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},
"code": "E53",
"name": "Недостаточность других витаминов группы B",
"icd_name": "Недостаточность других витаминов группы B",
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3
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"periodicity": 4,
"slug": "e53_nedostatochnost_drugih_vitaminov_gruppy_b",
"lead": " Патологическое состояние, обусловленное дефицитом этого витамина в организме и проявляющееся нарушениями преимущественно со стороны нервной системы, сердца и кишечника.",
"description": "",
"etiology": "<p>Гиповитаминоз B1 в развитых странах встречается нередко и наблюдается в основном у больных с хроническими заболеваниями желудочно-кишечного тракта, хроническим алкоголизмом, полиневритами, эндокринными заболеваниями (сахарный диабет, токсический зоб) и др. Недостаточность тиамина часто сочетается с дефицитом других витаминов группы В.</p>",
"pathogenesis": "<p>Витамин B1 хорошо растворяется в воде; кофермент тиаминдифосфат (кокарбоксилаза) играет существенную роль в углеводном обмене. Наряду с этим тиамин участвует в обмене аминокислот, нуклеотидов, ацетилхолина и холинэстеразы. При дефиците витамина В1 в тканях и крови накапливаются недоокисленные продукты: пировиноградная кислота, молочная кислота и др. При этом нарушается деятельность различных отделов нервной системы (особенно периферической нервной системы), скелетных мышц и миокарда, а также функция желудочно-кишечного тракта.</p>",
"diagnostics": "<p>Диагноз гиповитаминоза B1 подтверждается уменьшением содержания тиамина в крови (в сыворотке ниже 5 мкг/л, в эритроцитах ниже 30 мкг/л), резким повышением концентрации пировиноградной кислоты в крови (выше 0,01 г/л) и моче (выше 30 мг/сут), повышением содержания в крови молочной кислоты (выше 200 мг/л). В последнее время с этой целью используют также ряд более сложных современных методов.</p>",
"treatment": "<p>Лечение больных обычно проводится амбулаторно. Рекомендуется диета, богатая тиамином, в сочетании с препаратами тиамина внутрь (50-100 мг/сут) или парентерально (30-60 мг/сут).</p>\r\n<p>Больные с выраженными формами болезни часто нуждаются в стационарном лечении. Парентерально вводят тиамин по 1 мл и кокарбоксилазу. Одновременно назначают другие витамины группы В (рибоксин, пиридоксин, никотиновая кислота) и аскорбиновую кислоту.</p>",
"prevention": "",
"clinical_picture": "<p>Характерны ухудшение аппетита, <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a>, наклонность к запорам, парестезии в ногах, боль в икроножных мышцах при ходьбе, ухудшение сна, <a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>, плаксивость, снижение физической и психической работоспособности. Иногда умеренное похудание, лабильность пульса на фоне общей психоэмоциональной лабильности. Язык суховат, живот нерезко вздут, умеренно снижена болевая и глубокая чувствительность в области стоп и голеней, нерезко ослаблены сухожильные рефлексы (больше на ногах).</p>",
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{
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},
{
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},
{
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},
{
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},
{
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},
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},
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{
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},
{
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},
{
"name": "У ребенка болит живот"
},
{
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},
{
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},
{
"name": "Боль под ложечкой"
},
{
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{
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"code": "E51",
"name": "Недостаточность тиамина",
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0
