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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

Children born preterm are at risk of hospital admission for respiratory infection in the first years of life. Vitamin D deficiency has been associated with increased risk of developing lower respiratory tract infection (LRTI). We assessed vitamin D levels in children born preterm admitted to the hospital ward or pediatric intensive care unit (PICU) with viral LRTI. A prospective observational cohort study was conducted over 3 years that enrolled 87 children3 years of age, born37 weeks of gestation. Children were enrolled in the ward and PICU if they had a diagnosis of LRTI with confirmed viral testing. Children seen in the outpatient clinic for well-child care were enrolled as study controls. Vitamin D and cathelicidin levels were measured and associations between vitamin D, cathelicidin, and admission sites were tested. Vitamin D levels were lower in children admitted to the PICU when compared to controls (28 ng/mL versus 36 ng/mL

Mortality from COVID-19 has been particularly high in elderly patients on mechanical ventilation. Treatment outcomes for patients with do-not-intubate (DNI) status are unknown. One hundred patients admitted to the non-ICU ward during the “first wave” were retrospectively analyzed. Mortality rate was 49% in patients with a DNI order. This subgroup was characterized by significantly higher age, more comorbidity, and care dependency. Mortality among DNI patients was three times higher than other patients, but not higher than some of the published mortality rates for elderly mechanically ventilated patients. Advanced care planning is essential in COVID-19 to assist patient autonomy and prevent non-beneficial medical interventions.

Coronavirus disease 2019 caused one of the largest health crises ever known. It is primarily defined as a viral respiratory infection, and the symptomatology can take various forms, particularly among the elderly population, who are most at risk of severe disease. Despite rapid scientific advances, therapeutics unfortunately are still very limited, especially for this category of patients. The priority is therefore to adopt and comply with preventive measures as far as possible, while awaiting possible progress.

Background and Purpose: Acute viral respiratory infections (ARTIs) are among the most common reasons for a healthcare encounter throughout the industrialized world. Among the approximately100 million antibiotic prescriptions written every year for ARTI, half are prescribed inappropriately. Inappropriate antibiotic prescribing for viral illnesses poses a serious threat since many organisms have become resistant to commonly used antibiotics. The aim of this study was to develop an ARTI treatment protocol in accordance with current practice guidelines to decrease the number of inappropriately prescribed antibiotics in a primary care health clinic. Methods: Patient subjects were obtained using convenience sampling and data collection was completed using ICD queries in the clinic’s EHR system. A retrospective chart review analyzing antibiotic prescribing practices was conducted pre- and post- implementation of an educational session detailing current ARTI practice guidelines. Conclusions: The results of this project showed clinical significance in that clinician education, focused on ARTI current practice guidelines and attentiveness in antibiotic prescription practices, reduced antibiotic use for viral ARTIs by 12.0%. Implications for Practice: Clinician education and implementation of current practice guidelines for ARTI will assist clinicians decrease both the unnecessary adverse effects of antibiotics, as well as the threat of antibiotic resistance.

OBJECTIVE To evaluate the utility of procalcitonin (PCT) in identifying cobacterial pneumonia in pediatric patients with known viral respiratory infection.METHODS A retrospective cohort study was conducted in a stand-alone children's hospital during 2 time periods (period 1: October 1, 2014, to March 31, 2015; period 2: October 1, 2015, to March 31, 2016). Patients admitted with any upper respiratory tract infection were included. Exclusion criteria included any condition compromising lung function, age 18 years, or lack of PCT (period 2). PCT values of 1.5 ng/mL were used to identify cobacterial pneumonia. Receiver-operator characteristic curves were used with multiple logistic regression to evaluate patient variables.RESULTS Of the 374 pediatric patients evaluated, 64% were classified as having viral pneumonia and 23% as having cobacterial pneumonia across both study time periods. Non-significant predictors of cobacterial pneumonia included temperature (p = 0.0795, p = 0.1466), WBC count (p = 0.8774, p = 0.6675), and C-reactive protein (p = 0.7115, p = 0.3835). Median initial PCT for patients with viral pneumonia was 0.14 ng/mL compared with 1.41 ng/mL in patients with cobacterial pneumonia; median second PCTs were 0.26 ng/mL (viral pneumonia) and 4.55 ng/mL (cobacterial pneumonia). Patients with an elevated PCT had 17.5 times (95% CI, 5.2, 59.1) greater odds of having a cobacterial pneumonia.CONCLUSIONS PCT was found to be strongly associated with cobacterial pneumonia with an underlying viral etiology. Temperature, WBC, and C-reactive protein failed to be significant predictors in differentiating between viral and cobacterial pneumonia.

