Evaluation of blood lead levels by atomic absorption spectrometry in school going children of northern areas of Pakistan.

OBJECTIVE: To evaluate blood lead levels and assess their correlation with academic performance in school children. METHODS: The cross-sectional study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from January to December, 2017, and comprised school children in Rawalpindi, Pakistan, and Hajira, Azad Jammu and Kashmir. About 5 ml of venous blood was collected in potassium-ethylenediaminetetraacetic acid tubes for lead levels, haemoglobin and plasma ferritin. The preceding three years' academic performance, rated as excellent, good, fair and poor, of the subjects was categorised on a specifically-designed proforma. Data was analysed using SPSS 24. RESULTS: Of the 400 subjects, 205 (50.25%) were females. The overall mean age was 9.15±2.8 years. Mean level of lead was 4.3±2.6 µg/dL, and difference in values was significant between children of Hajira and Rawalpindi (p<0.05). Mean haemoglobin was 12.9±0.919g/dL and mean ferritin was 49.17±16.0ng/ml. Of the total, 85(21.3%) showed excellent school performance, 162(40.5%) good, 113(28.3%) fair and 40(10%) showed poor performance. Significant negative association was found between school performance and mean blood lead level (p>0.05). No significant difference was found in terms of gender and age with school performance of both regions. CONCLUSIONS: Majority of school going children in northern Pakistan were found to have lead levels ≤ 5µg/dL which is a level of concern as it is inversely related to academic performance.

Environmental impact assessment of municipal solid waste management value chain: A case study from Pakistan.

The present study quantified environmental impacts of the Rawalpindi Waste Management Company (RWMC) value chain in Pakistan for three consecutive years (2015-2018) using a cradle-to-grave life cycle assessment (LCA) approach. Energy potential from municipal solid wastes (MSW) was also predicted till the year 2050. Based on a functional unit of 1.0 tonne of MSW, the study analyzed inputs and outputs data through SimaPro v.8.3 applying CML 2000 methodology and cumulative exergy demand indicator (CExD). LCA revealed that operational activities of RWMC mainly contributed to marine aquatic ecotoxicity, i.e. 8962.83 kg1,4-DBeq t-1 MSW, indicating long-range transport of petrogenic hydrocarbons from the company's fleet gasoline combustion. Similarly, human toxicity potential, global warming potential and freshwater aquatic ecotoxicity potential were also found to be significant, i.e. 18.14 kg1,4-DBeq t-1 MSW, 15.79 kgCO2eq t-1 MSW and 6.22 kg1,4-DBeq t-1 MSW, respectively. The CExD showed that company activities consumed 827.14 MJ t-1 MSW exergy from nature, and gasoline used in MSW transport was the most exergy-intensive process, using 634.47 MJ exergy per tonne MSW disposed of. Projections for energy generation potential up to the year 2050 showed that MSW of Rawalpindi city will have the potential to produce 3901 megawatt of energy to fulfill the energy needs of the country. Possible stratagems to reduce environmental impacts from the municipal solid waste management (MSWM) value chain of RWMC include curtailing dependency on petrogenic and fossil fuels in mobile sources, optimization of waste collection methods and dumping routes, inclining attention toward suitable wastes-to-energy conversion technology and opting for a holistic approach of MSWM in Pakistan.

Assessment of the risk factors of hypertension among adult & elderly group in twin cities of Pakistan.

OBJECTIVE: To estimate the prevalence of hypertension and to explore the risk factors associated with it. METHODS: In a cross-sectional study, a population based survey was conducted on inhabitants of Rawalpindi-Islamabad region, 219 individuals; aged 18 years or above were included in the study. Blood pressure was measured along with information about individual's demographic and socio-economic characteristics were obtained using a standard questionnaire.. RESULTS: Overall prevalence of hypertension was 29.22% (males: 21.9% and females: 78.1%) in individuals residing in Rawalpindi-Islamabad. High blood pressure is more associated with obesity (59.4%) and a progressive increase in hypertension was observed with increasing age. Bivariate analysis revealed that hypertension has a significant correlation (p-value<0.05) with age, gender, family status, weight and physical health. CONCLUSIONS: The study concludes that our generation is well aware about the risks and consequences of hypertension, but they still continue to make no or little effort in managing or preventing it. The factors contributing to hypertension are low physical activity, diet and lack of interest to maintain their health.

