Historical Insight, Classification, and Common Features of Coronavirus Family

Coronaviruses are a large family of viruses that usually cause mild to moderate upper-respiratory tract illnesses, like the common cold. They were named according to the shape of glycoprotein spikes present on the viral surface and resembling to the solar corona. The first coronaviruses identified in human were HCoV 229E and the HCoV OC43, known also as β-coronavirus. This virus family has become increasingly important and received more attention within scientific community in the past two decades because of three new viruses that can cause serious, even fatal, disease. These are SARS coronavirus (SARS-CoV), which emerged in November 2002 and caused severe acute respiratory syndrome (SARS); Middle East respiratory syndrome (MERS) caused by the MERS coronavirus (MERS-CoV), identified in September 2012 and continues to cause sporadic and localized outbreaks. The third novel coronavirus to emerge in this century is called SARS-CoV-2. This chapter will describe the history of the coronavirus family discovery, emergence, and classification of the main coronaviruses.

Developments in pediatrics in 2020: choices in allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, ortopedics, respiratory tract illnesses and rheumatology

In this article, we describe the advances in the field of pediatrics that have been published in the Italian Journal of Pediatrics in 2020. We report progresses in understanding allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, orthopedics, respiratory tract illnesses, rheumatology in childhood.

Convalescent Plasma Reduces Mortality and Decreases Hospitalization Stay in Patients with Moderate COVID-19 Pneumonia

Humans infected with SARS-CoV-2 may develop COVID-19, which manifests across a wide spectrum of clinical severity ranging from mild upper respiratory tract illnesses to diffuse viral pneumonia, causing acute respiratory failure. Many therapies have been tested for their efficacy in treating COVID-19. Controversy surrounds convalescent plasma transfusions as an effective treatment for COVID-19. This study discusses the efficacy of this treatment on COVID-19 patients. Electronic medical record data were collected from patients diagnosed with COVID-19, from November 2020 to August 2021, in the Galilee Medical Center’s COVID-19 departments. Epidemiological, clinical, laboratory and imaging variables were analyzed. Multivariate stepwise regression and discriminant analyses were used to identify and validate the correlation between convalescent treatment and either death or time to negative PCR and hospitalization length. The study population included 270 patients, 100 of them treated with convalescent plasma. The results show that convalescent plasma therapy significantly prevented mortality in moderate patients, reduced hospitalization length and time to negative PCR. Additionally, high BMI, elderly age, high CRP and 4C-scores correlated with the severity and mortality of COVID-19 patients. Convalescent plasma also significantly reduced inflammatory markers, especially in moderate COVID-19 patients. In non-critical hospitalized patients, convalescent plasma therapy reduces morbidity and mortality in moderate COVID-19 patients and hospitalization length. Identifying patients who could benefit from this treatment could reduce the risk of death and shorten their hospitalization stay.

AHR signaling is induced by infection with coronaviruses

Coronavirus infection in humans is usually associated to respiratory tract illnesses, ranging in severity from mild to life-threatening respiratory failure. The aryl hydrocarbon receptor (AHR) was recently identified as a host factor for Zika and dengue viruses; AHR antagonists boost antiviral immunity, decrease viral titers and ameliorate Zika-induced pathology in vivo. Here we report that AHR is activated by infection with different coronaviruses, potentially impacting antiviral immunity and lung epithelial cells. Indeed, the analysis of single-cell RNA-seq from lung tissue detected increased expression of AHR and AHR transcriptional targets, suggesting AHR signaling activation in SARS-CoV-2-infected epithelial cells from COVID-19 patients. Moreover, we detected an association between AHR expression and viral load in SARS-CoV-2 infected patients. Finally, we found that the pharmacological inhibition of AHR suppressed the replication in vitro of one of the causative agents of the common cold, HCoV-229E, and the causative agent of the COVID-19 pandemic, SARS-CoV-2. Taken together, these findings suggest that AHR activation is a common strategy used by coronaviruses to evade antiviral immunity and promote viral replication, which may also contribute to lung pathology. Future studies should further evaluate the potential of AHR as a target for host-directed antiviral therapy.

