Assessment of Refractive Outcome of Photo Refractive Keratectomy in Myopia and Myopic Astigmatism.

OBJECTIVES: To determine the refractive outcomes of wavefront optimized photo refractive keratectomy (PRK) in patients having myopia and myopic astigmatism in terms of efficacy, safety, accuracy, stability and predictability of the procedure. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Refractive Surgical Unit, Armed Forces Institute of Ophthalmology, National University of Medical Sciences, Rawalpindi, Pakistan, from October 2013 to August 2018. METHODOLOGY: Patients having myopia and myopic astigmatism, consented to be a part of the study, underwent meticulous screening consisting of detailed medical history, ocular examination and investigations. Each case was compiled and evaluated. Those who satisfied the criteria for refractive surgery were subjected to PRK procedure. Postoperative follow-up was carried out and parameters were recorded at designated intervals of 1 week, 1, 3, 6 and 12 months. RESULTS: This study included 208 eyes of 106 patients with mean age of 25.33 + 5.196 years. At the end of one year, 97% (202 out of 208) eyes had uncorrected distance visual acuity (UDVA) better than 20/25 with efficacy index of 1.009 ± 0.132 and safety index of 1.019 ± 0.126. None of the eyes lost two or more lines. In this study, 207 out of 208 eyes remained within + 0.50 diopter (D) of intended spherical equivalent (SEQ). Results showed 100% accuracy of procedure since all the study patients achieved SEQ within + 1D. CONCLUSION: PRK is an effective, predictable, and safe treatment procedure for correcting myopia and myopic astigmatism. Key Words: Photorefractive keratectomy, Myopia, Refractive surgery, Myopic astigmatism, Uncorrected distance visual acuity.

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.

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.

Assessment of Refractive Outcomes of Femtosecond-assisted Laser in Situ Keratomileusis (LASIK) for Hyperopia.

OBJECTIVE: To determine the effect of refractive treatment in terms of safety, efficacy, stability, accuracy, and predictability with Wavefront Optimized Laser-assisted in situ keratomileusis (LASIK) on hyperopia. STUDY DESIGN: Descriptive, analytical study. PLACE AND DURATION OF STUDY: Armed Forces Institute of Ophthalmology, National University of Medical Sciences, Rawalpindi, Pakistan from August 2013 to June 2018.  Methodology: Participants were selected after detailed history, careful ocular examination and meticulous relevant assessment on refractive scans. Preoperative measurements were recorded. Refractive strategy was designed, considering individual requirements for each patient. Postoperative readings were taken at 1 day, 1 week, 1, 3, 6 and 12 months. RESULTS: A total of 54 patients participated with mean age of 28.07 + 8.13 years. Out of the 54 patients, 33 (61%) were males and 21 (39%) were females. Uncorrected distance visual acuity (UDVA) and Spherical equivalent (SEQ), which is algebraic sum of sphere and half of cylinder, were recorded pre- and postoperatively. These parameters were changed significantly at 12 months (p <0.001). SEQ reduced from 2.146 + 2.027 to 0.079 ± 0.269 Diopter (D) (p <0.001). UDVA improved from 0.672 ± 0.270 (20/93) to 0.153 ± 0.182 (20/28) (p <0.001). A total of 48 (out of 54) patients had uncorrected vision better than 20/40; and 49 patients showed either same or gain of Snellen lines when pre- and postoperative corrected distance visual acuity (CDVA) was compared. Two patients showed loss of two or more lines. All the patients had postoperative SEQ within + 1.0 D range. CONCLUSION: LASIK, performed to correct hyperopia, demonstrated satisfactory outcomes in terms of safety, efficacy, stability, accuracy, and predictability. LASIK is an effective treatment option for moderate (<6 D) hyperopia. Key Words: LASIK, Refractive surgery, Hyperopia, Spherical equivalent, Uncorrected distance visual acuity.

Screening Thresholds for the Corneal Tomography in Hyperopic Pakistani Population.