History of heart transplantation in combination with immunosuppressive therapy and acute viral respiratory infection overlay makes the patient difficult to manage. In case of COVID-19, the setting is complicated by unknown pathogenesis, including its effect on blood, coagulation system, and lung tissue. Current case report discusses the 60-year-old patient with a COVID-19 infection occurred in the immediate postoperative period after heart transplantation.

OBJECTIVE: To investigate the relationship of overnutrition (obese and overweight) with severity of illness in children hospitalized with acute lower respiratory infections (ALRIs), frequency of viral coinfections and leptin levels. METHODS: We studied 124 children

INTRODUCTION: We report the results of the active surveillance of influenza infections in hospitalized patients and the evaluation of the seasonality and correlation with temperature and rainfall data. METHODS: During the 2-year study period, 775 patients were tested for 15 respiratory viruses (RVs). RESULTS: Most of the 57% of (n=444) virus-positive samples were human rhinovirus and respiratory syncytial virus. However, 10.4% (n=46) were influenza virus (80% FluA; 20% FluB). Age and SARI were significantly associated with influenza. FluB circulation was higher is 2013. CONCLUSIONS: In the post-epidemic period, influenza remains an important cause of hospitalization in SARI patients.

We investigated the effect of annual winter visitor restrictions on hospital respiratory virus transmission. The healthcare-associated (HA) viral respiratory infection (VRI) transmission index (number of HA VRIs per 100 inpatient community-associated VRIs) was 59% lower during the months in which visitor restrictions were implemented. These data prompt consideration for instituting year-round visitor restrictions.

Problem Human parainfluenza virus (hPIV) is an important pathogen in respiratory infections, however the health burden of hPIV is underestimated. This study describes the infections by hPIV1‐3 in Rio Grande do Sul, Brazil, from 1990 to 2017, providing data of the frequency and seasonality of cases and associated clinical symptoms. Method of study Nasopharyngeal samples of patients with respiratory infection were collected, clinical data were analyzed, and immunofluorescence was used to detect hPIV. Results Respiratory viruses were detected in 33.63% of respiratory infections. In a total of 11 606 cases of viral respiratory infection, 781 were positive for hPIV; hPIV prevalence ranged from 2.14% to 27% of viral respiratory infections. hPIV1 circulates mainly during fall; hPIV3 circulation, in turn, starts in fall and peaks during spring; and cases of hPIV2 are reported along the year, with peaks in fall and early spring. The most affected age group was children, with hPIV prevalence of 74.23% in patients for less than 1 year. A higher proportion of girls were infected than boys, however, no difference by sex was observed considering all age groups. The most frequent type was hPIV3, especially in hospitalized patients. Both hPIV1 and 3 were associated with dyspnea, while hPIV2 caused mild symptoms mainly in nonhospitalized patients. Nineteen fatalities occurred, 89.5% of them associated with risk factors (prematurity; chronic diseases; age, 60 years). Conclusion hPIV causes a high number of respiratory infections, leading to hospitalization especially in children; epidemiological and surveillance studies are important for the control and management of respiratory infections., Highlights Parainfluenza viruses circulate throughout the year and cause severe acute respiratory infection in children.hPIV1 and 3 infections are associated with dyspnea and hospitalization.hPIV2 infection causes mild symptoms.

