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Особенности патогенеза и терапии острого риносинусита у пациентов с аллергическим ринитом
Особенности патогенеза и терапии острого риносинусита у пациентов с аллергическим ринитом
Кирдеева А.И., Косяков С.Я. Особенности патогенеза и терапии острого риносинусита у пациентов с аллергическим ринитом. Consilium Medicum. 2017; 19 (3): 91–94.
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Аннотация
Взаимосвязь острого риносинусита и аллергического ринита полностью не изучена, в связи с чем остается открытым вопрос об особенностях терапии острого риносинусита у пациентов с сопутствующей аллергией. Множественные патомеханизмы, включающие особенности иммунного ответа, специфический цитокиновый профиль, молекулярные механизмы на уровне эпителиальных клеток и межклеточного матрикса, являются общими для аллергического ринита и риносинусита. Механизм действия топических глюкокортикостероидов заключается в ингибировании синтеза провоспалительных цитокинов, предотвращении миграции воспалительных клеток. Использование интраназальных глюкокортикостероидов с целью нивелирования аллергического воспаления может препятствовать развитию и повысить эффективность терапии острого риносинусита.
Ключевые слова: аллергический ринит, острый риносинусит, топические глюкокортикостероиды.
Ключевые слова: аллергический ринит, острый риносинусит, топические глюкокортикостероиды.
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The relationships between acute rhinosinusitis and allergic rhinitis are not fully understood, and therefore the question concerning the characteristics of ARS therapy in patients with concomitant allergy remains open. Multiple pathomechanisms including aspects of the immune response, specific cytokine profile, molecular mechanisms at the level of epithelial cells and intercellular matrix are common for allergic rhinitis and rhinosinusitis. The mechanism of TGCSs action is inhibition of the synthesis of proinflammatory cytokines and preventing the migration of inflammatory cells. The use of intranasal glucocorticosteroids to leveling allergic inflammation may stop the development and increase the effectiveness of acute rhinosinusitis therapy.
Key words: allergic rhinitis, acute rhinosinusitis, topical glucocorticosteroids.
Key words: allergic rhinitis, acute rhinosinusitis, topical glucocorticosteroids.
Полный текст
Список литературы
1. Gwaltney JM, Phillips CD, Miller RD, Riker DK. Computed tomographic study of the common cold. New Engl J Med 1994; 330 (1): 25–30. DOI: 10.1056/NEJM199401063300105.
2. Chen CF, Wu KG, Hsu MC, Tang RB. Prevalence and relationship between allergic diseases and infectious diseases. J Microbiol, Immunol Infect 2001; 34: 57–62.
3. Pant H, Ferguson BJ, Macardle PJ. The role of allergy in rhinosinusitis. Cur Opin Otolaryngol Head Neck Surg 2009; 17 (3): 232–8. DOI: 10.1097/MOO. 0b013e32832ad3c0.
4. Gwaltney JM Jr. Acute community-acquired sinusitis. Clin Infect Dis 1996; 23 (1): 1224–5.
5. Mogensen C, Tos M. Quantitative histology of the maxillary sinus. Rhinology 1977; 15: 129.
6. Alho OP, Karttunen TJ, Karttunen R et al. Subjects with allergic rhinitis show signs of more severely impaired paranasal sinus functioning during viral colds than nonallergic subjects. Allergy 2003: 58: 767–71.
7. Blair C, Nelson M, Thompson K et al. Allergic inflammation enhances bacterial sinusitis in mice. J Allergy Clin Immunol 2001; 108: 424–9. DOI: 10.1067/mai.2001.117793.
8. Alho OP, Karttunen R, Karttunen TJ. Nasal mucosa in natural colds: effects of allergic rhinitis and susceptibility to recurrent sinusitis. Clin Experimental Immunol 2004; 137 (2): 366–72. DOI: 10.1111/j.1365-2249.2004.02530.x.
