Background. Study of the intestinal microbiota in children with allergic diseases during the first 1000 days of life is necessary for pathogenetic correction validation of intestinal dysbiosis during the “window of opportunity” period. Several studies on intestinal microbiota in children during the first 1000 days of life have been conducted in Russia, but not among children with allergies.

Objective. The aim of the study is to examine the intestinal microbiota composition in children under two years of age with food allergies.

Methods. The study included full-term children aged 6–24 months with food allergy who were followed up on outpatient basis. The taxonomic composition of intestinal microbiota was analyzed via 16S rRNA sequencing. Biological material was collected at home. The taxonomic profile of intestinal microbiota is presented as the relative abundance of taxa, calculated as the proportion (in %) of reads assigned to each taxon out of the total number of reads.

Results. The taxonomic composition of intestinal microbiota was studied in 60 children: 37 of them were of the first year of life (6–12 months) and 23 were of the second year of life (13–24 months). Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteria were revealed in both age groups, while children aged 13–24 months additionally had Verrucomicrobia. Ruminococcaceae family (p = 0.006), unclassified type of Lachnospiraceae family (p < 0.001), and Gemmiger (p = 0.007) were revealed more frequently in children aged 13–24 months, whereas Veillonella (p = 0.007) was revealed less frequently. Opportunistic microorganisms of Veillonella parvula (p = 0.017), Erysipelatoclostridium ramosum, and Intestinibacter bartlettii were revealed in children aged 6–12 months, while the proportion of Faecalibacterium prausnitzii was higher (p = 0.049) in children of the second year of life. Children of the second year of life showed lower degree of sensitization to cow’s milk proteins, while sensitization level to chicken egg proteins remained unchanged.

Conclusion. Children of the second year of life with food allergy have higher abundance of commensal microbes was observed in the absence of pathobionts. This result suggests the compensatory tolerance development in children with food allergy early in childhood.

Background. Early postoperative adverse events in children remain a significant clinical problem, their prognosis via multifactorial scales has several limitations (complexity, subjective assessment, insufficient accuracy). Thus, the search for accurate and non-invasive methods for assessing risk of postoperative events remains relevant.

Objective. The aim of the study is to examine the prognostic value of breath-holding test (BHT) duration after deep inhalation in assessing the risk of adverse events after elective abdominal surgery in children.

Methods. The single-center prospective cohort study included children aged 5–10 years with ASA I–II physical status and planned abdominal surgery. All participants were measured BHT duration (in seconds) three times after deep inhalation with calculating the mean value (at the preoperative stage — the day before anesthesia). Any adverse postoperative events were recorded during the first 6 hours after surgery: pain, postoperative nausea and vomiting, shivering, and agitation. The predictive BHT efficacy was analyzed via multivariate logistic regression and k-fold cross-validation.

Results. The study included 160 children. Adverse postoperative events were reported in 36 (22.5%) cases. BHT duration after deep inhalation was the only statistically significant predictor of adverse events in the multivariate logistic regression model: AUC — 0.833 (95% confidence interval (CI) 0.781–0.894), odds ratio — 0.82 (95% CI 0.77–0.88). BHT duration did not change significantly during cross-validation of predictive performance metrics. The optimal value for the development of adverse postoperative events prognosis was BHT duration  28 seconds. The frequency of adverse postoperative events in children with high postoperative risk (BHT  28 seconds) was more than twice as much as in children with BHT > 28 seconds (16.3 and 6.2%, respectively; p < 0.001).

Conclusion. BHT test after deep inhalation is a simple and non-invasive method to stratify risk while planning abdominal surgery in children. The BHT duration  28 seconds is the independent predictor of adverse events after such surgeries.

Background. Neuromuscular scoliosis (NMS) is the most challenging form of the disease to correct. Unlike idiopathic scoliosis (IS), in NMS, skeletal deformity is accompanied by primary weakness of the intercostal muscles and diaphragm, impaired cough clearance, and a tendency toward hypoventilation. The outcomes of surgical correction of IS and NMS in age- and deformity severity-matched patient groups have not been previously studied.

Objective. The aim of the study is to compare changes in volumetric and density characteristics of lung tissue in adolescents with IS and NMS after surgical correction.

