In order to improve the diagnosis and treatment of syphilitic aortitis, an analysis of known data on the clinical manifestations, course and diagnosis of this pathology was conducted, illustrating our own observations with the subsequent implementation of recommendations in clinical practice. The problem of syphilitic aortitis - the most frequent manifestation of late syphilis - was considered. Current data on clinical manifestations, possibilities and problems of diagnosing this pathology were presented. Modern methods of serological research used in the diagnosis of syphilitic aortitis were analyzed in detail; the course, complications and prognosis of this pathology were separately considered. All these aspects were illustrated by our own observations of clinical cases of syphilitic aortitis, which are of interest due to their rarity in clinical practice and demonstrate the importance of correct diagnosis and appropriate treatment. Serological tests for syphilis, ultrasound examination of the heart, extracardiac vessels and internal organs; X-ray examinations were used when examining patients. It was concluded that lesions of the cardiovascular system are currently among the most common forms of visceral syphilis. Syphilitic aortitis with symptoms of cardiovascular damage, which are caused by aortic valve insufficiency, narrowing of the ascending coronary arteries, aneurysmal dilatation of the ascending part and aortic arch, occurs in the late stages of syphilitic infection. Even in patients with syphilis who have been treated in the past with penicillin drugs, cardiovascular damage may occur, namely aortitis with aortic valve insufficiency. The most informative methods for detecting late cardiovascular damage are: enzyme-linked immunosorbent assay, passive hemagglutination reaction, immunoblotting and computed tomography of the heart and echocardiography. Special attention is paid to the fact that the uniqueness of the above observations lies in the fact that complicated forms of aortitis began to occur more often and also in treated syphilis patients who had previously been treated with water-soluble penicillin. Aortitis also occurs against the background of seroconversion (positivity) of non-treponemal tests, which were previously negative after treatment.

The review of foreign publications resulted in a generalisation of medical reports on the pathological changes of the gastrointestinal tract in burn disease. Burn disease produces an immediate reaction in all organs and systems, which are not always able to maintain homeostasis and frequently suffer pathophysiological and morphological damage. One of those target systems is the gastrointestinal tract. Only in very rare cases do severe (mainly electrical) burns cause direct injury to the abdominal cavity organs, thus resulting in a very severe clinical course and high mortality. Patients of all ages who have experienced a burn injury have an increased overall risk of developing gastrointestinal diseases, which include pathology of the esophagus, stomach, and intestines, as well as lesions of the gallbladder, biliary tract, and pancreas. With a burn area of 40—95%, 5.7% of the victims were diagnosed with pathology of the abdominal organs. Among them, 26.0% had an abdominal catastrophe (infarction or perforation), 37.0% had bleeding from the upper parts of the gastrointestinal tract, 32.0% had paralytic intestinal obstruction, and 5.0% developed pancreatitis and acute necrotizing cholecystitis. Large burns are usually associated with a significant decrease in splanchnic perfusion. After severe burns, intestinal ischemia and hypoxia disrupt the intestinal epithelial barrier and enteric bacterial translocation, leading to serious complications such as systemic inflammatory response syndrome, sepsis, and multiple organ failure. Peritonitis or gastrointestinal bleeding accounted for 88.2% of deaths among patients with gastrointestinal dysfunction. In general, gastrointestinal dysfunction was more common in patients with inhalation injuries, burn shock, large burn areas, and high analgesic requirements.

