Дифференцированный подход к лечению лактазной недостаточности и аллергии на белок коровьего молока у детей раннего возраста

One of the most common pathologies in infants is a lactase deficiency and allergy to cow's milk protein. Treatment of lactase deficiency and allergies to cow's milk protein in young children requires a differentiated approach. The best food for the child's first months of life is mother's milk provides adequate development of the child's body. The use of lactase preparations, such as LAKTAZAR® with lactase deficiency pathogenetically justified and allows a short time to eliminate its main clinical manifestations, while retaining the possibility of breastfeeding.Одной из распространенных патологий у детей первого года жизни является лактазная недостаточность и аллергия на белок коровьего молока. Лечение лактазной недостаточности и аллергии на белок коровьего молока у детей раннего возраста требует дифференцированного подхода. Оптимальным продуктом питания для ребенка первых месяцев жизни является материнское молоко, обеспечивающее адекватное развитие детского организма. Применение препаратов лактазы, например ЛАКТАЗАРА® при лактазной недостаточности патогенетически обосновано и позволяет за короткое время устранить ее основные клинические проявления, сохранив при этом возможность грудного вскармливания

Продолжительность жизни больных метастатическим раком мочевого пузыря в Российской Федерации: результаты многоцентрового регистрового исследования URRU

Background. Data on the overall survival (OS) of patients with metastatic bladder cancer (BCa) is rarely published.The objective of the URRU register study is to assess OS and collect information on the administration of different treatments in patients with metastatic BCa in routine clinical practice in Russia.Materials and methods. Patients were retrospectively identified in 9 oncology centers in different regions of Russia and included in the study if they were diagnosed with metastatic BCa between January 2017 and January 2018. We collected anonymized data online, including demographic characteristics of patients, details of their therapy, and outcomes.Results. This study included 246 patients. Their mean age upon the diagnosis of metastatic BCa was 72 years with 60.6 % of patients over 70 years of age. The proportion of males was 74.8 %. The histological subtype of BCa (urothelial carcinoma, etc.) was identified in 70.3 % of cases. Ninety-two patients (37.4 %) received pharmacotherapy. The most common treatment option was chemotherapy (76 %); the most common drug combination was gemcitabine and cisplatin (41.3 %). Immunotherapy was used in 19.6 % of patients; 13.6 % of participants received more than two lines of therapy. Three-year OS rate was 10.6 %; median OS was 7 months (95 % confidence interval (CI) 5.4-8.6). Patients receiving systemic therapy demonstrated significantly longer survival than those receiving no therapy (21 months; 95 % CI 17.38-24.62 vs 3 months; 95 % CI 1.79-4.22; p <0.0001). Patients receiving immunotherapy had better survival than individuals receiving chemotherapy (median OS 34.5 months vs 18 months; p = 0.003).Conclusion. The survival rates in the URRU study were relatively low, which can be attributed to the fact that only one-third of patients received pharmacotherapy and very few patients received immunotherapy. Second and subsequent lines of therapy were rarely used in patients with progressive disease. The implementation of novel treatments, including immune checkpoint inhibitors, will increase the survival of BCa patients.Введение. Данные по общей выживаемости (ОВ) пациентов с метастатическим раком мочевого пузыря (РМП) публикуются редко.Цель регистрового исследования URRU - оценка ОВ и сбор сведений по применению разных вариантов терапии метастатического РМП в условиях реальной клинической практики в российской популяции пациентов.Материалы и методы. Пациентов ретроспективно идентифицировали в 9 онкологических центрах в разных регионах России и включали в исследование, если диагноз метастатического РМП был установлен в период с января 2017 г. по январь 2018 г. Анонимные сведения собирали онлайн, регистр охватывал демографические характеристики, а также данные по терапии и исходам.Результаты. В исследование для анализа были включены 246 больных. Средний возраст на момент постановки диагноза метастатического РМП составил 72 года, при этом 60,6 % пациентов были старше 70 лет. Мужчин было 74,8 %, гистологический подтип РМП (уротелиальный или др.) верифицирован в 70,3 % случаев. Лекарственную терапию проводили 92 (37,4 %) пациентам. Самым часто применявшимся вариантом лечения была химиотерапия (76 %), а наиболее часто назначаемой комбинацией - гемцитабин и цисплатин (41,3 %). Иммунотерапию проводили у 19,6 % пациентов. Более 2 линий терапии получили 13,6 % больных. Трехлетняя ОВ составила 10,6 %, медиана ОВ - 7 мес (95 % доверительный интервал (ДИ) 5,4-8,6). Медиана ОВ (21 мес; 95 % ДИ 17,38-24,62) у пациентов, получавших системную терапию, была значительно больше, чем у пациентов, у которых терапия не проводилась (3 мес; 95 % ДИ 1,79-4,22; p <0,0001). Пациенты, получавшие иммунотерапию, имели лучшие результаты по показателям выживаемости по сравнению с таковыми у больных, у которых проводилась химиотерапия (медиана 0В 34,5 мес против 18 мес; p = 0,003).Заключение. Показатели ОВ в исследовании URRU являются скромными, что можно объяснить назначением лекарственного лечения только трети пациентов, низкой частотой применения иммуноонкологических препаратов, редким назначением терапии во 2-й и последующих линиях при прогрессировании заболевания. Внедрение новейших вариантов лекарственного лечения, в том числе ингибиторов контрольных точек, будет способствовать увеличению продолжительности жизни больных

