UCRAID (Ukrainian Citizen and refugee electronic support in Respiratory diseases, Allergy, Immunology and Dermatology) action plan.

Eight million Ukrainians have taken refuge in the European Union. Many have asthma and/or allergic rhinitis and/or urticaria, and around 100,000 may have a severe disease. Cultural and language barriers are a major obstacle to appropriate management. Two widely available mHealth apps, MASK-air® (Mobile Airways Sentinel NetworK) for the management of rhinitis and asthma and CRUSE® (Chronic Urticaria Self Evaluation) for patients with chronic spontaneous urticaria, were updated to include Ukrainian versions that make the documented information available to treating physicians in their own language. The Ukrainian patients fill in the questionnaires and daily symptom-medication scores for asthma, rhinitis (MASK-air) or urticaria (CRUSE) in Ukrainian. Then, following the GDPR, patients grant their physician access to the app by scanning a QR code displayed on the physician's computer enabling the physician to read the app contents in his/her own language. This service is available freely. It takes less than a minute to show patient data to the physician in the physician's web browser. UCRAID-developed by ARIA (Allergic Rhinitis and its Impact on Asthma) and UCARE (Urticaria Centers of Reference and Excellence)-is under the auspices of the Ukraine Ministry of Health as well as European (European Academy of Allergy and Clinical immunology, EAACI, European Respiratory Society, ERS, European Society of Dermatologic Research, ESDR) and national societies.

STUDY OF IMMUNO-PATHOGENETIC FEATURES OF PSORIASIS AND ACNE'S COURSE.

OBJECTIVE: The aim: The objective of our work was to improve the diagnostics of common chronic dermatoses (acne, psoriasis, АР) taking into account some indicators of the immune system and features of the disease course to specify their role in pathogenesis of these disease. PATIENTS AND METHODS: Materials and methods: A total of 114 patients with acne and 128 patients with psoriasis were observed. RESULTS: Results: Regardless of the disease duration period, we have detected in blood serum of psoriasis рatients probable changes in concentrations of stress-response mediators (decreased parameters of cellular immunity (CD3+, CD3+CD4+, CD3+CD8+ of T-lymphocytes, CD22+ fraction of B-lymphocytes and compensatory increased CD16+ of T-cells, cytokines - IL-1ß, IL-8, IL- 17, IL-22, immunoglobulins IgM, IgG, and CIC), which indicate tension of their stress-induced mechanisms even despite occasional clinical stabilization of skin and articular process. Consequently, most of the patients with acne had varying degrees of changes in rates of systemic immunity. The most significant changes in rates of systemic immunity with the depletion of T-cell immunity were found in patients with papular-pustular and pustular acne, and still more significant - in patients with acne conglobate. CONCLUSION: Conclusions: In patients with acne and psoriasis, changes in systemic immunity indexes that indicate the formation of secondary immunodeficiency state T-cell link, amid an adequate humoral immunity have been found. Relationship between the causes of changes of systemic immunity has been established.

COMPLEX TREATMENT THE PATIENTS WITH PSORIASIS AND CONCOMITANT ACTIVATED HERPES VIRUS INFECTION, TYPES 1, 2.

OBJECTIVE: The aim: Is to increase effectiveness and assess safety of the antiviral therapy in complex treatment of patients with psoriasis with activated chronic herpes virus infection of types 1 and 2. PATIENTS AND METHODS: Matherials and methods: 120 patients and 25 practically healthy persons were examined. RESULTS: Results: It has been studied an effect of antiviral therapy on the background of basic therapy in patients with P+HSV 1,2: the percentage of HSV 1,2 DNA detection after the use of acyclovir and/or inosine pranobex was decreased in saliva from 22.0±3.43 % to 6.7±1.32 % (р<0.01) and in epithelium - from 33.3±4.23 % to 6.7±1.8 % (р<0.01); The use of antiviral therapy has showed a decrease in the expression of miR 155 molecules from 126.3 ±10.5 U/6 to 62.4±5.48 U/6 (р<0.05), an increase in the number of T-regulatory lymphocytes from 6.8±1.25% to 9.1±1.41% (p=0.0503); a decrease of IFN-α level in saliva from10.1±1.84 ng/ml to 8.2±1.27 ng/ml (р1=0.0398); in the serum IL-23 level was significantly decreased from14.9±2.11 pg/ml to 8.8±2.03 pg/ml (р<0.05) and TGF-ß synthesis was increased from 3.9±1.23 pg/ml to 9.3±2.21 pg/ml (р<0.01). CONCLUSION: Conclusions: An improved method of treatment and evaluation of its clinical and immunological effectiveness based on an integral criterion was suggested as a result of conducted antiviral therapy amid basic therapy in patients with psoriasis with activated HSV-1 and HSV-2.

