Gestational diabetes mellitus (GDM) is a condition characterized by hyperglycemia first detected during pregnancy, but not meeting the criteria for overt diabetes. GDM is one of the most significant problems in the modern world due to its high prevalence, which necessitates studying the disease and its impact on the child. The relevance of this condition is due to its high and steadily increasing prevalence, which correlates with the epidemic of obesity and a sedentary lifestyle. Studying the pathophysiological mechanisms of GDM, especially at the placental level, is not just of scientific interest but an urgent necessity for developing effective preventive and therapeutic strategies. In the placenta with gestational diabetes mellitus (GDM), inflammatory, destructive, and dystrophic changes are detected, manifested by impaired microcirculation, fibrosis of the villous stroma, and endothelial dysfunction of the vessels. The identified structural damage leads to functional insufficiency, accompanied by impaired nutrient transport and chronic intrauterine hypoxia. In addition to significant obstetric complications, GDM increases the risk of macrosomia, preterm birth, and premature rupture of membranes. In our article, we present the characteristics of anthropometric indicators, gestational age at birth of children from mothers with gestational diabetes, and placental changes, showing that in this pathology, the mother has an increased likelihood of inflammatory and destructive changes in placental tissue, which, of course, can affect the fetus. Our study convincingly demonstrates that GDM is not merely an episode of hyperglycemia, but a systemic pathology that triggers a cascade of pathological reactions in the placenta, which are a key pathophysiological link mediating the entire spectrum of adverse effects on the fetus – from macrosomia to chronic hypoxia.

Cardiac conduction disorder is one of the most complex challenges in pediatric cardiology. In young children, the most important issue is the presence of atrioventricular (AV) block, which manifests as an abnormal slowing (incomplete block) or cessation (complete block) of electrical impulse conduction from the atria to the ventricles. The most severe form is complete AV block, which requires urgent diagnosis and, as a rule, implantation of a permanent pacemaker (PM). The aim of this study is to present a clinical case of complete AV block in a young child. A retrospective analysis of the patient’s medical history was performed; the patient was under follow-up and treatment in the cardiovascular surgery department. At the age of 2 years and 11 months, during a routine medical examination, ECG revealed cardiac rhythm disturbances manifested as sinus arrhythmia, heart rate of 50 bpm, and AV block. Due to suspected of complete AV block, the patient was urgently hospitalized for further examination and treatment. Comprehensive laboratory and instrumental examination of the child revealed complete AV block along with signs of heart failure. Based on clinical indications, the girl underwent permanent pacemaker implantation surgery with subsequent dynamic monitoring. During follow-up ECG monitoring, the primary rhythm was registered as IC in DDD mode, predominantly atrial-synchronized mode (pacemaker rhythm percentage 99 %). Five months post-implantation, during a follow-up examination, the ECG revealed ventricularpaced rhythm with a heart rate of 100 beats per minute. After two years, 24-hour ECG monitoring revealed a pacemaker rhythm in DDD mode with a baseline ventricular stimulation rate of 70–145 impulses per minute. The spontaneous rhythm was sinus. Pacemaker rhythm percentage reached 99 %. Echocardiographic findings showed no chamber enlargement, with a left ventricular ejection fraction of 70 %. This clinical case of complete AV block in a young child serves to draw attention of pediatricians, pediatric cardiologists, and specialists to the particularities of clinical presentation, diagnosis, and management of this rare pathology.

The high prevalence of periodontal inflammatory diseases (PID) among adolescents underscores the need to develop simple, non-invasive methods for their timely detection. Oral fluid is considered a promising diagnostic substrate, enabling the assessment of various biomarkers, particularly alkaline phosphatase (ALP), which is involved in inflammatory and reparative processes in periodontal tissues. However, there is a paucity of studies analyzing the diagnostic significance of this enzyme. Objective. To investigate the association between salivary ALP levels and clinical signs of PID in individuals aged 15–17 years permanently residing in the European North of Russia. In a cross-sectional study, participants (n = 439) residing in the Nenets Autonomous Okrug (n = 171), the Komi Republic (n = 146), and Murmansk Oblast (n = 121) underwent a dental examination with recording of periodontal parameters (bleeding, dental deposits, presence of periodontitis) and provided mixed saliva samples for subsequent determination of ALP activity. Data analysis was performed using Poisson regression models; unadjusted and adjusted (for sex, age, and place of residence) relative risks were calculated, and linear trends were assessed across quartiles of ALP distribution. Results: а direct statistically significant association was observed between enzyme concentration and the number of sextants exhibiting bleeding in the multivariable regression model, p for trend = 0.037. No statistically significant association was found between ALP levels and the likelihood of detecting periodontitis (p for trend = 0.404) or dental calculus (p = 0.521). Our results suggest that elevated ALP levels in the oral fluid of adolescents are associated with a greater prevalence of gingival bleeding. This suggests that this parameter may serve as a potential indicator of the severity and extent of generalized inflammation in periodontal tissues, although it is not specific for a diagnosis of periodontitis. Further prospective studies are required to definitively establish the clinical and diagnostic utility of ALP and to justify its application in routine clinical practice.