Recently discovered specific markers open up new possibilities for the diagnosis of acute kidney injury (AKI) in burn disease in order to optimize the treatment of such patients. Early diagnosis with the involvement of biomarkers prevents the sudden death of burn patients and allows predicting the course of the pathological condition. There are several characteristics that an “ideal” AKI biomarker should conform to: being non-invasive, locally specific, highly sensitive, being a stable molecule at different temperatures and pH values, having the ability to rapidly increase in response to kidney injury (quantify it), remaining at high levels during the episode and decreasing during the recovery period. There is a difference between the biomarkers that can be freely filtered in the glomerulus, so any increase in their plasma concentration (due to damage to other renal tissues) can lead to a high concentration of indicators in the urine (loss of specificity), and high-molecular-weight markers that are not freely filtered and therefore are more specific when measured in urine. Renal function in burn patients is usually determined by blood and urine tests, as biopsy can cause iatrogenic damage and is not commonly used in this cohort. After the onset of AKI, the level of biomarkers remains elevated for a certain period. None of the described indicators is monospecific for AKI; this makes estimating the time of AKI quite difficult. It has been proven that the combination of three biomarkers at two different time points in adults and the combination of two indicators at two time intervals in children allows to increase the reliability of determining AKI up to 0.78

The purpose of the review is to highlight clinically hidden variants of hormonal dysfunctions in burn disease, which strongly determine the peculiarities of the course of the pathological condition but are often overlooked by clinicians. Based on available literary sources, this study provides a comprehensive analysis of specialised medical reports from both domestic and foreign researchers. The focus of this analysis was on compensatory and pathological shifts in hormonal regulation of the body in individuals suffering from local heat injury. The collected scientific data is expected to be useful to practitioners in the field of combustiology in their practical activities. Damage to the endocrine glands is one of the key pathogenetic factors of local thermal injury, but the intracellular mechanisms of the influence of burn disease on these processes remain poorly understood. The criticality of burn injuries often leads to hypodiagnosis of endocrine disorders, which are indeed typical and rapidly developing. The neuroendocrine response to severe burns is a multisystem coordinated response of the body, which can not only maintain homeostasis and play a protective role in critical conditions but also cause tissue damage, realising the properties of a «double‑edged sword». Burns covering more than 40% of the total surface area of the body are accompanied by a stress reaction and hyperinflammation with a steady increase in the secretion of catecholamines, glucocorticoids, and cytokines. Classic studies confirm that a sharp post‑burn increase in stress hormones (adrenaline, norepinephrine, glucagon, and cortisol) contributes to the development of hyperglycemia, a systemic catabolic state, and multiple organ dysfunction. It has been established that the hypothalamic‑pituitary axis is responsible for fluctuations in the content of pituitary hormones in the blood serum of patients with local thermal lesions. After severe burns, the plasma renin‑angiotensin‑aldosterone system is activated, and the level of some hormones increases for more than 2 months after the injury.

Nowadays, rewarming of the affected tissues is the primary method of treatment for patients with cold injuries. But the warming manipulation has its own characteristics and limitations, depending on specific circumstances. Untimely and incorrectly performed rewarming can lead to a significant increase in the level of dangerous complications, mortality, and disability. The rewarming strategy is implemented according to one of the two scenarios. If there is a risk of freezing again, the injured area is not actively rewarmed; it is just immobilized, and thermo‑insulating bandages are applied. Slow warming with body heat is also acceptable. If the frozen area can be warmed and kept warm without refreezing until the evacuation is completed, a quick warming with warm water or special heating blankets is preferable. Recommendations on the ideal water temperature significantly differ among authors and include a wide range between 37 °C and 43 °C. The extent of damage to the tissues becomes obvious only after thawing. The traditional classification system of local cold injuries distinguishes four degrees of frostbite. First‑degree frostbite presents with superficial damage to the skin; second‑degree frostbite involves deep skin damage; third‑degree frostbite results in full‑thickness skin damage, including the subcutaneous and surrounding tissues; and fourth‑degree frostbite causes deep necrosis of the subcutaneous structures. Depending on the extent of damage, patients may experience constant and severe pain during rewarming, so analgesics should be prescribed to relieve it. It is recommended to use topical agents (creams, gels, and ointments) to improve circulation and prevent and treat infection. Tissue necrosis with severe frostbite requires surgical treatment of wounds. The authors hope that the provided information will be useful to doctors‑of‑first‑ contact and in hospital conditions in order to optimize the treatment of local cold injuries.

