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"lead": "Нарушение здоровья, относящееся к группе болезни наружного уха",
"description": "Наружный отит — отит, при котором поражаются ткани наружного слухового прохода (а также барабанной перепонки) или ушной раковины. Является широко распространённым заболеванием, которому подвержены все возрастные группы. ",
"etiology": "<p>Наиболее часто в практической отриноларингологии встречаются наружные отиты, вызываемые бактериальной флорой, по данным литературы воспалительные заболевания наружного уха в 60 - 98% имеют бактериальную природу. Возбудителем ограниченного наружного отита чаще всего является пиогенный стафилококк. Диффузный наружный отит может быть вызван стафилококками, гемофильной палочкой, пневмококками, клебсиеллой, синегнойной палочкой, моракселлой. </p>\r\n<p>Кроме бактериальной флоры, существенную роль в развитии наружного отита играют патогенные грибы. В настоящее время выделяют до 150 видов возбудителей отомикоза. </p>",
"pathogenesis": "<p>Развитию воспалительного процесса в наружном ухе предшествует нарушение целостности кожного покрова, которое может быть вызвано многими причинами - травматическими повреждениями, длительное пребыванием во влажной среде, изменениями кожи на фоне нарушения обмена веществ, сахарного диабета, различных дерматитов, экзематозных процессов. Предрасполагают к возникновению наружного отита анатомические особенности строения - узкие наружные слуховые проходы, наличие экзостозов, а также ношение слухового аппарата, попадание воды в уши, недостаточность образования и изменение состава ушной серы, нарушение местного и общего иммунного статуса, лучевое воздействие. </p>\r\n<p>После инфицирования начинается воспаление и отёк поверхностных тканей наружного слухового прохода, что приводит к появлению соответствующих симптомов. В тяжёлых случаях инфекция может распространиться и привести к целлюлиту лица или шеи, либо лимфадениту. </p>",
"diagnostics": "<p>Диагностика включает: </p>\r\n<ul>\r\n<li>Общий анализ крови – исследование, которое помогает выявить наличие очага воспаления в организме. </li>\r\n<li>Отоскопия - осмотр наружного слухового прохода, во время которого врач оценивает его состояние, а также внешний вид и состояние барабанной перепонки. </li>\r\n<li>Исследование слуха. </li>\r\n<li>Бактериологическое исследование выделений из уха - помогает выявить возбудителя заболевания и назначить правильное лечение. </li>\r\n</ul>",
"treatment": "<p>В большинстве случаев острый наружный отит хорошо поддаётся лечению местными препаратами. Основой терапии является применение антибиотиковлибо комбинаций антибиотиков с кортикостероидами в форме ушных капель. В случае сильного отёка наружного слухового прохода в него с помощью небольшого зонда может быть введена ватная или марлевая турунда, обеспечивающая более эффективную доставку и удержание лекарственных средств в месте воспаления. При этом капли наносятся на наружный конец турунды, в результате чего она пропитывается используемым препаратом, расширяется из-за поглощённой жидкости и хорошо удерживается в слуховом проходе. После того, как отёк уменьшится и, соответственно, необходимость в использовании турунды пропадёт, она сама выпадет из ушного канала или может быть удалена вручную. </p>\r\n<p>Некоторым пациентам может понадобиться назначение анальгетиков (в случае жалоб на сильные боли) в первые несколько дней лечения. При аллергической природе отита применяется терапия антигистаминными средствами. </p>\r\n<p>В большинстве случаев наружного отита системного приёма антибиотиков (перорально) не требуется, за исключением ситуаций с осложнениями в виде целлюлита кожи лица или шеи, а также пациентов, у которых сильный отёк слухового прохода затрудняет применение местных препаратов. Также возможно применение пероральных антибиотиков у лиц с ослабленным иммунитетом. </p>",
"prevention": "<p> </p>\r\n<p>Для предупреждения инфицирования кожи слухового прохода с развитием наружного отита необходимо избегать расчесывания ушной раковины, травмирования уха и попадания в него инородных тел. При купании следует беречь ухо от попадания в него воды. Ни в коем случае нельзя самостоятельно пытаться удалить инородное тело уха, поскольку это часто приводит к травмированию кожи слухового прохода. Не следует очищать ухо от серы не предназначенными для этого предметами: шпилькой, зубочисткой, спичкой, скрепкой и т. п. Туалет уха должен производиться специальной ушной палочкой на глубину не более, чем 0,5-1 см от начала слухового прохода.</p>",