The clinical efficacy of antiviral therapy (AVT) in moderate influenza, its dependence on virus serotype, and the contribution of interferon-inducer augmentation (kagocel) to the baseline regimen remain under active discussion. Aim. To characterise the immunological profile and clinical–laboratory efficacy of four AVT regimens in patients with moderate mono-influenza according to virus serotype and to evaluate the effect of Kagocel augmentation. 120 patients with laboratory-confirmed moderate influenza (30 per group: seasonal A(H1N1), A(H1N1)pdm09, A(H3N2), B) were examined in Vladivostok, 2016–2020. The control group comprised 31 apparently healthy donors. Four AVT regimens per serotype were used: umifenovir, umifenovir + kagocel, oseltamivir, oseltamivir + kagocel. Twenty-two immune, acute-phase, haematological and composite parameters (NLR, PLR, MLR, LMR, SII, SIRI) were assessed at admission (V1) and discharge (V2). Results. Pronounced systemic hypercytokinaemia was documented (IL-17, IL-18, TNF-α, IFN-α, CRP; all q<10-¹³); the highest IL-10 and IFN-γ response was observed in A(H1N1)pdm09, the weakest – in A(H3N2). All regimens produced comparable decline of cytokines and inflammatory indices. The maximal clinical effect of kagocel augmentation was seen in A(H1N1)pdm09 and influenza B. All AVT regimens produced comparable suppression of systemic inflammation. The augmentation with Kagocel demonstrated a serotype-specific clinical advantage without an additional cytokine-modulating effect. The oseltamivir + kagocel regimen provides the best integrated clinical profile.

Autosomal recessive polycystic kidney disease (ARPKD, MIM 263200) is one of the severe, rare hereditary diseases from the group of fibrocystic diseases of the liver and kidneys. The average frequency in the population is 1:20,000 – 1:40,000 newborns. This pathology has not been previously described in children in Yakutia. The article presents a severe clinical case of a 7-month-old girl with autosomal recessive polycystic kidney disease (ARPKD), diagnosed antenatally. The disease was characterized by an extremely severe course with rapid progression to the end stage of chronic kidney disease (stage 5 CKD), pronounced portal hypertension with hepatosplenomegaly and ascites, as well as a congenital heart defect (atrial septal defect). Against the background of immunosuppressive therapy, the development of uremia and nutritional deficiency, as well as the child’s prolonged stay in the intensive care unit, severe nosocomial complications developed: ventilator associated pneumonia, perforation of the small intestine with diffuse peritonitis, and sepsis. Despite comprehensive therapy, there was a steady progression of multiple organ failure, which led to a fatal outcome. This case illustrates the difficulties in managing patients with ARPKD and the catastrophically high risk of death when infectious complications develop. Managing patients with ARPKD is a complex task that requires a multidisciplinary approach to therapy and necessitates coordination among neonatologists, anesthesiologists, nephrologists, hepatologists, and surgeons. The prognosis for the disease always remains serious, and the child’s survival directly depends on the extent of kidney and liver damage. The described clinical case demonstrates an aggressive, catastrophically rapid course of ARPKD with early development of end stage CKD, severe portal hypertension, and fatal infectious complications.

Characterized by high mortality and the risk of life-threatening complications, newborn myocarditis remains one of the most severe pathologies in the structure of neonatal cardiology. Cerebral consequences, particularly ischemic brain injuries, are often underestimated, although they may determine the long-term neurological prognosis. Aim. To present a systemic analysis of the pathogenesis of cerebral ischemia in newborns with myocarditis from the perspective of P.K. Anokhin’s theory of functional systems, to identify clinical and instrumental predictors, and to substantiate the need for a multidisciplinary approach. Material and methods. A literature review was conducted, and a clinical case from the author’s practice is presented. Results. Cardiocerebral disturbances are based on a mismatch in the functional system that ensures adequate brain perfusion; ischemia can develop even without critical hypotension. Key predictors include reduced heart rate variability, increased resistance index in cerebral arteries, decreased regional oxygen saturation, and latent metabolic disturbances. Conclusion. Newborn myocarditis requires mandatory monitoring of cerebral status using neurosonography, cerebral oximetry, and heart rate variability analysis. An integrative approach is essential for improving outcomes. 

Tuberous sclerosis is a rare genetic disorder that causes benign tumors in various organs and tissues. Tuberous sclerosis is an autosomal dominant disorder caused by mutations in the TSC1 gene (#OMIM 605284) on chromosome 9q34, which encodes the protein hamartin, and the TSC2 gene (#OMIM 191092) on chromosome 16p13.3, which encodes tuberin. This article presents a clinical case of a boy diagnosed with tuberous sclerosis. The boy was born in 2013 and was 12 years old at the time of his last hospitalization. Cardiac rhabdomyomas were diagnosed in utero. Psychomotor and speech developmental delays have been observed since birth. Infantile spasms were noted at an early age, and drug-resistant epilepsy was diagnosed. The diagnosis of tuberous sclerosis was confirmed genetically and clinically. A family history of tuberous sclerosis includes a mother and younger brother; the family has five children. A genetic blood test in 2022 revealed a heterozygous deletion of three nucleotides in the TSC2 gene (NM_000548: exon 15: c.1595_1597del: p.F532fs), which, according to the ClinVar database, is classified as a pathogenic mutation leading to a frameshift and loss of function of the tuberin protein. This mutation is associated with the development of TS and explains the multisystem manifestations. The patient is receiving antiepileptic and targeted therapy. Stereotactic surgery was also performed. Following surgery, seizures became significantly less frequent: atonic-astatic seizures ceased, pseudo-absences occur up to five times per month, and tonic-clonic seizures occur up to twice per month.

