EXPERIENCE OF SUCCESSFUL ACNEFORM ERUPTIONS TREATMENT IN PATIENT WITH MULTIPLE MELANOMA

Objective: to describe the results of the joint monitoring and diversified treatment of oncologists and dermatologists those patient with multiple recurrent melanoma who received over a long period a targeted anti-cancer therapy, which was complicated by side-effect as widespread acneform rush, resistant to traditional treatment. Patient A., born in 1988, was followed up and got a treatment more than 2 years in oncology out-patient clinic diagnosed with “Melanoma of the front surface of the left leg T2bN0M0 IIA”. Subsequently, the patient was verified metastasis in the inginal lymph nodes, in the soft tissues of the hips, to liver. Acute adverse reaction has developed in a short time after getting the anti-tumor target therapy as generalized acneform rush and itching of the skin. Skin symptoms accompanied by pronounced psychological and emotional stress, therefore, dermatologists have been invited to provide additional medical assistance to this patient. Due to the fact that subsequent traditional anti-acne algorithms of topical and oral treatment was not such effective, there was made a decision to use an alternative supporting external therapy, which did not have similar examples of usage previously. Results. External application of tacrolimus ointment in combination with other drugs and then as a mono-therapy, allows us in a rather short period achieve a stable and pronounced regression of skin pathological lesions, to return to the previously cancelled initial drug dose of the anti-tumor target therapy, to change significantly components of the patient’s quality of life. Conclusion. The search for additional and alternative treatment approaches for similar patients, as in our case, remains relevant for specialists and patients themselves. This case is an example of alternative approach to the tacrolimus topical application in patient with drug-mediated acneform rush

Боль в спине и оценка активности анкилозирующего спондилита на фоне гестации: симптомы, отражающие обострение заболевания, и беременность

Objective: to study the dynamics of back pain severity and the frequency of its individual components, characterizing the inflammatory and mechanical rhythm, on the background of gestation in women with ankylosing spondylitis (AS) and compare them with manifestations of dorsopathy in healthy pregnant women; to determine the information value of BASDAI during pregnancy, i.e. to identify its components with the optimal sensitivity and specificity ratio for assessing AS activity during gestation.Patients and methods. The main group consisted of 49 pregnant women with AS who met the modified New York criteria of 1984. The average age of patients was 31.7±4.9 years, the average duration of the disease was 134.4±85.8 months. BASDAI for trimesters of pregnancy was: 2.3 [1.2; 4.4], 2.8 [1.4; 4.2] and 2.2 [1.6; 4.0]. The control group included 51 pregnant women with back pain associated with gestation, without rheumatic diseases. The average age was 28.0±4.4 years. The intensity of back pain was assessed on a numerical rating scale. ROC-analysis was performed with calculation of the area under the curve (AUC) of each component of BASDAI in each pregnancy trimester.Results and discussion. More than 80% of pregnant women with AS experienced back pain, while the intensity of general back pain did not differ from that in the control group. Night back pain with improvement on awakening in the main group was present in 70%, 58% and 68.8% of women, respectively, in the I-III trimesters; its intensity was 3 [1; 5], 3.5 [3; 6] and 3.4 [2; 5] respectively; the frequency and severity of night pain were higher than in the control group. The number of women with improvement after exercise in the II and III trimesters did not differ in both groups. In the second half of pregnancy, 40% of AS patients noted improvement during rest, 52.1% – increased pain after exercise; the frequency of mechanical rhythm pain elements remained lower than in the control group. The AUC value for BASDAI in the first trimester was 0.74; AUC of all BASDAI components was >0.5. In the II and III trimesters, the AUC values for fatigue and back pain were 0.8.Conclusion. During pregnancy the vast majority of women with AS experience back pain, the nature of which changes in the second half of gestation. Night pain that improves on awakening reflects AS activity and is not related to pregnancy. The BASDAI components of severity and duration of morning stiffness have the highest classification value during pregnancy. Цель исследования – изучить динамику выраженности боли в спине и частоту ее отдельных компонентов, характеризующих воспалительный и механический ритм, на фоне гестации у женщин с анкилозирующим спондилитом (АС) и сравнить их с проявлениями дорсопатии у здоровых беременных; определить информативность BASDAI во время беременности, т. е. выявить его компоненты с оптимальным соотношением чувствительности и специфичности для оценки активности АС при гестации.Пациенты и методы. Основную группу составили 49 беременных с АС, соответствовавших модифицированным Нью-Йоркским критериям 1984 г. Средний возраст пациенток – 31,7±4,9 года, средняя продолжительность болезни – 134,4±85,8 мес. BASDAI по триместрам беременности равнялся: 2,3 [1,2; 4,4], 2,8 [1,4; 4,2] и 2,2 [1,6; 4,0]. В контрольную группу вошла 51 беременная с болью в спине, связанной с гестацией, без ревматических заболеваний. Средний возраст – 28,0±4,4 года. Интенсивность боли в спине оценивали по числовой рейтинговой шкале. Выполнен ROC-анализ с вычислением площади под кривой (AUC) каждого компонента BASDAI в каждом триместре беременности.Результаты и обсуждение. Более 80% беременных с АС испытывали боль в спине, при этом интенсивность общей боли в спине не отличалась от таковой в контрольной группе. Ночная боль в спине с улучшением при пробуждении в основной группе имелась у 70, 58 и 68,8% женщин соответственно в I–III триместрах; ее интенсивность составила 3 [1; 5], 3,5 [3; 6] и 3,4 [2; 5] соответственно; частота и выраженность ночной боли были выше, чем в контрольной группе. Количество женщин с улучшением после выполнения физических упражнений во II и III триместрах не различалось в обеих группах. Во второй половине беременности 40% больных АС отметили улучшение во время отдыха, 52,1% – усиление боли после физических упражнений; частота элементов боли механического ритма оставалась ниже, чем в контрольной группе. Значение AUC для BASDAI в I триместре составляло 0,74; AUC всех компонентов BASDAI была >0,5. Во II и III триместрах значения AUC для утомляемости и боли в спине оказались 0,8.Заключение. Подавляющее большинство женщин с АС во время беременности испытывают боль в спине, характер которой меняется во второй половине гестации. Ночная боль с улучшением при пробуждении отражает активность АС и не связана с беременностью. Наиболее высокой классификационной ценностью при беременности обладают такие компоненты BASDAI, как выраженность и длительность утренней скованности

