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By Dr. Priyom Bose, Ph.D. Aug 4 2023 Reviewed by Lily Ramsey, LLM

Recently, scientists reviewed the available literature to better understand vitamin D's immunomodulatory and antiviral function.

The study explores how vitamin D influences the pediatric respiratory system after acute respiratory tract infections (ARTI), such as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which is the causal agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic. This review is available in Nutrients.

Study:  Immunomodulatory Effects of Vitamin D in Respiratory Tract Infections and COVID-19 in Children. Image Credit: YuliaFurman/Shutterstock.com Background

Children often develop ARTI, which accounts for 20% of all pediatric fatalities. There are two subsets of ARTI: upper respiratory tract infections (URTIs) and lower respiratory tract infections (LRTIs).

Most URTIs are associated with viral infection caused by rhinovirus, SARS-associated coronavirus, enterovirus, influenza virus, and respiratory syncytial virus. Bronchiolitis and pneumonia are the two most common LRIs in children.

SARS-CoV-2 infection in children has manifested a wide range of symptoms, i.e., from asymptomatic to severe infection. Although most children with COVID-19 have been asymptomatically infected, a small number of children developed severe forms of multisystem inflammatory syndrome in children (MIS-C).

A very limited amount of evidence has been documented regarding the SARS-CoV-2 disease in the pediatric population worldwide. 

Vitamin D is a crucial micronutrient that is associated with immune function. It can stimulate innate immunity, reduce the production of helper T lymphocytes (type 1), and improve the proliferation of type 2 and regulatory T lymphocytes.

Furthermore, vitamin D helps decrease the pro-inflammatory cytokines (e.g., IL1, IL6, IL12, TNFα, and IL17) and interferon γ, and increase IL10 (anti-inflammatory cytokines) via NFkβ metabolic pathway. About the study

Although several studies have shown that children with vitamin D deficiency are more susceptible to ARTI, the scientific community does not fully accept this observation. Related StoriesHigher-than-recommended doses of vitamin D linked to lower risk of atrial fibrillationLong COVID risk may increase with low levels of vitamin DVitamin D supplements may reduce risk of heart attacks in older adults

This review focussed on understanding whether there is a link between ARTIs and vitamin D supplementation. 

All relevant articles were obtained from PubMed. This review included all types of free articles published in English, such as clinical trials, systematic reviews, and meta-analyses.

The targeted population was children under 19 years of age. This review excluded studies with small sample sizes, i.e., less than 100 participants, and non-peer-reviewed articles. 

This systematic review used the Patient, Intervention, Comparison, and Outcome (PICO) framework.

A total of 518 citations were obtained after the initial search; however, 27 studies fulfilled all inclusion criteria and were considered in this review. Study findings

25(OH)D is the major circulating vitamin D form exhibiting antiviral properties through antimicrobial peptides. Monocytes and macrophages expressing CYP27B1 (1-α hydroxylase) enable the conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol.

Calcitriol is an active vitamin D form that is crucial in limiting pathogenic presence. Previous studies have shown that vitamin D enhances nitric oxide production, which is linked to the antioxidative effect of 25OHD. Vitamin D receptor (VDR) and CYP27B1 have been detected in considerable amounts in cells and tissues.

Most studies indicated a robust association between VD status and the incidence of ARTIs, including COVID-19 infections. These studies revealed that vitamin D levels were inversely related to the severity of COVID-19.

A limited number of studies contradicted this finding and reported no correlation between vitamin D deficiency (VDD) and a higher prevalence of SARS-CoV-2 infection.

In contrast, another study demonstrated VD's prospective protective and preventative function against COVID-19. An elevation in inflammatory markers occurs when vitamin D serum concentrations decrease.

Numerous factors are associated with VD's ability to prevent ARTIs. For instance, 25 hydroxyvitamin D enhances the synthesis of natural antibodies.

In addition, it improves immunity by promoting monocyte differentiation and preventing lymphocyte production. VD also enhances the phagocytic activity of macrophages. Therefore, many studies have indicated that VD intake lowers the risk of severe SARS-CoV-2 infection.