Cough is a forced expulsive manoeuvre, usually against a closed glottis and is associated with a characteristic sound that is easily recognised. It is a protective reflex against aspiration and to clear airway secretions. In children cough is extremely common and when prolonged it is often a cause for concern for parents, resulting in a high proportion of attendances to primary and secondary care. There are many causes of cough which may be divided into productive or non-productive in character. As there are many guidelines for the management of productive or ‘wet’ cough the focus of this paper will be to discuss some of the main causes, investigations and management options for ‘dry’ cough. Dry coughing suggests airways irritation and or inflammation (without excessive extra secretion formation) and is predominantly the result of an acute viral respiratory infection that may last up to 3-4 weeks.

BackgroundInfluenza-like illness occurs annually worldwide, with peak timing and severity varying seasonally, resulting in significant annual mortality.ObjectivesThere were three objectives: (1) to describe the epidemiological and clinical features of hospitalised patients with severe acute respiratory infection caused by influenza and other respiratory viruses (ORVs); (2) to report the influenza seasonality in the region and (3) to correlate findings of influenza circulation and immunisation time in Brazil.Patients/methodsThis study took place in three Brazilian hospitals located in cities with different climatic conditions (Curitiba (south), Rio de Janeiro (south-east) and Fortaleza (north-east)). Patients presenting with an acute process with indication for admission consisting of a predefined set of conditions potentially associated with recent influenza infection were enrolled.ResultsWe screened 1666 patients, with 595 meeting the inclusion criteria. Influenza viruses and ORVs were detected in 6.5% and 59% of patients, respectively. Influenza-positive cases fell into the severe spectrum as compared with those with ORVs (30% vs 11%), but without any difference in mortality rates. Epidemiological results revealed variations in the peak time of influenza infections between north-east (Fortaleza) and south (Curitiba) Brazil, basically following the rain period of each region. In north-east Brazil, viral circulation was prevalent in the first 4 months of the year, indicating that the vaccination campaign occurred in a postseasonal period, possibly explaining the low effectiveness.ConclusionsThe active-surveillance model is a valuable tool for investigating respiratory virus impact on hospitalised patients, with influenza-infection monitoring enabling implementation of adequate preventive measures.

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.

Background: Acute viral respiratory tract infections (ARTIs) are the most frequent diseases in children. Aim: To analyze risk factors for ARTIs, to evaluate clinical differences among children with different viral respiratory infection and to study virological risk factors for recurrent wheezing at 3 years follow-up. Methods: We studied 273 children (median age 2.9 months, 167M) hospitalized at the Paediatric Emergency Department, “Sapienza” University of Rome (Oct 2009-May 2014) with ARTIs (148 had RSV infection, 67 hRV, 13 hMPV, 10 hBoV, 29 co-infections and 6 other viruses) and 101 control children. We performed a follow-up after 3 years. Results: Risk factors for ARTIs were the presence of siblings (p Conclusions: Environmental and genetic factors contribute to ARTIs. Clinical entities depend on viral etiology. RSV is the virus. RSV infants had more often long lasting sequelae.