Skin microbial landscape and immune-endocrine parameters in patients with psoriasis by using narrowband UVB phototherapy.

OBJECTIVE: The aim: The study of skin microbial landscape and immune-endocrine parameters as well as improvement of treatment efficiency in patients with different clinical course of psoriasis by using narrowband UVB phototherapy. PATIENTS AND METHODS: Materials and methods: We examined 89 patients with psoriasis (51 men and 38 women) aged 18-60. The comparison group consisted of 43 psoriasis patients comparable by age, sex and clinical course with those from the main group (46 patients). Cytokine levels IL-4, IL-8, IL-10, TNFα, thyroid peroxidase (TPO) and thyroglobulin (Tg) autoantibodies and microbial flora of skin were determined in patients with psoriasis. RESULTS: Results: The study finds that conventional therapy does not have sufficient corrective impact on immune-endocrine disorders and the use of narrow-band light therapy has shown that it has a focused corrective impact on cytokine production and modulating effect on the level of TPO and Tg autoantibodies and the state of skin automicroflora of lesions in patients suffering from psoriasis. CONCLUSION: Conclusions: Using UVB (311 nm) therapy in patients with psoriasis allows improving efficiency of treatment and limiting clinical signs in the form of achieving remission and significant improvement in patients' health without any negative dynamic changes.

Clinical and metabolic analysis of disorders in psoriatic patients.

OBJECTIVE: Introduction: Elucidation of the primary nature of biochemical shifts in psoriatic disease and prediction of interconnected subsequent changes in metabolic and inflammatory processes are important in foreseeing the dynamic development of pathological process and the choice of individual treatment. The aim of the research was to assess the disorders and correlations between main indicators of protein, fat, hydrocarbon and pigment metabolism and specifics of inflammatory processes in psoriatic patients against the clinical course of dermatosis. PATIENTS AND METHODS: Materials and methods: We analysed the results of clinical and laboratory examinations conducted in 62 psoriatic patients. All these patients have been analysed as per their age,sex, prevalence and the type of skin rash as well as per the clinical disease form. Biochemical examinations were conducted using appropriate sets of reagents. To establish the possible correlation between the indicators of biochemical blood analysis, we calculated the correlation coefficient, which determines the nature of correlation between the studied variables. RESULTS: Results: The analysis of results received upon examining psoriatic patients indicated that microbial-viral associations, stress factors and genetic predisposition were the most frequent trigger factors of psoriatic disease, which corresponds to the data from literary sources. We detected that the duration of psoriaric disease up to 5 years was the most common, and relapses were manifested in its limited form against the background of the disease advanced stage; the prevalent psoriasis was more common at the hospital stage. Our study justifies that metabolic changes occurred in the overwhelming majority of examined patients of different age groups. At that, abnormalities of a number of indicators of protein, lipid, hydrocarbon and enzyme metabolism have been established. In addition, the expressiveness of corresponding changes correlated with the prevalence of skin psoriatic process and the duration of dermatosis course as well as the presence of pathology of a number of internal organs, in particular of gastrointestinal tract, hepatobiliary and cardiovascular systems, that suggest the presence of systemic disorders at psoriasis. CONCLUSION: Conclusions: The identification of independent mechanisms existing between some changes in metabolic process parameters in psoriasis has a theoretical and practical significance in dermatology, which involves the use of medications to regulate the detected disorders, the possibility to restore correlations, and it will inevitably contribute to the achievement of clinical and preventive effect.

Pathogenetic peculiarities of neuroendocrine and metabolic disorders in patients with acne associated with chronic stress.

OBJECTIVE: Introduction: Acne is a chronic relapsing skin condition with multifactorial nature associated with disorders of sebaceous glands activity, psycho-emotional disorders and slow response to treatment. The aim: To study a pathogenic role of chronic stress and certain metabolic and neuroendocrine disorders in the development of acne in women depending on the duration of the disease. PATIENTS AND METHODS: Materials and methods: A total of 119 women with acne were examined. Index insulin resistance (іndex HOMA), serum cortisol and prolactin, level of Reactivity-Personal Anxiety and Dermatology Life Quality Index (DLQI) was determined. RESULTS: Results: Possible changes in serum cortisol level depending on duration of the disease (increased in women with duration of the disease less than 1 year and decreased in women with duration of the disease 1-5 years), increased index of serum prolactin and HOMA, with more significant changes in women with duration of the disease 1-5 years. The DLQI was determined in all examined patients. An increased level of anxiety, characterized by higher levels of personal anxiety, was also observed, especially in a group of women with duration of the disease 1-5 years. CONCLUSION: Conclusion: The changes in certain neuroendocrine and metabolic indices, which are the markers of chronic stress, worsening of life quality and significant levels of reactivity and personal anxiety, were observed in women with acne. A strong and moderate correlational relationship between the nature of changes in the abovementioned indices and duration of the disease was detected.

