Introduction. In late 2019, a new subtype of coronavirus named severe acute respiratory syndrome-related coronavirus 2 (SARSCoV-2) rapidly spread around the world, causing a global pandemic. Initially, the proportion of confirmed cases among children was relatively small, and it was believed that children were rarely infected. Subsequent observations have shown that in children and adolescents, the infection is either asymptomatic or accompanied by minimal clinical symptoms, and therefore the true incidence is underestimated due to the low level of testing.

Aim. To summarize and systematize the results of studies on the prevalence, diagnosis, clinical picture, vaccination and treatment of children with a new coronavirus infection COVID-19.

Materials and methods. PubMed searched articles published up to January 15, 2022 using combinations of the following words: COVID-19, SARS-CoV-2, children, pediatrics, adolescents, infants, and school. We read the abstracts of 101 articles and selected 78 articles based on their relevance to the topics discussed. We also analyzed 3 articles on vaccination of children. A total of 89 articles were included in the review.

Results. The SARSCoV-2 positivity rate throughout the peak of the pandemic in children was low compared to adults, including those who had an acute respiratory infection. Children are not only less likely to become infected with the virus, but they also carry the infection more easily than adults. The mortality rate in children with COVID-19 was < 0.5%. In most children, infection is either asymptomatic or accompanied by an erased clinical picture. Vaccination of children and adolescents is recommended mainly to achieve herd immunity in all age groups. However, there are no convincing data on the duration of the immune response, the level of the required protective antibody titer, as well as on the long-term side effects of vaccination due to the insufficient follow-up period and the uncertainty of the immune response criteria.

Conclusion. As information is accumulated on the viral load of children and adolescents, their role in the transmission of the virus, diagnostic approaches in this age group are optimized. The effectiveness of the treatment was tested on patients admitted to the hospital, and recommendations for treatment were developed. Currently, global research efforts are focused on the protection of especially vulnerable children, the prospects for total childhood vaccination, its effectiveness and safety. 

Background. One of the current problem of medicine in general and in clinical allergy is becoming urticaria, the incidence of which has been rapidly increasing in recent years. The incidence of urticaria reaches 5% in young children, and 3% in older children. The high frequency of occurrence of urticaria, as well as the variety of causative factors, various pathogenic mechanisms and different peculiarities of therapy make it possible to attribute urticaria to the category of important problems of modern medicine.

Objective. To study of the influence of trigger factors and comorbidities on the clinical course of urticaria in children of different ages.

Patients and Methods. The survey included 215 children with urticaria aged 3 months to 18 years who were hospitalized in the allergy department of the Institute of Maternal and Child Health in the period 2018–2021. To identify comorbid conditions, special questionnaires were filled out, which reflected the results of collecting data on the history of development and allergic history, as well as the results of using a complex of laboratory and instrumental studies. The etiological structure was confirmed using methods for analyzing the results of elimination samples, identifying specific IgE antibodies.

Results. Depending on age, the patients were divided into 4 groups. Group I included 18 children under the age of 1 year; in II — 82 patients aged 1 to 4 years; in III — 94 children aged 5–13 years and group IV included 21 children aged 14 to 18 years. 44% were girls and 56%, respectively, boys. It was found that the occurrence of an acute allergic reaction was associated with food sensitization in 55.5%, with increased sensitization to drugs in 28.5% (antibiotics, antipyretics). Specific IgE antibodies were found more often to citrus fruits, food additives, chocolate, raspberries, strawberries, peaches, honey, watermelon, melon and less often to fish, milk, eggs. In 20% of children, the etiological factor was not identified. Comorbid conditions were detected in 84% of cases, among which pathology of the gastroduodenal system, functional disorders of the hepatobiliary system and pancreas, acute respiratory viral infections, neurological pathology prevailed. Parasitic diseases were found in 33% of patients (intestinal giardiasis in 32 patients, campylobacteriosis in 25, ascariasis in 16, toxocariasis in 9 patients).