9. Kauffman HF, Tomee JF, van de Riet MA et al. Protease-dependent activation of epithelial cells by fungal allergens leads to morphologic changes and cytokine production. J Allergy Clin Immunol 2000; 105: 1185–93. DOI: http://dx.doi.org/10.1067/mai.2000.106210.
10. Shah SA, Ishinaga H, Takeuchi K. Pathogenesis of eosinophilic chronic rhinosinusitis. J Inflam 2016; 13: 11. DOI: 10.1186/s12950-016-0121-8.
11. Prokopakis EP, Vlastos IM, Ferguson BJ et al. SCUAD and chronic rhinosinusitis. Reinforcing hypothesis driven research in difficult cases. Rhinology 2014; 52 (1): 3–8. DOI: 10.4193/Rhin.
12. Karatzanis A, Kalogjera L, Scadding G et al. Severe Chronic Upper Airway Disease (SCUAD) in children. Definition issues and requirements. Int J Pediatr Otorhinolaryngol 2015; 79 (7): 965–8. DOI: 10.1016/j.ijporl.2015.02.024.
13. Choi CH, Poroyko V, Watanabe S et al. Seasonal allergic rhinitis affects sinonasalmicrobiota. Am J Rhinology Allergy 2014; 28 (4): 281–6. DOI: 10.2500/ajra.2014.28.4050.
14. Patel ZM, Hwang PH. Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment. Uptodate. Literature review current through: Jan 2017.
15. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol – Head Neck Surg 2015; 152 (Suppl. 2): S1–S39. DOI: 10.1177/0194599815572097.
16. Wang YH, Ku MS, Sun HL, Lue KH. Efficacy of nasal irrigation in the treatment of acute sinusitis in atopic children. J Microbiol, Immunol Infect 2014; 47 (1): 63–9. DOI: 10.1016/j.jmii.2012.08.018.
17. King D, Mitchell B, Williams CP, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev 2015: CD006821.
18. Bende M, Fukami M, Arfors KE et al. Effect of oxymetazoline nose drops on acute sinusitis in the rabbit. Ann Otology, Rhinology Laryngology 1996; 105: 222. DOI: 10.1177/000348949610500309.
19. Fokkens W, Lund V, Mullol J. European position paper on rhinosinusitis and nasal polyps. Rhinol (Suppl.) 2007; 20: 1–136. Medscape J Med 2008; 10 (4): 105.
20. Valerie J. Lund. Therapeutic Targets in Rhinosinusitis: Infection or Inflammation? Medscape J Med 2008; 10 (4): 105.
21. Zalmanovici A, Yaphe J. Steroids for acute sinusitis. Cochrane Database Syst Rev 2007; 2: CD005149.
22. Mygind N, Nielsen LP, Hoffmann HJ et al. Mode of action of intranasal corticosteroids. J Allergy Clin Immunol 2001; 108 (Suppl. 1): S16–25. DOI: http://dx.doi.org/10.1067/mai.2001.115561
23. Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. Brit Med J 1998; 317: 1624–9.
24. Aksoy F, Dogan R, Kocak I et al. Effect of Nasal Corticosteroid on Secretory Immunoglobulin A Measured in Rat Nasal Lavage: Experimental Study. Otolaryngol – Head Neck Surg 2015; 153 (2): 298–301. DOI: 10.1177/0194599815589073.
25. Benninger MS, Ahmad N, Marple BF. The safety of intranasal steroids. Otolaryngol – Head Neck Surg 2003; 129: 739–50. DOI: http://dx.doi.org/10.1016/j.otohns.2003.10.001.
26. Zitt M, Kosoglou T, Hubbell J. Mometasonefuroate nasal spray: a review of safety and systemic effects. Drug Safety 2007; 30: 317–26.
2. Chen CF, Wu KG, Hsu MC, Tang RB. Prevalence and relationship between allergic diseases and infectious diseases. J Microbiol, Immunol Infect 2001; 34: 57–62.