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"description": "Гестационный сахарный диабет - один из вариантов диабета, который возникает или впервые диагностируется в период беременности. В основе заболевания лежит нарушение обмена углеводов различной степени, а именно снижение толерантности к глюкозе в организме беременной женщины. ",
"etiology": "<p>К основным факторам риска развития сахарного диабета беременных относят: </p>\r\n<ul>\r\n<li>Гормональная перестройка в организме беременной женщины; </li>\r\n<li>Аутоиммуные заболевания; </li>\r\n<li>Избыточный вес, ожирение; </li>\r\n<li>Вирусные инфекции на ранних сроках беременности; </li>\r\n<li>Курение, употребление алкогольных и наркотических веществ; </li>\r\n<li>Возраст беременной младше 18 и старше 30 лет; </li>\r\n<li>Сахарный диабет у ближайших родственников; </li>\r\n<li>Гестационный сахарный диабет в предыдущей беременности; </li>\r\n<li>Поликистоз яичников; </li>\r\n<li>Хроническое невынашивание (более 3 самопроизвольных абортов в I или II триместрах беременности); </li>\r\n<li>Многоводие; </li>\r\n<li>Мертворождение.</li>\r\n</ul>",
"pathogenesis": "<p>Заболевание развивается вследствие блокировки продукции достаточного количества инсулина гормонами, которые отвечают за правильный рост и развитие плода. При беременности организм женщины нуждается в большем количестве глюкозы, которая требуется не только для матери, но и для плода. Происходит компенсаторное увеличение продукции инсулина. Данные факторы становятся основной причиной гестационного диабета. </p>",
"diagnostics": "<p>Основным методом выявления гестационного диабета является исследование крови на определение уровня глюкозы. </p>\r\n<p>Также для определения функциональности поджелудочной железы и риска формирования гестационного диабета рутинно всем беременным на сроке 24-28 недель назначается пероральный тест на толерантность к глюкозе. </p>\r\n<p>Вначале сдается анализ крови из вены натощак, после чего женщина должна выпить 75 г глюкозы, разведенной в 300 мл воды. Спустя 2 часа забор крови повторяют. </p>\r\n<p>Диагноз «гестационный диабет» устанавливается, если первый показатель уровня глюкозы составляет более 7 ммоль/л, второй – более 7,8 ммоль/л. для его подтверждения беременной назначают еще один анализ в тот же день через несколько часов. </p>",
"treatment": "<p>Лечение сахарного диабета беременных включает: </p>\r\n<ul>\r\n<li>Диетотерапия с исключением продуктов, содержащих быстрые углеводы: кондитерских изделий, крахмалистых овощей, жирных и жареных блюд, фаст-фуда, магазинных соусов, сдоб. Необходимо включать в меню нежирную рыбу и мясо, крупы, злаковые каши, макароны твердых сортов, овощи. Углеводы должны составлять 45% от ценности рациона, жиры – 30%, белки – 25%. </li>\r\n<li>Умеренные физические нагрузки - гимнастика, ходьба, плавание. Они позволяют поддерживать организм в тонусе, предупреждают чрезмерный набор массы тела, улучшают усвояемость глюкозы тканями. </li>\r\n<li>Инсулинотерапия. </li>\r\n</ul>",
"prevention": "<p>Профилактика гестационного диабета заключается в планировании беременности и контроле массы тела. Женщина должна правильно питаться, отказаться от вредных привычек. Обязательно следует придерживаться активного образа жизни, поскольку умеренные физические нагрузки позволяют уменьшить вероятность развития гестационного диабета. Важно, чтобы упражнения были регулярными и не доставляли беременной дискомфорта.</p>",
"clinical_picture": "<p>Гестационный диабет не имеет специфической симптоматики. Главным признаком патологии является увеличение концентрации глюкозы в крови, что до наступления беременности у женщины не наблюдалось. Данное нарушение чаще всего диагностируется у пациенток после 20 недели вынашивания.</p>\r\n<p>Дополнительно при гестационном диабете может наблюдаться чрезмерное увеличение массы тела пациентки (более 300 г в неделю), сильное чувство жажды, повышение суточного диуреза. Также больные жалуются на снижение аппетита, быстро возникающую усталость.</p>\r\n<p>Со стороны плода признаком развития гестационного диабета может стать быстрый прирост массы, неправильные пропорции частей тела, избыточное отложение жировой клетчатки. </p>",
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