Values of the systemic immunity in patients suffering from acne with different clinical course.

OBJECTIVE: Introduction: Acne is chronic recurrent dermatosis, one of the essential skin inflammation in the structure of dermatological pathology, especially in young people of working age, often caused by persistent cicatricial changes in the skin, and affecting negatively the psychoemotional state of patients, their quality of life and working capacity. It has been established by today that the pathogenesis acne is complex and multifactorial, and the changes of immune reactivity of the organism play an important role in its clinical course development. The aim of the article is to determine and analyze the values of the systemic immunity in patients suffering from acne with different clinical course. PATIENTS AND METHODS: Materials and methods: 128 patients with acne aged from 18 to 35, among which 74 women (57,8 %) and 54 men (42,2 %) were observed. According to the clinical criteria, 26 patients (20,31%) were diagnosed with comedonal form of acne, 40 patients (31.25%) had papules, 10 people (7.81%) -papular-pustular acne, 29 of the observed (22.65%) had pustules, 9 patients (7.03%) suffered from acne conglobata, and 14 patients (10.94%) were diagnosed with post-acne. The control group consisted of 34 practically healthy people (donors) of the same age. RESULTS: Results: Consequently, most of the patients with acne had varying degrees of changes in rates of systemic immunity - the likely reduction in relative and absolute number of total lymphocytes, T-lymphocytes and their subpopulations against the growing number of B lymphocytes and the level of IgM and IgG, which generally indicates the formation in these patients secondary immunodeficiency state of T-link intensified by activation of humoral immunity in response to the development of skin inflammation. The most significant changes in rates of systemic immunity with the depletion of T-cell immunity were found in patients with papular-pustular and pustular acne, and still more significant - in patients with acne conglobate, which justifies differentiated treatment by immunomotropic drugs for these patients. CONCLUSION: Conclusion: In patients with acne, changes in systemic immunity indexes that indicate the formation of secondary immunodeficiency state T-cell link, amid an adequate humoral immunity have been found. Relationship between the causes of changes of systemic immunity has been established.

Modern specific features and therapy of psoriasis and arthropathic psoriasis courses.

OBJECTIVE: Introduction:Psoriasis affects about 2% of population. In 30-40% of occurrences arthropathic psoriasis (AP) is diagnosed and it leads to 11-19% of disability cases development. Recent studies have shown that psoriasis is often synergistically combined with herpesvirus of the 1st and 2nd type, which, according to many scientists, determines the severity, frequency of recurrences, and the course of this dermatosis. Recently, new biomarkers, i.e. a system of small ribonucleic microRNA acids, have been described. Their role and interconnection in respect of regulation of congenital and acquired immunity activity in patients with herpesvirus infection at psoriasis has been defined. The article analyses features of anamnesis, clinical, instrumental and laboratory tests related to arthropathic psoriasis, considers the relationship of probable mechanisms of disease aggravation and progression with the definition of a treatment method influencing the dynamics of a disease course. The aim of our work was to improve the diagnostics of AP patients taking into account some indicators of the immune-endocrine system and features of the disease course to specify their role in AP pathogenesis and to develop the system of integrated therapy of patients whose locomotor system is affected due to psoriasis. PATIENTS AND METHODS: Materials and methods: A total of 178 AP patients have been systematically examined. We have examined AP patients with varying severity of process development, generalization and the severity of skin and osseous-articular apparatus damage, the presence of associated pathology. Additional instrumental studies, determination of biochemical, serological parameters and an assessment of stress-induced immune-endocrine system have been conducted in AP patients. The content of trigger cytokines (IL-1ß, IL-8, IL-17, IL-22) in blood serum, stress hormones (ACTH, cortisol), cellular and humoral immunity condition (CD3 +, CD4 +, CD8 +, CD16 +, CD22 +, IgM and IgG levels) have been studied. RESULTS: Results: The clinical course and characteristic features of AP instrumental tests are extremely versatile as well as the depth of their present study is insufficient. Regardless of the disease duration period, we have detected in blood serum of AP patients probable changes in concentrations of stress-response mediators (decreased parameters of cellular immunity (CD3+, CD4+, CD8+ of T-lymphocytes, CD22+ fraction of B-lymphocytes and compensatory increased CD16+ of T-cells, cytokines - IL-1ß, IL-8, IL- 17, IL-22, stress hormones - cortisol, immunoglobulins IgM, IgG, and CIC), which indicate tension of their stress-induced mechanisms even despite occasional clinical stabilization of skin and articular process. We have offered and tested regiments to treat AP patients, which involve differential application within the integrated therapy of nonsteroidal anti-inflammatory medications (Arcoxia 30-60 mg 1 time daily / Naklofen Duo 75 mg daily), disease-modifying medications (Sulfasalazine ЕН from 500 mg to 2 g daily / Methotrexate 7.5-10 mg/week), lyophilised dialysate of leukocytes. CONCLUSION: Conclusions: The analysis of specific features of the AP clinical course and data of integrated studies allows identifying the probability of manifestation or persistence of the pathological psoriatic articular process. The improvement of AP patients diagnostics taking into account some indicators of the immune-endocrine system and specifics of the disease course contributed to the improved therapy and mended quality of life of patients.

