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Background: Respiratory viral infections may be associated with high morbidity and mortality among immunosuppressed children. Our aim was to characterize clinical course and epidemiology of respiratory infections suspected as viral among children treated in a single hematology-oncology department in a tertiary hospital. Methods: Prospective, observational study during 1.10.2014–1.10.2015. All children with respiratory infection event in the Pediatric Hematology-oncology department at the Ruth Rappaport Children Hospital, Haifa, who were tested for respiratory viruses, were included. Collected data included signs and symptoms, pathogens, background disease, epidemiological characteristics, complications and duration of illness. Viruses were detected by molecular methods. Results: 159 events were observed among 102 children (55 males). Age range: 3 months-19 years. Single event was observed in 62%. In 79 events (50%) a respiratory virus was detected. Children who underwent allogeneic bone marrow transplantation had more events compared with those with other diseases (58% vs. 32%, p = 0.018). Viral detection was positively associated with symptoms of cough and rhinitis (p

Owing to the COVID-19 outbreak in Lombardy, Italy) there is an urgent need to manage cardiovascular emergencies, including acute coronary syndrome (ACS), with appropriate standards of care and dedicated preventive measures and pathways against the risk of SARS-CoV-2 infection. For this reason, the Government of Lombardy decided to centralize the treatment of ACS patients in a limited number of centers, including our university cardiology institute, which in the past 4 weeks became a cardiovascular emergency referral center in a regional hub-and-spoke system. Therefore, we rapidly developed a customized pathway to allocate patients to the appropriate hospital ward, and treat them according to ACS severity and risk of suspected SARS-CoV-2 infection. We present here the protocol dedicated to ACS patients adopted in our center since March 13, 2020, and our initial experience in the management of ACS patients during the first 4 weeks of its use. Certainly, the protocol has room for further improvement as everyone's experience grows, but we hope that it could be a starting point, adaptable to different realities and local resources.

The effect of indoor airflow has been confirmed on the diffusion and transmission of droplets generated when talking or sneezing by a person with a viral respiratory infection such as COVID-19. The present study to investigate the effect of airflow in an indoor environment (a classroom) on the distribution and transmission of droplets emitted from speaking and cough by an infected person. A numerical analysis to investigate the persistence and deposition of particles on the surfaces of desks and the faces of residents (teacher and students) under various scenarios, including the opening of windows. This study puts forward two types of conditions while the teacher is speaking and the cough of some students for the distribution of pathogenic particles. Computational Fluid Dynamics used to conduct the study, using the Euler-Lagrange approach to capture the transport of the particles, and the RANS equations to compute the airflow field in the classroom. The results indicate the significant effect of air conditioning and open window close to the infected person in reducing environmental pathogens. Moreover, the concentrations of virus particles increase greatly near the output; hence, the presence of people in these areas increases the risk of contracting the disease. Furthermore, when all the windows are closed, due to the low output capacity, the particles spread in all areas of the domain and increase the risk of infection. Therefore, it is recommended that the window be open in indoors environment especially the window next to the speaker., Graphical abstract Image 1

Background:\ud \ud Molecular assays are the gold standard methods used to diagnose viral respiratory pathogens. Pitfalls associated with this technique include limits to the number of targeted pathogens, the requirement for continuous monitoring to ensure sensitivity/specificity is maintained and the need to evolve to include emerging pathogens. Introducing target independent next generation sequencing (NGS) could resolve these issues and revolutionise respiratory viral diagnostics.\ud \ud Objectives:\ud \ud To compare the sensitivity and specificity of target independent NGS against the current standard diagnostic test.\ud \ud Study design:\ud \ud Diagnostic RT-PCR of clinical samples was carried out in parallel with target independent NGS. NGS sequences were analyzed to determine the proportion with viral origin and consensus sequences were used to establish viral genotypes and serotypes where applicable.\ud \ud Results:\ud \ud 89 nasopharyngeal swabs were tested. A viral pathogen was detected in 43% of samples by NGS and 54% by RT-PCR. All NGS viral detections were confirmed by RT-PCR.\ud \ud Conclusions:\ud \ud Target independent NGS can detect viral pathogens in clinical samples. Where viruses were detected by RT-PCR alone the Ct value was higher than those detected by both assays, suggesting an NGS detection cut-off – Ct = 32. The sensitivity and specificity of NGS compared with RT-PCR was 78% and 80% respectively. This is lower than current diagnostic assays but NGS provided full genome sequences in some cases, allowing determination of viral subtype and serotype. Sequencing technology is improving rapidly and it is likely that within a short period of time sequencing depth will increase in-turn improving test sensitivity.