Background: Acute community-acquired sinusitis is considered a bacterial complication of the common cold. Radiologic abnormalities in sinuses occur, however, in most patients with upper respiratory virus infections. Objective: Assessment of the occurrence, clinical profile, laboratory findings, and outcome of radiologically confirmed sinusitis was carried out as part of a common cold study in young adults. Methods: Clinical examinations and radiography of the paranasal sinuses were carried out on days 1, 7, and 21 in 197 patients with the common cold. The symptoms were recorded on diary cards on days 1 to 20. Ten viruses and 5 bacteria were studied as etiologic agents of common cold as reported earlier. Serum C reactive protein concentrations, erythrocyte sedimentation rates, and total white blood cell counts with differentials were determined in 40 randomized subjects on day 7. The effect of 6 days of intranasal fluticasone propionate treatment of the common cold in the prevention of sinusitis was analyzed. Results: On day 7, 39% of patients with the common cold in the placebo group ( n = 98) had sinusitis, which we would prefer to call viral sinusitis. The symptoms of patients with sinusitis and those without it were not clinically distinguishable. Viral infection was detected in 81.6% of patients with sinusitis. No significantly increased levels of antibodies to bacteria were detected. Serum C reactive protein concentrations, erythrocyte sedimentation rates, and white blood cell counts were low in patients with sinusitis. All patients made a clinical recovery within 21 days without antibiotic treatment. Fluticasone propionate treatment tended to prevent paranasal sinusitis, especially in rhinovirus-positive subjects. Conclusion: Viral sinusitis frequently occurs in the early days of the common cold, but it is a self-limited illness. The sinuses should not be imaged in patients with the common cold if the signs and symptoms of illness gradually become less severe and no specific signs suggestive of bacterial sinusitis occur. (J Allergy Clin Immunol 1998;102:403-8.)

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)

1. All medications should be viewed with caution in pregnancy. 2. Management of medication use in pregnancy ideally begins with adequate preconception counseling and prepregnancy planning. 3. Medications used in pregnancy require clear identification of indication for use, duration of treatment, expected outcome, and signs or symptoms requiring early termination of their use. 4. When in doubt consultation with an expert in maternal–fetal medicine is strongly recommended.

We report clinical characteristics and outcome of infants

Acute respiratory infection (ARI) is a common diagnosis in outpatient and emergent care settings. Currently available diagnostics are limited, creating uncertainty in the use of antibacterial, antiviral, or supportive care. Up to 72% of ambulatory care patients with ARI are treated with an antibacterial, despite only a small fraction actually needing one. Antibiotic overuse is not restricted to ambulatory care: ARI accounts for approximately 5 million emergency department (ED) visits annually in the USA, where 52–61% of such patients receive antibiotics. Thus, an accurate test for the presence or absence of viral or bacterial infection is needed. In this review, we focus on recent research showing that the host-response (genomic, proteomic, or miRNA) can accomplish this task.

Objective To examine the influence of viral respiratory infection (VRI) on treatment response in acute asthma in children. Study design A total of 218 children (mean age, 6.6 years) with acute asthma were recruited. Symptoms were recorded, an asthma severity score was determined, and whenever possible, a per-nasal aspirate was obtained for detection of viruses. Each child’s response to inhaled b2-agonists was assessed after 6, 12, and 24 hours. Results The 168 children with VRI symptoms received more treatment with inhaled b2-agonists after 6 hours (P = .010), 12 hours (P = .002), and 24 hours (P = .0005) compared with the 50 children without such symptoms. Asthma severity did not differ between the 2 groups. A per-nasal aspirate was obtained from 77% of the children. The most frequently identified virus was rhinovirus (61.4%). Among children with symptoms of a VRI, those with rhinovirus had an impaired response to b2-agonists at 6 hours (P = .032). Conclusion Children with acute asthma and symptoms of VRI respond less effectively to b2-agonists after 6, 12, or 24 hours and thus may benefit from more intense therapy and monitoring. (J Pediatr 2012;160:82-7).

We determined the rate of nosocomial viral respiratory infection in infants and the effect of an infection control program during 4 winter seasons. The rate of nosocomial viral respiratory infection decreased from 6.09 episodes per 100 patients admitted during the first study year to 1.46 episodes per 100 patients admitted during the last study year.

