Effectiveness of Mobile Health Augmented Cardiac Rehabilitation (MCard) on health-related quality of life among post-acute coronary syndrome patients: A randomized controlled trial.

Objectives: To determine the effectiveness of Mobile health augmented Cardiac rehabilitation (MCard) on health-related quality of life (HRQoL) among post-acute coronary syndrome (post-ACS) patients. Methods: At the Armed Forces Institute of Cardiology (AFIC), a tertiary care hospital in Rawalpindi, Pakistan, a two-arm randomised controlled trial was conducted in which mobile health augmented cardiac rehabilitation (MCard) was developed and implemented on post-ACS patients from January 2019 until March 2021. The trial conforms to the CONSORT statement 2010. The post-ACS patients were randomly allocated (1:1) to an intervention group (received MCard; counselling, empowering with self-monitoring devices, short text messages, in addition to standard post-ACS care) or control group (standard post-ACS care). HRQoL was assessed by generic Short Form-12 and MacNew quality of life myocardial infarction (QLMI) tools. Participants were followed for 24 weeks with data collection and analysis at three time points (baseline, 12 weeks and 24 weeks). Results: At baseline, 160 patients (80 in each group; mean age 52.66±8.46 years; 126 male, 78.75%) were recruited, of which 121(75.62%) continued and were analysed at 12-weeks and 119(74.37%) at 24-weeks. The mean SF-12 physical component score significantly improved in the MCard group at 12 weeks follow-up (48.93 vs control 43.87, p<.001) and 24 weeks (53.52 vs 46.82 p<.001). The mean SF-12 mental component scores also improved significantly in the MCard group at 12 weeks follow-up (44.84 vs control 41.40, p<.001) and 24 weeks follow-up (48.95 vs 40.12, p<.001). At 12-and 24-week follow-up, all domains of MacNew QLMI (social, emotional, physical and global) were also statistically significant (p<.001) improved in the MCard group, unlike the control group. Conclusion: MCard is an effective and acceptable intervention at improving all domains of HRQoL. There was an improvement in physical, mental, social, emotional and global domains among the MCard group in comparison to the control group. The addition of MCard programs to post-ACS standard care may improve patient outcomes and reduce the burden on the health care setting.

Health related quality of life in post-acute coronary patient.

The study aimed to assess the effects of lifestyle-modification counselling on behavioural outcomes among patients after myocardial infarction. This was a quasi-experimental study, conducted at the Armed Forces Institute of Cardiology (AFIC), Rawalpindi, from December 2018 to February 2019, on 50 post-myocardial infarction (post-MI) patients. Knowledge, attitude, and practice regarding lifestyle was assessed using a self-designed, pre-tested, validated questionnaire. The participants were given health messages regarding lifestyle modifications for 15-20 minutes based on WHO guidelines on the nature of the disease, diet, exercise, smoking cessation, weight and blood pressure monitoring, and salt intake. The mean age of the patients was 58.68±10.8 years. The MI knowledge sufficiently improved (28,100%), positive attitude was observed (27, 96.4%), and healthy practices were anticipated (24, 85.71%) significantly (p<0.001) after counselling. The lifestyle modification counselling improved the knowledge, attitude, and practice among post- MI patients but significant improvement was seen only in knowledge and practice.

Post Discharge mHealth and Teach-Back Communication Effectiveness on Hospital Readmissions: A Systematic Review.

Hospital readmissions pose a threat to the constrained health resources, especially in resource-poor low-and middle-income countries. In such scenarios, appropriate technologies to reduce avoidable readmissions in hospitals require innovative interventions. mHealth and teach-back communication are robust interventions, utilized for the reduction in preventable hospital readmissions. This review was conducted to highlight the effectiveness of mHealth and teach-back communication in hospital readmission reduction with a view to provide the best available evidence on such interventions. Two authors independently searched for appropriate MeSH terms in three databases (PubMed, Wiley, and Google Scholar). After screening the titles and abstracts, shortlisted manuscripts were subjected to quality assessment and analysis. Two authors checked the manuscripts for quality assessment and assigned scores utilizing the QualSyst tool. The average of the scores assigned by the reviewers was calculated to assign a summary quality score (SQS) to each study. Higher scores showed methodological vigor and robustness. Search strategies retrieved a total of 1932 articles after the removal of duplicates. After screening titles and abstracts, 54 articles were shortlisted. The complete reading resulted in the selection of 17 papers published between 2002 and 2019. Most of the studies were interventional and all the studies focused on hospital readmission reduction as the primary or secondary outcome. mHealth and teach-back communication were the two most common interventions that catered for the hospital readmissions. Among mHealth studies (11 out of 17), seven studies showed a significant reduction in hospital readmissions while four did not exhibit any significant reduction. Among the teach-back communication group (6 out of 17), the majority of the studies (5 out of 6) showed a significant reduction in hospital readmissions while one publication did not elicit a significant hospital readmission reduction. mHealth and teach-back communication methods showed positive effects on hospital readmission reduction. These interventions can be utilized in resource-constrained settings, especially low- and middle-income countries, to reduce preventable readmissions.

