Parental consanguinity increases the risk of congenital malformations

Introduction: Congenital malformation is a physical or structural abnormality present either prenatally or after birth. These anomalies are either primary or secondary malformation. Primary malformations adversely affect body functions, however, the secondary malformations are the structural defects which may have less or no effect on body functions. Primary congenital anomalies show marked variations globally with respect to prevalence. The aim of the current study was to further add to the scientific evidences on the pattern and prevalence of congenital anomalies in cousins and non-cousins’ marriages in Khyber Pakhtunkhwa. Material and Methods: Data of 200 patients (divided into two groups) was collected by convenience sampling through cross-sectional survey. Group-I consisted of 100 gravidas who were diagnosed with anomalous foetus either hydrocephalous, anencephaly or cleft lip/palate and Group-II comprised of infants with inborn heart defects were selected. Results: The study shows 68% consanguineous and 32% non-consanguineous marriages. Hydrocephalous shows the highest rate of incidence (55%) followed by anencephaly (40%) cleft lip/palate (5%), Ventricular Septal Defect (43%), Atrial Septal Defect (29%), Patent Ductus Arteriosus (16%) and Tetralogy of Fallot (12%). The relative risk of hydrocephalus and anencephaly in consanguineous and non-consanguineous marriage was 0.98 while the relative risk of Ventricular Septal Defect and Patent Ductus Arteriosus was 1.1. Rate of miscarriages was comparatively high in cousin marriages. Frequency of CM was higher in multigravida compared to primigravida. Detection rate of hydrocephalus was highest in second trimester, cleft lip/palate in third trimester and anencephaly in first trimester. Conclusion: Parental consanguinity is one of the major risk factors for structural, neurological and cardiac anomalies.

Awareness of physical therapy among medical doctors in Swabi

Introduction: Physical therapists works in a number of environments including hospitals, private practitioners, outpatient clinics, health care agencies, colleges, sports and recreation centres, workplaces and nursing homes. In Pakistan, the referral of patients to the physical therapy is mainly by physicians or doctors. It is it is important for the doctors to have awareness about the role of physical therapists. Material & Methods: This was a cross sectional survey conducted from Jan 2020 to August 2020. The research was based on a self-structured questionnaire which was provided to medical doctors at a hospital in Swabi, Khyber Pakhtunkhwa. The total number of participants in this survey was 145 doctors. The sampling techniques used for this survey was convenient sampling. Inclusion criteria of the study was medical doctors holding MBBS or equivalent degree. Data collected was analysed through SPSS version 22. Results: Out of 145 participants, 112 (77.2%) were males and 33 (22.8%) were females. Questionnaire was filled by 11.7% orthopaedic specialists, 11.0% neurologists, 13.1% paediatricians, 20.7% gynaecologists and 43.4% by doctor of other specialties. From the total participants, only 98 (67.4%) were aware about the eligibility criteria of entering in the field of physiotherapy, 77.9 % were aware about the specialization in physiotherapy and 90.3% were aware about the treatment of physiotherapy. Those who agreed that physiotherapy helps in reducing pain were 132 with percentage 91.0%.120(82.8%) doctors agreed that physical therapy is crucial in community-based recovery. According to 125 doctors, early intervention through physical therapy leads to an effective rehabilitation. A total of 61(42.1%) doctors agreed that physiotherapy was an excellent field. Conclusion: It was found out that nearly 60% of the medical doctors in District Swabi were familiar with physiotherapy care and with the field of physiotherapy. A big number of these doctors (80 percent of doctors) were aware that physiotherapy helps in reducing pain, provide appropriate care and plays an important role in the community.