Background Viral respiratory infection has long been known to influence the occurrence of asthma exacerbations. Over the last 20 years much effort has been put into clarifying the role that viral respiratory infections play in the eventual development of asthma. Scope of review In this review we give a general background of the role of viruses in the processes of asthma exacerbation and asthma induction. We review recent additions to the literature in the last 3 years with particular focus on clinical and epidemiologic investigations of influenza, rhinovirus, bocavirus, respiratory syncytial virus, and metapneumovirus. Major conclusions The development of asthma emerges from a complex interaction of genetic predisposition and environmental factors with viral infection likely playing a significant role in the effect of environment on asthma inception. This article is part of a Special Issue entitled: Biochemistry of Asthma. General significance Further understanding of the role that viruses play in asthma exacerbation and inception will contribute to decreased asthma morbidity in the future. This article is part of a Special Issue entitled: Biochemistry of Asthma.

Summary Acute viral bronchiolitis remains a cause of substantial morbidity and health care costs in young infants. It is the most common lower respiratory tract condition and most common reason for admission to hospital in infants. Many respiratory viruses have been associated with acute viral bronchiolitis although respiratory syncytial virus (RSV) remains the most frequently identified virus. Most infants have a mild self limiting illness while others have more severe illness and require hospital admission and some will need ventilatory support. Differences in innate immune function in response to the respiratory viral insult as well as differences in the geometry of the airways may explain some of the variability in clinical pattern. Young age and history of prematurity remain the most important risk factors although male gender, indigenous status, exposure to tobacco smoke, poor socioeconomic factors and associated co-morbidities such as chronic lung disease and congenital heart disease increase the risks of more severe illness. Supportive therapy remains the major treatment option as no specific treatments to date have been shown to provide clinically important benefits except for inhaled hypertonic saline. Prophylaxis of high risk infants with palivizumab should be considered although the cost effectiveness is still unclear. Many questions remain regarding optimal management approaches for infants requiring hospitalisation with bronchiolitis including use of nasogastric feeding, the optimal role of supplemental oxygen, optimal use of hypertonic saline and the role of combinations of therapies, the use of heliox or modern physiotherapy approaches.

Resumen La infección respiratoria aguda es la enfermedad más frecuente a lo largo de toda la vida del ser humano, con una variación en cuanto a su etiología condicionada, fundamentalmente, por la edad, las circunstancias medioambientales, el ámbito asistencial y la enfermedad de base. Se han identificado más de 200 virus diferentes distribuidos en seis familias implicados en la patogenia de las infecciones del tracto respiratorio. Estos hechos generan una demanda diagnóstica, cuya incorporación al ámbito asistencial no debe ser retrasada. Consciente de ello la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica ha redactado un procedimiento sobre diagnóstico microbiológico de las infecciones virales respiratorias. En éste se efectúa una puesta al día de las infecciones debidas, en primer término, a los virus de la gripe y, en segundo lugar, a otros virus respiratorios convencionales y emergentes. En todos los casos se revisan los métodos de diagnóstico virológico directo (cultivo celular, detección de antígenos y de ácido nucleico), con particular referencia a las técnicas de detección molecular y de caracterización genética.

