АКТУАЛЬНОСТЬ: Неинвазивная респираторная поддержка является неотъемлемым компонентом терапии дыхательной недостаточности у новорожденных. Метод nCPAP (nasal continuous positive airway pressure) рекомендуется в качестве стартового для респираторной поддержки недоношенных. Единого мнения относительно критериев проведения nCPAP новорожденным во время межгоспитальной транспортировки в литературе нет, а рекомендации носят эмпирический характер. ЦЕЛЬ ИССЛЕДОВАНИЯ: Изучить возможность проведения nCPAP на этапе предтранспортной подготовки и межгоспитальной транспортировки новорожденных. МАТЕРИАЛЫ И МЕТОДЫ: В когортное ретроспективное исследование включены данные 70 случаев эвакуации новорожденных, выполненных транспортной бригадой реанимационно-консультативного центра Областной детской клинической больницы Екатеринбурга в период с 1 июля 2014 г. по 31 декабря 2018 г. пациентам, находившимся на неинвазивной вентиляции (nCPAP) на момент осмотра реаниматолога транспортной бригады в исходной медицинской организации. Исходная выборка разделена на группу пациентов, транспортированных на вентиляции (n = 22), и группу пациентов, транспортированных на nCPAP (n = 47), одному пациенту прекращено проведение респираторной поддержки. РЕЗУЛЬТАТЫ: При анализе параметров респираторной поддержки на момент осмотра реаниматологом транспортной бригады наблюдали различия между группами по фракции кислорода во вдыхаемой смеси (34 [30–45] % и 30 [21–30] %, группа 1 и группа 2 соответственно, р = 0,002) и сатурационному индексу оксигенации (2,1 [1,6–2,6] и 1,53 [1,1–1,8], группа 1 и группа 2 соответственно, р = 0,001). Сатурационный индекс оксигенации обладает приемлемой предиктивной ценностью в отношении интубации трахеи на этапе предтранспортной подготовки (AUC 0,799 [0,682–0,917]). Во время транспортировки одному пациенту группы 2 потребовалось выполнить интубацию трахеи (2,1 [0,1–11,3]). При поступлении одному пациенту группы 2 потребовалось выполнить интубацию трахеи (2,2 [0,1–11,5] %), другая коррекция параметров неинвазивной поддержки пациентам группы 2 не потребовалась. ВЫВОДЫ: Основным критерием перевода на искусственную вентиляцию легких (ИВЛ) на этапе предтранспортной подготовки является зависимость от дополнительного кислорода при проведении nCPAP. Сатурационный индекс оксигенации (AUC 0,799 [0,682–0,917]) и отношение SpO2/FiO2 (AUC 0,803 [0,687–0,919]) обладают приемлемой предиктивной ценностью в отношении потребности в интубации трахеи. Вероятность перевода на ИВЛ во время транспортировки составляет 2,1 (0,1–11,3) %.

Introduction. The problem of lung diseases in patients with primary defects in antibody production has not been sufficiently studied, especially depending on the climatic, geographical and demographic conditions of real clinical practice.Aim. To study the structure of lung disorders in adult patients with primary antibodies defects in the Middle Urals in real clinical practice.Materials and methods. Register of adult patients with primary immunodeficiencies (PID) were created in 2013 in the Sverdlovsk region. Now it contains 209 people. The main group of the register is patients with primary antibodies defects (PAD, n = 143, 68.4%: agammaglobulinemia (AGG, n = 11, common variable immune deficiency (CVID, n = 37), PIK3-Kinase deficiency (n = 3), Selective IgA deficiency (SD IgA, n = 92). The diagnosis of PID was established on the criteria for the Russian Association of Allergists and Clinical Immunologists and European Societies of Immunodeficencies, in some cases it has a genetic confirmation. We used medical history of patients, radiological, functional studies to establish lung lesions. We occurred immunological examination for all PID patients.Results. Repeated pneumonia were observed in all patients with AGG and CVID, especially in the onset of PID. Patients also had diseases such as bronchiectasis (up to 37.6% of patients), chronic obstructive lung disease (up to 70.3% of patients), bronchial asthma (only SD IgA), interstitial lung disease (only CVID).Conclusion. According to our data, in the Middle Urals, lung diseases, especially pneumonia and bronchiectasis, are the most common clinical manifestations in patients with DA. Analysis of immunoglobulins' level is necessary in patients with repeated pneumonia, bronchiectasis and interstitial lung disease, bronchial asthma and early onset of chronic obstructive lung disease without smoking status.