Ревматоидный артрит в реальной клинической практике. Результаты проекта «Компьютерные терминалы самооценки для пациентов с ревматическими заболеваниями» («ТЕРМИНАЛ-I»)

Objective: to describe the portrait of a patient with rheumatoid arthritis (RA) in real clinical practice, to assess disease activity from the point of view of a physician and a patient, functional status, quality of life (QOL), and the efficiency of the therapy performed.Patients and methods. The investigation enrolled 976 RA patients from a cohort of patients in the TERMINAL-I multicenter study, who, when visiting a rheumatologist, independently assessed the disease activity and QOL using a computer system (the «Computer Terminals of SelfAssessment for Patients with Rheumatic Diseases» project). The mean age of the patients was 52.30±13.3 years; women accounted for 85%; the median disease duration 8.0 [4.0; 14.0] years. Baseline clinical parameters and pharmacotherapy were evaluated for 6 months. The disease activity was determined by the DAS28 and RAPID-3 indices; functional status and quality of life were evaluated by the HAQ and the EQ-5D, respectively.Results. 83% of the RA patients were positive for rheumatoid factor and 60% were for anti-cyclic citrullinated peptide antibodies. There was a preponderance of patients with high (40.5%) and moderate (46.8%) RA activity; 6.9% were observed to have a low activity; 5.8% had clinical remission. The mean values of DAS28 and RAPID-3 were 4.7±1.3 and 13.7±3.6, respectively. Only 14.3% of patients had a good functional status that was comparable with the population-based control (HAQ≤0.5). The remaining patients were found to have a substantial decrease in joint functional parameters (median HAQ 1.88 [1.0; 2.5]) and EQ-5D QOL (0.60 [0.60; 0.74). Prosthetic joints were present in 7.4% of patients. At visit 1 to a rheumatologist, the therapy was changed in 15% of patients. During 6-month follow-up, conventional disease-modifying anti-rheumatic drugs were taken by almost all (91.2%) patients. Of them, 70.9% of the patients were treated with methotrexate (MTX): 77.0% received the latter at a dose of 15 mg/week and 23.0% had it at a dose of >15 mg (17.5 to 40 mg/week). Glucocorticoids could be stopped in 20.5% of the patients within six months. Tumor necrosis factor-α inhibitors and anti-B-cell therapy were used in 6.6 and 16.2% of patients, respectively. At 6-month follow-up (Visit 2), 54% of patients achieved a 20% clinical improvement in the ACR criteria. At the same time, the DAS28 scores decreased substantially from 4.5±1.2 to 3.8±1.1 (p = 0.0001). There was a minimal functional improvement in the HAQ index in 64% of patients and a better EQ-D QOL scores in 16%.Conclusion. The majority of RA patients who came to the rheumatologists showed high to moderate disease activity. This was due to long disease duration, inadequate MTX dose, and insufficient patient monitoring in real clinical practice. Introduction of a computer system for selfassessment of their health status by RA patients in an outpatient setting could improve the interaction of physicians, nurses, and patients, better monitor disease activity, and enhance therapeutic efficiency. Цель исследования – описание «портрета» пациента с ревматоидным артритом (РА) в реальной клинической практике, оценка активности заболевания с точки зрения врача и пациента, функционального состояния, качества жизни (КЖ) и эффективности проводимой терапии.