Resume La bronchopathie chronique obstructive est une maladie heterogene dans sa distribution anatomique et sa severite. Le seul facteur genetique identifie dans sa pathogenie est le deficit en alpha1-antitrypsine que l'on rencontre dans moins de 1 % des sujets atteints de cette maladie. L'exposition a des facteurs deleteres environnementaux semble egalement determinant, mais seulement 15 % des fumeurs developperont une bronchopathie chronique obstructive. La prevalence de la bronchopathie chronique obstructive augmente dans les pays industrialises et comme dans l'asthme, cela suggere une influence genetique avec une modification de l'expression phenotypique secondaire a une interaction genes–environnement. L'origine pediatrique des maladies obstructives de l'adulte est fortement etayee par differentes etudes epidemiologiques. Pour cette hypothese on peut retenir : (1) l'augmentation de la prevalence de l'asthme uniquement dans les tranches d'âge les plus jeunes, (2) la persistance a l'âge adulte de certains asthmes de l'enfant, (3) le risque evolutif des infections respiratoires virales de la petite enfance vers une bronchopathie chronique obstructive, (4) la transmission familiale du phenotype fonctionnel de certaines formes de bronchopathie chronique obstructive de l'adulte.

The many therapeutic options for asthma can confuse both physicians and patients. Great emphasis has been placed on maintenance medication, particularly inhaled corticosteroids (ICS), which are the most effective medication for patients with persistent symptoms. However, asthma in young children is most commonly intermittent, triggered almost exclusively by viral respiratory infections (VRI). It is, nevertheless, associated with the highest rate of hospitalization of any age. Conventional doses of ICS do not prevent exacerbations of VRI-induced asthma. In contrast, intervention with oral corticosteroids during exacerbations has been shown to prevent the progression that would otherwise require urgent care or hospitalization. An oral corticosteroid kept on hand by the patient permits initiation of more prompt and effective treatment than is likely to occur when a patient must first go to a physician's office or emergency department, because it can be given as soon as the response to bronchodilator therapy is incomplete. Monitoring by phone and regularly scheduled physician visits to review the clinical course and reinforce education can then replace urgent medical care, thereby improving the quality and efficacy of asthma management. (J Pediatr 2003;142:S34-S39)

In asthmatic children with persistent symptoms, maintenance therapy with nedocromil sodium, inhaled corticosteroids, or montelukast is associated with a decreased rate of asthma exacerbations. The greatest benefit is seen with use of regular inhaled corticosteroids in preschool- or school-age children, in whom asthma exacerbations, the need for rescue oral corticosteroids, unscheduled urgent medical visits, and hospitalizations are all decreased by approximately 50%. However, maintenance therapy is not beneficial in children with intermittent respiratory virus-induced wheezing without persistent symptoms. (J Pediatr 2003;142:S21-S25)

We report clinical characteristics and outcome of infants

DEFINITIONS of ‘asthma’ remain unsatisfactory. Patients and their doctors commonly use the word to mean intermittent wheezy breathlessness with or without cough or phlegm. This condition can be triggered by a wide variety of agents which induce the wheezy symptoms in a number of different ways, so that definitions based either on particular causes or upon mechanisms of bronchial narrowing are unsatisfactory because they are either unwieldy or incomplete. One practical way of defining asthma within our inadequate state of knowledge is in terms of function, as an increase of airways resistance which is completely or partially reversible either spontaneously or as a result of treatment. It is accepted that this definition includes clinical disorders such as those seen in children who wheeze with bacterial or viral respiratory infection and those in adults with acute or chronic bronchitis (defined in terms of cough and expectoration) who can be shown to have a variability in airways resistance. A major problem in the diagnostic use of the word ‘asthma’ is its differentiation from chronic bronchitis: many patients have features common to both conditions, and so long as asthma is defined in terms of function and bronchitis in terms of symptoms (chronic cough and sputum), a logical clear cut differentiation is impossible. Overlapping features are not, however, found in all patients, and it remains possible to identify typical patients who have a dominant history of