DRESS синдром -жизнеугрожающее осложнение, редко встречающееся в клинической практике. Постановку правильного диагноза затрудняет схожесть клинических проявлений с рядом других состояний, а также отсроченная во времени от начала приема «причинного» препарата клиническая манифестация. Наряду с этим своевременные диагностика и раннее начало лечения снижают риск тяжелого течения и осложнений синдрома. Описание случая. Пациентка 29 лет госпитализирована по поводу генерализованных макуло-папулезных высыпаний, лихорадки, генерализованной лимфаденопатии, слабости, спленомегалии, появившихся на фоне добавления меропенема к терапии карбамазепином. В анализах крови обнаружен лейкоцитоз -33,6×10 9 /л, гиперэозинофилия -7,9×10 9 /л, повышение печеночных трансаминаз. После исключения аутоиммунных, инфекционных и онкогематологических заболеваний установлен DRESS синдром. На фоне терапии метилпреднизолоном в дозе 1 мг/кг веса отмечена быстрая нормализация температуры тела, исчезновение сыпи, уменьшение эозинофилов. Обсуждение. Особенностью данного клинического случая является развитие DRESS синдрома на фоне присоединения антибиотика к противосудорожному препарату (с которым наиболее часто ассоциируется этот синдром), что затруднило диагностику. Повышение информированности врачей о возможности развития такой нежелательной реакции вследствие антибиотикотерапии представляется крайне важным для улучшения прогноза данной группы пациентов.
In recent years, the system of postgraduate education in medicine faces new challenges and the need for improvement. At the same time, it is necessary to search for a reasonable combination of various types of education in order to preserve and improve the professional knowledge of doctors.Aim. To demonstrate and assess the importance of combining distance learning technologies with traditional teaching methods.Material and methods. The paper analyzes the educational process at the Department of Therapy of the I.M. Sechenov First Moscow State Medical University in the period from 2020 to July 2022. The data are based on the results of the annual report of the department, a survey of students, and communication with students using electronic telecommunication technologies (forum, chat, e-mail). Data were analyzed using SPSS Statistics 23.0 software.Results. Department of Therapy of the I. M. Sechenov First Moscow State Medical University has been training doctors for a long time in advanced training programs using traditional and distance learning. In 2020, in connection with the pandemic of a coronavirus disease 2019 (COVID-19), distance learning technologies have been actively developed. Online lectures and video seminars have become an important component of advanced training programs, in which 252 students were trained in 2020, and 376 people from different cities of Russia during 2021 and the first half of 2022.In the first year of the pandemic, two short-term programs were created dedicated to epidemiology, clinic, diagnosis and treatment of patients with COVID-19. They were conducted using online seminars, which made it possible to train 4156 doctors from more than 29 regions of Russia. Most of the listeners noted the high professional level of the programs, the importance of using computer technology in addition to traditional methods.Conclusion. In the modern world, in order to maintain the required level of professional competence of a doctor, combination of traditional educational activities with distance learning should be used.
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