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase

Problems of development of the circular economy as a factor in Russia’s sustainable development

Aim. To investigate the process of formation of the circular economy in Russia within the framework of ensuring sustainable development and to identify the problems of forming a circular economy and the barriers that hinder the process of implementing business models of a circular economy in enterprises.Materials and Methods. Our study is based on systems analysis, comparative and statistical methods.Discussion. The research results have confirmed the necessity of transition to the formation a circular economy in Russia. This is despite the fact that the volume of recycled waste arising from production and consumption in Russia is growing faster than that of its generation, the actual proportion of recycling and waste disposal is growing rather slowly (somewhat more than 50%), while the proportion of the volume of production and consumption waste placed at company facilities, on average, amounted to 50% for the period analysed. Greenhouse gas emissions also have a negative impact on the environment with those of the "Economy" sector accounting for almost 79% thus determining the relevance of transition to renewable energy.Conclusion. The transition to a circular economy, in particular as a result of the use of renewable energy, will reduce the negative impact of anthropogenic pressure on the environment and ensure a balance between the environmental, economic and social components of sustainable development

APPLICATION OF INTENSIVE LIGHT RADIATION IN THE PATIENT WITH ERYTHEMATOTELANGIECTATIC ROSACEA

We present a description of the clinical case of a patient with an erythematotelangiectatic type of rosacea. Rosacea is a chronic recurrent dermatosis, characterized by skin lesions of the face in the  form of erythema and papulopustular elements, which has  polyethological origin. The disease occurs more frequently in women  aged 30-50 years who have a certain genetic predisposition to  transient reddening of the skin of the face or less often of the neck  and the decollete zone. It is believed that the dermatosis is more  likely to affect the I and II phototypes, but the disease can occur in  any skin phototype. The patient came to the clinic with complaints  about rashes in the chin and nasolabial triangle, flushing of the face,  accompanied by tingling and burning. The patient turned to the clinic with complaints about rashes in the chin and nasolabial triangle,  flushing of the face, accompanied by tingling and burning. She never consulted a dermatologist before. A diagnosis was made: “erythematotelangiectatic type of rosacea” (according to the  classification proposed by the USA National Rosacea Society, stage I  — persistent erythema and telangiectasia). Using the scale of diagnostic evaluation of rosacea, it was evaluated at 12 points.  There are many approaches to the treatment of rosacea. Drug  therapy is divided into systemic, external and complex. Systemic therapy has a number of side effects, so for light and medium-to- severe rosacea, only external therapy is more often prescribed.  Because of the presence of pathologically altered vessels, the low  efficacy of metronidazole, the patient was assigned a course of  phototherapy with intense incoherent pulsating light at standard  parameters. There was a significant improvement after two  procedures, but vessels smaller than 0.4 mm remained intact, so the duration of the first pulse was increased in order to influence small- caliber vessels. Individual selection of parameters (duration of the first impulse and fluence) was made based on the dermatoscopic picture and patient’s phototype, which resulted in a significant  clinical effect and persistent remission. Using the scale of diagnostic  evaluation of rosacea it was evaluated at 1 point after treatment.  This clinical case demonstrates the effectiveness of phototherapy  with intense incoherent pulsating light with individual selection of the duration of the first pulse and energy density in patients with  erythematotelangiectatic rosacea. In IPL-treatment schemes, it is  desirable to select individual parameters for the duration of the first pulse and the energy density, based on the features of the dermatoscopic picture and skin phototype of each individual patient