Societal knowledge, attitude, and practices towards dengue and associated factors in epidemic-hit areas: Geoinformation assisted empirical evidence.

Dengue is one of Pakistan's major health concerns. In this study, we aimed to advance our understanding of the levels of knowledge, attitudes, and practices (KAPs) in Pakistan's Dengue Fever (DF) hotspots. Initially, at-risk communities were systematically identified via a well-known spatial modeling technique, named, Kernel Density Estimation, which was later targeted for a household-based cross-sectional survey of KAPs. To collect data on sociodemographic and KAPs, random sampling was utilized (n = 385, 5 % margin of error). Later, the association of different demographics (characteristics), knowledge, and attitude factors-potentially related to poor preventive practices was assessed using bivariate (individual) and multivariable (model) logistic regression analyses. Most respondents (>90 %) identified fever as a sign of DF; headache (73.8 %), joint pain (64.4 %), muscular pain (50.9 %), pain behind the eyes (41.8 %), bleeding (34.3 %), and skin rash (36.1 %) were identified relatively less. Regression results showed significant associations of poor knowledge/attitude with poor preventive practices; dengue vector (odds ratio [OR] = 3.733, 95 % confidence interval [CI ] = 2.377-5.861; P < 0.001), DF symptoms (OR = 3.088, 95 % CI = 1.949-4.894; P < 0.001), dengue transmission (OR = 1.933, 95 % CI = 1.265-2.956; P = 0.002), and attitude (OR = 3.813, 95 % CI = 1.548-9.395; P = 0.004). Moreover, education level was stronger in bivariate analysis and the strongest independent factor of poor preventive practices in multivariable analysis (illiterate: adjusted OR = 6.833, 95 % CI = 2.979-15.672; P < 0.001) and primary education (adjusted OR = 4.046, 95 % CI = 1.997-8.199; P < 0.001). This situation highlights knowledge gaps within urban communities, particularly in understanding dengue transmission and signs/symptoms. The level of education in urban communities also plays a substantial role in dengue control, as observed in this study, where poor preventive practices were more prevalent among illiterate and less educated respondents.

Experiences, awareness, perceptions and attitudes of women and girls towards menstrual hygiene management and safe menstrual products in Pakistan.

Background: The taboo of menstruation, lack of discussion on puberty, misinformation and poor awareness on menstrual hygiene management and limited access to safe menstrual products can negatively impact the physical and mental health of women and girls residing in low middle income countries. Aim: The aim of the study was to explore the experiences, awareness, perceptions and attitudes of women and girls towards menstrual hygiene management in Pakistan. Moreover, the study also assessed consumer satisfaction towards locally manufactured organic menstrual products. Methods: A descriptive cross-sectional study design was used with a sample of 400 women and girls selected through convenience sampling from high schools, universities, outpatient department and gynaecological clinics located in 2 cities, i.e., Islamabad and Rawalpindi, Pakistan. A pre-structured questionnaire was used to explore experiences, awareness, perceptions and attitudes of women and girls towards menstrual hygiene management. Moreover, each respondent was provided with sample of locally designed and manufactured organic menstrual hygiene & wellness kit by a group of women researchers named "FemPure" including organic sanitary pads, feminine wellness mist and feminine wellness wash. The respondents were asked to use the products and a telephonic follow-up was conducted to assess consumer satisfaction for the products after a period of 1 month. Data was analyzed statistically using SPSS 21. Results: The results of the study reported that 86.2% (n = 345) of the respondents had normal periods. Out of 400 respondents, 58.5% (n = 234) knew about any health conditions related to abnormal menstrual cycle while 88.3% (n = 353) were aware of female menstrual hygiene. Majority of the respondents 78.7% (n = 315) felt ashamed while buying sanitary pads. Out of 400 respondents, 5.4% (n = 22) were interested in getting awareness regarding menstrual hygiene. The results of the study showed that all the respondents (100%, n = 400) were satisfied with FemPure organic menstrual products. Conclusion: The study concluded that majority of women and girls faced menstrual hygiene issues during and after the cycle and were eager to receive information on MHM and use organic rash free menstrual wellness products which could be ordered via mobile app. The respondents were satisfied after the use of FemPure organic menstrual products.

