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The research focuses on structural geological mapping and fracture analysis of part of Kala-Chitta Range, Himalayan foothills, northern Pakistan. The area exhibits complex geological settings characterized by intense deformation with eight litho-stratigraphic units ranging from the Late Jurassic to Paleocene. The outcropping rocks have well recorded imprints of Himalayan deformation and are represented by common east-west trending series of parallel synclines and anticlines. The study area features southward-directed thrust faults caused by north-south compressional stresses, indicating two distinct deformational phases. The internal stress within the basin causes thrust faults and compression. Most of the thrusts are northward dipping fore thrusts. The mesoscopic fracture analysis was conducted at six stations across the study area where fracture sets were nicely developed. The interpretation relied on field observations, orientation diagrams and graphical techniques. The data gathered from field observations were used to measure petrophysical properties including fracture density, fracture porosity and permeability within different formations of the study area. The results of the analysis revealed that most of the fractures are generally NW-SE oriented. The interpretation of fractures set indicates that the principal stress direction (Õ1) is NNW-SSE whereas the minimum stress direction (Õ3) is NEE-SWW.

Introduction: COVID-19, a novel disease, appeared in December 2019 in China and rapidly spread across the world. Till the second week of April 2020, high incidence (2.9/100,000) and cases fatality rates (1.7%) were observed in Pakistan. This study was conducted to determine the temporal and spatial distribution of the first 100 deaths attributed to COVID-19 in Pakistan and their associated demographic factors. Method: A record review of the first 100 deaths reported among RT-PCR confirmed COVID-19 cases was conducted. Demographic, epidemiological, and risk factors information was obtained associated comorbidities and clinical signs and symptoms were recorded and frequencies were determined. Results: A total of 100 mortalities with an overall case fatality rate of 1.67% (CFR) were analyzed. The median age of patients was 64.5 years (IQR: 54-70) with 75% (n=75) males. Among all deaths reported, 71 (71%) cases had one or more documented comorbidities at the time of diagnosis. The most frequently reported co-morbidities were: hypertension (67%), followed by Diabetes Mellitus (45%) and Ischemic Heart Diseases (27%). The most frequent presenting symptoms were shortness of breath (87%) and fever (79%). The median duration of illness was eight days (IQR: 4-11 days), the median delay reaching hospital to seek health care was three days (IQR: 0-6 days) while the median duration of hospital stay was also three days (IQR: 1-7 days). Among all, 62% had no history of international travel. The most affected age group was 60-69 years while no death reported in the age group below 20 years.

Background: Fever of unknown origin (FUO) in developing countries is an important dilemma and further research is needed to elucidate the infectious causes of FUO. Methods: A multi-center study for infectious causes of FUO in lower middle-income countries (LMIC) and low-income countries (LIC) was conducted between January 1, 2018 and January 1, 2023. In total, 15 participating centers from seven different countries provided the data, which were collected through the Infectious Diseases-International Research Initiative platform. Only adult patients with confirmed infection as the cause of FUO were included in the study. The severity parameters were quick Sequential Organ Failure Assessment (qSOFA) ≥2, intensive care unit (ICU) admission, vasopressor use, and invasive mechanical ventilation (IMV). Results: A total of 160 patients with infectious FUO were included in the study. Overall, 148 (92.5%) patients had community-acquired infections and 12 (7.5%) had hospital-acquired infections. The most common infectious syndromes were tuberculosis (TB) (n=27, 16.9%), infective endocarditis (n=25, 15.6%), malaria (n=21, 13.1%), brucellosis (n=15, 9.4%), and typhoid fever (n=9, 5.6%). Plasmodium falciparum, Mycobacterium tuberculosis, Brucellae, Staphylococcus aureus, Salmonella typhi, and Rickettsiae were the leading infectious agents in this study. A total of 56 (35.0%) cases had invasive procedures for diagnosis. The mean qSOFA score was 0.76±0.94 {median (interquartile range [IQR]): 0 (0–1)}. ICU admission (n=26, 16.2%), vasopressor use (n=14, 8.8%), and IMV (n=10, 6.3%) were not rare. Overall, 38 (23.8%) patients had at least one of the severity parameters. The mortality rate was 15 (9.4%), and the mortality was attributable to the infection causing FUO in 12 (7.5%) patients. Conclusions: In LMIC and LIC, tuberculosis and cardiac infections were the most severe and the leading infections causing FUO.

More recently Kohat's fold-thrust belt, including the Karak area has emerged as an important hydrocarbon fertile region of the western Himalayan orogenic system. The Eocene and Paleocene strata, including mechanical weak Eocene units representing a shallow decollement have a noticeable contribution to the deformation style and petroleum system of the area. In the present study, surface mapping is integrated with seismic information to elucidate the structural style of the Karak area, the data reveal that there are two different structural entities, separated by Karak Fault Zone. The northern domain portrays salt diapiric structures representing doubly plunging and complexity overturned, and fault bounded folds' geometries. However, in the subsurface below the Eocene sequence, the deformation is characterized by south-directed imbricate thrust system. In contrast, because of the absence of Eocene salt horizon, the southern domain of the Karak area illustrates a brittle style of deformation, mimicking fault propagation folding. In addition, an array of south-verging imbricate system from a regional basal decollement translates rock as old as Permian along the Surghar range frontal thrust. It can be observed that fault geometry and fold styles in the north and south of Karak Fault Zone are entirely different. Restored cross-sections across the area indicate 35% of shortening has been accommodated in the area. Moreover, from the present study it has been concluded that in the purlieu of Karak Fault Zone, possibly occupy auspicious structural traps at top Paleocene Lockhart level.