A meta-analysis considered around 4786 children to determine the efficacy of vitamin D supplementation in combination with antibiotics to treat pneumonia. A higher vitamin D concentration lowered the risk of recurring pneumonia.

Another study indicated that 25(OH)D concentration higher than 75.0 nmol/L significantly lowered the risk of acute pneumonia. A survey showed that 1/5 of children hospitalized due to pneumonia were VDD. Babies under three years old diagnosed with pneumonia subjected to 100,000 IU of VD3 almost eliminated the risk of recurrence.

In some cases, young patients with COVID-19 required hospitalization, and vitamin D was measured from this group without a baseline measurement. This has generated conflicting interpretations about causality.

A prior study reported reverse causality with the expression CYP24A1, which increased SARS-CoV-2 infection. Therefore, more research is required to elucidate how VD influences COVID-19.  Conclusions

Although systematic reviews and meta-analyses have indicated that a lower level of 25(OH)D enhances the risk of developing ARTI in children, the experimental findings sometimes contradict this observation.

There has been a growing consensus that serum VD should be maintained above 75 nmol/L to maintain overall health. To avoid VDI in all age groups, dietary VD intake and VD supplements have been recommended. Journal reference:

Nicolae, M. et al. (2023) "Immunomodulatory Effects of Vitamin D in Respiratory Tract Infections and COVID-19 in Children", Nutrients, 15(15), p. 3430. doi: 10.3390/nu15153430. https://www.mdpi.com/2072-6643/15/15/3430

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NHLPA appeals Hartman’s 10-game suspension

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NHLPA appeals Hartman's 10-game suspension

NEW YORK — The NHL Players’ Association said Wednesday it has filed an appeal on Ryan Hartman‘s behalf after the Minnesota Wild forward was suspended for 10 games for roughing.

Hartman had 48 hours from the league’s ruling Monday night to decide whether to appeal the ban for slamming an opponent’s head to the ice with his right forearm, the longest for on-ice conduct in more than six years.

The initial appeal goes to NHL commissioner Gary Bettman, who has regularly sided with the Department of Player Safety and disciplinary decisions made by its vice president, George Parros. If Bettman upholds the suspension, Hartman has the right to appeal to a neutral arbitrator.

Hartman is forfeiting $487,805 in salary as part of his fifth career suspension and fourth since 2023. He would get more than $48,000 back for each game it is reduced by, if at all.

Washington‘s Tom Wilson recouped six games worth of salary when his 2018 suspension was reduced from 20 to 14 on appeal to an arbitrator jointly appointed by the league and union, even though he had already served 16.

Hartman, 30, was initially ejected with a match penalty for roughing Ottawa‘s Tim Stutzle late in the second period of the teams’ game Saturday night.

“Hartman contends that he is attempting to use his hand to regain his balance, using Stutzle for support and that their fall to the ice is accidental. We disagree,” Player Safety said in a video announcing the suspension. “With Stutzle bent low and focused on winning the draw, Hartman chooses to take advantage of a vulnerable player in an unacceptable fashion. Hartman intentionally uses his forearm and body weight to drive Stutzle’s head directly into the ice from a height, which makes this play inherently dangerous and unacceptable.”

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Grenfell Tower will be demolished, government confirms

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Grenfell Tower will be demolished, government confirms

Grenfell Tower will be demolished, Angela Rayner has confirmed.

The demolition is expected to take “around two years” and be carried out “sensitively”, the government said.

The official announcement comes after the deputy prime minister met with campaigners to tell them of the decision on Wednesday evening – sparking an angry reaction.

Grenfell United has accused Ms Rayner of “ignoring” the voices of people who lost family in the fire in June 2017, which killed 72 people.

Read more: Grenfell Tower – what happens now?

The disaster was Britain’s deadliest residential fire since the Second World War and began a national reckoning over the safety and conditions of social housing and tower blocks.

There have been discussions over the years about how best to commemorate the tragedy.

Engineering experts have said that while the tower remains stable, and it is safe for people to live, work and study nearby, its condition will worsen over time and there is no realistic prospect of bringing it back into use.

