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Introduction: ST-elevation myocardial infarction (STEMI) is a leading cause of morbidity and mortality worldwide. Present study is designed to gather data in our population about the prevalence of metabolic syndrome (MetS) in STEMI. The gathered data will help in better understanding of association of STEMI and metabolic syndrome. This will also help the physicians to devise preventive strategies based on life style modifications to limit further progression of this syndrome particularly in individuals who are at higher risk for CAD. Objectives: To determine the frequency of metabolic syndrome in patients presented with ST segment elevated myocardial infarction. Study design: Cross sectional study. Duration of Study: 6 months (01-08-2018 to 31-01-2019) Settings: Department of Cardiology, Pakistan Institute of Medical Sciences Islamabad Subjects and Methods: A total of two hundred and fifty-seven (n=257) patients of both gender between age 18-75 years who were diagnosed cases of ST segment elevated myocardial infarction (STEMI) were enrolled in this study. Fasting blood sugar, Serum TG, HDL, blood pressure and waist circumference was estimated and frequency of metabolic syndrome was evaluated. Results: Metabolic syndrome was found present in 37.4% (n=96/257) patients as per our operational definition. Frequency of metabolic syndrome was significantly higher in males as compared to females (P=0.048). No significant difference noted in the frequency of metabolic syndrome when data was stratified for different age groups (P=0.717). Conclusions: Metabolic syndrome was observed to the highly prevalent among patients presented with ST segment elevated myocardial infarction and was significantly higher in males.

Background: The unprecedented outbreak of 2019 novel coronavirus disease (COVID-19) drastically spread worldwide. The study was aimed to articulate the findings of a descriptive and clinical characteristic, also to access the potential risk factors link with the spread of COVID-19. Method: The COVID-19 cases reported through April 30, 2020, were extracted from Balochistan’s COVID-19 Electronic Dashboard. All cases from March to April 2020 were included. The results of the laboratory finding as well as data acquired through COVID-19 Dashboard were cleaned; descriptive exploratory analysis and chi-square were calculated to demonstrate the association using Epi- Info. Results: A total of 1381 patient records extracted and screened. Of these, 1218 suspected cases and 1049 confirmed cases contributed to the analysis. Among confirmed cases, 77% (811) were male. The most affected age group was 60 – 69 years (attack rate 1.90/10,000), mean age was 36 ±17.11 SD with age range 2 months-94 years. District Quetta 82% (864) and district Pishin 5% (55) remained the epi-center for high attack rates. Among confirmed cases, a total of 14 deaths occurred for an overall Case fatality rate of 1.33%. The epi surge was peaked around March 19, April 5, and April 24, 2020. Among high-risk personals, those who had contact with infected individuals’ showed a high association of 97% (323/333) than without any contact 87% (221/254). Those who had travel history showed a prevalence of 86% (87/101) than in those who did not 59% (60/104) while those admitted in hospital with comorbid conditions showed a prevalence of 70% (26/37) than in those who did not 13% (6/46). Conclusion: COVID-19 epidemic has spread rapidly in the province. A series of multidimensional public health interventions, a cost-effective surveillance system, and the adoption of safe working practice, awareness sessions are necessary to control the COVID-19 outbreak

Objective: To determine the frequency of immediate procedural success of Primary PCI in patients with Acute ST segment elevation Myocardial infarction. Methodology: This observational study was conducted at Cardiology unit of P.I.M.S, Islamabad from April 2018 to October 2018. Study included 43 patients with STEMI. All of them had primary PCI. The main outcome variable was frequency of procedural success which was described as frequency distribution table. Results: Procedural success was achieved among all (100%) patients. There were 16.3% patients who developed contrast induced nephropathy (recovered), they all were diabetics. There were 4.6% patients who developed hematoma. No other complications seen Conclusions: Immediate procedural success of primary PCI is high (almost successful in every case) and should be offered to the patients with STEMI whenever the facility is available. Keywords: ST-segment elevation myocardial infarction; primary percutaneous coronary intervention.

