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Recently it has been highlighted by ESPEN Council that the COVID-19 pandemic is posing unprecedented challenges worldwide. There is significant correlation between age and polymorbidity and these factors are independently associated with malnutrition and its negative impact on patient survival [1]. The COVID-19 outbreak has shattered the world's economic giants with an estimated loss of $1 trillion during year 2020. This economic dent could have drastic effects on people living in extreme poverty [2]. As in year 2019 top donor countries of humanitarian aid and world food program were United States of America (USA), Germany, United Kingdom, and European Commission respectively (Fig. 1). Unfortunately these countries were badly hit by the COVID-* Corresponding author.

End Polio Pakistan program still has to overcome many hurdles; unfortunately on 8th February 2016 first polio case of the year has surfaced in Karachi. It seems that battle against polio demands little bit more conviction and motivation. WHO has set a goal of polio eradication in Pakistan till 2018, in order to evaluate the success of this target; polio eradication campaign in Pakistan has been analyzed in different perspectives. Our analysis indicated that major obstacles in eradication are low literacy rate, poor health infrastructure, lack of planning, natural disaster, economic crisis, counter insurgencies and almost no protection for polio health workers. WHO has allocated new funds to tackle this problem, now there is a need to spend this money more effectively; with proper planning and honest deployment of funds.

Sudden perinatal death that includes the victims of sudden infant death syndrome, sudden intrauterine death syndrome, and stillbirth are heartbreaking events in the life of parents. Most of the studies about sudden perinatal death were reported from Italy, highlighting two main etiological factors: prone sleeping position and smoking. Other probable contributory factors are prematurity, male gender, lack of breastfeeding, respiratory tract infections, use of pacifiers, infant botulism, extensive use of pesticides and insecticides, etc. However, extensive studies across the world are required to establish the role of these factors in a different subset of populations. Previous studies confirmed the widely accepted hypothesis that neuropathology of the brainstem is one of the main cause of sudden perinatal death. This study is an effort to summarize the neuropathological evaluation of the brainstems and their association to sudden perinatal death. Brainstem nuclei in vulnerable infants undergo certain changes that may alter the sleep arousal cycle, cardiorespiratory control, and ultimately culminate in death. This review focuses on the roles of different brainstem nuclei, their pathologies, and the established facts in this regard in terms of it’s link to such deaths. This study will also help to understand the role of brainstem nuclei in controlling the cardiorespiratory cycles in sudden perinatal death and may provide a better understanding to resolve the mystery of these deaths in future. It is also found that a global initiative to deal with perinatal death is required to facilitate the diagnosis and prevention in developed and as well as developing countries.

Dear Editor, COVID-19 pandemic is a global health crisis with 61, 149,391 confirmed cases and 370,478 deaths till 29May, 2020 [1]. This pandemic has shattered many economies with an estimated loss of $5.8 trillion to $8.8 trillion globally. This economic loss can result in reduction in funds to World Health Organization. Unfortunately, United States of America (USA) has announced termination of any further funding to WHO which can lead to another global health crisis [2]. As WHO is a voluntary funding based organization its main donor are America, China, Japan, Germany and United Kingdom. Among these USA is the main donor with a contribution of $115.8million alone followed by China $57.4 million, Japan $41million, Germany $29.1 million and UK $21.9 million [3].  America’s termination of funding can put WHO and child health programs in serious crisis. Among many programs run by WHO one of the most important program is immunization of children. Immunization coverage programs  save 2-3 million lives per year causing decline in measles related deaths, eradication of polio, surveillance of rotavirus, BCG and DTaP vaccination in children[4].  It is estimated that during Millennium Development Goal (MDG) there is overall decline in child related mortalities due to malaria, measles, diarrhea, AIDS and meningitis [5]. Remarkable results are achieved with measles are diarrhea immunization programs causing a decline in death rate by 73% and 80% respectively. According to a study with current success rate diarrhea related deaths can be virtually eliminated by 2030. Another successful program is “End Polio” program which eradicated polio from world except from Pakistan and Afghanistan [4][6]. This termination of funds to WHO can waste all previous efforts in developing countries. On the other hand despite of all efforts still 19.4 million children did not received prescribed dose of vaccines. Data analysis revealed among these  60% of children belong to 10 developing countries namely Angola, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines and Viet Nam [4]. These countries mainly rely on foreign funding and Non-Government Organization (NGOs) for child health care programs. According to WHO immunization coverage report updated on 6 December 2019 globally 100% results were not achieved Fig 1. The immunization rate was low in developing counties with high population density and poor health care facilities. People are already battling to fulfill basic necessities like food, clean drinking water and shelter [7]. COVID-19 pandemic has further worsened the economies of these counties. As a result these counties will not be able to support vaccination programs at their own. WHO has an already established network in these regions, any efforts from scratch will waste lots of time and eventually cost millions of lives. Now a heavy responsibility lies on the shoulders of world leaders to foresee this up-coming crisis and take appropriate measures. Timely management of funds by convincing USA government or by alternative funding sources can save work of decades done by global community through WHO in saving lives in developing countries.

