Bezoars are rarely occurring foreign bodies of the gastrointestinal tract, only 0.5–1% of cases cause the mechanical intestinal obstructions. It is very difficult to diagnose bezoar on early stages. The presented clinical case demonstrates the opportunities of multidisciplinary approach in diagnosis and rehabilitation of children with trichobezoar. Two weeks before hospitalization, the girl began to make complaints about periodic abdominal pain, nausea, episodes of vomiting occurred immediately after ingestion. The child underwent complex examination (including esophagogastroduodenoscopy) which revealed a giant trichobezoar occupying the entire lumen of the stomach. Gastrotomy, removal from the stomach in the form of his «impression» trichobezoar (12×15 cm) was performed. During the in-patient monitoring at hospital, both medical assistance and psychological and pedagogical support was provided to the child and to his parents as well; consultations on emotional state of the child and optimizing the process of education in the family were delivered. The joint work of pediatricians, surgeons, and specialists in the psychological and pedagogical service makes it possible to determine the necessary volume of medical assistance, as well as the psychological reason for the occurrence of neurotic reactions to prevent the «hair tumor» formation in future.

The article presents the experience of vaccination with a pneumococcal 13-valent conjugate vaccine (PCV13) of a patient aged 5 years with oligoarticular juvenile idiopathic arthritis (JIA) receiving methotrexate at a dose of 15 mg/m2 per week subcutaneously. Treatment with methotrexate provided a remission of JIA, but was accompanied by frequent respiratory infections — up to 8 times a year. During infection progression, methotrexate injections were omitted. Gaps in the treatment with methotrexate were accompanied by an exacerbation of the underlying condition. Vaccination of the patient with PCV13 reduced the frequency of respiratory infections to 2 times a year, which was accompanied by the development of persistent remission of the disease. Adverse events and exacerbation of JIA in a child after vaccination with PCV13 were not registered.

The article describes the case of successful use of human monoclonal antibodies to the tumor necrosis factor- adalimumab in a patient with a severe course of juvenile arthritis associated with enthesitis and uveitis resistant to non-steroidal anti-inflammatory drugs, methotrexate, glucocorticosteroids that have been applied topically and retrobulbarly. After the first adalimumab administration, the pain syndrome was stopped, the duration of morning stiffness was significantly reduced, the laboratory indices of the disease activity were normalized by the 4th week of treatment, uveitis activity was stopped, the inflammatory changes in the joints regressed and the phase of inactive disease was ascertained by the 12th week. The duration of remission of articular syndrome and uveitis during treatment with adalimumab was 26 months. Adverse reactions were not registered during therapy.

Background. Improving the quality of medical care is the absolute priority of the World Health Organization and all socially-oriented ministries and departments around the world.

Objective. Our aim was to evaluate the effectiveness of quality  assurance and supportive supervision in municipal hospitals to improve the quality of medical care for children (by the example of the Rostov region).

Methods. The open observational study included 10 second-level hospitals in the Rostov Region. At the start of the project, the quality of inpatient care for children in the region was audited based on recommendations and tools of the World Health Organization, and training of medical personnel was organized. Monitoring visits to hospitals were carried out by experts every 3 months (supportive supervision). Reaudit of the quality of care was conducted a year later.

Results. As a result of regular quality assurance and supportive supervision of hospitals during the first year of operation, such indicators of the quality of medical care as the availability of medical equipment for emergency care for children, the infrastructure of children’s departments, the triage and provision of emergency care in children’s departments, managing patients with various acute conditions (fever, diarrhea, respiratory diseases), supporting care, internal quality assurance, accessibility to standards of care and clinical guidelines for the diagnosis and treatment of various diseases, respect for children’s rights were significantly (p < 0.05) improved.

Conclusion. Supportive supervision and regular external quality assurances of hospitals contribute to a rapid increase in the quality of medical care for children.

In the Kyrgyz Republic (KR), several thousands of people including children and teenagers diagnosed with STD for the first time are registered annually.

Objective: To study the common incidence rate, including STD morbidity rate, in children and teenagers.

Methods:
The analysis of STD case rate and prevalence, in dynamics, during 2007–2014 (primary case rate, STDs prevalence) was conducted using social and hygienic, analytical, and statistical methods. The data of official statistics of National Statistical Committee and the Ministry of Health of the Territory are applied.