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"lead": "Заболевание протекающее с накоплением в крови и тканях пировиноградной кислоты, нарушением водного, углеводного, белкового и жирового обменов, сопровождающееся расстройством функций нервной системы, ослаблением сердечной деятельности.",
"description": "",
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"pathogenesis": "",
"diagnostics": "<p>Специалист назначает анализ крови и мочи. Для уточнения диагноза используют определение транскетолазной реакции.</p>",
"treatment": "<p>Как правило, терапия проводится амбулаторно. Во всех случаях больному назначается диета. Все продукты должны быть богаты витамином В1. Помимо этого, витамин вводится внутрь или принимается перорально.</p>\r\n<p>Пациентов с более тяжелыми формами болезни направляют в стационар. В этом случае микроэлемент вводят в организм парентерально по 1 мг наряду с кокарбоксилазой. Одновременно назначают другие витамины группы В.</p>",
"prevention": "<p>С целью профилактики медики рекомендуют потреблять пищу, богатую микроэлементами, особенно витамином В1.</p>",
"clinical_picture": "<p>К ранним проявлениям заболевания относят:</p>\r\n<ul>\r\n<li>неприятные ощущения в животе;</li>\r\n<li>ухудшение памяти;</li>\r\n<li>проблемы со сном;</li>\r\n<li>плохой аппетит;</li>\r\n<li>уменьшение веса;</li>\r\n<li><a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">утомляемость</a>;</li>\r\n<li><a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>.</li>\r\n</ul>\r\n<p>Необходимо своевременно обращаться к врачу при возникновении подобной симптоматики. При несвоевременном обращении к специалисту развивается тяжелый дефицит витамина В1. Впоследствии наблюдаются нарушения работы мозга, сердца, нервной системы. Во всех ситуациях изменяются процессы обмена в эритроцитах, а уровень микроэлемента в моче резко снижается.</p>\r\n<p>Наблюдается <a href=\"/symptom/onemenie_kozhi/\" title=\"Перейти на страницу симптома Онемение кожи\">покалывание</a> в пальцах нижних конечностей, жжение в стопах, которое усиливается в ночное время суток, также возникают судороги в мышцах икр и появляются боли в стопах. Во многих случаях развития болезни вибрационная чувствительность пальцев ног снижена.</p>",
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},
"code": "E50",
"name": "Недостаточность витамина A",
"icd_name": "Недостаточность витамина A",
"gender": 0,
"age_min": 0,
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0
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"slug": "e50_nedostatochnost_vitamina_a",
"lead": "Это патологическое состояние, возникающее вследствие дефицита в организме этого витамина и проявляющееся ухудшением зрения - в первую очередь гемералопией («куриная» слепота), конъюнктивитом, ксерофтальмией, гиперкератозом кожи. ",
"description": "",
"etiology": "<p>Недостаточность витамина А может быть обусловлена нарушением абсорбции витамина в кишечнике при его хронических заболеваниях, целиакии, болезнях печени и поджелудочной железы, железодефицитной анемии, длительном употреблении минерального масла. При потреблении с пищей небольших количеств жира также снижается абсорбция витамина А.</p>\r\n<p>Причиной недостаточности витамина могут быть и чрезмерные потери его организмом. Так, экскреция витамина А увеличивается при раке, болезнях мочевыводящих путей и хронических инфекционных заболеваниях. Низкое потребление белка приводит к недостаточности белка-переносчика и способствует снижению уровня витамина в плазме.</p>",
"pathogenesis": "",
"diagnostics": "<p>При гиповитаминозе А понижено содержание в крови ретинола или каротина (ниже 200 мкг/л), нарушена темновая адаптация, развивается гемералопия. При биомикроскопии глаза на слизистой конъюнктивы могут выявляться белесые и желтоватые мелкие бляшки.</p>",
"treatment": "<p>азначают диету, богатую витамином А и провитаминами, а также препараты ретинола. Растворы ретинола применяют внутрь и в виде внутримышечных инъекций.</p>\r\n<p>Суточная лечебная доза 25 000-100 000 ME ретинола (при приеме внутрь дозу делят на 2-3 приема, больше одной инъекции в сутки обычно не делают), продолжительность курса лечения 2-4 нед. Ретинол содержится в поливитаминных препаратах.</p>",