One of the major and most common diseases of the stomach is peptic ulcer. It occurs when the mucus secretion in the stomach decreases, acid secretion increases or both at the same time. There are multiple dietary and lifestyle factors that can cause peptic ulcers. However, peptic ulcers can be treated by consuming a balanced diet along with medications. Objective: Assessment of dietary intake among patients with peptic ulcers. Methods: The assessment was carried out at Services hospital, Lahore.  A sample of 100 patients aged between 20-80 years was taken by using non-probability convenient sampling. Data was collected with the help of pre-tested questionnaire and was analyzed by using SPSS version 21.0. Results: The results showed that chapatti was most commonly consumed by peptic ulcer patients from the carbohydrates group. Most patients consumed milk and chicken from the protein group while fats were not consumed in abundance. Fruits and vegetables made an integral part of the weekly dietary intake of the patients. Conclusions: Patients with peptic ulcers cannot consume spicy foods and fried items. In order to achieve complete cure, they tend to consume foods that provide satiety and do not cause any discomfort. A balanced diet along with proper medication can help alleviate symptoms of peptic ulcers.

Cirrhosis is defined as the development of regenerative nodules surrounded by fibrous bands and inflammation of liver, which can cause portal hypertension or hepatic insufficiency that causes jaundice, hepatic encephalopathy or various complications. The important function of liver is to maintain the body metabolic homeostasis. It also helps in protein, carbohydrate, and fat metabolism, due to which the diet of a person is fully affected Objective: To assess the nutritional status of liver cirrhosis patients, visiting Public Hospitals, Lahore Methods: A cross-sectional study was performed at Sir Ganga Ram Hospital Lahore, for a period of 4 months and 100 patients of liver cirrhosis were selected by non-probability convenient sampling to conduct the study. Results: Of total 100 patients, 53% were males and 47% were females. The mean of age, body mass index and calories intake were (53.17±18.414), (19.12±4.743) and (544.88±437.195). Out of 100 patients only 7% of the patients were nourished, 58% are malnourished, and 35% patients were severely malnourished. Mostly patients were malnourished and lost weight due to disease. The mean BMI of patients was19.12±4.743, which shows that mostly patients were malnourished and undernourished. Sarcopenia was common in patients suffering from liver cirrhosis.  Conclusions:  Cirrhosis is complication of liver disease that involves loss of liver cells and irreversible scarring of the liver. It is more prevalent in males as compared to females.

COVID-19 cases in Pakistan are increasing exponentially since last couple of days with over 50,000 infected individuals and over 1000 deaths [1]. Furthermore government has eased the lock down as Pakistan is facing serious economic crisis. A 4% GDP loss is predicted in economy due to disruptions in business activities. Government has also announced a reduction in budget goals for financial year 2020 and 2021. This ease in lockdown is a desperate effort to support collapsing economy and reducing unemployment.Government statistics are predicting many deaths due to hunger if lockdown prolongs