#16
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Äîêòîð, Âû âåñüìà íðàâîó÷èòåëüíûì òîíîì ðàññêàçûâàåòå çäåñü íàì î òîì, êàêèå áûâàþò èììóíîäåôèöèòû, è ñïðàøèâàåòå ïðî ñåðîíåãàòèâíîå îêíî?
ß âïîëíå ïîíèìàþ, ÷òî îá ýòîì íå ìîãóò çíàòü ïàöèåíòû, íî ÷òîáû âðà÷, êîòîðûé òàê óâåðåííî ïîó÷àåò êîëëåã? Âû íå ïðîáîâàëè ïîëüçîâàòüñÿ õîòÿ áû ßíäåêñîì? [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ïðÿìî äàæå íåóäîáíî... |
#17
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Öèòàòà:
Âî-âòîðûõ, ÿ ïèñàë, ÷òî: Öèòàòà:
Â-òðåòüèõ. Êàê Âû ñåáå ïðåäñòàâëÿåòå òàêóþ ñèòóàöèþ, ÷òî ó áîëüíîãî óæå óñïåë ðàçâèòüñÿ ÑÏÈÄ, åñëè ñ ìîìåíòà çàðàæåíèÿ ïðîøëî åùå òàê ìàëî âðåìåíè, ÷òî äàæå àíòèòåëà ê ÂÈ× åùå íå óñïåëè ïîÿâèòüñÿ? Â-÷åòâåðòûõ: Öèòàòà:
Òî åñòü, Âû óòâåðæäàåòå, ÷òî ó áîëüíîãî óæå óñïåë ðàçâèòüñÿ ÑÏÈÄ, à îí âñå åùå íàõîäèòñÿ â òîì ñàìîì ñåðîíåãàòèâíîì îêíå? Èëè ýòî óæå òåðìèíàëüíàÿ ñòàäèÿ çàáîëåâàíèÿ, è òîãäà âîçíèêàåò âîïðîñ: ïðè÷åì òóò ýòî ñåðîíåãàòèâíîå îêíî? |
#18
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Íó à òåïåðü åñëè ñåðüåçíî. ß çàãëÿíóëà â òåìó ïî ïðîñüáå Àíàñòàñèè, òàê êàê èìåþ îïðåäåëåííîå îáðàçîâàíèå â îáëàñòè ÂÈ×-èíôåêöèè è äîâîëüíî äàâíî (ïî ðîññèéñêèì ìåðêàì, êîíå÷íî) ðàáîòàþ ñ òàêèìè ïàöèåíòàìè.
Ïðåäëàãàþ äëÿ íà÷àëà ïî÷èòàòü òî, ÷òî åñòü ñåé÷àñ íà ðóññêîì ÿçûêå è â áåñïëàòíîì äîñòóïå: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Íà ñåãîäíÿ ýòî âïîëíå äîñòàòî÷íûé îáúåì èíôîðìàöèè, êîòîðûé íóæåí ëþáîìó âðà÷ó, êîòîðûé ìîæåò èìåòü äåëî ñ ÂÈ×-èíôåêöèåé. (Âîçìîæíî, ìíå ïîêàçàëîñü, íî öåëüþ äàííîãî ôîðóìà íå ÿâëÿåòñÿ èçðå÷åíèå èñòèí, à ïîëó÷åíèå èíôîðìàöèè è îáñóæäåíèå åå ñ êîëëåãàìè). |
#19
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Öèòàòà:
Êîíå÷íî AIDS - êàê äèàãíîç ïðè îòñóòñòâèè àíòèòåë íå ñòàâèòñÿ,íî âñå äåëî â òîì,÷òî â ïåðèîä ñåðîêîíâåðñèè (seroconversion) - ñåé÷àñ ïîëüçóþòñÿ òàêèì òåðìèíîì(êîòîðàÿ áûâàåò àññèìïòîìíàÿ è îñòðàÿ) - ìîæåò íàáëþäàòüñÿ òàê íàçûâàåìàÿ îñòðàÿ èììóíîñóïðåññèÿ (Acute immunosuppression),÷òî âåäåò ê âðåìåííîìó óìåíüøåíèþ ÑD4+ ëèìôîöèòîâ (òàê êàê îíè ÿâëÿþòñÿ êëåòêàìè-ìèøåíÿìè ÂÈ×), èíîãäà äî óðîâíÿ, äîñòàòî÷íîãî äëÿ ðàçâèòèÿ îïïîðòóíèñòè÷åñêèõ èíôåêöèé â ýòîé ôàçå . Òàêèõ ñëó÷àåâ îïèñàíî ìàëî (êîíòàãèîçíûé ìîëëþñê íå îïèñàí),íàïðèìåð îïèñàí ÖÌ àññîöèèðîâàííûé êîëèò Gupta(1993) [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ïíåâìîöèñòíàÿ ïíåâìîíèÿ Vento S (1993)[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Êîíå÷íî ìîæåò âñòðå÷àòüñÿ èäèîïàòè÷åñêàÿ CD4+ ëèìôîöèòîïåíèÿ (Idiopathic CD4+ lymphocytopenia),íî ðàçâèòèå íåîáû÷íûõ èíôåêöèé íåõàðàêòåðíîé ëîêàëèçàöèè è â íåõàðàêòåðíîì âîçðàñòå äîëæíà íàñòîðàæèâàòü â îòíîøåíèè ÂÈ×. |