Background: During 2020 and immediately prior to the COVID-19 pandemic, Sudan was experiencing multiple emergencies including violence, seasonal flooding, and vector-borne disease outbreaks. After more than ten years since its last case of wild poliovirus, Sudan declared a circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak on 9 August 2020. Methods: cVDPV2 outbreak response data and programme documents of the Federal Ministry of Health and WHO were reviewed. Surveillance data was verified through WHO-recommended procedures for detecting and characterizing polioviruses from stool and sewage samples collected from AFP cases and the environment. Results: This outbreak in Sudan led to a total of 58 confirmed cases of cVDPV2 from 15 of the 18 states. Two nationwide vaccination campaigns were held to increase immunity of children under-five against poliovirus type 2. Funding challenges were overcome by intense additional resource mobilization from domestic resources and partnerships. The funding gap was bridged from domestic resources (49%) sourced through GPEI partners, and in-country humanitarian funding mechanisms. Conclusions: During an outbreak response and challenge of funding shortfall, mobilizing domestic resources is possible through coordinated approaches and systematic communication with in-country partners, disaggregation of needs, and diverse interventions. A cVDPV2 outbreak requires a fast, resourced, and quality response to stop virus circulation.

The second wave of COVID-19 pandemic has started globally, right now 220 countries are infected and a total of 71,351,695 confirmed cases and 1,612,372 deaths due to COVID-19 have been reported. Infection Prevention and Control (IPC) measures for COVID-19 all have proved vital in decreasing the transmission rates among the communities. Methodology: Unmatched Case-Control Study was conducted where cases were defined as “every PCR positive contact (symptomatic or asymptomatic) for any index case” similarly controls were defined as “every PCR negative contact (symptomatic or asymptomatic) for any index case who was home quarantined for 14 days based on suspicion by PDSRU team”. A simple random technique was used and 300 individuals were made part of this study. Results: The major findings of this study shows that PCR positive contacts poorly adopted certain COVID-19 IPC measures of interest in their daily life hence got infected. The odds for all the variables of interest were found to be statistically significant among cases as compared to controls like the odds for knowingly and intentionally contacted with a COVID-19 positive case was 13.7 times more among the PCR positive contacts as compare to PCR negative contacts (p = 0.00, C.I = 7.62 - 24.90), similarly, the odds of being a family member of the index COVID-19 case was 7.07 times more among the PCR positive contacts as compared to the PCR negative contacts (p = 0.00, C.I = 3.25 - 15.86). Conclusion: Before the development and availability of a vaccine, the only tools that can help prevent the spread of COVID-19 are IPC measures.

Background: COVID-19 Pandemic is still circulating within the human population and proving to be a deadlier disease with a mortality rate ranging from 0.5% to 7%. Since COVID-19 is a highly transmissible disease; there is always a probability for its outward spread towards the general public and community from the hospitals and healthcare facilities where they come to seek treatment. Methodology: A prospective cohort study design was used, considering the limited available resources and time—a total of 200 healthcare workers (including doctors, nurses, para-medical staff, janitorial staff, reception staff & pharmacists) working in the OPDs of the two major public sector hospitals of Quetta were made part of this study. The study participants were selected using a simple random sampling technique and selection was made from the daily attendance register. The study participants from “Hospital-A” were first of all educated and trained on various COVID-19 IPC measures later on various COVID-19-IEC materials; written in simple Urdu language, were displayed clearly everywhere in the OPD. Similarly, handwashing stations along with hand sanitizers/soaps and surgical face masks were also made available free of cost for all the study participants of Hospital-A. Moreover the importance and effectiveness of COVID-19 IPC measures were continuously announced in the OPD gallery of Hospital-A, these announcements used simple wording in local languages (i.e., Urdu, Pashto, Balochi and Brahvi). On the other hand, in the OPD of “Hospital-B”, no such interventions were made. The study participants of both the hospitals were followed for one month and observations like which group showed more on-job noncompliance towards various COVID-19 IPC measures were recorded. The data was recorded on daily basis (from 1st May-to-31st May 2021) after observing the study participants for compliance towards using face masks, face shields, personal protective gowns, gloves, hand sanitizers, maintaining 6 feet social distancing and implanting triage at his or her OPD counter. Any study participant with daily proper practice of at least face masks, gloves, hand sanitizer and maintaining a 6 feet social distancing SOPs during duty hours at the outdoor patients department was considered to be a compliant individual if even one of these minimum required SOPs has not practiced the study participant, he/she was classified as non-compliant individual. A checklist was used to record these findings for every study participant on daily basis by trained data collectors. Lastly, all the data was analyzed using Microsoft Excel 2007 version. Results: The major findings of this study are almost in line with the set objectives, the study results are clearly showing the Risk Ratio (RR) as 0.27, indicating that the intervention group participants were only 27% as likely to develop on-job non-compliance for various COVID-19 IPC measures compare to the non-intervention group. Discussion & Conclusion: It is highly recommended that various COVID-19 specific infection prevention and control interventions like COVID-19 IPC trainings, COVID-19 IEC and BCC materials be displayed clearly everywhere in the healthcare facilities especially in the OPD department. Moreover, audio announcements made in simple wording using local languages like Urdu, Pashto, Balochi and Brahvi could really serve as constant reminder tools especially in an OPD department where every next patient in the queue could present with a different infectious bug.

