Medical mistakes in tactics of management of patients with atopic dermatitis associated with opportunistic yeast microflora infection

Infectious triggers play significant role in the pathogenesis of atopic dermatitis. Candida spp. yeasts and Malassezia spp. lipophilic yeasts hold a special place among these trigger factors. The former contribute to the severity of skin process in patients with atopic diseases due to the delayed hyperergic reaction, the latter can induce the production of specific IgE-antibodies. For this reason, the complex therapy including multifunctional drugs (antimycotic, antibacterial, and anti-inflammatory) provides faster therapeutic effect and longer interrecurrent period. Objective. The objective of this study was to analyze the mistakes of dermatologists in selection of treatment of patients with atopic dermatitis due to the underestimated role of Candida spp. yeasts and Malassezia spp. lipophilic yeasts in the pathogenesis of the disease. Material and methods. The investigation was carried out at the department of skin and venereal diseases with cosmetology course at the Extension Course Institute for Medical Practitioners. The detailed analysis of the characteristic features of atopic dermatitis associated with yeast microflora infection and the reasons for ineffectiveness of conventional therapies was provided and exemplified by three clinical cases of patients aged 18, 9 and 6 years. Results. The use of clinical, immunological, and bacteriological methods enabled us to detect concomitant mycological infection, which supports chronicity of atopic dermatitis and affects the effectiveness of treatment. Conclusion. The ineffectiveness of conventional therapies is often due to hypercolonization of skin and/or mucous membranes with yeast microflora. The use of topical antimycotics agent sertaconazole (Zalain) and universal antiseptic agent povidone-iodine (Betadine) results in significant clinical effect and longer interrecurrent period. © 2016, Media Sphera Publishing Group. All rights reserved

Alpha-adrenergic receptor agonists in terms of modern views on glaucoma monitoring and treatment

The article reviews historical aspects of direct and indirect (by reducing intraocular pressure (IOP)) neuroprotective effect of brimonidine in terms of modern views on glaucoma monitoring and treatment. Brimonidine, a selective alpha-adrenergic receptor agonist, is the first-line treatment choice for glaucoma. This agent reduces IOP by decreasing aqueous humor production and improving uveoscleral outflow. The result is the achievement of target IOP. Brimonidine prevents ganglionic cell death in glaucomatous optic neuropathy. Several in vitro and in vivo studies describe the mechanism of preventing mitochondrial dysfunction and excitotoxic retinal cell damage in ischemia. Brimonidine affects NMDA receptors, inhibits proapoptotic protein expression, activates neurotrophic processes, and normalizes oxidative phosphorylation thus preventing mitochondrial dysfunction.&nbsp; According to the modern concept, the aim of glaucoma treatment is to avoid vision loss by preventing ganglionic cell death. Therefore, lifelong visual field monitoring and neuroprotective therapy are required. Brimonidine provides target IOP and prevents retinal cell death thus preserving vision in glaucoma.&nbsp; Keywords: glaucoma, intraocular pressure, neuroprotection, visual field, monitoring, brimonidine, Luxfen.&nbsp; For citation: Erichev V.P., Petrov S.Yu., Volzhanin A.V. et al. Alpha-adrenergic receptor agonists in terms of modern views on glaucoma monitoring and treatment. Russian Journal of Clinical Ophthalmology. 2019;19(2):87–91.&nbsp; About the authors: 1Valery P. Erichev — MD, PhD, Professor, Head of Glaucoma Department, ORCID iD 0000-0001-6842-7164; 1Sergey Yu. Petrov — MD, PhD, Leading Research Associate of Glaucoma Department, ORCID iD 0000-0001-6922-0464; 1Andrey V. Volzhanin — postgraduate, ORCID iD 0000-0002-1421-8882; 1Darya M. Safonova — MD, PhD, Junior Research Associate of Modern Treatmen in Ophthalmology, ORCID iD 0000-0002-5082-1494; 2Tamara V. Yaremenko — postgraduate, ORCID iD 0000-0002-3094-1958; 3Serzh A. Kazaryan — resident, ORCID iD 0000-0003-2258-2964. 1Reseach Institute of Eye Diseases. 11A Rossolimo str., Moscow, 119021, Russian Federation. 2Sechenov University. 8 Trubeckaya Str., Moscow, 119146, Russian Federation. 3Mkhitar Heratsi Yerevan State Medical University. 2 Koryuna str., Erevan, 0025, Republic of Armenia. Contact information:&nbsp;Andrey V. Volzhanin, e-mail:&nbsp;[email protected].&nbsp;Financial Disclosure:&nbsp;no author has a financial or property interest in any material or method mentioned. There is no&nbsp;conflict of interests. Received&nbsp;11.04.2019. </p

