Differential Treatment Research Articles

Non-IgG4-Related Fibrosing Mediastinitis Diagnosed on Core Needle Biopsy and Treated with Steroids: A Case Study and Review of the Differential Diagnoses.

This study aimed to investigate the histological characteristics and treatment efficacy of non-immunoglobulin G4-related fibrosing mediastinitis and discuss differential diagnoses for this rare entity. We present a case study of non-immunoglobulin G4-related fibrosing mediastinitis diagnosed on core biopsy and treated with steroids. A total of four 18-gauge core needle biopsy specimens were obtained for surgical pathology. Analysis of the patient's medical history, radiological characteristics of fibrosing mediastinitis, histological features, immunohistochemistry results, the differential diagnosis and treatment efficacy of different types of fibrosing mediastinitis was performed. This report describes a unique presentation of fibrosing mediastinitis (syncope and weight loss) that was concerning for malignancy. Histological, laboratory and radiographical studies confirmed the diagnosis of non-immunoglobulin G4-related fibrosing mediastinitis. The patient received corticosteroid treatment which showed marked improvement after 1 month of treatment. Fibrosing mediastinitis is an extremely uncommon entity with unknown pathogenesis, and it is more important to rule out malignancy and infection than to delineate between fibrosing mediastinitis and IgG4-related disease. In doing this, we may reasonably initiate a trial of corticosteroids which may prove beneficial, as in this patient. More studies on the pathogenesis of fibrosing mediastinitis are necessary to guide better directed treatments.

A comparative study of cognitive function in young patients with bipolar disorder with and without non-suicidal self-injury

ObjectiveBipolar disorder (BD) is a chronic mental disorder characterized by alternating or mixed episodes of mania or hypomania and depression. Cognitive function impairment is a frequent associated feature of the disease. While many BD patients also engage in non-suicidal self-injury (NSSI), there is a lack of studies on the cognitive function of BD patients with NSSI. This study aimed to evaluate cognitive functioning of BD patients with NSSI and provide a clinical basis for the differential diagnosis and treatment of BD and NSSI. MethodsA total of 60 BD patients with NSSI, 60 BD patients without NSSI, and 60 healthy controls (HC) were selected for the study. All participants met the inclusion criteria and were not taking any medications, excluding the potential effects of medication on cognitive functions. The following neurocognitive tests were used to measure the cognitive functions in areas such as speed of processing, reasoning and problem solving, attention/vigilance, working memory, visual learning, and verbal learning: The Trail Making Test (TMT), Category Fluency, Digit Symbol Coding Test (DSCT), Brief Visuospatial Memory Test-Revised (BVMT-R), The Neuropsychological Assessment Battery Mazes (NABM), Wechsler Memory Scale Third Edition Spatial Span Test (WMS III-SST), Hopkins Verbal Learning Test-Revised (HVLTR) and Continuous Performance Test and Identical Prs (CPT-IP). ResultsThe findings indicated that BD patients with NSSI exhibited cognitive impairment in all measured cognitive domains. On the other hand, BD patients without NSSI showed less pronounced impairment in terms of speed of processing, but exhibited significant cognitive impairment in the remaining five areas compared to the HC group. ConclusionThe study underscores the presence of cognitive impairment in BD, and the cognitive impairment is more severe in BD patients with NSSI compared to those without NSSI. In conclusion, both individuals with NSSI and those without NSSI in BD exhibit cognitive impairment, which provides ideas and strategies for using cognitive-behavioral therapy to treat BD and NSSI.

Isolating the Drivers of Racial Inequities in Prostate Cancer Treatment.

Black individuals in the United States are less likely than White individuals to receive curative therapies despite a 2-fold higher risk of prostate cancer death. While research has described treatment inequities, few studies have investigated underlying causes. We analyzed a cohort of 40,137 Medicare beneficiaries (66 and older) linked to the Surveillance Epidemiology and End Results (SEER) cancer registry who had clinically significant, non-metastatic (cT1-4N0M0, grade group 2-5) prostate cancer (diagnosed 2010-2015). Using the Kitagawa-Oaxaca-Blinder decomposition, we assessed the contributions of patient health and health care delivery on the racial difference in localized prostate cancer treatments (radical prostatectomy or radiation). Patient health consisted of comorbid diagnoses, tumor characteristics, SEER site, diagnosis year, and age. Health care delivery was captured as a prediction model with these health variables as predictors of treatment, reflecting current treatment patterns. A total of 72.1% and 78.6% of Black and White patients received definitive treatment, respectively, a difference of 6.5 percentage points. An estimated 15% [95% confidence interval (CI): 6-24] of this treatment difference was explained by measured differences in patient health, leaving the remaining estimated 85% (95% CI: 74-94) attributable to a potentially broad range of health care delivery factors. Limitations included insufficient data to explore how specific health care delivery factors, including structural racism and social determinants, impact differential treatment. Our results show the inadequacy of patient health differences as an explanation of the treatment inequity. Investing in studies and interventions that support equitable health care delivery for Black individuals with prostate cancer will contribute to improved outcomes.