#20
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âîò åøå ïàðà ññûëîê äëÿ èíòåðåñà
ìîëëþñê ïðè ÂÈ× [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] ìîëëþñê ïðè èììóííîé ðå-êîíñòèòóöèè (íà÷àëî ÕÀÀÐÒ) [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#21
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Öèòàòà:
PS: Èíôîðìàöèþ ïî ÂÈ× è ÑÏÈÄ ñåé÷àñ â èíòåðíåòå íàéòè íå òðóäíî. |
#22
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Öèòàòà:
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Öèòàòà:
Îïèñàííûå 2 ñëó÷àÿ èíôåêöèè îòíîñÿòñÿ ê ò.í. îïïîðòóíèñòè÷åñêèì èíôåêöèÿì. Êîíòàãèîçíûé ìîëëþñê, â îòëè÷èå îò îïèñàííûõ âûøå 2 èíôåêöèé, íå îòíîñèòñÿ ê îïïîðòóíèñòè÷åñêèì èíôåêöèÿì, ò.ê. õîòü è âñòðå÷àåòñÿ â íåñêîëüêî ðàç ÷àùå (ó ïðèìåðíî 8% áîëüíûõ ÑØÀ, ñì. ïî ññûëêå ïðèâåäåííîé âûøå), äîâîëüíî ÷àñòî âñòðå÷àåòñÿ è ñðåäè ëþäåé áåç èììóíîäåôèöèòà. Ãèïîòåòè÷åñêè ìîæíî ñòðîèòü ëþáûå òåîðèè è ïðåäïîëîæåíèÿ. Íî ìû íà ýòîì ñàéòå òâåðäèì, ÷òî íóæíî îïèðàòüñÿ íà äîêàçàòåëüñòâà (íà äîêàçàòåëüíóþ ìåäèöèíó). Òàê ÷òî, äàâàéòå ïîêà áóäåì èñõîäèòü èç òîãî ôàêòà, ÷òî äî íàñòîÿùåãî âðåìåíè íå îïèñàíî íè îäíîãî ñëó÷àÿ êîíòàãèîçíîãî ìîëëþñêà, àññîöèèðîâàííîãî ñ ò.í. îñòðîé èììóíîñóïðåññèåé âî âðåìÿ ïåðèîäà ñåðîêîíâåðñèè. Òî åñòü, ñàìà âîçìîæíîñòü ñóùåñòâîâàíèÿ îïèñàííîé âûøå ñèòóàöèè äî íàñòîÿùåãî âðåìåíè íè ðàçó íå äîêàçàíà, íåñìîòðÿ íà áîëüøîå ÷èñëî íàáëþäåíèé çà çàáîëåâøèìè ÂÈ×. |
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#23
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Öèòàòà:
Äèñêóññèÿ èçíà÷àëüíî èäåò î òîì, ìîæåò ëè áûòü ÑÏÈÄ ó áîëüíîé, ïðè îòñóòñòâèè àíòèòåë ê ÂÈ× (âî âðåìÿ ò.í. ïåðèîäà ñåðîêîíâåðñèè), è ñ îáèëüíûìè ñâåæèìè âûñûïàíèÿìè êîíòàãèîçíîãî ìîëëþñêà. |
#24
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Öèòàòà:
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#25
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×òîáû íå âûçûâàòü ñîìíåíèé ó ïàöèåíòêè, ðåøèë çàïîñòèòü ýòó èíôîðìàöèþ çäåñü (â çàêðûòîì ðàçäåëå).
