π½Π° Π²ΡΡΠΎΠΊΠ°Ρ ΡΠ°ΡΡΠΎΡΠ° ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ. ΠΡΡΠ°ΡΠΈΡ Π±ΠΎΠ»ΡΠ½ΡΡ
ΡΡΠ΅Π±ΡΠ΅Ρ ΠΌΠ΅ΠΆΠ΄ΠΈΡΡΠΈΠΏΠ»ΠΈΠ½Π°ΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Π° ΠΈ Π²Π·Π°ΠΈΠΌΠΎΠ΄Π΅ΠΉΡΡΠ²ΠΈΡ ΠΌΠ΅ΠΆΠ΄Ρ Π²ΡΠ°ΡΠ°ΠΌΠΈ ΡΠ°Π·Π½ΡΡ
ΡΠΏΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΡΡΠ΅ΠΉ
Studying informativity of specific IgE levels to whole cow milk allergen and its components, as well as to soy and gluten in children
Successive development of immunological tolerance to cowβs milk proteins largely depends on the timeliness and validity of the elimination diet and is most difficult in IgE-mediated food allergy. From 2012 to 2017, when examining children aged 3 months to 10 years, we found some cases with high levels of specific IgE to beta-lactoglobulin that exceeded the levels of specific IgE to the whole cowβs milk allergen (the latter is often used as a screening allergen). The aim of this study was to assess the informativity of studying the levels of specific IgE to the whole cowβs milk allergens in blood serum of children at early, preschool and primary school age. We have also included gluten (gluten) and soy as possible components of early childhood nutrition into the list of allergens under study. The study involved 100 children aged 9 months to 12 years. Clinical selection criteria included presence of anamnestic data on exacerbation of atopic dermatitis, urticaria, exacerbation of rhinitis/asthma, diarrhea, constipation or abdominal pain in response to usage of cowβs milk and/or dairy products during the last 6 months. It is shown that extended study of specific IgE levels to whole cowβs milk allergen, its components, as well as to soy and gluten, increases the accuracy of laboratory diagnostics and differential diagnosis of IgEmediated form of food allergy to cowβs milk proteins, compared with determination of serum IgE to whole cowβs milk as a screening test. A detailed study of specific IgE to milk components allowed to confirm the presence of IgE-mediated form of allergy to cowβs milk in 7% of the examined children with signs of food allergy, but in absence of specific IgE to whole cowβs milk allergen. We have also shown that in 29% of cases, the level of specific IgE to milk components was higher than those to whole cowβs milk allergen. The results of this study may be of practical importance, since the form of food allergy, as well as intensity and dynamics of reduction of production of specific IgE, are accepted criteria to forecast development of tolerance to cowβs milk proteins. In addition, identification of specific allergen (including soy bean allergen) that causes the most intense production of specific IgE, may be importance for administration of a reasonable elimination diet. The most significant allergens for diagnosis and differential diagnostics of allergy to cowβs milk in children, in addition to the βwhole cowβs milk, f2β preparation, are the following allergens: βwhey, f236β, βbeta-lactoglobulin, f77β and βsoy, f14β
