Molecule which changed the view on skin treatment

Objective — to study the modern classification, mechanisms of action and clinical effects of vitamin A derivatives, to analyze retinoid for local treatment of various dermatoses with a universal mechanism of action at the epidermis and dermis levels. Materials and methods. A review of the literature and an analysis of the results of international clinical trials of drugs based on the natural retinoid of the first generation — tretinoin (retinoic acid) is presented. The works of dozens of authors since 1980s to the present day are analyzed. Most sources provide detailed information on the results of topical retinoids in acne therapy, which are the base of clinical guidelines. Long-term (6 months or more) studies of retinoic acid-based preparations carried out in recent decades have discovered the unique clinical effects of tretinoin in the treatment of skin photoaging, actinic keratosis, etc. They are achieved due to the effect of tretinoid on the nuclear receptors of keratinocytes and fibroblasts. Results and discussion. The molecular mechanisms of action of retinoic acid, realizing the cellular and tissue effects of the most studied retinoid, are systematized and grouped in a single review. It has been proven that a unique feature of tretinin is its ability to activate directly all subtypes of RARs- and, indirectly, RARs-nuclear receptors of skin cells. A new modern drug for external use is presented — AltrenoТМ lotion containing micronized 0.05 % tretinoin in combination with sodium hyaluronate, soluble collagen and glycerin. This combination exhibits the expected clinical efficacy in acne therapy and prevents side effects such as dryness, redness and exfoliation. AltrenoТМ is approved for use in children of 9 years of age and older. Conclusions. Tretinoin (retinoic acid) is a modern powerful retinoid with a universal mechanism of action, recommended for the treatment of acne.

Safety and clinical efficacy of bilastine in reduction of pruritus in patients with chronic spontaneous urticaria

Objective — to evaluate the efficacy/safety of bilastine in relieving pruritus in patients with chronic spontaneous urticaria. Materials and methods. This prospective randomized study included 50 adult patients aged 18 to 59 years with chronic spontaneous urticaria and pruritus with an intensity of more than 4 points by the visual analog scale of pruritus assessment in the last 3 days and more than 16 points by the Urticaria activity score 7 (UAS7) which assessed chronic urticaria intensity for the last week.Patients received bilastine orally at a dose of 20 mg once a day for 8 weeks. Patients who did not respond to therapy within the first 2 weeks subsequently received bilastine at a dose of 40 mg per day (two 20 mg tablets) till the end of the study (for 6 weeks). Results and discussion. The mean age of patients was 39.61 years with standard deviation (SD) of 12.33 years. In the group of patients who responded positively to the initial therapy, within 8 weeks, the pruritus intensity scoring level decreased significantly to 0.46 (95 % CI: 0.14—0.78) points (p < 0.05). The patients who received a double dose of bilastine also revealed a decrease in the intensity of pruritus and on average on the 8th week of treatment had 0.48 (95 % CI: 0.26—0.70) points (p < 0.05).The study reported 14 adverse events (AE) that occurred during bilastine treatment in 10 (23.8 %) patients. All of them were classified as mild and the most common was headache, registered in 12 (85.7 %) cases. No moderate or severe AEs were reported during the study. Conclusions. 8 week treatment with bilastine has demonstrated proven clinical efficacy both in reducing the urticaria activity index according to UAS7 and in reducing the intensity of pruritus in the absence of moderate and severe AEs. Patients who did not respond to starting therapy after doubling the bilastine dose also significantly decreased the urticaria activity index according to UAS7 and reduced the intensity of pruritus. At the same time, increasing the dose of the drug did not lead to an increase in the frequency of AEs.

Tasks, shortcomings and reservations in the process of reforming the specialized dermatovenereological sector of health care

Objective — to draw the attention of the Ukrainian health care management, the National Health Care Service (NHCS) and dermatovenereologists to urgent issues of reforming the industry, identifying shortcomings in the reform and presenting the views of experienced professionals on correcting organizational measures.Official statistics was used based on the materials of leading specialists of Kharkiv Research Institute of Dermatology and Venereology, scientific and practical institutions of Ukraine, the forecast of «GlobalData» analytical and statistical company on the trend of syphilis in the world, the results of discussion of current reform issues with leading specialists in dermatovenereology.The interpretation of the modern epidemiological panorama of skin and venereological pathology, the current state of organizational and material support of dermato-venereology institutions are presented. Some specific shortcomings and miscalculations in the process of reforming are revealed from the point of view of experienced specialists in the field, the authors’ vision of ways to improve the organization and activity of the dermatovenereological service of the country is presented.The need for correction in the process of reforming the specialized dermatovenereological service by resolving the urgent issue of organization in the areas of round-the-clock bed stock within reasonably adjusted limits and their financial and material support is substantiated. Calculations of the needs of round-the-clock inpatient beds in the regions should be carried out in the NHCS with the participation of the leadership of the Ukrainian Association of Dermatovenereologists and Cosmetologists (UADVC). The reforming of the dermatovenereology service should become a truly effective compo­nent of the generally progressive system of health care reform, taking into account the international medical and statistical forecasts.