Objective: To determines the incidence of depression in patients presenting with chronic heart failure at tertiary care Hospital. Materials and methods: This study was descriptive cross-sectional study conducted at Punjab institute of cardiology Lahore during six months from September 2018 to April 2019. Patients were of chronic heart failure with reduced ejection fraction (

يهدف البحث إلى تسليط الضوء على مفهوم الترتيبات المشتركة وفق معيار التقارير المالية الدولي 11 ، مع بيان التحديات التشريعية والمحاسبية في البيئة العراقية التي تواجه تطبيق المعيار الدولي للتقرير المالي IFRS11 ، فضلا عن دراسة واقع حال المحاسبة في مثل هذا النشاط الاقتصادي للشركات العاملة في هذا القطاع. ولغرض تحقيق أهداف البحث قام الباحثان بدراسة تحليلية مقارنة بين معيار الإبلاغ المالي الدولي IFRS11 (الترتيبات المشتركة) والنظام المحاسبي الموحد في العراق كخطوة أولى، ثم في الخطوة الثانية تطبيق IFRS11 على عينة البحث المتمثلة بشركة غاز البصرة. وقد توصل البحث الى مجموعة من الاستنتاجات أهمها وﺠود ﻓﺠوة واﺴﻌﺔ ﺒﻴن اﻟﻨظﺎم اﻟﻤﺤﺎﺴﺒﻲ اﻟﻤطﺒق ﻓﻲ العراق وﺒﻴن معايير التقارير المالية والمحاسبية اﻟدوﻟﻴﺔ وﻤﺘطﻠﺒﺎت تطبيقها محليا والمتمثلة باختلاف في بعض المعالجات المحاسبية وقصور اﻹﻓﺼﺎح ﻓﻲ اﻟﺘﻘﺎرﻴر اﻟﻤﺎﻟﻴﺔ عن الترتيبات المشترك مع وجود عوائق وتحديات في البيئة المحلية من النواحي القانونية والمحاسبية عند تطبيق معيار الترتيبات المشتركة. كما قدم البحث مجموعة من التوصيات تجلى أهمها في التوجه نحو تبني معيار التقرير المالي الترتيبات المشتركة (IFRS11) من قبل الشركات العراقية من خلال الدخول في المشاركات التي تسهم في تدعيم الاقتصاد الوطني من اجل زيادة الخبرات والحصول على التكنولوجيا وخلق فرص عمل للتخفيف من البطالة ، وأهمية دراسة العقد والية التعاقد من النواحي التعاقدية والقانونية والمحاسبية قبل الدخول في إي شراكات وخصوصا الخارجية منها منعا لأي مخالفات قانونية أو محاسبية.

The objective of the present study was to investigate what extent the leaf rust disease severity affects the photosynthesis and grain yield in wheat. This was done by estimating disease severity, p...