The effectiveness of combination of 7% hypertonic saline and 0.1% natrii hyaluronas in patients with chronic obstructive pulmonary disease who have suffered a new coronavirus infection
Introduction. New coronavirus infection (COVID-19) contributes to the aggravation of respiratory symptoms in patients with COPD, including affecting the intensity and nature of cough. Hypertonic solution (HS) has a positive effect on the rheological properties of sputum and mucociliary clearance. However, there are no studies in the available literature on the use of HS in patients who have undergone COVID-19.Goal. To evaluate the effect of the combination of 7% hypertonic saline and 0.1% natrii hyaluronas on the intensity and productive nature of cough in patients with COPD who have undergone a new coronavirus infection and the safety of its use in this cohort of patients.Materials and methods. 50 patients with severe COPD in remission who suffered a new coronavirus infection were examined. The rehabilitation stage of treatment was carried out in the conditions of the pulmonology department. From the moment of receiving the last negative PCR result for SARS-CoV-2 to admission to the hospital for rehabilitation, it took from 2 to 3 weeks. The duration of follow-up of patients was 10 days. The patients were divided into two groups: group 1 (n = 25) β patients who received combination of 7% hypertonic saline and 0.1% natrii hyaluronas 7% by inhalation through a nebulizer; group 2 (n = 25) β patients who did not receive combination of 7% hypertonic saline and 0.1% natrii hyaluronas. The severity of cough was assessed (cough severity scale; shortness of breath, cough and sputum scale), clinical and biochemical blood tests, ECG, spirometry.Results. In patients treated with combination of 7% hypertonic saline and 0.1% natrii hyaluronas, a significant decrease in the severity of cough, the amount of sputum was revealed. The tendency to reduce shortness of breath and improve the quality of life is determined. No serious adverse events were detected when using the drug.Conclusions. The use of the combination of 7% hypertonic saline and 0.1% natrii hyaluronas in patients with COPD who have suffered a new coronavirus infection at the rehabilitation stage leads to a decrease in the intensity of cough and improved sputum discharge, which helps to reduce the severity of shortness of breath and improve the quality of life. The use of the drug is safe and does not lead to clinically significant adverse events