Medical consortia help solve current healthcare problems. Four scientific medical institutions (GBUZ of the Moscow region “Research Institute of Childhood of the Ministry of Health of the Moscow Region”, Scientific Research Clinical Institute of Pediatrics and Pediatric Surgery named after Academician Yu. E. Veltishchev Federal State Autonomous Educational Institution of Higher Education “Russian National Research Medical University named after N. I. Pirogov” of the Ministry of Health Russia, the Federal State Budgetary Institution “Medical Genetic Research Center named after Academician N. P. Bochkov”, the Federal Budgetary Institution “Moscow Research Institute of Epidemiology and Microbiology named after G. N. Gabrichevsky” of Rospotrebnadzor) and one higher educational institution (the Federal State Budgetary Educational Institution of Higher Education “Ural State Medical University” of the Ministry of Health of the Russian Federation) united into the 5P “Children’s Medicine” consortium to solve pressing problems of children’s healthcare in accordance with the basic principles of personalized medicine. Organizing large congresses with international participation dedicated to the problems of children’s healthcare is an opportunity for doctors in the Russian Federation and other countries to share knowledge and best practices on saving a child’s life and treating diseases from an early age of the patient through direct communication. A systematic approach can be considered the most effective for solving problems in all areas, including children’s healthcare, and the 5 P “Children’s Medicine” congress helps doctors go beyond the boundaries of the familiar and familiar, learn new things, and get ideas for further professional growth.

Introduction . One of the main predictors of aging is sleep disturbance, the study of the role of which in the development of the accelerated aging process is recognized as an urgent problem for the medical community. The aim of the work is to analyze modern data on age-related aspects of sleep status and describe known markers of early aging associated with somnological disorders. Materials and methods . The search and selection of literary sources was carried out in the databases PubMed, eLibrary, CyberLeninka, Google Scholar. Search depth — 17 years, from 2007 to 2024. The total number of publications included in the review was 80. Results and discussion. Aging refers to a general pathological process that affects all human physiological systems. Differences between the terms biological and chronobiological age are established. The role of somnological disorders in the accelerated aging process has been determined. It has been established that as age increases, changes in the electrophysiological pattern of sleep are observed. It was found that changes in biological markers of aging are positively correlated with sleep disturbance. The importance of neuroimaging methods in determining the accelerated rate of aging in people with sleep disorders is shown. Conclusion . Sleep disturbance is defined as a significant indicator of accelerated aging of the body. Further research into changes in the structure and quality of sleep may change the understanding of the pathogenetic mechanisms of aging and contribute to the development of new diagnostic and therapeutic strategies in the field of anti-aging medicine.

Introduction. The “spot” effect of immunobiological drugs necessitates patients' selection based on pathogenetic mechanisms of the disease to ensure therapy effectiveness.Aim. To determine characteristics of T2-asthma main phenotypes and develop an algorithm for selecting a first- and second-line biologics.Materials and methods. Being retrospective and prospective in nature the research was directed at adult patients with severe asthma who received target therapy and were included in the registry of Sverdlovsk region. Cluster analysis made it possible to identify the most distinctive features of allergic, nonallergic eosinophilic and mixed SA. Pathogenetic mechanisms of T2 inflammation determined the choice of first-and-second-line biologics.Results. Allergic phenotype is characterized by existence of allergy and first appearance of asthma before the age of 18, satellite allergic rhinitis and the Phadiatop test result ≥ 1,53 PAU/L. The features of non-allergic eosinophilic asthma are as follows: asthma first appearance at the age of 32 and older, eosinophilia ≥ 150 cells/gl, absence of allergy, satellite chronic rhinosinusitis polyposa (CRSP) and NSAIDs intolerance. The features of the mixed asthma are as follows: first appearance at the age of ≥ 18 and < 32 years old, allergy in combination with eosinophilia ≥ 300 cells/gl, AR and a positive Phadiatop allergy test result, CRSP and NSAIDs intolerance. It is the allergic phenotype of SA when preference should be given to anti-IgE drug. Dealing with non-allergic phenotype of SA one should consider anti-IL5 biologics more preferable. Taking into consideration Th2 and ILC2 ways in action mechanism it is possible to affirm that anti-IL4R therapy is effective in mixed asthma.Conclusions. In real clinical practice the initial phenotyping of SA facilitates the correct choice of a first- and second-line targeted drug.