Conclusion. The identified features of the etiological structure and comorbid conditions in acute urticaria largely depend on the age of the children. Food sensitization prevails in the group of patients of early age. With age, there is an increase in cases of polyvalent sensitization and comorbid conditions. The most severe course of acute urticaria was noted in the group of patients with clinical manifestations of chronic gastroduodenitis with campylobacteriosis and parasitic diseases. It has been proven that comorbid conditions affect the clinical course and the effectiveness of the treatment of acute urticaria in childhood.

Introduction. Status epilepticus (SE) is a life-threatening neurological emergency requiring urgent medical intervention and is associated with high mortality and morbidity.

The aim: of this research was evaluation of clinical and etiological profile of refractory status epilepticus (RSE) among children aged between 1 month and 18 years.

Materials and methods. The study was done between January 1, 2017 and December 24, 2019. All children with the age limits mentioned above, who presented convulsive SE, subsequently with development in RSE, were included in the study. Patients were investigated and evaluated according to a standard protocol. Subsequently, the characteristics of children with RSE and those without an evolution in RSE were compared.

Results. In the study were enrolled 55 children, out of whom 32 boys with SE, of which 20 children (36%) developed RSE. The most common causes of SE and development of RSE were CNS infections (51% in SE and 53% in RSE, p > 0.05). As the second cause for evolution in RSE served noncompliance of antiepileptic medication. The overall mortality rate was 10.9%, the chances of death in RSE (20%) being higher than in SE (5.7%). In children with RSE the unfavorable prognosis was seven times higher, compared to children who developed SE (PR = 7.0; 95% CI:1.6–22.3).

Conclusions. Pediatricians should be aware of the high risk of developing RSE in the management of CNS infections. Adherence to the correct administration of antiepileptic medication should also be considered. In addition, the possibility of developing RSE should be considered and promptly managed in an intensive care unit in order to reduce the risk of mortality and morbidity of this severe neurological condition.

Background: Allergic diseases are recognized as a globally significant public health problem. According to the World Allergy Organization, globally, by 2025, the incidence of allergic diseases will reach 2.4 billion people. A high proportion of the increase in allergic diseases occurs in children and young people. The burden of allergic diseases is expected to increase significantly in the near future as these patients become adults.

Objective: To evaluate the features of medical care for children with allergic pathology and to identify the ways for improvement it in the Republic of Moldova.

Material and methods: The assessment of the state of allergic pathology among children was established on the basis of data from the National Center for Medical Statistics, and the activities of the department of pediatric allergy of the Institute of Mother and Child over the past 20 years were analyzed. An analysis was made of scientific research in the field of pediatric allergy over the past 20 years on the basis of the Institute of Mother and Child and the Department of Pediatrics of the State Medical and Pharmaceutical University after Nicolae Testemitanu. To assess the quality of personnel training, training programs at the level of pre- and postgraduate training of doctors were evaluated.

Results. Medical care for allergic children is provided at all levels, starting with the family doctor, pediatricians and allergists of consultative polyclinics and private centers, in district hospitals and at the tertiary level — in the consultative polyclinic and the Department of Pediatric Allergy of the Institute of Mother and Child. The inpatient care unit is deployed with 25 beds and has been operating for more than 35 years. About 67% of those hospitalized are patients in need of emergency care. Education on pediatric allergy is carried out on the basis of the department of allergy, where students, resident doctors, graduate students, and doctors are trained annually in continuing education courses.

Over the past 20 years, scientific research has been carried out in the field of diagnosis and treatment of food allergies, epidemiology using the international protocol ISAC (The International Allergy and Asthma in Childhood), the study of environmental determinants, integrated management of allergic diseases, atopic dermatitis. Studies have been conducted to assess the genetic risk factors for childhood asthma using the GMDR (Generalized Multifactor Dimensionality Reduction) Software. Molecular diagnostics of food allergy is carried out and the relationship with the quality of life of parents is determined, as well as the influence of psycho-emotional factors on the evolution of asthma in children.