Abstract Public health emergency management systems encountered difficulties in developing countries, especially in Pakistan. The COVID-19 pandemic was extremely challenging for different agencies/departments in Pakistan. Health emergency management depends on a well-established public health emergency operations center that could generate a coordinated response to emergencies. We conducted an assessment of public health emergency response coordination implemented during the COVID-19 at strategic level. This was mix-method qualitative study. Primary data was collected by using a structured questionnaire, and secondary data was collected by desk review. The agencies engaged in pandemic response at the national level in Pakistan were included in the assessment. The overall score of the emergency response coordination system during COVID-19 was 49% for all agencies. We found that agencies faced challenges in leadership, legislation, and financing issues during the pandemic response (44%). None of the agencies had a fully developed framework for joint planning and response system for health emergencies. Roles and responsibilities attached to designated agencies in response were relatively clear (55%) for most of the agencies. Effective public health emergency response is based on multi-departmental coordination, resource mobilization, and clear roles for each agency. Pakistan must proactively address these challenges for pandemic response in future.

Abstract Background A strong understanding of infection prevention and control (IPC) procedures and comprehensive training among healthcare workers is essential for effective IPC programs. These elements play a crucial role in breaking the chain of nosocomial infections by preventing the transmission of resistant organisms to patients and staff members. This study mapped the components of IPC education and training across various member states of the World Health Organization (WHO) in the Eastern Mediterranean Region (EMR) at national, academic, and healthcare institutional levels. Methods A self-administered structured online questionnaire based on the WHO “Core Component 3” of IPC programs at the national and acute healthcare facility levels (IPC education and training) was given to national IPC focal persons in each of the WHO’s EMR countries between February and March 2023. Results From 14 of the 22 countries,15 IPC persons participated in the survey. Most countries have scattered nonhomogeneous IPC education programs in human health undergraduate majors without considering it a standalone module. Academic institutions are rarely involved, and elaborate and predefined undergraduate IPC education programs provided by universities are present in 21.4% of the countries. In 71.4% of these countries, postgraduate training targeting IPC professionals is provided by national IPC teams, primarily based on national IPC guidelines developed with the aid of the WHO. Generally, healthcare worker training relies heavily on healthcare facilities in 92.9% of the countries, rather than on a national training program. In 42.9% of the countries, practicing IPC physicians are not necessarily specialists of infectious disease or medical microbiologists and IPC nurses are not required to specialize in IPC. However, nonspecialized IPC professionals are expected to undergo training upon employment and before beginning practice. Nongovernmental organizations such as the WHO play a significant role in IPC education and in supporting national IPC authorities in establishing national IPC guidelines, as it is the case in 78.6% of these countries. Conclusion Clear disparities exist in IPC education and training across different countries in the WHO’s EMR. Establishing a regional scientific network specializing in IPC would help bridge the existing gaps and standardize this education within individual countries and across countries in the region. This region needs to establish IPC certification standards and standardized education curricula.

Rabies is a neglected viral zoonotic disease with an almost 100% fatality rate. A pilot project was initiated by the National Institute of Health (NIH), Islamabad, in collaboration with Health Security Partners (HSP) to establish a real-time dog bite surveillance in humans in public sector secondary care hospitals of Islamabad. The main objective of this study was to analyze different characteristics of dog bite cases, identify gaps in surveillance, and recommend suggestions to improve and strengthen real-time dog bite surveillance systems. An observational cross-sectional study was conducted in two major public sector hospitals in Islamabad from December 2019 to July 2020. Data on demographic information, site of the dog bite, category of the dog bite, and treatment was collected via a WVS mobile-based application. Descriptive analysis was carried out for different variables at a p-value of

We explored the self-reported antibiotic stewardship (AS), and infection prevention and control (IPC) activities in intensive care units (ICUs) of different income settings. A cross-sectional study was conducted using an online questionnaire to collect data about IPC and AS measures in participating ICUs. The study participants were Infectious Diseases–International Research Initiative (IDI-IR) members, committed as per their institutional agreement form. We analyzed responses from 57 ICUs in 24 countries (Lower-middle income (LMI), n = 13; Upper-middle income (UMI), n = 33; High-income (HI), n = 11). This represented (~5%) of centers represented in the ID-IRI. Surveillance programs were implemented in (76.9%−90.9%) of ICUs with fewer contact precaution measures in LMI ones (p = 0.02); (LMI:69.2%, UMI:97%, HI:100%). Participation in regional antimicrobial resistance programs was more significantly applied in HI (p = 0.02) (LMI:38.4%,UMI:81.8%,HI:72.2%). AS programs are implemented in 77.2% of institutions with AS champions in 66.7%. Infectious diseases physicians and microbiologists are members of many AS teams (59%&50%) respectively. Unqualified healthcare professionals(42.1%), and deficient incentives(28.1%) are the main barriers to implementing AS. We underscore the existing differences in IPC and AS programs’ implementation, team composition, and faced barriers. Continuous collaboration and sharing best practices on APM is needed. The role of regional and international organizations should be encouraged. Global support for capacity building of healthcare practitioners is warranted.

