Ivan Igorevich Afukov

In Russia, viral agents dominate the etiological structure of аcute intestinal infections (AII), with rotavirus and norovirus playing the major role. Vaccination against rotavirus infection (RVI) demonstrates high efficacy (78—94%) in preventing severe forms requiring hospitalization. The introduction of rotavirus vaccination has altered the etiological landscape; however, the clinical features of AII in vaccinated children, including breakthrough infections and coinfections, remain insufficiently studied. Objective : to analyze the course of acute intestinal infections (AII) in unvaccinated and rotavirus-vaccinated children aged 8 months to 3 years. Materials and methods . A prospective observational cohort study was conducted at the G.N. Speransky Children's City Clinical Hospital (Moscow) in 2023—2024. The study included 205 patients hospitalized with AII within the first three days of symptom onset. Two groups were formed: children vaccinated against RVI (n = 93) and unvaccinated children (n = 112). Etiological diagnosis was performed by PCR; rotavirus genotyping was carried out (Sanger sequencing). Statistical analysis included the Mann—Whitney U test, Pearson's chi-squared test, calculation of odds ratios (OR) and 95% confidence intervals (CI). Results. The groups were comparable in sex, age, and time of hospitalization (median — second day of illness). Vaccinated patients had a significantly shorter duration of illness: median 5 days [4;5] versus a longer course in the unvaccinated group (p = 0.033). The frequency of gastroenteritis in the vaccinated group was almost twofold lower — 29.0% (95% CI: 20.4—38.6%) compared to 56.6% (95% CI: 46.7—65.3%) in the comparison group (p = 0.001). Rotavirus was detected significantly less often in vaccinated children: 10/93 (10.8%) versus 41/109 (37.6%) in unvaccinated children (χ² = 17.79; p < 0.0001; OR = 0.200; 95% CI: 0.093—0.428). The detection rate of norovirus did not differ between the groups (30.1% vs 20.2%; p = 0.143). Campylobacter was detected more frequently in vaccinated children: 12/93 (12.9%) versus 4/109 (3.7%) (p = 0.031; OR = 3.89; 95% CI: 1.21—12.51); however, the authors note the possibility of Berkson's bias due to the small number of cases. Among vaccinated children with confirmed rotavirus infection (n = 10), hyperthermia above 39°C was not recorded (0%), whereas in the unvaccinated group (n = 42) this symptom was observed in 31% (95% CI: 16.7—45.0%). The predominant rotavirus genotype in both groups was G3[P8].

BACKGROUND: A current trend in Russian pediatrics is an increase in the number of inpatient palliative care units for children and, accordingly, the number of beds and patients in this population. AIM: To identify the need for various types, forms, and techniques of surgical interventions depending on the pathology that indicates palliative care, clinical manifestations, risks of underlying disease complications, and planned procedures. METHODS: This retrospective observational study included data from 240 children with palliative status who underwent 405 different procedures between 2021 and 2025 at the G.N. Speransky Children's City Clinical Hospital No. 9. Older patients predominated (30.8%); no gender differences were found. The main group consisted of patients with cerebral palsy (40.4%), chronic (recurrent) respiratory failure (22.5%), and brain lesions (21.3%) of various etiologies. The assessment protocol included clinical, imaging, endoscopic, and laboratory methods. RESULTS: The most common procedures were gastrostomy (56.4%), tracheostomy (17.2%), thoracentesis with pleural drainage (10.3%), and fundoplication (9.1%). The number of procedures increased from 33 to 127 annually over the study period. We identified procedures aimed at improving quality of life and care conditions (75.8%), relieving (15.1%), and preventing (9.1%) complications. Elective surgery was performed in 66.9% of patients, while urgent and emergency procedures accounted for 17.5% and 15.6% of cases, respectively. Among early complications, wound suppuration predominated (1.7%); late complications included "bumper" syndrome and gastrostomy anchor failure in 3 (1.3%) patients. No procedure-related deaths occurred. CONCLUSION: Comprehensive palliative care for children was successfully implemented in a multidisciplinary children's hospital, where the surgical component is focused on preventing or alleviating suffering, improving quality of life for the child, family comfort, and working conditions for medical staff. With interdisciplinary agreement among specialists and a constructive approach from the patient's family, surgical interventions effectively and safely improve the quality of life of terminally ill children, alleviate suffering, and improve working conditions for medical staff.

