Markers of infectious-inflammatory process were studied by determining the levels of pro-inflammatory cytokines - interleukin (IL) 1 and IL-6 and proteins of the acute phase of inflammation - C-reactive protein (CRP) and fibrinogen in the serum of children with community-acquired pneumonia.  It was found that the course of community-acquired pneumonia is accompanied by an increase in serum concentrations of IL-1 and IL-6 in children in parallel with the disease severity. The synthesis of pro-inflammatory cytokines stimulates the production of acute CRP, but reduces the concentration of fibrinogen in the serum of sick children. The revealed connections between the content of the studied cytokines at the systemic level and multidirectional changes in the indicators of the acute phase of inflammation indicate a violation of the liver, where proteins are synthesized in the study. It is shown that with increasing severity of pneumonia, the enzyme activity of aminotransferases - alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the serum of children increases with a simultaneous decrease in the de Ritis coefficient, indicating "hepatic" genesis. High levels of aminotransferase is closely correlated with the activity of the infectious-inflammatory process, as indicated by the positive correlation between the level of IL-1 and ALT (r = 0.047) and AST (r = 0.111). At the same time, there is a negative correlation between the levels of IL-1, CRP and the activity of aminotransferases in blood serum.

Annotation. Respiratory diseases are relevant in pediatric practice, which is associated with its widespread and frequent complications, especially in young children. The aim of the study was to assess the diagnostic value of clinical symptoms, laboratory and ultra-sonographic parameters in pneumonia in children of the first 3 years of life. A retrospective study of medical records of 218 children who were hospitalized in the department for young children diagnosed with pneumonia for the period from 2016 to 2018. The average age of children was 11.67±9.97 months and it was within the range from 1 month to 3 years. The ration of boys and girls was practically identical (51.8% and 48.2% accordingly). The first group included children aged under one year (the average age is 4.57±0.84 months; n=88). The second group included children aged from 1 to 3 years (the average age is 18.2±4.25 months; n=130). To characterize the information content of clinical and laboratory symptoms the study has used objective parameters defined as the operational characteristics of tests. The most important operational characteristics of diagnostic methods included: sensitivity (Se, sensitivity) and specificity (Sp, specificity). To check the statistical hypothesis on differences of absolute and relative frequencies, fractions, and ratios in two independent samples, the criteria of хі-square (χ2) was used. While detailing an anamnesis, the disease was more often related to untimely treatment and outpatient care. Various data were obtained on the absolute and relative risk, as well as the sensitivity and specificity of the localization of pneumonia depending on age. Therefore, the incidence of bilateral pneumonia was considered an indicator of risk. On admission to hospital, the body temperature of patients was 38.2±0.66°С. Most of the complaints were on the unproductive or productive cough. Besides, in some cases, shortness of breath and runny nose were mentioned. Thus, in young children with pneumonia, a diagnostically significant clinical symptom is a bilateral lung impression (82.6%), compared with right-handed (15.1%) and left-handed (2.3%), which is significantly more common in children under 1-th year of life compared with patients 1–3 years; laboratory features are probably higher levels of liver-specific enzymes – ALT and AST in children under 1 year; ultrasonographic indicators associated with the presence of pneumonia in young children include increased liver size, gallbladder deformity, the presence of sediment in the gallbladder, dyskinesia of the biliary tract, thickening of the gallbladder wall; children under 1 year of age have a risk of liver enlargement and biliary dyskinesia.

Annotation. The prognostic criteria of complications of community-acquired pneumonia and the possibility of developing disorders of the hepatobiliary system (HBS) depending on the concentration in the serum of the secretory leukocyte protease inhibitor (SLPI) were studied. The data of clinical and laboratory examination of 338 children with community-acquired pneumonia aged from one to three years were analyzed. Statistical processing of the results was performed using the system “IBM SPSS Statistica” 12 using parametric and non-parametric methods. It was found that in young children with pneumonia in the serum increases the concentration of SLPI, the level of which depends on the course and severity of pneumonia. It has been shown that the development of lobar pneumonia is significantly higher in patients from the SLPI cohort IV quartile (OR – 1.986, 95% CI – 1.864-2.356), compared with children from the cohort SLPI II and III quartile (OR – 0.476, 95% CI – 0.405- 0.559, OR – 0.494, 95% CI – 10.423-0.576, respectively). At the same time, at the values of SLPI at the level of III-IV quartile (OR – 1.923, 95% CI – 1.457-1.866) there is the development of community-acquired pneumonia. It was found that the development of pathological processes in the organs of HBS is associated with increased levels of SLPI. Thus, patients with polysegmental pneumonia and SLPI III/IV quartile (OR – 2.190, 95% CI – 1.810-2,754) are twice as likely to develop pathology of the hepatobiliary system than children with SLPI I/II quartile (OR – 1.153, 95% CI – 1.071-1.527). The established fact indicates the involvement of SLPI in the pathogenesis not only of pneumonia, but also in disorders of HBS.