Acute kidney injury (AKI) is a common complication in critically ill burn patients and is associated with serious adverse outcomes, including increased length of hospital stay, development of chronic kidney disease, and increased risk of mortality. The incidence of AKI among burn patients in the intensive care units is 38 (30–46) %. A high percentage of the total burn surface area and a number of individual predisposing factors are considered to be the leading risk factors for AKI. Pathophysiological and morphological changes in the body under the combination of burn disease and kidney damage have certain discrepancies with the classical course of the pathological process in some nosological forms. Despite significant progress in the technologies of fluid resuscitation, intensive care and renal replacement therapy in recent years, the morbidity and mortality rate in such patients remain quite significant. A better understanding of clinical characteristics, early detection and prevention of risk factors for kidney damage in burns, as well as timely medical intervention can effectively reduce morbidity and progression of the pathological process, and also optimize the prognosis in the long run.

The objective of the work was to study the effectiveness of the use of purified bacterial lysates of the most therapy-resistant strains of microorganisms, the causative agents of pustular skin infections, by comparing clinical data and the skin microbiome in patients with acne. The results of the study are based on the data of a comprehensive examination of 35 patients with acne of 2-3 degrees before and after treatment, as well as data of the examination of 15 patients of the control group. Examination methods: clinical examination of the skin, determination of the quantitative composition and microbiological identification of the skin microbiome (bacteria of the genera Staphylococcus, Streptococcus, Propionibacterium Corynebacterium, Micrococcus, Sarcina, Aerococcus, Acinetobacter, Brevibacterium, Citrobacter, Serratia, Lactobacillus; yeast-like fungi of the genera Malassesia and Candida, mold fungi ). In the studied patients with acne, the representative microorganisms of the skin microbiome were Propionibacterium acnes, S. epidermidis, and C. lipophilicum. In patients with acne, the stability of the skin microbiome was carried out due to the redistribution between S. epidermidis and C. lipophilicum. In patients receiving "Acnevac"® (Bioveta, a. s.), a component of a complex treatment, along with earlier periods of clinical improvement, there was noted an earlier normalization of the skin microbiome in comparison with patients receiving standard therapy. Approaches to the treatment of acne with antibiotics and chemotherapy require a revision. The state of the skin microbiome broadens knowledge on the pathogenesis of acne and the search for other means for the individual treatment of patients. Positive changes in the skin microbiome under the influence of treatment with purified bacterial lysates of the most therapy-resistant strains of microorganisms, the causative agents of pustular skin infections, make it possible to recommend its use for a longer term – up to 6 months.

Local cold injury is a certain problem of peacetime and all-out military invasion. In modern guidelines, almost no attention is paid to the least severe local cold lesion of perniosis. However, such a variant of local cold injury should not be underestimated, although it can be a safe transient condition, since we cannot exclude its rather serious consequences and complications, which are sometimes accompanied by chronicity of the process and even disability.

Було проаналізовано більше ніж 260 анонімних анкет лікарів-інтернів за фахом "Анестезіологія та інтенсивна терапія" та «Дитяча анестезіологія» з метою визначення психологічної ресурсності особистості суб'єктів післядипломного навчання. Респонденти показали загальний середній рівень психологічної ресурсності особистості, але показники майже досягали його верхньої межі. Показник "віри у добро" початково займав найнижчу позицію, а після повномасштабної військової агресії ще значно зменшувався. У той самий час складові психологічної ресурсності "відповідальність", "самореалізація у професії" та "допомога іншим" під час військових дій прогресивно зростають. Дослідження психологічної ресурсності інтернів-анестезіологів як інтегральної характеристики особистості та широкого кола її психологічних детермінант є актуальним напрямком сучасної медичної психології, який має стати підґрунтям для створення практичних програм психологічного супроводу професійного навчання та професійної лікарської діяльності у воєнний час.

