Objective: To assess outcomes of neonates born to mothers who were COVID-19 positive. Study Design: Prospective observational study. Place and Duration of Study: Secondary and Tertiary Care Hospitals of the Armed Forces, Pakistan, from Apr to Aug 2020. Methodology: We studied 106 pregnant women who tested positive for SARS-CoV-2. Stable asymptomatic newborn babies were kept in SARS-CoV-2 specified incubators, at specially designated areas for observation. Nasopharyngeal swabs were taken at first 24 hours and if negative, babies were handed over to clinically stable mothers who were educated regarding use of facemasks and proper hand washing. Neonates who tested positive for SARS-CoV-2 were evaluated for SARS-CoV-2 again at 48 hours and then every 48-72 hours, until found to be negative. Results: Total 106 women were found to be SARS-CoV-2 positive during the study period. All the women delivered singleton babies. Of the 106 babies, 5 (4.71%) were found to be positive for SARS-CoV-2 at 24 hours and only 1 (0.94%) baby was found to be positive at 48 hours and then tested negative at 7th day. Conclusion: Babies born to SARS-CoV-2 mothers were mostly asymptomatic and there was no increased risk of morbidity or mortality to the neonates suffering from the infection.

Objective: To determine the frequency of respiratory syncytial virus (RSV) among hospitalized children with acute lower respiratory tract infections (ALRI) and associated risk factors. Study Design: Comparative cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jul 2019 to Aug 2020. Methodology: After approval from the Ethical Review Board, 126 children were included in the study. Nasopharyngeal aspirates were collected from children. The direct immunofluorescence method was utilized to detect intracellular viral antigens of the respiratory syncytial virus. In addition, the presence of symptoms and history for identification of the presence or absence of risk factors was recorded. Results: 57(45.2%) patients were found to be respiratory syncytial virus positive, and 69(54.8%) were respiratory syncytial virus negative. Significant differences were found in symptoms between RSV-positive and negative children (p=0.001). Conclusion: Respiratory syncytial virus was among the leading causes of children hospitalized with acute lower respiratory tract infections, with fever and recurrent wheezing as the most common symptoms.

Objectives: To assess the clinical characteristics of COVID-19 Virus disease in the pediatric population in Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Mar 2020 to Jan 2021. Methodology: All children presenting to the department with symptoms consistent with COVID-19 disease were tested for the virus. Patients who tested positive on the PCR were included in the study. Patients with non-consistent symptoms of COVID-19 and those who tested negative on the PCR were excluded from the study. All clinical data, including the age of the child, the onset of symptoms, the gap between the onset of symptoms and presentation as well as clinical symptoms, were documented on a predefined proforma. Results: A total of 106 patients were enrolled on the study. The mean age of patients was 5.6±2.5 years. The most frequent symptoms were fever (63, 59.6%) and cough (49, 46.2%). There were 3(2.9%) cases with severe or critical illness. The most frequent abnormal laboratory findings were leukopenia (29, 27.4%) and increased creatine kinase (38, 36.0%). Ground-glass opacities were observed in the HRCT chest of 17(65.3%) cases, out of 26 children diagnosed with pneumonia. The majority (70, 66%), had a positive exposure history. 88(83%) cases did not abide by the precautionary measures against the COVID-19 disease. Conclusions: The current study indicates that children usually present with mild symptoms but can present as severe diseases, as observed in this study.

Objective: To look for the associative factors in avoidance of exclusive and non-exclusive breastfeeding among mothers after lower segment Caesarean section. Study Design: Cross-sectional study. Place and Duration of Study: Paediatrics department, Pak Emirates Military Hospital, Rawalpindi Pakistan from Oct to Mar 2020. Methodology: Mothers bringing their infants for vaccination at six weeks of age with babies born with lower segment caesarean section were included in the study. They were asked simple questions regarding exclusive or non-exclusive breastfeeding. Relevant socio-demographic factors were also recorded and compared among mothers breastfeeding their babies and those avoiding it. Results: A total of 500 mothers were included in the study. The mean age of the study participants was 33.576±9.174 years. 336(67.2%) women were primiparous, while 164(32.8%) were multiparous. 208(41.6%) women were actively breastfeeding their child, while 292(58.4%) avoided breastfeeding their babies. 150(72.1%) women were non-exclusively breastfeeding, while 58(27.9%) showed an exclusive breastfeeding pattern. Pearson chi-square test revealed that low education and working outside the home had a statistically significant association with the avoidance of breastfeeding the babies among our target population (p-value <0.05). Conclusion: Avoidance of breastfeeding was a common finding after six weeks of birth among women who delivered the babies via lower segment caesarean section. Mothers with low education and duties to work outside the home were more at risk of avoiding this highly beneficial practice for the baby.

Majeed syndrome, characterized by chronic recurrent multifocal osteomyelitis and congenital dyserythropoeitic anemia, is a rare disease reported in children. We report a case of Majeed Syndrome in a 9-year-old boy, born of consanguineous marriage reporting to us for treatment of anemia, requiring blood transfusion. He underwent below-knee-amputation due to unresolving recurrent osteomyelitis at multiple sites. There was history of pain insensitivity and fever during hot weather as well. His interleukin-6 levels were raised. This is the first case of Majeed Syndrome from Pakistan and first in the world with Hereditary Sensory Autonomic Neuropathy type 4 as an associated feature.