Coronavirus disease 2019 (COVID-19) in children in most cases is asymptomatic or mild, and its most severe late complication is multisystem inflammatory syndrome in children (MIS-C). The aim of the study is to find clinical, laboratory and instrumental characteristics, description of therapeutic tactics, including determination of the profile of patients requiring Tocilizumab prescription and the outcomes of MIS-C associated with COVID-19. Materials and methods of research: 245 children aged 3 months – 17 years old were included in the pilot prospective multicenter open-label comparative study with MIS-C associated with COVID-19, verified based on CDC criteria (2020). Results: the median age of patients was 8 [5; 10] years, boys predominated among the patients (57.1%); MIS-C manifested itself as a combination of the symptom complex of Kawasaki disease (KD, 53.1% of patients), more often of atypical form, cardiovascular (66.1%), gastrointestinal (61.2%), neurological (27.3%) symptoms and signs of detection of the urinary (29.4%) and respiratory (19.6%) systems; macrophage activation syndrome (MAS) was diagnosed in 19.5% of patients. Therapy included glucocorticosteroids (97.6%), antibiotics (95.5%), anticoagulants (93.9%), intravenous immunoglobulin (34.7%), vasoactive/vasopressor support (31.8%), Tocilizumab (15.1%), mechanical ventilation (2.4%), extracorporeal membrane oxygenation (0.4%). Patients receiving Tocilizumab, statistically significantly more often compared with patients without this therapy, were in the intensive care unit (ICU, 86.5% versus 40.9%, p<0.001), more often required vasopressor therapy (70.3% versus 25%, p<0.001), had statistically significantly higher markers of laboratory inflammatory activity. Treatment in 47.8% of cases was carried out in an ICU; one child has died. In 4.1%, according to echocardiography, coronaritis, ectasia of the coronary arteries without the formation of persistent aneurysms were detected. Conclusion: MIS-C associated with COVID-19 has clinical signs of KD, often of the incomplete form, accompanied by arterial hypotension/shock, MAS, which requires intensive therapy, and the prescription of Tocilizumab.

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The article provides the review of literature on the issue of neurotoxic complications of chemotherapy in children. The data search was carried out in the PubMed, CyberLeninka, RSCI databases and others. There are many works devoted to studying the distribution, structure, and clinical features of chemo-induced neurological disorders in modern literature. In general, analysis of literature has shown that the incidence of neurotoxic complications varies widely depending on the research methods and used chemo-therapeutic drugs. Manifestations of chemotherapy-induced neurological disorders are quite diverse and accompanied by the central and peripheral nervous system damage. However, it has been shown that the platinum-based drugs have effective ototoxic effect with the damage of the auditory nerve. The Vincristine often causes peripheral polyneuropathy. Methotrexate and Ifosfamide cause metabolic encephalopathy. Cytarabine's neurotoxicity is the damage of the cerebellum. The addition of neurological symptoms leads to decrease in the quality of life of patients. Some studies present the results of study of the causes and pathogenetic manifestations of neurotoxic reactions, changes in the genome associated with the development of specific toxic effects are identified. Despite the fact that many pathogenetic mechanisms of chemotherapy-induced neurotoxic complications have been revealed, the significance of laboratory predictors for prognosing and early assessment of these complications has not been essentially established yet, thus, there is the need for further study of this topic.