The Dermatological Manifestations in the Coronavirus Infection COVID-19

The variety of dermatological manifestations in patients with the novel coronavirus infection COVID-19, the incidence of which depends on concomitant pathology and the characteristics of drug treatment, and their characteristics are similar to those that occur with conventional viral infections is discussed. At the present time it is proposed to distinguish several groups depending on the cause and mechanism of development: angiitis of the skin; papulo-squamous rash and pink lichen; measles rash and infectious erythema; papulo-vesicular rash; toxidermia; urticarial eruptions and artifical lesions. The variety of the clinical picture of the skin manifestations of coronavirus infection requires in-depth analysis in order to interpret correctly the skin lesions and other infectious exanthema and dermatoses in patients with COVID-19

Отчуждение студентов от обучения: могут ли метакогнитивная регуляция и осознание смысла обучения помочь его преодолеть?

Introduction. The alienation of students from learning and its consequences are an urgent problem for universities. The study of external and internal factors affecting the state of alienation, including metacognitive and meaning, will be helpful for the creation of prevention and correction programs and reduce the percentage of low academic performance, skipping classes, and deductions. This study is aimed to establish the interrelationships of alienation, metacognitive regulation of activity and the subjectively assessed meaning of learning. Methods. The study involved 209 students aged 17 to 24 years. We used: A test questionnaire "Subjective alienation of educational work", a questionnaire "Metacognitive involvement in activity", and an author\u27s questionnaire to study alienation from education among students of higher educational institutions and its semantic aspects. Results. The analysis showed the presence of negative correlations of the general level of metacognitive regulation of activity with the general indicator of alienation (-0.467, significance at 0.01) and with all scales of the methodology "Subjective alienation of educational work". The level of subjective feeling of fullness of learning with meaning was negatively associated with the general indicator of alienation (-0.564, significance at the level of 0.01) and with all scales of the methodology "Subjective alienation of educational work", and positively associated with the general level of metacognitive regulation of activity (0.471, significance at the level of 0.01). Discussion of the results. The results obtained complement the studies that indicate a significant role of meaning loss, feelings of meaninglessness, the fullness of meaning, and the life meaning of learning in assessing the level of alienation from learning. The relationships between the level of alienation and the level of metacognitive regulation of activity can serve as a starting point for studying how the management of cognition processes and the student\u27s involvement in the learning process are connected. The practical application of the results indicates the importance of increasing the adaptability of students and the importance of specialized training of students to manage their educational activities to reduce the state of alienation and involve them in the educational process.Введение. Отчуждение студентов от обучения и его последствия являются насущной проблемой для университетов. Исследование внешних и внутренних факторов, влияющих на состояние отчуждения, в том числе метакогнитивных и смысловых, поможет выстроить программы профилактики и коррекции, снизить процент низкой успеваемости, пропуска занятий, отчислений. Цель данного исследования заключения в установлении взаимосвязей отчуждения, метакогнитивной регуляции деятельности и субъективно оцениваемого смысла обучения. Методы. В исследовании приняли участие 209 студентов в возрасте от 17 до 24 лет. Нами были использованы: Тест-опросник «Субъективное отчуждение учебного труда», опросник «Метакогнитивная включенность в деятельность», авторский опросник для исследования отчуждения от образования среди студентов высших учебных заведений и его смысловых аспектов. Результаты. Проведенный анализ показал наличие отрицательных взаимосвязей общего уровня метакогнитивной регуляции деятельности с общим показателем отчуждения (-0,467, значимость на уровне 0,01) и со всеми шкалами методики «Субъективное отчуждение учебного труда». Уровень субъективного ощущения наполненности обучения смыслом оказался отрицательно связан с общим показателем отчуждения (-0,564, значимость на уровне 0,01) и со всеми шкалами методики «Субъективное отчуждение учебного труда», и положительно связан с общим уровнем метакогнитивной регуляции деятельности (0,471, значимость на уровне 0,01). Обсуждение результатов. Полученные результаты дополняют исследования, которые указывают на важную роль: смыслоутраты, ощущения бессмысленности, наполненности смыслом, жизненного смысла обучения при оценке уровня отчуждения от обучения. Обнаруженные взаимосвязи между уровнем отчуждения и уровнем метакогнитивной регуляции деятельности могут послужить отправной точкой для изучения того, как связано управление процессами познания и причастность студента к процессу обучения. Практическое применение результатов указывает на важность повышения адаптированности студентов, важность специализированного обучения студентов управлению своей учебной деятельностью для снижения состояния отчуждения и вовлечению их в учебный процесс