Racial Discrimination and Administrative Burden in Access to Public Services

Equal access to public services is a foundational element of democratic societies. Yet, stark inequalities in access to public services persist, partially due to bureaucratic discrimination, or differential treatment by bureaucrats. This study investigates the causal mechanism of bureaucratic discrimination, arguing that racial discrimination can serve as a means of cream skimming, when there are economic incentives to prioritize easier-to-serve clientele. We predict that in the absence of information regarding prospective clients’ performance, group-level performance information will be imposed on racially minoritized individuals. We implemented a nationwide email correspondence audit experiment including all charter school principals in the U.S. (n = 5850). The findings show that Black email aliases faced significantly higher administrative burdens in trying to get access to charter schools than White email aliases when no performance signal was provided. However, when a direct signal of clients’ performance was introduced, the racial disparities diminished. Overall, these results provide evidence on the causal mechanism of bureaucratic discrimination as a means of cream-skimming.

Intersections of gender and immigrant status in Japan: Analysis of the 2020 Basic Survey on Wage Structure

Economic integration of immigrants reflects a stratified structure of the receiving country’s labor market. Gender is one of the most important factors stratifying the labor market. While the intersection of gender and immigrant status in the labor market has been examined, a possibility that immigration policies intervene in it is understudied. This study examines how Japan’s restrictive immigration policies intervene in the gender wage gap by analyzing data from the 2020 Basic Survey on Wage Structure. Results show different gender wage gaps among immigrants according to their visa type. While those with job-related visas experience smaller wage disparity with their male counterparts than do Japanese women, those with status-based visas experience equally large wage disparity. Application of the decomposition method revealed that the large gender wage gap among status-based immigrants is caused by higher return to age for men than for women and different distributions of occupations by gender. While the constraints imposed by restrictive immigration policies on labor immigrants regarding their work mitigate the differential treatment of men and women, the gendered structure of the Japanese labor market maintains itself in the long-run through the process of integrating immigrants.

Paediatric sepsis survivors are resistant to sepsis-induced long-term immune dysfunction.

Sepsis-surviving adult individuals commonly develop immunosuppression and increased susceptibility to secondary infections, an outcome mediated by the axis IL-33/ILC2s/M2 macrophages/Tregs. Nonetheless, the long-term immune consequences of paediatric sepsis are indeterminate. We sought to investigate the role of age in the genesis of immunosuppression following sepsis. Here, we compared the frequency of Tregs, the activation of the IL-33/ILC2s axis in M2 macrophages and the DNA methylation of epithelial lung cells from post-septic infant and adult mice. Likewise, sepsis-surviving mice were inoculated intranasally with Pseudomonas aeruginosa or by subcutaneous inoculation of the B16 melanoma cell line. Finally, blood samples from sepsis-surviving patients were collected and the concentration of IL-33 and Tregs frequency were assessed. In contrast to 6-week-old mice, 2-week-old mice were resistant to secondary infection and did not show impairment in tumour controls upon melanoma challenge. Mechanistically, increased IL-33 levels, Tregs expansion, and activation of ILC2s and M2-macrophages were observed in 6-week-old but not 2-week-old post-septic mice. Moreover, impaired IL-33 production in 2-week-old post-septic mice was associated with increased DNA methylation in lung epithelial cells. Notably, IL-33 treatment boosted the expansion of Tregs and induced immunosuppression in 2-week-old mice. Clinically, adults but not paediatric post-septic patients exhibited higher counts of Tregs and seral IL-33 levels. These findings demonstrate a crucial and age-dependent role for IL-33 in post-sepsis immunosuppression. Thus, a better understanding of this process may lead to differential treatments for adult and paediatric sepsis.