Risk Factors of Dengue Fever in Urban Areas of Rawalpindi District in Pakistan During 2017: A Case Control Study.

BACKGROUND: During August 2017, increased numbers of suspected dengue fever cases were reported in the hospitals of Rawalpindi district. A case control study was conducted to determine the risk factors among urban areas, dengue serotype, and recommend preventive measures. OBJECTIVE: The objective of the investigation was to determine the risk factors among urban areas, dengue serotype, and recommend preventive measures. METHODS: A case was defined as having acute febrile illness with one or more of the following symptoms: retro-orbital pain, headache, rash, myalgia, arthralgia, and hemorrhage. The cases were residents of Rawalpindi and were confirmed for dengue fever from August 30, 2017, to October 30, 2017. All NS1 confirmed cases from urban areas of Rawalpindi were recruited from tertiary care hospitals. Age- and sex-matched controls were selected from the same community with a 1:1 ratio. Frequency, univariate, and multivariate analyses were performed at 95% CI with P<.05 considered statistically significant. RESULTS: Totally 373 cases were recruited. The mean age was 36 (SD 2.9) years (range 10-69 years), and 280 cases (75%) were male. The most affected age group was 21-30 years (n=151, attack rate [AR] 40%), followed by 31-40 years (n=66, AR 23%). Further, 2 deaths were reported (case fatality rate of 0.53%). The most frequent signs or symptoms were fever (n=373, 100%), myalgia and headache (n=320, 86%), and retro-orbital pain (n=272, 73%). Serotype identification was carried out in 322 cases, and DEN-2 was the dominant serotype (n=126, 34%). Contact with a confirmed dengue case (odds ratio [OR] 4.27; 95% CI 3.14-5.81; P<.001), stored water in open containers at home (OR 2.04; 95% CI 1.53-2.73; P<.001), and travel to a dengue outbreak area (OR 2.88; 95% CI 2.12-3.92; P<.001) were the main reasons for the outbreak, whereas use of mosquito repellents (OR 0.12; 95% CI 0.09-0.18; P<.001) and regular water supply at home (OR 0.03; 95% CI 0.02-0.04; P<.001) showed protective effects. The geographical distribution of cases was limited to densely populated areas and all the 5 randomly collected water samples tested positive for dengue larvae. CONCLUSIONS: Stored water in containers inside houses and subsequent mosquito breeding were the most probable causes of this outbreak. Based on the study findings, undertaking activities to improve the use of mosquito repellents and removing sources of breeding (uncovered water stored indoors) are some recommendations for preventing dengue outbreaks.

Risk Factors of Nephrolithiasis in a Tertiary Care Hospital in Rawalpindi: A Descriptive Cross-Sectional Study.

Background Nephrolithiasis (renal stones) is the most common urological disease. Its prevalence is high in every part of the world. Several factors lead to renal stone formation. In Pakistan, nephrolithiasis prevalence is also high as Pakistan is located in a region which is known as the salt belt. However, nephrolithiasis and its possible risk factors are under-researched in Pakistan. Objective This study aims to identify the risk factors for nephrolithiasis among admitted patients with renal stones. This may lead to a reduction in renal stone incidence and its allied complications by the prevention of risk factors that would have a major role in renal stone formation. Material and methods This descriptive cross-sectional study was performed among the 143 admitted patients with renal stones in the urology ward of Benazir Bhutto Hospital, Rawalpindi, for approximately six months from November 2021 to April 2022. Non-probability convenient sampling and developed inclusion and exclusion criteria were used for the recruitment of patients. After elaborating on the objectives, the study data were collected by interviewers through a self-structured questionnaire. Descriptive analysis was carried out using SPSS version 25.0 (IBM Corp., Armonk, NY). Results Nephrolithiasis was more prevalent among patients who had an age group range of 15-30 years (47.55%), male gender (56.65%), illiterate educational status (53.14%), lower socioeconomic status (66.43%), inadequate intake of water (61.53%), used tap water (56.64%), a habit of daily vegetable intake (65.04%), sedentary lifestyle (51.74%), family history of renal stones (57.34%), no diabetes mellitus (62.94%), no hypertension (52.45%), and overweight (48.23%). Conclusion In brief, the age group of 15-30 years, male gender, illiteracy, lower socioeconomic status, insufficient water intake, tap water, high vegetables, inactive lifestyle, family history of nephrolithiasis, and a high BMI all increase the risk of nephrolithiasis.

