Purpose of the study. Based on the analysis of modern scientific literature, study the features of clinical manifestations, pathogenesis, diagnosis and treatment of low histamine tolerance syndrome.

Materials and methods. Analysis of modern domestic and foreign scientific literary sources on the problem of impaired tolerance to histamine.

Results. The article presents modern information on histamine intolerance. Pathogenetic mechanisms of syndrome of low tolerance to histamine, features of its clinical manifestations are considered. Particular attention is paid to the diagnosis of this syndrome and the directions of its therapy.

Conclusion. Low histamine tolerance syndrome is a quite common pathology, which, in some cases, is considered by physicians as food allergy. In-depth study of this problem is an urgent task of modern medicine.

Cystic fibrosis (CF) is a chronic genetic disease in which life expectancy and prognosis are largely determined by the severity of the respiratory infection caused by the microbiological status. A breakthrough in the treatment of this disease is the introduction of targeted therapy, which opens up new prospects for increasing life expectancy and quality of life. The purpose of this study is to evaluate the dynamics of the species diversity of the microbiota, as well as the nature of the intermicrobial interactions of species colonizing the respiratory tract of patients with CF in the Samara region, against the background of the use of targeted therapy drugs. Depending on the type of the treatment received, the patients were divided into three groups: group 1 – elexacaftor/ tezacaftor/ ivacaftor + ivacaftor therapy, group 2 – ivacaftor+lumacaftor, and group 3, patients who were transferred from ivacaftor+lumacaftor therapy to elexacaftor/ tezacaftor/ ivacaftor +ivacaftor therapy due to the low clinical efficacy of the drug treatment. During the three-year follow-up period, representatives of 154 species of microorganisms were isolated from 23 patients with CF. The species diversity of representatives of the permanent, additional and accidental microbiota of the respiratory tract was assessed before the start of therapy and at different times using the coefficient of constancy C. To assess the degree of conjugacy of individual species, and, as a result, the nature of their symbiotic interactions, the Jaccard similarity coefficient was applied. In order to further assess the degree of biological diversity and microecology of the respiratory tract of patients with CF, calculations of the Shannon, Simpson and Richness indices were performed. It was found that the microbiota of the respiratory tract of patients with CF undergoes significant changes while receiving targeted therapy. There is a decrease in the prevalence of key pathogens due to an increase in representatives of the normal microbiota, as well as a change in the nature of inter-microbial interactions.

Cerebral palsy (CP) is a disabling disease of the nervous system that requires improvement of diagnostic and therapeutic approaches to achieve the most effective results in providing medical care to children with this pathology. The creation of comprehensive rehabilitation programs that include various rehabilitation methods contributes to a more pronounced positive effect in the form of minimizing neurological deficits and forming physiological motor patterns.

The aim of the study: to assess the effectiveness of complex rehabilitation treatment using the method of dynamic proprioceptive correction in children suffering from cerebral palsy, using stabilography and goniometry of the joints of the lower extremities. Materials and methods. The clinical study included 50 patients with cerebral palsy, spastic diplegia of moderate severity, and a control group of 30 healthy children aged 11–13 years. The main clinical syndrome of motor disorders in the patients was spastic tetraparesis corresponding to GMFCS (Gross Motor Function Classification System) level 3.

Results. Given the development of a «pathological postural stereotype» with impaired spatial organization of posture and the presence of motor impairments, the use of comprehensive rehabilitation using the method of dynamic proprioceptive correction, such as the Adele load suit, is advisable for children with cerebral palsy. In this study, the use of this method in the rehabilitation of children with cerebral palsy showed its effectiveness in improving vertical stability when standing with visual control by 22.6% and 16.4%, as well as increasing the amplitude of movement in the hip and knee joints by 15%.

Conclusion. The effectiveness of comprehensive rehabilitation using the dynamic proprioceptive correction method significantly exceeds the results of traditional treatment and contributes to increased vertical stability, improved lower limb movement patterns based on computerized stabilography and goniometry, as well as improved cognitive functions.

Background and Objective. Assessment of the clinical and psychological status of children exposed to traumatic events remains highly relevant in the context of armed conflicts, migration processes and humanitarian crises. In childhood, diagnosis of psychological disturbances is complicated by limited verbalization of emotional experiences and the presence of psychological defense mechanisms. Therefore, non-verbal assessment methods, including analysis of children’s drawings, may provide valuable diagnostic information. The objective of the study was to evaluate the informativeness of children’s drawings in assessing the clinical and psychological status of children who experienced psychological trauma.

