According to the World Health Organization, there are about 300 million people worldwide living with chronic hepatitis B, with about 1.5 million new infections occurring each year. In the Russian Federation, starting from the new century, there has been a gradual decrease in the incidence of acute hepatitis B, which retains the status of a socially significant viral infection. Vaccination against hepatitis B was included in the National Immunization Schedule in December 1997. by order of the Ministry of Health of the Russian Federation No. 375, which was later (in September 1998) enshrined in the Federal Law "On Immunoprophylaxis of Infectious Diseases". Currently, the main indicator of the body's protection against infection with the hepatitis B virus after immunoprophylaxis is the level of post-vaccination antibodies of the IgG class to HBsAg (anti-HBs), which can be determined using serological tests. The results of a study of the intensity of post-vaccination immunity against hepatitis B in children and young people vaccinated in the first year of life with a monocomponent recombinant hepatitis B vaccine are presented. A high proportion of children (85.5%) with anti-hepatitis B indicators at low (10-100 mMU/ml) or practically undetectable (below 10 mMU/ml) has been established.ml) levels. The results obtained correlate with a high proportion of children with a burdened premorbid background (87.1%) and, probably, the presence of immunodeficiency conditions. In young people, the proportion of seronegativation was 43.2%, and in combination with persons with low-level antibodies - 82.8% of the total number of examined. Thus, due to the weak response to the recombinant hepatitis B vaccine and the high medical and social significance of hepatitis B infection, various approaches are currently being developed to enhance the effectiveness of vaccination: changes in the vaccination regimen; correction of immune system functions to restore an adequate response to vaccine preparations, the use of various adjuvants, including recombinant interferons.

The prevalence of diseases of the reproductive system in children is, according to some data, more than 60% and this figure is increasing every year. The first place among the pathology of the reproductive system in childhood, with which the pediatrician meets at his appointment, is occupied by inflammatory diseases. We examined 54 children aged 1 to 6 years. The aim of our work was to determine the frequency of occurrence of diseases of the external genital organs in girls of early and preschool age at an outpatient appointment with a pediatrician. To analyze the obtained data, nonparametric statistics methods were used. As a result of our research, it was found that the peak age in the incidence of diseases of the external genital organs among girls of early and preschool age is the age of 2 years. This frequency may be due primarily to the anatomical and physiological characteristics of the child's body: the epithelial layer of the vulva and the vaginal mucosa are tender, vulnerable, loose, the pH in the vagina is alkaline, the epithelium does not contain glycogen. A feature of diseases of the reproductive system in children is the fact that the complaints made by children may be non-specific, and often there may not be any complaints at all. Vulvitis proceeds with more vivid clinical symptoms (itching, burning, pain during urination, hyperemia of the external genital organs), while vaginitis is characterized by a less vivid clinical picture (the presence of pathological discharge). The most common complaint that parents presented to a pediatrician during an outpatient appointment was the presence of pain and burning sensation when urinating in a child. Vulvitis was the most frequently diagnosed disease in outpatient appointments in girls aged 1 to 6 years. Vulvitis is an inflammation of the external genitalia. Risk factors for the development of this disease are: anatomical and physiological characteristics of the child's body, non-compliance with personal hygiene, extragenital diseases and exogenous factors.

In routine pediatric practice, non-IgE-mediated forms of gastrointestinal food allergy are still poorly recognized. This is due to the variety of clinical manifestations, the lack of reliable laboratory diagnostic methods, the unclear association with time, and the causal relationship with the allergen. Immature barrier mechanisms and early transition to formula feeding increase the penetration of allergen proteins, leading to sensitization. The article discusses three clinical forms of non-IgE-mediated gastrointestinal food allergy in children: food protein-induced enterocolitis syndrome, food protein enteropathy, and food protein-induced proctocolitis. In these cases, diet is a universal diagnostic and therapeutic measure. Eliminating the allergen allows for immunological reset and the induce the food tolerance. Therefore, strict adherence to elimination diets is crucial. The article also provides a differential diagnosis based on the level of allergic inflammation of the intestine and outlines principles and protocols for diagnostic and elimination diets.