HDV is the leading cause of death among all viral hepatitis types in the region, accounting for the highest proportion of mortality attributable to viral hepatitis. Therefore, the identification of predictors for rapid liver fibrosis progression is of high relevance. The purpose. To develop a prognostic model for classifying patients with CHD into high and low risk groups for liver fibrosis progression (using the Yakut population as a model). The study involved the review of 130 medical records of patients with CHD, 57 of whom were diagnosed with liver cirrhosis. A genetic analysis included the study of NOS3 gene polymorphisms using PCR. A logistic regression model was constructed based on the data on genetic markers, glucose levels, and thrombin time. Diagnostic accuracy was assessed using ROC analysis. Independent predictors associated with rapid liver fibrosis progression were identified: the NOS3 rs1799983 polymorphism was associated with a 3.53-fold reduction in the likelihood of rapid fibrosis progression (95 % CI: 1.21–10.25, p=0.021); a 1 mmol/L increase in glucose level increased the risk of rapid fibrosis by a factor of 2.06 (95 % CI: 1.18–3.60, p=0.011); and a 1-second prolongation of thrombin time decreased the probability of rapid fibrosis by a factor of 1.16 (95 % CI: 1.05–1.29, p=0.005). The model demonstrated a sensitivity of 98.2 %, a specificity of 85.1 %, a predictive accuracy of 90.8 %, and an area under the ROC curve of 0.820 ± 0.054 (95 % CI: 0.633–0.806). The proposed model can be used to stratify patients with CHD into high and low risk groups for developing liver fibrosis. The results underscore the importance of further research investigating the role of genetic factors in the pathogenesis of liver fibrosis.

Tuberculosis remains a leading cause of mortality from infectious diseases globally, with significant regional variability in the epidemiological situation; however, direct comparative studies at the subnational level between regions with contrasting conditions are lacking. The aim of this study is to conduct a comparative statistical analysis of tuberculosis epidemiology in Punjab province (Pakistan) and the Sakha Republic (Yakutia, Russia) for the period 2010–2023. Materials and methods: a retrospective comparative analysis of official statistical data from the Ministry of Health of the Sakha Republic (Yakutia), the Pakistan Bureau of Statistics, the Provincial TB Control Program of Punjab, the World Health Organization, and peer-reviewed publications was conducted using descriptive statistics and calculation of relative indicators. Results: during the study period, the incidence rate in Yakutia decreased by 59.5 % (from 74.9 to 30.3 per 100,000 population), while in Punjab the decrease was only 15 % (from 286 to 243 per 100,000 population); the gap in incidence rates increased from 3.8 to 8 times. The proportion of multidrug-resistant tuberculosis (MDR-TB) among new cases in Yakutia reached 24.6 %, while in Punjab it is 4.5 %. Differences in age structure were identified: the proportion of pediatric tuberculosis in Punjab is 18.4 %, compared to 4.3 % in Yakutia. Conclusion: the results can be used to improve anti-tuberculosis strategies in both regions, including scaling up diagnostics in Punjab and implementing new treatment regimens in Yakutia; a promising direction is the study of factors contributing to the rapid decline in incidence in Yakutia.

Aim of the Research: to assess the availability of emergency medical care to the population in the Arctic zone of the Sakha Republic (Yakutia) in 2022–2024. The object of the study is the organization of emergency medical care in the Arctic zone of the Sakha Republic (Yakutia); the subject of the study is the emergency (including specialized air ambulance) medical services. The analytical and selective statistical methods, as well as the methods of mathematical analysis and expert assessment, were used to carry out a retrospective analysis of the main performance indicators of the Republic’s Center for Disaster Medicine and the Emergency Medical Service in the Sakha Republic (Yakutia) in 2022–2024. The mortality rate of the population of the Arctic group of districts was established to be higher than the average indicators of the Sakha Republic (Yakutia), primarily due to circulatory system diseases and external causes. Land ambulance covers only 51.4 % of the population in the Arctic zone. Thus, the air ambulance services play a crucial role in providing emergency medical care to the ill and injured. In 2022–2024, the Arctic zone accounted for the prevailing share of the missions (from 27 % to 31 %). 45.0 % of the total number of intra-regional evacuations and 51.4 % of inter-regional evacuations were carried out in the Arctic districts. The Arctic zone also ranked first in the number of evacuated patients with acute cerebrovascular accidents and various injuries (24.9 % and 33.1 %, respectively).