3. Pant H, Ferguson BJ, Macardle PJ. The role of allergy in rhinosinusitis. Cur Opin Otolaryngol Head Neck Surg 2009; 17 (3): 232–8. DOI: 10.1097/MOO. 0b013e32832ad3c0.
4. Gwaltney JM Jr. Acute community-acquired sinusitis. Clin Infect Dis 1996; 23 (1): 1224–5.
5. Mogensen C, Tos M. Quantitative histology of the maxillary sinus. Rhinology 1977; 15: 129.
6. Alho OP, Karttunen TJ, Karttunen R et al. Subjects with allergic rhinitis show signs of more severely impaired paranasal sinus functioning during viral colds than nonallergic subjects. Allergy 2003: 58: 767–71.
7. Blair C, Nelson M, Thompson K et al. Allergic inflammation enhances bacterial sinusitis in mice. J Allergy Clin Immunol 2001; 108: 424–9. DOI: 10.1067/mai.2001.117793.
8. Alho OP, Karttunen R, Karttunen TJ. Nasal mucosa in natural colds: effects of allergic rhinitis and susceptibility to recurrent sinusitis. Clin Experimental Immunol 2004; 137 (2): 366–72. DOI: 10.1111/j.1365-2249.2004.02530.x.
9. Kauffman HF, Tomee JF, van de Riet MA et al. Protease-dependent activation of epithelial cells by fungal allergens leads to morphologic changes and cytokine production. J Allergy Clin Immunol 2000; 105: 1185–93. DOI: http://dx.doi.org/10.1067/mai.2000.106210.
10. Shah SA, Ishinaga H, Takeuchi K. Pathogenesis of eosinophilic chronic rhinosinusitis. J Inflam 2016; 13: 11. DOI: 10.1186/s12950-016-0121-8.
11. Prokopakis EP, Vlastos IM, Ferguson BJ et al. SCUAD and chronic rhinosinusitis. Reinforcing hypothesis driven research in difficult cases. Rhinology 2014; 52 (1): 3–8. DOI: 10.4193/Rhin.
12. Karatzanis A, Kalogjera L, Scadding G et al. Severe Chronic Upper Airway Disease (SCUAD) in children. Definition issues and requirements. Int J Pediatr Otorhinolaryngol 2015; 79 (7): 965–8. DOI: 10.1016/j.ijporl.2015.02.024.
13. Choi CH, Poroyko V, Watanabe S et al. Seasonal allergic rhinitis affects sinonasalmicrobiota. Am J Rhinology Allergy 2014; 28 (4): 281–6. DOI: 10.2500/ajra.2014.28.4050.
14. Patel ZM, Hwang PH. Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment. Uptodate. Literature review current through: Jan 2017.
15. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol – Head Neck Surg 2015; 152 (Suppl. 2): S1–S39. DOI: 10.1177/0194599815572097.
16. Wang YH, Ku MS, Sun HL, Lue KH. Efficacy of nasal irrigation in the treatment of acute sinusitis in atopic children. J Microbiol, Immunol Infect 2014; 47 (1): 63–9. DOI: 10.1016/j.jmii.2012.08.018.
17. King D, Mitchell B, Williams CP, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev 2015: CD006821.
18. Bende M, Fukami M, Arfors KE et al. Effect of oxymetazoline nose drops on acute sinusitis in the rabbit. Ann Otology, Rhinology Laryngology 1996; 105: 222. DOI: 10.1177/000348949610500309.
19. Fokkens W, Lund V, Mullol J. European position paper on rhinosinusitis and nasal polyps. Rhinol (Suppl.) 2007; 20: 1–136. Medscape J Med 2008; 10 (4): 105.
20. Valerie J. Lund. Therapeutic Targets in Rhinosinusitis: Infection or Inflammation? Medscape J Med 2008; 10 (4): 105.
21. Zalmanovici A, Yaphe J. Steroids for acute sinusitis. Cochrane Database Syst Rev 2007; 2: CD005149.
22. Mygind N, Nielsen LP, Hoffmann HJ et al. Mode of action of intranasal corticosteroids. J Allergy Clin Immunol 2001; 108 (Suppl. 1): S16–25. DOI: http://dx.doi.org/10.1067/mai.2001.115561
23. Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. Brit Med J 1998; 317: 1624–9.
