Питання зовнішнього контролю якості лабораторних досліджень на сифіліс у лікувальних закладах України

The objective of the work is to identify systemic and random errors in the formulation of controlled methods and to achieve comparative results obtained by laboratories participating in external quality control of laboratory tests for syphilis. Materials and methods. Laboratories of three levels took part in the activities of external quality control of serological diagnostics of syphilis: clinical diagnostic laboratories (CDL) of medical institutions of scientific research institutes of the NAMS of Ukraine, serological departments as part of the CDL of the dermatovenerological profile of the RDVD, CDVD. Results. The quality of serological tests for syphilis in 21 CDL (serological departments) was assessed using the following methods: RMP, RPR, Rapid-test, TPHA, FTA-abs, ELISA in three control serum samples according to formal and essential characteristics. The most significant differences in the results were revealed in the study of control serum samples with a low content of antibodies and those without antibodies to the causative agent of syphilis in the non-treponemal RMP test and the treponemal FTA-abs test. Conclusions. The conducted studies have shown the high efficiency of the practical application of the developed system of external quality control of laboratory methods for diagnosing syphilis.

Клінічні випадки фотосенсибілізації, асоційованої із SARS-CoV-2- інфекцією і її лікуванням

The objective. Raise physician awareness to prevent the development of photosensitization in patients with COVID-19. Materials and methods. A review of the literature and analysis of clinical cases of photosensitization associated with SARS-CoV-2- infection and its treatment carried out. Results. Based on the literature and clinical experience, the article presents the possible causes of manifestations and exacerbations of photoallergic contact dermatitis, presents clinical cases of photosensitization associated with coronavirus infection. Conclusions. The issue of protection against ultraviolet radiation is relevant in the summer, especially during a pandemic associated with the emergence of a new coronavirus infection.

Випадок прогресивної деменції на тлі пізнього нейросифілісу

The objective. Prevention of diagnostic errors associated with the rare detection of syphilis in patients in neurological hospitals. Results. A clinical case from the practice of dermatovenereologists is given. Conclusions. For timely detection of neurosyphilis it is necessary to conduct a cerebrospinal fluid examination of all patients in the neurological hospital who have a positive result of non-treponemal and treponemal tests in the serum.

State of antioxidant system in urogenital trichomoniasis and membranotropic effect of metronidazole

The objective of this work was to study the activity of glutathione peroxidase, glutathione reductase and the level of sulfhydryl groups in erythrocytes of patients with urogenital trichomoniasis and the effect of metronidazole on the degree of osmotic and peroxide resistance of erythrocytes from healthy donors. We examined 15 patients with urogenital trichomoniasis and 20 healthy volunteers. We studied native preparations, and also carried out a culture method using the Johnson-Trussel nutrient medium (CPLM) to identify Trichomona vaginalis. The activity of glutathione reductase, glutathione peroxidase and the level of total sulfhydryl groups were determined in erythrocytes of peripheral blood. The membrane effect of metronidazole was evaluated in in vitro experiment by the degree of osmotic and peroxide resistance of erythrocytes from healthy people. It has been established that a significant decrease in glutathione reductase and glutathione peroxidase activities in erythrocytes is observed, which indicates a violation of the antioxidant system in this pathology. It was shown in vitro experiment, that metronidazole in low concentration (80 μmol /l) has the ability to inhibit erythrocyte hypotonic hemolysis, and high concentration (250 μmol/l) leads to a decrease in osmotic and peroxide resistance of erythrocytes. Thus, inhibition of the activity of the enzymatic link of the antioxidant defense is observed in urogenital trichomoniasis, which is one of the mechanisms for the development of pathology at the cellular level in this disease. It has been shown that the isolated membranotropic action of metronidazole depends on its concentration – the drug at low concentration is able to inhibit hypotonic hemolysis of erythrocytes, and high concentration makes them more sensitive to the osmotic and peroxide hemolysis. The obtained results should be taken into account in the development of complex methods of therapy for urogenital trichomoniasis.

Клінічний випадок пізньої форми сифілісу у хворої на вульгарний пемфігус

The objective. Decrease the number of diagnostic mistakes of pemphigus vulgaris and late forms of syphilis to improve quality of life and prevent premature death in patients with pemphigus vulgaris. Raise doctors’ awareness of the use of treponemal tests to clarify the diagnosis of late forms of syphilis. Materials and methods. The case of pemphigus vulgaris determined on the basis of clinical picture, anamnesis, cytological examination results is described. A concomitant pathology was diagnosed, i.e., late syphilis due to the complex of serological tests: nontreponemal and treponemal (Venereal Disease Research Laboratory test (VDRL), Enzyme-Linked Immuno Sorbent Assay (ELISA), T. pallidum Haemagglutination Assay (TP-HA), Fluorescent Treponemal Antibody Absorption test (FTA abs), ELISA-Different). Results. At dynamic supervision and inspection of the patient on pemphigus vulgaris and late syphilis on the basis of positive treponemal tests was revealed: ELISA sums. (IgG+IgM) – positive, high-quality TP-HA «4+» – positive; semi-quantitative TP-HA 1: 8 «2+» – positive; FTA abs «3+» – positive. To verify the diagnosis, a serum sample was examined by ELISA-Different method. Conclusions. Due to a wide range of serological research and consultation of related specialists, late syphilis was diagnosed in a pemphigus vulgaris patient.

