INTRODUCTION:Acute respiratory infections (ARIs) represent a significant burden among children globally. The COVID-19 pandemic and its associated public health measures disrupted the transmission and detection of common respiratory pathogens. Yet, little is known about how these parameters have changed in the United Arab Emirates (UAE). OBJECTIVES:This study aims to describe the prevalence, causative pathogens, and seasonal patterns of pediatric ARIs in the UAE during the pre-, during, and post-COVID-19 pandemic periods. METHODS:This retrospective observational study included pediatric patients, aged 0-18 years, diagnosed with ARIs across one hospital network between 2019 and 2024. Statistical analysis was performed using SPSS 26.0 and compared across three distinct time periods. RESULTS:A total of 20,976 cases were included in the analysis. Of these, 11,248 (53.6%) were male, with a median age of 5 (IQR = 2,9). Overall, the most frequently detected pathogens were Human Rhinovirus/Enterovirus (34.6%), COVID-19 (22.6%), and Influenza A (14.8%). Seasonal peaks of all pathogens except Adenovirus became less pronounced after the pandemic, with reduced quarter-to-quarter variability in detection rates rather than a single dominant seasonal peak. We observed a shift in the peak of Human Rhinovirus/Enterovirus, from Q1 pre-pandemic to Q4 post-pandemic. CONCLUSIONS:Pediatric ARI patterns in the UAE changed during the COVID-19 pandemic, with an increase in cases after 2021 and a shift in seasonality for many common causative pathogens. COVID-19 was predominant during the pandemic, yet Human Rhinovirus/Enterovirus remained the most common pathogen overall.

Subglottic hemangiomas are uncommon forms of infantile vascular tumors often misdiagnosed due to symptom overlap with other conditions like laryngomalacia, bronchiolitis, and asthma. Early and accurate diagnosis is vital for effective management. This case report discusses a unique presentation of subglottic hemangioma in a three-month-old infant, highlighting its diagnostic challenge and management. It adds valuable insights into the differentiation of subglottic hemangioma from other common causes of respiratory distress in infants. The infant presented with severe respiratory distress since birth, worsening over the last four weeks, accompanied by gastroesophageal reflux and poor weight gain. Initially, the case was suspected and treated as croup and laryngomalacia. A CT angiogram revealed a vascular lesion in the subglottic area, confirmed by flexible bronchoscopy as a hemangioma. Treatment with propranolol led to significant improvement. Early diagnosis and treatment of subglottic hemangioma are crucial for a good prognosis. This case emphasizes the importance of considering subglottic hemangioma in infants with unresolved airway distress.

Patients with spinal muscular atrophy type 1 (SMA-1) requiring invasive ventilation can be eligible for gene therapy if they tolerate at least 8 h off ventilation per day. We aimed to assess the short-term safety and efficacy of gene therapy (onasemnogene abeparvovec; Zolgensma) on respiratory function in SMA-1 patients ventilated via tracheostomy pre-gene therapy. A prospective cohort study included 22 patients. Patients were weaned off ventilation for at least 8 h daily by optimizing ventilator settings and duration, using cough augmentation, managing excessive airway secretions, enhancing nutrition, screening for respiratory bacterial colonization, and treating infections. Gene therapy was administered at a median age of 26 (Q1: 18, Q3: 43) months with a mean follow-up period of 7.64 (SD: 6.50) months. Gene therapy was safe and effective in resolving paradoxical breathing, improving cough ability, reducing airway secretions, and enhancing CHOP-INTEND scores. The clinical assessment and management implemented pre-gene therapy were effective in safely weaning patients for at least 8 h off ventilation daily. Gene therapy at a late age was safe and effective over the short-term period; however, long-term follow-up is recommended. In conjunction with gene therapy, high-quality clinical care is beneficial and should be paired with gene therapy.