Objective – before and after the treatment to determine the functional state of the liver, serum levels of enzymes and biochemical indices in syphilis patients with viral hepatites B and C. The results of the study are based on the data from a comprehensive examination of 35 patients with syphilis alone and 127 patients with syphilis co-infected with viral hepatites B and C before and after treatment. Test methods: hepatology, rheogeopathography, enzyme content and biochemical parameters determined in the serum. According to the results of radionuclide hepatology it has been established that disorders of the functional capacity of the liver already occur in the early stages of the disease. The most significant disorders have been in the patients with the prescription of infection for more than 12 months and in the patients co-infected with viral hepatites B and C. A disorder of pigment metabolism and increased activity of trans­aminases have been revealed in early latent syphilis. In co-infection with viral hepatites B and C an increase in total bilirubin, Lactate dehydrogenase, Alanine transaminase, Aspartate aminotransferase and albumin has been revealed. Dysproteinemia has been revealed in patients with early latent syphilis co-infected with hepatitis C. Patients with early latent syphilis treated with immunomodulators tend to normalize these indices. In patients with syphilis a disorder of the functional state of the liver have been revealed already at an early stage of the disease. The most pronounced disorder of biochemical parameters and activity of liver enzymes are observed in syphilis patients with viral hepatites B and C, as well as in patients with early latent syphilis only with the prescription of the infection for more than 12 months; in such a case it is advisable to use drugs affecting the immune system.

Objective - to study the concentration of pro- and anti-inflammatory cytokines in patients with early latent syphilis before and after treatment. The study was conducted in 112 patients with early latent syphilis (52 men and 60 women) and 15 healthy persons of the control group - all aged 18-43. Serological tests were used: the classical complex of serological reactions (CSR), ELISA, the reaction of passive hemagglutination (RPGA), immunofluorescence reaction with absorption (RIF-abs) and RIF-200. Using ELISA, the levels of cytokines IL-2, IL-6, IL-10, TNF alpha, and INF gamma were determined in serum (in patients with latent syphilis, before and after treatment). The analysis of the received data was carried out with application of the program package Statistics 6.0. To identify the relationships between the indices, Friedman's nonparametric variance analysis with the definition of chi(2) was used. The concentration of IL-10 before treatment in patients with early latent syphilis was significantly increased by 3.7 (14.9 +/- 0.9 pg/ml compared to the control group 4.11 +/- 0.5 pg/ml). The dependence of the content of this cytokine on the period of infection was established. It was found that one year after treatment concentration of IL-10 remained 1.8 times higher. The concentration of IL-6 was increased by 6.5 times in patients with latent early syphilis and was also dependent on the period of the infection, and also even 1.5-2 years after treatment the IL-6 content remained elevated. It was also found that in patients with latent early syphilis the concentration of IL-2 was increased by 2.3 times and it did not normalize in 24.5% of patients even two years after treatment. In patients with latent early syphilis, the concentration of TNF alpha was increased by 3.6 times. After treatment, the concentration of TNF alpha decreased, but exceeded the control values by 1.55 times. Further analysis of the concentration of TNF alpha revealed that, with a disease period of up to one year, the concentration of this cytokine was normal during ten months after treatment, and in patients with the disease period of more than one year, after treatment normalization of the TNF alpha level was absent in 64.5% even after 18 months. It was found that the concentration of INF gamma in patients with early latent syphilis before treatment was increased by 3.8 times in comparison with the control group. After treatment, almost 25 % of patients with the duration of the infection more than one year revealed no normalization of INF gamma and it was increased by 1.5 times. In patients with latent early syphilis there was a significant increase in the concentration of cytokines TNF alpha and INF gamma, an imbalance of IL-2, IL-6, IL-10 as well as. The dependence of the cytokine concentration on the period of infection is noted. Based on the study of the cytokine status in patients with early latent syphilis with periods of infection of more than one year, the use of immunomodulatory therapy may be recommended. Increasing the concentration of such cytokines as TNF alpha, IL-6, IL-10 after treatment can be used as prognostic tests of serological resistance.

The observation of a clinical case of polymorphic dermal angiitis (cutaneous necrotizing angiitis) and modern ideas regarding etiopathogenesis, clinic, diagnosis and treatment of dermatosis have been presented.