Aim. To evaluate the efficacy and safety of riamilovir in the treatment of COVID-19 in adults. Materials and methods. The study included 180 patients with a laboratory-confirmed diagnosis of COVID-19 which fully meet the criteria for inclusion, non-inclusion and exclusion, signed a voluntary informed consent to participate in a clinical trial. Results. The efficacy, good tolerability and safety of the drug riamilovir in the treatment of COVID-19 have been established. Conclusion. As a result of a multicenter randomized double-blind clinical trial, the effectiveness of the drug riamilovir for therapeutic use in patients with COVID-19 according to the 1250 mg/day scheme (250 mg capsules 5 times per day) for 10 days was established. The drug riamilovir in a daily dose of 1250 mg for 10 days does not differ in safety from placebo.

Objective. To develop criteria for prognosis of the outcome of ischemic stroke, taking into account age, dynamics of state assessment, the Rankin and NIHSS scales readings and the fact of disability in the long-term period. The universal reliable criteria, that allow to predict the outcome of ischemic stroke, have not been developed yet. Material and methods. The study group consisted of 246 patients with ischemic stroke aged 18 to 44 who were observed from 2008 to 2021. Results. It is impossible to predict disability in a long-term period of ischemic stroke reliably. Predicting the outcome of ischemic stroke using the Rankin and NIHSS scales is significant in the acute period and allows to predict the dynamics of recovery in mild and moderate cases. Conclusion. The predictive value of the integrative indicators of the patient's condition, assessed by the Rankin and NIHSS scales, has been established.

Introduction . Severe asthma targeted therapy effectiveness depends on precise targeting of the selected drug to the key link in pathogenesis. Therefore, severe asthma phenotyping in real clinical practice is relevant. Aim . To determine main clinical and allergological characteristics of patients with severe asthma and to establish important phenotyping signs determined choice of a targeted drug for severe asthma treatment. Materials and methods . The prospective and retrospective study involved patients (n = 198) of the Sverdlovsk region registry receiving targeted therapy of severe asthma. Considering clinical and allergological picture, allergic, non-allergic eosinophilic and mixed severe asthma phenotypes were identified. Clinical and laboratory characteristics of phenotypes were described. A phenotyping algorithm was developed. Results . In the register of patients (n = 198) with severe asthma, non-allergic eosinophilic asthma was 46.5%, allergic – 34.8%, mixed – 18.7%. Significant signs for phenotyping were identified: age of asthma onset, proven allergy, Phadiatop ImmunoCAP level and blood eosinophils on baseline, concomitant allergic rhinitis, chronic rhinosinusitis with nasal polyps and hyper-sensitivity to NSAIDs. The main signs of allergic severe asthma determined: early onset, proven allergy and a positive result of Phadiatop ImmunoCAP (the probability of allergic phenotype increases with Phadiatop ≥ 1.53 PAU/l). Signs of non-allergic eosinophilic asthma were eosinophilia ≥ 150 cells/µl, absence of allergy, concomitant chronic rhinosinusitis with nasal polyps and hypersensitivity to NSAIDs, late onset (after 30 years). Signs were identified for mixed asthma: presence of proven allergy or latent sensitization in combination with high level of Phadiatop ImmunoCAP, late onset, eosinophilia ≥ 300 cells/µl, chronic rhinosinusitis with nasal polyps, hypersensitivity NSAIDs. Conclusions . The algorithm for severe asthma phenotyping based on the isolation of eosinophilia of allergic and non-allergic origin is proposed. Severe asthma phenotyping, which can be carried out in real clinical practice, should facilitate the selection of an initial targeted drug.