Пациенты и методы. В исследование включено 976 пациентов с РА из когорты больных, входящих в многоцентровое исследование «ТЕРМИНАЛ-I», которые при обращении к ревматологу самостоятельно оценивали активность заболевания и КЖ с помощью компьютерной системы (проект «Компьютерные терминалы самооценки для пациентов с ревматическими заболеваниями»). Средний возраст пациентов составил 52,30±13,3 года, 85% – женщины, медиана длительности заболевания – 8,0 [4,0; 14,0] лет. Проводилась оценка базовых клинических параметров и фармакотерапии в течение 6 мес. Активность заболевания определялась по индексам DAS28 и RAPID-3, функциональный статус – по индексу HAQ, качество жизни – по EQ-5D.Результаты. 83% больных РА были позитивными по ревматоидному фактору и 60% – по антителам к циклическому цитруллинированному пептиду. Преобладали пациенты с высокой (40,5%) и умеренной (46,8%) активностью РА, у 6,9% отмечалась низкая активность, у 5,8% –клиническая ремиссия. Среднее значение индекса DAS28 составило 4,7±1,3, RAPID-3 – 13,7±3,6. Только 14,3% пациентов имели хорошее функциональное состояние, сравнимое с популяционным контролем (HAQ ≤0,5). У остальных больных отмечалось значительное снижение показателей функции суставов (медиана HAQ 1,88 [1,0; 2,5]) и КЖ по индексу EQ-5D (0,60 [0,60; 0,74]). Протезированные суставы имели 7,4% больных. При 1-м визите к ревматологу терапия была изменена у 15% пациентов. В течение 6 мес наблюдения практически все пациенты (91,2%) получали стандартные базисные противовоспалительные препараты. Из них 70,9% пациентов находились на терапии метотрексатом (МТ): 77,0% получали его в дозе 15 мг/нед и 23,0% – >15 мг (от 17,5 до 40 мг/нед). 20,5% пациентам в течение полугода удалось отменить глюкокортикоиды. Ингибиторы фактора некроза опухоли α использовали 6,6% больных, анти-В-клеточную терапию – 16,2%. После 6 мес наблюдения (2-й визит к врачу) 20% клиническое улучшение по критериям ACR достигнуто у 54% больных. При этом отмечалось значительное снижение индекса DAS28 (с 4,5±1,2 до 3,8±1,1 балла; p=0,0001). Минимальное функциональное улучшение по индексу HAQ зафиксировано у 64% пациентов, улучшение КЖ по EQ-5D – у 16%.Выводы. Высокая и умеренная активность заболевания, снижение показателей КЖ были характерны для большинства пациентов с РА, обратившихся к ревматологу. Это было связано с большой длительностью заболевания, неадекватной дозой МТ и недостаточным мониторингом пациентов в реальной клинической практике. Введение компьютерной системы самооценки состояния здоровья пациентов с РА на поликлиническом уровне позволило улучшить взаимодействие врачей, медицинских сестер и пациентов, более качественно контролировать активность заболевания и повысить эффективность терапии.

