Vol 86, No 5 (2010)

Begun in 2004 administrative reform has caused for itself processes of the modernizations of the system of the public health that, on the one hand, has conditioned increasing to responsibility local organ of power for condition and development to network of the medical institutions of the territory, promoted increase the volume medical help, but with other - has lowered for separate part of population accessibility specialized type medical aid, as well as level quality its rendering, mainly to account of the absence to receivership in work physician primary section and dermatovenerology. For increasing quality specialized medical help children, sick chronic dermatitis, necessary organization of the efficient system of the interaction between primary medical section and dermatovenerology.

This review describes major directions in the development of laboratory diagnostics of STDs and dermatoses in the Russian Federation. It also discusses strategic directions in the development of diagnostics departments in dermatovenerological institutions (three-level structure of laboratory aid, centralization, automation, standardization of tests, external and internal laboratory quality control, introduction of laboratory information technologies and laboratory information exchange systems). It also substantiates the priority directions in the diagnostics of STDs (etiological diagnostics, acceleration of the cycle of laboratory tests for patients, determination of the resistance of causative agents to antimicrobial drugs, molecular monitoring of the spreading of STDs) and dermatoses (diagnosis verification, diagnosing an organ pathology, marker diagnostics, prevention and prediction of the efficacy and safety of dermatosis treatment).

The authors defined stages of development of high-end medical aid for skin and hypoderm diseases and presented particular features of such aid based on their many years experience and analysis of normative and legal acts as well as methodical guidelines. A study of the potential of regional medical institutions in rendering high-end dermatovenerological aid conducted by the authors enabled them to substantiate further ways of development for this type of medical aid.

The article covers problems of introduction of new information and communications technologies aimed at the improvement of dermatovenerological medical aid rendered to the population of the Russian Federation in medical institutions of the dermatovenerological profile. The authors evaluated indices of resources and operations of medical institutions of the dermatovenerological profile based on the data presented at www.monitoring-ippp.ru.

The authors conducted a study of the urine steroid profile in 56 women with acne in order to determine the form of their hyperandrogenism (HA). A ovarian form of HA was revealed in 28.7% of patients, a mixed form was revealed in 30.9%, and no laboratory signs of any hyperandrogenic state were revealed in 40.4%. The determination of the HA form enabled the authors to efficiently select a method of systemic treatment for the patients with the use of hormone drugs and to achieve excellent and good results in 70.4% for women with the ovarian form of HA and in 75.9% for women with the mixed form. As for the group of patients where no HA form was determined, good and excellent results were observed in 30.4% of women.

The article presents data on the pathogenetic role of Toll-like receptors in the development of immunopathological reactions in the skin. The authors examined the distribution and content of Toll-like receptors TLR2, TLR4 and TLR9 in the affected skin of psoriasis patients. They revealed a statistically significant increase in expression of Toll-like receptors TLR2 and TLR4, which can play an important role for the formation of the inflammatory process involving cells of the adaptive immune system.

The article describes the results of a study conducted in 1994-2005 by the immune-enzyme assay method. The study involved 1,014 subjects aged 14-64 and randomly selected from the population of Novosibirsk and rural regions of Tyva and Mountain Altai based on determination of G-class antibodies to HSV-1 and HSV-2 by the IEA method. The prevalence rate for anti-HSV-1 antibodies did not differ in the study populations and was 99.4%. The general prevalence rate of anti-HSV-2 antibodies was higher in women vs. men and did not differ in different regions. The frequency of cases when HSV-2 was diagnosed was growing in proportion to the age from 1.0% in teenagers aged 14-17 up to 19.4-37.5% in subjects aged 55-64. The prevalence of HSV-2 in Siberia was found to be similar to that in the United States and Scandinavian countries. The sexual profile of subjects infected with HSV-2 in Russia did not differ from that in other population-based studies conducted in the world.

The author provides data about the efficacy and side effects of current drugs for treatment of acne. He pays special attention to the problem of developing resistance in case of application of antibiotics. The article describes current approaches to the reduction of this problem in patients with acne. It lists main currently available hormone drugs taking into account their efficacy and side effects. The article presents a current algorithm for evaluating possible side effects of application of isotretinoin and measures of their prevention, and describes a new form of isotretinoin with extra bioavailability - Acnecutan. It also discusses characteristics of external drugs.

The article discusses the role of topical glucocorticosteroids in treatment of children suffering from atopic dermatitis as well as problems of clinical efficacy and safety of application of mometasone furoate (Elocom®) for this dermatosis during the period of exacerbation.

The article generalizes the current concepts of reasons and mechanisms of skin barrier dysfunction in newborns, presents a method to correct such disorders with the use of Emolium basic skin care products, and provides results of the efficacy, tolerance and safety study of the Emolium cosmetic line for skin care and hygiene for newborns.

A new method of skin rejuvenation with the use of fractional laser photothermolysis (MultiPlex technology) in a combination with the CAP system is based on the sequential skin exposure to low-intensity radiation with different wavelengths (1,440 nm and 1,320 nm). This method produces much more evident esthetic results than radiation of greater intensity but with one wavelength only.

During Peter the Great syphilis and gonorea had such a wide spread, that so called spinning houses for easy virtues were established in Saint Petersburg. One of this spinning yard established in 1718 by Peter the Great, later on was turned into the medical facility and called Kalinkinskaya Hospital under the rein of Elizaveta Petrovna. Her decree dated August 1st, 1750 was the first official reference of Kalinkinskaya Hospital as medical facility specialized in venerеological treatment. In this hospital the founder of Russian venereology Benjamin Mikhailovitch Tarnowsky (1837-1906) lectured syphilolody for 25 years since 1859, initiated the establishment of the Russian Venereological School, devoted his research to pereloy, gonorea, hypertrichosis, neurosyphilis, iodoform treatment. Experimental syphilis, congenital syphilis, Ulcus vulvae acutum were studied within the hospital. In Soviet period Kalinkinskaya Hospital was renamed to the Skin-Venereological Dispensary of the Leningrad Region. Nowedays it hosts the serological lab, experimental syphilis lab and is considered the biggest mycological lab in Russia. The Dispensary houses 110 beds, 34 specially equipped offices and 54 specialists.