In Case You Haven't Heard…

Can a wearable device change depression care? About one third of U.S. adults use a wearable device (for example, a smartwatch) to track their health and fitness, according to an APA Psychiatric News Alert news release. These devices — also known as “wearables”— capture a large amount of information that could be used one day to enhance how depression is diagnosed, monitored and treated, wrote Szymon Fedor, Ph.D., of the MIT Media Lab and colleagues from Massachusetts General Hospital in a review article in The New England Journal of Medicine. As the authors explained, the diagnosis and monitoring of depression today is based largely on symptoms reported by patients, which is subjective. However, wearables provide objective information by passively collecting physiological and behavioral information, that is, users do not need to input this information. “Complementing patient self‐reports, … measurements [from wearables] increase the information available for differential diagnosis or treatment planning,” they wrote. Additionally, “longitudinal measurements help establish patient‐specific behavioral and physiological baselines and support identification of personalized factors that result in deviations from these norms.” Data obtained from a patient's wearable could also influence how clinicians structure their time during visits with the patient, they continued. “In this proposed scenario, clinicians could use their limited time with patients more efficiently, gathering insights not provided by a wearable, thus forming a better therapeutic relationship and delivering personalized treatment.”

Proactive Customer Support: Re-Architecting A Customer Support/Relationship Management Software System Leveraging Predictive Analysis/AI and Machine Learning

This scholarly article explores the transformative evolution of customer relationship management (CRM) systems by integrating predictive analysis, artificial intelligence (AI), and machine learning. Traditional CRM systems exhibit weaknesses in areas such as customer privacy exploitation and differential treatment, necessitating a reevaluation of their foundational principles. Integrating advanced analytics and machine learning algorithms emerges as a strategic avenue for modernizing CRM, allowing organizations to anticipate customer needs, address issues proactively, and foster meaningful relationships. The paper details the re-architecting of CRM systems, emphasizing considerations for organizations transitioning from traditional to modern approaches. Scalability, flexibility, and adaptability are essential principles for ensuring CRM systems evolve with dynamic customer needs. The article also addresses the challenges and ethical considerations of integrating predictive analysis and AI into CRM, emphasizing responsible data practices and transparent decision-making processes. Furthermore, the paper projects future trends in CRM evolution, outlining the significance of automation, personalization, reliance on AI, and social media integration. The convergence of these trends is poised to redefine customer experiences, creating a landscape where hyper personalization and seamless omnichannel interactions are the norm. In conclusion, the transformative evolution of CRM systems extends beyond technological upgrades to encompass a strategic shift in organizational culture and customer-centricity. By embracing the potential of predictive analysis, AI, and machine learning, organizations can navigate challenges, ensuring CRM remains committed to genuine customer satisfaction, trust, and enduring partnerships.

Excluded workers and exempted employers: A qualitative study on domestic workers' access to social protection in the Netherlands

AbstractIn the Netherlands, many part‐time domestic workers fall within the scope of a particular type of labour law, that gives them fewer social protection rights and that renders private actors (households and workers) responsible for exercising those rights. Over the years, this policy has been criticised for institutionalising the differential treatment of domestic workers, which goes against ideas propagated in international initiatives, like the European Pillar of Social Rights. This contribution explores Dutch domestic workers' access to social protection in greater detail. Drawing on semi‐structured interviews with 30 domestic workers, we show that the actual access to social protection greatly varies over different workers and over different employment relationships of individual workers, but generally falls below par. Our findings indicate that this is partly due to the fact that the Dutch policy option underestimates domestic workers' wariness of placing demands on the households they work for, which raises questions over the desirability of non‐mediated employment relationships in the sector. We conclude with a brief discussion and suggestions for future policy directions.

Кашлевая головная боль: клиника, диагностика, лечение

Cough headache can be primary, characterized by a benign course, or symptomatic, resulting from pathologies of the posterior cranial fossa structures. According to the latest classification of the International Headache Society (IHS), primary cough headache is included in the «other primary headaches» registry and is defined as headache provoked by coughing, sneezing, or straining during defecation in the absence of any intracranial disorders. Symptomatic cough headache due to Chiari malformation is considered under the rubric of «headache associated with nonvascular intracranial lesions» and classified as headache associated with Chiari malformation type I. Different types of cough headaches require careful differential diagnosis and different treatment approaches.