Èíôîðìàöèÿ îò FDA ïî ýôôåêòèâíîñòè ëå÷åíèÿ êîíòàãèîçíîãî ìîëëþñêà (ó äåòåé) êðåìîì Àëäàðà: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Öèòàòà:
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#26
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îäîáðÿëêè çàêîí÷èëèñü. ñïàñèáî
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#27
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- ïðèñîåäèíÿþñü ê Íàñòå, åñòü ÷òî ïî÷èòàòü, ñïàñèáî
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#28
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- ýòî æå åñòü è çäåñü:
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Imiquimod (Aldara) Induces secretion of cytokines, including interferon-alpha, TNF, and interleukins; increases T-cell activity. Minimal immediate antiviral activity. May be more effective in women than in men. Use 5% cream. - ýòè äàííûå óæå åñòü â êëèí. ðóêîâîäñòâàõ: "Ïîëàãàþ, ÷òî ýòè ðåçóëüòàòû ìîæíî ýêñòðàïîëèðîâàòü è íà âçðîñëûõ ïàöèåíòîâ." - ó âçðîñëûõ-äà â ïëàíå ýôôåêòèâíîñòè, ó äåòåé - íåò, âñå âåðíî "Administer as in adults; efficacy not demonstrated in children aged 2-12 y" |
#29
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- ìåòà-àíàëèç êîêðàíîâñêèé:
"Interventions for cutaneous molluscum contagiosum" Authors' conclusions - îäíîçíà÷íûõ íà ýòîì óðîâíå ïîêà íåò: No single intervention has been shown to be convincingly effective in the treatment of molluscum contagiosum. The update identified six new studies, most of them reporting on interventions not included in the original version. However, the conclusions of the review did not change. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#30
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- âîò èç ïîñëåäíèõ ó äåòåé:
Comparative Study on the Efficacy, Safety, and Acceptability of Imiquimod 5% Cream versus Cryotherapy for Molluscum Contagiosum in Children. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] "To compare the efficacy, safety and acceptability of imiquimod (IMQ) 5% cream with cryotherapy for the treatment of molluscum contagiosum (MC) in children. Prospective, randomized, comparative, observer blinded study. A total of 74 children, with MC were divided randomly to receive treatment with either IMQ 5% cream (group A) 5 days a week or cryotherapy (group B) once a week until clinical cure or up to a maximum of 16 weeks. All the patients were followed up weekly during active treatment. The patients were followed-up for 6 months after clinical cure to look for recurrence. In the IMQ group (group A), the overall complete cure rate was 91.8% (34 of 37), 22 of the 37 patients cleared by the end of 6 weeks and 12 more patients cleared by the end of 12 weeks, while the remaining three patients (8.1%) did not clear even after 16 weeks. Whereas, in the cryotherapy group, all 37 patients achieved complete cure, 26 of 37 (70.27%) patients cleared after 3 weeks, and the remaining 11 (29.72%) cleared by the end of 6 weeks. No statistically significant difference was found between the overall complete cure rate in both groups at the end of maximum treatment period (16 weeks). Pain, bullae formation, pigmentary changes, and superficial scarring were more significantly common in the cryotherapy group compared with the IMQ group. Imiqimod 5% cream seems to be slow acting but an effective agent for the treatment of MC in children. IMQ appears to be practically painless and more cosmetically accepted treatment when compared with cryotherapy, and may be the preferred treatment of MC in children especially with numerous small lesions. Cryotherapy has the advantage of being rapidly effective, and is less expensive than IMQ and may be the preferred treatment for large solitary or few lesions." |