Methods. This study included data from patients aged 13–17 years with IS and NMS who underwent posterior spinal instrumentation due to thoracic/thoracolumbar scoliosis >40° between 2021 and 2024. The primary endpoint was the change in total lung volume (mL). Secondary endpoint included changes in right and left lung volumes (mL), as well as the proportion of density-defined lung parenchymal zones (% of normoventilated, hypoventilated, and atelectatic zones). Lung volume and pulmonary ventilation were assessed via CT volumetry before (no earlier than 2 months prior) and after surgery (no earlier than 2 weeks and no later than 3 months after the procedure).

Results. The outcomes of surgical correction of spinal deformity were studied in 30 patients with IS and 32 patients with NMS matched in gender, age, and degree of spinal deformity (Cobb angle). Baseline total lung volume in the NMS group was lower than in the IS group, with median values of 1084 (639; 1547) and 2041 (1580; 2509) mL, respectively (p < 0.001). After surgery, patients with NMS showed an increase in total lung volume of 110 mL (95% confidence interval [CI] 28 to 192, p = 0.002), whereas the IS group showed a decrease of 266 mL (95% CI –490 to –42; p = 0.012). At the same time, the proportion of normoventilated lung zones increased (right lung by 16.5%, left lung by 15.6%; p < 0.001) in patients with NMS, while the proportion of hypoventilated zones decreased (right lung by 15.0%, left lung by 9.3%; p < 0.001), as did the proportion of atelectatic zones (right lung by 4.8%, left lung by 6.9%; p<0.001). In the IS group, no significant changes in the distribution of lung density zones were observed, except for a decrease in the proportion of left-sided atelectasis from 5.1% to 2.3% (p = 0.044).

Conclusion. Surgical correction of scoliosis leads to different dynamics of lung volumetric and density characteristics in adolescents with NMS and IS. There is an increase in total lung volume, an increase in the proportion normoventilated zones, and a decrease in hypoventilated and atelectatic zones in NMS group, while in IS group there is a decrease in total lung volume and atelectatic zones without changes in other pulmonary ventilation parameters. The main limitations of the study are its retrospective design and the analysis of lung volumetric and density characteristics dynamics in early postoperative period.

Netakimab is a humanized anti-interleukin-17A monoclonal antibody, it has marketing approval for treatment of adult patients with moderate-tosevere plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis. This paper provides the results of the first 12-week period of phase III BCD-085-16/PLANETA-KIDS clinical study.

Objective. The aim of the BCD-085-16/PLANETA-KIDS is to evaluate netakimab efficacy and safety in pediatric patients 6+ years old with moderate-to-severe plaque psoriasis.

Methods. BCD-085-16/PLANETA-KIDS (NCT06640517) is a randomized, double-blind, placebo-controlled phase III clinical study with open-label active-comparator arm (adalimumab). A total of 155 male and female patients aged from 6 to 18 years with confirmed moderate-to-severe plaque psoriasis were randomized to receive netakimab (n = 83), placebo (n = 35), or adalimumab (n = 37). Netakimab dosage was weight adjusted: for patients weighing 50 kg or more netakimab dose was 120 mg (two injections of 60 mg/ml each), for patients weighing less than 50 kg netakimab dose was 60 mg (one injection of 60 mg/ml). Patients in the Netakimab group received netakimab subcutaneously once per week for the first three weeks (induction) and once every 4 weeks thereafter (maintenance). Patients in the Placebo group received placebo in blinded manner like netakimab. Adalimumab was administered in open-label way in doses recommended by the product’s SmPC. In this study co-primary efficacy endpoints were the proportion of patients achieving PASI75 and sPGA0/1 at week 12.

Results. Netakimab has shown superiority over placebo for both co-primary endpoints. The proportion of patients achieving PASI75 at week 12 was 89.2% in the Netakimab group and 14.3% in the Placebo group, odds ratio (OR) 59.0, 95% CI [16.5; 211.5] (p < 0.0001). The proportion of patients achieving sPGA0/1 at week 12 was 83.1% in the Netakimab group and 8.6% in the Placebo group, OR 54.9, 95% CI [14.6; 206.5] (p < 0.0001). The subgroup analysis has shown consistent netakimab superiority over placebo for both co-primary endpoints, regardless of age, body weight and psoriasis severity. Throughout the 12-week period netakimab has shown favorable safety profile comparable to that in the Placebo group.