Cutaneous Metastases as an Initial Presentation of Neo Infiltrative Process in the Lungs: Case Report and Literature Review

Cutaneous metastases are a rare clinical entity with a representation of about 0.8% as a secondary MS deposit originating from another tissue/organ. Most often, skin metastases are associated with a high degree of malignancy and a poor prognosis. Our case report is a 72-year-old male patient who was referred to CT because of a large soft-tissue cutaneous lesion of the upper right hemithorax, somewhere below the right shoulder joint. At the radio diagnostics department, an MDCT native series and series after i.v. contrast was performed, which allowed us to detect a neo infiltrative process of the lung and secondary deposits in the lung itself, liver, left adrenal gland and along the seventh rib on the left. It was recommended to perform bronchoscopy and biopsy of the lung tissue, for the purpose of further differentiation and further treatment. A pathohistological analysis of the skin change itself was carried out, with an answer for a finding that corresponds to a deposit of a malignant neoplasm with spinous differentiation.

Data-derived subtypes of delirium during critical illness

To understand delirium heterogeneity, prior work relied on psychomotor symptoms or risk factors to identify subtypes. Data-driven approaches have used machine learning to identify biologically plausible, treatment-responsive subtypes of other acute illnesses but have not been used to examine delirium. We conducted a secondary analysis of a large, multicenter prospective cohort study involving adults in medical or surgical ICUs with respiratory failure or shock who experienced delirium per the Confusion Assessment Method for the ICU. We used data collected before delirium diagnosis in an unsupervised latent class model to identify delirium subtypes and then compared demographics, clinical characteristics, and outcomes between subtypes in the final model. The 731 patients who developed delirium during critical illness had a median age of 63 [IQR, 54-72] years, a median Sequential Organ Failure Assessment score of 8.0 [6.0-11.0] and 613 [83.4%] were mechanically ventilated at delirium identification. A four-class model best fit the data with 50% of patients in subtype (ST) 1, 18% in subtype 2, 17% in subtype 3, and 14% in subtype 4. Subtype 2-which had more shock and kidney impairment-had the highest mortality (33% [ST2] vs. 17% [ST1], 25% [ST3], and 17% [ST4], p=0.003). Subtype 4-which received more benzodiazepines and opioids-had the longest duration of delirium (6 days [ST4] vs. 3 [ST1], 4 [ST2], and 3 days [ST3], p<0.001) and coma (4 days [ST4] vs. 2 [ST1], 1 [ST2], and 2 days [ST3], p<0.001). Each of the four data-derived delirium subtypes was observed within previously identified psychomotor and risk factor-based delirium subtypes. Clinically significant cognitive impairment affected all subtypes at follow-up, but its severity did not differ by subtype (3-month, p=0.26; 12-month, p=0.80). The four data-derived delirium subtypes identified in this study should now be validated in independent cohorts, examined for differential treatment effects in trials, and inform mechanistic work evaluating treatment targets. National Institutes of Health (T32HL007820, R01AG027472).

Indigenous zoom: Impact of the implementation of the School Feeding Program for Indigenous Peoples in Colombia on enrollment

Considering the socioeconomic and cultural heterogeneity of the Colombian population, which leads to lower access and permanence in the educational system of indigenous children and youth, the National Government has developed a feeding program with a differential approach for these students. Although the World Bank (2022) developed an analysis of the implementation of the School Feeding Program for Indigenous Peoples (PAEPI – because of the initials in Spanish –), its impact has not yet been evaluated. Hence, this article seeks to fill this gap by establishing whether the implementation of this program had a positive impact on the enrollment of indigenous students. For this purpose, a Difference-in-Differences model was estimated with data from 24 departments during the period 2017-2021. Although it was found that the impact of the PAEPI on indigenous enrollment is not statistically significant, the article provides evidence of the potential effect that this policy can have, since it showed a positive impact on indigenous enrollment. Thus, these findings support the idea that adopting differential treatments can enhance the impact of public policies.

