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Âèòàìèí D äëÿ ïðîôèëàêòèêè îñòðûõ ðåñïèðàòîðíûõ èíôåêöèé-
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#197
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Íèêîãäà íå ñëûøàë î òàêîì çàáîëåâàíèè, äóìàþ, äðóãèì ïåäèàòðàì òîæå áóäåò èíòåðåñíî: thiamine-responsive megaloblastic anaemia (TRMA) syndrome èëè ñèíäðîì Ðîäæåðñà - àññîöèàöèÿ ìåãàëîáëàñòíîé àíåìèè ñ äèàáåòîì è ïðîãðåññèðóþùåé ãëóõîòîé:
We studied 32 individuals with biallelic SLC19A2 mutations identified by Sanger or next generation sequencing. Clinical details were collected through a follow-up questionnaire. We identified 24 different mutations, of which nine are novel. The onset of the first TRMA symptom ranged from birth to 4 years (median 6 months [interquartile range, IQR 3-24]) and median age at diabetes onset was 10 months (IQR 5-27). At presentation, three individuals had isolated diabetes and 12 had asymptomatic hyperglycaemia. Follow-up data was available for 15 individuals treated with thiamine for a median 4.7 years (IQR 3-10). Four patients were able to stop insulin and seven achieved better glycaemic control on lower insulin doses. These 11 patients were significantly younger at diabetes diagnosis (p = 0.042), at genetic testing (p = 0.01) and when starting thiamine (p = 0.007) compared with the rest of the cohort. All patients treated with thiamine became transfusion-independent and adolescents achieved normal puberty. There were no additional benefits of thiamine doses >150 mg/day and no reported side effects up to 300 mg/day. --- Diabetologia. 2018 May;61(5):1027-1036. Pharmacogenomics in diabetes: outcomes of thiamine therapy in TRMA syndrome. Habeb AM è ñîàâò. Â ïîëíîì òåêñòå î çàáîëåâàíèè çäåñü: Thiamine-Responsive Megaloblastic Anemia Syndrome [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#198
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Ìîëíèåíîñíàÿ ôîðìà äèàáåòà 1 òèïà ó ðåáåíêà 3 ëåò - äèàáåòè÷åñêèé êåòîàöèäîç ðàçâèëñÿ çà 2 äíÿ áåç ïîâûøåíèÿ ãëèêèðîâàííîãî ãåìîãëîáèíà:
Low hemoglobin A1c levels in a patient with diabetic ketoacidosis: Fulminant type 1 diabetes mellitus [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Åùå î òàêîé ôîðìå äèàáåòà ó äåòåé èç ßïîíèè - âñåãî 5 ñëó÷àåâ ñðåäè äåòåé 1-5 ëåò, ñèìïòîìû ðàçâèâàëèñü â òå÷åíèå 2-7 äíåé: Fulminant type 1 diabetes mellitus in Japanese children and adolescents: multi-institutional joint research of the Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes. Endocr J. 2018 Aug 27;65(8):795-803. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] È èç Êèòàÿ 23 ñëó÷àÿ = âîçðàñò ~2 (1-6)ãîäà; äëèòåëüíîñòü ãèïåðãëèêåìèè 7 (2-10) äíåé Fulminant Type 1 Diabetes in Children: A Multicenter Study in China [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#199