24. Aksoy F, Dogan R, Kocak I et al. Effect of Nasal Corticosteroid on Secretory Immunoglobulin A Measured in Rat Nasal Lavage: Experimental Study. Otolaryngol – Head Neck Surg 2015; 153 (2): 298–301. DOI: 10.1177/0194599815589073.
25. Benninger MS, Ahmad N, Marple BF. The safety of intranasal steroids. Otolaryngol – Head Neck Surg 2003; 129: 739–50. DOI: http://dx.doi.org/10.1016/j.otohns.2003.10.001.
26. Zitt M, Kosoglou T, Hubbell J. Mometasonefuroate nasal spray: a review of safety and systemic effects. Drug Safety 2007; 30: 317–26.
2. Chen CF, Wu KG, Hsu MC, Tang RB. Prevalence and relationship between allergic diseases and infectious diseases. J Microbiol, Immunol Infect 2001; 34: 57–62.
3. Pant H, Ferguson BJ, Macardle PJ. The role of allergy in rhinosinusitis. Cur Opin Otolaryngol Head Neck Surg 2009; 17 (3): 232–8. DOI: 10.1097/MOO. 0b013e32832ad3c0.
4. Gwaltney JM Jr. Acute community-acquired sinusitis. Clin Infect Dis 1996; 23 (1): 1224–5.
5. Mogensen C, Tos M. Quantitative histology of the maxillary sinus. Rhinology 1977; 15: 129.
6. Alho OP, Karttunen TJ, Karttunen R et al. Subjects with allergic rhinitis show signs of more severely impaired paranasal sinus functioning during viral colds than nonallergic subjects. Allergy 2003: 58: 767–71.
7. Blair C, Nelson M, Thompson K et al. Allergic inflammation enhances bacterial sinusitis in mice. J Allergy Clin Immunol 2001; 108: 424–9. DOI: 10.1067/mai.2001.117793.
8. Alho OP, Karttunen R, Karttunen TJ. Nasal mucosa in natural colds: effects of allergic rhinitis and susceptibility to recurrent sinusitis. Clin Experimental Immunol 2004; 137 (2): 366–72. DOI: 10.1111/j.1365-2249.2004.02530.x.
9. Kauffman HF, Tomee JF, van de Riet MA et al. Protease-dependent activation of epithelial cells by fungal allergens leads to morphologic changes and cytokine production. J Allergy Clin Immunol 2000; 105: 1185–93. DOI: http://dx.doi.org/10.1067/mai.2000.106210.
10. Shah SA, Ishinaga H, Takeuchi K. Pathogenesis of eosinophilic chronic rhinosinusitis. J Inflam 2016; 13: 11. DOI: 10.1186/s12950-016-0121-8.
11. Prokopakis EP, Vlastos IM, Ferguson BJ et al. SCUAD and chronic rhinosinusitis. Reinforcing hypothesis driven research in difficult cases. Rhinology 2014; 52 (1): 3–8. DOI: 10.4193/Rhin.
12. Karatzanis A, Kalogjera L, Scadding G et al. Severe Chronic Upper Airway Disease (SCUAD) in children. Definition issues and requirements. Int J Pediatr Otorhinolaryngol 2015; 79 (7): 965–8. DOI: 10.1016/j.ijporl.2015.02.024.
13. Choi CH, Poroyko V, Watanabe S et al. Seasonal allergic rhinitis affects sinonasalmicrobiota. Am J Rhinology Allergy 2014; 28 (4): 281–6. DOI: 10.2500/ajra.2014.28.4050.
14. Patel ZM, Hwang PH. Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment. Uptodate. Literature review current through: Jan 2017.
15. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol – Head Neck Surg 2015; 152 (Suppl. 2): S1–S39. DOI: 10.1177/0194599815572097.
