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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: The purpose of this study was to build radiogenomics models from texture signatures derived from computed tomography (CT) and 18F-FDG PET-CT (FDG PET-CT) images of non-small cell lung cancer (NSCLC) with and without epidermal growth factor receptor ( EGFR) mutations. Methods: Fifty patients diagnosed with NSCLC between 2011 and 2015 and with known EGFR mutation status were retrospectively identified. Texture features extracted from pretreatment CT and FDG PET-CT images by manual contouring of the primary tumor were used to develop multivariate logistic regression (LR) models to predict EGFR mutations in exon 19 and exon 20. Results: An LR model evaluating FDG PET-texture features was able to differentiate EGFR mutant from wild type with an area under the curve (AUC), sensitivity, specificity, and accuracy of 0.87, 0.76, 0.66, and 0.71, respectively. The model derived from CT texture features had an AUC, sensitivity, specificity, and accuracy of 0.83, 0.84, 0.73, and 0.78, respectively. FDG PET-texture features that could discriminate between mutations in EGFR exon 19 and 21 demonstrated AUC, sensitivity, specificity, and accuracy of 0.86, 0.84, 0.73, and 0.78, respectively. Based on CT texture features, the AUC, sensitivity, specificity, and accuracy were 0.75, 0.81, 0.69, and 0.75, respectively. Conclusion: Non-small cell lung cancer texture analysis using FGD-PET and CT images can identify tumors with mutations in EGFR. Imaging signatures could be valuable for pretreatment assessment and prognosis in precision therapy.

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 (

Objective: To assess awareness and practices applied by health care workers to achieve patient safety during phlebotomy and ultrasound biopsy. Study Design: Cross-sectional study Place and duration of study: The present study was conducted from Jan 2019 to Jan 2020 at Combined Military Hospital (CMH), Kharian, Pakistan. Patients and Methods: The health care providers were interrogated about their knowledge and practices regarding patient safety with respect to phlebotomy and ultrasound biopsy. The responses of participants were evaluated through correlation analysis by SPSS v.17. Results: The results show that awareness and practice implementation for patient safety in phlebotomy and ultrasound biopsy enhance in accordance to age, education and experience. The findings of present study suggest that physicians and nurses tend to have better awareness and practices of patient safety as compared to other health care workers. However, all the health care workers included in present study showed adequate level of awareness and practice implementation. Conclusion: The managers and co-workers need to support the health care workers’ groups that tend to show lower levels of awareness and practice implantation in patient safety. This will not only enhance their competence but also help in better and secure provision of health care.

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.

During mid-January 2018, significant number of suspected sheep pox cases was reported to Director Animal Health from district Barkhan, Balochistan. An investigation team was deployed after unusual high mortality and complaint of skin lesions accompanied by lacrimal & nasal discharge. The aim of this investigation was to know the magnitude of the disease, identify risk factors and implement preventive measures so as to stop further spread of disease. We defined a sheep pox confirmed case as sheep with fever >40˚C and necrotic skin lesions along with one or more of the following: Papules, nodules anywhere on the body, Mucopurulent nasal discharge, hyperemia, oedema (generalized), swollen eyelids and enlarged prescapular lymph node. By using pre tested questionnaire rates and frequencies were calculated using Epi InfoTM 7 Software. A case control study was conducted in March 2018. During active case finding, 43 farms qualified as suspected for sheep pox infection with a total infected population of 4050 animals. Of these, infected adult sheep comprised 76% (3081), followed by 24% (969) lambs. The case fatality rate was 33% (1337/4050) with an overall attack rate of 55% (4050/7438). Majority 49% (21) responded that wool shearing within a flock was done, 42% (18) introduced new animals in a flock without prior quarantine but only 5% (2) were aware of isolation and 21% (9) vaccinate the animals. New animals with in flocks (OR: 3.7, CI 1.34 – 10, P value 0.008) and wool shearing (OR: 3.15, Cl 1.24 – 7.9, P value 0.01) were statistically associated with disease spread. Sheep pox outbreak occurred in the area with new animal arrival, low vaccine coverage and breach in biosecurity and sanitary measure. Standard biosecurity and sanitary prophylaxis measures were recommended to control the outbreak.

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 right vertebral artery most commonly originates as the first branch of the right subclavian artery. Although anatomical variants of the aortic arch are commonly encountered on cross-sectional imaging, certain variants of the right vertebral artery are exceedingly rare. In this report, we present 3 cases of aberrant right vertebral artery arising as the last branch of the aortic arch, a very rare variant.

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.

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.