A survey was conducted in two pediatric intensive care units in hospitals in Porto Alegre, Brazil, in order to monitor the main respiratory viruses present in bronchiolitis and/or pneumonia and their involvement in the severity of viral respiratory infections. Viral respiratory infection prevalence was 38.7%. In bronchiolitis, respiratory syncytial virus (RSV) was detected in 36% of the cases. In pneumonia, the prevalence rates were similar for adenovirus (10.3%) and RSV (7.7%). There was a difference among the viruses detected in terms of frequency of clinical findings indicating greater severity. Frequency of crackles in patients with RSV (47.3%) showed a borderline significance (p = 0.055, Fisher's exact test) as compared to those with adenovirus (87.5%). The overall case fatality rate in this study was 2.7%, and adenovirus showed a significantly higher case fatality rate (25%) than RSV (2.8%) (p = 0.005). Injected antibiotics were used in 49% of the children with RSV and 60% of those with adenovirus. Adenovirus was not detected in any of the 33 children submitted to oxygen therapy.

The concordance of nasal compared with nasopharyngeal swabs was assessed for the diagnosis of respiratory viral infections, and the degree of discomfort associated with each procedure was compared. The use of nasal swabs was shown to be as accurate but significantly less painful than nasopharyngeal swabs for virus diagnosis.

Attempts to relieve the misery of the common cold have been made since long before current understanding of its viral origin. Although current symptomatic therapies provide some relief, any effective treatment must incorporate an antiviral to address the infection. Symptom production is related not only to viral cytopathic effect but also to the early activation of several inflammatory pathways. Antiviral treatment alone may not be able to prevent these events. Combining an antiviral with selected therapeutic agents that block these inflammatory pathways has been shown to improve the effectiveness of cold treatment. Early diagnosis and initiation of treatment combined with regular dosing until symptoms subside appears to be the most effective treatment strategy to maximize therapeutic outcomes. This strategy reduces viral shedding in nasal fluid, provides treatment for the period of maximum symptom burden, and may reduce the frequency and severity of the sinus disease that accompanies colds.

Colvin JM, Muenzer JT, Jaffe DM, et al. Detection of viruses in young children with fever without an apparent source. Pediatrics. 2012; 130( 6): e1455- e1462; doi: 10.1542/peds.2012-1391[OpenUrl][1][Abstract/FREE Full Text][2] Investigators from Washington University, St. Louis and Biological Mimetics, Inc., Frederick, MD conducted a study to better understand the viral etiologies of fever without an apparent source (FWS) in young children. Children aged 2 to 36 months who presented to the emergency department (ED) at St. Louis Children’s Hospital with a temperature of ≥38°C without an apparent source and who had blood obtained for clinical management were enrolled. Children with symptoms suggestive of a viral respiratory infection or who had a positive rapid test for influenza were excluded. Two comparison groups of children were also enrolled: (1) children aged 2 to 36 months who presented to the ED with a temperature of ≥38°C but had a probable or definite bacterial infection, and (2) afebrile … [1]: {openurl}?query=rft.jtitle%253DPediatrics%26rft_id%253Dinfo%253Adoi%252F10.1542%252Fpeds.2012-1391%26rft_id%253Dinfo%253Apmid%252F23129086%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=130/6/e1455&atom=%2Faapgrand%2F29%2F3%2F27.atom

K Rueter, J Bizzintino, AC Martin. J Pediatr. 2012;160(1):82–87 To examine the influence of viral respiratory infection (VRI) on treatment response in acute asthma. A total of 218 children (mean age, 6.6 years) with acute asthma were recruited. Clinical symptoms were recorded, an asthma severity score was determined, and, whenever possible, a per-nasal aspirate was obtained for detection of viruses. Each child’s response to inhaled β2-agonists was assessed after 6, 12, and 24 hours. The 168 children with …

