Aims: Assess the knowledge, attitude, and practice (KAP) toward COVID-19 and its vaccines among the Lebanese population after the beginning of the vaccination campaign and identify the different factors affecting the acceptance of vaccination. Patients and methods: The data was collected through hard copies, then it was filled in Google Form. The questionnaire included questions about sociodemographic data, dependent sources of information for COVID-19 and its vaccines, having past experience with COVID-19, and vaccination or willingness to take the vaccine at the nearest opportunity. Attitude against vaccination was assessed using a new KAP toward virus and vaccine scale consisting of 14 items. Results: The average score of the attitude of 1,002 participants was 16.87 over 28. Accepting vaccination was significantly correlated with females, having past experience with COVID-19, being a healthcare worker, participants with a higher positive attitude, and participants following official resources like governmental resources and World Health Organization (WHO) or accredited international scientific institutions rather than social media. Conclusion: The attitude toward COVID-19 and its vaccines is moderate in Lebanon, and extensive efforts are necessary for the further promotion of vaccines among the public. Social media has a high influence on the population's attitude toward vaccination, and it should be monitored strictly. Clinical significance: Social media and other factors influence on the decision on vaccination and public health.

A seroprevalence of SARS-CoV-2 study among pediatric patients in a South Indian urban hospital found 37% of children to be COVID-19 IgG positive in a 7-month period. Data reveals widespread asymptomatic infection among children. We may achieve herd immunity faster than other countries which might also increase vaccine effectiveness. Manifestations like suppurative cervical lymphadenitis and intussusception were seen with greater frequency in our study sample. Aim: To study the seroprevalence of SARS-CoV-2 among pediatric patients admitted in an urban hospital in South India. Methods: An analytical study was conducted using medical records of children admitted for various conditions in the pediatric ward of our non-COVID-19 hospital from July 2020 through January 2021, a total of 7 months. All patients were tested for SARS-CoV-2 antibodies using the Cellex q Cassette rapid test. Those with a positive RT-PCR or positive IgM were referred to designated hospitals. Result: We found 37% of the children to be COVID-19 IgG positive. Manifestations like suppurative cervical lymphadenitis and intussusception were seen with greater frequency in our study sample. Conclusion: Data reveals widespread asymptomatic infection among children. We may achieve herd immunity faster than other countries which might also increase vaccine effectiveness.

Background: There is an increasing prevalence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli-associated urinary tract infections (UTIs) in the pediatric population. These multidrug infections are challenging to treat. Objectives: Our aim is to study the clinical profile in children having urine culture positive with ESBL E. coli, antibiotic sensitivity pattern for ESBL E. coli in urine cultures, and evaluate clinical outcomes in patients with ESBL E. coli-associated UTI in our hospital. Methods: We collected reports of all urine cultures for age group 0–18 years with colony counts >10⁵ CFU/mL during the study period from January 2017 to December 2021 done in our hospital pathology lab. All urine culture positive reports were separated according to causative organism. From this, the subgroup of patients with ESBL E. coli was our study's focus. The prevalence of ESBL E. coli as a causative organism was calculated. These patients were further analyzed for clinical spectrum, antibiotic sensitivity pattern, and clinical outcome. Results: Out of 450 urine culture positive reports during the study period, E. coli was the most common organism with 259 (57%) cases. The maximum incidence of ESBL E. coli-associated urinary infection was in patients between 0 and 5 years (56%). The prevalence of infection in females (59%) was slightly higher than in males (41%). Extended-spectrum beta-lactamase E. coli are highly sensitive to the carbapenem group of antibiotics, amikacin, and fosfomycin. Resistance was 100% for ampicillin, aztreonam, ceftriaxone, and cefixime. Other antibiotics with high resistance were trimethoprim/sulfamethoxazole and the fluoroquinolone group of antibiotics. About 25% of children had h/o previous episodes of UTI. About 43% of patients had some significant underlying medical problem. About 51% of indoor patient department (IPD) patients had normal ultrasonogram (USG) or no findings related to the renal system. Each IPD patient was treated with antibiotics (IV plus oral) for 11 days on average. There were differences between in vitro antibiotic sensitivity and clinical experience for a few cephalosporin antibiotics. Overall mortality among IPD patients was 4%. Conclusions: Girls have more chances of getting UTIs due to ESBL E. coli than boys. Incidence of UTI due to ESBL E. coli is more during 0–5 years of life than in older children. Urinary tract infection due to ESBL E. coli is associated with high mortality. Carbapenems, amikacin, and fosfomycin are good choices of antibiotics to treat such infections. Antibiotic sensitivity patterns for cephalosporins derived by currently available methods do not always match clinical experience.