16. Wang YH, Ku MS, Sun HL, Lue KH. Efficacy of nasal irrigation in the treatment of acute sinusitis in atopic children. J Microbiol, Immunol Infect 2014; 47 (1): 63–9. DOI: 10.1016/j.jmii.2012.08.018.
17. King D, Mitchell B, Williams CP, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev 2015: CD006821.
18. Bende M, Fukami M, Arfors KE et al. Effect of oxymetazoline nose drops on acute sinusitis in the rabbit. Ann Otology, Rhinology Laryngology 1996; 105: 222. DOI: 10.1177/000348949610500309.
19. Fokkens W, Lund V, Mullol J. European position paper on rhinosinusitis and nasal polyps. Rhinol (Suppl.) 2007; 20: 1–136. Medscape J Med 2008; 10 (4): 105.
20. Valerie J. Lund. Therapeutic Targets in Rhinosinusitis: Infection or Inflammation? Medscape J Med 2008; 10 (4): 105.
21. Zalmanovici A, Yaphe J. Steroids for acute sinusitis. Cochrane Database Syst Rev 2007; 2: CD005149.
22. Mygind N, Nielsen LP, Hoffmann HJ et al. Mode of action of intranasal corticosteroids. J Allergy Clin Immunol 2001; 108 (Suppl. 1): S16–25. DOI: http://dx.doi.org/10.1067/mai.2001.115561
23. Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. Brit Med J 1998; 317: 1624–9.
24. Aksoy F, Dogan R, Kocak I et al. Effect of Nasal Corticosteroid on Secretory Immunoglobulin A Measured in Rat Nasal Lavage: Experimental Study. Otolaryngol – Head Neck Surg 2015; 153 (2): 298–301. DOI: 10.1177/0194599815589073.
25. Benninger MS, Ahmad N, Marple BF. The safety of intranasal steroids. Otolaryngol – Head Neck Surg 2003; 129: 739–50. DOI: http://dx.doi.org/10.1016/j.otohns.2003.10.001.
26. Zitt M, Kosoglou T, Hubbell J. Mometasonefuroate nasal spray: a review of safety and systemic effects. Drug Safety 2007; 30: 317–26.
________________________________________________
2. Chen CF, Wu KG, Hsu MC, Tang RB. Prevalence and relationship between allergic diseases and infectious diseases. J Microbiol, Immunol Infect 2001; 34: 57–62.
3. Pant H, Ferguson BJ, Macardle PJ. The role of allergy in rhinosinusitis. Cur Opin Otolaryngol Head Neck Surg 2009; 17 (3): 232–8. DOI: 10.1097/MOO. 0b013e32832ad3c0.
4. Gwaltney JM Jr. Acute community-acquired sinusitis. Clin Infect Dis 1996; 23 (1): 1224–5.
5. Mogensen C, Tos M. Quantitative histology of the maxillary sinus. Rhinology 1977; 15: 129.
6. Alho OP, Karttunen TJ, Karttunen R et al. Subjects with allergic rhinitis show signs of more severely impaired paranasal sinus functioning during viral colds than nonallergic subjects. Allergy 2003: 58: 767–71.
7. Blair C, Nelson M, Thompson K et al. Allergic inflammation enhances bacterial sinusitis in mice. J Allergy Clin Immunol 2001; 108: 424–9. DOI: 10.1067/mai.2001.117793.
8. Alho OP, Karttunen R, Karttunen TJ. Nasal mucosa in natural colds: effects of allergic rhinitis and susceptibility to recurrent sinusitis. Clin Experimental Immunol 2004; 137 (2): 366–72. DOI: 10.1111/j.1365-2249.2004.02530.x.
9. Kauffman HF, Tomee JF, van de Riet MA et al. Protease-dependent activation of epithelial cells by fungal allergens leads to morphologic changes and cytokine production. J Allergy Clin Immunol 2000; 105: 1185–93. DOI: http://dx.doi.org/10.1067/mai.2000.106210.