Successful Control of Human Parainfluenza Type 3 Outbreak in a Level IV Neonatal Intensive Care Unit

Human parainfluenza (HPIV) is a common cause for upper respiratory tract illnesses (URTI) and lower respiratory tract illnesses (LRTI) in infants and young children. Here, we describe successful control of an HPIV type 3 (HPIV3) outbreak in a neonatal intensive care unit (NICU). NICU babies with new-onset clinical signs or symptoms of RTI and positive HPIV-3 nasopharyngeal specimen by respiratory pathogen panel (RPP) test on hospital day 14 or later were diagnosed with hospital-onset (HO) HPIV-3 infection. After 3 NICU babies were diagnosed with HO HPIV-3, an outbreak investigation was initiated on May 3, 2019, and continued for 2 incubation periods since the last identified case. Enhanced infection prevention measures were immediately implemented. All positive cases were placed in a cohort in a single pod of the NICU and were placed on contact precautions with droplet isolation precautions. Dedicated staffing and equipment were assigned. Environmental cleaning and disinfection with hospital-approved disinfectant wipes was performed daily. Visitors were restricted in the NICU. All employees entering the NICU underwent daily symptom screening for respiratory tract illness. All NICU babies were screened daily for respiratory tract illness with prompt isolation and RPP testing on positive screen. To determine the source of the HPIV3 outbreak, all HPIV3-positive specimens from the NICU and available temporally associated community-onset (CO) controls collected from non-NICU units were sent to the Centers for Disease Control and Prevention (CDC) for whole-genome sequencing (WGS) analysis. The first and last cases of HPIV-3 were diagnosed on May 1 and May 5, 2019, respectively. In total, 7 HO HPIV3 cases were reported: 1 in newborn nursery (NBN) and 6 in NICU. The case from the NBN was determined to be unrelated to the outbreak and the source was linked to a sick visitor. Of the 6 NICU babies, 5 had an LRTI and 1 had a URTI. Average time from admission to diagnosis was 71 days (range, 24–112). None had severe illnesses requiring intubation, and all had full recovery. No CO HPIV3 cases were reported from the NICU during the investigation. A maximum likelihood phylogenetic tree of HPIV3 WGS (Figure 1) showed that sequences from the 6 HO cases clustered together separately from the 3 CO controls, suggesting a single source of transmission, and 3 CO cases were not related to the HO cases or source of the outbreak. Early diagnosis and isolation of respiratory tract viral infections is important to prevent an outbreak. Successful control of outbreak in NICU requires prompt implementation of infection prevention measures with focus on symptom screening, cohorting, and disinfection practices.Funding: NoDisclosures: None

Ozonum—The Global Impact

The remedy Ozonum has become the highest-ranking prescription in my practice during the coronavirus pandemic. Respiratory tract illnesses represent a smaller percentage of cases that have responded well to the remedy. Most cases I have seen were predominantly affected by the indirect impact of the pandemic. I have noticed a similar increase in Ozonum prescriptions following former global events, for example, the terrorist attack on the Twin Towers on 11th September 2001 in New York, the 2004 Indian Ocean earthquake and tsunami, the 2010 eruption of Iceland's Eyjafjallajökull volcano which paralysed flights across Europe and the severe 2017 to 2018 flu season. Ozone is a gas, called 'activated oxygen', formed by three atoms of oxygen instead of the two that we normally breathe. We are familiar with the protective function of the ozone layer in the atmosphere. The life cycle of ozone and its connection to ocean and marine life, to trees, habitat, and life in general, is less commonly known. A dynamic constellation of the homeopathic remedy becomes clear once we understand the ozone life cycle and its ecosystem in its natural and disrupted form. Ozonum—the homeopathic remedy—was used by our forefathers but has almost been forgotten until Anne Schadde's proving in nineties of the last century. Ozonum as a remedy has a wide range of applications such as pandemics, mass casualties and disasters, as well as routine clinical uses. Within different levels of context, the main feeling of Ozonum dynamic is exemplified by the statement—'I can't breathe!' It may be considered a 'polychrest' of our time evidently resonating with contemporary climatic, medical, socio-political and economic global challenges. We need to adopt a global view to keep up with the times and perceive a link between individual and global health in a broader perspective.