Temporal Instability of Factors Affecting Injury Severity in Helmet-Wearing and Non-Helmet-Wearing Motorcycle Crashes: A Random Parameter Approach with Heterogeneity in Means and Variances.

Not wearing a helmet, not properly strapping the helmet on, or wearing a substandard helmet increases the risk of fatalities and injuries in motorcycle crashes. This research examines the differences in motorcycle crash injury severity considering crashes involving the compliance with and defiance of helmet use by motorcycle riders and highlights the temporal variation in their impact. Three-year (2017-2019) motorcycle crash data were collected from RESCUE 1122, a provincial emergency response service for Rawalpindi, Pakistan. The available crash data include crash-specific information, vehicle, driver, spatial and temporal characteristics, roadway features, and traffic volume, which influence the motorcyclist's injury severity. A random parameters logit model with heterogeneity in means and variances was evaluated to predict critical contributory factors in helmet-wearing and non-helmet-wearing motorcyclist crashes. Model estimates suggest significant variations in the impact of explanatory variables on motorcyclists' injury severity in the case of compliance with and defiance of helmet use. For helmet-wearing motorcyclists, key factors significantly associated with increasingly severe injury and fatal injuries include young riders (below 20 years of age), female pillion riders, collisions with another motorcycle, large trucks, passenger car, drivers aged 50 years and above, and drivers being distracted while driving. In contrast, for non-helmet-wearing motorcyclists, the significant factors responsible for severe injuries and fatalities were distracted driving, the collision of two motorcycles, crashes at U-turns, weekday crashes, and drivers above 50 years of age. The impact of parameters that predict motorcyclist injury severity was found to vary dramatically over time, exhibiting statistically significant temporal instability. The results of this study can serve as potential motorcycle safety guidelines for all relevant stakeholders to improve the state of motorcycle safety in the country.

A comparative study of machine learning classifiers for injury severity prediction of crashes involving three-wheeled motorized rickshaw.

Motorcycles and motorcyclists have a variety of attributes that have been found to be a potential contributor to the high liability of vulnerable road users (VRUs). Vulnerable Road Users (VRUs) that include pedestrians, bicyclists, cycle-rickshaw occupants, and motorcyclists constitute by far the highest share of road traffic accidents in developing countries. Motorized three-wheeled Rickshaws (3W-MR) is a popular public transport mode in almost all Pakistani cities and is used primarily for short trips to carry passengers and small-scale goods movement. Despite being an important mode of public transport in the developing world, little work has been done to understand the factors affecting the injury severity of three-wheeled motorized vehicles. Crash injury severity prediction is a promising research target in traffic safety. Traditional statistical models have underlying assumptions and predefined associations, which can yield misleading results if flouted. Machine learning(ML) is an emerging non-parametric method that can effectively capture the non-linear effects of both continuous and discrete variables without prior assumptions and achieve better prediction accuracy. This research analyzed injury severity of three-wheeled motorized rickshaws (3W-MR) using various machine learning-based identification algorithms, i.e., Decision jungle (DJ), Random Forest (RF), and Decision Tree (DT). Three years of crash data (from 2017 to 2019) was collected from Provincial Emergency Response Service RESCUE 1122 for Rawalpindi city, Pakistan. A total of 2,743 3W-MR crashes were reported during the study period that resulted in 258 fatalities. The predictive performance of proposed ML models was assessed using several evaluation metrics such as overall accuracy, macro-average precision, macro-average recall, and geometric means of individual class accuracies. Results revealed that DJ with an overall accuracy of 83.7 % outperformed the DT and RF-based on a stratified 10-fold cross-validation approach. Finally, Spearman correlation analysis showed that factors such as the lighting condition, crashes involving young drivers (aged 20-30 years), facilities with high-speed limits (over 60 mph), weekday, off-peak, and shiny weather conditions were more likely to worsen injury severity of 3W-MR crashes. The outcomes of this study could provide necessary and essential guidance to road safety agencies, particularly in the study area, for proactive implementation of appropriate countermeasures to curb road safety issues pertaining to three-wheeled motorized vehicles.

