Publications by authors named "Rozina Nuruddin"

9 Publications

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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

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

Using mobile phones to improve young people's sexual and reproductive health in low- and middle-income countries: a systematic review protocol to identify barriers, facilitators and reported interventions.

Syst Rev 2019 05 18;8(1):117. Epub 2019 May 18.

Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.

Background: Due to a growing reliance on mobile phone technology and decreasing mobile phone costs, the use of mobile phones is on the rise, especially among the youth population. Young people are responsive and enthusiastic to use novel approaches such as mHealth to access sexual and reproductive health information and services. Globally, reproductive health programs have used mHealth to provide sexual and reproductive health education and services to young people, through diverse communication channels. However, few attempts have been made to systematically review the mHealth programs for young people sexual and reproductive health (SRH) in low- and middle-income countries (LMICs). In addition, very little is known regarding the potential barriers and facilitators to the uptake of mobile phone interventions for improving young people SRH. This review aims to highlight facilitators and inhibitors to implementing and increasing uptake of mHealth interventions for young people's SRH, in LMICs specifically. Additionally, the review will identify the range of mHealth solutions which can be used for improving young people's SRH in LMICs.

Methods: The review will focus on comparing the various types of mHealth interventions/strategies that are used to improve young people's SRH services in LMICs. PubMed, CINAHL Plus, Science Direct, Cochrane, and gray literature will be explored using a detailed search strategy. The studies involving young people (adolescents and youth) aged 10-24 years to which mHealth interventions were delivered for improving their SRH outcomes will be included in this review. LMICs will be selected according to the World Bank's (WB) 2018 Country Classification list. Studies published between January 2005 and March 2018 will be included as the field of mHealth has emerged over the last decade. English language articles will be included as the authors are proficient in this language.

Discussion: The systematic review will assist researchers and SRH professionals in understanding facilitators and barriers to implementing and increasing the uptake of mHealth interventions for SRH in LMICs. Finally, this review will provide more detailed information about embracing the use of mobile phones at different levels of the healthcare system for improving young people's SRH outcomes.

Systematic Review Registration: PROSPERO CRD42018087585.
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http://dx.doi.org/10.1186/s13643-019-1033-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525977PMC
May 2019

Predicting the bracket bond failure rate in orthodontic patients: A retrospective cohort study.

Int Orthod 2019 06 12;17(2):208-215. Epub 2019 Apr 12.

University of Seattle, WA, USA.

The aim of this study was to determine the risk factors associated with orthodontic bracket bond failure and to develop a prediction equation for orthodontic bracket bond failure rate using the risk factors. This was a retrospective cohort study conducted on a sample of 690 brackets in orthodontic patients aged 10 to 28 years old (mean age 17.97±5.11 years old) visiting a dental hospital. The effect of various parameters of orthodontic bond strength was assessed on bracket failure rate using survival analysis. Parametric (exponential) regression analysis was used to determine the risk factors associated with bracket failure and a prediction equation was formulated to predict the bracket failure rate. The overall mean survival time for the brackets was 3.04 (2.9-3.17) years. The univariate analysis showed a statistically significant (P<0.05) association of bracket material, site, overjet, overbite, incisor and molar classification and age. The multivariate analysis showed a significant interaction between site and side along with bracket material, jaw, overjet and overbite in the model. The risk of bracket failure on the right posterior region is 7.7 times that in the right anterior region when adjusted for all other variables in the model (HR: 7.7; 95% CI: 4.3-13.6). The model including bracket material, jaw, overjet, overbite and interaction between site and side can be used as a predictor of hazard rate for orthodontic bracket failure. Care should be taken in bonding brackets in the posterior region, as their debonding rate is higher as compared to anterior region.
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http://dx.doi.org/10.1016/j.ortho.2019.03.002DOI Listing
June 2019

Macronutrient and fibre intake of young Spanish children with reference to their in utero growth status: Are they eating a healthy diet?

J Paediatr Child Health 2018 May 13;54(5):563-571. Epub 2018 Jan 13.

BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, The August Pi I Sunyer, Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain.

Aim: To compare macronutrient and fibre intake by pre-school children born with intra-uterine growth restriction (IUGR) or as appropriate for gestational age (AGA) and to compare their intake with paediatric nutritional recommendations for identification of potential areas of modification during early life.

Methods: A parental 3-day dietary record was obtained for children of age 1-6 years, born at Hospital Clinic, Barcelona, Spain (2002-2007) with IUGR (n = 37) or AGA (n = 53). Mean nutrient intake (adjusted for body mass index), nutrient adequacy ratios (NAR) and percentage of energy intake (EI%) were compared.