MISSION OF MODERN SCHOOL – SPIRITUAL-MORAL EDUCATION OF YOUTH

Introduction: unfavorable phenomena in society make new demands for the upbringing and development of the child's personality, for transforming his views on the surrounding reality, for changing his attitude towards people, himself and his own activity. However, some theorists and practitioners of education defend the position of denying the need for a school of educational work and shift their entire attention only to the problems of teaching, focusing on the technological development of education. However, it is quite obvious that the school has always been, is and will be a teaching and educational institution responsible not only for educating children, but also for the development of the child's personality. In modern conditions, the need to focus the content of educational programs on Russian culture, traditions of people's life, local history is actualized. The purpose of the article is to present the results of the long-term experience of one of the leading schools of Nizhny Novgorod, MAOU "School No. 187 with in-depth study of individual subjects"..Materials and methods: the diversity of the material studied required the use of different approaches and a set of complementary methods that ensured the objectivity and scientific validity of the research results: theoretical methods: comparative-comparative analysis of philosophical, psychological, pedagogical, methodological literature; method of scientific synthesis of factual materials; inductive and deductive methods in their unity in the generalization of materials; pedagogical monitoring: evaluation and analysis of products of activity. Methodological basis is system, personality-activity and culturological approaches.Results: in the scientific research, the conceptual foundations of the spiritual and moral system of the upbringing of the school are revealed; the modern approach to development and realization of educational process on the basis of orthodox values and cultural traditions is proved. The expediency of introduction of administrative-organizational, pedagogical, psychological, technological conditions of introduction of the system of education in school is proved. The development of the personality of the teacher in the spirit of traditional Orthodox values is determined by the fundamental condition for the realization of the tasks of spiritual and moral education of students in school. Features of introduction of innovative forms of the organization of educational process are considered. The criteria for the effectiveness of spiritual and moral education in the educational organization, diagnostic tools are presented.Discussion and Conclusions: the long-term experience of the school proves the readiness of the school to effectively ensure the formation of spiritual, moral, and civil security of the individual in pupils, successful socialization and professional self-determination of students, which ultimately contributes to increasing civil responsibility for the fate of the country, security and sustainable development of the country

RISK FACTORS OF LOW BONE MINERAL DENSITY IN CHILDREN WITH CELIAC DISEASE

The study shows that the long-term non-adherence to glutenfree diet, growth retardation, biological maturation are factors that adversely affect the parameters of BMC and BMD. On gluten-free diet patients with celiac retain physiological principles of accumulation of the mineral and bone remodeling in the skeleton

The Differentiated Approach to the Treatment of Lactase Deficiency and Allergies to Cow's Milk Protein in Infants

One of the most common pathologies in infants is a lactase deficiency and allergy to cow's milk protein. Treatment of lactase deficiency and allergies to cow's milk protein in young children requires a differentiated approach. The best food for the child's first months of life is mother's milk provides adequate development of the child's body. The use of lactase preparations, such as LAKTAZAR® with lactase deficiency pathogenetically justified and allows a short time to eliminate its main clinical manifestations, while retaining the possibility of breastfeeding

Family case of Schwachman-Diamond syndrome

Schwachman-Diamond syndrome is a disease characterized by exocrine pancreatic insufficiency, hematological disorders, growth retardation and bone abnormalities. The disease is caused by mutations in the SBDS gene. Early diagnosis and timely start of comprehensive treatment, including clinical nutrition, appointment of enzyme preparations and granulocyte colony stimulating factor, improve the quality of life and prognosis of these patients. The article describes the clinical observation of the Schwachman-Diamond syndrome’s family case

Some aspects of antiferromagnetic ordering in LiMnP 0.85V 0.15O 4: Neutron diffraction and DC-magnetization studies

V-substituted LiMnPO 4 has been synthesized by the solid state reaction route. Combined Rietveld refinement of neutron and X-ray data revealed that all vanadium ions are located in the same positions as the phosphorus ions. The magnetic structure of LiMnP 0.85V 0.15O 4 was found to be the same as that described for undoped antiferromagnetic LiMnPO 4 (T N=34.5 K). DC-magnetization measurements were carried out to study the peculiarities of magnetic ordering in LiMnP 0.85V 0.15O 4. An irreversible behavior of DC magnetization was found at magnetic fields less than ∼2 kOe. It was demonstrated that an increase in the magnitude of the applied field leads to a reduction of the discrepancy between zero-field-cooled and field-cooled processes. These effects were explained by the movement of domain walls and by transition of the system to a monodomain state. The anomaly in the magnetization vs field dependence attributed presumably to the spin-flop transition was observed at ∼40 kOe. The existence of magnetic inhomogeneity in the paramagnetic phase of LiMnP 0.85V 0.15O 4 was proved by the analysis of the χT product. It was concluded that the observed changes in χT are indicative of a competition between ferromagnetic and antiferromagnetic correlations at temperatures slightly exceeding T N. © 2012 Elsevier B.V. All rights reserved