Background:The Public Health Empowerment Program (PHEP) is a 3-month training program for frontline public health staff to improve surveillance quality and strengthen the early warning system capacities. Studies evaluating the program and its impact on the health systems in the Eastern Mediterranean Region (EMR) are lacking. Therefore, this study aimed to assess the level of PHEP graduates’ engagement in field epidemiology activities, assess their perceived skills and capacity to perform these activities and assess the extent to which PHEP helped the graduates to perform field epidemiology activities.Methods:A descriptive evaluation study was conducted based on levels 3 and 4 of Kirkpatrick’s model for evaluating training programs to assess the change in graduates’ behavior and the direct results of the program. Data were collected using two online surveys targeting PHEP graduates and programs’ directors/ technical advisers.Results:A total of 162 PHEP graduates and 8 directors/ technical advisers participated in the study. The majority of PHEP graduates reported that they are often involved in activities such as responding to disease outbreaks effectively (87.7%) and monitoring surveillance data collection (75.3%). High proportions of PHEP graduates rated their skills as good in performing most of field epidemiology activities. The majority of graduates reported that the PHEP helped them much in conducting, reviewing, and monitoring surveillance data collection (92%), responding effectively to public health events and disease outbreaks (91.4%), and communicating information effectively with agency staff and with the local community (85.2%).Conclusion:PHEP appears to be an effective program for improving the public health workforce’s skills and practices in epidemiological competencies in the EMR. PHEP strengthened the engagement of the graduates in most field epidemiology activities, especially during COVID-19.

ABSTRACT: Objectives: To evaluate infection prevention and control (IPC) training workshops using Kirkpatrick model level 1 and 2 regarding satisfaction of trainees and improvement of their knowledge and skills. Methods: A cross-sectional study was conducted on 353 healthcare workers from January 2020 to March 2020, at four hospitals in Islamabad, Pakistan. Training feedback questionnaires and pre and post tests were employed for data collection. The authors analyzed data using SPSS version 25. Results: The majority (52%) of participants rated the trainings as “Excellent”, 44% rated “Good” while 2% graded “Average”. Pre and post-tests mean scores demonstrated statistically significant improvement in knowledge and skills (p< 0.001). Conclusion: The training workshops significantly improved healthcare workers’ knowledge and skills regarding Infection Prevention and Control and earned high satisfaction scores from the trainees.

The present research was carried out to investigate the behavior of radon (222Rn) concentrations over the carbonate and evaporite sequences and to assess the related health hazards. A total of 50 points from three different stratigraphic units, namely, the Bahadurkhel Salt, Jatta Gypsum, and the Kohat Formation of the Eocene age, were analyzed for radon concentrations in the district of Karak, Khyber Pakhtunkhwa, Pakistan. Measurements for radon levels were made by using RAD7 of Durridge, United States. The highest average 222Rn concentration (16.5 Bq/L) was found in the limestone unit of the Kohat Formation of the Eocene age. However, the lowest radon levels were observed in the salt-bearing strata of the Bahadurkhel Salt of the Eocene age. The study revealed that the average radon concentration in all the lithologies varied in the order of RnLimestone > RnSalt > RnGypsum. The findings of the current research suggest that the study area is safe from radon-related health hazards.

Climate change is a hard reality that has already started affecting air quality, food production, water supply, coastal settlements, and human health. There is increasing evidence about the effect of climate change on vector-borne diseases (VBDs). In this article, we have collected data from published articles, journals, reports, and books on VBDs in Pakistan and review the changing epidemiology of the most important VBDs i.e. Malaria, Dengue fever, Chikungunya, Leishmaniasis, Crimean-Congo hemorrhagic fever (CCHF), West Nile fever and Japanese encephalitis in Pakistan. We have summarized the district-wise VBDs outbreaks and developed maps. There is no proper surveillance of vectors and diseases available in Pakistan. Early warning system for preventing outbreaks are direly needed. No study has done not the effect of climate change on disease vectors in Pakistan. Long-term observational studies are needed to monitor climate-change effects on vector-borne diseases in Pakistan. A multidisciplinary effort is needed to handle the situation before the vector-borne diseases become an epidemic in non-endemic areas. It is essential to address issues related to the establishment of the vector surveillance system, integrated vector management (IVM), and climate change with the utmost priority for the prevention and control of VBDs in Pakistan.