"prevention": "<p>Профилактика гиповитаминоза А состоит в рациональном питании и назначении внутрь препаратов ретинола (5000-10 000 ME) в течение не менее 2-3 нед. До и после проведенного профилактического курса целесообразно определить содержание в сыворотке крови ретинола или каротина.</p>",
"clinical_picture": "<p>Наблюдаются сухость в полости рта и носа, <a href=\"/symptom/izmeneniya_struktury_kozhi/\" title=\"Перейти на страницу симптома Изменения структуры кожи\">сухость кожи</a>, ее <a href=\"/symptom/shelushenie_kozhi/\" title=\"Перейти на страницу симптома Шелушение кожи\">шелушение</a>, повышенное <a href=\"/symptom/vypadenie_volos/\" title=\"Перейти на страницу симптома Выпадение волос\">выпадение волос</a>. Ухудшается сумеречное зрение («куриная» <a href=\"/symptom/slepota/\" title=\"Перейти на страницу симптома Слепота \">слепота</a>). Одновременно возможны <a href=\"/symptom/svetoboyazn/\" title=\"Перейти на страницу симптома Светобоязнь\">светобоязнь</a> (<a href=\"/symptom/glaznaya_bol/\" title=\"Перейти на страницу симптома Глазная боль\">боль в глазах</a> при ярком освещении) и ксерофтальмия (сухость конъюнктивы с утратой присущего ей блеска, снижение секреции слезных желез, появление бляшек Искерского - Бито, разбросанных по склере). В наиболее тяжелых случаях воспалительные процессы в роговице могут осложняться ее некротическим размягчением (кератомаляция), что обычно заканчивается слепотой.</p>\r\n<p>Сочетание гемералопии с ксерофтальмией позволяет с высокой достоверностью думать о недостаточности витамина А.</p>",
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},
"code": "B39",
"name": "Гистоплазмоз",
"icd_name": "Гистоплазмоз",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
2,
5
],
"periodicity": 1,
"slug": "b39_gistoplazmoz",
"lead": "инфекция, которую вызывают грибки под названием Histoplasma capsulatum. Она может проявляться в виде разных симптомов и поражать разные органы, но чаще всего страдают легкие.",
"description": "",
"etiology": "<p align=\"justify\" style=\"\">Возбудитель - Histoplasma capsulatum - диморфный гриб, существующий в тканевой и культуральной формах. Тканевая форма располагается в клетках органов ретикулоэндотелиальной системы (печень, селезенка, лимфатические узлы). По форме и размерам (2-4 мкм) этот микроорганизм напоминает лейшмании или токсоплазмы. Мицелиальная форма гриба никогда не встречается в тканях. Она хорошо развивается на питательных средах при температуре ниже 30С. Гистоплазмы в обеих фазах являются патогенными для белых мышей, крыс, морских свинок, золотистых хомячков, собак. Гриб длительно сохраняется во влажной почве (6 нед) и в воде. Быстро погибает под влиянием различных дезинфицирующих препаратов.</p><p align=\"justify\">Возбудитель болезни сохраняется в почве. В загрязнении (заражении) почвы имеет определенное значение выделение гриба инфицированными животными и птицами (летучие мыши, кошки, собаки, куры, скворцы и др.). Инфицирование людей происходит воздушно-пылевым путем. Случаев заражения человека от больных людей и животных не наблюдалось. Гистоплазмоз широко распространен в различных странах Африки и Америки, встречается также в Европе и Азии, единичные случаи гистоплазмоза описаны в нашей стране, возможны и завозные случаи. Наиболее инфицированными являются области, расположенные от 45° до 30° к северу. Важную роль в эпидемиологии гистоплазмоза играет почва. В период дождей гистоплазма размножается в почве. Одна колония гриба диаметром 2,5 см может нести миллионы спор. После окончания периода дождей споры рассеиваются во внешней среде. Заражение происходит при вдыхании спор, в частности при проведении разного рода земляных работ (рытье траншей, строительство и т. д.). Инфекция от больных людей здоровым не передается даже при длительных тесных контактах.</p>",