INTRODUCTION/AIMS:Spinal muscular atrophy (SMA) manifests with progressive motor neuron degeneration, leading to muscle weakness. Onasemnogene abeparvovec is a US Food and Drug Administration-approved gene replacement therapy for SMA. This study aimed to present short-term data of children in the United Arab Emirates (UAE) treated with onasemnogene abeparvovec, particularly in the context of children requiring invasive ventilatory support via tracheostomy. METHODS:A retrospective analysis was performed on 60 children who received onasemnogene abeparvovec. All these children received corticosteroids. They were followed up for up to 3 months. Motor function assessments were performed before and after the gene therapy. Comprehensive clinical evaluations, including pulmonary functions, were performed at baseline and the 3-month mark. RESULTS:Forty-three percent were male, and the mean age at the time of infusion was 29.6 months (SD ± 17.2). The mean weight was 10.1 kg (SD 2.6). All children demonstrated marked improvements in motor function within 3 months of gene therapy administration. No adverse effects attributable to corticosteroid therapy were observed. Positive clinical outcomes, including increased ventilator-free intervals, reduced antibiotic dependency, and fewer hospital admissions, were reported among children with invasive ventilation via tracheostomy. DISCUSSION:This study demonstrates the favorable tolerability and promising responses to onasemnogene abeparvovec in invasively ventilated pediatric patients. Early improvements in motor function, as observed within 3 months post-treatment, suggest its potential as a viable therapeutic option for this vulnerable patient population.

Long-term noninvasive respiratory support, comprising continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV), in children is expanding worldwide, with increasing complexities of children being considered for this type of ventilator support and expanding indications such as palliative care. There have been improvements in equipment and interfaces. Despite growing experience, there are still gaps in a significant number of areas: there is a lack of validated criteria for CPAP/NIV initiation, optimal follow-up and monitoring; weaning and long-term benefits have not been evaluated. Therapeutic education of the caregivers and the patient is of paramount importance, as well as continuous support and assistance, in order to achieve optimal adherence. The preservation or improvement of the quality of life of the patient and caregivers should be a concern for all children treated with long-term CPAP/NIV. As NIV is a highly specialised treatment, patients are usually managed by an experienced paediatric multidisciplinary team. This statement written by experts in the field of paediatric long-term CPAP/NIV aims to emphasise the most recent scientific input and should open up new perspectives and research areas.

OBJECTIVES:To provide up-to-date information on the use of long-term ventilation (LTV) in the UK paediatric population and to compare the results with data collected 10 and 20 years previously. DESIGN:A single timepoint census completed by LTV centres in the UK, carried out via an online survey. SETTING AND PATIENTS:All patients attending paediatric LTV services in the UK. RESULTS:Data were collected from 25 LTV centres in the UK. The total study population was 2383 children and young people, representing a 2.5-fold increase in the last 10 years. The median age was 9 years (range 0-20 years). Notable changes since 2008 were an increase in the proportion of children with central hypoventilation syndrome using mask ventilation, an increase in overall numbers of children with spinal muscular atrophy (SMA) type 1, chronic lung disease of prematurity and cerebral palsy being ventilated, and a 4.2-fold increase in children using LTV for airway obstruction. The use of 24-hour ventilation, negative pressure ventilation and tracheostomy as an interface had declined. 115 children had received a disease-modifying drug. The use of ataluren and Myozyme did not influence the decision to treat with LTV, but in 35% of the children with SMA type 1 treated with nusinersin, the clinician stated that the use of this drug had or may have influenced their decision to initiate LTV. CONCLUSION:The results support the need for national database for children and young people using LTV at home to inform future recommendations and assist in resource allocation planning.

Density and sedimentation analysis as well as electron microscopy demonstrate that upon reaction at 55° single-stranded DNA binds the osmium-cyanide complex and is left free of fragmentations, cross-links and aggregations.

Radiation overexposure is common in chest X-ray (CXRs) of pediatric patients. However, overexposure may reveal incidental findings that can help to guide patient management or warrant quality improvement. To assess the prevalence of overexposure in CXRs in pediatric intensive care unit (PICU); and identify the incidental findings within overexposed areas, we conducted a retrospective cohort study of children who were admitted to PICU. Two independent evaluators reviewed patient's charts and digital CXRs according to the American College of Radiology standards; to evaluate overexposure of the anatomical parameters and incidental findings. A total of 400 CXRs of 85 patients were reviewed. The mean number of CXRs per patient was 4.7. Almost all (99.75%) CXRs met the criteria for overexposure, with the most common being upper abdomen (99.2%), upper limbs (97%) and neck (95.7%). In addition, 43% of these X-rays were cropped by the radiology technician to appear within the requested perimeter. There was a significant association between field cropping and overexposure (t-test: t = 9.8, P < .001). Incidental findings were seen in 41.5% of the radiographs; with the most common being gaseous abdominal distension (73.1%), low-positioned nasogastric tube (24.6%), and constipation (10.3%). Anatomical overexposure in routine CXRs remains high and raises a concern in PICU practice. Appropriate collimation of the X-ray beam, rather than electronically cropping the image, is highly recommended to minimize hiding incidental findings in the cropped-out areas. Redefining the anatomic boundaries of CXR in critically ill infants and children may need further studies and consideration. Quality improvement initiatives to minimize radiation overexposure in PICU are recommended, especially in younger children and those with more severe illness upon PICU admission.