BackgroundThe second wave of COVID-19 pandemic has started globally, right now globally 220 countries are infected and a total of 71351695 confirmed cases and 1612372 deaths due to COVID-19 has been reported so far1. As of today i.e. (16th Dec 2020) a total of 11430955 new COVID-19 confirmed cases have been reported across the south-east asia1. These cases are showing an increasing trend in all the Asian countries including Pakistan1. Across Pakistan till date 440787 new confirmed COVID-19 cases have been reported across the Pakistan showing a doubling time of 10.63 days (95% C.I 9.68-11.8), while a total of 8832 new deaths have been reported across the Pakistan making the double time for death as 11.11 days (95% C.I 4.04-14.86) 1. Till the development and availability of a vaccine the only tools that can help prevent the spread of COVID-19 are IPC measures violating them can result in a quick spread across the population3.This study was conducted to assess the odds of various COVID-19 IPC measures among the Contacts of an index COVID-19 case traced by Provincial Disease Surveillance & Response unit Quetta.MethodologySample Size & Sampling techniqueUsing the detailed epidemiological reports of 600 COVID-19 contacts identified during the trace test and quarantine field activities form 1st October till 30th October 2020 in district Quetta, from this data a sample of 300 individuals was selected for this study using Simple random sampling technique.Study DesignConsidering different exposure rates and pandemic situation an Un-matched Case control study study was conducted where Cases were defined as “Every PCR positive contact (Symptomatic or asymptomatic) for any index case” similarly Controls were defined as “Every PCR negative contact (Symptomatic or asymptomatic) for any index case who was home quarantined for 14 days based on suspicion by PDSRU team. A set ratio of 1:2 for cases & controls respectively was used for this study.ResultsThe odds for various IPC measures like Knowingly and intentionally Contacted with a COVID-19 positive case, Family member of the index COVID-19 case, Knowingly and intentionally received an object handed over by a COVID-19 Positive case, Touched the same surface/surfaces after it was touched by the index case, Not doing regular Hand washing, Knowingly and intentionally did not follow the government SOPs of Social Distancing During encounter with a positive symptomatic case, Knowingly and intentionallydid not Follow the government SOPs of Social Distancing During sharing of bedroom and toilet with positive symptomatic case, used the same vehicle after it was used by the COVID-19 index case, Spoke with Positive COVID-19 index case for more than 15mins few days before catching the disease, Individual did not use a face mask during all of his contact episodes with the positive index case, Participating in gathering or social events were all found to be poorly followed by the PCR positive contacts.

The demand for counterfeit goods has exponentially grown and counterfeit goods trade has consequently emerged as a global problem. The present study investigates the determinants that encourage consumers to acquire counterfeit luxury goods. This research further analyzes purchase intention as mediator and gender role as a moderator between the contextual factors and consumer behavior. A quantitative approach was applied through a questionnaire to gather data from 380 Pakistani respondents. The measurement and structural model assessed through Smart PLS. The results confirmed that purchase intention acts as a mediator between hedonic motives, materialism and consumer behavior. However, purchase intention has no mediating effect on economic benefits. Similarly, gender role as moderator was insignificant.

Leishmaniasis is a parasitic disease transmitted by sand-flies and is considered one of the most neglected diseases in the world. It mostly affects the poorest of the poor. People living in poor situations are more susceptible. Leishmaniasis includes several variants. Cutaneous leishmaniasis (CL) presents as a localized lesion at the site of the sand-fly bite after a period of several days to months. The nodule then increases in size and progressively ulcerates. In immunocompetent persons, CL lesions are slowly self-healing but often form scar tissue. The disfiguring scars can lead to substantial psychological disturbance, social suffering, and economic losses. Community awareness on the spread and control of disease, reducing social stigma, vector control, public-private partnership, and substantial surveillance indicators to measure the exact burden of the disease is needed.

'Background:' On 1 March, 2018, 15 students of a religious boarding school presented to a tertiary care hospital in Islamabad with complaints of nausea, vomiting, abdominal pain and diarrhea. A team of FELTP fellows were tasked to investigate the suspected outbreak to confirm diagnosis, determine magnitude, evaluate possible risk factors, identify the source and implement control measures. 'Methods:' A retrospective cohort study was conducted from 25 February to 5 March, 2018. Medical records were reviewed at the hospital. All the students and staff of the boarding school were interviewed using a structured questionnaire. A case was defined as any student of the religious school reported with nausea, abdominal discomfort and one of the following symptoms of vomiting, diarrhea, and chills on 1 March, 2018. Information on demographics, history of food intake and clinical features was collected. Suspected food items and drinking water samples were sent to the National Institute of Health for microbiological analysis. Frequencies and attack rates were calculated and risk ratios computed at 95% confidence interval at the margin of error P