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Ïî ïîâîäó àíòèñòðåïòîëèçèíà Î ( ïîïóëÿðíûé àíàëèç â ñòðàíàõ áûâøåãî ÑÍÃ)íà ðóññêîì íåïëîõàÿ ñòàòüÿ+ åñòü ññûëêè
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#200
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Clinical Practice Guideline for the Management of Infantile Hemangiomas
Pediatrics January 2019, VOLUME 143 / ISSUE 1 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#201
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Î ïðèâèâêàõ è àíòèïðèâèâî÷íèêàõ:
Mandatory vaccinations in European countries, undocumented information, false news and the impact on vaccination uptake: the position of the Italian pediatric society [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] The Anti-vaccination Movement: A Regression in Modern Medicine [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#202
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 ñâÿçè ñ íåäàâíåé äèñêóññèåé íà ÔÁ î äîáðîêà÷åñòâåííîì âèðóñíîì ìèîçèòå ó äåòåé (â îñíîâíîì ïîñëå ãðèïïà), íåêîòîðûå íåäàâíèå ññûëêè î íåì â ïîëíîé âåðñèè - ñóòü: íå íóæíî íèêàêèõ äîîáñëåäîâàíèé è íàïðàâëåíèé ê ñïåöèàëèñòàì, äàæå ìàðêåðû ïîâðåæäåíèÿ ìûøö (ËÄÃ, ÊÔÊ) ñ èõ âïå÷àòëÿþùèìè öèôðàìè (ðàçû âûøå íîðìû) íèêàê íå âëèÿþò íà ýòîò ñàìîïðåõîäÿùèé ïðîöåññ:
Analysis of Clinical Manifestations and Laboratory Findings in Children with Influenza B-Associated Myositis: A Single Center Study. Yoon JW, è ñîàâò. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Viral myositis in children [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Review of Children Diagnosed with Acute Myositis of Calves Admitted to a Regional Hospital in Hong Kong in the Period 2003-2012 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] òåçèñû èç îáçîðà ëèòåðàòóðû: We identified 72 reports, including 451 patients, 325 males and 126 females. Sporadic acute benign calf myositis affected subjects ≤18 years of age (N = 450; 99%), who followed a prodromal flu-like illness (N = 411; 91%), presented with pain and tenderness affecting only the calves for ≤1.5 weeks (N = 441; 99%) and was never complicated by kidney involvement. The creatine kinase ratio was ≥10 in 310 (70%) out of 444 cases. Microbiological studies identified an infectious trigger in 181 cases, mostly influenza virus (type B more frequently than type A), Dengue, Epstein-Barr or Parainfluenza virus and Mycoplasma pneumoniae. Sporadic acute benign calf myositis is a self-limited condition that can usually be diagnosed on a clinical basis. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#203