Results: Macronutrient and fibre intake of the two groups did not differ significantly. However, IUGR children showed significantly higher than the recommended levels of protein EI% (18 (95% confidence interval (CI) 16-19)), NAR for saturated fatty acids (SFAs) (1.2 (95% CI 1.1-1.5)) and NAR for carbohydrate (1.4 (95% CI 1.2-1.6)) and significantly lower than the recommended levels of NAR for unsaturated fatty acids (UFAs) (0.6 (95% CI 0.5-0.8)) and for fibre (0.6 (95% CI 0.5-0.8)). Likewise, children born with AGA showed similar pattern compared to the recommended levels for protein EI% (17 (95% CI 16-18)), NAR for SFAs (1.3 (95% CI 1.2-1.4)), NAR for UFAs (0.6 (95% CI 0.5-0.7)) and NAR for fibre (0.8 (95% CI 0.7-0.9)).

Conclusion: Spanish pre-school children consume proteins and SFAs in abundance and UFAs and fibre in moderation. Reinforcement of healthy eating is recommended for long-term health benefits, especially for at-risk children born with IUGR, whose consumption of carbohydrate is additionally greater than that recommended.
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http://dx.doi.org/10.1111/jpc.13815DOI Listing
May 2018

Epidemiology and outcomes of out-of-hospital cardiac arrest in a developing country-a multicenter cohort study.

BMC Emerg Med 2016 07 28;16(1):28. Epub 2016 Jul 28.

Department of Emergency Medicine, Aga Khan University & Aman Health, Aman Foundation, Karachi, Pakistan.

Background: Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death and disability worldwide. Overall survival after an OHCA has been reported to be poor and limited studies have been conducted in developing countries. We aimed to investigate the rates of survival from OHCA and explore components of the chain of survival in a developing country.

Methods: We conducted a multicenter prospective cohort study in the emergency departments (ED) of five major public and private sector hospitals of Karachi, Pakistan from January 2013 to April 2013. Twenty-four hour data collection was performed by trained data collectors, using a structured questionnaire. All patients ≥18 years of age, presenting with OHCA of cardiac origin, were included. Patients with do-not-resuscitate status or referred from other hospitals were excluded. Our primary outcome was survival of OHCA patients at the end of ED stay.

Results: During the three month period, data was obtained from 310 OHCA patients. The overall survival to ED discharge was 1.6 % which decreased to 0 % at 2-months after discharge. More than half (58.3 %) of these OHCA patients were brought to the hospital in a non-EMS (emergency medical service) vehicle i.e. public or private transportation. Patients utilizing non-EMS transportation reached the hospital earlier with a median time of 23 min compared to patients utilizing any type of ambulances which had a delay of 7 min hospital reaching time (median time 30 min). However, patients utilizing ambulances with life-support facilities, as compared to all other types of pre-hospital transportation, had the shortest time to first life-support intervention (15 min). Most of the patients (92.9 %) had a witnessed cardiac arrest out of which only a small percentage (2.3 %) received bystander CPR (cardio pulmonary resuscitation). Median time from arrest to receiving first CPR was 20 min. Only 1 % of patients were found to have a shockable rhythm on first assessment.

Conclusion: This study showed that the overall survival of OHCA is null in this population. Lack of bystander CPR and weaker emergency medical services (EMS) leading to a delay in receiving life-support interventions were some of the important observations. Poor survival emphasizes the need to standardize EMS systems, initiate public awareness programs and strengthen links in the chain of survival.
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http://dx.doi.org/10.1186/s12873-016-0093-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4963996PMC
July 2016

Are pre-school girls more likely to be under-nourished in rural Thatta, Pakistan?-a cross-sectional study.

Int J Equity Health 2015 Dec 21;14:151. Epub 2015 Dec 21.

Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.

Background: Pakistan ranks third lowest on a global gender index (2013) and 13(th) highest on the prevalence of underweight among under-five children (2010). Through this population-based study, we examined gender differentials in the prevalence of stunting, wasting and under-weight defined by World Health Organization (WHO) Growth Standard among rural pre-school Pakistani children.

Methods: We performed secondary analysis of data collected through a cross-sectional survey of Thatta district during 1992-93. Prevalence ratios were calculated for 1051 children aged 0-35 months from 95 randomly selected villages of rural Pakistan using a clustered adjusted log binomial model. Level 1 variables included child and household characteristics and level 2 included village characteristics.

