Pediatrics. Consilium Medicum

Tick-borne viral encephalitis accounts for 9.1% of the total structure of natural focal diseases associated with tick bite. In 2023, 1,778 cases of tick-borne viral encephalitis were detected in more than 50 subjects in the Russian Federation, of which 272 cases were diagnosed in children. Our own case of tick-borne encephalitis in a child who arrived in the Ryazan region from an endemic region (Republic of Bashkortostan) is presented. After the tick bite, the child was injected with anti-tick immunoglobulin, and no laboratory examination of the tick or vaccination was performed. The symptoms of encephalitis debuted 3 weeks after the bite with neurological manifestations in the form of constipation, repeated vomiting, and tonic seizures. Febrile fever and meningoencephalitis clinic have joined the dynamics. The diagnosis was confirmed by the identified IgM to the tick-borne encephalitis virus. A course of treatment with human immunoglobulin against tick-borne encephalitis with a positive effect was carried out. The child's full recovery occurred by the 20th day of hospitalization, and she was discharged with full recovery. The peculiarity of this case is the development of the disease despite the specific immunoprophylaxis. The most effective is planned seasonal vaccination in endemic areas, within the time limits stipulated by the National Calendar of preventive vaccinations.

Classical homocystinuria (HCU), caused by cystathione-β-synthase deficiency, is a rare hereditary metabolic disorder with a high risk of systemic complications if not diagnosed and treated promptly. Extended neonatal and family screening are critical for early detection. This publication presents the clinical and genetic characteristics, as well as therapeutic outcomes, in two siblings with classical pyridoxine-responsive HCU. Two clinical cases involving siblings with HCU are presented. Diagnostic procedures included extended neonatal screening, quantification of methionine and total homocysteine levels, and molecular genetic analysis of the CBS gene. The efficacy of dietary therapy, pyridoxine, metabolic cofactors, and betaine was assessed longitudinally. Both patients exhibited a previously unreported pathogenic CBS gene variant (c.430G>C, p.Glu144Gln) in the homozygous state. The younger sibling was diagnosed during the neonatal period, while the older sibling was identified through family cascade screening. Both patients demonstrated an excellent response to pyridoxine and achieved target homocysteine concentrations with individualized dietary therapy and metabolic support. No severe clinical complications occurred during the follow-up period. The presented clinical cases confirm the effectiveness of early diagnosis and a personalized approach to the treatment of classical HCU. The availability and development of specialized Russian medical nutrition products, including a methionine-free mixture for "Homocystinuria" and the amino acid module "Betaine" under the trade mark "ОРФАНИК®", are essential for sustained metabolic control. Incorporation of the Aromin Flavor Module into amino acid-based mixtures improves adherence to dietary therapy.

The article is devoted to the evolution of medical thermometers, from ancient methods of temperature measurement to modern devices. The article considers the history of the creation and development of thermometers, starting with the first methods based on subjective sensations and manual palpation, and moving on to thermoscopes of the 16th–17th centuries, as well as liquid thermometers. Improvements in the design of thermometers and the introduction of standard measurement scales, such as the Celsius and Kelvin scales, are discussed. Modern innovations in thermometry, including electronic and infrared devices, are described.

The lower urinary tract has a well-defined anatomical structure at birth, which typically remains stable throughout life. Despite this anatomical consistency, the functional characteristics of the bladder and related structures undergo significant changes during the first decade of life. During this period, the involuntary "filling-emptying" reflex cycle becomes increasingly complex and subject to voluntary control, directly influencing quality of life. This maturation process is not automatic and is susceptible to dysfunction due to the inherent limitations of self-regulation. The bladder, pelvic floor, and urethra operate as an integrated functional unit with intricate innervation and vascularization. The complexity of these mechanisms increases their vulnerability to both external and internal insults. A comprehensive understanding of the structure and function of this system is essential for accurate assessment of the lower urinary tract and for the effective management of urinary disorders. Such knowledge is particularly critical in pelvic surgery, where awareness of the anatomical location of vessels and nerves alone is insufficient; a thorough understanding of their functional roles and safe exposure thresholds is required. Advancing knowledge of the structural, neural, and vascular features of the lower urinary tract is fundamental for ongoing scientific research. This lecture provides a detailed examination of the structure and regulatory mechanisms of the neuromuscular and vascular complexes of the lower urinary tract.

Background. Prebiotics are recommended in Russian guidelines for the management of functional gastrointestinal diseases in children. Evidence suggests their efficacy extends beyond constipation to include frequent acute respiratory viral infections (ARVI) in pediatric populations. Administration of fructooligosaccharide-based prebiotics for functional constipation (FC) may normalize both the qualitative and quantitative composition of the microbiota, thereby influencing nonspecific immunity and reducing the incidence and duration of ARVI episodes in children with recurrent illnesses.