Congenital diaphragmatic hernia (CDH) is a congenital malformation caused by a defect in the diaphragm and herniation of abdominal organs into the chest, requiring emergency surgical repair in the neonatal period. This review summarizes and analyzes data from international and national studies on the use of extracorporeal membrane oxygenation (ECMO) in newborns with CDH. We analyzed 153 publications from the PubMed, Cochrane, Springer, Clinical Key, and RSCI databases published between 2014 and 2025. Search keywords included ECMO, neonates, congenital diaphragmatic hernia, pulmonary hypertension, and mechanical ventilation. Only meta-analyses and randomized trials were included. Fifty articles on postnatal intensive care and ECMO use in infants with CDH were reviewed. Based on recent publications, this review provides an overview of ECMO techniques in newborns with CDH, including indications and contraindications, initial parameters, complications, methods for assessing efficacy, and weaning from ECMO. ECMO is a life-saving strategy that should be considered in children with CDH who do not respond to standard therapies; however, given the high risk of adverse effects and complications, the decision to use ECMO must be made on a case-by-case basis, guided by a personalized approach.

Bladder dysfunction in children, particularly due to spinal cord malformations, requires ongoing and precise monitoring. Video urodynamics remains the "gold standard" in this case, although its invasiveness and use of X-ray contrast drive the search for gentler alternatives. This task is especially critical in pediatrics. This review analyzes how closely existing alternative methods can approach the diagnostic value of classical Video urodynamics. Based on an analysis of a series of clinical studies, it can be stated that certain non-invasive techniques—such as ultrasound assessment of bladder wall thickness, elastography, or a combination of uroflowmetry with electromyography—indeed show diagnostic potential. Some studies have found correlations between their parameters and Video urodynamics findings, allowing them to be considered as tools for primary screening to identify risk groups. However, a key conclusion consistently seen in the literature is that none of these methods can become a full-fledged replacement for invasive urodynamics. They do not provide a direct and accurate assessment of intravesical pressure, do not always detect detrusor-sphincter dyssynergia, and often fail to capture vesicoureteral reflux in real time. The sensitivity and specificity of these methods vary, and their results can be contradictory, preventing them from fundamentally changing treatment strategies. Thus, this review allows the reader to form a comprehensive understanding of the current place of non-invasive technologies in pediatric urodynamics. The main takeaway is this: despite all technological attempts, video urodynamics retains its status as an indispensable method for making an accurate diagnosis in complex cases of lower urinary tract dysfunction. New techniques play an important but auxiliary role, helping to reduce the number of unjustified invasive procedures, but they do not eliminate the need for Video urodynamics where a complete and objective assessment is required. This knowledge is critically important for clinicians determining a management strategy for a child.

Ketamine, an N-methyl-D-aspartate receptor antagonist, developed more than 60 years ago as an anesthetic, has experienced a varied history but remains relevant in modern global medical practice. Over the past several decades, it has revealed new potential extending far beyond anesthesia. There is growing interest in the use of subdissociative doses of ketamine to treat various types of acute and chronic pain and depression. Its efficacy is similar to that of opioids, with a low incidence of transient adverse effects. Ketamine can be administered via multiple routes and is nearing the status of an ideal analgesic for the prehospital setting because of its favorable safety profile. In patients with severe trauma, ketamine is likely the optimal analgesic, as it provides hemodynamic stability without an increase in intracranial pressure. Ketamine is particularly useful in patients with opioid dependence, opioid tolerance, or opioid-induced hyperalgesia. The discovery of its multiple molecular targets and related effects enables the use of this unique agent in many areas of clinical and experimental medicine, including anesthesiology, emergency medicine, intensive care, pain management, psychiatry, research on the neurobiological basis of consciousness, and modeling of pathological mental states. This article presents the history of ketamine development and reviews current understanding of its mechanisms of action, methods, and areas of application.