Π‘ΠΈΠ½Π΄ΡΠΎΠΌ Π‘ΡΠΈΠ»Π»Π° Ρ Π²Π·ΡΠΎΡΠ»ΡΡ : Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ° ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΠ΅
The paper describes adult-onset Still's disease (AOSD), a rare multisystemic disease of unknown etiology that is referred to as seronegative rheumatoid arthritis. It presents the major manifestations of AOSD: long-term fever, arthritis or persistent arthralgias, maculopapular eruption, seronegativity for rheumatoid factor, neutrophilic leukocytosis, and disease onset after 16 years of age, as well as additional signs: lymphadenopathy, hepatosplenomegaly, polyserositis, nasopharyngeal infection. It is noted that particular difficulties in the diagnosis of AOSD emerge when it is complicated by the hematophagocytic syndrome (HPS). The distinctive features of AOSD are the development of cutaneous and articular symptoms in practically 80% of patients and their absence in HPS. It is stated that of greater value in the diagnosis of HPS is examination of aspirate of the bone marrow than its biopsy. Most patients develop refractoriness to glucocorticoids and essential anti-inflammatory drugs. The positive results of using anakinra, rituximab, and tocilizumab are promising.ΠΠΏΠΈΡΠ°Π½ ΡΠΈΠ½Π΄ΡΠΎΠΌ Π‘ΡΠΈΠ»Π»Π° Ρ Π²Π·ΡΠΎΡΠ»ΡΡ
(Π‘Π‘Π) - ΡΠ΅Π΄ΠΊΠΎΠ΅ ΠΌΡΠ»ΡΡΠΈΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅ Π½Π΅ΠΈΠ·Π²Π΅ΡΡΠ½ΠΎΠΉ ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΠΈ, ΠΎΡΠ½ΠΎΡΡΡΠ΅Π΅ΡΡ ΠΊ ΡΠ΅ΡΠΎΠ½Π΅-Π³Π°ΡΠΈΠ²Π½ΠΎΠΌΡ ΡΠ΅Π²ΠΌΠ°ΡΠΎΠΈΠ΄Π½ΠΎΠΌΡ Π°ΡΡΡΠΈΡΡ. ΠΡΠΈΠ²ΠΎΠ΄ΡΡΡΡ ΠΎΡΠ½ΠΎΠ²Π½ΡΠ΅ ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΡ Π‘Π‘Π - Π΄Π»ΠΈΡΠ΅Π»ΡΠ½Π°Ρ Π»ΠΈΡ
ΠΎΡΠ°Π΄ΠΊΠ°, Π°ΡΡΡΠΈΡ ΠΈΠ»ΠΈ ΡΡΠΎΠΉΠΊΠΈΠ΅ Π°ΡΡΡΠ°Π»Π³ΠΈΠΈ, ΠΌΠ°ΠΊΡΠ»ΠΎΠΏΠ°ΠΏΡΠ»Π΅Π·Π½Π°Ρ ΡΡΠΏΡ, ΡΠ΅ΡΠΎΠ½Π΅Π³Π°ΡΠΈΠ²Π½ΠΎΡΡΡ ΠΏΠΎ ΡΠ΅Π²ΠΌΠ°ΡΠΎΠΈΠ΄Π½ΠΎΠΌΡ ΡΠ°ΠΊΡΠΎΡΡ, Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΡΠ½ΡΠΉ Π»Π΅ΠΉΠΊΠΎΡΠΈΡΠΎΠ·, ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΠΏΠΎΡΠ»Π΅ 16 Π»Π΅Ρ, Π° ΡΠ°ΠΊΠΆΠ΅ Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΠΏΡΠΈΠ·Π½Π°ΠΊΠΈ - Π»ΠΈΠΌΡΠ°Π΄Π΅Π½ΠΎΠΏΠ°ΡΠΈΡ, Π³Π΅ΠΏΠ°ΡΠΎΡΠΏΠ»Π΅Π½ΠΎΠΌΠ΅Π³Π°Π»ΠΈΡ, ΠΏΠΎΠ»ΠΈΡΠ΅ΡΠΎΠ·ΠΈΡ, Π½ΠΎΡΠΎΠ³Π»ΠΎΡΠΎΡΠ½Π°Ρ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ. ΠΡΠΌΠ΅ΡΠ΅Π½ΠΎ, ΡΡΠΎ ΠΎΡΠΎΠ±ΡΠ΅ ΡΡΡΠ΄Π½ΠΎΡΡΠΈ ΠΏΡΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ Π‘Π‘Π Π²ΠΎΠ·Π½ΠΈΠΊΠ°ΡΡ Π² ΡΠ»ΡΡΠ°Π΅ Π΅Π³ΠΎ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ Π³Π΅ΠΌΠ°ΡΠΎΡΠ°Π³ΠΎΡΠΈΡΠ°ΡΠ½ΡΠΌ ΡΠΈΠ½Π΄ΡΠΎΠΌΠΎΠΌ (ΠΠ€Π‘). ΠΡΠ»ΠΈΡΠΈΡΠ΅Π»ΡΠ½ΡΠΌΠΈ ΡΠ΅ΡΡΠ°ΠΌΠΈ Π‘Π‘Π ΡΠ²Π»ΡΡΡΡΡ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ ΠΊΠΎΠΆΠ½ΠΎΠΉ ΠΈ ΡΡΡΡΠ°Π²Π½ΠΎΠΉ ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΡΠΈΠΊΠΈ ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈ Ρ 80% Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΈ ΠΎΡΡΡΡcΡΠ²ΠΈΠ΅ ΡΠ°ΠΊΠΎΠ²ΡΡ
