Publications by authors named "Nuruddin Mohammed"

20 Publications

  • Page 1 of 1

Influence of intrauterine growth status on aortic intima-media thickness and aortic diameter in near-term fetuses: a comparative cross-sectional study.

J Dev Orig Health Dis 2021 Jun 15:1-8. Epub 2021 Jun 15.

Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Aga Khan University, Pakistan.

Intrauterine undernutrition may lead to fetal vascular programming. We compared abdominal aortic intima-media thickness (aIMT) and aortic diameter (aD) between appropriate for gestational age (AGA) and growth-restricted fetuses (GRF). We recruited 136 singleton fetuses at 34-37 weeks of gestation from Fetal Medicine Unit of Aga Khan University Hospital, Karachi (January-November 2017). Subjects were classified as AGA (n = 102) and GRF (n = 34) using INTER-GROWTH 21st growth reference and standard ultrasound protocol. Their far- and near-wall aIMT and aD were compared after adjustment of maternal age, first-trimester body mass index, fetal gender, hypertension and hyperglycemia in pregnancy. As the severity of growth restriction increased in GRF, aIMT and aD showed an increasing and a decreasing trend, respectively. Both far- and near-wall aIMT in GRF [(adj. β = 0.082, 95% confidence interval [CI] 0.042-0.123) and (adj. β = 0.049, 95% CI 0.010-0.089)] were significantly greater with reference to AGA fetuses. GRF subgroup analysis into small for gestational age (SGA) fetuses and intrauterine growth restricted (IUGR) revealed highly significant difference between AGA and IUGR for far (0.142 mm, P-value < 0.001) and near-wall aIMT (0.115 mm, P-value < 0.001) and marginally significant aD difference (0.51 mm, P-value 0.05). These findings suggest that the extent of fetal aortic remodelling is influenced by the severity of growth restriction. Hence, the targeted interventions for the cardiovascular health promotion of IUGR and SGA born neonates are desirable during early childhood, particularly in set ups with high prevalence of low birth weight babies.
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http://dx.doi.org/10.1017/S2040174421000295DOI Listing
June 2021

The Impact of Maternal Preeclampsia and Hyperglycemia on the Cardiovascular Health of the Offspring: A Systematic Review and Meta-Analysis.

Am J Perinatol 2021 May 3. Epub 2021 May 3.

Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan.

Objectives:  The objective of this review was to assess the impact of maternal preeclampsia or hyperglycemia on the body composition and cardiovascular health in the offspring.

Study Design:  We conducted a systematic review utilizing PubMed, EBSCO, CINAHLPlus, Cochrane Library, and Web of Science to include all studies assessing the impact of preeclampsia/eclampsia and/or gestational/pregestational diabetes mellitus on the health of the offspring (children <10 years of age). The health measures included anthropometry, cardiac dimensions and function, and vascular function. We performed a meta-analysis using Review Manager software and computed net risk ratio (RR) with 95% confidence interval (CI) for dichotomous data and mean difference (MD) with 95% CI for continuous data.

Results:  There were 6,376 studies in total, of which 45 were included in the review and 40 in the meta-analysis. The results demonstrated higher birth weight (MD: 0.12 kg; 95% CI: 0.06-0.18) and systolic and diastolic blood pressure (BP; MD: 5.98 mmHg; 95% CI: 5.64-6.32 and MD: 3.27 mmHg; 95% CI: 0.65-5.89, respectively) in the offspring of mothers with gestational diabetes compared to controls. In contrast, the offspring of mothers with preeclampsia had lower birth weight (MD: -0.41 kg; 95% CI: -0.7 to -0.11); however, they had increased systolic (MD: 2.2 mmHg; 95% CI: 1.28-3.12) and diastolic BP (MD: 1.41 mmHg; 95% CI: 0.3-2.52) compared to controls. There is lack of data to conduct a meta-analysis of cardiac morphology, functional, and vascular imaging parameters.

Conclusion:  These findings suggest that the in-utero milieu can have a permanent impact on the body composition and vascular health of the offspring. Future work warrants multicenter prospective studies to understand the mechanism and the actual effect of exposure to maternal hyperglycemia and high BP on the cardiovascular health of the offspring and long-term outcomes.

Key Points: · Adverse in-utero exposures may have an impact on cardiovascular risk in children.. · Maternal hyperglycemia/preeclampsia lead to changes in birthweight and BP.. · Limited echocardiographic and vascular imaging data in these cohorts necessitates future work..
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http://dx.doi.org/10.1055/s-0041-1728823DOI Listing
May 2021

Association of chemerin gene promoter methylation in maternal blood and breast milk during gestational diabetes.