Новорожденный с тяжелой асфиксией и рабдомиолизом. Опыт лечения с применением различных методов заместительной почечной терапии и гемосорбции

Neonatal sepsis remains a pressing issue for healthcare both in Russia and globally due to its high mortality rate and resistance to treatment. Infection generalization in newborns is facilitated by a deficiency in innate immunity, which is particularly evident in impaired neutrophil function.The aim of this study was to identify phenotypic characteristics of specific neutrophil subsets that could be significant in predicting the development and progression of infection in newborns. Using flow cytometry, we examined CD16 and CD62L expression as well as neutrophil granularity in newborns across three groups: those without infectious complications (n=38), with localized infection (n=32), and with generalized infection (n=21). Neutrophil subsets with high and intermediate levels of CD16 and CD62L expression demonstrated prognostic relevance. Patients with generalized infection exhibited a significant reduction in surface CD16 and granularity in these neutrophil subsets. Cutoff points were calculated, showing that a decrease in these parameters on the first day of illness was significantly associated with extended stays in intensive care units and overall hospitalization duration. The proposed indicators show promise for predicting infectious complications in newborns, facilitating more targeted and proactive care in neonatal practice.

Background. Food allergy is a serious, life-threatening condition that negatively impacts the quality of life of patients and their families, especially among children. In Europe, approximately 7 million people suffer from food allergy, while in Russia, the prevalence varies from 5% to 30%. Accurate diagnosis and treatment of food allergy are crucial to preventing complications and improving quality of life. Primary diagnostic methods include medical history, laboratory tests, and elimination diets, though each has its limitations. Globally, oral food challenges are considered the "gold standard" for food allergy diagnosis. It helps to establish a precise connection between the allergen and the reaction, reducing anxiety for patients and their families. Objective. To evaluate the feasibility of using oral food challenges as a diagnostic method for food allergies in children. Materials and methods. This single-center, prospective, interventional, non-randomized, uncontrolled study is being conducted from January 1, 2022, to December 31, 2024, at the G. N. Speransky Children’s Hospital No. 9 in Moscow. Children aged 6 months to 17 years, suspected of having an immediate allergic reaction to cow's milk protein and/or egg protein by a doctor or legal guardian, were invited to participate. The study involves using an open food challenge for diagnosing food allergies. An open food challenge involves consuming increasing amounts of the suspected allergen (milk, egg, etc.) in its natural form under medical supervision. To determine the necessity of a provocation test, a consultation is conducted, including a physical examination, medical history, and allergy testing (specific IgE blood tests, component diagnostics for milk and egg, and a prick test with the native allergen). Additionally, during the consultation, questionnaires on anxiety and quality of life were completed. Our patient selection and test procedure algorithm is an adapted version of existing protocols from international allergology organizations. Conclusions. Preliminary results indicate that the provocation test is a safe diagnostic method when following a strict patient selection and test procedure algorithm. Notably, parents of children undergoing these tests exhibit high anxiety levels. We plan to continue this study and assess personal and situational anxiety levels over time post oral food challenges.