Effectiveness of Mobile Health Augmented Cardiac Rehabilitation on Behavioural Outcomes among Post-acute Coronary Syndrome Patients: A Randomised Controlled Trial.

OBJECTIVE: To determine the effectiveness of mobile health augmented cardiac rehabilitation (MCard) on behavioural factors among post-acute coronary syndrome (post-ACS) patients. STUDY DESIGN: Randomised controlled trial. PLACE AND DURATION OF STUDY: Armed Forces Institute of Cardiology (AFIC), from January 2019 till March 2021. METHODOLOGY: Post-ACS patients were assigned to one of two groups: intervention (counselling, brief text messages, and standard post-ACS care) or control (no intervention) (standard post-ACS care). Healthy eating (Healthy eating assessment tool) and physical activity (IPAQ tool), medication compliance, smoking, salt intake, blood pressure (BP), and weight self-monitoring were assessed as behavioural factors. Data were collected three times for a six-month follow-up period (baseline, 12 and 24 weeks). RESULT: At 12 weeks, 121 (76.62%) of the 160 patients enrolled patients (80 in each group) were analysed; and at 24 weeks, 119 (74.38%) were analysed. Mean MET score at baseline was 1170 control vs. 1161 intervention (p = 0.940), at 12 weeks 826 vs. 934 (p = 0.390); and at 24 weeks was 925 vs. 1454 (p = 0.007). Healthy eating value at baseline was 36.43 control vs. 36.38 intervention (p =0.897), at 12 weeks 38.76 vs. 40.98 (p<0.001); and at 24 weeks 40.12 vs. 43.54 (p <0.001). There was also a significant difference in salt intake (p = 0.008) and healthy diet (p = 0.012), but not in medicine compliance, smoking behaviour, self-monitoring of BP and weight. CONCLUSION: The MCard positively impacts the post-ACS participants' behaviours in terms of physical activity, healthy eating, and salt restriction. MCard evidenced as a feasible intervention in terms of having lasting behaviour modification among this vulnerable patient population. Key Words: Acute coronary syndrome, Myocardial infarction, Cardiovascular diseases, Cardiac rehabilitation, Healthy diet, Physical activity, Smoking, Tobacco, Telemedicine, Lifestyle modification.

Mobile Health Augmented Cardiac Rehabilitation (MCard) in Post-Acute Coronary Syndrome Patients: A randomised controlled trial protocol.

OBJECTIVES: To determine the effectiveness of mobile health augmented cardiac rehabilitation (MCard) on health-related quality of life (HRQoL), clinical and behavioural outcomes in post-ACS. METHODS: A single-centre, single-blinded, two-arm randomised controlled trial is planned at Armed Forces Institute of Cardiology (AFIC), Pakistan. The duration was two years, that is from January 2019 till December 2020. A total of 160 participants were recruited and randomly allocated to the control group or the intervention group. Intervention is a mobile health augmented cardiac rehabilitation (MCard), a medically supervised cardiac rehabilitation program for 23-24 weeks. The phase one includes individual counselling during the hospital stay and in phase two includes communication of standardised messages related to healthy lifestyle modification through a specifically designed software. RESULTS: This clinical trial results will give insight into the impact of MCard in improving the health outcomes (HRQoL, clinical and behavioural) of participants. If proven to be effective, this technology can be scaled up and implemented in other cardiac centres in the country. It utilises fewer human resources and can be delivered at a lower cost. CONCLUSION: The study protocol will be giving evidence either MCard can contribute to improving the HRQoL, clinical and behavioural outcomes of post-ACS patients following hospital discharge. Considering the COVID-9 situation, this is the perfect time to implement and evaluate the effectiveness of MCard on health outcomes among post-ACS patients.