"pathogenesis": "<p align=\"justify\">Воротами инфекции чаще являются органы дыхания. Споры гриба с пылью попадают в бронхи и альвеолы, там они превращаются в паразитические дрожжеподобные формы, внедряются в ткани и обусловливают возникновение первичного легочного очага. С током лимфы возбудитель проникает в регионарные лимфатические узлы, вызывая в них воспалительный процесс. Наличие гриба в ткани приводит к формированию гранулематозного процесса, который разрешается некрозом, изъязвлением или петрификацией легочной ткани и лимфатических узлов, реже абсцедированием. Эта форма напоминает первичный туберкулез легких. Антигены гистоплазм проникают в общий круг кровообращения и приводят к аллергической перестройке организма (что выявляется внутрикожной пробой с гистоплазмином) и выработке специфических антител. На этом процесс может закончиться, не давая выраженной симптоматики, иногда процесс протекает в виде инаппарантной формы. В других же случаях наступает гематогенная диссеминация гриба по всему организму с поражением многих органов. Процесс быстро прогрессирует и часто приводит к летальному исходу. В возникновении подобной формы большое значение имеет состояние иммунной системы. Такое течение, как правило, наблюдается у ВИЧ-инфицированных лиц.</p>\r\n<p> </p>",
"diagnostics": "<p style=\"padding-bottom: 15px; border: 0px; outline: 0px; vertical-align: baseline; -webkit-font-smoothing: antialiased; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;\">Распознавание гистоплазмоза является непростой задачей для инфекционистов, пульмонологов и других специалистов, к которым могут обращаться пациенты. Диагноз подтверждается выделением Histoplasma capsulatum из мокроты, промывных вод бронхов; при диссеминированной форме – из крови, мочи, кала, содержимого абсцессов, стернального пунктата, цереброспинальной жидкости. В пользу гистоплазмоза свидетельствует получение культуры гриба при посеве этих материалов на питательные среды. Для диагностики гистоплазмоза также используются серологические реакции (РСК, реакция преципитации и латекс агглютинации), биопсия бронха, лимфатических узлов, краев язв с последующим гистологическим исследованием. Высокоспецифичным тестом служит внутрикожная проба с гистоплазмином.</p><p style=\"padding-bottom: 15px; border: 0px; outline: 0px; vertical-align: baseline; -webkit-font-smoothing: antialiased; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;\">При рентгенографии легких в острой стадии легочного гистоплазмоза обнаруживаются крупно- и среднеочаговые инфильтраты. В дальнейшем на месте инфильтратов образуются очаги фиброза и кальциноза. При подозрении на острый легочный гистоплазмоз исключаются ОРВИ, бактериальная пневмония, атипичная пневмония, орнитоз, <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">лихорадка</a> Ку, микоплазмоз, туберкулез. Хронический гистоплазмоз легких требует дифференциации с легочными формами глубоких микозов (нокардиозом, аспергиллезом, кокцидиоидомикозом,бластомикозом), лимфогранулематозом. Диссеминированные формы микоза следует разграничивать с сепсисом и милиарным туберкулезом</p>",
"treatment": "<p><br></p>",
"prevention": "<p>Специфической профилактики гистоплазмоза пока не существует. К мерам профилактики относится предотвращение запыления воздуха в местах распространения в почве грибов-возбудителей, предохранение от вдыхания зараженного воздуха в помещениях, при работе с землей, в микологических лабораториях, обеззараживание воздуха в лабораториях. Овощи, фрукты, предметы и материалы, привезенные из зон распространения гистоплазмоза, требуют соответствующей обработки дезинфицирующими средствами.<br></p>",