Dermatovenerological service of Ukraine in the context of ongoing reform

The problems of preserving the dermatovenerological health of the population are extremely relevant for Ukraine, where diseases of the skin and subcutaneous tissue occupy the 5th place in the structure of morbidity. Objective — study of the structure of the dermatovenerological service in the context of reforming the healthcare system at this stage (end of 2021) and its characteristics. Materials and methods. The results of the analysis of the state of resources of medical institutions of communal ownership of dermatovenerological profile in Ukraine are presented. Results and discussion. Today, in Ukraine, the number of hospital beds for 24-hour hospitals for adults is 188 in the regions (Zaporizhzhia, Rivne, Kharkiv, Cherkasy) and 220 beds in Kyiv city, which is extremely insufficient. There are 24 beds for the pediatric patients in the regions (Luhansk, Rivne, Cherkasy) and in the city of Kyiv — 60. The number of day hospital beds for adults has significantly decreased — to 248 in the regions (Dnipropetrovs’k, Zaporizhzhia, Kyiv, Lviv, Poltava, Kherson, Cherkasy, Chernivtsi and Kramatorsk city), for pediatric patients — 61 (Dnipropetrovs’k, Kropyvnytskyi, Mykolaiv, Poltava regions). In 2021, 11 dermatovenerologic dispensaries were liquidated. Instead of them, dermatovenero­logic centers and subdivisions subordinate to regional hospitals were formed. Thus, there is an unfavorable restructuring of the bed fund of institutions providing dermatovenerological care. Conclusions. A decrease in the number of state and municipal institutions providing free dermatovenerological care will lead to the worsening of the epidemic situation, the spread of sexually transmitted infections and reduction of the availability of specialized dermatovenerological care for the population in a difficult economic and social situation.

Study of clinical features of patients with chronic eczema

Objective — s to study the clinical features of chronic eczema (CE) in 96 patients aged 18 to 78 years. Materials and methods. The study was carried out in the city clinical dermatovenerological dispensary No. 5 in Kharkov. All patients gave written informed consent to participate in the study.The majority of them (66.7 %) were between 31 and 50 years old. The duration of dermatosis in 6.3 % of the surveyed persons ranged from 6 months to 1 year, in 33.3 % — from 1 year to 5 years, in 42.7 % — from 5 to 10 years, in 17.7 % — over 10 years. The most frequent causes of exacerbation in 51.1 % were neuropsychiatric trauma and stress, in 15.6 % — dise­ases of internal organs and acute respiratory diseases, in 13.5 % — contact with chemicals. In all patients, dermatosis was recurrent. Most often, the surveyed patients complained of moderate intensity itching (51 %) and severe sleep disturbances (66.7 %). Moderate leukocytosis and accelerated ESR were found in 21.9 % of patients, eosinophilia — in 5.1 %. Results and discussion. 96 patients with chronic eczema aged 18 to 78 years were under observation. The diagnosis of chronic eczema was based on anamnestic data, patients’ complaints of itchy skin of varying intensity, objective examination of the patient, as well as recurrences of dermatosis for more than 1 year. The largest number of patients had dermatosis from 5 to 10 years. Chronic eczema in the observed patients was recurrent. The duration of remission was (4.9 ± 0.2) months. The duration of exacerbation was (6.1 ± 0.2) weeks. To characterize the severity of chronic eczema, a scoring system was used, according to which the average severity was (2.63 ± 0.08) points.According to the degree of skin lesions, the forms of dermatosis were limited and widespread. Patients complained of skin itching of varying intensity: more often itching of moderate intensity, periodic; painful, persistent, with an insurmountable need to scratch; short-term; no itching.Also, patients noted sleep disturbance in the form of difficulty falling asleep, sudden awakening at night and lack of a feeling of rest after waking up in the morning. 39 patients had bad habits (smoking, alcohol abuse).Сlinical analysis of blood revealed moderate leukocytosis, accelerated ESR, eosinophilia, signs of secondary infection. Conclusions. The average age of the patients ranged from 31 to 50 years. All examined patients had recurrent dermatosis. The average degree of its severity was (2.63 ± 0.08) points. Most often, patients complained of moderate intensity itching (51 %) and severe sleep disturbances (66.7 %). In 21.9 % of the examined patients moderate leukocytosis and accelerated ESR were revealed, in 5.1 % — eosinophilia.