10. Shah SA, Ishinaga H, Takeuchi K. Pathogenesis of eosinophilic chronic rhinosinusitis. J Inflam 2016; 13: 11. DOI: 10.1186/s12950-016-0121-8.
11. Prokopakis EP, Vlastos IM, Ferguson BJ et al. SCUAD and chronic rhinosinusitis. Reinforcing hypothesis driven research in difficult cases. Rhinology 2014; 52 (1): 3–8. DOI: 10.4193/Rhin.
12. Karatzanis A, Kalogjera L, Scadding G et al. Severe Chronic Upper Airway Disease (SCUAD) in children. Definition issues and requirements. Int J Pediatr Otorhinolaryngol 2015; 79 (7): 965–8. DOI: 10.1016/j.ijporl.2015.02.024.
13. Choi CH, Poroyko V, Watanabe S et al. Seasonal allergic rhinitis affects sinonasalmicrobiota. Am J Rhinology Allergy 2014; 28 (4): 281–6. DOI: 10.2500/ajra.2014.28.4050.
14. Patel ZM, Hwang PH. Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment. Uptodate. Literature review current through: Jan 2017.
15. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol – Head Neck Surg 2015; 152 (Suppl. 2): S1–S39. DOI: 10.1177/0194599815572097.
16. Wang YH, Ku MS, Sun HL, Lue KH. Efficacy of nasal irrigation in the treatment of acute sinusitis in atopic children. J Microbiol, Immunol Infect 2014; 47 (1): 63–9. DOI: 10.1016/j.jmii.2012.08.018.
17. King D, Mitchell B, Williams CP, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev 2015: CD006821.
18. Bende M, Fukami M, Arfors KE et al. Effect of oxymetazoline nose drops on acute sinusitis in the rabbit. Ann Otology, Rhinology Laryngology 1996; 105: 222. DOI: 10.1177/000348949610500309.
19. Fokkens W, Lund V, Mullol J. European position paper on rhinosinusitis and nasal polyps. Rhinol (Suppl.) 2007; 20: 1–136. Medscape J Med 2008; 10 (4): 105.
20. Valerie J. Lund. Therapeutic Targets in Rhinosinusitis: Infection or Inflammation? Medscape J Med 2008; 10 (4): 105.
21. Zalmanovici A, Yaphe J. Steroids for acute sinusitis. Cochrane Database Syst Rev 2007; 2: CD005149.
22. Mygind N, Nielsen LP, Hoffmann HJ et al. Mode of action of intranasal corticosteroids. J Allergy Clin Immunol 2001; 108 (Suppl. 1): S16–25. DOI: http://dx.doi.org/10.1067/mai.2001.115561
23. Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. Brit Med J 1998; 317: 1624–9.
24. Aksoy F, Dogan R, Kocak I et al. Effect of Nasal Corticosteroid on Secretory Immunoglobulin A Measured in Rat Nasal Lavage: Experimental Study. Otolaryngol – Head Neck Surg 2015; 153 (2): 298–301. DOI: 10.1177/0194599815589073.
25. Benninger MS, Ahmad N, Marple BF. The safety of intranasal steroids. Otolaryngol – Head Neck Surg 2003; 129: 739–50. DOI: http://dx.doi.org/10.1016/j.otohns.2003.10.001.
26. Zitt M, Kosoglou T, Hubbell J. Mometasonefuroate nasal spray: a review of safety and systemic effects. Drug Safety 2007; 30: 317–26.
Авторы
А.И.Кирдеева, С.Я.Косяков*
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования Минздрава России». 125993, Россия, Москва, ул. Баррикадная, д. 2/1
*serkosykov@yandex.ru
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования Минздрава России». 125993, Россия, Москва, ул. Баррикадная, д. 2/1
*serkosykov@yandex.ru
________________________________________________
A.I.Kirdeeva, S.Ya.Kosiakov*
Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
*serkosykov@yandex.ru
Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
*serkosykov@yandex.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.