Clinical Presentation, Diagnosis and Management of TB-HIV Comorbidity in Children

The problem of combination of tuberculosis and human immunodeficiency virus (HIV) infection remains urgent. Ninety percent of women with HIV infection are of childbearing age that results in increasing the number of children with HIV infection in perinatal contact. In Saint Petersburg from 2014 to 2017, about 5000 children were born from a perinatal contact for HIV infection; by 2017, more than 300 children have confirmed HIV infection. The comparative analysis of case histories of 25 children with TB/HIV combination and 50 children with tuberculosis without HIV infection was performed. Analysis of the study results showed that there are cases of late diagnosis of HIV infection. TB is detected clinically more frequently in children with HIV infection than in children without HIV infection (25 and 5%, respectively). More than one-third of the patients with coinfection had negative sensitivity to tuberculin and DST. The prevalence and the severity of TB in children with HIV infection correlates with the degree of immunosuppression. Eight percent of children had immune reconstitution inflammatory syndrome. Treatment of patients with coinfection associated in most cases with the increased period of total treatment course. Four children with HIV infection vaccinated with BCG were diagnosed with generalized tuberculosis

The Problem of Developing Schoolchildren’s Cognitive Activities in the Educational Process

This article aims to a research problem that emphasizes the necessity to guide and organize schoolchildren’s cognitive activities. In a situation when cognition becomes the leading activity, new opportunities are opened up for the organization of the whole educational process, including its other aspects such as – development, and learning. The experiment conducted revealed problem points of organizing the process of cognition as well as the necessity for collecting additional data for a future experiment. The paper also puts forward the idea of a correlation between the hierarchical system of principles of education and types of adequacy

OPPORTUNITIES AND PROSPECTS OF DEVELOPMENT FOR THE DIGITAL ECONOMY IN THE WORLD AND THE RUSSIAN FEDERATION

Implementation of digital economy tools in the new information environment is a catalyst for innovative development of the economic environment of the state as a whole. It is obvious that not all the available opportunities and resources for the development of the digital economy have found their vectors of implementation, many of them have not been studied sufficiently and haphazardly, the existing potential and prospects have not been disclosed.Understanding of the need to develop elements of the digital economy has come to a head in the Russian economic and legal environment, as evidenced by the development and implementation of priority areas of the strategy of scientific and technological development of Russia. The mentioned problems determine the relevance of the research study of the possibilities of applying the positive foreign experience of digitalization of the economy in domestic practice. The paper provides an overview of the main categories of the digital economy, examines the features of its widespread distribution in the countries of the world, assesses the opportunities and prospects for the development of digitalization in Russia. New technologies, criteria and approaches to assessing the level of the digital economy, its institutionalization require effective regulation and management.

Influence of the role and status of a preschool child on the keeping a positive microclimate inside the family

The article deals with the problem of the influence of the role and status of a child on the keeping a positive microclimate inside the family and positive relationships between parents and children. Preschool age is like no other characterized by the strongest dependence on adults, and this stage of personality development is mainly determined by the child’s relationships with adults. Even adults themselves sometimes do not understand how their personal qualities become the property of children, in what way, according to the specifics of childhood, they are interpreted, and what significance they acquire for the child. In connection with the special educational role of the family, the issue of how to maximize the positive interaction between family members, minimizing the negative impact of adult family members on children, is of particular importance. The article is devoted to this issue. The aim of the study is to identify the influence of the role status of a preschool child on maintaining a positive microclimate in the family. The methodology of our study was based on the application of a set of theoretical and practical methods. As a result of the study, we concluded that parents, in order to maintain a positive microclimate in the family, must take into account the following features of a preschool child: a) a child can arbitrarily control its behavior, as well as processes of attention and remembering, emotional reactions; b) in any type of activity, a child can go beyond the immediate situation, realize the time perspective, at the same time keep in consciousness a chain of interrelated events or different states of a substance or a process; c) the leading value in the psychological development of a preschool child is imagination. In order to maintain a positive microclimate in the family, it is necessary to accept the child as he is, with all his personality characteristics. The main role of the child in such a family is the role of her beloved member