J Dev Orig Health Dis 2021 Mar 30:1-7. Epub 2021 Mar 30.

Department of Family Medicine, Aga Khan University, Karachi, 74800, Pakistan.

The intrauterine environment and early-life nutrition are regulated by maternal biomarkers in the blood and breast milk. We aimed to explore epigenetic modifications that may contribute to differential chemerin expression in maternal plasma, colostrum, and breast milk and find its association with fetal cord blood and infant weight at 6 weeks postpartum. Thirty-three gestational diabetes mellitus (GDM) mothers and 33 normoglycemic mothers (NGT) were recruited. Two maternal blood samples (28th week of gestation and 6 weeks postpartum), cord blood, colostrum, and mature milk were collected. Methylation-specific polymerase chain reaction and enzyme-linked immunosorbent assay were conducted. The weight of the babies was measured at birth and 6 weeks postpartum. Serum chemerin levels at the 28th gestational week and 6 weeks postpartum were significantly lower for the NGT group as compared to the GDM group; (P < 0.05). Higher colostrum chemerin concentrations were observed in the GDM group and remained elevated in mature milk as compared to NGT (P < 0.05). Colostrum and breast milk chemerin levels showed an independent association with infant weight at 6 weeks postpartum (r = 0.270; P = 0.034) (r = 0.464; P < 0.001). Forty percent GDM mothers expressed unmethylated chemerin reflecting increased chemerin concentration in the maternal blood. This pattern was also observed in newborn cord blood where 52% of samples showed unmethylated chemerin in contrast to none in babies born to normoglycemic mothers. The results of this study highlight the critical importance of altered chemerin regulation in gestational diabetic mothers and its effect during early life period and suggest a possible role in contributing to childhood obesity.
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http://dx.doi.org/10.1017/S2040174421000118DOI Listing
March 2021

Pregnancy outcomes amongst adolescents/young adults at tertiary-care hospital in a low-middle-income country: Ten-year retrospective record review.

J Pak Med Assoc 2020 Dec;70(12(A)):2147-2153

4th Year Medical Student, Aga Khan University, Karachi, Pakistan.

Objective: Adolescent pregnancies are known to be associated with adverse outcomes. Our objective was to compare pregnancy outcomes amongst adolescents (young adolescents YA: 15-17 years; older adolescents OA: 18- 19 years) and young adults (20 to 25 years).

Methods: Study was conducted at the Aga Khan University Hospital, Karachi. Ten-year retrospective record review was done through convenience sampling. Data was collected on predesigned proforma. Participants were 396 primiparous adolescents (15-19 years) with singleton low-risk pregnancy. Reference-group included 410 primiparous, low-risk, young adults. Pregnancies complicated with preexisting diabetes mellitus, chronic hypertension, renal disorders or cardiac diseases were excluded. Maternal /neonatal outcomes were compared amongst groups.

Results: Out of 806 charts reviewed, 75 (9.3%) were YA, 321 (39.8%) were OA and 410 (50.9%) were 20-25 years old young adults. Most of the un-booked cases were in young adolescents; 17 (22.7% YA), 41 (12.8% OA) and 33 (8.0% reference -group) (p-value 0.001). This group also booked at a later gestational age; YA (19.6±10.4 weeks), OA (17.2±9.3 weeks) and controls (15.5n±8.8 weeks) (p-value 0.002). Gestational age at delivery was not significantly different among the groups. Adolescents had a decreased likelihood of Caesarian section with youngest group having 29% less chance of Caesarian delivery (OR 95% CI 0.41, 0.2) compared to women of 20-25 years of age. Difference in maternal/neonatal outcomes remained insignificant between groups at univariate and multivariate analysis.

Conclusions: Maternal/neonatal outcomes in adolescents were comparable to young adults. Good antenatal care, evidence-based protocols and strong family backing may reduce risks to mothers/babies in adolescent pregnancies.
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http://dx.doi.org/10.47391/JPMA.1181DOI Listing
December 2020

Cardiovascular Dysfunction in Children Exposed to Preeclampsia During Fetal Life.

J Am Soc Echocardiogr 2021 06 13;34(6):653-661. Epub 2021 Jan 13.

Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan. Electronic address:

Background: Keeping in view the developmental origin of health and disease hypothesis, the aim of this study was to assess differences in cardiac and vascular structure and function in children exposed to preeclampsia in utero compared with those of normotensive mothers. The hypothesis under investigation was that children exposed to preeclampsia would have altered cardiac and vascular structure and function compared with the unexposed group.

Methods: This was a retrospective cohort study that included children 2 to 10 years of age born to mothers with and without exposure to preeclampsia in utero (n = 80 in each group). Myocardial morphology and function using echocardiography and carotid intima-media thickness and pulse-wave velocity were determined. Multivariate linear regression was used to compare preeclampsia-exposed and nonexposed groups. Subgroup analysis to assess differences between early- and late-onset preeclampsia was also performed.

Results: Forty-one percent of mothers (n = 33) had early-onset preeclampsia. Children in the exposed group had a significantly higher prevalence of stage 1 systolic and diastolic hypertension (22% [n = 18] and 35% [n = 18], respectively) compared with the unexposed group (9% [n = 7] and 19% [n = 15], respectively; P = .01). Children in the exposed group also had higher pulse-wave velocity compared with those in the unexposed group (0.42 ± 0.1 vs 0.39 ± 0.1, P = .03). Subgroup analysis revealed that changes in blood pressure and pulse-wave velocity were determined primarily by early-onset preeclampsia. There was no significant difference in cardiac morphology or systolic and diastolic function between the exposed and unexposed groups.

Conclusion: In utero exposure to preeclampsia has an effect on vascular function in children aged 2 to 10 years, related primarily to early-onset disease. Routine blood pressure screening should be recommended for such children.
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http://dx.doi.org/10.1016/j.echo.2021.01.008DOI Listing
June 2021

Seeing the fetus from a DOHaD perspective: discussion paper from the advanced imaging techniques of DOHaD applications workshop held at the 2019 DOHaD World Congress.

J Dev Orig Health Dis 2021 04 21;12(2):153-167. Epub 2020 Sep 21.

Singapore Bioimaging Consortium, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore.

Advanced imaging techniques are enhancing research capacity focussed on the developmental origins of adult health and disease (DOHaD) hypothesis, and consequently increasing awareness of future health risks across various subareas of DOHaD research themes. Understanding how these advanced imaging techniques in animal models and human population studies can be both additively and synergistically used alongside traditional techniques in DOHaD-focussed laboratories is therefore of great interest. Global experts in advanced imaging techniques congregated at the advanced imaging workshop at the 2019 DOHaD World Congress in Melbourne, Australia. This review summarizes the presentations of new imaging modalities and novel applications to DOHaD research and discussions had by DOHaD researchers that are currently utilizing advanced imaging techniques including MRI, hyperpolarized MRI, ultrasound, and synchrotron-based techniques to aid their DOHaD research focus.
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http://dx.doi.org/10.1017/S2040174420000884DOI Listing
April 2021

Follicular Sensitivity Index: A Tool To Predict Successful Conception After Intra-cytoplasmic Sperm Injection.

J Coll Physicians Surg Pak 2020 Apr;30(4):443-445

Department of Obstetrics and Gynaecology, The Aga Khan University, Karachi, Pakistan.

Follicular sensitivity index (FSI) is used for estimation of follicular responsiveness to controlled ovarian hyperstimulation (COH) during intra-cytoplasmic sperm injection (ICSI). In a retrospective study, FSI of 1,385 females was calculated as [pre-ovulatory follicle count (PFC) × 100,000]/ [antral follicle count (AFC) × total received stimulation doses]. Females were then categorised into low, middle and high FSI groups according to FSI tertile values. FSI was 8.65 ±2.82 in non-pregnant as compared to 12.02 ±2.04 (p <0.01) in pregnant cohort. FSI turned out to be a strong predictor of successful conception on the receiver operating curve with cutoff value 10.36 at 76% specificity, sensitivity of 86% and area under the curve (AUC; 0.83). Calculation of FSI can thus predict the chances of successful conception in females with different causes of infertility. Key Words: Follicular sensitivity index, Infertility, Intra-cytoplasmic sperm injection, Ovarian response, Follicular output rate.
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http://dx.doi.org/10.29271/jcpsp.2020.04.443DOI Listing
April 2020

Time to adopt Developmental Origins of Health and Disease (DOHaD) science in Pakistan.

J Pak Med Assoc 2019 11;69(11):1581-1583

Maternal and Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan.

