Relevance The epidemiological disadvantage of measles in developed countries reflects the weakening of herd immunity and is caused, first of all, a change in society's attitude to vaccine prevention and the risks of infectious diseases, which requires a revision of the prevention strategyAim: assessment of measles immunity in employees of the regional multidisciplinary children's hospital.Materials & Methods. 365 employees were examined at the same time in 2019 on the basis of the regional children's hospital. Investigation of the intensity of immunity to measles by ELISA using the VectoKor-IgG test system (Vector-Best, Russia). The surveyed were divided into 4 age groups (20–29, 30–39, 40–49 and 50 years and older). Statistical processing was carried out using the χ2 test and Spearman's rank correlation.Results. 63% of the examined had a protective titer of antibodies. The least protected were medical workers under the age of 40, especially up to 30 years old, with a share of immune persons of 30%. In older age groups, the proportion of seropositive persons was 80.9%. The age of the employees and the levels of measles immunity were highly correlated (r = 0.72). There was no statistically significant effect on the state of measles immunity of professional status, the presence of documentary evidence of vaccination.Conclusions. Thus, the results of the conducted study indicate a high epidemiological risk of measles in medical institutions and when applying to them. The worst indicators of protective immunity were found among young employees. It is advisable to continue serological monitoring in medical institutions, organized vaccination of seronegative individuals, as well as conduct cooperative research

Voluntary anonymous questioning of groups of parents (n = 120), students of junior and senior courses of medical faculty (n = 250), оutpatient doctors (n = 45) concerning vaccination is carried out.Parents showed a generally positive (60%) attitude to vaccination, high anxiety (90%) in connection with the possible development of post-vaccination complications, as well as lack of awareness and inertia in acquiring knowledge about vaccination. The positive trend in knowledge among students from junior to senior courses is adjacent to the lack of practical orientation on vaccination. Outpatient doctors are cautious about vaccination, especially for children with chronic illnesses.

Рязанский государственный медицинский университет им. акад. И.П. Павлова, ул. Высоковольтная, 9, 390026, г. Рязань, Российская Федерация (1) Российский университет дружбы народов, ул. Миклухо-Маклая, 6, 117198, г. Москва, Российская Федерация (2) В обзоре представлены современные взгляды на причины коморбидности у де-тей. Структура и причины сочетанной патологии у детей имеют существенные от-личия от таковой у взрослых. Основные группы причин и факторов, определяющих развитие сочетанной патологии у детей: генетические, перинатальные, социальные, алиментарные и экологические. Перечисленные группы часто пересекаются. Ко-морбидность у детей имеет возрастную динамику, причѐм время воздействия при-чинного фактора и время реализации патологии могут быть удалены друг от друга. In a review modern looks are presented to reasons of comorbidity for children. A structure and reasons of combined pathology for children have substantial differences from such for adults. Main reasons of the combined pathology for children: genetic, perinatal, social, alimentary and ecological factors. Enumerated groups intersect often. Comorbidity for children has age-dependent dynamics, thus time of influence of causal factor and time of realization of pathology can be remote from each other.

A review of domestic and foreign literature on the disease and Caroli syndrome is presented. The review includes a historical background and a modern view on the etiology and pathogenesis of the disease, its place among fibrocystic diseases of the liver. Caroli’s disease is a rare genetic pathology, characterized by a wide clinical and morphological polymorphism from severe variants with fibrosis in the neonatal period to cases with manifestation at a late age. The genetic causes of pathology, in particular, mutations associated with autosomal recessive and autosomal dominant forms of polycystic kidney disease, have been studied. A large number of described mutations and the predominance of complex heterozygotes among patients explains the diversity of clinical forms of pathology. The relationship between the genotype and phenotypic variants of pathology has not been determined. In Caroli’s disease, in addition to cystic changes in the liver and kidneys, damage to other organs and systems, in particular cerebral vessels, can be observed. Extrahepatic and extrarenal symptoms of the disease are described, as well as combinations with various genetic diseases. A clinical case of Caroli syndrome in a child observed by the authors from birth is presented. The disease manifested as congenital cystic transformation of the kidney. Hepatic pathology was detected at the age of 5 years. Subsequently, there was a rapid progression of liver damage with the development of severe complications: cirrhosis of the liver, portal hypertension, edematous syndrome, hepatic encephalopathy. At the age of 11 years, the patient successfully underwent orthotopic liver transplantation. The presented case demonstrates the late detection of hepatic damage, its rapid progression. Despite the presence of severe complications, liver transplantation was a success and the patient is currently in a stable condition compensated for all functions.

Introduction. Mucopolysaccharidosis type III (Sanfilippo syndrome) is a rare multi-stem disease caused by the accumulation of glycosaminoglycans (GAG) in the cells of various organs, leading to a violation of their function, specific phentopic signs and progressive neurocognitive disorders. Neurologic manifestations are leading in the clinical picture of the disease, as by the time of manifestation, and by severity. In most patients, in the first and even second years of life, children have normal development or indistinctly pronounced deviations. In the absence of substitute enzyme therapy for this type of MPS, a severe delay in intellectual and speech development develops rapidly, recurrent respiratory episodes in the form of pneumonia and bronchial obstruction are observed, the child is disabled early. Polymorphism and non-specificity of clinical manifestations, lack of alertness of doctors to orphan diseases are a common cause of late diagnosis of MPS. The article presents an overview of data on the prevalence, genetic and phenotypic variants of type III mucopolysaccharidosis, features of patient management and presentation of clinical observation of a child with this pathology.Clinical observation. We present our own prolonged clinical observation of a type III MPS case in a patient who has been under our supervision for 12 years. The diagnosis was established and confirmed at the age of three years. The disease was manifested by neuropsychiatric regression and systemic somatic manifestations. Motor deficits, cognitive impairments with the development of dementia and recurrent aspiration syndrome progressed in the dynamics of the child.Conclusions. The classical clinical picture of type III MPS is distinguished by the aggressive development of cognitive and motor disorders at 2–3 years of life, characteristic phenotypic and somatic manifestations of the disease. This case demonstrates the multiplicity of problems and the need for interaction between doctors of various specialties.