Results: During the eight analyzed years the morbidity rate of diseases of genitourinary system increased by 17.6% (from 37.3‰ in 2007 up to 43.9‰ in 2014; р<0.05). The highest rates were registered in teenage girls aged 15–17 years during the period from 2007 to 2014: 52.3–54.4 (per 1000 girls in this age group) with fluctuations up to 58.8 in 2010 that authentically differed from similar indicators in young men: 22.0–40.4 (per 1000 young men in this age group; р<0.05). In young men the incidence rate increased almost twofold (р<0.05). Positive dynamics was observed from 2007 to 2014: gonorrhea incidence rate in children decreased from 1.1±0.2 to 0.4±0.01 cases, and in teenagers — from 5.7±0.4 to 4.1±0.3 cases per 100 thousand corresponding population (р<0.01).

Conclusion: Incidence rate increase in pathology of genitourinary system in general population and also in adolescents requires development and implementation of the effective prophylaxis programs for STD in children and adolescents, the careful analysis of the collected statistical data, and registration of cases in the private medical facilities.

Background. Prevention of ischemia-reperfusion injury of the allograft (IRIA) is an urgent problem in transplantology, which largely determines the prognosis for both the transplanted organ and the patient as a whole.

Objective. Our aim was to study the effectiveness of eculizumab in comparison with plasmapheresis during induction  immunosuppressive therapy in kidney transplantation in children.

Methods. The retrospective study includes children with terminal phase of chronic renal failure who have received kidney transplants from either a living relative or deceased donor. The age of patients is from 1 year to 18 years. Induction immunosuppression in both groups was performed with alemtuzumab. Group 1 (main) included children who were treated with eculizumab to prevent IRIA, Group 2 (comparison) included children who were treated with plasmapheresis for the same purpose. The comparative analysis was carried out according to the following criteria: the rate of blood creatinine subnormalization (in days), the rate of glomerular filtration (in ml/min) 30 days after the operation; daily protein excretion (mg/24 h) 30 days after organ transplantation; morphological characteristics of renal biopsy samples by Banff 30 days after surgery.

Results. During the comparative analysis from December 2012 to November 2016, eculizumab was administered to 32 patients, 24 patients underwent plasmapheresis. In Group 1, blood creatinine normalized almost 4 days earlier than in Group 2 (p=0.0049); the glomerular filtration rate in Group 1 was 4.5 times higher than in Group 2 (p=0.0018). Daily proteinuria in Group 1 was 4 times lower than in Group 2 (p=0.0019).

Conclusion. The carried out study showed better indices of renal allograft function when using eculizumab in comparison with plasmapheresis: consequently, eculizumab more effectively suppresses IRIA than plasmapheresis.

The article analyzes the possibilities of auditing the quality of medical care to improve the efficiency of medical organizations. The audit of the medical organization is a closed cycle to improve the quality of medical care, which should include assessing the actual assistance provided in relation to the approved high quality standards, developing a plan to bring the actual level of medical care into compliance with the declared standards, and improving this assistance to achieve the best health indicators. The review examines the different forms of clinical audit and the experience of their use in various countries of the world.

These clinical guidelines were developed by the professional association of pediatric specialists «Union of Pediatricians of Russia» and approved by the Association’s Executive Committee at the Congress of Pediatricians of Russia «Actual Problems of Pediatrics». Clinical guidelines are devoted to the problem of rotavirus infection, the relevance of which is determined by the high prevalence level and significant contribution of infectious diarrhea to the mortality pattern of children in the first 5 years of life. We present epidemiological data and detailed information on the infectious agent and pathogenesis of rotavirus infection progression. A detailed picture of clinical manifestations as well as extraintestinal complications is presented. The approach to specific prophylaxis has been reasoned. Practical recommendations for immunization as well as various regimens for administering the vaccine, depending on the 
age and condition of the patient, are given.

Methylmalonic acidemia (aciduria) is an inherited metabolic disturbance from the group of organic acidemias (acidurias). The article presents etiopathogenetic, epidemiological, diagnostic, and therapeutic aspects of the problem. The possibilities of laboratory and instrumental diagnostic methods the tactics of dietary correction of metabolic disorders in acute and interstitial periods of the disease are described in details; features of drug treatment are outlined. The necessary information for clinical practice and patients’ everyday life is given in the article.

The article briefly summarizes the key provisions of the clinical recommendations on medical care delivery for children with allergic rhinitis: modern approaches to diagnosis and therapy. The current document was developed by the professional association of pediatric specialists —the Union of Pediatricians of Russia — together with the leading experts of the Russian Association of Allergists and Clinical Immunologists. The recommendations are regularly updated due to the latest evidence-based results of effectiveness and safety of various medical interventions. The article presents information on the epidemiology of allergic rhinitis in children, specific diagnostic features which provide the opportunity for the timely and correct diagnosis and an effective therapy with personal approach.