Acquired idiopathic aplastic anemia is an extremely rare severe blood disease in which proliferation stops and blood stem cells die in the bone marrow, which is morphologically expressed in the replacement of functional BM cells with fat cells, as well as absolute pancytopenia. The disease is immune-mediated, according to the main theory, the development of the disease occurs as a result of a malfunction of the immune system, which in turn leads to autodestruction of hematopoietic stem cells, and leads to corresponding changes in blood tests and the appearance of characteristic symptoms. This disease is manifested mainly by three syndromes – anemic, hemorrhagic, toxic-infectious, which in turn determine the clinic and the severity of the disease. Despite the fact that this disease has been studied for more than 100 years, knowledge about it has always remained scarce, which did not allow effective management of patients in this group. This article describes a clinical case of acquired idiopathic aplastic anemia in a 7-year-old girl, with presented modern methods for diagnosing and treating this syndrome. The case described by us once again indicates that the etiology and pathogenesis of the syndrome at the present stage have not been studied enough, as a result of which the diagnosis and treatment of this pathology is difficult, and the developed methods of therapy at the current time are not enough to effectively treat most patients. Thus, the prognosis for these patients remains relatively unfavorable, since the selection of a bone marrow donor is quite complicated, as a result of the fact that the registry does not have a sufficient number of donors, there is a problem of selecting a donor according to tissue compatibility, and the transplant operation itself is associated with a large number of postoperative complications with the wrong approach. Conservative therapy, in turn, does not always have a sufficient therapeutic effect, necessary to improve the patient's condition.

Lactase insufficiency is widespread throughout the world. The development of clinical symptoms in lactase deficiency is due to the metabolism of lactose, which is not broken down in the small intestine and processed mainly by colon microorganisms with the formation of short-chain fatty acids and gases, leading to the development of diarrhea, flatulence, and often pain. Making a preliminary diagnosis based on complaints and the clinical picture is relatively simple, but a lot of methods have been developed to confirm the final diagnosis. These include, in particular, a glycemic test with a lactose load and a breath test with the determination of hydrogen in exhaled air after a lactose load. It is also possible to study the activity of lactase in biopsies of the mucous membrane of the small intestine and genetic research. Also in outpatient pediatric practice, the determination of carbohydrates in feces is used. This analysis is not specific, but can help in the diagnosis of carbohydrate malabsorption syndrome, especially in children in the first months of life. The general concept of nutrition in lactase insufficiency includes limiting lactose in the diet by eliminating lactose-containing foods or prescribing enzyme (lactase) replacement therapy. However, the degree of restriction depends on the degree of lactose intolerance and lactose can remain in the diet in tolerable amounts. A dairy-free diet is not recommended because milk is an important source of nutrients necessary for growth and metabolism, especially in childhood. The importance of milk in this regard is preserved in adults. Most individuals with lactase insufficiency can tolerate lactose-reduced fermented milk products. The use of probiotics helps to reduce the clinical symptoms of lactase insufficiency. It is also possible to use industrial lactose-free dairy products. It is important to correct a possible deficiency of minerals and vitamins in conditions of restriction of dairy products in the diet.

Gastroesophageal reflux disease is a retrograde throwing of stomach contents (hydrochloric acid, digestive enzymes and sometimes bile) into the esophagus, which leads to the appearance of symptoms. Gastroesophageal reflux disease occurs more often in palliative patients due to its anatomical features, genetic predisposition in the family, neurological diseases, gastrostasis, prolonged lying down, intolerance to the mixture. For the diagnosis of gastroesophageal reflux disease and esophageal diseases in children, it is possible to use esophagogastroduodenoscopy, daily pH monitoring of the esophagus, gastroesophageal scintigraphy, intraesophageal manometry and X-ray. Most of the techniques are difficult to use routinely in pediatric practice due to invasiveness and radiation exposure, so the use of non-invasive tests is of great importance. One of the non-invasive is ultrasound examination of the stomach, compared with the daily PH-metry of the esophagus, the sensitivity is up to 95%. The aim of the study was to study the clinical and instrumental manifestations of gastroesophageal reflux disease in children. The study was conducted on the basis of the "Zdorovy rebenok" medical center in Voronezh in the period from September to December 2022. During the examination, all children were examined by a gastroenterologist and ultrasound of the stomach with a water-siphon test. During the inspection , the following: clarification of complaints, collection of anamnesis, general examination and special status. Gastroesophageal reflux disease occurs in almost any age group, and most often the onset of the disease occurs at the age of up to 6 years, from which it can be concluded that at the present stage there is a "rejuvenation of the disease". Due to various clinical manifestations, gastroesophageal reflux disease can occur "under the masks of various diseases", which makes it difficult to make a timely diagnosis and delay rational therapy which requires a cautious attitude regarding this disease not only pediatricians and gastroenterologists, but also doctors of other specialties. Ultrasound examination of the stomach is one of the "gentlest" methods of gastroesophageal reflux disease research, which is especially important in childhood, as well as in palliative patients in pediatric practice.