Background: This study looks at the parental views of home Cardio Respiratory Sleep Studies (CRSS) during the Covid-19 pandemic. Prior to the pandemic all sleep studies were done as an inpatient at children's hospital. Objectives: To ascertain whether or not CRSS are successful at home. Methods: A random selection of 50 patients was done from the electronic database at a large tertiary children's hospital. These sleep studies were done between June 2020-Dec 2020. Parents were asked a series of pre-defined questions on telephone. Results: 30 parents agreed for this qualitative survey. 100% of parents agreed that the explanation received on equipment was adequate and easy to follow. 19/30 had a previous sleep study done in hospital. Of these, 14 agreed that the child slept better being at home compared to if they were in hospital. 19/30 would prefer home sleep studies over hospital studies. Of these, 14 said the reason for this was comfort and ease, while 4 said it was due to Covid-19. After pandemic is over 83.3% of parents agree that we should continue to offer home sleep studies after the pandemic is over. Overall, the view was that the home sleep study is easy to set up and convenient, especially for parents with other children to look after. Most parents would like for CRSS to continue after the pandemic, however, would like to have the option of having one done in hospital if more information is needed from the study. Conclusion: Home CRSS should be continued after the Covid-19 pandemic for routine appointments, however the option a sleep study done in the hospital should be kept open for patients who struggle at home, in-depth study like polysomnogram or for titration of ventilators.

BACKGROUND:The use of electronic cigarettes (e-cigarettes) among adolescents is increasing worldwide. E-cigarettes are marketed as a safe alternative to other tobacco products. The aim of this systematic review is to evaluate whether e-cigarette use in children and adolescents is associated with coughing.METHOD:Studies were identified through systematic searches of Excerpta Medica Database, Medline, Cumulative Index to Nursing and Allied Health Literature, British Nursing Index, OVID Emcare, Health Management Information Consortium, PsycINFO, and Allied and Complementary Medicine. The Grey Literature was also searched. Selected studies either contained only children and adolescents as study participants or if adults were included, the data for adolescents and children must be presented separately.RESULTS:Seven studies were selected from 104. Three studies compared e-cigarette users with nonusers; two studies found a significant association between coughing and e-cigarette use in adolescence. Two studies investigated whether adolescents attributed their symptoms to their e-cigarette use. One study reported that coughing was the most likely negative symptom reported by adolescents on initiation of e-cigarette use; the other study found that adolescents, on initiation of e-cigarette use, reported coughing. Two studies looked at the cases of children and adolescents who had presented to the hospital after e-cigarette use and found coughing was a common presenting symptom.CONCLUSION:This systematic review shows that adolescent use of e-cigarettes is associated with increased coughing and e-cigarette users are more likely to report coughing compared to non-users.

Viruses have evolved diverse mechanisms to antagonize host immunity such as direct inhibition and relocalization of cellular APOBEC3B (A3B) by the ribonucleotide reductase (RNR) of Epstein-Barr virus. Here, we investigate the mechanistic conservation and evolutionary origin of this innate immune counteraction strategy. First, we find that human gamma-herpesvirus RNRs engage A3B via largely distinct surfaces. Second, we show that RNR-mediated enzymatic inhibition and relocalization of A3B depend upon binding to different regions of the catalytic domain. Third, we show that the capability of viral RNRs to antagonize A3B is conserved among gamma-herpesviruses that infect humans and Old World monkeys that encode this enzyme but absent in homologous viruses that infect New World monkeys that naturally lack the A3B gene. Finally, we reconstruct the ancestral primate A3B protein and demonstrate that it is active and similarly engaged by the RNRs from viruses that infect humans and Old World monkeys but not by the RNRs from viruses that infect New World monkeys. These results combine to indicate that the birth of A3B at a critical branchpoint in primate evolution may have been a driving force in selecting for an ancestral gamma-herpesvirus with an expanded RNR functionality through counteraction of this antiviral enzyme.