The study of the secretory leukocyte protease inhibitor (SLPI) level in children with pneumonia is important because it may indicate protease-antiprotease imbalance and predict local regulation of proteolytic activity at different degrees of pneumonia in children. The aim of the study was to assess the level of SLPI as a marker of proinflammatory response in the serum of young children, depending on the severity of pneumonia, including the presence or absence of lesions of the hepatobiliary system. The study investigated the SLPI as a marker of the inflammatory response in children with community-acquired pneumonia, depending on the severity of the disease, lesions of the hepatobiliary system, age and sex. The level of SLPI in the serum was determined by enzyme-linked immunosorbent assay using a diagnostic test system from “IMMUNOTECH” (France). “IBM SPSS Statistica” Version 12 (20) was used for statistical processing of the results. It was found that the course of community-acquired pneumonia is accompanied by an increase in the serum level of SLPI in children in parallel with the severity of the disease. The development of a lesion from the GBS reduces the level of a protease inhibitor in the blood serum of children with pneumonia, which indicates a decrease in the body's defense systems. In children 1-12 months, the level of SLPI is higher than in children 13-36 months, which indicates more significant protective capabilities of the body of children in the first year of life. It has been shown that an increase in the level of SLPI correlates with an increase in the level of inflammatory cytokines, which indicates a unidirectional change in the formation of local immunity in response to damage to the lung tissue. At the same time, a negative correlation was found between the level of SLPI and the activities of AST, GGT and CRP (rxy= -0.054; rxy= -0.215; rxy= -0.215, respectively), which indicates a violation of liver function during the development of an infectious-inflammatory process in the body. Studies of the nature of the effects of cytokines and protease inhibitors (protective factors) on the development and maintenance of inflammatory process in the lungs in young children with community-acquired pneumonia with lesions of the hepatobiliary system may be the basis for predicting its course.

Cystic fibrosis related diabetes (CFRD) is a rare pathology that combines genetically determined systemicity with damage to the exocrine glands, which leads to early manifestations of the disease, a clear exacerbation and chronicity of the process, with possible complications in bone remodeling with the occurrence of malignant tumors. Purpose - to acquaint practitioners with the peculiarities of manifestations, diagnosis and course of chondroblastic osteosarcoma in a child with CFRD. Features of the clinical course and differential diagnosis are described and given osteosarcoma of the proximal part of the left tibia against the background of CFRD in a child. The main diagnostic value of history, clinical picture, laboratory, instrumental, immunohistochemical and microscopic research methods was highlighted, in particular, a biopsy of this tumor. Microscopic examination of tissue biopsy revealed alternating areas of atypical cartilaginous tissue corresponding to the structure of chondrosarcoma 1-2 cm, solid proliferates of atypical fibroblast-like cells and areas of atypical and fibroblastic tissue containing elements of atypical osteogenesis. Periosteally - randomly oriented bone fragments at the place of the cortical plate, as well as impressions of the lower metaphysis of the thigh and the upper metaphysis of the tibia, near the knee joint. The immunohistochemical examination showed a clear differential diagnosis of the existing CD99-positive tumor cells (DAKO, clone 12E7). Some cells were positive for SATB2 (Cell Marque, clone EP281); tumor cells were negative for S-100 - SOX-10. The histological picture and immunophenotype of the tumor cells correspond to chondroblastic osteosarcoma. Osteosarcoma with genetic, metabolic and aplastic features developing in the setting of a comorbid background significantly complicates diagnosis and requires certain changes in the treatment tactics of CFRD (correction of prophylactic and basic therapy, metabolic and toxic disorders, including those caused by chemotherapy). The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.