Рассмотрены вопросы подготовки врачей-интернов специальности «Общая практика – Семейная медицина» по предмету «Дерматовенерология» на кафедре кожных и венерических болезней Государственного учреждения «Днепропетровская медицинская академия Министерства здравоохранения Украины». Отмечено, что Днепропетровская область Украины включена в пилотный проект реформы здравоохранения по организации семейной медицины. Даны основные сведения о реформе охраны здоровья в регионе и данные о Государственном учреждении «Днепропетровская медицинская академия Министерства здравоохранения Украины». Ключевые слова: дерматология, интерн, подготовка, семейная медицина. The issue of training interns in the specialty General Practice – Family Medicine on the subject Dermatovenereology at the Department of Skin and Sexually Transmitted Diseases of the State Establishment Dnipropetrovsk Medical Academy of Health Ministry of is considered. It is noted that Dnepropetrovsk region of Ukraine is included in the pilot project of health care reform for the organization of family medicine. The basic information on the health care reform in the region and data on the State Establishment Dnipropetrovsk Medical Academy of Health Ministry of are given. Keywords: dermatology, family medicine, intern, training.

observation of a clinical case of cutaneous lymphoid hy­perplasia and modern ideas about the etiology, pathogene­sis, clinical, diagnosis and treatment of dermatosis are given.

THE AIM OF THE STUDY:determining the features of the clinical manifestations of malassezial infection of the genital organs in men. The main research group included 148 men who revealed the malassezia genital infection. The comparison group included 126 men having been examined for STIs and diagnosed with chlamydia, mycoplasma, trichomonas infection and candidiasis and having not been diagnosed with malassezial infection. To solve the assigned task, the patients have received physical and general clinical and laboratory studies provided by the current regulations of the Ministry of Health of Ukraine, as well as comprehensive clinical and laboratory investigation on STI pathogens; comprehensive clinical and instrumental examination of the urogenital system (ultrasound, urethro- and cystoscopy, X-ray); microscopic and cultural mycological investigations on fungi of the genus Malassezia to establish the etiological diagnosis of malasseziosis. A comparative analysis of the urogenital pathology course and its clinical and morphological manifestations in the patient population has been carried out; it is found that malasseziosis in men usually proceeds chronically with a characteristic tendency of its manifestations to transformation; the clinical manifestations of urogenital malasseziosis in men have a number of features that distinguish it from the manifestations of urogenital pathology of another etiology; urogenital malasseziosis in men almost always reveal manifestations on the skin of the external genital organs and the perigenital area. Based on the results of the study, it can be concluded that the malassezial infection of the genitalia in men has certain features of the clinical course and manifestations that should be considered in clinical practice. The problem of urogenital malasseziosis, taking into account the possibility of its spread, the features of diagnosis and treatment, may be considered as an urgent problem of the up-to-date clinical practice, which deserves more complete coverage and further research.

медична академія МОЗ України", Україна

Методично і послідовно представлені положення про акне і акнеподібні дерматози. Детально розглянуто етіологію та патогенез захворювань, клінічні прояви та основи диференціальної діагностики.The regulations on acne and acne-like dermatitis are presented systematically and consistently. The etiology and pathogenesis of the disease, its clinical manifestations and the basis of the differential diagnosis are considered in detail.

Представлено клінічне спостереження 4 стадії синдрому Блоха–Сульцбергера у дівчинки 5 років. Детально розглянуто етіологію і патогенез захворювань, клінічні прояви та основи діагностики синдрому.A clinical observation of Stage 4 Bloch–Sulzberger syndrome in a 5-year-old girl is presented. The etiology and pathogenesis of the disease, the clinical manifestations and the basis for the diagnosis of the syndrome are considered in detail.