Metered Dose Inhaler Technique: A Priority Catch for Physicians.

BACKGROUND: Asthma is a non-curable but preventable disease that can be controlled by a proper approach. Inhalational route is considered to be one of the fastest, non-invasive course for the management of asthma. Despite its importance, compliance towards proper inhalational technique remains quite low. Thus, United Kingdom guidelines and Global Strategy for Asthma Management and Prevention (GINA) recommend regular assessment of inhaler techniques in all asthma patients. OBJECTIVE: To evaluate the inhalational technique of asthma patients visiting out-patient departments of public sector tertiary care hospitals of Rawalpindi and correlate with various demographic factors. METHODS: A cross-sectional study was conducted on a total of 209 respondents visiting the outpatient department of public sector hospitals in Rawalpindi. Asthmatic patients were included via a non-probability consecutive sampling technique and were assessed for inhaler techniques via a structured checklist. Statistical data were analyzed using IBM Statistical Package for Social Sciences (SPSS®), version 25.0 (IBM Corp., Armonk, NY, USA). RESULTS: Two hundred and nine asthma patients were included. Only 10% of patients demonstrated the correct inhaler technique. Continuing inhaling till lungs are full, holding breath for five to 10 seconds, and breathing out slowly after using the inhaler were most poorly followed. CONCLUSION: Most asthma patients are using poor inhalation technique, risking sub-optimal drug delivery and inadequate effects. Hence, it is the need of the hour to focus on patient training and education.

First report of Chikungunya fever in Rawalpindi, Pakistan.

BACKGROUND: Chikungunya shares many clinical features with dengue fever, but to date, no case has been reported in Rawalpindi and surrounding areas. AIMS: To detect the presence in Rawalpindi of chikungunya masquerading as dengue fever. METHODS: An observational study was conducted at Rawalpindi Medical University from July to December 2017. Patients with clinical features suggestive of dengue fever, but negative for dengue virus NS1 antigen were included and tested at the National Institute of Health Islamabad, Pakistan, for chikungunya using reverse transcription polymerase chain reaction. RESULTS: We tested 129 patients and 28 were positive for chikungunya. There were 17 (60.7%) men and 11 (39.3%) women, with a mean age of 32.53 years (range 16-60 years). All had fever at presentation. Other clinical features at presentation were noted, such as fever, chills, fatigue, headache, myalgia, arthralgia, retro-orbital pain, abdominal pain, nausea, and diarrhoea. No long-term sequelae or bleeding diatheses were seen and there was no mortality reported. CONCLUSIONS: The clinical features observed and investigated confirmed our reporting of the first case of chikungunya in Rawalpindi, Pakistan.

Depression in Chronically ill Patients of Railway General Hospital, Pakistan.