Abstract Since its outbreak in 2019, the coronavirus disease (COVID-19) has become a pandemic, affecting more than 52 million people and causing more than 1 million mortalities globally till date. Current research reveals a wide array of disease manifestations and behaviors encompassing multiple organ systems in body and immense systemic inflammation, which have been summarized in this review. Data from a number of scientific reviews, research articles, case series, observational studies, and case reports were retrieved by utilizing online search engines such as Cochrane, PubMed, and Scopus from December 2019 to November 2020. The data for prevalence of signs and symptoms, underlying disease mechanisms and comorbidities were analyzed using SPSS version 25. This review will discuss a wide range of COVID-19 clinical presentations recorded till date, and the current understanding of both the underlying general as well as system specific pathophysiologic, and pathogenetic pathways. These include direct viral penetration into host cells through ACE2 receptors, induction of inflammosomes and immune response through viral proteins, and the initiation of system-wide inflammation and cytokine production. Moreover, peripheral organ damage and underlying comorbid diseases which can lead to short term and long term, reversible and irreversible damage to the body have also been studied. We concluded that underlying comorbidities and their pathological effects on the body contributed immensely and determine the resultant disease severity and mortality of the patients. Presently there is no drug approved for treatment of COVID-19, however multiple vaccines are now in use and research for more is underway.

Introduction: Climate factors play an important role in the transmission of viruses, such as influenza viruses, MERS-CoV, and SARS-CoV-1. This study aimed to determine the relationship between changes in temperature, humidity, rainfall, and SARS-CoV-2 contagion. Five ecologically and climatically distinct regions were considered—Karachi, Lahore, Islamabad, Peshawar, and Gilgit-Baltistan. Method: Data on daily COVID-19 cases and deaths were retrieved from government officials, while meteorological information was collected from Pakistan Meteorological Department.. Statistical analysis was performed using SPSS version 20 and the Spearman rank correlation test was used to analyze the correlation between the meteorological factors and COVID-19 cases and deaths. Result: Positive correlation of COVID-19 incidence was observed with all the temperature ranges (maximum, minimum and average) and negative correlation was seen with humidity, DTR and rainfall. COVID-19 deaths were positively associated with temperature and were negatively associated only with humidity. Linear regression showed that for every unit increase in humidity, there was a −3.345 daily significant decrease in COVID-19 cases, while in Karachi for every unit increase in humidity, there remained a 10.104 daily significant increase in cases. In Gilgit-Baltistan, for every unit increase in average temperature and rainfall respectively, significant increases of 0.534 and 1.286 in daily cases were found. Conclusion: This study signifies the effect of climate factors on COVID-19 incidence and mortality rate, but climate factors are not the only variable and several other interlinked factors enhance the spread of COVID-19. Hence, effective mitigation policies, enhancing testing capacities, and developing public attitudes toward adopting precautionary measures are important to overcome this overwhelming pandemic.

Objective: The objective of the study was to assess diabetes distress and other factors, which affect glycemic control in patients with type 2 diabetes mellitus (T2DM) and to assess the relation between hemoglobin A1c (HbA1c) and diabetes distress, duration of illness, educational status and treatment modalities, and body mass index (BMI). Methodology: A cross-sectional study conducted at Bangalore Medical College and Research Institute included T2DM patients attending outpatient departments between November 2018 and February 2019, 280 patients were screened for diabetic-related distress using Diabetes Distress Screening Scale (DDS), the patients with diabetes distress were subjected to DDS 17 Questionnaire to determine the type of diabetes distress, and based on score divided into (0–2) little/no distress, (2–2.9) moderate distress, and (3 and more) severe distress. Results: Among 280 patients, 184 patients had diabetic distress and among them, 58.2% had severe distress, 7.5% had moderate distress, 34.3% had little/no distress, 83.1% had emotional burden, 59.2% had physician-related distress, 60.4 had regimen-related distress, and 83% had interpersonal distress. The diabetes distress was significantly associated with age (P = 0.032) and medication adherence (P = 0.00) with educational status. 51.4% had poor glycemic control with HbA1c of >7. The factors significantly associated with poor glycemic control included duration of diabetes with P = 0.008, diabetic distress with P = 0.00, and no significant association with educational status, age, BMI, and treatment modalities. Conclusion: Among type 2 diabetes patients, diabetic distress is a serious problem and needs to be addressed for better glycemic outcome.

Background and Aims: Most data on electrocardiographic (ECG) changes in patients with coronavirus disease-19 (COVID-19) have been presented without comparison to patients with other acute respiratory illnesses. The correlation of ECG changes with disease severity has also not been studied. Subjects and Methods: We compared forty COVID-19-positive and forty COVID-19-negative patients in terms of clinical presentation, ECG at admission, and cardiac biomarkers. Statistical analysis was presented as frequency (percentage) and continuous as mean ± standard deviation. Chi-square test/Fischer's exact test was used. Results: Mean age overall in the study was 52.4 ± 16 years, 67.5% data were males. About 87.5% of the COVID-positive patients and 70% of the COVID-negative patients had ECG changes at baseline. Sinus tachycardia was seen in 45% (18/40) of COVID-positive patients. About 95% (38/40) of COVID-19 positive patients had normal axis, 5% (2/40) had supraventricular tachycardia, 2.5% (1/40) had premature atrial contractions (PACs), and 7.5% (3/40) had premature ventricular contractions. One patient had ventricular bigeminy. About 7.5% (3/40) of COVID-positive cases had complete right bundle branch block (RBBB), one had complete left bundle branch block (LBBB), whereas one had incomplete LBBB. About 7.5% (3/40) of COVID-positive cases had ST-segment elevation, one of whom also developed postmyocardial infarction left ventricular thrombus. About 15% (6/40) had nonST-segment elevation acute coronary syndrome. Conclusions: COVID-19 patients have ECG changes of left-sided heart disease (PACs and LBBB) and right-sided disease (RBBB, right axis deviation, and right ventricular strain pattern) at presentation, however, right heart changes predominate. COVID-19 patients had a higher occurrence and a wider variety of ECG changes at presentation than other acute respiratory illnesses and these changes correlate well with clinical disease severity as does troponin I level.