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÷åòûðå ïóáëèêàöèè îá èíñóëüòàõ ó äåòåé ïåðâûõ ëåò æèçíè ïîñëå ìèíèìàëüíîé òðàâìû ãîëîâû - âñåõ îáúåäèíÿåò íàëè÷èå êàëüöèôèêàöèè ëåíòèêóëîñòðèàòàëüíûõ ñîñóäîâ è ïîðàæåíèå áàçàëüíûõ ãàíãëèåâ:
Dev Med Child Neurol. 2014 Jan;56(1):78-84. (ïîëíûé òåêñò) Mineralizing angiopathy with infantile basal ganglia stroke after minor trauma [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] òåçèñû Stroke After Minor Head Trauma in Infants and Young Children With Basal Ganglia Calcification: A Lenticulostriate Vasculopathy? [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] A Case of Lenticulostriate Stroke Due to Minor Closed Head Injury in a 2-Year-Old Child: Role of Mineralizing Angiopathy [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Infantile Basal Ganglia Stroke after Mild Head Trauma Associated with Mineralizing Angiopathy of Lenticulostriate Arteries: An Under Recognized Entity. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#204
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ëàáîðàòîðíàÿ äèàãíîñòèêà êîêëþøà
ëàáîðàòîðíàÿ äèàãíîñòèêà êîêëþøà
êàê ïîêàçûâàåò ïðàêòèêà,ìíîãèå ïëîõî ñ íåé çíàêîìû è åñòü ïóòàíèöà è â ëèòåðàóðå è òåì áîëåå â ðåàëüíîé æèçíè,÷òî âèäíî èç òåìû:https://forums.rusmedserv.com/showth...45#post2779245 Ïîïðîáîâàë ñäåëàòü îòáîðû èç 3- ñòàòåé. â íèçó ñòàòè 2-é åñòü òàê æå òàáëèöû ïî äèàãíîñòèêå â ñîîòâåòñâèè ñ âîçðàñòîì [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ïîäòâåðæäåíèå äèàãíîçà Êëèíèöèñòû îáû÷íî èñïîëüçóþò íåñêîëüêî òèïîâ ëàáîðàòîðíûõ òåñòîâ äëÿ äèàãíîñòèêè êîêëþøà Bordetella. Ó÷åíûå ñ÷èòàþò êóëüòóðó çîëîòûì ñòàíäàðòîì, ïîòîìó ÷òî ýòî åäèíñòâåííûé 100% ñïåöèôè÷åñêèé ìåòîä èäåíòèôèêàöèè. Äðóãèå òåñòû, êîòîðûå ìîãóò áûòü âûïîëíåíû, âêëþ÷àþò ïîëèìåðàçíóþ öåïíóþ ðåàêöèþ (ÏÖÐ) è ñåðîëîãèþ. Ïîñêîëüêó êóëüòóðà îáëàäàåò îòëè÷íîé ñïåöèôè÷íîñòüþ, îíà îñîáåííî ïîëåçíà äëÿ ïîäòâåðæäåíèÿ äèàãíîçà êîêëþøà, êîãäà âû ïîäîçðåâàåòå âñïûøêó... Ëó÷øå âñåãî ïîëó÷èòü êóëüòóðó èç îáðàçöîâ íîñîãëîòêè (NP), ñîáðàííûõ â òå÷åíèå ïåðâûõ 2 íåäåëü êàøëÿ. Ýòî êîãäà æèçíåñïîñîáíûå áàêòåðèè âñå åùå ïðèñóòñòâóþò â íîñîãëîòêå. Ïîñëå ïåðâûõ 2 íåäåëü ÷óâñòâèòåëüíîñòü ñíèæàåòñÿ, à ðèñê ëîæíîîòðèöàòåëüíûõ ðåçóëüòàòîâ óâåëè÷èâàåòñÿ. ÏÖÐ ÿâëÿåòñÿ ýêñïðåññ-òåñòîì è îáëàäàåò îòëè÷íîé ÷óâñòâèòåëüíîñòüþ. Îäíàêî ÏÖÐ-òåñòû ðàçëè÷àþòñÿ ïî ñïåöèôè÷íîñòè. Ñëåäîâàòåëüíî, âû äîëæíû ïîëó÷èòü êóëüòóðíîå ïîäòâåðæäåíèå êîêëþøà ïî êðàéíåé ìåðå äëÿ îäíîãî ïîäîçðèòåëüíîãî ñëó÷àÿ â ëþáîå âðåìÿ, êîãäà åñòü ïîäîçðåíèå íà âñïûøêó êîêëþøà. Âû äîëæíû èíòåðïðåòèðîâàòü ðåçóëüòàòû íàðÿäó ñ êëèíè÷åñêèìè ñèìïòîìàìè è ýïèäåìèîëîãè÷åñêîé èíôîðìàöèåé. Âàì ñëåäóåò ïðîâåñòè àíàëèç ñ ïîìîùüþ ÏÖÐ èç îáðàçöîâ NP, âçÿòûõ ÷åðåç 0–3 íåäåëè ïîñëå íà÷àëà êàøëÿ. ÏÖÐ ìîæåò òàêæå ïðåäîñòàâèòü òî÷íûå ðåçóëüòàòû íà ñðîê äî 4 íåäåëü. Ïîñëå ÷åòâåðòîé íåäåëè êàøëÿ êîëè÷åñòâî áàêòåðèàëüíîé ÄÍÊ â íîñîãëîòêå áûñòðî óìåíüøàåòñÿ, ÷òî óâåëè÷èâàåò ðèñê ïîëó÷åíèÿ ëîæíîîòðèöàòåëüíûõ ðåçóëüòàòîâ. Êàê ïðàâèëî, ñåðîëîãè÷åñêèå òåñòû áîëåå ïîëåçíû äëÿ äèàãíîñòèêè íà ïîçäíèõ ñòàäèÿõ çàáîëåâàíèÿ. Äëÿ îäíîòî÷å÷íîãî ñåðîëîãè÷åñêîãî òåñòà CDC îïòèìàëüíîå âðåìÿ äëÿ ñáîðà îáðàçöîâ ñîñòàâëÿåò îò 2 äî 8 íåäåëü ïîñëå íà÷àëà êàøëÿ, êîãäà òèòðû àíòèòåë íàõîäÿòñÿ íà ñàìîì âûñîêîì óðîâíå. Òåì íå ìåíåå, âû ìîæåòå âûïîëíèòü ñåðîëîãèþ íà îáðàçöàõ, ñîáðàííûõ äî 12 íåäåëü ïîñëå íà÷àëà êàøëÿ. Ïðèãîäíîñòü àíòèòåë IgM, IgA è IgG äëÿ ïîñòàíîâêè äèàãíîçà. Ó ìîëîäûõ íåïðèâèòûõ äåòåé ñ êîêëþøåì, ïîäòâåðæäåííûì ïîñåâîì, îòâåòû IgM âîçíèêàëè òàê æå ÷àñòî èëè ÷àùå, ÷åì îòâåòû IgG .Îäíàêî îòâåòû IgM áûëè ìåäëåííûìè è ÷àñòî îòñóòñòâîâàëè ó ïðèâèòûõ äåòåé è âçðîñëûõ ñ êîêëþøåì. èññëåäîâàíèÿõ, â êîòîðûõ IgM, IgA è IgG-àíòèòåëà èçìåðÿëèñü â ñûâîðîòêàõ îò ïàöèåíòîâ ñ õîðîøî äîêóìåíòèðîâàííûì êîêëþøåì è ñ ðàçíûì âîçðàñòîì è èñòîðèÿìè âàêöèíàöèè, îáùèì âûâîäîì áûëî òî, ÷òî . Ó ìàëåíüêèõ äåòåé â ïàðàìåòðû IgG áûëè íàèáîëåå ÷óâñòâèòåëüíûìè .Àíàëîãè÷íî, â èññëåäîâàíèÿõ, â êîòîðûõ èçìåðÿëè àíòèòåëà IgG è IgA, ïàðàìåòðû IgG áûëè áîëåå ÷óâñòâèòåëüíûìè, ÷åì ïàðàìåòðû IgA, à êîìáèíàöèè ïàðàìåòðîâ IgG è IgA (ñ èíòåðïðåòàöèåé «è / èëè») íå óâåëè÷èâàëè èëè ëèøü íåçíà÷èòåëüíî ïîâûøàëè ÷óâñòâèòåëüíîñòü âîçðàñòå äî 4 ëåò ðåàêöèè IgA íà èíôåêöèþ ìîãóò áûòü î÷åíü íèçêèìè èëè äàæå îòñóòñòâîâàòü ,à â ïåðâûå 10–15 ëåò æèçíè ðåàêöèè IgA íà èíôåêöèþ B. pertussis èìåþò òåíäåíöèþ ê óâåëè÷åíèþ ñ âîçðàñòîì.Êðîìå òîãî, ðàñïðîñòðàíåííîñòü ñïåöèôè÷åñêîãî IgA-àíòèòåëà ê B. pertussis â ïîïóëÿöèè èìååò òåíäåíöèþ ê óâåëè÷åíèþ ñ âîçðàñòîì äèàãíîñòè÷åñêàÿ ñåðîëîãèÿ íå ìîæåò áûòü ïðàâèëüíî èíòåðïðåòèðîâàíà â òå÷åíèå îäíîãî ãîäà ïîñëå âàêöèíàöèè áåñêëåòî÷íûì êîêëþøåì (aP ) âàêöèíû; IgA-àíòè-PT ñëåäóåò èñïîëüçîâàòü òîëüêî ñ íåîïðåäåëåííûìè óðîâíÿìè IgG-àíòè-PT èëè êîãäà íåâîçìîæíî ïîëó÷èòü âòîðîé îáðàçåö IgG-àíòè-PT .