Results: Based on the new WHO growth reference, a major proportion of children were stunted (52.9 %), wasted (22.9 %) and under-weight (46.5 %). In a two-level model, compared to boys, girls had significantly greater risk of stunting [Prevalence Ratio (PR) (95 % C.I.) = 1.18 (1.03, 1.36)] and under-weight [P.R. (95 % C.I.) 1.14 (1.03, 1.26)], after adjustment of maternal literacy and village variables. Risk of wasting did not differ with gender [P.R. (95 % C.I.) = 1.04 (0.99, 1.15)]. Mothers of stunted and underweight children were respectively, 21 and 20 % more likely to be illiterate than those of normally nourished children. Sick children were at 16 % greater risk of wasting than those not reported ill.

Conclusion: Greater prevalence of stunting and under-weight among girls suggests adoption of a gender sensitive approach in nutritional intervention programmes. Prompt management of childhood illnesses may reduce prevalence of wasting. Better literacy among rural mothers may reduce prevalence of stunting and under-weight. Whether gender differences in nutrition status are an underlying pathway for excessive girl mortality in rural Thatta needs further examination.
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http://dx.doi.org/10.1186/s12939-015-0287-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4687337PMC
December 2015

Does primary closure increase surgical site infection after intestinal stoma reversal? A retrospective cohort study.

Surg Infect (Larchmt) 2014 Feb 27;15(1):58-63. Epub 2013 Nov 27.

1 Department of Surgery, The Aga Khan University Hospital , Karachi, Pakistan .

Background: This study was undertaken to test the veracity of the hypothesis that primary incision closure after intestinal stoma reversal in adult patients is associated with a greater risk of surgical site infection (SSI) than are open incisions.

Methods: A retrospective cohort study was conducted at the Surgical Department of the Aga Khan University Hospital, Karachi, Pakistan. The study included adult patients who underwent elective loop and double-barreled intestinal stoma (ileostomy or colostomy) reversal through peristomal incisions between January 2005 and May 2011. Files were reviewed independently by two surgeons to establish main exposure (closed or open surgical sites) and outcome; i.e., SSI based on U.S. Centers for Disease Control and Prevention criteria.

Results: Sample size calculation prior to the study required 71 patients to be included in each exposure arm. Patients with closed surgical sites were relatively younger (mean 36±15 [standard deviation] years) than those with open surgical sites (41±15 years), with a male preponderance in both groups. Fifteen patients were found to have SSI: 3/71 (4.2%) in open and 12/71 (16.9%) in closed incisions. The risk of SSI in closed surgical sites was 5.8 times greater than in open sites (95% confidence interval for relative risk 1.5-22.5) after adjusting for gender, body mass index (BMI), site of stoma, malignant disease, and preoperative chemo-radiotherapy.

Conclusion: The risk of SSI in closed incisions is greater than that in open incisions. It is suggested that incisions not be closed primarily in patients undergoing stoma reversal.
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http://dx.doi.org/10.1089/sur.2012.165DOI Listing
February 2014

Comparison of estimates of under-nutrition for pre-school rural Pakistani children based on the WHO standard and the National Center for Health Statistics (NCHS) reference.

Public Health Nutr 2009 May 27;12(5):716-22. Epub 2008 May 27.

Department of Community Health Sciences, The Aga Khan University, Karachi-74800, Pakistan.

Objective: To compare estimates of under-nutrition among pre-school Pakistani children using the WHO growth standard and the National Center for Health Statistics (NCHS) reference.

Design: Prevalence of stunting, wasting and underweight as defined by WHO and NCHS standards are calculated and compared.

Setting: The data are from two cross-sectional surveys conducted in the early 1990s, the time frame for setting the baseline for the Millennium Development Goals: (i) National Health Survey of Pakistan (NHSP) assessed the health status of a nationally representative sample and (ii) Thatta Health System Research Project (THSRP) was a survey in Thatta, a rural district of Sindh Province.

Subjects: In all, 1533 and 1051 children aged 0-35 months from national and Thatta surveys, respectively.

Results: WHO standard gave a significantly higher prevalence of stunting for both national [36.7 (95 % CI 33.2, 40.2)] and Thatta surveys [52.9 (95 % CI 48.9, 56.9)] compared to the NCHS reference [national: 29.1 (95 % CI 25.9, 32.2) and Thatta: 44.8 (95 % CI 41.1, 48.5), respectively]. It also gave significantly higher prevalence of wasting for the Thatta survey [22.9 (95 % CI 20.3, 25.5)] compared to the NCHS reference [15.7 (95 % CI 13.5, 17.8)]. Differences due to choice of standard were pronounced during infancy and for severely wasted and severely stunted children.

Conclusions: Pakistan should switch to the robustly constructed and up-to-date WHO growth standard for assessing under-nutrition. New growth charts should be introduced along with training of health workers. This has implications for nutritional intervention programmes, for resetting the country's targets for Millennium Development Goal 1 and for monitoring nutritional trends.
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http://dx.doi.org/10.1017/S1368980008002383DOI Listing
May 2009
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