Indicators of phagocytosis in women with acne during comprehensive treatment that included immunotherapy and probiotics.

OBJECTIVE: Introduction: Acne is one of the most common dermatological diseases. It may have a chronic course, leaving permanent marks, and in last years has been tending to have more and more severe clinical course with widespread skin lesions. According to recent studies, the development of acne is due to the combined effect of endogenous and exogenous factors, among which endocrine diseases (quite a significant aspect), disorders of metabolic processes, reduced systemic immunity and phagocytic ability of mononuclear phagocytes and granulocytes at various stages of phagocytosis of pyogenic cocci, which contributes to more severe clinical course, and frequent relapse of this diseases. It was also proved that the intestinal microbiota plays an important role in the formation of homeostasis and immune response. The aim of the studyis to determine the evolution of phagocytosis indices in patients with acne under differentcomprehensive treatments, using oral antibiotics, immunotherapy, probiotics and low-dose birth control pills. PATIENTS AND METHODS: Materials and methods: We observed 93 women with acne aged from 18 to 25 years old. In 19 (20,43 %) patients mild acne was diagnosed, in 41 (44.09%) - moderate acne, in 33 (35.48 %) persons - severe acne, 54 (58,06%) persons suffered from acne up to 1 year, 39 (41,93%) - from 1 to 3 years. To assess the state of phagocytosis in patients with acne vulgaris, we determined phagocytic activity (PA) and phagocytic index (PI) of polymorphonuclear leukocytes, nitro blue tetrazolium recovery test (NBT test spontaneous) and NBT-test pyrogenal stimulated by the recognized methods. RESULTS: Results: Analysis of the studied parameters of phagocytosis at the end of treatment showed a significant increase in patients of the core group who were administered a comprehensive treatment which included oral antibiotic, probiotic, low-dose birth control pills and autohemotherapy, as compared with the patients of other groups under study. CONCLUSION: Conclusions: Using combined therapy for women with acne occurring against the backdrop of a sluggish process of phagocytosis and concomittant intestinal dysbiosis leads to normalization of the leading indices of phagocytosis (PI, PA, NBT tests both spontaneous and stimulated), and enchances their phagocytic activity both during capture and formation of bactericidal activity and in the final stages of phagocytosis justifying the feasibility of a combined use of antibiotics, probiotic, low-dose birth control pills and autohemotherapy in the treatment of acne.

Evolution of some indicators of systemic immunity in patients with acne while using laser therapy.

INTRODUCTION: One of the important problems in modern dermatology is to improve treatment efficiency of acne being a common cause for cicatricial skin changes, loss of performance capability and social activity and negatively affects the psycho-emotional state of patients and their quality of life. The topicality of the disease is due to the high degree of its proliferation, chronic and recurrent course, and resistance to existing therapies. Reducing the effectiveness of skin diseases treatment, including that of acne, at present, is associated with developing resistance to drugs, which causes the use of non-drug methods in dermatology nowadays, including low-intensity laser therapy. Objective - to determine evolution of the systemic immunity indices in patients with acne with different degrees of severity in the course of a standard and comprehensive treatment by laser therapy. MATERIALS AND METHODS: We observed 77 patients with acne aged 18-25 years; 32 of them received standard therapy, other 45 patients were additionally prescribed combined (superficial venous and external) laser therapy. We determined the indices of all patients' systemic immunity using well-known techniques. RESULTS: It has been established, that using laser therapy in comprehensive treatment of patients with acne promotes the normalization or a tendency to normalization of the systemic immunity and phagocytosis with significant difference between the indices of the individuals who received a standard therapy alone.