Best practices, challenges and innovations in pediatrics in 2019

This paper runs through key progresses in epidemiology, pathomechanisms and therapy of various diseases in children that were issued in the Italian Journal of Pediatrics at the end of last year. Novel research and documents that explore areas such as allergy, critical care, endocrinology, gastroenterology, infectious diseases, neonatology, neurology, nutrition, and respiratory tract illnesses in children have been reported. These observations will help to control childhood illnesses.

Stunting Was Associated with Reported Morbidity, Parental Education and Socioeconomic Status in 0.5–12-Year-Old Indonesian Children

Stunting is highly prevalent in Indonesian children. The objective of this study was to identify the associations of stunting with morbidity, parental education and socioeconomic status (SES) in Indonesian children. The study population was part of the South East Asian Nutrition Surveys (SEANUTS). A total of 2236 Indonesian children aged 0.5 to 12 years, who had participated in the SEANUTS, were included in this study. Stunting was defined as height for age Z-score (HAZ) ≤ −2 using WHO criteria and severe stunting as HAZ ≤ −3. Information on morbidity, parental education and family SES were collected by structured questionnaires. ANOVA was used for evaluating differences across groups, with or without correction for confounders. The results showed that the overall prevalence of stunting was 31.4%. HAZ in stunted children was associated with disease incidence, including frequency, parental education and family income. There were no significant differences in HAZ values in stunted children with one or more bouts of infectious, digestive tract or respiratory tract illnesses compared to stunted children with no reported illness. The prevalence of stunting in Indonesian children was high and was strongly associated with child morbidity, parental education and SES.

CHILDREN IN CORONAVIRUSES’ WONDERLAND: WHAT CLINICIANS NEED TO KNOW

Human coronaviruses (HCoVs) commonly cause mild upper-respiratory tract illnesses but can lead to more severe and diffusive diseases. A variety of signs and symptoms may be present, and infections can range in severity from common cold and sore throat to more serious laryngeal or tracheal infections, bronchitis, and pneumonia. Among the seven coronaviruses that affect humans, (SARS)-CoV, the Middle East respiratory syndrome (MERS)-CoV and the most recent coronavirus disease 2019 (COVID-19) represent potential life-threatening diseases worldwide. In adults they may cause severe pneumonia that evolve in distress respiratory syndrome and multiorgan failure with a high mortality rate. Children appear to be less susceptible to develop severe clinical disease and present usually with mild and aspecific symptoms similar to other respiratory infections typical of childhood. However, some children such as infants, adolescents or those with underlying diseases may be more at-risk categories and require greater caution from clinicians. Available data on pediatric coronavirus infections are rare and scattered in the literature. The purpose of this review is to provide to clinicians a complete and updated panel useful to recognize and characterize the broad spectrum of clinical manifestations of coronavirus infections in the pediatric age.

Effect of a novel coronavirus in human and its clinical diagnosis and implications by students of community pharmacy

Coronavirus are coming under a broad family of virus that can cause respiratory illnesses such as the common cold, according to the centers for disease control and prevention (CDC). They are usual in many different species of animals, including camels and bats. Unusually, these corona viruses can evolve and infect humans and then spread between humans. Recent examples of this include SARS-CoV and MERS-CoV. 2019 Novel Corona virus (2019-nCoV) is a virus identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China. In some cases, the viruses can cause lower-respiratory tract illnesses such as pneumonia and bronchitis. In human corona viruses are currently classified into seven types that are HCoV-229E, HCoV-OC43, HCoV-NL63, SARS-CoV, HKU1, MERS-CoV and 2019-nCoV. These two types of corona virus (MERS-CoV and SARS-CoV) are more dangerous. Some of corona viruses like HCoV-229E, HCo-OC43, HCoNL63 and HKU1 that are continuously circulate in the population of human and cause respiratory infections in human either may children and adults world-wide. They are generally transmitted between animals and humans through sneezing, coughing, touching or shaking hands and making contact with a surface or object. The symptoms of corona virus are sneezing, cough, fatigue, runny nose, sore throat, breathing difficulty and exacerbated. In more severe cases SARS, kidney failure, pneumonia and even death. Diagnosis can be carried out by healthcare provider in laboratory test on respiratory specimens and serum to detect human corona virus. For this virus no specific treatment like vaccines and antiviral drugs but symptoms can be treated.