Ïðèíèìàÿ âî âíèìàíèå åãî îòíîñèòåëüíî âûñîêóþ ñïåöèôè÷íîñòü è íèçêóþ ÷óâñòâèòåëüíîñòü, îáîñíîâàííûì ìîæåò îêàçàòüñÿ ðàçóìíîå îãðàíè÷åíèå îêîëî ìèíèìàëüíîãî óðîâíÿ êîëè÷åñòâåííîãî îïðåäåëåíèÿ, êîòîðîå ìîæåò ñîñòàâëÿòü îò 10 äî 20 ÌÅ / ìë [b]Âîçìîæíî, öåëåñîîáðàçíî èñïîëüçîâàòü äâîéíîé ïîðîã IgG-àíòè-PT ìåæäó 62 è 125 ÌÅ / ìë â çàâèñèìîñòè îò ñòðàíû â êà÷åñòâå äîêàçàòåëüñòâà íåäàâíåé èíôåêöèè B. pertussis, ïðè óñëîâèè, ÷òî ïàöèåíò íå áûë âàêöèíèðîâàí â òå÷åíèå ïîñëåäíèõ 12 ìåñÿöåâ |
#205
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âåòðÿíêa è ãðóäíîå âñêàðìëèâàíèå
Cóììàðíûå ðåêîìåíäàöèè î âåòðÿíêè ó êîðì.ãðóäüþ ìîæíî ïîñìîòðåòü ( íà àíãë. äëÿ ðîäèòåëåé íàïèñàíî, íî u âðà÷àì ìîæåò áûòü èíòåðåñíî) çäåñü [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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#206
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ðóêîâîäòâî ïî ïíåâìîíèÿì ó äåòåé
1.[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] 2.[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] (òàáë.ñ äîçàìè íåñê.îòëè÷àþñòà â 2-õ èñòî÷íèêàõ) 3..[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] çäåñü ìîæíî çàìåòèòü, ÷òî ðåêîìåíäàöèè â ëå÷åíèè àìïèöèëëèíîì ìîãóò îòëè÷àòüñÿ îò 45 ìã/êã (åñëè íå ïîëó÷àë ïðåä. 3 ìåñ.ÀÁ) ñóòêè äî 75-90 ìã/êã ñóòêè |
#207
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[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] - Àñòìà 2019
Ñóùåñòâóþò óáåäèòåëüíûå äîêàçàòåëüñòâà òîãî, ÷òî ìîíîòåðàïèÿ ÁÀÊÄ íå çàùèùàåò ïàöèåíòîâ îò òÿæåëûõ îáîñòðåíèé, õîòÿ è îáåñïå÷èâàåò êðàòêîâðåìåííîå îáëåã÷åíèå ñèìïòîìîâ àñòìû, è ÷òî ðåãóëÿðíîå èëè ÷àñòîå èñïîëüçîâàíèå ÁÀÊÄ óâåëè÷èâàåò ðèñê îáîñòðåíèé.  ñâÿçè ñ ýòèì GINA ðåêîìåíäóåò âñåì âçðîñëûì è ïîäðîñòêàì, ñòðàäàþùèì àñòìîé, òåðàïèþ ñ ïðèìåíåíèåì èíãàëÿöèîííûõ êîðòèêîñòåðîèäîâ (ÈÊÑ) äëÿ ñíèæåíèÿ ðèñêà ñåðüåçíûõ îáîñòðåíèé è êîíòðîëèðîâàíèÿ ñèìïòîìîâ. Ïðè ëåãêîé ôîðìå àñòìû, ñîãëàñíî íîâûì ðóêîâîäñòâàì, â ñëó÷àå íåîáõîäèìîñòè ñëåäóåò íàçíà÷àòü íèçêîäîçèðîâàííûé ôîðìîòåðîë (formoterol), ÿâëÿþùèéñÿ áåòà-àãîíèñòîì äëèòåëüíîãî äåéñòâèÿ (ÁÀÄÄ), èëè, åñëè ýòîò ïðåïàðàò íåäîñòóïåí, ðåêîìåíäîâàòü ïðèåì ñëàáîé äîçû ÈÊÑ âñÿêèé ðàç, êîãäà èñïîëüçóåòñÿ ÁÀÊÄ. Ïðåäñåäàòåëü GINA ä-ð Õåëåí Ðåääåë (Helen Reddel), âûñòóïàÿ íà ìåæäóíàðîäíîì êîíãðåññå Åâðîïåéñêîãî ðåñïèðàòîðíîãî îáùåñòâà (European Respiratory Society 2019), îòìåòèëà, ÷òî íîâûå ðåêîìåíäàöèè áàçèðóþòñÿ íà ðåçóëüòàòàõ ìíîãî÷èñëåííûõ èññëåäîâàíèé. Íàïðèìåð, èññëåäîâàíèå 2018 ãîäà ïîêàçàëî