Background: Most pediatric adenovirus respiratory infections are mild and indistinguishable from other viral causes. However, in a few children, the disease can be severe and result in substantial morbidity. We describe the epidemiologic, clinical, radiologic features and outcome of adenovirus lower respiratory tract infections (LRTI) in Aboriginal and Non-Aboriginal children in Manitoba, Canada during the years 1991 and 2005. Methods: This was a retrospective study of 193 children who presented to the department of pediatrics at Winnipeg Children's Hospital, Manitoba, Canada with LRTI and had a positive respiratory culture for adenovirus. Patients' demographics, clinical and radiologic features and outcomes were collected. Adenovirus serotype distributions and temporal associations were described. Approximate incidence comparisons (detection rates) of adenovirus LRTI among Aboriginal and Non-Aboriginal children were estimated with 95% confidence intervals. Results: Adenovirus infections occurred throughout the year with clusters in the fall and winter. Serotypes 1 to 3 were the predominant isolates (two thirds of the cases). The infection was more frequent among Canadian Aboriginals, as illustrated in 2004, where its incidence in children 0-4 years old was 5.6 fold higher in Aboriginals (13.51 vs. 2.39 per 10,000, p < 0.000). There were no significant differences in length of hospitalization and use of ventilator assistance between the two groups (p > 0.185 and p > 0.624, respectively) nor across serotypes (p > 0.10 and p > 0.05, respectively). The disease primarily affected infants (median age, 9.5 months). Most children presented with bronchiolitis or pneumonia, with multi-lobar consolidations on the chest x-ray. Chronic (residual) changes were documented in 16 patients, with eight patients showing bronchiectasis on the chest computerized tomography scan. Conclusions: Adenovirus infection is associated with significant respiratory morbidities, especially in young infants. The infection appears to be more frequent in Aboriginal children. These results justify a careful follow-up for children with adenovirus LRTI.

Objective: Assessing the knowledge and awareness of the Saudi society about bronchial asthma in children. Methods: Structured questionnaires were randomly distributed to 1039 Saudi Arabians in May 2014 at Jeddah, Riyadh, and Dammam. Results: The awareness of bronchial asthma questions showed that 67% of total sample thought that it could be a fatal disease, and only 13.2% thought that there is a difference between bronchial asthma and chest allergies in children. 86.1% thought that the symptoms of bronchial asthma include dyspnea and nocturnal cough, and 45.7% thought that fever, a runny nose and throat inflammation are not symptoms. 60.2% thought that infectious respiratory diseases may increase bronchial asthma progression. In addition, 40% thought that the use of antibiotics doesn't help in diminishing bronchial asthma complications, and some thought that the patient can stop medication after an acute asthma attack. 34.1% thought that inhaled medication for asthma doesn't cause addiction. Very highly significant results are shown between bronchial asthma knowledge and age, the level of education, marital status, and if the individual knows a person who suffers from bronchial asthma (P < 0.001). There are positive correlations between bronchial asthma knowledge and age, marital status, and level of education (r = 0.152, 0.150, 0.197), respectively. Conclusion: The study demonstrated that bronchial asthma knowledge in the Saudi Arabian population is insufficient, and efforts should be carried out to spread bronchial asthma management.

Montelukast is a leukotriene receptor antagonist (LTRA) commonly prescribed for asthma, allergic rhinitis and sleep-related breathing disorders. Recently, some studies have reported several adverse events, such as neuropsychiatric disorders and sleep disturbances, among children. Objective: To obtain more insight into the safety profile of montelukast for children with asthma, allergic rhinitis and sleep-related breathing disorders. Method and results: We retrospectively studied all adverse drug reactions to montelukast among 385 children 6 months or older in six tertiary centers over a two-year period. A total of 89.6% were asthmatic, 50% had allergic rhinitis and 13.6% had sleep-related breathing disorders; Singulair was the most common type of montelukast used (67.9%). This study reported a high prevalence of adverse drug reactions among 123 patients (31.9%), predominantly in those aged 4–9 years (52.8%), followed by adolescents (24.4%) and toddlers (22.8%). Two (ADRs) were reported in 9.8% of the children, while three or more were reported in 5.5%. Sleep disturbance was the most common (ADRs), affecting 15.1% of participants (overlap was common; 5.5% of children experienced sleep difficulties, 4.4% experienced sleep interruption and decreased sleep, and 1.82% experienced nightmares), followed by agitation (10.4%), pain (9.4%) and hyperactivity (6.8%). No serious (ADRs) were reported. Eleven percent of families faced difficulties in purchasing montelukast, and only 57% of families had insurance. Misconceptions were common (9.8% reported it to be a steroid, while 30.6% believed it to be a bronchodilator). Although 81% of the families believed it was an effective and preventive medication, 5.3% stopped the drug due to concern about side effects, especially agitation (3%) and nightmares (0.6%). Conclusion: These data demonstrate that montelukast is effective, but the associated adverse neuropsychiatric drug reactions are more prevalent than those reported in the literature. In particular, sleep disturbance, agitation, pain and hyperactivity were observed. Pediatricians should be aware of such (ADRs). Misconceptions about montelukast are still common, and parental counseling and urgent epidemiological studies are needed to quantify the risk for management plans.

Introduction. Local data in Saudi Arabia regarding pediatric SARS-CoV-2 infection is limited. This study is aimed at adding insight regarding the effect of the novel coronavirus on pediatric patients by studying the presentation, laboratory parameters, and disposition of SARS-CoV-2-infected pediatric patients in one center in Jeddah, Saudi Arabia. Methodology. A retrospective study was conducted at the International Medical Center (IMC) in Jeddah, Saudi Arabia, to assess features of pediatric patients admitted with COVID-19 from April 2020 to September 2020. Results. A total of 43 patients were found to meet the study inclusion criteria. The most common presenting symptom was fever (53.5) in study participants followed by complaints of cough, runny nose, and shortness of breath (37.2). Lymphocytopenia was evident among 60 of those studied. Elevated C-Reactive Protein was remarkable in 24.9. More than half of those (53.5) studied required only supportive treatment. Conclusion. COVID-19 disease for the most part is mild in children with a varying clinical picture and nonspecific laboratory parameters. Further, large-scale national-based studies are needed to help in the early identification of pediatric cases at risk of complication due to COVID-19 infection hence providing proper and timely management, identifying population-specific disease pattern and perhaps targeted immunization.

Childhood interstitial and diffuse lung disease (chILD) is a heterogeneous group of rare and chronic respiratory disorders with an estimated prevalence of 1.5 cases per million children aged 0-18 years. Presented is the case of an immunocompetent young girl who presented with symptoms of recurrent cough and clubbing