The work conducted a study of the phenotype of the gum after dental implantation surgery using testiqular albuginea allografts in comparison with dental implantation with apical displacement of the split mucous flap without the use of transimplants. The growth of keratized gum was assessed immediately after surgery and 6 months after surgical treatment. Morphological studies of biopsy tissue samples from the implant projection zone were conducted. The results of microscopic studies and photographing of samples are presented. Based on the obtained results, it was concluded that testicular albuginea allografts are completely replaced by a structurally complete connective tissue regenerate, but at the transplantation site, a phenotype of “thin” gum (thickness 1 mm or less) is formed, which, most likely, will not be able to provide adequate protection of the underlying tissues, which will contribute to plaque retention and subsequent inflammation.

Diabetes mellitus (DM) is a serious medical and social problem of our time due to its high prevalence, lethality, early onset of disability and increasing morbidity. In children and adolescents, type 1 diabetes (DM1), characterized by absolute insulin deficiency due to autoimmune or idiopathic lesions of pancreatic β-cells, is registered more often. Every year, the total number of patients with DM1 under 18 years of age in the Russian Federation increases by several tens of thousands of people. DM is accompanied by various complications and one of the most frequent is diabetic polyneuropathy (DP), which occurs in half of children with DM1 more than 3 years. The progressive course of DP leads to the development of serious consequences affecting the quality of life and prognosis of patients. At the same time, at present, many aspects of this complication are insufficiently studied or have contradictory data, which justifies the expediency of systematization of materials on the pathogenesis of DP, effective methods of diagnostics and treatment of the disease in childhood.The aim of the work was to analyze modern scientific publications devoted to the study of DP in children, based on the search of literature sources in PubMed, CyberLeninka and RINC databases. A total of 58 bibliographic publications were reviewed, including contemporary resources from the period 2019–2023.

Introduction . There is insufficiency of direct comparative studies of genetically engineered biological drugs (GEBD) for severe bronchial asthma (SA) treatment in scientific databases. Aim . To compare omalizumab and dupilumab effectiveness in patients with allergic and mixed SA in real clinical practice. Materials and methods . The direct comparative study included SA patients with an allergic component from regional registry of Sverdlovsk region. The data of patients with allergic (n = 68) and mixed (n = 27) SA treated with omalizumab (n = 62) and dupilumab (n = 33) were analyzed. Therapy effectiveness was determined for 12 months in general group No. 1, allergic asthma group No. 2 and mixed asthma group No. 3 according to the following indicators: asthma control level (ACT), proportion of patients with uncontrolled asthma, need for systemic glucocorticosteroids (SGCS) and short‐acting beta agonists (SABA), basic therapy volume, asthma exacerbations number, emergency calls and hospitalizations, forced expiratory volume in the first second (FEV ), assessment of life quality (AQLQ and SNOT-22). Control evaluation visits were conducted before therapy start, after 4 and 12 months of biologics taking. Results . In general, during the 12 months of targeted therapy in patients receiving omalizumab statistically significant positive dynamics was observed in 12 of the 13 evaluated indicators; in patients receiving dupilumab – in 9 indicators. When analyzing such indicators as, ACT, taking SGCS, exacerbations of SA, FEV , statistically significant positive dynamics was revealed for all 4 indicators in patients receiving omalizumab in group No. 2 and in patients receiving dupilumab in group No. 3. Conclusions . Patients with allergic component of SA respond equally well to therapy with omalizumab and dupilumab. At the same time, a tendency towards the advantage of omalizumab in patients with allergic asthma, and dupilumab in patients with a mixed phenotype of the disease was revealed.