OBJECTIVE: To evaluate key corneal tomography parameters for screening mixed astigmatism and hyperopic males and females for refractive surgery and to compare the data to a previously studied myopic group in Pakistani population. STUDY DESIGN: Cross-sectional, observational study. PLACE AND DURATION OF STUDY: Armed Forces Institute of Ophthalmology AFIO, National University of Medical Sciences, Rawalpindi, Pakistan, from August 2013 to August 2018. METHODOLOGY: WaveLight Allegro Oculyzer II diagnostic device was used to examine eyes of 106 adult hyperopic patients in order to determine normal values of 20 parameters, which are considered most clinically applicable for refractive surgery screening. Kolmogorov-Smirnov test was used to evaluate normality of data. Results for outliers were displayed as 2.5%, 5%, 95% and 97.5% percentiles. RESULTS: Two hundred and nine eyes were examined; 110 men and 99 women with overall mean age of 31+11.7 years. Normal mean anterior segment values included: flat simulated keratometry (K1) 42.1±1.84 diopters (D), steep K2 43.8 ± 1.93 D, K maximum 44.4 ± 1.93 D, K mean 42.9 ± 1.75 D, astigmatism -1.3 ± 1.75 D, pachymetry at thinnest point 546.9 ± 33.3 um, front elevation at thinnest point 5.2 ± 3.47 um, and at the back was 14.1 ± 6.60 um, Ambrosio relational thickness maximum 472.0 ± 88.73, progression index (PI) maximum 1.2 ± 0.18, and anterior chamber depth (ACD) 2.7 ± 0.35 mm. CONCLUSION: Hyperopic patients had greater front and back elevation and pachymetry but lesser keratometry, anterior chamber depth and chamber volume as compared to myopic patients in Pakistani population. Front and back elevation data in this hyperopic study population was slightly higher than previously published studies. Key Words: Refractive surgery, Corneal tomography, Screening, Hyperope.

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.

ASSOCIATION OF MATERNAL PERIODONTITIS WITH LOW BIRTH WEIGHT IN NEWBORNS IN A TERTIARY CARE HOSPITAL.

BACKGROUND: Low birth weight is a major public health problem in Pakistan. So there is a need for identification of its modifiable risk factors like periodontitis which will reduce its burden on the society. The objectives of the study were to find out the association between maternal periodontitis and low birth weight in new-borns of all gestational ages delivered in a tertiary care hospital of Abbottabad as well as to see the frequency of periodontitis severity in these subjects. METHODS: A hospital-based matched case-control study was conducted among 160 postpartum mothers in Gynaecology/Obstetrics- B ward Ayub Teaching Hospital, Abbottabad. The 80 cases were mothers of low birth weight babies (< 2,500 g), the 80 controls were mothers of normal weight babies (> 2,500 g) matched with maternal age and gestational age. Data was collected through the hospital records, interview and a periodontal examination. RESULTS: Periodontitis was more in the cases than in the controls (OR: 4.167, 95% CI: 2.142-8.109, p = 0.000). On multivariate logistic regression, periodontitis was found to be a significant independent risk factor for low birth weight (aOR: 3.173, 95% CI: 1.429-7.047, p = 0.005). Other significant risk factors were educational level (aOR: 3.408, 95% CI: 1.452-7.996, p = 0.005), socioeconomic status (aOR: 3.173, 95% CI: 1.366-7.368, p = 0.007), maternal nutrition (aOR: 3.071, 95% CI: 1.392-6.778, p = 0.005) and moderate/severe anaemia (aOR: 3.035, 95% CI: 1.052-8.756, p = 0.040). CONCLUSIONS: Periodontitis is found to be a strong, independent, and clinically significant risk factor for low birth weight. So periodontal therapy should form a part of the antenatal care of the pregnant women in Abbottabad.

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.

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.

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.

Type A and Type B personality among Undergraduate Medical Students: Need for psychosocial rehabilitation.

OBJECTIVES: To find out the frequency of Type A and Type B personality among the students of Undergraduate Medical College. To find association between student year and personality type. METHODS: A descriptive cross sectional study was conducted at Undergraduate Medical College, Rawalpindi from Sept. 2012 till Feb. 2013. Among 500 sample size, 100 students from each MBBS year were inducted by probability systematic sampling technique. After taking consent from the institute and students, data was collected on BECK anxiety inventory (BAI) questionnaire. According to BAI scale, students were identified as Type A or B personality. Data was analyzed using SPSS version 20. To find association between student year and personality type, Chi-square test of significance with 95% confidence level was used. RESULTS: First, second, third, fourth and final year students had 5 (1%), 6 (1.2%), 11 (2.2%), (13 (2.6%) and 19 (3.8%) type A personality respectively. Among all the study participants (n=500), total number of type A was 54 (10.8%) and type B personality students were 446 (89.2%). Type A personality was 29 (11.6%) in female students (n=250) and 25 (10%) in male students (n=250). Association between student year and personality type was significant (p=0.010) at 95% confidence level. CONCLUSION: Type A personality students existed in every class and there was a gradual increase in the number of type A personality students from 1st year to final year in an undergraduate medical college of Rawalpindi. Significant association was observed in student year and type A personality.