Translation and cultural adaptation of Shoulder Pain and Disability Index in Urdu (SPADI-U)

Introduction: Shoulder joint is the third most-frequently involved structure in musculoskeletal conditions globally. More than 30 shoulder specific questionnaires have been generated in English in order to measure shoulder related quality of life and incidence of pain. Among all these questionnaires, Shoulder Pain and Disability Index (SPADI) is one of the most useful tools, therefore it has been translated, culturally adapted and validated to many languages. This study was carried out to translate and culturally adapt SPADI into Urdu language. Material & Methods: Study was conducted over a timeframe of three months, that’s March 2019 to May 2019 in Helping Hand Institute of Rehabilitation Sciences, Mansehra. Translation and cultural adaptation of Shoulder Pain and Disability Index (SPADI) was carried out according to internationally published six-step guidelines. In accordance with the provided directions a number of changes were made to the six-step guidelines. Through consensus of the expert panel, its final version was field in and tested on forty individuals with and without shoulder pathologies in an equal proportion. Results: Changes were required during each step of Beaton’s guidelines for cross-cultural adaptation. Translators during ‘forward and backward translations’ had faced a number of obstacles. Minor differences were found during reconciliation process and expert panel review. The pilot testing highlighted, misinterpretation among target population regarding item 3, 5, 7 and 8 of disability scale due to cultural differences. These items were adjusted according to cultural relevance and conceptual equivalence to the original version. Final version was found relevant and easily understood by the patients having shoulder pathology. Conclusion: SPADI-U has good face and content validity and it can be used to measure shoulder related quality of life in Urdu speaking population.

Sedentary behaviour and physical activity levels in employees of Khyber Medical University Peshawar

Introduction: The increase in sedentary behaviour and decrease in physical activity levels are some of the contributing factors to many of the non-communicable diseases. These non-communicable diseases included obesity, type-II diabetes and cardiovascular problems. Apart from causing financial burden on health care system, these diseases have been reported to cause nearly 1.9 million premature deaths per year. The aim of the study was to measure sedentary behaviour and physical activity levels among employees of Khyber Medical University, Peshawar. Material & Methods: A cross-sectional survey was conducted on employees of Khyber Medical University, Peshawar. The total sample size was 172 and the data was collected through convenience sampling by using International Physical Activity Questionnaire (IPAQ) long form. This questionnaire measures physical activity levels and sedentary behaviour at work. Results: Out of 172 participants, 154 (89.5%) were male and 18 (10.4%) were female with a mean age of 34.4 ± 2 years. According to the levels of physical activity, 49 (28.5%) were less active, 63 (36.6%) were moderately active and 60 (34.9%) were highly active. The average time spent by the participants for sitting was (8.93 ± 2.35) hours per day. A total of 73.8%, 23.3 % and 2.9% participants could be categorised as having high, moderate and low sedentary behaviour, respectively. Conclusion: Majority of the participants (two-thirds of the participants) demonstrated a high sedentary behaviour and therefore, needed modification in their daily routine.

Comparison of Mckenzie approach versus Lumbar Stabilization Exercises in the treatment of chronic low back pain

Introduction: Lumbar stabilization and McKenzie exercises are becoming a popular trend for managing chronic low back pain though it is currently not known whether lumbar stabilization exercises produce better results in improving functional status compared to McKenzie approach. The purpose of this study was to determine the effectiveness of the McKenzie approach versus lumbar stabilization in the treatment of chronic low back pain. Material & Methods: This was a randomized controlled trial. Lottery method was used to randomly divide individuals who fulfilled inclusion criteria into 2 groups. Assessments of the patients were done in OPD. Baseline assessment was done on day 1 and post intervention assessment was done after 2 weeks. A total of 8 treatment sessions spread across 2 weeks were given (4 days per week). Data were assessed at baseline level and post intervention. Data was entered and analysed by SPSS version 21. Results: A total of 28 females and 02 males (mean age of 50.88 ±12.29) participated in the study. After 02 weeks of intervention, both treatment groups showed improvement in decreasing pain and improving functional status. The lumber stabilization group showed significant gains on Numeric Pain Rating Scale and (p=0.001) and Modified Oswestry Disability Index (p=0.001) compared to the Mckenzie group. Conclusion: Patients in both lumber stabilisation and McKenzie groups showed significant improvement, however, the patients in lumbar stabilization group were superior than the patients in McKenzie group on the selected outcomes.