"clinical_picture": "<p align=\"justify\">Инкубационный период длится от 4 до 30 дней (чаще 7-14 дней). Чем короче инкубационный период, тем тяжелее протекает заболевание.</p>\r\n<p align=\"justify\">По клиническому течению выделяют следующие формы гистоплазмоза:<br />1. Острый гистоплазмоз легких:<br />а) бессимптомная (инаппарантная) форма;<br />б) клинически выраженные формы (легкая, средней тяжести, тяжелая).<br />2. Хронический прогрессирующий (кавернозный) гистоплазмоз легких.<br />3. Острый диссеминированный гистоплазмоз (доброкачественный, прогрессирующий).<br />4. Хронический диссеминированный гистоплазмоз (с поражением слизистых оболочек и кожи).</p>\r\n<p align=\"justify\">Чаще всего встречается острый гистоплазмоз легких, что обусловлено аэрогенным инфицированием. Острые формы легочного гистоплазмоза могут протекать бессимптомно и обнаруживаться лишь при постановке внутрикожной пробы с гистоплазмином, по положительным результатам серологических реакций, иногда по петрификатам в легких и прикорневых лимфатических узлах. При легких формах, которые преобладают, самочувствие больных остается хорошим, нередко они продолжают работать, <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">лихорадка</a> отсутствует или бывает кратковременной (3-4 дня), а общая длительность лечения 2-3 нед. При рентгенологическом исследовании выявляют усиление рисунка и увеличение тени корней легких, лишь у отдельных больных наблюдаются мелкоочаговые тени, преимущественно в нижних отделах легких.</p>\r\n<p align=\"justify\">Тяжелые формы острого гистоплазмоза легких характеризуются внезапным началом, быстрым повышением температуры тела до 40-41С. Температурная кривая неправильного типа с большим суточным размахом. Потрясающие ознобы сменяются диффузным потоотделением. Больные жалуются на сильную головную боль, <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, боли в мышцах и костях, <a href=\"/symptom/kashel/\" title=\"Перейти на страницу симптома Кашель\">кашель</a>, боли в груди. У некоторых больных отмечаются <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a>, <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a>, <a href=\"/symptom/diareya/\" title=\"Перейти на страницу симптома Диарея\">понос</a>, <a href=\"/symptom/bol_v_zhivote/\" title=\"Перейти на страницу симптома Боль в животе\">боли в животе</a>. Длительность лихорадки 2-6 нед. В периоде реконвалесценции длительно наблюдается субфебрилитет, астенизация, резкое снижение трудоспособности, <a href=\"/symptom/potlivost/\" title=\"Перейти на страницу симптома потливость\">потливость</a>. Эти явления сохраняются до 1 года. При перкуссии легких можно отметить некоторое укорочение звука, при аускультации - мелкопузырчатые влажные <a href=\"/symptom/hripy/\" title=\"Перейти на страницу симптома Хрипы\">хрипы</a>, преимущественно в нижних отделах легких. Рентгенологически выявляют крупно- и среднеочаговые тени в виде \"ватных хлопьев\", которые могут сливаться. В дальнейшем инфильтраты полностью исчезают или на их месте образуются очаги фиброза и кальцинации.</p>\r\n<p align=\"justify\">При среднетяжелых формах клинические и рентгенологические проявления выражены не так резко, <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">лихорадка</a> сохраняется около 2 нед, а продолжительность стационарного лечения составляет около месяца.</p>\r\n<p align=\"justify\">Хронический гистоплазмоз легких протекает в виде длительной прогрессирующей болезни, периодически дающей обострения. Наблюдают умеренную лихорадку, <a href=\"/symptom/kashel/\" title=\"Перейти на страницу симптома Кашель\">кашель</a> с мокротой, при рентгенологическом исследовании выявляются каверны, фиброз и множественные кальцинированные очаги.</p>\r\n<p align=\"justify\">Острая форма диссеминированного гистоплазмоза проявляется высокой лихорадкой гектического или неправильного типа, повторными ознобами и потоотделением, выраженными симптомами общей интоксикации (<a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома Головная боль\">головная боль</a>, мышечные и суставные боли, <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a>, <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a>, <a href=\"/symptom/bol_v_zhivote/\" title=\"Перейти на страницу симптома Боль в животе\">боли в животе</a>, нарастающая <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>). На этом фоне появляются множественные вторичные очаги как