According to the World Health Organization (WHO), chronic diseases are the leading cause of death and disability worldwide and estimated to contribute to 73% of all deaths by 2020. In addition to the difficulty in effectively managing chronic diseases, they are often complicated further by the co-morbid depression stemming from the original disease. Depression has the highest burden of disease affecting more than 264 million people worldwide and worsens the burden of co-existing chronic medical diseases as well. A bidirectional relation exists between depression and chronic medical diseases. Statistical mapping of chronically ill patients of Pakistan suggests that 50% of its population suffers from some form of chronic disease. Little data exists for the prevalence of depression in chronically ill patients from most of Pakistan. Our objectives were to observe the patterns of depression in chronically ill patients and outline the need for intervention (if any) on a population of Railway General Hospital (RGH - a tertiary healthcare hospital in Rawalpindi, Pakistan). We also aimed at finding out the relation (if any) of age, gender, number of hospital admissions, education and effectiveness of medical disease management with depression. A cross sectional study was conducted on patients admitted due to their chronic medical diseases out of a population of 11,000 presenting at the medical OPD of RGH over a period of three months using Patient Health Questionnaire-9 (PHQ -9) Urdu version. About 50% of the patients suffered from moderate to severe forms of depression. A significant positive correlation was found between age and past psychiatric history of illnesses other than depression with depression while no significance was found with number of hospital admissions, gender or education level; 35% had suicidal ideation. Depression is quite often dismissed, underdiagnosed and leads to a poor quality of life and decrease in cost effectiveness in our population. Pakistan needs to use more resources on managing depression and medical professionals need to change their attitudes in holistically managing the patients. Treating depression is just as important as managing other symptoms of chronic medical diseases.

Prevalence and Psychological Impact of Acne Vulgaris in Female Undergraduate Medical Students of Rawalpindi and Islamabad, Pakistan.

BACKGROUND: Acne vulgaris is a common skin disease, affecting approximately 9.4% of the world's population, with considerable effect on the quality of life. According to a previously conducted study, the prevalence rate of acne in Pakistan was found to be 5%. And to this date, no reliable data is available about the prevalence of acne in Rawalpindi and Islamabad, Pakistan. Objectives To determine the prevalence of acne vulgaris and its psycho-social impact on female undergraduate medical students of Rawalpindi and Islamabad. Methods A cross-sectional study was conducted during the month of August 2019 among female undergraduate medical students from three randomly selected medical colleges of Rawalpindi and Islamabad. The diagnosed cases of acne vulgaris were assessed by using the Dermatology Life Quality Index (DLQI). The collected data were then analyzed using SPSS version 20 (IBM Corp., Armonk, NY, US). Results The prevalence of acne vulgaris was found to be 14.47% in female undergraduate medical students of Rawalpindi and Islamabad. Sixty percent (n=99) were found to have itchy sores and stinging skin, 66.7% (n=110) were embarrassed by their acne-prone skin, and the social activity of 60% (n=99) of the participants was affected by their active acne. Of the students, 73.9% were not affected by their acne while studying or working. Around 61.2% (n=101) complained that their acne treatment was a problem and hiding it took time or made a mess. Two percent showed a severe impact, with 14% having very large, 44% moderate, 30% low, and the remaining 10% with no effect of acne in their psychosocial functioning. Conclusion Acne vulgaris is a chronic skin disease that considerably affects the psychosocial functioning of female undergraduate medical students. A holistic approach in treating acne requires the participation of a dermatologist and mental health professional.

Barriers in the management of tuberculosis in rawalpindi, pakistan: a qualitative study.

BACKGROUND: Tuberculosis (TB) is a contagious, airborne disease and remains a major global public health hazard. TB is a major cause of mortality and is affecting millions of people in low-income and middle-income countries. Worldwide, one person out of three is infected with the Mycobacterium tuberculosis. Timely diagnosis and treatment are the two key factors for better outcomes. Non-adherence to TB treatment is an important barrier for TB control programs. This study was designed to understand the barriers encountered by TB patients when seeking health care. MATERIALS AND METHODS: A qualitative study was conducted during the months of August and December 2010 on 15 health facilities. In-depth interviews were conducted with 23 TB patients (13 males and 10 females) aged 15-65 years. In addition, 15 health personnel were also interviewed. RESULTS: Most patients were found to be well informed about the idea of taking TB medications under direct supervision and its overall importance. However, many of them were not convinced with either drugs or treatment protocols. We found that limited knowledge of patients, loss of employment, financial burden, social stigma and long distance from health facility were the main barriers for TB adherence. CONCLUSION: More patient-centred interventions and attention to the barriers are required to improve the treatment adherence. Direct observation of patients and regular home visits by health workers can reduce the risk of non-adherence.