Background. The existence of community-acquired pneumonia with negative chest radiography (CAPNR) as a clinical phenomenon remains disputable until now. This phenomenon is deemed to occur in subjects with dehydration, neutropenia, diminished immune response. In case of CAPNR the possibility of diagnostic error and ensuing irrational use of antimicrobial drugs is fairly high.Objective. The study aimed at establishing the validity of diagnosis of pneumonia with negative chest radiography in children, using a comparative evaluation of clinical and laboratory criteria amid positive and negative results of radiological diagnosis of pneumonia.Methods. A one-time study was conducted which included analysis of medical documents selected by continuous sampling method, and comparison of children with CAPNR versus children with radiologically confirmed pneumonia. The comparison was based on analysis of medical histories, clinical pictures and results of paraclinical investigations.Results. A total of 35 medical histories have been analyzed (mean age of patients – 1.7 ± 0.2 years), of which 17 children were assigned to group 1 (CAPNR group) and 18 children to group 2 (pneumonia with positive radiography). Most clinical and laboratory signs in early childhood were similar for children with CAPNR and children with radiologically confirmed pneumonia. Veritable differences in terms of respiratory symptoms have been found for children with CAPNR, namely, expiratory dyspnea in 35.29% of children with CAPNR versus none in the comparator group (p < 0.05), respiratory rate (RR) — 33 ± 7.2/min versus 28 ± 7.3/ min in the comparator group (p < 0.05), and auscultatory findings showing predominantly diminished breath sounds on the right-hand side. Complete blood count showed differences in granulocyte counts — 70 ± 12.6% in the CAPNR group versus 62.9 ± 16.8% in the comparator group (p < 0.05). A combination of the majority of classical symptoms of community-acquired pneumonia has been rarely observed in either group (5.9% and 11.1%, respectively).Conclusion. Particular features of the CAPNR did not allow us to speak out with confidence in favor or against the diagnosis of community-acquired pneumonia (CAP) in patient groups. The conduct of prospective studies looking into the etiology of pneumonia, using radiologic and ultrasound diagnosis and analyzing clinical and laboratory particulars of CAP would be a worthwhile undertaking. Without radiographic identification of infiltrative changes the diagnosis of CAP remains problematic.

Background. The existence of community-acquired pneumonia with negative chest radiography (CAPNR) as a clinical phenomenon remains disputable until now. This phenomenon is deemed to occur in subjects with dehydration, neutropenia, diminished immune response. In case of CAPNR the possibility of diagnostic error and ensuing irrational use of antimicrobial drugs is fairly high.Objective. The study aimed at establishing the validity of diagnosis of pneumonia with negative chest radiography in children, using a comparative evaluation of clinical and laboratory criteria amid positive and negative results of radiological diagnosis of pneumonia.Methods. A one-time study was conducted which included analysis of medical documents selected by continuous sampling method, and comparison of children with CAPNR versus children with radiologically confirmed pneumonia. The comparison was based on analysis of medical histories, clinical pictures and results of paraclinical investigations.Results. A total of 35 medical histories have been analyzed (mean age of patients – 1.7 ± 0.2 years), of which 17 children were assigned to group 1 (CAPNR group) and 18 children to group 2 (pneumonia with positive radiography). Most clinical and laboratory signs in early childhood were similar for children with CAPNR and children with radiologically confirmed pneumonia. Veritable differences in terms of respiratory symptoms have been found for children with CAPNR, namely, expiratory dyspnea in 35.29% of children with CAPNR versus none in the comparator group (p < 0.05), respiratory rate (RR) — 33 ± 7.2/min versus 28 ± 7.3/ min in the comparator group (p < 0.05), and auscultatory findings showing predominantly diminished breath sounds on the right-hand side. Complete blood count showed differences in granulocyte counts — 70 ± 12.6% in the CAPNR group versus 62.9 ± 16.8% in the comparator group (p < 0.05). A combination of the majority of classical symptoms of community-acquired pneumonia has been rarely observed in either group (5.9% and 11.1%, respectively).Conclusion. Particular features of the CAPNR did not allow us to speak out with confidence in favor or against the diagnosis of community-acquired pneumonia (CAP) in patient groups. The conduct of prospective studies looking into the etiology of pneumonia, using radiologic and ultrasound diagnosis and analyzing clinical and laboratory particulars of CAP would be a worthwhile undertaking. Without radiographic identification of infiltrative changes the diagnosis of CAP remains problematic.