Спирометрические и структурно-функциональные изменения работы аппарата внешнего дыхания у пациентов с хронической сердечной недостаточностью

The purpose of the study. To identify structural changes and functional modifications in respiratory muscle performance in patients with congestive heart failure.Materials and methods. We conducted prospective observational study at the V.A. Almazov National Medical Research Center involving 118 subjects: 49 patients with congestive heart failure (CHF-group) and 69 healthy people (control group). NYHA functional classes of II to IV were taken as inclusion criteria in the CHF group, and respiratory diseases, abdominal pathology, morbid obesity, and anemia – as exclusion criteria.Ultrasound imaging was used to assess the structural (thickness) and functional (thickening and excursion indices) diaphragmatic impairments during quiet (resting) and deep breathing. Facemask spirometry was used to assess pulmonary function.Results. Patients with CHF were on average older than 59.0 years (53.0;70.0) vs. 25.0 years (24.0;26.0) in the control group, p=0.000001, had excessive body weight - 82.0 (73.0;95.0) vs. 68.5 (55.0;84.0) kg, p=0.000005 and higher body mass index - 28.4 (24.3;31.3) vs 21.8 (19.9;24.0) kg/m2, p=0.000001, but did not differ in height 173.0 (166.0;179.0) vs. 170.0 (165.0;183.0) cm, 0.97.Lower maximum inspiratory volume (MIV): 3000,0 (2300,0;4000,0) vs. 3684,1 (3392,5;4310,8) ml, p=0.0006, and negative inspiratory force (NIF) measured as max negative pressure generated by the respiratory muscles: 43,1 (-56,7; -33,0) vs. 53,5 (-58,8; - 50,9) mBar, p=0.000082, respectively were found in patients with CHF. The diaphragm was significantly thicker (mm) in patients with CHF during quiet (eupnea) and deep breathing compared to healthy subjects. The thickness at the end of quiet inspiration was 3,0 (2,2;3,6)/1,9 (1,5;2,2) in the right hemi-diaphragm, p <0.001; and 3,0 (2,4;3,5)/1,7 (1,4;2,0) – in the left, p=0.000001; thickness at the end of quite expiration - 2,2 (1,8;2,9)/1,5 (1,2;1,7) in the right dome, p=0.000001; and 2,0 (1,7;2,5)/1,4 (1,2;1,5) – in the left, p=0.000001. Thickness at the end of deep in spiration was 5.1 (4.4;6.1)/4.4 (3.6;5.1) in the right dome, p=0.0005, and 4,9 (4,2;6,2)/ 3,7 (3,1;4,8) – in the left, p=0,000007.The diaphragm thickening index during deep breathing was lower in the CHF group than in the control group: 131.1 (82.5;181.8) vs. 190.9 (150.0;240.0) in the right dome, p=0.000004; and 148.8 (112.5;190.3) vs. 175.2 (130.7;227.7) – in the left, p=0.03, respectively. Diaphragmatic excursions during quiet breathing were larger in patients with CHF than in healthy controls : 2,3 (1,6;2,8)/1,7 (1,5;1,9), p=0,0001 and 1,8 (1,5;2,2)/1,5 (1,3;1,9), p=0,03 of the right and left domes, respectively.Conclusion. Congestive heart failure contributes to the development of structural and functional impairments of the diaphragm.  Цель исследования. Выявить структурно-функциональные изменения состояния аппарата внешнего дыхания у пациентов с хронической сердечной недостаточностью.Материалы и методы. Провели проспективное обсервационное исследование на базе Национального медицинского исследовательского центра им. В.А. Алмазова у 118 испытуемых: 49 пациентов с хронической сердечной недостаточностью (ХСН) и 69 – здоровых людей (контрольная группа). Критериями включения пациентов в группу c ХСН служило наличие ХСН II-IV функционального класса по NYHA. Критериями исключения – заболеваний органов системы дыхания, морбидного ожирения, заболеваний органов брюшной полости, анемии.