Microcirculatory disorders play an important role in the pathogenesis of dermatoses, including those caused by the influence of adverse factors of production environment. 158 men from the Astrakhan gas processing plant (AGPS) aged from 28 to 59 years (40.23 ± 0.49 years) and 77 healthy volunteers, resident in the city of Astrakhan in age from 25 to 55 years (38,18 ± 0,99 years) were examined. Depending on the technological stage of processing of reservoir gas workers AGPS had contact with various harmful and dangerous factors, among which were the formation of gas, elementary sulfur, hydrocarbons, saturated and unsaturated aliphatic compound, nitrogen oxides, etc. In more than 90% of cases in the skin of workers AGPS serious violations of blood perfusion in small vessels, and in the surface areas more often than in the deep, while marked asymmetry of cutaneous microcirculation were revealed. Laser Doppler flowmetry can be recommended as a noninvasive method of monitoring the condition of microcirculation and early diagnosis of premorbid changes in the skin of workers of the gas processing plant exposed to adverse factors of production environment.
Aim. To improve the diagnosis of allergic skin diseases in childrenMaterials and methods. 135 children aged from 2 to 6 with atopic dermatitis were examined during exacerbation. They were on inpatient treatment in the skin and venereologic department of the Regional skin and venereologic dispensary and the Department of Allergology of the Regional children's clinical hospital. At the same time, 103 people (the main group) had uncomplicated course of the disease, 32 patients had complications of atopic dermatitis in the form of secondary infection. The control group consisted of 29 children aged 2 to 6. Neopterin in serum was determined by enzyme-linked immunosorbent analysis using test kits "Neopterin ELISA" (Germany). Statistical reliability of the obtained data was evaluated using The Student's test.Results. Atopic dermatitis in children, regardless of clinical manifestations, is accompanied by an increase in the content of neopterin in serum. The nature of the increase in the level of neopterin is determined by the duration of the disease, while its highest values are characteristic of the prolonged course of the process (over 4 years).Conclusion. The determination of neopterin in children with atopic dermatitis is a promising laboratory method for assessing the severity of dermatosis, monitoring and forecasting the further course of the process, as well as evaluating the effectiveness of therapeutic measures.
Increasing the effectiveness of treatment and restoring the quality of life in patients with moderate to severe and severe forms of psoriasis is one of the most important trends in modern dermatology. The appearance of biological products in the late XXth century opened new opportunities in the treatment and control of the course of the disease in patients suffering from moderate and severe forms of psoriasis. Conducting maintenance system treatment with biological products reduces the severity of course of dermatosis, and in some cases prevents the occurrence of disease relapses. Despite the increasing popularity of anti-cytokine drugs, there are difficulties in the treatment of choice of the therapy in some cases. Among the main reasons for the lack of response to ongoing biological therapy are the genetic characteristics of the patient and the immunogenicity of the drugs. Failures in the use of biological therapy can also result a low concentration of the drug before the next administered dose. It has been proven that the combined use of methotrexate and infliximab inhibits the development of anti-drug antibodies that are associated with the development of a low therapeutic response. The article describes the clinical observation of a patient suffering for 20 years from a severe form of psoriasis and psoriatic arthritis. The experience of long-term (about 10 years) prescription of the biological preparation infliximab with sufficient clinical response without additional use of methotrexate is shown. The results of successful combined therapy of psoriatic erythroderma and psoriatic arthritis with infliximab and acitretin in order to reduce the immunogenicity of the tumor necrosis factor α blocker and avoid the ”escape” effect are described. The data of restoration of a good therapeutic response to systemic biological therapy with infliximab after administration of acitretin are presented.
АННОТАЦИЯ Цель. Совершенствование диагностики преморбидных изменений кожи работников газоперерабатывающего производства. Материалы и методы. Обследованы 158 работников Астраханского газоперерабатывающего завода мужского пола в возрасте от 28 до 59 лет (в среднем 40,23±0,49 лет), не имевших на момент осмотра манифестных форм соматических и неврологических заболеваний и 77 клинически здоровых добровольцев контрольной группы, постоянно проживавших в г. Астрахань в возрасте от 25 до 55 лет (в среднем 38,18±0,99 года). Средний стаж работы на предприятии составил 9,02±0,29 лет. До 5 лет (в среднем 3,97±0,19 года) на заводе трудились 34 работника, от 6 до 10 лет (7,90±0,24 года)-61, от 11 до 15 лет (12,70±0,16 года)-63. Оценку функционального состояния кожи методом лазерной допплеровской флоуметрии проводили на лазерном анализаторе капиллярного кровотока (ЛАКК-01) (НПП «Лазма», Москва). Результаты. В результате проведенного обследования профессиональные заболевания кожи выявлены не были, но с высокой частотой регистрировались профессиональные стигмы, чаще всего локализовавшиеся на кистях. Из непрофессиональных поражений отмечены у 56 человек (35,44±0,30%) микозы стоп. Заключение. Нарушения микроциркуляции играют важную инициально-триггерную роль в патогенезе ряда дерматозов. Выявление ранних доклинических проявлений воздействия вредных производственных факторов на состояние здоровья работников газоперерабатывающей промышленности с целью прогнозирования риска возникновения профессионально обусловленных заболеваний и состояний представляется актуальным направлением современной медицины.
Despite the low number, the cases of leprosy continue to be detected, more often on endemic territories. In Russian Federation one of the endemic territories is located in Astrakhan region. The long incubation period eventually leads to inability to identify the source of infection. The combination of the leprosy with other dermatoses complicates the diagnosing. The isolated and early skin manifestations of leprosy can be mistaken for the clinical features of other dermatoses. This article presents the description of a case study of border line lepromatosis leprosy in a patient with a long-term dermatological background. A 66-year-old male was followed up for 14 years under different dermatological diseases. In 2017, after a change in the nature of rashes, atypical for supervised nosological forms, and in connection with the resistance of clinical manifestations of diseases to the therapy, a clinical diagnosis of leprosy was established. To verify this diagnosis, the patient was sent to the Federal State Budgetary Institution "Research Institute for the Study of Leprosy". At admission, he complained of rashes on the skin of the face, trunk, extremities, accompanied by itching, swelling, weakness and numbness in the distal extremities. As a result of clinical, laboratory examination (bacterioscopic examination of scarification from the skin, serological examination, pathomorphological examination of skin biopsies), the diagnosis of the underlying disease was made: leprosy, borderline lepromatous form, active stage. Complications of the underlying disease: chronic specific polyneuropathy with sensitive disorders. The described clinical situation illustrates the problem of early diagnosis of leprosy due to the variety of manifestations and low alertness of clinicians.
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