Burnout among surgeons; depression, anxiety and stress between consultant versus post-graduate trainee.

OBJECTIVE: To compare depression, anxiety and stress between consultant and post-graduate trainee (PG-trainee) surgeons and to find the difference of different factors i.e. gender, marital status, physical activity, BMI, comorbidity and Income per month between the two. METHODS: A descriptive cross-sectional study of eight months duration from March 2018 to August 2018 was conducted in Military Hospital and Combined Military Hospital, Rawalpindi, Pakistan. Convenient sampling technique was used. DASS 21 questionnaire was used for data collection. Data were entered and analysed by SPSS 22. A p-value of < 0.05 was considered statistically significant. RESULTS: The mean age of participants was 37.44±10.512 years. Out of 68 participants, 54 (79.4%) were males and 14 (20.6%) were females. There was a significant difference between the consultants and PG trainees in terms of gender, marital status and income per month (p= <0.005) PG-trainees were more depressed and anxious but not stressed as compared to consultants (p= 0.014, 0.012 and 0.280 respectively). CONCLUSIONS: There was a significant association in terms of gender, marital status and income per month between consultants and PG trainees. A statistically significant association was found between consultants and PG trainees concerning depression and anxiety showing PG trainees were more depressed and anxious.

Effectiveness of Cardiac Rehabilitation on Health-related Quality of Life in Patients with Myocardial Infarction in Pakistan.

OBJECTIVE: To find out the effectiveness of cardiac rehabilitation in patients with myocardial infarction in Pakistan. STUDY DESIGN: Randomised controlled trial. PLACE AND DURATION OF STUDY: Cardiac Rehabilitation Unit, Lady Reading Hospital, Peshawar, Pakistan, from July to December 2016. METHODOLOGY: Patients suffering first myocardial infarction (MI) were randomly allocated to usual care or cardiac rehabilitation in a 1:1 ratio. Cardiac rehabilitation comprised two phases: 1-2 weeks during hospital stay followed by 6-7 weeks outpatient structured exercise programme. Two generic health related quality of life (HRQoL) outcomes (General Health Questionnaire (GHQ) and Self-Rated Health (SRH)) and one post-MI specific tool (MacNew QLMI) were measured at baseline and at 8 weeks follow-up among both groups. Lower SRH and GHQ scores and higher MacNew QLMI scores indicate better health status. Data were analysed using STATA 14. RESULTS: Out of 206 participants, 195 (94.6%) were analysed at the end of trial. The mean age was 53 +8.3 years. In the cardiac rehabilitation group, the mean SRH score changed from 3.97 +0.9 at baseline to 2.36 +0.8 at follow-up (p<0.001). The mean GHQ of the cardiac rehabilitation group was 21.26 +5.5 at baseline and it decreased significantly to 7.43 +4.2 at follow-up (p<0.001). The MacNew QLMI of the cardiac rehabilitation group increased from 3.61 +1.07 to 5.62 +0.5 (p<0.001). The multivariate regression of all three HRQoL measures confirmed better HRQoL following cardiac rehabilitation compared with usual care (all p<0.001). CONCLUSION: Cardiac rehabilitation following MI was effective in terms of improving HRQoL and can be implement in Pakistan as it produced significant improvements in HRQoL.

Usage and types of mobile medical applications amongst medical students of Pakistan and its association with their academic performance.

OBJECTIVE: To estimate the frequency of usage and types of mobile medical applications amongst medical students of Pakistan and its association with their academic performance. METHODS: The is a descriptive cross-sectional study conducted in five medical colleges. It was of 6 months duration from Sept, 2017 to Feb 2018. A sample size of 448 undergraduates was calculated by using WHO sample size calculator. Sampling technique was non-probability convenient sampling. Self-constructed questionnaire was used as data collection tool. Data were entered and analysed in SPSS version 22. RESULTS: The study included 198 male (44.2%) and 250 female (55.8%) students (448 in total). The mean age was 21.08 ±1.542 years. About 323 (72%) students whose were routinely using medical application scored 69+7% in their professional examination while 125 (28%) students, who were not using medical application scored 67±9%. The association between average usage of medical application and academic performance was statistically significant (p<0.01). Amongst the medical applications "Medical Wikipedia" had the most frequent usage i.e. 162 (36.2%) while the least frequently used app was Disease Dictionary i.e. 50 (11.2%). CONCLUSION: More than half of medical students who participated in the study were using medical applications on daily basis with "Medical Wikipedia" being the most commonly used applications. Association between average usage of mobile medical applications and academic performance of the students was statistically significant. A large number of students agreed that medical applications were helpful in improving their medical as well as clinical knowledge.

Does playing video games effect cognitive abilities in Pakistani children?

OBJECTIVE: To find out the effect of playing video games on cognitive abilities among teenagers. METHODS: A comparative cross sectional study was conducted at two schools in Rawalpindi from August 2014 till February 2015. A sample size of 171 was calculated by using WHO sample size calculator using non-probability convenient sampling technique. A mixed questionnaire was used as a data collection tool and two groups were defined as video gamers and non-video gamers. Video gamers were those students who were using video games for two hours or more. Cognitive ability of the students were assess by standardized questionnaire named Wonderlic Cognitive Ability Test Questionnaire. Data were entered and analyzed in SPSS version 20. RESULTS: There were 93 (54.4%) gamers whereas 78(45.4%) were non-gamers. Mean age of the participants was 18.86+1.46 years. Gamers with correct answers to knowledge, analogy, processing speed, deductive reasoning, mathematical intelligence were 57(61.3%), 67(72%), 68 (73%), 58 (62.4%) and 73(78.5%) respectively. Significant association was found between gamer status and gender (p=0.023), analogy (p=0.049), processing speed (p<0.001), deductive reasoning (p=0.003) and mathematical intelligence (p<0.001). There was no significant association of gamer status with knowledge (p=0.188). CONCLUSION: Gamers exhibit better range of cognitive abilities specifically involving analogy, processing speed, deductive reasoning and mathematical intelligence. In this study, those who play video games on long term basis, showed improvement in cognitive abilities, in comparison to those who do not indulge in gaming activities.

Perceived stress and monetary burden among thalassemia patients and their caregivers.

OBJECTIVE: To find the perceived stress level and monetary burden in the thalassemia patients and their caregivers related to thalassemia treatment sessions. METHODS: A descriptive cross sectional study was conducted at Rawalpindi Thalassemia Centre and Military Hospital Rawalpindi of six months' duration from November 2016 to April 2017. A total of 87 sample size was calculated by using WHO sample size calculator. Participants were inducted through purposive sampling technique from thalassemia centers. A validated standardized Cohen's Perceived Stress score was used. Data were entered and analyzed in SPSS 22. RESULTS: Mean age of the participants was 30.42 ± 14.53 years. There were 30 (34.2%) males and 57 (65.8%) females. There were 39 (51.3%) patients and 48 (48.7%) caregivers. The mean income per month of the participants was 48706.9 ± 39492.68 PKR. The mean total expenditure per treatment session was 48706 ± 4037.12 PKR. Among the patients, there were 15 (38.5%) who were having average stress, while 4 (10.3%) were having moderate stress while 45 (51.7%0 were having severe stress. Among the caregivers, 10 (20.8%) were having mild stress, 13 (27.1%) were having moderate stress while 25 (52.1%) were having severe stress. The stress among the two groups was not statistically significant (p=0.066). CONCLUSION: More than half of the patients and caregivers were having a high perceived stress levels and there was a significant association between the two groups. The monetary burden was a lot to bear by the patients and the cost of treatment session most expensive.

Is Political Activism on Social Media an initiator of Psychological Stress?

OBJECTIVE: To find out the association of psychological stress with political activism on social networking sites (SNS) in adults. To find association of psychological stress and political activism with age, gender and occupational status. METHODS: A descriptive cross-sectional study of 8 months (Aug 2014 to March 2015) was conducted on young adults between age group of 20-40 years of different universities of Rawalpindi, Pakistan. Closed ended standardized questionnaires (i.e. Cohen Perceived Stress-10) were distributed via non-probability convenient sampling among a total sample size of 237. Sample size was calculated using WHO sample size calculator and data was analyzed in STATA version 12. RESULTS: The mean age of participants was 21.06±1.425 years. Out of the 237 participants, 150 (63.3%) were males and 87 (36.7%) females. Regarding their occupation, 13 (51.9%) were military cadets, 8 (3.4%) were consultant, 47 (19.8%) medical officer, 3 (1.3%) PG students and 56 (23.6%) MBBS students. Significant association of occupation was established with both political activism and psychological stress (p=0.4 and p=0.002 respectively). Among 237 individuals, 91 (38.4%) were stressed out and 146 (61.6%) were not. Among whole sample, political activists on SNS were found to be 23 (9.7%). Out of these 23 individuals who were politically active, 15 (65.2%) were stressed out and 8 (34.7%) were not. A significant association between stress and political activism was established (p=0.005). CONCLUSION: Political activism via social networking sites is playing significant role on adult person's mental health in terms of stress among different occupation.

Health Related Quality of Life in Patients with Single Lower Limb Amputation.

OBJECTIVE: To determine the effects of age, cause of amputation, and anatomic level of amputation on the health related quality of life (HRQOL) in individuals with unilateral lower limb amputation. STUDY DESIGN: Across-sectional survey. PLACE AND DURATION OF STUDY: The Armed Forces Institute of Rehabilitation Medicine, from August 2014 to February 2015. METHODOLOGY: Short Form-36 (SF-36) health related quality of life (HRQOL). Survey questionnaire was used to collect data. The responses were scored by using the quality metric health outcomes™ scoring software 4.5. The scores were entered and analysed in SPSS version 21. RESULTS: Atotal of 52 patients were inducted with mean age of 30.71 ±7.50 years. Mean physical component summary (PCS) was lower than mental component summary (MCS) (38.7 vs. 44.8). RP and RE scores were found to be significantly associated with gender (p=0.024 and p=0.003, respectively). Age group was also significantly associated with RP(p=0.037) and SF (p=0.041). When SF-36 domains were compared with level of amputation (i.e. trans-tibial and transfemoral), none of the domains showed any statistically significant results. CONCLUSION: Age and indication affect different aspects of quality of life but level of amputation did not. If these are known and anticipated before any type of rehabilitation, this could help in anticipation of health consequences and prevention accordingly.

Knowledge and attitude regarding Ebola virus disease among medical students of Rawalpindi: A preventable threat not yet confronted.

OBJECTIVE: To assess the knowledge and attitude regarding Ebola virus disease (EVD) among medical students of Rawalpindi. METHODS: A descriptive cross sectional study was carried out in a medical college of Rawalpindi from September 2014-November 2014. About 400 students were inducted with 77% (n=308) response rate. After taking informed verbal consent from students and administration, a pre-designed and pre-tested questionnaire was circulated among students of third, fourth and final year MBBS as well as third and fourth year BDS. The data collected was entered and analyzed using SPSS 20. RESULTS: The response rate was 77% (308/400). About 244 (79.2%) of students had heard about EVD before. One hundred and sixty four (53.2%) of the students correctly identified that no treatment is available for EVD as yet. Also 163 (52.9%) said that no vaccine was available against the virus either. Washing hands every time after touching a patient in clinics/wards was important for 151 (49.0%) while 223 (72.4%) claimed to use proper techniques to dispose off used injections. CONCLUSION: Students have basic knowledge regarding EVD. However, there is deficient information regarding the diagnosis and precautionary measures required to control it.

Regular breakfast consumption associated with high intelligence quotient: Myth or Reality?

OBJECTIVE: To find the frequency of regular breakfast consumption among Pakistani teenagers while the other objective was to find out the association between breakfast consumers (BC) and intelligence quotient (IQ). METHODS: This comparative cross sectional study was conducted on 102 students of a Public School Rawalpindi from August 2013 to January 2014. Participants were categorised into two groups i.e. regular breakfast consumers (RBC) and irregular breakfast consumers (IBC) according to their breakfast habits. A standardized questionnaire of Wechsler Intelligence Scale for Childrenwas used for IQ assessment. Data was then entered and analysed in SPSS version 20. RESULT: Out of the 102 individuals with mean age 17.17 ± 0.631, 58(56.9%) were females and 44 (43.1%) were males. There were 63 (61.8%) RBC while 39 (38.2%) were IBC. Among RBC there were 7 (6.9%) in challenged, 5 (4.9%) were below average, 33 (32.4%) in average group, 14(13.7%) in above average and 4 (3.9%) in gifted group. While among IBC, there was 1 (1%) among the severely challenged, 3 (2.9%) in challenged, 8 (7.8%) in below average, 22 (21.6%) in average group, 4 (3.9%) in above average and 1 (1%) in gifted group. There was no significant association found between breakfast intake and IQ level among students (p=0.98). CONCLUSION: More than half of the students were having regular breakfast. There was no significant association found among breakfast consumers and IQ. However the IQ score was more among RBC as compared to IBC.

Validity of C-reactive protein (CRP) for diagnosis of neonatal sepsis.

OBJECTIVE: To determine the validity of C-reactive protein levels for diagnosis of neonatal sepsis. METHODS: A cross sectional (Validation) study was conducted at Neonatology unit in KRL general hospital (emergency/OPD) of 7 months duration from February 2012 to August 2012. By using purposive sampling technique, 147, sample size was calculated by using WHO sample size calculator taking sensitivity 75%, specificity 95%, expected prevalence 50%, desired precision 10% and confidence level 95%. RESULTS: Mean age of the neonates was 5.72 days + 3.86. Male patients were 81(55.1%) while 66(44.9%) were female. Neonatal sepsis was observed in 43(29.25%) and were confirmed through blood culture while 104(70.75%) were not confirmed on blood culture as neonatal sepsis. The sensitivity and specificity of CRP in diagnosis of acute neonatal sepsis was 76.92% and 53.49% respectively while it had a positive predictive value of 80% and negative predictive value of 48.94%. Over all the diagnostic accuracy of CRP in diagnosis of neonatal sepsis was 70.07%. CONCLUSION: CRP estimation does have a role in the diagnosis of neonatal sepsis but the test is not specific enough to be relied upon as the only indicator.

Anorexia nervosa among teenage girls: Emerging or prevalent?

OBJECTIVES: To find out frequency of anorexia nervosa (AN) among teenage girls (TG) and to find out the knowledge and practice regarding anorexia nervosa among teenage girls. METHODS: A cross sectional study was conducted at higher secondary public school, Rawalpindi from June 2013 till December 2013. A sample of 100 female students of the age group 13-19 years were inducted by systematic sampling technique. Mixed pretested questionnaire was filled after informed verbal consent. Data was entered and analysed using SPSS version 20. RESULTS: Participants mean age was 15.81 ± 1.323 years. Mean weight, mean height and mean body mass index were found to be 50.34 ± 10.445 kg, 160.14 ± 7.846 cm and 19.675 ± 4.1477 kg/m(2) respectively. Anorexia nervosa was found in 42 (42%) teenage girls while 58 (58%) were not having anorexia nervosa. Sufficient knowledge and positive practice were found to be present in 57 (57%) and 49 (49%) respectively. Statistically no significant association was found between KP and AN (p=0.73). CONCLUSION: Anorexia nervosa is an emerging health concern in Pakistan. Anorexia prevalent behaviour was observed in almost half of the teenage girls.

Proportion of exposure of passive smoking in teenage group and symptoms precipitated after exposure to second hand smoke.

Exposure of passive smoking and second hand smoke (SHS) exposure in teenage group results in precipitation of several symptoms. Five hundred teenagers between ages of 13 - 19 studying in Army Public School and College Westridge, Rawalpindi, were selected for descriptive cross-sectional study from September 2012 till February 2013. Out of the total 500, 279 (55.8%) were exposed to passive smoking while 221 (44.2%) were not exposed to passive smoking. Out of the exposed 279 (55.8%) students, males were 132 (47.3%) and females were 147 (52.7%) with mean age of 15.06 ± 1.805 years. After exposure to SHS, multiple responses were observed. Statistical significant association was found between symptoms precipitation and exposure to SHS. Nose irritation was present in 84, while 195 did not complain of it (p = 0.002). Allergic symptoms were precipitated with SHS in 42, while not in 21 students (p < 0.001). Asthma attack was precipitated in 38, while 241 did not experience precipitation of asthma attack (p < 0.001). More cough was present in 168, while not in 111 students (p = 0.037). Nausea was present in 41, while not in 238 (p < 0.001). Nose irritation was seen in 84 and not in 195 students (p = 0.002). More than half of the teenagers had exposure to passive smoking. Statistical significant association was found between passive smoking exposure and precipitation of symptoms.

Knowledge, attitude and practice regarding folic acid deficiency; A hidden hunger.

OBJECTIVES: To find the Knowledge Attitude and Practice regarding Folic Acid Deficiency among Women of Child Bearing Age (WPCBA). To find out the Association of Education Level with Practice of Folic Acid in WPCBA. METHODS: A Descriptive cross sectional study (Knowledge Practice and Attitude) was conducted at Military Hospital and Combined Hospital Rawalpindi from September 2012 to February 2013. About 400 married females of age group 21-42 years were included by convenient sampling technique. After taking informed verbal consent, a closed ended interviewer administered questionnaire was filled. Data was entered and analyzed using SPSS version 20. RESULTS: Mean age of the respondents was 30.31 + 5.280 years. Illiterate and literate were 165 (41.25%) and 235 (58.75%) respectively. The knowledge regarding folic acid need was 172 (43%). Only 161 (40.25%) thought that folic acid deficiency in pregnant women results in abnormality in newborn. In pregnancy, 205 (51.25%) had received folic acid supplementation. Association between education level and practice of folic acid was significant (p= 0.009) at 95% confidence level. CONCLUSION: Knowledge regarding folic acid deficiency among WOCBA was low along with the poor attitude. Practice was also not satisfactory. Education status plays important role in preventing micronutrient deficiency.

Microbiological contamination in water filtration plants in Islamabad.

OBJECTIVE: To determine the frequency of microbiological contamination of water in different water filtration plants in Islamabad. STUDY DESIGN: Descriptive cross-sectional study. PLACE AND DURATION OF STUDY: Water Filtration Plants (WFP) in different sectors of Islamabad, from April to September 2012. METHODOLOGY: Water samples were collected in sterilized bottles according to the standard water sampling protocol from site and transported to Pakistan Council for Research in Water Resources (PCRWR) for analysis. Microbiological quality of water was determined in terms of total coliforms (< 2.0 MPN/100 ml) and Escherichia coli (< 2.0 MPN/100 ml). Microbiological contaminated water was defined the sample which had more than 2.0 MPN per 100 ml of either total coliforms or Escherichia (E.) coli. RESULTS: Thirty two WFP were analyzed for microbiological contamination. E. coli was present in 8 (25.0%) water samples, while 24 (75.0%) water samples were free from it. Total coliforms were present in 13 (40.6%) of the samples of WFP, while 19 (59.3%) samples were free from total coliform. Faecal coliforms were present in 8 (25.0%) and absent in 24 (75.0%) samples. Both E. coli and total coliform were present in 8 (25.0%) samples. Nine (59.3) WFP were free from E. coli, total coliform and faecal coliform. Statistically, no significant association was found (p > 0.05) between microbiological contamination and the sectors. CONCLUSION: Less than half of the water samples of the WFP were contaminated while certain sectors showed more frequent contamination than others.

Frequency of co-existence of dengue and malaria in patients presenting with acute febrile illness.

OBJECTIVE: To find out the frequency of co-existence of malaria and dengue fever in patients presenting with acute febrile illness. METHODS: The descriptive cross-sectional study was conducted at the Military Hospital Rawalpindi from June to November 2012. A total of 500 patients with complaint of acute febrile illness were selected after applying the inclusion and exclusion criteria. Preliminary data was collected on a pretested proforma. Blood samples of patients were tested for dengue serology and malaria parasite. Results were entered in respective proforma. Co-existence was considered present when a patient had both dengue serology and malaria parasite slide positive. SPSS 20 v was used for data analysis. RESULT: Of the total, 349 (69.8%) were males and 151 (30.2%) females. Dengue serology was positive in 16 (3.2%); 81(16.2%) had malaria parasite slide positive; 403 (80.4%) had none of the two findings. Co-existence of both dengue and malaria was nil among the whole sample. In males, 67 (13.4%) had malaria, while 11 (2.2%) had dengue. In females, 14 (2.8%) had malaria, while 5 (1%) suffered from dengue fever. CONCLUSION: Co-existence of dengue and malaria was zero per cent in 500 patients visiting Military Hospital Rawalpindi. More studies shall be conducted to find out whether the reason of having zero per cent co-existence is that dengue or/and malaria epidemic did not occur in 2012 or whether there are some other factors involved.