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      Paediatric virology as a candidate of paediatric subspecialisation: An interview with Assistant Professor of Molecular Microbiology-Virology Angeliki Melidou

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          Abstract

          According to Professor Angeliki Melidou, Assistant Professor of Molecular Microbiology-Virology at the School of Medicine of the Aristotle University of Thessaloniki in Greece, recent advances in modern virology have important implications in the successful clinical management of neonatal and paediatric viral infections. On the other hand, preventive measures for infectious diseases and their complications, including vaccinations, proper regular examinations and early diagnosis, are equally crucial. Molecular genetics reveals a new era both in the detection of viral infections and in following up the infection and treatment, as well as identifying genetic predisposition that would affect disease course and outcome. Professor Melidou supports that paediatric virology as a candidate of paediatric subspecialisation would definitely play an important role in preparing specialised medical scientists. These scientists would be properly educated for the management of emerging and re-emerging viral infections, treatment options and schemes according to children's special needs, available prevention strategies and diagnostic capacities. In the context of the ‘4th Workshop on Paediatric Virology’, Professor Melidou's lecture will focus on the epidemiology of influenza virus types and subtypes in childhood.

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          Paediatric Virology: A new paediatric subspecialty? A proposal at the Workshop on Paediatric Virology, Athens, October 10, 2015

          Paediatric subspecialty education involves the state-of-the-art training and practice on specific scientific fields of Paediatrics requiring clinical expertising and academic excellence (1). The medical school settings and the tertiary hospitals have been specified as the main employment sites of paediatric subspecialists, where their major professional activities include direct paediatric patient care, teaching, as well as management duties. A combination of enhanced paediatric demands and expectations have contributed to the need for standardised and comprehensive training programmes, focusing on the suitable education of paediatric subspecialty trainees. The paediatric infectious diseases subspeciality is one of the first subspecialities, which has been included in the paediatric training programmes in several countries, worldwide (2). To date, paediatric infectious diseases professionals have achieved a distinct role within the scientific field of Paediatrics and their contribution to tertiary paediatric care is considered invaluable (3,4). However, over the past decade, scientific advances on the field of Clinical Virology and Molecular Medicine have led to changes in current clinical practice as regards the management and treatment of neonates and children with viral infections. New viral infections are constantly emerging, requiring new prevention strategies and therapeutic protocols. Paediatric transplant infectious diseases are another challenge within paediatric infectious diseases, reflecting the complexity of this patient population (5). Moreover, new clinical practice guidelines for the vaccination of immunocompromised children have been established and thus regular reviewing of this matter is required (6). Additional scientific fields, including Evidence-based Medicine, Clinical Governance and Pharmacokinetic/Pharmacodynamics (7) have also a significant supportive input. These advances have highlighted the role of Paediatric Virology as a new paediatric subspeciality candidate, a new unique challenging scientific area, where paediatric professionals of the 21st century require an advanced state-of-the-art education. The new challenges related to paediatric viral infections include emerging infections, opportunistic infections in immunocompromised patients, antimicrobial resistance and the development of new diagnostic tests, vaccines and antiviral agents, ensuring the future of this paediatric subspecialty. The word ‘Paediatric’, referring to the branch of Medicine that deals with the medical care of children, derives from two ancient Greek words: ‘παῖς’ (pais), which in modern Greek has changed to ‘παιδί’ (paidi), meaning the ‘child’ and ‘ἰατρός’ (iatros), meaning ‘the doctor’ or ‘the healer’, from the verb ‘ἰάομαι/ἰῶμαι’ (iaome/iome), meaning ‘healing’. On the other hand, the word ‘Virology’, the study of viruses, comes from the Latin word ‘virus’, meaning ‘the poison’, which has been in common use in the English language for many centuries and the ancient Greek word ‘λόγος’ (logos) from the verb ‘λέγω’, meaning ‘talk about’. The ancient Greek origin of virus, ‘ἰός’, comes from the verb ‘ἵημι’ (iimi), meaning ‘actuating, causing movement’, such as throwing an arrow or a poison. Both words in the term ‘Paediatric Virology’ contain the 9th letter of the Greek alphabet ‘ι’, the vertical line presented as an upright rod, an Homer's symbol of the strength of life. Of note, both actions of ‘ἰῶμαι’ supporting life and ‘ἵημι’ causing movement denote the strength and power that a children's healer needs in order to fight the small viral agents that pose a threat to the health and the life of children. Paediatric trainees are proposed to play a leading role in this new subspeciality of Paediatrics, gaining valuable clinical and research experience on the prevention and management of viral infections in neonates and children (Fig. 1). They will be involved in the clinical care for hospitalised children with uncommon, recurrent, severe or complex neonatal and paediatric viral infections and will focus on their comprehensive assessment and treatment. Moreover, they will enhance the coordination of hospital and community care teams and offer appropriate consultation and assistance. After their qualification, Paediatric Virology subspecialists will play a multi-task role, not only in university-based research and educational settings, but also in primary, secondary and tertiary paediatric services (Fig. 2). Their increased accessibility can potentially result in cost savings to the health care system and better quality of care for paediatric patients. This will be achieved by limiting the unnecessary utilisation of emergency rooms, the multiple clinical visits to various health care providers and the request of unwarranted investigations. It is important to determine whether and how Paediatric Virology as a new paediatric subspecialty can help paediatric clinical practice. In the present era of job limitations due to the financial crisis, it would be interesting to determine whether this subspecialty can support educational and academic strategies promoting current paediatric health and prevention. Without any doubt, our proposal requires further evaluation and discussion. The official recognition of Paediatric Virology by the key worldwide scientific and academic paediatric stakeholders will allow the development of an accredited training programme able to attract the highest quality paediatric trainees. In the future, Paediatric Virology subspecialists will be expected to have a strategically principal role, both clinical and academic, at the fight against viral infections in childhood. These efforts will aim to offer a state-of-the-art continuous medical education provided by both clinicians and basic scientists. This definitely needs more time, passion and inspiration.
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            Molecular and phylogenetic analysis of the haemagglutinin gene of pandemic influenza H1N1 2009 viruses associated with severe and fatal infections.