Modern clinical and anamnestical aspects of lichenoid dermatoses

The objective of the work was to study modern clinical and anamnestic features of chronic lichenoid dermatoses. Materials and methods.Clinical and anamnestic examination of 100 patients with psoriasis and 80 patients with lichen planus (LP) was carried out. In both study groups, the majority were patients 51–60 years old, the minority – patients 31–40 years old. Among patients with psoriasis, men prevailed in all age groups, among patients with LP, men prevailed in the group of 20–30 years. Results. In the general gender structure, men prevailed in the group of patients with psoriasis, women prevailed in the group of patients with LP. Comparison of the anamnestic data regarding dermatoses revealed a chronic recurrent nature, characteristic of both psoriasis and lichen planus. According to the to the duration of the disease, among patients with psoriasis, the majority were patients with a long course of more than 10 years, among patients with LP – patients with a history of less than 1 year. In the group of patients with psoriasis, the majority were patients with early onset of dermatosis, in the group of patients with LP – with a late onset after 25 years. Annual manifestations of dermatosis were recorded in the vast majority of patients with psoriasis; in patients with LP, annual manifestations of dermatosis were recorded 12 times less frequently. A family history of psoriasis was found 10 times more often than in the LP group. In patients with psoriasis, compared with patients with LP, a greater relative number of long-term forms of dermatosis (38% of cases versus 22.5%), and early forms of dermatosis, which occurred before the age of 25 (52% of cases, versus 26.5%) were found. The leading provoking factor among patients with psoriasis was recognized as psychoemotional stress (61%), and among patients with LP, infections suffered the days before (49%). Also, in patients with psoriasis, obesity and overweight were recorded 5 times more often, cardiovascular diseases – 3.6 times more often, endocrine disorders – 2.4 times more often, concomitant pathology of the digestive system – 1.5 times more often than in patients with LP. At the same time, comorbital chronic infectious states were recorded more often in LP patients than in patients with psoriasis (31.25% of cases versus 22% of cases). Conclusions. The revealed results of the clinical and anamnestic characteristics of the studied groups turned out to be homogeneous in terms of age characteristics, heterogeneous in gender characteristics, trigger factors, comorbid pathologies, and multidirectional in terms of duration, manifestations and onset of dermatosis, which requires further study and systematization of key parameters.

EFFECT OF DYSLIPIDAEMIA AND INSULIN RESISTANCE ON THE COURSE OF ALOPECIA AREATA ASSOCIATED WITH METABOLIC SYNDROME

Alopecia areata (AA) is a tissue-specific disease of the hair follicles, manifested by foci of alopecia on a scalp and other areas of skin. The objective of our study was to evaluate the values of blood lipids and carbohydrate metabolism in patients with АА associated with metabolic syndrome (MS) to determine the relationship between disease severity and metabolic disorders. Materials and methods. Clinical and anamnestic characteristics and laboratory values of lipid spectrum and carbohydrate metabolism were analysed in 50 patients with AA associated with MS. Results. As a result of the study, the following regularities have been established: values of blood lipids (cholesterol, triglycerides, high-density lipoproteins) and carbohydrate metabolism (blood glucose, glycosylated haemoglobin, HOMA index) statistically significantly deteriorate with increasing number of the MS components (p <0.05); in patients with mild AA there is a statistically significantly (p <0.05) smaller number of MS components compared with patients with moderate to severe forms (φemp=2,645 < φcr=1,64); HOMA index increases statistically significantly with increasing severity of the disease: by 14.14% in patients with moderate form compared with patients with mild form, and in the presence of severe form by 28.31% compared with patients with moderate and by 46.46% compared with patients with mild forms of AA (p <0.05); the rate of triglycerides in the blood increases statistically significantly depending on the severity of AA: by 36.17% in patients with moderate form and by 41.78% in patients with severe form compared with mild form of AA (p <0.05); the content of high-density lipoproteins in the blood decreases statistically significantly depending on the severity of AA: by 2.12% in patients with moderate form compared with mild form and by 9.53% in patients with severe form compared with moderate form (p <0.05); no relationship has been found between the severity of MS, given the number of its components, and the stage of AA: active and chronic. Conclusions. As a result of the study, the relationship between the severity of AA and the severity of metabolic disorders in the presence of MS in patients has been established. An important area is the study of correction of dyslipidaemia and insulin resistance in a comprehensive therapy of AA associated with MS.