Hereditary tyrosinemia type 1 or hepatorenal tyrosinemia is a severe orphan autosomal-recessive disorder of tyrosine metabolism caused by a deficiency of the enzyme fumarylacetoacetate hydrolase (FAH). The disease is diagnosed in approximately 1:100 000-1:120 000 cases of live births, and in certain regions (such as the Chechen Republic in Russian Federation) the estimated frequency of diagnosis can be significantly higher. In hereditary tyrosinemia type 1, blood levels of tyrosine, succinylacetone and other toxic metabolites are increased, which results in the accumulation of the toxic metabolites in target organs causingliver damage with progressive development of liver failure and liver cirrhosis, damage to the renal tubules resulting in Fanconi syndrome and hypophosphatemic rickets, and central nervous system. In some patients, myocardium could be involved in the pathological process, resulting in the development of hypertrophic cardiomyopathy. The disease presents a great challenge for differential diagnosis due to its polyorganic nature and frequent combination with other hereditary disorders. The modern treatment of hereditary tyrosinemia type 1 includes an elimination-based diet and pathogenetic drug therapy. The potential of genetic engineering methods in target therapy of hereditary tyrosinemia type 1 is being actively researched. Within the article if presented a case of early onset hereditary tyrosinemia type 1 in an infant with multiple congenital defects of central nervous system, including Dandy – Walker syndrome, and congenital defects of maxillofacial area, with signs of an immunodeficiency state and a severe generalized recurring infectious process involving poly-resistant mixed flora. The dynamic changes of neurologic signs are provided for the first year of life of the patient receiving the pathogenetic therapy for the main disease. Laboratory findings are provided, showing the dynamic changes in liver function of the patient.

Currently, diseases of the arteries of the lower extremities are an urgent problem of modern medicine, one of the most common variants of peripheral artery diseases. Of these, obliterating atherosclerosis of the lower extremities and, as a consequence, intermittent lameness deserve special attention. Intermittent claudication is one of the main and striking symptoms of diseases of the arteries of the lower extremities, the main cause of disability, has a significant negative impact on the quality of life of the patient. In 60% of cases, it is possible to accurately establish the diagnosis using general clinical research methods (analysis of patient complaints, history taking, examination, palpation, auscultation, functional tests). On examination, it is necessary to pay attention to the color of the skin of the affected limbs, the presence of hairline, the condition of the nail plates. Palpation allows you to determine the pulsation at standard points (femoral triangles, popliteal fossae, posterior surfaces of the medial condyles of the tibia, dorsal surfaces of the feet), thereby revealing the level of damage to the arteries of the lower extremities. Auscultation also allows you to determine the level of damage to the arteries of the lower extremities – a systolic murmur will be heard over the stenotic artery. Functional tests include Oppel's symptom of plantar ischemia, Goldflam and Samuels's test, Goldflam's test, Sitenko – Shamova's test, Panchenko's knee phenomenon. To date, the vascular endothelium is considered an active endocrine organ that supports vascular hemostasis, due to the synthesis and isolation of biologically active compounds. This fact has found application in the diagnosis and treatment of this group of diseases. Despite the extensive range of medications, special attention is paid to cilostazol and alprostadil. In the case of insufficient effectiveness of drug treatment, it is necessary to resort to surgical intervention using the most rational method in this case. Lifestyle modification and physical activity play an important role in the treatment, which is confirmed by the results of research.

