The review details the role of the skin microbiome dysbiosis in the pathogenesis of atopic dermatitis. Changes in the normal microbiota of the skin with massive colonization with Staphylococcus aureus may play a key role in the disease. Studies have shown that commensal bacteria (for example, Staphylococcus epidermidis) can suppress  the inflammatory response  in the skin by activating production of IL10 by antigen-presenting  cells. New therapeutic approaches are described, including the use of topical emollients containing active substances that have an immunomodulatory effect and positively affect the skin microbiome of children with atopic dermatitis.

Background.The human papillomavirus (HPV) is one of the most common sexually transmitted viruses and, according to WHO, the cause of 7.5% of all women deaths from cancer. Every year, more than 500.000 new cases of HPV-associated cancer are registered in the world, approximately 90% of which fall into cervical cancer category. Aim. The aim of the work was to determine the economic and socio-demographic burden of HPV-associated diseases in Russia by analyzing the following indicators: fertility, life expectancy and cost of vaccines, as well as the impact of HPV vaccination. Methods. Mathematical modeling was performed using epidemiological data on prevalence and mortality of HPV-associated diseases in Russia, taking into account current data on the types of HPV-related diseases, the effectiveness of vaccination, statistics by sex and age structure of diseases, and age-specific birth rates. The calculations were based on 50% and 70% vaccination coverage, and the average life expectancy of 12-year-old girls. Treatment cost was calculated based on the fees charged by mandatory health insurance system. The weighted average cost of 1 dose of quadrivalent vaccine in 2018, and average cost of visiting a pediatrician before each vaccination were taken into account. To estimate the cost, a discount rate of 3.5% per year was used. The economic burden of HPV-associated diseases, direct and indirect medical costs were calculated. Results. The economic burden of HPV-associated diseases is estimated at 63.638 billion rubles. 70% vaccination rate would reduce the economic burden by 41.792 billion rubles, prevent 4,841 deaths from malignant neoplasms and reduce losses associated with a fall in the birth rate by 1,100 children per year. The estimated economic effect of vaccination per vaccinated girl will be 13,327 rubles, and the total economic effect over the entire simulation period will be 31.653 billion rubles. Conclusion. Taking into account the results of modeling, vaccination of 12-year-old girls against HPV in Russia is a cost-effective measure in the prevention of HPV-associated diseases.

The authors presented the main provisions of the current clinical guidelines for the treatment of children with urticaria. The specifics of disease epidemiolog y, etiolog y and pathogenesis are described. The steps of dif ferential diagnosis are highlighted. For pediatric patients, treatment recommendations are provided based on the principles of evidence and a step-by-step therapy is suggested. A clear explanation is given on how to conduct an analysis of the ef fectiveness of therapy and assess the degree of disease activity.

The authors provide a review of current clinical guidelines regarding medical care provided to children with Bartter’s syndrome — impaired renal tubular function (loop of Henle) with the development of hypokalemia, hypochloremia, metabolic alkalosis and hyperreninemic hyperaldosteronism.  The specifics of disease epidemiology, etiology and pathogenesis  are described. The issues of differential diagnosis and treatment based on the principles of evidence are covered.

The article describes the modern views on the relationship between altered development of gut microbiota in infants and the risk of developing atopic diseases (atopic dermatitis and bronchial asthma). The studies of genetic susceptibility to atopy and the influence of epigenetic mechanisms involved in the regulation of gene expression responsible for the hyperproduction of immunoglobulin E are discussed. The characteristics of the microbiota of infants with already developed atopic diseases and children at risk of atopy are analyzed. In infants who subsequently developed atopy, the composition of gut microbiota at the birth is characterized by a reduced abundance of bifidobacteria  and high content of potentially pathogenic microorganisms.  The triggering role of active metabolites of altered microbiota on the differentiation of T-regulatory  cells has been established.  A preventive effect of optimal breastfeeding has been confirmed: meta-analyzes of recent studies indicate a link between the duration of breastfeeding  and a decrease in the frequency of bronchial asthma. The microbiota of breast milk contributes to the proper development of the infant’s microbiota, determines its diversity and immunomodulating action. On the basis of the conducted research, methods of targeted correction of the intestinal microbiota in children with risk of atopy can be developed.

Pediatric education should take into account development of intellectual abilities that are necessary for the future specialist. Specifically, they are creativity, critical thinking, an integrated approach to problem solving, emotional intelligence, social and communication skills. These qualities are formed using active and interactive teaching methods.

In modern health care, the principles underlying patient-orientated healthcare, aimed at preserving the health of the patient, as well as the productive cooperation between the medical caregivers and the patient, are becoming increasingly important. The article presents the results of the timely improvement of the professional activities of nurses in the Trans-Baikal Territory. It considers the use of operational management tools to improve the work of the front desk (registry), pre-physician  examination rooms. Particular attention is paid to the implementation of the «Health Coordinators» project in the Trans-Baikal Territory.