EPIDEMIOLOGICAL SITUATION OF INCIDENCE OF MIXED UROGENITAL INFECTIONS IN PATIENTS WITH SYPHILIS IN THE SOUTH REGION OF UKRAINE

The objective. The analysis of the social-epidemiological situation and the incidence of mixed urogenital infection (MUI) in patients with syphilis in the southern region of Ukraine for the period 2015–2019 has been carried out. Materials and Methods. The structure of the incidence of syphilis in 1785 patients was studied and analyzed taking into account their social and epidemiological characteristics, of which – 1049 (58.8%) patients were diagnosed with mixed urogenital infection. A variety of combinations of association of urogenital microorganisms in mixed infections in patients with syphilis has been established. Results. The data obtained showed that the infection with syphilis with MUI was the highest in early latent syphilis. Analysis of the identified variants of the disease in patients with syphilis and patients with syphilis with MUI showed a low level of education on the issues of individual protection against sexually transmitted infections (STI) in both groups of patients. Conclusion. A high incidence of lesions of the genitourinary tract damage (58.8%) was established in patients with syphilis in the southern region of Ukraine. The presence of various associations of microorganisms in MUI in patients with syphilis is characteristic, which explains the complicated course of lesions of the urogenital system. The clinic of syphilis on the background of Sugi in patients was more severe. The clinical picture of syphilis against the background of SUGI in patients proceeded with more severe manifestations. The results obtained will serve as the basis for the development of targeted preventive measures, taking into account the epidemiological situation in the marine region.

ASSOCIATION OF HERPES SIMPLEX VIRUSIS (TYPE 1 AND 2) AND BACTERIAL SEXUALLY TRANSMITTED INFECTIONS

Introduction. Herpes simplex virus infections (HSV; Herpes simplex 1 and 2) are one of the most common sexually transmitted viral infections (STIs). Epidemiological and etiological factors of human HSV-infections are insufficiently studied, in particular, due to the optional registration in Ukraine. The objective was to evaluate the prevalence and etiological aspects of HSV-infection (Herpes simplex 1 and 2) association with some bacterial STIs (Treponema pallidum, Chlamydia trachomatis, Ureaplasma urealyticum, Trichomonas vaginalis), taking into account shifts in the microbiocenosis of the lower genital tract, as well as the psycho-emotional state of patients. Materials and methods. Markers of HSV-1 and HSV-2 were detected of specific antiherpetic antibodies (IgM and IgG) in the serum (plasma) (reagent sets VectoVPG – IgM, VectoVPG-1-IgG, VectoVPG-2-IgG) in 90 patients (43 men (mean age – 41.2 years) and 47 women (mean age – 34.7 years) with STIs (T. pallidum, Ch. trachomatis, U. urealyticum, T. vaginalis) and opportunistic microflora. Assessment of psychoemotional state patients was performed using the Hospital Anxiety and Depression Scale (HADS) and statistical processing was performed using the STATISTICA 9.0 package (StatSoft). Results. The incidence of STIs caused by HSV-1/2 among the population of Ukraine is gradually increasing and according to extrapolated data (lack of official registration) the true intensive rate per 1 year is 100–120 newly diagnosed cases per 100,000 populations. There are gender features (the prevalence of markers of HSV-1 among patients with urogenital pathology is 91.5% in women and 97.7% in men, HSV 2 – in 28.8% and 18.6%, respectively) with maximum infection is in reproductive age. The associations with STIs are following: Ch. trachomatis (up to 29%), U. urealyticum (up to 22%), T. vaginalis (up to 9%), T. pallidum (up to 6%) and opportunistic microflora (up to 26%). When assessing the psycho-emotional state of patients with HSV, the clinical severity of anxiety and depression was correlated with the duration of the disease, the frequency of episodes of exacerbation and the presence of a rash on the genitals. Conclusions. The modern management or sexually transmitted HSV should take into account gender and age, etiological aspects, be coercive with the modern data of microbiology, namely bacterial and viral associations of STIs, as well as with psycho-emotional state of patients.

TO THE QUESTION OF CLASSIFICATION OF SKIN LESIONS ASSOCIATED WITH GUEST RESPIRATORY DISEASE COVID-19

The objective. To systematize the clinical manifestations of skin lesions associated with COVID-19 and to propose the classification of these disorders. Materials and methods. The literature data describing skin lesions associated with COVID-19 and the results of observation of 31 patients with skin lesions and coronavirus infection were summarized. In the postcovid period patients with skin diseases were admitted to the hospital. They were divided into two groups: first – patients who did not suffer from skin diseases earlier; the second – patients with exacerbation of chronic dermatoses. All patients were examined by standard clinical and laboratory methods. Results. The proposed classification makes it possible to separately distinguish lesions caused precisely by COVID-19 and exacerbation of chronic dermatoses against the background of coronavirus infection, as well as as a result of the treatment of this disease (first of all, this consider to systemic corticosteroids, which are known to affect the course of psoriasis: cause the development of common forms that are resistant to other methods of therapy), which leads to their severe course. Photos of own observations are presented. This classification will improve the quality of diagnosis of COVID-19, especially in asymptomatic or low-symptomatic forms of the disease, and will also help prevent a number of complications associated with both the treatment of patients with coronavirus infection and the presence of concomitant diseases, in particular chronic dermatoses. Conclusions. The proposed classification, on the one hand, expands the possibilities of timely diagnosis of COVID-19, especially in asymptomatic or low-symptomatic forms of the disease, and also directs the doctor to the need to prevent a number of complications associated with both the treatment of patients and the presence of concomitant diseases, in particular chronic dermatoses.