Video urodynamics is the standard for assessment of the lower urinary tract in children with neurogenic urinary disorders aiming to provide more information about the condition of the lower urinary tract v. retrograde urethrocystography. Video urodynamics parameters are used as possible indicators for choosing various surgical treatment options, however, all work is focused on adult patients, and data for the pediatric cohort were not available as yet. The purpose of this research was the evaluation of the role of video urodynamics and retrograde urethrocystography in the selection of effective conservative and surgical treatment of neurogenic urinary disorders in children. Materials and methods used: 112 patients aged 1,8 to 18 y/o with neurogenic urinary disorders were included in the study, of whom 101 were those who had been proven effectively treated with conservative M-cholinoblockers or had successfully undergone minimally invasive surgery as follows: intradetrusor injection of botulinum toxin (n=21), transurethral correction of VUR (n=17), simultaneous execution of two of these interventions (n=22). Based on the results of video urodynamic and cystographic examination of these patients with the CHAID technique, the classification trees were built in order to evaluate the effective treatment (conservative/surgical). Results: the median age of patients was 9,0 years [7,8-12,0]. The first classification tree containing the parameter “presence of VUR according to the results of retrograde cystography.” The sensitivity of the obtained model for the effectiveness of surgical treatment was 83,3% v. 73,2% for conservative treatment. The accuracy was 79,2%. The ROC-AUC value was 0,783. The second classification tree contained the maximum Pves value according to the results of the video urodynamics, presence of hyperactivity, presence of VUR. The sensitivity of the obtained model for the effectiveness of surgical treatment was 93,3% v. 97,6% for conservative treatment. The accuracy was 95,0%. The ROC-AUC value was 0,972. Comparison of ROC-AUC values by the Delong test revealed statistically significant differences between these binary classification metrics (p<0.001). Conclusion: the parameters of video urodynamics have greater diagnostic accuracy in effective prediction of both conservative and surgical treatment methods compared to the retrograde urethrocystography.

BACKGROUND: Almost a third of patients with neurogenic urinary disorders have a refractory nature to therapy with antimuscarinic agents. The aim of the current trial was to identify predictors of the effectiveness of initial therapy with antimuscarinic agents in children with neurogenic urination disorders. For this, a comprehensive analysis of clinical parameters and video urodynamic findings in children was made. AIM: The purpose of this study was to identify predictors of the successful initial therapy with M-anticholinergic preparations in children with neurogenic urinary disorders. For this, results of a comprehensive analysis of initial clinical and video urodynamic parameters were used.. METHODS: A prospective longitudinal cohort study involved 62 patients, aged 1.8–18 years, with neurogenic urination. In addition to the standard examination, all patients underwent a video urodynamic examination at Laborite Delphis UDS-600 device with parallel cystography at Siemens X-ray C-arc (Siemens, Germany). By the obtained results, 52 out of 62 patients were prescribed antimuscarinic agents as the first line therapy. Therapy effectiveness was assessed in 3 months. Analysed parameters were age, presence/absence of self-catheterization, as well as presence/absence of vesicoureteral reflux (VUR) revealed at conventional retrograde urethrocystography and/or video urodynamic examination. RESULTS: The multivariate regression analysis demonstrated that the risk of ineffective antimuscarinic therapy increases by 75,6% in patients with VUR revealed at retrograde uretrocystography, regardless of patient's age and self-catheterization (OR=0.244; 95% CI=0.063-0.937; p=0.040) and by 89.8% (OR=0.102; 95% CI=0.019-0.554; p=0.008) when VUR is detected at video urodynamic examination. Unlike patients with a positive effect (n=24; 50%), 24 patients (50%) who had no response to antimuscarinic therapy were younger (median age 8 years); they also were self-catheterized and had VUR revealed at video urodynamic examination. Outcomes of the prescribed therapy were not associated with other video urodynamic parameters. The identified significant predictors (age, self-catheterization and VUR at video urodynamic examination) have allowed to develop a model for predicting antimuscarinic therapy effectiveness before its administration. This model can promote a rational selection of patients for antimuscarinic therapy, as the first line therapy, with a high probability of positive outcome in 84.9% of patients. CONCLUSION: When prescribing antimuscarinic agents, patient's age, self-catheterization, VUR revealed at retrograde urethrocystography and video urodynamic examination should be taken into account. Predictors of effective antimuscarinic therapy in children with neurogenic urinary disorders, which increase the likelihood of successful outcomes, are patient's age (over 12 years), no self-catheterization and no VUR at video urodynamic examination. Patients younger than 12 years, with self-catheterization and VUR are less likely to respond to antimuscarinic therapy.