ΠΏΡΠΈ ΠΠ€Π‘. Π£ΠΊΠ°Π·Π°Π½ΠΎ, ΡΡΠΎ Π΄Π»Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΠ€Π‘ Π±ΠΎΠ»ΡΡΠ΅Π΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΠΈΠΌΠ΅Π΅Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π°ΡΠΏΠΈΡΠ°ΡΠ° ΠΊΠΎΡΡΠ½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π°, ΡΠ΅ΠΌ Π΅Π³ΠΎ Π±ΠΈΠΎΠΏΡΠΈΡ. Π£ Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠ°Π·Π²ΠΈΠ²Π°Π΅ΡΡΡ ΡΠ΅ΡΡΠ°ΠΊΡΠ΅ΡΠ½ΠΎΡΡΡ ΠΊ Π³Π»ΡΠΊΠΎΠΊΠΎΡΡΠΈΠΊΠΎΠΈΠ΄Π°ΠΌ ΠΈ Π±Π°Π·ΠΈΡΠ½ΡΠΌ ΠΏΡΠΎΡΠΈΠ²ΠΎΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠΌ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°ΠΌ. ΠΠ°Π΄Π΅ΠΆΠ΄Ρ Π²ΡΠ΅Π»ΡΡΡ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ Π°Π½Π°ΠΊΠΈΠ½ΡΡ, ΡΠΈΡΡΠΊΡΠΈΠΌΠ°Π±Π°, ΡΠΎΡΠΈΠ»ΠΈΠ·ΡΠΌΠ°Π±Π°
ΠΠ°Π½Π½ΠΈΠΊΡΠ»ΠΈΡ: ΡΠ΅Π²ΠΌΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π°ΡΠΏΠ΅ΠΊΡΡ
Different types of panniculitis (Pn) can be one of the symptoms of rheumatic diseases (RDs). Pn is a group of heterogeneous inflammatory diseases that are characterized by subcutaneous adipose tissue (SAT) lesion and often occur with musculoskeletal and visceral involvements. There is no single concept of the etiology and pathogenesis of Pn. Infections, injures, hormonal and immune disorders, drug intake, pancreatic disease, malignant neoplasms, etc. can play a role in the development of Pn. The latter is associated with RDs in a fairly large group of patients. There have recently been reports of about 200 and 50 cases of only idiopathic lobular Pn in the world and Russian literature, respectively. There have also been publications on other types of Pn, such as erythema nodosum, eosinophilic fasciitis, superficial migratory thrombophlebitis, lupus Pn, dermatomyositis Pn, scleroderma systematica, gout, psoriatic arthritis, etc. There is now a need to study skin changes and SAT lesions in the context of RDs, which will be able to estimate the true clinical and prognostic value of Pn in RDs. Based on recent literature data, this review characterizes the main types of Pn, their clinical and histological signs, and diagnostic methods.Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠ΅Π²ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΠΌΠΈ (Π Π) Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΈΠ· ΡΠΈΠΌΠΏΡΠΎΠΌΠΎΠ² ΠΌΠΎΠ³ΡΡ Π²ΡΡΡΡΠΏΠ°ΡΡ ΡΠ°Π·Π½ΡΠ΅ ΡΠΎΡΠΌΡ ΠΏΠ°Π½Π½ΠΈΠΊΡΠ»ΠΈΡΠ° (ΠΠ½). ΠΠ½ β Π³ΡΡΠΏΠΏΠ° Π³Π΅ΡΠ΅ΡΠΎΠ³Π΅Π½Π½ΡΡ
Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ, Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΡΡΠΈΡ
ΡΡ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΠ΅ΠΌ ΠΏΠΎΠ΄ΠΊΠΎΠΆΠ½ΠΎΠΉ ΠΆΠΈΡΠΎΠ²ΠΎΠΉ ΠΊΠ»Π΅ΡΡΠ°ΡΠΊΠΈ (ΠΠΠ) ΠΈ Π½Π΅ΡΠ΅Π΄ΠΊΠΎ ΠΏΡΠΎΡΠ΅ΠΊΠ°ΡΡΠΈΡ