성격에 따른 일중독이 직무만족에 미치는 영향

Purpose - The purpose of this study is to determine the impact of workaholism according to personality on the job satisfaction of organizational members.&#x0D; Design/methodology/approach - Workaholism was defined as excessive working and compulsive work, suggesting a negative impact on job satisfaction, while predicting that conscientiousness would alleviate this effect and presented as a hypothesis. The unbalanced panel data constructed based on 19,283 samples of 6,863 people from the Korea Labor Institute's Korea Labor Panel Survey was used.&#x0D; Findings - Both excessive working and compulsive working were found to have a direct negative effect on job satisfaction. Additionally, as a result of verifying the interaction effect of conscientiousness, it was found that the negative impact of excessive work on job satisfaction was moderated and alleviated by conscientiousness. In other words, for employees with high conscientiousness, the negative impact of excessive work on job satisfaction is alleviated and the negative impact of overworking is offset, whereas for employees with low conscientiousness, the negative impact of overworking on job satisfaction is strengthened.&#x0D; Research implications or Originality - This study shows that the impact of workaholism on job satisfaction varies depending on personality. While existing research has treated personality only as a determinant of workaholism, this study contributes to previous research in that it expands the role of personality. In addition, in practical terms, it is suggested that differential treatment based on individual values or personality is necessary.

Sin Stocks and SEC Filing Reviews

In this study, we examine whether and how SEC regulators adjust their oversight processes when there are conflicting risks, specifically among sin stock firms operating in potentially controversial industries, such as alcohol, gaming, and tobacco. On the one hand, we would expect increased scrutiny from SEC staff if they believe that companies willing to offer these sin-related products and services are more likely to skirt SEC disclosure guidelines. On the other hand, if the SEC staff leverage the additional scrutiny these firms are already subjected to from investors, industry regulators, and auditors, we would expect decreased scrutiny from SEC staff. Consistent with the latter, we observe that the SEC is less likely to issue comments on the annual report of sin stock firms. Among those receiving a comment letter, there are no statistically significant differences in rigor or tone, on average. In additional analyses, we find limited evidence that specific reviewer characteristics are associated with differential treatment for sin stock firms in terms of rigor. Finally, we find that among firms that did not receive a comment letter, sin stock firms are less likely to restate their financial statements in the future. Collectively, we interpret this evidence as the SEC efficiently reducing scrutiny on sin stock firms, relative to non-sin stock firms, during the earlier phases of the review process, with minimal differences in the later phases of the review process.

평등심사의 구조와 단계

The essence of equality lies in comparison, and comparison is carried out in relation to the treatment of objects under comparison. There may or may not be inherent differences between objects under comparison and in the treatment of these objects. If there is no inherent difference between objects under comparison, identical treatment should be applied to such objects under comparison. On the other hand, if there is an inherent difference between objects under comparison, differential treatment should be applied to them. If one wants to justify providing differential treatment to comparison subjects when there is no inherent difference among them, or identical treatment when there is an inherent difference, one must present a rational reason for such justification. According to the structure of equality assessment, the stages of equality assessment are composed of ① verifying the existence of differences between objects under comparison, ② verifying the existence of differences in treatment towards objects under comparison, and ③ confirming the presence of rational reasons to justify discrepancies when there is inconsistency between the differences among objects under comparison subjects and the differences in treatment towards them.&#x0D; The structure and stages of equality assessment can be applied to evaluate decisions of the Constitutional Court in cases where only males are subjected to mandatory military service or in cases allowing only females to enroll in law schools or pharmacy colleges. In the case of military service, the debate may revolve around whether there is an inherent difference between males and females, who are the objects under comparison. However, in the context of academics, the question of whether there is an inherent difference between males and females, who are the objects under comparison, may not be a subject of debate. Instead, the controversy may arise regarding whether the 5% differential treatment observed in law schools and the approximately 18% differential treatment observed in pharmacy colleges constitutes an inherent difference. In cases related to military service, if there is no inherent difference between males and females, a rational reason must be provided to justify the differential treatment of imposing mandatory military service only on males. For females, the potential double disadvantage of handling both academic responsibilities and military service, given potential interruptions due to pregnancy and childbirth, could be presented as a rational reason. Regarding academics, if there is an inherent difference in the treatment of males and females who are the objects under comparison, a rational reason must be presented to justify such unfavorable treatment. The historical disadvantage faced by females in legal and pharmaceutical professions could be presented as a rational reason.