Materials and Methods. Drawings of 50 children aged 5–13 years participating in emergency psychological assistance programs were analyzed. The study included children affected by armed conflict in Tajikistan (1992– 1997), internally displaced persons from Ukraine (2015– 2024), and refugees from Karabakh (2023). Drawings were analyzed according to content-related, formal-graphic and dynamic characteristics with subsequent clinical and psychological interpretation.

Results. Three main groups of drawings were identified, reflecting different patterns of psychological response to traumatic events: fixation on traumatic experiences, incomplete psychological processing of trauma, and indicators of positive psychological recovery. Typical graphic indicators included reduced size of the child figure, dominance of dark colors, fragmented composition, strong line pressure and repetitive threat-related themes.

Conclusion. Children’s drawings represent an informative supplementary method for assessing the psychological condition of children exposed to traumatic events. The scientific novelty of the study lies in the systematization of graphic indicators reflecting different stages of psychological response to trauma, which expands the possibilities for early identification of psychological distress in children.

Objective: To assess the effectiveness and safety of using a Foley catheter for the removal of esophageal foreign bodies in young children.

Materials and Methods: We analyzed cases of esophageal foreign bodies in children from 6 months to 15 years of age. The type of ingested objects, their location, time to presentation, and outcomes of removal using a Foley catheter were evaluated.

Results. An increase in the number of such cases has been observed in recent years. The most common foreign bodies were coins (335 cases; 44.2%) and button batteries (157 cases; 20.7%). In most cases, the objects were located at the upper (580; 76.5%) and middle (146; 19.2%) esophageal constrictions. Nearly half of the patients (365; 48.1%) were admitted within the first 24 hours after ingestion or onset of symptoms. Foley catheter extraction was successful in 734 patients (96.8%). No serious complications related to the procedure were observed.

Conclusions. The Foley catheter appears to be an effective and safe option for removing esophageal foreign bodies in children. It can be considered in cases where the foreign body is located in the upper or middle esophagus, provided that proper indications and technique are followed.

Introduction. Allergic rhinitis (AR) in childhood is one of the most common conditions encountered by pediatricians in daily practice. The disease develops under the influence of multiple factors, including heredity, exposure to indoor and outdoor allergens, individual characteristics of early childhood, and comorbid conditions. Currently, available information on the prevalence and risk factors of AR across different age groups remains fragmented. This informational gap contributes to a low level of clinical vigilance among physicians regarding AR manifestation in children, resulting in a growing number of patients with delayed diagnosis, as well as a decline in the quality of life of patients and their families, leading to significant socioeconomic consequences.

Aim of the study was analyze the prevalence and incidence of allergic rhinitis, identify known risk factors for its development, and assess the likelihood of their implementation in children of different age groups across five regions of the Central Federal District of the Russian Federation.

Material and methods. A retrospective study was conducted for the period 2017–2021, including the assessment of epidemiological indicators and analysis of risk factors. Calculations included the assessment of attributable and relative risks, population attributable risk proportion, population attributable risk, attributable fraction, and odds ratio.

Results. Over the study period, there was a consistent annual increase in the proportion of newly diagnosed cases of AR (from 0.171% to 0.274%) and in overall prevalence (from 1.472% to 2.684%). The population-based investigation identified 28 risk factors associated with the development of allergic rhinitis in children across different age groups.

Conclusion. Allergic rhinitis is a widespread condition among children in the Central Federal District, exerting a substantial impact on their quality of life. The population study revealed multiple risk factors and established their contribution to the manifestation of AR in children aged 0–17 years. Grouping these factors according to their modifiability may enable the redesign of preventive and therapeutic interventions aimed at reducing the prevalence of AR, which in turn serves as a predictor for the subsequent development of bronchial asthma.

Testicular feminization syndrome (TFS) or androgen insensitivity syndrome (AIS) is a disorder of sexual development in which an individual with a 46 XY karyotype develops a female phenotype due to an androgen receptor defect. Currently, the genetic, endocrinological, and gynecological aspects of the pathology are welldocumented, while neurological disorders remain poorly understood. This review summarizes current data on the impact of androgen resistance on the central nervous system (CNS). Neurological manifestations in TFS are predominantly indirect and include: a high risk of anxiety-depressive and psychovegetative disorders associated with psychosocial stress; specific features of the cognitive profile (with a relative decline in visuospatial functions); impaired motor development and coordination; pain syndrome due to the increased likelihood of early osteoporosis. Understanding these aspects is important for organizing multidisciplinary (neurologist-endocrinologist-psychiatrist) patient management.