BackgroundThis paper analyses any possible association of various factors like gender, last COVID-19 PCR test results, BCG Vaccination, Seasonal Flu vaccination, Occupation and confirmed case contact history with COVID-19 RDT results of the participants. COVID-19 will soon become endemic in Pakistan, the government should adopt COVID-19 RDT kits for trace, test and quarantine activities.MethodologyConsidering the availability of COVI-19 rapid diagnostic kits, 596 individuals all previously COVID-19 PCR tested were made part of this cross sectional study. Simple random sampling was used for the selection of study participants. The whole study was conducted during September and October 2020.ResultsThe major findings of this study is clearly showing that the Positive Likely hood ratio of the COVID-19 RDT Kits (LR+) is well above 1; similarly the Negative Likely hood ratio is approaching 0.On the other hand the Sensitivity and Specificity 80% and 74% respectively. Similarly study found statistically significant association was between RDT out comes and Last PCR Test status, Occupation and Contact with COVID-19 positive individuals. While other variables like Gender, BCG Vaccination and history of seasonal flu vaccinations were found to have no significant associations with COVID-19 RDT Kit out comes.ConclusionBeing the first study of its kind in Pakistan the major findings of this study are almost in line with the set hypothesis and objectives of this study and based on study findings it will be of high value to use COVID-19 RDT kits during mass screening especially during Test, Trace and Quarantine activities.

Introduction: On 14 February 2018, the District Health Officer of Nasirabad reported 16 suspected measles cases from the nomadic population of Dera Murad Jamali to the disease surveillance and response unit of Quetta and requested an investigation. A FELTP fellow was deputed by the Director of General Health Services, Balochistan to investigate the outbreak, evaluate risk factors and recommend control measures. Methodology: A purposive sampling technique was adopted and a case control study was planned and conducted. Case was defined as “acute onset of generalized maculopapular rash and fever with cough or coryza or conjunctivitis from 29 January to 20 February 2018 in a resident of Dera Murad Jamali”. Active case searches along with interviews were conducted through a semi structured questionnaire. Demographic, socioeconomic, clinical and epidemiological information was collected along with assessment of routine immunization. Five blood samples were sent for serology. Results: A total of 49 cases (AR= 0.17%), including five deaths (CFR=10.2%), were identified. Males, 61% (n=30), were more affected. The median age was three years (age range=1-10 years). The age-group 0-4 years, 69% (n=34), was most affected. The median age group of controls were four years (age range 1-11 years). Of the cases, 71% were unimmunized for any routine antigen while 32% of controls were unimmunized. Pneumonia, 42.8% (n=21), and diarrhea, 38.7% (n=19), were the most common complications. All five samples were positive for measles IgM. Significant statistical association was found between nomadic populations having zero routine doses of measles containing vaccines (MCV1) (OR 2.85; CI 1.83 – 4.42; p value

The present study analysed the determinants which encourage Pakistani consumers to willingly purchase counterfeit products. Total five variables were selected and out of five three were independent variables i.e. economic benefits, materialism, and perceived value. The purchase intention was used as mediating variable and consumer behaviour was taken as a dependent variable. A theoretical model was developed by combining these variables and empirically tested as shown in figure 1. The theory of planned behaviour provided bases for theoretical support to the proposed model which resulted in the development of seven hypotheses. The results confirmed that all independent variables positively related to purchase intention and consumer behaviour. Furthermore, purchase intention also had a mediating effect on independent variables. The model was found satisfactory from the goodness-of-fit point of view and all values are in the range of accepted fit and based on these results, all proposed hypotheses were accepted positively.

We introduce bivariate C 1 piecewise quintic finite element spaces for curved domains enclosed by piecewise conics satisfying homogeneous boundary conditions, construct local bases for them using Bernstein–Bezier techniques, and demonstrate the effectiveness of these finite elements for the numerical solution of the Monge–Ampere equation over curved domains by Bohmer's method.

