Porokeratoses-A Comprehensive Review on the Genetics and Metabolomics, Imaging Methods and Management of Common Clinical Variants.

Porokeratosis is a heterogeneous group of keratinising disorders characterised by the presence of particular microscopic structural changes, namely the presence of the cornoid lamella. This structure develops as a consequence of a defective isoprenoid pathway, critical for cholesterol synthesis. Commonly recognised variants include disseminated superficial actinic porokeratosis, disseminated superficial porokeratosis, porokeratosis of Mibelli, palmoplantar porokeratosis (including porokeratosis palmaris et plantaris disseminata and punctate porokeratosis), linear porokeratosis, verrucous porokeratosis (also known as genitogluteal porokeratosis), follicular porokeratosis and porokeratoma. Apart from the clinical presentation and epidemiology of each variant listed, this review aims at providing up-to-date information on the precise genetic background, introduces imaging methods facilitating the diagnosis (conventional and ultraviolet-induced fluorescence dermatoscopy, reflectance confocal microscopy and pathology), discusses their oncogenic potential and reviews the literature data on the efficacy of the treatment used, including the drugs directly targeting the isoprenoid-mevalonate pathway.

Diagnostics of Gonococcal Infection in Ukraine: Current Challenges in Resource-Constrained Settings.

OBJECTIVE: This study aimed to evaluate the compliance of laboratory diagnostics of gonorrhoea in Ukraine with the World Health Organization (WHO) laboratory manual. MATERIALS AND METHODS: A quantitative non-randomised cross-sectional descriptive postal survey was conducted to evaluate the diagnostics of gonorrhoea in sexually transmitted infections (STI) clinics in Ukraine. RESULTS: The survey provided data about diagnostics of Neisseria gonorrhoeae in STI clinics from 14 regions of Ukraine from January 2013 to September 2014. The clinics performed microscopy, culture, and point-ofcare- testing in 100%, 85.7%, and 7.1% of the cases, respectively. None of the respondents had the option of performing nucleic acid amplification tests and antimicrobial susceptibility testing. Two regions reported their participation in the collaborative project by WHO on antimicrobial resistance investigation, as national antimicrobial susceptibility surveillance program had not been established in Ukraine. A "three-site testing" (urogenital, pharyngeal, and rectal specimens) in symptomatic heterosexuals was conducted by 25%, "twosite testing" (urogenital and pharyngeal specimens) was conducted by 41.7%, and "one-site testing" (urogenital specimen) was conducted by 33.3% of the respondents. External quality control of laboratory tests for the detection of N. gonorrhoeae was not performed in 50% of the regions in Ukraine. Non-selective culture media for isolation of N. gonorrhoeae and culture media in tubes instead of the recommended Petri dishes were used in 16.7% and 58.3% of the laboratories, respectively. CONCLUSION: Increased adherence to evidence-basedWHO and/or nationally adapted management guidelines is essential for monitoring gonorrhoea and preventing antimicrobial resistance of N. gonorrhoeae in Ukraine.

The role of Candida spp. contamination and efficacy of camphorated oil in skin care of incontinent associated dermatitis patients.

Candida albicans is the most prevalent human fungal commensal organism and is reported to be the most frequent aetiological factor responsible for infection associated with incontinence-associated dermatitis (IAD). AIM: The aim of the study was to investigate the Candida spp. colonisation and efficacy of camphorated oil in the skin care of the patients with incontinence-associated dermatitis. MATERIALS AND METHODS: In patients of the study group (n=104), a local application of camphorated oil was used to clean and protect their skin from urine and/or faeces. In 30 patients of the control group routine wet wipes 3 in 1 or a combination of cleansing foam with protective cream were used. Pre-treatment (day 1) and post-treatment (day 30±1) study evaluations included detailed description of eruption, assessment by evaluation tools, and mycological culture for Candida spp. from sites with fungal-appearing rash. RESULTS: Fungal-appearing rash was found in almost a half (51.0%) of patients at pre-treatment examination and in less than one-third (31.7%) of the patients after the course of application of camphorated oil. Candida spp. was cultivated in 39 (37.5%) patients. Fungal-appearing rash was approved by mycological culture in 56.6%. In patients with urine incontinence, Candida spp. negative cases (43.3%) were significantly prevalent over Candida spp. positive (22.1%). At post-treatment, this prevalence become more noticeable, accordingly obtaining 62.5% of negative and 2.9% of positive results. In patients with double incontinence, Candida spp. negative cases (19.2%) were almost equal to the number of Candida spp. positive (15.4%). After a course of study treatment, Candida spp. negative cases (26.0%) significantly overpassed Candida spp. positive level (8.7%). At an early and moderate grade of IAD Candida spp. negative cases were prevalent, but at severe grade did not differ from the number of positive mycology cultures. CONCLUSIONS: The topical use of camphorated oil in skin care of the incontinence-associated dermatitis significantly decreases the severity of disease, reduces fungal appearing rash and Candida spp. colonisation. Camphorated oil was superior to routine products in the controlling of yeast colonisation of the skin in incontinence-associated dermatitis, especially in cases with double incontinence.

The Clinico-Epidemiological Profile of Patients with Gonorrhoea and Challenges in the Management of Neisseria gonorrhoeae Infection in an STI clinic, Ternopil, Ukraine (2013-2018).

Gonorrhea is the second most common sexually transmitted infection spreading worldwide and a serious public health problem. However, further data are required to improve the management of gonorrhea. Our aim was to review the features of gonococcal infection and characterize the challenges of its management. A retrospective descriptive study of the medical records of 136 adult patients with gonorrhea that visited Ternopil Regional Sexually Transmitted Infections Clinic (Ukraine) in 2013-2018 was performed. The male-to-female ratio was 6.6:1. Homosexually-acquired gonorrhoea was 3.7%. Also, most patients acquired gonorrhea in Ukraine (98.4%). The mean infectious period lasted 2-16 days, including the incubation period of 1-9 days and the period from the onset of symptoms to the first visit of the clinic of 1-7 days. The probability of N. gonorrhoeae transmission within the frame of the epidemiologic sexual chain was 1:2.4. Concurrent T. vaginalis (39.7%) and C. trachomatis (2.2%) were detected. HIV and syphilis screening rates were 1.6% and 0.7%, respectively. The examining rate of sexual partners was 11%, testing extragenital specimens - 0.7%, screening coverage for HIV - 46.3%, compliance with follow-up visits - 41.9%. Part of patients (16.2%) received monotherapy with clarithromycin, doxycycline, benzylpenicillin, azithromycin, or ofloxacin. The management of N. gonorrhoeae infections was compromised by a low rate of examining sexual partners, females and testing extragenital specimens, screening for HIV, compliance to follow-up visits, access to nucleic acid amplification tests, and receiving questionable or even obsolete antimicrobial treatment. Therefore, more accurate and comprehensive management of gonorrhea is urgently needed in Ukraine.