Background: Standardization of a compound Ayurvedic formulation is a critical and essential issue to be considered in assuring the therapeutic efficacy and safety and to rationalize their use in the health care. Sitopaladi churna is a reputed polyherbal formulation of Ayurveda. It is prescribed for the treatment of pleurodynia, intercostal neuralgia, cold, cough associated with bronchitis, pneumonia, tuberculosis, viral respiratory infection, and in pharyngeal and chest congestion. Objective: The present study aimed at physico-chemical standardization of in-house and two marketed brands of Sitopaladi churna. Materials and Methods: In our investigation, in-house churna and two commercial brands of Sitopaladi churna were standardized based on powder microscopy, physico-chemical evaluations, thin layer chromatography (TLC) and high performance thin layer chromatography (HPTLC) finger printing as per standard procedures. Results: The set parameters were sufficient to evaluate the churna based on various physico-chemical parameters. Conclusion: The data evolved can be adopted for laying down the standards for the manufacturing units of Sitopaladi churna.

Bacterial tracheitis after an upper viral respiratory infection is a well-recognized entity in the pediatric literature. Bacterial tracheitis has only recently been reported in adults, and it is a potentially life-threatening illness. We report a case of bacterial tracheitis in a patient with AIDS.

Csonka P, Kaila M, Laippala P, et al. J Pediatr. 2003;143:725–730 Systemic corticosteroid use for the treatment of acute wheezing among preschool-aged children is controversial, with a recent meta-analysis finding only marginal positive effects with orally administered corticosteroids among children

A total of 131 infants were monitored from birth through the first year of life for respiratory viral infection and illness and evaluated for the relationship that these had to certain social and familial factors. The results showed no general patterns of association between viral infection and the study factors, but there were several significant individual associations. Excess influenza virus infection was found for black infants, infants with at least one sibling, and especially those with school age siblings. Rhinovirus infection rates were highest among girls attending daycare. In addition, significantly higher rates of lower respiratory disease (LRD) were seen in daycare infants and low socioeconomic infants and a definite trend to increasing amounts of LRD was seen with increasing family size. Protection from LRD seen in girls was apparently lost in daycare. No convincing differences for viral infection or respiratory illness were seen with parental smoking as an isolated factor.

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

Molecular assays have resulted in increased detection of viral respiratory infections, including virus coinfection, from children with acute respiratory infections. Yet the clinical severity of virus coinfection compared to single virus infection remains uncertain. We performed a retrospective study of children presenting with acute respiratory infections comparing clinical severity of single respiratory virus infection to virus coinfection, detected on midturbinate swabs by molecular assays. Patient characteristics and measures of clinical severity were abstracted from health records. A total of 472 virus-infected children were included, 391 with a single virus infection and 81 with virus coinfection. Virus status did not affect admission to hospital (odds ratio (OR) = 0.8; 95 % confidence interval (CI) 0.5–1.4; p 0.491) or clinical disease severity among inpatients (OR = 0.8; 95% CI 0.5–1.5; p 0.515) after adjusting for age and underlying comorbidities. However, children infected with rhinovirus/enterovirus (HRV/ENT) alone were more likely to be admitted to the hospital compared to those coinfected with HRV/ENT and at least another virus, although this was not significant in multivariable analyses (OR 0.47; 95% CI 0.22–1.0; p 0.051). In multivariable analyses, children coinfected with respiratory syncytial virus (RSV) and other viruses were significantly more likely to present with radiologically confirmed pneumonia compared to those with an isolated RSV infection (OR 3.16, 95% CI 1.07–9.34, p 0.037). Equivalent clinical severity was observed between children with single virus infection and virus coinfection, although children coinfected with RSV and other viruses presented more frequently with pneumonia than those with single RSV infection. Increased disease severity observed among children with single HRV/ENT infection requires further investigation.

Background Human rhinovirus is most prominently associated with asthma exacerbations in humans. The U-BIOPRED project of the Innovative Medicine Initiative (IMI) aims to define biomarkers of asthma exacerbations. Within this context, this study aimed to establish a mouse model of asthma exacerbations induced by viral respiratory infection on the background of chronic allergic airway inflammation.