Introduction. There is insufficient data on effectiveness and safety of targeted drugs aimed at T2 inflammation in real-life practice.Aim. To evaluate benralizumab effectiveness in patients with T2-inflammatory airway diseases in real-life clinical practice and to identify predictors of a positive response to therapy.Materials and methods. Patients' data from Sverdlovsk region registry with non-allergic eosinophilic (n = 32) and mixed (n = 6) severe asthma received benralizumab were analyzed. Reduction in proportion of patients requiring systemic GCS and proportion of patients with a good response to therapy according to BARS were the main endpoints. Dynamics in ACT score, basic therapy, asthma exacerbations frequency, emergency calls and hospitalizations, FEV1 and eosinophil blood count, scores in AQLQ, SNOT-22 and VAS were also evaluated. Control visits were conducted at baseline, after 4 and 12 months of benralizumab administration. Analysis of good response predictors to benralizumab was performed.Results. Over 12 months of benralizumab therapy, the proportion of patients requiring systemic GCS decreased by 81.8%. According to BARS, a good response to therapy was demonstrated by 69.6% of patients (n = 16), satisfactory - 21.7% (n = 5), and insufficient - 8.7% (n = 2). Significant positive dynamics were observed in asthma control level, therapy volume (doses of inhaled GCS, intake of LABA, SABA), frequency of asthma exacerbations and hospitalizations, FEV1 and eosinophil blood count, AQLQ, SNOT-22 and VAS questionnaires. Patients with insufficient response to benralizumab had high initial blood eosinophilia.Conclusions. In real clinical practice, benralizumab improves asthma control, reduces frequency of asthma exacerbations even in discontinuation of SGCS and reduction of basic therapy, improves lung function, quality of life, and reduces nasal symptoms in patients with concomitant inflammatory nasal diseases. A possible predictor of insufficient response to benralizumab was high initial eosinophilia (>2330 cells/μl).

INTRODUCTION: Noninvasive respiratory support is a crucial component of neonatal respiratory disorders therapy. The nCPAP (nasal continuous positive airway pressure) is recommended for respiratory support of a premature. There is no consensus on criteria for non-invasive respiratory support for newborns during transfer, the recommendations are empirical. OBJECTIVE: To study the possibility of using nCPAP during pre-transport preparation and transfer of newborns. MATERIALS AND METHODS: The cohort, retrospective study included data on 70 cases of newborns evacuation performed by the transport team (July 1, 2014 — December 31, 2018) to patients who were on nCPAP at the time of the transport team examination in the initial institution. The initial sample was divided into a group of patients transported on ventilation (n = 22) and a group of patients transported on nCPAP (n = 47), respiratory support was discontinued in one case. RESULTS: Statistically significant differences were observed between the FiO2 (34 [30–45] % and 30 [21–30] %, the first and second groups, respectively, p = 0.002) and the saturation index of oxygenation (2.1 [1.6–2.6] and 1.53 [1.3–1.8]) the first and second groups, respectively, p = 0.001). The saturation index of oxygenation has an acceptable predictive value for tracheal intubation during pre-transport preparation (AUC 0.799 [0.682–0.917]). During transfer, one patient of the second group required tracheal intubation (2.1 [0.1–11.3] %). Upon admission, one patient of the second was intubated (2.2 [0.1–11.5] %), no other correction of the parameters of noninvasive support was required for patients of the second group. CONCLUSIONS: The main criterion for intubation at the stage of pre-transport preparation is oxygen requirement during the nCPAP. The saturation oxygenation index (AUC 0.799 [0.682–0.917]) and the SpO2/FiO2 ratio (AUC 0.803 [0.687–0.919]) have an acceptable predictive value for tracheal intubation. The probability of intubation during transportation is 2.1 (0.1–11.3) %.