Complete Revascularization Strategies in Women and Men With Acute Coronary Syndrome and Multivessel Disease

This prespecified substudy of the randomized BIOVASC trial aimed to compare immediate complete revascularization (ICR) and staged complete revascularization (SCR) in patients with ACS and MVD, stratified by sex. The primary endpoint consisted of a composite of all-cause mortality, myocardial infarction, unplanned ischemia driven revascularization (UIDR) and cerebrovascular events at 1 year follow-up. Secondary endpoints included the individual components of the primary composite and major bleedings. We used Cox regression models to relate randomized treatment with study endpoints. We evaluated multiplicative and additive interactions between sex and randomized treatment. The BIOVASC trial enrolled 338 women and 1187 men. Women were older than men (median 71.6 vs. 63.7 years, p<0.001) and had a higher prevalence of COPD (10.1% vs. 5.6%, p=0.003), renal insufficiency (7.7% vs. 4.4%, p=0.015) and hypertension (60.4% vs. 51.7%, p=0.005). In women, the composite primary outcome occurred in 7.3% vs. 12.9% (hazard ratio [HR] 0.53, 95% confidence interval [CI] 0.26 to 1.08) in patients randomized to ICR and SCR respectively and in men in 7.7% vs. 8.4% (HR 0.89, 95% CI 0.60 to 1.34), with no evidence of a differential effect (interaction pmultiplicative = 0.20, padditive = 0.87). No evidence of heterogeneity between women and men was found when comparing ICR with SCR in terms of the secondary outcomes. In conclusion, no differential treatment effect was found when comparing immediate complete revascularization versus staged complete revascularization in women or men presenting with ACS and MVD.

The integrated sphere of coopetition of digital services and the regulatory approach of diagonal equity

Telecommunications Service providers (TSPs) and Content and Application Providers (CAPs) that operate over the Internet are traditionally regarded as complementary. However, the growth of 5G technologies has led to the emergence of an integrated sphere of competition and cooperation between TSPs and CAPs.The new elements of this competitive landscape stem from the hybridization of network provisioning, the growth of substitute services, and the emergence of end to end value networks comprising of devices, connectivity solutions, and a variety of content and application services. Simultaneously, the regulatory drivers that occasioned a differential treatment of TSP in their role as providers of essential utility communication services are converging with the features observed with respect to certain CAPs. These dynamics warrant the application of a new regulatory framework in the form of Diagonal Equity, that recognizes the need for similar regulatory principles to be applied to TSPs and CAPs, while acknowledging that with respect to certain issues a differential treatment will continue to be required.

Differential diagnosis and treatment of idiopathic occipital epilepsy and visual seizures in an adolescent case: Is “hallucination” always “hallucination”?

Epilepsy is the most common childhood neurological disorder that affects 0.5 to 1.0 % of children younger than 16 years of age. Cognitive and behavioral impairments as well as various psychiatric and neurodevelopmental disorders can accompany this condition. Among children and adolescents, occipital epilepsy can be easily overlooked because it can mimic other epileptic syndromes and symptoms may be subtle. The initial complaint of a patient suffering from occipital epilepsy could be visual hallucinations. Child and adolescent psychiatrists must be aware of the difference between these neurological-originated hallucinations and others denoting psychopathologies.

Діагностика та лікування позалікарняної пневмонії в дітей дошкільного віку: проблеми та дискусійні питання

Community-acquired pneumonia remains one of the most common diseases in preschool children, but despite the intensive study of this pathology, in the practice of a primary care physician, the issue of differential diagnosis and treatment of viral and bacterial pneumonia causes certain problems. The aim of the study is to determine the problems existing in the practice of a primary care physician regarding the diagnosis and treatment of community-acquired pneumonia in preschool children, to determine ways to solve them, using data from domestic and foreign literature. Modern clinical guidelines for the diagnosis and treatment of community-acquired pneumonia in preschool children at the ambulatory stage were reviewed and analyzed. Med Line, Embase, Web of Science and Scopus databases were analyzed to search for literature sources. Modern epidemiological data on viral and bacterial pneumonia in preschool children are presented. The issue of the role of clinical manifestations and paraclinical research methods in their differential diagnosis is covered. In the context of the problem, an integrated approach to the diagnosis of viral and bacterial pneumonia, which is based on the determination of clinical signs and symptoms, is recommended. Special attention is paid to the issue of the treatment of community-acquired pneumonia in preschool children. A comparative description of the recommendations of national and foreign guidelines and generalized retrospective analyzes regarding the advisability of prescribing and cancelling antibiotics is given. Wider implementation of etiological examination using modern methods is recommended. Conclusions. The final decision regarding the diagnosis of viral or bacterial pneumonia in each specific case should be based on the totality of the anamnesis data, clinical signs and symptoms. The implementation of integrated management of preschool children into the practice of a primary care physician will allow determining the probability of the etiology of pneumonia without auxiliary methods of examination and prescribing empirical therapy during the initial examination. The authors declare no conflict of interest.