Foaling is a process of giving birth to foal which is prompt and forceful event in equine breeding. Dystocia is declared when 2nd stage of parturition exceeds from 20 min without fetal movements in mare. Dystocia is very challenging situation for both mare and veterinarian. Survivability of mare and foal, and subsequent fertility of mare depends on efficient management. Therefore, the current report described a rare case of wry neck (torticollis or unilateral bent neck) resulted in dystocia, that was efficiently resolved by partial fetotomy and repulsion technique in mare under field conditions. Intensive post operative care was performed to avoid infection and to achieve fertility subsequently.

Objective: Sheep farming is an important source of livelihood in the southern Khyber Pakhtun Khwa province of Pakistan where they are reared under extensive system (ES). This system has limitations of improper feeding, rearing, and management which negatively affect their productivity. The pres¬ent study compares different rearing systems and their stresses on fertility, behavior, and growth rate potential of two sheep breeds of Pakistan. Materials and Methods: Eighty ewes were selected; forty each from Damani and Balkhi breeds reared in semi-intensive system (SIS) and ES at Paharpur district, Dera Ismail Khan. Blood samples were collected in triplicate on days 0, 14, and 28 of May, and the molecular and behavioral stress, growth, and fertility rates were recorded. Results: The highest growth and fertility rate were observed in both the breeds in SIS than in ES (p < 0.01). The values of stress indicators (cortisol, heat shock protein (HSP-70)) and behavioral stress parameters were found lower in Damani breed as compared to Balkhi breed in both rearing systems (p < 0.01). All the molecular stress and behavioral stress parameters were negatively associated with metabolic hormones (T3 and T4) (p < 0.01). A positive correlation was observed among all the molecular stress and behavioral stress parameters (p < 0.01). Similarly, T3 and T4 were positively interlinked to one another (p < 0.01). Conclusion: It was concluded that both Damani and Balkhi sheep showed lower stress levels and better fertility and growth parameter in SIS than ES system of rearing. Local Damani breed exhibited well tolerant ability and genetic adaptation to the local environment as compared to Balkhi breed. [J Adv Vet Anim Res 2020; 7(1.000): 170-176]

Background: Avian influenza H9 is endemic in commercial and backyard poultry in Pakistan and is a serious occupational health hazard to industry workers. This study aimed to determine the seroprevalence of avian influenza H9 infection in people working with poultry in Rawalpindi, Pakistan and assess the measures they took to protect themselves from infection. Methods: A cross-sectional study was conducted from December 2016 to May 2017 of 419 people working with poultry in Rawalpindi Division, including farm workers, vaccinators, field veterinarians, butchers and staff working in diagnostic laboratories. Potential participants were randomly approached and gave written consent to participate. Data were collected using a standardized questionnaire and serum samples were processed to detect H9 antibodies using the haemagglutination inhibition test. Results: Of the 419 participants, 406 (96.9%) were male. The mean age of the participants was 36.4 (SD 10.86) years. A total of 332 participants agreed to a blood test, 167 of whom were positive for A(H9) antibodies, giving an overall seroprevalence of 50.3%. Laboratory staff had the highest seroprevalence (100%) and veterinarians the lowest (38.5%). Vaccinators, butchers and farm workers had a seroprevalence of 83.3%, 52.4% and 45.5% respectively. Personals who used facemasks had significantly lower (P

Pakistan has been experiencing a continuous rise in the incidence of Crimean Congo Haemorrhagic Fever (CCHF). Sporadic cases of CCHF are reported from rural areas of Punjab, Azad Jammu Kashmir and Khyber Pakhtunkhwa and neighbouring Afghanistan where cattle herding is common. The objective of this paper was to describe the epidemiology of CCHF. A descriptive study was carried out in the CCHF isolation ward in Islamabad in a tertiary care hospital from February to November 2018. Using a standardised case definition, all patients admitted in the isolation ward with clinical evidence of CCHF were included in the study. After taking the informed consent, data were collected on demographic factors, history of animal contact, tick-bite history, co-morbidity, laboratory results and treatment outcome. Data were analysed as per time, place and person. During the study period, 40 suspected CCHF patients were admitted in the isolation ward, 32 (80%) males were affected. Mean age of the cases was 33.5 years (range 13–70 years). Most affected 17 (42.5%) age group was 20–29 years. Animal contact history was found in Thirty-seven (92.5%) of cases and 28 (70%) with tick bites. Most of the cases, 26 (65%), were reported from July to August. Forty patients in this study were tested by Real Time Polymerase Chain Reaction (PCR), 20 (50%) were positive, out of which 6(30%) expired. Majority of the positive patients were animal handlers by occupation (37.5%). Proper personal protective equipment was available. The reference laboratory facility was not available for immediate investigations was sent to National Institute of Health for confirmation. The overall results show the important risk factors for CCHF a history of tick bites, high-risk occupations and having contact with livestock. Public health measures should focus on preventing tick bites, increasing awareness of CCHF signs and symptoms, timely investigation, and treatment to reduce mortality. Our analyses recommend the government to set up isolation units in all major hospitals, and proper surveillance system.