Parkinson's disease is characterized by a combination of motor and non-motor symptoms. One of the most common non-motor symptoms is asthenia, the prevalence of which in the structure of Parkinson's disease is 37.7-81.6%, depending on the stage. Due to the insufficient effectiveness of standard antiparkinsonian therapy for asthenia, it is advisable to study additional methods for correcting this condition. Our aim was to evaluate the clinical efficacy of the drug fonturacetam in patients with Parkinson's disease as an additional therapy for the correction of asthenic syndrome. A clinical comparative observation of 50 patients with Parkinson's disease of various stages and symptoms of asthenia was carried out. Patients were randomly assigned to 2 groups: the main group (n = 30), where in addition to basic antiparkinsonian therapy, fonturacetam was prescribed at a dose of 200 mg per day, divided into 2 doses; the control group (n = 20), where patients received only basic therapy. The course of therapy with fonturacetam was 30 days, the total duration of follow– up was 60 days. The effectiveness of treatment was assessed on the scales of asthenia MFI-20 (before (Visit 1), after treatment (Visit 2), 1 month after completion of treatment (Visit 3)); anxiety and depression HADS (Visits 1, 2); daytime sleepiness and the risk of sudden falling asleep Epworth (Visits 1, 2). In the main group, there was a distinct statistically significant effect of therapy after completion of the course (p = 0.00091), as well as in the follow–up period according to the MFI-20 scale (median values of the total score of 58 points, 48.5 and 50.5 at visits 1, 2, 3, respectively), while the most significant changes were observed in patients with Stage II according to Hoehn and Yahr, while an increase in asthenic symptoms was recorded in the control group. According to the HADS scale, there was a decrease in the severity of depression symptoms in the main group (the dynamics of scores was from 7 to 5, p = 0.01853); no such effect was observed in the control group. When assessing daytime sleepiness, patients of the main group noted a subjective improvement by visit 2, however, according to the Epworth scale, there were no statistical changes in both the main and control groups. The drug fonturacetam has significant antiasthenic and antidepressant effects in patients with Parkinson's disease, while the effect of therapy on the symptoms of asthenia is prolonged. Fonturacetam in a daily dose of 200 mg may be recommended for use in patients with Parkinson's disease as an adjunct to the main antiparkinsonian therapy.

The article provides information on local inflammatory bowel diseases therapy, the peculiarities of the use of various rectal forms of anti-inflammatory drugs. The basic drug for the treatment of patients with inflammatory bowel diseases is 5-ASA, used both topically or orally, and in combination, including as part of complex therapy. The most common form of the initial stage of ulcerative colitis is proctosigmoiditis or left-sided colitis. All three forms of 5-ASA for rectal administration (candles, enemas and foam), according to clinical studies that evaluated the frequency of achieving clinical remission of proctitis, were equally effective. The introduction of mesalazine foam through the rectum acts directly on the mucous membrane of the end parts of the intestine. Due to the high adhesive ability of the foam, the drug 5-ASA can "stick" to the mucous membrane, which ensures long-term contact of the drug with the affected area of the intestine. In addition, the foam, having the ability to diffuse, spreads from the injection site proximally along the course of the colon, gradually expanding to the maximum possible volume. At the same time, the duration of contact (exposure) of the drug with the intestinal mucosa increases the effectiveness of its action. A small volume of a single dose of rectal foam, compared with enemas, contributes to better patient tolerance and higher adherence to treatment. In mild and moderate course of ulcerative proctitis, as well as left-sided ulcerative colitis, rectal preparations of 5-ASA are the first line of therapy. For common and total colitis, it is advisable to use a combination of rectal and oral forms of 5-ASA. Detailed recommendations of the doctor on the administration of the drug help to comply with the treatment regimen and significantly increase the effectiveness of therapy.