Objective. To assess the orientation of changes in the coagulation system in children in the acute and long-term periods after COVID-19 infection. Materials and methods. The results of the examination of children aged from 1 to 18 with confirmed COVID-19 infection were included in a cohort retrospective study conducted in order to assess the orientation of changes in the coagulation system in children in the acute and long-term period after COVID-19 infection. The set of examinations included indicators for assessing vascular-platelet (platelet count, platelet aggregation) and plasma-coagulation (INR, APTT, thrombin time, fibrinogen level, antithrombin III, SFMC, euglobulin lysis, D-dimer level) links of hemostasis. 130 children comprising the main observation group and 113 children of the control group (healthy children) were examined. Results. It was determined that the acute period of a new coronavirus infection in children is characterized by changes in the hemostasis system, and disturbances affect all links - vascular platelet, plasma coagulation and fibrinolysis system, not depending on the severity of the infection. The changes persist within 4–4.5 months after the infection. Conclusion. Younger children (1–5 years old) are the most alert. Both in the debut of COVID-19 and in the postcovid period, the maximum number of abnormalities was revealed in these patients and the largest number of children had these changes. The most favorable state of the blood coagulation system is determined in the older age group (children 11–18 years old). Despite the fact that the onset of the disease in children is accompanied by significant changes in hemostasis indicators, which is typical for COVID-19, in the post-ovarian period, almost all indicators reached their optimal values. The data obtained confirm the opinion that one of the complications of COVID-19 is the development of coagulopathy, which in turn can lead to thrombosis in large and small vessels, and inhibition of fibrinolysis (hypofibrinolysis) can be a predictor of thromboembolic complications. Children who have suffered a new coronavirus infection form a risk group for the development of the above-mentioned complications and require more attention, possibly follow-up for a long period after the disease.

Introduction. Respiratory support remains the most common procedure performed by neonatal transport team specialists. Non-invasive ventilation is a very common method of respiratory support for newborns, reducing the incidence of chronic lung disease. However, the safety and efficacy of this type of support during transportation remain controversial. The aim of the work is to determine the current state of the problem of non-invasive respiratory support in newborns in the initial medical organization, at the stage of pre-transport preparation and during transportation. Materials and methods. Literature sources were searched and selected in PubMed and eLibrary. The following queries were used for the search: nasal continuous positive airway pressure, non invasive ventilation, neonate, newborn, patient transportation, transport, transfer. Types of studies considered: retrospective observational studies, prospective studies (randomized, quasi-randomized, non-randomized), systematic reviews, meta-analyses, clinical protocols. Depth of search − 20 years. The total number of publications included in the review was 61, including 29 studies directly related to the use of noninvasive ventilation in interhospital neonatal transport. Results and discussion. Non-invasive respiratory support is one of the priority and actively used methods of therapy of respiratory disorders of various genesis in neonatology. Nasal CPAP is used both independently and in conjunction with various methods of surfactant administration, reducing the risk of a combined outcome “death or chronic lung disease”. It is recommended both as a method of starting respiratory support and as an intermediate option to increase the probability of successful extubation. There is limited experience with non-invasive respiratory support during interhospital transport of neonates. The available studies suggest that when patients are selected rationally and reasonable criteria are applied to administer nCPAP en route, this method of respiratory support is safe, effective, maintains the benefits of spontaneous breathing, and reduces the duration of intensive care. The small number and poor design quality of studies in this direction do not allow at this stage to form evidence-based recommendations. Conclusion. Medical evacuation of newborns from 1−2 level institutions to level 3 organization with nCPAP is safe and has a number of potential benefits. Existing recommendations are empirical, and there are exceptionally few studies evaluating the validity of such recommendations.