In Pakistan, the first confirmed case of COVID-19 was reported on 26 February 2020, having the travel history from Iran. Islamabad and Rawalpindi have also been affected by COVID-19 epidemic. On 23 March 2020, the Government of Pakistan has declared smart lockdown all over the country including Islamabad and Rawalpindi. The aim of the study was to identify the status of the knowledge, attitudes and practices regarding COVID-19 among the general population of the twin cities (Islamabad and Rawalpindi) in Pakistan during the COVID-19 outbreak. A cross-sectional web-based survey was conducted from 5 to 19 May 2020, the week during smart lockdown in Islamabad and Rawalpindi. Demographic characteristics were compared with independent-samples t-test, one-way, or Chi-square test. Multivariable linear regression analysis was used to identify factors associated with low knowledge score. Data analyses were conducted with SPSS version 21.0. A total of 1,282 participants completed the questionnaire. Among this final sample, the average age was 30.65 years. Among the survey respondents, 680 (53%) were women, 1096 (86%) held a bachelor’s degree or above, 634 (50%) were engaged with the government and private sector and 606 (47%) were married. The overall correct rate of knowledge was 70%. The majority of the respondents agreed that COVID-19 will finally be successfully controlled (59%). Most of the participants had not visited any crowded place (74%) and 95% responded that they have reduced their outdoor activities. In response to precaution measures, 86% stated that they would isolate themselves if they ever felt a fever or cough. The study findings suggest that residents of the two cities have reasonable levels of knowledge on COVID-19. However, it is necessary to launch health education and awareness campaigns to improve the knowledge and practices about COVID-19, to control its transmission.

'Introduction;: Since the start of pandemic new variants have been evolving and moving from one country to another either by air travel or ground crossings. 'Objective': To find out factors associated with noncompliance of recommended guidelines by international passengers so that we can improve the arrangements at airports where required, improve future preparedness, and give recommendations to concerned authorities for improvement in enforcing guidelines. 'Methodology': A cross-sectional study was carried out at Islamabad International Airport during the months of June and July 2021. The study population included international arriving passengers aged 12 years and above. Questions were asked about following guidelines before boarding, on board, and after disembarkation. Twenty questions were asked to assess compliance level. A median cut off value was set for assessment of noncompliance. 'Results:' The male to female ratio was 1:1. The age range was 12 – 75 years. The odds of noncompliance to guidelines was higher in females compared to males. The results revealed a significant association between region of arrival of respondents and noncompliance. Passengers arriving from Afghanistan, France , UK and USA were more likely to be noncompliant to guidelines (p-value = 0.00). There was a significant association between occupation of participants and noncompliance. Housewives and retired were more likely to be noncompliant (p-value = 0.00). A significant association was observed between vaccinated people and noncompliance. 'Conclusion:' Travelers arriving from some specific countries were noncompliant to guidelines. Vaccinated were most noncompliant which indicates still we need to work on awareness and need legislations, fines or travel restrictions to noncompliant travellers.

Introduction: Fear is the normal response to any perceived threat especially when it comes to contracting a new disease resulting in stress and anxiety. This study was conducted during the peak epidemic phase of COVID-19 in Pakistan to assess fear level among Pakistani population regarding COVID-19. Method: A cross-sectional study was conducted during June-July 2020 in Pakistan. A pre-designed questionnaire based on “Fear of COVID-19 Scale” was distributed through email and social media platforms. Descriptive analysis was conducted and frequencies were calculated. Each response scored as 1 (strongly disagree) to 5 (strongly agree). The fear level was categorized as high (>20 score), Moderate (14-20 score) and low (