In September last year, the public inquiry into Grenfell found “systematic dishonesty” of firms who made and sold cladding contributed to the horrific fire.

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Anger over Grenfell Tower plans

Why is Grenfell Tower being demolished?

In its announcement of the demolition, the government said Ms Rayner was told by engineers that the tower is “significantly damaged”.

While it “remains stable”, this is due to the supports put in place after the fire.

Engineers said it is also not “practicable” to keep many of the damaged storeys as part of a long-term memorial.

“Taking the engineering advice into account the deputy prime minister concluded that it would not be fair to keep some floors of the building that are significant to some families, whilst not being able to do so for others and knowing that, for some, this would be deeply upsetting,” the government said.

Angela Rayner has confirmed that Grenfell Tower will be demolished. Pic: PA
Image:
Angela Rayner has confirmed that Grenfell Tower will be demolished. Pic: PA

How will the demolition take place?

The government says it wants to take the next steps “respectfully and carefully”, with continued support for the community around Grenfell.

It said no changes will take place before the eighth anniversary of the fire in June this year.

The next step is to find someone to carry out the demolition.

A “specialist contractor” will be found to come up with a “detailed plan” for taking down the tower.

The government estimates it will take around two years to “sensitively take down the tower through a process of careful and sensitive progressive deconstruction that happens behind the wrapping”.

Any leftover materials from the tower and its surrounding communal areas can be carefully removed and then returned as part of any memorial, if the community so chooses, according to the government.

Read more:
How the tragedy happened – minute by minute
Powers to fix fire safety crisis are being ignored

Community reaction

Ahead of the decision being made publicly, Ms Rayner wrote to families, survivors and surrounding residents to tell them of the planned demolition.

The government says it has “prioritised” engaging with the community, and that Ms Rayner has been offering to speak with them and listen to their views for several months. The deputy prime minister also met with community groups, residents’ associations, schools and faith leaders.

These conversations have made it clear the tower “remains a sacred site” – however it is also clear “there is not a consensus about what should happen to it”.

The government said that for some the tower remains a “symbol of all they lost” and helps ensure “the tragedy is never forgotten and can act as a reminder of the need for justice and accountability”.

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The visibility of the tower also “helps some people continue to feel close to those they lost”.

But the announcement added that for some, the tower is a “painful reminder of what happened and is having a daily impact on some members of the community”.

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Major travel disruption in Greater Manchester after car crashes on rail lines and driver arrested

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Major travel disruption in Greater Manchester after car crashes on rail lines and driver arrested

There’s major travel disruption in Greater Manchester after a car smashed through a rail bridge and fell on the tracks.

The incident happened about 2am near Regent Road roundabout in Eccles, Salford.

A man in his 30s was arrested on suspicion of drink-driving and taken to hospital with injuries that aren’t believed to be serious.

No other vehicles were involved.

The road reopened at 7.30am and pictures later showed the car being lifted away, but rail firms said problems were likely for much of the day.

Pic: Manchester Evening News
Image:
Pic: Manchester Evening News

Pic: PA
Image:
Pic: PA

Network Rail’s page on the incident said no trains would run through Eccles until the line is cleared.

It means services between Newton-le-Willows / Wigan North Western and Manchester Oxford Road / Manchester Victoria will be cancelled, revised or diverted.

TransPennine Express services are not running between Liverpool Lime Street and Manchester Victoria.

People going between those cities are advised to travel via Warrington Central instead.

Northern trains are also affected between Liverpool and Manchester Airport, and Chester and Leeds to Manchester Victoria.

Transport for Wales routes from Chester / Llandudno to Manchester Airport / Manchester Oxford Road are impacted, as are Holyhead to Manchester Airport services.

Replacement buses are running in some areas and tickets are being accepted on other services.

Pic: Manchester Evening News
Image:
Pic: Manchester Evening News

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A Network Rail spokesperson said engineers were “assessing the situation in order to repair the damaged cables as quickly as possible” but the line was likely to stay closed for most of the day.

They added: “We’re really sorry to any passengers affected by this incident and urge anyone planning to travel by train between Liverpool and Manchester to plan ahead and check with their train operator for the latest travel information.”

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