There is a scarcity of data regarding coronavirus disease 2019 (COVID-19) infection in children from southeast and south Asia. This study aims to identify risk factors for severe COVID-19 disease among children in the region. This is an observational study of children with COVID-19 infection in hospitals contributing data to the Pediatric Acute and Critical Care COVID-19 Registry of Asia. Laboratory-confirmed COVID-19 cases were included in this registry. The primary outcome was severity of COVID-19 infection as defined by the World Health Organization (WHO) (mild, moderate, severe, or critical). Epidemiology, clinical and laboratory features, and outcomes of children with COVID-19 are described. Univariate and multivariable logistic regression models were used to identify risk factors for severe/critical disease. A total of 260 COVID-19 cases from eight hospitals across seven countries (China, Japan, Singapore, Malaysia, Indonesia, India, and Pakistan) were included. The common clinical manifestations were similar across countries: fever (64%), cough (39%), and coryza (23%). Approximately 40% of children were asymptomatic, and overall mortality was 2.3%, with all deaths reported from India and Pakistan. Using the multivariable model, the infant age group, presence of comorbidities, and cough on presentation were associated with severe/critical COVID-19. This epidemiological study of pediatric COVID-19 infection demonstrated similar clinical presentations of COVID-19 in children across Asia. Risk factors for severe disease in children were age younger than 12 months, presence of comorbidities, and cough at presentation. Further studies are needed to determine whether differences in mortality are the result of genetic factors, cultural practices, or environmental exposures.

The COVID-19 pandemic requires a rapid understanding of the pathogenesis of the spectrum of the disease and factors associated with varied clinical presentations. Immune dysregulation with a cytokine storm (CS) progressing to ARDS with resemblance to sHLH is suggested as a main cause of tissue injury. Low levels of vitamin D were observed in COVID-19 cases with higher incidence of mortality in 20 European countries, increased risk of severity in COVID-19 contributing to ARDS or fulminant myocarditis and micro vascular thrombosis is proposed. Vitamin D may be protective against acute respiratory tract infections, as it regulates the inflammatory cytokine response of respiratory epithelial cells and macrophages, suppress CS and other manifestations seen in SARS-Cov-2. Hence, it is suggested as one of the therapies in SARS-CoV-2 infection. Major research gaps are identified globally in clinical management and this relationship. There is an imperative requisite to understand the interplay of markers in SARS-CoV-2, its risk factors and potential role of vitamin D to improve clinical outcome by pandemic of COVID-19. We therefore perform this review for understanding the pathophysiology of SARS-CoV-2 infections and the role of vitamin D in combating it.

Corona virus disease of 2019 is the infectious disease caused by the novel coronavirus SARSCoV-2 (severe acute respiratory syndrome coronavirus 2) (Lai et al., 2020).The first case was reported in Wuhan, China, in the December of 2019 (Lai et al., 2020). In March 2020, the WHO declared COVID-19 as a pandemic and to this date (i.e., 6th April 2021) 131,487,572 cases and 2,857,702 deaths have been recorded by the WHO worldwide (WHO Coronavirus Disease Dashboard, 2020). Therefore, it is necessary to educate the public regarding preventive measures, and healthcare professionals regarding accurate and up to date knowledge that help them manage and treat patients. Here we talk about the possible role of Vitamin D in COVID-19 based on current scientific evidence.

Objective: To investigate the possible association of serum and follicular fluids(FF) Vitamin D levels with reproductive outcomes after assisted reproductive techniques (ART). Secondly, to detect Vitamin D Receptors (VDR) in serum and follicular fluid (FF) of ovarian follicle and explore its relationship with Vitamin D levels as well as reproductive outcomes. Methodology: This study was conducted on May 2019 in Aga Khan Hospital, Karachi, Pakistan. A total of 8 infertile female subjects were conveniently recruited. Serum was collected and follicular fluid(FF) was obtained by transvaginal-guided follicular puncture; 34 hours after intramuscular administration of Human Chorionic Gonadotrophin (HCG). Vitamin D and VDR was assessed in serum as well as in FF by Paired Sample t-test. Results: Females 2 out of 8 acquired clinical pregnancy, whereas 3 had pre-clinical abortion or no pregnancy. Vitamin D and VDR were detected highest in those female patients that acquired pregnancy in comparison to the pre-clinical abortion or non-pregnant ones (p value<0.007). Serum VDR did not show any significant results in all groups   Conclusion: Vitamin D in serum and FF and vitamin D receptor in serum and FF were associated with number of oocytes. High levels of VDR in FF observed in clinical pregnancy group proved our hypothesis that the presence of VDR in FF is a contributing factor for successful conception after ART success.  

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