A review of modern Russian and foreign, predominantly English-language, literature on endothelial dysfunction in menopause and the development of cardiovascular complications was carried out. Publications not older than 5 years published in specialized medical journals and manuals were taken into account. A lot of works are devoted to the problem of studying cardiovascular diseases in menopausal women, which is due to the high incidence and mortality of women from cardiovascular diseases in this age period. However, hormonal changes in women begin quite early, several years before ovarian failure and menopause, which leads to a wide range of metabolic and vascular changes that significantly increase cardiovascular risk. The review presents clinical studies demonstrating the functioning of the vascular endothelium and the risk of developing cardiovascular diseases in women with hormonal dysfunction. The work of a single-layer layer of squamous cells of mesenchymal origin, lining the inner surface of blood and lymph vessels, heart cavities, as a full-fledged organ, which is involved in the regulation of many processes in the body, is presented. A large number of factors, both internal and external, affect pathogenetic processes in endothelial tissue, which makes the study of its dysfunction even more relevant. Of all the factors synthesized by the endothelium, the role of the ″controller″ of the main functions of the endothelium belongs to the endothelial relaxation factor or nitric oxide. It is this compound that regulates the activity and sequence of ″launching″ of all other biologically active substances produced by the endothelium. Nitric oxide not only causes vasodilation, but also blocks the proliferation of smooth muscle cells, prevents the adhesion of blood cells and has antiplatelet properties. Thus, nitric oxide is a basic factor in anti-atherogenic activity and depends on the activity of estrogens. According to modern concepts, endothelial dysfunction occupies a key place in the pathogenesis of atherosclerosis, hypertension, thrombosis, chronic heart failure, and diabetes mellitus. Understanding the mechanisms underlying age-related pathophysiological changes in the vascular bed of women during hormonal changes is necessary for risk stratification and the development of new methods of pathogenetic treatment.

Cough is one of the most important symptoms of the pathology of various organs and systems, which occurs in about 30% of the human population. This symptom prevails in patients with various bronchopulmonary pathologies, however, in addition, it can occur with the pathology of other organs and systems (ENT organs, upper gastrointestinal tract, cardiovascular and nervous systems), as well as a side effect when taking certain drugs (ACE inhibitors, inhaled drugs,etc.), because of endoscopic interventions. In addition to discomfort for the patient, an abnormal cough can lead to the development of several serious complications. The article presents the reflex arc of the cough reflex, various classifications of cough. Cough can be acute and chronic, the therapy of each of these types will depend on the causes of occurrence. The causes of acute cough can be SARS, COVID-19, influenza, acute bronchitis, pneumonia. Among the most common causes of chronic cough, the so-called "cough triad" is distinguished, which includes cough cider of the upper respiratory tract, bronchial asthma and gastroesophageal reflux disease. In addition to the "cough triad", the causes of chronic cough can be chronic bronchitis, bronchiectasis, lung cancer, idiopathic fibrosing lung disease, interstitial pneumonia of known etiology. As a cough therapy, antitussive and protussive pharmacological strategies are distinguished, which are given in the article. Thus, cough has a different pathogenesis and clinical characteristics, therefore, a thorough collection of anamnesis, data from an objective examination of the patient, the use of additional laboratory and instrumental research methods, as well as an understanding of the differential diagnostic series of diseases accompanied by cough, will help in timely diagnosis with the correct rationale for the choice. therapeutic tactics and cough management strategies.

Chronic adrenal insufficiency is caused by insufficient secretion of hormones by the adrenal cortex due to dysfunction of one or more links of the hypothalamic-pituitary-adrenal system. If the pathological process is localized in the adrenal glands themselves, causing almost total destruction of the cortical layer (at least 90% of the cortex of both adrenal glands), a clinical picture of primary chronic adrenal insufficiency (1-HH) develops. The most common cause of 1-HN is currently autoimmune destruction of the adrenal cortex, which can occur either in the form of an isolated 1-HH of autoimmune genesis, or be a component of autoimmune polyglandular syndromes (APS), which are a primary autoimmune lesion of several peripheral endocrine glands, and often associated with non-endocrine autoimmune diseases. The most common variant of APS is APS type 2, which is a combination of 1-HH with autoimmune thyroiditis (autoimmune thyroiditis, Graves' disease), or with type 1 diabetes mellitus. Despite the fact that adrenal insufficiency is a rare disease, from 40-60 to 100-110 new cases are detected per 1 million adults per year, its timely diagnosis is very important, because without timely replacement therapy with glucocorticoids and mineralocorticoids, a life-threatening condition develops. condition – acute adrenal insufficiency (adrenal crisis). The most common cause of acute hypocorticism is decompensation or acute manifestation of chronic forms of adrenal insufficiency. The article presents a clinical case of late diagnosis of primary adrenal insufficiency in APS type 2, which led to the development of an adrenal crisis in a 42-year-old patient. Late diagnosis was caused by errors in the interpretation of clinical symptoms, as well as unaccounted for data from the anamnesis, namely, the presence of diabetes mellitus of autoimmune genesis in the patient.

