Vol 87, No 3 (2011)

To colleagues

According to the analysis of the state statistical reporting, the rate of new neurosyphilis cases was growing in the Russian Federation in 1999-2009. Substantial differences in the number of detected neurosyphilis cases by different federal districts were established. Low-quality laboratory diagnostics was proved to be one of the factors promoting the neurosyphilis incidence rate. The quality of the neurosyphilis laboratory diagnostics was studied by means of questionnaires distributed among dedicated dermatovenerological medical institutions. Substantial shortcomings in the neurosyphilis laboratory diagnostics were established including absence of spinal fluid diagnostics in 17%-33% of the institutions and inadequate compliance with the regulatory study methods (immunofluorescence test with whole spinal fluid, microprecipitation test, cytosis and protein determination in the spinal fluid). For the purposes of optimizing the neurosyphilis diagnostics in the Russian Federation, we suggest to provide for all-round and complex examination of patients with suspected neurosyphilis based on the regulatory laboratory and functional diagnostics methods; it is also required to make the spinal fluid examination based on the passive hemagglutination test being highly sensitive and specific as well as having a high diagnostic efficacy for neurosyphilis a part of the standards aimed at rendering medical aid to neurosyphilis patients.

The article presents the data on antibiotic resistance and N. gonorrhoeae mechanisms for developing resistance to antimicrobial drugs belonging to different pharmacologic groups and applied for causal treatment of gonorrhea. The article proves the key problem related to the treatment of gonococcal infection in Russia lies in the prevalence of strains being resistant to most of the antibacterial drugs that used to be applied in the clinical practice on a broad scale and efficiently. So, cephalosporins of the third generation are presently the only drug type that N. gonorrhoeae remains sensitive to. Their application ensures the maximum efficacy against the gonococcal infection. According to the presentday international recommendations complying with the WHO criteria as well as accumulated experience, cefixime, a drug belonging to cephalosporins of the third generation, can be a drug of choice for the antibacterial therapy of gonorrhea along with ceftriaxon.

The article presents the data on the studies contributing to improving the differential diagnostics of T-cell and B-cell cutaneous lymphomas including large-plaque parapsoriasis and T-cell and B-cell cutaneous pseudolymphomas as well as frequency of their transformation into malignant cutaneous lymphomas. There was a study of 101 patients using the polymerase chain reaction method to determine the T-cell and B-cell lymphocyte clonality by genes of g and ƒ chains in the T-cell receptor and immunoglobulin heavy chain genes. Monoclonality was determined in 40 of 46 cases in patients with T-cell cutaneous lymphomas and in three of four cases in patients with B-cell cutaneous lymphomas. Monoclonality was revealed in one of 14 cases of large-plaque parapsoriasis and one of two cases of T-cell cutaneous pseudolymphoma. In all of the 24 cases of chronic benign dermatoses, five cases of small-plaque parapsoriasis and ten skin tissue samples obtained from healthy donors, polyclonal lymphocytes were revealed. So, the obtained results make it possible to consider the method to be an important addition in the field of diagnosing lymphoproliferative skin diseases.

There was a clinical and economic study of ustekinumab (stelara) as compared to etanercept (enbrel), infliximab (remicade) and adalimumab (humira) for treating patients with severe psoriasis. The clinical efficacy and safety of the biological drugs were analyzed, and estimated costs for their application as well as cost/efficacy ratio and cost efficacy increment were calculated. Advantages of ustekinumab vs. etanercept were demonstrated: the costs per one patient with severe psoriasis turned out to be less with the achieved positive effect. When the cost/efficacy ratio was calculated, the economic advantages of ustekinumab vs. infliximab were established beginning with Weeks 24-28 of the therapy (according to the results of individual studies, as early as beginning with Week 10 of the therapy). The economic advantage of ustekinumab vs. adalimumab increases by Week 52 of the therapy. The calculations of the cost efficacy increment proved that ustekinumab was more efficient than infliximab both in the short (Weeks 10-12 of the therapy) and long run (Weeks 50-52) and more efficient than adalimumab in the long run (Week 52 of the therapy).