Ρ Π²ΠΎΠ²Π»Π΅ΡΠ΅Π½ΠΈΠ΅ΠΌ Π² ΠΏΡΠΎΡΠ΅ΡΡ ΠΎΠΏΠΎΡΠ½ΠΎ-Π΄Π²ΠΈΠ³Π°ΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ Π°ΠΏΠΏΠ°ΡΠ°ΡΠ° ΠΈ Π²Π½ΡΡΡΠ΅Π½Π½ΠΈΡ
ΠΎΡΠ³Π°Π½ΠΎΠ². ΠΠ΄ΠΈΠ½Π°Ρ ΠΊΠΎΠ½ΡΠ΅ΠΏΡΠΈΡ ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΈ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π° ΠΠ½ ΠΎΡΡΡΡΡΡΠ²ΡΠ΅Ρ. Π ΡΠ°Π·Π²ΠΈΡΠΈΠΈ ΠΠ½ ΠΌΠΎΠ³ΡΡ ΠΈΠ³ΡΠ°ΡΡ ΡΠΎΠ»Ρ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ, ΡΡΠ°Π²ΠΌΡ, Π³ΠΎΡΠΌΠΎΠ½Π°Π»ΡΠ½ΡΠ΅ ΠΈ ΠΈΠΌΠΌΡΠ½Π½ΡΠ΅ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ, ΠΏΡΠΈΠ΅ΠΌ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ², Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΏΠΎΠ΄ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ, Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠ΅ Π½ΠΎΠ²ΠΎΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΡ ΠΈ Π΄Ρ. Π£ Π΄ΠΎΠ²ΠΎΠ»ΡΠ½ΠΎ ΠΌΠ½ΠΎΠ³ΠΎΡΠΈΡΠ»Π΅Π½Π½ΠΎΠΉ Π³ΡΡΠΏΠΏΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΠ½ Π°ΡΡΠΎΡΠΈΠΈΡΡΠ΅ΡΡΡ Ρ ΡΠ΅Π²ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΠΌΠΈ (Π Π). ΠΠ° ΠΏΠΎΡΠ»Π΅Π΄Π½ΠΈΠ΅ Π³ΠΎΠ΄Ρ Π² ΠΌΠΈΡΠΎΠ²ΠΎΠΉ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΠ΅ ΠΎΠΏΠΈΡΠ°Π½ΠΎ ΠΎΠΊΠΎΠ»ΠΎ 200, Π° Π² ΠΎΡΠ΅ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΠ΅ β 50 ΡΠ»ΡΡΠ°Π΅Π² ΡΠΎΠ»ΡΠΊΠΎ ΠΈΠ΄ΠΈΠΎΠΏΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»ΠΎΠ±ΡΠ»ΡΡΠ½ΠΎΠ³ΠΎ ΠΠ½. ΠΠΏΡΠ±Π»ΠΈΠΊΠΎΠ²Π°Π½Ρ ΠΈ ΡΠ°Π±ΠΎΡΡ, ΠΏΠΎΡΠ²ΡΡΠ΅Π½Π½ΡΠ΅ Π΄ΡΡΠ³ΠΈΠΌ ΡΠΎΡΠΌΠ°ΠΌ ΠΠ½, ΡΠ°ΠΊΠΈΠΌ ΠΊΠ°ΠΊ ΡΠ·Π»ΠΎΠ²Π°ΡΠ°Ρ ΡΡΠΈΡΠ΅ΠΌΠ°, ΡΠΎΠ·ΠΈΠ½ΠΎΡΠΈΠ»ΡΠ½ΡΠΉ ΡΠ°ΡΡΠΈΠΈΡ, ΠΏΠΎΠ²Π΅ΡΡ
Π½ΠΎΡΡΠ½ΡΠΉ ΠΌΠΈΠ³ΡΠΈΡΡΡΡΠΈΠΉ ΡΡΠΎΠΌΠ±ΠΎΡΠ»Π΅Π±ΠΈΡ, Π»ΡΠΏΡΡ-ΠΠ½, ΠΠ½ ΠΏΡΠΈ Π΄Π΅ΡΠΌΠ°ΡΠΎΠΌΠΈΠΎΠ·ΠΈΡΠ΅, ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠΉ ΡΠΊΠ»Π΅ΡΠΎΠ΄Π΅ΡΠΌΠΈΠΈ, ΠΏΠΎΠ΄Π°Π³ΡΠ΅, ΠΏΡΠΎΡΠΈΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΌ Π°ΡΡΡΠΈΡΠ΅ ΠΈ Π΄Ρ. Π Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ ΠΎΡΡΡΠ°Π΅ΡΡΡ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ ΠΈΠ·ΡΡΠ΅Π½ΠΈΡ ΠΊΠΎΠΆΠ½ΡΡ
ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ ΠΈ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ ΠΠΠ Ρ ΠΏΠΎΠ·ΠΈΡΠΈΠΉ Π Π, ΡΡΠΎ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΡ ΠΎΡΠ΅Π½ΠΈΡΡ ΠΈΡΡΠΈΠ½Π½ΠΎΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΠΠ½ ΠΏΡΠΈ Π Π.ΠΠ° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ Π΄Π°Π½Π½ΡΡ
Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΡ ΠΏΠΎΡΠ»Π΅Π΄Π½ΠΈΡ
Π»Π΅Ρ Π² ΠΎΠ±Π·ΠΎΡΠ΅ ΠΎΡ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΠΎΠ²Π°Π½Ρ ΠΎΡΠ½ΠΎΠ²Π½ΡΠ΅ ΡΠΎΡΠΌΡ ΠΠ½, ΠΈΡ
ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈ Π³ΠΈΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΏΡΠΈΠ·Π½Π°ΠΊΠΈ, ΠΌΠ΅ΡΠΎΠ΄Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ.