Introduction. Vincristine-induced peripheral neuropathies (VIPN) is a current problem in the management of pediatric acute lymphoblastic leukemia (ALL). There are no effective therapeutic strategies for VIPN. The aim of the study to present the results of evaluation of neurometabolic therapy in the acute period of VIPN in children with ALL and the method of virtual rehabilitation in the recovery period. Materials and methods. The single-center prospective comparative pilot study involved 69 children with VIPN who were treated in the acute period with the following drugs: group 1 - pyridoxine, group 2 - thioktovic acid, group 3 - inosine + nicotinamide + riboflavin + succinic acid. Clinical and electrophysiological parameters before and after drug treatment were analyzed. Among 10 children with motor deficits in the lower extremities in the recovery period of VIPN, rehabilitation with immersive virtual reality was performed, and the clinical parameters before and after the course were compared. Results. A positive effect of the studied drugs on the clinical condition of patients by the 30th day of therapy was revealed. In groups 1 and 3 the total score on the NIS-LL scale correlated with mild polyneuropathy - 4 [2÷8] and 2 [2÷6] points, respectively. Neurologic impairment in each of these groups persisted for 19 [14÷25] and 19 [13÷30] days, which was less in contrast to the duration of symptoms in group 2 (p1-2 = 0.021 and p2-3 = 0.046). In the VIPN recovery period before and after virtual rehabilitation: muscle strength in the lower limbs increased (p = 0.025); the severity of polyneuropathy decreased according to the NIS-LL scale (p = 0.003); balance improved according to the Berg scale (p = 0.017); and patients’ mobility increased according to the Functional Walking Category test (p = 0.025) and walking speed according to the time-recorded walking test (p = 0.008). Discussion. Improvement of clinical parameters with neurometabolic therapy and virtual rehabilitation in children with VIPN has been shown. Conclusion. Preliminary results of the effectiveness of pyridoxine and inosine + nicotinamide + riboflavin + succinic acid in the acute period of VIPN in children with ALL and the method of virtual rehabilitation in the recovery period were obtained.

Objective. To analyze the content of interleukins, chemokines in plasma and liquor of children with acute lymphoblastic leukemia depending on the development of vincristine polyneuropathy. Materials and methods. A single-center prospective cohort non-randomized study was conducted involving 131 children aged 3 to 17 years with acute lymphoblastic leukemia who received chemotherapy according to the protocol. The content of interleukins and chemokines in blood plasma and liquor was assessed with the subsequent comparative analysis of the indicators in two groups depending on the development of vincristine polyneuropathy. The level of the studied parameters was determined before the administration of chemotherapy and on the 36th day of treatment using multiparametric immunofluorescence analysis. Results. In the studied cohort of patients vincristine polyneuropathy was registered in 80.9 % (n = 106) of patients. In the majority of cases – 84.9 % (n = 90) neurotoxic complication developed during the induction stage of chemotherapy. In the clinical picture there dominated sensory and motor disorders in 70.7 % (n = 75) of patients. The data of electrophysiologic study testified to motor axonal polyneuropathy with peroneal nerves lesion. When comparing the primary level of interleukins with their concentration after completion of the induction stage of chemotherapy, it was found that in children without vincristine polyneuropathy there was a statistically significant increase in almost all proinflammatory and anti-inflammatory interleukins. Besides, in this group high and medium direct statistically significant correlations between these cytokines were established. Especially close correlations were noted between pro-inflammatory IL-1, IL-17 and anti-inflammatory interleukins (IL-10, IL-13, IL-22 and IL-27). Additionally, in patients with vincristine polyneuropathy, a 3.7-fold increase in CXCL10 (IP-10) and a 1.4-fold increase in CXCL12 (SDF-1α) chemokines (p = 0.005 and p = 0.054, respectively) was detected in the liquor during the completion of the induction phase of chemotherapy. Conclusions. The balanced interleukin response in children with acute lymphoblastic leukemia receiving vincristine probably reflects a link between the immune and nervous systems aimed at preventing peripheral nerve damage. An imbalance of proinflammatory and anti-inflammatory interleukins may contribute to the development of vincristine polyneuropathy. Significant increase in the content of chemokines CXCL10 (IP-10) and CXCL12 (SDF-1α) in the liquor of children with vincristine polyneuropathy gives grounds to consider them as biological markers of vincristine neurotoxicity.