Conclusions: Based on the research conducted is need to develop aNational Strategy forImproving the Management of Children with Allergic Pathology, which should include sections on improving clinical management of patients, improving the healthcare system and strengthening patient, family and community knowledge. Strengthening the participation of the general public, including the government, is essential. An important component is the improvement of communication skills among medical staff, the creation of websites for professionals and patients, and the observance of the rights of the child to access free and/or compensated diagnostics and treatment of allergic diseases in children.

Introduction. Klinefelter’s syndrome, the most common chromosomal abnormality with an incidence of 1 : 500–700 newborns with a male phenotype, is characterized by the additional presence of one (rarely several) X chromosome in boys.

The aim. Is to study the peculiarities of the clinical and cytogenetic polymorphism of Klinefelter Syndrome in different periods of ontogenetic development for an early diagnosis of children.

Material and methods. The study was performed on 73 children of pediatric age, selected during medical genetic counseling in the Center for Reproductive Health and Medical Genetics, having the following phenotypic selection criteria: developmental anomalies of the external genitalia — peno-scrotal hypospadias, micropenis, small testes, cryptorchidism, cranio-facial dysmorphism, waist high and disproportionate, hypogonadism, gynecomastia, mental retardation, psychosocial problems.

Results. Klinefelter’s syndrome was confirmed cytogenetically in 32 patients. The most common cytogenetic variant diagnosed was homogeneous free trisomy 47,XXY (28 cases—87.5%), followed by mosaic form (47,XXY/46,XY: 2 cases — 6.2%), polysomy X (variant 48,XXYY: 1 case — 3.1% and pentasomy — 49,XXXXY: 1 case — 3.1%). Most patients with variant 47,XXY classic and mosaic form showed mild to moderate mental retardation, language disorders with cognitive-verbal retardation, slow motor development, coordination disorders, immature behavior. In variants 48,XXYY and 49,XXXXY, moderate to severe mental retardation, severe cognitive-verbal retardation, severe behavioral problems. Most patients with Klinefelter Syndrome had been diagnosed in puberty (22 cases — 68.7%), 6 patients (18.7%) were diagnosed prepubertal, and only 4 patients (12.5%) were diagnosed during early childhood.

Conclusions: Early recognition of Klinefelter’s syndrome, with cytogenetic and phenotypic heterogeneity, allows the initiation of the correct treatment, the prevention of complications and the minimization of the negative psycho-social impact. The cytogenetic variant of Klinefelter syndrome correlates with the severity of the clinical picture, being directly proportional to the number of supernumerary X chromosomes.

Introduction. Early recognition of stroke in children involves rapid neurological consultation, hospitalization in stroke departments, to provide a management of diagnosis (brain imaging) and coherent etiological and pathogenetic treatment, to improve results. Research into the importance of immune markers in stroke has become current.

The aim. Purpose. Assessment of antiphospholipid antibodies (APA) in ischemic stroke (IS) in children to determine their role in early diagnosis and predictive factors of the disease.

Materials and methods. In 2017–2020, a prospective study was performed in the Republic of Moldova on 53 children with IS (study group — L.S.), in which, during the acute period of the disease, the serum levels (by ELIZA method) of APA were assessed. At the same time, this marker was appreciated in 53 children from the control group (L.C.).

Results. A mean level of 1.37 ± 0.046 U/ml in L.S. compared to the mean level of 0.92 ± 0.021 U/ml in L.C. In L.S. there was an increase of approximately 2.6 — fold increase in maximum APA values in children with stroke compared to LC, 1.7 — fold increase in mean and 1.6 — fold increase in minimum (F = 60,701, p < 0.001), which was suggestive of the presence of inflammation in children with acute stroke, but also of a state of hypercoagulability, attesting to the initiation of proactive thrombotic mechanisms for coagulation cascades and the promotion of cerebral ischemia.

Conclusions. A statistically significant difference can be observed between the groups included in the study, by increasing the APA level in children with IS. Thus, APA can be considered an important marker in the onset and severity of the cerebral ischemic process.