According to modern ideas, the pathogenesis of the new coronavirus infection COVID-19 (from the English Corona Virus Disease-2019) is an acute infectious disease caused by a new strain of SARS-CoV-2 coronavirus with an aerosol-drip and a contacthousehold transmission mechanism) is characterized and the systemic immunospitalus process, hyperactivity of the coagulation cascade, endotheliopathy and hypoxia, leading to the development of microtrombs and mactrombs. The main source of infection is a sick person, including the disease in the incubation period. The greatest danger to others is a person in the last two days of the incubation period and the first days of the disease. A new coronavirus infection in medical workers can be considered as an occupational disease if the infection occurred while they were performing their professional duties. In the Samara region in 2020-2021, 146 cases of acute occupational disease caused by the new coronavirus infection COVID-19 were diagnosed to medical workers, of which 72 diagnoses (48.63%) were established posthumously. In 2021, 6 diagnoses of chronic occupational diseases associated with a coronavirus infection were established, which determined persistent disability. The presence of severe complications of a new coronavirus infection, disability, give relevance to the analysis of the features of occupational diseases of medical workers in order to improve their diagnosis, improve prevention, treatment and rehabilitation.One of the most important manifestations of the new coronavirus infection is the defeat of the cardiovascular system. The presented clinical case reflects one of such possible variants of serious lesions – myocarditis, which led to the development of rhythm disturbances. The article presents the principles and results of a medical examination conducted in order to establish a causal relationship of the disease with the professional activity of a medical worker.

Familial Mediterranean fever is an autoinflammatory genetically determined autosomal recessive disease caused by a mutation of the MEFV gene. Familial Mediterranean fever is recorded mainly in populations of Middle Eastern origin, historically inhabiting the territories of the Eastern Mediterranean. Taking into account the increasing migration of the population, there is an increase in cases of Mediterranean fever in countries far from the Mediterranean region, including in our country. Manifestations of familial Mediterranean fever include episodes of fever, acute abdominal pain and/or chest pain lasting up to 3 days. After three days of acute course, complete relief of symptoms occurs according to laboratory data and clinical manifestations. Knowledge about the clinical manifestations, diagnosis and treatment of familial Mediterranean fever is necessary for practitioners of various specialties. The clinical manifestations of an attack of familial Mediterranean fever resemble an acute abdomen and patients are often subjected to unjustified surgical intervention. In some cases, an untimely diagnosis increases the risk of amyloidosis and chronic renal failure, and modern therapy can improve the quality of life of patients and prevent the development of complications. The goals of familial Mediterranean fever treatment are to improve the quality of life, reduce the frequency, severity and duration of seizures, prevent disability and the development of complications, in particular amyloidosis. Taking into account the variety of clinical manifestations and the severity of the disease in different patients, treatment should always be selected individually. The introduction of colchicine into clinical practice radically changed the prognosis for familial Mediterranean fever. The risk of developing amyloidosis in patients who adhere to colchicine therapy is less than 1%, even in cases where there is no complete control of seizures. Thus, all patients with familial Mediterranean fever are recommended lifelong prevention with colchicine, regardless of the symptoms, unless serious side effects occur during its administration. The experience of using IL-1β antagonists, anakinra and kanakinumab, is currently available in thousands of patients with colchicine resistance. In case of ineffectiveness of kanakinumab and contraindications to its administration, TNF-α inhibitors are used.