Objective — to assess the effectiveness and tolerability of AEvit in the complex treatment of patients with acne.Materials and methods. We observed 100 patients with acne. All patients were randomly assigned to the main (50 patients) and control (50 patients) groups. Inclusion criteria were: age from 18 to 40 years; diagnosis of acne in papulo­pustular form of light or moderate severity (2—4 scores on B.S. Allen and J.G. Smith’s scale).All the patients were examined using the following methods: examination of the skin of the face, chest, back, assessment of the intensity of the inflammatory process, calculation of the elements of the rash, assessment of the severity of acne on B.S. Allen and J.G. Smith’s scale and consideration of subjective feelings of the patient, general and biochemical blood test, general urine test. Patients with acne received standard therapy. Patients of the main group were additionally prescribed AEvit 1 capsule per day after meals during 30 days.Statistical processing of the obtained results was carried out using the methods of biometric analysis implemented in the packages of licensed programs Еxcel­2003® and Statistica 6.1 (StatSoftInc., serial number AGAR909E415822FA).Results and discussion. In 23 (46.0 %) patients of the control and 28 (56.0 %) patients of the main group, the disease duration ranged from 1 to 5 years. In 15 (30.0 %) patients of the main group and 17 (34.0 %) patients of the control group the disease lasted from 6 to 10 years, and in 12 (24.0 %) patients of the main group and 5 (10.0 %) patients of the control group the disease duration was of up to 1 year. Assessment of the severity of acne on B.S. Allen and J.G. Smith’s scale was performed on 10th, 21st and 30th days of the complex treatment. Prior to treatment, the severity of acne on B.S. Allen and J.G. Smith’s scale in the main group was (3.83 ± 0.42) scores, and in the control group — (3.79 ± 0.34) scores. After treatment, the severity of acne significantly decreased in the main group to (1.43 ± 0.65) scores and in the control group — to (2.31 ± 0.18) scores.Conclusions. According to the results of the analysis, in both groups there was a statistically significant decrease in the severity of acne symptoms, the number of rash elements, the severity of acne, but in the group of patients receiving AEvit it was more pronounced.

Objective — to assess the effectiveness and tolerability of AEvit in the complex treatment of patients with acne. Materials and methods. We observed 100 patients with acne. All patients were randomly assigned to the main (50 patients) and control (50 patients) groups. Inclusion criteria were: age from 18 to 40 years; diagnosis of acne in papulo­pustular form of light or moderate severity (2—4 scores on B.S. Allen and J.G. Smith’s scale). All the patients were examined using the following methods: examination of the skin of the face, chest, back, assessment of the intensity of the inflammatory process, calculation of the elements of the rash, assessment of the severity of acne on B.S. Allen and J.G. Smith’s scale and consideration of subjective feelings of the patient, general and biochemical blood test, general urine test. Patients with acne received standard therapy. Patients of the main group were additionally prescribed AEvit 1 capsule per day after meals during 30 days. Statistical processing of the obtained results was carried out using the methods of biometric analysis implemented in the packages of licensed programs Еxcel­2003 ® and Statistica 6.1 (StatSoftInc., serial number AGAR909E415822FA). Results and discussion. In 23 (46.0 %) patients of the control and 28 (56.0 %) patients of the main group, the disease duration ranged from 1 to 5 years. In 15 (30.0 %) patients of the main group and 17 (34.0 %) patients of the control group the disease lasted from 6 to 10 years, and in 12 (24.0 %) patients of the main group and 5 (10.0 %) patients of the control group the disease duration was of up to 1 year. Assessment of the severity of acne on B.S. Allen and J.G. Smith’s scale was performed on 10th, 21st and 30th days of the complex treatment. Prior to treatment, the severity of acne on B.S. Allen and J.G. Smith’s scale in the main group was (3.83 ± 0.42) scores, and in the control group — (3.79 ± 0.34) scores. After treatment, the severity of acne significantly decreased in the main group to (1.43 ± 0.65) scores and in the control group — to (2.31 ± 0.18) scores. Conclusions. According to the results of the analysis, in both groups there was a statistically significant decrease in the severity of acne symptoms, the number of rash elements, the severity of acne, but in the group of patients receiving AEvit it was more pronounced.