ΠΠ΅Π·Π΅Π½ΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΡΠΉ ΠΏΠ°Π½Π½ΠΈΠΊΡΠ»ΠΈΡ Π² ΠΏΡΠ°ΠΊΡΠΈΠΊΠ΅ ΡΠ΅Π²ΠΌΠ°ΡΠΎΠ»ΠΎΠ³Π°
Mesenteric panniculitis (MPn) is a rare form of adipose tissue inflammation, mainly of the intestinal mesentery, less often of the omentum, preand retroperitoneal tissue. There are not many descriptions of MPn in rheumatic diseases in the literature: in systemic lupus erythematosus, systemic sclerosis, Sjogren's syndrome, rheumatoid arthritis (RA), ankylosing spondylitis, mesenteric form (MF) of idiopathic lobular panniculitis (ILPn) and IgG4-related disease (IgG4-RD). Given the polymorphism of clinical manifestations, including systemic ones, it is of interest to look at the problem of MPn from the perspective of a rheumatologist.Objective: to evaluate the clinical and laboratory features of MPn in modern rheumatological practice.Material and methods. The study included 64 patients (19 men and 45 women aged 19 to 76 years, median disease duration 28.6 [0.3; 243] months). Laboratory and instrumental studies were carried out according to a single algorithm, which included standard clinical, immunological methods, as well as the determination of fecal calprotectin and tumor markers, ultrasound of the skin and subcutaneous adipose tissue (SAT), computed tomography of the chest and abdominal organs, abdominal positron emission tomography, pathomorphological examination of biopsies of the skin, pancreas and mesentery.Results and discussion. 89% of patients had abdominal pain, 48.4% had nausea, 53.1% had weakness, 44% had subfebrile fever, 32.8% had articular syndrome, and 29.6% β skin and pancreas involvement. Median ESR was 34 [11; 52] mm/h, CRP level β 14 [2; 72] mg/l. Most of the immunological parameters remained within the normal range, but in some cases there was an increase in the concentration of rheumatoid factor, antibodies to the cyclic citrullinated peptide, IgG4. The level of tumor markers CA 125, CEA, CA 19β9 and TumorM2-PK was increased 2 times or more in 5 patients. In our study, all radiological signs and all degrees of severity of MPn were observed. An additional examination confirmed the presence of MF ILPn, RA, IgG4-RD, gastrointestinal, malignant, hematological and other diseases, which made it possible to identify five diagnostic blocks.Conclusion. Early diagnosis and correct interpretation of the described changes require a lot of work-up and a multidisciplinary approach, which contributes to accurate and timely recognition of the disease.Mesenteric panniculitis (MPn) is a rare form of adipose tissue inflammation, mainly of the intestinal mesentery, less often of the omentum, preand retroperitoneal tissue. There are not many descriptions of MPn in rheumatic diseases in the literature: in systemic lupus erythematosus, systemic sclerosis, Sjogren's syndrome, rheumatoid arthritis (RA), ankylosing spondylitis, mesenteric form (MF) of idiopathic lobular panniculitis (ILPn) and IgG4-related disease (IgG4-RD). Given the polymorphism of clinical manifestations, including systemic ones, it is of interest to look at the problem of MPn from the perspective of a rheumatologist.Objective: to evaluate the clinical and laboratory features of MPn in modern rheumatological practice.Material and methods. The study included 64 patients (19 men and 45 women aged 19 to 76 years, median disease duration 28.6 [0.3; 243] months). Laboratory and instrumental studies were carried out according to a single algorithm, which included standard clinical, immunological methods, as well as the determination of fecal calprotectin and tumor markers, ultrasound of the skin and subcutaneous adipose tissue (SAT), computed tomography of the chest and abdominal organs, abdominal positron emission tomography, pathomorphological examination of biopsies of the skin, pancreas and mesentery.Results and discussion. 89% of patients had abdominal pain, 48.4% had nausea, 53.1% had weakness, 44% had subfebrile fever, 32.8% had articular syndrome, and 29.6% β skin and pancreas involvement. Median ESR was 34 [11; 52] mm/h, CRP level β 14 [2; 72] mg/l. Most of the immunological parameters remained within the normal range, but in some cases there was an increase in the concentration of rheumatoid factor, antibodies to the cyclic citrullinated peptide, IgG4. The level of tumor markers CA 125, CEA, CA 19β9 and TumorM2-PK was increased 2 times or more in 5 patients. In our study, all radiological signs and all degrees of severity of MPn were observed. An additional examination confirmed the presence of MF ILPn, RA, IgG4-RD, gastrointestinal, malignant, hematological and other diseases, which made it possible to identify five diagnostic blocks.Conclusion. Early diagnosis and correct interpretation of the described changes require a lot of work-up and a multidisciplinary approach, which contributes to accurate and timely recognition of the disease
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