Структурное (толщину) и функциональное (индекс утолщения и экскурсию) состояние диафрагмы во время спокойного и глубокого вдоха/выдоха оценивали с помощью ультразвукового аппарата, параметры функции внешнего дыхания – с помощью аппарата искусственной вентиляции при самостоятельном дыхании через маску.Результаты. Пациенты с ХСН были старше 59,0 лет (53,0;70,0) против 25,0 (24,0;26,0) в контрольной группе, р=0,000001, имели большую массу тела - 82,0 (73,0;95,0) против 68,5 (55,0;84,0) кг, р=0,000005 и индекс массы тела 28,4 (24,3;31,3) против 21,8 (19,9;24,0) кг/м2, р=0,000001, но не различались в росте 173,0 (166,0;179,0) против 170,0 (165,0;183,0) см, 0,97.У пациентов с ХСН выявили меньший максимальный объем вдоха 3000,0 (2300,0;4000,0) против 3684,1 (3392,5;4310,8) мл, р=0,0006 и генерируемое дыхательными мышцами отрицательное давление – «силу вдоха»: 43,1 (-56,7; -33,0) против 53,5 (-58,8;-50,9) мБар, р=0,000082, соответственно. Диафрагма у пациентов с ХСН была значимо толще (мм) при спокойном и глубоком дыхании по сравнению со здоровыми испытуемыми: толщина на высоте спокойного вдоха составила справа 3,0 (2,2;3,6)/1,9 (1,5;2,2), р <0,001; слева 3,0 (2,4;3,5)/1,7 (1,4;2,0), р=0,000001; толщина в конце спокойного выдоха справа - 2,2 (1,8;2,9)/1,5 (1,2;1,7), р=0,000001; слева - 2,0 (1,7;2,5)/1,4 (1,2;1,5), р=0,000001; толщина на высоте глубокого вдоха справа - 5,1 (4,4;6,1)/4,4 (3,6;5,1), р=0,0005, слева 4,9 (4,2;6,2)/ 3,7 (3,1;4,8) p=0,000007, соответственно. Индекс утолщения при глубоком дыхании был меньше в исследуемой группе, чем в контрольной: справа 131,1 (82,5;181,8) против 190,9 (150,0;240,0), р=0,000004; слева 148,8 (112,5;190,3) против 175,2 (130,7;227,7), р=0,03, соответственно. Экскурсия в покое была более выражена у пациентов с ХСН, чем у здоровых: справа 2,3 (1,6;2,8) против 1,7 (1,5;1,9), 0,0001; слева 1,8 (1,5;2,2) против 1,5 (1,3;1,9), p=0,03, соответственно.Заключение. Хроническая сердечная недостаточность вносит вклад в развитие структурно-функциональных нарушений диафрагмы

The Problem of Developing Schoolchildren’s Cognitive Activities in the Educational Process

This article aims to a research problem that emphasizes the necessity to guide and organize schoolchildren’s cognitive activities. In a situation when cognition becomes the leading activity, new opportunities are opened up for the organization of the whole educational process, including its other aspects such as – development, and learning. The experiment conducted revealed problem points of organizing the process of cognition as well as the necessity for collecting additional data for a future experiment. The paper also puts forward the idea of a correlation between the hierarchical system of principles of education and types of adequacy.Este artículo apunta a un problema de investigación que enfatiza la necesidad de guiar y organizar las actividades cognitivas de los escolares. En una situación en la que la cognición se convierte en la actividad principal, se abren nuevas oportunidades para la organización de todo el proceso educativo, incluidos sus otros aspectos, como el desarrollo y el aprendizaje. El experimento realizado reveló puntos problemáticos de organizar el proceso de cognición, así como la necesidad de recopilar datos adicionales para un experimento futuro. El documento también plantea la idea de una correlación entre el sistema jerárquico de principios de educación y los tipos de adecuación

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk