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Abstract 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 acute flaccid paralysis (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 in-country sources. 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 in-country resources is possible through coordinated approaches, regular communication with partners, disaggregation of needs, and matching in-kind and financial support to fill gaps. A cVDPV2 outbreak requires a fast, resourced, and quality response to stop virus circulation.

In Rhabdomyolysis, muscle releases its contents into blood that can cause Acute Kidney Injury. We reported a very rare case of rhabdomyolysis after Diclofenac intramuscular injection with super added gluteal abscess formation, eventually led to acute kidney injury.

Acute Motor and Sensory Axonal Neuropathy is a rare form of Guillain-Barré syndrome (GBS). The incidence after viral encephalitis is rare in contrast to other variants of GBS. We reported a very rare case of Acute Motor and Sensory Axonal Neuropathy in a 70-year-old man after viral encephalitis, diagnosed by clinical evaluation, Electromyography (EMG) and Nerve Conduction Studies (NCS).

Objective: To correlate the serum uric acid, Thyroid-stimulating hormone (TSH) and free-thyroxine (FT4) in overt and subclinical hypothyroidism. Study Design: Cross sectional comparative. Place and Duration of Study: Capital Development Hospital, Islamabad from January 2019 to June 2019. Materials and Methods: Total 114 participants, recruited through convenient non-probability sampling technique, were sub-divided in three groups, comprising 38 participants each. Group I included patients of overt hypothyroidism. Group II had patients with subclinical hypothyroidism and Group III included healthy controls. Serum uric acid levels were measured for all participants. For data analysis, SPSS 21 was used. Statistical significance was estimated using one way ANOVA. p value of < 0.05 was considered significant. Correlation between numerical variables was determined by Pearson correlation coefficient. Results: Mean serum uric acid level in overt hypothyroid patients (7.5±0.84 mg/dL) was significantly raised than the patients in the subclinical hypothyroid and control group (4.7±0.82, 4.6±1.09 mg/dL respectively) with p value

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.

Objective: To determine diagnostic accuracy of fractional flow reserve in diagnosing stentable intermediate stenosis in patients of coronary artery disease keeping angiography as gold standard. Study Design: Cross sectional validation study. Place and Duration of Study: Cardiology ward and Coronary Care Unit of PIMS Islamabad, from Jun 2015 to Nov 2015. Methodology: This study included 130 patients with coronary artery disease. General physical examination and systemic examination was done for all subjects as per protocol of inclusion and exclusion criteria. All the patients underwent Conventional angiography followed by fractional flow reserve in intermediate coronary artery disease. Diagnostic accuracy of fractional flow reserve was detected by determining sensitivity, specificity and accuracy. Results: The mean age of the patients was 56 ± 8.790 years, ranging from 31 to 72 years. There were 88 (67.7%) male patients and 42 (32.3%) female patients in the study. There were 31 true positive, 3 false negative and 92 were found true negative. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of fractional flow reserve for diagnosis of stentable intermediate stenosis was 91.2%, 95.8%, 88.6%, 96.8% and 94.6%, respectively. Conclusions: Fractional flow reserve is a reliable test for detection of stentable intermediate stenosis among patients with coronary artery disease and should be done in every case of coronary artery disease.

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.