ZAO ECOlab (Russia) developed Line Blot Syphilis, a new test system on the basis of the linear immunoblotting method using Treponema рallidum recombinant antigens. The article assessed the diagnostic value of the Line Blot Syphilis test system in the form of a confirmatory test. As a part of the conducted study, the test system demonstrated its absolute sensitivity and specificity to serum-positive (n = 237) and serum-negative (n = 114) samples, in which the presence or absence of Т.pallidum antibodies was confirmed by two treponemal tests. As a result of examining 14 samples attributed to doubtful analytes based on two test results (passive hemagglutination test and immunofluorescence test with absorption), the data compliance between the Line Blot Syphilis test system and data from INNO-LIA Syphilis Score amounted to 100% (14/14) or 93% (13/14) for the immune-enzyme assay and 57% (8/14) for the immunofluorescence test with absorption. It is recommended to use the Line Blot Syphilis test system (ZAO ECOlab) as a confirmatory syphilis test.

The number of patients suffering from severe forms of psoriatic arthritis has increased for the recent years. Psoriatic arthritis is accompanied by synovitis and exudation in the joint cavity in some patients. Healing depends on the timely and correct treatment

There was a study involving 726 patients with different syphilis forms with the aim of revealing a neurological deficiency in them. Nervous system affection symptoms were founding 298 of them. Neurosyphilis was diagnosed in 165 patients based on the conducted examination. There were five neurosyphilis cases in sex partners among them. The article provides a detailed description of the clinical picture of the disease and discloses the laboratory examination results. The polymorphism of clinical and laboratory manifestations of the syphilitic infection in sex partners can be explained by different terms of infestation, particulars of the immunity and presence of concomitant neurologic and somatic diseases.

The article discusses the most prevalent errors in the course of examining and treating patients with dermatoses in the anogenital area. Different forms of mycoses are diagnosed in 58% of male and 25% of female patients. Isoconazole (Travogen) demonstrated a high clinical efficacy for the treatment of dermatomycoses due to providing a high skin concentration of the active ingredient. Travocort, a combination drug comprising isoconazole nitrate and diflucortolone valerate, was indicated to treat patients with burdened allergic anamnesis and mixed infection (bacterial and fungal association) at the first stage of treatment to reduce the risk of developing complications in the form of eczematization.

There was a clinical and ultrasonic study of the clinical efficacy of levocetirizine as a part of a complex therapy in 60 patients with eczema. The dynamic calculation of the EASI, EQ-5D and DLQI indices as well as analysis of ultrasound showings made it possible to confirm the benefits of glencet vs. cetirizine for achieving the clinical effect. The eczema therapy with glencet contributes to the elimination of both exudative and proliferative parts of the complex pathologic chain of the disease in patients with this type of dermatosis.

The article presents the current data on the sensitive skin types and methods to study the skin biophysical properties. The authors provide the data confirming the clinical efficacy of the Aqua Precis skin care products in patients with sensitive skin.

Eighteen female patients with the signs of photoageing underwent skin rejuvenation using a fractional CO2 laser (SmartXide DOT, DEKA M.E.L.A., Florence, Italy) with varying energy density (2.07, 2.77 and 4.15 J/cm2). Clinical efficacy of the said laser irradiation parameters was assessed in all of the subjects, and the skin cytokine profile was studied by using the immunohistochemistry technique based on skin tissue samples taken prior to the treatment, right after the treatment and in 3 and 30 days. There were significant improvements in the wrinkle and skin texture condition, and hyperpigmentation was reduced as a result of the treatment, which proves the efficacy of using the fractional CO2 laser for the skin photorejuvenation. The technique ensures good clinical results and is distinguished by a short rehabilitation period and excellent safety profile. In the course of the immunohistochemistry, a relation between the skin cytokine production, reepithelization and laser irradiation density was established.

28 мая 2011 г. исполнилось 85 лет доктору медицинских наук профессору Фаине Александровне Зверьковой. Трудовой путь Фаины Александровны начался в суровые годы Великой Отечественной войны. Студентка Ленинградского педиатрического медицинского института, отличница учебы, после окончания института в 1949 г. поступает в клиническую ординатуру кафедры кожных и венерических болезней, где проходит путь от клинического ординатора - ассистента - доцента до заведующего кафедрой (1972-1994). Преподавательскую и научную деятельность начала будучи клиническим ординатором, а затем в 1957 г. защитила кандидатскую диссертацию на тему «Витамин А и каротин при некоторых кожных заболеваниях у детей первого года жизни».