ñîêðàùåíèå ÷èñëà òÿæåëûõ îáîñòðåíèé íà 64% ïðè êîìáèíàöèè ÁÀÄÄ áóäåñîíèäà (budesonide) ñ ôîðìîòåðîëîì ïî ñðàâíåíèþ ñ òåðáóòàëèíîì (terbutaline), ÿâëÿþùèìñÿ ÁÀÊÄ. Äðóãîå èññëåäîâàíèå, òàêæå ïðîâåäåííîå â 2018 ãîäó, âûÿâèëî, ÷òî ñî÷åòàíèå áóäåñîíèäà ñ ôîðìîòåðîëîì, èñïîëüçóåìîå ïî ìåðå íåîáõîäèìîñòè, íå óñòóïàëî ïîääåðæèâàþùåé òåðàïèè áóäåñîíèäîì ó ïàöèåíòîâ ñ ñåðüåçíûìè îáîñòðåíèÿìè àñòìû. Áîëåå òîãî, íåäàâíåå èññëåäîâàíèå, ïðîâåäåííîå â Íîâîé Çåëàíäèè, ïðîäåìîíñòðèðîâàëî, ÷òî ó âçðîñëûõ ñ ëåãêîé è óìåðåííîé ôîðìàìè àñòìû îáëåã÷åíèå ñèìïòîìîâ ïî ìåðå íåîáõîäèìîñòè ïðè ïîìîùè áóäåñîíèäà â ñî÷åòàíèè ñ ôîðìîòåðîëîì ïðåâçîøëî ïîääåðæèâàþùóþ òåðàïèþ íèçêîäîçèðîâàííûì áóäåñîíèäîì âìåñòå ñ òåðáóòàëèíîì. Ïî ìíåíèþ ä-ðà Ðåääåë, êëèíèöèñòàì ñëåäóåò âûáèðàòü íàèáîëåå ïîäõîäÿùóþ òåðàïèþ àñòìû ñîâìåñòíî ñ ïàöèåíòîì. Íåîáõîäèìî ó÷èòûâàòü, íàìåðåí ëè áîëüíîé åæåäíåâíî ïðèíèìàòü ïðåïàðàòû, èëè îí íà÷èíàåò òåðàïèþ ïðè óõóäøåíèè ñèìïòîìîâ çàáîëåâàíèÿ. Ýêñïåðò èç Èìïåðñêîãî êîëëåäæà Ëîíäîíà (Imperial College London) ä-ð Ñåáàñòüÿí Äæîíñòîí (Sebastian Johnston) çàÿâèë, ÷òî íîâûå ðóêîâîäñòâà GINA äîëæíû ñòàòü òîë÷êîì äëÿ òîãî, ÷òîáû óñòðàíèòü âîçìîæíîñòü ìîíîòåðàïèè ÁÀÊÄ. Îí îòìåòèë, ÷òî â öåëÿõ áåçîïàñíîñòè íåîáõîäèìî ââåñòè çàïðåò íà îòäåëüíî èñïîëüçóåìûå áåòà-àãîíèñòû è çàìåíèòü èõ íà ñî÷åòàíèå áåòà-àãîíèñòû ïëþñ ÈÊÑ â îäíîì èíãàëÿòîðå, ÷òîáû ïàöèåíòû íå ìîãëè ïðèíèìàòü áåòà-àãîíèñò áåç îäíîâðåìåííîãî ïðèåìà ñòåðîèäîâ.  òî æå âðåìÿ ó÷åíûé ïðèçíàë, ÷òî, âîçìîæíî, ýòà èäåÿ ïðîòèâîðå÷èâà. |
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ñòàòüÿ èíòåðåñíàÿ, íî ñòîèò îáðàòèòü âíèìàíèå, ÷òî ðåêîìåíäàöèè äàíû äëÿ ïîäðîñòêîâ è âçðîñëûõ , áîëüíûõ àñòìîé , íî íå äëÿ äåòåé ìëàäøåãî âîçðàñòà(ïî êðåéíåé ìåðå íå äëÿ äåòåé ìëàäøå 5 ëåò),ñ çàáîëåâàíèåì êîòîðûõ ÷àùå âñòðå÷àþòñÿ ïåäèàòðû
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Âñåìèðíàÿ îðãàíèçàöèÿ çäðàâîîõðàíåíèÿ îáúÿâèëà î ãëîáàëüíîì èñêîðåíåíèè 3 òèïà ïîëèîâèðóñà, îäíîé èç äâóõ îñòàâàâøèõñÿ â ñâîáîäíîé öèðêóëÿöèè ðàçíîâèäíîñòåé âîçáóäèòåëÿ ïîëèîìèåëèòà.
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Íàïîìíþ, ÷òî øèðîêî èñïîëüçóåìàÿ âàêöèíà ÎÏ â Ðîññèè - ÁèÂàê Ïîëèî - ñîäåðæèò øòàììû ïîëèîâèðóñîâ 1 è 3 òèïà.
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Ñ óâàæåíèåì, Èãîðü Àëåêñàíäðîâè÷ |
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Ðóêîâîäñòâî ïî ëå÷åíèþ è âåäåíèþ äåòåé ñ ïñîðèàçîì ( AAD / NPF , îêòÿáðü 2019 )-https://www.jaad.org/article/S0190-9622(19)32655-6%20/fulltext
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