Testicular feminization syndrome (TFS) or androgen insensitivity syndrome (AIS) is a disorder of sexual development in which an individual with a 46 XY karyotype develops a female phenotype due to an androgen receptor defect. Currently, the genetic, endocrinological, and gynecological aspects of the pathology are welldocumented, while neurological disorders remain poorly understood. This review summarizes current data on the impact of androgen resistance on the central nervous system (CNS). Neurological manifestations in TFS are predominantly indirect and include: a high risk of anxiety-depressive and psychovegetative disorders associated with psychosocial stress; specific features of the cognitive profile (with a relative decline in visuospatial functions); impaired motor development and coordination; pain syndrome due to the increased likelihood of early osteoporosis. Understanding these aspects is important for organizing multidisciplinary (neurologist-endocrinologist-psychiatrist) patient management.

Asphyxia in birth among full-term newborns is one of the most common causes of neonatal morbidity and mortality in the majority of countries around the world. Prolonged oxygen deprivation in the foetus leads to developmental delays and causes dystrophic changes in the brain structures, including the respiratory and vasomotor centers. About 15–20% of such newborns die during the neonatal period, and 25% of survivors have neurological disorders of varying severity. Longterm outcomes of acute asphyxia during childbirth and subsequent hypoxic-ischemic encephalopathy (HIE) in infancy also lead to delayed psychomotor and speech development, cortical blindness, sensorineural hearing loss, epilepsy, cerebral palsy, and often to death. The aim of the review: on the basis of the modern literature references, to demonstrate the effectiveness of the early continuous rehabilitation of newborns who have suffered from moderate to severe asphyxia. The analysis of 37 Russian and foreign articles published during last 10 years was performed. The use of comprehensive rehabilitation programs as early as possible, as well as ensuring the continuity of rehabilitation treatment for children who have suffered from moderate to severe asphyxia, will allow to achieve the most effective results in reducing neurological deficits, severe outcomes, and disability in this cohort of children.

Infectious mononucleosis (IM), caused by the Epstein-Barr virus (EBV), remains one of the most pressing problems in pediatric infectology. Despite a relatively favorable course in immunocompetent children, this infection requires accurate laboratory verification for differential diagnosis from acute leukemia, streptococcal sore throat, and other diseases. This review critically analyzes current methods for laboratory diagnostics of IM, with a particular emphasis on polymerase chain reaction (PCR) in its various modifications. The principles of molecular diagnostics, optimal assay matrices, interpretation of quantitative viral load indicators, and age-related characteristics of this method’s use in pediatric practice are discussed. Data on the comparative effectiveness of PCR, serological tests, and direct virus detection methods are presented. Promising approaches, including digital PCR and next-generation sequencing (NGS), in the diagnosis of EBV-associated diseases are discussed. The results of a retrospective analysis of 309 suspected IM cases in children are presented, demonstrating the high diagnostic value of the PCR method. The review is based on an analysis of current international guidelines and meta-analyses of recent years.

Introduction. Serotypes 6B, 9V and 19F of Streptococcus pneumoniae are traditionally associated with increased resistance to beta-lactams and macrolides, the development of multidrug resistance (MDR), and high epidemiological significance. This review systematically analyses the molecular genetic mechanisms of resistance, the evolution of resistance in the era of conjugated pneumococcal vaccines (PCV7, PCV10, PCV13), regional patterns of dissemination of these serotypes, and their clinical significance, including detailed data for the Russianian Federation.

Objective of the study. A systematic analysis of the evolution of antibiotic resistance in vaccine serotypes of Streptococcus pneumoniae 6B, 9V, and 19F in the context of the global introduction of conjugated pneumococcal vaccines; the study of molecular genetic mechanisms of resistance to penicillin and macrolides; regional patterns of dissemination of these serotypes; the role of clonal complexes in the spread of resistance; and an assessment of clinical implications and prospects for developing new therapeutic strategies.

Materials and methods. A systematic review of published literature was conducted using the PubMed, Scopus, eLibrary, and Web of Science databases for the period 2020–2026. Selection criteria included publications in Russia and English on national surveillance systems for invasive pneumococcal infections in Europe, North America, Asia, and Russia, as well as results of molecular epidemiological studies using PCR methods, capsular gene sequencing, analysis of penicillin-binding protein genes (pbp1a, pbp2x, and pbp2b), detection of macrolide resistance genes (erm(B) and mef(A)), and clonal typing by multilocus sequence typing.