            The objectives of this research is molecular and phylogenetic analysis of pandemic influenza A(H1N1) 2009 strains that circulated in northern Greece, focusing on severe or fatal infections, identification of sequence variations in relation with the severity of the illness and comparison of circulating viruses with the vaccine strain. A total of 1598 infections were attributed to the novel influenza A(H1N1) virus. Molecular analysis revealed a number of variations at the HA1 sequences of northern Greek circulating strains, some of which were more frequent in viruses that caused severe or fatal infections. Such mutations, the most common being D222G, demand close monitoring to continuously assess associated risks. Phylogenetic analysis confirmed the close match of the majority of circulating strains with A/California/7/09. However it also reveals a trend of 2010 strains to accumulate amino acid variations and form new plylogenetic clades. Constant molecular surveillance is important to monitor the pathogenicity of circulating strains and evaluate the vaccine efficacy. Copyright 2010 Elsevier B.V. All rights reserved.
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              Predominance of influenza A(H1N1)pdm09 virus genetic subclade 6B.1 and influenza B/Victoria lineage viruses at the start of the 2015/16 influenza season in Europe.

              Influenza A(H1N1)pdm09 viruses predominated in the European influenza 2015/16 season. Most analysed viruses clustered in a new genetic subclade 6B.1, antigenically similar to the northern hemisphere vaccine component A/California/7/2009. The predominant influenza B lineage was Victoria compared with Yamagata in the previous season. It remains to be evaluated at the end of the season if these changes affected the effectiveness of the vaccine for the 2015/16 season.
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                Author and article information

                Journal
                Exp Ther Med
                Exp Ther Med
                ETM
                Experimental and Therapeutic Medicine
                D.A. Spandidos
                1792-0981
                1792-1015
                September 2018
                31 July 2018
                31 July 2018
                : 16
                : 3
                : 2795-2798
                Affiliations
                Department of Clinical Virology, School of Medicine, University of Crete, Heraklion 71003, Greece
                Author notes
                Correspondence to: Professor Demetrios A. Spandidos, Department of Clinical Virology, School of Medicine, University of Crete, Heraklion 71003, Greece, E-mail: spandidos@ 123456spandidos.gr
                Article
                ETM-0-0-6545
                10.3892/etm.2018.6545
                6122537
                5c937f5a-370f-4f1d-9023-79340605d093
                Copyright: © Mammas et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                : 22 June 2018
                : 23 July 2018
                Categories
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                Medicine
                virology,paediatric virology,influenza,workshop,professor angeliki melidou,aristotle university

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