Effects of psychological intervention on rehabilitation outcomes in patients with spinal cord injury; a systematic review

Introduction: Psychological issues are common in patients with spinal cord injury (SCI) which negatively affects rehabilitation outcomes. Therefore, early psychological interventions are as important as physical rehabilitation. The aim of the study was to systematically review literature regarding the effects of psychological interventions on rehabilitation outcomes in patients with SCI. Material & Methods: A systematic review was conducted according to the PRISMA guidelines. Literature was searched in PubMed and PEDro databases. Articles published in English language from earliest record to August 2020 were searched. Observational and interventional studies which assessed effects of different psychological interventions on rehabilitation outcomes in patients with SCI were included. Review articles, editorials, short communications and conference papers were excluded. Quality assessment of the interventional studies was assessed using PEDro scale while methodological quality of the observational studies was carried out using NIH quality assessment tools. Results: On the basis of eligibility criteria, 13 studies were included. Out of the total studies, 11 were observational studies and the remaining 2 were interventional studies. The included studies reported that psychological interventions improve rehabilitation outcomes such as functional independence, community participation and quality of life. Conclusion: Psychological treatment is an effective complement to physical rehabilitation interventions to improve functional status of patients with SCI.

Effects of mental imagery on lower limb function in sub-acute stage of stroke patients; a randomized controlled trial

Introduction: Stroke is the most common type of cerebrovascular injury caused by sudden decrease in blood supply that can lead to weaknesses and other associated problems. Many treatment options are available for stroke with promising results. This trial was designed to explore the role of mental imagery (visual) in the sub-acute stage, considering the stroke patient, especially in evaluating its effects on the lower extremities. Material & Methods: An experimental randomized controlled trial was performed from July to August 2018 in physiotherapy departments of National Hospital and Aadil Hospital Defence Lahore. A total of 80 patients having sub-acute stroke with strong perceptions having a score of 25 or more in the Mini Mental Score Exam and a 3 +/5 manual muscle testing grade system in the lower extremity were taken using non-probability consecutive sampling procedure. All the patients were divided into 2 groups randomly. Conservative treatment including strengthening and balance training were given to one group and conservative treatment with addition of visual imagery to the second group. Independent t-test was used to assess significant differences between the two groups. Results: Comparison of Berg Balance Scale at pre-intervention between the experimental group and the controlled group was not significant, 13.76 ± 2.85 vs 13.84 ± 3.26 (p=0.927), respectively. After intervention the effects of treatment were significant in both groups, 18.64 ± 2.33 vs 17.80 ± 2.94(p=0.007), respectively. Comparison of Time Up and Go test at pre-intervention between groups was not significant, 6.28 ± 1.86 vs 6.68 ± 0.99(p=0.347), respectively. The intervention effects after treatment in both groups were significant, 1.84 ± 1.28 vs 3.56 ± 1.26 (p=0.001), respectively. Conclusion: It is concluded that mental imagery along with conservative treatment plays a vital role in construction of neural circuit in sub-acute stroke patients.

Effects of COVID-19 pandemic on mental health

The COVID-19 pandemic and its resulting economic and social consequences have significantly affected the mental health of the individuals.1Nevertheless, related literature on the effects of COVID-19 pandemic on mental health is scarce.2 Moreover, COVID-19 pandemic has profound effects on public mental health and their routine activities. Anxiety, sleep disturbance and overall lower perceived state of health are among some of the adverse effects.3 It has been reported that health organizations across the globe are working in coordination to cope with the mental health issues associated with the COVID-19 pandemic.4 The mental state of individuals vary based on their health, profession and status.5 Most importantly, mental health issues are common in quarantined and self-isolated individuals. It might be due to loneliness, fear of death and separation from their family members.6 Similarly, children, who have less interaction with their school friends on daily basis, may suffer from psychological problems. Additionally, separation from parents and friends can cause grief in children. They may encounter distress, anxiety, and loneliness; all of which affects their psychological health.7 Elderly people are highly susceptible to the COVID-19 outbreak as they are already prone to autoimmune, neurovascular, cardiovascular and psychological disorders. Social isolation among the elderly may cause irritating and shouting behaviour and emotional anger.8 Health care professionals are at the forefront of the battle to tackle the COVID-19. Therefore, fear of getting infection, extended work shifts, dealing with COVID-19 patients, inaccessibility to COVID-19 medicine, deaths of their colleagues at line of work, exposure to COVID-19, self-isolation, and keeping distance from friends and family can adversely affect their mental health.2 In general, individuals who recover from COVID-19 disease may face social stigma and get emotional disturbance. Each of us have a different attitude towards people who recovered from COVID-19. Health care workers who try to save people’s lives and limit the spread of COVID-19 can also face stigmatization for potentially being carriers of the COVID-19.2 The COVID-19 is a world problem, so concrete efforts are needed to address this pandemic at a global level. In the case of Pakistan, it is the responsibility of the Pakistani government to implement effective strategies to fight the Covid-19, as per the guidelines set by the World Health Organization (WHO).