Conclusion. The results of the 12-week period in the BCD-085-16/PLANETA-KIDS study have shown high efficacy of netakimab compared with placebo with favorable safety profile in children aged 6 years and older and adolescents with moderate-to-severe plaque psoriasis.

Background. Congenital bladder diverticulosis is a rare urological abnormality (about 70 cases described). Other comorbid birth defects of neighboring organs and systems allows to diagnosis bladder diverticulum in early childhood. However, this disease remains unrecognized in many children until the development of urinary tract infection, incontinence, or acute urinary retention.

Case description. A child, 1 year 9 months old, was diagnosed with large congenital (primary) Hutch diverticulum. The first diverticulum manifestation was acute urinary retention within 24 hours and anxiety. Moreover, the child had no comorbid malformations of organs and systems. There was no duplication of lower segments of gastrointestinal tract, reproductive system organs, or other urinary tract defects (renal dystopia, dysplasia). There were no signs of vesicoureteral reflux and no fistulas between gastrointestinal and urogenital systems. Video-assisted resection of double bladder segment was performed with favorable outcome.

Conclusion. The latent disease course diagnosed after complication development (acute urinary retention) is described. Video-assisted diverticulum resection is an effective and safe treatment method even after delayed diagnosis of this congenital anomaly.

Background. Transitory ischemic attacks (TIA) remain a significant public health problem in the pediatric population. The difficulties of diagnostics of TIA in children and the high risk of recurrence (up to 40%) are due to the lack of standards for the patients management, as well as the similarity of the clinical manifestations of TIA with other paroxysmal states (migraine with aura, for example).

Case description. A 14-year-old girl was admitted to the hospital in the home area, complaints: headaches, blurred vision (a “light line” in the left F.V.), numb feeling of the left hand, lasts up to 2.5 hours. Diagnosis: migraine with aura. At the checkup the carrier state of variants of six genes (FGB, F13, ITGA2, PAI-1, MTR, MTRR) associated with thrombophilia was revealed, as well as hypoplasia of the right vertebral artery, Kimmerle anomaly with extravasal compression, atrial septal defect, and bradycardia. Recurrent TIAs were diagnosed in the vertebrobasilar territory. Acidum acetylsalicylicum (75 mg/day) was prescribed as per the off-label, with complete relief of TIA episodes for 2 years. Withdrawal of the drug provoked a recurrence of TIA. The resumption of Antiplatelet therapy ensured the onset of remission.

Conclusion. Diagnostics of TIA in children is a complex clinical case which requires to exclude a wide range of diseases (migraine with aura, epilepsy, demyelinating diseases). To diagnose the TIA promptly doctors need to remain alert to cerebrovascular pathology, they also need an interdisciplinary step-by-step approach, and analyze the risk factors (thrombophilic gene variants, vascular anomalies, and cardiac pathology). When prescribing antiplatelet therapy to children with TIA doctors conduct the laboratory efficacy monitoring (ASPI test), when discontinuing the therapy doctors assess the risk/benefit ratio due to high risk of relapse.

Mucopolysaccharidosis type II (MPS II, Hunter syndrome) is a progressive lysosomal storage disease with X-linked recessive inheritance. This disease is caused by pathogenic or probably pathogenic variants in the IDS gene encoding iduronate 2-sulfatase. This enzyme insufficiency leads to glycosaminoglycans accumulation in cells of various organs and tissues, which underlies the multisystem lesion. There is neuropathic form of MPS II with progressive central nervous system (CNS) damage and behavioral disorders, and milder form without any intellectual disorders. There are methods of effective pathogenetic therapy for this disease, however, they do not affect CNS manifestations. Thus, there is topical issue in management of neuropathic MPS II forms on transporting enzyme-replacement medications through the blood-brain barrier (BBB). Development of pabinafusp alfa (JR-141), innovative drug penetrating the BBB via transcytosis mediated by the transferrin receptor, became one of the approaches to solve this problem. This publication provides the literature review on the pabinafusp alfa administration for management of neuropathic MPS II forms focusing its efficacy and safety.