Results. Based on the analysis of literature data, it was established that Serotype 6B is traditionally associated with the clonal complex ST81 and demonstrates moderate resistance to penicillin with an MIC of 0,12–1 mg/L, a macrolide resistance rate of 50–70%, and predominance of the MLSB phenotype caused by the erm(B) gene. After the introduction of PCV7 and PCV13, a significant decrease in the frequency of this serotype was observed in developed countries with high vaccination coverage. However, serogroup dynamics persist, with replacement by serotype 6C, which is not included in vaccines. Serotype 9V was identified as a marker of pronounced multidrug resistance, dominated by the ST156 clone. This clone is characterised by high penicillin MICs of up to 3 mg/L and extreme erythromycin MICs exceeding 256 mg/L. More than 90% of isolates exhibit the MLSB phenotype, and the MDR rate exceeds 50%. Serotype 19F has formed a global resistant core of the pneumococcal population due to the clonal complex ST271/CC271. This complex demonstrates 100% resistance to erythromycin, 94% to clindamycin, 92% to tetracycline, and 76,6% to cefotaxime. It combines triple mosaic pbp genes with erm(B), mef(A), tet(M), and cat. A resistant mutation on a “favourable” genetic background ensures minimal fitness costs of resistance and stable global spread, regardless of vaccine pressure. Significant regional differences were identified in the persistence of target serotypes, with the greatest decline observed in North America and Western Europe (vaccination coverage > 90%) and continued high circulation in Asian countries, including China, India, and Russia. In these regions, serotype 19F remains a leading cause among invasive isolates, with macrolide resistance rates of up to 85% and penicillin resistance of up to 60%. It was demonstrated that the phenomenon of serotype replacement has led to the spread of highly resistant non-vaccine serotypes 19A and 6C, with resistance profiles comparable to those of vaccine serotypes. The clinical significance of detecting serotypes 9V and 19F as prognostic markers of multidrug resistance was established, necessitating empirical therapy with reserve antibiotics. It was shown that expanding vaccine valency to PCV20 – which includes serotype 19F along with other resistant serotypes – provides a basis for controlling the spread of antibiotic-resistant pneumococci, provided that molecular epidemiological surveillance, including clonal typing and analysis of resistance mechanisms, is maintained.

Introduction. Community-acquired pneumonia (CAP) maintains a leading position in the morbidity and mortality structure of the pediatric population. The introduction of polymerase chain reaction (PCR) methods has expanded diagnostic capabilities; however, it has also brought to the forefront issues regarding the choice of respiratory specimen and the interpretation of results, considering cycle threshold (Ct) values and asymptomatic colonization.

Objective. To systematize current data on the diagnostic value of various respiratory specimens in PCR diagnostics of CAP in children, to define the applicability limits of cycle thresholds for differentiating infection from colonization, and to justify the necessity of integrating molecular methods with biomarkers.

Methods. A systematic literature search was conducted in the PubMed, Scopus, Web of Science, Google Scholar, Cochrane Library and eLibrary databases (2000–2026). A total of 83 studies were selected for the final analysis.

Results. Three key factors for the successful interpretation of PCR diagnostics were identified: specimen selection, Ct interpretation, and integration with biomarkers. It is shown that the diagnostic value of nasopharyngeal (NP) swabs for verifying pneumococcal etiology of CAP approaches zero due to the high frequency of colonization (40–60%), making sterile loci the only reliable source. In contrast, for Mycoplasma pneumoniae, oropharyngeal swabs are optimal (sensitivity 96.2%), while saliva demonstrates comparable results. Critically important for the Russian Federation is the identification of 36–41% macrolide-resistant M. pneumoniae strains with regional variations; 62% of cases are accompanied by viral coinfection (parainfluenza 28%, SARS-CoV-2 19%, RSV 12%). A Ct value < 25 in Mycoplasma infection serves as an independent predictor of severe disease and necessitates hospitalization. For respiratory syncytial virus (RSV), Ct < 25 is associated with severe disease (adjusted odds ratio, aOR 2.26); for human metapneumovirus (hMPV), Ct < 27 (aOR 4.32). Procalcitonin-guided protocols can reduce inappropriate antibiotic prescriptions; however, the heterogeneity of pediatric data dictates the need for multi-marker approaches, including heparin-binding protein (HBP), with sensitivity 82%, specificity 86%, and its combination with procalcitonin increasing the area under the curve (AUC) to 0.94.

Conclusion. The success of PCR diagnostics for CAP in children is determined by three factors: appropriate specimen selection, correct interpretation of Ct values, and integration with biomarkers.