MALT-lymphomas in Sjogren's disease

Aim. To develop algorithm of early diagnosis of extranodal lymphoma arising in patients with Sjorgen's disease (SD). Material and methods. SD diagnosis was made in 457 patients treated in Rheumatology Institute clinic in 1999-2004, 38 (8.3%) females aged 19-82 had lymphoproliferative diseases. MAL T-lymphomas were diagnosed in 15 (42.2%) patients. All the patients have undergone morphological, immunomorphological investigations of the salivary glands, postoperative material was analysed in some patients. In addition, the following investigations were made: ultrasonography of the salivary glands, lymph nodes, viscera; scintigraphy; trephine biopsy of the bone marrow; myelograms; CT of the chest, abdomena and brain; tests for monoclonal immunoglobulins in the serum and light chains in urine, biopsy of the parotid gland. Clinical, morphological and immunophenotypical characteristics of MALT-lymphomas were assessed by WHO classification. Lymphoma stages were classified according to Ann Arbor. Results. Parotid glands were affected with MALT-lymphoma most frequently. Predominant were extranodal lymphomas of the parotid submandibular, minor salivary glands of the lip and lacrimal glands of stage IE-II E. Extranodal lymphoma with nodal lesion of stage IV occurred less frequently. Untreated long existing MALT-lymphomas of the parotid glands may transform into B-large cell lymphomas deteriorating SD prognosis. The presence of long-term (> 12 months) massive enlargement of parotid/submandibular salivary and lacrimal glands, massive infiltration, monoclonal immunoglobulins in blood serum and their light chains in the urine predict development of MALT-lymphoma in SD. Conclusion. In SD, MALT-lymphomas develop primarily in target organs - salivary and lacrimal glands. SD patients with persistent enlargement of the parotid glands need biopsy for early detection of malignant lymphoproliferation

MALT-lymphomas in Sjogren's disease

Aim. To develop algorithm of early diagnosis of extranodal lymphoma arising in patients with Sjorgen's disease (SD). Material and methods. SD diagnosis was made in 457 patients treated in Rheumatology Institute clinic in 1999-2004, 38 (8.3%) females aged 19-82 had lymphoproliferative diseases. MAL T-lymphomas were diagnosed in 15 (42.2%) patients. All the patients have undergone morphological, immunomorphological investigations of the salivary glands, postoperative material was analysed in some patients. In addition, the following investigations were made: ultrasonography of the salivary glands, lymph nodes, viscera; scintigraphy; trephine biopsy of the bone marrow; myelograms; CT of the chest, abdomena and brain; tests for monoclonal immunoglobulins in the serum and light chains in urine, biopsy of the parotid gland. Clinical, morphological and immunophenotypical characteristics of MALT-lymphomas were assessed by WHO classification. Lymphoma stages were classified according to Ann Arbor. Results. Parotid glands were affected with MALT-lymphoma most frequently. Predominant were extranodal lymphomas of the parotid submandibular, minor salivary glands of the lip and lacrimal glands of stage IE-II E. Extranodal lymphoma with nodal lesion of stage IV occurred less frequently. Untreated long existing MALT-lymphomas of the parotid glands may transform into B-large cell lymphomas deteriorating SD prognosis. The presence of long-term (> 12 months) massive enlargement of parotid/submandibular salivary and lacrimal glands, massive infiltration, monoclonal immunoglobulins in blood serum and their light chains in the urine predict development of MALT-lymphoma in SD. Conclusion. In SD, MALT-lymphomas develop primarily in target organs - salivary and lacrimal glands. SD patients with persistent enlargement of the parotid glands need biopsy for early detection of malignant lymphoproliferation

Иммунотерапия

Руководство написано ведущими иммунологами и врачами разных специализаций, применяющими иммунотерапию в своей практике. В книге рассмотрены принципы иммунотерапии, механизмы действия иммунотропных препаратов и их применение в клинической практике. Описаны иммуноглобулины, пептиды тимуса, цитокины, интерфероны и их индукторы, бактериальные иммуномодуляторы и другие группы препаратов иммунной направленности. Представлены схемы применения иммуномодуляторов и результаты лечения инфекционных заболеваний респираторного и желудочно-кишечного трактов, мочевыделительной и репродуктивной систем, кожи и ее придатков, гепатитов, герпесвирусных инфекций, эндокринных заболеваний, различных видов аллергии. Значительное место уделено иммунотерапии в онкологии. Издание предназначено для врачей различных специальностей: терапевтов, педиатров, хирургов, урологов, дерматологов, микологов, венерологов, онкологов, эндокринологов, инфекционистов, аллергологов-иммунологов