Introduction. Biologics for severe asthma (SA) treatment are widely used in real clinical practice. But there are very few direct comparative studies at the moment. Aim. To compare mepolizumab and dupilumab effectiveness in patients with non-allergic eosinophilic SA in real clinical practice using regional register of Sverdlovsk region. Materials and methods. The data of patients with non-allergic eosinophilic SA treated with dupilumab (n = 23) and mepolizumab (n = 19) were analyzed. Therapy effectiveness was determined according to BARS and patients’ proportion who achieved asthma remission, dynamics of ACT, AQLQ, FEV 1 , blood eosinophils, frequency of short-acting bronchodilators use and systemic glucocorticosteroids (SGCS) demand, frequency of asthma exacerbations and hospitalizations. Results. Within 12 months of targeted therapy a good response to biologics according to BARS in 77.8% of patients on dupilumab and in 82.4% of patients on mepolizumab (p = 1.000) was revealed. Remission of SA (without FEV 1 ) was achieved in 62.5% of patients in dupilumab group and in 68.8% of patients in mepolizumab group (p = 1.000). Remission of SA (with FEV 1 ) was achieved in 43.8% of patients on dupilumab and in 56.2% of patients on mepolizumab (p = 0.724). There were statistically significant improvements for all separately analyzed indicators in each observation group. Statistically significant differences after a year of therapy between groups were recorded in terms of eosinophil levels (p < 0.001) and nasal symptoms assessed using the SNOT-22 questionnaire (p = 0.048) in favour of mepolizumab. Conclusions. Patients with non-allergic eosinophilic SA have good response to both dupilumab and mepolizumab. The drugs equally improve disease control, life quality, reduce the need for relievers and SGCS, show a similar safety level.

Objective. To evaluate clinical and electroneuromyographic characteristics of vincristine polyneuropathy in children with acute lymphoblastic leukemia.Materials and methods. A single-centre prospective cohort study involved 106 children with acute lymphoblastic leukemia, aged 3 to 17 years, with vincristine polyneuropathy; clinical and electroneuromyographic data were analyzed.Results. In the majority of cases, 84.9 % (n = 90) of patients, vincristine polyneuropathy debuted during the induction phase of chemotherapy. The clinical picture was dominated by combined neurological disorders in 67.9 % (n = 72) cases, with sensory and motor disorders dominating. Sensory dysfunction was manifested predominantly by pain in the lower extremities, changes in the motor sphere were characterized by the development of distal paresis of the lower extremities. In 66.0 % (n = 70) of patients, neurological disorders corresponded to the 2nd degree of severity according to the toxicity scale (NCI-STAE). According to the ENMG study, all children had motor axonal neuropathy of the peroneal nerves.Conclusions. The results of the study showed that the clinical picture of vincristine polyneuropathy is accompanied by sensory and motor symptoms. Currently, a complex of clinical and instrumental methods is used to verify the neurotoxic complication. The main objective method of diagnosis is an electroneuromyographic study. However, its capabilities are limited for determining the clinical manifestations associated with sensory disorders.

Introduction. Pre-transport preparation reduces the risks of deterioration when transporting a newborn. Correction of intensive care in the original medical organization may be an indicator of the need for the transport team to travel to the patient. Purpose of the study is to identify predictors of the need for correction of neonatal therapy during pre-transplant preparation. Materials and Methods. Data from all transport team departures of the neonatal intensive care and consultation center between July 1, 2014, and December 31, 2018 (n = 2029) were included in an observational, cohort, retrospective study. Two groups were identified: the first group (n = 502) – patients who underwent correction of intensive care, the second group (n = 1527) – newborns who did not require correction of the ongoing therapy before evacuation. Results. Statistically significant differences in the volume of intensive care administered at baseline medical organization, parameters of respiratory support were observed between patient groups. The oxygenation saturation index demonstrated good predictive properties regarding the need for correction of intensive care with an AUC ROC of 0.696 [0.662–0.730]. Logistic regression revealed the following reliable predictors of the need for therapy correction: Apgar score at 1 and 5 minutes, giving the patient respiratory support, SpO₂/FiO₂ ratio value, catecholamine infusion, and giving therapy in a Level 1 organization. Discussion. The identified predictors indirectly indicate the need for correction of intensive care, which is an argument in favor of an evacuation trip and can be a tool for determining the order of such trips. Conclusion. Predictors of the need to adjust the neonate's therapy include the need for respiratory support (EVI or pCPR), SpO₂/FiO₂ ratio, need for adrenaline or dopamine infusion, Apgar scores at 1 and 5 minutes, and therapy in a Level 1 medical organization.