Monitoring of self­assessment by health care workers of the quality of own life during the pandemic of acute respiratory disease caused by SARS-­CoV­-2 coronavirus in 2020

Comparative analysis of changes in self-assessment of quality of life (QoL) indicators by young medical students during 2020 revealed certain correlations depending on the time during which they were forced to study and work against the background of the predominantly negative influence of the chronic stressful situation — the need to daily contact with different patients in conditions of many months of quarantine due to pandemic of acute respiratory disease caused by the SARS-CoV-2 coronavirus. The overall negative impact of the infectious pandemic and the resulting fears on public consciousness were quite expected. Medical workers with different clinical experiences and qualifications (nursing students and doctors), quite emotionally reacted to the potential danger of being infected with coronavirus infection due to daily professional contacts with various patients who had somatic diseases, some of which might already be in the incubation period of clinical course of coronavirus pathology. This directly reduces their self-esteem of QOL and, in certain situations, can be a factor that leads to the appearance of psychosomatic disorders in them as a kind of somatic occupational pathology, especially with prolonged (many months) continuation of lockdown restrictions due to the high level of morbidity and mortality of the population. The monitoring of changes in self-esteem of individual components of QoL turned out to be quite dependent both on the expression of individual psychological traits of each tested person and on the time of the survey (spring—late summer—winter 2020—2021).

Strategy of planning HIV/AIDS fight in Ukraine: a review

HIV epidemic in Ukraine remains a nationwide problem. The current epidemiological situation does not yet give grounds to talk about a significant decrease in the load associated with HIV/AIDS in Ukraine. Predicting the further spread of the epidemic throughout the country is becoming more and more complicated due to the crisis socio-economic phenomena and the deterioration of the situation in the eastern regions of Ukraine. Objective — to substantiate the ways of optimization of monitoring, diagnosis and treatment of HIV infection as the basis for a strategy of overcoming the HIV/AIDS epidemic in the public health system in Ukraine; expanding treatment of HIV-infected patients using modern approaches and standards; volumes and algorithms of cooperation of specialists from different branches in the provision of treatment services to patients with skin diseases and sexually transmitted infections. Materials and methods. We analyzed: 1) documents of international policy in the field of public health; 2) the latest changes in the documents of the state policy in the field of health care of Ukraine; 3) international strategies and approaches to overcoming the HIV epidemic; 4) WHO strategies for applying public health approaches to tackling the HIV epidemic; 5) the dynamics of the incidence of skin and venereal diseases in Ukraine and the virtual creation of an epidemiological situation in the absence of integrative relations between individual health care services; 6) modeling and forecasting with account of all available relevant data as an important source of information for monitoring national and global HIV epidemics, as well as managing the prevention and treatment programs. Results and discussion. Based on the review of statistical information, key directions are presented for further strengthening of the system of monitoring and evaluation to strengthen the control over the HIV epidemic in Ukraine, as well as optimize specific treatment. At the present stage of the implementation of medical reforms, final revision and improvement are required of existing strategies and policies for organizing a response to the HIV epidemic in Ukraine, as well as the search for new ways and tools that can be mobilized in the health care system by increasing the efficiency of the use of existing resources, introducing new forms of management and coordination of actions. Conclusions. Bringing national standards in line with the best world practices in the field of HIV counteraction contributes to the effective planning of the need for specific therapy in order to ensure a sustainable response to the HIV epidemic in Ukraine, the use of a «treat all» approach with effective and safe antiretroviral therapy. The optimization is based on the principles of public health as having the highest priority and effectiveness in comparison with individual approaches to the prevention, treatment and support of people with chronic diseases. The principle of maintaining balanced treatment regimens helps to reduce dependence on donor funding in the context of limited resources in Ukraine, as well as ensure the achievement of Fast track goals and adherence to the UNAIDS strategy.