Aim. To evaluate the efficacy and safety of a dietary supplement (DS) formulated as sugar-free candies containing fructooligosaccharide prebiotics, "Ecobiotic Immuno" (JSC AVVA RUS, Russia), for the treatment of FC in children with recurrent illnesses.

Materials and methods. An open-label, randomized, comparative study was conducted with 100 children aged 4 to 6 years diagnosed with FC and classified as sickly using the Sickly Children Scale and the Canadian Acute Respiratory Illness and Flu Scale (CARIFS). The test group (n=50) received one candy containing the DS daily for 28 days, while the comparison group (n=50) did not receive pro- or prebiotics. Symptom changes were evaluated using the Pediatric Quality of Life Inventory (PedsQL). Additional assessments included stool frequency, Bristol stool type, fecal calprotectin levels, and the frequency and course of ARVI episodes. The study duration for each patient was up to 54 days, including a 14–19-day follow-up period after DS treatment. The study was conducted from February 2022 to January 2023.

Results. From the second week onward, the number of children with daily stools in the test group increased significantly compared to the comparison group (p<0.05), and stool consistency normalized. Calprotectin levels in feces decreased significantly only in the test group (p=0.011). The mean PedsQL score, indicating the severity of gastrointestinal symptoms, decreased by 77.7% from baseline to Week 6 in the test group, which was significantly greater than the reduction observed in the comparison group (34.2%; p<0.001). The CARIFS score also decreased more substantially in the test group from Week 2 of follow-up, with statistically significant differences between groups from Week 3 onward (p<0.01). During the study period, the test group experienced fewer ARVI episodes than the comparison group (138 vs 241; p<0.001). No adverse events were associated with the DS.

Conclusion. The DS "Ecobiotic Immuno" is effective for treating FC and reducing the frequency of ARVI episodes in sickly children, supporting its use in this patient population.

Background. Posterior correction of pediatric spinal deformities using multisegmental pedicle screw fixation is the gold standard for surgical treatment of scoliosis. However, placement accuracy with the «free-hand» technique varies, and the risk of screw malposition depends on anatomical complexity and deformity parameters, creating the need for a simple preoperative planning tool for risk stratification.

Aim. To develop a preoperative planning tool based on radiographic deformity parameters to predict the risk of pedicle screw malposition with the «free-hand» technique.

Materials and methods. A single-center retrospective study was performed. Forty-five patients who underwent posterior spinal deformity correction with «free-hand» pedicle screw insertion were included; a total of 696 screws were analyzed. Females accounted for 73.3% (n=33) and males for 26.7% (n=12), median age was 14.0 [12.0; 16.0] years. Idiopathic scoliosis predominated (71.1%, n=32). Screw position was assessed on postoperative CT with multiplanar reconstructions, recording malposition and breach direction (medial, lateral, anterior). Preoperatively, vertebral frontal tilt, sagittal tilt, and vertebral rotation were measured at each instrumented level. A predictive model was built using binary logistic regression with Nagelkerke’s R²; discriminative performance was evaluated by ROC analysis (AUC) and the optimal cut-off was determined using the Youden index.

Results. The median preoperative Cobb angle was 69° [61°; 93°]; the postoperative mean Cobb angle was 28±12°, corresponding to a 59% mean correction (p<0.001). CT identified 148 malpositions (21.3% of screws). Malposition rates increased significantly with increasing frontal tilt and vertebral rotation (p<0.001). Lateral malpositions were significantly more frequent with greater frontal tilt (p<0.001), whereas medial malpositions increased with higher rotation compared with anterior and lateral breaches (p<0.001). In the binary logistic model, both coronal tilt and rotation were significant predictors; the model differed from the null model (p<0.001) with a Nagelkerke pseudo-R² of 10.3%. Each 1° increase in coronal tilt increased the odds of malposition by 2.7% (OR 1.027; 95% CI 1.013–1.042), and each 1° increase in rotation increased the odds by 5.0% (OR 1.050, 95% CI 1.030–1.070). The AUC was 0.682 (95% CI 0.631–0.733; p<0.001). The optimal probability threshold was P=0.212, yielding 70.5% sensitivity and 62.0% specificity; P≥0.212 corresponded to a combination of coronal tilt and rotation of approximately 20° or more at the same instrumented level.

Conclusion. The risk of pedicle screw malposition with the «free-hand» technique is significantly associated with vertebral coronal tilt and rotation at the instrumented level, with rotation exerting a stronger effect. When coronal tilt and rotation are approximately 20° or greater, the use of CT-based navigation or additive manufacturing (3D-printing) technologies should be considered, as well as modification of the fixation strategy (e.g., use of hook constructs or omission of screw placement at that level) to improve the safety of pediatric scoliosis correction.