Background: Postpartum haemorrhage would affect mother and her neonates. Objective: To determine outcome of mothers presenting with PPH in a tertiary care hospital. Methodology: This was cross sectional study conducted in Sheikh Zayed Hospital, Rahim Yar Khan from April to May 2018 on 76 mothers presenting in Gynaecology and obstetrics ward with postpartum hemorrhage. Results: Regarding maternal outcome, out of 76, 31 (48.8%) mothers were healthy and alive, 7 (9.2%) were admitted in ICU, 29 (38.2%) went into shock and 9 (11.8%) died. Our study showed mode of delivery had no significant effect on maternal mortality or morbidity. Similarly history of ANC don’t have any significant effect on maternal outcome. Conclusion: This study showed that mothers with postpartum haemorrhage (PPH) faced complications like shock, ICU admission and even death. Mode of delivery and history of ANC has no significant association with maternal outcome. Keywords: PPH, maternal outcome of PPH, Mortality, Morbidity.

This paper describes a unique approach to generate the graph based ontology. Ontology is created from text graph. Many other tools are available to create the ontology but each tool has its own method and complex structure to generate ontology. Ontology is very popular in many fields today and also became the necessary part of www. In this paper, the proposed tool that is used to generate the ontology consists of four different phases. Each phase has its own purpose. First, the text graph is input in notepad and implementing in java (eclipse). Second, the output of first step is converts into XML file. Third, the XML file is parsed with the help of DOM or SAX parser. In the last step, XML file is converted into RDF file which is validating by the help of online RDF parser. In the future, the RDF file is converted into RDFS and in the last ontology is created. After this, the working of proposed tool is improved and its produce more accurate result in term of accuracy.

This paper presents a novel approach to generate a referent graph for semantic business vocabulary and rules. Graphs have many applications in social media, Google map and search engine to locate a specific goal. In social media websites, friends are linked to other friends, Google map help to search a specific location, path and distance from specific location, search engine are used to make a specific search, all these task are performed by used of referent graph. Semantic business vocabulary and rules are the standards from object management group for the business organization to form the polices and rules. On the based of these rules business organization develop different software from software industry to make transaction globally. But these rules are complex and ambiguous, cause misunderstanding and miscommunication for the software developer. Our used approach give the solution of this problem, to make a representation of semantic vocabulary and rules in form of referent graph, visual representation of these rules.

The association of immune thrombocytopenic purpura and tuberculosis is extremely rare. We presented a case with tuberculous lymphadenopathy and immune-mediated thrombocytopenia, the complete remission with anti-tuberculous therapy, and partial response to immunoglobulin and steroid suggested a causal relationship between the two conditions.

This paper explains a suspension system of a vehicle which comprises of spring mass and damper. The main objective is to design a proper controller that can damp oscillations in order to provide safety, ease and comfort to passengers of vehicle during uneven road surface, bumps and small patches. To perform the desired task state space model of a quarter wheel vehicle suspension system is derived. The response of the system is simulated in MATLAB/SIMULINK. The open loop response showed that the derived model is stable. Different types of controllers are designed i.e. Linear Quadratic Regulator (LQR) and Observer based controller to analyze the system in closed loop. Both the controllers showed improved performance for different road profiles. It is observed and shown that observer based controller has better response than Linear Quadratic Regulator (LQR) controller. Simulink models for Linear Quadratic Regulator (LQR) and observer based controller are designed. Besides, different types of realization techniques (minimal realization, balanced realization, modal realization, observer canonical realization) are compared for minimum fragility in controller implementation. The difference among the different realization controllers has been analyzed in detail for rounding off error or truncation error and an optimal non fragile controller design has been presented. Different disturbances were imposed upon the simulated model. All the results are analyzed in open and closed loops. The closed loop response showed that the oscillations were damped quickly and the desire results were achieved successfully.