Physical activity levels and suggestions for its promotion among university students

Introduction: Physical activity not only has positive effects on health, but is also linked to various aspects of life. Physical activity is considered one of the main components that contribute to a healthy lifestyle and general improvement in health including physical strength, muscle endurance and flexibility. A variety of evidences show that regular physical activity is beneficial to health and strong scientific research exists that reported decreased mortality rate with an optimal level of physical activity. This study was designed to evaluate the physical activity status of university students and their suggestions to promote physical activity. Material & Methods: From January to October 2019, a cross-sectional study was conducted among 2,916 university students, studying at different universities in Faisalabad. The aim was to measure the levels of physical activity according to the pre-defined inclusion/exclusion criteria. Participants were enrolled in the study using convenient sampling. The questionnaire used in this study consisted of three sections, with the first part recording the demographics of the participants, the second part an International Physical Activity Questionnaire and the third part containing several suggestions for promoting physical activity. Logistic regression analysis was used for factors influencing physical activity behaviour. Confidence interval (CI=95%) and odds ratio (OR) were calculated and P-value <0.05 was considered significant. Results: The findings of our study revealed that 2469 (84.6%) of the students out of 2916 were physically active. Of 2916, 1541 (52.8%) participants were moderately active, while 928 (31.8%) participants were highly active. Overall 92.20% male were physically active compared to females 81.70%. Moreover, our study found that the most preferred suggestion for the promotion of physical activity proposed by the students (n=1011, 34.7%) was a provision of physical and social environments that encourage and allow safe and pleasurable physical activity. The least preferred suggestion by the students (n=735, 25.2%) was the addition of at least thirty minutes of exercise as part of the curriculum. Conclusion: This study found that the physical activity profile of most students was between moderate and high. The top-ranked suggestion for the promotion of physical activity among the students was a provision of physical and social environments that encourage and allow safe and pleasurable physical activity.

Effects of Low Molecular Weight and Unfractionated Heparin on Lipoprotein Lipase and Lipid Profile in haemodialysis patients

Introduction: In haemodialysis patients, mortality from cardiovascular disease is much greater than in the general population. The current study aimed to evaluate the effects of two different types of heparin, low molecular weight heparins (LMWH) and high molecular weight heparin (HMWH), on lipid profile in patients undergoing haemodialysis.Material & Methods: A total of 60 patients on haemodialysis were selected from two main hospitals of Lahore, Pakistan and were divided into two major groups based on the type of heparin used. A 5 ml blood sample was taken from the dialysis machine to get the serum and was kept frozen at -20ºC for analysis of total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein. Comparison of lipoprotein lipase activity between groups were evaluated by using the student t-test. A P-value of ? 0.05 was considered statistically significant.Results: Gender wise distribution of study population (n=60) was 67% (n=40) males and 33% (n=20) females. The age distribution of individuals varied from 39-43 years. Moreover, use of HMWH was high in males (73%) as compared to female (27%) with an average age of 39 ± 12 years where duration of haemodialysis was 4.44 ± 2.83. A significant difference in LPL activity related to different times in all patients was observed. A clearer difference observed in case of LDL where LPL activity was markedly different in both groups. Our data showed that individuals using LMWH had less chances of dyslipidaemia as compared to those using HMWH.Conclusion: LMWH is a useful and safe anticoagulant during haemodialysis as compared to HMWH.