результат диссеминации: различного рода экзантемы (макулопапулезная, фурункулоподобная, геморрагическая, типа многоформной или узловатой эритемы), <a href=\"/symptom/uvelichenie_limfaticheskih_uzlov/\" title=\"Перейти на страницу симптома Увеличение лимфатических узлов\">лимфаденопатия</a>, мезаденит, <a href=\"/symptom/uvelichenie_pecheni/\" title=\"Перейти на страницу симптома Увеличение печени\">увеличение печени</a> и селезенки, энцефалит или менингоэнцефалит, септический эндокардит, язвенный колит, перитонит. Клинические и рентгенологические изменения могут напоминать милиарный туберкулез (при аэрогенном инфицировании).</p>\r\n<p align=\"justify\">Хронический диссеминированный гистоплазмоз характеризуется вялым течением, самочувствие больных вначале удовлетворительное, <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">лихорадка</a> не выражена, типично вовлечение в процесс кожи и слизистых оболочек. Образуются характерные язвы на языке, слизистых оболочках глотки и гортани. В дальнейшем состояние ухудшается, появляется <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">лихорадка</a> неправильного типа (септического), наблюдается <a href=\"/symptom/uvelichenie_pecheni/\" title=\"Перейти на страницу симптома Увеличение печени\">увеличение печени</a>, селезенки, всех групп лимфатических узлов, поражение желудка, глаз (хорио-ретиниты) и т. д.</p>\r\n<p align=\"justify\">Особенности гистоплазмоза у детей раннего возраста.<br />Гистоплазмоз может наблюдаться у детей первых месяцев жизни (2-6 мес.). Заболевание детей характеризуется лихорадкой (38-39°С), жидким пенистым стулом с неприятным запахом, бледностью, а иногда и умеренной желтушностью кожных покровов и слизистых оболочек, значительным увеличением печени (5-9 см ниже реберной дуги) и селезенки (3-5 см ниже реберного края), во всех случаях в процесс вовлекаются легкие. При исследовании крови отмечается прогрессирующая анемизация, лейкопения, повышенное содержание билирубина, повышается активность сывороточных ферментов (АлАТ, АсАТ, щелочной фосфатазы и др.). В периферической крови отмечается пойкилоцитоз, анизоцитоз, полихроматофилия, тромбоцитопения. Болезнь протекает как диссеминированный гистоплазмоз. Во всех случаях (до начала противомикозной терапии) можно выделить гистоплазмы из крови и из костного мозга.</p>\r\n<p align=\"justify\">Гистоплазмоз у ВИЧ-инфицированных лиц.<br />Снижение иммунитета существенно повышает риск инфицирования гистоплазмами. Эта проблема особенно актуальна в регионах, эндемичных по гистоплазмозу. По сравнению с аспергиллезом и кандидозом, гистоплазмоз встречается реже (у 0,5% больных СПИДом). В эндемичных районах США этот процент значительно выше. Гистоплазмоз у ВИЧ-инфицированных протекает как гематогенно диссеминированный процесс и характеризуется высокой лихорадкой, лимфаденопатией, значительным увеличением печени и селезенки, постоянными проявлениями служат <a href=\"/symptom/kashel/\" title=\"Перейти на страницу симптома Кашель\">кашель</a> и инфильтраты в легких. При исследовании крови отмечается лейкопения и анемия. Протекает тяжело, даже в начальных стадиях</p>\r\n<p align=\"justify\">При ВИЧ-инфекции летальность свыше 80% (при отсутствии терапии), при раннем назначении противомикозных препаратов летальность снижается до 15%. У больных СПИДом летальность достигает 100%, и даже большие дозы амфотерицина В не предупреждают рецидивов болезни.</p>\r\n<p align=\"justify\">Диагностика затрудняется отрицательными результатами как внутрикожной пробы с гистоплазмином, так и серологических реакций. При наличии гистоплазмоза (особенно диссеминированных форм) больной должен обязательно проверяться на ВИЧ-инфекцию.</p>",
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{
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{
"name": "Боль головная у детей"
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{
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"name": "Жжение в голове "
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