Pakistan is one of those countries that heavily dependent on hydrocarbon fuel for energy production which results in severe climate change. Although renewable energy resources, like wind, are available in abundance, they are not completely utilized due to which energy crises of the country increases day by day. This study comprehensively elaborates the potential of wind power of a site located in the Northern part of Pakistan. The potential of wind power for the site was accessed and analyzed by using two years (2016–18) wind data at four heights (80, 60, 40 and 20 m from sea level). Six numerical methods are used for the estimation of Weibull parameters (shape ‘k’ and scale ‘c’). Using these parameters, Weibull mean velocity, power density, and energy density are computed at all mast heights for each year. The seasonal wind characteristics parameters and power density are also calculated. Among these methods, the modified maximum likelihood method (MMLM) is found to be the most effective method to represent the wind data, while the graphical method (GM) showed the weakest fit. Root mean square error (RMSE), determination of coefficient (R2), and mean bias error (MBE) are computed to validate the computed results. Wind power potential assessment of the calculated data shows that the proposed location is appropriate for small scale wind energy generation.

Measles is a communicable viral disease which is a major public health problem and a leading cause of morbidity and mortality in the developing countries including Pakistan with implications for outbreaks. An outbreak was reported from Ibrahim Khan Village of Manzari union council (UC), Pishin District by medical officer during polio campaign on 15th April 2014. A team was sent to investigate the outbreak and suggest control measures.Rapid assessment of outbreak was done by collecting data from house-to-house from April 16th-20th, 2014. Case was defined as "a person of any age, resident of village Ibrahim Khan village with non-vesicular maculopapular rash and fever along with one of the symptoms of cough, coryza and conjunctivitis from April 4th-20th, 2014". Routine immunization (RI) was assessed through recall and immunization cards and BCG scars were checked. Line list was developed and data was analyzed.Fifty-five cases (attack rate = 11.27%) including 4 deaths (Case Fatality Rates = 7.27%) were found. Mean age of children was 47 months (4-132 Months). Age-group 0-5 years was most affected (n = 48, 87.27%). Along-with maculopapular rash and fever. Other predominant symptoms were: coryza (n = 52, 95%), conjunctivitis (n = 51, 92%) and pneumonia (n = 42, 77%). RI status assessment showed that none of these children had been immunized. About 56.36% of the respondents were unaware about RI, 16.36% mentioned that vaccinator had not visited their homes, 14.54% reported that health facility is far away and 12.72% reported that even if they could get access to a health facility, the vaccines were not available.Functionalization of EPI centre, vaccinations of all children and mass education was strongly recommended. Surveillance system for vaccine preventable diseases (VPDs) should be strengthened to prevent such outbreaks. Outreach activity must be carried out regularly to reach scattered population.

Extensive research is done on nursing work environments but less is known about the job conditions and environments of other health professionals. This study was aimed to fill this information gap by highlighting the factors affecting the work environment and stressors causing turnover of staff.A cross sectional study was conducted in Bolan Medical College Quetta for the assessment of working environment of the faculty from 22nd April to 22nd July 2012. All permanent teaching staff was included. A structured questionnaire was adopted fromI health sciences association of Alberta (HSSA), 2006 work Environment Survey. An observational check list for assessment of the physical environment /infrastructure and other general physical stuff was used.The faculty menibers were-not-satisfied with the security and safety of their work place but were satisfied with salaries, employer, and management. Work teams and relationship between employees and employers were respectful with good communication. Majority found their work times stressful and opportunities for on job trainings and professional development, adequate tools, equipment and conditions were mostly lacking.The overall working environment is not that good and few areas need serious attention like: professional development, trainings, adequate equipment, and security.

Medical imaging provides information regarding the body part, and their tissues. Any disorder in their structure and function is detected easily and then correlates with clinical findings. This all provide the suitable treatment guidelines with less pain and convenient ways. With the passage of time as technology advances, the accuracy and efficiency in medical imaging get also advanced. Different kinds of algorithms are developed to enhance the sensitivity of medical imaging process lines.

We develop stable splitting of the minimal determining sets for the spaces of bivariate C1 splines on triangulations, including a modified Argyris space, Clough-Tocher, Powell-Sabin and quadrilateral macro-element spaces. This leads to the stable splitting of the corresponding bases as required in Böhmer's method for solving fully nonlinear elliptic PDEs on polygonal domains.

Dilated ureters are often due to mechanical obstruction. This case report describes a young adult lady with primary megaureter due to aganglionosis finally managed with extravesical Leech-Gregor Uretroneocystostomy.