'Background:' On 18 March 2020, the second case of COVID-19 in the capital territory was reported by the local health department of Islamabad who presented with typical COVID-19 symptoms and had travel history. As per directions of Chief FEDSD, a team of field epidemiologists conducted outbreak investigations. The main objectives of this study were to investigate the clinical and epidemiological patterns of disease transmission and implementation of recommended SOPs. 'Methods:' Descriptive outbreak investigation followed by contact tracing was done in Kot Hathyal, Islamabad, from 21March to 4 April 2020. Each case was enrolled as per the WHO predefined case definition and questionnaire, and data was maintained in line list. The daily health status of affected individuals was monitored physically as well as through phone calls. Data was maintained in Microsoft Excel. Secondary attack rate, median age, male to female ratio and 95% confidence interval was calculated in OpenEpi (version 3.01) for low and high risk contact groups. 'Results:' During investigation, 17 confirmed COVID-19 cases were enrolled as a result of contact with index case, male to female ratio was 5:1, and median age was 41 years (34 to 56 years). All cases exhibited symptoms compatible with COVID-19 except two. The median incubation period was 4 days. The secondary attack rate was 81.80%. No transmission from asymptomatic cases were noted. 'Conclusion:' The index case was a foreign national who had arrived in Pakistan mid-November 2019 to attend a religious gathering at Lahore from 12 to 15 March 2020. The intra and inter city travel caused the introduction of 17 new cases in Islamabad. Due to the lack of fully-fledged isolation centers in Islamabad, a home-based isolation strategy was introduced for the first time in the country. As the affected area was densely populated, the whole area was cordoned off for two weeks. This was also the country’s first lockdown.

Brucellosis is a bacterial zoonotic disease that affects many animal species and can be transmitted to humans via direct contact or via contaminated food. Although brucellosis is a serious health hazard, its public health concern has been neglected in many countries. In some developing countries, such as Pakistan, where brucellosis is endemic, this disease continues to be of importance. A literature search for the past 11 years (2011–2021) provided a comprehensive insight into brucellosis in Pakistan. In this review, particular emphasis was placed on occurrence, diagnostic tests used, and prevention, treatment, and control in the context of the “One Health” approach.

Objective: High ambient temperature in poultry is a challenging and fatal stress among environmental factors. It affects the production quality, damages the liver, and increases mortality in broilers. The present study is focused to explore appropriate utilization of Selenium (Se) as a feed additive in broiler chickens against high temperature. Materials and Methods: Day-old male broiler chickens (Ross 308) (n = 200) were grouped according to the supplements used in their basal diets such as: corn-soybean basal diet as control (Con), a basal diet containing sodium selenite, basal diet with probiotics, and a basal diet containing selenium-enriched probiotics (SP). At the end of the experimental period of 42 days, the liver was isolated and was used to determine the antioxidant capacity through a spectrophotometer. Inflammatory and anti-inflammatory cytokines production in the liver was measured through a real-time polymerase chain reaction. Results: Hepatic analyses revealed the decreased level of malondialdehyde, whereas glutathione, glutathione peroxidase (GSH-Px), and superoxide dismutase levels were increased in the SP group. Furthermore, supplementation of SP significantly up-regulated the mRNA expression of glutathione peroxidase 1 (GPx1), GPx4, IL6, and IL10 and down-regulated the expression of pro-inflammatory cytokines. Conclusion: It is thus concluded that SP as a potential nutritive supplement may facilitate hepatic protection by suppressing hepatic oxidation, inflammation, and necrosis during the high ambient temperature of summer. [J Adv Vet Anim Res 2019; 6(3.000): 355-361]

In March 2020, the World Health Organization declared COVID-19 as a global pandemic. The COVID-19 pandemic has affected various public health functions and essential services in different ways and magnitudes. Although all countries have witnessed the effect of COVID-19, the impact differed based on many factors including the integrity and resiliency of the countries’ health systems. This paper presents opinions and expectations of the authors about the anticipated changes in the future of public health at the global, regional, and national levels. The viewpoint is based on the current efforts and challenges that various stakeholders have carried out to control COVID-19 and the contribution from the literature on the future of public health. Numerous agencies and actors are involved in the fight against COVID-19 with variations in their effectiveness. The public health services showed weaknesses in most of the countries, in addition to the lack of adequate curative medicine settings. The pandemic highlighted the need for better governance and stronger and more resilient health systems and capacities. The COVID-19 experience has also emphasized the importance of coordination and collaboration among the countries and stakeholders. The COVID-19 pandemic might lead to a wide discussion to improve international and national approaches to prepare for and respond to similar events in terms of preparedness and response mechanisms and tools. Public health will not be the same as before COVID-19. New health priorities, approaches, and new agendas will be on the table of the global platforms and initiatives. More investment in research and technology to meet the demand for new vaccines and medicines, innovative methods like distance learning and working, more respect and remuneration to health professionals, and normalization of the public health and social measures that were induced during the COVID-19 pandemic are expected to be seen in future.

'Background:' Coronavirus disease (COVID-19) is an infectious disease caused by the newly discovered zoonotic virus SARS-CoV-2. This disease presents the worst public health crisis the world has faced since the Spanish flu pandemic in 1918. It is the biggest global public health challenge of our lifetimes. COVID-19 situation in each country and sometimes even within countries is different and evolving. The objective of this study was to determine the impact of actions taken by the governments and individual behaviour on the coronavirus epidemic in a country. 'Methods:' Three countries were selected. COVID-19 daily news reported cases and deaths in Pakistan, Vietnam and UAE data between 21 January to 30 April 2020, was extracted from COVID-19 dashboard. Articles, TV channels and newspapers were searched. These three countries were visited during 12 to 21 March 2020 and public’s behaviour was observed. 'Results:' In Vietnam, during the first stage of outbreak, the main strategy was to impose international travel restrictions to prevent imported cases from COVID-19 highly effected countries, and to delay the spread and reduce the magnitude of prevailing epidemic. Furthermore, combination of preventive measures and national level readiness to respond to coronavirus disease aided to contain the further spread of virus. Government of Vietnam took swift preventive measures as compared to Pakistan and UAE, to limit imported COVID-19 cases and to contain the local transmission of the coronavirus. Delayed in decision making regarding travel restrictions and imposing lockdown by Pakistan and UAE may have resulted in rapid spread of the disease. 'Conclusion:' In developing countries, the decision regarding travel and complete lockdown is challenging due to prevalent socio-economic circumstances and maintenance of supply of food and essential goods. The response of an individual to advice issued by the government on preventive measures and Government communication strategies to inform the public to respond positively against this disease are important factors.