'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

The concept of localized surface plasmon resonance has been applied to increase the absorption efficiency of dye-sensitive solar cells (DSSCs) by using various photoanode structures. A three-dimensional model for a photoanode of the DSSC based on composite materials was developed using COMSOL Multiphysics. Spherical-, rod- and triangular-shaped aluminum nanoparticles were employed in the core of SiO2 to examine the influence of morphology on the performance of DSSCs in the 350–750 nm wavelength range. The UV-Vis absorption results indicated that aluminum nanoparticles with spherical, rod and triangle morphologies had 39.5%, 36.1% and 34.6% greater absorption capability than aluminum-free nanoparticles. In addition, we investigated the effect of plasmonic absorption in DSSCs for photoanodes made of TiO2, SiO2 and bilayer TiO2/SiO2 with and without covering aluminum nanoparticles. The TiO2 and SiO2 nanoparticles had fixed diameters of 90 nm each. The UV-Vis absorption and Tauc curves indicated that the TiO2/SiO2 bilayer structure (with and without aluminum nanoparticles) had greater absorption and lower bandgap energies than individual TiO2 and SiO2 nanoparticles. Furthermore, bilayer photoanode nanostructures were investigated based on nanospheres and nanorods for core–shell Al@SiO2 nanoparticles. The results indicated that a photoanode with nanorod/nanosphere structure had a 12% better absorption capability than a nanosphere/nanorod configuration. This improvement in absorption is attributed to the high surface area, which boosts dye loading capacity and long-term light capture, resulting in greater interaction between the dye and the photon. Our study develops core–shell nanoparticles with optimized shape and materials for bilayer photoanode structures in photovoltaic technology.

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

Objective: To determine the association between hypothyroidism and metabolic syndrome Study Design: Observational cross sectional study Place and Duration of Study: Data was collected from Medical unit and Department of Pathology, Pakistan Railways Hospital, Islamic International Medical College, Rawalpindi and Capital Hospital Islamabad from April 2017 to April 2018. Materials and Methods: One hundred and fifty adult subjects participated in this study. Hundred hypothyroid subjects were recruited as cases on the basis of laboratory findings of raised serum thyroid stimulating hormone (TSH) levels and low serum free thyroxine (FT4) level. Newly diagnosed/ untreated cases of Hypothyroidism and adults of either sex were included. After an overnight fasting, participants were tested for various components of metabolic syndrome. Fifty euthyroid subjects were taken as controls. Data was analyzed by SPSS-21. Results: Among 150 total recruited subjects, 25% hypothyroid cases and 10% euthyroid controls were diagnosed with metabolic syndrome. These results were statistically significant with p value 0.030. Mean serum triglycerides 183 ±26 and 153±26 mg/dl and mean fasting blood glucose 100 ±30 and 96 ±18 mg/dl respectively among hypothyroid and euthyroid patients were significant with p-value 0.001. Whereas, waist circumference, high density lipoprotein cholesterol and blood pressure measurement of hypothyroid and euthyroid individuals were not significant. Conclusion: Hypothyroidism is associated with various components of metabolic syndrome.

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.

Background: Crimean Congo Haemorrhagic Fever (CCHF) is an acute viral zoonotic disease that is endemic in Pakistan. Poverty, limited awareness and lack of biosafety practices make it a potential occupational health risk. A poor surveillance system makes it more difficult to monitor the disease burden. ' ' Purpose: An evaluation was carried out to identify the strengths and weaknesses of the event-based CCHF surveillance system in Balochistan, Pakistan, and to propose recommendations for improvement. Methods: A descriptive evaluation study was conducted at an isolation ward of a public hospital from November 2017 to February 2018 in Balochistan Province. Event-based CCHF surveillance system was evaluated by using updated CDC guidelines for Evaluating Public Health Surveillance Systems. Data were collected through review of records and interaction with stakeholders. Using a semi-structured questionnaire, surveillance system attributes were assessed according to the guidelines in the study tool. Findings: The system was simple, but had no standardised case definition. It was found to be flexible as new health-related events could be easily incorporated. Data quality was moderate; 80% (75/94) of the reports were completely filled. The system had good timeliness but lacked involvement of the private sector. Acceptability was good with involvement of different government stakeholders. Sensitivity was poor while positive predictive value was 27.5%. Conclusion: Event based surveillance for CCHF can be improved by involvement of private practitioners and laboratories in the surveillance system to improve representativeness. The timeliness could be improved by adopting an online reporting mechanism. Feedback, support and supervision should be ensured for data quality assurance. Periodic refresher trainings of the staff could be organized.

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.