Features of CD-­­phenotype of peripheral blood lymphocytes in adult patients with atopic dermatitis during the exacerbation

Objective — to study the dynamics of peripheral blood lymphocytic populations in adult patients with atopic dermatitis (AD) with the onset of the disease in childhood, depending on the level of IgE secretion and the method of treatment. Materials and methods. We examined 67 adult patients with AD, which were divided into 4 groups depending on the level of total serum IgE and the basic treatment or treatment in combination with Glycine and Ketotifen. The severity of AD was determined by the SCORAD index. The content of peripheral blood lymphocytes according to the phenotype CD3+, CD4+, CD8+, CD19+, CD65+, HLADR+ and CD95+ was assessed during hospitalization of patients, at the end of the inpatient stage of treatment and after 1 month of outpatient follow-up. The obtained data were compared with the indices of the control group and between the groups of examined patients with AD in the dynamics of their treatment and observation. The results were processed statistically using the methods of parametric and nonparametric statistics. Results and discussion. The indices of the number of cells of peripheral lymphocytic populations of different CD pheno­type in the groups in the dynamics of observation were determined, their relationship with the severity of the course of AD was established, and differences were found depending on the pathogenetic variant of AD. Against the background of an exacerbation of AD, a significant increase in the number of cells in most of the defined populations was revealed, with its gradual decrease as the clinical manifestations of AD subsided. It was established that 1 month after achievement of clinical/subclinical remission, a part of the peripheral blood lymphocytic populations was characterized by higher values compared to the norm. In patients with an IgE-dependent AD variant, aggravation is accompanied by high levels of peripheral lymphocytes with CD3+, CD4+, CD8+, CD19+ and HLA-DR phenotypes, which more often than in the case of an IgE-independent variant of AD, remain above the norm after 1 month of outpatient monitoring. Introduction of glycine and ketotifen to the treatment complex for patients with AD is accompanied by a faster return of peripheral lymphocyte cells to normal values, which is more evident in patients with an IgE-dependent variant of AD. Conclusions. In adult AD patients, the dynamics of the number of peripheral lymphocyte population cells depends on the severity of the disease, its pathogenetic variant and the treatment received by the patient. Against the background of the use of glycine and ketotifen, the normalization of indicators of peripheral lymphocytic populations occurs significantly faster than with only standard basic therapy.

Awareness and knowledge of sexually transmitted diseases among population in Georgia (epidemiological survey)

Sexually transmitted infections (STIs), often known as sexually transmitteddiseases, are still a major public health concern across the world. According to WHO estimates, sexually transmitted diseases (STIs) have an annual incidence of 357 million cases among which chlamydia (131 million), gonorrhoea (78 million), syphilis (5.6 million) and trichomoniasis (143 million), half of those among young people aged 15—24. Every day, almost one million people worldwide develop an STI, and the majority of them are ignorant of their infection status, making them a source of infection for others. The frequency and consequences of this on the health and socioeconomic condition of whole nations, particularly African countries, have long been regarded as a serious emergency. The epidemiology of STIs, the history and physical findings, screening standards, and the overall approach to combat STIs are all covered in this article. Infections covered in terms of causation, epidemiology, and risk factors include gonorrhea, Chlamydia trachomatis, Trichomonas vaginalis, syphilis and trichomoniasis. For a variety of reasons, the worldwide illness burden represented by STI remains unclear. First, many STIs are asymptomatic; second, diagnostic procedures are unavailable in some of the most affected nations; and finally, surveillance systems are non-existent or very poor in many parts of the world. According to the World Health Organization, there were 340 million new cases of syphilis, gonorrhoea, chlamydia infection, and trichomoniasis in 1999. In the European Union, there has been an increase in the incidence of gonorrhoea and syphilis in recent years. The survey instrument was an online self-administered anonymous questionnaire conducted in Georgia using Google survey software, which automatically populates and saves digital responses to a secure database protecting participant confidentiality throughout the surveying process. The survey was conducted in 2019. The opportunity to participate in the questionnaire was one-time. The question naire for this study was developed based on a review of literature.Health education, early diagnosis and treatment, screening for asymptomatic infections, contact inquiry, and immunization for illnesses for which a vaccine is available should all be used in STI prevention and control. In general, the studies reported low levels of knowledge and awareness of sexually transmitted diseases. Although, as shown by some of the findings on condom use, knowledge does not always translate into behavior change, adolescents’ sex education is important for STD prevention, and the school setting plays an important role.