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November 2019

Isolation and culture of dental pulp stem cells from permanent and deciduous teeth.

Pak J Med Sci 2019 Jul-Aug;35(4):997-1002

Dr. Tashfeen Ahmad, FCPS, Ph.D., Departments of Surgery and Biological & Biomedical Sciences, Aga Khan University, Karachi, Pakistan.

Objective: To isolate dental pulp mesenchymal stem cells (MSCs) from non-infected human permanent and deciduous teeth.

Methods: It was an in-vitro experimental study. Human teeth were collected from 13 apparently healthy subjects including nine adults and four children. After decoronation dental pulps were extirpated from teeth and cultured via explant method in a stem cell defined media. Data was analyzed by descriptive statistics.

Results: As above MSCs emerged exhibiting fibroblast-like morphology. In vitro culture was positive for 100% (9/9) and 75% (3/4) of the permanent and deciduous teeth respectively. First cell appeared from deciduous teeth pulp in 10±6.2 days while permanent teeth pulp took 12.4±3.7 days. Together, 26.6±3.6 and 24.5±3.5 days were required for permanent and deciduous tooth pulp stem cells to be ready for further assays.

Conclusions: The protocol we developed is easy and consistent and can be used to generate reliable source of MScs for engineering of calcified and non-calcified tissue for regenerative medicine approaches.
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http://dx.doi.org/10.12669/pjms.35.4.540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659089PMC
August 2019

Is the child at risk? Cardiovascular remodelling in children born to diabetic mothers.

Cardiol Young 2019 Apr 3;29(4):467-474. Epub 2019 Apr 3.

Department of Paediatrics and Child Health,The Aga Khan University,Karachi, Pakistan.

Objective: The objective of this study was to assess differences in myocardial systolic and diastolic function and vascular function in children 2-5 years of age born to diabetic as compared to non-diabetic mothers.

Methods: This study was a retrospective cohort conducted in 2016 at The Aga Khan University Hospital, Karachi, Pakistan. It included children between 2 and 5 years of age born to mothers with and without exposure to diabetes in utero (n = 68 in each group) and who were appropriate for gestational age. Myocardial morphology and function using echocardiogram and carotid intima media thickness (cIMT) and pulse wave velocity was performed to evaluate cardiac function as well as macrovascular remodelling in these children. Multiple linear regression was used to compare the groups.

Results: There was no significant difference in cardiac morphology, myocardial systolic and diastolic function, and macrovascular assessment between the exposed and unexposed groups of AGA children. Subgroup analysis demonstrated a significantly decreased mitral E/A ratio in children whose mothers were on medications as compared to those on dietary control (median [IQR] = 1.7 [1.6-1.9] and 1.56 [1.4-1.7], respectively, p = 0.02), and a higher cIMT in children whose mothers were on medication as compared to controls (0.48 [0.44-0.52] and 0.46 [0.44-0.50], respectively, p = 0.03).

Conclusion: In utero exposure to uncontrolled maternal diabetes has an effect on the cardiovascular structure and function in children aged 2-5 years. However, future work requires long-term follow-up from fetal to adult life to assess these changes over the life course.
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http://dx.doi.org/10.1017/S1047951119000040DOI Listing
April 2019

Impact of pre-eclampsia on the cardiovascular health of the offspring: a cohort study protocol.

BMJ Open 2018 09 26;8(9):e024331. Epub 2018 Sep 26.

Cardiology Care for Children, Philadelphia, Pennsylvania, USA.

Introduction: Pre-eclampsia is a common disorder associated with serious maternal and fetal complications. It is associated with abnormal placentation, which significantly reduces flow, resulting in a relative hypoxic state. These pathophysiological changes lead to subtle macrovascular and cardiac structural and functional changes in the fetus. This can predispose the child with maternal history of pre-eclampsia to risk of premature cardiovascular disease.

Methods And Analysis: The children will be identified from a cohort of women with pre-eclampsia. The study will be conducted at The Aga Khan University Hospital, Karachi. Inclusion criteria will be children who are between 2 and 5 years of age and have a maternal history of pre-eclampsia. The child's current weight, height and blood pressure will be recorded. A two-dimensional functional echocardiogram and vascular assessment will be performed to evaluate alterations in cardiac function as well as macrovascular remodelling in these children. Data will be presented as mean±SD, median (IQR) or percentages as appropriate. Independent t-test or Mann-Whitney U test will be used for testing of continuous variables (based on the assumption of normality). A p<0.05 will be used to determine statistical significance.