Aim: To show that pyuria and significant growth in urine culture (UCx) in fever without focus done early and with only urinary symptoms in girls don\'t always indicate a urine infection and need antibiotic treatment. Materials and methods: Three children had fevers without focus for about 2 days, and one girl with urinary symptoms but no fever had urine tests done. These included urine microscopies and a UCx by collecting a midstream urine/clean catch urine sample. As they looked well, despite significant pyuria in all of them, antibiotic therapy was withheld till the UCx results were available 48 hours later. Results: The three children having fever without focus became afebrile before the UCx report was available. The girl was treated with moisturizing and emollient creams for local application, and her symptoms disappeared. Hence, despite the significant growth of bacteria in the UCx, none of the children received antibiotics, and they remained well. Conclusion: Despite significant pyuria and positive UCx in the three children who had a fever without focus, the fever settled without antibiotics. In case 4, vulval redness was present, and despite significant pyuria and positive UCx, symptoms settled with the local application of moisturizing creams. Clinical significance: UTI guidelines suggest urine tests in children having fever without focus or only urinary symptoms. The time to send the urine samples is not clear in fever without focus. In a well child, where urine tests are done after at least 2 days of fever, if the fever or symptoms settle without antibiotics before the urine culture is available, these children should not be labeled as having UTIs even if the urine Cx is positive. An algorithm suggests the way out in such cases.

Tuberculosis (TB), caused by Mycobacterium tuberculosis, is a chronic granulomatous disease that can affect all systems of the body. Osteoarticular TB is a rare entity that can involve any bone or joint. We are reporting a 6-year-old female child with tubercular osteomyelitis of the mandible who presented in our hospital with swelling in the right cheek for 1 month. She was started on anti-tubercular therapy and showed response on follow-up. By reporting this case, we attempt to familiarize practitioners with the various atypical presentations of TB, which if overlooked can lead to unnecessary investigations and erroneous management.

Background and aim: Dirofilariasis is considered mainly as a zoonosis that may inadvertently cause disease in humans. Though there are many reports about different body locations for this parasitic infection, the subcutaneous involvement in the paravertebral region is mentioned in none. It could possibly cause diagnostic uncertainties when manifested in this particular area. Case description: A 2-year-old male child presented with an asymptomatic swelling in his right lower thoracic paravertebral region for the last 6 months. Ultrasonogram done showed the presence of a worm in a subcutaneous hypoechoic nodule. The lesion was excised and the histopathology of the specimen was consistent with dirofilariasis. Conclusion: Dirofilariasis should be thought of as a differential diagnosis in any case of subcutaneous paravertebral swelling. Clinical significance: We projected this case to realize the possibility of occurrence of parasitic granuloma in this area of the body and the uncertainties it could create in the mind of a pediatrician.

Aim: Reporting a rare case of bilateral tuberculous otitis media with cerebellar abscess, its treatment and its outcome. Background: Mycobacterial tuberculosis is a rare cause of otitis media. Nevertheless, it is more commonly encountered in immunocompromised children. Delay in diagnosis and inadequate treatment can cause intra-cranial spread. Cases of tuberculous cerebellar abscess due to otitis media in immunocompromised patients have hardly been documented in literature. Case description: 7-year-old male child with HIV infection presented with History of ear discharge from 3 years and recent onset of cerebellar symptoms. He was diagnosed to have cerebellar abscess and was treated with twist drill aspiration and ventriculoperitoneal shunt. The child had recurrence of the abscess. Craniotomy and excision of the abscess was done. ZN staining of the pus showed Acid-fast bacilli. The child recovered with full course of anti-tubercular drugs. Conclusion: A tuberculous cerebellar abscess has a good prognosis even in an immunocompromised child if treated adequately. Clinical significance: Tuberculous etiology for otitis media must be suspected early in the presentation of an immunocompromised child with ear discharge especially when bilateral aggressive surgical approaches like craniotomy and excision must be considered when the disease is more wide spread such as in bilateral ear disease.

Polio eradication efforts have seen major advances since 1988 when the thrust for eradication was initiated on a global level. The endgame polio strategy, as announced by the World Health Organization (WHO), is a program from 2019 to 2023 that attempts at the four-point target of eradication, integration, containment, and certification of polio that has ravaged the world across centuries. According to the latest available data, Pakistan has reported 11 cases of wild poliovirus type 1 (WPV1) in 2022, while Afghanistan reported four cases since the start of 2022. Mozambique reported one case of WPV1 in March 2022, while Malawi had one reported case in November 2021. Circulating vaccine-derived poliovirus (cVDPV) types 1, 2, and 3 have been reported from various parts of the globe, especially from the African continent. Active methods are needed to combat and mitigate the spread of PV, especially in the vulnerable and under-immunized regions of the world. The WHO has authorized the use of a novel oral polio vaccine (nOPV), which has been found to be more stable and not revert to neurovirulence when used in the community. These candidates’ vaccine is being used in cases of outbreaks of cVDPV, with good results.

Autoimmune disorders are a heterogeneous group of disorders characterized by immune dysregulation and are associated with a loss of tolerance to self-antigens. Autoimmunity in patients with inborn errors of immunity (IEI) has always been a puzzling phenomenon! Autoimmunity may be the first clinical presentation or sequel in patients with IEI. In this paper, we discuss the mechanisms of autoimmunity in IEI and present a few clinical cases highlighting the need to consider an IEI in patients presenting with autoimmunity and infections, polyautoimmunity, and polyendocrinopathy.