We read with interest the article by Leong et al on the use of polysomnography (PSG) in children,1 covering indications for PSG, along with limitations of oximetry, and clearly outlining how to undertake and interpret PSG in paediatric patients. It briefly discusses limited channel recordings (respiratory polygraphy, RP) and concludes that this ‘is not standard practice’. In many paediatric centres RP is standard practice, and routinely used for assessment of sleep-disordered breathing (SDB) in children, with the most common diagnosis being obstructive sleep apnoea (OSA). In a recent survey …

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in adults is an essential tool for investigating mediastinal and hilar lymphadenopathy. It is now integral to the diagnostic and staging algorithm for lung cancer [1], as well as the diagnosis of other malignancies, lymphoma and non-malignant granulomatous conditions, such as sarcoidosis and tuberculosis. The comparable diagnostic yield, along with decreased complications, has reduced the requirement for previously standard surgical biopsy sampling [2, 3]. This first European case series demonstrates that EBUS-TBNA, well established in the diagnosis of mediastinal and hilar adenopathy in adults, is a safe and useful diagnostic alternative to invasive surgical biopsy in the paediatric population http://bit.ly/389Uvq4

Background Perinatal and infantile hypophosphatasia (HPP) are associated with respiratory failure and respiratory complications. Effective management of such complications is of key clinical importance. In some infants with HPP, severe tracheobronchomalacia (TBM) contributes to respiratory difficulties. The objective of this study is to characterize the clinical features, investigations and management in these patients. Methods We report a case series of five infants with perinatal HPP, with confirmed TBM, who were treated with asfotase alfa and observed for 3–7 years. Additionally, we reviewed respiratory function data in a subgroup of patients with perinatal and infantile HPP included in the clinical trials of asfotase alfa, who required high-pressure respiratory support (positive end-expiratory pressure [PEEP] ≥6 cm H 2 O and/or peak inspiratory pressure ≥18 cm H 2 O) during the studies. Results The case series showed that TBM contributed significantly to respiratory morbidity, and prolonged respiratory support with high PEEP was required. However, TBM improved over time, allowing weaning of all patients from ventilator use. The review of clinical trial data included 20 patients and found a high degree of heterogeneity in PEEP requirements across the cohort; median PEEP was 8 cm H 2 O at any time and some patients presented with high PEEP (≥8 cm H 2 O) over periods of more than 6 months. Conclusion In infants with HPP presenting with persistent respiratory complications, it is important to screen for TBM and initiate appropriate respiratory support and treatment with asfotase alfa at an early stage. Trial registration ClinicalTrials.gov numbers: NCT00744042 , registered 27 August 2008; NCT01205152 , registered 17 September 2010; NCT01176266 , registered 29 July 2010.

Introduction: Adverse nutritional factors in early life, such as food insecurity, may affect the risk of developing asthma in childhood, and worsen asthma control. Aim: To systematically review literature on the impact of family food insecurity on prevalence of childhood asthma, and asthma control. Methods: We included cohort, case-control, and cross-sectional studies evaluating food insecurity and the risk of children developing asthma in childhood or having poor asthma control. We used the SCOPUS platform to search several databases, using a predefined strategy. We used the CASP tool to evaluate study quality. We extracted effect sizes for risk of developing asthma or having poor asthma control. Results: From 109 abstracts we included 8 studies. The studies were of adequate quality but methodological heterogeneity precluded meta-analysis. Six studies evaluated the impact of food insecurity on the risk of developing childhood asthma. Of these, five large studies (n 54,207) found that family food insecurity significantly increased risk of children developing asthma (Odds ratio 1.04 – 2.08). One study (n 486) found no increased risk. Two studies evaluated the impact of food insecurity on asthma control. In one (n 553) food insecurity doubled the risk of poor asthma control (OR 2.01) but in the other (n 127) there was no increased risk. Conclusions: Food insecurity may increase the risk of childhood asthma but the impact on asthma control is uncertain. Large epidemiological studies with standardised methodology are required to evaluate the impact of food insecurity on childhood asthma outcomes.