Ethics And Dissemination: Ethical approval has been obtained from AKUH Ethics Review Committee. Findings will be disseminated through scientific publications and project summaries for the participants.
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http://dx.doi.org/10.1136/bmjopen-2018-024331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169754PMC
September 2018

Online versus offline spatiotemporal image correlation (STIC) M-mode for the evaluation of cardiac longitudinal annular displacement in fetal growth restriction.

J Matern Fetal Neonatal Med 2018 Jul 31;31(14):1845-1850. Epub 2017 May 31.

a BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu) , Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona , Barcelona , Spain.

Purpose: Our first aim was to compare online M-mode with offline spatiotemporal image correlation (STIC) M-mode for assessing longitudinal annular displacement (LAD) in growth-restricted fetuses (FGR). Our second aim was to compare LAD measures of FGR cases with controls.

Materials And Methods: Prospective study including 40 FGR cases (defined estimated fetal weight and birth weight <10th centile) and 72 normally grown fetuses matched to cases by gestational age at scan. LAD was measured with online M-mode and offline STIC M-mode at the left and right ventricular free walls and septum in all fetuses.

Results: FGR cases had a significant decrease in LAD by STIC in all sites as compared to controls (e.g. right LAD in FGR mean 6.7 mm (SD 1.2) versus controls 7.2 mm (1.2), p = .033). There was a non-significant trend for lower values in FGR when using online M-mode (e.g. right LAD in FGR 6.9 mm (1.5) versus controls 7.4 mm (1.5), p = .084).

Conclusions: STIC M-mode seems a better method than online M-mode for detecting subtle changes in myocardial motion. STIC presents more precise results and allows an ideal placement of the M-mode arrow. These results confirm previous data suggesting decreased longitudinal motion in FGR.
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http://dx.doi.org/10.1080/14767058.2017.1330408DOI Listing
July 2018

Transcervical chorionic villus sampling: a practical guide.

J Matern Fetal Neonatal Med 2016 11;29(8):1244-51. Epub 2015 Jun 11.

a Prenatal Diagnosis Unit, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic, University of Barcelona , Barcelona , Catalonia , Spain.

First trimester screening for fetal aneuploidies has made the implementation of diagnostic techniques essential. Chorionic villus sampling (CVS) is the method of choice for obtaining chorionic villi for molecular and cytogenetic analysis in the first trimester. Two techniques have been developed, a transcervical and a transabdominal. The selection criteria have been based historically on factors, such as placental location, parity, maternal weight and preference of the operator. In our institution, we developed an elevated level of expertise in the field of transcervical approach, resulting in good quality of samples and comparable fetal loss rate to other approaches. Despite three decades of transcervical CVS performance, little consensus in terms of its technique and clinical guidelines exists. Considering the expertise and the volume of procedures performed at our center, we suggest a practical clinical guideline for transcervical CVS.
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http://dx.doi.org/10.3109/14767058.2015.1043261DOI Listing
October 2016

Evolution of foetal echocardiography as a screening tool for prenatal diagnosis of congenital heart disease.

J Pak Med Assoc 2011 Sep;61(9):904-9

Maternal and Foetal Medicine Unit, Department of Obstetrics & Gynaecology, Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan.

Congenital cardiac anomalies are the most common anomalies, with an estimated incidence of about 4-13 per 1000 live births. Proper perinatal and neonatal management is dependent upon accurate prenatal diagnosis. Approximately 10% of foetuses with cardiac abnormalities have identified risk factors; hence, most of the anomalies occur in pregnancies without prenatal risk factors. Foetal echocardiography allows for prenatal diagnosis of congenital heart disease and serves as a routine screening tool for congenital heart defects. Advanced technology, has not only allowed more accurate and early detection of cardiac abnormalities but has also improved the care and outcome of selected foetuses with severe cardiac malformations or arrhythmias. It can also identify patients for in-utero cardiac interventions. Prenatal diagnosis of congenital heart disease has allowed for better counseling and preparation of families regarding the expected prenatal development of the foetus as well as the anticipated postnatal management strategy and prognosis.
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September 2011

Foetus as a patient: art and science of foetal medicine.

J Pak Med Assoc 2010 Jun;60(6):417-8

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June 2010

Non-invasive prenatal determination of fetal RhD genotyping from maternal plasma: a preliminary study in Pakistan.