'Background': The 2019 novel coronavirus (SARS-CoV-2) originated in the central Chinese city, Wuhan, at the end of December 2019. Pakistan reported its first 2 confirmed cases on 26February 2020, linked to a travel history of Iran. This study was conducted to see the trends of COVID-19 infection growth and doubling time in Pakistan, from an early containment state to a much belated exponential rise pattern. 'Method': This study is based on the analysis of the publicly available data on COVID-19 from the Ministry of National Health Services Regulations and Coordination’s COVID-19 dashboard and the publicly available National command and operation centre daily situation reports from 26February - 27July 2020 to show the trends and patterns of COVID-19 among the Pakistani population. 'Results': A total of 275,225 COVID-19 patients have been reported, with 5,865 deaths, 1,229 critically ill, and 242,436 recovered. Sindh has the highest number of confirmed cases (92,279). The majority of affected patients are male (72%). Local transmission cases stand at 97%. The percentage positivity has now declined to 4.8%, reaching a peak value of 25.7% in May. An average of 6.4 daily tests were conducted for each confirmed case, which makes 0.11 daily tests per thousand people. Daily cases surge had a 5.8% increase per day, with a 5-fold increase in infection until mid-June, which has now decreased to 80%. On 13 June 2020, the highest number of cases were reported (6,825 new highest daily deaths were reported on 19 June 2020). The case doubling time was 3 days initially and now stands at 28 days. The current CFR is 2.1%, with 5,865 deaths. 'Conclusion': The lack of effective quarantine facilities and limited testing capacities at the Taftan border crossing resulted in the importation of the virus in the country. Risk mitigation measures that were implemented, such as lockdown by provinces and the Federal government, were eased in mid-May due to the economic impact but was followed by a spike in cases. The cumulative confirmed case count, after showing an exponential growth pattern within two months of the start of the outbreak, is now on the decline. Careful and responsible behaviors from people, preparedness, and planning, including sentinel surveillance at the district level, are required for the sustainability of COVID-19 control.''

Background: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; named 2019 novel coronavirus or 2019-nCoV) disease in China at the end of 2019 has led to pandemic. A robust surveillance system is required for true estimation of burden of the disease. This study was conducted to identify the strengths and weaknesses of laboratory-based COVID-19 surveillance system in Pakistan and to propose some doable actions for improvement. Method: An evaluative study was conducted from February to March, 2020 at National Institute of Health (NIH) Islamabad, Pakistan. CDC’s “Updated Guidelines for Evaluation Public Health Surveillance System-2001” were used to evaluate the COVID-19 disease surveillance system. Information was gathered and analyzed on different system attributes using qualitative and quantitative methods. Results: System found simple, stable and readily acceptable at all public and private sectors with flexibility to incorporate other respiratory pathogens detection. Reporting was timely, typically within 24-48 hours of sample reception, using electronic as well as paper based management system. All stakeholders contributed in this health emergency. With evolving cases definition and unknown prevalence till first week of April, sensitivity and predictive value positive was found 1.25% and 4.50% respectively. Representativeness was good since it is a reference lab with few sentinel sites for COVID-19 specific testing. Conclusion: Based on the findings of this study, system meets the initial objectives of the surveillance but rapid expansion of sentinel sites along with continuous provision of logistics, supplies and trained human resources is needed to meet the increasing need of detection in wake of rapidly spreading pandemic.

Background: This study was aimed to see the frequency of polyzoospermia and teratozoospermia, among men with history of infertility, presenting at National Institute of Health, Islamabad. Material and Methods: Seven hundred and ninety married men presenting with a complaint of infertility underwent their semen analysis. They were categorized on the basis of sperm count and morphology. The sperm count was performed by Neubauer haemocytometer, while morphology assessed after staining the slides as described by the WHO methodology. Results: The 790 men were classified as having azoospermia (203), oligozoospermia (353), polyzoospermia (13) and normozoospermia (221). While on the basis of morphology as teratozoospermia (37) and normozoospermia (550). The frequency of polyzoospermia in our study was 1.65% and teratozoospermia 6.30%. Conclusion: The study highlights the importance of both qualitative and quantitative analysis of sperms i.e. count and morphology in order to accurately diagnose the causes of infertility. It shows low frequency of polyzoospermia and teratozoospermia in infertile men.