J Coll Physicians Surg Pak 2010 Apr;20(4):246-9

Department of Obstetrics and Gynaecology, The Aga Khan University Hospital, Karachi.

Objective: To determine the accuracy of the non-invasive pre-natal real-time polymerase chain reaction based fetal RhD genotyping from maternal plasma.

Study Design: Cross-sectional study.

Place And Duration Of Study: Juma Health Sciences Research Laboratory, The Aga Khan University Hospital, Karachi, from July to December 2008.

Methodology: Cell-free plasma DNA from 21 D-negative women with D-positive spouse between 20-39 weeks of gestation was tested for the presence of exon 5 region of RhD gene using real-time polymerase chain reaction. b-globin was employed as the house-keeping gene. Sensitivity and specificity of the real-time PCR-based non-invasive fetal RhD genotyping was obtained by calculating proportion of the D-positive fetuses that were D-positive at birth as well.

Results: Of the 21 D-negative women 13 and 8 neonates were determined to be D-positive and D-negative, respectively, by serologic studies on cord blood samples at birth. RhD status was correctly determined in 17 of 21 cases. There were three false-positive and one false-negative results. The sensitivity and specificity of the assay was 92.3% (95% CI: 62.1, 99.6) and 62.5% (95% CI: 25.9, 89.8), respectively. The positive and negative predictive value of the assay was 80% (95% CI: 51.4, 94.7) and 83.3% (36.5, 99.1), respectively.

Conclusion: These preliminary results demonstrate the feasibility of non-invasive pre-natal diagnosis of fetal RhD status of D-negative mothers in Pakistan.
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http://dx.doi.org/04.2010/JCPSP.246249DOI Listing
April 2010

Prospects of non-invasive prenatal diagnosis of beta-thalassaemia in Pakistan.

J Pak Med Assoc 2007 Feb;57(2):111

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February 2007

Three-dimensional transvaginal sonographic diagnosis of asymptomatic interstitial pregnancy at 6 weeks of gestation.

Acta Obstet Gynecol Scand 2004 Apr;83(4):408-10

Department of Obstetrics and Gynecology, National University of Singapore, Singapore.

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http://dx.doi.org/10.1111/j.0001-6349.2004.00025c.xDOI Listing
April 2004

Uterine fibroid: clinical presentation and relative morbidity of abdominal myomectomy and total abdominal hysterectomy, in a teaching hospital of Karachi, Pakistan.

Singapore Med J 2002 Jun;43(6):289-95

Department of Obstetrics and Gynaecology, The Aga Khan University, Karachi, Pakistan.

Objective: To compare clinical presentation and morbidity of abdominal myomectomy and hysterectomy.

Methods: We reviewed medical records of 441 patients with symptomatic fibroid, treated by myomectomy (135) or hysterectomy (306) at The Aga Khan University Hospital, Karachi, from January 1991 to December 1995. Z-test and risk estimates with 95% confidence intervals were calculated.

Results: Pregnancy loss [Risk Ratio = 2.79, 95% Confidence Interval = 1.90-4.10], pelvic mass [Risk Ratio = 2.22, 95% Confidence Interval = 1.68-2.92] and infertility [Risk Ratio = 1.44, 95% Confidence Interval = 1.05-1.96] were more likely to be managed by myomectomy than in the absence of these complaints. Abnormal uterine bleeding was less likely to be treated by myomectomy than in its absence [Risk Ratio = 0.54, 95% Confidence Interval = 0.41-0.71]. With myomectomy, both the estimated mean intra-operative blood loss and the risk of febrile morbidity were significantly less than with hysterectomy [Mean (S.D.): 386 milliliters (48) versus 567 milliliters (62), p-value 0.000 and Risk Ratio = 0.37, 95% Confidence Interval = 0.16-0.87, respectively]. The risk of visceral injury [Risk Ratio = 2.24, 95% Confidence Interval = 0.74-6.82], blood transfusion [Risk Ratio = 0.69, 95% Confidence Interval = 0.44-1.07], mean duration of operating time [Mean (S.D.) 127 minutes (35) versus 131 minutes (47), p-value 0.93] and mean duration of hospital stay [Mean (S.D.): 5.44 days (1.28) versus 5.42 days (1.09), p-value 0.92] did not differ significantly between the groups.

Conclusion: Myomectomy can be considered as a safe alternative to hysterectomy for the surgical management of uterine fibroids, with an added advantage of preservation of women's sexual and reproductive functions.
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June 2002
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